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A model of the change process : an event-based study in couple therapy Sweetman, Esther 1996

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A M O D E L O F T H E C H A N G E PROCESS: A N E V E N T - B A S E D S T U D Y IN COUPLE THERAPY  by  ESTHER SWEETMAN B . A . , M c G i l l University,  1990  A T H E S I S S U B M I T T E D IN P A R T I A L F U L F I L L M E N T O F T H E REQUIREMENTS FOR T H E D E G R E E O F MASTER OF ARTS  in  T H E F A C U L T Y O F G R A D U A T E STUDIES (Department  We  of Counselling  accept this thesis as to  the  required  Psychology)  conforming  standard  T H E UNIVERSITY O F BRITISH C O L U M B I A March ©Esther  1996  Sweetman,  1996  In  presenting  degree  this  at the  thesis  in  partial  fulfilment  University  of  British  Columbia,  freely available for copying  of  department publication  this or of  reference  thesis by  this  for  his thesis  and study. scholarly  or for  her  Department The University of British Columbia Vancouver, Canada  DE-6 (2/88)  I further  purposes  the  requirements  I agree  that  agree that  may  representatives.  financial  permission.  of  It  gain shall not  the  permission  granted  is  understood allowed  an  advanced  Library shall make  be  be  for  by  for  the that  without  it  extensive  head  of  my  copying  or  my  written  II Abstract  The main purpose of this investigation was to develop a detailed model of the change process of an in-session therapeutic event co-created by therapist and couple in an alcohol recovery treatment context, using Experiential Systemic Therapy (ExST; Friesen,  Grigg,  Peel, & Newman, 1989).  Two videotaped episodes in which a couple  successfully  resolved a relational impasse (RI event) and one episode in which a couple did not resolve a relational impasse were examined.  To  discover patterns that distinguished between the RI events that were successfully resolved and the RI event that was not, a step by step analysis of the therapist and couple behavior and interactions was conducted using Rice and Greenberg's (1984) Task Analytic Methodology. Key components and mechanisms of change in both therapist and couple performance and their interaction were identified.  A  model of the change process for the RI event specific to ExST is provided as well as a more general model that may be applied across theoretical approaches. are also delineated.  Factors inhibiting the change process  In addition, two process measures: The  Experiencing Scale and the Self-Disclosure Coding System were found to discriminate between the successful  and unsuccessful RI  events. Finally, implications of the results for clinical practice and training, limitations of the study as well as recommendations for future directions in research are presented.  ill Table  Abstract  of  Contents  '.  List of tables  ii :  '.'  viii  List of figures  Chapter 1:  ix  Introduction and framework  1  Background to the research problem  1  Purpose of the study  3  Significance of the study . .  3  Research questions  4  Summary of the method  5  The utility of the Task Analytic  methodology  in the study of psychotherapy  6  Definition of terms  7  Chapter 2:  Review of the literature  .13  Definitions and recommendations  13  A definition of family therapy process research Recommended  research  directions  14  for  family therapy Event-based change  15 process research in couple therapy . .  .16  Emotionally Focused Therapy  16  Experiential Systemic Therapy  19  Event-based  change  Analytic methodology Summary  process research using  the  Task 23 30  iV  Chapter 3: Methodology  32  Methodological strategies  32  The Success-Failure Strategy  33  The Episode or Small Chunk Strategy  34  Task Analysis  35  Procedure  .40  Project description  40  Subject inclusion criteria for T A R P  40  Therapist variables  42  Selection of cases  43  Decision criteria  45  Selection of events  50  Inter-judge reliability  53  Content outline of the selected  successful  and unsuccessful RI events  54  Summary of the first successful RI event  54  Summary of the second successful RI event . . .  55  Summary of the unsuccessful RI event Procedural application of the Task Analytic steps . . .  .55 56  The Experiencing Scale  59  The Self-Disclosure Coding System  61  Coding strategy  62  Chapter 4: Results Section 1: The rational analysis  64 65  Four phases of the RI event  67  Relational Novelty  68  Intensification  69  V Transactional Classes  71  Summary  74  Section 2:  First empirical analysis of therapist and  client performances  74  First therapeutic phase / marker  75  Mechanisms of the change process  78  Therapist performance  78  Couple performance  82  Second therapeutic phase  84  Mechanisms of the change process  85  Relational Novelty  86  Intensification  87  Third therapeutic phase / resolution . ,  90  Mechanisms of the change process  94  Summary  95  Section 3: Comparison of actual and possible Construct a specific model  performances: 97  Maintenance of the therapeutic relationship  99  First therapeutic phase  99  Second therapeutic phase  101  Summary  105  Section 4:  Validation: First empirical analysis of the  unsuccessful RI event Phases of the change event  106 106  First therapeutic phase/marker  106  Second therapeutic phase  108  Mechanisms of the change process  Ill  W  The  development  and maintenance  of  the  therapeutic relationship  Section 5:  112  Therapist performance  112  Couple performance  116  The therapist's use of empathy  118  Intensification / Relational novelty  119  Summary  119  The second empirical analysis of  all three events  120  The Experiencing Scale  120  Summary  122  The Self Disclosure Coding System  122  Summary  123  Chapter 5: Discussion and Conclusion K e y mechanisms  of change  125  within the E x S T framework  for a RI event  125  Phases of a change event / Transactional Classes Components  of  Intensification  126 /  tenets of Relational Novelty The two coding systems . The Experiencing Scale The Self Disclosure Coding System  128 129 129 130  A general model of the change process for a RI event . . . .131 Implications for clinical practice and training  140  Limitations to the study  141  Areas for further research  142  vii Therapist input variables  142  Client input variables  142  Models of the change process  145  References  147  Appendices  154  List  of  Tables  Table 1:  Short Form of the Experiencing Scale  60  Table 2:  Summary of the Self-Disclosure Coding System  62  Table 3: Average scores of the level of modal and peak for the husband and wife in each event Table 4:  Results of the Self-Disclosure Coding System  experiencing 121 123  IX  List  of  Figures  Figure 1: A bar graph comparing the pre-treatment and posttreatment scores for the husband of the couple chosen as "deteriorators" on the A l c o h o l Dependency Questionnaire ( A D D ) , the Symptom Checklist 90 revised ( S C L - 9 0 - R ) , and the Dyadic Adjustment Scale ( D A S )  46  Figure 2: A bar graph comparing the pre-treatment and posttreatment scores for the wife of the couple chosen as "deteriorators" on the A l c o h o l Dependency Questionnaire ( A D D ) , the Symptom Checklist 90 Revised ( S C L - 9 0 - R ) , and the Dyadic Adjustment Scale ( D A S ) 47 Figure 3: A bar graph comparing the pre-treatment and posttreatment scores for the husband of the couple chosen as "improvers" on the A l c o h o l Dependency Questionnaire ( A D D ) , the Symptom Checklist 90 Revised (SCL-90-R), and the Dyadic Adjustment Scale ( D A S ) 48  Figure 4: A bar graph comparing the pre-treatment and posttreatment scores for the wife of the couple chosen as "improvers" on the A l c o h o l Dependency  Questionnaire  ( A D D ) , the Symptom Checklist 90 Revised ( S C L - 9 0 - R ) , and the Dyadic Adjustment Scale (DAS)  49  Figure 5: A rational model of the change process specific to Experiential Systemic Couple Therapy, for a RI event. . . . . .66  Figure 6: A detailed model of the change process specific Experiential Systemic Couple Therapy, for a RI event  Figure 7:  to 98  A simplified model of the change process, including  both therapist and couple performance, for a RI event. . .  133  1  Chapter  1  INTRODUCTION AND F R A M E W O R K  Background to the Research Problem  A changes  main task of psychotherapy is to help clients in their lives.  A main task of psychotherapeutic research is  to empirically examine the &  changes Hill,  make  the process  of the therapeutic session and  that result from participation in this process  1994).  (Lambert  Consequently, a crucial practitioner-relevant question  is, what factors influence change in the therapy session? Researchers  have  become  increasingly interested  question with regards to specific settings and for specific Change how  process  psychotherapy  change  process  this  forms of therapy, in particular  client groups. research attempts  produces  change.  to address the question of  The difference  research as opposed to process  increased attention given to context process  in answering  between  research is the  (Greenberg, 1986).  Change  researchers state that there is a need to go beyond  measuring which process  variables occur in therapy to studying  context in which process variables occur (Greenberg, 1986; 1990; Marmar, 1990). epistemology  the  Hill,  This shift in focus is rooted in an  that asserts that nothing can be known or ultimately  even exist independently of the context in which it occurs (Greenberg & Pinsof, process  1986).  has equal significance  Instead of assuming that a given or similar meaning at any given point  2  in therapy, Greenberg (1986) states that it is important to segment therapy into different therapeutic episodes or events in order to understand the process  in the context  of clinically meaningful units.  Whether or not the events represent the process of change is one of the most  important criteria for selecting  episodes.  Recently, couple therapy process infancy,  research, although in its  has received increasing attention  (Johnson & Greenberg,  1988; Greenberg, James & Conry, 1988; Greenberg, Ford, A l d e n & Johnson, 1995).  1993;  Dubberley-Habich, 1992; Wiebe, 1993;  Change process  researchers  research provides couple  provides  the  opportunity to  Specifically, development contexts,  change process research that leads  of models  of change  to the  in different in-session  therapy  is considered crucial to the growth of psychotherapy  of change  allows  describe interventions  1978,  theoreticians  or predict results  Rice & Greenberg 1984), 1993).  Focusing on the  and practitioners to not only but to explain how  set of interventions creates change in a specific  context (Johnson & Greenberg, 1988). process  which in turn,  improve therapy.  including couple therapy (Jacobson & Addis,  specific  confirm or  (Greenberg, 1986)  (Greenberg 1986; Orlinsky & Howard,  process  therapy  with the opportunity to test, challenge,  expand theory via empirical means  Newman,  involved in successful  that facilitate this change. successful  couple  change  a  therapeutic  The goal is to understand the  client change  and the  interventions  The goal of this study is to understand and the interventions  that facilitate  change for a specific form of therapy, for a specific therapeutic event and for a specific  client group.  in-session  this  3 The remainder of this chapter will include: and significance summary  of this study, (b) specific research questions,  of the methodological  definitions  (a) the purpose  strategies employed  and  (c) a  (d)  of terms utilized in the current investigation.  Purpose of the Study  The purpose of this research study is twofold: (a) T o develop a detailed model of successful undergone in a couple  couple change for a particular task  treatment context  for alcohol  dependency,  using Experiential Systemic Therapy (Friesen, Grigg, Peel, & Newman,  1989).  relational  impasse  The specific task under study is the resolution of a created by disparate beliefs  oriented interactions in couple treatment,  and  distance  (b) G i v e n that  Experiential Systemic Therapy (ExST) has been shown to be effective  for couple treatment in alcohol recovery (Friesen, Conry,  Grigg, & Weir 1995), it is important to empirically investigate processes of change  the  within this therapy.  Significance of the Study  According to Jacobson and Addis (1993), if couple therapy research is to contribute to the development effective  treatments  discovery-oriented remain a priority. develop  as opposed and  of increasingly  to simply evaluating existing  hypothesis-generating  research  Researchers conducting process  and later test theories  of change,  ones,  must  research can  thereby contributing to  4  the knowledge base of the change process (Jacobson & Addis, Therefore, this study is significant for two reasons: investigation  provides the  effective  treatment;  and (b)  this  change  how  the  Therapy, leading to more  investigation  in therapy that lead to and hinder the change Discovering  (a) This  opportunity to expand and refine  underlying theory of Experiential Systemic  1993).  will  identify  elements  process.  therapist and client interactions  influence  has meaningful and relevant impact for clinical practice.  Whereas it may be difficult to use the results from clinical trials in work with particular clients, the results of process directly applicable and useful to clinicians. understanding  how  particular therapies  populations with specific investigation how  will  More  work  problems is extremely  provide helping professionals  the therapist and couple co-create  studies can be specifically,  with particular valuable.  This  with information on  change in alcohol recovery  couple treatment, when dealing with the task of resolving a relational impasse and  distance  between a couple  oriented  research study, mechanisms  observational,  Questions  descriptive  and discovery  oriented  the main aim is to understand the underlying  that  facilitate  and hinder psychotherapeutic  Accordingly, this study will attempt to answer the questions:  beliefs  interactions.  Research  In this  created by disparate  change.  following  5 1. What are the specific process  steps taken by therapist and couple  in the development of the co-creation of successful  change in couple  therapy?  The focus of this study will be on the resolution of a  relational  impasse  oriented  interactions.  created by  disparate beliefs  and  distance  2. What are the factors that inhibit the completion of the steps towards  resolution,  thereby  inhibiting the  Summary  Pinsof  (1988) has  strategies he considers  change  process?  of the Method  suggested the employment  valuable in couple  of  various  therapy process  research.  T w o of his suggested research strategies are employed in this investigation. The first of these two strategies is  TheSuccess-Failure  Strategy, which creates extreme sub-groups from a group of cases that have been exposed  to a certain kind of treatment.  maximizes the likelihood of finding process-outcome  This  links.  strategy  The  second strategy is called The Episode or Small Chunk Strategy, which targets  smaller episodes of therapy to discover links between  process  and in-session  outcomes.  Rice and Greenberg (1984) have proposed a new  strategy  studying the change process in smaller episodes of therapy.  The  aim of this new strategy is to increase the understanding of the interactions in therapy in such a way that it can be fed back into practice.  Accordingly,  they  developed  methodology known as Task Analysis.  a rationale-empirical Task Analysis is  also  for  6  employed  in this  investigation  to study in-session  change  processes.  Task Analysis is a form of theory-guided observation models from  of change  the  within  processes are developed  by identifying  where  patterns  empirically derived data and interpreting these data  the  framework generated  conjectures involves:  the  initial  (Greenberg, James, & Conry,  1988).  (a)  generating  identifying  hypotheses  these segments, (c)  by  theoretical This method  important segments of therapy  regarding what  developing  processes  sessions,  operate  during  a method for coding these processes,  (d) confirming or disconfirming the resultant model of change coding the transactions,  and (e)  (b)  testing  by  the viability of particular  hypotheses.  The Utility of the Task Analytic Methodology in the  Study of  Psychotherapy  First, Task Analysis assists in the understanding of change  phenomena  a clearly defined  and the  mechanisms  context. This  that underlie change  standardized process  replicability.  Second, although connections  outcome  be  may  phenomena  complex,  can move  factors that influence researcher successful therapist  in  outcome.  client change. training  and  within  enables  between process  and  understanding particular change  researchers  understanding  the  closer  to  comprehending  the  Third, Task Analysis will assist the  which  therapist  interventions  This information will be relevant supervision.  facilitate to  7  Definition of Terms  To  provide increased clarification and understanding of  research investigation, the following key terms and concepts this study are defined in the following  Process  this  used in  section.  and Outcome Research Process  research addresses  what  happens  in a psychotherapy  session,  examining therapist and client behavior and the  between  the two (Lambert & H i l l ,  research referred to the efficacy recently,  researchers have  1994). Traditionally,  interactions  outcome  of a particular treatment.  broadened the  definition of  More  outcome.  According to Greenberg (1986), in studying the process of change it is possible to measure three types of client outcome or change over the course of therapy. outcomes, outcomes.  These three types include: (a) immediate  (b) intermediate outcomes  ultimate (or final)  A n immediate outcome or impact is change that is  evident in the session itself. are  and (c)  These short-term, in-session  outcomes  also referred to as "little o's" and are conceptualized as building  toward final outcomes, which are designated as "Big O's" (Marmar, 1990).  Final outcomes, or "Big O's",  treatment  and at follow-up,  are measured at the end of  and represent ultimate  Intermediate change (building of small o's) psychotherapy  session,  change.  are tracked over the  shedding light on the process  outcome. In reality, Lambert and H i l l  towards  (1994) state that process and  outcome overlap, in that changes in process can be early indications of positive or negative outcome.  This investigation will focus on  8 examining  "small-o", or immediate  Experiential  Systemic  outcome.  Therapy  Experiential Systemic Therapy ( E x S T ) , Grigg,  Newman and Peel (1989) is an integrative treatment model  that synthesizes was  developed by Friesen,  individual, couple and family formats.  developed in response  The model  to the lack of integrated individual,  couple and family therapy models for the treatment of alcohol dependency.  The development of E x S T prompted a large  research effort named The Alcohol conducted efficacy  studies  Recovery  Project  scale  (TARP).  TARP  and process research, of which this  research is a part. E x S T is based on three interlocking dimensions: the experiential,  the symbolic and the systemic.  that encompasses  The primary  component  all E x S T concepts is that of relationships.  ExST  views relationships to be the foundation of human existence and views the human condition as an "intricate web of  systemic  connections" (Friesen, Grigg, & Newman, pp.2, 1991). E x S T is centrally process  concerned  with  the  interpersonal and intrapersonal  of therapy, using a variety of therapeutic transactions  facilitate  Relational  progress  and relationally novel  to  experiences.  Novelty  Relational novelty is considered a change experience in E x S T in  which the client experiences  alternative behaviors, feelings  thoughts that grow out of the therapeutic process. relationally novel experience,  and  In the  clients gain a physical, cognitive and  9  behavioral sense of a new way of being in the world. "New patterns of interaction are not just felt, talked about, thought or designed; they are born in a moment when all the elements of experiencing converge to form a new coherent whole." (p.7). differently  Clients see the world  and no longer maintain the same rigid patterns  behavior to which they  had been previously  of  accustomed.  Intensification Intensification clients  experience  different  their relationships  aspects of self  and intensity. Grigg, Peel, greater  refers to the therapeutic process with  the  in which  presenting problem,  and others, with increasing depth,  richness  According to Experiential Systemic Theory (Friesen, & Newman 1989), change occurs as clients gain a  awareness  of  their present  condition.  Event According to Greenberg (1984), recurring  events  within the  complexity  client and therapist in a therapy session, probability of affecting sequence  between  there are discriminable of  performance  between  which possess a high  change. A n event consists of an interactional  client  and  therapist  . . . that has a beginning, an end, and a particular structure that gives it meaning as an island of behavior distinguishable the  surrounding behaviors  process.  ongoing  psychotherapeutic  For the client, the event has the quality of a whole and its  completion therapist.  in the  from  is experienced as a closure of some interaction with the Likewise for the therapist, the event represents  a  therapeutic activity that comes to some closure in the hour. (p.  138)  10  A n event is a significant episode in therapy in which a client problem, is followed by a defined set of therapist interventions and the ensuing client behaviors (Greenberg, 1986).  The selection  events helps to specify context and provides a sharper focus study of the change  of for the  process.  Task Within this event  there are attempts  and therapist at resolving an impasse or task. conflict, which  misunderstanding, or disagreements  clients  and therapists  actively  made by the  client(s)  A n impasse such as can become  tasks  for  seek resolution.  The analysis of tasks within a therapeutic event study of the therapist's influence on the process  includes  the  and whether it  hinders or facilitates the client's resolution performance.  One of the  therapist's roles is to keep the client in a productive psychological problem space (Greenberg, 1984).  A productive problem space in  therapy is one that keeps the client working on the task in such a way that will facilitate resolution.  Resolution A  successful event is one in which the task under study has  been resolved.  A task within an event that has been resolved is  called a successful  resolution  event.  The definition and  identification of a successful resolution of a particular task is derived from (a) the definition of change within the task environment,  (b)  clinical knowledge  of the particular event  under  11 study,  and (c)  intensive  task at hand.  analysis  of therapeutic  videotapes  of  In addition, according to Greenberg (1984),  resolution of a therapeutic task is marked by feelings of relief,  decisiveness, firmness  and a sense of direction.  successful calmness,  Moreover,  Heatherington and Friedlander (1990) found that in family resolution of an interpersonal impasse shift  in the observable  members  became  dysfunctional  interactions  of relating.  therapy,  marked by a distinct  of family members.  "unstuck" from the  patterns  was  the  previously  Unsuccessful  Family  identified  rigid  resolution  and  events  are events in which the client marker is identified but no resolution occurs.  Task  Environment The  change  sequences of client and therapist behaviors  constitute  the task environment of the event.  that  promote  These  sequences of behavior are also referred to as client or therapist performance. unsuccessful  A successful  performance leads to resolution, an  performance does not lead to resolution.  The  performance of the therapist is guided by their adherence particular  theoretical  approach which is  implemented  to  to a facilitate  the client's resolution of the task.  Marker The events to be studied begin with a client marker, that is, a statement made  by the  The marker signals resolution  client(s) introducing the  relational  the beginning of the successful  events to be analyzed.  and  impasse.  unsuccessful  In order to clarify the features  of  12  this marker and develop a formal definition intensive  analysis  of psychotherapeutic  of its  videotapes  structure,  an  in which  are a number of samples of the task under study, is conducted &  Greenberg 1984;  1994).  there (Rice  Friedlander, Heatherington, Johnson & Skowron,  13 2  Chapter  REVIEW O F T H E L I T E R A T U R E  In  this chapter a definition of couple therapy and family  therapy process  research will be provided.  Recommended  directions for family therapy will be discussed. studies  investigating  in-session,  event-based,  research in couple therapy will be presented, section  research  Next, current change  process  including a  specific  on those studies using the Task Analytic Methodology.  Definitions  and  Recommendations  A Definition of Couple Therapy Definitions  of couple  therapy are derived from  understanding of family therapy.  researchers'  Gurman (1988) discusses  two  common views of what constitutes the operational essence of family therapy: 1. F r o m the broadest perspective,  family therapy may be defined  the "conceptual map" in the mind of the therapist. If the regularly  and systematically  considers  the  are conducting family therapy irrespective in  the therapeutic  session.  therapy by the therapist's therapist aim to influence, family,  A related perspective intent for the outcome. the distressed  including non-family  members.  therapist  family context then of how  many people defines  by  they are  family  W h o m does the  person only or the  whole  14  2.  F r o m the most  restrictive perspective  focuses on those persons  who  a family therapy  are present  Family  therapy requires the presence  related  individuals.  in treatment  and treatment  definition  sessions.  of two  or more  Gurman, Kniskern and Pinsof (1986), provide a definition of family  therapy that is derived from the first perspective  therapy mentioned above. Any  Their definition is as  psychotherapeutic  altering  the  interactions  endeavour  that  of family  follows:  explicitly  between or among  focuses  family  on  members  and seeks to improve the functioning of the family as a unit, or its subsystems and/or the functioning of individual members of the family. regardless "patient".  This is the goal  of whether or not an individual is identified Family therapy typically involves  work with more than one family member,  as  face-to-face  . . . although it  may involve only a single member for the entire course of treatment . . . " (pp. 565-566).  Within this definition marital or couple a subclass  of family therapy.  intrapersonal goals  A  considered  This definition does not address  aspects of treatment  and conceptual  therapy is  but focuses  primarily  on  the  the  framework of therapy.  Definition of Family Therapy Process  Research  Derived from Gurman et al's (1986) definition of family therapy and his own understanding of process (1989) has proposed a definition of family  research, Pinsof  therapy  process  research,  15  Family  therapy process  research  studies the  between therapist and family systems. identify  change  systems.  interaction  Its goal is to  processes in the interaction between these  Its data include all of the behaviors and  experiences  of these systems and their subsystems,  and outside  of the treatment  within  sessions, that pertain to  changes in the interaction between family members their individual and collective  and in  levels of functioning.  (P-54)  The interaction of these two bidirectional  systems, is non-linear and implies  mutual causality  or  influence.  Recommended Research Directions for Family Pinsof  (1988)  Therapy  states,  Outcome research, without process  research is minimally  informative [in family therapy]. It can only tell us families  that received  a particular treatment  whether  did better,  as a  group, than families that received no treatment or an alternative  treatment.  Without process  research,  we  cannot  know what actually occurred in the therapy and what processes were associated treatment,  Pinsof (1988) asserts that the family field is  in need of specific  generate and test specific family  therapy.  the  (p. 162)  In addition, desperately  with the success (or failure) of  micro-theories that can be used  hypotheses about change  He specifies  foundation for subsequent  processes in  that discovery-oriented  research has the potential to not only develop research but has  to  process  an empirical  the capacity  to  facilitate  16  the  development  of these specific  according to Pinsof,  family therapy researchers  investigations  and development  major process  dimensions:  specific  of  Moreover,  should focus  these micro-theories  on  their three  (a) the therapeutic alliance, (b)  the  acts and behavior patterns of the therapist and family  system,  (c) delineations Reiss  focus  micro-theories.  of proximal or small-o  outcomes.  (1988) agrees that family therapy research  should  on process research, specifically trying to improve our  understanding of the mechanisms  of therapeutic change.  Gurman  (1988) adds that the overriding research priority in the field of family therapy is to enhance  the quality and amount of research  that w i l l have a direct impact on clinical practice. intending  to influence  recommendations of  the  most  methods  practice, he provides  including: (a)  potent  the  For researchers  several  identification  and  specification  change-inducing elements within the major  of family therapy, (b) the study of common elements and  mechanisms of change across methods, and (c) the study of the factors  associated  with deterioration or negative  effects.  Event-Based Change Process Research in Couple Therapy  Emotionally Much change  Focused  Therapy  of the  in-session,  and no-change  influencing  event-based  performances  the change process  research, comparing  and identifying  in couple therapy, has  factors been  examined in Emotionally Focused Couples Therapy ( E F T ; Greenberg & Johnson, 1986,  1988).  17 In  1986,  Vaughan investigated  interaction patterns couples  by testing  would demonstrate  dependence  change  in in-session  if during in-session  both  greater  conflict  affiliation  negative events,  and inter-  at the end of 8 to 10 sessions of Emotionally Focused  Therapy, than at the beginning. The Structural Analysis of Social Behavior ( S A S B ; Benjamin, 1974) session 7 of 22 couples. promotes  significantly  was used to code session 2 and  The results support the assertion that E F T  more  autonomous  affiliative  behaviors  in  the  latter stages of therapy in comparison with the early stages of therapy. earlier  Couples' behaviors in a latter session as opposed to an session were significantly  understanding.  more  In addition, couples  supportive,  became  affirming, and  more  assertive,  disclosing,  and self-expressive.  However, there were no  differences  found regarding the occurrence of affiliative  and accepting behaviors or the occurrence of hostile  significant influence  and controlling  behaviors. EFT expressing manner.  suggests that interactions  are changed by accessing  underlying feelings in a self-disclosing It was  therefore  session conflict events, productive (designated depth of experience  hypothesized  and  affiliative  by A l d e n (1989) that in i n -  that were viewed by the couple as highly as "peak" sessions), would differ in both  and degree of affiliation from events in sessions  seen as unproductive ("poor" sessions). of therapy for 16 couples receiving E F T .  A l d e n examined the  process  A self-reported peak and  poor session were assessed and compared for each couple using  the  S A S B and the Experiencing Scale (Klein, Mathieu-Coughlan, Kiesler, & 1986).  Results  showed  that depth of experiencing was  greater and  18  interactions  were more affiliative  poor sessions.  and autonomous  in peak  Experiencing scores revealed that peak session  events contained nearly three times as many level 4 and experiencing  statements (on a 7-point  scale), coded by  Experiencing Scale, than did poor sessions. rather than outward focusing focus,  one's responses to situations,  The results  above  the suggest that  and blaming the other, taking a self-  turning inward to one's experience  manner is  than  for information about  and accepting the other in a friendly  important in resolving  conflict.  Ford (1989) examined the role of intimate  self-disclosure  in  couples therapy, specifically in E F T . E F T suggests that selfdisclosures  of feelings and needs with affective  change in couples' therefore  immediacy lead to  interactions and the creation of intimacy.  proposed that emotionally  sessions would lead to affiliative  intimate  It was  self-disclosures  in E F T  statements by the responder.  The  Self-Disclosure Coding System ( S D C S ; Chelune, 1976) and the S A S B were used to code the selected events. study was after  The main finding of this  that spouses in E F T are likely to respond  an intimate  disclosure,  self-disclosure  by their partners.  the proportion of affiliative  affiliatively After  codes were 90% compared  with 54% in the control segment, as coded by the S A S B . control segment, disaffiliative interactions. intimate  self-  In the  codes accounted for 34% of the  In contrast, only 8% of the interactions following an  self-disclosure  was  disaffiliative.  The results  attest to  the  radical changes in the responses of the listener to his or her partner following  an intimate  self-disclosure  in therapy.  B u i l d i n g on the previous process  research in couple  therapy,  19  Johnson and Greenberg (1988) attempted to link in-session with therapy outcome.  process  Six high- and six low-change couples,  as  indicated by their pre and post score on the Dyadic Adjustment Scale (Spanier, 1976), were identified.  The "best" therapy session  for each couple was then intensively analyzed. Greenberg couples  identified  two  characteristics of  Johnson and  successfully  treated  that differentiated them from treatment failures.  different coding systems,  Using  The Experiencing Scale (Klein,  two  Mathieu,  Keisler & Gendlin, 1969) and the S A S B , successful couples were found to demonstrate higher levels of experiencing, defined greater emotional involvement Couples  also  demonstrated more autonomous  identified by more acceptance Despite theoretical  and self-description  in the  as sessions.  and affiliative  actions,  and less hostility and coercion.  the increasing research conducted within this  framework, therapists  still do not fully understand how  change is produced in E F T . Jacobson and Addis (1993) point out that the methodology  for studying change  mechanisms  exists, much  of it having been developed by Greenberg and colleagues Greenberg,  1984), however,  it has not yet been  (eg. Rice &  comprehensively  applied to E F T .  Experiential  Systemic  Investigators  Therapy  have also  studied the change process  based research in Experiential Systemic Couples Therapy Dubberley-Habich investigate  (1992) used  the process  alcohol-involved  conversational  analyses  in  event-  (ExST). to  of change undergone in therapy by an  couple participating in a ritualizing intervention in  20  ExST.  F r o m the data, the investigator delineated twelve themes that  influenced  various aspects of change  These themes include the  throughout the  therapy  event.  following:  1. Ritualization. 2. Personal and family myths. 3. Symbolization. 4.  Experiential  experiences.  5. Externalization of a problem. 6.  Intensification  of  experience.  7.  Contextual/systemic  8.  Constructivist/meaning  9.  Therapist empathy.  10.  Therapist  11.  Collaboration.  12.  Therapist artistry. In  create  approach. shift.  genuineness.  1993  change  Wiebe investigated using  how  couple  and therapist  an intervention called symbolic  co-  externalization  in a successful case of E x S T , for couple treatment of alcohol dependence. interactive discourse  Therapeutic change was found to be a dynamic, and  context-dependent  analysis  process.  Comprehensive  was used to study the data revealing  themes that contributed to the co-creation of change. included the  eight  These themes  following:  1.  Creating  and maintaining a collaborative  2.  Challenging propositions  and  atmosphere.  competence.  3. Reframing alcohol as seducer. 4. M o v i n g from an individual to a relational understanding of the  21  role of alcohol in the couple's relationship. 5. Re-defining and accenting the couple's 6. Diffusing tension  and defensiveness.  7. Regulating the intensity 8.  Deepening  contrasting  In a second investigated successful  two  of  experiences.  experiences.  study using discourse  events that demonstrated  was  to the  development  where  (b)  process  influenced  disparate beliefs  these members.  the  process  The syncretic change  existed  process  system and  The syncretic change  parts that represent different but related aspects of  construct: (a) initial disagreement  transformation (via therapeutic  in  Newman found  of intimacy by therapeutic  initially there  behavior that isolated  same  change  through an interactional  termed the syncretic change process.  has two  the  by which the therapist and clients  creation of relational novelty  members  analysis, Newman (1995)  Experiential Systemic Couple Therapy.  that the means  refers  commonalities.  process the  and conflicting belief,  system  efforts),  and  which lead  to  increased mutuality and commonality of belief and practice in the relationship. of  The discourse  differing viewpoints  of  intensification atmosphere, two  revealed that the  and behaviors was  intimacy enhancing activities. employment  analysis  convergence  facilitated through  These two activities  two  included (a)  the  intense experiential exercises resulting in and (b) the provision of a collaborative  between clients  and therapist.  intimacy enhancing activities  various tenets of relational novelty  It was  therapeutic  found that these  facilitated the occurrence of and effected  a shift  from  22  distance  oriented interactions  harmonious exchanges.  toward more  cooperative  and  Newman (1995) found that six  components  of intensification which are previously delineated in E x S T (Friesen et al., 1989) experience.  theory  were found to be helpful in deepening client  The first four components  were:  1. Providing a detailed definition of the specific of the clients' dilemma.  2. Creating an interaction between  clients or between  clients  and the  symptom.  3. Maintaining a present tense focus client  during sequences of  intense  experiencing.  4. E m p l o y i n g varying degrees of empathy ranging from paraphrasing to advanced empathy to access underlying feeling context  dependent  on a  basis.  The last two components of intensification were found to be contingent These  upon the nature of the experiential activity conducted.  two  components  were:  5. U t i l i z i n g meaningful metaphors and symbols.  6.  Personalizing and amplifying physiological states.  Furthermore, convergence  the  means  of disparate beliefs  by which intensification and practices was  enabled  through the  facilitation of four tenets of relational novelty which included:  the  23 1. A t y p i c a l  experiencing during which clients  speak,  think and behave  feel,  feeling,  2.  atypically rather than speaking,  Cognitive understanding resulting in new  learning and  insights  spouse or the presenting problem.  Increased  experience  4.  to  thinking or behaving in a recurrently characteristic fashion.  about self,  3.  are encouraged  awareness  such  is brought into  The evocation  that  previously  unacknowledged  consciousness.  of substantive  Event-Based Change Process  relational  themes.  Research using the Task  Analytic  Methodology Task Analyses is a method increasingly employed in the study of change processes in couple/family therapy. Plysiuk  used  this  methodology  between two couples conflict.  to investigate  In  1985,  what transpired  as they completed the process  Four therapy sessions where the couple  of resolving  successfully  resolved a conflict and one therapy session where a resolution attempted but was unsuccessful, Task  Analysis was  conducted,  were  selected for investigation.  which distinguished  moment  interactional patterns  conflicts  from those who were not successful  marital conflicts.  of  couples  who  the  resolved  was A  moment-bymarital  at resolving their  The Task Analysis Plysiuk conducted involved six  strategies: 1. Developing a rational model of the resolution process.  24  2. Defining the task as a pursuer-distancer conflict in which partner was identified  3.  identified  as  Identifying  as an emotional  an emotional  the  pursuer and the  one  other  withdrawer.  task environment  as Emotionally Focused  Therapy.  4.  Reviewing  transcripts  and identifying  repeated  interpersonal  patterns.  5. Employing two process indicators, the Experiencing Scale and the SASB  in an attempt to distinguish between the successful  unsuccessful  and  events.  6. Developing a final model of conflict resolution.  The final model of conflict resolution consisted of four steps which the couples progressed through to reach resolution. steps were identified as: and  (a) escalation,  (d) mutual openness.  defend",  "attack-withdraw",  (b) de-escalation,  (c)  focus  or "attack-attack"  felt  withdrawing or attacking.  on representing  pattern  where  openly disclosed their experience  In de-escalation  partner was  the  either  observed  and both partners  observed  one partner  of vulnerability.  responding with  to  usually  or asked for what he or she  This usually involved an expression  this point the "affirming  Each partner was  their own position  angry, frustrated, or unheard.  needed.  testing  Escalation involved either an "attack-  pursuer is blaming their partner and the other partner is defending,  These  At  either  of understanding" or "helping and protecting" behavior.  25 A of  failure to move from escalation to de-escalation and the "affirming  distinguished resolution  absence  and understanding" communication behaviors the  unsuccessful  resolution event  from  the  successful  events.  Greenberg, James and Conry (1988) used the Task  Analytic  Method to discover what couples experienced to be critical  change  incidents in E F T . Couples' self-reports of critical change processes therapy  were  compared with the  theoretically  in  derived, rational  model of the change process in Emotionally Focused Couples Therapy.  This comparison was conducted in order to develop a  rational-empirical model of the change process in therapy.  The  subjects were 21 couples who had received E F T treatment in a couples research project. to generate  A critical incident technique was  adapted  descriptions of change events from each partner's  perspective.  Five categories  of change processes  were derived from  the couples' reports: (a) expression of underlying feelings  leading to  change  and  (c)  in interpersonal perception, (b) expressing  acquiring  understanding, (d)  (e) receiving validation. processes  taking responsibility for  investigating  clients'  experience,  theoretical-rational model of  change  This result implies that the proposed  rational model of change processes needs to be reinspected.  needs,  Only one of the five reported change  matched with the  proposed by the authors.  feeling  This  self-reports  in Emotionally Focused Therapy  study demonstrates regarding critical  the importance of change  order to increase the understanding of change processes  events in  in marital  therapy. Heatherington and Friedlander  (1990) examined two  of  26  Salvador M i n u c h i n ' s videotaped and how the process therapy,  family interviews  to determine  of change in multiperson events,  can be investigated  particularly on a  to engage.  change  In their first stage of  analysis  they  family.  Each family was found to be caught in a cycle where the  parents  simply observed  in structural  using the Task Analytic Methodology.  Heatherington and Friedlander focused event they called commitment  pursued and the  of interventions  the behavior and dialogue  child distanced.  signalled the need for change  This  of  the  unproductive pattern  and Minuchin then conducted a series  that led to an emotional disclosure by the  child,  which set the stage for productive problem solving to begin. shift in interaction signalled the successful pursuer-distancer  resolution of  stage of analysis  & Heatherington,  This  1989;  system operationalizes  coding system showed  various  communication  with every  patterns  to  family  members  competitive  symmetry.  concluded by emphasizing measuring  event processes  Finally, (1994) used  progressed  patterns  Results  from  each  phase.  complementary  Heatherington  and Friedlander  the importance of conceptualizing systemically  or  using  other person at the  beginning of the session, changed during the resolution Particularly,  the  (FRCCCS;  that the relational pattern that  person in the family established  used  Heatherington & Friedlander,  reflecting interpersonal control on a structural level. this  the  the researchers  Family Relational Communication Control Coding System  1987).  This  impasse.  During the second  Friedlander  if  and  interactionally.  Friedlander, Heatherington, Johnson, and Skowron  the Task  Analytic Methodology  to investigate  sustained  27 engagement  in problem-solving tasks in family therapy.  step of the analysis, Friedlander et al. followed the Analytic Induction Method (Bogdan and Biklen, scrutinize 33 videotapes  ( S E Event), (b) disengagement  engagement when  the  (resolution).  pp. 69-72) to  (a) a sustained  engagement  (the marker), and (c)  sustained  a task environment geared toward  family members'  problem-solving  1992,  A S E Event was defined as "occurring  therapist creates  enhancing  Modified  of family therapy in order to develop and  refine the operational definitions of: event  In the first  (p.441).  engagement  with each other in  Disengagement  (the  marker) was  defined  as "the therapist requesting two or more family members to  discuss  a specific problem or set of problems together in the here-and-now" (p. 441),  after resistance  observed. sequence  to engagement  Sustained engagement  on a particular problem was  (resolution), was defined as "a  of speaking turns in which family members are  observably willing to disclose  thoughts  or feelings  on the  designated  topic, to share or cooperate, to show interest and involvement in the discussion, or to be responsive and attentive present)" (p.442).  (ie.  emotionally  A S E Event was defined as unsuccessful when the  marker was present and then the topic shifted or the session ended. In the second step of their analysis, four successful sustained  engagement  and four unsuccessful  sustained  engagement  were  operational  definitions  Induction Method.  selected  developed  The successful  events  of  events of  attempted  using criteria based on  from  the  Modified  and unsuccessful  Analytic S E events were  qualitatively compared using the Task Analytic Methodology. model  developed  from  their rational and empirical  the  The  investigation  28 depicts move  five from  steps through which family members proceeded as an interpersonal impasse  engagement  sustained  (resolution).  In their investigation, step successful  therapists  facilitated a process successfully outlined  (marker) to  they  the researchers found that during  engaged  in certain behaviors  below,  that  conducive to helping the family members  through the task environment.  each  move  The five steps are  including a description of therapist  interventions  that were found to be facilitative.  1. Recognition  of Personal  Contribution  to the  Impasse.  In this step  there is a shift from the specific activity or identified problem to an understanding of the relational difficulty. successful  therapists  During this step the  seemed to have recognized the  cognitive-  emotional basis for each family's impasse.  B y paying attention to  nonverbal  therapist was  and paralinguistic behaviors the  attuned  the fear behind the anger, the anger behind the politeness. therapist helped the clients impasse, following  bringing  interventions:  metacommunication,  The  recognize their own contribution to  unexpressed  emotions  clarifications,  to  awareness  with  the  the  reflections,  and self-disclosures.  When  the  therapist, h i m  or her self, did not recognize the importance of the underlying thoughts  and feelings of the family and consequently  the family recognize their own underlying thoughts about their impasse, environment.  to  did not help and feelings  the family did not progress through the task  29  2. Communication  about  Impasse.  Family members  disclosed  thoughts  and feelings regarding the impasse.  thoughts  and feelings seemed to allow for the possibility of  emotional responses to be experienced,  Disclosures of  leading to new  about one another's behavior found in step three. the therapist coached, for example, her son's experience the  different  attributions  During this step,  a mother on how  by validating the son's experience  to understand in front of  mother.  3. Acknowledgment contains  of  explicit  understanding  Others'  Thoughts  and encourage  Feelings.  This step  statements made by family members  or nonverbal indicators  acknowledgement  and  or concern.  disclosures  of  of  acceptance,  The therapist continued to  from family members, as well  validate as  challenging clients who attempted to rescind or dilute a disclosure in the face of blame by other family members.  The therapist also  redirected the interactions if they were moving off topic.  4. New  Constructions  information  about  Impasse.  that seemed to allow  family members  attributions about the disengagement. supported  5. Motivation to believe  the  Disclosures provided to  reevaluate  A t this point the  therapist  process.  for  Engagement  Recognized.  Family members  at some level that their engagement  would pay off.  The potential benefits  needed  mattered, that it  of engaging  were  addressed  by the therapist if family members had not already discussed matter.  the  30 6. Resolution  Phase.  Successful where  Sustained engagement was  S E events were episodes of interpersonal learning  family members  thoughts  taught  and feelings.  members  gaining  disengagement,  accomplished.  each  other  about  their private  Resolution seemed to depend on family  some awareness or insight  allowing  new  during the therapy session.  about  their  behavioral alternatives  to  Specifically, resolution was  a marked shift from the previous pattern of relating. who  focused  family members  about the impasse,  the  behavior,  movement  Some unsuccessful  the third step where disinterest,  by  and feelings  on the potential benefits of engagement, and on  family's  engagement.  revealed Therapists  on their own thoughts  their attributions of one another's facilitate  emerge  seemed most  from disengagement  to  sustained  events were marked by a stall at  derision, joking, off-topic  disqualification,  to  able  or defensiveness  discussions,  occurred instead  of  acknowledgement.  Summary The  literature reveals  study in the field of change  a growing recognition process  research  growth of family and couple therapy. event-based  change  process  that  is necessary  It is clear that  research, using  continued  the  in-session,  Task A n a l y t i c  Methodology has the potential to impact clinical practice. the potential (a)  for the  It also has  to respond to Gurman's (1988) recommendations  identifying  and specifying  the  elements within the major methods  most  potent  by:  change-inducing  of family therapy,  (b)  allowing  31 for the comparison of common elements and mechanisms  of  across methods,  with  and by (c) identifying factors associated  deterioration or negative effects in therapy. (1988),  including: patterns  process  micro-theories  in family therapy,  (a) therapeutic alliance, (b) the specific  acts and behavior  of the therapist and family system and (c)  proximal of "small-o" outcomes, To the Task  delineations  further studies  Analytic Methodology need to be undertaken in-session,  therapy.  regarding  the  change  processes  It will build on Newman's  syncretic  and disparate beliefs therapeutic  event-based  change  process,  between a couple  system efforts),  leading  (1995)  where  in  Task Analytic Methodology,  were transformed mutuality  by  disparate  interactions,  w i l l be  beliefs  a relational  and distance  Using the  frameworks. investigated.  the  impasse  oriented  on the topics  will have the potential  same theoretical  to  suggested by Pinsof and can  also be compared to other models of the change process within the  and  delineated.  In addition, the model developed provide micro-theories  (via  a model of the step by step process  therapist and couple engage in to resolve characterized  couple  disagreements  commonality of belief and practice in the relationship.  tasks,  family-  investigation  initial  to increased  using  when  The present research addresses this need in  therapy research.  of  which can later be tested.  respond to these recommendations,  investigating couple  A s suggested by Pinsof  Task Analysis can also produce specific  regarding the steps of the change  change  approach or across  Factors inhibiting the change process  for similar  theoretical  w i l l also be  32 Chapter  3  METHODOLOGY  This  chapter describes  the  methodological  strategies used  in  the present study: (a) The Success-Failure Strategy, (b) The Episode or  Small Chunk Strategy and (c) the Task Analytic Methodology.  Data collection procedures, demographics conceptual instruments  and psychometric  of the subjects,  information on the  are also provided.  and  selected  The procedures used to select the  subjects and events under investigation  are delineated.  Next,  summary of the content of each selected event is outlined.  a  The  chapter ends with the procedural application of the Task A n a l y t i c steps.  Methodological  Discovery-oriented between process Pinsof  research  and outcome  (1988) proposed  several  Strategies  involves  identifying  linkages  variables including small-o research methodologies,  strategies, for discovering these linkages:  outcome.  or  (a) The Success-Failure  Strategy, (b) The Episode or Small Chunk Strategy, and (c) The Multivariate Correlational Strategy. mutually exclusive These  These  strategies are not  and can be used to complement  strategies are based  on P i n s o f s primary  each  other.  recommendations  the immediate future of family therapy research: (a) the need focus  on the analysis  of within-group as opposed  to  for  to  between-group  33 variance; (b) the need to identify those families deteriorate  or improve to  determine  the  (couples)  process  that  variables  that  account for that variance; (c) the need to focus on smaller processoutcome  units  measurement focus  that reduce the time points; (d)  the need  less on summary measures  patterns of process therapy.  and experience  interval between  for family therapy researchers of process  variables and more on  variables within sessions and over the course  Pinsof suggests that researchers who combine the use  these approaches scientifically  stand the  greatest chance  reliable and clinically meaningful  research methodologies:  (a)  of of  of producing results.  This research study has combined two of the mentioned  to  above  The Success-Failure  Strategy;  and (b) The Episode or Small Chunk Strategy.  The  Success-Failure  Strategy  The Success-Failure Strategy involves subjects  and rank-ordering them  taking a group of  on pre-selected  outcome  variables  at some significant evaluation point such as midtherapy, termination, or follow-up. distribution  The cases at the low end of the  (therapeutic  deteriorators),  are compared on  process  variables with the cases at the high end of the distribution (therapeutic  improvers).  This  strategy  generates extreme  groups from a larger group of cases exposed The subjects included should be as similar as demographically  and diagnostically.  important in regard to context.  the  to the same  treatment.  possible  Homogeneity  presenting  sub-  problems  is particularly  and interpersonal  The therapists treating the families in such a study should  34 be as similar in training, orientation and expertise  as possible.  G i v i n g recognition to the difficulty of uncovering process-outcome links  in psychotherapeutic research, this  strategy  maximizes  the  chances of discovering how certain process variables lead to positive or  negative  outcome.  The The of  Episode  Episode or Small-Chunk Strategy or Small  Chunk  Strategy  involves the targetting  small chunks of therapy or therapeutic episodes.  outcome  or process-outcome  Traditional  research, which focused on  finding  links between the "Big O " or final outcome and some dimension of the process at some point in treatment over the whole course of therapy, has been widely criticized (Gottman & Markman,  1978;  1982; H i l l , Helms, Tichenor, et al, 1988 and Stiles, 1988).  This type  of  research has failed to identify any consistent  patterns.  process-outcome  Pinsof (1988) suggests that it is not that there are no  process-outcome  links but that the  traditional methodological  strategy used to discover these links is limited.  He concludes that  the solution is to focus on smaller units of therapy. behind The Episode  or Small  Chunk  Strategy  intervals of time and experience between measurements.  The rationale  is to reduce the  the process  The smallest process-outcome  within a session. episode.  Hill,  unit is  and outcome the  episode  One can meaningfully discuss the outcome of an  For example, if a therapist is attempting to have a couple  focus on a specific problem within a session, one can ask whether the problem was achieved.  resolved or whether desired outcome  was  This kind of outcome is called a "proximal" as opposed to  35  a "distal" outcome. increasingly episodes.  Task Analysis is the methodology that is  employed  in research  studying  these  in-session  A l l of the episode or small chunk strategies focus on  "small-o" outcomes process-outcome  and are based on two assumptions:  (a) that  links are best discovered in smaller units that do  not obscure the phases of therapy; (b) that small-chunk results meaningful  and  valuable.  The purpose of implementing The and The Episode  are  or Small  Success-Failure  Strategy  Chunk Strategy is not to make conclusive  statements of how certain process variables affect final or " B i g - O " outcome,  rather, in this  descriptive, discovery  observing episodes in extreme discover differences unsuccessful  cases increases  in the therapeutic process  resolution  oriented the  study,  opportunity to  of successful  and  events.  Task  Analyses  There are eight steps in the Task Analytic Methodology (Greenberg, last two  1991).  steps are  Discovery  oriented  The first six steps are discovery oriented, the verification oriented. steps:  Step 1. Explicate implicit map of expert clinician. Step 2. Select  and describe the task and task environment.  Step 3. Verify the efficacy  of the task environment on the task to be  studied. Step 4. Rational analysis of performance: Constructing possible performance  diagrams.  Step 5. Empirical Analysis of performance: Measurement of actual  36 performance. Step 6. Comparison of actual and possible performances: Construct a specific  model.  Verification  oriented  steps:  Step 7. Validation of the model. Step 8. Relating complex process to  The following  descriptions  outcome.  are fuller explanations  of  each  step: Step 1. Explicate implicit map of expert clinician. The  investigator  delineates his/her  which he/she will study therapeutic  map  change.  or framework from  This map or framework  is often a general model of therapy.  Step 2. Select and describe the task and task environment. This step is based on the assumption underlying this research approach that psychotherapy  can be broken down into a  series of events revolving around a specific resolution of which advances  confused,  states of  being  or wanting understanding can be considered actively  the  Functional problems such as  of conflict, problematic reactions,  which clients  task,  the course of therapy and leads to  change (Rice & Greenberg, 1984). experience  therapeutic  seek resolution.  Examples of  tasks for  therapeutic  tasks are the resolution of splits in Gestalt therapy (Greenberg, 1984)  or the resolution of problematic reactions in client  therapy (Wiseman & Rice, 1989).  centred  Each task begins with an in-  37 session statement or marker of the problem. constitute  process  amenable  to,  diagnoses  specific  These markers  of states in need of,  and currently  types of intervention (Greenberg, 1991).  The analysis of tasks within a therapeutic event includes study of the therapist's whether  influence  it hinders or facilitates  the  on the task performance and the  client's  resolution performance.  One of the therapist's roles is to keep the client(s) in a productive psychological problem space  (Greenberg, 1984).  A productive  problem space in therapy is one that keeps the client working on the task in such a way that will facilitate resolution. task environment is considered the behaviors that promote change. guided by their adherence  Therefore, the  sequences of client  and therapist  The performance of the therapist is  to a particular theoretical approach  which is implemented to facilitate the client's resolution of the task.  Step 3. Verify the Efficacy of the Task Environment on the Task to be  Studied. Demonstrating the efficacy  of the therapist's  approach on the task to be analysed is often needed proceeding on an intensive Greenberg  research program.  (1984), demonstrated  for resolving  the  efficacy  theoretical before  For example, of  two-chair  dialogue  splits.  Step 4. T h e Rational Analysis: Constructing Possible Performance Diagrams. According to Rice and Greenberg (1984) the rational analysis is a thought  experiment  conducted on the basis of clinical knowledge  38  and one's theory, which is part of the task environment. by asking such questions components  as "What are some of the  of performances  One begins  possible  that lead to resolution?  and "What  series of processes does the client need to go through in order to reach resolution?" (p. 37).  This is an attempt to map out and create  a model of the idealized client resolution performance by rational means.  E x S T theory describes  the processes of change  between client and therapist (Friesen et al. 1989). rational  model  performance  as  Therefore a  of resolution performance w i l l include  as well  as client  The rational analysis  co-created  therapist  performance. serves as a framework for organizing  the vast amounts of data to be obtained from the study of the actual resolution performances. refined  This rational model will be modified and  as the researcher discovers  what aspects of the  performances fits or fails to fit the rational model.  actual  This is done by  comparing the rational model of idealized performances empirical analysis  and the  of actual performances in a number of  cycles.  Step 5. Empirical Analysis of Performances: Measurement of  Actual  Performances. The  investigator  description of the therapeutic analyzes  process  now  develops  a detailed  sequential  actual therapist and client performances under study.  the performances  In this  intensively  step the (coding  in the  investigator  systems may  be  used in this step) and attempts to diagram the data.  Step 6. Comparison of Actual and Possible Performances: Construct a  39 Specific Model. The investigator compares the actual performances with the possible performances (comparing steps 4 and 5).  From this  comparison the investigator begins to construct a specific model, consistent with the rational model, of the kind of performances that could have generated the resolution process.  At this stage the  investigator attempts to conceptualize the mechanisms that enable the process of therapeutic change by progressively correcting, expanding, and making more explicit his or her understanding of the processes involved in generating successful resolution performances. The goal of this investigation is the construction of a detailed specific model of the components of resolution.  This step provides a  model of change that can now be tested and ends the discovery oriented phase of the task analysis.  Step 7. Validation of the model Using the newly constructed model, successful resolution and unsuccessful resolution performances, of the same task, are rigorously compared to validate that the specified discriminate between resolvers and non-resolvers.  components This is an  attempt to validate the model.  Step 8 . Relating Process to Outcome. In this step the complex client-therapist process patterns, which are viewed as a causal chain of change processes, are related to "small o" outcome.  40  Procedure  A l l data used will come from The Alcohol  Recovery  ( T A R P ) , in which 150 families participated in fifteen Experiential  Systemic  sessions of  Therapy ( E x S T ) or Supported Feedback  Therapy ( S F T ) for the treatment of alcohol dependency. was  structured according to  group design.  Project  a repeated  measures  The study  experimental  A l l counselling sessions were videotaped.  Project Description Phase I of this project began in 1987  with the  development  of treatment manuals and the training of alcoholism therapists E x S T and S F T .  Phases II began in 1989 and ended in 1994 and  involved the data collection. continuing. analyses.  in  This phase  Phase III began in 1994  includes  quantitative  and is  and qualitative data  The present study is part of the ongoing  qualitative  research.  Subject Inclusion Criteria for T A R P Each of the  150 families that participated in the research  project were screened  for the following inclusion criteria:  1. The father was struggling against a dependency to alcohol, and had consumed  alcohol within the previous three  months.  2. The mother had experienced no alcohol problems within the previous  five  years.  41  3. The couple was experiencing marital distress, together  and desiring to  preserve  the  but still living  relationship.  4. The couple had been living together for at least one year (married or  common-law).  5. The couple was ready and willing to participate in couples therapy,  should they  be  assigned  to that treatment  condition.  6. Each family included one or more children who lived at home, or were in regular contact with the family.  A l l children, nine years of  age and older, were asked to participate in the project.  7. Families could be remarried or blended, and the children included could be of either parent.  Families that met the above  criteria were excluded at point  of screening if one or more of the following exclusion criteria were evident:  1. The father's problem with alcohol was not severe enough for him to exceed the critical cut-off score of five on the Michigan A l c o h o l i s m Screening Test (Mast; Selzer,  1971).  2. The mother's use of alcohol was severe enough for her to exceed the cut-off score of four on the M A S T .  42  3. Both father and mother scored above 99 on the Dyadic Adjustment  Scale  (Spanier,  1976)  indicating negligible  marital  distress.  4. Mother or father scored exceptionally high on either the psychiatric  or depression  Revised (Derogatis,  sub-scales  of the  Symptom Checklist-90  1983), indicating a severe psychiatric  disturbance.  Those families  that met the criteria were  randomly  assigned  to one of the three treatment groups: (a) SFT-Individual, (b) Individual or (c) E x S T - C o u p l e .  A large battery of  ExST-  questionnaires  tapping three levels of client functioning: (a) level of alcohol dependency, were (15  (b)  intrapersonal distress  administered weeks  process.  after  at  the  pretreatment, treatment  The measures  and (c)  marital  posttreatment  session) during  the  were employed to assess  Therapist  and  adjustment, follow-up  treatment  outcome.  Variables  Therapists involved in the T A R P project were at the Master's level or higher in counselling psychology, social work or a related field.  A l l of the therapists had at least three years of  working with clients Therapists  underwent  exhibiting alcohol and drug systematic  experience  dependencies.  training in the Experiential  Systemic  M o d e l , their work being supervised" on a weekly  Training  manuals  were  adhering to the model.  provided to ensure  that the  basis.  therapists  were  43 Therapist variables did not influence the selection subjects  of the  as key therapist variables were found to be held constant  across treatment cases.  Friesen et al. (1995) report a high degree of  treatment adherence for all therapists involved in this study.  A  high degree of treatment adherence refers to the fact that E x S T treatment was therapists. associated  delivered as outlined in the treatment manual by all  In addition, no treatment effects were found to be with therapist or gender of therapist.  Selection of Cases T w o couples, one who improved and one who deteriorated, who participated in the A l c o h o l Recovery Project and had videotapes  of their therapy sessions, were  chosen  for investigation.  The manner in which these couples were selected is explained in this  section. Using a modified version of the Success-Failure  identified  earlier, couples who were assigned to the  treatment,  were  assessed on their pretest,  Strategy, ExST-Couple  and posttest measures  on  the A l c o h o l Dependency Data Questionnaire ( A D D ) , the Symptom Checklist Revised ( S C L - 9 0 - R ) , and the Dyadic Adjustment Scale (DAS).  These instruments were chosen as each one assesses one of  the three levels of client functioning, respectively.  The A l c o h o l  Dependency Data Questionnaire ( A D D ) assesses the level of alcohol dependency in the husband. The Symptom Checklist Revised ( S C L 90-R)  assesses intrapersonal distress  and the D y a d i c Adjustment  Scale ( D A S ) assesses marital adjustment. description of each  measure:  The following  section is a  44  1. The A l c o h o l Dependency Data Questionnaire ( A D D ) - a 39 item form was used to indicate change in severity of alcohol  dependence  over time. The 39 items are rated on a 4 point scale ranging from never= 0 to nearly always = 3. A final score of 0 indicates no dependency,  scores  score between between  31  61-117  ranging from  1-30  indicate mild  dependence,  and 60 indicates moderate dependence,  indicates  severe  dependence.  A  at  posttreatment  from  pretreatment  would  a score  split half reliability  of .87 is reported (Raistrick, Dunbar & Davidson, 1983). score  a  A larger  indicate  deterioration.  2. The Symptom Checklist Revised ( S C L - 9 0 - R ; Derogatis, measures  the level of psychiatric symptomatology on a range of  symptoms. .90. would  1983)  The authors reports reliability coefficients  from  .77  to  A larger score at posttreatment as compared to pretreatment indicate deterioration.  3. The Dyadic Adjustment Scale ( D A S ; Spanier, 1976).  This 32 item  scale is used to measure marital satisfaction by tapping four dimensions  of the marital relationship. These four dimensions are:  (a) Dyadic Consensus which measures the degree to which couples agree  on important relationship matters, (b) Dyadic  which measures  the degree  relationship,  Affectional Expression measures  (c)  of satisfaction  Satisfaction  and commitment to the degree  which the respondent is satisfied with the expression of  the  to  affection  and sex in the marriage and (d) Dyadic Cohesion which measures degree of couple togetherness.  the  A score of 0 to 151 may be obtained,  45 a score of 100 or below indicates marital dissatisfaction. Reliability has been reported as .96 pretreatment  would  .  A larger score at posttreatment  indicate  from  improvement.  Decision Criteria The decision criteria employed to chose a couple  who  improved and a couple who deteriorated was to select the couple in which one amount  or both spouses deteriorated or improved the  on the An  identified earlier.  appropriate deteriorator  spouse from by two  measures  the E x S T - C o u p l e  standard deviations  previously identified.  greatest  was identified as only one  treatment  group (N=24) deteriorated  from the mean on two of the  The measures  were  the A l c o h o l  measures  Dependency  Data Questionnaire ( A D D ) and the Symptom Checklist Revised ( S C L 90-R). This spouse did not provide a final Dyadic Adjustment score as the couple separated soon after treatment. therefore  chosen  for  This couple  was  examination.  The same decision criteria was employed to identify an appropriate Couple  improver.  treatment  However, three spouses from the  group improved by two  the mean, on three separate measures. was  ExST-  standard deviations  from  A second decision criteria  implemented to select between these three couples.  The couple  whose time lag between the initial intake interview and the start of therapy was selected.  most similar to the couple chosen  as deteriorators  Graphs depicting the scores from pre-treatment to  post-  treatment, for the husband and wife of each couple for all three measures, are found in Figure 1, 2, 3, and 4.  was  46  Figure treatment  1.  A bar graph comparing the pre-treatment  scores for the husband of the couple  "deteriorators" on the A l c o h o l Dependency  chosen  and postas  Questionnaire ( A D D ) ,  Symptom Checklist 90 revised ( S C L - 9 0 - R ) , and the Dyadic Adjustment Scale  (DAS).  the  47  Figure  2.  treatment  A bar graph comparing the pre-treatment scores for the wife of the couple  on the A l c o h o l Dependency  chosen  and postas  "deteriorators"  Questionnaire ( A D D ) , the Symptom  Checklist 90 Revised ( S C L - 9 0 - R ) , and the Dyadic Adjustment Scale (DAS).  48 Figure  3.  A bar graph comparing the pre-treatment  treatment scores for the husband of the couple "improvers" on the A l c o h o l Dependency  and post-  chosen as  Questionnaire  (ADD),  Symptom Checklist 90 Revised ( S C L - 9 0 - R ) , and the Dyadic Adjustment  Scale ( D A S ) .  the  48a  49  Figure  4.  treatment  A bar graph comparing the pre-treatment scores for the wife of the couple chosen  the A l c o h o l Dependency  Questionnaire ( A D D ) , the  and post-  as "improvers" Symptom  Checklist 90 Revised ( S C L - 9 0 - R ) , and the Dyadic Adjustment (DAS).  Scale  50 Selection of Events The first step in selecting  events within the Task Analytic  Methodology, is to develop operational definitions of (a) an that includes the task under study, (b) the marker, the event,  (c) successful  and (d) unsuccessful  resolution resolution  that  event  introduces  of the task under investigation of the task under study.  The task  under investigation in this study is the resolution of a relational impasse  created by  disparate beliefs  interactions between a couple. called a relational impasse  and distance  oriented  A n event that includes this task is  event (RI event).  The manner in which these definitions  were  developed  similar to the procedure used by Friedlander et al., (1994).  was  They  conducted an initial analysis of 33 family therapy sessions using Modified Analytic Induction Method (Bogdan & Biklen, 72)  to develop  study.  and refine the operational definitions  the  1992 pg. 69-  used in their  The steps to the Modified Analytic Induction Method are: (a)  develop  a rough definition and explanation of the particular  phenomenon under study, (b) use purposeful purposeful  selection  of observations  sampling,  which is  the  that are thought to facilitate  the  expansion of the developing definition, (c) modify the definition as new  cases that do not fit the definition, as previously formulated,  are encountered.  The ultimate objective is to develop  a descriptive  definition that encompasses all cases of a phenomenon. In this investigation, sessions of E x S T - c o u p l e Modified  an initial intensive  treatment  Analytic Induction steps.  was  analysis of  45  undertaken employing  The purpose was  the  to understand  the characteristics of a therapeutic event that included a couple  51  attempting beliefs  to resolve  and behaviors.  a relational impasse  created by disparate  The definitions that were developed are as  follows:  1. A RI Event -  A RI event is a significant episode in therapy in  which a relational impasse is identified by a marker. impasse becomes by  a set  2. The  the task to be resolved.  of therapist interventions  Marker  -  The marker is  followed  and ensuing client performance.  The marker is a statement made by each member  of the couple that refers to a relational impasse. demonstrate a difference in opinion, belief,  The statements  idea, behavior or not  having a similar understanding of a situation.  Interactions or  behaviors that lead to further distancing between observed.  T h e relational  Examples of distance  the couple are  oriented interactions between  the  couple are: (a) the use of sarcasm, (b) raising one's voice, or (c) ignoring each  other.  3. A Successful  RI Event -  shift  A successful RI event contains a distinct  in observable interactions between  approach  oriented interactions  the  couple, marked by  and statements  or behaviors  from  one or both partners of a greater calmness, relief, direction, or decisiveness. the couple are:  Examples of approach oriented interactions  between  (a) expressions  of understanding of the other, (b) a  willingness to remove obstacles,  or (c) a willingness to complete an  activity  together.  52  4. An  Unsuccessful  RI Event  -  A unsuccessful RI event is defined as  an event in which the marker is observed and the attempts  to  interactions  address  the problem.  However, the  therapist  subsequent  between therapist and couple do not lead to resolution  as defined above.  The event ends when the topic is changed or the  therapy session comes to a close.  The second step in selecting  events within the Task  Analytic  Methodology is to use the definitions developed in the first step as a basis for the identification of the RI events to be analyzed. Identification  of Successful  and  Unsuccessful  RI Events  Form  Appendix A ) was developed to identify two successful unsuccessful newly  RI events.  developed  events. observed.  and included on this form.  a period of interactions defined,  is  the  Therapeutic RI  RI event, the marker, as defined above, is  The therapist addresses  previously  and one  all six criteria are considered successful  In a successful  (See  Six inclusion criteria were derived from  definitions  episodes that fulfil  The  the relational impasse,  and  after  between therapist and couple resolution,  as  observed.  Therapeutic episodes that fulfil  the first three criteria of  this  form, but do not fulfil the last three, are considered unsuccessful RI events.  In an unsuccessful  therapist impasse  addresses  RI event the marker is observed,  the relational impasse  but resolution of  is not observed in the following interactions  couple and therapist.  the the  between  The topic is changed or therapy comes to a  close. All  videotaped treatment sessions of the two  couples  chosen  53 by the Modified Identification  Success-Failure of Successful  successful  Strategy  and  were analyzed.  Unsuccessful  RI events were selected  RI Events  Using  Form,  from the couple who  The  two  improved  and one unsuccessful RI event was selected from the couple who deteriorated. M a n y episodes were not chosen as they did not fulfil criteria  mentioned  below:  1. The couple did not demonstrate disparate beliefs over a particular  2.  the  or disagreement  issue.  The couple demonstrated disagreement but the therapist did not  address  the  relational impasse.  3. There was no interaction between between  a spouse  resembled  the couple, only interaction  and therapist individually,  individual  so that the  therapy rather than couple  event  therapy.  4. T h e therapist's approach was directive to the point that there was no room for disagreement to arise.  Inter-Judge T o ensure that the episodes event,  marker,  and successful  and  two judges evaluated the selected of Successful two  and  Unsuccessful  graduate students  therapy.  They  Reliability selected  for analysis fulfilled  unsuccessful episodes  RI Events  RI  event  using The  Form.  definitions, Identification  The judges were  in Counselling Psychology studying family  reviewed the episodes  the  independently and their  54 results judge  were compared to the researcher's. agreement  for successful indicates  that these episodes fulfilled the  and unsuccessful  that there was  researcher  There was  with respect  RI events.  100%  required criteria  This high agreement  no discrepancy between the judges to the identification  inter-  rate  and the  of the required criteria.  Content Outline of the selected Successful  and Unsuccessful RI  Events  The following section contains an outline of the content of the two  successful  RI events and the unsuccessful  RI event.  Summary of the First Successful RI Event This event occurred in the first of twelve treatment  sessions.  It started at the beginning of the session and is approximately minutes long.  A transcription of this event can be found in  Appendix B .  The husband brought various forms  information  from a previous  treatment  program to  session, he gave these forms to the therapist. information was together.  a Couple  The wife  Plan  containing the  therapy  Included in this  that the husband and wife  created  stated that she felt discounted and controlled  because she was not consulted regarding giving the Couple the therapist.  15  Plan  The therapist, with the couple, addressed this  issue.  A t the end of the event the husband stated that he more clearly understood his wife's viewpoint. Plan  to the  therapist.  Together, they gave the  to  Couple  55 Summary of the Second Successful  RI Event  This event began at the start of the third of twelve sessions of treatment.  It is approximately 30 minutes  long.  A transcription  of this event can be found in Appendix C .  The couple brought two  symbols  session.  that represented  themselves to the  brought a rock, the husband brought a trophy. statement indicated she symbols.  wanted  T h e wife  The wife's first  a wall put between the  two  She placed a symbolic wall (a book) between the  She stated that what she was doing wasn't very right  symbols.  because  she  thought she should be striving to be closer, not putting up a wall. The husband responded discouraged  with  and frustrated  between he and his wife. symbolic  experience  surprise and stated that he  as this event represented  the  couple  placed themselves  the walls and within the maze that was discussed. session, the husband stated that he understood  the  symbolic  coming  behind  A t the end of the  that his wife puts  up  She protected herself as it was difficult to  trust that their relationship would continue removed  a wall  The therapist guided them through a  in which  walls to protect herself.  felt  so well.  wall from between the  Summary of the Unsuccessful  The wife  symbols.  RI Event  This event occurred in the third of five sessions.  It began in  the middle of the session and is approximately 25 minutes long.  A  transcript of this event can be found in Appendix D .  The husband  and wife  demonstrated  issue  finances.  The wife stated she was angry.  different  opinions  around the  of  She said she was lucky if  the bills were paid and if she had money for groceries.  The husband  56 stated that the  wife was  never happy with anything. The  therapist  asked many times if the couple would like to "work on" this issue. In the  subsequent interactions  between therapist  greater  understanding  the  between  couple  there was no sense of relief, calmness, no resolution occurred.  and couple,  occurred.  no  Furthermore,  direction or decisiveness,  i.e.  Finally, the counsellor brought the session to  a close.  Procedural Application of Task Analytic Steps The following  section delineates the procedural application of  the Task Analytic Methodology to this investigation.  The findings  from the application of steps four through seven are elaborated the Results  section.  in  Step eight is found in the Discussion/Conclusion  section.  Step 1: Explicate Implicit M a p of Expert Clinician This study is grounded in the E x S T couple framework. one.  therapy  A n outline of this therapy has been provided in chapter  For a fuller elaboration, the reader may refer to the works of  Friesen, Grigg, Peel and Newman (1989).  Step 2: Select and Describe the Task and Task Environment Heatherington  and Friedlander,  addition to  the  meaningful  changes in family or couple  by  the  intrapsychic changes that  resolution  members.  (1990) argue  of  interpersonal  typify  that in  individual therapy,  contexts are characterized  impasses between  The task under study, therefore,  was  family  selected to  facilitate  57 a greater understanding of the process fostered  in couples  the resolution of a relational impasse  beliefs and distance  oriented interactions.  adherence  The therapist  performance  to Experiential Systemic  created  that  by  disparate  In this study, the  environment is considered to be the therapist performances.  therapy  is  and  task  couple  influenced  Therapy during the  by  his/her  event.  Step 3: Verify the Efficacy of the Task Environment on the Task to be  Studied First, this investigation  is built on the previous  research conducted on E x S T .  process  Dubberley-Habich (1992), Wiebe  (1993) and Newman (1995) all noted the influence  of E x S T ' s  and collaborative expressions  cognitive  of intense affective,  physiological states in facilitating change Moreover, EFT  the above  studies,  advancement  mentioned  in couple  studies as well as the  marital affiliation  when  and  therapy. accumulated  describe the importance of deep experiencing of  guided  experiential  for the  therapy  was  used to effect marital change. Second, the task under study is relational in nature. environment used in this  study employs  The task  a relational paradigm as  Newman (1995) states "The concepts integral to the E x S T theory of change  centre on the utility of a relational paradigm to understand  human  experience  and the  importance  themes and the intensification novelty  " (p.41).  process  of  substantive  relational  in the creation of relational  58 Step 4: The Rational Analysis: Constructing Possible Performance Diagrams A  thought experiment was  conducted to map out the  processes therapist and couple progress process.  Possible  components  through in the  and mechanisms  derived from an examination of E x S T theory. idealized  therapist-couple  resolution  Step 5: Empirical Analysis:  were  A rational model of was  developed.  section.  Description of Actual Performances  In this investigation, conducted.  change  of resolution  performances  This model is presented in the results  possible  two  empirical analyses  have  been  Following the method used by both Rice and Saperia's  (1984) and Plysiuk (1985) of conducting the first empirical analysis, this investigator conducted a step by step description of the process for the first and second successful videotape  the process  couple were engaged in at each step. develop  RI events using the  recordings and transcribed protocols.  description was to specify  The purpose of  couple performance. components  this  in which the therapist and A n attempt was made to  an increasingly precise set of descriptive labels  with which to classify  change  or codes  each unit of therapist, couple and therapistThe categories  were taken from  the  of the rational model.  For the  second empirical analysis  were employed to code the. successful  two  measuring systems  and unsuccessful  RI events.  The measuring systems are: (a) The Experiencing Scale (Klein, Mathiew, Gendlin & Kiesler, 1969)  and (b) The Self-Disclosure  Coding System ( S D C S ; Chelune, 1976).  Friedlander et al. (1994)  59 found that successful contained  family change  interpersonal  learning.  family members to disclose  made in couple therapy. can  accurately  measure  the  learning required and  The S D C S was therefore chosen as it  amount and type  of  self-disclosures  The Experiencing Scale was chosen as it the  important in experientially descriptions  Interpersonal  those that  to each other their private thoughts  feelings related to the impasse. can accurately measure  events were  experiential  process  oriented therapies.  and reliability coefficients  considered Below  for each  are  detailed  instrument.  The Experiencing Scale. The Experiencing Scale was developed to capture the essential  quality of a client's  involvement in psychotherapy.  The  concept of "experiencing" refers to the quality of a client's participation in therapy; that is, the extent to which inner referents become  the felt data of attention, and the degree to which  efforts  are made to focus on, expand, and probe those data." (Klein, Mathieu-Coughlan, & Kiesler, 1986, p. 21).  The scale was  designed  to use with recordings and transcripts of therapy sessions, for units of 2-8  minutes in length. These units or segments are selected from  the therapy hours at a location chosen to meet the needs of the particular study.  The scale has also been applied to  structured interviews, two-chair exercises.  group therapy,  couple  therapy  Wherever an individual's speech  monologues, and  may be  isolated to be rated, the scale can be applied. It has also applied  to  example,  therapy from  different  theoretical  Gestalt  orientations,  been for  dynamic, psychoanalytic, Gestalt and cognitive.  The Experiencing Scale consists of one seven point scale.  The  60  seven levels define referents.  Table  Table 1:  the progression of client involvement  with inner  1 provides a description of the experiencing  levels.  Short Form of the Experiencing Scale  CONTENT  LEVEL 1.  External  events; refusal  to participate.  2.  External event; behavioral or self-description  3.  Personal reactions to external events; limited self-descriptions; behavioral descriptions of feelings.  4.  Descriptions of feelings and personal  5.  Problems or propositions personal experiences.  6.  Synthesis  intellectual  experiences.  about feelings  and  of readily accessible feelings and  experiences  to resolve  personally  significant  issues. F u l l , easy presentation  7.  elements  A  confidently  training manual presents the scale in detail, it  rater training procedures rater reliabilities have  and includes  been  obtained  manual, ranging from .80 to .99, professional Kiesler,  of experience;  practice materials. after  1969).  training with  no differences  and non-professional judges  all  integrated.  outlines Excellent this  emerged between  (Klein, Mathieu, Gendlin &  Raters are trained to summarize their ratings by  two  61  scores: modal ratings and peak ratings.  A modal rating characterizes  the overall or average scale level of the segment, it is  representative  of the most general or frequently occurring experiencing level in the segment.  A peak rating is given to any point where a higher level is  reached even  momentarily in the  segment.  The Self-Disclosure Coding System. The Self-Disclosure Coding System ( S D C S ) is a behavioral content  analysis  system  designed  of self-disclosing behavior.  to examine  the basic  parameters  Self-disclosure is the process of  revealing one's inner thoughts,  feelings,  and memories to another  person. This system was designed to be used with audio recordings and transcripts.  A detailed scoring procedure, provided in the  coding manual, has been developed for the S D C S and has been shown to be both highly reliable (reliabilities ranging from .77 .98)  and a valid predictor of observers' perceptions of  behavior (Chelune, 1976).  to  self-disclosing  The amount of self-disclosure in a 30  second interval of communication is scored in terms of the number of thought units which describe the speaker in some way. thought units are referred to as self-references. may be judged to be positive, negative or neutral. summary  of four of the possible  eleven  selected to code the events in this study.  A  The  self-reference  Table 2 is a  self-disclosure  dimensions  62  Table 2: Summary of the Self-Disclosure Coding  Description  Variable  Self-Reference  System  The number of thought units that are descriptive of some aspect or quality of the speaker.  (SR):  Positive SelfReference Percent (SR+%)  The percentage of SRs that describe a positive aspect or quality of the speaker.  Negative SelfReference Percent (SR-%)  The percentage of SRs that describe a negative aspect or quality of the speaker.  Neutral SelfReference Percent (SRo%)  The percentages of SRs that cannot be clearly classified as either SR+ or S R - .  Waring  and Chelune (1983) found that  self-disclosing  behavior as measured by the Self-Disclosure Coding System is a major determinant of various aspects of marital intimacy. recent study conducted by Waring, the relationship of changes couple's who  in self-disclosure  perception of marital intimacy.  and Fry (1994) explored in therapy to  the  They found that spouses  were rated as disclosing in greater depth, and referring to  themselves in a more positive in  Shaefer,  A more  manner, perceived increased intimacy  their marriages.  Coding  Strategy T o obtain a representative  sample of each of the three events  63 in their entirety, the three events were broken down into consecutive  five minute sections.  code randomly selected section. clients'  T w o judges used both systems to  two minutes  segments of every five  minute  The Experiencing Scale was used to code the depth of the intense  experiencing and the Self-Disclosure C o d i n g  was used to code the amount and type of self-disclosures  System  made in  therapy.  Step 6: Comparison of Actual and Possible Performances: Construct a Specific Model. The description of the step by step change process  was  compared to the rational model of resolution performances. discrepancies model.  corrections and alternations were  New codes were added for processes  anticipated. to  arose,  Where  made to  the  that had not been  Categories from the rational model that did not prove  make interesting  distinctions  were  removed or reformulated.  Step 7: Validation of the Model: First Empirical Analysis of the Unsuccessful RI Event. A  step by step description of the change process was  for the unsuccessful RI event. of the unsuccessful  between  the  The step by step process description  RI event was compared to the newly  model to discover if specific resol vers  and  made  process  constructed  components discriminate  non-resolvers.  64  Chapter  4  RESULTS  In  this chapter the results  of the task analytic steps numbers  four through seven will be presented in five sections. outline of each of the  Below is an  sections.  Section one includes the results of the task analytic step number four, The Performance  Rational  Analysis:  Diagrams.  resolution  resolution event derived from E x S T  and  are developed  five, Empirical  Analyses of  Actual  of  Therapist  the  derived  descriptions  Performances.  of  the  of task analytic step number  and  empirical analysis of the two successful sequential  from  processes.  Section two includes the results  Measurement  theory  A rational model of idealized therapist and couple  performances  components  Possible  In this section possible components and  processes of a successful are delineated.  Constructing  actual  Couple  Performances:  This section contains the first RI events.  Detailed  therapist-couple  performances  are provided.  The rational model served as the framework for  organizing  data.  the  Section three includes the results of task analytic step number six, Comparison Construct  a Specific  therapist-couple of  of Actual Model.  performances  idealized therapist-couple  and  Possible  Performances:  The results from the actual successful are compared to performances.  revisions to the rational model are discussed  the  rational model  Modifications and and a new  model,  65  specifying  particular components  of resolution is  Section four includes the results seven,  Validation  Unsuccessful  of the Model:  Resolution  First  Event.  presented.  of task analytic step number  Empirical  Analysis  compared to the modified model of successful performances.  The purpose of this step was  the  performances  performances  indeed  and to validate the  discriminate  between  the  A step by step description of the  therapist and couple performances in the unsuccessful  successful  of  successful  differed  specific  RI event are  therapist and couple to determine  from  process  and unsuccessful  whether  unsuccessful components resolution  that events.  Section five includes the results of the second empirical analysis of all three events.  A l l three events were coded using the  Experiencing Scale and the Self-Disclosure Coding System.  The  results of The Experiencing Scale and The Self-Disclosure Coding System  for all three events, are presented  and compared.  Section 1 Step 4: The Rational Analysis: Constructing  Possible  The following possible successful  therapist-couple  Performance Diagrams  components  and processes of  performances in a RI event are derived  from an examination of E x S T theory.  The possible components and  processes include: (a) four phases of a therapeutic event, relational novelty,  (b)  (c) intensification, (d) transactional classes.  A  rational model of idealized therapist and couple performances in a RI event was figure 5.  developed from this examination and is presented in  Below, each of the components  and the positions  and processes are defined  they hold in the rational model are delineated.  Figure 5.  A rational model of the change process specific  Experiential Systemic Couple Therapy for a RI event.  66c  —> (N o  v~> \o r~  67 Four Phases of a Therapeutic Event In E x S T theory the therapeutic process phases which are: (a) Forming Context  for  Change;  Expanding  1991).  (b) Perturbing  Alternatives;  (d) Disbanding  the  the  Therapeutic Patterns  (c) Integrating  Therapeutic  System  System, and  Setting  a  Sequences,  Experiences  of  Change  and;  (Friesen, Grigg, & Newman,  The first phase involves the creation of a therapeutic  relationship producing a safe atmosphere between clients perturbing  and therapist.  a couple's  third phase  and a sense of trust  The second phase consists of  current relational patterns  relationship with self, others expands  consists of four  and evoking  and the world.  alternatives  new  patterns  E v o k i n g new  patterns  for behavior and interaction.  focuses on consolidating  the therapeutic  gains  of  The  and  integrating the changes made in therapy into everyday life.  The  rigidity that the couple once had in their relationship changes into relational flexibility.  "Where there was once such things  hopelessness, anger, and hurt now acceptance  and forgiveness"  fourth phase represents therapy  are  lies compassion,  (Friesen et al. 1989,  the end of therapy.  as  tolerance,  p. 14).  Finally,  the  Changes made in  celebrated.  These phases are interlocking and can occur cyclically over the course of therapy (Friesen, Grigg, Newman, 1991). researcher suggests that a change therapy roughly follows of the treatment phases.  This  event within the course  this larger organization of the  of  progression  In each event the focus may be more or  less on some aspects of each phase. Moreover, the process  may  return to some earlier phase within an event, as occurs within the  68 larger course  of therapy.  The first three phases will therefore  form  the general outline of the change process in the rational model.  The  fourth phase is not included as it particularly refers to the end of treatment.  Relational  Novelty  Relational novelty E x S T theory.  is the key concept  Once a client experiences relational novelty  no longer maintain the same rigid patterns they had previously become accustomed" Newman, the  1989,  change  p. 7).  the  six  tenets that  A s relational novelty  process and an outcome  (Newman,  the  phases of  Newman,  1995)  both a  the tenets of relational  therapy.  patterns,  narratives  of  collaboration.  substantive  or behavior  spouse or the presenting  via  emerge  in  therapy.  relational themes, relational therapeutic  transactions  problem.  3. Important experiences, previously awareness  are (Friesen et al.,  1995):  T h e intensification  self,  characterize  is considered  six tenets that characterize relational novelty  1. Therapist and couple  2.  Peel,  will be placed in the model as occurring concurrently  throughout  1989;  which  are also included in the rational model of  resolution performance.  The  "they can  of behavior to  (Friesen, Grigg,  in  This concept is important in understanding  process and therefore  relational novelty  novelty  describing change  out of client  conscious  with  69  4. Clients speak, feel, think and behave atypically rather than speaking,  feeling,  characteristic  thinking and behaving in a recurrently  fashion.  5. Clients identify something new about self, their spouse or the presenting  problem.  6. Relationally novel episodes follow a general pattern and begin with the facilitation of client narratives or utterances.  The therapist  then suggests delving into a salient aspect of the narrative or utterance through a therapeutic transaction. the therapist guides  The clients  consent  and  them through a deep, intense and novel  encounter with self, other or with the presenting problem.  This  encounter  therapist  ends with a de-intensification  may mark a change,  during  congratulate the clients,  which the  summarize the  encounter or ask the clients for their views of the experience. the therapist encourages do  so  clients  to talk about the experience,  Either or they  spontaneously.  Intensification The  general principle that experientially  oriented  therapies,  including E x S T , adhere to is that therapeutic change involves a deepening, enhancing and broadening of the client's focus is on increasing the client's awareness current feelings,  of the recursiveness  of  perceptions and physical states (Friesen, G r i g g ,  Peel, Newman, 1989).  Six components that facilitate deep  experiencing, also called intensification deepening  experience. T h e  client experience,  were found to be helpful in  facilitating relational novelty  or  change  70  (Newman,  1995).  These components are activities in which the  therapist engages and the client responds to positively. rational model, these components  are expected  utilized during the second phase of therapy. phase  of  therapy, the  patterns between  therapist attempts  to be  primarily  During the  second  to perturb relational  the couple, the intensification of their relational  experience is therefore expected to occur at this point components  In the  The six  of intensification are:  1. Providing a detailed definition of the specifics of the clients' dilemma.  2. Creating an interaction between  clients or between  clients  and the  symptom.  3. Maintaining a present tense focus client  during sequences of  intense  experiencing.  4. E m p l o y i n g varying degrees of empathy ranging from paraphrasing to advanced empathy to access underlying feeling context  dependent  The  on a  basis.  last two  components  facilitating intensification  were  found to be contingent upon the nature of the experiential activity conducted.  These two components  were:  5. Utilizing meaningful metaphors and symbols.  6.  Personalizing and amplifying physiological states.  71  Transactional  Classes  There are seven underlying  therapeutic  transactional classes used to describe mechanisms  that facilitate  change within the therapeutic process in E x S T . transaction  is used instead of interaction  complexity of the process  the  the  co-creation  of  The word  as it denotes the  of accommodation and influence  engaged  in by all members of the therapeutic system (Friesen et al. 1991). Not all transactional classes need to be engaged in over the course of therapy for change to occur.  Therefore, the transactional classes are  positioned outside of the main outline of the rational model of the change process.  The empirical analyses may indicate i f a particular  transactional class is crucial to facilitate resolution and at that point the transactional class will be included. are  delineated  The transactional classes  below.  1. Therapist-Client Relationship Enabling Transactional The  creation and maintenance  of the  Class.  therapeutic relationship  is the focus of this class. This transactional class occurs throughout the duration of therapy and ensures and safe.  Openness, honesty,  encouragement engaged  are examples  in this  qualities  as  immediacy  when  information sharing, spontaneity, of behaviors observed in  transactional class.  empathy,  that the client feels understood  respect,  clients  Therapists demonstrate  such  understanding, self-disclosure  involved in relationship enabling  and  and  transactions.  2. Process Facilitation Transactional Class. The therapist focuses on the relational patterns of the in this transactional class.  The therapist emphasizes  clients  the recursive  72  nature of the clients' patterns as well as the cognitive, physical  experiences  that underline these interactions.  goal when involved in process forms  emotional and A  facilitation, is to perturb some  of behavior that expand alternatives  and are more  to the to the client than the ones previously expressed. techniques  therapist's  included in the process  are: directing, coaching, expressing  new  satisfying Therapist  facilitation transactional underlying feelings,  class  and  enactment.  3. Expressive Transactional Class. This class induces  activities  aimed at the exploration,  discovery,  naming and owning of experiences  that have not had  expression  within a client's  Expressive  frequently  include the use  such as the use  4.  own awareness. of mediums  transactions  other than verbal exchanges  of metaphor, artwork, or physical  movement.  Symbolic Externalization Transactional Class. A  clients'  symbolic representation  world is created and externalized  to it from a distance. opportunity for client specific client.  qualities  the  so that he/she can relate  Given form, externalized symbols provide an and therapist to directly encounter  of the relationship between the  and is placed on a chair.  his/her relationship to the bottle. chair and process  recall.  the  symbol and the  For example, a bottle can represent a client's  dependency  empty  of some problematic aspect of  alcohol  The client proceeds to express  Techniques include  two-chair,  73 5. Meaning Shift Transactional Class. As  client  self  or interpersonal interpretations  often  leave  little room for flexibility,.the focus of this transactional class is to expand the alternative ways clients make sense of their world. therapist can help clients  expand their alternatives  The  by aiding them  in developing a view of the problem that implies a solution or that facilitates  a compassionate  response  Meaning  shifts  moments  of irreversible progress.  reframing,  6.  to another or  are important in therapy since  him/herself.  they  often  These transactions  normalizing and circular  mark  can include  questioning.  Invitational Transactional Class. These transactions generally occur at the end of the session  and are centred on sharing a concern for client activities in the interim  period between  meetings..  sessions,  providing continuity  between  They are useful in building and maintaining the  momentum of the therapy, and result in the development  of a clear  and concrete invitation for aspects of client behavior to be before class  the next meeting.  enacted  Techniques included in this transactional  are journals, monitoring, homework and symptom prescription.  7. Ceremonial Transactional Class. These  transactions  include events or ceremonies  that  formally acknowledge  progress and change in clients.  celebrations  in a dramatic fashion the metaphors  symbols  condense  of the therapeutic system  punctuate experience  itself.  These  These and  transactions  and contribute to the sense of belonging in the  74  system  and thereby  contribute  of the therapeutic journey. transactions  to  the  internalization  and  ownership  Techniques included in ceremonial  are rituals, burials, cremations  or confessions.  Summary This model will serve as the  framework for the  organization  of the data obtained from the next task analytic step which is first empirical analysis performances.  of the actual therapist and couple  Results of that analysis  Section  the  resolution  are found in the next  section.  2  Step 5: First Empirical Analyses of Therapist and Couple Performances:  Measurement  of  Actual  Performances  The following results of the first empirical analysis linguistic  summaries  excerpts from the drawn.  of  the  findings,  transcripts to  accompanied  support the  T o maintain confidentiality,  by  are  verbatim  inferences  that  in the transcribed protocols  refers to the wife, H refers to the husband, T refers to the and (name) refers to a specific  were  person's  W  therapist,  name or the name of an  organization. The phases and mechanisms RI events were similar. presentation RI  events  of the two  are  discussed  successful  simultaneously.  RI events were found to progress  phases which roughly follow phase specific  successful  Therefore, to provide a clear and concise  of the findings, the results of the first two  Both successful  each  of change  through  the E x S T ' s phases of therapy.  process mechanisms  engaged in by the  During therapist  75 and couple,  which facilitated the change process,  were observed.  In this section, the phases of the change process are outlined and the mechanisms of the change process, are delineated.  observed within each phase,  Examples from both the first and second  successful  RI events will be provided.  First  Therapeutic  Phase/Marker  The first phase, the Formation was  of  the  Therapeutic  identified by therapist-couple collaboration.  System,  The introduction  of the marker in both successful RI events, occurred during this phase.  T h e marker was identified by distance oriented interactions  and statements,  made by the couple.  Event One. Text lines Therapeutic 20-23 is  1-119  System,  encompass the first phase, Formation  in the first successful event.  of  Text lines 12, 13,  are the markers that introduce the relational impasse  the task to be resolved.  the  which  The husband has brought the therapist a  "Couple Plan" that he and his wife have developed in previous treatment. effort.  The therapist demonstrates  her appreciation for  this  The wife sarcastically notes that he gave this plan to the  therapist without consulting her.  The husband responds by ignoring  his wife's statement and proceeds to talk to the therapist.  The  following is an excerpt from the transcript. Text: Lines  1-23  1  T.  So I noticed that you've brought some of your forms.  2  W . Right.  76  3  T . That's wonderful, so shall I take those?  4  H . Y a , that's ours in there ah, (handing envelope to therapist).  5  That's the report from  6  T . I had something from  7  H . O h , maybe you got it already, that's probably it then.  8  T . That looks like what I got.  9  H . O . K . so  10 1 1 12  T . I really appreciate having it, so thank you , I already have one but I really appreciate you bringing it in. It's important to me to read it. So is this your other stuff?  13 14  H . Y a this is a couple plan we went over before we left, I don't know if you want to see that or not?  15  T . I would be very interested to see it, if you don't mind me  16  seeing it.  17  W . Y o u ' v e got another copy of it?  18  H . N o that's the only one, we'll need it back, or make copies.  19 20  T . W e l l , maybe I could make a copy before you go (Name H ) , thank you.  2 1  W . It's really funny how you brought that without asking.  22 23  H.(Mumbling),and this is what I told you about,(talking to T ) the questions that we do every day or have been doing  24  mostly  (name). (name).  I've got the exact same thing.  I guess (name) must have forwarded you a copy.  every  day.  Event T w o . Text lines 1- 144 of the second successful RI event encompass  the Formation  therapist demonstrates  of  the  Therapeutic  her willingness  System  to address  Phase.  the issues  The that  77 are important to her clients. therapist.  The wife demonstrates openness to  In this phase, text lines 4 - 8 ;  44-45 are the markers  introducing the relational impasse which is the task to be The wife states she would like a symbolic representing stating  her and her husband.  he is  stunned  and discouragement.  The following  resolved.  wall put between  The husband responds  by this revelation  the  and mentions his  symbols  by frustration  is an excerpt from the  transcript: Text: Lines  1-19;  42-45  1 2  T . I'm not sure when we left off last week , where we had this, whether behind the chair or in front?  3  W . In front, ya.  (Pause) (Counselor places symbols, represent  themselves,  on the  that the couple brought in to  floor).  4  W.(Referring to the symbols,  laughing)  Put a wall between  5  the  6  T . Pardon.  7  W . I said I need to put a wall in between the two.  8  T . Y o u would like a wall in between the two.  9  W . No not really, well ya, I suppose I would, if I could.  10  T . Maybe we should put one then, that's what you would like  1 1  right  12  W . No it's o.k.  13  T . N o I think that's important, that ah, I know what you  14  want. Y o u could make one (gives wife a piece of paper), or  15  you could use a book.  two.  now.  78 16  W . I want something tall.  (Looks through a bookcase.  She  17  gets a book and puts it between the symbols). It's kind of  18  leaning.  19  T . (Talking to husband) So you can't even see your symbol.  4 2 4 3  T . (Speaking to H) continue?  44 4 5  H . For me, I'm actually quite surprised at this wall all of a sudden, that surprises the hell out of me.  I've pushed the rock over.  What do you need to tell me before we  •t-  Mechanisms of the Change Process The Therapist-Client Class  Relationship  descriptions  and couple engaged relationship.  successful  and examples  RI events.  of activities  creation of  of the  that both  therapist  therapeutic  are also considered the therapist and  Similar performances  were  The lists demonstrate  therapist and couple performances  development  observed in both  the collaborative nature  that influence  the  therapeutic relationship which facilitates  the  co-  change.  Therapist  Performance.  1. The therapist clarifies Event  The two following lists  in to form and maintain the  These activities  couple performance.  of the  Transactional  is the process mechanism by which the therapeutic  relationship is formed and maintained. provide  Enabling  client  statements.  One - Text: Lines 152-160  160  W . and this is just an example of where you didn't, you  161  decided your own and it involved me.  162  would have said yes, but you didn't ask me, all you had to do  163  was  ask.  A n d that's o.k., I  79  164 165  T . You're saying that it's o.k. but it seems as though that it's very much not o.k..  166 167  W . No, no, it's o.k. that he gave it to you, that's o.k., I don't have any problem with you having it. It's not o.k. that he  168 169  didn't ask me. It's not o.k. that you didn't ask, and it's fine that (Name C) has it.  Event  T w o - Text: Lines  31-36  3 1  W . It's not very nice.  32 33  T . It's not very nice of you? that?  34  W . U m , I think it's just um, it's just not  35 36  doesn't feel like I should be doing that. I should be striving to be closer rather than putting a wall up.  What's not very nice about  right (laughing), it  2. The therapist questions or "checks in" with each periodically,  regarding their perspective,  emotions,  (especially if they have not spoken in a while). examples express  Event  spouse experience  The following  exemplify how the therapist's inquiries allow the couple to themselves,  facilitating the  change  process.  One - Text: Lines 170-177; 304-309.  170  T . (Asking the husband) So what's going on for you right  171  now?  172  H . I just don't see the problem, for want of a better word, I  173  don't see  174 175  I didn't tell you before hand, I can see that. But I may as well do nothing, that's what I feel like right now, is why  what the, like o.k. I understand you're hurt  because  80 176 17 7  bother with it then. T o me it seems like you don't even the intent, why I bothered or anything.  3 04  T . (Speaking to husband) I really appreciate this and I want  3 05  to know how you are experiencing yourself right now,  3 06  this  3 07 308  H . M m m . W e l l , honestly, o.k. I'm relieved, I honestly don't see the reasoning for going through the dance to get to this  3 09  result, like, follow  Event  T w o - Text: Lines 231-234; 292-295  23 1  T . What's it like inside for you right now, (Name H)?  23 2 23 3 23 4  H . W e l l it's really frustrating, it's really ah, really angry I guess. It feels almost like it's stupid, ah, I don't really understand what is happening.  292  T . O h , it went away, I see.  29 3  W . The same, just letting go of the problem, focusing on the  2 94  positive.  295  better.  Event  in  after  conversation?  me?  What about for you (NameW)?  A n d um, I'm just, that he moved,  it just feels  The ache isn't there anymore.  3. T h e therapist acknowledges makes  see  the hard work and efforts  the  couple  therapy.  One - Text:  Lines 53-57  5 3 54 5 5  T . I'm really impressed with how hard you have been working. A n d I read in the (name) report of how committed you were to your recovery and I'm really impressed. I  5 6 57  haven't met anyone who has been doing that, wonderful.  I think this is  81  Event T w o - Text: Lines  37-41  37  T . I've been hearing about your striving, and see the striving.  38 39  I see the commitment and at the same time I know that boundaries are very important and I know some of the steps  4 0 4 1  you are taking too keep talking and tell each other about your fears. Last time when you were here . . .  4.  T h e therapist uses accurate empathy.  Event  One - Text: Lines 212-215  212 213  T . Maybe part of you feels a little bit angry that such a big deal is being made out of this, when you just wanted to come  214  in and help.  215  H . Y a right, I am.  Event  T w o - Text:Lines 296-308  296  T . So what is there instead?  297 29 8 299  W . K i n d of a patience I think. First of all I was going to say excitement, and there probably is some maybe there is some excitement but it's not real deep but there is some. I just  3 00  kind of have this feeling that we can get over this hurdle and  301  if something would change for the good, we'd get  302  moving.  3 03 3 04 3 05  T . Y o u feel more relaxed and more hopeful and a little tiny bit excited, and thinking "well, we just got to get over this hurdle and things will seem better". A n d looking down at  3 06 3 07  your symbols here, do you have that wall up between and (NameH) right now?  308  W . Not as big.  you  82 Couple  Performance.  1. The couple asserts their wants or needs to the Event  therapist.  One - Text: Lines 247-253  247  W . A n d he is saying, "well why make such a big deal?"  But  24 8 249 25 0 251 25 2 253  for me right now, it is a big deal, everywhere in my life, to stand up for what I want, like just to give people permission to have my things. A n d I can sit back (NameH) and be the nice person and go "oh, sure fine", like everybody can have everything of mine but why should I anymore, that's what I have done all my life.  Event T w o - Text: Line 4-6 4  W . (Referring to the symbols, laughing). Put a wall between  5  the  6  T . Pardon.  7  W . I said I need to put a wall in between the  two.  2. The couple interacts  authentically  (openly  two.(symbols).  and honestly)  with  the  therapist.  Event One - Text: Lines 307-309 3 07  H . Mmm.  W e l l , honestly, o.k. I'm relieved, I honestly  don't  3 08  see the reasoning for going through the dance to get to this  3 09  result, like, follow  Event  me?  T w o - Text: Lines 353-363  353  T . (Speaking to the husband) D o you know what (NameW) is  3 54  talking about  (NameH)?  83 3 55  H . Y a , I can understand her feeling that way, but then, like  356  right now, I just get confused too because what I'm thinking  3 57 358  about is, when I talked to her before and I didn't tell her I was frustrated or why or what not, she picked up that I was  3 59 3 60  but I wasn't verbalizing it so that scared her. N o w when things do bother me I let her know it, I let everybody know  3 61 3 62 3 63  about it, and I tell (NameW) how I feel, what I say and what I do. She's afraid, it's just like the same old thing except before I wasn't doing something, and now I'm doing them.  3. The couple demonstrates address  the  treatment readiness  (a willingness  to  impasse).  Event One - Text: Lines 115-118 115 116 117  H . (Interrupting) W e l l , it's not only that, it's not only that she's not going to say no, I wasn't just going to hand it to you anyways, Ilet you know about it before hand, well it's just, I  118  hear you though.  Event T w o - Text: Lines 48-50 4 8  T . A n d I wonder if we might spend some time just focusing  49  on it, would you like to do that ?  50  H . Y a sure, fine with me.  4. One or both members of the couple spontaneously reveal growth, changes, Event 6 6 6 6  0 1 2 3  64 6 5 6 6  emotions,  or revelations to the therapist.  One - Text: Lines 64-73 W . A n d another change for me, is the other night when he was just really upset, and I could understand why he was upset, but what it does to me, was I got upset. A n d it was like midnight and I didn't go to sleep till about two o'clock. A n d what I wanted to do was just say, "get out of here", and I didn't, I didn't say it. I just let it be. But that's what I would have done in the past, I would have just asked him to  84 67 6 8 69  Event  leave, I didn't do that this time. It's upsetting, you know, and I don't think that you should go to bed upset, I think that it's just not, it doesn't work if we do it that way.  T w o - Text: Lines 314-321  3 14  W . Maybe it's just that I'm testing him.  315  T . You're testing him? I  3 16 3 17 3 18 319 3 20 3 21  Second  W . I think so, I want him to jump over it. I was talking to a friend last week and um, telling her what was going on for me, I just didn't want him to be on top of me, I didn't want him taking over. She thought that that was, she kind of understood. I think why I'm so upset right now is because I'm not sure why this is going on for me.  Therapeutic  Phase  The progression through each phase is identified in the transcripts  and videotapes  by statements made by the therapist.  The beginning of the second phase, Perturbing Sequences,  Patterns  and  is marked by references made by the therapist,  regarding the relational patterns emerging in the process of addressing the impasse or is marked by the therapist's attempt to perturb relational patterns. in the first event. second Event 120 121  Text lines  Text lines 145-150  120-122 mark  this transition  mark this transition in the  event. One - Text: Lines 120-122 T . This seems to be something that is a pattern in your relationship, he doesn't mean to discount you but you feel  85 122  Event  discounted.  T w o - Text: Lines 145-150  14 5 14 6 147 14 8 149  T . I would like to invite you (NameH), and (NameW) to do something here. I would like to, what we do here is kind of create psychological space. What I would like to do is to invite you to build these walls around you so that, we can understand what it is like for you. I'm just going to go,  15 0  would you be willing to do this?  Mechanisms of the Change Process The key process Process  Facilitation  mechanism characterizing this phase  Transactional  relational patterns  The therapist  that underlie the content  perturbs relational patterns and deeply  Class.  experience  by encouraging  their underlying reactions,  hopes and expectations to the present situation.  Specific novelty  of intensification  components  are observed in both successful  of intensification  for change  which are upheld employed.  and tenets of relational  process.  RI events are not  that  considered  to occur.  The following is the list of the tenets of relational novelty and components  of intensification  are  Those  and tenets of relational novelty  were not observed in both successful necessary  fears,  RI events and therefore  considered important factors in the change components  disclose  This is brought  which are  of intensification  to  or  emotions,  about through certain tenets of relational novelty and certain components  the  identifies  of the impasse both clients  is  that were identified in both  86 successful the  RI events. The examples  transactional process  occurring between therapist  facilitating the co-creation of Relational Tenet 1: Event  that are provided  demonstrate and  couple,  change.  Novelty.  Therapist and couple collaboration.  One - Text:Lines 298-300  29 8 29 9  A n d I'm wondering that i f together you would be willing to give me that paper, if you are ready. .  3 00  W . Certainly,  Event T w o - Text: Lines 48-50 4 8  T . A n d I wonder if we might spend some time just focusing  4 9  on it, would you like to do that ?  5 0  H . Y a sure, fine with me.  Tenet 3: Important experiences, awareness  emerge  in  previously out of client  conscious  therapy.  Tenet 5: Clients identify something new about self, their spouse or the  presenting  problem.  Examples demonstrating  Event  216  the  last two  tenets are:  One - Text: Lines 216-219  T.  Is it true that sometimes when you feel angry you say,  87 217  "oh well why bother, what I'm really trying to do is just help  218  and I don't feel appreciated and I think I want to give up".  219  H . Y a , Y a , quite often.  Event T w o - Text: Lines 78-85  7 8  T . Y o u seem far away, right now.  7 8 8 8 8 8  H . I'm just thinking about, I hit a lot of walls I guess. I just tend to, not ignore a lot of them but ah, not acknowledge that they are there, or acknowledge that they are there, but not let them really bother me, I guess that's another way to do it, just carry on, and it's getting harder and harder to do that now. Not just with (NameW) but with a lot of other  9 0 1 2 3 4  85  things.  Intensification.  Component 1: Providing a detailed definition of the specifics of the client's dilemma.  Event  One -  Text:Lines 120-126  120  T . This seems to be something that is a pattern in your  121 122  relationship, he doesn't mean to discount you but you feel discounted.  123  W.  124  doesn't ask.  125  knows that I'm going to say no, so he doesn't ask either, so  126  it's both ways.  No, no 'cause he knows that I'm going to say yes, so he O n the other hand, there are times that he  88 Event  T w o - Text: Lines 95-102  9 5 9 6  T . So you are feeling, these walls have been put there and you feel stunned and confused and you feel " well I have to  9 7 9 8  accept them, this is the way it is right now". feel kind of all alone.  9 9 100 101 102  H . Y a and I am losing my drive, I really am losing my drive, I know that. A s far as, it's not even like they are different walls, that would be o.k., handle it differently, but it seems like I keep hitting the same ones, over time and time again.  It makes you  Component 3: Maintaining a present tense focus.  Event  One - Text:Line  170-177  170 171  T . (Asking the husband) So what's going on for you right now?  172 173 174 175 176 17 7  H . I just don't see the problem, for want of a better word, I don't see what the, like o.k. I understand you're hurt because I didn't tell you before hand, I can see that. But I may as well do nothing, that's what I feel like right now, is why bother with it then. T o me it seems like you don't even see the intent, why I bothered or anything.  Event  T w o - Text: Lines 114-124  114  T . (Speaking to the husband).So I'm wondering about  115  going on for you right now, it seems like there are a lot of  what's  116  walls, I don't know how many there are,  117  amongst all those walls,  118 119 120  H . Basically in the middle, in the middle with a lot of walls around, basically just feeling whatever I have to do to find my way around them. I just keep running into them, that's  121 122  all, like once I think I've gotten around it, there's another one, the same thing right there, I try and find another way  and where you are  I don't know that.  89 12 3 124  around it, or over it or whatever, so I just keep going, going, very tiring, very tiring.  Component 4: E m p l o y i n g varying degrees of empathy ranging from paraphrasing to advanced empathy context  dependent  Event One  to access underlying feeling  on a  basis.  Text: Lines 195-206  195  H.  196  right  197  T . W h y bother with what (NameH).  19 8 199  H . A h , by bringing anything along, or doing anything that is going to try and help, like it just causes another problem it  200  seems to me.  201  T.  202  H . Y a basically, ya and if something like this causes such a  20 3 204 205 206  big thing and to me this is a big thing, like such a misunderstanding, like what do I do, I do nothing. I should do nothing and then there is not going to be such a big misunderstanding.  Event T w o  It's just, it's just, like my automatic reaction is why bother now.  Y o u just feel hopeless right now.  Text: Lines 62-77  6 2  T . When you look at it, what do you see?  6 3  H . Nothing just a blank, nothing I can't see beyond it , it's just  64  a wall.  6 5  T . It's just a blank.  6 6  H . Y a , there's nothing beyond it now, everything stops right  67  there.  90 6 8  T . Everything stopped.  How does that feel?  69  H . W e l l it's discouraging, frustrating, what's the use.  7 0  T . Y o u are discouraged and frustrated.  7 1  H. Y a  7 2  T . A bit hopeless.  7 3  H . Hopeless,  74  T . Nothing beyond that wall?  7 5  H . N o , there is nothing, just like the end.  7 6  T . Y o u ' v e come up against a blank wall.  ya, that's good.  (Pause) 7 7  H . It surprises me.  Third  Therapeutic Phase/Resolution The transition into the third phase, Integrating  of  Change,  is noted when the therapist makes a statement  to the new relational patterns that are developing in the relationship.  referring  couple's  Text lines 259-262 in the first event and text lines  404-407 in the second event  Event  Experiences  mark this transition.  One - Text: Lines 259-262  25 9 2 60  T A n d you're kind of in the transition process right now, together you are developing some new patterns and  2 61 262  you are finding that sometimes there, (NameH) will go away.  even though you hang in  91  Event  T w o - Text: Lines 404-407  404  T . So now there is something  very different happening and  405  this time it is very likely that it will go on being good, and  406 407  it's hard at the moment to trust that that will happen. you get scared and up goes your wall.  Resolution occurs during this phase.  A s described by  Heatherington and Friedlander (1990) a distinct behavior occurs between the interactions  couple,  shift  from distant  to approach oriented interactions.  So  in  observable  oriented  This shift is  indicated  when one or both members of the couple indicate that they have a new  understanding of their spouse.  relief, calmness  In addition, expressions  and a sense of direction are observed.  307-313 in event one and text lines 428-446 in event demonstrate  that  resolution  has  taken  of  Text lines two  place.  Event One - Text: Lines 307-313  3 07  H . Mmm.  W e l l , honestly, o.k. I'm relieved, I honestly  308  see  3 09  result, like,  3 10  T . It's a long way to go a long way around.  311  H . Y a , that's all but like I understand (NameW)'s  312  now more anyway.  313  little  don't  the reasoning for going through the dance to get to this  things  follow  me?  viewpoint  I guess I just can't take what I consider  for granted.  92 Event  Two  - Text: Lines 428-446  428  T . It seems that you are very tuned into what's going on with  429 43 0 4 31  (NameW) and you understand that in her past, there were times when things were good and then she learnt not to trust that they would go on being good . . .  432  H. Ya.  43 3  T . because then it changed.  434  of.  435  H . U h uh, ya.  43 6 43 7 43 8 43 9 440  T . So I noticed that you are still nearer to the goals than a little while ago and (NameW) took down her wall and put it here. A n d I sort of put it there thinking "she may still need it again", who knows, sometimes people need walls. I don't know if I did the right thing? D i d you want it here? (asking  441  wife?).  44 2  W . Doesn't matter.  44 3  T . Let me ask you where you want it now?  444  W . Just there (wife removes the wall from between  Y o u know what she is thinking  the  symbols) 445  T . (Speaking to husband) Now you can see your symbol.  446  H. Ya.  Significant statements were made in event two, at the end of the second phase, that indicated resolution was in progress. lines  281-308  Text:  Lines  demonstrate  this  gradual  Text  process.  281-308  2 81  T . O . K . so if you are focusing on the goals then somehow you  28 2  don't see the paths, blocked paths and those walls.  93  283  H. Ya.  284  T . So you feel clearer?  285  H . Y a much clearer ya.  286  T . How's your body feeling now that you are clearer?  287  H.  288  T . What's that like, that better feeling, what's that like?  289  H . A h , more relaxed.  290  T . Y o u feel more relaxed, right now.  291  H . Y a , loose, not rigid, and even that went away.  292  T . O h , it went away, I see.  293 294  W . The same, just letting go of the problem, focusing on the positive. A n d um, I'm just, that he moved, it just feels 295 better. The ache isn't there anymore.  296  T . So what is there instead?  297 29 8 299  W . K i n d of a patience I think. First of all I was going to say excitement, and there probably is some maybe there is some excitement but it's not real deep but there is some. I just  3 00 301  kind of have this feeling that we can get over this hurdle and if something would change for the good, we'd get  302  moving.  3 03 3 04  T . Y o u feel more relaxed and more hopeful and a little tiny bit excited, and thinking "well, we just got to get over this  3 05  hurdleand things will seem better".  M u c h better, much better.  What about for you (NameW)?  A n d looking down at  3 06  your symbols here, do you have that wall up between  3 07  and (NameH) right now?  308  W . Not as big.  you  94 Mechanisms of the Change Process During  this phase  regarding their experience from  the  couple,  interactions,  reveal  Class  therapist questions  of the process.  each  resolution.  The  Shift  appears to be the crucial process mechanism at the couple  the task at hand, including the  identifies  the  reframes  their present  following  development  excerpts  of a new  from the  She  relational pattern or  relational pattern,  creating  has  couple's  underlying feelings and personal history to the impasse.  The  statements,  oriented  Meaning  The therapist summarizes the process  undergone to resolve  spouse  The resulting  understanding and approach  which constitute  Transactional this stage.  the  new  positively  meaning.  transcripts demonstrate  these  processes. Event  One - Text: Line 288-297; 326-330  28 8  T . A t times, I also see a lot of energy between you two, I  28 9  think this is a brand new relationship, in a way and I think  290  that one way you show your caring is by telling (NameH)  291  how you feel and hanging in there.  292  his caring is sometimes by continuing to walk away, out of  29 3  self-respect and the need to, just to make the situation  2 94  safe.  29 5  questionnaire  296  frustrated at the same time, is to wait almost twenty  297  for this session to start and we start off with a bang.  3 26  T . It seems very important and I really appreciate  3 27  privilege to be reading it so, I'm going to make a copy before  A n d one way he shows more  A n d other ways you show your caring is by doing this at night and another  way,  probably  3 28  you go and then I'll give it back.  3 29 3 30  plan) "When in doubt check out your partner's That's what you just did.  feeling  (Reading from the  minutes  the couple's  feelings".  96  disclosures of thoughts, feelings, and reactions to the impasse.  The  third step of the change process includes the development of new relational patterns or the positive reframing of relational patterns that already exist. The therapist's performance was marked by five behaviors: 1. Guidance.  The therapist guided the couple through the phases of  the process of change.  The therapist did not get caught up in the  content of the impasse but was able to identify the underlying relational patterns and feelings of the couple and articulated them clearly, which allowed the event to progress.  2. Empathy.  The therapist employed empathy to acknowledge and  validate the thoughts, feelings and experiences of both husband and wife.  3. Modelling.  By acknowledging and validating the thoughts,  feelings, experiences of both the husband and wife, the therapist modelled understanding and acceptance.  4. Probing.  The therapist probed the thoughts, feelings and  experiences of both the husband and wife.  5. Reframing. The therapist reframed the relational patterns of the couple, providing new meaning.  The couple's performance was marked by three behaviors:  97  1. Cooperation. change  The couple demonstrated a willingness  collaboratively with  2. Self-Reflection.  the  therapist.  The couple demonstrated a willingness  on, expand and probe their feelings, relational  thoughts,  to  experiences  focus  and  patterns.  3. Self-Disclosure. feeling,  to seek  The couple expressed  openly what they  were  thinking and experiencing.  Section 3 Step 6: Comparison of Actual and Possible Performances: Construct a Specific M o d e l In this section rational  model  therapist-couple  of  the results of the comparison between the  therapist-couple  performances  is  performances  presented.  and the  actual  Modifications and  revisions  to the rational model are made and are presented  category:  (a)  maintenance  first therapeutic phase,  of the therapeutic relationship, (b)  (c)  third therapeutic phase. is presented in Figure 6.  the second  therapeutic phase,  (d)  The amended model of the change  by the the process  Figure 6.  A detailed model of the change process  specific  Experiential Systemic Couple Therapy, for a RI event.  98a  oo oo  pq  O  z<  <  X u p..  O  oo W U  H U  J  <c  o  cu  BC  oo  2  § <  Oh  < oo Z  0 w 0w  <  XX &, Z  pa O  o  O H  D  H D  O oo  w PH  H H Pu  oo O  PJ  w BC H  00  W >  O  w o  PL)  <  H H W < H  zw  o. J  H  <  a §S <Q Z  a  < a.  X w  oo  pq u a z  p  B3  w w  < zo u  < oo  z H z o HH  H  < <  PH 00 00  P3  00  O oo O < U  PH OO  BC 00  Z g  O H < i-J  H PH  O O H Z P W  o H  12  CU  o oo 5 Jm < z z ww< ~ HH  u  CL,  ^  I  H HH £2 6 U PH  BC H  Z  £2  2  "  99  Maintenance An was  of  the  Therapeutic Relationship  important component missing in the rational model that  observed in both successful  events was  therapeutic relationship throughout the  event.  delineated in the previous section and was  First  the maintenance This  component  the was  added to the model.  Therapeutic Phase There  were  three  important process  mechanisms  that  occurred in the first therapeutic phase in both successful events, that were not mentioned in the rational model. process  mechanisms  are mentioned  1. In both successful  therapist,  by  revealing  their immediate  listened  or by invitation of emotional  to the emotions  validated and acknowledged  The these last  without judgment  following two  excerpts  from  both the  couple the  reactions.  expressed,  providing empathy to both members of the couple.  experiences,  These  resolution events, both members of the  2. The therapist actively  empathy  resolution  below.  responded to the markers, spontaneously  wife's  of  This use of  husband and  the  or interpretation.  the  transcripts  demonstrate  mechanisms.  First Event - Text: Lines 96-104 9 6 9 7 9 8  W . O h , no it's fine, I don't mind you seeing it at all. But that, it's just another time that (Name H) has chosen to do something that involved me, he's controlled it.  100  9 9  T . Y o u felt excluded from the decision.  100  W . Y a , excluded and controlled, that I'm not capable of  101  making my own decisions  102  don't trust me to say, "ya it's o.k. (NameH), you can give that  103  to (Name C ) .  104  T . Wow, a lot went on for you.  and that I'm not trusted, that you  Event T w o - Text: Lines 62-76  6 2  T . When you look at it [the wall], what do you see?  6 3  H . Nothingjust a blank, nothing, I can't see beyond it, it's just  64  a wall.  6 5  T . It's just a blank.  6 6  H . Y a , there's nothing beyond it now, everything stops right  67  there.  6 8  T . Everything stopped.  69  H . W e l l it's discouraging, frustrating, what's the  70  T . Y o u are discouraged and frustrated.  7 1  H. Ya  7 2  T . A bit hopeless.  7 3  H . Hopeless,  7 4  T . Nothing beyond that wall?  7 5  H . N o , there is nothing,  7 6  T . Y o u ' v e come up against a blank wall.  How does that feel?  ya, that's good.  just like the end.  use.  101  3. A n important mechanism occurring before the process the second phase was husband.  moved into  an acknowledgment of the impasse by the  The husband, in both of the successful events, was  the  member of the couple who did not initiate the impasse.  It may be  necessary  before  process his  for both spouses to acknowledge  can progress.  The husband's  the impasse  statements below  the  demonstrate  acknowledgment.  First Event - Text:Lines 115-118 115 116  H . (Interrupting) W e l l , it's not only that, it's not only that she's not going to say no, I wasn't just going to hand it to you  117 118  anyways, let you know about it before hand, well it's just, I hear you though.  Event T w o - Text:Lines 79-85 7 9  H . I'm just thinking about, I hit a lot of walls I guess.  80  tend to, not ignore a lot of them but ah, not acknowledge that  8 1  they are there, or acknowledge  82  let them really bother me,  83  it, just carry on, and it's getting harder and harder to do that  84  now.  85  things.  The  I just  that they are there, but not  I guess that's another way to do  Not just with (NameW) but with a lot of other  Second Therapeutic Phase There  this phase,  are two  important process  found during  in both successful RI events.  1. Both the husband and wife disclose regarding  discoveries  the relational impasse.  their personal history  The disclosures  are acknowledged  and validated by the therapist via the use of empathy.  Examples  102  are  provided.  Event  One - Text:Lines 225-253  225 226 2 27 22 8 22 9 230 231  W . What's really strange, because I've been thinking about this questionnaire that we do every night, and one of the things (NameH) has requested of me if there is any, this is where it makes no sense to me, he said at (name),that i f there is a confrontation he doesn't want me to back down, he wants me to continue with the confrontation, because this is what I would always do before, I would just back down and  23 2  walk away and come back happy.  233  T . This is new.  234 23 5 23 6 23 7 238  W . So come back happy and it always confused him and yet, if we are having a confrontation about money or anything else that's what he does, he walks away, he walks off. A n d he doesn't come out loud and say out loud, "oh why bother", but by his actions that is what he is saying and he walks  239 240 241 24 2 24 3 244 24 5  away. A n d we have been working really hard together, to go through stuff and it's hard, really really hard and there are times that both of use just feel, "well, why bother, why do this?" A n d yet um, before I never would have said anything, it's not just with (Name H) but it's with everyone, if that's what you want you can have it, and I wouldn't have stood up for myself.  24 6  T . A n d now you are standing up for yourself.  247  W . A n d he is saying, "well why make such a big deal?"  24 8  for me right now, it is a big deal, everywhere in my life, to  249  stand up for what I want, like just to give people permission  25 0  to have my things.  But  A n d I can sit back (NameH) and be the  2 51  nice person and go "oh, sure fine", like everybody can have  25 2  everything of mine but why should I anymore, that's what I  25 3  have done all my life.  Event  T w o - Text: Lines 103-113  103 103  T . What are these walls?  104  H . Lack of people listening, that's a big one.  105  T . W h o , who is not listening?  106  H . Friends, family, not  107  family, her family.  108  T . Y o u don't feel heard by your family, by (Name W)'s family.  109  H . W e l l , not so much (NameW)'s family, my family.  110  T . W h o in your family is not listening?  111 112  H . W h o ' s not listening? W e l l , my brother in-law, sister, are running scared too, because of their addictions.  2. T h e potential obstacle successful  resolution  In each successful  my immediate family, friends, my  of defensiveness was  overcome  events through the therapist's  use  they  in both of  RI event, one or both members of the  empathy.  couple  became  defensive during the second phase.  Not until the  clearly  and accurately  underlying reaction,  empathized  with the  therapist  emotion, or fear, of the defensive person, was the client able to progress.  Text lines  event.  Note  identifies reflects  172-219 demonstrate  this process  in the  that the husband remains defensive until the  the husband's  underlying emotion  of anger  and  first  therapist accurately  the crucial point, that his underlying intent, in giving the  "Couple Plan" to the therapist, was to help. Text:  Lines  172-219  172  H . I just don't see the problem, for want of a better word, I  173  don't see  174 175  I didn't tell you before hand, I can see that. But I may as well do nothing, that's what I feel like right now, is why  what the, like o.k. I understand you're hurt because  104  176  bother with it then.  177  the intent,  178  W.  179  H . Because there wasn't time, you weren't  18 0  put the stuff together . . .  18 1  W . (interrupting)  182  today.  183  H . W e l l , I didn't think about it, I had it in there, that's all.  184  T . So is this typical of what goes on between you two?  18 5  H . Y a , I think so.  18 6 18 7  T . So this is a familiar pattern and you are saying that you would like to change the pattern.  188  W. Mmm.  18 9 190  T . A n d you are saying, you would like to change the pattern and you would like to be consulted, when there is a decision  191 19 2  to be made that involves the two of you. A n d you're saying well, I feel confused because, "I knew you would agree and  193  I'm sorry", well I don't know if you said you were sorry," but  194  I forgot to consult you".  195  H:  196  right  197  T . W h y bother with what (NameH).  19 8 199  H . A h , by bringing anything along, or doing anything that is going to try and help, like it just causes another problem it  200  seems to me.  201  T.  202 20 3 204  H . Y a basically, ya and if something like this causes such a big thing and to me this is a big thing, like such a misunderstanding, like what do I do, I do nothing. I should  why  T o me it seems like you don't even  see  I bothered or anything.  I just don't know why you didn't ask. there and when I  It took us an hour and a half to drive here  It's just, it's just, like my automatic reaction is why bother now.  Y o u just feel hopeless right now.  105  205 206  do nothing and then there is not going to be such a big misunderstanding.  207  W . O n the other hand, I feel that is hopeless too because we  20 8  talked so much about it at (name).  209  H . That's why I brought it.  210  W . and it's the same stuff.  211  H . Ya.  212 213  T . Maybe part of you feels a little bit angry that such a big deal is being made out of this, when you just wanted to come  214  in and help.  215  H . Y a right,  216 217 218  T . Is it true that sometimes when you feel angry you say, "oh well why bother, what I'm really trying to do is just help and I don't feel appreciated and I think I want to give up".  219  H . Y a , Y a , quite often.  I am.  Summary K e y mechanisms  of change not included in the rational model  were discovered in both of the actual therapist and couple performances. Mechanisms  discovered  in the  couple  performance  are:  1. Disclosure of immediate emotional reaction to the marker.  2.  Acknowledgment of the relational  impasse.  3. Disclosure of personal history regarding the  impasse.  106  Mechanisms  discovered in the  therapist performance are:  1. The use of empathy to acknowledge and validate the disclosed  emotional reactions  couple's  and history.  2. The use of empathy to diffuse  defensiveness.  Section 4 Step 7: Validation: First Empirical Analysis of the Unsuccessful RI Event  In this section the unsuccessful RI event was rigorously compared to the newly constructed model of the change process discover i f the  specified  between resolvers patterns  event. may  and non-resolvers.  and sequences  successful  components  in the  to  and mechanisms discriminate This was  done by identifying  therapist-couple performances  in  the  RI events that were not observed in the unsuccessful RI  A n investigation was also conducted into the factors that  have inhibited these change  patterns  and sequences  from  occurring.  Phases of the Change Event First  Therapeutic  Phase/Marker  The marker is observed in this event when the couple are in disagreement this  over the family finances.  disagreement.  Text: Lines  1-32  Text lines  1-32  demonstrate  107  1  T . W o u l d you like to work with this image, the juggler, is  2  there a point in that, if not, what other ideas would you  3  have.  4  W . W e l l , I know (Name H)'s  5  few years, particularly in the finances.  6 7 8 9 10 1 1 12 13 14 15 16  know about them, then he can spend as much as he wants on whatever he wants and I have no say and that's what I see as juggling. I see lack of responsibility. I mean, most people have budgets, we don't have anything near a budget. It's like, if her gives me grocery money, I'm lucky. A n d if the hydro bill gets paid, we're lucky. Y a , that's juggling, sure juggling to keep from being evicted. I don't consider that juggling very constructive and that's why, and that's one of the areas that I have been particularly angry with through the last few years. It's because when we were first married I was involved in the finances, and even though he had total  17  control that was fine, I knew what was happening , we had  18  fixed goals and I didn't buy clothes and things . . .  19 20  H . (Places coffee mug down on table loudly) mean you didn't buy clothes?  2 1  W . I didn't, I didn't even go to a second hand store in the  22  first five  2 3  H . (Talking at the same time as the wife)  24  W.  25  we don't own a house.  been juggling things now for a A s long as I don't  What do you  years.  Y a sure I do now, I buy a lot more clothes now because The only thing that I own is my 26  persona, that I project, that is the only thing that I own in 27  this  world.  2 8  H . She's never been happy with anything.  29  she doesn't like the house I get.  30  house, she doesn't like that house.  3 1  doesn't like it because quote, unquote, it doesn't live up to  32  the Jones'.  I get a house and  W e move to Ontario, I get a Everything I get,  she  A n d she is a very pressuring women.  The therapist in this event does address the marker, and  108 acknowledges Text: Lines  that finances  are a contentious issue for the couple.  36-45  36  T . C a n I step in?  37  W . Yes, please.  3 8  H . (Coughs) I'm, catching a cold.  39  T.  4 0 4 1  from the cold. O . K . there's a kind of, an understatement to say there is something here, that you guys are talking about,  4 2 4 3 44  that is very contentious, really contentious and perhaps, I know, how do you feel about it, do you think, that you have been successful at working through this contentious kind of  4 5  thing  Second  Y a , I can see that, however, you won't die fortunately,  before?  Therapeutic Phase The  therapist attempts  to refer to the relational patterns that  are emerging in this event as in the successful RI events, however, his statements are vague and ambiguous.  The husband's reaction is  to help the  therapist with the interpretation.  Text: Lines  53-94  5 3  T.  5 5 5 5 5  saying, there is something that is leaving you feeling not happy, uncomfortable with the way that you two guys have so far worked out say finances and some of these things and you're unhappy. He's also unhappy too and and how can I say this the argument that you guys are having in here right  4 5 6 7 8  59  . . . There is something there to what you are  now.  (Speaking to husband) stop grinning at me !  (Both T . and H . talking at once) 60  H . You're trying to find the words,  6 1  T . You're saying, "This guy is trying to figure this one out  6 2  here."  109  6 3  H . I know what you are trying to get across.  64  T . (Speaking to husband) what am I trying to say?  6 5  I trying to get across?  66  H . She sees one way I see the other way, and the thing is  6 6 6 7 7 7  7 8 9 0 1 2  there is something in between this all. Y o u are trying to picture all that in between us. " A n d while he is right (referring to himself). You're right (referring to wife), you both a little balance here and you have worked it out over the years but still (Name H.) steps down on this and she says the reason why (Name H.) steps down is because he  7 7 7 7  3 4 5 6  doesn't let me get involved in the finances and all that stuff and so he would rather just back out." I'm not saying that I'm stuck with words like you are but I know what you're trying to get through  7 7 7 8 8 8  7 8 9 0 1 2  T . Y a . O . K . and in addition to that I'm trying to say "well, look you guys both feel stuck in this, right? and you feel like the only response ultimately for you is to step down" and I'm saying that's not good, there's a different way and I think there is growth to come out of this for the both of you. I think there is a different way. There is a different way,  What am  8 3 84  there's a way in which you could say, "oh, wow, the way my husband is handling this right now, makes me feel just fine,  85  and we've worked through this to a great degree".  86  there is a spot that you can get at where you can say that.  87 8 8 89  A n d you'll also say, "ya, and he's not stepping down, we haven't solved this in such a way that he ends up stepping down or that I end up just closing off my mouth and not  90  saying anything."  9 1  would you guys like to work on that?  92  H . I've been secretly doing things in the past, just in the past  9 3 94  couple of weeks. I mention to you a little while ago that I'm going to try some different things.  The  therapist's  I know  There's a different way is all I'm saying,  attempt  at identifying the  relational patterns  between the couple does not move the process forward. seems to produce some confusion and frustration.  It only  Moreover,  the  110  therapeutic mandate is not clearly co-created or pursued. therapist  continually returns the  therapeutic process  to  The the  marker  phase by repeatedly asking the couple if finances is an issue would like to "work on".  they  The therapist does not examine the issue,  in any depth, even when the couple has explicitly stated that finances is a problematic issue. event to a close, phase.  Finally, the therapist draws the  the therapeutic process remaining in the marker  Examples of the therapist returning the therapeutic process  to the marker phase Text: Lines  150-  follow:  172  15 0  T . W e are still looking for something to work on today.  151  H . Money is always a problem.  15 2  T . A n d sometimes it seems discouraging, you say "well you  153 154 15 6 15 7  know, we've made some progress but you know, but this one we'll never get through never. Never will we ever be able to get through this one." Y o u must feel so discouraged sometimes when we go to the next step.  15 8  W . Y a , money is pretty contentious.  15 9  T . Could this be one of those situations where  160  looking back and saying "ya there is some kindness there  161 162 16 3 164 16 5  and it wasn't there before and we are able to do a few things now that we weren't able to do before, it is still tentative you know um, um, but now we are facing the next step, and we are facing it and how are we going to get through this one". A m I right? Is there that kind of feeling?  166 167 168  H . I don't know, but you said about having your set goal or whatever, and I told you last week since I've got something to work on for the next couple of weeks, and I'm seeing it  169  myself,  170  T. O.K.  you guys are  111  171  H . forget  172  T. Ya.  Text:  Lines  everybody  else.  209-214  209  T . Whatever we do, if we do get to work on something  210  today, whatever,  211 212 213  say "ah wonderful", nor should we even go to far too fast. W e ' v e got to really work on something. I'm still coming back to this. Is there something, perhaps this, that we can work  214  on  Text: 411 412 413 414 415  Text:  here  we do, if there is any success then we  can't  today?  Lines 411-415 T . (Interrupting) I'm going to jump in here for a minute. Do you notice what's going on between you two, well you have to notice, you guys are having a disagreement, squabble, spat, fight, o.k.. That's alright, I know you have concerns about that. Would you like me to help you with this ?  Lines  422-429  4 22  T . (Referring to husband) W o u l d you like me to help you  423  work on this so that it could be more satisfying.  4 24 425  know what you are saying now is "it's o.k. you can survive it, you are a survivor, you will survive" But you know that  426 4 27 42 8 4 29  there is a better way, so would you like me to , would you like to take some risks with me, walk out on some thin ice, all three of us together, do you think there might be a way to dance on this thin ice.  ' Cause I  Mechanisms of the Change Process Similar the couple  sequences and patterns  of interaction identified  and therapist performances in the two  successful  RI  in  112  events are strikingly lacking in the unsuccessful following topics:  (a) development  and maintenance  therapeutic relationship, (b) the therapist's components  of intensification,  Development  use  of  The  the  of empathy,  (c)  and tenets of relational novelty,  be examined in the unsuccessful The  RI event.  resolution event.  and Maintenance of the Therapeutic Relationship  The therapeutic relationship does not appear to have developed nor maintained in this event: therapist-couple  will  collaboration,  (b)  been  (a) there is limited  interactions  between  therapist  and couple are disconnected, (c) there is no common goal. The therapist does not employ empathy, or clarification. makes little effort to facilitate the couple's other.  understanding of  each  The therapist does not probe either the husband or wife  regarding  their perspective,  interrupts the  clients  emotions  when they  or experience.  disregards could be  important feeling  statements  H e uses sarcasm,  and makes  comments  that  considered insulting.  In this  event the husband makes  non-cooperation, unwillingness Examples  T h e therapist  are trying to express their  viewpoint, in an attempt to maintain his agenda.  revealing his  to pursue change  statements referring to  lack of treatment  readiness  collaboratively with his  of both therapist and couple performances  to the lack of a therapeutic relationship follow. Therapist  Performance.  1. The therapist uses sarcasm. Text: Lines 38-40 3 8  He  H . (Coughs) I'm, catching a cold.  his  and  wife.  that contribute  113  39  T.  40  from the cold.  2.  Y a , I can see that, however, you won't die fortunately,  T h e therapist interrupts clients.  Text: Lines 46-59;  357-364  4 6  H.  4 7  though.  W e get by because I step down, but it's always there  4 8 4 9  T . O . K . you step down, as the underdog steps down. O . K . hold it for a minute, (facing wife) that doesn't make you feel  50  good right.  5 1  W.  W e l l that may be his perception of the situation but . . .  52  T.  (Interrupting her) Hang on for a second because you are  5 5 5 5 5  3 4 5 6 7  not hearing what I'm saying. There is something there to what you are saying, there is something that is leaving you feeling not happy, uncomfortable with the way that you two guys have so far worked out say finances and some of these things and you're unhappy. He's also unhappy too and and  58  how can I say this the argument that you guys are having in  59  here right now . . .  3 57 35 8  T . Y a o.k. and yet in this point in time, today they find themselves in a malign bind, that they really don't deserve, I  3 59  mean really, he doesn't deserve to be in this bind, you don't  3 60  deserve to be in this bind,  3 61  W . W e l l , I think what happened was we were both involved  3 62  in the finances . . .  3 63  T . (Interrupting)  3 64  D o you have a sense of . . .  but you are in the bind.  What was your reaction to my  (Both T and W talking at once)  statement?  114  3. The therapist makes Text:  Lines  comments  that could be considered  insulting.  127-143  127  W . It's not as if I haven't tried to do things that  12 8  T . (Interrupting, facing wife, moving closer)  12 9  have tried, (Name W ) you are a wonderful woman, you are a  13 0 13 1 13 2 133 13 4 13 5 136 13 7 13 8 139  wonderful woman and you have tried, you have struggled to do you very very best. I know that and I bet ah, you know, in his sanest moments, in his most calm and secure moment, he's going to say exactly what I've just said. I don't see evil in your heart or mal intent inside you, ya sometimes you set out to thump people (punching hand in fist). I mean your human right, but you are not a witch, you're just a human being, doing your very, very best. (Looking to husband) A m I telling a tale here, in your sanest, calmest, secure moments, you're going to say, "ya she's really doing her best".  140  H . Y a she's human.  141 142  T . A n d human too. A n d you guys are taking second best with this, you're putting up with it and that's o.k., in a way  143  that's good.  4.  T h e therapist misses key feelings  husband  and  Text:Lines  . . .  (Name W ) , you  and interactions  between  wife.  394-421  3 94 395 3 96 3 97 398 3 99  W . I shouldn't pay for it when he drank last month and spent the money. He should give me the grocery money for the month, and then if he has to go work in the fields to pay for the bills that he owes because he went drinking last month, then he should do that because that's his responsibility. He doesn't want me involved in the finances,  400  he doesn't want me to work, he doesn't want me to do a lot  401 402  of things, then at least he should do his part of the bargain which is providing a place to live and what to eat. I'm not  403  asking for new clothes all the time, I'm not asking for new  115  404  clothes for my kids, or runners or fancy anything, or brand  405  new  406 407 40 8 409  any new furniture,that's fine I'm not asking for those things, I'm simply asking for grocery money. A n d I don't understand why I'm being blamed when I'm simply asking for grocery money.  410  H . I didn't blame you.  411  T . (Interrupting) I'm going to jump in here for a minute.  412 413  you notice what's going on between you two, well you have to notice, you guys are having a disagreement, squabble,  414 415  spat, fight, o.k.. That's alright, I know you have concerns about that. W o u l d you like me to help you with this ?  416  W. M M M  417  T . I mean you would (pointing to wife)  418 419 4 20 421  H . I have my mind made up what I'm doing, it doesn't matter what, if she doesn't like what I'm doing, that's too bad, there's the door. 'Cause I'm doing what I have to do and that's right and if she doesn't like it that's too bad.  5.  cars or anything, new furniture, which we haven't  T h e therapist  Text:Lines  disregards key  got  Do  emotions.  448-459  44 8 449  T . O.k. so then what I'm saying, this is what I'm saying (Name H ) , would you like, I'm giving you an invitation, in fact I'm  45 0 451 45 2  telling you this is the way that it is possible to do it. And I don't want to help you guys make any changes whatsoever, that leave one of you feeling that you were forced into  45 3  making any kind of a change, even if it was a tiny one.  454 45 5  now she has to get involved in a particular kind of way and that's the only way that she can . . .  45 6  H . (Interrupting)  45 7  T . O.k., ya fine but if that's the only way to work it out to  45 8  make her happy, it won't ultimately lead to happiness  It's  her  Right  security.  for the  116  459  two of you.  C o u p l e Performance. The  husband, repeatedly, makes  statements referring  unwillingness to pursue change collaboratively with his wife. each  example,  the therapist never addresses  oriented statements made by the husband. Text: Lines  to  his  In  these clear distance Examples follow.  92-102  92 9 3 94  H . I've been secretly doing things in the past, just in the past couple of weeks. I mention to you a little while ago that I'm going to try some different things.  9 5  T. Ya.  9 6 97  H . A n d I have been and a lot of stuff she's kept in the dark. But when we first met she was in the dark.  9 8  T. O.K.  99  H . A n d so I'm going back to square one when I built all my  100  wealth up, quote, unquote material things.  I'm getting into  101  that area and keeping her out, just deliberately, I don't want  102  her involved.  Text:  166  Lines  I'm doing what I have to do.  166-181  H . I don't know, but you said about having your set goal or  167  whatever, and I told you last week since I've got something  168  to work on for the next couple of weeks, and I'm seeing it  169  myself,  17 0  T. O.K.  171  H . forget everybody else.  172  T. Y a .  117  17 3 174  H . I see myself on something that seems to be heading in the right direction. A n d i f they happen to be there, they are  17 5  there.  17 6 177  change this pattern. Like I said, I went and got myself a job, and I did a bunch of things. She'd be happy if I hang onto a  178 179 18 0  job for twenty years, my thoughts are again, I could make my mistakes and go back to entrepreneuring again, so that's where you have to sit and  181  T . Juggle.  Text:  Lines  If they are not, they are not, I'm still not going to  199-204  199  H . I'm pretty strong with what I'm saying, I mean it,  200  given up on her disagreements,  201  doing.  202  T . One of your strengths,  203  H . Ya.  204  T . Great.  Text:  Lines  I've  now I'm doing just what I'm  one of your strengths.  418-429  418  H . I have my mind made up what I'm doing, it doesn't matter  419 4 20  what, if she doesn't like what I'm doing, that's too bad, there's the door. 'Cause I'm doing what I have to do and  421  that's right and if she doesn't like it that's too bad.  42 2 42 3  T . (Referring to husband) Would you like me to help you work on this so that it could be more satisfying. ' Cause I  424  know what you are saying now is "it's o.k. you can survive it,  425  you are a survivor, you will survive"  42 6  there is a better way, so would you like me to , would you  427  like to take some risks with me, walk out on some thin ice,  42 8  all three of us together, do you think there might be a way to  But you know that  118 429  Text:  dance on this thin ice.  Lines  477-491  47 7 47 8 47 9 480 481  H . So she's out in the dark a lot but I do what I have to do. If I need twenty dollars for gas to go to some place and she ask me where the money was, I'll just you know, if she doesn't smell alcohol on my breath, then she doesn't have a question. I've been to Victoria three times this week, she doesn't know  482  that.  483  T . She knows now.  4 84  H . But she didn't know that and where the money goes and  4 85  that I'm  48 6 4 87  W . I'm not asking where its going, I'm asking , give me my grocery money first and then do whatever you want. That's  48 8 489  always been my attitude, I've never been a demanding sort of "I'm in charge of the chequebook" kind of woman, I've  49 0  never have been and I don't feel that I need to be, so.  491  T . W e l l , let me draw this to a close.  . . .  The Therapist's use of Empathy Similar to the successful and wife  resolution events, both the husband  reveal their immediate emotional reactions to the  (ie. their disagreements over finances). personal history regarding the impasse.  marker  They also provide their The wife  expresses her  frustration and anger over not being able to afford basic necessities such as groceries because her husband has spent the money on alcohol.  The husband mentions that he feels his wife will never be  happy with what he provides. events, however,  Unlike the successful resolution  the therapist does not empathize with their  119  underlying feelings or reactions.  The husband and wife  get  caught  up again and again in the content of their financial problems as their underlying  feelings  and experiences  are not acknowledged  validated.  Moreover, it has been observed from the two  or successful  RI events that accurate empathy is key in diffusing defensiveness in clients.  In the unsuccessful  diffused  as empathy is not used.  Intensification  /  never  Relational Novelty  N o components novelty  RI event, defensiveness is  of intensification nor tenets of relational  were observed to have been utilized or upheld in a manner  that facilitated the progression of the change  process.  Summary A  comparison of the successful  unsuccessful  RI event reveals  several  and couple  performance factors  progress of the change event.  Therapist  performance  1. L i m i t e d  attempt  2.  therapist  Limited  RI events and the therapist performance  that may have inhibited the These factors are listed  below.  factors:  at forming a therapeutic relationship.  guidance  through the  therapeutic  process.  3. L a c k of the therapeutic use of empathy (a) to acknowledge validate the couple's  factors  thoughts,  feelings or experiences  or  (did not  120  model understanding or acceptance to the couple); (b) to  diffuse  defensiveness.  4.  Limited probing into the couple's thoughts, feelings, and  perspectives.  5. D i d not address non-collaboration.  Couple  performance factors:  1. Limited  collaboration with the therapist.  2. Unwillingness to pursue change collaboratively as a couple.  3. N o acknowledgement that the impasse is relevant.  4.  D i d not demonstrate  treatment readiness.  Section 5 The Second Empirical Analyses for all Three Events The Experiencing Scale and the Self-Disclosure Coding System were used to discover if the level of experiential activity and the amount and type of self-disclosures discriminate  between  successful  made by the couples could  and unsuccessful  change  events.  The Experiencing Scale T o be able to compare events of unequal length, and percentages  were computed from the raw scores.  averages  The results of  121  the Experiencing Scale will be presented in mode and peak scores.  The scores represent the level of experiencing, for the  husband and wife  separately, for each event.  the two successful event.  Inter-rater reliability was  3 presents  Event one and two are  RI events, event three is the unsuccessful RI  moment correlational coefficient Table  the  Table 3:  calculated using Pearson product-  resulting in a reliability of  Average scores of the level of modal and peak experiencing for the husband and wife in each event.  Event One:  Wife  Mode  Peak  Mode  2.3  3  3.5  3.1  2.7  1.7  1.3  Event Two:  Event  Three:  Reviewing  1.2  the results  levels of the two successful experiencing levels  two  .98.  results.  Husband  were  average  it appears that the peak  Peak 4  2.7  experiencing  RI events are greater than the peak  of the unsuccessful  computed to test the significance  RI event.  One-tailed T-tests  of the difference  between  means. The first T-test compared the peak experiencing  couple  scores in the first event with the peak experiencing couple scores in  122  the third event.  The peak experiencing couple scores were found to  be significantly larger for the first event, t ( l l ) The  second  T-test  = 1.73,  compared the peak experiencing  scores in the second event with the peak experiencing in the third event.  (p=.056). couple  couple  scores  The peak experiencing couple scores were found  to be significantly larger for the second event, t(14)  = 1.98,  (p=.033).  Summary The husband and wife's peak levels of experiencing found  to  events.  discriminate between successful  and unsuccessful  were change  Significantly higher levels of experiencing were found to  occur in the successful  RI events than the unsuccessful  The Self-Disclosure Coding  System  Inter-rater reliability was system  using  the  Pearson  RI event.  calculated for the coding of  product-moment  resulting in a reliability of .74.  correlational  this  coefficient  The average number of self-  disclosures, per five minute segment (SR/5 min.) of each event, both the husband and wife, percentages of positive  were calculated.  these  results.  For each event, the  (SR+%/Event), negative (SR-%/Event), and  neutral (SRo/Event) self-disclosures presents  for  were also calculated.  Table  4  123  Table 4: Results of the Self-Disclosure Coding System  Event T w o  Event One Husband  Wife  Husband  Event  Wife  Three  Husband  Wife  SR/5 m i n .  8  9  5  3.4  8  7.8  SR+%/Event  16%  23%  34%  35%  5%  5%  SR-%/Event  38%  37%  47%  41%  41%  61%  SRo/Event  46%  41%  20%  24%  54%  34%  Reviewing these results it appears that the couple in the third unsuccessful self-disclosures events.  R I event  disclosed proportionately fewer  positive  than the couple in the first and second successful RI  A Z-statistic was used to test the significance of the  difference  between  combined positive  two proportions. self-disclosure  The husband and  scores  wife's  for the third event  were  compared to those of the first event and to those of the second event  seperately.  disclosed  It was found that the couple in event  significantly fewer  positive  self-disclosures  three  than the  couple in event one, Z=2.639, p=.004; and than the couple in event two, Z=4.338, p=.000.  Summary The total amount of self-disclosures between  did not discriminate  successful and unsuccessful RI events.  frequency  However, the  of the type of disclosures did discriminate between  the  124  successful  and unsuccessful  unsuccessful disclosures.  RI events.  RI event disclosed  The couple in the  significantly  fewer  positive  self-  125  Chapter  5  DISCUSSION A N D CONCLUSION  Addressing the task analytic step number eight, Process  to  Outcome,  Relating  a summary and discussion of the results are  presented in three sections:  (a) a review of the key components  in  the change process within the E x S T framework for an RI event, (b) a discussion of the results from The Experiencing Scale and The Self Disclosure Coding System, and (c) a presentation of a general model of  successful  therapist  couple change for an RI event, including couple-  performance factors  change process. approaches. and  This model is  for  applicable across  the  therapeutic  Finally, implications of the results for clinical practice  Mechanisms of Change within the E x S T Framework  Responding specify  models,  to Gurman's  effective  ingredients  (1988) recommendation to of change  a detailed performance model of successful  and distance  Systemic  oriented interactions,  identify  within family therapy  the task of resolving the relational impasse  beliefs  A  and hindered  further research.  Key  for  facilitated  training will be discussed as well as limitations of the study and  areas  and  that  couple  change  created by disparate  using Experiential  Couple Therapy, has been provided in the results  section.  review of these results specific to Experiential Systemic Couple  Therapy  follows.  126  Phases of a Change Event / Transactional Classes The phases of the change process of the in-session RI event roughly followed the larger organization of the phases described in the E x S T theory.  of therapy  Three of the seven transactional  classes were found to be crucial mechanisms in facilitating change in therapy.  These three transactional classes which characterize the  interrelated nature of the therapist and couple performances in a successful  change event are as  follows:  1. Therapist-Client Relationship Enabling Transactional The  creation and maintenance  of the  Class.  therapeutic relationship  is the focus of this class. This transactional class occurs throughout the duration of therapy and ensures and safe.  Openness, honesty,  encouragement engaged  are examples  information sharing, spontaneity, of behaviors observed in  in this transactional class.  qualities  as  immediacy  empathy, when  that the client feels understood  respect,  clients  Therapists demonstrate  such  understanding, self-disclosure  involved in relationship enabling  and  and  transactions.  2. Process Facilitation Transactional Class. The therapist focuses on the relational patterns of the in this transactional class.  The therapist emphasizes  clients  the recursive  nature of the clients' patterns as well as the cognitive, emotional and physical  experiences  that underline these interactions.  A  therapist's  goal when involved in process facilitation, is to perturb some forms  of behavior that expand alternatives  and are more  to the client than the ones previously expressed.  new  satisfying  Therapist  127  techniques  included in the process  are: directing, coaching, expressing  facilitation transactional class underlying feelings,  and  enactment.  3. The Meaning Shift Transactional Class. As  client  self  or interpersonal interpretations  often  leave  little room for flexibility,.the focus of this transactional class is to expand the alternative ways clients make sense of their world. therapist can help clients  expand their alternatives  The  by aiding them  in developing a view of the problem that implies a solution or that facilitates  a compassionate  M e a n i n g shifts moments  response  another or  are important in therapy since  of irreversible progress.  reframing,  to  him/herself.  they often  These transactions  normalizing and circular  mark  can include  questioning.  In addition, there appears to be an appropriate sequence or progression of these classes in the process of change. However, the process may not flow  smoothly from one phase into another.  There  may be a return to a previous phase, or less emphasis placed on the process  of one phase than another.  sequence follows: (a) The Transactional  Class  therapeutic  experience  process; (b) The engaged Relational  Therapist-Client  the general  Relationship  Enabling  should be engaged in at the start of the  Process  and maintained Facilitation  in during the second Patterns,  Nevertheless  Sequences;  throughout  Transactional  therapeutic phase, Expanding  the Class  entire should be  Perturbing  Alternatives;  (c) the  Meaning Shift Transactional Class should be engaged in during  the  128  final phase of Integrating  Experiences  of  Change.  Components of Intensification / Tenets of Relational Novelty Three intensification components mechanisms in the change process. characterize the therapist's  were found to be  These components  performance are as  key  which  follows:  1. Providing a detailed definition of the specific of the clients' dilemma.  2. Maintaining a present tense focus client  during sequences of  intense  experiencing.  3. E m p l o y i n g varying degrees of empathy ranging from paraphrasing to advanced empathy to access underlying feeling context  dependent  on a  basis.  Three tenets of relational novelty were also found to be key mechanisms of the change process. the couple's performance are as  These tenets which characterize  follows:  1. Therapist and couple collaboration.  2. Important experiences, awareness  emerge  previously out of client  conscious  in therapy.  3. Clients identify something new about self, their spouse or the presenting  problem.  129  Other  transactional classes,  tenets of relational novelty were However,  the  mechanisms  event.  This  observed in the  mentioned were  observed in both successful unsuccessful  intensification  components successful  those that  Experiential  events.  were  events and not observed in the  suggests that these specific  mechanisms  are key ingredients in the change process of an RI event, employing  and  Systemic  Couple  The T w o Coding  when  Therapy.  Systems  The Experiencing Scale Research on the Experiencing Scale suggests that peak experiencing levels are more predictive of outcome  in therapy than  are the modal scores (Klein, M . , Mathieu-Coughlan, P., & Kiesler, D.,1986).  In this investigation it was found that the peak  experiencing levels of the husband and wife in the successful were  statistically  significantly greater than those of the husband  and wife in the unsuccessful event. quality  The level of experiencing, or  of client involvement in therapy, does discriminate  successful  events  and unsuccessful  resolution events.  between  These results  are  similar to those found by Alden (1989) and Johnson and Greenberg, (1988) and emphasize  the importance of couple participation in the  change process and their willingness to focus on, expand and probe inner referents.  However, other factors may be at play.  therapist or therapeutic approach facilitate client  Can a  or hinder the  involvement in the psychotherapeutic process?  quality of  Strupp  found that many therapists react adversely to a client's  (1980)  negativism  130 and hostility, and these reactions, in turn, may contribute to negative  outcome.  effective  Professional therapists were found to be no more  when dealing with clients' resistance  untrained counselors.  Professional therapists  motivated and nonresistant clients.  and negativism than did better  Moreover,  with highly  data showed  particular therapeutic approach may work well  that a  with persons  who  possess qualities that enable them to use it, but that it may not be the treatment for all. Both A l d e n (1989) and Johnson and Greenberg (1988) found a large proportion of couple responses  in successful  sessions scored  at a level of four or higher on the Experiencing Scale.  Results from  this study demonstrate relatively lower levels of modal and peak experiencing in both the unsuccessful  and successful  events.  This  may suggest that change can take place even at moderate levels of client  involvement  and participation in therapy.  Self-Disclosure Coding  System  The results of the Self-Disclosure Coding System that the total amount of self-disclosures wife  did not discriminate between  resolution events. change event  the  made by the husband and successful  and  unsuccessful  However, the type of self-disclosures  did discriminate between  demonstrate  the events.  made in a  In the  unsuccessful resolution event only five percent of all selfdisclosures for both the husband and wife disclosures, three to seven  times fewer  were positive  than in the  self-  successful  events, this difference was found to be statistically significant. result supports Waring, Schaefer, and Fry's, (1994) findings.  This Their  131 research couples  suggested that increased intimacy was who reciprocally disclosed  a positive  associated  disclosure pattern to  one another, as opposed to one that was negative. that i f their findings therapeutic thoughts  They concluded  were repeatedly validated it may suggest that  approaches  and hostile  with  encouraging  couples  to  feelings may not increase  exchange  negative  closeness.  A General Model of the Change Process  Responding  to two  more recommendations  made by  (1988) for family therapy research, which are, (a) to study common elements and mechanisms  of change  (b) to study the factors  with deterioration or  effects,  associated  the research questions  addressed.  Gurman the  across methods,  negative  posed in the introduction w i l l  These two questions  and  be  are:  1. What are the specific process steps taken by therapist and couple in the development of the co-creation of successful couple treatment context, impasse  created by  change, in a  focusing on the resolution of a relational  disparate beliefs  and distance  oriented  interactions?  2. What are the factors that inhibit the completion of the steps toward resolution,  thereby  inhibiting change  from occurring?  T o respond to the two research questions,  a simplified model  132  of the change process (see present  investigation,  approaches,  Figure 7), derived from the results of the  which may be  is presented  applied to  and discussed.  other  therapeutic  Although the original  model is based on the E x S T framework, aspects of the original model are applicable to family-couple  therapy as practised in the  Gurman  common ingredients  (1988) states that two  therapy are "the creation of alternative  in family  modes of problem  and "the modification of the permeability of channels the exchange of information" (p. 132). of the model presented A  in this  field.  solving"  available  Both ingredients  for  are aspects  investigation.  description of the therapist  and couple  performances  that  facilitated the process of change for each step is outlined below. description  of  therapist  and couple  performance  factors  A  that  inhibited the facilitation of the change process is also provided.  Step One: The Marker: Introduction to the Relational Impasse; The  Therapeutic  Introduction to  the  Relational  The relational impasse indicated oriented  by disparate  Relationship  Impasse.  is introduced by the marker which  beliefs between the  interactions.  The therapist  couple  addresses the  and  is  distance  relational  impasse. The  Therapeutic  Relationship.  C o m m o n elements of many researcher's therapeutic mutuality,  relationship, engagement,  also called  definition of  therapeutic  and collaboration,  where  the  alliance, both  include  therapist  and  133 Figure 7.  A simplified model of the change process, including both  therapist and client performance, for a R I event.  H '  Q  PH  o  OH  H W W ^» p4 £ X H 1—1  <  2 oo W PH  o u  o o § w PH  >-J oo  9  <  O0 PH  134 client have the capacity to participate in the therapeutic  contract  (Hovarth, and Symonds, 1991, Frieswyk et al., 1986).  consistent  A  assumption is that the therapeutic relationship plays a key role in treatment (Gelso & Carter, 1985; Highlen & H i l l , 1984; Tichenor & Hill,  1989).  The Vanderbilt Project (Strupp 1980), also involved the  investigation  of the process  of the therapeutic experience  who improved and for clients  who deteriorated.  what the deteriorators had in common was relationship with their therapist. therapeutic  therapeutic successful  Their data suggest that  previous research, this  relationship to be and unsuccessful  therapist performances  very early in  investigation  found  RI events and a crucial process  in the  fateful  a discriminating factor between  successful  collaboration, mutuality and engagement lack of,  and fixed  "the  716).  the co-creation of change in couple therapy.  The  of a working  the end of the third session), and that is is  for its course and outcome" (p. Supporting  clients  It was found that  an absence  relationship becomes established  treatment (before  for  the the  step in  Both couple and  RI events included towards  a similar goal.  or a limited therapeutic relationship in the  unsuccessful  RI event appears to be an inhibiting factor in the change  process.  This finding is suppported by the Therapeutic Alliance scores of each couple (see Appendix E for a description of this Individuals and couples in T A R P  scale).  completed either an individual or  couple Therapeutic Alliance Scale (Pinsof and Catherall, 1986). synthesized  version of these two  comparison purposes (see unsuccessful  scales was  Olsen, 1993).  RI event scored  1.7  computed for  The husband in the  standard deviations  below  the  A  135  average Therapeutic Alliance score of all T A R P participants, indicating that he did not perceive the therapeutic alliance to be very strong as compared to the other participants. in  the unsuccessful  resolution event was  The wife's  equal to the  therapeutic alliance score of all T A R P participants.  score  average  In the  successful  RI event the husband's score was equal to the mean and the wife's score  was  1.2  standard deviations  above  the mean, indicating she  perceived the therapeutic alliance to be fairly strong as compared to the  other  participants.  Couple of  performance factors  a therapeutic relationship were  and  the unwillingness  and  with the therapist.  inhibited  the  that inhibited the  development  the lack of treatment  readiness  to pursue change collaboratively as a couple The therapist performance factors  development  of  the  therapeutic  around the inability or unwillingness  relationship  that revolved  of the therapist to lay aside  agenda to respond facilitatively to the responses of his client's. example,  the  husband in the unsuccessful  overt cues and statements that he was  husband's own  cues were  therapeutic  never addressed  efforts.  change  However,  the  as the therapist followed  his  plan.  Leitner & Guthrie (1993) assert that therapists and  For  event provided many  unwilling to pursue  collaboratively, invalidating the therapist's  his  need to learn  respond to their client's personal style of validation and  invalidation of their interventions.  If a therapist is unwilling or  unable to attend to the cues provided by their clients and is unwilling or unable to search for another path to meet their clients, a stumbling block to a therapeutic relationship will occur.  The  136 therapist in the unsuccessful  resolution event was  not "picking up"  or responding to cues from his clients that something was wrong, that they  were not feeling  acknowledged,  unwilling to work collaboratively. invalidated change  the  therapist's  that the husband  The responses from the  interventions  but the  therapist  was clients  did not  his approach. T o facilitate  therapeutic  the accomplishment of developing  relationship in the moment  to moment  the  interactions  therapy, Leitner & Guthrie (1993) suggest that therapists recognize  the  interventions psychology interplay  subtle  in  learn to  validations and invalidations of their  by their clients  early in therapy.  Personal construct  suggests that all interactions in therapy are an intricate  of validation and invalidation which forms  of the meeting of these persons.  the  A therapeutic intervention is a  crucial test of the therapist's understanding of the client. intervention is  validated, the  movement  therapist can have  in his or her understanding of the client.  W h e n an  greater  confidence  "Validation may give both  the therapist and the client the courage to continue the venture" (p. 285).  Invalidation, on the other hand, marks a distance  client and therapist and signals understanding of the client.  the need for a reconstructed  When a client invalidates  intervention, the client is telling the therapist that there something  between the  wrong with the intervention.  a therapists is  If the therapist notes  the  invalidation, he/she is led to try to understand why, to listen more carefully to the client and to "search for another path toward the process that is the client". Direct validation or invalidation of a therapist's  intervention  137 in moment by moment interactions may be as obvious as the saying, "Yes, that's right" or "No, that's wrong". invalidation of an intervention allows  Immediate  the therapist to change  and therefore form a closer relationship with the client. problem in interpreting direct validations is what they say, but not say all they mean. may not be socialized to disagree the  client  course  One  that persons  may  mean  For example, some people  and they therefore may agree  with  therapist and then in their following discussion reveal their  disagreement. invalidation evidence  Because of issues such as this, indirect validation or frequently  give  the  therapist more reliable  of the quality of their approach to their clients.  validation conveys than words. client  may  Indirect  "right" or wrong" to the therapist in ways other  The therapist must attend to (as opposed to hear) the  in order to  understand whether  being validated or invalidated.  his/her interventions  are  Validation data may be found in  vocal cues, such as pace or tone, and body movements.  A  client's  rigid body slowly relaxing in a session may reveal that the client is validating the therapist's beginning to feel  interventions,  that is, they  safe and are demonstrating more  Step 2: Immediate Emotional Response  to the  may  be  openness.  Impasse  The couple performance in this step is characterized by the revelation of their immediate impasse.  T h e therapist's  emotional response  performance is  validation and acknowledgement  to the relational  characterized by  his/her  of the emotional responses of  husband and wife via the use of empathy.  The successful  the  therapist,  138 at this point, elicits the emotional responses from the couple if not spontaneously  offered.  Couple performances that inhibit the  process  at this point are if the husband or wife or both are unable to or refused  to disclose  their emotions.  Therapist performances  that  inhibit the process at this step is if he/she validates or acknowledges  only one or neither of the spouses'  emotional  responses.  Step  3:  Acknowledgement  Successful  couple performance is characterized, in this  by both members of the couple acknowledging impasse is relevant and in need of resolving.  that the relational  A factor inhibiting the  process is if only one or neither of the spouses acknowledged relational impasse  step,  as relevant and in need of resolving.  A  the  successful  therapist performance, at this point, is to help one or both of the spouses to recognize the relevance of resolving it.  of the impasse,  benefits  A factor inhibiting the process is if the therapist, him  or herself does not recognize the relational impasse the benefits  and the  of resolving the  as relevant, nor  impasse.  Step 4 : Self-Disclosure  In this  step, successful  by  (a)  (c)  disclosure of thoughts,  impasse  couple performance is characterized  their collaboration with the therapist,(b)  and present  feelings,  experience.  self-reflection  and  and history regarding the Successful  therapist performance  139 is characterized by: acknowledge acceptance,  the  (a) the use of empathy to validate and  couples'  experiences  and to diffuse  feelings and experiences  modelling understanding and  defensiveness; (b) probing the  of both the husband and wife; and (c)  articulating clearly the ongoing process of  the relational impasse,  (ie. providing a description  or emerging relational patterns).  Potential factors that inhibit the change process emerging defensiveness  thoughts  of either husband or wife  are: (a) i f  is not  addressed;  (b) if the husband or wife are unable or unwilling to collaborate, self-reflect  (disregarding or denying their feelings)  or  self-disclose;  and (c) if the therapist is caught up in the content and unable to observe  and specify  the process  that is  developing.  Step 5: Insight / Resolution  Successful by  increased  other's  understanding between  thoughts,  manifests  itself  willingness  couple performance at this  feelings  the  step is characterized  couple  and experiences.  regarding each  This understanding  in approach oriented behaviors, for example,  to accomplish an in-session  therapist performance is  activity together.  characterized by the  technique  any negative  the  Successful of  reframing.  The therapist reframes  interpretations  of  the process  and imparts new meaning into the couple's relational  patterns. Similar to the findings of Friedlander et al.(1994), resolution depends other's  on each spouse gaining insight or awareness thoughts  and feelings regarding the impasse,  into  the  allowing for  140  new  behavioral alternatives  to emerge  in therapy.  Therefore, it is  important at this point, for the therapist to ask each spouse if they truly  understand their partner's perspective  remaining confusion. necessary other.  to agree  and to  The therapist may emphasize  clarify  any  that it is  not  with each other to understand and accept  each  Factors that inhibit this step from occurring are if the  husband or wife  or both, have privately committed  themselves  the dissolution of the relationship and are therefore understand or accept  their  to  unwilling to  spouse.  Implications for Clinical Practice and Training  The results of this study can be applied in clinical practice and training using the Experiential Systemic across  theoretical orientations  investigation  offers  that identifies  Couple Approach or  in the family therapy field.  This  a model of the change process for an RI event  the key components  and mechanisms  of the  co-  creation of change within E x S T , as well as providing a more general model of change therapist  specifying key steps in successful  performances  couple therapy.  for  a common problem encountered  These models  and therapist process,  providing direction to the  (especially  and acceptance  practitioner dealing  For example, couple therapists  positive  couple  in a couple treatment context,  (a) facilitating deeper levels of experiencing, disclosures  in  can be used to understand the  with a similar relational impasse a similar population.  couple and  ones),  (c)  should focus  (b) facilitating  modelling  with  self-  understanding  of both partners via the use of empathy, and (d)  on:  141  learning their clients' their interventions  personal style of validation and invalidation of  and be willing to "search for another path  toward the process that is the  clients'".  Limitations to the Study  Three limitations to this investigation will be discussed.  The  first, is that there was no opportunity for triangulation of key observations, which Stake (1994) states is one of the major conceptual responsibilities  of the qualitative case researcher.  The  limited scope of this investigation did not allow for the use of multiple  perceptions  therapists.  acquired through interviewing  Multiple perceptions  verified observations  might have  of key mechanisms  clients  or  clarified meaning or  of change.  Second, the  data are from a small heterogeneous sample of couples in alcohol recovery.  The results may therefore not be generalizable  populations.  Finally,  distinguished  the  the components  successful  and mechanisms  events from  the  to other  that  unsuccessful  events  may be due to important therapeutic work, that had been previously conducted, which was event. (eg.  A s well,  personality)  not observable  unknown pretreatment and client  research  input variables  regarding therapist  variables are discussed  in the next  change  therapist input variables  may play a large part in the change process. further  in the  (eg.  treatment  Recommendations for  input variables section.  readiness)  and client  input  142  Areas  Therapist  Input  for Further Research  Variables  Therapist variables such as skills underestimated 1989).  as  determinants  "Interactions  client/patient  of  and attributes  outcome  of therapist factors  variables, as well  (Insititute  have  of M e d i c i n e ,  with treatment  as the main effects  been  of  and therapist  characteristics, may account for a substantial amount of variance in client/patient 197).  motivation, dropout, compliance,  and outcome"  (p.  Research has shown (Institute of Medicine, 1989): (a)  empathic been  understanding as  a common element  one  therapist  in brief interventions  impact on alcohol problems; and (b) clients  whose  therapists  According  characteristic  influencing outcome;  area are the  client drop out, motivation for change,  (b) i f certain types of people  confrontational); and (c)  Client  three  of: (a) the role therapist characteristics play in  with particular characteristics  empathy,  substantial  self-statements.  of Medicine (1989),  important areas for further research in this investigation  that have  has  greater improvement among  reinforced positive  the the Institute  which  and treatment  respond better to  or style (e.g., empathic  the influence  likability and effectiveness  versus  client perceptions may have  on  therapists  of  therapist  outcome.  Input Variables Prochaska, DiClemente and Norcross (1992) have found that  the  amount- of progress  interventions  clients  make following  tends to be a function of their  therapeutic  143 pretreatment  stage of  treatment  In their research, stages outcome  than age,  of  change  socioeconomic  duration, goals and expectations, fact,  or readiness  for  change.  scores were better predictors of status, problem severity  self-efficacy  and  and social support.  the only variables that outperformed the stages of change  outcome  predictors were the processes  early in therapy. overt they  readiness  activities attempt  allows  enable  and experiences  practitioners intentions  to  used  are defined as "covert and  that individuals engage in  when  During  represent a temporal dimension  understand when  each  practitioners to understand how  1. Precontemplation.  of each stage of  that  particular shifts in  and behavior occur.  are brief descriptions  change  change  the clients  as  certain processes have been found to be used by the  Stages of change  attitudes,  of  change  to modify problem behaviors" (p. 1107).  stage of change clients.  Processes  of  In  The processes of  change  these shifts occur.  Below  change.  In this stage the individual has no intention to  behavior in the foreseeable future.  unaware or underaware of their problems.  Individuals may Resistance  be  to recognizing  or modifying a problem is the hallmark of precontemplation.  2. Contemplation.  In this stage people are aware that a problem  exists and are thinking about overcoming it but have not yet made a commitment  to take action.  Individuals may know  what they  want  to change but are not yet ready to put the effort in to make that change.  Weighing the pros and cons, and cost-benefit  characterizes  this  stage.  of changing,  144  3. Preparation. combined.  In this stage intention and behavioral criteria are Individuals are intending to take action in the next  month or have unsuccessfully  4. Action.  In this stage individuals modify their behavior,  experiences This  taken action in the last year.  or environment in order to overcome  stage requires considerable  5. Maintenance. and consolidate  and  energy.  In this stage individuals work to prevent  relapse  the  gains  The ten change empirical  commitment  their problems.  attained during  processes  of time  action.  receiving most  theoretical  and  support in their work are: consciousness raising, self-  reevaluation,  self-liberation,  reinforcement  management,  environmental  reevaluation  From their research, integrated the transtheoretical behaviors.  counterconditioning, helping and  relationships,  social  Prochaska et al.  This  of change,  transtheoretical  dramatic  have  relief,  systematically  and have  for individuals with model  offers  an  perspective  on the structure of intentional change  applied  client-treatment  to  control,  liberation.  stages and processes of change model  stimulus  developed addictive  integrative which can be  matching.  The Institute of Medicine (1989) reports that in the past years  matching clients  idea with  yet  and efficiency  untapped possibilities  may be effective action stages.  with treatment  of treatment.  a  has become  recognized  for improving the  For example,  with individuals who  as an  effectiveness  action oriented  therapies  are in the preparation or  These same programs may be ineffective  ten  for  145  individuals  in the  precontemplation or contemplation  stages.  Similarly, individuals in the contemplation stage have been found to be most open to consciousness  raising techniques  while those in the  action stage used higher levels of self-liberation as they believed  that they had the autonomy to change  Facilitating may  be  inappropriate change  ineffective  and even  processes  their  at the  increasingly  lives.  various  stages  detrimental.  The direct implication of this research is the need to assess the stage of a client's readiness interventions  for  change  accordingly, especially  appropriate change  processes.  and to tailor  in regards to facilitating stage  Matching  clients  to an appropriate  level of treatment intensity can take place at the initiation of treatment.  The complexity of matching clients  of treatment is increased when engaged  to appropriate levels  in couple therapy  spouses may be at very different levels of readiness therefore  requiring  very  different  interventions.  for change and  However,  discovering if a couple has different levels of readiness may potentially influence  provide crucial  the interventions  as  information to the  for  change  therapist and  he or she may provide.  Models of the Change Process A t this point, the models presented in this investigation data.  that have been developed and  should be tested with a new  set  of  D o similar steps, involving similar processes occur in  successful investigate involved,  change  events of the same task?  Future research should  (a) i f information from the couples concur with the change  mechanisms  and  therapists  delineated,  (b) i f the  146  components  described are necessary  between successful this in-session  and unsuccessful  change relates  and sufficient  to  distinguish  resolution events,  and (c)  how  to long term change.  Building working models  detailing how change  occurs for  specific events in therapy continues  to be crucial in the growth of  couple therapy (Jacobson & Addis,  1993), especially  comprehending facilitate  the  mechanisms  how  couple-therapist  the co-creation of change.  tasks within couple  important  complex  (Heatherington et  extra-therapy factors  dynamics  research  on  and couple  change.  process  manual-like guidelines  are  al.  understanding  (eg,  1990).  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(1989). therapist-client approach. 281-286.  interaction during  change  Sequential analysis of events:  A  task-focused  Journal of Consulting and Clinical Psychology. 57, (2),  154  Appendix  A  155  IDENTIFICATION OF SUCCESSFUL AND UNSUCCESSFUL RI EVENTS F O R M  Does  the  following  therapeutic  e p i s o d e y o u are  about  to w a t c h m e e t  the  criteria?  1. A r e there statements m a d e  b y the  husband  and wife  that  indicate  a d i f f e r e n c e i n o p i n i o n , b e l i e f , i d e a , b e h a v i o r , o r not h a v i n g a understanding  o f a s i t u a t i o n i n this  similar  episode?  yes no  2.  A r e there  wife  that  couple? of  statements a n d i n d i c a t i o n s m a d e  demonstrate  distancing  E x a m p l e s o f distance  sarcasm, expressions  ignoring  one  oriented  by  the  interactions  husband between  o r i e n t e d i n t e r a c t i o n s i n c l u d e the  o f anger  or frustration  and  toward each  the use  other,  or  another.  yes no  3. D o e s the  therapist  attempt  to address  this i s s u e i n the  therapy  session? yes no  4.  Is there a p o i n t i n this e p i s o d e w h e r e  made  by  the  husband  or  wife  statements o r b e h a v i o r s  demonstrating  approaching  are  oriented  156  interactions,  replacing the  previous  distancing  oriented  statements  and behaviors?  Examples of approach oriented interactions  statements made  by the husband or wife  understanding of the other's difference  perspective  indicate  are  greater  in regards to the original  of opinions, ideas, etc. identified in question number one,  the removal of barriers, or engaging in joint activities  in therapy.  yes no  5. Is there a point in this episode  where either the husband or wife  make statements that refer to increased feelings of calmness, decisiveness, original  relief,  firmness or a sense of direction in regards to the  difference  identified  in questioned  number  one?  yes no  6. D o you consider that the episode consists of an interactional sequence between clients  and therapist, "that has a beginning, and  end, and a particular structure that gives it meaning as an island of behavior going yes no  distinguishable  psychotherapeutic  from  the  process"?  surrounding behaviors  in the  on  157  Appendix  B  158  Transcript of Successful RI Event # 1  (T. = Therapist; W . = Wife; or  H . = Husband;  name = name of person  organization)  1  T . So I noticed that you've brought some of your forms.  2  W . Right.  3  T . That's wonderful, so shall I take those?  4  H . Y a , that's ours in there ah, (handing envelope  5  counselor).  6  T . I had something from (Name).  7  H . O h , maybe you got it already, that's probably it then.  8  T . That looks like what I got.  9  H . O . K . so  10  T . I really appreciate having it, so thank you , I already have  1 1  one but I really appreciate you bringing it in. It's important  12  to me to read it.  13  H . Y a this is a couple plan we went over before we left, I  14  don't know if you want to see that or not?  15  T . I would be very interested to see it, if you don't mind me  16  seeing it.  17  W . Y o u ' v e got another copy of it?  18  H . N o that's the only one, we'll need it back, or make copies.  19 20  T . W e l l , maybe I could make a copy before you go (Name H ) , thank you. '  That's the report from  to  (Name).  I've got the exact same thing.  I guess (name) must have forwarded you a copy.  So is this your other stuff?  159  2 1  W . It's really funny how you brought that without asking.  22  H.(Mumbling),and this is what I told you about, (talking to  2 3  T ) the questions that we do every day or have been doing  24  mostly  25  T . Both of you?  26  H. Ya.  27  W. M M M  28  T . H o w wonderful.  29  H . W e are getting kind of tired of it.  30  T . Y o u ' v e been doing this every day?  3 1  H . Basically ya.  32  W . W e ' v e missed, we haven't been doing it for  33  H . the last few days.  34  W . Since Saturday.  35  T . How come?  36  W . W e l l , when we were doing it, we have been doing it  37  actually, but when we were doing it was when we went to  38  bed at night, and in this past week (Name H)'s been kind of  39  um, angry and one night this week we did it, well I got home  4 0  late . . .  4 1  H . (Interrupting) just getting it done too late ya.  4 2 4 3  W . and he was feeling a lot of frustration, so his whole report was about frustration. A n d I just said, it doesn't work to do  44 4 5  this in bed, with all these feelings. So we were going to talk about doing it at a different time. Like even if we did it, just  4 6 4 7 4 8  before bed, but not in the bedroom, just sitting and doing it. Because it's not working, doing it in bed. Some of the time I feel like I'm not giving it my best because it's late and I just  every day.  160 4 9  want to go to sleep.  50  T . Y o u don't feel ready to do that just as you get into bed.  5 1  W . No, so I think if we do it we should do it before.  52  H . Ya.  53  W . Like before we go upstairs to bed.  54 55 56  T . I'm really impressed with how hard you have been working. A n d I read in the (name) report of how committed you were to your recovery and I'm really impressed. I  57  haven't met anyone who has been doing that,  5 8  wonderful.  5 6 6 6  W . It's good, it really is good because actually our relationship um, has been a lot better than it has ever been. Part of it is that we have been doing this at night time. Because before, well, we didn't even sleep together, before.  9 0 1 2  I think this is  6 3  T . So that's a change that you made together.  64  W . A n d another change for me, is the other night when he  6 5  was just really upset, and I could understand why he  6 6  upset, but what it does to me, was I got upset.  6 7  like midnight and I didn't go to sleep till about two o'clock.  was  A n d it was  6 8  A n d what I wanted to do was just say, "get out of here", and  69  I didn't, I didn't say it.  7 0  would have done in the past, I would have just asked him to  7 1  leave, I didn't do that this time. It's upsetting, you know, and  7 2  I don't think that you should go to bed upset, I think that it's  7 3  just not, it doesn't work if we do it that way.  7 4  T . So you've talked together about this before?  7 5  H . O h , ya  7 6  W . Yes.  7 7  T . Is this for me (NameH)?  7 8  H . Y a , I brought that.  I just let it be. But that's what I  161  7 9 80  T . B o y I feel pleased to have this. Thank you. So I heard you say, it sounded like you hadn't been consulted about . . .  8 1  W . Right and . . .  82 8 3  H . (interrupting) no the plan, because when I talked to you I said I would bring this and the other thing and I saw the 84 couple's plan, so I thought I would bring it.  85  W . But I wasn't consulted,  86  H . No  87 8 8  W . and one of the things that is in the couple's plan is about how we would discuss anything that is important . .  89  T . Maybe I should get it back.  9 9 9 9  W . before it may be important, before we  0 1 2 3  one of us makes a decision. It might not be in that, in something else, when it was something that was that concerned us both, we would discuss it first made a decision.  94  T . Maybe you need to do that, maybe you are not ready to  95  have me see  9 6  W . O h , no it's fine, I don't mind you seeing it at all.  97  it's just another time that (Name H) has chosen to do  9 8  something that involved me, he's  99  T . Y o u felt excluded from the decision.  100 101  W . Y a , excluded and controlled, that I'm not capable of making my own decisions and that I'm not trusted, that you  102  don't trust me to say, "ya it's o.k. (NameH), you can give that  103  to (Name T ) .  104  T . W o w , a lot went on for you.  105  W . Y a , that's exactly how I, like you didn't trust that I would  106  say it's o.k. .  this. But that,  controlled it.  162  107  T . I'm curious to know. . .  108  H . (Interrupting)  109  W . But you still didn't . . .  110 111 112  H . I just didn't ask you, that's all. A n d it's just that I found it when I was going through the other stuff, and I thought it might be worthwhile to bring, that's all.  113 114  T . Y o u thought all this will be o.k. with (Name W ) and she is not going to say no, in fact . . .  115 116  H . (Interrupting) W e l l , it's not only that, it's not only that she's not going to say no, I wasn't just going to hand it to you  117  anyways, let you know about it before hand, well it's just, I  118  hear you though.  119  W. I  120 121  T . This seems to be something that is a pattern in your relationship, he doesn't mean to discount you but you feel  122  discounted.  123 124  W . N o , no 'cause he knows that I'm going to say yes, so he doesn't ask. O n the other hand, there are times that he  125  knows that I'm going to say no, so he doesn't ask either, so  126  it's both ways.  127  T . Is that your perspective too (Name H)?  12 8  H . No, no,  129  W . It came up. . .  13 0  H . maybe in the past but not in this.  13 1  W . So why didn't you ask?  132  H . Because you weren't there, and I didn't even think about  13 3  it, I just threw it all together.  134  W . That's where you do it alone, when it involves me.  I do trust, I knew you would say o.k.  just feel discounted.  163  13 5  H . Y a o.k. whatever.  136  W . A n d that's what you say, you just don't think about it.  137  I'm just asking what you do  138  T . It kind of hurts inside,  139  W. Ya  140  T . that you are not in (NameH)'s mind, at that moment when  141  he makes a decision that involves the two of you.  142  W . Right.  143  T . Y o u feel kind of hurt about that and unimportant to him.  144  W. Ya.  145 146  H . See the actual reason I brought it is so you could use it to back up anything that you wanted to say from the couple's  147  program,  148  W . O h , I see. (laughing)  149  H . A n d I know that you didn't even think about it.  150  W . N o I wouldn't of.  15 1  H . N o you wouldn't have thought of it, usually, so is that my  152  fault?  15 3  T.  15 4  H . Y a , I do.  155 156 15 7 15 8  W . I feel confused now too (Name, H ) , 'cause I'm not saying that it's your fault. It's just that in the couple's plan, we said that if anything, if any decisions were made that involved the two of us, we would decide together,  159  H. Ya.  right.  I feel a little confused right now.  164  160  W . and this is just an example of where you didn't, you  161  decided on your own and it involved me.  162  would have said yes, but you didn't ask me, all you had to do  A n d that's o.k., I  163  was  ask.  164  T . You're saying that it's o.k. but it seems as though that it's  165  very much not o.k..  166 167 168  W . No, no, it's o.k. that he gave it to you, that's o.k., I don't have any problem with you having it. It's not o.k. that he didn't ask me. It's not o.k. that you didn't ask, and it's fine  169  that (Name C) has it.  170  T . (Asking the husband) So what's going on for you right  171  now?  172 173 174 175  H . I just don't see the problem, for want of a better word, I don't see what the, like o.k. I understand you're hurt because I didn't tell you before hand, I can see that. But I may as well do nothing, that's what I feel like right now, is  176 17 7  why bother with it then. T o me it seems like you don't even see the intent, why I bothered or anything.  178  W.  179  H . Because there wasn't time, you weren't  180  put the stuff together . . .  181  W . (Interrupting)  182  today.  183  H . W e l l , I didn't think about it, I had i f in there, that's all.  18 4  T . So is this typical of what goes on between you two?  18 5  H . Y a , I think so.  18 6  T . So this is a familiar pattern and you are saying that you  18 7  would like to change  188  W. Mmm.  189  T . A n d you are saying, you would like to change the pattern  I just don't know why you didn't ask. there and when I  It took us an hour and a half to drive here  the pattern.  165  19 0  and you would like to be consulted, when there is a decision  191  to be made that involves the two of you.  A n d you're saying  19 2  well, I feel confused because, "I knew you would agree and  193  I'm sorry", well I don't know if you said you were sorry," but  194  I forgot to consult you".  195  H.  196  bother right now.  197  T . W h y bother with what (NameH).  19 8 199 200  H . A h , by bringing anything along, or doing anything that is going to try and help, like it just causes another problem it seems to me.  201  T.  20 2 20 3  H . Y a basically, ya and if something like this causes such a big thing and to me this is a big thing, like such  204  misunderstanding, like what do I do, I do nothing. I should  205 206  do nothing and then there is not going to be such a big misunderstanding.  207 20 8  W . O n the other hand, I feel that is hopeless too because talked so much about it at (name).  209  H . That's why I brought it.  210  W . and it's the same stuff.  211  H. Ya.  212  T . Maybe part of you feels a little bit angry that such a big  213  deal is being made out of this, when you just wanted to come  214  in and help.  215  H . Y a right,  216  T.  217  "oh well why bother, what I'm really trying to do is just help  218  and I don't feel appreciated and I think I want to give up".  219  H . Y a , Y a , quite often.  It's just, it's just, like my automatic reaction is why  Y o u just feel hopeless right now.  we  I am.  Is it true that sometimes when you feel angry you say,  166  220 221 222  T . A n d I'm kind of making a big deal out of this because I'm very curious about what goes on between you two. A n d what I really appreciate enormously, at this moment, is your  223 2 24  honesty and your clarity about what you want and how you feel, I'm quite amazed, at this moment.  225  W.  226 227  this questionnaire that we do every night, and one of the things (NameH) has requested of me if there is any, this is  22 8 2 29 23 0 2 31 23 2  where it makes no sense to me, he said at (name), that i f there is a confrontation he doesn't want me to back down, he wants me to continue with the confrontation, because this is what I would always do before, I would just back down and walk away and come back happy.  233  T . This is new.  234  W . So come back happy and it always confused him and yet,  235 23 6  i f we are having a confrontation about money or anything else that's what he does, he walks away, he walks off. A n d  23 7 238 23 9 240 241 24 2  he doesn't come out loud and say out loud, "oh why bother", but by his actions that is what he is saying and he walks away. A n d we have been working really hard together, to go through stuff and it's hard, really really hard and there are times that both of use just feel, "well, why bother, why do this?" A n d yet um, before I never would have said  24 3  anything, it's not just with (Name H) but it's with everyone,  244  if that's what you want you can have it, and I wouldn't have  245  stood up for myself.  246  T . A n d now you are standing up for yourself.  24 7  W . A n d he is saying, "well why make such a big deal?"  24 8 249  for me right now, it is a big deal, everywhere in my life, to stand up for what I want, like just to give people permission  25 0  to have my things. A n d I can sit back (NameH) and be the  251  nice person and go "oh, sure fine", like everybody can have  25 2  everything of mine but why should I anymore, that's what I  25 3  have done all my life.  254  T.  What's really strange, because I've been thinking about  But  You're telling me that (NameH) wants you to hang in 255  there and not run away, not back off when there is  167  25 6  confrontation and you're doing this and still sometimes  you  25 7  feel  25 8  W . That's right.  25 9 2 60  T . Still you do. A n d you're kind of in the transition process right now, together you are developing some new patterns  2 61 262  and you are finding that sometimes there, (NameH) will go away.  263  W . Right.  2 64  T . A n d then you feel alone.  265 266 2 67  H . A lot of that stuff is because I learned a lot about myself when I was at (name) and there is certain situations where I will walk away from, and I walk away knowingly now and  26 8 269 27 0 271  it's for specific reasons. raising the voices, I just don't like yelling, I don't like people yelling period, I haven't since, that was part of my problem when I was a little boy and ah (pause)  27 2  T . Y o u feel really threatened when people yell.  alone.  even though you hang in  27 3  H . Y a really threatened, and I don't want to tolerate it  274  anymore.  27 5  T . So clearly and consciously now, when there is yelling,  27 6  walk away from it.  27 7  H . O h ya,  27 8  T.  27 9  situation safe around you.  28 0  H . Just for myself.  281  T . Just for yourself.  282  H . 'Cause I can't even think straight.  28 3 284  T . Y a so this is brand new for you both and you are in transition, and you have a new pattern, which is wonderful  you  Y o u need to do that in order to feel safe and to keep the  168 28 5  and at the moment it is not familiar, and still you find that  286  you are hurt is what I think that I'm hearing.  2 87  W . Y a at times.  28 8  T . A t times, I also see a lot of energy between you two, I  2 89  think this is a brand new relationship, in a way and I think  290 2 91 29 2 29 3 294 29 5 296 297 29 8 299  that one way you show your caring is by telling (NameH) how you feel and hanging in there. A n d one way he shows his caring is sometimes by continuing to walk away, out of self-respect and the need to, just to make the situation more safe. A n d other ways you show your caring is by doing this questionnaire at night and another way, probably feeling frustrated at the same time, is to wait almost twenty minutes for this session to start and we start off with a bang. A n d I'm wondering that if together you would be willing to give me that paper, if you are ready.  3 00  W . Certainly,  301  T . Could you do that ?  3 02  W . It's not a secret  (laughing)  (Handing the paper to counselor  together)  3 03  H . N o it's not.  3 04  T . (Speaking to husband) I really appreciate this and I want  3 05  to know how you are experiencing yourself right now,  3 06  this  3 07  H. Mmm.  3 08  see the reasoning for going through the dance to get to this  3 09  result, like, follow  310  T . It's a long way to go a long way around.  311 312  H . Y a , that's all but like I understand (NameW)'s viewpoint now more anyway. I guess I just can't take what I consider  313  little things for granted.  314  T . A n d it seems like a little thing but we've been spending a  after  conversation? W e l l , honestly, o.k. I'm relieved, I honestly don't me?  169  315  lot of time on it, and it seems like you've been willing to  316  hang in here.  3 17  H. MMM.  318 319  T . (Speaking to the wife) on for you?  3 20 321 3 22  W . W e l l , I'm proud that I stood up for myself, even though it appears to be a little thing, I don't feel guilty, I don't feel guilty about stating what I felt.  3 23  T.  3 24  W . N o it's not, it's our plan, it's not a chocolate chip cookie  3 25  recipe.  3 26 3 27 3 28 3 29 3 30  T . It seems very important and I really appreciate the privilege to be reading it so, I'm going to make a copy before you go and then I'll give it back. (Reading from the couple's plan) "When in doubt check out your partner's feelings". That's what you just did.  3 31  H. MMM.  How are you?  What's been going  It's not a little thing to you.  Appendix  171  Transcript of Successful  RI Event  #2  (T. = Therapist, W . = Wife, H . = Husband)  1  T . I'm not sure when we left off last week , where we had  2  this, whether behind the chair or in front?  3  W . In front, ya.  (Pause) (Counselor places symbols, that the couple brought in to represent themselves, on the floor). 4  W.(Referring to the symbols, the  laughing)  Put a wall between 5  two.  6  T . Pardon.  7  W . I said I need to put a wall in between the two.  8  T . Y o u would like a wall in between the two.  9  W . No not really, well ya, I suppose I would, if I could.  10  T . Maybe we should put one then, that's what you would like  1 1  right  12  W . No it's o.k.  13  T . N o I think that's important, that ah, I know what you  14  want. Y o u could make one (gives wife a piece of paper), or  15  you could use a book.  16  W . I want something  17 18  gets a book and puts it between the symbols). leaning. I've pushed the rock over.  19  T . (Talking to husband) So you can't even see your symbol.  now.  tall.  (Looks through a bookcase.  She  It's kind of  172  (Laughter by all.) 20  T . So I apologize for keeping you waiting I'm sorry about 21 that and I'm wondering if you can stay until a quarter after  22  seven?  2 3  W . Yes.  24  T . What about with (NameH)?  25  H . Yup.  26  W . (Laughing)  27  T . What's going on?  2 8  W . I don't think that putting a wall up was very nice  29  (laughing).  30  T . Y o u feel, you are laughing when you say that.  3 1  W . It's not very nice.  32  T . It's not very nice of you?  33  that?  34  W . U m , I think it's just um, it's just not right (laughing), it  35  doesn't feel like I should be doing that. I should be striving  36  to be closer rather than putting a wall up.  37 38 39  T . I've been hearing about your striving, and see the striving. I see the commitment and at the same time I know that boundaries are very important and I know some of the  4 0 4 1  steps you are taking too keep talking and tell each other about your fears. Last time when you were here . . .  What's not very nice about  . . . digression, review of last week. 4 2  T . (Speaking to H)  What do you need to tell me before we  4 3  continue?  44 4 5  H . For me, I'm actually quite surprised at this wall all of a sudden, that surprises the hell out of me.  173  4 6  T . Y o u feel quite stunned.  4 7  H . Ya.  4 8  T . A n d I wonder if we might spend some time just focusing  4 9  on it, would you like to do that ?  50  H . Y a sure, fine with me.  5 1  T . Unless there is anything else that you need to tell me  5 2  first?  5 3  H . No, not me.  (Short digression - off  topic)  54  T . (Speaking to husband).  Y o u didn't expect to see a wall  5 5  H . No  5 6  T . come between these two important symbols.  57  can't even see  5 8  H . No,no.  59  T . Y o u can see the wall and the rock and I am quite amazed  60  that (Name W ) has put a wall there.  6 1  H. M M M  6 2  T . When you look at it, what do you see?  6 3  H . Nothing just a blank, nothing I can't see beyond it , it's 64  In fact you  your symbol from there.  just a wall. 65  T . It's just a blank.  6 6  H . Y a , there's nothing beyond it now, everything stops right  67  there.  6 8  T . Everything stopped.  How does that feel?  174  69  H . W e l l it's discouraging, frustrating, what's the use.  7 0  T . Y o u are discouraged and frustrated.  7 1  H. Ya  7 2  T . A bit hopeless.  7 3  H . Hopeless,  74  T . Nothing beyond that wall?  7 5  H . N o , there is nothing,  7 6  T . Y o u ' v e come up against a blank wall.  ya, that's good.  just like the end.  (Pause) 7 7  H . It surprises me.  (Pause) 7 8  T . Y o u seem far away, right now.  7 9 80 8 1  H . I'm just thinking about, I hit a lot of walls I guess. I just tend to, not ignore a lot of them but ah, not acknowledge that they are there, or acknowledge that they are there, but  82  not let them really bother me, I guess that's another way to  83  do it, just carry on, and it's getting harder and harder to do  84  that now. Not just with (NameW) but with a lot of other  85  things.  86  T . Y o u feel that there are a lot of walls around you right now.  87  What kind of walls?  8 8 89  H . W e l l just dealing with friends and people, ah, I can see where they are coming from and why they are doing things  90 9 1 9 2  clearer than I ever could before. A n d it's not just a bunch of assumptions, it's really true because they'll come out to be true. I just, like I can't see for the world, why they are  9 3  doing, or why people play the games that they do and what  94  not.  175  9 5  T . So you are feeling, these walls have been put there and  9 6  you feel stunned and confused and you feel " well I have to  9 7  accept them, this is the way it is right now".  9 8  feel kind of all alone.  It makes you  9 9  H . Y a and I am losing my drive, I really am losing my drive,  100  I know that.  101 102  walls, that would be o.k., handle it differently, but it seems like I keep hitting the same ones, over time and time again.  A s far as, it's not even like they are different  103  T . What are these walls?  104  H . Lack of people listening, that's a big one.  105  T . W h o , who is not listening?  106  H . Friends, family, not  107  family, her family.  108  T . Y o u don't feel heard by your family, by (Name W)'s  109  family.  110  H . W e l l , not so much (NameW)'s family, my family.  111  T . W h o in your family is not listening?  112  H . Who's not listening?  113  are running scared too, because  my immediate family, friends, my  W e l l , my brother in-law, sister,  they  of their addictions.  (Digression into the problems with his family) 114  T . (Speaking to the husband).  So I wondering about what's  115  going on for you right now, it seems like there are a lot of  116  walls, I don't know how many there are, and where you are  117  amongst all those walls, I don't know that.  118 119 120 121 12 2 12 3 124  H . Basically in the middle, in the middle with a lot of walls around, basically just feeling whatever I have to do to find my way around them. I just keep running into them, that's all, like once I thin I've gotten around it, there's another one, the same thing right there, I try and find another way around it, or over it or whatever, so I just keep going, going, very tiring, very tiring.  176  125  T . V e r y tiring.  126  H . A n d I'm also losing a lot of compassion that I used to have  127 128  for people, probably shorter, as far as my patience goes. I feel I'm getting harder, I don't necessarily like it or not, I  129  just feel I'm getting harder.  13 0  T . So when you hear that (NameW) wants a wall between  131  you two you're fed up?  13 2  H . So that, when I first saw that, to me that is the straw that  133  brakes the camels back, right now.  134  T . That you didn't expect.  13 5  H . No.  136 13 7 13 8  W . I don't know if it is really so much that I want a wall, I think there is a wall, I think I put a wall. it may have been just before we started coming here. A n d it may  139 140  be like (NameH) says it's been, it may be around the same time that he started to become frustrated.  141  T . Y o u ' v e had it since you came back from  142  W . Y a , it was um, and it wasn't right away, I don't know  14 3  when we  144  time.  145 146  T . I would like to invite you (NameH), and (NameW) to do something here. I would like to, what we do here is kind of  147 14 8 149  create psychological space. What I would like to do is to invite you to build these walls around you so that, if we can understand what it is like for you. I'm just going to go, 150  ?  started coming in that was December, around that  would you be willing to do this? 151  H . Y a sure.  152  T . I'm just going to go and see if I can find anything that  15 3  might do as a wall.  15 4  the room to find something that can create that space in  155  here.  Meanwhile, maybe you can look around  177  (T. leaves to find a "wall"), (Pause) 156  T . (Counselor returns with a tall board)  I don't know how  15 7  large your walls are?  158  found that resembles  15 9  H . Actually,  160  for me, is it is more like a maze.  161  T . Like a maze.  162  H . With all the walls connected, like a maze.  163  T . Interesting.  164  H . That's what came to me.  165  T . So if we were to put these out of the way for a moment  166 167 168  (moves symbols and book (wall)). Now, (NameH) if you can tell us about the names. How can you make this maze and how high are the walls, are high are they?  169  H . A h , (pause)  170  T . Say your maze is somewhere here, (pointing to the middle  171  of the room),  17 2  H . Basically in the middle of the maze.  17 3 174 17 5  T . W i l l you come over here then (husband gets up and stands in the middle of the room). What kind of position are you in, are you standing, sitting?  17 6  H . Standing, standing looking say, looking at some different  17 7  pathways, at the end of each pathway, along the sides or  17 8  what not. I see the walls, the walls of the maze.  179  T . Yes, so you would have walls on either side and one at the  180  end?  181  H . Y a , I can see three or four ways to go right now.  18 2  T . A r e you alone in this maze?  How is this ? (She shows what she has a wall).  what came to me to describe it in more detail  in this space, where are you?  178  18 3  H . Y a right now I am ya.  18 4  T . C a n we use this? (Brings over the tall board she brought in  185  to the  18 6  H . Y a sure.  18 7  T.  18 8  H.  189 190 191 192  than me so that I can't see beyond them, and high enough that I couldn't get over without using something else. Like I couldn't get over it myself. So maybe ten feet high, twelve feet high.  19 3  T . Very high, much higher than you.  194  in this  19 5  H . N o , not right now, no.  196  T . So it's like there is a wall between you and (NameW) right  197  now?  19 8  H . Ya.  199  T . C a n I put this here? (Starts to put wall between them)  200 201  H . N o that's not either right now, no because, it's not, it's like we are together, we are together. I think what it is right  202  now is that we are  20 3  T . You're  204  H . Together in the maze.  205  T . W o u l d you be willing to have (NameW)?  206  H . O h ya.  207  T . W o u l d you put her where she is?  20 8  H . She would be right beside me.  office)  How high is it? If you want the height of the walls,  they would be higher  C a n you see (NameW)  maze?  together.  together.  179  209  T . Right beside you ?  So you have come a long  ?  210  H . N o , just standing.  211  right now.  212  T . There is no one else but you two?  213  H . A h , no, just us two right now.  214 215  T . Just you two. You're walls are high, you have no way to get over them. What's on ;the other side of the walls?  216 217 218  H . O . K . say the other side of the wall would be the ideal situation. I haven't seen it, but I believe it's there. So I know there is something there, but I haven't actually seen it,  219 2 20  I'm hoping it's there, right now.  221  T . The other  222  there is an ideal situation but you haven't seen it .  223  H . Y a , but it is real.  224 225  T . Here you stand together in this space, and you're not where you want to be, where are you?  226  H . Like in relationship to where I want to be, where am I?  227  don't know, I really don't know. I want to be moving, I feel  22 8  like I have kinda stopped. I want to be moving.  229  T . Y o u have stopped and you want to be moving.  23 0  H . Y a , but I've stopped and just standing here.  231  T . What's it like inside for you right now, (Name H)?  23 2  H . W e l l it's really frustrating, it's really ah, really angry I  23 3  guess.  23 4  understand what  23 5 23 6  feel frustrated and you feel some tension in your chest, and you don't understand it. It's really hard to accept that it is  Just standing looking, that's how I feel  it's really there,  just standing there  side of the walls, you're hoping and believing  I  It feels almost like it's stupid, ah, I don't really is happening.  180  23 7  this way now. I want to ask (NameW) what it is like for her.  238  C a n you imagine what it is like for her?  23 9  listens to you and stands beside you what do you imagine  Right now as she  240  going on for her?  241 24 2  H . O h , I would say, like honestly, I know there are a lot of things going on for (NameW), she's probably relating it, I  24 3 244  would think, to what's happening with her. It's too far off from what I'm feeling.  245  T . How do you think she is feeling inside right now?  246  H . Feeling? A h , (pause) sad,  247  T . Is that right (NameW)?  24 8  W . Sad, not confused.  249 25 0  T . Sad. It's really hard to be at this place in your recovery together and it seems like you're stopped.  251 25 2 25 3  H . I don't see, as far as I'm concerned regarding my family part, I'm not looking for the road down there actually for that part. I want the path for, I got goals, for friends, for us  254  and our  255  W.  256  T.  25 7  W.  25 8  T . What's it like to stand still (NameH)?  25 9  H . Stand still?  2 60  tapping my  261  T . A n d if that foot had a message to give to you?  26 2  H . T o get moving, to do something.  263  T . How would it be for you two to get moving, right now?  264  W o u l d you be willing to do that?  is  probably not  confused.  situation.  I don't like it, that's the thing, why I am  foot.  181  265  T . I want you to stay tuned in with the space that you  266 267 268  created and to honour that place inside you, where you feel some tension, some frustration and you feel sadness and to move slowly and notice what goes on for you. I really want  269  you to stay connected and to move being aware of those  27 0  precious symbols and move and notice what is going on 271 inside you without talking. A r e you willing to do that?  27 2  H . M m m . (Moves to face goals with wife.)  27 3  T . So you moved over here.  How come you moved over 274  here? 27 5  H . W e l l , I want to move towards where our goals are, that's  276  why.  27 7  T . What's it like to have moved and be standing here now?  27 8  H . W e l l what comes to me is that it is a lot clearer all of a  27 9  sudden, if I'm focusing on that then I'm not looking at all of  28 0  these other blank wall, basically blocked paths.  2 81  T . O . K . so if you are focusing on the goals then somehow you  282  don't see the paths, blocked paths and those walls.  28 3  H . Ya.  2 84  T . So you feel clearer?  285  H . Y a much clearer ya.  28 6  T . How's your body feeling now that you are clearer?  2 87  H . M u c h better, much better.  28 8  T . What's that like, that better feeling, what's that like?  2 89  H . A h , more relaxed.  290  T . Y o u feel more relaxed, right now.  291  H . Y a , loose, not rigid, and even that went away.  182  292  T . O h , it went away, I see.  What about for you (NameW)?  29 3  W . The same, just letting go of the problem, focusing on the  294  positive.  295  better. The ache isn't there anymore.  29 6  T . So what is there instead?  297  W . K i n d of a patience I think.  29 8  excitement,  29 9 3 00  excitement but it's not real deep but there is some. I just kind of have this feeling that we can get over this hurdle  301 302  and i f something would change for the good, we'd get moving.  3 03 3 04 3 05 3 06  T . Y o u feel more relaxed and more hopeful and a little tiny bit excited, and thinking "well, we just got to get over this hurdle and things will seem better". A n d looking down at your symbols here, do you have that wall up between you  3 07  and (NameH) right now?  308  W . Not as big.  3 09  T . Not as big, but there is still the wall there.  310  W. Ya.  311  T . I feel a little torn right now, because  3 12  W . It's not as big as this though, it's very little.  313  T . It's little, could you find something to replace that with?  A n d um, I'm just, that he moved,  it just feels  First of all I was going to say  and there probably is some maybe there is  some  (Wife gets a small paper to put between the symbols, and takes away  the  book)  3 14  W . Maybe it's just that I'm testing him.  315  T . You're testing him?  316 3 17  W . I think so, I want him to jump over it. I was talking to a friend last week and um, telling her what was going on for  183 3 18  me, I just didn't want him to be on top of me, I didn't want  319  him taking over. She thought that that was, she kind of 320 understood. I think why I'm so upset right now is because  3 21  I'm not sure why this is going on for me.  3 22  T . Y o u feel really confused about it.  3 23 3 24 3 25  W . Y a , because I didn't expect this, and it's not for any reason, not out of anger or fear, I'm sure it's not fear. So I don't have any reason for it, but it's just there.  3 26  T . Is it something you want to keep there for a moment?  3 27  W . I don't want to keep it there, but the truth is that it is  328  there.  3 29 3 30 331  T . What if we just for a moment we could take it away. Just think, I'm not sure that you want to do that and I was going to say, just think before you do it, make sure you really 332 want to do it.  33 3  W . (The wife takes the wall away). Y a I do want to take it  334  away.  335  T . Because it's important that you are able to put it back if  336  you need to.  3 37  protect  338  W . I don't need to protect myself.  339  T . Y o u don't need to protect yourself.  3 40 341  W . A n d yet the only thing I can think of is if he's been feeling frustrated, and stuff, it's me just protecting myself in  3 42  case he goes away again.  343  T . So you are really afraid that you might loose him?  3 44  W. Ya.  3 45  T . The wall is kind of a safeguard, I will stay behind my wall  Y o u know, sometimes we need walls up, to  ourselves.  3 46  because if he goes away again then I won't have to be so  347  disappointed.  184  348  W . Y a , and maybe it started just coming up when he started  3 49  feeling  3 50  T . When he feels frustrated you are afraid he is going to go  351  away?  352  W. Ya.  353  T . (Speaking to the husband) D o you know what (NameW) is  3 54  talking about  355  H . Y a , I can understand her feeling that way, but  356 3 57 358  right now, I just get confused too because what I'm thinking about is, when I talked to her before and I didn't tell her I was frustrated or why or what not, she picked up that I was  3 59 3 60 3 61 3 62 3 63  but I wasn't verbalizing it so that scared her. Now when things do bother me I let her know it, I let everybody know about it, and I tell (NameW) how I feel, what I say and what I do. She's afraid, it's just like the same old thing except before I wasn't doing something, and now I'm doing them.  3 64 3 65  W . Y o u were doing something before, you may not have been saying anything, but you would drink and go away.  3 66  H . Ya.  3 67  W.  3 68  are frustrated, I just . . .  3 69  H . (Interrupting) But I see that as good even though  370  W . it is  371  H . because I'm not bottling everything up in me.  372  W . I'm not saying that I did that on purpose but all of a 373  frustrated.  (NameH)? then, like  A n d now you are not drinking and you are saying you  sudden it was back again.  I didn't do it on purpose.  374  H. Ya.  37 5 3 76  T . You're saying (speaking to the husband) "I'm telling you what is going on for me and I'm making this big effort, and  185  3 77  it's not fair that you should go away or you should put this  37 8  wall, I'm making this big effort to change".  379  H . Ya.  3 80  W . Right.  3 81 3 82 383  T . A n d (NameW) is saying, "well I don't mean to, but I'm just really scared, that he might go away." You're really afraid of losing him again. Y o u lost him to alcohol and your afraid. . .  3 84  W . (Interrupting)  385 386  T . Y o u never really had him. (Speaking to husband). Y o u laughed when (NameW) said that.  3 87  H . W e l l , she did.  388 389 3 90  W . I didn't feel like I did. So it's just changed so much now and there are things that are just so good (crying) so I just don't understand why I put the wall up.  3 91  T . Things are so good they are wonderful, in some ways they  3 92  are  3 93  W . Y a , he does things for me without asking.  3 94  T . Hard to believe that they are going to stay this good.  3 95  W . Right.  3 96  T . A n d in your past when things were good, maybe then  3 97  they didn't stay good. Is that right?  398  W . Right.  3 99  H. M M M  400  T . (Name H) you understand?  401  H . Y a sure, ya.  402  T . Is that right?  I never really had him.  wonderful.  186  403  H. Ya.  404 405  T . So now there is something very different happening and this time it is very likely that it will go on being good, and  406  it's hard at the moment to trust that that will happen.  407  you get scared and up goes your wall.  408  W. Ya  409 410  H . See what I see, is that it's not so much (NameW) not trusting me, it's her not trusting herself.  411 412 413 414 415  T . Or just having a pattern of not trusting. W e sometimes learn that when we grow up. I certainly did, I learnt that it wasn't safe to trust because people would go away from me. So to learn a new pattern, it took quite a long time, I had to be patient with myself. A n d it is scary to think that you  416 417  might loose (NameH), it seems that you love him, I don't know but it seems that he is very important to you.  418  W . (Crying) Y a .  419  T . (Notices husband's foot tapping) A n d your foot gets  420  impatient,  421  H . It could just be what I normally do.  422  T . This is one of your old patterns, this restless foot.  423  W . Even the wedding pictures is like that.  4 24  T . When my partner used to tap his foot I used to think that  42 5  he's not listening to me, and that may not have been the case  426  at all.  427  H. Ya.  42 8 429  T . It seems that you are very tuned into what's going on with (NameW) and you understand that in her past, there  43 0 4 31  were times when things were good and then she learnt not to trust that they would go on being good . . .  So  restless?  187 432  H. Ya.  43 3  T . because then it changed.  4 34  of.  435  H . U h uh, ya.  43 6 43 7 438 43 9 440  T . So I noticed that you are still nearer to the goals than a little while ago and (NameW) took down her wall and put it here. A n d I sort of put it there thinking "she may still need it again", who knows, sometimes people need walls. I don't know if I did the right thing? D i d you want it here? (asking  441  wife?).  442  W . Doesn't matter.  44 3  T . Let me ask you where you want it now?  444  w . Just there (wife removes the wall from between the  Y o u know what she is thinking  symbols) 445  T . (Speaking to husband) Now you can see your symbol.  446  H . Ya.  447  T . W e have come a long circuitous route today.  44 8  went into a maze, well first of all you told us about these  449 450  walls that you are coming up against in your life. A n d then I invited you to create a maze and you did and you told me  451 45 2 45 3 45 4 45 5  that you are not alone, you have (NameW) and it felt really uncomfortable to be stopped and you wanted to get moving and so you did and you come over here, the two of you, and you felt clearer, more relaxed, the pain changed, you felt differently inside, more hopeful, and realized to keep  45 6  focused on the goals is to feel much clearer, much better.  457 45 8  A n d to put attention on all these walls and on people who are not listening just drags you down, makes you run out of  45 9 4 60  gas. A n d you came here and (Name W ) took down her wall and told you what that means, that she's really scared.  A n d you  Appendix  189  Transcript of Unsuccessful RI Event  (T. = Therapist;  W . = Wife;  H . Husband)  1  T . W o u l d you like to work with this image, the juggler, is  2 3  there a point in that, if not, what other ideas would you have.  4  W . W e l l , I know (Name H)'s  5 6 7 8 9 10 1 1 13 14 15 16 17  few years, particularly in the finances. A s long as I don't know about them, then he can spend as much as he wants on whatever he wants and I have no say and that's what I see as juggling. I see lack of responsibility. I mean, most people have budgets, we don't have anything near a budget. It's like, if her gives me grocery money, I'm lucky. A n d if the hydro bill gets paid, we're lucky. Y a , that's juggling, sure 12 juggling to keep from being evicted. I don't consider that juggling very constructive and that's why, and that's one of the areas that I have been particularly angry with through the last few years. It's because when we were first married I was involved in the finances, and even though he had total control that was fine, I knew what was happening , we had  18  fixed goals and I didn't buy clothes and things . . .  19  H . (Places coffee mug down on table loudly)  20  mean you didn't buy clothes?  2 1  been juggling things now for a  What do you  W . I didn't, I didn't even go to a second hand store in the 22 first five  years.  2 3  H . (Talking at the same time as the wife)  24  W . Y a sure I do now, I buy a lot more clothes now because  25  we don't own a house.  26  persona, that I project, that is the only thing that I own in  27  this  2 8 29  H . She's never been happy with anything. I get a house and she doesn't like the house I get. W e move to Ontario, I get a  The only thing that I own is my  world.  190  30 3 1  house, she doesn't like that house. Everything I get, she doesn't like it because quote, unquote, it doesn't live up to  32  the Jones'.  33  W . I'm the one who is willing to wall paper and paint but he  34  won't buy it.  35  H.  36  T . C a n I step in?  37  W . Yes, please.  38  H . (Coughs) I'm, catching a cold.  39 4 1 4 2 4 3  T . Y a , I can see that, however, you won't die fortunately, 40 from the cold. O . K . there's a kind of, an understatement to say there is something here, that you guys are talking about, that is very contentious, really contentious and perhaps, I know, how do you feel about it, do you think, that you have  44  been successful  4 5  thing  4 6  H.  4 7  though.  4 8  T.  A n d she is a very pressuring women.  Pressure on the finances (People talking all at once)  at working through this contentious kind of  before?  W e get by because I step down, but it's always there  O . K . you step down,  as the underdog steps down.  O . K . 49  hold it for a minute, (facing wife) that doesn't make you feel 50  good right.  5 1  W.  W e l l that may be his perception of the situation but . . .  52  T.  (Interrupting her) Hang on for a second because you are  53 54  not hearing what I'm saying. There is something there to what you are saying, there is something that is leaving you  55 56  feeling not happy, uncomfortable with the way that you two guys have so far worked out say finances and some of these  57 5 8 59  things and you're unhappy. He's also unhappy too and and how can I say this the argument that you guys are having in here right now. (Speaking to husband) stop grinning at me !  (Both T . and H . talking at once)  191  6 0  H . You're trying to find the words,  6 1  T . You're saying, "This guy is trying to figure this one out 62 here."  6 3  H . I know what you are trying to get across.  64  T . (Speaking to husband) what am I trying to say?  6 5  I trying to get  6 6  H . She sees one way I see the other way, and the thing is 67  What am  across?  there is something in between this all.  Y o u are trying to  6 8  picture all that in between us.  6 7 7 7 7 7 7 7  (referring to himself). You're right (referring to wife), you both a little balance here and you have worked it out over the years but still (Name H.) steps down on this and she says the reason why (Name H.) steps down is because he doesn't let me get involved in the finances and allthat stuff and so he would rather just back out." I'm not saying that I'm stuck with words like you are but I know what you're trying to get through  9 0 1 2 3 4 5 6  " A n d while he is right  7 7  T . Y a . O . K . and in addition to that  7 8  look you guys both feel stuck in this, right? and you feel like  7 8 8 8  the only response ultimately for you is to step down" and I'm saying that's not good, there's a different way and I think there is growth to come out of this for the both of you. I think there is a different way. There is a different way,  9 0 1 2  I'm trying to say  "well,  8 3  there's a way in which you could say, "oh, wow, the way my  84  husband is handling this right now, makes me feel just fine,  85  and we've worked through this to a great degree".  86 87  there is a spot that you can get at where you can say that. A n d you'll also say, "ya, and he's not stepping down, we  8 8 89  haven't solved this in such a way that he ends up stepping down or that I end up just closing off my mouth and not  9 0  saying anything."  9 1  would you guys like to work on that ?  9 2  H . I've been secretly doing things in the past, just in the past  9 3  couple of weeks.  9 4  going to try  9 5  T. Ya.  I know  There's a different way is all I'm saying,  I mention to you a little while ago that I'm  some different things.  192  96 97  H . A n d I have been and a lot of stuff she's kept in the dark. But when we first met she was in the dark.  9 8  T. O.K.  99  H . A n d so I'm going back to square one when I built all my  100 101 102  wealth up, quote, unquote material things. I'm getting into that area and keeping her out, just deliberately, I don't want her involved. I'm doing what I have to do.  103 104 105 106  W . (Interrupting) I've never asked to be in charge of the finances or even know, as long as I got my grocery money every week. I'm not a pushy woman in that regard. But when I'm getting $60 a week at most for groceries for a 107 family of four and it cost $125.  108  H . but that's not true (speaking over wife)  109  W.  110 111 112  a second hand store, 'cause I don't have enough money. A n d this has been going on for months and months and months, and in fact it's being going on for two years, and I've  113  basically had enough.  114  H . (Starts to talk but then waves his hand and decides not to  115  speak).  116  T . N o w you've just stepped down.  117  and that means I can't buy any clothes, I can't even go to  H.Ya.  118  T . O . K . that's second best.  119 120  H . I could say things but I don't want to add to the situation, I don't want to make it even worse, so I'll just stay down.  121  T . So do you notice what you are telling me is that you feel  122  right now is that you guys are in an argument, and you could  123  cycle the argument . . .  124  H . (Interrupting) It's always been there, it's just that we just  125  deal with it, we exist with it.  193  12 6  T . Y o u exist with it.  127  W . It's not as if I haven't tried to do things that  12 8 129  T . (Interrupting, facing wife, moving closer) (Name W ) , you have tried, (Name W ) you are a wonderful woman, you are a  13 0 13 1 132 133 13 4 135 136 13 7 13 8  wonderful woman and you have tried, you have struggled to do you very very best. I know that and I bet ah, you know, in his sanest moments, in his most calm and secure moment, he's going to say exactly what I've just said. I don't see evil in your heart or mal intent inside you, ya sometimes you set out to thump people (punching hand in fist). I mean your human right, but you are not a witch, you're just a human being, doing your very, very best. (Looking to husband) A m I telling a tale here, in your sanest, calmest, secure moments,  139  you're going to say, "ya she's really doing her best".  140  H . Y a she's human.  141  T . A n d human too.  142  with this, you're putting up with it and that's o.k., in a way  143  that's good.  144  H.  145  T . You're trying to do  146  H . I did.  147  T . Your  148  H . N o , no I've done this before, but I'm just older and more  149  mature now, so I  150  T . W e are still looking for something to work on today.  151  H . Money is always a problem.  15 2 153 154 15 6  T . A n d sometimes it seems discouraging, you say "well you know, we've made some progress but you know, but this one we'll never get through never. Never will we ever be able to get through this one." Y o u must feel so discouraged  . . .  A n d you guys are taking second best  W e l l I'm not now. something?  experimenting?  take it more in stride.  194  157  sometimes  when we go to the next step.  15 8  W . Y a , money is pretty contentious.  15 9  T . Could this be one of those situations where  160 161 162 163 164 165  looking back and saying "ya there is some kindness there and it wasn't there before and we are able to do a few things now that we weren't able to do before, it is still tentative you know um, um, but now we are facing the next step, and we are facing it and how are we going to get through this one". A m I right? Is there that kind of feeling?  166  H . I don't know, but you said about having your set goal or  167  whatever, and I told you last week since I've got something  168  to work on for the next couple of weeks, and I'm seeing it  169  myself,  17 0  T. O.K.  171  H . forget everybody else.  172  T. Ya.  17 3  H . I see myself on something that seems to be heading in the  174  right direction.  you guys are  A n d if they happen to be there, they are  175  there.  17 6  change this pattern.  If they are not, they are not, I'm still not going to  177  and I did a bunch of things.  17 8  job for twenty years, my thoughts are again, I could make  17 9  my mistakes and go back to entrepeneuring again,  18 0  where you have to sit and  181  T . Juggle.  18 2  H . juggle. "Keep your thoughts to y o u r s e l f , because every  18 3  time I mentioned it to her, ah pounce on me.  184  W . That's not true, that's not true, if you,  18 5 18 6  what they want to do and before they let go of one, they move onto the other, kind of like rock climbing but to just  187 18 8 189  sort of say, "well I've finished with that, I've quit that's it with that and then spend the next six months unemployed because they can't find a decent job". That's no the way to  Like I said, I went and got myself a job, She'd be happy if I hang onto a so  that's  if a person knows  195  190  go about it, when you are trying to raise a family.  191  H . N o it's not. I agree with that.  192  W.O.K.  193  H . I've never said anything negative.  194  T . Y o u guys are having a spat, squabble.  195  W . (laughs)  196  H . N o just disagreements.  197  T . W e l l , I call it a spat, squabble, disagreement would fit for  19 8  me too.  199  H . I'm pretty strong with what I'm saying, I mean it, I've  200 201  given up on her disagreements, now I'm doing just what I'm doing.  20 2  T . One of your strengths, one of your strengths.  203  H. Ya.  204  T . Great.  (Pause) 205 206  T . I have to add too though, sometimes one of your weaknesses is your strength.  207  H . Correct, go to fast, get too cocky as they say, and you can  20 8  just crash down as fast as you got there.  209 210  T . Whatever we do, if we do get to work on something here today, whatever, we do, if there is any success then we can't  211 212  say "ah wonderful", nor should we even go to far too fast. W e ' v e got to really work on something. I'm still coming back  213  to this.  214  on  215  H . W e l l , as I say we have come here to get counselling, we  Is there something, perhaps this, that we can work  today?  196  216  have come here to figure it out, you are suppose to be calling  217  the shots.  I understand that you have to get subjects to find  218  out what the problems are, everybody has a problem, so you  219 2 20 221  have to find the main group and take it out. The whole thing is the drinking created a problem, for action there is a reaction, so of course that created a lot of the financial  222 223 2 24  problems also, the drinking too. But even i f I didn't drink there is still financial problems, so they are always going to be there, it's just how you cope with it in your daily life.  225  T . Y a , that's why the financial problems could be a subject  226 2 27 22 8 229 23 0 23 1 23 2 233 23 4 235 23 6 237  that we work on and it's a legitimate thing for us, for this team in here to work on, because it is linked to her behavior, to your behavior and it's linked very much to the bottle. A n d feelings and thoughts are' very much involved. But I really appreciate that you say that I'm the expert and you can trust my judgment and one of the things that I'm acutely aware of though is that I cannot come in here and say "I think, well I know that we must work on this today, so you guys are going to work on this ". I know its my role to say, "well look it, to me it makes sense today to work on this , what do you guys think about that?" That's my role, the one thing that I just can't do is, won't do, is say "we are going to  23 8  work on this today".  23 9  H . W e l l , I'm not a woman's libber.  240  and helpful, right, but when a woman starts to get out of  241  her place in my life, I kind of put the wall up and that's what I've been doing lately.  I believe in supportive  I remember the first few  242  days  24 3  we met each other, I shouldn't mention this but I was  244  banking all my money and I was living in all these in all  245  these houses and I was living just with a mattress on a  246  heater, I'm just one of these, I didn't have any friends , I just  247  knew a lot of people, and so I functioned by that means,  24 8  people used to borrow money off of me or cigarettes,  249  whatever, that's fine, I didn't mind helping out in that area.  250  T . Yes.  251 25 2 25 3 25 4  H . But I lived in all and then went to the floor, the owner who me and that's how I  these homes, I built them, lived next one, just with a mattress I worked for at that time used did it free room and board and  in them on the to feed I got my  197  25 5 256 25 7  pay cheque and I banked it. A n d I do this and this and I met her, ah, she ah I remember driving over to the (Name of a place) once, I only had one pair of pants and one pair of  25 8  shoes and I was contented with what I was doing, you know,  25 9 2 60 261  if I wanted to I could have went and bought another pair of pants, I didn't want to. I didn't know what I was saving my money up for, I just put it away, I'm just that kind of a guy.  262 26 3 264  A t that time and she mentioned to me "well I don't have this, I don't have that" and I thought my goodness, "I got one pair of pants and your complaining". It's just, I function that  265 266 2 67  way, but over the years that part has changed. I still have domination, I guess you could say. When we bought our first house and then we sold that and bought our second  26 8 269 27 0 271 27 2 27 3 27 4 27 5 27 6 27 7  house, then we went on from there and eventually it went down hill. I wasn't satisfied working in the mill, I was a first aid attendant and shop steward and I was getting burned out, I was working day and night, night shift, afternoons, overtime, and all that stuff. I was getting pretty burned out, sure I'd stop, I was drinking a bit, at that time, not to the point to realize that I was getting into a problem. A n d I'm just generalizing here, at that time too I always had two cars and she complains she doesn't have a car, and we got one car but she needs two, one for her and one for me. . .  27 8  W . (Interrupting) I'm not complaining about not having a  27 9  car.  2 80  H . W e l l , not now but we mentioned this over the years, but  2 81  she says'T gotta have a car if we are going to live here"  282  want to go to the country. . .  28 3  W . (Interrupting)  284  gives me the car ever.  285 28 6  H . One of the thoughts of juggling is that I want to get a hobby farm. I want to go work Monday to Friday. I have a  287 28 8  nice job now, and I want to come home and feed my animals on the weekends, do the garden, I love the garden and all  2 89  that stuff, quite mellow country life, but there is no way  29 0  is going to live in the country she says.  291 29 2  W . I simply said, that 's right, that I will not live in the country without the car because he will not give me any  I  I have to have a car because he never  she  198  293  particular days of the week that are my car.  He just won't  294 295 296  give me the car, like I can't say, "I want the car this day a week every week". Like he won't give me any kind of firm thing that he will keep his word on. So therefore, i f I live in  297  the country that means I'm totally dependent on him. . .  29 8  H . (Interrupting) I did state too, if you don't mind my  29 9 3 00 3 01 3 02 3 03 3 04 3 05 3 06 3 07 308 3 09 310  saying,that ah, I've always, I gave her a car for Christmas once, you know, I've always had two cars for her, I had seven cars at one time, a van and all this stuff, I had all the material things. A n d ah, the cost has changed today since it was years ago but I've always said "yes I want to give you a car". I do, I wouldn't mind, the thing is I'm getting older, things have changed a bit, now i f I can take the car to go to work and back that's fine. W e are going to have to juggle 3something around, so we can make it so she can have a car to go to school, while I go to work or something, because I have to work it out but it takes time. Y o u have to go with it, that's what I'm doing right now I'm just sitting back and  311 312  doing what I have to do. If she is not going to be patient enough then that's up to her, but I'm doing what I have to  313  do.  314  T . You're telling me, listen to what you're telling me,  315  saying, you're saying, "I'm doing juggling and ah, it seems to  you're  3 16  me . . .  317  H . (Interrupting) It's a long term goal.  3 18  T . It seems to me, it feels legitimate to me, the long term  3 19  goal feels legitimate to me, but it seems like "she'll never  3 20  appreciate  3 21  H . She will after.  3 22  T . O.k. but right, o.k. then I'll adjust that/cause you are  3 23  helping me understand this o.k. "I have a long term goal and  3 24  I feel good about that long term goal and right now to get  3 25  there I'm doing kind of a juggling and she will want to reach  3 26  that  3 27  and that doesn't feel good to you.  3 28  H . W e l l , she'll hear it and do it, but it's very difficult for her  this".  goal but right now she is just not going to appreciate it"  199  3 29 3 30  to believe things too. So she's in a situation, I understand her when she's "Oh sure, sure, sure". So instead of telling her  331 332  anymore and forgetting promises and all that stuff, I'm just keeping her out in the dark and do what I have to do. A n d  333 3 34  eventually I'll come out and say here is your car. O r eventually I'll do this and that but now she's hearing this  3 35  you see and she's probably thinking "o sure, I heard this  3 36  before".  3 37  T. Ahh  33 8  H . She's not to be blamed for it,  3 39  T . No  3 40  H.  3 41  difficult for me every time I say something. . .  3 42  T . (Interrupting) I know, so what you are talking about is  343 3 44 3 45 3 46 3 47  there is a kind of stuckness, right? She's hearing this heard all of these blaming thing, its  348  H . Right.  3 49  T . But you say, but that's not quite, that's not satisfying  3 50  because  3 51  H . W e l l , all it does is create a daily disturbance.  352  T . That's what I'm saying this a bind between the two of you.  353  A good woman and a good man, who are in a terrible bind,  354  you are both trying to get to a dream spot which is  355  legitimate.  3 56  H . A contented spot.  357  T . Y a o.k. and yet in this point in time, today they find  358  yourselves in a malign bind, that they really don't deserve, I  3 59  mean really, he doesn't deserve to be in this bind, you don't  3 60  deserve to be in this bind,  her feelings are right, I don't mind that, but  it's  it makes it  a bind that you guys are in a kind 'Cause you just said "she's a good woman" . and she is probably thinking, "oh, I have things before, but (Name T . ) , this is not a she's logical that she would think that."  trouble between  us.  but you are in the bind.  200  3 61  W . W e l l , I think what happened was we were both involved  3 62  in the finances . . .  3 63  T . (Interrupting)  3 64  D o you have a sense of . . .  What was your reaction to my  statement?  (Both C and W talking at once)  3 65  W.  W e l l he is reaping what he is sowing through the years,  3 66 3 67 3 68  he's constantly deceiving me about the finances and how much he owed or who he owed or who he borrowed from. A n d then we get the welfare cheque and instead of paying  3 69 3 70 3 71 372 373 3 74 375 3 76  the rent, paying the hydro and putting money aside for groceries, he pays the rent, maybe pays the hydro, sometimes pays the rent, sometimes pays the hydro and then he pays back everybody that he thinks he owes, that I don't know who he owes, that he borrowed money for drinking or whatever and then we got to go three weeks of every month without grocery money. This is what is upsetting to me, is I cannot rely on being able to you know, I  3 77 378  have to buy a book, I and don't have any money today for a story that I have to write a 1500 word essay for next  3 79  Wednesday.  380  H . Y o u know, every time she snaps her finger we got to  381 3 82  respond to it, everybody I know, I've talked to households who are both career people and they are having there  3 83 3 84  financial troubles. It doesn't matter what level it is, or how much money they make, they are still having their  3 85 386  difficulties. I have like I said, the old traditional ways, that you do what you do. I come form a family where we had  Y o u think I'm not upset, I'm upset.  3 87  nothing, we didn't even have sugar in our house and they  388 3 89  had to start from there on. W e lived on rice for a while, I mean she was brought up that way too. The thing is "I'm  3 90  never going to do this", but the system, sometimes you are  3 91  going to have your up and downs, you learn from that.  3 92 393  depression, we learned from depressions, misers today because of that.  3 94 3 95  W . I shouldn't pay for it when he drank last month and spent the money. He should give me the grocery money for  The  my parents are  201  3 96 3 97  the month, and then if he has to go work in the fields to pay for the bills that he owes because he went drinking last 398 month, then he should do that because that's his  3 99  responsibility.  400  he doesn't want me to work, he doesn't want me to do a lot  401  of things, then at least he should do his part of the bargain  402 40 3 404 405 406  which is providing a place to live and what to eat. I'm not asking for new clothes all the time, I'm not asking for new clothes for my kids, or runners or fancy anything, or brand new cars or anything, new furniture, which we haven't got any new furniture,that's fine I'm not asking for those things,  407 40 8  I'm simply asking for grocery money. A n d I don't understand why I'm being blamed when I'm simply  409  for grocery  410  H . ( H . husband talking over W.) I didn't blame you.  411 412 413 414  T . (Interrupting) I'm going to jump in here for a minute. Do you notice what's going on between you two, well you have to notice, you guys are having a disagreement, squabble, spat, fight, o.k.. That's alright, I know you have concerns  415  about that.  416  W. M M M  417  T . I mean you would (pointing to wife)  418 419  H . I have my mind made up what I'm doing, it doesn't matter what, if she doesn't like what I'm doing, that's too  4 20 421  bad, there's the door. 'Cause I'm doing what I have to do and that's right and if she doesn't like it that's too bad.  422 42 3  T . (Referring to husband) W o u l d you like me to help you work on this so that it could be more satisfying. ' Cause I  424  know what you are saying now is "it's o.k. you can survive it,  425 426  you are a survivor, you will survive" But you know that there is a better way, , so would you like me to , would you  427  like to take some risks with me, walk out on some thin ice,  42 8  all three of us together, do you think there might be a way  4 29  to dance on this thin ice.  43 0 43 1  H . It's just the things that I was doing right now is the right thing to do o.k.. A n d the first thing is to get the job, the first  He doesn't want me involved in the  finances,  asking  money.  Would you like me to help you with this ?  202  43 2  thing is working there, it takes time and it takes its course  43 3  and the thing is you are going to say "get her involved in the  434  finances"  43 5  T . W e l l , I'm not going to say that .  43 6  H . W e l l , that is what she desires so of course you are going to  43 7  have to have a mutual consent on this area.  43 8  T . But you see  43 9  H . I'm doing what I did before and I'm doing it again.  440 441 44 2 44 3  T . O.k. now listen, compromise isn't what you guys need, it's not what you guys need. Y o u must not be forced into any position. There may be times when you look at yourself and say " ah, gee, am I doing the right thing", and you really  444 445 44 6  deeply question yourself and then you make a decision one way or the other but you must not make any changes that you feel are forced upon you by me.  447  H . She's forcing something.  44 8 449  T . O.k. so then what I'm saying, this is what I'm saying (Name H ) , would you like, I'm giving you an invitation, in  45 0 451  fact I'm telling you this is the way that it is possible to do it. A n d I don't want to help you guys make any changes  45 2 45 3 454  whatsoever, that leave one of you feeling that you were forced into making any kind of a change, even if it was a tiny one. Right now she has to get involved in a particular  45 5  kind of way and that's the only way that she can . . .  45 6  H . (Interrupting) It's  45 7 45 8  T . O.k., ya fine but if that's the only way to work it out to make her happy, it won't ultimately lead to happiness for  459 460 4 61 462  the two of you. So somehow there has to be an evolution, that you'll walk away from this saying "gosh, this feels right, we made a change and I like it" she says at the same time" we made a change, ya and I like this too". It won't work if  46 3 464  the change comes an you say " well he's happy but I'm not" or "she's happy now but I'm not". So my invitation, my \  465  question, would you like me to help you?  her security.  203  466  H . Time.  467  T . O.k.  46 8 4 69 47 0  H . It takes time to do what I'm doing right now, and she doesn't see the result right now, but at the end she will. But of course she is angry and bitter at me right now.  471  T . Y a and that's dissatisfying to you.  47 2 47 3 47 4  H . W e l l to a point but I can take it, 'cause I know the light is there, so I'm just going to keep driving at it, you know, I don't know how long it takes, but if you keep going you'll  47 5  eventually  47 6  T . O . K . that's fine.  47 7 47 8 47 9 480 481  H . So she's out in the dark a lot but I do what I have to do. If I need twenty dollars for gas to go to some place and she ask me where the money was, I'll just you know, if she doesn't smell alcohol on my breath, then she doesn't have a question. I've been to Victoria three times this week, she  482  doesn't  48 3  T . She knows now.  484  H . But she didn't know that and where the money goes and  4 85  that I'm  486  W . I'm not asking where its going, I'm asking , give me my  487  grocery money first and then do whatever you want.  48 8  always been my attitude, I've never been a demanding sort  48 9  of "I'm in charge of the chequebook" kind of woman, I've  490  never have been and I don't feel that I need to be, so.  491  T . W e l l , let me draw this to a close.  get  there.  know that.  . . .  That's  204  Appendix  E  205  The  Therapeutic A l l i a n c e Scales-Revised  Pinsof  and Catherall  (TAS-rev.)  (1986) designed  the Therapeutic  Alliance Scale ( T A S ) as a self-report measure of the experience client has of the therapeutic alliance.  They defined the  a  therapeutic  alliance as " . . . that aspect of the relationship between the therapist system  and the patient system  that pertains to their capacity  mutually invest in, and collaborate on, the therapy" (p. T w o dimensions  represented by three subscales: dimension  is  other-therapist,  The content  dimension  bonds, tasks, and goals.  represented  the multiple relationships possible therapist,  139).  are used to operationalize this definition -  Contents and Interpersonal System.  interpersonal  to  and  by  three  is  The  subscales  reflecting  in the therapeutic milieu such  as  group-therapist.  There are three versions of the T A S .  T w o of these versions,  namely, the Individual Therapeutic Alliance Scale ( I T A S ) and the Couple Therapeutic Alliance Scale ( C T A S ) were used in T A R P . order to provide a statistical  comparison between the  two  In treatment  modes, the two scales were revised so as to render them alike (Olsen,  1993).  

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