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The resolution of decisional conflict : relating process to outcome Webster, Michael Charles 1981

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THE RESOLUTION OF DECISIONAL CONFLICT: RELATING PROCESS TO OUTCOME by MICHAEL CHARLES WEBSTER B.A., University of Notre Dame, 1966 M.Ed., Western Washington State College, 197 6 THIS THESIS IS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF EDUCATION in THE FACULTY OF GRADUATE STUDIES (Department of Counselling Psychology) We accept t h i s t hesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA September 1981 o Michael Charles Webster, 1981 In presenting t h i s thesis i n p a r t i a l f u l f i l m e n t of the requirements for an advanced degree at the University of B r i t i s h Columbia, I agree that the Library s h a l l make i t f r e e l y available for reference and study. I further agree that permission for extensive copying of t h i s thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. I t i s understood that copying or publication of t h i s thesis for f i n a n c i a l gain s h a l l not be allowed without my written permission. Department of I—- cr< The University of B r i t i s h Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 Date DE-6 (.3/81) Abstract Thirty-one c l i e n t s completed a b r i e f psychotherapy program aimed at resolving intrapsychic c o n f l i c t related to the making of a d e c i s i o n . The c l i e n t s completed a group induction session prior to therapy where they were introduced to the Gestalt conception o f intrapsychic c o n f l i c t as opposition between two aspects of the personality, to the two chair operation, and were given the pre-experimental measures. The c l i e n t s then attended therapy sessions once a week for a maximum of s i x ses-sions. If they resolved t h e i r c o n f l i c t s before the sixth session they were required to return one week and one month following the resol u t i o n session for a b r i e f termination and follow-up interview at which time they completed the termination and follow-up measures. If the c l i e n t s d i d not resolve their c o n f l i c t s before the sixth session, they t e r -minated at the completion of the s i x t h session, completed the ques-tionnaires and returned one month l a t e r for follow-up. The t h i r t y - o n e c l i e n t s were then separated i n t o two groups, resolvers and nonresolvers, based on a pattern of rated process i n d i c a -t o r s . The resolvers were i d e n t i f i e d as those c l i e n t s who had manifested the three c r i t i c a l components of Greenberg's (1980a) proposed model of i n t r a p s y c h i c c o n f l i c t r e s o l u t i o n . The t h r e e c r i t i c a l components necessary for resol u t i o n were the expression of c r i t i c i s m toward the experiencing aspect of the personality (the organism i n Rogers' (1959) terms), the expression of f e e l i n g s and wants from the organism and a subsequent softening i n attitude by the c r i t i c ( " s e l f i n Rogers' (1959) terms) toward the organism. The c r i t i c a l component of c r i t i c i s m was measured by the Voice Quality System (Rice, Koke, Greenberg, & Wagstaff, i i 1979) and the Structural Analysis of Social Behavior (Benjamin, 1974). Felt wants were measured by the Experiencing Scale (Klein, Mathieu, Keisler, & Gendlin, 1969), Benjamin's system, and voice. The softening of the "critical self" was measured by the occurrence of affiliative behaviors on Benjamin's system, focused voice on Rice's system and a level four or above on Klein's system. Nonresolvers were defined as a l l those clients who completed six sessions and did not exhibit the preceding critical components. This process analysis produced thirteen resolvers and eighteen nonresolvers. Pre-experimental and post-experimental outcome measures were taken on an adapted version of Osipow's Scale of Educational and Vocational Indecision (Osipow, Carney, & Barak, 1976), Spielberger1s A-State (State Anxiety) (Spielberger, Gorsuch, & Lushene, 1970), Target Complaints (Battle, Imber, Hoehn-Saric, Stone, Nash, & Frank, 1966), and a report of behavior change. Pre-session and post-session measures also were taken on the effects of the critical session (session .resolvers) on sense of conflict resolution, Target Complaint Discomfort Box Scale (Battle et al., 1966) and the scales of self acceptance, integration and power from Epstein's (1979) Prevailing Mood Scale. The effects of the critical session on attainment of a goal set at the end of the critical session, and on attitude change and Epstein's measures were also examined over one and four week periods. Two-way repeated measure!? analyses of variance were used to analyze the pretest posttest data that satisfied the homogeneity of variance conditions for this test. A Wilcoxon rank sum test was used for the remaining data. Statistically significant differences at the .05 level were found between resolvers and nonresolvers on indecision and state i i i anxiety. Simple comparisons revealed that the groups were s i g n i f i c a n t l y d i f f e r e n t at both termination and follow-up on indecision and at follow-up on anxiety. An inspection of the means revealed that the resolvers were les s undecided and l e s s state anxious. S t a t i s t i c a l l y s i g n i f i c a n t differences at the .05 l e v e l were also found on target complaints and reported behavior change at termination and follow-up. An inspection of the means revealed that resolvers had improved and changed behavior more than nonresolvers. With regard to the c r i t i c a l session measures, the resolvers and nonresolvers were s i g n i f i c a n t l y d i f f e r e n t on sense of c o n f l i c t r e s o l u t i o n , target complaints discomfort, s e l f acceptance, integration, and f e e l i n g s of power. The prolonged e f f e c t s of the c r i t i c a l session yielded s i g n i f i c a n t differences between resolvers and nonresolvers on s e l f acceptance, i n t e g r a t i o n , f e e l i n g s of power, goal attainment, and attitude change. An inspection of the means revealed that the resolvers had made greater gains on a l l these mea-sures. i v TABLE OF CONTENTS I. INTRODUCTION 1 Background 1 The Problem 4 D e f i n i t i o n of Terms 7 Gestalt Two Chair Operation 7 S p l i t 9 C o n f l i c t Resolution 10 Model of Successful Performance 11 Change 12 Resolution Components 12 Blame 13 Standards and/or Values 13 C r i t i c i s m 15 Feelings 16 Wants 18 F e l t Wants 19 Softening 19 Negotiation 20 Re solver 20 Nonresolver 21 Rationale for Hypotheses 21 Hypotheses 22 Treatment Outcome Hypotheses 22 Hypotheses for C r i t i c a l Session Outcomes 23 1. Immediate E f f e c t s 23 2. Prolonged E f f e c t s 24 I I . LITERATURE REVIEW 26 The Relationship of Process to Outcome 27 The Steps of the Task Analysis 31 1. S p e c i f i c a t i o n of a general model of human 31 functioning 2. Task s e l e c t i o n and task d e s c r i p t i o n 31 3. Evaluation of the task environment 32 4. The d e s c r i p t i o n of possible performance—"the 33 thought experiment 5. Description of the actual performance 33 6. Constructing a s p e c i f i c model 33 The S p e c i f i c Model 34 7. The p r e d i c t i o n of performance 36 8. The r e l a t i n g of process to outcome 36 Decision Making 37 S p l i t s and P o l a r i t i e s i n Human Functioning 44 Research on the Two-Chair Operation and C o n f l i c t Resolution 52 Decision and C o n f l i c t 55 v III. METHODOLOGY 60 Measuring Instruments 60 Overview 60 Process Instruments 61 1. The experiencing scale 61 2. Structural analysis of social behavior 62 3. Client voice quality system 65 Relationship Instruments 66 1. Working alliance inventory 66 2. Barrett-Lennard relationship inventory 67 Treatment Outcome Instruments 69 1. Scale of indecision 69 2. State-trait anxiety inventory 70 3. Target complaints measure 72 4. Phillips personalized questionnaire 74 5. Behavioral report 77 Critical Session Outcome Instruments 78 1. Immediate effects instruments 78 Conflict resolution scale 78 Target complaints discomfort box scale 79 Epstein's prevailing mood scale 79 2. Prolonged effects instruments 83 Goal attainment scaling 83 Post critical session questionnaire 84 Miscellaneous Forms 85 1. Therapist report form 85 2. Consent form 85 3. Information sheet 86 Participants in the Study 86 Subject Selection 86 Sample 87 Therapists 88 Raters 88 Data Collection 89 Scoring Procedures 92 1. Identification of engagers 92 2. Identification of critical sessions 95 Softening 97 Felt wants 98 Criticisms 98 Design 100 Statistical Analysis 101 Analysis of Treatment Outcome Measures 101 Analysis of Critical Session Outcome Measures 103 1. Immediate effects 103 2. Prolonged effects 103 IV. RESULTS 104 Treatment Outcome Results 104 Critical Session Results 116 Immediate Effects 116 Prolonged Effects 119 The Provision of Additional Information by Nonspecific Factors 127 Summary of Results 129 vi V. DISCUSSION 131 Summary 131 Conclusions 134 General Discussion 139 Example 1 144 Example 2 145 Example 3 146 Limitations of the Study 148 Recommendations for Further Research 149 Implications 150 REFERENCE NOTES 152 BIBLIOGRAPHY 153 APPENDICES 164 A. The Instruments 164 B. Phillips Personalized Questionnaire Analysis 186 Procedures and Data C. Preliminary Tests on Data 204 D. A-Trait Data 211 v i i LIST OF FIGURES Figure 1.1: The Specific Model 6 Figure 2.1: The Combined Model 59 Figure 3.1: The Structural Analysis of Social Behavior 64 Figure 3.2: Flowchart of Measures 93 Figure 5.1: Proposed Path of Resolution 143 Figure B.1: Graph of Clients' Responses from Table B.1 188 Figure B.2: Reported Client Symptoms and Frequencies 191 v i i i LIST OF TABLES Table 3.1: Agreement Matrix: Identification Process of Resolution 101 Components Table 4.1: Summary of Analysis of Variance for Scale of Indecision 105 Table 4.2: Summary of Analysis of Variance for State Anxiety 105 Table 4.3: Bonferroni Confidence Intervals for Scale of Indecision 107 Table 4.4: Means and Standard Deviations for Resolvers and 107 Nonresolvers on Scale of Indecision Table 4.5: Bonferroni Confidence Intervals for Resolvers and 109 Nonresolvers on State Anxiety Table 4.6: Means and Standard Deviations for Resolvers and 109 Nonresolvers on State Anxiety Table 4.7: Wilcoxon Rank Sum Test (Resolvers vs. Nonresolvers) 111 for Target Complaints and Behavioral Report Table 4.8: Means and Standard Deviations for Resolvers and 111 Nonresolvers on Target Complaints Table 4.9: Means and Standard Deviations for Resolvers and 113 Nonresolvers on Behavioral Report at Follow-up Table 4.10: Arrangement of Resolvers and Nonresolvers on Trend 115 for Phillips Personalized Questionnaire Table 4.11: Wilcoxon Rank Sum Tests for Critical Session 118 ; Differences between Resolvers and Nonresolvers (Immediate Effects) on Conflict Resolution Scale, , Target Complaints Discomfort Box Scale, Pleased with Self, Integrated and Powerful Table 4.12: Means and Standard Deviations for Resolvers on 120 Conflict Resolution Scale, Target Complaints Discomfort Box Scale, Pleased with Self, Integrated and Powerful over the Critical Sessions Table 4.13: Means and Standard Deviations for Nonresolvers on 120 Conflict Resolution Scale, Target Complaints Discomfort Box Scale, Pleased with Self, Integrated and Powerful over the Critical Sessions ix X Table C.9: Pooled Within Groups Covariance Matrix for Goal 208 Attainment Scaling Table D.1: Bartlett-Box Homogeneity of Dispersion Test for Trait 210 Anxiety Table D.2: Pooled Within Groups Covariance Matrix for Trait Anxiety 210 Table D.3: Summary of Analysis of Variance for Trait Anxiety 212 Table D.4: Bonferroni Confidence Intervals for Resolvers and 212 Nonresolvers on Trait Anxiety Table D.5: Means and Standard Deviations for Resolvers and 212 Nonresolvers on Trait Anxiety xi ACKNOWLEDGEMENTS I acknowledge with my thoughts and my thanks: Les Greenberg for the caring and frustration he provided. Steve Foster for his undying good humour and his pro fe s s ionali sm. Larry Cochran for his view of the world and his orange juice. Sharon Kahn for her stately appearance and her encouragement. Steve Marks for his understanding and his keen proof-reading. Moira Webster for her untiring support and not always understanding. Michael Webster for his sensitivity and his impa-tience. Andi Webster for her awe and her anger. And last, yet far from least, Lacey Webster, for her involvement in my work and her jealousy of i t . x i i Chapter I INTRODUCTION Background The phenomenon of intrapsychic conflict lies at the heart of many theories of personality. Freud's analytic theory was founded upon the continuous battle between the id and the superego, that is, between the desire for instinctual gratification and the fear of breaching social prohibitions (Freud, 1923/1960). Similarly for Murray (1938) the conflict was one of the person attempting to maximize instinctual gratification while minimizing punishment and guilt. Sullivan (1953) viewed individuals as torn between the pursuit of satisfaction and the pressing need for security. Rank (1929, 1945) theorized that the internal conflict was one between the fear of l i f e , of becoming an individual, separate, autonomous person, and the fear of death, of becoming united, fused, dependent upon others. In harmony with Rank were both Angyal (1941, 1951, 1965) and Bakan (1966, 1968). For Angyal the conflict within was the attempt to maximize both the expression of autonomy, a basic striving to assert independence and self determin-ation, and the expression of homonomy (surrender), a kind of dependence or merging with others. Bakan interpreted the inner struggle as an attempt to maximize both the expression of agency, a pervasive pressure towards individuation and separation, and the expression of communion, a need for unity with others, self and the inanimate environment. Rogers (1961) found conflict between a person's natural tendency to actualize 1 2 his/her potential and the conditions of worth introjected from parents while Mahrer (1978) has recently suggested that the conflict is between deeper and surface potentials. Consistency theorists such as Festinger (1957, 1958) believed that conflict arises when a person's constructs, that is, his/her generalizations or beliefs based upon the perception of previous experience, comes to be contradicted by new experience. Though each of these theorists has cast different characters in the roles of the inner protagonists they a l l accept a duality at the core of human functioning. From the Gestalt perspective, persons are viewed as a composition or alloy of characteristics rather than a personality of a single or pure characteristic. The internal struggle is a battle for existence that is waged by each facet of the person's personality; with each of these facets having its own needs, support, and opponents. Perls, Hefferline and Goodman (1951) stated that: Situations in which you encounter blocks in carrying out tasks which you have set for yourself are conflict situa-tions—and further more, the conflict is between one part of your personality and another. (p. 44) One situation in which this conflict between parts of the per-sonality comes vividly into play is the situation of choice or decision. One part wants to do something, another part does not. Without a resolution of this conflict the person becomes frozen, no choices are made and the decision of whom to be in a particular situation is avoided. The person does not take a stand, is unable to carry out a task and a l l effort is wasted in the struggle. The decisions that people encounter range from the daily choice of what to eat for breakfast to major lifestyle decisions that reflect the 3 ultimate choice of whom to be in any situation. In between these extremes people face major choices on a routine basis regarding voca-tion, education and marriage, and family l i f e . Some decisions are made on impulse with l i t t l e thought or con-sideration of the consequences. For example, "I don't care about the price; I simply must have that antique chair." Other decisions are automatic—similar to a reflex action. There is a minimal amount of thought involved in stopping at a red light. S t i l l , other decisions, especially those made by people who seek the help of counsellors, require much more thought, consideration, and working through. Many of these decisions involve intrapsychic conflict. Often problems en-countered in making a decision are reflective of a deeper underlying struggle within the person (Janis & Mann, 1977). It is important that people involved in decisional conflict are assisted in resolving these l i f e conflicts and in making decisions to ensure the resolution of important adult developmental tasks (Knox, 1977; Schossberg & Entine, 1978) and the progression to higher stages of ego development (Loevinger, 1977). The necessity of utilizing a decision making framework in the counselling of adults and the central importance of decision making in healthy adult development has been stressed in the adult counselling literature (e.g., Schossberg, Troll, & Leibowitz, 1978) . Counsellors who are able to facilitate the integration and recon-ciliation of the conflicting parts of the personality to relieve underlying struggle can enhance decision making and choice in their clients. A method shown to be significantly effective at this task of the reconciliation of opposites is the Gestalt "two chair operation" 4 (Greenberg 1975; Greenberg & Clarke, 1979; Greenberg & Dompierre, In press). The procedure calls for a dialogue through which the client can bring the warring factions of his/her being into contact. This dialogue is designed to bring the isolated polarities into a position where mediation can begin. The incessant struggle for control can then cease in favour of communication. Baumgardner (1975) pointed out the benefits to be reaped from the integration of polarities within the personality: As two of our roles which represent extremes of divergent messages begin to hear each other, we experience our strength more wholly...We can act among other people direct-ly and in our own behalf, and we find that our manipulative roles are not so necessary. We know what we can do, and what we do not have to do. (P- 72) The Problem This thesis was part of an ongoing research program to investigate the task analysis of the resolution of intrapsychic conflict. This research program was built upon the belief that the resolution of an intrapsychic conflict using the Gestalt two chair operation, followed observable, specific, and identifiable paths or patterns. From the task analysis of successful intrapsychic conflict resolution performances, Greenberg (1975, 1980a) and Johnson (1980) had developed a theoretical model that specified the necessary steps that a client performed on the path toward the resolution of a conflict split. It was the purpose of this thesis to relate process to outcome—the process of intrapsychic conflict resolution to decision making. Specifically i t was the purpose of this thesis to test for an hypothe-sized relationship between the critical components (criticisms, felt 5 wants and softening) of the in-therapy process of intrapsychic conflict resolution and decision-making outcomes. A series of conflict performances was examined and successful and unsuccessful resolutions were identified based upon the presence or absence of the three critical components of competence (criticism, felt wants, softening) specified in the model of conflict resolution. That is, i f the specified components were present in the performance, the conflict was regarded as successfully resolved, and if some or a l l of the components were absent, it was viewed as unsuccessfully resolved. The prediction was then made that those clients who generated performances containing the specified components would show indications of resolution at outcome. The thesis attempted to relate in-therapy process to the client's functioning in his/her world. The research program on intrapsychic conflict resolution to date had yielded detailed information as to the process of intrapsychic conflict resolution in therapy and had provided a specification of the optimum conditions for change in the form of a therapist s k i l l manual (Greenberg, 1979a) . It was the task of this study to verify that the indications of good process, that is change in therapy, carry over or generalize into the client's universe beyond the sessions. As a broader or more general goal this study attempted to begin "to provide a comprehensive, descriptive and explanatory theory of how people actually resolve decisional conflicts, make choices and develop commitments in order to solve psychological problems in living which i f left unresolved would hinder development (Greenberg, 1979b, p. 3 Ref. Notes). The intrapsychic conflict resolution research program had developed a credible, specific model (see Fig. 1.1) that was in need of R D L E P L A Y I D E N T I F Y E X P E C T A T I O N S V A L U E S A N D S T A N D A R D S F E E L I N G S A N D W A N T S I M P A S S E S O F T E N U N D E R S T A N D D E E P F E E L I N G S N E G O T I A T I N G > * I N T E G R A T I O N V R E S O L U T I O N F I G U R E 1 . 1 T H E S P E C I F I C M O D E L 7 a more traditional outcome effects study which would relate competent client performance (the three critical components of the model) to change after one month. Definition of Terms Gestalt Two-Chair Operation The Gestalt two chair operation required that the client alter-nately play each of the two parts involved in an intrapersonal or interpersonal conflict situation. The client may state, "I want to return to school yet I'm not absolutely sure," indicating two opposing "parts." The therapist at this time would assist the client by separat-ing out these two "parts" and acting as a guide in a dialogue between them. The client would take on, from one chair, the "I want.." position and speak to an empty chair in which he/she has been instructed to imagine the other side of the split, the "I'm not absolutely sure." The client would then be instructed to change chairs and respond to the statement he/she just made from the previous chair. The client would move bodily from one chair to the other alternately playing each position. Greenberg (1975) formally defined the two-chair operation as, ...a series of suggestions and observations made by the therapist or facilitator to clearly separate two aspects or partial tendencies of the self process and to facilitate direct communication between these. The purpose of the experiment is to maintain a process of demarcation and contact between these parts. The following underlying principles are presented in an attempt to convey the struc-ture of the operation—the nature of what can be done to achieve the process goal. These principles serve as guides to the therapist's behavior. (p. 1, Appendix II) 8 The five principles of two chair operation abstracted from Greenberg (1979a) are: 1. Maintenance of a contact boundary: Maintaining clear separation and contact between the partial aspects of the self. 2. Responsibility: Directing the person to use his/her abilities to respond in accordance with the true nature of his/her experience in each chair. 3. Attending: Directing the person's attention to par-ticular aspects of his/her present functioning. 4. Heightening: Highlighting aspects of experience by increasing the level of arousal. 5. Expressing: Making actual and specific that which is intellectual or abstract. Particularizing experience by moving from talking about to doing. Greenberg (1980a) has separated and identified characteristic behaviors for each of the two chairs. The experiencing or feeling "part" of the person is represented by the "experiencing chair" which is characterized by a shift, during the process of the dialogue, from whining and excusing to inner exploration and deeper levels of experi-encing. When in this chair the client has been found to engage in deeper levels of experiencing (Greenberg, 1980a) than when in the "other" chair as measured by the Experiencing Scale (Klein, Mathieu, Keisler, & Gendlin, 1969). In addition, the client in this chair has been found to utilize more focused and expressive voice (Greenberg, 1980a) measured by the Voice - Quality System (Rice, Koke, Greenberg, & Wagstaff, 1979) . The remaining chair, termed the "other chair" is filled with the person's internal objects, that is, with the person's attributions and with other people and things. The person when in this chair typically utilizes an external or lecturing voice and engages in low levels of i 9 experiencing. The client speaks from this chair as if he/she were his/her internal objects. In the language of the intrapsychic conflict resolution model (Greenberg, 1980a) and hereafter in this thesis the terms "experiencing chair" and "other chair" are used to stand for a speaker or person in the chair. Of course there is one person referred to and the chairs denote positions as different "parts" of the personality. Split A split is present in the client's experiencing when he/she is struggling between two opposing polarities or positions. Greenberg (1979a) defined the split as follows: Instead of a single clear preference arising, the person is torn between alternatives. There is an experience of two parts, of the self split into partial selves in opposition, rather than the experience of a single integrated self in process. Clearly identifying this split and sensing the opposed forces within, becoming aware of the conflict between the two parts, represent the fundamental task for the client in the experiment. (p. 311) He went on to specify the following features of the split: 1. A statement of a tendency or partial aspect of the self, e.g., "I don't want to do this." 2. A statement of a second tendency or partial aspect of the self, e.g., "I feel I have to." 3. An indication of an intrapersonal contradiction revealing the two parts in opposition to each other e.g., "but" or "yet." 10 4. A verbal or non-verbal indication that the person is in conflict, involved in a struggle, or striving, e.g., "I have to" or voice quality. Greenberg (1979a) has identified and described three types of splits: 1. Conflict split. This split is characterized by two partial aspects of the self opposing each other. For example, "I want the company of having friends but I also want the privacy of being alone." 2. Subject—object split. This split is characterized by one partial aspect of the self (the subject, "I") doing something to the other partial aspect of the self (the object, "self"). For example, "I judge myself continually." 3. Attribution split. This split is characterized by the attribution of a part of the self onto an outside object or person. For example, "I want to return to school but my wife is really hesitant to embark upon such a venture." Conflict Resolution The concept of conflict resolution in this study refers to a subjective experience of the client related to his/her ability to grapple with a distressing li f e issue. The concept does not mean that the issue dealt with in therapy had been completely resolved or that the client existed in a conflict free world. It does mean however, that the client, following therapy, experiences an increase in inner peace—a sense of diminished inner struggle—some increased clarity around the issue worked on in therapy. 11 P e r l s (1970) referred to resolution as: ...the r e c o n c i l i a t i o n of opposites so that they no longer waste the energy in useless struggle with each other but can j o i n i n productive combination and i n t e r p l a y . (P- 19) At a more micro-level Greenberg (1979a) described r e s o l u t i o n as being t y p i f i e d by: ...a s h i f t at some point in the dialogue in the "other chair" to higher l e v e l s of experience and more focused, expressive voice much as though the person i n the "other chair" becomes less c r i t i c a l , softer and more understanding or accepting of the s e l f . (p. 313) S p e c i f i c a l l y , the c o n f l i c t r e s o l u t i o n i s an outcome of the process out l i n e d by Greenberg (1980a) in his proposed model of c o n f l i c t resolu-t i o n . The resolution of the c o n f l i c t i s preceeded by the negotiation of the two chairs which i s preceeded by the softening of the c r i t i c a l aspect of the personality in the other c h a i r . Just as softening i s a precondition to negotiation so i s the l a t t e r a precondition to resolu-t i o n . The c o n f l i c t r e s o l u t i o n takes the form of an integration or synthesis through which both p a r t i e s are s a t i s f i e d . Model of Successful Performance For the purpose of t h i s study a model of intrapsychic c o n f l i c t r esolution performance was adapted using Taylor's (1980) work as a r a t i o n a l e . The adaptation was designed to c l a r i f y , s i m p l i f y , and h i g h l i g h t the process of intrapsychic c o n f l i c t r e s o l u t i o n using the two chair operation. It was proposed that there existed three c r i t i c a l components in the process—these being the component of c r i t i c i s m in the other c h a i r , the softening of the c r i t i c a l other chair and the expres-sion of a want in the context of f e e l i n g ( f e l t want) by the experiencing 12 chair. It was suggested that an expression of criticism to initiate the process followed by an expression of felt wants by the experiencing chair and a softening by the other chair were representative of the resolution process. Change The phenomenon of change was defined operationally in this study as a statistically significant difference on the treatment outcome measures of indecision, state anxiety, target complaints and symptom relief. Change was also defined in terms of the effects of the critical session. Immediate effects of the critical session were obtained on measures of conflict resolution, discomfort associated with target complaint and prevailing mood. Prolonged effects of the critical session were measured on prevailing mood, goal attainment, and attitude change. Resolution Components The research of Greenberg (1975), Johnson (1980), and Taylor (1980) produced a model of intrapsychic conflict resolution composed of six resolution components (blame, standards and values, an expression of feelings, an expression of wants, a softening, and a negotiation). For the purposes of this study it was assumed that the presence of the three critical components—criticism, felt wants, and softening—was suf-ficient to resolve an intrapsychic conflict. In essence these critical components suggest an in-therapy process that can be used to discrimin-ate between competent and incompetent client performances. The resolution components of the original model are discussed below; the critical components of the model of successful performance 1 3 used in this thesis and their development are noted. These components denote components of in-therapy performance that were then to be related to the post performance states measured by the outcome variables. Blame The behavior of blaming in this study was viewed as that type of behavior most often associated with Perls' et al. (1951) "topdog." That is, controlling, bullying, lecturing or threatening remarks issued from an omnipotent and/or moralistic stance that was assumed by one aspect of the personality (other chair). For example, the harsh internal blamer delivered such general statements as "You are a failure as a father," "You've got no backbone," "You'll never make i t , " "You should do better for yourself." These statements were delivered with an outward focus, on the other—as if they were an attack. Standards and/or Values Standards and/or values are thought to be ideals toward which people are trying to move. A standard or value is a type of psychologi-cal centre, "a kind of core of integration which draws together [our] powers as the core of a magnet draws the magnet's lines of force together" (May, 1953, p. 175). The standard or value is a self invest-ment (Curran, 1976), that is, an area of li f e out of which persons form and pattern, uniquely for themselves, their own self quests and obliga-tions to others. These values are formulated from material introjected from the person's social cultural environment in order to f u l f i l l certain needs. For example, an individual may value an even temper, shying away from the expression of anger, because mother and father do 14 not believe in expressions of anger—to indulge in anger would mean the loss of parental love and support, a crucial need at certain stages of development. Carl Rogers (1951) wrote that it became apparent to him as he listened to recordings of therapeutic interviews and studied transcribed material that much of therapy deals with what people perceive as "good" or "bad," "right" or "wrong," "satisfying" or "unsatisfying." That is, a great deal of therapy seems to involve the value system of the person and the changes that occur in that system. Frequently the values that | people construct to meet their needs must be rebuilt as they contain anachronistic material, that is, atrophied evaluations based upon past needs. A useful and necessary value serving a current need will persist and the personality will function smoothly. An archaic value, however, that no longer serves a present need causes stereotypic evaluations and appraisals that block persons from controlling their actions and blur the direction in which they wish to go (Polster & Polster, 1973). In this study standards and/or values were expressed by the other chair in the form of differentiated expectations placed on the experi-encing chair. No longer were general statements of blame issued with an outward focus. Rather, a more specific statement of values held by the speaker (other chair) and a revealing of its inner meaning were made. The focus changed from outward attack to an inward sharing of personal values expressed as expectations. For example, the other chair uttered such statements as "Your kids need you, I believe a l l children need a mom and dad," "You didn't complete that project because you were afraid to f a i l , " "I think you are wasting your skills at this job, its impor-tant to make the most of oneself." 15 Criticism The critical component of criticism was developed for this study by combining blaming and standards and/or values. Criticism, as it was perceived in this study can best be viewed as a process. This process commences with broad general statements of blame, such as those men-tioned above (Blaming), and moves to more and more refined statements of expectations such as those contained in the preceding paragraphs of Standards and/or Values. Phenomenologically this critical component appears as the socially formed "part" or aspect of the personality, the self concept (other chair) in Rogerian terms (1959), or Perls' (1969) "topdog," criticizing the experiencing "part" (experiencing chair) of the personality (the organism in Rogerian terms, organismic self regulation for Perls) for not living up to the expectations of the former. It was hypothesized that the individual in conflict must identify with and express strongly his/her harsh and "critical blamer" in order to facilitate a resolution. It was thought that if the individual was unable to identify and express his/her criticisms the dialogue would not become real. The expression of criticism was measured by the Voice Quality System (VQS), the Structural Analysis of Social Behavior (SASB), and the Experiencing Scale (ES). An expression of criticism appeared as an external voice on the VQS, as behaviors located in quadrants 2 and 3 of the SASB's other grid (e.g., 135 Accuse, blame) and as a level 3 or less on the ES. 16 Feelings For the purposes of this study feelings were thought to be intui-tive appraisals (Arnold, 1960) which persons rely upon to t e l l them what is important in their lives. Carl Jung believed that sensation estab-lishes what is real for us while thinking gives us its meaning and feelings t e l l us its value. Our intellect and physical senses bring us only part of the picture—the value, impact, and passion in our lives exists in our feelings. The word "feeling" receives much use in our daily lives and at the same time may not truly be understood by a l l who make use of i t . The word has been heavily used in, and extensively examined by client-centered therapy and theory and is defined by Rogers (1959) as: ...an emotionally tinged experience, together with its personal meaning. Thus i t includes the emotion but also the cognitive content of the meaning of that emotion in its experiential context. It thus refers to the unity of emotion and cognition as they are experienced inseparably in the moment. It is perhaps best thought of as a brief theme of experience, carrying with i t the emotional coloring and the perceived meaning to the individual. (p. 198) Gendlin (1973) specified and differentiated the phenomenon of feeling by stating that i t is the bodily felt experience of our exis-tence. Feeling is the answer to the question, "How does one have access to one's own existence?" He specifies just what aspect of body it is and in what sense the word "feel" is used. Our sense of and access to existence is the life of our body as we feel i t from the inside. This does not mean only the feeling of our muscles or posture. This is a special use of the word "feeling"—more than the feel of clothes on our body or the sidewalk under our f e e t — i t is the whole complexity of our living. Gendlin refers to that process whereby our feelings are 17 precognitive (Zajonc, 1980) yielding to us a felt impression or sense of what we encounter even before the internal phrases of cognition begin to arise. "This feel is bodily sensed in the "gut" or viscera, or in the chest, throat, or other body locations, and yet i t can give rise to very many complex aspects of observation, of thought, and of situational significances" (Gendlin, 1973, p. 323). The phenomenon Gendlin describes drives home again the belief that psyche and body are one. To feel is more than indigestion or muscle stretching, which is solely body, and more than just thoughts or perceptions of objects. To feel is our experience of being alive now and within that are a great number of potentially separable aspects. Our existence is bodily felt and we have direct access to this visceral felt complexity which, although i t may be many-faceted, we can feel as one feeling in this special sense of the word. In this study the expression of feelings under investigation took place in the "experiencing chair". Expression of feelings in the experiencing chair was measured (Taylor, 1980) by the ES, the VQS and the SASB. A significant expression of feeling was indicated on the seven point ES as level four or higher. This level was chosen because of the quality of personal involvement captured by a level four (Klein et al., 1969). The client, at this level, no longer concerns him/her-self exclusively with external or remotely experienced feelings, instead he/she draws directly from his/her experiencing to describe feelings and personal reactions. Gendlin's process of "experiential focusing" begins here as the client begins to attend to and grasp the direct inner referent of his/her experiencing and makes i t the core of his/her communications (Gendlin 1969; Gendlin, Beebe, Cassens, Klein, & 18 Oberlander, 1968). The VQS measures the expression of feelings by means of the focused or emotional categories. These voice patterns have been found to indicate the expression of feelings by Rice and Wagstaff (1967), Greenberg (1975), and Rice et a l . (1979). The focused voice is described as a turning inward of attentional energy as the person observes his/her own experience and struggles to symbolize and communi-cate the process. The emotional voice is characterized as being the vehicle of feelings where the person may lose control or focus and experience emotional overflow (Rice et al., 1979). Feelings were measured on the SASB as behaviors in the first quadrant of the Self grid (e.g., 215 Openly disclose reveal). Wants The expression of wants was another resolution component from the original model. Before a person can resolve an issue, he/she must know what he/she wants. The want is an orienter—a compass on the journey to resolution. Polster and Polster (1973) described a "want" in this way: It directs, it mobilizes, it channels, it focuses. , A want is a blip into the future. People who have no wants...have no future...A want is a linking function, integrating present experience with the future where its gratification lies and also with the past which it culminates and sum-marizes. Wants grow from where one has been; making sense out of the sensations and feelings which lead to this moment of wanting. Only by touching into where one is and what one wants right now can one forge the central link in the chain of events and experiences which make up one's l i f e . (pp. 227-228) Wants have been measured (Taylor, 1980) with the SASB and the ES. An example of the former would be "243 Ask, trust, count on" and an expression of wants was rated on the ES at level four or above where feelings are explored leading to problem solving and self understanding. 19 Felt Wants Felt wants is the second of the three critical resolution com-ponents used in this study. It represents, in this study, a mingling of the two original components of feelings and wants. It was the expres-sion of a need or desire in the context of feelings. The expression of a felt want was identified by the use of focused voice (VQS), level four or above on experiencing (ES), behaviors from quadrant four of the SASB's Self grid (e.g. 243 Ask, trust, count on) and the semantic criterion of a statement of a want or a desire (e.g. "I want...," "I need...," "I'd like..."). \ V Softening The concept of "softening" is the third of the critical resolution components. The term refers to a change in the person in the other chair. The change was one of an expression of compassion, caring or understanding or an expression of underlying feelings such as inadequacy or fear. Phenomenologically it appeared as if the harsh "internal critic" had melted—expectations were suspended and there was a soften-ing in attitude toward the person in the experiencing chair. At this point the softening appeared to cause the process of resolution to lurch forward into a constructive interchange between the previously opposed parts of the individual. The experiencing in the other chair began to increase along with a feeling of understanding and compassion—rather than the harsh criticism. The softening of the "harsh critic" is the key to the resolution of the protagonists' conflict and is followed by negotiation and the 20 resolution of the underlying issue. The softening is a precondition to conflict resolution and one step removed from i t . This occurrence of softening was measured by the ES which indicated a rise at the point of softening to levels of four or above; the VQS which indicated a shift from a poor contact external lecturing voice to a good contact focused or expressive voice; and the SASB which showed a change of stance, moving from behaviors centered in quadrants two and three to behaviors located in quadrants one and four of the Other grid. Negotiation The final resolution component of the original model followed the softening of the "internal critic" and appeared in an atmosphere of self acceptance and self appreciation. In this atmosphere the two chairs began to listen to each other and negotiate toward a creative resolution of the conflictual issue. Phenomenologically it looked like an af- • fective discussion during which the speaking turn was relinquished frequently allowing both chairs to clear themselves and understand the other. Re solver A resolver was defined as a client who manifested, either in a single performance (session) or over the course of the five working sessions, a declaration of criticism, an expression of a want in a feeling context, and a softening. It was assumed that the differentia-tion of the conflict into other and experiencing chairs, the statement of the other chair's criticism, the expression of the experiencing 21 chai r ' s f e l t want, and the softening of the other chair would constitute an in-therapy process that would r e s u l t i n a d i f f e r e n t i a l outcome. Nonresolver A nonresolver was defined as a c l i e n t who manifested over the course of the f i v e working sessions something l e s s than an expression of c r i t i c i s m , an expression of a f e l t want, and a softening. In other words, they manifested only c r i t i c i s m s and/or f e l t wants. They did not soften. It was suggested that the expression of these one or two reso l u t i o n components would not be enough to re l a t e to a s i g n i f i c a n t change in outcome. Rationale for Hypotheses The rati o n a l e for the hypotheses was based upon the work of Greenberg (1975, 1979a, 1980a, in press). His work has led him to present f i r s t a two phase and then a three phase model of intrapsychic c o n f l i c t r e s o l u t i o n consisting of opposition, merging and r e s o l u t i o n . However with further work (Johnson, 1980; Taylor, 1980) he and h i s students found that these phases were broad and that i t was more p r o f i t a b l e to define components of competence of r e s o l u t i o n . After i n t e n s i v e l y analyzing the actual performances of c l i e n t s on i n t e r n a l c o n f l i c t tasks Greenberg (1980a) concluded: — The softening of the harsh i n t e r n a l c r i t i c appears to allow the experiencing in the "other" chair to emerge and a constructive interchange between alienated parts of the s e l f to follow... F i r s t l y , i n the experiencing chair the person must f u l l y experience and accept the unaccepted or hidden aspects of the s e l f . Secondly, the harsh c r i t i c , i n order to take a d i f f e r e n t stance, must accept, l i s t e n to, or contact the feelings and wants underlying i t s c r i t i c i s m . By 22 so doing a softening of the c r i t i c i s m and a f e e l i n g of understanding and compassion for the s e l f occurs. T h i r d l y , from the base of s e l f acceptance and s e l f appreciation established by the above processes, the two chair s can then l i s t e n to each other or negotiate to form a cr e a t i v e resolu-t i o n between the parts. (pp. 149-150) In l i g h t of these conclusions the objective of t h i s thesis was to investigate whether the occurrence of the three c r i t i c a l in-therapy process components of c r i t i c i s m , f e l t wants, and softening was related to treatment e f f e c t s in the form of c r i t i c a l session immediate e f f e c t s , c r i t i c a l session prolonged e f f e c t s , and f i n a l treatment outcome e f f e c t s . Hypotheses Treatment Outcome Hypotheses Ho1: It was hypothesized that resolvers and nonresolvers would not be s i g n i f i c a n t l y d i f f e r e n t on indecision as measured by the Scale of Indecision (SI) at termination or follow-up. Hi1: It was hypothesized that resolvers and nonresolvers would be s i g n i f i c a n t l y d i f f e r e n t on indecision as measured by the SI at termination or follow-up. Ho2: It was hypothesized that resolvers and nonresolvers would not be s i g n i f i c a n t l y d i f f e r e n t on state anxiety (A-state) as measured by the State T r a i t Anxiety Inventory (STAI) at termination or follow-up. Hi2: It was hypothesized that resolvers and nonresolvers would be s i g n i f i c a n t l y d i f f e r e n t on A-State as measured by the STAI at termination or follow-up. Ho3: It was hypothesized that resolvers and nonresolvers would not be s i g n i f i c a n t l y d i f f e r e n t on t a r g e t c o m p l a i n t s r e d u c t i o n as measured by the Target Complaints (TC) instrument at termination or follow-up. Hi3: It was hypothesized that resolvers and nonresolvers would be s i g n i f i c a n t l y d i f f e r e n t on t a r g e t c o m p l a i n t s r e d u c t i o n as measured by the TC measure at termination or follow-up. Ho4: It was hypothesized that resolvers and nonresolvers would not be s i g n i f i c a n t l y d i f f e r e n t on reported behavior change as measured by the Behavioral Report (BR) at follow-up. Hi4: It was hypothesized that resolvers and nonresolvers would be s i g n i f i c a n t l y d i f f e r e n t on reported behavior change as measured by the BR at follow-up. Ho5: It was hypothesized that on an i n d i v i d u a l i z e d treatment measure ( P h i l l i p s Personalized Questionnaire) (PPQ) there would be no s i g n i f i c a n t d i f f e r e n c e in the number of resolvers and nonre-solvers who obtained symptom r e l i e f . Hi5: It was hypothesized that on an i n d i v i d u a l i z e d treatment measure (PPQ) there would be a s i g n i f i c a n t difference i n the number of resolvers and nonresolvers who obtained symptom r e l i e f . Hypotheses for C r i t i c a l Session Outcomes 1. Immediate E f f e c t s Ho6: It was hypothesized that there would be no s i g n i f i c a n t d i f f e r e n c e between resolvers and nonresolvers on sense of c o n f l i c t resolu-t i o n as measured by the C o n f l i c t Resolution Scale (CRS) over the c r i t i c a l session. Hi6: It was hypothesized that there would be a s i g n i f i c a n t d i f f e r e n c e between resolvers and nonresolvers on sense of c o n f l i c t resolu-t i o n , as measured by the CRS, over the c r i t i c a l session. Ho7: It was hypothesized that there would be no s i g n i f i c a n t d i f f e r e n c e between r e s o l v e r s and n o n r e s o l v e r s on c o n f l i c t a s s o c i a t e d discomfort, as measured by the Target Complaints Discomfort Box Scale (TCDBS), over the c r i t i c a l session. Hi7: It was hypothesized that there would be a s i g n i f i c a n t d i f f e r e n c e between r e s o l v e r s and n o n r e s o l v e r s on c o n f l i c t a s s o c i a t e d discomfort, as measured by the TCDBS, over the c r i t i c a l session. Ho8: It was hypothesized that there would be no s i g n i f i c a n t difference between resolvers and nonresolvers on three mood i n d i c a t o r s , acceptance of s e l f (PWS), sense of integration (INT), sense of power (POW), measured by the items from the Epstein P r e v a i l i n g Mood Scale (EPMS), over the c r i t i c a l session. Hi8: It was hypothesized that there would be a s i g n i f i c a n t d i f f e r e n c e between resolvers and nonresolvers on acceptance of s e l f , sense of integration and feelings of power, as measured by the items from the EPMS, over the c r i t i c a l session. 2. Prolonged E f f e c t s Ho9: It was hypothesized that there would be no s i g n i f i c a n t difference between resolvers and nonresolvers on mood (pleased with s e l f , integrated, powerful) , as measured by the EPMS, over the week following the c r i t i c a l session. Hi9: It was hypothesized there would be a s i g n i f i c a n t difference between resolvers and nonresolvers on mood (pleased with s e l f , integrated, powerful), as measured by the EPMS, over the week following the critical session. Ho10: It was hypothesized that there would be no significant difference between resolvers and nonresolvers on attainment of a goal, measured by Goal Attainment Scaling (GAS), set after the critical session and measured at termination and follow-up. Hi10: It was hypothesized that there would be a significant difference between resolvers and nonresolvers on attainment of a goal, measured by GAS, set after the critical session and measured at termination and follow-up. Ho11: It was hypothesized that there would be no significant difference between resolvers and nonresolvers on attitude change, as measured by the Post Critical Session Questionnaire (PCSQ), at termination and follow-up. Hi11: It was hypothesized that there would be a significant difference between resolvers and nonresolvers on attitude change as measured by the PCSQ, at termination and follow-up. Chapter II LITERATURE REVIEW There has been over the last decade a call for psychotherapy researchers to demonstrate differential effects of differential treat-ments to enable clinicians to specify the effects of a particular treatment for a particular individual (Strupp & Bergin, 1969). Greenberg (1975; in press) has refined this quest even further by suggesting that certain client behaviors mark specific moments in therapy that can be used as indicators for the use of particular therapist interventions. Much can be done to answer the differential effects question by demonstrating empirically that the use of a par-ticular intervention at a specific moment (client marker) in therapy, to produce a particular process, delivers more beneficial outcome results than some other intervention for the moment (client marker) in question. The focus of this thesis was the application of the two chair method to the occurrence of an in-therapy statement of intrapsychic conflict by clients involved in resolving decisional conflict. Reviewed below is the literature on the relation of process to outcome, decision making theory, splits and polarities, decision making, and conflict. Included are explications of the steps of the task analysis and Greenberg's model of intrapsychic conflict resolution. 26 27 The Relationship of Process to Outcome In 1952 when Eysenck published his first criticism of the efficacy of psychotherapy, in which he asserted that spontaneous remission was no less effective than psychotherapy, he stimulated a rush amongst re-searchers to establish the efficacy of psychotherapy. The init i a l scramble, however, produced disappointing results. Serious applied researchers using the prevailing methodology of experimental psychology, that is, the between groups comparison design, found that in an over-whelming majority of cases psychotherapy had no significant effect on subjects when compared to a well matched control group. This left researchers searching for answers to difficult methodological questions on how to even approach the issue of evaluating the effectiveness of psychotherapy. Some hope was finally brought to the problem by Bergin (1966) who reexamined these studies and illustrated the discrepancies between clinical evidence of success and experimental evidence of failure. He showed how some clients in these studies were improving while some were getting worse and that when these effects were subjected to a statistical averaging of results they cancelled each other out yielding an overall finding of no effect when compared to the control group. Bergin stated that the results of these studies rather than proving that psychotherapy was ineffective for given individuals demonstrated that people, especially clients with emotional and behav-ioral disorders, are very different from each other. Therefore, attempts to apply a grossly defined and global treatment like psycho-therapy to a heterogeneous group of clients gathered under a nebulous diagnostic category (e.g., neurosis) are not able to answer the more 28 refined question of the efficacy of specific treatments for specific individuals. i The conclusion that psychotherapy was ineffective was not only an error | but also premature (Hersen & Barlow, 1976). It has become ;i increasingly clear that to ask whether or not psychotherapy is effective i is far too global and complex a research question to pose (Gottman & Markman, 1978). It is afflicted by the uniformity assumptions that a l l clients, a l l therapists, and al l treatments are the same. Researchers have now gathered around a new question, "What treatment for whom by whom and to what end?" (Kiesler, 1971), and moved away from broadly based studies of therapeutic effectiveness toward designs that are more representative of the clinical situation. They are examining the specific interactions that exist between treatments, therapists, clients, and their specific concerns. It is hoped that the results of this type of research will allow clinicians to f i t specific therapeutic procedures to specific client problems. Greenberg (In press) however pointed out that this question is s t i l l too global and does not adequately deal with the complexity of the therapeutic situation. Researchers need to examine specific therapist interventions in relation to specific client contexts (e.g., the resolu-tion of decisional conflict using the two chair method) and relate this to outcome. The focus is not on the relation of a particular approach to outcome but on the relation of a particular technique applied to a specific client in therapy performance and outcome. There have been a number of studies that have focused on the therapeutic outcome for different approaches while ignoring client performance. In two monumental efforts Glass and Smith (1976) and Luborsky, Singer, and Luborsky (1975) independently reviewed this work and both concluded that there were at best only marginal differences in the efficacy of those techniques studied. A flaw in this body of research, however, was the identification of the technique under study by the therapist's professed orientation in the absence of actual in therapy observation. The pitfall of assuming a close relationship between theoretical orientation and actual practice is highlighted by the Sloane, Staples, Cristol, Yorkston, and Whipple (1975) study where analytic and behavioral therapists were found to be both different and similar to each other in unexpected ways. In general no single therapy has shown itself to be more potent than any other in relation to a variety of client problems, especially after long term follow-up (Frank, 1979). There are no existing empiri-cally-based detailed descriptions of the therapeutic process using different treatment techniques. One observation that can be gleaned from all the research findings is that, even though the field of psycho-therapy is composed of a vast number of procedures, no single approach has been clearly established as superior to any other across a variety of client concerns. The strongest predictors of therapeutic success remain the nonspecific factors or general conditions involving the personal qualities of both therapist and clients and the relationship that forms between them (Strupp, 1977). Two of the most promising variables in this area are the client's perception of the therapist's empathy (Barrett-Lennard, 1962; Cain, 1973; Carmichael, 1970; Gurman, 1977; H i l l , 1974; McClanahan, 1974; Ryan & Gizynski, 1971) and the working alliance (Bordin, 1975, 1976, Ref. Notes; Horvath, 1981; Luborsky, 1976; Strupp, 1973). These variables and the research 30 generated by them have produced findings relating therapist qualities or relationship qualities and outcome. Another approach for pursuing differential effects has been suggested, that is, that the study of process in the context of stra-tegic interactions may reveal differential effects by pinpointing which therapist intervention at which specific point in therapy initiates which client performance (Greenberg, 1975; Orlinsky & Howard, 1978). The uncovering of the relationship between the client's process in distinct in-therapy contexts (which includes therapeutic intervention) and outcome can help illuminate differential treatment effectiveness by relating client in-therapy performance to outcome. To date the majority of effort has been aimed at relating the different therapeutic methods (i.e., what therapists do) to outcome. This is based on the assumption that all clients or a l l clients of a particular type involve themselves in the same way with a particular approach. This is untrue as it misses the significance of person/situation interaction variables and smacks of a uniformity myth concerning client process, that is, a l l client process is the same. As Greenberg (in press) pointed out the description of various client in-therapy processes for various contexts is crucial for controlling some parts of the client performance variance. Attention must therefore be focused upon the relation of strategic process to outcome in order to further research on the differential question. This shift should provide a much clearer picture of the relationship that exists among what the therapist does in therapy, how the client responds to this intervention, and what precise changes occur in the client's l i f e as measured in terms of outcome. With this picture 31 clinicians may be able to show the efficacy of different treatments with different client concerns. The Steps of the Task Analysis One method of studying process in the context of strategic inter-actions with the aim of discovering and verifying the active ingredients of psychotherapy has been suggested by Greenberg (1975) and Rice and Greenberg (In press). The steps of the method are as follows: 1. Specification of a general model of human functioning The intuitive and explicit aspects of a theory, in this case the Gestalt approach, are specified as a context for the explorations. Perls, Hefferline, and Goodman (1951) outlined human functioning: The average person, having been raised in an atmosphere ful l of splits, has lost his Wholeness, his Integrity. To come together again he has to heal the dualism of his person, of his thinking, and of his language. He is accustomed to thinking of contrasts—of infantile and mature, of body and mind, organism and environment, self and reality, as i f they were opposing entities. The unitary outlook which can dissolve such a dualistic approach is buried but not des-troyed and,...can be regained with wholesome advantages. (p. 20) 2. Task selection and task description. Based on *-he general model a task is selected and a description of the task and the task environment is provided. The task in this instance was the resolution of a conflict split, defined by Greenberg (1979a) as a situation where: ...the person is torn between alternatives. There is an experience of two parts, or the self split into partial selves in opposition, rather than the experience of a single integrated self in process. (p. 311) The s p l i t i s i d e n t i f i e d by four d i s t i n c t features (Greenberg, 1975). For example, i n the statement of the s p l i t , "I don't want to be t i e d down but I would l i k e a more permanent r e l a t i o n s h i p , " the four features are: 1. A statement of a tendency or p a r t i a l aspect of the s e l f , "I don't want to be t i e d down." 2. An ad d i t i o n a l statement of a second tendency or p a r t i a l aspect of the s e l f , "I would l i k e a more permanent r e l a t i o n s h i p . " 3. An i n d i c a t i o n of some intrapersonal dissension denoting the two aspects as being i n opposition to each other, "but." 4. An i n d i c a t i o n that the i n d i v i d u a l i s involved i n some s t r a i n , struggle or s t r i v i n g , (usually i n the voice "I don't want...") . The task environment r e f e r s to the interventions made by the counsellor to reintegrate the two c o n f l i c t i n g aspects of the c l i e n t ' s being; i n t h i s case the two-chair o p e r a t i o n — d e f i n e d by Greenberg (1979a) as an instance where: ...the person plays the ro l e of both sides of the c o n f l i c t , usually l o c a t i n g each side i n a separate c h a i r , and proceeds to have an encounter between them. (P. 312) 3. Evaluation of the task environment The potency of the task environment i s e m p i r i c a l l y v e r i f i e d to show that some of the active ingredients of therapy are present when that task i s worked on in the s p e c i f i e d task environment. Greenberg and Dompierre (in press), Greenberg and Clarke (1979) and Greenberg (1975) d i d t h i s by showing that the two chair method for resolving s p l i t s stimulated greater depth of experiencing, change i n awareness, and reported behavior change than empathic r e f l e c t i o n of f e e l i n g at a s p l i t . 33 4. The description of possible performances— "the thought experiment" Against the background of the general model of human functioning (the Gestalt approach) and the task (resolution of a conflict split) descriptions are formulated of the client's possible performances on the task. Husserl (1973) termed this operation the "thought experiment" and it was performed on the idealized case. Johnson (1980) made this step in the task analytic approach the subject of her thesis and she attempt-ed to create and check models which illustrate, in specific detail, what actually occurs during a psychotherapeutic event. She described, hypothetically, the reintegration or resolution of a conflict split with the use of the two chair method of Gestalt Therapy. 5. Description of the actual performance The client's performance while engaged in an actual conflict resolution was observed and described. Greenberg (1980a) intensively observed and analyzed nine resolution performances by three clients where he discovered and demonstrated the existence of a two phase resolution process in these events. He concluded from this: ...that intensive research of this nature allowed a detailed elaboration of some of the subtleties of therapeutic process and by so doing opened new avenues for research and for clinical practice. (p. 151) 6. Constructing a specific model A specific model was developed by Johnson (1980) to satisfy the general model and the task description. She accomplished this step by comparing the hypothetical performances from her "thought experiment" with a few actual performances. Taylor (1980) in addition, constructed 34 a more specific three phase model in which the three stages of opposi-tion, merging, and integration were abstracted from Johnson's 13 step model which is presented below (Fig. 1.1). The Specific Model Greenberg and Johnson discovered that clients regularly initiated the conflict performance by "role playing" the characters (see Fig. 1.1). That is, they behaved "as i f " topdog and underdog (or in terms of this study "other" chair and "experiencing" chair respectively) were engaging each other in a productive dialogue. However, the reality of the interaction was more that the other chair was expressing broad statements of blame toward the experiencing chair (e.g. "You're a failure", "You're lazy") and the experiencing chair was passively whining in the face of the attack (e.g. "I know I am but I can't help i t " ) . These universal polar opposites, to be found in the disguise of an infinite number of specific roles, were only engaging each other in a game of "you should—I can't." The clients were then found to shift and to begin identifying with and experiencing each of the polarities. The "as i f " quality of the dialogue began to disappear as the clients began to become aware of the conflicting "parts" of their personality. The next step in the model revealed the other chair differentiating its general blaming into statements of standards and/or values. In the face of specific expectations the experiencing chair began to cease its whining and express how it "felt" as the object of the other chair's expectations. After receiving specific criticism and expressing its feelings the experiencing chair began to express its "wants." That is, what i t wanted from the other chair and for itself in place of the unrelenting criticism so that i t could function more comfortably and productively. Occasionally, at this point, the client reached an impasse and experienced that he/she could not move on—he/she had nowhere to go and experienced a feeling of being stuck. The need to change had met a force that resisted change with an equal amount of power. The client appeared to believe that there was no way out—no new ways existed and most certainly no power of his/her own creation was available to him/her to break this vicious circle. The process degenerated into, for example, "You must place your children's needs before your own"—"I won't do i t , I'm tired of being in the back seat and now its my turn." Either following the expression of a want (in the context of a feeling) or the breaking of the impasse the turning point in the dialogue occurred, the "softening". After hearing how the experiencing chair felt in the face of its criticisms and what the experiencing chair really wanted from i t , the other chair softened toward the object of its criticism. The other chair expressed its fear, concern or understanding in relation to the experiencing chair. In response the experiencing chair began either to understand the other chair's concern, or to express even deeper feelings associated with the other chair's harsh criticism. Following the softening the two protagonists began to negotiate with each other in order that each could have its wants met and that both could live in peaceful coexistence. The dialogue took on a different tone as the two chairs made real contact and finally listened to one and other. Both were listening, open, and understanding toward 36 each other which led them to integration and resolution of the conflict that had disrupted smooth functioning. 7. The prediction of performance This step represents the predictive hypothesis testing phase of the task analytic approach. At this point the newly constructed specific model was used (Taylor, 1980) to hypothesize client performance on resolution tasks. Resolution and nonresolution performances were compared in an attempt to verify that the presence of the components of the specific model had the power to discriminate between competent and incompetent client performances. Statistical tests were employed to compare the hypothesized and observed performances. As predicted, i t was found that clients progressed through three sequential stages as they had travelled toward the resolution of their conflict split (Greenberg, 1980). These stages were composed of a set of necessary constituent behaviors that were measured and identified with the use of scales that were designed to measure process data. Confirmation of this prediction added credibility to the specific model. Building on the seven previous stages of this task analytic oriented research program the present study focused on the eighth, and final, step. 8. The relating of process to outcome The fruit of the research program, before this study, had been the development of a three step model of conflict resolution complete with its necessary constituent behaviors and the verification of the model through the comparison of competent and incompetent conflict perform-ances. A problem that remained was one of relating competent client performance to long term outcome. Specifically, the relating of the presence of the critical resolution components (i.e., a statement of criticisms, an expression of feelings and wants, a softening of the critic) in a client's resolution performance to some change in the client's world • beyond therapy. This is the task addressed in the present study. Decision Making The literature on effective decision making, while extensive, reports almost wholly group, management, or administrative decision making processes (e.g. Clark, 1958; Etzioni, 1967; Freedman, 1965; Gordon, 1961; Hoffman, 1975; Katz & Kahn, 1966; Maier, 1967; Maltzman, 1960; Miller & Starr, 1967; Osborn, 1963; Paponek, 1969; Simon, 1976; Taylor, 1965; Vroom & Yetton, 1973; Wilensky, 1967; Young, 1966). Noticeably absent are reports of individuals in the process of making personal decisions that often involve emotional conflict. Even clas-sical decision theory (Slovic, Fischoff, & Lichtenstein, 1977), that employs probability and utility theory to predict decisions, is unable to provide much in the way of a tool for counsellors working with adults who are involved in the felt .uncertainty of a conflict. Researchers must observe their subjects in order to find out how they make decisions and then mold this knowledge into theory that rests upon an empirical base. The focus in the construction of decision making theory must be returned to "the specific nature of performance 38 discrepancies between competent and incompetent populations" (Gottman & Markman, 1978, p. 40). A recent contribution to the literature by Horan (1979) entitled Counseling for Effective Decision Making presents a behavioral approach to decision making counselling. This work is a germinal contribution in the area and is constructed as a summary of predominately normative theories which describe how decisions "should" be made rather than a theory based upon the investigation of the actual process of personal decision making (i.e., the laying bare of the psychological processes involved in the making of a decision). Many of the established theories that anchor Horan's approach are either speculative in nature (Dewey, 1933; Krumboltz & Baker, 1973; Urban & Ford, 1971), or are extensions to decision making from broad problem solving theories (D'Zurilla & Goldfried, 1971) that more often concern themselves with conceptual problem solving (see Gagn§, 1970) rather than emotional problem solving. Janis and Mann (1977) presented a theoretical model of decision making, based on a decade of research, that began to focus inward on the psychological processes of deciding. The model was an attempt at answering such important questions as "why do people so often f a i l to look into the available alternatives with care even when vital conse-quences are at stake?" and "Under what conditions are they most likely to make a sound choice that they can live with?" The unique feature of their model is its definition of conditions relating to conflict—hope and time pressure—that mediate distinctive coping patterns. The conflict theory model of decision making postu-lates that the way persons cope with resolving a difficult choice is determined by the presence or absence of three psychological conditions: awareness of the risks involved, hope of finding a better solution, and the time available in which to make the decision. These mediating psychological conditions specify the following coping patterns: 1. Unconflicted adherence or inertia. The decision maker decides in an unruffled fashion to continue on his/her present course of action, ignoring information about the risk of losses. 2. Unconflicted change. The decision maker uncritically adopts whichever new course of action is most salient or most strongly recommended. 3. Defensive avoidance. The decision maker avoids the conflict by procrastinating, buck passing (i.e., leaving decision to someone else) or bolstering (i.e., constructing wishful rationalizations while remaining selectively inattentive to corrective information). 4. Hypervigilance. The decision maker wildly searches for a way out of the predicament and impulsively grasps a hastily contrived solution that appears to promise immediate deliverance. This is done while overlooking the ful l range of consequences of his/her choice due to emotional excitement, repetitive thinking, and cognitive constriction (apparent in a reduction of immediate memory span and simplistic ideas) . In its most extreme form this coping pattern is known as "panic". 5. Vigilance. The decision maker comprehensively searches for relevant information, assimilates it in an impartial manner and evaluates alternatives carefully before making a choice. The authors stated that the first two patterns are occasionally adaptive in conserving time, effort and emotional wear and tear, especially when used for routine or minor decisions. However, they 40 often lead to defective decision making if the person must make a vital choice. In a similar fashion, defensive avoidance and hypervigilance can be occasionally adaptive, but in general they reduce the decision maker's chances of avoiding serious losses. Consequently a l l four patterns are regarded as defective decision making strategies. The fifth pattern, vigilance, while having the potential to be maladaptive if danger is imminent and a split second response is necessary, gener-ally provides decisions of the best quality. Another of the mediating processes that dictates the coping pattern chosen is stress. People know from experience that making a vital choice is troubling and can generate anxiety reactions such as agita-tion, quick temper, sleeplessness, loss of appetite, and other psychoso-matic symptoms. Despite this, most behavioral scientists had neglected the study of the arousal of stress and its implications for the decision making process until Janis and Mann (1977) set out to describe the conditions under which psychological stress imposes limitations on the process of decision making. The authors held that psychological stress related to decisional conflict springs from at least two sources. First, the decision maker is concerned about the material and social losses he/she might suffer as a result of the choice of a certain course of action. Second, the decision maker recognizes that his/her reputation and self esteem as a competent decision maker are at stake. The greater the loss that is anticipated, the greater will be the level of stress. Janis and Mann (1977) began with the assumption that stress itself is frequently a major cause of errors in decision making. Their assumption was made in recognition of other common causes such as 41 information overload, the limitations of human information processing, group pressures, blinding prejudice, ignorance, organizational con-straints, and bureaucratic politics (see Janis, 1972, 1974; Simon, 1976). They maintained, however, that a major reason for many i l l formed and poorly implemented decisions has to do with the motivational consequences of decisional conflict, especially attempts to escape from the stresses generated by agonizingly difficult choices. In the past two decades along with Janis and Mann (1977), psycholo-gists have investigated the anxiety reaction and the effect that stress and conflict can have on the quality* of a decision maker's search for and appraisal of alternative courses of action. Those studies that examined the physiological facets of decision making have revealed that there are conspicuous changes in heart rate, finger pulse amplitude and galvanic skin response when an individual is required to make an arduous decision (e.g., Fleischer, 1969; Gerard, 1967; Jones & Johnson, 1973; Mann, Janis, & Chaplin, 1969). These changes in autonomic arousal point to varying levels of stress during the decision making process. Much of the data on physiological reactions supported the belief that decisional conflicts produce marked increases in stress when an individual is compelled to make an essential decision. For example, in general the data revealed that during the predecision period heartrate increased sharply; during the announcement of the decision heartrate peaked and then dropped off rapidly during the postdecisional period. These records of physiological arousal suggested that the task of making a decision acts as a significant stressor. Further, the data lead to the finding that regardless of the degree of difficulty or importance of the decision to be made, the autonomic indicators of stress increased as the clients progressed toward a decision and tailed off gradually in the postdecisional period to return to the level of the resting state. Generally, the finding has been that the intensity of physiological and psychological symptoms of stress seem to depend upon the decision maker's construal of his/her circumstances. That is, the greater the loss that any one choice is perceived to hold, the greater will be the stress experienced by the decision maker. Based upon an analysis of the research literature on psychological stress, Janis and Mann (1977) presented five general propositions that illustrate the functional relationships between psychological stress, and decisional conflict; 1) the more goals expected to be unfulfilled the more stress will result; 2) stress will be a function of the degree to which a person is com-mitted to a present course in the face of information causing him/her to consider a new course of action; 3) when faced with several inferior alternatives stress leads to defensive avoidance as hope is lost for finding a better alternative than the least objectionable one; 4) when threat is high and time is short for finding an adequate alternative stress leads to hypervigilance (panic) as the decision maker anticipates serious losses; and 5) moderate stress leads to vigilance provided the decision maker expects to find a satisfactory way of resolving the decisional conflict. Janis and Mann (1977) claimed that the coping patterns are depend-ably linked to the previously specified psychological conditions and the level of stress experienced. Thus they provided testable implications about environmental contexts that give rise to vigilance and about deliberate interventions that could check the beliefs and perceptions responsible for defective coping patterns. 43 While constituting a move in the right direction Janis and Mann's (1977) work remains too global to utilize in a study of intrapsychic conflict resolution in the context of decision making. Their research is based mainly upon the psychological processes involved in emergency and health oriented decisions that seem more similar to those processes involved in problem solving than to those involved in the resolution of emotional and intrapsychic conflict. Tiedeman and O'Hara (1963) have presented a more refined two stage process model that has proven to be a valuable tool for counsellors. This model outlines two stages of decision making; anticipation and implementation. Anticipation is composed of the substages exploration, crystallization, choice, and clarification whereas implementation is composed of the induction, reformation, and integration substages. In the exploration substage of the anticipation stage, a number of different alternatives or possible goals are considered. During crystallization distinctions or differences emerge as the value of various alternatives are assessed resulting in a stabilization of thought—the situation takes on a tentative definition with a few alternatives becoming central. As the crystallization process occurs, choice or decision in which one alternative is chosen readily follows, bringing with it a goal and an orientation of the person's behavioral system towards that goal. Finally, during the clarification substage the individual perfects his/her image of him/herself and dissipates some of the former doubts concerning the decision. The implementation stage becomes the meeting place for imagination and reality. The individual, in the induction substage, enters into the new circumstance in an accommodating manner, that is, his/her primary-44 orientation of relevance for goal attainment is receptive. This receptivity persists as long as the individual's social system is accepting of his/her uniqueness. The essence of this substage is both a general defense of self and a partial giving up of self to group purpose when the person is accepted. When the group demonstrates sufficient acknowledgement that the person is successful and accepted, the recep-tive orientation of induction changes to the more assertive orientation of reformation, where the individual exhibits a strong sense of self and l i t t l e hesitancy in showing the benefits of his/her new found convic-tions with those who may not be so enlightened. If the individual effects the compromise of the reformation substage he/she enters the final substage of integration. The essence of this substage is synthe-sis and it is not unalterable—but merely a condition of dynamic equilibrium where the individual becomes more confident and assertive in regard to the decision made. This model, although useful for understanding the process of decision making, does not deal directly with the process of intrapsychic conflict resolution. Splits and polarities are discussed below to provide information for a way of integrating findings on intrapsychic conflict resolution and decision making theory. Splits and Polarities in Human Functioning Latner (1973) views polarities as being deeply rooted in our organismic functioning—more so, they are a necessary part of our functioning as human beings. Their interaction provides a dialectical process whereby: 45 The opposites become distinguished and opposed; then, i n th e i r c o n f l i c t , a r e s o l u t i o n i s achieved that unites the poles in a figure that i s greater than the combination of the o p p o s i t e s — i t i s a new c r e a t i o n . (p. 43) The r e s o l u t i o n of the c o n f l i c t becomes a synthesis of the poles that turns out to be greater than either one of them taken s i n g l y . Although ultimately b e n e f i c i a l the s p l i t takes i t s t o l l upon the i n d i v i d u a l u n t i l r esolution or integration i s reached. P e r l s (1970) believed that the s p l i t was i n d i c a t i v e of fragmentation i n people's f u n c t i o n i n g . P e r s o n a l i t i e s are composed o f unre s o l v e d c o n f l i c t s , s p l i t s , and p o l a r i t i e s and as long as these are l e f t out of awareness, unattended to and unfinished, energy w i l l be invested in useless struggle and s e l f - c a n c e l l a t i o n rather than i n productive combination and i n t e r p l a y . People e x i s t in a state of immobilization and unproductive confusion, however, with awareness comes c h o i c e — t h e choice of whether to continue or to change (Wallen, 1970) . Polster and Polster (1973) asserted that psychopathology i s the r e s u l t of an incongruence between f e e l i n g one thing and doing another. This i s similar to Rogers' (1951, 1959) view of the c o n f l i c t between the person's attempt to be true to his/her own a c t u a l i z a t i o n thrust and at the same time preserve his/her environment by remaining l o y a l to the conditions of worth in t r o j e c t e d from his/her parents. Integration occurs which leads to change when the i n d i v i d u a l i s able to embrace the f e e l i n g s and sensations of both sides of the s p l i t and allow contact between them. That i s , the i n d i v i d u a l becomes aware of and takes r e s p o n s i b i l i t y for wanting both sides (for d i f f e r e n t r e a s o n s ) — t h e s i s and a n t i t h e s i s make contact forming a new synthesis and change. i 46 Zinker (1977) presented h i s perception of the s p l i t as a struggle between two extreme positions within the i n d i v i d u a l that drains energy and p o t e n t i a l and p r o h i b i t s him/her from coping f u l l y with l i f e s i t u a -t i o n s . The mending of t h i s s p l i t brings s p e c i a l rewards; When brought into awareness with c l a r i t y , c o n f l i c t s tend to allow the person the sense of h i s i n t e r n a l d i f f e r e n t i a t i o n , and at the l e v e l of c r e a t i v i t y , hold the p o s s i b i l i t y for i n t e g r a t e d b e h a v i o r — b e h a v i o r which i s h i g h l y a d a p t i v e because i t spans the f u l l range of responses between former-l y experienced polar extremes. (p. 196) Perls et a l . (1951) referred to t h i s c o l l u s i o n or impasse described by the above authors as a stalemated b a t t l e between the top dog and the underdog. He claimed that only when the person can give up the struggle for c ontrol of his/her parts, or his/her investment in one of those parts, can he/she begin to l i s t e n to and to accept both sides and become free to function f l u i d l y and grow. The roles of "topdog" and "underdog" appear i n the guise of many s p l i t s . The topdog makes i t s presence f e l t by c o n t r o l l i n g , b u l l y i n g , l e c t u r i n g , threatening—being omnipotent, and m o r a l i s t i c . Quite the opposite, the underdog makes i t s mark by c o n t r o l l i n g passively. It i s h e l p l e s s , passive, v i n d i c t i v e , confused, apologetic, uncommitted, and p r o c r a s t i n a t i n g . The two players attempt to s a t i s f y t h e i r wants through manipulation. Although l o g i c a l l y i t may seem that the topdog i s more powerful, a c t u a l l y the underdog wins the day by being passive, avoiding and r e t r e a t i n g , leaving the topdog i n f r u s t r a t i o n . The r e s u l t of the struggle i s that neither one obtains anything authentic. Communication and integration are nonexistent and a l l that remains i s the struggle for control between them. 47 As implied above in the discussion of splits, an integration of these partial aspects of the self must be reached to enable the in-dividual to move. Polster and Polster (1973) upheld the goal of integration rather than control over one aspect or the other when they said: The effort devoted to keeping the squelched characteristic servile or silent is a doomed e f f o r t — i t will pop up in inconvenient ways to assert whatever validity i t can muster, like a l l resistance forces which have been compelled to go underground. (p. 247) Greenberg (1979a) has defined the split: ...as a verbal performance pattern in which a client reports a division of the self process into two partial aspects of the self... (p. 311) He believed that the identification of the split as well as the bringing into awareness of the opposed aspects from within were the basic therapeutic tasks of the client (Greenberg 1975) . The moment when the client becomes aware of his/her split is the optimal time for the therapist to intervene; for the client is most open to change. The therapist's ability to recognize the presentation of the split can be the turning point in therapy—the doorway to highly creative work by the client. The spl i t is most easily identified by its verbal markers. Greenberg (1975) stated: The split is characterized by a division of the self process into two partial aspects of the self. These tendencies or partial aspects of the self are related to each other in different ways and the different relationships between the tendencies define different types of splits. (p. 1, Appendix I) 48 He defines three types of splits: conflict, subject/object, and attribution. The conflict split is characterized by a statement such as "I want to do X but I just can't..." Here the person presents two obviously opposed sides connected by a conjunction such as "but" or "yet" with an indication of some struggle usually apparent in the voice quality. The subject/object split which is recognized by two "parts" of the self with one "part" (subject) doing something to the other "part" (object). This split is marked by a statement like "I am always judging myself." The attribution split is identified by the client attributing part of an inner struggle to someone or something out in the world, for example, "I want to return to school but my wife just won't hear of i t . " At the moment the client presents the two conflicting aspects of him/herself, if contact can be made between the two sides, the potential for resolu-tion exists. Bandler and Grinder (1976) presented a detailed and intricate perspective on splits; or as they term them, incongruencies. They identified, from a broader neurolinguistic framework, incongruencies being potentially expressed through several "output" channels such as body posture, movements, voice tempo, voice tonality, and words. They believed that each one of these channels is capable of communicating a message, and further, each message is true in its own right and could be sorted into two opposing aspects of the person. The therapist's job is to promote the client's experience of the split by facilitating con-gruence in the latter's output channels. This task is performed through a keen awareness on the therapist's part to bring any inconsistencies to the attention of the client. The client is instructed to move from one 49 chair to the other until he/she has fully experienced the feelings, gestures, voice quality, and postures of both sides of the conflict. The two-chair technique is a powerful tool in facilitating the integration of the opposing sides of an intrapsychic conflict. Baumgardner (1975) stated that: By identifying the client's polarities and then providing for the dialogue which can bring forth these two hostile roles, we create a place where the client grows more willing to relinquish his struggle for control, at least for a moment, now and then, and to put some energy into listening and hearing. (p. 67) Even though much of the Gestalt approach relies on the creative intuition of the therapist there exists some basic principles around the two-chair technique that can be abstracted and used as guides toward the resolution or integration of the opposing aspects of client's splits (Greenberg, 1975) . The five basic principles of two-chair work are, a) separation and the restoration of contact, b) the responsibility of the client, c) the attending function, d) the heightening function, and e) the expressive function. The primary and most basic task for the client is to restore the contact between the partial aspects of the self. When the client is able to dialogue as both sides of him/herself, only then will he/she experience the difference and the validity of each pole. Polster and Polster (1973) highlight this process: Almost invariably, when contact is restored, the individual discovers that these disowned parts have many redeeming features and his life expands when these are recovered. (P. 248) The next task for the client is the assuming of responsibility for the conflict rather than viewing it as something imposed from outside. The client may shirk responsibility by avoiding or blocking awareness or by ignoring feelings or experience—this is a marker for therapist intervention. The client is instructed to "own" his/her experience by talking in the first person (e.g., "Would you say I?"). The client is encouraged to be aware of and express (in an authentic fashion) the characteristics of each role. He/she is asked to identify with every piece of his/her present experiencing—the tension in the neck, the tightness in the chest, the tears, or the wavering voice. The task of attending entails the therapist stimulating an in-creased awareness on the part of the client of a l l the latter's experi-ence. The therapist directed the client's attention inside by request-ing that he/she stay with a particular feeling or by asking what is happening inside at the moment—or directed his/her attention to the outside by inquiring what was going on in the context of a wiggling foot, tapping fingers, or an interesting voice quality. The heightening principle calls for the therapist to increase the impact of an experience by increasing the client's arousal. This is attained by requesting that the client exaggerate some movement, repeat some statement, or act out the style of one of his/her partial aspects of self. The therapist also heightens and creates higher levels of arousal by making explicit messages that remained implicit in the interaction. The principle of expressing highlights facets of experience by doing rather than talking about. The impact of actually doing something is far greater than just talking about i t . The therapist stimulated this by requesting that the client reveal the particular content of the inner dialogue instead of remaining with generalities. The client is 51 asked how he/she defeats him/herself in specific rather than vague terms. Greenberg and his associates (Greenberg & Clarke, 1979; Greenberg & Dompierre, in press; Greenberg & Higgins, 1980) discovered that when these five basic principles were utilized in the two-chair operation, there was a resulting increase in depth of experiencing, which is an indication of productive psychotherapy (Klein et al., 1969) and conflict resolution in populations seeking counselling as well as student volunteers. Gestalt therapists have been guilty of describing conflict resolu-tion or the integration of the opposed forces in a nebulous almost poetic manner. For example, Perls (1970) account of resolution as: ...the reconciliation of opposites so that they no longer waste energy in useless struggle with each other but can join in productive combination and interplay... (p. 19) offers l i t t l e direction to therapists. There is a new thrust in Gestalt Therapy, however, which is: ...to move in the direction of finer discriminations of therapist interventions and more objective, illuminating measurement of client process. (Clarke, 1977, p. 48) A much more concrete description of intrapsychic conflict resolu-tion as indexed by scores on process instruments like the Experiencing Scale (Klein et al., 1969) and the Voice Quality Scale (Rice & Wagstaff, 1967) was presented by Greenberg (1979a). He described the two sides of the dialogue as the "other chair" which contains introjections and the "experiencing chair" which contains the organismic processes and found that: Resolution performances appear to be characterized by a shift at some point in the dialogue in the "other" chair to 52 higher l e v e l s of experience and more focused—expressive voice much as though the person i n the "other" chair becomes l e s s c r i t i c a l , softer and more understanding or accepting of the s e l f . (p. 313) This kind of work constituted a step in the d i r e c t i o n of discovering the effectiveness of p a r t i c u l a r c l i e n t in-therapy processes as related to outcome. Research on the Two-Chair Operation and C o n f l i c t Resolution The studies published in t h i s area are scarce. One analogue study (Bohart, 1977), designed to investigate the effectiveness of several interventions on the resolution of personal anger c o n f l i c t s , reported that the two-chair "role play" was the only s i g n i f i c a n t intervention. The author stated: ...role playing can be e f f e c t i v e in modifying f e e l i n g s , a t t i t u d e s , and b e h a v i o r s a s s o c i a t e d with i n t e r p e r s o n a l c o n f l i c t . . . t h e greater effectiveness of role play i s in accord with the p o s i t i o n that insight and emotion must go hand in hand for a change to occur. (p. 316) Bohart also discovered that h i s subjects who were in the r o l e play condition seemed more accepting of the reasons for t h e i r antagonist's behavior as a r e s u l t of having the opportunity to dialogue with them-selves . Greenberg and Clarke (1979) conducted an analogue study that revealed the "two-chair" operation to be more e f f e c t i v e in stimulating experiencing and changes i n awareness than empathic r e f l e c t i o n in c l i e n t s who were working on s p l i t s . Greenberg and Dompierre (In press) using c l i e n t s involved in counselling attained s i m i l a r r e s u l t s adding 53 credibility to the use of the two-chair technique over empathic reflec-tion at the occurrence of a split. Greenberg (1975) reported a similar finding in a study that focused on the particular effect of the two-chair dialogue on clients involved in counselling. These findings are particularly significant as level of experiencing has been consistently correlated with varied measures of successful outcome (Orlinsky & Howard, 1978). In other words, if therapists can promote high levels of experiencing they are facilitating change. Greenberg (1980a) conducted a further intensive analysis of the two-chair operation. In this study he viewed each chair as an indepen-dent system and was able to find a consistent pattern of experiencing in nine successful resolution events. He discovered that in the preresolu-tion phase the experiencing chair consistently functioned at higher levels of experiencing (level four and above) than the other chair. This pattern persisted until the merging point was reached and then the other chair suddenly increased its experiencing to levels that equalled the experiencing chair. At this- point the chairs passed into the resolution phase where both of them functioned at levels higher than four. Greenberg (1980a) stated that "This attainment of the merging point by the other chair can therefore be regarded as a sufficient condition of a resolution and a signal of the resolution phase" (p. 147) . The same data were then analyzed for voice quality to provide a richer base of information on the process. The other chair was found to possess a quality of voice that was a combination of an energetic, outer directed voice (external) and an energyless, restricted voice (limited). The experiencing chair on the other hand, used a combination of a high 54 energy inner directed voice (focused) and an emotionally expressive voice (emotional). Based on the voice data Greenberg concluded that the other chair was less involved in the dialogue and made poorer contact with itself than the experiencing chair. However, in the resolution phase a significant decrease in the amount of poor contact, external voice was discovered in the other chair. This change to focused voice in the other chair consistently appeared around the merging point although occasionally some focused voice was found before and more often after. Greenberg concluded: Change to focused voice does, however, appear to be a necessary condition for resolution. This change of voice by the "other chair" is, therefore, an important therapeutic cue. When this voice change in the "other chair" is accom-panied by an increase in experiencing to the level of the "experiencing chair", the demarcation event has entered the resolution phase. (p. 146) The concept of a reconciliation of the opposing parts of the split by integration seemed to be supported by the findings of Greenberg's (1980a) study. The other chair appeared to soften in the resolution phase becoming more similar to the experiencing chair in its function-ing--more involved, more subjective, engaging in a more personal description of its feelings. The two chairs began to match each other's levels of experiencing—depth of experiencing began to integrate. The voice data revealed a shift in the other chair from a person preaching or lecturing at him/herself to productively dialoguing with him/herself. Greenberg's study (1980a) in which possible performances were compared with actual performances constituted the beginning of the model building phase of the task analysis. Those studies by Johnson (1980), Taylor (1980), and Greenberg (In press), where the specific model was created, checked and refined, and where, based on the model, the behavior of clients was hypothesized on task, are not reviewed here as they were outlined earlier in this chapter (The Steps of the Task Analysis). Decision and Conflict In an effort to integrate intrapsychic conflict resolution and the process of decision making the following explanation of their relation-ship is given. The explanation utilizes Tiedeman and O'Hara's (1963) model of decision making, that clearly represents the decision making process, and Greenberg's (1975) model that deals directly with the process of intrapsychic conflict resolution. During the crystallization substage of Tiedeman and O'Hara's (1963) model, alternatives and their consequences are being formed and listed. The advantages and disadvantages of each are being evaluated. In other words, the value of each alternative is being assessed. The alterna-tives become organized and ordered in this process of valuing. The valuing process is generating, examining, and altering values to assist in fixing the order of the alternatives in relation to the individual's goal(s) as crystallization occurs. During clarification doubts related to the decision are grappled with by the individual, in an attempt to work them through. He/she continually views the decision in the light of new and relevant informa-tion. The individual's valuing process is in operation attempting to provide information regarding the value of the decision taken. It was suggested, by the experimenter, that the block to the making of a decision is a conflict of values that is being experienced at 56 either the crystallization or clarification substages—and that the protagonists in this conflict are, in Rogerian (1959) terms, similar to the organism and the self (or self concept). The self is defined as the representative of the conditions of worth; developed in infancy in order to preserve the positive regard of others, and then introjected into the self structure where they represent other's attitudes about experience and behavior, in contrast to the individual's own values. The organism is taken to be the whole person (Goldstein, 1939; Perls et al., 1951; Rogers, 1951) rooted in the organismic valuing process; that process that provides information regarding the value of experience through organically existing sensations and feelings in the moment. The individual learns early to differentiate between actions and feelings that are worthy and those that are unworthy. It is when an organismic-ally occurring experience comes under the scrutiny of the self and its conditions of worth that the stage is set for intrapsychic conflict. Similarly in Gestalt terms (Perls, 1969) the protagonists of the conflict could be cast as organismic self regulation and the meddling intojections. Organismic self regulation is that process whereby the organism strives to maintain an equilibrium of the whole organization which is continuously disturbed by its needs and balanced through their gratification or elimination. The introjects are those early provisions from the environment that were passively incorporated with l i t t l e or no effort expended by the individual to specify his/her requirements or preferences. Conflict arises when the individual becomes aware of his/her personal choices and his/her power to t e l l the difference between "me" and "you". Those values introjected early in development press for what the individual "should" or "ought" to be while organismic 57 self regulation places the individual's well being in the hands of an experiencing self that strives inherently towards satisfying its needs. In more general psychological terms it appears that organismic valuing relies on an independent affective system which operates on a pre-cognitive basis (Zajonc, 1980) and evaluates situations as positive or negative. That is, i t is a system of intuitive appraisal (Arnold, 1960) that operates not as a deliberate or reflective judgement but as an estimative sense that in a direct and immediate manner appraises that which is favourable or unfavourable to the functioning of the organism. It was suggested that this system of intuitive appraisal, the organismic valuing process, could run headlong into those values reflected in the pseudoassimilated introjects (Perls et al., 1951), or conditions of worth at the crystallization and/or clarification points in the model, where cognitions are pressing for stabilization (Tiedeman & O'Hara, 1963). In addition, i t was assumed that the resolution of this intrapsychic conflict (whether i t occurred in the crystallization or clarification substages) allowed the person to pass through the anticipatory stage. The decision is made and the next steps are taken into the implementation stage where imagination encounters reality—the decision is implemented in the real world. By combining in a conceptual manner the models of Tiedeman and 0'Hara(1963) and Greenberg (1975) this study attempts to provide the init i a l steps toward a differentiated stage theory of decision making which outlines the elementary psychological processes involved in the anticipation and implementation of a decision by adults. The processes of the combined models appear diagrammatically as follows (see Fig. 2.1) . I 58 The aim of this combined model is to explain the place of intra-psychic conflict resolution in decision making. In short, the explana-tion advanced here is that individuals engaged in the decision making process, in Tiedeman and O'Hara's (1963) terms, could become intra-psychically conflicted over the value of alternatives at either the crystallization or the clarification substages of the anticipation stage of the model. At either of these points Greenberg's (1975) model applies and suggests a path toward resolution of the conflict and eventually to the making of a decision. Figure 2.1 The Combined Model Exploration M P L E M E N T A T I 0 N Chapter III METHODOLOGY This chapter contains descriptions of the instruments used in the study, the design, procedures, the statistical analyses, and sources of variance. Measuring Instruments Overview The measuring instruments in the study served several purposes. Process instruments were used to identify resolvers and nonresolvers. Relationship instruments were used to identify engagers and nonengagers in the sessions and the two chair operation. Treatment outcome instru-ments were used to measure the dependent variables of indecision, state anxiety, target complaints, and symptom relief. Critical session outcome instruments were used to measure the immediate effects of the session on change in conflict resolution, discomfort reduction, and mood change over the critical session. The prolonged effects of the session were measured on change in mood over the week following the critical session, and goal attainment and attitude change measured at one week and one month follow-ups. 60 61 Process Instruments These instruments were used to measure the clients' in-therapy performance of the critical components (criticisms, felt wants, soften-ing) of the conflict resolution model (Greenberg 1980a). 1. The Experiencing Scale (ES) The in-process level of experiencing during the critical session performance was measured in both chairs on the Experiencing Scale (Klein et al., 1969). The scale was created for the purpose of assessing the quality of client involvement or "experiencing" in psychotherapy. Experiencing...refers to the quality of an individual's experiencing of himself, the extent to which his on-going, bodily, felt flow of experiencing is the basic datum of his awareness and communication about himself, and the extent to which this inner datum is integral to action and thought. (Klein et al., 1969, p. 1) Because of its sensitivity to changes in a client's involvement even within a single therapy hour, the seven point.scale is a particu-larly useful rating device for psychotherapy research. The instrument is particularly valuable to a moment by moment process study such as this one. The lower levels on the scale are identifiable by impersonal or superficial references to self. As one moves up the scale there is a progression from simple, limited, impersonal or externalized references to self to an elaborate inner description of feelings. The highest levels of experiencing are characterized by an exploration of one's feelings and new awarenesses that facilitate problem solving and greater understanding of one's self. The validity of the scale and the concept of experiencing has been strengthened by the application of the scale in various settings; i t has 62 been related consistently to positive therapeutic outcome (Orlinsky & Howard, 1978). Seven studies revealed significant rating reliabilities ranging from rk .79 - .91 modes and .75 - .92 peaks using the Ebel Interclass Reliability method which produces an estimate of the average of the judges' ratings. 2. Structural Analysis of Social Behavior (SASB) The quality of the dialogue between the two chairs or polarities involved in the decisional conflict was measured in this study by the SASB. The assumption is made that as the conflict progresses the quality of the interaction between the two chairs will change. The use of the SASB provides the opportunity for a highly specific rating of the conflictual interaction. The dialogue presented during the interaction can be examined utterance by utterance with each statement being categorized as one of 36 characteristic phrases on one of three grids. This provides the opportunity for the specifying of patterns and subtle changes that occur in the dialogue between the two chairs. Benjamin (1973) has illustrated the development of the SASB from its predecessor, the Leary classification system. The SASB extends Leary's system into a model composed of three, two dimensional grids. The f i r s t grid measures behaviors that focus outward on others, typically parent-like behaviors. For example, "118 Encourage separate identity." In the Gestalt two-chair dialogue this grid was employed to measure the statements of either the "other chair" or the "experiencing chair" when those .statements were focused away from themselves and on the opposite chair. Those statements issued from either chair that referred to or were focused on themselves and away from the opposite 63 chair were measured on the second grid. This grid measured behaviors that focused on "self," typically child-like behaviors, for example, the corresponding behavior to 118 is 218 "Own identity standards." The third grid measures those behaviors which are intrapsychic or introjects of other to self, for example, the corresponding behavior to 118 on this grid would be 318 "Let nature unfold." The third grid was not used in this study. The purpose of the three digit behavioral code is to a) pinpoint the grid 1, 2, or 3 (first number); b) specify the quadrant on that grid 1, 2, 3, or 4 (second number); and c) identify the specific chart point in that quadrant (third number) (see Figure 3.1). All three grids are two dimensional and composed of four quadrants. Correspondingly, each quadrant is two dimensional. The grids are crossed by two perpendicular axes that create the quadrants. The horizontal axis is characterized by the poles of affiliation and disaffiliation. The vertical axis by the poles of maximum dependence to maximum independence. Each point within each quadrant is composed of a proportionate amount of the behaviors described by each of the axes. For example, the first grid chart point 118 "Encourage separate identi-ty," is located in the first quadrant (upper right hand corner) and i contains 1 unit of affiliation and 8 units of endorsing freedom (+1,+8). The 36 pairs of complements described by the first two surfaces allow definition of complimentarity in relationship and have clear and specific implications for the relevance of the patients' significant others to interpersonal diagno-sis and treatment. (Benjamin, 1977, p. 7) Throughout its development and use the SASB has proven itself to be a reliable and sound measuring instrument. Benjamin (1977) pointed out that its validity has been established with the use of factor analysis, circumplex analysis, auto-correlation techniques, and dimensional 120 Endorse freedom INTERPERSONAL Uncaringly let go 12S Forget 177 OTHER Ignore, pretend not there 126 Neglect interests, needl 125 Illogical inilijlion 124 Abandon, leave in lurch 123 Starve, cut out 122 Angry dismiss, reject 121 r-Annihilating iruck 130 — j -Approach menacingly 131 Rip off. drain 132 Punish, take revenge 133 Delude, divert, mitlead 134 Accuse, blame 135 Put down, act superior 136 Intrude, block, restrict 137 Enforce conformity 138 11B Encourage separate identity 117 You can do it fine 116 Suggest fair exchange 115 Friendly explore, listen 114 Show cmpathic understanding 113 Confirm as OK as is 112 Stroke, soothe, calm J11 Warmly welcome _ 110 Tender sexuality 141 Friendly invite 142 Provide for. nurture 143 Protect, back up 144 Sensible analysis 145 Constructive stimulate 146 Pamper, overindulge 147 Benevolent monitor, remind 148 Specify what's best Manage, control 140 220 Freely come and go SELF Go own separate way 228 Defy, do opposite 227 Wall-off, nondiicloie 226 Busy with own thing 225 Noncontingent reaction 224 Grieve, mourn, (eel alone 223 Refuse assistance, care 222 Flee, escape, withdraw 221 Desperate protest 2 3 0 Wary, fearful 231 Sacrifice greatly 232 Appease, scurry 233 Uncomprehending agree 234 Whine, defend. Justify 235 Sulk, act put upon 236 Apathetic compliance 237 Follow rules, proper 238 218 Own identity, standards 217 Assert on own 216 Reciprocal negotiate 215 Ooenly disclose, reveal 214 Clearly express 213 Enthusiastic showing | 212 Relax, (low. enjoy J — 2 1 1 Joyful approach — 210 Ecastatic response 241 Folio' maintain contact 242 Accept caretaking 243 Ask. trust, count o« 244 Accept reason 245 Tjke >n. try. learn from 246 Cting. depend 247 Defer, overcontorm 248 Submerge into role Y i e l d , submi t , give in 2 4 0 320 Happy-go-lucky INTRAPSYCHIC Introject o f OTHER t o SELF Drift with the moment 328 Neglect options 327 Fantasy, dream 326 Neglect own potential 325 Undefined, unknown self 324 Reckless 323 Ignore own basic needl 322 Reject, dismiss self 371 Torture, annihilate self 330 " Menace to self 331 Drain, overburden self 332 Vengeful self punish 333 Deceive, divert tell 334 Guilt, blame, bad sell 335 Doubt, put sell down 336 Restrain, hold back self 337 318 Let potential unfold 317 Let sell do it. confident 316 Balanced self acceptance 315 Explore, listen to inner sell 314 Integrated, solid core 313 Pleased with sell I 3*12 Stroke, soothe self 311 Entertain, eniov sell 310 Love, cherish self T 341 Seek best lor self 342 Nurture, restore self Force propriety 338 Control, manage self 340 343 Protect self 344 Examine, analyie self 345 Practice, become accomplished 346 Self Damper , indulge 347 Benevolent eye on self 348 Force specified identity FIGURE 3.1 THE STRUCTURAL ANALYSIS OF BEHAVIOR 65 ratings. Further proof of its strength was gained from its utilization in the setting of psychosocial treatment goals and in "before, during and after" self ratings that were successful as measures of the effec-tiveness of therapy. The SASB has been used specifically to analyze Gestalt two-chair dialogue employing Cohen's Kappa to test the reliability of interjudge agreement. The reliability was measured at .911. Benjamin concluded in Greenberg (1979b) that: These high Kappas between independent judges establish that despite the complexity, the rules for applying the SASB model to therapy transactions are communicable and can yield consistent judgements among careful independent observers. (p. 20) 3. Client Voice Quality System Voice quality has been viewed by Greenberg and Rice (in press) as an indication of the client's involvement and level of processing in the moment. In their pioneering voice study Rice and Wagstaff (1967) reported that more focused voice was discovered in good therapy sessions than in poor therapy sessions. In the present study the Voice Quality System (VQS) was used to track the quality of the dialogue between the two chairs. It was assumed that the use of focused and expressive voice would be an indication of a deeper level of processing (feelings). Thus, the expression of feelings or an increasing involvement (better contact) was identified using the VQS. The VQS embodies four mutually exclusive voice patterns—focused, externalized, limited, and emotional—that are identified with the use of six features: 1) energy, 2) primary stresses, 3) regularity of stresses, 4) pace, 5) timbre, and 6) contours. The VQS has revealed 66 interjudge agreement through rank order correlation from .7 to .88 on the various voice patterns (Rice, Koke, Greenberg, & Wagstaff, 1979). Relationship instruments 1. Working Alliance Inventory (WAI) The WAI (Horvath 1981; Horvath & Greenberg, 1980, Ref. Notes) is based upon the theoretical work of Bordin (1975, 1976, Ref. Notes) dealing with the importance of the therapeutic relationship. In his 1975 paper, "The generalizability of the psychoanalytic concept of the working alliance", Bordin outlined the alliance as having three com-ponents: agreement on therapeutic goals, the existence of personal bonds, and the development of tasks that are perceived by the client as relevant to his/her concern. He proposed that the therapeutic alliance is a necessary element of all therapies and that different treatment orientations will engender alliances of different kinds but that a l l successful therapies will possess a powerful alliance factor. With these theoretical statements in mind Horvath designed the WAI to encompass the three functional elements of the working alliance: Bonds, Goals, and Tasks. The convergent validity of these three scales was examined using a multi-trait multi-method matrix (Horvath, 1981; Horvath & Greenberg, 1980) that produced evidence supporting the convergent validity of the Goal and Task scales while the Bond scale seemed more diffuse and intermingled with Empathy. The scales were further analyzed for reliability using Hoyt's ANOVA and yielded the following coefficients of reliability: Goal (.88), Task (.88), and Bond (.85). The relationship of the working alliance to outcome was assessed by both zero order correlations and multiple regression analysis. Client reported alliance scores produced significant relationships with outcome. The regression analysis using the WAI dimensions of Task, Bond, and Goal revealed that Task accounted for 40 per cent of the predictable outcome variation. The task dimension of the WAI was selected for use in this study to measure engagement in the task. This consisted of sixteen five-point Likert items ranging from "never" through "sometimes" to "always" (see Appendix A). 2. Barrett-Lennard Relationship Inventory (RI) The RI was designed to measure the client's perception of the counsellor's warmth, congruence, empathy, and positive regard and is based upon Rogers' classic statement on the therapeutic relationship that "the client's experience of his therapist's responses is the primary locus of therapeutic influence in their relationship" (Barrett-Lennard, 1962, p. 2). The questionnaire was used in individual psycho-therapy and has since undergone several revisions as well as being adapted for use in a variety of relationships (group therapy, family interactions, and friendship relations) other than the therapy dyad (Barrett-Lennard, 1972, Ref. Notes). The stability of the RI has been evaluated in 14 studies of internal consistency reliability and in 10 studies of test-retest reliability (see Gurman, 1977, p. 507). Five of the studies that reported on the RI's internal consistency were of actual therapy situations, four were of therapy analogues and one was a friendship relationship. The split-half reliabilities for each of the RI's 68 subscales and the RI total score were consistently very high. Across the 14 studies the mean internal reliability coefficients were: Empathy (.84); Regard (.91); Unconditionality of Regard (.74); Congruence (.88); Total (.91). Similar strength of stability was shown by the reports of test-retest reliability. The mean test-retest correlations were: Empathy (.83); Regard (.83); Unconditionally of Regard (.80); Congruence (.85); Total (.90). These findings indicate that perceptions of therapists by clients, perceptions of therapists by themselves and perceptions of parents by children appear highly stable over time. For the purposes of this research the 16 items of the empathy subscale were used to measure the client's perception of the therapist's understanding. The items ranged from "yes I strongly feel that i t is true" through four intermediate levels to "No I strongly feel that i t is not true" (see Appendix A). The remaining instruments (treatment outcome, critical session immediate and prolonged effects) were used to measure the results of the in-therapy performance on several post performance states (i.e., in-decision, state anxiety, target complaint, conflict symptom, conflict resolution, conflict-related discomfort, mood, goal attainment, and attitude change). 69 Treatment Outcome Instruments 1. Scale of Indecision Due to the lack of a general measure of indecision a specific scale, the "Scale of Vocational Indecision" (Osipow, Carney, & Barak, 1976) was adapted to suit the purposes of the present study. The scale consists of 18 items to be rated on a four point scale from (1) "not at all like me" to (4) "exactly like me." A high score reflects indecision, a low score reflects decidedness. The scale measures 16 distinctive antecedents of educational and/or vocational indecision based on the authors' interview experience with clients. The instrument provides a conceptual f i t with this study's idea of internal conflict over the potential alternatives involved in a decision. Former attempts at dealing with the construct of indecision have approached it either as a totality or in over simplified terms. Since most of the items on the scale were particular to educational and/or vocational indecision some minor revision of wording was neces-sary to make it appropriate for this study. For example, the item, "I know what I would like to major in, but I don't know what careers i t can lead to that would satisfy me", was changed to "I know what I would like to do now but I don't know what it would lead to in the future." The essential meaning of each item was maintained. Appendix A presents the revised form of the Scale of Vocational Indecision. In order to verify that these changes had not adversely affected the validity and reliability of the scale, the adapted form was ad-ministered to 136 graduate students in a pilot study. The students were instructed to respond to the questionnaire in terms of a current 70 decision or if they were not presently in a state of indecision to respond as they felt and thought in the last situation in which they were undecided. The results of this pilot project were analyzed using the LERTAP procedure, a computer program at the University of British Columbia Computing Centre. The resulting r=.85 based on Hoyt's ANOVA internal consistency reliability (LERTAP UBC, 1980), indicates that the revised items are consistent with the other items in the test and that the adapted test is reliable. Since the adapted instrument was essentially the same as the original, research on the reliability and validity of the latter is taken to be relevant to the present study. Osipow, Carney, & Barak (1976) evaluated the validity and r e l i -ability of the Scale of Vocational Indecision using seven groups of Ohio State University students (N = 837). These groups represented a wide range of career decidedness and because several of them were involved in various career decision-making programs, post-testing of the scale was permitted. The overall test-retest Pearson correlation for two groups of nontreated subjects was high (.902, .819), as was the item by item test-retest correlation which ranged from .343 to .820. The scale revealed significant differences between students who requested help and those who did not. It also reflected the pre-treatment and post-treat-ment effects of an intervention designed to reduce vocational indecision (see Appendix A). 2. State—Trait Anxiety Inventory (STAI) The STAI' is based upon a theoretical distinction between state anxiety (A-State), which is viewed as a changing condition of perceived 71 tension, and trait anxiety (A-Trait), a more stable condition of anxiety proneness (Spielberger & Gorsuch, 1966; Spielberger, Gorsuch, & Lushene, 1970). The instrument consists of 40 brief items. Twenty of the items assess "how you feel right now, that is, at this moment", and another 20 assess "how you generally feel". The items are presented in substantively counterbalanced order relative to anxiety. The scales are printed on opposite sides of a single test form. Each scale may be given by itself; when the two are given together, the manual recommends that the state anxiety scale be ad-ministered first. The STAI is self-administered and the directions are self explana-tory. There is no time limit, but to complete both forms generally takes no more than twenty minutes. The manual instructs the examiner not to use the term "anxiety" when referring to the questionnaire. While the face validity of some of the STAI items is obvious, the test forms are titled Self-Evaluation Questionnaire. Two scores are obtained with the inventory, one each for A-State and A-Trait. The range of possible scores for Form X of the STAI varies from a minimum of 20 to a maximum of 80 on both scales. The higher the score, the greater the level of anxiety. The scoring keys reverse the direction of the nonanxiety items so that a high score suggests high state or trait anxiety. Norms for the STAI (Form X) are available for large samples of U.S. college freshmen, high school juniors, psychology students, male neuropsychiatric patients, general medical and surgical patients and prisoners. The norms are presented separately for male and female students. Test-retest reliablilities are reported for state (Form X-1) and trait (Form x-2) scores separately for males and females. One hour interval: .33 (males) and .16 (females) for state, .84 and .76 for trait; 20 days: .54 and .27 for state, .86 and .76 for trait; 104 days: .33 and .31 for state, .73 and .77 for trait. The high reliabilities (.84 and .76) for trait scores suggest that Form X-2 (trait) is measur-ing a considerable amount of state anxiety, even when theoretically predicted fluctuations in trait anxiety are allowed for. Alpha r e l i -ability coefficients for the normative samples range from .83 to .92 for state scores and .86 to .92 for trait scores; i t is suggested that alpha coefficients are more suitable reliability indicators for state anxiety than test-retest coefficients. The construct validities for trait scores were estimated by correlating the scores of the STAI with the IPAT Anxiety Scale, Manifest Anxiety Scale, and Affect Adjective Checklist. The coeffiecients were .75, .80, and .52, respectively, for a group of 126 college women. In summary, i t appears that the STAI is an easy to administer, easy to score, reliable, and valid index of either individual differences in proneness to anxiety or individual differences in transitory experience of anxiety. 3. Target Complaints (TC) Measure The TC measure (Battle, Imber, Hoehn-Saric, Stone, Nash, & Frank, 1966), recommended in Waskow and Parloff (1975) as a core battery instrument for use in psychotherapy outcome research, consists of three five point scales on which the client is asked to rate the amount of change on three different complaints or goals running from "Worse" to "No change" to "A l i t t l e better" to "Somewhat better" to "A lot better" 73 (scored 1-5). The client and his/her counsellor selected a minimum of two and a maximum of three main problems or goals to construct the scales. Numerical values can be assigned to each rating point. The client's score on the instrument then becomes a mean value consisting of the sum of the ratings for a l l target complaints divided by the number of target complaints rated. Several other methods of scoring are mentioned in the literature (Battle et al., 1966), however, measurement questions concerning the weighting of different complaints within clients, as well as the comparison of different complaints between clients, remain problematical. Battle et al. (1966) stated that evidence for the validity of the TC measure was provided by analyzing and comparing its mean target complaint improvement scores with the results of four other outcome measures. The TC correlated to a significant degree with a l l four measures. A further study cited by Battle et al. (1966) revealed highly reliable severity ratings of pre-session and post-session complaints. The mean severity rating for the main complaint was 9.3 for the pre-session measure and 8.8 for the post-session measure, a difference of half a point on a 12 point scale that was constructed specifically to gauge the reliability of target complaint severity. This difference was not significant. Fourteen out of 20 clients had identical pre-session and post-session severity ratings and only four differed more than one point on the scale. When the severity of a l l clients' target complaints was averaged, the results were similar. The mean change of the 74 pre-session and post-session severity ratings of the average target com-plaints differed only .4 of a point. In the same study client's target complaints were compared when reported to two different interviewers. All the judges involved agreed that the client's main problem was present in its content in the pre-session and post-session target complaint of a l l subjects; they concurred that three-fifths of the subjects produced identical pre-session and post-session target complaints and that the remainder differed in only some minor way. This led the authors to conclude ...that target complaints, when properly elicited, can be obtained reliably from the patient and in the majority of patients they do not change in their main content nor in their severity ratings...Moreover, the treatment goal is stated as perceived by the patient himself, whether it constitutes improvement of classic neurotic symptoms or changes in interpersonal relationships. Target complaints are easily and reliably obtainable even from patients with l i t t l e education... (Battle et al., 1966, p. 191) In addition to the significant correlations with other outcome measures the authors offered indirect evidence of the face validity of the target complaints measure. They suggest that target complaints are valid complaints as they correspond to the complaints obtained in an intensive psychiatric interview (see Appendix A). 4. Phillips Personalized Questionnaire A more intensive personalized measure based upon the work of Shapiro (1961a, 1961b, Ref. Notes), and extended by Phillips (1970, Ref. Notes), was used to follow, session by session, each client's conflict related symptom. These symptom statements (e.g., "I feel depressed," "I can't concentrate," "My mind is unclear") usually constitute a major 75 factor in the client's seeking of treatment and are an important index of response to i t . Shapiro tapped this important indicator of change by constructing a special form of questionnaire. Each item on the questionnaire was derived from a statement similar to those examples above, made by the client and expressing a symptom of his/her problem, and provided a scaling of the levels assumed by the symptom. Repeated administrations of the questionnaire over a number of successive occasions yielded a scaling of the successive levels of a l l the symptoms occurring in i t . An important feature of Shapiro's original technique and a l l other personalized questionnaire techniques is that, unlike many conventional questionnaires they have a built in test of the internal consistency of the client's responses. The simpler ordinal and ordered metric tech-niques are tested by Slater's statistic i (1960, 1961) whereas the more complex interval technique is tested in the final analysis of variance on scores over all events, person by person. This test of internal consistency yields a specification of the reliability of a particular questionnaire item created for a particular client. The specification for the ordinal and ordered metric techniques is given by the proportion of the client's responses which are con-sistent (i.e., the difference between unity and the proportion, given by summing i over a ll occasions and dividing by the total number of inconsistent responses.). In the case of the interval technique, this specification is given by the standard error of estimate of the occasion values obtained from the final analysis of variance by taking the square root of the residual variance estimate divided by the number of state-ments. Following Shapiro's invaluable foundation work it was pointed 76 out ( P h i l l i p s , 1963) that h i s form was a very sp e c i a l case of a general class of such techniques. The s p e c i f i c member of t h i s c l a s s chosen for use in the present study was the i n t e r v a l personal questionnaire technique ( P h i l l i p s , 1970). In using t h i s technique a symptom statement (or statements) was e l i c i t e d from each c l i e n t and a set of f i v e statements representing d i f f e r e n t l e v e l s of the symptom was drawn up. For example the set of statements representing the d i f f e r e n t l e v e l s of the symptom statement, "I'm depressed" were: 1. I am very g r e a t l y depressed. 2. I am very depressed. 3. I am moderately depressed. 4. I am s l i g h t l y depressed. 5. I am not depressed at a l l . The degrees of i n t e n s i t y represented by the scale are adapted from the Singer-Young a f f e c t i v e rating scale (Singer & Young, 1941) that has been found to be c l e a r l y d i s t i n c t and discriminable to a number of subjects. After creating the set of symptom statements the next step was to obtain a preliminary scaling of the statements from the c l i e n t by simply asking him/her to rank the statements as they were presented i n a random order. A s t r i p of paper (approximately 30 cm. X 6 cm.) with the standard pair of statements typed on i t ( i . e . , 1 + 5) one at each end, and a standard difference of 100 indicated between them was prepared. Also each of the statements was typed on a separate 12 cm. X 7 cm. index card, forming a deck of statements. Each item of the questionnaire was administered by f i r s t laying the s t r i p in front of the c l i e n t and then presenting to him/her in random order each card of the deck i n turn, with the request to say whether the present i n t e n s i t y of his/her symptom was greater or l e s s than the l e v e l represented by the statement, and by o c c a s i o n of a d m i n i s t r a t i o n the same procedure was f o l l o w e d ; each statement was presented to the c l i e n t with the request to judge the d i f f e r e n c e between his/her current p o s i t i o n and the statement in terms of a standard d i f f e r e n c e . Refer to Appendix B for an explanation of the scoring and analytic procedures used on the PPQ i n t h i s study. 5. Behavioral Report (BR) A follow-up interview was conducted with each c l i e n t approximately one month after his/her termination session. One of the purposes of t h i s interview was to discover i f the c l i e n t had made a choice, imple-mented i t and maintained i t and secondarily to discover how the c l i e n t had construed the process he/she had just completed. The questions used to obtain the primary information were based upon Tiedeman and O'Hara's (1963) model. The questions were constructed to determine i f the c l i e n t was t r u l y in the implementation stage. This was done by posing eight q u e s t i o n s ; one substage r e q u i r e d two q u e s t i o n s and the remaining substages of the model required one question (see Appendix A): how much in terms of the standard d i f f e r e n c e . On each subsequent Substage of Model Question Number Exploration C r y s t a l l i z a t i o n Choice C l a r i f i c a t i o n Induction Reformation Integration 8 3,4 2 5 6 7 78 Each stage was scored either 1 for yes or 0 for no, with crystal-lization requiring 2 yeses to get a 1. The instrument was scored by summing the answers. The total was a possible 7. Critical Session Outcome Instruments 1. Immediate Effects Instruments Conflict Resolution Scale (CRS) The CRS was created by Dompierre (1979) for use in her comparison study of empathy versus the two chair operation at a split in therapy. The measure consists of a seven point box scale, on which clients indicate their feelings of resolution regarding the issue they have identified as their conflict. The first box (starting from the bottom) is labelled "not at all resolved" and the seventh box "totally re-solved". The face validity of the instrument was confirmed indepen-dently by two experts. The instrument was shown to successfully discriminate between more and less resolved sessions in the study, comparing the effect of two chair and empathic reflections on conflict resolution (Greenberg & Dompierre, in press). The CRS was used in this study to track the client's feelings of resolution through the experiment. In addition to the client's indica-tion of resolution the counsellors indicated after each session on a therapist report form (TRF) their perception of each of their client's degree of resolution using the CRS. (see Appendix A) 79 Target Complaints Discomfort Box Scale (TCDBS) The c l i e n t ' s severity rating of target complaints was obtained by asking c l i e n t s to rank th e i r problems ("which of these problems do you most want help with?") (Battle et a l . , 1966). After ranking a l l t h e i r complaints the c l i e n t s were asked to rate the amount of discomfort associated with each target complaint. The i n i t i a l discomfort r a t i n g was made on the TCDBS, a column divided into t h i r t e e n boxes. The words "not at a l l " are printed beside the bottom box, "a l i t t l e " by the fourth box from the bottom, "pretty much" by the seventh box, and "couldn't be worse" by the top or thirteenth box. The instrument was used to rate c l i e n t s ' discomfort both before and after interviews. In a r e l i a b i l i t y study the authors found the c o r r e l a t i o n between the pre-session and post-session ranks for the o r i g i n a l p r ior complaints was .68. The severity ratings of the target complaints did not change to a s i g n i f i -cant degree leading the authors to conclude that the TCDBS produced r e l i a b l e r e s u l t s (see Appendix A). Epstein's P r e v a i l i n g Mood Scale (EPMS) (Epstein, 1979) The p r e v a i l i n g mood scale consists of nine, nine-point scales where each end of a scale i s defined by opposite groups of items. The c l i e n t was asked which side of the scale, defined by opposite groups of items, best described his/her fe e l i n g " r i g h t now, t h i s very moment" and to rate t h i s on the scale. For example: 1. Happy, cheerfu l , joyous 2. Sad, Unhappy, depressed 1 1 2 1 1 2 2 1 1 Extremely Moderately Not at a l l Moderately Extremely or Neutral 80 When one end of the scale is chosen and rated the other end or item must receive a rating of "1" ("not at al l " ) . If neither feelings apply in the moment or i f they exactly balance each other the clients are instructed to give both a rating of "1". Each scale is identified by clusters of three adjectives, such as happy, cheerful, joyous, the clusters having been determined by factor analysis of adjective checklists used in previous studies by Epstein (1976) . Epstein (1979) reported a series of studies of which a major focus was the examination of the temporal reliability and validity of data derived from self observation of feelings (i.e., the prevailing mood scales). The procedure followed was to observe behavior on several occasions and single observations were treated like single items on a test. More precisely, stability coefficients were first determined for a one-day sample by correlating each subject's scores on Day One with each subject's scores on Day Two. Coefficients were then determined for a two-day sample by correlating the mean of a subject's scores on Days One and Four and so on, until the mean of a subject's scores on a l l odd days was correlated with the mean of the subject's scores on all even days. It was then possible to examine split-half stability coefficients for each variable as a function of the number of observations that were averaged. This type of procedure is analogous to that which compares the reliability coefficients of tests of different lengths. 81 The reliability coefficients for each bi-polar variable are: Emotion Happy-Sad Kind-Angry Secure-Threatened Aroused-Tired Spontaneous-Inhibited Calm-Tense External attention-Introspective Wor thy-Unwor thy Integral-Disorganized Powerful-Helpless Peaceful-Ag itated Attractive-Unattractive Optimistic-Pessimistic Alert-Unreactive Outgoing-Seclusive X Correlation 1 day sample 7 day sample 14 day sample .43 .55 .41 .32 .41 .34 .22 .56 .52 .59 .53 .59 .41 .34 .46 .45 .66 .78 .67 .66 .79 .83 .55 .79 .84 .85 .82 .89 .85 .64 .70 .75 .80 .88 .80 .80 .88 .91 .71 .88 .91 .92 .90 .94 .92 .78 .86 .86 The work reported by Epstein (1979) led him to conclude: ...that once high levels of reliability are established, evidence of construct validity is apt to emerge in relation-ships among the different variables, including ones that do not share common method variance. In other words high levels of stability can be demonstrated for subjective data when the data are averaged over a sufficient number of events since reliability determines the upper limit of validity i t can be taken as a necessary but not sufficient condition for validity. In this study attention was focused on only three of the scales of the EPMS. This was done because of their perceived theoretical link to the phenomenon of intrapsychic conflict. The following statement by Simkin (1974) constructs the frame of reference: ...There are two sides to every coin. There are two sides to you. Polarities are the two sides to your coin. If you are aware of beating yourself and you identify with the beaten part, that's your side of the coin. Or you may be aware of beating, but not in touch with the part of you that is being beaten. If you are aware of a part of you which feels put down, there is also a part of you that is doing the putting down... By getting in touch with both sides of the polarity, especially the side that you don't ordinarily (p. 121) 82 identify with there is the possibility of integration, of putting yourself together. To achieve integration, centred-ness, and balance you need to learn the two sides of your coin. (p. 56) The scales percieved as theoretically relevant were originally (Epstein, 1979) worded as: 1) Worthy - Unworthy 2) Integral - Disorganized 3) Powerful - Helpless More recently (Epstein, 1980, Ref. Notes) the wording of the scales was changed to: 1) Pleased with self - Ashamed (PWS) 2) Integrated - Disorganized (INT) 3) Powerful - Weak (POW) The most recent scales were used in this study. It was assumed that prior to conflict resolution people would be self critical and generally displeased with themselves whereas following resolution they would be more self accepting or pleased with self and this would be captured by the PWS scale. Similarily, i t was assumed that prior to resolution people would be disintegrated or disorganized and after resolution they would be more integrated which would be reflected on the INT scale. Finally it was assumed that individuals prior to conflict resolution would experience themselves as weak or helpless and following resolution would experience themselves as more powerful and self directed which would be registered on the POW scale of the EPMS (see Appendix A). 83 2. Prolonged Effects Instruments Goal Attainment Scaling (GAS) The GAS measurement procedure is a method of goal definition and goal measurement (Kiresuk & Sherman, 1968). It is a way of obtaining specific observable and quantifiable goals for clients that produces a common measure among very personalized individual goals. The procedure includes a means of formally and routinely specifying the actual goals undertaken by a client in relation to his/her presenting concerns. With this procedure it is possible to determine the extent to which the client's goals have been attained. The GAS scores are based on a mean of 50 and a standard deviation of 10. The goal outcomes range from "much worse than expected" (-2) through "expected" (0) to "much better than expected" with each outcome level defined by a particular observable behavior or group of behaviors. A scale must have at least two points that are sufficiently precise and objective in their description so that an unfamiliar observer would have no trouble in determining whether the client's position lay above or below the chosen point. The scale thus becomes an evaluative trans-formation of the treatment outcome into an approximate random variable with a mean of zero and a. variance of one (before transformation to the standard variable with mean = 50 and standard deviation = 10). One purpose in the development of the GAS system was to allow outcome data to be grouped for easy analysis without losing the import of individual client goals. A standard score may be generated for each client to evaluate his/her position before and after counselling. 84 Essentially, the GAS has the following characteristics: (1) a set of statements of goals for an individual; (2) a system of weights for these goals; (3) a set of expected outcomes for these goals ranging from "most unfavourable" to "most favourable;" (4) a follow-up scoring of these outcomes; and (5) a score summarizing the outcome across a l l goals (Kiresuk & Sherman, 1968) . Mauger, Audette, Simonini, and Stolberg (1974) analyzed the GAS against the Minnesota Multiphasic Personality Inventory (MMPI) for validity. They reported a correlation of .30 between MMPI scores and the GAS ratings. Reliability was found to be .71 for different follow-up raters in initial goal setting, .70 after two months, and .47 after six months (Garwick, 1974). The test-retest reliability has been reported as .57 (Sherman, Baxter, & Audette, 1974). (see Appendix A). Post Critical Session Questionnaire (PCSQ) The PCSQ is an instrument constructed by the author for this study in an attempt to measure attitude change. The most desirable method of measuring this change would have been to obtain a pre-session measure of attitude toward the issue that the client wished to work on and then at post-session measure to . see i f any attitude change had occurred. However, due to the fluid nature of therapy it was hypothesized that the previously specified issue would shift into remotely related areas rendering the pre-session measure useless. To combat this problem a retrospective method of measuring critical session attitude change was developed. in the therapist's judgement when a critical session had occurred, or the fifth session had elapsed, he/she administered the PCSQ. The instrument asked the client to 85 identify the "core issue" that he/she had worked on in these sessions and then proceeded to enquire i f some attitude around this issue had changed as a result of "the sessions". Two five point Likert scales on the instrument were utilized to derive the PCSQ score. These scales were scale 2 and scale 4 and ranged from "no change" through "somewhat" to "very greatly changed." (see Appendix A). Miscellaneous Forms 1. Therapist Report Form (TRF) The TRF was used in the study to keep track, session by session, of the client's manifestation of resolution components and the counsellor's perception of the client's degree of resolution. Each counsellor marked a check l i s t of the five resolution components after each session to indicate which had been manifested by his/her client. This proved to be an aid in locating critical sessions and tabulating resolution com-ponents, through strings of sessions, to determine how many components each client had demonstrated. In addition, each counsellor marked a CRS after each session to indicate how resolved he/she believed his/her client was at that particular session (see Appendix A). 2. Consent Form A written explanation of the study was given to a l l clients along with a consent form. The explanation described the study as about "how people make decisions." It also informed the clients of their rights to confidentiality and withdrawal. 86 All clients were asked to sign the Consent Form which stated that they were freely volunteering to participate in the study, and had been informed of the nature of their participation (see Appendix A). 3. Information Sheet A short form was used to collect information such as name, address, age, sex, occupation, marital status, and education (see Appendix A). Participants in the Study Subject Selection Subjects were solicited through radio, television and newspaper advertisements, as well as posters and brochures placed in community centres and libraries. The announcements described a free, short program, conducted under the auspices of the University, for people experiencing difficulty in making decisions. Radio and television announcements were the most effective advertising modes accounting for fully three quarters of the sample. Sixty-five people responded to the advertising, 45 were selected for use in the study. A preliminary screening occurred at the i n i t i a l telephone contact. If callers were not experiencing a current conflict between two (or more) equally attractive options but were s t i l l in an exploratory or information gathering stage they were referred to an alternate community service. If they were currently experiencing such a conflict, they were invited to an "introductory" interview. 87 At the introductory interview subjects were screened for evidence of severe disturbance. Only persons who were relatively well function-ing and experiencing a decisional conflict were accepted for the study. Appendix A presents a protocol of the screening interview and a check-l i s t of the acceptance criteria. These were based on Malan's (1976) criteria for brief analytic therapy. Of 58 persons interviewed 13 were screened out, seven because they did not meet acceptance criteria and six because of scheduling problems. Of the remaining 45 persons nine did not show up for the induction session. Five persons of the remaining 36 dropped out of the study at various points from the initial session to the follow-up interview. Data were collected through the mail and by telephone on a l l dropouts. Reasons for dropping out ranged from scheduling problems (e.g., summer holidays) to more substantive issues (e.g., "It's just not for me"). In al l cases an alternative referral was offered. Thirty-one subjects completed the designed package. Following the screening interview, volunteers accepted for the study were provided with a written explanation of the study and asked to sign the informed consent form. Sample The clients in this study were 36 adults who voluntarily sought counselling to help them resolve a conflict that they were experiencing. There were 31 women and five men, ranging in age from 17 to 65 years (X = 34.72, S.D. = 12.28). The sample was fairly well educated; of 36 participants, 34 had graduated from high school, 19 had some university education, five had attended graduate or professional school, and six 88 had vocational or technical school training. Various occupations were represented in the sample; seven of the 36 were professionals, 10 were employed in skilled trades and the rest were housewives or students or retired persons. The clients were experiencing difficulty in making a decision and could be regarded as being in the anticipatory stage of Tiedeman and O'Hara's (1963) model. They were screened so that they were beyond the exploration substage and were either in the crystallization or c l a r i f i -cation substage of the initial anticipatory stage. Therapists Six therapists, three men and three women were used in this study. All the therapists had a minimum of 100 hours of training and super-vision in the Carkhuff/Egan model of counselling (Egan, 1975). In addition all had at least 96 hours of training in the Gestalt two-chair operation, consisting of thirty-two weekly, three hour sessions. The therapist's working experience using these skills ranged from two to seven years with a median experience of three years four months. Raters Two raters and one clinical judge were used in this study. All were uninformed of the hypotheses of the research. All were trained in the conflict split resolution model (Greenberg, 1975) (see Chapter I) and on scoring the process rating instruments, Experiencing Scale (ES), Voice Quality System (VQS), and Structural Analysis of Social Behavior (SASB) . Both raters and the judge had 4 hours of training on the conflict split resolution model, 16 hours of training on the ES, 16 89 hours of training on the VQS, and 13 hours of training on the SASB. The results recorded by the two raters were checked for inter-rater re-liabil i t y at the end of training yielding a Pearson product moment correlation of .86 for experiencing, and Cohen's Kappas (a more strin-gent test of interaction reliability) of .89 on SASB and .50 on VQS which were significant at the .05 level. In addition the raters were checked on their identification of the two chairs and showed a 100% agreement on chair identification. Data Collection The study began with an induction session, conducted by an advanced doctoral student in counselling psychology. The clients were briefly introduced to the Gestalt theory of intrapsychic conflict (as opposition between parts of the personality), the two-chair technique and engaged in an exercise designed to create an awareness of each client's own "top-dog" and "under-dog". Time was allowed for questions and c l a r i f i -cation. The induction session was of approximately one hour duration followed by a half hour period for the completion of questionnaires. During this half hour the client's constructed the Target Complaints measure, the Phillips Personalized Questionnaire and completed the first administration of the latter. They were given the Scale of Indecision and the State Trait Anxiety Inventory to take home with the instructions to complete both instruments the night before their first counselling session and to turn them in at the first session. The two purposes of the induction session were: 1) to educate the clients in how to engage 90 in the two-chair process and; 2) to construct and receive the treatment outcome instruments. During the week f o l l o w i n g the i n d u c t i o n s e s s i o n each c l i e n t embarked upon the series of counselling sessions. The c l i e n t s were seen once a week for six weeks or u n t i l they resolved t h e i r c o n f l i c t ( i . e . , whichever came f i r s t ) . When in the counsellor's judgement, the c l i e n t had manifested a resolution performance, that i s , the three c r i t i c a l elements (an expression of c r i t i c i s m , f e l t wants, and a softening) had been present, the session i n which softening occurred was defined as the counsellor judged c r i t i c a l session. If a c l i e n t f a i l e d to manifest the c r i t i c a l elements, the f i f t h session was declared the c r i t i c a l session. At t h e i r c r i t i c a l session both those who had manifested the res o l u t i o n elements and those who had not, were t o l d that the next session was the termination session. They reported i n one week for the session and then again one month after the termination session to complete a battery of questionnaires designed to discover how resolved or decided they were at those times. A l l counselling sessions were audiotaped. The administration of instruments followed a set pattern for each session. Before a session the instruments were administered in the following order: 1) P h i l l i p s Personalized Questionnaire; 2) C o n f l i c t Resolution Scale; 3) Target Complaints Discomfort Box Scale; and 4) Epstein's P r e v a i l i n g Mood Scale. The tape recorder was then turned on and the session was conducted. Following the session, which was of approximately one hour in length, the tape was turned o f f and the post session instruments were admini-stered in the following order: 1) C o n f l i c t Resolution Scale; 2) Target Complaints Discomfort Box Scale; and 3) Epstein's P r e v a i l i n g Mood Scale. 91 At the conclusion of the second session the Relationship Instru-ments (WAI, RI) were given to the c l i e n t s with the i n s t r u c t i o n to f i l l them out at home and return them at the next session sealed i n the provided envelope. The data generated by these instruments permitted the d i v i s i o n of the c l i e n t s into engagers and nonengagers. This ensured that a l l c l i e n t s were engaged in the counselling process and any dif f e r e n c e s between resolvers and nonresolvers could not be attributed to the nonresolvers being not engaged and hence poor c l i e n t s for that i reason. The instruments for the c r i t i c a l session followed the same pattern as a routine session, as there was no way of i d e n t i f y i n g a c r i t i c a l session beforehand. The c r i t i c a l session d i f f e r e d by the administration of the Post C r i t i c a l Session Questionnaire and the construction of the Goal Attainment Follow-up Guide after the session. In addition, c l i e n t s were given six copies of Epstein's Prevailing Mood Scale with the i n s t r u c t i o n to complete one instrument per day u n t i l the next session (termination) one week away. At the termination session c l i e n t s discussed what they had achieved and completed the instruments. The instruments were completed i n the following order: 1) P h i l l i p s Personalized Questionnaire; 2) C o n f l i c t R e s o l u t i o n S c a l e ; 3) Target Complaints Discomfort Box S c a l e ; 4) Epstein's P r e v a i l i n g Mood Scale; 5) Target Complaints; 6) Goal A t t a i n -ment Scaling; 7) Post C r i t i c a l Session Questionnaire; 8) Scale of Indecision; and 9) State T r a i t Anxiety Inventory. During the follow-up interview one month l a t e r c l i e n t s completed these instruments i n the order l i s t e d : 1) P h i l l i p s Personalized Q u e s t i o n n a i r e ; 2) C o n f l i c t R e s o l u t i o n S c a l e ; 3) Target Complaints Discomfort Box Scale; 4) Target Complaints; 5) Goal Attainment Scaling; 6) Post C r i t i c a l Session Questionnaire; 7) Scale of Indecision; 8) State T r a i t Anxiety Inventory; and 9) Behavioral Report. Following each session therapists completed the Therapist Report Form. In addition to the report form therapists completed the Target Complaints measure after the termination and follow-up interviews. A schematic representation of the order of the t e s t s i s presented as a flowchart i n Figure 3.2. Scoring Procedures A l l paper and pen c i l tests were scored, checked, and tabulated and the tapes were rated for the presence or absence of process i n d i c a t o r s of the resolution components. This rating allowed the sample to be s p l i t into resolvers and nonresolvers. 1. I d e n t i f i c a t i o n of Engagers The WAI and the RI were scored as follows. The c l i e n t ' s perception of task relevance was measured by the task dimension of the WAI. Out of a possible score of 60, c l i e n t s had to a t t a i n a score of 36 in order for the task to be perceived as minimally relevant. Thus a l l c l i e n t s rated the relevancy of the task equal to or above 36. The mean and standard deviation scores for the sample were 51.84 and 5.96 re s p e c t i v e l y . The c l i e n t s ' perception of their counsellor's empathy was deter-mined using the empathy scale of the RI. In order for the therapist to be perceived as empathic he/she had to obtain a minimum score of 16 on the scale, out of a maximum of 48. A l l c l i e n t s rated t h e i r counsellors IS TC PPQ "STAI" <-1 wk-> "S I" 1 PPQ CRS TCDBS EPMS CRS TCDBS EPMS <-l wk-> PPQ CRS TCDBS EPMS CRS TCDBS EPMS "WAI" "BLR I" <-1 wk-> <-1 wk-> CRS TCDBS EPMS RS PPQ CRS TCDBS EPMS CRS TCDBS EPMS TS PPQ CRS TCDBS EPMS TC <-1 wk-> GAS PCSQ SI STAI <-1 wk-> PPQ CRS TCDBS EPMS CRS TCDBS EPMS PCSQ GAS <-1 mo -> a PPQ CRS TCDBS EPMS <-1 wk-> TC b GAS PCSQ SI STAI PPQ CRS TCDBS TC <-l mo-> GAS PCSQ SI STAI BR See Legend on next page Figure 3.2 Flowchart of Measures a - presession "SI" b - postsession IS - Induction Session S ...S - Sessions 1 - 5 PPQ 1 5 TS - Termination Session FS - Follow-up Session CRS RS - Resolution Session TCDBS TC - Construction of Target Com-plaints EPMS PPQ - C o n s t r u c t i o n of P h i l l i p s "WAI" Personalized Questionnaire "STAI" - State Tra i t Anxiety Inventory to be completed at home before f i r s t session "BLR I" Scale of Indecision to be completed at home before f i r s t session. Phi l l ips Personalized Ques-tionnaire Confl ict Resolution Scale Target Complaints Discomfort Box Scale Epstein Prevailing Mood Scale Working Alliance Inventory and Barrett-Lennard Relationship to be taken home, completed and returned in sealed envel-ope see WAI, above. GAS - construction of Goal Attain-ment Follow-up Guide . - c r i t i ca l elements manifested before f i f th session SI - Scale of Indecision STAI - State Tra i t Anxiety Inventory GAS - Goal Attainment Scaling BR - Behavioral Report Figure 3.2 (Continued) Flowchart of Measures 95 above 16. The mean and standard deviation scores for the group of six therapists were 31.58 and 8.89 respectively; It was concluded from the data of the 1 WAI and RI that a l l clients both perceived the task presented to them as relevant to their concern and perceived their therapist as empathic; None of the clients who completed the project were identified as nonengagers due to their perception of the task as nonrelevant or of their therapist as not understanding them. 2. Identification of Critical Sessions The tapes of potential critical sessions were identified by having the therapist indicate on a questionnaire (Therapist Report Form), following each session, the occurrence of any resolution components. When the data collection was complete the counsellors were asked to return to the session audiotapes which they had marked as containing the most advanced component and to indicate a good example of each of the components that had occurred during the hour or from a previous session if necessary. The experimenter then took the tape and used the indi-cated component as a mid-point for an eight minute segment. That is, the segment was composed of the four minutes before the indicated component plus the following four minutes including the component. This eight minute segment was regarded as the critical episode and was presented to the two trained raters. The critical episodes were composed of either criticism, felt wants, or softening. It was possible for one, two, or three of the components to be present in a single episode. If a l l the components necessary to qualify the segment as a resolution eposide were not present in a single segment, the necessary 96 number of preceding critical episodes (tape segments) were presented to the raters. The critical episodes were presented in random order to the raters. In the case of the as yet unverified "nonresolvers" the counsellors were asked to identify the session (tape) that contained the greatest number of components for that client, and to indicate the components in i t . The experimenter, in addition to this tape, selected the session (tape) in which the client reported being most resolved (Conflict Resolution Scale). When these sessions coincided or when the client never reported his/her conflict being more resolved than i t was in the counsellor's chosen session then this whole session was broken into eight minute segments (with the indicated component as the mid-point). If the counsellor's choice and the client's report were discrepant, i.e., the client reported his/her conflict being more resolved in a session, other than the one identified by the counsellor, then both tapes were submitted to the raters for examination. The counsellor's tape was prepared in the manner mentioned above and the client's tape was prepared by using the beginning of the two chair dialogue as an entry point and then breaking the remainder of the session into eight minute segments. The prepared segments of the nonresolvers were then shuffled and presented in random order to the raters. All unused tapes from the nonresolvers (i.e., never identified as containing a softening component) and several sessions from resolvers already rated as containing a softening component were sent to a clinical judge, trained in the model and unaware of the hypotheses of the study, to be scanned for the occurrence of a softening component possibly overlooked by the counsellors. If any softening components 97 were i d e n t i f i e d i n the nonresolver tapes, the tape in question was segmented in the manner described above, and sent to the r a t e r s . The raters decided on which chair was speaking in the dialogue and then rated each segment for the presence or absence of softening and c r i t i c i s m s i f i t was the other chair and f e l t wants i f i t was the experiencing c h a i r . The base unit for these ratings was the c l i e n t statement. These ratings were based on ratings of the depth of experi-encing, voice q u a l i t y , and s t r u c t u r a l analysis of s o c i a l behavior of each c h a i r . In the case of any disagreements the segment was given to the judge. The following c r i t e r i a were used for i d e n t i f y i n g the components: Softening 1. At l e a s t two consecutive c l i e n t statements from the other chair had to be rated as a f f i l i a t i v e on SASB (A c l i e n t statement was defined as everything occurring between two counsellor statements). 2. At least one c l i e n t statement in focused voice had to be coincident with the above SASB rating ( i . e . , one of the two consecutive SASB statements). 3. At l e a s t one statement in the other chair must have reached l e v e l four or above on the Experiencing Scale, "Descriptions of f e e l i n g s and personal experiences" (Klein, et a l . , 1969, p. 64). Level four was used rather than l e v e l f i v e , as in previous studies, because of the smaller unit ( i . e . , one statement). If a l l three c r i t e r i a were s a t i s f i e d the episode was defined as an instance of softening. -If a l l three were not s a t i s f i e d the episode was not so defined. 98 A comparison between the two raters on their overall ratings was performed. There was agreement on 12 out of 13 of the cases. A third person, the judge, was called in to break the disagreement in favour of a thirteenth instance of softening. Felt Wants 1. At least one client statement in the experiencing chair on SASB had to be rated in the categories 243 Ask, trust, count on, 217 Assert on own, 216 Put cards on table. * 2. At least one client statement had to have reached a level four on the Experiencing Scale. However, a secondary judgement was made in order to provide some spread on this variable. That judgement was whether there was only one or more than one statement at level four. One statement at level four satisfied the criterion and more than one provided a stronger statement of experiencing. 3. At least one client statement coincident with the SASB statement had to be in focused voice. 4. The client must have met the semantic criterion of expressing directly to the other chair a desire, for example, "I want...," "I need...," or "I'd like..." or some other equivalent statement of a want. Criticisms 1. At least two client statements in the other chair had to be rated in either quadrants II (Invoke Hostile Autonomy) or III (Hostile Power) of the Other grid on the SASB. 99 2. At le a s t two c l i e n t statements had to be rated as being i n external voice on the Voice Quality System. The i d e n t i f i c a t i o n p rocess y i e l d e d 158 eight-minute segments. These segments were submitted to the r a t e r s , independently, for r a t i n g on the process instruments. Each rater rated two-thirds (105) of the t o t a l number of segments i n order to provide an i n t e r r a t e r r e l i a b i l i t y check. The one-third overlap upon which the raters' r e l i a b i l i t y was checked was composed of 53 eight-minute segments that contained a l l the therapist indicated softenings. Although there were only 53 segments, there were 56 ratings due to 3 segments being rated as containing 2 components. Twenty segments were rated as containing "nothing" ( i . e . , no c r i t i c a l components). Sixteen segments were rated as containing softenings. Thirteen of these were true softenings, that i s , they were accompanied by the other c r i t i c a l components ( c r i t i c i s m s , f e l t wants). Two of the 16 were apparent softenings, that i s , they were not supported by the other two c r i t i c a l components. It was thought by the experimenter that i f any i n d i v i d u a l was unable to be c r i t i c a l of him/herself, i n i t i a l l y , then he/she could not soften a harsh c r i t i c a l a ttitude l a t e r in the process. If i n d i v i d u -a l s had not experienced both sides of their c o n f l i c t as represented by an expression of c r i t i c i s m (other chair) and an expression of a f e l t want (experiencing chair) then they r e a l l y could not soften. The f i n a l softening was accounted for by a double softening, that i s , one person (of the 13) had softened twice. T h i r t y - s i x segments had been rated, up to t h i s point, y i e l d i n g 37 ratings, as a r e s u l t of one segment contain-ing both a softening and a f e l t want. The 17 remaining segments 100 contained two double ratings which produced the final total of 56 ratings. To determine the extent of agreement between the raters, Cohen's Kappa (Cohen, 1960), a procedure that yields a coefficient of agreement for nominal scales was used. Cohen's Kappa (K) differs from simply calculating the proportion of cases in which the raters agree by including a factor which adjusts for chance agreement. K can range from "1" for perfect agreement, to "0" when attained agreement equals chance agreement. The 53 segments upon which the two raters overlapped were selected for calculations of Cohen's K. The results are displayed in Table 3.1. The coefficient of agreement for these data was K=.925 indicating very high agreement between raters on the identification of the resolu-tion components. This suggested that the criteria were clear, indepen-dent, and mutually exclusive with respect to the defining of resolvers and nonresolvers. Design The design employed in this study incorporated some of the features of the "split plot design" (Kirk, 1968). Due to the impossibility of randomly assigning clients to the resolver and nonresolver groups the essence of the design, however, is quasi-experimental (Campbell & Stanley, 1963) . The result is a design that is quasi-experimental in nature with many features of the split plot design. In the split plot design subjects receive only one level of factor A (in this study group membership) but all levels of factor B (in this 101 Table 3.1 Agreement Matrix: Identification Process of Resolution Components Judge Two Category Criticism Felt Wants Softening Nothing Row Totals J Criticism 8 (1.28)* 8 u d Felt Wants 10 (1.96) 1 11 9 e Softening 15 (4.28) 15 0 Nothing 1 1 20 (8.25) 22 n e Column Totals 9 10 16 21 N = 56 * adjustment for chance agreement study measurement occasions). The status variable group membership, in this study, has two levels (resolver/nonresolver) and measurement occasions has three levels represented by the repeated measures (i.e., pre-experiment, termination, and follow-up). Statistical Analysis Several different statistical tests were utilized to analyze the data generated by the various instruments employed in the study. In addition and prior to the main analyses some preliminary tests were required to insure that the data met certain assumptions. Analysis of Treatment Outcome Measures Before evaluating the experimental hypotheses associated with indecision and state anxiety (see Appendix D for A-Trait data) i t was necessary to insure that, due to unequal sample sizes, the test for 102 homogeneity of variance was met by the data. To investigate this concern a Bartlett-Box Homogeneity of Dispersion Test was conducted on each dependent measure for each measurement occasion (see Appendix C for tests of homogeneity of variance on dependent measures). In addition, as a result of the desire to analyze these same data with univariate parametric procedures it was necessary for the data to pass the test for equality of variance - covariance matrices thus permitting an analysis of clients who had participated under more than one treatment condition or in this study, measurement occasion (Kirk, 1968) . This was completed by an inspection of the pooled within groups covariance matrix for each variable. The experimental hypotheses concerned with indecision and anxiety were analyzed by a two-way analysis of variance with repeated measures on one factor (p < .05). Group membership was considered as a fixed factor with two levels (resolvers, nonresolvers) and i t was taken that the second consisted of repeated measures over three occasions. That is, SI and A-State over pre-experiment, termination, and follow-up. The experimental hypotheses involving TC and BR were analyzed using a nonparametric statistical test due to several inadequacies present in the data (e.g., unequal sample size, lack of homogeneity of variance, concern over the underlying metric of the scales). The test performed on these data was the Wilcoxon Rank Sum test. Evaluation of the experimental hypotheses concerning symptom change was made by executing 31, N=1 two-way analyses of variance, one for each client. The client statements were considered a fixed factor, with five levels and the counselling sessions were considered a fixed factor with 103 as many levels (N < 8) as there were sessions (p < .05). (Phillips, 1970). The shape and significance of the relationship between the treat-ment and experimental variables were then tested with trend analysis, an application of the analysis of variance. The results of these tests produced the numbers of resolvers and nonresolvers who had exhibited significant symptom relief. The probability of obtaining such an arrangement was then tested with Fisher's exact test of probability, over a l l clients between the two groups. Analysis of Critical Session Outcome Measures 1. Immediate Effects The experimental hypotheses dealing with the sense of conflict resolution (CRS), the conflict associated discomfort (TCDBS), and mood (PWS, INT, POW) as related to before and after critical session differ-ences between the two groups were also analyzed with the Wilcoxon Rank -Sum test (p < .05). This test was chosen as the data in question shared similar inadequacies to the TC and BR measures (i.e., unequal sample size, lack of homogeneity of variance, concern over the underlying metric of the scale). 2. Prolonged Effects The experimental hypotheses concerning goal attainment (GAS), attitude change (PCSQ) and mood (PWS, INT, POW) were also analyzed using the Wilcoxon Rank Sum test (p < .05) because of concerns with sample size, homogeneity of variance, and the underlying metric of the scales. Chapter IV RESULTS This chapter contains the results of preliminary tests on the data (see Appendix C) under their respective outcome categories as well as the results of the final statistical analyses of the data. Treatment Outcome Results The pretest, termination, and follow-up scores for the SI and A-State were submitted to two-way analyses of variance with repeated measures on the second factor (occasions). Group membership was viewed as a two level fixed factor and the measurement occasions were the repeated measure. The computer program used for this analysis was ANOV 23 from the University of Alberta's Division of Educational Research Services (1980). The analysis was used to determine whether or not there were statistically significant differences between resolvers and nonresolvers (2) or, measurement occasions (3 levels) or a significant interaction of resolver/nonresolvers with measurement occasion on treatment outcome measures. Tables 4.1 and 4.2 summarize these analy-ses. The repeated measures analysis of variance related to the differ-ences on indecision between the resolvers and nonresolvers at the three measurement occasions (times) was used to test the following hypotheses: Ho1: Resolvers and nonresolvers will not be significantly different on indecision, as measured by the SI, at termination or follow-up. 104 105 Table 4.1 Summary of Analysis of Variance for Scale of Indecision Source SS DF MS F P Main E f f e c t s 1135.030 1 1135.030 10.529 .003 (Resolvers/Nonresolvers) Main E f f e c t s 1608.868 2 804.434 75.528 <.001 (Time) Interaction 223.444 2 111.722 10.489 <.001 (Resolver/Nonresolver X Time) Error 617.750 58 10.651 Total 3585.092 63 2061.837 Table 4.2 Summary of Analysis of Variance for State Anxiety Source SS DF MS F P Main E f f e c t s 446.711 1 446.711 2.788 .106 (Resolvers/Nonresolvers) Main E f f e c t s 1988.529 2 994.264 21.256 <.001 (Time) Interaction 879.269 2 439.635 9.399 <.001 (Resolvers/Nonresolvers X Time) Error 2713.000 58 46.776 Total 6027.509 63 1927.386 106 Hi 1: Resolvers and nonresolvers will be significantly different on indecision, as measured by the SI, at termination or follow-up. The probabilities of the differences on the SI between resolvers and nonresolvers, time, and resolvers/nonresolvers and time interaction being due to chance were .003, < .001 and < .001 respectively. It was assumed, therefore, that the resolvers/nonresolvers main effect, the measurement occasion main effect and the interaction (resolvers/non-resolvers X measurement occasion) were significantly different (p < .05) . Due to the interaction l i t t l e direct attention was paid to the tests of the main effects (Kirk, 1968, p. 263). Instead, the simple main effects were examined by constructing Bonferroni confidence intervals around the mean differences of the resolvers and nonresolvers groups at each measurement occasion (Kirk, 1968, p. 79). Table 4.3 presents the results of the construction of the Bonferroni confidence intervals and Table 4.4 presents the means for the repeated measures on the SI for resolvers and nonresolvers. The confidence intervals revealed that the dyadic differences were in the predicted direction and were not statistically significant on the first measurement occasion but were statistically significant on the termination and follow-up mea-sures. An inspection of the means indicated that these significant differences were in the direction of greater reduced scores on the SI for the resolvers, reflecting a reduction of undecidedness. The repeated measures analysis of variance on the differences related to state anxiety between the resolvers and nonresolvers at the three measurement occasions was used to test the following hypotheses: 107 Table 4.3 Bonferroni Confidence Intervals for Scale of Indecision Dependent Variable Lower Limit Upper Limit p=.05 Time 1 -8.48 3.20 N.S. Resolvers vs. Nonresolvers Time 2 -15.45 -2.85 significant Resolvers vs. Nonresolvers Time 3 -15.38 -3.52 significant Resolvers vs. Nonresolvers Table 4.4 Means (X) and Standard Deviations (SD) for Resolvers and Nonresolvers on Scale of Indecision Re solver N=13 Pretest Termination Follow-up X 36.69 24.46 24.38 SD 4.97 6.02 5.09 Pretest Nonresolver Termination N=18 Follow-up 39.33 33.61 33.83 7.18 7.40 7.25 108 Ho2: Resolvers and nonresolvers will not be significantly different on A-State, as measured by the STAI, with repeated measures at termination and follow-up. Hi2: Resolvers and nonresolvers will be significantly different on A-State, as measured by the STAI, with repeated measures at termination and follow-up. The probabilities of the differences on A-State between resolvers and nonresolvers, time and resolvers/nonresolvers and time interaction being due to chance, were .110, *.001, and >.001 respectively. It was concluded, therefore, that the resolvers/nonresolvers main effect was not significant and the measurement occasion main effect and the interaction (resolvers/nonresolvers X measurement occasion) were statistically significant (p < .05). Once again as a result of the significant interaction the main effects received l i t t l e direct atten-tion. Instead the simple main effects were examined by constructing Bonferroni confidence intervals around the mean difference of the resolvers and nonresolvers at each measurement occasion. Table 4.5 displays the results of the construction of the Bonferroni confidence intervals and Table 4.6 displays the means and standard deviations of the resolvers and nonresolvers for the repeated measures on A-State. The confidence intervals revealed that the differences between the resolvers and nonresolvers were in the predicted and same direction and significant at the follow-up measure only. An inspection of the means indicated that the difference was in the direction of greater reduced scores on A-State for the resolvers, reflecting a reduction of state anxiety. 109 Table 4.5 Bonferroni Confidence Intervals for Resolvers (N=13) and Nonresolvers (N=18) on State Anxiety Dependent Lower Upper Variable Limit Limit p=.05 Time 1 Resolvers vs. Nonresolvers -3.90 12.02 N.S. Time 2 Resolvers vs. Nonresolvers -15.43 2.07 N.S. Time 3 Resolvers vs. Nonresolvers -19.34 -2.06 significant Table 4.6 Means (x) and Standard Deviations (SD) for Resolvers and Nonresolvers on State Anxiety X SD Pretest 46.61 10.25 Resolvers Termination 31.54 8.25 N=13 Follow-up 29.08 5.94 Pretest 42.55 7.32 Nonresolvers Termination 38.22 10.31 N=18 Follow-up 39.78 11.22 110 No hypotheses were formulated for A-Trait. In the process of collecting A-State data, A-Trait data were also obtained. The scores were collected and analyzed and are presented in Appendix D in the interests of inquiry and completeness. Wilcoxon rank sum tests (Ferguson, 1971) on the termination and follow-up scores of the Target Complaints measure were used to test the following hypotheses: Ho3: Resolvers and nonresolvers will not be significantly different on target complaints reduction at termination and follow-up, as measured by the TC instrument. Hi3: Resolvers and nonresolvers will be significantly different on target complaints reduction at termination and follow-up, as measured by the TC instrument. The termination scores on the TC measure for the resolvers and nonresolvers were submitted to a Wilcoxon rank sum nondirectional test of significance. This test was performed to find out i f the resolvers and nonresolvers differed significantly on target complaints at termina-tion. The procedure utilized, which employed the normal approximation and a continuity correction, lead to estimates of the required probabilities which did not differ much from those obtained from the exact distribu-tions. The normal deviate Z (with continuity correction) was 2.336. This value was > 1.96 therefore statistically significant at the .05 level. Application of a "more exact procedure" proposed by Ferguson (1971) revealed that the probability of obtaining a value less than or equal to the sum of ranks (R^ ) for the resolvers in samples of this size (13) was < .01. Table 4.7 displays the results of these tests. 111 Table 4.7 Wilcoxon Rank (Ri) Sum Test (Resolvers vs. Nonresolvers) for Target Complaints and Behavioral Report Variable Z Value P r o b a b i l i t y R Exact Prob-a b i l i t y Target Complaints (termination) 2.336 .05 262.5 .010 Target Complaints (follow-up) 2.880 .01 274.0 .005 Behavioral Report (follow-up) 4.670 .01 322.5 .001 Table 4.8 Means (X) and Standard Deviations (SD) for Resolvers and Nonresolvers on Target Complaints X SD Termination 4.69 0.630 Resolvers N=13 Follow-up 4.85 0.375 Termination Nonresolvers N=18 Follow-up 3.94 3.94 0.937 0.937 112 It was assumed, therefore, that the resolvers and nonresolvers were significantly different at follow-up on target complaints. Inspection of the means indicated that this difference was in the direction of greater improved scores on the TC for the resolvers, reflecting an improvement of target complaints. Table 4.8 presents the means and standard deviations for the resolvers and nonresolvers on TC. The follow-up scores on the TC measure were submitted to the same Wilcoxon rank sum nondirectional test to discover whether the resolvers and nonresolvers were significantly different on target complaints at follow-up. The normal deviate Z (with continuity correction) was 2.88. This value was > 2.58 therefore significant at the .01 level. The more exact procedure revealed that the probability of obtaining a value less than or equal to the sum of the ranks (R^ ) for the resolvers in samples of this size was < .005. Table 4.7 displays the results of these tests. It was assumed, therefore, that the resolvers and nonresolvers were significantly different at follow-up on target complaints improvement. Inspection of the means indicated that this difference was in the direction of higher scores on the TC for the resolvers, reflecting an improvement on target complaints. i A Wilcoxon rank sum test (2 tail) was performed on the follow-up data of the BR in order to test the following hypotheses: Ho4: Resolvers and nonresolvers will not be significantly different on reported behavior change as measured by the BR at follow-up. Hi4: Resolvers and nonresolvers will be significantly different on reported behavior change as measured by the BR at follow-up. 113 Table 4.9 Means (X) and Standard Deviations (SD) for Resolvers and Nonresolvers on Behavioral Report at Follow-up X SD N Resolvers 5.61 0.506 13 Nonresolvers 2.78 1.215 18 The scores on the BR, taken at follow-up, were analyzed using the Wilcoxon test in order to discover whether the resolvers and nonresolv-ers were s i g n i f i c a n t l y d i f f e r e n t on reported behavior change at the one month follow-up session. The normal deviate Z (with c o n t i n u i t y correc-tion) was 4.67. This value was > 2.58, therefore, s i g n i f i c a n t at the .01 l e v e l . The more exact procedure revealed that the p r o b a b i l i t y of obtaining a value le s s than or equal to the sum of ranks (R^) for the resolvers in samples of t h i s size (13) was < .001. Table 4.7 displays the r e s u l t s of these t e s t s . It was assumed, therefore, that the resolvers and nonresolvers were s i g n i f i c a n t l y d i f f e r e n t at f o l l o w - u p on r e p o r t e d behavior change. Inspection of the resolvers' and nonresolvers' means indicated that t h i s difference was in the d i r e c t i o n of greater improved scores on the BR for the resolvers, r e f l e c t i n g more reported behavior change. Table 4.9 presents the means and standard deviations for the groups on the BR. The thirty-one (N=1) analyses of variance with accompanying trend analysis (and associated s t a t i s t i c a l p r o b a b i l i t i e s ) were performed on the P h i l l i p s Personalized Questionnaire (PPQ) data to test the following hypotheses: 114 Ho5: On an i n d i v i d u a l treatment measure (PPQ) there w i l l be no s i g n i f i -cant d i f f e r e n c e in the proportion of resolvers to nonresolvers who obtain symptom r e l i e f . Hi5: On an i n d i v i d u a l treatment measure (PPQ) there w i l l be a s i g n i f i -cant d i f f e r e n c e in the proportion of resolvers to nonresolvers who obtain symptom r e l i e f . The PPQ of each c l i e n t was analyzed using a two-way analysis of variance in order to discover whether: a) there were any r e a l changes reported in the symptom; b) the set of statements represented s a t i s -f a c t o r i l y d i s t i n c t l e v e l s of i n t e n s i t y of the symptom; and c) whether the inevitable errors in the c l i e n t ' s responses were in any way systema-t i c . These questions were answered by the F r a t i o s for occasions, statements, and non-additivity re s p e c t i v e l y (the F r a t i o for mean differen c e was s t a t i s t i c a l l y necessary but not p s y c h o l o g i c a l l y meaning-ful ) . The s i g n i f i c a n c e of the F r a t i o s for occasions and statements was desirable, as i t indicated r e a l e f f e c t s , while that of the F r a t i o for non-additivity i s not, since i t indicated some degree of d i s t o r t i o n i n the c l i e n t ' s responses. Appendix B presents the r e s u l t s of these analyses. In the resolvers group ( c l i e n t s 1-13) c l i e n t #11 had to be d i s -carded as the F r a t i o for statements did not a t t a i n s i g n i f i c a n c e . This l e f t a sample of twelve resolvers. In the nonresolvers group ( c l i e n t s 14-31) c l i e n t s #17, 26, 27, and 30 were discarded due to s i g n i f i c a n t F r a t i o s for non-additivity which r e f l e c t e d a systematic inconsistency in responses. This l e f t a sample of fourteen nonresolvers. Of the twelve remaining resolvers, eleven produced symptom data that had a s i g n i f i c a n t p o s i t i v e l i n e a r trend (which indicated o v e r a l l 115 Table 4.10 Arrangement of Resolvers and Nonresolvers on Trend for P h i l l i p s Personalized Questionnaire Resolvers Nonresolvers S i g n i f i c a n t p o s i t i v e l i n e a r trend 11 9 Nonsignificant and nonlinear trend 1 5 symptom improvement) when the sum of squares for sessions was tested for trend. C l i e n t 8 f a i l e d to a t t a i n a s i g n i f i c a n t p o s i t i v e l i n e a r trend and manifested a s i g n i f i c a n t quadratic trend (which indicated a pattern of improvement followed by worsening in the experimental variable) and remainder (which indicated that further analysis would produce further s i g n i f i c a n t trends (e.g., cubic, q u a r t i c , or q u i n t i c ) , however i t i s d i f f i c u l t to find any psychologically meaningful explanation of these trends ( P h i l l i p s , 1970). Of the fourteen nonresolvers, nine had a s i g n i f i c a n t p o s i t i v e l i n e a r trend. C l i e n t s 18, 20, and 28 manifested s i g n i f i c a n t quadratic trends and c l i e n t s 21 and 23 produced s i g n i f i c a n t negative l i n e a r trends (an o v e r a l l worsening of the symptom) that were discovered by inspecting the graphs constructed on each c l i e n t . The Fisher's test of exact proportion was performed on the arrange-ment of resolvers and nonresolvers for trend, displayed i n Table 4.10, and yielded a p r o b a b i l i t y of .104. For a=.05 or l e s s the hypothesis of a random arrangement was not rejected since the p r o b a b i l i t y was at l e a s t .104 that a sample t h i s systematic or more so could occur by chance alone. It can be concluded, therefore, that the groups were not s i g n i f i -c a n tly d i f f e r e n t on symptom r e l i e f over the length of the study as assessed on the PPQ. C r i t i c a l Session Results 116 Immediate E f f e c t s Wilcoxon rank sum tests (2 t a i l ) were performed on the pretest and posttest scores of the C o n f l i c t Resolution Scale (CRS), Target Com-p l a i n t s Discomfort Box Scale (TCDBS), and Pleased with s e l f (PWS), Integrated (INT) and Powerful (POW) scales of the Epstein P r e v a i l i n g Mood Scale (EPMS) to test the following hypotheses: Ho6: There w i l l be no s i g n i f i c a n t d i f f e r e n c e between resolvers and nonresolvers on sense of c o n f l i c t r e s o l u t i o n , as measured by the CRS, over the c r i t i c a l session. Hi6: There w i l l be a s i g n i f i c a n t difference between resolvers and nonresolvers on sense of c o n f l i c t r e s o l u t i o n , as measured by the CRS, over the c r i t i c a l session. Ho7: There w i l l be no s i g n i f i c a n t difference between resolvers and nonresolvers on c o n f l i c t associated discomfort, as measured by the TCDBS, over the c r i t i c a l session. Hi7: There w i l l be a s i g n i f i c a n t d i f f e r e n c e between resolvers and nonresolvers on c o n f l i c t associated discomfort, as measured by the TCDBS, over the c r i t i c a l session. Ho8: There w i l l be no s i g n i f i c a n t difference between resolvers and nonresolvers on mood (pleased with s e l f , integrated, powerful) as measured by the PWS, INT, and POW scales from the EPMS, over the c r i t i c a l session. Hi8: There w i l l be a s i g n i f i c a n t difference between resolvers and nonresolvers on mood (pleased with s e l f , integrated, powerful) as 117 measured by the PWS, INT, and POW scales from the EPMS, over the critical session. The foregoing hypotheses were advanced on the basis of the assump-tion of no statistically significant differences between the resolvers and nonresolvers on the pre-critical session scores. The pre-critical session scores on the CRS, TCDBS, PWS, INT, and POW produced normal deviate Z scores (with continuity corrections) of .081, .407, .370, and .496 respectively. None of these values were > 1.96 therefore the null hypothesis of the resolvers and nonresolvers being significantly different on these measures at pre-critical session could not be rejected at the .05 level of significance. Ferguson's (1971) more exact procedure revealed that the probability of obtaining a value less than or equal to the sum of ranks (R^ ) for the resolvers, on the five scales, in samples of this size (13) was greater than .10 for each measure. Table 4.11 displays these results. It was assumed, therefore, that the resolvers and nonresolvers were not significantly different at the pre-critical session measure on the five scales. That is, there was no significant difference between resolvers and nonresolvers on sense of conflict resolution, conflict associated discomfort, self acceptance, integration, or feelings of power. The post critical session scores on the CRS, TCDBS, PWS, INT, and POW produced normal deviate Z scores (with continuity corrections) of 2.47, 1.68, 2.19, 3.04, and 2.03 respectively. The values for the CRS, PWS, and POW were * 1.96 therefore statistically significant at the .05 level. The value for INT was > 2.58 therefore significant at the .01 level of significance. The value* for TCDBS was < 1.96 therefore not 118 Table 4.11 Wilcoxon Rank (R 1) Sum Tests for C r i t i c a l Session Differences between Resolvers (N=13) and Nonresolvers (N=18) (Immediate Effects) on C o n f l i c t Resolution Scale, Target Complaints Discomfort Box Scale, Pleased with S e l f , Integrated and Powerful Variable Z Value Prob-a b i l i t y R1 Exact Prob-a b i l i t y C o n f l i c t Resolution Scale (pretest) .081 > .05 205.0 > .10 C o n f l i c t Resolution Scale (posttest) 2.470 .05 268.5 < .01 Target Complaints Discomfort Box Scale (pretest) .407 > .05 219.0 > .10 Target Complaints Discomfort Box Scale (posttest) 1.680 > .05 250.0 < .05 Pleased with Self (pretest) .041 > .05 210.0 > .10 Pleased with Self (posttest) 2.190 .05 262.0 < .01 Integrated (pretest) .370 > .05 218.0 > .10 Integrated (posttest) 3.040 .01 281.5 < .005 Powerful (pretest) .496 > .05 221.0 > .10 Powerful (posttest) 2.03 .05 258.0 < .025 I 119 s i g n i f i c a n t at .05. The more exact test revealed that the p r o b a b i l i t i e s of obtaining a value l e s s than or equal to the sum of ranks, for the reso l v e r s , on the f i v e scales, i n samples of t h i s s i z e (13) were .01, .05, .01, .005 and .025 res p e c t i v e l y . Table 4.11 di s p l a y s these r e s u l t s . It was assumed, therefore, that the resolvers and nonresolvers were s i g n i f i c a n t l y d i f f e r e n t at the post measure on the f i v e scales. That i s , there was a s i g n i f i c a n t d i f f e r e n c e between the resolvers and n o n r e s o l v e r s on sense of c o n f l i c t r e s o l u t i o n , c o n f l i c t a s s o c i a t e d d i s c o m f o r t , s e l f acceptance, i n t e g r a t i o n , and f e e l i n g s o f power. Inspection of the resolvers' and nonresolvers' means indicated that these di f f e r e n c e s were in the d i r e c t i o n of improved scores for resolvers on the f i v e scales, r e f l e c t i n g an increase i n sense of c o n f l i c t r e s o l u -t i o n , a decrease in c o n f l i c t - a s s o c i a t e d discomfort, and an increase i n s e l f acceptance, integration, and feel i n g s of power (see Tables 4.12 and 4.13). Prolonged E f f e c t s Wilcoxon rank sum nondirectional tests were performed on the PWS, INT, and POW scales from the EPMS i n order to test the following hypo-theses : Ho9: There w i l l be no s i g n i f i c a n t d i f f e r e n c e between resolvers and nonresolvers on mood (pleased with s e l f , integrated, powerful) as measured by the PWS, INT, and POW scales from the EPMS, over the week following the c r i t i c a l session. Hi9: There w i l l be a s i g n i f i c a n t difference between resolvers and nonresolvers on mood (pleased with s e l f , integrated, powerful) as 120 Table 4.12 Means (X) and Standard Deviations (SD) for Resolvers (N=13) on C o n f l i c t Resolution Scale, Target Complaints Discomfort Box Scale, Pleased with S e l f , Integrated and Powerful over the C r i t i c a l Session Variable X SD C o n f l i c t Resolution (pretest) 4.92 1.497 C o n f l i c t Resolution (posttest) 6.46 0.660 Target Complaints Discomfort Box Scale (pretest) 9.85 2.270 Target Complaints Discomfort Box Scale (posttest) 11.92 1.110 Pleased with S e l f (pretest) 6.46 1.510 Pleased with S e l f (posttest) 7.61 0.767 Integrated (pretest) 6.00 1.630 Integrated (posttest) 7.85 0.688 Powerful (pretest) 6.69 1.110 Powerful (posttest) 7.46 0.967 Table 4.13 Means (X) and Standard Deviations (SD) for Nonresolvers (N=18) on C o n f l i c t Resolution Scale, Target Complaints Discomfort Box Scale, Pleased with S e l f , Integrated and Powerful over the C r i t i c a l Session. Variable X SD C o n f l i c t Resolution Scale (pretest) 5.00 1.608 C o n f l i c t Resolution Scale (posttest) 4.94 1.731 Target Complaints Discomfort Box Scale (pretest) 9.22 2.860 Target Complaints Discomfort Box Scale (posttest) 10.05 3.080 Pleased with Self (pretest) 6.55 1.200 Pleased with S e l f (posttest) 6.55 1.380 Integrated (pretest) 5.83 1.500 Integrated (posttest) 6.44 1.380 Powerful (pretest) 6.50 1.150 Powerful (posttest) 6.55 1.250 121 measured by the PWS, INT, and POW scales from the EPMS, over the week following the critical session. The three mood scales (PWS, INT and POW) were administered eight times (including critical session) over the week between the critical session and the termination session. Each scale was submitted to a Wilcoxon rank sum test in order to discover whether the groups differed significantly on self acceptance, integration, or feelings of power over the week. The scores for the week on the PWS, INT, and POW scales produced normal deviate Z values (with continuity corrections) of 2.26, 2.34, and 2.30 respectively. These values were a l l > 1.96 and therefore signifi-cant beyond the .05 level. The exact test revealed that the probabili-ties of obtaining a value less than or equal to the sum of ranks (R^ ) for the resolvers in samples of this size (13) were .025, .01, and .01 respectively. Table 4.14 displays the results of these tests. As a result of these tests i t was assumed that the resolvers and nonresolvers were significantly different on the PWS, INT, and POW scales over the week following the critical session. That is, there was a significant difference between resolvers and nonresolvers on self acceptance, integration, and feelings of power during the week following the critical session. An inspection of the resolvers' and nonresolvers' means on the three scales for the week indicated that this difference was in the direction of improved scores for the resolvers, reflecting increases in self acceptance, integration, and feelings of power. Table 4.15 illustrates the means and standard deviations of the groups. 122 Table 4.14 Wilcoxon Rank (R1) Sum Tests for Differences over Week Following Critical Session (prolonged effects) between Resolvers and Nonresolvers on Pleased with Self, Integrated, Powerful, Goal Attainment Scaling and Post Critical Session Questionnaire. Variable Z Value Probability R1 Exact Probability Pleased with Self 2.26 .05 265.5 < .025 Integrated 2.34 .05 267.5 < .010 Powerful 2.30 .05 266.5 < .010 Goal Attainment Scaling , (termination) 2.81 .01 270.5 < .005 Goal Attainment Scaling (follow-up) 3.70 .01 295.0 < .001 Post Critical Session Questionnaire (termination) 3.16 .01 285.5 < .001 Post Critical Session Questionnaire (follow-up) 2.69 .01 275.0 < .005 Wilcoxon rank sum nondirectional tests were performed on the termination and follow-up measures of the Goal Attainment Scaling (GAS) instrument in order to test the following hypotheses: Ho10: There will be no significant difference between resolvers and nonresolvers on attainment of a goal, measured by GAS, set after the critical session and measured at termination and follow-up. Hi10: There will be a significant difference between resolvers and nonresolvers on attainment of a goal, measured by GAS, set after the critical session and measured at termination and follow-up. 123 Table 4.15 Means (X) and Standard Deviations (SD) for Resolvers and Nonresolvers on Pleased with Self, Integrated and Powerful, over Week Following Critical Session Groups Resolvers Scales Pleased with self Integrated Powerful X 6.95 6.74 6.88 SD 1.150 1.250 0.964 Pleased with self Nonresolvers Integrated Powerful 5.85 5.65 5.93 1.360 1.330 1.150 The termination and follow-up scores on the resolvers and non-resolvers were each submitted to a Wilcoxon rank sum test to discover whether the resolvers and nonresolvers differed significantly on their goal attainment measured at one week following the critical session and one month following the critical session. The termination session scores for the resolvers and nonresolvers on GAS produced a normal deviate Z (with continuity correction) of 2.81. This value was > 2.58 therefore i t was significant at the .01 level. The exact test revealed that the probability of obtaining a value less than or equal to the sum of ranks (R^ for the resolvers in samples of this size (13) was < .005. Table 4.14 illustrates these results. ' It was concluded, as a result of these tests, that the resolvers and nonresolvers were significantly different on GAS at the termination session. That is, there was a significant difference between resolvers and nonresolvers on goal attainment one week following the critical 124 session. An inspection of the resolvers' and nonresolvers' means at the termination measure indicated that t h i s d i f f e r e n c e was in the d i r e c t i o n of higher scores for resolvers, r e f l e c t i n g greater success at goal attainment. Table 4.16 displays means and standard deviations. Table 4.16 Means (X) and Standard Deviations (SD) for Resolvers and Nonresolvers on Goal Attainment Scaling X SD Termination 55.38 8.77 Resolvers N=13 Follow-up 60.77 6.40 Termination 47.22 4.61 Nonresolvers N=18 Follow-up 49.44 7.25 The follow-up session scores for the resolvers and nonresolvers on GAS produced a normal deviate Z (with c o n t i n u i t y correction) of 3.70. This value was > 2.58 and therefore s i g n i f i c a n t at the .01 l e v e l . The exact test revealed that the p r o b a b i l i t y of obtaining a value le s s than or equal to the sum of ranks (R^) for the resolvers i n samples of t h i s s i z e was < .001. Table 4.14 i l l u s t r a t e s these r e s u l t s . It was concluded, as a r e s u l t of these t e s t s , that the resolvers and nonresolvers were s i g n i f i c a n t l y d i f f e r e n t on GAS at the one month follow-up measure. That i s , there was a s i g n i f i c a n t d i f f e r e n c e between the resolvers and nonresolvers on goal attainment after one month. An inspection of the resolvers' and nonresolvers' means on GAS at termina-t i o n and follow-up indicated that t h i s d i f f e r e n c e was in the d i r e c t i o n 125 of greater improved scores (both groups were improving) for the resolv-ers, r e f l e c t i n g greater success at goal attainment. Wilcoxon rank sum nondirectional tests were performed on the termination and follow-up measures of the PCSQ to tes t the following hypotheses: Ho11: There w i l l be no s i g n i f i c a n t d i f f e r e n c e between resolvers and nonresolvers on attitude change, as measured by the PCSQ at termination or follow-up. Hi11: There w i l l be a s i g n i f i c a n t d i f f e r e n c e between resolvers and nonresolvers on attitude change, as measured by the PCSQ at termination and follow-up. The termination and follow-up scores for the resolvers and non-resolvers were submitted to Wilcoxon rank sum tes t s to discover whether resolvers and nonresolvers d i f f e r e d s i g n i f i c a n t l y on attitud e change over one week following the c r i t i c a l session and over one month follow-ing the c r i t i c a l session. The termination scores for the resolvers and nonresolvers on the PCSQ produced a normal deviate Z (with c o n t i n u i t y correction) of 3.16. This value was > 2.58 and therefore s i g n i f i c a n t at the .01 l e v e l . The exact test revealed that the p r o b a b i l i t y of obtaining a value l e s s than or equal to the sum of ranks (R^) for the resolvers i n samples of t h i s size (13) was < .001. Table 4.14 i l l u s t r a t e s these r e s u l t s . It was concluded, as a r e s u l t of these t e s t s , that the resolvers and nonresolvers were s i g n i f i c a n t l y d i f f e r e n t on the PCSQ at the termination session. That i s , there was a s i g n i f i c a n t d i f f e r e n c e between resolvers and nonresolvers on attitud e change over the week following the c r i t i c a l session. An inspection of the resolvers' and 126 nonresolvers' means at the termination measure indicated that t h i s difference was in the d i r e c t i o n of higher scores for resolvers, r e f l e c t -ing greater attit u d e change. Table 4.17 i l l u s t r a t e s means and standard deviations for the resolvers -and nonresolvers on PCSQ. Table 4.17 Means (X) and Standard Deviations (SD) for Resolvers and Nonresolvers on the Post C r i t i c a l Session Questionnaire X SD Termination 9.31 0.630 Resolvers N=13 Follow-up 9.38 0.768 Termination 7.28 1.670 Nonresolvers N=18 Follow-up 7.17 1.380 The follow-up session scores for the resolvers and nonresolvers on the PCSQ produced a normal deviate Z (with c o n t i n u i t y correction) of 2.69. This value was > 2.58 therefore i t was s i g n i f i c a n t at the .01 l e v e l . The exact test revealed that the p r o b a b i l i t y of obtaining a value le s s than or equal to the sum of ranks (R^) for the resolvers i n samples of t h i s size (13) was < .005. Table 4.14 displays the r e s u l t s of these t e s t s . It was concluded, as a r e s u l t of these t e s t s , that the resolvers and nonresolvers were s i g n i f i c a n t l y d i f f e r e n t on the PCSQ at the one month follow-up measure. That i s , there was a s i g n i f i c a n t difference between the resolvers and nonresolvers on attitud e change over the one month period. An inspection of the resolvers' and nonresolvers' means on the PCSQ at termination and follow-up indicated that t h i s d i f f e r e n c e 127 was i n the d i r e c t i o n of greater improved scores (both resolvers and nonresolvers were improving) for the resolvers, r e f l e c t i n g greater a t t i t u d e change. The Provision of A d d i t i o n a l Information  by Nonspecific Factors The primary hypotheses of t h i s study were formulated to examine the s p e c i f i c e f f e c t s of the two-chair operation i n r e l a t i o n to d e c i s i o n a l c o n f l i c t . They were not designed to investigate the nonspecific e f f e c t s of therapy (e.g., c l i e n t perceptions of therapist understanding or task relevance). In fact due to the d i f f e r e n t i a l temporal occurrence of the empathy and task measures (end of second session) and the softening (t h i r d to f i f t h session in a l l cases) the design of the study prevents a rigorous comparison of s p e c i f i c and nonspecific f a c t o r s . However, data e x i s t that are relevant to the s p e c i f i c / n o n s p e c i f i c e f f e c t s issue. It was found that the mean score for resolvers was s i g n i f i c a n t l y d i f f e r e n t ( s t a t i s t i c a l l y ) (t=3.54, p<.05) than the mean for nonresolvers on the task measure (see Table 4.18). This finding provides suggestive evidence that the nonspecific e f f e c t of c l i e n t perception of task relevance was an operating factor in explaining the e f f e c t of treatment. That i s , those c l i e n t s who resolved viewed the task as more relevant than those who did not resolve and t h i s seemed to be a precondition although not a predictor of a competent performance. Support i s provided for the strength of the s p e c i f i c e f f e c t of the two-chair operation as an operating factor by the c o r r e l a t i o n (r=.43) between task and softening, suggesting that these two v a r i a b l e s are moderately related. Additional support for the strength of the s p e c i f i c 128 Table 4.18 Means (X) and Standard Deviations (SD) for Resolvers and Nonresolvers on the Working A l l i a n c e Inventory (WAI) X SD Resolvers 55.46 3.69 Nonresolvers 48.99 6.50 e f f e c t s of the two-chair operation i s offered by the magnitude of the c o r r e l a t i o n s between softening and the treatment outcome variables at termination i n comparison to the c o r r e l a t i o n s between task and the treatment outcome variables (see Table 4.19). The s i g n i f i c a n c e of the d i f f e r e n c e s of the c o r r e l a t i o n s between softening and the outcome var i a b l e s was tested (Glass & Stanley, 1970, p. 313). The obtained value of Z f e l l above the required c r i t i c a l value of 1.96 in three out of the four t e s t s , i n d i c a t i n g that the r e l a t i o n s h i p of softening to the outcome va r i a b l e s and task to the outcome va r i a b l e s i s not the same (see Table 4.19). The c o r r e l a t i o n s with state anxiety at follow-up were r=-.35 and r=-.46 for task and softening, r e s p e c t i v e l y , showing that although the c o r r e l a t i o n s of these variables at termination were not high, they increased considerably at follow-up. These c o r r e l a t i o n s and t h e i r s i g n i f i c a n c e s suggest that the nonspecific factor of task accounts for some of the c l i e n t variance but not a l l . (The decision was made to c o r r e l a t e these variables based simply upon the s i m i l a r i t y of the r e s o l v e r s ' and n o n r e s o l v e r s ' p r e - s c o r e s on the treatment outcome measures.) In summary, i t appears that both s p e c i f i c and nonspecific factors play a part in the e f f e c t s presented in t h i s study. The data suggest 129 Table 4.19 The Correlations and Their Significances of Softening and Task to the Treatment Outcome Variables Z value Task Softening (p<.05) Task 1.00 .43 a c Scale of Indecision -.33 -.69 4.07 State Anxiety3 .20 .18 .76 b c Target Complaints .49 .71 3.29 b Behavioral Report .52 .93 5.52c a. Pearson's r b. Spearman's rho c. Significant difference that the s p e c i f i c factors dominate, with assistance from the nonspecific f a c t o r s . Future research, however, ought to be conducted to determine the r e l a t i v e contribution of each as t h i s study was not designed to address t h i s question. Summary of Results S t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s between r e s o l v e r s and nonresolvers on treatment outcome measures were found. Resolvers were found to have s i g n i f i c a n t l y l e s s indecision, l e s s state anxiety, greater target complaint improvement, and greater reported behavior change. No s i g n i f i c a n t differences were found between the groups on the i n d i v i d u a l -ized symptom measure. The impact of the c r i t i c a l session was tested and s i g n i f i c a n t d i f f e r e n c e s related to i t s immediate e f f e c t s were found. Resolvers were 130 found to have s i g n i f i c a n t l y more sense of c o n f l i c t r e s o l u t i o n , l e s s discomfort, more s e l f acceptance, more int e g r a t i o n , and greater f e e l i n g s of power over the c r i t i c a l session. The prolonged e f f e c t s of the c r i t i c a l session were tested and they yielded s i g n i f i c a n t d i f f e r e n c e s . The resolvers were found to have s i g n i f i c a n t l y more s e l f acceptance, integration, and fe e l i n g s of power, over the week following the c r i t i c a l session. Resolvers were found to have greater goal attainment success at one week and at one month following the c r i t i c a l session. In addition, the resolvers had greater a t t i t u d e change at one week and one month following the c r i t i c a l session. Chapter V DISCUSSION This chapter contains a summary, conclusions, general discussion, statement of l i m i t a t i o n s of the study, recommendations for further research, and implications that can be evolved from the study. Summary T h i r t y one c l i e n t s completed a b r i e f (up to six sessions) psycho-therapy program aimed at resolving d e c i s i o n a l c o n f l i c t . The c l i e n t s completed a group induction session prior to treatment where they were introduced to the Gestalt conception of c o n f l i c t , as the opposition between two parts of the personality, to the two chair dialogue opera-ti o n and were given the pre-experimental measures. The c l i e n t s were then seen once a week for a maximum of six sessions. If the c l i e n t s reported that they had resolved t h e i r c o n f l i c t s before the s i x t h session they were required to return one week, and one month after the resolu-t i o n session for a b r i e f termination and follow-up interview at which time they completed the termination and follow-up measures. If the c l i e n t s did not resolve t h e i r c o n f l i c t s and report r e s o l u t i o n before the s i x t h session, they terminated at the completion of the s i x t h session, f i l l e d out the questionnaires and returned one month l a t e r for follow-up. The t h i r t y - o n e c l i e n t s were then separated i n t o two groups, resolvers and nonresolvers, on the basis of a pattern of process 131 132 i n d i c a t o r s . Resolvers were defined as those c l i e n t s who had manifested the three c r i t i c a l components of Greenberg's (1980a) proposed model of i n t r a p s y c h i c c o n f l i c t r e s o l u t i o n . The three c r i t i c a l components regarded as necessary for resolution were the demonstration of c r i t i c i s m toward the experiencing aspect of the personality (organism in Rogers' (1959) terms), the expression of f e l t wants from the organism, and a subsequent softening in attitude by the c r i t i c ("self" in Rogers' (1959) terms) toward the organism. The c r i t i c a l component of c r i t i c i s m was measured by the Voice Quality System (Rice et a l . , 1979) and the St r u c t u r a l Analysis of Social Behavior (Benjamin, 1974) . F e l t wants were measured by the Experiencing scale (Klein et a l . , 1969), Benjamin's system, and voice. The softening of the s e l f ' s a t t i t u d e was measured by the occurrence of a f f i l i a t i v e behaviors on Benjamin's system, focused voice on Rice's system, and a l e v e l four or above on Klein's system. A l l those c l i e n t s who completed six sessions and did not manifest the preceding c r i t i c a l components were c l a s s i f i e d as nonresolvers. This process analysis yielded 13 resolvers and 18 nonresolvers. Pre-experimental and post-experimental outcome measures were taken on an adapted version of Osipow's Scale of Indecision (Os.ipow et a l . , 1976), Spielberger's A-State (state anxiety) (Spielberger et a l . , 1970), Target Complaints (Battle et a l . , 1966) and a report of behavior change. Pre-session and post-session measures also were taken on the e f f e c t s of the c r i t i c a l session (session r e s o l v e r s ) , on sense of c o n f l i c t resolu-t i o n , Target Complaint Discomfort Box Scale (Battle et a l . , 1966), and Epstein's (1979) measures of s e l f acceptance, integration and fee l i n g s of power. The e f f e c t s of the c r i t i c a l session on attainment of a goal 133 set at the end of the c r i t i c a l session, and on attitude change and Epstein's measures also were examined over one and four week periods. A two way repeated measures analysis of variance was used for the data that s a t i s f i e d the homogeneity of variance conditions for t h i s t e s t . A Wilcoxon rank sum test was used for the remaining data. S t a t i s t i c a l l y s i g n i f i c a n t d ifferences at the .05 l e v e l were found between resolvers and nonresolvers on indecision F(2,58)=10.49 and state anxiety F(2,58)=9.40. Simple comparisons revealed that the groups were s i g n i f i c a n t l y d i f f e r e n t at both termination and follow-up on indecision and at follow-up on anxiety. Inspection of the means revealed that the resolvers were les s undecided and les s anxious ( s t a t e ) . S t a t i s t i c a l l y s i g n i f i c a n t d ifferences at the .05 l e v e l were also found on target complaints and reported behavior change at termination and follow-up (Z=2.88, p=.01 and Z=4.67, p=.01 for the two measures, res p e c t i v e l y , at follow-up). Inspection of the means revealed that resolvers had improved and changed behavior more than the nonresolvers. With regard to the c r i t i c a l session measures the resolvers and nonresolvers revealed s i g n i f i c a n t d i f f e r e n c e s on sense of c o n f l i c t r e s o l u t i o n (Z=2.47, p=.05), target complaints discomfort (Z=1.68, p=.05), s e l f acceptance (Z=2.19, p=.05), integration (Z=3.04, p=.01), and feel i n g s of power (Z=2.03, p=.05). The prolonged e f f e c t s of the c r i t i c a l session yielded s i g n i f i -cant differences between resolvers and nonresolvers on s e l f acceptance (Z=2.26, p=.05), integration (Z=2.34, p=.05), f e e l i n g s of power (Z=2.30, p=.05), goal attainment (Z=3.70, p=.01), and attitud e change (Z=2.69, p=.01). Inspection of the means revealed that resolvers made greater gains on a l l these measures. 0 Conclusions 134 The r e s u l t s of the study revealed several s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s between resolvers and nonresolvers. The resolvers were s i g n i f i c a n t l y l e s s undecided at termination and follow-up and s i g n i f i -c a n t l y l e s s anxious (A-State) at follow-up than the nonresolvers. The resolvers, in addition, were found to be s i g n i f i c a n t l y more improved on thei r target complaints and on a report.of behavior change at termina-tion and follow-up. Over the c r i t i c a l session the resolvers revealed a s i g n i f i c a n t l y greater sense of c o n f l i c t r e s o l u t i o n , l e s s target com-p l a i n t discomfort, greater sense of s e l f acceptance, greater integra-t i o n , and greater f e e l i n g s of power. The prolonged e f f e c t s of the c r i t i c a l session yielded, in the resolvers favor, s i g n i f i c a n t l y greater s e l f acceptance, integration, and feelings of power during the week following the c r i t i c a l session. F i n a l l y , a d d i t i o n a l prolonged e f f e c t s of the c r i t i c a l session were shown in favor of resolvers on goal attainment and attitude change at both termination and follow-up. In l i g h t of these findings i t was concluded that the a b i l i t y of the resolvers to resolve an intrapsychic c o n f l i c t i n the session according to the process c r i t e r i a was suggestive of d i f f e r e n t i a l outcome predic-t i o n . In other words, the in-therapy process of c r i t i c i z i n g the s e l f from one side of the c o n f l i c t , expressing a desire embedded in a f e e l i n g context from the opposite side, and then softening the attitud e of the c r i t i c appeared to be related to p o s i t i v e outcome. Those c l i e n t s who completed t h i s process showed greater gains on a l l the experimental measures except for the i n d i v i d u a l i z e d symptom instrument. It appeared therefore that the occurrence of change in the resolvers was not due to 135 chance factors but rather there existed a functional r e l a t i o n s h i p between the resolution of an intrapsychic c o n f l i c t and outcome. These outcome variables were a l l indicators of some aspect of the decision making process. Therefore i t was shown that the r e s o l u t i o n of an intrapsychic c o n f l i c t was related to these ind i c a t o r s of decision making. S p e c i f i c a l l y , the re s o l u t i o n of the c o n f l i c t was shown to be related to the degree of indecision reduction (SI) , the degree of reduction in momentary anxiety (A-State), the degree of progress through the stages of making a decision (BR), and the degree of target complaint improvement(TC). The resolution of an intrapsychic c o n f l i c t seemed to have enabled resolvers to become s i g n i f i c a n t l y more decided than nonresolvers at termination and follow-up (Hypothesis 1). Inspection of the session content in conjunction with the process analysis suggests that the obstacle to becoming more decided was the i n t e r n a l b a t t l e between the introjected conditions of worth and the organismic valuing process and that when th i s c o n f l i c t was resolved the i n d i v i d u a l was free to decide. Resolvers experienced s i g n i f i c a n t l y l e s s state anxiety at follow-up than did nonresolvers (Hypothesis 2). The occurrence of a s t a t i s t i c a l l y s i g n i f i c a n t difference at follow-up only suggests that i t took time to enter the integration substage of the implementation stage and that i t required one month following termination to a t t a i n integration and i t s c h a r a c t e r i s t i c reestablishment of equilibrium. In other words, i t would take the i n d i v i d u a l at least t h i r t y days to work through the substages of implementation and reach integration where anxiety would subside to a s t a t i s t i c a l l y s i g n i f i c a n t degree. 136 The findings of t h i s study provided support for those reported by Fleischer (1969), Gerard (1967), Jones and Johnson (1973), and Mann, J a n i s , and Chaplin (1969) whereby anxiety and other p h y s i o l o g i c a l and psychological indicators of stress were discovered to decrease during the postdecisional period. The s i g n i f i c a n t decrease in state anxiety exhibited by the resolvers at follow-up in t h i s study was interpreted as support for the r e l a t i o n s h i p between anxiety and d e c i s i o n making. The resolution of intrapsychic c o n f l i c t seemed to lead to s i g n i f i -c a n t l y more improvement on target complaints for resolvers than nonre-solvers (Hypothesis 3) . Inspection of the data revealed that the improvement in target complaints could be explained by the fact that 100% of the target complaints were decisions to be made—thus when the decision was made the target complaint improved. The resolvers reported s i g n i f i c a n t l y more behavior change than nonresolvers (Hypothesis 4). It was suggested in terms of the Tiedeman and O'Hara (1963) model that when an i n d i v i d u a l resolves an intrapsychic c o n f l i c t and makes a decision he/she i s then free to pass from the a n t i c i p a t o r y stage into the implementation stage where any change in behavior would take place. The i n d i v i d u a l has completed his/her covert work of exploring, c r y s t a l l i z i n g , choosing, and c l a r i f y i n g and now enters into operating i n t e r a c t i o n with his/her context and implements the d e c i s i o n . In r e l a t i o n to the i n d i v i d u a l i z e d symptom instrument, the resolu-t i o n of the intrapsychic c o n f l i c t produced no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e between the resolvers and nonresolvers on change of their reported symptom (Hypothesis 5). It appeared that t h i s finding was due to the fact that the reported symptom was such a s e n s i t i v e index of 137 response to treatment that even the nonspecific or simple b e n e f i t s of treatment experienced by the nonresolvers were enough to r e s u l t in reported symptom r e l i e f . (For example, reported r e l i e f of such symptoms as tension, anger, los s of appetite, insomnia, and discouragement). That i s , j u s t having the opportunity to experience the persecution of th e i r c r i t i c , and r e a l i z e they were doing t h i s to themselves, and/or to express their f e e l i n g s in an accepting and understanding atmosphere was enough to have some impact on many of the nonresolvers" reported symptoms even though they f a i l e d to a t t a i n r e s o l u t i o n . It appeared that the resolvers experienced a s i g n i f i c a n t l y greater sense of c o n f l i c t r e s o l u t i o n over the c r i t i c a l session than the non-resolvers did over th e i r f i f t h session (Hypothesis 6) . The f i n d i n g suggests that the resolution component of softening manifested by the resolvers in t h e i r c r i t i c a l session i s a key component of r e s o l u t i o n . That i s , when the " s e l f " — t h e keeper of the conditions of worth— experienced a change in attitude toward the organism and i t s valuing process, a reduction of the sense of i n t e r n a l c o n f l i c t r esulted. In addition, over the c r i t i c a l session the act of softening was related to the report by the resolvers of s i g n i f i c a n t l y greater r e l i e f of discomfort associated with the target complaint (Hypothesis 7). This was probably due to the fact that when the c o n f l i c t was resolved the target decision improved and the related discomfort also improved. F i n a l l y , over the c r i t i c a l session, the resolution of the i n t r a -psychic c o n f l i c t appeared to r e l a t e to the resolvers experiencing s i g n i f i c a n t l y greater s e l f acceptance, integration, and f e e l i n g s of power than the nonresolvers d i d over th e i r f i f t h session (Hypothesis 8). It i s suggested that the r e s o l v e r s 1 increase in s e l f acceptance was a 138 d i r e c t r e s u l t of the " s e l f " changing i t s a t t i t u d e , viewing the s i t u a t i o n more empathically, and becoming more accepting of the organism. It i s suggested that the increase in integration was a r e s u l t of the merging of the disparate, disorganized, p a r t i a l aspects of the p e r s o n a l i t y ( i . e . , s e l f vs. organism) that were formerly in opposition to each other. It i s further suggested that the resolvers' increase in f e e l i n g s of power was a r e s u l t of having taken r e s p o n s i b i l i t y for their con-f l i c t s , and having resolved them, they experienced more s e l f d i r e c t i o n . It appeared that the resolvers' a b i l i t y to resolve t h e i r i n t r a -p s y c h i c c o n f l i c t was r e l a t e d to t h e i r s i g n i f i c a n t l y g r e a t e r s e l f acceptance, integration, and f e e l i n g s of power over the week following the c r i t i c a l session (Hypothesis 9) . The act of resolving an i n t r a -psychic c o n f l i c t in the session appears to have been powerful enough to have the changes discussed in the previous paragraph p e r s i s t over one week. It seemed that the resolution process was related to s i g n i f i c a n t l y greater goal attainment for the resolvers at both one week and one month following the c r i t i c a l session (Hypothesis 10). Intrapsychic c o n f l i c t resolution appeared to promote the attainment of a s p e c i f i c goal. In other words, and to use the combined models of Tiedeman and O'Hara (1963) and Greenberg (1975), the work of resolving the intrapsychic c o n f l i c t took place in the a n t i c i p a t i o n stage. Once the c o n f l i c t was resolved and a decision made the goal was a c t i v e l y pursued, that i s , goal attainment took place in the implementation stage and only the resolvers t r a v e l l e d that f a r . Nonresolvers who also set a goal at the end of their f i f t h session did not a t t a i n their goal as well as the 139 resolvers who had resolved a c o n f l i c t . This i s an i n t e r e s t i n g finding which shows that c o n f l i c t r e s o l u t i o n leads to greater goal attainment. The a b i l i t y of the resolvers to resolve their intrapsychic c o n f l i c t appeared to be related to s i g n i f i c a n t l y more attitude change for them over nonresolvers at both one week and one month follow-up measures (Hypothesis 11). It was suggested that resolving an intrapsychic c o n f l i c t was analogous to adopting a new a t t i t u d e . In other words, when the " s e l f " softened toward the "organism" what a c t u a l l y happened was that an old cognition ( a t t i t u d e ) , or introjected value, was restructured into a new one where more emphasis was placed on the worth of present experience. General Discussion The r e s u l t s obtained in the study support research findings and t h e o r e t i c a l propositions reported in Chapter II as well as adding knowledge to the f i e l d of psychotherapy research. These r e s u l t s show not only that in-therapy performance i s related to beyond-therapy c l i e n t report but also that the performance of softening i s related to con-ce p t u a l l y d i s t i n c t variables such as indecision, anxiety, goal a t t a i n -ment . This study demonstrates that persons who were able to resolve an intrapsychic c o n f l i c t related to a d e c i s i o n , u t i l i z i n g the two chair intervention experienced greater change over a month than those who were not able to resolve. The study went beyond both broadly based studies of therapeutic effectiveness and those .studies that have examined s p e c i f i c i nteractions between treatments, th e r a p i s t s , c l i e n t s , and t h e i r 140 presenting problems. Instead, the study attempted to illuminate the more r e f i n e d problem o f the r e l a t i o n s h i p between s p e c i f i c c l i e n t processes in s p e c i f i c in-therapy s i t u a t i o n s and outcome. An attempt was made to l i n k c l i e n t performance (intrapsychic c o n f l i c t resolution) i n therapy to outcome. Previous research e f f o r t s have examined the r e l a t i o n s h i p of d i f f e r e n t i a l therapist performance or o r i e n t a t i o n , to c l i e n t outcome making the assumption that a l l c l i e n t s are involved in the same way by a p a r t i c u l a r approach. This assumption was interpreted i n t h i s study as another uniformity myth concerning process (Greenberg, 1980b). The i d e n t i f i c a t i o n of d i s t i n c t c l i e n t in-therapy performances for d i s t i n c t s i t u a t i o n s i s e s s e n t i a l in order that more c l i e n t per-formance variance may be accounted f o r . The focus of t h i s study was on r e l a t i n g the s t r a t e g i c process of intrapsychic c o n f l i c t resolution to outcome. It was suggested that t h i s focus produced a much closer tracking of the r e l a t i o n s h i p between what the therapist did during therapy (two-chair technique), how the c l i e n t reacted (resolve/nonresolve), and what s p e c i f i c changes occurred as a r e s u l t of t h i s i n t e r a c t i o n . It appeared in t h i s study that the t i g h t e r l i n k between in-therapy performance and outcome demonstrated the active ingredients of the two chair technique for the s p e c i f i c problem of intrapsychic c o n f l i c t . It had been suggested (Greenberg, 1980a; Johnson, 1980) that a c l i e n t performance path to resolution would follow a c e r t a i n d i r e c t i o n . The f i r s t step on the path seemed to be for an i n d i v i d u a l to perceive his/her therapist as understanding and the task he/she was about to engage in as relevant to his/her concern. This i n i t i a l step provided a working a l l i a n c e within which the business of making a decision could be 141 undertaken. In t h i s context the expression of c r i t i c i s m by the " s e l f " (other chair) directed at the "organism" (experiencing chair) would be the f i r s t step of the actual r e s o l u t i o n process, and thus e s s e n t i a l to ensure that the other r e s o l u t i o n components would follow. At t h i s point the i n d i v i d u a l was encouraged to bring f o r t h a l l his/her "shoulds" and "oughts" and to progress toward more and more refined c r i t i c i s m . The next step along the path was the expression of f e l t wants. After the " s e l f " had expressed i t s c r i t i c i s m i n a more and more refined fashion i t was e s s e n t i a l to obtain from the "organism" a d e c l a r a t i o n of a "want" that was embedded i n a f e e l i n g context, (e.g., "I f e e l com-p l e t e l y hopeless when you say that to me and I want you to stop running me down and just l e t me be.") It appeared that t h i s combination ( f e l t want) provided a powerful c a t a l y s t toward r e s o l u t i o n . In the expression of f e e l i n g was evidence of deep experiencing, i n the moment (rather than t a l k i n g about), and the expression of the want acted as an o r i e n t e r , or compass, that c o l l e c t e d t h i s unruly mass of f e e l i n g and channeled i t i n a meaningful d i r e c t i o n . The f i n a l r esolution component on the path was the softening. At t h i s point i t seemed that the " s e l f " was able to r e a l l y hear and understand what the s i t u a t i o n was l i k e for the "organism." The response from the " s e l f " i n the other chair was one that expressed either understanding or some fe e l i n g of i t s own. (e.g., "I guess i t has been r e a l l y tough . for you, and you have been doing your best." or "I'm j u s t a f r a i d that you won't succeed.") It appeared that t h i s act of softening was analogous to the spontaneous changing or reconstructing of a cognition or perception in the " s e l f " (other c h a i r ) . With t h i s per-sonally generated perceptual/cognitive restructuring i t seemed that 142 something had changed for the i n d i v i d u a l . The path from the beginning of treatment to follow-up suggested for r e s o l u t i o n , by the data i s shown in Figure 5.1. Following engagement and the process of c r i t i c i s m , f e l t wants and softening the i n d i v i d u a l reported a number of changes on the outcome instruments. It appeared that they were related to the softening and to each other. Immediately after the softening ( c r i t i c a l session) the i n d i v i d u a l reported being more resolved. Associated with t h i s sense of resolution were s t a t i s t i c a l l y s i g n i f i c a n t changes in s e l f acceptance, int e g r a t i o n , and f e e l i n g s of power. In addition, there were s t a t i s -t i c a l l y s i g n i f i c a n t changes in attitude and attainment of a goal (set a f t e r the c r i t i c a l session) that persisted over one month. The resolu-t i o n of the intrapsychic c o n f l i c t led to the making of a d e c i s i o n , r e f l e c t e d in a decrease of the indecision score and also to a decrease in state anxiety (reflected in the follow-up measure). F i n a l l y t h i s act of becoming more decided seemed linked to an improvement on the target complaint and i t s associated discomfort. It seems that the combined model i s a useful explanatory construct or tool for the understanding of the r e s o l u t i o n of an intrapsychic c o n f l i c t related to a d e c i s i o n . The model suggests that those i n d i v i d u -als who are blocked (and unable to decide) in the a n t i c i p a t o r y stage of a d e c i s i o n , s p e c i f i c a l l y the c r y s t a l l i z a t i o n and/or c l a r i f i c a t i o n substages, are involved in an intrapsychic c o n f l i c t and that the r e s o l u t i o n of that c o n f l i c t frees them to decide and to implement t h e i r choice. An inspection of the data reveals t h i s to be true. Some examples were drawn from the study and are presented here in order to i l l u s t r a t e the r e l a t i o n s h i p between intrapsychic c o n f l i c t Attitude Change Task Softening Increase in Goal Attainment Increase in Symptom Rel ief Figure 5.1 Proposed Path of Resolution Increase in Self Acceptance ConfI ict Re so I ut i on Decrease in Indecision Decrease in Anxiety Increase in Integration Increase in Feel ings of Power Decrease in Target Complaint Dl scomfort Increase in in Target Compla int Improvement 144 r e s o l u t i o n and de c i s i o n making, and the l i n k t h i s appeared to have with the symptoms of decision making. Example 1 Decision to be made: A woman separated from her husband, and about to be divorced, was undecided about remaining i n Canada or returning to her native country. She thought that remaining in Canada, which would not meet her needs, would be best for her teenage c h i l d r e n (education, s o c i a l r e l a t i o n s h i p s , e t c . ) , that i s , they would experience no addi-t i o n a l d i s r u p t i o n in t h e i r l i v e s above the a l t e r i n g of t h e i r family structure. C o n f l i c t : The c o n f l i c t for t h i s woman was one of her " s e l f " (representing the conditions of worth) pointing the finger at her and saying "Your c h i l d r e n must come f i r s t , i f they don't you're being s e l f i s h — a good mother should always put her ch i l d r e n above h e r s e l f , " and her organism (representing the organismic valuing process) respond-ing "I'm t i r e d of putting my needs i n the background—I want to do something for me for a change, before I'm too old." The ce n t r a l experience for t h i s woman was one of f e e l i n g g u i l t y under the barrage from her c r i t i c , and her decision making symptoms (r e f l e c t e d on the instruments) were inde c i s i o n , anxiety, lack of re s o l u t i o n , discomfort and minimal or reduced s e l f acceptance, integration, and feeli n g s of power. Resolution: The resolution of t h i s woman's intrapsychic c o n f l i c t came when the " s e l f , " and i t s conditions of worth (other c h a i r ) , was able to hear, understand, and accept that the organism (experiencing chair) was t i r e d of placing herself i n second p o s i t i o n and that she 145 desperately wanted to f u l f i l l h e r s e l f i n some way. The s e l f had s h i f t e d perspective and was able to view the s i t u a t i o n from the perspective of the organism—no longer did the woman make hers e l f f e e l g u i l t y . This change was r e f l e c t e d in her improved responses to those measures of the symptoms of in d e c i s i o n . Decision taken: The woman was able to decide that she would return to her native country. She c a l l e d her ch i l d r e n together and explained that they were welcome to come with her or stay in Canada with t h e i r father; and that her door would always be open to them. She then began to make the arrangements (sale of house, purchase of tickets) and was able to report t h i s by the time of the one month follow-up interview. Example 2 Decision to be made: A young woman was undecided about returning to u n i v e r s i t y to complete her studies. She was unsure i f the d i s r u p t i o n of her l i f e s t y l e (terminating employment, changing l i v i n g accommoda-tions, etc.) would be worth i t . She had returned to u n i v e r s i t y once before and had to drop out because she could not cope and she did not want to go through that experience again. C o n f l i c t : The i n i t i a l c o n f l i c t for t h i s young woman was between her " s e l f , " that said "You should return to school and make something of yourself—you've wasted four years at that menial job of yours and should improve yourself," and her r e s i s t i n g organism "You're r i g h t but I can't seem to get motivated." The c o n f l i c t soon changed to "You're a f a i l u r e - - y o u w i l l never succeed at s c h o o l " v e r s u s the organism's response "You're r i g h t ; I am a fl o p ; I should do better for myself, but I'm a f r a i d that I haven't got what i t takes." This response from the 146 organism, once expressed, after some therapeutic work moved to "I'm not a f l o p , I worked at that menial job because i t was a l l I could handle after dropping out of u n i v e r s i t y — I wasn't ready for anything else and now I am and furthermore I ' l l be successful at i t because i t s what I want." In general, her responses to the measurement instruments at the beginning of the sessions suggested that she was undecided, anxious, uncomfortable, unresolved, and minimally s e l f accepting, integrated, and powerful f e e l i n g . Resolution: The resolution of t h i s young woman's intrapsychic c o n f l i c t came when her " s e l f " was able to understand and accept that she was not a f a i l u r e but was doing the best she could. The " s e l f " then ceased to persecute and demoralize the organism. No longer did the woman experience her usual overwhelming lack of s e l f confidence—and t h i s change was r e f l e c t e d i n her improved responses to the instruments. Decision taken: The young woman was able to decide that she would work for a few months i n order to gather some funds for her education, and then resume her studies at the beginning of the F a l l term. Example 3 Decision to be made: A man presented as h i s dec i s i o n h i s uncer-t a i n t y about commencing the tedious process of f u l f i l l i n g the f i n a l o b l i g a t i o n toward a master's degree that he had undertaken several years e a r l i e r . In his work since leaving u n i v e r s i t y he had completed a major project that he thought would f i t the thesis requirements of h i s old department. However, he was unsure i f he should take time away from h i s family and h i s job to engage i n the process of writing up, submitting, receiving r e j e c t i o n s , and rew r i t i n g . 147 C o n f l i c t : The intrapsychic c o n f l i c t for t h i s man was centred around h i s " s e l f " saying things l i k e "You should f i n i s h , you were wrong not t o — I don't l i k e q u i t t e r s or i r r e s p o n s i b i l i t y — y o u wasted a l l that time and didn't receive your degree" and h i s "organism" responding with, at least i n i t i a l l y "Yes, you're r i g h t I am a q u i t t e r . I d i d waste a l l that t i m e — t h a t was i r r e s p o n s i b l e . " However, once t h i s was expressed the organism moved to "I'm a f r a i d to submit my work, I'm not a q u i t t e r , I've been a f r a i d a l l along that I wouldn't succeed at the thesis and I'm s t i l l f e a r f u l that my p r i z e project won't be enough and I ' l l f a i l . " He too manifested a t y p i c a l undecided, anxious, and uncomfortable p r o f i l e . Resolution: The resolution of t h i s man's c o n f l i c t was attained when his " c r i t i c " was able to say "I understand that you've been a f r a i d to f a i l and at the same time I also have been a f r a i d , a f r a i d that others would view you as a q u i t t e r . " The "organism's" experience was accepted and the " s e l f " did not engage in the barrage of c r i t i c i s m that resulted in f e e l i n g s of g u i l t and discouragement around the thesis issue. The r e s o l u t i o n was r e f l e c t e d in the man's improved responses to the experi-mental measures. Decision taken: The man was able to make a decision to submit h i s project in order to discover i f i t would be suitable for a t h e s i s . At the one month follow-up interview he was able to report that he was involved in the rewriting of the work to meet the s p e c i f i c a t i o n s set out by h i s u n i v e r s i t y advisors. 148 Limitations of the Study The discussion of the l i m i t a t i o n s of the study centers upon design and g e n e r a l i z a b i l i t y issues. The samples employed in the study were composed of c l i e n t s who responded to advertisements regarding the decision making project i n order to obtain assistance in making a d e c i s i o n . These c l i e n t s may have been d i f f e r e n t from people who were having d i f f i c u l t y making a de c i s i o n and did not respond to an advertisement. The g e n e r a l i z a b i l i t y of the r e s u l t s , s t r i c t l y , should be l i m i t e d to persons who are having d i f f i c u l -ty making a decision and who seek assistance for t h i s d e c i s i o n . The c l i e n t s responded from the population at large. These r e s u l t s may or may not have had implications for a more disturbed population. It was impossible to randomly assign c l i e n t s to sample groups. Therefore, something other than chance factors and the diffe r e n c e in resolution of an intrapsychic c o n f l i c t could d i s t i n g u i s h the two groups. The two-chair operation i s only one technique among many in the Gestalt approach to counselling. Even though i t i s based upon Gestalt concepts i t i s abstracted for experimental purposes from the f u l l context of Gestalt therapy. The r e s u l t s , therefore, have l i m i t e d g e n e r a l i z a b i l i t y to Gestalt therapy as a whole and only to the use of the two-chair technique in the context of a good working a l l i a n c e with an empathically perceived ther a p i s t . The design of the study i s c o r r e l a t i o n a l in nature thus allowing l i m i t e d causal claims. However, the d e t a i l e d nature of the process analysis provided such a complete de s c r i p t i o n of the s p e c i f i c c l i e n t 149 in-therapy process that was related to outcome (with two-chair dialogue) that i t was suggestive of a possible change mechanism in psychotherapy. Recommendations for Further Research The following recommendations were deemed appropriate on the basis of the findings of t h i s research. This research concerned i t s e l f with the s t r a t e g i c i n t e r a c t i o n that existed between the therapist intervention (two-chair technique) and the s p e c i f i c i n - t h e r a p y process of the c l i e n t ( i n t r a p s y c h i c c o n f l i c t resolution) as i t related to outcome. I t / would be of int e r e s t to examine the in-therapy process of d i f f e r e n t decision making s t y l e s (Miller-Tiedeman & Niemi, 1977) and th e i r r e l a t i o n to outcome. Related to t h i s , i t i s suggested that research of i n t e r e s t could be c a r r i e d out around the s t r a t e g i c i n t e r a c t i o n between therapist i n t e r -vention and type of decision to be made (e.g., vocational decisions, r e l a t i o n s h i p decisions, education vs. t r a v e l decisions) as related to outcome. It i s recommended that the examination of the in-therapy process of sample groups representing d i f f e r e n t i n d i v i d u a l d i f f e r e n c e v a r i a b l e s , thought to a f f e c t treatment, i n s t r a t e g i c i n t e r a c t i o n with therapist interventions could y i e l d findings based upon more refined c l i e n t samples. F i n a l l y , i t i s l e f t to future research to determine the r e l a t i v e contributions and impacts of the s p e c i f i c and nonspecific e f f e c t s at work in t h i s study as the study was not designed to address t h i s s i g n i f i c a n t issue. 150 Implications The r e s u l t s of t h i s study have implications for c l i n i c a l p r a c t i c e , counsellor education and counselling t h e o r i s t s . For c l i n i c i a n s , the study not only describes a therapeutic i n t e r -vention that has been operationally defined and em p i r i c a l l y validated (Greenberg, 1975; Greenberg & Clarke, 1979; Greenberg & Dompierre, In press) but relates that intervention to a s p e c i f i c c l i e n t in-therapy process and then to outcome. For counsellor educators and th e o r i s t s t h i s study presents the i n i t i a l steps towards an understanding of how people make personal decisions and how they block, i n t e r f e r e , or prevent themselves from making decisions, which could enable the design of developmental and preventive psycho-educational programs. These programs could a s s i s t people i n gaining f a c i l i t y with the psychological processes that are needed to ensure e f f i c i e n t decison making and c o n f l i c t r e s o l u t i o n . The competency to e f f e c t personal decisons and resolve intrapsychic con-f l i c t s about p r i n c i p a l l i f e choices reduces stress (Janis & Mann, 1977) and stimulates healthy adult development. An issue remaining i s whether t h i s study i s merely a demonstration of the o b v i o u s — t h a t i s , i f you resolve a c o n f l i c t , you f e e l resolved. Components of competence, however, have been delineated and intrapsychic c o n f l i c t resolution i s not merely a simple performance task l i k e adding and then measuring i f you have indeed completed the performance. Rather, i t appears that those components of competence i n the a f f e c t i v e domain, expressing c r i t i c i s m s , experiencing f e l t wants, and softening in attitude have been attained by resolvers. The attainment of these 151 components i s analogous to the attainment of competence in the use of the operator (the "how") of addition. Resolvers were f i r s t l y not instructed to soften and secondly, although they were instructed to express c r i t i c i s m s and experience f e e l i n g s , these were not performances which could have occurred with any a u t h e n t i c i t y on demand. The perform-ance competencies and the immediate and t e r m i n a t i o n measures are s u f f i c i e n t l y conceptually d i s t i n c t to suggest that a r e a l change has occurred. The competencies are a measure of performance and the outcome measures are s e l f reports about states such as r e s o l u t i o n or mood (quite distant from performance) and states such as indecision and anxiety that are even more d i s t i n c t from the performance competencies. Therefore, i t i s suggested that softening does not l o g i c a l l y require that r e s o l u t i o n w i l l follow but increases the chances that i t w i l l . A further step i s to understand f u l l y the component of softening. In other words, what are the actual tasks involved in softening? Some ind i c a t i o n of where to begin t h i s understanding i s offered by the process instruments used in t h i s study. Voice indicates that softening requires some focusing inward of attention. 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C r e a t i v e p r o c e s s i n G e s t a l t therapy. New York: Brunner/Mazel, 1977. APPENDIX A THE INSTRUMENTS 164 WAIC I n s t r u c t i o n s B e l o w a r e some s e n t e n c e s t h a t d e s c r i b e some o f t h e d i f f e r e n t ways a p e r s o n n i g h t t h i n k o r f e e l a b o u t h i s o r h e r e x p e r i e n c e i n c o u n s e l l i n g . A s y o u r e a d t h e s e n t e n c e s m e n t a l l y I n s e r t t h e name o f y o u r c o u n s e l l o r i n t h e p l a c e o f t h e I n t h e t e x t . B e l o w e a c h s e n t e n c e t h e r e i s a f i v e p o i n t s c a l e : 1 2 3 4 5 N e v e r Sometimes A l w a y s I f t h e s e n t e n c e d e s c r i b e d t h e way t h a t y o u a l w a y s f e e l ( o r t h i n k ) c i r c l e n o . 5 ; i f i t n e v e r a p p l i e s t o y o u c i r c l e t h e number 1. U s e t h e p o i n t s i n b e t w e e n t o d e s c r i b e t h e v a r i a t i o n s b e t w e e n t h e s e e x t r e m e s . T h i s q u e s t i o n n a i r e i s c o n f i d e n t i a l ; YOUR COUNSELLOR WILL NOT SEE  YOUR ANSWERS. P l e a s e w o r k f a s t , y o u r f i r s t i m p r e s s i o n s a r e t h e o n e s we w o u l d l i k e t o g e t . ( P l e a s e d o n ' t f o r g e t t o r e s p o n d t o e v e r y i t e m . ) Thank y o u f o r y o u r c o o p e r a t i o n . 166 1 2 3 4 5 N e v e r S e l d o m Somet imes O f t e n A l w a y s 1. I f e e l we a r e a p p r o a c h i n g my p r o b l e m s t h e r i g h t w a y . 1 2 3 4 5 2 . and I a g r e e a b o u t t h e s t e p s t o b e t a k e n t o i m p r o v e my s i t u a t i o n 1 2 3 4 5 3 . I f i n d what we do i n t h e s e s s i o n s c o n f u s i n g . 1 2 3 4 5 4 . I b e l i e v e t h a t t h e t i m e we a r e s p e n d i n g t o g e t h e r i s n o t s p e n t e f f i c i e n t l y . 1 2 3 4 5 5 . I am c l e a r on what my r e s p o n s i b i l i t i e s a r e i n t h e s e s s i o n s . 1 2 3 4 5 6 . I f i n d what and I a r e d o i n g f a r removed f r o m my c o n c e r n s . 1 2 3 4 5 7. I f e e l t h a t what I do h e r e w i l l h e l p me t o a c c o m p l i s h t h e c h a n g e s t h a t I w a n t . 1 2 3 4 5 8 . I am c l e a r as t o what w a n t s me t o do i n t h e s e s e s s i o n s . 1 2 3 4 5 9 . We a g r e e o n what i s i m p o r t a n t f o r me t o w o r k o n . 1 2 3 4 5 1 0 . w n a t s me t o change t o o f a s t . 1 2 3 4 5 1 1 . The t h i n g s t h a t 1 am d o i n g h e r e d o n ' t make much s e n s e t o me. 1 2 3 4 5 1 2 . I b e l i e v e t h a t t h e way we a r e w o r k i n g w i t h my p r o b l e m i s c o r r e c t . 1 2 3 4 5 167 DO NOT COPY LEAVES 1 6 6 - 7 0 . C o d e : ' D a t e : (BARRETT-LENNARD) RELATIONSHIP INVENTORY—FORM O S — 6 4 * B e l o v a r e l i s t e d a v a r i e t y o f ways t h a t one p e r s o n may f e e l o r b e h a v e i n r e l a t i o n t o a n o t h e r p e r s o n . P l e a s e c o n s i d e r e a c h numbered s t a t e m e n t w i t h r e f e r e n c e t o y o u r p r e s e n t r e l a t i o n s h i p w i t h y o u r c o u n s e l l o r , m e n t a l l y a d d i n g h i s o r h e r name i n t h e s p a c e p r o v i d e d . F o r e x a m p l e , i f t h e o t h e r p e r s o n ' s name was J o h n , y o u w o u l d r e a d s t a t e m e n t 111, as ' J o h n r e s p e c t s me a s a p e r s o n ' . M a r k e a c h s t a t e m e n t i n t h e a n s w e r c o l u m n on t h e r i g h t , a c c o r d i n g t o how s t r o n g l y y o u f e e l t h a t i t i s t r u e , o r n o t t r u e , i n t h i s r e l a t i o n s h i p . P l e a s e  be s u r e t o mark e v e r y o n e . W r i t e i n + 3 , + 2 , + 1 , o r - 1 , - 2 , - 3 , t o s t a n d f o r t h e f o l l o w i n g a n s w e r s : + 3 : Y e s , I s t r o n g l y f e e l t h a t i t i s - 1 : N o , I f e e l t h a t i t i s p r o b a b l y t r u e . u n t r u e , o r more u n t r u e t h a n t r u e . +2: Y e s , I f e e l i t i s t r u e . - 2 : N o , I f e e l i t i s n o t t r u e . + 1 : Y e s , I f e e l t h a t i t i s p r o b a b l y - 3 : N o , I s t r o n g l y f e e l t h a t i t i s t r u e , o r more t r u e t h a n u n t r u e . n o t t r u e . ANSWER 1. w a n t s t o u n d e r s t a n d how I see t h i n g s 2 . may u n d e r s t a n d my w o r d s b u t h e / s h e does n o t see t h e way I f e e l 3 . n e a r l y a l w a y s knows e x a c t l y what I mean 4 . l o o k s a t what I do f r o m h i s / h e r own p o i n t o f v i e w 5 . u s u a l l y s e n s e s o r r e a l i s e s what I am f e e l i n g . . . . . . . . 6 . ' s own a t t i t u d e s t o w a r d some o f t h e t h i n g s I do o r s a y . . . p r e v e n t h i m / h e r f r o m u n d e r s t a n d i n g me 7. Somet imes t h i n k s t h a t _I f e e l a c e r t a i n w a y , b e c a u s e t h a t ' s t h e way h e / s h e f e e l s 8 . r e a l i s e s what I mean e v e n when I h a v e d i f f i c u l t y i n s a y i n g i t . 9 . u s u a l l y u n d e r s t a n d s t h e w h o l e o f what I mean 1 0 . j u s t t a k e s no n o t i c e o f some t h i n g s t h a t I t h i n k o r f e e l 1 1 . a p p r e c i a t e s e x a c t l y how t h e t h i n g s I e x p e r i e n c e f e e l t o me 168 1 2 . A t t i m e t h i n k s t h a t I f e e l a l o t more s t r o n g l y a b o u t a p a r t i c u l a r t h i n g t h a n I r e a l l y do 1 3 . d o e s n o t r e a l i s e how s e n s i t i v e I am a b o u t some o f t h e t h i n g s we d i s c u s s 1 4 . u n d e r s t a n d s me > 1 5 . ' s . r e s p o n s e t o me i s u s u a l l y so f i x e d and a u t o m a t i c t h a t I d o n ' t r e a l l y g e t t h r o u g h t o h i m / h e r 1 6 . When I am h u r t o r u p s e t c a n r e c o g n i z e my f e e l i n g s e x a c t l y , w i t h o u t b e c o m i n g u p s e t t o o 169 INDECISION SCALE Please indicate on the answer sheet if these statements describe you. 1. I have decided on a long-term goal and feel comfortable with i t . I also know how' to go about implementing my choice. 2. I have decided on a short-term goal and feel comfortable with i t . I also know how to go about implementing my choice. 3. If I had the abi l i ty or the opportunity I would but this choice is really not possible for me. I haven't given much thought to other alternatives however. k. Several options have equal appeal to me. I'm having a d i f f icu l t time decid-ing among them. 5. I know I will have to decide eventually but none of the options I know about appeal to me. 6. I'd like to but I'd be going against the wishes of someone who is important to me if I did so. Because of this, i t ' s d i f f i cu l t for me to make a decision right now. I hope I can find a way to please them and myself. 7. Until now I haven't given much thought to making a choice. I feel lost when I think about it becuase I haven't had many experiences in making decisions on my own and I don't have enough information to make a decision right now. 8. I feel discouraged because everything about making a choice seems so " i f y " and uncertain; I feel discouraged, so much so that I'd like to put off making decisions for the time being. 9. I thought I knew what I wanted, but recently I found out that it wouldn't be possible for me to pursue i t . Now I've got to start looking for other alternatives. 10. I want to be absolutely certain in that my choice is the "r ight" one, but none of the options I know about seem right to me. 11. Having to make a decision bothers me. I'd like to make a decision quickly and get It over with. I wish I could take a test that would tel l me what choice I should make. 12. I know what I'd like to do now but 1 don't know what it would lead to in the future. 13. I can't make a choice right now because I don't know what my ab i l i t ies or capabilities are. 14. I don't know what I really want (that making this decision could provide for me). A few things are clear to me but I'm not certain that they are related in any way to toy possible alternatives. 170 - 2 15. I seem to want so many things and I know I have the abi l i ty to do well regardless of what I choose. It's just hard for me to find the one thing I wan t. 1 6 . I have made a decision but I'm not sure how to go about implementing my choice. 17. I need more information about what different alternatives are like before I can make a decision. 18. I think I know what I want now but feel I need some additional support for it as a choice for myself. 19. None of the above items describe me. The following would describe me better: (write your response on the answer sheet)-Samuel H. Osipow, Clarke G. Carney, Jane Winer, Barbarba Yanico, Maryanne Koschier, 1 9 7 6 (3rd. Revision) A l l Rights Reserved. Reproduced and Adapted with Permission of the Copyright Holders. QUESTIONNAIRE I (at termination) We are Interested in how much the following conflict(s) of yours has (have) changed since you started the program. Please circle the words that describe your position. (a) worse ... some... slightly better... somewhat better... a lot better (b) worse ... same... slightly better... somewhat better... a lot better (c) ;  worse ... same... slightly better... somewhat better... a lot better 172 FOLLOW-UP INTERVIEW GUIDE T h e r a p i s t C l i e n t 1 . Have y o u made a c h o i c e a b o u t ? YES ; NO 2. Do y o u h a v e a n y d o u b t s a b o u t t h i s c h o i c e ? YES NO 3 . Have y o u d e c i d e d t o o r t o 4 . I s t h i s s a t i s f y i n g y o u and m e e t i n g y o u r n e e d s ? V E S ; NO ( i f y e s go t o 115, i f no go t o #8) 5. Have y o u l e a r n e d s o m e t h i n g a b o u t 6 . Have y o u t o l d o t h e r s a b o u t y o u r d e c i s i o n ? 7. A s a f u n c t i o n o f y o u r d e c i s i o n , how a r e y o u f e e l i n g a b o u t y o u r s e l f and y o u r new s i t u a t i o n ? 173 12 8 . Are you s t i l l exploring or looking for a solution? 9 " J o " m a L ^ ' d ^ o n f " t h a n t h C S e S e S S i 0 n S «»•« t h . main cause i n h e l p i n g 1 0' decision?61100 ^ y ° U r C U n i C a l J u d « e n i e n t h a * 'his person made a satisfactory Y E S NO 11 . How did you come to make a decision (or: What prevented you from makin* a decision) - how would you describe what happened to you? * 1 2 . Did anything in these sessions stand out for you as helpful ' If so whar were the outstanding features? »"piuj.. n so what ./3 Is there anything else you can t e l l us that could help us understand your decision making process? ' P.S. Thank you C O N F L I C T R E S O L U T I O N S C A L E We a r e i n t e r e s t e d i n h o w r e s o l v e d y o u f e e l r i g h t n o w , a b o u t y o u r d e c i s i o n a l c o n f l i c t . P l e a s e i n d i c a t e w i t h a n ( X ) y o u r p r e s e n t p o s i t i o n . I 1 T o t a l l y r e s o l v e d S o m e w h a t r e s o l v e d N o t a t a l l r e s o l v e d 176 T A R G E T C O M P L A I N T S D I S C O M F O R T  B O X S C A L E We a r e i n t e r e s t e d i n h o w m u c h d i s c o m f o r t y o u r d e c i s i o n a l c o n f l i c t i s c a u s i n g y o u r i g h t n o w . P l e a i n d i c a t e w i t h a n ( X ) y o u r p r e s e n t p o s i t i o n . C o u l d n ' t b e w o r s e V e r y m u c h P r e t t y m u c h A l i t t l e N o n e a t a l l 177 PREVAILING HOOD SCALE Rate how you feel right now, this very moment using the following scales. Note that the ends of each scale are defined by opposite groups of items. Decide which side of the scale best describes your feeling right now and rate that item. The other item must then receive a rating of "1 " ("not at a l l " ) . If you have neither of the feelings at this moment or i f they exactly balance each other, give both a rating of " 1 " . Happy, c h e e r f u l , o r joyous 5 4 3 2 2. 1 Sad, unhappy, o r depressed 2 3 4 5 Extremely Moderately Not at a l l , or neutral Moderately Extremely 3. Warm-hearted, a f f e c t i o n a t e or k ind ly 5 4 3 2 4. 1 Angry, annoyed, or i r r i t a t e d 2 3 4 5 Extremely Moderately Not at a l l , or neutral Moderately Extremely 5. Proud, worthy, or pleased w-se l f 5 4 3 2 6. 1 Ashamed, g u i l t y , o r d i sp leased w 2 3 4 5 Extremely Moderately Not at a l l , or neutra l Moderately Extremely 7. Calm, re l axed , o r serene 5 4 3 2 8. 1 Tense, j i t t e r y , o r shaky 2 3 4 5 Extremely Moderately Not at a l l , or neutral Moderately Extremely 9. Scared, or worried about something s p e c i f i c 5 4 3 2 10. 1 Vaguely anxious o r troubled about something i n d e f i n i t e 2 3 4 5 Extremely Moderately Not at a l l , or neutral Moderately Extremely 11. Integrated, or a l l - t o g e t h e r 5 4 3 2 12. 1 Confused, o r d isorganized 2 3 4 5 Extremely Moderately Not at a l l , or neutral Moderately Extremely 13. Op t im i s t i c , or hopeful 5 4 3 2 14. 1 Pes s im i s t i c , or hopeless 2 3 4 5 Extremely Moderately Not a t a l l , or neutral Moderately Extremely 15. Powerful, or i n - con t ro l of events 5 4 3 2 - 16. 1 Weak, or he lp less 2 3 4 5 Extremely Moderately Not at a l l , or neutral Moderately Extremely 17. A l e r t , wide-awake, or energet ic 5 4 3 2 18. 1 T i r e d , weary, o r unreact ive 2 3 4 5 Extremely Moderately Net at a l l . 178 C O A L A T T A I N M E N T FOLLOV.TJP C U I D E N A M E :  B A T E : •  DESCRIPTION OF DECISIONAL CONFLICT YOU HAVE BEEN WORKING ON. MUCH HORSB T l t t N E X P E C T E D R E S U L T S : SOMEWHAT L E S S T H A N E X P E C T E D R E S U L T S : E X P E C T E D OR MOST L I K E L Y R E S U L T S : SOMEWHAT B E T T E R THAN E X P E C T E D R E S U L T S : MUCH B E T T E R T H A N E X P E C T E B R E S U L T S : ( p l a c e asterisk (*) next to level w h e r e y o u are now) 179 POST C R I T I C A L SESSION QUESTIONNAIRE 1 . What was t h e c o r e I s s u e y o u w o r k e d o n I n t h e s e s e s s i o n s ? 2. D i d some a t t i t u d e a r o u n d t h i s i s s u e change f o r y o u ? NO MAYBE D E F I N I T E L Y 3. I f s o , what was t h e a t t i t u d e y o u changed? I*. How much d i d y o u c h a n g e on t h i s a t t i t u d e ? NO CHANGE SOMEWHAT CHANGED VERY GREATLY CHANGED I- H H h —I 5. How s i g n i f i c a n t was t h e a t t i t u d e o n w h i c h y o u changed? NOT VERY SOMEWHAT HIGHLY | — I 1 — k 1 180 THERAPIST REPORT FORM Therapist's Name_ Client's Name 1. Were you able to ut i l ize the two chair operation today? 2. Did you use any other major intervention? If so, what? 3. During this session which resolution elements were expressed by your cl lent (Please check) Standards and values Feelings '  Wants ; Softening Negotiation k. How resolved do you think your cl ient is right now in regard to their decisional conflict Totally resolved Somewhat resolved Not at a l l resolved D i d a n y t h i n g s i g n i f i c a n t h a p p e n i n t h i s s e s s i o n ? I s t h e r e a n y t h i n g s p e c i a l a b o u t t h i s c a s e t h a t we s h o u l d know? ( e . g . a n e x t e r n a l e v e n t i n f l u e n c i n g t h e d e c i s i o n m a k i n g p r o c e s s ) . T H E U N I V E R S I T Y O F B R I T I S H C O L U M B I A 2075 WESBROOK M A L L VANCOUVER. B.C., CANADA VST 1W5 F A C U L T Y OF E D U C A T I O N CONSENT FORM I h e r e b y g i v e c o n s e n t t o t h e use o f t a p e r e c o r d i n g s o f my c o u n s e l l i n g s e s s i o n s and my w r i t t e n r e s p o n s e s t o q u e s t i o n n a i r e s f o r t h e p u r p o s e s o f t h i s r e s e a r c h . I u n d e r s t a n d t h a t t h e s t u d y i s a imed a t d i s c o v e r i n g and e x p l o r i n g how p e o p l e make d e c i s i o n s . I u n d e r s t a n d t h a t t h e s e t a p e r e c o r d i n g s and my w r i t t e n r e s p o n s e s w i l l be coded t o p r o t e c t my p r i v a c y b e f o r e t h e y a r e g i v e n t o r e s e a r c h a s s i s t a n t s f o r s c o r i n g . I u n d e r s t a n d t h a t I may w i t h d r a w f r o m t h i s s t u d y a t any t i m e o r r e q u e s t t h a t a t a p e be e r a s e d , w i t h o u t j e o p a r d i z i n g my o p p o r t u n i t y f o r c o u n s e l l i n g . 1 am w i l l i n g t o c o m p l e t e a number o f q u e s t i o n n a i r e s u s e d t o e v a l u a t e t h e e f f e c t s o f my c o u n s e l l o r ' s i n t e r v e n t i o n s . I am p a r t i c i p a t i n g i n t h i s s t u d y o f my own f r e e w i l l , w i t h o u t c o e r s i o n o f any s o r t . S i g n a t u r e W i t n e s s D a t e D a t e 183 MAKE AGE ADDRESS . S E X T E L E P H O N E : home w o r k O C C U P A T I O N M A R I T A L STATUS E D U C A T I O N : h i g h s c h o o l g r a d u a t e : Y e s No u n i v e r s i t y : n u m b e r o f y e a r s d e g r e e g r a d u a t e o r p r o f e s s i o n a l s c h o o l : n o . o f y r s . t r a d e o r v o c a t i o n a l s c h o o l : n o . o f y r s . c o l l e g e : n o . o f y r s . d e g r e e c e r t i f i c a t e d i p l o m a D E C I S I O N SCREENING INTERVIEW Vie would like to ask you some questions to see i f what we are off erring would be suitable for you. If i t doesn't seen appropriate, we will suggest some other sources of help. 1. Is there a particular issue you wish to work on in counseling? How urgent or critical is this issue? 2. Have you ever sought counseling before? From whom? For what reason? With what result? 3. What do you expect from the counselling sessions? 4. What are you doing now? (e.g. working, at school, raising family) How do you spend your leisure tine? 5. What is your present living arrangement? . Are there any other general issues of concern to you at this time? a. It looks like our sessions will be appropriate for you. or b. Perhaps another resource would be more helpful to you. 185 EVALUATION OF SCREENING INTERVIEW 1. Evidence of severe disturbance? Yes_ No 2. Is there a conflict related to a Yes No decision? 3. Are the client's expectations reasonable? Yes NO k. Client has some significant relationships? Yes No. 5. Recommend client for the study? Yes No. If not recommended for study, suggest appropriate referral: Student Services Women's Resources Health Sciences Outpatient Canada Employment Centre . Continuing Education • Others (please specify) APPENDIX B PHILLIPS PERSONALIZED QUESTIONNAIRE ANALYSIS, PROCEDURES, AND DATA 186 187 Scoring The scoring and analysis were done according to P h i l l i p s (1970a). The c l i e n t ' s responses on each occasion were entered i n a table such as Table B.1, where the convention was adopted that responses i n d i c a t i n g that the c l i e n t was more symptomatic than the statement were to be viewed as p o s i t i v e and responses i n d i c a t i n g he/she was l e s s symptomatic as negative. Estimates of the i n t e n s i t y of the symptom on each occasion were given by the average of the judgements to each of the cards on that occasion, as i l l u s t r a t e d in the t a b l e . Table B.1 Responses for a c l i e n t on each statement over a l l occasions Symptom Statement very g r e a t l y explosive g r e a t l y explosive moderately explosive s l i g h t l y explosive not at a l l explosive Total Estimate Session Stand ardized 1 +01 7 To t a l Total Estimate -20 -15 -25 -60 -45 -90 -100 -355 -443 63.2587 -10 -5 -15 -25 -30 -70 -75 -230 -318 45.4285 0 -20 -10 -30 -50 -100 -188 26.8571 +25 +10 +20 0 +10 -15 -25 +25 -63 9.0000 +70 +75 +25 +25 +20 +5 0 +220 +132 -18.8571 75 65 5 -80 -55 -200 -250 -440 15 13 1 -16 -11 -40 -50 188 When the c l i e n t ' s responses were obtained for the various occasions they were graphed as shown i n Figure B.1 for the data of Table B.1, affording an ongoing chart of the c l i e n t ' s progress. Following termina-t i o n of treatment, or the experiment, estimates of the scale values of the statements were obtained by subtracting the mean of the "T o t a l " column from each row t o t a l y i e l d i n g the "Standardized T o t a l " ; t h i s was then divided by the number of sessions, the sign changed, and the "Estimate" produced. The estimates were then entered on the ordinate, as shown in the f i g u r e , so that the d i f f e r e n t l e v e l s the symptom had assumed could be d i r e c t l y compared with those of the statements. Analysis Interval scaling data, unlike o r d i n a l scaling data, which can be and often are p e r f e c t l y consistent, are almost c e r t a i n to contain some inconsistencies. It was necessary to know whether or not the errors f e l l within permissible l i m i t s ; also i t was desirable to know whether or not, i r r e s p e c t i v e of the i r magnitude, the errors showed any evidence of being systematic. P h i l l i p s (1970) presented an extension of the analysis of variance technique for i n t e r v a l scaling that can be used to answer these questions. This extension i s presented i n Table B.2. E s s e n t i a l l y there were three points that were desirable to know. F i r s t l y , were the changes in the symptom r e a l changes or could they have been accounted for in terms of random error? Secondly, d i d the state-ments represent s a t i s f a c t o r i l y d i s t i n c t l e v e l s of i n t e n s i t y of the symptom? T h i r d l y , were the ine v i t a b l e errors i n the c l i e n t ' s judgements in any way systematic? These questions were answered by the F r a t i o s for occasions, statements and non-additivity r e s p e c t i v e l y (the F r a t i o 189 Figure B.1 Graph of Client's Responses From Table B.1 70 very greatly explosive 60 50 greatly explosive 40 30 moderately explosive 20 slightly explosive not at a l l explosive 70 190 Table B.2 Analysis of Variance for interval scaling using client data from Table B.1 Source DF SS VE F Probability Sessions 6 18828.5719 3138.0953 28.33 .01 Statements 4 28461.4286 7115.3571 64.23 .01 Mean Difference 1 5531.4258 5531.4258 49.93 .01 Non-Additivity 1 280.7121 280.7121 2.53 N.S. Residual 23 2547.8617 110.7766 Total 35 55650.0000 for the mean difference, while being statistically necessary was not here nor usually is psychologically meaningful). Since real effects were indicated by the significance of the F ratios for occasions and statements, they were most desirable. The F ratio for non-additivity indicated some degree of distortion in the client's responses and was somewhat less desirable. After obtaining significance on the F ratio for occasions the first and most obvious question to be answered was whether the symptom had improved or worsened during the counselling sessions. This question was investigated by extending the analysis of variance to accomodate sums of squares for linear and quadratic trend obtained by fitting the first two orthogonal polynomials to the occasions estimates (McNemar, 1962, pp. 346-61; Edwards, 1968, pp. 145-8). The orthogonal polynomials were taken from the Pearson & Hartley tables (1966). Using the data from Table B.2 the extended analysis of variance is shown in Table B.3 where 191 Table B.3 Extended Analysis of Variance of the data of Table B.2 Source Sessions Quadratic Trend Remainder Statements Mean Difference Non-Additivity Residual Total DF 6 Linear Trend 1 1 4 4 1 1 23 35 SS 18828.5719 17494.4643 390.5357 943.5719 28461.4286 5531.4258 280.7121 2547.8617 55650.0000 VE 3138.0953 390.5357 235.8930 7115.3571 280.7121 110.7766 F 28.33 17494.4643 157.93 3.53 2.13 64.23 5531.4258 49.93 2.53 P .01 .01 N.S. N.S. .01 .01 N.S. the significant F ratio for linear trend indicated an overall improve-ment (discovered by inspecting the graph in Fig. B.1), the insignificant F ratio for quadratic trend indicated no tendency for initial improve-ment followed by a worsening and the insignificant remaining variance indicated that a l l of the change shown by the symptom had been accounted for. The remainder of this appendix contains a l i s t of the individual client symptoms (see Fig. B.2) and the individual analyses of variance on the data over a l l the sessions person by person. 192 Figure B.2 Reported C l i e n t Symptoms and Frequencies. fear (3) d i s t r a c t i o n (2 uncertainty (D depression (4 d i s s a t i s f a c t i o n (2) worry (1 anxiety (3) impatience (1 f r u s t r a t i o n (D i r r i t a b i l i t y (1 explosiveness (1) immobility (1 upset (2) loss of weight (1 tension (2) unhappiness (1 anger (1) s e l f doubt (3 ANALYSIS OF VARIANCE FOR 1 SOURCE DF s.s. V.E. SESSIONS LINEAR TREND QUADRATI C REMAINDER STATEMENTS MEAN DIFFERENCE NON-ADDITIVITY RESIDUAL 4 1 1 27 16418.1750 5883.0107 1893.0012 8642.1631 50053.6563 44023.2227 4.8691 431.0770 2345.4536 5883.0107 1893.0012 1728.4326 12513.4141 44023.2227 4.8691 15.9658 146.90 368.48 118.57 108.26 783.76 2757.34 0.30 TOTAL 40 110931.0000 ANALYSIS OF VARIANCE FOR SOURCE DF SESSIONS 5 LINEAR TREND QUADRATIC REMAINDER STATEMENTS 4 MEAN DIFFERENCE 1 NON-ADDITIVITY 1 RESIDUAL 19 S.S. 5017.5000 4865.7857 26.2500 125.4643 43080.0000 35707.5000 106.6012 763.3988 V.E. 1003 i 5000 4865.7857 26.2500 41.8214 10770.0000 35707.5000 106.6012 40.1789 24.98 121.10 0 1 268.05 888.71 2.65 65 04 TOTAL 30 84675.0000 ANALYSIS OF VARIANCE FOR SOURCE SESSIONS LINEAR TREND QUADRATIC REMAINDER STATEMENTS MEAN DIFFERENCE NON-ADDITIVITY RESIDUAL DF 4 1 1 27 S.S. 19857.5000 1097.1429 13042.9762 5717.3810 50533.7500 23522.5000 18.4330 917.8170 V.E. 2836.7857 1097.1429 13042.9762 1143.4761 12633.4375 23522.5000 18.4330 33.9932 83.45 32.23 383.69 33.64 371.65 691.98 0.54 TOTAL 40 94850.0000 ANALYSIS OF VARIANCE FOR SOURCE DF SESSIONS 7 LINEAR TREND 1 QUADRATIC 1 REMAINDER 5 S.S. 21004.3750 14708.6012 643.1250 5652.6488 V.E. 3000.6250 14708.6012 643.1250 1130.5295 92.69 454.37 19.87 34.92 STATEMENTS 4 54910.0000 13727.5000 MEAN DIFFERENCE 1 17430.6250 17430.6250 NON-ADDITIVITY 1 5.9727 5.9727 RESIDUAL 27 874.0273 32i3714 TOTAL 40 94225.0000 424.06 538.46 0.18 ANALYSIS OF VARIANCE FOR SOURCE DF SESSIONS 7 LINEAR TREND QUADRATIC REMAINDER STATEMENTS 4 MEAN DIFFERENCE 1 NON-ADDITIVITY 1 RESIDUAL 27 S . S . 28264.3750 13560.2679 2383.6012 12320.5060 51358.7500 3150.6250 11.0168 540.2332 V.E. 4037.7679 13560.2679 2383.6012 2464.1011 12839.6675 3150.6250 11.0168 20.0086 201.80 677.72 119.13 123.15 641.71 157.46 0.55 TOTAL 40 83325.0000 ANALYSIS OF VARIANCE FOR 6 SOURCE DF S.S. V.E. F SESSIONS 6 16577.1430 2762.8572 29.69 LINEAR TREND 1 4571.4286 4571.4286 49.12 QUADRATIC 1 160.9524 160.9524 1.73 REMAINDER 4 11844.7620 2961.1904 31.62 STATEMENTS 4 38445.7143 9611.4286 103.2S MEAN DIFFERENCE 1 4457.8555 4457.8555 47.90 NON-ADDITIVITY 1 3.8423 3.8423 0.04 RESIDUAL 23 2140.4450 93.0628 TOTAL 35 61625.0000 ANALYSIS OF VARIANCE FOR 7 SOURCE DF S.S. V.E. F SESSIONS 7 30530.0000 4361.4286 173.38 LINEAR TREND 1 3320.1190 3320.1190 131.98 QUADRATIC 1 921.9048 921.9048 36.65 REMAINDER 5 26287.9762 5257.5938 209.00 STATEMENTS 4 44235.0000 11058.7500 439.61 MEAN DIFFERENCE 1 14440.0000 14440.0000 574.02 NON-ADDITIVITY 1 65.7903 65.7903 2.62 RESIDUAL 27 679.2097 25.1559 TOTAL 40 89950.0000 ANALYSIS OF VARIANCE FOR 8 SOURCE DF SESSIONS 7 LINEAR TREND QUADRATIC REMAINDER STATEMENTS 4 MEAN DIFFERENCE 1 NON-ADDITIVITY 1 RESIDUAL 27 TOTAL 40 S.S. 14000.0000 2 1 62.9762 1 4207.6190 4 5 9729.4048 1 45668.7500 11 4000.0000 4 50.2273 731.0227 64450.0000 V.E. F 000.0000 73.87 62.9762 2.33 207.6190 155.41 945.8809 71.87 417.1875 421.69 000.0000 147.74 50.2273 1.86 27.0749 ANALYSIS OF VARIANCE FOR SOURCE DF S.S. V.E. SESSIONS LINEAR TREND QUADRATIC REMAINDER STATEMENTS MEAN DIFFERENCE NON-ADDITIVITY RESIDUAL 4 1 1 23 18828.5719 17494.4643 390.5357 943.5719 28461.4286 5531.4258 280.7121 2547.8617 3138.0953 17494.4643 390.5357 235.8930 7115.3571 5531.4258 280.7121 110.7766 28.33 157.93 3.53 2.13 64.23 49.93 2.53 TOTAL 35 55650.0000 ANALYSIS OF VARIANCE FOR 10 SOURCE DF S.S. V.E. SESSIONS 5 LINEAR TREND 1 QUADRATIC 1 REMAINDER 3 STATEMENTS 4 MEAN DIFFERENCE 1 NON-ADDITIVITY 1 RESIDUAL 19 3797.5000 1501.7857 1183.3929 1112.3214 38770.0000 367.5000 46.2656 643.7344 759.5000 1501.7857 1183.3929 370.7737 9692.5000 367.5000 46.2656 33.8808 22.42 44.33 34.93 10.94 286.08 10.85 1.37 TOTAL 3 0 43625.0000 ANALYSIS OF VARIANCE FOR SOURCE DF SESSIONS 4 LINEAR TREND 1 QUADRATIC 1 REMAINDER 2 STATEMENTS 4 11 S.S. 17376.0000 3528.0000 1120.0000 12728.0000 376.0000 V.E. 4344.0000 .3528.0000 1120.0000 6364.0000 94.0000 79 46 46 63 04 MEAN DIFFERENCE 1 29584.0000 NON-ADDITIVITY 1 7221.2766 RESIDUAL 15 36342.7234 29584.0000 7221.2766 2422.8482 12.21 2.98 TOTAL 25 90900.0000 ANALYSIS OF VARIANCE FOR 12 SOURCE DF SESSIONS 4 LINEAR TREND QUADRATIC REMAINDER STATEMENTS 4 MEAN DIFFERENCE 1 NON-ADDITIVITY 1 RESIDUAL 15 S.S. 1810.5602 729.6200 802.4143 278.5259 31330.5602 11837.4375 1.6332 749.8090 V.E. 452.6400 729.6200 802.4143 139.2629 7832.6400 11837.4375 1.6332 49.9873 9.06 14.60 16.05 2.79 156.69 236.81 0.03 TOTAL 25 45730.0000 ANALYSIS OF VARIANCE FOR 13 SOURCE DF SESSIONS 5 LINEAR TREND QUADRATIC REMAINDER STATEMENTS 4 MEAN DIFFERENCE 1 NON-ADDITIVITY 1 RESIDUAL 19 S.S. 9616.6672 7968.2857 221.4881 1426.8934 32907.2005 2050.1333 69.0576 1530.9414 V.E. 1923.3334 7968.2857 221.4881 475.6311 8226.8001 2050.1333 69.0576 80.5759 23.87 98.89 2 5 102 .75 ,90 ,10 25.44 0.86 TOTAL 3 0 46174.0000 ANALYSIS OF VARIANCE FOR SOURCE DF SESSIONS 5 LINEAR TREND 1 QUADRATIC 1 REMAINDER 3 STATEMENTS 4 MEAN DIFFERENCE 1 NON-ADDITI VITY 1 RESIDUAL 19 14 S.S. 19304.1750 17220.0714 228.8095 1855.2940 30405.0000 17040.8320 202.8378 1322.1552 V.E. 3860.8350 17220.0714 228.8095 618.4312 7601.2500 17040.8320 202.8378 69.5871 55.48 247.46 3.29 8.89 109.23 244.88 2.91 TOTAL 30 68275.0000 ANALYSIS OF VARIANCE FOR 15 SOURCE DF SESSIONS 7 LINEAR TREND QUADRATIC REMAINDER STATEMENTS 4 MEAN DIFFERENCE 1 NON-ADDITIVITY 1 RESIDUAL 27 TOTAL 40 S.S. 59S7.5000 860.1190 17.1429 5080.2381 50252.5000 9922.5000 0.2282 17.2718 66150.0000 V.E. 851.0714 860.1190 17.1429 1016.0476 12563.1250 9922.5000 0.2282 0.6397 1330.43 1344.57 26.80 1588.33 19639.20 15511.26 0.36 ANALYSIS OF VARIANCE FOR WARNING SOURCE SESSIONS STATEMENTS MEAN DIFFERENCE NON-ADDITIVITY RESIDUAL TOTAL 16 SUM OF SQUARES IS 0 DF 2 40 S . S . 18359.3750 50000.0000 3515.6250 71875.0000 V . E . ANALYSIS OF VARIANCE FOR 17 SOURCE SESSIONS LINEAR TREND QUADRATIC REMAINDER STATEMENTS MEAN DIFFERENCE NON-ADDITIVITY RESIDUAL TOTAL DF 4 1 1 23 35 S.S. 21268.5719 4071.6071 4.8214 17192.1433 37935.7143 12071.4258 619.4393 2204.8488 74100.0000 V . E . 3544.7620 4071.6071 4.8214 4298.0352 9483. 9286 12071.4258 619.4393 95.8630 36.98 42.47 0.05 44.84 98.93 125.92 6.46 ANALYSIS OF VARIANCE FOR 18 SOURCE DF SESSIONS 7 LINEAR TREND QUADRATIC REMAINDER STATEMENTS 4 MEAN DIFFERENCE 1 NON-ADDITIVITY 1 RESIDUAL 27 S.S. 17139.1000 17.7190 2420.8048 14700.5762 39936.6504 656.0999 34.2728 807.8769 V.E. 2448.4429 17.7190 2420.8048 2940.1152 9984.1626 656.0999 34.2728 29.9214 81.83 0.59 80.91 98.26 333.68 21.93 1.15 TOTAL 40 58574.0000 ANALYSIS OF VARIANCE FOR 19 SOURCE DF SESSIONS 6 LINEAR TREND QUADRATIC REMAINDER STATEMENTS 4 MEAN DIFFERENCE 1 NON-ADDITIVITY 1 RESIDUAL 23 TOTAL 35 S.S. 5357.1430 111.6071 37.2024 5208.3334 43750.0000 7142.8555 0.0000 0.0016 56250.0000 V.E. 892.8572 111.6071 37.2024 1302.0833 10937.5000 7142.8555 0.0000 0.0001 13142857.41 1642857.14 547619.05 19166665.46 160999999.94 105142832.46 0.00 ANALYSIS OF VARIANCE FOR SOURCE DF SESSIONS 7 LINEAR TREND 1 QUADRATIC 1 REMAINDER 5 STATEMENTS MEAN DIFFERENCE NON-ADDITIVITY RESIDUAL TOTAL 4 1 1 27 40 20 S . S . 1670.0000 145.8333 1029.6429 494.5238 25491.2500 40.0000 5.8199 1092.9301 28300.0000 V.E. 238.5714 145.8333 1029.6429 98.9048 6372.8125 40.0000 5.8199 40.4789 5.89 3.60 25.44 2.44 157.44 0.99 0.14 ANALYSIS OF VARIANCE FOR 21 SOURCE DF SESSIONS 5 LINEAR TREND QUADRATIC REMAINDER STATEMENTS 4 MEAN DIFFERENCE 1 NON-ADDITIVITY 1 RESIDUAL 19 S . S . 29400.0000 4046.0000 3343.3929 22010.6071 32371.6667 1470.0000 43.4062 2864.9271 V.E. 5880.0000 4046.0000 3343.3929 7336.B672 8092.9167 1470.0000 43.4062 150.7856 39.00 26.83 22.17 48.66 53.67 9.75 0.29 TOTAL 30 66150.0000 ANALYSIS OF VARIANCE FOR SOURCE DF SESSIONS 5 22 S.S. 10364.1667 V.E. 2072.8333 F 25.01 199 LINEAR TREND 1 7637.7857 7637.7857 92.15 QUADRATIC 1 221.4881 221.4881 2.67 REMAINDER 3 2504.8929 834.9641 10.07 STATEMENTS 4 35520.0000 8880.0000 107.14 MEAN DIFFERENCE 1 100.8333 100.8333 1.22 NON-ADDITIVITY 1 65.2352 65.2352 0.79 RESIDUAL 19 1574.7647 82.8824 TOTAL 30 47625.0000 ANALYSIS OF VARIANCE FOR 23 SOURCE DF S . S . V.E. F 7 17187.5000 2455.3571 60.63 1 669.6429 669.6429 16.54 QUADRATIC 1 7440.4762 7440.4762 183.74 5 9077.3810 1815.4761 44.83 4 48906.2500 12226.5625 301.93 . 1 1562.5000 1562.5000 38.59 NON-ADDITIVITY 1 0.4084 0.4084 0.01 RESIDUAL 27 1093.3416 40.4941 TOTAL 40 68750.0000 SESSIONS LINEAR TREND REMAINDER STATEMENTS MEAN DIFFERENCE ANALYSIS OF VARIANCE FOR 24 *** WARNING *** SUM OF SQUARES IS 0 SOURCE DF SESSIONS 7 STATEMENTS 4 MEAN DIFFERENCE 1 NON-ADDITIVITY 1 RESIDUAL 27 TOTAL 40 S.S. V.E. 18359.3750 50000.0000 9765.6250 78125.0000 ANALYSIS OF VARIANCE FOR 25 SOURCE SESSIONS LINEAR TREND QUADRATIC REMAINDER STATEMENTS MEAN DIFFERENCE NON-ADDITIVITY RESIDUAL TOTAL DF S.S. V.E. F 5 5976.6672 1195.3334 15.67 1 1360.2857 1360.2857 17.84 1 40.2381 40.2381 0.53 3 4576.1434 1525.3811 20.00 4 34808.3333 8702.0833 114.10 1 10083.3320 10083.3320 132.22 1 32.6506 32.6506 0.43 19 1449.0168 76.2640 30 52350.0000 ANALYSIS OF VARIANCE FOR 26 SOURCE. DF S.! S. SESSIONS 4 10336 .0000 LINEAR TREND 1 8192 .0000 QUADRATIC 1 1120 .0000 REMAINDER 2 . 1024 .0000 STATEMENTS • 4 30736 .0000 MEAN DIFFERENCE 1 7569 .0000 NON-ADDITIVITY 1 1049 .8234 RESIDUAL 15 1134 .1766 TOTAL 25 50825 .0000 V.E. 2584.0000 8192.0000 1120.0000 512.0000 7684.0000 7569.0000 1049.8234 75.6118 34.17 108.34 14.81 6.77 101.62 100.10 13.88 ANALYSIS OF VARIANCE FOR 27 SOURCE DF SESSIONS 7 LINEAR TREND QUADRATIC REMAINDER STATEMENTS 4 MEAN DIFFERENCE 1 NON-ADDITIVITY 1 RESIDUAL 27 S . S . 540.0000 1.0714 1.0714 537.8571 '59685.0000 86490.0000 229.4665 1005.5335 V.E. 77.1429 1.0714 1.0714 107.5714 14921.2500 86490.0000 229.4665 37.2420 2.07 0.03 0.03 2.89 400.66 2322.38 6.16 TOTAL 40 147950.0000 ANALYSIS OF VARIANCE FOR 28 SOURCE SESSIONS LINEAR TREND QUADRATIC REMAINDER STATEMENTS MEAN DIFFERENCE NON-ADDITIVITY RESIDUAL DF 4 1 1 15 S . S . 11350.0000 112.5000 9723.2143 1514.2857 32600.0000 16900.0000 15.6618 384.3382 V.E. 2837.5000 112.5000 9723.2143 757.1428 8150.0000 16900.0000 15.6618 25.6225 110.74 4.39 379.48 29.55 318.08 659.58 0. .61 TOTAL 25 61250.0000 ANALYSIS OF VARIANCE FOR SOURCE DF SESSIONS 7 LINEAR TREND 1 QUADRATIC 1 REMAINDER 5 29 S.S. 15242.7000 2721.6000 8486.7857 4034.3143 V.E. 2177.5286 2721.6000 8486.7857 806.8628 35.33 44.15 137.68 13.09 201 STATEMENTS 4 51920.6563 12980.1641 MEAN DIFFERENCE 1 10956.0977 10956.0977 NON-ADDITIVITY 1 30.2619 30.2619 RESIDUAL 27 1664.2842 61.6402 TOTAL 40 79814.0000 210.58 177.74 0.49 ANALYSIS OF VARIANCE FOR 30 SOURCE DF SESSIONS 5 LINEAR TREND QUADRATIC REMAINDER STATEMENTS 4 MEAN DIFFERENCE 1 NON-ADDITIVITY 1 RESIDUAL 19 S.S. 10836.6672 8257.1429 110.0595 2469.4648 37661.6667 4813.3320 718.2887 1120.0455 V.E. 2167.3334 8257.1429 110.0595 823.154B 9415.4167 4813.3320 718.2887 58.9498 36.77 140.07 1.87 13.96 159.72 81.65 12.18 TOTAL 3 0 55150.0000 ANALYSIS OF VARIANCE FOR 31 SOURCE DF SESSIONS 7 LINEAR TREND QUADRATIC REMAINDER STATEMENTS 4 MEAN DIFFERENCE 1 NON-ADDITIVITY 1 RESIDUAL 27 S.S. 13313.1750 9022.6298 1023.0107 3267.5345 51081.6016 30195.0234 15.7760 597.4240 V.E. 1901.8821 9022.6298 1023.0107 653.5068 12770.4004 30195.0234 :15.7760 22.1268 85.95 407.77 46.23 29.53 577.15 1364.63 0.71 TOTAL 40 95203.0000 ANALYSIS OF VARIANCE FOR 32 *** WARNING *** SUM OF SQUARES IS SOURCE DF S.S. SESSIONS •4 2500.0000 STATEMENTS 4 31250.0000 MEAN DIFFERENCE 1 625.0000 NON-ADDITIVITY 1 RESIDUAL 15 TOTAL 25 34375.0000 V.E. ANALYSIS OF VARIANCE FOR 33 202 SOURCE DF S.S. V.E. SESSIONS LINEAR TREND QUADRATIC REMAINDER STATEMENTS MEAN DIFFERENCE NON-ADDITIVITY RESIDUAL 4 • 1 1 19 1176.6750 14.0000 228.8095 933.8655 29186.6667 14963.3320 365.7539 907.5724 235.3350 14.0000 228.8095 311.2883 7296.6667 14963.3320 365.7539 47.7670 4.93 0.29 4.79 6.52 152.76 313.26 7.66 TOTAL 30 46600.0000 ANALYSIS OF VARIANCE FOR 34 SOURCE DF SESSIONS 5 L I N E A R TREND QUADRATIC REMAINDER STATEMENTS 4 MEAN DIFFERENCE 1 NON-ADDITIVITY 1 RESIDUAL 19 TOTAL 30 S.S. 8838.1667 380.6429 1781.4881 6676.0357 29107.2000 537.6333 25.9679 3010.0321 41519.0000 V.E. 1767.6333 380.6429 1781.4881 2225.3452 7276.8000 537.6333 25.9679 158.4227 11.16 2.40 11.25 14.05 45.93 3.39 0.16 ANALYSIS OF VARIANCE FOR 35 *** WARNING *** SUM OF SQUARES IS 0 SOURCE SESSIONS STATEMENTS MEAN DIFFERENCE NON-ADDITIVITY RESIDUAL DF S.S. 8593.7500 25000.0000 7031.2500 V.E. TOTAL 20 40625.0000 ANALYSIS OF VARIANCE FOR 36 SOURCE DF S.S. V.E. SESSIONS 5 2907.5000 581.5000 11.87 LINEAR TREND 1 1897.7857 1897.7857 38.73 QUADRATIC 1 105.0000 105.0000 2.14 REMAINDER 3 904.7143 301.5713 6.15 STATEMENTS 4 45416.6667 11354.1667 231.73 MEAN DIFFERENCE 1 42187.5000 42187.5000 861.01 NON-ADDITIVITY 1 32.3752 32.3752 0.66 RESIDUAL 19 930.9581 48.9978 203 TOTAL 30 9 1 4 7 5 . 0 0 0 0 APPENDIX C PRELIMINARY TESTS ON DATA 204 205 Preliminary Tests for Homogeneity of Variance When the number of observations i n each sample are equal the F d i s t r i b u t i o n i s robust i n the face of v i o l a t i o n s of the assumptions of homogeneity of population error variances (Kirk, 1968). However, when c e l l frequencies of unequal size are employed, v i o l a t i o n s of the homogeneity assumption can have a marked e f f e c t on the t e s t of s i g n i f i -cance. Therefore, due to unequal sample si z e s i n t h i s study the data, where appropriate, were tested for homogeneity of variance. These t e s t s are described below. The treatment outcome data generated by the SI, A-State and TC on the two groups were tested with the Bartlett-Box Homogeneity of Disper-sion Test. Table C.1 presents the r e s u l t s of these t e s t s . The f a i l u r e to a t t a i n s t a t i s t i c a l s i g n i f i c a n c e (p > .05) between the two groups' population error variances on the SI and the A-State, using the Bartlett-Box Test, led to the acceptance of the assumption of homo-geneity of variance for these two measures. A s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e (p<.05) between the two groups on the TC measure, using the Bartlett-Box Test, was attained i n d i c a t i n g a s i g n i f i c a n t d i f f e r e n c e between the groups' population error variances and resulted i n the re j e c t i o n of the assumption of homogeneity of variance. The remaining treatment outcome measure, the Behavioral Report (BR), was already deemed to be appropriate for analysis by nonparametric s t a t i s t i c s due to a questionable metric underlying i t s scale so i t was tested for homo-geneity of variance by the computationally simpler Hartley's F max. The re s u l t s of the test on the BR appear i n Table C.2. When F max exceeds the tabled value the hypothesis of homogeneity of variance i s rejected. 206 Table C.1 Bartlett-Box Homogeneity of Dispersion Tests for Treatment Outcome Measures Variable F ratio probability Scale of Indecision 0.70 0.65 State Anxiety 1.57 0.15 Target Complaints 4.09 0.006 Scale of Indecision = p>.05 State Anxiety = p>.05 Target Complaints = p>.05 Table C.2 Hartley's F max Statistic for Behavioral Report Variable F max Tabled F Value Behavioral Report 5.896 2.63 p<.01 The critical session outcome data was comprised of immediate and prolonged effects measures. The immediate effects measures (i.e. CRS, TCDBS, PWS, INT, POW) were tested for before and after critical session homogeneity of variance with Hartley's F max statistic. Table C.3 is a l i s t of the results of these tests. The prolonged effects measures for mood differences over the week following the critical session (i.e. PWS, INT, POW), goal attainment (GAS) and attitude change (PCSQ) at one week and one month followups were tested for homogeneity of variance. The PWS, INT, POW and GAS were tested with the Bartlett-Box Homogeneity of Dispersion Test. Table C.4 207 Table C.3 Hartley's F max S t a t i s t i c on C r i t i c a l Session (Immediate Effects) Outcome Data Variable F max Tabled F Value C o n f l i c t Resolution Scale -pretest 7.04 2.63 -posttest Target Complaints Discomfort Box Scale -pretest 7.795 2.63 -posttest Pleased with S e l f -pretest Integrated Powerful -posttest -pretest 5.63 2.63 -posttest -pretest -posttest C o n f l i c t Resolution Scale = p<.01 Target Complaints Discomfort Box Scale = p<.01 Pleased with S e l f = p<.01 Integrated = p<.01 Powerful = p<.01 208 Table C.4 The Bartlett-Box Homogeneity of Dispersion Test for C r i t i c a l Session (Prolonged Effects) Outcomes Variable P r a t i o P r o b a b i l i t y Pleased with S e l f Integrated 1.47 0.02 Powerful Goal Attainment Scaling 2.72 0.04 Pleased with Self = p<.05 Integrated = p<.05 Powerful = p<.05 Goal Attainment Scaling = p<.05 l i s t s these r e s u l t s . The PCSQ was tested with Hartley's F max and Table C.5 presents t h i s r e s u l t . The r e s u l t s of the t e s t s for the homogeneity of variance assumption revealed that only the SI and A-State exhibited homogeneous variances and thus were e l i g i b l e for analysis by parametric s t a t i s t i c a l pro-cedures. Preliminary Tests for Variance-Covariance The data of the SI, A-State, TC and GAS were analyzed by s t a t -i s t i c a l t e s t s suggested by Box (1950) for equality of variance-covari-ance matrices permitting, i f the assumptions were met, the use of conventional parametric univariate analysis procedures i n an experiment where c l i e n t s had par t i c i p a t e d under more than one treatment l e v e l . The 209 Table C.5 Hartley's F max Statistic for Post Critical Session Questionaire Variable F max Tabled F Value Post Critical Session Questionaire 7.21 2.63 Post Critical Session Questionaire = p<.05 univariate procedures were preferred over multivariate procedures from the perspective of computational labour and ease of interpretation. In particular the tests for equality of variance-covariance matrices allowed the experimenter to determine if the matrices were equal for both groups and if they met the conditions for symmetry. Tables C.6, C.7, C.8 and C.9 present the pooled covariance matrices for each variable. The results of the tests for equality of var iance-covariance matrices revealed that the SI and A-State data exhibited variance-covar iance matrices equal for both groups and fulfilled the conditions for symmetry thus qualifying for analyses by parametric univariate statistical procedures. Table C.6 Pooled Within Groups Covariance Matrix for Scale of Indecision. Column 1 2 3 Row Row Row 1 2 3 40.440 29.558 29.984 29.558 47.086 37.604 29.984 37.604 41.571 210 Table C.7 Pooled Within Groups Covariance Column 1 Row 1 74.880 Row 2 17.568 Row 3 19.435 Matrix for A-State 2 3 17.568 19.435 90.494 76.460 76.460 88.415 Table C.8 Pooled Within Groups Covariance Matrix for Target Complaints, Column 1 2 Row 1 0.680 0.528 Row 2 0.528 0.574 Table C.9 Pooled Within Groups Covariance Matrix for Goal Attainment Scaling. Column 1 2 Row 1 44.282 28.220 Row 2 28.220 47.819 APPENDIX D A-TRAIT DATA 211 212 Preliminary Tests The A-Trait data were analyzed by the same s t a t i s t i c a l t e s t s used on the other treatment outcome data (see Chapter IV) . The r e s u l t s of the Bartlett-Box Homogeneity of Dispersion Test are displayed i n Table D.1 and the pooled within groups covariance matrix tested for homo-geneity of variance-covariance i s displayed i n Table D.2. The data met the assumptions of homogeneity of population error variances and homogeneity of variance-covariance matrices. Thus the data were e l i g i b l e for the parametric univariate s t a t i s t i c a l procedure; the two-way analysis of variance with repeated measures. Table D.1 B a r t l e t t - B o x Homogeneity o f D i s p e r s i o n Test f o r T r a i t Anxiety. Variable F r a t i o p r o b a b i l i t y T r a i t Anxiety 1.05 0.39 A- T r a i t = p<.05 Table D.2 Pooled Within Groups covariance Matrix for T r a i t Anxiety Column 1 2 3 Row 1 73.083 49.862 48.269 Row 2 49.862 76.878 66.192 Row 3 48.269 66.192 67.554 213 Results The p r o b a b i l i t i e s associated with s t a t i s t i c a l t e s t s of the d i f f e r -ences on A - T r a i t between the groups, the measurement occasions (time) and the group and measurement occasion i n t e r a c t i o n being due to chance were .210, .000 and .060 res p e c t i v e l y . These r e s u l t s are displayed i n Table D.3. It was assumed, therefore, that the A main e f f e c t s (groups) were not s t a t i s t i c a l l y s i g n i f i c a n t , the B main e f f e c t s (time) were s i g n i f i c a n t and the AB i n t e r a c t i o n (group x time) also f a i l e d to reach s i g n i f i c a n c e . As a r e s u l t of the s i g n i f i c a n t B main e f f e c t ( i n d i c a t i n g that the combined means of the groups at one occasion or some combina-t i o n of occasions were s i g n i f i c a n t l y d i f f e r e n t than the combined means at the other occasions) simple comparisons were undertaken using the Bonferroni confidence i n t e r v a l s . That i s , the i n t e r v a l s were construc-ted around the combined means at the d i f f e r e n t measurement occasions. Table D.4 i l l u s t r a t e s the r e s u l t s of the Bonferroni confidence i n t e r v a l s and Table D.5 i l l u s t r a t e s the means and standard deviations of the groups for A-Trait on each measurement occasion. The confidence i n t e r v a l s a p p l i e d as simple comparisons, y i e l d e d a s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e between the f i r s t and second measurement oc-casions and between the f i r s t and t h i r d measurement occasions but not between the second and t h i r d measurement occasions. It appeared that the combined means of the groups on the pretest for A-Trait were s i g n i f i c a n t l y d i f f e r e n t than the combined group means on the termination and followup administrations of the instrument. This finding however had no obvious meaningful i n t e r p r e t a t i o n on conceptual grounds. 214 Table D.3 Summary of Analysis of Variance for T r a i t Anxiety Source SS DF MS F P A Main E f f e c t s (Groups) 303.056 1 303.056 1.665 .207 B Main E f f e c t s (Time) 469.415 2 234.708 13.237 .000 AB Interaction 106.208 2 53.104 2.995 .058 Error 1028.438 58 17.732 Table D.4 Bonferroni Confidence Intervals for Resolvers and Nonresolvers on T r a i t Anxiety Dependent Variable Lower Limit Upper Limit (group 1 time 1 plus group 2 time 1) minus (group 1 time 2 minus group 2 time 2) 3.02 (group 1 time 1 plus group 2 time 1) minus (group 1 time 3 minus group 2 time 3) 5.03 (group 1 time 2 plus group 2 time 2) minus (group 1 time 3 minus group 2 time 3) -3.47 p=.05 13.98 s i g n i f i c a n t 15.99 s i g n i f i c a n t 7.49 N.S. Table D.5 Means (X) and Standard Deviations (SD) for Resolvers and Nonresolvers on T r a i t Anxiety Resolvers Pretest Resolvers termination Resolvers followup Nonresolvers pretest Nonresolvers termination Nonresolvers followup X 45.23 40.84 37.61 47.22 43.11 44.33 SD 8.32 8.00 6.60 8.71 9.27 9.19 215 Discussion Hypotheses were not formulated for A-Trait data as i t was thought that t r a i t anxiety being a more stable index of anxiety proneness, or pers o n a l i t y c h a r a c t e r i s t i c , would not be s i g n i f i c a n t l y effected by approximately six counselling sessions. However, the A- T r a i t data was c o l l e c t e d i n order to make sure that the two groups were not d i f f e r e n t on anxiety at the outset of the experiment. 0 

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