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Process analysis of critical versus noncritical events in therapy related to the client’s depth of experiencing McCrea, Muriel 1984

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PROCESS ANALYSIS OF CRITICAL VERSUS NONCRITICAL EVENTS IN THERAPY RELATED TO THE CLIENT'S DEPTH OF EXPERIENCING By M u r i e l McCrea B.A., The U n i v e r s i t y o f B r i t i s h Columbia, 1973 A THESIS SUBMITTED IN PARTIAL FULFHIMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n < THE FACULTY OF GRADUATE STUDIES (Department o f C o u n s e l l i n g Psychology) We accept t h i s t h e s i s as conforming ""£o f $ a requrjred standard THE UNIVERSITY OF BRITISH COLUMBIA June 1984 ^ ) M u r i e l McCrea, 1984 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 fo r 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 a v a i l a b l e for reference and study. I further agree that permission f o r extensive copying of t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the head of my department or by h i s or her representatives. I t i s understood that copying or p u b l i c a t i o n 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. Muriel McCrea Department of Counselling Psychology The University of B r i t i s h Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 Date July 4, 1984. ABSTRACT This research study involved the process analysis of change events that occurred during the therapy session which the c l i e n t perceived as 1 laving s i g n i f i c a n t impact- The events surrounding a " c r i t i c a l " moment were compared with events of a "noncritical" moment. The behavioural components of particular interest were the cli e n t ' s depth of experiencing, vocal qua-l i t y and levels of silence. Study was also directed at the c l i e n t ' s eva-luation of the therapist's helpfulness before and after a c r i t i c a l event. TVelve 3-minute " c r i t i c a l " episodes i n therapy were compared with twelve 3-minute "noncritical" episodes. The c l i e n t ' s behaviour was mea-sured under both conditions using the Experiencing Scale, Vocal Quality C l a s s i f i c a t i o n System and the Speech Interaction System. The cli e n t ' s assessment of the therapist's helpfulness before and after a c r i t i c a l mo-ment was measured on the Helpfulness Scale. Using a dependent t-test, significant differences were found i n the cl i e n t ' s depth of experiencing and speaking pauses during a " c r i t i c a l " versus a "noncritical" episode. A Chi square test on vocal quality pro-duced a s i g n i f i c a n t l y higher l e v e l of focused/errotional c l i e n t responses under the " c r i t i c a l " condition. A dependent t-test of the helpfulness ratings of therapeutic interventions indicated a significant difference i n the c l i e n t ' s perception of helpfulness before the " c r i t i c a l " focal event than a f t e r the event., The nature of the change process was discussed from the perspectives of the c l i e n t and the therapist./ These findings support the contention that the depth of client experiencing is a key component in the process of change and that internal focusing, an increase in client affect and a reduction of client dialogue accompany profound experiencing. TABLE OF CGNTEOTS ABSTRACT L I S T OF TABLES LIST OF GRAPHS ACK^o^LEDG^E^^^s Chapter I SCOPE AND FOCUS OF THE STUDY I n t r o d u c t i o n Background o f the Problem Purposes o f the Study Statement o f the Problem D e f i n i t i o n s o f Terms Research Hypotheses and R a t i o n a l e Assumptions u n d e r l y i n g t h i s Study D e l i m i t a t i o n s o f the Study J u s t i f i c a t i o n o f t h e Study I I REVIEW OF THE LISTERATURE C o n t r o v e r s i a l I s s u e s P r o c e s s Research v e r s u s Outcome Research P r o c e s s A n a l y s i s v e r s u s Content A n a l y s i s D e f i n i t i o n s o f Pro c e s s P r o c e s s V a r i a b l e s v e r s u s Input V a r i a b l e s Analogue S t u d i e s and Students as S u b j e c t s Therapy as A c t i v i t y V Therapist instrurnental a c t i v i t y 20 Therapist camiunicative a c t i v i t y 26 Therapist interpersonal behaviour 28 Client ccmTiunicative a c t i v i t y 31 Clie n t interpersonal behaviour 32 Behaviour interaction and therapeutic outcome 33 Therapy as Experience . 36 Cli e n t perceptions 36 Therapist perceptions 41 Conjoint experience and therapeutic outcome 44 Therapy as Dramatic Interpretation 46 Cli e n t messages 47 Therapist messages and therapeutic outcane 47 Symbolic interaction and therapeutic outcome 48 Therapy as /Association 49 Normative organization and therapeutic outcome 49 The therapeutic r o l e system 49 Temporal aspects of therapeutic association 50 Summary of Process Studies 5JL New Theoretical /Approaches to Process Analysis 52 C r i t i c a l Events 55 v i III METHODOLOGY 61 Population and Sampling Procedure 62 Therapists 63 Raters 64 Description of measuring Instruments 64 The Experiencing Scale 64 The Client Vocal Quality C l a s s i -f i c a t i o n System 65 The Speech Interaction System 66 Transcription 67 Audio Process Recall 68 The Helpfulness Scale 69 Change Process Questionnaire 70 Data Collection and Rating Procedures 70 Vocal Quality 70 Speech Interaction System 71 Transcription System 71 Helpfulness Scale 71 Change Process Questionnaire 71 Process Recall 72 R e l i a b i l i t y Scores of Ratings 72 S t a t i s t i c a l Analysis 73 IV RESULTS 75 Comparison of Client Performances under- Conditions #1 and #2 Experiencing Scale 75 Comparison of Client Performances under Conditions #1 and #2 Client's Vocal Quality (3omparison of Client Performances under Conditions #1 and #2 Durations of Silence Comparison of Interventions Before and After Focal Event  Client Ratings on Helpfulness Scale Comparison of Client and Therapist Perceptions of-Change  Change Process Questionnaire V DISCUSSION OF RESULTS AND CONCLUSIONS Discussion and Conclusions Experiencing Vocal Quality Durations of Silence Helpfulness Scale Process Recall Client/Therapist Perceptions of Change Process Implications for Theory and Practice ReaDmmendations for Future Research BIBLIOGRAPHY APPENDICES V l l l LIST OF TABLES Table Page 1 Comparison o f C l i e n t Performances under C o n d i t i o n s #1 and #2 - The E x p e r i e n c i n g S c a l e 76 2 Comparison o f C l i e n t Performances under C o n d i t i o n s #1 and #2 - C l i e n t ' s V o c a l Q u a l i t y C l a s s i f i c a t i o n 77 3 C h i Square A l t e r n a t i v e s based on d f o f 3 and 1 77 4 Comparison o f C l i e n t Performances under C o n d i t i o n s Ml and jf2 - D u r a t i o n s o f S i l e n c e 79 5 Comparison o f C l i e n t P e r c e p t i o n s ox t h e H e l p f u l n e s s o f T h e r a p i s t I n t e r v e n t i o n s b e f o r e and a f t e r a C r i t i c a l Event 80 6 C l i e n t and T h e r a p i s t Reponses t o q u e s t i o n , '•"What changed i n t h i s event?" 82 7 C l i e n t and T h e r a p i s t Responses t o q u e s t i o n , "What was t h e na t u r e o f the change p r o -c e s s ? " 84 8 C l i e n t and T h e r a p i s t Responses on q u e s t i o n , ,fWhat changed i n t h i s event?" 86 9 C l i e n t and T h e r a p i s t Responses t o q u e s t i o n , "What was t h e n a t u r e o f the Change P r o -c e s s ? " 87 10 Comparison o f Timing P o s i t i o n s w i t h i n t h e S e s s i o n where c r i t i c a l and n o n c r i t i c a l events o c c u r 89 i x LIST OF GRAPHS Graph Page 1 Sequential Order of Score Means 80 2 Frequencies of Client and Therapist Responses 86 3 Frequencies of Client and Therapist Responses 87 4 Time Intervals into Session - Critical Event 90 5 Time Intervals into Session. - Noncritical Event 90 X I would l i k e t o express my s i n c e r e a p p r e c i a t i o n t o Dr. John Banmen f o r h i s e x c e l l e n t guidance and a c t i v e support i n t h e f o r m u l a t i o n o f t h i s r e s e a r c h p r o j e c t and f o r h i s h i g h academic standards i n f o l l o w i n g through t o completion. I am a l s o v e r y g r a t e f u l t o Dr. Les Greenberg who was an ongoing source o f i n s p i r a t i o n i n t h i s v e n t u r e and c o n t r i b u t e d v a l u a b l e time and e x p e r t i s e i n measurement and a p p r a i s a l . I a l s o want t o thank Dr. W a l t e r B o l d t f o r h i s a d v i c e and s t r u c -t u r e r e g a r d i n g t h e s t a t i s t i c a l o p t i o n s a v a i l a b l e f o r t h i s t h e s i s . My s i n c e r e a p p r e c i a t i o n a l s o goes t o t h e c o u n s e l l o r s - i n - t x a i n i n g f o r t h e i r e s s e n t i a l h e l p and c o - o p e r a t i o n i n s p i t e o f heavy demands on t h e i r time and t o t h e c l i e n t s who were w i l l i n g and e n t h u s i a s t i c about t h e i r p a r t i c i p a t i o n i n t h i s r e s e a r c h . Scope and Focus of the Study Introduction The current li t e r a t u r e on process research indicated a revival of interest i n the analysis of c l i e n t and therapist insession beha-viours as a means of understanding the change process resulting from psychotherapy (Kiesler, 1982). Outcome studies have largely focused on treatment effectiveness with iirijiimal consideration of the nature of process. Kiesler (1982) and H i l l (1982) claimed that a synthesis of both process and outcome studies i s essential to explaining the change mechanism i n terms of the influence of therapeutic interven-tions and external events. Following the introduction of process research i n the 1940's, as an outgrowth of psychoanalytic studies ( H i l l , 1982), attention shifted to client-centered variables i n the. 1950's with a particular interest i n the effect of the therapist's l e v e l of empathy (Orlinsky & Howard, 1978). Findings were mixed and inconclusive, but the subse-quent decline i n process analysis was attributed to a "short-sighted, simplistic" perspective of change events occurring i n the therapeutic sessions and to the limited u t i l i t y of research evidence to practising c l i n i c i a n s ( E l l i o t t , 1983; Greenberg, 1983; H i l l , 1982). In effect, the claim was made that therapists are determining the focus of re-search after the fact, rather than drawing on well formulated paradigms 2 for direction. Traditionally, the meticulous and painstaking efforts demanded of process researchers who invest substantial time and energy i n a pursuit offering no predictable rewards may have inhibited i t s progress (Greenberg, 1983). Certainly, the practical limitations of current funding cutbacks have not enhanced i t s attractiveness as a f i e l d of study. In spite of these drawbacks, the importance of pro-cess i n understanding c l i e n t change remained apparent, and by the lat e 1970*s, process research regained prominence with more sophis-ticated measurement instruments to strengthen i t s resources and new measurement units under consideration. E l l i o t t (1981) predicted that these promising new avenues of i n -vestigation would re-shape process research i n the 1980's. He favoured sequential analysis of c r i t i c a l events, the mapping of significant trends and prediction based on a temporal ordering of significant moments i n therapy across and within the interview sessions. H i l l (1982) believed the lack of a contextual framework for c r i t i c a l i n c i -dents analysis might be resolved by post-session questionnaires, coun-s e l l o r and/or c l i e n t process r e c a l l testing or by a theoretical analy-s i s of the events that led to change. Gottman & Markman (1978) suggested that new directions are required of research by which c l i n i c i a n s learn from past mistakes and predict the r e l a t i v e usefulness of a therapeutic intervention on the basis of a knowledge of the change process. A major development i n the selection of research focus was a s h i f t from single variable study to an examination of patterns emerging across the c l i e n t -therapist interaction (Greenberg, 1983). The choice of the measurement unit then became c r u c i a l i n process analysis, and various approaches were tested to capture the most comprehensive picture of the change 3 elements in therapy. Background of the Problem An important issue in process research then i s the selection of me-thods by which the largest number of important process variables may be analyzed within a manageable framework that produces the most significant findings on the nature of client change. H i l l (1982) claimed that a l l re-search designs involved a "trade-off" of some kind, and the practical realities of time, economics and availability of participants must be con-sidered. H i l l f e l t that i n •the past, variables of lesser significance were chosen for study because of their suitability to mathematical calculation, producing results of irrinimal value. E l l i o t t (1983) and H i l l , Carter & O'Farrell (1983)selected the case study as a means of gaining a more indepth analysis of process which could be measured by more sophisticated instruments than were available to re-searchers of the past. E l l i o t t (1983) used an existential-phenomenological approach which Valle & King (1978) viewed as an appropriate alternative to empirical designs. H i l l et a l . (1983) traced the progress of a single client in a time-limited treatment across twelve interview sessions. E l l i o t t (1983) confined his attention to a brief episode evaluated as c r i t i c a l and demonstrated the range of process that could be examined from a short segment. The effectiveness of this method had been tested by Mintz & Luborsky (1971) who compared the ratings of four-minute seg-ments with the ratings of whole sessions and achieved equivalent results. H i l l et a l . (1983) made comparisons of sessions identified as the "best" and the "worst" and found that the client's level of experiencing was more intense in the best sessions, while problem description and external con-cerns were higher in the worst sessions. 4 The evidence suggested therefore that the study of small portions of a therapy treatment provided valuable information on the larger con-text, and the nature of the change process can be effe c t i v e l y examined by comparisons of events c l a s s i f i e d as important with other events of lesser significance. The components of change may emerge as i n f l u e n t i a l by virtue of their presence under one condition and their absence under another condition. I t also appeared to be valuable to reduce the lev e l of c l i e n t dialogue and to f a c i l i t a t e an inward focusing that intensifies the depth of c l i e n t experiencing • i n the pursuit o f c l i e n t change. E l l i o t t (1983)and H i l l et al.(1983)concluded from their studies that the success of a process analysis could be measured by findings that answered the following questions: What changed i n the event? What was the nature of the change process? and, What are the implications for the practice of psychotherapy? Purposes of the Study The purpose of t h i s study i s to examine whether change occurs i n an event that has been evaluated as c r i t i c a l by the c l i e n t and to compare the l e v e l of c l i e n t experiencing, vocal quality and speech pauses i n such events with another segment of equivalent length that has been rated as ins i g n i f i c a n t . Attention i s also directed towards the cli e n t ' s perception of c r i t i c a l events, the value of therapist interventions and the possible recognition of signals that may a l e r t the therapist to an irnminent c l i e n t s h i f t . The main objective of th i s study, however, i s to compare c r i t i c a l and n o n c r i t i c a l events on the basis of the c l i e n t ' s depth of experiencing. The second objective i s to determine whether the c l i e n t ' s voice quality and periods of silence that accompany c l i e n t experiencing are different _ 5 under such conditions. Statement of the Problem In order to meet the purposes or this study, tne f i r s t problem was to secure sessions that were perceived by the therapist and the client as exceptionally meaningful and then to have tne client identify events within tne session that were c r i t i c a l ana noncritical. The second pro-olem was to convert the events to written and audiotaped forms for mea-surement: on the appropriate rating scales. The third problem was to de-termine the client's perception of the therapist's nelpfumess before and after a c r i t i c a l event. The fourth problem was to measure tne c l i -ent's insession benaviour i n terms ot the depth of experiencing, vocal quality and durations of silence under both conditions. The f i f t h pro-blem was to compute tne results of measurements statistically to test the accuracy of the hypotheses. The last problem was to interpret the findings and their implications and to recommend future studies that might replicate or expand on these results. The means by which significant sessions were located involved a ver-bal presentation ro counsel ling teams witn an invitation to therapists to participate. When the session was identified by the therapist and confirmed by the client as important, the client rated interview seg-ments across tne session on tne Interpersonal Process Recall Scale (Ap-pendix A) at a 6 "greatly significant" or 7 "extremely significant." A - noncritical event was specified by a mid-range score of 4 "I don't know" or 3 "some meaning"on the same scale. The moment of dialogue chosen by the client was called a focal event and served as the central point a-round which a 3-minute episode was transcribed. This episode was shifted to some degree to use a therapist intervention as a starting point and 6 to provide a logical sequence. Transcription was cased on the standards set qy Sacks, Schegloff & Jefferson (1978)(Appendix B). The nature of the client's oehaviour i s operationally defined in terms of the level of experiencing, the quality of voice and tne dura-tions of silence that occurred in the client's speaking turns. The c l i -ent evaluated the therapist's level of helpfulness on the basis of four interventions delivered before the focal event and two interventions after the event on the Helpfulness Scale (Appendix C). Standard process rating systems used to evaluate client insession behaviour included the Experiencing Scale (Klein, Mathieu, Gendlin & Kiesier, 1970), the Client Vocal Quality Classification System (Rice, Koke, Greenberg & Wagstaff, 1979) and the Speech Interaction System (Matarazzo, Wiens, Matarazzo & Saslow, 1968) from which precise measure-ments of both conditions were achieved. Definitions of Terms Operational definitions of terms used in this study are as follows: "Process" i s defined as "behaviour in the counselling sessions fo-cused on the counsellor, client and the inreraction between both" (Hill, 1982). This includes "both observable behaviour and internal perceptions and experiences" (Greenberg, 1983). A " c r i t i c a l moment" i s conceptualized as "an event in the process of tnerapy i n which the therapist confronted or interpreted some key set of feelings or behaviours to which the client i s receptive and which re-sults in the client having f e l t some significant emotional impact, ha-ving achieved a sense of mutual closeness with the therapist, having had some major cognitive reorganization, having achieved some important 7 i n s i g h t i n a way t h a t i s u s e f u l , and h a v i n g s h i f t e d some o f h i s / h e r d i s -t o r t e d p e r c e p t i o n s o f the t h e r a p i s t more toward r e a l i t y " (Rand, 1978). A " c r i t i c a l s e s s i o n " r e f e r s t o a ther a p y s e s s i o n i d e n t i f i e d by the t h e r a p i s t and confirmed by the c l i e n t as p a r t i c u l a r l y e f f e c t i v e . A " c r i t i c a l event" i s the h i g h e s t s c a l e range on the I n t e r p e r -s o n a l R e c a l l s c a l e g i v e n t o a segment and when required,' t h e c l i e n t ' s c h o i c e o f t h e most meaningful segment r a t e d a t a 7 when more, than one 7 s c o r e o c c u r s . A " n o n c r i t i c a l event" i s the midrange 4 " I don't know" o r a 3 "no meaning" s h o u l d t h e 4 r a t i n g n ot be used. I n t n e event t h a t more than one 3 o r 4 s c o r e o c c u r s , t h e r a t i n g f u r t h e s t i n t o t h e s e s s i o n i s used t o a v o i d t h e warm-up e f f e c t o f the s e s s i o n ' s opening. A " f o c a l event" i s t h e key c l i e n t statement s e l e c t e d by t h e c l i e n t f o r a c r i t i c a l and n o n c r i t i c a l d e s i g n a t i o n and i s t h e c e n t r a l p o i n t from where t h e 3-minute episode i s t r a n s c r i b e d , A " c r i t i c a l episode" r e f e r s t o t h e 3-minute segment e x t r a c t e d from t h e e n t i r e s e s s i o n w i t h the f o c a l - e v e n t c e n t e r e d w i t h s h i f t s t o a l l o w t h e t h e r a p i s t t o be f i r s t speaker and l o g i c a l sequence. H i g h c l i e n t r a t i n g . A " n o n c r i t i c a l episode" r e f e r s t o t h e 3-minute segment e x t r a c t e d from t h e e n t i r e s e s s i o n w i t h t h e f o c a l event c e n t e r e d w i t h s h i f t s t o a l l o w t h e t h e r a p i s t t o be f i r s t speaker and l o g i c a l sequence. Low c l i e n t r a t i n g . "Depth o f e x p e r i e n c i n g " r e f e r s t o t h e q u a l i t y o f t h e c l i e n t ' s p a r t i c i p a t i o n i n therapy as i t r e l a t e s t o "the e x t e n t t o which i n n e r r e f e r e n t s become the f e l t d a t a o f a t t e n t i o n , and t h e degree t o which e f f o r t s a r e made t o focus on, expand and probe t h a t d a t a " ( K l e i n , Mathieu-Coughlan & K i e s l e r , i n p r e s s ) . "Vocal quality" i n this study represents a measure of the cli e n t ' s involvement and processing l e v e l (Pace et a l , , 1979) by a c l a s s i f i c a t i o n system that assesses productive and nonproductive processing styles (Rice & Gaylin, 1973), I t i s measured by four vocal categories: focused, emotional, external and limited, each containing six features: perceived energy, primary stress, regularity of stresses, pace, timbre and contours. "Durations of silence" refers to the pauses occurring between the therapist's and the c l i e n t ' s speaking turns and to pauses within the speaker's dialogue. Research Hypotheses and Rationale The following research hypotheses were tested i n t h i s study: 1. There w i l l be a s i g n i f i c a n t l y higher depth of c l i e n t experiencing i n a c r i t i c a l episode than i n a non c r i t i c a l episode. 2. There w i l l be a s i g n i f i c a n t l y higher incidence of focused plus eiio-t i o n a l voice quality i n the focal event of a c r i t i c a l episode than i n the focal event of a n o n c r i t i c a l episode. 3. There w i l l be s i g n i f i c a n t l y longer durations of silence i n a c r i t i c a l episode than i n a n o n c r i t i c a l episode. 4. There w i l l be a s i g n i f i c a n t l y higher value placed on the therapist's l e v e l of helpfulness before a focal event of a c r i t i c a l episode than after the event. 9 For general interest but apart from the s t a t i s t i c a l claims of t h i s study, the following questions were asked of the cl i e n t s and therapists: What change occurred i n this event? What was the nature of the change pro-cess? Assumptions underlying t h i s Study A major assumption of t h i s study was that c r i t i c a l events occur with a reasonable degree of frequency. E l l i o t t (1983) contended that such moments were rare, but Rand (1978) id e n t i f i e d c r i t i c a l sessions i n eight of the ten dyads he studied based on c r i t e r i a established by 46 practising psychotherapists with a mean experience l e v e l of 14.4 years. Mthough research has f a i l e d to document the superiority of one treatment orientation over another (Orlinsky & Howard, 1978), the assump-ti o n was made that the c l i e n t 1 s depth of experiencing has a p p l i c a b i l i t y across therapeutic models (Rice & Greeriberg, i n press). The t h i r d and l a s t assumption was that the perception of the c l i e n t was a valuable resource i n the researcher's quest for urderstanding of ireaningful process. The focus of t h i s study on the c l i e n t ' s appraisal of significant events was not intended to diniinish the therapist's value but was designed to test the effects of tapping the resources of the c l i e n t to learn more about the mechanism of change. ^ Delimitations of the Study Twenty-four 3-minute segments of therapy sessions involving 12 sub-jects were transcribed and taped for analysis. I t was recognized that longer sequences within and across sessions involving larger populations would have enhanced the significance of results. The subjects were rest r i c t e d to individuals attending a cost-free counselling training center on an individual basis to resolve a personal problem issue. Their q u a l i f i c a t i o n depended on the therapist's i d e n t i f y -ing a c r i t i c a l session and confirming this evaluation with the c l i e n t who was then required to rate a segment of the session at a 6 or 7 l e v e l on the Process Recall scale. This process created an imbalance of sexes (two male and ten female) and an age group with a mean of 26.58. The therapists consisted of counsellors-in-txaining who responded to a verbal request f o r participation following a presentation of the research requirements. Their involvement also required a taped i n t e r -view session that they regarded as exceptionally meaningful. An imbalance also occurred with the therapists' sexes (one male and seven female), the number of c l i e n t s involved (four had two c l i e n t s and four had one client) and variations i n experience i n counselling. Three therapists were i n the doctoral program and f i v e were i n the master's program. It should also be noted that d i f f e r e n t treatment techniques were used across the twenty-four episodes. Another limitation was the necessary selection of c r i t i c a l and noncritical events from the same therapy session which had been cate-gorized as a highly meaningful interview by the therapist and the c l i e n t . Ideally, the no n c r i t i c a l events should be selected from a separate session ide n t i f i e d as less s i g n i f i c a n t and comparisons of episodes might be based on an equivalent position within the session. A pre- and post-measurement of the c l i e n t ' s level of progress would have enriched this design and contributed supportive evidence of the effects of perceived change on successful outcome. This study, however, was limited to the c l i e n t and therapist reports of the na-ture of change from th e i r perspectives. In the past, the therapist's ratings on the Interpersonal Process Recall and Helpfulness scales were combined with the c l i e n t ' s ratings ( H i l l et al.,1983; Elliott,1983) but the therapist's evaluations were omitted from t h i s investigation so as not to detract from the values of the c l i e n t who has gained recognition as a r e l a t i v e l y untapped source of knowledge on the change mechanism. Possibly, there was a tendency to give added weight to the therapist's perceptions of change, p a r t i c u l a r l y when they conflicted with the c l i e n t ' s opinions. J u s t i f i c a t i o n of the Study The process analysis of c r i t i c a l events has attracted considerable interest from process researchers who viewed t h i s approach as an im-portant means of measuring process and mderstanding how change occurs (Kiesler, 1982; H i l l , 1982; E l l i o t t , 1981). Such evaluations gave added c r e d i b i l i t y to i t s selection as a research topic by virtue of the experience of the investigators who recommended i t . The comparison of aspects of therapy perceived as important by the c l i e n t with other features regarded as nonproductive offered the potential discovery of meaningful patterns that were not only significant by t h e i r presence but conspicuous by t h e i r absence. Studies thus f a r have i d e n t i f i e d process variables which influence positive change during s i g n i f i c a n t moments, but t h e i r prevalence under less s i g n i f i c a n t moments has not been c l e a r l y determined. A reduced occurrence of such variables under reverse conditions would greatly substantiate tneir importance i n the change process. The use of the c l i e n t as a source of informa-tion enabled the researcher to evaluate his contribution and also uncovered discrepancies between the participants' perceptions of the therapy session. Attention to the c l i e n t ' s depth of experiencing under the c r i -t i c a l and no n c r i t i c a l conditions supported H i l l et al.'s (1983)findings i n comparing the best and the worst sessions of therapy that heavy dialogue by the c l i e n t i n h i b i t s internal focusing and experiencing and the amount of problem description can predict outcome. In t h i s study, i t was found that deeper le v e l s of experiencing occurred i n the c r i t i c a l events than i n the n o n c r i t i c a l events and that more focused/emotional vocal q u a l i t y and longer incidence of silence acccmpanied t h i s experiencing. The j u s t i f i c a t i o n of t h i s study was therefore based on the per-ceived need for an analysis o f process to increase an understanding of i t s relationship to change and on the assumption that comparisons of opposite conditions provided the opportunity to assess s i g n i f i c a n t variables by t h e i r presence or absence i n a c l i n i c a l interaction. The following review of process l i t e r a t u r e demonstrates the com-plexity of t h i s subject and the e f f o r t s that have been applied to the study of therapist and c l i e n t and the characteristics each bring to the therapeutic session. CHAPTER II Review of the Literature The intent of t h i s l i t e r a t u r e search was to gain an overall appreciation f o r the nature of process research i n terms of i t s h i s t o r i c a l past, current focus and future directions. This objec-tiv e was achieved by a thorough investigation of the major psycho-l o g i c a l and psychiatric journals, doctoral dissertations and the comprehensive reviews of Qrlinsky & Howard (1978) and Greenberg (1983). Qrlinsky & Howard (1978) brought order to a scattered body of liter a t u r e by c l a s s i f y i n g studies into four main categories, i . e . Therapy as A c t i v i t y , Therapy as Experience, Therapy as Dramatic In-terpretation and Therapy as Association. These divisions were adopted for t h i s survey, and t h e i r definitions and respective topics are ex-plained l a t e r i n t h i s chapter. Attention was mainly focused on the perceptions and conrnunicatians of the c l i e n t and the therapist and thei r insession exchanges. Some extension occurred to give f u l l coverage to the Ctlinsky & Howard format. Following t h i s evidence, the new theoretical approaches to process analysis were presented. The sur-vey concluded with the research on c r i t i c a l events and basic p r i n -ciples of c l i e n t experiencing on which t h i s study was concerned. F i r s t , however, t h i s review described some of the areas of controversy e x i s t -ing i n t h i s r e l a t i v e l y new f i e l d . H i l l (1982) claimed that process research had cane " f u l l c i r c l e " which Kiesler (1973) also noted when he called f o r a convergence of va-rious methods of analysis - regarded as marginally different - to serve the common objectives of a l l researchers interested i n formulating a cohe-sive body of process literature from which both process investigators and practising c l i n i c i a n s might draw. Greenberg (1983) confirmed that e f f o r t s along these l i n e s were sup-ported by more sophisticated methodology, the use of observers and t h i r d -party raters, video and audiotape devices and ongoing refinements to exis-ting measurement instruments. E l l i o t t (1983) developed a new model for process analysis which combined qualitative and quantitative interpreta-tion, and Rice & Greenberg (in press) offered a new paradigm for under-standing the mechanism of c l i e n t change by c l a s s i f i c a t i o n of patterns that occur across therapy sessions and c l i e n t s . Therefore, the renewal of i n t e -rest i n the issue of process was accompanied by fresh approaches to inves-tigation but carried along with them some areas of confusion. Controversial Issues A review of process analysis studies was complicated by an apparent confusion between process research and outcome research; these terms are often used interchangeably (Kiesler, 1973). Distinctions also existed be-tween process analysis and content analysis (Fine, 1979) , p a r t i c u l a r l y since process was largely examined on the basis of verbal content ( H i l l , 1982). However, nonverbal behaviour was also considered to be v i t a l to understand ing the meaning of cues passing between the c l i e n t and the the-r a p i s t (OrLinsky & Howard, 1978; Ki e s l e r , 1982). H i l l (1982) contended that verbal response modes have been somewhat overworked, but verbal be-haviour "was. essential to understanding nonverbal messages. Other areas of confusion i n process studies involved the variations of definitions used to describe the word "process", outcome studies without recogni-t i o n of process variables as factors i n the prediction of outcome, the differences between process variables and input variables, and an existing controversy regarding the r e l i a b i l i t y of analogue studies as a legitimate measure of the real c l i n i c a l setting ( E l l i o t t , 1979;^ Fretz, Corn, Tuemmler & Bellet, 1979; Helms, 1976, 1978) and the use of college students as representative of therapy patients. Resolution of these questions have been attempted by some resear-chers, but c l a r i f i c a t i o n varied from one issue to another. Process Research versus Outcome Research Process research has t r a d i t i o n a l l y referred to changes that mani-fest themselves i n the counselling interview as a r e s u l t of the insession behaviour of the participants ( H i l l , 1982; Kiesler, 1982). Outcome re-search concentrated on the differences between pre-test and post-test measurement from which conclusions were :drawn about sp e c i f i c variables Qrlinsky & Howard (1978) claimed that too much emphasis was placed on successful outcome and f e l t a great deal of knowledge on process could be learned from i n s i g n i f i c a n t results. Cohen (1979) found that practising c l i n i c i a n s were more c r i t i c a l i n their judgments of s c i e n t i f i c merit and c l i n i c a l relevance of studies that produced negative findings, instead of viewing the results as one statement concerning treatment effectiveness. Qrlinsky & Howard (1978) implied that an absorption with c l i e n t improvement placed process i n the shadows,, while attention focused on the therapist's characteristics and treatment orientation. 16 Process Analysis versus Content Analysis Kiesler (1973) described content analysis as an outgrowth of pro-cess analysis and i n his endeavour to systematize the literature as a common base for future research, the significance of the differences between content and process analyses was minimized. Fine (1979) de-fined content as the verbalized problem and process as the manner and sequence i n which the content was presented. Gendlin (1979) defined content as the "what" of counselling and process as the "how". He f e l t that i t was important to distinguish between the two because process i s less subject to conscious control. Satir (1967) described the d i f -ferences between content and process i n the same terms as Gendlin (1979) and perceived content as one measure of process or a marker that d i f f e -rentiates some aspects of process. Other definitions appeared to be i n -fluenced by the researcher *s particular area of interest. Definitions of Process Gendlin (1968, 1969) claimed, "I c a l l process 'experiential focusing' ....Even i f what was being talked about i s very s p e c i f i c , the f e e l of i t w i l l be multiple. I t i s a f e e l of 'that whole thing' or 'whatever i s s t i l l wrong'." H i l l (1982) ca l l e d process "an analysis of behaviour i n counselling session focused on counsellor,client and interaction between both." Greenberg extended t h i s definition to include the non-observable facets of behaviour that were necessarily arrived at by self-report. Patron (1982) described process as "an inferred relation between or among c l i e n t and counselor observations... In empirical terms, a process i s a statement of relations between and among observation (e.g. a learning curve, correlational coefficient, F ratio or a prepositional state-ment." Patton fel t that the term "process" was often a label applied vaguely to change or to cover inexplicable events. Chaplin (1975) viewed process as "any change to any object or organism, particularly a behavioural or physiological change; the manner in which a change in an organism or a response i s brought about; a sensa-tion or other conscious content without reference to i t s context or meaning; a projection or outgrowth from an organ or-cell." Eisenberg & Delaney (1977) believed that process contained the essence of counselling and described i t as "an identifiable sequence of events taking place over time. Usually there i s the implication of progressive stages to the process. States are common to a l l human beings but what happens i s uniquely different for each individual." While Kiesler (1973) acknowledged the ambiguities and confusion associated with process, he defined i t emphatically for his own purposes as "any research investigation that, totally or in part, contains as i t s data some direct or indirect measurement of patient, therapist or dyadic behaviour in.the therapy interview. Process studies then are those asses-sing therapy interview behaviours in some fashion. If there i s no measure-ment of interview behaviours, the study i s not of process." Satir (1967) distinguished between form and process by stating that "Process implies movement. It i s dynamic, not static...Process focuses not on the activity per se, but on the carrying on of the acti-vity. " I n v i e w o f the d i f f e r e n t shades o f meanings connected w i t h p r o -c e s s as a term, i t was not too s u r p r i s i n g t o f i n d t h a t c o n f u s i o n e x i s t e d between p r o c e s s and i n p u t v a r i a b l e s which H i l l ( 1 9 8 2 ) attempted t o d i s t i n g u i s h f o r easy r e f e r e n c e . P rocess V a r i a b l e s versus Input V a r i a b l e s H i l l ( 1 9 8 2 ) s t a t e d t h a t t h e c l i e n t i n p u t v a r i a b l e s c o n t a i n t h e problem i s s u e s , t h e c l i e n t ' s p e r s o n a l i t y and i n t e l l e c t u a l c a p a b i l i t i e s , modes o f e x p r e s s i o n , a t t i t u d e s and s u i t a b i l i t y t o s p e c i f i c treatment modes. The t h e r a p i s t i n p u t v a r i a b l e s a r e demographic d a t a , h i s t o r i c a l and p r o f e s s i o n a l s t a n d i n g w i t h r e s p e c t t o t r a i n i n g , e x perience and s o c i a l s t a t u s , as w e l l as p e r s o n a l e x p e c t a t i o n s and treatment o r i e n -t a t i o n s . S i t u a t i o n a l i n p u t v a r i a b l e s r e l a t e d t o t h e environment and p r a c t i c a l i s s u e s o f treatment d u r a t i o n s and payment o f f e e s . P r e - and post-measurements o f t h e c l i e n t ' s c o n d i t i o n a r e a l s o examples o f i n p u t v a r i a b l e s . P r o c e s s v a r i a b l e s a r e p e r c e i v e d as the dynamics o f the c l i e n t / t h e r a p i s t a s s o c i a t i o n when a l l i n p u t i n g r e d i e n t s a r e brought t o the t h e r a p e u t i c exchange. Lambert & B e r g i n ( 1 9 8 3 ) i d e n t i f i e d t h e t h e r a p i s t p r o c e s s v a r i a b l e s as p e r s o n a l s t y l e , t h e r a p e u t i c i n t e r v e n t i o n s o r opera-t i o n s and t h e r e l a t i o n s h i p elements o f b o t h p a r t i c i p a n t s . K i e s l e r ( 1 9 7 3 ) r e f e r r e d t o s m a l l p i e c e s o f pr o c e s s which were qua-l i f i e d as t h e c h a r a c t e r i s t i c s o f t h e t h e r a p i s t ' s c o nceptions and the c l i e n t ' s p r e f e r e n c e s which formed "systems o f i n d i r e c t p r o c e s s ana-l y s i s ". O r l i n s k y & Howard ( 1 9 7 8 ) c l a i m e d t h a t s i g n i f i c a n t p r o c e s s o c c u r -r e d a t an unconscious l e v e l t h a t was b a r e l y p e r c e p t i b l e t o the p a r t i c i p a n t s i n t h e t h e r a p e u t i c i n t e r a c t i o n and u n a v a i l a b l e t o independent o b s e r -v e r s . These u n d e r l y i n g i n f l u e n c e s which a r e l a r g e l y a mystery may p a r t i a l l y e x p l a i n the r e l u c t a n c e o f some r e s e a r c h e r s t o accept ana-logue s t u d i e s as r e p r e s e n t a t i v e o f the c l i n i c a l s e t t i n g . A r e l a t e d concern vyas the use o f students as i n d i c a t i v e o f the c l i e n t s eeking t h e r a p e u t i c treatment. Analogue S t u d i e s and Students as S u b j e c t s Analogue s t u d i e s might be d e s c r i b e d as one o f the " t r a d e - o f f s " r e f e r r e d t o by H i l l (1982) i n her d i s c u s s i o n o f exp e r i m e n t a l a l t e r -n a t i v e s . Q r l i n s k y & Howard (1978) found t h e r e s e a r c h evidence on analogue s t u d i e s v e r s u s c l i n i c a l i n v e s t i g a t i o n t o be c o n t r a d i c t o r y and e x c l u d e d analogue d e s i g n s from t h e i r l i t e r a t u r e review. Some f i n d i n g s i n d i c a t e d a s t r o n g s i m i l a r i t y i n t h e r a p i s t s ' behaviours under b o t h c o n d i t i o n s (Helms, 1978), b u t concerns were more s t r o n g l y c e n t e r e d on the r e a c t i o n s o f c l i e n t s who a r e t h e " s e n s i t i v e " members o f t h e c l i n i c a l i n t e r a c t i o n . S t u d i e s t h a t o f f e r e d more promise o f b r i d g i n g t h e gap between t h e c l i n i c a l c l i e n t and t h e st u d e n t were those t h a t measured t he s u b j e c t ' s l e v e l o f a n x i e t y o r o t h e r n e g a t i v e emotions "(Kolko & M i l a n , 1983; C l a i b o r n , 1983) t h a t can be equated a c r o s s b o t h p o p u l a t i o n s . The c o n t r o v e r s y i s s u e s r a i s e d i n t h i s s u r v e y excluded t h e ongoing s u r v e i l l a n c e o f s t u d i e s i n terms o f the soundness o f e m p i r i c a l d e s i g n s and t h e s c i e n t i f i c r e l e v a n c e o f c o n c l u s i o n s . New approaches t h a t ap-peared t o o f f e r t h e p o t e n t i a l -for f u t u r e c o n t r o v e r s y a r e the t r e n d s towards e x i s t e n t i a l - p h e n o m e n o l o g i c a l i n v e s t i g a t i o n which V a l l e & K i n g (1978) viewed as a v i a b l e a l t e r n a t i v e t o e m p i r i c a l methods. The f o l l o w i n g s t u d i e s , however, were m a i n l y conducted on the b a s i s o f a ccepted s c i e n t i f i c p r a c t i c e s : Therapy as A c t i v i t y Therapy as A c t i v i t y i n c o r p o r a t e d s t u d i e s o f p r o c e s s from the p e r s p e c t i v e s o f n o n - p a r t i c i p a t i n g o b s e r v e r s who i n t e r p r e t e d meanings o f t h e t h e r a p i s t / c l i e n t i n t e r a c t i o n by o b s e r v a t i o n o f i n s e s s i o n be-h a v i o u r s ( O r l i n s k y & Howard, 1978). The major f i n d i n g s suggested t h a t t h e q u a l i t i e s brought t o the r e l a t i o n s h i p by t h e t h e r a p i s t and by the c l i e n t c o n t r i b u t e d more t o s u c c e s s f u l outcome t h a n t h e s e l e c t i o n o f treatment s t r a t e g i e s (Lambert, D e J u l i o & S t e i n , 1978; Molner, 1983; Todd, 1981; Crohn, 1977; S c h a f f e r , 1977; S t e a r n s , 1980), and the c l i e n t 1 l e v e l o f involvement was a b e t t e r p r e d i c t o r o f outcome than t h e t h e r a -p i s t ' s c h a r a c t e r i s t i c s . O r l i n s k y & Howard (1978) c l a s s i f i e d t h e t h e r a p i s t ' s behaviours as t a s k - o r i e n t e d o r i n t e r p e r s o n a l . The t a s k - o r i e n t e d a c t i v i t y i n c l u d e d i n s t r u m e n t a l and communicative s t r a t e g i e s d e signed t o f a c i l i t a t e t he c l i e n t ' s p r o g r e s s . I n t e r p e r s o n a l b e h a v i o u r r e f l e c t e d the t h e r a p i s t ' s p e r s o n a l s t y l e o f r e l a t i n g t o people and i n c l u d e d p h y s i c a l appearance, l i k e a b i l i t y and o v e r a l l p r e s e n t a t i o n . T h e r a p i s t i n s t r u m e n t a l a c t i v i t y I n a s i n g l e case study, E l l i o t t (1983) an a l y z e d t r a n s c r i b e d d i a -logue from segments o f a therapy s e s s i o n t o determine the f a c t o r s t h a t l e d t o a c r i t i c a l moment i n therapy. A s i g n i f i c a n t i n t e r v e n t i o n was s e l e c t e d on t h e b a s i s o f the c l i e n t ' s profound r e a c t i o n t o the i n c i d e n t on r e p l a y and the h i g h r a t i n g i t r e c e i v e d a c r o s s a s u b s t a n t i a l number o f o b s e r v e r s . E l l i o t t d e s c r i b e d such f o c a l events as r a r e . He f e l t such moments sh o u l d be s e i z e d upon w i t h immediacy, although the power o f t h e t h e r a p i s t statement was n o t a n t i c i p a t e d . Based on the i n t e g r a -t i o n o f an e a r l i e r i n s i g h t by t h e c l i e n t , t he t h e r a p i s t t r a n s l a t e d t h e c l i e n t ' s e x p r e s s i o n o f thoughts and f e e l i n g s on a p a r t i c u l a r i s s u e t o a major problem ar e a . E l l i o t t s t r e s s e d the v a l u e o f f o r m u l a t i n g v i v i d metaphors and w e l l - t i m e d a n a l o g i e s i n an e f f o r t t o b r i n g new u n derstanding t o t h e c l i e n t . Amira (1982) a l s o endorsed the d e l i b e r a t e usage o f metaphoric and f i g u r a t i v e language i n t h e r a p e u t i c i n t e r v e n -t i o n s , a l t h o u g h h i s r e s u l t s produced no s i g n i f i c a n t d i f f e r e n c e s by the use o f such tec h n i q u e s , Amira concluded t h a t h i s use o f frequency counts and r a t e s o f p r o d u c t i o n were inadequate measurements f o r d e t e r m i n i n g t h e q u a l i t y and impact o f c r e a t i v e ccrarnjnications. The n a t u r e o f the i n v e r v e n t i o n s d e s c r i b e d by E l l i o t t (1983) sug-ge s t e d a r e f r a m i n g element t h a t impacted w i t h profound meaning i n a new c o n t e x t (Bandler & G r i n d e r , 1982) .In an a n a l y s i s o f the d i a l o g u e imme-d i a t e l y p r e ceding'the c r i t i c a l moment, E l l i o t t (1983) found t h a t the c l i e n t had i g n o r e d t h r e e t h e r a p i s t statements and had d i s a g r e e d w i t h another. T h i s f i n d i n g negated t h e l i k e l i h o o d o f a p r e d i c t a b l e sequence and suggested t h a t the t h e r a p i s t ' s i n f l u e n c e was i n d i r e c t . A p p a r e n t l y , i n a c c u r a t e i n v e r v e n t i o n s a l s o c o n t r i b u t e d sorrething u s e f u l t o t h e prooass. One h y p o t h e s i s i m p l i e d t h a t i n a c c u r a c y c r e a t e d a need f o r t h e c l i e n t t o r e c t i f y an e r r o r by a more i n d e p t h s e l f e x p l o -r a t i o n . C l a i b o r n , Crawford & Hackman (1983) compared the e f f e c t s o f discrepant interventions with active listening and congruent inter-pretation. The discrepant statement proved to be the most consistent-l y effective response, although the c l i e n t s f a i l e d to gain a greater understanding of their problem by having to str a i n for higher accu-racy. The degree of new insight achieved with discrepant interven-tions was equivalent to the therapist's active listening condition. Greenberg (1983) referred to a single-session study conducted by Strong, Wambach, Lopez & Cooper (1979) where the motivation of the cl i e n t was enhanced by interpretation, p a r t i c u l a r l y when the inter-vention spotlighted causes that were subject to the c l i e n t ' s control. Claiborn (1983), H i l l (1978) and Spooner & Stone (1977) viewed interpretation as valuable when i t contained information that extended beyond the c l i e n t ' s expressed content. Gendlin (1968) claimed that t h i s broader perspective hovered below the c l i e n t ' s immediate l e v e l of awareness and encouraged a deeper experiencing. Rather than being a concrete verbal proposition, Claiborn (1982) described interpreta-tion as a method that can take the form of anecdotes, metaphors and re-statement, as well as manifesting i t s e l f i n a well-timed question or movement of the c l i e n t towards his/her own interpretation. Overlaps on ratings of interpretation, confrontation and re-statement were perceived as common occurrences attributable to d i f f e r i n g perspectives ( H i l l & Gormally, 1977). Interpretation, however, was not always re-garded as ben e f i c i a l . Claiborn (1983) pointed to occasions when interpretation could be i n h i b i t i n g . I f the therapist's tone was accusatory, the c l i e n t was intirnidated, but i f the interpretation was proposed tentatively, the c l i e n t was receptive. When the interpretation provided the c l i e n t with a new perception of the problem issue, i t appeared to be more useful than an accurate statement. Spooner & Stone (1977) shared Claiborn's (1982) view of interpretation as having negative poten-t i a l when i t was presented without s e n s i t i v i t y . They found that the cl i e n t read the interpretation as a . h o s t i l e form-of confrontation when i t pointed to a discrepancy i n the c l i e n t ' s content. H i l l & Gor-mally (1977) preferred the more d i r e c t technique of probing which produced more favourable results than restatement or r e f l e c t i o n be-cause i t appeared to encourage the expression of feelings. The i d e n t i f i c a t i o n of therapist responses was not found to be clearcut. E l l i o t t (1983) defined the c r i t i c a l intervention i n his study as reflective-interpretive, but acknowledged the p o s s i b i l i t y that Goodman (1979) might regard the statement as a deep r e f l e c t i o n and Shapiro, Barkham & Irving (1980) might qualify i t as an explora-tion. Kivlingham (1982) stressed the value of matched content be-tween the c l i e n t and the therapist and timing of interventions that were appropriate to intimacy and anger. He found that when the thera-pist ' s interventions were s t r a t e g i c a l l y timed, intimacy could be hand-led with a higher l e v e l o f comfort. The c l i e n t was less l i k e l y to res-pond inappropriately, appeared to be more f l e x i b l e and self-ratings were more congruent with outside observations. In an attempt to reduce resistance i n c l i e n t s , Kolko & Milan (1983) combined paradoxical interventions with retraining when t r a d i -t i o n a l behavioural rrethods f a i l e d . Results indicated a significant improvement i n c l i e n t performances which sustained over time. The administration of paradoxical directives was believed to lend i t s e l f to refraining techniques which Haley (1976) contended must change the meaning of an issue i n a way that i s compatible to the c l i e n t ' s frame of reference. Refraining statements were also found to require o r i g i n a l i t y but should not be so extreme as to throw question on the c r e d i b i l i t y of the therapist (Brehm, 1976). Procedures f o r nunimizing c l i e n t resistance and for promoting compliance a t early stages of treatment were also designed by Brehm (1976), Goldfried & Davison (1976) and Jan & Lichstein (1980). U t i l i -zation of paradoxical techniques had h i s t o r i c a l l y been limited to un-controlled case studies (Jessee & L'Abate, 1980; Lamontagne, 1978) and although Orlinsky & Howard (1978) questioned the v a l i d i t y of such studies, Gombatz (1983) found that paradoxical directives were as e f -fective as Client-Centered or Rational Emotive therapies i n dealing with problem resolution. Ascher & Turner (1980) concluded that the underlying rationale of the therapist s i g n i f i c a n t l y affected the ad-ministration of a paradoxical strategy. The therapist's l e v e l of empathy underwent substantial investiga-t i o n as a therapeutic t o o l . Orlinsky & Howard (1978) cited 23 studies on t h i s c haracteristic and claimed that empathy could be perceived as an interpersonal quality or as an instrumental a c t i v i t y projected to b u i l d rapport. Feldstein & Gladstein (1980) viewed i t as subjective or 25 objective. In spite of i t s popularity as a research topic, Lambert & Berg i n (1983) c r i t i c i z e d the singlenundedness of researchers who exa-mined empathy i n isolation from other important variables. Lambert et a l , (1978) limited i t s value to p a r t i c u l a r l y sensitive moments when the c l i e n t required strong emotional support or acceptance following a major disclosure. The r e l i a b i l i t y of ratings on empathy has also been open to conjecture ( H i l l & King, 1976; Fridman & Stone, 1978 and Feldstein & Gladstein, 1980), The perceived deficiencies of ratings were attributed to the poor material quality of recording instruments, the questionable proficiency of raters and the discre-pancies that appeared to e x i s t between empathy definitions and actual measures, Kohut (1978) c a l l e d empathy a "vicarious introspection" which description carried connotations of an internal condition not easi l y observed or agreed upon. In a study of schizophrenics and neurotics, Franco (1978) found that higher observer ratings of the therapist's empathy, warmth and genuineness could be secured by the use of "emotion" words and s e l f -referents. High levels of f a c i l i t a t i v e conditions were negatively r e -lated to i n t e l l e c t u a l responses. E l l i o t t (1983) found that responses of high impact were rated moderately on t h e i r empathic value. Glad-stein (1983) reviewed the l i t e r a t u r e on empathy by analysis of social and developmental psychology studies. He distinguished two approaches on the d e f i n i t i o n and measurement of empathy which differed again from counselling/psyctotherapy. The common denominators i n these three o r i e n t a t i o n s r e l a t e d t o an agreement t h a t " a f f e c t i v e empathy" meant t h e a b i l i t y t o f e e l what another p e r s o n f e e l s and " c o g n i t i v e empathy" was t h e c a p a c i t y t o p u t one's s e l f i n t o another person's p o s i t i o n . G l a d s t e i n d i f f e r e n t i a t e d empathy i n c h i l d r e n from empathy experienced by a d o l e s c e n t s o r a d u l t s and c o n c u r r e d w i t h o t h e r f i n d i n g s t h a t empathy was no guarantee o f e f f e c t i v e h e l p i n g . B e r g i n & Suinn (1975) r e s t r i c t e d t h e v a l u e o f empathy t o c l i e n t - c e n t e r e d t h e r a p y under s p e c i f i c c o n d i -t i o n s . The evidence suggested t h a t i t s impact as an e f f e c t i v e i n s t r u -mental t o o l has y e t t o be v e r i f i e d (Lambert e t a l , , 1978; P a r l o f f , Waskow & Wolfe, 1978; G l a d s t e i n , 1977). T h e r a p i s t communicative a c t i v i t y Greenberg (1983) mentioned t h e need f o r nonverbal measurement i n -struments and t h e c o m p l e x i t y o f drawing c o n c l u s i o n s from c u r r e n t s t u d i e s which a r e " o f t e n u n i n t e r p r e t a b l e and even c o n t r a d i c t o r y " (Graves & Robin-son, 1976; Stragan & Zytowski, 1976; Smith-Hanen, 1977: Tepper & Haase, 1978; Young, 1980). H i l l , Siegelman, Gronsky, S t u r n i o l o , Frank & F r e t z (1981) conducted a study t h a t i n d i c a t e d t h a t v e r b a l and nonverbal con-gruence was s i g n i f i c a n t l y r e l a t e d t o outcome. M i n d i e s (1977) t e s t e d n o n v e r b a l behaviour t o determine whether t h e c o o r d i n a t i o n o f body move-ment produced a h i g h e r p e r c e p t i o n o f t h e r a p i s t empathy. The r e s u l t s i n d i c a t e d no s i g n i f i c a n t r e l a t i o n s h i p , b u t i t was e v i d e n t t h a t more movement was a s s o c i a t e d w i t h h i g h e r t h e r a p i s t r a t i n g s and c o - o r d i n a t e d head nods and hand g e s t u r e s c o r r e l a t e d w i t h t h e s e s c o r e s . The t h e r a p i s t ' s l e v e l o f e x p e r i e n c i n g i n t h e r a p y appeared t o have a m o t i v a t i n g i n f l u e n c e on the c l i e n t ( E l l i o t t , 1983). T h i s i n t e r n a l state of the therapist was conveyed to the c l i e n t by vocal quality, words that reflected a deep involvement with the cl i e n t ' s feelings and s i g n i f i c a n t spans of silence. H i l l et a l . (1983)found that a higher l e v e l of c l i e n t experiencing occurred after periods of silence and less experiencing resulted from the therapist's closed questions. Feldman (1978) correlated silence and speech latency with submissive-ness i n the presence of female therapists. This trend was associated with a "ladies f i r s t " courtesy i n her particular study. H i l l claimed that the c l i e n t engaged i n more problem description when the therapist focused on fart-finding. When interpretation, confron-tation, ego-stxe^g1±iening and refraining techniques were applied, the c l i e n t moved to experiencing, self-exploration and insight. The "Gloria" training f i l m has been widely used to study the dyna-mics and impact of language (Meara, Pepinsky, Shannon & Murray, 1981), early moments i n therapy (Nicholas, 1978) and the u t i l i t y of verbal response categories across d i f f e r e n t treatment orientations ( H i l l , Thames & Rardin, 1979). Meara et a l . (1981) compared verb usage with three therapists interacting i n a dyad with the same c l i e n t and t h e i r performances with other c l i e n t s . S i m i l a r i t i e s of verb forms emerged between Rogers (Client-Centered) and Perls (Gestalt). The differences between Rogers and E l l i s (Rational Emotive) were more i n l i n e with expectations of a Client-Centered therapy versus the highly directive Rational Emotive approach. The frequency of c l i e n t dialogue was much higher with Rogers than with E l l i s , demonstrating that active listening encouraged more c l i e n t participation than the direct argument of cognitive treatment. H i l l et ali!983), however, found that passive lis t e n i n g of a c l i e n t with a proneness f o r excessive story-telling did nothing to i n h i b i t t h i s tendency. More directive measures were required to lead the c l i e n t away from problem description. Meara, Pepinsky, Shannon & Murray (1979) noted the consistency with which the c l i e n t retained a personal language style i n a single interview with three proninent therapists. Bieber, Patron & Fuhriman (1977) claimed the independence of c l i e n t conversational styles.at i n -take was a temporary tendency that dissipated by the eleventh session, when the c l i e n t ' s mode of speaking converged with the carmunication style of the therapist. Meara e t a l . (1979) also i d e n t i f i e d a tracking and convergence with the therapist's s t y l e and emphasized the instruc-tional potential of language choices i n the guidance of c l i e n t s . H i l l e t a l . (1983) counted number of words spoken by tnerapist and c l i e n t i n her case study and c l a s s i f i e d the therapist's dialogue at 40% as an indicator of high a c t i v i t y and therapeutic involvement. Pope (1979) produced findings that indicated the positive reinforcing effects of an active therapist. Therapist Interpersonal Behaviour Hackney (1978) traced the changes i n definitions of empathy over a 20-year span and i d e n t i f i e d a current s h i f t of interest i n empathy as a carrrnunications s k i l l . He concluded, however, that emphasis was better placed on i t s emotional components i n the study of process. Barrett-Lennard (1981) expressed a similar opinion and described empathy i n terms of unconscious emotional l i n k s which strived on a conscious l e v e l to b u i l d a natural rapport between the therapist and the c l i e n t . Schaffer (1977) tasted therapists on their drive levels and found that a significant correlation existed between perceived drive and accurate errpathy. Expressive and deliberate therapists were also believed to be more empathic than inhibited or impulsive therapists. The high-drive group and those exhibiting more benign attitudes responded with less s p e c i f i c i t y , and the more modulated the expression of drive, the higher the.therapists were rated on nonposses-sive warmth. Bordin (1979) viewed empathy as an essential component of the "working alliance" which developed early i n the client/thera-p i s t association. Ross (1983) f a i l e d to make a l i n k between empathy levels and a c l i e n t ' s decision to terminate treatment, but dropout occurred more frequently when the therapist was authoritarian than when he/she was democratic. Hoffman & Spencer (1977) studied a characteristic described as "empathic distress" that developed when therapists formed too strong an emotional attachment with their c l i e n t s . They found t h i s condi-t i o n occurred and created a barrier to e f f e c t i v e treatment. Their recornrnendations involved the testing of the therapist's physiological reactions to s p e c i f i c c l i e n t s by measuring skin responses during the-rapy. Schaffer (1977) also supported the measurement of therapists' personality t r a i t s by a battery of tests i n order to predict t h e i r behaviour with c l i e n t s . Apparently, sexual intimacy between therapists and t h e i r c l i e n t s was not'unheard of. Friedeman (1983) studied the post—treatment a t t i -tudes of c l i e n t s who had engaged i n sexual intercourse with their t h e r a p i s t s and found t h e m a j o r i t y o f c l i e n t s regarded the experience as d e t r i m e n t a l t o treatment. There were s i g n i f i c a n t l y g r e a t e r i n c i -dence o f resentment and g u i l t i n t h i s group and t h r e e - f o u r t h s o f t h e s u b j e c t s r a t e d outcome as "no change" o r "change f o r the worse". There a l s o appeared t o be a l e s s e r a b i l i t y t o work p a s t the - therapy s t a g e . A s m a l l number o f p a r t i c i p a n t s a t t r i b u t e d improvement t o t h i s i n t i m a c y , i n d i c a t i n g t h a t s e x u a l involvement d i d not i n h i b i t t h e p r o -g r e s s o f a l l c l i e n t s . S t r i e k e r (1977) viewed a s e x u a l r e l a t i o n s h i p between a male' t h e r a p i s t and a female c l i e n t as a s e r i o u s abuse o f h i s p o s i t i o n . Delehanty (1979) took s t r o n g e x c e p t i o n t o t h i s view which was c l a s s i f i e d as a s e x i s t statement. She r e f e r r e d t o e q u i v a l e n t impediments t o s u c c e s s f u l treatment s h o u l d t h e i n t i m a c y i n v o l v e a f e -male t h e r a p i s t and a male c l i e n t . P e t e r s o n & B r a d l e y (1980) q u e s t i o n e d whether t h e p e r s o n a l v a l u e systems o f t h e r a p i s t s r e l a t e d t o t h e i r t reatment o r i e n t a t i o n s . T h e i r r e s u l t s uncovered" s i g n i f i c a n t d i f f e r e n c e s i n b e l i e f s and a t t i t u d e s o f p r a c t i t i o n e r s o f Behaviourism, G e s t a l t and R a t i o n a l - E m o t i v e t h e r a -p i e s . I n t h i s study, the G e s t a l t t h e r a p i s t s were t h e o n l y group who demonstrated a s t r o n g endorsement f o r t h e v a l u e s o f warmth, congruence, genuineness and u n c o n d i t i o n a l p o s i t i v e r e g a r d i n c r e a t i n g a s a f e en-vironment f o r t h e c l i e n t . Brunink & Schroeder (1979), however, found G e s t a l t t h e r a p i s t s t o be more d i r e c t i v e and l e s s f a c i l i t a t i v e , w h i l e t h e B e h a v i o u r a l and A n a l y t i c t h e r a p i s t s had s t r o n g s i m i l a r i t i e s . P e t e r -son & B r a d l e y (1980) echoed t h e senti m e n t s o f Meara e t a l . (1979) t h a t v a l u e s and a t t i t u d e s expressed v e r b a l l y by t h e r a p i s t s may d i f f e r s i g n i f i c a n t l y from t h e behaviour observed i n the therapy s e s s i o n . This behaviour appeared bo be more strongly effected by the charac-t e r i s t i c s of the c l i e n t than was previously thought, and the c l i e n t has emerged as a strong participant i n the therapeutic exchange. Qrlinsky & Howard (1978) viewed the c l i e n t ' s role as task-oriented but encountered the largest body of literature i n the areas of ccrnmunicative a c t i v i t y and interpersonal behaviour. Client carrnunicative a c t i v i t y Probably a camunications device that i s familiar to most c l i n i -c a l practitioners i s the " f l a t a ffect" adopted by clients to reduce internal and external stimulation (Fosha, 1983). A study was conduc-ted on psychotics to compare the improvement l e v e l of cl i e n t s who had dropped t h i s exaggerated monotone speaking style with cl i e n t s who re-tained i t . Fosha concluded that t h i s tendency was a means of control-l i n g emotionally charged material and should be respected as an effec-t i v e defense that allowed more information to be processed and s e l f -arousal to occur. Her findings denied-that a " f l a t affect" was sympto-matic of a higher le v e l of pathology. Clients scored equally on improve-ment under both speaking conditions. In a sense, the " f l a t affect" bears some resemblance to the "externalizing" manner of speaking that E l l i o t t (1983) noted i n h i s c l i e n t who used this device to keep sensi-t i v e material at arm's length u n t i l she was prepared to deal with i t . I t was described as a reporting s t y l e of self-interpretation which gave the c l i e n t control of the communications and staved o f f intense experien-cing u n t i l a state of readiness was reached. E l l i o t t concluded that the c l i e n t monitored progress by a sequential, contemplative style which proceeded on a course and ignored or challenged interventions that tended to interfere with the pattern set. H i l l e t a l . (1983) measured l e v e l o f c l i e n t p a r t i c i p a t i o n by the number o f s e l f - r e f e r e n t statements t h a t were v e r b a l i z e d . Carlson (1980) claimed t h a t the d e s i r a b i l i t y and p r o d u c t i v i t y o f s e l f -l e a r n i n g increased w i t h the q u a n t i t y and e x p l i c i t n e s s o f the s e l f -r e f e r e n t data. C l a i b o r n e t a l . (1983) b e l i e v e d t h a t the v e r b a l p a r t i -c i p a t i o n o f the c l i e n t c o n t r i b u t e d t o a s e l f - d i s c i p l i n e over nega-t i v e emotions which Gendlin (1979) p r e f e r r e d t o hear expressed. St a p l e s , Sloane, Whipple, C r i s t o l & Yorkston (1976) found the highest r a t e o f improvement amongst c l i e n t s who spoke f o r long durations du-r i n g treatment. In a study o f the v e r b a l and nonverbal behaviour o f v i o l e n t and nonviolent adolescents, H a s s e l l (1983) noted t h a t the v i o l e n t groups spoke f r e q u e n t l y i n s h o r t segments and engaged i n a l o t o f hand and arm movements. The n o n v i o l e n t group spoke l e s s o f t e n but f o r longer periods, were more open and r e l a x e d i n d i s c u s s i o n s , smiled more f r e q u e n t l y and leaned forward during communication exchanges. McDaniel (1981) l i n k e d v e r b a l response modes w i t h l e v e l s o f disturbance and found t h a t more s e l f - d i s c l o s u r e s and l e s s "demonstrations o f e d i -f i c a t i o n s " occurred i n the d i s t u r b e d group, but a b e t t e r q u a l i t y o f p a r t i c i p a t i o n accompanied improvement which was unrelated t o the pe r -centage o f s e l f - d i s c l o s u r e s . C l i e n t i n t e r p e r s o n a l behaviour Holden & Quan (1983) found t h a t improvement i n short-term therapy r e l a t e d t o the c l i e n t ' s a b i l i t y t o s t r u g g l e through negative transference and the working through depended on the presence o f " a c t i v e anger" r a t h e r than a "passive anger". "Passive anger" suggested the more wi t h -drawn and r e l u c t a n t c l i e n t whose prognosis i s poorer than the motivated c l i e n t (Gomes-Schwartz, 1978). S t a p l e s e t a l . (1976) viewed the c l i e n t ' s personal characteristics as more instrumental i n producing positive change than the therapist's interventions. Gomes-Schwartz (1978) r e -lated successful outcome to the c l i e n t ' s l e v e l of involvement which Kolb (1982) confirmed was the best indicator of success. The degree to which the c l i e n t was liked by the therapist appeared to serve as a motivator (O'Malley, Chong, Suh & Strupp, 1983). This relationship was confirmed by the Vanderbilt Process Scale measurement which found no correlation i n the f i r s t session, a weak indication i n the second and a clear connection by the t h i r d interview. This finding supported Bordin's (1979) concept of the "working alliance" as an early deve-lopment' i n therapy. Behaviour interaction and therapeutic outcome Orlinsky's & Howard's (1978) coverage of studies related to the therapist and c l i e n t behaviour interaction focused on group dynamics and the quality of performances resulting from a f a c i l i t a t i v e but per-missive environment. Positive results were attributed to the indepen-dence encouraged by therapists i n group and dyad situations. High therapist expectations and the complementarity of c l i e n t and therapist characteristics were related to successful outcome. Research also i n -volved the influence of the participants' genders on the therapeutic interaction and outcome and attention was given to the early termina-tions of c l i e n t s from treatment. In a study of patient-to-patient interactions i n a group treatment program, Ellsworth, Casey, Hickey, Twemlow, Co l l i n s , Schoonover, Hyer & Nesselroade (1979)produced s i g n i f i c a n t evidence that a higher le v e l of improvement could be achieved by mixing acute ward patients with chronic p a t i e n t s , r a t h e r than a s s i g n i n g them on the b a s i s o f s i m i l a r patho-l o g y . The i n t r o d u c t i o n o f a "buddy" system i n a six^week program f o r c h r o n i c s c h i z o p h r e n i c s a l s o produced some dramatic e f f e c t s (Ot-t e s o n , 1979). P a r t i c i p a n t s worked h a r d e r t o f a c i l i t a t e the d i s c h a r g e o f one o f t h e i r c o u n t e r p a r t s t h a n would be expected i n n e g o t i a t i n g t h e i r own r e l e a s e . P a t i e n t s w i t h up t o 14 y e a r s c o n s i s t e n t h o s p i -t a l i z a t i o n were e l i g i b l e f o r d i s c h a r g e on the b a s i s o f t h i s p a r t n e r -s h i p support. I t was concluded t h a t t h e e f f e c t i v e n e s s o f c a r i n g f o r another i n d i v i d u a l exceeded t h e d i r e c t t h r e a t imposed by a c t i n g on one's own b e h a l f i n t h i s s e t t i n g . T h i s f i n d i n g a l s o supported the s t r e n g t h o f t h e c o l l a b o r a t i v e bond t h a t e x i s t s between t h e r a p i s t and c l i e n t and i n t e n s i f i e d i t s meaning as an e q u a l p a r t n e r s h i p . Crohn (1977) produced d i v e r g e n t r e s u l t s i n two s t u d i e s aimed a t examining t h e i n t e r a c t i o n between c l i e n t and t h e r a p i s t . I n one study, t h e i n t e r a c t i o n was symmetrical and i n t h e o t h e r , a s t r o n g p o l a r i z a t i o n o c c u r r e d based on the p a t t e r n s e t by t h e t h e r a p i s t . A c o n t r o l l i n g type o f behaviour i n the t h e r a p i s t produced a d o c i l e response from the c l i e n t w h i c h m o d i f i e d p r o p o r t i o n a t e l y when t h e d i r e c t i v e approach was reduced. S c h a f f e r (1977) f e l t t h i s tendency c r e a t e d an o p p o r t u n i t y t o i n c r e a s e t h e c l i e n t ' s i n i t i a t i v e by a d o p t i n g a l e s s a c t i v e r o l e as t h e r a p i s t . P e t r o & Hansen (1977) confirmed s u b s t a n t i a l evidence t h a t b o t h male and female t h e r a p i s t s a r e e q u a l l y as s e n s i t i v e t o t h e needs o f the c l i e n t . However, p r e v i o u s c l a i m s that.male and f e m a l e . t h e r a p i s t s show more em-pathy t o male c l i e n t s than female c l i e n t s were a l s o supported i n t h i s s t udy. P a s t e r (1982) c o u l d f i n d no i n d i c a t i o n s t h a t t h e r a p i s t s h e l d a b i a s f o r c l i e n t s on gender o r sex r o l e . S t e a rns (1980) a l s o found t h a t s e x u a l s t e r e o t y p i n g was not an i s s u e i n therapy, and t h e p a r a -mount f a c t o r s were t h e c l i e n t ' s p r e s e n t i n g problem, p e r s o n a l h i s t o r y , o c c u p a t i o n a l s a t i s f a c t i o n and r e a c t i o n s t o s t r e s s . Helms (1978)con-c l u d e d t h a t v o c a t i o n a l c o n f u s i o n was r a t e d as more s e r i o u s t h a n p e r -s o n a l problems when c l i e n t s were under 25 y e a r s o l d . Female t h e r a p i s t s were a l s o i n c l i n e d t o p e r c e i v e female c l i e n t s as h a v i n g more problems than male t h e r a p i s t s d i d . T h i s d i s c r e p a n c y was t e n t a t i v e l y a t t r i b u t e d t o the h i g h e r l e v e l o f encouragement t h a t c l i e n t s r e c e i v e d from female t h e r a p i s t s t o v e r b a l i z e c e r t a i n problems. Feldman (1978) found t h a t t h e r a p i s t s o f b o t h sexes tended t o t a l k more t o female c l i e n t s t h an t o male c l i e n t s and t h a t male t h e r a p i s t s engaged i n a h i g h e r volume o f " s m a l l t a l k " i n t h e i r i n t e r v i e w s . C l i e n t s o f b o t h sexes tended t o be more dependent w i t h male t h e r a p i s t s and more co m p l i a n t w i t h female t h e r a p i s t s , a l t h o u g h n o t t o a l e v e l o f s i g n i f i c a n c e . The r a t i n g s o f c l i e n t s and t h e r a p i s t s by o b s e r v e r s were s i g n i f i -c a n t l y c o r r e l a t e d t o t h e t h e r a p i s t ' s f e e l i n g s about t h e c l i e n t s (Sharf & Bishop, 1979). LaCrosse(1977) had c l i e n t s , t h e r a p i s t s and o b s e r v e r s r a t e t h e t h e r a p i s t ' s b e h a v i o u r on e x p e r t n e s s , a t t r a c t i v e n e s s , t r u s t w o r t h i -ness, empathic understanding, congruence and u n c o n d i t i o n a l p o s i t i v e r e -gard. The r e s u l t s i n d i c a t e d t h a t c l i e n t s r a t e d t h e r a p i s t s h i g h e r than o b s e r v e r s and t h e r a p i s t s . Observers' r a t i n g s o f t h e r a p i s t s were lower than t h e r a p i s t s ' s e l f - r a t i n g s , and a h i g h e r c o r r e l a t i o n e x i s t e d between c l i e n t s and o b s e r v e r s t h a n between c l i e n t s and t h e r a p i s t s . Schwartz (1983) found h i g h e r agreement between o b s e r v e r r a t i n g s o f t h e t h e r a -p e u t i c a l l i a n c e ' than between t h e r a t i n g s o f c l i e n t s and t h e r a p i s t s . The p e r c e p t i o n s o f these p a r t i c i p a n t s a r e covered i n the f o l l o w i n g c l a s s i f i c a t i o n s . Therapy as Experience Therapy as Experience was d e f i n e d by Q r l i n s k y & Howard (1978) as pr o c e s s viewed i n t e r n a l l y by t h e c l i e n t and t h e r a p i s t engaged i n an i n t e r a c t i o n t h a t can be measured o r r e p o r t e d on i n an e m p i r i c a l l y sound way. The c l i e n t ' s involvement i n t h e r a p y was d e s c r i b e d as a reenactment o f e x p e r i e n c e s w i t h t h e e x t e r n a l w o r l d . I n t h i s s o c i a l w o r l d , the i n d i -v i d u a l ' s a t t e n t i o n s h i f t s from t h e s e l f t o o t h e r s . I n treatment, t h e c l i e n t f ocuses on t h e t h e r a p i s t f o r u n d e r s t a n d i n g o f the environment and h i s / h e r r e l a t i o n s n i p t o i t . • ^ C l i e n t p e r c e p t i o n s Process r e s e a r c h s t u d i e s suggested t h a t c l i e n t s e l f - p e r c e p t i o n s were i n f l u e n c e d by the t h e r a p i s t ' s p e r c e p t i o n o f him/her. The g r e a t e r a t h e r a p i s t ' s optimism and degree o f r e s p e c t , t h e h i g h e r the c l i e n t ' s l e v e l o f c o n f i d e n c e (Tovian, .1977), and t h i s tendency grew when the t h e r a p i s t encouraged independence (Cooley & L a j o y , 1980). P r a t t (1978) designed a b e h a v i o u r a l model t h a t a l l o w e d t h e r a p i s t s t o t e s t t h e e f f e c t s o f noncongruent p a t t e r n s on t h e c l i e n t ' s p e r c e p t i o n s . He found t h a t t h e s i g n i f i c a n c e o f no n v e r b a l cues a c c e l e r a t e d when combined w i t h c o n f l i c t i n g v e r b a l messages. The e x t e n t t o which the c l i e n t was aware o f d e l i b e r a t e incongruence has n o t been examined, but i t i s apparent t h a t t h e c l i e n t i s f i n e l y attuned t o t h e degree t o which the t h e r a p i s t i s ex-p e r i e n c i n g l e g i t i m a t e l y ( E l l i o t t , 1983). Peterson & Bradley (1980) found that the therapist's l e v e l of ex-perience did not affect c l i e n t responses, and Pratt (1978) found no significant influence on the c l i e n t ' s perception of the therapist's congruence as a r e s u l t of the le v e l of experience, but s i g n i f i c a n t differences occurred i n evaluating congruence when the l e v e l of ex-perience was disregarded. Dye (1983) studied the effects of the therapist's touch on the client's perception of the therapist*s expertness, attractiveness and advice-giving s k i l l s . No si g n i f i c a n t differences emerged as a result of touching the c l i e n t nor did th i s physical contact increase the l i k e -lihood of continued attendance. Belcore (1983), however, found a posi-ti v e l i n k between the patient's attitude toward a physician and medical care i n general as a re s u l t of being touched during treatment v i s i t s . Stockwell & Dye (1980) discovered a higher l e v e l of self^reported s a t i s -faction amongst c l i e n t s who were not touched, although no main effect emerged as s i g n i f i c a n t i n the touched and untouched groups. In a study on the c l i e n t ' s perception of the therapist based an the influence of talking levels, Kleinke & Tull y (1979) found that low leve l talkers were evaluated more favourably on the l i k i n g scale, and high level talkers were rated as high on domineering. The quieter thera-p i s t was also viewed as more experienced. Contrary to other research, spans of silence were reacted to negatively by the c l i e n t s i n t h i s study even though they were b r i e f . Possible causes for t h i s discomfort were not determined. Barxett-Lennard (1981) found that the c l i e n t ' s perception of the therapist's l e v e l of empathy was .related t o successful perception or. the therapist's l e v e l of empathy was related to successful outcome. LaCrosse(1977) and Beard (1983) claimed that the c l i e n t perceived the therapist as attractive when the levels of empathy and positive regard are high. Beard (1983) also confirmed that a high rating on trustworthiness and expertness was a by-product of perceived warmth and empathy. Kubinski (1983) found that the value the c l i e n t placed on the therapist's quality depended on the nature of the pre-senting problem. Attractiveness was important when the issue was a personal problem, but expertness took precedence i n a vocational gui-dance situation. Barak & LaCrosse (1975) suggested that expertness and trustworthiness might be two components i n the c l i e n t ' s perception of c r e d i b i l i t y . Of these three q u a l i t i e s , expertness was most predic-t i v e of outcome (LaCrosse, 1980). Meara et a l . (1981) confirmed the c l i e n t ' s recognition and appreciation of an empathic therapist" but contended that the discomfort of confrontation was highly valued by the c l i e n t intent on improvement. An analysis of a single c l i e n t who was treated by three therapists i n -dependently indicated that empathy produced more c l i e n t dialogue and experiencing of deep feelings, but the c l i e n t perceived the therapist who challenged her as offering the potential f o r greater learning. Bieber, Patton & Fuhriman (1977) and Meara e t a l . (1981) suggested that the i n t e n s i t y of the c l i e n t ' s e f f o r t s could be measured by the strength of the therapist's demands. However, Meara et a l . warned against an overloading of the c l i e n t , i f the therapist neglects to pace himself/ herself according to the c l i e n t ' s capacity to keep up with the process. Meara et a l . (1979) discovered a strong willingness on the part of the c l i e n t to meet therapeutic expectations and a sense of responsibility f o r a substantial share of e f f o r t when the therapist i s perceived as involved ( E l l i o t t , 1983). On the negative side, the c l i e n t ' s needs can be transferred to the therapeutic relationship i n terms of un r e a l i s t i c demands ( H i l l et a l . , 1983). H i l l found that the c l i e n t ' s loneliness created a longing to perceive the association as a personal friendship. The client's even-tual termination i n advance of her willingness to discontinue heigh-tened a sense of rejection and feelings of h o s t i l i t y which may have contributed to a return to the baseline established before treatment. The c l i e n t ' s agreement to a short-term contractual arrangement did not lessen the impact of termination which H i l l contended must be deter-mined by the nature of presenting problems. Hawes (1983) investigated c l i e n t and therapist s i m i l a r i t i e s as a measure of c l i e n t satisfaction and found that both participants eva-luated the relationship negatively when t h e i r personal characteristics were extremely different. A relationship existed between the extent of these differences and early termination. Hawes also found that the personality t r a i t s of therapists and c l i e n t s d i f f e r substantially from members of the general population. In a study of cli e n t s who terminate therapy after one session, King (1983) found t h e i r perceptions of treatment was positive. Clients rated the experience as useful and expressed an intention to return when another problem arose. Clients attributed t h e i r success from one interview to the i r a b i l i t y to present their concerns well and the therapist's personality and the quality of the c l i n i c a l environment were not factors i n the i r decisions to discontinue. Gruder (1983) related successful outcome to therapeutic condi-tions where both the client and the therapist were in agreement as to the client's capability of developing and maintaining an intense involvement in a trusting, collaborative relationship. A sense of cormdtrnent to an active process, a recognition of the value of i n -sight, receptivity to the open expression of feelings, an ability to confront problems and act upon new solutions and confidence in the therapist's s k i l l s were a l l prerequisites to improvement. Striano (1982) surveyed clients who had interacted with more than one therapist. He found that warmth, friendliness and self-disclosures were not perceived by clients as sufficient to carry the therapeutic relationship, i f other sk i l l s were lacking. Many clients had found their therapists to be too active and authoritarian and perceived treat-ment as a negative and unrewarding experience* Schaffer (1977) suggested that a more self-effacing character style on the part of the therapist allowed the client to develop a more prominent role in the therapeutic interaction. Discrepancies apparently occurred in the client's perceptions of events and the therapist's perceptions of the same events. Stiles (1980) related treatment effectiveness to the client's degree of comfort and found that both the therapist and client were i n agreement on the benefits occurring in the f i r s t half of the therapy session. At the end of the second half, however, the therapist f e l t positive about events that carried deep and rough client experiences, while the client fe l t shaken and vulnerable. The client viewed these experiences negatively and f e l t nore positively about sessions that ran smoothly and easily. S t i l e s concluded that pleasant feelings i n session do not necessa-r i l y demonstrate good therapy. The c l i e n t s and therapists agreed i n p r i n c i p l e that the powerful sessions may be more valuable, even when they are accompanied by uncomfortable moments. Orlinsky & Howard (1978) reported that the largest body of process research on the therapist's experiencing deals with his/her views of the client, few studies related to the therapist's self-perceptions and a sl i g h t number focused on the therapist's view of the therapeutic relationship. The following outlined some of the results of these investigations: Therapist's Perceptions Sharf & Bishop (1979) believed that the therapist's feelings about a c l i e n t are established at the intake interview, and a positive a t t i -tude i s based on the c l i e n t ' s degree of .motivation and the extent to which his/her goals seem r e a l i s t i c , Vaccaro (1981) related successful outcome to the therapist's high expectations of a c l i e n t ' s p o t e n t i a l f o r improvement. The c l i e n t ' s physical appearance also played a s i g n i f i c a n t part i n the therapist's evaluations (Sharf & Bishop, 1979), while the c l i e n t ' s l e v e l of anxiety and problem severity d i d not. A high rating on physical attractiveness tended to increase the l i k e l i h o o d of favourable ratings on other characteristics. When the c l i e n t expressed confidence i n his/her own a b i l i t y to resolve inner c o n f l i c t s , the therapist's positive feelings towards him/her increased and a higher correlation occurred when the c l i e n t s were members o f the o p p o s i t e sex. Shullman & Betz (1979) d i s -covered a tendency f o r the t h e r a p i s t c o n d u c t i n g i n t a k e i n t e r v i e w s t o r e f e r c l i e n t s t o t h e r a p i s t s o f t h e same sex. I t was not known whe-t h e r t h i s p r a c t i c e r e f l e c t e d t h e c l i e n t ' s expressed p r e f e r e n c e o r . whether t he t h e r a p i s t favoured an i n t e r a c t i o n based on matched genders. Rouse (1983) found t h a t t h e t h e r a p i s t ' s p r e d i c t i o n s o f p r o g r e s s were s i g n i f i c a n t l y h i g h e r w i t h w e l l - e d u c a t e d c l i e n t s , b u t no s i g n i f i -c a n t d i s c x i m i n a t i o n s o c c u r r e d between w h i t e c o l l a r workers o v e r b l u e c o l l a r workers. The age o f the" c l i e n t a p p a r e n t l y had an i n f l u e n c e on the t h e r a p i s t ' s p e r c e p t i o n o f c l i e n t p r o g n o s i s , I n g a l l s (1983) compared t h e c l i n i c a l p s y c h o l o g i s t ' s e v a l u a t i o n s w i t h t h e g e r i a t r i c s s p e c i a l i s t and found t h e p s y c h o l o g i s t was more p e s s i m i s t i c i n h i s p r e d i c t i o n s about e l d e r l y c l i e n t s . I t was not apparent t h a t t h i s tendency a f f e c t e d t h e c l i n i c a l e v a l u a t i o n p r o c e s s . Taboada (1983) a n t i c i p a t e d a n e g a t i v e b i a s towards e l d e r l y c l i e n t s . a n d found t h a t t h e ' r e v e r s e o c c u r r e d . S i x t y - f i v e y e a r - o l d s were r a t e d s i g n i f i c a n t l y h i g h e r t han t h i r t y - y e a r - o l d s on s o c i a l d e s i r a b i l i t y i n t h i s study, and were p e r c e i v e d as more p o w e r f u l , more a c t i v e and m e n t a l l y h e a l t h i e r . I t was concluded t h a t a dramatic r e v e r s e d i s c r i m i n a t i o n o c c u r r e d wherein t h e t h e r a p i s t was accused o f i g n o r i n g p a t h o l o g y i n t h e e l d e r l y c l i e n t because o f a l a c k o f i n t e r e s t i n adrrunis-t e r i n g treatment t o t h i s p o p u l a t i o n . Ponzo (1981) confirmed t h e p r e v a -l e n c e o f age p r e j u d i c e s as t h e y r e l a t e d t o r e s t r i c t i o n s p l a c e d on t h e e l d e r l y c l i e n t . Ponzo contended t h a t t h e r a p i s t ' s p e r c e p t i o n s were d i s -t o r t e d on t h i s i s s u e and developed a l i s t o f c o g n i t i v e , a f f e c t i v e and b e h a v i o u r a l o b j e c t i v e s designed t o reduce t h i s tendency. Gaffin (1981) found a positive correlation between the s e l f -rated complementarity of therapists and c l i e n t s and successful out-come, but the s i m i l a r i t i e s were not apparent at selected phases of treatment. Frank (1982) found significant differences between the c l i e n t ' s expressed needs and the therapist's perceptions of the c l i e n t ' s needs. Therapists tended to believe the c l i e n t wanted more supportive r e a l i t y -oriented treatment than he/she did, and expected less a preference f o r expressive insight-oriented therapy than was wanted. There was no apparent recognition of the point of treatment when the c l i e n t wanted l e s s help and more independence. These findings suggested that the therapist may be lagging behind the c l i e n t ' s actual state of readi-ness to move forward. From a study of the therapist's ratings regarding a l i k i n g for the c l i e n t , Peiser (1982) was able to predict the number of sessions the c l i e n t would attend or miss, and measurement of the c l i e n t ' s im-provement s i g n i f i c a n t l y correlated to the therapist's degree of l i k i n g , the therapist's perception of t h e i r s i m i l a r i t y . Tfe:highest success rates were correlated to dyads where both participants were female. Schuh (1981) investigated the q u a l i t i e s of the c l i e n t s that influenced the therapist's choice of an appropriate treatment model. He found a high l e v e l of discrimination i n the selection of c l i e n t s for group therapy on the basis of t h e i r diagnosed condition. Reactive paranoid schizophrenics and phobic c l i e n t s were ra r e l y recommended for group interaction. Single people were referred more often than married people, p a r t i c u l a r l y when the married c l i e n t s f e l l into hysterical or obsessive/compulsive categories. The alcoholics' need for group sup-port, however, was generally accepted across the range of therapists under study. Schuh also found that therapists tended to favour their own specialization when referring c l i e n t s , i . e . a family therapist tended to refer c l i e n t s for family therapy and a group s p e c i a l i s t rarely reccrnmended individual treatment when group options were avai-lable. In the group situation, i t might be natural to sel e c t people who are most l i k e l y to interact favourably i n a j o i n t e f f o r t and one might expect therapists to favour t h e i r own mode of treatment. Conjoint experience and therapeutic outcome In h i s analysis of a c r i t i c a l moment .in therapy, E l l i o t t (1985) re-ported on the discrepancies between the therapist's perception of c l i e n t change and the c l i e n t ' s perception of the same event. When the c l i e n t reacted t o a strategic intervention, the therapist viewed i t as an i n -tegration of an e a r l i e r insight, and the c l i e n t described the "moment" as a sudden recognition of progress to a new plateau i n her therapeutic struggle which Sarbin & Mancuso (1980) called a "positive transvalua-tio n of personal iden t i t y " . E l l i o t t (1983) experienced no apparent d i f -f i c u l t y i n incorporating both c l i e n t and therapist perceptions into an explanation of the change process. The important issue was the collabo-rative e f f o r t that successfully produced a major s h i f t f o r the c l i e n t . Church (1982) also i d e n t i f i e d a collaborative exchange i n c l i e n t and therapist statements i n a sequential analysis of nonent-by-moment responses. Church believed that good process could be recognized across sessions by examining the impact of each participant's response to to the previous response. Successful therapists appeared to react more spontaneously to their c l i e n t s , while successful c l i e n t s made more comments of an exploratory or pondering nature. The intensity with which they worked their way through d i f f i c u l t i e s and the wider variety of response types were also apparent. S t i l e s (1980) found discrepancies between the perceptions of the therapist and of the c l i e n t as to what constituted an effective therapy session. The participants were i n agreement on the f i r s t half of the treatment interview. At the end of the second half, the therapist f e l t positive about the interaction when the c l i e n t had undergone some deep and rough experiences. The c l i e n t f e l t shaken and vulnerable and viewed the experience negatively, preferring the sessions that ran smoothly and easily. S t i l e s concluded that pleasant feelings i n session are not ne-cessarily indicators of good therapy, and the c l i e n t s tended to agree that progress related to uncomforable noments. Rouse (1983) and S t i l e s (1979) found a positive correlation between the therapist's ratings of patient's progress and self-ratings of a c t i v i t y and advice-giving. No such s i g n i f i c a n t relationship emerged from the 1 c l i e n t ' s perceptions of progress and the therapist's degree of a c t i v i t y and advice-giving. Both parties agreed, however, that the therapist's a c t i v i t y exceeded his/her advice-giving, and the therapist's participa-t i o n surpassed the c l i e n t ' s i n i t i a l expectations. Bieber et a l . (1977) confirmed Meara et al.'s (1979) findings that a tracking and convergence developed over repeated sessions which also resembled the interaction that Patton, Fuhriman & Bieber (1977) called a "concerted activity". May (1977) noted a convergence which Pepinsky & Karst (1977) attributed to the client's natural inclination to f o l -low an implied treatment direction coirmunicated by the therapist i n -directly and possibly unconsciously. Wexler & Butler (1976) examined ways that the therapist might effect a higher expressiveness rate from clients by his own example, since the client's lack of verbal proficiency had been linked to poor prog-nosis. In a single case study with an inarticulate client, the thera-pist projected a high level of expressiveness i n an early session. /An increase i n the client's expressive behaviour was noted, and rein-forcement was not required as treatment progressed. Wexler & Butler f e l t that timing might be c r i t i c a l i n establishing an expressive pattern. Fessler (1978) investigated the therapist and client perceptions of particular events, the intentions of the participants and the nature of their respective experiencing. The findings suggested that the therapist and client experience an event differently and congruence related to the accuracy of the therapist's understanding of the client's experience. Fessler corrrnented that the f u l l complexity of interpretation could not be measured by studying recall or observations independently. The following studies attempted to understand the underlying meanings contained i n the client's and the therapist's corrnunication systems. Therapy as Dramatic Interpretation Therapy as Dramatic Interpretation involved the interpretation and understanding o f c l i e n t and t h e r a p i s t messages. I t i s p e r c e i v e d as a symbolic process t h a t r e f l e c t s t h e mutual c o n t r i b u t i o n s o f p a r t i c i -p ants engaged i n a r e c i p r o c a l bond t h a t has e x p l i c i t and vague com-ponents. Meanings a r e n o t apparent t o o b s e r v e r s and t h e i r s u b t l e t i e s may be more o f t e n sensed than q u a l i f i e d by t h e c l i e n t and t h e r a p i s t . ^ . C l i e n t messages S t i l e s (1979) suggested t h a t the c l i e n t ' s q u a l i t y o f s e l f -d i s c l o s u r e and e x p r e s s i o n s o f immediate e x p e r i e n c i n g were good i n d i -c a t o r s o f e f f e c t i v e c o u n s e l l i n g . When the c l i e n t ' s e x p e r i e n c i n g l e v e l was s u p e r f i c i a l , t h e t h e r a p i s t r e c o g n i z e d t h a t s u b s t a n t i a l change was u n l i k e l y t o occur. Schenken (1978) endorsed t h e a n a l y s i s o f c o n v e r s a -t i o n a l s t y l e s as a means o f i n t e r p r e t i n g u n d e r l y i n g messages. N a r r a -t i v e c o n t e n t , t o p i c s w i t c h e s and t h e s p e c i f i c new themes t h a t were i n t r o d u c e d were c l u e s t o unconscious r e a c t i o n s . H i l l e t a l . (1983)found a tendency f o r the t h e r a p i s t t o i n d u l g e t h e c l i e n t i n e a r l y s e s s i o n s u n t i l s u f f i c i e n t r a p p o r t had been developed and a t t e n t i o n c o u l d be d i r e c t e d t o s e l f - e x p l o r a t i o n . Mahrer, F e l l e r s , Burak, G e r v a i z e & Brown (1981) i n t e r p r e t e d t o p i c s w i t c h e s as a s i g n a l o f c l i e n t d i s c o m f o r t , as E l l i o t t ' s (1983) " e x t e r n a l i z i n g " i n d i c a t e d a c l i e n t move i n t o s a f e r channels. T h e r a p i s t messages and t h e r a p e u t i c outcome Mahrer e t a l . (1981) c l a i m e d an e x h a u s t i v e search o f t h e r e s e a r e h l i t e r a t u r e uncovered o n l y one s t u d y on the t h e r a p i s t ' s s e l f - d i s c l o s u r e . T h i s s i n g l e p i e c e o f evidence i n v o l v e d a v e r b a t i m t r a n s c r i p t o f an a c t u a l i n - c o u n s e l l i n g s e s s i o n ( J o u r a r d , 1976). The f i n d i n g s f a i l e d t o support a c o n t e n t i o n t h a t t h e t h e r a p i s t ' s w i l l i n g n e s s t o s e l f d i s c l o s e would a c c e l e r a t e t h e r a t e o f c l i e n t ' s s e l f - d i s c l o s i n g statement and that the therapist would be perceived in a more favourable light. Their analysis of the dialogue indicated no increase in client self-disclosure and no improvement in the client's perception of the therapist or their relationship. On the contrary, there was a ten-dency for the client to withdraw to external topics as a consequence of the therapist's self-disclosure. A negative view of the associa-tion was intensified when the client perceived the self-disclosure as a reaction to unfavourable behaviour. Malan (1979) recommended that the therapist restrict attention to a specific central theme in his ccmmunications with the client, in order to facilitate a structured and manageable plan of therapeutic activity. Silverberg (1982) found that client satisfaction was not dampened by the therapist's failure to meet expectations. Symbolic interaction and-therapeutic outcome Lewis (1983) studied symbolic processes as a means of communications with clients who suffered perceptual and linguistic dysfunctions that prohibited an effective corrmunication exchange between therapist and client. This condition was apparently magnified when the client expe-rienced, an increase in anxiety. Lewis contended that the use of meta-phors and the development of symbolic messages with the client might counteract the barriers of such disabilities and reduce the threat of direct confrontation. Amundsen (1981) found that the client tended to adopt the thera-pist's values, and the therapist influenced the client-therapist similarity in terms of equality and self-respect. Lichtenberg & Barke (1981) failed to find communication similarities and common relationship patterns across orientations i n which the therapist maintained a con-t r o l position. Cox (1978) found similar cornrnunications patterns of therapists and c l i e n t s using the medical, behavioural and systems models. The medical model was i d e n t i f i e d as the prevailing favourite i n the practice of psychotherapy when distinguishing health from pathology. Therapy as Association Therapy as Association involved process developing from recurring contact, physical presence and temporal continuity and reflected the practical issues of fees, length of treatment and orientation. Normative organization and therapeutic outcome Janesh (1982) investigated the effects of objective evidence of expertness and nonverbal behaviour that projected an image of c o n f i -dence and professionalism on the c l i e n t ' s perception of the therapist's competence. The display of university degrees and the therapist's adoption of a professional stance enhanced the c l i e n t ' s acceptance of the therapist as an "expert". The therapeutic r o l e system Considerable attention has been paid to the possible benefits of pre-training c l i e n t s f o r an e f f e c t i v e participation i n therapy. Hogan, Beck, Kunce & Heisler (1983) found predischarge training interventions to c l i e n t s who were transferred to a community aftercare program pro-duced more knowledge and greater congruence with therapist expectations. The pre-trained c l i e n t s had an 82% rate of transfer success as compared to 59% i n the control groups. McCraine & M e z i l l (1978) and Winston, Pardes, Papernik & Breslin (1977) studied clients who returned to treatment after f a i l u r e to make a satisfactory adjustment to after-care f a c i l i t i e s and concluded that in-patient units do not f a c i l i t a t e re-entry into the comnunity. Barton (1977) reported a 37% base rate for successful transfer from state hospitals to outpatient follow-up c l i n i c s . Craigie & Ross (1980) f e l t that re-l a t i v e l y minor alterations i n the r e f e r r a l system would improve after-care effectiveness. Robertson (1982) gained more r e a l i s t i c expectations from c l i e n t s by simply showing them a training f i l m i n advance of treatment. In-accurate expectations about therapy were correlated with premature termination and outpatient dropout rates (Horenstein & Houston, 1976). Fraps, McReynolds, Beck & Heisler (1982) found that events occurring i n the f i r s t session determined the l e v e l of persistence that would be applied to treatment. The factors that encouraged c l i e n t enrollment were different to those that motivated continuation Temporal aspects of therapeutic association Ross (1979) surveyed 100 c l i e n t s attending the private practices of seven therapists to define the durations of treatment i n terms of long-and short-term therapy. Long-term was qu a l i f i e d as v i s i t s extend-ing beyond 25 sessions. Short-term was seen as any number under 25. The median length of treatment involved eight v i s i t s , and 80% of clients terminated before 25 sessions. Horn-George (1981) compared the client-therapist relationship i n long- and short-term treatments and found significant differences in the participants' perceptions of therapy. Long-term treatment produced a higher degree of client-therapist similarities i n how interviews should be conducted and the nature of goals to be achieved. In the long-term association, a higher value was placed on the independence of the client. Short-term participants perceived a greater need for conformity and i n -terpersonal support. Summary of Process Studies A summary of the studies presented i n this thesis confirmed the importance of a positive reciprocal bond between the therapist and the client. Progress appeared to be linked to the development of the "working alliance" and the client's perceptions of his/her level of participation. Successful outcome was connected to effective com-munications between the participants, the client's focus on feelings with irtrnediacy and specificity and the therapist's attention to his/ her own inner experiences i n a genuine, congruent way which tended to produce more evidence of sharing behaviour. In addition, the effects of pre—training and the client's advance knowledge of what i s expected in therapy enhanced insessian performance. Greenberg (1983) qualified these process research findings i n terms of their fundamental purposes which were predictive, explanatory or descriptive. The predictive studies confirmed the strength of the mutual -participation of client and therapist. The major feature of the explanatory category was the move from single-variable study towards a focus on the relationship of meaningful patterns. The descriptive element related to the measurement instruments required to capture an accurate picture of process variables from the perspectives of the participants and independent observation. New Theoretical Approaches to Process Analysis Rice & Greenberg (in press) developed a new paradigm fo r the analysis of process variables i n terms of a c l a s s i f i c a t i o n system of patterns that have meaning outside the context i n which they occur. They suggested the i d e n t i f i c a t i o n and description of si g n i f i c a n t change events that are manifested i n the c l i e n t ' s insession behaviour w i l l help i n accumulating recurring patterns i n c l i e n t change performances that relate to individual styles and therapeutic strategies which can also be categorized,The comprehensive process analysis of these events and a detection of t h e i r common elements that match the c l a s s i f i c a t i o n s would be helpful i n the construction of de f i n i t i v e models of change. Rice & Greenberg claimed that i f understanding the mechanisms of c l i e n t change i s the. goal, then the c l i e n t should be the focus of study. Past absorption with the characteristics of the therapist has l e f t the client's participation i n therapy largely unexplored, although i t i s the c l i e n t who i s performing therapeutic tasks of substantial complexity i n order to change. Klein, Mathieu-Coughlan & Kiesler (in press) related significant change events t o the experiential therapy originated by Gendlin (1969) and to the various stages of the Experiencing scale (Klein et a l . , 1970). The fo c a l change moment was described as a major c l i e n t s h i f t to a higher plateau i n the pursuit of a "new state of ccgnitive—af fective awareness". Focusing inward to a deeper l e v e l of experiencing was viewed as a c l i e n t operation that could attend any treatment orientation. Research into this new theoretical approach to process pro-poses to address the following questions: What actually takes place in a particular class of change phenomena? and, do clients for whom a successful performance on a particular change event i s clearly documented tend to have more successful eventual outcome on cer-tain change measures than do others? Rice & Greenberg (in press) stated "It i s not tne amount of a given client process during the episode that i s important but the pattern of the client process that i s under study." The possible variations that determine the mechanisms of client change relate to the client's personality characteristics and the environmental influences that encourage or inhibit i t s occurrence. Differences relate to the t client's state of readiness to change and the natural propensity for change, and to the s k i l l s of the therapist. Rice & Greenberg suggested that "therapists as well as researchers might benefit from greater use of clients as guides i n the discovery and mapping of new territories of therapeutic process." The new paradigm emerged from Greenberg's (1975) task analytic approach to the study of significant events. The task-analytic approach began with the formulation of an ex-p l i c i t framework i n which significant events "were isolated by obser-vations of behaviour. The investigator conceptualized a task situa-tion with a recurring theme of high potency and measured the change process i t effected. The potency of the hypothesized event was then verified by analysis of the ingredients (task plus task instruction plus client performance) that qualified i t for intensive study. The behaviour and i t s possible alternatives were compared on the basis of i t s practice r e a l i t i e s versus the hypothetical version. The f i n a l step i n this paradigm related to an outcome measurement correlating successful treatment with therapeutic interventions. E l l i o t t (1983) developed a Comprehensive Process Analysis model based on three dimensions: (a) the person being studied ( i . e . c l i e n t or therapist); (b) the aspect of process measured, i . e . content, i n t e r -personal action, style as r e f l e c t e d i n vocal quality and timing, and response effectiveness of interventions; (c) the perspective from which the measure i s taken, i . e . c l i e n t , therapist, third-party rater or observer. The f i v e stages of t h i s process analysis procedure included the i d e n t i f i c a t i o n of the event, d e f i n i t i o n of context and episode, trans-cription of dialogue, measurement of process variables and integration of the analysis. E l l i o t t (1983) tested t h i s model on a case study involving a c r i -t i c a l moment i n therapy which was selected on the basis of the highest combined ratings of the therapist and the c l i e n t on an intervention distinguished from 200 therapist statements. The c l i e n t ' s change process was explained i n terms of Gendlin's (1979) experiential concepts by relating-the c l i e n t ' s reaction to a private f e l t s h i f t that was followed by a public f e l t s h i f t . These hypothesized s h i f t s represented a signal of new c l i e n t awareness at a deep experiencing l e v e l . Other indications of a s i g n i f i c a n t event were manifested by the c l i e n t ' s t e a r f u l response on r e c a l l and the need to explain content to observers because i t was embedded i n past interactions. H i l l (1982) identified six levels of process analysis, i.e. ancillary components of an extralinguistic, linguistic, nonverbal and physiological nature, verbal response modes that measure the quality and timing of interventions and other speech, the manifest or latent properties of content, overt behaviour such as empathy, covert behaviour accessed by self report on process recall and stra-tegies associated with treatment orientations. Critical Events Research studies that focused on c r i t i c a l events i n psychothe-rapy were scarce, although E l l i o t t (1983) contended that their signi-ficance was central to understanding the nature of change. His ana-lysis of the sequence of dialogue before and after the key moment suggested a collaborative effort between the therapist and the client. The therapist's influence was facilitative but indirect, i n that the client ignored three interventions and disagreed with one. The c r i t i -cal event was influenced by a well-timed, vivid metaphor that related the client's description to a key problem issue. E l l i o t t claimed that the f u l l significance of the analysis could only be understood by testing interpretations i n other contexts. This conclusion reflected a basic principle of the Rice & Greenberg (in press) classifications of change mechanisms. Rand (1978) also viewed c r i t i c a l sessions or events as a "turn-ing point i n therapy", He surveyed experienced psychotherapists for confirmation of their occurrence and for a set of criteria that exem-plified such events. 46 respondents classified their experiences with c r i t i c a l inoments into three types of insights:" (a) some conflict that the client has been dealing with i n a less direct or less affect-laden manner gets confronted directly; (b) some material that the client was previously unaware of i s brought into the client's aware-ness in a way that i s useful to him or her; and (c) some cognitive reordering occurs in the client so that he perceives the therapy situation, the self, the therapeutic relationship or his world view in a different way; important insight i s obtained." Rand studied ten consecutive sessions i n their entirety for ten clients. The the-^ rapist chose the client and the starting point in the therapy process. Rand hypothesized that a relationship existed between the sessions identified by the client as c r i t i c a l and the criteria provided by the therapists which he converted to five components. Depending on the scores on client affect before and after a c r i t i c a l session, Rand failed to support his hypotheses. The significant finding i n this study was the difference in client ratings of c r i t i c a l sessions versus the total group of sessions measured. Rand concluded his study with the observations that choices must be made in studying c r i t i c a l events in the selection of large populations or extensive measurement scales, since realistically he found the co-operation of busy practitioners and "tired" clients after adnunistration of only three scales was strained at a point well below researchers' recommendations. Rand also questioned the r e l i a b i l i t y of clients' appraisals of c r i t i c a l moments which often gained significance over time. The nearest equivalent to " c r i t i c a l event" studies was an investi-gation conducted on the "goodness" of a therapy session (Mintz, Auerbach, Luborsky & Johnson (1973) as deterrnined by the Therapy Session Re-port (Qrlinsky & Howard, 1967) which was rated by the c l i e n t , the therapist and an observer. The findings produced a high correlation between the value of the session and the helpfulness of the thera-p i s t . The quality of treatment was si g n i f i c a n t l y t i e d to the "active experiencing" of the c l i e n t . Auerbach & Luborsky (1968) c l a s s i f i e d sessions as "good" and "poorer" by taking the top 18% and the low 18% of scores on a mea-surement scale of limited description, e n t i t l e d Therapist Responds Effec t i v e l y to Patient's Main Ccmriunicatian. A comparison of 60 ses-sions by independent raters provided significant differences i n the therapists' s k i l l s but no apparent distinctions could be found on the cli e n t s ' characteristics. Orlinsky & Howard (1967) studied the "good" therapy hour, using 17 experienced therapists and 60 female c l i e n t s i n sessions ranging from 8 to 26. Results were based on the Therapy Session Report adrrunistered to the therapist "and the c l i e n t . No i n -dependent ratings were involved. "Good" sessions were those rated high on a single item on the Session Report. Both the c l i e n t s and the therapists considered a session successful when the c l i e n t d i s -played friendly, affective and motivated behaviour and when the the-rap i s t was perceived as effective, optimistic and interested. The d i f -ferences i n perception of an interview session related to the le v e l of c l i e n t affect. The cl i e n t s valued sessions highly when t h e i r affect was positive, while the therapists valued a display of both positive and negative c l i e n t affect. These results are similar to S t i l e s (1980) findings that therapists placed significance on c l i e n t insession discomfort while the c l i e n t s preferred a smooth session. /An alternative approach to c r i t i c a l events involved the grouping of subjects i n terms of opposite personal characteristics for com-parison. Greenberg & Webster (1982) divided c l i e n t s into resolvers and nonresolvers of c o n f l i c t situations. Using the Gestalt two-chair technique, one part of the person expressed c r i t i c i s m while another part expressed feelings and desires. The expression of these contradictory aspects of the s e l f tended to soften the authority of the c r i t i c a l part. By termination of treatment and at the time of follow-up, the resolvers had gained the a b i l i t y to resolve t h e i r con-f l i c t s , to make more effective decisions and to accept themselves as people with a measure of power. The nonresolvers were unable to achieve t h i s level of resolution, but they experienced a new awareness of the effects of t h e i r behaviours and a reduction of the discomfort that naturally accompanied indecision. An analysis of nine recurring events i d e n t i f i e d from the perfor-mances of three subjects engaged i n the resolution of c o n f l i c t issues was conducted by Greenberg (1980) using the Gestalt two-chair method and measurement by the Experiencing Scale (Klein et a l . , 1970) and Vocal Quality C l a s s i f i c a t i o n System (Rice et a l . , 1979). Results i n -dicated that performance patterns associated with the resolution of c o n f l i c t s p l i t s depended on the softening of the internal c r i t i c and an integration of opposing c o n f l i c t elements. Current interest i n key events occurring i n therapy appeared to be extensive ( E l l i o t t , 1981; H i l l , 1982; E l l i o t t , 1983: Greenberg, 1983) and strongly linked to experiential therapy. Klein et a l . (in press) have claimed that experiential theory of treatment can be used to define c r i t i c a l moments of change and progress i n therapy" by r e l a -ting significant events to the progression stages of the Experiencing Scale. Based on Gendlin's (1979) Experiential Psychotherapy and Rogers' (1979) Client-Centered theories, experiencing was described as "the ex-tent to which the ongoing bodily, f e l t flow of experiencing i s the basic datum of an individual's awareness and communications about the s e l f and the extent to which th i s inner datum i s integral to action and thought" (Klein et a l . , i n press). At the low end of the Experiencing Scale, the c l i e n t ' s dialogue was impersonal and s u p e r f i c i a l . Indications of progress were marked by expressions of feelings and an increase i n self-understanding. Moving along a continuum, a knowledge of be l i e f s and values were c l a r i f i e d and integrated, contributing to a "new state of cognitive-affective awareness" which moved the individual to new behaviour Another perspective of a c r i t i c a l event was qualified by Rice & Greenberg (in press) as a moment i n c l i e n t experiencing when a f e l t s h i f t occurred as an "insight event" and was described as an "experiential-behavioural" process: "On the one hand, the insight event unfolds i n the cli e n t ' s experience. Thus, the c l i e n t ' s energy i s turned inward (focused voice, posture) towards the experience of newness, r e l i e f and cognitive stimulation-connection, At the same time, however, t h i s experience ' s p i l l s over' behaviourally and becomes manifest both i n the characteristic sequence of agreement - insight marker - unfolding and i n enhanced task performance (experiencing and working), Thus s h i f t s i n experience and behaviour occur together." Rice & Greenberg suggested that insight events may not a l l achieve t h i s ultimate stage of experiencing and perhaps a major f e l t s h i f t occurs only with ideal cases. Hence, the concepts of a c r i t i c a l event as presented by E l l i o t t (1983), Rand (1978) and Rice & Greenberg (in press) - although sharing common features - appeared to d i f f e r i n some important ways that may need c l a r i f i c a t i o n i n terms of the c r i -t e r i a used to identify them. E l l i o t t (1583) conceptualized a c r i t i c a l moment as a rare occurrence of substantial magnitude, Rand (1978) linked a more frequent event with c l i e n t a f f e c t and Rice & Greenberg (in press) introduced a category of events on a graduating continuum that raised the question of how c r i t i c a l i s " c r i t i c a l " . On the basis of t h i s extensive l i t e r a t u r e review, the c r i t i c a l event was selected as a challenging area of study u t i l i z i n g the measurement .scales that have been designed f o r process analysis and have been refined by the e f f o r t s of a considerable number of process investigators. The following chapter outlined the irethodology that was used i n t h i s study. Chapter III Methodology S e l l t i z , Wrightsman & Cook (1976), i n an introduction to research methods i n social relations, suggested; "One of the functions of s o c i a l research i s to develop and evaluate practices, concepts, and theories - i n short, to know the l i m i t s of one's knowledge and keep pressing against them. Yet s o c i a l research may be entirely p r a c t i c a l i n i t s functions; the desire may be to know for the sake of being able to do scmething better or more e f f i c i e n t l y " (p.7). These principles reflected the objectives of s c i e n t i f i c investigation and the requirements of the c l i n i c a l p ractitioners who are "concerned with the social and psychological meaning of one's findings as well as t h e i r s t a t i s t i c a l significance" (p.489). With these thoughts i n mind, the intent of t h i s investigation rested on the anplication of systematic process methodology to the comparisons of patterns of c l i e n t behaviours under c r i t i c a l and n o n c r i t i c a l in-therapy conditions. Several process measurements were used to illuminate the c l i n i c a l l y relevant q u a l i t i e s of c l i e n t performances during periods regarded as s i g n i f i c a n t i n impact, and to identify operationally the sequential patterns. The following methodology outlined the parameters i n detail. Population and Sampling Procedure The 24 therapy episodes i n t h i s study were drawn from actual sessions conducted with 12 c l i e n t s attending a cost-free conrrnunity counselling txaining center. The subject sample consisted of two male and ten female adults, ranging i n age from 19 to 46 years (M = 26.58) who sought individual counselling on a personal problem issue. The sample was therefore composed of subjects who were broad-l y representative of a population of people i n this particular age group which experiences discomfort at some time with personal pro-blems and attempts to resolve such issues by voluntarily applying for cost-free counselling services. i The focus of t h i s study was on the experiencing behaviour of cli e n t s during a therapy session at points that they perceived as c r i t i c a l and nonc r i t i c a l . The actual c l i e n t performances chosen were dependent on the therapist and c l i e n t meeting a set of predetermined c r i t e r i a . F i r s t , the therapists were invit e d to identify sessions that they considered highly meaningful and to confirm that the c l i e n t concurred with t h i s opinion. When agreement was reached and an i n t e r -view chosen, the c l i e n t was asked to participate i n the research project. After signing a consent form, the c l i e n t selected an appropriate time for an interview with the researcher. In advance of the appointment, taped segments of the interview session were made. These tapes were played f o r the c l i e n t who was asked to rate t h e i r significance on an Interpersonal Process Recall Scale. I f the c l i e n t rated at segment at a 6 or 7 point on the scale, i t was c l a s s i f i e d as a c r i t i c a l event. the higher of the two ratings were used. When more than one rating occurred at the highest point, these segments were replayed and the client assigned the highest priority rating. To be considered as a noncritical event, the client had to assign a 3 or 4 rating to a segment of the taped dialogue. The rating occurring furthest into the session was as a noncritical point to avoid the early warm-up stage of the therapy session. Eleven of the twelve subjects rated a 7 on the Process Recall Scale and one subject gave the highest rating at a 6. Nine subjects rated segments at the 3 point of the scale with no 4 ratings occurring. Three subjects rated at the 4 point of the scale. One- client failed to qualify for the study when his highest rating occurred at a 5 on the Process Recall Scale. Therapists Eight counsellors-in-training, one male and seven female, con-tributed to this study on the basis of a two-client maximum per coun-sellor. Three counsellors were in a doctoral program and five were in a master's program. Four counsellors provided two clients each and four provided one client each. A l l counsellors had a minimum of 100 hours of training i n the Carkhuff/Egan model of counselling and vary-ing levels of experience i n the use of other therapy treatments. Three counsellors had specialized training i n the Gestalt model and one had substantial experience with this method. A l l counsellors were selected on the basis of their ability to produce a therapy session that they and their respective clients regarded as exceptionally significant. A l l counsellors responded to a questionnaire on their perceptions of the change and change process, after reading the transcribed episodes selected from the client's ratings on the Process Recall Scale. Raters Three independent raters were engaged i n th i s study and two were involved i n each measurement instrument scale. One rater was a univer-s i t y professor i n the Counselling Psychology department, one rater was a Master's student and one was a counsellor at a c r i s i s center. The raters were chosen on the basis of their f a m i l i a r i t y with a par-t i c u l a r rating scale. Description of Measuring Instruments -The Experiencing Scale The measurement of the c l i e n t ' s depth of experiencing was made on the Experiencing Scale (Klein et a l . , 1970) and covered twelve 3-minute episodes that surrounded each event c l a s s i f i e d as c r i t i c a l and twelve 3-minute episodes that surrounded each event c l a s s i f i e d as noncr i t i c a l . This scale i s a seven-point rating instrument that evaluated the l e v e l of c l i e n t involvement as determined by seven phases that increase i n expressiveness and self-referents, from a starting point o f impersonal and s u p e r f i c i a l dialogue to a graduated sequence of increased involvement to an ultimate l e v e l where s e l f -awareness and personal integration lead to discussions of thoughts and action. Based on Gendlin's (1979) experiential theory of an inter n a l s h i f t achieved by inward focusing and Rogers' (1973) concept of the "communication of s e l f " i n Client-Centered Therapy, the Experiencing Scale has undergone considerable development and modification by the contributions of many people (Gendlin & Zimring, 1955; Gendlin, 1962; Rogers, 1958; 1959; Gendlin & Tomlinson, 1961; Klein et a l . , 1970). The Experiencing Scale was designed for direct application to audiotaped seg-ments of the therapy session when measuring the client's depth of experien-cing from insession dialogue. This study used the Experiencing Scale on tapes and typed transcripts of the 3-minute segments. A two-volume re-search and training manual i s available to raters and requires 16 hours of practice. One rater i n this study had considerably more experience and one rater trained by the use of this manual. The validity of the scale has been confirmed across experimental conditions where experiencing i s a focus of attention, and r e l i a b i l i t y f i -gures range from 0.79 to 0.91 on modes and 0.85 to 0.92 on peaks using the Ebel inter-class r e l i a b i l i t y method. A short form (Appendix D) of the Ex-periencing Scale used i n this study i s attached, along with r e l i a b i l i t y figures of ratings on individual therapy segments (Appendix E). The Client Vocal Quality Classification System The manual for Client Vocal Quality required the use of taped and transcribed segments and qualified training on this instrument as analo-gous to developing an ear for music. The Client Vocal Quality Classifica-tion System (Rice et a l . , 1970) i s frequently used to supplement the Ex-periencing Scale (Hill et a l . , 1983; E l l i o t t , 1983). This system has four voice patterns - focused, emotional, external and limited. Each voice pat-tern has six features: (a) perceived energy, (b) primary stress, (c) regularity of stress, (d) pace, (e) timbre and (f) contour. This classification system has been successfully used to measure the quality of the client's voice (Rice & Gaylin, 1973) and has been a r e l i a b l e predictor of therapeutic outcome (Rice & Wagstaff, 1967) on the basis of voice quality and expres-sive stance. Rice & Wagstaff reported r e l i a b i l i t y figures a t 0.70 to 0.79 on the correlations of independent judges on the four voice patterns with a percentage agreement of 70. A b r i e f description of each category of mea-surement by pattern type i s shown i n Appendix F. The Speech Interaction System The Speech Interaction System (Matarazzo et a l . , 1968) measured three speech variables: (a) the mean speech duration, i . e . the t o t a l time i n seconds the c l i e n t or the therapist speaks divided by the t o t a l number of respective speech units; (b) mean speech latency; i . e . the t o t a l laten-cy time which consists of periods of silence separating -two diff e r e n t speech units, divided by the number of respective c l i e n t and therapist speaking pauses; (c) percentage interruptions, the t o t a l number of times the c l i e n t or therapist speaks divided into the number of these same speech units which were interruptions of the other participant. Since t h i s study was mainly concerned with the periods of silence that occurred, only the speech pauses were s t a t i s t i c a l l y measured. The speech interaction and speech interruptions were excluded. The r e l i a b i l i t y figures on the Speech Interaction are high at 0.90 but r e l i a b i l i t y drops t o 0.55-0.75 for measurements of silence because of variations i n raters' response times. Matarazzo et a l . (1968) claim high r e l i a b i l i t y on 15-minute segments and evidence has shown a drop i n r e l i a -b i l i t y with reduced time periods. Training of raters required several hours of practice time to achieve the r e l i a b i l i t y levels of judges of extensive experience. Nine speech scores f o r inexperienced observers produced a r e l i a b i l i t y of 0.71 to 1.00 with eight of the nine variables having coefficients above 0.94 (Kiesler, 1973). Periods of silence included speech pauses between speaker turns and within the dialogue sequence of a speaker. I t excludes pauses for breathing, choosing words and re f l e c t i o n when i t i s apparent that the speaker has not yet completed the utterance. The silence following a therapist's statement i s included i n the c l i e n t ' s latency time and vice versa. Refer to Appendix G for further description. Matarazzo et a l . (1968) developed a recording aid which el e c t r o n i -c a l l y measures the components of t h i s system by attachment to a recording unit. The use of a stopwatch or other chronographic device i s claimed to be as effective. This study employed a stopwatch. Transcription System The transcription system developed by Sacks, Schegloff & Jefferson (1978) supplemented the Speech Interaction System by identifying and ^re-cording breathing patterns, latching of speaking turns and recording time throughout the dialogue. The description of sounds i n terms of volume and pacing increased i t s usefulness to vocal measurement along with the taped segments. The period selected for transcription after i d e n t i f i c a t i o n of the focal event involved running the tape-recorder back approximately a minute and a half from t h i s central point and transcribing the dialogue for three minutes. Some s h i f t i n g was necessary to start with a therapist interventions and to achieve a balance of dialogue between c l i e n t and therapist with a l o g i c a l sequence that could be understood by nonparti-cipating observers. By this transcription method, uncertain hearings are typed i n parenthesis and changes i n sound are i d e n t i f i e d by symbols. Ap-pendix B provided an outline of symbols used. Typing and editing of trans-c r i p t s required four to fi v e replays of audiotaped dialogue. Audio Process Recall The audio process r e c a l l used i n t h i s study was a process c l a s s i f i -cation procedure adapted from E l l i o t t ' s (1979) Interpersonal Process Re-c a l l . E l l i o t t ' s 9-point scale divided the figure points into a plus and minus p l i t , representing both helpful and hindering aspects of the ses-sion. However, th i s study u t i l i z e d t h i s scale s o l e l y for the purpose of identifying the significance the c l i e n t attached to particular segments of the session which have been complicated by the evaluation of negative features. The scale was therefore changed to a 7-point scale starting from 1 "no meaning" to a mid-point of 4 "I don't know" to a maximum of 7 "ex-tremely significant". The procedure recommended by the process r e c a l l instructions was to view the whole sessions and select a cut-off point when the c l i e n t i s c alled upon to rate the segment. E l l i o t t (1979) mentioned the s k i l l required i n determining an appropriate length of a segment and to avoid causing the c l i e n t confusion or undue loss of time, i t was decided to select consecutive segments i n advance of the c l i e n t ' s a r r i v a l . Each seg-ment was numbered and presented on audio equipment with logical cut-off points for rating. The segments varied i n length to present s u f f i c i e n t material to understand a piece of the interaction. Fifteen segments were extracted i n sequence across the session. The same recall consultant was used to review a l l of the segments after training for the purposes of this study in accordance with the pro-cedures set out in Ell i o t t ' s (1979) manual. The revised format for the Interpersonal Process Recall i s shown in Appendix A. The Helpfulness Scale The Helpfulness Scale i s a 9-point Likert scale. The lower end of the scale starts with a point called "extremely hindering". It moves to a central "neutral" rating and up to an "extremely helpful" point at the reverse end of the scale. This scale can be used to measure the therapist's level of helpfulness as perceived by the client, the therapist or indepen-dent observers. In this study, i t was used to determine the client's per-ception of the helpfulness of interventions before and after the focal event. As i n the Process Recall Scale, the words "use sparingly" i s placed at the extreme ends of the scale. The recall consultant may ask the client to elaborate on the scoring. E l l i o t t (1979) reported rather low r e l i a b i l i t y coefficients on the Helpfulness Rating Scale on a rate-rerate method at 0.38 to 0.71. Internal consistency between the Helpfulness Scale and measures of therapist em-pathy produced a 0.49 correlation which increased to 0.66 when ratings were pooled. Studies comparing the Helpfulness Scale to a Global Helpful-ness measurement by clients only, correlated at 0.61 and 0.63. The Helpfulness Rating Scale used i n t h i s study i s shown i n Appen-dix C. Change Process Questionnaire The Change Process Questinnaire was adrninistered to both the c l i e n t and the therapist and simply asked two questions. The f i r s t question was "What changed i n t h i s event?" The second question was "What was the na-ture of the change process?" When some c l i e n t s did not appear to under-stand the second question, i t was replaced with "How did change come about?" A l l responses to these questions were recorded and transcribed verbatim. The c l i e n t and therapist statements were typed i n p a r a l l e l form which was provided i n Tables 6 and 7 (pp.82-83). Data Collection and Rating Procedures The Experiencing Scale An analysis of twenty-four 3-minute episodes was conducted by rating the clients' behaviour on the Experiencing Scale f o r mode and peak by two independent raters. A separate rating was made of the twenty-four f o c a l events i d e n t i f i e d by the c l i e n t s . These ratings were l i s t e d under cate-gories called c r i t i c a l and n o n c r i t i c a l . Vocal Quality Ratings were taken on the Client's Vocal Quality C l a s s i f i c a t i o n Sys-tem at the c r i t i c a l and n o n c r i t i c a l f o c a l points of the twenty-four e p i -sodes by two independent raters. Speech Interaction System Two independent raters calculated the durations of silence using the formula contained i n the Speech Interaction System and these figures were l i s t e d f o r subjects #1 to #12 under the two conditions, c r i t i c a l and n o n c r i t i c a l . Transcription System A separate t a l l y of speech pauses i n seconds across the 24 episodes was calculated from the Sacks, Schegloff & Jefferson (1978) transcription system using a ccmrnon rater and a second independent rater. Helpfulness Scale When the foc a l event was established by the c l i e n t on a 7 rating or the highest p r i o r i t y 7 item, t h i s point was located on the taped whole session. Then the audiotape was run back t o cover two therapist's statements i n advance of the c r i t i c a l moment and two statements after i t s occurrence f o r rating by the c l i e n t on the Helpfulness scale. Comparisons were then made of the therapist's statements leading up to and following the focal moment. Change Process Questionnaire The c l i e n t s and therapists were asked to respond to two questions on the change process. Their responses were l a b e l l e d with the l e t t e r s A to E which correspond to Rand's (1978)- f i v e sets of c r i t e r i a r e f l e c t i n g the responses of 46 psychotherapist as to the ingredidents of a c r i t i c a l event. Where the change process responses appeared to overlap into two cla s s i f i c a t i o n s , such as new insight and cognitive reordering, both were included to respresent the c l i e n t ' s or therapist's perceptions of change. Appendix G specified the f i v e categories by l e t t e r s A to E, and Table 8 (p.86) showed a breakdown of responses by l e t t e r designation. The change process questions were addressed to the c l i e n t s after they had heard the taped episode, and to the therapist after they had read the 3-minute transcriptions of the c r i t i c a l episodes. The designation of categories was determined by the researcher merely f o r interest's sake, and no claims are made on th e i r significance. Process Recall The Process Recall Scale was completed by the c l i e n t t o isolate events as c r i t i c a l and n o n c r i t i c a l . The words "use sparingly" appeared on the rating scale at the outer end of the scale at the 6 and 7 scores. The positions of the fo c a l events on the c r i t i c a l and no n c r i t i c a l conditions were times to establish the points of t h e i r occnxrrence i n the interview session i n order t o sel e c t n o n c r i t i c a l events most representa-tiv e of involvement, i . e . furthest away from the warm-up stage, and to de-termine at what point a l l events ciccurred within the session. R e l i a b i l i t y Scores of Ratings R e l i a b i l i t y scores were high across most ratings. On the Experien-cing Scale f o r the 3-minute episodes, agreement was reached on the mode at 0.93 and the peak at 0.75, using a Pearson product moment correlation co-e f f i c i e n t . This s t a t i s t i c also correlated on the foc a l events a t r = 0.84. On c l i e n t vocal quality, the raters obtained a Cohen's kappa of 0.75 for each of the conditions rated. On the durations of silence, the Pearson product moment correlation produced a s t a t i s t i c of r = 0.68 using the Speech Interaction System formula and 0.91 using the Sacks et a l . (1978) transcription method which provided a means of recording the pauses i n se-conds. S t a t i s t i c a l /Analysis The dependent t-test f o r correlated means was used on the data. This method was recommended by Ferguson (1981) "when a single group' of subjects are studied under two separate experimental conditions and ... the data are composed of pairs of measurements". The Experiencing Scale produced two figures, peak and mode, and each were computed separately. The dependent t - t e s t was also administered to the combined scores of two Helpfulness ratings before the c r i t i c a l focal event and two ratings after the event. The t-tes t was calculated by Mini tab computer. The C l i e n t Vocal Quality C l a s s i f i c a t i o n System scores are i n the form of frequencies, and the Chi square was chosen as an accepted means of measuring differences i n frequency data. In general, r e s t r i c t i o n s on i t s use related t o the independence of the scores from one another, some l o g i c a l or empirical basis f o r the way the data are categorized and f r e -quency of data should be higher than 5 f o r each c e l l . When results on t h i s measure were marginally si g n i f i c a n t and i t was recognized that a l l data did not exceed 5, the scores were combined to reduce the df from 3 t o 1 and produced a higher l e v e l of significance. Greenberg (1983) claimed that "Measurement i s the core issue i n pro-cess research and any research i s only as good as the measurement system used." Efforts to find appropriate process instruments were rewarded by rating scales with a long history of development and refinement and well-documented relia b i l i t y figures. The statistical procedures selected for this study were appropriate to the values of the data, the size of the sample population and accounted for the variance of the paired measure-ments. The following chapter presented the results of this investigation in terms of the four hypotheses proposed. CHAPTER IV Results This chapter presents the results of client performances under Conditions #1 (critical episode/event) and #2 (noncritical episode/event) and the statistical significance of between-group comparison which are made in terms of the process variables selected for investigation. Also presented i s a tentative or speculative approach to the meaning of the change process from the perceptions of both participants in the therapeu-t i c interaction and the factors they view as having produced change. Dis-cussion and implications of these results are covered in Chapter V. Comparison of Client Performances under Conditions #1 and #2  The Experiencing Scale Results of this comparison are shown in Table 1 (p.76). The mode scores for the 3-minute episodes indicated a t value of 4.31, .01, peak scores yielded a t value of 7.29, p-<r .01 and focal event scores a t of 5.20, p<r .01. It i s therefore concluded that the behaviour component of depth of experiencing i s distinctly greater in a c r i t i c a l event than in a noncritical event. Comparison of Client Performances under Conditions #1 and #2  Client's Vocal Quality Results of this comparison are shown in Table 2 (p. 77). A Chi square value of 9.33, p-*' .05 was yielded on a f u l l table and 8.71, p<**.01 for a reduced table. Table 3 (p.77) shows distribution of frequencies. It i s 76 TABLE 1 Comparison of Client Performances under Conditions .#1 and M2 The Experiencing Scale  3-Minute Episodes Focal Events C r i t i c a l Noncritical C r i t i c a l Noncritical Subject Mode Peak Mode Peak 1 4 5 4 4 5 3 2 3 4 2 3 3 3 3 3 4 2 3 3 2 4 3 4 3 3 3 3 5 4 4 3 3 4 2 6 3 3 2 3 3 2 7 3 4 2 3 4 3 8 4 4 3 3 4 3 9 5 5 2 3 5 2 10 5 5 2 3 5 2 11 3 4 2 3 4 2 12 3 4 2 3 4 2 Dependent t - t e s t indicates the following: For MODES, t value = 4.31, p<r .01, M =1.17, .S.D. = 0.94 PEAKS, t value = 7.29, p <- .01, M = 1.08, S.D. = 0.52 FOCAL, t value =-5.20, p ^ - . O l , M = 1.50, S.D. =1.00 TABLE 2 Comparison of Client Performances Under Conditions #1 and #2 - Client's Vocal Quality Classification  FOCAL EVENTS  SUBJECT CRITICAL NONCRITICAL 1 X X 2 X X 3 E X 4 X X 5 F X 6 L X 7 E X 8 E L 9 E X 10 F L 11 E X 12 F F NOTE: F = Focused E = Emotional X = External L = Limited TABLE 3 Chi Square Alternatives based on Full Table (df = 3) and Reduced Table (df = 1)  FULL TABLE F E X L Total 3.0 5.0 1 2.0 2.5 3.0 6.0 1.0 1.5 12.0 1.0 0 2 2.0 2.5 9.0 6.0 2.0 1.5 12.0 lot.4.0 5.0 12.0 3.0 24.0 Chi Square = 9.33, p^.05, df = 3 REDUCED TABLE F + E X + L Total 8.0 1 4.5 4.0 7.5 12.0 1.0 2 4.5 11.0 7.5 12.0 lot. 9.0 15.0 24.0 Chi Square = 8.71, p^.01, df = 1 concluded t h a t the behaviour component o f voice q u a l i t y i s s i g n i f i c a n t l y d i f f e r e n t i n a c r i t i c a l event than i n a n o n c r i t i c a l event. Comparison o f C l i e n t Performances under Conditions #1 and #2  Durations o f S i l e n c e R e s u l t s o f comparisons are shown i n Table 4 (p.79). The 3-minute episodes y i e l d e d a t value o f 4.65, p<".01 f o r the count o f scores r e c o r -ded on the Sacks e t a l . (1978) t r a n s c r i p t i o n system. The Speech I n t e r a c -t i o n System (Appendix H) y i e l d e d a t value o f 5.89, p<" .01 on the 3-minute segments and a t v a l u e o f 2.69, p-^.01 on the f o c a l events. I t i s t h e r e -fore concluded t h a t the durations o f s i l e n c e are s i g n i f i c a n t l y d i f f e r e n t i n a c r i t i c a l event than i n a n o n c r i t i c a l event. Comparison o f I n t e r v e n t i o n s Before and A f t e r the F o c a l Event  C l i e n t Ratings on Helpfulness Scale Results o f comparisons o f Helpfulness r a t i n g s before and a f t e r the c r i t i c a l f o c a l events are shown i n Table 5 (p.80). A dependent t t e s t measuring two i n t e r v e n t i o n s before the event and two i n t e r v e n t i o n s a f t e r the event i n terms o f the Helpfulness Scale r a t i n g s produced a t value o f 2.66, p«^ .05. Graph 1 (p.80) i l l u s t r a t e d the sequential score means which suggested a peak immediately preceding the f o c a l event w i t h a descent a f t e r the event. I t i s t h e r e f o r e concluded t h a t the c l i e n t ' s p e r c e p t i o n o f the t h e r a p i s t ' s l e v e l o f h e l p f u l n e s s before a f o c a l event i s h i g h e r than a f t e r the event. These r e s u l t s ended the s t a t i s t i c a l p o r t i o n o f t h i s study. The f o l l o -wing data covered comparisons o f the t h e r a p i s t and c l i e n t p e r c e p t i o n s o f the 79 TABLE 4 Comparison of Client Performances under Conditions jfl and #2 Durations of Silence  3-min.Episodes-J3acks 3-min.Episodes - Focal Events -Transcription Count Speech Interaction Speech Interaction Ss. - Critical JNoncritical C r i t i c a l Noncritical Critical Noncritical 1 81.5 45.5 2.037 1.625 2.9 0.5 2 38.5 32.0 0.786 0.593 0.5 0.67 3 87.5 40.5 " 1.620 0.844 2.22 0.5 4 64.0 51.0 1.422 1.133 1.96 1.25 5 66.5 32.5 1.511 0.739 2.32 0.5 6 55.5 63.0 2.921 1.432 2.67 1.5 7 56.5 30.5 0.958 0.649 0.86 1.5 8 71.0 57.5 1.614 0.777 2.25 0.7 9 73.0 49.0 2.920 1.815 2.3 0.5 10 66.5 40.0 2.463 1.111 3.14 1.0 11 72.0 10.5 1.756 0.656 9.0 0.5 12 66.0 49.0 1.119 0.753 1.28 0.5 t values = 4.65,'P-^--01- 5.89, p-r .01 2-r69, p<: .05 TABLE 5 Comparison of Client Perceptions of the Helpfulness of Therapist Interventions before and after a Critical Focal Event Helpfulness Ratings Helpfulness Ratings Subject Before Event After Event 1st 2nd 3rd 4th 1 9 5 4 4 2 7 8 9 6 3 5 9 5 5 4 8 9 8 7 5 8 9 9 8 6 8 7 4 4 7 6 8 7 5 8 6 5 7 8 9 8 8 7 5 10 6 8 6 7 11 9 9 7 . 5 12 8 7 7 7 Means 7.30 7.67 6.67 5.91 t value = 2.66, p<\05. GRAPH 1 Sequential Order of Score Means Before and After a Focal Event Indicates peak before focal event 1st 2nd 3rd 4th Order of Interventions 81 Comparison of Client and Therapist Perceptions of Change  Change Process Questionnaire The client and therapist responses to the question, What changed in this event? were abbreviated and outlined i n Table 6 (pp.82 and 83). These statements are verbatim and identified i n categories A to E as shown in Appendix G. These letters correspond to Rand's (1978) five clas-sifications as determined by the researcher for interest only, and are open to conjecture. Table 7 (pp.84 and 85) show answers to question, What was the nature of the change process? Table 8 (p.86) and Graph 2 (p.86) indicated that the client most frequently recognized change as D "some important insight that i s useful", followed by A "having f e l t some significant emotional impact", C "cogni-tive reordering", B "emotional closeness with therapist" and lastly, E "a shift in distorted perceptions of therapist" which was unique to one client. The therapist most frequently chose C "cognitive reordering" as the nature of change, followed by A "significant emotional impact" and D "important insight that i s useful" and made no reference to B "emotional closeness" or E "distorted perceptions" relating to the therapist. One client and one therapist from different dyads perceived no client change as a result of the c r i t i c a l event, while their partners i n the interaction found a significant change. Table 9 (p. 87) listed responses by client and therapist and Graph 3 (p. 87) presented a frequency distribution of answers to the second ques-tion, What was the nature of the change process? In responses, change was 82 TABLE 6 Client and Therapist -Responses to Question, "What changed in this event?"  Ss. Client Statement Classification Therapist Statement Classification If I wanted to gain from counselling, I'd have to do i t myself. D + E Client faced herself and learned the game of self-pity was some-thing she had control and choice over. When she took my hus-band, she also took my family. A move back home (England) would recover half the loss. Client came to terms with discrepancies be-tween goals set in counselling and the results. C + D A clear understand-ing of what she wanted to do to re-solve problem. Nothing changed as a result of the event. A recognition of how she contributed to her husband's helplessness. Client's realization that change would only come from himself. Recognition of power-ful feelings towards grandmother whom I thought I didn't care anything about. Got ri d of anger by putting myself i n her shoes. A4C+D My own behaviour kept my family seeing me as a child. I used this to get love from them. C + D By reliving the pain and guilt from hus-band's infidel i t y was able to move on the problems now. A Client was able to for-give her grandmother and see her as a person who did the best she could. Recognition of her mis-guided way of getting what she needed from her family. A+C+D C + D No change. 8 Talking about my fear of causing violence Movement towards a higher self-sufficiency. TART.F, 6 (cont'd.) Ss. Client Statement Classification Therapist Statement Classification when I'm frustra-ted and seeing i t wasn't inherited. A+C+D A + C 9 Able to express feelings without feeling ashamed. A + D 10 Recognized I had no intention to change i f I had to do scire thing in particular. D 11 Ability to admit sorrow regarding breakup and move beyond i t . A + B 12 Recognition that I can't make every-thing right. I can't be a father and find a father purely for that reason. A+C+D Able to get in touch with feelings. D Cognitively separa-ting self from per-formance. C A heightened ability to get i n touch with her deeper affect. A Able to express deep feelings by accessing through children, and then moving beyond this block. A + C TABLE 7 Client and Therapist Responses to Question, "What was the Nature of the Change Process?" Client Statement Attributed to Therapist Statement Attributed to I f e l t that the counsellor took my mother's side, so I had to take responsibility for my own pro-gress. By exploring past events i n terms of their meanings now. By showing me how I was being mani-pulated by a sense of guilt. Words "unfulfilled pro-mises". No change. self self inter-ventions Rejection by the therapist of client's "empty" content by confrontation that fixed client on a direction. counselling strategy By creating an en-vironment that fa-cilitated expression counselling of feelings. strategy. An awareness that she kept husband helpless and then disliked his weak-ness. client's self exploration. Persistent confron-tation on how he was viewing himself. interventions By putting myself i n other person's shoes. By thinking se-riously about therapist's comments and ex-ploring own beha-viour. Counsellor's re-ference to pain center. counselling technique. inter-ventions inter* ventions By linking pat-terns with parents' inter-situation, ventions By experiencing her grandmother's posi- counselling tion. technique. Interpretation of conflicting state-ments and confron-tation on discre-pancies between goals and behaviour, interventions No change. Clarifying client's perceptions of self. interventions 85 TABLE 7 (Cont'd.) Ss. Client Statement Attributed to Therapist Statement Attributed to 10 By adopting role of feelings inter-acting with Intel- counselling lect-Pressure and con-frontation from counsellor. technique. interventions By experiencing what i t was like to be pure feelings. Clarifying client's perceptions of the self. counselling technique. interventions 11 Support of coun-sellor and con-centration on feelings inter-ventions Creating strong rapport that en-couraged internal ex-ploration. Keeping client away from sur-face issues and re-turning her to fee-ings. interventions 12 Going through process of feeling things at "gut level" and l e t - inter-ting go of guilt, ventions Focusing on emo-tions indirectly by connecting through client's counselling children strategy TABLE 8 Client and Therapist Responses to Question, "What Changed in this Event?"  Subject Client's Responses Therapist's Responses 1 D + E C 2 C + D C 3 D D 4 - D 5 A + C+D A + C + D 6 C + D C + D 7 A -8 A + C + D A+C 9 A + D A 10 D C 11 A + B A 12 A + C + D A + C GRAPH 2 Frequencies of Client and Therapist Responses i r \ > A B C D E Emotional Closeness Cognitive Use- Shift of Impact to Reordering ful Distor-Therapist Insight ted Per-ceptions _= Client Therapist 00 TABLE 9 Client and Therapist Responses to Question, "What was the Nature of the Change Process?" Subject Client's Response Therapist's Response 1 client activity counselling strategy 2 client activity counselling strategy 3 intervention client activity 4 - intervention 5 technique technique 6 intervention intervention 7 intervention -8 intervention intervention 9 technique technique 10 intervention intervention 11 intervention intervention 12 intervention strategy GRAPH 3 Frequencies of Client and Therapist Responses  Interventions Client Technique Strategy = client = therapist CO attributed to c l i e n t ' s a c t i v i t y and the therapist's interventions or strategies. Two cli e n t s attributed change to themselves and ine c l i e n t related change to the therapist's interventions. One therapist a t t r i -buted change to the cl i e n t ' s a c t i v i t y and ten therapists related change to their own interventions or strategies. Agreement was reached by eight c l i e n t s and their therapists that the c r i t i c a l event was attributable to the therapist's statement or techniques. Comparison of Positions i n Sessions for Focal Events . Time into Session Table 10 (p. 89)-listed the times that the c r i t i c a l and non-c r i t i c a l events occurred into the sessions Graphs 4 and 5 (p-90) showed their positions across the session. In the c r i t i c a l event, the time positions ranged from 15:03 to 53:31 with a mean of 34.43. In the nonc r i t i c a l event, the time posi-tions ranged from 5:10 to 47:20 with a mean of 20:48. In the c r i t i c a l episode, one subject experienced a focal event i n the f i r s t t h i r d of the session, eight i n the second t h i r d and three i n the l a s t t h i r d . In the noncritical episode, six subjects experienced the noncritical event i n the f i r s t t h i r d , four i n the second t h i r d and two i n the l a s t t h i r d . The s t a t i s t i c a l results supported the hypotheses on c l i e n t expe-riencing, vocal quality and durations of silence. The quality of therapist's helpfulness before and after the focal event was also confirmed although not to the same le v e l of significance. A discussion of these results and conclusions-were provided i n tiie following cliapter. TABLE 10 Comparison or Timing Positions within the Session where c r i t i c a l and noncritical events occur (in minutes; Subject C r i t i c a l Events Noncritical Events 1 15:03 40:49 2 29:00 22:57 3 22.50 7:33 4 50;25 7:01 5 35:24 13:22 6 40:06 6:16 7 24.10 5:10 8 38.43 26:59 9 53:31 15:55 10 33:47 23:20 11 3SU43 31:31 12 32;39 47:20 Mean 34.43 20:48 Critical Event F i r s t Third 1 subject Second Third = 8 subjects Last Third 3 subjects Noncritical Event First Third 6 subjects Second Third 4 subjects Last Third 2 subjects GRAPH 4 Tome Intervals into Session CRITICAL EVENT 5 10 15 20 25 30 35 40 45 .50 55 60 Time i n Minutes GRAPH 5 Time Intervals into Session NOJ^ CRTTICAL EVENT 8 n 9 10 15 20 25 30 35 40 45 50 55 £0 Time i n minutes CHAPTER V Discussion of Results and Conclusions This chapter i s involved with a discussion of the results of this study and conclusions on the meanings that emanated from this research, implications for theory and practice of psychothe-rapy and recommendations for future investigation. Discussion and Conclusions The significant findings on the four stated hypotheses supported the contention that the client i s a valuable resource in the selection of significant events. This client's involvement i n procedures clearly indicated an ability to make fine distinctions between various segments of the therapy session i n terms of their productive and nonproductive quality by a fairly swift appraisal of the passing dialogue. It was also apparent from an analysis of the data that the client's depth of experiencing was a vita l factor in creating an environment in which a c r i t i c a l event might occur, particularly at the focal moment which differed significantly in experiencing from a noncritical moment. Experiencing In the three-ininute c r i t i c a l episode, three subjects peaked at a 5 level on the 7-point Experiencing Scale which indicated a focus on f e e l i n g s and p e r s o n a l e x p e r i e n c e s , e i g h t s u b j e c t s peaked a t a 4 l e v e l i n v o l v i n g d e s c r i p t i o n s o f f e e l i n g s and p e r s o n a l expe-r i e n c e s and one s u b j e c t reached the 3 l e v e l a s s o c i a t e d w i t h r e a c -t i v e and e m o t i o n a l l y i n v o l v e d behaviour. I n the n o n c r i t i c a l e p i -sodes, e l e v e n s u b j e c t s peaked a t t h e 3 l e v e l and one a t the 4 l e v e l . Scores a t t h e f o c a l events were s h a r p l y d i f f e r e n t i n terms o f c l i e n t e x p e r i e n c i n g . The c r i t i c a l event c o n t a i n e d t h r e e 5 s c o r e s , f i v e 4 scores and f o u r 3 s c o r e s as opposed t o f i v e 3 s c o r e s and seven 2 s c o r e s (which c o n c e n t r a t e on e x t e r n a l events and i n t e l l e c t u a l s e l f -d e s c r i p t i o n ) i n t h e n o n c r i t i c a l event. Two c l i e n t s who peaked a t t h e 5 l e v e l a t t r i b u t e d change t o a new awareness t h a t success i n therapy was t h e i r r e s p o n s i b i l i t y and one c l i e n t was a b l e t o connect w i t h deeper l e v e l f e e l i n g s . The v o c a l q u a l i t y o f t h e s u b j e c t s under t h e c r i t i c a l and n o n c r i t i c a l f o c a l c o n d i t i o n s tended t o match the l e v e l o f e x p e r i e n c i n g . V o c a l Q u a l i t y I n t he c r i t i c a l event, t h r e e examples o f focused v o i c e q u a l i t y emerged, f i v e e m o t i o n a l , t h r e e e x t e r n a l and one l i m i t e d . One c l i e n t remained f o c u s e d under t h e n o n c r i t i c a l c o n d i t i o n , b u t n i n e d i s p l a y e d e x t e r n a l q u a l i t y and two l i m i t e d . There was no evidence o f t h e e m o t i o n a l dimension under t h i s c o n d i t i o n . The t h r e e focused s u b j e c t s s c o r e d 4 and 5 on the E x p e r i e n c i n g S c a l e and the two l i m i t e d s u b j e c t s s c o r e d a t a 2 and 3 on t h e E x p e r i e n c i n g S c a l e . The Gestalt two-chair dialogue technique produced a high level of experiencing for two subjects i n this study, but two other subjects rejected this therapeutic strategy. It i s con-cluded that a state of client readiness for this particular ex-ercise i s present. These varying inclinations amongst clients supports the concept of "process diagnosis" that determines an appropriate choice of treatments on the basis of the client's emotional state. An outstanding example of vocal variation within a c r i t i c a l episode occurred with a client i n a Gestalt two-chair exchange involving dialogue between the self and her grandmother. The sub-ject shifted dramatically from the voice of an anxious child to a strong, authoritative tone that demonstrated the power of re-experiencing a past event i n a current context. A further variation occurred i n the noncritical event when the client projected the personality of her adult self. Her experiencing score under the cri t i c a l and noncritical conditions ran from 4 to 2 with a voice quality shift from focused to external. The impact of deep experiencing and focused vocal quality become particularly significant when their occurrence during a cr i t i c a l episode i s compared with the cognitive reflection and pro-blem description level of the noncritical episodes. This heavy dialogue i s also significant when compared with the longer speaking pauses contained in the c r i t i c a l episodes. Durations of Silence The th i r d hypothesis that longer durations of silence accom-pany a higher depth of experiencing and are more prevalent i n c r i t i -c a l events than n o n c r i t i c a l events was based on the rationale that the c l i e n t cannot engage i n extensive dialogue and focus inward at the same time. Therefore, although i t i s preferable to have the c l i e n t speaking rather than the therapist, t h i s practice may be-come c i r c u l a r and nonproductive as occurred i n the n o n c r i t i c a l e p i -sodes of t h i s study. The findings resulting from the Speech Inter-action System indicated s i g n i f i c a n t differences i n the levels of silence i n the c r i t i c a l and n o n c r i t i c a l episodes, A comparison of t h i s method with the simple accumulation of silence focused on the balance created by the formula between individual speaking styles. I t was noted that variations amongst subjects were substantial, i . e . the silence of same subjects i n the n o n c r i t i c a l condition? was higher than other subjects i n the c r i t i c a l condition. The significance of differences rested i n each speaker's tendency to change under these conditions. The three subjects who scored at the 5 l e v e l on the Ex-periencing Scale had 61% more silence under the c r i t i c a l oondition, subject scoring at a 4 had 57% more silence and the one client ;,who scored at a 3 under both conditions had a 49% higher l e v e l of silence i n the c r i t i c a l episode. An extreme imbalance occurred with one sub-ject that related t o excessive dialogue of the therapist using Rational Emotive therapy. However, the Speech Interaction formula balanced out th i s discrepancy when i t related the occasions of silence to the speaking units for each participant. H i l l et a l . (1983) claimed a 40% dialogue participation by the the-rapist was an indicator of productive a c t i v i t y . In this study, the thera-p i s t provided a 41.7% contribution i n the noncritical episodes and 34.1% contribution under the c r i t i c a l conditions . I t i s therefore suggested that a reduced tendency for discussion might produce a higher likelihood of i n -ternal focusing and t h i s may be controlled by the therapist. Helpfulness Scale A si g n i f i c a n t difference occurred i n the c l i e n t ' s perceptions of the therapist's l e v e l of helpfulness before and after a c r i t i c a l event and a decided peak occurred immediately, before the focal event. This find ing occurred i n spite of two 5 ratings on the Helpfulness Scale before the event and two 9 and one 8 ratings af t e r the event. The peak event sugges-ted a process of effective intervention that connects with the c l i e n t ' s experiencing and f a c i l i t a t e s movement to seme new realization. The de-c l i n e of helpfulness from the c l i e n t ' s perspective suggested more of a d i s -engagement frcm the therapist's influence than a reduction i n therapist proficiency. On the whole, the c l i e n t s ' regard for their therapists were c l e a r l y apparent during this study. Apart from self-report, c l i e n t ratings of therapists were positive. Only four hindering scores were recorded across seventy-two rated interventions. Although their association was of a short-term nature, nine subjects volunteered t h e i r feelings of appreciation for their therapists. Two of the subjects expressed some animosity that appeared to have an age bias, and one subject was indifferent. Of the nine positive cli e n t s , f i v e regarded their therapists as irreplaceable. Most of the dialogue on the therapeutic alliance ' occurred during the Interpersonal Process Recall on a voluntary basis. Process Recall The process r e c a l l interaction created interesting reactions from clients who viewed i t as a learning experience i n i t s e l f . The therapy sessions that were reviewed had taken place from one week to several months before. The time lapse since the event may have been instrumental i n producing a variety of responses. Similar to E l l i o t t ' s (1983) c l i e n t , three subjects (one male and two female) were moved to tears on r e c a l l within two weeks after the session. Three c l i e n t s , female, expressed j u b i l a t i o n because of a recognition of how far they had progressed since the event some months before. The one c l i e n t who expressed no change as a r e s u l t of the c r i t i c a l event attributed considerable improvement i n attitude and personal regard as a result of the process r e c a l l . Two therapists i d e n t i f i e d a fresh motivation i n t h e i r c l i e n t s as a result of the process re-c a l l and this appeared to occur with dyads that were experiencing an impasse situation i n counselling. M l c l i e n t s believed they had gained from the experience, even when discomfort occurred. The ratings on the Process Recall instrument suggested perio-dic peaks throughout the session. Scores mainly occurred at the 5 "moderately significant" l e v e l , and c l i e n t s were obviously intimidated by the instruction "use sparingly" at the 6 and 7 ends of the scale. When they scored at the 6 and 7, i t appeared to be a serious decision that overrode the r e s t r i c t i o n . An unforeseen d i f f i c u l t y i n this study was the i d e n t i f i c a t i o n of n o n c r i t i c a l events that were de-terrained by a 3 or 4 rating on the Process Recall Scale. The deeper the c l i e n t went into the session, the more d i f f i c u l t i t was to attach limited significance to any of the dialogue.The c l i e n t tended to l i n k the importance of a l l dialogue to the relevance of the larger picture of problem issues. Perhaps i f a session had been selected on the basis of i t s limited significance t h i s problem would not have arisen. There also appeared t o be very l i t t l e content that the c l i e n t d i d not have an opinion on, and the 4 l e v e l "I don't know" was rarely used f o r scoring. The tendency to attach meaning to a l l dialogue a f t e r the f i r s t ten minutes supported H i l l e t a l . * s (1983) findings i n a 3-way s p l i t of the interview session. The highest l e v e l of experiencing appeared to occur i n the second t h i r d of the session. In t h i s study, the major-i t y of c r i t i c a l events occurred a f t e r the f i r s t t h i r d , and a higher incidence of n o n c r i t i c a l events happened i n the f i r s t t h i r d . No apparent relationship existed i n the content of a c r i t i c a l versus a n o n c r i t i c a l event, indicating one event d i d not influence another. However, only two n o n c r i t i c a l events followed a c r i t i c a l event which i s assumed would have the strongest e f f e c t . Client/Therapist Perceptions of Change Process The comparison of c l i e n t and therapist perceptions of the change events indicated that the c l i e n t i d e n t i f i e d change across a wider range of criteria, i.e. the client identified 22 dimensions and therapists identified 16. It also appeared that the client more frequently perceived change as insight while the therapist tended to identify client change as a cognitive reframing. The possibility existed that the participants overlapped on these definitions. Both client and therapist placed significant emotional impact high on their priority l i s t s , possibly because of the observable nature of high client affect i n a therapy session. However, this factor had different implications across clients. An inability to exper-ience emotionally was a key element i n three clients' core problems, while three other clients appeared to have a natural propensity for high affect. The therapists did not consider "emotional closeness with the therapist" and "distorted perceptions of the therapist" when called upon to consider the nature of client change. It appeared that these characteristics were perceived more to be basic factors in the counselling interaction than indicators of change, i.e. "emotional closeness" was related to client/therapist rapport and "distorted perceptions" were perceived to be examples of transference. It was found that the criteria developed by Rand (1978) covered a l l responses of clients and therapists, and there was no need to build extra categories into this framework. The comparison of client and therapist perceptions on the nature of the change process yielded a high level of agreement. Twenty-one of ^ responses attributed change exclusively to some element of counselling; 12 of which related to the therapist's interventions. Contrary to past research, there was l i t t l e evidence that the client or therapist perceived the therapy interaction as a collaborative effort. Cn the whole, clients attributed progress to the therapist's s k i l l s and the therapists f e l t the same. In the two instances where the clients attributed change to themselves, there was no apparent re-cognition of the therapist's contribution to the event. The clients were encouraged to explore a variety of factors, without direct re-ference to the therapist, but expansions tended to be related to self-perceptions. Interestingly, these two clients were the sub-jects who expressed hostility towards their therapists, although one of these issues was resolved on process recall. The two hostile clients and a third subject were being ad-ministered indirect counselling strategies ..which their therapists f e l t created the c r i t i c a l event. The clients however indicated no awareness that particular techniques were being used. Agreement between clients and therapists on the nature of the change process occurred as a result of the Gestalt two-chair interaction which i s easily recognizable by clients. Other clients responded to reflec-tion of their feelings which does not place the same demands on the client. This finding supported the Rice & Greenberg (in press) concept of "process diagnosis" as "markers" to the client's readi-ness to work on problems in particular ways. The therapist who perceived no change in his client as a re-sult of the c r i t i c a l event actually was tenronating treatment i n the session under study. The therapist accurately predicted this client's 100 emotional reaction to process recall, but perhaps his assessment of change would be better described as "anticipated no change" as a result of the event. The client perceived the episode as highly meaningful and instrumental i n creating change by the the-rapist 1 s intervention. The impact of the intervention was unexpec-ted, possibly contributing to the therapist's reservations about its effectiveness. ^Implications for Theory and Practice The results of this study suggested that a focus of atten-tion oh the c r i t i c a l events occurring during the therapy session offers valuable information on the nature of the client change process. It was also apparent that the client has an intuitive sense of ' the important features and the nonproductive elements of the interaction. The varying perceptions of events of the thera-pist and client suggested that assumptions regarding discrepancies would serve .the participants better than assumed agreement, part-icularly i f these differences were shared. The tendencies were for the therapist to identify change events in terms of the client's cognitive restructuring, while the client referred to insight as a kind of revelation that was accompanied by strong emotions. This feature has some relevance to the Frank (1982) study i n which clients favoured an insight-oriented therapy, while therapists tended to believe the client wanted more reality-oriented treatment. The degree to which the client's depth'of experiencing was as-sociated with a c r i t i c a l event and a noncritical event i n this study has important implications for the practice of psychotherapy, particularly when i t i s considered that the 24 3-minute episodes encompassed a range of treatment orientations under both the c r i -t i c a l and noncritical conditions. The level of client experiencing was an independent feature of the process and this result supports the contention that experiencing can be facilitated by any practi-tioner regardless of his orientation. The client appears to deter-mine i t s suitability at any point in time. The Experiencing Scale appears to be an effective tool in measuring the client's level of experiencing and might be used as an indicator of the client's progress as various stages of this graduated scale are reached and surpassed. The Vocal Quality Classi-fication System serves to confirm the findings of the Experiencing Scale. The use of the Speech Interaction System confirmed the pre-valence of increased periods of silence in the conditions where experiencing intensified. It i s suggested by these results that the importance of productive dialogue should be balanced with silence as a necessary condition of inward focusing. The rate of dialogue and quantity of speaking pauses are also measures of the success of a counselling session i f deeper level client experiencing i s the ob-jective. The timing of c r i t i c a l events as an area of study offered a better understanding of the sequential rhythms across the therapy hour from which predictions might be made regarding client behaviour and the most aavantageous taming and p a c i n g o f t h e r a p e u t i c i n t e r -v e n t i o n s . Knowing some o f t h e component processes i n terms o f emotional c h a r a c t e r i s t i c s and p r e v a i l i n g l e v e l s o f r e a d i n e s s may enable t h e t h e r a p i s t t o s e l e c t a p p r o p r i a t e s t r a t e g i e s a t a time when t h e i r e f f e c t i v e n e s s i s a s s u r e d . The c l i e n t and t h e r a p i s t responses t o what changed i n t h e c r i t i c a l event i n d i c a t e d a combination o f Rand's (1978) c r i t e r i a were o p e r a t i n g s i m u l t a n e o u s l y . The i m p l i c a t i o n o f t h i s f i n d i n g was t h a t some events c r e a t e a s i n g l e change f a c t o r and o t h e r s may impact on a number o f problem c o n c e r n s , e.g. a change event may n o t con-t a i n i n s i g h t a l o n e b u t may compound t o i n c l u d e i n s i g h t , c o g n i t i v e r e s t r u c t u r i n g and a new c l o s e n e s s w i t h the t h e r a p i s t . I f such qua-l i t y d i f f e r e n c e s e x i s t i n t h e change p r o c e s s , then the q u e s t i o n a r i s e s as t o what v a r i a t i o n s a r e p r e s e n t a c r o s s a group o f events c l a s s i f i e d as c r i t i c a l and what i n t e r n a l f a c t o r s i n a p o p u l a t i o n o f s u b j e c t s c o n t r i b u t e t o these v a r i a t i o n s . Recommendations f o r F u t u r e Research The f i r s t recommendation f o r r e s e a r c h would be a r e p l i c a t i o n o f t h i s study. O r l i n s k y & Howard (1978) a d v i s e d t h a t v e r y l i t t l e r e p l i c a -t i o n o f p r o c e s s i n v e s t i g a t i o n s has been made, and f i n d i n g s have r e -s t r i c t e d meaning w i t h o u t such v e r i f i c a t i o n from independent r e s e a r c h e r s . A r e p l i c a t i o n would g a i n from an i n c r e a s e i n p o p u l a t i o n s i z e , a b e t t e r b alance o f male and female s u b j e c t s , w i t h t h e c o n s i d e r a t i o n o f separate groups under t h e c r i t i c a l and n o n c r i t i c a l c o n d i t i o n s . More thought needs to be put into a method o f identifying non-c r i t i c a l events for comparison and might be achieved by the selec-tion of n o n c r i t i c a l sessions from which focal events could be taken. Taking n o n c r i t i c a l events from dif f e r e n t sessions than those used for the c r i t i c a l events provides the opportunity of matching the timing within the session where focal moments occur. A r e p l i c a t i o n study might also include an analysis of content and the c l a s s i f i c a t i o n o f dialogue. The use of H i l l ' s (1978) Coun-sel l o r Verbal Response Category system would give an indication of the type of intervention that precipitates a strong impact from the cli e n t . A sequential analysis of the therapist/client exchanges may also determine whether the c l i e n t reaction i s immediate or prompted by an e a r l i e r intervention. For example, i n t h i s study, one c l i e n t interrupted her own dialogue to comment on a therapist's suggestion that occurred three statements e a r l i e r . The compilation of c r i t i c a l and n o n c r i t i c a l episodes also offers substantial material f o r the study of the s t y l i s t i c complexity of language of the counsellor and .client (Meara e t a l . , 1979). I t would be interesting t o determine whether a tracking and convergence of language styles occurs i n both c r i t i c a l and n o n c r i t i c a l episodes ard whether a disp a r i t y exists or widens i n a n o n c r i t i c a l situation. I t would also be interesting to study how experiencing of the c l i e n t could be incorporated with d i f f e r e n t treatment orientations, without disturbing the basic techniques of a p a r t i c u l a r therapy. This would be p a r t i c u l a r l y challenging with the cognitive therapies that are less involved with internal focusing than experiential models. In this study, experiencing appeared to occur dramati-cally by use of the Gestalt two-chair technique, but this exercise created considerable difficulty for some clients who appeared to lack the creative, innovative s k i l l s to deal with a conflict sp l i t in this way. Other resistance appeared to be con-nected to a difficulty in comprehending the mechanics of the tech-nique. On the other hand, one subject appeared to have a natural s k i l l that utilized visualization and imagery. Perhaps certain qualities that distinguish these two types of clients by a classi-fication system resembling the resolver/nonresolver model might be developed as i t relates to natural competence and transitory states of mind. The Vocal Quality Classification System has been extensively used to measure the client's speech patterns as focused, emotional, external and limited. It i s also suggested that i t has application to the vocal quality of the therapist who may use voice to create an environment that encourages emulation of more focused and emotional tendencies. Wexler & Butler (1976) found that the deliberate adop-tion of a higher level of expressiveness established this pattern for nonexpressive clients, and i t i s f e l t that such a mood may be set that invites deeper experiencing. Nonverbal ccranunications might also provide valuable information on the different properties of c r i t i c a l and noncritical episodes. Greenberg (1983) expressed the current need for a nonverbal measure-ment, and the comparison of nonverbal cues under these two conditions 105 might o f f e r an e x c e l l e n t t e s t i n g ground f o r such a s c a l e . P o s s i b l y one o f the most unexpected r e s u l t s from t h i s s t u d y was t h e impact o f the I n t e r p e r s o n a l Process R e c a l l experience on s u b j e c t s . T h i s instrument was merely i n t e n d e d t o s e l e c t f o c a l event from c l i e n t e v a l u a t i o n s but p r o v i d e d c o n s i d e r a b l y more i n f o r m a t i o n . T h i s measure was reccnrnended f o r r a t i n g s i r t m e d i a t e l y f o l l o w i n g s e s s i o n s ( E l l i o t t , 1978). However, because o f the a v a i l a b i l i t y o f s i g n i f i c a n t s e s s i o n s extending back over s e v e r a l months, t h i s requirement was n o t f u l f i l l e d . The r e s u l t i n d i c a t e d t h a t a d e l a y e d time frame produced b e n e f i t s i n two important ways. F i r s t l y , t h e c l i e n t s gained new p e r s p e c t i v e s o f themselves and a new a p p r e c i a t i o n f o r t h e i r t h e r a p i s t s 1 involvement. One c l i e n t r e p o r t e d g r e a t e r change from t h e process r e c a l l t h a n from the c r i t i c a l event, and another r e s o l v e d a f e e l i n g o f h o s t i l i t y towards her t h e r a p i s t . Secondly, t h e c l i e n t s became aware o f t h e p r o g r e s s t h e y had made s i n c e t h e c r i t i c a l e vent had o c c u r r e d . T h i s v e r i f i c a t i o n o f movement by r e c a l l appeared t o have more impact and s u b s t a n t i a t i n g qua-l i t y than t h e r a p i s t r e a s s u r a n c e might p r o v i d e . I t would t h e r e f o r e appear u s e f u l t o conduct r e s e a r c h on the implementation o f the P r o c e s s R e c a l l S c a l e t o i n c r e a s e c l i e n t awareness and t o encourage c o n t i n u e d e f f o r t . I t appeared t o be p a r t i c u l a r l y f r u i t f u l f o r those o c c a s i o n s where treatment had reached an impasse and some form o f r e v i t a l i z a t i o n was c a l l e d f o r . The I n t e r p e r s o n a l P r o c e s s R e c a l l S c a l e might a l s o be combined w i t h the a n a l y s i s o f c r i t i c a l and n o n c r i t i c a l events i n t h e t r a i n i n g o f c o u n s e l l o r s who would n o t o n l y g a i n from t h e i r own performance a p p r a i s a l s over t i m e , b u t from those o f t h e i r s u p e r v i s o r s and c l i e n t s . It would be possible to plot variations in perceptions within and across sessions and progress of counselling s k i l l s over a training period. Certainly, in this study, the feedback directed to the participating therapists was of considerable interest to them in confirming their appraisals with the client's view and uncovering discrepancies of which they were unaware. Another possible focus for future research would be a grading system for c r i t i c a l events determined possibly by the level of im-pact and the long-term effects of apparent improvement, what diffe-rences exist i n movement to higher levels on the Experiencing Scale and can the client's state of readiness to change be antici-pated. Do particular counselling styles lend themselves to each graduation point on the scale and are these indicators that more responsibility and more demanding tasks should be assigned to the client? In this study, there was a high level of protectiveness dis-played by therapists towards their clients when sessions were highly experiential and sensitive to the invitation to participate i n re-search. It was therefore concluded that more powerful .sessions .would have to be postponed for study until the client had passed some c r i t i c a l point in treatment. The three clients who cried on recall were examples of a review a week after the session.. In conclusion, i t appears evident that the study of c r i t i c a l and noncritical events i s a means by which process can be effectively studied, compared and substantiated by the presence and the absence of the characteristics that create positive client change. BIBLIOGRAPHY Amira, Stephen A l a n . F i g u r a t i v e language and metaphor i n s u c c e s s f u l and u n s u c c e s s f u l psychotherapy. D i s s e r t a t i o n A b s t r a c t s I n t e r n a - t i o n a l , 1982, V o l . 4 3 , No.4, 1044B. Amundsen, Adrienne E l i z a b e t h . V a l u e s i n psychotherapy. D i s s e r t a t i o n  A b s t r a c t s I n t e r n a t i o n a l , 1981, V o l . 4 2 , No.4, 1594B. Ascher, L. and Turner, R. A comparison o f two nethods o f a d m i n i s t r a -t i o n o f p a r a d o x i c a l i n t e n t i o n . B e h a v i o r Research and Therapy, 1980, 18, 121-126. Auerbach, A. and Luborsky, L. Accuracy o f judgments o f psychotherapy and t h e n a t u r e , o f t h e "good hour". I n S h l i e n , J . (ed.), Research  i n psychotherapy,' V o l . 3 . Wash., D.C.: American P s y c h o l o g i c a l Asso-c i a t i o n , 19b8, 155-168. Bandler, R i c h a r d ana G r i n d e r , John, ReFraming Neurc>-Linguistic P r o -gramming ana t h e T r a n s f o r m a t i o n o f Meaning. Noab, Utah: R e a l People P r e s s , 1982. Barak, A. and LaCrosse, M.B. M u l t i d i m e n s i o n a l p e r c e p t i o n o f c o u n s e l o r b e h a v i o r . J o u r n a l o f (Zounseling Psychology, 1975, 22, 471-476. B a r r e t t - L e n n a r d , G.T. The empathy c y c i e : Refinement o f a n u c l e a r concept. J o u r n a l o f C o u n s e l i n g Psychology, 1981, 28, 91-100. Bart o n , A.K. F o l l o w i n g up on a f t e r c a r e : Show v e r s u s no-show r a t e s i n N o r t h C a r o l i n a . H o s p i t a l and (immunity P s y c h i a t r y , 1977, 28, 545-546. Beard, Myron Joseph. E f f e c t s o f n o n d i r e c t i v e ana p a r a d o x i c a l t h e r a -p i s t ccnrnunication on c o r e t n e r a p e u t i c c o n d i t i o n s and p e r c e i v e d c l i e n t i n f l u e n c e . D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1983, V o l . 4 3 , No.7, 2325B. B e l c o r e , Leonard P a t r i c k . The e f f e c t s o f d o c t o r s ' t o u c h i n g p a t i e n t s d u r i n g p a t i e n t v i s i t s as measured by p a t i e n t s ' r e p o r t s o f t n e i r a t t i -tudes towards p h y s i c i a n s and p r i m a r y m e d i c a l c a r e . D i s s e r t a t i o n Ab- s t r a c t s I n t e r n a t i o n a l , 1982, V o l . 4 2 , No.8, 2977B. B e r g i n , A.E. and Lambert, M.B. The e v a l u a t i o n o f t h e r a p e u t i c outcomes, i n S.L. G a r f i e l d and A.E. B e r g i n (eds.) Handbook o f psychotherapy  and b e h a v i o r change. New York: John W i l e y & Sons, 1978. B e r g i n , A.E. and Suinn, R.M. I n d i v i d u a l psychotherapy and b e h a v i o r t h e r a p y , Annual Review o r Psychology, 1975, 26, 509-556. 108 Bieber, M.R., Patton, M.J. and Fuhriman, A.J. A metalanguage analysis of counselor and client verb usage in counseling. .Journal of Coun- seling Psychology, 1977, 24, 264-271. Bordin, E.S. The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice, 1979, 16, 252,260. Brehm, S. Tne application of social psychology to c l i n i c a l practice, Morristown, N.J.: General Learning Press, 1976, Brunink, Sharon A. and Schroeder, Harold E. Verbal therapeutic be-havior of expert psychoanalytically oriented, Gestalt and behaviour therapists. Journal of Consulting and Clinical Psychology, 1979, Vol.47, No.3, 567-574. " Carlson, Jeanine R. Audiotape and videotape procedures: A study of subjects* reactions. Journal of Counseling Psychology, 1980, Vol.27, No.6, 605-610. Chaplin, J.P. Dictionary of Psychology, new revised edition.A Laurel Original, New York: Dell Publishing. Co.Inc., 1975, p.410. Church, Michael Seymour. Sequential analysis of mcment-by-marnent psy-chotherapy interactions. Dissertation Abstracts International, 1982, Vol.42, No.10, 4185B. Claiborn, CD. Interpretation and change in counseling. Journal of  Counseling Psychology, 1982, 29, 439-453. ' Claiborn, Charles D., Crawford, JacJc B. and Hackman, Hollis W. Effects of intervention discrepancy i n counseling for negative emotions, Journal of Counseling Psychology, 1983, Voo.30, No.2, 164-171. Cohen, Lawrence H. Clinical psycnologists 1 judgments of the scientific merit and clinical-relevance of psychotherapy outcome research. Journal of Consulting and Clinical Psychology, 1979, 47 (2), 421-3, Cooley, E.J. and Lajoy, R. Therapeutic relationship and improvement as perceived by clients and therapists. Journal of Clinical Psycho-logy, 1980, 36, 562-570. Cox, Beverlee. Communications systems in psychotherapy: An empirical investigation into treatment ideologies of patients and therapists. Dissertation Abstracts International, 197a. Vol.38, No.9. Craigie, F.C. and Jtoss, S.M. The use of videotape pre-therapy training program to encourage treatment seeking among alcohol de-toxification patients, Behavior Therapy, 1980, 11,141-147. Crohn, Joel. Interpersonal aspects of psychotherapy. Dissertation Abstracts International, Vol,38, No.6, 2852B and 2853B. Delenanry, Kosalyn, C o u n s e l i n g human beings o f t h e female sex. Ca- n a d i a n C o u n s e l l o r , 1979, V o l . 1 4 , N o . l , 12-16. Dye, L a r r y Wayne. E f f e c t s o f c o u n s e l o r touch on p e r c e i v e d c o u n s e l o r e x p e r t n e s s , a t t r a c t i v e n e s s and t r u s t w o r t h i n e s s . D i s s e r t a t i o n Ab-s t r a c t s I n t e r n a t i o n a l , 1983, V o l . 4 4 , No.2,' 604B. E i s e r i b e r g , Sheldon and Delaney, D a n i e l J . The c o u n s e l i n g p r o c e s s . Chicago, I l l i n o i s : Rand M c N a l l y C o l l e g e P u b l i d i i n g Company, 1977, 63-65. E l l i o t t , R. How c l i e n t s p e r c e i v e h e l p e r b e n a v i o r s . J o u r n a l o f Coun- s e l i n g Psychology, 1979, 26, 285-294. E l l i o t t , R. F i t t i n g p r o c e s s r e s e a r c h t o the working c l i n i c i a n . EPIC/CAPS. Resources i n E a u c a t i o n , 1981. E l l i o t t , Robert. "That i n your Hands" A comprehensive p r o c e s s a n a l y s i s o f a s i g n i f i c a n t e v e n t i n psychotherapy. Psychiatry,' 1983, V o l . 4 6 , 113-129. E l l s w o r t h , Robert B.,. Casey, Nancy A., Hickey, Robert Y., Twemlow, S t u a r t W,, C o l l i n s , Joseph F., Schoonover, R e g i n a l d A., Hyer, Leon and Nesselroade, John K. Some c h a r a c t e r i s t i c s o f e f f e c t i v e p s y c h i a -t r i c treatment programs. J o u r n a l o f C o n s u l t i n g and C l i n i c a l P sychology, 1979, V o l . 4 7 , No.5, 799-817. Feldman, L a u r i e P. Sex e f f e c t s i n therapy p r o c e s s measures o f dominance and dependency. D i s s e r t a t i o n A p s t r a c t s I n t e r n a t i o n a l , 1978, V o l . 3 9 , N o . l , 376B. F e l d s t e i n , J.C. and G l a d s t e i n , G.A. A comparison o f t h e c o n s t r u c t v a l i d i t i e s o f f o u r measures o f empathy. Measurement and E v a l u a t i o n  i n Guidance, 1980, 13, 49-57. Ferguson, George A. S t a t i s t i c a l A n a l y s i s i n Psychology and E d u c a t i o n . F i f t h E o i t i o n . New York: McGraw-Hill Book Company, 1981. F e s s l e r , Robert K. A phenomenological i n v e s t i g a t i o n o f p s y c h o t h e r a p e u t i c i n t e r p r e t a t i o n . D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1978, 39, 2981B and 2982B. F i n e , Leon J . I n Raymond J . C o r s i n i and C o n t r i b u t o r s (2nd e d i t i o n ) C u r r e n t P s y c h o t h e r a p i e s . I l l i n o i s : F.E. Peacock P u b l i s h e r s , 1979, 428-459. Fosha, Diana. F l a t a f f e c t as phenomenon and p r e d i c t o r o f s h o r t - t e r m outcome i n p s y c h o s i s : Words w i t h o u t f e e l i n g s , f e e l i n g s w i t h o u t words. D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1983, V o l . 4 3 , No.9, 3028B. Franco, Edward A. Therapist: personality and verbal behavior in therapy hour: An analytical study of psychotherapy with schizophrenic and neurotic clients. Dissertation Abstracts International, 1978,Vol.38, No.9, 44b3B. Frank, Arlene Freda. Patient requests and treatment outcome in an inpatient psychiatric setting: Patients' and therapists' perspec-tives. Dissertation Abstracts International, 1982, Vol.42, No.8, 3418B. Fretz, B.R., Corn, R., Tuertinler, J.M. and Belief, W. Counselor non-verbal behaviors and client evaluations. Journal of Counseling  Psychology, 1979, 26,' 304-311. Fridman, M.S. and Stone, S.C. Effect of training, stimulus context and mode of stimulus presentation on empathy ratings. Journal of Counseling Psychology, 1978, 25, 131-136. Friedeman, Sheila Dickson Sweet. The effects of sexual contact between therapist and client on psychotherapy outcome. Dissertation Abstracts  International, 1983, Vol.44, No.2, 606B. Gaff in, Gerald Lee. Client-therapist complementarity as i t relates to the process and outcome of psychotherapy. Dissertation Abstracts  International, 1981, Vol.42, No.4, 1603B. Gendlin, Eugene T. The role of knowledge in practice, in Gail F. Farwell, Neal R. Gamsky, Philippa Mathieu-Coughlan (eds.) The  Counselor's Handbook, New York: Intent Educational Publishers, 1969. Gendlin, E.T. Experiential Psychotherapy, in R.J. Corsini, ed., Current Psychotherapies, Second Edition, Itasca, Illinois: Peacock, 1979, 340-373. Gendlin, E.T. and Zimring, F.M. The qualities or dimension of experien-cing and their change. University of Chicago library, Counseling  Center Discussion Papers, 1955, 1(3). Gendlin, E.T. Experiencing and the creation of meaning. New York: Free Press of Glencoe, 1962. Gendlin, E.T. and Tomlinson, T.M. Psychotherapy process rating scale: Experiencing (EXP) Scale. Unpublished manuscript, Wisconsin Psychiatric Institute, 1961. Gladstein, G.A. Empathy and counseling outcome: An empirical and conceptual review. Counseling Psychologist, 1977, 6, 70-79. Gladstein, Gerald A. Understanding empathy: Integrating counseling, developmental and social psychology perspectives. Journal of Counseling  Psychology, 1983, Vol.30, No.4, 467-482. Goldfried, M. And Davison, G.- Clin i c a l Behavior Therapy/ New York: Holt, Rinehart and Winston, 1976. Gombatz, Michael. The effectiveness on problem resolution of three different modalities: C l i e n t centered, Rational Emotive therapy and paradoxical directives. Dissertation Abstracts International, 1983, Vol.44, No.4, 1237B. Cores-Schwartz, B. Effective ingredients i n psychotherapy: Predic-tion of outcome from process variables. Journal of Consulting and  C l i n i c a l Psychology, 1978, Vol.46, 1023-2035. Goodman, G. Sashatapes: S e l f - l e d automated series on help-intended  alternatives. Los Angeles: UCLA Extension, Department of Human Development, 1979. Gottman, J.M. and Markman, H.J. Experimental designs i n psychotherapy research. In S.L. Ga r f i e l d and A.E.Bergin (Eds.) Handbook of psycho- therapy and behavior change (2nd ed.) New York: Wiley, 1978. " Graves, J.R. and Ro Vinson, J.D. Proxemic behavior as a function of inconsistent verbal and nonverbal messages.- Journal of Counseling  Psychology, 1976, Vol.23, 333-8. Greenberg, L e s l i e S. Psychotherapy process research. In C. Eugene Walker (ed.), The Handbook of C l i n i c a l Psychology, Theory, Research  and Practice, Vol.1, Homewood, I l l i n o i s : Dow Jones-Irwin, 1983, 169-204. Greenberg, L.S.The intensive analysis of recurring events from the practice of Gestalt therapy. Psychotherapy: Theory Research and  Practice, 1980, 17, 143-152. Greenberg, L.S. A task analytic approach to the study of psychotherapy  events. Unpublished doctoral dissertation, York University, 19/5. Greenberg, L.S. and Webster, M, Resolving decisional c o n f l i c t : Rela-ting process to outcome. Journal of Counseling Psychology, 1982, Vol.29, 468-77. Gruder, David S. C l i e n t q u a l i t i e s in-therapy perceived to be related to outcome: A retrospective study. Dissertation Abstracts Interna- t i o n a l , 1983, Vol.43, NO.10, 3362B-3B. Hackney, H. The evolution of empathy. Personnel and Guidance Journal, 1978, 57, 14-18. Haley, J . Problem-solving therapy. San Francisco: Jossey-Bass, 1976. Hassell, Perry Len. Differences i n nonverbal behavior and i n t e r -personal relationships of violent and nonviolent adolescents. Dissertation Abstracts International, 1983, Vol.44, No.3, 911B. Hawes, Richard John. Satisfaction with therapy, early termination, mixed sessions and patients' views of their therapists as a fun-ction of patient-therapist personality s i m i l a r i t y . Dissertation  Abstracts International, 1983, Vol.44, No.3, 912B. Helms, J.E. A comparison of two types of counseling analogues, Journal of Counseling Psychology, 1976, 23, 422V7. Helms, J.E. Counselor reactions to female c l i e n t s : Generalizing from analogue research to a counseling setting. Journal of Counseling  Psychology, 1978, 25, ly3-y. H i l l , Clara E. Counseling process research: philosophical and methodo-, l o g i c a l dilemmas. The Counseling Psychologist, 1982, Vol.10, No.4,7. H i l l , Clara E., Siegelman, Larry, Gronsky, Barbara R., Sterniolo, Frank and Fretz, Bruce R. Nonverbal coinmunicaticn and counseling outcome, Journal of Counseling Psychology, 1981, Vol.28, No.3, 203-212. H i l l , C E . and Gormally, J . Effects of rerlection, restatement, probe and nonverbal behaviors on c l i e n t affect. Journal of Counseling  Psychology, 1977, Vol.24, 92-97. H i l l , C E . and King, J . Perceptions of empathy as a function of the measuring instrument. Journal of Counseling Psychology, 1976, 23, 155-157. H i l l , C E . , Thames, T.B. and Rardin, D.K. Comparison of Rogers, Perls and E l l i s on the H i l l Counselor Verbal Response Category System. Journal of Counseling Psychology, 1979, 26, 198-203. H i l l , Clara E., Carter, Jean A. and O'Farrell, Mary K. A case study of the process and outcome of time limited counseling. Journal of  Counseling Psychology, 1983, Vol.30, 3-18. H i l l , C E . Development of a counselor verbal response category system, Journal of Counseling Psychology, 1978, 25, 461-468. Hoffman, M.A. and Spencer, G.P. Effect of interviewer self-disclosure and interviewer-subject sex pairing on perceived and actual subject behavior. Journal of Counseling Psychology, 1977, 24, 383-390. Hogan, Leigh D., Beck, Niels C., Kunce, Joseph T. and Heisler, Gerald H. F a c i l i t e t i n g psychiatric patient follow-up: A study of transfer a t t r i t i o n . Journal of C l i n i c a l Psychology, July 1983, Vol.39, No.4, 494-498. Holden, Myrna and Quan, Annette. The use o f the n e g a t i v e t r a n s f e r -ence i n a f o l l o w - u p s t u d y : I t s impact on s h o r t - t e r m psychotherapy. D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1983, Vol.44, N o . l , 310B. H o r e n s t e i n , D. and Houston, B.K. The e x p e c t a t i o n - r e a l i t y d i s c r e p a n c y and premature t e r m i n a t i o n from psychotherapy. J o u r n a l o f C l i n i c a l  Psychology, 1976, 32, 373-8. Horn-George, J a c q u e l i n e B. The t h e r a p i s t - c l i e n t r e l a t i o n s h i p i n long-versus s h o r t - t e r m psychotherapy. D i s s e r t a t i o n A b s t r a c t s  I n t e r n a t i o n a l , 1981, V o l . 4 2 , No.4, 1609B. Howard, George S. Toward i r e t h o d o l o g i c a l p l u r a l i s m . J o u r n a l o f Coun- s e l i n g Psychology, 1983, V o l . 3 0 , N o . l , 19-21. I n g a l l s , C h r i s t o p h e r Warren. The e f f e c t o f age on the p s y c h o l o g i c a l e v a l u a t i o n o f the depressed c l i e n t : A comparison between c l i n i c a l p s y c h o l o g i s t s and s p e c i a l i s t s i n a g i n g . D i s s e r t a t i o n A b s t r a c t s I n - t e r n a t i o n a l , 1983, V o l . 4 4 , No.4, 1240B. Isa a c , Stephen and M i c h a e l , W i l l i a m B. Handbook i n Research and E v a l u a -t i o n . 2nd e d i t i o n , San Diego, C a l i f . : EDITS P u b l i s h e r s , 1982. Jan, D. and L i c h s t e i n , K. The r e s i s t i v e c l i e n t : A n e g l e c t e d phenomenon. Behavior M o d i f i c a t i o n , 1980, 4, 303-320. Janesh, Ronald Jerome. A r e p l i c a t i o n study o f the e f f e c t s o f o b j e c t i v e evidence o f e x p e r t n e s s , n o n v e r b a l b e h a v i o r and s u b j e c t sex on c l i e n t p e r c e i v e d e x p e r t n e s s . D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1982, Vol.43, to.3, 872B. Jes s e e , E. and L'Abate, L. The use o f paradox w i t h c h i l d r e n i n an i n p a t i e n t s e t t i n g . F a m i l y P r o c e s s , 1980, 19, 59-64. J o u r a r d , S.M. E x i s t e n t i a l q u e s t . I n A. Wanderman, P.Poppen and D. R i c k s (eds.) Humanism and Behaviorism: Dialogue and Growth. Ox f o r d , New York: Pergamon P r e s s , 1976. K i e s l e r , Donald J . Reaction:The comeback t r a i l f o r p r o c e s s a n a l y s i s . The C o u n s e l i n g P s y c h o l o g i s t , 1982, Vol.10, No.4, 21. K i e s l e r , Donald J . The p r o c e s s or psychotherapy, e m p i r i c a l f o u n d a t i o n s  and systems o f a n a l y s i s . Chicago: A l d i n e P u b l i s h i n g Company, 1973. K i n g , L a u r e l Ann. E a r l y t e r m i n a t i o n from therapy a t a u n i v e r s i t y coun-s e l i n g c e n t e r . D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1983, V o l . 4 3 , No.2, 4150B. K i v l i n g h a m , Dennis M a r t i n . The e f f e c t s o f t h e c o n t e n t and t i m i n g o f t r a i n i n g i n t e r v e n t i o n s on group therapy p r o c e s s and outcome. D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1982, V o l . 4 3 , No.2, 1986B. K o l b , D a n i e l Len. An examination o f psychotherapy p r o c e s s and o u t -come: The r o l e s o f p a t i e n t l o c u s o f c o n t r o l , p e r c e p t i o n o f the q u a l i t y o f the t h e r a p e u t i c r e l a t i o n s h i p and involvement i n therapy. D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1982, V o l . 4 2 , No.11, 4581B. K l e i n , M.H., M a t h i e u , P.L., G e n d l i n , E.T. and K i e s l e r , D.J. The E x p e r i e n c i n g S c a l e : A r e s e a r c h and t r a i n i n g manual. Madison: Wiscon-s i n P s y c h i a t r i c I n s t i t u t e , Bureau o f Audio V i s u a l I n s t r u c t i o n , 1970. K l e i n , M a r j o r i e , Mathieu-Coughlan, P h i l i p p a and K i e s l e r , Donald J . I n L. Greenberg and W. P i n s o f (eds.) The P s y c h o t h e r a p e u t i c P r o c e s s : A Research Handbook. New York: G u i l f o r d P r e s s .(in p r e s s ) . K l e i n k e , C h r i s L. and T u l l y , T r a c y Beach. I n f l u e n c e o f t a l k i n g l e v e l on p e r c e p t i o n s o f c o u n s e l l o r s . J o u r n a l o f C o u n s e l i n g Psychology, 1979, V o l . 2 6 , N o . l , 23-29. Kohut, H. The s e a r c h f o r t h e s e l f . New York: I n t e r n a t i o n a l U n i v e r -s i t i e s P r e s s , 1978. K o l k o , David J . and M i l a n , M i c h a e l A. Refraining and p a r a d o x i c a l i n s t r u c t i o n t o overcame r e s i s t a n c e i n the treatment o f d e l i n q u e n t youths: A m u l t i p l e b a s e l i n e a n a l y s e s . J o u r n a l o f C o n s u l t i n g and  C l i n i c a l Psychology, 1983, V o l . 5 1 , No.5, 655-660. K u b i n s k i , John A. A n a l y z i n g p e r c e p t i o n s o f c o u n s e l o r u s i n g m u l t i -d i m e n s i o n a l s e a l i n g . D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1983, V o l . 4 4 , No.3, 916B. LaCrosse, M i c h a e l B, Comparative p e r c e p t i o n s o f c o u n s e l o r b e h a v i o r : A r e p l i c a t i o n and e x t e n s i o n . J o u r n a l o f C o u n s e l i n g Psychology, 1977, V o l . 2 4 , No.6, 464-71. LaCrosse, M.B. P e r c e i v e d c o u n s e l o r s o c i a l i n f l u e n c e and c o u n s e l i n g outcome, v a l i d i t y o f t h e c o u n s e l o r r a t i n g form. J o u r n a l o f C o u n s e l i n g  Psychology, 1980, 27, 320-7. Lambert, M.J. and B e r g i n , A.E. T h e r a p i s t c h a r a c t e r i s t i c s and t h e i r c o n t r i b u t i o n . I n C.E-gene Walker (Ed.), The Handbook o f C l i n i c a l  P sychology, Theory, Research and P r a c t i c e , V o l . 1 . Homewood, I l l i -n o i s : Dow J o n e s - I r w i n , 1983. Lambert, M.J., D e J u l i o , S.S. and S t e i n , D.M. T h e r a p i s t i n t e r p e r s o n a l s k i l l s : P r o c e s s , outcome, m e t h o d o l o g i c a l c o n s i d e r a t i o n s and recom-mendations f o r f u t u r e r e s e a r c h . P s y c h o l o g i c a l B u l l e t i n , 1978, 85, 467-89. 115 Lambert, Michael J . comments on "A case study of the process and outcome of time limited counseling". Journal of Counseling Psy- chology, 1983, Vol.30, No.l, 22-5. Lamontagne, Y. Treatment of erythrophobia by paradoxical intention. Journal of Nervous and Mental Disease, 1978, 166, 304-6. Lewis, Nona L. Ego boundaries and comprehension of metaphor i n schizo-phrenia: A study of symbolic processes. Dissertation Abstracts In- ternational, 1983, Vol.44 (3), 918B. Lichtenberg, James W. and Barke, Kathryn Heider. Investigation of transactional corrrnunication relationship patterns i n counseling. Journal of Counseling Psychology, 1981, Vol.28 (6), 471-80. Luborsky, L. Quantitative research on psychoanalytic therapy. In S.L. Garfield and A.E. Berg i n (eds.) Handbook of psychotherapy and behavior  change. New York: John Wiley & Sons, 1978. Mahrer, Alvin R., F e l l e r s , G l o r i a L.Durak, Gary M., Gervaize, Patri c i a A., and Brown, Sheila, D. When does the counsellor s e l f -disclose and what are the in-counselling consequences? Canadian  Counsellor, 1981, Vol.15 (4), 175-8. Malan, D.H. Individual psychotherapy and the science of psychodynamics. London: Butterworth, 1979. Matarazzo, J.D., Wiens, A.N., Matarazzo, R.G. and Saslow, G. Speech and silence behavior i n c l i n i c a l psychotherapy and i t s laboratory correlates. In J.M. Schlien, H.F. Hunt, J.D. Matarazzo and C. Savage (eds.), Research i n Psychotherapy, Vol.3, Washington, D.C: American Psychological Association, 1968, 347-94. May, Gregory D. Psychotherapy and language l i n g u i s t i c convergence be-tween therapist and c l i e n t , Dissertation Abstracts International, 1977, Vol.38 (5), 2375B. McCraine, E.W. and M e z i l l , T.A. Aftercare for psychiatric patients: Does i t prevent rehospitalization? Hospital and Community Psychiatry, 1978, 29, 554-87. McDaniel, Susan H. Correlations of male college students* verbal response mode use i n psychotherapy with measures of psychological disturbance and psychotherapy outcome. Journal of Consulting and  C l i n i c a l Psychology, 1981, Vol.49 (4), 571-82. Meara, N.M., Pepinsky, H.B., Shannon, J.W. and Murray, W.A. Comparison of the s t y l i s t i c complexity of the language of counselor and c l i e n t across three theoretical orientations. Journal of Counseling Psychology, 1979, 26 (3), 181-9. 116 Meara, Nacmi M., P e p i n s k y , H a r o l d B., Shannon, Joseph W. and Murray, W i l l i a m A. Semantic ccmmunication and e x p e c t a t i o n s f o r c o u n s e l i n g a c r o s s t h r e e o r i e n t a t i o n s . J o u r n a l o f C o u n s e l i n g Psychology, 1981, Vol.28 ( 2 ) , 110-8. M i n d i e s , L.A. Nonverbal r e c i p r o c i t y : F a c i l i t a t o r o f c o u n s e l i n g p r o -cess? D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1977, V o l . 3 8 , No.5, 2377B. " M i n t z , J i m and Luborsky, L e s t e r . Segments v e r s u s whole s e s s i o n s : Which i s t h e b e t t e r u n i t f o r psychotherapy p r o c e s s r e s e a r c h ? J o u r - n a l o f Abnormal Psychology, 1971, 78 ( 2 ) , 180-191. M i n t z , J . , Auerbach, A., Luborsky, L., and Johnson, M. P a t i e n t ' s , t h e r a p i s t ' s and o b s e r v e r ' s views o f psychotherapy: A "Rashomon" ex p e r i e n c e o r a r e a s o n a b l e consensus? B r i t i s h J o u r n a l o f M e d i c a l Psychology, 1973, 46 ( 1 ) , 83-89. Molner, Suzanne L o u i s e . C o u n s e l i n g process and premature termination, D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1983, Vol.43 ( 9 ) , 3036B. Nagy, T.F. T h e r a p i s t l e v e l o f f u n c t i o n i n g and change i n c l i e n t s ' q u a n t i f i a b l e a n x i e t y l e v e l and v e r b a l behaviour. D i s s e r t a t i o n Ab- s t r a c t s I n t e r n a t i o n a l , 1973, 34, 878B-879B. N i c h o l a s , Dennis P. W i l l t o power as a p s y c h o l o g i c a l model f o r under-s t a n d i n g t h e t h e r a p e u t i c p r o c e s s . D i s s e r t a t i o n A b s t r a c t s I n t e r n a - t i o n a l , 1978, Vol.39 ( 1 ) , 133A. O'Malley, Stephanie S., Chong, S. Suh and Strupp, Hans H. The Vander-b i l t psychotherapy p r o c e s s s c a l e : A r e p o r t on t h e s c a l e development and a process-outcome s t u d y . - J o u r n a l o f C o n s u l t i n g and C l i n i c a l  Psychology, 1983, V o l . 5 1 ( 4 ) , 581-6. O r l i n s k y , D.E. and Howard, K . I . The r e l a t i o n o f p r o c e s s t o outcome i n psychotherapy. I n S.L. G a r f i e l d and A.E. B e r g i n (2nd e d i t i o n ) , Hand- book o f psychotherapy and b e h a v i o r change. New York: John W i l e y & Sons, I n c . , 1978, 283-330. O r l i n s k y , D.E. and Howard, K . I . The good therapy hour: E x p e r i m e n t a l c o r r e l a t e s o f p a t i e n t s ' and t h e r a p i s t s ' e v a l u a t i o n s o f t h e r a p y s e s -s i o n s . _ A r c h i v e s _ o f _ G e n e r a l ^ 1967, 16, 621-632. Otteson, James P. C u r a t i v e c a r i n g : The use o f buddy groups w i t h c h r o n i c s c h i z o p h r e n i c s . J o u r n a l o f C o n s u l t i n g and C l i n i c a l P s y c hology, 1979, Vol.47 ( 3 ) , 649-51. P a r l o f f , M., Waskow, I . and Wolfe, B. Research on t h e r a p i s t v a r i a b l e s i n r e l a t i o n t o p r o c e s s and outcome. I n S.L. G a r v i e l d and A.E.Bergin (Eds.) Handbook o f psychotherapy and b e h a v i o r change: An e m p i r i c a l a n a l y s i s (2nd e d i t i o n ) New York: W i l e y , 1978. _~~ P a s t e r , Mary Rose CXiinn. The i n f l u e n c e o f t h e r a p i s t s ' sex r o l e o r i e n -t a t i o n and gender on c l i n i c a l e v a l u a t i o n s . D i s s e r t a t i o n A b s t r a c t s  I n t e r n a t i o n a l , 1982, V o l . 4 2 , No.8, 3435B. P a t t o n , M i c h a e l J . R e a c t i o n : A m e t h o d o l o g i c a l p r e f a c e t o r e s e a r c h on c o u n s e l i n g . The C o u n s e l i n g P s y c h o l o g i s t , 1982, V o l . 1 0 , No.4, 23. P a t t o n , M.H., Fuhriman, A.H, and B i e b e r , M.R. A model and a metalan-guage f o r r e s e a r c h on p s y c h o l o g i c a l c o u n s e l i n g . J o u r n a l o f C o u n s e l i n g  Psychology, 1977, V o l . 2 4 , 25-34. P e i s e r , I l e n e . S i m i l a r i t y , l i k i n g and missed s e s s i o n s i n r e l a t i o n t o psychotherapy outcome. D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1982, V o l . 4 2 , No.11, 4587B. Pepinsky, H.B. and K a r s t , T.O. A metalanguage o f t e x t . I n H. F i s h e r and R. D i a z - G u e r r e r o (Eds.) Language and l o g i c i n p e r s o n a l i t y and  s o c i e t y , New York: Academic P r e s s , 1977. P e t e r s o n , G a i l and B r a d l e y , R i c h a r d W, Counselor o r i e n t a t i o n and t h e o r e t i c a l a t t i t u d e s toward c o u n s e l i n g : H i s t o r i c a l p e r s p e c t i v e and new d a t a . J o u r n a l o f C o u n s e l i n g Psychology, 1980, Vol.27 ( 6 ) , 554-6U. P e t r o , C a r o l e Smith and Hansen, James C. Counselor sex and empathic judgment. J o u r n a l o f C o u n s e l i n g Psychology, 1977, V o l . 2 4 , No.4, 373-6. Ponzo, Zander. C o u n s e l i n g t h e e l d e r l y : A l i f e t i m e p r o c e s s . C o u n s e l i n g  and V a l u e s , 1 9 o l , vol.26 ( 1 ) , 68-80. Pope, B. The mental h e a l t h i n t e r v i e w . E l m s f o r d , New Yorx: Pergamon P r e s s , 1979. P r a t t , George J . R e l a t i v e c o n t r i b u t i o n o f v e r o a l and nonverbal communi-c a t i o n i n psychotherapy. D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1978, 38, 44/7B. Rand, N e i l B. An e x p l o r a t o r y s t u d y o f " c r i t i c a l s e s s i o n s " i n i n d i v i -d u a l a d u l t psychotherapy. D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1978, Vol.39 ( 7 ) , 353bB. R i c e , L.N. and Greenberg, L.S. P a t t e r n s o f change: An i n t e n s i v e a n a l y s i s  o f p s y c h o t h e r a p e u t i c p r o c e s s . New York: G u i l f o r d P r e s s ( i n p r e s s ) . R i c e , L. and G a y l i n , N. P e r s o n a l i t y p r o c e s s e s r e f l e c t e d i n c l i e n t v o c a l s t y l e and Rorschach performance. J o u r n a l o f C o u n s e l l i n g and C l i n i c a l  P sychology, 1973, 40, 133-138. 118 R i c e , L., Koke, C., Greenberg, L. and Wagstaff, A. Manual f o r c l i e n t v o c a l q u a l i t y . Toronto: York U n i v e r s i t y C o u n s e l l i n g and Development C e n t r e , 1979. R i c e , L. and Wagstaff, A. C l i e n t v o i c e q u a l i t y and e x p e r e s s i v e s t y l e as indexes o f p r o d u c t i v e psychotherapy. J o u r n a l o f C o n s u l t i n g Psycho- l o g y , 1967, 31, 557-563. Robertson, Helen C a l d w e l l . P r e p a r i n g p a t i e n t f o r therapy: The e f f e c t s o f p r e therapy t r a i n i n g f i l m on d u r a t i o n and outcome o f treatment. D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1982, 43 ( 2 ) , 2000B. Rogers, C.G. Person-centered therapy. I n R.J, C o e s i n i , ed. C u r r e n t  P s y c h o t h e r a p i e s , 2nd e d i t i o n . I t a s c a , I L : Peacock, 1979, 131. Rogers, C.G. A p r o c e s s c o n c e p t i o n o t psychotherapy. American P s y c h o l o - g i s t , 1958, 13, 142-149. Rogers, C a r l R. A t h e o r y o f t h e r a p y , p e r s o n a l i t y , and i n t e r p e r s o n a l r e l a t i o n s n i p s , as developed i n the c l i e n c - c e n t e r e a framework, i n S. Kocn i e d . ) , Psychology: A study o f a s c i e n c e , V o l . I I I . F o r m u l a t i o n s  o f the person and the s o c i a l c o n t e x t . New York: M c G r a w - H i l l , 1959, 184-256. Ross, Sherr y A. V a r i a b l e s a s s o c i a t e d w i t h - d r o p p i n g o u t o f t h e r a p y . D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1983, Vol.44 ( 2 ) , 616B. Rouse, Lynn A.G. P a t i e n t s ' and t h e r a p i s t s ' e x p e c t a t i o n s and p e r c e p t i o n s o f p r o g r e s s and impasse i n psychotherapy. D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1983, Vol.44 ( 4 ) , 1252B. Sacks, H., S c h e g l o f f , E,A, and J e f f e r s o n , G. "A s i m p l e s t s y s t e m a t i c s f o r t h e o r g a n i z a t i o n o f t u r n - t a k i n g i n c o n v e r s a t i o n " , i n J.Schenkein, ed. S t u d i e s i n t h e O r g a n i z a t i o n o f C o n v e r s a t i o n a l I n t e r a c t i o n , Academic P r e s s , 1978. S a r b i n , T.R. ana Mancuso, J . S c h i z o p h r e n i a - M e d i c a l D i a g n o s i s o r  M o r a l V e r d i c t ? Pergamon, 19SCK S a t i r , V i r g i n i a . C o n j o i n t F a m i l y Therapy. P a l o A l t a , C a l i f . : S c i e nce and Behavior Books I n c . , 1967. S c h a f f e r , Norman D. The impact o f t h e r a p i s t p e r s o n a l i t y v a r i a b l e s on p s y c h o t h e r a p e u t i c p r o c e s s . D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1977, V o l . 3 9 , N o . l , 397B. Schenkein, J . , Ed. S t u d i e s i n the o r g a n i z a t i o n o f c o n v e r s a t i o n a l  i n t e r a c t i o n , Academic P r e s s , 1978. Schuh, M a r t i n George. The r e l a t i o n s h i p o f p a t i e n t and t h e r a p i s t v a r i a b l e s t o group t h e r a p y reccrnrrendations. D i s s e r t a t i o n Abstracts  I n t e r n a t i o n a l , 1981, Vol.42 ( 3 ) , 1190B-1B. Schwartz, Wendy G a i l . The n a t u r e and r o l e o f the t h e r a p e u t i c a l l i a n c e i n psycnotherapy: A c o n s t r u c t v a l i d i t y study. D i s s e r t a t i o n A b s t r a c t s  I n t e r n a t i o n a l , 1983, Vol.44 ( 3 ) , 927B. S e l l t i z , C l a i r e , Wrightsman,..Lawrence S. and Cook, S t u e a r t W. Research  Methods i n S o c i a l R e l a t i o n s . 3 r d e d i t i o n . New York: H o l t , R i n e h a r t and Winston, 1976. Shap i r o , D., Barkham, M. and I r v i n g , L. Helper Behaviour R a t i n g Manual, u n p u b l i s h e d , u n i v e r s i t y o f S h e f f i e l d , England, 1980. Sharf, R i c h a r d S. ana B i s h o p , John B. Counselors' f e e l i n g s toward c l i e n t s as r e l a t e d t o i n t a k e judgments and outcome v a r i a o l e s . J o u r n a l  o f C o u n s e l i n g Psychology, 1979, V o l . 2 6 , No.2, 140-5. Shullman, R., Storm, C.L. and S p r e n k l e , D.H. Therapy based on a c y b e r - n e t i c epistemology. Proolems and s o l u t i o n s f o r the r e s e a r c h e r . P a n e l pre s e n t e d a t tne Annual M e e t i n g o f tne American A s s o c i a t i o n r o r Marriage and F a m i l y Therapy, D a l l a s , Oct.1982. S i l v e r b e r g , Rooert Thomas. E f f e c t s o f c o n f i r m a t i o n and d i s c o n f i r m a t i o n o t c l i e n t r o i e e x p e c t a t i o n s on c l i e n t s a t i s t a c t i o n , l e n g t h o f t h e r a p y and outcome r a t i n g s o f psychotherapy. D i s s e r t a t i o n A b s t r a c t s I n t e r n a - t i o n a l , 1982, Vol.42 18), 3442B. Smith-Hanen, S. E f f e c t s o f n o n v e r b a l b e h a v i o r s on judged l e v e l s o f c o u n s e l o r warmth and empathy. J o u r n a l o f C o u n s e l i n g Psychology, 1977, Voi.24, 87-91. Spooner, S.E. and Stone, S.C. Maintenance o f s p e c i f i c c o u n s e l i n g s k i l l s o v e r time. J o u r n a l o f C o u n s e l i n g Psychology, 1977, 24, 66-71. S t a p l e s , F r e d R., Sloane, R. Bruce, Whipple, K a t h e r i n e , C r i s t o l , A l l e n H. and Y o r k s t o n , N e i l . P r o c e s s and outcome i n psychotherapy and b e n a v i o r therapy. J o u r n a l o f C o n s u l t i n g and C l i n i c a l Psychology, 1976, V o l . 4 4 , No. 3, 340-50. Stearns, Beth C., Penner, L o u i s A. and Kimmel, E l l e n . Sexism among p s y c h o t h e r a p i s t s : A case n o t y e t proven. J o u r n a l o f C o n s u l t i n g  and C l i n i c a l Psychology, 1980, Vol.48 ( 4 ) , 548-550. S t i l e s , W i l l i a m B. Measurement o f t h e impact o f psychotherapy s e s -s i o n s , J o u r n a l o f C o n s u l t i n g ana C l i n i c a l Psychology, 1980, V o l . 4 8 , ( 2 ) , 186-185. 120 S t i l e s , W i l l i a m B., McDa n i e l , Susan H. and McGaughey, Kim. V e r b a l response mode c o r r e l a t e s o f e x p e r i e n c i n g . J o u r n a l o f C o n s u l t i n g and C l i n i c a l Psychology, 1979, Vol.47 ( 4 ) , 795-7. S t o c K w e l l , S.R. and Dye, A. E f f e c t s o f c o u n s e l o r touch on c o u n s e l i n g outcome. J o u r n a l o f C o u n s e l i n g Psychology, 1980, V o l . 2 7 , 443-b. Stragan, C. and Zyto w s k i , D.A. Impact o f v i s u a l , v o c a l and t e x i c a l cues on judgments o f c o u n s e l o r q u a l i t i e s . J o u r n a l o f Co u n s e l i n g  Psychology, 1976, V o l . 2 3 , 387-y3. S t r i a n o , J u d i t h Cecere. C l i e n t p e r c e p t i o n o f " h e l p f u l " and "not h e l p -f u l " p s y c h o t h e r a p e u t i c e x p e r i e n c e s . D i s s e r t a t i o n A b s t r a c t s I n t e r - n a t i o n a l , 1982, Vol.43 ( 3 ) , 88bB. S t r i e k e r , G. I m p l i c a t i o n s o f r e s e a r c h f o r p s y c h o t h e r a p e u t i c t r e a t -ment o f women. American P s y c h o l o g i s t , 1977, V o l . 3 2 , 14-22. Strong, S.R., Wambach, C A , , Lopez, F.G. and Cooper, R.K. M o t i v a t i o n a l and e q u i p p i n g f u n c t i o n s o f i n t e r p r e t a t i o n i n c o u n s e l i n g . J o u r n a l o f Co u n s e l i n g Psychology, 1979, V o l . 2 6 , 98-107. Strupp, H.H. Success and f a i l u r e i n t i m e - l i m i t e d psyenotnerapy: A s y s t e m a t i c comparison o f two cas e s : Comparison 1. A r c h i v e s o f General  P s y c h i a t r y , l y 8 0 , 37, 59^-6u3. Strupp, H.H. and Bloxom, A. P r e p a r a t i o n o f l o w e r - c l a s s p a t i e n t s f o r group psychotherapy. J o u r n a l o f C o n s u l t i n g ana C l i n i c a l Psychology, 1973, 41, 373-384. Taboaaa, Olympia. The e f f e c t o f age o f c l i e n t on c l i n i c a l juagment. D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1983, V o l . 4 4 , 930B. Tepper, D.T. and Haase, R.F. v e r b a l and nonverbal communication o f f a c i l i t a t i v e c o n a i t i o n s . J o u r n a l o f C o u n s e l i n g Psychology, 1978, Vo l . 2 5 , 35-44. Todd, R i c h a r d Leroy. E f f e c t s o f i n t a k e procedures on e a r l y dropout from psychotherapy. D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1981, 42 ( 3 ) , 1196B-7B. Tovian, S.M. P a t i e n t e x p e r i e n c e s and psychotherapy outcome. Unpublished d o c t o r a l d i s s e r t a t i o n , Northwestern U n i v e r s i t y , 1977. Vaccaro, V i n c e n t M. The e f f e c t o f t h e t h e r a p i s t ' s l e v e l o f e x p e c t a -t i o n on t n e outcome o f planned s h o r t - t e r m treatment. D i s s e r t a t i o n  A b s t r a c t s I n t e r n a t i o n a l , 1981, V o l . 4 2 , No.4, 1626E. V a l l e , Ronald S. and K i n g , MarK. E x i s t e n t i a l - P h e n o m e n o l o g i c a l A l t e r - n a t i v e s f o r Psychology. New York: Oxford U n i v e r s i t y P r e s s , 1978. 121 Wexler, David A. and Butler, John M. Therapist modification of c l i e n t expressiveness i n client-centered therapy. Journal of Consulting and  C l i n i c a l Psychology, 1976, 44 (2), 261. Winston, A., Pardes, ti., Papernik, D.S. and Breslin, L. Aftercare of psychiatric, patients and i t s relation to rehospitalization. Hospital and Corcrnuniry Psycniatry, 1977, 28, 118-121. Young, D.W. Meanings of counselor nonverbal gestures: Fixed or i n t e r -pretative? Journal of Counseling Psychology, 1980, Vol.27, 447-52. INTERPERSONAL PROCESS RECALL - CLIENT C l i e n t ' s r a t i n g o f se l e c t e d segments i n terms o f h i s l e v e l o f f e e l i n g s and perception of s i g n i f i c a n t moments t h a t were rreaning-ful meaning USE SPARINGLY 1 2 3 no very some i don't moderately o r e a t l y extremely meaning l i t t l e meaning know s i g n i f i c a n t s i g n i f i c a n t s i g n i f i c a n t APPENDIX B T R A N S C R I P T I O N O F E P I S O D E S ( S a c k s , S c h e g l o f f a n d J e f f e r s o n , 1978) " H " a n d " h " a r e o u t - b r e a t h s ; " h " s t a n d s f o r i n b r e a t h ; " = " s t a n d s f o r " l a t c h i n g " o n o n e s p e a k i n g t u r n o n t o a n o t h e r w i t h o u t p a u s e ; " " r e p r e s e n t s t h e s t r e t c h i n g o u t o f a s o u n d ; t i O n i n d i c a t e s s o m e t h i n g s a i d o v e r s o f t l y ; u n d e r l i n i n g d e n o t e s r a i s e d l o u d n e s s o r p i t c h ; " t " i s a t o n g u e c l i c k U n c e r t a i n h e a r i n g s a r e e n c l o s e d b y p a r e n t h e s e s T i m e i n s e c o n d s i n p a r e n t h e s e s i s o r c a n b e a p p r o x i m a t e . C I : w o u l d b e c l i e n t ' s f i r s t s t a t e m e n t T l : w o u l d b e t h e r a p i s t ' s f i r s t s t a t e m e n t C 2 : c l i e n t ' s s e c o n d s t a t e m e n t T 2 : t h e r a p i s t ' s s e c o n d s t a t e m e n t . L a r g e d o t r e p r e s e n t s f o c a l t h e r a p i s t i n t e r v e n t i o n , p r e c e d i n g c l i e n t ' c r i t i c a l m o m e n t . ( E l l i o t t , 1 9 8 3 ) RESPONSE HELPFULNESS RATING SCALE - C L I E N T V E R S I O N ( 7 / 7 9 ) How h e l p f u l o r h i n d e r i n g t o y o u w a s t h a t r e s p o n s e by y o u r t h e r a p i s t ? S I G N I F I C A N T L Y HINDERING r S I G N I F I C A N T L Y H E L P F U L 1 * 2 * 3 * i J» i 5 i 6 i 7 i 8 * i 9 * i E G M S NEUTRAL OR S M G E X R 0 L DOES NOT L 0 R X T E D 1 A P P L Y 1 D E T R A E G G E A R E T R H H R T E M L • A T T A L M E Y T L L T Y E L E Y Y E L Y L " — ^ Y L Y ^ Y HINDERING I n s t r u c t i o n s : - T r y t o r e m e m b e r how h e l p f u l / h i n d e r i n g t h e r e s p o n s e f e l t t o y o u a t t h e t i m e ; I m m e d i a t e l y a f t e r y o u r t h e r a p i s t s a i d I t . I f how I t s e e m e d t h e n I s d i f f e r e n t f r o m how I t s e e m s n o w , p l e a s e t e l l t h e R e c a l l C o n s u l t a n t b o t h r a t i n g s . - S i g n i f i c a n t l y H i n d e r i n g ° R e s p o n s e s w h i c h made t h i n g s w o r s e f o r y o u o r r e a l l y I n t e r f e r e d w i t h y o u r g e t t i n g h e l p . - S i g n i f i c a n t l y H e l p f u l ° R e s p o n s e s w h i c h b r o u g h t a b o u t d e s l r e a b l e c h a n g e ( s ) f o r y o u o r w h i c h h a v e r e a l l y made I t p o s s i b l e f o r y o u t o c h a n g e ( u s e t h e s e r a t i n g s s p a r i n g l y ) . -ft m | f y o u r a t e a r e s p o n s e I n t h i s r a n g e , p l e a s e g i v e a b r i e f ( 1 - s e n t e n c e ) d e s c r i p t i o n o f how I t was h e l p f u l o r h i n d e r i n g . 125 APPENDIX D Short form of the Experiencing Scale used. Stage 1 Content External events; refusal to participate. External events; behavioural or i n t e l l e c t s ! self-description. Personal reactions to external events; limited s e l f -descriptions, behavioural descriptions Treatment Impersonal, Detached. Interested, personal, sel f -p a rticipating Reactive, emo-t i o n a l l y i n -volved. Descriptions of feelings and personal experiences. Self-descrip-t i v e , associa-t i v e . Problems or propositions about feelings and personal experiences. Synthesis of re a d i l y accessible feelings and experiences to resolve personally significant issues. F u l l , easy presentation of experiencing; a l l elements confidently integrated. Exploratory, laborative, hypothetical. Feelings v i v i d -l y expressed, integrative, conclusive, or affirming. Expansive,illu-minating, con-fident , buoyant. MODE AND PEAK RATINGS 1. I f a segment i s more or le s s equally divided between two stages of the scale, make the higher stage the peak and the lower the mode. 2. I f more than h a l f of the segment i s a t the higher stage, then the mode and the peak should be the same. 3. I f the statements at the higher stage occur so frequently and so regu-l a r l y throughout the segment that they seem to encompass and upgrade any lower portion, the mode and peak can also be the same. 4. I f the segment covers a range of the scale (e.g. sta r t i n g a t 1, moving to 2 and ending at 3, make the highest stage the peak and the predomi-nant lower stage the mode. I t may be useful to note the range of the " scale covered. I t i s not unusual f o r the modal rating t o be two stages lower than the peak. The intervening stages may or may not be present. APPENDIX E Reliabilities of Ratings of Individual Therapy Segments Study Segment type N raters rkk and length Mode Peak Rubenstein, 1971 Audio, 1/2 to n - 247 2 min 5 • 9 1 . 9 3 Rogers et al . , 1967 Audio, 4 min n - 592 4 .76 . 7 9 Kiesler et a l . , 1964 Audio, 4 min n - 21 4 early late . 9 1 .89 .92 .89 Kiesler, 1971 Audio, 4 min n - 780 4 .79 NR Gruver, 1971 Audio, 4 min n - 90 3 .78 .87 Schaeffer & Abies, 1977 Audio, 4 min n - 80 2 .92 .88 Yalom et a l . , 1977 Transcript, n • 5 min 807 3 .65 .61 Fontana et a l . , 1980 Transcript, n • 5 min 120 2 .80 . 9 1 Jachim, 1978 Audio, 5 min n - 46 2 - 9 3 . 9 1 Schoeninger, 1965 Audio, 6 min n - 30 4 .76 • 91 Fishman, Note 8 Audio, 6 min n • 287 3 .92 . 9 0 Kiesler et a l . , 1965 Audio, 8 min n - 120 4 .85 .87 Ryan, 1966 Audio, 8 min n - 96 4 .76 .77 Jennen et a l . . Note 5 Transcript, n = length unknown 176 4 .87 .86 Leitaer, Note 9 Transcript, n " length unknown 36 4 .85 .84 127 APPENDIX F CT.TENT VOCAL QUALITY CLASSIFICATION SYSTEM The characteristics of the four different patters are as follows: A. Focused 1. Energy. The energy i s f a i r l y high. Pitch i s moderate to low, with appropriate loudness. 2 . Primary stresses. Primary stresses are achieved more by an increase in loudness than by a rise in pitch. Loudness/pitch i s greater than 1 . The stress may also be acliieved by lengthening the stressed syllable (a drawl). 3. Regularity of stresses. The stress pattern i s irregular for English, and stresses sometimes occur i n unexpected places. For instance, adjoining syllables sometimes receive almost equal stress. 4 . Pace. The pace i s irregular, i t i s usually slowed, but there may be patches that are speeded up. 5 . Timbre. The voice i s f u l l and resting firmly on the platform. 6. Contours. These may be unexpected in direction, but the effect i s ragged rather than mellifluous. A. External 1. Energy. The energy i s f a i r l y high. The pitch i s moderate to high, but the volume i s adequate. 2 . Primary stresses. These are achieved with pitch rise as well as some increase in loudness. Loudness/pitch i s equal to or less than 1 . 3. Regularity of stresses. The stress pattern i s markedly regular for English. The melodic line may sound sing-song at lower energy levels and resounding at higher levels. 4. Pace. The pace i s fairly even, though i t may be slightly speeded as i t approaches a stress point. 5 . Timbre. The voice i s f a i r l y f u l l and resting on the platform. 6. Contours. These may go up, down or remain level at times when this would not be quite the expected pattern, although meaning i s not usually distorted, the Effect i s oratorical rather than ragged. C. Limited 1. Energy. The energy i s low. The volume i s not adequate for the pitch. APPENDIX F (cont'd.) C. L i m i t e d (cont'd.) 2 . Primary s t r e s s e s . Tne p r i m a r y s t r e s s e s a r e n o t v e r y s t r o n g , and a r e achieved by normal balance o f p i t c h t o loudness. 3 . R e g u l a r i t y o f s t r e s s e s . The s t r e s s p a t t e r n has about the normal i r r e g u l a r i t y o f E n g l i s n . 4. Pace. Tne pace i s somewhat slowed b u t tends t o be q u i t e r e g u l a r . 5 . Timbre. T h i s i s one o r t h e c l e a r e s t c d s t i n g u i s h i n g c h a r a c -t e r i s t i c s . The v o i c e i s t n i n n e d from beiow, and the e f i e c t i s t h a t o f a v o i c e t h a t i s •nor. r e s t i n g on i t s p l a t f o r m . " 6 . Contours. Nothing n o t a b l e h e r e . D. Emotional Overflow Eo. x h i s subcategory i s d i f f i c u l t t o d e s c r i b e u s i n g t n e s i x f e a t u r e s , because a v a r i e t y o r d i f f e r e n t emotions a r e p u t i n the same c i a s a . Tne p rimary c h a r a c t e r i s t i c i s a d i s r u p t i o n o f o r d i n a r y speech p a t t e r n s . The v o i c e may c r e a k , t r e m b l e , r i s e t o a s h r i e k , e t c . However, t h e mere presence o f emotion does n o t p u t i r i n t h i s c l a s s , w i t h o u t d i s r u p t i o n o f speech p a t t e r n s . F o r i n s t a n c e , l a u g h t e r i s o f t e n found i n c o n j u n c t i o n w i t h E x t e r n a l i z i n g , and would n o t push t h e response i n t o Emotional u n l e s s i t r e a l l y d i s r u p t s speech. T h i s i s n o t a v e r y s a t i s -f a c t o r y c l a s s as i t now s t a n d s , b u t i s n o t t o o d i f f i c u l t t o r e c o g n i z e . E x p r e s s i v e Ee. 1 . Energy, v e r y h i g h . P i t c h i s g e n e r a l l y h i g h e r and loudness g r e a t e r than any of t h e o t n e r c a t e g o r i e s . 2 . P r i m a r y s t r e s s e s . These a r e g e n e r a l l y achieved by s u b s t a n t i a l i n c r e a s e s i n b o t h p i t e n and loudness - a l t h o u g h one may nave a l a r g e r r e l a t i v e i n c r e a s e t han t h e o t h e r . A l s o , t h e r e i s o f t e n a c l i p p e d sense t o s t r e s s e d s y l l a b l e s , and a s l i g h t pause a f t e r each one. E x p r e s s i v e v s . e x t e r n a l - a s i d e from r e g u l a r i t y o f s t r e s s e s d i s t i n g u i s h i n g e x p r e s -s i v e from e x t e r n a l (see below) t h e r e i s a g r e a t e r p i t c h and loudness r i s e w i t h e x p r e s s i v e v o i c e than w i t h e x t e r n a l . I f X i s g e n e r a l l y a t modal p i t c n and one s t e p arjove, E v a r i e s rjetween modal and two o r t n r e e s t e p s above (or even h i g h e r ) . E x p r e s s i v e v s . f o c u s ed - s i m i l a r l y , focused g e n e r a l l y s t a y s on modal p i t c n and o c c a s i o n a l l y goes down, o r t h e r e may be a p i t c n r i s e w i t h o u t loudness i n c r e a s i n g t o any marked degree. 3 . R e g u l a r i t y o f s t r e s s e s . The most d i s t i n g u i s h i n g f e a t u r e o f t h i s c a t e g o r y i s s t r e s s e d , a d j o i n i n g s y l l a b l e s , w i t h h i g h e r p i t c h and APPENDIX F (cont'd.) greater loudness than found in focused; e.g. the stressed adjoining syllables in the sentence below are "I hate." I hate you There may be a pitch rise on the second of the stressed syllaoles, but there i s a clear sense of adjoining stressed syllables as shown in the sentence below. I don't care about you. 4. Pace. Regular over stressed syllables, out not regular in general. Often a stacatto quality to stressed syllables (relates to the slight pauses after stressed syllables). 5. Timbre. Generally a very f u l l voice. 130 APPENDIX G Rand's (1978) Cl a s s i f i c a t i o n s of Factors that q u a l i f y a C r i t i c a l Event from the Opinions of 46 Practising Psychotherapists A = C l i e n t having f e l t same s i g n i f i c a n t emotional impact. B = C l i e n t having achieved some sense of emotional closeness with the therapist. C = C l i e n t having had some major cognitive reorganization. D = C l i e n t having achieved some important insight that i s useful. E = Client having s h i f t e d some distorted perceptions o f thera-p i s t more towards r e a l i t y . APPENDIX H SPEECH INTERACTION SYSTEM "Three speech variables are derived from the interview data: 1. Mean speech duration The t o t a l times i n seconds the interviewee (or i n t e r -viewer) speaks divided by his t o t a l number of speech units; 2. Mean speech latency The t o t a l latency time (the period of silence separating two different speech units) divided by the number of units of interviewee (or interviwer) latency; 3. Percentage interruption The t o t a l number of times the interviewee (or interviewer) speaks divided into the number of these same speech units which were interruptions of his partner. Hence, the system has as i t s basic units the duration of each interview participant's speech, his reaction time before each unit of speech, and the number of these units which are interrup-tions of his conversational partner." (Kiesler, 1973) Matarazzo, Holman and Wiens (1967) point out that "...a word count from a typescript of an interview i s a l l that an investigator needs to derive (our) variables...since the correlation between average duration of utterance for each speaker as recorded by stopwatch or other chronographic device and the average number of words spoken per utterance by this same person i n that interview i s of the order of 0-«92. Thus, any investigator can now tape record a therapy interview, transcribe i t , count the number of words spoken i n each utterance by each speaker, compute the mean number of words per utterance for both speakers, and thereby have data for his own cases comparable to(ours). (Kiesler, 1973) Training required of judges "...The results were s t r i k i n g evidenee that one obtains r e l i a b l e and equivalent interview speech scores from an inexperienced observer. The intrarater r e l i a b i l i t i e s for nine speech scores for the inexperienced APPENDIX H (cont'd.) graining required of judges (cont'd.) observer ranged from 0.71 to 1.00, with eight of the nine variables having coefficients above 0.94. Tne means and standard deviations of each measure for the two ooservers were almost identical and the scores for the two observers ranged i n int e r correlation from 0.94 to 1.00. (Kiesler, 1973) 

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