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Differential effects of Gestalt two-chair dialogue and empathic reflection at a split in therapy Dompierre, Lyse M. 1979

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DIFFERENTIAL EFFECTS OF GESTALT TWO-CHAIR DIALOGUE AND EMPATHIC REFLECTION AT A SPLIT IN, THERAPY by LYSE M. DOMPIERRE B.A., U n i v e r s i t y of Ottawa, 1973 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n THE FACULTY OF GRADUATE STUDIES (Department of 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 to the re q u i r e d standard THE UNIVERSITY OF BRITISH COLUMBIA October, 1979 © Lyse M. Dompierre, 1979 I n p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f t h e r e q u i r e m e n t s f o r an a d v a n c e d d e g r e e a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , I a g r e e t h a t t h e L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e a n d s t u d y . I f u r t h e r a g r e e t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y p u r p o s e s may be g r a n t e d by t h e Head o f my D e p a r t m e n t o r by h i s r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l n o t be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . D e p a r t m e n t o f &CULCaJicnn The U n i v e r s i t y o f B r i t i s h C o l u m b i a 2075 W e s b r o o k P l a c e V a n c o u v e r , C a n a d a V6T 1W5 • E-6 B P 75-51 1 E ABSTRACT This study examined the differential effects of Gestalt two-chair dialogue and empathic reflection at a split in therapy. Sixteen clients, involved in counselling, were used as subjects in a repeated measure design. Ten counsellors were used, six of whom formed a low-experience therapist group and four of whom formed a high-experience therapist group. The Barrett-Lennard Relationship Inventory (Barrett-Lennard, 1962) was used to measure client perceived empathy after the third session of therapy. Subjects qualified when described on the Sixteen Personality Factor Questionnaire (Cattell, et al., 1970) as not overly conscientious, experimenting and not overly controlled. The process measure, Depth of Experiencing (Klein, et al., 1969) was used as a dependent variable to compare the effects of Gestalt two-chair dialogue and empathic reflection at a split. Five outcome measures were also used as dependent variables: the Target Complaints Box Scale (Battle, et al., 1966), two awareness questions, the Conflict Resolution Box Scale, the Behaviour Change Scale and two progress and change questions. - i i i -Each c l i e n t received both treatments before the experi-mental session, i n order to reduce novelty e f f e c t . None of c the experimental sessions occurred before the f i f t h therapy session i n order to allow f o r the formation of a working a l l i a n c e . Half of the c l i e n t s received empathic r e f l e c t i o n i n the f i r s t experimental session and h a l f received G e s t a l t two-chair dialogue, to reduce order of presentation e f f e c t . The following session was not used f o r the purposes of t h i s study, i n order to increase the independence of the two experimental sessions. Treatments were reversed f o r the second experimental session. A 2 x 2 (therapist experience by treatment) f u l l y crossed f a c t o r i a l design was used for analysis of the data. Three of the dependent variables were measured more than once, y i e l d i n g a t h i r d repeated measure factor on these variables. The l e v e l of s t a t i s t i c a l significance used was .05. Results showed Gestalt two-chair dialogue to be more ef f e c t i v e than empathic r e f l e c t i o n at producing peak exper-iencing le v e l s of f i v e or above, as well as greater s h i f t s of awareness, c o n f l i c t reduction, behaviour change and reports of change and progress. The two treatment groups did not d i f f e r on d i s t r e s s reduction, nor were there any i n t e r a c t i o n effects between therapist experience l e v e l and treatment l e v e l . - iv -TABLE OF CONTENTS Page Abstract i i Table of Contents iv List of Tables v i i i List of Figures x Acknowledgements x * CHAPTER I INTRODUCTION 1 The Problem 1 Background of the Problem 1 Definition of Terms 3 Empathic Reflection 3 Gestalt Two-Chair Dialogue 5 The Split 6 Depth of Experiencing 7 Distress Reduction 7 Shift of Awareness 8 Conflict Resolution 3 Sense of Change and Progress 9 Behaviour Change 9 Hypotheses 10 Rationale for the Hypotheses 12 - V -TABLE OF CONTENTS - Continued CHAPTER Page D e l i m i t a t i o n of the Study 13 Assumptions 14 J u s t i f i c a t i o n of the Study 15 I I LITERATURE REVIEW 17 S p l i t s and P o l a r i t i e s i n Psychotherapy . . . 17 The Use of Two-Chair Dialogue i n G e s t a l t Therapy 20 Research on Empathy and Empathic R e f l e c t i o n i n Therapy 22 Awareness 24 Conclusions 24 I I I METHODOLOGY 27 Instruments 27 Subject D e s c r i p t i o n 27 To Measure Dependent V a r i a b l e s 29 C l i e n t Information 33 Design 34 Population . . . . . . 37 Subject P r e p a r a t i o n and Demographic Data . . 37 T h e r a p i s t s 39 Raters 40 - v i -TABLE OF CONTENTS - Continued CHAPTER Page Data C o l l e c t i o n 41 Scoring Procedures 42 Procedure of A n a l y s i s 50 IV RESULTS 51 Comparison of Depth of Experiencing P r o p o r t i o n Scores Under G e s t a l t Two-Chair Dialogue and Empathic R e f l e c t i o n . 51 Comparison of D i s t r e s s Reduction Scores Under G e s t a l t Two-Chair Dialogue and Empathic R e f l e c t i o n 55 Comparison of S h i f t of Awareness Scores Under G e s t a l t Two-Chair Dialogue and Empathic R e f l e c t i o n 5# Comparison of C o n f l i c t R e s o l u t i o n Scores Under G e s t a l t Two-Chair Dialogue and Empathic R e f l e c t i o n 61 Comparison of Behaviour Change Scores Under G e s t a l t Two-Chair Dialogue and Empathic R e f l e c t i o n 64 Comparison of Change and Progress Scores Under G e s t a l t Two-Chair Dialogue and Empathic R e f l e c t i o n 67 C l i e n t Information 70 - v i i -TABLE OF CONTENTS - Continued CHAPTER Page V DISCUSSION 74 Summary 74 Conclusions 76 General D i s c u s s i o n S i Recommendations 84 I m p l i c a t i o n s 85 BIBLIOGRAPHY 87 APPENDICES 92 - v i i i -LIST OF TABLES Table Page I Empathy Ratings on the Barrett-Lennard R e l a t i o n s h i p Inventory.. 45 I I Mean Empathic R e f l e c t i o n R ating f o r Each Session 47 I I I P r o p o r t i o n Scores f o r Segments of Depth of Experiencing o f 5 or More 52 IV Means and Standard Deviations of Transformed Depth of Experiencing P r o p o r t i o n Scores . . . 53 V A n a l y s i s of Variance f o r Transformed Depth of Experiencing P r o p o r t i o n Scores 54 VI Means and Standard Deviations f o r D i s t r e s s Reduction Scores 56 V I I A n a l y s i s of Variance f o r Three Occasions of D i s t r e s s Reduction Scores . . . . 57 V I I I Means and Standard Deviations f o r S h i f t of Awareness Scores . . . . . . . . 59 IX A n a l y s i s of Variance f o r S h i f t of Awareness Scores . . . . . . 60 X Means and Standard Deviations f o r C o n f l i c t R e s o l u t i o n Scores 62 XI A n a l y s i s o f Variance f o r Two Occasions of C o n f l i c t R e s o l u t i o n Scores . 63 X I I Means and Standard Deviations f o r Behaviour Change Scores . . . . . . . . . 65 X I I I A n a l y s i s of Variance f o r Two Occasions of Behaviour Change Scores 66 XIV Means and Standard Deviations f o r Change and Progress Scores . 68 - i x -LIST QF TABLES - Continued Table Page XV Analysis of Variance for Change and Progress Scores 69 XVI Means and Standard Deviations f o r Evaluation of Therapy Scores 71 XVII Analysis of Variance f o r Two Occasions of Evaluation of Therapy Scores 72 - X -LIST OF FIGURES Figure Page 1 F a c t o r i a l Design 36 2 Order of Tests w i t h Respect to Treatments. . 43 - x i -ACKNOWLEDGEMENTS. I wish t o extend my a p p r e c i a t i o n t o the f o l l o w i n g people, who were p i l l a r s i n the pre p a r a t i o n of t h i s t h e s i s . I thank: L e s l i e Greenberg, f o r h i s i n s p i r a t i o n , guidance, u n f a i l i n g a v a i l a b i l i t y and support, Harold R a t z l a f f , f o r h i s calm and e d i f y i n g counsel regarding the research design and s t a t i s t i c a l a n a l y s i s , and C a r l Chiko, f o r h i s support and c l a r i f i c a t i o n of the t h e o r e t i c a l c o n c e p t u a l i z a t i o n and a n a l y s i s . D I am g r a t e f u l a l s o t o those, too numerous to name, who gracious l y gave of t h e i r time to serve as t h e r a p i s t s , r a t e r s and s t a t i s t i c a l consultants f o r t h i s study. - 1 -CHAPTER I INTRODUCTION THE PROBLEM The purpose of t h i s study was t o compare the e f f e c t on depth of experiencing of the G e s t a l t two-chair dialogue and of empathic r e f l e c t i o n which r a t e d at l e a s t " l e v e l t h r e e " on the Empathy Scale (Carkhuff, 1969), at a " s p l i t " i n therapy. This study a l s o i n v e s t i g a t e d whether d i s t r e s s r e d u c t i o n , s h i f t of awareness, c o n f l i c t r e s o l u t i o n , change i n c l i e n t be-haviour and report s of change and progress are r e l a t e d t o the type of i n t e r v e n t i o n used i n the therapy hour. BACKGROUND OF THE PROBLEM Rogers' (1957) necessary and s u f f i c i e n t c o n d i t i o n s of accurate empathy, warmth and genuineness have been the object of much research i n psychotherapy. I n a d d i t i o n t o s t r e s s i n g the d e s i r a b i l i t y of these c o n d i t i o n s , however, c e r t a i n c l i e n t -centered t h e o r i s t s are now saying t h a t t h e r a p i s t s w i t h c l i e n t -centered o r i e n t a t i o n s may w e l l want to vary t h e i r r e p e r t o i r e of in-therapy techniques i n response t o c l i e n t s t y l e or c l i e n t performance (Gendlin, 1969; R i c e , 1974; Wexler and B u t l e r , 1976). - 2 -Certain process measures, notably the Experiencing Scale (Klein, et a l . , 1969) have been suggested as revealing the change process'in therapy* Kl e i n has i n fact•recommended. that the Experiencing Scale be used as a measure of the s p e c i f i c effects of therapist interventions. The scale has also correlated p o s i t i v e l y with outcome i n a number of studies (Orlinsky and Howard, 1978) although a causal l i n k between the two has not been demonstrated. In the aforementioned studies, the rela t i o n s h i p between depth of experiencing and outcome was investigated over the whole of therapy rather than at s p e c i f i c instances where p a r t i c u l a r interventions or techniques were being used. Studies focusing on pr e c i s e l y defined therapeutic techniques used at c l e a r l y marked occurrences i n therapy are one means of r e f i n i n g psychotherapy research (Bergin and Strupp, 1972; Greenberg, 1975; Luborsky, et a l . , 1971). Studies of t h i s nature enable examination of the r e l a t i o n between process and outcome as i t relates to p a r t i c u l a r therapist and c l i e n t behaviours. Given the t h e o r e t i c a l and research emphasis on the sig n i f i c a n c e of an index of involvement such as depth of experiencing, i t was the concern of the present study to examine whether a s p e c i f i c therapeutic intervention performed by a therapist at a s p e c i f i c moment i n therapy would resu l t i n - 3 -g r e a t e r depth of experiencing, g r e a t e r sense of movement f o r the c l i e n t and g r e a t e r change i n a , s p e c i f i e d behaviour. G e s t a l t two-chair dialogue has been shown t o produce s i g n i f i c a n t l y g r e a t e r depth o f experiencing than empathic r e -f l e c t i o n , upon p r e s e n t a t i o n of a s p l i t , i n an analogue study (Greenberg and Clar k e , 1979). This study proposes t o i n v e s t i -gate these f i n d i n g s , using a pop u l a t i o n o f r e a l c l i e n t s i n therapy.: DEFINITION OF TERMS. Empathic R e f l e c t i o n Empathic r e f l e c t i o n i s a t h e r a p e u t i c technique by means of which the t h e r a p i s t expresses understanding of what the c l i e n t i s f e e l i n g and the experiences u n d e r l y i n g these f e e l i n g s . The t h e r a p i s t , i n h i s or her own words and i n h i s or her own way, communicates t h i s understanding t o the c l i e n t . Egan (1975) provides the f o l l o w i n g example: I f a person comes t o me, s i t s down, looks at the f l o o r , hunches over, and h a l t i n g l y t e l l s me t h a t he has j u s t f a i l e d two t e s t s , t h a t h i s g i r l f r i e n d has t o l d him she doesn't want t o see him anymore, and t h a t he might l o s e h i s part-time job, I might begin t o respond t o him by s a y i n g : "Counselor: You're r e a l l y f e e l i n g miserable — your world has a l l of a sudden begun t o f a l l a p a r t " I see h i s depression ( f e e l i n g s ) and begin t o under-stand what u n d e r l i e s t h i s depression (experience) and I communicate t o him t h i s understanding of h i s world (p. 76) . - 4 -Carkhuff (1969) has described empathic r e f l e c t i o n as oc c u r r i n g at f i v e l e v e l s . L e v e l 1 and 2 are considered d e t r i m e n t a l . L e v e l 3, 4 and 5 empathic r e f l e c t i o n s are considered f a c i l i t a t -i v e , and are described by Carkhuff (1969) as f o l l o w s : The expressions o f the h e l p e r i n response t o the expressions o f the c l i e n t ( s ) are e s s e n t i a l l y interchangeable w i t h those of the c l i e n t i n t h a t they express e s s e n t i a l -l y the same a f f e c t and meaning. The responses o f the helper add n o t i c e a b l y to the expressions o f the c l i e n t i n such a way as t o express f e e l i n g s at a l e v e l deeper than the c l i e n t was able to express h i m s e l f . The helper's responses a d d - s i g n i f i c a n t l y , t o the f e e l i n g and meaning of the express-ions o f the c l i e n t ( s ) in,such a way as t o ac c u r a t e l y express f e e l i n g l e v e l s below what the c l i e n t h i m s e l f was able t o express or, i n the event o f ongoing, deep s e l f -e x p l o r a t i o n on the c l i e n t ' s p a r t , t o be f u l l y w i t h him i n h i s deepest moments (pp. 174-175). I n t h i s study, t h e r a p i s t s were i n s t r u c t e d t o respond w i t h a L e v e l 3, 4 or 5 empathic r e f l e c t i o n when the c l i e n t presented a s p l i t . Empathic r e f l e c t i o n i s one means of communicating empathic understanding t o a c l i e n t . Other t h e r a p i s t behaviours, such as non-verbal messages, empathic questions and humour can a l s o convey empathic understanding. The Barrett-Lennard R e l a t i o n -s h i p Inventory provides an index of the t o t a l Rogerian concept of empathy i n 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 and encompasses L e v e l 3: L e v e l 4: L e v e l 5: •> - 5 -a more g l o b a l range of t h e r a p i s t behaviours which may be perceived as empathic by the c l i e n t . G e s t a l t Two-Chair Dialogue I n the G e s t a l t two-chair dialogue, the c l i e n t i s asked to a l t e r n a t e l y assume the two parts o f an i n t r a p e r s o n a l or i n t e r p e r s o n a l c o n f l i c t s i t u a t i o n . A c l i e n t may say " I want to do t h i s , but then, I'm not r e a l l y sure i t ' s a good i d e a " , at which point the t h e r a p i s t guides the c l i e n t i n a dialogue between both s i d e s . The c l i e n t , t a k i n g on the r o l e o f " I want to do t h i s " addresses h i m s e l f or h e r s e l f t o an empty c h a i r i n which he or she imagines the other s i d e of the p o l a r i t y . He or she then moves to the other c h a i r , and responds to what he or she has j u s t s a i d from the previous p o s i t i o n . The c l i e n t moves b o d i l y from one c h a i r t o the other, speaking from both p o s i t i o n s a l t e r n a t e l y . Greenberg (1979) has presented f i v e p r i n c i p l e s which con-s t i t u t e the main s t r u c t u r e of the o p e r a t i o n : 1. Maintenance o f a contact boundary: M a i n t a i n -i n g c l e a r s e p a r a t i o n and contact between the p a r t i a l aspects of the S e l f . 2. R e s p o n s i b i l i t y : D i r e c t i n g the person t o use h i s or her a b i l i t i e s t o respond i n accordance w i t h the t r u e nature of h i s or her experience. 3. Attending: D i r e c t i n g the person's a t t e n t i o n to p a r t i c u l a r aspects o f experience by i n -c r e a s i n g the l e v e l o f a r o u s a l . - 6 -4 . Heightening: H i g h l i g h t i n g aspects of experience by i n c r e a s i n g the l e v e l of a r o u s a l . 5. Expressing: Making a c t u a l and s p e c i f i c t h a t which i s i n t e l l e c t u a l or a b s t r a c t . P a r t i c u l a r -i z i n g experience by moving from theory t o p r a c t i c e . The S p l i t A " s p l i t " i s s a i d t o occur when the c l i e n t presents a c o n f l i c t i n which he or she i s s t r u g g l i n g between two opposing p o s i t i o n s . The two f o l l o w i n g examples, s e l e c t e d from the experimental data, are presented as i l l u s t r a t i o n s : 1. I t f e e l s as though I'm on the edge of a c l i f f , t h at out the r e , there's some unknown f e e l i n g and emotion. I'd l i k e t o di s c o v e r what t h a t i s , but I'm a f r a i d t o l e t go, t o t r u s t people. 2. I want f r i e n d s , but I spend a l o t o f energy being angry t h a t they don't behave the way I would want them t o . Greenberg (1979) s p e c i f i e s the f o l l o w i n g features o f the s p l i t : A statement of a tendency or p a r t i a l aspect of the s e l f , e.g., " I don't want t o do t h i s . " A statement of a second tendency or p a r t i a l aspect of the s e l f , e.g., " I f e e l I have t o . " An i n d i c a t i o n o f i n t r a p e r s o n a l c o n t r a d i c t i o n i n d i c a t i n g t h a t the two parts are being set against each other, e.g., "but". A v e r b a l or non-verbal i n d i c a t i o n t h a t the person i s i n c o n f l i c t , i n v o l v e d i n s t r u g g l e , s t r i v i n g or c o e r c i o n , e.g., " I have t o " , or voi c e q u a l i t y . 1. 2. 3 . 4. - 7 -Kepth of Experiencing K l e i n , et a l . (1969) use "experiencing" to denote the q u a l i t y o f personal involvement i n therapy. At a low l e v e l of experiencing, the c l i e n t provides no d e s c r i p t i o n of f e e l -i n g s , and discourse i s s u p e r f i c i a l or impersonal. At a moder-ate l e v e l o f experiencing, the c l i e n t describes and elaborates h i s or her f e e l i n g s . The greatest depths of experiencing are achieved when the c l i e n t explores h i s or her f e e l i n g s , and progresses to s e l f - u n d e r s t a n d i n g and problem r e s o l u t i o n . Depth of experiencing i s the extent to which a person's b o d i l y f e l t f l o w of experiencing c o n s t i t u t e s h i s or her aware-ness, and i s expressed v e r b a l l y . I t i s an important construct f o r t h e r a p i e s i n which self-awareness and s e l f - u n d e r s t a n d i n g are major goals. D i s t r e s s Reduction D i s t r e s s r e d u c t i o n r e f e r s t o the c l i e n t ' s s u b j e c t i v e sense of r e l i e f i n a n x i e t y w i t h regard t o the i s s u e he or she chose to deal w i t h during the t h e r a p e u t i c s e s s i o n . I t focuses on how t r o u b l e d or "bothered" the c l i e n t f e e l s by h i s or her p r e s s i n g concern. I f the c l i e n t f e e l s l e s s d i s t u r b e d by the i s s u e f o l l o w i n g therapy, he or she may i n v e s t l e s s emotional energy i n t o t h i s area of concern and f e e l f r e e r t o deal w i t h other l i f e i s s u e s . - 8 -S h i f t o f Awareness P o l s t e r and P o l s t e r (1973) regard d y s f u n c t i o n as a t t r i b u t -able t o the f a c t t h a t people are unaware of t h e i r f e e l i n g s , wants and values, such t h a t they a l i e n a t e parts of t h e i r s e l f -f u n c t i o n i n g . An i n t e r r u p t i o n i n t h i s flow of awareness could t h e r e f o r e be conceived of as r e l a t e d to i n t r a p s y c h i c c o n f l i c t . I f therapy could be h e l p f u l t o the c l i e n t i n a s s i s t i n g him or her t o become more aware of f e e l i n g s , wants and va l u e s , a s h i f t i n p e r s p e c t i v e might occur, l e a d i n g t o greater i n t e -g r a t i o n of opposing p a r t s . For example, wi t h regard t o the examples presented e a r l i e r , a s h i f t i n awareness was reported t o have taken place i n the f o l l o w i n g way: 1. I now see t h a t a part o f me shuts o f f my f e e l -i n g — not an e x t e r n a l source. I r e a l i z e t h a t I make myself disappear on some l e v e l when the f e e l i n g l e v e l i s too high. A part of me be-l i e v e s the other part o f me can't handle emotions, so i t closes them o f f . I can choose t o f e e l s o f t , s e n s i t i v e at some times; the "shut down system" need not remain automatic. 2. Instead o f blaming my f r i e n d s f o r being s e l f i s h , I now see t h a t I'm g i v i n g up my power by not saying what I want i n my r e l a t i o n s h i p s . C o n f l i c t R e s o l u t i o n This concept r e f e r s t o the c l i e n t ' s s u b j e c t i v e perception of h i s or her a b i l i t y t o deal w i t h a t r o u b l i n g l i f e i s s u e . I t does not imply that c o n f l i c t no longer e x i s t s i n the c l i e n t ' s - 9 -wo r l d , or th a t the i s s u e d e a l t w i t h during the therapy hour has been completely r e s o l v e d . Rather, c o n f l i c t r e s o l u t i o n r e f e r s t o the f a c t t h a t a f t e r therapy, the c l i e n t may ex-perience a diminished sense of i n t e r n a l s t r u g g l e , and f e e l more s e t t l e d about the i s s u e he or she d e a l t w i t h i n therapy. Sense of Change and Progress This concept r e f e r s t o the c l i e n t ' s s u b j e c t i v e impression of becoming d i f f e r e n t , or changing as a r e s u l t o f therapy. I t a l s o r e f e r s t o the c l i e n t ' s sense of improvement w i t h regard t o a t r o u b l i n g i s s u e which was focused on i n therapy. Behaviour Change I n t h i s study "change" r e f e r s t o an overt or covert m o d i f i c a t i o n of a s p e c i f i c c l i e n t behaviour during the week f o l l o w i n g the therapy hour, and i s measured on a t a r g e t be-haviour s c a l e . A f t e r the therapy s e s s i o n , the c l i e n t deter-mines a t a r g e t behaviour r e l a t e d to the i s s u e discussed i n therapy and repo r t s the present frequency of the behaviour. One week l a t e r the c l i e n t r e p o r t s the frequency of the p r e v i o u s l y i d e n t i f i e d behaviour, as i t has occurred f o l l o w i n g therapy. - 10 -HYPOTHESES HQ : The G e s t a l t two-chair dialogue, when used at a 1 s p l i t , w i l l not l e a d to depths of experiencing on the K l e i n , et a l ; , Experiencing Scale s i g n i f i c a n t l y 1 d i f f e r e n t from those produced by the use of empathic r e f l e c t i o n at a s p l i t . H-i : The G e s t a l t two-chair dialogue, when Used at -1 a s p l i t , w i l l l e a d t o depths -of experiencing on the K l e i n , et a l . , Experiencing Scale s i g n i f i c a n t l y . d i f f e r e n t from those produced by the-use of rempathic r e f l e c t i o n at a s p l i t . HQ : The G e s t a l t two-chair dialogue, when used at 2 a s p l i t , w i l l not lead t o l e v e l s of d i s t r e s s r e d u c t i o n , ! s i g n i f i c a n t l y d i f f e r e n t ! from those -produced by the use o f empathic r e f l e c t i o n at a s p l i t , * a s measured on a t h i r t e e n - p o i n t box s c a l e administered before, immediately a f t e r , and one week a f t e r therapy. H, : The G e s t a l t two-chair dialogue, when used at-2 a s p l i t , w i l l l e a d t o l e v e l s of d i s t r e s s r e -duction s i g n i f i c a n t l y d i f f e r e n t from those produced by the use of empathic r e f l e c t i o n at a s p l i t , as measured-on a t h i r t e e n - p o i n t box s c a l e administered before, immediately a f t e r , and one .week a f t e r therapy. I - ! ^ <• H N : The G e s t a l t two-chair dialogue, when used at u 3 a s p l i t , w i l l not l e a d to l e v e l s of s h i f t of awareness s i g n i f i c a n t l y d i f f e r e n t from those produced by the use o f empathic r e f l e c t i o n at a s p l i t , as measured on two f i v e - p o i n t s c a l e s administered three hours a f t e r therapy. H-j : The G e s t a l t two-chair dialogue, when used a t ! a • 3 s p l i t , w i l l l e a d t o l e v e l s of s h i f t of awareness s i g n i f i c a n t l y d i f f e r e n t from those produced by the use of empathic r e f l e c t i o n at a s p l i t , as measured on two f i v e - p o i n t s c a l es administered three hours a f t e r therapy. XA non d i r e c t i o n a l t e s t of s t a t i s t i c a l s i g n i f i c a n c e at the ^ - .05 l e v e l . I n a sample of subjects described as experimenting, not o v e r l y c o n t r o l l e d and not o v e r l y conscientious on the Sixteen P e r s o n a l i t y Factor Questionnaire. - 1 1 -HQ The G e s t a l t two-chair dialogue, when used at a 4 s p l i t , w i l l not l e a d t o l e v e l s of c o n f l i c t r e s o l u t i o n s i g n i f i c a n t l y d i f f e r e n t from those produced by the use of empathic r e f l e c t i o n a t a s p l i t , as measured on a seven-point box s c a l e administered three hours a f t e r and one week a f t e r therapy. H : The G e s t a l t two-chair dialogue, when used at a 1 4 s p l i t , w i l l l e a d t o l e v e l s of c o n f l i c t r e s o l u t i o n s i g n i f i c a n t l y d i f f e r e n t from those produced by the use of empathic r e f l e c t i o n at a s p l i t , as measured on a seven-point box s c a l e administered three hours a f t e r , and one week a f t e r therapy. HQ : The G.estalt, two-chair dialogue, when used at a 5 s p l i t , w i l l not l e a d t o l e v e l s of behaviour change s i g n i f i c a n t l y d i f f e r e n t from those produced by the use of empathic r e f l e c t i o n at a s p l i t j as measured on a seven-point s c a l e administered three hours a f t e r , and one week a f t e r therapy. H, : The G e s t a l t two-chair dialogue, when used at a 5 s p l i t , w i l l l e a d to l e v e l s of behaviour-change s i g n i f i c a n t l y d i f f e r e n t from those produced by the use of empathic r e f l e c t i o n at a s p l i t , as measured on a seven-point s c a l e administered three hours a f t e r , and one week a f t e r therapy. H : The G e s t a l t two-chair dialogue, when used at a ° 6 s p l i t , w i l l not l e a d to l e v e l s of change and progress s i g n i f i c a n t l y d i f f e r e n t from those produced by the use of empathic r e f l e c t i o n at a s p l i t ' , as-measured on two f i v e - p o i n t s c a l e s administered one week a f t e r therapy. H, : The G e s t a l t two-chair dialogue, when used at a 6 s p l i t , w i l l l e a d t o l e v e l s o f change and progress s i g n i f i c a n t l y d i f f e r e n t from those produced by the use of empathic r e f l e c t i o n at a s p l i t , as measured on two f i v e - p o i n t s c a l e s administered one week a f t e r therapy-^. ^There w i l l be no s i g n i f i c a n t e f f e c t of t h e r a p i s t l e v e l of experience, f o r a l l hypotheses. - 12 -RATIONALE FOR THE HYPOTHESES Gestalt two-chair dialogue has been shown e f f e c t i v e at deepening experiencing i n three single case studies (Greenberg, 1975), and i n a counselling analogue study (Greenberg and Clarke, 1979). There i s support i n the l i t e r a t u r e for the notion that depth of experience i s p o s i t i v e l y correlated with outcome (Klein, et a l . , 1969). ( Gestalt therapists believe that the r e q u i s i t e factor lead-ing to change i s awareness (Perls, 1969), and that awareness i s preceded by deep l e v e l s of experiencing (Kempler, 1973). Therefore, deep l e v e l s : o f experiencing 1 along with'shifts of awareness may lead : to resolution, or to the exposition of a more important underlying issue, enabling a c e r t a i n degree of c o n f l i c t resolution, distress reduction and behaviour change. This t h e s i s ' objective i s to investigate whether Gestalt two-chair dialogue w i l l lead subjects selected from a normal population of c l i e n t s seeking therapy to s i g n i f i c a n t l y d i f f e r -ent l e v e l s of experiencing, d i s t r e s s reduction, s h i f t of aware-ness, c o n f l i c t resolution, sense of change and progress and behaviour change than w i l l empathic r e f l e c t i o n , when used at a s p l i t i n therapy. - 13 -DELIMITATION OF THE STUDY This study concerns i t s e l f with subjects who have been involved with a therapist i n a counselling r e l a t i o n s h i p f o r a minimum of four sessions. Saltzman, et a l . (1976) found that c l i e n t and therapist report forms discriminated good and poor outcome most powerfully by the t h i r d session. The Barrett-Lennard Relationship Inventory was administered i n t h i s study immediately following the t h i r d session of therapy, to i d e n t i f y the l e v e l s of client-perceived empathy. It was f e l t that i f the c l i e n t perceived the therapist as empathic, the existence of a climate 1of t r u s t in-the r e l a t i o n s h i p would-be indicated. The c l i e n t involved in :such a r e l a t i o n s h i p would f e e l free to work i n depth fon an emotional-issue (Carkhuff, 1969). Saltzman, et a l ; (1976) showed that by the t h i r d session, c l i e n t state-ments of perceived understanding and uniqueness were predictive of positive-outcome. : ... The therapists used i n t h i s study were a l l trained i n the Carkhuff/Egan model of empathic reflection-(Egan', 1975), as well as i n the use of Gestalt two-chair dialogue. The majority (70 per cent) had f u l f i l l e d the;same Masters program in* Counselling Psychology and had been trained i n the Gestalt two-chair dialogue technique-by the same trainer;-- 14 -The c l i e n t s i n the study were described according to f a c t o r s G, and of the Six t e e n P e r s o n a l i t y F a c t o r Questionnaire ( C a t t e l l , et a l . , 1970). The r e s u l t s - o f t h i s study may therefore: be g e n e r a l i z e d t o subjects seeking therapy who score w i t h i n c e r t a i n s t a t e d l i m i t s on f a c t o r s G, Q1 and Q^  of the 16-PF, who have been engaged i n a c o u n s e l l i n g r e l a t i o n s h i p f o r at l e a s t three s e s s i o n s w i t h t h e r a p i s t s t r a i n e d i n empathic r e f l e c t i o n and G e s t a l t two-chair dialogue techniques and who perceive t h e i r t h e r a p i s t s as empathic, according to the Barrett-Lennard R e l a t i o n s h i p Inventory. ASSUMPTIONS I t i s assumed th a t the s p l i t s presented by the c l i e n t s i n t h i s study are separate and/or independent and tha t pre-s e s s i o n , p o s t - s e s s i o n , and follow-up instruments measure change achieved-during the s e s s i o n . I n order to reduce the p o s s i b i l i t y of contamination be-tween the two experimental s e s s i o n s , the design i n c l u d e d one i n t e r v e n i n g s e s s i o n between the two that are used f o r the purposes of t h i s study, during which the t h e r a p i s t i s i n s t r u c t -ed t o work according t o any c o u n s e l l i n g model. Th e r a p i s t s were i n s t r u c t e d not to respond t o a s p l i t i n the i n t e r v e n i n g s e s s i o n i n order to reduce the p o s s i b i l i t y of contamination o f the f o l l o w i n g experimental s e s s i o n . - 15 -The Experiencing Scale was also useful as a check on possible contamination, as i t measured moment by moment what i s happening "now" i n the session; t h i s referent does not depend on preceding interviews. JUSTIFICATION OF>THE-STUDY Liter a t u r e i n the area of psychotherapy demands that more vigorous attempts be made to= understand process and outcome i n therapy (Butcher and Koss, 1978). In:this thesis, both pro-cess, and outcome f o r subjects- are examined. Kl e i n , et a l . (1969) suggests that depth of experiencing i s p o s i t i v e l y correlated with outcome. This leads to the b e l i e f that i f a p a r t i c u l a r therapeutic technique can enhance a c l i e n t ' s depth of experiencing, he or she may experience more benefit from therapy. This study examines d i s t r e s s re-duction, s h i f t s of awareness, c o n f l i c t resolution, sense of change and progress and behaviour change as possible ways i n which c l i e n t s may perceive themselves changing following deep level s of experiencing i n therapy. I f the hypotheses stated e a r l i e r - r i n t h i s Chapter are indeed supported, more weight w i l l be given to the argument that although empathy may be a necessary, "baseline" condit-ion for successful counselling, a more active technique such - 16 -as G e s t a l t two-chair dialogue, when used at a s p e c i f i c moment i n therapy, may help move the c l i e n t more q u i c k l y toward change than w i l l the use of empathic r e f l e c t i o n . Such a f i n d i n g would have i m p l i c a t i o n s f o r c o u n s e l l i n g as i t i s p r a c t i s e d i n the f i e l d today, as w e l l as f o r c o u n s e l l o r t r a i n i n g . - 17 -CHAPTER II LITERATURE REVIEW Psychotherapy research has f o r too long assumed that what the participants do i n therapy can be adequately portrayed by broad statements as to the therapists' o r i e n t a t i o n and the general nature of therapy. There i s recently, however, an increasing demand within the f i e l d for greater s p e c i f i c a t i o n of treatment interventions. A number of areas r e l a t i n g to s p e c i f i c in-therapy behaviours of c l i e n t s and therapists are included i n t h i s survey of the l i t e r a t u r e : discussion of s p l i t s and p o l a r i t i e s i n psycho-therapy, the use of the two-chair dialogue i n Gestalt Therapy, and research i n the use of empathic r e f l e c t i o n . i n psychotherapy. In addition, the r o l e of experiencing and changes i n reported awareness and feelings of r e s o l u t i o n are discussed. SPLITS AND POLARITIES IN PSYCHOTHERAPY Research on the d i f f e r e n t i a l effects of d i f f e r e n t t r e a t -ments i s needed i n order to be able to specify the e f f e c t s of p a r t i c u l a r treatments f o r p a r t i c u l a r individuals (Strupp and Bergin, 1969). Greenberg (1975) states that the d i f f e r e n t i a l treatment question can be even further refined and that highly - 18 -s p e c i f i e d c l i e n t behaviours marking p a r t i c u l a r moments i n psychotherapy can be used as prognostic i n d i c a t o r s f o r p a r t i c u l a r i n t e r v e n t i o n s . I f i t can be shown through r e -search t h a t the performance o f a p a r t i c u l a r o p e r a t i o n at a c l e a r l y i d e n t i f i e d moment i n therapy y i e l d s more p o s i t i v e r e s u l t s f o r the c l i e n t than does another o p e r a t i o n , the a r t of psychotherapy w i l l become more r i g o r o u s l y exact. The object of t h i s t h e s i s i s to compare two treatments at a moment i n therapy l a b e l l e d a " s p l i t " . Greenberg (1979) defines the s p l i t as a "ve r b a l perform-ance p a t t e r n i n which a c l i e n t r e p o r t s a d i v i s i o n of the s e l f process i n t o two p a r t i a l aspects of the s e l f . . . ." The s p l i t i s i n d i c a t i v e of fragmentation i n the c l i e n t ' s f u n c t i o n -i n g ; u n t i l the i n d i v i d u a l has r e s o l v e d the d u a l i t y w i t h i n , energy w i l l be invested i n us e l e s s s t r u g g l e and s e l f - c a n c e l -l a t i o n , r a t h e r than i n productive combination and i n t e r p l a y ( P e r l s , 1970). P o l s t e r and P o l s t e r (1973) i n a s i m i l a r v e i n , purport t h a t psychopathology i s a consequence of a discrepancy between f e e l i n g one t h i n g and doing another. Change occurs when an i n d i v i d u a l encompasses both the f e e l i n g s and sensations of both si d e s of a s p l i t and brings these i n t o contact w i t h one another. Grinder and Bandler (1976) o f f e r a s i m i l a r v i s i o n of the s p l i t , although t h e i r frame of reference i s not ex-c l u s i v e l y t h a t of G e s t a l t therapy, but a broader n e u r o l i n g u i s t i c - 19 -approach. T h e i r b e l i e f i s t h a t s p l i t s and p o l a r i t i e s are r e -vealed by i n c o n g r u i t i e s i n para messages, f o r example, when a c l i e n t ' s body language sends a d i f f e r e n t message from the message being sent v e r b a l l y . Zinker (1977) i n t e r p r e t s the s p l i t as a s t r u g g l e between two extreme p o s i t i o n s , preventing the i n d i v i d u a l from u t i l i z -i n g h i s or her f u l l p o t e n t i a l i n d e a l i n g w i t h a s i t u a t i o n . When brought i n t o awareness wi t h c l a r i t y , c o n f l i c t s tend to al l o w the person the sense of h i s i n t e r n a l d i f f e r e n t i a t i o n , and at the l e v e l of c r e a t i v i t y , h o l d the p o s s i b i l i t y f o r i n t e g r a t e d b e h a v i o r — behavior which i s h i g h l y adaptive because i t spans the f u l l range of responses between formerly ex-perienced polar extremes (p. 196) . Baumgardner (1975) a l s o holds t h i s view, of the person as d i v i d e d between two extremes of a continuum, but w i t h no center. She r e f e r s t o t h i s s t a t e as of having a "hole" i n the person-a l i t y . Latner (1972) s t a t e s that p o l a r i t i e s are a necessary feature of human f u n c t i o n i n g and tha t t h e i r i n t e r a c t i o n f u n c t -ions as a d i a l e c t i c a l process. The opposites become d i s t i n g u i s h e d and opposed; then, i n t h e i r c o n f l i c t , a r e s o l u t i o n i s achieved that u n i t e s the poles i n a f i g u r e t h a t i s gr e a t e r than the combination of the opposites — i t i s a new c r e a t i o n (p. 43). It seems clear, in.view of the number of references to s p l i t s and p o l a r i t i e s i n the l i t e r a t u r e , that t h e i r occurrence i n therapy merits attention. I t would be desirable f o r the therapist to both recognize the advent of a s p l i t i n therapy and to be able to e f f e c t i v e l y intervene at t h i s moment i n therapy i n such a way as to make a difference for the c l i e n t and help resolve the s p l i t . THE USE OF GESTALT TWO-CHAIR DIALOGUE IN GESTALT THERAPY Greenberg (1975) found that Gestalt two-chair role-play, when used at a s p l i t i n therapy, repeatedly produced deeper l e v e l s of experiencing than did empathic r e f l e c t i o n , i n three single cases. Greenberg and Clarke (1979), i n an analogue study using sixteen subjects, found that the Gestalt two-chair dialogue technique used at a s p l i t , l e d to deeper experiencing and greater change i n awareness than did empathic r e f l e c t i o n . Bohart (1977) reported that Gestalt two-chair role-play was more e f f e c t i v e i n reducing anger, h o s t i l e attitudes and be-havioural aggression than were i n t e l l e c t u a l analysis or emotion-a l discharge techniques. Kipper and G i l a d i (1978) found that the psychodramatic use of the two-chair method l e d to an equivalent reduction of test anxiety as systematic desensitiz-ation procedures. Most of the claims i n the f i e l d of Gestalt therapy, how-ever, are not substantiated by experimental data. Polster and - 21 ' Polster (1973) presented a comprehensive exposition of key therapist interventions, describing both t h e i r t h e o r e t i c a l intention and providing c l i n i c a l i l l u s t r a t i o n s . Many other Gestalt therapists have provided descriptive analyses of t h e i r techniques, among them Latner (1973), Fagan (1975), and Stephenson (1975). More recently, c e r t a i n therapists have focused t h e i r attention on the two-chair technique, and attempted to explain i t s effectiveness. Baumgardner (1975) maintains that the c l i e n t feels more "together", i . e . , l e s s " s p l i t " when given the opportunity, i n the two-chair exercise, to hear each side. Grinder and Bandler believe that the c l i e n t engaged i n a two-chair dialogue expresses the s e l f incongruence sequentially rather than simultaneously. In other words, the c l i e n t has changed from a confus-ed, s e l f - i n t e r r u p t i n g , tortured, incongruent human being into one who can express himself f o r c e f u l l y and congruently at each point i n time (1976, p. 77). I t would appear therefore that Gestalt two-chair role-play i s instrumental i n enabling the c l i e n t to gain awareness of the struggle going on within, between two d i s t i n c t parts of the s e l f . Following awareness, the c l i e n t becomes capable of a greater range of alternatives f o r change (Greenberg, 1979; Yontef, 1976). - 22 -RESEARCH ON EMPATHY AND EMPATHIC REFLECTION IN THERAPY Since Rogers (1957) suggested empathy as one of the core conditions which were necessary and s u f f i c i e n t - f o r therapeutic personality change, many research studies have concentrated on researching t h i s claim. Among the ones more relevant to t h i s study are Carkhuff (1969) who suggests that, to be min-imally f a c i l i t a t i v e , the therapist must function at l e v e l 3.0 and above on his 5-point accurate empathy scale. Several studies lend credence to t h i s affirmation, i n that they report a c o r r e l a t i o n between higher l e v e l s of empathy, as measured by the Carkhuff and Truax scale, and pos i t i v e c l i e n t outcome (Altman, 1973; Bozarth and Rubin, i n press; Kurtz and' Grummon, 1972; Mullen and Abeles, 1971; Truax, 1970; Truax and Wittner, 1971; and Truax, et a l . , 1971). M i t c h e l l , et a l . (1977), however, i n an extensive review of the l i t e r a t u r e published to date on the issue of the r e l a t i o n s h i p of i n t e r -personal s k i l l s to c l i e n t outcome, demonstrate the inconclusive-ness of these findings and suggest that: . . . many e a r l i e r conclusions concerning c l i e n t -perceived therapist dimensions need reformulation, that some q u a l i f i c a t i o n i s necessary and that much of the e a r l i e r and more recent data, when taken together prove to be s u r p r i s i n g l y inconclusive with respect to a number of issues. By the same token, we f e e l that none of the previous conclusions need to be discarded completely (p. 498). - 23 -However, they do point out a l s o that the "high group" mean scores among psychotherapists and co u n s e l l o r s i n many s t u d i e s b a r e l y surpassed 2.0 on the Garkhuff and Truax s c a l e s , suggest-i n g t h a t the i n c o n c l u s i v e r e s u l t s may have been due to low l e v e l s of empathy. Bergin and Suinn (1975) i n a review of the research l i t -e r ature up u n t i l t h a t time, noted that the o r i g i n a l claims t h a t the "core c o n d i t i o n s " were the b a s i c i n g r e d i e n t s of good therapy probably does not hold f o r a l l approaches and should not be g e n e r a l i z e d as necessary and s u f f i c i e n t c o n d i t i o n s be-yond the c l i e n t - c e n t e r e d approach. More r e c e n t l y Lambert, de J u l i o and S t e i n (197&) i n an extensive review of i n t e r -personal s k i l l s research concluded t h a t notwithstanding twenty years of research, o n l y a modest r e l a t i o n s h i p has been found between therapy outcome and the core c o n d i t i o n s of accurate empathy, nonpossessive warmth and genuineness. This r e - e v a l u a t i o n concerning the core c o n d i t i o n s which has been t a k i n g place i n the l a s t decade has given b i r t h t o a new attempt at c o n c e p t u a l i z i n g some general f a c t o r t o e x p l a i n t h e r a p e u t i c e f f e c t i v e n e s s (Strupp, 1973). A new concept a r i s -i n g out o f psychoanalytic terminology but not confined t o a dynamic framework, r e f e r r e d to as the th e r a p e u t i c or working a l l i a n c e has generated much i n t e r e s t . A number of t h e o r i s t s and researchers have argued f o r the not i o n t h a t by the t h i r d - 24 -to f i f t h session of therapy an a l l i a n c e of some sort has been formed between c l i e n t and therapist that w i l l be predictive of outcome (LpBorsky, 1976; Hartley, 1978; Horvath, 1979). U / Saltzman, et a l . (1976) showed that by the t h i r d session c l i e n t n o ) statements of perceived understanding and uniqueness predicted 1 p o s i t i v e outcome. I t has also been suggested that the Barrett-Lennard r e l a t i o n s h i p inventory, which has been highly pre-d i c t i v e of outcome (Gurman, 1977), can be used to measure the qual i t y of the r e l a t i o n s h i p or the a l l i a n c e as perceived by the c l i e n t (Greenberg and Clarke, 1979; Gurman, 1977). AWARENESS; In Gestalt therapy, the concept of awareness i s the sine qua non of change. Perls (1969) states: . . . and I believe that t h i s i s the great thing to understand — (that awareness per se by and of i t -s e l f — can be curative). Because with f u l l aware-ness you become aware of t h i s organismic s e l f - r e g -u l a t i o n , you can l e t the organism take over without i n t e r f e r i n g , without interrupting; we can r e l y on the wisdom of the organism . . . . (pp. 16-17). Perls states further (1973) that i f people can become t r u l y \ aware of themselves they can see how they are producing per-sonal d i f f i c u l t i e s , can recognize what the d i f f i c u l t i e s are and can solve them i n the here-and-now. - 25 -Awareness transcends mere s e n s o r i a l or c o g n i t i v e data-processing and i s conceived of as a feedback loop between the i n t e r n a l organism and the o u t s i d e world (Kempler, 1973). Dysfunction occurs when a person becomes "stuck" i n one of these realms, and feedback i s blocked. Lack of awareness r e s t r i c t s the organism's experiencing and emerging g e s t a l t e n become f u r t h e r blocked ( P o l s t e r and P o l s t e r , 1973). Therapy s t r i v e s t o permit awareness i n the "here-and-now", and fre e s the i n d i v i d u a l t o recognize unmet needs. Yontef (1976) main-t a i n s t h a t only an aware g e s t a l t leads t o change, and Passons (1975) s t a t e s t h a t : . . . awareness must not only be present to c l a r i f y the emergent need which dominates the moment, but i t must a l s o be a v a i l a b l e t o the problem-solving . . . processes r e q u i r e d t o meet the need (p. 21). Greenberg and Clarke (197#) found that increased aware-ness as w e l l as deep l e v e l s of experiencing occurred i n the G e s t a l t two-chair dialogue, i n a therapy analogue. This study sought to disc o v e r whether the two-chair dialogue would have a s i m i l a r e f f e c t on c l i e n t s i n therapy, and whether i t would f a c i l i t a t e human behavioural changes. - 26 -CONCLUSION The core c o n d i t i o n s , as o p e r a t i o n a l i z e d and measured by the Truax-Garkhuff s c a l e s have f a i l e d to y i e l d the hoped f o r r e s u l t s across t h e r a p i e s . This has r e s u l t e d i n new e f f o r t s at c o n c e p t u a l i z i n g a g e n e r a l i z e d t h e r a p e u t i c f a c t o r and h i g h l i g h t e d the need f o r more research on s p e c i f y i n g what works i n therapy. There i s some evidence t o support the usefulness of empathic r e f l e c t i o n as a method and i t i s the method of empathic r e f l e c t i o n that w i l l be used i n the present thesis-. The G e s t a l t two-chair dialogue used at a s p l i t w i l l be compared f o r i t s s p e c i f i c e f f e c t s on c l i e n t process and s e s s i o n outcome w i t h the use of empathic r e f l e c t i o n at s p l i t . These two t h e r a p i s t operations w i l l be administered a f t e r the f o u r t h s e s s i o n of psychotherapy f o l l o w i n g the con f i r m a t i o n of the formation of a s a t i s f a c t o r y t h e r a p e u t i c 1 a l l i a n c e as measured by the. Barrett-Lennard-Relationship'Inventory. - 27 -CHAPTER I I I METHODOLOGY This chapter w i l l present the instruments used i n the study and b r i e f l y d i s c u s s t h e i r composition and r e l i a b i l i t y . The design, population, sampling, data c o l l e c t i o n and s c o r i n g procedure w i l l then be described and the t h e r a p i s t s and r a t e r s w i l l be c h a r a c t e r i z e d . F i n a l l y , the s t a t i s t i c a l a n a l y s i s and sources o f variance w i l l be d e l i n e a t e d . INSTRUMENTS The instruments used i n t h i s study served t h r e e purposes: to describe the s u b j e c t s , t o measure the dependent v a r i a b l e s , and t o gain c l i e n t i n f o r m a t i o n . Subject D e s c r i p t i o n 1. The S i x t e e n P e r s o n a l i t y F a c t o r Questionnaire (16-PF) In order to describe subjects more f u l l y , the Sixteen P e r s o n a l i t y Factor Questionnaire ( C a t t e l l , et a l . , 1970) was administered to a l l c l i e n t s before the f i r s t experimental s e s s i o n . The 16-PF i s an o b j e c t i v e l y scoreable p e r s o n a l i t y measure, which describes the subject according t o s i x t e e n primary p e r s o n a l i t y f a c t o r s , along with f o u r second order f a c t o r s (see Appendix A). F a c t o r s : G: Expedient/Conscientions, - 2a -Q^: Conservative/Experimenting, and Q3: Undisciplined s e l f -c o n f l i c t / c o n t r o l l e d , were used to describe the subjects used i n t h i s study. These factors rest within the context of a general theory of personality and are based on a population of normal and c l i n i c a l subjects. Form A, a pencil and paper tes t devised for l i t e r a t e individuals with high school educat-ion, was used i n t h i s research. The v a l i d i t y and r e l i a b i l i t y of the 16-PF have been ex-tensively researched. Test-retest r e l i a b i l i t y are .58 to .92 fo r each source t r a i t on the t e s t , with a 2 to 7 day i n t e r v a l and .36 to .88 with a 2 to 48 month i n t e r v a l . Direct v a l i d i t -ies range from .44 to .92, and i n d i r e c t v a l i d i t i e s , from .63 to .96. A more comprehensive review of the 16-PF i s available i n the Handbook fo r the 16-PF ( C a t t e l l , et a l . , 1970). 2. The Barrett-Lennard Relationship Inventory The Barrett-Lennard Relationship Inventory measures the c l i e n t ' s perception of the counsellor's warmth, congruence, empathy and p o s i t i v e regard. For the purposes of t h i s research, the sixteen items constituting the empathy sub-scale were used: items 1, 5, 9, 13, 17, 21, 25, 29, 33, 37, 41, 45, 49, 53, 57, and 59 (see Appendix B). - 29 -Numerous studi e s have reporte d r e s u l t s i n which an em-path i c understanding measure, based on c l i e n t perceptions, has g e n e r a l l y y i e l d e d e f f e c t i v e measures of outcome, and the Barrett-Lennard R e l a t i o n s h i p Inventory has been found to be more s t r o n g l y p r e d i c t i v e than other such measures ( B a r r e t t -Lennard, 1974). This measure determines the c l i e n t ' s percept-i o n of c o u n s e l l o r empathy, r a t h e r than the c o u n s e l l o r ' s e f f e c t -i v e use of empathic r e f l e c t i o n , which i s but one means of ex-pr e s s i n g empathic understanding and b u i l d i n g a working a l l i a n c e . To Measure Dependent V a r i a b l e s The dependent v a r i a b l e s s t u d i e d i n t h i s research were con-s i d e r e d to be summated s c a l e s , i . e . , s c a l e s not c l e a r l y i d e n t -i f i a b l e as e i t h e r o r d i n a l or i n t e r v a l , but occupying an i n t e r -mediate p o s i t i o n between o r d i n a l and i n t e r v a l s c a l e s (Gardner, 1975)• The Experiencing Scale and the Target Complaints Box Scale have been t r e a t e d as i n t e r v a l s c a l e s i n previous research ( K l e i n , et a l . , 1969; B a t t l e , et a l . , 1966). U n i t s of measure-ment on the remaining dependent v a r i a b l e s ( s h i f t of awareness questions, c o n f l i c t r e s o l u t i o n box s c a l e , change and progress questions and t a r g e t behaviour questions) were equal over the s c a l e s , v i s u a l l y , i f not s e m a n t i c a l l y . Deviations from i n t e r -v a l p r o p e r t i e s were not considered t o be extreme. The data were t h e r e f o r e considered appropriate f o r a n a l y s i s u s i n g para-metric s t a t i s t i c s (Gardner, 1975). - 30 -1. The Experiencing Scale The Experiencing Scale (Klein, et a l . , 1969) was used to measure the dependent variable, Depth of Experiencing. This scale was developed to evaluate the quality of a patient's s e l f involvement i n psychotherapy, d i r e c t l y from tape recordings or tape-scripts of the same session. The scale i s a seven-point r a t i n g device, s e n s i t i v e to s h i f t s i n c l i e n t involvement i n therapy. The lowest l e v e l s of the scale rate s u p e r f i c i a l c l i e n t discourse, the central l e v e l s mark simple descriptions of feelings whereas high l e v e l s of experiencing indicate exploration of feelings that may lead to problem solving and self-understanding (see Appendix C). Several studies have used the Experiencing Scale and have determined i n t e r r a t e r r e l i a b i l i t y . Ebels i n t r a - c l a s s method was used to determine r e l i a b i l i t y of the means of the judges' ratings ( r ^ j and an estimate of the average i n t e r c o r r e l a t i o n of a l l possible judge pairs ( r ^ ) . The r values obtained i n the various studies have ranged from 0.44 to 0.67, while the c r u c i a l r ^ c o e f f i c i e n t s vary from 0.?6 to 0.91 (Klein, et a l . , 1969, p. 45). Audio-tape recordings of a l l sessions were made, and sub-sequently divided into four-minute segments. Tape recordings of the randomized segments were then submitted to two independ-ent raters for r a t i n g according to the Experiencing Scale. - 31 -2. Target Complaint Box Scale This measure was designed by B a t t l e , et a l (1966) t o de-termine the degree of discomfort of d i s t u r b e d p a t i e n t s before and a f t e r psychotherapy. P a t i e n t s were asked t o s t a t e , and then rank t h e i r problems, and asked t o r a t e t h e i r discomfort on a Box S c a l e , which was a column d i v i d e d i n t o t h i r t e e n boxes. The words "not at a l l " were p r i n t e d beside the bottom box; "a l i t t l e " by the seventh box; "very much" by the t e n t h box; and "couldn't be worse" by the top box. P a t i e n t s were asked t o r a t e t h e i r discomfort both before and a f t e r i n t e r v i e w s . The scores were analyzed and compared w i t h the r e s u l t s of the three other outcome measures: a) P a t i e n t ' s r a t i n g of o v e r a l l improvement; b) Therapist's r a t i n g of p a t i e n t ' s o v e r - a l l improvement; and c) S o c i a l I n e f f e c t i v e n e s s S c a l e . ' B a t t l e , et a l . (1966) found t h a t the t a r g e t complaints scores c o r r e l a t e d to a s i g n i f i c a n t degree w i t h these three other outcome measures, which provides evidence f o r i t s v a l i d -i t y . The Target Complaint Box Scale (see Appendices D, question 2; E,:question 3; and G, question 2) was administered immed-i a t e l y before and immediately a f t e r therapy and one week a f t e r therapy i n the present study to help determine therapy e f f e c t -iveness i n reducing d i s t r e s s a s s o c i a t e d w i t h the c o u n s e l l i n g i s s u e . - 32 -3 . Awareness Question This measure c o n s i s t s o f two questions t h a t were ad-m i n i s t e r e d to the s u b j e c t s on a questionnaire completed three hours a f t e r therapy (see Appendix F, question 1). The f i r s t question r e q u i r e d c l i e n t s t o i d e n t i f y whether a s h i f t i n awareness had occurred; the second, whether c l i e n t s had obtained an increased awareness of themselves. A f i v e - p o i n t s c a l e was used to r a t e both questions, and the scores were combined and t r e a t e d as one dependent v a r i a b l e . 4. C o n f l i c t Reduction Box Scale This measure was created f o r the purposes of t h i s research p r o j e c t . I t c o n s i s t s of a seven-point box s c a l e , on which the c l i e n t s i n d i c a t e d t h e i r f e e l i n g s of r e s o l u t i o n regarding the i s s u e that they focused on during therapy. Box one i s l a b e l e d "not at a l l r e s o l v e d " , box f o u r "somewhat r e s o l v e d " , and box seven " t o t a l l y resolved!' (see Appendices E, question 4 ; G, question 3 ) . The c o n f l i c t r e d u c t i o n box s c a l e was administ-ered immediately a f t e r and one week a f t e r the experimental s e s s i o n . Face v a l i d i t y of the instrument was confirmed by two experts. - 33 -5. Behaviour Change Three hours a f t e r the therapy session, subjects were ask-ed to specify overt or covert target behaviours on a target behaviour scale. These behaviours were i d e n t i f i e d as behav-i o r s they hoped to change as a function of the therapy hour (see Appendix F, question 3 ) . They estimated the present f r e -quency of the target behaviours and one week a f t e r the experi-mental session, c l i e n t s again reported the actual frequency of the target behaviour. They further reported any occurrence other than the counselling hour which they f e l t might have contributed to the behavioural change they had reported. 6. Reports of Change and Progress One week afte r the experimental session, c l i e n t s were ask-ed to state how much progress they f e l t they had made i n deal-ing with t h e i r issue, and how much they had changed since the counselling hour. Each of these questions (see Appendix G, questions 4 and 6) were measured on a five-point r a t i n g scale, with descriptors at each point and the scores were combined to form one dependent variable on reported progress. C l i e n t Information 1. Semantic D i f f e r e n t i a l Scale This measure i s described by Warr and Knapper (1968) as a semantic t o o l for use i n psychotherapy. I t consists of a number - 34 -of p a i r s of a d j e c t i v e s , separated by a seven-point s c a l e , and defined as l y i n g i n r e l a t i v e p o s i t i o n s on the semantic space. Three such p a i r s were used i n the present study (see Appendices D, question 1; and E, question 1). The su b j e c t s reported on general f e e l i n g s of w e l l - b e i n g , t e n s i o n and c l a r i t y both before and immediately f o l l o w i n g the experimental s e s s i o n , i n order to examine whether therapy would produce change along these dimensions. 2. Perceived Understanding Immediately a f t e r the hour, subjects s t a t e d on the quest-i o n n a i r e (see Appendix E, questions 6 and 7) whether they per-ceived the t h e r a p i s t as having been understanding and h e l p f u l . The responses were r a t e d on a f i v e - p o i n t s c a l e , w i t h d e s c r i p t -ors at each l e v e l . This measure was included to in s u r e t h a t no s p e c i a l occurrence during the therapy hour might have i n -fluenced the c l i e n t ' s perception of the t h e r a p i s t s i n c e admin-i s t r a t i o n of the Barrett-Lennard R e l a t i o n s h i p Inventory, a f t e r the t h i r d s e s s i o n . 3. Unusual Events Question One week a f t e r the experimental s e s s i o n , subjects were asked to describe any unusual occurrence t h a t might have happen-ed during the week, other than the t h e r a p e u t i c hour, to which they might a t t r i b u t e any change i n t h e i r behaviour (see Appendix - 35 -G, question 7 ) . This enabled subjects t o r e p o r t l i f e events which might have been more r e s p o n s i b l e than the c o u n s e l l i n g hour f o r behaviour change. DESIGN A group of s i x t e e n subjects was used i n t h i s r e s e a r c h , w i t h each subject r e c e i v i n g both treatments. Subjects served as t h e i r own c o n t r o l s i n order to help minimize the e f f e c t of subject d i f f e r e n c e s (Gay, 1 9 7 6 ). Eight c l i e n t s were randomly s e l e c t e d to r e c e i v e empathic r e f l e c t i o n at a ' s p l i t ' during the f i r s t experimental s e s s i o n and eight were s e l e c t e d to r e -ceive G e s t a l t two-chair dialogue at a ' s p l i t ' during the f i r s t experimental s e s s i o n . The f o l l o w i n g s e s s i o n was not considered f o r the purposes of t h i s study i n order to i n s u r e greater i n -dependence of the two treatment s i t u a t i o n s . Counsellors were i n s t r u c t e d not t o respond a c t i v e l y to a s p l i t d uring t h i s i n -t e r v e n i n g s e s s i o n . C l i e n t s r e c e i v e d the a l t e r n a t e t h e r a p e u t i c technique at the next experimental s e s s i o n . This balanced ordering e l i m i n a t e d bias i n the dependent v a r i a b l e s which could be a t t r i b u t e d to the order of treatment p r e s e n t a t i o n . Measures were taken before, during, immediately a f t e r , three hours a f t e r , and one week a f t e r the experimental s e s s i o n s . A 2 x 2 f a c t o r i a l design w i t h repeated measures was used f o r the process data and f o r the r e p o r t s on awareness, and - 36 -change and progress. There were two l e v e l s of f i x e d f a c t o r A, treatment, and two l e v e l s o f f i x e d f a c t o r B, t h e r a p i s t experience. A 2 x 2 x r f a c t o r i a l design w i t h repeated measures on two f a c t o r s was used on the remaining s e s s i o n r e p o r t measures: d i s -t r e s s r e d u c t i o n , c o n f l i c t r e s o l u t i o n , and behaviour change. The two f a c t o r s — treatment and t h e r a p i s t experience — were the same as i n the previous design and the t h i r d f a c t o r r represented occasions of the report — before, immediately a f t e r , three hours a f t e r , and one week a f t e r treatment. The f a c t o r i a l design f o r t h i s study i s represented i n Figu r e 1. THERAPEUTIC INTERVENTION EMPATHIC GESTALT TWO-CHAIR REFLECTION DIALOGUE Ther a p i s t Experience L e v e l High Low n l ' n 2 ' * ' * n 8 nl» n2> * ' • n# °9' n10' ' * * n l 6 V n 1 0 ' * * ' n i 6 Figur e 1: F a c t o r i a l Design - 37 -POPULATION The subjects f o r t h i s study c o n s i s t e d of c l i e n t s engaged i n therapy at various c o u n s e l l i n g , f a c i l i t i e s i n the Vancouver, B r i t i s h Columbia area: p r i v a t e p r a c t i c e s , a u n i v e r s i t y counsel-l i n g center, a c o l l e g e c o u n s e l l i n g center, a women's resources center, and a div o r c e c o u n s e l l i n g center. F i f t e e n c o u n s e l l o r s were asked to p a r t i c i p a t e i n the study, on a v o l u n t a r y b a s i s , of which ten were f i n a l l y used. The subjects were obtained from various o u t p a t i e n t f a c i l i t i e s and are broadly represent-a t i v e of a population which seeks a s s i s t a n c e i n d e a l i n g w i t h p s y c h o l o g i c a l d i f f i c u l t i e s . The r e s u l t s of t h i s study can th e r e f o r e be g e n e r a l i z e d to a popu l a t i o n of people d e a l i n g w i t h problems i n l i v i n g , e.g., experiencing r e l a t i o n s h i p or i n t r a -psychic d i f f i c u l t i e s (Gurney and S t o l l a c k , 1965). Because of d i f f e r e n c e s i n r e a c t i o n s t o therapy between " n e u r o t i c " and "ps y c h o t i c " p a t i e n t s ( K i e s l e r , 1971), these r e s u l t s w i l l not apply to an extremely d i s t r e s s e d p o p u l a t i o n . SUBJECT PREPARATION AND DEMOGRAPHIC DATA Subjects f o r t h i s t h e s i s were t o l d t h a t the study focused on i n t e r p e r s o n a l communication i n therapy. They were a l s o t o l d t h a t a l l sessions would be audio tape recorded, t h a t some would be l i s t e n e d to by e x t e r n a l c o u n s e l l o r s , and tha t they would be asked to f i l l out eigh t questionnaires regarding therapy, as w e l l as one paper and p e n c i l questionnaire and one - 38 -r e l a t i o n s h i p inventory. They were insured of c o n f i d e n t i a l i t y and signed a form s t a t i n g that they agreed to p a r t i c i p a t e i n the study, but were free to withdraw from the experiment, without penalty, i f they so wished. One subject refused to p a r t i c i p a t e i n the study. After the second session, c l i e n t s completed the 16-PF. A l l subjects i n t h i s experiment scored below sten 6 on Factor G: Expedient vs. Goncientious; above sten 3 on Factor Q-j_: Conservative vs. Experimenting; and below sten 7 of Factor Q^: Undisciplined S e l f - C o n f l i c t vs. Controlled. The subjects could therefore be characterized according to the 16-PF, as not overly conscientious, i . e . , not having stronger superego strength, experimenting, i . e . , inquiring regarding old or new ideas and tolerant of inconvenience and change, and not overly controlled, i . e . , not having strong control over t h e i r emotions. After the t h i r d session, subjects completed the Barrett-Lennard Relationship Inventory. The experimental hours a l l occurred between the f i f t h and the ninth session. Subjects ranged i n age from 20 to 46 (mean 29.5, s.d. 5.89). Two subjects were male, fourteen were female. Three subjects were students, three were counsellors, three were unemployed, two were teachers, two were homemakers, and there were one of each of the following: microbiologist, c h i l d care counsellor, and a salesperson. - 3 9 -A l l c l i e n t s r e c e i v e d empathic r e f l e c t i o n and G e s t a l t two-chair dialogue p r i o r to the f i r s t experimental s e s s i o n . THERAPISTS Ten t h e r a p i s t s , eight women and two men, were used i n t h i s study. Low experience t h e r a p i s t s had at l e a s t f i f t y hours of t r a i n i n g i n the G e s t a l t two-chair dialogue technique, con-s i s t i n g of twenty weekly three-hour s e s s i o n s , during which explanations and examples of the f i v e p r i n c i p l e s of G e s t a l t two-chair dialogue were given, as reported i n Chapter I o f t h i s t h e s i s . I n the course of t h i s t r a i n i n g , p a r t i c i p a n t s acted as both c l i e n t s and t h e r a p i s t s , f o r l e a r n i n g purposes, and p a r t i c i p a t e d i n feedback and d i s c u s s i o n of the t h e r a p e u t i c i n t e r v e n t i o n . More i n f o r m a t i o n about the t r a i n i n g can be obtained i n a paper by Greenberg ( i n p r e s s ) . The s i x "low experienced" t h e r a p i s t s had from one t o three months* exper-ience i n the use of the technique, f o l l o w i n g t r a i n i n g . Four of the t h e r a p i s t s had at l e a s t 100 hours of t r a i n i n g experience and two or more years of c l i n i c a l experience w i t h the technique. These four c o n s t i t u t e d the "high-experience" group. A l l the t h e r a p i s t s had a minimum of 100 hours of t r a i n i n g and supervised p r a c t i c e i n empathic r e f l e c t i o n and the use of i n t e r p e r s o n a l s k i l l s and had working experience using these s k i l l s ranging from two to seven years. - 40 -Three of the experienced t h e r a p i s t s ' professed o r i e n t a t i o n was G e s t a l t , the remaining t h e r a p i s t s ' professed o r i e n t a t i o n was the Carkhuff model. A l l of the inexperienced t h e r a p i s t s ' professed o r i e n t a t i o n was the Carkhuff model. The r a p i s t s were randomly assigned a treatment sequence i n s u r i n g that h a l f of the subjects would r e c e i v e empathic r e f l e c t i o n i n the f i r s t experimental s e s s i o n and the remaining h a l f would r e c e i v e G e s t a l t two-chair dialogue f i r s t . Therap-i s t s were t o l d t o use both techniques w i t h c l i e n t s before, but not immediately preceding the experimental s e s s i o n s , i n order t o a void a n o v e l t y e f f e c t during the experimental s e s s i o n (Gay, 1976). Therapists were a l s o t o l d t o d i s p l a c e the experimental s e s s i o n to the subsequent meeting i f a s p l i t d i d not occur during the chosen therapy hour, or i f the c l i e n t presented a c r i s i s t h a t r e q u i r e d s p e c i f i c a l t e r n a t e a t t e n t i o n . RATERS Empathic r e f l e c t i o n was r a t e d on the Carkhuff s c a l e by two graduate students i n a c o u n s e l l i n g psychology programme. Both had approximately f o r t y - f i v e hours' experience i n the use of the s c a l e . The G e s t a l t two-chair dialogue operation was r a t e d as o c c u r r i n g or not o c c u r r i n g , according to the c r i t e r i a pre-sented i n Chapter I , by two graduate students w i t h s i x t y hours' t r a i n i n g i n the use of the o p e r a t i o n . - 41 -The Experiencing Scale r a t i n g was performed by two graduate students i n a c o u n s e l l i n g psychology programme. They re c e i v e d approximately 48 hours of t r a i n i n g and p r a c t i c e , according t o the procedures described i n The Experiencing  S c a l e , T r a i n i n g Manual ( K l e i n , et a l . , 1969), plus some a d d i t i o n a l t r a i n i n g on two-chair dialogue m a t e r i a l which had been r a t e d by the author of the Experiencing S c a l e . These r a t e r s were f a m i l i a r w i t h the empathic r e f l e c t i o n technique and the G e s t a l t two-chair r o l e - p l a y o p e r a t i o n , but n e i t h e r was aware of the experimental hypotheses. DATA COLLECTION C l i e n t s completed the S i x t e e n P e r s o n a l i t y F a c t o r Question-n a i r e between the second and t h i r d sessions of therapy and the Barrett-Lennard R e l a t i o n s h i p Inventory f o l l o w i n g the t h i r d s e s s i o n of therapy. Before the f i r s t experimental c o u n s e l l i n g s e s s i o n (programmed t o be the f i f t h i n t e r v i e w ) , c l i e n t s f i l l e d i n the t a r g e t complaints box s c a l e r e l a t i n g t o the is s u e t h a t they intended t o deal w i t h during therapy. During the f i f t h i n t e r v i e w , t h e r a p i s t s responded t o c l i e n t s who presented a s p l i t w i t h the pre-assigned t h e r a p e u t i c t e c h -nique. I f the c l i e n t d i d not present a s p l i t or d e a l t w i t h an is s u e t h a t required some other form of immediate t h e r a p e u t i c a t t e n t i o n , t h e r a p i s t s postponed the experimental procedure un-t i l the f o l l o w i n g s e s s i o n . A l l experimental i n t e r v i e w s were audiotape recorded. - 42 -Immediately a f t e r the s e s s i o n c l i e n t s completed the t a r g e t complaints box s c a l e and the r e s o l u t i o n question. Three hours a f t e r the therapy s e s s i o n , when c l i e n t s had had some time to i n t e g r a t e what had t r a n s p i r e d i n the therapy hour, they answer-ed the awareness question, the change and progress questions, and s p e c i f i e d the a c t u a l frequency of a t a r g e t behaviour, which they wanted to change as a f u n c t i o n of the s e s s i o n . One week a f t e r the s e s s i o n , c l i e n t s f i l l e d i n the t a r g e t complaints box s c a l e , the r e s o l u t i o n question and reported any behavioural change i n connection w i t h the behaviour s p e c i f i e d p r e v i o u s l y . The f o l l o w i n g therapy s e s s i o n was not considered f o r the purposes of t h i s study. For the next experimental s e s s i o n , the procedure, as f o r the f i r s t experimental s e s s i o n , was repeated. A schematic r e p r e s e n t a t i o n of the order of t e s t s w i t h respect to treatments i s presented i n Figure 2, page 43. SCORING PROCEDURE Scoring occurred i n three s t a g e s . A check was f i r s t made to ensure t h a t a l l c l i e n t s perceived t h e i r t h e r a p i s t as empathic. A check was then made to ensure that t h e r a p i s t s were c o r r e c t l y conducting the th e r a p e u t i c operations. Ratings of the c l i e n t process were performed from tape recordings on the Depth of Experiencing S c a l e . - 43 -' X2 D-L D 2 0 ^ O p ^ 0 T 2 0 T 3 0 T 4 X 3 0 ^ O p ^ 0 ^ 0 ^ X' X, D , ) T 1 , o T 5 0, T2» °T6 ^T3 ' ^T7 o T 4 , o T d Empathic R e f l e c t i o n G e s t a l t two-chair Role-play Non-experimental s e s s i o n S i x t e e n P e r s o n a l i t y Factor Questionnaire Barrett-Lennard R e l a t i o n s h i p Inventory Pre-measure: Target Complaints Box Scale Process Measure: The Experiencing Scale Immediately a f t e r the Session: Three hours a f t e r the Session: One week a f t e r the Session: Target Complaints Box S c a l e . R e s o l u t i o n Question. Awareness Question. Change and Progress Question. Target Behaviour S e t t i n g . Target Complaints Box S c a l e . R e s o l u t i o n Question. Target Behaviour Report. Figure 2 - Order of Tests w i t h Respect to Treatments. - 44 -C l i e n t s ' p e r c e p t i o n of t h e i r t h e r a p i s t ' s empathy was determined according t o the empathy s c a l e of the B a r r e t t -Lennard R e l a t i o n s h i p Inventory (Barrett-Lennard, 1962). C l i e n t s r a t e d t h e i r t h e r a p i s t from 1 t o 3 on each of the s i x t e e n items o f the s c a l e (see Appendix B, items 1, 5 , 9 , 13, 17, 21 , 25, 29, 33 , 37, 41, 45 , 4 9 , 53, 57 and 6 1 ) . I n order to be perceived as mini m a l l y f a c i l i t a t i v e , t h e r a p i s t s had t o ob t a i n a minimum score o f 16 on the s c a l e , out of a p o s s i b l e maximum of 4 8 . A l l c l i e n t s r a t e d t h e i r t h e r a p i s t s above 16. The mean score f o r the group of s i x t e e n t h e r a p i s t s was 3 4 . 7 5 , w i t h a standard d e v i a t i o n of 7 . 6 9 . The data obtained from t h i s r a t i n g procedure i s presented i n Table I , page 4 5 . I t was concluded from t h i s data t h a t a l l c l i e n t s p e r c e i v -ed t h e i r t h e r a p i s t to be empathic by Barrett-Lennard's (1962) c r i t e r i a . Therefore, none of the t h e r a p i s t s had t o be r e -j e c t e d because they were not perceived as being empathic by t h e i r c l i e n t . I n order to ensure t h a t t h e r a p i s t s were using the a s s i g n -ed o p e r a t i o n i n sessions where empathic r e f l e c t i o n was t o occur, tapes were submitted t o two r a t e r s who r a t e d t h e r a p i s t respons-es from one t o f i v e on the Carkhuff Scale (Carkhuff, 1969) . The r a t e r s l i s t e n e d t o f i v e minute segments s e l e c t e d from the beginning, middle and end o f each i n t e r v i e w , and determined whether each segment was at l e a s t minimally f a c i l i t a t i v e on - 45 -TABLE I EMPATHY RATINGS ON THE  BARRETT-LENNARD RELATIONSHIP INVENTORY CLIENT PERCEIVED THERAPIST EMPATHY RATING 1 39 2 29 3 39 > 45 5 26 6 32 7 30 8 43 9 34 10 48 11 25 12 22 13 29 14 39 15 42 16 34 - 46 -the Carkhuff Scale, i . e . , t h a t each segment scored three or more. The r e s u l t i n g 48 r a t i n g s of each r a t e r were t e s t e d . The i n t e r r a t e r r e l i a b i l i t y expressed as a Pearson Product moment c o r r e l a t i o n c o e f f i c i e n t across the 48 p a i r s of ratings,was . 8 7 . The r a t e r s agreed on 78 per cent of the r a t i n g s and w i t h i n a h a l f step of the s c a l e ( .5) on one hundred per cent of the r a t i n g s . None of the segments warranted a r a t i n g of l e s s than 3 . 0 . The three r a t i n g s obtained from each s e s s i o n by each r a t e r were averaged t o o b t a i n a mean empathy r a t i n g f o r each s e s s i o n . The data thus obtained i s presented i n Table I I , page 47 . I t i s concluded from t h i s data that a l l t h e r a p i s t s respond-ed to t h e i r c l i e n t s w i t h at l e a s t minimally f a c i l i t a t i v e l e v e l s of empathic r e f l e c t i o n according to Carkhuff's (1969) c r i t e r i a , i n the sessions where t h i s technique was used. Therefore, none of the empathic r e f l e c t i o n sessions had to be r e j e c t e d because the technique was not adequately implemented. In order to ensure that t h e r a p i s t s were using the assigned operation i n sessions where G e s t a l t two-chair dialogue was to occur, tapes were submitted to two r a t e r s who determined the occurrence of the G e s t a l t two-chair dialogue according to the f i v e p r i n c i p l e s o u t l i n e d i n Chapter I . There i s no o b j e c t i v e s c a l e according to which the G e s t a l t two-chair dialogue can - 47 -TABLE I I MEAN EMPATHIC REFLECTION RATING FOR EACH SESSION THERAPIST MEAN EMPATHIC REFLECTION RATING 1 4 . 0 2 4 . 0 3 3 .0 4 4 . 0 5 3.5 6 3 . 0 7 4 . 0 3 3.0 9 4 . 0 10 4 . 0 11 3.5 12 3.5 13 3 .0 14 4 . 0 15 3.5 16 3 .0 - 48 -be r a t e d ; u n t i l such a s c a l e i s a v a i l a b l e , c l i n i c a l judgement must s u f f i c e . Both r a t e r s confirmed the occurrence of the G e s t a l t two-chair dialogue i n a l l s i x t e e n of the experimental sessions, and no sessions had t o be discarded. Twenty-five hours of tape recorded data r e s u l t e d from the 32 tapes which were c o l l e c t e d , once m a t e r i a l which preceded the occurrence of a ' s p l i t ' had been e l i m i n a t e d . These 25 hours of data were then segmented i n t o four minute excerpts which were randomly recorded on tape. There were a t o t a l of 171 segments of G e s t a l t two-chair dialogue and 181 segments of empathic r e f l e c t i o n . The t o t a l number of segments was not found to be s i g n i f i c a n t l y d i f f e r e n t at the .05 l e v e l according to a t - t e s t .(for both techniques). These tapes were submitted to two r a t e r s f o r r a t i n g on the Experiencing Scale ( K l e i n , et a l . , 1969) . Each r a t e r r a t e d two-thirds of the tapes, i n order to provide o n e - t h i r d o f the tapes f o r an i n t e r r a t e r r e l i a b i l i t y check. Segments were assigned two scores, from one to seven i n c l u s i v e , i n d i c a t i n g the peak and the mode score obtained by the c l i e n t , according to the Experiencing S c a l e . These r a t e r s were t r a i n e d c o n c u r r e n t l y , before the data was c o l l e c t e d . At the end o f t h e i r t r a i n i n g , the r a t e r s ' r a t i n g s of twenty randomized four-minute therapy segments had - 4 9 -y i e l d e d a Pearson Product moment c o r r e l a t i o n of . 8 3 . They-agreed on 7 4 per cent of the r a t i n g s and w i t h i n one point per r a t i n g on a l l of the scores. Both r a t e r s then r a t e d o n e - t h i r d of overlapping tape on the a c t u a l experimental segments. The i n t e r r a t e r r e l i a b i l i t y at t h i s time was . 77 . They agreed on 67 per cent of the r a t i n g s and w i t h i n one point per r a t i n g on a l l s cores. For each i n t e r v i e w the frequency of segments as w e l l as the p r o p o r t i o n of segments assigned a r a t i n g equal to o r great-er than f i v e was c a l c u l a t e d . Scores of f i v e i n d i c a t e t h a t the c l i e n t has presented and explored a personal problem, and scores o f s i x and seven i n d i c a t e t h a t the c l i e n t has r e s o l v e d a p e r s o n a l l y s i g n i f i c a n t i s s u e . These stages were s e l e c t e d as c r i t e r i a f o r the "deeper experiencing" comparison. For each four minute segment, running scores were c a l -c u l a t e d according to the depth of the c l i e n t s ' responses. One most common score (mode) and one highest score (peak) were c a l c u l a t e d f o r each four minute segment. The peak scores were analyzed f o r t h i s study, as they have been p r e v i o u s l y shown to be d i f f e r e n t i a l l y a f f e c t e d by the G e s t a l t two-chair dialogue (Greenberg and C l a r k e , 1 9 7 9 ; Higgins, 1 9 7 9 ) . Frequency counts and p r o p o r t i o n scores were taken f o r segments o b t a i n i n g a peak score of f i v e or more, f o r a l l empathic r e f l e c t i o n and a l l G e s t a l t two-chair dialogue s e s s i o n s . I n the f i r s t method o f - 50 -data c o l l e c t i o n (use of frequency) time was considered an irre l e v a n t variable and in t e r e s t was focused on the number of high Depth of Experiencing scores, regardless of time spent i n therapy. In the second method (use of proportion) time was considered as a main element i n obtaining scores. The t o t a l number of segments for both treatments were approximately equal, thus making frequency a more acceptable measure than i t would have been, had t h e i r been a s i g n i f i c a n t difference i n the t o t a l number of segments for both treatments. PROCEDURE OF ANALYSIS The data were analyzed i n a two-way analysis of variance, with repeated measures on one f a c t o r . Fixed factor A was therap-i s t experience l e v e l and fix e d factor B, therapeutic i n t e r -vention (Winer, 1971). The proportion scores, representing the percentage of segments i n each interview which were rated for peak depths of experiencing of 5 or more, were passed through an arc s i n transformation i n order to make them approp-r i a t e for analysis of variance (Kirk, 1968). The University of C a l i f o r n i a program, BMDP2V (1978), was used f o r analysis of measures administered at more than one point i n time; the S t a t i s t i c a l Package for the Soc i a l Sciences (1978) was used f o r analysis of measures administered one time only. The pro-gramme was run at the University of B r i t i s h Columbia Computing Center. - 51 -CHAPTER IV RESULTS This chapter presents the r e s u l t s of the s t a t i s t i c a l analyses performed on the dependent v a r i a b l e s , and c l i e n t i n f o r m a t i o n . They w i l l be presented i n the order used t o describe them i n Chapter I I I . The r e s u l t s of a n a l y s i s of variance were used t o determine the d i f f e r e n t i a l e f f e c t s o f G e s t a l t two-chair dialogue on s i x dependent v a r i a b l e s : depth of experiencing, d i s t r e s s r e d u c t i o n , s h i f t of awareness, c o n f l i c t r e s o l u t i o n , behaviour change and re p o r t s o f change and progress. Depth of experiencing proportion scores were subjected to an arc s i n t r a n s f o r m a t i o n to make them amenable to a n a l y s i s of varia n c e . C l i e n t information gathered on the semantic d i f f e r e n t i a l s c a l e , evaluations of the hour, perceived t h e r a p i s t understanding and h e l p f u l n e s s , and re p o r t s of unusual events are a l s o given. COMPARISON OF DEPTH OF EXPERIENCING PROPORTION SCORES UNDER  GESTALT TWO-CHAIR DIALOGUE AND EMPATHIC REFLECTION P r o p o r t i o n scores of therapy segments r a t e d 5 or more f o r peak depth o f experiencing may be found i n Table I I I . The means and standard d e v i a t i o n s o f depth of experiencing pro-p o r t i o n scores may be found i n Table IV. The means r e v e a l - 52 -TABLE I I I PROPORTION SCORES FOR SEGMENTS OF PEAK  DEPTH OF EXPERIENCING OF 5 OR MORE C l i e n t P r o p o r t i o n of segments G e s t a l t two-chair Empathic dialogue r e f l e c t i o n 1 .06 .00 2 .13 .09 3 .17 .09 High-Experience 4 .26 .00 The r a p i s t s 5 .55 .30 6 .50 .00 7 .14 .13 8 .00 .00 1 .00 .00 2 .63 .00 3 .22 .00 Low-Experienc e 4 .14 .13 Th e r a p i s t s 5 .40 .20 6 .17 .30 7 .00 .00 8 .43 .29 - 53 -TABLE IV MEANS AND STANDARD DEVIATIONS OF TRANSFORMED DEPTH OF EXPERIENCING PROPORTION SCORES TREATMENT MEAN STANDARD DEVIATION G e s t a l t Two-Chair Dialogue High-Experience T h e r a p i s t s 0.892 0.546 G e s t a l t Two-Chair Dialogue Low-Experience T h e r a p i s t s 0.903 0.457 Empathic R e f l e c t i o n High-Experience Therapists 0.400 0.657 Empathic R e f l e c t i o n Low-Experience T h e r a p i s t s 0.495 0.545 These scores have been subjected t o an arc s i n transform-a t i o n t o make them amenable f o r a n a l y s i s of v a r i a n c e . - 54 -TABLE V ANALYSIS OF VARIANCE FOR TRANSFORMED DEPTH OF EXPERIENCING PROPORTION SCORES SOURCE SUM OF SQUARES DEGREES OF FREEDOM MEAN SQUARES F RATIO PROBABILITY Between Experience Levels .023 1 .023 .054 0.819 S-within 5.369 14 .419 Between Therapies 1 .623 1 1 .623 8.188 0.013 S-within 2.775 14 .198 Between ELxT 0.014 1 0.014 0 .072 0 .792 - 55, -t h a t greater proportions of depth experiencing reaching peaks of 5 or more on the Experiencing Scale were obtained w i t h the use of G e s t a l t two-chair dialogue than w i t h the use o f empathic r e f l e c t i o n . A n a l y s i s of variance o f these r e s u l t s (Table IV) revealed t h a t t h e r e was no s i g n i f i c a n t d i f f e r e n c e between t h e r a p i s t experience l e v e l s . A s i g n i f i c a n t d i f f e r e n c e was found between t h e r a p i e s . No i n t e r a c t i o n e f f e c t s were found to be s t a t i s t i c -a l l y s i g n i f i c a n t (<=*=r.05). On the basis of these analyses, the n u l l hypothesis: H Q : The G e s t a l t two-chair dialogue, when used 1 at a s p l i t , w i l l not l e a d t o depths of experiencing on the K l e i n , et a l . , Experienc-in g S cale, s i g n i f i c a n t l y d i f f e r e n t from those produced by the use of empathic r e f l e c t i o n at a s p l i t , i s r e j e c t e d i n favour of the a l t e r n a t i v e , Hn . • 1 GOMPARISION OF DISTRESS REDUCTION SCORES UNDER GESTALT  TWO-CHAIR DIALOGUE AND EMPATHIC REFLECTION Means and standard d e v i a t i o n s f o r l e v e l s of d i s t r e s s r e -du c t i o n , as measured on three occasions, may be found i n Table V I . - 56 -TABLE VI MEANS AND STANDARD DEVIATIONS FOR DISTRESS REDUCTION SCORES TREATMENT OCCASIONS 1 MEAN STANDARD DEVIATION G e s t a l t Two-Chair Dialogue 01 5.00000 2.56348 High-Experience Th e r a p i s t s 02 10 .25000 1.38873 03 9.37500 2.5037 Ge s t a l t Two-Chair Dialogue 01 4.87500 2.90012 Low-Experience Th e r a p i s t s 02 8.87500 1.72689 03 8.62500 3.02076 Empathic R e f l e c t i o n 01 4.87500 1.80772 High-Experience Therapists 02 8 .87500 2.16712 03 7 .75000 2.81577 Empathic R e f l e c t i o n 01 4.87500 1.55265 Low-Experience Therapists 02 9.37500 2.61520 03 8.50000 2.56348 01 •=» D i s t r e s s r e d u c t i o n scores obtained before the s e s s i o n . 02 ~ D i s t r e s s r e d u c t i o n scores obtained immediately a f t e r the s e s s i o n . 03 =» D i s t r e s s r e d u c t i o n scores obtained one week a f t e r the s e s s i o n . - 57 -TABLE VII ANALYSIS OF VARIANCE FOR THREE OCCASIONS OF DISTRESS REDUCTION SCORES SOURCE SUM OF DEGREES MEAN F TAIL SQUARES OF SQUARES RATIO PROBABILITY FREEDOM OCCASION 1: IMMEDIATELY BEFORE THERAPY Between Experience Levels 0.031 1 0.031 0.007 0.936 S-within 65.188 14 4.656 Between Therapies 0.031 1 0.031 0.006 0.942 S-within 79.438 14 5.674 Between ELxT 0.031 1 0.031 0.006 0.942 OCCASION 2: IMMEDIATELY AFTER THERAPY Between Experience Levels 1.531 1 1.531 0.240 0.632 S-within 89.188 14 6.371 Between Therapies 1.531 1 1.531 0.827 0.379 S-within 25.933 14 1.353 Between ELxT 7.031 1 7 .031 3.795 0.720 OCCASION 3 : ONE WEEK AFTER THERAPY Between Experience Levels 0 . 0 1 0 . 0 0 . 0 0.999 S-within 102.875 14 7 .343 Between Therapies 6.125 1 6.125 0.806 0.384 S-within 106.375 14 7.593 Between ELxT 4.500 1 4.500 0.592 0.454 - 58 -Analyses of variance performed on each occasion revealed no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e between t h e r a p i s t ex-perience l e v e l , or between t h e r a p i e s , on a l l three occasions. No i n t e r a c t i o n e f f e c t s were found to be s i g n i f i c a n t (=><. =• . 0 5 ) . On the basis of these analyses, the n u l l hypothesis: HQ : The G e s t a l t two-chair dialogue, when used at 2 a s p l i t w i l l not lead t o l e v e l s of d i s t r e s s r e d u c t i o n s i g n i f i c a n t l y d i f f e r e n t from those produced by the use of empathic r e f l e c t i o n at a s p l i t , as measured on a t h i r t e e n - p o i n t box s c a l e , administered before, immediately a f t e r , and one week a f t e r therapy. i s not r e j e c t e d i n favour of the a l t e r n a t i v e , H, . 1 2 COMPARISON OF SHIFT OF AWARENESS SCORES UNDER GESTALT  TWO-CHAIR DIALOGUE AND EMPATHIC REFLECTION Scores obtained on the two awareness questions were not found t o be s i g n i f i c a n t l y d i f f e r e n t . 0 5 ) , upon execution of a dependent t - t e s t . The scores were then combined, and t r e a t e d as one measure. Means and standard d e v i a t i o n s of l e v e l s of s h i f t o f aware-ness may be found i n Table V I I I . The means r e v e a l t h a t higher scores were obtained w i t h the use of G e s t a l t two-chair dialogue than w i t h the use o f empathic r e f l e c t i o n . - 59 -TABLE V I I I MEANS AND STANDARD DEVIATIONS  FOR SHIFT OF AWARENESS SCORES TREATMENT MEAN STANDARD DEVIATION G e s t a l t Two-Chair Dialogue High Experience Therapists 10.000 0.0 G e s t a l t Two-Chair Dialogue Low-Experience T h e r a p i s t s 9.500 1.065 Empathic R e f l e c t i o n High-Experience T h e r a p i s t s 7.375 1.598 Empathic R e f l e c t i o n Low-Experience Therapists a. 625 2.134 - 60 -TABLE IX ANALYSIS OF VARIANCE FOR SHIFT OF AWARENESS SCORES SOURCE SUM OF DEGREES MEAN F TAIL SQUARES OF SQUARES RATIO PROBABILITY FREEDOM Between Experience Levels 1.125 1 1.125 .674 0.425 S-within 23.375 14 1.670 Between Therapies 24.500 1 24.500 9.978 .007 S-within 34.375 14 2.455 Between ELxT 6.125 1 6.125 2.495 .137 - 61 -A n a l y s i s of variance of these r e s u l t s (Table IX) revealed t h a t there was no s i g n i f i c a n t d i f f e r e n c e between t h e r a p i s t experience l e v e l s . A s i g n i f i c a n t d i f f e r e n c e was found between t h e r a p i e s . No i n t e r a c t i o n e f f e c t s were found to be s t a t i s t i c -a l l y s i g n i f i c a n t (©<^ .05). On the basi s of these analyses, the n u l l hypothesis: HQ : The G e s t a l t two-chair dialogue, when used 3 at a s p l i t , w i l l not l e a d t o l e v e l s of s h i f t of awareness s i g n i f i c a n t l y d i f f e r e n t from those produced by the use of empathic r e -f l e c t i o n at a s p l i t , as measured on two f i v e - p o i n t s c a l e s administered three hours a f t e r therapy, i s r e j e c t e d i n favour of the a l t e r n a t i v e , H-, . 3 COMPARISON OF CONFLICT RESOLUTION SCORES UNDER GESTALT  TWO-CHAIR DIALOGUE AND EMPATHIC REFLECTION Means and standard d e v i a t i o n s o f l e v e l s of c o n f l i c t r e s o l u t i o n , as measured on two occasions, may be found i n Table X. The means r e v e a l that on both occasions (three hours a f t e r therapy and one week a f t e r t h e r a p y ) , higher scores were obtained w i t h the use of G e s t a l t two-chair dialogue than w i t h the use of empathic r e f l e c t i o n . A n a l y s i s of variance performed on each occasion (Table XI) showed th a t G e s t a l t two-chair dialogue l e d t o - 62 -TABLE X MEAN AND STANDARD DEVIATIONS FOR CONFLICT TREATMENT RESOLUTION OCCASIONS1 SCORES MEAN STANDARD DEVIATION G e s t a l t Two-Chair Dialogue 01 5.500 0.925 High-Experience Therapists 02 5.250 0.834 Ge s t a l t Two-Chair Dialogue 01 4.875 0.886 Low-Experience Therapists 02 5.000 1.069 Empathic R e f l e c t i o n 01 4.375 1.187 High-Experience T h e r a p i s t s 02 3.625 .744 Empathic R e f l e c t i o n 01 4.250 1.035 Low-Experience Therapists 02 3.625 1.505 01 = Scores of c o n f l i c t r e s o l u t i o n obtained three hours a f t e r therapy. 02 - Scores of c o n f l i c t r e s o l u t i o n obtained one week a f t e r therapy. - 63 -TABLE XI ANALYSIS OF VARIANCE FOR TWO OCCASIONS  OF CONFLICT RESOLUTION SCORES SOURCE SUM OF DEGREES MEAN F TAIL SQUARES OF SQUARES RATIO PROBABILITY FREEDOM OCCASION 1: THREE HOURS AFTER THERAPY Between Experience Levels 1.125 1 1.125 0.792 0.388 S-within 19 .875 14 1.420 Between Therapies 6.125 1 6.125 10.239 0.006 S-within 8.375 14 0.598 Between ELxT 0.500 1 0.500 0.336 0.376 OCCASION 2: ONE WEEK AFTER THERAPY Between Experience L e v e l s 0.125 1 0.125 0.069 0.797 S-within 25.375 14 1.813 Between Therapies 18.000 1 18.000 32.000 0.001 S-within 7.375 14 0.563 Between ELxT 0.125 1 0.125 0.222 0.645 - 64 -s i g n i f i c a n t l y greater c o n f l i c t r e s o l u t i o n than d i d empathic r e f l e c t i o n , both three hours a f t e r therapy and one week a f t e r therapy. On the b a s i s of these analyses, the n u l l hypothesis: The G e s t a l t two-chair dialogue, when used at a s p l i t , w i l l not l e a d t o l e v e l s o f c o n f l i c t r e s o l u t i o n s i g n i f i c a n t l y d i f f e r e n t from those produced by the use of empathic r e f l e c t i o n at a s p l i t , as measured on a seven-point box sca l e administered three hours a f t e r and one week a f t e r therapy, i s r e j e c t e d i n favour of the a l t e r n a t i v e , H, . COMPARISON OF BEHAVIOUR CHANGE SCORES UNDER GESTALT TWO-CHAIR  DIALOGUE AND EMPATHIC REFLECTION Means and standard d e v i a t i o n s of l e v e l s of behaviour change may be found i n Table X I I . The means r e v e a l t h a t higher scores were obtained w i t h the use of G e s t a l t two-chair dialogue than w i t h the use of empathic r e f l e c t i o n . A n a l y s i s of variance performed on each occasion i n d i v i d u a l -l y (Table X I I I ) showed t h a t present behaviour, measured before therapy, was not s i g n i f i c a n t l y d i f f e r e n t between t h e r a p i s t experience l e v e l s or between t h e r a p i e s . There were no s t a t i s t i c a l l y s i g n i f i c a n t i n t e r a c t i o n e f f e c t s . Behaviour achieved i n the week f o l l o w i n g therapy was s i g n i f i c a n t l y greater f o r c l i e n t s HQ : - 65 -TABLE X I I MEANS AND STANDARD DEVIATIONS  FOR BEHAVIOUR CHANGE SCORES TREATMENT' OCCASIONS] L MEAN STANDARD DEVIATION G e s t a l t Two-Chair Dialogue 01 2 .750 0.707 High-Experience T h e r a p i s t s 02 4.625 1.061 G e s t a l t Two-Chair Dialogue 01 2.625 1.302 Low-Experience Therapists 02 4 .250 1.165 Empathic R e f l e c t i o n 01 2.375 0.835 High-Experience T h e r a p i s t s 02 3.875 0.641 Empathic R e f l e c t i o n 01 2.375 1.138 Low-Experience Therapists 02 3.625 1.188 01 * Scores o f present behaviour reported three hours a f t e r therapy. 02 = Scores of achieved behaviour reported one week a f t e r therapy. - 66 -TABLE XIII ANALYSIS GF VARIANCE FOR TWO OCCASIONS OF SOURCE BEHAVIOUR SUM OF SQUARES CHANGE DEGREES OF FREEDOM SCORES MEAN SQUARES F RATIO TAIL PROBABILITY OCCASION 1: THREE HOURS AFTER THERAPY Between Experience Levels 0.781 1 0.781 0.785 0.391 S-within 13.938 14 0.996 Between Therapies 0.031 1 0.031 0.027 0.872 S-within 16.188 14 1.156 Between ELxT 0.281 1 0.281 0.243 0.630 OCCASION 2: ONE WEEK AFTER THERAPY Between :. Experience Levels 0.781 1 0.781 0.563 O.466 S-within 19.4^3 14 1.388 Between Therapies 3.781 1 3.781 4.953 0.043 S-within 10.688 14 0.763 Between ELxT 0.031 1 0.031 0.041 0.843 - 67 -having r e c e i v e d G e s t a l t two-chair dialogue than f o r c l i e n t s having r e c e i v e d empathic r e f l e c t i o n . T herapist experience l e v e l was not s i g n i f i c a n t . There were no s i g n i f i c a n t i n t e r -a c t i o n e f f e c t s (*=»< = .05). On the b a s i s of these analyses, the n u l l hypothesis: The G e s t a l t two-chair dialogue, when used at a s p l i t , w i l l not l e a d t o l e v e l s o f behaviour change s i g n i f i c a n t l y d i f f e r e n t from those pro-duced by the use of empathic r e f l e c t i o n at a s p l i t , as measured on a seven-point s c a l e administered three hours, and one week a f t e r therapy, i s r e j e c t e d i n favour of the a l t e r n a t e , H, . COMPARISON OF CHANGE AND PROGRESS SCORES UNDER GESTALT  TWO-CHAIR DIALOGUE AND EMPATHIC REFLECTION Scores obtained on the change question and the progress question were not found to be s i g n i f i c a n t l y d i f f e r e n t on a dependent t - t e s t . Scores were combined, and t r e a t e d as one v a r i a b l e . Means and standard d e v i a t i o n s f o r r e p o r t s of change and progress scores may be found i n Table XIV. The means r e v e a l t h a t higher scores were obtained w i t h the use of G e s t a l t two-c h a i r dialogue than w i t h the use of empathic r e f l e c t i o n . - 68 -TABLE XIV MEANS AND STANDARD DEVIATIONS FOR CHANGE AND PROGRESS SCORES TREATMENT MEAN STANDARD DEVIATION G e s t a l t Two-Chair Dialogue High-Experience T h e r a p i s t s 8.250 .707 G e s t a l t Two-Chair Dialogue Low-Experience T h e r a p i s t s 8.000 1.512 Empathic R e f l e c t i o n High-Experience Therapists 6.125 .991 Empathic R e f l e c t i o n Low-Experience T h e r a p i s t s 6.000 1.195 - 69 -TABLE XV ANALYSIS OF VARIANCE  FOR CHANGE AND PROGRESS SCORES SOURCE SUM OF DEGREES MEAN F TAIL SQUARES OF SQUARES RATIO PROBABILITY FREEDOM Between Experience L e v e l s .281 1 0.281 .396 .539 S-within 9.938 14 0.710 Between Therapies 34.031 1 34.031 18.021 .001 S-within 26.438 14 1.888 Between ELxT .031 1 .031 .017 .899 - 70 -A n a l y s i s of variance of these r e s u l t s (Table XV) revealed t h a t there was no s i g n i f i c a n t d i f f e r e n c e between experience l e v e l s . A s i g n i f i c a n t d i f f e r e n c e was found between t h e r a p i e s . No i n t e r a c t i o n e f f e c t s were found to be s t a t i s t i c a l l y s i g n i f i -cant (°<= .05). On the basi s of these analyses, the n u l l hypothesis: PL. : The G e s t a l t two-chair dialogue, when used at 6 a s p l i t , w i l l not lead t o l e v e l s of change and progress s i g n i f i c a n t l y d i f f e r e n t from those produced by the use of empathic r e f l e c t -i o n at a s p l i t , as measured on two f i v e - p o i n t s c a l e s administered one week a f t e r therapy, i s r e j e c t e d i n favour of the a l t e r n a t i v e , Hi . 6 CLIENT INFORMATION Scores on the three sub-scales of the semantic d i f f e r e n t -i a l s c a l e were t r e a t e d as one v a r i a b l e , as they have been shown not to d i f f e r s i g n i f i c a n t l y i n measuring e v a l u a t i o n of the hour (Warr and Knapper, 1968). Means and standard d e v i a t i o n s of scores on the semantic d i f f e r e n t i a l s c a l e may be found i n Table XVI. The means r e v e a l that c l i e n t s f e l t b e t t e r , l e s s tense and c l e a r e r a f t e r therapy. A n a l y s i s of variance performed on each occasion i n d i v i d u a l -l y (Table XVII) showed no s i g n i f i c a n t d i f f e r e n c e between t h e r a p i s t experience l e v e l s or between t h e r a p i e s , on both occasions. No i n t e r a c t i o n e f f e c t s were found to be s i g n i f i c a n t . - 71 -TABLE XVI MEANS AND STANDARD DEVIATIONS FOR EVALUATION OF THERAPY SCORES TREATMENT OCCASIONS1 MEAN STANDARD DEVIATION G e s t a l t Two-Chair Dialogue 01 10.875 4.673 High-Experience Therapists 02 15.500 2.563 G e s t a l t Two-Chair Dialogue 01 12.125 1.458 Low-Experience Therapists 02 16.250 3.694 Empathic R e f l e c t i o n 01 9.125 1.458 High-Experience Therapists 02 15.500 3.505 Empathic R e f l e c t i o n 01 10.625 4.033 Los-Experience T h e r a p i s t s 02 17.875 2.532 01 = Scores obtained on the semantic d i f f e r e n t i a l s c a l e before therapy. 02 = Scores obtained on the semantic d i f f e r e n t i a l s c a l e immediately a f t e r therapy. - 72 -TABLE XVII ANALYSIS OF VARIANCE FOR TWO OCCASIONS  OF EVALUATION OF THERAPY SCORES SOURCE SUM OF DEGREES) MEAN F TAIL SQUARES OF SQUARES RATIO PROBABILITY FREEDOM OCCASION 1: BEFORE THERAPY Between Experience Levels a. OOO 1 8.000 0.437 0.519 S-within 256.500 14 13.321 Between Therapies 12.500 1 12.500 1.080 0.316 S-within 162.000 14 11.571 Between ELxT 0.500 1 0.500 0.043 0.838 OCCASION 2: IMMEDIATELY AFTER THERAPY Between Experience Levels 19.531 1 19.531 1.906 0.189 S-within 143.433 14 10.246 Between Therapies 5.231 1 5.281 0.573 0.461 S-within 128.933 14 9.210 Between ELxT 5.281 1 5.281 0.573 O .46I - 73 -On the f o u r other i n f o r m a t i o n gathering measures, c l i e n t s r e p o r t e d that the hour had been good (at l e a s t f o u r on a seven-point scale) and t h a t t h e i r t h e r a p i s t had been understanding (at l e a s t four on a f i v e - p o i n t s c a l e ) and h e l p f u l (at l e a s t f o u r on a s i x - p o i n t s c a l e ) . No c l i e n t r e p o r t e d any unusual event, other than the therapeutic hour, to which they would have a t t r i b u t e d change i n t h e i r t a r g e t behaviour. - 74 -- CHAPTER V DISCUSSION This chapter presents a summary of the study, as w e l l as conclusions, i m p l i c a t i o n s and recommendations based on the f i n d i n g s e v o l v i n g from t h i s r e s e a r c h , SUMMARY Nature of the Problem Emphasis i s c u r r e n t l y being placed on g r e a t e r s p e c i f i c i t y i n psychotherapy research. More s t u d i e s examining s p e c i f i c t h e r a p i s t behaviours used at s p e c i f i c moments i n therapy w i t h s p e c i f i c c l i e n t s are needed. G e s t a l t two-chair dialogue has been shown t o lead to g r e a t e r depths of experiencing i n three s i n g l e case s t u d i e s (Greenberg, 1975) and i n an analogue study using s i x t e e n subjects (Greenberg and C l a r k e , 1979). Purpose The purpose of the present study was t o examine the e f f e c t of G e s t a l t two-chair dialogue and empathic r e f l e c t i o n at a s p l i t i n therapy, i n a population of r e a l c l i e n t s described as not o v e r l y c o n s c i e n t i o u s , experimenting and not o v e r l y c o n t r o l -l e d on f a c t o r s G, Q 1 and Q^ , r e s p e c t i v e l y , of the Sixteen P e r s o n a l i t y F a c t o r Questionnaire. - 75 -Procedure S i x t e e n c l i e n t s engaged i n therapy f o r a minimum of f o u r sessions and p e r c e i v i n g t h e i r t h e r a p i s t as empathic were used i n t h i s study. Eight subjects r e c e i v e d G e s t a l t two-chair dialogue at a s p l i t during the f i f t h s e s s i o n , e i g h t r e c e i v e d empathic r e f l e c t i o n . The f o l l o w i n g s e s s i o n was not considered f o r the purposes of t h i s research. During the seventh s e s s i o n , t h e r a p i s t s performed the a l t e r n a t e t h e r a p e u t i c o p e r a t i o n at a s p l i t . The sessions were tape recorded and submitted to r a t e r s who r a t e d them on the Depth of Experiencing Scale ( K l e i n , et a l . , 1969). C l i e n t s completed questionnaires before, immediate-l y a f t e r , three hours a f t e r and one week a f t e r each experimental s e s s i o n . A two-factor, repeated measure ; a n a l y s i s of variance was performed. The two f a c t o r s were t h e r a p i s t l e v e l of experience and t h e r a p e u t i c i n t e r v e n t i o n . R e s u l t s The G e s t a l t two-chair dialogue l e d t o g r e a t e r depth of experiencing, s h i f t of awareness, c o n f l i c t r e s o l u t i o n , behaviour change and r e p o r t s of change and progress than d i d empathic r e f l e c t i o n . I t d i d not l e a d t o g r e a t e r d i s t r e s s r e d u c t i o n . C l i e n t s f e l t b e t t e r a f t e r both experimental s e s s i o n s . They reported a l s o t h a t both therapy sessions had been good, - 76 -and t h a t they had perceived t h e i r t h e r a p i s t as h e l p f u l and understanding. CONCLUSIONS The f o l l o w i n g conclusions may be drawn from the data c o l l e c t e d : 1. G e s t a l t two-chair dialogue leads t o g r e a t e r depth o f experiencing than does empathic r e f l e c t i o n , when used at a s p l i t i n therapy. This may be due t o the f a c t t h a t G e s t a l t two-chair dialogue encourages c l i e n t s to confront c o n f l i c t . When the t h e r a p i s t uses empathic r e f l e c t i o n , c l i e n t s may choose t o deeply explore the s p l i t , or they may choose t o pursue other l e s s anxiety-provoking and p o s s i b l y l e s s meaningful areas of concern. G e s t a l t two-c h a i r dialogue could t h e r e f o r e be s a i d to f a c i l i t a t e c l i e n t s e l f - c o n f r o n t a t i o n . G e s t a l t two-chair dialogue a l s o d i f f e r s from empathic r e f l e c t i o n , i n th a t during the former o p e r a t i o n , the c l i e n t a c t i v e l y engages i n the c o n f l i c t s i t u a t i o n , making i t a l i v e and present. When empathic r e f l e c t i o n i s used, the c l i e n t t a l k s about the c o n f l i c t , p o s s i b l y at a more c o g n i t i v e l e v e l and wit h l e s s of an immediate experience o f the c o n f l i c t . - 77 -2. G e s t a l t two-chair dialogue leads to g r e a t e r s h i f t of awareness than does empathic r e f l e c t i o n , when used at a s p l i t . C e r t a i n expressive aspects of the G e s t a l t two-c h a i r dialogue may be r e s p o n s i b l e f o r t h i s e f f e c t . C l i e n t s are o f t e n encouraged to repeat and exaggerate key v e r b a l i z a t i o n s or gestures or act out c e r t a i n aspects of what they are saying such t h a t unaware i d i o s y n c r a s i e s are brought i n t o awareness. C l i e n t s are t h e r e f o r e helped to see themselves, or t h e i r i n t e r a c t i o n w i t h o t h e r s , i n a new l i g h t . The f o l l o w i n g examples, s e l e c t e d from the data, i l l u s t r a t e s h i f t s of awareness: a) I saw myself more c l e a r l y separated from my f a m i l y than I give myself c r e d i t f o r . I can be as separate as I choose to be. b) I r e a l i z e d t h a t my v a l u e s , what I f e e l s t r o n g l y about, are somewhat clouded and unclear. 3. G e s t a l t two-chair dialogue leads to g r e a t e r c o n f l i c t r e s o l u t i o n than does empathic r e f l e c t i o n , when used at -a s p l i t . T h i s f i n d i n g may be due t o the f a c t that i n e x p l o r i n g a c o n f l i c t deeply w i t h the two-chair dialogue technique, c l i e n t s a c t i v e l y experience deep f e e l i n g s on both " s i d e s " of the i s s u e and g a i n more e x p l i c i t awareness of t h e i r p o l a r i t y . They may then choose to r e s o l v e t h e i r c o n f l i c t by r e j e c t i n g one aspect of the p o l a r i t y i n favour of the a l t e r n a t e , or by reach-ing a new understanding between both p a r t s , as a r e s u l t of the dialogue. - 78 -When empathic r e f l e c t i o n i s used at a s p l i t , c l i e n t s may e l e c t t o deeply explore a s p l i t , or may go on t o another t o p i c . I f the s p l i t i s indeed explored, c l i e n t s , may pursue only one aspect of the p o l a r i t y , and not deal with the other one. I f both aspects o f the p o l a r i t y are explored, c l i e n t s may or may not gain s u f f i c i e n t new awareness to dis c o v e r a way t o r e s o l v e t h e i r c o n f l i c t . 4. G e s t a l t two-chair dialogue leads t o gre a t e r behaviour change than does empathic r e f l e c t i o n , when used at a s p l i t . Perhaps t h i s i s r e l a t e d to the f a c t that i f c l i e n t s experience deeply, and through a c t i v e l y confront-i n g a c o n f l i c t i v e aspect of t h e i r l i f e , g a i n a gr e a t e r sense of r e s o l u t i o n , they become more committed t o modify-in g t h e i r behaviour outside o f therapy, and have more awareness f o r implementing such a change. The c l i e n t s whose s h i f t s of awareness were quoted p r e v i o u s l y (number 2) reported increases i n the f o l l o w i n g behaviours, as a r e s u l t of therapy: a) I want to spend more time w i t h my f a m i l y without being c r i t i c a l of myself and saying "You should not spend time w i t h them. You are an a d u l t " . b) I want to be more r e l a x e d and accepting of my own moods and thoughts. P r e s e n t l y , I tend t o "panic" when I evaluate c e r t a i n thoughts or f e e l i n g s as abnormal and/or wrong. I want t o t r u s t myself more. - 79 -C l i e n t s reported that they f e l t they had made more change and progress f o l l o w i n g sessions i n which G e s t a l t two-c h a i r dialogue was used r a t h e r than empathic r e f l e c t i o n at a s p l i t . These r e p o r t s are i n the same d i r e c t i o n as the r e s u l t s reported on the previous measures. G e s t a l t two-chair dialogue and empathic r e f l e c t i o n used at a s p l i t were not s i g n i f i c a n t l y d i f f e r e n t w i t h regard t o d i s t r e s s r e d u c t i o n . One p o s s i b l e explanation f o r t h i s f i n d i n g may be due t o the f a c t t h a t during the e x p e r i -mental s e s s i o n , c e r t a i n c l i e n t s d i d not work on the i s s u e t h a t they had i d e n t i f i e d as d i s t r e s s i n g before therapy. C l i e n t s i n d i c a t e d t h a t they had worked on a " d i f f e r e n t " or "very d i f f e r e n t " issue f o r one empathic r e f l e c t i o n s e s s i o n , and f o r two G e s t a l t two-chair dialogue s e s s i o n s . An a l t e r n a t e explanation might be that c l i e n t s are l e s s bothered by an i s s u e once they have had a chance t o t a l k about i t , to "get i t o f f t h e i r chest", r e g a r d l e s s o f the th e r a p e u t i c i n t e r v e n t i o n used. Findings on the semantic d i f f e r e n t i a l s c a l e would support t h i s e x p l a n a t i o n , as c l i e n t s r e p o r t e d l y f e l t b e t t e r a f t e r both t h e r a p e u t i c operations had been used. Much a t t e n t i o n was given t o various aspects of t h i s r e -search design, i n order t o provide optimum t h e r a p e u t i c c o n d i t i o n s f o r both G e s t a l t two-chair dialogue and empathic r e f l e c t i o n . - 80 -Both t h e r a p e u t i c i n t e r v e n t i o n s s t u d i e d were perform-ed by the same t h e r a p i s t , at the same moment i n therapy w i t h the same c l i e n t . This design allowed the comparison of i n d i v i d u a l s t o themselves and reduced e f f e c t s due t o i n d i v i d u a l d i f f e r e n c e s i n s u b j e c t s . The m a j o r i t y (60 per cent) of the t h e r a p i s t s ' - professed o r i e n t a t i o n was the Carkhuff model r a t h e r than G e s t a l t therapy. C l i e n t s had been exposed to both t h e r a p e u t i c treatments before the experimental s e s s i o n s , i n order t o dim i n i s h any n o v e l t y or Hawthorne e f f e c t w i t h e i t h e r o p e r a t i o n . A l l c l i e n t s perceived t h e i r t h e r a p i s t as empathic, and reported that both experimental sessions had been good. F i n a l l y , the order of treatment p r e s e n t a t i o n was c o n t r o l l e d , to e l i m i n a t e any p o s s i b l e e f f e c t thereof. The l e v e l o f t h e r a p i s t experience d i d not provide s i g n i f i c a n t l y d i f f e r e n t r e s u l t s i n any of the hypotheses t e s t e d . I t may be s a i d then, t h a t the G e s t a l t two-chair dialogue i s a powerful technique, when used at a s p l i t by t r a i n e d t h e r a p i s t s with v a r y i n g degrees of experience i n i t s use. Examination of the data r e v e a l e d that three c l i e n t s used i n t h i s study d i d not reach peak depths of experiencing o f f i v e or more i n e i t h e r t h e r a p e u t i c s e s s i o n . These were the two men used i n the study, along w i t h one woman. An a l y s i s of t h e i r 16-PF p r o f i l e show t h a t these subjects - 31 -achieved three of the highest scores (sten 6, 6 and 7) on f a c t o r of the 16-PF and thus represented the more "con-t r o l l e d " segment of the p o p u l a t i o n . F a c t o r "Undiscip-l i n e d S e l f - C o n f l i c t vs. C o n t r o l l e d " of the 16-PF may there-f o r e be the most accurate p r e d i c t o r of w i l l i n g n e s s to deep-l y experience i n therapy. I t may a l s o be t r u e t h a t women are more w i l l i n g than men to deeply experience i n therapy. The r e s u l t s on experiencing should only be g e n e r a l i z e d to female c l i e n t s . 10. The outcome r e s u l t s of t h i s study can be g e n e r a l i z e d t o c l i e n t s who are not o v e r l y c o n t r o l l e d (sten 5 and under on the 16/PF) and who seek therapy to deal w i t h problems i n l i v i n g . They can a l s o be g e n e r a l i z e d t o t h e r a p i s t s who are t r a i n e d i n both empathic r e f l e c t i o n and G e s t a l t two-chair dialogue, who are perceived as empathic by t h e i r c l i e n t s and who are engaged i n a r e l a t i o n s h i p i n which a working a l l i a n c e has been e s t a b l i s h e d . GENERAL DISCUSSION The r e s u l t s obtained i n t h i s research lend support to various research f i n d i n g s and t h e o r e t i c a l p r o p o s i t i o n s r e p o r t -ed i n Chapter I I . This research showed that G e s t a l t two-chair dialogue y i e l d -ed s i g n i f i c a n t l y g r eater depth of experiencing and gr e a t e r s h i f t - 82 -of awareness than d i d empathic r e f l e c t i o n when used at a " s p l i t " i n therapy. I t would seem t h e r e f o r e , t h a t these f i n d i n g s , r e -ported by Greenberg (1979) and Greenberg and Clarke (1979), apply to a sample o f therapy-seeking c l i e n t s , as w e l l as t o subj e c t s i n an analogue study. Therapists working w i t h c l i e n t s such as those s t u d i e d i n t h i s research might want t o focus on the " s p l i t " as a point at which to use a s p e c i f i c i n t e r v e n t i o n (Gendlin, 1969; R i c e , 1974; Wexler and B u t l e r , 1976), and i t would seem th a t G e s t a l t two-chair dialogue would be more e f f e c t i v e than empathic r e f l e c t i o n at a " s p l i t " . These f i n d i n g s are a l s o i n accordance w i t h those r e p o r t e d by Bohart (1977) and Kipper and G i l a d i (1978) whereby c l i e n t s a c t i v e l y experiencing f e e l i n g s such as anger or f e a r , w i t h the use of the G e s t a l t two-chair d i a l o g u e , may progress and make behav i o u r a l changes. The G e s t a l t two-chair dialogue's e f f e c t -iveness may be a t t r i b u t a b l e t o the f a c t t h a t c l i e n t s do not merely " t a l k about" t h e i r f e e l i n g s , as they do when t h e r a p i s t s use empathic r e f l e c t i o n , systematic d e s e n s i t i z a t i o n , i n t e l l e c t -u a l a n a l y s i s or emotional discharge techniques. Rather, they a c t i v e l y engage i n these f e e l i n g s , as i s suggested by P e r l s (1970) and P o l s t e r and P o l s t e r (1973), and g a i n new i n s i g h t and awareness i n t o p r o b l e m a t i c a l s i t u a t i o n s . The G e s t a l t two-chair dialogue s t i m u l a t e s c l i e n t s to engage aloud i n what i s u s u a l l y covert dialogue. Therapists using the - 83 -o p e r a t i o n can a s s i s t c l i e n t s t o perceive t h e i r behaviour more a c u t e l y , by using such s k i l l s as heightening, d i r e c t i n g and expressing. This 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 can be perceived as a "feedback" loop (Kempler, 1973) i n which c l i e n t s g a i n more awareness of themselves, both i n t e r n a l l y and as a c t i v e l y i n t e r -a c t i n g i n the world. The c l i e n t , i n expressing h i m s e l f or her-s e l f i n the "here-and-now" can a l s o experiment w i t h p o s s i b l e s o l u t i o n s to problems and a c t i v e l y experience them emotionally, r a t h e r than simply d i s c u s s them i n a detached manner and speculate as t o consequences (Yontef, 1975; Passons, 1976). Many G e s t a l t t h e o r i s t s view p s y c h o l o g i c a l d y s f u n c t i o n as a m a n i f e s t a t i o n o f fragmentation or d i v i s i o n of the s e l f i n t o p a r t i a l aspects ( P e r l s , 1970; Greenberg, 1979). The G e s t a l t two-chair dialogue provides a medium through which both " p a r t s " of the s e l f can f r e e l y express themselves (Grinder and Bandler, 1976) and work towards an a l t e r n a t i v e t o c o n f l i c t . C l i e n t s may become more f u l l y aware of what " r e a l " p r i o r i t i e s they want to set f o r themselves and i n v e s t t h e i r energy i n t o f u l f i l l i n g such needs, r a t h e r than d e a l i n g with c o n f l i c t about what they "should" and what they "want" to do. C l i e n t s a t t a i n i n g such a balance could be r e f e r r e d to as more "centered" (Baumgardner, 1975) o r , from Latner's (1972) p e r s p e c t i v e , as reaching a r e s o l u t i o n created from both poles of the c o n f l i c t . - 84 -The results of t h i s research also uphold Carkhuff 1s (1969) notion that i n i t i a t i v e therapist s k i l l s such as the Gestalt two-chair dialogue, when used i n addition to responding s k i l l s , are more powerful than a responding s k i l l s such as empathic r e f l e c t i o n used alone. RECOMMENDATIONS The following recommendations seem appropriate on the basis of the findings of t h i s research; 1. Since some c l i e n t s were found not to experience under either therapeutic condition, i t might prove useful f o r further research to attempt to discriminate more c l e a r l y between potential deep experiencers and non experiencers. Factor of the 16-PF may be a good indicator. However, a non-pencil and paper performance type instrument such as the Voice Quality Index (Rice, et a l . , 1979), might be a better indicator as i t takes the person's reaction to the s i t u a t i o n into account. E f f o r t s should also be made to include more male subjects i n future studies, as both men studied here were found not to experience deeply under either treatment. 2. Since some of the Gestalt two-chair dialogue's e f f e c t i v e -ness may be attributable to i t s f a c i l i t a t i n g c l i e n t s e l f -- 35 -c o n f r o n t a t i o n , f u t u r e research may want t o compare t h i s technique w i t h C a r k h u f f f s (1969) t h e r a p i s t s k i l l , con-f r o n t a t i o n . 3. Future researchers i n the area of d i f f e r e n t i a l e f f e c t s may want to use a video process measure such as I n t e r -personal Process R e c a l l i n a d d i t i o n to a v e r b a l s c a l e such as the Experiencing S c a l e . This would enable the gathering of i n t e r n a l non v e r b a l i z e d m a t e r i a l f o r i n -t e n s i v e a n a l y s i s . 4. This study showed t h a t greater depth of exp e r i e n c i n g , s h i f t of awareness, c o n f l i c t r e s o l u t i o n , behaviour change and r e p o r t s of change and progress occurred f o l l o w i n g the use of G e s t a l t two-chair dialogue at a s p l i t . Future r e -search may want t o i n v e s t i g a t e a c o r r e l a t i o n a l l i n k among these v a r i a b l e s . IMPLICATIONS The r e s u l t s of t h i s study have i m p l i c a t i o n s f o r c l i n i c a l p r a c t i c e , c o u n s e l l o r education and c o u n s e l l i n g t h e o r i s t s . For c l i n i c i a n s , the study describes a t h e r a p e u t i c i n t e r -v e n t i o n t h a t has been o p e r a t i o n a l l y defined and e m p i r i c a l l y v a l i d a t e d . 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"Problems i n L i v i n g , Psycho-therapy Process Research, and an A u t o a n a l y t i c Method." Journal of Consulting Psychology, 29 (1965), 58I-585. - 89 -Ha r t l e y , D. E. Therapeutic A l l i a n c e and the Success o f B r i e f Psychotherapy. Unpublished D o c t o r a l d i s s e r t a t i o n , N a s h v i l l e : V a n d e r b i l t U n i v e r s i t y , 1978. Higgins, H. The E f f e c t s of C o u n s e l l i n g Methods on Process and Outcome. Unpublished Master's t h e s i s : Vancouver, B.C.: U n i v e r s i t y of B r i t i s h Columbia, 1979. Horvath, A. An E x p l o r a t o r y Study of the Concept of Therapeutic A l l i a n c e and i t s Measurement. Unpublished D o c t o r a l d i s s e r t a t i o n proposal: Vancouver, B.C.: U n i v e r s i t y of B r i t i s h Columbia, 1979. Kempler, W. " G e s t a l t Therapy." I n R. C o r s i n i (ed.). Current  Psychotherapies. I t a s c a , 111.: Peacock, 1973. K i e s l e r , D. J . 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New York: Brunner/Mazel, 1977. - 92 -APPENDIX A 16-PF TEST PROFILE - 9 3 - DO WOT COPY • 16 PF TEST PROFILE FACTOR R aw Score Stan-dard Score LOW SCORE . DESCRIPTION FACTOR Form A/C/E Form B/D Total A RESERVED, D E T A C H E D , C R I T I C A L , A L O O F , ST IFF (Si zothymla) B LESS INTELLIGENT, C O N C R E T E -THINKING (Lower scholastic mental capacity) C AFFECTED BY FEELINGS, EMOTIONAL-.. LY LESS S T A B L E , EASILY U P S E T " ' . C H A N G E A B L E (Lower ego strength) E HUMBLE, MILD, EAS ILY L E D , DOCILE , ACCOMMODATING (Submi ssiveness) F SOBER, T A C I T U R N , SERIOUS (Desurgency) G EXPEDIENT, D ISREGARDS R U L E S (Weaker superego strength) H SHY, TIMID, T H R E A T - S E N S I T I V E (Threctio) I TOUGH-MINDED, S E L F - R E L I A N T , REALIST IC (Horrio) L TRUSTING, A C C E P T I N G CONDITIONS (Alaxia) M PRACTICAL, " D O W N - T O - E A R T H " C O N C E R N S (Praxernio) N FORTHRIGHT, U N P R E T E N T I O U S , GENUINE BUT SOCIALLY CLUMSY (Artlessness) 0 SELF -A5SURED, P L A C I D , S E C U R E , C O M P L A C E N T , S E R E N E (Untroubled adequacy) Qi CONSERVATIVE, R E S P E C T I N G TRADIT IONAL IDEAS (Conservatism of temperament) Q. GROUP-DEPENDENT, A " J O I N E R " AND SOUND FOLLOWER (Group odherence) Q, UNDISCIPLINED SELF-CONFLICT, L A X , FOLLOWS OWN URGES, C A R E L E S S OF SOCIAL R U L E S (Low integration) Q< RELAXED, TRANQUIL , U N F R U S T R A T E D , COMPOSED (Low ergic tension) 1 -t—•—I STANDARD TEN SCORE (STEN) ••Average 3 4 5 8 7 8 \—\-—V 10 HIGH SCORE DESCRIPTION Copyright © 1956, 1973 by the Institute for Porsonolity end Abi l i ty Test ing, 1602 Coronado Drive, Champaign, I l l inois . A l l property rights reserved. Printed in U.S.A. \ . T O I « -t ' 5 ° • Qi-* 4 Q. J OUTGOING, W A R M H E A R T E D , EASY-GOING, P A R T I C I P A T I N G (Affectothymla) MORE INTELLIGENT, A B S T R A C T -THINKING, BRIGHT (Higher scholostic mental capacity) EMOTIONALLY STABLE, M A T U R E , F A C E S R E A L I T Y , C A L M (Higher ego strength) ASSERTIVE, A G G R E S S I V E , S T U B B O R N , COMPET IT IVE (Dominance) HAPPY-GO-LUCKY. ENTHUSIASTIC (Surgency) . , CONSCIENTIOUS, P E R S I S T E N T , MORALISTIC, STAID (Stronger superego strength) VENTURESOME, UNINHIBITED, S O C I A L L Y BOLD (Pormla) TENDER-MINDED, SENSITIVE, CLINGING, O V E R P R O T E C T E D (Premslo) SUSPICIOUS, HARD TO FOOL (Protension) IMAGINATIVE, BOHEMIAN, ABSENT -MINDED (Autia) A S T U T E , POLISHED, S O C I A L L Y AWARE (Shrewdness) APPREHENSIVE, S E L F - R E P R O A C H ING, INSECURE, WORRYING, T R O U B L E D (Guilt proneness) E X P E R I M E N T I N G , L I B E R A L , F R E E -THINKING (Radical i sm) S E L F - S U F F I C I E N T , R E S O U R C E F U L , P R E F E R S OWN DECISIONS (Self-sufficiency) CONTROLLED, E X A C T I N G W I L L POWER, SOCIALLY P R E C I S E , COMPULSIVE (High strength of self-sentiment) TENSE, F R U S T R A T E D , DRIVEN, OVERWROUGHT (High ergic tension) A iten of 1 2 3 4 5 6 7 8 9 10 It obtalntd by about 2 J % 4.4% 9 J % 15.0% 19.1% 19.1% 15.0% 9 J % 4.4% J.3% of adulti - 9 4 -APPENDIX B DO NOT COPY (BARRETT-LENNARD) RELATIONSHIP INVENTORY—FORM OS—64' B e l o w a r e l i s t e d a v a r i e t y o f w a y s t h a t o n e p e r s o n m a y f e e l o r b e h a v e i n r e l a t i o n t o a n o t h e r p e r s o n . P l e a s e c o n s i d e r e a c h n u m b e r e d s t a t e m e n t w i t h r e f e r e n c e t o y o u r ( - r e s e n t r e l a t i o n s h i p w i t h , m e n t a l l y a d d i n g h i s o r h e r n a m e i n t h e s p a c e p r o v i d e d . F o r e x a m p l e , i f t h e o t h e r p e r s o n ' s n a m e w a s J o h n , y o u w o u l d r e a d s t a t e m e n t # 1 , a s ' J o h n r e s p e c t s me a s a p e r s o n ' . M a r k e a c h s t a t e m e n t i n t h e a n s w e r c o l u m n o n t h e r i g h t , a c c o r d i n g t o how s t r o n g l y y o u f e e l t h a t i t i s t r u e , o r n o t t r u e , i n t h i s r e l a t i o n s h i p . P l e a s e  b e s u r e t o m a r k e v e r y o n e . W r i t e i n +3, +2, +1, o r -1, -2, -3, t o s t a n d f o r t h e f o l l o w i n g a n s w e r s : +3: Yes, I strongly feel that -it is ~1: No, I feel that it is probably true. Untrue, or more untrue than true +2: Yes, I feel it is true. -2: No, I feci it is not true. +1: Yes, I feel that it is probably ~3: No, I strongly feel that it is true, or more" true than untrue. not true. ANSWR 1. r e s p e c t s me a s a p e r s o n . . . 2. w a n t s t o u n d e r s t a n d h o w I s e e t h i n g s . . . . . . 3- ' s i n t e r e s t i n me d e p e n d s o n t h e t h i n g s I s a y o r d o . k. i s c o m f o r t a b l e a n d a t e a s e i n o u r r e l a t i o n s h i p . . 5. f e e l s a t r u e l i k i n g f o r me 6. _ _ _ _ _ m a Y u n d e r s t a n d my w o r d s b u t h e / s h e d o e s n o t s e e t h e w a y I f e e l . • . . . . 7. W h e t h e r I am f e e l i n g h a p p y o r . u n h a p p y w i t h m y s e l f m a k e s n o r e a l d i f f e r e n c e t o t h e w a y f e e l s a b o u t me . . 8. I f e e l t h a t p u t s o n a r o l e o r f r o n t w i t h me . . . 9. i s i m p a t i e n t w i t h me . . . 1 0 . n e a r l y a l w a y s k n o w s e x a c t l y w h a t I m e a n . . . . . 1 1 . D e p e n d i n g o n my b e h a v i o u r , h a s a b e t t e r o p i n i o n o f me s o m e t i m e s t h a n h e / s h e h a s a t o t h e r t i m e s . . . . J ^ _. DO NOT COPY AUSWl'R 1 2 . I f e e l t h a t i s r e a l a n d g e n u i n e w i t h me . . .• . . 1 3 . I f e e l a p p r e c i a t e d b y . . . ]h. l o o k s a t w h a t I d o f r o m h i s / h e r o w n p o i n t o f v i e w . 1 5 . 1 s f e e l i n g t o w a r d me d o e s n ' t d e p e n d o n h o w I f e e l t o w a r d h i m / h e r . . . . . . . . . . . . . 1 6 . I t m a k e s u n e a s y w h e n I a s k o r t a l k a b o u t c e r t a i n t h i n g s . . . . . . . . . . . . . . 1 7 . i s i n d i f f e r e n t t o me 1 8 . u s u a l l y s e n s e s o r r e a l i s e s w h a t I am f e e l i n g 1 9 . w a n t s me t o be a p a r t i c u l a r k i n d o f p e r s o n 2 0 . I f e e l t h a t w h a t s a y s u s u a l l y e x p r e s s e s e x a c t l y w h a t h e / s h e i s f e e l i n g a n d t h i n k i n g a t t h a t m o m e n t . . . . ^ • ' f i n d s me r a t h e r d u j l a n d u n i n t e r e s t i n g . . . . 2 2 . ' s own a t t i t u d e s t o w a r d s o m e o f t h e t h i n g s I d o o r s a y p r e v e n t h i m / h e r f r o m u n d e r s t a n d i n g me . . 2 3 - I c a n ( o r c o u l d ) b e o p e n l y c r i t / i c a l or_ a p p r e c i a t i v e o f w i t h o u t r e a l l y m a k i n g h i m / h e r f e e l a n y d i f f e r e n t l y a b o u t me 2h. w a n t s me t o t h i n k t h a t h e / s h e l i k e s me o r u n d e r s t a n d s me m o r e t h a n h e / s h e r e a l l y d o e s . . . . . . . . 2 5 - c a r e s f o r me 2 6 . S o m e t i m e s t h i n k s t h a t J_ f e e l a c e r t a i n w a y , b e c a u s e t h a t 1 s t h e w a y h e / s h e f e e l s . . 2 7 - l i k e s c e r t a i n t h i n g s a b o u t m e , a n d t h e r e a r e o t h e r . t h i n g s h e / s h e d o e s n o t l i k e . . . 2 8 . d o e s n o t a v o i d a n y t h i n g t h a t i s i m p o r t a n t f o r o u r r e l a t i o n s h i p . . 2 9 . I f e e l t h a t d i s a p p r o v e s o f me 3 0 . r e a l i s e s w h a t I m e a n e v e n w h e n I h a v e d i f f i c u l t y i n s a y i n g i t . . . . . . . . . . . . . . • . 3 1 . ' s a t t i t u d e t o w a r d me s t a y s t h e s a m e : h e / s h e i s n o t p l e a s e d w i t h me s o m e t i m e s a n d c r i t i c a l o r d i s a p p o i n t e d a t o t h e r t i m e s 3 2 . S o m e t i m e s i s n o t a t a l 1 ' c o m f o r t a b l e b u t we g o o n , o u t w a r d l y i g n o r i n g i t . . . . . . . . . . . 3 3 - j u s t t o l e r a t e s m e . . . . . . . . . D O N O T C O P Y • ' - 9 6 . - • ANSllER 35. I f t show t h a t I am a n g r y w i t h h e / s h e becomes h u r t o r a n g r y w i t h me , t o o . . . . . . . . . . . . . 36. e x p r e s s e s h i s / h e r t r u e i m p r e s s i o n s and f e e l i n g s wi t h me . . . . . . . . . . . . . . . . . 37. ' s f r i e n d l y and warm w i t h me 38. j u s t t a k e s no n o t i c e o f some t h i n g s t h a t I t h i n k o r f e c i • • _ • • • • • , • » * • • 39. How much l i k e s o r d i s l i k e s me i s n o t a l t e r e d by a n y t h i n g t h a t I t e l l h i m / h e r a b o u t m y s e l f . . kO. A t t i m e s I s e n s e t h a t . i s n o t a w a r e o f what h e / s h e i s r e a l l y f e e l i n g w i t h me . . . •. . . . . . . *»1. f f e e l t h a t _ _ _ _ _ r e a l 1 y va 1 ues me . . . . . . k l . a p p r e c i a t e s e x a c t l y how t h e t h i n g s I e x p e r i e n c e f e e l t o me . . . . . . . . . 43. a p p r o v e s o f some t h i n g s I d o , and p l a i n l y d i s a p p r o v e s o f o t h e r s . . . . kk. . i s w i l l i n g t o e x p r e s s w h a t e v e r i s a c t u a l l y i n h i s / h e r m i n d w i t h me, i n c l u d i n g p e r s o n a l f e e l i n g s a b o u t e i t h e r o f us 45. d o e s n ' t 1 i k e me f o r m y s e l f . . . . . . . . . 46. A t t i m e s t h i n k s t h a t I f e e l a l o t more s t r o n g l y a b o u t a p a r t i c u l a r t h i n g t h a n I r e a l l y do . . . . . 47. W h e t h e r I h a p p e n t o be i n good s p i r i t s o r f e e l i n g u p s e t d o e s n o t make f e e l a n y more o r l e s s a p p r e c i a t i v e o f me . kB. • i s o p e n l y h i m s e l f / h e r s e l f i n o u r r e l a t i o n s h i p . . . kS. I seem t o i r r i t a t e a n d b o t h e r . . . . . . 50. d o e s n o t r e a l i s e how s e n s i t i v e i am a b o u t some o f t h e t h i n g s we d i s c u s s . . ; . . . . . ' . . . . . 51. W h e t h e r t h e i d e a s a n d f e e l i n g s I e x p r e s s a r e " g o o d " o r " b a d " seems t o make no d i f f e r e n c e t o - ' s f e e l i n g t o w a r d me 52. T h e r e a r e t i m e s when I f e e l t h a t ' s o u t w a r d r e s p o n s e t o me i s q u i t e d i f f e r e n t f r o m t h e way h e / s h e f e e l s u n d e r -n e a t h . . . . . . . . . . . . 53- f e e l s c o n t e m p t f o r me 5*1. u n d e r s t a n d s me 55- S o m e t i m e s I am more w o r t h w h i l e i n ' s e y e s t h a n I am a t o t h e r t i m e s . . . . . . . . . . . . . . - 9 7 -DO NOT COPY ANSWER 56. d o e s n ' t h i d e a n y t h i n g f r o m h i m s e l f / h e r s e l f t h a t h e / s h e f e e l s w i t h me . . . . . . . . , . . . . . . 57 • i s t r u l y i n t e r e s t e d i n me . . . . . . . . • , 58. ' s r e s p o n s e t o me i s u s u a l l y s o f i x e d a n d a u t o m a t i c t h a t I d o n ' t r e a l l y g e t t h r o u g h t o h i m / h e r . . . . . . 59- I d o n ' t t h i n k t h a t a n y t h i n g I s a y o r d o r e a l l y c h a n g e s t h e w a y f e e l s t o w a r d me . . . . . . . . . 60. V/hat s a y s t o me o f t e n g i v e s a w r o n g i m p r e s s i o n o f h i s / h e r t o t a l t h o u g h t o r f e e l i n g a t t h e t i m e 61. f e e l s d e e p a f f e c t i o n f o r me . . . . . . . . 62. W h e n I am h u r t o r u p s e t c a n r e c o g n i s e my f e e l i n g s e x a c t l y , w i t h o u t b e c o m i n g u p s e t t o o 63. W h a t o t h e r p e o p l e t h i n k o f me d o e s ( o r w o u l d , i f h e / s h e k n e w ) a f f e c t t h e w a y f e e l s t o w a r d me . . . ' '. . . 6k. I b e l i e v e t h a t • h a s f e e l i n g s h e / s h e d o e s n o t t e l l me a b o u t t h a t a r e c a u s i n g d i f f i c u l t y i n o u r r e l a t i o n s h i p . . . P l e a s e a l s o p r o v i d e t h e f o l l o w i n g i n f o r m a t i o n a b o u t y o u r s e l f a n d t h e o t h e r p e r s o n . Yourself Age: S e x : O c c u p a t i o n : y e a r s (M o r F ) Other Person y e a r s ( k n o w n o r e s t i m a t e d ) [H or F) P o s i t i o n i n t h i s  p e l a t i o n s h i p . E x a m p l e s : bon C 1 i e n t / o r p a t L e n t > F r i e n d M o t h e r  C o u n s e l l o r ( t h e r a p i s t ) ( B e s t ) F r i e n d A c t u a l : ( P l e a s e f i l l i n ) APPENDIX C SHORT FORM OF THE EXPERIENCING SCALE STAGE CONTENT TREATMENT 1 2 E x t e r n a l events; p a r t i c i p a t e . r e f u s a l t o 4 5 Ex t e r n a l events; behavioural or 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 . Personal r e a c t i o n s t o e x t e r n a l events; l i m i t e d s e l f - d e s c r i p t -i o n s ; behavioural d e s c r i p t i o n s of f e e l i n g s D e s c r i p t i o n s of f e e l i n g s and personal experiences Problems or p r o p o s i t i o n s about f e e l i n g s and personal experiences. Synthesis of r e a d i l y a c c e s s i b l e f e e l i n g s and experiences t o re s o l v e p e r s o n a l l y s i g n i f i c a n t i s s u e s F u l l , easy p r e s e n t a t i o n of experiencing; a l l elements c o n f i d e n t l y i n t e g r a t e d . Impersonal, detached. I n t e r e s t e d , personal, s e l f - p a r t i c i p a t i o n . R e a c t i v e , emotionally i n v o l v e d . S e l f - d e s c r i p t i v e ; a s s o c i a t i v e . E x p l o r a t o r y , elaborat-i v e , h y p o t h e t i c a l . F e e l i n g s v i v i d l y ex-pressed, i n t e g r a t i v e , c o n c l u s i v e or a f f i r m -a t i v e . Expansive, i l l u m i n a t -i n g , c o n f i d e n t , buoyant. Reference: K l e i n , M. H.; Mathieu, P. L.; Gendlin, E. T.; and K i e s l e r , D. J . , The Experiencing Scale (Madison, Wisconsin: Wisconsin P s y c h i a t r i c I n s t i t u t e , 1969), p. 42. - 9 9 -APPENDIX D QUESTIONNAIRE A (Immediately preceding the experimental session) B r i e f l y describe the issue that you wish to work on: On each of the scales below, please indicate with an (x), your present position: 1. Please indicate, by checking one of the boxes below, how much the issue you described above bothers you now: I—I couldn't be worse very much pretty much a l i t t l e riot at a l l 2. My inner feelings (what i t ' s l i k e i n s i d e ) : Good Bad Tense Relaxed Clear Hazy - 100 -APPENDIX E QUESTIONNAIRE B (Immediately a f t e r the experimental session) On each of the sc a l e s below, please i n d i c a t e your present p o s i t i o n w i t h an "X". My inner f e e l i n g s (what i t ' s l i k e i n s i d e ) : Good - Bad Tense Relaxed C l e a r Hazy Was the iss u e t h a t you worked on during the hour the same or s i m i l a r t o the i s s u e t h a t you brought i n ? ( C i r c l e one) Very d i f f e r e n t 1 D i f f e r e n t 2 Related 3 S i m i l a r 4 Same 5 3. Please i n d i c a t e , by checking one of the boxes below, how much the i s s u e which you i d e n t i f i e d before the hour bothers you now: couldn't be worse very much p r e t t y much a l i t t l e not at a l l - 1 0 1 -How r e s o l v e d do you f e e l about the i s s u e you worked on  today? t o t a l l y r e s o l v e d somewhat r e s o l v e d not at a l l r e s o l v e d How do you f e e l about the hour which you have j u s t completed? (Please c i r c l e the one answer which best a p p l i e s ) : 1. P e r f e c t 2. E x c e l l e n t 3. Very good 4. P r e t t y good 5. F a i r 6. P r e t t y poor 7. Very poor How w e l l d i d your t h e r a p i s t seem to understand what you were f e e l i n g and t h i n k i n g t h i s session? My t h e r a p i s t : 1. Understood e x a c t l y how I thought and f e l t . 2. Understood very w e l l how I thought and f e l t . 3. Understood p r e t t y w e l l , but there were some th i n g s he/she didn't seem t o grasp. 4. Didn't understand too w e l l how I thought and f e l t . 5. Misunderstood how I thought and f e l t . How h e l p f u l do you f e e l your t h e r a p i s t was t o you t h i s session? 1. Completely h e l p f u l 2. Very h e l p f u l 3. P r e t t y h e l p f u l 4. Somewhat h e l p f u l 5. S l i g h t l y h e l p f u l 6. Not at a l l h e l p f u l - 102 -APPENDIX F QUESTIONNAIRE C (Three hours a f t e r the experimental session) 1. a) Did you inc r e a s e your awareness of y o u r s e l f as a r e s u l t of the c o u n s e l l i n g session? ( C i r c l e one): 1 2 3 4 5 D e f i n i t e l y Don't t h i n k Unsure Think D e f i n i t e l y no so so yes b) Did you have a s h i f t of awareness i n the hour? ( P o s s i b l e examples: maybe you saw something d i f f e r e n t l y , experienced something f r e s h l y , made some discovery about y o u r s e l f , or became aware of new c h o i c e s ) : 1 2 3 4 5 D e f i n i t e l y Don't t h i n k Unsure Think D e f i n i t e l y no so so yes c) I f so, what was the s h i f t ? Please describe what happened and how you see y o u r s e l f or the world d i f f e r e n t l y : 2. From t h i s p e r s p e c t i v e , are there any general thing s about y o u r s e l f or your l i f e t hat you would l i k e t o change? 3. a) From t h i s general p e r s p e c t i v e , what s p e c i f i c f e e l i n g or behaviour would you hope to change i n the coming week? Please i n d i c a t e the s i t u a t i o n i n which you wish t h i s change to occur. (For example, " c r i t i c i z e myself l e s s about my appearance", "spend more time w i t h my f a m i l y i n the evenings", "discuss my f e e l i n g s w i t h my b o y f r i e n d " , "assert myself more at the o f f i c e " , "be aware of the moments when I act happy but am r e a l l y f e l l i n g lousy".) - 103 -How o f t e n have you been experiencing y o u r s e l f or behaving i n t h i s way i n the l a s t while? 1. Not at a l l 2. Hardly ever 3. Seldom 4. Sometimes 5• Frequently 6. Most of the time 7. A l l of the time How o f t e n would you l i k e t o see t h i s experience < behaviour o c c u r r i n g i n the coming week? 1. Not at a l l 2. Hardly ever 3. Seldom 4. Sometimes 5. Frequently 6. Most of the time 7. A l l of the time - 104 -APPENDIX G QUESTIONNAIRE D (One week a f t e r the experimental session) 1. B r i e f l y d escribe the i s s u e t h a t you i d e n t i f i e d before the l a s t s e s s i o n : 2. Please i n d i c a t e , by checking one of the boxes below, how much t h i s i s s u e bothers you now: couldn't be worse very much p r e t t y much a l i t t l e not at a l l 3. How r e s o l v e d do you f e e l about the i s s u e you d i d work on? t o t a l l y r e s o l v e d somewhat r e s o l v e d not at a l l r e s o l v e d 4 During the past week, have you experienced a change i n y o u r s e l f which you a t t r i b u t e to the c o u n s e l l i n g session? ( C i r c l e one): - 105 -1 2 3 4 5 D e f i n i t e l y Don't t h i n k Unsure Think so D e f i n i t e l y no so yes 5. A f t e r the l a s t hour, you i n d i c a t e d that you hoped that the f o l l o w i n g f e e l i n g or behaviour would change duri n g the week: How o f t e n are you experiencing y o u r s e l f behaving t h i s way now? 1. Not a t a l l 2. Hardly ever 3 . Seldom 4 . Sometimes 5. Frequently 6. Most of the time 7. A l l of the time 6. How much progress do you f e e l you made i n d e a l i n g w i t h your i s s u e s i n c e the l a s t hour? (Please c i r c l e the item which best a p p l i e s ) : 1. 2. 3 . 4 . 5 . A great d e a l of progress Considerable progress Moderate progress Some progress Didn't get anywhere 7. Has anything unusual happened during the week other than the hour to which you a t t r i b u t e any change you have reported? I f so, what? 

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