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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 GESTALT AND  OF  TWO-CHAIR DIALOGUE  EMPATHIC A  EFFECTS  SPLIT  REFLECTION  AT  IN, THERAPY  by LYSE M. DOMPIERRE B.A., U n i v e r s i t y o f Ottawa, 1973  A THESIS SUBMITTED I N PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS  in THE FACULTY OF GRADUATE STUDIES (Department  o f C o u n s e l l i n g Psychology)  We a c c e p t t h i s t h e s i s as c o n f o r m i n g t o t h e required standard  THE UNIVERSITY OF BRITISH COLUMBIA O c t o b e r , 1979 ©  L y s e M. Dompierre,  1979  In p r e s e n t i n g t h i s  thesis in partial  an a d v a n c e d d e g r e e a t the  Library  I further for  shall  the U n i v e r s i t y  make i t  agree that  freely  this  thesis for  It  Department of  f i n a n c i a l gain shall  &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 Wesbrook P l a c e V a n c o u v e r , Canada V6T 1W5  BP  75-51 1 E  the requirements I agree  r e f e r e n c e and copying of  this  that  not  copying or  for  that  study. thesis  by t h e Head o f my D e p a r t m e n t  i s understood  permission.  of  B r i t i s h Columbia,  extensive  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  written  • E-6  of  available for  permission for  by h i s r e p r e s e n t a t i v e s . of  fulfilment  or  publication  be a l l o w e d w i t h o u t  my  ABSTRACT  This study examined the differential effects of Gestalt two-chair dialogue and empathic reflection at a split i n 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 a l . , 1970) as not overly conscientious, experimenting and not overly controlled. The process measure, Depth of Experiencing (Klein, et a l . , 1969) was used as a dependent variable to compare the effects of Gestalt two-chair dialogue and empathic reflection at a s p l i t .  Five outcome measures were also used as dependent  variables:  the Target Complaints Box Scale (Battle, et a l . ,  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 r e c e i v e d both treatments  before the e x p e r i -  mental s e s s i o n , i n o r d e r t o reduce n o v e l t y e f f e c t . c  None of  the experimental s e s s i o n s o c c u r r e d before the f i f t h  therapy  s e s s i o n i n order t o a l l o w f o r the formation o f a working alliance.  H a l f o f the c l i e n t s r e c e i v e d empathic  i n the f i r s t  reflection  experimental s e s s i o n and h a l f r e c e i v e d G s t a l t e  two-chair d i a l o g u e , t o reduce order o f p r e s e n t a t i o n e f f e c t . The f o l l o w i n g s e s s i o n was  not used f o r the purposes  study, i n o r d e r t o i n c r e a s e the independence o f the experimental s e s s i o n s . second  of t h i s two  Treatments were r e v e r s e d f o r the  experimental s e s s i o n .  A 2 x 2 ( t h e r a p i s t experience by treatment) f a c t o r i a l design was  f u l l y crossed  used f o r a n a l y s i s o f the data.  Three of  the dependent v a r i a b l e s were measured more than once, y i e l d i n g a t h i r d repeated measure f a c t o r on these v a r i a b l e s . of  s t a t i s t i c a l s i g n i f i c a n c e used was  The  level  .05.  R e s u l t s showed G e s t a l t two-chair d i a l o g u e t o be more e f f e c t i v e than empathic r e f l e c t i o n at producing peak  exper-  i e n c i n g l e v e l s o f f i v e or above, as w e l l as g r e a t e r s h i f t s of awareness, c o n f l i c t r e d u c t i o n , behaviour of  change and p r o g r e s s .  change and r e p o r t s  The two treatment  groups d i d not  d i f f e r on d i s t r e s s r e d u c t i o n , nor were t h e r e any  interaction  e f f e c t s between t h e r a p i s t experience l e v e l and treatment  level.  - iv -  TABLE OF CONTENTS  Page Abstract  i i  Table of Contents L i s t of Tables  iv viii  L i s t of Figures  x  Acknowledgements  x  *  CHAPTER I  INTRODUCTION  1  The Problem  1  Background of the Problem  1  D e f i n i t i o n of Terms  3  Empathic Reflection  3  Gestalt Two-Chair Dialogue  5  The S p l i t  6  Depth of Experiencing  7  Distress Reduction  7  S h i f t of Awareness  8  C o n f l i c t Resolution  3  Sense of Change and Progress  9  Behaviour Change  9  Hypotheses  10  Rationale f o r the Hypotheses  12  -  V  -  TABLE OF CONTENTS - C o n t i n u e d  CHAPTER  II  Page D e l i m i t a t i o n o f t h e Study  13  Assumptions  14  J u s t i f i c a t i o n o f t h e Study  15  LITERATURE REVIEW  17  S p l i t s and P o l a r i t i e s  III  i n Psychotherapy  ...  17  The Use o f Two-Chair D i a l o g u e 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  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  Client  33  Information  34  Design Population  37  . . . . . .  S u b j e c t P r e p a r a t i o n and Demographic Data  . .  37  Therapists  39  Raters  40  - v i-  TABLE OF CONTENTS - C o n t i n u e d CHAPTER  IV  Page Data C o l l e c t i o n  41  S c o r i n g Procedures  42  Procedure o f A n a l y s i s  50  RESULTS  51  Comparison o f Depth o f E x p e r i e n c i n g Proportion Scores Under G e s t a l t Two-Chair D i a l o g u e and Empathic R e f l e c t i o n .  51  Comparison o f D i s t r e s s R e d u c t i o n Scores Under G e s t a l t Two-Chair D i a l o g u e and Empathic Reflection  55  Comparison o f S h i f t o f Awareness Scores Under G e s t a l t Two-Chair D i a l o g u e and Empathic Reflection  5#  Comparison o f C o n f l i c t R e s o l u t i o n S c o r e s Under G e s t a l t Two-Chair D i a l o g u e and Empathic R e f l e c t i o n  61  Comparison o f Behaviour Change Scores Under G e s t a l t Two-Chair D i a l o g u e and Empathic Reflection  64  Comparison o f Change and P r o g r e s s Scores Under G e s t a l t Two-Chair D i a l o g u e and Empathic R e f l e c t i o n  67  Client Information  70  - v i i -  TABLE OF CONTENTS - C o n t i n u e d  CHAPTER V  Page DISCUSSION  74  Summary  74  Conclusions  76  General D i s c u s s i o n  Si  Recommendations  84  Implications  85  BIBLIOGRAPHY  87  APPENDICES  92  - viii -  LIST OF TABLES  Table I II III IV V VI VII VIII IX X XI XII XIII XIV  Page Empathy R a t i n g s on t h e B a r r e t t - L e n n a r d Relationship Inventory..  45  Mean Empathic R e f l e c t i o n R a t i n g f o r Each Session  47  P r o p o r t i o n Scores f o r Segments o f Depth o f E x p e r i e n c i n g o f 5 o r More  52  Means and S t a n d a r d D e v i a t i o n s o f Transformed Depth o f E x p e r i e n c i n g P r o p o r t i o n Scores . . .  53  A n a l y s i s o f V a r i a n c e f o r Transformed o f E x p e r i e n c i n g P r o p o r t i o n Scores  54  Depth  Means and S t a n d a r d D e v i a t i o n s f o r D i s t r e s s R e d u c t i o n Scores  56  A n a l y s i s o f V a r i a n c e f o r Three O c c a s i o n s o f D i s t r e s s R e d u c t i o n Scores . . . .  57  Means and S t a n d a r d D e v i a t i o n s f o r S h i f t o f Awareness Scores . . . . . . . .  59  A n a l y s i s o f V a r i a n c e f o r S h i f t o f Awareness Scores . . . . . .  60  Means and S t a n d a r d D e v i a t i o n s f o r C o n f l i c t R e s o l u t i o n Scores  62  A n a l y s i s o f V a r i a n c e f o r Two O c c a s i o n s o f C o n f l i c t R e s o l u t i o n Scores  .  63  Means and S t a n d a r d D e v i a t i o n s f o r B e h a v i o u r Change Scores . . . . . . . . .  65  A n a l y s i s o f V a r i a n c e f o r Two Occasions o f B e h a v i o u r Change S c o r e s  66  Means and S t a n d a r d D e v i a t i o n s f o r Change and P r o g r e s s Scores .  68  - ix -  LIST QF TABLES - Continued  Table  XV XVI XVII  Page  A n a l y s i s o f V a r i a n c e f o r Change and 69  Progress Scores Means and Standard D e v i a t i o n s f o r E v a l u a t i o n o f Therapy Scores  71  A n a l y s i s o f V a r i a n c e f o r Two Occasions o f E v a l u a t i o n o f Therapy Scores  72  - X  -  LIST OF FIGURES  Figure  Page  1  F a c t o r i a l Design  36  2  Order o f T e s t s w i t h Respect t o T r e a t m e n t s . .  43  - xi -  ACKNOWLEDGEMENTS.  I w i s h t o extend my a p p r e c i a t i o n t o t h e f o l l o w i n g who were p i l l a r s i n t h e p r e p a r a t i o n o f t h i s t h e s i s .  people,  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 , g u i d a n c e , u n f a i l i n g a v a i l a b i l i t y and s u p p o r t , H a r o l d R a t z l a f f , f o r h i s calm and e d i f y i n g c o u n s e l r e g a r d i n g t h e r e s e a r c h d e s i g n 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 C h i k o , f o r h i s support and c l a r i f i c a t i o n o f t h e 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 analysis.  D  I am g r a t e f u l a l s o t o t h o s e , t o o numerous t o name, who g r a c i o u s l y gave o f t h e i r t i m e t o s e r v e a s 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 o f t h i s s t u d y was t o compare t h e e f f e c t on  depth o f e x p e r i e n c i n g o f t h e G e s t a l t t w o - c h a i r d i a l o g u e and o f empathic r e f l e c t i o n w h i c h r a t e d a t l e a s t " l e v e l t h r e e " on t h e Empathy S c a l e ( C a r k h u f f , 1969), a t a " s p l i t " i n t h e r a p y . T h i s s t u d y 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 o f 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 beh a v i o u r and r e p o r t s o f change and p r o g r e s s a r e r e l a t e d t o t h e t y p e o f i n t e r v e n t i o n used i n t h e t h e r a p y h o u r .  BACKGROUND OF THE PROBLEM Rogers' (1957) n e c e s s a r y and s u f f i c i e n t c o n d i t i o n s o f a c c u r a t e empathy, warmth and genuineness have been t h e o b j e c t o f much r e s e a r c h i n psychotherapy.  In addition to stressing  t h e d e s i r a b i l i t y o f t h e s e c o n d i t i o n s , however, c e r t a i n  client-  c e n t e r e d t h e o r i s t s a r e now s a y i n g t h a t t h e r a p i s t s w i t h c l i e n t c e n t e r e d o r i e n t a t i o n s may w e l l want t o v a r y t h e i r r e p e r t o i r e o f i n - t h e r a p y t e c h n i q u e s i n response performance ( G e n d l i n , 1969; 1976).  toclient style or client  R i c e , 1974;  Wexler and B u t l e r ,  - 2 -  C e r t a i n process measures, n o t a b l y the E x p e r i e n c i n g S c a l e ( K l e i n , et a l . ,  1969) have been suggested as r e v e a l i n g the  change p r o c e s s ' i n therapy*  K l e i n has i n fact•recommended.  t h a t the E x p e r i e n c i n g S c a l e be used as a measure o f t h e s p e c i f i c effects of therapist interventions.  The s c a l e has  a l s o c o r r e l a t e d p o s i t i v e l y w i t h outcome i n a number o f s t u d i e s ( O r l i n s k y and Howard, 1978) although a c a u s a l l i n k between t h e two has not been  demonstrated.  In the aforementioned s t u d i e s , t h e r e l a t i o n s h i p between depth o f e x p e r i e n c i n g and outcome was i n v e s t i g a t e d over the whole o f t h e r a p y r a t h e r than at s p e c i f i c i n s t a n c e s where p a r t i c u l a r i n t e r v e n t i o n s o r t e c h n i q u e s were being used. Studies f o c u s i n g on p r e c i s e l y d e f i n e d t h e r a p e u t i c 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 r e s e a r c h ( B e r g i n and Strupp, 1972; Greenberg,  1975;  Luborsky,  et a l . , 1971).  Studies of t h i s  nature enable examination o f t h e r e l a t i o n between process and outcome as i t r e l a t e s t o p a r t i c u l a r t h e r a p i s t and c l i e n t behaviours. Given the t h e o r e t i c a l and r e s e a r c h emphasis on the s i g n i f i c a n c e o f an index o f involvement such as depth o f e x p e r i e n c i n g , i t was the concern o f the present study t o examine whether a s p e c i f i c t h e r a p e u t i c i n t e r v e n t i o n  performed  by a t h e r a p i s t at a s p e c i f i c moment i n therapy would r e s u l t i n  - 3 -  g r e a t e r depth o f e x p e r i e n c i n g , g r e a t e r sense o f movement f o r t h e 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 b e h a v i o u r . G e s t a l t t w o - c h a i r d i a l o g u e 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 e x p e r i e n c i n g t h a n empathic r e f l e c t i o n , upon p r e s e n t a t i o n o f a s p l i t , i n a n analogue s t u d y (Greenberg  and C l a r k e , 1979).  T h i s s t u d y proposes t o i n v e s t i -  gate these f i n d i n g s , u s i n g a p o p 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 t e c h n i q u e by means of which the t h e r a p i s t expresses understanding  o f what t h e  c l i e n t i s f e e l i n g and t h e e x p e r i e n c e s u n d e r l y i n g t h e s e  feelings.  The t h e r a p i s t , i n h i s o r h e r own words and i n h i s o r h e r own way,  communicates t h i s u n d e r s t a n d i n g t o t h e c l i e n t .  Egan  (1975) p r o v i d e s t h e f o l l o w i n g example: I f a person comes t o me, s i t s down, l o o k s a t t h e f l o o r , hunches o v e r , 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 p a r t - t i m e j o b , I might b e g i n 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 m i s e r a b l e — your w o r l d has a l l o f a sudden begun t o f a l l a p a r t " I see stand and I world  h i s d e p r e s s i o n ( f e e l i n g s ) and b e g i n t o underwhat u n d e r l i e s t h i s d e p r e s s i o n ( e x p e r i e n c e ) communicate t o him t h i s u n d e r s t a n d i n g o f h i s (p. 7 6 ) .  - 4 -  Carkhuff at  (1969) has d e s c r i b e d empathic r e f l e c t i o n as o c c u r r i n g  five levels.  L e v e l 1 and 2 a r e c o n s i d e r e d d e t r i m e n t a l .  L e v e l 3, 4 and 5 empathic r e f l e c t i o n s a r e c o n s i d e r e d ive,  facilitat-  and a r e d e s c r i b e d by C a r k h u f f (1969) as f o l l o w s : L e v e l 3:  The e x p r e s s i o n s o f t h e h e l p e r i n response to the expressions o f the c l i e n t ( s ) a r e e s s e n t i a l l y interchangeable w i t h those o f 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 t h e same a f f e c t and meaning.  L e v e l 4:  The responses o f t h e h e l p e r add n o t i c e a b l y t o t h e e x p r e s s i o n s o f t h e c l i e n t i n such a way as t o e x p r e s s f e e l i n g s a t a l e v e l deeper t h a n t h e c l i e n t was a b l e t o express himself.  L e v e l 5: >• The h e l p e r ' s responses a d d - s i g n i f i c a n t l y , t o t h e f e e l i n g and meaning o f t h e e x p r e s s i o n s o f t h e c l i e n t ( s ) i n , s u c h a way as t o a c c u r a t e l y e x p r e s s f e e l i n g l e v e l s below what t h e c l i e n t h i m s e l f was a b l e t o e x p r e s s o r , i n t h e event o f ongoing, deep s e l f e x p l o r a t i o n on t h e 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 s t u d y , t h e r a p i s t s were i n s t r u c t e d t o respond a L e v e l 3, 4 o r 5 empathic r e f l e c t i o n when t h e c l i e n t a  with  presented  split. Empathic r e f l e c t i o n i s one means o f communicating empathic  understanding t o a c l i e n t .  Other t h e r a p i s t b e h a v i o u r s ,  such  as n o n - v e r b a l messages, empathic q u e s t i o n s and humour can a l s o convey empathic u n d e r s t a n d i n g .  The B a r r e t t - L e n n a r d R e l a t i o n -  s h i p I n v e n t o r y p r o v i d e s an i n d e x o f t h e t o t a l R o g e r i a n  concept  o f empathy i n t h e 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  - 5  -  a more g l o b a l range o f t h e r a p i s t b e h a v i o u r s w h i c h may perceived  as empathic by t h e  be  client.  G e s t a l t Two-Chair D i a l o g u e In the G e s t a l t two-chair dialogue, t o a l t e r n a t e l y assume t h e two  p a r t s o f an i n t r a p e r s o n a l  interpersonal conflict situation. t o do t h i s , but t h e n , I'm  the c l i e n t i s asked  A c l i e n t may  or  say " I want  not r e a l l y s u r e i t ' s a good i d e a " ,  a t w h i c h p o i n t t h e t h e r a p i s t g u i d e s the c l i e n t i n a d i a l o g u e between both s i d e s .  The  c l i e n t , t a k i n g on t h e r o l e o f " I want  t o do t h i s " a d d r e s s e s h i m s e l f which he o r she  o r h e r s e l f t o an empty c h a i r i n  imagines t h e o t h e r s i d e o f t h e p o l a r i t y .  He  o r she t h e n moves t o t h e o t h e r c h a i r , and responds t o what he o r she has  j u s t s a i d from t h e p r e v i o u s p o s i t i o n .  moves b o d i l y from one  The  client  c h a i r t o the o t h e r , s p e a k i n g from b o t h  positions alternately. Greenberg (1979) has  p r e s e n t e d f i v e p r i n c i p l e s w h i c h con-  s t i t u t e t h e main s t r u c t u r e o f t h e  operation:  1.  Maintenance o f a c o n t a c t boundary: Maintaini n g c l e a r s e p a r a t i o n and c o n t a c t between t h e p a r t i a l a s p e c t s o f 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 p e r s o n t o use h i s o r 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 t h e person's a t t e n t i o n t o p a r t i c u l a r a s p e c t s o f e x p e r i e n c e by i n creasing the l e v e l of a r o u s a l .  - 6 -  The  4.  Heightening: H i g h l i g h t i n g aspects o f experience by i n c r e a s i n g t h e l e v e l o f 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 o r a b s t r a c t . P a r t i c u l a r i z i n g e x p e r i e n c e by moving from t h e o r y t o practice.  Split A " s p l i t " i s s a i d t o o c c u r when t h e c l i e n t p r e s e n t s  a  c o n f l i c t i n w h i c h he o r she i s s t r u g g l i n g between two o p p o s i n g positions.  The two f o l l o w i n g examples, s e l e c t e d from t h e  experimental  d a t a , a r e p r e s e n t e d 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 t h e edge o f a c l i f f , t h a t out t h e r e , t h e r e ' s some unknown f e e l i n g and emotion. I ' d l i k e t o d i 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 p e o p l e .  2.  I want f r i e n d s , but I spend a l o t o f energy b e i n g angry t h a t t h e y don't behave t h e way I would want them t o .  Greenberg (1979) s p e c i f i e s t h e f o l l o w i n g f e a t u r e s o f t h e s p l i t : 1.  A statement o f a tendency o r p a r t i a l a s p e c t o f t h e s e l f , e.g., " I don't want t o do t h i s . "  2.  A statement o f a second tendency o r p a r t i a l a s p e c t o f t h e s e l f , e.g., " I f e e l I have t o . "  3.  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 t h e two p a r t s a r e b e i n g s e t a g a i n s t each o t h e r , e.g., "but".  4.  A v e r b a l or non-verbal i n d i c a t i o n that t h e 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 o r c o e r c i o n , e.g., " I have t o " , o r voice quality.  - 7 -  Kepth o f E x p e r i e n c i n g K l e i n , et a l . (1969) use " e x p e r i e n c i n g " t o denote t h e q u a l i t y o f personal involvement i n therapy.  At a low  level  o f e x p e r i e n c i n g , t h e c l i e n t p r o v i d e s no d e s c r i p t i o n o f f e e l i n g s , and d i s c o u r s e i s s u p e r f i c i a l o r i m p e r s o n a l .  At a moder-  a t e l e v e l o f e x p e r i e n c i n g , t h e c l i e n t d e s c r i b e s and h i s o r her f e e l i n g s .  elaborates  The g r e a t e s t depths o f e x p e r i e n c i n g  a c h i e v e d when t h e c l i e n t e x p l o r e s h i s o r h e r f e e l i n g s , progresses  are  and  t o 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 o f e x p e r i e n c i n g i s t h e e x t e n t t o which a p e r s o n ' s b o d i l y f e l t f l o w o f e x p e r i e n c i n g c o n s t i t u t e s h i s o r h e r awaren e s s , and i s e x p r e s s e d  verbally.  I t i s an i m p o r t a n t  f o r t h e r a p i e s i n which s e l f - a w a r e n e s s  and  construct  self-understanding  are major g o a l s . Distress  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 o f r e l i e f i n a n x i e t y w i t h r e g a r d t o t h e i s s u e he o r chose t o d e a l w i t h d u r i n g t h e t h e r a p e u t i c s e s s i o n . on how  t r o u b l e d o r "bothered"  p r e s s i n g concern.  It  she  focuses  t h e c l i e n t f e e l s by h i s o r her  I f t h e 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  i s s u e f o l l o w i n g t h e r a p y , he o r she may  invest less  the  emotional  energy i n t o t h i s a r e a o f c o n c e r n and f e e l f r e e r t o d e a l 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) r e g a r d d y s f u n c t i o n as a t t r i b u t a b l e t o t h e f a c t t h a t people a r e unaware o f t h e i r  feelings,  wants and v a l u e s , such t h a t t h e y a l i e n a t e p a r t s o f t h e i r functioning.  self-  An i n t e r r u p t i o n i n t h i s f l o w o f awareness c o u l d  t h e r e f o r e be c o n c e i v e d  o f as r e l a t e d t o i n t r a p s y c h i c c o n f l i c t .  I f t h e r a p y c o u l d be h e l p f u l t o t h e c l i e n t i n a s s i s t i n g him o r h e r t o become more aware o f f e e l i n g s , wants and v a l u e s , a s h i f t i n p e r s p e c t i v e might o c c u r , l e a d i n g t o g r e a t e r g r a t i o n o f opposing p a r t s . examples presented  inte-  F o r example, w i t h r e g a r d t o t h e  e a r l i e r , a s h i f t i n awareness was r e p o r t e d  t o have t a k e n p l a c e i n t h e f o l l o w i n g way: 1.  I now see t h a t a p a r t 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 s o u r c e . I r e a l i z e that I make m y s e l f d i s a p p e a r on some l e v e l when t h e f e e l i n g l e v e l i s t o o h i g h . A p a r t o f me bel i e v e s t h e o t h e r p a r t o f me can't h a n d l e emotions, so i t c l o s e s 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 a t some t i m e s ; t h e "shut down system" need n o t remain a u t o m a t i c .  2.  I n s t e a d o f blaming my f r i e n d s f o r b e i n g 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 n o t s a y i n g what I want i n my r e l a t i o n s h i p s .  Conflict Resolution T h i s concept r e f e r s t o t h e c l i e n t ' s s u b j e c t i v e p e r c e p t i o n of h i s or her a b i l i t y t o deal with a t r o u b l i n g l i f e issue. I t does not i m p l y t h a t c o n f l i c t no l o n g e r e x i s t s i n t h e c l i e n t ' s  - 9 -  w o r l d , o r t h a t t h e i s s u e d e a l t w i t h d u r i n g t h e t h e r a p y hour has been c o m p l e t e l y r e s o l v e d .  Rather, c o n f l i c t  resolution  r e f e r s t o t h e f a c t t h a t a f t e r t h e r a p y , t h e c l i e n t may exp e r i e n c e a d i m i n i s h e d sense o f 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 t h e i s s u e he o r she d e a l t w i t h i n t h e r a p y . Sense o f Change and P r o g r e s s T h i s concept r e f e r s t o t h e c l i e n t ' s s u b j e c t i v e i m p r e s s i o n o f becoming d i f f e r e n t , o r changing as a r e s u l t o f t h e r a p y .  It  a l s o r e f e r s t o t h e c l i e n t ' s sense o f improvement w i t h r e g a r d t o a t r o u b l i n g i s s u e which was f o c u s e d on i n t h e r a p y . B e h a v i o u r Change I n t h i s s t u d y "change" r e f e r s t o an o v e r t o r c o v e r t m o d i f i c a t i o n o f a s p e c i f i c c l i e n t b e h a v i o u r d u r i n g t h e week f o l l o w i n g t h e t h e r a p y hour, and i s measured on a t a r g e t behaviour scale.  A f t e r the therapy session, the c l i e n t deter-  mines a t a r g e t b e h a v i o u r r e l a t e d t o t h e i s s u e d i s c u s s e d i n t h e r a p y and r e p o r t s t h e p r e s e n t f r e q u e n c y o f t h e b e h a v i o u r . One week l a t e r t h e c l i e n t r e p o r t s t h e f r e q u e n c y o f t h e p r e v i o u s l y i d e n t i f i e d b e h a v i o u r , as i t has o c c u r r e d f o l l o w i n g therapy.  - 10 -  HYPOTHESES HQ  1  :  The G e s t a l t t w o - c h a i r d i a l o g u e , when used a t a s p l i t , w i l l not l e a d t o depths o f e x p e r i e n c i n g on t h e K l e i n , e t a l ; , E x p e r i e n c i n g S c a l e s i g n i f i c a n t l y d i f f e r e n t from t h o s e produced by t h e use o f empathic r e f l e c t i o n a t a s p l i t . 1  H-i  1  :  The G e s t a l t t w o - c h a i r d i a l o g u e , when Used a t a s p l i t , w i l l l e a d t o depths -of e x p e r i e n c i n g on t h e K l e i n , e t a l . , E x p e r i e n c i n g S c a l e s i g n i f i c a n t l y . d i f f e r e n t from t h o s e produced by the-use o f e m p a t h i c r e f l e c t i o n a t a s p l i t . r  HQ  H,  2  2  :  The G e s t a l t t w o - c h a i r d i a l o g u e , when used a t 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 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 t h o s e produced by t h e use o f empathic r e f l e c t i o n a t 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 t h e r a p y .  :  The G e s t a l t t w o - c h a i r d i a l o g u e , when used a t a s p l i t , w i l l lead to levels of distress 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 t h o s e produced by t h e use o f empathic r e f l e c t i o n a t 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 t h e r a p y . I ^ <• !  H  N u  3  :  H-j : 3  X  the ^  The G e s t a l t t w o - c h a i r d i a l o g u e , when u s e d a t 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 s h i f t o f awareness s i g n i f i c a n t l y d i f f e r e n t from t h o s e produced by t h e use o f empathic r e f l e c t i o n a t 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 a d m i n i s t e r e d t h r e e hours a f t e r t h e r a p y . The G e s t a l t t w o - c h a i r d i a l o g u e , when used a t a • s p l i t , w i l l l e a d t o l e v e l s o f s h i f t o f awareness s i g n i f i c a n t l y d i f f e r e n t from t h o s e produced by t h e u s e o f empathic r e f l e c t i o n a t 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 a d m i n i s t e r e d t h r e e hours a f t e r t h e r a p y . !  A non d i r e c t i o n a l t e s t o f s t a t i s t i c a l s i g n i f i c a n c e a t - .05 l e v e l .  I n a sample o f s u b j e c t s d e s c r i b e d as e x p e r i m e n t i n g , 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 c o n s c i e n t i o u s on t h e S i x t e e n Personality Factor Questionnaire.  -  HQ  H  1  HQ  H,  H  5  5  °6  H,  6  -  The G e s t a l t t w o - c h a i r d i a l o g u e , when used a t 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 t h o s e produced by t h e use o f empathic r e f l e c t i o n a t a s p l i t , as measured on a s e v e n - p o i n t box s c a l e a d m i n i s t e r e d t h r e e hours a f t e r and one week a f t e r therapy.  4  4  11  :  The G e s t a l t t w o - c h a i r d i a l o g u e , when used a t a s p l i t , w i l l lead to levels of c o n f l i c t resolution s i g n i f i c a n t l y d i f f e r e n t from t h o s e produced by the use o f empathic r e f l e c t i o n a t a s p l i t , as measured on a s e v e n - p o i n t box s c a l e a d m i n i s t e r e d t h r e e hours a f t e r , and one week a f t e r t h e r a p y .  :  The G.estalt, t w o - c h a i r d i a l o g u e , when used a t 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 b e h a v i o u r change s i g n i f i c a n t l y d i f f e r e n t from t h o s e produced by t h e u s e o f empathic r e f l e c t i o n a t a s p l i t j as measured on a s e v e n - p o i n t s c a l e a d m i n i s t e r e d t h r e e hours a f t e r , and one week a f t e r therapy.  :  The G e s t a l t t w o - c h a i r d i a l o g u e , when used a t a s p l i t , w i l l 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 t h o s e produced by t h e use o f empathic r e f l e c t i o n a t a s p l i t , as measured on a s e v e n - p o i n t s c a l e a d m i n i s t e r e d t h r e e hours a f t e r , and one week a f t e r t h e r a p y .  :  The G e s t a l t t w o - c h a i r d i a l o g u e , when used a t 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 change and p r o g r e s s s i g n i f i c a n t l y d i f f e r e n t from t h o s e produced by t h e use o f empathic r e f l e c t i o n a t 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 a d m i n i s t e r e d one week a f t e r t h e r a p y .  :  The G e s t a l t t w o - c h a i r d i a l o g u e , when used a t a 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 p r o g r e s s s i g n i f i c a n t l y d i f f e r e n t from t h o s e produced by t h e use o f empathic r e f l e c t i o n a t 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 a d m i n i s t e r e d 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 o f 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 G e s t a l t two-chair d i a l o g u e has been shown e f f e c t i v e a t deepening e x p e r i e n c i n g  i n t h r e e s i n g l e case s t u d i e s  (Greenberg,  1975), and i n a c o u n s e l l i n g analogue study (Greenberg and Clarke,  1979).  There i s support i n the l i t e r a t u r e f o r the  n o t i o n t h a t depth o f experience i s p o s i t i v e l y c o r r e l a t e d w i t h outcome ( K l e i n , et a l . , 1969).  (  G e s t a l t t h e r a p i s t s b e l i e v e t h a t the r e q u i s i t e f a c t o r i n g t o change i s awareness ( P e r l s , 1969), and t h a t i s preceded by deep l e v e l s o f e x p e r i e n c i n g T h e r e f o r e , deep l e v e l s o f e x p e r i e n c i n g :  lead-  awareness  (Kempler, 1973).  along w i t h ' s h i f t s o f  1  awareness may l e a d t o r e s o l u t i o n , o r t o t h e e x p o s i t i o n o f a :  more important u n d e r l y i n g  i s s u e , enabling  c o n f l i c t resolution, distress reduction This t h e s i s ' objective  and behaviour change.  i s t o i n v e s t i g a t e whether G e s t a l t  two-chair d i a l o g u e w i l l l e a d s u b j e c t s population  a c e r t a i n degree o f  s e l e c t e d from a normal  o f c l i e n t s seeking therapy t o 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 o f e x p e r i e n c i n g ,  d i s t r e s s reduction,  s h i f t o f aware-  ness, c o n f l i c t r e s o l u t i o n , sense o f change and progress and behaviour change than w i l l a split  i n therapy.  empathic r e f l e c t i o n , when used at  - 13  DELIMITATION OF THE  -  STUDY  T h i s study concerns i t s e l f with s u b j e c t s who  have been  involved with a t h e r a p i s t i n a counselling r e l a t i o n s h i p f o r a minimum o f f o u r s e s s i o n s .  Saltzman, et a l . (1976) found t h a t  c l i e n t and t h e r a p i s t r e p o r t forms d i s c r i m i n a t e d good and outcome most p o w e r f u l l y  by the t h i r d s e s s i o n .  Lennard R e l a t i o n s h i p Inventory was  administered  The  Barrett-  in this  immediately f o l l o w i n g the t h i r d s e s s i o n o f therapy, t o the l e v e l s o f c l i e n t - p e r c e i v e d empathy. the c l i e n t  perceived  I t was  poor  study identify  f e l t that i f  the t h e r a p i s t as empathic, the  existence  o f a c l i m a t e o f t r u s t i n - t h e r e l a t i o n s h i p would-be i n d i c a t e d . 1  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 f r e e t o  work i n d e p t h o n an emotional-issue f  et  (Carkhuff,  1969).  Saltzman,  a l ; (1976) showed t h a t by the t h i r d s e s s i o n , c l i e n t s t a t e -  ments o f p e r c e i v e d understanding and uniqueness were p r e d i c t i v e o f positive-outcome. The  : ...  t h e r a p i s t s used i n t h i s study were a l l t r a i n e d i n the  Carkhuff/Egan model o f empathic r e f l e c t i o n - ( E g a n ' , 1975), as w e l l as i n the use (70 per cent) had  o f G e s t a l t two-chair d i a l o g u e .  majority  f u l f i l l e d the;same Masters program i n *  C o u n s e l l i n g Psychology and had t w o - c h a i r dialogue  The  been t r a i n e d i n the  technique-by the same t r a i n e r ; -  Gestalt  - 14 -  The c l i e n t s i n t h e s t u d y were d e s c r i b e d a c c o r d i n g t o f a c t o r s G,  and  of the Sixteen Personality Factor  Q u e s t i o n n a i r e ( C a t t e l l , e t a l . , 1970). The r e s u l t s - o f t h i s s t u d y may t h e r e f o r e : be g e n e r a l i z e d t o s u b j e c t s s e e k i n g t h e r a p y who s c o r e 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, Q  1  and Q^ o f t h e 16-PF, who have been engaged i n  a counselling r e l a t i o n s h i p f o r at l e a s t three sessions with 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 t w o - c h a i r d i a l o g u e t e c h n i q u e s and who p e r c e i v e t h e i r t h e r a p i s t s as empathic, a c c o r d i n g t o t h e B a r r e t t - L e n n a r d R e l a t i o n s h i p Inventory. ASSUMPTIONS I t i s assumed t h a t t h e s p l i t s p r e s e n t e d by t h e c l i e n t s i n t h i s s t u d y a r e s e p a r a t e and/or independent and t h a t p r e s e s s i o n , p o s t - s e s s i o n , and f o l l o w - u p i n s t r u m e n t s  measure  change a c h i e v e d - d u r i n g t h e s e s s i o n . I n o r d e r t o reduce t h e p o s s i b i l i t y o f c o n t a m i n a t i o n between t h e two e x p e r i m e n t a l s e s s i o n s , t h e d e s i g n 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 t h e two t h a t a r e used f o r t h e purposes o f t h i s s t u d y , d u r i n g which t h e t h e r a p i s t i s i n s t r u c t ed t o work a c c o r d i n g t o any c o u n s e l l i n g model.  Therapists  were i n s t r u c t e d n o t t o respond t o a s p l i t i n t h e i n t e r v e n i n g s e s s i o n i n o r d e r t o reduce t h e p o s s i b i l i t y o f c o n t a m i n a t i o n of the f o l l o w i n g experimental session.  - 15 -  The E x p e r i e n c i n g S c a l e was  a l s o u s e f u l as a check on  p o s s i b l e contamination, as i t measured moment by moment what i s happening  "now"  i n the s e s s i o n ;  t h i s r e f e r e n t does not  depend on preceding i n t e r v i e w s . JUSTIFICATION OF>THE-STUDY L i t e r a t u r e i n the area o f psychotherapy v i g o r o u s attempts therapy  be made to= understand  (Butcher and Koss, 1978).  demands t h a t more  process and outcome i n  I n : t h i s t h e s i s , both pro-  cess, and outcome f o r subjects- are examined. K l e i n , et a l . (1969) suggests t h a t depth o f e x p e r i e n c i n g i s p o s i t i v e l y c o r r e l a t e d w i t h outcome.  T h i s l e a d s t o the  b e l i e f t h a t i f a p a r t i c u l a r t h e r a p e u t i c technique can enhance a c l i e n t ' s depth o f e x p e r i e n c i n g , he or she may more b e n e f i t from t h e r a p y .  experience  T h i s study examines d i s t r e s s r e -  d u c t i o n , s h i f t s of awareness, c o n f l i c t r e s o l u t i o n , sense o f change and progress and behaviour change as p o s s i b l e ways i n which c l i e n t s may  p e r c e i v e themselves  changing f o l l o w i n g deep  l e v e l s o f e x p e r i e n c i n g i n therapy. I f the hypotheses  s t a t e d e a r l i e r - i n t h i s Chapter are r  indeed supported, more weight w i l l be g i v e n t o the argument t h a t although empathy may  be a necessary, " b a s e l i n e " c o n d i t -  i o n f o r s u c c e s s f u l c o u n s e l l i n g , a more a c t i v e technique  such  - 16 -  as G e s t a l t t w o - c h a i r d i a l o g u e ,  when used a t a s p e c i f i c moment  i n t h e r a p y , may h e l p move t h e c l i e n t more q u i c k l y toward change t h a n w i l l t h e use o f 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 t h e f i e l d t o d a y , as w e l l as f o r c o u n s e l l o r  training.  - 17  -  CHAPTER I I  LITERATURE REVIEW  Psychotherapy r e s e a r c h  has  f o r too long assumed t h a t what  the p a r t i c i p a n t s do i n therapy can be adequately p o r t r a y e d broad statements as t o the t h e r a p i s t s ' o r i e n t a t i o n and g e n e r a l nature o f t h e r a p y .  by  the  There i s r e c e n t l y , however, an  i n c r e a s i n g demand w i t h i n the f i e l d f o r g r e a t e r s p e c i f i c a t i o n of treatment  interventions.  A number o f areas r e l a t i n g to s p e c i f i c i n - t h e r a p y o f c l i e n t s and literature:  t h e r a p i s t s are i n c l u d e d  discussion  therapy, the use and  research  of s p l i t s and  SPLITS AND  the  p o l a r i t i e s i n psychoTherapy,  o f empathic r e f l e c t i o n . i n psychotherapy.  In a d d i t i o n , the r o l e o f e x p e r i e n c i n g awareness and  i n t h i s survey o f  o f the two-chair d i a l o g u e i n G e s t a l t  i n the use  behaviours  and  f e e l i n g s o f r e s o l u t i o n are  changes i n  reported  discussed.  POLARITIES IN PSYCHOTHERAPY  Research on the  d i f f e r e n t i a l e f f e c t s of d i f f e r e n t t r e a t -  ments i s needed i n o r d e r t o be able t o s p e c i f y 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 i n d i v i d u a l s (Strupp B e r g i n , 1969).  Greenberg (1975) s t a t e s t h a t the  treatment q u e s t i o n can  and  differential  be even f u r t h e r r e f i n e d and  that  highly  - 18 -  s p e c i f i e d c l i e n t b e h a v i o u r s marking p a r t i c u l a r moments i n p s y c h o t h e r a p y can be used as p r o g n o s t i c i n d i c a t o r s f o r particular interventions.  I f i t can be shown t h r o u g h r e -  s e a r c h t h a t t h e performance o f a p a r t i c u l a r o p e r a t i o n a t a c l e a r l y i d e n t i f i e d moment i n t h e r a p y 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 t h e c l i e n t t h a n does a n o t h e r o p e r a t i o n , t h e a r t of  psychotherapy w i l l become more r i g o r o u s l y e x a c t . The  o b j e c t o f t h i s t h e s i s i s t o compare two t r e a t m e n t s a t a moment i n t h e r a p y l a b e l l e d a " s p l i t " . Greenberg (1979) d e f i n e s t h e s p l i t as a " v e r b a l p e r f o r m ance p a t t e r n i n w h i c h a c l i e n t r e p o r t s a d i v i s i o n o f t h e s e l f p r o c e s s i n t o two p a r t i a l a s p e c t s o f t h e s e l f . . . ." The split  i s i n d i c a t i v e o f fragmentation i n the c l i e n t ' s  function-  ing;  u n t i l t h e i n d i v i d u a l has r e s o l v e d t h e d u a l i t y w i t h i n ,  energy w i l l be i n v e s t e d i n u s 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 t h a n i n p r o d u c t i v e c o m b i n a t i o n 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 , p u r p o r t t h a t psychopathology  i s a consequence o f a d i s c r e p a n c y between  f e e l i n g one t h i n g and d o i n g a n o t h e r .  Change o c c u r s when an  i n d i v i d u a l encompasses b o t h t h e f e e l i n g s and s e n s a t i o n s o f both s i d e s o f a s p l i t and b r i n g s t h e s e i n t o c o n t a c t w i t h one another.  G r i n d e r and B a n d l e r (1976) o f f e r a s i m i l a r v i s i o n  of t h e s p l i t , a l t h o u g h t h e i r frame o f r e f e r e n c e i s n o t exc l u s i v e l y t h a t o f G e s t a l t t h e r a p y , but a b r o a d e r n e u r o l i n g u i s t i c  -  approach.  19 -  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 a r e r e -  v e a l e d by i n c o n g r u i t i e s i n p a r a 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 t h e message b e i n g sent v e r b a l l y . Zinker  (1977) i n t e r p r e t s t h e 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 , p r e v e n t i n g  t h e i n d i v i d u a l from u t i l i z -  ing  his or her f u l l potential i ndealing with a s i t u a t i o n . When brought i n t o awareness w i t h c l a r i t y , c o n f l i c t s t e n d t o a l l o w t h e person t h e sense o f 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 a t t h e l e v e l o f 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 — b e h a v i o r which i s h i g h l y a d a p t i v e because i t spans t h e f u l l range o f r e s p o n s e s between f o r m e r l y exp e r i e n c e d p o l a r extremes (p. 1 9 6 ) .  Baumgardner (1975) a l s o h o l d s t h i s view, o f t h e p e r s o n as d i v i d e d between two extremes o f a continuum, but w i t h no c e n t e r . She  r e f e r s t o t h i s s t a t e as o f h a v i n g a " h o l e " i n t h e p e r s o n -  ality. Latner  (1972) s t a t e s t h a t p o l a r i t i e s a r e a n e c e s s a r y  f e a t u r e o f human f u n c t i o n i n g and t h a t t h e i r i n t e r a c t i o n f u n c t i o n s as a d i a l e c t i c a l  process.  The o p p o s i t e s 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 t h e poles i n a f i g u r e that i s g r e a t e r than t h e combination o f t h e opposites — i t i s a new c r e a t i o n (p. 4 3 ) .  I t seems c l e a r , in.view o f the number of r e f e r e n c e s t o 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 , t h a t t h e i r i n therapy m e r i t s a t t e n t i o n .  occurrence  I t would be d e s i r a b l e f o r t h e  t h e r a p i s t to both r e c o g n i z e the advent o f a s p l i t  i n therapy  and t o be able t o e f f e c t i v e l y i n t e r v e n e at t h i s moment i n therapy i n such a way and h e l p r e s o l v e the THE  as t o make a d i f f e r e n c e f o r the  client  split.  USE OF GESTALT TWO-CHAIR DIALOGUE IN GESTALT THERAPY Greenberg  (1975) found t h a t G e s t a l t two-chair r o l e - p l a y ,  when used at a s p l i t  i n therapy, r e p e a t e d l y produced  l e v e l s o f e x p e r i e n c i n g than d i d empathic s i n g l e cases.  Greenberg  deeper  r e f l e c t i o n , i n three  and C l a r k e (1979), i n an  analogue  study u s i n g s i x t e e n s u b j e c t s , found t h a t the G e s t a l t t w o - c h a i r d i a l o g u e technique used at a s p l i t ,  l e d t o deeper e x p e r i e n c i n g  and g r e a t e r change i n awareness than d i d empathic Bohart  reflection.  (1977) r e p o r t e d t h a t G e s t a l t two-chair r o l e - p l a y  was  more e f f e c t i v e i n r e d u c i n g anger, h o s t i l e a t t i t u d e s and  be-  h a v i o u r a l a g g r e s s i o n than were i n t e l l e c t u a l a n a l y s i s or  emotion-  a l discharge techniques. the psychodramatic  K i p p e r and G i l a d i  (1978) found t h a t  use o f the t w o - c h a i r method l e d t o an  e q u i v a l e n t r e d u c t i o n o f t e s t a n x i e t y as s y s t e m a t i c d e s e n s i t i z ation  procedures. Most o f the claims i n the f i e l d o f G e s t a l t therapy, how-  ever, are not s u b s t a n t i a t e d by experimental d a t a .  Polster  and  - 21  Polster  '  (1973) presented a comprehensive e x p o s i t i o n o f key  t h e r a p i s t i n t e r v e n t i o n s , d e s c r i b i n g both t h e i r i n t e n t i o n and p r o v i d i n g c l i n i c a l  illustrations.  theoretical Many o t h e r  G e s t a l t t h e r a p i s t s have p r o v i d e d d e s c r i p t i v e analyses o f t h e i r techniques, among them L a t n e r Stephenson (1975).  (1973), Fagan (1975),  and  More r e c e n t l y , c e r t a i n t h e r a p i s t s have  focused t h e i r a t t e n t i o n on the two-chair technique,  and  attempted to e x p l a i n i t s e f f e c t i v e n e s s . Baumgardner (1975) maintains  t h a t the c l i e n t f e e l s more " t o g e t h e r " , i . e . , l e s s  " s p l i t " when g i v e n the o p p o r t u n i t y , i n the two-chair e x e r c i s e , to hear each s i d e .  G r i n d e r and Bandler b e l i e v e t h a t the  engaged i n a two-chair d i a l o g u e expresses the s e l f s e q u e n t i a l l y r a t h e r than  client  incongruence  simultaneously.  I n other words, the c l i e n t has changed from a confused, s e l f - i n t e r r u p t i n g , t o r t u r e d , incongruent human being i n t o one who can express h i m s e l f f o r c e f u l l y and congruently at each p o i n t i n time (1976, p. 77). I t would appear t h e r e f o r e t h a t G e s t a l t two-chair  role-play  i s i n s t r u m e n t a l i n e n a b l i n g the c l i e n t to g a i n awareness o f the s t r u g g l e going on w i t h i n , between two self.  d i s t i n c t p a r t s o f the  F o l l o w i n g awareness, the c l i e n t becomes capable o f a  g r e a t e r range of a l t e r n a t i v e s f o r change (Greenberg, Yontef,  1976).  1979;  - 22  RESEARCH ON EMPATHY AND  -  EMPATHIC REFLECTION IN THERAPY  S i n c e Rogers (1957) suggested  empathy as one o f the core  c o n d i t i o n s which were n e c e s s a r y and s u f f i c i e n t - f o r t h e r a p e u t i c p e r s o n a l i t y change, many r e s e a r c h s t u d i e s have c o n c e n t r a t e d on r e s e a r c h i n g t h i s c l a i m . t h i s study are C a r k h u f f  Among the ones more r e l e v a n t t o  (1969) who  suggests t h a t , to be min-  i m a l l y f a c i l i t a t i v e , the t h e r a p i s t must f u n c t i o n a t l e v e l and above on h i s 5-point accurate empathy s t u d i e s l e n d credence  scale.  3.0  Several  t o t h i s a f f i r m a t i o n , i n t h a t they r e p o r t  a c o r r e l a t i o n between h i g h e r l e v e l s o f empathy, as measured by the Carkhuff and Truax s c a l e , and p o s i t i v e c l i e n t outcome (Altman,  1973;  Grummon, 1972;  Bozarth and Rubin,  i n press;  Mullen and Abeles, 1971;  and W i t t n e r , 1971;  and Truax,  Kurtz  Truax,  et a l . , 1971).  (1977), however, i n an e x t e n s i v e review o f the  and'  1970;  Truax  M i t c h e l l , et a l . literature  p u b l i s h e d t o date on the i s s u e o f the r e l a t i o n s h i p o f i n t e r p e r s o n a l s k i l l s t o c l i e n t outcome, demonstrate the i n c o n c l u s i v e ness o f these f i n d i n g s and suggest t h a t : . . . many e a r l i e r c o n c l u s i o n s concerning c l i e n t p e r c e i v e d t h e r a p i s t dimensions need r e f o r m u l a t i o n , t h a t some q u a l i f i c a t i o n i s necessary and t h a t much of the e a r l i e r and more r e c e n t data, when taken t o g e t h e r prove t o be s u r p r i s i n g l y i n c o n c l u s i v e w i t h r e s p e c t t o a number of i s s u e s . By the same token, we f e e l t h a t none o f the previous c o n c l u s i o n s need to be d i s c a r d e d completely (p. 498).  - 23 However, t h e y do p o i n t out a l s o t h a t t h e " h i g h group" mean scores  among p s y c h o t h e r a p i s t s  and c o 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 s u r p a s s e d 2.0 on t h e G a r k h u f f and T r u a x s c a l e s , s u g g e s t i n g t h a t t h e i n c o n c l u s i v e r e s u l t s may have been due t o l o w l e v e l s o f empathy. B e r g i n and S u i n n  (1975) i n a r e v i e w o f t h e r e s e a r c h  e r a t u r e up u n t i l t h a t t i m e , n o t e d t h a t t h e o r i g i n a l  lit-  claims  t h a t t h e "core c o n d i t i o n s " were t h e b a s i c i n g r e d i e n t s o f good t h e r a p y p r o b a b l y does not h o l d f o r a l l approaches and s h o u l d not be g e n e r a l i z e d as n e c e s s a r y and s u f f i c i e n t c o n d i t i o n s beyond t h e 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 a n e x t e n s i v e r e v i e w o f i n t e r personal s k i l l s research years o f research,  concluded t h a t notwithstanding  twenty  o n l y a modest r e l a t i o n s h i p has been found  between t h e r a p y outcome and t h e c o r e c o n d i t i o n s o f a c c u r a t e empathy, n o n p o s s e s s i v e warmth and g e n u i n e n e s s . T h i s r e - e v a l u a t i o n c o n c e r n i n g t h e core c o n d i t i o n s w h i c h has been t a k i n g p l a c e i n t h e l a s t decade has g i v e n b i r t h t o a new attempt a t c o n c e p t u a l i z i n g some g e n e r a l 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 ( S t r u p p , 1973). i n g out o f psychoanalytic  terminology  A new concept a r i s -  but not c o n f i n e d t o a  dynamic framework, r e f e r r e d t o as t h e t h e r a p e u t i c o r w o r k i n g a l l i a n c e has g e n e r a t e d much i n t e r e s t . and r e s e a r c h e r s  A number o f t h e o r i s t s  have argued f o r t h e n o t i o n t h a t by t h e t h i r d  - 24 -  to f i f t h formed  s e s s i o n o f therapy an a l l i a n c e o f some s o r t has been  between c l i e n t and t h e r a p i s t t h a t w i l l be p r e d i c t i v e of  outcome (LpBorsky, 1976; Saltzman,  H a r t l e y , 1978;  et a l . (1976) showed t h a t by the t h i r d s e s s i o n c l i e n t  statements o f p e r c e i v e d understanding and uniqueness p o s i t i v e outcome.  predicted  I t has a l s o been suggested t h a t the B a r r e t t -  Lennard r e l a t i o n s h i p i n v e n t o r y ,  which has been h i g h l y pre-  d i c t i v e o f outcome (Gurman, 1977),  can be used to measure the  q u a l i t y of the r e l a t i o n s h i p o r the a l l i a n c e as p e r c e i v e d the c l i e n t  U /  Horvath, 1979).  (Greenberg and C l a r k e , 1979;  by  Gurman, 1977).  AWARENESS; I n G e s t a l t therapy, the concept o f awareness i s the s i n e qua non o f change.  Perls  (1969) s t a t e s :  . . . and I b e l i e v e that t h i s i s the g r e a t t h i n g t o understand — (that awareness per se by and o f i t s e l f — can be c u r a t i v e ) . Because w i t h f u l l awareness you become aware o f 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 t a k e over without i n t e r f e r i n g , without i n t e r r u p t i n g ; we can r e l y on the wisdom o f the organism . . . . (pp. 16-17). P e r l s s t a t e s f u r t h e r (1973) t h a t i f people can become t r u l y \ aware o f themselves they can see how sonal d i f f i c u l t i e s ,  they are producing per-  can r e c o g n i z e what the d i f f i c u l t i e s are  and can s o l v e them i n the here-and-now.  no 1  )  - 25 -  Awareness t r a n s c e n d s mere s e n s o r i a l o r c o g n i t i v e d a t a p r o c e s s i n g and i s c o n c e i v e d o f as a feedback i n t e r n a l organism  l o o p between t h e  and t h e o u t s i d e w o r l d (Kempler,  1973).  D y s f u n c t i o n o c c u r s when a person becomes " s t u c k " i n one o f t h e s e r e a l m s , and feedback restricts  i s blocked.  Lack o f awareness  t h e organism's e x p e r i e n c i n g and emerging g e s t a l t e n  become f u r t h e r b l o c k e d ( 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 t h e "here-and-now", and f r e e s t h e i n d i v i d u a l t o r e c o g n i z e unmet needs.  Yontef  (1976) main-  t a i n s t h a t o n l y an aware g e s t a l t l e a d s t o change, and Passons (1975) s t a t e s t h a t : . . . awareness must not o n l y be p r e s e n t t o c l a r i f y t h e emergent need which dominates t h e moment, b u t i t must a l s o be a v a i l a b l e t o t h e p r o b l e m - s o l v i n g . . . p r o c e s s e s r e q u i r e d t o meet the need (p. 2 1 ) . Greenberg and C l a r k e (197#) found t h a t i n c r e a s e d awareness as w e l l as deep l e v e l s o f e x p e r i e n c i n g o c c u r r e d i n t h e G e s t a l t t w o - c h a i r d i a l o g u e , i n a t h e r a p y analogue.  This  s t u d y sought t o d i s c o v e r whether t h e t w o - c h a i r d i a l o g u e 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 t h e r a p y , and whether i t would f a c i l i t a t e human b e h a v i o u r a l 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 t h e T r u a x - G a r k h u f f s c a l e s have f a i l e d t o y i e l d t h e hoped f o r r e s u l t s across t h e r a p i e s .  T h i s has r e s u l t e d i n new e f f o r t s  a t 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 t h e need f o r more r e s e a r c h on s p e c i f y i n g what works i n t h e r a p y .  There i s some e v i d e n c e t o s u p p o r t t h e  u s e f u l n e s s o f empathic r e f l e c t i o n as a method and i t i s t h e method o f empathic r e f l e c t i o n t h a t w i l l be u s e d i n t h e p r e s e n t thesis-.  The G e s t a l t t w o - c h a i r  d i a l o g u e used a t a s p l i t  will  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 p r o c e s s and s e s s i o n outcome w i t h t h e use o f empathic r e f l e c t i o n a t s p l i t . These two t h e r a p i s t o p e r a t i o n s w i l l be a d m i n i s t e r e d  a f t e r the  f o u r t h s e s s i o n o f psychotherapy f o l l o w i n g t h e c o n f i r m a t i o n o f t h e f o r m a t i o n o f a s a t i s f a c t o r y t h e r a p e u t i c a l l i a n c e as 1  measured by the.  Barrett-Lennard-Relationship'Inventory.  - 27 -  CHAPTER I I I  METHODOLOGY  T h i s c h a p t e r w i l l p r e s e n t t h e i n s t r u m e n t s used i n t h e s t u d y and b r i e f l y d i s c u s s t h e i r c o m p o s i t i o n and r e l i a b i l i t y . The d e s i g n , p o p u l a t i o n , s a m p l i n g , d a t a c o l l e c t i o n and s c o r i n g procedure w i l l t h e n be d e s c r i b e d and t h e 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 , t h e s t a t i s t i c a l  a n a l y s i s and  s o u r c e s o f v a r i a n c e w i l l be d e l i n e a t e d .  INSTRUMENTS The i n s t r u m e n t s u s e d i n t h i s s t u d y s e r v e d t h r e e p u r p o s e s : to  d e s c r i b e t h e s u b j e c t s , t o measure t h e dependent v a r i a b l e s ,  and t o g a i n 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 Q u e s t i o n n a i r e I n o r d e r t o d e s c r i b e s u b j e c t s more f u l l y ,  (16-PF)  the Sixteen  P e r s o n a l i t y F a c t o r Q u e s t i o n n a i r e ( C a t t e l l , e t a l . , 1970) was administered t o a l l c l i e n t s before the f i r s t session.  experimental  The 16-PF i s an o b j e c t i v e l y s c o r e a b l e p e r s o n a l i t y  measure, w h i c h d e s c r i b e s t h e s u b j e c t a c c o r d i n g t o s i x t e e n p r i m a r y p e r s o n a l i t y f a c t o r s , a l o n g w i t h f o u r second o r d e r factors  (see Appendix A ) . F a c t o r s :  G:  Expedient/Conscientions,  - 2a Q^:  and Q3:  Conservative/Experimenting,  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 t o d e s c r i b e the s u b j e c t s used i n t h i s study.  These f a c t o r s r e s t w i t h i n the context o f a  g e n e r a l theory o f p e r s o n a l i t y and are based on a p o p u l a t i o n o f normal and  c l i n i c a l subjects.  Form A, a p e n c i l and  t e s t d e v i s e d f o r l i t e r a t e i n d i v i d u a l s with h i g h s c h o o l i o n , was  used i n t h i s  f o r each source t r a i t and  to  have been ex-  T e s t - r e t e s t r e l i a b i l i t y are .58 t o on the t e s t , with a 2 t o 7 day  .36 t o .88 with a 2 to 48 month i n t e r v a l .  i e s range from .44 t o  educat-  research.  The v a l i d i t y and r e l i a b i l i t y o f the 16-PF t e n s i v e l y researched.  paper  .92,  and  .92  interval  Direct v a l i d i t -  i n d i r e c t v a l i d i t i e s , from  .63  .96. A more comprehensive review o f the 16-PF  the Handbook f o r the 16-PF 2.  is available i n  ( C a t t e l l , et a l . , 1970).  The  Barrett-Lennard Relationship  The  Barrett-Lennard  Inventory  R e l a t i o n s h i p Inventory measures the  c l i e n t ' s p e r c e p t i o n o f the c o u n s e l l o r ' s warmth, congruence, empathy and p o s i t i v e r e g a r d . the s i x t e e n items items and 59  1, 5,  9, 13,  For the purposes o f t h i s  research,  c o n s t i t u t i n g t h e empathy s u b - s c a l e were used: 17,  21, 25,  (see Appendix B).  29, 33, 37, 41, 45,  49,  53,  57,  - 29 -  Numerous s t u d i e s have r e p o r t e d r e s u l t s i n w h i c h an empathic understanding  measure, based on c l i e n t p e r c e p t i o n s , 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 o f outcome, and t h e B a r r e t t - L e n n a r d R e l a t i o n s h i p I n v e n t o r y has been f o u n d t o be more s t r o n g l y p r e d i c t i v e t h a n o t h e r such measures ( B a r r e t t L e n n a r d , 1974).  T h i s measure determines t h e c l i e n t ' s  percept-  i o n o f c o u n s e l l o r empathy, r a t h e r t h a n t h e c o u n s e l l o r ' s e f f e c t i v e use o f empathic r e f l e c t i o n , w h i c h i s but one means o f exp r e s s i n g empathic u n d e r s t a n d i n g  and b u i l d i n g a w o r k i n g 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 r e s e a r c h were cons i d e r e d t o be summated s c a l e s , i . e . , s c a l e s n o t 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 o r i n t e r v a l , but o c c u p y i n g  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 1975)•  (Gardner,  The E x p e r i e n c i n g S c a l e and t h e T a r g e t C o m p l a i n t s Box  S c a l e 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 p r e v i o u s ( K l e i n , et a l . , 1969; ment on t h e r e m a i n i n g  B a t t l e , e t a l . , 1966).  research  U n i t s o f measure-  dependent v a r i a b l e s ( s h i f t o f awareness  q u e s t i o n s , 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 p r o g r e s s q u e s t i o n s and t a r g e t b e h a v i o u r  q u e s t i o n s ) were e q u a l o v e r t h e  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 .  D e v i a t i o n s from i n t e r -  v a l p r o p e r t i e s were not c o n s i d e r e d t o be extreme.  The d a t a  were t h e r e f o r e c o n s i d e r e d a p p r o p r i a t e f o r a n a l y s i s u s i n g m e t r i c s t a t i s t i c s (Gardner,  1975).  para-  - 30 -  1.  The E x p e r i e n c i n g  Scale  The E x p e r i e n c i n g S c a l e ( K l e i n , et a l . , 1969)  was  used t o  measure the dependent v a r i a b l e , Depth of E x p e r i e n c i n g . s c a l e was  developed  involvement  This  to e v a l u a t e the q u a l i t y o f a p a t i e n t ' s s e l f  i n psychotherapy, d i r e c t l y from tape r e c o r d i n g s o r  t a p e - s c r i p t s of the same s e s s i o n . The  s c a l e i s a seven-point  s h i f t s i n c l i e n t involvement  r a t i n g d e v i c e , s e n s i t i v e to  i n therapy.  The  lowest  l e v e l s of  the s c a l e r a t e s u p e r f i c i a l c l i e n t d i s c o u r s e , the c e n t r a l  levels  mark simple d e s c r i p t i o n s o f f e e l i n g s whereas h i g h l e v e l s  of  e x p e r i e n c i n g i n d i c a t e e x p l o r a t i o n o f f e e l i n g s t h a t may problem s o l v i n g and  l e a d to  s e l f - u n d e r s t a n d i n g (see Appendix C ) .  S e v e r a l s t u d i e s have used the E x p e r i e n c i n g S c a l e and have determined i n t e r r a t e r r e l i a b i l i t y . was  used to determine r e l i a b i l i t y  ratings  E b e l s i n t r a - c l a s s method o f the means o f the  judges'  ( r ^ j and an estimate o f the average i n t e r c o r r e l a t i o n  of a l l p o s s i b l e judge p a i r s ( r ^ ) . The r v a l u e s obtained i n the v a r i o u s s t u d i e s have ranged from 0.44 crucial r ^ 1969,  p.  c o e f f i c i e n t s v a r y from 0.?6  to 0.67,  to 0.91  while  the  ( K l e i n , et a l . ,  45).  Audio-tape r e c o r d i n g s o f a l l s e s s i o n s were made, and sequently d i v i d e d i n t o four-minute  segments.  of t h e randomized segments were then submitted  sub-  Tape r e c o r d i n g s to two  independ-  ent r a t e r s f o r r a t i n g a c c o r d i n g to the E x p e r i e n c i n g S c a l e .  - 31 -  2.  T a r g e t Complaint  Box S c a l e  T h i s measure was d e s i g n e d by B a t t l e , e t a l (1966) t o det e r m i n e t h e degree o f d i s c o m f o r t o f d i s t u r b e d p a t i e n t s b e f o r e and a f t e r p s y c h o t h e r a p y .  P a t i e n t s were asked t o s t a t e , and  t h e n rank t h e i r problems, and asked t o r a t e t h e i r d i s c o m f o r t 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 a t a l l " were p r i n t e d b e s i d e t h e bottom box; l i t t l e " by t h e s e v e n t h box;  "a  " v e r y much" by t h e t e n t h box; and  " c o u l d n ' t be worse" by t h e t o p box.  P a t i e n t s were asked t o  r a t e t h e i r d i s c o m f o r t both b e f o r e and a f t e r i n t e r v i e w s .  The  s c o r e s were a n a l y z e d and compared w i t h t h e r e s u l t s o f t h e t h r e e o t h e r outcome measures: a)  P a t i e n t ' s r a t i n g o f o v e r a l l improvement;  b)  Therapist's rating of patient's over-all improvement; and  c)  Social Ineffectiveness Scale. '  B a t t l e , e t a l . (1966) found t h a t t h e t a r g e t c o m p l a i n t s s c o r e s c o r r e l a t e d t o a s i g n i f i c a n t degree w i t h these t h r e e o t h e r outcome measures, w h i c h p r o v i d e s evidence f o r i t s v a l i d ity. 2;  The T a r g e t Complaint E , : q u e s t i o n 3;  Box S c a l e (see Appendices D, q u e s t i o n  and G, q u e s t i o n 2) was a d m i n i s t e r e d immed-  i a t e l y b e f o r e and i m m e d i a t e l y a f t e r t h e r a p y and one week a f t e r t h e r a p y i n t h e p r e s e n t s t u d y t o h e l p determine  therapy  effect-  iveness i n reducing d i s t r e s s associated with the c o u n s e l l i n g issue.  - 32  3.  Awareness  -  Question  T h i s measure c o n s i s t s o f two  q u e s t i o n s t h a t were ad-  m i n i s t e r e d t o the s u b j e c t s on a q u e s t i o n n a i r e completed t h r e e hours a f t e r t h e r a p y  (see Appendix F, q u e s t i o n 1 ) .  The  first  q u e s t i o n 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 o c c u r r e d ;  t h e second, whether c l i e n t s  o b t a i n e d an i n c r e a s e d awareness o f t h e m s e l v e s . s c a l e was  had  A five-point  u s e d t o r a t e both q u e s t i o n s , and t h e s c o r e s 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 R e d u c t i o n Box T h i s measure was  project.  Scale  c r e a t e d f o r t h e purposes o f t h i s  research  I t c o n s i s t s o f a s e v e n - p o i n t 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 o f r e s o l u t i o n r e g a r d i n g the i s s u e t h a t t h e y f o c u s e d on d u r i n g t h e r a p y .  Box one i s l a b e l e d  "not a t 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, q u e s t i o n 4;  G,  question 3).  The  ered immediately  c o n f l i c t r e d u c t i o n box s c a l e was a f t e r and one week a f t e r t h e  administ-  experimental  session. Face v a l i d i t y o f the i n s t r u m e n t was experts.  confirmed  by  two  - 33 -  5.  Behaviour Change Three hours a f t e r the t h e r a p y s e s s i o n , s u b j e c t s were ask-  ed t o s p e c i f y o v e r t or c o v e r t t a r g e t behaviours on a t a r g e t behaviour s c a l e .  These behaviours were i d e n t i f i e d as behav-  i o r s they hoped t o change as a f u n c t i o n o f the therapy hour (see  Appendix F, q u e s t i o n 3 ) .  They estimated the present f r e -  quency o f the t a r g e t behaviours and one week a f t e r the e x p e r i mental s e s s i o n , c l i e n t s a g a i n r e p o r t e d the a c t u a l frequency o f the t a r g e t behaviour.  They f u r t h e r r e p o r t e d any occurrence  o t h e r than the c o u n s e l l i n g hour which they f e l t might have c o n t r i b u t e d t o the b e h a v i o u r a l change they had r e p o r t e d . 6.  Reports o f Change and Progress One week a f t e r t h e experimental s e s s i o n , c l i e n t s were ask-  ed t o s t a t e how much progress they f e l t they had made i n d e a l ing  with t h e i r i s s u e , and how much they had changed s i n c e t h e  c o u n s e l l i n g hour.  Each o f t h e s e questions (see Appendix G,  questions 4 and 6) were measured on a f i v e - p o i n t r a t i n g s c a l e , w i t h d e s c r i p t o r s a t each p o i n t and the scores were combined to  form one dependent v a r i a b l e on r e p o r t e d p r o g r e s s .  Client 1.  Information  Semantic D i f f e r e n t i a l S c a l e T h i s measure i s d e s c r i b e d by Warr and Knapper (1968) as a  semantic t o o l f o r use i n psychotherapy.  I t c o n s i s t s o f a number  - 34  -  o f p a i r s o f a d j e c t i v e s , s e p a r a t e d by a s e v e n - p o i n t s c a l e , and d e f i n e d 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 t h e semantic  space.  Three such p a i r s were used i n t h e p r e s e n t s t u d y (see Appendices D, q u e s t i o n 1;  and E, q u e s t i o n 1 ) . The s u b j e c t s r e p o r t e d on  g e n e r a l f e e l i n g s o f 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 b e f o r e and i m m e d i a t e l y f o l l o w i n g t h e e x p e r i m e n t a l s e s s i o n , i n o r d e r t o examine whether t h e r a p y would produce change a l o n g t h e s e dimensions. 2.  Perceived Understanding Immediately a f t e r t h e hour, s u b j e c t s s t a t e d on t h e quest-  i o n n a i r e (see Appendix E, q u e s t i o n s 6 and 7) whether t h e y p e r c e i v e d t h e t h e r a p i s t as h a v i n g been u n d e r s t a n d i n g 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 o r s a t each l e v e l .  T h i s measure was i n c l u d e d t o i n s u r e t h a t  no s p e c i a l o c c u r r e n c e d u r i n g t h e t h e r a p y hour might have i n f l u e n c e d t h e c l i e n t ' s p e r c e p t i o n o f t h e t h e r a p i s t s i n c e admini 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 t h e e x p e r i m e n t a l s e s s i o n , s u b j e c t s were asked t o d e s c r i b e any u n u s u a l o c c u r r e n c e t h a t might have happened d u r i n g t h e week, o t h e r t h a n t h e t h e r a p e u t i c hour, t o which t h e y might a t t r i b u t e any change i n t h e i r b e h a v i o u r (see Appendix  - 35  G,  question 7 ) .  -  This enabled s u b j e c t s t o r e p o r t l i f e events  w h i c h might have been more r e s p o n s i b l e t h a n t h e c o u n s e l l i n g hour f o r b e h a v i o u r change. DESIGN A group o f s i x t e e n s u b j e c t s was  used i n t h i s  w i t h each s u b j e c t r e c e i v i n g both t r e a t m e n t s . as t h e i r own  research,  Subjects  c o n t r o l s i n order to h e l p minimize the e f f e c t  s u b j e c t d i f f e r e n c e s (Gay,  1976).  the f i r s t e x p e r i m e n t a l ceive G e s t a l t two-chair  for  session.  s e s s i o n and  during  e i g h t were s e l e c t e d t o r e -  dialogue at a ' s p l i t ' The  of  E i g h t c l i e n t s were randomly  s e l e c t e d t o r e c e i v e empathic r e f l e c t i o n a t a ' s p l i t '  experimental  served  during the  f o l l o w i n g s e s s i o n was  not  first  considered  the purposes o f t h i s s t u d y i n o r d e r t o i n s u r e g r e a t e r i n -  dependence o f t h e two t r e a t m e n t s i t u a t i o n s .  C o u n s e l l o r s were  i n s t r u c t e d not t o r e s p o n d a c t i v e l y t o a s p l i t d u r i n g t h i s i n tervening session. technique  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  at the next experimental  session.  This  balanced  o r d e r i n g e l i m i n a t e d b i a s i n the dependent v a r i a b l e s w h i c h c o u l d be a t t r i b u t e d t o t h e o r d e r o f t r e a t m e n t p r e s e n t a t i o n . Measures were t a k e n b e f o r e , d u r i n g , i m m e d i a t e l y a f t e r , hours a f t e r , and one week a f t e r t h e e x p e r i m e n t a l A 2 x 2 f a c t o r i a l design with repeated for  three  sessions.  measures was  the p r o c e s s d a t a and f o r t h e r e p o r t s on awareness,  used and  - 36 -  change and p r o g r e s s .  There were two l e v e l s o f f i x e d f a c t o r A,  t r e a t m e n t , 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 d e s i g n w i t h r e p e a t e d measures on two f a c t o r s was used on t h e r e m a i n i n g s e s s i o n r e p o r t measures: 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 b e h a v i o u r The two f a c t o r s —  change.  t r e a t m e n t and t h e r a p i s t e x p e r i e n c e —  were  t h e same as i n t h e p r e v i o u s d e s i g n and t h e t h i r d f a c t o r r represented occasions o f the report —  before,  immediately  a f t e r , t h r e e hours a f t e r , and one week a f t e r t r e a t m e n t .  The  f a c t o r i a l d e s i g n f o r t h i s s t u d y i s r e p r e s e n t e d i n F i g u r e 1.  THERAPEUTIC EMPATHIC REFLECTION n  Therapist  l' 2' n  INTERVENTION GESTALT TWO-CHAIR DIALOGUE  * ' *  n  8  n  l» 2> n  * ' •  n  #  High  Experience Level  F i g u r e 1:  °9' 1 0 ' ' * * l 6 n  Low  F a c t o r i a l Design  n  V  n  dis-  10' * * ' i 6 n  - 37 -  POPULATION The s u b j e c t s f o r t h i s s t u d y c o n s i s t e d o f c l i e n t s engaged i n t h e r a p y a t v a r i o u s c o u n s e l l i n g , f a c i l i t i e s i n t h e Vancouver, B r i t i s h Columbia a r e a :  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 c e n t e r , a c o l l e g e c o u n s e l l i n g c e n t e r , a women's c e n t e r , and a d i v o r c e c o u n s e l l i n g c e n t e r .  F i f t e e n counsellors  were asked t o p a r t i c i p a t e i n t h e s t u d y , on a v o l u n t a r y o f w h i c h t e n were f i n a l l y used.  resources  The s u b j e c t s were  from v a r i o u s o u t p a t i e n t f a c i l i t i e s and a r e b r o a d l y  basis,  obtained represent-  a t i v e o f a p o p u l a t i o n 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 psychological d i f f i c u l t i e s .  The r e s u l t s o f t h i s s t u d y can  t h e r e f o r e be g e n e r a l i z e d t o a p o p u l a t i o n o f people d e a l i n g w i t h problems i n l i v i n g , e.g., e x p e r i e n c i n g psychic d i f f i c u l t i e s  relationship or intra-  (Gurney and S t o l l a c k , 1965).  Because o f  d i f f e r e n c e s i n r e a c t i o n s t o t h e r a p y between " n e u r o t i c " and " p s y c h o t i c " p a t i e n t s ( K i e s l e r , 1971), t h e s e r e s u l t s w i l l n o t a p p l y t o an e x t r e m e l y 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 t h e s t u d y f o c u s e d  on i n t e r p e r s o n a l communication i n t h e r a p y .  They were a l s o t o l d  t h a t a l l s e s s i o n s would be audio t a p e r e c o r d e d , t h a t some would be l i s t e n e d t o by e x t e r n a l c o u n s e l l o r s , and t h a t t h e y would be asked t o f i l l o u t e i g h t q u e s t i o n n a i r e s  regarding  t h e r a p y , as w e l l as one paper and p e n c i l q u e s t i o n n a i r e  and one  - 38 -  r e l a t i o n s h i p inventory.  They were i n s u r e d o f  confidentiality  and s i g n e d a form s t a t i n g t h a t they agreed t o p a r t i c i p a t e i n the study, without  but were f r e e to withdraw from the  p e n a l t y , i f they so wished.  p a r t i c i p a t e i n the  One  experiment,  subject refused to  study.  A f t e r the second s e s s i o n , c l i e n t s completed the 16-PF. A l l s u b j e c t s i n t h i s experiment scored below s t e n 6 on G:  Expedient  Conservative Q^:  Factor  v s . Goncientious;  above s t e n 3 on F a c t o r Q-j_:  v s . Experimenting;  and below s t e n 7 of F a c t o r  Undisciplined S e l f - C o n f l i c t vs. Controlled.  The  subjects  could t h e r e f o r e be c h a r a c t e r i z e d a c c o r d i n g t o the 16-PF, as not o v e r l y c o n s c i e n t i o u s , i . e . , not having s t r e n g t h , experimenting,  s t r o n g e r superego  i . e . , i n q u i r i n g regarding o l d or  ideas and t o l e r a n t o f inconvenience c o n t r o l l e d , i . e . , not having  and  new  change, and not o v e r l y  s t r o n g c o n t r o l over t h e i r emotions.  A f t e r the t h i r d s e s s i o n , s u b j e c t s completed the B a r r e t t Lennard R e l a t i o n s h i p Inventory.  The  experimental  hours a l l  o c c u r r e d between the f i f t h and the n i n t h s e s s i o n . Subjects ranged i n age from 20 t o 46 5.89).  Two  (mean 29.5,  s.d.  s u b j e c t s were male, f o u r t e e n were female.  Three  s u b j e c t s were students, t h r e e were c o u n s e l l o r s , t h r e e were unemployed, two were one  were t e a c h e r s , two  were homemakers, and  of each o f the f o l l o w i n g :  care c o u n s e l l o r , and a  salesperson.  there  microbiologist, child  -  39  -  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 , e i g h t women and two men, t h i s study.  Low  were used i n  e x p e r i e n c e t h e r a p i s t s had a t l e a s t f i f t y h o u r s  o f t r a i n i n g i n the G e s t a l t t w o - c h a i r d i a l o g u e t e c h n i q u e ,  con-  s i s t i n g o f twenty weekly t h r e e - h o u r s e s s i o n s , d u r i n g which e x p l a n a t i o n s and examples o f t h e f i v e p r i n c i p l e s o f G e s t a l t t w o - c h a i r d i a l o g u e were g i v e n , as r e p o r t e d i n Chapter this thesis.  I n t h e course o f t h i s t r a i n i n g ,  I of  participants  a c t e d 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 intervention.  and d i s c u s s i o n o f t h e t h e r a p e u t i c  More i n f o r m a t i o n about t h e t r a i n i n g can  o b t a i n e d i n a paper by Greenberg ( i n p r e s s ) .  be  The s i x "low  e x p e r i e n c e d " t h e r a p i s t s had from one t o t h r e e months*  exper-  i e n c e i n the use o f t h e t e c h n i q u e , f o l l o w i n g t r a i n i n g . Four o f t h e t h e r a p i s t s had a t l e a s t 100 hours o f t r a i n i n g e x p e r i e n c e and two o r more y e a r s o f c l i n i c a l e x p e r i e n c e w i t h the technique.  These f o u r c o n s t i t u t e d t h e  "high-experience"  group. A l l t h e t h e r a p i s t s had a minimum o f 100 hours o f t r a i n i n g and s u p e r v i s e d p r a c t i c e i n empathic r e f l e c t i o n and t h e use i n t e r p e r s o n a l s k i l l s and had w o r k i n g e x p e r i e n c e u s i n g t h e s e s k i l l s r a n g i n g from two t o seven y e a r s .  of  - 40  -  Three o f t h e e x p e r i e n c e d t h e r a p i s t s ' p r o f e s s e d 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  t h e C a r k h u f f model.  p r o f e s s e d o r i e n t a t i o n was  A l l of the inexperienced t h e r a p i s t s ' t h e C a r k h u f f model.  T h e r a p i s t s were randomly a s s i g n e d a t r e a t m e n t  sequence  i n s u r i n g t h a t h a l f o f t h e s u b j e c t s would r e c e i v e empathic r e f l e c t i o n i n t h e f i r s t e x p e r i m e n t a l s e s s i o n and t h e r e m a i n i n g h a l f would r e c e i v e G e s t a l t t w o - c h a i r d i a l o g u e f i r s t .  Therap-  i s t s were t o l d t o use both t e c h n i q u e s w i t h c l i e n t s b e f o r e , but not i m m e d i a t e l y p r e c e d i n g t h e e x p e r i m e n t a l s e s s i o n s , i n o r d e r to avoid a novelty e f f e c t during the experimental s e s s i o n 1976).  (Gay,  T h e r a p i s t s were a l s o t o l d t o d i s p l a c e t h e e x p e r i m e n t a l  s e s s i o n t o t h e subsequent meeting i f a s p l i t d i d not  occur  d u r i n g t h e chosen t h e r a p y h o u r , o r i f t h e c l i e n t p r e s e n t e d  a  c r i s i s that required specific alternate attention. RATERS Empathic r e f l e c t i o n was r a t e d on t h e C a r k h u f f s c a l e by two g r a d u a t e s t u d e n t s i n a c o u n s e l l i n g p s y c h o l o g y programme. Both had a p p r o x i m a t e l y f o r t y - f i v e h o u r s ' e x p e r i e n c e i n t h e use o f t h e s c a l e . The G e s t a l t t w o - c h a i r d i a l o g u e o p e r a t i o n was  r a t e d as  o c c u r r i n g o r not o c c u r r i n g , a c c o r d i n g t o t h e c r i t e r i a  pre-  s e n t e d i n Chapter I , by two g r a d u a t e s t u d e n t s w i t h s i x t y hours' t r a i n i n g i n t h e use o f t h e o p e r a t i o n .  - 41 -  The E x p e r i e n c i n g S c a l e r a t i n g was performed  by two  graduate s t u d e n t s i n a c o u n s e l l i n g p s y c h o l o g y programme. They r e c e i v e d a p p r o x i m a t e l y 48 hours o f t r a i n i n g and p r a c t i c e , a c c o r d i n g t o t h e procedures  d e s c r i b e d i n The E x p e r i e n c i n g  S c a l e , T r a i n i n g Manual ( K l e i n , et a l . , 1969), p l u s some a d d i t i o n a l t r a i n i n g on t w o - c h a i r d i a l o g u e m a t e r i a l which had been r a t e d by t h e a u t h o r o f t h e E x p e r i e n c i n g S c a l e . r a t e r s were f a m i l i a r w i t h t h e empathic r e f l e c t i o n  These  technique  and t h e G e s t a l t t w o - c h a i r 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 o f t h e e x p e r i m e n t a l  hypotheses.  DATA COLLECTION C l i e n t s completed t h e S i x t e e n P e r s o n a l i t y F a c t o r Q u e s t i o n n a i r e between t h e second and t h i r d s e s s i o n s o f t h e r a p y and t h e 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 session o f 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 t h e f i f t h i n t e r v i e w ) , c l i e n t s  filled  i n t h e t a r g e t c o m p l a i n t s box s c a l e r e l a t i n g t o t h e i s s u e t h a t they intended t o deal with during therapy. D u r i n g t h e 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 p r e s e n t e d a s p l i t w i t h t h e p r e - a s s i g n e d t h e r a p e u t i c t e c h nique.  I f t h e c l i e n t d i d not p r e s e n t a s p l i t o r d e a l t w i t h an  i s s u e t h a t r e q u i r e d some o t h e r form o f 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 t i l the following session. audiotape  recorded.  t h e e x p e r i m e n t a l procedure un-  A l l e x p e r i m e n t a l i n t e r v i e w s were  - 42 Immediately  a f t e r t h e s e s s i o n c l i e n t s completed  c o m p l a i n t s box s c a l e and t h e r e s o l u t i o n q u e s t i o n .  the target  Three hours  a f t e r t h e t h e r a p y s e s s i o n , when c l i e n t s had had some time t o i n t e g r a t e what had t r a n s p i r e d i n t h e t h e r a p y hour, t h e y answered t h e awareness q u e s t i o n , t h e change and p r o g r e s s q u e s t i o n s , and s p e c i f i e d t h e a c t u a l f r e q u e n c y o f a t a r g e t b e h a v i o u r , t h e y wanted t o change as a f u n c t i o n o f t h e s e s s i o n .  which  One week  a f t e r t h e s e s s i o n , c l i e n t s f i l l e d i n t h e t a r g e t c o m p l a i n t s box s c a l e , t h e r e s o l u t i o n q u e s t i o n and r e p o r t e d any b e h a v i o u r a l change i n c o n n e c t i o n w i t h t h e b e h a v i o u r 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 t h e r a p y s e s s i o n was n o t c o n s i d e r e d f o r t h e purposes  o f t h i s study.  F o r t h e next e x p e r i m e n t a l s e s s i o n , t h e p r o c e d u r e , as f o r t h e f i r s t e x p e r i m e n t a l s e s s i o n , was r e p e a t e d . A schematic r e p r e s e n t a t i o n o f t h e o r d e r o f t e s t s w i t h r e s p e c t t o t r e a t m e n t s i s p r e s e n t e d i n F i g u r e 2, page 43. SCORING PROCEDURE Scoring occurred i n three s t a g e s . to  A check was f i r s t  made  ensure t h a t a l l c l i e n t s p e r c e i v e d t h e i r t h e r a p i s t as empathic.  A check was t h e n made t o ensure t h a t t h e r a p i s t s were c o r r e c t l y conducting the t h e r a p e u t i c operations. p r o c e s s were performed Experiencing Scale.  Ratings of the c l i e n t  from t a p e r e c o r d i n g s on t h e Depth o f  -  43  -  ' 2 X  D-L  D  O  0^  2  p  ^ 0  T  2  0  T  3  0  T  4  X  3  0 ^  O  p  ^  0 ^  0 ^  X'  X,  Empathic R e f l e c t i o n Gestalt two-chair Role-play Non-experimental s e s s i o n Sixteen Personality Factor Questionnaire  D,  Barrett-Lennard Relationship Inventory )  T 1  ,  o  T 5  Pre-measure:  T a r g e t C o m p l a i n t s Box S c a l e  P r o c e s s Measure:  The E x p e r i e n c i n g S c a l e  T2»  °T6  Immediately a f t e r the Session:  T a r g e t C o m p l a i n t s Box S c a l e . Resolution Question.  ^T3'  ^T7  Three hours a f t e r the Session:  Awareness Q u e s t i o n . Change and P r o g r e s s Q u e s t i o n . Target Behaviour S e t t i n g .  o ,  o  One week a f t e r the S e s s i o n :  T a r g e t C o m p l a i n t s Box S c a l e . Resolution Question. Target Behaviour Report.  0,  T 4  T d  Figure 2  -  Order o f T e s t s w i t h Respect t o T r e a t m e n t s .  - 44 -  C l i e n t s ' p e r c e p t i o n o f t h e i r t h e r a p i s t ' s empathy was determined  a c c o r d i n g t o t h e empathy s c a l e o f t h e B a r r e t t -  Lennard R e l a t i o n s h i p I n v e n t o r y ( B a r r e t t - L e n n a r d , 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 o f t h e s i x t e e n items o f t h e s c a l e (see Appendix B, items 1,  5, 9, 13,  17, 2 1 , 2 5 , 29, 3 3 , 37, 4 1 , 4 5 , 4 9 , 5 3 , 57 and 6 1 ) .  I n order  t o be p e r c e i v e d as m i n i 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 o b t a i n a minimum s c o r e o f 16 on t h e s c a l e , o u t o f a p o s s i b l e maximum o f 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 1 6 .  The mean s c o r e f o r t h e group o f s i x t e e n t h e r a p i s t s was 3 4 . 7 5 , with a standard d e v i a t i o n of 7.69.  The d a t a o b t a i n e d from  t h i s r a t i n g procedure i s p r e s e n t e d i n T a b l e I , page 4 5 . I t was concluded from t h i s d a t a 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 t o be empathic by B a r r e t t - L e n n a r d ' s criteria.  (1962)  T h e r e f o r e , none o f t h e t h e r a p i s t s had t o be r e -  j e c t e d because t h e y were not p e r c e i v e d as b e i n g empathic by their client. I n o r d e r t o ensure t h a t t h e r a p i s t s were u s i n g t h e a s s i g n ed o p e r a t i o n i n s e s s i o n s where empathic r e f l e c t i o n was t o o c c u r , t a p e s were s u b m i t t e d 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 t h e C a r k h u f f S c a l e ( C a r k h u f f , 1 9 6 9 ) . 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 t h e b e g i n n i n g , m i d d l e and end o f each i n t e r v i e w , and determined whether each segment was a t l e a s t m i n i m a l l y f a c i l i t a t i v e on  - 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 -  t h e C a r k h u f f S c a l e , i . e . , t h a t each segment s c o r e d t h r e e o r more.  The r e s u l t i n g 48 r a t i n g s o f 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 e x p r e s s e d 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 a c r o s s t h e 48 p a i r s o f ratings,was  .87.  The r a t e r s agreed on 78 p e r cent o f t h e  r a t i n g s and w i t h i n a h a l f s t e p o f t h e s c a l e (.5) per cent o f t h e r a t i n g s .  on one hundred  None o f t h e segments w a r r a n t e d  a  r a t i n g o f l e s s than 3 . 0 . The t h r e e r a t i n g s o b t a i n e d 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 session.  The data thus o b t a i n e d i s p r e s e n t e d i n T a b l e I I ,  page 4 7 . I t i s c o n c l u d e d from t h i s d a t a t h a t a l l t h e r a p i s t s responded t o t h e i r c l i e n t s w i t h a t l e a s t m i n i m a l l y f a c i l i t a t i v e o f empathic r e f l e c t i o n a c c o r d i n g t o C a r k h u f f ' s (1969) i n t h e s e s s i o n s where t h i s t e c h n i q u e was u s e d .  levels  criteria,  T h e r e f o r e , none  o f t h e empathic r e f l e c t i o n s e s s i o n s had t o be r e j e c t e d because the t e c h n i q u e was n o t a d e q u a t e l y  implemented.  I n o r d e r t o ensure t h a t t h e r a p i s t s were u s i n g t h e a s s i g n e d o p e r a t i o n i n s e s s i o n s where G e s t a l t t w o - c h a i r d i a l o g u e was t o o c c u r , tapes were s u b m i t t e d t o two r a t e r s who determined t h e occurrence of t h e G e s t a l t two-chair dialogue according t o t h e 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 a c c o r d i n g t o which t h e G e s t a l t t w o - c h a i r d i a l o g u e 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  must s u f f i c e .  judgement  Both r a t e r s c o n f i r m e d t h e o c c u r r e n c e o f t h e  G e s t a l t t w o - c h a i r d i a l o g u e i n a l l s i x t e e n o f the e x p e r i m e n t a l s e s s i o n s , and no s e s s i o n s had t o be d i s c a r d e d . T w e n t y - f i v e hours o f tape r e c o r d e d d a t a r e s u l t e d from t h e 32 tapes which were c o l l e c t e d , once m a t e r i a l which  preceded  t h e o c c u r r e n c e o f a ' s p l i t ' had been e l i m i n a t e d . These 25 hours o f data were t h e n segmented i n t o f o u r minute e x c e r p t s which were randomly r e c o r d e d on t a p e . There were a t o t a l o f 171 d i a l o g u e and 181  segments o f empathic r e f l e c t i o n .  number o f segments was at  t h e .05  segments o f G e s t a l t t w o - c h a i r The  not found t o be s i g n i f i c a n t l y  l e v e l a c c o r d i n g t o a t - t e s t .(for  total  different  both t e c h n i q u e s ) .  These t a p e s were s u b m i t t e d t o two r a t e r s f o r r a t i n g the E x p e r i e n c i n g S c a l e ( K l e i n , e t a l . , 1 9 6 9 ) .  on  Each r a t e r r a t e d  t w o - t h i r d s o f t h e t a p e s , i n o r d e r t o p r o v i d e o n e - t h i r d o f 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  a s s i g n e d two s c o r e s , from one t o seven i n c l u s i v e ,  indicating  t h e peak and t h e mode s c o r e o b t a i n e d by the c l i e n t , a c c o r d i n g to the E x p e r i e n c i n g 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 , b e f o r e t h e d a t a was  collected.  At the end o f t h e i r t r a i n i n g , t h e r a t e r s '  r a t i n g s o f twenty randomized f o u r - m i n u t e t h e r a p y segments had  -  49  -  y i e l d e d a Pearson P r o d u c t moment c o r r e l a t i o n o f . 8 3 .  They-  agreed on 7 4 p e r cent o f t h e r a t i n g s and w i t h i n one p o i n t p e r r a t i n g on a l l o f t h e s c o r e s .  Both r a t e r s t h e n r a t e d o n e - t h i r d  o f o v e r l a p p i n g tape on t h e a c t u a l e x p e r i m e n t a l segments. i n t e r r a t e r r e l i a b i l i t y a t t h i s time was . 7 7 .  The  They agreed on  67 p e r cent o f t h e r a t i n g s and w i t h i n one p o i n t p e r r a t i n g on a l l scores. For each i n t e r v i e w t h e f r e q u e n c y o f segments as w e l l as the p r o p o r t i o n o f segments a s s i g n e d a r a t i n g e q u a l t o o r g r e a t e r t h a n f i v e was c a l c u l a t e d .  Scores o f f i v e i n d i c a t e t h a t t h e  c l i e n t has p r e s e n t e d and e x p l o r e d a p e r s o n a l problem, and s c o r e s o f s i x and seven i n d i c a t e t h a t t h e c l i e n t has r e s o l v e d a personally significant issue.  These s t a g e s were s e l e c t e d  as c r i t e r i a f o r t h e "deeper e x p e r i e n c i n g "  comparison.  F o r each f o u r minute segment, r u n n i n g s c o r e s were c a l c u l a t e d a c c o r d i n g t o t h e depth o f t h e c l i e n t s ' r e s p o n s e s . most common s c o r e (mode) and one h i g h e s t s c o r e (peak) c a l c u l a t e d f o r each f o u r minute segment.  One  were  The peak s c o r e s were  a n a l y z e d f o r t h i s s t u d y , as t h e y have been p r e v i o u s l y shown t o be d i f f e r e n t i a l l y a f f e c t e d by t h e G e s t a l t t w o - c h a i r d i a l o g u e (Greenberg  and C l a r k e ,  1979;  Higgins,  1979).  Frequency  counts  and p r o p o r t i o n s c o r e s were t a k e n f o r segments o b t a i n i n g a peak s c o r e o f f i v e o r 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 sessions.  I n t h e f i r s t method o f  - 50 -  data c o l l e c t i o n  (use o f frequency)  time was c o n s i d e r e d an  i r r e l e v a n t v a r i a b l e and i n t e r e s t was focused on the number o f h i g h Depth o f E x p e r i e n c i n g s c o r e s , r e g a r d l e s s o f time i n therapy.  spent  I n t h e second method (use o f p r o p o r t i o n ) time was  c o n s i d e r e d as a main element i n o b t a i n i n g s c o r e s . The t o t a l number o f segments f o r both treatments were approximately  equal, thus making frequency a more a c c e p t a b l e  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 d i f f e r e n c e i n t h e t o t a l number o f segments f o r both  treatments.  PROCEDURE OF ANALYSIS The  data were analyzed i n a two-way a n a l y s i s o f v a r i a n c e ,  w i t h repeated measures on one f a c t o r . ist  F i x e d f a c t o r A was therap-  experience l e v e l and f i x e d f a c t o r B, t h e r a p e u t i c i n t e r -  v e n t i o n (Winer, 1971). the percentage  The p r o p o r t i o n s c o r e s , r e p r e s e n t i n g  o f segments i n each i n t e r v i e w which were r a t e d  f o r peak depths o f e x p e r i e n c i n g o f 5 or more, were passed through an a r c s i n t r a n s f o r m a t i o n i n o r d e r t o make them appropr i a t e f o r a n a l y s i s o f v a r i a n c e ( K i r k , 1968).  The U n i v e r s i t y  o f C a l i f o r n i a program, BMDP2V (1978), was used f o r a n a l y s i s o f measures a d m i n i s t e r e d a t more than one p o i n t i n time; S t a t i s t i c a l Package  the  f o r the S o c i a l Sciences (1978) was used  f o r a n a l y s i s o f measures administered one time o n l y .  The pro-  gramme was r u n a t the U n i v e r s i t y o f 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 o f t h e s t a t i s t i c a l a n a l y s e s performed on t h e dependent v a r i a b l e s , and c l i e n t information.  They w i l l be p r e s e n t e d  i n t h e o r d e r used t o  d e s c r i b e them i n Chapter I I I . The r e s u l t s o f a n a l y s i s o f v a r i a n c e were used t o determine t h e 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 t w o - c h a i r d i a l o g u e on s i x dependent v a r i a b l e s :  depth  o f e x p e r i e n c i n g , d i s t r e s s r e d u c t i o n , s h i f t o f awareness, c o n f l i c t r e s o l u t i o n , behaviour and p r o g r e s s .  change and r e p o r t s o f change  Depth o f e x p e r i e n c i n g p r o p o r t i o n s c o r e s were  s u b j e c t e d t o an a r c s i n t r a n s f o r m a t i o n t o make them amenable to a n a l y s i s of variance.  C l i e n t information gathered  on t h e  semantic d i f f e r e n t i a l s c a l e , e v a l u a t i o n s o f t h e h o u r , p e r c e i v e d t h e r a p i s t understanding  and h e l p f u l n e s s , and r e p o r t s o f u n u s u a l  events a r e a l s o g i v e n .  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 s c o r e s o f t h e r a p y segments r a t e d 5 o r more f o r peak depth o f e x p e r i e n c i n g may be found i n T a b l e I I I . The means and s t a n d a r d d e v i a t i o n s o f depth o f e x p e r i e n c i n g  pro-  p o r t i o n s c o r e s may be found i n T a b l e I V . 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  Client  P r o p o r t i o n o f segments Gestalt two-chair dialogue  Empathic reflection  1  .06  .00  2  .13  .09  3  .17  .09  4  .26  .00  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  Therapists  5  .40  .20  6  .17  .30  7  .00  .00  8  .43  .29  High-Experience Therapists  - 53 -  TABLE IV  MEANS AND STANDARD DEVIATIONS OF TRANSFORMED DEPTH OF EXPERIENCING PROPORTION SCORES  TREATMENT  G e s t a l t Two-Chair High-Experience  STANDARD DEVIATION  0.892  0.546  0.903  0.457  0.400  0.657  0.495  0.545  Dialogue  Therapists  G e s t a l t Two-Chair  MEAN  Dialogue  Low-Experience T h e r a p i s t s Empathic R e f l e c t i o n High-Experience  Therapists  Empathic R e f l e c t i o n Low-Experience T h e r a p i s t s  These s c o r e s have been s u b j e c t e d t o an a r c s i n t r a n s f o r m a t i o n t o make them amenable f o r a n a l y s i s o f v a r i a n c e .  - 54 -  TABLE V  ANALYSIS OF VARIANCE FOR TRANSFORMED DEPTH OF EXPERIENCING PROPORTION SCORES  Between Experience  Levels  S-within  Between  DEGREES OF FREEDOM  MEAN SQUARES  .023  1  .023  5.369  14  .419  1.623  1  1.623  2.775  14  .198  0.014  1  0.014  SUM OF SQUARES  SOURCE  Therapies  S-within  Between ELxT  F RATIO  PROBABILITY  .054  0.819  8.188  0.013  0.072  0.792  - 55, t h a t g r e a t e r p r o p o r t i o n s o f depth e x p e r i e n c i n g r e a c h i n g peaks o f 5 o r more on t h e E x p e r i e n c i n g S c a l e were o b t a i n e d w i t h t h e use o f G e s t a l t t w o - c h a i r d i a l o g u e t h a n w i t h t h e use o f empathic reflection. A n a l y s i s o f v a r i a n c e o f t h e s e r e s u l t s (Table IV) r e v e a l e d 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 . therapies.  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  No i n t e r a c t i o n e f f e c t s were found t o 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 t h e b a s i s o f t h e s e a n a l y s e s , t h e n u l l H  Q  1  :  hypothesis:  The G e s t a l t t w o - c h a i r d i a l o g u e , when u s e d a t a s p l i t , w i l l n o t l e a d t o depths o f e x p e r i e n c i n g on t h e K l e i n , e t a l . , E x p e r i e n c i n g S c a l e , s i g n i f i c a n t l y d i f f e r e n t from t h o s e produced by t h e use o f 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 f a v o u r o f t h e 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 s t a n d a r d d e v i a t i o n s f o r l e v e l s o f d i s t r e s s r e d u c t i o n , as measured on t h r e e o c c a s i o n s , may be f o u n d i n Table VI.  - 56 -  TABLE V I  MEANS AND STANDARD DEVIATIONS FOR DISTRESS REDUCTION SCORES  TREATMENT  G e s t a l t Two-Chair  OCCASIONS  1  MEAN  STANDARD DEVIATION  Dialogue  01  5.00000  2.56348  High-Experience Therapists  02  10.25000  1.38873  03  9.37500  2.5037  01  4.87500  2.90012  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 T h e r a p i s t s  02  9.37500  2.61520  03  8.50000  2.56348  G e s t a l t Two-Chair  Dialogue  Low-Experience T h e r a p i s t s  01 •=» D i s t r e s s r e d u c t i o n s c o r e s o b t a i n e d b e f o r e t h e 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 s c o r e s o b t a i n e d i m m e d i a t e l y 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 s c o r e s o b t a i n e d one week a f t e r the session.  -  57  -  TABLE V I I  ANALYSIS OF VARIANCE FOR THREE OCCASIONS OF DISTRESS REDUCTION SCORES SOURCE  SUM OF SQUARES  OCCASION 1:  DEGREES OF FREEDOM  IMMEDIATELY  MEAN SQUARES  F RATIO  TAIL PROBABILITY  BEFORE THERAPY  Between Experience L e v e l s S-within  0.031 65.188  1 14  0.031 4.656  0.007  0.936  Between T h e r a p i e s S-within  0.031 79.438  1 14  0.031 5.674  0.006  0.942  0.031  1  0.031  0.006  0.942  Between ELxT  OCCASION 2:  IMMEDIATELY AFTER THERAPY  Between Experience L e v e l s S-within  1.531 89.188  1 14  1.531 6.371  0.240  0.632  Between T h e r a p i e s S-within  1.531 25.933  1 14  1.531 1.353  0.827  0.379  7.031  1  7.031  3.795  0.720  Between ELxT  OCCASION 3 :  ONE WEEK AFTER THERAPY  Between Experience L e v e l s S-within  0.0 102.875  1 14  0.0 7.343  0.0  0.999  Between T h e r a p i e s S-within  6.125 106.375  1 14  6.125 7.593  0.806  0.384  4.500  1  4.500  0.592  0.454  Between ELxT  - 58 -  A n a l y s e s o f v a r i a n c e performed on each o c c a s i o n r e v e a l e d 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 exp e r i e n c e l e v e l , o r between t h e r a p i e s , on a l l t h r e e o c c a s i o n s . No i n t e r a c t i o n e f f e c t s were found t o be s i g n i f i c a n t (=><. =• . 0 5 ) . On t h e b a s i s o f these a n a l y s e s , t h e n u l l h y p o t h e s i s : HQ : 2  The G e s t a l t t w o - c h a i r d i a l o g u e , when u s e d a t 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 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 t h o s e produced by t h e use o f empathic r e f l e c t i o n a t 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 , a d m i n i s t e r e d b e f o r e , i m m e d i a t e l y a f t e r , and one week a f t e r t h e r a p y .  i s n o t r e j e c t e d i n f a v o u r o f t h e 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 o b t a i n e d on t h e two awareness q u e s t i o n s were n o t 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 o f a dependent t - t e s t .  . 0 5 ) , upon e x e c u t i o n  The s c o r e s were t h e n combined, and  t r e a t e d as one measure. Means and s t a n d a r d d e v i a t i o n s o f l e v e l s o f s h i f t o f awareness may be found i n T a b l e V I I I .  The means r e v e a l t h a t h i g h e r  s c o r e s were o b t a i n e d w i t h t h e use o f G e s t a l t t w o - c h a i r d i a l o g u e than w i t h t h e 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 D i a l o g u e High E x p e r i e n c e T h e r a p i s t s  10.000  0.0  G e s t a l t Two-Chair D i a l o g u e Low-Experience  Empathic  Therapists  1.065  7.375  1.598  a. 625  2.134  Reflection  High-Experience Therapists  Empathic  9.500  Reflection  Low-Experience  Therapists  - 60 -  TABLE I X  ANALYSIS OF VARIANCE FOR SHIFT OF AWARENESS SCORES  SOURCE  SUM OF SQUARES  DEGREES OF FREEDOM  MEAN SQUARES  1.125  1  1.125  23.375  14  1.670  24.500  1  24.500  34.375  14  2.455  6.125  1  6.125  F RATIO  TAIL PROBABILITY  Between Experience Levels S-within Between T h e r a p i e s S-within  Between ELxT  .674  0.425  9.978  .007  2.495  .137  - 61 -  Analysis of variance o f these r e s u l t s  (Table I X ) r e v e a l e d  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 . therapies.  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  No i n t e r a c t i o n e f f e c t s were found t o 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 (©<^ . 0 5 ) . On t h e b a s i s o f t h e s e a n a l y s e s , t h e n u l l h y p o t h e s i s : HQ  3  :  The G e s t a l t t w o - c h a i r d i a l o g u e , when used a t 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 s h i f t o f awareness s i g n i f i c a n t l y d i f f e r e n t from t h o s e produced by t h e use o f empathic r e f l e c t i o n a t 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 a d m i n i s t e r e d t h r e e hours a f t e r therapy,  i s r e j e c t e d i n f a v o u r o f t h e 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 s t a n d a r d d e v i a t i o n s o f l e v e l s o f c o n f l i c t resolution, T a b l e X.  as measured on two o c c a s i o n s , may be found i n  The means r e v e a l t h a t on both o c c a s i o n s  ( t h r e e hours  a f t e r t h e r a p y and one week a f t e r t h e r a p y ) , h i g h e r s c o r e s were o b t a i n e d w i t h t h e use o f G e s t a l t t w o - c h a i r d i a l o g u e t h a n w i t h t h e use o f empathic r e f l e c t i o n . A n a l y s i s o f v a r i a n c e performed on each o c c a s i o n ( T a b l e X I ) showed t h a t G e s t a l t t w o - c h a i r d i a l o g u e l e d t o  - 62 -  TABLE X  MEAN AND STANDARD DEVIATIONS FOR CONFLICT RESOLUTION SCORES  TREATMENT  OCCASIONS  1  MEAN  STANDARD DEVIATION  G e s t a l t Two-Chair D i a l o g u e  01  5.500  0.925  High-Experience Therapists  02  5.250  0.834  G e s t a l t Two-Chair D i a l o g u e  01  4.875  0.886  Low-Experience T h e r a p i s t s  02  5.000  1.069  Empathic  01  4.375  1.187  High-Experience T h e r a p i s t s  02  3.625  .744  Empathic  01  4.250  1.035  02  3.625  1.505  Reflection  Reflection  Low-Experience T h e r a p i s t s  01 = Scores o f c o n f l i c t r e s o l u t i o n o b t a i n e d t h r e e hours a f t e r therapy. 02 - Scores o f c o n f l i c t r e s o l u t i o n o b t a i n e d one week a f t e r therapy.  - 63 -  TABLE X I  ANALYSIS OF VARIANCE FOR TWO OCCASIONS OF CONFLICT RESOLUTION SCORES  SOURCE  SUM OF SQUARES  OCCASION 1 :  DEGREES OF FREEDOM  MEAN SQUARES  F RATIO  TAIL PROBABILITY  THREE HOURS AFTER THERAPY  Between Experience Levels S-within  1.125 19.875  1 14  1.125 1.420  0.792  0.388  Between T h e r a p i e s S-within  6.125 8.375  1 14  6.125 0.598  10.239  0.006  Between ELxT  0.500  1  0.500  0.336  0.376  OCCASION 2:  ONE WEEK AFTER THERAPY  Between Experience Levels S-within  0.125 25.375  1 14  0.125 1.813  0.069  0.797  Between T h e r a p i e s S-within  18.000 7.375  1 14  18.000 0.563  32.000  0.001  0.125  1  0.125  0.222  0.645  Between ELxT  - 64 -  s i g n i f i c a n t l y 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 t h a n d i d empathic r e f l e c t i o n , both t h r e e hours a f t e r t h e r a p y and one week a f t e r therapy. On t h e b a s i s o f t h e s e a n a l y s e s , t h e n u l l h y p o t h e s i s : HQ  :  The G e s t a l t t w o - c h a i r d i a l o g u e , when used a t a s p l i t , w i l l not lead 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 t h e use o f empathic r e f l e c t i o n a t a s p l i t , as measured on a s e v e n - p o i n t box s c a l e a d m i n i s t e r e d t h r e e hours a f t e r and one week a f t e r t h e r a p y ,  i s r e j e c t e d i n f a v o u r o f t h e 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 s t a n d a r d d e v i a t i o n s o f l e v e l s o f b e h a v i o u r may be f o u n d i n T a b l e X I I .  change  The means r e v e a l t h a t h i g h e r s c o r e s  were o b t a i n e d w i t h t h e u s e o f G e s t a l t t w o - c h a i r d i a l o g u e t h a n w i t h t h e u s e o f empathic r e f l e c t i o n . A n a l y s i s o f v a r i a n c e performed on each o c c a s i o n i n d i v i d u a l ly  (Table X I I I ) showed t h a t p r e s e n t b e h a v i o u r , measured b e f o r e  t h e r a p y , was n o t 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 e x p e r i e n c e l e v e l s o r between t h e r a p i e s . a l l y significant interaction effects. t h e week f o l l o w i n g  There were no s t a t i s t i c  Behaviour a c h i e v e d i n  t h e r a p y was s i g n i f i c a n t l y g r e a t e r f o r c l i e n t s  - 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 D i a l o g u e  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 D i a l o g u e  01  2.625  1.302  Low-Experience T h e r a p i s t s  02  4.250  1.165  Empathic  01  2.375  0.835  High-Experience T h e r a p i s t s  02  3.875  0.641  Empathic  01  2.375  1.138  02  3.625  1.188  Reflection  Reflection  Low-Experience T h e r a p i s t s  01 * Scores o f p r e s e n t b e h a v i o u r r e p o r t e d t h r e e hours a f t e r therapy. 02 = Scores o f a c h i e v e d b e h a v i o u r r e p o r t e d one week a f t e r therapy.  - 66 -  TABLE X I I I  ANALYSIS GF VARIANCE FOR TWO OCCASIONS OF BEHAVIOUR CHANGE SCORES  SUM OF SQUARES  SOURCE  OCCASION 1:  DEGREES OF FREEDOM  MEAN SQUARES  F RATIO  TAIL PROBABILITY  THREE HOURS AFTER THERAPY  Between Experience L e v e l s S-within  0.781 13.938  1 14  0.781 0.996  0.785  0.391  Between Therapies S-within  0.031 16.188  1 14  0.031 1.156  0.027  0.872  0.281  1  0.281  0.243  0.630  Between ELxT  OCCASION 2:  ONE WEEK AFTER THERAPY  Between :. Experience L e v e l s S-within  0.781 19.4^3  1 14  0.781 1.388  0.563  O.466  Between Therapies S-within  3.781 10.688  1 14  3.781 0.763  4.953  0.043  0.031  1  0.031  0.041  0.843  Between ELxT  - 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 h a v i n g r e c e i v e d empathic r e f l e c t i o n . l e v e l was not s i g n i f i c a n t . action effects  Therapist experience  There were no s i g n i f i c a n t  inter-  (*=»< = .05).  On t h e b a s i s o f t h e s e a n a l y s e s , t h e n u l l h y p o t h e s i s : The G e s t a l t t w o - c h a i r d i a l o g u e , when used a t 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 b e h a v i o u r change s i g n i f i c a n t l y d i f f e r e n t from t h o s e produced by t h e use o f empathic r e f l e c t i o n a t a s p l i t , as measured on a s e v e n - p o i n t s c a l e a d m i n i s t e r e d t h r e e h o u r s , and one week a f t e r therapy, i s r e j e c t e d i n f a v o u r o f t h e 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 o b t a i n e d on t h e change q u e s t i o n and t h e p r o g r e s s q u e s t i o n were n o t 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 dependent t - t e s t .  on a  Scores were combined, and t r e a t e d as one  variable. Means and s t a n d a r d d e v i a t i o n s f o r r e p o r t s o f change and p r o g r e s s s c o r e s may be found i n T a b l e XIV. The means r e v e a l t h a t h i g h e r s c o r e s were o b t a i n e d w i t h t h e use o f G e s t a l t twoc h a i r d i a l o g u e than w i t h t h e use o f empathic  reflection.  - 68 -  TABLE X I V  MEANS AND STANDARD DEVIATIONS FOR CHANGE AND PROGRESS SCORES  MEAN  TREATMENT  STANDARD DEVIATION  G e s t a l t Two-Chair D i a l o g u e High-Experience T h e r a p i s t s  8.250  .707  8.000  1.512  6.125  .991  6.000  1.195  G e s t a l t Two-Chair D i a l o g u e Low-Experience T h e r a p i s t s  Empathic  Reflection  High-Experience Therapists  Empathic  Reflection  Low-Experience T h e r a p i s t s  - 69 -  TABLE XV  ANALYSIS OF VARIANCE FOR CHANGE AND PROGRESS SCORES  SOURCE  SUM OF SQUARES  DEGREES OF FREEDOM  MEAN SQUARES  F RATIO  TAIL PROBABILITY  Between Experience Levels S-within Between T h e r a p i e s S-within  Between ELxT  .281  1  0.281  9.938  14  0.710  34.031  1  34.031  26.438  14  1.888  .031  1  .031  .396  .539  18.021  .001  .017  .899  - 70 -  A n a l y s i s o f v a r i a n c e o f t h e s e r e s u l t s ( T a b l e XV) r e v e a l e d 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 e x p e r i e n c e levels.  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 t o be s t a t i s t i c a l l y cant  signifi-  (°<= . 0 5 ) . On t h e b a s i s o f these a n a l y s e s , t h e n u l l h y p o t h e s i s : PL. : 6  The G e s t a l t t w o - c h a i r d i a l o g u e , when used a t 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 change and p r o g r e s s s i g n i f i c a n t l y d i f f e r e n t f r o m t h o s e produced by t h e use o f empathic r e f l e c t i o n a t 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 a d m i n i s t e r e d one week a f t e r t h e r a p y ,  i s r e j e c t e d i n f a v o u r o f t h e a l t e r n a t i v e , Hi . 6 CLIENT INFORMATION Scores on t h e t h r e e s u b - s c a l e s o f t h e semantic  different-  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 t h e y have been shown not t o 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 o f t h e h o u r (Warr and Knapper, 1968). o f s c o r e s on t h e semantic Table XVI.  Means and s t a n d a r d d e v i a t i o n s  d i f f e r e n t i a l s c a l e may be f o u n d i n  The means r e v e a l t h a t c l i e n t s f e l t b e t t e r , l e s s  t e n s e and c l e a r e r a f t e r t h e r a p y . A n a l y s i s o f v a r i a n c e performed on each o c c a s i o n i n d i v i d u a l ly  (Table X V I I ) 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  e x p e r i e n c e l e v e l s o r between t h e r a p i e s , on both o c c a s i o n s . i n t e r a c t i o n e f f e c t s were found t o be s i g n i f i c a n t .  No  - 71 -  TABLE XVI  MEANS AND STANDARD DEVIATIONS FOR EVALUATION OF THERAPY SCORES  TREATMENT  OCCASIONS  1  MEAN  STANDARD DEVIATION  G e s t a l t Two-Chair D i a l o g u e  01  10.875  4.673  High-Experience Therapists  02  15.500  2.563  G e s t a l t Two-Chair D i a l o g u e  01  12.125  1.458  Low-Experience  02  16.250  3.694  01  9.125  1.458  High-Experience T h e r a p i s t s  02  15.500  3.505  Empathic  01  10.625  4.033  02  17.875  2.532  Empathic  Therapists  Reflection  Reflection  Los-Experience Therapists  01 = Scores o b t a i n e d on t h e semantic d i f f e r e n t i a l before therapy. 02 = Scores o b t a i n e d on t h e semantic d i f f e r e n t i a l immediately a f t e r therapy.  scale scale  - 72 -  TABLE X V I I  ANALYSIS OF VARIANCE FOR TWO OCCASIONS OF EVALUATION OF THERAPY SCORES  SOURCE  SUM OF SQUARES  OCCASION 1:  DEGREES) MEAN OF SQUARES FREEDOM  F RATIO  TAIL PROBABILITY  BEFORE THERAPY  Between Experience Levels S-within  a. OOO 256.500  1 14  8.000 13.321  0.437  0.519  Between T h e r a p i e s S-within  12.500 162.000  1 14  12.500 11.571  1.080  0.316  0.500  1  0.500  0.043  0.838  Between ELxT  OCCASION 2 :  IMMEDIATELY AFTER THERAPY  Between Experience Levels S-within  19.531 143.433  1 14  19.531 10.246  1.906  0.189  Between T h e r a p i e s S-within  5.231 128.933  1 14  5.281 9.210  0.573  0.461  5.281  1  5.281  0.573  O.46I  Between ELxT  - 73  -  On t h e f o u r o t h e r i n f o r m a t i o n g a t h e r i n g measures, c l i e n t s r e p o r t e d t h a t t h e hour had been good (at l e a s t f o u r on a sevenp o i n t s c a l e ) and t h a t t h e i r t h e r a p i s t had been u n d e r s t a n d i n g (at l e a s t f o u r on a f i v e - p o i n t s c a l e ) and h e l p f u l f o u r on a s i x - p o i n t s c a l e ) .  No  (at l e a s t  c l i e n t r e p o r t e d any  unusual  e v e n t , o t h e r t h a n t h e t h e r a p e u t i c hour, t o w h i c h t h e y 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 b e h a v i o u r .  - 74 -  - CHAPTER V  DISCUSSION  T h i s c h a p t e r p r e s e n t s a summary o f t h e s t u d y , as w e l l as c o n c l u s i o n s , i m p l i c a t i o n s and recommendations based on t h e 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 o f t h e Problem Emphasis i s c u r r e n t l y b e i n g p l a c e d on g r e a t e r s p e c i f i c i t y i n psychotherapy  research.  t h e r a p i s t behaviours  More s t u d i e s examining s p e c i f i c  used a t s p e c i f i c moments i n t h e r a p y w i t h  s p e c i f i c c l i e n t s a r e needed.  G e s t a l t t w o - c h a i r d i a l o g u e has  been shown t o l e a d t o g r e a t e r depths o f e x p e r i e n c i n g i n t h r e e s i n g l e case s t u d i e s (Greenberg,  1975)  and i n an analogue s t u d y  u s i n g s i x t e e n s u b j e c t s (Greenberg and C l a r k e , 1979). Purpose The purpose o f t h e present s t u d y was t o examine t h e e f f e c t o f G e s t a l t t w o - c h a i r d i a l o g u e and empathic r e f l e c t i o n a t a s p l i t i n t h e r a p y , i n a p o p u l a t i o n o f r e a l c l i e n t s d e s c r i b e d as not o v e r l y c o n s c i e n t i o u s , e x p e r i m e n t i n g l e d on f a c t o r s G, Q Personality Factor  1  and not o v e r l y c o n t r o l -  and Q^, r e s p e c t i v e l y , o f t h e S i x t e e n Questionnaire.  - 75  -  Procedure S i x t e e n c l i e n t s engaged i n t h e r a p y f o r a minimum o f f o u r s e s s i o n s 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 received Gestalt  two-chair  dialogue at a s p l i t during the f i f t h session, eight received empathic r e f l e c t i o n . for  The f o l l o w i n g s e s s i o n was  t h e purposes o f t h i s r e s e a r c h .  not  considered  During the seventh  session,  t h e r a p i s t s performed t h e 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 a t a split. who  The  s e s s i o n s were t a p e r e c o r d e d and s u b m i t t e d  to r a t e r s  r a t e d them on t h e Depth o f E x p e r i e n c i n g S c a l e ( K l e i n , et  a l . , 1969).  C l i e n t s completed q u e s t i o n n a i r e s b e f o r e , immediate-  l y a f t e r , t h r e e hours a f t e r and one week a f t e r each  experimental  session. A t w o - f a c t o r , r e p e a t e d measure a n a l y s i s o f v a r i a n c e ;  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 o f  was  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 . Results The  G e s t a l t t w o - c h a i r d i a l o g u e l e d t o g r e a t e r depth o f  e x p e r i e n c i n g , s h i f t o f awareness, c o n f l i c t r e s o l u t i o n , b e h a v i o u r change and r e p o r t s o f change and p r o g r e s s t h a n d i d empathic reflection.  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  sessions.  They r e p o r t e d a l s o t h a t both t h e r a p y s e s s i o n s had been good,  - 76 -  and t h a t t h e y had p e r c e i v e d 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 c o n c l u s i o n s may be drawn f r o m t h e d a t a collected: 1.  G e s t a l t t w o - c h a i r d i a l o g u e l e a d s t o g r e a t e r depth o f e x p e r i e n c i n g t h a n does empathic r e f l e c t i o n , when u s e d a t a s p l i t i n therapy.  T h i s may be due t o t h e f a c t t h a t  G e s t a l t t w o - c h a i r d i a l o g u e encourages c l i e n t s t o c o n f r o n t conflict.  When t h e 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 d e e p l y e x p l o r e t h e s p l i t , o r t h e y may choose t o pursue o t h e r l e s s a n x i e t y - p r o v o k i n g and p o s s i b l y l e s s m e a n i n g f u l areas o f c o n c e r n .  G e s t a l t two-  c h a i r d i a l o g u e c o u l d t h e r e f o r e be s a i d t o f a c i l i t a t e client self-confrontation.  Gestalt 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 t h a t d u r i n g t h e former o p e r a t i o n , t h e c l i e n t a c t i v e l y engages i n t h e 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 p r e s e n t .  When  empathic r e f l e c t i o n i s used, t h e c l i e n t t a l k s about t h e c o n f l i c t , p o s s i b l y a t a more c o g n i t i v e l e v e l and w i t h l e s s o f an immediate e x p e r i e n c e o f t h e c o n f l i c t .  - 77 2.  Gestalt two-chair dialogue leads to greater s h i f t of awareness t h a n does empathic r e f l e c t i o n , when used a t a split.  C e r t a i n e x p r e s s i v e a s p e c t s o f t h e G e s t a l t two-  chair dialogue  may  be r e s p o n s i b l e f o r t h i s  C l i e n t s are o f t e n encouraged t o r e p e a t and  effect. exaggerate  key v e r b a l i z a t i o n s o r g e s t u r e s o r a c t out c e r t a i n a s p e c t s o f what t h e y a r e s a y i n g such t h a t unaware i d i o s y n c r a s i e s a r e brought to  i n t o awareness.  C l i e n t s are t h e r e f o r e helped  see t h e m s e l v e s , o r 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 t h e  d a t a , i l l u s t r a t e s h i f t s o f awareness:  3.  a)  I saw m y s e l f more c l e a r l y s e p a r a t e d from my f a m i l y t h a n I g i v e m y s e l f c r e d i t f o r . I can be as s e p a r a t e as I choose t o 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, a r e somewhat c l o u d e d and unclear.  G e s t a l t two-chair dialogue leads to greater 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 a t a split.  T h i s f i n d i n g may  be due t o t h e f a c t t h a t  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 d i a l o g u e t e c h n i q u e , c l i e n t s a c t i v e l y e x p e r i e n c e deep f e e l i n g s on b o t h " s i d e s " o f t h e i s s u e and g a i n more e x p l i c i t awareness o f t h e i r p o l a r i t y .  They may  then  choose t o 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 t h e p o l a r i t y i n f a v o u r o f t h e a l t e r n a t e , o r by r e a c h ing  a new u n d e r s t a n d i n g between both p a r t s , as a r e s u l t  of the d i a l o g u e .  - 78 -  When empathic r e f l e c t i o n i s u s e d a t a s p l i t ,  clients  may e l e c t t o deeply e x p l o r e a s p l i t , o r may go on t o another t o p i c .  I f t h e s p l i t i s indeed e x p l o r e d ,  clients,  may pursue o n l y one aspect o f t h e p o l a r i t y , and not d e a l w i t h t h e o t h e r one.  I f both aspects o f t h e p o l a r i t y a r e  e x p l o r e d , c l i e n t s may o r may n o t g a i n s u f f i c i e n t new awareness t o d i s c o v e r a way t o r e s o l v e t h e i r 4.  Gestalt two-chair dialogue leads t o greater  conflict. behaviour  change t h a n does empathic r e f l e c t i o n , when u s e d a t a split.  Perhaps t h i s i s r e l a t e d  c l i e n t s experience  to the fact that i f  d e e p l y , and t h r o u g h 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 o f t h e i r l i f e , g a i n a g r e a t e r sense o f r e s o l u t i o n , ing t h e i r behaviour  t h e y become more committed t o m o d i f y o u t s i d e o f t h e r a p y , 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 o f awareness were quoted p r e v i o u s l y (number 2) r e p o r t e d i n c r e a s e s i n t h e f o l l o w i n g  behaviours,  as a  r e s u l t o f therapy: a)  I want without saying them.  t o spend more t i m e w i t h my f a m i l y b e i n g c r i t i c a l o f m y s e l f and "You s h o u l d not spend t i m e w i t h You a r e an a d u l t " .  b)  I want t o be more r e l a x e d and a c c e p t i n g o f my own moods and t h o u g h t s . Presently, I tend t o " p a n i c " when I e v a l u a t e c e r t a i n t h o u g h t s o r f e e l i n g s as abnormal and/or wrong. I want t o t r u s t m y s e l f more.  - 79 -  C l i e n t s r e p o r t e d t h a t t h e y f e l t t h e y had made more change and  progress f o l l o w i n g sessions  i n w h i c h G e s t a l t two-  c h a i r d i a l o g u e was used r a t h e r t h a n 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 a r e i n t h e same d i r e c t i o n as  the r e s u l t s reported Gestalt two-chair  on t h e p r e v i o u s  dialogue  measures.  and empathic r e f l e c t i o n used  a t 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 to d i s t r e s s reduction.  regard  One p o s s i b l e e x p l a n a t i o n f o r t h i s  f i n d i n g may be due t o t h e f a c t t h a t d u r i n g t h e 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 n o t work on t h e i s s u e t h a t t h e y had i d e n t i f i e d as d i s t r e s s i n g b e f o r e  therapy.  C l i e n t s i n d i c a t e d t h a t t h e y had worked on a " d i f f e r e n t " o r " v e r y d i f f e r e n t " i s s u e 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 t w o - c h a i r  dialogue  sessions.  An a l t e r n a t e e x p l a n a t i o n might be t h a t c l i e n t s a r e l e s s b o t h e r e d by an i s s u e once t h e y have had a chance t o t a l k about i t , t o "get i t o f f t h e i r c h e s t " , r e g a r d l e s s o f t h e t h e r a p e u t i c i n t e r v e n t i o n used.  F i n d i n g s on t h e 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 operations  therapeutic  had been u s e d .  Much a t t e n t i o n was g i v e n t o v a r i o u s a s p e c t s o f t h i s r e search  design,  i n o r d e r t o p r o v i d e 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 t w o - c h a i r empathic r e f l e c t i o n .  d i a l o g u e and  - 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 performed by t h e same t h e r a p i s t , a t t h e same moment i n t h e r a p y w i t h t h e same c l i e n t .  T h i s d e s i g n a l l o w e d t h e comparison  o f i n d i v i d u a l s t o themselves and r e d u c e d e f f e c t s due t o individual differences i n subjects. cent) o f t h e t h e r a p i s t s ' -  The m a j o r i t y (60 p e r  p r o f e s s e d o r i e n t a t i o n was t h e  C a r k h u f f model r a t h e r t h a n G e s t a l t t h e r a p y .  C l i e n t s had  been exposed t o both t h e r a p e u t i c t r e a t m e n t s b e f o r e t h e experimental  s e s s i o n s , i n o r d e r t o d i m i n i s h any n o v e l t y  o r 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 clients  p e r c e i v e d t h e i r t h e r a p i s t as empathic, and r e p o r t e d both e x p e r i m e n t a l  s e s s i o n s had been good.  that  F i n a l l y , the  o r d e r o f t r e a t m e n t p r e s e n t a t i o n was c o n t r o l l e d , t o e l i m i n a t e any p o s s i b l e e f f e c t t h e r e o f . The l e v e l o f t h e r a p i s t e x p e r i e n c e  d i d not provide  signific  a n t l y d i f f e r e n t r e s u l t s i n any o f t h e hypotheses t e s t e d . I t may be s a i d t h e n , t h a t t h e G e s t a l t t w o - c h a i r i s a powerful  technique,  dialogue  when used a t a s p l i t by t r a i n e d  t h e r a p i s t s w i t h v a r y i n g degrees o f e x p e r i e n c e  i n i t s use.  E x a m i n a t i o n o f t h e data r e v e a l e d t h a t t h r e e c l i e n t s u s e d i n t h i s s t u d y d i d n o t reach peak depths o f e x p e r i e n c i n g o f f i v e o r 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 t h e two men used i n t h e s t u d y , a l o n g w i t h one woman. A n a l y s i s o f t h e i r 16-PF p r o f i l e show t h a t t h e s e s u b j e c t s  - 31 -  achieved  three of the highest scores  factor  ( s t e n 6, 6 and 7) on  o f t h e 16-PF and thus r e p r e s e n t e d  t r o l l e d " segment o f t h e p o p u l a t i o n .  t h e more "con-  Factor  "Undiscip-  l i n e d S e l f - C o n f l i c t v s . C o n t r o l l e d " o f t h e 16-PF may t h e r e f o r e be t h e most a c c u r a t e p r e d i c t o r o f w i l l i n g n e s s t o deepl y experience  i n therapy.  I t may a l s o be t r u e t h a t women  a r e more w i l l i n g t h a n men t o d e e p l y e x p e r i e n c e  i n therapy.  The r e s u l t s on e x p e r i e n c i n g s h o u l d o n l y be g e n e r a l i z e d t o female c l i e n t s . 10.  The outcome r e s u l t s o f t h i s s t u d y can be g e n e r a l i z e d t o c l i e n t s who a r e n o t o v e r l y c o n t r o l l e d ( s t e n 5 and under on t h e 16/PF) and who seek t h e r a p y in living.  t o d e a l w i t h problems  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 a r e 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  d i a l o g u e , who a r e p e r c e i v e d as empathic by  t h e i r c l i e n t s and who a r e engaged i n a r e l a t i o n s h i p i n w h i c h a w o r k i n g 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 o b t a i n e d i n t h i s r e s e a r c h l e n d s u p p o r t t o v a r i o u s r e s e a r c h 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 C h a p t e r I I . T h i s r e s e a r c h showed t h a t G e s t a l t t w o - c h a i r  dialogue  ed s i g n i f i c a n t l y g r e a t e r depth o f e x p e r i e n c i n g and g r e a t e r  yieldshift  -  82  -  o f awareness t h a n d i d empathic r e f l e c t i o n when used a t 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 t h e s e f i n d i n g s , r e -  p o r t e d by Greenberg (1979) and Greenberg and C l a r k e (1979), a p p l y t o a sample o f t h e r a p y - s e e k i n g s u b j e c t s i n an analogue s t u d y .  c l i e n t s , as w e l l as t o  T h e r a p i s t s 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 r e s e a r c h might want t o f o c u s on t h e " s p l i t " as a p o i n t a t which t o use a s p e c i f i c i n t e r v e n t i o n ( G e n d l i n , 1969;  R i c e , 1974;  Wexler and B u t l e r , 1976), and  i t would seem t h a t G e s t a l t t w o - c h a i r d i a l o g u e would be more e f f e c t i v e t h a n empathic r e f l e c t i o n a t a " s p l i t " . These f i n d i n g s a r e a l s o i n accordance w i t h t h o s e by Bohart  reported  (1977) and K i p p e r and G i l a d i (1978) whereby c l i e n t s  a c t i v e l y e x p e r i e n c i n g f e e l i n g s such as anger o r f e a r , w i t h t h e use o f t h e G e s t a l t t w o - c h a i r d i a l o g u e , may p r o g r e s s and make b e h a v i o u r a l changes.  The G e s t a l t t w o - c h a i r d i a l o g u e ' s  effect-  i v e n e s s may be a t t r i b u t a b l e t o t h e f a c t t h a t c l i e n t s do not m e r e l y " t a l k about" t h e i r f e e l i n g s , as t h e y do when t h e r a p i s t s use empathic r e f l e c t i o n , s y s t e m a t i c d e s e n s i t i z a t i o n , ual  a n a l y s i s or emotional discharge techniques.  intellect-  Rather,  a c t i v e l y engage i n t h e s e f e e l i n g s , as i s suggested  they  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 t w o - c h a i r d i a l o g u e s t i m u l a t e s c l i e n t s t o engage a l o u d i n what i s u s u a l l y c o v e r t d i a l o g u e .  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 u s i n g such s k i l l s as h e i g h t e n i n g , d i r e c t i n g and expressing.  T h i s 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 c a n be p e r c e i v e d  as a "feedback" l o o p (Kempler, 1973) i n which c l i e n t s g a i n more awareness o f t h e m s e l v e s , both i n t e r n a l l y and as a c t i v e l y acting i n the world.  inter-  The c l i e n t , i n e x p r e s s i n g h i m s e l f o r h e r -  s e l f i n t h e "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 t o problems and a c t i v e l y e x p e r i e n c e  them e m o t i o n a l l y ,  r a t h e r t h a n s i m p l y d i s c u s s them i n a detached manner and s p e c u l a t e as t o consequences ( Y o n t e f , 1975;  Passons, 1976).  Many G e s t a l t t h e o r i s t s v i e w 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 manifestation o f fragmentation p a r t i a l aspects  ( P e r l s , 1970;  or d i v i s i o n of the s e l f  Greenberg, 1979).  into  The G e s t a l t  t w o - c h a i r d i a l o g u e p r o v i d e s a medium through w h i c h b o t h " p a r t s " o f t h e s e l f c a n f r e e l y express themselves ( G r i n d e r and B a n d l e r , 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 .  Clients  may become more f u l l y aware o f what " r e a l " p r i o r i t i e s t h e y want t o s e t f o r themselves and i n v e s t t h e i r energy i n t o  fulfilling  such needs, r a t h e r t h a n d e a l i n g w i t h c o n f l i c t about what t h e y " s h o u l d " and what they "want" t o do. a balance  C l i e n t s a t t a i n i n g such  c o u l d be r e f e r r e d t o as more " c e n t e r e d "  1975) o r , from L a t n e r ' s  (Baumgardner,  (1972) p e r s p e c t i v e , as r e a c h i n g a  r e s o l u t i o n c r e a t e d from b o t h p o l e s o f t h e c o n f l i c t .  - 84 -  The  r e s u l t s o f t h i s r e s e a r c h a l s o uphold C a r k h u f f s (1969) 1  n o t i o n t h a t i n i t i a t i v e t h e r a p i s t s k i l l s such as the G e s t a l t two-chair d i a l o g u e , when used i n a d d i t i o n to responding are more powerful than a responding s k i l l s such as  skills,  empathic  r e f l e c t i o n used a l o n e .  RECOMMENDATIONS The f o l l o w i n g recommendations seem a p p r o p r i a t e on the b a s i s o f the f i n d i n g s o f t h i s r e s e a r c h ; 1.  S i n c e some c l i e n t s were found not t o experience under e i t h e r t h e r a p e u t i c c o n d i t i o n , i t might prove u s e f u l f o r f u r t h e r r e s e a r c h to attempt  to d i s c r i m i n a t e more c l e a r l y  between p o t e n t i a l deep e x p e r i e n c e r s and non e x p e r i e n c e r s . Factor  o f the 16-PF  may  be a good i n d i c a t o r .  a n o n - p e n c i l and paper performance  However,  type instrument such  as the V o i c e Q u a l i t y Index (Rice, et a l . , 1979), might be a b e t t e r i n d i c a t o r as i t takes the person's r e a c t i o n t o the s i t u a t i o n i n t o account.  E f f o r t s should a l s o be made  to i n c l u d e more male s u b j e c t s i n f u t u r e s t u d i e s , as both men  s t u d i e d here were found not t o experience deeply under  either 2.  treatment.  S i n c e some o f the G e s t a l t two-chair d i a l o g u e ' s e f f e c t i v e ness may  be a t t r i b u t a b l e t o i t s f a c i l i t a t i n g c l i e n t  self-  - 35 -  c o n f r o n t a t i o n , f u t u r e r e s e a r c h may want t o compare t h i s technique with C a r k h u f f s f  (1969) t h e r a p i s t s k i l l ,  con-  frontation. 3.  Future researchers i n the area o f d i f f e r e n t i a l  effects  may want t o use a v i d e o p r o c e s s 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 t o a v e r b a l s c a l e such as t h e E x p e r i e n c i n g S c a l e .  T h i s would enable t h e  g a t h e r i n g o f 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 tensive analysis. 4.  T h i s s t u d y showed t h a t g r e a t e r depth o f e x p e r i e n c i n g , s h i f t o f awareness, c o n f l i c t r e s o l u t i o n , b e h a v i o u r change and r e p o r t s o f change and p r o g r e s s o c c u r r e d f o l l o w i n g t h e use o f G e s t a l t t w o - c h a i r d i a l o g u e a t a s p l i t .  Future r e -  s e a r c h 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 o f t h i s s t u d y 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 e d u c a t i o n 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 d e f i n e d and e m p i r i c a l l y validated.  They a r e o f f e r e d an i n t e r v e n t i o n w h i c h t h e y may  wish to include i n t h e i r r e p e r t o i r e .  - 86 -  For c o u n s e l l o r e d u c a t o r s and t h e o r i s t s , v e r i f i e s the e f f e c t i v e n e s s o f a therapeutic  t h i s studyintervention  w h i c h has been d e l i n e a t e d i n s p e c i f i c t e a c h a b l e (Greenberg, 1980).  The f i n d i n g s r e p o r t e d  suggest t h a t t h e G e s t a l t t w o - c h a i r be a v i a b l e component o f c o u n s e l l o r  terms  i n this  research  d i a l o g u e t e c h n i q u e would training.  - 37.--  BIBLIOGRAPHY  Altmann, H. A. " E f f e c t s o f Empathy, Warmth and Genuineness in the I n i t i a l Counselling Interview," Counsellor E d u c a t i o n and S u p e r v i s i o n , 12 (1973), 225-228. B a r r e t t - L e n n a r d , C. T. 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" E f f e c t s o f C l i e n t - c e n t e r e d P s y c h o t h e r a p y w i t h S c h i z o p h r e n i c P a t i e n t s : Nine Years P r e t h e r a p y and Nine Years P o s t t h e r a p y H o s p i t a l i z a t i o n . " J o u r n a l o f C o n s u l t i n g and C l i n i c a l P s y c h o l o g y . 35 (1970), 417-422. , and W i t t m e r , J . "The E f f e c t s o f T h e r a p i s t Focus on P a t i e n t A n x i e t y Source and t h e I n t e r a c t i o n w i t h t h e T h e r a p i s t L e v e l o f A c c u r a t e Empathy." J o u r n a l o f C l i n i c a l P s y c h o l o g y . 27 (1971), 297-299. ; Wittmer, J . ; and Wargo, D. G. " E f f e c t s o f t h e T h e r a p e u t i c C o n d i t i o n s o f A c c u r a t e Empathy, Nonp o s s e s s i v e Warmth, and Genuineness o f H o s p i t a l i z e d M e n t a l P a t i e n t s D u r i n g Group Therapy." Journal o f C l i n i c a l P s y c h o l o g y , 27 ( 1 9 7 D , 137-142. Warr, P. B., and Knapper, C. The P e r c e p t i o n o f People and E v e n t s . New York: J . W i l e y and Sons, 1968. W e x l e r , D., and B u t l e r , J . " T h e r a p i s t M o d i f i c a t i o n o f C l i e n t E x p r e s s i v e n e s s i n C l i e n t Centered Therapy." Journal o f C o n s u l t i n g and C l i n i c a l P s y c h o l o g y . 44 (1976), 261-265. Winer, B. J . S t a t i s t i c a l P r i n c i p l e s i n E x p e r i m e n t a l D e s i g n . New York: McGraw H i l l , 1971. Y o n t e f , G. "Theory o f G e s t a l t Therapy." I n C. H a t c h e r and P. H i m e l s t e i n The Handbook o f G e s t a l t Therapy. New York: Jason Aronson, 1976. Z i n k e r , Joseph. C r e a t i v e P r o c e s s i n G e s t a l t Therapy. York: Brunner/Mazel, 1977.  New  - 92 -  APPENDIX A  16-PF TEST PROFILE  -  93  -  DO WOT  FACTOR  •  COPY  16 PF TEST PROFILE R aw Score Form A/C/E  Form B/D  Total  Standard Score  .  STANDARD TEN  LOW S C O R E DESCRIPTION  S C O R E (STEN) HIGH S C O R E DESCRIPTION  ••Average  1  3  4  5  -t—•—I  8  7  10  8  \—\-—V  OUTGOING, W A R M H E A R T E D , E A S Y GOING, P A R T I C I P A T I N G (Affectothymla)  A  RESERVED, D E T A C H E D , C R I T I C A L , ALOOF, STIFF (Si zothymla)  B  LESS INTELLIGENT, C O N C R E T E THINKING (Lower scholastic mental capacity)  C  A F F E C T E D BY FEELINGS, E M O T I O N A L .. LY LESS S T A B L E , E A S I L Y U P S E T " ' . C H A N G E A B L E (Lower ego strength)  E  HUMBLE, M I L D , E A S I L Y L E D , D O C I L E , ACCOMMODATING (Submi ssiveness)  F  SOBER, T A C I T U R N , SERIOUS (Desurgency)  G  EXPEDIENT, D I S R E G A R D S R U L E S (Weaker superego strength)  CONSCIENTIOUS, P E R S I S T E N T , M O R A L I S T I C , STAID (Stronger superego strength)  H  SHY, TIMID, T H R E A T - S E N S I T I V E (Threctio)  VENTURESOME, U N I N H I B I T E D , SOCIALLY BOLD (Pormla)  I  TOUGH-MINDED, S E L F - R E L I A N T , REALISTIC (Horrio)  L  TRUSTING, A C C E P T I N G CONDITIONS (Alaxia) PRACTICAL,  M  MORE INTELLIGENT, A B S T R A C T THINKING, BRIGHT (Higher scholostic mental capacity) EMOTIONALLY S T A B L E , M A T U R E , FACES REALITY, CALM (Higher ego strength) ASSERTIVE, A G G R E S S I V E , S T U B B O R N , COMPETITIVE (Dominance) HAPPY-GO-LUCKY. E N T H U S I A S T I C (Surgency) . ,  \ .  O  T  TENDER-MINDED, S E N S I T I V E , CLINGING, O V E R P R O T E C T E D (Premslo) SUSPICIOUS, H A R D TO (Protension)  I  «  -t IMAGINATIVE, BOHEMIAN, ABSENT-MINDED (Autia)  "DOWN-TO-EARTH" CONCERNS (Praxernio)  N  FORTHRIGHT, U N P R E T E N T I O U S , G E N U I N E BUT S O C I A L L Y CLUMSY (Artlessness)  0  SELF-A5SURED, P L A C I D , SECURE, COMPLACENT,SERENE (Untroubled adequacy)  FOOL  ASTUTE, POLISHED, AWARE (Shrewdness)  SOCIALLY  APPREHENSIVE, S E L F - R E P R O A C H ING, I N S E C U R E , WORRYING, T R O U B L E D (Guilt proneness)  '5°  Qi  CONSERVATIVE, R E S P E C T I N G T R A D I T I O N A L IDEAS (Conservatism of temperament)  Q.  GROUP-DEPENDENT, A " J O I N E R " AND SOUND F O L L O W E R (Group odherence)  SELF-SUFFICIENT, RESOURCEFUL, P R E F E R S OWN DECISIONS (Self-sufficiency)  Q,  UNDISCIPLINED SELF-CONFLICT, L A X , F O L L O W S OWN U R G E S , C A R E L E S S OF SOCIAL R U L E S (Low integration)  CONTROLLED, E X A C T I N G W I L L POWER, SOCIALLY PRECISE, COMPULSIVE (High strength of self-sentiment)  Q<  RELAXED, T R A N Q U I L , U N F R U S T R A T E D , COMPOSED (Low ergic tension)  Copyright © 1956, 1973 by the Institute for Porsonolity end A b i l i t y Testing, 1602 Coronado Drive, Champaign, I l l i n o i s . A l l property rights reserved. Printed in U.S.A.  A iten of by about  • Qi-*  EXPERIMENTING, L I B E R A L , FREETHINKING (Radical i sm)  4  Q. 1  2  3  2J%  4.4%  9J%  4 15.0%  5 19.1%  TENSE, F R U S T R A T E D , OVERWROUGHT (High ergic tension)  J 6  19.1%  7 15.0%  8  9  9J%  4.4%  10  It obtalntd adulti  J.3% of  DRIVEN,  DO  -94-  NOT  COPY  APPENDIX B (BARRETT-LENNARD) RELATIONSHIP INVENTORY—FORM OS—64'  Below in  are  relation Please  read  the  each  For  numbered  Mark  statement  each you  feel  mark  following  as  example,  #1,  to  ways  'John  that  every  that  one person  statement ,  statement  sure  of  may f e e l  or  behave  person.  with  provided.  strongly be  a variety  another  consider  relationship space  listed  to  the other  respects  in  it  if  one.  true,  or  Write  i n +3,  to  his or  person's  your  (-resent  h e r name  name w a s J o h n ,  in  the  you  would  person'.  column not  reference  adding  me a s a  the answer  is  with  mentally  on  true, +2,  the in or  +1,  right,  this  according  to  relationship.  -1,  -2,  to  -3,  how Please  stand  for  answers:  +3: Yes, I strongly feel that -it is true.  ~1: No, I feel that it is probably 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 true, or more" true than untrue.  ~3: No, I strongly feel that it is not true.  ANSWR 1.  respects  me a s a  2.  wants  understand  to  3-  's  interest  k.  is  comfortable  5.  feels  6.  _ _ _ _ _  m  a  Y  the 7.  8. 9. 10. 11.  understand  I am f e e l i n g difference that  is  on  ease  for  my w o r d s  happy  the things  in our  on  but  with  Depending  o n my b e h a v i o u r ,  sometimes  than  role  or  exactly  has a t  .  I say or  does  with  not .  .  .  .  do  .  .  .  see .  myself  feels  about  front  with  . makes  me  .  .  .  .  .  .  .  .  me  me  knows  he/she  .  relationship  he/she  or.unhappy  a  .  .  me  t h e way  puts  always  .  . • .  to  impatient  nearly  I see things  I feel  no  I feel  and a t  liking  Whether real  how  .  i n me d e p e n d s  a true  way  person  .  what  I mean  .  .  .  .  has a  better  opinion  of  me  other  times  .  ..  .  J ^  _.  DO  NOT COPY  AUSWl'R 12.  I  feel  that  13.  I  feel  appreciated  ]h.  is  looks  15.  s  1  toward 16.  It  at  .  .  is  18.  usually  19.  wants I  feel  ^  •  '  is  's prevent  23-  I  can  (or  2h.  26.  me  1  s  27-  does  I  feel  30.  does  's pleased other  32.  certain  am  feeling person  expresses  that  the  me  crit/ical  him/her  feel  .  .  .  .  things  I  that  .  .  do  or  just  say  .  me o r .  .  about  me  understands  .  .  .  things  a  .  .  about  like  .  anything  certain  way,  because  . me,  .  and  there  are  other  .  that  is  important  for  our  I  .  of  mean e v e n  .  .  .  toward  . me  me when .  stays  sometimes  and  is  I  . the  have .  .  difficulty .  same:  critical  or  .  .  he/she  in  . • . is  disappointed  times  Sometimes  .  of  differently  likes .  J_ f e e l  feel s  not  what  me  .  .  or_ a p p r e c i a t i v e  he/she  what  .  any  does  exactly  moment  some o f  .  .  .  .  .  feel .  .  uninteresting  toward  view  about  dujl  and  .  I .  .•  .  attitude  outwardly 33-  .  of  that  .  .  .  with  how  .  at  really  avoid  realises  31.  I  kind  usually  disapproves  it  what  .  me  that  saying  .  .  of  on  .  talk .  understanding  he/she  not  point  thinking  think  certain  he/she  relationship 29.  particular  openly  he/she  way  likes  28.  a  thinks  the  .things  be  .  realises  making  Sometimes  .  own  .  ask or  or  and  me t o  me  depend .  me  rather  for  I .  says  from  .  to  attitudes  than  cares  that  be  could)  wants me m o r e  25-  .  .  senses  really  .  when  him/her  without  .  .  feeling  with  his/her  me d o e s n ' t  what  own  from  uneasy  me t o  finds  22.  do  .  indifferent  that  he/she  I  toward  .  genuine  .  .  makes  17.  20.  what  feeling  and  by  him/her  things  real  ignoring  not  at  al1'comfortable  it  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  tolerates  me..  but  we g o .  .  on, .  not at  .  DO NOT COPY  •' - 96.-  • ANSllER  35.  36.  If or  t show t h a t I am a n g r y w i t h a n g r y w i t h me, t o o . . .  expresses w i t h me . . '  37. 38. or  s  his/her true . . . .  friendly  just feci  kO.  At times I sense that r e a l l y f e e l i n g w i t h me  kl. feel 43. of kk.  h e / s h e becomes . . . . .  hurt . .  i m p r e s s i o n s and f e e l i n g s . . . . . . . . . .  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 • • _• • • • • , • » *  How much anything that  f feel  .  I  . .  appreciates exactly t o me . . . .  by  i s not aware o f what he/she . . •. . . . . . .  t h a t _ _ _ _ _ r e a l 1 y v a 1 u e s me  of  .  think • •  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 I t e l l him/her about myself . .  approves others  .  a n d warm w i t h me  39.  *»1.  .  .  .  how t h e t h i n g s . .  some t h i n g s  I do,  .  I .  .  .  is  .  experience . .  and p l a i n l y d i s a p p r o v e s . . . .  . i s w i l l i n g to express whatever is a c t u a l l y in his/her mind 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 doesn't  45.  1 i k e me f o r  myself  .  .  .  .  .  .  .  .  46.  At times a particular  47.  W h e t h e r I h a p p e n t o be i n g o o d 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 m o r e o r l e s s a p p r e c i a t i v e o f me .  kB.  •  kS.  I seem t o  50. things  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 t h i n g than I r e a l l y do . . . . .  .  is openly  himself/herself  irritate  in our  and b o t h e r  relationship .  .  .  .  .  about  .  .  .  .  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 we d i s c u s s . . ; . . . . .' . . . .  the .  51.  Whether the i d e a s and f e e l i n g s seems t o make n o d i f f e r e n c e t o  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 outward response 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 neath . . . . . . . . . . . .  53-  feels  5*1.  u n d e r s t a n d s me  55-  contempt  I express are "good" or "bad" ' s f e e l i n g t o w a r d me  f o r me  S o m e t i m e s I am m o r e w o r t h w h i l e at other times . . . . .  in .  .  .  's .  eyes than . . .  I am . .  DO NOT COPY  -  -97  ANSWER 56.  doesn't feels  with  57 • 58. that 59-  feels I  interested  in  me  .  .  .  .  usually  so  the  also  to  to  deep or  people  provide  me  is  get  through  me o f t e n  feeling  to  gives  at  affection  the for  upset  fixed  .  me  think  upset  of  feels  me d o e s toward  following  he/she  . .  .  .  .•  ,  automatic  .  .  .  .  .  changes . . .  .  impression  of  .  his/her  .  .  recognise  .  my  .  .  .  .  .  feelings  too  • has f e e l i n g s causing d i f f i c u l t y  the  . .  and  him/her  a wrong  that  .  time  can  becoming  way  I believe that about that are  Please  .  without  other  affect 6k.  ,  or  am h u r t  exactly, What  .  t h a t a n y t h i n g I say o r do r e a l l y f e e l s t o w a r d me . . . . .  thought  61.  63.  .  says  total  When  .  really  think  himself/herself  .  response  don't  .  from  .  's I  anything .  truly  V/hat  62.  .  is  I don't t h e way  60.  hide  me  (or me  would, .  he/she in our  information  .  if . '  he/she '.  .  knew)  .  d o e s n o t t e l l me relationship . .  about  yourself  and  .  the  other  person.  Yourself Age:  Other Person years  years  (known  or  estimated) (M o r  Sex:  [H or F)  F)  Occupation:  Position  in  this  pel at ionsh i p .  C1i ent/or  Examples:  Fr iend Actual : (Please  Mother  bon  f i l l  in)  pat Lent >  Counsellor (Best)  (therapist)  Friend  APPENDIX C  SHORT FORM OF THE EXPERIENCING SCALE  STAGE  CONTENT  1  E x t e r n a l events; participate.  2  External 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 ion.  refusal to  TREATMENT I m p e r s o n a l , detached. Interested, personal, self-participation.  Personal reactions t o external Reactive, events; l i m i t e d s e l f - d e s c r i p t - involved. ions; behavioural descriptions of f e e l i n g s  emotionally  4  D e s c r i p t i o n s o f f e e l i n g s and personal experiences  Self-descriptive; associative.  5  Problems o r p r o p o s i t i o n s about f e e l i n g s and p e r s o n a l experiences.  Exploratory, elaborative, hypothetical.  Synthesis o f r e a d i l y accessible f e e l i n g s and e x p e r i e n c e s t o resolve personally significant issues  F e e l i n g s v i v i d l y expressed, i n t e g r a t i v e , conclusive or a f f i r m ative.  F u l l , easy p r e s e n t a t i o n o f experiencing; a l l elements confidently integrated.  Expansive, i l l u m i n a t ing, confident, buoyant.  Reference: K l e i n , M. H.; M a t h i e u , P. L.; G e n d l i n , E. T.; and K i e s l e r , D. J . , The E x p e r i e n c i n g S c a l e (Madison, W i s c o n s i n : W i s c o n s i n P s y c h i a t r i c I n s t i t u t e , 1969), p. 42.  -  99  -  APPENDIX D  QUESTIONNAIRE A (Immediately  preceding t h e experimental  session)  B r i e f l y d e s c r i b e the i s s u e t h a t you wish t o work on:  On each o f t h e s c a l e s below, p l e a s e i n d i c a t e w i t h an ( x ) , your present p o s i t i o n : 1.  P l e a s e i n d i c a t e , by checking one o f t h e boxes below, how much t h e i s s u e you d e s c r i b e d above bothers you now: I—I c o u l d n ' t be worse v e r y much p r e t t y much a  little  riot a t a l l  2.  My i n n e r f e e l i n g s Good  (what i t ' s l i k e  inside): Bad  Tense  Relaxed  Clear  Hazy  - 100 -  APPENDIX E  QUESTIONNAIRE B (Immediately a f t e r t h e e x p e r i m e n t a l s e s s i o n )  On each o f t h e s c a l e s below, p l e a s e i n d i c a t e y o u r p r e s e n t p o s i t i o n w i t h an "X". My i n n e r f e e l i n g s (what i t ' s l i k e Good  inside):  -  Bad  Tense  Relaxed  Clear  Hazy  Was t h e i s s u e t h a t you worked on d u r i n g t h e hour t h e same o r s i m i l a r t o t h e i s s u e t h a t you brought i n ? ( C i r c l e one)  3.  Very d i f f e r e n t  Different  Related  Similar  Same  1  2  3  4  5  P l e a s e i n d i c a t e , by c h e c k i n g one o f t h e boxes below, how much t h e i s s u e w h i c h you i d e n t i f i e d b e f o r e t h e hour b o t h e r s you now: c o u l d n ' t be worse v e r y much p r e t t y much a  little  not a t a l l  -101  How r e s o l v e d today?  -  do you f e e l about t h e i s s u e you worked  totally somewhat  on  resolved resolved  not a t a l l r e s o l v e d  How do you f e e l about t h e hour w h i c h you have j u s t completed? ( P l e a s e c i r c l e t h e one answer w h i c h b e s t applies): 1. 2. 3. 4. 5. 6. 7.  Perfect Excellent V e r y good P r e t t y good Fair P r e t t y poor V e r y poor  How w e l l d i d your t h e r a p i s t seem t o u n d e r s t a n d what you were f e e l i n g and t h i n k i n g t h i s s e s s i o n ? My t h e r a p i s t : 1. 2. 3. 4. 5.  Understood e x a c t l y how I thought and f e l t . Understood v e r y w e l l how I t h o u g h t and f e l t . Understood p r e t t y w e l l , but t h e r e were some t h i n g s he/she d i d n ' t seem t o g r a s p . D i d n ' t u n d e r s t a n d t o o w e l l how I t h o u g h t and felt. M i s u n d e r s t o o d how I t h o u g h t 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. 2. 3. 4. 5. 6.  Completely h e l p f u l Very h e l p f u l Pretty helpful Somewhat h e l p f u l Slightly helpful Not a t a l l h e l p f u l  - 102 -  APPENDIX F  QUESTIONNAIRE C (Three hours a f t e r t h e e x p e r i m e n t a l s e s s i o n )  1.  a)  D i d you i n c r e a s e your awareness o f y o u r s e l f as a r e s u l t of the counselling session? ( C i r c l e one): 1 Definitely no  b)  3 Unsure  4 Think so  5 Definitely yes  D i d you have a s h i f t o f awareness i n t h e 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 , e x p e r i e n c e d something f r e s h l y , made some d i s c o v e r y about y o u r s e l f , o r became aware of new c h o i c e s ) : 1 Definitely no  c)  2 Don't t h i n k so  2 Don't t h i n k so  3 Unsure  4 Think so  5 Definitely yes  I f s o , what was t h e s h i f t ? P l e a s e d e s c r i b e what happened and how you see y o u r s e l f o r t h e w o r l d differently:  2.  From t h i s p e r s p e c t i v e , a r e t h e r e any g e n e r a l t h i n g s about y o u r s e l f o r your l i f e t h a t you would l i k e t o change?  3.  a)  From t h i s g e n e r a l 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 b e h a v i o u r would you hope t o change i n t h e coming week? P l e a s e i n d i c a t e t h e s i t u a t i o n i n w h i c h you w i s h t h i s change t o o c c u r . ( F o r example, " c r i t i c i z e m y s e l f l e s s about my appearance", "spend more t i m e w i t h my f a m i l y i n t h e e v e n i n g s " , " d i s c u s s my f e e l i n g s w i t h my b o y f r i e n d " , " a s s e r t m y s e l f more a t t h e o f f i c e " , "be aware o f t h e moments when I a c t 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 e x p e r i e n c i n g y o u r s e l f o r behaving i n t h i s way i n t h e l a s t w h i l e ? 1. 2. 3. 4. 5• 6. 7.  Not a t a l l Hardly ever Seldom Sometimes Frequently Most o f t h e t i m e A l l o f t h e time  How o f t e n would you l i k e t o see t h i s e x p e r i e n c e < b e h a v i o u r o c c u r r i n g i n t h e coming week? 1. 2. 3. 4. 5. 6. 7.  Not a t a l l H a r d l y ever Seldom Sometimes Frequently Most o f t h e t i m e A l l o f t h e time  - 104 -  APPENDIX G  QUESTIONNAIRE D (One week a f t e r t h e e x p e r i m e n t a l s e s s i o n )  1.  B r i e f l y d e s c r i b e t h e i s s u e t h a t you i d e n t i f i e d the l a s t session:  before  2.  P l e a s e i n d i c a t e , by c h e c k i n g one o f t h e boxes below, how much t h i s i s s u e b o t h e r s you now: c o u l d n ' t be worse v e r y much p r e t t y much a little not a t a l l  3.  How r e s o l v e d do you f e e l about t h e i s s u e you d i d work on? t o t a l l y resolved somewhat r e s o l v e d not a t a l l r e s o l v e d  4  D u r i n g t h e p a s t week, have you e x p e r i e n c e d a change i n y o u r s e l f w h i c h you a t t r i b u t e t o t h e c o u n s e l l i n g s e s s i o n ? ( C i r c l e one):  - 105 -  1 Definitely no 5.  2 Don't t h i n k so  3 Unsure  4 Think so  5 Definitely yes  A f t e r t h e l a s t hour, you i n d i c a t e d t h a t you hoped t h a t t h e f o l l o w i n g f e e l i n g o r b e h a v i o u r would change d u r i n g the week: How o f t e n a r e you e x p e r i e n c i n g y o u r s e l f behaving way now? 1. 2. 3. 4. 5. 6. 7.  6.  Not a t a l l H a r d l y ever Seldom Sometimes Frequently Most o f t h e time A l l o f t h e time  How much p r o g r e s s 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 t h e l a s t hour? ( P l e a s e c i r c l e t h e i t e m which best a p p l i e s ) : 1. 2. 3. 4. 5.  7.  this  A great d e a l o f progress Considerable progress Moderate p r o g r e s s Some p r o g r e s s D i d n ' t g e t anywhere  Has a n y t h i n g u n u s u a l happened d u r i n g t h e week o t h e r t h a n t h e hour t o which you a t t r i b u t e any change you have r e p o r t e d ? I f s o , what?  

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