Open Collections

UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Empathy, client depth of experiencing, and goal attainment scaling : a within-session examination of… Colistro, Frank Peter 1977

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Notice for Google Chrome users:
If you are having trouble viewing or searching the PDF with Google Chrome, please download it here instead.

Item Metadata

Download

Media
831-UBC_1978_A2 C65.pdf [ 6.43MB ]
Metadata
JSON: 831-1.0054605.json
JSON-LD: 831-1.0054605-ld.json
RDF/XML (Pretty): 831-1.0054605-rdf.xml
RDF/JSON: 831-1.0054605-rdf.json
Turtle: 831-1.0054605-turtle.txt
N-Triples: 831-1.0054605-rdf-ntriples.txt
Original Record: 831-1.0054605-source.json
Full Text
831-1.0054605-fulltext.txt
Citation
831-1.0054605.ris

Full Text

EMPATHY, CLIENT DEPTH OF EXPERIENCING, AND GOAL ATTAINMENT SCALING: A WITHIN-SESSION EXAMINATION OF THE CLIENT-CENTERED THERAPY PROCESS by Frank Peter C o l i s t r o B.A., Portland State University, 1972 M.A., Portland State University, 1973 A THESIS SUBMITTED. IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF EDUCATION i n the department of COUNSELLING PSYCHOLOGY FACULTY OF EDUCATION We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA September, 1977 J©L_F?.?n.H ?^sr.. C o l i s. 1^°.» 1 9 7 7  In p r e s e n t i n g t h i s t h e s i s in p a r t i a l f u l f i l m e n t of the requirements f an a d v a n c e d d e g r e e at the U n i v e r s i t y o f B r i t i s h Columbia, I agree tha t h e L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r reference and study. I f u r t h e r a g r e e t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g of th i s thes is f o r s c h o l a r l y p u r p o s e s may be g r a n t e d by the Head of my Department or by h i s r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d that copying or p u b l i c a t i o n of th is t h e s i s f o r f i n a n c i a l g a i n s h a l l not be a l l o w e d without my w r i t t e n p e r m i s s i o n . Department o f Counselling Psychology, Education 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 Place Vancouver, Canada V6T 1W5 Date November 15, 1977 ABSTRACT This i s an analogue study of process and outcome i n c l i e n t - c e n t e r e d therapy focusing c h i e f l y on empathy. Therapist experienced, therapist communicated, and c l i e n t received empathy were i n t e r r e l a t e d , and t h e i r impact on c l i e n t depth of experiencing and problem r e s o l u t i o n was examined. T h i r t y subjects engaged i n one session of Client-Centered treatment i n which they dealt with " s p l i t s " , i n t e r n a l c o n f l i c t s characterized by personal incongruence.. Before the sessions the subjects prepared a Goal Attainment Scale, which s p e c i f i e d f i v e personalized stages of behavioral and a f f e c t i v e change regarding the s p l i t . During sessions audio recordings were made which were, l a t e r rated for therapist communicated empathy and c l i e n t depth of experiencing. Subjects also rated therapist empathy, and seven days l a t e r they assessed change on t h e i r Goal Attainment Scales. Session scores for therapist experienced empathy, therapist communicated empathy, c l i e n t received empathy,. c l i e n t depth of experiencing, and t r e a t -ment outcome were then i n t e r c o r r e l a t e d and analyzed i n a manner analogous to path a n a l y s i s . A s i m i l a r process was applied to the combined r e s u l t s of s i m i l a r research, and the path generated from t h i s i n t e g r a t i v e summary and the r e s u l t s of the present study were compared to gain a c l e a r e r perspective on the causal flow among the process and outcome v a r i a b l e s . As w e l l , scores on the three empathy phases were compared f o r therapists across the two subjects they interacted with, and the i n t e r a c t i o n of therapist communicated empathy and c l i e n t depth of experiencing was examined by a content a n a l y s i s of each session. The path r e s u l t s suggest that therapist empathic communications lead to c l i e n t perceptions of therapist empathy, which d i r e c t l y f a c i l i t a t e s t r e a t -ment outcome. C l i e n t depth of experiencing was remote from the empathy - i i -phases and outcome, f a i l i n g to demonstrate that experiencing i s an i n t e r -vening v a r i a b l e between therapist empathy and outcome, These r e s u l t s are tentative since only one c o r r e l a t i o n , communicated by received empathy, was s i g n i f i c a n t at .05. However the pattern i s highly supported: by the r e l a t i o n s among empathy, experiencing, and outcome derived from the ±n~ tegrative summary. The content analysis of therapist communicated empathy and c l i e n t depth of experiencing suggested that c l i e n t self-expression and exploration can be i n h i b i t e d by therapists making an excessive number of r e f l e c t i o n s based on inaccurate or i n s u f f i c i e n t understanding of the c l i e n t . This implied that there are some cases i n which empathy and experiencing may be causally r e l a t e d , although t h i s causal linkage i s not consistent when examined across a l l c l i e n t - t h e r a p i s t i n t e r a c t i o n . Comparison of the c o r r e l a t i o n s between the three empathy phases and process and outcome measures, i n conjunction with the c o r r e l a t i o n s among the phases, suggested that the phases were r e l a t e d but d i s t i n c t constructs. Therapist experienced empathy appeared to be a r e l a t i o n s h i p v a r i a b l e that was e s s e n t i a l l y unrelated to treatment process and outcome. Therapist communicated empathy and c l i e n t received empathy were r e l a t i v e l y stable across c l i e n t s , suggesting that these v a r i a b l e s r e f l e c t therapist t r a i t empathy. Of the three phases, c l i e n t received empathy was most strongly p r e d i c t i v e of treatment outcome. Overal l , the study suggests that, within f i r s t sessions of c l i e n t -centered treatment, therapist empathic communications are r e l a t e d to the c l i e n t ' s perceptions of the therapist's empathy l e v e l i n the r e l a t i o n s h i p . Thses perceptions i n turn p o s i t i v e l y influence treatment outcome. Changes i n the l e v e l of c l i e n t depth of experiencing may also be affected to a minor degree by communicated empathy, but experiencing does not appear to - i i i -powerfully influence the treatment process at t h i s early stage. The r e s u l t s suggest that c l i e n t received empathy, being the empathy phase most p r e d i c t i v e of treatment outcome, should be the phase most highly stressed i n client-centered treatment. Frequent CRE ratings could f u r n i s h the therapist with a valuable index of the e f f i c a c y of the treatment process. A further i m p l i c a t i o n f o r t r a i n i n g of Rogerian therapists i s that the over-a l l concept of empathy encompasses therapist verbal and k i n e s i c actions beyond the scope of scales measuring communicated empathy, the empathy phase most often stressed in>the t r a i n i n g process. F i n a l l y , t h i s study points to the p o t e n t i a l value of an extensive meta-analysis of client-centered treatment ..research which would q u a n t i t a t i v e l y integrate and summarize the extant findings regarding t h i s school of psycho-therapy . -IV-•TABLE OF CONTENTS ( Page Acknowledgements ± Abstracts -^j. Chapter One: The Scope of the Study 1 Background of the Problem 1 The Research Problem 3 D e f i n i t i o n of Terms 5 Statement of the Hypotheses 6 Pattern Hypotheses 6 Segment-by-Segment Hypothesis Concerning the Relationship of Therapist Communicated Empathy to Depth of Experiencing 7 S t a b i l i t y Hypothesis Concerning the Three Empathy Phases f o r Therapists Across Subjects 7 Rationale f o r the Hypotheses 8 Assumptions II Del i m i t a t i o n 11 J u s t i f i c a t i o n for the study 12 Chapter Two: Survey of the L i t e r a t u r e 14 The Integrative Summary of Previous Research 23 Issues Relating to Client-Centered Therapy 29 Chapter Three: Methodology Formal Hypotheses Hypothesis Testing 34 36 38 -v-Page Therapists 39 Subjects 39 Instruments 40 Secondary Data Sources 45 Procedure 46 Design 48 Chapter Four: Results 51 Staggered Correlations of Therapist Communicated Empathy and C l i e n t Depth of Experiencing 53 Examination (Session One by Session Two) of the Three Empathy Phases and Depth of Experiencing 54 Results of Hypothesis Tests 55 Pattern Suggested by the Data 57 Qu a l i t a t i v e Results: Descriptive Analysis of the Therapist Communicated Empathy by C l i e n t Depth of Experiencing Relationship 61 Divergence 61 Chapter Five: Discussion 68 Is empathy a unitary construct? 68 Therapist empathy: state or t r a i t ? 75 Empathy: What i s the Most Useful Operational D e f i n i t i o n ? 76 Cl i e n t Depth of Experiencing: State or Trai t ? 77 How i s C l i e n t Process Best Predicted? 78 How do Empathy and Experiencing Interrelate? 79 How i s Treatment Outcome Best Predicted? 80 What i s the Overa l l Statement of Client-Centered Therapy Process Supported by the Study? 81 The Role of Congruence Limitations Chapter Six: Conclusion Implications Theory Pr a c t i c e Research Summary Bibliography Appendix A Appendix B Appendix C - V l l -LTST OF FIGURES Page Figure 1: The Client-Centered Therapeutic Process 3 Figure 2: Expected Pattern to be Derived from I n t e r c o r r e l a t i o n of Five Main Variables 6 Figure 3: Data from Table 1 Applied to the Main Variables 26 Figure 4: The Data from Table 1 Applied to C o r r e l a t i o n a l Analysis with Main Variables 28 Figure 5: The Ten C o r r e l a t i o n a l Paths Among the Main Variables 35 Figure 6: The Research Process 48 Figure 7: Path Arrangement of Data from the Main Analysis 58 Figure 8: F i n a l Path Arrangement Derived from Study Data 60 Figure 9: Divergence Pattern 62 Figure 10: Relations among Empathy Phases from Data of the Present Study 69 Figure 11: Relations among Empathy Phases from Summary Data of Previous Research 70 Figure 12: The Relationship of the Three Phases of Empathy to Cl i e n t Depth of Experiencing From Summary Data of Previous Research 70 Figure 13: The Relationship of the Three Phases of Empathy to ' Treatment Outcome from Summary Data of Previous Research 71 Figure 14: The Relationship of the Three Phases of Empathy to C l i e n t Depth of Experiencing from the Data of This Study. 72 - V l l l -LIST OF FIGURES CON'T Page Figure 15: The Relationship of the Three Phases of Empathy to Treatment Outcome from the Data of This Study 72 Figure 16: The In t e r r e l a t i o n s h i p s among Therapist Communicated Empathy, C l i e n t Received Congruence, C l i e n t Received Empathy, and Treatment Outcome. 86 - i x -LIST OF TABLES Table One Table Two Table Three Table Four Table Five Table Six Table Seven Table Eight : T Table Nine Table Ten Matrix of the Findings from Other Studies Issues Relating to Client-Centered Therapy Description of Therapists Description of Subjects I n t e r c o r r e l a t i o n s among the Empathy Phases, Depth of Experiencing, Outcome, and Four Secondary Variables Staggered Correlations of Therapist Communicated Empathy and C l i e n t Depth of Experiencing Session by Session Correlations of Process Variables - Tests f o r Therapist Experienced Empathy, Therapist Communicated Empathy, C l i e n t Received Empathy, and C l i e n t Depth of Experiencing Correlations among CRC, TCE, CRE, and TO T - Tests of CRC by CRE, and CRC (Session One by Session Two). Page 25 31-33 39 40 52 53 54 55 84 85 -X-ACKNOWL EDGEMENTS I would l i k e to thank Dr. L e s l i e Greenberg and the other members of my thesis committee f o r t h e i r patience, support and guidance. Thanks also to Daniel Naegeli, Brian Harper, Adam Horvath, and Catherine Clarke fo r t h e i r assistance i n the execution and data analysis phases of t h i s study. A f i n a l thank you i s addressed to my parents f o r t h e i r moral support throughout nine years of u n i v e r s i t y . -1-CHAPTER ONE  The Scope of the Study Background of the Problem Empathy i s a construct of major importance i n psychotherapy research. I t i s also a construct which i s s t i l l obscured by controversies regarding i t s d e f i n i t i o n and value. Empathy was f i r s t investigated i n depth by Carl Rogers (1951, 1957). He wrote that three "core" therapeutic conditions: genuineness, empathy, and warmth, inhered i n a l l successful therapy and were necessary and suf-f i c i e n t conditions for p o s i t i v e c l i e n t change. Rogers believed t h i s true not only for client-centered therapy but also for treatments based on a l l other t h e o r e t i c a l o r i e n t a t i o n s . He described empathy as a focusing on the c l i e n t ' s phenomenal world. This focusing on or immersion i n the c l i e n t ' s thoughts and f e e l i n g s was i n fa c t the source of the term " c l i e n t centered". Meador and Rogers wrote regarding empathy: The therapist attempts to "get into the shoes" of his c l i e n t , to get "under his skin". He not only l i s t e n s to the c l i e n t ' s words, but he immerses himself i n h i s world. His comments r e f l e c t not only what the c l i e n t i s saying, but also r e f l e c t the hazy area at the edge of the c l i e n t ' s awareness. Through the therapist's communicating his understanding of the c l i e n t ' s f e l t meanings not yet conceptualized into awareness, the c l i e n t broadens his understanding of himself and allows into awareness more of h i s organismic experiencing. The confirmatory experience of f e e l i n g understood seems .12 -2-to give substance and power to the c l i e n t ' s expanding self-concept. It i s as though the c l i e n t affirms, " I t ' s o.k. to be me, even t h i s tentative new me which i s emerging." The therapist does not focus on the present experiencing of the c l i e n t ' s world i n order to make an i n t e r p r e t a t i o n or diagnosis. He believes that i t i s the experience of f e e l i n g understood i t s e l f which e f f e c t s growthful change (Meador & Rogers, 1973, p. 138). Others have supported Roger's hypothesis. Several researchers have focused on therapist communicated empathy as an important therapeutic condition (Carkhuff, 1973; Carkhuff & Berenson, 1967; G a r f i e l d & Bergin, 1971; Gurman, 1973; Truax, 1965; 1972), and have developed methods of r a t i n g therapist communicated empathy from video and audio tapes of therapy sessions, and of r a t i n g therapist empathic understanding or experiencing from therapist s e l f - r e p o r t inventories (Barrett-Lennard, 1963; 1974). During the years since Rogers' o r i g i n a l work several i n t e r e s t i n g and provocative issues have received attention i n the c l i e n t - centered l i t e r a -ture. 1. Is empathy a therapist t r a i t or a b i l i t y which i s stable at a s p e c i f i c l e v e l and which can be measured outside of treatment, or does therapist empathy vary sharply as a function of some q u a l i t i e s of the p a r t i c u l a r r e l a t i o n s h i p and situation? 2. How i s empathy best measured? 3. Is empathy a unitary construct? 4. How does therapist empathy r e l a t e to therapy process and outcome? ./3 -3-These issues s t i l l require empirical and conceptual c l a r i f i c a t i o n , and the present study seeks to provide both these types of c l a r i f i c a t i o n , p r i m a r i l y f or issue number four. S p e c i f i c a l l y , the study f i r s t discusses the t h e o r e t i c a l model of the client-centered treatment process. This model i s also examined by means of a quantitative summary of previous re-search. F i n a l l y , data on empathy, c l i e n t process, and outcome are generated by means of a laboratory analog of the f i r s t session of client-centered treatment. The pattern of the i n t e r r e l a t i o n s of these v a r i a b l e s i s then compared to the pattern suggested by client-centered theory and previous research. Tangential questions r e l a t i n g to empathy such as issues one to three on the previous page are also discussed i n l i g h t of the r e s u l t s of t h i s study and previous fi n d i n g s . In these ways the study presents c l i e n t -centered treatment examined within sessions and tests the e f f i c a c y of i t s findings by comparing them to theory and to re l a t e d research. The Research Problem A client-centered view of process i n psychotherapy i s represented by the following flowchart: A B therapist exper-iences empathy for the c l i e n t D therapist commun-icates empathy to the c l i e n t c l i e n t receives therapist com-municated em-pathy c l i e n t depth of s e l f - e x -periencing i s enhanced c l i e n t exper-iences p o s i t i v e change Figure 1. The Client-Centered Therapeutic Process Barrett-Lennard (1974) r e f e r s to parts A, B, and C i n t h i s s e r i e s as 7 4 -4-the "empathy cycle " . The cycle s t a r t s with the therapist a c t i v e l y attend-ing to the c l i e n t who i s i n some way expressing h i s unique experiencing (A). The therapist r e f l e c t s the c l i e n t ' s experiencing i n such a way that ov e r t l y or covertly expressed aspects of i t are enhanced (B). The c l i e n t i s attending to the therapist's response s u f f i c i e n t l y f o r him to perceive the extent of the therapist's immediate personal understanding (C). The c l i e n t then continues expressing himself i n a manner n o t i c -ably enriched by the therapist's empathic r e f l e c t i o n s (D). This study en-deavors to examine the p r i n c i p a l components to the empathy cycle and t h e i r r e l a t i o n s h i p to c l i e n t depth of experiencing and treatment outcome (E). ./5 -5-D e f i n i t i o n of Terms Therapist experienced empathy (A) has been defined by Rogers (.1957) as sensing "the c l i e n t ' s world as i f i t were your own, but without l o s i n g the "as i f " q u a l i t y . . . t o sense the c l i e n t ' s anger, fear, or confusion as i f i t were your own, yet without your anger, fear, or confusion getting bound up i n i t . . . " (p. 99). In t h i s study, l e v e l of therapist experienced empathy i s operationally defined as a score on the therapist form of the Barrett-Lennard Relationship Inventory (BLRI), (Barrett-Lennard, 1963). Therapist communicated empathy (B) i s the degree to which therapist statements r e f l e c t empathic understanding, and i s measured by Carkhuff's (1969) f i v e point scale f or measuring empathy from tapes. C l i e n t received empathy (C) i s the degree to which the c l i e n t f e e l s understood by the therapist. I t i s operationally defined as a score on the BLRI ( c l i e n t form). C l i e n t depth of experiencing (D) i s defined as the degree to which c l i e n t statements evidence a willingness and a b i l i t y to explore personally relevant f e e l i n g s and thoughts, and i s operationally defined as a score on the Experiencing (EXP) Scale (Klein, Mathieu, Gendlin, & K i e s l e r , 1969). Treatment outcome (E) i s assessed through the l e v e l of success i n treatment as measured by Goal Attainment Scaling (GAS), a technique i n which c l i e n t and therapist c o n j o i n t l y set goals and devise a f i v e l e v e l scale describing the degree of achievement of these as a r e s u l t of therapy (Kiresuk & Sherman, 1974). .76 -6-Statemerit of the Hypotheses The hypotheses w i l l be presented i n formal fashion i n the methoda-logy section of the th e s i s . Following are the i r e s s e n t i a l intents. Pattern Hypotheses The f i r s t set of hypotheses deals with the p r i n c i p a l focus of the study; the pattern of i n t e r a c t i o n among the three empathy phases, depth of experiencing, and treatment outcome. The expected o v e r a l l pattern formed by the c o r r e l a t i o n s of the f i v e main v a r i a b l e s i s i l l u s t r a t e d i n Figure 2. Figure 2. Expected Pattern to be Derived from I n t e r c o r r e l a t i o n of Five Main Variables. The main hypotheses a r i s i n g from t h i s pattern are: 1. It i s predicted that c l i e n t received empathy (CRE)- w i l l be the strongest p o s i t i v e s i g n i f i c a n t c o r r e l a t e of treatment outcome (TO). 2. I t i s predicted that therapist communicated empathy (TCE) w i l l be the strongest p o s i t i v e , s i g n i f i c a n t c o r r e l a t e of c l i e n t received empathy (after treatment outcome). 3. It i s predicted that therapist communicated empathy w i l l be the strong-est p o s i t i v e , s i g n i f i c a n t c o r r e l a t e of depth of experiencing (EXP). 4. I t i s predicted that therapist experienced empathy (TEE) w i l l be p o s i t i v e -l y and s i g n i f i c a n t l y r e l a t e d to therapist communicated empathy, and that the TEE by TCE c o r r e l a t i o n w i l l be s i g n i f i c a n t l y stronger than the -EXP ,,.11 -7-c o r r e l a t i o n s between TEE and CRE, EXP, or TO. Segment-by-Segment Hypothesis Concerning the Relationship of Therapist Communicated Empathy to Depth of Experiencing Therapist communicated empathy and depth of experiencing are c o r r e l a t e d i n the main analysis by using TCE and EXP scores averaged within segments. In a further a n a l y s i s , however, TCE and EXP ratings are correlated using i n d i v i d u a l scores from each four-minute segment of the 30 experimental sessions. This was done to increase accuracy by producing a c o r r e l a t i o n c o e f f i c i e n t based on a large n including a l l possible data points. A further analysis involved c o r r e l a t i n g a l l the EXP segment scores ^ with TCE scores from preceeding and following segments. The complete r a t i o n a l e f o r these a d d i t i o n a l analysis components i s contained i n the Design section of the Methodology chapter. The hypothesis which deals with these analyses i s : It i s predicted, that the c o r r e l a t i o n of TCE and EXP ratings i n the same segment w i l l be s i g n i f i c a n t l y greater than TCE by EXP c o r r e l a t i o n s derived from staggering segment TCE scores ahead or lack of time within sessions. S t a b i l i t y Hypothesis Concerning the Three Empathy Phases for Therapists Across Subjects Disagreement e x i s t s over whether therapist experienced, communicated, and c l i e n t received empathy are p r i m a r i l y therapist t r a i t s or r e l a t i o n -ship v a r i a b l e s . Since each therapist i n the study interacted with two ./8 n — o — subjects, the t r a i t - s t a t e issue i s addressed by computing _t - scores f o r the two sets of three empathy measures generated by the two interviews conducted by the therapist. The following hypotheses deal with t h i s phase of a n a l y s i s : 6. I t i s predicted that the subject one-by-subject two comparison of therapist experienced empathy w i l l y i e l d a s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e . 7. It i s predicted that the subject one-by-subject two comparison of therapist communicated empathy w i l l y i e l d a s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e . 8. It i s predicted that the subject one-by-subject two comparison of c l i e n t received empathy w i l l y i e l d a s t a t i s t i c a l l y s i g n i f i c a n t d i f -ference. Rationale for the Hypotheses The hypotheses follow from client-centered theory which suggests that experienced empathy, communicated empathy, c l i e n t received empathy, depth of experiencing, and treatment outcome are p o s i t i v e l y r e l a t e d . A therapist's i n t e r n a l experiencing of the c l i e n t ' s thoughts, f e e l i n g s , and behaviors should lead to accurate empathic r e f l e c t i o n s . These communications, i f received by the c l i e n t , tend to enhance the p r o b a b i l i t y of successful treatment outcome. They also are thought to enhance c l i e n t expressions of personal thoughts and f e e l i n g s . Research has shown that therapist communicated empathy and c l i e n t received empathy can be p o s i t i v e l y r e l a t e d to outcome (Kurtz & Grummon, 1972), and that communicated empathy and depth of experiencing can be .19 -9-p o s i t i v e l y i n t e r r e l a t e d . . However, these r e l a t i o n s h i p s have not been con s i s t e n t l y demonstrated. I t i s these r e l a t i o n s h i p s which are the focus of th i s study. An often successful means of improving on previous research i s to examine suggestions made by researchers i n re l a t e d studies. A search of th i s type through the l i t e r a t u r e r e l a t i n g therapist communicated empathy and c l i e n t depth of experiencing to treatment outcome yielded f r u i t f u l r e s u l t s , four recommendations appearing c o n s i s t e n t l y . One concerned the measurement of therapist communicated empathy and depth of experiencing. Researchers suggested that these variables could vary considerably i n l e v e l within the therapy hour. They therefore recom-mended that TCE and EXP would most accurately be measured by minute-by-minute ratings rather than by the usual procedure of extracting and r a t i n g only two or three sample segments of the va r i a b l e s i n a treatment session (Beutler, 1973; Kurtz and Grummon, 1973; K i e s l e r , K l e i n and Mathieu, 1965; Mintz and Luborsky, 1971). Another recommendation concerned the assessment of treatment outcome. Researchers pointed to the ever-present problem i n psychotherapy research of f i n d i n g s e n s i t i v e , responsive instruments with which to discern c l i e n t progress. They tended to downplay the value of global outcome measures such as the MMPI, p r e f e r r i n g more c l i e n t - s p e c i f i c measures which allow themselves to be t a i l o r e d to the i n d i v i d u a l c l i e n t ' s goals (Bergin and Suinn, 1975; G a r f i e l d and Bergin, 1971; Luborsky and Spence, 1971). A t h i r d suggestion arose from the fac t that most research on the client—centered treatment process has been conducted i n the form of l o n g i -tudinal studies of actual therapy. This p r a c t i c e has augmented the genera-l i z a b i l i t y of the research but has also allowed for considerable error ./10 -10-variance inasmuch as exact treatment interventions, nature of presenting problem and treatment duration were often not f i x e d . Researchers there-fore have recommended that these factors be held constant as much as possible (Clarke, 1977; Greenberg, 1976; K l e i n , et a l . , 1969). A f i n a l recommendation has come mainly from the research of Rappaport and Chinsky (Chinsky and Rappaport, 1970; Rappaport and Chinsky, 1971). They advocated the use of as many therapists as possible i n studies of communicated empathy to protect against rater bias. That i s , having a number of therapists generate hundreds of rateable segments e f f e c t i v e l y eliminates the p o s s i b i l i t y that empathy raters w i l l recognize therapists from voice or s t y l e , and thus develop a response set to p a r t i c u l a r thera-p i s t s . The importance and nature of c l i e n t depth of experiencing as an intervening v a r i a b l e which leads to p o s i t i v e change i n treatment are much debated issues. K l e i n et a l . (1969) c i t e d numerous findings that show a high l e v e l of experiencing as being associated with p o s i t i v e therapy out-come, but no s i g n i f i c a n t trend of improvement i n experiencing from be-ginning to end of successful therapy. The present s i n g l e session, problem and treatment method-specific therapy analog study was designed to examine the communicated empathy/depth of experiencing r e l a t i o n s h i p more powerfully by looking i n s i d e a treatment session i n a moment-to-moment manner. It was expected that the analysis would show that therapist communicated empathy and c l i e n t received empathy lead to higher l e v e l s of experiencing and outcome through examination of Pearson product-moment co r r e l a t i o n s among the v a r i a b l e s i n a manner analagous to path a n a l y s i s . The importance of therapist experienced empathy i n the therapeutic chain of events has received no strong empirical support. I t was none-theless included i n the study i n hopes that the novel experimental s i t u a t i o n . / l l - 1 1 -would expose a r e l a t i o n s h i p between t h i s and any of the other main v a r i a b l In summary t h i s study seeks to examine e m p i r i c a l l y the i n t e r r e l a t i o n s among three types of empathy, and to see which type better predicts c l i e n t depth of experiencing and treatment outcome by an intensive examination of the f i r s t session of client-centered treatment. The study also seeks to augment the empirical analysis with a thorough i n t e g r a t i v e summary of pre-vious research f i n d i n g s . Assumptions The medium for examining the research questions was a therapy analog. That i s , subjects and therapists Interacted i n a client-centered therapy s i t u a t i o n for only one session. It was therefore assumed that 1 ) the treatment analog was s u f f i c i e n t l y s i m i l a r to the f i r s t session of an actual therapy s i t u a t i o n to enable the researcher to generalize r e s u l t s to such a s e t t i n g , 2 ) that therapists with more than two years of experience were s u f f i c i e n t l y q u a l i f i e d to conduct one session of c l i e n t -centered treatment, 3 ) that the audio-taping and s e l f - r e p o r t measures did not s i g n i f i c a n t l y contaminate the treatment e f f e c t s , and 4 ) that volunteer c l i e n t s drawn from a community college population could be regarded as c l i e n t s i n aeneral. This l a s t assumption was grounded i n the b e l i e f that everyone, regard-les s of whether or not they have a c t i v e l y sought professional help, i s continually engaging i n the r e s o l u t i o n of emergent l i f e issues. These issues may vary i n t h e i r d e b i l i t a t i n g e f f e c t but the basic dynamics of r e s o l u t i o n remain the same. Delimitation S t r i c t l y speaking, since subjects were re c r u i t e d from students i n a . / 1 2 -12-community college, t h i s study generalizes to community college students i n the f i r s t session of client-centered counselling, but i t possesses implications for psychotherapy i n general inasmuch as the r e l a t i o n s i t demonstrates inhere i n 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 s at a l l stages of treatment. That i s , high l e v e l s of therapist empathy should enhance c l i e n t s e l f - e x p l o r a t i o n and self-expression, c l i e n t processes which should t h e o r e t i c a l l y be causally linked to modest cognitive, a f f e c t i v e , and behavioral change with regard to the problem the c l i e n t brought into treatment. J u s t i f i c a t i o n f or the study Unlike s i m i l a r studies i n which communicated empathy and depth of experiencing ratings were taken at random from three or four points i n treatment sessions, y i e l d i n g only several data points for these two v a r i -ables per session, the intensive analysis phase of t h i s study includes ratings of every therapist-subject i n t e r a c t i o n i n each session on communi-cated empathy and experiencing. As w e l l , the study seeks to augment the power of i t s design by c o n t r o l l i n g treatment duration (one session per c l i e n t ) , method of therapist intervention ( s t r i c t l y r e f l e c t i v e ) , and the form of the presenting issue (a personal incongruence, or " s p l i t " ) , factors which other studies have often l e f t uncontrolled. In t h i s study the minute-by-minute measurement mentioned above was en-gineered to provide a powerful test of the r e l a t i o n s h i p between communicated empathy and experiencing, being more s e n s i t i v e to small f l u c t u a t i o n s i n l e v e l of these two v a r i a b l e s . It was assumed that t h i s control would remove some of the design-in-duced error variance that can obscure r e l a t i o n s among v a r i a b l e s . ./13 -13-O v e r a l l , the present study reviews the p r i n c i p l e s of client-centered theory and q u a n t i t a t i v e l y summarizes relevant previous research which has generally examined client-centered process by spot-checking c l i e n t s across the f u l l duration of t h e i r treatment. The study then generates comparable data by examining the therapeutic process on a moment-to-moment basis within one session of client-centered treatment, and compares t h i s data to theory and previous research. .../14 -14-CHAPTER TWO Survey of the L i t e r a t u r e Rogers conceptualized therapy as c o n s i s t i n g of "...experiencing the s e l f i n a wide range of ways i n an emotionally meaningful r e l a t i o n s h i p with the t h e r a p i s t " (Rogers, 1951, p. 172). Presence of the three core con-d i t i o n s i n the therapist i s the c a t a l y s t f o r change. Change w i l l occur i f the c l i e n t perceives the .core conditions i n the therapist and has a suf-f i c i e n t amount of anxiety r e l a t e d to the problem that he i s experiencing. Rogers and others conducted research that suggested a p o s i t i v e r e l a t i o n between the core conditions and change i n treatment (Rogers, 1967). Iiu-the ensuing years other researchers offered support f o r Roger's propositions. Truax, Imber, B a t t l e , Hoehn-Saric, Nash, and Stone (1966), found s i g n i f i c a n t p o s i t i v e r e l a t i o n s h i p s between the core conditions and therapy outcome. Barrett-Lennard (1962) found that c l i e n t received em-pathy as measured by the Barrett-Lennard Relationship Inventory was p o s i -t i v e l y r e l a t e d to outcome as measured by the Manifest Anxiety Scale, the MMPI, and the Q-Adjustment Scale. Other research, however, that has examined empathy i n and outside of client-centered treatment has produced r e s u l t s which often have not con-firmed Roger's i n i t i a l formulations. Gladstein (1970) reviewed s i x major studies (Dickenson and Truax, 1966; Gonyea, G.G., 1963; Hountras, P.T., and Anderson, 1969; Katz, 1962; Kratocheil, 0., Aspy, D., and Carkhuff, R.R., 1967; Lesser, W.M., 1961) that attempted to l i n k the core conditions to outcome and concluded that "empathy does not appear important i n c o u n s e l l i n g " (p. 823). G a r f i e l d and Bergin (1971) conducted a study of the r e l a t i o n s h i p .715 of the core conditions to therapy outcome with a sample of predominately non client-centered therapists. No s i g n i f i c a n t r e l a t i o n s h i p was secured between tape-rated measures of the core conditions and a v a r i e t y of out-come measures. Furthermore i t was found that while empathy and warmth were p o s i t i v e l y and s i g n i f i c a n t l y correlated, both correlated negatively with genuineness. The authors concluded: The widely discussed Truax et a l . (1965) findings are probably not r e p l i c a b l e outside of a client-centered therapy s i t u a t i o n . I t could be argued that genuineness, empathy and warmth are j u s t as important i n other o r i e n t a -tions, but they must be measured d i f f e r e n t l y i n those se t t i n g s . This may be true, and i t i s worth developing new scales, but t h i s i s not what client- c e n t e r e d r e -searchers have advocated. The burden of proof would appear to rest on them to demonstrate that t h e i r concepts and scales have the wide a p p l i c a b i l i t y which they have claimed. ( G a r f i e l d & Bergin, 1971, p. 113). Another noteworthy study attempting to empi r i c a l l y evaluate the thera-peutic process described by Rogers was conducted by Kurtz and Grummon i n 1972. Using s i x measures of therapist empathy employed i n previous research, the authors correlated the empathy measures with each other, with a measure of therapeutic process (depth of s e l f - e x p l o r a t i o n ) , and several outcome measures (Tennessee Self-Concept Scale, MMPI, therapist and c l i e n t ratings of success). The empathy measures were not s i g n i f i c a n t l y r e l a t e d to each other, and the authors concluded that previous research had been measuring several d i f f e r e n t v a r i a b l e s employing a common l a b e l . Of the s i x empathy ./16. -16-measures, only therapist communicated empathy was related to depth of s e l f -exploration*, a v a r i a b l e s i m i l a r to depth of experiencing. A l l the c o r r e l a -tions between communicated empathy and therapy outcome measures were p o s i -t i v e , but only one (with the Tennessee Self-Concept Scale) was s i g n i f i c a n t (p < .01). C l i e n t received empathy was the most powerful.predictor of ther-apy outcome i n the study, accounting f o r 30% of the variance of the com-bined outcome score. The most important f i n d i n g of the Kurtz and Grummon study f o r present purposes was that c l i e n t received empathy more or less independently of therapist experienced and communicated empathy, was the strongest predictor of outcome, suggesting that what r e a l l y matters i n treatment i s whether or not the c l i e n t perceives the therapist as understanding h i s problem and as being honest with the c l i e n t , and that t h i s perceived or received empathy may vary almost independently of communicated or experienced empathy i n the therapist. A review of the research re l a t e d to the core conditions and t h e i r r e -l a t i o n to outcome was c a r r i e d out by Bergin and Suinn (1975). They con-cluded : It could be that a number of negative findings on genuineness, empathy, and warmth are due to the f a c t that the therapists being studied were not employing a s t r i c t l y c lient-centered technique and thus the Truax-type scales were not applicable even though the o r i g i n a l claim was that these v a r i a b l e s cut across schools. Perhaps these conditions are v i t a l to p o s i t i v e change, or are at l e a s t correlated with i t , but are not being measured appropriately. For example, i n a number of studies showing a p o s i t i v e re-la t i o n s h i p between tape rated empathy and outcome there * A f i v e - p o i n t scale measuring experiencing l e v e l s from "remote from ex-periencing. .. unaware" to " l i v e s i n process of experiencing" (Walker, Rablen, & Rogers, 1960, p. 80). -17-were quite significant correlations between client re-ceived empathy and outcome, usually as measured by the Barrett-Lennard Relationship Inventory (p. 515). Five issues of major importance in understanding the role of empathy in the therapeutic process have been: 1. Is empathy a therapist trait or is i t a variable quality of therapeutic relationships? ; 2. Is empathy a unitary construct? 3. How are experienced, communicated, and client received empathy operationally defined? 4. How do the three phases of empathy relate to depth of experiencing and therapy outcome? 5. How does depth of experiencing relate to therapy outcome? The question of whether empathy is a stable therapist t r a i t (ability) or a function of particular relationship variables was f i r s t dealt with by Rogers (1957) who defined the therapeutic condition of empathy as a two-phase process: The therapist experiences an empathic understanding of the client's internal frame of reference and endeavors to communicate this experience to the client (p. 95), and the communication to the client of the therapist's empathic ./18 -18-understanding i s to a minimal degree achieved (p. 96). The empathy described by Rogers was conceptualized by some as a con-s i s t e n t a b i l i t y of the therapist to understand the c l i e n t and then to com-municate t h i s understanding f u l l y and c l e a r l y . They used t h i s t r a i t model of empathy to construct measures of therapist empathy outside the therapy s e t t i n g (Kagan, 1967) and within i t (Carkhuff, 1967; Truax, 1967). However, a study by Beutler (1972) showed that communicated empathy was not always constant between or within sessions, but often v a r i e d con-siderably. He concluded that: accurate empathy may not be a stable q u a l i t y of the therapist as i s usually assumed, but instead may r e f l e c t a dyadic or r e l a t i o n s h i p v a r i a b l e (p. 167). Gurman (1973) examined the s t a b i l i t y of the therapeutic conditions of three high and three low functioning therapists with one ongoing c l i e n t per therapist. He too found that empathy ratings of therapists v a r i e d , not only from session to session, but also from minute to minute i n a given session. It i s thus also possible that therapist empathy may not be a t r a i t , but rather a state of being which can vary considerably from minute to minute i n therapy. The issue i s s t i l l unresolved inasmuch as the l i t e r a t u r e abounds i n contradictory f i n d i n g s . Regarding the construct d e f i n i t i o n of empathy, the data of several studies i n d i c a t e that the f a c i l i t a t i v e condition i n question i s probably a group of rel a t e d but d i s t i n c t constructs. Kurtz and Grummon (1972) looked at measures of empathy representing three facets of the construct; therapist t r a i t empathy, which was measured by the A f f e c t i v e S e n s i t i v i t y Scale (Kagan et a l . , 1967); therapist communicated empathy as measured by tape ra t i n g s ; and c l i e n t received empathy as measured by the BLRI. They concluded "The data do not reveal a unitary construct of empathy, but several d i f f e r e n t .../19 -19-va r i a b l e s which are thought to be s i m i l a r but i n fa c t are not" (p. 113). McWhirter (1973) also found that therapist experienced empathy, thera-p i s t communicated empathy, and c l i e n t received empathy were three d i s t i n c t v a r i a b l e s . Barrett-Lennard (1974) most accurately summed up t h i s s i t u a t i o n by p o s i t i n g three phases of empathy: Phase One — empathic understanding or experienced empathy, which i s a therapist's a b i l i t y to f u l l y comprehend what the c l i e n t i s saying and f e e l i n g ; Phase Two — communicated empathy, which i s the q u a l i t y of the feedback the therapist gives to the c l i e n t ; and Phase Three — c l i e n t received empathy, which i s the degree to which the c l i e n t f e e l s understood and respected by the therapist. Regarding the lack of c o r r e l a t i o n sometimes found between measures of the three phases, Barrett-Lennard wrote: One might expect that a modest c o r r e l a t i o n would e x i s t among v a l i d measures of the p r i n c i p a l e x p e r i e n t i a l and com-municational processes involved i n the d i f f e r e n t phases (over a broad sample of r e l a t i o n s h i p s ) . However, t h e o r e t i c a l l y , there i s no reason to expect, for example, a close associa-t i o n between a genuine empathic set and l e v e l of expressed empathy; or a strong r e l a t i o n s h i p between inner resonation and personal understanding (phase one) and the degree t o which the r e c e i v i n g person i s a c t u a l l y conscious that the ./20 -20-other i s with him i n personal understanding (phase three) (p. 6). Thus empathy appears to be most accurately conceptualized as three constructs: therapist experienced empathy, therapist communicated empathy, and c l i e n t received empathy, which may or may not be s t a t i s t i c a l l y r e l a t e d . The most appropriate means of o p e r a t i o n a l l y d e f i n i n g empahy depends on the type of phase under examination. The l i t e r a t u r e i n d i c a t e s that phase one empathy i s most commonly measured by the therapist form of the Barrett-Lennard Relationship Inventory, phase two empathy by tape r a t i n g scales such as those of Carkhuff (1969) and Truax (1961), and phase three empathy by the c l i e n t form of the BLRI. The question of whether or not (and how) therapist communicated em-pathy r e l a t e s to therapy outcome has drawn a f a i r l y consistent response i n the l i t e r a t u r e . Kurtz and Grummon (1972), G a r f i e l d and Bergin (1971), and Bergin and Suinn (1975) found that communicated empathy tended to cur-r e l a t e p o s i t i v e l y but usu a l l y n o n - s i g n i f i c a n t l y with a v a r i e t y of outcome measures. Therapist experienced empathy has not been shown to be a powerful p r e d i c t o r of outcome, and c l i e n t received empathy has c o n s i s t e n t l y been hig h l y c o r r e l a t e d with the r e s u l t s of psychotherapy (Barrett-Lennard, 1962; Kurtz and Grummon, 1974). A possible problem with the above-cited studies and other s i m i l a r r e -search has been that a l l employed gl o b a l outcome measures which can be i n -s e n s i t i v e to p o s i t i v e c l i e n t change. I t i s i n t e r e s t i n g with respect to t h i s to note that the authors of these studies a l l recognized that t h i s problem might have existed and suggested that i t might have been remedied by u t i l i z a t i o n of a more c l i e n t - s p e c i f i c outcome measure. To summarize, the construct empathy i s e i t h e r a s i t u a t i o n a l q u a l i t y of psychotherapy or a therapist t r a i t that can best be conceptualized as a group -21-of three v a r i a b l e s : therapist experienced empathy, therapist communicated empathy, and c l i e n t received empathy. Of these, communicated empathy and c l i e n t received empathy have been most con s i s t e n t l y p o s i t i v e l y related to therapeutic outcome, and of the two, c l i e n t received empathy has been the more powerful predictor of change. Communicated empathy i s best measured by frequent ratings of video or audio tapes of therapy sessions, and c l i e n t received empathy i s most e f f e c t i v e l y measured by the Barrett-Lennard Relationship Inventory. Therapist communicated and c l i e n t received empathy have been rel a t e d to several global therapy outcome measures, but more c a s e - s p e c i f i c measures have been recommended by researchers (Barrett-Lennard, 1962; Bergin and Suinn,,1975; G a r f i e l d and Bergin, 1971; Greenberg, 1976; Gurman, 1973; Kelley, 1976; Kiresuk and Sherman, 1968). Bergin and Suinn (1975) summed up the status of empathy as i t r e l a t e s to process and outcome i n counselling and psychotherapy when they wrote: I t i s clearer now that (the core conditions of genuinesness, empathy, and warmth) are not as prepotent as once believed, but t h e i r presence and influence are ubiquitious, even showing up strongly i n behavior therapies (p. 521). In other words, empathy i s les s and l e s s seen as a necessary or suf-f i c i e n t condition f o r f a c i l i t a t i n g c l i e n t movement. Change can occur i n the presence of low empathy l e v e l s . However, the e f f i c a c y of most forms of psychotherapy i s often enhanced by an empathic c l i e n t - t h e r a p i s t r e l a t i o n -ship . The r o l e and importance of c l i e n t depth of experiencing i n therapy are f i n a l issues to be dealt with. The most authoratative t r e a t i s e on experiencing i s the two volume manual f o r measuring the construct written -22-by K l e i n , Mathieu, Gendin, and K i e s l e r , 0.969). They defined depth of experiencing as: The q u a l i t y of an i n d i v i d u a l ' s experiencing of himself, the extent to which his ongoing, bodily f e l t flow of experiencing i s the basic datum of h i s awareness and communications about himself, and the extent to which t h i s inner datum i s i n t e g r a l to action and though (p. 1). These authors conceptualized experiencing as a seven point continuum. At a low l e v e l of t h i s hierarchy, c l i e n t communication i s markedly im-personal and s u f e r f i c i a l . Moving up the scale, communications become more and more personal and feeing-oriented. Higher s t i l l , f e e l i n g s are f r e e l y examined and emergent l e v e l s of experiencing serve as. the basic referents for problem solving. They continue: (The EXP Scale i s ) s e n s i t i v e to s h i f t s i n patient involvement, even within a s i n g l e interview session, making i s u s e f u l for microscopic process studies, for example, to assess the p r o d u c t i v i t y of d i f f e r e n t t o p i c s , to appraise d i f f e r e n t patterns of i n t e r a c t i o n between patients and therapists, or to e s t a b l i s h a p r o f i l e of patient performance during the therapy hour (p. 1). K l e i n et a l , reviewed over a dozen studies i n t h e i r manual ranging from 1960 to 1969 which sought to r e l a t e experiencing to various process and outcome v a r i a b l e s . They concluded: In toto, these early studies show that both depth of experiencing and the global process ratings of b r i e f therapy segments are c o n s i s t e n t l y and highly r e l i a b l e , and y i e l d a meaningful d i f f e r e n t i a t i o n between more and less successful cases and between neurotics and schizophrenics. ./23 -23-.The most powerful and consistent f i n d i n g i s that successful therapy patients s t a r t , continue^ and end therapy at a higher . l e v e l than do'less successful patients. Apparently the behavior that the scales measure i s higher i n successful cases from the s t a r t . Some of these studies show change i n experiencing or process, that i s , upward movement over therapy associated with success and downward movement associated with f a i l u r e , but these findings are generally le s s s t r i k i n g than those f o r o v e r a l l l e v e l , and are less c o n s i s t e n t l y r e p l i c a t e d . We can sa f e l y conclude that the process and experiencing scales measure patient behavior af-f e c t i n g change, but how th i s behavior may vary or change over therapy i s more open to question (p. 16). Thus, while i t i s clear that o v e r a l l adjustment and l i k e l i h o o d of success i n therapy vary d i r e c t l y with l e v e l of experiencing, i t i s s t i l l unclear whether EXP changes from beginning to end of treatment and whether c e r t a i n therapist behaviors strongly influence i t s occurrence. Experiencing can thus be interpreted as tapping the degree of depth of the patient's involvement i n therapy, including his willingness and a b i l i t y to provide the therapist with material with which to empathize, and h i s openness to the therapist's approach. It i s , however, s t i l l unclear i f c l i e n t depth of experiencing i s or i s not s i g n i f i c a n t l y affected by therapist empathy. The Integrative Summary of Previous Research This summary i s a cumulative review of major, o r i g i n a l studies presented i n a quantitative form. The goal of the summary i s to provide a model of ./24 -24-client^centered treatment with which to compare the date derived from the study. A t h e o r e t i c a l model of course already e x i s t s (see Figure 1). How-ever, the empirical examination of client-centered therapy over two decades has not co n s i s t e n t l y demonstrated r e l a t i o n s h i p s among a l l elements of t h i s model. The studies included i n the summary matrix were chosen c h i e f l y because they are major, landmark inv e s t i g a t i o n s of client-centered therapy, inves-t i g a t i o n s that spawned a multitude of s i m i l a r examinations of Rogerian t r e a t -ments. Other considerations that led to t h e i r i n c l u s i o n were that they were c o r r e l a t i o n a l i n nature and that with the exception of Goal Attainment Scaling, they employed s i m i l a r or i d e n t i c a l measures to those i n the present study. The summary i s not intended to constitute an a l l - i n c l u s e review of the re-search which has i n t e r r e l a t e d some or a l l of the f i v e main v a r i a b l e s i n the present study. However, the researcher has endeavored to include research with findings representative of the r e s u l t s of s i m i l a r studies. In other words, i f a l l the research r e l a t i n g , f o r example, TCE and EXP were presented i n the appropriate c e l l , the summary c o r r e l a t i o n c o e f f i c i e n t would not be expected to d i f f e r appreciably from .60,"the value presented i n the matrix. The r e s u l t s of t h i s procedure are presented i n Table 1 (following). Where several c o r r e l a t i o n c o e f f i c i e n t s were a v a i l a b l e mean c o e f f i c i e n t s were calculated. When r e s u l t s were not c o r r e l a t i o n a l , c o e f f i c i e n t s were derived from the n and the alpha l e v e l (Glass and Stanley, 1970). This exercise was undertaken with the understanding that the r e s u l t s from the various studies c i t e d were not d i r e c t l y comparable i n any s t r i c t , quanti-t a t i v e manner, but nonetheless could serve as h e u r i s t i c s . In other words, an i n d i c a t i o n of causal linkages or paths among var i a b l e s could be de-ri v e d from the combined data. This i s what i s presented i n Figure 3. ./25 Kurtz & Grummon, 1974. BLRI therap-ist form & Carkhuff empathy scale were correlated. r= -.24 (NS). n = 31)  TEE |r» .09 (ns). Barrett-Lennard, 1963. Compared client & therapist forms of BLRI. (n= 29) [Kurtz & Grummon, 1974. BLRI client & therapist forms correlated. r=.20 (n = 31, ns) . TCE Kurtz & Grummon, 1974. Correlation between BLRI client form & Carkhuff [Empathy scale = .31 (n=31.' p<-10) CRE TEE: Therapist Experienced Empathy TCE: Therapist Communicated Empathy CRE: Client Received Empathy EXP: Depth of Experiencing TO: Treatment Outcome EXP Kurtz & Grummon, 1974. Carkhuff pathy ratings correlated w. depth of self-exploration. r=.47 (p <.Q1, n = 31)  EXP Kurtz & Grummon, 1974. BLRI thera-pist form correlated w. depth of self-exploration. r= -.06 (n = 31. NS) .  Kurtz 6. Grummon, 1974. BLRI thera-pist Form correlated w. composite outcome measures score. r= .01 (NS. n = 31).  Rogers et a l , 1967. BLRI correlated w. EXP:r = -.23 (Mode) & -72 (peak); = 29. ' Rogers et a l . 1967. TCE correlated w modal exp; r=.54 (p*.05) and peak EXP; r=.73 (p<-01). n =28 . van der Veen, 1965. TCE significant lv related to EXP (n=3, £_£_ 0011; Kurtz & Grummon, 1974. BLRI client form correlated w depth at self-exploratlon. r-= .24 (n=31. NS). (Rogers et a l , 1967. EXP correlated iw BLRI client form: r=.19 (p<.05) for modal EXP & r=38 for peak EXP tn-28).  ,27 .01 Kurtz & Grummon, 1974. Carkhuff scale correlated to TSCS r=.42 (p<.01, n=31) & composite outcome score, r - .30 (ns). Rogers, et a l . 1967. TCE signific antly related to several outcome measures. n=14 •-Truax et a l , 1966. TCE significant lv related to several outcome measures. (p<.05, n=40).  Barrett-Lennard, 1963. Differences on CRE between more & less improved clients as measured by MMPI, MAS, Qadjl & therapist ratings. | (p-< .05). n=29  Kurtz & Grummon, 1974. BLRI client form correlated w composite out-come measures score. r=.55 (p^ .01, n=31i. .55 Kirsler, 1971. More improved patients have higher EXP scores throughout therapy (p^.05, n=26) Rogers et a l . 1967. EXP si g n i f l cantly related to MMPI & Wittenbom scales (p <.10). n=28. Tomlinson & Hart, 1962. Rogers Process Scale significantly related to success in therapy (n=10, p .01) .40 I ro l Figure 3. Data from Table 1 Applied to the Main Variables. The dotted l i n e represents one path or possible, causal flow suggested by a comparison of the r e l a t i v e magnitudes of the c o r r e l a t i o n s i n Table 1, with consideration given to the t h e o r e t i c a l and l o g i c a l f a c t o rs involved. The l i n e was determined by working backward from treatment outcome, pickin g the strongest c o r r e l a t e , working back from that to i t s strongest c o r r e l a t e , and so on. The path implies that treatment outcome i s most l i k e l y to be successful when therapist communicated empathy i s high and when i t i s per-ceived and received by the c l i e n t . Depth of experiencing drops out of the process since the EXP/TO c o r r e l a t i o n i s smaller than the CRE/TO c o r r e l a t i o n . Since the c o r r e l a t i o n between therapist communicated empathy and c l i e n t received empathy i s close to the one between c l i e n t received empathy and c l i e n t depth of experiencing, another p o s s i b i l i t y suggests i t s e l f ; that c l i e n t received empathy leads to treatment outcome and experiencing, which are thus conceptualized as two outcome v a r i a b l e s which are r e l a t e d (r = .40) but d i s t i n c t nonetheless. If one works backward from EXP as well as TO, the pattern suggested i n Figure 4 emerges. I OR-' -29-Therapist communicated empathy i s the strongest c o r r e l a t e of exper-iencing, c l i e n t received empathy the strongest c o r r e l a t e of treatment out-come. CRE and TCE are moderately r e l a t e d . This model implies that thera-p i s t communicated empathy most d i r e c t l y induces experiencing. It may also f a c i l i t a t e c l i e n t received empathy which i n turm would lead to treatment outcome. This would be the expected model to appear from the data gener-ated from t h i s study. In summary, the l i t e r a t u r e has d e l i n i a t e d f i v e v a r i a b l e s (therapist experienced empathy, therapist communicated empathy, c l i e n t received em-pathy, c l i e n t depth of experiencing, and treatment outcome) as the s a l i e n t elements i n the client-centered therapy process. I t i s the aim of t h i s study to see which of these v a r i a b l e s best predict therapy process and outcome and to determine i f a causal l i n k i s indicated between any of the empathy measures, between empathy and depth of experiencing, or among the empathy measures, depth of experiencing, and treatment outcome within a session of client-centered treatment. The three phases of empathy, therapist experienced, therapist com-municated, and c l i e n t received empathy are also examined f or each therapist across subjects by means of t - tests to address the s t a t e / t r a i t issue, and i n t e r r e l a t i o n s among the three phases are analyzed f o r information r e -garding the construct d e f i n i t i o n of empathy. Issues Relating to Client-Centered Therapy The chief goal of this study i s to present an o v e r a l l statement of the client-centered treatment process by examining the i n t e r r e l a t i o n s among measures of empathy, experiencing, and outcome. The study also examines several issues conceptually r e l a t e d to t h i s goal. They are: Is empathy a therapist t r a i t or a r e l a t i o n s h i p variable? Is empathy a unitary e n t i t y ./30 -30-or a group of rela t e d but d i s t i n c t constructs? What i s the preferred operational d e f i n i t i o n of empathy? Is depth of experiencing a c l i e n t t r a i t or a r e l a t i o n s h i p variable? What measure of empathy best predicts depth of experiencing? How do communicated empathy and experiencing i n -terrelate? and What empathy measure best predicts outcome? The chief goal and the rela t e d issues are presented i n Table 2 along with the va r i a b l e s they encompass and the relevant data analysis components i n the study. /11 -31-TABLE 2 Issues Relating to Client-Centered Therapy Questions Variables Involved* Data Analysis Component 1) What i s the o v e r a l l s t a t e - a l l v a r i a b l e s ment of the c l i e n t - c e n t e r -ed therapy process i n the study? a l l components, esp. path chart (Figures 7 & 8) 2) Empathy: state or t r a i t ? TEE TCE CRE therapist sessions 1 x 2 ; (Table 8) 3) Is empathy a unitary construct? TEE x TCE x CRE main analysis matrix (Table 5) 732 -32-4) Empathy: what i s the TEE main an a l y s i s preferred operational TCE x EXP x TO matrix d e f i n i t i o n i n terms of (Table 5) pr e d i c t i n g c l i e n t process & treatment outcome? 5) EXP: state or t r a i t ? EXP graphs of EXP i sessions (Appendix B) 6) How i s c l i e n t process a l l main therapist sessions (EXP) best predicted? v a r i a b l e s 1 x 2 (Table 8) 7) How do communicated TEE main analysis empathy and experiencing TCE x EXP matrix i n t e r r e l a t e ? CRE (Table 5) TCE x EXP staggered (Table 6) analysis -33-8) How i s outcome best a l l main main analysis predicted? v a r i a b l e s x TO matrix (Table 5) * TEE: therapist experienced empathy TCE: therapist communicated empathy CRE: c l i e n t received empathy EXP":, depth of experiencing TO: treatment outcome. ,/34 -34-' CHAPTER THREE  Methodology The primary focus of this study is what happens inside a therapy session; how therapist affects client on an immediate basis and how this relates to the resolution of client issues. The methodology presented below describes a therapy analog situation which attempted to allow a naturalistic observation of client-centered therapeutic communication while simultaneously structuring the interactive process so as to eliminate through i t s design interference from other variables not important to the study (Heller, 1971; Yee and Gage, 1970). Five main variables (therapist experienced empathy, therapist com-municated empathy, client received empathy, depth of experiencing, and treatment outcome) and four secondary variables (number of hours doing client-centered treatment, total number of hours spent doing treatment, therapist valuation of client-centered treatment, and subject a b i l i t y to focus) were examined in the main analysis, which consisted of a correlational analysis with inference and s t a t i s t i c a l procedures analogous to path-analysis (Neale and Leibert, 1973; Yee and Gage, 1970). As well, therapist communicated empathy and depth of experiencing were examined on a minute-by-minute basis, and TCE/EXP patterns within sessions were observed in the intensive analysis. The results of the main and intensive analyses were combined and compared to a summary matrix (Table 1) in which data from selected similar studies,were summarized. The pattern suggested by the summary matrix has been presented in Figure 4. It i s the pattern expected to be derived from the data generated by this study, and is reproduced in Figure 5 with the correlations labelled with letters A to I. .735 - 3 6 -The r e l a t i o n s h i p i l l u s t r a t e d i n Figure 5 are expressed i n the follow-ing general equation: D > B > C > E = F > I > A > G > H > J This equation i s the basis f o r the formal hypotheses presented below. Formal Hypotheses It i s predicted that the following r e l a t i o n s h i p s between the magnitude of the c o r r e l a t i o n c o e f f i c i e n t s w i l l be found and that differences i n each case w i l l be s i g n i f i c a n t at the .05 l e v e l . 1 ' R T 0 . C R E W i l 1 b e s i g n i f i c a n t l y greater than r^rj E >cRE 2. R T O . C R E W l 1 1 b e s i g n i f i c a n t l y greater than r^g.T C E 3. R T O . C R E W i l 1 b e s i g n l f i c a n t l y greater than r E X p > T 0  4 ' R T O . C R E W l 1 1 b e s i g n i f i c a n t l y greater than rgxp .CRE 5 > R T 0 . C R E W l 1 1 b e s i g n i f i c a n t l y greater than 6. R T 0 . C R E W i l 1 b e s ± g n i f l c a n t l y greater than r ^ E E _ ^ 0 7. R T 0 . C R E W i l 1 b e s i g n i f i c a n t l y greater than r T E E > E X p 8. r T Q C R E w i l l be s i g n i f i c a n t l y greater than r T E E > T C E 9. r E X P > T C E w 1 1 1 b e s i g n i f i c a n t l y greater than * C R E < T C E 10. r E X P - X C E w i l 1 b e s i g n i f i c a n t l y greater than r T O t T C E 11. r E X p T C E w i l l be s i g n i f i c a n t l y greater than r^Q > E^p 1 2 ' R E X P . T C E W i l 1 b e s i g n i f i c a n t l y greater than 1 3 ' R E X P . T C E W i l 1 b e s i g n i f i c a n t l y 8 r e a t e r T H A N R T C E . T E E 1 4 * R E X P . T C E W i l 1 b e s i g n i f i c a n t l y greater than r ^ ^ 1 5 , R E X P . T C E w i l 1 b e s i g n i f i c a n t l y greater than • • r E X p > T E E 16. r E X P - T C E w i l l be s i g n i f i c a n t l y greater than r ^ E _ r n E E i in -37-17. RCRE.TCE W L 1 1 B E s i g n i f i c a n t l y greater than RT0.TCE 18. RCRE.TCE W I L 1 B E s i g n i f i c a n t l y greater than RTO.EXP 19. RCRE.TCE W I L 1 B E s i g n i f i c a n t l y greater than RCRE.EXP 20. r „„ m„„ w i l l be CRE.TCE s i g n i f i c a n t l y greater than RTCE.TEE 21. r„„„ m „ „ w i l l be CRE.TCE s i g n i f i c a n t l y greater than RT0.TEE 22. RCRE.TCE W I L 1 B S s i g n i f i c a n t l y greater than REXP.TEE 23. RCRE.TCE W I L 1 B £ s i g n i f i c a n t l y greater than RCRE.TEE 24. RT0.TCE W L 1 1 B E s i g n i f i c a n t l y greater T H A N RCRE.EXP 25. RT0.TCE W I L 1 B £ s i g n i f i c a n t l y greater T H A N TTCE.TEE 26. RTO.TCE W L 1 1 B E s i g n i f i c a n t l y greater T H A N RTO.TEE 27. RTO.TCE W L 1 1 B E s i g n i f i c a n t l y greater than rEXP.TEE 28. RTO.TCE W L 1 1 B E s i g n i f i c a n t l y greater than : CCRE.TEE 29. RCRE.EXP W I L 1 B £ s i g n i f i c a n t l y greater than RTCE.TEE 30. RCRE.EXP W ± 1 1 B E s i g n i f i c a n t l y greater than RTO.TEE 31. RCRE.EXP W I L 1 B E s i g n i f i c a n t l y greater than REXP.TEE 32. RCRE.EXP W 1 1 1 B E . s i g n i f i c a n t l y greater than RCRE.TEE Since t h i s study focuses on the r e l a t i o n of three phases of empathy to c l i e n t depth of experiencing and outcome, several of the hypotheis are of s p e c i a l importance. Hypotheses 12 and 15, i f s i g n i f i c a n t , w i l l imply that therapist communicated empathy i s the empathy phase most highly p r e d i c t i v e of c l i e n t process. The r e l a t i o n s h i p of the empathy phases to outcome i s addressed by hypotheses 2 and 6. Significance of these w i l l suggest that c l i e n t received empathy i s the strongest empathy co r r e l a t e of the r e s u l t s of treatment. .738 -38-Hypothesis Testing The process involved performing - tests to determine the l e v e l of s i g n i f i c a n c e of the 34 pair-wise comparisons between the nine c o r r e l a t i o n a l c o e f f i c i e n t s i n Table 5. Two classes of comparisons existed. Class One comparisons involved p a i r i n g c o r r e l a t i o n c o e f f i c i e n t s which had a common va r i a b l e ; f o r example, the c o r r e l a t i o n between therapist experienced em-pathy and treatment outcome and the c o r r e l a t i o n between therapist com-municated empathy and treatment outcome (r__„ „_) ( r ^ ^ , n ) . For these ILK.. 10 Ihr.. Iu comparisons, Glass and Stanley's z_ - test f o r dependent c o r r e l a t i o n s was employed (Glass and Stanley, 1970, p. 313). Class two comparisons tested the difference between two c o r r e l a t i o n s with no common v a r i a b l e (for example, the c o r r e l a t i o n between therapist ex-perienced empathy and c l i e n t received empathy (r NT>S) > a n ^ the c o r r e l a t i o n between depth of experiencing and treatment outcome ( r Evj> ^Q) • Class two comparisons were computed by means of the Pearson - F i l o n test f o r dependent co r r e l a t i o n s ( A r l i n , 1976). Computer programs were written to perform the two classes of comparisons described above (see Appendix C). / o n -39-Theraplsts Of the seventeen therapists involved in the study, eleven were grad-uate students in Counselling Psychology, three in C l i n i c a l Psycholgy, and one in School Psychology. Seven of these were engaged in Doctoral and six in Master's level studies. The remaining two experimental thera-pists were practicing psychologists. Other information i s summarized in Table 3 below. TABLE 3  Description of Therapists Age Hours of experience conducting client-centered therapy. Total Hours of . experience con-ducting therapy. Mean Mode S.D. Range 28.94 32 6.35 23-50 489.80 1000 1139.62 10-2000 884.07 1000 1002.04 10-3000 Sex M=6 F=ll The table shows that most of the therapists had ample background in conducting therapy and that most were familiar with the client-centered method of counselling. Subjects. The subjects acting as clients in the treatment analog sessions were adult education students at the British Columbia Institute of Technology. They volunteered for what was described as a study of communication processes. They represented as a group a wide age range, and were f a i r l y equally . ,./40 -40-balanced by sex, as can be seen by the Information i n Table 4 below. TABLE 4 Description of Subjects Mean Age 29.25 Sex Mode Age 32 M=17 S.D. Age 6.36 F=13 Range Age 23-50 The experimental sessions averaged 40.16 minutes with a mode of 40 minutes and a range of from 25 to 55 minutes. Instruments Each of the f i v e main v a r i a b l e s was measured by one instrument, and c l i e n t and therapist perceptions of the value of the treatment, and c l i e n t focusing a b i l i t y were assessed as w e l l . These inventories, questionnaires, and r a t i n g scales are described below and are contained i n t h e i r e n t i r e t y i n Appendix A. Therapist communicated empathy (CRE) was measured by r a t i n g therapist statements from audio tapes of the experimental sessions, which were broken into four-minute segments and randomized f o r r a t i n g . Two empathy rater s were employed, and i n t e r - r a t e r r e l i a b i l i t i e s were obtained before and during the r a t i n g . The r e l i a b i l i t y c o e f f i c i e n t s ( r X y ) were .90 and .85 res p e c t i v e l y . These compare favorably to the c o e f f i c i e n t s reported i n . M l -41-studies by Gurman (1973) and G a r f i e l d and Bergin (1971), which were .95 and, .91 r e s p e c t i v e l y for s i m i l a r r a t i n g s i t u a t i o n s . The raters were both f a m i l i a r with the construct involved, and both had experience as thera-p i s t s i n conducting client-centered treatment. Informed judges were chosen over naive ones, as was the case i n the Wisconsin Study (Rogers, 1967) to increase the v a l i d i t y of the ratings (Blaas and Heck, 1975). The therapist communicated empathy scores f o r each segment were c o l -lapsed into 30 mean TCE scores, one for each session, for comparison with the other sessional measures (therapist experienced and c l i e n t received empathy) i n the main an a l y s i s , and were employed separately (n = 257 four-minute segments) i n the intensive analysis of the communicated em-pathy/experiencing r e l a t i o n s h i p . The scale employed for r a t i n g therapist communicated empathy was Carkhuff's (1967) Empathic Understanding i n Interpersonal Process Scale, which derived from the Truax Accurate Empathy Scale (Truax, 1961) which i n turn was based on the e a r l i e r t h e o r e t i c a l presentations of Rogers (1957). Carkhuff's scale i s composed of f i v e l e v e l s of which the following three are examples: Level One: the therapist's responses either do not attend to or detract s i g n i f i c a n t l y from the expressions of the c l i e n t ; Level Three: the therapist's responses are interchangeable with the c l i e n t ' s i n that they express e s s e n t i a l l y the same a f f e c t and meaning; ,,./42 -42-Level Five: the responses of the therapist add s i g n i f i -cantly to the f e e l i n g s and meanings of the c l i e n t i n such a way as to express accurately fe e l i n g s and meanings which the c l i e n t himself i s unable to express c l e a r l y , or i n the event of ongoing deep self-expression by the c l i e n t , the therapist i s f u l l y with the c l i e n t i n his deepest moments. Therapist experienced empathy (TEE) i s the degree to which the thera-p i s t sees himself as being cognizant of h i s c l i e n t ' s cognitions and f e e l -ings. I t was measured by the Barrett-Lennard Relationship Inventory (therapist form). This instrument was f i l l e d out by the therapists im-mediately a f t e r each session. It has a range of -48 to +48 and i t y i e l d s one score which rates average empathy for the e n t i r e session. Some ex-amples of BLRI items are: I want to understand how sees things I understand 's words but do not know how he/she f e e l s I nearly always know exactly what means. Respondents rated the accuracy of these and s i m i l a r statements on a six-point scale which ranged from -3 (No, I strongly f e e l that i t i s not true) to +3 (Yes, I strongly f e e l that i t i s true). C l i e n t received empathy (CRE) i s the degree to which the receiving person sees the therapist as being i n touch with h i s issues. I t was measured by the c l i e n t form of the BLRI, which the c l i e n t f i l l e d out im-mediately a f t e r the experimental session. As with the therapist form of the BLRI, t h i s form e l i c i t s one score f o r average received empathy i n the ent i r e session. Examples of items are: .../43 -43-_____ wants to understand how I see things ' usually senses or r e a l i z e s what I am f e e l i n g r e a l i z e s what I mean even when I have d i f f i c u l t y i n saying i t . Barrett-Lennard (1969) reported that the s p l i t - h a l f r e l i a b i l i t y of the two forms of the r e l a t i o n s h i p inventory ranged from .75 to .94, and a te s t - r e t e s t c o r r e l a t i o n over a two to si x week period of .92. Since there ex i s t no p a r a l l e l inventories to which the BLRI can be correlated to assess v a l i d i t y , Barrett-Lennard (1962) had f i v e judges rate the strength of the inventory items, and these ratings contributed to the f i n a l development of the instrument. Depth of experiencing (EXP) i s the degree to which the c l i e n t ' s s t a t e -ments evidence the depth of h i s involvement i n the therapy task. I t was measured by the EXP Scale (Klein et a l . , 1969), which has a range of one to seven and was rated from treatment session tapes by three trained r a t e r s . The EXP Scale possesses construct v a l i d i t y inasmuch as the concept of c l i e n t w i llingness to introspect and own feeli n g s and behaviors i s a core one i n client-centered therapy theory. Below are examples of several of the seven l e v e l s from the short' form of the scale: content treatment Level One — external events; impersonal, r e f u s a l to detached p a r t i c i p a t e content treatment Level Four — d e s c r i p t i o n of s e l f - d e s c r i p t i v e ; f e e l i n g s and personal a s s o c i a t i v e experiences .744 -44-Level Seven — content f u l l , easy pre-sentation of ex-periencing; a l l elements con-f i d e n t i a l l y integrated. treatment expansive, i l l u m i n a t i n g , confident, buoyant. The i n t e r r a t e r r e l i a b i l i t y of the EXP Scale has been found by K i e s l e r (1967) to be as high as .79 for four judges. In t h i s study, r e -l i a b i l i t y c o e f f i c i e n t s of .85 (modal EXP) and .75 (peak EXP) were obtained. As with therapist communicated empathy, sessions were broken into four-minute segments f or EXP rat i n g s , which were c a r r i e d but by as c r i b i n g two EXP l e v e l s (peak and mode) to each segment. Goal Attainment Scaling — t h i s i s a process of designing before treatment a scale f o r each c l i e n t - t h e r a p i s t goal and spec i f y i n g f o r each goal a transformation of o v e r a l l goal attainment into a standardized t_ score (Kiresuk and Sherman, 1968). I t allows for i d i o s y n c r a t i c goals i n -stead of evaluating achievement according to general c r i t e r e a of improve-ment (Kelley, 1976). The use of GAS i n t h i s study involved a f a c i l i t a t o r and the subjects w r i t i n g a de s c r i p t i o n of projected stages df improvement (for example, see appendix A). With reference to behaviorally observable outcome, the GAS has been shown to be an e f f e c t i v e and e f f i c i e n t measure i n various treatment modali-t i e s with a v a r i e t y of problems. Mauger (1974) analyzed the GAS against the MMPI for v a l i d i t y . He found i t s concurrent v a l i d i t y to be .84 when correlated with MMPI scores. R e l i a b i l i t y was found to be .71 for d i f f e r e n t follow-up raters i n i n i t i a l goal s e t t i n g , .70 a f t e r two months, and .47 af t e r six months (Garwick, 1974). Sherman, Baxter and Audette (1976) found a moderately high t e s t - r e t e s t r e l i a b i l i t y of .57. ...745 - 4 5 -Secondary Data Sources Questionnaires (see appendix A) e l i c i t i n g demographic and other i n -formation were completed by a l l p a r t i c i p a n t s immediately a f t e r the r e -search interviews. The P a r t i c i p a n t Questionnaire, administered to a l l subjects one week af t e r the interviews, contained several items designed to screen out sub-j e c t s who had experienced a d i s r u p t i v e event during that time period. On the basis of the responses to these questions, no respondents were rejected. The questionnaire also asked: "Sometimes people change goals as a r e s u l t of t a l k i n g with a s k i l l e d l i s t e n e r . Did t h i s happen to you?". If subjects checked "yes" they were instructed to f i l l out a Goal Attainment Scale regarding t h e i r new goal and check o f f t h e i r progress. Seven subjects of the t h i r t y did i n fa c t experience such goal s h i f t s , and the scores de-rived from t h e i r a lternate GAS forms were entered as treatment outcome scores for these subjects i n the main data a n a l y s i s . P a r t i c i p a n t s were a l -so asked i f they would seek help from a client-centered psychologist or p s y c h i a t r i s t . Information regarding t r a i n i n g , t h e o r e t i c a l o r i e n t a t i o n , and amount of general and client-centered therapy experience was c o l l e c t e d i n the Therapist Questionnaire, administered to a l l therapists on the day of the research interview. They were asked to give t h e i r v a l u ation of c l i e n t -centered treatment on a f i v e - p o i n t scale. From the therapist questionnaire were derived three v a r i a b l e s , amount of time i n hours spent conducting client-centered treatment and conducting therapy i n general, and the therapist's valuation of the treatment method employed i n the study. . /46 -46-The Post-Focusing Questionnaire (Gendlin, 1973) was also administered to a l l subjects one week p r i o r to the interviews. This unstandardized instrument purports to measure c l i e n t a b i l i t y to function adequately i n an a f f e c t i v e l y oriented, e x p e r i e n t i a l form of psychotherapy. Only 17 subjects completed the questionnaire, the remaining 13 subjects claiming i t was too abstract or unclear to f i l l out. Results from t h i s instrument were i n -tegrated with the f i v e main v a r i a b l e s and the three above-mentioned therapist v a r i a b l e s i n the main a n a l y s i s . Procedure The research procedure was b u i l t around 30 quasi-treatment sessions (one per subject) i n which subjects and t h e r a p i s t s i n t e r a c t e d i n a c l i e n t -centered manner. Therapists were r e c r u i t e d from graduate programs i n counselling, c l i n i c a l , and school psychology. Subjects were s o l i c i t e d from the student body of B r i t i s h Columbia I n s t i t u t e of Technology. Their only screening c r i t e r i o n other than w i l l i n g n e s s to p a r t i c i p a t e i n research on the " l i s t e n i n g process" was normality, defined here as Rogers (1967) de-f i n e d i t : "any i n d i v i d u a l s who are functioning outside a h o s p i t a l s e t t i n g , with no external evidence of psychological malfunctioning and no expressed desire for help" (p. 27). A l l experimental sessions were c a r r i e d out on the same morning. They were preceeded by a group administration of the Goal Attainment Scaling process, during which subjects were f i r s t asked to define a " s p l i t " , or area of intra-personal c o n f l i c t (Greenberg, 1976). The format f o r t h i s s p l i t was, "I am torn between and " (e.g. I am torn between spending my free time with my family or studying). The s p l i t format was employed for two reasons. F i r s t i t was considered advantageous to keep problem nature homogeneous to eliminate as much as p o s s i b l e error variance -47-due to subjects presenting issues for discussion that d i f f e r e d greatly i n nature. While the " s p l i t " format allowed f o r considerable l a t t i t u d e i n seriousness of issue^ i t s t i l l kept subjects focused on i n t e r n a l l y defined problems. This i n t e r n a l or self-focused problem type was highly compatible with the Rogerian concept of incongruence, defined as a c o n f l i c t between r e a l and i d e a l s e l f . This compatibility with the client-centered therapy pro-cess was the second reason for using the " s p l i t " format. Once a l l subjects had defined a s p l i t , they were asked to devise be-haviora l and a f f e c t i v e indices of change for better or worse regarding t h e i r issue. For example, the above-mentioned s p l i t could have been moni-tored by charting amount of time spent studying or with the subject's family (behavioral measure) and f e e l i n g s of anxiety ( a f f e c t i v e measure). Subjects would subsequently check o f f t h e i r progress on the f i v e - p o i n t GAS one week a f t e r the experimental sessions. This Goal Attainment Scaling procedure took one hour. The i n s t r u c t i o n s were read from a prepared pro-cedural format which was also given to a l l subjects so they could read along with the researcher and have a reference to past parts of the i n -structions (see appendix A). When a l l subjects had completed the GAS procedure, they were random-l y assigned to therapists. The interviews which ensued were conducted i n small classrooms (one subject and therapist per room). The therapists were instructed to stay as much as possible i n a client-centered mode throughout the sessions. Audio recordings were made of a l l sessions f o r purposes of r a t i n g therapist communicated empathy and depth of experiencing. I t was o r i g i n a l l y hoped that each therapist would see two subjects, the ./48 -48-interviews running i n tandem. Due to several therapists being absent, however, 17 therapists were employed y i e l d i n g 13 cases of two subjects per therapist and four cases i n which a therapist interacted with only one subject. The 30 sessions which resulted were considered to be ex-amples of a f i r s t session i n client-centered treatment. Exactly one week a f t e r the sessions subjects re-examined t h e i r per-sonal Goal Attainment Scales and checked off the appropriate l e v e l desc-r i p t i v e of t h e i r p o s i t i v e or negative progress regarding t h e i r s p l i t . The movement was assessed on both a f f e c t i v e and behavioral c r i t e r e a y i e l d -ing scores with a possible range of from -4 to +4 f o r each c r i t e r i o n . The enti r e research process i s diagramed below: (one week pre- (morning of (one week post-treatment) experiment) treatment) administration introduction to client-centered GAS follow-up & of Focusing Q'aire research and how experimental p a r t i c i p a n t to f i l l out GAS sessions Q'aire Figure 6. The Research Process . Design The design was c o r r e l a t i o n a l , due to the nature of the process being explored. Relationships among va r i a b l e s were examined by means of Pearson c o r r e l a t i o n s i n three d i s t i n c t elements, 1) a general c o r r e l a t i o n matrix of the f i v e primary and four secondary v a r i a b l e s , 2) a s p e c i f i c analysis of the re l a t i o n s h i p between therapist communicated empathy and c l i e n t depth of experiencing , and 3) sessions one by two comparison of the scores f o r the .749 -49-three empathy measures. In the f i r s t element, differences among c o r r e l a t i o n s were tested for s t a t i s t i c a l s i g n i f i c a n c e by _ - tests f or dependent c o r r e l a t i o n s . In the second element, the covariation of TCE and EXP was explored i n two ways. F i r s t , every p a i r of TCE and EXP scores (257 segments i n a l l , ergo 257 pairs) was entered into a c o r r e l a t i o n program, the purpose being to produce a c o e f f i c i e n t based on as much data as possible. This procedure was some-what biased inasmuch as some sessions contained more segments than others, but t h i s was not considered a serious problem since over 50% of the sessions contained between eight and ten rateable segments. Next an i n t r i g u i n g p o s s i b i l i t y was investigated. I t was considered possible that communicated empathy's e f f e c t on experiencing could be of a latent nature ( i . e . could have a delayed e f f e c t on experiencing). Perhaps the f a c i l i t a t i v e powers of TCE on EXP would not become evident u n t i l sever-a l minutes a f t e r the therapist had spoken. To test f or t h i s possible de-layed e f f e c t , the EXP scores for the 257 TCE/EXP segments were staggered so that for each of the t h i r t y sessions, the EXP scores were auto-correlated with the therapist communicated empathy score i n the next time segment of the session, and then with the TCE score i n the segment below that. This staggering was then reversed. The EXP scores were moved up twice within each session's segments. This was done to explore another i n t e r e s t i n g p o s s i b l i t y : perhaps c l i e n t depth of experiencing was the causal element i n the TCE/EXP r e l a t i o n s h i p . I t was assumed that a high magnitude of cor-r e l a t i o n at either l e v e l of staggering would suggest t h i s . Next the TCE and EXP scores i n each of the t h i r t y cases were graphed and examined for any consistent trends. Several were i d e n t i f i e d . The audio tapes of the sessions were then re-examined to gain subjective im-pressions regarding the nature of the trends (see Appendix B). ./50 -50-In addition, jt - tests were performed on the TCE and EXP scores from the 13 therapist who saw two subjects, comparing subject one to subject two to assess consistency on therapist experienced, communicated, and c l i e n t received empathy scores across interviews. These scores were also correlated across the two subjects seen by each therapist. The t_ -t e s t s and the c o r r e l a t i o n s were both employed i n order to get closer to a clea r understanding of therapist empathy as perceived by therapist, c l i e n t , and independent r a t e r , across c l i e n t s . The _t - tests i n d i c a t e whether or not the therapist's performance i s s i g n i f i c a n t l y d i f f e r e n t across subjects. Of course, i f the tests do not y i e l d s i g n i f i c a n t r e s u l t s , i t cannot be claimed that the two groups are the same. This i s because the lack of s i g n i f i c a n c e could have been a r e s u l t of differences among therapists which would mask a l l but very large d i f f e r e n c e s for therapists across subjects. The c o r r e l a t i o n s were included to see whether variables that are found to be n o n s i g n i f i c a n t l y d i f f e r e n t across subjects i n f a c t are highly r e l a t e d i n a c o r r e l a t i o n a l sense. I f , for example, TCE i s found to be n o n s i g n i f i c a n t l y d i f f e r e n t across subjects by means of the _t - test, and i f the TCE sessions one-by-two c o r r e l a t i o n is. s i g n i f i c a n t , these two pieces of information taken together would suggest a c o n t i n u i t y of TCE l e v e l across subjects implying a therapist t r a i t d e f i n i t i o n of TCE. ./51 ' CHAPTER FOUR Results Scores for the f i v e main and four secondary variables were i n t e r c o r -related, and the c o e f f i c i e n t s obtained are arrayed i n Table 5. The only c o r r e l a t i o n among the three empathy phases that was s i g n i f i c a n t l y d i f f e r e n t from zero was the CRE by TCE c o r r e l a t i o n ( p ^ . 0 5 ) . None of the empathy phases correlated s i g n i f i c a n t l y with outcome, but c l i e n t received empathy was, as predicted, (hypotheses 2 and 6), the strongest outcome c o r r e l a t e among the phases. Also, as predicted (hypotheses 12 and 15), therapist communicated empathy was the strongest c o r r e l a t e of experiencing. The therapist communicated empathy by c l i e n t depth of experiencing c o r r e l a t i o n ( -.13) was obtained by averaging empathy and experiencing scores within each experimental session, and then c o r r e l a t i n g these averages with the other measures, a l l of which also yielded one score per session. When a l l 257 therapist communicated empathy by experiencing scores were correlated, the c o e f f i c i e n t was .04, also n o n - s i g n i f i c a n t . The differ e n c e between t h i s and the averaged sessional c o r r e l a t i o n was .09, a non-significant value. -51-./52 Intercorrelations amon^ the Empathy Phases,  Depth of Experiencing, Outcome, and Four Secondary Variables n = 30 TEE TCE CRE EXP TO HRCC HRTOT VALCC • 1 2 3 4 5 6 7 8 1. Therapist experienced empathy (TEE). 2. Therapist communicated empathy (TCE). .2254 3. Client received empathy (CRE). -.1196 .3803* 4. Depth of experiencing (EXP). .0084 (.0406)+ -.1314 ++ -.2895 •5. Treatment outcome (TO). .1449 -.0034 .1959 .0142 6. Hours of experience C l i e n t -centered (HRCC). .0851 .3083 .1146 -.0109 -.2201 7. Hours of experience: t o t a l (HRTOT). .0452 -.0480 -.2137 .0773 -.2420 .8612** 8. Therapist valuation of c l i e n t -centered treatment (VALCC). .3488 .2763 -.1098 -.2334 .2534 .1651 -.0069 9. Focusing a b i l i t y (FA). -.2603 .2018 .2802 -.0833 .1696- .5400 -.5779 -.1807 * p .05 ** p .001 + taken from intensive analysis of TCE/EXP relationships (n = 257) ++ taken from averaged TCE and EXP session scores. -53-Staggered Correlations of Therapist Communicated Empathy arid Client: Depth  of Experiencing When a l l the 257 segments were included i n the TCE by EXP c o r r e l a t i o n , EXP scores were staggered two segments ahead and two back f o r each TCE segment score (e.g., the TCE score f o r segment three of a treatment session was paired with the EXP score f o r segment one, two, three, four, and f i v e ) y i e l d i n g f i v e separate TCE by EXP c o r r e l a t i o n c o e f f i c i e n t s . These are presented i n Table 6. TABLE 6 Staggered Correlations of Therapist Communicated Empathy and C l i e n t Depth of Experiencing Experiencing scores C o r r e l a t i o n Number of Level of C o e f f i c i e n t s Segments Significance Staggered back two -.0142 197 .421 Staggered back one . 0098 227 .442 Direct .0406 257 .217 Staggered ahead one -.0027 227 .484 Staggered ahead two .0247 197 .365 The d i r e c t phase of the staggering process, i n which TCE and EXP scores from the same four-minute segment of an experimental session were i n t e r r e l a t e d , achieved a higher c o r r e l a t i o n than any of the staggered phases. However, none of the c o r r e l a t i o n s , including the d i r e c t phase, achieved s t a t i s t i c a l s i g n i f i c a n c e at the .05 l e v e l . Therefore the data -54-indicate no latency of the e f f e c t of empathy on experiencing. As w e l l , no suggestion i s given that experiencing has a lat e n t e f f e c t on com-municated empathy. Examination (Session One by Session Two) of the Three Empathy Phases and  Depth of Experiencing Twelve of the therapists interacted with two subjects, thus generating two scores on the empathy and other measures. These two scores were cor-re l a t e d , and the r e s u l t s are presented i n Table 7. The only s i g n i f i c a n t c o r r e l a t i o n was of TCE sessions one by two ( p^.025). I t i s i n t e r e s t i n g that although the TCE scores generated by trained r a t e r s showed a s i g n i f i -cant r e l a t i o n s h i p f o r therapists across subjects, therapist's own evalua-tions of t h e i r empathy and c l i e n t perceptions of therapist empathy were not s i g n i f i c a n t l y correlated across subjects. TABLE 7 Session by Session Correlations of Process Variables Variable C o e f f i c i e n t Z-Value Alpha Level TEE .412 1.420 .150 TCE .609 2.239 .025* CRE .359 1.190 .240 EXP .177 .606 .790 * p < . 05 ./55 -55-The di f f e r e n c e between the three empathy phases f o r therapists across t h e i r two subjects were further explored by subjecting scares to _t - tests for dependent samples. The r e s u l t s of these tests are presented i n Table 8. Only therapist experienced empathy (TEE) d i f f e r e d s i g n i f i c a n t l y from session one to session two. The information i n Tables 7 and 8 i s employed i n the following chapter c h i e f l y to examine construct d e f i n i t i o n s of the empathy phases. TABLE 8 T-Tests f o r Therapist Experienced Empathy, Therapist Communicated Empathy, C l i e n t Received Empathy, arid C l i e n t Depth of Experiencing. Variable t-value TEE 2.208* TCE .258 CRE .047 * p <.05 Results of Hypothesis Tests The 32 hypotheses of r e l a t i o n s h i p s among the three empathy phases, c l i e n t depth of experiencing, and treatment outcome are restated below. Only hypotheses 4, 17, and 23 were s i g n i f i c a n t at an alpha l e v e l of .05. .756 -56-Formal Hypotheses 1. r-j0.CRE W l 1 1 t e s i S n i f l c a n t l y g r a t e r t h a n R T C E . C R E 2. r T Q C R E w i l l be s i g n i f i c a n t l y greater Laau r T O _ T C E 3. r T Q C R E w i l l be s i g n i f i c a n t l y greater than r E X p > T 0 4. r T Q C R £ w i l l be s i g n i f i c a n t l y greater than r Exp.CRE 5. r w i l l be s i g n i f i c a n t l y greater than r T E E i C R E 6. r T 0 C R £ w i l l be s i g n i f i c a n t l y greater than r T E E T 0 7. r T 0 C R E w i l l be s i g n i f i c a n t l y greater than r T E E . E X P 8. r T Q C R E w i l l be s i g n i f i c a n t l y greater than r f E j ? < TCE 9 * R E X P . T C E 1 0 ' R E X P . T C E 11 r A X " EXP. TCE 12. r A ' EXP. TCE 13. r X EXP.TCE 1 / > ' R E X P . T C E 15 r EXP.TCE 1 6 " R E X P . T C E 29. w i l l be s i g n i f i c a n t l y greater than rCRE.TCE w i l l be s i g n i f i c a n t l y greater than rTO.TCE w i l l be s i g n i f i c a n t l y greater than RT0.EXP w i l l be s i g n i f i c a n t l y greater than rCRE.EXP w i l l be s i g n i f i c a n t l y greater than rTCE.TEE w i l l be s i g n i f i c a n t l y greater than rTO.TEE w i l l be s i g n i f i c a n t l y . greater than rEXP.TEE w i l l be s i g n i f i c a n t l y greater than rCRE.TEE w i l l be s i g n i f i c a n t l y greater than rTO.TCE w i l l be s i g n i f i c a n t l y greater than rTO.EXP w i l l be s i g n i f i c a n t l y greater than rCRE.EXP w i l l be s i g n i f i c a n t l y greater than rTCE.TEE w i l l be s i g n i f i c a n t l y greater than rTO.TEE w i l l be s i g n i f i c a n t l y greater than rEXP.TEE w i l l be s i g n i f i c a n t l y greater than rCRE.TEE 17 r CRE.TCE 1 8 • R C R E . T C E 19 r V CRE.TCE 20. r CRE.TCE 21 r X ' CRE.TCE 22 r CRE.TCE 23 r ' CRE.TCE 24. r j o . T C E W 1 1 1 B E s ± 8 n l f i c a n t l y greater than 25. R T O . T C E W ± 1 1 B S S I S n i f ± c a n t l y S R E A T E R T H A N R T C E . T E E 26. r T ( ) T C E w i l l be s i g n i f i c a n t l y greater than ^ Q ^ T E E 27. R T O , T C E W l 1 1 b S s l S n l f i c a n r - 1 y 8 r e a t e r T H A N R E X P . T E E 28. R T 0 . T C E W l 1 1 b e s i g n i f l c a n t l y g r e a t e r t h a n R C R E . T E E RCRE.EXP W i l 1 b e s l g n l f i c a n t l y greater than r T O E . T E E 30. r C R E E X p w i l l be s i g n i f i c a n t l y greater than r T O , T E E 31. r C R E > E X P w 1 1 1 b e s i g n i f i c a n t l y greater than r E X p / p E E  3 2 ' rCRE.EXP W l 1 1 b G s i g n i f i c a n t l y greater than r ^ ^ ^ (* Indicates hypotheses that are s i g n i f i c a n t at .05 (one-t a i l e d test of s i g n i f i c a n c e ) ) . -57-Since only three of the 32 pattern hypotheses have been confirmed, the pattern describing the causal i n t e r r e l a t i o n s among the va r i a b l e s (Figure 5 ) i s not supported at the .05 l e v e l of s i g n i f i c a n c e . This lack of s i g n i f i c a n c e and i t s implications are discussed i n the following chapter. The pattern suggested by the r e l a t i v e magnitudes of the c o r r e l a t i o n c o e f f i c i e n t s , however, does merit discussion insofar as i t coincides c l o s e l y with a pattern found i n the Integrative summary of previous research. Pattern Suggested by the Data As was done e a r l i e r with c o r r e l a t i o n c o e f f i c i e n t s derived from pre-vious research, the r e s u l t s of t h i s study were examined f o r causal l i n k s or paths. Figure 7 represents the expected l i n e a r r e l a t i o n s h i p among the va r i a b l e s . The dotted l i n e represents the path derived by f i n d i n g the strongest c o r r e l a t e of TO ( i n t h i s case, CRE), l o c a t i n g the strongest predictor of CRE, and so on. I t suggests that therapist understanding of c l i e n t issues (TEE) leads to therapist empathic communications (TCE). TCE f a c i l i t a t e s c l i e n t received empathy which i n turn i s p o s i t i v e l y related to treatment outcome. Again i t i s emphasized that only one of these c o r r e l a t i o n a l l i n k s , TCE by CRE, achieved s t a t i s t i c a l s i g n i f i c a n c e . Therefore t h i s discussion of patterns suggested by the data i s presented with the understanding that the patterns are only interpretable insofar as they r e l a t e to c l i e n t -centered theory and extant research. /SR Figure 7. Path Arrangement of Data from the Main Analysis. -59-Depth of experiencing was p o s i t i v e l y r e l a t e d only to therapist com-municated empathy (.0406) and t h i s c o r r e l a t i o n was non-significant (p = .259). Therefore the data do not confirm the expected importance of EXP i n the client-centered therapy process as suggested by theory and previous r e -search. This i s presented i n Figure 8.. -61-With the exception of the TCE - EXP i n t e r r e l a t i o n , Figure 8 presents the same patterns i l l u s t r a t e d i n Figure 5. The pattern i n Figure 5 was produced using c o r r e l a t i o n c o e f f i c i e n t s which represented summaries of past research. Therefore the r e s u l t s of the present study regarding the i n t e r r e l a t i o n of empathy, experiencing, and outcome, although n o n - s i g n i f i -cant, present a pattern highly s i m i l a r to the pattern derived from the summarized findings i n the extant l i t e r a t u r e of client-centered therapy. Q u a l i t a t i v e Results: Descriptive Analysis of the Therapist Communicated Empathy by C l i e n t Depth of Experiencing Relationship This section describes a q u a l i t a t i v e analysis of the data derived from a v i s u a l examination of the 30 graphs generated by the experimental procedure (see Appendix B). Unlike other components of the data analysis which were focused on s p e c i f i c issues i n the therapy process, t h i s examina-t i o n was purely exploratory. The object was to seek any pronounced pat-terns i n the graphs and then to re t u r n to the o r i g i n a l data tapes of the i n d i v i d u a l sessions to l i s t e n to the subject and therapist statements i n order to generate possible explanations f o r the observed patterns. Several patterns were discovered. They are f u l l y described i n the following paragraphs and are presented here with the other more quantitative data. A l l the information gained from the various data components w i l l be referred to when discussing the r e s u l t s i n following sections of the paper. Divergence A pattern occurring frequently was divergence of the l e v e l s of com-municated empathy and experiencing as sessions progressed. This type of - 6 2 -deviation was operationally defined as a measurable shift of TCE and EXP (one point for the former, one-half point for the latter) away from each other. The shifting variables remained at their new levels for two or more four-minute segments. The divergence pattern was observed in the graphs of sessions 1.2, 8.13, 16.28, and 17.30*, and i t appeared like the pattern illustrated below: (graph 1.1) TCE EXP Figure 9: Divergence Pattern The tapes were examined with particular attention to the segment (indicated by parallel vertical lines) in which the divergence occurred. An example of the dialogue involved in and around the point of divergence is presented below in edited form:** The graphs are located in Appendix B; the f i r s t number indicates therapist, the second indicates subject. The elipses represent deletion of segments of the dialogue. -63-Session 1.2 S: . . . t h i s man wasn't doing h i s job...1 complained to the manager...he f i r e d him. Maybe I didn't give him enough time to prove himself... TH: Kind of a f e e l i n g . . . what more can I do... could I have done... S: He should have done better...not my f a u l t , at l e a s t I don't think i t s a l l my f a u l t , i s i t ? . . . b u t s t i l l I'm unsettled... TH: Maybe i t ' s my f a u l t , not h i s . . . I f e e l very g u i l t y . . . S: Everybody else though h^e did a bad job: i t wasn't j u s t me... I mean nobody l i k e s being a heavy...being the one whose responsible for some-one getting f i r e d , but somebody has to...people should help one another... TH: There's a f e e l i n g o f . . . I don't want to be a r e a l son-of-a-gun and have the guy out on the street with no job to get because of t h i s . . . there's s t i l l a ' f e e l i n g of "what more can I do?"... S: Well, yes...people should be responsible for others...people should watch out for themselves. This excerpt exemplifies the apparent cause of the divergence pat-tern with therapist communicated empathy ascending and c l i e n t experiencing descending i n the other three cases as w e l l . The cause seems to be a thera-p i s t response that i s perhaps too accurate, too i n c i s i v e , too a f f e c t i v e l y l Cl. -64-oriented f o r the c l i e n t to handly immediately. This i s experienced as a threat to which the subject reacts by r e t r e a t i n g from personal material into vague g e n e r a l i t i e s i n hope of shaking o f f the attacker. This "too much too soon" phenomenon was the most c l e a r l y defined trend noticed i n the tapes. It has also been discussed by Carkhuff (1970) who wrote that the pattern i s often c h a r a c t e r i s t i c of therapists who possess perhaps a minimum of empathic understanding f o r t h e i r c l i e n t that they seek to compensate f o r by making r e f l e c t i o n s based on erroneous or i n s u b s t a n t i a l understanding of t h e i r c l i e n t s issues. In one case, 17.30, i t appeared that the opposite of the "too much too soon" type of divergence occurred. In that case, empathy decreased while experiencing increased. Eventually experiencing dropped as empathy rose. The explanation i n t h i s case appeared to be "too l i t t l e too soon"; i n i t i a l l y high experiencing was brought down by low therapist communicated empathy. This pattern also was noted and discussed by Carkhuff, and i s discernable i n the following b r i e f segments from the interview: S: I'm t i r e d of t h i s l i n e of study...unhappy...I want a change but...I'm a f r a i d of my father's pressure... TH: You're a f r a i d . S: I'm homesick...miss my family...want to return and work there now, but I can't without a degree...I'm very upset... TH: You're very upset. You want to be able to help your family at home... S: ...Well, I'm not sure...I'm confused...what do you want to know... .,./65 -65-people want a happy family at home... TH: Now how does that make you f e e l . . . I don't understand... In t h i s example the subject eventually succumbed to the low f a c i l i -t a t i v e l e v e l therapist statements, u l t i m a t e l y lapsing into a confused i n t e r -action i n which the session ceased being client-centered and became "thera-pist-centered", with the subject t r y i n g to help the therapist understand the content of t h e i r communications. Another commonality noticed i n a number of sessions (.3.4, 3.5, 5.8, 5.9, 11.19, 12.21, 12.22, 12.24) was an i n i t i a l high l e v e l of experiencing which almost immediately decreased. To a large extent t h i s pattern may have been a r t i f a c t u a l , r e s u l t i n g from subjects being instructed before the session to conceptualize t h e i r topic i n terms of an incongruence or " s p l i t " described e a r l i e r . Subjects tended to v e r b a l i z e these s p l i t s almost im-mediately i n each interview. To test f or t h i s a r t i f a c t , a l l 30 f i r s t segments were removed from the data, and communicated empathy and experiencing were again correlated, r e s u l t i n g i n a c o e f f i c i e n t of .0601. The c o r r e l a t i o n c o e f f i c i e n t o r i g i n -a l l y generated with f i r s t segments i n was .0405, and the difference be-tween these two c o e f f i c i e n t s , .0202 w a s not s i g n i f i c a n t when subjected to a z. - test f or dependent c o r r e l a t i o n s . , Therefore, although over 34% (11 out of 30) of the sessions evidenced a one point or greater drop i n the modal l e v e l of EXP, at the beginning of the session i t was not e m p i r i c a l l y demonstrated that the EXP scores i n the f i r s t segments of sessions induced an appreciable amount of error variance into the c o r r e l a t i o n of TCE and EXP. ./66 -66-A f i n a l phenomenon that has received a t t e n t i o n i n the c l i e n t - c e n t e r e d therapy l i t e r a t u r e (Carkhuff, 1967; Rogers, 1951) appeared i n graphs 8.13 and 8.14. Here experiencing remained low i n the presence of barely adequate l e v e l s of therapist communicated empathy. In these sessions the t h e r a p i s t offered no structure, no guidance as to the appropriateness of the material presented by the subject, chosing instead simply to parrot subject s t a t e -ments i n much the same words as used by a subject, a s i t u a t i o n exemplified by the following statements taken from session 8.13: S: I'm worried about the o i l c r i s i s . . . e l e c t r i f y i n g Canada's r a i l r o a d s i s imperative... TH: You seem disturbed about the f a c t that no one seems to be reacting to t h i s c r i s i s . . . S: E l e c t r i c r a i l r o a d s are highly e f f i c i e n t . . . t h e y produce w e l l over ten thousand horsepower... TH: You sound impressed by that much horsepower... Perhaps i t was appropriate to stay with the subject's t o p i c , but one cannot help but suggest that a more s k i l l f u l and f a c i l i t a t i v e therapist could have focused the subject on more personally relevant m a t e r i a l . The meaning of these subjective impressions and of the q u a n t i t a t i v e data w i l l now be discussed i n the l i g h t of the study expectancies and research ques-ti o n s . -67-In.summary, the d e s c r i p t i v e analysis has presented several patterns which suggest that c e r t a i n therapist empathic behaviors may influence c l i e n t depth of experiencing. This f i n d i n g may seem contradictory to the low TCE/EXP c o r r e l a t i o n s presented i n the main an a l y s i s . In f a c t , there i s no cont r a d i c t i o n . The low c o r r e l a t i o n s together with the patterns may be taken to imply that while communicated empathy inr'.iriitial treatment sessions i s not strongly related.to EXP when received across subjects, there do ex i s t instances i n which TCE does i n f a c t strongly influence ex-periencing. Perhaps TCE/EXP c o r r e l a t i o n s taken from l a t e r sessions of client-centered therapy, when a deeper c l i e n t - t h e r a p i s t r e l a t i o n s h i p has been formed, would be -more supportive fo such a r e l a t i o n s h i p . The possible bearing of the r e s u l t s of the study die to the f i r s t - s e s s i o n nature of the experimental sessions l i m i t s g e n e r a l i z a b i l i t y of the r e s u l t s to f i r s t ses-sions of client-centered treatment. -68-• CHAPTER"FIVE  Discussion The purpose of t h i s study i s to present an o v e r a l l statement of the clien t - c e n t e r e d treatment process by examining the I n t e r a c t i o n of empathy, experiencing, and outcome. Several issues r e l a t e d to the treatment process have also been presented. These issues w i l l now be discussed i n l i g h t of findings of t h i s study. The information presented regarding the r e l a t e d issues w i l l then be employed to describe the view of c l i e n t - c e n t e r e d therapy that the r e s u l t s of the study suggest. The nature of the construct empathy i s f i r s t discussed since i t en-compasses the i n t e r a c t i o n of the three empathy phases and t h e i r r e l a t i o n to experiencing and outcome. Is empathy a unitary construct? Various measures of empathy may a l l be assessing the i d e n t i c a l con-s t r u c t from d i f f e r e n t perspectives. They may a l t e r n a t e l y be measuring related but d i s t i n c t constructs. This question was approached by examining the c o r r e l a t i o n s among the three empathy measures (see Table 5). Results suggest that therapist experienced empathy i s a d i s t i n c t construct and that therapist communicated and c l i e n t received empathy are separate but re l a t e d constructs (see Figure 10 below). However, the degree of r e l a t e d -ness here i s small (approximately 15% of the variance i n these constructs i s overlapping), and more extensive examination of the CRE/TCE r e l a t i o n s h i p i s needed to more concretely define«the nature of t h e i r i n t e r r e l a t i o n . -69-TEE Figure 10: Relations among Empathy Phases from Data of the Present Study. Their r e l a t i o n s h i p i s indexed by t h e i r s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n ( .38, p <.05). It could be assumed that i f they were measuring the same process or construct the c o r r e l a t i o n s between them and process and outcome measure would be equivalent. Since t h i s was f a r from the case (see Figure 3) i t follows that communicated and c l i e n t received empathy are two as-sociated but d i f f e r e n t steps i n the therapy process. These conclusions must be tempered by the low values of the c o r r e l a t i o n c o e f f i c i e n t s i n -volved. The r e s u l t s presented here are, however, encouragingly s i m i l a r to the findings of s i m i l a r studies presented i n Table 3 e a r l i e r . There again two patterns t e l l the story. The f i r s t i s i l l u s t r a t e d below: ,/70 -70-TEE CRE .14 .31 Figure 11: Relations among Empathy Phases from Summary Data of Previous Research. Again therapist experienced empathy i s i s o l a t e d , with communicated and received empathy showing an a f f i n i t y . The second pattern concerns the association of the three empathy measures with the process and outcome mea-sures. It i s i l l u s t r a t e d i n Figures twelve and thirteen below: TEE 14 Figure 12: The Relationship of the Three Phases of Empathy to C l i e n t Depth of Experiencing From Summary Data of Previous Research. -71-TCE TEE .01 .29 TO CR: Figure 13: The Relationship of the Three Phases of Empathy to Treatment In these f i g u r e s , i t i s again apparent that therapist experienced empathy remains d i s t i n c t and that communicated and received empathy, though rel a t e d , are nonetheless separate inasmuch as t h e i r associations with pro-cess and outcome are d i s t i n c t l y d i f f e r e n t . When the above two figures are reproduced with c o e f f i c i e n t s from t h i s study, the important p a r a l l e l s are that communicated empathy i s the strongest p o s i t i v e c o r r e l a t e of experienc-ing and c l i e n t received empathy i s the strongest p o s i t i v e c o r r e l a t e of t r e a t -ment outcome. Outcome from Summary Data of Previous Research. . . . / 7 2 Figure 14: The Relationship of the Three Phases of Empathy to Cl i e n t Depth of Experiencing from the Data of This Study. Figure 15: The Relationship of the Three Phases of Empathy to Treatment Outcome from the Data of This Study. However, several d i s p a r i t i e s between the integrated review and study data are also evident. One i s the negative c o r r e l a t i o n (-.29) between c l i e n t received empathy and experiencing appearing i n the study analysis ./73 -73-which contrasts strikingly with the coefficient of .27, a summary figure representing related research. The likely reason for the negative correlation is that the Barrett-Lennard Relationship Inventory tends to phrase items in such a way that they are more applicable to long-standing relationships than to brief encounters such as the experimental sessions that occurred in this study. The re-lationship between client received empathy and depth of experiencing in other studies is small at best (see Table 3), and this added error variance was perhaps responsible for obscuring an accurate quantification of the relationship. Another anomaly is the .29 correlation between communicated empathy and treatment outcome in the integrated review table that shrank to the vanishing point (-.003) in the study data. Here the problem likely l i e s with the outcome measure in this study which was of a behavioral, action-oriented type. The basic problem here is that outcome, like empathy, is a confused construct, and the quantitative relationship between i t and any process measure is dependent on their qualitative association. In other words, depth of experiencing, being related as i t is to introspection, •focus on affect, and in general to cognitive and affective rather than behavioral change, tends to correlate more highly with intro-spective, non-action-oriented outcome measures, such as the Tennessee Self-Concept Scale (Ashcraft & F i t t s , 1964). This is not to say that one kind of outcome is necessarily superior to another. It merely high-lights a problem encountered when one attempts to compare outcome results. The communicated empathy/depth of experiencing correlation in the present study ( r = . 04 ) was noticeably smaller than the TCE/EXP correlation ( r = .60) from the combined data of other studies (Table 3). Therapist ...Ilk communicated empathy was, however, the strongest p o s i t i v e c o r r e l a t e of depth of experiencing i n t h i s study as well as i n the studies summarized i n Table 3. Again, a probable explanation for the d i f f e r e n c e i n size of the c o e f f i c i e n t s was the f i r s t - s e s s i o n nature of the experimental t r e a t -ment sessions. That i s , perhaps as the therapeutic r e l a t i o n s h i p matures, the TCE by EXP r e l a t i o n s h i p i s enhanced. I f , i n l a t e r sessions, the TCE and EXP l e v e l s increased, perhaps t h i s heightened l e v e l of c l i e n t and therapist involvement would r e s u l t i n a stronger p o s i t i v e c o r r e l a t i o n be-tween communicated empathy and experiencing. To summarize the issue which began t h i s discussion, there appear to be two types of empathy, therapist communicated and c l i e n t received. The former i s the better predictor of psychotherapy process, the l a t t e r of treatment outcome. Therapist empathy: state or t r a i t ? The issue here i s whether therapist empathy i s p r i m a r i l y an a b i l i t y applied with consistency by a therapist to a l l h i s c l i e n t s , or an un-stable r e l a t i o n s h i p v a r i a b l e . The analysis components that address t h i s question are the _t - tests of the therapist experienced, communicated, and c l i e n t received empathy scores between subjects one and two f o r each therapist (see Table 8). The r e s u l t s i n d i c a t e that only therapist ex-perienced empathy was s i g n i f i c a n t l y d i f f e r e n t for therapists between t h e i r subjects, and t h i s indicates a state or r e l a t i o n s h i p v a r i a b l e d e f i n i t i o n for t h i s empathy phase. The reasoning i s that i f any of the empathy phases i s dependent l a r g e l y on interpersonal dynamics, i t w i l l tend to rate d i f -f e r e n t l y for each c l i e n t seen by a given therapist. Conversely, a t r a i t d e f i n i t i o n could be indicated by stable scores on empathy phase measures for p a r t i c u l a r therapists across c l i e n t s . .../75 . The s i g n i f i c a n t TCE session one by session two c o r r e l a t i o n (p«£.05) supports the motion that t h e r a p i s t communicated empathy may be consistent across c l i e n t s . The c l i e n t received empathy sessions one by two cor-r e l a t i o n was not s i g n i f i c a n t , but the t_ - test showed no d i f f e r e n c e be-tween the session scores f o r t h i s v a r i a b l e . C l i e n t received and therapist communicated empathy are thus portrayed as more l i k e l y i n d i c a t i v e of thera-p i s t t r a i t s than r e l a t i o n s h i p v a r i a b l e s . However, any consistency of empathy measures f o r therapists across c l i e n t s may be the r e s u l t of the r a p i s t s tending to communicate with c l i e n t s i n a very uniform " l e t ' s get to know each other" manner in f i r s t sessions of treatment. In that case, communicated empathy scores f o r therapists i n f i r s t sessions across c l i e n t s would understandably be homogeneous and only i n l a t e r therapy hours would any s u b s t a n t i a l deviation i n therapist empathic communication surface as the the r a p i s t adjusts to the unique i n d i v i d u a l he i s t r e a t i n g . Gurman (1973), i n a study which examined three high and three low functioning therapists engaged i n cl i e n t - c e n t e r e d treatment with one c l i e n t found that while variance of communicated empathy between and with-i n sessions was considerable, the high and low th e r a p i s t s could s t i l l be distinquished by t h e i r communicated empathy performance p r o f i l e s . The s i g n i f i c a n t communicated empathy c o r r e l a t i o n f o r therapists across c l i e n t s i n the present study supports Gurman's f i n d i n g s , since i t , too, suggests a degree of consistency f o r therapists on t h e i r general l e v e l of TCE. The r e l a t i o n s h i p of c l i e n t perceptions of therapist understanding ( c l i e n t received empathy) f o r therapists across c l i e n t s could also have been obscured by v a r i a b l e s not accounted f o r i n the present study. Again the p o s s i b l i t y e x i s t s that the c l i e n t may be des c r i b i n g some sort of " i d e a l t h e r a p i s t " i n the f i r s t session, and that only l a t e r would received /nc -76-empathy scores accurately r e f l e c t the nature and q u a l i t y of the r e l a t i o n -ship . Kurtz and Grummon (1972), however, found s i g n i f i c a n t consistency i n CRE fox c l i e n t ratings of the t h i r d and f i n a l interviews of c l i e n t -centered therapy. To r e c a p i t u l a t e , the data suggest that therapist communicated and c l i e n t received empathy are r e l a t i v e l y stable across c l i e n t s i n d i c a t i n g a t r a i t empathy d e f i n i t i o n f o r phase two and phase three empathy. Empathy: What i s the Most Useful Operational D e f i n i t i o n ? Several "answers" emerge from Table 3 (.the i n t e g r a t i v e summary) and from Table 5 (the study data). . They are based on one premise: that a us e f u l operational d e f i n i t i o n i s one that enables 1a v a r i a b l e to be measured i n such a way that i t can be u t i l i z e d to predict r e l a t e d v a r i a b l e s . There-fore therapist behavioral v a r i a b l e s such as experienced, communicated, and c l i e n t received empathy are only of -value inasmuch as they are able to pre d i c t process and/or outcome. In the l i g h t of t h i s premise, therapist communicated empathy emerges as the strongest p o s i t i v e predictor of depth of experiencing. Thus the Carkhuff Accurate Empathy Scale i s considered the more accurate predictor of experiencing. In the same way, c l i e n t received empathy i s the strongest c o r r e l a t e of treatment outcome, i n f e r r i n g that the c l i e n t ' s perceptions of empathy are the strongest prognosticators of measured outcome. It i s recognized that the s i z e of the empathy-by-process-by-outcome, cor r e l a t i o n s i s small and thus any conclusions based upon i t are incon-c l u s i v e . The data arrayed from previous studies i n Table 3 do, however, lend support and c r e d i b i l i t y to the study findings i n that there too one -77-finds communicated empathy the most powerful predictor of depth of experiencing, and c l i e n t received empathy the strongest predictor of treatment outcome. Cl i e n t Depth of Experiencing: State or Tr a i t ? This question would be best answered by a l o n g i t u d i n a l study ex-amining trends of experiencing i n subjects across a number of sessions. Consistent l e v e l s or trends among subjects would i n d i c a t e a t r a i t d e f i n i -t i o n , while varying l e v e l s and patterns would point more toward a state or r e l a t i o n s h i p v a r i a b l e . The data presented here can address t h i s issue by examining the v a r i a t i o n of depth of experiencing i n the sessions and the c o r r e l a t i o n s between the empathy measures and experiencing. I f ex-periencing were a r e l a t i o n s h i p v a r i a b l e one would expect to see a moderate to strong p o s i t i v e c o r r e l a t i o n between i t and therapist behavior as measured by the three empathy te s t s . As evidenced by the low, n o n - s i g n i f i c a n t TCE by EXP c o r r e l a t i o n of .04. This was not the case, as w e l l , examination df the s h i f t s i n experiencing within experimental sessions showed that 80% of these were of only one point, the smallest possible increment of change on the experiencing scale, and 17% were s h i f t s of two points. On the basis of these tenuous r e s u l t s , notably the TCE by EXP cor-r e l a t i o n , i t appears that the l e v e l of experiencing stood r e l a t i v e l y steady and immutable i n the face of s h i f t s i n therapist empathy within experimental sessions. This study therefore f a i l s to i n d i c a t e a d e f i n i -t i o n of experiencing as r e l a t i o n s h i p v a r i a b l e that i s s i g n i f i c a n t l y under the c o n t r o l of .the therapist by means of h i s empathic r e f l e c t i o n s . This conclusion i s supportive of the r e s u l t s of other researchers who examined experiencing trends across sessions ( k i e s l e r , Mathieu, & K l e i n , 1967; -78-K l e i n , Gendlin, & K i e s l e r , 1969; Tomlinson & Hart, 1962). The only s i g -n i f i c a n t change i n experiencing these researchers discovered was a v a r i a -t i o n of the l e v e l of o v e r a l l experiencing corresponding to degree of patho-logy; the more severe the pathology, the lower the o v e r a l l EXP l e v e l . I t therefore seems that other studies of the client-centered process as well as t h i s one indicate a predominately t r a i t d e f i n i t i o n of depth of ex-periencing. However, several studies r e l a t i n g Gestalt treatment techniques to c l i e n t depth of experiencing have demonstrated the EXP can be s i g n i f i c a n t l y influenced by therapist interventions (Clarke, 1977; Greenberg, 1976). These findings point to a state or r e l a t i o n s h i p v a r i a b l e d e f i n i t i o n of EXP, thus posing an apparent controversy i n the l i t e r a t u r e , a controversy further complicated by findings i n client-centered studies which show p o s i t i v e and s i g n i f i c a n t r e l a t i o n s h i p s between communicated empathy and experiencing (Rogers et a l . , 1967; van der Veen, 1965). In view of the contradictory findings described above, the answer to the s t a t e / t r a i t issue regarding depth of experiencing must be held i n a-beyance u n t i l future research can e s t a b l i s h some consistent f i n d i n g s . The most promising vein of research at present i s examining changes i n ex-periencing within sessions as a r e s u l t of v a r i e d therapeutic intervention techniques (Clarke, 1977; Greenberg, 1976). The ultimate answer to the nature of c l i e n t depth of experiencing probably l i e s i n studies such as these. How i s C l i e n t Process Best Predicted? The l i t e r a t u r e has supported therapist communicated empathy, usually as measured by the Carkhuff or Truax scales, as the empathy phase that i s most /-70 -79-highly correlated with c l i e n t depth of experiencing (Kurtz & Grummon, 1974; Rogers et a l . , 1967; van der Veen, 1965). TCE was the strongest p o s i t i v e c o r r e l a t e of EXP i n t h i s study, but the magnitude of the cor-r e l a t i o n (.04) i s not great enough to lead to any s o l i d conclusions. Again, i t may w e l l have been the f i r s t - s e s s i o n nature of the experimental interviews that surpressed the TCE by EXP r e l a t i o n s h i p . A noteworthy point here i s that although c o r r e l a t i o n does not neces-s a r i l y denote causation, the two variables c o r r e l a t i n g s i g n i f i c a n t l y can be an i n d i c a t o r that they are somehow causally r e l a t e d . The f a c t that several studies c i t e d above have demonstrated s i g n i f i c a n t c o r r e l a t i o n s between therapist communicated empathy and c l i e n t depth of experiencing could therefore suggest an element of causation e x i s t i n g between them. This i s mentioned here inasmuch as i f experiencing were i n f a c t a c l i e n t t r a i t , therapist interventions such as empathic r e f l e c t i o n would have l i t t l e r e l a t i o n to i t . Therefore, the f a c t that some studies have shown a p o s i t i v e and s i g n i f i c a n t TCE/EXP c o r r e l a t i o n i s i n a l o g i c a l sense i n -d i c a t i v e of a d e f i n i t i o n of experiencing as a r e l a t i o n s h i p v a r i a b l e i n -fluenced by communicated empathy or some other concomitant therapist be-havior. These studies possibly are more accurately portraying the true nature.of the TCE/EXP r e l a t i o n s h i p since they measured the v a r i a b l e s f a r -ther on i n treatment, when a deeper r e l a t i o n s h i p had developed. How do Empathy arid Experiencing Interrelate? The data from t h i s study do not i n d i c a t e that any of the three empathy measures i s strongly, p o s i t i v e l y r e l a t e d to experiencing. The extensive analysis, however, does show a small p o s i t i v e c o r r e l a t i o n between com-municated empathy and experiencing (.04). The intensive analysis r e s u l t s ./80 -80-are also notable i n that they f a i l to support the p o s s i b i l i t y that depth of experiencing causes empathy. This would have been suggested by a s i g -n i f i c a n t TCE/EXP c o r r e l a t i o n when TCE scores were correlated with EXP scores from segments e a r l i e r on i n the sessions. This did not occur, implying that c l i e n t s generally had l i t t l e e f f e c t on the communicated em-pathy of t h e i r therapists i n the experimental sessions. How i s Treatment Outcome Best Predicted? This i s not an outcome study, but an answer i s suggested by the data, an answer which meshes with the findings of studies presented i n the i n -tegrative summary; that c l i e n t received empathy, or the c l i e n t ' s perception of the therapist's empathic a b i l i t y , i s the v a r i a b l e most highly p r e d i c t i v e of the r e s u l t s of therapeutic i n t e r v e n t i o n . This f i n d i n g reaffirms the findings of previous research (Barrett-Lennard, 1962; Bergin and Suinn, 1975; Kurtz and Grummon, 1974). As w e l l , the s i g n i f i c a n t TCE/CRE c o r r e l a t i o n i n t h i s study suggests that c l i e n t perceptions of therapist empathy as measured by the Barrett-Lennard Re-l a t i o n s h i p Inventory are to a large extent based on a therapist's empathic v e r b a l i z a t i o n s as operationally defined by the Truax empathy scale. The f a c t that the TCE and EXP do not c o r r e l a t e p e r f e c t l y i s probably due l a r g e l y to the f a c t that when a c l i e n t perceives a therapist as being empathic, he i s probably r e c e i v i n g cues of t h i s empathy that are non-verbal. For example, therapist eye contact, posture, and r e l a t e d k i n e s i c cues are probably involved. -81-What Is the Overa l l Statement of Client-Centered Therapy Process Supported by the Study? Empathy was not shown to be a s i g n i f i c a n t p r e d i c t o r of outcome i n t h i s study. However, s i m i l a r research has often shown that empathy ac-counts f o r a s i g n i f i c a n t proportion of the variance of the r e s u l t s of cli e n t - c e n t e r e d therapy. The three phases of empathy, th e r a p i s t experienced, t h e r a p i s t com-municated, and c l i e n t - r e c e i v e d empathy, are shown to r e l a t e to one another (the TCE/CRE c o r r e l a t i o n was s i g n i f i c a n t at .05), but they c o r r e l a t e d d i f -f e r e n t i a l l y with depth of experiencing and treatment outcome. These f i n d -ings imply that the empathy phases are r e l a t e d but d i s t i n c t constructs. Examination of the three empathy scores f o r each t h e r a p i s t across subjects supports a t r a i t d e f i n i t i o n of communicated empathy with a s i g n i f i c a n t a c r o s s - c l i e n t c o r r e l a t i o n . C l i e n t received empathy a c r o s s - c l i e n t scores were not s i g n i f i c a n t l y c o r r e l a t e d , and a c r o s s - c l i e n t _t - t e s t s showed no s i g n i f i c a n t subjects one-by-two d i f f e r e n c e s . The data therefore do not conc l u s i v e l y show that CRE i s a r e l a t i o n s h i p v a r i a b l e . This i s most l i k e l y due to the f i r s t session nature of the experimental interviews. That i s , i t i s possible that n o n - s i g n i f i c a n t l y d i f f e r e n t CRE scores f o r therapists across t h e i r two subjects were the r e s u l t of c l i e n t expectancies or stereo-typic views of t h e i r t h e r a p i s t s . Perhaps only i n l a t e r therapy sessions would c l i e n t statements r e f l e c t a true image of the therapeutic r e l a t i o n s h i p , a f t e r the c l i e n t would have had the opportunity to get to know the t h e r a p i s t more f u l l y . This f i r s t - s e s s i o n s i t u a t i o n was the strongest l i m i t a t i o n of the study. C l i e n t received empathy i s the strongest p r e d i c t o r of outcome, a con-s i s t e n t f i n d i n g across studies, suggesting that c l i e n t perceptions of a .../82 -82-therapist's understanding are more valuable prognosticators of success than judgements of the therapists themselves or of outside r a t e r s . C l i e n t depth of experiencing i s not p o s i t i v e l y and s i g n i f i c a n t l y r e l a t e d to empathy or outcome measures. As predicted, therapist com-municated empathy i s the empathy phase that r e l a t e d most highly to EXP, but the c o r r e l a t i o n value i s n o n - s i g n i f i c a n t . This implies that EXP i s a c l i e n t v a r i a b l e not powerfully influenced by therapist interventions. A content analysis of the TCE/EXP r e l a t i o n s h i p i n each of the 30 ex-perimental sessions, however, indicates that there may be s p e c i f i c i n -stances i n which TCE and EXP are causally r e l a t e d . O v e r a l l , the data coincide with a majority of r e l a t e d research presenting depth of ex-periencing as predominately a c l i e n t t r a i t v a r i a b l e . In toto t h i s study suggests that, within f i r s t sessions of C l i e n t -Centered treatment, therapist empathic communications are r e l a t e d to the c l i e n t perceptions of the therapist's empathic a b i l i t y . These perceptions i n turn p o s i t i v e l y influence treatment outcome. Changes i n c l i e n t depth of self-experiencing may also be a f f e c t e d to a minor degree by therapist communicated empathy, but EXP does not appear to powerfully a f f e c t the treatment process at t h i s e a r l y stage. The Role of Congruence Thus f a r t h i s study has focused on empathy as the prepotent core condition i n the client-centered therapy process. However, Rogers and Truax (1967) and Barrett-Lennard (1962) also stressed the importance of c l i e n t perceptions of therapist congruence i n treatment. ,/83 -83-Client-received.congruence (CRC) refers to the degree to which one person is functionally integrated in the context of the relationship with another, such that there is absence of conflict or inconsistency be-tween his total experience, his awareness, and his overt communication...the highly congruent individual i s com-pletely honest, direct, and sincere in what he conveys, but he does not feel any compulsion to communicate his perceptions, or any need to withold them for emotionally self-protective reasons... Direct evidence of lack of congruence includes, for example, inconsistency between what the individual says, and what he implies by ex-pression, gestures, or tone of voice. Indications of discomfort, tension, or anxiety are considered to be less direct but equally important evidence of lack of congruence. (Barrett-Lennard, 1962, p. 4). The central role of CRC in therapy process is seen by Barrett-Lennard (1962) as establishing an upper limit to the degree to which empathic under-standing of another is possible... (and) the degree to which an individual can actually respond uncon-ditionally to another is considered a function of his security and integration in relation to the other... lack of congruence implies threat and defensiyeness and this would tend to reduce over a l l regard ( p . 5). -84-Since congruence can be defined as exerting a l i m i t i n g or enhancing e f f e c t on therapist empathy, i t was included i n t h i s study to enhance the completeness of the d e s c r i p t i o n of Client-Centered treatment. Cl i e n t received congruence as well as c l i e n t received empathy i s measured by the BLRI. Examples of BLRI items assessing CRC are: ' ' ' i s comfortable and at ease i n our r e l a t i o n s h i p . I f e e l that puts on a r o l e or front for me. Since a l l 30 subjects completed the BLRI, data was a v a i l a b l e for CRC, and these data were analyzed to examine r e l a t i o n s h i p of CRC to therapist communicated empathy (TCE), c l i e n t received empathy (CRE) and treatment outcome (TO). CRC ratings of therapists by t h e i r two subjects were also examined by means of a t - test f o r dependent samples. As w e l l , a _t - test was performed on the CRC and CRE scores f o r each ther a p i s t . This analysis of congruence was added post hoc to the study to provide a d d i t i o n a l i n f o r -mation to more thoroughly describe the client-centered therapy process. The r e s u l t s of these analyses are summarized below: TABLE 9 Correlations among CRC, TCE, CRE, arid TO TCE CRE TO CRC * p <.0001 , -85-' TABLE 10 T - Tests of CRC by CRE, arid CRC (session one by session two) Variables _t - value (dependent) CRC x CRE -.12 CRC (subject one x .54 subject two) The correlation between client received congruence and client received empathy i s high « . 72) and significant ( p<.0001). This index of relation-ship between the two variables could be interpreted either to mean that CRC and CRE are tapping the same variable or highly related but distinct v a r i -ables in the therapeutic process. This interpretation can be addressed by diagramming the interrelationships among CRC, CRE, TCE, and TO. ./86 -86-Figure 16: The I n t e r r e l a t i o n s h i p s among Therapist Communicated Empathy, C l i e n t Received Congruence, C l i e n t Received Empathy, and Treatment Outcome. Figure 16 shows that the TCE by CRC and the TO by CRC c o r r e l a t i o n c o e f f i c i e n t s are s i g n i f i c a n t l y d i f f e r e n t (. p < . 05); and that the TO by CRC and TO by CRE c o e f f i c i e n t s also d i f f e r , although n o n - s i g n i f i c a n t l y ( p<£. 10). This pattern suggests that c l i e n t perceptions of empathy and congruence are highly s i m i l a r , but t h a t . c l i e n t s are nonetheless perceiving two separate therapist q u a l i t i e s . The r e s u l t of the t_ - test of CRE by CRC i s supportive of the above conclusions inasmuch as the scores f o r subjects on the two variables were not s i g n i f i c a n t l y d i f f e r e n t . These findings support the p o s i t i o n of Barrett-Lennard (1962) that therapist congruence i s related to c l i e n t perceptions of therapist empathy. However, the data are c o r r e l a t i o n a l and therefore cannot prove t h i s deO f i n i t i v e l y . Research i s indicated that would vary the l e v e l congruence i n a c o n t r o l l e d , systematic fashion, and observe changes on empathy and outcome. ,/87 -87-Limitatibns A primary l i m i t a t i o n of t h i s study was the small n, a necessary con-d i t i o n i n view of the amount of rater hours involved i n assessing TCE and EXP. I t was predicted that a r a t i o of t h i r t y subjects f o r f i v e main v a r i -ables would fu r n i s h s u f f i c i e n t power to achieve strong c o r r e l a t i o n a l r e -s u l t s . This p r e d i c t i o n proved to be o p t i m i s t i c . It appears that enough error variance was present i n the design to weaken the r e s u l t s . Another l i m i t a t i o n was the " f i r s t session" nature of the experimental sessions. I t seems that even when subjects have a prepared topic to d i s -cuss, i t may well take more time to e s t a b l i s h a therapeutic r e l a t i o n s h i p of the type intended by Rogers. Perhaps only i n l a t e r sessions do c l i e n t and therapist shed t h e i r stereotypic behaviors and begin to i n t e r a c t mean-i n g f u l l y . The treatment outcome measure, Goal Attainment Scaling, also presents i t s e l f as being susceptible to r e a c i t i v i t y inasmuch as simply the act of mapping out the a f f e c t i v e and behavioral steps toward getting better can be of i t s e l f an e f f e c t i v e treatment (Kelley, 1976; Kiresuk and Sherman, 1968). Another problematic instrument i s Carkhuff's scale for measuring com-municated empathy. Truax (1972) has shown that communicated empathy ratings with and without c l i e n t statements present are not s i g n i f i c a n t l y d i f f e r e n t . Rappaport and Chinsky (1972) have raised the issue that i f Truax's findings are representative of the use of empathy r a t i n g scales i n general, i t would be possible for therapists to achieve high communicated empathy ratings by simply r e c i t i n g from memory statements possessing c h a r a c t e r i s t i c s of high ratings on an accurate empathy scale without even considering the content of c l i e n t communications. In the l i g h t of t h i s research, i t i s c e r t a i n l y ./88 -88-possible that communicated empathy scales are measuring a therapist q u a l i t y best described as a s k i l l i n u t t e r i n g words and phrases that sound em-pathic but are not necessa r i l y accurate r e f l e c t i o n s of t h e i r c l i e n t ' s thoughts and f e e l i n g s . Another issue regarding l i m i t a t i o n s i s : did the experimental sessions provide an accurate analog of the actual client-centered therapy process? K l e i n et a l . , (1969) considered productive therapy to be happening when l e v e l s four through seven on the experiencing scale are achieved i n t r e a t -ment. In the present study, segments with peak ratings at these EXP l e v e l s comprised 23% of the t o t a l number of segments, and seventeen out of the t h i r t y c l i e n t s achieved l e v e l s of experiencing at or over l e v e l f i v e . One could make the case that i n the other t h i r t e e n sessions productive therapy was not r e a l l y occurring. This may have been true, but even i f i t were, i t would not ne c e s s a r i l y follow that the r e l a t i o n s h i p s among the empathy and experiencing variables were any d i f f e r e n t . That i s , even i n si t u a t i o n s where the EXP l e v e l was low, the i n t e r r e l a t i o n of empathy, experiencing, and outcome i s l i k e l y to be e s s e n t i a l l y i d e n t i c a l to the i n t e r r e l a t i o n occurring when EXP l e v e l s are high. At any rate, t h i s i s an empirical question which i s not answered i n the l i t e r a t u r e . O v e r a l l , the experimental sessions are considered to be acceptable analogs of i n i t i a l sessions of client-centered treatment since 60% of the subjects achieved EXP scores at or over l e v e l four, 60% of the therapists achieved TCE scores over l e v e l three (the minimum f a c i l i t a t i v e l e v e l ) , a l l t herapists acted i n a r e f l e c t i v e manner, and a l l subjects discussed issues of personal incongruence. A f i n a l comment regarding the r e l a t i v e l y small magnitude of the cor-r e l a t i o n s among the v a r i a b l e s involved i n t h i s study i s that the three empathy phases alone c e r t a i n l y do not account f o r the majority of the / Q O -89-variance i n c l i e n t depth, of experiencing or treatment outcome. A large v a r i e t y of other v a r i a b l e s such as sev e r i t y of problem, c l i e n t w i l l i n g n e s s to change, and amenability to treatment method account for the re s t of the variance. In f a c t , Moos and Macintosh (1970), con-ducted a study of the therapy process and found that empathy accounted f o r only 30% of the variance of treatment outcome. Therefore i t i s not un-reasonable to expect small c o r r e l a t i o n s when only three of these many pre-d i c t o r s of therapy process and outcome are assessed. -90-CHAPTER SIX  Conclusion This study has depicted empathy as being most accurately defined operationally as two r e l a t e d but d i s t i n c t constructs, therapist com-municated and c l i e n t - r e c e i v e d empathy, each possessing unique q u a l i t i e s and p r e d i c t i v e powers. This f i n d i n g i s not unique, but rather represents a r e a f f i r m a t i o n of s i m i l a r findings i n recent l i t e r a t u r e . The importance of t h i s study l i e s mainly i n i t s within-session focus on the f i v e s a l i e n t v a r i a b l e s i n the therapy process, a departure from s i m i l a r studies dealing with the same topic which have tended to be macroscopic or l o n g i t u d i n a l i n nature, taking l e s s frequent measures of the f i v e v a r i a b l e s . This study arose out of a perceived need to p a r a l l e l these broad, n a t u r a l i s t i c studies of the client-centered therapeutic process i n i n vivo s i t u a t i o n s with analog research which kept constant treatment method, dura-ti o n , and problem type, and which employed a more i n d i v i d u a l l y t a i l o r e d , action-oriented measure of change. The contradictory findings i n t h i s and s i m i l a r studies attest to the confused nature of the client-centered process (and the v a r i a b l e s involved i n i t ) under study. Each piece of research i s able only to d i s t i l l a part of the truth about the therapeutic process, but an i n t e g r a t i o n of the r e -search does add up to some inescapable conclusions. Regarding the issue of whether empathy i s a state or a t r a i t , t his study along with a majority of others i n the current l i t e r a t u r e favors the conceptualization of empathy as having two phases, therapist communi-cated and c l i e n t received empathy, and this study defines both of these as being r e l a t i v e l y stable for therapists across c l i e n t s . Therapist experienced empathy, the weakest of the empathy phases i n /ni - 9 1 -a p r e d i c t i v e sense, has been at best a measure of dubious value from i t s inception (Barrett-Lennard, 1962), and th i s study further undermines i t s usefulness. Therapists seemed to have some idea of how much t h e i r v e r b a l i -zations sounded empathic ( r t c e / _ e e = •'•22 (NS)), but no conception at a l l as to how t h e i r words were received by c l i e n t s (r . = -.12 (NS)). In f a c t , ere/tee i n some cases i t was apparent that those with the highest ratings from c l i e n t s gave themselves equally low ra t i n g s , while i n several other cases the converse appeared. Similar findings were reported by Rogers i n the Wisconsin Study (1967). He wrote: It i s a sobering f i n d i n g that our therapists, competent and conscientious as they were, had over-o p t i m i s t i c and i n some cases s e r i o u s l y i n v a l i d per-ceptions of the r e l a t i o n s i n which they were invol v -ed (Rogers et a l . , 1967, p. 92). The inaccuracy of these perceptions i s l i k e l y due i n large part to therapists basing t h e i r r a t i n g s on eit h e r a comparison of t h e i r actual and i d e a l performance or on an " e f f o r t " scale r e f l e c t i n g how hard they t r i e d to be empathic. These and other s i m i l a r biasing factors are e s s e n t i a l l y un-avoidable i n any s e l f - r a t i n g scale of performance. The importance of depth of experiencing as a v a r i a b l e describing the i n t e r n a l process the c l i e n t engages i n as a mediator between therapist i n -tervention and treatment outcome has not been reaffirmed i n th i s study. This r e s u l t , however, may have been a r t i f a c t u a l inasmuch as perhaps the therapeutic r e l a t i o n s h i p must be allowed to mature and deepen over a greater number of therapy sessions f o r the empathy-experiencing i n t e r r e l a t i o n to achieve i t s maximum potency. . ./92 -92-A f i n a l comment on the causal linkage between experiencing and therapist communicated empathy i s that, a f t e r l i s t e n i n g to many hours of therapy, i t i s s u b j e c t i v e l y apparent that the causal forces can flow both ways; from therapist to c l i e n t i n some cases and v i c e versa i n others. This i s affirmed by van der Veen's f i n d i n g i n a s i m i l a r study that "both c l i e n t and therapist s i g n i f i c a n t l y influenced each other's behavior" (van der Veen, 1965, p. 6). In other words, i n s i g h t f u l therapist r e f l e c t i o n s i n some cases brought about increased s e l f - e x p l o r a t i o n by subjects, while at other times i t was the therapist whose l e v e l of empathic communication seemed to be elevated by a c l i e n t whose statements were r i c h with s e l f - d e s c r i p t i o n and a f f e c t . Implications -93-Theory The c l i n i c a l importance of empathy has not been reaffirmed at a s i g -n i f i c a n c e l e v e l of .05. However, of the three empathy phases (therapist experienced, therapist communicated, and c l i e n t received empathy), c l i e n t received empathy was the strongest p o s i t i v e c o r r e l a t e of treatment outcome. Thus the findings support Roger's I n i t i a l hypothesis (1951) that the c l i e n t ' s perception of the therapist's empathic understanding i s one of the c r u c i a l conditions for change i n psychotherapy. This runs counter to Truax and Carkhuff (1967) who stated that the c l i e n t often uiisperceives therapist empathy, leaving tape-judged or therapist communicated empathy as the pre-ferred empathy measure. - . .- . It could thus be concluded that whatever i t i s that communicates empathic understanding to the c l i e n t , i t i s not simply high-rated verbal behavior as measured by the Carkhuff Accurate Empathy Scale. If i t were, the TCE/CRE cor-r e l a t i o n would probably have been much higher. I t can only be assumed that the empathic communication as measured by the r a t i n g scale i s but one component of t o t a l empathic communication, other components perhaps being variables such as eye contact, voice q u a l i t y , and k i n e s i c responses. Therapist communicated empathy seems to be viewed less and l e s s often as. the f o c a l point for measuring empathy i n therapy. As Rogers wrote: The method (of r a t i n g empathy from audio tapes of therapy sessions) was open to the p i t f a l l s of a rather wooden im i t a t i o n , a sort of formula behind which a frightened, or c o n f l i c t e d , or uninvolved therapist could hide. The r e f l e c t i o n formula of "you f e e l . . . " might look good on a tape t r a n s c r i p t , but i n a c t i o n i t could vary from a deep response to an a r t i f i c i a l front (Rogers et a l . , 1967, p. 10). - 9 4 -Practice This h i g h l i g h t i n g of c l i e n t received empathy and downplaying of com-municated empathy i n empathy assessment has d e f i n i t e implications f o r thera-p i s t t r a i n i n g , since many graduate programs, p a r t i c u l a r l y those i n counsel-l i n g psychology, are heavily committed to nurturing empathic a b i l i t y i n trainees, often r e q u i r i n g moderate to high p r o f i c i e n c y in. communicated em-pathy as a c r i t e r i o n for completion of the program or as an i n d i c a t i o n of counselling expertise. The empathy measure of choice i n assessing trainee performance has been the tape r a t i n g scale popularized by Carkhuff and Truax, but i t appears im-probable that t h i s i s the most meaningful way of measuring therapeutic s k i l l . I t i s suggested that the augmentation of these scales with the Barrett-Lennard Relationship Inventory as the empathy measure would y i e l d performance, p r o f i l e s based le s s on acquired a b i l i t y to parrot a c e r t a i n s t y l e of com-munication and more on a genuine s k i l l of understanding the c l i e n t and com-municating t h i s understanding i n a l u c i d manner. Emphasis on c l i e n t per-ceptions rather than on stereotyped therapist verbal performance could free the trainee from the r e s t r a i n t s of the s y l i z e d r e f l e c t i v e mode of responding, allowing him to explore l e s s orthodox means of expressing h i s inner understand-ing of the c l i e n t . Levels of CRE have been shown to change throughout the course of c l i e n t -centered counselling (Kurtz and Grummon, 1974). Therefore, frequent assess-ments of c l i e n t received empathy i n ongoing treatment could provide the thera-p i s t with a powerful barometer of his effectiveness as a f a c i l i t a t o r of change. On the basis of the information he would obtain, the therapist could take p o s i t i v e steps toward enhancing the counselling r e l a t i o n s h i p , such as a l t e r i n g his t r e a t -ment methods or communication s t y l e . The communicated and c l i e n t received /OS -95-empathy ratings could also be openly discussed with the c l i e n t , both as a means to help the therapist function more e f f e c t i v e l y and as an aid to the c l i e n t i n getting i n touch with h i s expectations and desires regarding the therapist and the treatment process. Research This study has presented the within-session format as a valuable means of examining the client-centered process. Future studies could benefit from a p p l i c a t i o n of t h i s focused analysis of therapy sessions by examining sessions from the middle and end of t r e a t -ment as w e l l as the beginning to see i f r e l a t i o n s h i p s among var i a b l e s are constant at these various points. Such investigations would perhaps show that the strongest p r e d i c t o r s of c l i e n t movement vary as treatment progress-es. Maybe, for example, therapist communicated empathy and depth of ex-periencing are more highly correlated at the middle-point of treatment than at the beginning or end. Another i n t e r e s t i n g avenue of study would be to measure therapists on empathy measures across many c l i e n t s , a process that would probably c l a r i f y the s t a t e / t r a i t d e f i n i t i o n s of the phases of the construct. The exact nature of therapist communicated empathy should also be ex-plored, perhaps by open-ended inquir y into what cues c l i e n t s interpreted as in d i c a t o r s of empathic communications. A f i n a l and most emphatic recommendation i s that more attempts should be made to q u a n t i t a t i v e l y summarize the vast amount of data regarding the client-centered treatment process. Table 3 i n t h i s text i s a simple ex-ample of such a quantitative summary. I t was i n s p i r e d by a thorough, elabo-rate methodology devised by Glass (1976) c a l l e d meta-analysis. Using these -96-techniques, Glass was able to perform s t a t i s t i c a l operations to compare the curative powers of various psychotherapeutic treatments by summarizing hundreds of relevant studies. I t i s apparent that meta-analysis of the s a l i e n t v a r i a b l e s i n c l i e n t -centered treatment could serve the valuable function of p u l l i n g together the vast quantity of exact data and d i s t i l l i n g from i t a s o l i d l y based model of the therapeutic process. The a p p l i c a t i o n of meta-analysis to one t h e o r e t i c a l formulation of psychotherapy process such as the c l i e n t -centered model would probably r e s u l t i n a powerful, a u t h o r i t a t i v e p i c t u r e of the process since the studies from which r e s u l t s would be drawn would have employed very s i m i l a r measures to quantify e s s e n t i a l l y the same v a r i -ables. Summary Empathy as i t r e l a t e s to therapy process and outcome has been the focus of one of therapeutic psychology's most f r u i t f u l and e x c i t i n g veins of research. For a long time, the findings have been accumulating but have not been cumulative. This study and s i m i l a r recent research has, how-ever, been i n t e g r a t i n g past r e s u l t s , and has caused them to begin maturing i n t o consistent and us e f u l information f o r the psychotherapist. -97-BIBLIOGRAPHY Ashcraft, C , and F i t t s , W. Self-concept changes i n psychotherapy. Psychotherapy, 1964, 1_, 115 - 118. Barrett-Lennard, G.T. Dimensions of therapist response as causal factors i n therapeutic change. Psychological Monographs, 1962, 76, 1 - 36. Barrett-Lennard, G.T. Empathy i n human r e l a t i o n s h i p s : s i g n i f i c a n c e , nature, and measure. Paper presented to the annual conference of the Au s t r a l i a n Psychological Society, August, 1974. Bergin, A.E., and Suinn, R.M. Individual psychotherapy and behavior therapy. Annual Review of Psychology, 1975, 26_, 509 - 556. Beutler, L.E. Some sources of variance i n "accurate empathy" ratings. Journal of Consulting and C l i n i c a l Psychology, 1973, 40, 167 - 169. Blaas, CD., and Heck, E.J. Accuracy of accurate empathy ra t i n g s . Journal of Counseling Psychology, 1975, 22, 243 - 246. Carkhuff, R.R. Helping and Human Relations. Vols. 1 and 2, New York: Holt, Rinehart, and Winston, 1967. Carkhuff, R.R., "A human technology for group helping processes." Educational Technology, 1973, 13_, 31 - 38. Chinsky, J.M., and Rappaport, J . Br i e f c r i t i q u e of the meaning and r e l i a b i l i t y of "accurate empathy" r a t i n g s . Psychological B u l l e t i n , 1970, 73, 379 - 382. Clarke, CM. The d i f f e r e n t i a l e f f e c t s of two treatments at a c o n f l i c t marker i n therapy (Doctoral d i s s e r t a t i o n , University of B r i t i s h Columbia, 1977). 7 9 8 -98-Dalton, R.F.; Sundblad, L.M.; and Hylbert, K.W. An a p p l i c a t i o n of p r i n c i p l e s of s o c i a l learning to t r a i n i n g i n communication of empathy. Journal of Counseling Psychology, 1973, 20, 378 - 383. Dickenson, W.A., and Truax, C.B. Group counseling with college under-achievers. Personnel arid Guidance Journal, 1966, 45_, 243 - 247. F i t t s , W. Tennessee Self-Concept Scale Manual. Na s h v i l l e : Counselor Recordings and Tests, 1965. G a r f i e l d , S.L. Basic ingredients or common factors i n psychotherapy? Journal of Consulting and C l i r i i c a l Psychology, 1973, 40, 9 - 1 2 . G a r f i e l d , S.A., and Bergin, A.E. Therapeutic conditions and outcome. Journal of Abnormal Psychology, 1971, 77, 108 - 114. G a r f i e l d , S.L., and Kurg, M. Evaluation of treatment and r e l a t e d procedures i n 1216 cases r e f e r r e d to a mental hygiene c l i n i c . P s y c h i a t r i c Quarterly, 1952, 2_, 414 - 424. G a r f i e l d , S.L., and Walpin, M. Expectations regarding psychotherapy. Journal of Nervous arid Merital Disease, 1963, 137, 353 - 362. Garwick, G. An introduction to r e l i a b i l i t y and the goal attainment s c a l i n g methodology. 'P.E.P. Report 1963 - 1973, 1974, Chapter 3. Garwick, G., and B r i n t a l l (Eds.). Proceedings of the Secdrid Annual Goal Attainment Scaling Conference. Minneapolis, Minnesota: Program Evaluation Resource Center, 1974. Gendin, E.T. Gestalt therapy IN: Current Psychotherapies. R. C o r s i n i (Ed.), Itascu, I l l i n o i s : F.E. Peacock Publishers, Inc. 1973. Gladstein, G.A. "Is empathy important i n counseling? Personnel and Guidance Journal, 1970, 48, 823 - 827. .799 -99-Glass, G.V. Primary, secondary, and meta-analysis of research, Paper presented as presidential address: of AERA, San Francisco, April, 1976. Glass, G.V., and Stanley, J.C. Statistical Methods in Education and Psychology. Englewood C l i f f s , New Jersey: Prentice-Hall, Inc., 1970. Glass, G.V., Willson, V.L., and Gottman, J.M. Design and Analysis of Time Series Experiements. University of Colorado, 1972. Gonyea, G.G. The "ideal therapeutic relationship" and counseling outcome. Journal of Cl i n i c a l Psychology, 1963, 19, 481 - 487. Greenberg, L.S. A task-analytic approach to the events of psychotherapy CDoctoral Dissertation, York University, Toronto, 1976). Grief, E.B., and Hogan, B. The theory and measurement of Empathy. Journal of Counseling Psychology, 1973, 20, 280 - 284. Gurman, A.S. Instability of therapeutic conditions in psychotherapy. Journal of Counseling Psychology, 1973, 20, 16 - 24.' Gurman, A.S. The patient's perception of the therapeutic relationship. In Gurman, A.S., and Razin (Eds.), Effective Psychotherapy: a handbook of research. N.Y: Pergamon, 1977. Heller, K. Lab interview research as an analog to treatment. In A. Bergin and S. Garfield - (Eds.), Handbook of psychotherapy and behavior  change. New York: Wiley and Sons, Inc., 1971. Hountras, P,T., and Anderson, D.L. Counselor conditions for self-exploration of college students. Personnel and Guidance Journal, 1969, 48, 45 - 48. Kagan, N. Interpersonal process r e c a l l . Journal of nervous arid Mental  disease, 1969, 148, 365 - 374. -100-Kagan, N., Krathwohl, D., Goldberg, A.D., Campbell, R.J,, Shouble.,P.G., Greenberg, L.S., Danish, S.J., Resnikoff, J , , Bowes, J . , and Bondy, S.B. Studies i n human i n t e r a c t i o n : Inter- personal process r e c a l l stimulated' by videotape. East Lansing: Educational P u b l i c a t i o n Service, 1967. Katz, B. P r e d i c t i v e and behavioral empathy and c l i e n t change i n short-term counseling. Unpublished doctoral d i s s e r t a t i o n , New York Un i v e r s i t y , 1962. Kelley, D.F. The use of goal attainment s c a l i n g i n evaluating the therapeutic process. Paper presented at the twenty-fourth annual con-vention of the American Society of Adlerian Psychology, 1976. K i e s l e r , D.J. Refinement of the experiencing scale as a counseling t o o l . Report to US Department of Health, Education, arid Welfare, Bureau of Research, 1969. K i e s l e r , D.J., Mathieu, P.L., and K l e i n , M.H. Measurement of conditions and process v a r i a b l e s . In CR. Rogers, E.T. Gendin, D.J. K i e s l e r , and C.B. Truax (Eds.), The Therapeutic Relationship  arid i t s Impact: A Study of Psychotherapy with Schizophrenics. Madison, W i s e : University of Wisconsin Press, 1967. Kiresuk, T., and Sherman, R. Goal Attainment Scaling: A general method f o r evaluating comprehensive community mental health programs. Community Merital Health Journal, 1968, 4_, 443 - 453. K l e i n , M.H., Mathieu, P.L., Gendlin, E.T., and K i e s l e r , D.J. The Experiencing  Scale: A Research arid Trairiirig Manual Vols. 1 and 2). Madison Wisconsin P s y c h i a t r i c I n s t i t u t e , 1969. K r a t o c h v i l , D., Aspy, D., and Carkhuff, R.R. The d i f f e r e n t i a l e f f e c t s of absolute l e v e l and the d i r e c t i o n of counselor change i n l e v e l of functioning. Journal of C l i n i c a l Psychology, 1967, 23, 216 - 218. Kurtz, R.R., and Grummon, D.L. Different approaches to the measurement of therapist empathy and their relationship to therapy outcomes. Journal of Consulting and Cl i n i c a l Psychology, 1972, 39, 106 - 115. Lesser, W.M. The relationship between counseling progress and empathic understanding. Journal of Counseling Psychology, 1961, 8, 330 - 336. Luborsky, L., and Spence, D. Quantitative research on psychoanalytic therapy. IN Handbook of psychotherapy arid behavior change. New York: Wiley and Sons, Inc. 1971. Mauger, P. A study of the construct v a l i d i t y of Goal Attainment Scaling. P.E.P. Report 1969 - 1973, 1974, Chapter 6. Mc Whirter, J.J. Two measures of the f a c i l i t a t i v e conditions: a correlational study. Journal of Counseling Psychology, 1973, 20, 4, 317 - 320 McWhirter, J.J., and Marks, S.E. An investigation of the relationship between the f a c i l i t y conditions and peer and group leader ratings of perceived counseling effectiveness. Journal of Cliriical Psychology, 1972, 28, 116 - 117. Meador, B.D., and Rogers, CR. Iii Current Psychotherapies, R. Corsini CEd.), Itasca, I l l i n o i s : F.E. Peacock Publishers, Inc. 1973. Means, B.L. Levels of Empathic Response. Personnel and Guidance Journal, 1973, 52_, 1, 23 - 28. Neale, J.M. and Liebert, R.M. Science arid Behavior. Englewood C l i f f s , New Jersey: Prentice-Hall, 1973. Payne, R.A., Weiss, S.D., and Kapp, R.A. Didactic, experiential, and modeling factors in the learning of empathy. Journal of Counseling Psychology, 1972, 19, 425 - 429. ./102 -102-P i n s o f f , W.M. Truax's Accurate Empathy Scale: A c r i t i c a l review of the research. Unpublished doctoral major paper, York University, Toronto, Ontario, 1976. Rappaport, J . , and Chinsky, J. Accurate empathy: confusion of a construct. Psychological B u l l e t i n , 1972, 77, 400 - 404. Resnikoff, A. A measure of d i s c r i m i n a t i o n f or the d i s c r i m i n a t i o n of counselor e f f e c t s . Journal of Counseling Psychology, 1972, 19, 464 - 465. Rogers, C.R. Client-Centered Therapy.' Boston, Houghton-Mifflin, 1951 Rogers, C.R. The necessary and s u f f i c i e n t conditions of therapeutic per-s o n a l i t y change. Journal of Consulting Psychology, 1957, 21, 95 - 103. Rogers, C.R. (Ed.). The therapeutic r e l a t i o n s h i p arid i t s impact: A study of psychotherapy with schizophreriics. Madison, Wise: Uni v e r s i t y of Wisconsin Press, 1967. Saltmarsh, R.E. Development of empathic interview s k i l l s thru programmed i n s t r u c t i o n . Journal bf Counseling Psychology, 1973, 20, 375 - 377. Sherman, R.E., Baxter, J.W., and Audette, D.M. An examination of the r e l i a b i l i t y of the Kiresuk-Sherman goal attainment score by means of components of variance. P.E.P. Report 1969 - 1973, 1974, Chapter 4. Tomlinson, T.M. , and Hart, J.T. A v a l i d a t i o n study of the process scale. Journal of Consulting Psychology, 1962, 26, 74 - 78. Truax, C.B. A scale f or the measurement of accurate empathy. P s y c h i a t r i c I n s t i t u t e B u l l e t i n , University of Wisconsin, 1961, 1 - 1 2 . Truax, C.B. The meaning of r e l i a b i l i t y of accurate empathy r a t i n g s : A rejoinder. Psychological B u l l e t i n , 1972, 77_, 397 - 399. -103-Truax, C., and Carkhuff, R, Toward E f f e c t i v e Counseling arid Psychotherapy: Theory arid P r a c t i c e . Chicago, Aldike, 1967. Truax, C.B., Frank, J.D., Imber, S.D., B a t t l e , C C , Hoehn-Saric, R., Nash, E.H., and Stone, A.R. Therapist empathy, genuineness, and warmth and therapeutic outcome. Journal of Counsulting Psychology, 1966, 30_, 395 - 401. Truax, C.B., Wargo, D.C, Frank, J.D. , Imber, S.D., B a t t l e , C C , Hoehn-Saric, R., Nash, E.H., and Stone, A.R. The therapist's contribution to accurate empathy, non-possessive warmth, and genuineness i n psychotherapy. Journal of C l i n i c a l  Psychology, 1966, 22_, 331 - 334. van der Veen, F. E f f e c t s of the therapist and the patient on each other's therapeutic behavior. Journal of Consulting Psychology, 1965, 29, 19 - 26. Walker, A.M., Rablen, R.A., and Rogers, CR. Development of a scale to measure process changes i n psychotherapy. Journal of C l i n i c a l Psychology, 1960, 16, 79 - 85. Yee, A.H., and Gage, N.L. Techniques f or estimating the source and d i r e c t i o n of causal influence i n panel data. Psychological B u l l e t i n , 1970, 46, 115 - 126. ./104 APPENDIX A COMPILATION OF MEASURES AND SCALES -105-SCALE 1: EMPATHIC UNDERSTANDING IN INTERPERSONAL PROCESSES 1 A SCALE FOR MEASUREMENT Level 1: The ve r b a l and behavioural expressions of the helper e i t h e r do not attend to or detract s i g n i f i c a n t l y from the verbal and behavioural expressions of the helpee (2) i n that they communicate s i g n i f i c a n t l y l e s s of the helpee 1s f e e l i n g s and experiences than the helpee has com-municated himself. Example: The helper communicated no awareness of even the most obvious, expressed surface f e e l i n g s of the helpee. The helper may be bored or d i s i n t e r e s t e d or simply operating from a preconceived form of reference which t o t a l l y excludes that of the helpee(s). In summary, the helper does everything but express that he i s l i s t e n i n g , understanding, or being s e n s i t i v e to even the most obvious f e e l i n g s of the helpee, and does so i n such a way as to detract s i g n i f i c a n t l y from the communications of the helpee. Level 2: While the helper responds to the expressed f e e l i n g s of the helpee(s), he does so i n such a way that he subtracts noticeable a f f e c t from the communications of the helpee. Example: The helper may communicate some awareness of obvious surface f e e l i n g s of the helpee, but h i s communications drain o f f a l e v e l of the a f f e c t and d i s t o r t the l e v e l of meaning. The helper may communicate h i s own ideas of what may be going on, but these are not congruent with the expressions of the helpee. In summary, the helper tends to respond to something other than that which the helpee i s expressing or i n d i c a t i n g . Level 3: The expressions of the helper i n response to the expressions of the helpee (2) are e s s e n t i a l l y interchangeable with those of the helpee i n that they express the same a f f e c t and meaning. Example: The helper responds with accurate understanding of the surface f e e l i n g s of the helper but may not respond to or may mis-int e r p r e t the deeper f e e l i n g s . In summary, the helper i s responding so as to neither subtract nor add to the expressions of the helpee. He does not respond accurately to how that person r e a l l y f e e l s beneath the surface f e e l i n g s , but he ind i c a t e s a w i l l i n g n e s s and openess to do so. Level I I I c o n s t i t u t e s the minimal l e v e l of f a c i l i t a t i v e i n t e r p e r s o n a l functioning. Level 4: The responses of the helper add noticeably to the expressions of the helpee(s) i n such a way as to express f e e l i n g s at a l e v e l deeper than that with which the helpee was able to express himself. Example: The helper communicates h i s understanding of the expressions of the helpee at a l e v e l deeper than they were expressed and thus enables the helpee to experience and/or express f e e l i n g s he was unable to express previously. In summary, the helper's responses add deeper f e e l i n g and meaning to the expressions of the helpee. Level 5: The helper's responses add s i g n i f i c a n t l y to the f e e l i n g and meaning of the expressions of the helpee(s) i n such a way as to accurately express fee l i n g s some l e v e l s below that which the helpee himself was able to express,, or, i n the event or ongoing, deep s e l f - e x p l o r a t i o n on the helpee's part, to be f u l l y with him i n h i s deepest moments. Example: The helper responds with accuracy to a l l of the helpee's deeper as w e l l as surface f e e l i n g s . He i s "tuned i n " on the helpee's wave length. The helper and the helpee might proceed together to explore previously unexplored areas of human existence. In summary, the helper i s responding with a f u l l awareness of who the other person i s and with a comprehensive and accurate empathic under-standing of that i n d i v i d u a l ' s deepest f e e l i n g s . 1Carkhuff, Robert R., Helping and Human Relations, Vol. 1. /I 07 Short Form of EXP Scale Stage I if 5 6 Conten t Externa 1 events ; refusal to part ic ipate . External events ; behavioral or i n t e l l e c t u a l s e1 f - d e s c r i p t i o n . Personal react ions to external events ; l imi ted s e1 f - d e s c r i p t i o n s ; behavioral descr ip t ions of fee 1i ngs. Descr ip t ions of f e e l i n g s and personal exper iences. Problems or p ropos i t ions about fee l ings and personal exper iences. Synthesis of read i l y access ib le fee l ings and experiences to re -solve personal ly s i g n i f i c a n t "i ssues. F u l l , easy presentat ion of ex-p e r i e n c i n g ; a l l elements con-f i d e n t l y integrated. Treatment Impersona1, detached. Interested, persona l , se1 f -part i c i pat i on. React ive , emotion-a l l y i nvolved. Se 1 f - desc r ipt i ve; assoc i at i ve. Exp loratory , e labo -r a t i v e , h y p o t h e t i c a l . Feel ings v i v i d l y ex-pressed, i n t e g r a t i v e , conc lus ive or a f f i r -mative. Expans ive, i11umi-nat ing , con f ident , buoyant. /1 no C o d e : D a t e : -108-(BARRETT-LENNARD) RELATIONSHIP INVENTORY—FORM OS—64* B e l o w a r e l i s t e d a v a r i e t y o f ways t h a t o n e p e r s o n may f e e l o r b e h a v e fn r e l a t i o n t o a n o t h e r p e r s o n . P l e a s e c o n s i d e r e a c h numbered s t a t e m e n t w i t h r e f e r e n c e t o y o u r p r e s e n t r e l a t i o n s h i p w i t h , m e n t a l l y a d d i n g h i s o r h e r name i n t h e s p a c e p r o v i d e d . F o r e x a m p l e , i f t h e o t h e r p e r s o n ' s name was J o h n , y o u w o u l d r e a d s t a t e m e n t #1, a s ' J o h n r e s p e c t s me as a p e r s o n ' . Mark e a c h s t a t e m e n t i n t h e a n s w e r c o l u m n on t h e r i g h t , a c c o r d i n g t o how s t r o n g l y y o u f e e l t h a t i t i s t r u e , o r n o t t r u e , i n t h i s r e l a t i o n s h i p . PI e a s e  be s u r e t o mark e v e r y o n e . W r i t e i n +33 +23 +13 o r -13 -23 -33 t o s t a n d f o r t h e f o l l o w i n g a n s w e r s : No3 I feel that it is probably untrue3 or more untrue than true. No3 I feel it is not true. No3 I strongly feel that it is not true. +Z: Yes3 I strongly feel that it is -1: true. +2: Yes3 I feel it is true. -2: +1: Yes3 I feel that it is probably -3: true, or more true than untrue. ANSWER 1. r e s p e c t s me a s a p e r s o n ______ 2. w a n t s t o u n d e r s t a n d how I s e e t h i n g s . . . . . . . . v » 3. ' s i n t e r e s t i n me d e p e n d s on t h e t h i n g s I s a y o r do . . k. i s c o m f o r t a b l e and a t e a s e i n o u r r e l a t i o n s h i p . . . 5. f e e l s a t r u e l i k i n g f o r me 6. may u n d e r s t a n d my w o r d s b u t h e / s h e d o e s n o t see t h e way I f e e l 7. W h e t h e r I am f e e l i n g happy o r unhappy w i t h m y s e l f makes no r e a l d i f f e r e n c e t o t h e way f e e l s a b o u t me . . . 8. I f e e l t h a t p u t s on a r o l e o r f r o n t w i t h me . . . . 9. i s i m p a t i e n t w i t h me . . . . . -10. n e a r l y a l w a y s knows e x a c t l y what I mean 11. D e p e n d i n g on my b e h a v i o u r , has a b e t t e r o p i n i o n o f me s o m e t i m e s t h a n h e / s h e has a t o t h e r t i m e s * Combines Forms 0S-M-64 and 0S-F-64 2. 4 -109-ANSWER 12. I fee l that is real and genuine with me . . . . . . 13. I fee l apprec iated by ]k. looks at what I do from his/her own point of view . . . 15. ' s f e e l i n g toward me doesn ' t depend on how I fee l toward him/her 16. It makes uneasy when I ask or t a l k about c e r t a i n things 17. " is i n d i f f e r e n t to me 18. usua l l y senses or r e a l i s e s what I am f e e l i n g 19. wants me to be a p a r t i c u l a r kind of person 20. I fee l that what says usua l l y expresses exac t l y what he/she is f e e l i n g and th ink ing at that moment 21. f i n d s me rather du l l and un in te res t ing . . . . 22. ' s own a t t i t u d e s toward some of the things I do or say prevent him/her from understanding me 23. I can (or could) be openly c r i t i c a l or_ a p p r e c i a t i v e of without r e a l l y making him/her fee l any d i f f e r e n t l y about me 2k. wants me to think that he/she l i k e s me or understands me more than he/she r e a l l y does . 25. cares fo r me 26. Sometimes thinks that j_ fee l a c e r t a i n way, because t h a t ' s the way he/she f e e l s 27. l i k e s c e r t a i n things about me, and there are other things he/she does not l i k e 28. does not avoid anything that is important for our r e l a t i o n s h i p . . 29. I fee l that disapproves of me . 30. r e a l i s e s what I mean even when I have d i f f i c u l t y in saying i t 31. ' s a t t i t u d e toward me stays the same: he/she is not pleased with me sometimes and c r i t i c a l or d isappointed at other times 32. Sometimes is not at a l l comfortable but we go o n , outwardly ignor ing i t 33- j u s t t o l e r a t e s me 3k. u s u a l l y understands the whole of what I mean I f I show that I am angry w i t h he/she becomes hurt or angry w i t h me, too expresses h i s / h e r t r u e impressions and f e e l i n g s w i t h me . fs f r i e n d l y and warm w i t h me J u s t takes no n o t i c e of some th i n g s t h a t I t h i n k or f e e l How much l i k e s o r d i s l i k e s me i s not a l t e r e d by anything that I t e l l him/her about myself . At times I sense that i s not aware o f what he/she i s • r e a l l y f e e l i n g w i t h me . I f e e l t h a t r e a l l y values me a p p r e c i a t e s e x a c t l y how the th i n g s I experience f e e l to me approves of soma t h i n g s I do, and p l a i n l y disapproves of o t h e r s Is w i l l i n g to express whatever i s a c t u a l l y in h i s / h e r mind w i t h me, i n c l u d i n g personal f e e l i n g s about e i t h e r o f us doesn't l i k e me f o r myself . . . . . . . . . At times t h i n k s that I f e e l a l o t more s t r o n g l y about a p a r t i c u l a r t h i n g than I r e a l l y do . Whether I happen t o be i n good s p i r i t s o r f e e l i n g upset does not make f e e l any more or l e s s a p p r e c i a t i v e of me . . Is openly h i m s e l f / h e r s e l f i n our r e l a t i o n s h i p . ..' . I seem to i r r i t a t e and bother does not r e a l i s e how s e n s i t i v e I am about some of the things we d i s c u s s Whether the ideas and f e e l i n g s I express are "good" o r "bad" seems to make no d i f f e r e n c e t o 's f e e l i n g toward me There are times 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 from the way he/she f e e l s under-neath • f e e l s contempt f o r me understands me ' . Sometimes I am more worthwhile in at other times 1 s eyes than I am it. 56. doesn ' t hide anything from h imse l f/herse l f that he/she f e e l s with me 57. i s t r u l y in terested in me . . . . 58. ' s response to me is usua l l y so f i xed and automatic that I don ' t r e a l l y get through to him/her . . . . . . 59. I don ' t th ink that anything I say or do r e a l l y changes the way f e e l s toward me 60. What says to me of ten g ives a wrong impression of his/her t o t a l thought or f e e l i n g at the time . . 61. f e e l s deep a f f e c t i o n fo r me 62. When I am hurt or upset can recognise my f e e l i n g s e x a c t l y , without becoming upset too . 63. What other people think of me does (or would, i f he/she knew) a f f e c t the way f e e l s toward me dk. I be l ieve that has f e e l i n g s he/she does not t e l l me about that are causing d i f f i c u l t y in our r e l a t i o n s h i p . . . -111-ANSWER Please a l s o provide the fo l lowing information about yourse l f and the other person. " Yourself Age: Sex: Occupat ion: years (M or F) Other Person years (known or est imated) (M or F) Pos i t i on in th is r e l a t i o n s h i p . Examples: Actual : (Please f i l l in) Son C l i e n t / o r pat ient Fr iend '^Mother Counsel lor ( therap is t )  (Best) Fr iend Code: Date: RELATIONSHIP INVENTORY—FORM MO—64 " Below are l i s t e d a va r ie ty of ways that one person may fee l or behave in r e l a t i o n to another person. Please consider each statement with reference to your present r e l a t i o n s h i p with , mental ly adding h is or her name in the space prov ided . If, for example, the other person 's name was John, you would read statement #1 as 't respect John as a p e r s o n ' . Mark each statement in the l e f t margin, according to how st rongly you fee l that i t is t r u e , or not t rue , in th i s r e l a t i o n s h i p . Please mark  every one. Write in +3, +2, +1, or -1, -2, ~3, to stand f o r the fo l lowing answers: +3: Yes, I strongly feel that it is true. +2: Yes, I feel it is true +1: Yes, I feel that it is probably true, or more true than untrue. -1: No, I feel that it is probably untrue, or more untrue than true. -2: No, I feel it is not true. -3: No, I strongly feel that it is not true. 1. I respect as a person. 2. I want to understand how sees th ings . 3. The i n t e r e s t I fee l in ' depends on the things he/she says or does. k. I fee l at ease with . _5. I rea 11 y 1 i ke . JS. I understand 's words but do not know how he/she a c t u a l l y f e e l s . _7. Whether • is f e e l i n g pleased or unhappy with himself/ h e r s e l f does*,change my f e e l i n g toward him/her. hot JB. I am i n c l i n e d to put on a ro le or f ront with , . _9. I do fee l impatient with . 10. I near ly always know exac t l y what means. 11. Depending on ' s a c t i o n s , I have a better op in ion of him/her sometimes than I do at other t imes. 2. 12. I f ee l that I am genuinely myself with . 13- I apprec iate , as a person. 14. I look at what does from my own point of view. 15. The way I fee l about doesn ' t depend on his/her f e e l i n g s toward me. 16. It bothers me when t r i e s to ask or t a l k about c e r t a i n th ings . 17. I f ee l i n d i f f e r e n t to . 18. I do usua l l y sense or r e a l i s e how is f e e l i n g . 19- I would l i k e to be a p a r t i c u l a r kind of person. _20. When I speak to I near ly always can say f r e e l y j u s t what I'm th ink ing or f e e l i n g at that moment. 21. I f i n d rather du l l and u n i n t e r e s t i n g . 22. What says or does arouses feel i ngs in me that prevent me from understanding him/her. _23> Whether _ _ _ _ c r i t i c i s e s me or shows apprec ia t ion of me does not (or would not) change my inner f e e l i n g toward him/her. 2k. I would r e a l l y prefer to think that I l i k e or understand him/her even when I d o n ' t . _25. I care fo r . _26. Sometimes I think that . f e e l s a c e r t a i n way, because t h a t ' s the way I fee l mysel f . ^ _27. I l i k e in some ways, whi le there are other th ings about him/her that I do not l i k e . _28. I don ' t feel that I have been ignor ing or putt ing o f f anything that is important for our r e l a t i o n s h i p . _29. I do fee l d isapproval o f . _30. I can t e l l what means, even when he/she has d i f f i c u l t y in saying i t . _31. My f e e l i n g toward stays about the same; I am not in sympathy with him/her one time and out of pat ience another. _32. Sometimes I am not at a l l comfortable with _^ but we go on, outwardly ignoring i t . 3 3 - I put up with . 3 4 . I usua l l y catch and understand the whole of ' s meaning. 3 5 - If gets impatient or mad at me I become angry or upset t o o . 3 6 . I am able to be s incere and d i r e c t in whatever I express wi th _ 3 7 - I fee l f r i e n d l y and warm toward • . _ 3 8 . I ignore some of 's f e e l i n g s . _ 3 9 - My l i k i n g or d i s l i k i n g of is not a l t e r e d . b y anything that he/she says about h i m s e l f / h e r s e l f . J » 0 . At times I j us t don' t know, or don' t r e a l i s e u n t i l l a t e r , what my f e e l i n g s are with . J » l . I value our r e l a t i o n s h i p . J t 2 . I apprec iate jus t how ' s experiences fee l to him/her. __*3. I fee l qu i te pleased with sometimes, and then he/she d isappoints me at other t imes. J\k. I fee l comfortable to express whatever is in my mind with , inc lud ing any f e e l i n g s about myself or about him/her. _ 4 5 . I r e a l l y don' t l i k e as a person. J » 6 . At times I thi nk that f e e l s s t rong ly about some-thing and then i t turns out that he/she d o e s n ' t . J*l. Whether is in good s p i r i t s , or bothered and upset , doesn' t make me to fee l any more or any less appre -c i a t i o n of him/her. _J*8. I can be qu i te openly myself in our r e l a t i o n s h i p . __49. Somehow r e a l l y i r r i t a t e s me (gets 'under my s k i n ' ) . _ 5 0 . At the time,I don' t r e a l i s e how touchy or s e n s i t i v e is about some of the things we d i s c u s s . _ 5 1 . Whether 's expressing "good" thoughts and f e e l i n g s , or "bad" ones, does not a f f e c t the way I fee l toward him/her. __52. There are times when my outward response to is q u i t e d i f f e r e n t from the way I fee l underneath. _ 5 3 . In f a c t , I fee l contempt toward . -115-55-5 6 . _57-58. _59-60. 6 1 . 6 2 . _63 . 6 4 , I understand Sometimes seems to me a more worthwhile person than he/she does at other t imes. I don ' t sense any f e e l i n g s in r e l a t i o n to _ are hard for me to face and admit to myself , I t ru l y am interested in _ . that I o f ten respond to taking in what he/she is exper iencing I don' t think that anything rather a u t o m a t i c a l l y , without a l t e r s the way I fee l toward him/her. says or does r e a l l y What I say to of ten would give a wrong impression of my f u l l thought or f e e l i n g at the t ime. I fee l deep a f f e c t i o n for . When is hurt or upset I can recognise jus t how he/she f e e l s , without ge t t ing upset mysel f . What other people think and fee l about to make me fee l as I do toward him/her. does help I f e e l there are things we don' t t a l k about that are causing d i f f i c u l t y in our r e l a t i o n s h i p . Please a l s o provide the fo l lowing information about yourse l f and the other person. You A_e: Sex: Occupat ion : years (M or F) The Other years (known or estimated) (M or F) P o s i t i o n in th i s  r e l a t i o n s h i p . Examples: Mother Counsel lo r Personal Fr iend Teacher Son C l i e n t Personal Fr iend  Pupi1 (or Student) A c t u a l : (Please f M 1 in) -116-GUID2 TO GOALS People have many different s p l i t s they might wish to deal v/ith. The purpose of th i s interview i s to define cl e a r l y and s p e c i f i c a l l y what you think treatment could do to help you with your s p l i t in the near future. This page shows how one person completed his guide to goals. Yours w i l l be f i l l e d i n generally l i k e this one during t h i s interview. SPLIT: I AM TORN BETWEEN SPENDING MY FREE TIME (ABOUT 18,;. HOURS PER WEEK) WORKING AT SCHOOL OR WITH MY FAMILY. MUCH WORSE THAN EXPECTED RESULTS: SOMEWHAT LESS THAN EXPECTED RESULTS; EXPECTED OR MOST LIKELY RESULTS; SOMEWHAT BETTER THAN EXPECTED RESULTS; MUCH BETTER THAN EXPECTED RESULTS: LESS THAN AN HOUR OF FREE TIME SPENT PRODUCTIVELY WITH WORK AND/OR FAMILY, WITH A GREAT AMOUNT OF FEELINGS OF CONFLICT SPENT ABOUT CHOICE. ABOUT THREE HOURS 0? FREE TIMS SPENT PRODUCTIVELY WITH WORK AND/OR FAMILY, WITH MODERATE TO GREAT FEELINGS OF CONFLICT ABOUT CHOICE. SIX HOURS/WEEK FREE TIMS SPENT PRO-DUCTIVELY WITH WORK AND/OR FAMILY WITH MODERATE FEELINGS OF CONFLICT ABT. CHOICE. TEN OR MORS HOURS OF FREE. TIMS SPENT PRO-DUCTIVELY WITH WORK AND/OR FAMILY, WITH LITTLE FEELINGS OF CONFLICT ABOUT CHOICE. FOURTEEN OR MORE HOURS OF WORK SPENT PRO-DUCTIVELY WITH WORK AND/OR FAMILY, WITH LITTLE OR NO FEELINGS OF CONFLICT ABOUT CHOICE. (asterisk indicates the level at which this person thinks he i s nov;) -117-Now think of a p r a c t i c a l , s p e c i f i c way of measuring how well you are doing with your s p l i t . Por example, i f you were concerned about an issue dealing with time spent on c o n f l i c t i n g tasks, number of hours would be a simple way to see how you were doing. I f your s p l i t involved seeing f r i e n d 3 , number of contacts with friends would be a concrete way to gauge change. A good c r i t e r i o n for determining the adequacy of your measure i s " i s t h i s measure clear enough so that someone else could be able to t e l l i f I am getting better at handling my s p l i t " . You can also use an indication of your feeling state to c l a r i f y your progress i n dealing viith your s p l i t . Por example, you might talk about mild to severe feelings of anxiety, joy, c o n f l i c t , fear, or love, to men-tion a few f e e l i n g states. In the example on page one, the person spoke of "feelings of c o n f l i c t " , and then he projected change of feelings for better or worse. Now use the concrete measure of change and the measure of feelings to predict how well you would be doing after one week once you have i n t e r -acted with your counsellor. Of course, you cannot know for sure how well you w i l l be doing, but try your best to predict. Be r e a l i s t i c about: how hard i t i s for you to handle your problems, your own a b i l i t i e s and your determination to handle your problems,-and how much success you have had before in dealing with your problems. (DO: EXPECTED OR MOST LIKELY RESULTS) / 1 1 o -118-So f a r you have w r i t t e n down what you t h i n k i s the most l i k e l y r e s u l t f o r progress on your s p l i t i n a week's time. However, i t i s pos-s i b l e t o do much b e t t e r than expected. T h e r e f o r e , u s i n g the same a f f e c -t i v e and b e h a v i o r a l measures you used to p r e d i c t your "expected r e s u l t s " , w r i t e i n what the s p e c i f i c r e s u l t s would be i f you d i d much b e t t e r than expected. Show s p i c i f i c a l l y how you would be doing something d i f f e r e n t . Use numbers i f you can. i I f you expected, f o r example to be with f r i e n d s one night a week, doing much b e t t e r might mean being with f r i e n d s three n i g h t s a week. Be r e a l i s t i c . Do not set goals f o r y o u r s e l f that you are sure you could not reach. (DO: MUCH BETTER THAN EXPECTED RESULTS) Next, use your same measures to f i l l i n the two remaining l e v e l s of your s c a l e . The l a s t two l e v e l s are SOMEWHAT LESS THAN EXPECTED RESULTS and SOMEWHAT BETTER THAN EXPECTED RESULTS. They are c l o s e t o your ex-pected l e v e l o f r e s u l t s , but are a l i t t l e l e s s or a l i t t l e b e t t e r than the expected l e v e l . (DO: SOMEWHAT LESS THAN EXPECTED RESULTS AND SOMEWHAT BETTER THAN EXPECTED RESULTS) -119-F i n a l l y , please make an a s t e r i s k (*) at the l e v e l that shows how w e l l you are doing now, today. T h i s mark w i l l help show how you s t a r t e d w i t h your problems and whether or not you improve i n the f u t u r e . i Thank you GOAL ATTAINMENT FOLLOWUP GUIDE -120-NAMS: EDUCATION LEVEL: DATE: AGE: DESCRIPTION OF SPLIT YOU'-WILL BE WORKING ON: MUCH VTORS3 T H A N EXPECTED RESULTS: SOMEWHAT LESS THAN EXPECTED RESULTS: EXPECTED OR MOST LIKELY RESULTS: SOMEWHAT BETTER THAN EXPECTED RESULTS: MUCH BETTER T1LAN EXPECTED RESULTS: ( p l a c e a s t e r i s k (*) next to l e v e l where you are now) FC 76. T O T P -v ?L T IJ IP Ali T QU33TI0K1IAIR3 -121-Thank you very much f o r v o l u n t e e r i n g your time to our research, on the l i s t e n i n g process. Please complete t h i s for.'a on the same day you check o f f your Goal Attainment Eollovi-up Guide and r e t u r n the two together to Mr. N a e g e l i or Mr. Harper. NAME: SEX: M 1. Has any s e r i o u s event, such as s i c k n e s s i n the f a m i l y or job problems, occurred d u r i n g the past week? ^ 1 7 3 T J Q 2. I f you checked "yes" to #1, d i d the i n c i d e n t a f f e c t your a t t a i n i n g the goal you set a week ago i n the l i s t e n i n g exercise? YES NO 3. Sometimes people, change goals as a r e s u l t of t a l k i n g with a s k i l l e d l i s t e n e r . Did t h i s ha-onen to vou? ,„.„„ YES NO 4. I f you checked "yes to ,.^ 3, c i r c l e the appropriate Goal Attainment l e v e l f o r your new g o a l : 1" 2 3 4 5 much worse than somewhat expected or somewhat b e t t e r much b e t t e r expected r e s u l t s l e s s than most l i k e l y than expected than expected expected r e s u l t s r e s u l t s r e s u l t s r e s u l t s -j. Was the l i s t e n i n g process h e l p f u l i n a t t a i n i n g your goal? YES NO 6. Would you go to a p s y c h o l o g i s t or p s y c h i a t r i s t who worked mainly i n a l i s t e n i n g - o r i e n t e d manner? ,^  Comments: -122-TO ALL THERAPISTS: Please f i l l i n the f o l l o w i n g demographic i n f o r m a t i o n . 1. Naine: 2. Age: 3. T r a i n i n g i n empathy s k i l l s ( d e s c r i b e ) : 4. Approximate number o f hours of c l i e n t - c e n t e r e d - t y p e treatment you have done: 5. Approximate number of hours of therapy i n any o r i e n t a t i o n : 6. T h e o r e t i c a l o r i e n t a t i o n : 7. How v a l i d do you see c l i e n t - c e n t e r e d treatment as a means o f induci n g change? 1 2 3 4 5 t o t a l l y very e f f e c t i v e i n e f f e c t i v e / i 01 POSTFOCUSINC QUESTIONNAIRE -123-Questioris: In t h i s questionnaire we are seeking your help i n evaluating the i n s t r u c t i o n s which were j u s t read to you. Please do not omit any questions. Do not report what you were thinking about. 1. In no more than four (4) sentences (one short paragraph) please describe what was happening to you i n the l a s t 10 minutes. 2. How d i d the f e e l i n g change a f t e r you got the words or picture? 3. What was the best thing about doing t h i s ? 4. What was the worst thing about doing this ? 5. What surprised you most about a l l t h i s ? 6. How. was thinking t h i s way d i f f e r e n t from the way you usually do i t ? 7. Many people get l o s t near the s t a r t and then the r e s t doesn't make sense. Did that happen to you? Yes No _ _ _ _ _ . 8. Some people use words and f e e l i n g s . Others use p i c t u r e s and f e e l i n g s . Which d i d you f i n d most important? Words_ Pi c t u r e s Neither 9. Your age - •  Sex: M a l e Female :FW AUCE 1 -124-"• .' y' • .  : " -APPENDIX B SESSION GRAPHS . ' • . / " OF ; .• V - ' 'THERAPIST COMMUNICATED EMPATHY AND " DEPTH OF EXPERIENCING " T H E R A P I S T S U B J E C T E X P L E V E L M O D E E X H _ Q . P E A K E X P . . . , . , T C E — & -O - ® — O - ^ © 1 2 3 4 5 6 7 8 9 10 11 12 13 F O U R - M I N U T E S E G M E N T S 1 2 3 4 5 6 7 8 9 10 11 1 2 1 3 F O U R - M I N U T E S E G M E N T S THERAPIST _2_ SUBJECT , J L TCE LEVEL 5.0. 4.5 4.0. 3.5 3.0. 2.5 2.0. 1.1 1.0. .5 EXP LEVEL 6 •5 -4 MODE EXfL -Q. PEAK EXP..^. TCE P—«5—0 1 2 3 4 5 6 7 8 FOUR-MINUTE SEGMENTS •0 11 12 13 FOUR-MINUTE SEGMENTS ./127 T H E R A P I S T J L S U B J E C T JL E X P L E V E L M O D E E X R . _ Q . P E A K E X P . . . . . T C E A -Na-o—o 1 2 3 4 5 6 F O U R - M I N U T E S E G M E N T S 8 10 11 12 13 F O U R - M I N U T E S E G M E N T S ./128 T H E R A P I S T JL S U B J E C T _7_ T C E L E V E L 5 . 0 J 4 . 5 4.0 3 . 5 3.6 2 . 5 1 - 3 2 . 0 | •1.1 1 . 0 . 5 i E X P L E V E L 9-4 ©-i^Ost / j > V» 4 ft 4 *f> / M O D E E X F L _ Q P E A K E X P . . . . . . . T C E _ _ A F O U R - M I N U T E S E G M E N T S ./129 T H E R A P I S T S U B J E C T J5_ 9 T C E L E V E L 5 . 0 4 . 5 4 . 0 3 . 5 3.0 2 . 5 & 3 2 . 0 1.1 1 .0 . 5 E X P L E V E L 6 I"5 I4 i i 1 2 3 4 5 6 F O U R - M I N U T E S E G M E N T S 8 M O D E E X H _ Q P E A K E X P . . . 0 . . . T C E A 9 10 11 12 13 T H E R A P I S T JL S U B J E C T 1P_ T C E / E X P L E V E L I L E V E L M O D E E X P _ _ Q _ _ P E A K E X P . . . © . - . T C E —• —• 4 . 0 2 O—O 1 2 3 4 5 6 7 8 9 10 11 F O U R - M I N U T E S E G M E N T S 12 13 . /130 THERAPIST JL SUBJECT J_L T C E L E V E L 5.0 4.5 4.0 3.5 3.01 2.5 2 ' ° ! 1.1 1.0 .5 16 EXP LEVEL M O D E E X P _ _ Q P E A K E X P . . . _ . . . T C E _ A _ Ess jO §)*'"{j)n,"'(2^  o 1 2 3 4 5 6 FOUR-MINUTE SEGMENTS 10 11 12 13 THERAPIST JL SUBJECT 12. TCE g-EXP LEVEL i L E V E L 5.0. 4 .5. 4.0 3.5. 3.0 2.5 2.0. 1.5 1.0 .5 -A r^ - A h 0 - - - 0 s / •32 5 6 FOUR-MINUTE SEGMENTS M O D E E X P _ _ Q _ _ _ P E A K E X P . . . © . . . T C E ./131 T H E R A P I S T J L S U B J E C T JJi T C E L E V E L 4.5 4.0 3.5 3.0 2 .5 f3 2.0 1 . 0 | .5 EXP LEVEL M O D E E X P _ _ Q . P E A K E X P . . . . . . T C E _ A -i-4 \1 0 1 2 3 4 5 6 7 8 9 10 11 12 FOUR-MINUTE SEGMENTS 13 THERAPIST 8 SUBJECT 14_ T C E / E X P L E V E L i L E V E L 12 M O D E E X P . _ Q _ _ P E A K E X P . . . © . . . T C E 0---®-.~<® O - ' - O - - ^ 1 2 3 4 5 6 FOUR-MINUTE SEGMENTS ./132 T H E R A P I S T J L S U B J E C T JJL 6 T C E L E V E L 5 . 0 4 . 5 4 . 0 3 . 5 m 3 . 0 l 2 . 5 2 . 0 • 1 . 1 1 . 0 | . 5 E X P L E V E L 12 O—O 1 M O D E E X R . _ Q P E A K E X P . . . * . . . T C E _ A _ a ••• • R 1 2 3 4 5 6 7 8 9 10 1 1 1 2 1 3 F O U R - M I N U T E S E G M E N T S T H E R A P I S T JL S U B J E C T 1& T C E g.EXP L E V E L I L E V E L 5 . 0 4 . 5 4 . 0 3 . 5 ^ 4 3 . 0 2 . 5 2 . 0 1 . 5 1 . 0 . 5 I 1 2 3 4 5 6 F O U R - M I N U T E S E G M E N T S M O D E E X P . _ Q _ _ P E A K E X P . . . © . . . T C E 1 0 1 1 1 2 1 3 ./133 T H E R A P I S T 10. S U B J E C T JLL T C E L E V E L 5 . 0 4 . 5 4 . 0 | ] 3 . 5 3.0 2 . 5 2 . 0 J 1.1 1.0 . 5 fi E X P L E V E L 6 • 5 M O D E E X P _ _ Q P E A K E X P . . . © . . . T C E A 1 2 o-o-a 1 2 3 4 5 6 F O U R - M I N U T E S E G M E N T S 1 0 1 1 1 2 1 3 T H E R A P I S T 10 S U B J E C T T C E L E V E L 5 . 0 | | 6 4 . 5 J 4 . 0 | 3 « 5 # 4 3 . 0 2 . 5 2 . 0 1.5 1.0l . 5 E X P M O D E E X P _ _ 0 _ . P E A K E X P . T C E — A — L E V E L 15 11 M - O - Agh - O - O - O' O-:0 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2 1 3 F O U R - M I N U T E S E G M E N T S . / 1 3 4 T H E R A P S U B J T C E L E V E L 5 . 0 . 4 . 5 4 . 0 . 3 . 5 3 . 0 . 2 . 5 2 . 0 . 1 . 1 1 . 0 . . 5 1 S T E C T 11 1 9 E X P L E V E L M O D E E X P _ _ Q . P E A K E X P . . . . . . T C E — A -1 2 3 4 5 6 7 8 9 1 0 1 1 1 2 1 3 F O U R - M I N U T E S E G M E N T S T H E R A P I S T XL S U B J E C T 2Q M O D E E X P _ _ 0 _ _ P E A K E X P . . . © . . . T C E 1 2 3 4 5 6 F O U R - M I N U T E S E G M E N T S 8 1 0 1 1 1 2 1 3 ./135 F O U R - M I N U T E S E G M E N T S ./i'36 T H E R A P I S T S U B J E C T 1 3 2 3 3-6 5 T C E L E V E L 5.0J 4.5 4 . 0 f 3.5 3.0 2 . 5 ^ 3 2 .0 1.1 1.0 .5 E X P L E V E L M O D E E X P _ . P E A K E X P . . T C E _ & 2 cT a 1 2 3 4 5 6 F O U R - M I N U T E S E G M E N T S 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 F O U R - M I N U T E S E G M E N T S ./137 T H E R A P I S T __L S U B J E C T J25. T C E L E V E L 5 . 0 . 4 . 5 4 . 0 . 3 . 5 3 . 0 2 . 5 2 . 0 1 . 1 1 . 0 . 5 E X P L E V E L | 6 13 O—Cf 1 2 3 4 5 6 F O U R - M I N U T E S E G M E N T S M O D E E X P _ _ Q P E A K E X P . . . . . . . T C E _ A . _ 8 9 1 0 1 1 1 2 T H E R A P I S T 15. S U B J E C T 2fi M O D E E X P _ _ Q _ . P E A K E X P . . . . . . . T C E - A -1 2 3 4 5 6 F O U R - M I N U T E S E G M E N T S 8 9 1 0 1 1 1 2 ./138 T H E R A P I S T JUL S U B J E C T ' J - 6 5 T C E L E V E L 5 . 0 4 . 5 4 . 0 J 3 . 5 3 . 0 2 . 5 § 3 2 . 0 •1.1 1.6 . 5 E X P L E V E L ® • 'J3K \ / % 2 » 1 M O D E E X P _ _ Q P E A K E X P . . . . . . . T C E A 1 2 3 4 5 6 F O U R - M I N U T E S E G M E N T S • 0 1 1 1 2 1 3 F O U R - M I N U T E S E G M E N T S . I~\ 19 T H E R A P I S T XL S U B J E C T 2_L T C E g E X P L E V E L I L E V E L 5.0J.6 4.5 4.0 3.5 fr4 3.G 2.5f 3 2.0 • 1 . 1 * 2 1.0. .5 M O D E E X R . - Q -P E A K E X P . . . . . . 1 2 3 : 5 6 7 8 9 10 11 12 13 F O U R - M I N U T E S E G M E N T S F O U R - M I N U T E S E G M E N T S . / 1 4 0 APPENDIX C COMPUTER PROGRAMS FOR COMPARISON OF CORRELATION COEFFICIENTS -141-#L T2 Class One comparison of the type r =r xy xz. > 1 REAL#4 N»Z4»Z3fZ2iZl 2 WRITE(6y10) > 3 10 FORMAT ( ' ' r ' THIS PR0GRAM TESTS TI-IE F0LL.0UING HYPOTHES 4 5 6 1 /HO:P<X»Y>=P<X»Z)'/ 2 'HO:P<X»Y> *NE» P<X»Z)V 3 'INPUT DATA FORMAT IS #*•****') •]• 7 12 WRITE(6 v15) •\ 8 15 FORMAT(' 'f'PLEASE INPUT YOUR R(X ?Y)') \ 9 READ(5?20).R12 10 20 FORMAT(F7.4)' 11 WRITE(6»25) 12 25 FORMAT <' ','PLEASE INPUT YOUR R < Y,Z)') :• 13 READ*5/20) R23 :•• 14 WRITE(6x30) :• 15 30 FORMAT<'PLEASE INPUT YOUR R<X»Z>'> :• 16 17 READ(5?20) R13 WRITE(6y40) ; • 18 40 FORMAT(' 'y'PLEASE INPUT YOUR N') :• 19 READ(5y27) N 20 27 FORMAT(F3•0) 22 Z1 = ( 2 * R 2 3 - R12 * R13 > * < 1 - R12 * R12 - R13 * R13 -- R 2 3 * R 2; ;:• 23 Z2=2*R23*R23*R23 ••--, 24 Z 3 = (1 -- R13 * R13 ) * (1 - - R13 * R13 ) • 25 Z4 = (1 --R12*R 12 ) * < 1 - R12*R 12 ) ^ \ 26 Z5=SQRT(Z4+Z3-Z2-Z1) 27 Z 6 = S Q R T < N ) * < R12 • • R13 ) > 28 Z=ZA/Z5 29 WRI TE ( 6 y 50 ) Z •> Z 1 y Z2 y 73 y Z4 y Z5 y Z6 y N 30 50 FORMAT(' ' y'Z='y(F9.4)) 31 WRITE<6»60) 32 60 F0RMAT(' 'y'DO YOU WANT TO C0NTINUE? » 1 = YESt 2=N0') 33 READ(5 y 70) IANS 34 70 FORMAT(11) :• 35 IF CLANS ,EQ. 1) GO TO 12 36 IF(IANS .EQ. 2) GO TO 100 > 37 GO TO 55 > 38 100 STOP > 39 END *END OF F l LF ./142 -142 Class Two comparison of the type: r =r wz xy. Tl V ND 4 5 6 7 8 9 10 11 12 .,13 14 .15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 OI-IO 12 15 20 30 40 REAL*4 N»Z2»ZlrAK WRITE<6r10) FORMAT(' 'y 'THIS PROGRAM T H E F 0 L L 0 WIN G I-l Y P 0 T I-l E SI 60 65 70 75 100 i /HO:F(U*Z>=P<XI>Y)'/ 1 'HlJPCWyZ) .NE. P ( X r Y ) ' / 1 'INPUT DATA FORMAT IS ft*.****") WRITE<6v .1.5) FORMAT(' '»'PLEASE INPUT YOUR R(WrX)') READ(6y20)R12 FORMAT(F7•4) WRITE<6y25) FORMAT(' '?'PLEASE INPUT YOUR R(UrY)') READ(6f20)R13 WRl'TE<6y30) FORMAT ( ' ' * ' PLEASE INPUT YOUR R ( Ul, 2 ) ' ) READ(6v20)R14 WRITE(6 y35) FORMAT(' ','PLEASE INPUT YOUR R(X rY)') READ(6»20)R23 WRITE (6 MO) FORMAT( ' ' f'PLEASE INPUT YOUR R(X,2)') READ(6»20)R24 WRITE<A>45) FORMAT(' ' y 'PLEASE INPUT YOUR R(Y ?2)') READ(6r20)R34 WRITE (As-50) FORMAT(' 'PLEASE INPUT YOUR N') READ<6»20)N AK=<R12-R24*R14)*<R34-R24*R23)+ " 1< R13 -R12* R 23)* <R 24-R12 * R14)+ 1< R12 - R13 * R 2 3) * < R 3 4 -- R13 * R14 ) + 1 (R13 ~ R13 * R 3 4 ) * (R 2 4 - R 3 4 * R 2 3 ) Z1 = <1-R23*R23)* <1-R23*R23) T*2 -<1-R14*R 1-4-) * (• 1-R .1.-4 * R l 4 ) -Z3=R14-R23 Z= ( SORT ( N ) *Z3 ) /SORT (Z2 + Z.1. -AK ) WRITE(6 r60)Z t21 ,22tZ3»AK »N FORMAT(' '»'Z='»F9*4) WRITE(6 y70) FORMAT ( ' ' y ' D0 YOU WANT TO C0NTINUE? 1=YES v 2-• NO') READ(5»75)IANS FORMAT <11) IF(IANS.EQ*1) GO TO 12 IF(IANS.Ea.2) GO TO 100 GO TO 65 STOP END 'ILE 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            data-media="{[{embed.selectedMedia}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
https://iiif.library.ubc.ca/presentation/dsp.831.1-0054605/manifest

Comment

Related Items