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

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EMPATHY, CLIENT DEPTH OF EXPERIENCING, AND GOAL ATTAINMENT SCALING: A WITHIN-SESSION EXAMINATION  OF THE CLIENT-CENTERED THERAPY PROCESS  by  Frank P e t e r  Colistro  B.A., P o r t l a n d  S t a t e U n i v e r s i t y , 1972  M.A.,  S t a t e U n i v e r s i t y , 1973  Portland  A THESIS SUBMITTED. IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF EDUCATION  in the department o f COUNSELLING PSYCHOLOGY FACULTY OF  We accept  EDUCATION  t h i s t h e s i s as conforming  to the r e q u i r e d  standard  THE UNIVERSITY OF BRITISH COLUMBIA September, 1977  J©L_ ?.? .H ?^sr.. F  n  Colis  . ^°.» 1  1  9  7  7  In p r e s e n t i n g an  advanced  the I  this  degree  Library shall  further  for  thesis  agree  scholarly  at the U n i v e r s i t y make  that  purposes  h i s representatives.  of  this  written  it freely  permission  by  thesis  in p a r t i a l  f o r financial  of  The U n i v e r s i t y  Counselling  of British  November  15, 1977  requirements f  of  I agree and this  shall  that  copying  n o t be a l l o w e d  Psychology,  Education  or  tha  study. thesis  by t h e Head of my Department  i s understood  Columbia  2075 Wesbrook Place Vancouver, Canada V6T 1W5  Date  copying  permission.  Department  the  f o r reference  for extensive  gain  of  o f B r i t i s h Columbia,  available  may be g r a n t e d It  fulfilment  or  publication  without my  ABSTRACT  T h i s i s an analogue study therapy  of p r o c e s s  f o c u s i n g c h i e f l y on empathy.  communicated, and  and  Therapist experienced,  T h i r t y s u b j e c t s engaged i n one i n which they d e a l t w i t h incongruence..  "splits", Before  a f f e c t i v e change r e g a r d i n g  their  problem r e s o l u t i o n was  s e s s i o n of C l i e n t - C e n t e r e d internal conflicts  the s e s s i o n s  A t t a i n m e n t S c a l e , which s p e c i f i e d and  therapist  c l i e n t r e c e i v e d empathy were i n t e r r e l a t e d , and  impact on c l i e n t depth of e x p e r i e n c i n g and  personal  outcome i n c l i e n t - c e n t e r e d  treatment  c h a r a c t e r i z e d by  the s u b j e c t s p r e p a r e d  f i v e p e r s o n a l i z e d stages  the s p l i t .  examined.  During  of  a Goal  behavioral  s e s s i o n s audio  recordings  were made which were, l a t e r r a t e d f o r t h e r a p i s t communicated empathy c l i e n t depth of e x p e r i e n c i n g .  Subjects  seven days l a t e r  change on  they a s s e s s e d  Session scores empathy, c l i e n t  a l s o r a t e d t h e r a p i s t empathy, t h e i r Goal A t t a i n m e n t  f o r t h e r a p i s t experienced  ment outcome were then i n t e r c o r r e l a t e d and A s i m i l a r process  s i m i l a r r e s e a r c h , and  the p a t h  the r e s u l t s of the p r e s e n t  was  analyzed  and  treat-  a p p l i e d to the combined r e s u l t s of  generated from t h i s i n t e g r a t i v e summary  and  study were compared to g a i n a c l e a r e r p e r s p e c t i v e  the c a u s a l f l o w among the p r o c e s s  on  the t h r e e empathy phases were compared f o r t h e r a p i s t s a c r o s s  empathy and  Scales.  i n a manner analogous  on  s u b j e c t s they  and  empathy, t h e r a p i s t communicated  r e c e i v e d empathy,. c l i e n t depth of e x p e r i e n c i n g ,  to path a n a l y s i s .  and  interacted with,  and  and  outcome v a r i a b l e s .  As w e l l , the  scores  two  the i n t e r a c t i o n of t h e r a p i s t communicated  c l i e n t depth of e x p e r i e n c i n g was  examined by a c o n t e n t  analysis  of each s e s s i o n . The  path  r e s u l t s suggest t h a t t h e r a p i s t empathic communications l e a d  c l i e n t perceptions ment outcome.  of t h e r a p i s t empathy, which d i r e c t l y  C l i e n t depth of e x p e r i e n c i n g was  facilitates  remote from the  treat-  empathy  to  -ii-  phases and  outcome, f a i l i n g  to demonstrate t h a t e x p e r i e n c i n g  v e n i n g v a r i a b l e between t h e r a p i s t empathy and  outcome,  i s an  inter-  These r e s u l t s  are  t e n t a t i v e s i n c e o n l y one  c o r r e l a t i o n , communicated by r e c e i v e d empathy,  was  However the p a t t e r n i s h i g h l y supported: by  s i g n i f i c a n t a t .05.  r e l a t i o n s among empathy, e x p e r i e n c i n g , and  the ±n~  outcome d e r i v e d from the  t e g r a t i v e summary. The  content  a n a l y s i s of t h e r a p i s t communicated empathy and  depth of e x p e r i e n c i n g  suggested t h a t c l i e n t s e l f - e x p r e s s i o n and  can be i n h i b i t e d by t h e r a p i s t s making an e x c e s s i v e number of based on i n a c c u r a t e or i n s u f f i c i e n t u n d e r s t a n d i n g i m p l i e d t h a t t h e r e are some cases be c a u s a l l y r e l a t e d , although  exploration  reflections  of the c l i e n t .  i n which empathy and  This  experiencing  t h i s c a u s a l l i n k a g e i s not  examined a c r o s s a l l c l i e n t - t h e r a p i s t  client  may  c o n s i s t e n t when  interaction.  Comparison of the c o r r e l a t i o n s between the t h r e e empathy phases process  and  outcome measures, i n c o n j u n c t i o n w i t h the c o r r e l a t i o n s among  the phases, suggested t h a t the phases were r e l a t e d but d i s t i n c t T h e r a p i s t experienced was  constructs.  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 t h a t  e s s e n t i a l l y u n r e l a t e d to treatment p r o c e s s  communicated empathy and  and  outcome.  Therapist  c l i e n t r e c e i v e d empathy were r e l a t i v e l y  across c l i e n t s , suggesting empathy.  and  t h a t these v a r i a b l e s r e f l e c t  stable  therapist trait  Of the t h r e e phases, c l i e n t r e c e i v e d empathy was  most s t r o n g l y  p r e d i c t i v e of treatment outcome. Overall, centered  the study  s e s s i o n s of  client-  treatment, t h e r a p i s t empathic communications a r e r e l a t e d to  c l i e n t ' s perceptions Thses p e r c e p t i o n s in  suggests t h a t , w i t h i n f i r s t  the  of the t h e r a p i s t ' s empathy l e v e l i n the r e l a t i o n s h i p .  i n t u r n p o s i t i v e l y i n f l u e n c e treatment outcome.  the l e v e l of c l i e n t depth of e x p e r i e n c i n g may  m i n o r degree by communicated empathy, but  Changes  a l s o be a f f e c t e d to a  experiencing  does not appear to  -iii-  powerfully  i n f l u e n c e the treatment p r o c e s s a t t h i s e a r l y s t a g e .  The r e s u l t s suggest t h a t c l i e n t r e c e i v e d  empathy, b e i n g the empathy  phase most p r e d i c t i v e of treatment outcome, should be the phase most stressed the  i n client-centered  treatment.  therapist with a valuable  Frequent CRE r a t i n g s c o u l d  highly  furnish  index of the e f f i c a c y o f the treatment p r o c e s s .  A f u r t h e r i m p l i c a t i o n f o r t r a i n i n g of Rogerian t h e r a p i s t s i s t h a t the o v e r all  concept of empathy encompasses t h e r a p i s t v e r b a l and k i n e s i c  beyond the scope of s c a l e s m e a s u r i n g communicated empathy, most o f t e n s t r e s s e d  the empathy phase  in>the t r a i n i n g p r o c e s s .  F i n a l l y , t h i s study p o i n t s meta-analysis of c l i e n t - c e n t e r e d  to the p o t e n t i a l v a l u e of an  extensive  treatment ..research which would q u a n t i t a t i v e l y  i n t e g r a t e and summarize the e x t a n t f i n d i n g s r e g a r d i n g therapy .  actions  t h i s school  o f psycho-  -IV-  •TABLE OF CONTENTS ( Acknowledgements  Page ± ^-j.  Abstracts Chapter One:  The Scope o f the Study  Background  1  o f the Problem  1  The Research Problem  3  D e f i n i t i o n o f Terms  5  Statement o f the Hypotheses  6  P a t t e r n Hypotheses  6  Segment-by-Segment H y p o t h e s i s C o n c e r n i n g the Relationship of Therapist  Communicated Empathy  to Depth o f E x p e r i e n c i n g  7  S t a b i l i t y H y p o t h e s i s C o n c e r n i n g the Three Empathy Phases f o r T h e r a p i s t s A c r o s s S u b j e c t s R a t i o n a l e f o r the Hypotheses  7 8  Assumptions  II  Delimitation  11  J u s t i f i c a t i o n f o r the study  12  Chapter Two:  14  Survey o f the L i t e r a t u r e  The I n t e g r a t i v e Summary o f P r e v i o u s Research  23  I s s u e s R e l a t i n g to C l i e n t - C e n t e r e d  29  Chapter Three: Formal  Methodology Hypotheses  Hypothesis  Testing  Therapy  34 36 38  -vPage Therapists  39  Subjects  39  Instruments  40  Secondary Data Sources  45  Procedure  46  Design  48  Chapter Four:  Results  51  Staggered C o r r e l a t i o n s o f T h e r a p i s t Communicated and  Empathy  C l i e n t Depth o f E x p e r i e n c i n g  Examination ( S e s s i o n One by S e s s i o n  53 Two) o f the Three  Empathy Phases and Depth o f E x p e r i e n c i n g  54  R e s u l t s of H y p o t h e s i s T e s t s  55  Pattern  57  Suggested by the Data  Qualitative Results:  D e s c r i p t i v e A n a l y s i s of the  T h e r a p i s t Communicated Empathy by C l i e n t Depth o f Experiencing  Relationship  61  Divergence  Chapter F i v e :  61  Discussion  68  Is empathy a u n i t a r y c o n s t r u c t ?  68  T h e r a p i s t empathy:  75  Empathy:  s t a t e or t r a i t ?  What i s the Most U s e f u l O p e r a t i o n a l  C l i e n t Depth o f E x p e r i e n c i n g : How  State or T r a i t ?  i s Treatment Outcome Best  78  Interrelate?  79  Predicted?  What i s the O v e r a l l Statement o f C l i e n t - C e n t e r e d P r o c e s s Supported by the Study?  76 77  i s C l i e n t P r o c e s s Best P r e d i c t e d ?  How do Empathy and E x p e r i e n c i n g How  Definition?  80 Therapy 81  The Role of Congruence Limitations  Chapter S i x :  Conclusion  Implications Theory Practice Research Summary  Bibliography Appendix A Appendix B Appendix C  -Vll-  LTST OF FIGURES Page Figure  1:  The C l i e n t - C e n t e r e d T h e r a p e u t i c  Figure  2:  Expected P a t t e r n to be D e r i v e d  Process  3  from I n t e r c o r r e l a t i o n  o f F i v e Main V a r i a b l e s  6  Figure  3:  Data from Table 1 A p p l i e d to the Main V a r i a b l e s  Figure  4:  The Data from Table 1 A p p l i e d  26  to C o r r e l a t i o n a l  A n a l y s i s w i t h Main V a r i a b l e s  28  Figure  5:  The Ten C o r r e l a t i o n a l Paths Among the Main V a r i a b l e s  35  Figure  6:  The Research P r o c e s s  48  Figure  7:  Path Arrangement  58  Figure  8:  F i n a l Path Arrangement  Figure  9:  Divergence P a t t e r n  Figure  10:  11:  12:  62  69  Research  70  The R e l a t i o n s h i p o f the Three Phases o f Empathy t o  Previous 13:  60  R e l a t i o n s among Empathy Phases from Summary Data  C l i e n t Depth o f E x p e r i e n c i n g  Figure  from Study Data  Study  of P r e v i o u s Figure  Derived  R e l a t i o n s among Empathy Phases from Data o f the Present  Figure  o f Data from the Main A n a l y s i s  From Summary Data o f  Research  70  The R e l a t i o n s h i p o f the Three Phases o f Empathy to ' Treatment Outcome from Summary Data o f P r e v i o u s Research  Figure  14:  71  The R e l a t i o n s h i p o f the Three Phases o f Empathy to C l i e n t Depth of E x p e r i e n c i n g T h i s Study.  from the Data o f 72  -Vlll-  LIST OF FIGURES CON'T Page Figure  15:  The R e l a t i o n s h i p o f the Three Phases of Empathy to Treatment Outcome from the Data o f T h i s Study  Figure  16:  The I n t e r r e l a t i o n s h i p s among T h e r a p i s t  72  Communicated  Empathy, C l i e n t R e c e i v e d Congruence, C l i e n t R e c e i v e d Empathy, and Treatment Outcome.  86  -ix-  LIST OF TABLES Page M a t r i x o f the F i n d i n g s from Other  Table Two  Issues R e l a t i n g t o C l i e n t - C e n t e r e d Therapy  31-33  Table  D e s c r i p t i o n of Therapists  39  Table Four  D e s c r i p t i o n of Subjects  40  Table F i v e  I n t e r c o r r e l a t i o n s among the Empathy Phases, Depth  Three  Studies  25  Table One  of E x p e r i e n c i n g , Outcome, and Four Secondary 52  Variables Staggered C o r r e l a t i o n s of T h e r a p i s t Communicated  Table S i x  Empathy and C l i e n t Depth o f E x p e r i e n c i n g Table  S e s s i o n by S e s s i o n C o r r e l a t i o n s o f Process  Seven  54  Variables Table E i g h t  53  :  T - T e s t s f o r T h e r a p i s t Experienced  Empathy,  T h e r a p i s t Communicated Empathy, C l i e n t  Received  Empathy, and C l i e n t Depth of E x p e r i e n c i n g  55  Table Nine  C o r r e l a t i o n s among CRC, TCE, CRE, and TO  84  Table Ten  T - T e s t s o f CRC by CRE, and CRC ( S e s s i o n One by S e s s i o n Two).  85  -X-  ACKNOWL EDGEMENTS  I would l i k e t o thank Dr. L e s l i e Greenberg  and the o t h e r members o f  my t h e s i s committee f o r t h e i r p a t i e n c e , s u p p o r t and guidance. a l s o to D a n i e l N a e g e l i , B r i a n Harper, Adam Horvath, for  Thanks  and C a t h e r i n e C l a r k e  t h e i r a s s i s t a n c e i n the e x e c u t i o n and data a n a l y s i s phases o f t h i s  study.  A final throughout  thank you i s addressed  nine years of u n i v e r s i t y .  to my p a r e n t s f o r t h e i r moral  support  -1-  CHAPTER The  ONE  Scope of the  Study  Background of the Problem Empathy i s a c o n s t r u c t of major importance i n psychotherapy I t i s a l s o a c o n s t r u c t which i s s t i l l i t s d e f i n i t i o n and Empathy was  obscured  research.  by c o n t r o v e r s i e s r e g a r d i n g  value.  first  i n v e s t i g a t e d i n depth by C a r l Rogers (1951, 1957).  He wrote t h a t t h r e e " c o r e " t h e r a p e u t i c c o n d i t i o n s : genuineness, empathy, and warmth, i n h e r e d i n a l l s u c c e s s f u l therapy f i c i e n t conditions for positive c l i e n t not o n l y f o r c l i e n t - c e n t e r e d therapy other  and were n e c e s s a r y  change.  and  suf-  Rogers b e l i e v e d t h i s  true  but a l s o f o r treatments  based on a l l  theoretical orientations. He d e s c r i b e d empathy as a f o c u s i n g on the c l i e n t ' s phenomenal  T h i s f o c u s i n g on or immersion i n the c l i e n t ' s thoughts and fact  the source of the term " c l i e n t Meador and  f e e l i n g s was  in  centered".  Rogers wrote r e g a r d i n g empathy: The  t h e r a p i s t attempts to "get i n t o the shoes" of  his client,  to get "under h i s s k i n " .  to the c l i e n t ' s words, but he world.  He not o n l y  listens  immerses h i m s e l f i n h i s  H i s comments r e f l e c t not o n l y what the  client  i s s a y i n g , but a l s o r e f l e c t  the hazy a r e a a t the edge  of the c l i e n t ' s awareness.  Through the t h e r a p i s t ' s  communicating h i s u n d e r s t a n d i n g  of the c l i e n t ' s  meanings not y e t c o n c e p t u a l i z e d i n t o awareness, c l i e n t broadens h i s u n d e r s t a n d i n g  of h i m s e l f  a l l o w s i n t o awareness more of h i s o r g a n i s m i c The  .12  world.  confirmatory  experience  felt the  and experiencing.  of f e e l i n g understood  seems  -2-  to  g i v e substance  and  power to the c l i e n t ' s  self-concept.  I t i s as though the c l i e n t a f f i r m s , " I t ' s  o.k.  even t h i s t e n t a t i v e new me  The of  to be me,  which i s emerging."  t h e r a p i s t does not f o c u s on the p r e s e n t the c l i e n t ' s world  or d i a g n o s i s .  i n o r d e r to make an  interpretation  p.  138).  Roger's h y p o t h e s i s .  S e v e r a l r e s e a r c h e r s have  focused on t h e r a p i s t communicated empathy as an important  1971;  ( C a r k h u f f , 1973;  Gurman, 1973;  rating  Carkhuff  Truax, 1965;  & Berenson, 1967;  therapeutic  G a r f i e l d & Bergin,  1972), and have developed  methods of  t h e r a p i s t communicated empathy from v i d e o and audio  s e s s i o n s , and of r a t i n g t h e r a p i s t empathic u n d e r s t a n d i n g  tapes of  therapy  or e x p e r i e n c i n g  from t h e r a p i s t s e l f - r e p o r t i n v e n t o r i e s ( B a r r e t t - L e n n a r d , 1963; During  of  i t s e l f which e f f e c t s g r o w t h f u l change  (Meador & Rogers, 1973, Others have supported  experiencing  He b e l i e v e s t h a t i t i s the e x p e r i e n c e  f e e l i n g understood  condition  expanding  1974).  the y e a r s s i n c e Rogers' o r i g i n a l work s e v e r a l i n t e r e s t i n g  p r o v o c a t i v e i s s u e s have r e c e i v e d 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  and  litera-  ture. 1.  Is empathy a t h e r a p i s t t r a i t  specific  or a b i l i t y which i s s t a b l e a t a  l e v e l and which can be measured o u t s i d e of treatment,  or  does t h e r a p i s t empathy v a r y s h a r p l y as a f u n c t i o n of some q u a l i t i e s of  ./3  the p a r t i c u l a r r e l a t i o n s h i p and  2.  How  3.  Is empathy a u n i t a r y c o n s t r u c t ?  4.  How  situation?  i s empathy b e s t measured?  does t h e r a p i s t empathy r e l a t e to therapy process and  outcome?  -3-  These i s s u e s s t i l l and  the p r e s e n t  study  r e q u i r e e m p i r i c a l and  seeks to p r o v i d e both  p r i m a r i l y f o r i s s u e number f o u r .  conceptual  clarification,  these types of  Specifically,  clarification,  the study f i r s t  the t h e o r e t i c a l model of the c l i e n t - c e n t e r e d treatment  discusses  process.  This  model i s a l s o examined by means of a q u a n t i t a t i v e summary of p r e v i o u s r e search.  F i n a l l y , data on empathy, c l i e n t p r o c e s s , and outcome are  by means of a l a b o r a t o r y a n a l o g of the f i r s t treatment.  generated  s e s s i o n of c l i e n t - c e n t e r e d  The p a t t e r n 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 p a t t e r n suggested  by c l i e n t - c e n t e r e d theory and  previous  research. Tangential questions r e l a t i n g on  to empathy such as i s s u e s one  to t h r e e  the p r e v i o u s page are a l s o d i s c u s s e d i n l i g h t of the r e s u l t s of  study and centered  previous f i n d i n g s . treatment  In these ways the study p r e s e n t s  examined w i t h i n s e s s i o n s and  f i n d i n g s by comparing them to theory and  this  client-  t e s t s the e f f i c a c y of i t s  to r e l a t e d  research.  The Research Problem A c l i e n t - c e n t e r e d view of p r o c e s s  i n psychotherapy  i s represented  by  the f o l l o w i n g f l o w c h a r t :  A  B  t h e r a p i s t experi e n c e s empathy f o r the c l i e n t  F i g u r e 1.  The  D t h e r a p i s t communi c a t e s empathy to the c l i e n t  Client-Centered Therapeutic  Barrett-Lennard  74  c l i e n t receives t h e r a p i s t communicated empathy  c l i e n t depth of s e l f - e x periencing i s enhanced  client experiences positive change  Process  (1974) r e f e r s to p a r t s A, B, and  C i n this series  as  -4-  the "empathy c y c l e " .  The  i n g to the c l i e n t who  i s i n some way  (A).  The  c y c l e s t a r t s w i t h the t h e r a p i s t a c t i v e l y  attend-  e x p r e s s i n g h i s unique e x p e r i e n c i n g  t h e r a p i s t r e f l e c t s the c l i e n t ' s e x p e r i e n c i n g i n such a way  o v e r t l y o r c o v e r t l y expressed  a s p e c t s of i t are enhanced  (B).  i s a t t e n d i n g to the t h e r a p i s t ' s response s u f f i c i e n t l y f o r him the extent of the t h e r a p i s t ' s immediate p e r s o n a l u n d e r s t a n d i n g The  c l i e n t then c o n t i n u e s  The  that client  to p e r c e i v e (C).  e x p r e s s i n g h i m s e l f i n a manner n o t i c -  a b l y e n r i c h e d by the t h e r a p i s t ' s empathic r e f l e c t i o n s  (D).  T h i s study  deavors to examine the p r i n c i p a l components to the empathy c y c l e and r e l a t i o n s h i p to c l i e n t depth of e x p e r i e n c i n g and  ./5  treatment  en-  their  outcome ( E ) .  -5-  D e f i n i t i o n of Terms T h e r a p i s t experienced empathy (A) has been d e f i n e d by Rogers (.1957) as s e n s i n g "the c l i e n t ' s world as i f i t were your own, the "as i f " q u a l i t y . . . t o sense the c l i e n t ' s anger, if  i t were your own,  bound up i n i t . . . "  y e t w i t h o u t your anger, (p. 99).  but w i t h o u t  losing  f e a r , or c o n f u s i o n as  f e a r , or c o n f u s i o n g e t t i n g  In t h i s study, l e v e l o f t h e r a p i s t  experienced  empathy i s o p e r a t i o n a l l y d e f i n e d as a s c o r e on the t h e r a p i s t form o f the B a r r e t t - L e n n a r d R e l a t i o n s h i p Inventory  (BLRI),  ( B a r r e t t - L e n n a r d , 1963).  T h e r a p i s t communicated empathy (B) i s the degree statements  reflect  empathic  u n d e r s t a n d i n g , and i s measured by C a r k h u f f ' s  (1969) f i v e p o i n t s c a l e f o r measuring  empathy from  C l i e n t r e c e i v e d empathy (C) i s the degree understood  by the t h e r a p i s t .  the BLRI ( c l i e n t  to which t h e r a p i s t  tapes.  to which the c l i e n t  I t i s o p e r a t i o n a l l y d e f i n e d as a s c o r e on  form).  C l i e n t depth of e x p e r i e n c i n g (D) i s d e f i n e d as the degree client  statements  e v i d e n c e a w i l l i n g n e s s and a b i l i t y  r e l e v a n t f e e l i n g s and  thoughts, and  on the E x p e r i e n c i n g (EXP)  Treatment  to which  to e x p l o r e p e r s o n a l l y  i s o p e r a t i o n a l l y d e f i n e d as a s c o r e  S c a l e ( K l e i n , Mathieu,  Gendlin, & K i e s l e r ,  1969).  outcome (E) i s a s s e s s e d through the l e v e l of success i n  treatment as measured by Goal Attainment which c l i e n t and  Scaling  (GAS),  a technique i n  t h e r a p i s t c o n j o i n t l y s e t g o a l s and d e v i s e a f i v e  s c a l e d e s c r i b i n g the degree of achievement of these as a r e s u l t of ( K i r e s u k & Sherman, 1974).  .76  feels  level therapy  -6-  Statemerit of the Hypotheses The hypotheses w i l l be p r e s e n t e d l o g y s e c t i o n o f the t h e s i s .  i n formal  f a s h i o n i n the methoda-  Following are their e s s e n t i a l i n t e n t s .  P a t t e r n Hypotheses The f i r s t study;  s e t of hypotheses d e a l s w i t h  the p r i n c i p a l f o c u s o f the  the p a t t e r n o f i n t e r a c t i o n among the t h r e e empathy phases, depth  of e x p e r i e n c i n g ,  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 o f 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. -EXP  F i g u r e 2.  Expected P a t t e r n to be D e r i v e d  from I n t e r c o r r e l a t i o n of F i v e  Main V a r i a b l e s .  The main hypotheses a r i s i n g from t h i s p a t t e r n a r e : 1.  I t i s p r e d i c t e d t h a t c l i e n t r e c e i v e d empathy  (CRE)- w i l l be the s t r o n g e s t  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 p r e d i c t e d t h a t t h e r a p i s t communicated empathy  (TCE) w i l l be the  s t r o n g e s t 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 r e c e i v e d empathy ( a f t e r treatment outcome). 3.  I t i s p r e d i c t e d t h a t t h e r a p i s t communicated empathy w i l l be the s t r o n g est p o s i t i v e ,  4.  s i g n i f i c a n t c o r r e l a t e o f depth of e x p e r i e n c i n g  I t i s p r e d i c t e d that t h e r a p i s t e x p e r i e n c e d  empathy  (EXP).  (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 t h e r a p i s t communicated empathy, and t h a t 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 s t r o n g e r  ,,.11  than the  -7-  c o r r e l a t i o n s between TEE  and  CRE,  EXP,  or  TO.  Segment-by-Segment H y p o t h e s i s Concerning the R e l a t i o n s h i p Communicated Empathy to Depth of Therapist  TCE  and  In a f u r t h e r a n a l y s i s , however, TCE  depth of e x p e r i e n c i n g  EXP  and  T h i s was  done to i n c r e a s e  EXP  r a t i n g s are  w i t h TCE  involved  30  segments.  experimental  following  points.  segment s c o r e s  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 a n a l y s i s components i s c o n t a i n e d i n Design s e c t i o n of  using  a c c u r a c y by p r o d u c i n g a c o r r e l a t i o n  c o r r e l a t i n g a l l the EXP  s c o r e s from p r e c e e d i n g and  correlated  correlated  c o e f f i c i e n t based on a l a r g e n i n c l u d i n g a l l p o s s i b l e d a t a A further analysis  are  s c o r e s averaged w i t h i n  i n d i v i d u a l s c o r e s from each four-minute segment of the sessions.  Therapist  Experiencing  communicated empathy and  i n the main a n a l y s i s by u s i n g  of  the Methodology c h a p t e r .  The  the  h y p o t h e s i s which d e a l s  w i t h these a n a l y s e s i s :  It i s predicted, ratings  i n the  greater  than TCE  staggering  that  c o r r e l a t i o n of TCE  same segment w i l l be by  EXP  segment TCE  time w i t h i n  the  Across  EXP  significantly  c o r r e l a t i o n s derived s c o r e s ahead or l a c k  from of  sessions.  S t a b i l i t y H y p o t h e s i s Concerning the Therapists  and  Three Empathy Phases f o r  Subjects  Disagreement e x i s t s over whether t h e r a p i s t e x p e r i e n c e d , communicated, and  c l i e n t received  ship v a r i a b l e s .  ./8  empathy are p r i m a r i l y t h e r a p i s t  t r a i t s or  relation-  S i n c e each t h e r a p i s t i n the study i n t e r a c t e d w i t h  two  ^  n  —o—  subjects, the  two  the  t r a i t - s t a t e i s s u e i s addressed by computing _t - s c o r e s  s e t s of three  conducted by  the  empathy measures generated by  therapist.  The  the  two  for  interviews  f o l l o w i n g hypotheses d e a l w i t h t h i s phase  of a n a l y s i s : 6.  It i s predicted  that the s u b j e c t  one-by-subject two  comparison of  t h e r a p i s t e x p e r i e n c e d empathy w i l l y i e l d a s t a t i s t i c a l l y  significant  difference. 7.  It i s predicted  that  the s u b j e c t  one-by-subject two  comparison of  t h e r a p i s t 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  significant  difference. 8.  It i s predicted  t h a t the s u b j e c t  one-by-subject two  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  comparison significant  of dif-  ference.  Rationale The  f o r the Hypotheses  hypotheses f o l l o w from c l i e n t - c e n t e r e d theory which suggests  e x p e r i e n c e d empathy, communicated empathy, c l i e n t r e c e i v e d of e x p e r i e n c i n g ,  and  should  the c l i e n t ,  treatment outcome. of p e r s o n a l  received  thoughts, f e e l i n g s , and  empathic r e f l e c t i o n s .  A therapist's behaviors  These communications, i f  tend to enhance the p r o b a b i l i t y of  They a l s o are  thoughts and  Research has  thought to enhance c l i e n t  successful expressions  feelings.  shown t h a t t h e r a p i s t communicated empathy and  client  empathy can be p o s i t i v e l y r e l a t e d to outcome ( K u r t z & Grummon,  1972), and  .19  of the c l i e n t ' s  l e a d to a c c u r a t e  r e c e i v e d by  empathy, depth  treatment outcome are p o s i t i v e l y r e l a t e d .  i n t e r n a l experiencing  that  t h a t communicated empathy and  depth of e x p e r i e n c i n g  can  be  -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 c o n s i s t e n t l y demonstrated. focus of t h i s  I t i s these r e l a t i o n s h i p s which a r e the  study.  An o f t e n s u c c e s s f u l means o f improving on p r e v i o u s r e s e a r c h i s t o examine s u g g e s t i o n s made by r e s e a r c h e r s i n r e l a t e d s t u d i e s . t h i s type through the l i t e r a t u r e r e l a t i n g  t h e r a p i s t communicated  and c l i e n t depth o f e x p e r i e n c i n g to treatment outcome y i e l d e d results, One  A search of empathy  fruitful  f o u r recommendations a p p e a r i n g c o n s i s t e n t l y . concerned  the measurement o f t h e r a p i s t communicated empathy and  depth o f e x p e r i e n c i n g .  Researchers suggested  that these v a r i a b l e s c o u l d  v a r y c o n s i d e r a b l y i n l e v e l w i t h i n the therapy hour.  They t h e r e f o r e recom-  mended t h a t TCE and EXP would most a c c u r a t e l y be measured by minute-byminute r a t i n g s r a t h e r than by the u s u a l procedure o f e x t r a c t i n g and r a t i n g o n l y two or t h r e e sample segments of the v a r i a b l e s i n a treatment  session  ( B e u t l e r , 1973; K u r t z and Grummon, 1973; K i e s l e r , K l e i n and Mathieu, 1965; Mintz and Luborsky, Another  1971).  recommendation concerned  the assessment  Researchers p o i n t e d t o the e v e r - p r e s e n t problem of  o f treatment outcome.  i n psychotherapy r e s e a r c h  f i n d i n g s e n s i t i v e , r e s p o n s i v e i n s t r u m e n t s w i t h which to d i s c e r n  c l i e n t progress.  They tended  to downplay the v a l u e o f g l o b a l 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 a l l o w themselves and  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 g o a l s ( B e r g i n  Suinn, 1975; G a r f i e l d and B e r g i n , 1971; Luborsky and Spence, A third  s u g g e s t i o n arose from the f a c t  client—centered  lizability  ./10  t h a t most r e s e a r c h on the  treatment p r o c e s s has been conducted  t u d i n a l s t u d i e s of a c t u a l therapy.  1971).  i n the form o f l o n g i -  T h i s p r a c t i c e has augmented the genera-  o f the r e s e a r c h but has a l s o a l l o w e d f o r c o n s i d e r a b l e e r r o r  -10-  v a r i a n c e inasmuch as exact treatment i n t e r v e n t i o n s , n a t u r e of p r e s e n t i n g problem  and treatment d u r a t i o n were o f t e n not f i x e d .  Researchers t h e r e -  f o r e have recommended t h a t these f a c t o r s be h e l d c o n s t a n t as much as possible  ( C l a r k e , 1977;  Greenberg,  1976;  K l e i n , et a l . ,  1969).  A f i n a l recommendation has come m a i n l y from the r e s e a r c h of and Chinsky  (Chinsky and Rappaport,  They advocated  1970;  Rappaport  1971).  the use o f as many t h e r a p i s t s as p o s s i b l e i n s t u d i e s o f  communicated empathy to p r o t e c t a g a i n s t r a t e r b i a s . number of  and Chinsky,  Rappaport  That i s , having a  t h e r a p i s t s generate hundreds of r a t e a b l e segments  effectively  e l i m i n a t e s the p o s s i b i l i t y t h a t empathy r a t e r s w i l l r e c o g n i z e t h e r a p i s t s from v o i c e o r s t y l e , and  thus develop a response s e t to p a r t i c u l a r  thera-  pists . The  importance  and n a t u r e of c l i e n t depth of e x p e r i e n c i n g as an  i n t e r v e n i n g v a r i a b l e which l e a d s to p o s i t i v e change i n treatment a r e much debated  issues.  K l e i n et a l . (1969) c i t e d numerous f i n d i n g s t h a t show a  h i g h l e v e l of e x p e r i e n c i n g as b e i n g a s s o c i a t e d w i t h p o s i t i v e therapy o u t come, but no s i g n i f i c a n t  t r e n d of improvement i n e x p e r i e n c i n g from  g i n n i n g to end of s u c c e s s f u l therapy. and  The p r e s e n t s i n g l e s e s s i o n ,  treatment m e t h o d - s p e c i f i c therapy a n a l o g study was  beproblem  designed to examine  the communicated empathy/depth of e x p e r i e n c i n g r e l a t i o n s h i p more p o w e r f u l l y by l o o k i n g i n s i d e a treatment s e s s i o n i n a moment-to-moment manner. expected client  I t was  t h a t the a n a l y s i s would show t h a t t h e r a p i s t communicated empathy and  r e c e i v e d empathy l e a d to h i g h e r l e v e l s o f e x p e r i e n c i n g and outcome  through examination of Pearson product-moment c o 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 The chain  importance  to path  analysis.  of t h e r a p i s t e x p e r i e n c e d empathy i n the t h e r a p e u t i c  o f events has r e c e i v e d no s t r o n g e m p i r i c a l s u p p o r t .  I t was  none-  t h e l e s s i n c l u d e d i n the study i n hopes t h a t the n o v e l e x p e r i m e n t a l s i t u a t i o n  ./ll  -11-  would expose a r e l a t i o n s h i p between t h i s and any o f the o t h e r 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 t h r e e types o f empathy, and depth o f e x p e r i e n c i n g and the f i r s t  to see which type b e t t e r p r e d i c t s  client  treatment outcome by an i n t e n s i v e examination o f  s e s s i o n of c l i e n t - c e n t e r e d  treatment.  The study a l s o seeks to  augment the e m p i r i c a l a n a l y s i s w i t h a thorough i n t e g r a t i v e summary of p r e vious research findings.  Assumptions The medium f o r examining analog.  That i s , s u b j e c t s and  of  the treatment analog was  session.  I t was  t h e r e f o r e assumed  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  that  session  an a c t u a l therapy s i t u a t i o n to enable the r e s e a r c h e r to g e n e r a l i z e  results of  a therapy  therapists Interacted i n a client-centered  therapy s i t u a t i o n f o r o n l y one 1)  the r e s e a r c h q u e s t i o n s was  to such a s e t t i n g ,  2)  that t h e r a p i s t s w i t h more than two  e x p e r i e n c e were s u f f i c i e n t l y q u a l i f i e d  c e n t e r e d treatment,  3)  that  not s i g n i f i c a n t l y contaminate  to conduct one s e s s i o n of  the a u d i o - t a p i n g and  years client-  s e l f - r e p o r t measures d i d  the treatment e f f e c t s , and  4)  that volunteer  c l i e n t s drawn from a community c o l l e g e p o p u l a t i o n c o u l d be regarded  as  c l i e n t s i n aeneral. T h i s l a s t assumption  was  grounded i n the b e l i e f  t h a t everyone, r e g a r d -  l e s s of whether o r not they have a c t i v e l y sought p r o f e s s i o n a l h e l p , i s c o n t i n u a l l y engaging i s s u e s may  i n the r e s o l u t i o n o f emergent l i f e i s s u e s .  These  v a r y 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 b u t the b a s i c dynamics o f  r e s o l u t i o n remain  the same.  Delimitation Strictly  ./12  speaking, s i n c e s u b j e c t s were r e c r u i t e d from s t u d e n t s i n a  -12-  community c o l l e g e , i n the  first  implications  t h i s study g e n e r a l i z e s  session  of c l i e n t - c e n t e r e d  to community c o l l e g e  counselling,  f o r psychotherapy i n g e n e r a l inasmuch as  but  students  i t possesses  the  relations i t  demonstrates i n h e r e 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 a t a l l stages of treatment.  That i s , h i g h l e v e l s of t h e r a p i s t empathy s h o u l d enhance  client  s e l f - e x p l o r a t i o n and  should  t h e o r e t i c a l l y be  and  behavioral  self-expression,  c l i e n t p r o c e s s e s which  c a u s a l l y l i n k e d to modest c o g n i t i v e , a f f e c t i v e ,  change w i t h r e g a r d 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 o r the Unlike  similar studies  experiencing  i n which communicated empathy and  session,  y i e l d i n g only the  s e v e r a l data p o i n t s  c a t e d empathy and the  i n t e r a c t i o n i n each s e s s i o n  study seeks to augment the power of i t s  (strictly  (one  session  r e f l e c t i v e ) , and  (a p e r s o n a l incongruence, or " s p l i t " ) , often  left  in vari-  includes on  communi-  experiencing.  c o n t r o l l i n g treatment d u r a t i o n intervention  f o r these two  i n t e n s i v e a n a l y s i s phase of t h i s study  r a t i n g s of every t h e r a p i s t - s u b j e c t  As w e l l ,  depth of  r a t i n g s were taken a t random from three or f o u r p o i n t s  treatment s e s s i o n s , a b l e s per  study  per  design  by  c l i e n t ) , method of  the form of the p r e s e n t i n g f a c t o r s which o t h e r s t u d i e s  therapist issue have  uncontrolled.  In t h i s study the minute-by-minute measurement mentioned above was  en-  g i n e e r e d to p r o v i d e a p o w e r f u l t e s t of the r e l a t i o n s h i p between communicated empathy and  experiencing,  l e v e l of these two I t was  fluctuations in  variables.  assumed that  duced e r r o r v a r i a n c e  ./13  b e i n g more s e n s i t i v e to s m a l l  t h i s c o n t r o l would remove some of the  that can  design-in-  obscure r e l a t i o n s among v a r i a b l e s .  -13-  O v e r a l l , the p r e s e n t study reviews theory and q u a n t i t a t i v e l y summarizes g e n e r a l l y examined  the p r i n c i p l e s o f c l i e n t - c e n t e r e d  r e l e v a n t p r e v i o u s r e s e a r c h which has  c l i e n t - c e n t e r e d p r o c e s s by s p o t - c h e c k i n g c l i e n t s  the f u l l d u r a t i o n o f t h e i r treatment.  The study then generates  across  comparable  data by examining the t h e r a p e u t i c p r o c e s s on a moment-to-moment b a s i s w i t h i n one s e s s i o n o f c l i e n t - c e n t e r e d to theory and p r e v i o u s r e s e a r c h .  .../14  treatment,  and compares  this  data  -14-  CHAPTER  TWO  Survey of the L i t e r a t u r e  Rogers c o n c e p t u a l i z e d therapy as c o n s i s t i n g of " . . . e x p e r i e n c i n g  the  s e l f i n a wide range of ways i n an e m o t i o n a l l y m e a n i n g f u l r e l a t i o n s h i p the t h e r a p i s t "  (Rogers,  1951,  p. 172).  with  Presence of the t h r e e core con-  d i t i o n s i n the t h e r a p i s t 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 p e r c e i v e s the .core c o n d i t i o n s i n the t h e r a p i s t and has a s u f f i c i e n t amount of a n x i e t y r e l a t e d  to the problem t h a t he i s e x p e r i e n c i n g .  Rogers and o t h e r s conducted r e s e a r c h t h a t suggested  a positive  between the core c o n d i t i o n s and  (Rogers,  Iiu-the ensuing propositions. found  change i n treatment  1967).  y e a r s o t h e r r e s e a r c h e r s o f f e r e d support  Truax, Imber, B a t t l e , Hoehn-Saric, Nash, and  f o r Roger's Stone  outcome.  Barrett-Lennard  (1962) found  pathy as measured by the B a r r e t t - L e n n a r d  that c l i e n t received  R e l a t i o n s h i p Inventory was  t i v e l y r e l a t e d to outcome as measured by the M a n i f e s t A n x i e t y MMPI, and  c l i e n t - c e n t e r e d treatment f i r m e d Roger's i n i t i a l Gladstein  K r a t o c h e i l , 0.,  the  con-  formulations.  1963;  Aspy, D.,  Hountras, P.T., and  and Anderson, 1969;  C a r k h u f f , R.R.,  "empathy does not appear important (1971)  o u t s i d e of  has produced r e s u l t s which o f t e n have not  1967;  Truax,  Katz,  concluded  i n c o u n s e l l i n g " (p. 823).  conducted a study of the  and  L e s s e r , W.M.,  t h a t attempted to l i n k the core c o n d i t i o n s to outcome and  .715  posi-  Scale,  examined empathy i n and  (1970) reviewed s i x major s t u d i e s (Dickenson  Gonyea, G.G.,  Bergin  em-  the Q-Adjustment S c a l e .  Other r e s e a r c h , however, t h a t has  and  (1966),  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 c o n d i t i o n s and  therapy  1966;  relation  relationship  1962; 1961) that  Garfield  of t h e c o r e c o n d i t i o n s t o therapy outcome w i t h a sample o f p r e d o m i n a t e l y 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 t a p e - r a t e d measures of t h e core c o n d i t i o n s and a v a r i e t y o f o u t come measures.  Furthermore  i t was found t h a t w h i l e 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 c o r r e l a t e d , both c o r r e l a t e d n e g a t i v e l y w i t h genuineness.  The authors  concluded:  The w i d e l y d i s c u s s e d Truax e t a l . (1965) f i n d i n g s are probably not r e p l i c a b l e outside of a c l i e n t - c e n t e r e d therapy s i t u a t i o n .  I t c o u l d be argued  that  genuineness,  empathy and warmth a r e j u s t as important i n o t h e r o r i e n t a t i o n s , but they must be measured d i f f e r e n t l y i n those settings.  T h i s may be t r u e , and i t i s worth d e v e l o p i n g  new s c a l e s , but t h i s i s n o t what c l i e n t - c e n t e r e d r e s e a r c h e r s have advocated.  The burden o f p r o o f would  appear to r e s t on them t o demonstrate  that t h e i r  concepts  and s c a l e s have t h e wide a p p l i c a b i l i t y which they have claimed. Another noteworthy  ( G a r f i e l d & B e r g i n , 1971, p. 113). study a t t e m p t i n g t o e m p i r i c a l l y e v a l u a t e the t h e r a -  p e u t i c p r o c e s s d e s c r i b e d by Rogers was conducted 1972.  by K u r t z and Grummon i n  U s i n g s i x measures o f t h e r a p i s t empathy employed i n p r e v i o u s r e s e a r c h ,  the authors c o r r e l a t e d t h e empathy measures w i t h each o t h e r , w i t h a measure of t h e r a p e u t i c p r o c e s s measures (Tennessee of s u c c e s s ) .  (depth o f s e l f - e x p l o r a t i o n ) , and s e v e r a l outcome  S e l f - C o n c e p t S c a l e , MMPI, t h e r a p i s t and c l i e n t  The empathy measures were n o t s i g n i f i c a n t l y r e l a t e d to each  o t h e r , and t h e a u t h o r s concluded  t h a t p r e v i o u s r e s e a r c h had been  s e v e r a l d i f f e r e n t v a r i a b l e s employing  ./16.  ratings  a common l a b e l .  measuring  Of t h e s i x empathy  -16-  measures, o n l y t h e r a p i s t communicated empathy was r e l a t e d exploration*, a variable similar  to depth of s e l f -  to depth of e x p e r i e n c i n g .  A l l the c o r r e l a -  t i o n s between communicated empathy and therapy outcome measures were p o s i t i v e , but o n l y one (with the Tennessee S e l f - C o n c e p t S c a l e ) was (p < .01).  significant  C l i e n t r e c e i v e d empathy was the most p o w e r f u l . p r e d i c t o r of t h e r -  apy outcome i n the study, a c c o u n t i n g f o r 30% of the v a r i a n c e of the comb i n e d outcome s c o r e . The most important purposes  f i n d i n g of the K u r t z and Grummon study f o r p r e s e n t  was t h a t c l i e n t r e c e i v e d empathy more or l e s s i n d e p e n d e n t l y of  t h e r a p i s t e x p e r i e n c e d and communicated empathy, was the s t r o n g e s t p r e d i c t o r of  outcome, s u g g e s t i n g t h a t what r e a l l y matters  i n treatment  i s whether or  not the c l i e n t p e r c e i v e s the t h e r a p i s t as u n d e r s t a n d i n g h i s problem and as b e i n g honest w i t h the c l i e n t , and t h a t t h i s p e r c e i v e d or r e c e i v e d empathy may v a r y almost  i n d e p e n d e n t l y of communicated o r e x p e r i e n c e d empathy i n the  therapist. A review of the r e s e a r c h r e l a t e d lation  to the c o r e c o n d i t i o n s and t h e i r r e -  to outcome was c a r r i e d out by B e r g i n and Suinn  (1975).  They con-  cluded : It  c o u l d be t h a t a number of n e g a t i v e f i n d i n g s on  genuineness,  empathy, and warmth a r e due to the f a c t  the t h e r a p i s t s b e i n g s t u d i e d were not employing client-centered  a  technique and thus the Truax-type  that  strictly scales  were not a p p l i c a b l e even though the o r i g i n a l c l a i m was t h a t these v a r i a b l e s c u t a c r o s s s c h o o l s . conditions are v i t a l correlated with i t ,  Perhaps  these  to p o s i t i v e change, o r a r e a t l e a s t but a r e not b e i n g measured a p p r o p r i a t e l y .  For example, i n a number of s t u d i e s showing a p o s i t i v e r e l a t i o n s h i p between tape r a t e d empathy and outcome t h e r e * A f i v e - p o i n t s c a l e measuring e x p e r i e n c i n g l e v e l s from "remote from exp e r i e n c i n g . .. unaware" to " l i v e s i n p r o c e s s of e x p e r i e n c i n g " (Walker, Rablen, & Rogers, 1960, p. 8 0 ) .  -17-  were quite s i g n i f i c a n t correlations between c l i e n t received empathy and outcome, usually as measured by the Barrett-Lennard Relationship Inventory (p. 515). Five issues of major importance i n understanding the role of empathy in the therapeutic process have been:  1.  Is empathy a therapist t r a i t or i s i t a variable  quality of therapeutic relationships?  2.  Is empathy a unitary  3.  How are experienced, communicated, and c l i e n t  ;  construct?  received  empathy operationally defined?  4.  How do the three phases of empathy r e l a t e to depth  of experiencing  5.  and therapy outcome?  How does depth of experiencing  relate to therapy  outcome?  The question of whether empathy i s a stable therapist t r a i t  (ability)  or a function of p a r t i c u l a r relationship variables was f i r s t dealt with by Rogers (1957) who defined the therapeutic condition of empathy as a twophase process: The therapist experiences an empathic understanding of the c l i e n t ' s i n t e r n a l frame of reference and endeavors to communicate this experience to the c l i e n t (p. 95), and the communication to the c l i e n t of the therapist's empathic  ./18  -18-  u n d e r s t a n d i n g i s to a m i n i m a l degree a c h i e v e d The  empathy d e s c r i b e d  by Rogers was c o n c e p t u a l i z e d  (p.  96).  by some as a con-  s i s t e n t a b i l i t y o f the t h e r a p i s t to understand the c l i e n t and then to communicate t h i s u n d e r s t a n d i n g 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 t o c o n s t r u c t measures o f t h e r a p i s t empathy o u t s i d e setting  (Kagan, 1967) and w i t h i n i t ( C a r k h u f f ,  However, a study by B e u t l e r was not always c o n s t a n t siderably.  He c o n c l u d e d accurate  the therapy  1967; Truax, 1967).  (1972) showed t h a t communicated empathy  between o r w i t h i n s e s s i o n s , b u t o f t e n v a r i e d conthat: empathy may n o t be a s t a b l e q u a l i t y o f the  t h e r a p i s t as i s u s u a l l y assumed, but i n s t e a d may r e f l e c t a dyadic  o r 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 t h e r a p e u t i c  conditions of  t h r e e h i g h and t h r e e low f u n c t i o n i n g t h e r a p i s t s w i t h one ongoing c l i e n t p e r therapist.  He too found t h a t empathy r a t i n g s o f t h e r a p i s t s v a r i e d , n o t o n l y  from s e s s i o n to s e s s i o n , but a l s o from minute t o minute i n a g i v e n  session.  I t i s thus a l s o p o s s i b l e t h a t t h e r a p i s t empathy may n o t be a t r a i t , b u t r a t h e r a s t a t e o f b e i n g which can v a r y therapy.  The i s s u e  isstill  considerably  unresolved  from minute t o minute i n  inasmuch as the l i t e r a t u r e abounds  in contradictory findings. Regarding the c o n s t r u c t  d e f i n i t i o n o f empathy, the d a t a o f s e v e r a l  s t u d i e s i n d i c a t e t h a t the f a c i l i t a t i v e c o n d i t i o n i n q u e s t i o n group o f r e l a t e d b u t d i s t i n c t  constructs.  a t measures o f empathy r e p r e s e n t i n g  i s probably a  K u r t z and Grummon (1972) looked  t h r e e f a c e t s o f the c o n s t r u c t ;  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  therapist  Scale  (Kagan  e t a l . , 1967); t h e r a p i s t communicated empathy as measured by tape r a t i n g s ; and  c l i e n t r e c e i v e d empathy as measured by the BLRI.  d a t a do n o t r e v e a l a u n i t a r y c o n s t r u c t  .../19  They concluded "The  o f empathy, but s e v e r a l  different  -19-  v a r i a b l e s which are thought McWhirter  to be s i m i l a r but i n f a c t are n o t " (p. 113).  (1973) a l s o found t h a t t h e r a p i s t e x p e r i e n c e d empathy, t h e r a -  p i s t communicated empathy, and c l i e n t r e c e i v e d empathy were t h r e e d i s t i n c t variables. Barrett-Lennard  (1974) most a c c u r a t e l y summed up t h i s s i t u a t i o n by  p o s i t i n g t h r e e phases o f empathy: Phase One  —  empathic  u n d e r s t a n d i n g o r e x p e r i e n c e d empathy,  which i s a t h e r a p i s t ' s a b i l i t y the c l i e n t i s s a y i n g and  Phase Two  —  the feedback  to f u l l y comprehend what  feeling;  communicated empathy, which i s the q u a l i t y of the t h e r a p i s t g i v e s to the  client;  and  Phase Three —  c l i e n t r e c e i v e d empathy, which i s the  to which the c l i e n t  f e e l s understood  degree  and r e s p e c t e d by  the  therapist. Regarding  the l a c k of c o r r e l a t i o n sometimes found between measures of  the t h r e e phases,  B a r r e t t - L e n n a r d wrote: One might expect t h a t a modest c o r r e l a t i o n would  among v a l i d measures o f the p r i n c i p a l  exist  e x p e r i e n t i a l and  com-  m u n i c a t i o n a l p r o c e s s e s i n v o l v e d i n the d i f f e r e n t phases a broad  sample of r e l a t i o n s h i p s ) .  However,  theoretically,  there i s no reason to expect, f o r example, a c l o s e t i o n between a genuine  empathic  s e t and  (over  l e v e l of  associa-  expressed  empathy; or a s t r o n g r e l a t i o n s h i p between i n n e r r e s o n a t i o n and p e r s o n a l u n d e r s t a n d i n g  (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 c o n s c i o u s t h a t  ./20  the  -20-  o t h e r i s w i t h him i n p e r s o n a l u n d e r s t a n d i n g  (phase  three)  (p. 6). Thus empathy appears constructs:  t o be most a c c u r a t e l y c o n c e p t u a l i z e d as t h r e e  t h e r a p i s t e x p e r i e n c e d empathy, t h e r a p i s t communicated  empathy,  and c l i e n t r e c e i v e d empathy, which may o r may not be s t a t i s t i c a l l y  related.  The most a p p r o p r i a t e means o f 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 o f phase under e x a m i n a t i o n .  The l i t e r a t u r e  indicates  that  phase one empathy i s most commonly measured by the t h e r a p i s t form o f the B a r r e t t - L e n n a r d R e l a t i o n s h i p I n v e n t o r y , phase two empathy by tape s c a l e s such as those o f C a r k h u f f empathy by t h e c l i e n t The  (1969) and Truax  rating  (1961), and phase t h r e e  form o f the BLRI.  q u e s t i o n o f whether o r n o t (and how) t h e r a p i s t communicated  pathy r e l a t e s t o therapy outcome has drawn a f a i r l y i n the l i t e r a t u r e . and B e r g i n and Suinn  consistent  response  K u r t z and Grummon (1972), G a r f i e l d and B e r g i n (1975) found  em-  t h a t communicated empathy tended  (1971), to c u r -  r e l a t e p o s i t i v e l y but u s u a l l y n o n - s i g n i f i c a n t l y w i t h a v a r i e t y o f outcome measures.  T h e r a p i s t e x p e r i e n c e d empathy has n o t been shown t o be a p o w e r f u l  p r e d i c t o r o f outcome, and c l i e n t r e c e i v e d empathy has c o n s i s t e n t l y been h i g h l y c o r r e l a t e d with the r e s u l t s of psychotherapy and  ( B a r r e t t - L e n n a r d , 1962; K u r t z  Grummon, 1974). A p o s s i b l e problem w i t h t h e a b o v e - c i t e d s t u d i e s and o t h e r s i m i l a r r e -  s e a r c h has been t h a t a l l employed g l o b a l outcome measures which can be i n sensitive to p o s i t i v e c l i e n t to note  change.  I t i s i n t e r e s t i n g w i t h r e s p e c t to t h i s  t h a t the a u t h o r s o f these s t u d i e s a l l r e c o g n i z e d t h a t  might have e x i s t e d and suggested  this  t h a t i t might have been remedied  problem 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, t h e c o n s t r u c t 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 o f psychotherapy  or a t h e r a p i s t  trait  t h a t can b e s t be c o n c e p t u a l i z e d as a group  -21-  of three v a r i a b l e s :  t h e r a p i s t experienced  empathy, and c l i e n t r e c e i v e d empathy.  empathy, t h e r a p i s t communicated  Of these,  communicated empathy and  c l i e n t r e c e i v e d empathy have been most c o n s i s t e n t l y p o s i t i v e l y r e l a t e d to t h e r a p e u t i c outcome, and o f the two, c l i e n t r e c e i v e d empathy has been the more p o w e r f u l p r e d i c t o r of change. Communicated empathy i s b e s t measured by f r e q u e n t  r a t i n g s of v i d e o  or audio tapes o f therapy s e s s i o n s , and c l i e n t r e c e i v e d empathy i s most e f f e c t i v e l y measured by the B a r r e t t - L e n n a r d  Relationship  Inventory.  T h e r a p i s t communicated and c l i e n t r e c e i v e d empathy have been r e l a t e d to s e v e r a l g l o b a l therapy outcome measures, but more c a s e - s p e c i f i c measures have been recommended  by r e s e a r c h e r s  Suinn,,1975; G a r f i e l d and B e r g i n ,  (Barrett-Lennard,  1962; B e r g i n and  1971; Greenberg, 1976; Gurman, 1973;  K e l l e y , 1976; K i r e s u k and Sherman, 1968). B e r g i n and Suinn (1975) summed up the s t a t u s o f empathy as i t r e l a t e s to p r o c e s s  and outcome i n c o u n s e l l i n g and psychotherapy when they wrote: I t i s c l e a r e r now t h a t  (the core c o n d i t i o n s o f  genuinesness, empathy, and warmth) a r e n o t as  prepotent  as once b e l i e v e d , but t h e i r presence and i n f l u e n c e are u b i q u i t i o u s , even showing up s t r o n g l y i n b e h a v i o r therapies  (p. 521).  In other words, empathy i s l e s s and l e s s seen as a n e c e s s a r y o r s u f f i c i e n t c o n d i t i o n f o r f a c i l i t a t i n g c l i e n t movement. the presence of low empathy l e v e l s .  Change can occur i n  However, the e f f i c a c y o f most forms  of psychotherapy i s o f t e n enhanced by an empathic c l i e n t - t h e r a p i s t  relation-  ship . The r o l e and importance of c l i e n t depth of e x p e r i e n c i n g are f i n a l i s s u e s to be d e a l t w i t h . experiencing  The most a u t h o r a t a t i v e  i n therapy  t r e a t i s e on  i s the two volume manual f o r measuring the c o n s t r u c t w r i t t e n  -22-  by K l e i n , Mathieu, Gendin, and K i e s l e r , experiencing  0.969).  They d e f i n e d depth of  as: The  q u a l i t y of an i n d i v i d u a l ' s e x p e r i e n c i n g of h i m s e l f ,  the e x t e n t  to which h i s ongoing, b o d i l y f e l t  experiencing  i s the b a s i c datum of h i s awareness and  communications about h i m s e l f , and  the extent  t h i s i n n e r datum i s i n t e g r a l to a c t i o n and These authors  to which  though (p. 1 ) .  c o n c e p t u a l i z e d e x p e r i e n c i n g as a seven p o i n t continuum.  At a low l e v e l of t h i s h i e r a r c h y , c l i e n t p e r s o n a l and  f l o w of  suferficial.  more and more p e r s o n a l and f r e e l y examined and  Moving up  communication i s markedly  im-  the s c a l e , communications become  feeing-oriented.  Higher s t i l l ,  f e e l i n g s are  emergent l e v e l s of e x p e r i e n c i n g serve as. the b a s i c  r e f e r e n t s f o r problem s o l v i n g . (The EXP  They  continue:  S c a l e i s ) s e n s i t i v e to s h i f t s i n p a t i e n t  involvement, even w i t h i n a s i n g l e i n t e r v i e w s e s s i o n , making i s u s e f u l f o r m i c r o s c o p i c example, to a s s e s s  process  studies, for  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 a p p r a i s e d i f f e r e n t p a t t e r n s of i n t e r a c t i o n between p a t i e n t s and  t h e r a p i s t s , or to e s t a b l i s h a p r o f i l e  of  p a t i e n t performance d u r i n g the therapy hour (p. 1 ) . K l e i n e t a l , reviewed over a dozen s t u d i e s i n t h e i r manual from 1960 and  to 1969  which sought to r e l a t e e x p e r i e n c i n g  outcome v a r i a b l e s .  They  ranging  to v a r i o u s  process  concluded:  In t o t o , these e a r l y s t u d i e s show t h a t both depth of e x p e r i e n c i n g and therapy  the g l o b a l p r o c e s s  r a t i n g s of b r i e f  segments are c o n s i s t e n t l y and h i g h l y r e l i a b l e ,  and y i e l d a m e a n i n g f u l d i f f e r e n t i a t i o n between more and l e s s s u c c e s s f u l cases and between n e u r o t i c s and  ./23  schizophrenics.  -23-  .The most p o w e r f u l and c o n s i s t e n t f i n d i n g i s t h a t s u c c e s s f u l therapy p a t i e n t s s t a r t , c o n t i n u e ^ and end  therapy a t a h i g h e r . l e v e l than d o ' l e s s s u c c e s s f u l  patients.  A p p a r e n t l y the b e h a v i o r  t h a t the s c a l e s  measure i s h i g h e r i n s u c c e s s f u l cases from the s t a r t . Some o f these s t u d i e s show change i n e x p e r i e n c i n g o r p r o c e s s , t h a t i s , upward movement over therapy a s s o c i a t e d w i t h success and downward movement a s s o c i a t e d w i t h f a i l u r e , but these f i n d i n g s a r e g e n e r a l l y l e s s than those f o r o v e r a l l l e v e l , and a r e l e s s replicated. and  We can s a f e l y conclude  striking  consistently  t h a t the p r o c e s s  e x p e r i e n c i n g s c a l e s measure p a t i e n t b e h a v i o r a f -  f e c t i n g change, but how t h i s b e h a v i o r may v a r y o r change over therapy i s more open to q u e s t i o n (p. 16). Thus, w h i l e i t i s c l e a r t h a t o v e r a l l adjustment  and l i k e l i h o o d of  success i n therapy v a r y d i r e c t l y w i t h l e v e l o f e x p e r i e n c i n g , i t i s s t i l l u n c l e a r whether EXP changes from b e g i n n i n g to end of treatment  and whether  c e r t a i n therapist behaviors s t r o n g l y i n f l u e n c e i t s occurrence. E x p e r i e n c i n g can thus be i n t e r p r e t e d as t a p p i n g the degree o f depth of the p a t i e n t ' s involvement to  i n therapy, i n c l u d i n g h i s w i l l i n g n e s s and a b i l i t y  p r o v i d e the t h e r a p i s t w i t h m a t e r i a l w i t h which t o empathize, and h i s  openness to the t h e r a p i s t ' s approach.  I t i s , however, s t i l l  unclear i f  c l i e n t depth o f e x p e r i e n c i n g i s o r i s not s i g n i f i c a n t l y a f f e c t e d by t h e r a p i s t empathy.  The  I n t e g r a t i v e Summary of P r e v i o u s  Research  T h i s summary i s a cumulative review of major, o r i g i n a l s t u d i e s p r e s e n t e d in  a q u a n t i t a t i v e form.  ./24  The g o a l o f the summary i s to p r o v i d e a model o f  -24-  c l i e n t ^ c e n t e r e d treatment w i t h which to compare the date d e r i v e d from study.  A t h e o r e t i c a l model of course a l r e a d y e x i s t s  e v e r , the e m p i r i c a l examination  the  (see F i g u r e 1 ) .  of c l i e n t - c e n t e r e d therapy over two  Howdecades  has not c o 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  this  model. The  s t u d i e s i n c l u d e d i n the summary m a t r i x were chosen c h i e f l y because  they a r e major, landmark i n v e s t i g a t i o n s of c l i e n t - c e n t e r e d therapy, i n v e s t i g a t i o n s t h a t spawned a m u l t i t u d e of s i m i l a r examinations ments.  Other  of Rogerian  c o n s i d e r a t i o n s t h a t l e d to t h e i r i n c l u s i o n were t h a t they were  c o r r e l a t i o n a l i n n a t u r e and  t h a t w i t h the e x c e p t i o n of Goal Attainment  they employed s i m i l a r o r i d e n t i c a l measures to those i n the p r e s e n t The  treat-  Scaling,  study.  summary i s not i n t e n d e d to c o n s t i t u t e an a l l - i n c l u s e review of the r e -  s e a r c h which has i n t e r r e l a t e d p r e s e n t study.  some or a l l of the f i v e main v a r i a b l e s i n the  However, the r e s e a r c h e r has endeavored to i n c l u d e r e s e a r c h  w i t h f i n d i n g s r e p r e s e n t a t i v e of the r e s u l t s of s i m i l a r s t u d i e s .  In o t h e r  words, i f a l l the r e s e a r c h r e l a t i n g , f o r example, TCE and EXP were p r e s e n t e d i n the a p p r o p r i a t e c e l l , expected  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  to d i f f e r a p p r e c i a b l y from  The r e s u l t s of t h i s procedure  .60,"the v a l u e p r e s e n t e d are p r e s e n t e d  i n Table 1  be  i n the m a t r i x . (following).  Where s e v e r a l 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 c a l c u l a t e d .  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  d e r i v e d from the n and e x e r c i s e was  undertaken  the a l p h a l e v e l  ( G l a s s and  w i t h the u n d e r s t a n d i n g  S t a n l e y , 1970).  t h a t the r e s u l t s from  v a r i o u s s t u d i e s c i t e d were not d i r e c t l y comparable i n any t a t i v e manner, but n o n e t h e l e s s c o u l d s e r v e as h e u r i s t i c s .  ./25  T h i s i s what i s p r e s e n t e d  the  s t r i c t , quantiIn o t h e r words,  an i n d i c a t i o n of c a u s a l l i n k a g e s o r paths among v a r i a b l e s c o u l d be r i v e d from the combined d a t a .  This  de-  i n F i g u r e 3.  EXP Kurtz & Grummon, 1974. BLRI therapi s t form & Carkhuff empathy scale were correlated. r= -.24 (NS). n = 31)  |r» .09 (ns). Barrett-Lennard, 1963. Compared c l i e n t & therapist forms of BLRI. (n= 29) [Kurtz & Grummon, 1974. BLRI client & therapist forms correlated. r=.20 (n = 31, ns) .  Kurtz & Grummon, 1974. BLRI therapist form correlated w. depth of self-exploration. r= -.06 (n = 31. NS) .  Kurtz 6. Grummon, 1974. BLRI therapist 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. '  TEE .01 Kurtz & Grummon, 1974. Correlation between BLRI client form & Carkhuff [Empathy scale = .31 (n=31.' p<-10)  TCE  Kurtz & Grummon, 1974. Carkhuff pathy ratings correlated w. depth of self-exploration. r=.47 (p <.Q1, n = 31) 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 s e l f exploratlon. r-= .24 (n=31. NS). CRE  TEE: Therapist Experienced Empathy TCE: Therapist Communicated Empathy  (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).  CRE: Client Received Empathy EXP: Depth of Experiencing TO:  EXP  Treatment Outcome  ,27  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 s i g n i f i c 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 outcome 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 s i g n i f l cantly related to MMPI & Wittenbom scales (p <.10). n=28. Tomlinson & Hart, 1962. Rogers I Process Scale s i g n i f i c a n t l y ro related to success i n therapy (n=10, p .01) l .40  F i g u r e 3.  Data from T a b l e 1 A p p l i e d  to the Main V a r i a b l e s .  The  dotted l i n e represents  by a comparison o f the r e l a t i v e  one path o r p o s s i b l e , c a u s a l f l o w  suggested  magnitudes o f the c o r r e l a t i o n s i n T a b l e  1,  w i t h c o n s i d e r a t i o n g i v e n 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 r s i n v o l v e d . The  l i n e was determined by working backward from treatment outcome, p i c k i n g  the s t r o n g e s t c o r r e l a t e , working back from t h a t to i t s s t r o n g e s t c o r r e l a t e , and  so on.  The path  i m p l i e s t h a t treatment outcome i s most l i k e l y  to be  s u c c e s s f u l when t h e r a p i s t communicated empathy i s h i g h and when i t i s p e r c e i v e d and r e c e i v e d by the c l i e n t . process  Depth o f e x p e r i e n c i n g drops out o f the  s i n c e the EXP/TO c o r r e l a t i o n i s s m a l l e r than the CRE/TO c o r r e l a t i o n .  S i n c e the c o r r e l a t i o n between t h e r a p i s t communicated empathy and c l i e n t r e c e i v e d empathy i s c l o s e to the one between c l i e n t r e c e i v e d empathy and c l i e n t depth o f e x p e r i e n c i n g , 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 r e c e i v e d empathy l e a d s t o treatment outcome and e x p e r i e n c i n g ,  which  a r e thus c o n c e p t u a l i z e d as two outcome v a r i a b l e s which a r e r e l a t e d ( r = .40) but d i s t i n c t  nonetheless.  I f one works backward from EXP as w e l l as TO, the p a t t e r n suggested i n F i g u r e 4 emerges.  I OR-'  -29-  T h e r a p i s t communicated empathy i s the s t r o n g e s t c o r r e l a t e o f experi e n c i n g , c l i e n t r e c e i v e d empathy the s t r o n g e s t c o r r e l a t e o f treatment come.  CRE and TCE a r e moderately r e l a t e d .  out-  T h i s model i m p l i e s t h a t t h e r a -  p i s t communicated empathy most d i r e c t l y induces  experiencing.  I t may a l s o  f a c i l i t a t e c l i e n t r e c e i v e d empathy which i n turm would l e a d to treatment outcome.  T h i s would be the expected model to appear from the d a t a  ated from t h i s  gener-  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 ( t h e r a p i s t experienced  empathy, t h e r a p i s t communicated empathy, c l i e n t r e c e i v e d em-  pathy, c l i e n t depth o f e x p e r i e n c i n g , and treatment outcome) as the s a l i e n t elements i n the c l i e n t - c e n t e r e d therapy study  process.  I t i s the aim o f t h i s  to see which o f these v a r i a b l e s b e s t p r e d i c t therapy  p r o c e s s and  outcome and to determine i f a c a u s a l l i n k i s i n d i c a t e d between any o f the empathy measures, between empathy and depth o f e x p e r i e n c i n g , o r among the empathy measures, depth o f e x p e r i e n c i n g ,  and treatment outcome w i t h i n a  s e s s i o n o f c l i e n t - c e n t e r e d treatment. The t h r e e phases o f empathy, t h e r a p i s t e x p e r i e n c e d ,  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 a r e a l s o examined f o r each t h e r a p i s t a c r o s s s u b j e c t s by means o f t - t e s t s t o address the s t a t e / t r a i t i s s u e , and  i n t e r r e l a t i o n s among the t h r e e phases a r e a n a l y z e d  garding  the c o n s t r u c t d e f i n i t i o n o f empathy.  Issues R e l a t i n g t o C l i e n t - C e n t e r e d The c h i e f g o a l of t h i s study c l i e n t - c e n t e r e d treatment p r o c e s s  Therapy i s to p r e s e n t  an o v e r a l l statement o f the  by examining the i n t e r r e l a t i o n s among  measures o f empathy, e x p e r i e n c i n g , and outcome. s e v e r a l i s s u e s c o n c e p t u a l l y r e l a t e d to t h i s g o a l . therapist t r a i t  ./30  f o r information r e -  or a r e l a t i o n s h i p variable?  The study a l s o examines They a r e :  I s empathy a  I s empathy a u n i t a r y e n t i t y  -30-  or a group o f r e l a t e d but d i s t i n c t o p e r a t i o n a l d e f i n i t i o n o f empathy? t r a i t or a relationship variable? depth o f e x p e r i e n c i n g ? terrelate?  and  constructs?  What i s the p r e f e r r e d  I s depth o f e x p e r i e n c i n g a c l i e n t What measure o f empathy b e s t p r e d i c t s  How do communicated empathy and e x p e r i e n c i n g i n -  What empathy measure b e s t p r e d i c t s outcome?  g o a l and the r e l a t e d i s s u e s a r e p r e s e n t e d  The c h i e f  i n Table 2 a l o n g w i t h the  v a r i a b l e s they encompass and the r e l e v a n t data a n a l y s i s components i n the  study.  /11  -31-  TABLE 2 I s s u e s R e l a t i n g to C l i e n t - C e n t e r e d  Questions  Variables Involved*  1)  a l l variables  What i s the o v e r a l l s t a t e -  3)  Data A n a l y s i s  all path  ed therapy p r o c e s s i n  (Figures  chart 7 & 8)  study?  Empathy: s t a t e o r t r a i t ?  I s empathy a u n i t a r y construct?  TEE  therapist  TCE  1x2;  CRE  (Table  TEE  x TCE x CRE  sessions  8)  main a n a l y s i s matrix (Table  732  Component  components, esp.  ment o f the c l i e n t - c e n t e r -  the  2)  Therapy  5)  -32-  4)  Empathy: what i s the  TEE  preferred operational  TCE x EXP x TO  d e f i n i t i o n i n terms of predicting client & treatment  5)  EXP:  main a n a l y s i s matrix (Table  5)  process  outcome?  s t a t e or t r a i t ?  EXP  graphs o f EXP i sessions (Appendix B)  6)  How  i s c l i e n t process  (EXP) best p r e d i c t e d ?  a l l main variables  therapist sessions 1 x 2 (Table  7)  How  do communicated  8)  TEE  main a n a l y s i s  empathy and e x p e r i e n c i n g  TCE x EXP  matrix  interrelate?  CRE  (Table  5)  TCE x EXP staggered  (Table  6)  analysis  -33-  8)  How  i s outcome b e s t  predicted?  a l l main  main  analysis  v a r i a b l e s x TO  matrix (Table  *  5)  TEE:  t h e r a p i s t e x p e r i e n c e d empathy  TCE:  t h e r a p i s t communicated  CRE:  c l i e n t received  EXP":,  depth of  TO:  treatment outcome.  ,/34  empathy  experiencing  empathy  -34-  ' CHAPTER THREE Methodology  The primary focus of this study i s what happens inside a therapy session; how therapist affects c l i e n t on an immediate basis and how relates to the resolution of c l i e n t issues.  this  The methodology presented  below describes a therapy analog s i t u a t i o n which attempted  to allow a  n a t u r a l i s t i c 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 communicated  empathy, c l i e n t received empathy, depth of experiencing, and  treatment outcome) and four secondary variables (number of hours doing client-centered treatment, t o t a l 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 i n the main analysis, which consisted of a c o r r e l a t i o n a l analysis with inference and s t a t i s t i c a l procedures analogous to pathanalysis (Neale and Leibert, 1973; Yee and Gage, 1970).  As w e l l , therapist  communicated empathy and depth of experiencing were examined on a minuteby-minute basis, and TCE/EXP patterns within sessions were observed i n the intensive analysis.  The r e s u l t s of the main and intensive analyses were  combined and compared to a summary matrix (Table 1) i n which data from selected similar studies,were summarized.  The pattern suggested by the  summary matrix has been presented i n Figure 4.  I t i s the pattern expected  to be derived from the data generated by this study, and i s reproduced i n Figure 5 with the correlations l a b e l l e d with l e t t e r s A to I.  .735  -36-  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 F i g u r e 5 a r e expressed i n the f o l l o w ing  general equation:  D > B > C > E  =  F > I > A > G > H > J  T h i s e q u a t i o n i s t h e b a s i s f o r the f o r m a l hypotheses  Formal  Hypotheses  It i s predicted of  t h a t the f o l l o w i n g r e l a t i o n s h i p s between the magnitude  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 t h a t d i f f e r e n c e s i n each  case w i l l be s i g n i f i c a n t  '  R  2.  a t t h e .05 l e v e l .  T0.CRE  W  R  TO.CRE  W  l  1  1 b  e  3.  R  TO.CRE  W  i  l  1 b  e  '  R  TO.CRE  W  l  1  1 b  e  significantly  g r e a t e r than g x p . C R E  5 >  R  T0.CRE  W  l  1  1 b  e  significantly  g r e a t e r than  6.  R  T0.CRE  W  i  l  1 b  e  7.  R  T0.CRE  W  1  4  8. 9. 10.  r  T  QC  R  E  i  i  X  P  >  T  C  E  E  X  P  -  X  C  E  r  E  X  C  1 b  s  s  e  s  significantly  g r e a t e r than  significantly  g r e a t e r than r ^ g . T C E  i  ±  i  g  n  g  n  g  n  l  i  i  f  f  f  i  l  i  c  c  c  a  a  a  n  n  n  t  t  t  l  l  l  y  r  g r e a t e r than  r  y  g r e a t e r than r ^  y  g r e a t e r than  g r e a t e r than  E  i  1 b  l  1 b  e  e  E  X  p  >  w i l l be s i g n i f i c a n t l y  r  E E  T  E  E  >  E  X  p  T  E  E  >  T  C  r  *  C  R  T  O  t  i  l  1 b  e  significantly  g r e a t e r than  1 3  '  R  EXP.TCE  W  i  l  1 b  e  significantly  8  1 4  *  R  EXP.TCE  W  i  l  1 b  e  significantly  g r e a t e r than r  1 5 ,  R  EXP.TCE  w  i  l  1 b  e  significantly  g r e a t e r than • • r  i in  T  C  E  w i l l be s i g n i f i c a n t l y  C  E  T  C  E  E >  W  -  T  r  EXP.TCE  P  <  g r e a t e r than ^Q ^ p  R  X  E  E  r  '  E  0  _^0  1 2  r  T  r  significantly  1  ^rj cRE E >  g r e a t e r than  1  w  T  l  e  significantly  r  p  1 b  g r e a t e r than  w E  l  w i l l be s i g n i f i c a n t l y  r  11.  16.  p r e s e n t e d below.  r e a t e r  T H A N  R  g r e a t e r than  TCE.TEE ^  r  ^  E X p > T E E  ^ _ r n E  E  E  -37-  significantly  g r e a t e r than  R  T0.TCE  E  significantly  g r e a t e r than  R  TO.EXP  E  significantly  g r e a t e r than  R  CRE.EXP  17.  R  CRE.TCE  W  L  1  1  B  E  18.  R  CRE.TCE  W  I  L  1  B  19.  R  CRE.TCE  W  I  L  1  B  20.  r „„ „ „ w i l l be CRE.TCE  significantly  g r e a t e r than  R  TCE.TEE  21.  r„„„ „ „ w i l l be CRE.TCE  significantly  g r e a t e r than  R  T0.TEE  m  m  22.  R  CRE.TCE  W  I  L  1  B  S  significantly  g r e a t e r than  R  EXP.TEE  23.  R  CRE.TCE  W  I  L  1  B  £  significantly  g r e a t e r than  R  CRE.TEE  24.  R  T0.TCE  W  L  1  1  B  E  significantly  greater  T  H  A  N  25.  R  T0.TCE  W  I  L  1  B  £  significantly  greater  T  H  A  N  26.  R  TO.TCE  W  L  1  1  B  E  significantly  greater  T  H  A  N  27.  R  TO.TCE  W  L  1  1  B  E  significantly  g r e a t e r than E X P . T E E  28.  R  TO.TCE  W  L  1  1  B  E  significantly  g r e a t e r than :  29.  R  CRE.EXP  W  I  L  1  B  £  significantly  g r e a t e r than  R  TCE.TEE  30.  R  CRE.EXP  W  ±  1  1  B  E  significantly  g r e a t e r than  R  TO.TEE  31.  R  CRE.EXP  W  I  L  1  B  E  significantly  g r e a t e r than  R  EXP.TEE  32.  R  CRE.EXP  W  1  1  1  B  E  . significantly  g r e a t e r than  R  CRE.TEE  Since t h i s study client  R  T  CRE.EXP  TCE.TEE R  TO.TEE  r  C  CRE.TEE  f o c u s e s on the r e l a t i o n of three phases of empathy to  depth o f e x p e r i e n c i n g and outcome, s e v e r a l of the h y p o t h e i s  s p e c i a l importance.  are of  Hypotheses 12 and 15, i f s i g n i f i c a n t , w i l l imply  that  t h e r a p i s t communicated empathy i s the empathy phase most h i g h l y p r e d i c t i v e of  c l i e n t process.  addressed client of  by hypotheses 2 and 6.  S i g n i f i c a n c e o f these w i l l suggest  that  r e c e i v e d empathy i s the s t r o n g e s t empathy c o r r e l a t e of the r e s u l t s  treatment.  .738  The r e l a t i o n s h i p of the empathy phases to outcome i s  -38-  Hypothesis  Testing  The p r o c e s s i n v o l v e d significance  - t e s t s to determine the l e v e l of  of the 34 p a i r - w i s e comparisons between the n i n e 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 T a b l e 5. comparisons i n v o l v e d variable;  performing  Two  classes  of comparisons e x i s t e d .  Class  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  f o r example,  the c o r r e l a t i o n between t h e r a p i s t  e x p e r i e n c e d em-  pathy and treatment outcome and the c o r r e l a t i o n between t h e r a p i s t municated empathy and treatment outcome  (r__„ „_)  (r^^, ) . n  ILK.. 10  comparisons, G l a s s and S t a n l e y ' s z_ employed  One  (Glass and S t a n l e y , 1970,  C l a s s two comparisons t e s t e d w i t h no common v a r i a b l e  com-  For these  Ihr.. Iu  t e s t f o r dependent  correlations  was  p. 313). the d i f f e r e n c e  ( f o r example,  p e r i e n c e d empathy and c l i e n t r e c e i v e d  between two  correlations  the c o r r e l a t i o n between t h e r a p i s t empathy (r  >S) >  a n  NT  between depth of e x p e r i e n c i n g and treatment outcome  ^  the c o r r e l a t i o n  ( vj> ^Q) • C l a s s r  E  ex-  two  comparisons were computed by means of the Pearson - F i l o n t e s t f o r dependent correlations two c l a s s e s  /on  ( A r l i n , 1976).  Computer programs were w r i t t e n  of comparisons d e s c r i b e d above (see Appendix  C).  to perform the  -39-  Theraplsts Of the seventeen therapists involved i n the study, eleven were graduate students i n Counselling Psychology, three i n C l i n i c a l Psycholgy, and one i n School Psychology.  Seven of these were engaged i n Doctoral  and s i x i n Master's l e v e l studies.  The remaining two experimental thera-  p i s t s were p r a c t i c i n g psychologists.  Other information i s summarized i n  Table 3 below. TABLE 3 Description of Therapists  Age  Hours of experience conducting c l i e n t centered therapy.  Total Hours of . experience conducting therapy.  Mean  28.94  489.80  884.07  Mode  32 6.35  S.D. Range  23-50  Sex  1000  1000  M=6  1139.62  1002.04  F=ll  10-2000  10-3000  The table shows that most of the therapists had ample background i n conducting therapy and that most were f a m i l i a r with the client-centered method of counselling.  Subjects. The subjects acting as c l i e n t s i n the treatment analog sessions were adult education students at the B r i t i s h Columbia  I n s t i t u t e of Technology.  They volunteered f o r 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 I n f o r m a t i o n i n T a b l e 4 below. TABLE 4 D e s c r i p t i o n of Subjects  Mean Age  29.25  Sex  Mode Age  32  M=17  S.D. Age  6.36  Range Age  The  F=13  23-50  experimental  s e s s i o n s averaged  minutes and a range o f from  40.16 minutes w i t h a mode o f 40  25 to 55 minutes.  Instruments Each o f 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 t h e r a p i s t p e r c e p t i o n s of the v a l u e of the treatment, f o c u s i n g a b i l i t y were a s s e s s e d as w e l l .  and c l i e n t  These i n v e n t o r i e s , q u e s t i o n n a i r e s ,  and r a t i n g s c a l e s a r e d e s c r i b e d below and a r e c o n t a i n e d i n t h e i r  entirety  i n Appendix A.  T h e r a p i s t communicated empathy (CRE) was measured by r a t i n g statements  from audio  therapist  tapes o f the e x p e r i m e n t a l s e s s i o n s , which were  broken i n t o four-minute  segments and randomized f o r r a t i n g .  Two empathy  r a t e r 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 o b t a i n e d b e f o r e and  d u r i n g the r a t i n g .  respectively.  .Ml  The r e l i a b i l i t y  coefficients  (  r X  y ) were .90 and .85  These compare f a v o r a b l y to the c o e f f i c i e n t s r e p o r t e d i n  -41-  s t u d i e s by and, .91  Gurman (1973) and  G a r f i e l d and  Bergin  respectively for similar rating situations.  f a m i l i a r w i t h the  construct  involved,  p i s t s i n conducting c l i e n t - c e n t e r e d  and  both had  treatment.  chosen over n a i v e ones, as was  the  1967)  of the r a t i n g s  to i n c r e a s e The  lapsed  (1971), which were  the v a l i d i t y  The  .95  r a t e r s were both  e x p e r i e n c e as  thera-  Informed judges were  case i n the W i s c o n s i n Study (Blaas  and  (Rogers,  Heck, 1975).  t h e r a p i s t communicated empathy s c o r e s f o r each segment were c o l i n t o 30 mean TCE  scores,  one  f o r each s e s s i o n ,  f o r comparison w i t h  the other s e s s i o n a l measures ( t h e r a p i s t e x p e r i e n c e d and empathy) i n the main a n a l y s i s , and four-minute segments) i n the  client  were employed s e p a r a t e l y  i n t e n s i v e a n a l y s i s of  received  (n =  257  the communicated  em-  pathy/experiencing r e l a t i o n s h i p . The  s c a l e employed f o r r a t i n g t h e r a p i s t communicated empathy  Carkhuff's  (1967) Empathic Understanding i n I n t e r p e r s o n a l  which d e r i v e d i n t u r n was  from the Truax A c c u r a t e Empathy S c a l e  based on  the e a r l i e r  Process  (Truax, 1961)  t h e o r e t i c a l presentations  was Scale, which  of Rogers  (1957). C a r k h u f f ' s s c a l e i s composed of f i v e l e v e l s of which the t h r e e are  following  examples: L e v e l One:  the  to or d e t r a c t  therapist's  responses e i t h e r do not  s i g n i f i c a n t l y from the e x p r e s s i o n s of  attend the  client;  Level  Three:  the  t h e r a p i s t ' s responses are  w i t h the c l i e n t ' s i n t h a t a f f e c t and  ,,./42  meaning;  interchangeable  they express e s s e n t i a l l y the same  -42-  Level Five:  the responses of the t h e r a p i s t add  signifi-  c a n t l y to the f e e l i n g s and meanings of the c l i e n t a way the  i n such  as to express a c c u r a t e l y f e e l i n g s and meanings which  c l i e n t h i m s e l f i s unable to express c l e a r l y , or i n the  event of ongoing deep s e l f - e x p r e s s i o n by the c l i e n t ,  the  t h e r a p i s t i s f u l l y w i t h the c l i e n t i n h i s deepest moments.  T h e r a p i s t e x p e r i e n c e d empathy pist  the t h e r a -  sees h i m s e l f as b e i n g c o g n i z a n t of h i s c l i e n t ' s c o g n i t i o n s and  ings.  I t was  feel-  measured by the B a r r e t t - L e n n a r d R e l a t i o n s h i p I n v e n t o r y  ( t h e r a p i s t form).  T h i s instrument was  m e d i a t e l y a f t e r each s e s s i o n . one  (TEE) i s the degree to which  filled  out by the t h e r a p i s t s  I t has a range of -48  to +48  im-  and i t y i e l d s  s c o r e which r a t e s average empathy f o r the e n t i r e s e s s i o n .  Some ex-  amples of BLRI items a r e : I want to understand how I understand  sees t h i n g s  's words but do not know  how  he/she f e e l s I n e a r l y always know e x a c t l y what  means.  Respondents r a t e d the a c c u r a c y of these and s i m i l a r statements on a s i x - p o i n t s c a l e which ranged t r u e ) to +3  from -3  (No, I s t r o n g l y f e e l t h a t i t i s not  (Yes, I s t r o n g l y f e e l t h a t i t i s t r u e ) .  C l i e n t r e c e i v e d empathy  (CRE)  i s the degree  to which  the r e c e i v i n g  person sees the t h e r a p i s t as b e i n g i n touch w i t h h i s i s s u e s . measured by the c l i e n t  form of the BLRI, which  m e d i a t e l y a f t e r the e x p e r i m e n t a l s e s s i o n . the  BLRI, t h i s form e l i c i t s one  entire session.  .../43  the c l i e n t  I t was  filled  out  im-  As w i t h the t h e r a p i s t form of  s c o r e f o r average r e c e i v e d empathy i n the  Examples of items a r e :  -43-  _____  wants to understand  '  how I see t h i n g s  u s u a l l y senses o r 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  in saying i t . Barrett-Lennard  (1969) r e p o r t e d t h a t the s p l i t - h a l f r e l i a b i l i t y o f  the two forms o f the r e l a t i o n s h i p  i n v e n t o r y ranged  from  .75 to .94, and a  t e s t - r e t e s t c o r r e l a t i o n over a two to s i x week p e r i o d o f .92.  Since there  e x i s t no p a r a l l e l i n v e n t o r i e s to which the BLRI can be c o r r e l a t e d t o a s s e s s v a l i d i t y , Barrett-Lennard  (1962) had f i v e judges r a t e the s t r e n g t h o f the  i n v e n t o r y items, and these r a t i n g s c o n t r i b u t e d to the f i n a l development o f the  instrument.  Depth o f e x p e r i e n c i n g (EXP) i s the degree to which the c l i e n t ' s ments evidence  the depth o f h i s involvement  measured by the EXP S c a l e ( K l e i n e t a l . , seven and was r a t e d from treatment The EXP S c a l e possesses  i n the therapy t a s k .  state-  I t was  1969), which has a range o f one to  s e s s i o n tapes by t h r e e t r a i n e d  construct v a l i d i t y  raters.  inasmuch as the concept of  c l i e n t w i l l i n g n e s s to i n t r o s p e c t and own f e e l i n g s and b e h a v i o r s i s a c o r e one  i n c l i e n t - c e n t e r e d therapy  the seven  Below a r e examples o f s e v e r a l o f  l e v e l s from the short' form of t h e s c a l e :  L e v e l One —  L e v e l Four —  .744  theory.  content e x t e r n a l events; r e f u s a l to participate  content description of f e e l i n g s and p e r s o n a l experiences  treatment impersonal, detached  treatment self-descriptive; associative  -44-  L e v e l Seven  The Kiesler  content f u l l , easy p r e s e n t a t i o n of experiencing; a l l elements confidentially integrated.  —  i n t e r r a t e r r e l i a b i l i t y o f the EXP S c a l e has been found by  (1967) to be as h i g h as .79 f o r f o u r judges.  liability  treatment expansive, i l l u m i n a t i n g , c o n f i d e n t , buoyant.  I n t h i s study, r e -  c o e f f i c i e n t s o f .85 (modal EXP) and .75 (peak EXP) were o b t a i n e d .  As w i t h t h e r a p i s t communicated empathy, s e s s i o n s were broken i n t o four-minute two  segments f o r EXP r a t i n g s , which were c a r r i e d b u t by a s c r i b i n g  EXP l e v e l s  (peak and mode) to each segment.  Goal Attainment treatment  Scaling —  t h i s i s a process of designing before  a s c a l e f o r each c l i e n t - t h e r a p i s t  g o a l and s p e c i f y i n g f o r each  g o a l a t r a n s f o r m a t i o n o f o v e r a l l g o a l attainment score  ( K i r e s u k and Sherman, 1968).  i n t o a s t a n d a r d i z e d t_  I t allows f o r i d i o s y n c r a t i c goals i n -  stead o f e v a l u a t i n g achievement a c c o r d i n g to g e n e r a l c r i t e r e a of improvement ( K e l l e y , 1976). and (for  The use of GAS i n t h i s study i n v o l v e d a f a c i l i t a t o r  the s u b j e c t s w r i t i n g a d e s c r i p t i o n of p r o j e c t e d stages d f improvement example, see appendix A ) . With r e f e r e n c e to b e h a v i o r a l l y o b s e r v a b l e outcome, t h e 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 v a r i o u s treatment t i e s with  a v a r i e t y o f problems.  the MMPI f o r v a l i d i t y .  He found  c o r r e l a t e d w i t h MMPI s c o r e s . follow-up r a t e r s i n i n i t i a l a f t e r s i x months (Garwick, a moderately  ...745  Mauger (1974) a n a l y z e d the GAS a g a i n s t i t s concurrent v a l i d i t y  R e l i a b i l i t y was found goal s e t t i n g ,  1974).  modali-  t o be .84 when  t o be .71 f o r d i f f e r e n t  .70 a f t e r two months, and .47  Sherman, Baxter and Audette  h i g h t e s t - r e t e s t r e l i a b i l i t y o f .57.  (1976) found  -45-  Secondary Data Sources  Questionnaires  (see appendix A) e l i c i t i n g demographic and o t h e r i n -  f o r m a t i o n were completed by a l l p a r t i c i p a n t s immediately  after  the r e -  search interviews. The P a r t i c i p a n t Q u e s t i o n n a i r e , a d m i n i s t e r e d  to a l l s u b j e c t s one week  a f t e r the i n t e r v i e w s , c o n t a i n e d s e v e r a l items designed j e c t s who  had  experienced  the b a s i s of the responses The  to these q u e s t i o n s , no respondents  r e s u l t of t a l k i n g w i t h a s k i l l e d  "Sometimes people  listener.  s u b j e c t s checked "yes" they were i n s t r u c t e d g o a l and  from t h e i r a l t e r n a t e GAS  were r e j e c t e d .  Did t h i s happen to you?". to f i l l  out a Goal  such g o a l s h i f t s , and  If  Attainment Seven s u b j e c t s  the s c o r e s  forms were e n t e r e d as treatment  s c o r e s f o r these s u b j e c t s i n the main data a n a l y s i s . so asked  On  change g o a l s as a  check o f f t h e i r p r o g r e s s .  of the t h i r t y d i d i n f a c t e x p e r i e n c e rived  sub-  a d i s r u p t i v e event d u r i n g t h a t time p e r i o d .  q u e s t i o n n a i r e a l s o asked:  S c a l e r e g a r d i n g t h e i r new  to s c r e e n out  de-  outcome  P a r t i c i p a n t s were a l -  i f they would seek h e l p from a c l i e n t - c e n t e r e d p s y c h o l o g i s t or  psychiatrist. Information of g e n e r a l and  regarding t r a i n i n g ,  c l i e n t - c e n t e r e d therapy  Therapist Questionnaire, administered research interview. centered  t h e o r e t i c a l o r i e n t a t i o n , and  treatment  They were asked on a f i v e - p o i n t  e x p e r i e n c e was  collected  amount  i n the  to a l l t h e r a p i s t s on the day of to g i v e t h e i r v a l u a t i o n of  the  client-  scale.  From the t h e r a p i s t q u e s t i o n n a i r e were d e r i v e d t h r e e v a r i a b l e s , amount of time i n hours spent therapy  i n g e n e r a l , and  employed i n the  ./46  study.  conducting  c l i e n t - c e n t e r e d treatment  and  conducting  the t h e r a p i s t ' s v a l u a t i o n of the treatment  method  -46-  The  Post-Focusing  Questionnaire  ( G e n d l i n , 1973)  to a l l s u b j e c t s one  week p r i o r  instrument  to measure c l i e n t a b i l i t y  purports  to the i n t e r v i e w s .  was  This  also  unstandardized  to f u n c t i o n a d e q u a t e l y  a f f e c t i v e l y o r i e n t e d , e x p e r i e n t i a l form of p s y c h o t h e r a p y . completed the q u e s t i o n n a i r e , a b s t r a c t or u n c l e a r tegrated with  to f i l l  the remaining out.  13  Only 17  the  i n an  subjects  s u b j e c t s c l a i m i n g i t was  R e s u l t s from t h i s i n s t r u m e n t  the f i v e main v a r i a b l e s and  administered  too  were i n -  t h r e e above-mentioned t h e r a p i s t  v a r i a b l e s i n the main a n a l y s i s .  Procedure The  r e s e a r c h p r o c e d u r e was  b u i l t around 30 q u a s i - t r e a t m e n t  (one per s u b j e c t ) i n which s u b j e c t s and c e n t e r e d manner.  screening  and  school psychology.  w i t h no  i n d i v i d u a l s who  e x t e r n a l evidence  desire for help" All  normality,  (p.  experimental  from  Their only  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 r e s e a r c h  the " l i s t e n i n g p r o c e s s " was "any  client-  S u b j e c t s were s o l i c i t e d  body of B r i t i s h Columbia I n s t i t u t e of Technology.  c r i t e r i o n other  fined i t :  therapists interacted in a  T h e r a p i s t s were r e c r u i t e d from graduate programs i n  counselling, c l i n i c a l , the student  sessions  d e f i n e d here as Rogers (1967)  on de-  are f u n c t i o n i n g outside a h o s p i t a l s e t t i n g ,  of p s y c h o l o g i c a l malfunctioning  and  no  expressed  27). s e s s i o n s were c a r r i e d out on  the same morning.  They  were preceeded by a group a d m i n i s t r a t i o n of the Goal A t t a i n m e n t S c a l i n g process,  d u r i n g which s u b j e c t s were f i r s t  a r e a of i n t r a - p e r s o n a l c o n f l i c t s p l i t was,  " I am  spending my  f r e e time w i t h my  employed f o r two problem n a t u r e  t o r n between  reasons.  asked to d e f i n e a " s p l i t " ,  (Greenberg, 1976). and  i t was  format f o r t h i s  " (e.g. I am  f a m i l y or s t u d y i n g ) .  First  The  considered  The  or  t o r n between  split  format  was  advantageous to keep  homogeneous to e l i m i n a t e as much as p o s s i b l e e r r o r v a r i a n c e  -47-  due  to subjects presenting issues f o r d i s c u s s i o n that d i f f e r e d g r e a t l y 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  s e r i o u s n e s s o f i s s u e ^ i t s t i l l kept s u b j e c t s focused  on i n t e r n a l l y  defined  problems. T h i s i n t e r n a l o r s e l f - f o c u s e d problem type was h i g h l y compatible  with  the Rogerian concept o f incongruence, d e f i n e d as a c o n f l i c t between r e a l and  ideal self.  T h i s c o m p a t i b i l i t y w i t h the c l i e n t - c e n t e r e d therapy  c e s s was the second reason  f o r u s i n g the " s p l i t "  Once a l l s u b j e c t s had d e f i n e d a s p l i t ,  format.  they were asked to d e v i s e be-  h a v i o r a l and a f f e c t i v e i n d i c e s o f change f o r b e t t e r o r worse their issue.  F o r example, the above-mentioned s p l i t  t o r e d by c h a r t i n g amount o f time spent family  check o f f t h e i r p r o g r e s s  one week a f t e r the e x p e r i m e n t a l procedure took one hour.  regarding  c o u l d have been moni-  studying or with the subject's  ( b e h a v i o r a l measure) and f e e l i n g s o f a n x i e t y  S u b j e c t s would subsequently  pro-  sessions.  ( a f f e c t i v e measure). on the f i v e - p o i n t GAS  T h i s Goal Attainment S c a l i n g  The i n s t r u c t i o n s were read from a prepared  c e d u r a l format which was a l s o g i v e n to a l l s u b j e c t s so they c o u l d  pro-  read  a l o n g w i t h the r e s e a r c h e r and have a r e f e r e n c e to p a s t p a r t s o f the i n structions  (see appendix A ) .  When a l l s u b j e c t s had completed the GAS p r o c e d u r e , they were randoml y assigned  to t h e r a p i s t s .  The i n t e r v i e w s which ensued were conducted i n  s m a l l classrooms (one s u b j e c t and t h e r a p i s t p e r room).  The t h e r a p i s t s  were i n s t r u c t e d to s t a y as much as p o s s i b l e i n a c l i e n t - c e n t e r e d mode throughout the s e s s i o n s .  Audio r e c o r d i n g s were made o f a l l s e s s i o n s f o r  purposes o f r a t i n g t h e r a p i s t communicated empathy and depth o f e x p e r i e n c i n g . I t was o r i g i n a l l y hoped t h a t each t h e r a p i s t would see two s u b j e c t s , the  ./48  -48-  i n t e r v i e w s running i n tandem.  Due to s e v e r a l t h e r a p i s t s b e i n g  absent,  however, 17 t h e r a p i s t s were employed y i e l d i n g 13 cases o f two s u b j e c t s per t h e r a p i s t and f o u r cases i n which a t h e r a p i s t i n t e r a c t e d w i t h o n l y one  subject.  The 30 s e s s i o n s which r e s u l t e d were c o n s i d e r e d to be ex-  amples of a f i r s t  session i n client-centered  treatment.  E x a c t l y one week a f t e r the s e s s i o n s s u b j e c t s re-examined t h e i r s o n a l Goal Attainment  S c a l e s and checked  o f f the a p p r o p r i a t e l e v e l  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  perdesc-  split.  The movement was assessed on both a f f e c t i v e and b e h a v i o r a l c r i t e r e a  yield-  i n g s c o r e s w i t h a p o s s i b l e range o f from -4 to +4 f o r each c r i t e r i o n .  The  e n t i r e r e s e a r c h p r o c e s s i s diagramed below: (one week p r e treatment)  administration of F o c u s i n g Q ' a i r e  Figure  6.  (morning o f experiment)  (one week p o s t treatment)  i n t r o d u c t i o n to r e s e a r c h and how to f i l l out GAS  The Research  client-centered experimental sessions  GAS f o l l o w - u p & participant Q'aire  Process .  Design  The explored.  d e s i g n was c o r r e l a t i o n a l , due t o the n a t u r e of the p r o c e s s  being  R e l a t i o n s h i p s among v a 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,  of the f i v e primary and f o u r secondary  1) a g e n e r a l c o r r e l a t i o n  variables,  matrix  2) a s p e c i f i c a n a l y s i s of the  r e l a t i o n s h i p between t h e r a p i s t communicated empathy and c l i e n t depth o f e x p e r i e n c i n g , and  .749  3) s e s s i o n s one by two comparison o f the s c o r e s f o r the  -49-  t h r e e empathy measures. In the f i r s t  element, d i f f e r e n c e s among c o r r e l a t i o n s were t e s t e d f o r  s t a t i s t i c a l s i g n i f i c a n c e by _ - t e s t s f o r dependent c o r r e l a t i o n s . second element, the c o v a r i a t i o n of TCE First,  every p a i r of TCE  p a i r s ) was  entered  and  EXP  and  scores  EXP  (257  was  explored  ergo  i n t o a c o r r e l a t i o n program, the purpose b e i n g  t h i s was  contained  257  to produce  T h i s procedure was  what b i a s e d inasmuch as some s e s s i o n s c o n t a i n e d more segments than but  some-  others,  not c o n s i d e r e d a s e r i o u s problem s i n c e over 50% of the  between e i g h t and  the  i n two ways.  segments i n a l l ,  a c o e f f i c i e n t based on as much data as p o s s i b l e .  In  sessions  ten r a t e a b l e 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  p o s s i b l e t h a t communicated empathy's e f f e c t on e x p e r i e n c i n g c o u l d be of a l a t e n t nature  ( i . e . c o u l d have a delayed  the f a c i l i t a t i v e powers of TCE a l minutes a f t e r layed e f f e c t ,  on EXP  the t h e r a p i s t had  the EXP  e f f e c t on e x p e r i e n c i n g ) .  would not become e v i d e n t u n t i l  spoken.  s c o r e s f o r the 257  TCE/EXP segments were  then w i t h  T h i s s t a g g e r i n g was  the TCE  possiblity:  T h i s was  The EXP  s c o r e s were moved up  done to e x p l o r e another  perhaps c l i e n t depth of e x p e r i e n c i n g was  i n the TCE/EXP r e l a t i o n s h i p .  I t was  and  and  examined f o r any  audio  EXP  interesting  the c a u s a l element  this.  s c o r e s i n each of the t h i r t y cases were graphed  consistent trends.  S e v e r a l were i d e n t i f i e d .  tapes of the s e s s i o n s were then re-examined  p r e s s i o n s r e g a r d i n g the n a t u r e  ./50  twice  assumed t h a t a h i g h magnitude of c o r -  r e l a t i o n at e i t h e r l e v e l of s t a g g e r i n g would suggest Next the TCE  time segment of  s c o r e i n the segment below t h a t .  then r e v e r s e d .  w i t h i n each s e s s i o n ' s segments.  staggered  s c o r e s were a u t o - c o r r e l a t e d  the t h e r a p i s t communicated empathy s c o r e i n the next  the s e s s i o n , and  sever-  To t e s t f o r t h i s p o s s i b l e de-  so t h a t f o r each of the t h i r t y s e s s i o n s , the EXP with  Perhaps  of the t r e n d s  The  to g a i n s u b j e c t i v e im-  (see Appendix B).  -50-  In a d d i t i o n , jt - t e s t s were performed on the  13  t h e r a p i s t who  two  to assess c o n s i s t e n c y  c l i e n t received  saw  two on  the  and  comparing s u b j e c t  two  subjects  the  seen by each t h e r a p i s t .  _t - t e s t s i n d i c a t e whether or not  s i g n i f i c a n t r e s u l t s , i t cannot be  same.  This  large differences  t h a t are  by  for therapists across  the Of  course, i f the  claimed t h a t  the  to see whether  of TCE  ./51  pieces  sessions  of i n f o r m a t i o n  l e v e l across subjects  client,  two  t e s t s do  not  groups  are  have been a very  variables in fact  I f , f o r example, TCE  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 a c r o s s s u b j e c t s  these two  t_ -  subjects.  are h i g h l y r e l a t e d i n a c o r r e l a t i o n a l sense.  TCE  The  t h e r a p i s t ' s performance 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 a c r o s s s u b j e c t s  i f the  and  c l o s e r to a  among t h e r a p i s t s which would mask a l l but  c o r r e l a t i o n s were i n c l u d e d  _t - t e s t , and  subject  therapist,  i s because the l a c k of s i g n i f i c a n c e c o u l d  r e s u l t of d i f f e r e n c e s  The  to  clients.  s i g n i f i c a n t l y d i f f e r e n t across subjects. yield  one  c o r r e l a t i o n s were both employed i n o r d e r to get  independent r a t e r , a c r o s s The  s c o r e s from  These s c o r e s were  c l e a r u n d e r s t a n d i n g of t h e r a p i s t empathy as p e r c e i v e d and  EXP  t h e r a p i s t e x p e r i e n c e d , communicated,  empathy s c o r e s a c r o s s i n t e r v i e w s .  a l s o c o r r e l a t e d a c r o s s the t e s t s and  subjects,  the TCE  by means of  is the  one-by-two c o r r e l a t i o n i s . s i g n i f i c a n t ,  taken t o g e t h e r would suggest a  implying  a therapist  trait  continuity  d e f i n i t i o n of  TCE.  -51-  '  CHAPTER FOUR Results  Scores f o r the f i v e main and f o u r  secondary v a r i a b l e s were i n t e r c o r -  r e l a t e d , and the c o e f f i c i e n t s o b t a i n e d a r e a r r a y e d i n Table 5.  The o n l y  c o r r e l a t i o n among the three empathy phases t h a t 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 ) . phases c o r r e l a t e d  None o f the empathy  s i g n i f i c a n t l y w i t h outcome, but c l i e n t r e c e i v e d  was, as p r e d i c t e d ,  (hypotheses 2 and 6 ) , the s t r o n g e s t  among the phases.  Also,  as p r e d i c t e d  communicated empathy was the s t r o n g e s t The t h e r a p i s t communicated correlation  outcome c o r r e l a t e  (hypotheses 12 and 15), t h e r a p i s t c o r r e l a t e of  experiencing.  empathy by c l i e n t depth o f  ( -.13) was o b t a i n e d by a v e r a g i n g empathy and  scores within  each e x p e r i m e n t a l s e s s i o n ,  session.  experiencing experiencing  and then c o r r e l a t i n g these  averages w i t h the o t h e r measures, a l l of which a l s o y i e l d e d per  one s c o r e  When a l l 257 t h e r a p i s t communicated empathy by  s c o r e s were c o r r e l a t e d ,  empathy  the c o e f f i c i e n t was .04, a l s o  experiencing  non-significant.  The d i f f e r e n c e between t h i s and the averaged s e s s i o n a l c o r r e l a t i o n was .09, a non-significant  ./52  value.  I n t e r c o r r e l a t i o n s amon^ the Empathy Phases, Depth of Experiencing,  Outcome, and Four Secondary V a r i a b l e s n = 30  •  1.  Therapist experienced  empathy  2.  Therapist communicated empathy (TCE).  TEE  TCE  CRE  EXP  1  2  3  4  TO 5  HRCC  HRTOT  VALCC  6  7  8  (TEE).  .2254  3.  C l i e n t received empathy (CRE).  4.  Depth o f experiencing  (EXP).  -.1196  .3803*  .0084 (.0406)+  -.2895  -.1314 ++ •5.  Treatment outcome (TO).  6.  Hours of experience centered  7.  9.  .0142  .0851  .1146 -.0109  .3083  -.2201  total  (HRTOT). 8.  .1959  Client-  (HRCC).  Hours of experience:  .1449 -.0034  .0452 -.0480  -.2137  .3488  .2763  -.1098 -.2334  .2534 .1651  -.0069  -.2603  .2018  .2802 -.0833  .1696- .5400  -.5779 -.1807  .0773  -.2420 .8612**  Therapist v a l u a t i o n of c l i e n t centered  treatment  Focusing  a b i l i t y (FA).  *  p  .05  **  p  .001  (VALCC).  + ++  taken from i n t e n s i v e a n a l y s i s of TCE/EXP r e l a t i o n s h i p s (n = 257) taken from averaged TCE and EXP session scores.  -53-  Staggered of  C o r r e l a t i o n s of T h e r a p i s t Communicated Empathy arid Client: Depth  Experiencing When a l l the 257 segments were i n c l u d e d i n the TCE by EXP c o r r e l a t i o n ,  EXP s c o r e s were staggered segment s c o r e  two segments ahead and two back f o r each TCE  (e.g., the TCE s c o r e f o r segment t h r e e o f a treatment  session  was p a i r e d w i t h the EXP s c o r e f o r segment one, two, t h r e e , f o u r , and f i v e ) y i e l d i n g f i v e separate presented  i n Table  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 a r e  6.  TABLE 6 Staggered  C o r r e l a t i o n s of T h e r a p i s t Communicated  Empathy and C l i e n t Depth o f E x p e r i e n c i n g  Experiencing scores  Correlation Coefficients  Number of Segments  Level of Significance  Staggered  back two  -.0142  197  .421  Staggered  back one  . 0098  227  .442  .0406  257  .217  Direct Staggered  ahead one  -.0027  227  .484  Staggered  ahead two  .0247  197  .365  The d i r e c t phase of the s t a g g e r i n g p r o c e s s , i n which TCE and EXP s c o r e s from the same four-minute  segment of an e x p e r i m e n t a l  s e s s i o n were  i n t e r r e l a t e d , a c h i e v e d a h i g h e r c o r r e l a t i o n than any o f the staggered phases.  However, none of the c o r r e l a t i o n s , i n c l u d i n g 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 a t the .05 l e v e l .  Therefore  the d a t a  -54-  i n d i c a t e no l a t e n c y of the e f f e c t of empathy on e x p e r i e n c i n g . no s u g g e s t i o n  As w e l l ,  i s g i v e n t h a t e x p e r i e n c i n g has a l a t e n t e f f e c t on com-  municated empathy.  Examination ( S e s s i o n One by S e s s i o n Two) of the Three Empathy Phases and Depth of E x p e r i e n c i n g Twelve of the t h e r a p i s t s i n t e r a c t e d w i t h two s u b j e c t s , thus two s c o r e s on the empathy and o t h e r measures. r e l a t e d , and the r e s u l t s a r e p r e s e n t e d  These two s c o r e s were c o r -  i n Table 7.  The o n l y  c o r r e l a t i o n was of TCE s e s s i o n s one by two ( p ^ . 0 2 5 ) . that although  the TCE s c o r e s generated  generating  significant  It i s interesting  by t r a i n e d 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 t h e r a p i s t s a c r o s s s u b j e c t s , t h e r a p i s t ' s own  evalua-  t i o n s of t h e i r empathy and c l i e n t p e r c e p t i o n s of t h e r a p i s t empathy 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 a c r o s s s u b j e c t s .  TABLE 7 S e s s i o n by S e s s i o n C o r r e l a t i o n s o f Process  Variable  Coefficient  Z-Value  Variables  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 d i f f e r e n c e between the t h r e e empathy phases f o r t h e r a p i s t s a c r o s s t h e i r two s u b j e c t s were f u r t h e r e x p l o r e d by s u b j e c t i n g s c a r e s to _t - t e s t s f o r dependent samples. 8.  The r e s u l t s of these t e s t s a r e p r e s e n t e d  Only t h e r a p i s t e x p e r i e n c e d  s e s s i o n one to s e s s i o n two. i n the f o l l o w i n g chapter  i n Table  empathy (TEE) d i f f e r e d s i g n i f i c a n t l y  from  The i n f o r m a t i o n i n T a b l e s 7 and 8 i s employed  c h i e f l y to examine c o n s t r u c t d e f i n i t i o n s o f the  empathy phases.  TABLE 8 T-Tests  f o r T h e r a p i s t Experienced C l i e n t Received  Empathy, T h e r a p i s t Communicated Empathy,  Empathy, arid C l i e n t Depth of E x p e r i e n c i n g .  Variable  t-value  TEE  2.208*  TCE  .258  CRE  .047  * p <.05  R e s u l t s o f Hypothesis  Tests  The 32 hypotheses of r e l a t i o n s h i p s among the t h r e e empathy phases, c l i e n t depth of e x p e r i e n c i n g , and treatment  outcome a r e r e s t a t e d below.  Only hypotheses 4, 17, and 23 were s i g n i f i c a n t a t an a l p h a l e v e l of .05.  .756  -56Formal  1.  -j0.CRE  W  l  1  1  t  e  s  n  i  f  l  c  a  n  t  y  l  grater  t  h  a  n  .CRE  R T C E  r  T  QC  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  _  3.  r  T  QC  R  E  w i l l be s i g n i f i c a n t l y  g r e a t e r than  r  E  X  p  4.  r  T  QC  R  £  w i l l be s i g n i f i c a n t l y  greater  5.  r  6.  r  T  0C  R  £  w i l l be s i g n i f i c a n t l y  7.  r  T  0C  R  E  w i l l be s i g n i f i c a n t l y g r e a t e r than r E E . E X P  8.  r  T  QC  R  E  w i l l be s i g n i f i c a n t l y  * '  0  r  '  A  13.  r  EXP. T C E  r  EXP.TCE  X  1 / >  '  EXP.TCE  R  15  r  "  r  •  1 8  19  r  20.  r  21 '  r  22  r  X  23  E  E  i  E  T  C  R  E  0  greater  than f j ? T C E r  E  <  r  CRE.TCE  w i l l be s i g n i f i c a n t l y  g r e a t e r than  r  TO.TCE  w i l l be s i g n i f i c a n t l y  g r e a t e r than  R  T0.EXP  w i l l be s i g n i f i c a n t l y  greater  than  r  CRE.EXP  w i l l be s i g n i f i c a n t l y  g r e a t e r than  r  TCE.TEE  w i l l be s i g n i f i c a n t l y  greater  than  r  TO.TEE  w i l l be s i g n i f i c a n t l y . g r e a t e r  than  r  EXP.TEE  than  r  CRE.TEE  be s i g n i f i c a n t l y  greater  w i l l be s i g n i f i c a n t l y  greater than  r  TO.TCE  w i l l be s i g n i f i c a n t l y  greater than  r  TO.EXP  w i l l be s i g n i f i c a n t l y  greater than  r  CRE.EXP  w i l l be s i g n i f i c a n t l y  greater than  r  TCE.TEE  w i l l be s i g n i f i c a n t l y  greater than  r  TO.TEE  w i l l be s i g n i f i c a n t l y  greater  than  r  EXP.TEE  w i l l be s i g n i f i c a n t l y  greater than  r  CRE.TEE  CRE.TCE CRE.TCE CRE.TCE CRE.TCE CRE.TCE  r  jo.TCE  W  1  1  1  B  25.  R  TO.TCE  W  ±  1  1  B  26.  r  T  (  )T  C  E  s ±  S  S  TO,TCE  W  l  1  1  b  S  s l  28.  R  T0.TCE  W  l  1  1  b  e  s  R  30.  r  C  R  C  R  E  CRE.EXP E  E  X  r  W  w E  X  n  i  f  ±  c  a  n  t  greater  y  l  S  i  l  1  b  e  1  1  1  b  e  P  CRE.EXP  i  S g s  l  n l f i c a n r  n  i  g  f  n  l  l  c  f  a  i  n  c  W  l  1  1  b  G  R  E  A  T  E  R  than T  H  A  N  8  r e a t e r  T  H  A  N  y  g  r  t  h  a  n  1  t  a  l  n  t  l  y  significantly  R  TCE.TEE  greater than ^ Q ^ T E E  - y  w i l l be s i g n i f i c a n t l y  p  r >  S  y  n l f i c a n t l  w i l l be s i g n i f i c a n t l y  E  R  29.  8  I  27.  '  T  E  than  24.  3 2  T  r  CRE.TCE  r  '  31.  r  than  0  xp.CRE  than  greater  T  greater  CRE.TCE  R  V  E  E  EXP.TCE  R  17  r  >  C  w i l l be s i g n i f i c a n t l y  EXP.TCE w i l l 6  greater  EXP. TCE  12.  than  T  T  EXP.TCE  R  "  A X  w i l l be s i g n i f i c a n t l y  EXP.TCE  R  11  1  S  i  2.  9  1  r  Hypotheses  e  a  t  e  r  R  EXP.TEE  R C  greater than  RE.TEE r  greater than greater than  TOE.TEE r  r  TO,TEE E  X  p  /  p  E  E  s i g n i f i c a n t l y g r e a t e r than r ^ ^ ^  (* I n d i c a t e s hypotheses t h a t a r e s i g n i f i c a n t t a i l e d test of s i g n i f i c a n c e ) ) .  a t .05 (one-  -57-  Since o n l y t h r e e of the 32 p a t t e r n hypotheses have been  confirmed,  the p a t t e r n d e s c r i b i n g the c a u s a l i n t e r r e l a t i o n s among t h e v a r i a b l e s ( F i g u r e 5 ) i s n o t supported  a t the .05 l e v e l o f s i g n i f i c a n c e .  l a c k o f s i g n i f i c a n c e and i t s i m p l i c a t i o n s a r e d i s c u s s e d  This  i n the f o l l o w i n g  chapter. The  p a t t e r n suggested by the r e l a t i v e magnitudes o f 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 m e r i t d i s c u s s i o n i n s o f a r as i t c o i n c i d e s c l o s e l y w i t h a p a t t e r n found i n t h e I n t e g r a t i v e summary o f p r e v i o u s research.  P a t t e r n Suggested by the Data As was done e a r l i e r w i t h c o r r e l a t i o n c o e f f i c i e n t s d e r i v e d from vious research, or paths.  the r e s u l t s o f t h i s study were examined f o r c a u s a l  Figure  variables.  7 represents  links  t h e expected l i n e a r r e l a t i o n s h i p among t h e  The d o t t e d l i n e r e p r e s e n t s  the path d e r i v e d by f i n d i n g the  s t r o n g e s t c o r r e l a t e o f TO ( i n t h i s case, p r e d i c t o r o f CRE, and so on.  pre-  CRE), l o c a t i n g the s t r o n g e s t  I t suggests t h a t t h e r a p i s t u n d e r s t a n d i n g  c l i e n t i s s u e s (TEE) l e a d s to t h e r a p i s t empathic communications  (TCE).  of TCE  f a c i l i t a t e s c l i e n t r e c e i v e d empathy which i n t u r n i s p o s i t i v e l y r e l a t e d to treatment outcome. A g a i n i t i s emphasized t h a t o n l y one o f these c o r r e l a t i o n a l TCE  by CRE, achieved  statistical significance.  of p a t t e r n s suggested by the data i s p r e s e n t e d  Therefore with  links,  this discussion  the u n d e r s t a n d i n g  the p a t t e r n s a r e o n l y i n t e r p r e t a b l e i n s o f a r as they r e l a t e to c l i e n t centered  /SR  theory and e x t a n t  research.  that  F i g u r e 7.  Path Arrangement o f Data from the Main A n a l y s i s .  -59-  Depth o f e x p e r i e n c i n g was p o s i t i v e l y r e l a t e d o n l y to t h e r a p i s t communicated empathy Therefore  the data do not c o n f i r m the expected  client-centered search.  (.0406) and t h i s c o r r e l a t i o n was n o n - s i g n i f i c a n t (p = .259).  therapy p r o c e s s as suggested  This i s presented  i n F i g u r e 8..  importance o f EXP i n the  by theory and p r e v i o u s r e -  -61-  With the e x c e p t i o n o f the TCE - EXP i n t e r r e l a t i o n , F i g u r e 8 p r e s e n t s the same p a t t e r n s i l l u s t r a t e d  i n F i g u r e 5.  The p a t t e r n i n F i g u r e 5 was  produced u s 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 r e p r e s e n t e d past research.  Therefore  the r e s u l t s o f the p r e s e n t  summaries o f  study r e g a r d i n g the  i n t e r r e l a t i o n o f empathy, e x p e r i e n c i n g , and outcome, a l t h o u g h cant, present  non-signifi-  a p a t t e r n h i g h l y s i m i l a r t o the p a t t e r n d e r i v e d from the  summarized f i n d i n g s i n the e x t a n t  Qualitative Results:  l i t e r a t u r e o f c l i e n t - c e n t e r e d therapy.  D e s c r i p t i v e A n a l y s i s o f the T h e r a p i s t  Empathy by C l i e n t Depth o f E x p e r i e n c i n g  Communicated  Relationship  T h i s s e c t i o n d e s c r i b e s a q u a l i t a t i v e a n a l y s i s o f the data  derived  from a v i s u a l examination o f the 30 graphs generated by t h e e x p e r i m e n t a l procedure  (see Appendix B ) .  which were focused  U n l i k e other components o f t h e data a n a l y s i s  on s p e c i f i c i s s u e s i n the therapy  t i o n was p u r e l y e x p l o r a t o r y .  process,  t h i s examina-  The o b j e c t was t o seek any pronounced  t e r n s i n the graphs and then to r e t u r n to the o r i g i n a l data  pat-  tapes o f the  i n d i v i d u a l s e s s i o n s to l i s t e n to the s u b j e c t and t h e r a p i s t statements i n order  to generate p o s s i b l e e x p l a n a t i o n s S e v e r a l p a t t e r n s were d i s c o v e r e d .  f o l l o w i n g paragraphs and a r e presented data.  A l l the i n f o r m a t i o n gained  referred  f o r the observed p a t t e r n s . They a r e f u l l y d e s c r i b e d i n the here w i t h  the o t h e r more q u a n t i t a t i v e  from the v a r i o u s data components w i l l be  to when d i s c u s s i n g the r e s u l t s i n f o l l o w i n g s e c t i o n s o f the paper.  Divergence  A p a t t e r n o c c u r r i n g f r e q u e n t l y was d i v e r g e n c e  of the l e v e l s o f com-  municated empathy and e x p e r i e n c i n g as s e s s i o n s p r o g r e s s e d .  T h i s type o f  -62-  deviation was EXP  operationally defined as a measurable s h i f t of TCE  and  (one point for the former, one-half point for the l a t t e r ) away from  each other.  The s h i f t i n g variables remained at their new  or more four-minute segments. the graphs of sessions 1.2,  The divergence  8.13,  pattern was  levels for two observed i n  16.28, and 17.30*, and i t appeared l i k e  the pattern i l l u s t r a t e d below:  (graph  1.1) TCE  Figure 9:  EXP  Divergence Pattern  The tapes were examined with p a r t i c u l a r attention to the segment (indicated by p a r a l l e l v e r t i c a l l i n e s ) i n which the divergence  occurred.  An example of the dialogue involved i n and around the point of  divergence  i s presented  below i n edited form:**  The graphs are located i n 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  S:  1.2  . . . t h i s man  f i r e d him.  TH:  S:  Maybe I d i d n ' t g i v e him  He  should have done b e t t e r . . . n o t my  S:  fault,  Maybe i t ' s my  i s it?...but s t i l l  TH:  g e t t i n g f i r e d , but somebody has  guilty...  i t wasn't j u s t me...  I mean  the one whose r e s p o n s i b l e f o r somet o . . . p e o p l e should help one  another...  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  the guy  out on the s t r e e t w i t h no job to get because of t h i s . . . t h e r e ' s  still  S:  think  I'm u n s e t t l e d . . .  f a u l t , not h i s . . . I f e e l v e r y  nobody l i k e s b e i n g a heavy...being  c o u l d I have done...  f a u l t , a t l e a s t I don't  Everybody e l s e though ^he d i d a bad j o b :  one  to the manager...he  enough time to prove h i m s e l f . . .  Kind of a f e e l i n g . . . what more can I do...  i t s a l l my  TH:  wasn't doing h i s job...1 complained  a ' f e e l i n g of "what more can I do?"...  Well, yes...people watch out f o r  should be r e s p o n s i b l e f o r o t h e r s . . . p e o p l e  cause of the d i v e r g e n c e  t e r n w i t h t h e r a p i s t communicated empathy ascending and i n the o t h e r three cases as w e l l .  p i s t response  l Cl.  should  themselves.  T h i s e x c e r p t e x e m p l i f i e s the apparent  descending  have  The  pat-  c l i e n t experiencing  cause seems to be a t h e r a -  t h a t i s perhaps too a c c u r a t e , too i n c i s i v e ,  too  affectively  -64-  o r i e n t e d f o r the c l i e n t  to handly immediately.  This i s experienced  as a  t h r e a t to which the s u b j e c t r e a c t s by r e t r e a t i n g from p e r s o n a l m a t e r i a l i n t o vague g e n e r a l i t i e s i n hope of shaking much too soon" phenomenon was the  o f f the a t t a c k e r .  This  "too  the most c l e a r l y d e f i n e d t r e n d n o t i c e d i n  tapes. I t has  a l s o been d i s c u s s e d by Carkhuff  (1970) who  p a t t e r n i s o f t e n c h a r a c t e r i s t i c of t h e r a p i s t s who of empathic understanding  for their client  wrote t h a t  the  p o s s e s s perhaps a minimum  t h a t 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 u n d e r s t a n d i n g  of  their clients issues. In one  case,  17.30, i t appeared t h a t the o p p o s i t e of the "too much  too soon" type of d i v e r g e n c e while experiencing rose.  The  occurred.  increased.  In t h a t case, empathy  Eventually experiencing  e x p l a n a t i o n i n t h i s case appeared to be  decreased  dropped as empathy  "too l i t t l e  too soon";  i n i t i a l l y h i g h e x p e r i e n c i n g was  brought down by low t h e r a p i s t communicated  empathy.  noted and  T h i s p a t t e r n a l s o was  d i s c u s s e d by C a r k h u f f ,  d i s c e r n a b l e i n the f o l l o w i n g b r i e f segments from the  S:  I'm  is  interview:  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  TH:  You're a f r a i d .  S:  I'm  homesick...miss my  I can't without  You're v e r y upset.  S:  ...Well, I'm  not  pressure...  family...want to r e t u r n and work t h e r e now,  a degree...I'm v e r y  TH:  .,./65  and  but  upset...  You want to be a b l e to h e l p your f a m i l y at home...  sure...I'm confused...what do you want to know...  -65-  people  TH:  Now  want a happy f a m i l y a t home...  how  does t h a t make you  f e e l . . . I don't understand...  In t h i s example the s u b j e c t e v e n t u a l l y succumbed to the low tative level  t h e r a p i s t statements,  a c t i o n i n which the s e s s i o n ceased  u l t i m a t e l y l a p s i n g i n t o a confused  of t h e i r  the t h e r a p i s t  11.19, 12.21, 12.22, 12.24) was  which almost immediately  decreased.  s e s s i o n to c o n c e p t u a l i z e t h e i r  mediately To  Subjects  (.3.4, 3.5,  an i n i t i a l h i g h l e v e l of To a l a r g e extent  have been a r t i f a c t u a l , r e s u l t i n g from s u b j e c t s b e i n g  described e a r l i e r .  understand  communications.  Another commonality n o t i c e d i n a number of s e s s i o n s 5.9,  inter-  b e i n g c l i e n t - c e n t e r e d and became " t h e r a -  p i s t - c e n t e r e d " , w i t h the s u b j e c t t r y i n g to help the content  facili-  5.8,  experiencing  this pattern  may  i n s t r u c t e d before  t o p i c i n terms of an incongruence or  tended to v e r b a l i z e these s p l i t s almost  the  "split" im-  i n each i n t e r v i e w . t e s t f o r t h i s a r t i f a c t , a l l 30 f i r s t  the d a t a , and  communicated empathy and  r e s u l t i n g i n a c o e f f i c i e n t of a l l y generated tween these  two  with f i r s t  .0601.  e x p e r i e n c i n g were a g a i n c o r r e l a t e d , The  segments i n was  coefficients,  .0202  w a  s  segments were removed from  correlation coefficient .0405, and  origin-  the d i f f e r e n c e be-  not s i g n i f i c a n t when s u b j e c t e d to a  z. - t e s t f o r dependent c o r r e l a t i o n s . , Therefore, although a one  (11 out of 30)  of the s e s s i o n s  segments of s e s s i o n s induced and  evidenced  a t the b e g i n n i n g  not e m p i r i c a l l y demonstrated t h a t the EXP  i n t o the c o r r e l a t i o n of TCE  ./66  34%  p o i n t o r g r e a t e r drop i n the modal l e v e l of EXP,  the s e s s i o n i t was first  over  of  s c o r e s i n the  an a p p r e c i a b l e amount of e r r o r v a r i a n c e  EXP.  -66-  A f i n a l phenomenon t h a t has therapy l i t e r a t u r e and  8.14.  (Carkhuff,  Here e x p e r i e n c i n g  r e c e i v e d 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  1967;  Rogers, 1951)  remained low  l e v e l s of t h e r a p i s t communicated empathy. o f f e r e d no presented  s t r u c t u r e , no by  the s u b j e c t , c h o s i n g  ments i n much the by  S:  guidance as  worried  8.13  i n the p r e s e n c e of b a r e l y adequate In these s e s s i o n s  to the a p p r o p r i a t e n e s s  i n s t e a d simply  to p a r r o t  the t h e r a p i s t of the m a t e r i a l  subject  state-  same words as used by a s u b j e c t , a s i t u a t i o n e x e m p l i f i e d  the f o l l o w i n g statements taken from s e s s i o n  I'm  appeared i n graphs  8.13:  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 this  S:  seem d i s t u r b e d about the f a c t  t h a t no  one  seems to be  r e a c t i n g to  crisis...  Electric  r a i l r o a d s are h i g h l y 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  Perhaps i t was cannot h e l p but  t h a t much horsepower...  appropriate  to s t a y w i t h  suggest t h a t a more s k i l l f u l  c o u l d have f o c u s e d  be d i s c u s s e d  tions.  and  t o p i c , but  facilitative  and  of the q u a n t i t a t i v e data  i n the l i g h t o f the s t u d y e x p e c t a n c i e s  and  one  therapist  the s u b j e c t on more p e r s o n a l l y r e l e v a n t m a t e r i a l .  meaning of these s u b j e c t i v e i m p r e s s i o n s now  the s u b j e c t ' s  research  The will ques-  -67-  In.summary, the d e s c r i p t i v e a n a l y s i s has p r e s e n t e d s e v e r a l which suggest t h a t c e r t a i n t h e r a p i s t empathic b e h a v i o r s may c l i e n t depth o f e x p e r i e n c i n g . low  be  influence  T h i s f i n d i n g may seem c o n t r a d i c t o r y  TCE/EXP c o r r e l a t i o n s p r e s e n t e d i n the main a n a l y s i s .  i s no c o n t r a d i c t i o n .  The low c o r r e l a t i o n s t o g e t h e r w i t h t h e p a t t e r n s  i s not strongly  t h e r e do e x i s t i n s t a n c e s periencing.  to the  In f a c t , t h e r e  taken to imply t h a t w h i l e communicated empathy i n r ' . i r i i t i a l  sessions  patterns  r e l a t e d . t o EXP when r e c e i v e d  treatment  across  i n which TCE does i n f a c t s t r o n g l y  may  subjects, i n f l u e n c e ex-  Perhaps TCE/EXP c o r r e l a t i o n s taken from l a t e r s e s s i o n s o f  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 s u p p o r t i v e f o such a r e l a t i o n s h i p .  The p o s s i b l e  b e a r i n g o f the r e s u l t s o f t h e study d i e to the f i r s t - s e s s i o n n a t u r e o f 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 o f t h e r e s u l t s to f i r s t  sions of c l i e n t - c e n t e r e d  treatment.  ses-  -68-  • CHAPTER"FIVE Discussion  The purpose of t h i s study  i s to p r e s e n t  c l i e n t - c e n t e r e d treatment p r o c e s s experiencing,  and  outcome.  have a l s o been p r e s e n t e d . f i n d i n g s o f t h i s study.  an o v e r a l l statement of  by examining the I n t e r a c t i o n of empathy,  S e v e r a l i s s u e s r e l a t e d to the treatment These i s s u e s w i l l now  The  the  process  be d i s c u s s e d i n l i g h t  information presented  regarding  of  the r e l a t e d  i s s u e s w i l l then be employed to d e s c r i b e the v i e w o f c l i e n t - c e n t e r e d t h e r a p y t h a t the r e s u l t s o f the study The n a t u r e  suggest.  of the c o n s t r u c t empathy i s f i r s t  discussed  compasses the i n t e r a c t i o n o f the t h r e e empathy phases and to e x p e r i e n c i n g and  s i n c e i t en-  their  relation  outcome.  Is empathy a u n i t a r y  construct?  V a r i o u s measures o f empathy may s t r u c t from d i f f e r e n t p e r s p e c t i v e s . r e l a t e d but d i s t i n c t c o n s t r u c t s .  a l l be a s s e s s i n g the i d e n t i c a l They may  a l t e r n a t e l y be measuring  T h i s q u e s t i o n was  approached by  the c o r r e l a t i o n s among the t h r e e empathy measures (see T a b l e 5 ) . suggest t h a t t h e r a p i s t e x p e r i e n c e d t h a t t h e r a p i s t communicated and  con-  empathy i s a d i s t i n c t c o n s t r u c t  examining Results and  c l i e n t r e c e i v e d empathy a r e s e p a r a t e  related constructs  (see F i g u r e 10 below).  ness here i s s m a l l  (approximately  but  However, the degree o f r e l a t e d -  15% o f the v a r i a n c e  i n these  constructs  i s o v e r l a p p i n g ) , and more e x t e n s i v e e x a m i n a t i o n o f t h e CRE/TCE r e l a t i o n s h i p i s needed to more c o n c r e t e l y define«the n a t u r e  of t h e i r  interrelation.  -69-  TEE  F i g u r e 10:  R e l a t i o n s among Empathy Phases from Data o f the P r e s e n t  T h e i r 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 ( .38, p <.05).  Study.  correlation  I t c o u l d be assumed t h a t i f they were measuring the same  p r o c e s s o r c o n s t r u c t t h e c o r r e l a t i o n s between them and p r o c e s s and outcome measure would be e q u i v a l e n t .  Since t h i s was f a r from the case  (see F i g u r e  3) i t f o l l o w s t h a t communicated and c l i e n t r e c e i v e d empathy a r e two a s s o c i a t e d b u t d i f f e r e n t s t e p s i n the therapy p r o c e s s .  These c o n c l u s i o n s  must be tempered by the low v a l u e s o f 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 p r e s e n t e d here a r e , however, e n c o u r a g i n g l y s i m i l a r to  the f i n d i n g s o f s i m i l a r s t u d i e s p r e s e n t e d i n Table 3 e a r l i e r . two p a t t e r n s t e l l  ,/70  the s t o r y .  The f i r s t  i s illustrated  below:  There a g a i n  -70-  TEE .14  CRE .31  F i g u r e 11:  Again  R e l a t i o n s among Empathy Phases from Summary Data of P r e v i o u s  t h e r a p i s t experienced  empathy i s i s o l a t e d , w i t h  and r e c e i v e d empathy showing an a f f i n i t y .  The second  Research.  communicated  p a t t e r n concerns the  a s s o c i a t i o n o f the t h r e e empathy measures w i t h the p r o c e s s and outcome measures.  It i s illustrated  i n Figures  TEE  Figure  twelve and t h i r t e e n below:  14  12: The R e l a t i o n s h i p o f the Three Phases of Empathy t o C l i e n t Depth of  E x p e r i e n c i n g From  Summary Data o f P r e v i o u s  Research.  -71-  TEE  .01  TCE  .29  TO  CR:  F i g u r e 13:  The R e l a t i o n s h i p of the Three Phases of Empathy to Outcome from Summary Data of P r e v i o u s  In these f i g u r e s , i t i s a g a i n apparent empathy remains  d i s t i n c t and  Treatment  Research.  that t h e r a p i s t  experienced  t h a t communicated and r e c e i v e d empathy, though  r e l a t e d , are n o n e t h e l e s s s e p a r a t e inasmuch as t h e i r a s s o c i a t i o n s w i t h p r o cess and outcome a r e d i s t i n c t l y d i f f e r e n t .  When the above two  f i g u r e s are  reproduced w i t h 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  t h a t communicated empathy i s the s t r o n g e s t p o s i t i v e c o r r e l a t e of e x p e r i e n c i n g and c l i e n t r e c e i v e d empathy i s the s t r o n g e s t p o s i t i v e c o r r e l a t e of ment outcome.  . . . /72  treat-  F i g u r e 14: The R e l a t i o n s h i p of the Three Phases of Empathy to C l i e n t of E x p e r i e n c i n g from the Data of This  F i g u r e 15:  Depth  Study.  The R e l a t i o n s h i p of the Three Phases of Empathy to Treatment Outcome from the Data o f T h i s  Study.  However, s e v e r a l d i s p a r i t i e s between the i n t e g r a t e d r e v i e w and study data a r e a l s o e v i d e n t .  One i s the n e g a t i v e  c l i e n t r e c e i v e d empathy and e x p e r i e n c i n g  ./73  correlation  appearing  (-.29) between  i n the study a n a l y s i s  -73which contrasts s t r i k i n g l y with the c o e f f i c i e n t of .27, a summary figure representing related research.  The l i k e l y reason for the  negative correlation i s that the Barrett-Lennard Inventory  tends to phrase items i n such a way  Relationship  that they are more  applicable to long-standing relationships than to b r i e f encounters such as the experimental  sessions that occurred i n this study.  The re-  lationship between c l i e n t received empathy and depth of experiencing i n other studies i s small at best (see Table 3), and this added error variance was perhaps responsible for obscuring an accurate q u a n t i f i c a t i o n of the relationship. Another anomaly i s the .29 correlation between communicated empathy and treatment outcome i n the integrated review table that shrank to the vanishing point (-.003) i n the study data.  Here the problem l i k e l y l i e s  with the outcome measure i n this study which was of a behavioral, actionoriented type. confused  The basic problem here i s that outcome, l i k e empathy, i s a  construct, and the quantitative relationship between i t and  process measure i s dependent on their q u a l i t a t i v e association.  any  In other  words, depth of experiencing, being related as i t i s to introspection, •focus on a f f e c t , and i n general to  cognitive and a f f e c t i v e rather  than behavioral change, tends to correlate more highly with i n t r o spective, non-action-oriented Self-Concept  Scale  outcome measures, such as the Tennessee  (Ashcraft & F i t t s , 1964).  This i s not to say that  one kind of outcome i s necessarily superior to another.  It merely high-  l i g h t s a problem encountered when one attempts to compare outcome results. The communicated empathy/depth of experiencing c o r r e l a t i o n i n the present study  ( r = . 04 ) was noticeably smaller than the TCE/EXP correlation  ( r = .60) from the combined data of other studies (Table 3 ) .  ...Ilk  Therapist  communicated empathy was,  however, the  strongest p o s i t i v e correlate  depth of e x p e r i e n c i n g i n t h i s study as w e l l as i n the i n Table the  3.  studies  summarized  A g a i n , a p r o b a b l e e x p l a n a t i o n f o r the d i f f e r e n c e  i n s i z e of  c o e f f i c i e n t s was  ment s e s s i o n s .  the  f i r s t - s e s s i o n n a t u r e of the e x p e r i m e n t a l t r e a t -  That i s , perhaps as  the  TCE  by  and  EXP  l e v e l s increased,  therapist  EXP  relationship  be  two  the  therapeutic  i s enhanced.  r e l a t i o n s h i p matures,  I f , i n l a t e r sessions,  the  perhaps t h i s h e i g h t e n e d l e v e l of c l i e n t  TCE  and  involvement would r e s u l t i n a s t r o n g e r p o s i t i v e c o r r e l a t i o n  tween communicated empathy and To  of  summarize the types o f  experiencing.  i s s u e which began t h i s d i s c u s s i o n ,  empathy, t h e r a p i s t  former i s the b e t t e r  predictor  be-  communicated and  t h e r e appear to  c l i e n t received.  of psychotherapy p r o c e s s , the  The  latter  of  treatment outcome.  Therapist  The  empathy:  s t a t e or  i s s u e here i s whether t h e r a p i s t  a p p l i e d w i t h c o n s i s t e n c y by  a therapist  stable relationship variable. q u e s t i o n are  (see  and  Table 8).  The  ability  to a l l h i s c l i e n t s , or an  analysis therapist  un-  components t h a t address t h i s e x p e r i e n c e d , communicated, and  two  and  f o r each  r e s u l t s i n d i c a t e that only t h e r a p i s t  s i g n i f i c a n t l y different for therapists  ex-  between t h e i r  t h i s i n d i c a t e s a s t a t e 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  f o r t h i s empathy phase. i s dependent l a r g e l y on  The  d e f i n i t i o n could  be  r e a s o n i n g i s t h a t i f any  interpersonal  f e r e n t l y f o r each c l i e n t  seen by  i n d i c a t e d by  for particular therapists .../75 .  empathy i s p r i m a r i l y an  empathy s c o r e s between s u b j e c t s one  p e r i e n c e d empathy was subjects,  The  the _t - t e s t s of the  c l i e n t received therapist  trait?  of the empathy phases  dynamics, i t w i l l  a given therapist. stable  tend to r a t e  Conversely, a  dif-  trait  s c o r e s on empathy phase measures  across c l i e n t s .  The s i g n i f i c a n t TCE s e s s i o n s u p p o r t s the motion t h a t across c l i e n t s .  one by s e s s i o n  two c o r r e l a t i o n (p«£.05)  t h e r a p i s t communicated empathy may be  The c l i e n t r e c e i v e d  empathy  sessions  consistent  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_ - t e s t showed no d i f f e r e n c e tween the s e s s i o n  scores f o r t h i s v a r i a b l e .  C l i e n t received  communicated empathy a r e thus p o r t r a y e d as more l i k e l y pist  traits  and  therapist  i n d i c a t i v e of  thera-  than r e l a t i o n s h i p v a r i a b l e s .  However,  any c o n s i s t e n c y  of empathy measures f o r t h e r a p i s t s  c l i e n t s may be the r e s u l t o f t h e r a p i s t s  a v e r y u n i f o r m " l e t ' s get to know each o t h e r " manner i n f i r s t  of  treatment.  in  first  In that c a s e , communicated empathy  sessions  across  t e n d i n g to communicate w i t h c l i e n t s  in  only  be-  sessions  scores f o r t h e r a p i s t s  a c r o s s c l i e n t s would u n d e r s t a n d a b l y be homogeneous and  i n l a t e r therapy hours would any s u b s t a n t i a l d e v i a t i o n  empathic communication s u r f a c e  as the t h e r a p i s t a d j u s t s  i n therapist  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 t h r e e h i g h and t h r e e low functioning client in  t h e r a p i s t s engaged i n c l i e n t - c e n t e r e d  found t h a t w h i l e v a r i a n c e  sessions  was c o n s i d e r a b l e ,  distinquished  treatment w i t h one  of communicated empathy between and w i t h -  the h i g h and low t h e r a p i s t s  could  still  by t h e i r communicated empathy performance p r o f i l e s .  be  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 t h e r a p i s t s a c r o s s c l i e n t s in  the p r e s e n t study s u p p o r t s Gurman's f i n d i n g s , s i n c e  a degree o f c o n s i s t e n c y  i t , too, s u g g e s t s  f o r t h e r a p i s t s on t h e i r g e n e r a l l e v e l of TCE.  The r e l a t i o n s h i p o f c l i e n t p e r c e p t i o n s of t h e r a p i s t (client received  understanding  empathy) f o r t h e r a p i s t s a c r o s s c l i e n t s c o u l d  a l s o have  been obscured by v a r i a b l e s not accounted f o r i n the p r e s e n t study. the p o s s i b l i t y e x i s t s t h a t  the c l i e n t may be d e s c r i b i n g  " i d e a l t h e r a p i s t " i n the f i r s t  /nc  session,  and t h a t o n l y  Again  some s o r t o f  l a t e r would  received  -76-  empathy s c o r e s a c c u r a t e l y r e f l e c t ship .  the n a t u r e  and q u a l i t y o f the r e l a t i o n -  K u r t z 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 r a t i n g s o f the t h i r d and f i n a l i n t e r v i e w s 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 t h a t t h e r a p i s t communicated and c l i e n t r e c e i v e d empathy a r e r e l a t i v e l y s t a b l e a c r o s s c l i e n t s a t r a i t empathy d e f i n i t i o n f o r phase two and phase t h r e e  Empathy:  indicating  empathy.  What i s the Most U s e f u l O p e r a t i o n a l D e f i n i t i o n ?  S e v e r a l "answers" emerge from T a b l e 3 (.the i n t e g r a t i v e summary) and from Table 5 (the study d a t a ) . . They a r e based on one premise: u s e f u l o p e r a t i o n a l d e f i n i t i o n i s one t h a t e n a b l e s a 1  i n such a way t h a t i t can be u t i l i z e d  that a  v a r i a b l e to be measured  to p r e d i c t r e l a t e d v a r i a b l e s .  f o r e t h e r a p i s t b e h a v i o r a l v a r i a b l e s such as e x p e r i e n c e d ,  There-  communicated, and  c l i e n t r e c e i v e d empathy a r e o n l y o f -value inasmuch as they a r e a b l e to p r e d i c t process  and/or outcome.  In the l i g h t of t h i s premise, t h e r a p i s t communicated empathy as the s t r o n g e s t p o s i t i v e p r e d i c t o r of depth of e x p e r i e n c i n g . Carkhuff of  Accurate  Empathy  Scale i s considered  emerges  Thus the  the more a c c u r a t e p r e d i c t o r  experiencing. In the same way,  c l i e n t r e c e i v e d empathy i s the s t r o n g e s t c o r r e l a t e  of treatment outcome, i n f e r r i n g t h a t the c l i e n t ' s p e r c e p t i o n s  of empathy  are the s t r o n g e s t p r o g n o s t i c a t o r s of measured outcome. It i s recognized  t h a t the s i z e of the empathy-by-process-by-outcome,  c o r r e l a t i o n s i s s m a l l and thus any c o n c l u s i o n s based upon i t are i n c o n clusive.  The data a r r a y e d  l e n d support  from p r e v i o u s  and c r e d i b i l i t y  to the study  s t u d i e s i n Table 3  do, however,  f i n d i n g s i n t h a t t h e r e too one  -77-  f i n d s communicated empathy the most powerful e x p e r i e n c i n g , and  p r e d i c t o r of depth of  c l i e n t r e c e i v e d empathy the s t r o n g e s t p r e d i c t o r of  treatment outcome.  C l i e n t Depth of E x p e r i e n c i n g :  S t a t e or  Trait?  T h i s q u e s t i o n would be b e s t answered by a l o n g i t u d i n a l study amining t r e n d s of e x p e r i e n c i n g  i n s u b j e c t s a c r o s s a number of  ex-  sessions.  C o n s i s t e n t l e v e l s or trends among s u b j e c t s would i n d i c a t e a t r a i t  defini-  t i o n , w h i l e v a r y i n g l e v e l s and  p a t t e r n s would p o i n t more toward a s t a t e  or r e l a t i o n s h i p v a r i a b l e .  data p r e s e n t e d  The  here can address t h i s  by examining the v a r i a t i o n of depth o f e x p e r i e n c i n g the c o r r e l a t i o n s between the empathy measures and p e r i e n c i n g were a r e l a t i o n s h i p v a r i a b l e one  s t r o n g p o s i t i v e c o r r e l a t i o n between i t and  by  the t h r e e empathy t e s t s .  TCE by EXP  c o r r e l a t i o n of  .04.  T h i s was  by not  on the e x p e r i e n c i n g On  and  If  ex-  as measured  the low, n o n - s i g n i f i c a n t the case, as w e l l , examination s e s s i o n s showed t h a t  17% were s h i f t s of two  tenuous r e s u l t s , n o t a b l y  r e l a t i o n , i t appears t h a t the l e v e l of e x p e r i e n c i n g steady  and  80%  p o i n t , the s m a l l e s t p o s s i b l e increment of change  s c a l e , and  the b a s i s of these  experiencing.  t h e r a p i s t behavior  df the s h i f t s i n e x p e r i e n c i n g w i t h i n e x p e r i m e n t a l of these were of o n l y one  i n the s e s s i o n s  would expect to see a moderate  to  As evidenced  issue  points.  the TCE stood  by EXP  cor-  relatively  immutable i n the f a c e of s h i f t s i n t h e r a p i s t empathy w i t h i n  experimental  sessions.  T h i s 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 e x p e r i e n c i n g as r e l a t i o n s h i p v a r i a b l e t h a t 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 t h e r a p i s t by means of h i s empathic r e f l e c t i o n s . c o n c l u s i o n i s s u p p o r t i v e of the r e s u l t s of o t h e r r e s e a r c h e r s who experiencing  trends a c r o s s s e s s i o n s  ( k i e s l e r , Mathieu, & K l e i n ,  This  examined 1967;  -78-  K l e i n , Gendlin,  & K i e s l e r , 1969;  n i f i c a n t change i n e x p e r i e n c i n g  Tomlinson & H a r t , 1962). these r e s e a r c h e r s  t i o n of the l e v e l of o v e r a l l e x p e r i e n c i n g logy;  The  discovered  was  seems t h a t other  as t h i s one  sig-  a varia-  c o r r e s p o n d i n g to degree of patho-  the more severe the p a t h o l o g y , the lower the o v e r a l l EXP  therefore  only  level.  s t u d i e s of the c l i e n t - c e n t e r e d p r o c e s s as  i n d i c a t e a p r e d o m i n a t e l y t r a i t d e f i n i t i o n of depth of  It well  ex-  periencing. However, s e v e r a l s t u d i e s r e l a t i n g G e s t a l t treatment t e c h n i q u e s to c l i e n t depth of e x p e r i e n c i n g  have demonstrated the EXP  i n f l u e n c e d by t h e r a p i s t i n t e r v e n t i o n s These f i n d i n g s p o i n t  ( C l a r k e , 1977;  can be  Greenberg, 1976).  to a s t a t e 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  thus p o s i n g  an apparent c o n t r o v e r s y  complicated  by  i n the l i t e r a t u r e , a c o n t r o v e r s y  EXP,  further  f i n d i n g s i n c l i e n t - c e n t e r e d s t u d i e s 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 (Rogers e t a l . , 1967;  van  experiencing  der Veen, 1965).  In view of the c o n t r a d i c t o r y f i n d i n g s d e s c r i b e d the s t a t e / t r a i t i s s u e r e g a r d i n g beyance u n t i l f u t u r e r e s e a r c h  depth of e x p e r i e n c i n g  above, the answer to must be h e l d i n a-  can e s t a b l i s h some c o n s i s t e n t f i n d i n g s .  most p r o m i s i n g v e i n of r e s e a r c h  at present  i s examining changes i n  p e r i e n c i n g w i t h i n s e s s i o n s as a r e s u l t of v a r i e d t h e r a p e u t i c techniques  significantly  ( C l a r k e , 1977;  Greenberg, 1976).  n a t u r e of c l i e n t depth of e x p e r i e n c i n g  The  ultimate  The  ex-  intervention  answer to  the  p r o b a b l y l i e s i n s t u d i e s such as  these.  How  i s C l i e n t Process Best  The  l i t e r a t u r e has  measured by  /-70  Predicted?  supported t h e r a p i s t communicated empathy, u s u a l l y  as  the Carkhuff or Truax s c a l e s , as the empathy phase t h a t i s most  -79-  h i g h l y c o r r e l a t e d w i t h c l i e n t depth of e x p e r i e n c i n g 1974;  Rogers e t a l . , 1967;  p o s i t i v e c o r r e l a t e of EXP relation  (.04)  A g a i n , i t may interviews  i s not  van  der  Veen, 1965).  i n t h i s study, but  great  enough to l e a d  (Kurtz  TCE  was  & Grummon,  the  strongest  the magnitude of the  to any  solid  conclusions.  w e l l have been the f i r s t - s e s s i o n n a t u r e of the  t h a t s u r p r e s s e d the TCE  by  EXP  experimental  relationship.  A noteworthy p o i n t here i s t h a t a l t h o u g h c o r r e l a t i o n does not s a r i l y denote c a u s a t i o n ,  the  two  be an i n d i c a t o r t h a t they are several  studies  variables  therefore  The  fact  that  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 c l i e n t depth of  suggest an element of c a u s a t i o n  trait,  therapist interventions  little  r e l a t i o n to i t .  experiencing  e x i s t i n g between them.  T h i s i s mentioned here inasmuch as i f e x p e r i e n c i n g  a p o s i t i v e and  neces-  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  somehow c a u s a l l y r e l a t e d .  between t h e r a p i s t communicated empathy and could  cor-  were i n f a c t a  client  such as empathic r e f l e c t i o n would have  T h e r e f o r e , the  f a c t t h a t some s t u d i e s have shown  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 e x p e r i e n c i n g fluenced  by  havior.  These s t u d i e s p o s s i b l y  as a r e l a t i o n s h i p v a r i a b l e i n -  communicated empathy or some o t h e r concomitant t h e r a p i s t are more a c c u r a t e l y  portraying  the  be-  true  n a t u r e . o f the TCE/EXP r e l a t i o n s h i p s i n c e they measured the v a r i a b l e s f a r t h e r on  i n treatment, when a deeper r e l a t i o n s h i p had  How  do  Empathy arid E x p e r i e n c i n g  The  d a t a from t h i s study do not  developed.  Interrelate?  i n d i c a t e t h a t any  of the  measures i s s t r o n g l y , p o s i t i v e l y r e l a t e d to e x p e r i e n c i n g .  The  t h r e e empathy extensive  a n a l y s i s , however, does show a s m a l l p o s i t i v e c o r r e l a t i o n between communicated empathy and  ./80  experiencing  (.04).  The  intensive analysis  results  -80-  are a l s o n o t a b l e i n t h a t of e x p e r i e n c i n g nificant  they f a i l  causes empathy.  to support the p o s s i b i l i t y  TCE/EXP c o r r e l a t i o n when TCE  that c l i e n t s generally  had  sessions.  little  i s not  an outcome study, but  an answer which meshes w i t h the t e g r a t i v e summary; the  therapist's  that  e f f e c t on  Lennard,  1962;  B e r g i n and  empathy, or the  lationship  I n v e n t o r y are  i s the v a r i a b l e most h i g h l y  the  TCE  and  EXP  the  f i n d i n g s of p r e v i o u s r e s e a r c h  Suinn, 1975;  K u r t z and  not  i s p r o b a b l y r e c e i v i n g cues of  probably  involved.  predictive  (Barrett-  Grummon, 1974).  As  contact,  by  the  well,  client  the B a r r e t t - L e n n a r d  Re-  empathic  Truax empathy s c a l e .  The  c o r r e l a t e p e r f e c t l y i s p r o b a b l y due  f a c t t h a t when a c l i e n t p e r c e i v e s  example, t h e r a p i s t eye  perception  to a l a r g e e x t e n t based on a t h e r a p i s t ' s  do  data,  intervention.  v e r b a l i z a t i o n s as o p e r a t i o n a l l y d e f i n e d that  the  client's  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 t h a t  to the  em-  sessions.  p e r c e p t i o n s of t h e r a p i s t empathy as measured by  he  the communicated  f i n d i n g s of s t u d i e s p r e s e n t e d i n the i n -  empathic a b i l i t y ,  This f i n d i n g r e a f f i r m s  fact  EXP  occur,  an answer i s suggested by  c l i e n t received  of the r e s u l t s of t h e r a p e u t i c  the  T h i s d i d not  sig-  i s Treatment Outcome Best P r e d i c t e d ?  This  of  a  s c o r e s were c o r r e l a t e d w i t h  pathy of t h e i r t h e r a p i s t s i n the e x p e r i m e n t a l  How  depth  T h i s would have been suggested by  s c o r e s from segments e a r l i e r on i n the implying  that  largely  a t h e r a p i s t as b e i n g empathic,  t h i s empathy t h a t are n o n - v e r b a l . p o s t u r e , and  r e l a t e d k i n e s i c cues  For are  -81What I s the O v e r a l l  Statement o f C l i e n t - C e n t e r e d  Therapy P r o c e s s  Supported by the Study?  Empathy was n o t shown to be a s i g n i f i c a n t p r e d i c t o r o f outcome i n t h i s study.  However, s i m i l a r r e s e a r c h  counts f o r a s i g n i f i c a n t p r o p o r t i o n client-centered The  has o f t e n  shown t h a t empathy a c -  o f the v a r i a n c e  o f the r e s u l t s o f  therapy.  t h r e e phases o f empathy, t h e r a p i s t e x p e r i e n c e d , 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, a r e shown to r e l a t e to one a n o t h e r (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 a t .05), but they c o r r e l a t e d f e r e n t i a l l y w i t h depth o f experiencing  and t r e a t m e n t outcome.  i n g s imply t h a t the empathy phases a r e r e l a t e d but d i s t i n c t  dif-  These f i n d -  constructs.  Examination o f t h e t h r e e empathy s c o r e s f o r each t h e r a p i s t a c r o s s  subjects  s u p p o r t s a t r a i t d e f i n i t i o n o f communicated empathy w i t h a s i g n i f i c a n t across-client correlation.  Client received  empathy a c r o s s - c l i e n t s c o r e s  were n o t 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 d a t a t h e r e f o r e  c o n c l u s i v e l y show t h a t CRE i s a r e l a t i o n s h i p v a r i a b l e . due to the f i r s t it  i s possible  This  do n o t  i s most  s e s s i o n n a t u r e o f the e x p e r i m e n t a l i n t e r v i e w s .  likely  That i s ,  t h a t 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 s c o r e s f o r t h e r a p i s t s  a c r o s s t h e i r two s u b j e c t s  were the r e s u l t o f c l i e n t e x p e c t a n c i e s o r s t e r e o -  t y p i c views o f t h e i r t h e r a p i s t s .  Perhaps o n l y  i n l a t e r therapy  would c l i e n t statements r e f l e c t a t r u e image o f the t h e r a p e u t i c  sessions relationship,  a f t e r the c l i e n t would have had the o p p o r t u n i t y to get t o know the t h e r a p i s t more f u l l y .  T h i s f i r s t - s e s s i o n s i t u a t i o n was the s t r o n g e s t  l i m i t a t i o n o f the  study. Client received  empathy i s the s t r o n g e s t  s i s t e n t f i n d i n g across studies,  .../82  p r e d i c t o r o f outcome, a c o n -  suggesting that c l i e n t perceptions of a  -82-  t h e r a p i s t ' s u n d e r s t a n d i n g are more v a l u a b l e than judgements of the  therapists  C l i e n t depth of e x p e r i e n c i n g  prognosticators  of  themselves or of o u t s i d e i s not  r e l a t e d to empathy o r outcome measures.  p o s i t i v e l y and  success  raters.  significantly  As p r e d i c t e d ,  t h e r a p i s t com-  municated empathy i s the empathy phase t h a t r e l a t e d most h i g h l y but  the  c o r r e l a t i o n value i s non-significant.  i s a c l i e n t v a r i a b l e not  powerfully  influenced  that  by  interventions.  therapist  perimental sessions,  however, i n d i c a t e s t h a t t h e r e may  s t a n c e s i n which TCE  and  coincide with a majority periencing  are  causally related.  of r e l a t e d r e s e a r c h  as p r e d o m i n a t e l y a c l i e n t  In t o t o  EXP,  This implies  A c o n t e n t a n a l y s i s of the TCE/EXP r e l a t i o n s h i p i n each of the  EXP  to  be  EXP  30  ex-  specific i n -  O v e r a l l , the  presenting  depth of  data ex-  trait variable.  t h i s study suggests t h a t , w i t h i n  first  sessions  of C l i e n t -  Centered treatment, t h e r a p i s t empathic communications are r e l a t e d to c l i e n t p e r c e p t i o n s of the  t h e r a p i s t ' s empathic a b i l i t y .  i n turn p o s i t i v e l y influence of s e l f - e x p e r i e n c i n g may communicated empathy, but  treatment outcome.  does not  treatment p r o c e s s a t t h i s e a r l y  The  These p e r c e p t i o n s  Changes i n c l i e n t  a l s o be a f f e c t e d to a minor degree by EXP  the  appear to p o w e r f u l l y  depth  therapist  affect  the  stage.  Role of Congruence  Thus f a r t h i s study has condition  f o c u s e d on empathy as the p r e p o t e n t c o r e  i n the c l i e n t - c e n t e r e d  Truax (1967) and  Barrett-Lennard  therapy p r o c e s s .  However, Rogers  (1962) a l s o s t r e s s e d  the  c l i e n t p e r c e p t i o n s of t h e r a p i s t congruence i n treatment.  ,/83  and  importance of  -83-  Client-received.congruence  (CRC)  refers to the  degree to which one person i s f u n c t i o n a l l y integrated in the context of the relationship with another, such that there i s absence of c o n f l i c t or inconsistency  be-  tween his t o t a l experience, his awareness, and his overt communication...the highly congruent i n d i v i d u a l i s comp l e t e l y honest, d i r e c t , and sincere i n what he conveys, but he does not f e e l any compulsion to communicate his perceptions, or any need to withold them for emotionally s e l f - p r o t e c t i v e reasons...  Direct evidence of lack of  congruence includes, for example, inconsistency between what the i n d i v i d u a l says, and what he implies by pression, gestures, or tone of voice. discomfort,  ex-  Indications of  tension, or anxiety are considered  to be  less d i r e c t but equally important evidence of lack of congruence.  (Barrett-Lennard,  The central r o l e of CRC seen by Barrett-Lennard  1962,  p. 4).  i n therapy process i s  (1962) as establishing an  upper l i m i t to the degree to which empathic understanding of another i s possible... (and) the degree to which an i n d i v i d u a l can a c t u a l l y respond uncond i t i o n a l l y to another i s considered  a function of  his security and integration i n r e l a t i o n 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 e f f e c t on  defined  t h e r a p i s t empathy, i t was  as e x e r t i n g included  a l i m i t i n g or enhancing  i n t h i s study to enhance  completeness of the d e s c r i p t i o n of C l i e n t - C e n t e r e d Client received measured by  Examples of BLRI items a s s e s s i n g  '' '  i s c o m f o r t a b l e and  I f e e l that  Since a l l 30 and  treatment.  congruence as w e l l as c l i e n t r e c e i v e d  the BLRI.  subjects  CRC  a t ease i n our  puts on a r o l e or f r o n t f o r  completed the BLRI, d a t a was  outcome (TO).  t h e i r two  r a t i n g s of t h e r a p i s t s by  examined by means of a t - t e s t f o r dependent samples. the  of congruence was  CRC  and  CRE  added p o s t hoc  mation to more thoroughly d e s c r i b e The  r e s u l t s of these a n a l y s e s are  TCE  CRC  * p <.0001  were a l s o  As w e l l , a _t - t e s t This  analysis  therapy p r o c e s s .  summarized below:  CRE  therapist  study to p r o v i d e a d d i t i o n a l i n f o r -  the c l i e n t - c e n t e r e d  among CRC,  CRC,  treatment  subjects  TABLE 9 Correlations  to  and  s c o r e s f o r each t h e r a p i s t . to the  me.  available for  empathy (CRE)  performed on  are:  relationship.  communicated empathy (TCE), c l i e n t r e c e i v e d  was  empathy i s  these data were a n a l y z e d to examine r e l a t i o n s h i p of CRC  CRC  the  TCE,  CRE,  TO  arid TO  , -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 c o r r e l a t i o n between c l i e n t received congruence and c l i e n t received empathy i s high « . 72) and s i g n i f i c a n t ( p<.0001).  This index of r e l a t i o n -  ship between the two variables could be interpreted either to mean that CRC and CRE are tapping the same variable or highly related but d i s t i n c t v a r i ables i n the therapeutic process.  This interpretation can be addressed  by diagramming the i n t e r r e l a t i o n s h i p s among CRC, CRE, TCE, and TO.  ./86  -86-  F i g u r e 16:  The  Interrelationships  among T h e r a p i s t Communicated Empathy,  C l i e n t Received Congruence, C l i e n t R e c e i v e d Empathy,  and  Treatment Outcome.  F i g u r e 16  shows t h a t the  c o e f f i c i e n t s are CRC  and  TO  by  ( p<£. 10).  c o e f f i c i e n t s also  h i g h l y s i m i l a r , but  separate therapist  CRC  i s s u p p o r t i v e of  s u b j e c t s on  the  two  These f i n d i n g s  qualities.  the  and  the  TO  (. p < . 05);  by  CRC  and  d i f f e r , although  correlation  t h a t the  TO  by  non-significantly  variables  The  r e s u l t of  were not  are the  t_ - t e s t of CRE the  correlational  finitively.  Research i s i n d i c a t e d  and  of Barrett-Lennard  for  (1962) t h a t  therapist  t h e r e f o r e cannot prove t h i s  t h a t would v a r y the  s y s t e m a t i c f a s h i o n , and  scores  by  different.  to c l i e n t p e r c e p t i o n s of  d a t a are  and  nonetheless p e r c e i v i n g  significantly  support the p o s i t i o n  congruence i s r e l a t e d  in a controlled,  that.clients  above c o n c l u s i o n s inasmuch as  However, the  ,/87  CRC  T h i s p a t t e r n suggests t h a t c l i e n t p e r c e p t i o n s of empathy  two  outcome.  by  significantly different  CRE  congruence are  therapist  TCE  empathy. deO  l e v e l congruence  observe changes on  empathy  and  -87-  Limitatibns  A primary  l i m i t a t i o n of t h i s study was  the s m a l l n, a n e c e s s a r y  d i t i o n i n view of the amount of r a t e r hours i n v o l v e d i n a s s e s s i n g TCE EXP.  I t was  conand  p r e d i c t e d t h a t a r a t i o o f t h i r t y s u b j e c t s f o r f i v e main v a r i -  a b l e s would f u r n i s h s u f f i c i e n t power to a c h i e v e s t r o n g c o r r e l a t i o n a l r e sults.  T h i s p r e d i c t i o n proved  e r r o r v a r i a n c e was  and  the " f i r s t  results.  s e s s i o n " n a t u r e of the  I t seems t h a t even when s u b j e c t s have a prepared  cuss, i t may of  I t appears t h a t enough  p r e s e n t i n the d e s i g n to weaken the  Another l i m i t a t i o n was sessions.  to be o p t i m i s t i c .  experimental  t o p i c to d i s -  w e l l take more time to e s t a b l i s h a t h e r a p e u t i c r e l a t i o n s h i p  the type i n t e n d e d by Rogers.  Perhaps o n l y i n l a t e r s e s s i o n s do  client  t h e r a p i s t shed t h e i r s t e r e o t y p i c b e h a v i o r s and b e g i n to i n t e r a c t mean-  ingfully. The itself  treatment  outcome measure, Goal Attainment  as b e i n g s u s c e p t i b l e to r e a c i t i v i t y  S c a l i n g , a l s o presents  inasmuch as simply the a c t of  mapping out the a f f e c t i v e and b e h a v i o r a l s t e p s toward g e t t i n g b e t t e r can of  itself  an e f f e c t i v e treatment  Another p r o b l e m a t i c municated empathy. w i t h and without Rappaport and  ( K e l l e y , 1976;  instrument  Chinsky  Sherman, 1968).  i s C a r k h u f f ' s s c a l e f o r measuring com-  Truax (1972) has  c l i e n t statements  K i r e s u k and  be  shown t h a t communicated empathy r a t i n g s  p r e s e n t a r e not s i g n i f i c a n t l y  (1972) have r a i s e d  different.  the i s s u e t h a t i f Truax's f i n d i n g s  a r e r e p r e s e n t a t i v e of the use of empathy r a t i n g s c a l e s i n g e n e r a l , i t would be p o s s i b l e f o r t h e r a p i s t s to a c h i e v e h i g h communicated empathy r a t i n g s by simply r e c i t i n g from memory statements  p o s s e s s i n g c h a r a c t e r i s t i c s of h i g h  r a t i n g s on an a c c u r a t e empathy s c a l e without of  c l i e n t communications.  ./88  even c o n s i d e r i n g the  content  In the l i g h t of t h i s r e s e a r c h , i t i s c e r t a i n l y  -88-  p o s s i b l e t h a t communicated empathy s c a l e s a r e measuring a t h e r a p i s t q u a l i t y b e s t d e s c r i b e d as a s k i l l  i n u t t e r i n g words and p h r a s e s t h a t sound em-  p a t h i c but a r e n o t n e c e s s a r i l y a c c u r a t e r e f l e c t i o n s o f t h e i r  client's  thoughts and f e e l i n g s . Another i s s u e r e g a r d i n g l i m i t a t i o n s i s : p r o v i d e an a c c u r a t e analog Klein et a l . ,  d i d the e x p e r i m e n t a l  o f the a c t u a l c l i e n t - c e n t e r e d therapy  process?  (1969) c o n s i d e r e d p r o d u c t i v e therapy t o be happening when  l e v e l s f o u r through seven on the e x p e r i e n c i n g s c a l e a r e a c h i e v e d ment.  sessions  In the p r e s e n t  study,  i n treat-  segments w i t h peak r a t i n g s a t these EXP l e v e l s  comprised 23% o f the t o t a l number o f segments, and seventeen out o f the t h i r t y c l i e n t s achieved c o u l d make the case  l e v e l s o f e x p e r i e n c i n g a t o r over l e v e l f i v e .  t h a t i n the o t h e r t h i r t e e n s e s s i o n s p r o d u c t i v e  was n o t r e a l l y o c c u r r i n g .  One  therapy  T h i s may have been t r u e , but even i f i t were,  i t would not n e c e s s a r i l y f o l l o w t h a t the r e l a t i o n s h i p s among the empathy and  e x p e r i e n c i n g v a r i a b l e s were any d i f f e r e n t .  That i s , even i n s i 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 o f empathy, e x p e r i e n c i n g , 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  o c c u r r i n g when EXP l e v e l s a r e h i g h .  At any r a t e , t h i s i s an e m p i r i c a l  q u e s t i o n which i s n o t answered i n the l i t e r a t u r e . O v e r a l l , the experimental analogs  of i n i t i a l  sessions are considered  to be a c c e p t a b l e  s e s s i o n s o f c l i e n t - c e n t e r e d treatment  s i n c e 60% o f the  s u b j e c t s a c h i e v e d EXP s c o r e s a t o r over l e v e l f o u r , 60% o f the t h e r a p i s t s achieved  TCE s c o r e s over l e v e l t h r e e  (the minimum f a c i l i t a t i v e  level),  a l l t h e r a p i s t s a c t e d i n a r e f l e c t i v e manner, and a l l s u b j e c t s d i s c u s s e d issues of personal  incongruence.  A f i n a l comment r e g a r d i n g the r e l a t i v e l y s m a l l magnitude o f t h e c o r r e l a t i o n s among the v a r i a b l e s i n v o l v e d i n t h i s study i s t h a t t h e t h r e e empathy phases alone c e r t a i n l y do n o t account f o r t h e m a j o r i t y o f t h e  /QO  -89-  v a r i a n c e i n c l i e n t depth, of e x p e r i e n c i n g o r treatment outcome. A l a r g e v a r i e t y o f o t h e r v a r i a b l e s such as s e v 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 a m e n a b i l i t y to treatment method f o r the r e s t o f the v a r i a n c e .  I n f a c t , Moos and Macintosh  ducted a study of the therapy p r o c e s s and found o n l y 30% of  the v a r i a n c e o f treatment outcome.  (1970),  account con-  that empathy accounted f o r T h e r e f o r e i t i s n o t un-  r e a s o n a b l e to expect s m a l l c o r r e l a t i o n s when o n l y t h r e e o f these many p r e d i c t o r s o f therapy p r o c e s s and outcome a r e a s s e s s e d .  -90-  CHAPTER  SIX  Conclusion  T h i s study has  depicted  o p e r a t i o n a l l y as two municated and and  empathy as being most a c c u r a t e l y  r e l a t e d but  d i s t i n c t c o n s t r u c t s , t h e r a p i s t com-  c l i e n t - r e c e i v e d empathy, each p o s s e s s i n g  p r e d i c t i v e powers.  t h i s study l i e s mainly i n i t s w i t h i n - s e s s i o n the  therapy p r o c e s s ,  unique  T h i s f i n d i n g i s not unique, but  a r e a f f i r m a t i o n of s i m i l a r f i n d i n g s i n r e c e n t  in  defined  a departure  rather  literature. focus on  The  qualities represents importance of  the f i v e s a l i e n t v a r i a b l e s  from s i m i l a r s t u d i e s d e a l i n g w i t h  same t o p i c which have tended to be m a c r o s c o p i c or l o n g i t u d i n a l i n taking l e s s frequent  t i o n , and  need to p a r a l l e l  these broad,  s t u d i e s of the c l i e n t - c e n t e r e d t h e r a p e u t i c process  s i t u a t i o n s with  nature,  measures of the f i v e v a r i a b l e s .  T h i s study a r o s e out of a p e r c e i v e d naturalistic  the  analog  problem type,  r e s e a r c h which kept constant  i n i n vivo  treatment method, d u r a -  and which employed a more i n d i v i d u a l l y  tailored,  a c t i o n - o r i e n t e d measure of change. The  c o n t r a d i c t o r y f i n d i n g s i n t h i s and  s i m i l a r s t u d i e s a t t e s t to  confused n a t u r e of the c l i e n t - c e n t e r e d p r o c e s s i n i t ) under study.  Each p i e c e of r e s e a r c h  of the t r u t h about the t h e r a p e u t i c p r o c e s s , search  does add  up  to some i n e s c a p a b l e  (and  the v a r i a b l e s i n v o l v e d  i s able only but  to d i s t i l l  and  c l i e n t r e c e i v e d empathy, and  as b e i n g r e l a t i v e l y Therapist  i n the c u r r e n t l i t e r a t u r e  /ni  two  this  favors  phases, t h e r a p i s t communi-  t h i s study d e f i n e s both of  stable f o r t h e r a p i s t s across  experienced  re-  conclusions.  the c o n c e p t u a l i z a t i o n of empathy as having cated  a part  an i n t e g r a t i o n of the  Regarding the i s s u e of whether empathy i s a s t a t e or a t r a i t , study along w i t h a m a j o r i t y of o t h e r s  the  these  clients.  empathy, the weakest of the empathy phases i n  -91-  a p r e d i c t i v e sense, has been a t b e s t a measure of dubious v a l u e from i t s inception  ( B a r r e t t - L e n n a r d , 1962), and t h i s study f u r t h e r undermines i t s  usefulness.  T h e r a p i s t s seemed to have some i d e a o f how much t h e i r v e r b a l i -  z a t i o n s sounded empathic  (  r t c e  /_  = e e  •'•22 (NS)), but no c o n c e p t i o n a t a l l as  to how t h e i r words were r e c e i v e d by c l i e n t s i n some cases i t was apparent c l i e n t s gave themselves the converse  (r . = -.12 (NS)). ere/tee  t h a t those w i t h the h i g h e s t r a t i n g s  In f a c t , from  e q u a l l y low r a t i n g s , w h i l e i n s e v e r a l o t h e r cases  appeared.  S i m i l a r f i n d i n g s were r e p o r t e d by Rogers i n the W i s c o n s i n Study  (1967).  He wrote: I t i s a s o b e r i n g f i n d i n g t h a t our t h e r a p i s t s , competent and c o n s c i e n t i o u s as they were, had o v e r 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-  c e p t i o n s of the r e l a t i o n s i n which they were i n v o l v ed  The  (Rogers e t a l . ,  1967, p. 9 2 ) .  i n a c c u r a c y o f these p e r c e p t i o n s i s l i k e l y due i n l a r g e p a r t to  t h e r a p i s t s b a s i n g t h e i r r a t i n g s on e i t h e r a comparison i d e a l performance be empathic.  o f t h e i r a c t u a l and  o r on an " e f f o r t " s c a l e r e f l e c t i n g how hard they t r i e d to  These and o t h e r s i m i l a r b i a s i n g f a c t o r s a r e e s s e n t i a l l y un-  a v o i d a b l e i n any s e l f - r a t i n g s c a l e o f performance. The importance  o f depth o f e x p e r i e n c i n g as a v a r i a b l e d e s c r i b i n g the  i n t e r n a l p r o c e s s the c l i e n t engages i n as a mediator  between t h e r a p i s t i n -  t e r v e n t i o n and treatment outcome has not been r e a f f i r m e d i n t h i s study. r e s u l t , however, may have been a r t i f a c t u a l inasmuch as perhaps r e l a t i o n s h i p must be allowed  . ./92  the therapeutic  to mature and deepen over a g r e a t e r number o f  therapy s e s s i o n s f o r the empathy-experiencing maximum potency.  This  interrelation  to a c h i e v e i t s  -92-  A f i n a l comment on  the c a u s a l l i n k a g e between e x p e r i e n c i n g  t h e r a p i s t communicated empathy i s t h a t , a f t e r l i s t e n i n g therapy, ways;  and  to many hours of  i t i s s u b j e c t i v e l y apparent t h a t the c a u s a l f o r c e s can flow  from t h e r a p i s t to c l i e n t  T h i s i s a f f i r m e d by van c l i e n t and  i n some cases and v i c e v e r s a i n o t h e r s .  der Veen's f i n d i n g i n a s i m i l a r study  t h a t "both  t h e r a p i s t s i g n i f i c a n t l y i n f l u e n c e d each o t h e r ' s b e h a v i o r "  der Veen, 1965,  p.  (van  6).  In other words, i n s i g h t f u l about i n c r e a s e d  both  t h e r a p i s t r e f l e c t i o n s i n some cases  s e l f - e x p l o r a t i o n by s u b j e c t s , w h i l e a t o t h e r  brought  times i t was  the t h e r a p i s t 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 w i t h  affect.  s e l f - d e s c r i p t i o n and  -93-  Implications  Theory  The  c l i n i c a l importance of empathy has  n i f i c a n c e l e v e l of  .05.  However, of the  e x p e r i e n c e d , t h e r a p i s t communicated, and received  empathy was  the s t r o n g e s t  not  been r e a f f i r m e d a t a  three empathy phases ( t h e r a p i s t c l i e n t received  perception  of the  conditions  f o r change i n psychotherapy.  (1967) who  empathy),  (1951) that the  t h e r a p i s t ' s empathic u n d e r s t a n d i n g i s one  stated  client  p o s i t i v e c o r r e l a t e of treatment outcome.  Thus the f i n d i n g s support Roger's I n i t i a l h y p o t h e s i s  Carkhuff  sig-  of the  client's  crucial  T h i s runs counter to Truax  and  that the c l i e n t o f t e n u i i s p e r c e i v e s t h e r a p i s t  empathy, l e a v i n g tape-judged or t h e r a p i s t communicated empathy as the f e r r e d empathy measure. It could  thus be  -  the  i t i s not  simply  empathic communication as measured by t o t a l empathic communication, other contact, Therapist  high-rated  Carkhuff A c c u r a t e Empathy S c a l e .  r e l a t i o n would p r o b a b l y have been much h i g h e r .  as eye  . .- .  concluded t h a t whatever i t i s t h a t communicates empathic  u n d e r s t a n d i n g to the c l i e n t , measured by  pre-  v o i c e q u a l i t y , and  v e r b a l behavior  I f i t were, the TCE/CRE c o r I t can o n l y be  the r a t i n g s c a l e i s but  components perhaps being  assumed that one  k i n e s i c responses.  as. the f o c a l p o i n t f o r measuring empathy i n therapy.  less often  As Rogers wrote:  (of r a t i n g empathy from audio tapes of  therapy s e s s i o n s ) was  open to the p i t f a l l s of a  rather  wooden i m i t a t i o n , a s o r t of f o r m u l a behind which a f r i g h t e n e d , or c o n f l i c t e d , or u n i n v o l v e d could h i d e .  The  might l o o k good on a tape t r a n s c r i p t , but could vary  therapist  r e f l e c t i o n formula of "you  feel..."  in action i t  from a deep response to an a r t i f i c i a l  (Rogers et a l . , 1967,  p.  10).  the  component of  v a r i a b l e s such  communicated empathy seems to be viewed l e s s and  The method  as  front  -94-  Practice  T h i s h i g h l i g h t i n g of c l i e n t r e c e i v e d empathy and municated empathy i n empathy assessment has pist  definite  downplaying of comimplications for  t r a i n i n g , s i n c e many graduate programs, p a r t i c u l a r l y  those i n  thera-  counsel-  l i n g p s y c h o l o g y , are h e a v i l y committed to n u r t u r i n g empathic a b i l i t y  in  t r a i n e e s , o f t e n r e q u i r i n g moderate to h i g h 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 f o r c o m p l e t i o n of the program or as an i n d i c a t i o n of counselling The  expertise.  empathy measure of c h o i c e i n a s s e s s i n g  t r a i n e e performance has  the tape r a t i n g s c a l e p o p u l a r i z e d by C a r k h u f f  and  p r o b a b l e t h a t t h i s i s the most m e a n i n g f u l way  of measuring t h e r a p e u t i c  It  i s suggested t h a t the augmentation of  Lennard R e l a t i o n s h i p Inventory p r o f i l e s based l e s s on a c q u i r e d  these s c a l e s w i t h  ability  r a t h e r than on s t e r e o t y p e d  ing  of the  to e x p l o r e  performance,  of u n d e r s t a n d i n g the c l i e n t and Emphasis on c l i e n t  com-  per-  t h e r a p i s t v e r b a l performance c o u l d  l e s s orthodox means of e x p r e s s i n g  free  responding,  h i s i n n e r understand-  client.  L e v e l s of CRE centered  skill.  the B a r r e t t -  t r a i n e e 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  a l l o w i n g him  im-  to p a r r o t a c e r t a i n s t y l e of com-  m u n i c a t i n g t h i s u n d e r s t a n d i n g i n a l u c i d manner.  the  i t appears  as the empathy measure would y i e l d  m u n i c a t i o n and more on a genuine s k i l l  ceptions  Truax, but  been  have been shown to change throughout the course of  c o u n s e l l i n g (Kurtz and  ments of c l i e n t  Grummon, 1974).  Therefore,  frequent  r e c e i v e d empathy i n ongoing treatment c o u l d p r o v i d e  clientassess-  the  thera-  p i s t w i t h a p o w e r f u l barometer of h i s e f f e c t i v e n e s s as a f a c i l i t a t o r of change. On  the b a s i s of the i n f o r m a t i o n he would o b t a i n , the t h e r a p i s t could  steps  toward enhancing the c o u n s e l l i n g r e l a t i o n s h i p , such as a l t e r i n g h i s t r e a t -  ment methods or communication s t y l e .  /OS  take p o s i t i v e  The  communicated and  client  received  -95-  empathy r a t i n g s c o u l d a l s o be openly d i s c u s s e d w i t h the c l i e n t , b o t h as a means to help the t h e r a p i s t f u n c t i o n more e f f e c t i v e l y and as an a i d to the c l i e n t i n g e t t i n g i n touch w i t h h i s e x p e c t a t i o n s and d e s i r e s r e g a r d i n g the t h e r a p i s t and  the treatment  process.  Research  T h i s study has p r e s e n t e d of examining  the w i t h i n - s e s s i o n format as a v a l u a b l e means  the c l i e n t - c e n t e r e d p r o c e s s .  Future s t u d i e s c o u l d b e n e f i t from a p p l i c a t i o n of t h i s focused of therapy s e s s i o n s by examining  analysis  s e s s i o n s from the m i d d l e and end of  treat-  ment as w e l l as the b e g i n n i n g to see i f r e l a t i o n s h i p s among v a r i a b l e s c o n s t a n t a t these v a r i o u s p o i n t s .  Such i n v e s t i g a t i o n s would perhaps show  t h a t the s t r o n g e s t p r e d i c t o r s of c l i e n t movement v a r y as treatment es.  are  progress-  Maybe, f o r example, t h e r a p i s t communicated empathy and depth of  ex-  p e r i e n c i n g a r e more h i g h l y c o r r e l a t e d a t the m i d d l e - p o i n t of treatment at the b e g i n n i n g o r  than  end.  Another i n t e r e s t i n g avenue o f study would be to measure t h e r a p i s t s empathy measures a c r o s s many c l i e n t s , a p r o c e s s t h a t would p r o b a b l y  on  clarify  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 c o n s t r u c t . The exact n a t u r e of t h e r a p i s t communicated empathy s h o u l d a l s o be p l o r e d , perhaps by open-ended i n q u i r y i n t o what cues c l i e n t s as i n d i c a t o r s of empathic  ex-  interpreted  communications.  A f i n a l and most emphatic recommendation i s t h a t more attempts  should  be made to q u a n t i t a t i v e l y summarize the v a s t amount of d a t a r e g a r d i n g the client-centered  treatment  process.  T a b l e 3 i n t h i s t e x t i s a simple  ample of such a q u a n t i t a t i v e summary. r a t e methodology d e v i s e d by G l a s s  I t was  i n s p i r e d by a thorough,  (1976) c a l l e d m e t a - a n a l y s i s .  Using  exelabothese  -96-  techniques,  G l a s s was a b l e to perform  s t a t i s t i c a l o p e r a t i o n s to compare  the c u r a t i v e powers o f v a r i o u s p s y c h o t h e r a p e u t i c  treatments  by summarizing  hundreds o f r e l e v a n t s t u d i e s . I t i s apparent centered  treatment  that meta-analysis  o f 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 -  c o u l d s e r v e the v a l u a b l e f u n c t i o n o f p u l l i n g  the v a s t q u a n t i t y o f e x a c t data and d i s t i l l i n g model o f t h e t h e r a p e u t i c p r o c e s s . one  from i t a s o l i d l y based  The a p p l i c a t i o n o f m e t a - a n a l y s i s t o  t h e o r e t i c a l f o r m u l a t i o n o f psychotherapy  c e n t e r e d model would p r o b a b l y r e s u l t of the p r o c e s s  together  process  i n a powerful,  such as t h e c l i e n t authoritative picture  s i n c e the s t u d i e s from which r e s u l t s would be drawn would  have employed v e r y s i m i l a r measures t o q u a n t i f y 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 p r o c e s s and outcome has been the f o c u s of one o f t h e r a p e u t i c p s y c h o l o g y ' s of r e s e a r c h .  F o r a l o n g time,  have n o t been c u m u l a t i v e .  most f r u i t f u l and e x c i t i n g v e i n s  the f i n d i n g s have been a c c u m u l a t i n g but  T h i s study and s i m i l a r r e c e n t r e s e a r c h has, how-  ever, been i n t e g r a t i n g p a s t r e s u l t s , and has caused  them t o b e g i n  i n t o c o n s i s t e n t and u s e f u l i n f o r m a t i o n f o r the p s y c h o t h e r a p i s t .  maturing  -97BIBLIOGRAPHY  A s h c r a f t , C , and F i t t s , W. Psychotherapy, B a r r e t t - L e n n a r d , G.T.  S e l f - c o n c e p t changes i n psychotherapy. 1964, 1_, 115 - 118.  Dimensions  o f t h e r a p i s t response as c a u s a l f a c t o r s  i n t h e r a p e u t i c change.  P s y c h o l o g i c a l Monographs, 1962,  76, 1 - 36. 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Rogers,  A c r i t i c a l review o f the  1-12.  o f a c c u r a t e empathy r a t i n g s : A  P s y c h o l o g i c a l B u l l e t i n , 1972,  77_, 397  -  399.  -103Truax, C., and C a r k h u f f , R,  Toward E f f e c t i v e C o u n s e l i n g arid Psychotherapy:  Theory arid P r a c t i c e . Truax, C.B., Frank, J.D., Imber, S.D., E.H., and Stone, A.R.  Chicago, A l d i k e ,  B a t t l e , C C , Hoehn-Saric, R., Nash, T h e r a p i s t empathy, genuineness, and  warmth and t h e r a p e u t i c outcome. Psychology, 1966, Truax, C.B., Wargo, D . C ,  1967.  30_, 395  -  J o u r n a l of C o u n s u l t i n g  401.  Frank, J.D. , Imber, S.D.,  Battle, C C ,  S a r i c , R., Nash, E.H., and Stone, A.R.  Hoehn-  The t h e r a p i s t ' s  c o n t r i b u t i o n to a c c u r a t e empathy, n o n - p o s s e s s i v e warmth, and genuineness i n p s y c h o t h e r a p y . Psychology, 1966, van der Veen, F.  22_, 331 -  J o u r n a l of C l i n i c a l  334.  E f f e c t s of the t h e r a p i s t and the p a t i e n t on each o t h e r ' s therapeutic behavior.  J o u r n a l of C o n s u l t i n g Psychology,  1965, 29, 19 - 26. Walker, A.M.,  Rablen, R.A.,  and Rogers, C R .  Development o f a s c a l e to  measure p r o c e s s changes i n psychotherapy. C l i n i c a l P s y c h o l o g y , 1960, Yee, A.H., and Gage, N.L.  16,  79 - 85.  Techniques f o r e s t i m a t i n g the source and d i r e c t i o n  of c a u s a l i n f l u e n c e i n p a n e l d a t a .  1970, 46, 115 - 126.  ./104  J o u r n a l of  Psychological  Bulletin,  APPENDIX A COMPILATION OF MEASURES AND SCALES  -105-  SCALE 1: EMPATHIC UNDERSTANDING A SCALE FOR MEASUREMENT  IN INTERPERSONAL PROCESSES 1  L e v e l 1: The v e r b a l and b e h a v i o u r a l e x p r e s s i o n s o f t h e h e l p e r e i t h e r do not attend t o o r d e t r a c t s i g n i f i c a n t l y from the v e r b a l and b e h a v i o u r a l e x p r e s s i o n s o f t h e h e l p e e (2) i n t h a t they communicate s i g n i f i c a n t l y l e s s o f the h e l p e e s f e e l i n g s and e x p e r i e n c e s than t h e helpee has communicated h i m s e l f . 1  Example: The h e l p e r communicated no awareness o f even the most o b v i o u s , expressed s u r f a c e f e e l i n g s o f t h e h e l p e e . The h e l p e r may be bored o r d i s i n t e r e s t e d or simply o p e r a t i n g from a p r e c o n c e i v e d form o f r e f e r e n c e which t o t a l l y e x c l u d e s t h a t o f t h e helpee(s). In summary, the h e l p e r does e v e r y t h i n g but express t h a t he i s l i s t e n i n g , understanding, o r b e i n g s e n s i t i v e t o even t h e most obvious f e e l i n g s o f the h e l p e e , and does so i n such a way as to d e t r a c t s i g n i f i c a n t l y from the communications o f the h e l p e e . L e v e l 2: While the h e l p e r responds to the expressed f e e l i n g s o f the h e l p e e ( s ) , he does so i n such a way t h a t he s u b t r a c t s n o t i c e a b l e a f f e c t from the communications o f the h e l p e e . Example: The h e l p e r may communicate some awareness o f obvious s u r f a c e f e e l i n g s o f the h e l p e e , but h i s communications d r a i n 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 o f meaning. The h e l p e r may communicate h i s own i d e a s o f what may be going on, b u t these a r e not congruent w i t h t h e e x p r e s s i o n s o f t h e h e l p e e . In summary, the h e l p e r tends t o respond t o something o t h e r than t h a t which the helpee i s e x p r e s s i n g o r i n d i c a t i n g . L e v e l 3: The e x p r e s s i o n s o f the h e l p e r i n response to the e x p r e s s i o n s of the helpee (2) a r e e s s e n t i a l l y i n t e r c h a n g e a b l e w i t h t h o s e o f t h e h e l p e e i n t h a t they express t h e same a f f e c t and meaning. Example: The h e l p e r responds w i t h a c c u r a t e u n d e r s t a n d i n g o f t h e s u r f a c e f e e l i n g s o f the h e l p e r but may not respond t o o r may misi n t e r p r e t the deeper f e e l i n g s . In summary, the h e l p e r i s r e s p o n d i n g so as t o n e i t h e r s u b t r a c t nor add to the e x p r e s s i o n s o f the h e l p e e . He does n o t respond a c c u r a t e l y t o how t h a t person r e a l l y f e e l s beneath t h e s u r f a c e f e e l i n g s , b u t he i n d i c a t e s a w i l l i n g n e s s and openess t o do s o . L e v e l I I I c o n s t i t u t e s the minimal l e v e l o f 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 f u n c t i o n i n g .  L e v e l 4: The responses o f the h e l p e r add n o t i c e a b l y to t h e e x p r e s s i o n s of the h e l p e e ( s ) i n such a way as t o e x p r e s s f e e l i n g s a t a l e v e l deeper than that w i t h which t h e h e l p e e was a b l e to express h i m s e l f . Example: The h e l p e r communicates h i s u n d e r s t a n d i n g o f the e x p r e s s i o n s o f the h e l p e e a t a l e v e l deeper than they were expressed and thus e n a b l e s the h e l p e e t o e x p e r i e n c e and/or express f e e l i n g s he was unable to express p r e v i o u s l y . In summary, the h e l p e r ' s r e s p o n s e s add deeper the e x p r e s s i o n s o f the h e l p e e .  f e e l i n g and meaning t o  L e v e l 5: The h e l p e r ' s responses add s i g n i f i c a n t l y t o the f e e l i n g and meaning o f t h e e x p r e s s i o n s o f t h e h e l p e e ( s ) i n such a way as t o a c c u r a t e l y express f e e l i n g s some l e v e l s below t h a t which the h e l p e e h i m s e l f was a b l e to express,, o r , i n the event o r ongoing, deep s e l f - e x p l o r a t i o n on the helpee's p a r t , to be f u l l y w i t h him i n h i s deepest moments. Example: The h e l p e r responds w i t h a c c u r a c y to a l l o f t h e h e l p e e ' s deeper as w e l l as s u r f a c e f e e l i n g s . He i s "tuned i n " on the h e l p e e ' s wave l e n g t h . The h e l p e r and the h e l p e e might proceed t o g e t h e r t o e x p l o r e p r e v i o u s l y u n e x p l o r e d a r e a s o f human existence. In summary, the h e l p e r i s r e s p o n d i n g w i t h a f u l l awareness o f who t h e other person i s and w i t h a comprehensive and a c c u r a t e empathic unders t a n d i n g o f t h a t i n d i v i d u a l ' s deepest f e e l i n g s .  1  C a r k h u f f , Robert  /I  07  R., H e l p i n g and Human R e l a t i o n s , V o l . 1.  Short  Form of EXP S c a l e  Conten t  Stage I  Externa 1 e v e n t s ; part ic i p a t e .  refusal  Treatment to  Impersona1, detached.  E x t e r n a l e v e n t s ; b e h a v i o r a l or intellectual se1f-description.  Interested, personal, s e 1 f - p a r t i c i pat i on.  Personal r e a c t i o n s to e x t e r n a l events; limited se1f-descriptions; b e h a v i o r a l d e s c r i p t i o n s of fee 1i ngs.  Reactive, emotiona l l y i nvolved.  if  D e s c r i p t i o n s of f e e l i n g s and personal e x p e r i e n c e s .  Se 1 f - d e s c r ipt i v e ; assoc i at i v e .  5  Problems or p r o p o s i t i o n s about f e e l i n g s and personal e x p e r i e n c e s .  Exploratory, elaborative, hypothetical.  6  /1  no  S y n t h e s i s of r e a d i l y a c c e s s i b l e f e e l i n g s and e x p e r i e n c e s to r e solve personally s i g n i f i c a n t "i s s u e s .  F e e l i n g s v i v i d l y expressed, integrative, c o n c l u s i v e or a f f i r mative.  F u l l , easy p r e s e n t a t i o n of exp e r i e n c i n g ; a l l elements c o n fidently integrated.  Expans i v e , i11uminating, confident, buoyant.  Code:  Date:  -108(BARRETT-LENNARD) RELATIONSHIP INVENTORY—FORM OS—64*  fn  Below a r e l i s t e d a v a r i e t y r e l a t i o n to another person.  Please consider relationship with  each  o f ways  that  o n e p e r s o n may f e e l  or  behave  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 , 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  space 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 , r e a d s t a t e m e n t #1, a s ' J o h n r e s p e c t s me a s a p e r s o n ' .  you would  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 o n t h e r i g h t , a c c o r d i n g t o how s t r o n g l y you feel that i t i s t r u e , o r not 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 +3 +2 +1 o r -1 -2 -3 to stand f o r the f o l l o w i n g answers: 3  +Z: Yes I strongly true. 3  +2: Yes  3  I feel  feel  that it is  3  3  -1:  3  3  3  No I feel that it is probably untrue or more untrue than true. 3  3  it is true.  +1: Yes I feel that it is probably true, or more true than untrue. 3  -2:  No  -3:  No I strongly not true.  3  I feel  it is not true. feel that it is  3  ANSWER 1.  respects  2.  wants  3.  's  k.  is comfortable  5.  feels  6.  may u n d e r s t a n d my w o r d s  8. 9. 10. 11.  *  to understand  interest  the 7.  me a s a p e r s o n  a true  .  .  .  .  .  .  .  I s a y o r do .  in our relationship  .  .  v  »  . .  f o r me but he/she  does  not see  way I f e e l  no  difference that  is  .  on t h e t h i n g s  and a t e a s e  liking  I am f e e l i n g  I feel  how I s e e t h i n g s  i n me d e p e n d s  Whether real  ______  o r unhappy w i t h  t o t h e way puts  impatient  nearly  happy  always  on a r o l e o r f r o n t  with  me  knows  Depending  o n my b e h a v i o u r ,  sometimes  than  he/she  feels  .  .  .  exactly  what  about with  makes  me me  .  .  .  .  . .  .  times  . -  I mean  has a b e t t e r  has a t o t h e r  Combines Forms 0S-M-64 and 0S-F-64  .  myself  o p i n i o n o f me  2.  4  -109ANSWER 12.  I feel  that  is  13.  I feel  a p p r e c i a t e d by looks a t what  ]k. 15.  's feeling toward him/her  16.  It makes things  17.  "  is  real  and genuine w i t h me  .  .  .  I do from h i s / h e r own p o i n t o f view .  .  .  uneasy when I ask or t a l k about  indifferent  .  certain  to me  usually  19.  wants me to be a p a r t i c u l a r  senses or  r e a l i s e s what  I feel  t h a t what  he/she  i s f e e l i n g and t h i n k i n g at  I am f e e l i n g  kind of  person  says u s u a l l y expresses e x a c t l y  f i n d s me r a t h e r d u l l  21.  .  toward me d o e s n ' t depend on how I f e e l  18.  20.  .  what  t h a t moment  and u n i n t e r e s t i n g  .  .  .  .  22.  ' s own a t t i t u d e s toward some o f the t h i n g s prevent him/her from u n d e r s t a n d i n g me  23.  I can (or c o u l d ) be o p e n l y c r i t i c a l or_ a p p r e c i a t i v e o f w i t h o u t r e a l l y making him/her f e e l any d i f f e r e n t l y about me  2k.  wants me to t h i n k that he/she l i k e s me o r me more than he/she r e a l l y does .  say  understands  c a r e s f o r me  25. 26.  I do or  Sometimes t h i n k s t h a t j_ f e e l t h a t ' s the way he/she f e e l s  27. things  a c e r t a i n way,  because  l i k e s c e r t a i n t h i n g s about me, and t h e r e a r e he/she does not l i k e  28.  does not a v o i d a n y t h i n g relationship  29.  I feel  30.  r e a l i s e s what saying i t  31.  ' s a t t i t u d e toward me s t a y s the same: he/she i s not p l e a s e d w i t h me sometimes and c r i t i c a l or d i s a p p o i n t e d at o t h e r times  32.  Sometimes is not at a l l outwardly i g n o r i n g i t  that  that  is  d i s a p p r o v e s of me  33-  just  3k.  usually  I mean even when  important  for  other  our . .  . I have d i f f i c u l t y  c o m f o r t a b l e but we go o n ,  t o l e r a t e s me understands the whole o f what  I mean  in  I f I show t h a t I am a n g r y w i t h o r a n g r y w i t h me, t o o  he/she becomes h u r t  expresses his/her t r u e impressions  and f e e l i n g s  w i t h me .  f s f r i e n d l y and warm w i t h me  J u s t t a k e s no n o t i c e o f some t h i n g s t h a t I t h i n k or feel 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 a n y t h i n g t h a t I t e l l him/her about m y s e l f At t i m e s I sense t h a t r e a l l y f e e l i n g w i t h me I feel  that  .  i s n o t aware o f what he/she i s • .  r e a l l y v a l u e s me  a p p r e c i a t e s e x a c t l y how t h e t h i n g s I e x p e r i e n c e f e e l t o me a p p r o v e s o f soma t h i n g s I d o , and p l a i n l y d i s a p p r o v e s of others Is w i l l i n g t o e x p r e s s w h a t e v e r i s a c t u a l l y i n h i s / h e r mind w i t h me, i n c l u d i n g p e r s o n a l f e e l i n g s about e i t h e r o f us d o e s n ' t l i k e me f o r m y s e l f  .  .  .  .  .  .  .  .  .  At t i m e s t h i n k s t h a t I f e e l a l o t more s t r o n g l y 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 u p s e t does not make f e e l any more o r l e s s a p p r e c i a t i v e o f me . . Is o p e n l y h i m s e l f / h e r s e l f i n o u r r e l a t i o n s h i p  .  ..' .  I seem t o i r r i t a t e and b o t h e r does not r e a l i s e how s e n s i t i v e I am about some o f t h e t h i n g s we d i s c u s s Whether t h e i d e a s and f e e l i n g s I e x p r e s s a r e "good" o r " b a d " seems t o make no d i f f e r e n c e t o 's f e e l i n g toward me T h e r e a r e t i m e s when I f e e l t h a t 's o u t w a r d response t o me i s q u i t e d i f f e r e n t from t h e way he/she f e e l s underneath • f e e l s contempt f o r me u n d e r s t a n d s me Sometimes I am more w o r t h w h i l e i n a t o t h e r times  '  . 1  s eyes than I am  it. -111-  ANSWER doesn't hide anything  56.  from h i m s e l f / h e r s e l f  t h a t he/she  f e e l s w i t h me is truly  57. 58. 59.  60.  What  61.  63.  dk.  in me  .  .  .  .  ' s response to me i s u s u a l l y so f i x e d and a u t o m a t i c t h a t I d o n ' t r e a l l y get through t o him/her . . . . . I d o n ' t t h i n k that a n y t h i n g I say o r do r e a l l y changes the way f e e l s toward me  total  62.  interested  says to me o f t e n g i v e s a wrong thought  or f e e l i n g a t the time  .  i m p r e s s i o n of  .  his/her  .  f e e l s deep a f f e c t i o n f o r me When I am hurt or upset can r e c o g n i s e my f e e l i n g s e x a c t l y , w i t h o u t becoming upset too . What o t h e r people t h i n k of me does (or w o u l d , i f he/she knew) a f f e c t the way f e e l s toward me I b e l i e v e that has f e e l i n g s about t h a t a r e c a u s i n g d i f f i c u l t y  Please a l s o provide person.  the f o l l o w i n g  he/she does not t e l l me in our r e l a t i o n s h i p . .  i n f o r m a t i o n about y o u r s e l f  Yourself  .  and the "  Other Person  Age:  years  Sex:  (M or  F)  years  (known o r e s t imated)  (M o r  F)  Occupation:  P o s i t i o n in t h i s relationship.  Son  Examples:  Client/or Friend  Actual : (Please f i l l  in)  other  '^Mother patient  Counsellor (Best)  (therapist)  Friend  Date:  Code:  RELATIONSHIP INVENTORY—FORM MO—64 "  Below a r e l i s t e d a v a r i e t y in r e l a t i o n  o f ways  t h a t one person may f e e l  or  behave  to another p e r s o n .  P l e a s e c o n s i d e r each statement w i t h r e f e r e n c e to your p r e s e n t relationship with , m e n t a l l y a d d i n g h i s o r her name in the space p r o v i d e d . If, f o r example, the o t h e r p e r s o n ' s name was J o h n , you would read statement #1 as 't r e s p e c t John as a p e r s o n ' . Mark each statement in the l e f t m a r g i n , a c c o r d i n g to how s t r o n g l y f e e l that i t i s t r u e , or not t r u e , in t h i s r e l a t i o n s h i p . P l e a s e mark every o n e . W r i t e in +3, +2, +1, o r -1, -2, ~3, t o stand f o r the f o l l o w i n g answers: +3:  Yes, I strongly true.  feel  that it is  +2:  Yes, I feel  +1:  Yes, I feel that it is probably true, or more true than untrue.  it is true  1.  I respect  2.  I want to understand how  3.  The i n t e r e s t I f e e l says or d o e s .  k.  I feel  _5.  I rea 11 y  JS.  I understand  _7.  -1:  No, I feel that it is probably untrue, or more untrue than true.  -2:  No, I feel  -3:  No, I strongly not true.  it is not true. feel  that it is  as a p e r s o n . sees  in  '  at ease w i t h  actually  you  things.  depends on the t h i n g s  he/she  .  1 i ke  . ' s words but do not know how he/she  feels.  Whether • i s f e e l i n g p l e a s e d or unhappy w i t h h e r s e l f does*,change my f e e l i n g toward him/her.  himself/  hot  JB.  I am i n c l i n e d to put on a r o l e or  _9.  I do f e e l  10.  I n e a r l y always know e x a c t l y what  11.  Depending on ' s a c t i o n s , I have a b e t t e r him/her sometimes than I do at o t h e r t i m e s .  impatient with  front with  ,  .  . means. opinion  of  2. 12.  I feel  13-  I appreciate  14.  I look at what  15.  The way I f e e l about f e e l i n g s toward me.  16.  It bothers me when certain things.  17.  I feel  18.  I do u s u a l l y  19-  I would  _20.  that  I am g e n u i n e l y myself w i t h  .  , as a p e r s o n . does from my own p o i n t o f  indifferent  view.  d o e s n ' t depend on h i s / h e r  tries  to  .  sense or  r e a l i s e how  like  to ask or t a l k about  is  to be a p a r t i c u l a r  feeling.  kind o f  person.  When I speak to  I nearly  j u s t what  f e e l i n g at t h a t moment.  I'm t h i n k i n g or  dull  freely  21.  I find  22.  What says or does arouses f e e l i ngs in me t h a t prevent me from u n d e r s t a n d i n g him/her. Whether _ _ _ _ c r i t i c i s e s me o r shows a p p r e c i a t i o n o f  _23>  rather  always can say  me does not (or would not) toward him/her. 2k.  and u n i n t e r e s t i n g .  change my inner  I would r e a l l y p r e f e r understand him/her even when I  _25.  I care for  _26.  Sometimes I t h i n k that because t h a t ' s the way  to t h i n k don't.  feeling  that  I like  . . feels a certain I feel myself.  way, ^  _27.  I like in some ways, w h i l e t h e r e are t h i n g s about him/her that I do not l i k e .  _28.  I d o n ' t f e e l t h a t I have been i g n o r i n g or p u t t i n g a n y t h i n g t h a t is important f o r our r e l a t i o n s h i p .  _29.  I do f e e l d i s a p p r o v a l  of  _30.  I can t e l l difficulty  it.  _31.  what in s a y i n g  My f e e l i n g toward not  or  other  off  . means, even when he/she has  s t a y s about the same;  in sympathy w i t h him/her one time and out o f  I am patience  another. _32.  Sometimes I am not at a l l c o m f o r t a b l e w i t h we go o n , outwardly i g n o r i n g it.  ^_ but  33-  I put up w i t h  34.  I usually meaning.  35-  If upset  36.  .  c a t c h and understand the whole of  gets  's  impatient or mad at me I become angry  or  too.  I am a b l e to be s i n c e r e and d i r e c t with  in whatever  _37-  I feel  •  _38.  I  _39-  My l i k i n g or d i s l i k i n g of a n y t h i n g that he/she says about  J»0.  At times I j u s t d o n ' t know, or d o n ' t r e a l i s e u n t i l what my f e e l i n g s a r e w i t h .  friendly  and warm toward  ignore some o f  's  I express  .  feelings. is not a l t e r e d . b y himself/herself. later,  J»l.  I v a l u e our  Jt2.  I appreciate just him/her.  __*3.  I feel q u i t e pleased with he/she d i s a p p o i n t s me at o t h e r  J\k.  I feel  c o m f o r t a b l e to express whatever i s in my mind w i t h , i n c l u d i n g any f e e l i n g s about myself or about him/her.  _45.  I really  J»6.  At times I t h i nk t h a t t h i n g and then i t t u r n s out  J*l.  relationship.  don't  how  's experiences  like  feel  to  sometimes, and then times.  as a p e r s o n .  that  f e e l s s t r o n g l y about he/she d o e s n ' t .  some-  Whether is in good s p i r i t s , or bothered and u p s e t , d o e s n ' t make me to f e e l any more o r any l e s s a p p r e c i a t i o n o f him/her.  _J*8.  I can be q u i t e openly myself  __49.  Somehow  _50.  At the t i m e , I d o n ' t r e a l i s e how touchy o r s e n s i t i v e is about some of the t h i n g s we d i s c u s s .  _51.  Whether 's e x p r e s s i n g " g o o d " thoughts and f e e l i n g s , or " b a d " o n e s , does not a f f e c t the way I f e e l toward him/her.  __52.  There are times when my outward response to q u i t e d i f f e r e n t from the way I f e e l u n d e r n e a t h .  _53.  In f a c t ,  really  I feel  in our  irritates  contempt toward  relationship. me (gets  .  'under my s k i n ' ) .  is  -115-  I 55-  56.  _57-  58.  _59-  60. 61. 62.  _63.  64,  understand  Sometimes  times. that  I d o n ' t sense any f e e l i n g s in r e l a t i o n to _ a r e hard f o r me to f a c e and admit to m y s e l f , I  truly  am i n t e r e s t e d  I o f t e n respond to t a k i n g in what he/she  in _  What I say to of my f u l l thought I feel  . rather  is  automatically,  says or does  deep a f f e c t i o n  feeling  really  him/her.  o f t e n would g i v e a wrong or  without  experiencing  I don't think that anything a l t e r s the way I f e e l toward  at  for  impression  the t i m e . .  When i s hurt or upset I can r e c o g n i s e j u s t he/she f e e l s , w i t h o u t g e t t i n g upset m y s e l f . does  What o t h e r people t h i n k and f e e l about to make me f e e l as I do toward him/her. I f e e l t h e r e are t h i n g s we d o n ' t t a l k about c a u s i n g 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 other  seems to me a more w o r t h w h i l e person  than he/she does at o t h e r  the f o l l o w i n g  information  that  about y o u r s e l f  how  help  are  and the  person.  The Other  You A_e:  years  Sex:  (M o r  y e a r s (known or estimated) (M or  F)  F)  Occupat i o n :  P o s i t i o n in t h i s relationship. Examples:  Mother  Son  Counsel l o r  Client  Personal  Friend  Teacher Actual: (Please f M 1  in)  Personal Pupi1  (or  Friend Student)  -116-  GUID2  People have many d i f f e r e n t  TO GOALS  s p l i t s they might wish to deal v/ith. The  purpose o f t h i s i n t e r v i e w i s t o define c l e a r l y and s p e c i f i c a l l y what you t h i n k treatment could do to help you with your s p l i t i n the near f u t u r e .  T h i s page shows how one person completed h i s guide t o goals. w i l l be f i l l e d i n g e n e r a l l y l i k e t h i s one during t h i s  SPLIT:  Yours  interview.  I AM TORN BETWEEN SPENDING MY FREE TIME (ABOUT 18,;. HOURS PER WEEK) WORKING AT SCHOOL OR WITH MY FAMILY.  MUCH WORSE THAN  LESS THAN AN HOUR OF FREE TIME SPENT  EXPECTED RESULTS:  PRODUCTIVELY WITH WORK AND/OR FAMILY, WITH A GREAT AMOUNT OF FEELINGS OF CONFLICT SPENT ABOUT CHOICE.  SOMEWHAT LESS THAN  ABOUT THREE HOURS 0? FREE TIMS SPENT  EXPECTED RESULTS;  PRODUCTIVELY WITH WORK AND/OR FAMILY, WITH MODERATE TO GREAT FEELINGS OF CONFLICT ABOUT CHOICE.  EXPECTED OR MOST  SIX HOURS/WEEK FREE TIMS SPENT PRO-  LIKELY RESULTS;  DUCTIVELY WITH WORK AND/OR FAMILY WITH MODERATE FEELINGS OF CONFLICT ABT. CHOICE.  SOMEWHAT BETTER THAN  TEN OR MORS HOURS OF FREE. TIMS SPENT PRO-  EXPECTED RESULTS;  DUCTIVELY WITH WORK AND/OR FAMILY, WITH LITTLE FEELINGS OF CONFLICT ABOUT CHOICE.  MUCH BETTER THAN  FOURTEEN OR MORE HOURS OF WORK SPENT PRO-  EXPECTED RESULTS:  DUCTIVELY WITH WORK AND/OR FAMILY, WITH LITTLE OR NO FEELINGS OF CONFLICT ABOUT CHOICE.  ( a s t e r i s k i n d i c a t e s the l e v e l at which t h i s person thinks he i s nov;)  -117-  Now  t h i n k of a p r a c t i c a l , s p e c i f i c way  doing with your s p l i t .  of measuring how  Por example, i f you were concerned  well you are  about an i s s u e  d e a l i n g with time spent on c o n f l i c t i n g tasks, number of hours would be a simple way  t o see how  you were doing.  I f your s p l i t  i n v o l v e d seeing f r i e n d 3 ,  number of contacts with f r i e n d s would be a concrete way  to gauge change.  A good c r i t e r i o n f o r determining the adequacy of your measure i s " i s t h i s measure c l e a r enough so that someone e l s e could be able to t e l l i f I am g e t t i n g b e t t e r at handling my  split".  You can also use an i n d i c a t i o n of your f e e l i n g state to c l a r i f y progress i n d e a l i n g viith your s p l i t .  your  Por example, you might t a l k about  mild to severe f e e l i n g s of anxiety, joy, c o n f l i c t , fear, or love, to ment i o n a few f e e l i n g s t a t e s .  In the example on page one, the person spoke  of " f e e l i n g s of c o n f l i c t " , and then he p r o j e c t e d change of f e e l i n g s f o r b e t t e r or worse.  Now  use the concrete measure of change and the measure of f e e l i n g s  to p r e d i c t how  w e l l you would be doing a f t e r one week once you have i n t e r -  acted with your c o u n s e l l o r .  Of course, you cannot know f o r sure how  you w i l l be doing, but t r y your best to p r e d i c t . how your own  Be r e a l i s t i c  well  about:  hard i t i s f o r you to handle your problems,  abilities  and your determination to handle your problems,and  how  much success you have had before i n d e a l i n g with your problems.  (DO: / 1 1  o  EXPECTED OR MOST LIKELY RESULTS)  -118-  So result  f a r y o u have w r i t t e n  f o r p r o g r e s s on y o u r  down what y o u t h i n k i s t h e most  split  i n a week's t i m e .  s i b l e t o do much b e t t e r t h a n e x p e c t e d . tive  i n what t h e s p e c i f i c  expected. Use  Show s p i c i f i c a l l y  However, i t i s p o s -  T h e r e f o r e , u s i n g t h e same  and b e h a v i o r a l measures y o u u s e d t o p r e d i c t  write  likely  your "expected  results",  r e s u l t s would be i f y o u d i d much b e t t e r how y o u would be d o i n g s o m e t h i n g  affec-  than  different.  numbers i f y o u c a n . i  I f you expected,  f o r example t o be w i t h f r i e n d s  d o i n g much b e t t e r might realistic.  one n i g h t a week,  mean b e i n g w i t h f r i e n d s t h r e e n i g h t s a week. Be  Do n o t s e t g o a l s f o r y o u r s e l f t h a t y o u a r e s u r e y o u c o u l d n o t  reach. (DO: MUCH BETTER THAN EXPECTED RESULTS)  Next, u s e y o u r your and  scale.  The l a s t  same measures t o f i l l  two l e v e l s a r e SOMEWHAT LESS THAN EXPECTED RESULTS  SOMEWHAT BETTER THAN EXPECTED RESULTS.  pected  level  expected  i n t h e two r e m a i n i n g l e v e l s o f  of results,  but a r e a l i t t l e  They a r e c l o s e t o y o u r e x less  or a l i t t l e  level. (DO:  SOMEWHAT LESS THAN EXPECTED RESULTS AND  SOMEWHAT BETTER THAN EXPECTED RESULTS)  better than the  -119-  Finally,  please  make an a s t e r i s k (*)  w e l l y o u a r e d o i n g now,  today.  at t h e l e v e l  T h i s mark w i l l  help  that  shows how  show how y o u s t a r t e d  w i t h y o u r p r o b l e m s and w h e t h e r o r n o t y o u improve i n t h e f u t u r e .  i  Thank y o u  GOAL ATTAINMENT FOLLOWUP GUIDE -120-  NAMS:  EDUCATION LEVEL:  DATE:  AGE:  DESCRIPTION OF SPLIT YOU'-WILL BE WORKING ON:  MUCH VTORS3  THAN  EXPECTED RESULTS:  SOMEWHAT LESS THAN EXPECTED RESULTS:  EXPECTED OR MOST LIKELY RESULTS:  SOMEWHAT BETTER THAN EXPECTED RESULTS:  MUCH BETTER  T1LAN  EXPECTED RESULTS:  (place  FC 76. TOT  a s t e r i s k (*) n e x t  to level  where y o u a r e now)  P -v ?L T I J IP Ali T QU33TI0K1IAIR3  Thank y o u v e r y the  much f o r v o l u n t e e r i n g y o u r  l i s t e n i n g process.  check o f f your  -121-  P l e a s e complete  Goal Attainment  t o Mr. N a e g e l i o r Mr.  this  Eollovi-up  t i m e t o our r e s e a r c h , on  for.'a on t h e same day y o u  G u i d e and r e t u r n t h e two t o g e t h e r  Harper.  NAME: SEX: M 1. Has any s e r i o u s  event,  s u c h as s i c k n e s s i n t h e f a m i l y o r j o b p r o b l e m s ,  2. I f y o u c h e c k e d  " y e s " t o #1,  T J Q  ^173  o c c u r r e d d u r i n g t h e p a s t week?  d i d the incident  a f f e c t your  a t t a i n i n g the  g o a l y o u s e t a week ago i n t h e l i s t e n i n g e x e r c i s e ? YES 3.  Sometimes people, change g o a l s as a r e s u l t  listener.  D i d t h i s ha-onen t o vou?  4. I f y o u c h e c k e d f o r y o u r new  of t a l k i n g with a s k i l l e d  ,„.„„ YES  " y e s t o ,.^3, c i r c l e  NO  the a p p r o p r i a t e Goal Attainment  1"  2  3  4  somewhat expected or l e s s t h a n most l i k e l y expected results results  the l i s t e n i n g process h e l p f u l  6. Would y o u go t o a p s y c h o l o g i s t listening-oriented  manner?  5  somewhat b e t t e r much b e t t e r than expected than expected results results  i n a t t a i n i n g your YES  Comments:  level  goal:  much worse t h a n expected r e s u l t s  -j. Was  NO  or p s y c h i a t r i s t ,^  goal?  NO who  worked m a i n l y  in a  -122-  TO  ALL  THERAPISTS: Please  1.  fill  i n the f o l l o w i n g  demographic  information.  Naine:  2. Age: 3.  Training  4.  Approximate have  i n empathy s k i l l s  (describe):  number o f h o u r s o f c l i e n t - c e n t e r e d - t y p e  treatment you  done:  5.  Approximate  number o f h o u r s o f t h e r a p y i n any o r i e n t a t i o n :  6.  Theoretical  orientation:  7.  How  valid  do y o u see c l i e n t - c e n t e r e d  t r e a t m e n t as a means o f  inducing  change?  1  2  totally ineffective  / i  01  3  4  5 very  effective  POSTFOCUSINC QUESTIONNAIRE Questioris:  -123-  In t h i s q u e s t i o n n a i r e we a r e s e e k i n g your h e l p i n e v a l u a t i n g the i n s t r u c t i o n s which were j u s t read to you. P l e a s e do not omit any q u e s t i o n s . Do not r e p o r t what you were t h i n k i n g about.  1.  I n no more than f o u r (4) s e n t e n c e s (one s h o r t paragraph) p l e a s e d e s c r i b e what happening to you i n the l a s t 10 minutes.  2.  How  3.  What was  the b e s t  4.  What was  t h e w o r s t t h i n g about d o i n g t h i s ?  5.  What s u r p r i s e d you most about a l l t h i s ?  6.  How. was  7.  Many p e o p l e get l o s t n e a r the s t a r t and then t h e r e s t doesn't make sense. t h a t happen to you? Yes No _ _ _ _ _ .  8.  Some p e o p l e use words and f e e l i n g s . you f i n d most i m p o r t a n t ? Words_  9.  d i d the f e e l i n g change a f t e r you got the words or p i c t u r e ?  :FW AUCE 1  t h i n g about d o i n g t h i s ?  t h i n k i n g t h i s way  Your age Sex:  was  Male  d i f f e r e n t from the way  - • Female  you u s u a l l y do i t ?  O t h e r s use p i c t u r e s and f e e l i n g s . Pictures  Neither  Did  Which d i d  -124-  "• .' y' • .. :  " -APPENDIX B SESSION GRAPHS  . ' • . / " V  OF  ;  .•  - ' 'THERAPIST COMMUNICATED EMPATHY AND " DEPTH OF EXPERIENCING  "  THERAPIST  MODE  SUBJECT  PEAK  E X H _ Q . EXP...,., TCE—&-  EXP LEVEL  O-®—O-^©  1  2  3  FOUR-MINUTE  1  2  3  FOUR-MINUTE  4  5  6  7  8  9  10  11  12  13  SEGMENTS  4  5  SEGMENTS  6  7  8  9  10  11  1 2 1 3  THERAPIST  _2_  MODE  EXfL-Q.  SUBJECT  ,JL  PEAK  EXP..^.  TCE LEVEL 5.0.  TCE  EXP LEVEL  6  4.5  4.0. •5 3.5 3.0.  P—«5—0  -4  2.5 2.0. 1.1 1.0. .5 1  ./127  2  3  4  5  FOUR-MINUTE  SEGMENTS  FOUR-MINUTE  SEGMENTS  6  7  8  •0  11  12  13  THERAPIST  JL  MODE  SUBJECT  JL  PEAK  EXR._Q. EXP..... TCE  EXP LEVEL  A-  a-o—o  N  1  2  3  FOUR-MINUTE  FOUR-MINUTE  ./128  4  5  SEGMENTS  SEGMENTS  6  8  10  11  12  13  T H E R A P I S T  JL  S U B J E C T  _7_  TCE  MODE P E A K  L E V E L  9-  5 . 0 J  4.5  4.0  4  3 . 5  3.6  i  ©-i^Ost  V» 4  ft  4  /j>  *f>  2 . 5 1 - 3  / 2 . 0 |  •1.1 1.0 . 5  F O U R - M I N U T E  ./129  E X P . . . . . . . T C E _ _ A  EXP  L E V E L  EX FL_Q  S E G M E N T S  THERAPIST SUBJECT TCE  J5_ 9  MODE  EX H _ Q  PEAK  5.0  0  TC E  EXP LEVEL  LEVEL  EXP... ... A  6  4.5 4.0 3.5  3.0  I"  5  I  4  2.5&3 2.0 1.1 1.0 .5  ii 1  2  3  4  FOUR-MINUTE  THERAPIST SUBJECT  5  6  9  8  10  11  12  13  SEGMENTS  MODE  JL 1P_  PEAK  E X P _ _ Q _ _ EXP...©.-. TCE  T C E / E X P  —• —•  LEVELILEVEL  4.0  O—O  2  1  2  3  FOUR-MINUTE  ./130  4  5  6  SEGMENTS  7  8  9  10  11  12  13  THERAPIST  JL  M  O  D  E  SUBJECT  J_L  P  E  A  K  L  T  C  E  E  V  E  E  E  T  EXP LEVEL  L  X  P _ _ Q  X  P  C  .  .  E  .  _  _  .  .  A  .  _  5.0 16 4.5 4.0 3.5  3.01 2.5  jO  '°! 1.1 1.0 .5  §)*'"{j)"'(2^ n,  2  o  Ess 1  2  3  FOUR-MINUTE  THERAPIST SUBJECT  4  5  10  6  JL 12.  M  P  4.5. 4.0 3.5.  h  -A r ^ - A  0---0  s  2.0. 1.5 1.0 .5 •32  FOUR-MINUTE  ./131  O  D  E  E  A  K  E  E  T  5.0.  2.5  12  13  SEGMENTS  TCE g-EXP LEVEL i L E V E L  3.0  11  5 6 SEGMENTS  /  X  X  C  P  E  P  .  _  .  _  .  ©  Q  .  _  .  _  .  _  T  H  L  E  R  A  P  I  S  U  B  J  E  T  C  E  E  V  E  S  C  T  JL  T  JJi  M  O  D  E  E  P  E  A  K  E  T  EXP LEVEL  L  X  X  C  P  P  _  .  E  _  .  .  _  .  A  Q  .  .  .  -  4.5 4.0 3.5 i-4  3.0  2.5f3 2.0  0  \1  1.0| .5 2  1  3  FOUR-MINUTE  THERAPIST SUBJECT  4  5  6  7  10  M  P  TCE/EXP LEVELiLEVEL  11  O  D  E  E  A  K  E  E  T  12  O-'-O--^  0---®-.~<® 2  3  FOUR-MINUTE  ./132  9  12  13  SEGMENTS  8 14_  1  8  4  5  SEGMENTS  6  C  X  X  P  E  P  .  .  .  _  .  ©  Q  .  .  _  .  _  T  H  E  R  A  P  I  S  S  U  B  J  E  T  C  JL  T  JJL  M  O  D  E  P  E  A  K  E  X  E  T  L  T  C  E  V  E E  L  5 . 0  E  X  P  L  E  V  E  X  R  .  _  P  .  .  C  E  Q  .  *  _  .  A  .  .  _  L  6  4 . 5  m  4 . 0  3 . 5  3.0l  a ••• • R  2 . 5  12  2 . 0  • 1 . 1  1  .  0  O—O  |  1 . 5  1  2  F  T  H  E  R  A  P  I  S  S  U  B  J  E  C  O  U  T  R  -  3  M  I  N  U  4  T  5  E  S  E  G  6  M  E  N  T  7  10  9  E  V  E  L  5  .  0  4  .  5  4  .  0  I  L  E  1 2  1 3  M  O  D  E  P  E  A  K  E  X  P  .  _  Q  _  _  1&  T C E g.EXP L  11  S  JL  T  8  V  E  T  E  C  X  P  .  .  .  ©  .  .  .  E  L  3 . 5 ^ 4  3  .  0  2 . 5  2  .  I  0  1 . 5  1 . 0  . 5  1  F  ./133  2  O  U  R  -  3  M  I  N  U  4  T  E  5  S  E  G  M  6  E  N  T  S  1 0  1 1  1 2  1 3  T  H  L  E  R  A  P  I  S  U  B  J  E  T  C  E  V  S  T  C  E  O  D  E  P  E  A  K  E  X  E  T E  X  L  L  M  JLL  T  fi  E  10.  E  P  X  _  P  C  .  _  .  Q  .  ©  .  .  .  A  E  P V  E  L  5 . 0  6 4  .  5  4  .  0  3  .  5  • 5 |  ]  3.0 2  .  5  2  .  0  o-o-a  J  1.1 2 1.0  1  . 5  1  2  F  T  H  L  E  R  A  P  I  S  T  S  U  B  J  E  C  T  T  C  E  E  V  E  5  .  0  |  4  .  5  4  .  0  «  3  X  L  E  .  0  2  .  5  2  .  0  R  -  M  I  N  U  T  E  S  E  G  M  1  6  E  N  T  0  S  M  O  D  E  P  E  A  K  E X P _ _ 0 _ . E  P  V  T  E  1 3  1 2  1 1  X  C  P  E  .  —  A  —  L  6  J  15  5  3  |  U  5  10  E  L  O  4  3  |  #  M -O  4  - O - O - O'  - Agh  O- 0 :  1.5  1.0l .  5  11 1  F  ./134  2  O  U  R  -  3  M  I  N  U  4  T  E  5  S  E  G  M  6  E  N  T  S  7  8  9  1  0  1 1  1 2  1 3  T  H  E  R  A  P  1  S  T  S  U  B  J  E  C  T  C  E  E  V  E  T  11  M  O  D  E  E  X  19  P  E  A  K  E  X  T  L  L  E  X  P  L  E  V  E  C  P  P  _  .  _  .  —  E  .  .  A  Q  .  .  .  -  L  5 . 0 .  4 . 5  4 . 0 .  3 . 5  3 . 0 .  2 . 5  2 . 0 .  1 . 1  1 . 0 .  . 5  1  2  F  T  H  E  R  A  P  I  S  S  U  B  J  E  C  O  U  R  -  3  M  I  N  U  4  T  5  E  S  E  G  6  M  E  N  T  7  8  9  T  11  1 3  M  O  D  E  E  A  K  E X P _ _ 0 _ _  2Q P  E  T  1  F  ./135  1 2  S  XL  T  1 0  2  O  U  R  -  3  M  I  N  U  4  T  E  5  S  E  G  M  6  E  N  T  S  8  1 0  C  X  P  .  .  .  ©  .  .  .  E  1 1  1 2  1 3  F  ./i'36  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  U  B  J  E  S  13 23  T  C  T  M  O  D  E  P  E  A  K  E  E  T  L  T  C  E  V  E E  L  5.0J  E  X  P  L  E  V  E  X  P_.  X  C  P  E  .  .  _  L  3-6  4.5 5  4.0f 3.5  3.0 2.5^3 2.0 1.1  &2  cT  a  1.0 .5 1 F  2 O  U  R  -  M  1 F  ./137  I  N  U  2 O  U  R  -  4  3  M  T  E  S  3 I  N  U  5 E  G  4 T  E  M  E  N  T  5 S  E  G  E  N  8  9  10  11  S  6 M  7  6  T  7 S  8  9  10  11  T  H  E  R  A  P  I  S  U  B  J  E  S  __L  T  C  M  O  D  E  P  E  A  K  J25.  T  E  X  E  T  L  T  C  E  V  E E  L  5 . 0 .  |  E  X  P  L  E  V  E  P  X  _  P  C  .  E  _  .  Q  .  _  .  .  A  .  .  .  _  L  6  4 . 5  4 . 0 .  3 . 5  3  .  0  13  2 . 5  O—Cf  2 . 0  1 . 1  1 . 0  . 5  1  2  F  T  H  E  R  A  P  I  S  S  U  B  J  E  C  O  U  R  -  3  M  I  N  U  4  T  5  E  S  E  G  8  6  M  E  N  T  9  1 0  15.  T  1 1  M  O  D  E  P  E  A  K  E  X  P  _  _  Q  _  .  2fi  T  E  T  1  F  ./138  1 2  S  2  O  U  R  -  3  M  I  N  U  4  T  E  5  S  E  G  M  6  E  N  T  S  8  9  1 0  X  C  P  E  1 1  .  .  .  .  -  .  .  A  .  -  1 2  T  H  E  R  A  P  I  S  S  U  B  J  E  T  C  JUL  T  '  M  O  D  E  P  E  A  K  E  E  T  L  T  C  E  V  E  E  5  .  E  X  P  L  L  E  V  0  J - 6  4 . 5  .  0  J  •  .  2  2  P  .  X  C  E  _  .  Q  .  .  .  .  .  A  %  /  0  .  .  _  'J3K  \  3 . 5  3  P  L  ®  5 4  E  X  5  3  §  0  •1.1 1.6  2  »  1  . 5  1  2  F  O  F  . I~\ 19  U  O  R  U  3  -  R  M  -  I  M  N  I  U  N  4  T  U  E  T  5  S  E  E  S  G  E  M  G  6  E  M  N  E  T  N  S  T  S  • 0  1 1  1 2  1 3  T  H  L  E  R  A  P  I  S  U  B  J  E  T  C  E  V  T  C  g  E E  S  L  I  XL  T  M  O  D  E  P  E  A  K  E  X  E  X  R  P  .  .  .  -  .  .  Q  -  .  .  2_L  E  X  P  L  E  V  E  L  5.0J.6 4.5 4.0 3.5 3.G 2.5f 3 2.0 fr4  •1.1*2  1.0. .5 1 F  O  F  ./140  2 U  O  R  U  -  R  3  M  -  M  I  N  I  U  N  :  T  U  E  T  S  E  5 E  S  G  E  G  M  M  6  E  N  E  N  T  S  T  S  7  8  9  10  11  12  13  APPENDIX C COMPUTER PROGRAMS FOR COMPARISON OF CORRELATION COEFFICIENTS  -141-  C l a s s One comparison o f the type r =r xy xz.  #L T2 > 1 2 > 3  10  4 5 6 •]• 7 8 •\ 9 10 11 12 :• 13 :•• 14 :• 15 16 :• 17 ;• 18 :• 19 20 22 ;:• 23 ••24 -, 25 • 26 27 > 28 29 30 31 32 33 34 :• 35 36 > 37 > 38 > 39 *END OF F l L F  \  REAL#4 N»Z4»Z3fZ2iZl WRITE(6y10) FORMAT ( ' ' r ' THIS PR0GRAM 1  12 15 20 25  30  40 27  50 60 70  100  ./142  /  TESTS TI-IE F0LL.0UINGHYPOTHES  HO:P<X»Y>=P<X»Z)'/  2 'HO:P<X»Y> *NE» P < X » Z ) V 3 'INPUT DATA FORMAT I S #*•****') WRITE(6 v15) FORMAT(' ' f ' P L E A S E INPUT YOUR R(X ?Y)') READ(5?20).R12 FORMAT(F7.4)' WRITE(6»25) FORMAT <' ','PLEASE INPUT YOUR R < Y , Z ) ' ) READ*5/20) R23 WRITE(6x30) FORMAT<'PLEASE INPUT YOUR R<X»Z>'> R E A D ( 5 ? 2 0 ) R13 WRITE(6y40) FORMAT(' 'y'PLEASE INPUT YOUR N') READ(5y27) N FORMAT(F3•0) Z1 = ( 2 * R 2 3 - R12 * R13 > * < 1 - R12 * R12 - R13 * R13 -- R 2 3 * R 2; Z2=2*R23*R23*R23 Z 3 = (1 -- R13 * R13 ) * (1 - - R13 * R13 ) Z4 = (1 --R12*R 12 ) * < 1 - R12*R 12 ) ^ \ Z5=SQRT(Z4+Z3-Z2-Z1) Z 6 = S Q R T < N ) * < R12 • • R13 ) Z=ZA/Z5 WRI TE ( 6 y 50 ) Z •> Z 1 y Z2 y 73 y Z4 y Z5 y Z6 y N FORMAT(' ' y'Z='y(F9.4)) WRITE<6»60) F0RMAT(' 'y'DO YOU WANT TO C0NTINUE? » 1 = YESt 2=N0') READ(5 y 70) IANS FORMAT(11) I F CLANS ,EQ. 1) GO TO 12 I F ( I A N S .EQ. 2) GO TO 100 GO TO 55 STOP END  -142  C l a s s Two comparison o f the type: r =r wz xy.  Tl IO  V  4 5 6 7  12 15  ND  OI-  20  30  40  f  r  60 65 70 75  100 'ILE  T H E F 0 L L 0 WIN G I-l Y P 0 T I-l E SI  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 ( U r Y ) ' ) 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( ' ' 'PLEASE INPUT YOUR R ( X , 2 ) ' ) READ(6»20)R24 WRITE<A>45) FORMAT(' ' y ' P L E A S E 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 2 3 ) * <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 6 0 ) 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 /  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  REAL*4 N»Z2»ZlrAK WRITE<6r10) FORMAT(' 'y 'THIS PROGRAM  

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