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The differential effects of empathic reflection and empathic reflection plus the gestalt empty-chair… King, Sharron G. 1988

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THE  DIFFERENTIAL EFFECTS OF EMPATHIC  REFLECTION AND EMPATHIC REFLECTION PLUS THE  GESTALT EMPTY-CHAIR DIALOGUE  ON THE ISSUE OF UNFINISHED BUSINESS  By SHARRON G. KING  Diploma  B.A., L a k e h e a d U n i v e r s i t y , 1967 i n E d u c a t i o n of t h e M e n t a l l y Retarded,  U.B.C.,  1977  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE  REQUIREMENTS  FOR THE DEGREE OF  MASTER  OF ARTS in  THE THE  FACULTY OF GRADUATE STUDIES  DEPARTMENT  We a c c e p t to  THE  OF COUNSELLING PSYCHOLOGY  this  T h e s i s as  the required  conforming  standard  UNIVERSITY OF BRITISH April 0  Sharron  COLUMBIA  1988  G. K i n g ,  1988  5S  In  presenting this  degree at the  thesis  in  University of  partial  fulfilment  of  of  department  this thesis for or  by  his  or  scholarly purposes may be her  representatives.  permission.  C o u n s e l l i n g Psychology  The University of British Columbia Vancouver, Canada  Date  DE-6 (2/88)  A p r i l 29,  1988.  for  an advanced  Library shall make  it  agree that permission for extensive  It  publication of this thesis for financial gain shall not  Department of  requirements  British Columbia, I agree that the  freely available for reference and study. I further copying  the  is  granted  by the  understood  that  head of copying  my or  be allowed without my written  ABSTRACT  The client  purpose  of t h i s  study  empty-chair population enrolled  and  first  two  the  Inventory,  amount  the  and  the  significant  were not  amount  other.  Target  and  evaluate  regarding  the  empathy  plus  condition.  Two  of the B a r r e t t -  to assess and  to  were u s e d t o a s s e s s  the  in their  presenting feelings  Complaint  current  amount  the p r e s e n t i n g complaint  subject's perception  the  the  Target  the  the  process.  s e s s i o n measures, the the  of  M e a s u r e and  o f change i n t h e i r Two  subjects  Task Dimension  Complaint  felt  S c a l e , were u s e d t o a s s e s s  discomfort  the  The  engaged i n t h e  Questionnaire,  Evaluation Questionnaire Box  students  t h e r a p i s t ' s behaviour  of r e s o l u t i o n s u b j e c t s  complaint  and  Scale  were a d m i n i s t e r e d  of t h e i r  outcome m e a s u r e s , t h e  A f f e c t i v e Reactions  The  the  reflection  Empathy  Lennard R e l a t i o n s h i p Inventory  f o r s u b j e c t s who  the  Gestalt  reflection.  in either  Empathic  instruments,  subject's perception  the  specific  of a M a s t e r ' s D e g r e e p r o g r a m i n  counselling sessions  Working A l l i a n c e  comparing  at a major u n i v e r s i t y .  c o n d i t i o n or t h e  relationship  by  the  s u b j e c t s drawn f r o m  year  Psychology  explore  empathy p l u s  empathic  c o n s i s t e d o f 28  i n the  received Gestalt  e f f e c t i v e n e s s of technique  Counselling  Two  to  i s s u e of u n f i n i s h e d b u s i n e s s  differential  screen  was  of the  and  sessions.  toward  Session Discomfort of to  The chair  study  showed t h a t  dialogue  subjects'  produced s i g n i f i c a n t l y  f e e l i n g s toward a  m e a s u r e d by issue  the  reflection.  The  improvement  Gestalt  in  s i g n i f i c a n t other person  as  business  in i n i t i a l  than  on  t h a n t h o s e p r o d u c e d by  target  M e a s u r e was  condition  empty-  more t o l e r a n c e  results further  Complaint  Gestalt  the  A f f e c t i v e Reactions Questionnaire  of u n f i n i s h e d  Target  empathy p l u s  suggest  complaint felt  f o r the  that as  f o r the  empathic  a  the  an empathic  greater  m e a s u r e d by empathy  the  plus  reflection  condition.  T.he  review  unfinished results  business  that  literature  i s an  from t h i s study  investigation upheld  of the  to  in a clinical  the  empathic treatment  Gestalt  empty-chair  the  issue  one  the  i f the  setting.  r e l a t i o n s h i p may of  important  suggest  determine  suggests that  The  and  the  need f o r  dialogue  i n the  of  tentative  results  are  results  suggest  context  of  make a c o n t r i b u t i o n  of u n f i n i s h e d  issue  further  preliminary tentative  the  business.  to  the  an  iv  TABLE OF  CONTENTS Page  ABSTRACT  i i  TABLE OF CONTENTS  iv  L I S T OF APPENDICES  vi  L I S T OF TABLES  v i i  L I S T OF FIGURES  ix  ACKNOWLEDGEMENTS  x  CHAPTER I  INTRODUCTION  .  Background of t h e Study Purpose o f t h i s Study D e f i n i t i o n o f Terms Statement of Problem and Hypotheses II  REVIEW OF LITERATURE Unfinished Business i n Psychotherapy R e s e a r c h on t h e Use o f G e s t a l t T e c h n i q u e s ... G e s t a l t A p p r o a c h on t h e I s s u e o f U n f i n i s h e d Business R e s e a r c h o f t h e Use o f E m p a t h i c R e f l e c t i o n .. P s y c h o t h e r a p y R e s e a r c h R e l a t i n g t o Outcome ..  III  METHODOLOGY P a r t i c i p a n t s i n t h e Study Measuring Instruments Overview Subject D e s c r i p t i o n R e l a t i o n s h i p Instruments \ Outcome M e a s u r e s S e s s i o n Measures D e s c r i p t i o n of Treatments Procedure D e s i g n and A n a l y s i s  1 2 5 6 10 14 14 20 23 31 35 49 49 53 53 54 55 58 60 62 66 69  V  IV  RESULTS Subject D e s c r i p t i o n Instruments R e l a t i o n s h i p Instruments Outcome M e a s u r e s S e s s i o n Measures  V  DISCUSSION I n t e r p r e t a t i o n of Findings L i m i t a t i o n s o f t h e Study I m p l i c a t i o n s and F u t u r e R e s e a r c h Directions Conclusion  REFERENCES  '71 72 73 75 84  96 97 107 110 112 113  vi  L I S T OF APPENDICES  Pacre A.  Consent  Form  120  B.  Client  C.  A b b r e v i a t e d 16-PF I n t e r e s t  D.  Barrett-Lennard Relationship  Information  Form  121 Questionnaire  122  Inventory  Empathy S c a l e  127  E.  Working A l l i a n c e Inventory  F.  T a r g e t Complaint Measure  132  G.  Affective  134  H.  Session  I.  Questionnaire  A  138  J.  Questionnaire  B  139  K.  Questionnaire  C  141  L.  Therapist Questionnaire  Reactions  -  Task Dimension  Questionnaire  Evaluation Questionnaire  . . . .  129  136  143  vii L I S T OF TABLES  1 2 3  4 5 6 7 8 9 10 11 12 13 14 15  Means a n d S t a n d a r d D e v i a t i o n s o f Barrett-Lennard R e l a t i o n s h i p Inventory  74  Means a n d S t a n d a r d D e v i a t i o n s o f Working A l l i a n c e Inventory  74  A n a l y s i s of V a r i a n c e w i t h Repeated Measures of T a r g e t C o m p l a i n t M e a s u r e S c o r e s  76  Means a n d S t a n d a r d D e v i a t i o n s o f T a r g e t Complaint Measure Scores  76  Item A n a l y s i s f o r A f f e c t i v e Questionnaire  80  Reactions  Subtest I n t e r c o r r e l a t i o n s f o r A f f e c t i v e R e a c t i o n s Q u e s t i o n n a i r e ( P r e - and Post-)  80  Subtest I n t e r c o r r e l a t i o n s f o r A f f e c t i v e R e a c t i o n s Q u e s t i o n n a i r e (Follow-up)  81  M u l t i v a r i a t e A n a l y s i s of Variance f o r A f f e c t i v e Reactions Questionnaire  81  U n i v a r i a t e R e s u l t s : Therapy I n t e r a c t i n g with A f f e c t i v e Reactions Questionnaire  Time 82  Means - C o n f i d e n t D i m e n s i o n A f f e c t i v e Reactions Questionnaire  82  Means - I n t o l e r a n t D i m e n s i o n A f f e c t i v e Reactions Questionnaire  83  Means - D i s c o u r a g e d A f f e c t i v e Reactions  83  Dimension Questionnaire  A n a l y s i s o f V a r i a n c e w i t h Repeated Measures of T a r g e t C o m p l a i n t D i s c o m f o r t Box S c a l e  85  Means a n d S t a n d a r d D e v i a t i o n s o f T a r g e t C o m p l a i n t D i s c o m f o r t Box S c a l e  85  Item A n a l y s i s o f S e s s i o n E v a l u a t i o n Q u e s t i o n n a i r e - S u b j e c t Data  89  Subtest I n t e r c o r r e l a t i o n s - Session E v a l u a t i o n Q u e s t i o n n a i r e - S u b j e c t Data  89  M u l t i v a r i a t e A n a l y s i s of Variance f o r Session Evaluation Questionnaire - Subject Data  90  U n i v a r i a t e R e s u l t s : Therapy Main Session Evaluation Questionnaire  90  Effect - Subjects  ...  Means - Smoothness D i m e n s i o n - S e s s i o n E v a l u a t i o n Q u e s t i o n n a i r e - S u b j e c t Data  91  Means - Depth Questionnaire  91  Dimension - S e s s i o n E v a l u a t i o n - Subject Data  Means - P o s i t i v i t y D i m e n s i o n - S e s s i o n E v a l u a t i o n Q u e s t i o n n a i r e - S u b j e c t Data  92  Means - A r o u s a l D i m e n s i o n - S e s s i o n Q u e s t i o n n a i r e - Subject Data  92  Evaluation  Item A n a l y s i s f o r S e s s i o n E v a l u a t i o n Q u e s t i o n n a i r e - T h e r a p i s t Data Subtest I n t e r c o r r e l a t i o n s f o r Session Q u e s t i o n n a i r e - T h e r a p i s t Data  93 Evaluation 93  M u l t i v a r i a t e A n a l y s i s of Variance f o r Sesssion Evaluation Questionnaire - Therapists  94  U n i v a r i a t e R e s u l t s : Therapy Main E f f e c t Evaluation Questionnaire - Therapists  94  Means - Smoothness D i m e n s i o n - S e s s i o n Q u e s t i o n n a i r e - T h e r a p i s t Data  - Session Evaluation 95  ix  L I S T OF FIGURES  Page  1  2  P r e l i m i n a r y E m p i r i c a l Model Incomplete Experience Order of A d m i n i s t r a t i o n Instruments  of F i n i s h i n g 29  of Measuring 67  ACKNOWLEDGEMENTS  I would l i k e Committee, Dr. Woolsey  o f my  I wish Greenberg  support  C o n r y and  guidance.  committee c h a i r ,  t o my  Advisory  Dr.  I would l i k e  f o r her a d v i c e  I am  Lorett  grateful  i n a s s i s t i n g with  and  t o Dr.  the  to  Conry  statistical  data.  t o e x p r e s s my  sincere  thanks  t o Dr.  Les  f o r h i s c o n t i n u e d encouragement, u n d e r s t a n d i n g  patience.  His  To my grateful  and  in this project.  his t i r e l e s s  analysis  support  Kahn, my  consultation  appreciation  S h a r o n Kahn, Dr. R o b e r t  for their  t h a n k Dr.  for  t o e x p r e s s my  ongoing  children,  for their  d u r i n g t h i s major  support  Kimberley  was  invaluable to  and A l l i s o n ,  continued support undertaking.  and  I am  me.  deeply  understanding  an  1 Chapter 1  INTRODUCTION  The  issue  expression fully and  express  and e x p e r i e n c e  painful feelings.  person  functioning,  of t h e s e  this  i n t e r f e r e with  i s considered  by a l l o w i n g  the f u l l  Many and  forms  negative  of therapy  of a c c e p t i n g  & Greenberg,  Safran,  1987; 1979;  expression  the c l i e n t  suppressed  1985;  Latner,  i s released to  1970;  of e m o t i o n s and emotions. Daldrup,  Greenberg &  & P e r l s , 1970; 1951; and P o l s t e r  on t h e t h e o r e t i c a l as an  i s a paucity  the s p e c i f i c  these  1987).  therapies  (Cohn, 1970;  Levitsky  of u n f i n i s h e d business  investigating  experiencing  or unexpressed  Enright,  1973;  issue, there  business.  (Greenberg & Safran,  P e r l s , H e f f e r l i n e & Goodman,  significance  and  other  current  encourage t h e p r o c e s s  & P o l s t e r , 1973) have w r i t t e n  therapeutic  the c l i e n t ' s  a number o f a u t h o r s  Beutler  Perls,  to a significant  the f e e l i n g s associated with  However, a l t h o u g h  e m o t i o n s and  including client-centered  previously  emotions  o f t h e s i t u a t i o n a n d l e t go o f  feelings  experiential therapies  expressing  struggle to  t o be u n f i n i s h e d  interrupted f e e l i n g s that  associated  as c l i e n t s  When t h e s e b l o c k e d  d e v e l o p a more b a l a n c e d v i e w the  emotional  a v a r i e t y of b l o c k e d  feelings are i n r e l a t i o n  and when t h e y  i s only  interrupted  i s a common one i n t h e r a p y  unexpressed  It  of completing  issue  important  of r e s e a r c h  of u n f i n i s h e d business  and  2 the It  t e c h n i q u e s w h i c h may i s the  client  intent  issue  of  effectiveness therapeutic Gestalt  at  helpful  of t h i s study unfinished the  end  approaches,  empty-chair  emotional  be  to  investigate  b u s i n e s s by  of t r e a t m e n t empathic  dialogue,  research  m e a s u r i n g "change i n t h e individual,  at b o t h  which c l i n i c i a n s  as  mature"  (Rogers,  well  e x p l i c a t e d by the  improvement  Rogers therapist empathy  of two  specific the  different and  i n r e s o l v i n g the  empathy  plus  incomplete  has  been c o n c e r n e d  personality  surface  and  structure  deeper  as  p.95).  Rogers  in client  the  for effective regarded  Both c l i e n t - c e n t e r e d  (1957), and  less  Gestalt  therapy  as  therapy, have  t h e i r approaches which  lead  functioning.  (1957) f e l t  that  c e r t a i n core conditions  genuineness, unconditional to the  of  integration,  change " t o w a r d s b e h a v i o r s  1957,  with  levels in a direction  more e n e r g y u t i l i z a b l e  components w i t h i n  offered  Study  w o u l d a g r e e means g r e a t e r  conflict,  living"  studied  the  experiences.  Psychotherapy  as  resolution.  comparing  reflection  Background of the  internal  in achieving  client  i n the  p o s i t i v e regard, context  therapeutic  r e l a t i o n s h i p were n e c e s s a r y  therapeutic  change t o  occur.  of  and  of  and  a  sufficient  Many r e s e a r c h e r s  (Gurman,  for  to  3 1977j L a m b e r t , Krauft,  1977;  Mitchell,  S h a p i r o & B e r g i n , 1986; Orlinsky  1971)  facilitate necessary  agree  client  & Howard, 1978, that  change and  researchers  are w i l l i n g  sufficiency  ( C a r k h u f f , 1969;  1967;  techniques necessary 1972;  and  that  or t e c h n i c a l addition  Greenberg,  and  Truax  i s important  to develop,  however  Rogers'  & • &  to  few  c l a i m of  P a t t e r s o n , 1984;  & Wargo, 1 9 6 6 ) .  Truax  &  Therapeutic  c o n s i d e r a t i o n s are considered a  t o a good r e l a t i o n s h i p  1983;  Bozarth  these c o n d i t i o n s are  to support  Truax  1986;  a relationship  f o r the r e l a t i o n s h i p  Carkhuff,  Mitchell,  Greenberg  (Bergin &  & Kahn, 1979;  and  Strupp, Strupp,  1978) .  Gestalt facilitate  therapy  client  i s one  change by  the necessary  relationship  (1957),  and  and  Truax  Carkhuff  Wargo  (1969).  approach adding  that  Gestalt  Truax  therapy  s t a t e d by  and  main t e c h n i q u e  which  i s designed  of the G e s t a l t  i s an  experiment  relationship  and  One two-chair  a good w o r k i n g  experiment  alliance  u s e d by  of  w h i c h was  intrapsychic  developed conflicts  (1967),  awareness.  i s the  experiment  contact. trusting  (Greenberg,  Gestalt  to  experiential  must t a k e p l a c e w i t h i n a  of the t e c h n i q u e s  client-presented  approach  t o p r o m o t e a w a r e n e s s and  However, t h e  to  Rogers  Carkhuff  t h e r a p y whose m a j o r g o a l i s t h e r e s t o r a t i o n The  used  therapeutic techniques  c o n d i t i o n s as  (1966),  can be  1983) .  therapists  i s the  t o work w i t h or s p l i t s .  In a  4  number o f s t u d i e s  (Bohart,  1977;  1984;  Greenberg & Dompierre,  1980;  Greenberg & R i c e ,  Gestalt  two-chair  significantly  1981;  a variety  client-presented emerge as  significant di stant  of other  approaches  of t h i s  technique  1982)  studied  including  as  i s the  other person  i n the  empty-  a means o f d e a l i n g w i t h These  i s s u e s of u n f i n i s h e d b u s i n e s s client's  conflicts  with  present  a  life  or  past.  of unexpressed  person.  To  i n an  b e e n c o n c e p t u a l i z e d as  emotion  in relation  importance  i t i s important  emotion p l a y s effects  has  evaluate the  experiences  emotional  life  adaptive  and  and  emotional  role  t h e r e f o r e as that  an  ally  i n the  and  another incomplete  role  that  "the  and  of e m o t i o n i n potentially  change  process.  " p s y c h o l o g i c a l problems are  that  the  Greenberg  of b l o c k i n g or a v o i d i n g p o t e n t i a l l y experience"  the  to explore  c o n c e p t u a l i z e d e m o t i o n as  f u r t h e r suggest result  and  expression.  (1987) have i n v e s t i g a t e d t h e  to  of r e s o l v i n g  to determine the  individual's  of i n h i b i t i n g  psychotherapy  the  Greenberg & Webster,  interpersonal conflicts.  blocking  They  Higgins,  shown t o p r o d u c e  evolved  Unfinished business  Safran  1979,  reflection.  d i a l o g u e w h i c h has  often  and  Greenberg &  g r e a t e r changes i n the v a r i a b l e b e i n g  A f u r t h e r refinement chair  1981;  d i a l o g u e was  when compared w i t h empathic  Greenberg & C l a r k e ,  often  adaptive  complete p r o c e s s i n g of a  specific of the  emotional  emotional  experience"  adaptive response it  experience  leads to a s h i f t (p.7)  t o emerge.  Gestalt  i s the b l o c k i n g of emotions,  awareness, t h a t  thus  allowing a  therapy  new  and u n f i n i s h e d  Therapy  situations  i n which they p r e v i o u s l y experienced the  or e x c i t e m e n t "  (Greenberg  are c a l l e d  people  experiencing similar  from  fully  enter  the  & S a f r a n , 1987,  These e x p e r i e n c e s  that  enter  business.  emotions  "help the person  nature  maintains  o f t e n b e f o r e they  leads to underlying c o n f l i c t must  i n the  unwanted p.52).  u n f i n i s h e d b u s i n e s s and situations  prevent  i n the  present.  Purpose of t h i s  The client  issue  clearly was  purpose  of t h i s  of u n f i n i s h e d b u s i n e s s through  chosen  as  one  treatment  second  technique  treatment  i s not  testing  therapy versus  Empathic  to f a c i l i t a t e  of a g o o d w o r k i n g and  core  client  of  as  active  relationship  therapist.  t h e r a p y but  change.  chosen  employs an  the g e n e r a l e f f e c t i v e n e s s  client-centered  of  reflection  d i a l o g u e was  intervention  a l l i a n c e between c l i e n t  specific  t h e use  i t represents the  empty-chair  as t h i s  i n the context  therapeutic study  as  considered necessary  Empathy p l u s t h e G e s t a l t the  to explore the  defined therapeutic procedures.  conditions  0  s t u d y was  study  and  This Gestalt  rather i t is  6  investigating  the u s e f u l l n e s s  deriving  these approaches  from  of p a r t i c u l a r on a s p e c i f i c  Definition  Empathic  reflection  which a t h e r a p i s t feeling  and  d e s c r i b e d by extent  Mitchell,  measuring  Krauft  (1977) as  has t h e a b i l i t y t o communicate h i s u n d e r s t a n d i n g of h i s c l i e n t ' s f e e l i n g s and t h i n k i n g , and has t h e a b i l i t y attuned to that  t o use language of the c l i e n t .  the t h e r a p i s t  senses  i f t h e y were h i s / h e r own  i s that  objectivity  the  the  (p.483)  client's  while at the  same  which a l l o w s the c l i e n t  feelings.  the c l i e n t  understanding  A  further  f o r change t o  understanding.  to  essential  must p e r c e i v e t h e  therapist's  occur.  (1969) d e v i s e d a f i v e - p o i n t  empathic  client  been  2.  experience these  Carkhuff  and  empathy has  i s s e n s i t i v e to the c u r r e n t f e e l i n g s and t h o u g h t s of t h e h e l p e e ( b o t h i n and out o f awareness),  t i m e m a i n t a i n i n g an  ingredient  Bozarth  of what t h e  therapist  In b e i n g e m p a t h i c 'as  Accurate  through  1.  3.  empathic  o f Terms  understanding  experiencing.  I  fully  issue.  i s a therapeutic technique  expresses  to which the  feelings  client  Reflection  Empathic  is  interventions  scale for  L e v e l 1 and  Level 2  are  7 considered detrimental i n that the c l i e n t ' s  statement.  in  level  that  level  this  subtract  noticeably  L e v e l 3 i s c o n s i d e r e d t o be  allows the c l i e n t  L e v e l 4 and 5 a r e c o n s i d e r e d a d d i t i v e  help the c l i e n t ' s affect  self-exploration  and m e a n i n g .  Carkhuff  from  neutral  t o m a i n t a i n t h e same  o f u n d e r s t a n d i n g b u t does not deepen a f f e c t  meaning.  as  they  at deeper  or  i n that  levels  (1969) d e s c r i b e d t h e s e  they  of levels  follows:  In  Level  3:  The e x p r e s s i o n o f t h e h e l p e r i n response t o the e x p r e s s i o n s of the helpee(s) are e s s e n t i a l l y i n t e r changeable with those of the helpee i n that they express e s e n t i a l l y t h e same a f f e c t and meaning.  Level  4:  The r e s p o n s e s o f t h e h e l p e r add n o t i c e a b l y t o t h e e x p r e s s i o n s of t h e h e l p e e (s) i n such a way as t o express f e e l i n g s at a l e v e l deeper t h a n t h e h e l p e e was a b l e t o e x p r e s s himself.  Level  5:  The h e l p e r ' s r e s p o n s e s add s i g n i f i c a n t l y t o t h e f e e l i n g and m e a n i n g of t h e e x p r e s s i o n s of t h e h e p l e e ( s ) i n s u c h a way as t o a c c u r a t e l y e x p r e s s f e e l i n g l e v e l s b e l o w what t h e h e l p e e h i m s e l f was a b l e t o express o r , i n t h e event of ongoing, deep s e l f - e x p l o r a t i o n on t h e h e l p e e ' s p a r t , t o be f u l l y w i t h him i n h i s d e e p e s t moments. (p. 174-5)  this  study  t h e r a p i s t s were  w i t h a L e v e l 3, 4 or 5 e m p a t h i c p r e s e n t e d an i s s u e  instructed  to  r e f l e c t i o n when  of u n f i n i s h e d b u s i n e s s .  respond clients  8 Gestalt  Empty-Chair  The  Gestalt  requiring  empty-chair  the c l i e n t  significant  other person.  The c l i e n t  i s imagined  to v i s u a l i z e t h i s person therapist  will  t h e n a c t as a g u i d e  position  chair,  and w i l l  was a s k e d  will  The c l i e n t  t h e " I am a n g r y  is  from  primarily  as a s t i m u l u s .  made from  the s e l f  alternates  The  position  empty-chair  and r e s p o n d  There  he/she  The m a j o r i t y o f t h e work  serving  t o the statements  i s some movement as t h e  b u t t h i s work i s p r i m a r i l y  i n the s e l f  technique  t h e work d e s c r i b e d by G r e e n b e r g therapists  part  ..."  As t h e work p r o g r e s s e s t h e c l i e n t  chair.  on t h e c l i e n t  t a k e on,  i n which  w i t h t h e empty c h a i r  move t o t h e empty c h a i r  focused  will  ..." o r " I am h u r t  s p e a k t o t h e empty c h a i r  chair  The  i n a d i a l o g u e between t h e  the dialogue p a r t i c u l a r l y i n the early  client  a s s i s t the c l i e n t  t o v i s u a l i z e the s i g n i f i c a n t other.  the s e l f  s a y " I am  f o r n o t h e l p i n g me  of  will  may  i n an  of t h i s  as b e i n g i n t h e empty c h a i r .  and t h e s i g n i f i c a n t o t h e r .  the s e l f  to a  on t h e r o l e  a client  the therapist  feelings  t o be p r e s e n t  sometimes t a k e s  (a s i g n i f i c a n t o t h e r )  enough" a t w h i c h p o i n t  from  interrupted  During the session  at  client  dialogue i s a technique  t o express  o t h e r p e r s o n who  empty c h a i r .  angry  Dialogue  chair.  i s somewhat  different  from  (1979) i n t r a i n i n g  i n t h e use of t h e two-chair t e c h n i q u e i n that  t w o - c h a i r work i n v o l v e s  an a c t i v e  and a l t e r n a t i n g  dialogue  between two  parts  of the  client  i n an  intrapersonal  conf1ict.  Unfinished  Business  G r e e n b e r g and  Safran  (1987) have i d e n t i f i e d  collection  of markers which taken t o g e t h e r  indication  of u n f i n i s h e d b u s i n e s s  completed.  T h e s e components  a  c o n s t i t u t e an  w h i c h needs t o  be  are:  1.  C l i e n t s e x h i b i t a 'hanging onto' r e a c t i o n , a h o l d i n g on t o o l d r e s e n t m e n t s , h u r t s , f r u s t r a t i o n s , g u i l t , g r i e f , or even u n e x p r e s s e d f e e l i n g s o f l o v e and appreciation.  2.  This often results in a s e l f - p i t y i n g a t t i t u d e , or a b l a m i n g or complaining a t t i t u d e , or a f e e l i n g of h u r t , r e s i g n a t i o n and hopelessness.  3.  The e x p r e s s i o n o f t h i s l i n g e r i n g u n r e s o l v e d f e e l i n g i s r e l a t e d to a s i g n i f i c a n t other.  4.  The e x p e r i e n c e and e x p r e s s i o n currently being i n h i b i t e d .  5.  The e x p e r i e n c e o f t h e f e e l i n g and i t s i n t e r r u p t i o n i s problematic f o r the c l i e n t as i n d i c a t e d by d i r e c t v e r b a l s t a t e m e n t s s u c h as " I f o n l y " s t a t e m e n t s or s e l f - s t a t e m e n t s s u c h as " I f o n l y I had b e e n a n i c e r , b e t t e r m o t h e r , s p o u s e , and so f o r t h . " Non-verbal s i g n s of b o d i l y t e n s i o n may be p r e s e n t .  is  (Greenberg & Safran,  1987)  10 Statement  The  importance  of a p o s i t i v e been  of t h e r a p y  relationship  Carkhuff,  Horvath  1969;  & Greenberg,  Truax & C a r k h u f f , Howard, 1978, Inventory  1967;  1986).  (1964) was  perception  Inventory  ( B a r r e t t - L e n n a r d , 1962,  perception  Horvath  designed  The  t o measure t h e  empathy to the  therapists'  (1982) d e s i g n e d  g o a l and  Alliance  perceptions the task  bond.  Inventory  The  was  of t h e i r  scale  and  1977;  Orlinsky &  client's  of the R e l a t i o n s h i p their  empathy.  the Working A l l i a n c e along three  t a s k dimension  ability  Inventory  dimensions:  of the  administered to assess  therapists'  empathy  Working  the s u b j e c t s '  to stay focused  on  presented.  Inventory  to determine in  1977;  & Krauft,  subjects to assess  Both the R e l a t i o n s h i p I n v e n t o r y Alliance  1982,  Gurman,  warmth, c o n g r u e n c e ,  t o measure t h e w o r k i n g a l l i a n c e task,  Bozarth  T r u a x & Wargo, 1966;  administered  of t h e i r  1982;  has  Barrett-Lennard's Relationship  regard.  was  1981,  Mitchell,  of t h e t h e r a p i s t ' s  positive  atmosphere  a good w o r k i n g a l l i a n c e  Greenberg, 1986;  Hypotheses  o c c u r r i n g i n the  and  e x t e n s i v e l y documented  1986;  and  o f P r o b l e m and  and  the  Working  a r e d e s c r i p t i v e m e a s u r e s w h i c h were  i f t h e t h e r a p e u t i c i n t e r v e n t i o n s were  the context  o f an  empathic  relationship  and  an  used  conducted  11 environment t o be  i n which the  1  In c h o o s i n g  an  issue  subjects focused  designed target  the Target  complaints  as  o n l y one  complaints subjects  rated  began t h e  complaint  again at follow-up.  as  on t h i s  u s e d w i t h an in  issue  significantly  target  complaint  f o l l o w - u p by produced  Hypothesis  by  Battle  et a l  the c l i e n t s .  In  Battle  complaint 1  three  et a l .  The and  states:  empty-chair  d i a l o g u e , when  as m e a s u r e d a f t e r Complaint  of Empathic  result  on t h e p r e s e n t i n g  treatment  and  Measure, than  at that  Reflection.  2  C l i e n t - c e n t e r e d t h e r a p i e s encourage c l i e n t s aware o f t h e i r own  on  to  at t e r m i n a t i o n  g r e a t e r improvement  t h e use  in  this  of u n f i n i s h e d b u s i n e s s , w i l l  the Target  on  (1966)  s u b j e c t s were a s k e d  by  Hypothesis  Empathy p l u s t h e G e s t a l t  of importance  opposed t o t h e  suggested  changes  t o work  M e a s u r e t o measure c h a n g e s  i d e n t i f i e d by  originally  issue  other person.  Complaint  study b e f o r e treatment identify  of u n f i n i s h e d b u s i n e s s  on a s p e c i f i c  regard to a s i g n i f i c a n t  their  therapists  engaged i n t a s k - r e l e v a n t a c t i v i t i e s .  Hypothesis  the  subjects perceived their  f e e l i n g s both  inner world  s i t u a t i o n s they  and  as t h e s e  as t h e y  contact i n t h e i r  feelings  relate life.  t o be  relate  to persons In t h i s  more to  and  study  12 clients  were a s k e d  business  relating  important over  t o d i s c u s s an i s s u e o f u n f i n i s h e d to a significant  other person.  t h e r e f o r e t o measure how t h e s e  treatment.  significant  feelings  The A f f e c t i v e R e a c t i o n s  (1984) was d e s i g n e d  to capture  other person  other person.  Hypothesis  Empathy p l u s t h e G e s t a l t with  Intolerant treatment  lower  Empathic  Hypothesis  states:  d i a l o g u e when  used  produce dimension  means on t h e S u p e r i o r , dimensions  as m e a s u r e d  a n d a t f o l l o w - u p by t h e A f f e c t i v e those produced  after  Reactions  by t h e u s e o f  Reflection.  3.  Target  Complaint  M e a s u r e was u s e d  changes i n t h e p r e s e n t i n g c o m p l a i n t . t o measure s m a l l e r u n i t s treatment.  The T a r g e t  administered to assess  2  empty-chair  and D i s c o u r a g e d  Q u e s t i o n n a i r e than  The  towards a  h i g h e r means on t h e C o n f i d e n t  significantly  towards a  study t o  an i s s u e o f u n f i n i s h e d b u s i n e s s , w i l l  significantly and  feelings  i n this  measure c h a n g e i n t h e s u b j e c t ' s f e e l i n g s significant  change  Questionnaire  a person's  a n d was u s e d  Iti s  I t was a l s o  o f change over  Complaint  t o measure  Discomfort  of discomfort  regarding the presenting complaint.  important  t h e course of Box S c a l e was  t o t h e s u b j e c t s b e f o r e and a f t e r  t h e amount  global  currently  each s e s s i o n being  Hypothesis  felt  3 states:  13 Empathy p l u s t h e G e s t a l t e m p t y - c h a i r with  an i s s u e o f u n f i n i s h e d b u s i n e s s ,  significantly session Box  d i a l o g u e when  less  discomfort  before  as m e a s u r e d by t h e T a r g e t  Scale than  will  used  produce  and a f t e r  Complaint  each  Discomfort  t h a t p r o d u c e d by t h e u s e o f E m p a t h i c  Reflection.  Hypothesis  4  Stiles  and h i s c o l l e a g u e s  1984a, 1984b; a n d S t i l e s , d i s c u s s e d t h e importance of  the session.  designed  this  subject's perspective. participants feelings  immediately  impact  from both  impact was  t h e t h e r a p i s t ' s and  T h i s measure was a d m i n i s t e r e d i n an a t t e m p t  on c o n c l u d i n g t h e s e s s i o n .  to the  to capture the  i n t h e s e s s i o n and t h e i r  feelings  Hypothesis  4  states:  d i a l o g u e when  an i s s u e o f u n f i n i s h e d b u s i n e s s ,  significantly  1982) have  Evaluation Questionnaire  Empathy p l u s t h e G e s t a l t e m p t y - c h a i r with  & Snow,  of a s s e s s i n g t h e immediate  i n t h e study  aroused  1980; S t i l e s  Tupler & Carpenter,  The S e s s i o n  t o assess  (Stiles,  will  produce  h i g h e r means f o r t h e P o s i t i v i t y ,  dimensions and s i g n i f i c a n t l y  Arousal  for  t h e Smoothness d i m e n s i o n  the  end o f t h e s e s s i o n s as m e a s u r e d by t h e S e s s i o n  use  of Empathic  than  Reflection.  lower  Depth  and  Evaluation Questionnaire  means  f o r the subjects at  those  used  p r o d u c e d by t h e  Chapter  11  LITERATURE REVIEW  A review focus  on  five  of the  literature pertinent  areas:  psychotherapy;  discussion  research  use  of G e s t a l t  research  Gestalt  treatment  the  of u n f i n i s h e d b u s i n e s s ;  research  empathic  reflection  research  relating  the  i n psychotherapy;  to  theory  inhibiting our  with  business  our  the  not  these  only  full  us.  to avoid  e m o t i o n s and  At  to the the  techniques  approach i n the  in  with  use  of  psychotherapy  but  i s from G e s t a l t i s common and  therapeutic  situations.  core  our  one  the  that  experience  emotions  actions of the  towards  term  Safran  i s one  is  the  associated the  unfinished  unfinished  arises repeatedly  g r i e v i n g process  which  experiencing  i s s u e of  G r e e n b e r g and  and  blocking  Although the  theory  Gestalt  emotional  also to avoid  business  situations  of  from  the p a i n f u l f e e l i n g s  emotions themselves.  the  in  i n Psychotherapy  awareness of  negative  suggested that  and  i s a term d e r i v e d  responsiveness  e m o t i o n s prompt  desire  Business  which r e f e r s to the b l o c k i n g  thus p r e v e n t i n g  will  outcome.  Unfinished  Unfinished  study  of u n f i n i s h e d b u s i n e s s  therapy; issue  on  i n the  to t h i s  in  (1987) have  form  of  15 interrupted  emotional  unfinished business  e x p r e s s i o n but  extends  other blocked processes anger,  resentment,  abandonment. unfinished  The  restructuring view.  The  h a t r e d , p a i n , and  inability  of the person  inhibits  current discussion from  i s one  to Gestalt  full  to complete  integration  emotions i n t o  on t h e p r e m i s e guiding their personal  that own  course  of  of e x i s t e n t i a l are capable  through  life  for their  i s that  and  life  of  vis  their  of  events.  Gestalts  environment.  In t h i s  choices.  thereby  based  An environ-  of  individuals  organisms,  vis-a-  forming a continuous  series  a t t h e p o i n t where t h e  as  of  of a c c e p t i n g  humans p e r c e i v e t h e i r  o r g a n i z e r s of themselves,  environment,  Gestalt  effectively  approach  as  as  therapy  unrelated, seen  will  context.  as a s e r i e s  are  world  theorists  ment as a u n i f i e d w h o l e , r a t h e r t h a n isolated  and  theory to p l a c e the d i s c u s s i o n  individuals  u n d e r l y i n g assumption  these  begin with a general  i s a form  responsibility  one's  of t h e c o r e c o n c e p t s  unfinished business within i t s theoretical  therapy  of  of  of u n f i n i s h e d b u s i n e s s  This discussion w i l l  Gestalt  of  to a v a r i e t y  fear  the w r i t i n g s of G e s t a l t  unfinished business  introduction  the  of these b l o c k e d  draw p r i m a r i l y  theory.  w e l l beyond t h i s  the area  i n c l u d i n g b l o c k e d e x p r e s s i o n of  rage,  situations  state that  organism  contacts  the  16 G r e e n b e r g and a major r o l e  Safran  in this  (1987) s u g g e s t  o r g a n i z a t i o n a l process  g u i d i n g the adaptive a c t i o n state  that  concerns  of the  or needs and  t h a t emotions  as c l e a r  The that and  guides  first  a need  and  to a c t i o n . "  and  (p.  n e e d has  and  the  been s a t i s f i e d  Gestalt  However, a p e r s o n sequential "the  Gestalt  needs o f t h e  Gestalt  does not  to  "need t o be  allowed i n order  both  energizes the  o b j e c t i v e motor  the G e s t a l t  i n t o the background  the  a r e not  (Greenberg,  with  this  important  fully  result  satisfied  1983).  Hefferline,  (1951) have l a b e l l e d  that  Goodman  of t e n s i o n " u n f i n i s h e d b u s i n e s s " . c o n t i n u e t o be  the pressure  c o n t r o l l e d by  i s not  Perls this  of u n f i n i s h e d b u s i n e s s w i l l  i n t e r f e r e with  our  ability  to respond  i n t e r f e r e with  our  ability  t o form  new  t o new  of  that  and  the  T h i s need  Perls,  t h a t we  thus  process  the G e s t a l t  feels  level.  i s complete  i n t o t h e background but  residue  to  formation i s  recede  and  to  51).  often interferes  organism  our  form.  formation with  close"  t o become aware of  of G e s t a l t  t h a t need o r g a n i z a t i o n r e c e d e s  a l l o w i n g a new  further  T h i s t a k e s p l a c e on b o t h  subjective perceptual level When t h i s  They  comes t o a w a r e n e s s and  organizes behaviour.  continually  differentiation  step i n the process  or c o n c e r n  by  organism.  e m o t i o n s a r e what a l l o w us  undergo n a t u r a l development act  t h a t emotion p l a y s  may  complete. this  (1970) need  and  continue  to  situations  Gestalts until  and  these  17 unfinished  situations  r e a c t i o n s may  remain  rationalization, denial  (Daldrup  suggest  that  incomplete  L e v i t s k y and constitute  unfinished business. b u s i n e s s may  judgments, a n a l y z i n g or  Daldrup  Perls  of the range  a n x i e t y , mourning, and  u n f i n i s h e d b u s i n e s s as  Safran  is  unchanneled.  in  s t a t i n g that  is  the avoidance  Greenberg the core  and  The  feelings  individual  slowing l i f e  concept  cornerstones  She  etc.  intimacy  t h e o r y and  Enright this  and  the  characterized unfinished business  avoidance  as t h e mechanism whereby t h e i n d i v i d u a l  1970).  (1970) core  as  the  unexpressed  these u n f i n i s h e d s i t u a t i o n s .  a  the  Cohn  as P e r l s '  Cohn  of  of  events  completing  of  emotions  (Enright,  emotions,  from  view  excitement  fear  i s one  linger  of  emotions  despair with  practice.  avoidance  and memories w h i c h  form  of b l o c k e d  the  i n t o boredom and  v i e w s u n f i n i s h e d b u s i n e s s and concepts.  o f human  becomes s t u c k on  of u n f i n i s h e d b u s i n e s s  of G e s t a l t  that  (1987) go b e y o n d  and  anger  the u n f i n i s h e d  incomplete  Safran  o f s p o n t a n e i t y , autonomy and  The  involve  of the b l o c k i n g of t h e s e  of p a i n f u l  unwanted e m o t i o n .  that  a major consequence  further  important  (1987) s u p p o r t  a w a r e n e s s where e x p e r i e n c e r e m a i n s  lack  (1985)  (1970) c o n t e n d  (1970) s t a t e s  encompass any  Greenberg  unexpressed,  et a l  t h e most common and Cohn  i n c l u d i n g p a i n , rage, (1970) and  emotional  or u n f i n i s h e d t h r o u g h  intellectualized et a l , 1985).  These  t h e s e u n f i n i s h e d emotions u s u a l l y  and/or h u r t . resentments  are completed.  and  k e e p s away  These  18 unfinished powerful  situations  enough w i l l  resolution  preoccupation,  1973,  and  (Polster  enough " t h e compulsive  p r e s s u r e as  Perls  et a l  a n e u r o t i c compulsion situation  circumstances  suggests  that  their  expressions by  the  emerge as  individual  or i t . may  f o r completion  e x p r e s s i o n can.  In G e s t a l t  cannot  individual  can  not move on t o c r e a t e new  situations  but  rather compulsively repeats  an  t o complete  the present  can be  Greenberg incomplete that  as a g u i d e  intervention  Safran  repressed,  as  blocked  attempts  c l o s u r e to the  Gestalts  in  new  old solutions awareness  as  (1987) have i d e n t i f i e d one  of the a f f e c t i v e  across a v a r i e t y An  event  in of  t o be most  finishing  change  of s i t u a t i o n s  b e g i n s w i t h a marker  to the t h e r a p i s t  likely  t< .&  these  completion  the past before a f u l l  experiences  of c l i e n t s .  this  form  enjoyed.  recur i n therapy  variety acts  and  be  therapy  situations.  the  (1973)  the need t o b r i n g  Without  cyclical  relate  symptoms w h i c h a r e v i e w e d  to s a t i s f y  Polster,  take the  Latner  unfinished  attempt  &  this  T h i s may  i n the present.  the urges  oppressive  to repeat u n t i l  i s completed.  parallel  When t h e y  with  (Polster about  and i f until  1973).  i s beset  energy"  (1951) t a l k  1978)  themselves  behavior, wariness,  of r e t u r n i n g t o the o l d b u s i n e s s  only  (Perls,  & Polster,  individual  much s e l f - d e f e a t i n g  p.36).  unfinished  completed  continue to present  i s achieved  become p o w e r f u l  energy  must be  to indicate  effective  events and  which  the type  in inducing a  of  a  19 particular  client  unfinished  business  refer  unexpressed or f e a r  person  the client's  original  situation.  Anger  with  and which i s  functioning.  full  When  rage,  hatred,  expression the  i s one o f t h e most one o f t h e most  the incompletely  c a r r i e d a r o u n d as b o d i l y  o f w h i c h t h e p e r s o n may be unaware.  allows  through  arousal  completion  t o b r i n g about experience"  fantasies  associated  take place  with  continue t o a f f e c t current current  behaviour.  tension  and t h i s  The i m p o r t a n t  a cognitive reorganization  change mechanism d o e s n ' t  This  of the experience  (Greenberg & Safran,  damaging.  states of  o f emotions t o t h e i r  and t h e r e p r o c e s s i n g  common  processed''  and e x p r e s s i o n  new meanings t o emerge.  mechanism i s " t h e e x p r e s s i o n  inhibit  current  emotions and i s o f t e n  be r e l e a s e d  release  f o rthe c l i e n t  other  d i f f e r e n t i a t e a l l the feelings involved i n  feelings associated  tension  the  above and p r i m a r i l y  f e e l i n g s of anger, resentment,  emotions a r e o f t e n  can  The m a r k e r s f o r  seems t o be r e l i e v e d o f an i n t e r n a l b u r d e n a n d i s  unexpressed The  alive  o f abandonment a r e a l l o w e d  freed to fully the  have b e e n d e s c r i b e d  i s presently  i n t e r f e r i n g with  pain  approach.  t o a l i n g e r i n g bad f e e l i n g towards a s i g n i f i c a n t  person which  the  problem-solving  change  natural i n order  or r e e v a l u a t i o n of  1987, p . 2 2 2 ) . I f t h i s t h e memories a n d  the original functioning  interrupted feeling and t o i n f l u e n c e and  20 Research  on t h e Use  of G e s t a l t  Techniques  in  Therapy  A number of r e s e a r c h s t u d i e s have b e e n c o n d u c t e d the  last  ten years  particular  emphasis  This technique i n which  on t h e  "two  opposition  efficacy  of G e s t a l t  on t h e t w o - c h a i r  i s used p r i m a r i l y p a r t s of the s e l f  in a live  dialogue  when w o r k i n g  over  therapy with  a  technique. with  splits,  a r e p r e s e n t e d as b e i n g i n  or p o i g n a n t  manner"  (Greenberg,  1980a,  P.143) .  Greenberg nine  events  splits  i n which t h r e e c l i e n t s  using the Gestalt  Greenberg in  (1980a) d e s c r i b e d an  resolving  In t h i s  study  which r e s o l u t i o n  occurs  i n d i c a t e d ways i n w h i c h t h e r a p i s t s  (1983) p e r f o r m e d  of c o n f l i c t  fourteen  resolution  an  in-depth analysis  performances  n o n - r e s o l u t i o n performances.  Greenberg conflict  t w o - c h a i r method.  on  of  can  this information.  Greenberg process  analysis  were w o r k i n g  d e l i n e a t e d t h e p r o c e s s by  t w o - c h a i r work and  utilize  intensive  compared  From t h i s  Greenberg  (1980a, 1983)  immeasurably  t o our u n d e r s t a n d i n g  facilitating  c h a n g e when t h e G e s t a l t  performed.  of the  the  with  analysis  p r e s e n t e d a t h r e e - s t a g e s e q u e n t i a l model resolution.  of  of  adds  process  two-chair  dialogue i s  21 Bohart with  80  (1977) r e p o r t e d  s u b j e c t s who  anger c o n f l i c t s . effective  emotional  on  an  Gestalt two-chair  discharge  analogue study  empathic  were i n t e l l e c t u a l  16  Depth  study the  by  clients  analogue study  examining the  Gestalt two-chair  significantly plus  empathic  Dompierre studied that  depth  conflict chair  16  o f 28  (1979)  i n t e r v e n t i o n and  a  change i n Gestalt  split.  of the the  Clarke  dialogue  and  (1979)  component  of  focusing technique  Two-chair d i a l o g u e  of  the  f o l l o w i n g the  G r e e n b e r g and  method w i t h  split.  reported  subjects Greenberg  e x p e r i e n c i n g than  at  produced did  focusing  reflection.  (1979) and  G r e e n b e r g and  experiencing,  than  Dompierre  i n ongoing c o u n s e l l i n g . shifts  r e s o l u t i o n were g r e a t e r  dialogue  a n a l y s i s or  e x p e r i e n c i n g and  greater  effect  more d e p t h  clients of  Clarke  were w o r k i n g on  (1980) e x t e n d e d t h e  a subject presented  more  and  s u b j e c t s comparing  of  a w a r e n e s s were s i g n i f i c a n t l y  Higgins  attitudes  study  personal  p l a y was  of a G e s t a l t t w o - c h a i r  reflection.  In an  role  G r e e n b e r g and  using  effects  o p e r a t i o n when t h e  analogue  techniques.  (1977) and  differential  than  o f an  to resolve  anger, h o s t i l e  aggression  Clarke  results  were a t t e m p t i n g  in reducing  behavioural  the  with  empathic  (1981)  Results  i n a w a r e n e s s and  f o l l o w i n g the reflection.  showed reported  Gestalt  two-  22 G r e e n b e r g and of t h r e e was  clients  two-chair  was  an  Gestalt  a c t i v e empathy  significantly  a study  two-chair  (1981) and  Clarke  and  study  operation Depth  f o l l o w i n g the  i n v o l v i n g forty-eight subjects dialogue  was  compared w i t h  resolve  interpersonal  Gestalt  two-chair dialogue  conflict was  of  Gestalt  variety  of  report,  the  return  which other  included  pain  throughout  the  schizophrenic  well  therapy as  In a s i n g l e c a s e  a study  c e a s e d a f t e r f o u r weeks and course  of an  a d d i t i o n a l ten  capacity  of group t h e r a p y  more e f f e c t i v e on  t w o - c h a i r work as  greater  Zemet  to  decision.  from a G e s t a l t  designed to reintegrate p o l a r i t i e s  S e r o k and  problem-  of r e t r o f 1 e c t i o n i n  therapy  for  Gestalt  intervention.  function  G e s t a l t methods.  patient's  a cognitive  f o u n d t o be  (1983) examined t h e  reported  i n which  r e l a t e d to a  emergence o f p s y c h o g e n i c p a i n  perspective  (1984)  were a t t e m p t i n g  i n d e c i s i o n than a c o g n i t i v e  Rogers  not  in-depth  operation.  Greenberg  i n t e r v e n t i o n when s u b j e c t s  the  an  two-chair  higher  solving  reducing  on  operation.  Clarke on  (1981) r e p o r t e d  i n which the  compared w i t h  experiencing  Rice  and  did month  enhance a  self-sufficiency.  (1983) d e s c r i b e  using  patients.  Gestalt  an  experimental  p r i n c i p l e s and  Results  study  methods  show a s i g n i f i c a n t  with  increase  23 in  reality  perception  experimental  and d i f f e r e n t i a t i o n i n t h e G e s t a l t  group.  It would appear t h a t particular  the two-chair  facilitating  client  the Gestalt dialogue  change b o t h  s e t t i n g s when compared w i t h  method a n d i n  i s effective in  i n d i v i d u a l l y and i n group  a number o f o t h e r  interventions  on a v a r i e t y  also  apparent  that  that  more i n v e s t i g a t i o n needs t o be c o n d u c t e d t o d e t e r m i n e  the  effectiveness  the research  client  research  has b e e n r e p o r t e d  in  issues.  technique.  a l l areas  of G e s t a l t  Gestalt  is and  working  which  Further  issues  on i s s u e s  necessary  research  that  with no  r e s u l t s using the  i s therefore  needed  on t h e I s s u e o f  Business  of u n f i n i s h e d  business  relating to interpersonal necessary  the c l i e n t relationships  t o evoke n o t o n l y  t h e memory  t o a c t i v a t e t h e memory  of the r e l a t i o n s h i p with Once t h i s memory s t r u c t u r e i n therapy  i s s p a r s e and  research.  of p a r t i c u l a r e p i s o d e s but a l s o  person.  However i t i s  techniques  indicates  Treatment Approach  i t i s therefore  structure  i n t h i s area  I t i s a l s o apparent  Unfinished  In r e s o l v i n g  issues.  of p a r t i c u l a r G e s t a l t  specific  empty-chair  of c l i e n t  therapeutic  to destructure  the s i g n i f i c a n t other i s activated  i t becomes  t h i s memory a n d r e f o r m  24 it.  What seems t o happen i n t h i s  breaking the  emotional  process  i s "that  s t r u c t u r e i n t o components  b r i n g i n g a l l t h e components t o a w a r e n e s s , them from  automatically reintegrating  (Greenberg  & S a f r a n , 1987,  (1987) f u r t h e r memories the this  suggest  p.  281).  into  o f new  that a c t i v a t i o n  emotional  i s no  longer  i n v o l v e d i n the has  acquired other  significant  and  potentially  support  currently  available  than  situation.  The  person  They  was  through  and  a r e not p r o b l e m a t i c ,  space  death,  significant  other person  or t h e  time  may  events  (Polster  situation  be  & Polster,  no  of  of  therapy  original longer Or  frightening  be  i f time  a confrontation with too  this  the  t o engage i n  to discuss  earlier  1973).  In u n f i n i s h e d b u s i n e s s  work t h e t h e r a p i s t  number o f a s s u m p t i o n s  r e g a r d i n g how  during this  The  therapist  with  available.  focus  simply  first  the c l i e n t  of t h e s e  assumes t h a t t h e c l i e n t  the  and  a g r e a t e r range  a move or a l i e n a t i o n .  may  because  situation  originally  l o n g s i n c e have p a s s e d  process.  facilitates  speculate that  only r o u t e back t o the  available  Safran  emotional  experiences  has  i n v o l v e d may  prevent  same n e t w o r k "  greatly  U n f i n i s h e d b u s i n e s s work becomes t h e because i t i s o f t e n the  the  original  because the c l i e n t person  can  of these  schema.  reformulation i s possible in this  client  and  G r e e n b e r g and  i n the t h e r a p e u t i c environment  formation  one  by  makes a changes  i s that  the  i s o f t e n unaware o f  the  25 specific  i n f l u e n c e of p a s t  unfinished situations  current  functionning  (Daldrup  e t a l , 1985;  Safran,  1987).  I t i s because of t h i s  Gestalt  therapy  places  a central  a w a r e n e s s - a w a r e n e s s o f what importantly  how  this  call  the  contact  the  therapeutic tool  momentary  experience  h u r t s , but  also to  to  and  responsive  us"  Anger  i s often  i s aroused  tension  and  experience" not  only  and  (p. 4 ) . the  1987,  p.  Daldrup expressed  I f the  et a l  t o be and  of  p.  of  old  and  53).  responses  i s done r i d of  with emotions  t o become aware feelings  to  of  prompt  53).  emotions  involved in  (1985) s u g g e s t  "there  that  once  i s r e l e a s e of p h y s i c a l  for a reprocessing  of  anger remains unexpressed, i t of o t h e r  emotions but  i n s i t u a t i o n s where i t i s not  unproductive.  1987,  on what  i s not  i s an  expression  adaptive  of the primary  flow  Gestaltists  surprising perspectives  is placed  opportunity  inhibits  activated clearly  the  to the  a c t i o n s toward which  one  unfinished business. anger  only  i n t e r r u p t i v e process  (Greenberg & Safran,  the  emotion then  (Greenberg & Safran,  t o the  as  of  more  s i n c e "renewed a w a r e n e s s  ultimate goal  "undo t h e  and  a t what  of  e m o t i o n s a r e v i e w e d as  the  but  Awareness  f r e s h and  situations value  e m o t i o n s and  occurs  &  that  the process  i s o c c u r r i n g now  l e a d s not  enhanced p e r c e p t i o n "  specific  on  environment  boundary.  important  Because primary  focus  her/his  Greenberg  assumption  censoring process  organism i n t e r a c t s with  and  on  also i s re-  appropriate  I t i s f u r t h e r assumed by  or  Gestalt  therapists  that  e x p e r i e n c e by process.  clients  being actively  I t i s through  able to experience e m o t i o n s and  thus  the  et a l  experience  that  'experiment'  called  the  may The  emotional  relearning the c l i e n t or  go  disowned  of t h e s e  emotions  a series  through  of phases  i n the process  p h a s e s c o i n c i d e w i t h what  five  is  schema.  (1985) have s u g g e s t e d a client  that  the denied  structuring  u n f i n i s h e d b u s i n e s s work. (1970) has  i n v o l v e d i n the  allow a reintegration  Daldrup  Perls  rediscover their  i n the present  into his/her internal  of  can b e s t  layers  of n e u r o s i s .  1.  Disowning - i n i t i a l l y the c l i e n t enters therapy disowning the strong problematic e m o t i o n s , such as a n g e r or h u r t , o r a t l e a s t d e n y i n g t h e impact t h e s e emotions a r e c u r r e n t l y h a v i n g on t h e c l i e n t . This may i n v o l v e m i n i m i z i n g , d e n i a l or a t t r i b u t i n g one's a n g e r t o a n o t h e r .  2.  P h o b i c R e a c t i o n - As t h e c l i e n t r e c o g n i z e s t h e a v a i l a b i l i t y and s i g n i f i c a n c e of the l e f t o v e r emotions t h e r e i s o f t e n a p h o b i c r e a c t i o n where c a t a s t r o p h i c r e s u l t s are p r e d i c t e d i f t h i s emotion i s a l l o w e d e x p r e s s i o n .  3.  I m p l o s i y e S t a g e - At t h i s p o i n t t h e c l i e n t a p p e a r s t o r e a c h an i m p a s s e and h e / s h e f e e l s numb, d e a d and w i t h o u t a w a r e n e s s o f emotion.  4.  E x p l o s i v e Stage - C l i e n t s here b e g i n t o express spontaneously a l l thoughts, f e e l i n g s and s e n s a t i o n s a s s o c i a t e d w i t h the i n t e r r u p t e d experience. P e r l s (1970) has i d e n t i f i e d f o u r t y p e s o f e x p l o s i o n : explosion into joy, into grief, into orgasm, and i n t o a n g e r .  5.  Completion Stage - Spontaneous e x p r e s s i o n t a k e s a more i n t e g r a t e d form and t h e r e i s a marked d i m i n u t i o n o f hostile feelings.  of  27 The  process  of Gestalt  unfinished business 1985).  First  consists  a focus  t h e i s s u e of  stages  (Daldrup  et a l ,  The work s t a g e i n v o l v e s  technique.  In t h i s  o f t h e work t a k e s p l a c e i n t h e " s e l f  this position and  of f i v e  t o work.  use of t h e empty-chair  bulk  with  f o r t h e work must be e s t a b l i s h e d  f o l l o w e d by a commitment the  therapy  that the c l i e n t  disowned emotions.  begins  process the  chair".  t o express  The empty c h a i r  It i s i n  the denied  i s only used  as a  stimulus  o b j e c t so t h a t t h e e m o t i o n s may b e h e i g h t e n e d i n  the  chair.  self  there  Expression  is a letting  i s c l o s e t o completion  go; a r e a l i z a t i o n  that the c l i e n t  g e t what h e / s h e wanted f o l l o w e d by a g r a d u a l this of  expectation.  feeling  important as  Often,  stage  there i s a softening  In e i t h e r  This  reintegration final  Although resolution  i t is  literally  o f t h e work o r by c o n n e c t i n g t h e work f u t u r e work.  the results  The f o u r t h  o f t h e work  i s a c o g n i t i v e stage which  of the current experience.  stage  w i t h no  case  1970) e i t h e r  i s an a s s e s s m e n t p h a s e i n w h i c h t h e g o a l  completed.  the  (O'Connell,  the session to potential  i n t e g r a t e and a s s e s s  go o f  o t h e r a c c o m p a n i e d by  or s o f t e n i n g of f e e l i n g . t o s a y goodbye  d i d not  letting  however, an i m p a s s e i s r e a c h e d  the concluding part  within  occurs  towards t h e s i g n i f i c a n t  forgiveness. resolution  If resolution  when  emerges i n w h i c h  just f o c u s e s on  Out o f t h i s  future plans  i s i s not y e t c l e a r l y  understood  o c c u r s , Greenberg and Safran  i sto  stage  a r e made.  how  (1987) have  28 developed  a p r e l i m i n a r y e m p i r i c a l model  finishing  incomplete  T h i s model  suggests  experience. that the  identifying  an  significant  other person  lingering  therapist person an  aroused  often two  affective  shows t h i s with  with  visualize  and the  T h e s e two  state.  In t h i s  significant  activities state  of f e e l i n g s  are hurt  and as  e x p r e s s i o n o f each e m o t i o n  each a l l o w e d  their  a n g e r have been  full  process  the harsh,  (often  a parent)  f o l l o w e d by  more human, c o m p a s s i o n a t e p e r s o n . essential  accept  the  to resolution significant  that view.  negative affect subsequent  identification  of t h i s  T h e s e two  rejecting of  o b j e c t and  seem  i s able  e x p r e s s i o n of  the r e j e c t i n g  the  components  o t h e r ' s p o i n t o f v i e w and  with  When  resolution  i n which the c l i e n t  toward the r e j e c t i n g  and  i s then  the a c t i v a t i o n  I t seems t h a t " t h e  It  the  anger  expression, the c l i e n t  in activating  may  differentiated  Part  understand  The  separately.  a b l e t o work t o w a r d s r e s o l u t i o n . seems t o be  is  a complaint.  full  be  b r i n g about  anger which  allow the  to  other  simultaneously.  appear u n d i f f e r e n t i a t e d  o f h u r t and  the  the c l i e n t  i t s component p a r t s o f h u r t and  person  a  a r e q u e s t by  into  and  client  i n u n f i n i s h e d b u s i n e s s work t o s e p a r a t e  emotions  model.  the a s s o c i a t e d  complaint  these  the  of  T h i s i s f o l l o w e d by  o f t e n most a l i v e  or may  important  begins  the c l i e n t  empty c h a i r .  aware o f a v a r i e t y  alternate is  feelings.  that the c l i e n t  that are  event  a c c o m p a n i e d by  e x p r e s s i o n by  i n the  Figure 1  i s s u e of u n f i n i s h e d b u s i n e s s  negative  intensified  of t h e p r o c e s s  to  to intense  the  object produce  29  FIGURE 1 PRELIMINARY EMPIRICAL MODEL OF FINISHING INCOMPLETE EXPERIENCE  L i n g e r i n g bad f e e l i n g toward s i g n i f i c a n t other  w  Intensified expression  Imagining of t h e o t h e r  Differentiation of h u r t a n d a n g e r  Taking the r o l e of t h e o t h e r  \!/ A r o u s a l and expression of h u r t and anger  Evocation of a l t e r n a t e schema o f good, l o v i n g , internal representation  Understanding of s i g n i f i c a n t other's p o i n t of view  Shift to expresssing difficulties in being nurturing  /  Emotional r e s t r u c t u r i n g , e x p r e s s i o n of l o v e and f o r g i v e n e s s  Note. From E m o t i o n i n P s y c h o t h e r a p y (p. 289) by L.S. G r e e n b e r g a n d J.D. S a f r a n , 1987, N.Y.: G u i l f o r d  Press.  30 sufficient  c u e s t o a c t i v a t e an  compassionate This by  leads  t o an  (Greenberg & Safran,  emotional  f e e l i n g s of acceptance  Safran in  other"  process  i s that  or  of  "by  forgiveness.  t h a t what  breaking  i n t o components and  b r i n g i n g a l l the  awareness"  the  (p. 281)  e m o t i o n a l memories the  current  suggest  client  the  brings  to the  three  G r e e n b e r g and  and  place  structure  to the  They p o s t u l a t e  that  therapeutic  feelings  current  levels:  Safran  marked  to r e i n t e g r a t e  and  experience  expressive  s c h e m a t i c memory s t r u c t u r e ; and  aspects.  be  emotional  i n the  different  290).  Greenberg  components  schema.  inherent  r e s t r u c t u r i n g on  components; symbolic  the  p.  more  seems t o t a k e  the  i s able  i n t o a new  combined w i t h  perspectives facilitate  client  l a c k of t h r e a t  environment  1987,  r e s t r u c t u r i n g w h i c h may  (1987) f u r t h e r s u g g e s t  this  a l t e r n a t e schema o f t h e  motor  conceptual  (1987)  and  further  that ''the a c t i v a t i o n o f an a l t e r n a t e , more p o s i t i v e i n t e r n a l o b j e c t schema a n d / o r t h e a c t i v a t i o n o f a more p o s i t i v e s e l f - s c h e m a and a s e n s e o f s e l f - w o r t h i s b r o u g h t a b o u t by t h e a r o u s a l of the n e g a t i v e a f f e c t i n v o l v e d i n t h e u n f i n i s h e d e x p e r i e n c e and t h e c a r r y i n g f o r w a r d t o c o m p l e t i o n of t h i s p r e v i o u s l y interrupted expression." (p. 2 9 0 ) .  Because G e s t a l t importance of  the  techniques  therapeutic  can  therapist-client  i n c r e a s i n g prominence  that the  of the  techniques  be  encounter.  powerful,  the  r e l a t i o n s h i p i s becoming  (Greenberg,  emerge out  very  of the  1983).  It i s e s s e n t i a l  ongoing d i a l o g u e  A g o o d r e l a t i o n s h i p i s not  of seen  31 as  sufficient  relationship  f o r t h e r a p e u t i c change b u t and  preconditions  Research  good w o r k i n g  for effective  on t h e Use  Rogers  alliance  Gestalt  of Empathic R e f l e c t i o n  the necessary  and  sufficient  conditions  empathic  be  at l e a s t  minimally  were y o u r  without  f i n e b a l a n c e between maintaining further  t o be  of  objectivity  the c l i e n t  understanding  and  empathy and  the t h e r a p i s t s verbal  as a t h e r a p i s t .  facility  language  stated  sensitivity  the  with the c l i e n t  and  (1957)  has  world  f o r empathy  initiated  specified  " a c c u r a t e empathy  three  t o communicate t h i s  claims.  the  concept  i n v o l v e s both  to current feelings  attuned to the c l i e n t s  i f " it Truax  t o i n v e s t i g a t e Rogers'  (1967) f u r t h e r  that  "as  must p e r c e i v e t h e  This position  Carkhuff  Empathic  stressed  Rogers  of the c l i e n t ' s  of r e s e a r c h d e s i g n e d  Truax  these  world.  G l a d s t e i n (1983) a l s o  over-identification  deemed t o o c c u r .  decades  world  b e c o m i n g p a r t of t h i s  stressed that  therapist's  of  communicated t o t h e c l i e n t .  (1971) and  he  u n d e r s t a n d i n g w h i c h must  i n v o l v e d sensing the c l i e n t s  and M i t c h e l l  Therapy  conditions for  One  understanding own  in  o u t l i n e d what  change t o o c c u r .  d e f i n e d as  be  work.  constructive personality he  trusting  a r e assumed t o  (1957) i n a l a n d m a r k p a p e r  c o n s i d e r e d t o be  a  and  understanding  current feelings"  his in a (p. 4 6 ) .  32 This position Carkhuff respect  (1967) f e l t  that  f o r the c l i e n t  emotional rather  i s s u p p o r t e d by  tentative  t r a i n i n g model this  clients  and  & Wargo,  of R o g e r s '  Barrett-Lennard's  primary  (1977),  (1981, 1986)  and  initially  sufficient  perceptions  and  in his  scale  attuned to  the c l i e n t s Truax  used  the  own  language  & Carkhuff,  1967;  to assess  for client  assumption  of h i s t h e r a p i s t s '  and  This viewpoint Howard  Greenberg  (1982).  a s p e c t s : empathic feelings  the Rogers  change.  was  that  response  the  i s the  in their i s s u p p o r t e d by  Gurman  (1978, 1 9 8 6 ) , B a r r e t t - L e n n a r d  c o n c e p t u a l i z e d empathic  e n c o m p a s s i n g two  revised  (1957) work, B a r r e t t - L e n n a r d  (1962) b a s i c  (p. 2 ) .  and  of a c c u r a t e  i n communicating  l o c u s of t h e r a p e u t i c i n f l u e n c e  Orlinsky  a  o f t h e c o n d i t i o n s p o s t u l a t e d by  experience  relationship"  an  client  five-point  the R e l a t i o n s h i p Inventory  as b e i n g n e c e s s a r y  and  1966).  experience  "client's  condition  and w h i c h r e f l e c t s  a result  client's  f o r t h e measurement  & K r a u f t , 1977;  of  They d e v e l o p e d  to the  and  of a warmth  of t h e  (1969) s u b s e q u e n t l y  further  Bozarth  (1962) d e s i g n e d  feelings  expressed.  Truax  function  i n v o l v e s u s i n g language  feelings  Truax  As  A  empathy  (Mitchell,  the  for therapists  study.  accurate  p r o v i d e d the  nine-stage scale  empathy w h i c h C a r k h u f f  in  and  the content  (1977).  empathy grew out  mirror to r e f l e c t  than  Gurman  directly  Barrett-Lennard understanding recognition  (1962)  as of  the  communicated by  the  client  33 and  empathic  merely  i n f e r e n c e which  i m p l i e d or  writings,  indirectly  Barrett-Lennard  conceptualization process.  empathic  resonation  of h i s this  therapist's generated be  most  including change. conducted  Orlinsky  the  his of  own  the  client's  third  stage  during  extensive  quantity  attempt  Howard  are  the  "should  448).  function to  w e l l as  of  "expand his  further states  e a r l y phases  that  is  critically  of  helping.  conditions,  sufficient  of r e s e a r c h  t o answer t h i s  b e e n r e v i e w e d and  as  of  results  (p.  client  of  received  empathy  o f h e l p i n g and  the  reflection  i n c l u d i n g T r u a x and and  He  r e m a i n s , however, i f t h e s e  i n an has  the  self-understanding (p. 2 0 2 ) .  the  the  stages  expression  perception and  implied  two  Phase 3 -  change"  suggested that  ingredient  or  i n c o r p o r a t i n g the  i s to a s s i s t  others"  three-stage  expressed  t h e r a p i s t ; and  This  (1969) has  empathic An  to a  Phase 1 -  form m e a s u r i n g r e c e i v e d  especially  question  authors  (thus  incorporates  i s t h e key  important  research  by  understanding  understanding  The  t h e r a p i s t to  recent  expanded h i s  w o r k ) ; Phase 2 - c o m m u n i c a t i v e  from the  clarify  has  understanding  strongly r e l a t e d to c l i e n t  empathic  empathy  the  position.  Carkhuff  and  by  client  understanding  empathy w h i c h  (1981, 1986)  that which i s  In h i s most  These t h r e e phases a r e :  of the  earlier  sensing  expressed.  of empathic  cyclical  experience  involves  for  has  been  question.  summarized by  client  This  a number  M i t c h e l l (1971); Gurman  (1978, 1986); P a t t e r s o n  (1984);  of  (1977); and  34 Lambert,  S h a p i r o and B e r g i n  (1971) f e e l  that  (1986).  the evidence  T r u a x and M i t c h e l l  i s convincing  responses play  an i m p o r t a n t  role.  (1978) s u g g e s t  that  i s a highly  but  stop  short  necessary  empathy  of s t a t i n g that  and s u f f i c i e n t  that  Orlinsky  empathic  and Howard  desirable  quality  warmth and empathy  are  conditions  o f g o o d outcome.  (1977) goes so f a r as t o s t a t e t h a t  these conditions  necessary rarely  sufficient  change. strong  as p r e c o n d i t i o n s  Orlinsky  for therapeutic  evidence supporting  important  c o n t r i b u t i o n when empathy  perceived  by t h e c l i e n t .  stress how  that  or behaviour  (1986) c o n c l u d e d t h a t  therapist  empathy was  L a m b e r t , S h a p i r o and B e r g i n  number o f ways. states  worded  but  f a r d i f f e r e n t conclusions  warmth, and g e n u i n e n e s s  counseling therapeutic  that  in a and  i f not s u f f i c i e n c y , empathy,  respect,  i s i n c o n t r o v e r t i b l e " (p. 4 3 7 ) .  the " e f f e c t i v e n e s s  o r p s y c h o t h e r a p y may  o f a l l methods  strongly  of  be due t o t h e p r e s e n c e  understanding  supports  the conclusion  i s a necessary  component  of  or  He  r e l a t i o n s h i p " (p. 4 3 7 ) .  The e v i d e n c e empathic  literature  He r e a c h e s  of accurate  (1986)  Patterson  t h e s e r e v i e w e r s were b i a s e d  of t h e t h e r a p i s t c o n d i t i o n s  states  of the  f o r the necessity,  an  question  suggests  "the evidence  further  criticism  was  m e a s u r e d as  these f a c t o r s r e l a t e to t h e r a p i s t technique.  w h i c h he r e v i e w e d  there  as m a k i n g  r e l a t i o n s h i p f a c t o r s are important  (1984) i n a s t r o n g l y  are  change but a r e  for constructive personality and Howard  Gurman  that  of a  35 therapeutic plus  change y e t  Rogers'  therapeutic  i s mixed i n s t a t i n g whether  (1957) o t h e r  core  conditions  are  sufficient  Orlinsky "a  and  relation  individuals their  (p.285).  the  as  engaged i n by  needing  defined  This  as  able  definition  client.  1986).  implies  s p e c i f y i n g what undermines the of  or more  to  one  to  improve  or more  special  help"  investigate  researcher  also considered  must  the  determine  i n the  life  to take  outcome w i t h o u t  limited value 1986).  how  c h a n g e came a b o u t  of  (Bergin The  improvements Shapiro  (1969) have s t a t e d t h e  and  i n the  study  life  basic  research  research, result  1986).  question  of  place 1978,  also  in  and  is  1978;  o f change must  of the  of  i t worked  & Lambert,  should  & Bergin,  how  scientific  outcome i n p s y c h o t h e r a p y  Lambert,  such  that  the  only  replicabi1ity  to  important  with  t h a t worked and  process the  one  r e l a t i o n s h i p ( O r l i n s k y & Howard,  i t was  Greenberg & P i n s o f ,  psychotherapy  c h a n g e s have o c c u r e d  However t o c o n s i d e r  ultimately  to render  These changes a r e  a therapeutic  Outcome  special assistance  of p s y c h o t h e r a p y  demonstrably b e t t e r  within  1986;  (1978) have d e f i n e d  among p e r s o n s ,  defined  effectiveness that  Howard  f u n c t i o n i n g as p e r s o n s , t o g e t h e r  individuals  for  change.  Psychotherapy Research R e l a t i n g to  as  empathy  should  link explain  practically  client  (Greenberg,  S t r u p p and  Bergin  psychotherapy  36 research changes  as  in specific  (p.20).  Strupp  "isolation for  "What s p e c i f i c  and  advancing  therapeutic  i n t e r v e n t i o n s produce  p a t i e n t s under  and  Bergin  specific conditions?"  (1969) a l s o  manipulation  becomes a f o c u s e d  suggest  that  of s i n g l e v a r i a b l e s  knowledge c o n c e r n i n g  change"  (p.25).  The  investigation  the process  study  effective  research design to explore t h i s  therapy  (1986) i n h i s r e v i e w supports  n e e d t o be  clinical  evaluation treatment  s t r a t e g y which  a p p r o a c h e s a r e most particular these  approach  which  w h i c h has  out  the c l i e n t - c e n t e r e d studies (Bohart,  have b e e n u s e d 1977;  therapy  of Rogers'  approach.  and  (1957) work and  Dompierre,  1981;  G r e e n b e r g & H i g g i n s , 1980; Webster,  1981)  and  Two  and  of  reflection represents  treatment Gestalt  therapy  C l a r k e & Greenberg,  G r e e n b e r g & C l a r k e , 1979;  and  clients  empathic  1979;  1982;  treatment  be p r e d i c t e d .  Dompierre,  Webster,  of  treatment  Differential  1981;  and  comparative  i n i n v e s t i g a t i n g both  C l a r k e , 1977,  variable.  to r e s e a r c h e r s because  specific  i s s u e s so t h a t outcome may  evolved  of  successful with p a r t i c u l a r  approaches are G e s t a l t  t h e most  specific  i s the  is familiar  of t h e d e s i r e t o d e t e r m i n e  thus  effects  to  discusses a variety One  of  isolated  that the  evaluated i n r e l a t i o n  stategies.  essential  of r e s e a r c h d e s i g n  the p o s i t i o n  p r o b l e m s and  the  of a s i n g l e t h e r a p e u t i c  t h e p r o b l e m becomes t h a t o f c h o o s i n g  methodology  is  of change  i s s u e and  Kazdin  specific  1984;  Greenberg & Greenberg  the r o l e  &  of empathy i n  f a c i l i t a t i n g c l ient Patterson  change  1984; T r u a x  (Orlinsky  & Mitchell,  & Howard 1978,  1971;  and  1986;  St Wargo,  Truax  1966) .  Although unique  comparative  problems  r e s e a r c h p r e s e n t s a number  i n keeping  the techniques  (1986) s t r e s s e s  that  which t e c h n i q u e  s h o u l d be  (p.29).  (1986) f u r t h e r  Kazdin  r e s e a r c h makes an alternative  suggest may  be  due  components control  that  effects  that  the  t o an  has lack  1978;  Kazdin  to y i e l d  comparative  in characterizing  indices  of t h e  as t h e y  Greenberg  (1986) s t a t e  It i s also  ( B e r g i n , 1971;  use  of s p e c i f i c ,  apply to s p e c i f i c (1984), the  To  help  suggests important  that  altered with  r a t h e r than  Bergin & The  Lambert, research  clearly delineated  therapeutic issues.  Gottman and Markman  importance  active  are e f f e c t i v e  in specific  and  effects  systematically  S h a p i r o , & B e r g i n , 1986).  the comparative  Greenberg  differential  (1986b)  on what t e c h n i q u e s resulting  determine  differential  Greenberg  s h o u l d be  to  conclusive results  of demonstrated  states  Lambert,  techniques R i c e and  failed  Kazdin  problem"  R i c e and  o f t e n r e s e a r c h on  difficulty  improvement  supports  contribution  empirically.  under study  problem  and  that  imprecise understanding  to provide evidence  global  to a given  states  smaller research units.  the techniques  specific  are e s s e n t i a l  i n t h e t e c h n i q u e s b e i n g compared.  for this  examining  applied  important  approaches  (1984) p o i n t out treatment  "comparisons  distinct  of  (1978)  of e n s u r i n g t h a t  and  the  38 t r e a t m e n t s were a d m i n i s t e r e d , behaviours  and  checking to  strengthens the issue  i n the  or n o t with use  to  ensure they  differential  use  of  include  including  use  of  design  a control  the  treatments being  studied  of a  second treatment  group.  Control alternative Bergin  differential  ( 1 9 7 1 ) , Gottman and  S h a p i r o and control  Bergin  (1986) s t a t e  groups are  impossible  d i s t r e s s e d persons act relief  i s not  help w i l l  be  groups  non-professional  or  friends,  clergy  services.  or  appears that  the  tests  of t h e r a p y  t h e r a p y w o u l d be m a g n i t u d e by control  elsewhere,  set  up.  They s t a t e  Bergin  e f f e c t s , and larger  through  i f t h e y were not  181).  the  professional  (1986) s t a t e  often  effect  sizes  that " i t have  not  provide  effect  sizes  reduced of  then  of  g r o u p methods t h a t  that  i f this  self-help  form  other  t h e y do  an  that  environment  i n the  the  Lambert,  no-treatment  through  inadequate, that  (p.  for  true  assistance  control  subtracting  groups"  comparison  However,  ( 1 9 7 8 ) , and  s u c h as  S h a p i r o and  various  been d e s i g n e d a r e  a  a substitute  in a therapeutic  r e l a t i v e s or  Lambert,  i s whether  t o r e l i e v e t h e i r d i s t r e s s and  forthcoming sought  This further  g r o u p as  studies.  that  to  therapist  b e e n c o n s i d e r e d as  effects Markman  A  studies  or as  g r o u p s have f r e q u e n t l y to  occurred.  effects design.  differential  the  specifying  in  so-called  fair for  39 Treatment research. design  s t r a t e g y i s but  Another  important  i n v o l v e s the  conducted  and  approximate  the degree  those  environment. situations  setting  and  of  techniques  setting  and  be  of c l a r i f y i n g research  further  study  that  i n an  analogous  provides  the  treatment  to begin  and  experimental  c h a n g e and  study  has  one  Bohart  analogue  settings"  q u e s t i o n and  of these  to control  obvious  concern  trials  of t h i s  found  to  ideas f o r  (1977) and  Bergin  be  situation  of t h e  as a  way  Kazdin  analogue  the  (p.33).  The  the analogue elements  elements  study of  to  multiple conditions Analogue r e s e a r c h of r e s e a r c h  r e p r e s e n t i n g the design  in  issues associated with  end p o i n t o f t h e c o n t i n u u m  designs with c l i n i c a l  been  stimulating  thereby minimizing t h e i r v a r i a b i l i t y . represents  investigation  effectiveness  ethical  the c o n t r i b u t i o n s  found  their  o p p o r t u n i t y to look at the b a s i c  and  therapeutic  to those  o f t h e change p r o c e s s .  conducting research in c l i n i c a l i s the  will  research i n  i s i t s " c a p a c i t y t o surmount many o f  priority  be  clinical  the major advantage  methodological, p r a c t i c a l  The  study w i l l  a s i n g l e v a r i a b l e may  understanding  (1986) s u g g e s t s  and  ( B e r g i n , 1971) .  investigated  our  analogue  complex  (1972) s u g g e s t  productively to  The  psychotherapy  setting  in a  are used  to begin t e s t i n g  situations.  Strupp  t o which t h a t  and  of  of t h e r e s e a r c h  i n which the  c o n d i t i o n s found  specific  and  component  under c i r c u m s t a n c e s  the c l i n i c a l  further  aspect  Analogue s t u d i e s conduct  in  a way  one  other  i s the a b i l i t y  to  end.  40 generalize  from t h i s  controlled  situation  to the  clinical  s ett ing.  A  l a r g e body  conducted  of psychotherapy  using a variety  research  designs.  research  r e l a t i n g process  Orlinsky  and  review  Howard  of the  psychotherapy five  (2)  the  elements:  format,  t e r m s and  forms t h e p l a n not  the  this  review  u s e d by  the  client  and  refers  to aspects  relationship  limits  substance  therapist  of  the  of  therapy;  therapist;  (4)  i n response  forms between  f u n c t i o n i n g and  of "openness" v e r s u s  realizations  which r e f e r s  to the  effect  demonstrable  outside therapy.  c a t e g o r i e s may  participant client.  client's  life  should  by  either  framework o u t l i n e d by  the  therapist  O r l i n s k y and  of  be These  include non-participant observations  observations  This  the  "defensiveness";  b o n d and  five  bond  i s often  t h e t h e r a p e u t i c i n t e r v e n t i o n s and i n the  to  P a t i e n t s e l f - r e l a t e d n e s s which  of the c l i e n t ' s  i n terms  considered  (3) T h e r a p e u t i c  that  into  c o n t r a c t which  i n t e r v e n t i o n s which are g e n e r a l l y  to the  (5) T h e r a p e u t i c  extensive  t o outcome i n  Therapeutic  presenting d i f f i c u l t y ;  which r e f e r s  formulated  (1)  organized  study  discussed.  their  They  and  current  t o outcome w i l l b e  research.  techniques  client's  of t h e  r e l a t i n g process  Therapeutic  t o be the  and  the purposes  been  strategies  (1986) r e p o r t e d on  the purpose,  encounter  of treatment  literature  conceptual  defines  For  r e s e a r c h has  or  the  Howard  or  41  (1986) w i l l  be  psychotherapy  The  first  timing  and  Howard  on  contract  and  the  sessions  have r e l e v e n c e contract  The  to the  delineate  the  determine the  current  of the  c o u r s e of the  used.  Strupp  developing treatment  Therapeutic  believe  outcome"  clients  for  the  significant of  the  s t u d y however  is therefore  the  settings  of  by  Orlinsky  and  interventions  minimal  therapy. of b e i n g  specific the  p r o b l e m s have b e e n d e l i n e a t e d  about  defineable  relating  regarding  to  the  growing  of p a r t i c u l a r p a t i e n t  techniques  and  Of p a r t i c u l a r  (1978) s t r e s s e s  "more c l e a r l y  Howard  which  m a j o r d i f f e r e n c e s between t h e r a p i e s  techniques  (p.17).  preparing  and  therapeutic  necessity  geared to the  r e l a t e d to  present  the  contract.  "good e v i d e n c e t o  discussed  i s the  on  including  research.  importance  emphasis  of the  of  relates^ p r i m a r i l y to c l i n i c a l  second element  (1986) i s t h a t  Howard  T h e s e components  than to analogue s t u d i e s  importance t o the  and  a p o s i t i v e and  outcome.  outcome.  experience  length  had  to  Orlinsky  i s strongly  r o l e of c l i e n t  the  which c o n s i s t s  therapy  (1986) f o u n d  therapeutic  therapeutic rather  by  contract  of the  summarize  relating  They a l s o c o n c l u d e d t h a t  therapeutic result  described  sessions  number o f  (p.315).  element  limits  and  literature  therapeutic  of the  Orlinsky that  the  organize  research  (1986) i s t h e defining  used to  techniques  problems"  specific  client  a v a r i e t y of  client  42 issues  including  dealing with  suppressed, u n f i n i s h e d  emotional  r e a c t i o n s (Daldrup, B e u t l e r , & Greenberg,  resolving  splits  conflicts  (Greenberg,  Gestalt  methods  stresses and  (Greenberg,  t h e importance  techniques specific  and t h e s p e c i f i c  to a specific  have d e v e l o p e d  also  procedures  treatment  used  i n this  study w i l l  identify  improvement  their  be  client  Measure  &  1978) t h e s e t e c h n i q u e s must b e problem.  a means o f i d e n t i f y i n g  Complaint  The  Three.  or p r o b l e m s a n d m e a s u r i n g  Battle  e t a l (1966)  the s p e c i f i c  problem  change i n t h e s e c o m p l a i n t s . (Battle  core concerns  at the completion  Lambert  (1978) a n d Lambert,  support  the inclusion  client  (1986)  d y s f u n c t i o n t o be t r e a t e d .  techniques  i n Chapter  counsellors i n  has b e e n p o i n t e d o u t ( K a z d i n , 1986; O r l i n s k y  related  to  Kazdin  resolving  of s p e c i f y i n g concrete  Howard, 1986; a n d S t r u p p ,  Target  1980b).  t h e c o n n e c t i o n between  treatment  described  As  1983b); and t r a i n i n g  (Greenberg,  of s p e c i f y i n g  1979, 1 9 8 0 a ) ;  1985);  e t a l , 1966) a l l o w s and t o e v a l u a t e  of treatment.  clients  their  B e r g i n and  S h a p i r o and B e r g i n  of t h i s  The  (1986)  k i n d o f g l o b a l measure o f  c h a n g e i n a s s e s s i n g t h e r a p e u t i c outcome.  Therapeutic arousal  i n t e r v e n t i o n s which add t o t h e c l i e n t ' s  a r e important  to f a c i l i t a t e  t h e r a p e u t i c change.  Outcome i s t h e r e f o r e o p t i m i z e d when c l i e n t s involved  i n the therapeutic process.  are actively  Affective  immediacy o r  43 arousal  seems t o b e s i g n i f i c a n t l y  benefits  from  the t h e r a p e u t i c involvement  who e x p e r i e n c e a f f e c t i v e affective better  outcomes"  (Orlinsky  Stiles  perceptions and  depth  (1984a,  the Session Evaluation  of the session.  of the session  the c l i e n t ' s  The c l i e n t s  and they a l s o  rate  rate  o f p o s i t i v i t y and a r o u s a l .  allows  to quantify  issue  of c l i e n t  facilitating  Another  component  integrity,  been c a r r i e d distinguished another  determine what  a n d Howard  element i n  (1986) i s t h a t o f  T h i s needs t o be  differentiation  delineated  not only that  i n t e r v e n t i o n s were u s e d designed  o f one t r e a t m e n t  Once t h e t r e a t m e n t i t i s important they  from  techniques  have  t o be a b l e t o  o c c u r r e d b u t a l s o t o measure t o  e x t e n t t h e y were c a r r i e d  specifically  o f a r o u s a l and t a p s  o r t h e e x t e n t t o w h i c h t r e a t m e n t has  ( K a z d i n , 1986) .  been c l e a r l y  mood a l o n g  of t h e r a p e u t i c i n t e r v e n t i o n s  out as i n t e n d e d . from  level  their  change.  i d e n t i f i e d by O r l i n s k y treatment  their  t h e smoothness  T h i s measure  a r o u s a l as an i m p o r t a n t  client  Stiles  (1982) have e x p l o r e d t h e i s s u e o f  the dimensions  the  t o experience  1984b) a n d S t i l e s ,  ( S t i l e s , 1984) t o i d e n t i f y  clients  clients  & Howard, 1986, p . 3 6 5 ) .  a r o u s a l a n d have d e v e l o p e d  Questionnaire  and those  quite consistently  a n d Snow  T u p l e r and C a r p e n t e r  in attaining  d i s c h a r g e and " g r e a t e r immediacy o f  expression tended  (1980, 1986),  client  important  out.  In t h i s  s t u d y two  a n d were m e a s u r e d w i t h  for this  purpose.  scales  Carkhuff  (1969)  44 devised  a  empathic  five-point scale r e f l e c t i o n was  a l s o been d e v i s e d empty-chair  t o measure t h e  c a r r i e d out.  to rate  dialogue.  the  A  extent  to  which  five-point scale  o c c u r r e n c e of  B o t h were u s e d t o  the  has  Gestalt  establish  treatment  int egrity.  The  third  (1986) i s t h a t the  element of  therapeutic  documented 1969;  therapeutic  (Barrett-Lennard,  Greenberg,  1981,  1986; 1967;  outcome.  One  i s "very  when empathy  Barrett-Lennard (1986) , and  of t h e  most  importance  strong  Carkhuff,  Horvath  important  p.344).  (1962, 1982,  Orlinsky  components  and  of t h e  important  and  &  Howard and the  factor  in  aspects  of  this  been d i s c u s s e d  in  detail  perceived  to  note  by  patients"  benefit (Orlinsky  supported  1 9 8 6 ) , G r e e n b e r g and (1978) .  that  therapist  to patient  position is also  Relationship  Truax  resonant  i n d i c a t i n g that  Howard  &  conclude that  contribution  This  1977;  Orlinsky  It i s important  evidence  of  1986;  important  empathy w h i c h has  (1964) d e s i g n e d t h e various  extremely  i s m e a s u r e d as  Howard, 1986,  and  Howard  extensively  feeling solid,  client  i n t h i s review.  empathy makes an  &  and  .  and  been  Gurman, 1977;  t h i s b o n d as  bond i s t h e r a p i s t  there  The  1982,  T r u a x & Wargo, 1966)  o f t h i s b o n d i s an  elsewhere  1962,  1982;  warm t o b o t h t h e r a p i s t  client  bond.  M i t c h e l l , Bozarth & Krauft,  (1986) d e s c r i b e  quality  Orlinsky  r e l a t i o n s h i p or b o n d has  Greenberg,  Carkhuff,  the  i d e n t i f i e d by  Pinsof  Barrett-Lennard  Inventory  to assess  the  client-therapist relationship  by  45 including Support is  therapist  f o r the  r e p o r t e d by  importance Lambert,  to behavioural  In  issue  of  and  therapist.  components  to  the  of  the  Bordin  the  Working A l l i a n c e  the  outcome.  therapist  bond.  therapist  and  important  factor  1986,  357).  p.  The  is  the  concept  clients  t o be  therapies feelings  the  one  the  of  which  the  of  the  outcome"  described  important  open t o  by  bearing  feelings.  more aware o f  client  of  Horvath  a measure,  designed to  most  and  assess they  predictive one  therapeutic  of  the an  Orlinsky on  client-  b o n d between  "extremely  (Orlinsky  &  and  Howard,  Howard  therapeutic  self-relatedness  their  goal.  enhance t h e  quality  is  three  working a l l i a n c e i s  i s c o n s i d e r e d t o be  of p a t i e n t  t o be  e x i s t s between  relationship  i s seen t o  positive  element  apply  relationship  seems t o be  e n c o u r a g e c l i e n t s t o be and  the  development  therapeutic  in patient  an  (1986) t o  t a s k , b o n d and  understanding  client  (1986) w h i c h has  of  I n v e n t o r y , w h i c h was  The  fourth  Bergin  client.  relationship  (1979) i d e n t i f i e d t h e  concept  our and  therapeutic  importance  task dimension  The  w h i c h adds t o relationship  of  the  well.  (1986) d e s c r i b e  t h e s e components  of  as  t h i s a l l i a n c e as  Greenberg  that  the  working a l l i a n c e that  and  stated  of  p e r c e i v e d by  S h a p i r o and  therapists  addition  the  empathy as  or  the  outcome  ability  of  Client-centered  more open t o  their  t h e i r t h o u g h t s and  wishes.  46 From t h e v i e w p o i n t and  acceptance  of c l i e n t - c e n t e r e d  of p r e v i o u s l y d e n i e d  be  t h e m a j o r mechanism o f c h a n g e "  p.  46).  Gestalt  adaptive our  orientation  experience  Awareness states  t h e o r y views system  of emotions  that  and  chair  Gestalt  critic  and  the  does not  a critical  that  c h a n g e may  necessarily i t may  change i n t h e s e  Broughton  occur.  necessary  feelings.  two-  of r e s o l u t i o n  focused  and  Wiggins  stance.  e x p e r i e n c e and  Often  feelings  need t o o c c u r be  1983b)  r e s p o n s i v e toward  feelings.  these  that  of the harsh e x t e r n a l  to a s i g n i f i c a n t  acknowledging  other person,  aspect  they  and  following  o f a more i n t e r n a l l y  inherent i n these  W i g g i n s and  of  painful  emotions  (1979, 1980a, 1982,  t o become aware o f and  expression  us  approach  experience  r e - e n t e r i n g the  a r e a v a l u e d p a r t o f our  in relationship i s by  by  "softening"  the adoption  Feelings  it  It.is  work t h a t  change was  are  1987,  1987).  the G e s t a l t  leads to incomplete  Greenberg  client  actions  and  i n h i s w r i t i n g s on t h e r e s o l u t i o n  important  informs  & Safran,  r e - e x p e r i e n c i n g the blocked  change.  concluded  & Safran,  to  biologically  continually  (Greenberg  ... a p p e a r s  i t i s o f t e n the b l o c k i n g of emotions b e f o r e  unfinished business.  clients  (Greenberg  is essential  e n t e r awareness t h a t  feelings  feelings  e m o t i o n as a  that  i n the world  therapies "experience  these  person and  the feelings  i n our  lives  and  allowing their  Although  this  expression  i n the presence t o be  i t is  of  able to assess  (1979, 1980,  1982)  the the and  (1985) have i n v e s t i g a t e d t h e r e a l m  of  47 interpersonal changes  behaviour  in feelings  reviewed  and  toward  the development  have e x p l o r e d ways t o d e t e c t another  person.  Wiggins  of c i r c u m p l e x models  (1982)  of  i n t e r p e r s o n a l b e h a v i o u r w h i c h have been d e s i g n e d t o d e s c r i b e the u n i v e r s e of c o n t e n t (1980) s u g g e s t s well-suited continuous  ... c l a s s  and  useful  and p e r s o n a l i t y  is  (1985) a l s o  i n the study  using this  Wiggins feel  that  target  individuals'  person.  (1979, this  specific process  feelings  The  format.  One  such  scale  to those that  Stiles  and  of  or  these  o f change i n t h e s e  therapy.  d i s c u s s e d by  Orlinsky  and  Howard  which they  the t h e r a p e u t i c process that  i s making a p o s i t i v e  Snow  i s designed  the sampling  of t h e r a p e u t i c r e a l i z a t i o n  signs within  therapy  i s the  at v a r y i n g p o i n t s i n the t h e r a p e u t i c  element  (1986) i s t h a t  two  towards a s i g n i f i c a n t  facilitates  at the c o n c l u s i o n of  last  and  format  t h e y have d e v e l o p e d  and p r o v i d e s a measurement  feelings  1982)  of i n t e r p e r s o n a l p e r c e p t i o n  feelings  This scale  and  describing  A f f e c t i v e R e a c t i o n s Q u e s t i o n n a i r e (1984) w h i c h t o c a p t u r e an  Wiggins  "particularly  fuzzy boundaries  (p. 2 6 9 ) .  r e s e a r c h and  scales  behaviour.  membership o f a d j e c t i v e s  qualities"  Broughton  would prove  adjective  t h e c i r c u m p l e x model  f o r r e p r e s e n t i n g the  interpersonal Wiggins  that  of i n t e r p e r s o n a l  (1984a,  impact.  1 9 8 4 b ) , and  Carpenter  (1982) i n t h e i r  immediate  impact  indicate (1980),  Tupler  and  r e s e a r c h have f o c u s e d on  the  of t h e r a p y  Stiles,  Stiles  limit  as r a t e d by b o t h t h e c l i e n t  and  48 the  therapist.  Questionnaire  The mood d i m e n s i o n  of the Session  measures p o s t - s e s s i o n  method o f c a p t u r i n g  t h e immediate  Evaluation  mood a n d p r o v i d e s  impact  o f each  a  session.  Greenberg's  (1979, 1980a, 1982, 1983b) d e s c r i p t i o n o f t h e  "softening"  of the harsh c r i t i c  therapeutic  impact.  in  This  o v e r v i e w o f outcome r e s e a r c h  multiplicity  of factors that  conducting psychotherapy importance  treatments  person  shift  i nthe  reflection technique.  n e e d t o be c o n s i d e r e d  research.  A consistent  when  finding i s  delineating the d i f f e r e n t i a l  I t i s a l s o apparent  within  interventions current  of c l e a r l y  h i g h l i g h t s the  t o be u s e d and o f s p e c i f i y i n g t h e c l i e n t  examined.  take place  the  other  a  life.  This  be  i n d i c a t i o n of  s o f t e n i n g may a l s o r e f l e c t  f e e l i n g towards a s i g n i f i c a n t  client's  the  i s a further  an e m p a t h i c  that  these treatments  relationship.  s t u d y two t r e a t m e n t s were u s e d :  The c l i e n t  of u n f i n i s h e d  business.  must  r e l a t i o n s h i p and t h a t t h e  used a r e a d d i t i v e t o that  a n d empathy p l u s  issue to  the Gestalt  issue that  In  empathic  empty-chair  was i n v e s t i g a t e d was  that  49  Chapter I I I  METHODOLOGY  This  chapter  study and b r i e f l y The  design,  analysis  will  discuss  population,  will  present their  be c h a r a c t e r i z e d .  will  be i n c l u d e d .  composition  sampling and data  be d e s c r i b e d  will  t h e instruments used  i n the  and r e l i a b i l i t y . c o l l e c t i o n and  and t h e t h e r a p i s t s and r a t e r s  A d e s c r i p t i o n of the treatments  Participants  used  i n t h e Study  Subj e c t s Subjects first  were s o l i c i t e d  from students  enrolled i n the  year  o f a Master's Degree program  i n Counselling  Psychology  at the U n i v e r s i t y of B r i t i s h  Columbia.  told  that  business issue  t h e s t u d y was an i n v e s t i g a t i o n o f u n f i n i s h e d a n d were a s k e d t o t h i n k  to discuss.  The s u b j e c t s  of a p e r s o n a l l y were n o t i n f o r m e d  the  v a r i a b l e s under c o n s i d e r a t i o n .  the  activities  were d e s c r i b e d  c o m p l e t e a number in  They were  in superficial  o f any o f  of time and  terms ( i e .  of p e n c i l and paper measures, p a r t i c i p a t e  two c o u n s e l l i n g s e s s i o n s  41 v o l u n t e e r s  The amount  meaningful  was s o l i c i t e d  as a c l i e n t , from  eight  c o n t a i n i n g b e t w e e n 10 a n d 20 s t u d e n t s  etc.).  different each.  A pool of classes  Twenty-eight  50 s u b j e c t s were r a n d o m l y  s e l e c t e d from t h i s p o o l o f  volunt eers.  The included only  s u b j e c t s ranged  7 men a n d 21 women.  Some o f t h e s u b j e c t s h a d t a k e n  one i n t r o d u c t o r y c o u r s e  completed  seven c o u r s e s .  t h e amount the past  year  scores  on a r a t i n g  i n both  felt  3.5.  experience  The either  from  during  " 1 " - "no  " 3 " - "somewhat"; t o " 5 " - "maximum".  groups ranged  from  "2" t o " 5 "  with  brought  The  t h e mean  3.6 a n d t h e mean f o r t h e Empathy  t o the study  of change throughout  t h e G e s t a l t empty-chair group.  After  and i n t h e i r  the past  i n the  self-  year.  c o n d i t i o n or t h e empathic  t h e s u b j e c t s were r a n d o m l y  e a c h s u b j e c t was i n d i v i d u a l l y  given  issue of u n f i n i s h e d business  rationale  had e x p e r i e n c e d  s e l e c t e d v o l u n t e e r s were r a n d o m l y a s s i g n e d t o  reflection  the  to rate  B o t h g r o u p s , t h e r e f o r e , showed d i v e r s i t y they  perceptions  they  scale ranging  t h e G e s t a l t group b e i n g  being  i n t h e program and o t h e r s had  The s u b j e c t s were a s k e d  o f change they  change"; through  for  i n age f r o m 24 t o 52 y e a r s a n d  f o r t h e use o f t h e form  experience.  a brief  and then  introduction to  presented  of therapy  assigned  with a  e a c h was t o  51 Therapists Seven t h e r a p i s t s ,  3 men a n d 4 women, were u s e d i n t h e  study.  A l l therapists  Gestalt  therapy c o n s i s t i n g  hour  sessions.  approximately  20 h o u r s  training model. skills  96 h o u r s  a l l therapists  a c c o r d i n g t o t h e Egan model  Each  had w o r k i n g  first  with t h e i r  two u s i n g t h e G e s t a l t  Empathic  a s s i g n e d treatment  the therapists  technique with t h e i r reflection  or o t h e r p e r s o n a l  saw f o u r c l i e n t s ,  T h e r a p i s t s were r a n d o m l y half  skill  experience using these  t e c h n i q u e and two u s i n g  insuring that  of i n t e r p e r s o n a l  two y e a r s .  therapist  empty-chair  i n empty-chair  of unfinished business. A l l  h a d a minimum o f 100 h o u r s  of at least  three-  received  of i n t e n s i v e t r a i n i n g  to the issue  A l l therapists  of t r a i n i n g i n  o f a minimum o f 32 w e e k l y  In a d d i t i o n  work as i t a p p l i e s therapists  had a t l e a s t  modalities  used G e s t a l t  subject  first  reflection.  and h a l f  empty-chair  used  empathic  subject.  Raters. Two r a t e r s were u s e d t o e n s u r e t h a t the  assigned operation  sessions  the  i n which  The r a t e r s  hours  of B r i t i s h of t r a i n i n g  Columbia.  used  reflection  the Gestalt  empty-chair  were g r a d u a t i n g s t u d e n t s i n  Masters program i n C o u n s e l l i n g  University 100  i n b o t h t h e empathic  and t h e s e s s i o n s  t e c h n i q u e was u s e d .  the therapists  Psychology at the  The r a t e r s  had a minimum o f  i n t h e Egan model a n d a t l e a s t  100  52 hours the  of t r a i n i n g  Gestalt  in Gestalt  empty-chair  therapy i n c l u d i n g  training in  procedure.  The v i d e o t a p e s f r o m t h e e m p a t h i c  reflection  were s u b m i t t e d t o two  r a t e r s who  from L e v e l  5 on t h e C a r k h u f f S c a l e ( C a r k h u f f ,  1969)  1 to Level  i n which  facilitative.  Level The  rated  sessions  therapist  3 i s c o n s i d e r e d t o be m i n i m a l l y  raters  listened  t o two f i v e - m i n u t e  segments t a k e n a t a p p r o x i m a t e l y t h e 15 m i n u t e 35 m i n u t e  mark i n each  segment was scale. 3.0.  at l e a s t  chair  minimally f a c i l i t a t i v e  of the G e s t a l t raters  at a l l " , through  "All  t h e t i m e " was  of  "A  used.  A  empty-chair  five point  little", The  r a t e r s were t o d e t e r m i n e  of l e s s  sessions  the G e s t a l t scale  than  empty-  "Mostly" to  used c l i n i c a l  at l e a s t  were  r a n g i n g from  t h e segments were  that  each  on t h e C a r k h u f f  "Somewhat" and  raters  d e t e r m i n e where on t h e s c a l e  the  retained.  to ensure that  dialogue occurred.  "Not  The  and d e t e r m i n e d w h e t h e r  T h e r e f o r e a l l s e s s i o n s were  s u b m i t t e d t o two  to  session  mark and  None o f t h e segments w a r r a n t e d a r a t i n g  Videotapes  responses  judgement placed.  the middle  rating  "Somewhat" o c c u r r e d .  A ten-minute rating.  The  rating  d e t e r m i n e t o what occurred.  segment was  s e l e c t e d and g i v e n a  s c a l e d e s c r i b e d above was  extent the G e s t a l t  Clinical  judgement was  combined  used to  empty-chair  technique  used to determine  that  the  53 o p e r a t i o n was p e r f o r m e d the  occurrence  Gestalt  of the G e s t a l t  sessions.  a minimum  rating  sessions.  adequately.  Both  Both  empty-chair  raters  also  o f "Somewhat"  confirmed  dialogue i n a l l  confirmed  that  occurred i n a l l Gestalt  T h e r e f o r e , a l l s e s s i o n s were  Measuring  raters  retained.  Instruments  Qverview The  measuring  of purposes.  instruments  i n this  Subject d e s c r i p t i o n  study  instruments  d e s c r i b e t h e s u b j e c t s and t o g a i n c l i e n t Relationship clients  who  t h o s e who  instruments  were u s e d  were n o t .  emotional  Outcome  reaction  i n s t r u m e n t s were u s e d  were u s e d t o  information.  t o determine  instruments of t a r g e t  to the s i g n i f i c a n t  those  were u s e d t o complaints other.  t o measure t h e amount  a s s o c i a t e d with the p r e s e n t i n g complaint client's  number  were engaged i n t h e t h e r a p e u t i c p r o c e s s a n d  measure t h e d e p e n d e n t v a r i a b l e s and  served a  Session  of discomfort  a n d t o measure t h e  p e r c e p t i o n o f t h e s e s s i o n a n d p o s t - s e s s i o n mood.  54 Subject  The  Sixteen The  Personality Factor Questionnaire  Sixteen  (Cattell,  D e s c r i p t i o n Instruments  Personality Factor  Eber, & Taksuoka,  subjects.  Two  factors,  administered  t o a l l the  experimental  session.  was  the  that the of  first  a low  primary  score  on  Factor  Factor source  this  torpid,  frustration,  and  The  16-PF  personality  the  theory  test  and  ego  strength,  i t was  felt on  considered  a measure  from r e l a x e d ,  tranquil,  frustrated, source  driven  trait  objectively  w i t h i n the  and  selected.  scored  measures  a r e b a s e d on  sixteen  broader context  and  personality of a  general  a population  of  subjects.  16-PF  The  reliability  and  first  would n e g a t i v e l y impact  encorporating  Handbook f o r t h e validity  to the  s e l e c t e d as  ranging  the  were  determined p e r s o n a l i t y v a r i a b l e s  A comprehensive review  extensively  trait  independently  o f p e r s o n a l i t y and clinical  F a c t o r Q4,  a measure o f  second primary  which  chosen to d e s c r i b e  F a c t o r Q4,  These f a c t o r s r e s t  n o r m a l and  C,  factor  secondary dimensions  traits.  C and  i s a standardized  factor-analytically four  was  u n f r u s t r a t e d to tense,  o v e r w r o u g h t was  Questionnaire  subjects p r i o r  counselling sessions. general  1970)  (16-PF)  researched.  of t h e  (Cattell,  16-PF  is available in  Eber, & Taksuoka,  of the  16-PF  1970).'  have b e e n  Test-retest r e l i a b i l i t y  the  are  from  (.58)  to  (.92)  7 day  interval  interval. indirect  f o r each s o u r c e and  validities  Client  Questionnaire subjects  subject's  from  report  B and to gain  (.63)  to  forms  o c c u r e n c e s had  with  a 2  a 2 t o 48  (.44)  to  mont  (.92)  and  (.96).  C)  and  a l s o important  were a d m i n i s t e r e d  to determine  these  which might  change t h a n t h e  about  to assess  t a k e n p l a c e between t h e  and  A,  r e a c t i o n to the  have had  for  with  (Questionnaire  i n therapy  s e s s i o n s w h i c h may sessions  test  subjective information  of change i n t h e i r  I t was  (.88)  the  range from  Questionnaire  involvement  perception  to  on  Information  Three c l i e n t  other.  (.36)  Direct validities  Subjective  all  from  trait  an  treatment  impact  on  the  their significant  i f any  two  to  unusual  experimental  the  outcome  have b e e n more  of  responsible  sessions.  Bfllit-lamhip ImtEumanfei Barrett-Lennard The Lennard,  Barrett-Lennard 1964)  perception and that the  Relationship  was  of the  client  which  Relationship  designed  (RI) Inventory  t o measure t h e  (Barrett-  client's  c o u n s e l l o r ' s warmth, c o n g r u e n c e ,  p o s i t i v e regard. " i t i s the  Inventory  The  RI  i s based  q u a l i t y of the i s t h e most  on R o g e r ' s  empathy  statement  i n t e r p e r s o n a l encounter  significant  element  in  wit  56 determining  effectiveness"  Rogers' b e l i e f for  that  the  (Rogers,  client  change i n b e h a v i o u r t o  research  only  the  sixteen  strongly  occur.  stages to is  no  that  "No,  tentative was  this  choice  administered  experimental  may  f o r empathic  studies  or  to  the  of  this  empathy  sub-  perception  four  on  qualities  purposes  of  the  "Yes,  I  intermediate true".  ensure that  "no"  The  There  subjects  d i r e c t i o n , however  empathy  scale  of the  of the  RI  second  the  24  retest  reliabilities  (1986) s t a t e d  studies  that  "extensive  and  split-half  understanding  stability of  across  of t h e s e  of  (.86).  findings  internal reliability He  found  f o r empathy  there strong  was  of  and  internal  f o r empathy t o be  (.84)  (.85).  of  Gurman in a  ten  review  studies  reliabilities and  test-  Barrett-Lennard  e v i d e n c e of c o n t e n t  evidence  reliability  validity  (predictive)  construct  (p. 459) .  Barrett-Lennard distinct  these  i t i s not  completion  of t e s t - r e t e s t r e l i a b i l i t y .  validation"  that  (1962) r e p o r t e d  (1977) c o n f i r m e d t h e  and  through  be.  and  session.  coefficients  fourteen  "yes"  85)  items range from  category  a f t e r the  Barrett-Lennard  of  The  feel  or m i d p o i n t  make a s e l e c t i o n i n t h e  the  subject's  i t is true"  I strongly  neutral  For  items comprising  understanding.  feel  p.  must p e r c e i v e  s c a l e were u s e d t o measure t h e therapist's  1971,  stages  (1981) d e l i n e a t e d  involved  i n the  process  a sequence of of  empathic  three  57 interaction:  empathic  r e s o n a t i o n by  expression  of the c l i e n t ;  expression  or e x p r e s s e d  p e r c e i v e d by method and articles  he  t h e OS  Form o f t h e RI  he  form  Inventory  Working A l l i a n c e  self-report  Inventory  taps  the  In t h i s  the  both  response study  subject's  instrument  (Horvath,  designed  dimensions:  T a s k , Bond and  Goal.  p e r c e p t i o n s of t h e i r  seven-point  Likert  "sometimes" t o  Horvath R e v i s e d WAI reliability:  For  is a  t o outcome a l o n g  i n the  each item t h e  from  three  was early  subjects rate  along a f u l l y "never"  36-  the  This instrument  therapist  scale ranging  1982)  to assess  t o sample t h e t h e r a p e u t i c a l l i a n c e  of the r e l a t i o n s h i p .  suggest  other's  In  (WAI)  of the working a l l i a n c e  their  theory,  history.  of t h e RI  to assess  relationship  stages  the  as  o f r e c e i v e d empathy.  Working A l l i a n c e  designed  reviewed  of the  used  the  r e c e i v e d empathy  or Phase 3 empathy.  was  to  communicative  i t s 25 y e a r  description  the r e l a t i o n s h i p  item  over  s t r e s s e d t h a t t h e OS  within  The  In 1986  o f t h e RI  r e c e i v i n g person's  perception  the t h e r a p i s t ' s  empathy; and  the c l i e n t .  uses  the t h e r a p i s t  anchored  through  "always".  and  Greenberg  which y i e l d e d Goal  (1986) r e p o r t e d r e s e a r c h on the  following coefficients  (.89), T a s k  t h a t the Task dimension  most u s e f u l p r e d i c t o r  (.92), and o f t h e WAI  of a l l a s p e c t s  Bond  of  (.92).  seems t o be  of t h e r a p y  the  outcome  They the and  58 that  this  dimension  psychotherapy strategies" dimension the  "may  be  process.across (p. 5 5 3 ) .  o f t h e WAI  was  situations.  administered i n therapy  This dimension of the  second  component  a variety  In t h e p r e s e n t  s u b j e c t ' s engagement  completion  a critical  was  of  in  intervention  study  only the  i n order  i n both  t o measure  experimental  administered after  experimental  Task  the  session.  Outcome M e a s u r e s  Target  Complaints  The Saric,  Target  Stone,  designed  Measure  Complaints  F o l l o w i n g treatment on  "No  c h a n g e " t o "A  lot  better".  ratings  to  i s an  to i d e n t i f y  a five-point  i s asked  Imber,  Hoehn-  instrument the  before beginning  the c l i e n t  little  (Battle,  primary  treatment.  t o r a t e changes i n  scale ranging  from  "Worse" t o  b e t t e r " t o "Somewhat b e t t e r " t o  (1966) r e p o r t e d h i g h l y r e l i a b l e  the Target  Complaint  Discomfort  the degree of d i s c o m f o r t caused  gauge t h e r e l i a b i l i t y  instrument measures.  is detailed  by  Box  i n the  section  Scale  They to  each c o m p l a i n t  of t a r g e t c o m p l a i n t  "A  severity  o f p r e - s e s s i o n and p o s t - s e s s i o n c o m p l a i n t s .  developed assess  et a l  1966)  the c l i e n t  problems c a u s i n g d i s t r e s s  Battle  Measure  Nash, & F r a n k ,  to enable  each c o m p l a i n t  (TC)  severity.  describing session  and This  59 Battle the  e t a l (1966) c i t e  TC measure by a n a l y z i n g  complaint  improvement  outcome m e a s u r e s . with  a l l four  In  again  and comparing  scores  with  subjects  regarding  sessions  following  one week  Wiggins  item  other  were a s k e d t o i d e n t i f y t h e i r one  the s i g n i f i c a n t other before the  began and t o r a t e  changes i n t h i s  t h e second experimental  s e s s i o n and  later.  (ARQ)  A f f e c t i v e R e a c t i o n s Q u e s t i o n n a i r e was d e s i g n e d by (1984) t o measure an i n d i v i d u a l s e m o t i o n a l  to another person. model  target  the r e s u l t s of four  A f f e c t i v e Reactions Questionnaire The  i t s mean  measures.  core complaint  complaint  f o r the v a l i d i t y of  The TC c o r r e l a t e d t o a s i g n i f i c a n t d e g r e e  t h i s study  experimental  evidence  The ARQ i s a t w o - d i m e n s i o n a l  of i n t e r p e r s o n a l single adjective  semantically  bipolar  weighting  the  scores.  Superior,  scales opposite  into four  scales  other  four-  representing  The e i g h t by  were t i t l e d  reversing and combining Confident,  and D i s c o u r a g e d .  a r e a s k e d t o i n d i c a t e how a c c u r a t e l y  described  significant  each end  variables.  The r e s u l t i n g s c a l e s  Subjects adjective  with  on one end o f t h e b i p o l a r p a i r s  Intolerant  circumplex  f e e l i n g s c o n s i s t i n g of eight  d i m e n s i o n s were c o l l a p s e d the  reaction  t h e i r current  an  f e e l i n g s towards a  on an e i g h t - p l a c e  Likert scale  ranging  60 from  "1" - extremely  inaccurate,  i n a c c u r a t e , through  t o "8" - e x t r e m e l y  administered  three times;  second experimental  "4" -  accurate.  before  slightly  The ARQ was  the f i r s t  and a f t e r t h e  s e s s i o n a n d one week a f t e r  t h e second  session.  Session  Measures  Session Evaluation Questionnaire Stiles' consists in  to  of twenty-four  bipolar  semantic  t o measure s e s s i o n i m p a c t .  responding  each  of twelve  the phrase along  "Right  different  a n d Snow  level  follows: Positivity  of twelve  ".  (.84 t o . 8 9 ) ;  therapist-client  adjective " and  responding to  The SEQ y i e l d s perceptions  results  of therapy  two d i m e n s i o n s o f  and A r o u s a l .  therapist  across  pairs  v a r i a n c e removed as  Smoothness  (.76 t o . 9 2 ) ; a n d A r o u s a l  inter-correlations  asked  (1984b) r e p o r t e d i n t e r - c o r r e l a t i o n s f o r  comparisons with  Depth  and i s  The s u b j e c t s were  Smoothness a n d D e p t h : a n d a l o n g  Stiles  presented  " T h i s s e s s i o n was  of p a r t i c i p a n t s '  p o s t - s e s s i o n mood; P o s i t i v i t y  client  format  adjective pairs  now I f e e l  two d i m e n s i o n s  sessions;  f o r each  t o the phrase  (1984)  adjective scales  differential  p l a c e an "X" on t h e l i n e  pairs for  Session Evaluation Questionnaire  a seven-point  designed  (SEQ)  (.79 t o . 9 1 ) ;  (.61 t o .84) a n d  sessions with  t h e e f f e c t s of  removed as f o l l o w s :  Depth  (.74 t o  61 .82); and  Smoothness  Arousal  that  (.77 t o . 8 7 ) ;  (.54 t o . 7 9 ) .  Positivity  Stiles  (.76 t o . 8 5 ) ;  a n d Snow  (1984a)  estimated  t h r e e t o s i x s e s s i o n s would be needed t o a t t a i n  retest  reliability  differentiation  The session  o f (.80) t o o b t a i n a  among dyads  on e a c h  SEQ was a d m i n i s t e r e d a f t e r t o both  a  test-  reliable  index.  each  experimental  t h e s u b j e c t s and t h e t h e r a p i s t s  independently.  Target  Complaints  The  Discomfort  s u b j e c t s used  Box S c a l e  the Target  Complaints  S c a l e t o r a t e t h e amount o f d i s c o m f o r t p r e s e n t i n g t a r g e t complaint Complaint  box;  Measure d e s c r i b e d above.  "a l i t t l e "  Box  associated with the  Battle  e t a l (1966)  column d i v i d e d  into  The words " n o t a t a l l " a r e p r i n t e d b e s i d e by t h e f o u r t h box f r o m  much" by t h e s e v e n t h or  Discomfort  as i d e n t i f i e d by t h e T a r g e t  d e v i s e d t h e TCDBS as a v e r t i c a l boxes.  (TCDBS)  thirteen  t h e bottom  t h e bottom;  "pretty  box; a n d " c o u l d n ' t be w o r s e " by t h e t o p  t h i r t e e n t h box.  In  a reliability  correlation prior target  Battle  e t a l (1966) f o u n d t h e  between t h e p r e - s e s s i o n r a n k s  complaints complaints  was  results.  (.68).  The s e v e r i t y  f o r the o r i g i n a l ratings  of the  d i d n o t change t o a s i g n i f i c a n t  degree  leading the authors reliable  study  to conclude  t h a t t h e TCDBS  produced  The  instrument  discomfort each  The  used  to rate the subjects'  regarding the t a r g e t complaint  experimental  Therapist  was  session for a total  Questionnaire TQ was  b e f o r e and a f t e r  of four  ratings.  (TQ)  administered after  each s e s s i o n t o  determine  t h e t h e r a p i s t ' s p e r c e p t i o n of t h e i n t e r v e n t i o n performed to assess the  t h e t h e r a p i s t ' s view of the r e s o l u t i o n  Gestalt  Empty-Chair  The designed  Gestalt  of Treatments  Dialogue  empty-chair  to access  d i a l o g u e i s an a c t i v e  unexpressed  e x p r e s s i o n and i n t e g r a t i o n  emotional this  schema.  work:  emotions and f a c i l i t a t e  Three p r o c e s s e s  (Greenberg,  significant  modality  seem t o be i n v o l v e d i n  1986a).  other person  This w i l l  i s asked  i n t h e empty c h a i r  involve the c l i e n t ' s  - perhaps v i s u a l i z i n g  hearing the person's  voice.  image so t h a t e m o t i o n a l  client.  their  i n t o the i n d i v i d u a l ' s  In t h e a r o u s a l s t a g e t h e c l i e n t  contact.  technique  a r o u s a l ; e x p r e s s i o n ; and r e c o v e r y and  completion  the  a c h i e v e d by  subject.  Description  full  and  this  the  a n d t o make  preferred  person  The f o c u s  t o imagine  sense  or i m a g i n i n g  i s on  intensifying  a r o u s a l i s e x p e r i e n c e d by t h e  The  central  part  of the process i s e x p r e s s i o n .  the c l i e n t  has i m a g i n e d  the c l i e n t  i s t h e n a s k e d what h e / s h e i s e x p e r i e n c i n g .  Initially which  this  the other person  e x p e r i e n c e may  i s viewed  as c o n f l u e n t  Once  i n t h e empty  chair  be e x p r e s s e d as a c o m p l a i n t anger  and h u r t w h i c h  must  s e p a r a t e d and a l l o w e d independent  expression.  expression  is intensified  t h e use of a v a r i e t y  techniques  including repetition  feeding use  through  sentences; h i g h l i g h t i n g  of r e v e r s a l s ,  such  of phrases  majority  of t h e time  empty-chair experience  i s spent  of the c l i e n t .  emotional  is  With  this  demand  There  n e e d e d as a c h i l d giving  about  occurred. what was  to i n t e n s i f y the  i s not t o develop a  a r e g r e s s i o n of  not a v a i l a b l e  really  the g r i e v i n g  at the loss  up t h e r e s e n t m e n t s .  a n d what  needed cycle  c a n be  a r e two components t o t h e l o s s : and n o t r e c e i v e d ;  t o be  of resentments i t  f o r what was  a n d e x p r e s s i o n o f need and t h e sadness  b l o c k i n g of  I t i s important t o  F o l l o w i n g the statement  t o e x p r e s s t h e demand  c a n be i n i t i a t e d expressed.  The  chair with the  seems t o i n v o l v e  expression f i r s t  stated.  crucial  The i n t e n t  resistance  to cry".  b a c k t o c h i l d h o o d when t h e o r i g i n a l  allow the resentments clearly  i n the s e l f  and t h  would decrease the a f f e c t i v e e x p r e s s i o n .  The p r o c e s s i n v o l v e d the c l i e n t  want  of  or a c t i o n s ;  as s u p p o r t i n g a c l i e n t ' s  s e r v i n g as a s t i m u l u s o b j e c t  d i a l o g u e which  This  non-verbal a c t i v i t y ;  t o c r y i n g by h a v i n g them s a y " I d o n ' t  be  what  i s lost  by  was  64  Expression letting  i s close  t o c o m p l e t i o n when t h e r e  go f r o m t h e c l i e n t .  recognition  that  need f u l f i l l e d .  the  forgiveness  client  involves a  not take  go o f t h e e x p e c t a t i o n  place of having  T h e r e i s a s e n s e o f no l o n g e r  t o make i t d i f f e r e n t . forms:  usually  what was d e s i r e d w i l l  a c c o m p a n i e d by a l e t t i n g this  This  isa  trying  C o m p l e t i o n may t a k e a number o f  - a signal of softening  and a s i g n  has c o m p l e t e d t h e u n f i n i s h e d b u s i n e s s ;  that  an a c t i o n  t e n d e n c y may emerge - a d e c i s i o n may be made t o t a l k t o t h e significant yet  feel  other;  finished  a temporary or t h e c l i e n t  emerging p o s i t i v e f e e l i n g an  goodbye - t h e c l i e n t may n o t want  the  situation  forgiveness  hasn't  followed  other.  a sense of c l o s u r e ,  or  that  a statement  often  involves  of c a r i n g .  a statement  A final  b u s i n e s s work i n v o l v e s  by l i n k i n g  experience.  of saying  e x p r e s s e d by b o t h t h e c l i e n t  This  unfinished  meaning b r i d g e life  involves  by a s t a t e m e n t  completing  resignation  c h a n g e d o r may i n v o l v e  not been p r e v i o u s l y  significant  other;  that  i s impossible.  Resolution had  t o l e t go o f an  towards t h e s i g n i f i c a n t  i m p a s s e may emerge - t h i s may i n v o l v e  may n o t  what  and t h e o f needs  step i n creating a  t h e work t o t h e c l i e n t ' s • c u r r e n t  65 Empathic  Reflection  Carkhuff  (1969) d e v e l o p e d  the communication  o f empathy.  communicate t o t h e c l i e n t his/her  difficulties  eight  of understanding of  the c l i e n t  understanding  and t h e u n d e r s t a n d i n g  (1969) s t a t e s  that  in  communicating  the helper w i l l  empathic  guidelines for  These a r e d e s i g n e d t o  a depth  so t h a t  training  may c l a r i f y  of others. f i n d most  understanding  self-  Carkhuff  effectiveness  when  1. c o n c e n t r a t i n g i n t e n s e l y upon t h e h e l p e e ' s e x p r e s s i o n s , both v e r b a l and n o n v e r b a l , 2.  c o n c e n t r a t i n g upon r e s p o n s e s t h a t a r e interchangeable with those of the helpee,  3.  f o r m u l a t i n g responses i n language most a t t u n e d t o t h e h e l p e e ,  4. r e s p o n d i n g i n a f e e l i n g t o n e c o m m u n i c a t e d by t h e h e l p e e , 5.  that i s  similar  t o that  c o m m u n i c a t i n g empathic u n d e r s t a n d i n g ( t h e h e l p e e ) i s most r e s p o n s i v e ,  when he  6. m o v i n g t e n t a t i v e l y t o w a r d e x p a n d i n g a n d c l a r i f y i n g the helpee's experiences at higher l e v e l s , 7. c o n c e n t r a t i n g upon what by t h e h e l p e e ,  i s not b e i n g  expressed  8. e m p l o y i n g t h e h e l p e e ' s b e h a v i o r a s t h e b e s t g u i d e l i n e t o assess the e f f e c t i v e n e s s of h i s (the h e l p e r ' s ) r e s p o n s e s . (p. 202-204)  Procedure  Before  the f i r s t  s e s s i o n s u b j e c t s were a s k e d t o  complete t h e a b b r e v i a t e d A f f e c t i v e Reactions to  identify  (TC)  their  Measure.  participated briefed  Questionnaire  core complaint  i n an i n d i v i d u a l  unfinished business.  Session  Complaint  They were  were t o r e c e i v e a n d a  f o r i t s use i n the r e s o l u t i o n of  The s u b j e c t s t h e n  Evaluation Questionnaire  their  completed first  counselling  Before  (SEQ) a n d Q u e s t i o n n a i r e  the subjects returned this  C.  Inventory  session subjects  After  SEQ, Q u e s t i o n n a i r e  Alliance  asked  F o l l o w i n g the s e s s i o n the subjects completed the  Questionnaire the  using the Target  they  A before beginning  A week l a t e r session.  were  induction session.  of therapy  r a t i o n a l e was p r e s e n t e d  session.  (ARQ) a n d t h e y  Following a short break the subjects  on t h e f o r m  Questionnaire  f o r m o f t h e 16-PF, a n d t h e  for their  B, t h e T a s k d i m e n s i o n  Lennard R e l a t i o n s h i p Inventory.  second  completed  the session the subjects  a n d t h e Empathy  B.  completed  of t h e Working  s c a l e of t h e B a r r e t t -  The s u b j e c t s t h e n  completei  t h e ARQ a n d t h e TC M e a s u r e .  The and  s u b j e c t s took  home a p a c k e t  t h e TC M e a s u r e t o be c o m p l e t e d  s e c o n d s e s s i o n a n d t o be r e t u r n e d  c o n t a i n i n g t h e ARQ  one week f o l l o w i n g t h e i n an e n c l o s e d  addressed  67 FIGURE 2 ORDER OF ADMINISTRATION OF MEASURING  II  TI  T2  1  .  si:  :  !  EI  :si  1 week  INSTRUMENTS  !  si:  :s2  E2  : ~~~  Factor C aA d  !  Rl  :SI . R2 :s2 TI  TI  Target  T2  Affective  51  Target  52  Session  Rl  Barrett-Lennard R e l a t i o n s h i p Inventory - Empathy S c a l e  R2  Working A l l i a n c e Inventory - Task Dimension  El  First  E2  Second E x p e r i m e n t a l  Complaint  Measure  (TO  Questionnaire  Discomfort  Session Session  (ARQ)  Box S c a l e  Evaluation Questionnaire  Experimental  T2  Fa«tw  16-PF;  Reactions  TI  T2  II  Complaint  1 week  (WAI)  (TCDBS)  (SEQ)  (RI)  68 stamped  envelope.  Figure  2 shows a summary  o f t h e measures  administered.  F o l l o w - u p phone c a l l s day  were made t o t h e s u b j e c t s  t h e take-home m e a s u r e s were t o b e c o m p l e t e d .  subjects treated those  failed  t o r e t u r n t h e forms.  as i f t h e i r  follow-up  to administering  permission videotape  was o b t a i n e d  audiotaped  permission  case  subject  of t h i s  to determine  session.  any o f t h e m e a s u r e s  with  to videotape  i fthe therapeutic  each  Therapist  Questionnaire  signed  t o audiotape  the exception  the audiotapes  Following  were  A l l counselling sessions  and v i d e o t a p e d  who w i t h h e l d  Their data  from each s u b j e c t  the sessions.  Two  r e s p o n s e s were i d e n t i c a l t o  made f o l l o w i n g t h e s e c o n d  Prior  on t h e  and  were  o f one s u b j e c t  the sessions.  In t h e  were u s e d by t h e r a t e r s  i n t e r v e n t i o n had o c c u r r e d .  s e s s i o n t h e t h e r a p i s t s completed t h e a n d t h e SEQ.  Scoring Scoring using  occurred  t h e Empathy  ensure t h a t minimally  i n two s t a g e s .  A c h e c k was f i r s t  s c a l e of the R e l a t i o n s h i p  a l l clients  empathic.  perceived  their  Inventory  made  to  t h e r a p i s t as  The r a t e r s t h e n r a t e d t h e t a p e s t o  ensure that  t h e t h e r a p i s t s were c o r r e c t l y  therapeutic  operations  as d e s c r i b e d a b o v e .  conducting  both  69 Design  The the  design  employed  and A n a l y s i s  in this  s t u d y was  P r e t e s t - P o s t t e s t - C o n t r o l Group D e s i g n  1982) than  employing an  used  techniques  and  and  a control  group.  i n which a l l t h e r a p i s t s the  order  used  A  used  empathic  rather  counterbalanced both  treatment  varied  reflection  empty-chair  characteristics  so t h a t  and  half  technique.  to e l i m i n a t e the p o t e n t i a l  e f f e c t s between t h e t h e r a p i s t s  Gall,  treatments  o f a d m i n i s t e r i n g was  empathy p l u s t h e G e s t a l t  d e s i g n was  ( B o r g and  experimental  t h e t h e r a p i s t s began w i t h  began w i t h This  different  experimental  d e s i g n was  half  two  a m o d i f i c a t i o n of  confounding and  treatment  differences.  The  major a n a l y s i s  a multivariate analysis on t h e A f f e c t i v e variance with Target as  The  of  of v a r i a n c e with  Reactions  Questionnaire.  Discomfort  An  was  measures  analysis  to analyze  of  the change  treatment.  r e p e a t e d measures  Box  multivariate  used  repeated  effect  Measure which measured s e l f - r e p o r t e d  s e s s i o n d a t a were was  variance with  used  t o measure t r e a t m e n t  r e p e a t e d m e a s u r e s was  Complaint  a result  used  on t h e T a r g e t  analysis  the  of v a r i a n c e w i t h  and  a  r e p e a t e d measures  Session Evaluation Questionnaire  measured s e s s i o n e f f e c t  p o s t - s e s s i o n mood.  of  Complaint  S c a l e w h i c h m e a s u r e d s e s s i o n c h a n g e and  analysis  to analyze  a n a l y z e d u s i n g an  was  which  70  The  Working A l l i a n c e  Relationship assess for  Inventory  Inventory  were a n a l y z e d u s i n g a t - t e s t t o  the subject-therapist  the e f f e c t  and t h e B a r r e t t - L e n n a r d  relationship  o f non-engagement  and t o c o n t r o l  on t h e t r e a t m e n t  outcome.  71 Chapter  IV  RESULTS  This  chapter  presents  analyses performed measures.  on t h e t r e a t m e n t  The r e s u l t s  m e a s u r e s were u s e d  the r e s u l t s  of a n a l y s i s  t o determine  of t h e  and s e s s i o n outcome of v a r i a n c e with  the d i f f e r e n t i a l  empathic  reflection  dialogue  on one outcome measure - t h e T a r g e t  Measure Target  (Battle Complaint  Reactions  repeated  effects  and empathy p l u s t h e G e s t a l t  of  empty-chair  Complaint  e t a l , 1966) and one s e s s i o n measure - t h e Discomfort  A multivariate analysis was p e r f o r m e d  statistical  (Battle  of v a r i a n c e with  on t h e s e c o n d  Questionnaire  Box S c a l e  et a l , 1966).  r e p e a t e d measures  outcome measure - t h e A f f e c t i v e  (Wiggins,  1984) and t h e  second  s e s s i o n measure - t h e S e s s i o n E v a l u a t i o n Q u e s t i o n n a i r e (Stiles,  1984).  relationship Lennard  T - t e s t s were u s e d  instruments;  t h e Empathy  R e l a t i o n s h i p Inventory  the Task dimension (Horvath,  1982).  to analyze the scale  of the B a r r e t t -  ( B a r r e t t - L e n n a r d , 1964) and  of the Working A l l i a n c e  Inventory  72 Subject The  Sixteen  Description  Personality Factor  A t-test  was  strength.  indicated that  two  groups  A t-value  no  between t h e  two  Both groups  scored  of  significant  sten  Cattell,  A t-test  was  that  between t h e The with  scores the  r a n g e as  felt  they  no  within  two  groups  A t-value  significant  on  d e f i n e d by  Cattell,  measure  which  C with  'average'  F a c t o r Q4, was  as  a a measure  found  of  which  (p_=.750) e x i s t e d  between s t e n within  E b e r , and  the  range  cx=.05 c o n f i d e n c e  the  level.  (1970).  difference  fell  3 and the  Taksuoka  level. sten  8  'average' (1970).  Information  s u b j e c t i v e measures  indicated that  were i n v o l v e d i n t h e events  the  o f -0.32  mean f o r each g r o u p f a l l i n g  significant  Factor  Taksuoka  c o n d i t i o n s at  Client  found  the  cX=.05 c o n f i d e n c e  4 or a b o v e on  f o r both groups  Subjective The  two  was  C,  u s e d t o d e t e r m i n e i f t h e r e was  frustration.  indicated  1.07  Factor  a  d i f f e r e n c e (p_=.295) e x i s t e d  E b e r , and  d i f f e r e n c e between t h e general  i f t h e r e was  on  c o n d i t i o n s at the  means f o r each g r o u p f a l l i n g d e f i n e d by  Questionnaire  used to determine  d i f f e r e n c e between the o f ego  Instruments  occurred  f o r any  the p e r i o d between the  two  have had  effect  a significant  therapeutic of the  a l l subjects process. subjects  No during  s e s s i o n s w h i c h were c o n s i d e r e d on  the  therapy.  to  73 Relationship  Barrett-Lennard The  Relationship  subjects'  Barrett-Lennard perceived obtain  as m i n i m a l l y  condition  These s u b j e c t s not  perceive  As a r e s u l t in  of  In o r d e r  t o be  had t o  out o f a p o s s i b l e  two f r o m t h e G e s t a l t  therapists  condition, scale  rated  their  of the RI.  as b e i n g m i n i m a l l y  were c o n s i d e r e d  12 i n t h e G e s t a l t The mean  i n t h e s t u d y was  t o have p a r t i c i p a t e d  condition  score  empathic.  a n d 12 i n t h e  f o r the therapists  34.26, w i t h  a standard  deviation  7.66.  A t-test  was u s e d t o d e t e r m i n e  d i f f e r e n c e b e t w e e n t h e two g r o u p s the  therapists.  that  A t-value  no s i g n i f i c a n t  two c o n d i t i o n s and  of the  therapists  16 on t h e empathy  24 s u b j e c t s  condition.  remaining  scale  empathy  were removed f r o m t h e s t u d y b e c a u s e t h e y d i d  their  the study,  empathic  subjects,  lower than  therapist's  o f 16 on t h e s c a l e ,  a n d two f r o m t h e e m p a t h i c  therapists  (RI)  Inventory.  facilitative,  a minimum s c o r e Four  of t h e i r  t o t h e empathy  Relationship  maximum o f 48.  Inventory  perception  was d e t e r m i n e d a c c o r d i n g  Instruments  standard  Table  a t t h e CX=.fJ5  group  reflection  (32.18) was  group  i n perceived  empathy o f indicated  (p_=.231) e x i s t e d b e t w e e n t h e  confidence  level.  The means  o f t h e two g r o u p s may b e f o u n d i n  1 and i n d i c a t e t h a t  Gestalt  was a  o f 1.23 was f o u n d w h i c h  difference  deviations  i f there  (36.17).  t h e mean  f o r t h e empathy  lower t h a t  that  plus  f o r t h e empathic  74 TABLE 1 MEANS AND STANDARD  DEVIATIONS OF  BARRETT-LENNARD RELATIONSHIP INVENTORY EMPATHY  DIMENSION SCORES *  TREATMENT GROUP  MEAN  STANDARD DEVIATION  Empathy p l u s G e s t a l t Empty-Chair D i a l o g u e  32.1818  7.653  Empathic R e f l e c t i o n  36.1667  7.826  * Administered after  the second  session  TABLE 2 MEANS AND THE  STANDARD  DEVIATIONS OF  WORKING ALLIANCE INVENTORY TASK DIMENSION SCORES *  TREATMENT GROUP  MEAN  Empathy p l u s G e s t a l t Empty-Chair Dialogue Empathic R e f l e c t i o n * Administered after  49.4167  ;  t h e second  47.4167 session.  STANDARD DEVIATION  3.343 4.274  75  Working A l l i a n c e A t-test WAI  was  to determine  perception t-value  Inventory used  to analyze  i f t h e r e was  of t h e i r  of  (WAI)  -1.28  a difference  therpists' was  found  ability  w h i c h was  CX=.05 c o n f i d e n c e  (E=.22) a t t h e  s t a n d a r d d e v i a t i o n s f o r t h e two 2 and  indicate  Gestalt the  t h a t t h e mean  g r o u p was  empathic  slightly  reflection  the Task dimension  not  task.  A  significant  The  g r o u p s may  means  be  (49.42) f o r t h e  h i g h e r than  the  i n the s u b j e c t s '  t o s t a y on  level.  of  and  found empathy  t h e mean  i n Table plus  (47.42) f o r  group.  Outcome M e a s u r e s  Target  Complaint  An  analysis  performed  on  administered the  second  later  the  (TC)  of v a r i a n c e w i t h TC  twice  r e p e a t e d measures  Measure because t h i s - immediately  experimental  session  instrument  following (Score  1)  the and  was was  completion again  of  one-week  ( S c o r e 2) .  Analysis revealed Ot =.05 the  Measure  of v a r i a n c e of t h e s e  t h a t t h e r e was  confidence  level  CX=,10 c o n f i d e n c e  effect  of time  receiving  the  and  no  significant  although  level  therapy  results  (Table  3)  difference  at  t h e r e was  significance  between t h e two were c o m b i n e d  empathy p l u s G e s t a l t  the  g r o u p s when  (p_=. 0 6 7 ) .  at the  Those  c o n d i t i o n showed more  76 TABLE 3 ANALYSIS OF VARIANCE WITH REPEATED MEASURES  OF  TARGET COMPLAINT MEASURE SCORES  SOURCE  SUM OF SQUARES  Between Therapies S-within t h e r a p i es Between Time S-interacting w i t h time Therapies X Time  DEGREES OF FREEDOM  MEAN SQUARES  1.333  1  1.333  46.583  22  2 .117  0.750  1  0.750  7.917  22  0.360  1.333  1  1.333  F RATIO  PROBABILITY  0.630  0.4.36  2.084  0.163  3.705  0.067  TABLE 4  TARGET COMPLAINT MEASURE SCORES MEANS TIME  STANDARD DEVIATIONS  GESTALT  EMPATHY  GESTALT  EMPATHY  PostSession 2  3.667  3.667  0.985  0.985  Follow-up  3.750  3.083  0.662  1 .621  77 change at the  follow-up  OC=.10 l e v e l  The  means  rests  and  between  The Gestalt  than  their those  ( T a b l e 4)  (3.67) f o r b o t h condition  on  the  f o r Score  empathic  little  change s l i g h t l y reflection mean o f  Gestalt  group d e c r e a s i n g the  group.  with  the  Reactions  and  the  amount  Questionnaire  the A f f e c t i v e Reactions  accounting  for i t being  Time 1 - b e f o r e week a f t e r  The  on  the  of t h i s  administered  treatment;  of  plus  of p e r c e i v e d  empathic felt  change t o  a  performed  to take  into  account  measure as w e l l on  three  Time 2 - a f t e r  on  as  occasions:  treatment;  Time  3  termination.  Affective  scales measuring other  value  (ARQ)  Questionnaire  f o u r combined dimensions  one  This  emapthy  amount  A m u l t i v a r i a t e a n a l y s i s o f v a r i a n c e was  -  same  3.08.  Affective  the  reflection.  "Somewhat b e t t e r " .  i n c r e a s i n g the  t o a mean o f 3.75  at  empty-chair  reflection  2 differed  group  empathic  1 were t h e  b e t t e r " and  means f o r S c o r e empty-chair  receiving  empathy p l u s  f o r the "A  p r e s e n t i n g t a r g e t complaint  Reactions  Questionnaire  interpersonal feelings  f o l l o w i n g dimensions:  Superior;  DE  - Intolerant;  Insecure;  JK  - Humble;  LM  FG  PA  yields  toward a  eight significant  - Confident;  - Discouraged;  - Receptive;  NO  HI  BC  -  -  - Enthusiastic.  78 The  PA  and HI d i m e n s i o n s were c o m b i n e d t o f o r m t h e C o n f i d e n t  dimension: the  t h e BC  and  JK d i m e n s i o n s were c o m b i n e d t o  Superior dimension:  t h e DE  combined t o form t h e I n t o l e r a n t dimensions  An  item a n a l y s i s  inter-item  were as  0.59  0.73;  w i t h a low  yielded  conducted  on  the f o l l o w i n g  consistency  reliability  were  the results. coefficients  scores f o r the Superior dimension o f 0.43  scores  f o r the Discouraged dimension indicated  that  averaged  at post-therapy a d m i n i s t r a t i o n ;  f o r the Intolerant  dimension  averaged  0.82;  averaged  and  0.87.  the Confident, Intolerant  Superior dimension  t i m e and It  does n o t d i s p l a y  i t does n o t a p p e a r  appears  that  t o measure a d i s c r e t e study  a d e q u a t e l y measure t h e S u p e r i o r d i m e n s i o n and therefore  eliminated  However  reliability  the data generated i n t h i s  from t h e m u l t i v a r i a t e  These  and  D i s c o u r a g e d d i m e n s i o n s measure d i s c r e t e v a r i a b l e s . the  NO  scores f o r the Confident dimension  scores  results  dimensions  d i m e n s i o n : and t h e FG and  ( T a b l e 5) was  internal  follows:  averaged  LM  were c o m b i n e d t o f o r m t h e D i s c o u r a g e d d i m e n s i o n .  combined d i m e n s i o n s which The  and  form  over  variable. don't  i t was  analysis  of  6 and  are a l l  variance.  The low  subtest  except  Discouraged  intercorrelations  f o r the c o r r e l a t i o n  of  (Tables  7)  .77 between I n t o l e r a n t  on t h e p r e - t h e r a p y a d m i n i s t r a t i o n ;  a  and  79 correlation  of  .67  on p o s t - t h e r a p y  correlation  of  .61  between t h e  The  results  same d i m e n s i o n s  8 which  multivariate analysis  difference  at the  found  between t h e two  g r o u p s when t h e  were c o m b i n e d .  The  level  a significant  on t h e  indicates  that the  level  35.92 a t  results  from  the  (pj=.064) . indicate level  The  group  follow-up while from  the  from  38.25 a t p r e - t h e r a p y  37.33 a t  dimension  follow-up.  11)  to a high  o f 41.67  to  at  univariate  a significant  difference  12  10) their  t o 40.08 a t  group  o f 35.83 a t  and  (Table  group i n c r e a s e d  means f o r t h e  at  dimension  dimension  reflection  are reported i n Table  examination  The  t o a low  The  confidence  decreased  34.75 a t p r e - t h e r a p y  empathic  show t h a t  group  empathy p l u s G e s t a l t  of c o n f i d e n c e  level  therapy  reflection  means f o r t h e C o n f i d e n t  that the  the  40.25 a t p r e - t h e r a p y  empathic  indicate  An  (Table  b a c k t o 38.00 a t f o l l o w - u p . also  and  £* = .05  (p_=.042) .  the  significant  ( T a b l e 9)  at the  38.42 a t p r e - t h e r a p y  ( T a b l e 9)  A  of  confidence  C X = . i o c o n f i d e n c e l e v e l on t h e C o n f i d e n t  the  to  difference  of i n t o l e r a n c e from  post-therapy  results  I n t o l e r a n t dimension  and  follow-up.  Only  of t i m e  empathy p l u s G e s t a l t  follow-up  increased  effect  I n t o l e r a n t dimension  o f t h e means o f t h e  their  univariate  cX = .05  a  of v a r i a n c e  of v a r i a n c e .  are d i s p l a y e d .  (p_=.045) was  and  summarizes t h e r e s u l t s  terms t e s t e d f o r s i g n i f i c a n c e  t h e r e was  at  of the m u l t i v a r i a t e a n a l y s i s  are d i s p l a y e d i n Table Hotellings  administration;  decreased post-therapy  Discouraged  indicate  no  TABLE 5 ITEM ANALYSIS FOR A F F E C T I V E REACTIONS QUESTIONNAIRE * OCCASION PRETREATMENT  POSTFOLLOW-UP TREATMENT  DIMENSION MEANS  Confident  0.51  0.81  0.88  0.73  Superior  0.60  0.43  0.74  0.59  Intolerant  0.68  0.91  0.86  0.82  Discouraged  0.82  0.89  0.91  0.87  0.75  0.80  0.87  Totals * internal  consistency  reliability  coefficients  TABLE 6 SUBTEST INTERCORRELATIONS FOR A F F E C T I V E REACTIONS QUESTIONNAIRE * Con Confident Superior  Sup 0 .157  0 .286  Intolerant  -0 .370  0 .180  Discouraged  -0 .399  0 .195  Int  Dis  -0. 067  0. 006  -0. 029  -0. 02 8 0. 774  0. 671  * E n t r i e s above d i a g o n a l a r e f o r p r e - t h e r a p y a d m i n i s t r a t i Those below a r e f o r p o s t - t h e r a p y a d m i n i s t r a t i o n .  TABLE 7 SUBTEST INTERCORRELATIONS FOR A F F E C T I V E REACTIONS QUESTIONNAIRE - FOLLOW-UP Con  Sup  Int  0.525  0.095  -0.222  0.259  0.016  Dis  1  Confident S u p e r i or  Intolerant  0.614  Discouraged  TABLE 8 MULTIVARIATE ANALYSIS OF VARIANCE * A F F E C T I V E REACTIONS SOURCE  QUESTIONNAIRE  DEGREES OF FREEDOM  F RATIO  PROBABILITY  Between S u b j e c t s Therapies  1, 22  0.173  0.914  Within Time  2, 22  0.962  0.456  2, 22  2 .264  0.045  Subjects  Therapies X Time * Hotellings  multivariate  analysis  of v a r i a n c e  TABLE 9 UNIVARIATE RESULTS: THERAPY INTERACTING WITH TIME A F F E C T I V E REACTIONS  VARIABLE  QUESTIONNAIRE  F RATIO  PROBABILITY  Confident  2.92082  0.064  Intolerant  3.39897  0.042  Discouraged  2.10284  0.134  TABLE 10 MEANS - CONFIDENT DIMENSION A F F E C T I V E REACTIONS  QUESTIONNAIRE  OCCASION PRE  POST  FOLLOW-UP  TREATMENT MEANS  Gestalt  34.750  37.583  40.083  37.472  Empathy  38.250  35.833  37.333  37.139  36.500  36.708  38.708  37.305  Occasion Means  83 TABLE 11 MEANS - INTOLERANT  DIMENSION  A F F E C T I V E REACTIONS QUESTIONNAIRE  OCCASION PRE  POST  FOLLOW-UP  TREATMENT MEANS  Gestalt  40.250  35.917  35.917  37.361  Empathy  38.417  41.667  38.000  39.361  39.334  38.792  36.956  38.361  Occasion Means  TABLE 12 MEANS - DISCOURAGED AFFECTIVE  DIMENSION  REACTIONSQUESTIONNAIRE  OCCASION PRE  POST  FOLLOW-UP  TREATMENT MEANS  Gestalt  44.833  41 .417  40.417  42 .222  Empathy  42.333  42.667  45.167  43.389  43.583  42.042  42.792  42.806  Occasion Means  84 d i f f e r e n c e s between t h e two g r o u p s a t t h e CX=.05  significant confidence  level.  significantly increased  The empathy p l u s G e s t a l t g r o u p  decreased  their  their  feelings  feelings  of c o n f i d e n c e  significant  other  group which  showed l i t t l e c h a n g e o v e r  treatment feelings  i n their  feelings  of confidence  Complaint  An  Box S c a l e  on f o u r o c c a s i o n s :  experimental  s e s s i o n ; Time 2 - a f t e r  after  two  of variance  instrument  Time 1 - b e f o r e the f i r s t  experimental  of these  was  the f i r s t  session;  s e s s i o n ; Time 4 -  results  t h a t t h e r e was no s i g n i f i c a n t  groups a t t h e  alone  measures  t h e second s e s s i o n .  Analysis reveal  (TCDBS)  repeated  administered  t h e second  other.  Measures  on t h e TCDBS b e c a u s e t h i s  Time 3 - b e f o r e  reflection  the course of  towards t h e s i g n i f i c a n t  Discomfort  to the  of i n t o l e r a n c e and t h e i r  a n a l y s i s of v a r i a n c e with  was p e r f o r m e d  i n relation  as compared t o t h e e m p a t h i c  Session  Target  of i n t o l e r a n c e and  (p_=. 607)  were c o m b i n e d was f o u n d  c,t  =.05 c o n f i d e n c e  d i f f e r e n c e between t h e level  o r t h e when t h e e f f e c t (p_=.211) .  ( T a b l e 13)  A significant  between t h e f o u r measurement  due t o t h e r a p y  of therapy  and time  d i f f e r e n c e (p_=.001) occasions.  TABLE 13 ANALYSIS OF VARIANCE WITH REPEATED MEASURES TARGET COMPLAINT DISCOMFORT SOURCE  SUM OF SQUARES  Between Therapies  DEGREES OF FREEDOM  3.762  SCALE SCORES  MEAN SQUARES  1  3.762  303.148  22  13.779  133.617  3  44.539  247.270  66  3.747  17.361  3  5.787  S-within therapies Between Time S-interacting with time  BOX  Therapies X Time  OF  F RATIO  PROBABILITY  0.273  0.607  11.888  0.001  1.545  0.211  TABLE 14 MEANS AND TARGET COMPLAINT  STANDARD DEVIATIONS OF DISCOMFORT  MEANS TIME  BOX  SCALE ANALYSIS STANDARD DEVIATIONS  GESTALT  EMPATHY  COMBINED  GESTALT  EMPATHY  1  8.667  7.583  8.125  2.188  2.539  2  7.833  6.500  7.167  2.209  3.119  3  5.750  6.500  6.125  2.379  3.261  4  4.917  5.000  4.959  1.505  2.374  6.292  6.792  6.594  O c c a s i on Means  The found  means a n d s t a n d a r d  i n Table  experienced target  four  Session  the  dropped a t o t a l  o f 3.75 f r o m 8.67 t o 4.92  Questionnaire  SEQ t o a c c o u n t  f o r the four  dimensions  on two o c c a s i o n s :  experimental  This  The  two  dimensions  The  subject  (Table  t o both t h  of p a r t i c i p a n t s '  Smoothness a n d D e p t h ; a n d  mood: P o s i t i v i t y  be p r e s e n t e d  reliability  0.82 f o r t h e f o u r reliability  16)  will  a f t e r each  first.  and A r o u s a l  An i t e m  15) was c o n d u c t e d w h i c h y i e l d e d i n t e r - i t e m  consistency  Session  sessions:  of post-session  data  of the instrumen  occasion.  SEQ examines two d i m e n s i o n s of therapy  was p e r f o r m e d on  i n s t r u m e n t was g i v e n  a n d t h e t h e r a p i s t s a t each  perceptions  reflection  (SEQ)  w h i c h was a d m i n i s t e r e d session.  coefficients  dimensions  coefficient  2 was 0.83.  ranging  from  The s u b t e s t  internal 0.49 t o Total  1 was 0.81 a n d f o r  i n t e r c o r r e l a t i o n s (Table  These r e s u l t s suggest  that the  d i m e n s i o n s measure d i s c r e t e v a r i a b l e s and w a r r a n t a multivariate analysis  analysis  o v e r t h e two s e s s i o n s .  f o r Session  were a l l b e l o w 0.60.  over  o f 2.58 f r o m 7.58 t o 5.00.  m u l t i v a r i a t e a n a l y s i s of variance  subjects  empty-chair  The mean f o r t h e e m p a t h i c  dropped a t o t a l  groups  c a u s e d by t h e i r  The mean f o r t h e G e s t a l t  Evaluation  An  The means r e v e a l t h a t b o t h  occasions.  condition  o f t h e TCDBS may b e  a decrease i n the discomfort  complaint.  condition the  14.  deviations  of v a r i a n c e .  t h e use o  87 The are  r e s u l t s of the  multivariate  reported  i n Table  17  multivariate  analysis  of v a r i a n c e  tested  which d i s p l a y s  f o r s i g n i f i c a n c e are  displayed.  were f o u n d between t h e  variable  the  ot  =.05 c o n f i d e n c e  Smoothness d i m e n s i o n a r e dimension 21;  and  i n T a b l e 20;  f o r the  An  item a n a l y s i s  results  and  the  coefficients reliability four  inter-item  are  reported  1 was  over the  0.86  intercorrelations 0.60.  The  variables variance  The T a b l e 25  and  that  the  The  i n Table  on  any  f r o m 0.61  show t h a t  each  use  Depth  in  Table  22.  therapist reliability  inter-item  to The  2 was  the  f o r the  dimension  The  sessions.  24)  items  means f o r  19;  i n Table  i n T a b l e 23.  for Session  (Table  the  internal consistency  two  suggests that  0.92  for  total  for  0.85.  the  Subtest  a l l v a l u e s were b e l o w  s c a l e measures  discrete  of a m u l t i v a r i a t e  analysis  of  i s warranted.  multivariate  analysis  which d i s p l a y s  of v a r i a n c e  results.  are  displayed.  the  two  of  and  Only  conducted f o r the  c o e f f i c i e n t s ranged  dimensions  Session  also  variance  Hotellings  groups  Positivity  dimension  was  two  of  No s i g n i f i c a n t  level.  reported  f o r the  Arousal  the  results.  differences at  analysis  A  groups at  therapy  the  of v a r i a n c e  Hotellings  Only the  i s reported  multivariate  items t e s t e d  for  s i g n i f i c a n t d i f f e r e n c e was the  (p_=.044) .  c< =.05 The  confidence  univariate  level  results  in  analysis  significance  f o u n d between on  the  (Table  effect 26)  88 indicate  that  there  i s a significant  between t h e two g r o u p s therapists smoother  rating  on t h e Smoothness  t h e empathic  t h a n t h e empathy  mean f o r t h e emapthy p l u s  plus  two s e s s i o n s was 25.83.  may be f o u n d i n T a b l e 27.  s e s s i o n s as  Gestalt sessions.  G e s t a l t group  (£=.008)  dimension with the  reflection  was 21.25 and t h e mean f o r e m p a t h i c the  difference  The  f o r t h e two s e s s i o n s  reflection  group f o r  The means f o r t h e two g r o u p s  TABLE 15 ITEM ANALYSIS OF SESSION EVALUATION QUESTIONNAIRE - SUBJECT DATA *  OCCASION SUBTEST  SESSION 1  SESSION 2  Smoothness  0.65  0 79  Depth  0.82  0 78  Positivity  0.61  0 71  Arousal  0.49  0 67  0.81  0 83  Totals * internal  consistency  reliability  coefficients  TABLE 16 SUBTEST  INTERCORRELATIONS  SESSION EVALUATION QUESTIONNAIRE - SUBJECT DATA * Smoothness Smoothness  Depth  Positivity  0.435  0.562  0.048  0.210  0.324  Depth  0.242  Positivity  0.547  0.472  Arousal  0.025  0.168  *  Entries Entries  above t h e d i a g o n a l below t h e d i a g o n a l  Arousal  0.354 0.300  are f o r Session are f o r Session  1. 2.  90 TABLE 17 MULTIVARIATE  ANALYSIS OF VARIANCE*  SESSION EVALUATION SOURCE  QUESTIONNAIRE  DEGREES OF FREEDOM  FOR  - SUBJECT DATA  F RATIO  PROBABILITY  Between S u b j e c t s Therapies  1, 22  2 .10295 ,  •0 .120  Within Time  1, 22  0,.71086  0 .595  1, 22  0,.59542  0 .670  Subjects  T h e r a p i es X Time * Hotellings  multivariate  analysis  of variance  TABLE 18 UNIVARIATE RESULTS: THERAPY MAIN EFFECT SESSION EVALUATION  VARIABLE  QUESTIONNAIRE  - SUBJECT DATA  F RATIO  PROBABILITY  Smoothness  3.99765  0.058  Depth  2.54752  0.125  Positivity  0.48063  0.495  Arousal  1.36710  0.255  TABLE 19 MEANS - SMOOTHNESS DIMENSION SESSION EVALUATION  QUESTIONNAIRE - SUBJECT DATA  OCCASION SESSION 1  SESSION 2  TREATMENT MEANS  Gestalt  23.167  21 .250  22 .209  Empathy  23.167  24 .500  23.834  23.167  22.875  23.021  Occasion Means  TABLE 20 MEANS - DEPTH DIMENSION SESSION EVALUATION  QUESTIONNAIRE - SUBJECT DATA  OCCASION SESSION 1  SESSION 2  TREATMENT MEANS  Gestalt  29.083  29.667  29.375  Empathy  26.250  27.417  26.834  27.667  28.542  28.104  Occasion Means  TABLE 21 MEANS - P O S I T I V I T Y SESSION EVALUATION  DIMENSION  QUESTIONNAIRE - SUBJECT DATA OCCASION  SESSION 1  SESSION 2  TREATMENT MEANS  Gestalt  21.417  22.333  21.875  Empathy  21.750  23.917  22.834  21 .584  23.125  22.354  Occasion Means  TABLE 22 MEANS - AROUSAL DIMENSION SESSION EVALUATION  QUESTIONNAIRE - SUBJECT DATA  OCCASION SESSION 1  SESSION 2  TREATMENT MEANS  Gestalt  15 .250  14.500  14.875  Empathy  15 .583  18.250  16.917  15 .417  16.375  15.896  Occasion Means  TABLE 23 ITEM ANALYSIS FOR SESSION EVALUATION QUESTIONNAIRE - THERAPIST DATA * OCCASION SUBTEST  SESSION 1  SESSION 2  Smoothnes s  0.73  0.81  Depth  0.92  0.85  Positivity  0.61  0.77  Arousal  0.65  0.61  0.86  0.85  Totals * internal  consistency  reliability  coefficients  TABLE 24 SUBTEST INTERCORRELATIONS FOR SESSION EVALUATION QUESTIONNAIRE - THERAPIST DATA * Smoothness Smoothness  Depth  Positivity  0.498  0.407  0.089  0.550  0 .134  Depth  0.061  Positivity  0.313  0.503  Arousal  0.079  0.368  * Entries Entries  above t h e d i a g o n a l below t h e d i a g o n a l  Arousal  0.334 0.566  are f o r Session are f o r Session  1. 2.  94 TABLE 25 MULTIVARIATE ANALYSIS OF VARIANCE*  FOR  SESSION EVALUATION QUESTIONNAIRE - THERAPIST DATA  SOURCE  DEGREES OF FREEDOM  F RATIO  PROBABILITY  Between S u b j e c t s Therapies  1, 22  3,.02121  0,,044  Within Time  1, 22  1 .15119 ,  0.,363  1, 22  1 .14872 ,  0.,364  Subjects  Therapies X Time * Hotellings  multivariate  analysis  of v a r i a n c e  TABLE 26 UNIVARIATE RESULTS:  THERAPY MAIN EFFECT  SESSION EVALUATION QUESTIONNAIRE - THERAPIST DATA  VARIABLE  F RATIO  PROBABILITY  Smoothness  8.39218  0.008  Depth  0.85443  0.365  Positivity  1.96770  0.175  Arousal  0.02466  0.877  TABLE 27 MEANS - SMOOTHNESS DIMENSION SESSION EVALUATION  QUESTIONNAIRE - THERAPIST  DATA  OCCASION SESSION 1  SESSION 2  TREATMENT MEANS  Gestalt  20.083  22 .417  21 .250  Empathy  24.750  26.917  25.833  22 .417  24.667  23.542  O c c a s i on Means  96 Chapter  V  DISCUSSION  The  purpose of t h i s  specific the  client  plus  the  The  differential  effects  The effects  of  empathic  felt  of t h e s e  two  toward the  u s i n g two  M e a s u r e and  Differential Complaint  Questionnaire. empathy was Inventory, measure t h e behavi our.  Box  Subject's  technique  significant  the  other  and  initial  complaint.  differential  the  perception  Session  treatment the  Target  Questionnaire.  subject's perception  Target  Evaluation  of t h e i r t h e r a p i s t ' s  Barrett-Lennard  the Working A l l i a n c e  the  their  were m e a s u r e d u s i n g t h e  S c a l e and  compare  on  on  outcome m e a s u r e s :  measured u s i n g the and  to  empathic  the A f f e c t i v e Reactions  session effects  Discomfort  and  chosen to assess  change t o w a r d s t h e i r  treatment  and  treatments  i n v e s t i g a t o r measured the  Complaint  i n v e s t i g a t e the  reflection  a n a l o g u e f o r m a t was  feelings  perception  to  G e s t a l t empty-chair  resolution.  subject's  was  i s s u e of u n f i n i s h e d b u s i n e s s ,  e f f e c t i v e n e s s of  reflection  study  Inventory  of the  Relationship was  used  to  t h e r a p i s t ' s on-task  97 Interpretation The place  research  within  stresses  the  the  facilitate  client  1984;  & Mitchell,  and  empathic  Shapiro  1957;  the The  Relationship subjects'  significant  d i f f e r e n c e between t h e  e s t a b l i s h e d the  therapeutic  The  therapists group. an  as  This  reflection  and  developing bodily  empathy  Inventory  was  of  their was  empathic.  considered  necessary  g r o u p however p e r c e i v e d than d i d the  core  Gestalt  technique  therapists the  of  between d i f f e r e n t  (Greenberg,  1983,  p.135).  their  Gestalt group  added  empathic  traditionally therapist in favor  a c l o s e r r e l a t i o n s h i p between t h e p e r s o n  personality"  a  t h e r a p i s t s t o be  r e l a t i o n s h i p with  f e e l i n g s , and  not  therefore  s u r p r i s i n g s i n c e the  since Gestalt  "deemphasize the  Truax  g r o u p s and  somewhat more e m p a t h i c i s not  1967;  occur.  a c t i v e technique to the  reflection  two  1983;  1986;  The  perception  environment  change t o  empathic  their  and  Mitchell,  r e s u l t s indicated there  t h a t both groups p e r c e i v e d  for  1986;  T r u a x & Wargo, 1 9 6 6 ) .  to assess  taking  Greenberg,  Truax & Carkhuff,  empathy.  then  1969;  & Howard, 1978,  therapists'  This  of t h e r a p y  r e l a t i o n s h i p to  & Bergin,  Orlinsky  Barrett-Lennard  administered  importance  (Carkhuff,  Rogers,  1971;  of t h e  of an  1977;  Findings  o f a good w o r k i n g r e l a t i o n s h i p  change  Lambert,  & Krauft,  Patterson,  scale  context  necessity  Gurman, 1977; Bozarth  supports the  of  parts  of  However  and  the these  of  98 findings  suggest  importance  that  Gestalt  of t h e t h e r a p i s t - c l i e n t  ensure that  Gestalt  o f an e m p a t h i c  Another  therapeutic  of the t h e r a p e u t i c  influence client  between t h e t h e r a p i s t  subjects'  Horvath  the t a s k dimension  "may b e a c r i t i c a l  component  indicated  that  i n psychotherapy  strategies"  and t h a t  t o be engaging  suggested Inventory  process across  (p.553).  The r e s u l t s  difference  the subjects perceived their  i n on-task behaviour.  The  t h e n may b e c o n s i d e r e d t o have e s t a b l i s h e d a t  minimal  group.  1986;  a b i l i t y to  (1986) have  t h e r e was n o t a s i g n i f i c a n t  between t h e two g r o u p s  slightly  of the  The t a s k d i m e n s i o n o f  of t h e Working A l l i a n c e  of i n t e r v e n t i o n  The  found  established  therapists'  and Greenberg  a variety  important  environment  (Horvath & Greenberg,  p e r c e p t i o n of t h e i r  that  least  the context  I n v e n t o r y was a d m i n i s t e r e d t o a s s e s s  on t a s k .  therapists  alliance  and c l i e n t  stay  therapist  a n d must  change i s t h e q u a l i t y  & Howard, 1978, 1 9 8 6 ) .  the Working A l l i a n c e the  relationship  relationship.  bond and t h e working  Orlinsky  consider the  techniques take p l a c e within  component  to p o s i t i v e l y  and  t h e r a p i s t s must  levels  of on-task behaviour c o n s i d e r e d  to f a c i l i t a t e  client  change.  mean f o r t h e empathy p l u s G e s t a l t  group  h i g h e r t h a n t h e mean f o r t h e e m p a t h i c This  the Gestalt  i s not s u r p r i s i n g because therapist  was  reflection  o f t h e emphasis  p l a c e s on t h e ' e x p e r i m e n t '  that  and t h e  99 emphasis  on t h e r o l e  of the t h e r a p i s t  assumes t h e r e s p o n s i b i l i t y f o c u s and p.8).  direction  o f g u i d e " and  to the p r o c e s s "  T h i s more a c t i v e  role  stance  importance  of c l i e n t  t o be may  the  of c l i e n t - c e n t e r e d  their  clients  Working A l l i a n c e  suggest  relationship  less  The  behaviour  needs  therapists  who  s l o w l y or, o f  empathy d i m e n s i o n  the task dimension  of  of  of  the  t h a t r e g a r d l e s s of  o c c u r r e d w i t h i n the context and  be  active,  therapists.  of the  and  empathic  1985,  treatment.  the R e l a t i o n s h i p Inventory  a l l therapy  et a l ,  who  a  t h e r a p i s t s may  as m o v i n g t o o  Taken t o g e t h e r t h e r e s u l t s  Inventory  "provides  client-centered  not p r o v i d i n g a f o c u s t o t h e  condition  who  p e r c e p t i o n of on-task  c o n s i d e r e d however by  be v i e w e d by  a collaborator  (Daldrup  of G e s t a l t  p e r c e i v e d t o be more on t a s k t h a n supportive  "as  the an  t a s k - o r i e n t e d environment.  H y p o t h e s i s 1. The  Target  Complaint  M e a s u r e was  t h e change i n t h e p r e s e n t i n g c o m p l a i n t treatment results at  and  at  showed no  either  Hypothesis  follow-up. significant  occasion. 1 that  The  over  analysis  support  assess  the course  of  of v a r i a n c e  d i f f e r e n c e between t h e  T h i s does not  states:  administered to  research  groups  100 Empathy  plus  used with in  the Gestalt  dialogue,  an i s s u e o f u n f i n i s h e d b u s i n e s s ,  significantly  target  empty-chair  greater  complaint  follow-up  improvement  as m e a s u r e d a f t e r  by t h e T a r g e t  Complaint  when  will  result  on t h e p r e s e n t i n g  treatment  and a t  Measure than  that  p r o d u c e d by t h e use o f Empathic R e f l e c t i o n . Since difference therapy  the results  of the data  no  significant  i n t h e means when c o n s i d e r i n g t h e e f f e c t o f  i n t e r a c t i n g with  retained.  showed  This  time, the n u l l  hypothesis  s u g g e s t s t h a t when w o r k i n g w i t h  unfinished business  n e i t h e r group y i e l d e d  greater  on p r e s e n t i n g  improvement  o f two t r e a t m e n t  sessions  However on e x a m i n a t i o n  of the data  an i s s u e o f  significantly  complaint  a n d one week  over the course  after.  an  important  d i f f e r e n c e between t h e two g r o u p s i s s u g g e s t e d . termination groups.  of treatment  However a f t e r  group had not only presenting positive other  feelings.  to feel  only  suggests that  sessions  d i d n o t h o l d as s t r o n g l y w i t h  empathic  reflection  plus  Gestalt  t h e improvement  treatment  while  slightly  empty-chair  f o r both Gestalt on t h e i r  in their  g r o u p on t h e  one week, h a d d e c r e a s e d  This  empathy  slightly  reflection  change.  h e l d but a l s o increased  plus  improvement  b u t had i n c r e a s e d The e m p a t h i c  At  identical  one week t h e empathy  continued  complaint  hand, a f t e r  t h e means were  was  their  felt  those  after the  r e c e i v i n g the  t h e improvement  f o r those dialogue  felt  not only  r e c e i v i n g the treatment.  This  101  may  present  who  encounter  practice of  information for practicing  i s s u e s of u n f i n i s h e d b u s i n e s s  s i n c e the present  the G e s t a l t  lasting use  important  study  empty-chair  technique  change i n the c l i e n t ' s  of e m p a t h i c  reflection  their  that the  may  addition  facilitate  more  p r e s e n t i n g complaint  than  alone.  however t h a t t h e c u r r e n t s t u d y further  suggests  in  therapists  I t must be  remembered  i s a p r e l i m i n a r y one  r e s e a r c h i s n e e d e d t o draw more  the  and  definitive  conclusions.  Hypothesis The to  A f f e c t i v e Reactions  assess  o t h e r and of  2  the  subjects' feelings  t o m e a s u r e how  treatment.  The  these  in a significant  when t h e  effect support  an  of time  and  therapy  research Hypothesis  c h a n g e d as  Intolerant treatment  and and  were c o m b i n e d . 2 that  empty-chair  lower  means on t h e  Discouraged at  dimensions  f o l l o w - u p by  Q u e s t i o n n a i r e than  by  result  groups These  states: d i a l o g u e when  used  produce dimension  Superior, as m e a s u r e d  the A f f e c t i v e  those produced  Reflection.  a  of v a r i a n c e  h i g h e r means on t h e C o n f i d e n t  significantly  Empathic  significant  i s s u e of u n f i n i s h e d b u s i n e s s , w i l l  significantly and  feelings  administered  d i f f e r e n c e between t h e two  Empathy p l u s t h e G e s t a l t with  toward the  multivariate analysis  resulted  results  Q u e s t i o n n a i r e was  t h e use  after  Reactions of  102 Since the r e s u l t s variance t h e two  showed a s i g n i f i c a n t groups  in  retained.  empty-chair  facilitating  changes  other than  particular,  the G e s t a l t  and  that  has  t h e empathic  will  In a d d i t i o n  develop  person but  significantly  sense  Greenberg  Safran  and  expression w i l l competent  hypothesis.  individual  t o act i n the world.  The  significantly  The  The  empathy p l u s G e s t a l t  more t o l e r a n t  of the treatment  Gestalt  group  Safran  felt  than  (1987) to  individuals only of  et a l  this  (1985)  feeling results  support group  empathic  resolving  empowered of  to  the this  felt o t h e r as  reflection  more c o n f i d e n t i n r e l a t i o n  a  group.  t o the  a  and  emotional  of the s i g n i f i c a n t the  lead  stated that  or r e l e a s i n g b l o c k e d i n the  less  significant  that  Daldrup  (1986) have a l s o  result  more  e n h a n c e d s e l f - e s t e e m and  A f f e c t i v e Reactions Questionnaire lend  result  and  t o l e r a n c e of the  of s e l f - w o r t h .  situations  the  group.  Greenberg  have an  the  In  somewhat  reflection  t h e y have s u g g e s t e d  also will  more p o s i t i v e  and  alone.  a more b a l a n c e d p e r s p e c t i v e not  they  unfinished  reflection  felt  time,  effective  about  of u n f i n i s h e d b u s i n e s s w i l l  e n h a n c e d u n d e r s t a n d i n g and other.  f o u n d t o be more  b e e n h y p o t h e s i z e d by  the r e s o l u t i o n  over  o f empathy p l u s  subjects f e l t  empathic group  use  of  between  somewhat more c o n f i d e n t and  d i s c o u r a g e d than  It  i n how  analysis  of treatment  The  d i a l o g u e was  significant  tolerant  difference  i n t h e main e f f e c t  t h e h y p o t h e s i s was Gestalt  of the m u l t i v a r i a t e  significant confidence empathic  other a f t e r  treatment  i n c r e a s e d over the  reflection  group  showed a d e c r e a s e  of t r e a t m e n t .  group  more e n c o u r a g e d  reflection  felt group  felt  tentatively  dialogue  i n t h e c o n t e x t o f an  suggest of  suggest  in facilitating  hypothesized. that  his/her  once a p e r s o n  c r e a t e a "schematic reformulation  t h e w o r l d and  themselves (p.11). charge  that of  as a c t i v e  of themselves The  and  and  significant  tolerance therapists  et a l full  wh  expression will  overall (p.7).  It i s individuals  move " t o e x p e r i e n c e  of t h e i r  own  individuals  in control  experiences" feel  of t h e i r  of t h i s p r e l i m i n a r y  more i n  emotional study  suggest  have a c h i e v e d a g r e a t e r u n d e r s t a n d i n g  o t h e r w h i c h c o u l d l e a d t o an  i n the a b i l i t y  of o t h e r s .  (1985)  f l e x i b l e posture i n dealing  of c o n f i d e n c e i n themselves,  encouragement  direction  the person  an  stance"  they w i l l  creators  results  t h e s u b j e c t s may  the  sense  that  empty-chair  i n t h e change p r o c e s s  Through t h i s p r o c e s s  reactions.  allowed the  of the assumptive  the  relationship is  supports Daldrup  and  Gestalt  Taken t o g e t h e r  change i n the  has  the  empathic  the G e s t a l t  empathic  restructuring  move t o a more s p o n t a n e o u s with  empathy p l u s  disowned emotions  further postulated that  of  i n confidence  whereas t h e  that  client  This result  d e n i e d and  The  more d i s c o u r a g e d .  findings  helpful  level  e n s u i n g week whereas  over the course also  arid t h i s  a renewed s e n s e  to take charge,  This result  enhanced  may  o u t s i d e the experimental  and  of  more  have s i g n i f i c a n c e  environment  who  may  to fin  104 the G e s t a l t unfinished  approach u s e f u l emotional  A correlation Discouraged  dimensions.  i s t o be e x p e c t e d  of  a significant  particularly feelings  The  discouraged  about  Complaint  presenting complaint. measures r e s u l t e d over  i n t e r a c t i n g with  the r e l a t i o n s h i p  Discomfort  i n the  in a significant  of discomfort  Hypothesis  session  occasions.  t o t h e combined  Reflection.  to their repeated  effect  This  result  of treatment  a n d t h e r e f o r e does n o t s u p p o r t  3 that  states: empty-chair  less  d i a l o g u e when  that produced  Complaint  used  produce  d i s c o m f o r t b e f o r e and a f t e r  a s m e a s u r e d by t h e T a r g e t  Scale than  by t h e  d i f f e r e n c e between t h e  an i s s u e o f u n f i n i s h e d b u s i n e s s , w i l l  significantly  felt  of v a r i a n c e with  t h e f o u r measurement  time  Box S c a l e was  each s e s s i o n i n r e l a t i o n  Empathy p l u s t h e G e s t a l t  Box  would  other.  An a n a l y s i s  however does n o t r e l a t e  with  this  3  s u b j e c t s b e f o r e and a f t e r  research  intolerant  when t h e r e were hopes f o r an improvement  Target  groups  felt  i n his/her l i f e  a d m i n i s t e r e d t o measure t h e amount  two  i s n o t s u r p r i s i n g as  t h a t i f an i n d i v i d u a l  toward t h e s i g n i f i c a n t  Hypothesis  to resolve  between t h e I n t o l e r a n c e a n d  This finding  other person  in feeling  clients  experiences.  was f o u n d  it  result  in assisting  each  Discomfort  by t h e u s e o f E m p a t h i c  105 The in  results  of the data  t h e means o f t h e s c o r e s  time,  thus  indicating  treatments time  overall  hypothesis  occasions.  of s p e c i f i c  of treatment  over  effects.  i n t h e amount  enough  Therefore the n u l l that  of discomfort  to their presenting  therapy  felt  by t h e  complaint.  4  S e s s i o n E v a l u a t i o n Q u e s t i o n n a i r e was a n a l y z e d of variance.  of the subject data  does n o t s u p p o r t  The r e s u l t s  r e v e a l e d no  of t h e  significant  empty-chair  4 that  states:  d i a l o g u e when  an i s s u e o f u n f i n i s h e d b u s i n e s s , w i l l  significantly  and s i g n i f i c a n t l y  A r o u s a l dimensions  for  t h e Smoothness d i m e n s i o n  the  end o f t h e s e s s i o n s as m e a s u r e d by t h e S e s s i o n  of Empathic  Reflection.  lower  Depth  and  use  used  produce  h i g h e r means f o r t h e P o s i t i v i t y ,  E v a l u a t i o n Q u e s t i o n n a i r e than  using  on any o f t h e v a r i a b l e s .  research Hypothesis  Empathy p l u s t h e G e s t a l t with  combined  treatment  d i f f e r e n c e s between t h e two g r o u p s This  over  measure was n o t s e n s i t i v e  a multivariate analysis analysis  the effect  difference  that t h i s  in relation  Hypothesis The  n o t h i n g about  sampling  was r e t a i n e d a n d i t was c o n c l u d e d  made no d i f f e r e n c e subjects  at d i f f e r e n t  on e a c h g r o u p o r t h e e f f e c t  and suggests  to detect  f o r t h e two g r o u p s  t h a t when t h e g r o u p s were  s i g n i f i c a n c e was f o u n d T h i s however s a y s  showed a s i g n i f i c a n t  means  f o r the subjects at  those produced  by t h e  106 Since the r e s u l t s variance  of the m u l t i v a r i a t e  showed no s i g n i f i c a n t d i f f e r e n c e  treatment  groups, the n u l l  indicates  that  empathy  plus  sessions,  group f e l t  retained.  similar reactions  An a n a l y s i s differences  and A r o u s a l  of the subject  inspection  a difference  group p e r c e i v e d  smoother t h a n t h e s e c o n d s e s s i o n . the  opposite  shift  i n considering  smoother t h a n t h e f i r s t  no s i g n i f i c a n t  on any o f t h e v a r i a b l e s .  of the e f f e c t of therapy  approaching  session.  data  s i g n i f i c a n c e between t h e Of i n t e r e s t h e r e i s  the f i r s t  session  The e m p a t h i c the second  t o be  group  The r e s u l t s  f o r the  show t h e same d i s t i n c t i o n and i n d i c a t e t h a t  therapists  felt  significantly sessions. therapy  t h e empathic  For both  sessions  t o be r e a c h i n g  somewhat d e e p e r This  plus  the Gestalt  t h a n t h e empathy  group.  Gestalt  subjects  move more d e e p l y  process  this active  with  r e f l e c t i o n sessions  s m o o t h e r t h a n t h e empathy  showed  session  therapists  that  the were  Gestalt  subjects  felt  the  l e v e l s of f e e l i n g  t e n t a t i v e l y suggests that  intervention  as  dimensions.  on t h e Smoothness d i m e n s i o n .  the Gestalt  the sessions,  data revealed  between t h e two g r o u p s  closer  two g r o u p s that  t o the  as i n d i c a t e d by t h e Smoothness and D e p t h  i n d i c a t e d by t h e P o s i t i v i t y  revealed  This  r e f l e c t i o n g r o u p and t h e  d i m e n s i o n s , and h a d s i m i l a r moods f o l l o w i n g  However  of  between t h e two  h y p o t h e s i s was  b o t h t h e empathic  Gestalt  analysis  i n t o the  therapeutic  a l l o w s more v i v i d  u n e x p r e s s e d e m o t i o n s and f a c i l i t a t i e s  as  more  contact  dramatic  107 expression  of these  feelings.  The  subjects are l i k e l y  p e r c e i v e t h e work as more d i f f i c u l t empathic levels  reflection  and  supports and  g r o u p t e n d not  Safran  (1987) who  intensifying e m o t i o n and  of Daldrup suggest  current feelings w i l l a deeper  conditions  and  found  of t h i s  resemblance  settings  Greenberg  and a flow  of  an  analogue  in  the c l i n i c  study  study  i s that  setting.  vary  setting.  The  as  worked on  u n f i n i s h e d b u s i n e s s had  approximate  and  suggested  less  to those severe.  of  presented observed In  this  study w i t h a p r e - s e l e c t e d  reached  s u b j e c t s were c h o s i n g t o e n t e r t h e r a p y have i n d e e d b e e n l e s s  (1986)  problems  i n a meaningful not  an  i n the degree  similar  are probably  s u b j e c t s d i d enter the  may  i t was  Kazdin  s t u d y may  are viewed  s e t t i n g but  w h i c h was  Study  on n i n e d i m e n s i o n s  to the c l i n i c a l  in  problem  This  emotions i n  i s t h e r e f o r e only able to  ways i n w h i c h t h e a n a l o g u e  this  (1985) and  facilitate  of the  in a clinical  compared t h e s e two  problem  deep  smoother.  e x p l o r a t i o n of b l o c k e d  limitation  study  the  i n the  the u n f i n i s h e d s i t u a t i o n s .  A major  study  et a l  such  that magnifying  Limitations  analogue  to reach  t e n d t o p e r c e i v e t h e work as  the p o s i t i o n  resolving  whereas t h o s e  to  however,  t h e p o i n t where  and  severe.  way  t h e r e f o r e the  the  The to  s u b j e c t s were r a n d o m l y a s s i g n e d  maintain  personal  the  experimental  preferences.  On  spontaneously  indicated  to  had  which they  s u b j e c t s who  design without  two  occasions  their  the  same way  This preference  f o r treatment  reaction  to the  g r o u p a s s i g n e d may  subjects  involvement  The  university  nature  of s t u d y .  some t h e r a p y Therefore, who  study  the  results  with  be  the c o u n s e l l i n g process  represent  typically  clinical  setting  who and  The represent  had  results  found  in this  to regarding  and  a  therapist.  are  supportive  results  for a clinic study  may  be  people  knowledgeable  study  may  chose t o seek h e l p  minimal  of a  a l l experienced  are  only to a s i m i l a r  i s normal  year  at a major  subjects in this  number o f s e s s i o n s was what  first  information  who  t h e r e f o r e the  considered to apply  subsequent  volunteered  a client  and  The  clients  other  silent.  g e n e r a l i z a b l e only to  therapeutic process.  the  and  have b e e n i n c o u n s e l l i n g b e f o r e , who  about  be  from the  minimal  as b o t h may  group  have i n f l u e n c e d t h e  These s t u d e n t s  experience  have b e e n  the  i n c o u n s e l l i n g psychology  i n the  the  study.  i n a l a r g e urban area  participate  about  chose t o remain  method and  s u b j e c t s were s o l i c i t e d  masters program  the  i n the  their  subjects  T h e r e may  who  groups  regard to  disappointment  been a s s i g n e d .  felt  t o treatment  of t h i s  of  the  not  in a study  may  population.  and  does  setting.  not Therefore,  considered to  apply  only not  to be  i n d i v i d u a l s i n the  e a r l y stages  a p p l i c a b l e t o t h o s e who  longer  course  The  of  small  subjects  due  to the  exploratory  analysis  greatly increased  (incorrectly  concluding  when i t i s f a l s e ) and analyzing  the  in a  i n each e x p e r i m e n t a l  i s a minimal requirement  error  involved  have b e e n  However t h i s and  and  the  for  risk  that  presented  nature  the  have b e e n t h e r a p e u t i c  w h i c h may  have i n c r e a s e d that  the  r e d u c e d by  decreasing  increasing  the  experience  not  hypothesis  a major  limitation  therapists  i n and  is  true  in  the  of  difficulty  and  could  a f f e c t i n g the have been  number o f m e a s u r e s g i v e n  and  sessions.  a model  of t h e  reflection.  of t h e  may  Gestalt  o u t l i n e of the  The  Gestalt A  r e s o l u t i o n of  forms o f t r e a t m e n t  i n favour  subjects  incorrectly  unfinished business.  empathic  delineated  to the  of themselves  possibility  a v a i l a b l e f o r the  using  for both  clearly  This  number of  approach to completing  model  the  t h e r a p i s t s were g i v e n  model was  study.  o f m a k i n g a Type 2  h y p o t h e s e s were f a l s e by  of t r e a t m e n t .  The  of the  data.  w h i c h may  results  condition  statistical  A number o f m e a s u r e s were a d m i n s t e r e d  concluding  may  therapy.  number o f  (n=12) was  of t h e r a p y  comparable incomplete  l a c k of a c l e a r  have i n f l u e n c e d  the  t r e a t m e n t w h i c h had  resolution  process.  a  110 Implications  There are interested  differential techniques  specific  issues.  e i t h e r the Gestalt  both  sessions.  build  to  the  A use  of  of the  specific  further  studies  there  were a t  also  eliminate  null  researchers  issue  of  against felt  condition  were  empathy  t h i s form of t h e r a p y devote the  reflection  only  empathic This  The  so  as  to the  subjects  reflection  of the  would  or  would prevent  use  for  first  relationship before  the  of  assigned  or t h e  a r e l a t i o n s h i p had  experimental  would p o s s i b l y  hypothesis.  when  the  empty-chair been  therapist.  i n each  l e a s t 20  subjects  could  condition.  their  the  the  relevance  investigation  techniques.  e i t h e r the  from r e a c t i n g  numbers  study  has  the  received  therapeutic  Gestalt  with  and  empathic  technique b e f o r e they  The  for  of the  to  reflection  further  assigned to  established  applied  In t h i s s t u d y  necessary  empathy p l u s subjects  are  condition  the  application t h e n be  exploration  e f f e c t s design  empathic  plus  session  implications  Suggestions  business.  specific  to  Future Research  a number of  in pursuing  unfinished  The  and  subjects  possiblility  yield  condition  and  significant results i f  i n each g r o u p . of  were low  This  would  incorrectly retaining  the  Ill The Gestalt and  issue  of u n f i n i s h e d b u s i n e s s  therapists  t o be  t h e r e f o r e i s one  course  of t h e r a p y  environment. results  business. that  technique  this  Although  than  t h e use  t o t h e use  study  issue  of e m p a t h i c  c o u l d be  investigate  conducted.  i f therapists  technique  into  issue  their  of u n f i n i s h e d b u s i n e s s  Only  two  s u b j e c t s which  experimental i s less  reflection that  with  This research could suggested  work w i t h c l i e n t s  that  normally  w o u l d be  study  empty-chair  active  this  whenever  could offer  technique.  to  an  the  technique  i n the  a course  of  instructed  i s s u e s o f u n f i n i s h e d b u s i n e s s as t h e y  with another  of  encountered  s e s s i o n s i n w h i c h t h e r a p i s t s w o u l d be  this  to  arises.  10  a r i s e with the Gestalt  issue  further  here  t h e use  setting.  deal with  further  the  further  clinical t o 12  A  empathic  s e s s i o n s were o f f e r e d  than  Gestalt  concludes  could encorporate  ongoing  the  d i a l o g u e i s more  the p r e l i m i n a r y f i n d i n g s  determine  i n the  of u n f i n i s h e d  i n no way  empty-chair  of t h e  o f an  of u n f i n i s h e d b u s i n e s s , i t does s u g g e s t research  to a r i s e  experimental  i n the context  of G e s t a l t  therapy  i s a p r e l i m i n a r y study  support  this  i s s u e s of  expected  the  when d e a l i n g w i t h an  t h e use  effective  be  i n other than  Although  relationship  of the c o r e  which w i l l  lend tentative  empty-chair  one  i s c o n s i d e r e d by  and  naturally compare  T h e s e two c o n d i t i o n s  o f f e r e d w i t h i n a c l i m a t e o f an  empathic  to  112 relationship  and  a working a l l i a n c e perceived  t o be  task  related.  Conclusion  In c o n c l u s i o n , the  Gestalt  tolerance other  empty-chair  i n the  p e r s o n as  Questionnaire p r o d u c e d by suggest  felt  results the is  an  issue  a greater  which  the  suggest  Gestalt  the  that  suggest of an  of u n f i n i s h e d  business  merits that  treatment  further  the  empathic  i s an  issue  Complaint  condition  i f one  client  important The  empty-chair  r e l a t i o n s h i p may  of the  in i n i t i a l  business.  study.  Gestalt  results  These are  s e t t i n g to determine  issue  more  significant  business  than  those  further target Measure  than  for  was the  preliminary  need f o r f u r t h e r  more h e l p f u l i n f a c i l i t a t i n g  unfinished  The  Target  condition.  plus  A f f e c t i v e Reactions  of u n f i n i s h e d  the  empathy  significantly  f e e l i n g s toward a  improvement  empathy p l u s  reflection  shown t h a t  produced  reflection.  as m e a s u r e d by  clinical  w i t h an  one  dialogue  subjects'  empathic  f o r the  empathic  s t u d y has  m e a s u r e d by  on  that  complaint  this  investigation in  form of  treatment  change when The  dealing  resolution  therapeutic  of  issue  and  tentative results dialogue  i n the  context  make a c o n t r i b u t i o n t o  of u n f i n i s h e d  business.  the  113 REFERENCES  B a r r e t t - L e n n a r d , G.T. (1962). 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Review of P e r s o n a l i t y and S o c i a l P s y c h o l o g y ( V o l . 1 pp. 2 6 5 - 2 9 4 ) . Beverly H i l l s : Sage. Wiggins, J.S. (1982). C i r c u m p l e x models of i n t e r p e r s o n a l behaviour i n c l i n i c a l psychology. In K e n d a l l , P.C., & B u t c h e r , J.N. (Eds.). Handbook o f R e s e a r c h Methods i n C l i n i c a l P s y c h o l o g y (pp. 1 8 3 - 2 2 1 ) . N.Y.: John W i l e y & Sons . Wiggins,  J.S.  (1984).  A f f e c t i v e Reactions Questionnaire.  W i g g i n s , J . S . , & B r o u g h t o n , R. (1985). The i n t e r p e r s o n a l c i r c l e : A s t r u c t u r a l model f o r t h e i n t e g r a t i o n o f personality research. Perspectives in Personality, 1, 1-47.  APPENDIX A  Consent Sharron Unfinished Greenberg U.B.C.  will  Subjects w i l l sessions.  will  completion.  2 counselling  Tapes w i l l  to bring  from  Subjects w i l l  t h e study  sessions.  4 hours.  This  s e s s i o n s and  be made o f t h e  s e s s i o n s f o r r e s e a r c h purposes  research materials.  class  be a s k e d  be a p p r o x i m a t e l y  o f t h e r e s e a r c h team w i l l  time  i n 2 one-hour  B u s i n e s s t o work on i n t h e c o u n s e l l i n g  questionnaire  any  t o be c l i e n t s  Subjects w i l l  i n c l u d e an o r i e n t a t i o n ,  outside  of Dr. Les  of C o u n s e l l i n g Psychology,  be a s k e d  t i m e committment  counselling  a r e c o n d u c t i n g a s t u d y on  under t h e s u p e r v i s i o n  o f t h e Department  Unfinished Total  K i n g and Vera Maslove  Business  counselling  Form  only.  No one  have a c c e s s t o t h e be f r e e t o w i t h d r a w a t  f o r any r e a s o n w i t h o u t  jeopardy t o  standing.  If contact  y o u have any q u e s t i o n s r e g a r d i n g t h e s t u d y , p l e a s e Vera Maslove  Psychology  I  or Sharron  theCounselling  Department.  have r e a d a n d u n d e r s t o o d  participate  King through  i n t h e above  Signature  t h e above, and I a g r e e t o  study.  Date  121 APPENDIX B  Client  Information  Form  Name:  Client  Address:  Age:  Phone:  Home:  Courses  taken  Work:  How much c h a n g e do y o u f e e l  1 no  #  change  2  you've undergone t h i s  3 s omewhat  4  year?  5 maximum  APPENDIX C  Abbreviated  On  the  interests items  you  Don't Give  have and  right  answer what  the  course,  "right"  to their  you or  own  i n f o r m a t i o n you  some q u e s t i o n s  might  t o see  things.  what  On  most  "wrong" answers b e c a u s e  views.  A l l you  people  have t o do  is  you.  t h i n k i n g over  n a t u r a l answer as  questions  Questionnaire  f e e l about  s p e n d t o o much t i m e  the  are too like,  each  i t comes t o y o u .  s h o r t t o g i v e you  but  question.  give the best  Of  a l l the  answer y o u  can  circumstances.  Please  answer e v e r y  s h o u l d mark t h e the middle  how  i s true for  first,  under the  Interest  f o l l o w i n g pages a r e  t h e r e a r e no  have t h e  16-PF  'b'  'a'  or  question  'c'  one  answer most  answer o n l y when y o u  b e c a u s e n e i t h e r 'a' n o r  way  or t h e  of the  f e e l you  ' c ' seems t o be  right  other.  time.  Mark  have t o , for  you.  You  When I'm i n a s m a l l , cramped s p a c e e l e v a t o r ) , I have an u n c o m f o r t a b l e "shut i n " .  (as on a c r o w d e d f e e l i n g of being  a. never,  c. o c c a s i o n a l l y .  b. r a r e l y ,  I f i n d myself t h i n k i n g over q u i t e t r i v i a l t r o u b l e s a g a i n a n d a g a i n a n d have t o make a r e a l e f f o r t t o p u t them out o f my mind. a. y e s ( t r u e ) , b. o c c a s i o n a l l y , c . no (f a l s e ) . I feel what .  r e s t l e s s as i f I want  a. v e r y r a r e l y , If  I h a d my  life  something  b. o c c a s i o n a l l y , to live  b u t do n o t know c. often.  over a g a i n , I would:  a. p l a n i t d i f f e r e n t l y , b . unc e r t a i n , c . want i t much t h e same. In m a k i n g d e c i s i o n s i n my l i f e a n d work, I was n e v e r t r o u b l e d by l a c k o f u n d e r s t a n d i n g on t h e p a r t o f my family. a. t r u e ,  b . i n between,  c. f a l s e .  My n e r v e s g e t on edge, so t h a t c e r t a i n s o u n d s , f o r example, a s c r e e c h y h i n g e , a r e u n b e a r a b l e a n d g i v e me the " s h i v e r s " . a.  often,  I often a. y e s ,  feel  b . sometimes, quite  tired  a.  true,  when I g e t up i n t h e m o r n i n g ,  b . i n between,  Changes i n w e a t h e r d o n ' t and mood. b.  c. never.  usually  i n between,  c . no. a f f e c t my c.  efficiency false.  124 9.  I sometimes f i n d q u i t e u s e l e s s s t r a y i n g t h r o u g h my m i n d . a. y e s ,  10.  b.  b.  t h e way  In an can't  c. people  no. that  i n between,  c.  from w o r k i n g  i n between, likes  to avoid  b.  meeting  people  a v e r a g e day, t h e number o f p r o b l e m s s o l v e on my own i s :  a . h a r d l y one, b . i n between, c . more t h a n h a l f  a  dozen.  false. than  false.  no.  f o r people c.  seldom,  when  by  c.  and d i s l i k e s  I  false.  say t h i n g s  b. u n c e r t a i n ,  I cross the s t r e e t feel l i k e seeing. a. never,  16.  c.  i n between,  I d o n ' t f o r m immediate I have j u s t met. a. t r u e ,  15.  b.  In some moods I'm e a s i l y k e p t d i s t r a c t i o n s amd d a y d r e a m s . a. y e s ,  14.  c.  b. u n c e r t a i n ,  I am o f t e n h u r t more by by what t h e y s a y . a. t r u e ,  13.  i n between,  memories  I f i n d i t h a r d t o " t a k e 'no' f o r an a n s w e r , " even I know I'm a s k i n g t h e i m p o s s i b l e . a. t r u e ,  12.  and  I n e v e r f i n d m y s e l f so a n n o y e d i n d i s c u s s i o n s c a n ' t c o n t r o l my v o i c e . a. t r u e ,  11.  b.  thoughts  false. I don't  c.  sometimes.  I meet t h a t  I  125 17. When p u s h e d and o v e r w o r k e d , I s u f f e r f r o m i n d i g e s t i o n or c o n s t i p a t i o n . a . occasionally,  b.  18. I f someone annoys me,  hardly  ever,  c . never.  I:  a. c a n k e e p i t t o m y s e l f , b. i n between, c. must s p e a k t o someone e l s e  " t o l e t o f f steam".  19. Modern l i f e has t o o many a n n o y i n g f r u s t r a t i o n s and restrictions. a.  true,  20. I f e e l a.  b. i n between,  ready  for life  always,  c.  false.  and i t s demands.  b. sometimes,  c. h a r d l y  ever.  21. A n e a r - a c c i d e n t , o r even a l i v e l y argument, sometimes l e a v e s me shaky and e x h a u s t e d , so that. I c a n ' t s e t t l e down t o what I was d o i n g . a. 22.  true,  I f i n d my a.  b. i n between, f e e l i n g s b o i l i n g up  rarely,  c.  false.  inside:  b. o c c a s i o n a l l y ,  c. q u i t e  often.  23. I have d i f f i c u l t y i n f o l l o w i n g what some p e o p l e a r e t r y i n g t o say b e c a u s e o f t h e i r odd use o f common words. a . yes , 24. On o c c a s i o n s , my w i t h me". a.  true,  b.  in  between,  e m o t i o n s and f e e l i n g s b.  uncertain,  c . no. " r u n away c . false.  126 25.  I f e e l so f u r i o u s b r e a k a window:  I want t o s l a m a d o o r , a n d maybe  a. v e r y r a r e l y , b. o c c a s i o n a l l y , c. f a i r l y f r e q u e n t l y .  26.  I would  prefer  to lead:  a . t h e same k i n d o f l i f e I now l e a d , b. u n c e r t a i n , c. a more s h e l t e r e d l i f e , w i t h fewer to face.  difficulties  APPENDIX (Barrett-Lennard)  Relationship Empathy  D Inventory  - Form OS  -  64  Seale  Date;  feel  Below a r e l i s t e d a v a r i e t y o f ways t h a t one or b e h a v e i n r e l a t i o n t o a n o t h e r p e r s o n .  person  may  P l e a s e c o n s i d e r each numbered s t a t e m e n t w i t h r e f e r e n c e to your present r e l a t i o n s h i p w i t h your c o u n s e l l o r , mentally a d d i n g h i s or h e r name i n t h e s p a c e p r o v i d e d . F o r example, i f t h e o t h e r p e r s o n ' s name was J o h n , y o u w o u l d r e a d s t a t e m e n t #1, as 'John r e s p e c t s me as a p e r s o n ' . Mark e a c h s t a t e m e n t i n t h e answer column on t h e r i g h t , a c c o r d i n g t o how s t r o n g l y y o u f e e l t h a t i t i s t r u e , or not t r u e , i n t h i s r e l a t i o n s h i p . P l e a s e be s u r e t o mark e v e r y one. W r i t e i n +3, +2, +1, -1, -2, -3, t o s t a n d f o r t h e f o l l o w i n g answers: +3:  Yes, that  I strongly feel i t i s true,  -1:  No, I f e e l t h a t i t i s p r o b a b l y u n t r u e , or more untrue than t r u e .  +2:  Yes,  I feel  -2:  No,  +1:  Yes, I f e e l t h a t i t i s p r o b a b l y t r u e , or more t r u e than untrue.  -3:  No, I s t r o n g l y f e e l i t i s not t r u e ,  i t i s true.  I feel  i t i s not  true, that  ANSWER 1.  wants t o  u n d e r s t a n d how  2.  may  u n d e r s t a n d my  not  see  the  way  I see  words b u t  things  he/she  I feel  3.  nearly  4.  l o o k s a t what I do f r o m h i s / h e r of view u s u a l l y s e n s e s or r e a l i s e s what f eeling  5.  does  a l w a y s knows e x a c t l y what  I mean.. own I  point am  128  6.  's own a t t i t u d e s t o w a r d some o f t h e t h i n g s I do o r s a y p r e v e n t h i m / h e r f r o m u n d e r s t a n d i n g me  7. Sometimes because t h a t ' s  t h i n k s t h a t I f e e l a c e r t a i n way, t h e way h e / s h e f e e l s  8.  r e a l i s e s what I mean even when I have d i f f i c u l t y i n saying i t  9.  u s u a l l y u n d e r s t a n d s t h e w h o l e o f what I mean  10.  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 i n k or f e e l  11.  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  12.  that I  At time 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 t h a n I r e a l l y do  13.  does n o t r e a l i z e how s e n s i t i v e I am a b o u t some o f t h e t h i n g s we d i s c u s s  14.  u n d e r s t a n d s me  15.  's r e s p o n s e t o me i s u s u a l l y so f i x e d a n d a u t o m a t i c t h a t I don't r e a l l y get through t o him/her  16.  When I am h u r t o r u p s e t f e e l i n g s e x a c t l y , without  c a n r e c o g n i z e my becoming upset too....  129 APPENDIX  Working  Alliance  E  Inventory - Task  Dimension  On t h e f o l l o w i n g p a g e s t h e r e a r e s e n t e n c e s t h a t d e s c r i b e some o f t h e d i f f e r e n t ways a p e r s o n m i g h t t h i n k or f e e l about h i s or h e r t h e r a p i s t ( c o u n s e l l o r ) . As y o u r e a d t h e s e n t e n c e s , m e n t a l l y i n s e r t t h e name o f y o u r t h e r a p i s t ( c o u n s e l l o r ) i n p l a c e of i n the text .  Below e a c h  1 Never  statement  inside,  2 3 Rarely Occasionally  there i s a seven-point  4 5 6 Sometimes O f t e n V e r y o f t e n  scale:  7 Always  I f t h e s t a t e m e n t d e s c r i b e s t h e way y o u a l w a y s f e e l ( o r t h i n k ) , c i r c l e t h e number '7'; i f i t n e v e r a p p l i e s t o y o u , c i r c l e t h e number '1'. Use t h e numbers i n between t o d e s c r i b e t h e v a r i a t i o n s between t h e s e e x t r e m e s . This neither  questionnaire  your t h e r a p i s t  i s CONFIDENTIAL;  n o r t h e agency  will  see your  answers  Work f a s t ; y o u r f i r s t i m p r e s s i o n s a r e t h e ones we l i k e t o see. (PLEASE DON'T FORGET TO RESPOND TO EVERY ITEM).  Thank y o u Copyright  f o r your c o o p e r a t i o n A.O.  H o r v a t h , 1981,  1982. v  would  130  1 . do  and I a g r e e a b o u t t h e i n t h e r a p y t o h e l p i m p r o v e my  1 2 Never R a r e l y 2.  What I am d o i n g a t my p r o b l e m .  1 2 . Never R a r e l y 3.  I am  on what my  3 Occasionally  i n therapy  3 Occasionally  I am c l e a r sessions.  1 2 Never R a r e l y  as  t o what  3 Occasionally  me  new  and I a r e efficiently.  6 Very  looking  6 Very  to  7 Always  often  ways o f  often  7 Always  often  7 Always  6 Very  spending  4 5 Sometimes O f t e n  Very  responsibilities  are  4 5 Sometimes O f t e n  Very  I are  need  confusing.  4 5 Sometimes O f t e n  and concerns.  3 Occasionally  gives  4 5 Sometimes O f t e n  doing  4 5 Sometimes O f t e n  I f e e l t h a t t h e t h i n g s I do a c c o m p l i s h the changes t h a t  1 2 Never R a r e l y 8.  3 Occasionally  I f i n d what u n r e l a t e d t o my  1 2 Never R a r e l y 7.  3 Occasionally  clear  1 2 Never R a r e l y 6.  doing  I b e l i e v e the time t o g e t h e r i s not s p e n t  1 2 Never R a r e l y 5.  I am  4 5 Sometimes O f t e n  i n therapy  3 Occasionally  I f i n d what  1 2 Never R a r e l y 4.  3 Occasionally  things I w i l l situation.  6  in therapy. 6  i n therapy  is  6 Very  7 Always  often help  me  6 Very  wants me 4 5 Sometimes O f t e n  7 Always  often  i n therapy w i l l I want.  4 5 Sometimes O f t e n  7 Always  often  often  t o do  in  6 Very  often  to  7 Always these 7 Always  131  9.  We  a g r e e on what  1 2 Never R a r e l y 10.  I am  f o r me  things  I am  way  we  3 Occasionally  4 5 Sometimes O f t e n  6 Very me  are  my  working with  Date :  often  t o do  Very  Name :  often  7 Always  i n therapy.  4 5 Sometimes O f t e n  4 5 Sometimes O f t e n  on.  6 Very  doing  i s asking  3 Occasionally  t o work  4 5 Sometimes O f t e n  that  I b e l i e v e the correct.  1 2 Never R a r e l y  the  3 Occasionally  The t h i n g s sense.  1 2 Never R a r e l y 12.  3 Occasionally  f r u s t r a t e d by  1 2 Never R a r e l y 11.  i s important  7 Always  d o n ' t make  6 often  7 Always  problem i s 6  Very  often  7 Always  132  APPENDIX F Target  Complaint  Measure  Date: Name:  P l e a s e name t h e main c o n c e r n t h a t in  this  counselling:  y o u want  t o work on  133  Client  #  _  Sex: F  _ M  Target  Session  #  Date  Complaints  We a r e i n t e r e s t e d i n how much t h e f o l l o w i n g c o n f l i c t y o u r s has c h a n g e d s i n c e words t h a t  describe  worse  same  the last  session.  Please  c i r c l e the  your p o s i t i o n .  slightly better  somewhat better  of  a lot better  134  APPENDIX G  A f f e c t i v e Reactions  Target  Questionnaire  Person  Name Male  Female  Age  On t h e n e x t p a g e y o u w i l l f i n d a l i s t o f words t h a t d e s c r i b e t h e f e e l i n g s o r e m o t i o n a l r e a c t i o n s p e o p l e e x p e r i e n c e when they i n t e r a c t with others. P l e a s e imagine t h a t you a r e i n t h e p r e s e n c e o f t h e t a r g e t p e r s o n and t h a t y o u a r e i n t e r a c t i n g w i t h him or h e r . Then, f o c u s on t h e f e e l i n g s you e x p e r i e n c e w h i l e i n t e r a c t i n g w i t h t h e t a r g e t p e r s o n . F o r each word i n t h e l i s t , i n d i c a t e how a c c u r a t e l y t h e word d e s c r i b e s your f e e l i n g s . The a c c u r a c y w i t h w h i c h a word d e s c r i b e s y o u r f e e l i n g s i s t o be j u d g e d on t h e f o l l o w i n g scale: 1  Extremetly  2 Very 3 Quite  inaccurate  5 Slightly 6 Quite  inaccurate  7 Very  inaccurate  4 Slightly  accurate accurate  8 Extremely  inaccurate  accurate  accurate  C o n s i d e r t h e word EXCITED. How a c c u r a t e l y does t h a t word d e s c r i b e how y o u f e e l when i n t e r a c t i n g w i t h t h e t a r g e t person? I f y o u t h i n k t h a t t h i s word i s a q u i t e a c c u r a t e d e s c r i p t i o n o f y o u r f e e l i n g s , w r i t e t h e number "6" t o t h e l e f t of the item: 6  EXCITED  I f y o u t h i n k t h a t t h i s word i s a s l i g h t l y i n a c c u r a t e d e s c r i p t i o n o f y o u r f e e l i n g s , w r i t e t h e number "4" n e x t t o i t , i f i t i s v e r y i n a c c u r a t e , w r i t e t h e number "2", e t c .  Copyright  1984  Jerry  S. W i g g i n s ,  Ph.D.  Target  Extremely Very Quite  Person  inaccurate  inaccurate inaccurate  Slightly  inaccurate  makes me  5  Slightly  6  Quite  7  Very  8  Extremely  feel:  accurate  accurate accurate accurate  (01) D a r i n g  (17) A f r a i d  (02) C o n f i d e n t  (18) T i m i d  (03) A d v e n t u r o u s  (19) Weak  (04) S t r o n g  (20) I n s e c u r e  (05) Smug  (21) U n a g g r e s s i v e  (06) A r r o g a n t  (22) Modest  (07) Cocky  (23) Humble  (08) S u p e r i o r  (24) O b l i g i n g  (09) A n t a g o n i s t i c  (25) Rec ept i v e  (10) I n t o l e r a n t  (26) C o o p e r a t i v e  (11) A g g r e s s i v e  (27) A g r e e a b l e  (12) Demanding  (28) T o l e r a n t  (13) D i s c o u r a g e d  (29) E n t h u s i a s t i c  (14) D i s a p p o i n t e d  (30) J o y f u l  (15) D i s s a t i s f i e d  (31) D e l i g h t e d  (16) R e s e n t f u l  (32) Happy  136  APPENDIX H Spssion  Circle  one:  Today's  Evaluation  Therapist  date:  - Form_4  Client  month  day  T # C #  /  Directions: Please you f e e l about t h i s This  Questionnaire  year  p l a c e an "X" on each l i n e session.  t o show how  s e s s i o n was: GOOD  BAD  DANGEROUS  SAFE DIFFICULT  EASY  VALUABLE  WORTHLESS  SHALLOW  DEEP  RELAXED  TENSE  UNPLEASANT  PLEASANT EMPTY  FULL  POWERFUL  WEAK SPECIAL  _  ROUGH COMFORTABLE.  ORDINARY SMOOTH UNCOMFORTABLE  137  Right  now  I  feel: SAD  HAPPY ANGRY  :-  STILL  MOVING UNCERTAIN  PLEASED  DEFINITE  ,  EXCITED CALM  sAFRAID  CONFIDENT  SLEEPY  WAKEFUL FRIENDLY  :.  SLOW  '-.  ENERGETIC  :__  INVOLVED  :__  QUIET  UNFRIENDLY FAST PEACEFUL DETACHED AROUSED  138  APPENDIX I  Questionnaire  A  Date: Name:  1.  Briefly  describe  the issue  that  y o u w i s h t o work on.  2.  P l e a s e i n d i c a t e , by c h e c k i n g one o f t h e b o x e s b e l o w , much t h i s i s s u e b o t h e r s y o u now.  !  ! C o u l d n ' t be w o r s e  !  ! V e r y much  !  ! Pretty  \~'< !  A  much  little  ! Not a t a l l  how  APPENDIX J  Questionnaire  B Date: Name: S e s s i o n #:  Was t h e i s s u e t h a t y o u w o r k e d on d u r i n g t h e h o u r t h e same o r s i m i l a r t o t h e i s s u e t h a t y o u b r o u g h t i n ? ( C i r c l e one) Very  different 1  Different  Related  2  Similar  3  4  Same 5  P l e a s e i n d i c a t e , by c h e c k i n g one o f t h e b o x e s b e l o w , much t h e i s s u e w h i c h y o u i d e n t i f i e d b e f o r e t h e hour b o t h e r s y o u now. Couldn't Very  much  Pretty A Not  be w o r s e  much  little at a l l  how  How do y o u completed?  f e e l a b o u t t h e hour w h i c h y o u have ( C i r c l e one)  1.  Perfect  2.  Excellent  3. V e r y  good  4.  Pretty  5.  Fair  6. P r e t t y 7.  good  poor  Very poor  just  APPENDIX K  Questionnaire  C  Date: Name :  B r i e f l y d e s c r i b e the i s s u e that you i d e n t i f i e d the l a s t s e s s i o n .  before  P l e a s e i n d i c a t e , by c h e c k i n g one o f t h e b o x e s b e l o w , much t h i s i s s u e b o t h e r s y o u now. !  ! Couldn't  !  ! Very  !  ! P r e t t y much  how  be w o r s e  much  !~!  A  little  !~!  Not a t a l l  D u r i n g t h e p a s t week, have y o u e x p e r i e n c e d a change i n y o u r s e l f which you a t t r i b u t e t o t h e c o u n s e l l i n g s e s s i o n ? ( C i r c l e one) 1  2  3  Definitely no  Don't t h i n k so  Unsure  4 Think  5 so  Definitely yes  142  4.  How much p r o g r e s s do y o u f e e l y o u made i n d e a l i n g w i t h your i s s u e s i n c e t h e l a s t hour? (Please c i r c l e the item which best a p p l i e s . ) 1. A g r e a t  d e a l of p r o g r e s s .  2. C o n s i d e r a b l e 3. M o d e r a t e  progress.  progress.  4. Some p r o g r e s s . 5. D i d n ' t  g e t anywhere.  5.  I f y o u a n s w e r e d p o s i t i v e l y t o q u e s t i o n s 3 o r 4 above, p l e a s e d e s c r i b e t h e changes or p r o g r e s s which y o u f e e l occurred.  6.  Has a n y t h i n g u n u s u a l h a p p e n e d d u r i n g t h e week o t h e r t h a n t h e s e s s i o n t o w h i c h y o u a t t r i b u t e any change y o u have reported? I f s o , what?  143 APPENDIX L  Therapist  Questionnaire Date: Name : Client  1.  How many  2.  D i d t h e c l i e n t p r e s e n t an i s s u e o f u n f i n i s h e d during t h i s session? ( C i r c l e one)  Definitely no If  4.  sessions  have y o u h a d w i t h  Don't t h i n k so  Unsure  s o , what was t h e u n f i n i s h e d  this  Yes  What i n t e r v e n t i o n were y o u p l a n n i n g  Very Definitely  t o perform? 2  Empathy Were y o u a b l e  business  business?  1  5.  client?  Empty~Chair  t o perform the experimental  1  2  3  4  Definitely yes  Yes  Somewhat  Don't t h i n k so  intervention? 5 Definitely no  144  6.  During t h i s  session,  1. I u n d e r s t o o d  exactly  how my  2. I u n d e r s t o o d v e r y w e l l felt .  client  how my  thought  client  and  thought  felt.  and  3. I u n d e r s t o o d my c l i e n t p r e t t y w e l l , b u t t h e r e were c e r t a i n t h i n g s I d i d n ' t seem t o g r a s p . 4. I d i d n ' t u n d e r s t a n d t o o w e l l and f e l t . 5. I m i s u n d e r s t o o d  how my  client  how my  client  thought  happen i n t h i s  and  thought felt.  7.  Did anything s i g n i f i c a n t  session?  8.  Is t h e r e a n y t h i n g s p e c i a l a b o u t t h i s c a s e t h a t we s h o u l d resolution know? ( e g . An e x t e r n a l e v e n t i n f l u e n c i n g t h e of t h e u n f i n i s h e d b u s i n e s s . )  

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