ENYEchU-DGE RELEAEEMTCH AND SELECTED CLIENT - THERAPEST VAMABLES: A COME?“ ANALYSK‘S OF ENETEAL PSYQHOTHERAP‘EUTEC ENTER-VIEWS Thesis for the chm at M. A. WCKIGRN STATE UREVERSITY Karen S. Kamer‘schen 1965 THESIS LIBRARY Michlgan State UniverSIty ABSTRACT INTER-JUDGE RELIABILITIES AND SELECTED CLIENT- THERAPIST VARIABLES: A CONTENT ANALYSIS OF INITIAL PSYCHOTHERAPEUTIC INTERVIEWS by Karen S. Kamerschen The analysis of psychotherapeutic interaction is an important means for learning about the process of psycho— therapy. Several researchers have developed systems of _molecular content analysis to explore the verbal interaction emphasized in psychotherapy. The present study assesses the inter-judge reliability of KOpplin's recently deve10ped system and then utilizes this system to investigate the ef- fects of several therapist variables upon the psychothera— peutic process. The first hypothesis states that psychotherapists will tend to approach the client's discussion of hostility, dependency, affiliation, self-assertion, sex, and vague feel— ings more than they will avoid them. In addition, the extent of the therapist's approach will vary with the tOpic. A further hypothesis predicts that therapists will approach a client's affective discussion of any area more than his non—affective discussion. Both therapist approaches Karen S. Kamerschen and avoidances to client statements should consist of more responses that focus on the client's feelings than that focus upon objects external to the client. Similarly, any thera- pist initiation of a discussion will focus upon the client's feelings about the tOpic rather than upon the objective aspects of that topic. These tOpical initiations should con— tain a greater prOportion of internal foci than do approaches to existing topics. The study also predicts that experienced psychothera- pists will be more apt to approach client discussions of hostility and dependency than will less experienced or inex- perienced therapists. The final prediction asserts that there is a correlation between the duration of psychotherapy and the psychotherapist's rating of that psychotherapy as successful or unsuccessful. A content analysis is made of the taperecorded initial psychotherapeutic interviews for 46 clients treated at a university counseling center by psychotherapists at the staff, interne, and practicum trainee levels of experience. Client-therapist interactions are coded for the frequency of? client statements of hostility, dependency, affiliation, self-assertion, sex, vague, and other; client affective and non-affective expression; therapist internally and/or ex— ternally focused approaches and avoidances of the Karen S. Kamerschen above—mentioned client statements; and for client continu— ances of the tOpic following the various therapist responses. Results: Inter—judge reliability obtains for 169 of the 181 variables included in the study. 1. Therapists significantly approach dependency and vague, significantly avoid affiliation, tend to avoid self— assertion, and show no statistically significant difference. in their approach—avoidance behavior toward hostility and sex. 2. Therapists significantly approach client affect more than non-affect for the tOpics of self-assertion and sex, significantly approach non-affect for dependency, and show no significant differences for hostility and affiliation. 3. Therapists' approach and avoidance responses to all client topics proceed via a greater focus on client feelings than on objective data. A 4. Therapist initiations of all topics contain signifi— cantly more internal than external foci. 5. The prOportion of internal foci for initiations is significantly greater than that prOportion for approaches for the topics of hostility, dependency, self-assertion, and vague but shows no significant difference for affiliation or sex. Karen S. Kamerschen 6. Although no differences in approach behavior to client hostility and dependency appear in the simultaneous comparison of the three experience levels, inexperienced therapists are significantly less apt to approach hostility and dependency when compared with the two more experienced levels of therapists as considered together. 7. A significant positive correlation exists between the duration of psychotherapy and the psychotherapist's rating of that psychotherapy as successful. Ample Opportunity for future research lies in the more complete use of KOpplin's recently developed system of molecular content analysis. Approved Z/WW Chairman, Thesis Committee— Date INTER-JUDGE RELIABILITIES AND SELECTED CLIENT- THERAPIST VARIABLES: A CONTENT ANALYSIS OF INITIAL PSYCHOTHERAPEUTIC INTERVIEWS BY Karen S. Kamerschen A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS Department of Psychology 1965 To My Wonderful Parents ii ACKNOWLEDGMENTS The writer is sincerely grateful to her committee chairman Dr. C. L. Winder for his extremely competent guidance and supervision and especially for his introduction of the writer to process studies of psychotherapy. Appreci— ation is also due to her committee members, Dr. Charles Hanley and Dr. William Kell for their kind encouragement and assistance. : A deep appreciation extends to Dr. David A. KOpplin for his work as primary judge, his supervision of data col- lection, and his vast contribution to the academic and personal growth of the writer. Thanks are due to Mrs. Carol Boice, Miss Mary Berk: and Mrs. Nancy Whitman for their aid in coding and data analysis. Acknowledgments are made to the psychotherapists and clients at the Michigan State University Counseling Center for their cooperation in making available the taperecordings on which this study is based. The research for this study was completed during the tenure of a Predoctoral Fellowship from the National Insti-- tute of Mental Health, United States Public Health Services. Sincere thanks are due them for the freedom that permitted the writer to fully invest herself in this research. iii TABLE OF CONTENTS Chapter Page I. INTRODUCTION 1 Hypothesis I 4 Hypothesis II 5 Hypothesis III 5 Hypothesis IV 6 Hypothesis V 7 II. METHOD 8 Subjects . . . . . . . . . . . . . . . . . 8 Coding of client-therapist interaction . . 10 Scoring reliability . . . . . . . . . . . 11 III. RESULTS . . . . . . . . . . . . . . . . . . . 15 Reliability . . . . . . . . . . . . . . . 15 Hypothesis I . . . . . . . . . . . . . . . 22 Hypothesis II . . . . . . . . . . . . . . 25 Hypothesis III . . . . . . . . . . . . . . 3l Hypothesis IV . . . . . . . . . . . . . . 34 Hypothesis V . . . . . . . . . . . . . . . 34 IV. DISCUSSION . . . . . . . . . . . . . . . . . . 37 Reliability 0 o o o o o a o o o o o o o o 37 Hypothesis I . . . . . . . . . . . . . . . 39 Hypothesis II . . . . . . . . . . . . . . 42 Hypothesis III . . . . . . . . . . . . . . 43 Hypothesis IV . . . . . . . . . . . . . . 45 Hypothesis V . . . . . . . . . . . . . . . 45 V. SUMMARY‘ . . . . . . . . . . . . . . . . . . . 47 REFERENCES 0 a o I o o o o o o o o o o o o o o o o a o 51 APPENDICES . . . . . . . . . . . . . . . . . . . . . . A—l iv Table 10. 11. LIST OF TABLES Page Characteristics of therapists and clients . . 9 Inter—judge reliability coefficients for approach and avoidance . . . . . . . . . . . 16,18,20 Inter-judge reliability coefficients for initiation and initiation continuance . . . 21 Inter-judge reliability coefficients for client and therapist affect levels . . . . . 23 Comparison of therapist responses of ap— proach and avoidance to interpersonal categories . . . . . . . . . . . . . . . . . 24 Comparison of percent approach after client affect and non-affect . . . . . . . . . . . 26 Internalization—externalization ratios for therapist approaches . . . . . . . . . . . . 29 Internalization-externalization ratios for therapist avoidances . . . . . . . . . . . . 3O PrOportion of internalizations for thera— pist initiations of interpersonal categories . . . . . . . . . . . . . . . . . 32 Comparison of proportions of internali-- zations for therapist initiations and approaches . . . . . . . . . . . . . . . . . 33 Experience level and duration of treatment . . 35 Appendix A. B. LIST OF APPENDICES SCORING MANUAL RATING SHEET FOR THERAPISTS vi I . INTRODUCTION Psychotherapy is the major interest of many psy— chologists but, as with many fields, too little is yet known about it. Research on psychotherapy frequently centers on one or the other of two main foci, outcome studies and pro- cess studies. The former is the older and more heavily emphasized pattern and seeks to ascertain whether psycho- therapy is beneficial and, if so, in what way. This re- search tack suffers from an absence of adequate criteria by which to appropriately assess the outcome. The latter and more recently emphasized focus of research on psychotherapy is not upon the benefit of the treatment but rather upon the process of psychotherapeutic interaction. Since verbal interaction is emphasized in psychotherapy, analysis of psychotherapy seems most aptly directed at the content of these verbalizations. Recent years have witnessed the development of several systems of molecular content analysis (Murray, 1956; Bandura, Lipsher, and Miller, 1960; Winder, Ahmed, Bandura, and Rau, 1962). Kopplin (1963) and Caracena (1963) employed a modified version of the Bandura—Winder system in their investigations of psychotherapy. Although these systems show limitations in scope, they represent significant advancements in establishing a methodological means for investigating the process of psychotherapy. The present study is primarily an attempt to demon— strate inter-rater reliability for a recently developed molecular method of content analysis (KOpplin, 1965) that is broader than those of previous studies. Kopplin's system (see Appendix A) expands and supplements the basic Bandura- Winder model in several ways. The interpersonal behavior categories classifying client statements now include Affiliation, Self-assertion, and Vague as well as the Hostility, Dependency, Sex, and "Other" categories of the prior model. An important inno- vation in Kopplin's system is the delineation of the intra- psychic states of Need, Anxiety, Guilt, Frustration—hurt, Frustration—aggression, and Satisfaction. Situations where the client does not fully specify his intrapsychic state necessitated adding the conditions "Unstated" and "Simple agreement-disagreement" to the previously mentioned intra- psychic states. (See coding manual in Appendix A for further details on scoring.) Coders score the appropriate intra- psychic states for the clients'verbalizations in each cate— gory of interpersonal behavior. The present study does not utilize the entire breadth of this innovation. Rather, it combines the first six intrapsychic states, Need, Anxiety, Guilt, Frustration—hurt, Frustration-aggression, and Satis— faction, to form the class of affect and combines the last two states, Unstated and Simple agreement-disagreement, to form the class of non—affect. This mutually exclusive and exhaustive affect/non-affect dichotomy applies to each inter- personal category except Vague, which is defined as always affective, and Other, which is defined as always non— affective. The present study also excludes a six-point psychotherapeutic relevancy scale developed by KOpplin as a further and more discriminative measure of client affectivity and behavior (See section II D of Appendix A). The therapist variables in KOpplin's recently formu- lated system extend beyond those of the Bandura—Winder model. The new system retains both the initial approach-avoidance dichotomy for therapist behavior toward client statements and the therapist's initiation of an interpersonal category. Therapist initiation of an interpersonal category refers to the psychotherapist's introduction of an interpersonal be- havioral category that was not present in the client's im— mediately preceding statement. In addition to these, the system goes on to assess the qualitative aspect of the therapist's reply by using an internalizing—externalizing dichotomy for each approach, avoidance, or initiation response. Internalization (I) focuses upon the client's concept of himself, his feelings, and his reactions to the stimuli impinging on him. The therapist encourages the client to express his feelings. In contrast, externalization (E) focuses upon something "outside" the client and clearly lacks any focus on how the client ”feels”. The therapist does not encourage the client to ex- press his feelings. The current investigation utilizes KOpplin's system to explore the effects of several therapist variables upon the psychotherapeutic process. Hypothesis I. The first hypothesis revolves around the therapists' approach-avoidance behavior toward the clients' verbalizations and predicts that therapists will tend to approach any given interpersonal category more than to avoid it. The assumption underlying the prediction is that the client will talk about the areas in which he has problems. In order to resolve these difficulties, the thera- pist must approach and fully explore the client's concerns. However, it is also reasonable to predict that the thera— pist's approach ratio to the various categories will vary with the category rather than remaining constant, i.e., therapists will show differential category approach ratios. This prediction follows from the general belief among psycho— therapists that some areas of interpersonal behavior are more important for psychotherapy than other areas. For ex— ample, since, for the client, psychotherapy is basically a help-seeking process, one might expect therapists to view Dependency as a more relevant psychotherapeutic concern can Affiliation. Although individual differences would probably preclude all therapists from holding a uniform hierarchy of psychotherapeutic relevancy, some general trends should emerge. Hypothesis II. Therapists and theories of psycho— therapy frequently advance affect as an important factor for psychotherapeutic progress. The second set of hypotheses concerns the level of affect sought by the therapist. More specifically, the therapist should approach affect more often than he approachessnon—affective expression for any given category. The basis for this hypothesis is relatively straightforward. Since, according to social—learning theory, approaching an action tends to elicit its continuation and avoiding it tends to elicit its cessation, approaching af— fect and avoiding non—affect should yield the desired be- havioral result of increased affectivity. Proceeding one step further, since, by definition, internalization en— courages affect and externalization discourages it, therapist approach responses to any interpersonal category should con— sist of more internalizations than externalizations. If the therapist desires the client to be affective in whatever tepic is under discussion, his avoidance responses to inter— personal categories should also be made via internalizations rather than externalizations. Hypothesis III. The expectation that therapist initiations of interpersonal categories will follow the same principle regarding internalizations and externalizations as do therapist approach and avoidance responses leads to the hypothesis that the percentage of internalizations for initiations will be greater than the corresponding percentage of externalizations. The therapist's initiation of an inter— personal category cannot be in terms of an existing af- fective level for that category because a category that was not present cannot have an affective level. In contrast, the therapist's approach to a category must consider the level of affect in the client's discussion of that category. The client's discussion will frequently be non-affective. Although the therapist may either continue this discussion at its existing non-affective level or raise it to a higher level, it is harder to raise the level than to maintain its status quo. Internalization is not more difficult than ex— ternalization for initiations, but it sometimes is for ap- proaches. The above factors lead to the prediction that initiations should contain a greater proportion of internali- zations than externalizations. Hypothesis IV. The present study encompases three psychotherapeutic experience levels. Two prior studies (Caracena, 1963; Kopplin, 1963) have demonstrated that ex— perienced therapists are more likely to approach dependency and hostility statements than less experienced or inexperi- enced ones. The present study attempts to replicate these findings. '(J 't! 'T1 'r1 'r1 Hypothesis V. Behavioral change and resolution of problems are frequently difficult goals to achieve, and it requires considerable time and effort to achieve them. Hy- pothesis V predicts that there will be a positive correlation between the duration of psychotherapy and the psychothera- pist's rating of the case as having a successful or unsuc— cessful outcome. That is, the greater the duration of psychotherapy the greater the liklihood that the psychothera- pist will rate the case as successful. II - METHOD Subjects. Table 1 presents relevant client and therapist characteristics. Taperecorded interviews of the first therapy session for forty-six clients at a university counseling center provide the raw material for this study. Therapist availability generally dictated the assignment of these clients to their respective therapists. The thera- pists encompass males and females on three experience levels: staff are doctoral level counseling and clinical psy— chologists having 4-20 years of experience; internes are ad- vanced graduate students having at least one year of in— tensive psychotherapy supervision; and practicum students are similar to the interne level but have less experience in that they were carrying their first supervised case at the center. The clients are male and female college students from the late adolescent age bracket who voluntarily sought help from the university counseling center fOr their social and personal problems. The duration of therapy varies from two to forty-one interviews. A minor selection of cases entered into the compo- sition of the data. Fifty-four cases compose the counseling center's library of taperecorded interviews. Of these l A H g .- -xp '8‘ T Table 1. Characteristics of therapists and clients. Male Therapists Female Therapists Therapist Experience Male Female Male Female . ' Level Clients Clients Clients Clients Total Staff 3 7 2 2 l4 Interne 6 11 l 5 23 Practicum 2 3 l 3 9 Total 11 21 4 ll 46 lO fifty-four cases, four were not taped on the initial inter- views, two lacked distinguishable difference between sound and noise levels,and two were recorded by the therapist subsequently coding the interviews. The initial interviews for the remaining forty—six cases constitute the data for this study. Codinq of Client-Therapist Interaction. Scoring unit: The three-unit verbal interaction se- quence developed by Bandura et a1. (1960) and Winder et al. (1962) provides the paradigm for the present study. An interaction sequence consists of three units: a beginning client statement, an intermediate therapist response, and the immediately following client statement. To minimize con— tamination effects, coders score each unit before listening to the following unit. Client behavior categories: The coder first scores each client statement for the relevant interpersonal cate— gory, i.e., Hostility, Dependency, Affiliation, Self— assertion, Sex, Vague, and Other. (See Appendix A for de— tailed definitions.) The coder then examines each category he scored as being present and decides whether or not it is affectively expressed. On the basis of client affectivity, he subcategorizes the category statement into the mutually exclusive dichotomy of need (affect) or unstated (non- affect). The scoring of affect takes precedence over ll non-affect if both are present for a given category state- ment. The final decision regarding the client statement indicates the subjects and objects of the verbalization for each category. The possible options are client, mother, father, therapist, peers, other home members or home unit, and other. Psychotherapist response categories: In accordance with the Bandura and Winder systems, the coder classifies the psychotherapist responses in each sequence into one of the two general and mutually exclusive categories of approach and avoidance, depending upon whether the therapist's re— sponse seemingly intended to elicit further client dis— cussion of the present tOpic or to inhibit it. Having de- cided this, the coder assesses each approach and avoidance for its potential to elicit affect. A rating of internali— zation corresponds to attempts by the therapist to focus on client feelings and one of externalization corresponds to a focus upon things external to the client and with an absence of feelings. In addition, the coder scores the therapist re- sponse for any initiation of an interpersonal category not in the client's preceding statement and assigns each an internalization or externalization rating. Scoring Reliability. Coding of the client-therapist interactions consists of two procedures. The first one is dividing the interview into separate client and therapist 12 units and the second is placing the units into their appropri- ate categories. If coders working independently of each other are to perform the second process accurately and re- liably, they must first agree on the delineation of the unit to be coded. If this first process is bypassed, a lack of agreement on what is to be coded may Confound the actual coding of the individual units. Thus, to get a truer picture of the scoring and a measure of its reliability, demarkation of units must precede the coding. Since accurate, reliable scoring requires all coders to use a consistent division of client-therapist units, Judge A devised a method of re—recording the interview on stereophonic dual track tapes and inserting a "beep" at the beginning of statements by the client and therapist. This procedure insures that all coders will consistently divide the tape into units at the same points. To determine the reliability of Judge A's divisions, Judge B "beeped" three randomly selected interviews from the reliability pool. Per- cent agreement rather than Pearson correlation coefficients served to assess "beep" reliability because the exact points of division were critical and the balancing effect of corre- lation coefficients would not allow an adequate assessment of point by point agreements. Inter—judge Reliability: The complexity and diffi— culty of the required coder judgments prompted a method of double-scoring in an effort to attain inter—judge reliability. 13 Initially, four "judges,” A, B, C, and D, coded a selection of interviews. Judge D, the least reliable, drOpped out of the study at an early stage. Judges A, B, and C proceeded to establish familiarity with the coding system by mutually coding a series of interviews. At this point, a selection of five independently coded interviews served to assess trial reliability. Since reliability did not yet reach the de- sired level, the coders decided to alter the procedure before coding the actual data. Judge A was to independently code all forty-six interviews. Because of the number and com- plexity of discriminations called for by this coding system, Judge A then rescored his own coding to increase his ac- curacy. Judge C coded twenty—five interviews independently from Judge A. Judge B recoded Judge C's twenty—five randomly selected interviews in order to improve accuracy by es- tablishing a dual perspective. The reliability sample con- sisted of the twenty-five randomly selected interviews re— scored by Judge B and independently scored by Judge A. ? Pearson product—moment correlation coefficients for the scores necessary to evaluate the hypotheses served as the method of assessing inter-judge reliability. Since the variables used to test hypotheses are summary scores for each interview, it is necessary to establish inter-judge relia- bility for these summary scores. The summary scores all per- tain to the scoring of two or three unit sequences, i.e., a sequence of specified types of client statements, therapist 14 responses, and subsequent client responses. Reliability for sequences also demands agreement in scoring independent units whereas the opposite, i.e., agreement in scoring inde— pendent units does not insure reliability for sequences, is not true. Correlation coefficients indirectly assert the degree of agreement for the units and sequences composing the summary scores and directly assert the extent of relia- bility for the summary scores. Since the latter scores are the relevant ones for the hypotheses, the correlation method of assessing inter—judge reliability for the summary scores seems most appropriate. A prior study (Winder et al., 1962) used the percent agreement method to assess the reliability of the individual units but did not directly assess scoring reliability for the total scores of specified sequences, despite the use of total scores for sequences in testing. While reliability of total scores may be inferred from per— cent agreement on individual units, the preferable method is the Pearson "r", because it establishes reliability for the specified sequence of total scores per interview. III. RESULTS Reliability. Agreement between coders on the "beep- ing” of units was sought only for the beginnings of client statements. Since the therapist's statement necessarily intervenes between two client statements, including thera— pist units would spuriously raise the measure of percent agreement by increasing the total number of units without permitting an Opportunity for disagreement to occur on the additional therapist units. To determine the "beeping" per- cent agreement for each of the three tapes in the sample, the total number of client units in the interview, i.e., those units scored by either Judge A or B, is divided into the number of units scored by both judges. The prOportions and percent agreements for each respective interview are: 60/64=93.75%, 113/ll7=96.58%, and 120/126=95.24%. The pooled and weighted figures for the three tapes considered simul— taneously are 293/307=95.44%. Product-moment coefficients serve to evaluate inter- judge coding reliability. These coefficients were computed for each critical summary score for each interview included in the reliability sample. Table 2 Part I contains relia- bility coefficients for the psychotherapist variables of per— cent approach to each interpersonal category and for percent 15 16 Table 2. Inter-judge reliability coefficients for approach and avoidance. Part I: Percent approach and avoidance. Percent Percent Percent Category Approach Approach I Avoidance I r N r N r N Hostility .900 25 .967 24 .966 25 Hos. Affect .917 25 .855 22 .915 24 Hos. Non-affect .929 22 .724 16 .862 21 Dependency .923 25 .899 24 .903 25 Dep. Affect .901 25 .826 24 .927 25 Dep. Non-affect .852 25 .812 24 .840 24 Affiliation .787 25 .998 17 .802 25 Affil. Affect .753 24 .950 15 .923 24 Affil. Non-affect .586 24 .929 13 .736 24 Self-assertion .916 25 .773 22 .930 25 S.A. Affect .770 25 .784 20 .927 25 S.A. Non-affect .830 19 .991 13 ‘.878 18 Sex .976 23 .634 18 .960 23 Sex Affect .964 20 .871 16 .882 18 Sex Non—affect .965 20 .675 16 .961 18 Vague .766 25 .832 25 .787 25 Other .819 24 .869 18 .811 24 Note: All correlation coefficients are significant, p<<.01 17 approach and avoidance with an internalizing response. Computation of proportion of approach to Hostility, for ex— ample, proceeds by dividing the frequency of Hostility state- ments per interview into the frequency of therapist approach responses following a client's expression of HOstility. (2 therapist's approaches following Hostility/Z client's Hostile expressions.) Similarly, calculating the percent of internalizing approaches for Hostility proceeds by dividing the frequency of therapist approach responses for Hostility into the frequency of therapist internalizing approaches for Hostility. (3 therapist's internalizing approaches follow- ing Hostility/>3 therapist's approaches following Hostility.) Part II of Table 2 presents the reliability coef- ficients for the client—therapist interaction variables of client continuances following therapist approach responses. To compute the proportion of client Hostility continuances following therapist approach to-Hostility, divide the fre— quency of therapist approaches to Hostility into the fre— quency of client Hostility continuances following the thera- pist's approach to Hostility. (2 client continuances of Hostility givent the therapist's Hostility approach/Z thera- pist approaches to Hostility.) The internalization and .'externalization approach continuance prOportions are computed in a manner analogous to the internalization—externalization variable in Part I. 18 Table 2. Inter-judge reliability coefficients for approach and avoidance. Part II: Continuances following approach. All Approach Approach I Approach E Initial Unit Continuance Continuance Continuance .£ N E. N _r N Hostility .783 24 .673 24 .947 17 Affective .799 22 .688 22 .942 12 Non-affective .964 16 .853 16 .905 11 Dependency .928 24 .906 24 .702 23 Affective .911 24 .894 23 .747 16 Non—affective .891 24 .761 23 .752 21 Affiliation .972 17 .994 16 .000* 6 Affective .976 15 .970 15 ** 2 Non-affective .433* 13 .504 10 .ooo*' 4 Self-Assertion .779 22 .807 20 .695 14 I Affective .934 19 .923 17 .936 ll Non-affective .567 13‘ .830 11 -.102* 5 Sex .847 18 .913 16 ' .941 10 Affective .985 16 .807 15 .854 7 Non—affective .454 16 .441* 13 , .975 8 Vague . .899 25 .893 25 .786 17 *p >.05. All other coefficients: _p (.05. **Correlation procedures require that NC>2. thera; ident: place: the p. perso: to th conti ation 19 The reliability coefficients contained in Table 2 Part III represent the client—therapist interaction variables of client continuances following avoidance responses by the therapist. Computation of the proportions for Part III is identical to those for Part II, except for the wholesale re— placement of the word approach with the word avoidance. Table 3 contains reliability coefficients for both the psychotherapist variable of initiation of an inter— personal category and for the client's subsequent response to the therapist's initiation, i.e., continuance or non— continuance. The prOportion of therapist internalizing initi— ations is computed by dividing the frequency of initiations, e.g., for Hostility, into the frequency of internalizing initiations of Hostility. (2 internalizing therapist initi— ations of Hostility/E therapist initiations of Hostility.) To compute the prOportion of client continuances of the thera— pist's initiations of Hostility, divide the frequency of therapist initiations of Hostility into the frequency of client continuances of Hostility following its initiation by the therapist. (2 client continuances of therapist's Hos— tility initiations/z therapist's Hostility initiations.) Computation of percent of client continuances following an internalizing initiation or an externalizing initiation is analogous to the procedure for the internalizing-externalizing variables of Table 2 Part II. 1?.“ Se 20 Table 2. Inter—judge reliability coefficients for approach and avoidance. Part III: Continuances following avoidance. . I _ All Avoid Avoid I Avoid E Initial Unit Continuance Continuance Continuance r N .E N _r N Hostility .914 25 .897 25 .947 20 Affective .915 24 .901 22 .902 15 Non-affective .772 21 .792 20 .327* 12 Dependency .909 25 .886 25 .891 21 Affective .888 25 .913 25 .849 12 Non-affective .679 24 .676 21 .893 17 Affiliation .908 25 .978 24 .886 17 Affective .927 24 .964 21 .853 14 Non-affective .098* 24 .441 21 .983 11 Self-Assertion .812 25 .817 24 .281* 17 Affective .817 25 .714 24 .477 14 NOn-affective .831 18 .799 14 .698 9 Sex .845 23 .831 21 .997 15 Affective .385* 18 .582 18 1.000 9 Non—affective .921 18 .841 15 .993 13 Vague .932 25 .832 23 .857 22 _p >.05. All other coefficients: p (.05. 21 Table 3. Inter-judge reliability coefficients for initiation and initiation continuance. Init. Init. % I for Init.. E Category Init. Cont. Cont. Cont. r N r N r N r N Hostility .982 18 .702 18 .628 18 .985 6 Dependence .937 23 .930 23 .937 23 .928 ll Affiliation 1.000 14 .929 14 .861 13 1.000 4 Self—Assertion .667 16 .518* 16 .652 14 1.000 3 Sex .660 13 .954 13 .803 11 1.000 4 Vague .215ns 24 .603 24 .897 23. .000nS 3 ns: p‘>.05, * p‘<.05; All other coefficients are sig— nificant, p < . 01 . 22 Table 4 presents the reliability coefficients for the client-therapist interaction in regard to the client's level of expression of affect. To compute the proportion of affect expressed by a client in the entire interview, divide the frequency of client units in the interview into the fre— quency of client units coded as affective. (2 client affect units/2 client units.) Compute the percentage of therapist internalizing responses in a similar manner. Computation of the degree of therapist internalizing following client affect proceeds by dividing the frequency of therapist internalizing into the frequency of therapist internalizing after affect. (2 therapist internalizations following affect/Z therapist internalizations.) Turning to the subsequent client ex- pression of affect, the proportion for the client's ex- pression of affect after internalizing following affect is calculated by dividing the frequency of client affect after internalizing into the frequency of client affect after in— ternalizing following affect. (2 client affect after in— ternalizing following affect/>3 client affect after internal— izing.) The remaining proportions of Table 4 are computed in a manner similar to their respective examples. Hypothesis I. The results do not completely support the hypothesis that therapists tend to approach all inter- personal categories more than to avoid them. Inspection of Table 5 reveals that while therapists in this study do ap- proach the categories of Dependency and Vague significantly 23 Table 4. Inter—judge reliability coefficients for client and therapist affect levels. Score r N Client Affect Units .995 25 Therapist Internalizing Responses .969 25 Therapist Internalizing following Affect .972 25 Therapist Internalizing g9; following Affect .895 24 Subsequent client expression of Affect After Internalizing Responses .984 25 After Internalizing following Affect .964 25 After Internalizing Egg following Affect .871 24 After Externalizing Responses .979 25 After Externalizing following Affect .853 25 After Externalizing_ng§ following Affect .925 24 *All correlations are significant at the .01 level. Table Ca' Hosti Depen Affil Self- Sex Vague 24 Table 5. Comparison of therapist responses of approach and avoidance to interpersonal categories. Percent % Approach Sign Test Approach )1 _2- Category Median % Avoidance (two-tailed) Hostility 50 21/41 . n.s. Dependency 65 33/44 .002 Affiliation 37 9/42 .001 (neg.) Self-Assertion 42 16/43 n.s. (.126) Sex 53 23/42 n.s. Vague 66 39/43 .001 25 more than 50% of the time (sign test, p><.002L they signifi— cantly avoid (p (.001) the category of Affiliation, tend to avoid that of Self-assertion (p4f.126), and show no signifi- cant difference in approach—avoidance behavior to the cate- gories of Hostility and Sex. A Friedman two-way analysis of variance by ranks was performed on the approach ratios to test the prediction that therapists would show differential approach ratios with re— spect to the category approached. Highly significant results (pVvever, the sign test on the two ratios for Affiliation did reach significance (p( .026) . In 21 out of 29 cases, the proportion of approach internalizations exceeded the corres- ponding ratio for avoidance. The sign test was also signifi- cant for Vague (p< .00-1) . In 38 out of 42 cases, the ratio of approach internalizations excelled that of avoidances. _Hypothesis III. Inspection of Table 9 decisively supports the prediction that the therapist's initiations of each interpersonal category will contain a greater pro- POrtion of internalizations than externalizations. A Friedman two—way analysis of variance by ranks fails to reveal a differential internalization—externalization ratio for thera— Pist initiations of the various categories. In the absence of further data, one may tentatively speculate that a relatively constant internalization-externalization ratio holds for all categories. Table 10 compares the prOportion of internalizations for the therapist initiations of the interpersonal categories With the proportion of internalizations for the therapist's - albproach to each category. The prediction that initiations will contain a greater proportion Of internalizations than Will the corresponding approaches is not entirely supported 32 Table 9. Proportion of internalizations for therapist initiations of interpersonal categories. Sign Test Initiation I P. Initiations ‘2. Category Median where I ) .50 (two-tailed) Hostility 100 28/30 .001 Dependency 100 41/41 .001 Affiliation 100 24/26 .001 Self-Assertion 100 28/31 .001 'Sex 100 21/25 .002 Vague* ‘ 100 43/43 .001 *indicates that the inter-judge reliability is not significant (p‘(.05) for the variable. 33 Table 10. Comparison of proportions of internalizations for therapist initiations and approaches. P. Init. I Sign Test Init. I App. I p. Category Median Median P. App. I (twoJTailed) Hostility 100 79 24/34 .05 Dependency 100 76 30/43 .02 Affiliation 100 100 9/14 n.s Self-Assertion 100 94 18/20 002 Sex 100 83 14/20 n.s Vague* 100 93 27/29 .001 *indicates that the inter—judge reliability is not significant (p<:.05) for one of the variables compared. 34 for all categories. Although the hypothesis is not upheld for Affiliation or Sex, it is substantiated for Hostility, Dependency, Self—assertion, and Vague (sign test, p<<.05). Hypothesis IV. It was predicted that experienced psychotherapists will approach client expressions of Hostility and Dependency to a greater extent than will either less ex- perienced or inexperienced ones. A Kruskal-Wallis H test was performed for both Hostility and for Dependency to com- pare staff vs interne vs practicum. Neither test reached the p.<.05 significance level. Because degree of experience beyond a certain level seems to be less important than presence or absence of experience, the experience levels were regrouped by placing staff and internes in the experi— enced group and practicum students in the inexperienced one. The Mann—Whitney U tests for approach to Hostility and ap- proach to Dependency were both significant (p<:.03, p (.05 respectively) indicating that experienced therapists approach client expressions of both Hostility and Dependency to a greater extent than do inexperienced therapists. Hypothesis V. Table 11 presents information on therapist experience levels and the duration of client therapy. A jx? analysis fails to reveal any relationship be- tween these two variables. There is, however, a significant point-biserial correlation (rpb = .495, p<<.01) between the number of interviews in psychotherapy and the therapist's 35 Table.ll. Experience level and duration of treatment. m _— <- — _L Number of Interviews Experience Level 1—5 6-10 11—15 16—20 21—- Staff 5 4 2 2 1 Interne 6 6 . 2 8 1 Practicum 1 2 2 3 1 Note: X2 test is not significant: 1 = 4.154, df II (I) 36 subsequent rating of success, such that the liklihood of a rating as successful increases as the number of psychotherapy interviews increases. IV. DISCUSSION All clients in the study were self-referrals and stu- dents at the same university, thus they are not representa— tive of clients in general. A similar assertion of insti— tutional homogeneity and therefore nonrepresentativeness pertains to the therapists involved. In addition, the psychotherapists for the present study selected in part the clients whose psychotherapies they subsequently recorded. Since neither the clients nor the therapists are representa- tive samples, generalization of the study's findings to clients and therapists in general is not warranted. Reliability. The significant correlation coef— ficients (one—tailed, p<:.05) obtained for 169 of the 181 variables comprising the study clearly demonstrate that it is indeed possible for two independent judges to reach a high degree of reliability in coding these variables. In fact, 163 of these 169 variables reached significance at the p < . 01 level (one-tailed) . It is informative to outline in detail the procedure that enabled this high degree of reliability. First, it was essential to have precise definitions for the following basic Variables: the interpersonal categories of Hostility, 37 38 Dependency, Affiliation, Self—assertion, Sex, Vague, and "Other"; for affect and non-affect; for approach and avoid- ance; for initiation; and for internalization and externali- zation. Second, these definitions had to be operationalized to allow the coders to utilize them reliably. These rigid specifications frequently necessitated definitional revisions during development and trial use of the manual. In addition to precise, Operationalizable definitions for the basic variables, extensive training to familiarize the coders in the use of the manual was absolutely mandatory. Individuals could not simply familiarize themselves with the manual and the expect to begin reliably coding interview tapes. Ex- ’ tensive training in the employment of the manual cannot be omitted. The procedure of "beeping" to eliminate the con— founding variable of inter-judge disagreement on division of client and therapist units also increased reliability. Although the present study and its parallel study (KOpplin, 1965) did not use the full scope of the manual since the eight intrapsychic states were dichotomized into affect and non—affect, some preliminary scoring which used these finer discriminations as well as the ranked relevancy categories indicates that reliability could be achieved for othe scoring of these categories with more extensive training of the judges. While low frequencies of Categories are generally associated with most of the non-reliable coefficients, 39 perhaps increased training and refinement in operational defi— nitions would facilitate reliable scoring for these category sequences. An important attribute of the manual seems to be that, although there is some correlation between degree of psychological sophistication and reliable scoring, extensive training in the manual's use appears to be the more important variable. Although it has not yet been fully tested, an individual having only limited acquaintance with psychology could theoretically employ the coding manual reliably subse— quent to his extensive training in its use. This possibility has obvious implications for future research with process studies of psychotherapy. Hypothesis I. Although the prediction that psycho- therapists would approach all interpersonal categories more than they would avoid them is not confirmed in the present study, the corollary hypothesis that therapists would ex— hibit a differential approach ratio to these various cate— gories is confirmed. The results for these hypotheses can be most profitably understood by considering them simul- taneously. The scoring procedure in this study permits multiple scoring for each unit, i.e., more than one inter— personal category may occur and be scored within a given client unit. While it is entirely possible for a therapist to respond by approaching all categories in which the client Verbalized, it is considerably easier to respond to a selected 4O portion of the client's statement. Thus, if the client's comments encompass four categories, the therapist may re- spond to only one or two of the four. If one views the therapist as being a rational person, it is sensible to assume that he approaches that segment of the preceding statement he considers to be the most important and ignores or avoids that which he views as unimportant or less important. At this point, it is important to consider the thera— pist's hierarchy of values pertaining to the behavioral areas he sees as most important to psychotherapy. It is reasonable to assume that all categories of interpersonal behavior are not equally important or relevant in psycho— therapy. Although client individual differences may cause alterations in the therapist's relevancy hierarchy, knowledge of the subgroup to which the client belongs, e.g., college freshman at a large university, and the therapist's prior relevancy schema would probably play a large part in de— termining which categories the therapist chooses to approach. The present study revealed that the therapists ap— proached the categories of Dependency and Vague significantly more than they avoided them and avoided Affiliation signifi- cantly more than they approached it. Recalling that the interviews used in the present study are all initial inter- views of psychotherapies and that the client enters psycho- therapy seeking help with his problems, Dependency becomes 41 an important aspect of the client's behavior. In addition, the clients are basically late adolescents in the midst of their first extended experience away from home, thereby bringing Dependency concerns to the fore once again. The therapist's high approach ratio to the category Vague is also readily explainable. Since clarification of client feelings is an important aspect of understanding those feelings as well as the problem represented by them, the therapist approaches the client's vague feelings to increase his comprehension of them. The avoidance of the client's affiliative behavior seems to indicate that either the present clients do not suffer difficulties in the sphere of Affiliation or that the psychotherapists View these diffi— culties as relatively minor. The tendency for therapists to avoid Self-assertion is rather puzzling considering the composition of the sample. Perhaps part of the explanation lies in the stage of psychotherapy selected for this study. Since, as mentioned above, the client comes to the psycho- therapist seeking help, the therapist may view Dependency as much more relevant at this stage than Self-assertion. This primary concern with Dependency may also cause the therapists' moderate approach ratios to Hostility and Sex. The median for-therapist approach to Hostility was 50% and to Sex was 53%. As the approach medians imply, the approach ratios to both categories clearly fail to attain significance. 42 Hypothesis II. Hypothesis II predicted that the therapist would approach affect more than non-affect for all categories. Although examination of the results showed this to be the case for Sex and Affiliation, the reverse appeared for Dependency. A closer look at the operationalized defi- nition for the non-affect subcategory of dependency readily reveals an explanation for this initially puzzling finding. The non-affect Dependency subcategory includes all questions directed at the therapist. The therapist rarely fails to answer a question asked him by the client, thus the query al— most inevitably results in an approach to non—affect De- pendency. In View of the knowledge that questions composed a large portion of the non-affect Dependency scoring in the present study, the high approach rate to this subcategory is indeed understandable. It is probable that the questioning increased this approach rate to the extent that it masked a high approach rate to the affective Dependency. A sign test demonstrating that the prOportion of internalizations for ap— proach to affect significantly exceeded the proportion of internalizations for approach to non—affect yields additional support for this explanation. . The failure of the therapist's approach ratio for Hostility affect to'exceed his approach rate for Hostility non-affect may be accounted for by positing that approach to Hostility, especially its affective component, creates anxiety and uneasiness in the therapist. Kopplin (1963) and the 43 present study both showed that inexperienced therapists ap- proach Hostility significantly less than experienced thera- pists. Since it is not unreasonable to infer from this that approaching Hostility creates anxieties in the approacher, it is logical to assume that the therapist would tend to refrain from increasing his own anxiety and thus would somewhat avoid the client's affective Hostility. The therapists' significant avoidance of the category of Affiliation indicates that they do rxflzview it as being a primary area of client problems. Therefore, it is not likely that they would View affect as something to diligently strive for in this particular area. The therapists'responses may be more apt to be oriented toward background data than to— ward affect in this evidently less relevant area. The results drawn from the data clearly supported the prediction that therapists would internalize more than ex— ternalize on both their approaches and avoidances. This re— sult obtained for all categories and thus concurs with the general tenet that focusing on the feelings of the client is an integral part of psychotherapy. Hypothesis III. The prediction,that therapist initi— .ations of interpersonal categories would contain a greater prOportion of internalizations than externalizations was clearly supported by the data. Since most psychotherapists believe that affect is important to psychotherapy, their 44 decision to introduce the discussion of a topic not mentioned in the immediately preceding client statement would be ex- pected to be in such a way as to encourage the client to speak affectively about it, i.e., through the therapists' use of internalization. The failure to find a differential rate of internalization for initiation of the various inter; personal categories can be best explained by the extremely high rate of internalizations for all categories (all cate— gory medians are 100). In introducing the discussion of a category not con— tained in the immediately preceding client statement, the therapist is not as encumbered by the client's prior level of affect as he is when the client was already engaged in discussion of the topic and the therapist is simply approach- ing the client's existing verbalizations. Since it is easier to initiate affect in a new area than to alter the status of the discussion from a non-affective to an affective level, initiations of a category should contain more internalizations than approaches to that category. This prediction was sup— ported for Hostility, Dependency, Self-assertion, and Vague. In addition, Affiliation and Sex tend toward affirmation of the hypothesis. The failure of Affiliation to reach signifi- cance appears to be due to the combination of very low fre— quencies and the general lack of emphasis upon Affiliation in the present study's sample of psychotherapies. Low fre- quencies also seems to partially cause Sex to fall below the level of significance. 45 Hypothesis IV. The present study did not find sig- nificant differences in approach rates to Hostility and De— pendency for therapists at the staff, interne, and practicum levels of experience. However, a difference is found when the staff and interne levels are combined and compared with the practicum therapists. Prior studies by KOpplin (1963) and Caracena (1963) performed in the same university as the present one did find significant differences for both sets of comparisons. The increased psychological sophistication of the internes in the present sample appears to account for the discrepancy between these studies and the present one. The increased SOphistication of the internes apparently brings them much closer in performance to the staff psycho- therapists and thus reduces the previously found differences. Hypothesis V. The hypothesized positive correlation between the duration of psychotherapy and the outcome rating as successful appeared in the data of this study. Consider— ing the information that the acting therapist rated the out— comes of his own psychotherapies together with the well known lack of agreement upon adequate criteria by means of which to assess outcomes, the most tenable explanation appears to .be one of dissonance resolution. A therapist who conducts fifteen interviews with a client very likely needs to feel that he achieved more than if he had conducted only five with that client. Otherwise, the therapist may View himself as somewhat ineffective in the ten interviews constituting the 46 difference. It is not unlikely that a similar process of dissonance resolution accounts for a sizeable share of the significant (p<<.01) point—biserial correlation between the above-mentioned variables. V. SUMMARY The analysis of psychotherapeutic interaction is an important means for learning about the process of psycho- therapy. Several researchers have developed systems of molecular content analysis to explore the verbal interaction emphasized in psychotherapy. The present study assesses the inter-judge reliability of Kopplin's recently developed system and then utilizes this system to investigate the ef~ fects of several therapist variables upon the psychothera- peutic process. l The first hypothesis states that psychotherapists will tend to approach the client's discussions of Hostility, Dependency, Affiliation, Self-assertion, Sex, and Vague feel— ings more than they will avoid them. In addition, the extent of the therapists' approach will vary with the topic. A further hypothesis predicts that therapists will approach a client's affective discussion of any area more than his non-affective discussion. Both therapist approaches and avoidances to client statements should consist of more responses that focus on the client's feelings than that focus upon objects external to the client. Similarly, any thera- pist initiation of a discussion will focus upon the client's feelings about the t0pic rather than upon the objective 47 48 aspects of that topic. These topical initiations should con- tain a greater proportion of internal foci than do approaches to existing topics. The study also predicts that experienced psychothera- pists will be more apt to approach client discussions of Hostility and Dependency than will less experienced or inex- perienced therapists. The final prediction asserts that there is a correlation between the duration of psychotherapy and the psychotherapist's rating of that psychotherapy as successful or unsuccessful. A content analysis is made of the taperecorded ini— tial psychotherapeutic interviews for 46 clients treated at a university counseling center by psychotherapists at the staff, interne, and practicum trainee levels of experience. Client—therapist interactions are coded for the frequency of: client statements of Hostility, Dependency, Affiliation, Self-assertion, Sex, Vague,and Other; client affective and non-affective expression; therapist internally and/or ex- ternally focused approaches and avoidances of the above— mentioned client statements; and for client continuances of the tOpic following the various therapist responses. Results: Inter-judge reliability obtains for 169 of the 181 variables included in the study. 1. Therapists significantly approach Dependency and Vague, significantly avoid Affiliation, tend to avoid 49 Self-assertion, and show no statistically significant differ— ence in their approach—avoidance behavior toward Hostility and Sex. 2. Therapists significantly approach client affect more than non—affect for the topics of Self-assertion and Sex, significantly approach non-affect for Dependency, and show no significant differences for Hostility and Affiliation. 3. Therapists' approach and avoidance responses to all client topics proceed via a greater focus on client feelings than on objective data. 4. Therapist initiations of all tOpics contain signifi- cantly more internal than external foci. 5. The prOportion of internal foci for initiations is significantly greater than that proportion for approaches for the topics of Hostility, Dependency, Self—assertion, and Vague but shows no significant difference for Affiliation or Sex. 6. Although no differences in approach behavior to client Hostility and Dependency appear in the simultaneous comparison of the three experience levels, inexperienced therapists are significantly less apt to approach Hostility and Dependency when compared with the two more experienced Clevels of therapists as considered together. 7. A significant positive correlation exists between the duration of psychotherapy and the psychotherapist's rating of that psychotherapy as successful. 50 Ample opportunity for future research lies in the more complete use of Kopplin's recently developed system of molecular content analysis. REFERENCES Bandura, A., Lipsher, D., and Miller, P. Psychotherapists' approach—avoidance reactions to patients' expressions of hostility. J. consult. Psychol., 1960, 24, 1—8. Butler, J., Rice, L., and Wagstaff, A. On the naturalistic definition of variables : an analogue of clinical analysis. In H. Strupp and L. Luborski (Eds.), Research in Psychotherapy, Vol. II, Washington: American Psychological Association, 1962. Caracena, P. Verbal reinforcement of client dependency in the initial stage of psychotherapy. Unpublished doctoral dissertation, Michigan State University, 1963. Kbpplin, D. Hostility of patients and psychotherapists' approach—avoidance responses in the initial stage of psychotherapy. Unpublished masters thesis, Michigan State University, 1963. KOpplin, D. Eliciting responses in client—therapist inter- action: a content analysis of initial psychothera- peutic interviews. Unpublished doctoral dissertation, Michigan State University, 1965. Murray, E. The contenteanalysis method of studying psycho- therapy. Psychol. M0nogr., 1956, 70 (13; Whole No. 420). . - Winder, C., Ahmad, F., Bandura, A., and Rau, L. Dependency of patients, psychotherapists' responses, and aspects of psychotherapy. J. consult. Psychol., 1962, 26, 129-134. 51 APPENDIX A SCORING MANUAL (The categories of dependency, hostility, approach and avoidance are a modification of manuals used in the follow— ing studies: Winder, C. L., Ahmad, F. 2., Bandura, A., & Rau, L. C., Dependency of patients, psychotherapists' re- sponses, and aspects of psychotherapy, J. Consult. Psychol., 1962, 26, 129—134; Bandura, A., Lipsher, D. H., & Miller, P. E., Psychotherapists' approach—avoidance reactions to patients' expressions of hostility, J. Consult. Psychol., 1960, 24, l—8. The definition for internalizing and externalizing responses is drawn in part from the section on ”Functional Level of Response" in Butler, John M., Rice, Laura N., & Wagstaff, Alice K., On the naturalistic defi- nition of variables: an analogue of clinical analysis, In Hans H. Strupp & Lester Luborsky (Eds.), Research in Psycho— therapy, Vol. II, Washington: American Psychological Associ— ation, 1962.) I. Scoring Unit and Interaction Sequence. A. Definition. A unit is the total verbalization of one speaker bounded by the preceding and succeed- ing speeches of the other speaker with the ex- ception of interruptions. There are three types of scoring units: the "client statement" (C St), the "therapist response" (T R), and the "client response" (C R). A sequence of these three units composes an "interaction se- quence." The client response not only completes the first interaction sequence but also initiates the next sequence and thereby becomes a new client statement. Example: C. I can't understand how you can stand me. (C St) T. You seem to be very aware of my feelings. (T R) C. I am always sensitive to your feelings. (C R) A-2 B. Pauses. If a speaker pauses between statements, his statements are not scored as separate units. The verbalization before and after the pause is considered one unit. Therapist silences are scored as prescribed under III,A,2,e, of this manual. There are no client silences in this system. C. Interrpptions. Statements of either therapist or client which interrupt the other speaker will be scored only if the content and/or temporal conti— nuity of the other speaker is altered by the interruption. Then the interrupting verbalization becomes another unit and is scored. A non—scored interruption is never taken into account in the continuation of the other speaker.’ Interruption scored as one unit: C. I asked him to help me and—- T. Why was that? C. —-he refused to even try. Non-interruption scored as 3 units, one inter- action sequence: C. I asked him to help me and-— T. Why was that? l C. I don't know. Verbalizations such as "um hmm," "yes," "I see" are ignored in scoring unless they are so strongly stated as to convey more than a listening or re— ceptive attitude. Client requests for the therapist to repeat his response are considered interruptions and are not scored. Therapists' requests of this sort are scored as units (as approach or avoidance of the client statement) except for simple requests to the client to repeat a few words. II. Categories of Client Statements A” Interpersonal Categories: There are seven major categories: Dependency, Hostility, Affiliation, Self-assertion, Sex, Vague, and Otheru They are A-3 scored as exhaustive categories. All discrimi— nations are made on the basis of what is explicitly verbalized by the speaker in the unit under con- sideration. One statement or unit may be scored for several categories. 1. Hostility (Hos): Hostility statements include description or expression of unfavorable, critical, sarcastic, depreciatory remarks; oppositional attitudes; antagonism, argument, expression of dislike, disagreement, resent— ment, resistance, irritation, annoyance, anger; expression of aggression and punitive behavior, and aggressive domination. Hostility which the client directs at himself is not scored as hostility; it is scored as vague. The following examples group under a series of types of hostility. These types aid in identification of hostility statements, but are not differentiated in the scoring. a. Anger: expresses or describes feelings or actions which indicates anger. C. I'm just plain mad! (Hos;N;C;O;l)* C. I just couldn't think——I was so angry. (Hos;N;C;O;l) C. My uncle was furious at my aunt. (HOS;-;O;O;5) b. Dislike: expresses dislike or describes actions which would usually indicate dislike. C. I just don't get interested in them and would rather be somewhere else. (HOS;N;C;O;l) C. I've never ever felt I liked them and I don't suspect I ever will. (HOS;N;C;O;l) *Complete scoring of examples is listed to aid in training coders. The sequence is: interpersonal category; intrapsychic state(s); subject(s); object(s); and thera- peutic relevance. When a statement is scored for two inter— personal categories, two separate scorings are listed. A-4 C. He hates editorials. (Hos;-;O;O;5) Resentment: expresses or describes a per- sistent negative attitude which does or might change to anger on a specific occasion. C. They are so smug; I go cold whenever I think about having to listen to their 'our dog' and 'our son.‘ BOy! (Hos;N;C;O;1) C. I was always jealous of my brother; he was their favorite. (Hos;N;C;H;2) Antagonism: expresses or describes an- tipathy or enmity. C. It's really nothing definite, but we always seem at odds somehow. (Hos; Uns;C;O;4) C. There is always this feeling of be- ing enemies. (Hos;N;C;O;1) - Opposition: expresses or describes Oppo— sitional feelings or behavior. C. If he wants to do one thing, I want to do another. (Hos;N;C;O;1) C. It always seems she is against things. She is even against things she wants. (Hos;-;O;O;5) C. No, I don't feel that way (in re— sponse to T's assertion). (Hos;N;C; T;l) Critical attitudes: expresses negative evaluations or describes actions which usually imply negative evaluations. C. If I don't think the actors are doing very well, I just get up and walk out. (Hos;N;C;O;1) C. There is something to be critical about in almost everything anyone says or does. (Hos;Uns;C;O;6) A-S g. Aggressive actions: acts so as to hurt another person or persons either physically or psychologically. C. He deserves to suffer and I'm making it that way every way I can. (Hos; N;C;O;l) C. I can remember Mother saying: 'We slap those little hands to make it hurt.’ (Hos;Uns;M;C;3) Dependency (Dep): Dependency statements in— clude expressions of needs to depend on some— one; let someone else take the initiative; to be told what to do; to be helped; to be cured by an outside agent; description of dependent behavior; approval seeking and concern about disapproval; dependent agreement with others; accepting nurturant actions from others; making personal security contingent on another; expresses concern about parental plans and expectations regarding the client; expresses need to confide in, write to or communicate with parents; includes discussion of relation— ship between the client and therapist. The types listed below aid in identification, but are not differentiated in scoring. a. Problem Description: States problem in coming to therapy; gives reason for seek— ing help; expresses a dependent status or a general concern about dependency. C. I wanted to be more sure of myself. That's why I came. (Dep;N;C;T;l) C. I wanted to talk over with you my reasons for dropping out of school next quarter. (Dep;N;C;T;l) C. Part of the reason I'm here is that everything's all fouled up at home. (Dep;N7C;T;1) C. I depend on her--am tied to her. (Dep7N:C:O7l) C. I want to be babied and comforted. (Dep7N7C;O;1) A-6 Help-seeking: Asks for help; reports ask- ing for help; describes help-seeking be- havior; describes going to see a teacher, therapist or other professional. C. I asked him to help me out in this situation. (Dep;Uns;C;O;4) C. I try to do it when he can see it's too hard for me. (Dep;Uns;C;O;4) Approval—seeking: Requests approval or ac- ceptance; asks if something has the ap- proval of another; reports having done so with others; tries to please another; con- fides in parents for support or approval; expresses fear of "hurting" parents and superiors; asks for or needs support or security; seeks acceptance or approval by achievement; expresses or describes some activity geared to meet his need. C. I hope you will tell me if that is what you want. (Dep;N;C;T;l) C. If there was any homework, I did it so Dad would know I was studying like a good girl. (Dep;N;C;F;2) C. Is it all right if I talk about my girl's problem? (Dep;N;C;T;l) C. That's the way I see it, is that wrong? (Dep;N;C;T;l) C. I asked him if I were doing the right thing. (Dep;N;C;O;2) Succorance: A wish to be taken care of: to seek another's help when troubled, de- pressed or hurt; to seek encouragement from others; to have others be sympathetic and understanding about personal problems; to go home to see one's parents, feel close to one's parents in the sense of be— ing loved; to receive nurturant behavior from others (especially parents, authori— ties and therapist). A-7 C. It looks as if it'll be another lonely weekend, and who's going to cheer me up? (Dep;FH;C;O;1) C. Instead of studying, I go talk with the guys about my problems. (Dep; Uns;C;O;4) C. I went home just for the day; I told my mother to make a home cooked meal because that is what I was coming home for. (Dep;Uns;C;M;4) C. My father isn't rich, but he's putting me through college, and he gives me all the money I want; he's always given me everything I've ever wanted. (Dep;Sat;C;F;1) Information-seeking: Asks for cognitive, factual or evaluative information; ex- presses a desire for information from others; arranges to be the recipient of information. C. I asked him why he thought a girl might do something like that. (Dep; Uns;C;O;4) C. I came over here to see about tests you have to offer. I want to know what they say. (Dep;Uns;C;T;4) I'm planning to change my major. I;d like to know how to do it. (Dep; N:C:T:4) Dependent agreement with another: Responds with dependent agreement with others, readily accepts the therapist's reflection; often illustrates therapist's remarks with examples, draws a parallel example to indi- cate agreement; may accept preceding state— ment on authority. C. Oh, yes! You're absolutely right about that. (Dep;Uns;C;T;4) C. Immediately I felt he was right and I had never thought about it that way. (Dep;N;C:O;l) A-8 g. Concern about disapproval: Expresses fear, concern, or unusual sensitivity about disapproval of others, describes unusual distress about an instance of disapproval, insecurity, or lack of support. Little or no action is taken to do something about the concern. C. She didn't ever say a thing but I kept on wondering what she doesn't like about me. (Dep;N;C;O;l) C. My parents will be so upset about my grades, I don't even want to go home. (Dep;N;C;MF;l) C. It seems like I always expect I won't be liked. (Dep;FH;C;O;1) C. I can't understand how you can stand me when I smoke. (Dep;N;C;T;l) h. Initiative-seeking: Asks the therapist or others to initiate action, to take the responsibility for starting something (to start discussion, determine the topic); arranges to be a recipient of therapist's initiative; may solicit suggestions. C. Why don't you say what we should talk about now? (Dep;Uns;C;T;4) C. If you think I should keep on a more definite track, you should tell me. (Dep;Uns;C;T;4) C. I got my advisor to pick my courses for next term. (Dep;N;C;O;2) C. Tell me what to do in these circum— stances. (Dep;N;C;T;l) _Affiliation (Aff): Affiliation statements in- clude description or expression of needs for- appreciation of or concern about friendships, group activities, affectionate relationships, loyalty to friends, sharing with others; in- cludes expression of confiding with or Sharing experiences and feelings with peers or sib- ‘ lings. The focus is upon social relationships A-9 where the participants are broadly social equals. Relationships where the individual clearly receives nurturant behavior from others, or clearly manifests dependent behavior, are scored as dependency rather than as affiliation. Social behavior related to dating is generally scored as sex; to be scored here there must be expression of activity with other people, such as double dating, card playing. The following examples group under a series of types of affiliation which aid in the scoring, although not differentiated in scoring. a. Company seeking: Describes or expresses a need or wish to be with people; describes making arrangements to do so; describes ef- forts to be with others; talks about being with others; needs to do things with friends rather than alone; seeks the at— tention of peers and siblings. C. I only joined so I could be in a group. (Aff;Uns;C;O;4) C. We try to see if other kids we know - will be going. (Aff;Uns;C;O;4) C. I used to spend a lot of time over a coke at the union. (Aff;Uns;C;O;4) C. Last spring, I used to go out drink- ing occassionally. (Aff;Uns;C;O;4) C. we eat almost all our meals together and it's nice that way. (Aff;Sat;C; P;l) C. To be with other people, oh, I don't know, I could be with myself, it wouldn't make any difference. I don't care. (Aff;Anx;C;O;l) b. Friendship seeking: Describes efforts to make friends; expresses need to haVe as many friends as possible; expresses a de— sire to be popular among peers. c. I like peOple to want me as their friend. (Aff;N;c:o:l) A-lO C. Whenever I move to a new dorm, I make an effort to get to know the people around me. (Aff;Uns;C;P;4) c. Affection: Describes or expresses needs for and appreciation of relationships of love and affection; affectionate behavior where all participants generally give and receive alike; confides or shares feelings and experiences with peers or siblings; expressed feelings for entering into af- fectionate relationships; needs for feel- ings of strong liking, giving affection and accepting others. C. My roommate and I get along very well. (Aff;Sat;C;O;l) C. I like people to like me. (Aff;N;C;O;l) C. I like even the unpopular people; I like people for what they are, not just because they are popular. (Aff;N;CrO;l) d. Loyalty and admiration: Describes or ex- presses a need or desire to help friends, relatives and associates; keeping up freinds through letters and telephone calls; holding someone in high regard with respect and appreciation; doing something positive for or with another person. C. I always try to help my friends out of a bind. (Aff;N;C;P;l) C. Last night I tutored Jane in her _ math. (Aff;Uns;C;P;4) C. I write so many letters to friends I use tons of stationery. (Aff;Uns; C;O;4) C. I admire Jean because she has so many wonderful qualities. (Aff;N;C;P;1) 4. Self—assertion (SA): Self—assertion includes expression of needs to be independent, achieve- ing, self—assertive, mature, ambitious, A-ll competitive and adult; standing up for one's rights; expressing an Opinion; accomplishing difficult tasks; being respected as a success. The following examples group under a series Of type which aid in the scoring, though not individually scored. a. Achievement: Expressions of needs to do one's best; to be successful; to accomplish tasks requiring skill and effort; to ac- complish something of great significance; to solve problems and puzzles; to express concern about or lack of self-confidence; express concern about academics and study- ing; expresses desire to be looked upon as a success or authority. C. I'm sure I can pull a better grade in the course. (SA;N;C;O;1) C. I want to get a 4-point. (SA;N;C;O;1) C. I love to work crossword puzzles. (SA;Sat;C;O;l) C. Preparing gourmet foods are such a challenge for me. (SA;Uns;C;O;4) Independence: Expression of needs to be independent, adult and mature; saying "no” when one has to; planning and executing behavior where one acts on his own; making decisions independent of others; to act without regard for what others may think; to be able to come and go as desired; to do things that are unconventional. C. I just had to tell him I thought it was better if he did it himself. (SA:N7C;O72) C. After thinking about it for a while, I figured out how to solve our dilemma. (SA;Uns;C;O;4) C. I'm going to arrange it so mother can't move in with me. (SA;Uns;C;M;3) C. If I want to grow a beard, I'll grow a beard. (SA;N;C;O;1) A-12 C. I had to be home by 11:00. I didn't want to. (SA;FH;C;O;2) c. Self—assertiveness: Expression of needs to be competitive, ambitious, assertive; standing up for one's rights, defending against attack; overcoming; to give a personal opinion; to articulate ideas, plans and goals; to stand up to those in positions of authority. C. I can only achieve growth by meeting new situations. (SA;Uns;C;Oy6) C. I just didn't think he was the best person for that job and said so. (SA;N;C;O;2) C. I used to be afraid to assert myself to my mother. (SA;Anx;C;M;2) C. He didn't want my opinion but I told him anyhow. (SA;N;C;O;2) C. I told my roommate it was her turn to clean the room. (SA;Uns;C;P;4) Sexuality (Sex): Statements of sexuality in- clude all statements referring to the positive approach component of the sexual drive; direct expression Of sexual needs and wishes, de— scription of sexual attraction and arousal; sexual activity; planning for sexual satis— faction; courtship and dating among unmarried people where the erotic element is present al— though it may be institutionalized; descrip- tions of behavior or wishes to form friend— ships with someone of the opposite sex; wishes to be regarded as sexually attractive by members of the Opposite sex; description of homosexual feelings and sexual perversions; descriptions of masturbation; discussion of normal sex education. The following examples group under a series of types which aid in identification. a. Heterosexual behavior: Includes expression of sexual intercourse and related behavior and feelings; discussion of petting; ex— pression of sexual excitement. A-l3 C. He wanted to have sexual relations with me. (Sex;Uns;P;C;4) C. I like to make out but I'm not sure where to stOp. (Sex;Anx;C;P;l) C. Physically, we are very compatible; our relations are tremendously satisfying. (Sex;Sat;C;P;1) Dating: Discussion of wishes to go out with members of the Opposite sex, to en- gage in social activities with a member of the opposite sex; being in love with some— one of the opposite sex. C. I hOpe he calls me for Saturday night. (SeX:N;C;P;1) C. Jim and I went with the other couples to the party. (Sex;Uns;C;P;4) (Aff;Uns;CP;P;4) G. I just met the greatest boy the other night and he's asked me out. (Sex;Sat;C;P;2) Homosexuality and perversions; Discussions Of homosexual feelings and behavior; dis- cussion of sexual perversions. C. I have a very liberal attitude about sex; what people do privately is their own business. (Sex;Uns;C;0;6) C. They were saying she was a Lesbian, and so they kind of avoid her. (Sex;-;O:0:5) Autoerotic behavior: Descriptions of masturbation; discussion about mastur— bation and autoerotic behavior. C. I used to feel masturbation was very bad, but I don't anymore. (Sex;Gui1t;C;C;2) C. I used to wonder if anyone else masturbated. (Sex;Uns;C;O;4) G. I guess I masturbate mostly to re— lieve tension. (Sex;N:C;C;l) A-l4 e. Generalized discussion of sexuality: In— cludes discussion Of normal sex education; general discussion about sex; discussion of needs to be regarded as physically at- tractive by those of the opposite sex; con— cern about sexual role and identity; in- cludes discussion of menstruation. C. I am a girl, there is nothing I can do about it. (Sex;FH;C;C;1) C. Tell me, does this make me less manly? (Sex;Anx;C;O;l) (Dep;N;C;T;l) C. Our bull sessions frequently revolve around sex. (Sex;Uns;C;0;4) C. When I first menstruated, I was scared a little. (Sex;Anx;C;O;2) Vague affective expressions (Vag): Vague in- cludes affective expressions which cannot be scored in one of the previous categories but which have a reference to some affective intra- psychic Or interpersonal need of the client. This category is not scored if the feelings are related to a scored interpersonal category, unless there is a clear indication Of some vague intrapsychic state as depression, anxiety, euphoria, etc. which the client doesn't connect to any other need. Examples group under several subtypes to facilitate scoring. a. Generalized anxiety: InclUdes all psycho- logical and somatic expressions of anxiety which are not related explicitly to a major category; general "free floating" anxiety and guilt. - C. I feel scared about dying. (Vag;Anx;C;O;l) C. I just feel Very tense and anxious. (Vag;Anx;C;O;l) C. I dream of being chased and scared. (Vag;Anx;C;O;l) 7. A-15 C. I often feel pessimistic about the future. (Vag;Anx;C;O;l) C. I hear about couples getting married and then one of them is killed on the honeymoon. I worry about the lives of people. You never know. (Vag;Anx;C;O;l) b. Undefined feeling: Includes expression of a feeling, condition or concern of the client which is not related to one Of the five major drives. I C. I just feel good today. (Vag;Sat;C;O;1) C. Right now I feel pretty good. (Vag;Sat;C;O;1) C. Very Often I just get real depressed about everything. (Vag;Anx;C;O;l) C. I don't know why I do this. (Vag;N;C;O;l) C. I find myself reluctant to tell you how I feel about it. (Vag;Anx;C;T;l) Other (0th): Includes all content of client's verbalizations not classified as one Of the previous six categories. Included here are many topics Of disCussion which are not sig- nificantly interpersOnal or affective. Often the items are actions, events, facts, stereo- typed comments. Items scored in this category usually will have a relevance score Of 4, 5, or 6. (See II, D) When other is integral to another category, do not score. TO score other, the other state- ments must be distinct from the discussion Of another major category. C. I grew up in Chicago. (Oth;—;C;0;4) C. Everyone ought to have a liberal education. (Oth;—;C;0;6) A-l6 C. My aunt went to Smith. (Oth;-;M;O;5) Client Intra—psychic States: For each major inter— personal category that is scored for a single client speech except for the category "other," a coding is also given for the intra—psychic state of the client. The following eight categories are exhaustive: need, anxiety, guilt, frustration- hurt, frustration-aggression, satisfaction, simple agreement-disagreement, and unstated. Intra- psychic states for other individuals or groups mentioned in the client speech are not scored. One or more Of the intrapsychic states can be scored for a single major interpersonal category (excluding "other”). Note: When need, guilt, anxiety, frustration- aggression or satisfaction are scored, the rele- vance category usually is 1 or 2. (cf. II, D.) When ”unstated" is scored, the relevance category usually is 3, 4, 5 or 6. When simple agreement- disagreement is scored, no relevance category is scored. 1. Simple Need (N): Includes expression of an interpersonal need or drive; direct expression of the positive or approach component of the drive or wish; description of plans, or activi- ty which will satisfy the need. When guilt, anxiety, frustration-hurt, frustration- aggression, or satisfaction can be scored, this category is usually not scored because the other categories are considered to include the existence of the interpersonal need. However, to score this category, there must be some ex— pression of feeling, affect or analysis of be— havior in regard to the client's needs. C. I like peOple to like me, to be my friends. (Aff;N;C;O;l) C. I depend on her, am tied to her. (Dep;N7C70:l) C. I always get this terrible impression you're trying to make me angry. (This is hostility need, not frustration, since therapist is not preventing or blocking his need to be angry.) (Hos;N;C;T;l) 2. A—l7 Anxiety (Anx): Includes expressions of fear and anxiety in regard to a major category; ex- pressions of nervousness, irrational fears, phobias, compulsions, hopelessness, confusion, helplessness, internal conflict, avoidance be— havior, denial of the interpersonal need, nega- tive attitude toward the need, feelings of in- adequacy; somatic symptoms; worry about future disappointment. C. It is hard for me to take things serious— ly, to work without a whole lot of pres- sure on me,and yet I certainly don't en- joy it. (SA;AnX;C;O;1) C. To be with other peOple, oh, I don't know, I could be with myself and it wouldn't make any difference. I don't care. (Aff;Anx;C;O;l) C. My money just slips away; I get so irri— tated with myself why I forgot to do this. (Vag;Anx;C;C;l) (Not Hos.) Guilt (Gu): Includes expressions of guilt and self-depreciating behavior; accepting blame when things do not go right; needing punish— ment for wrong doing; needing to confess errors. C. I resent the way I'm so observant cuz if they don't know, I wish I was like them and didn't bother to care about little things like that. (SA;Anx,Gu;C;O;l) C. I know how I feel, and I know how other people feel, and I feel angry that I feel this way, but I can't help it. (Vag:GU:C:O;l) C. It makes me feel bad because I want to do good. (SA;Gu;C;O;l) C. I feel like I disappointed my father very badly. (Dep;Gu;C;F;l) Frustration-hurt (FH): Includes expression of feelings of hurt, discomfort and lack of satis- faction because a drive or need of the client (major category scored) has been frustrated by some external agent or situation; the client A—18 expresses his discomfort as a reaction to the frustration of the drive. The frustrating agent is seen by the client as other than him— self. When the client indicates that he caused the frustration himself, score guilt or anxiety. C. I always had to be home by 11:00; and I didn't want to. (SA;FH;C;O;2) C. we didn't feel accepted socially. (Aff;FH;CO;O;2) C. Darn it, there aren't any eligible men around. (SeX;FH;C;O;l) C. I'm discouraged because therapy isn't helping me; I just feel worse. (Dep;FH;C;T7l) C. I've tried, but jobs are hard for women to get. (SA;FH;C;O;1) C. As far as I know, mother loved my sister more than me. (Dep;FH;C;MH;2) C. Dad had to work all the time and take care of the shOp, that's why we never had enough time to get close to him. (Dep;FH;C;F71) Frustrationraggression (FA): Includes hate, anger and criticism about the frustration of a major drive (dependency, hostility,sex, affili— ation, self—assertion or vague); the aggression must be indicated as a reaction to the frus— tration caused by some external agent or situ— ation, usually the attitude or behavior Of an— other person. When this category is scored, hostility is also scored as a major category since the reaction to frustration is hostility. When frustration is caused by the client him— self, score guilt or anxiety. C. My stingy mother just wouldn't send me the money when I needed it. (Dep;FA7C;M;2) (Hos;N;C;M;2) C. My wife just doesn't do things for me the Way my mother used to; I resent it. (Dep;FA;C;P;l) (Hos;N;C;P;l) A—19 C. I hate my mother for the way she domi- nated me in high school and didn't let me do anything on my own. (Hos;N;C;M;l) (SA;FA;C;M;2) C. It's just damn hard to study at home with everybody in the way. (SA;FA;C;H;1) (Hos;N;C;H;l) 6. Satisfaction (Sat): Includes expressions of the client's satisfaction and gratification in regard to a major interpersonal need. C. I just feel good today. (Vag:Sat;C;O;l) C. We eat almost all of our meals together and it is nice that way. (Aff;Sat;C;P;l) C. He does nice things for me and yet he is not a puppy dog. He has enough strength to make him masculine. (Sex;Sat;C;P;l) (Aff;Uns;P;C;4) C. Finally I told my roommate what I thought about her sloppiness, and I felt good I did. (Hos;Sat;C;P;2) (SA;Sat;C;P;2) C. It was a tough job; but I'm glad I did it. (SA;Sat;C70;2) C. It was great when Dad took us to the Ice Follies each year. (Dep;Sat;C;F;2) 7. Simple Agreement or Disagreement (Agr): This category includes those statements of the client which simply acknowledge, agree or dis— agree without elaboration to the preceding statement of the therapist; this category is not used if one of the preceding six can be scored. Note: In all cases the subject of this statement is the client and the Object is scored as the therapist; see subject and object below (Section II, C.). When simple agreement or disagreement is scored, relevance scorings are omitted; (Section II, D.). C. Yes. Co Surely. C. I agree. A-20 C. I think so. C. I don't think so. C. No (as a matter of fact without hostility). By definition, simple agreement by the client covers all categories that the therapist ap- proached or introduced. Special example: C. (A client statement which scored sex, affiliation, and dependency.) T. You sound as though you have been a pretty lonely girl. (Score approach to sex, affiliation and dependency.) c. Yes. (Sex;Agr;C;T;-) (Aff;Agr;C;T;-) (Dep7Agr;C;T;-) T. Is that right? (Approach to sex, affili— ation and dependency.) C. Yes. (Sex;Agr;C;T;-) (Aff;Agr:C;T7-) (Dep;Agr;C;T;-) Unstated (Uns): Includes all the statements when any of the above categories cannot be scored becauSe the client has not eXpressed his affective feelings. Usually these state- ments will be simple expressions about the activity of the client or-other people. C. we went to the show. (Aff;Uns;C;P;4) C. I asked him why he thought a girl might do something like that. (Dep;Uns;C;O;4) C. I do lots of crossword puzzles. (SA;Uns;C;O;4) Special case: When the client is not a partici— pant in the described behavior, do not score any intra—psychic state. C. My aunt really chewed out my uncle. (HOS:-7O:O;5) C. Mary went out with Bill last night. (SeX7-:P;P:5) A-21 Subject and Object: For each major category scored for a client statement, the subject and the object of the client's expression in regard to that major category is also scored. 1. Subject: The subject of statement is the person whose attitude, feeling or behavior is being expressed. This may not be the gram— matical subject of the sentence. 2. Object: The object of the statement is the person or situation that receives the action, feeling or attitude of the subject. Objects need not be the direct object of any verb. Symbols: C, client; M, client's mother; F, client's father; T, client's therapist; P, client's peers; H, other members of client's immediate family or the family as a unit; 0, other (people, situations, events, etc.). These are exhaustive, but not mutually ex— clusive in scoring. C. My uncle was furious at my aunt. (HOS:-:O;O;5) C. I've always felt my mother loved my sister more than me. (Dep;FH;C;MH;3) Psychotherapeutic Relevance for Client Statements: For each major category scored, a relevance score is marked, except when the psychic state is scored as simple agreement—disagreement. These six cate- gories are exhaustive and mutually exclusive. When two categories could be scored for the same interpersonal drive, score only the lower numbered choice. Note: When the psychic state is scored as need, guilt, anxiety, frustration-hurt, frustration- aggression or satisfaction, a relevance score of l or 2, generally-is scored. When the psychic state is scored as "unstated," the relevance score usually is 3, 4, 5 or 6. 1. Present Affective Feeling (1): Includes ex- pression or description of client's present feelings; analysis of client's present feel—' ings; affective problem analyzing or affective problem solving; affective discuSsion of client's actions, motivations and their A—22 consequences. 'For any scoring in this cate— gory the statement must express a present feel— ing or analysis of a feeling or behavior of the client. If the feeling related to a past event, the feeling must continue into the present to be scored "1". C. I'm just plain mad. (Hos;N;C;O;1) C. Is it all right if I talk about my girl's problem? (Dep;N;C;T;1) C. I hope he calls me for Saturday night. (Sex;N;C;P;1) C. I want to get a 4-point. (SA;N;C;O;l) Past Affective Feelipg (2): Includes ex- 'pression or description of client's past feel- ings; analysis of client's past feelings; af- fective discussion of client's past actions, motivations and their consequences. For any scoring in this category the statement must express a past feeling which is not stated as carrying over to the present feelings of the client. Score as category 1, when a past feel— ing continues into the present. C. I didn't want to move; I didn't want to leave the friends I had there and so I hated it for the longest time. (Aff;FA,FH;C;P;2) (Hos;N;C;O;2) Behavior Within the Family (3): Includes ex— pression of behavior of parents, siblings or spouse; discussion of their behavior toward the client and of the client toward them; analy- sis of their behavior where the client is seek- ing to understand their behavior as it has af— fected the client. C. If dad doesn't like what I do, he just grumbles about it. (Hos;Uns;F;C;3) C. My mother was furious about it. (HOS:-:M:O73) C. When my mother and father quarrel, my sister is always on my father's side. (Hos;—;H;H;3) A—23 C. My parents always ask if I am getting enough sleep. (Dep;Uns;MF;C;3) C. Dad resents all her questions. (HOS:-:F:073) Participant Behavior (4): Includes description of actions of the client; includes description of behavior, feelings, actions, attitudes of others when the client is a participant in the scene; includes brief comments which are personal in reference but with little if any affective significance. The expressions are of a lower energy level and without mention of the client's internal feelings about the be- havior described. C. Last spring I used to go out drinking occasionally. (Aff:Uns:C;P;4) C. Yes, John is one of the exceptions in our group. (Oth;-;O;O;4) .C. I don't think they resent my doing that. (Hos;Uns;C;C74) C. If I don't hOp out of bed the second the alarm goes Off, I know I'd roll over and go back to sleep. (Oth;-;C;O;4) Observed Behavior (5): Includes description of the actions of specifiable others where the client is only an observer or reporter, rather than a participant in the scene. Again there is no mention of the client's internal feel- ings about the behavior of others. C. My uncle was furious at my aunt. (H087-7O;O75) C. Bill reads all the editorials. (Oth;—-O; o; 5) Description of Impersonal Events, Facts, Opinions (6): Includes statements with no psychological reference to any significant individual; discuSsion of intellectual, ab— stract or philOSOphical matters. Includes statements where the client may be manifesting affective expression, but the expression is like a speech he could give to any one or any group, usually stylized by cadence or rhythmic patterns (soap-box). A-24 C. Most people‘have a liberal attitude about sex; what people do privately is their own business. (Sex;Uns;C;O;6) C. The individual is only a number here; the place is so large. (Oth;-;C;O;6) III. Categories of Therapist Responses. A. Approach—Avoidance Response: Therapist responses to each scored client interpersonal category are divided first into two mutually exclusive classes, approach and avoidance responses. When both ap- proach and avoidance are present, score only the portion which is designed to elicit a response from the client. Examples of approach and avoid- ance responses are grouped in sub-types to aid scoring. But the judge must decide first that a response is an approach or avoidance before he con— siders the various sub-types. 1. Approach responses (Ap): An approach response is any verbalization by the therapist which seems designed to elicit from the client further expression or elaboration of the de- pendent, hostile, affiliate, self—assertive, sexual, vague or other expression which was scored in the client's immediately preceding statement. Approach is to the major category, not necessarily to the specific subcategories or the particular content of the client's pre— ceding speech. The following subcategories are exhaustive. a. Exploration (probing): Includes remarks or questions that encourage the client to de— scribe or express his feelings, attitudes, or actions further; asks for further clarification, elaboration, descriptive information, continuance; calls for details or examples; probing Opinions which direct the client to reconsider by more careful thinking a previous statement. Should de- mand more than a yes or no answer; if not, may be a "label." C. How do I feel? I feel idiotic. T. What do you mean, you feel idiotic? (1)* *TO aid in training judges, approach and avoidance responses are also marked as (I) for internalizin responses and (E) for externalizing responses. (cf. III, C. A-25 I can't understand his behavior. What is it about his behavior you can't understand? (E) Tell me more how you felt. (I) I don't completely follow that sequence. (E) Reflection: Repeats or restates a portion of the client's verbalization of feeling, attitude or action. May use phrases of synonymous meaning. Therapist may some— times agree with his own previous response; if the client had agreed or accepted the first therapist statement, the second ‘ therapist statement is scored asfla re— flection of the client statement. Therapist finishes client statement in an obvious manner. C. I wanted to spend the entire day with him. T. You wanted to be together. (I) C. His doing that stupid doodling upsets me. T. It really gets under your skin. (I) Labeling: The therapist gives a name to the feeling, attitude or action contained in the client's verbalization. May be a tentative and broad statement not clearly aimed at exploration. Includes "bare" in- terpretation, i.e., thOSe not explained to the client. May be a question easily answered by yes or no. It may be more than a simple clause, but it is a statement of fact, opinion or situation without elaboration. C. I just don't want to talk about that any more. T. What I said annoyed you. (I) C. She told me neVer to come back and I really did have a reaction. T. You had some strong feelings about that--maybe disappointment or anger. (I) A-26 Interpretation: Points out and explains patterns or relationships in the client's feelings, attitudes and behavior: ex— plains the antecedents of them, shows the similarities and discriminations in the client's feelings and reactions in diverse situations or at separate times. C. I had to know if Barb thought what I said was right. T. This is what you felt earlier about your mother . . . (I) Support: Expresses sympathy, reassurance, approval, agreement or understanding of client's feelings, attitudes or behavior. Includes strongly emphasized, "Mm Hmm," fiYes"; offers explicit permissiveness. C. It's hard for me to just start talking. T. I think I know what you mean. (I) C. I hate to ask favors from peOple. T. I can understand that would be diffi— cult for you. (I) C. But this, I don't know whether I am - cheating myself or not. well, I want to feel, you see. You're feeling. (I) May I just be quiet for a moment? Certainly. (E) O HO I-3 I have my girlfriend's problems on my mind. Could we talk about them? T. Why don't we talk about that? (E) Information: Gives factual information or therapist opinion to general, direct or im— plied questions; includes general remarks about the counseling procedure; tells the client what to do; points out that the client's feelings are natural or common (generalization). C. Shall I take tests? T. I feel in this instance tests are not needed. (E) A-27 C. What's counseling all about? T. It's a chance for a person to say just what's on his mind. (E) C. I don't like to talk about it. T. Mary, we have to deal with this somehow. (I) Avoidance Responses (Av): The following sub- categories are exhaustive. An avoidance re— sponse is any verbalization by the therapist which seems designed to inhibit, discourage or divert further expression of the dependent, hostile, affiliation, self-assegtion, sex, vague or other categories. The therapist at— tempts to inhibit the feelings, attitudes or behavior described or expressed in the im— mediately preceding client statement which determined its placement under the major cate- gory. Avoidance is avoidance Of the major category, not specific subcategories or psychic states. a. Disapproval: Therapist is critical, sar— castic or antagonistic toward the client or his statements, feelings or attitudes, expressing-rejection in some way. May point out contradictions or challenge statements. (Note: remember you must de— cide response is an avoidance before you consider sub—types.) C. Why don't you make statements? Make a statement. Don't ask another question. ' T. It seems that you came here for a reason. (E) C. well, I wonder what I do now? T. What do you think are the possibili- ties? You seem to have raised a number of logical possibilities in our discussion. (E) C. I'm mad at him: that's how I feel. T. You aren't thinking of how she may feel. (E) b. TOpic Transition: Therapist changes or introduces a new tOpic of discussion not in the immediately preceding client verbali- zation. USually fails to acknowledge even a minor portion of the statement. A-28 Those kids were asking too much. It would have taken too much of my time. We seem to have gotten away from what we were talking about earlier . . . (E) My mother never seemed interested in me. And what does your father do for a living? (E) Ignoring: Therapist responds only to a minor part of the client response or re- sponds to content, ignoring affect. He misses the point of the client statement. May under- or over-estimate affect. May approach the general topic but blatently ignore the affect verbalized. C. T. C. T. You've been through this with other people so help me out, will you? You are a little uneasy. (I) You can see I don't know what to do and I want you to give me advice. Just say whatever you feel is im- portant about that. (I) My older sister gets me so mad I could scream. Mm-hmm. How old did you say she was? (E) we went out for Chinese food; he's so easy to get along with. Is he from New York? (E) Mislabeling: Therapist names attitudes, feelings ‘or actions which are not present in the actual verbalization preceding the response. C. T C. T I just felt crushed when she said that. Really burned you up, huh? (I) I don't know how I felt--confused, lost-- I wonder if what you felt was re- sentment. (I) A-29 C. I may drop out of Honors College. T. You mean Arts and Letters. (E) C. No—-Honors College. e. Silence: Scored when it is apparent that the client expects a response from the therapist but none is forthcoming within five seconds after the client stops talk— ing. If the therapist approaches after five seconds have elapsed, silence cannot be scored and the therapist's response is merely "delayed." C. If you think I should keep on a more definite track, tell me because I'm just rambling. T. (five second silence) (E) C. It is very confusing to know what to do. Major Interpersonal CateqorypInitiated by Therapist. Scored whenever the therapist introduces the topic of dependency, hostility, affiliation, self- assertiveness, sex or vague affective feelings when the client statement was not scored as the category which the therapist attempts to introduce. Each category so introduced is also scored for internalizing or externalizing elicitation. l. Dependency Initiation (Dep Init): C. Last week I talked about Jane. T. You've mentioned a number of things you have done to please her. (E) C. (Enters office) T. Now, how may I help you? (I) 2. Hostility Initiation (Hos Init): C. I was late for class this morning. T. I wonder if you dislike the teacher or the class? (I) C. I like to run around in blue jeans. T. You hate your mother. (I) C T I don't really understand but that really makes me anxious. You get mad when I Open up some feelings in you. (I) A-3O C. He's the only dog I ever cared for. T. Do you feel that your mother sort of re— jects you or isn't giving you enough at- tention and love. (I) (Init both Dep and Hos) 3. Affiliation Initiation (Aff Init): T. Do you join lots of campus organi- zations? (E) T. Do you want to stick up for your friends when they're criticized? (I) 4. Self-Assertion Initiation (SA Init): T. I was wondering if you felt you have been studying more efficiently lately. (I) T. Tell me something about your needs to be independent. (I) 5. Sex Initiation (Sex Init): T. Do these feelings have anything to do with sex? (I) T. Did your mother ever prepare you to know what menstruation would be like? (E) 6. Vague Initiation (Vag Init): T. Have you started feeling anxious in the last few minutes? (I) T. What are you feeling right now? (I) T. . . . because we won't be able to deal with your feelings that are tender and I suspect that this is really what we need to deal with. (I) Internalizing or Externalizing RespOnses: Thera— pist responses of approach, avoidance or initi— ation are scored in one of two mutually exclusive classes: internalizing or externalizing responses. When both types are present, score the portion of the response which is designed to elicit a re— sponse from the client. A—3l Internalizing (I): In this category the focus is on the client's concept of himself, his feelings and reactions to the stimuli imping- ing on him. The therapist is encouraging the client to express his feelings. The therapist may label the client's feeling; he may verbally act them out with feeling or sensory words; he may explore the feelings by eliciting the client to discuss the idiosyncratic edges of his feelings and the impulse edge of his feelings. T. What would you like to talk about to- day? (I) T. You keep a pretty close check on those you let yourself love because it's pretty dangerous. (I) T. Can you accept the fact that some of your ambitions will be frustrated? (I) T. You want to be a boy, but if you were you couldn't have children. (I) T. What did you think your mother meant by - that? (I) T. What is it about his behavior you can't understand? (I) Externalizing (E): The distinction is between a focus outside or inside the client. Here the therapist joins with the client on focusing on Something that is "outside" the client, or re- sponds in such a way as to encourage the client to focus 0n something outside himself. Re— sponse may refer to the client and still be placed here if it is a behavioral description of the client as an external object. There is a clear absence in this category of any focus on how the client "feels." T. In a sense you're being compared to people who are not doing things. (E) T. How old is your sister? (E) T. What did your mother feel when you said that? (E) A-32 Note: In the case of certain avoidance re— sponses, it may be impossible to score a re- sponse as internalizing or externalizing. a) b) C) d) e) Silence responses cannot be scored, but are listed as E. Topic transition responses are scored in respect to the discussion they intended to elicit, e.g., if a discussion of sex is introduced, score it also on the basis of whether it attempts to internalize or externalize the client's response about sex, and not in regard to the preceding client discussion. C. And so we went downtown shopping. T. Let's go on to something else; how did you feel about last week's hour? (I) Disapproval can be scored either internal— izing or externalizing. Ignoring can be scored either internalizing or externalizing On the basis of what the therapist said which was scored ignore. Mislabel can be scored either internal— izing or externalizing. APPENDIX B A RATING SHEET FOR THERAPISTS Client Counselor You saw the client listed above for counseling. Now that you have terminated your relationship with him, how would you judge the success of your contacts with him? (Check one) ( ) Successful ( ) Partially Successful ( ) Mainly Unsuccessful ( ) Unsuccessful mum/mun 966 lllllUll 3 0 El T 1293 030 IIHIUIUIUII l I l l l I III I l l I II I l l I ll 3