CLIENT ATTRACTION AND DISTRESS:

ANTECEDENTS 0F EXPERIENCING
IN PSYCHOTI'IERAPY

Thais for the Degree of M. A.
MICHIGAN. STATE UNIVERSITY
NORMAN DAVID SCHAFFER
1974

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ABSTRACT

CLIENT ATTRACTION AND DISTRESS: ANTBCEDENTS
OF EXPERIENCING IN PSYCHOTHERAPY

BY

Norman David Schaffer

The purpose of this study was to determine the relationship
between client variables and behavior in the therapeutic situation.
The client variables were attraction to the therapeutic situation, and
self-reported distress. The behavior selected as the dependent
variable was Experiencing, defined as the extent to which the client
refers to his own feelings and searches for the meaning of the
personal reactions to events that he is reporting.

A review of the literature suggested that Experiencing early
in therapy was a function of the client, not the therapist. Therefore,
it was hypothesized that Experiencing would not relate to the level
of experience of the therapist. With respect to Attraction and
Distress, it was hypothesized that Experiencing would be positively
related to each variable. Lastly, it was hypothesized that the
independent variables would interact in an additive manner.

The independent variable of self-reported distress was
measured by the MMPI. Libo's Picture Impressions Test (1969) was

used to measure Attraction. The dependent variable of client

Norman David Schaffer

Experiencing was measured early and late in the second interview by
Gendlin's Experiencing Scale (Klein et al., 1970).

It was found that Experiencing did not relate to the level
of experience of the therapist, which confirmed the first hypothesis.
Experiencing was not found to relate significantly to either Attrac-
tion or Distress when these variables were analyzed separately.
However, the interaction of the two variables was significant, though
falling in an unexpected pattern. Low levels of Experiencing were
found in the Not Distressed, Not Attracted group and the Distressed,
Attracted group. High levels of Experiencing were found in the Not
Distressed, Attracted group, and in the Distressed, Not Attracted
group.

The unexpected finding that high levels of 225h_independent
variables inhibits Experiencing was discussed in terms of security
operations. Refinements in the current theories concerning attrac-
tion and expectation were suggested. Implications for treatment

were discussed.

CLIENT ATTRACTION AND DISTRESS: ANTECEDENTS

OF EXPERIENCING IN PSYCHOTHERAPY

BY

Norman David Schaffer

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF ARTS

Department of PsycholOgy

1974

‘3 ACKNOWLEDGMENTS

I would like to thank Dr. Norman Abeles, chairman of this
thesis committee. I deeply appreciated his "student-centered"
approach towards helping me do this research. It is no accident that
over the course of time, research became something I wanted to do,
rather than something I had to do.

I am also grateful to Dr. Thornton and Dr. Zucker, for their
encouragement and insight. I appreciated their "really being there,"
even when they were late.

I would like to thank the stranger from the PRB calculator
room, who roused me from the depths of despair by reminding me to
plot the group means.

Lastly, I would like to acknowledge myself, because I don't

do that very often. I did one hell of a job.

ii

TABLE OF CONTENTS

LIST OF TABLES .

Chapter
I. INTRODUCTION

Expectations
Experiencing

II. REVIEW OF THE RESEARCH LITERATURE

Attraction . . . . .
PrOgnostic Expectations .
Degree of Disturbance .
Therapist Level of Experience .
Experiencing

III. HYPOTHESES .
IV. METHODOLOGY

Subjects .
Experiencing

Sampling
Rater Selection and. Training

Degree of Reported Distress-~MMPI
Attraction . . .
Level of Experience of the Therapist . . .

V. RESULTS AND CONCLUSIONS

Reliability of Measures . . . . . .
Hypotheses . . . . . . . . . . .

Therapist Level of Experience as Independent

Variable . . . . .
Attraction and Distress as Independent Variable

iii

Page

11

11
14
15
19
22

28
29

29
29

29
33

34
35
36
38
38
39

39
41

Chapter
VI. DISCUSSION . . . . . . . . . . . .

Hypothesis 1: Therapist Level of Experience .

Hypothesis 2 and 3: Main Effects of Attraction

and Distress . . . . . . .

Hypothesis 4: Attraction and Distress Interact .

VII. IMPLICATIONS . . . . . . . . . . . .
APPENDIX

REFERENCES .

iv

Page
50
SO

51
53

56
59

6O

Table

A1.

LIST OF TABLES

Inter-rater Reliability on Experiencing Scale .
Inter-rater Reliability on the PIT

Therapist Level of Experience, and Client Distress
and Attraction . . . . . . . . . . . .

Therapist Level of Experience and Client Experiencing
Early Modal Level of Experiencing .

Late Modal Level of Experiencing

Early Peak Level of Experiencing

Late Peak Level of Experiencing . .

Data for Attraction, Distress, and Experiencing . .

Page
38

39

40
41
44
45
46
47

S9

CHAPTER I

INTRODUCTION

This investigation will focus upon the process of psychotherapy
as it occurs in the setting of a university counseling center. The
focus will be on the relationship between client expectations and
selected process variables.

In a recent article Kiesler (1971) attacks the "client uni-
formity assumptions" in psychotherapy research. By this he refers to
the assumption that all clients share basically the same characteris-
tics. Kiesler emphasizes the need for researchers to question why
different clients respond in different ways to the same treatment.
This is essential because a therapist must know as fully as possible
whgfis trying to help before he can determine the most effective way
to help him.

Expectations

 

To learn who a person is involves learning how that person
interacts with his environment. Much of this interaction is deter-
udned by the mediator of the person's point of view, his internal
frame of reference. As Kelly has been often quoted (kelly, 1955), "A
person's processes are psychologically channelized by the way in

which he anticipates events . . . This is to say that human behavior

may be viewed as basically anticipatory rather than reactive, and
that new avenues of behavior will Open themselves to a person when
he reconstrues the course of events surrounding him."

No person can process completely the infinitely complex data
that make up his environment. Therefore in man there has evolved a
psychological mechanism for selectively attending and responding to
salient a5pects of the environment. This mechanism has been con-
ceptualized as a set of hypotheses that the individual posits, on the
basis of his past experiences. What he has learned leads the indi-
vidual to assume that certain consequences, helpful or harmful as the-
case may be, will occur as the result of a given action in a given
situation (J. B. Rotter, 1954). To synthesize Kelly and Rotter's
statements, if the client expects change to occur, then he will
selectively attend and respond to the aspects of his environment and
of himself most relevant to the process of change. Conversely, if
the individual does not expect to change, then he will miss cues that
are relevant to the process of change.

The client enters into therapy as into any other situation,
with a set of expectations based on hearsay and experience. As Strupp
observes (1962), clients are usually committed either with or without
awareness toward maintaining their psychological status quo. They
are reluctant to give up what neurotic gratification they manage to
eke out for uncertain, delayed gains. Strupp is one of many who feels
that the therapist will get the client to overcome his resistance to
change and to look at his inner conflicts only when there is a strong

desire to be helped and to collaborate with the therapist. Thus, the

client's attraction to therapy and his expectations concerningthe
likelihood of success should be major determinants of the client's

behavior in the therapeutic situation.

 

The client's expectations of and attraction to therapy was
assessed in this investigation by making use of an aspect of projec-
tive testing. Libo (1957) has developed the TAT-like Picture Im-
pression Test as a means of harnessing the recognized effect of the
interpersonal situation on a projective test. The Picture Impression
Test is designed to assess the client's attraction to therapy following
the initial interview. Libo comments that the Picture Impression Test
can be used to characterize the client's expectations of therapy, his
perceptions of and attitudes towards therapy, and the kind of role
that he would prefer to play. Libo asserts that his test measures a
temporary state, rather than an enduring, trait-like variable (1969).
However, in this investigation, attraction as a relationship--
maintaining variable is hypothesized to be an expression of a need
for relief which is stable early in therapy. Thus, attraction is
the operational definition of some of the enduring aspects of the way
that the client construes the therapeutic situation.

The Picture Impression Test was utilized in this investi-
gation to further clarify the antecedent client variables of expecta-
tions and attraction that can be correlated with different types of
processes that occur over the course of therapy. The research litera-
ture as reviewed by Goldstein (1962) deals primarily with outcome
rather than process. However, the findings about outcome relate to

the hypotheses made in this study concerning process.

In general, Goldstein's review and analysis support the
position that the more successful clients tend to be more highly
attracted to therapy, have more favorable expectations, and have
expectations of playing a more active and collaborative role in
therapy than the less successful clients. These are the variables
which the Picture Impression Test will be used to measure. A con-
.sistent secondary finding in Goldstein's review is the tendency
toward greater communicativeness in the clients who are more success-
ful, more attracted to therapy, and have more favorable outcome

expectations, and more actively collaborative role-expectations.

Experiencing.

 

The finding of greater communicativeness relates to the focus
on process in this investigation. To this end, use was made of
a scale designed to measure "experiencing" during the process of
psychotherapy. In the manual for the Experiencing scale (Klein et al.,
1970), experiencing "refers to the quality of an individual's
experiencing of himself, the extent to which his ongoing, bodily,
felt flow of experiencing is the basic datum of his awareness and
communications about himself, and the extent to which this inner datum
is integral to action and thought." Experiencing includes "the
broader band of implicit meanings that structure sensations and
feelings and articulate one's sense of continuity by supplying the
personal coloring of events and the personal significance of one's
reactions to them (Klein et al., 1970)." Experiencing must not be
equated with emotionality or expressiveness. Experiencing refers

to the individual's experiencing g£_his feelings, sensations,

impressions, cognitions, etc. It must also be noted that ratings of
Experiencing reflect the individual's willingness to report what he
is experiencing.

This theory of personality emphasizes upon the full avail-
ability and the free flow of inner process as the criteria for mental
health. This frame of reference stems most directly from the work of
Carl Rogers, though its relationship to the psychoanalytic emphasis
upon making conscious the unconscious is clear. In his second major
book, Client-Centered Therapy_(1951), Rogers takes the position that
if the client can be provided with a sufficiently non-threatening
environment his rigidly defensive behavior will decrease. The source
of this defensiveness and lack of awareness is that the client finds
aspects of his behavior unacceptable to himself. He therefore must
conceal his true nature from himself and from others by distorting or
simply not symbolizing his experience. Thus, what is present in the
client's experiencing (the organism/environment interaction) is not
fully represented in the client's awareness.

In the security of a facilitative relationship the client will
"loosen up" in terms of being able to talk, think, and feel more
freely. As client-centered therapy proceeds, Rogers notes that the
client begins to experience contradictory attitudes towards himself
of which the therapist is consistently accepting. Within the safe
context the client explores these contradictions and gradually comes
to perceive himself more fully and accurately. He becomes more able
to accept himself "as is." Greater focus on current feelings and

attitudes leads to greater objectivity, lessening the tendency to

emotionally approve or condemn oneself. The client comes to value
himself and his experiencing more, and is therefore less tied to the
judgments of others. A key aspect of this process is that abstract
generalizations about himself and his environment are discarded as
unsatisfactory guides for living. Abstract conceptualization of
self are replaced by guiding principles which are built more closely
on direct experience.

Rogers' emphasis on the importance of the recovery of denied
experience is not far from the psychoanalytic frame of reference.

The difference lies in Rogers' assertion that the client's concept of
self must be changed before he can Subsequently accept the denied
experiences. Hence the client-centered therapist's emphasis on
emitting unconditional positive regard, accurate empathy, and genuine-
ness which facilitate this (1957). On the other hand, the psycho-
analytic position holds that treatment effort is directed primarily at
uncovering the resistances and repressions £i£§£_which subsequently
leads to change in the patient's self-concept. Thus the '
psychoanalytically-oriented therapist emphasize directly attempting
to uncover what is ng£_conscious, while the client-centered therapist
emphasize accepting and clarifying what is conscious.

However, this difference blurs when one realizes that both are
working towards the same end, more complete self-awareness. Further-
more, it appears that both techniques focus upon making interpreta-
tions or reflections that are only one "step" ahead of the client's
present awareness. In this way the client stands the best chance of

Vassimilating the therapist's response (Gendlin et al., 1965). The

most exciting aSpect of this issue is the convergence of two trains

of thought with vastly different origins. The psychoanalytic position
is that the unconscious must be made conscious. The client-centered
vieWpoint is that what is present in experiencing must become

accurately represented in awareness. This suggests that the main area

 

of convergence, the crucial role in the psychotherapeutic situation
of rich versus impoverished experiencing, is indeed ofgprime
importance.

The work of Gendlin and his colleagues springs directly from
that of Rogers. In fact, the Experiencing scale is an extensive modi-
fication and refinement of a set of 7 scales developed by Rogers and
his coworkers in 1959. The client's experiencing is important to
this group of psychologists because they feel that effective client
behavior in psychotherapy requires more than employing certain kinds
of cognitive concepts in an attempt to intellectually understand
oneself (Gendlin et al., 1968). They assert that productive behavior
in psychotherapy requires more than detailed descriptions of external
events and situations. It is clear to them that their clients who
intellectualize or externalize and do nothing else tend to fail in
therapy as they define it. As this point, Kiesler (1966) points out
that such a generalization, which implies that there is only one
kind of "good" patient and only one kind of productive process in
therapy, cannot be totally valid. However, he also points out that
Rogers' early theories of the therapeutic process are based on college
students. Thus, it may well be that the ability to experience the

full range of one's feelings and be aware of the implications of this

experiencing for oneself (Kiesler, et al., 1964) is a key process in
therapy for college students.

These researchers and therapists assert that the successful
client tends to work with his feelings as well as cognitive explana-
tions and descriptions of events. However, the client must do more
than just express and talk about his feelings: he must be able to
focus on his not yet conceptually clear but directly felt experiencing
of himself and his problems. He must refer to his inner experiencing
directly, silently, attending to it and feeling it out further, which
hopefully leads to a shift and partial resolution of the more fully
experienced feeling complex. If experiencing has been carried for-
ward further, more completely felt through, then cognitive and
emotional insight into the full implications and real meaning of
one's experience can reveal what the client can do about himself and
his situation (Gendlin et al., 1968).

Thus experiencing is conceived of as the means by which
painful feelings can be faced and changed. An unclear, fragmented,
or unavailable aspect of the client's experience is in this way re-
structured such that its impact becomes clear, its meaning explicit,
and such that it is immediately available as a clear and useful
referent for self-awareness, decision and action.

The Experiencing scale has been constructed to measure the
degree to which the client engages in experiencing, which is asserted
to tend to characterize the interviews of successful rather than
unsuccessful clients (Gendlin et al., 1968). The lower levels of the

7-point scale rate the degree to which direct inner reference is

apparent in the client's communication. This refers to the degree
to which the client is aware of, focuses on, and expresses the
subjective and personal meanings and experiences of events, and his
reactions to them (Klein et al., 1970). The higher levels of the
scale deal with the experiencing that has been achieved, and the
extent to which the experiential perspective is used for exploration
and problem solving.

It is clear that experiencing deals with a truly vital
aSpect of the psychotherapeutic situation. Therefore the hypothetical
connections between these areas of research are spelled out and
subject to test in the setting of a university counseling center.
What will be investigated will be the nature of the client variables
which are associated with differing responses during the therapy hour
to similar treatments.

It seems that adequate measures of the antecedent variables
and their effects have been found in the form of the Picture Im-
pression Test and the Experiencing scale, respectively. The scope
of the present study «did not permit including a measure of the
degree of similarity of treatment administered to the clients.
However, treatment received by the clients can be broadly construed
as similar to the extent that the therapists at the Michigan State
Counseling Center during 1968-1969 emphasized an interpersonal,
Sullivanian, "relationship"-oriented approach, as opposed to orthodox
psychoanalytic, traditional client-centered, or a strict behavior
modification approach. The importance of measuring the treatment

variable is recognized for future research which should focus upon

10

separating the effects of treatment variables from the effects of

client variables on process in psychotherapy.

CHAPTER II

REVIEW OF THE RESEARCH LITERATURE

Attraction

 

The research whose central focus is client attraction to therapy
or to the therapist Springs from the development of the Picture Im-
pression Test by Libo (1957). This is a TAT-like test whose four cards
deal with interpersonal situations that are easily construed as psycho-
therapy. It is administered after the initial interview.‘ The assump-
tion is that the client's re5ponses on the Picture Impressions Test,
like any projective test, will be determined in part by the inter-
personal aspects of the situation. Therefore the Picture Impressions
Test should reflect to some extent the client's perceptions of and
attitudes toward the therapist and the treatment setting (Libo, 1957).

Libo has developed a standardized scoring system which yields
an attraction score, defined as the resultant forces acting on the
client to maintain his relationship with the therapist. The system is
based on differentiating between responses which indicate actual or
desired motion towards or away from the therapist in the story. The
details of this system will be dealt with in the section on the
methodology of this study. What is most important at this point is

the reliability of this scoring system.

11

12

In the reprint of his manual, (1969) Libo reports reliability
obtained in his 1957 study of 87% for two independent coders and 95%
for one coder repeating the scoring, concerning the discrimination
of attracted from not attracted protocols. He reports three other
studies which obtained reliability of 83%, 82%, 73%, and 97.5% dealing
with the variable of attraction. Thus it is clear that Libo's scoring
system does in fact reliably discriminate between attracted and not
attracted protocols.

The validity of the Picture Impressions Test fer measuring the
construct of attraction, a relationship-maintaining variable, is
supported by his 1957 finding that the Picture Impressions Test
accurately identifies 6 out of 9 clients who do not return fer more
therapy, and 24 out of 31 who did return. The relationship between
predicted and actual return is significant at the .05 level.

Mullen and Abeles (1967) substantiate the validity of the
Picture Impressions Test with their finding that clients with higher
attraction scores are more likely to continue in therapy than clients
with low attraction scores. They also find that college students
coming for an intake interview have significantly higher attraction
scores than a similar group of college students who have not sought
out an intake interview.

Further support fer the validity of the Picture Impressions
Test is provided by their finding that the low scores of the no contact
group tend to reflect a general feeling of ill will towards medicine
or therapy of any kind. The low scores of the group with therapy

contact tend to reflect a specific, unsatisfactory interpersonal

13

situation. 0n the basis of qualitative analysis of the protocols,
highly attracted individuals in both the contact and no contact groups
tend to "(1) talk more about advice and psychotherapy (2) express
positive feelings about doctors, psychologists, or psychiatrists, and
(3) be more communicative about themselves [p. 395]." On the other
hand, the individuals with low scores in both groups tend not to get
involved in what they are saying an an affective way. This suggests
that attracted clients will show higher levels of Experiencing than
non-attracted clients.

In the Picture Impressions Test Manual, (1969) Libo reports two
studies by Pope and Siegman (1966, 1968) that show that the Picture
Impression Test measures a variable which is affected by the quality
of the relationship between two people. In the 1966 study, changes in
the direction of higher attraction of pre- and post-interview scores
is related to verbal fluency as measured by fewer hesitations, pauses,
or silences. In the 1968 study, there is a relationship at the .10
level between interviewer warmth and attraction. The only other study
focusing on client attraction and using the Picture Impressions Test
is one reported by Goldstein and Simonson (in Bergin 6 Garfield, 1971).
They find that attracted clients are less covertly resistant, mg£g_
talkative, more self-descriptively sick, and that they have more
favorable prognostic expectations.

The attracted client has been shown to have a greater likeli-
hood of high participation and affective involvement in the psycho-
therapeutic situation than the unattracted client. The clients who

are less attracted tend to show evidence of being dissatisfied with

14

the interpersonal relationship with the therapist. The not attracted
clients therefore tend to be less communicative about themselves and
their feelings, particularly their feelings about the therapist. This
probably inhibits the psychotherapeutic process. However, Goldstein
and Simonson (1971) are cited as detecting a factor that seemed to be
present along with attraction, i.e., more favorable prognostic expec-
tations. The present investigation makes the assumption that the
attractiveness of therapy for the client is in part an expression of
his favorable prognostic expectations. As was noted earlier, these
expectations are assumed to be a relatively enduring, rather than
transitory characteristic. Expectations have been found by some

studies to effect the psychotherapeutic process.

Prognostic Expectations

In a major review of the research on the outcome of psycho-
therapy, Luborsky (1971) reports that the extent of the client's
expectation of change is predictive of change. However, he also
notes that the typg_of expectation has not been found to be a good
predictor of change. Though this research deals with outcome rather
than process, it warrants further investigation.

Brady, Zeller and Reznikoff (1959) find that a conscious,
favorable attitude towards therapy is significantly related to improve-
ment in therapy in a sample of 135 hospitalized patients. However, in
a later study, Brady, Reznikoff and Zeller (1960) do not find a
significant relationship between expected and patient-reported

improvement nor does Goldstein (1960). In his interpretation of the

15

Brady et al. study (1960), Goldstein (1962) attributes these results

to the intentional heterogeneity of disturbances and treatments sampled
in this study. He suggests that a variable like expectation with such
complex ramifications calls for greater, not less, control of treatment
and client variables.

The contradictory results of the studies reported so far can
be found in the rest of the literature as well. Lipkin (1954) finds
that the expectation that counseling will be successful and gratifying
correlates positively with personality change. Like Goldstein, Lipkin
also relies on self-reports of change. Lipkin's results can be
explained in terms of minimizing the cognitive dissonance between
one's attitudes and one's perception of reality. This analysis applies
to four other studies (Frank et al., 1957; Gliedman, et al., 1958;
Goldstein and Shipman, 1961; and Friedman, 1963) which also rely on
client reports of change and find a positive correlation between
favorable expectations and improvement.

Clearly, the need to appear consistent in studies with self-
reports as outcome measures could counfound the effects of expecta-
tions upon symptom reduction. The problem stemming from the use of
self-reports can be avoided by looking at ratings of process by out-

side observers, as was done in this study.

Degree of Disturbance

 

The effect of favorable or unfavorable expectations upon
process is mediated by the degree and type of client distress.

Goldstein and Shipman (1961) and Lipkin (1954) find that the greater

16

the degree of self-reported distress, the greater the expectation of
relief. Goldstein (1962) speculates that this finding can be accounted
for by the following theory: The more crucial the confirmation of a
hypothesis is to carrying out goal-striving activity, the greater will
be the strength of the hypothesis. Thus, great distress interfering
with one's satisfaction in vital areas will lead to a strong expecta-
tion that this distress will be.relieved. This expectation would
unrealistically assume instantantaneous cures. Such a client might
give up when his expectations were disconfirmed. 0n the other hand,
this expectation could motivate the client to remain in therapy and to
make an effort to benefit from therapy. The client who intensely feels
the need for help could work hard in therapy. Facilitative or in-
hibitory effects of expectations on therapy are dependent on two
factors: whether or not these expectations are unrealistic, and how
the client reacts to possible disconfirmation and disappointment.

For the purposes of this investigation, one must hypothesize
how degree of disturbance will interact with the other variables. The
studies reviewed above suggest that the more disturbed the client, the
greater his need for relief, and the greater his need to participate in
a relationship from which he expects some relief. However, it is clear
from other lines of research, that degree of disturbance does not always
correlate positively with how well the client will do in therapy.

In a brief but incisive review of outcome research, Luborsky et
al., (1971) states that the majority of studies show a significant posi-
tive relationship between outcome and the overall adeguacy, rather than

inadequacy, of personality functioning. Contrary to the findings

17

reviewed above, degree of disturbance seems to impede, rather than
enhance, the productiveness of the therapeutic relationship.

Analysis of the studies reported by Luborsky with the nature
of the measurement of disturbance in mind reveals a consistent trend.
The research shows a significant positive relationship between self-
reported anxiety and successful outcome. Furthermore, the greater the
number of symptoms checked on a symptom checklist, the better the
prognosis. Two studies show that the greater the felt depression, the
better the prognosis. Luborsky interprets this as evidence that the
presence of strong affect and pain indicates that the client is more
likely to ask for and be open to help than clients who have flattened
affect and do not feel such pain. The latter may be in the position
of not wanting to reach out for help, or of having given up entirely.

It appears that the best affective indicators which suggest
Openness to change and motivation for therapy are anxiety and depression.
From the measurements of disturbance cited, it seems that the MMPI and/
and/or a symptom checklist could be the most appropriate measurements
to use. However, Figler (1968) finds that student counselees who are
more disturbed on MMPI do ng£_refer to their own feelings, needs, and
reactions more frequently than less disturbed student counselees. This
seems to contradict Luborsky's conclusion, but this may be a function
of differences in population in the two studies.

The assertion that the greater the degree of distress, the
better the prognosis seems to contradict the firmly grounded notion
from clinical experience that the clients most likely to benefit from
psychotherapy are those best off to begin with (Goldstein, 1962).

However, the hypothesis that disturbance relates positively to outcome

18

has to do with the d3g£32_of disturbance within the neurotic Eypg of
disturbance. Thus, it is 22£_being asserted that, for example, a
schizophrenic is more likely to benefit from therapy than a neurotic.
As Luborsky's review (1971) might suggest, the college student popula-
tion which is used in the present study i§_relatively well-off
psychologically. Students who are going through college tend not to
fall into the clearly psychotic categories of disturbance. In addi-
tion, Luborsky et al., (1971) note that the evidence suggests that
those who are younger, more intelligent, and who are high in social
achievement do best in psychotherapy. These must be contributing
factors to the finding that student status is associated with success
in therapy (Luborsky et al., 1971). Luborsky et al., (1971) state
that the type of disturbance in overall personality functioning must
be within the moderate range because college student status implies

a fair amount of ego strength and social competence.

In effect the population presents a situation which fits into
what Luborsky et al. (1971) identify as a promising predictive
combination: "High affect (anxiety and other fbrms of distress) with
high integration or ego strength form a good combination of prognostic
conditions for change through psychotherapy [p. 156]." Thus, for the
purposes of this investigation, the hypothesis will be tested that
felt distress enhances the process of psychotherapy. To apply
Luborsky's analysis (1971), the anxious or depressed student who is
still functioning knows that he needs help and is more likely to be
Open to it. He therefore should be more likely to be attracted to the

therapist, and more likely to get effectively involved in the

19

therapeutic situation than a less distressed fellow student. However,
a variable which may possibly interact with these factors is that of

the level of the therapist's experience.

Therapist Level of Experience

 

As Fiske et al. put it (1964), "One would expect that an
important concomitant of greater experience is a greater ability to
provide benefit for the clients [p. 424]." This ability should be
reflected in higher levels of in-therapy process for clients treated
by experienced than inexperienced therapists. The review of Luborsky
et al. (1971) lists eight out of thirteen studies in which a rela-
tionship is found between successful outcome and experience level.
However, analysis of these outcome studies raises important questions
for a process study.

Fiske et al. (1964) do not find a significant relationship
between the square root of the number of clients seen by each thera-
pist and outcome. They Speculate that the number of interviews would
be a better measure of experience, and perhaps the number of years as
a therapist would be the best, since it correlates highly with the
number of interviews done and is easier to get. However, they caution
against claiming that experience necessarily implies skill. Fiske
et al. also note that if experience level is to be proved to effect
outcome, it must be shown that each level of experience treated a
population that was equally likely to improve.

The findings in Cartwright and Vogel's study (1960) raises
yet another question: perhaps experienced therapists generate a

qualitatively different change process in their clients than

 

20

inexperienced therapists. This could be missed by a study using only
one measure of treatment effects. Such a situation is possible in
light of two studies examining the relationship between client percep-
tions of therapists and therapist experience level (Rice, 1965; Grigg,
1961). Experienced client-centered therapists are significantly more
expressive, less directive, less interpretive, and tend to focus more
on internalized self-exploration than less experienced therapists.
This finding is substantiated by Strupp's objective evaluation of
client-centered techniques (1955). He finds that experienced client-
centered therapists offer more exploratory (asking fer opinion) and
less reflective responses than inexperienced therapists. However, he
does not find significant differences between levels of experience
for non-Rogerian therapists. Nevertheless, Strupp speculates that
perhaps experience implies a diversification of technique and less
reliance on stereotypes of interventions.

In two studies of non-client-centered therapists, Mills and
Abeles (1965) and Mullen and Abeles (1971) find significant differences
between Ph.D. staff members, interns, and practicum students contrary
to Strupp's finding. Mills and Abeles find that need for nurturance
and need for affiliation are significantly related only for the least
experienced therapists. They also shown that "liking" for the client
is significantly related to these needs only for the practicum
students. Mullen and Abeles' data also focus on the variable of
"liking," because "liking" is significantly related to accurate
empathy only for the inexperienced therapists. The experienced

therapist's accurate empathy is not related to "liking" the client,

21

and he offers significantly more accurate empathy than the inexper-
ienced therapist. It appears that experienced therapists are more
skilled at understanding and accurately perceiving their clients.
They are also more prone to guard against making the client too
dependent upon them than inexperienced therapists.

Anthony (1967) looks at the therapist's report of his approach
as it changes over time. He finds that, regardless of orientation,
the more experienced the therapist becomes, the more involved he
becomes with his clients. The more experienced therapist also assigns
more importance to the client's understanding of himself, and shows
greater concern with how the client relates to him, than the less
experienced therapist.

It is clear that experience of the therapist does in fact
change the way he conducts therapy. How these differences would inter-
act with the variables of concern in this investigation is less clear.
In general, it may be that the more consistent use of accurate empathy
by the experienced therapist will have a significant impact.

Research reported by Klein et al. (1970) shows a significant
correlation between client Experiencing and therapist empathy.

Gendlin speculates (1961) that the more empathic therapist, by his
more accurate and direct reference to the client's Experiencing, will
help the client to refer to his Experiencing more directly and be more
aware of its meaning to him. Research shows that the more experienced
therapists are more consistently and accurately empathic than less
experienced therapists (Mullen andAbeles, 1971). Therefore exper-

ienced therapists should be able to facilitate a higher level of

22

Experiencing than inexperienced therapists no matter how attracted or
how disturbed the client is.

Though such a hypothesis is quite straightfbrward, it is not
warranted in this investigation. It appears from the research on
Experiencing, that Experiencing is more a function of the client than
of the therapeutic process or the therapist himself. Successful
clients have not been shown to significantly increase their level of
Experiencing over the course of therapy (Gendlin et al., 1968; Klein
et al., 1970). Thus, Experiencing seems to be an "innate" rather than
a "learned" ability. The influence of the therapist's level of
experience should be even less strong in a sample of non-client-
centered therapists as will be used in the present study.

This investigation fbcuses on the importance of the variable
of attraction in psychotherapy process. Therefore it is hypothesized
that amount of attraction will most strongly correlate with the highest
levels of experiencing found in the clients. If the client is highly
attracted to therapy he will be highly involved during the therapeutic
situation whether the therapist is experienced or not. It is hypo-
thesized that felt distress will enhance both attraction and Exper-
iencing. At this point the research on experiencing will be dealt

with.

Experiencipg_

 

In an article on the Process Scale from which the Experiencing
scale was derived, the client-centered position is advanced that "If

personality development proceeds in the direction of full experiencing

23

and living in an integrated flow of implicit meaning, then the fully
functioning person is one who has become the process of experiencing
through which his deve10pment has been moving [p. 84, Walker et al.,
1960]." Thus, if therapy has been successful, then high levels of
Experiencing should be attained by the end of therapy. Such high
levels of Experiencing means that the client has overcome the diffi-
culties that blocked his development.

However, evidence does not support the contention that the
Experiencing scale measures the key process in successful therapy.
In some studies, high levels of Experiencing are associated with
successful outcome (Klein et al., 1970). However, in other studies
this association was not found (Ryan, 1966; Harris, 1971; Kiesler,
1965). In all studies, it is clear that clients with a moderate
Experiencing level, 2.00-2.99, are equally likely to succeed as to

fail (Gendlin et al., 1968). In some but not all studies it is shown

 

that clients move from low levels of Experiencing to high levels over
the course of therapy (Klein et al., 1970; Gendlin, 1968). Gendlin
et al., (1968) find that only 6 of 50 clients move from low to high
levels of Experiencing over the course of therapy.

The evidence shows that high levels of Experiencing can be
found in both mggg_and lg§§_disturbed clients within the neurotic
class of disturbances (Ryan, 1966; Harris, 1971; Kiesler et al.,
1969; Gendlin et al., 1968; Klein et al., 1970). Well adjusted
clients at the end of therapy do not necessarily Experience at high

levels, nor do maladjusted clients Experience at low levels.

24

To summarize, in some but not all studies, higher levels of

 

Experiencing are found in the less well adjusted clients than in the
more well adjusted clients within the neurotic class of disturbances
(Ryan, 1966; Harris, 1971; Kiesler et al., 1969). In part as a

result of this finding, in some but not all studies, higher levels of

 

Experiencing are associated with successful than with unsuccessful
therapy. These two general findings are related because success is
defined as level of psychological adjustment as measured on personality
inventories, problem checklists, and client or therapist judgements.
Thus, if Experiencing is not consistently associated with psychological
health, it will not be consistently associated with successful outcome

as measured by psychological health.

 

The most significant aspect of these findings is that as
Kiesler (1966) points out, the assumption of the uniformity of success-
ful therapeutic process is untenable, at least with respect to the
Experiencing process. High levels of Experiencing account for some
of the variance of successful outcome, but this process does not
account for gll_of the variance.

It is recognized that the nature of the relationship between
Experiencing and outcome is a crucial question. It taps into the vital
area dealing with what helps or does not help the client in psycho-
therapy. However, if this question is to be explored as meaningfully
as possible, the construct of Experiencing must first be as well-
defined as possible. Establishing a clear relationship between two

vague entities is not useful. Therefbre, this investigation seeks to

25

clarify the nature of the Experiencing construct by determining the
contribution of selected variables to this in-therapy behavior.

For the purposes of the present study, an operational defi-
nition of Experiencing can be posited which makes no assumptions
relating to its role in the course of therapy or in psych010gical
adjustment in general. As Kiesler puts it (Kiesler et al., 1964), the
Experiencing scale measures the dimension of "The degree to which the
client manifests Inward Reference in his verbalizations. The client
is referring inwardly when he is referring to his own feelings and
reactions - when he is searching for the meaning of the personal
events, feelings, and ideas he is reporting [p. 350]." The present
investigation limits the construct of Experiencing to this definition.
However, previous research can be related to Experiencing within the
constraints of this investigation.

The research on Experiencing itself (Kiesler et al., 1965;
Ryan, 1966; Harris, 1971) suggests that, within the neurotic type of
disturbance, the more stress a client feels, the greater will be his
tendency to refer inwardly in an affective and involved way about his
immediate feelings of stress. Luborsky et al., 1971, make this same
point about outpatient clients who are functioning in society and
therefore must have the necessary ego strength. Felt distress for a
college student motivates him in the direction of being more open to
help because he feels the need for help more strongly than a less
distressed college student.

With respect to attraction, Ryan (1966) finds that the group

with high levels of Experiencing during the middle stage of therapy

26

tend to be the ones who showed "strong faith" in psychotherapy
initially. In an ana10gue study done with normal college students

who volunteer to discuss a personal problem, Schoeninger (1965) finds
that "client" level of Experiencing is closely related to the
"client's" expectations. In two studies by Mintz and his associates
(Mintz, 1969; Mintz G Luborsky, 1969) ratings of Experiencing saliently
load onto factors labeled as "Patient Receptiveness" and "Patient
Involvement." Upon analysis of these studies, Klein et al., (1970)
conclude that "In general Experiencing can be interpreted as tapping
the degree of the patient's involvement in the therapeutic task,
including his productivity, his capacity to provide the therapist with
experiential material with which to empathize, and his openness to

the therapist's experiential approach [p. 26]."

None of these studies employ a measure whose focus is directly
centered upon client attraction for therapy and fer the therapist.

The purpose of the present study is to focus on attraction. Therefbre
Libo's Picture Impressions Test was used.

In the present study, the central hypothesis was that the
clients who are highly attracted to therapy will become involved in
the therapeutic situation in such a way that they will refer more
frequently to their own feelings and reactions, and explore more
frequently the possible implications and significance of their
internal process early in the course of therapy. As Strupp asserts
(1962) only when the client has a strong desire to be helped and to
collaborate with the therapist will he overcome the resistance toward

giving up immediate neurotic gratification fer uncertain, delayed

27

long term gains. This desire to be helped is hypothesized to be a
function of the client's attraction to therapy and his felt distress.
The tendency to collaborate with the therapist and work hard in
therapy was operationalized in this study as the frequency with

which the client engages in various levels of Experiencing. It is
also hypothesized that the therapist's level of experience contributes
to the client's willingness to refer directly to his own experience

less in the early stage of therapy than in later stages.

Hypothesis 1.

 

Hypothesis 2.

 

Hypothesis 3.

 

Hypothesis 4.

 

CHAPTER III

HYPOTHESES

Experiencing is not related to level of experience
of the therapist. Each level of experience of
therapists treats a representative sample of
clients in terms of:

a) attraction

b) degree of distress
Experiencing is positively related to attraction.

Experiencing is positively related to distress

reported on the MMPI.

Felt distress and attraction interact. Therefore,
the highest average level of Experiencing will be
found where there are high levels of both inde-
pendent variables, the lowest average level of
Experiencing will be found where there are low
levels of both variables. Intermediate levels of
process will be feund in clients where one variable

is high and one is low.

28

CHAPTER IV

METHODOLOGY

Subjects

The subjects of this study are undergraduates at Michigan
State University who voluntarily came to the counseling center during
the 1968-1969 school year. They presented personal and social
problems rather than primarily vocational or academic problems. They
were screened via an initial interview to determine the appropriate-
ness of psychotherapy in each case. The tape recordings of the
entire case for each client forms the tape library from which the
samples are drawn. The possibility of sample bias exists, because
tape recordings of cases were made only with the consent of both
client and the therapist. All cases are sampled which consisted of
at least two sessions, and had data on the MMPI and the Picture

Impression Test.

Experiencing_

 

Sampling
The method of sampling the therapy tapes has been arrived at

on the basis of Kiesler's recommendation (1966) to make sampling

decisions consistent with the theoretical position concerning the

29

30

nature of the variables to be empirically investigated. The first
issue that is raised by such considerations is the location of the
interview to be sampled. It is necessary to test for the hypothesized
difference in Experiencing for the different groups of clients where
they are most likely to occur (Karl and Abeles, 1969). The scape of
this investigation does not permit sampling from more than one stage
of therapy. The variables of attraction and distress are hypothesized
to affect the client's willingness and need to Experience at high
levels, respectively. However, both these variables change over the
course of therapy. Therefore, the earliest stage of therapy will be
sampled in order to get the best estimate of the effects of the
presence of the variables close to the time when these variables were
measured. This will be the second interview with the therapist.

The next problem is that of the number of segments and the
location of segments within the hour. The research hypothesis that
the variable of attraction affects one's readiness to initially engage
high levels of Experiencing necessitates non-random sampling early in
the hour. This is also recommended by Kiesler's finding (1966) that
the Experiencing level early in the hour, at its 1233§£_point,
differentiates well among groups differing in degree of disturbance.
Sampling the data non-randomly has been selected for the following
reason. Sampling the data randomly when the sample is small relative
to the data pool runs the risk "of obtaining data that are unrepre-
sentative of the general ordering of group means, or data that are

insensitive to meaningful differences [Kiesler et al., 1965]."

31

Kiesler et al. note that this is particularly true when Experiencing
fluctuates differently for different groups, as is hypothesized in
this study.

However, one segment early in the hour is not sufficient to
capture the behavior of the variables. The work of Karl and Abeles
(1969), Gurman (1973) and Kiesler et al., (1965) Convincingly show
that clients and therapist phenomena of many types are not uniformly
distributed throughout the therapy hour. The time that the sample
occurs in the hour is a significant determinant of the extent to
which a given phenomenon is fbund to occur in the segment. Karl and
Abeles (1969) recommend sampling for the variable of concern where
it is most likely to occur.

Kiesler et al. (1965) and Klein et al. (1970) suggest that
one is most likely to differentiate among groups if one samples late
in the hour. Gurman (1973) shows that therapeutic conditions are
highest in the last two-fifths of the hour. This investigation
attempts to differentiate between groups in the way that they respond
to therapeutic conditions. Therefbre samples will be drawn from late
as well as early in the therapy hour. The peak facilitative condi-
tions are not expected to confound the differences due to the
variables of attraction and distress in the groups of clients, because
psychotherapy has not been shown to significantly change client
Experiencing (Gendlin et al., 1968). Therefore, the procedure will
be to extract one segment each from the first four minutes of the

second and fourth fifths of the therapy hour.

32

Short Form of EXP Scale

 

Stage
1

Content

External events; refusal to
participate.

External events; behavioral
or intellectual self-
description.

Personal reactions to
external events, limited
self-descriptions; behavioral
descriptions of feelings.

Descriptions of feelings and
personal experiences.

Problems or propositions about
feelings and personal
experiences.

Synthesis of readily accessible
feelings and experiences to
resolve personally signi-
ficant issues.

Full, easy presentation of
experiencing; all elements
confidently integrated.

Treatment

Impersonal,
detached.

Interested, personal,
self-participation.

Reactive, emotionally
involved.

Self-descriptive;
associative.

Exploratory, elaborative,
hypothetical.

Feelings vividly ex-
pressed, integrative,
conclusive or
affirmative.

Expansive, illumi-
nating, confident,
buoyant.

33

The segments will be four minutes in length. This will
result in a manageable amount of data to be coded, approximately 320
minutes for 40 clients and £!2_segments per client. Kiesler et al.
(1964) show that this segment length will be as reliably rated, cover
a comparable scale range, and be as sensitive to change and group

differences as segments of other lengths.

Rater Selection and Training

 

The two raters other than the author were selected, one a
graduating senior and the other a third year graduate student in
clinical psychology. The 16-hour training program was administered
to the raters just as it is elaborated in detail in the Experiencing
Manual (Klein et al., 1970).

The tape segments were copied, coded, and numbered as sug-
gested in the Manual (Klein et al., 1970). The raters were given the
segments and instructed to rate them in the manner suggested by Klein
et al. (1970), checking the appropriate level for each scorable
response on the "Short Form of the Experiencing Scale," which appears
on p. 32. Transcripts are not used (Klein et al., 1970) but the
raters had as much time per segment as they need. Each rater then
listed the mode and peak levels of Experiencing for each segment.
Klein et al. (1970) suggest this because of the evidence that mode
and peak ratings relate to other variables in different ways. The
average of the two modes and two peak ratings on each segment served

as the final process scores for the segment.

34

Degree of Reported Distress--MMPI

 

Rogers' recent review of the status of the MMPI concluded
that it is "the instrument of choice for screening or assessing
emotional upset in a research population [Rogers, 1972]." The vast
literature dealing with the applications of this instrument reveal a
number of ways in which the MMPI can be adapted for the purpose of
measuring the client-reported degree of felt distress.

Rogers (1972) points out in detail that any application must
conform to the task for which the test was developed-~dichotomously
discriminating abnormals for normals. He convincingly argues against
using the MMPI profiles as a way to place an individual on a
continuum, or dimension of a personality trait.

The measure of distress utilized approximated the way that
the MP1 is intended to be used, to dichotomously discriminate
between normals and abnormals. Mullen's findings (1969) suggest that
there are indeed a group of clients with normal MMPI profiles and a
group of clients with abnormal MMPI profiles who received counseling.
In general, the attempt was made to set criteria for cut-off points
on T scores, and to set a criteria for the number of scales within a
given range that define a level of distress. Again, the exact values
of these criteria was determined after consideration of the range
of the MMPI scores, but before work was done with any of the other
variables. Clients in the Not Distressed group have less than 3 "T"
scores of 70 or greater. Clients in the Distressed group have 3 or

more "T" scores greater than or equal to 70.

3S

Attraction

 

The degree to which the client is attracted to the therapist
and the therapeutic situation was assessed using Libo's standardized
scoring procedure on his Picture Impressions Test (1969). In this
test, after the initial interview the therapist presents four TAT-like
cards whose pictures represent situations which can readily be con-
strued in terms of a therapist and his client, or a doctor and his
patient. The client is asked to write a story about each picture
covering the following areas:

What is happening?

What led up to this?

What is thought and felt?

What will happen? (p. 6, Libo, 1969)

A scoreable unit is defined as any phrase, clause, or sentence
that qualifies under one of the scoring categories. A +1 is given
for every presumable indicator of attraction in the story as defined
in the Scoring Manual (1969). A -l is given for every presumable
indicator of repulsion in the story as defined in the Libo's Manual
(1969).

The total score is defined as the algebraic sum of all the
"+1" and +-l" scores on all stories. The higher this score, the
greater the individual's presumed attraction to the therapist and/or
the therapeutic situation. The number of stories receiving a score
is considered an indicator of the client's involvement in the task

of story-writing.

36

Concerning the interpretation of each protocol as a whole in
terms of attraction or lack of attraction, the present investigation
used Libo's criteria (1969). These criteria have significant pre-
dictive ability (return vs. non-return) in his own study (1957) and in
Mullen and Abeles study (1967) at the MSU Counseling Center. "For an
interpretation of 'attracted' to be made, the subject must have re-
ceived a total score of +1 or higher, while also receiving scores on
at least two of the four stories. A subject who has a total score of
zero or minus, or who has not received scores on at least two of the
four stories would be judged 'not attracted' [p. 4, Libo, 1969]."

Thus, for each protocol, a rating of "attracted" or "not
attracted" was made, and the total score and total number of stories

receiving a score was obtained.

Level of Experience of the Therapist
The level of therapist experience was operationalized in the
manner of Mills and Abeles (1965) and Mullen and Abeles (1971):

Most experienced - staff members with Ph.D. in counseling or
clinical psychology, minimum of 3 years experience.

Moderately experienced - interns, advanced students in clinical
or counseling psychology with a minimum of 1 year intensive
therapy supervision.

Least experienced - practicum students handling their first
cases for an introductory practicum course.

These studies obtained significant differences in therapist behavior
between the most and least experienced therapists, particularly with
respect to accurate empathy (Mullen and Abeles, 1971). With the

finding in mind that psychotherapy does not appear to enhance

37

Experiencing (Gendlin et al., 1968), level of therapist experience
was not expected to correlate with client Experiencing early in the
course of therapy.

However, a test was made to see whether each level of
therapist experience treats a representative sample of the clients
with respect to attraction and level of disturbance. Assuming the
samples are equivalent, if there did_appear to be some correlation
between experience level and Experiencing at the earliest stage of
therapy, then one speculatively could attribute the result of the
experienced therapist's more consistently high accurate empathy
(Mullen G Abeles, 1971). Without a test for sample bias, any
differences among the groups on Experienced could be attributed to

such a bias, if it existed.

CHAPTER V
RESULTS AND CONCLUSIONS

Reliability_of Measures

Two raters were used to establish inter-rater reliability for
the Experiencing Scale. Two correlations were computed: one for
ratings of modes, and one for ratings of peaks. As can be seen from

Table l, inter-rater reliability was high.

Table l. Inter-rater Reliability on Experiencing Scale

 

Rater Mean S.D. Pearson r

 

Ratings of Modes
Rater A 2.18 .85 .92
Rater B 2.19 .86

Ratings of Peaks
Rater A 2.84 .92 .88

Rater B 2.76 .90

 

Reliability on the Picture Impressions Test was established
by the author rating 25 randomly selected protocols from the 40

protocols that were independently rated. The first criteria of

38

39

reliability was percentage of agreement on the overall rating of

Attracted vs. Not Attracted. The rater agreed with the author in

24 out of 25 cases: 96% agreement. The rater classified 11 out of

25 as attracted, whereas the author rated 10 out of 25 as attracted.
A correlation was computed for the total scores (sum of

+ and - scores) of the author and the rater for the 25 protocols.

As can be seen in Table 2, reliability with this strict criteria

was excellent.

Table 2. Inter-rater Reliability on the PIT

 

 

 

Rater Mean S.D. Pearson r
Author 2.52 5.16 r = .95
Rater C 3.04 4.82
Hypotheses

 

Therapist Level of Experience as
Independent Variable

 

 

Hypothesis 1. The relationship between therapist level of

 

experience; and attraction, distress, and
Experiencing.

It was hypothesized the level of experience of the therapist
was unrelated to the level of client Experiencing. In this sample
of clients, there were many more senior staff therapists (N = 22)
than either first year interns (N = 8) or second year interns (N = 10).
Therefore, the first and second year interns were labeled "inexper-

ienced," and the senior staff were labeled "experienced."

40

In order to definitely establish the equivalency of the
sample of clients that were treated by each group of therapists, the
fellowing analysis was made. It was hypothesized that the two
samples were equivalent with respect to the variables of attraction
and distress. It was determined by t tests that level of therapist
experience was not significantly related to either variable.

From Table 3 it is evident that no sample bias exists.
Therefore, if there is a difference in Experiencing fbr the clients
of the 2 groups of therapists, it is likely to be due to the differ-
ence in therapist level of experience.

Table 3. Therapist Level of Experience, and Client Distress
and Attraction .

 

 

Mean and S2 fer Mean and $2 for
Variable Experienced Inexperienced Observed
Therapists Therapists
Attraction Mean = 2.32 Mean 2 2.50 .08
52 = 21.94 s2 = 21.36: N.S.
Distress Mean = 3.36 Mean = 2.33 1.44
$2 = 7.05 s2 = 6.33 N.S.

Cr1t1cal value of t = t.05, 40 = 1.684

 

To directly test Hypothesis 1, t tests were computed for the
variable of client Experiencing for the two levels of therapist
experience. It is evident from Table 4 that client Experiencing

is not related to the therapist variable.

41

Table 4. Therapist Level of Experience and Client Experiencing

 

 

Category of Mean and $2 for Mean and $2 for Observed
Experiencing Experienced Inexperienced t
Rating Therapists Therapists
Early Mode* Mean = 2.05 Mean = 2.31 .85
$2 = .43 32 =1.25 N.S.
Late Mode Mean = 2.09 Mean = 2.28 -.66
$2 = .63 52 = .80 N.S.
Early Peak Mean = 2.82 Mean = 2.75 .23
$2 = .66 52 = .95 N.S.
Late Peak Mean = 2.80 Mean = 2.89 -.29
52 = .54 32 =1.13 N.S.

Critical value of t = t.05, 40 = 1.684

 

*Early rating = first 4 minutes of second fifth of therapy
hour. Late rating = first 4 minutes of fifth fifth of therapy hour.

The above data suggest that Experiencing early in the course of
therapy is a function of the client, rather than this therapist
variable. However it is recognized that other therapist variables
may influence client Experiencing.

Attraction and Distress as
Independent Variables

 

 

Hypotheses 2, 3, 8 4. The relationship between the independent

 

variables of attraction and distress, and the
dependent variable of client Experiencing.
A two-by-two analysis of variance was used to test Hypotheses

2, 3, and 4. However, before the main analysis was performed, a

42

chi-squared test was computed to determine the influence of the

variables on cell frequencies, which were as follows:

 

 

NA A
ND 7 13
D 10 10

 

 

 

 

NA = Not Attracted
A = Attracted

ND = Not Distressed
D = Distressed

The chi-square without the Yates correction was .915. Given a
critical value of x2.10, 1 = 2.71, cell frequencies do not seem to
be influenced by the independent variables.

The two-by-two analysis of variance was then computed. The
variable of attraction was dichotomized using Libo's criteria (1957)
for Attracted vs. Not Attracted. To be rated "Attracted," a complete
protocol had to have a total score of at least +1 on at least two
scorable stories. The variable of distress was dichotomized by
selecting a cut-off point of at least three T scores over 70 to
qualify as "Distressed."

The unequal N of the cells necessitated the use of the unequal
weighted-means analysis of variance, and approximate test which is

not excessively sensitive (Tsao, 1946). On the following pages,

43

Tables 5 through 8 show the F tests and the plots of the means for
each category of Experiencing.
Key -

NA = Not Attracted
<+l on <2 scorable stories

A = Attracted
3+1 on 32 scorable stories

ND

Not Distressed
<3 T scores over 70

D = Distressed
:3 T scores over 70

The results of the analysis of variance do not confirm
Hypotheses 2 and 3: at no type of Experiencing rating did the main
effects for the variables of attraction and Distress reach the .05
level of significance.

Hypothesis 4 is partially confirmed. For each type of
Experiencing rating, the A X 0 interaction was significant at the .05
level. Thus, the variables in question do in fact seem crucial, but
in a more complex way than predicted. For the early and late model
ratings of Experiencing, the lowest mean of Experiencing was found
among the clients who were Not Attracted and Not Distressed, as was
predicted (ND, NA). However, this was not true for peak ratings of
Experiencing, both early and late. In this case, the lowest mean
of experiencing was found among clients who were Attracted and
Distressed (D, A). It was predicted that these clients would have
the highest mean.

In all cases of Experiencing, the two highest means were

 

found among the clients who were either Attracted and Not Distressed

Table 5.

44

Early Modal Level of Experiencing

 

Source

DF

SS MS F

 

SEN:

O‘HHI—I

.48 .48 .66
.95 .95 1.30
4.19 4.19 5.74*

26.32 .73

 

*Significant - F

1.9

1.

1.

8

7

 

ND,NA°

.05; 1, 38 = 4°1°°

' D,NA

Distress

45

Table 6. Late Modal Level of Experiencing

 

 

Source DF SS MS F
A l .10 .10 <1
0 1 .48 .48 <1
AD 1 3.62 3.62 6.83*
S/AD 36 18.95 .53

 

*Significant F 05- 1 38 = 4 10

- D,NA

ND,A '

1.9 ’ D,A

1.8

1.7 ND,NA°

 

ND Distress D

46

Table 7. Early Peak Level of Experiencing

 

 

 

 

 

Source DF SS MS F
A 1 .95 .95 1.98
D 1 1.90 1.90 3.96
A/D 1 7.81 7.81 16.27**
S/AD 36 17.31 .48
**Significant F 01. 1 38 = 7.35.
3.2
3-1 ND,A . . D,NA
3.0
2.9
2.8
E 2.7
X 2.6
P 2.5
2.4
2.3
ND,NA °
2.2
2.1
° D,A
2.0
1.9
1.8
1.7 l ‘
ND D

Distress

47

Table 8. Late Peak Level of Experiencing

 

Source

DF SS MS F

 

sec.

.38 .38 <1
.38 .38 <1
4.67 6.77*
24.69 .69

C‘HI—‘H
A
O)
\I

 

*Significant - F 05. 1 38

ND,A . . D,NA

ND,NA °

. D,A

 

0
ND Distress

48

(ND, A), or Not Attracted andDistressed (D, NA). This disconfirmed
the hypothesis that the intermediate levels of client Experiencing
would be found where one variable was high and one was low.

To summarize, the interaction was significant as predicted in

Hypothesis 4. However, the predicted pattern was not confirmed. The

predicted pattern was as follows:

EXP

- D,NA
ND,A 0/
ND,NA .

ND Distress D

 

 

The observed pattern, in general form, was quite different:

ND,A . . D,NA

EXP

ND,NA . - D,A

 

 

Distress

49

When Distress was low, the Attracted clients were Experiencing at a
significantly higher level than the Not Attracted clients. When
Distress was high, the Not Attracted were Experiencing at a signi-
ficantly higher level. Possible explanations of these unexpected
findings, and their implications will be dealt with in the next

section.

CHAPTER VI
DISCUSSION

Hypothesis 1: Therapist Level of Experience

 

It was established that experienced (senior staff) and in-
experienced therapists were assigned samples of clients equivalent to
one another in terms of the mean level of distress and attraction.

The hypothesis that client Experiencing in the samples was not related
to therapist level of experience was confirmed. One clear implica-
tion of this finding is that client variables seem to be more crucial
early in therapy than therapist variables. This in turn suggests
that research on therapist variables must focus on the later stages

of therapy.
I Gendlin argues that therapy per se is not effective in
helping a client move from low to high levels of Experiencing (Gendlin
et al., 1968). The thrust of his latest work is toward a technique
involving explicit instructions by the therapist for the client to
focus on Experiencing. The focus on the present study on the second
session precludes a blanket endorsement of Gendlin's position. How-
ever, these results suggest that perhaps focusing instructions would

be useful early in therapy.

50

51

Hypotheses 2 and 3: Main Effects of
Attraction and Distress

 

A 2—by-2 analysis of variance yielded no significant main
effects for Attraction or Distress. However, these variables did.
effect level of client Experiencing when their interaction was taken
into account (Hypothesis 4). Keeping in mind the confirmation of
the interaction hypothesis, the interpretation of the disconfirma-
tion of the main effects hypotheses must be limited.

In light of the confirmation of the interaction hypotheses,
it seems that the client's liking for the therapist and/or the
therapeutic situation dpg§_effect client Experiencing deSpite
disconfirmation of main effects hypotheses. The main effects were

not significant because of the nature of the interaction. The

 

nature of the interaction was such that in every pair of cells that
comprised one level of each variable, there was always one high and
one low Experiencing cell. Thus, significant differences between
levels of each variable were not apparent.

Goldstein (1962) suggests that clients who are Attracted
are more communicative in therapy than clients who are Not Attracted.
The present study suggests that early in therapy, under the condi-
tion of low distress, this is true, but that the reverse is true for
high distress. The failure to confirm the hypothesis of a main
effect for attraction does not disprove Goldstein's theory. Given
the significant interaction, these data suggest refinement of the
hypothesis.

The same interpretation is applicable to Goldstein's hypo-

thesis (1962, Luborsky et al., 1971) that favorable expectations are

52

correlates of success in psychotherapy. The PIT to some extent
measures expectations (desired locomotion, satisfaction obtained or
lost). The results from the main effects and interaction hypotheses
show that expectations £12 have an effect on what the client does in
therapy. However, the present results suggest that these effects
change for different degrees of client distress. Again, these data
suggest refinement, not rejection, of hypotheses concerning
expectations.

A possible explanation for the unexpected results is sex
differences in the way the independent variables are associated with

Experiencing. The cells are composed as follows:

 

 

 

A0 Al
5 females 12 females
D
° 2 males 1 male
8 males 6 males
D1
2 females 4 females

 

 

 

 

The Scheffe' method of multiple comparisons (Hayes, 1963) was used

to test for sex differences. No significant differences in Exper-
iencing were found. Nevertheless, inspection of the table shows that
the high Experiencing Attracted group are females and the high Exper-
iencing Distressed group are males. This suggests that Experiencing
is associated with the independent variables in different ways for
each sex. Further research is necessary to explicitly test this

hypothesis.

53

To look at the main effects tests by themselves, it becomes
clear that early response to therapy cannot be predicted solely on
the basis of the client's degree of Distress, or solely on the basis
of the client's amount of Attraction. This may be a reflection of
Gendlin's observation (Gendlin et al., 1968) that clients who Exper-
ience in the range from 2.00 to 2.99 are equally likely to succeed as
to fail. However, the confirmation of the interaction hypothesis
suggests that if one takes into account both Attraction gpd_0istress,

the clients who refer inwardly early in therapy are predictable.

Hypothesis 4: Attraction and Distress Interact

Hypothesis 4. Attraction and distress interact. The highest

 

level of Experiencing will be found where both
variables are high; the lowest level where both
variables are low. Intermediate levels of process
will be found where 1 variable is high and l is

low.

The 2-by-2 analysis of variance showed that the interaction
for Attraction and Distress was significant at the .05 level for
modal and peak Experiencing both early and late in the second inter-
view. As predicted, a low level of Experiencing was found where both
Attraction and Distress was low. However, lg!_levels of client
Experiencing were found where both variables were high in all 2-by-2
analyses.

Apparently, the variable of Attraction interacts with the

variable of Distress in unexpected ways early in the course of

54

therapy. It is not surprising that within the Not Distressed group,
Attracted clients Experience at a higher level than Not Distressed
clients. What must be accounted for is the fellowing: for the
Distressed group, Not Attracted clients Experience at higher levels
than Attracted clients.

One possible explanation rests on the following hypothesis.
The combination of Attraction apd_0istress inhibit a client because
he wants to make the therapist like him. He is therefore reluctant
to express the unpleasantness of his disturbed world because this
would run the risk of "turning off" the therapist. This results in
low levels of Experiencing.

The Not Attracted, Distressed client is free of Attraction,
one of the factors inhibiting the Attracted, Distressed client. This
client is not so concerned with pleasing the therapist. He is not
inhibited by the possibility of "turning off" the therapist. He can
be seen as being preoccupied with his internal pain. The Not
Attracted, Distressed client is therefore more likely to disclose
what is really bothering him and Experience at higher levels than
the Attracted, Distressed client.

The Attracted, Not Distressed client is free of Distress,
the other factor inhibiting the Attracted, Distressed client. Both
groups are Attracted, and are therefbre hypothesized as involved in
trying to make the therapist like them. However, the Attracted, Not
Distressed group have little unpleasantness in their world to hide.
They can be open and expressive, which results in their higher level

of Experiencing than the Attracted, Distressed clients. Such an

55

analysis clarifies how Attraction and Distress can inhibit inward

reference when both are at high levels. This also explains how

Attraction and Distress can facilitate inward reference when only

one is at a high level.

CHAPTER VII

IMPLICATIONS

This research suggests that high Attraction and favorable
expectations are not essential for the client to begin Experiencing
in psychotherapy. The most striking aspect of these findings is
that seemingly encouraging prognostic signs may hinder the client
early in therapy. Further research is needed to substantiate such a
surprising finding. If replicated, subsequent research should focus
on the antecedent conditions, to determine if they are in fact due
to the vicissitudes of client security Operations.

In light of this research, therapists have a rationale for
taking on the "bad," or Not Attracted client, and for making an
honest effort in his behalf. Though less pleasant to work with than
a "good" client who is Attracted, these data suggest that the Not
Attracted client can Experience at high levels even during the
unsettling experience of starting therapy.

It was the assumption of this study that the client would
get in touch with and disclose his inner feelings if he was
Attracted to the person with whom he was talking. It was hypo-

thesized that attraction would facilitate Experiencing. It was

56

57

found that for the Not Distressed group, attraction dig_facilitate
Experiencing. However, within the Distressed group, attraction did
pp£_facilitate Experiencing.

Thus, the Not Attracted, Distressed clients are Experiencing
early in therapy despite the disinterest in the relationship with the
therapist that they are likely to have. Critics of behavior modifi-
cation and psychoanalysis, who object to the impoverished therapist-
patient relationship that they claim such approaches utilize, may be
mistaken in their view of the necessity of a therapist—patient rela-
tionship involving mutual "positive regard" (Rogers, 1957). Further
research is needed which more directly measures patient perception
of these qualities.

Early identification of the various combinations of Attrac-
tion and Distress has implications for treatment. It might prove
fruitful to consider the differential impact of confronting vs.
non-confronting styles of therapy. Perhaps a confronting approach
is more likely to elicit Experiencing in the Not Attracted than in
the Attracted clients. The latter might require a more non-
confronting style on the part of their therapist, with more emphasis
on acceptance. Acceptance and confrontation are not necessarily
mutually exclusive. However, this may well be true from the point
of view of the client who needs the therapist to like him. Further
research is called for to investigate this possibility. The outcome
of such a study would be particularly useful in short-term therapy
situations, where one must know how to get therapy started as

rapidly as possible. In general, it appears that the therapist must

58

tailor his approach to the client, rather than screen for tailor-
made clients (Garfield, 1973).

Three factors not considered in this study may determine
whether a client Experiences at high or low levels. One possibility
is the actual interventions made by the therapists, which may be
differentially effective in eliciting Experiencing. A second possi-
bility are personality variables in the therapists: perhaps the kind
of person a therapist presented himself as determined to what extent
a client would reveal his inner world to him. A third possibility
is that perhaps client variables not dealt with in the present study
are major determinants of Experiencing early in therapy. Very likely
a combination of all three variables is important: The crucial factor
factor may be that a certain type of person is intervening in a
specific manner in the life of another particular type of person.

0n the whole, the present study shows that client variables
of distress and Attraction to therapy are concomitants of behavior

in therapy.

APPENDIX

APPENDIX

 

 

Table A1. Data for Attraction, Distress, and Experiencing.

. * * ** Early Exp. Late Exp. Early Exp. Late Exp.
Cl1ent PIT MMPI Mode Mode Peak Peak

801 + 5(4) 3 2.0 3.0 2.0 3.0
803 +ll(3) l 2.0 2.0 3.0 3.5
804 + 5(3) 5 2.0 2.0 3.0 2.0
805 + 8(3) 0 2.0 3.0 4.0 2.0
806 - 7(4) 6 4.0 3.0 4.5 2.5
808 +10(3) 3 3.0 2.0 3.0 2.0
810 + 7(3) 0 2.0 3.0 3.0 3.5
812 +10(4) l 2.0 2.0 2.5 3.0
815 - 2(1) 7 1.5 2.0 2.0 3.0
817 - 3(4) 2 2.0 2.0 2.0 2.5
818 +ll(4) l 2.0 2.0 3.0 3.0
820 + 8(4) 1 2.0 2.0 2.0 2.5
823 + 2(1) 1 2.0 1.0 2.0 2.0
824 + 2(4) 1 2.0 2.0 2.0 3.0
825 - 3(4) 0 1.0 3.0 2.0 4.0
827 + 3(3) 0 2.0 2.0 2.0 2.0
828 - 1(3) 4 2.0 2.0 4.0 4.0
829 + 2(3) 0 5.0 4.0 5.0 5.0
830 + 2(2) 2 3.5 3.0 4.0 3.5
831 + 2(3) 8 1.0 2.0 2.0 2.0
832 0(2) 1 1.0 1.0 2.0 2.0
834 + 1(1) 3 2.0 3.0 3.0 4.0
835 + 3(2) 3 2.0 2.0 2.5 2.0
838 + 4(4) 4 2.0 1.0 2.0 2.0
842 + 4(3) 7 2.0 2.5 2.0 3.5
843 - 4(3) 9 1.0 2.0 3.0 3.0
845 - 2(3) 6 2.0 3.0 3.0 4.0
846 0(4) 1 2.0 2.0 2.0 2.0
847 - 1(1) 0 2.0 1.0 2.0 2.0
848 + 3(4) 0 2.0 1.0 2.0 2.0
849 + 1(2) 0 5.0 4.0 5.0 5.0
854 + 1(2) 4 2.0 1.0 2.5 2.0
855 +l3(4) 3 1.0 2.0 2.0 2.0
856 + 1(2) 6 1.0 2.0 2.0 2.0
858 + 9(3) 0 2.5 2.0 3.0 3.0
859 — 1(3) 1 2.0 2.0 4.0 4.0
861 0(1) 4 2.0 2.0 2.0 3.0
867 0(2) 5 2.0 3.5 3.5 2.0
870 - 3(2) 5 2.0 2.0 3.0 2.0
875 - 5(2) 8 3.0 3.0 3.0 3.0

 

in parentheses.

*Sum of +‘s and -'s, followed by number of

59

scorable stories

**Number of T scores greater than or equal to 70.

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