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ABSTRACT
THE IMPLICATIONS FOR CONSTRUCT VALIDITY AND

ROGERIAN THEORY‘IN THREE MEASURES OF
THERAPIST EMPATHY

BY

Lawrence Langer

This study examined three measures of therapist
empathy to (1) determine their construct validity and
(2) provide additional information about the theoretical
dispute between Rogers and Truax and Carkhuff regarding
the necessity that the client actually perceive the ther-
apist's empathy if therapy is to be successful.

Two of the therapist empathy measures required
judges to rate tape-recorded interviews with (l) the Cark-
huff Empathic Understanding in Interpersonal Processes
Scale and (2) the Barrett-Lennard Relationship Inventory.
The latter instrument was also used by the client to re-
cord his therapist's empathy. A previous study by Kurtz
and Grummon (1972) failed to establish construct validity
for several therapist empathy measures but could not
determine if this was due to the empathy instrument or

1

Lawrence Langer

to the different persons making the ratings, i.e., an ob-
jective judge or the client. The present study corrected
this deficiency. It also examined the relationship be-
tween therapy outcome and the same measure of therapist
empathy as recorded by the client and an objective judge,
thereby adding to our knowledge about the theoretical dis-
pute between Rogers and Truax and Carkhuff.

Twenty-four clients and their therapists at the
Michigan State University Counseling Center served as the
sample for this study. All the therapist empathy measures
were correlated with each other and with six different
measures of therapy outcome.

Clients completed the Relationship Inventory after
the third therapy interview and again after the conclusion
of therapy. One judge rated three tape-recorded segments
of five different therapy interviews for each client to
determine the therapist's level of empathy on the Carkhuff
scale. Another judge made ratings on the same five therapy
interviews to obtain the therapist's empathy score on the
Relationship Inventory. The reliabilities for the tape-
judged Relationship Inventory and Carkhuff empathy scale

were low.

Lawrence Langer

Therapeutic outcome was assessed by: 1) changes
in the Number of Deviant Signs score of the Tennessee
Self Concept Scale, 2) changes in the clinical judgments
of improvement over therapy based upon MMPI profiles, 4) a
four-point scale upon which the therapists made judgments
as to the clients' progress in therapy, 5) a seven-point
scale upon which clients recorded their judgments as to
how helpful therapy had been to them, and 6) a composite
outcome score obtained by converting the above measures
into standard scores.

The results comparing the empathy scales show
that: 1) there is no relationship between the tape-judged
Carkhuff empathy scale and the client-perceived Relation—
ship Inventory, 2) there is no relation between the tape—
judged Relationship Inventory and the tape-judged Carkhuff
scale, and 3) there is a positive relation between the
client-perceived Relationship Inventory and the tape—
judged Relationship Inventory. The results comparing the
empathy scales to the outcome measures show that: 1) there
is no relation between either the tape-judged Relationship
Inventory or the tape-judged Carkhuff scale with any of

the six outcome measures, and 2) there is a positive

Lawrence Langer

relation between three of the outcome measures and the
client-perceived Relationship Inventory.

The first three findings comparing the empathy
scales to each other found no support for construct val-
idity of therapist empathy. Further, the findings overall
tended to support the Rogerian rather than Truax-Carkhuff
position that the client must perceive the therapist's
empathy. The relation of those findings to the findings
of previous research was discussed. A possible explana-
tion was offered for the: 1) random relationship found
between the tape-judged Carkhuff empathy scale with both
the tape-judged and client-perceived Relationship Inven-
tories, and 2) the random relationship found between both
the Carkhuff scale and the tape-judged Relationship Inven-
tory with the many outcome measures. Implications for
future research regarding the therapist empathy concept

were discussed.

Thesis Committee

  

Dr. Donald L. Grummon, Chairman

I \

Dr. Mary M. Leichty Date: ///é
/ /

Dr. Bill L. Kell

THE IMPLICATIONS FOR CONSTRUCT VALIDITY AND
ROGERIAN'THEORY IN THREE MEASURES OF

THERAPIST EMPATHY

BY

Lawrence Langer

A THESIS

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

MASTER OF ARTS

Department of Psychology

1972

To the memory of my father

ACKNOWLEDGEMENTS

I would like to thank the many people who helped
me with this research. First, I would like to especially
thank Dr. Donald L. Grummon for the patience, understand-
ing, and support he has extended to me in this research
and throughout my graduate career. Further thanks goes
out to the other members of my committee, Dr. Bill L. Kell
and Dr. Mary M. Leichty for their careful reading and con-
structive criticisms of this thesis.

Next, I would like to thank my rater, Maressa
Gershowitz, who spent many long hours rating the therapy
interviews. In addition, a word of thanks goes to Miriam
Smith of the Michigan State University Counseling Center
for her helpful assistance.

Finally, I would like to thank my wife, Ginette.
It is impossible to really express my feelings toward you
and to thank you enough for all your help and encourage-
ment in a short statement. Yet, I'm sure you know how

much you mean to me.

iii

TABLE OF CONTENTS

Page
LIST OF TABLES. . . . . . . . . . . . . . . . . . . vi

LIST OF APPENDICES. . . . . . . . . . . . . . . . . Vii

Chapter

I. INTRODUCTION. . . . . . . . . . . . . . . . 1
General Definitions of Empathy . . . . . l

Therapist's Empathy and its Relationship
to Counseling and Psychotherapy. . . . 4
Construct Validity . . . . . . . . . . . 18
Theoretical Issue. . . . . . . . . . . . 25
Statement of the Problem . . . . . . . . 27
Research Questions . . . . . . . . . . . 29
II. METHOD. . . . . . . . . . . . . . . . . . . 31
Data Collection. . . . . . . . . . . . . 31
Subjects . . . . . . . . . . . . . . . . 31
Description of Empathy Measures. . . . . 33
Computation of Empathy Scores. . . . . . 39
Description of the Outcome Measures. .i. 41
III. RESULTS . . . . . . . . . . . . . . . . . . 45

iv

TABLE OF CONTENTS (cont.)

Chapter Page
IV. DISCUSSION. 0 O O O O O O O O O O O O O O O 50

V. SUMMARY . . . . . . . . . . . . . . . . . . 57

REFEMNCES O O O O O O O O O O O O O O O O O O O O O 61

APPENDICES. O O O O O O O O O O O O O O I O O O O O 65

lil‘llll‘lll'i Ell

Table

10.

11.

LIST OF TABLES

Summary of therapy outcome studies using
accurate empathy scale. . . . . . . . . .

Correlations between the client-perceived
Relationship Inventory after the third
interview, at post-therapy testing, the
tape-judged Relationship Inventory, and
the Carkhuff Empathic Understanding
Interpersonal Processes Scale with the
outcome measures. . . . . . . . . . . . . .

Number of interviews per client . . . . . . .

Barrett-Lennard Relationship Inventory,
Client Perceptions after 3rd interview. . .

 

Barrett-Lennard Relationship Inventory,
Client Perceptions, Post. . . . . . . . . .

Barrett-Lennard Relationship Inventory,
Tape-rated Average ratings. . . . . . . . .

Judges ratings of counselor empathy Average
ratings, Carkhuff Empathic understanding in
Interpersonal Processes Scale . . . . . . .

Tennessee Self Concept difference scores. . .

MMPI profile analysis--average ratings. . . .

Clients and counselors evaluation of
counseling scores . . . . . . . . . . . .

Post t scores-~for cOmbined outcome score . .

vi

Page

15

49

65

74

75

76

77

78

79

80

81

LIST OF APPENDICES

Appendix Page
A. NUMBER OF INTERVIEWS PER CLIENT . . . . . . 65
B. EMPATHY MEASURES USED IN THE STUDY. . . . . 66

C. RAW SCORES OBTAINED BY CLIENTS AND
OBJECTIVE JUDGES ON THE EMPATHY
MEASUES . O O O O O O O C O O O C C O C C 74

D. SCORES ON OUCOME MEASURES . . . . . . . . . 78

vii

Chapter I

INTRODUCTION

General Definitions of Empathy

 

This research attempts to clarify the concept of
therapist empathy and its relationship to psychotherapy
outcomes. Before reviewing the literature specific to the
concept of therapist empathy, we will briefly examine the
ways that empathy, in general, has been defined.

The original use of the word "einffihling" or
empathy was by Lipps (l909). Einffihling meant, to Lipps,
a process wherein entering stimuli would be reintegrated
by the receiver. In this definition, the word "stimuli"
is a general, undifferentiated term. It remained for fur-
ther researchers to specify the elements or makeup of a
stimulus.

Following the original formulation of empathy, a
variety of disciplines within psychology have employed,
defined, and worked with the concept of empathy. Within
the psychoanalytic school, Sullivan (1945) employed the

term empathy as a part of his theory of personality.

1

Within the theory, empathy "refers to the peculiar emo-
tional linkage that subtends the relationship with signif-
icant people--the mother and the nurse. Long before there
are signs of any understanding of emotional problems there
is evidence of this emotional contagion." Empathy is part
’of a learning process which occurs in association with
significant others.

Fromm-Reichmann (1950) generally agreed with Sul-
livan's formulation of empathy. She further postulated
that in a psychotherapeutic situation "success is depen-
dent upon an empathic quality between the psychiatrist and
patient."

Another psychoanalytic theorist, Fenichel (1945)
further elaborated on the definition of empathy. He con-
ceived of empathy as a process consisting of two acts:

"an identification with the other person and an awareness
of one's own feelings after the identification." Here
Fenichel introduced the notion that one becomes aware of
his own feelings, an active process which is more than
identification. Fenichel's formulation of empathy has
some important implications for both psychotherapy and

research as it lends itself to operational definitions.

The position of both Sullivan and Fenichel give
one an intuitive understanding of empathy and provide a
base from which Operational definitions may be evolved.
There is, however, in some of the psychoanalytic writing,
a tendency toward circular reasoning. Remembering Feni-
chel's (1945) definition of empathy as being composed of
identification with the other person and self-awareness,
we have Adler's (1929) definition of identification as
"the ability to place oneself empathically in the situa-
tion."

Other researchers have used the concept of empathy.
Within the area of industrial and social psychology, in a
study of interpersonal harmony in an industrial setting,
Speroff (1953) proposed a "quantitative definition of em-
pathy designed for communicative interpersonal use." He
defined empathy as "the ability to put yourself in the
other person's position, establish rapport and anticipate
his feelings, reactions, and behavior." This approach,
then, is concerned with prediction and control of behavior.
Another researcher, whose theory of sensitivity seems to
be consistent with Speroff's definition of empathy, is

Smith (1966). He sees sensitivity as "the ability to

predict what an individual will feel, say, and do about
you, himself, and others.

Dymond (1948, 1949) who was among the first to
conduct research studies on empathy defined empathy as
"the imaginative transposing of oneself into the thinking,
feeling, and acting of another." She further believed
that the family atmosphere that surrounds a person during
childhood is one of the major determinants in his future

ability to empathize.

Therapist's Empathy and its Relationship
to Counseling and Psychotherapy~

As the main thrust of this paper is concerned with
issues centered around therapist's empathy, it is appro-
priate to begin with the work of Rogers (1957, 1959, 1967).
Empathy for him, "is to perceive the internal frame of
reference of another with accuracy and with the emotional
components and meanings which pertain thereto, as if one
were the other person, but without losing the 'as if' con-
dition. Thus it means to sense the hurt or pleasure of
another as he senses it, and to perceive the causes thereof

as he perceives them, but without ever losing the

recognition that it is as if I were hurt or pleased, etc.
If this 'as if' quality is lost, then the state is one of
identification." Rogers uses this definition of empathy
as part of his general theory of therapy which states that
the greater the therapist's genuineness, his warm accep-
tance and his empathic understanding of the client, the
more likely it is that the therapeutic process will pro-
gress, which in turn is related to positive therapeutic
outcomes. Thus, Rogers attaches considerable importance
to the notion of therapist's empathy and his theory has
stimulated much empathy research in the counseling and

psychotherapy area.

Positive Results

According to Truax and Carkhuff (1967), Halkides
(1958) was one of the earliest empathy researchers who
tried to relate outcome with the therapist's level of
empathic understanding, unconditional positive regard and
self-congruence. Brief samples of early and late therapy
interviews, taken from ten successful and ten unsuccessful
therapy cases, were rated on a scale based upon Rogers'

theory of therapist conditions. She found that the

successful cases showed significantly higher levels of the
three conditions than did the unsuccessful cases.

Another study which related the three therapist
conditions to the therapy process was done by Hountras and
Anderson (1969). The subjects of the study were 27 male
and 27 female undergraduates coming for help at a univer-
sity counseling center. The subjects were assigned to one
of nine counseling interns on the basis of whether their
problems were educational, vocational, or personal-social.
Conditions of empathy, respect, and genuineness were mea-
sured by the Carkhuff scales. As a measure of process,
the Truax Depth of Self-Exploration Scale was given to the
clients. They found a significant relationship between
all three counselor-offered conditions and self-exploration
in each of the problem categories.

In another study, Dickenson and Truax (1966) inves-
tigated the usefulness of time limited group counseling
upon college underachievers, by comparing a group of under-
achievers receiving group therapy with a matched group
receiving no group counseling. As part of the study,
Dickenson and Truax hypothesized that of those receiving
group therapy, the underachievers receiving the highest

levels of accurate empathy, nonpossessive warmth and

genuineness would have the greatest improvement in grade
point average. Those students in group therapy who re-
ceived high levels of therapist conditions showed signif-
icantly more improvement than either the control students,
or those students receiving only moderate levels of ther-
apist conditions.

Although the preceding studies have shown a posi-
tive relationship between therapist variables of empathy,
warmth, and genuineness and process and outcome, it is
difficult to determine precisely what effect empathy alone
had on outcome, as it was only one of three variables.

The following studies were concerned specifically with the
relationship of therapist empathy and therapy process and
outcome.

A study by Dombrow (1966) was in part concerned
with the relationship of therapist empathy and outcome.
The subjects were 29 mothers at a Child Guidance Clinic
who were seen once a week for six to ten months by 14
social workers. Empathy was determined by the therapists'
sorting of Q sort statements as if they were the patients.
Change or outcome was determined by the degree of the
mothers' divergence or convergence of self and ideal self

concepts during the course of therapy, as measured by

Q sortings. Dombrow found a significant positive rela-
tionship between empathy and change, although the actual
change which occurred was small.

In a study by Cartwright and Lerner (1963), it was
hypothesized that empathic understanding of the patient by
the therapist is directly related to the degree of improve-
ment in the patient during psychotherapy. The subjects
included 28 clients at a university counseling center and
their 16 client—centered therapists. The therapists pre-
dicted what their clients' responses would be on a scale
developed from the Kelly Repertory Test. The measure of
empathic understanding was the difference between the
client's self-description and the therapist's prediction
of the client's self-description. This measure was taken
in the early part of therapy and later at post-therapy
testing. Outcome or improvement was determined by judges'
ratings of three components: 1) the patient's integration,
2) the kind of organization (defensive vs. open), and
3) present life adjustment. An additional measure of
improvement was the therapists' post-therapy ratings of
therapy outcome. They found that empathic understanding
measured at post-therapy testing was positively related

to client improvement. The relationship between

improvement and empathic understanding was not significant
when the earlier measures of empathic understanding were
correlated with outcome. From this, Cartwright and Lerner
concluded that the magnitude of the therapist's empathy
which occurs later in therapy, is more crucial for client
change than the magnitude of empathy which occurs earlier
in therapy.

Another researcher, Barrett-Lennard (1962), de-
veloped an empathy scale, the Relationship Inventory,
based upon Rogers'theory (1957, 1959) that the client's
experience of his therapist's empathy is necessary for
therapy to progress. In the Barrett—Lennard study, the
Relationship Inventory was administered after the first
five therapy interviews, after 15, after 25, and at termi-
nation of therapy. The sample consisted of 42 clients at
a university counseling center and their 21 therapists.
The degree of client change during therapy was determined
by scores on Q sorts, adjustment, therapist rating mea-
sures, the Taylor Manifest Anxiety and Minnesota Multi-
phasic Personality Inventory Depression scales. Two com-
posite indices of change were used, one derived from

therapist ratings, and the other from client

10

self-descriptive data. He found that the 16 cases in the
upper category of change perceived their therapists as
having greater empathic understanding than those falling
in the lower category.

The psychotherapy research project with hospital-
ized schizophrenics at the University of Wisconsin, under
the leadership of Rogers (1967) has provided data for a
number of studies investigating the relationship between
therapist empathy and its effect on therapy process and
outcome. The overall design of the project is too exten-
sive to report here. Therefore, only the findings and
conclusions germane to this study will be summarized.

Therapist empathy in the study was measured in
three ways. First, judges rated therapists on the Ac-
curate Empathy Scale (Truax, 1961). Second, it was mea-
sured by clients' perceptions of their therapists' empathy
on the Barrett-Lennard Relationship Inventory. Finally,
therapists rated their own empathy on the Relationship
Inventory.

The major process scale used was designed by
Gendlin (1962) in terms of the experiencing dimension.
This seven-point rating scale is Operationalized as fol-

lows: At the lowest levels of experiencing, the patient

11

makes no personal reference and has little or no expres-
sion of feeling. At the higher levels, the patient exper-
iences his feelings, understands them, and integrates them
into a meaningful framework.

A great number of outcome indices were employed in
this study. Among them were the Minnesota Multiphasic
Personality Inventory, the Thematic Apperception Test, the
Butler-Haigh Q sort, etc.

In general it was found that: l) Judges' ratings
of therapist empathy (Accurate Empathy Scale--AE) were
significantly correlated to the level of process the pa-
tient engaged in. 2) Patient perceptions of the therapist
empathy were moderately associated with process level.

3) Judges' ratings (AE) and patient perceptions were re-
lated (initial, r = .71; terminal, r = .38). 4) Thera-
pists' perceptions of their empathy were negatively corre—
lated with judge ratings (initial, r =-=53; terminal,

r = .02). 5) Therapists' perceptions of their own empathy
were negatively correlated with the level of process the
patient was engaged in (initial, r = —.47; terminal,

r = -.37). 6) Patient perceptions of therapist empathy
tended teremain stable over therapy. 7) The process

level exhibited by patients was positively related with

12

many measures of outcome, although patients did not move
on the process dimension as a group to greater experienc-
ing. 8) The patients receiving the highest level of ac-
curate empathy (tape ratings) in their relationships,
showed the greatest reduction in schizophrenic tendencies
as measured by the MMPI.

Truax and Carkhuff (1967) reported a series of
studies which were designed to investigate the relation-
ship between therapist empathy and therapy outcome.
Therapist empathy was measured by the Accurate Empathy
Scale (Truax, 1961). In one of the first studies, Truax
(1961) compared the levels of accurate empathy, after six
months of psychotherapy, for four hospitalized patients
who showed a considerable improvement on a variety of per-
sonality scales, with four who showed personality deter-
ioration. A total of 384 two-minute segments from the
middle third of the therapy sessions, were randomly
assigned to raters who made judgments using the Accurate
Empathy Scale. He found that those therapists whose
clients improved on the personality scale were rated con-
sistently higher on Accurate Empathy than those therapists

whose clients had deteriorated.

13

I

This finding relating therapist empathy to therapy
outcome was extended and refined in a study using 14
schizoPhrenic patients who had been in intensive psycho-
therapy from six months to four and one half years (Truax,
1963). Five naive undergraduates having no knowledge of
the clients, therapists, or therapy cases were the raters
for the study. A four-minute tape segment from every
fifth interview was selected for rating. .The correlation
between the mean level of Accurate Empathy in each case
and a composite outcome score for each client was r = .77.
A correlation between Accurate Empathy and a second out-
come criterion, consisting of blind ratings of degree of
personality change based upon the Rorschach and MMPI, was
r = .48. Both of these correlations were significant.

After having shown a positive relationship between
therapist empathy and outcome with a sampling of psychotic
patients, Truax (1963) sought to extend his research to
an outpatient population by the use of an additional 14
cases (seven successful and seven unsuccessful). Scoring
tape segments from the beginning and end of therapy with
the 14 hospitalized and 14 outpatient cases, he found that
the level of Accurate Empathy was significantly higher for

successful cases than for the failures, for both populations.

14

Table 1 presents a summary of the studies comparing
the Accurate Empathy Scale to therapy outcome. Many of the
studies support the notion of a relationship between ther-

apist empathy and therapy outcome.

Negative'Results

Not all research has shown a positive relationship
between therapist empathy and outcomes. Lesser (1958)
investigated the relationship between counseling progress
and empathic understanding. The therapist's empathic
understanding was measured by means of the Empathic Under-
standing Scale, a 12 statement scale derived from Fied-
ler's (1950) statements of therapeutic relationships.

This scale was administered to both therapist and client.
In addition, the investigator had the therapists predict
'what the clients' initial q sorts would be as a measure
of the counselor's ability to predict his client's self-
concept.

Differences between pre- and post-Q sorts were
used as an index of change. Lesser found no significant

relationship between empathy as measured by the Empathic

15

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16

Understanding Scale and the counselor's prediction of his
client's Q sort and neither measure correlated with out—
come.

Katz (1962) investigated the relationship between
two different measures of empathy and client change in
short term counseling. Using 21 high school students and
their 21 counselors-in-training as subjects, Katz took
measures of predictive and behavioral empathy. Predictive
empathy was measured by the counselor's ability to predict
how his client would arrange the self-concept Q sort.
Behavioral empathy was measured by independent judges'
ratings of the counselor's behavior within the interview
on the Rating Scale of Empathic Behavior.

Two measures of client change were used. The
first was the difference in the scores on the self-concept
Q sort taken by the client before and after counseling.
The second measure was the difference in the scores at
the beginning and end of therapy on the Rating Scale of
Counselor Behavior which independent judges rated. All
clients had at least six interviews. However, Katz found
no relationship between either predictive or behavioral

empathy and outcome.

l7

Gonyea (1963) studied the relationship between the
quality of therapeutic relationship provided by eight
counseling interns and counseling outcome. The counseling
supervisors were asked to sort statements (Q sort) de—
scribing the therapeutic relationship established by each
of the supervisees. The q sorts were then correlated with
Fiedler's (1950) descriptions of experienced therapists to
provide a measure of therapeutic relationships offered by
each counselor.

As a measure of outcome, the Gregg and Kelly Self-
Description Form, a measure of improvement, was used. The
208 clients seen by the eight interns in the study took
the measure before and after counseling. These outcomes
were correlated with the supervisor's ratings of the coun-
selors.

No significant relationships were found between the
ratings of the counselors and counselor outcome. One as-
pect of the study worth adding is that it was not pos-
sible to isolate the counselor empathy variable from other
partsansinfluencing the supervisors' ratings. For example,
Fiedler's statements, while containing references to
counselor's empathic understanding, includes statements

of other variables as well.

18

The literature relating therapist empathy to
therapy process and outcome, therefore, has been mixed.
There are, of course, many differences among the various
studies: population, treatment modalities, empathy in-
struments, outcome and process measures, etc. However,
two issues have compicated the research investigating
the relationship of therapist empathy to counseling and
psychotherapy. The first of these is a methodological
issue, the problem of construct validity of the empathy
measures. The second is a theoretical issue, that of
whether the client's perception of his therapist's em-
pathy or the level of therapist empathy as determined by
an independent judge, is the more crucial measure of
empathy in terms of the relationship to therapy process

and outcome.

Construct Validity

 

Investigators have used four general approaches
in operationalizing and studying therapist empathy:
situational, predictive, tape-judged and client-perceived.

'The situational approach (Astin, 1957) involves presenting

19

subjects with some standardized situation to which the
subjects are to respond empathically. The predictive
approach asks one to make predictions about another's
behavior. The judge may know the subject or is given
data about him. The judge is then asked to make predic-
tions of the subject's performance on test items or his
responses to personality inventories (Astin, 1957). In
the tape-judged approach, trained judges either listen to
or observe interactions between people. On the basis of
some defined criteria, the judges rate the amount of em-
pathy displayed by the subject being rated. Finally, the
client-perceived approach consists of having the client
rate how empathic he perceived his counselor had been
during the previous interview. This is typically done
by the use of a questionnaire, however, post-therapy
interviews or q sorts may also be used for this purpose.
Kurtz and Grummon (1972), two researchers inter-
ested in the problem of construct validity of the empathy
measures, used six different measures of therapist empathy
which corresponded to the four general approaches to
lneasuring empathy, previously discussed. As a measure of
therapy process the Carkhuff Self Exploration in Inter-

personal Processes scale (1967) was used. For their

20

outcome measures, the following were used: Number of
Deviant Signs and Total Positive of the Tennessee Self
Concept Scale (Fitts, 1965), changes in the clinical
judgments of improvement over therapy based upon MMPI
profiles, client and counselor judgments of the client's
progress, and a composite outcome measure based upon the
above five measures.

The subjects of the study consisted of 31 clients
and their counselors where the experience of the coun-
selors ranged from one year of doing therapy to over
twenty years of experience. The therapy ranged from 4
to 27 one-hour interviews, with a mean of 12 interviews.

Kurtz and Grummon found that the only significant
intercorrelation among the empathy measures was between
the client-perceived empathy after the third and after
the final therapy interviews. A positive relationship
between tape-judged empathy and client-perceived empathy
taken after the third interview approaches significance.
With regard to the relationship between empathy and
therapy process, only tape-judged empathy was signifi-
cantly related to the client's Depth of Self Exploration.
Finally, Kurtz and Grummon generally found non-significant

correlations between the empathy measures and outcome.

21

An exception to this was that client-perceived empathy
after the third interview showed strongenuimostly signif-
icant relationships with outcome measures. The correla-
tions between tape-judged empathy and outcome were all
positive, but only one of these six correlations was
statistically significant.

Therefore, the several different ways of con-
ceptualizing and measuring empathy failed to correlate
with each other, thus casting considerable doubt upon
the construct validity of all the operational measures
of empathy employed in previous research. The only rela-
tionship that would tend to support construct validity
would be that between client-perceived and tape-judged
empathy measures. As mentioned, the Rogers et a1. (1967)
study with hospitalized schizophrenics found a positive
relationship between client-perceived and tape-rated
empathy.

However, the issue is not clear, as somewhat dif-
ferent results were obtained in a study by Burstein and
Carkhuff (1968). Their results indicated that among
moderate to low functioning therapists, there were no
positive relationships between objective ratings and

client-perceived ratings of empathy. It is debatable

22

as to how much consideration should be given to this
study as they only sampled moderate to low functioning
therapists.

In the Kurtz and Grummon (1972) study, a rela-
tionship approaching significance was found between tape-
judged empathy and client-perceived empathy after the
third interview. These researchers felt that a sampling
error may have been committed which may have some bearing
on the results. In their study, the rater scored seg-
ments of the first or second interviews, as well as seg-
ments of the next-to-last interview for tape-judged
empathy. The mean of these two ratings was used as a
measure of tape-judged empathy for all therapy inter-
views. The possibility exists therefore, that if more
tapes were sampled of the middle therapy interviews,
this might have bearing on the relationship between
tape-judged and client-perceived empathy and thus on the
construct validity of these two measures. Thus, one part
of the present study involved making additional ratings
of the therapy interviews to obtain an overall measure
of tape-judged empathy which has a better sampling, in
order that its relationship to client-perceived empathy

be re-examined.

23

Additional studies (Hanson, Moore and Carkhuff,
1968; Truax, 1966) were also concerned with the relation-
ship between client perceived and tape-rated empathy mea-
sures and,therefore, have a bearing on the issue of con-
struct validity. One study (Hanson, Moore, and Carkhuff,
1968) was designed to compare correlations of the raters'
judgments with clients' perceptions, as related to change
in self concept. The client population was composed of
students in the eighth to twelfth grades who had behav-
ioral problems. The counselors were all school counselors
who had completed an intensive course in multiple coun—
seling. Client perceptions were obtained by administer-
ing the Barrett-Lennard Relationship Inventory to the
clients. Tape-judged therapist conditions were obtained
by having Truax-trained raters score four-minute tape
segments for Accurate Empathy, Unconditional Positive
Regard, and Genuineness. No significant correlations
existed between any of the client's ratings and the
judge's ratings of the counselor-offered therapeutic con—
ditions. Further, the judge's ratings of each variable
was positively related to client changes in self-concept

while the clients' ratings were not.

24

An additional study related to this issue was
done by Truax (1966). The predictive value for outcome
of measures of Accurate Empathy, Nonpossessive Warmth,
and Genuineness taken from tape recordings of therapy,
were compared with measures taken from patient percep-
tions. Three approaches to tape ratings were used:
therapist-patient-therapist (TPT) samples, patient-
therapist-patient (PTP) samples and group time samples.
In order to measure patient perceptions, the Barrett-
.Lennard Relationship Inventory was administered to the
clients after the twelfth group session. Half the
groups were composed of hospitalized psychiatric in-
patients, while the rest of the groups were composed of
institutionalized juvenile delinquents. Each group met
twice a week.

The results indicated that for all three therapist-
offered conditions, the TPT, PTP, and group time sampling
procedures tended to be sampling the same aspect of
psychotherapy, while the Relationship Inventory appeared
to be measuring some different aspect of the therapy pro-
cess. Further, the three sample procedures yielded
approximately equivalent predictive power (average r

with patient outcome for all three conditions of AE,

25

UPR, and Gen. of .40, .37, and .42, respectively). The
Relationship Inventory tended to be less predictive of
outcome (average r = .25).

One of the difficulties in all these studies is
the confounding of variables. When the two measures of
empathy have been compared, they have differed in two
ways simultaneously--(l) the measuring instrument (e.g.
the Carkhuff Empathic Understanding in Interpersonal Pro-
cesses Scale and the Relationship Inventory), and (2) the
person doing the rating (the client or an impartial judge).

This study then eliminated the confounding of the
variables and thus the issue of construct validity was
examined without this influence. Therefore, therapy in-
terviews were scored by independent judges using the
Relationship Inventory. These empathy ratings were com-
pared to the client-perceived Relationship Inventory and

tape-judged Carkhuff empathy ratings.

Theoretical Issue

 

The confounding of variables also has some bearing

on a theoretical dispute between the positions of Rogers

26

and Barrett-Lennard vs. Truax and Carkhuff. According to
Rogers (1957, 1959) and Barrett-Lennard (1962), in order
for therapy to progress, the client must perceive the
therapist's empathy. The Truax and Carkhuff (1967) posi-
tion, in effect, states that the actual amount of thera-
pist empathy influences the outcome, even though the
client may not be sufficiently aware to perceive it. They
further doubt that clients,particularly disturbed clients
such as hospitalized psychotics, are good judges of ther-
apist empathy.

The research which has come from Truax and Cark—
huff (1967) has attempted to demonstrate that the client-
perceived measure is not as effective as the tape-rated
measure in predicting outcome. Their emphasis, there-
fore, has been primarily on the differences in the two
measures. Rogers (1957, 1959), in his work, has been
more concerned with the idea that the client must per-
ceive the empathy, regardless of the instrument used to
measure therapist empathy.

The fact that the two variables are confounded
makes it difficult to draw any conclusions with respect
to whether or not the client must perceive empathy. What

this research attempted to do then was to try to eliminate

27

the confounding so that the Rogers and Barrett-Lennard
positions could be compared with the Truax and Carkhuff

position.

Statement of the Problem

 

This research, a follow-up to the Kurtz and
Grummon (1972) study, investigates two issues: 1) a
methodological one--construct validity of two empathy
measures and 2) a theoretical dispute between the posi-
tions of Truax and Carkhuff (1967) and Rogers (1957,
1959) as to whether or not clients must perceive their
therapist's empathy in order for therapy to be successful.

The construct validity issue was looked at in two
different ways. First unlike the Kurtz and Grummon (1972)
study, a more complete sampling of the therapy tapes was
rated on the Carkhuff empathy scale (a tape-judged mea-
sure). These ratings were correlated with the client's
ratings made on the Relationship Inventory.

Second, it is felt that a correlation of the Cark-
huff empathy scale and the client-perceived Relationship

Inventory is confounded by two variables varying

28

simultaneously--l) by the different instruments used, and
2) by the person making the ratings--a client or an objec-
tive judge. To control for this, the Relationship In—
ventory, a client-perceived empathy measure, was used by
objective judges to make ratings on the therapy tapes.
These ratings were then correlated with those made on the
client-perceived Relationship Inventory and the tape-
judged Carkhuff empathy scale.

The other issue, the theoretical dispute, was also
investigated in light of the confounding of variables
operating in the two-empathy measures-—the client per-
ceived R.I. and the tape-judged Carkhuff scale. As in the
construct validity issue, the relationship between both
the tape-judges Carkhuff empathy scale and the client-
perceived Relationship Inventory were examined in relation
to the tape-judged Relationship Inventory. Further, both
the ratings made on the Carkhuff empathy scale and the
tape-judged RI were correlated with several empathy mea-

sures.

29

Research Questions

 

To summarize, this research attempts to answer the

following questions:

1)

2)

3)

4)

5)

Is there a relationship between the tape-rated
Relationship Inventory and the client—perceived
Relationship Inventory measures of therapist

empathy?

Is there a relationship between the tape-rated
Relationship Inventory and the tape-rated Carkhuff

empathy measures?

Is there a relationship between the tape-rated

Relationship Inventory and the outcome measures?

Is there a relationship between the tape-rated
Carkhuff and client-perceived Relationship Inven-

tory measures of therapist empathy?

Is there a relationship between the tape-rated

Carkhuff scale and the outcome measures?

30

6) Is there a relationship between the client-
perceived Relationship Inventory and the outcome

measures?

 

1This question was investigated by Kurtz and
Grummon (1972) but is reported here in order to present
the results in a consistent and systematic way. The
sample used in the present study is basically the same
one used by Kurtz and Grummon (1972) with the exception
of two or three clients.

Chapter II

METHOD

Data Collection

 

The data for this research were part of a larger
research project conducted at the Michigan State Univer-
sity Counseling Center during 1967 through 1969. All
therapy interviews were taped. In addition, there were
about four hours of pre- and post-therapy testing of the
clients and their counselors. Participation in this
research project was voluntary and neither the therapist
nor the client had access to the test data until after

completion of therapy.

Subjects

The 24 clients that provide the data for this
research consisted of eight undergraduate males and 16
undergraduate females who were self-referred for a var-
iety of personal and emotional problems. To be included

31

-132

in the overall research design clients had to present some
emotional problem (rather than vocational or educational)
that in the judgment of the intake interviewer would in-
volve several therapy sessions. The clients also had to
agree to donate their time for the testing.

In the research project, many clients were asked
to participate. However, several of them failed to com-
plete the in- and post—therapy testing after formerly
agreeing to do so. As the 24 clients in the present re-
search completed all of the testing, some bias may exist
in this sample. Impressionistically, however, the clients
included in this study appear no different from the usual
run of clients bringing personal-emotional problems to the
MSU Counseling Center.

About half of the 24 therapists in this study were
senior staff counselors at the Michigan State University
Counseling Center who held their Ph.D. in either clinical
or counseling psychology. The other half were second year
interns in either clinical or counseling psychology and
had at least one year of experience doing therapy before
participating in this study. The range of experience for
all therapists was one to twenty years. The therapists

tended to emphasize self-exploration, insight,

‘1‘" u M. 1

 

{IT-r. 'Ju_ :.

33

interpersonal personality theory, and a here and now
rather than a historical approach to treatment, although
the therapists did hold diverse theoretical orientations
within this general framework.

The number of therapy interviews ranged from three
to 27 with a mean number of 12.2 interviews per client.
In some cases where the end of the school year was draw-
ing near and the counselor would not be seeing the client
until the next fall, post-testing occurred prior to termi-

nation.

Description of Empathy Measures

 

Empathic Understanding in Interpersonal
Processes Scale

This scale (see Appendix B) was derived from the
Truax Accurate Empathy Scale (Truax and Carkhuff, 1967)
which was based on earlier work by Rogers. Carkhuff
(1969) employs a five—point rating scale of which the
following is illustrative: Level l—-the therapist's re-
sponses either do not attend to or detract from the ex-

pression of the client. Level 3--the therapist's responses

34

are essentially interchangeable with the client's in that
they express the same affect and meaning. Level 5--the
therapist's responses add significantly to the feeling

and meaning of the client such that they accurately ex-
press those feelings which the client himself is unable

to express, or, in the event of the client's ongoing self-
exploration, the therapist is fully with him in his deep-
est moments.

The Carkhuff scale was chosen instead of the Truax
Accurate Empathy Scale since it tends to get better reli-
ability. Further, the person who trained the one judge in
this study had himself been trained by Carkhuff.

Five tapes per client were chosen for rating in an
attempt to sample different segments of the therapy pro-
cess. The first, third, and next to last interviews were
rated except in one case where there was only three ses-
sions. In addition, two more tapes were selected to
sample the middle segments of the therapy process. For
each therapy interview three, three-minute segments
selected from the beginning, middle, and end of the tape
were rated.

The order in which the therapy tapes were rated

was randomized in two ways. First, the order of the

35

clients was randomized by a table of random numbers.
Then, one of the five tapes was randomly chosen, by the
same procedure for each client and the ratings of thera-
pist empathy made. This procedure was repeated four more
times with the same order or clients, until all the tapes
were rated.

In order to accurately make ratings on the Cark-
huff scales, the writer met with an expert rater for two
sessions. During this time, the two listened to three,
three-minute segments of therapy tapes and made their
judgments of the level of empathy. The expert rater, in
each instance, required the rater to give a rationale for
each rating based upon those definitions of the levels
of empathy established by Carkhuff. If there were no
discrepancies, the two would proceed to the next tape.
However, if the expert rater differed, he would explain
why he made the ratings and would illustrate this by re-
playing the segment of the tape pertaining to that rating.

The reliability computed after the training ses-
sions was r = .74 over 19 ratings. At the conclusion of
the study, the judge rerated those tapes originally used
to establish reliability. The correlation between the

judge's new ratings and the ratings originally made by

36

the other judge was r = .95 over 12 ratings. Another
method used to compare the judge's ratings to a standard
was to match the mean score of the first and next-to-last
Carkhuff tape ratings of the Kurtz and Grummon (1972)
study with the same scores of the present study. A cor-
relation of r = .51 for 24 ratings was found. A statis-
tical procedure was then used to determine if a correla-
tion of r = .51 for 24 ratings was from the same popula-
tion as the reliability r = .74, or whether these two
scores were from different populations (Walker and Lev,
1953). The two correlations were found to be from the

same population but nevertheless are both low.

Barrett-Lennard Relationship Inventory (RI)

To measure the client's perceptions of the thera-
pist‘s empathy, the Barrett-Lennard Relationship Inventory
(1962) was administered to the client after the third
interview and after the conclusion of therapy (see Ap-
pendix B). Only that part of the measure dealing with
empathic understanding was used in this study. This scale
consists of 16 statements such as: "He tries to see

things through my eyes," and "Sometimes he thinks a

37

certain way, because he feels that way." The client indi-
cates three levels of agreement or disagreement, with no
neutral position provided.

Barrett-Lennard reports a split-half reliability
on the Relationship Inventory of .86 for 42 clients. He
reports no test-retest reliability for clients because
the therapist-client relationship can be expected to vary
from interview to interview. However, he did report a
test-retest value of .89 on 45 college students describing

their friendship relationships.

Relationship Inventory--Tape Rated

In this approach, an independent judge listened to
the tapes and made a judgment of the therapist's empathy
on the Barrett-Lennard Relationship Inventory items. The
Barrett-Lennard items were slightly modified from the ori-
ginal as noted in the parentheses as: "He (the thera-
pist) tries to see things through my (the client's) eyes,"
and "Sometimes he (the therapist) thinks that I (the
client) feel (feels) a certain way because he (the thera-

pist) feels that way."

38

The same interviews used to make the tape-rated
Carkhuff scale ratings also provided the raw data source
for the Relationship Inventory tape judged ratings and a
similar procedure was used for randomizing the order of
the ratings. The actual therapeutic interactions rated
within these interviews differed, however, in that instead
of three three-minute segments, the R.I. tape-ratings
were made on one 10-minute segment of the interview. This
was done because pilot studies on these ratings suggested
that in order to be able to score 16 statements pertaining
to the therapist's empathy more information was needed
than merely a three-minute segment. A ten—minute section
of each of the interviews was randomly selected for rat-
ings except that the judge was instructed to vary her
selections between the first, middle, and last thirds of
the interview in a non-systematic way.

Two different judges were used in making the em-
pathy ratings, one for Carkhuff empathy scale (the writer)
and a second judge for the tape-judged Relationship In-
ventory so as to control for bias which might have oc-
curred had the same judge scored both empathy scales. In
order to begin to establish reliability on the tape—

judged R.I., these two judges met together for about five

39

training sessions. During these sessions, they listened
to therapy tapes together, then each made ratings and the
two discussed their differences. As a basis for making
ratings, Barrett-Lennard's definition of therapist empathy
was used.

Two judges established reliability of r = .99
using tape material not connected with the present study.
However, this correlation is inflated because there was
some discussion between the judges during the time they
were establishing reliability. A post-study check on
reliability was then made where a sample of the tapes
rated in the study was re-rated by the writer. When these
were correlated with those ratings made by the R.I. judge,
the reliability was r = .63. The interrater reliability

of r = .63 is pro-ably the more accurate measure.

Computation of the Empathy Scores

To obtain a therapist empathy score on the Cark-
huff Scale which would reflect the whole therapy process
for each client, a mean score was derived. Three, three-

minute tape segments of five tapes were rated for each

4O

client and the ratings of the fifteen tape segments were
then added together and divided by fifteen. This proce-
dure was done for each of the clients with the necessary
adjustments made if all five tapes were not scored for

a particular client.

Computation of the client-perceived empathy scores
followed directly from the scoring system of Barrett-
Lennard and is therefore straightforward. The procedure
used to derive the tape-judged RI was similar with some
additions. After following the Barrett-Lennard method
and obtaining a measure of empathy for each tape segment
rated, a mean of these rating scores was derived. Since
there were five tapes per client, and one 10-minute seg-
ment rated from each tape, the five scores were added
together and divided by five. It was found that for both
R.I. scores, it was necessary for purposes of eliminating
negative numbers, to add a constant to each score. This

0

is noted in Tables 4, 5, and 6.

41

Description of the Outcome Measures

 

Tennessee Self Concept Scale

The Tennessee Self Concept Scale (Fitts, 1965)
provided two measures of client change:' "the Number of
Deviant Signs" (NDS) score and the "Total Positive" (P)
score. Ashcraft and Fitts (1964) demonstrated the scale's
sensitivity to changes in the client resulting from
therapy. According to Fitts, the Total Positive score,
which reflects the client's self-esteem, is the more im-
portant score derived from the test. The other measure,
the Number of Deviant Signs is a measure derived from the
deviance features of the other sub-scales. Fitts has
stated that, "this score alone identifies deviant indi-
viduals with about 80% accuracy. The NDS is the best
index of psychological disturbance." The outcome measure
used for both of these scores was the difference between

pre- and post-therapy scores.

Reliability

Reliability based upon test-retest with college

students over a two-week period was r = .92 for the "P"

42

score, and r = .90 for the NDS score. Fitts reports a
correlation of r = -.68 between the "P" score and the NDS

score.

Validity

Ashcraft and Fitts (1964) compared changes on the
TSCS between 30 patients who had been in therapy for an
average of six months and a no~therapy control group
(N = 24) who had been waiting for therapy for an average
of 6.7 months. Using a test-retest procedure, the therapy
group changed significantly in the expected direction on
18 of the 22 variables (including the P score and NDS
scores) while the control group changed on only two of
the variables. This suggests that this instrument is
able to detect changes on the different scales as a result

of psychotherapy.

Clinical Judgments of the MMPI

Another outcome measure involved clinical judg-
ments based upon the Minnesota Multiphasic Personality

Index. Three judges who had a great deal of experience

43

with the MMPI compared pre- and post-therapy MMPI pro-
files for each client who had completed the post-test.
Each pair of profiles was rated on a five-point scale for
client changes as follows: 5...satisfactory, 4...par-
tially satisfactory, 3...no change, 2...partially unsatis—
factory, l...unsatisfactory.
Kurtz reported intra-judge reliability which in-

volved having each profile rated twice, one week apart.

The intra-judge reliability index of the three judges was:

r = .68. The reliability of average ratings was r = .81.
The reliability of inter-judge ratings was r = .74 and the
reliability of average ratings between judges was r = .90.

Therapist Ratings of Therapy Outcome

At the conclusion of therapy, each therapist com—
pleted a five-point scale which attempted to assess his
client's progress as follows: 4...successful, 3...par-
tially successful, 2...partially unsuccessful, l...un-

successful.

44

Client Ratings of Therapy Outcome

Also after termination, the client made a judgment
as to how helpful the therapeutic experience had been to
him. This was based on a seven-point scale such that:
l...extremely harmful, 2...harmed meaaihyt,3...harmed me
somewhat, 4...indifferent, 5...he1ped me somewhat,

6...helped me quite a lot, 7...extreme1y helpful.

Composite Outcome

Finally a composite outcome was used. This was
derived by converting all five measures to standard (t)
scores and dividing by five. In this way, each outcome
measure had an equal weight in determining the composite

score 0

Chapter III

RESULTS

In this section, the experimental questions have
been restated. This is followed by an analysis of the

results and conclusions.

1) Is there a relationship between the tape-rated
Relationship Inventory and the client-perceived

Relationship Inventory?

The correlation of r = .46 (p < .05) between the
tape-rated Relationship Inventory and the client-perceived
Relationship Inventory, after the third interview was
found. The corresponding correlation of r = .42 (p < .05)
was found with the client-perceived Relationship Inventory
at post-therapy testing. Thus, the client and an inde-
pendent observer agree about therapist empathy when they

record their judgments on the same instrument.

2) Is there a relationship between the tape-rated
Relationship Inventory and the tape-rated Cark-

huff scale?

45

46

These two measures of therapist empathy correlate
r = .11 which is nonsignificant. Therefore, independent
observers do not agree on the amount of therapist empathy
when they record their judgments on different instruments.

Construct validity has not been established.

3) Is there a relationship between the tape-rated

Relationship Inventory and the outcome measure?

Table 2 shows that none of the correlations be-
tween therapist empathy as measured by the tape-rated
Relationship Inventory and the several outcome measures

were significant.

4) Is there a relationship between the tape-rated
Carkhuff scale and the client-perceived Relation-

ship Inventory?

The correlation of r = -.04 between the tape-rated
Carkhuff scale and the client-perceived Relationship In-
ventory after the third interviews was nonsignificant.

The corresponding correlation of r = -.13 with the Rela-
tionship Inventory at post-therapy testing was also non-
significant. Thus even with a larger sampling of tapes

scored on the Carkhuff empathy scale, no relationship has

47

been found to exist between that measure and the client-

perceived Relationship Inventory.

5) Is there a relationship between the tape-rated

Carkhuff scale and the outcome measures?

Table 2 shows that none of the correlations be-
tween the tape-judged Carkhuff scale and the several out-

come measures were significant.

6) Is there a relationship between the client-
perceived Relationship Inventory and the outcome

measures?

The results, summarized in Table 2, indicate that
of the six measures of outcome, three of them were posi-
tively correlated (p < .01) with the empathy scores from
the client-perceived Relationship Inventory administered
after the third therapy interview. In addition, a corre-
lation approaching significance was found between the
Total Positive scale of the Tennessee Self-Concept Scale
and the client-perceived Relationship Inventory.

Similar results were obtained between the outcome
measures and the ratings obtained by the client-perceived

empathy measure when administered after the conclusion of

48

therapy. The same three outcome measures were positively
correlated with this measure of therapist empathy (p < .01).
In addition, a correlation approaching significance was
found between the empathy scale and the client's judgment

of therapy outcome measure.

49

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Chapter IV

DISCUSSION

In their discussion of construct validity, Cron-
bach and Meehl (1955) pointed out that when two tests are
purported to measure the same construct, a correlation
between them is expected. However, if no correlation is
obtained, one can only speculate as to whether the error
lies in one test, or the other, or in the formulation of
the construct.

In the study by Kurtz and Grummon (1972) they
generally found no evidence in support of construct val-
idity. The possible exception they noted might be a rela—
tionship between the Carkhuff empathy scale (the tape-
judged measure) and the Barrett-Lennard Relationship In-
ventory (the client-perceived measure). However, the
research comparing the empathy scales of these two ap-
proaches has been mixed. In the Wisconsin project with
hospitalized schizophrenics, Rogers et a1. (1967) found
there was a relationship between the client-perceived
Relationship Inventory and the tape-judged Truax Accurate

50

51

Empathy Scale. Kurtz and Grummon (1972) found a positive
correlation approaching significance between the Relation-
ship Inventory and Carkhuff empathy scales.

On the other hand, some researchers using either
the Truax Accurate Empathy scale or the Carkhuff empathy
scale (Burstein and Carkhuff, 1968; Hansen, Moore and
Carkhuff, 1968; Truax, 1966) have found no relationship
between the tape-judged and client-perceived approaches.
It is difficult to know how to interpret these conflicting
findings.

In the present study, the relationship between the
client-perceived Relationship Inventory and the tape-
judged Carkhuff empathy scale was considered in terms of
the construct validity issue. One part of the study was
concerned with correcting a possible sampling error com-
mitted by Kurtz and Grummon (1972). In their research
the empathy score for each client was determined by the
mean of the ratings of the first and next-to-last inter-
views. In that way, none of the tapes were sampled from
the middle of the therapy process. However it was found
that with the addition of more data, there was a lower
correlation between the Carkhuff empathy scale rated by

judges and the client-perceived Relationship Inventory,

52

than in the Kurtz and Grummon study. On the basis of the
present research, there does not seem to be any evidence
in support of construct validity for the measures studied.
Another way in which the relationship between the
client-perceived Relationship Inventory and the tape-
judged Carkhuff scale was examined was by conflrolling for
confounding of variables. In this study the Relationship
Inventory, though usually a client-perceived measure, was
scored by an objective judge who rated the therapist's
empathy. The correlation between the tape-judged Rela-
tionship Inventory and the client-perceived Relationship
Inventory was significant. Thus the findings show that
both the client and an independent judge are in fair agree-
ment about the amount of therapist empathy offered when
they both employ the same instrument to record their judg-
ments. This is true whether one compares the judge's
average ratings over therapy with the client's ratings
after the third interview or at the end of therapy. It
must, of course, be kept in mind that with the low corre-
lations found between these two instruments, much of the
variance is unaccounted for. However, Rogers et a1.
(1967) reported an unpublished study by Van der Veen with

similar results, but no details of the study are available.

53

The relationship between the tape-judged Relation-
ship Inventory and the tape-judged Carkhuff scale was also
examined. In this case the same type of rater, i.e. ob-
jective judges, made ratings on two different empathy
scales. No relationship between these two measures was
found.

At this juncture, it is appropriate to draw to—
gether all the findings of this study relating to con-
struct validity. The results indicated that by control-
ling for confounding of variables, when two types of
judges made ratings on the same scale, they were in agree-
ment. However, when the same type of rater, i.e., two
objective judges, made ratings on two different empathy
scales, they did not agree. Finally when more data were
included in the Carkhuff empathy scores and it was corre-
lated with the client-perceived Relationship Inventory,
no relationship was found. All of this demonstrates that
there is no support of construct validity for these two
measures. When these results are considered along with
those of Kurtz and Grummon (1972), the evidence is even
stronger that the operational measures of therapist empathy

lack construct validity.

 

54

Future research should re-examine the whole con-
cept of therapist empathy in order to determine whether
this concept is either too broad or is perhaps so embedded
in other concepts that, by itself, it cannot be measured.
In a discussion of the results of the Wisconsin project,
Keisler, Mathieu, and Klein (Rogers, et a1., 1967) had
some interesting insights on the problem of construct
validity. They proposed that the Truax Accurate Empathy
scale may be tapping a more global quality which they
perceive as the therapist‘s communicated commitment to
the therapy interaction and involvement in the problems
of a specific patient in the interaction. Although their
comments were directed to this one scale, perhaps they
could be applied more generally to other empathy measures.

Before considering the rest of this research, some
statement about the inter-rater reliabilities is neces-
sary. The reliabilities obtained on both the tape-judged
Relationship Inventory and the tape-judged Carkhuff Empathy
scale were low. The results and conclusions of this study
must therefore be evaluated in light of this.

Another part of this study was concerned with a
theoretical dispute between Rogers and Barrett-Lennard

vs. Truax and Carkhuff. Rogers (1957, 1959) believes

55

that in order for change to occur in therapy the client
must perceive the therapist empathy. The Truax and Cark-
huff (1967) position is that the therapist-offered em-
pathy, whether perceived by the client or not, is what
helps to determine success in therapy. Therefore the
Truax and Carkhuff position is concerned with how well
the instrument can predict outcome without regard to who
is making the ratings.

To recapitulate the results of this study, a sig-
nificant positive relationship was found between the tape-
judged and client-perceived Relationship Inventory mea-
sures of therapist empathy. No relationship was found
between the tape-judged Relationship Inventory and the
tape-judged Carkhuff scale. Further, a significant posi-
tive relationship was found between the client-perceived
Relationship Inventory measured either after the third
therapy interview or at the conclusion of therapy, and
three of the outcome measures. Finally, no relationship
was found between either the tape-judged Relationship
Inventory or tape-judged Carkhuff empathy scale with any
of the outcome measures.

The fact that the two tape-judged instruments

were unrelated and that neither of these instruments was

56

significantly related to outcome, contradicts the Truax
and Carkhuff position. Although previous research (Kurtz
and Grummon, 1972; Carkhuff, 1969; Hansen, Moore, and
Carkhuff, 1968) found that the Carkhuff empathy scale was
correlated with some outcome measures, this study found
no such evidence. The earlier study by Kurtz and Grummon
(1972) used a smaller sample which may have accounted for
their findings. However, the low inter-rater reliability
on the Carkhuff empathy, in the present study, may have
some bearing on why no relationship was found between this
scale and outcome.

The results of this study indicate some support
for the Rogerian position. This study demonstrated a
relationship between the client—perceived empathy scale
taken at two different points in therapy with three of the
outcome measures. Using the same data, the Relationship
Inventory, when scored by an objective judge, was unre-
lated to any of the outcome measures. This suggests,
then, that clients must experience the therapist's empathy

in order for therapy to be successful.

Chapter V

SUMMARY

This study examined three measures of therapist
empathy to (1) determine their construct validity and
(2) provide additional information about the theoretical
dispute between Rogers and Truax and Carkhuff regarding
the necessity that the client actually perceive the ther-
apist's empathy if therapy is to be successful.

Two of the therapist empathy measures required
judges to rate tape-recorded interviews with (l) the
Carkhuff Empathic Understanding in Interpersonal Pro-
cesses Scale and (2) the Barrett-Lennard Relationship
Inventory. The latter instrument was also used by the
client to record his therapist's empathy. A previous
study by Kurtz and Grummon (1972) failed to establish
construct validity for several therapist empathy measures
but could not determine if this was due to the empathy
instrument or to the different persons making the rat-
ings--i.e. an objective judge or the client. The present
study corrected this deficiency. It also examined the

57

58

relationship between therapy outcome and the same measure
of therapist empathy as recorded by the client and an
objective judge, thereby adding to our knowledge about
the theoretical dispute between Rogers and Truax and
Carkhuff.

Twenty-four clients and their therapists at the
Michigan State University Counseling Center served as the
sample for this study. All the therapist empathy measures
were correlated with each other and with six different
measures of therapy outcome.

Clients completed the Relationship Inventory after
the third therapy interview and again after the conclu-
sion of therapy. One judge rated three tape—recorded
segments of five different therapy interviews for each
client to determine the therapist's level of empathy on
the Carkhuff scale. Another judge made ratings on the
same five therapy interviews to obtain the therapist's
empathy score on the Relationship Inventory. The relia-
bilities for the tape-judged Relationship Inventory and‘
Carkhuff empathy scale were low.

Therapeutic outcome was assessed by: 1) changes
in the Number of Deviant Signs score of the Tennessee

Self Concept Scale, 2) changes in the Total Positive score

59

of the Tennessee Self Concept Scale, 3) changes in the
clinical judgments of improvement over therapy based upon
MMPI profiles, 4) a four-point scale upon which the ther-
apists made judgments as to the clients' progress in
therapy, 5) a seven-point scale upon which clients re-
corded their judgments as to how helpful therapy had been
to them, and 6) a composite outcome score obtained by
converting the above measures into standard scores.

The results comparing the empathy scales show
that: 1) there is no relationship between the tape-judged
Carkhuff empathy scale and the client-perceived Relation-
ship Inventory, 2) there is no relation between the tape-
judged Relationship Inventory and the tape-judged Carkhuff
scale, and 3) there is a positive relation between the
client-perceived Relationship Inventory and the tape-
judged Relationship Inventory. The results comparing
the empathy scales to the outcome measures show that:

1) there is no relation between either the tape-judged
Relationship Inventory or the tape-judged Carkhuff scale
with any of the six outcome measures, and 2) there is a
positive relation between three of the outcome measures

and the client-perceived Relationship Inventory.

60

The first three findings comparing the empathy
scales to each other found no support for construct val-
idity of therapist empathy. Further, the findings overall
tended to support the Rogerian rather than Truax-Carkhuff
position that the client must perceive the therapist's
empathy. The relation of these findings to the findings
of previous research was discussed. A possible explana-
tion was offered for the: 1) random relationship found
between the tape-judged Carkhuff empathy scale with both
the tape-judged and client-perceived Relationship Inven-
tories, and 2) the random relationship found between both
the Carkhuff scale and the tape-judged Relationship Inven-
tory with the many outcome measures. Implications for
future research regarding the therapist empathy concept

were discussed.

REFERENCES

REFERENCES

Adler, A. The science of living, New York: Greenberg
Publishers, 1929.

 

Ashcraft, C. & Fitts, W. W.2 Self concept change in psy-
chotherapy. Psychotherapy, 1964, 1, 115-118.

 

Astin, H. A comparative study of the situational and
predictive approaches to the measurement of
empathy. Unpublished doctoral dissertation,
University of Maryland, 1957.

Barrett-Lennard, G. T. Dimensions of therapist response
as causal factors in therapeutic change. Psycho-
logical Monographs, 1962, Z§_(43 Whole No. 562).

Buchheimer, A. The development of ideas about empathy.
Journal of Counseling Psychology, 1963,_19, 61-70.

Burstein, J. W. & Carkhuff, R. R. Objective therapist and
client ratings of therapist offered facilitative
conditions of moderate to low functioning thera-
pists. Journal of Clinical Psychology, 1968, 24!
240-249.

 

Carkhuff, R. R. Helping and human relations, Vol. 11,
Practice and research. New York: Holt, Rinehart
and Winston, 1969.

 

Cartwright, R. D. & Lerner, B. Empathy, need to change,
and improvement with psychotherapy. Journal of
Consulting Psychology, 1963, 22, 138—144.

 

 

Cronbach, L. J. & Meehl, P. E. Construct validity in
psychological tests. Psychological Bulletin,
1955, 52, 281-302.

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62

Dickenson, W. & Truax, C. B. Group counseling with under-
achievers. Personnel and Guidance Journal, 1966,
45, 243-247.

Dombrow, R. A. A study of the relationship between ther-
apist's empathy for patients and changes in
patient's self concepts during therapy. Disser-
tation Abstracts, 1966, 21 (l-B), 301-302.

Dymond, R. F. A preliminary investigation of the relation
of insight and empathy. Journal of Consulting
Psychology, 1948, 12, 228-223.

 

 

Dymond, R. F. A scale for the measurement of empathic
ability. Journal of Consulting Psychology: 1949,
‘13, 127-133.

 

Fenichel, O. The psychoanalytic theory of neurosis. New
York: W. W. Norton, 1945.

 

Fiedler, F. C. A comparison of therapeutic relationships
in psychoanalytic, nondirective, and Adlerian
therapy. Journal of Consulting Psychology, 1950,
14, 436-445.

Fitts, W. W. Tennessee self concept scale: Manual.
Nashville: Counselor Recordings and Tests, 1965.

 

Fromm-Reichmann, F. Principles ofzintensive psychotherapy.
Chicago: University of Chicago Press, 1950.

 

Gendlin, E. T. Experiencing and the creation of meaning.
New York: Free Press of Glencoe, 1962.

 

Gonyea, G. G. The "ideal therapeutic relationship" and
counseling outcome. Journal of Clinical Psychology,
1963, 19, 481-487.

 

Hansen, J. C., Moore, G. D. & Carkhuff, R. R. The differ-
ential relationship of objective and client per-
ceptions of counseling. Journal of Clinical
Psychology, 1968, 24, 244-246.

 

 

63

Hountras, P. & Anderson, D. Counselor conditions for
self-exploration of college students. Personnel
and Guidance Journal, 1969, 38(1), 45-48.

 

 

Katz, B. Predictive and behavioral empathy and client
change in short-term counseling. UnpUblished
doctoral dissertation, New York University, 1962.

Kurtz, R. R. & Grummon, D. L. Different approaches to
the measurement of therapist empathy and their

 

 

relationship to therapy outcomes. Journal of
Cossultinq and Clinical Psychology, 1972, 12,
106-115.

Lesser, W. M. The relationship between counseling pro—
gress and empathic understanding. Journal of
Counseling Psychology, 1969, 8, 330-336.

 

 

Rogers, C. R. The necessary and sufficient conditions of
therapeutic personality change. Journal of Con-
sulting Psychology, 1957, 2;, 95-103.

 

 

Rogers, C. R. A theory of therapy, personality, and
interpersonal relationships, as developed in the
client centered framework. In S. Koch (Ed.),
Psychology: a study of a science. Vol. III.
Formulations of the person and the social context.
New York: McGraw-Hill, 1959, 184-258.

 

Rogers, C. R. (Ed.) The therapeutic relationship and its
impact: a study of psychotherapy with schizo-
phrenics. Madison: University of Wisconsin
Press, 1967:

 

 

Smith, H. C. Sensitivity to people. New York: McGraw-
Hill, 1966.

 

Speroff, B. J. Empathy and role reversal as factors in
industrial harmony. Journal of Social Psychology,

 

1953, 31, 117-120.

Sullivan, H. S. The interpersonal theory_of psychiatry.
New York: W. W. Norton, 1945.

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Truax, C. B. Therapist empathy, warmth and genuineness,
and patient personality change in group psycho-
therapy: A comparison between Interaction unit
measures, time sample measures, patient percep-
tion measures. Journal of Clinical Psychology,
1966, 22! 225-229.

 

Truax, C. B., Wargo, D. C., and Silber, L. D. Effects of
group psychotherapy with high accurate empathy
and non-possessive warmth upon female institu-
tionalized delinquents. Journal of Abnormal
Psychology, 1966, 71, 267-274.

 

 

Truax, C. B. & Carkhuff, R. R. Toward effective coun-
seling and psychotherapy. Chicago: Aldine, 1967.

 

Walker, H. W. and Lev, J. Statistical inference. New
York: Herry Hold, 1953.

 

APPENDICES

APPENDIX A

NUMBER OF INTERVIEWS PER CLIENT

TABLE 3.--Number of interviews per client.

 

g

 

 

Client Counselor Number of
Number Number Interviews*
832 02 3I
848 43 12M
812 12 12M
801 05 24M
834 35 71
835 29 SM
805 22 SM
831 04 24M
818 26 17M
830 27 9M
808 08 9M
867 10 20M
829 25 6M
858 09 6M
815 18 7M
847 45 15M
845 44 15M
855 24 6M
828 15 13M
838 03 16M
849 49 17M
850 40 12M
825 28 7M
823 19 22M
E=289
2&12.04
*I = Independent Termination.
M = Mutual Termination.

65

illlllllll'lll
I

APPENDIX B

EMPATHY MEASURES USED IN THIS STUDY

EMPATI-IIC UNDERSTANDING IN INTERPERSONAL
PROCESSES. II
A Scale for Measurement1

Robert R. Carkhuff

Level I

The verbal and behavioral expressions of the first person
either do not attend to or detract significantly from the
verbal and behavioral expressions of the second person(s)
in that they communicate significantly less of the second
person's feelings than the second person has communicated
himself.

 

 

 

1The present scale "Empathic Understanding in In-
terpersonal Processes" has been derived in part from "A
Scale for the Measurement of Accurate Empathy" by C. B.
Truax which has been validated in extensive process and
outcome research on counseling and psychotherapy (summar-
ized in Truax and Carkhuff, 1967) and in part from an
earlier version which has been validated in extensive pro-'
cess and outcome research on counseling and psychotherapy
(summarized in Carkhuff and Berenson, 1967). In addition,
similar measures of similar constructs have received exten—
sive support in the literature of counseling and therapy
and education. The present scale was written to apply to
all interpersonal processes and represent a systematic
attempt to reduce the ambiguity and increase the relia-
bility of the scale. In the process many important delin-
eations and additions have been made, including in partic-
ular the change to a systematic focus upon the additive,
subtractive or interchangeable aspects of the levels of
communication of understanding. For comparative purposes.
Level 1 of the present scale is approximately equal to
Stage 1 of the Truax scale. The remaining levels are
approximately correspondent: Level 2 and Stages 2 and 3

66

67

Examples: The first person communicates no awareness of
even the most obvious, expressed surface feel-
ings of the second person. The first person
may be bored or disinterested or simply operat-
ing from a preconceived frame of reference which
totally excludes that of the other person(s).

In summary, the first person does everything but express
that he is listening, understanding or being sensitive to
even the feelings of the other person in such a way as to
detract significantly from the communications of the second
person.

Level 2

While the first person responds to the expressed feelings

of the second person(s), he does so in such a way that he

subtracts noticeable affect from the communications of the
communications of the second person.

 

Examples: The first person may communicate some awareness
of obvious surface feelings of the second per-
son but his communications drain off a level of
the affect and distort the level of meaning.

The first person may communicate his own ideas
of what may be going on but these are not con-
gruent with the expressions of the second person.

In summary, the first person tends to respond to other than
what the second person is expressing or indicating.

Level 3

The expressions of the first person in response to the ex-
pressed feelings of the second person(s) are essentially
interchangeable with those of the second person in that
they express essentially the same effect and meaning.

 

 

of the earlier version; Level 3 and Stages 4 and 5; Level 4
and Stages 6 and 7; Level 5 and Stages 8 and 9. The levels
of the present scale are approximately equal to the levels

of the earlier version of this scale.

68

Example: The first person responds with accurate under-
standing of the surface feelings of the second
person but may not respond to or may misinter-
pret the deeper feelings.

The summary, the first person is responding so as to neither
subtract from nor add to the expressions of the second
person; but he does not respond accurately to how that
person really feels beneath the surface feelings. Level 3
constitutes the minimal level of facilitative interpersonal
functioning.

Level 4

The responses of the first person add noticeably to the
expressions of the second person(s) in such a way as to
express feelings of level deeper than the second person
was able to express himself.

 

Example: The facilitator communicates his understanding
of the expressions of the second person at a
level deeper than they were expressed, and thus
enables the second person to experience and/or
express feelings which he was unable to express
previously.

In summary, the facilitator's responses add deeper feeling
and meaning to the expressions of the second person.

Level 5

The first person's responses add significantly to the feel-
ing and meaning of the expressions of the second person(s)
in such a way as to (1) accurately express feelings levels
below what the person himself was able to express or (2) in
the event of ongoing deep self-exploration on the second
person's part to be fully with him in his deepest moments.

 

Examples: The facilitator responds with accuracy to all
of the person's deeper as well as surface feel-
ings. He is "together" with the second person
or "tuned in" on his wave length. The facili-
tator and the other person might proceed

69

together to explore previously unexplored areas
of human existence.

In summary, the facilitator is responding with a full
awareness of who the other person is and a comprehensive
and accurate empathic understanding of his most deep

feelings.

70

RELATIONSHIP INVENTORY--CLIENT FORM

(Please do not write your name on this form. It
will be coded anonymously and your answers used for re-
search purposes only.)

Below are listed a variety of ways that one person
could feel or behave in relation to another person. Please
consider each statement with respect to whether you think
it is true or not true in your present relationship with
your therapist. Mark each statement in the left margin
according to how strongly you feel it is true or not true.
Please mark every one. Write in +1, +2, +3; or -1, -2,

-3, to stand for the following answers:

 

+1: I feel that it is probably true, or more true
than untrue.

+2: I feel it is true.
+3: I strongly feel that it is true.

-1: I feel that it is probably untrue, or more untrue
than true.

-2: I feel it is not true.

—3: I strongly feel that it is not true.

1. He tries to see things through my eyes.
2. He understands my words but not the way I feel.
3. He is interested in knowing what my experiences

mean to ms.
4. He nearly always knows exactly what I mean.
5. At times he jumps to the conclusion that I feel

more strongly or more concerned about something
that I actually do.

10.

ll.

12.

13.

14.

15.

16.

71
Sometimes he thinks that I feel a certain way,
because he feels that way.
He understands me.
His own attitudes toward some of the things I
say, or do, stop him from really understanding

me.

He understands what I say, from a detached, ob-
jective point of view.

He appreciates what my experiences feel like to
me.

He does not realize how strongly I feel about
some of the things we discuss.

He responds to me mechanically.
He usually understands all of what I say to him.

When I do not say what I mean at all clearly he
still understands me.

He tries to understand me from his one point of
View.

He can be deeply and fully aware of my most pain-
ful feelings without being distressed or burdened
by them himself.

Client

72

Relationship Inventory--Judges Form

 

Code number

Rater #

 

 

10.

11.

12.

The therapist tries to see things through the
client's eyes.

The therapist understands the client's words but
not the way he feels.

The therapist is interested in knowing what the
client's experiences mean to the client.

 

The therapist nearly always knows what the client
means.

At times the therapist jumps to the conclusion
that the client feels more strongly or more con-
cerned about something than the client actually.

Sometimes the therapist thinks that the client
feels a certain way because he (the therapist)
feels that way.

The therapist understands the client.

The therapist's own attitudes toward some of the
things the client says or does stop him from

really understanding the client.

The therapist understands what the client says
from a detached, objective point of view.

The therapist appreciates what the client's exper-
iences feel like to him (the client).

The therapist does not realize how strongly the
client feels about some of the things they discuss.

The therapist responds to the client mechanically.

13.

14.

15.

16.

73

The therapist usually understands all of what
the client says to him.

When the client dOes not say what he means at
all clearly, the therapist still understands
him.

The therapist tries to understand the client
from his (the therapist'S) own point of View.

The therapist can be deeply and fully aware of
the client's most painful feelings without being
distressed or burdened by them himself.

Total

APPENDIX C

RAW SCORES OBTAINED BY CLIENTS AND

OBJECTIVE JUDGES ON THE

EMPATHY MEASURES

TABLE 4.--Barrett-Lennard Relationship Inventory, Client
Perceptions after 3rd interview.*

 

 

 

 

Client Counselor Score # Converted Score
832 02 —4 10
848 43 34 48
812 12 29 ' 43
801 05 23 37
834 35 33 47
835 29 32 46
804 22 8 22
831 04 16 30
818 26 25 39
830 27 24 38
808 08 09 33
867 10 05 19
829 25 4 18
858 09 25 39
815 18 15 29
847 45 22 36
845 44 22 36
855 24 18 32
828 15 8 22
838 03 21 35
849 49 25 39
850 40 8 22
825 28 25 39
823 19 4 18

N = 24 X = 32.37 SD = 10.12

 

*Constant of 14 added to avoid negative numbers.

74

75

TABLE 5.--Barrett-Lennard Relationship Inventory, Client
Perceptions, Post.*

 

 

 

Client Counselor Score # Score Converted
832 02 -9 5
848 43 27 41
812 12 36 50
801 05 34 48
834 35 35 49
835 29 30 44
804 22 8 22
831 04 3 17
818 26 ' 34 48
830 27 26 40
808 08 -12 2
867 10 4 18
829 25 9 23
858 09 26 40
815 18 16 30
847 45 21 35
845 44 27 41
855 24 16 30
828 15 23 37
838 03 29 43
849 49 40 54
850 40 7 21
825 28 27 41
823 19 -1 13

N = 24 X = 33 SD = 14.39

 

*Constant of 14 added to avoid negative numbers.

76

TABLE 6.--Barrett-Lennard Relationship Inventory, Tape-
rated* Average ratings.

 

 

 

Client Counselor Mean Score
832 02 29.67
848 43 46.00
812 12 36.20
801 05 39.40
834 35 42.00
835 29 46.00
804 22 14.00
831 04 49.20
818 26 34.00
830 27 47.40
808 08 30.40
867 10 24.80
829 25 42.80
858 09 45.40
815 18 17.60
847 45 39.60
845 44 46.00
855 24 36.80
828 24 36.80
838 03 46.00
849 49 46.00
850 40 7.60
825 28 49.20
823 19 46.00

N = 24 X = 33.95 SD = 19.42

 

*Constant of 14 added to avoid negative numbers.

77

TABLE 7.--Judges ratings of counselor empathy average
ratings, Carkhuff Empathic understanding in
Interpersonal Processes Scale.

 

 

 

Client Counselor Average Ratings
832 02 3.17
848 43 1.90
812 12 2.00
801 05 3.10
834 35 2.80
835 29 2.30
804 22 1.75
831 04 2.20
818 26 2.00
830 27 2.40
808 08 2.60
867 10 2.00
829 25 2.00
858 09 2.70
815 18 1.70
847 45 1.20
845 44 1.70
855 24 2.10
828 15 2.40
838 03 2.20
849 49 1.30
850 40 1.90
825 28 2.20
823 19 1.88

24 x = 2.15 so = .37

2
ll

 

APPENDIX D

SCORES ON OUTCOME MEASURES

TABLE 8.--Tennessee Self Concept difference scores.

 

 

 

Client Counselor Total "p" Gain NDS Fewer
832 02 36 10
848 43 55 33
812 12 4O 2
801 05 44 17
834 35 34 8
835 29 -2 2
804 22 -9 -17
831 04 16 2
818 26 12 17
830 27 -3 0
808 08 103 40
867 10 2 13
829 25 -23 10
858 09 53 14
815 18 0 -4
847 45 6 —7
845 44 68 22
855 24 -9 -9
828 15 10 -5
838 03 34 11
849 49 60 20
850 40 38 13
825 28 42 37
823 19 -20 ll

 

78

79

TABLE 9.--MMPI profile analysis-~average ratings.

 

 

 

Client ‘ Counselor Average Ratings
832 02 2.17
848 43 5.00
812 12 3.50
801 05 3.67
834 35 5.00
835 29 3.67
804 22
831 04 1.67
818 26 5.00
830 27 3.00
808 08 5.00
867 10 2.17
829 25 1.33
858 09 4.67
815 18 3.33
847 45 3.33
845 44 5.00
855 24 . 3.33
828 15 4.17
838 03
849 49 4.33
850 40 4.83
825 28 5.00
823 19 1.67

N = 22 x = 3.67 SD = 1.228

 

1--Unsatisfactory
2--Partly‘unsatisfactory
3--No change

4--Partly satisfactory
5--Satisfactory

80

TABLE 10.--C1ients and counselors evaluation of counseling

 

 

 

 

scores.
. Client Counselor
Client Counselor Rating Rating
832 02 4 3
848 43 6 3
812 12 7 4
801 05 7 4
834 35 7 4
835 29 6 3
804 22 5 4
831 04 5 3
818 26 7 4
830 27 6 4
808 08 5 3
867 10 6 3
829 25 6 4
858 09 6 2
815 18 - 3
847 45 6 4
845 46 6 3
855 24 5 2
828 15 7 3
838 03 7 3
849 49 6 4
850 40 6 3
825 28 7 4
823 19 5 2
Client rating: Counselor rating:

1--extreme1y harmful l--unsuccessfu1
2--harmed me a lot 2--partially unsuccessful
3--harmed me somewhat 3--partially successful
4--indifferent 4--successful

5--helped me somewhat
6--he1ped me quite a lot
7--extreme1y helpful

81

 

 

 

TABLE 11.--Post t scores--for combined outcome score.
. Ten Ton
Client Counselor MMPI " H CO EV C1 EV Ave.
p NDS

832 02 38 54 50 49 27 44
848 43 61 61 70 49 51 58
812 12 49 56 48 59 64 55
801 05 54 61 52 59 64 58
834 35 61 54 50 59 64 58
835 29 50 42 53 49 51 49
804 22 -- 38 34 59 39
831 04 34 45 73 49 39 46
818 26 61 45 59 59 64 58
830 27 45 42 55 59 51 50
808 08 61 75 63 49 39 57
867 10 38 42 47 49 51 45
829 25 31 34 40 59 41 46
858 09 59 60 56 38 51 53
815 18 48 42 4O 49 51 46
847 45 48 43 42 59 51 49
845 44 61 65 68 49 51 59
855 24 48 42 40 38 39 41
828 15 55 45 43 49 64 51
838 O3 -- 53 42 59 39
849 49 66 61 61 59 51 60
850 40 60 55 56 49 51 54
825 28 61 56 67 59 64 61

823 19 34 40 40 38 39 38

 

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