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THE EFFECTS OF DISPARITY IN CLIENT AND THERAPIST PERSONAL
POWER ON SECURITY OPERATIONS IN BRIEF PSYCHOTHERAPY

BY

Robert Neal Graham Jr.

A DISSERTATION

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

DOCTOR OF PHILOSOPHY

Department of Psychology

1995

ABSTRACT

THE EFFECTS OF DISPARITY IN CLIENT AND THERAPIST PERSONAL
POWER ON SECURITY OPERATIONS IN BRIEF PSYCHOTHERAPY

BY
Robert Neal Graham Jr.

In the traditions of psychoanalysis, the technique of
interpretation has played a central role in the theory and
practice of psychotherapy. The effect of interpretations on
clients and, more importantly, the effect of clients'
reactions on therapists, were systematically investigated.
Specifically, this study examined client and therapist
responses following therapist interpretation from an extended
Sullivanian perspective which incorporated security
operations and personal power functions. Data consisted of
audio-cassettes and transcripts of 24 sixteenth session
therapies conducted as a part of the Vanderbilt Psychotherapy
Research Project II. Psychotherapists were eight clinical
psychologists and seven psychiatrists from the Nashville area
trained in Time-Limited Dynamic Psychotherapy. Clients were
comparable to a general psychiatric outpatient population.
Interpretations and depth of interpretation were
operationalized with a new pantheoretical measure called the
Interpretation Scoring Guide.

Client and therapist personal power were operationalized
using the Personal Power Functions Profile. Client and
therapist responses were scored using an extended version of

the Security Operations Inventory. Although reliabilities

were modest, they entered into a variety of functional
relationships in an orderly fashion consistent with theory.
Prominant among these, clients frequently responded to
therapist with security operations, especially following
therapist interpretations; therapists had more personal power
and used more mastery-dominant security operations than
clients; therapists with more personal power tended to have
more years of therapy experience.

As predicted, the mastery-dominance level of therapist
security operation(s) following both interpretation and
noninterpretation statements was found to be directly related
to personal power, but the corresponding analysis for clients
was not inversely related to personal power, as expected.
Hypotheses relating depth of interpretation to disparity of
personal power functions and security operations did not have
an opportunity to demonstrate its scientific value. Neither
did number of interpretations.

Overall, the findings converge on the conclusion that
therapist's interpretations are apt to function as security

operations.

ACKNOWLEDGMENTS

The completion of this research project culminates my
graduate school education and training. I relished the
opportunity to interact with a multitude of people along the
way who have enriched my educational, professional, and
personal life.

I want to thank Drs. Hans Strupp and William Henry of
Vanderbilt University for their generosity and assistance in
making their psychotherapy data available for this study. I
extend my sincere appreciation to Dr. Ruth Kanfer and the
University of Minnesota Department of Psychology for allowing
me to use their resources in obtaining student raters for my
project. I also want to thank those individuals who served
as raters for this research: Tim Cefai, Melissa Chell, Barb
Clark, David Finke, Sherry Graham, Brett May, and Charlotte
Miller. Their dedication and perseverance aided in the
completion of this project. In addition, Suzy Pavick's
attention to detail and continuous support was invaluable.

I am grateful for the critical guidance and valuable
input of Drs. Norman Abeles, Albert Aniskiewicz, Andrew
Barclay, and Raymond Frankmann in their roles as dissertation
committee members. Their interest and encouragement were

greatly appreciated.

iv

Dr. Joseph Reyher, my dissertation chairperson, mentor,
and clinical supervisor, was a driving force behind my
professional development and refinement as a clinician and
researcher. I am grateful for the opportunity to work so
closely with him. I have benefitted greatly from his wisdom,
knowledge, and enthusiasm.

I extend a special thanks to Brett May for co-authoring
both the Interpretation Scoring Guide and the literature
review. His intelligence, ideas, friendship, and support
were invaluable. I look forward to collaborating with him
again on future projects.

Most importantly, I dedicate this work to my wife,
Sherry, and daughter, Carrie. Their love, support, and

patience were immeasurable.

TABLE OF CONTENTS

List of Tables. ....................................... .. x
List of Figures...... ......... .......................... xi
Introduction. ......... . ................................. 1
Psychoanalytic theory............... ..... . ..... ...... 1
Interpretation and resistance..... ..... . ........ ....1
Relevant Sullivanian theory.... ........ ... ........... 3
Interpretation and resistance ...................... 3
Self-system.... ..... . ................ . ............ 4
Interpretation and security operations ........ ... 5
Client strivings and reactivity .................. . 7
Therapist strivings and reactivity ................ 8
Client-therapist collusion....... ....... .......... 8
Interpretation: Theory and Practice ........... ...... 9
Favorable views ............... . ............ ....... 10
Unfavorable views ............... . ............. .... 12
Summary............................. ..... ......... 14
Research on interpretation ...... .... ..... ............ 14

Present ResearChOOOOOO0.0...O.......OOOOOOOOOOOOOOOO. 16

Hypotheses........................ ......... . ........ . 26
Hypothesis I. .................................... . 26
Hypothesis II.. ................................... 27
Hypothesis III ..... ............. ...... ............ 27
Hypothesis IV ......... . ........................... 28

vi

HethOdOOOOOOOOOOOOOOOOO. 000000000000 O OOOOOOOOOOOOOO .0...
Participants. ...... . .............. . ......... . ........
Therapists... ....................................... .

TheraPYOOOOOOOOOOOOOOOOO............OOOOOOOOOOOOOOOOO

Instruments............... ..... ....... ...............
The Interpretation Scoring Guide (ISG) ........... .
The Security Operations Inventory ................ .
The Personal Power Functions Profile ..... .........

Procedure........... ............... ..................

Data set - preparation of verbatim protocols ....... ..

Paints Of interest. 0 O. O O O O O O O O O O O O O O O O O O O O O O O O O O O O 0
Data reduction.................... ......... ..........
Interpretation Scoring Guide (ISG)................

Expanded Security Operations Scale (ESOS).........

Personal Power Functions Profile (PPFP) ........ ...
Results......... ....................................... .
Reliability............ ............................. .
Interrater agreement.. ......................... ...

Personal power functions..........................
Depth.. ...... ...... ...................... .........
Security operations. ...... ........................
Conclusion........................................
Preliminary analyses.................................
Personal Power Functions Profile.....................
Personal power ..... ...............................

Componential analysis of PPFP scale..... ....... ...

vii

29

29

3O

30

31

31

33

35

36

36

37

39

39

42

44

46

46

46

46

47

49

51

51

52

52

54

Security operations ...... ...... . ............ ........

Submissive-compliant security operations (SOs)....

Client response following therapist
interpretation (CRI)..............................

Therapist response following
interpretation (TRI).......... ................. ...

Therapist response following client
verbalization (TRC).. ...................... .......

Client response following therapist
Verbalization (CRT)00.000.000.00000000000000......

Comparison of client and therapist security

operations following both interpretation and
noninterpretation statements......................
Therapist interpretation (TI) .................... .
Therapist experience. ............ .................
Conclusion... .................................... .
Implications......................................
Principal Hypotheses...... ....... . .................. .
Hypothesis Ia.....................................
Hypothesis Ib... ...... ..... ........ . ........ ......
Hypothesis IIa......... ................... ........
Hypothesis IIb ............................. .......
Hypothesis III....................................

Hypothesis

Iv00000000000000000000.0 ...... 0.0.0000.

DiscuSSion0000.0.00.0...00.00.0000000000000.000.00000.00

summary00.000000000000000000000.0000000.000.00.000000

Implications..................... ............... ........

Treatment and interpretation.........................

Limitations00.0..00 0000000000 0000.00.00 0000000 0.00..0

viii

54

56

56

58

58

58

59

60

6O

61

62

62

62

64

64

64

65

66

69

71

71

73

Future research ............................... . ...... 73
References 0 O O O I O 0 O O O 000000000 O ....... O O O ........ O O 0 O O O 0 O 7 5
Appendices O 0 0 O O O O O O O O O O I O O O O O O O O O O O O O O O O O O O O O O I O O O O 0 O O O O 8 6

Appendix A. Theory and research on therapist
interpretation: A literature review........ ..... . 87

Appendix B. The Interpretation Scoring Guide........ 127

Appendix C. Ranked Scale of Constituent Security
operations.00000000000000.000000000000000000000000 162

Appendix D. The Extended Security Operations Scale.. 165
Appendix E. The Personal Power Functions Profile.... 168
Appendix F. Consent form................ ........ .... 171
Appendix G. Educational Debriefing Form............. 174

Appendix H. Examples of Security Operations
(Therapy SituationS)00000000...00000000000000.0000 175

Appendix 1. Additional training material for
scoring personal power functions.................. 180

Appendix J. Histograms of average scores for
clients and therapists on personal power
functions and security operations........ ....... .. 181

Appendix R. General References...................... 186

ix

LIST OF TABLES

Table 1

Conpngison pf lntercorrelation Coefficients Between
Aggpngg Egg and Consensus PPF for Both Therapists and
m0...00000000000.000000000000000.0000000000000 48

Table 2

Inpgpznpg; Reliabilities for Depth pf
Illgexgxetat;.on0..0.0000..000000000000.000000000000000.0 50

Table 3

 

Inpepratgp Reliabilities for each _f he
WW ................ 52

Table 4

Mggn Epggp §cpze§ for Therapist PPF and Client 22F
gnggg’pn Eng Bensonnl Bower Funcpions Profile....... 55

Table 5

Eggcentage _f Client and Thepapist Secupity
Operation Responses Following Interpretations
and No nin tgzppetation Statements.................... 57

Table 6

Spgnzmnn Bank Qrder Correlations Between Persona;
Pope; (2P2) and Median Secupity Operation (SO)
SCOIeSOO0.0.0.0.0....000.0000.000.000.0000000000000. 63

Table A-1

Qgfiinipipng pf inpepppetation in psychotherapy
mESECIzoanalESj-s000000000000..0000000000000000000 96

LIST OF FIGURES

Figure J-1

Wfimmsna muhoesmm 'et

and pnezapis .. ...................................... .. 181
Figure J-2

Histogpams pf aveyage security operation scores for
ciienp and pherapist ....................... . ......... .. 185

xi

In the traditions of psychoanalysis, the technique of
interpretation plays a central role in the theory and
practice of psychotherapy. Numerous authors have presented
guidelines to consider when utilizing interpretive techniques
(e.g., Levy, 1984; Weiner, 1975; Hammer, 1968. See Appendix
A for a review of the literature). Theoretical and technical
approaches to interpretation abound yet the empirical
evidence to support these claims is sparse. The effect of an
interpretation on the client and, more important still, the
effect of the client's reaction on the therapist, have yet to
be systematically investigated. These interpersonal events
constitute the psychoanalytic domain of the present study, as
elucidated below.

Wm

lnpgppxgpgpipn and resistance. Whereas the analysis of
resistance is the sine qua non of a successful analysis in
classical psychoanalysis (e.g., Freud, 1904, 1913, 1923,
1937; and Reich, 1949), it is generally regarded as an
obdurate and unwelcome problem in psychodynamically oriented
psychotherapy. This dichotomy is not absolute because some
analysts also regard it as an obstacle to progress, i.e.,
understanding the ego defenses and the defensive and
regressive functions of values and ideals, rather than as a
vehicle to a fundamental understanding of the ego or self.
Whether there is such a thing as a productive interpretation

is a moot question. Resistance, that is, all the forces

within the client which oppose the procedures and processes
of psychoanalytic work, is ever present (Freud, 1913, 1937;
Greenson, 1967).

A relationship between therapist interpretations and
client resistance has been previously recognized in the
literature. For example, Levy (1984) declared,
"Interpretations stir up resistance, the intensity of which
determine whether or not the interpretation will be accepted
and expand the patient's self-knowledge" (p. 23). Some
psychoanalysts believe that resistance arises from errors in
technique or from issues of countertransference (Fenichel,
1945; Greenson, 1978; Hammer, 1968b; Langs, 1973, 1982, 1983;
& Wolberg, 1977).

Spero (1977) noted, "In many cases, resistance emerges
when anxiety-provoking material is touched by an
interpretation. A more pervasive form of resistance is that
based on interpretations perceived as a threat to self" (p.
75). Spero explained that interpretations that are perceived
as a threat to the self mobilize strong resistance in many
clients. If interpretations are perceived as threats to
clients, then observation of threat reducing-behavior is
likely. For instance, after a therapist makes an
interpretation, the client provides the illusion of
acceptance and then changes the topic (Reyher, 1989). This
maneuver functions to protect the therapeutic relationship
while moving away from something that imposes a threat,

provokes anxiety, or invokes a loss of euphoria in the

client. Whatever the rationale, it has been observed that
therapist interpretation is likely to meet with client
resistance.

It has also been noted that all resistances have both an
intrapersonal (intrapsychic) and an interpersonal component
and function to avoid real or imagined pain (Milman &
Goldman, 1987; Freud, 1923, 1937; Langs, 1987; Strupp &
Binder, 1984). '

How do therapists cope with outright rejection of an
interpretation or, more commonly, a tentative or conditional
acceptance? Poorly timed interpretations cue anxiety that
typically cannot be mastered (Freud, 1900), consequently
generating excessive resistances.
WWW

Inpggngpnpipn nng resistance. Sullivanian theory is

one way to make sense of client responses and reactions to
proffered interpretations and a therapist's subsequent
response to a client. The contention is made that
resistance, even in its extremes of automatic compliance
versus rejection or opposition, can be interpersonally
conceptualized as security operations.

Sullivan (1954) defined resistance as, ". . . in general
it has come to mean something that opposes what was presumed
to be helpful" (p. 219). How therapists and analysts choose
to address this resistance is directly influenced by their
theoretical beliefs and corresponding treatment techniques or

practices.

Security operations function to maintain self-esteem and
thereby prevent anxiety (the lowering of euphorial) in
interpersonal situations and increase interpersonal security.
Sullivan (1954) argued that anxiety2 is aroused in the client
and "resistance" follows when something threatening to the
client, e.g., a disturbing, anxiety-provoking topic or
interpretation, is introduced. Clients will employ all kinds
of devices to avoid the topic (resistance) while attempting
to preserve the therapist's esteem of them (security
operations). Therefore, security operations could be
conceptualized as one component of resistance, functioning to
maintain interpersonal security in the face of intrapsychic
threat.

Sglf;§y§;§m. The self-system or anti-anxiety system is
"the system involved in the maintenance of felt interpersonal
security . . ." (Sullivan, 1953, p. 109). The self-system
provides more of an equilibrating influence by functioning to
either avoid, conceal, or minimize anxiety to insure safety
from dangerous situations. It develops from interpersonal
experiences with anxiety beginning very early in life. Any
lowering of self-esteem (lowering of euphoria) is experienced
as anxiety (Sullivan, 1954). Within the self-system,

security operations function as a protective measure against

1. Euphoria is a sense of well-being characterized by high
self-esteem and minimal anxiety.

2. Anxiety is any drop in the sense of well-being or any
lowering of self-esteem.

undue anxiety or the threat of anxiety arising from
forbidding gestures (behavioral and expressive cues that
lower euphoria) in interpersonal situations.

Therapy, although different from typical everyday
interactions, is an interpersonal situation. It involves two
participants seeking to communicate with each other while
striving to remain secure from anxiety. When communications
stir up anxiety in one or both parties, security operations
are generated to protect against any drop in euphoria.

Security operations are generated by the self-system
whenever it reacts to threat. As Sullivan (1954) stated, "In
other words, all anti-anxiety operations are security
operations; all efforts to protect one's self-esteem are
security operations" (p. 97). They sustain a feeling of
safety or measure of interpersonal security as well as
relieve anxiety while protecting a person's self-esteem from
additional threat.

Intezpretnpion and security gperations. Interpretations
have the potential to produce anxiety and be perceived as
threats. Assuming that the therapist is inferring something
about a client they do not want to know, interpretation can
be viewed as a stimulus for security operations.
Interpretations stimulate a sequence of interpersonal
interactions between client and therapist that are
hypothetically characterized by security operations. This
occurs because the clients perceive an interpretation as a

threat (lowering of euphoria) yet want to preserve their

established esteem in the presence of the therapist. In
fact, a pattern of client responses to interpretation has
been identified as the application of security operations
(Reyher, 1978).

Spence (1987) observed, ". . . minor misinterpretations
by the analyst are frequently overlooked by the patient, and
even significant mistakes may either be ignored or
rationalized away" (p. 87). The client's strategy is to
engage in security operations in the form of ignoring,
rationalizing, or overlooking something that has been
communicated, i.e., an interpretation. However, the client
does not want to alienate the therapist by rejecting an
interpretation outright (Reyher, 1989). This conflict causes
undue anxiety and increases the possibility of eliciting
forbidding gestures. If this were to happen, the self-system
would work to minimize the anxiety and prevent a drop in
self-esteem by using security operations.

Therapists, trained to interpret, have their esteem
wrapped up in the interpretation that is proffered to the
client and have a narcissistic investment in the outcome of
their interventions. If the interpretation is rejected or
ignored, therapists struggle to restore their own sense of
security and esteem in the eyes of the client by engaging in
security operations of their own. A therapist may even use
an interpretation to attack or retaliate against a client for
rejecting a previous interpretation. Hence, it follows that

interpretations can generate security operations in both

client and therapist (Reyher, 1989).

Self-esteem has been implicated as an important variable
in the outcome of an interpretation. Spiegel & Hill (1989)
have hypothesized that self-esteem may function as a
moderating variable affecting how receptive a client is to
interpretation. Furthermore, Weiner (1975) asserted, "Hence
even a mild interpretation challenges the patient's integrity
and deflates his self-esteem, and it thereby constitutes an
attack against which he may feel a need to defend himself"
(p. 120).

I propose that security operations are employed to
protect oneself against "attack" or any other perceived
threats to one's self-esteem.

Client stpivings and reactivity. Therapist and client
are brought together into a relationship by the client's life
problems. Even though clients come in with these problems,
they attempt to create a favorable impression with the
therapist to minimize their level of anxiety. Clients
carefully watch the therapist, whom they typically hold in
high esteem, for signs of approval to bolster their self-
esteem or signs of disapproval (forbidding gestures) which
can precipitate intense anxiety in the client (Sullivan,
1954). In response to perceived or anticipated forbidding
gestures, the self-system activates security operations to
avoid or minimize any drop in euphoria, often experienced as
anxiety. In addition to decreasing clients' level of

anxiety, client security operations help preserve therapist's

esteem and, thereby, maintain a feeling of safety in the
therapy relationship. Clients use security operations to
gain or maintain interpersonal safety.

Ingznpigp §tnivings and zeactivity. Therapists strive
to generate respect, esteem, prestige, approval, etc. from
clients, which can impede the work of therapy. They have an
investment in what they communicate to the client and how the
therapy session proceeds. Therapists are also concerned with
the client's appraisal of their abilities and technical
skills while attempting to sustain the "favored status"
conferred by the therapist role. When they make an
intervention, they leave themselves vulnerable to client
communications (forbidding gestures) that pose a potential
threat to their self-esteem, often signaled by an increase in
anxiety. Any topics or experiences that lower euphoria and
generate client' forbidding gestures will be experienced by
therapists as a need for relief (Sullivan, 1953).
Consequently, security operations become engaged to decrease
their anxiety level as well as maintain their esteem and
status in the eyes of the client.

Qiignt;pngznpi§p gplingipn. Reyher (1989) has drawn
attention to the articulation between client and therapist
security operations. He explained that both therapist and
client are pursuing security in the relationship by avoiding
direct acknowledgement of forbidding gestures, rejection, or
disapproval by the other. In addition, their self-systems

are actively repairing any drop in self-esteem. A shared

avoidance of confrontation leads both parties to collude in
two ways. One way is to ignore the injury to self-esteem
that occurs. The other way is to repair the damage. This
collusion, whether conscious or unconscious, allows the
relationship to continue in a relatively safe environment
with minimal threat to one's self-esteem.

W __xtheor s.n_d Lira—dig

Clients and therapists have certain expectations about
what goes on in therapy and interpretive interventions are
often central to those expectations as well as the
therapeutic interaction itself. Clients expect to hear
interpretations and some may even ask for them directly, but
at the same time, clients appear to dread interpretations (J.
Reyher, personal communication, May 20, 1990).
Interpretations often contain revelations about clients that
they do not want to know about, e.g., reprehensible content
that the client is not aware of. An interpretation may also
threaten one's sense of interpersonal security within the
therapist-client relationship, e.g., "How can you really
value me while knowing that I harbor such infantile
cravings."

Definitions of interpretation in the psychotherapy
literature have been inconsistent at best (Spiegel and Hill,
1989). In the present study, interpretation is defined as,
"any therapist statement in a session that infers something
about the client that the client has not explicitly (i.e.,

verbally) expressed" (Graham and May, 1989, p. 56). This is

10

a broad conceptualization of interpretation and may include
other types of interventions (e.g., confrontations,
clarifications, etc.) that have been defined elsewhere (See
Elliott, 1985; Hill, 1989; & Stiles, 1979). However, these
distinctions deal with the intent (e.g., why therapists used
a particular response) of an intervention as well as the
content (e.g., what therapists actually said or did). This
makes the various interventions difficult for impartial
raters to differentiate and identify. Actual interpretations
make up only a fraction of therapist inferences and
therapists do not share with clients all the inferences they
make during the course of therapy (Ramzy, 1974). The
important factor for the present study is whether a therapist
statement contains an inference about the client that the
client is not explicitly and verbally acknowledging.

Egyppnplg yig_§. There is a dichotomy of opinion on the
role of interpretation in therapy. Some theorists advocate
strongly for interpretive techniques while others focus on
the limits of interpretation and emphasize more of a
noninterpretive approach (refer to review in Appendix A for
additional theoretical perspectives).

Ross et al. (1986) pointed out that most therapists who
practice brief psychotherapy believe that some form of
interpretation is the key to behavioral change. They also
suggested that the manner in which interpretive remarks by
the therapist are received and processed by the client may be

one way to gain a better understanding of the components of

11

the interpretive process.

There have been a number of theoretical arguments
proffered to explain how interpretations bring about change
in therapy. Most of these theoretical postulates have come
from the psychoanalytic literature. Early on, Freud (1904)
wrote that the therapist works to reveal repressed traumatic
experiences and bring these hidden traumas into consciousness
while encouraging the client to release the corresponding
emotions in the safety of the therapy setting. Coltrera and
Ross (1976) have outlined the function and rationale of
interpretive interventions based on Freud's early writings on
technique. They explained that when a therapist makes an
interpretation, the client's attention is directed to
preconscious material that is generated from the unconscious.
The explanatory contents and form elements contained in an
interpretation facilitate the recognition of unconscious
derivatives by the conscious system. Wolberg (1977) believed
that unconscious material must be related to what is
happening in the present. He stated that all conscious and
unconscious behavior is dynamically motivated, having a
definite meaning and function that interpretation helps to
uncover.

Other writers have focused more on structural theory in
delineating how interpretations work. More specifically, the
ego is viewed as the central structure involved in the
process of change. Various perspectives include, bringing

repressed material into awareness and placing it at the

12

control of the ego (Hammer, 1966); drawing the attention of
the client's ego to 'preconscious derivatives' which become
less distorted as the client observes himself and comprehends
previously unknown motives for his own activity (Fenichel,
1941); employing ego capabilities to modify its' relationship
with the id (Saul, 1958); decreasing the amount of energy
built up in the id by increasing awareness of unconscious
impulses (Strachey, 1934); and influencing the ego through
the transference relationship to bring about change (Weiss,
1986).

The importance of patterns rather than of exact events
when formulating and making interpretations has been noted
(Loewenstein, 1957). Loewenstein argued that interpretation
works on the psychological dynamics and conflicts within the
client and its effectiveness is dependent on the client's
reaction. Interpretations are often developed over a series
of interventions and seek to provide new material for the
client to consider along with the therapist (Glover, 1955;
Langs, 1973; Loewenstein, 1957; and Zac, 1972).

annvornblg yigy_. Interpretations can generate both
anxiety and defensiveness or resistance in the client
(Weiner, 1975). Certain interpretations have actually been
viewed as accusations, criticisms, or pejorative statements
and tend to evoke negative responses in clients, like
resistance or even rage (Wile, 1984). Wile believed that
interpretations are made because they are theory-based and

therapists subscribe to the philosophy that their clients

13

need to know the 'truth.'

Fine (1968) stated that few interpretations are heard by
clients in the way that therapists intended them. The
therapist needs to attend to how the client reacts and
elaborates on an interpretation rather than focusing on the
correctness of it. It is also crucial to monitor how the
therapist responds to the reactions of the client.

It is not interpretation that cures the client and
insight does not lead directly to beneficial structural
transformations characteristic of a successful analysis
(Kohut, 1977). Kohut maintained that clients are
narcissistically vulnerable in the face of interpretations
and may experience the intervention as a nonempathic response
in the present that is "genetically connected" to traumatic
events from the past. It is a narcissistic injury that
threatens the cohesion of the self and narcissistic rage is
really motivated by the wish to increase self-esteem (Kohut,
1977).

Rogers (1942, 1957) believed that interpretations have
limited value in therapy. He stated that interpretations
have no essential value to therapy other than to become a
channel for communicating the essential conditions of
unconditional positive regard, empathy, and genuineness of
the therapist (Rogers, 1957). Furthermore, Rogers (1942)
declared, "Interpretation has value only to extent that it is
accepted and assimilated by the client" (p. 26). He thinks

that the therapist needs to provide more than an intellectual

14

picture or explanation to change a client's behavior.
finnnnzy. A dichotomy of opinion regarding the role of
interpretation in therapy is evident. Some theorists or
practitioners advocate strongly for an interpretive method
while others relegate interpretation to a minor or even
harmful role in therapy. This discrepancy highlights the
complex characteristics and theoretical intricacies of
interpretive techniques as well as the interpersonal nature
of therapy.
Maw

There is a broad body of research on various aspects of
interpretive interventions (refer to the review of the
empirical literature on interpretation in Appendix A for
detailed findings). The empirical outcomes have been mixed
in terms of providing support for making interpretations in
therapy. The erratic results are due in part to
methodological problems and limitations in external validity.
Renewed interest in psychotherapy process research and
interpretation in particular has been observed (Kiesler,
1982).

In brief, results of empirical research on
interpretation have been inconsistent at best. Numerous
studies employing a verbal conditioning paradigm have
consistently found a reinforcement effect (Adams, Butler, &
Noblin, 1961; Adams, Noblin, Butler, & Timmons, 1962;
Auerswald, 1974; Kanfer, Phillips, Matarazzo, & Saslow, 1960;

Noblin, Timmons, & Reynard, 1963). However, they have

15

displayed a lack of external validity, limiting their
usefulness. Other research that exhibited an increased
methodological refinement did not investigate actual therapy
sessions (Claiborn, 1979; Claiborn, Ward, & Strong, 1981;
Cooke & Kipnis, 1986; Forsyth & Forsyth, 1982; Strong,
Wambach, Lopez, & Cooper, 1979).

Naturalistic studies show promise but results have been
varied and systematic investigation of the effects of
interpretation have been limited in scope (Bergman, 1951;
Brunink & Schroeder, 1979; Elliott, Barker, Caskey, &
Pistrang, 1982; Elliott, Hill, Stiles, Friedlander, Mahrer, &
Margison, 1987; Fiedler, 1951; Frank & Sweetland, 1962;
Goodman & Dooley, 1976; Hawton, Reibstein, Fieldsend, &
Whalley, 1982; Hill, 1978; Hill, Carter, & O'Farrell, 1983;
Hill, Helms, Tichenor, Spiegel, O'Grady, & Perry, 1988;
Russell & Stiles, 1979; Snyder, 1945; Staples, Sloane,
Whipple, Cristol, & Yorkson, 1975; Stiles, 1979; Stiles,
Shapiro, & Firth-Cozens, 1988; Zimmer & Pepyne, 1971).

Studies exploring specific theoretical distinctions in
interpretive interventions have found that: (a) "moderately
deep" interpretations (Fisher, 1956; Garduk & Haggard, 1972;
Gill & Hoffman, 1982; Grossman, 1952; Harway, Dittman, Raush,
Bordin, & Rigler, 1955; Raush, Sperber, Rigler, Williams,
Harway, Bordin, Dittmann, & Hays, 1956; Sklansky, Issacs,
Levitov, & Haggard, 1966; Speisman, 1959), (b) relevant
transference interpretations (Forman & Marmar, 1985; Frances

& Perry, 1983; Luborsky, Bachrach, Graff, Pulver, & Cristoph,

16

1979; Marziali, 1984; Marziali & Sullivan, 1980;
Silberschatz, Fretter, & Curtis, 1986; Weiss & Sampson,
1983), (c) increased productivity with therapist skill
(Fiedler, 1951; Games-Schwartz, 1978; Gomes-Schwartz &
Schwartz, 1978; Strupp, 1955, 1958; Strupp & Hadley, 1979),
(d) object focus (Piper, Debbane, Bienvieu, Carufel, &
Garant, 1986), and (e) interpretation tense (Abramowitz &
Jackson, 1974) have all produced mixed findings. In
addition, theory-based research has demonstrated that the
suitability and accuracy of interpretations are more
predictive of client response than type of interpretation
(Crits-Cristoph, Cooper, & Luborsky, 1988; Malan, 1976;
Marziali, 1984; Marziali & Sullivan, 1980; Silberschatz,
Fretter, & Curtis, 1986; Weiss & Sampson, 1983, 1986).
EIESEDL {$522120

Personal power functions (PPF) have been affiliated with
security operations as a way to increase the ability to
predict the type of security operations an individual will
use (Reyher, 1979). Personal power is the constellation of
resources, properties, attributes or characteristics of an
individual which are all external in nature, can be
determined through observation or biographical data, and tend
to create positive conceptions in others (Gavrilides, 1980;
Hamernik, 1987). A personal power functions profile (PPFP)
was developed by Reyher (1979) that initially was based on
Sullivanian theory but later (Reyher, 1992) came under the

sway of Freudian and ethological perspectives. It consists

1.

17

of sixteen different personal power functions that provide a
measure of an individual's level of power1 in a relationship.
Although no longer an instrument hewing to Sullivanian
theory, personal power has been shown to influence the
selection and use of security operations (now called
"security measures") in therapy. Personal power plays a
central role in the dynamics of interpersonal interaction
process.

Gavrilides (1980) demonstrated that the personal power
functions of communication style, communications skills, and
achievement status were significantly correlated with
security operations while physical factors were not. In
addition, high personal power persons were less anxious,
interrupt more, and tend to use more aggressive or assertive
security operations compared to low personal power persons.
It was concluded that the aforementioned power functions
influence interpersonal dynamics. Based on this finding, the
differential status or disparity in power might help predict
which security operations will be utilized by a particular
individual.

Relative control in relational communications is another
concept that has similarities to power from an ethological
perspective. A coding system was developed and used with
marital couples that focused on the control defining aspects

of communication (Ericson, 1972; Ericson & Rogers, 1973;

Intimidation via threat of narcissistic injury or life and

limb (Reyher, 1992).

In

SI

18

Mark, 1970). Sequences of messages are analyzed in relation
to the control aspects of verbal exchanges that define an
individual's role at a given moment in an interaction.
Control can move toward dominance (one-up position), being
controlled (one-down position), or neutralized (one-across
position). In this scheme, a message is both a response to
what precedes it and a stimulus for the message that follows.
In therapy, if the therapist offers a message that is
dominant, the client can respond with a dominant message
(competitive response), a submissive message (complementary
response), or a neutral message (leveling response, e.g.,
ignore the message). It therefore seems reasonable to assume
that personal power and the control defining aspects of
communication influence what type of security operations are
selected by both therapists and clients during a therapy
session.

Security operations involve observable interpersonal
acts and can be mobilized in therapy when a topic generates
anxiety in the client (Chapman, 1978). Chapman stated, "A
healthy security operation usually increases a person's
social effectiveness and emotional stability. In contrast,
an unhealthy security operation diminishes anxiety at some
cost to the person" (p. 58).

Gavrilides (1980) found a similar relationship
indicating that high personal risk-takers possessing greater
personal power will utilize more productive security

operations resulting in less observed anxiety and greater

19

happiness compared to low personal risk-takers. The inverse
relationship was also validated demonstrating that low
personal risk-takers with low personal power utilize more
nonproductive security operations resulting in more observed
anxiety and less happiness compared to high personal risk-
takers.

Interpersonal security operations have been
operationally defined and elaborated on by Reyher (1978) in
his development of the Security Operations Inventory and
recent Security Operations Scale (Reyher, 1992; Tobias, 1993)
wherein each security operation has an empirically derived
value. The original inventory identified 38 separate
security operations (Reyher, 1979). The most recent version
of the inventory contains 61 different security operations
that are combined to make up eight subheadings subsumed under
five separate categories (Reyher, 1989). These five main
categories can be divided into productive mastery-dominance
security operations and nonproductive submissive-compliant
security operations which are more self-protective in nature.

In his most recent communication, Reyher (1992)
contended that Sullivanian theory does not include postulates
or assertions regarding personal power and mastery-dominance.
He pointed out that mastery-dominance is not a factor in
Sullivan's interpersonal construal of the self-system. These
matters are more in keeping with Freud's notion of "security
measures" in the service of the ego-interests and narcissism.

In addition, these ideas are also consistent with ethological

20

perspectives on dominance hierarchies, agonistic dominance in
particular.

According to Sullivan, a power drive is compensatory, a
failure in competence in integrating interpersonal
situations. A well-oriented person resists momentary
opportunities for satisfaction or to enhance one's prestige
(Sullivan, 1953). Disparity in personal power in an
interpersonal relationship has great consequences for clients
who, in Sullivanian terms, are deemed to be ill-oriented.
Thus the different sets of strivings that characterize these
two divergent styles of interpersonal interaction result in
distinct security operations that can be objectively observed
and identified (Reyher, 1980; J. Reyher, personal
communication, May 15, 1991).

Therefore, the mastery-dominant category of security
operations in the revised Security Operation Scale (Reyher,
1989) is regarded by Sullivan as compensatory strivings in an
ill-oriented person. Thus, these too are deemed as attempts
to avoid anticipated loss of euphoria, i.e., they are driven
by anxiety. As Reyher noted, "One who has insight into these
processes to 'anxiety-free discharge' of needs (integrating
tendencies) and resists momentary opportunities for
satisfaction or to enhance one's prestige can be said to be
well-oriented in living (Sullivan, 1953, p. 243)....More in
keeping with Sullivanian (1956, p 70-71) parlance, the
righting movement of the self-system is impaired in a person

whose compensatory power drive is attempting to integrate the

21

interpersonal situation, but the other fellow is trying to do
the same thing. In attempting to take charge (how the
encounter is to be integrated), the user of this security
operation runs great risk (an assessment made by the self-
system) of generating forbidding gestures and anxiety (the
lowering of euphoria) associated with the fogging of 'Good
Me' and the 'Good Mother' personifications by the 'Bad Me'
and the 'Bad Mother' personifications." (Reyher, 1992, pp.
6-7).

Gavrilides' findings (1980) demonstrated that persons
with high personal power functions (PPF) tend to engage in
mastery-dominant (M-D) 805; however, by implication, as if
there is a disparity in PPF, the disadvantaged member of the
dyad is less apt to employ M-D SOs. As Reyher (1992)
asserted, "The greater the disparity in perceived PPF by the
person of lower PPF, the more likely he or she will expect
retaliation in return for his or her attempt to take charge
of the interaction (mastery-dominance)" (Reyher, 1992, p. 7).

Reyher (1992) noted, however, that the positive
correlation between M-D SOs and well-being and a negative
correlation with objective (behavioral) indices of anxiety
(refer to Appendix C) strongly suggests that the
interpersonal actualization of M-D striving is associated
with a well-orientation, not a compensatory ill-orientation.
Reyher went on to show that Gavrilides' findings fit well
into Freudian and ethological perspectives.

Although the Sullivanian theory under test is not

22

supported by this outcome, this study will attempt to
increase its empirical content by testing hypotheses that
potentially can refute (discorroborate) this previous finding
(See Weimer on Popper, 1979, p. 37). In other respects than
its failure to accommodate the findings, that persons who
engage in M-D SOs are well-oriented, additional failures
further jeopardize its viability. In Lakatos'(1970) view,
the Sullivanian research program would be considered
degenerative rather than progressive.

Therefore, not in keeping with Sullivanian theory,
productive security operations are utilized more often by
individuals who are more concerned with strivings of mastery
and autonomy rather than generalized approval seeking
(Pottinger, 1982; Reyher, 1978). Hence they are less
dependent on the approval of others and are typically
perceived by others as successful, arrogant, and insensitive
to the feelings of others (Reyher, 1978, 1980, 1989, 1992).

Conversely, and in keeping with Sullivanian theory,
nonproductive security operations are more likely to be used
by individuals who seek approval from others, anticipate
rejection and signs of disapproval because of negative self-
conceptions of personal insufficiency, or attempt to offset
any loss of euphoria by actively avoiding or minimizing
negative self-other conceptions (Pottinger, 1982; Reyher,
1980, 1989). They tend to be more submissive, conforming,
placating, indirect, and self-effacing compared to the more

mastery-dominant individuals.

23

I assume that most clients use the therapy relationship
in order to gratify their own unidentified needs, whatever
they might be. Clients dread experiencing a loss of
euphoria. Therefore, they will engage in security operations
in an attempt to maintain or repair the therapy relationship
if they think they have diminished the therapist's esteem of
them. Therapists perceiving a rejection by the client will
also engage in security operations to salvage their own
self-esteem. Therapists may consciously or unconsciously
retaliate against the client because of the anger generated
(Reyher, 1989). They punish the client for not accepting
their interpretation, i.e., make a critical or negative
remark, interrupt the client, their tone of voice changes,
etc.

An interpretation can also be an uplifting, self-esteem
enhancing (euphoria increasing) experience for the therapist
who has a personal investment in the interpretation. In
these terms, interpretations can be construed as security
operations.

Clients tend to respond to interpretations in such a way
as to reject them while giving the impression that they have
accepted them or that they deserve consideration (Reyher,
1989). The client does this in an attempt to preserve the
therapy relationship and modify or cover up their own real
feelings (Silberschatz & Curtis, 1986). However, this type
of rejection by the client is often experienced by therapists

as a loss of euphoria (Sullivan, 1953). Clients will attempt

24

to cover up by making some ambiguous comment or remark, i.e.,
Uh huh; that's interesting; I was not aware of that; that
makes sense; etc. and then either change the topic, go on
with what they were saying before the interpretation, or wait
for the therapist to continue on a different course (Reyher,
1989). If therapists remain uniform in following a
particular method of interpretation, it is expected that
clients would respond to interpretations in a characteristic
fashion.

To facilitate the organization of all possible types of
interpretation, the Interpretation Scoring Guide (ISG) was
developed. The ISG allows researchers to operationalize
interpretations along a number of qualities derived from an
extensive review of the theoretical literature. In an
initial study using the ISG, May and Graham (1990,
unpublished raw data) compared two of Carl Roger's therapy
sessions (Snyder, 1947) with two of Lewis Wolberg's therapy
sessions (Wolberg, 1954). They found that Rogers made more
inferential statements (interpretations) that focused on the
client only, that were stated in the present tense, and that
were based on material immediately preceding the inferential
statement itself. They also discovered a degree of
consistency between Roger's therapy sessions and Wolberg's
therapy sessions which corresponds with their therapy method
and technique of interpretation. These were short-term
therapies in which interpretations were proffered to clients.

This study also demonstrated that the ISG is a valuable tool

25

for operationalizing theoretical constructs of interpretation
and delineating theory-based differences in interpretation
use as it occurs in actual therapy sessions.

The present study seeks to determine if security
operations indeed play a major role in client response to
interpretation and subsequent therapist response to the
client. The intent here is to gain a better understanding
about the course or outcome of an interpretation from the
cascade of interpersonal interactions between therapist and
client that follow an interpretive intervention. An
additional goal of this study is to extend and systematize
Sullivanian (1953, 1954) theory as conceptualized by Reyher
(1978, 1979, 1980, 1989) in terms of personal power functions
and security operations.

Although the following experimental hypotheses were
formulated before problematic aspects of Sullivanian theory
-personal power, strivings to procure narcissistic uplifts,
mastery-dominant security operations- were identified by
Reyher, they, nevertheless, are consistent with both Freudian

and ethological perspectivesl. Also therapists were not

1. The original idea for this study was developed prior to the
discovery that mastery-dominance was more consistent with
Freudian theory than Sullivanian theory. Through further work
with Gavrilides (1980) data, Reyher found that security
operations could be ranked on the basis of mastery-dominance
scores. Reyher also reviewed the theoretical literature,
discovering that Sullivan never adequately addressed the concept
of mastery-dominance in his writings. However, Sullivan does
account for approbation and submissive-compliant security
operations. The experimental hypotheses in this study were
formulated with Sullivanian theory in mind. The shortcomings of
Sullivan's theoretical model in explaining the results are

26

presumed to be necessarily well-oriented and, accordingly,
interpretations are most likely to be security operations.
Finally, theory must accommodate relevant experimental
findings. In this case, the critical significance of
personal power in relation to type of security operation
(SO).

0 se 1:

Hypppnggig 1. (a) The mastery-dominance level in client
SO(s) is inversely related to the discrepancy (differential
power) between therapist and client personal power. The
derivation from the theory under test is straightforward.
For every client response in a therapy session, clients will
use SOs that are based on the discrepancy in personal power
between therapist and client. As the discrepancy between
therapist and client personal power increases in favor of the
therapist, clients experience greater intimidation and their
808 decrease in their relative level of mastery-dominance.

(b) The mastery-dominance level in client SO(s)
following therapist interpretation is inversely related to
the discrepancy (differential power) between therapist and
client personal power. This is a variation of hypothesis Ia
wherein only a portion of the same data is used. The

predictions are the same.

...Continued...
acknowledged in light of this new data and information.

1. Bold, italicized text identifies those auxiliary hypotheses
(constructs) that enable derivation to proceed.

27

Hypppnggig LI. (a) The mastery-dominance level in
therapist SO(s) is directly related to the discrepancy
between therapist and client personal power. This derivation
is straightforward too. For every therapist response in a
therapy session, therapists will select 805 that are based on
the discrepancy in personal power between therapist and
client. As the discrepancy between therapist and client
personal power increases in favor of the therapist,
therapists experience less intimidation and their 805
increase in their relative level of mastery-dominance.

(b) The mastery-dominance level of the therapist
response (therapist $0) to client following an interpretation
is directly related to the discrepancy (differential power)
between therapist and client personal power. This is a
variation of hypothesis IIa wherein only a portion of the
same data is used. The predictions are the same.

fiypppngsig LII. The depth of therapist interpretation
is (a) directly related to the discrepancy between therapist
and client personal power, but (b) is inversely related to
client mastery-dominance level (client 808).

With respect to the particulars of the theory under
test, derivation of the foregoing formalized propositions
preceeded as follows: As the discrepancy between therapist
and client personal power increases in favor of the
therapist, the therapist, experiencing less intimidation, is
more likely to go beyond client awareness and understanding

when formulating and proffering interpretations. For this

28

hypothesis, another auxiliary hypothesis is needed, in
addition to intimidation, to complete the derivationl. In
this case, going beyond clients' awareness is asserting
greater mastery-dominance. So as therapist power increases,
depth of interpretation increases. In turn, clients
relatively low in personal power, and experiencing greater
intimidation, will be more likely to use less mastery-
dominant SOs in response to these "deep" interpretations than
to the more "superficial" interpretations.

flypptnesis l1. The total number of interpretations
proffered by a therapist is directly related to the
discrepancy between therapist and client personal power. The
derivation of this proposition requires that therapists who
are relatively high in personal power are experiencing less
intimidation. Consequently, they assert greater dolinance
and, thereby, experience an increase in euphoria by
interpreting more of what clients say and try to get clients

to agree with their interpretations (client submission and

acceptance).

1. Unlike hypotheses I and II, an additional mediating auxiliary
hypothesis is required to connect the central propositions
relating to relative personal power and type of SOs.

Method

W

The participants were 24 psychotherapy clients seeking
psychotherapy services in the greater Nashville area. They
received brief, time-limited, dynamic psychotherapy as part
of a research project conducted by the Vanderbilt University
Psychotherapy research group. The entire data set, which
consisted of 24 clients who completed all 25 therapy
sessions, was used. They ranged in age from 24 to 64 years
(mean 41.04). Seventy-nine percent were female, twenty-one
percent were male. Seven were married, one widowed, eleven
divorced, and five were single. Twenty-three of the clients
were Caucasian (96%). Their level of education ranged from
eleventh grade to graduate school with two thirds of them
having at least two years of college. Approximately 69% had
been involved in one prior therapy experience.

Participants presented with complaints of anxiety,
depression, and interpersonal difficulties. They were given
corresponding diagnoses on Axis I of DSM-III and 70% were
also given a diagnosis of dependent personality, avoidant
personality, or mixed personality on Axis II of the DSM-III.
As indicated by intake scores in the Global Severity Index,
these clients were comparable to a general psychiatric
outpatient population (Henry, Schacht, & Strupp, 1990). In
addition, scores on the SCL-90-R (Derogatis, 1977) were

consistent with the mean of national samples.

29

30

e ' ts

The psychotherapists were all practicing therapy in the
Nashville community. There were seven psychiatrists and
eight clinical psychologists with several years of
postdoctoral experience (Range = 2 to 14 years). Nine were
male, and six were female. Nine therapists completed two
therapy cases. They all participated in the time-limited
dynamic psychotherapy (TLDP) training program under the
careful supervision of expert therapists in this method over
a period of six months. They were also closely supervised on
a training case during this time. The therapist's skills in
TLDP were assessed toward the end of this experience and
deemed acceptable. After the training, the therapists
conducted the therapies included in this sample.
IDQIQEX

Strupp and Binder (1984) advocate for a time-limited
dynamic psychotherapy that has an empirical basis. Clients
were paired randomly with therapists. Data from their files
were used in the present study. Interpretation was defined
as, "an intervention that enlarges the patient's awareness of
his or her current psychological state by a communication
that facilitates understanding of a current interpersonal
experience and the factors complicating it" (Strupp and
Binder, 1984, p. 165). Some of the principles therapists are
taught include emphasizing the here and now in transactions
between therapist and client, an interpersonal focus using

low level inferences, and maintaining a specific theme to

31

focus on with the client.

ID§LIBEQDL§
In; Inpepppgpnpipn Scoring Guide (ISG). The

Interpretation Scoring Guide was developed by Graham and May

 

(1989) to measure objectively the parameters that make up an
inference and to identify the different levels of
interpretation that therapists use (see Appendix B for
detailed instrument).

Interpretation is defined broadly in the ISG as, "any
therapist statement in a session that infers something about
the client that the client has not explicitly (i.e.,
verbally) expressed" (Graham & May, 1989, p. 56). The ISG is
made up of parameters and corresponding dimensions were
derived from an extensive review of the theoretical
literature. Parameters are those determining factors or
characteristics that are essential to the delineation of an
interpretation. The ten ISG parameters include Inference
Location, Causal Connection, Object, Content, Tense,
Immediacy, Depth, Topic Reintroduction, Specificity, and Form
of interpretation. Dimensions are subsets of the parameters
and provide a definition of each category contained within
each parameter e.g., for the parameter Content, the
corresponding dimensions are affective, behavioral, and
cognitive. In addition, the ISG identifies seven levels or
specific types of interpretations (e.g., Resistance,
Transference, Genetic, etc.) that have been both empirically

demonstrated and theoretically postulated to be of some

32

importance in the process of psychotherapy. These levels
were not used in this study. The ISG allows researchers to
quantify and qualify therapist interpretations as broadly or
as specifically as needed.

In the current study, the definition of interpretation
as stated above was used to identify interpretations in the
24 sixteenth session therapies. The ISG parameter, Depth,
was used to investigate the relationship between depth of
interpretation and security operations. The other ISG
parameters and the levels were not used.

The Depth parameter is defined as: The extent to which
the therapist departed from what the client explicitly stated
in an interpretation. This parameter consists of three
mutually exclusive dimensions: Substitution, Extension, and
Introduction. These dimensions are defined as follows:

1. Substitution: The therapist replaces the client's
nondenotative word or phrase with a more specific one. The
therapist substitutes a more narrowly defined word(s) for a
client verbalization that has a broader meaning. This is
similar to specifying a single object from a class of objects
(e.g., the client says flower, the therapist says tulip). If
it is unclear whether the therapist's statement is a subset
of the client's verbalization, then substitution is not
scored. The therapist's interpretation must refer to client
material that is readily identifiable in the transcript.
Importantly, synonyms are not included in this dimension

because they are restatements and do not include an

33

inference.

2. Extension: The therapist's interpretation includes
both reference to what the client has explicitly stated and
additional material that has not been verbalized by the
client. In an Extension, the therapist adds material that
goes beyond but is related to what the client has previously
expressed. The meaning of a client verbalization is either
added to or modified in some manner.

3. Introduction (of a new idea): The therapist 's
interpretation only contains ideas that the client has not
explicitly verbalized. The introduction of the new idea(s)
by the therapist must differ in meaning from what the client
actually said in the session. The therapist may reintroduce
an interpretation even though the client has not verbalized
any of this material after the first time it was presented.
These interpretations are still scored as introductions.

In; Seguzity Operations Inventony. Four investigations
(Gavrilides, 1980; Pottinger, 1982; Reyher, 1980; and Tobias,
1990) have used the Security Operations Inventory developed
by Reyher (1979). A subsequent extension of this inventory
(Reyher, 1989) increased the number of security operations
(SO) from 36 to 61, classified by category.

This most recent version of this instrument includes 34
of the items in the original inventory for which data were
available on personal power, happiness, and manifest anxiety.
Whereas mastery-dominant (M-D) SOs tended to load high in

personal power, high in happiness, and low in manifest

34

anxiety, submissive-compliant (S-C) SOs tended not to load
high in personal power and happiness and load high in
manifest anxiety, the mirror opposite of mastery-dominance.
Reyher (1992) then created a scale (see Appendix C) by
ranking the constituent $05 in terms of their joint loading
on the three differentiating variables (well-being, PPF,
anxiety). Each SO now has a score (rank) with respect to its
discrepancy from the mastery-dominant configuration on the
three variables. An investigator has the option of using the
inventory where each SO contributes a score of one or the
scale which permits the use of rank order statistics.

A new version of the Security Operations Inventory
called the Extended Security Operations Scale (ESOS) was used
to test the experimental hypotheses. The ESOS (Appendix D)
contains 40 80s. Thirty of the SOs contained in the original
inventory (Reyher, 1979) were used and can be scored based on
audiotapes alone. Loewenstein (1951) noted, "The therapeutic
effects of analytic interpretations are displayed not only in
objective and subjective changes in the patient, but also in
verbal manifestations . . ." (p. 12). Other investigators
have had success reliably rating verbal material (Duncan,
Rice, 8 Butler, 1968; Mahl, 1956; Rice 8 Gaylin, 1973; Rice 8
Wagstaff, 1967; Stiles, Shapiro, 8 Firth-Cozens, 1988, 1989;
Wiseman 8 Rice, 1989). Thus the effects of interpretations
can be recognized or perceived within the verbal context.

Some of the SOs from the original inventory could not be

reliably scored from an audiotape since they require actual

35

observation of the people involved (e.g., Head nodding,
Pasted on smile). These 805 were removed from the E508. Ten
additional SOs of interest in the present investigation were
taken from the most recent 80 scale (Reyher, 1989). By
consensus, Reyher and Graham inserted them into the E808 on
the basis of their similarity to one or more scaled 80s. The
ten 808 were Taking Charge, Nonanswers to Questions,
Skepticism, Facelessness, You Know, Self-effacement,
Apologizing, Silence, Stalling, and Incomplete Sentences.

In; Persona; gpyg; Functions Profile. The Personal
Power Functions Profile (PPFP) was developed by Reyher in
1979 (see Appendix E) to complement the Security Operations
Inventory . This instrument has been used effectively in
previous studies (Gavrilides, 1980, Hamernik, 1987, and
Tobias, 1993). The profile consists of sixteen different
personal power functions that provide a measure of an
individual's power in a relationship. The profile is further
divided into four subcategories: personal characteristics,
interpersonal skills, physical characteristics, and
personal-social attributes. These functions are scored using
a scale ranging from one (low power) to five (high power).
The seven power functions used in this study were
Knowledge/Ability/Talent Germans to Interaction, Savoir
Faire, Voice, Speech, Expression of Ideas, Authority, and
Education. Personal power scores can range from 7 to 35.

The personal power functions of Physical Attractiveness,

Height, Stature, Attire, Carriage, Socio-Economic Status,

36

Personal Fame, Family Fame, and Eye Contact were not used
because the information was not available or it could not be
determined based on audiotapes alone.

232902;:

The third and sixteenth therapy sessions, videotaped at
Vanderbilt University, contributed videotapes, audiotapes,
and written transcripts to the data set. All the other
sessions were audio-taped and conducted at the therapists'
private offices. Only the audiotapes and transcripts for
sessions three and sixteen were made available for this
study. Clients had to complete the entire 25 session
therapies for inclusion in the study. The sixteenth therapy
session was selected over the third because it was believed
that a more representative sample of therapist
interpretations would be present based on the time-limited
dynamic psychotherapy model (Strupp 8 Binder, 1984).
ann pg; - ppepanation pf vepbatim pherapy ppptocols

First two raters identified and scored the specific $05,
when present, for each client and therapist verbalization
contained in each of the 24 therapy transcripts as described
above. Both raters had to agree that there was an SO present
for it to be scored on the ESOS. Thus, each therapist and
client verbalization was scored for the presence or absence
of 80s. It is noted that there may be more than one SO per
verbalization. A client verbalization was combined with the
next client verbalization when there was no intervening

therapist verbalization listed on the transcript, i.e., a

37

blank line and nothing identifiable on the audiotape. The
same procedure was done for therapist verbalizations. If
there was intervening text, then verbalizations were combined
based on grammatical, syntactic, and semantic considerations
as well as structural discourse, i.e., turn of speech. For
example, the therapist is talking, then pauses briefly before
continuing and then both therapist and client begin talking
at the same time (marked "simultaneous" on the transcript),
the therapist's verbalization would be combined with his or
her previous verbalization and the client's verbalization
would be combined with his or her subsequent verbalization.
Both verbalizations would retain their respective SO scores.

Epints pf interes . Five points of interest in the
verbatim record were selected for analysis.

The first point of interest is the therapist's
interpretation (TI) itself. There had to be 100% agreement
among raters on the ISG for an interpretation to be included
in the scoring procedure outlined above. Therefore, for each
client-therapist pair (n = 24), there is 100% agreement for
those interpretations that are identified. Each client-
therapist pair generated a different number of
interpretations per session. Also, interpretations can be
proffered in response to any client statement or to follow-up
a previous interpretation. Some TIs continued onto the next
therapist verbalization, so they were included as part of the
TI.

The second point of interest in the verbatim record is

38

the client response (CRI) following a TI. CRI will be used
throughout the remainder of the text to represent client 808
following therapist interpretation only. CRI consisted of
those client SOs immediately following TI. When the client
response continued onto the next client verbalization, it was
included as part of the CRI.

The third point of interest is the therapist's
subsequent response (TRI) to CRI. This includes TIs that
occur after the initial CRI. TRI will be used throughout the
remainder of the text to represent therapist SOs in response
to CRI. TRI consisted of those therapist 805 immediately
following CRI. When the therapist response continued onto
the next therapist verbalization, it was included as part of
the TRI. Therefore, TI could also be considered a TRI.

The fourth point of interest is the therapist's 805 in
response to client (TRC) following each client verbalization.
TRC consisted of those therapist 805 immediately following
CRT (see below) or CRI. When the therapist response
continued onto the next therapist verbalization, it was
included as part of the TRC.

The fifth point of interest is the client's $05 in
response to therapist (CRT) following each therapist
verbalization. CRT consisted of those client SOs immediately
following TI, TRI and TRC. When the client response
continued onto the next client verbalization, it was included

as part of the CRT.

39

DQEQ :egnction

The verbatim data (transcripts) had to be prepared in a
variety of ways to facilitate the use of the ISG and the
ESOS. Additionally, the raters' ratings on the ISG and E808
had to be processed in a variety of ways in preparation for
statistical analyses. These changes in the data set are
detailed below.

Ingram-$821211 Scoring 9111913 ESQ).- Four advanced
graduate students in clinical psychology at Michigan State
University, who had at least one year of practicum
experience, scored therapy transcripts using the ISG. They
were extensively trained over the course of five months on
sample material. The sample therapy sessions used for
training were selected from published transcripts by Wolberg
(1954) and Snyder (1963). Scoring interpretations with the
ISG was a multi-step process described in a 34-page training
manual (see Appendix B). This procedure is outlined below.

First, each rater carefully read written transcripts of
the 24 psychotherapy sessions and identified all therapist
verbalizations containing inferences about the clients. They
then met as a group and reached a consensus on which
therapist verbalizations were actually inferences. If the
raters did not agree that there was an inference, the
statement was discussed and both sides of the disagreement
were processed with the principle investigators. If
agreement could not be reached within a reasonable amount of

time (approximately 10 minutes) or if the raters thought that

40

they could not reliably rate a given statement, then it was
dropped from subsequent ratings. If agreement was reached,
then the inferential statement was marked as an
interpretation.

These interpretations were then numbered and divided
into three basic units for scoring according to the ISG:
clause, sentence, and segment. These were defined as
follows: A clause (independent or dependent) is a group of
words that have a subject and a predicate; a sentence
contains one or more clauses and expresses a complete
thought; and a segment is a group of sentences containing at
least one inference. If a clause or sentence contained a
pronoun, raters replaced the pronoun with actual text where
it could be readily identified from the transcript and all
raters agreed with the modification (e.g., 'it' is replaced
with 'intellectualizing' because the therapist is referring
to something the client just said). A pronoun was designated
as general if the raters could not identify any actual text
in the transcript to which the pronoun referred back to.
Pronouns were modifed so that the raters were scoring
identical material.

Once modifications were completed, the transcripts were
randomly distributed among the raters so that each of the
four graduate students scored 18 of the 24 sessions. With
this arrangement, each transcript was scored by three raters.
The raters independently scored their 18 sessions on all of

the 10 operationally defined parameters and dimensions. Once

41

this was completed, the raters categorized the
interpretations on one or more of the seven interpretive
levels from the ISG.

Raters were monitored on a regular basis in terms of the
agreement and reliability of their ratings compared to expert
ratings. This was to ensure a minimum of rater drift.
Portions of a short-term therapy session that was not part of
the data set were rated periodically throughout actual
scoring with the ISG to check rater agreement. Supervision
was provided when errors in procedure needed correcting or if
there were questions about rating the material. Questions
about the scoring system were answered based on the
instructions. Discussion of any material not relevant to the
scoring procedures was deferred until the ratings were
completed.

Depth was the only parameter from the ISG used in this
study. At least 2 out of 3 raters had to agree on a
particular Depth dimension. Most of the ratings on Depth
(96.3%) met this criterion. When this criterion was not met,
e.g., each rater selected a different Depth dimension for the
same interpretation, Extension was marked because it includes
aspects of both Substitution and Introduction (see
descriptions above) in addition to the fact that one rater
did mark Extension.

The three ISG Depth dimensions were rank ordered based
on how far removed the therapist's interpretation was from

what the client said i.e., moving from being within the

42

client's awareness to outside of their awareness. The
resulting rank order was Substitution = 1 (aware), Extension
= 2 (partially aware), and Introduction = 3 (unaware). These
rank ordered values were assigned to each interpretation,
based on the ISG Depth ratings, and labelled Depth score. If
a therapist interpretation contained more than one inference
and the Depth score for each inference was different, then an
average Depth score was calculated (e.g., Extension = 2 and
Introduction = 3; so the Depth score would be 2.5). There
was a Depth score for each interpretation.

Raters were blind to the hypotheses of this study.

Expnnggg Security Operations Sgnig (ESOS). Two
undergraduate students were recruited to rate the therapy
transcripts using the E808. They received both research
credit (see Appendix F for consent form and Appendix G for
the written debriefing summary) and money for their
participation. Training consisted of studying the
definitions and descriptions of the different 805 to ensure
that the raters understood the meaning of each one; reviewing
written examples of the 803 (see Appendix H for training
materials); rating a partial transcript as a group and
discussing the procedure; scoring complete sample sessions
individually and meeting as a group to evaluate and discuss
the ratings so that each rater was familiar with the rating
system.

Sample therapy sessions selected from published

transcripts by Snyder (1963) were used to rate 805 based on

43

the content of therapist and client verbalizations. A
published transcript and the accompanying tape taken from
Budman and Gurman (1988) were used for training the raters to
discriminate SOs based on tone of voice, patterning of
speech, etc.

Given that the raters engage in interpersonal
interactions where 505 are likely to be employed, it is
expected that they will be able to discriminate and identify
SOs based on their own personal experiences. In addition,
voice tone provides important information and is an ingrained
part of the subculture, so the raters will know how to decode
that piece of the data and apply it to the scoring of SOs.

Raters scored the actual therapy sessions for 805 while
listening to an audiotape and following along with the
session transcript. Client and therapist verbalizations were
numbered sequentially on both the transcripts and the rating
sheets used to record the ratings so that ratings matched up
with the corresponding text in the transcripts. Ratings were
completed on all verbalizations contained in the transcripts.
Interpretations were not identified anywhere on the
transcripts or rating sheets.

Raters were monitored on a regular basis in terms of the
agreement and reliability of their ratings compared to
independent ratings completed by the principal investigator.
Half of a short-term therapy session that was not part of the
data set was rated halfway through the rating process to

check rater agreement on the E808 and correct any rater

44

drift. Supervision was provided when errors in procedure
needed correcting or if there were questions about rating the
material.

Raters were blind to the hypotheses of this study.

Egpgpnnl 2922; 2nnctipns 22921;; 122221. The principle
investigator and another graduate student rated the therapy
tapes using the PPFP. Both raters were already familiar with
the instrument and needed only minimal training. Training
consisted of studying the descriptions of the different PPFP
variables to ensure that the raters understood the rating
scale; reviewing examples of specific qualities to listen for
while rating the audiotapes (see Appendix I for training
materials); rating a partial transcript together and
discussing the procedure; evaluating and discussing the
practice ratings so that each rater was familiar with the
rating system.

Portions of seven therapy sessions on a therapy tape
taken from Budman and Gurman (1988) were used for training
the raters to discriminate PPFP scores based on tone of
voice, patterning of speech, content of verbalizations, etc.
In addition, a sample therapy tape from the data set was used
to complete training following the procedure below.

Raters scored the actual therapy sessions on five PPFP
variables (Knowledge, Savoir Faire, Speech, Voice, and
Expression) while listening to an audiotape of each therapy
session. The PPFP variables of Education and Authority were

obtained from demographic data that was available on both the

45

clients and therapists. Ratings began approximately five
minutes into the sessions because it generally took a few
minutes for clients and therapists to get situated in the
room. Raters were able to complete their ratings using the
next fifteen minutes of the audiotapes. They worked
independently on their ratings while listening to the
audiotapes together. Previous ratings were covered with a
sheet of paper to minimize their effect on subsequent
ratings. Ratings were set aside after they were completed
for each therapy session.

Next, the raters worked together to arrive at a
consensus PPF rating. They discussed the previous ratings
and material from the audiotape until agreement was reached
for the consensus rating. The audiotape was played again if
the raters needed to listen to a particular passage to
identify material in the session relevant to making a final
rating. This served as a check on the procedures and
provided a consensus score to compare the independent ratings
against. The independent ratings were combined into an
average PPF rating score. Then the average scores for each
of the seven personal power functions were added together to
make an overall PPF score. There was an overall average PPF
score for each client (n = 24) and therapist (n = 24) in the

data set. This score was used for statistical analysis.

Results

W

Interrate: agpggngnp. Interrater agreement provided a
measure of how well the scoring criteria were adhered to for
the dependent measures. The greater the agreement, the more
fairly the hypotheses can be tested. Interrater
reliabilities for Personal Power Functions, Interpretation
Depth, and Security Operations are presented below. The
critical values for all the Spearman rank order correlations
throughout were taken from E. G. Olds (1938).

Egzspnnl ppyg; fnnctions. The average score of the two
raters' ratings of personal power functions (PPF) was used.
Average PPF scores derived from the original independent
ratings of both raters were selected to represent client and
therapist personal power. Rater reliabilities on these
ratings were low but acceptable (Kraemer, 1981) for both
client PPF, Ls = .61, p < .005, and therapist PPF, Is = .63,
p < .001. In comparison, Gavrilides (1980) obtained high
interrater reliability (r = .90) on the full PPFP. The fact
that the more objective personal power functions were not
available and, therefore, not included, might account for the
lower reliabilities in this study.

Comparing the average PPF intercorrelation coefficients
(APIC) with the consensus PPF intercorrelation coefficients
(CPIC), by inspection, they are very similar (see Table 1).
For therapist PPF, the APIC are higher than the CPIC (8 out

of 10). Education and Authority PPF scores, 3 and 4

46

47

respectively, were identical for the therapists. For client
PPF, the APIC are higher than the CPIC (7 out of 10 and 1
tie). Education and Authority PPF scores favor APIC over
CPIC (6 out of 11 and 2 ties) for the clients. In addition,
the average PPF scores and the consensus PPF scores are
essentially identical. Thus the rating methods are regarded
as equivalent. Contrary to my expectations, the CPIC did not
perform better than the APIC. In fact, the trend is that it

performed worse.

Comparing therapist APIC with client APIC, the
correlations are all positive in the therapist matrix,
suggesting coherence. The correlations in the client matrix
are mixed with respect to sign of the correlations,
suggesting incoherence. This difference could be attributed
to the clients use of submissive-compliant $05 or the
resulting narcissitic injury or decrease in euphoria by being
placed in the client role is proportionate to the disparity
in clients' authority and education.

Qgppn. From the Interpretation Scoring Guide (ISG), a
criterion of at least 2 of 3 raters in agreement on the Depth
rating was established. Such agreement occurred 96% of the
time, but this is illusory because the agreement of all three
raters was much less, 45%. Unlike the pilot study,

interrater reliabilities were disappointing (see to Table 2).

48
Table 1
sennnrisen ef.1nsereesrelnsien Coefficients Betneen Axereee
BEE and sensensns BEE fer Beth Inereeists ens Elients
Entries in the body of the table are average PPF
intercorrelation coefficients and entries in parentheses

are consensus PPF intercorrelation coefficients.

 

Therapist PPF

 

 

 

KN SF SP vo
SF .12 (.45)
SP .37 (.12) .37 (.19)
vo .57 (.40) .46 (.39) .56 (.40)
EX .43 (.36) .36 (.44) .49 (.42) .43 (.37)
Client PPF
KN SF SF vo EX ED

SF .42(.48)

SP .22(.o7) -.22(-.22)

vo .32(.37) -.40(-.27) .57( .37)

EX .50(.38) .30( .14) .53( .31) .40( .56)

ED .08(.06) .28( .15) -.02(-.26) -.01(-.01) .48(.40)

AU -.12(.03) .33( .25) -.36(-.50) -.20(-.26) .04(.04) .43*

 

uppg. PPF means personal power functions. KN = Knowledge
germane to the interaction; SF = Savoir Faire; SP = Speech;
VO 8 Voice; EX = Expression of ideas; ED = Education;

AU = Authority.

*Average and consensus correlation coefficients

were identical.

49

The defining criteria for Depth, based on the ISG, were
inadequate and the lack of examples contributed to the lower
reliabilities. In addition, the graduate students may have
been biased by their own theoretical views in rating Depth
and the 24 therapy transcripts were verbatim material whereas

the training materials were edited and much easier to rate.

§ecunipy pperations. The overall agreement for the
presence of $03 was 93% (range of 79% to 100%). That is,
raters agreed that an 80 exists but they do not necessarily
agree on which particular SO is present. For example, both
raters agreed that there is an SO contained in a client
verbalization, but one rater rated it as Take Charge and the
other rated it as Turning the Tables. However, since both
raters had to agree that there was an 80 for it to be
included and scored, SOs identified (presence of) by only one
rater were not included.

Combining all twenty-four sessions, rater agreement for
each of the forty SOs varied from -0.001 to 0.976 (Pearson
product-moment correlationsl). The smaller correlation

coefficients tended to result from a low frequency of 80

scores for that particular SO. Most of the correlation

1. Pearson product-moment correlations were calculated on the
raw data to determine interrater reliabilities.

SO

 

 

 

Table 2

Interreter Belieeilities fer Dense ef Intereretetien
Raters

Raters BC TC DF

TC .18 .37 .72

DF .36 .21

cm 33

 

rater 2. DE rater 3.

292;. BC = rater 1. TC

CM = rater 4.

51

coefficients are acceptable. For the others that are not at
acceptable levels of agreement, the operational definitions
and examples need to be improved or those particular SOs need
to be dropped from the scale. Refer to Table 3 for a summary

of Pearson correlations for each of the forty $03.

It was necessary to account for multiple 80 scores
contained in some of the client and therapist responses. In
addition, SO ratings needed to reflect only one score per
response. Therefore, rater SO scale scores in the same
response were combined into a mean 80 score. This score was
used in the data analysis and statistical calculations to
test the hypotheses.

gpnglngipn. Rater agreement is low but at acceptable
levels for PPF and Depth; however, it varied considerably for
the particular type of 80 (Table 3). Some of the 805 were
scored infrequently, and the corresponding interrater
reliabilities were very low. According to Kraemer (1981),
most of these rater reliabilities would be regarding as
acceptable but possibly improvable. Therefore, the
hypotheses may not receive a fair test.

Erelininerx ene_1_1 ses

These are routine exploratory comparisons which were not

theory-driven; nevertheless, the outcomes are either

consistent or inconsistent with the theoretical model under

52

 

 

 

Table 3
Interremraelienilitiesfereeeneftnefieeensxeeemsiens
S.O. Pearson ra S.O. Pearson r
Interrupting 0.76 Obsequiousness 0.55
Take Charge 0.38 Char. Bld. I 0.37
Repartee 0.47 Questioning 0.73
Dramatization 0.74 Diffidence 0.31
Sentence Finishing 0.67 Qualifying 0.51
Teasing 0.48 Exemption 0.28
Turning The Tables 0.41 Facelessness 0.51
Humor 0.44 You Know 0.89
Arm Twisting 0.60 Char. Bld. II 0.61
Incessant Talking 0.30 Self-justify 0.52
Changing Topic 0.63 Self-efface 0.47
Annoyance 0.46 Apologizing 0.71
Security Blanket 0.43 Char. Bld. III 0.40
Connecting 0.68 Reassurance 0.30
Placation 0.56 Silence 0.96
Disparagement 0.13 Taciturn 0.33
Nonanswers to Questions 0.11 Stalling 0.76
Skepticism 0.31 Word Change 0.66
Side-stepping 0.16 Incom. Sentence 0.61
Dissembling 0.00 Automatic Laugh 0.98
uppg. 8.0. = security operation. Char. Bld. = Character

Building.

Incom. = Incomplete.

aPearson product-moment correlations coefficients

calculated on the raw data over all (n = 24) sessions.

Used for convenience.

Very similar to Spearman rank

correlations calculated on a subset of these data.

53

test.
Egpspnn; 29222 Ennctions Protile

2gpgpnnl ppygp. A differential power score (Difpower)
was calculated by subtracting the client personal power score
from the therapist personal power score. Twenty-one of
twenty-four client-therapist pairs favored the therapist in
terms of personal power (PPF). Of the three remaining pairs,
one pair was equal in PPF and the other two had power scores
favoring the client over the therapist. Thus, consistent
with therapists being more powerful and intimidating, they
possessed greater overall personal power than clients. The
medians for therapists and clients were 26 and 22
respectively. The former ranged between 20.5 and 29.0, and

the latter ranged between 16.5 and 26.5. The Sign test was

significant, 3 = 2 (N 23), p < .005.

Examining the distributions of PPFP scores (refer to
Figure J-1 in Appendix J), the histograms illustrate that
therapist scores were approaching a normal distribution or
were skewed to the left. Client scores were either bi-modal
or shewed to the right, opposite that of the therapists.
This suggests that there is an orderly, functional
relationship.

Inconsistent with background theory (Sullivan, Freud,
Ethology), therapist PPF scores and client PPF scores
appeared to be functionally related, as revealed by a

positive correlation between them, gs = .34, p < .06, that

approached significance. That is, therapist and client

54

personal power functions covary in the same direction.
Unfortunately, there is no way of ascertaining what is
happening to account for this: Does high therapist PPF
elicit high client PPF? Perhaps the reverse is true and low
client PPF elicits low therapist PPF.

gpnppngnpinl analysis 92 PPFP scale. The uniform

disparity between client-therapist mean PPF scores (see Table

 

4) favoring therapists indicates that the latter were indeed

more powerful and, therefore, intimidating.

Table 1 above shows the interrelations between the
components of PPFP. Whereas the 10 coefficients in the
therapists' matrix were all positive and often significant (9
out of 10), two in the clients' matrix were negative.
Moreover, five of the correlations involving Authority and
Education, which could not be done for therapists, were
negative. Consistent with the theory under test, client
intimidation (loss of euphoria) is proportionate to their own
level of education and authority. If these results are taken
at face value, then interpretive methods of psychotherapy
appear to be counterproductive.

We 'teperetiens
§ubnissive-compliant security operations nggl.
Consistent with the provisions of the theory under test, that

clients would be more submissive-compliant in relation to

55
Table 4
Mean Rener seeres fer Thereeist 22: ene glient BEE
eased en the Bersenel Bener Ennetiens firefile

Entries in the body of the table are mean PPF scores

n = 24) and entries in parentheses are standard

deviations.

 

Mean scores (SD)

 

 

 

Power function Therapist PPF Client PPF
Knowledge 3.79 (0.72) 3.27 (0.71)
Savoir Faire 3.50 (0.49) 2.81 (0.51)
Speech 4.10 (0.42) 3.69 (0.36)
Voice 3.75 (0.77) 3.44 (0.65)
Expression 4.15 (0.56) 3.48 (0.54)
Authority 3.00 (0.00) 2.58 (0.97)
Education 4.00 (0.00) 3.29 (0.87)
uptg. PPF means personal power functions.

56

therapists given therapists' role and "favored status" in
therapy, clients used more submissive-compliant 805 than did
therapists. The average median scale values for clients and
therapists were 16.74 and 28.05 respectively. The former
ranged between 6.64 and 25.94, and the latter ranged between
17.73 and 34.50. The Sign test was significant, 2 = 0

(fl = 24), p < .001.

Qiient response following therapist interpretation

 

12211. Consistent with the provisions of the theory under
test, that interpretations decrease client euphoria, clients
used a high percentage of SOs following an interpretation.
Overall, clients used an 80 after an interpretation 87% of
the time. Within each therapy session, clients responded to
interpretations with $05 anywhere from 67% to 100% of the
time (Table 5). Once again, interpretive methods of

psychotherapy appear to be counterproductive.

Therapist response following interpretation 11211.
Consistent with background knowledge on clients' typical
limited acceptance or side-stepping SOs, therapists
experience a decrease in euphoria and therefore typically
employ 805 following a clients' response (usually an SO) to
interpretations. Overall, therapists responded to a CRI with
an SO 61% of the time. Within each therapy session,

therapists responded to CRIs with 805 ranging from 22% to 92%

57

Table 5
BemnteeeefennetnnelnereeLstSeenritxMerat'
Responsss Epllpying Intespretstions sng Noninterpretation
spspements

Entries in the body of the table are percentages.

 

Interpretation response Noninterpretation response

 

 

 

Case Client Therapist Client Therapist
01 96 78 62 65
02 82 68 71 48
O3 72 4O 62 46
04 82 74 73 59
05 83 92 82 76
06 100 74 63 57
07 92 25 85 52
O8 82 41 71 59
O9 94 47 83 32
10 100 44 8O 63
11 75 54 61 62
12 90 71 81 65
13 88 36 76 38
14 82 59 76 68
15 81 63 80 43
16 100 60 78 42
17 80 90 7O 60
18 67 61 64 35
19 88 67 63 51
20 94 88 9O 61
21 89 22 81 45
22 94 39 75 39
23 93 73 88 73

24 86 57 58 21

_¥

58

of the time (Table 5). This finding diminishes claims that
therapists can be objective.

Inergpist response following pligp; yerpplipppipp 11391.
In accord with Sullivan, 803 are ubiquitous. Therapists
responded with an 80 after client statements (noninterpretive
event) 54% of the time, with a range of 21% to 76% (Table 5).
Consistent with their intimidation by client nonacceptance of
S08, TRC (excluding TRI) was less than TRI (54% vs.
61%)(Wi1coxon, I = -75.5, g = 22, g = -1.66, p < .05).
Again, the evidence favors the claim that therapists self-
system is too involved for them to be objective.

gligpp response following therapist verbalization 1932).
Once again documenting the ubiquity of SOs, overall, clients
responded with an SO after TRC (excluding TRI) 73% of the
time. For each therapy session, the range was 58% to 90%
(Table 5). Consistent with the inherent intimidation of
therapists' interpretations, CRT (excluding CRI) was less
than CRI (73% vs. 87%)(Wilcoxon, 1 = 0, fl = 24, p = -4.29, p
< .0001).

Cpmparispp p; glient gpg therapist security ppgpgpippg
fpllpgipg ppth ipterpretatiop and nonipterpretatigp
s e e s. Consistent with their disadvantage in PPF,
clients responded with an SO more often than therapists
following an interpretation (87% vs. 61%)(g = 522.5, E = 48,
p < .0003). Moreover, clients also responded with an SO more

often than therapists following a noninterpretation statement

(73% vs 54%)(g = 519, n = 48, p < .0003). Overall, clients

59

used 80s more often than therapists in the therapy sessions,
revealing their greater intimidation.

Examining the distributions of SO scores (zero scores,
representing no security operation scored, were taken out of
the histograms, refer to Figure J-2 in Appendix J), the
histograms illustrate that therapist scores were skewed to
the left following both interpretations and
noninterpretations while client scores were shewed to the
right following both interpretations and noninterpretations.
This suggests that there is an orderly, functional
relationship in the way clients and therapists use security
operations.

Clients did not use an 80 following TI only 13% of the
time. With regard to acceptance of interpretations, some
portion of that 13% would possibly be included.
Unfortunately, the question of TI acceptance by the client
goes beyond the scope of this study but these findings do
suggest that clients parry interpretations most of the time;
that is, they are not accepted.

ingrppigr interpretation Lil). There were 24 client-
therapist pairs with 464 interpretations made by the
therapists collectively. The mean number of interpretations
per session was 19.3, ranging from 5 to 34. The percentage
of therapist utterances that were interpretations ranged from
5% to 38%. Therapists followed a client's response to an
interpretation with another interpretation almost 30% of the

time. Consistent with their intimidation by client

6O

nonacceptance of interpretations, it is not surprising that
they responded with another interpretation, when clients
responded with an 80. This is not in accord with the
therapeutic task of helping clients deal with the impact and
aftermath of an interpretation.

When proffering an interpretation, therapists went
beyond a client's awareness [introduction depth level: The
therapist interpretation only contains ideas that the client
has not explicitly verbalized (refer to ISG in Appendix 8)]
over 50% of the time. Consistent with both Sullivanian and
Freudian theory, deep interpretations are more intimidating
than shallow ones. When therapists' interpretations went
beyond a client's awareness, it led to a high frequency of
client 80s (74%). For Sullivan, this would imply
disapprobation; for Freud, this would suggest that the client
was unprepared for such "insight."

ngrapigr experiencg. In exploring the data further,
therapists' years of therapy experience was significantly

correlated with PPF, (rS = 0.48), t =

2.59, p < .02. So as
years of therapy experience increased, therapists tended to
possess more personal power.

Cppclusiop. Although the foregoing contrasts are
consistent, for the most part, with the theory under test,
they were not formulated as hypotheses or predictions
beforehand. Therefore, they have less
confirmatory/corroborative impact, i.e., the theory did not

"stick its neck out," compared to the experimental hypotheses

61

below (Popper, 1959).

The preliminary analysis attested to the apparent
validity of the two research instruments (PPFP and E808);
they behaved as they should, often significantly, in a
variety of contrasts. Also the relationship between personal
power (clients low, therapists high) and SOs (clients' median
80 score lower than therapists' median 80 score) is
consistent with Gavrilides (1980) findings. This empirical
appearance of validity ensured that the experimental
hypotheses were provided a fair test in the present
investigation. There is no question as to the ability of the
designated instruments of mensuration to order data
(observations) and to enter into significant and meaningful
relationships with each other (Hilgard, 1969).

'c ' ns. Even though uniformly consistent with the
theory under test and background theory, the foregoing post
hoc comparisons do not have empirical content (Popper, 1963).
Only where theory "sticks its neck out" by making a
prediction is there empirical content. Nonetheless, a theory
is better off if there is consistency rather than
inconsistency in post hoc findings (Popper, 1963), i.e., it
accommodates experimental facts not associated with
successful predictions. Post hoc and ad hoc claims of
consistency are more apt to involve the stretching and
twisting of theoretical propositions than does logically
deriving hypotheses from them (J. Reyher, personal

communication, September 24, 1995).

62

The negative light in which this particular interpretive
method (Time-Limited Dynamic Psychotherapy) is cast is both
surprising and discouraging.

Expgripgprpl hypotheses:

flypprhggig 1_. This hypothesis, which asserts that
mastery-dominance level of client SOs, as measured by the
E808, following each therapist verbalization is inversely
related to the discrepancy (dif.PPF) between therapist and
client personal power, was not corroborated, rs = -.21,

p > .10 (Table 6). Although this hypothesis did not achieve
statistical significance, it was certainly in the predicted
direction (negative). The low reliabilities in PPFP may have
contributed to this. Perhaps this could have been remedied

if the more objective dimensions of PPFP had been available

on videotape or other sources.

nyppthesis 1h. This hypothesis, which asserts that
mastery-dominance level of client 80s, as measured by the
E808, following each therapist interpretation is inversely
related to the discrepancy (dif.PPF) between therapist and
client personal power, was not corroborated, rs = -.01,
p > .10 (Table 6). The obtained correlation is only trivially

in the predicted direction (negative).

63

 

 

 

Table 6
Spearman Bank Order Correlation Coefficienrs Eerween Personal
Bower 12221 and Median.§egnrirx Operation l§21 Scores
Personal power
Differential Client Therapist
participants PPFa PPF PPF
Client
CRIb -0.01 0.06 0.20
CRTC -0.21 0.09 -0.03
Therapist
TRId 0.46* -O.18 0.36**
TRCe 0.37** -0.11 0.38**

 

395;. n = 24. Critical values for the Spearman's rank order
correlation coefficients taken from E. G. Olds (1938). TI =
therapist interpretation. CR = all client SOs & non 80s in
response to all therapist verbalizations. TR = all therapist
SOs & non SOs in response to all client verbalizations.
aDifferential power obtained by subtracting client personal
power (PPF) score from therapist personal power (PPF) score.
bCRI = client SOs following TI only.

cCRT = client 805 following both TI and TR.

dTRI - therapist SOs following CRI only.

eTRC = therapist SOs following both CRI and CR.

*9 < .025. **p < .05.

64

hypprhgsip 11;, This hypothesis, which proposed that
the mastery-dominance level of therapist 805, as measured by
the E808, following each client verbalization is directly
related to the discrepancy (dif.PPF) between therapist and
client personal power, was corroborated, rs = .37, p < .05
(Table 6).

flypprhggig ILQ. This hypothesis, which proposed that
the mastery-dominance level of therapist SOs, as measured by
the E808, following each therapist interpretation (TI) is
directly related to the discrepancy between therapist and
client personal power (dif.PPF), was corroborated, rs = .46,
p < .02 (Table 6).

flypprhgsig ILL. This hypothesis asserts that depth of
therapist interpretation is (a) directly related to the
discrepancy (differential power) between therapist and client
personal power, but (b) is inversely related to client
mastery-dominance level (client SOs as measured by ESOS).

a. Interpretation depth and dif.PPF were not related as
predicted, rs = .12, p > .10. Once again this failure to
corroborate is mitigated by the obtained correlation being in
the predicted direction and the relatively low reliability of
the abbreviated PPFP.

b. Client mastery-dominance level and depth of
therapist interpretation were not related as predicted, rs =
-.06, p > .10.

Both part a and b of this hypothesis were not

corroborated. The minimally acceptable interrater

65

reliabilities associated with Depth have contributed to these
disappointing findings. As discussed later, the levels of
depth were insufficiently delineated and were not clearly
defined.

Hypothesis i_, This hypothesis, which proposed that
total number of interpretations proffered by therapists is
directly related to the discrepancy (dif.PPF) between
therapist and client personal power, was not corroborated, rs
= -.29, p < .09. Moreover, the obtained correlation (-0.29)

was negative and approached significance (rs, .05 = -0.34).

Discussion

Evaluating the impact of interpretations in therapy
based on extended Sullivanian theory was the main purpose of
this study. Overall, the findings are mixed regarding the
hypothesized relationships between personal power and
security operations. The success of only one of the four
experimental hypotheses reveals some of the limitations of
the theory under test, despite its consistency with the
preliminary analyses. One limitation was the low rater
reliabilities on PPFP and Depth. Another limitation was the
varied reliabilites on ESOS. Nevertheless, PPFP and E808
entered into a variety of orderly relationships based on
results from the preliminary analyses. Depth did not have
the same opportunity to demonstrate its scientific value.

Only the magnitude in differential PPF in relation to
therapist's SOs (hypothesis II) survived falsification.
Fortunately, this hypotheses happens to be derived directly
from the most central conceptual region of the theory without
the need of auxiliary hypotheses other than those relating to
the instruments used (PPFP and E808); namely, the relation
between relative personal power and type of security
operations.

In contrast, the corresponding derivation for clients
was not corroborated (hypothesis I). Even though clients
used more security operations in the therapy sessions than
therapists, they did not display a behavior pattern of

submissive-compliance hypothesized to be consistent with low

66

67

PPF.

The relation between type of SO and Depth of
interpretation (hypothesis III) is complicated by the
inclusion of additional auxiliary hypotheses relating Depth
to the personal power of the therapist, thereby increasing
the separation between the theoretical core and dependent
variables. There is a thicker "protective belt" of auxiliary
hypotheses (Lakatos, 1979). This hypothesis as stated was
not corroborated.

Hypothesis IV also requires additional auxiliary
hypotheses to relate frequency of interpretation to personal
power. Despite discorroboration, the results do suggest the
possibility of interpretations functioning as intimidating
SOs when the therapist's self-system perceives a threat or
anticipates a lowering of euphoria. Proffering an
interpretation may momentarily increase experienced power of
the therapist's self-system but decrease experienced power of
the other participant in the interaction.

Why the difference between therapists and clients?
Perhaps being in the disadvantaged side of the dyad, clients
are continually striving (a dynamism) to "right themselves",
in Sullivanian theory, that is, to integrate the relationship
with the therapist wherein they can obtain deference in the
integration. This dynamism is presumed to be intensified as
differential in personal power increases. This righting
dynamism, analogous to the righting reflex, generates verbal

attempts to assert mastery-dominance which therapists are

68

likely to construe as resistance against emerging dissociated
material (i.e., lust dynamism, "bad" personifications). This
is not to say that this reaction accounts for all resistance.
In one context Sullivan (1953) relates this to an attempt, in
some relationships, for the participants to extract deference
from each other in their pursuit of security. This ad hoc
explanation requires installing righting behavior as a
central theoretical construct in the conceptualization of the
self-system. In a Popperian perspective, this would only add
empirical content to the theory if it provided a falsifiable
prediction. Accordingly, one testable prediction is that the
righting reaction of a person with low relative personal
power in a dyad would be displayed in projective stimuli
(e.g., TAT) as "turning the tables" and becoming dominant,
whereas enjoying mastery-dominance would be displayed for the
member of the dyad enjoying high relative personal power.
However, this remedial tactic also requires that personal
power be installed as a central construct in the self-system,
that is, in addition to only being attentive to forbidding
gestures, the self-system would equally be alert to
extracting deference from others.

Such massive theoretical surgery is not required in
Reyher's (1992) extension of Freud's conceptualization of the
ego interests; namely, the ego's attempt to extract an
advantage from any interpersonal situation and thereby
experience satisfaction. As previously noted, the extended

Sullivanian theory under examination already includes

69

ethological components; namely personal power, dominance
hierarchy, and implicit agonistic dominance.

In regard to Depth (Hypothesis III), only some types of
interpretations would cue a righting reaction.
Interpretation pertaining to content, resistance, and
transference, particularly, the latter two, should reliably
produce it, whereas stitching together recollections
interpretively to construct a coherent life story
(hermeneutic perspective) should not be as reliably causal.
The same should be true for nondirective (Rogerian)
reflections.

Frequency of interpretation (Hypothesis IV) ignores type
of interpretation and requires the same auxiliary hypotheses
as does Depth. It also assumes a nontonic, linear
relationship between rate of interpretations and lowering of
euphoria. One "ugly" ad hoc explanation (ad hoc3, [Lakatos,
1979]) is that there might be a point where selective
inattention (Sullivan) intervenes - clients no longer pay
attention but give the appearance of listening. However,
this is not a mere auxiliary hypothesis. This turn off
point, if it indeed exists, is both idiosyncratic and
variable and must be determined empirically as it happens
(e.g., failure to maintain eye contact, cessation of eye
blinks) but is likely to be undetectible.

Summary. The intent of this study was to examine an
extended Sullivanian theory by assessing the effects of

personal power on the selection and use of security

70

operations by both clients and therapists following therapist
interpretations in brief time-limited dynamic psychotherapy.
The preliminary findings revealed that clients were more
likely to respond with a security operation than therapists,
especially following therapist interpretations. Therapists,
as a group, had more personal power in the therapy situation
and used more dominant security operations when compared to
clients. In addition, the therapists with more personal
power tended to have more years of therapy experience.

Overall, the hypotheses under test were tested fairly
except for those two that included Depth. The orderly
relationships in which PPFP and E805 entered, as demonstrated
by the consistency of the preliminary results, attests to
their validity with respect to background theory. The
hypothesis on mastery-dominance level of therapist security
operation(s) following both interpretation and
noninterpretation statements was directly related to personal
power, but the corresponding analysis for clients was pp;
inversely related to personal power as expected.

Perhaps the hypotheses regarding depth of interpretation
were not corroborated because low interrater reliabilities
did not provide a fair test of this hypothesis. A
reexamination of the different levels of Depth revealed that
they may have been insufficiently defined and illustrated to
enable raters to decipher and rate the therapy sessions with
any consistency.

Even though the total number of interpretations

71

proffered by therapists was not directly related to the
discrepancy between therapist and client personal power as
predicted, the outcome suggests that interpretations may
indeed function as security operations. That is, therapists'
threat (anticipation of lowered euphoria) increases as they
experience less power vis-a-vis clients. If this finding
holds up in future investigations, then it is legitimate to
infer that objectively manifested greater personal power in
an interpersonal encounter is not experienced as such by the
self-system, which always perceives opportunities for loss in
the neighboring future (J. Reyher, personal communication,
August 4, 1995).

Overall, both clients and therapists respond with
security operations in therapy. Interpretations seem to cue
anxiety (a lowering of euphoria) that typically cannot be
mastered, consequently generating security operations in
response. These security operations function to maintain
interpersonal security in the face of no threat. They serve
as a protective measure against undue anxiety or the threat
of anxiety arising from forbidding gestures (behavioral and
expressive cues that lower euphoria) in interpersonal
situations.

Implications

Irgprmghr and interpretation. Therapists need to
reexamine why they proffer interpretations to clients in
therapy. Is it because they were trained to interpret and

they feel obligated to provide these "gifts" to their clients

72

or do they anticipate that their competence and skill as a
therapist will be questioned if they do not interpret?
Therapists in this study were using more dominant $03 when
responding to clients and the more powerful therapists seemed
to be interpreting less. It could be that the therapists
were anticipating a lowering of euphoria because these
sessions were being videotaped and audiotaped. If therapists
are not responding objectively to clients then that leads one
to question this particular method of interpretive therapy.
Maybe they need to take more care in timing interpretations.

On the other hand, maybe all 805 are not necessarily
bad, i.e., some 805 may provide an opportunity for clients to
explore their own social effectiveness as well as learn about
alternative 80s by observing and interacting with the
therapist. Therapists might interpret less and help clients
decrease their anxiety to a level where they are able to
attend to what is happening in the therapy sessions. This
may free up therapists so that they are not feeling pressured
to interpret, thereby decreasing their anxiety level and
circumventing an anticipated drop in euphoria by the self-
system.

What about when therapists or clients do not use SOs?
One possibility is the therapist proffered a "good"
interpretation. Alternatively, clients might be so
overwhelmed by a previous interpretation, that the self-
system has not had enough time to respond with another $0 or

either party may employ "selective inattention" to avoid

73

further taxing the self-system.

Limirpripps. As stated previously, low interrater
reliabilities on the measures used in this study did not
allow for a fair test of extended Sullivanian theory
regarding Depth. This investigation included only the
sixteenth session therapies out of 25 total sessions and
therapy outcome was not examined. Also Sullivanian theory
itself cannot accommodate client "righting" behavior without
major additions to its core assumptions.

Eptpre research. Even though evaluation of extended
Sullivanian theory was not given a fair test based on these
findings, an alternative theory, i.e., Freudian theory, was
found to be better matched to the constructs. That is,
mastery-dominance and personal power are not a central
constructs of Sullivanian theory, but more in keeping with
Freudian and ethological perspectives. Future investigations
developed from these models could provide a better test of
mastery-dominance and personal power constructs in a therapy
setting.

Other possible studies that are suggested by the above
findings include: 1) using undergraduate students, in fields
other than psychology, to rate interpretations using the ISG
to determine if theoretical bias influenced the Depth
ratings; 2) editing the therapy transcripts to resemble the
training materials, being careful not to distort the data
contained in the transcripts, and compare that to ratings of

the 'raw' data; or 3) given that there was a qualitative

74

difference between therapists (PPF influenced therapist 80s
in Clirection of mastery-dominance) and clients (the same
relationship was negative but not statistically significant),
this has implications regarding both participants' state of
mind during therapy. One would need to conceptualize what
that state of mind might be and attempt to corroborate their

conceptualization or theory.

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75

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86

APPENDICES

APPENDIX A

87

Theory and Research on Therapist Interpretation:

A Literature Review

BY

Brett A. May Robert N. Graham, Jr.

Michigan State University

88

Abstract

Interpretation has been hailed by many influential theorists
as rhs specific factor in psychotherapy. Yet research in
this area has been repeatedly criticized for a simplistic
treatment of the construct and for the failure to
consistently show therapeutic effectiveness. This paper
presents a review of the literature on the use of
interpretation in psychoanalysis and psychotherapy. The role
of interpretation in theory is reviewed, followed by an
investigation of the empirical literature. Criticisms of
past research are examined, variations in methodological
approach are considered, and recent works are presented that
redress prior shortcomings. Finally, recommendations for

future research are given.

89

Table of Contents

IntroauctionOOOOOOOO......OOOOOOOOOOOOOOO...0.0.0.0....

Interpretation in Theory......... ......................
The origins of interpretation.. .................... .
Later perspectives on interpretation .............. ..

The problem of definition........................

Perspectives on effectiveness..... .............. .
Rules of Interpretation......... .................. ..
Depth of interpretation........ .............. ....
Working with active conflict .....................

Dosage of interpretation.........................

Proffering interpretations.. ................... ..

Tact of interpretations... ...... . ...... ..........
Timing........................... .......... ......
Interpretation in Empirical Research ................. ..
Experimental studies...................... ..... .....
Interpretation as reinforcement ..................
Social influence studies .........................
Naturalistic studies........... ................ .....
Verbal response mode systems... ................ ..

Restricted focus stUdieSOOOOOOOOIOO......OOOOOOOO

Theory-based studies............... ............ ..
Summary of prior works ............................ ..
Current Directions........ ................... ..........
Theory-based empirical testing.......... ........ ....
Parameters of interpretation........ ..... ...........
New methodologies........... ............... . ....... .
Conclusion....... ..... . ........................... .....

References..... .......................... . .......... ...

91

91

92

94

94

95

100
101
103
103
104
105
106
108
108
108
109
109
109
110
112
113
114
114
116
117
118
119

90

"How, for instance, can we expect to agree upon the vexed
question of whether and when we should give a 'deep
interpretation,' while we have no clear idea of what we mean
by a 'deep interpretation,' while, indeed, we have no exact
formulated view of the concept of 'interpretation' itself, no
precise knowledge of what 'interpretation' is and what effect

it has upon our patients."
James Strachey, 1934

91

Introduction

Clinical interpretation has been hailed by many
influential theorists as rhs specific factor in
psychoanalysis and psychodynamic psychotherapy (e.g.,
Fenichel, 1935; Freud, 1900, 1904, 1923; Glover, 1931;
Strachey, 1934). Yet research conducted over the past 50
years has largely failed to corroborate the premier status
ascribed to its use, particularly within the psychodynamic
domain. It seems that many would still consider Strachey's
statement valid today. Research on the interpretive process
in psychotherapy has been repeatedly criticized for its
incomplete operationalization (Garduk 8 Haggard, 1972;
Spiegel 8 Hill, 1989), shallow theoretical base (Claiborn,
1982; Garduk 8 Haggard, 1972; Gomes-Schwartz 8 Schwartz,
1978), methodological limitations (Gomes-Schwartz, 1978;
Spiegel 8 Hill, 1989; Windholz 8 Silberschatz, 1988), and
lack of relation to practice (Garduk 8 Haggard, 1972;
Kiesler, 1979; Strupp, 1989).

In contrast, even a casual perusal of the theoretical
literature on the use of interpretation reveals that
treatment of the construct, especially post-1950, is widely
varied in both proposed application and underlying
orientation. The theoretical literature reveals an over-
abundance of prescriptive texts that differ on why, when, and
how to make interpretations--if at all. This paper presents
a review of the literature on the use of interpretation in
psychoanalysis and psychotherapy. A brief historical review
of the theoretical role of interpretation is offered,
followed by a more thorough investigation of the empirical
literature in this domain. Criticisms of past empirical work
are examined, some variations in methodological approach are
reviewed, and more recent research is presented. Finally,
recommendations for future work in this area are given.

Interpretation in Theory
One primary criticism of past empirical work on

92

interpretation has been the lack of grounding in theory.
Although a comprehensive treatment of interpretive theory is
beyond the scope of this review, a partial review of this
literature, with a focus on the historical origins of
interpretation, is warranted.
Inaorioinaofinoaroretation

Modern day interpretation developed from the pioneering
work of Sigmund Freud. Unfortunately, Freud never addressed
the construct of interpretation in a comprehensive manner,
despite two series of papers (Coltrera 8 Ross, 1976) that
speak fairly directly to his therapeutic technique. In his
chapter from Lowenfeld's book, Freud (1904/1963) wrote, "The
details of this technique of interpretation or translation
have not yet been published by Freud. According to the hints
he has given, they comprise a number of rules, reached
empirically, of how the unconscious material may be
reconstructed from the associations, directions of how to
interpret the fact when the patient's ideas cease to flow,
and experience concerning the most important typical
resistances that arise in the course of such a treatment"
(pp. 58-59). This hinted at book of rules was ultimately
abandoned and replaced by the six essays which comprise the
bulk of his second series on technique (Coltrera and Ross,
1976; Gay, 1988). In these essays, Freud outlined only the
most general of principles pertaining specifically to
interpretation.

Exploring the underpinnings of what Freud did write about
interpretive technique, Coltrera and Ross (1976) reported
that the theoretical intent of interpretation varied between
Freud's earlier topographic perspective and his later
structural view (also see Arlow 8 Brenner, 1964). Viewed
from the topographic perspective, the patient's attention
becomes fixed by a 'widening of attention' attained through
free association on derivative formations that have reached
the preconscious through their cathexis with neutral
material. They stated that, according to Freud,

93

interpretation "discharges a very necessary hypercathetic
function by providing the additional quantum of attention
cathexes above and incidental to the attention-directing
function of a semantic explanatory proposition whose content
is one of elucidation and synthesis" (pp. 20-21). In other
words, interpretation allows the synthetic and integrative
functions of the ego access to the interpretive content that
previously existed in preconscious derivative form (Fenichel,
1941). Through the therapist's translation of the
preconscious derivative, it becomes hypercathected, or
conscious. Thus, Freud (1904) stated that the role of the
analyst is to demonstrate to the patient through
interpretation that which is hidden, or unconscious (i.e., in
the form of preconscious derivatives). Prior to about 1905,
Freud thought that this demonstration or translation was
optimally achieved through the interpretation of dreams,
although slips of the tongue, free associations, and other
phenomena could also provide insight into these derivative
formations (Freud, 1904).

Coltrera and Ross (1976) reported that Freud's later
structural perspective emphasized the importance of
transference and resistance elements in the treatment
situation as both facilitating and blocking changes in
personality. They stated that by 1920, Freud "had arrived at
the realization that a recapitulation of the personal history
of his patients could be achieved only through the
instrumentality of the transference by means of the
resolution of resistances" (p. 703). This resolution was
achieved through interpretation. Freud realized through his
working with patients that genetic reconstruction (via
topographic theory) alone was insufficient to bring about
change. The ultimate goal of interpretation and treatment
remained basically the same, "bringing to the knowledge of
the patient the unconscious, repressed impulses existing in
his mind" (Freud, 1919/1963, p. 181). However, this was now

94

thought best achieved through "exploiting the patient's
transference to the person of the physician, so as to induce
him to adopt our conviction of the inexpediency of the
repressive processes established in childhood and of the
impossibility of conducting life on the pleasure-principle"
(Ibid, p. 182).

Latarporaoaciiuaoonmm terr t'

Freud's lack of specificity regarding the development of
guiding principles of interpretive technique has contributed
to the proliferation of later attempts to define the
construct and develop rules for therapists to follow.
Importantly, almost all later constructions follow from
Freud's structural theory, rather than from his topographic
perspective. This literature varies considerably. Even in
clinical discussions about interpretation (Scientific
Proceedings, 1983, 1984) there is little consensus on how
interpretations work or what is the most important aspect of
interpreting. Hammer (1966) summarized this rather nicely:
"Interpretation is perhaps the most widely used therapeutic
tactic and is one aimed directly at the promotion of self-
understanding. The fact is that the vast majority of
therapists employ interpretations in varying degrees and
style, yet surprisingly little agreement has been reached
with respect to their place, role and timing, much less the
art of their delivery" (p. 140). To provide a sample of this
variation, some definitions and guidelines for interpreting
will be reviewed. When possible, similarities among
perspectives will be highlighted.

Tha prphlam pr gefiinition. To begin with, authors have
had difficulty defining the construct of interpretation.
Definitions range in complexity from "the verbal expression
of what is understood about the patient and his problems"
(Levy, 1984, p. 4), to "an attempt to describe by means of
verbal symbols an emotional reaction or a behavior pattern
exhibited by the patient in relation to the therapist, of
whose interpersonal or dynamic significance the patient is

95

unaware" (Strupp, 1973, p. 49). Strachey (1934) has even
devoted an entire manuscript to the problem.

Among the definitions given in Table A-1, one commonality
is evident. They refer to a process whereby the therapist
makes an inference about the client that the client has not
explicitly stated prior to the interpretation. The client
either exhibits a lack of awareness or is unconscious of the
interpreted material.

W on afLo_1__§e t'venes

Writers have also offered differing theoretical views
regarding how an interpretation works. As noted previously,
most of these elaborations begin from some aspect of Freud's
structural theory, even though viewpoints vary considerably
within this framework. For example, Hammer (1966) stated
that interpretations help connect dissociated actions which
have become automatic. The interpretation brings the
dissociated material into awareness and places it at the
control of the ego. Interpretations attempt to make sense
out of an irrational world by giving control back to the ego.
Saul (1958) wrote, "The analyst allies with the ego, not
threatening it with the id, but working through the ego to
help the patient understand, accept and learn to deal with
the id. Interpretation theoretically employs the ego
capabilities in an effort to modify its relationship with the
id" (p. 240). Strachey (1934) furnished this description,
"In the classical model of an interpretation, the patient
will first be made aware of a state of tension in his ego,
will next be made aware that there is a repressive factor at
work (that his super-ego is threatening him with punishment),
and will only then be made aware of the id-impulse which has
stirred up the protests of his super-ego and so given rise to
the anxiety in his ego" (p. 147). He further conceptualized

Table A-1

96

02mm of 1n$_ror___ne etatio
in psychotherapy& dpsyshoanalysis.

Author—— Dofinirmn

Fenichel
(1945)

Freud

$1913
1923

(1937a)

Greenson
(19 67)

Grotstein
( 1934)

11111
( 1989)

"Helping something unconscious to become conscious
by naming it just at the moment it is striving to
break through' (p. 322).

"The inter retation ofa dream falls into two
phases:t e phase in which it is translated and
he phase in which it is udged or has its values
assessed (1923). " "Even 1n the later stages of
the analysis one must be careful not to
communicate the meaning of a sym tom or the
interpretation of a wish until t e patient is
already close upon it, so that he has only a short
step to take in order to grasp it himself (1913L
"Our therapeutic work swings to and fro like a
pendulum, analyzing now a fragment of the id and
now a fragment of the e o. In one case our aim is
to bring a part of the 1d into consciousness and
1n the)other to correct something in the ego

1937a

"To interpret means to make an unconscious
phenomenon conscious. More precisely, it means to
make conscious the unconscious meaning, source,
history, mode, or cause of a given psychic event.
This usually requires more than a Single
intervention" (p. 39L

"An interpretation that...goes further than the
patient's experience--that is, further than the
manifest content of the exper1ence--ma undermine
the vouchsafement or notar1zation of t e
experience and suggest that the analyst knows
more about what goes on inside the patient than
the patient does, thereby leading to a situation
rife with intimidation and consequent envy. "

An interpretation, "Goes beyond what the client
has overtly recognized and provides reasons,
alternative mean1ngs, or new frameworks for
feelings, behaviors, or personality. It may
establish connections between seemingly isolated
statements or events; interpret defenses,
feelings, resistance, or transference; or indicate
themes, patterns, or causal relationships in
behavior or personality, related present events to
past events" (p. 15).

table conrinues

Korchin

(1.976)

Isumgs
(1973)

L. Levy
(1963)

Strump
( 1973‘))

97

"Classically the effort [of interpretation] was
directed at divining ult1mate causes of the
patient's symptoms in terms of their originating
experiences. Interpretation is now made of
defensive strategies, resistance, and transference
reactions in therapy, and of current fantasies,
impulses, and behaVior, not only to discover their
origins but to understand their dynamics in
contemporary functioning" (p. 315).

"There is a brief and deceptively simple
definition of interpretations: That theg are
verbal interventions through which the t erapist
makes material previously unconscious in the
patient, conscious for him in a meaningful and
affective way" (p. 451).

"To sum up, psychological interpretation, viewed
as a behaVior, is engaged in whenever a state
exists that seems refractory to other efforts at
mitigation or understanding. In essence it
conSists of bringing an alternative frame of
reference, or language system, to bear upon a set
of observations or behav1ors, with the end in view
of making them more amenable to manipulation."

,"Interpretation, defined more narrowly, is the

verbal expression of what is understood about the
patient and his problems" (p. 4).

"Thus in making an interpretation about the
behavior of the patient, the therapist goes beyond
the personal information communicated to him; e
makes a causal inference about this information.
The analyst would not object to the designation of
inference as an attribute of interpretation. But
he would hasten to add that the inferences made
pertain to motives, experiences, images, and
thoughts beyond the patient's awareness. Thus,
the therapist as interpreter amplifies and
translates the signals from the patient's
unconscious" (p. 368).

"An interpretation, then, is an attempt to
describe by means of verbal symbols an emotional
reaction or a behavior attern exhibited b the
gatient in relation to he therapist, of w ose
nterpersonal or dynamic significance the patient
is unaware or insufficiently aware" (p. 49).

98

each interpretation as involving the release of a certain
quantity of id-energy. He added the super-ego and the
concept of energy to his explanation. From his viewpoint,
interpretations decrease the amount of energy built up in the
id by increasing awareness of unconscious impulses.

Along the same lines, Bergler (1946) conceptualized the
therapist's goal as wanting to, "change the inner,
unconscious part of the personality. Conscious belief
inevitably follows" (p. 420). He reasoned that initially the
patient fights the analyst's interpretations, then gradually
accepts them consciously, followed by a working through of
the resistances to understand what the meaning of various
symptoms are. Loewenstein (1957) highlighted the importance
of interpreting patterns rather than exact events. He
explained that, "Interpretations aim at reflecting the work
not only of the id, but also of the superego and the ego.
While interpretations decisively influence the process of
analysis and while, to be effective, they have to be timed
and worded in certain ways, they are continuously influenced
in their turn by the psychological processes taking place in
the patient" (p. 182). Therefore, the interpretation works
on the psychological dynamics and conflicts within the
patient and effectiveness is dependent on the patient's
reaction. Taking this idea further, Wolberg (1977) wrote
that the patient has to be capable of understanding the
meaning of the analyst's interpretations and be able to
integrate them within himself in the form of insight. In
addition, he said that it is always essential to get the
patient to realize that current problems cannot be solved
merely by revealing unconscious material. This material must
be related to what is happening in the present.

In contrast to the structurally-based perspectives
described above, Wolman (1965) divided interpretation into
topographic and economic elements. "Repressed material is,
topographically speaking, unconscious, but at the same time

99

it carries an emotional load of libido or destructive energy.
Interpretation by means of verbal symbols may modify the
direction of cathexes and neutralize impulses. The ego
operates with symbols, and it is capable of binding and
neutralizing great amounts of hitherto blind, id-seated
energy. To talk about impulses and to understand them are
great steps toward their neutralization and control" (p.
123). Insight into unconscious impulses and conflicts by way
of interpretation help the patient to negate the energy
contained in the id and give the ego some measure of control.
Authors from other perspectives have also referred to
interpretation in their writings. Staines (1969) offered the
following comparison between analytic and client-centered
approaches, "The counselor (therapist) via his empathic
responses (interpretations) brings to awareness (makes
conscious) the feelings (strivings) of the experiencing
organism (unconscious)" (p. 406). This comparison
underscores the change in focus and language between these
two theories as well as their similarities. Rogers (1957)
indicated that interpretation may be one way of communicating
the 'essential conditions' of therapy, but cautioned that
interpretation can also function to signal the therapist's
'conditional regard.’ It has also been pointed out that
gestalt therapists make interpretations through structural
vehicles (e.g. empty-chair technique) even though they may
deny it (Nielsen, 1980). Additionally, experiential
therapists have commented on interpretive interventions. The
basic principle of the experiential method in terms of
interpretive technique is that the analyst can say any hunch
or idea in an asking way, sometimes adding another
possibility, to insure that the patient knows it's not a
conclusion but an invitation for him to explore the
interpretation further (Gendlin, 1974). The interpretation
is made experiential by not including any of the inferential
and thinking steps the therapist makes and by the therapist
asking himself what the patient would concretely feel or find

100

within himself if the therapist is right. Rice (1974)
presented an alternative to interpretation that is called
'evocative reflection.' The aim of this intervention is to
help the client get in touch with their experience and
provide a process where the client can form their own more
accurate constructions of their experience. Yet another
conceptualization of interpretation is that the therapist
provides a new way of construing events or an alternate frame
of reference to consider a problem from that is cognitively
discrepant from the patient's own view (Claiborn, 1982; Levy,
1963).
Buloaofintaroraarion

Numerous authors have presented informal 'rules' or basic
'principles' that provide pointers on interpretive technique
and offer some general guidelines about the process of making
interpretations. Some of these principles are described
below. Importantly, many authors have cautioned or qualified
the development of interpretive guidelines. One
qualification was aptly stated by Glover (1955) when he noted
that, "Rules in therapy never have more than a relative
validity." Eissler (1958) observed that analysts and
theorists seem more prepared to demonstrate errors and
mistakes in analytic technique than to formulate a general
code to follow. Even if rules were developed, errors in
technique would probably be given primary emphasis.
Blomfield (1982) has stated that it is best to avoid leading
students to believe that there is a complete set of rules to
interpreting that they will know in time. He said that
interpretation arises from the analyst's internal
understanding of the development of a patient's thoughts, the
patient's effect on the analyst, and the effect of the
patient's thoughts on their own behavior. In addition, Reich
(1949) warned that it is an error to interpret just because
the material presents itself rather than considering the
different levels of material and the structure of the

101

neurosis. Finally, Saul (1958) reminds us, "There are always
exceptions. We have guiding principles, not inexorable
rules" (p. 232).

Paprh pr inrsrprsraripn. Depth is most commonly thought
of as pertaining to the degree of inference in an
interpretation. Depth is determined by "the extent to which
the therapist includes what the client explicitly stated in
an interpretation" (Graham 8 May, 1989, p. 11). The greater
the degree of inference on the therapist's part from what the
client has actually said, the greater the depth of the
interpretation. While not all theorists refer to the
distinctions they create as variations in the "depth" of
interpretation, many systems of interpretation seem
adequately organized by this heuristic.

For instance, Collier (1953) has proposed that a
continuum exists in the realm of interpretation. He
maintained that restatements and reflections of feeling
actually call the patient's attention to what the therapist
thinks is significant or reveals previously unrecognized
material. Others echo this sentiment that reflections of
feelings and restatements are really mild or conservative
interpretations (Giovacchini, 1969; Korchin, 1976).

Paul (1963) differentiated between two types of
interpretation. He presented the following distinction,
"Type I interpretation points to and describes and names what
and who and where and when of the most pre-eminent presenting
preconscious behavior; Type II interpretation adds the why,
or how come" (p. 252-253). The Type I interpretations bring
prominent derivative material to the patient's awareness and
Type II provides a causal explanation.

Other analysts approach interpretation using a hierarchy
model. The first 'rule' in most analyst's hierarchy is that
therapists or analysts should deal with patient resistances
first. It follows that if the therapist interprets material
other than resistance, the resistance will interfere with
exploring the material presented and inhibit the progress of

102

therapy. Reich (1949) strongly advocated interpreting
resistance before content. He added that not making a
resistance interpretation in favor of another interpretation
can complicate the transference situation as well as miss the
opportunity to give the interpretation when the material is
immediate and the patient can make the best use of it.

Strupp (1971) noted that after the resistances are overcome,
the therapist will move to interpreting underlying conflicts.
Kapelovitz (1987) said that the main motives behind
resistance are the avoidance of pain and the evasion of
change. These phenomena make the analysis of resistances
before other material an imperative for psychotherapy to be
effective.

It was Strachey's (1934) opinion that an interpretation
of a resistance will almost invariably be a transference
interpretation. Hammer (1968b) agreed and advocated that
when the patient's resistance or manner of deflecting the
therapist's interpretations is active, this needs to be dealt
with before content can be considered. He recommended that
when the resistances intensify, it is time to interpret
within the frame of the transference. Both of these
theorists identified the transference relationship as the
arena where resistance should be resolved.

The therapist should deal with present conflicts before
exploring earlier material (Bergler, 1946). This idea is
consistent with the onion metaphor where the surface layers
are explored before other 'deeper' layers are uncovered.
Presumably, only 'deeper' layers are the dynamically
effective ones. In line with this, process should be
addressed before content. It is important not to dampen or
short-circuit the patient's emotional experiences (Nydes,
1966). This will inhibit the patient's ability to fully
integrate what is being interpreted and result in an
intellectual exercise with limited success. One of French's
(1958) 'rules' is to interpret at the level of the focal

103

conflict because it is easier for the patient to understand
and assimilate the interpretation as well as easier for the
analyst to predict its effect. Both participants are more
likely to end up working on the same material and not be
dealing with deeper, genetic conflicts that are better left
alone until the patient is ready to make the connection
between past and present.

Parking yirh activs spnfiligr. Another 'rule' of
interpretation is to work with what the patient is presenting
at the moment. Loewenstein (1957) noted that when
interpretations deal with the conflict that is active at the
moment, they also implicitly encompass and indirectly affect
other conflicts in the patient. It is also recommended by
Gendlin (1974) that the therapist deal with what is
concretely there rather than with inferential concepts.

Thus, focusing on currently active material that is readily
apparent to the patient enhances the impact of
interpretation. Hammer (1968b) added that an interpretation
is more useful and better able to access feelings if it is
directed toward emotionally relevant aspects of the patient's
experience. This view emphasizes the notion that affect is
primary in interpreting material and the patient needs to be
close to their affect for maximum effectiveness.

Qgsags gr interpretation. Taking into consideration the
amount of the material that is interpreted to the patient has
also been addressed in the literature. This has been
referred to as the dosage or economics of an interpretation,
though clearly it is also related to depth. Tarachow (1962)
declared that interpretations should seldom go as far as
possible, preferably falling short of their intended goal.
This allows the patient to become more involved in the
process of therapy by providing an opportunity for the
patient to expand on an interpretation. Fialkow and Muslin
(1987) stated that more than one interpretation is often
needed to extend patient self-knowledge and insight. Patient
resistance to changing their attitudes and behavior is one

104

reason why a single interpretation is ineffective. They also
reported that the influence of the immediate transference and
the multiply determined nature of conflict prevents a single
interpretation from resolving a conflict. Another aspect of
dosage arises when considering that a given conflict may be
active in a number of various situations. A single
interpretation cannot account for all the situations that
arouse conflict (Fenichel, 1945). This further conveys the
implicit message that one interpretation does not make or
break an analysis or therapy. As Colby (1958) stated, an
analysis does not stand or fall with the response to a single
interpretation.

Strachey (1934) recommended that the patient be given
minimal doses of interpretation so that the patient's ego
functions can continue to cope with reality. Moving beyond
the patient's ability to cope would be counterproductive.
Freud himself pointed out that a single interpretation is
more likely to be 'accepted' than a construction (Freud,
1937), as the dosage of a construction is more than an
interpretation and therefore may be more difficult to
integrate.

Prpfrsring interpretations. Langs (1973) stated that,
after a formulation is made, attention should be given to
expressing the interpretation in terms of language that is
relatively simple and similar to the patient's own way of
communicating. They should be precise, succinct, and
straightforward to increase the possibility of integration.
He further said that it is preferred if interpretations are
balanced with respect to other interventions, presented
systematically rather than at random, and are few in number.
Strupp (1989) agreed that communication with the patient
should be free of jargon, be based on a minimum of inference,
and meaningful. He added that talking to the patient in a
way that they can easily understand will greatly assist in
the progress of therapy. Hammer (1968b) maintained that

105

phrasing an interpretation using the patient's vernacular
places the therapist closer to the patient and translates
meanings back into the patient's specific experience.

Some theorists have divided language into an unconscious,
primary process, infantile level; and a reality based,
conscious, secondary process level (Blomfield, 1982, Major,
1974). Major (1974), for instance, views language as the
primary path to consciousness and stated that interpretation
should exploit this. He noted that interpretations can act
on both the unconscious and conscious levels of a patient's
experience.

Tag; pr intsrpretatipn. The issue of offering an
interpretation with tact is independent of any thoughts of
offending or needing to please the therapist. Saul (1958)
wrote that interpretations should not be made in a dogmatic
way since they are much more effective if elicited directly
from the patient, especially when a patient is not ready for
an insight. Greenson (1960) presented two attributes of
tact, the intonation with which the analyst speaks and the
language the therapist uses. The therapist can present an
interpretation in either a tentative or an authoritative
manner to the patient. Sometimes tentative interpretations
are made on the basis of a hunch by the therapist or when the
therapy seems to be stuck. The therapist then waits for
further material to develop to verify the accuracy of their
hunch. Burton (1972) said, "A good rule of thumb is that no
therapist has a right to make an interpretation he would be
unprepared to receive about himself were he the client" (p.
91). Burton also advocated that interpretations be made
tentatively. This allows the patient to feel less coerced
into accepting an interpretation by the therapist. Bauer and
Mills (1989) said that a posture of 'certainty' on the part
of the therapist may interfere with the patient's ability to
work in therapy. Additionally, Nydes (1966) alleged that a
direct interpretation will almost invariably be construed as
a personal accusation that may confirm any feelings of morbid

106

guilt or stir up a defensive response despite careful
wording. Along the same lines, Colby (1958) recommended
offering an interpretation to a patient in the form of
hypotheses-provisional statements to be confirmed or
disconfirmed on the basis of observable evidence. He
reasoned that by maintaining a provisional atmosphere, an
interpretation does not have a closure effect and allows the
patient to explore it further.

Timfing. Timing is often considered another vital factor
in formulating and proffering interpretations. Devereux
(1951) recommended that the analyst interpret only material
that the analysand is psychologically ready to consider and
utilize immediately. He said that the interpretation will
have a higher likelihood of being considered by the patient
if it follows clearly and is sufficiently developed from the
patient's material. When evidence is readily identifiable
from the session, the patient is more likely to accept and
confirm the interpretation with additional material. This
process usually takes more than one session and at times
requires a series of partial interpretations rather than
comprehensive ones that can overwhelm the patient. Olinick
et al., (1973) noted that these partial interpretations or
statements are often aimed at working through as well as
toward developing more complete interpretations. Sandler,
Dare, and Holder (1971) alleged that, "It is fairly generally
accepted in the psychoanalytic literature that no
interpretation can ever be complete and perhaps the most
practical use of the concept would be to include within it
all comments and other verbal interventions which have the
aim of making the patient aware of some aspect of his
psychological functioning of which he was not previously
conscious" (p. 56). They used the term 'preparation for
interpretation' to describe other verbal interventions that
are made to set up an interpretation. Again, single
interpretations cannot incorporate all the complexities of a

107

patient's psychological functioning. Change occurs over
time.

Timing is considered best when either the behavior
that is interpreted is occurring immediately within the
session or when minimal fear or anxiety will be aroused by
the interpretation if the patient is unlikely to see the
point on their own (Dollard 8 Miller, 1950). If anxiety or
fear are likely responses, the interpretation should be made
in a tentative manner. Thus the plausibility of the
interpretation helps to determine whether it is proffered to
the patient. If the patient seems less inclined to accept an
interpretation, withholding it is usually recommended. As
Wolberg (1977) put it, "To advance an opinion in a hit or
miss manner, hoping that it will touch something off in the
patient, is worse than useless" (p. 445). This can lead to
'wild-analysis' which is more harmful to the patient than
helpful. The patient should not be taken too much by
surprise when an interpretation is proffered. In contrast,
Binstock (1974) suggested that the therapist can influence a
patient to think new thoughts and respond in new ways by
presenting an interpretation which surprises the patient.

Saul (1958) wrote that it is rarely a mistake to wait

until near the end of the session to deliver an
interpretation. The guiding principle that he used in timing
interpretations is that of 'readiness' or 'ripeness.' These
terms refer to how close derivative formations are to
consciousness. He also advocated allowing time near the end
of the session for the patient to react to the
interpretation. Spero (1977) combined a psychodynamic and
learning theory orientation to present a guide for timing
interpretation. He emphasized gauging the patient's ego
readiness to receive an interpretation. That is, the extent
that the ego can visibly reinforce and enlarge on the new
adaptive model suggested by an interpretation should be
estimated before a given interpretation is proffered.

108

Interpretation in Empirical Research
Empirical studies on interpretation as a specific factor

in psychotherapy can be differentiated into naturalistic and
experimental works. Experimental studies can be further
divided into early research based on a reinforcement paradigm
and later works conducted from the social influence
perspective. Within the naturalistic studies, interpretation
has been empirically investigated in three primary ways; as
one aspect of a larger verbal response mode system, in works
where single qualities of interpretation are examined, and as
part of a theory-based system of intervention.
Exporimtal 2L: d'es

ansrprsraripn as reinforcement. Early experimental works
have viewed the use of interpretation from within a verbal
conditioning paradigm (Adams, Butler, 8 Noblin, 1961; Adams,
Noblin, Butler, 8 Timmons, 1962; Auerswald, 1974; Kanfer
Phillips, Matarazzo,8 Saslow, 1960; Noblin, Timmons, 8
Reynard, 1963). These studies purported to demonstrate that
'psychoanalytic-type' interpretations were simply a method
whereby therapists differentially reinforced particular
client responses (e.g., Adams, Butler, 8 Noblin, 1961).
Unfortunately, as Spiegel and Hill (1989) noted, the context
for these findings deviate quite drastically from the natural
circumstances of therapy. Most of these studies utilized
undergraduate volunteers who received only one or two 30-
minute sessions of "therapy" (Auerswald, 1974; Kanfer et al.,
1960). In some studies, interpretations were read from a set
randomly mixed index cards (Adams, Butler, 8 Noblin, 1961;
Noblin, Timmons, 8 Reynard, 1963). Additionally, while these
studies have consistently found a reinforcement effect, this
might be said of any therapist verbalization. Korchin (1976)
noted that even a simple "tell me more" carries the meaning
that an issue is important and more information is desired.
In general, the limitations of these early studies restrict
their external validity and subsequent usefulness.

109

£22111 inflpsnss srpgiss. More recently, experimental
works have investigated clinical interpretation both as an

influence process (Claiborn, 1979; Cooke 8 Kipnis, 1986), and
as depending on the patient's potential control over what is
interpreted (Claiborn, Ward, 8 Strong, 1981; Forsyth 8
Forsyth, 1982; Strong, Wambach, Lopez, 8 Cooper, 1979).

While these efforts evidence greater methodological
sophistication, problems with artificiality persist. With
one notable exception (Cooke 8 Kipnis, 1986), these studies
have continued to use extremely time-limited formats with
individuals who are not seeking treatment. Overall, these
recent studies have found that: (a) use of interpretation is
perceived as more expert by outside observers (Claiborn,
1979), (b) therapists use more direct forms of influence with
female clients and explain their actions more with male
clients (Cooke 8 Kipnis, 1986), and (c) interpretations
identifying causal factors that clients can directly control
are responded to more productively (Claiborn, Ward, 8 Strong,
1981; Forsyth 8 Forsyth, 1982; Strong et al., 1979)
particularly if the client has an internal locus of control
(Forsyth 8 Forsyth, 1982).

Naturalistis stugies

ysrpal response mode systems. Verbal response mode
systems (VRM) attempt to divide therapist and client

 

verbalizations into a comprehensive set of categories. These
systems typically include interpretation as one type of
therapist response. Early works tended to vary widely
depending on the theoretical perspective of the author
(Goodman 8 Dooley, 1976; Russell 8 Stiles, 1979), and
relatively little attention was paid to statistical
composition (Spiegel 8 Hill, 1989). More recent VRM systems
have shown an increased awareness of both linguistics and
statistical design, resulting in systems that are more
similar than different. In a comparison of six popular
rating systems (Elliott et al., 1987), "moderate to strong
convergence" was found for six of the modes represented in

110

all of the systems, which included interpretation.

In these VRM systems, interpretations are simply
identified and tallied. No effort is made to investigate
similarities or differences among interpretations. As might
be expected, the specificity and complexity of information
provided by these studies as they apply to interpretation has
been limited in scope. When investigations have examined VRM
in connection with client response, comments regarding the
effects of interpretation are typically limited to a brief
paragraph. Definitions of interpretation have varied among
VRM systems as well, likely contributing to the largely mixed
findings (Spiegel 8 Hill, 1989). Furthermore, interpretation
has been found to be related to other response modes in the
same system. For example, Hill (1978) noted that
confrontation, interpretation, reflection, and restatement
were all highly correlated in her system. Overall, the
primary results of the VRM line of inquiry are: (a)
interpretation is consistently related to rejecting or
unproductive client responses (Bergman, 1951; Snyder, 1945),
(b) interpretation is consistently related to productive
client response (Elliott, Barker, Caskey, 8 Pistrang, 1982;
Frank 8 Sweetland, 1962; Hill, Carter, O'Farrell, 1983; Hill
et al., 1988), (c) interpretation is used with similar
frequency by different types of therapists (Brunink 8
Schroeder, 1979; Fiedler, 1951; Stapes, Sloane, Whipple,
Cristol, 8 Yorkston, 1975; Stiles, 1979), (d) interpretation
is used with differing frequencies by different types of
therapists (Stiles, 1979; Stiles, Shapiro, Firth-Cozens,
1988; Zimmer 8 Pepyne, 1971), and (e) interpretation use
increases as therapy progresses (Hawton, Reibstein,
Fieldsend, 8 Whalley, 1982; Hill, 1978; Hill, Carter,
O'Farrell, 1983).

Bsstrisrsg fpsns stugies. Another area of research
has focused on a limited set of theoretically important
distinctions within the construct of interpretation. In this

111

regard, depth has been studied most often (Fisher, 1956;
Garduk 8 Haggard, 1972; Gill 8 Hoffman, 1982; Grossman, 1952;
Harway, Dittmann, Raush, Bordin, 8 Rigler, 1955; Raush et
al., 1956; Sklansky, Isaacs, Levitov, 8 Haggard, 1966;
Speisman, 1959). Transference (Forman 8 Marmar, 1985;
Frances 8 Perry, 1983; Luborsky, Bachrach, Graff, Pulver, 8
Cristoph, 1979; Marziali, 1984; Marziali 8 Sullivan, 1980;
Silberschatz, Fretter, 8 Curtis, 1986; Weiss 8 Sampson,
1983), object focus (Piper, Debbane, Bienvieu, Carufel, 8
Garant, 1986), skill (Fiedler, 1951; Gomes-Schwartz, 1978;
Gomes-Schwartz 8 Schwartz, 1978; Strupp, 1955, 1958; Strupp 8
Hadley, 1979), and tense (Abramowitz 8 Jackson, 1974) have
been investigated as well. Although studies on depth of
interpretation have typically used different measures of the
construct, they have fairly consistently concluded that
"moderately deep" interpretations are responded to
productively (Grossman, 1952; Sklansky et al., 1966;
Spiesman, 1959). In addition, some of these works have noted
that ”deep" interpretations are followed by a less productive
response (Garduk 8 Haggard, 1972; Sklansky et al., 1966).
Research on transference interpretation is more recent

and tends to be more theory-based. Two works have
investigated interpretation in connection with therapeutic
alliance (Forman 8 Marmar, 1985; Frances 8 Perry, 1983).
Both studies found that transference interpretations improved
productivity in cases with extremely poor alliances when they
addressed the client's current transference experience.
Luborsky and colleagues (1979) found that in three of four
cases transference interpretations were responded to
productively. In contrast to the two studies just mentioned,
they found that transference interpretations were responded
to negatively in the one case where the therapeutic alliance
was poor. Other investigations of transference have reported
significant correlations with positive outcome (Malan, 1976;
Marziali, 1984; Marziali 8 Sullivan, 1980).

The research findings on therapist skill, object focus,

112

and tense have been mixed. Examining therapist skill,
researchers have shown no differences in outcome between
professionals and "inherently helpful" nonprofessionals
(Gomes-Schwartz 8 Schwartz, 1978; Strupp 8 Hadley, 1979).
Other investigators have concluded that "nonspecific" factors
in general are more important than specific technical skills
(e.g., Anderson, 1968; Strupp, 1958). Piper et al. (1986)
found "little evidence" that therapist-parent links in object
focus led to better client outcome. Finally, Abramowitz 8
Jackson (1974) found that in therapy groups a combination of
here-and-now and there-and-then interpretations were more
productive than either type alone.

Thspry;hassg studies. Two related lines of investigation
have focused on the role of theory as it pertains to
interpretation in psychotherapy. One of these addresses
psychoanalytic psychotherapy (Crits-Cristoph, Cooper, 8
Luborsky, 1988; Silberschatz, Fretter, 8 Curtis, 1986; Weiss
8 Sampson, 1983; Weiss 8 Sampson, 1986), while the other
stems from Malan's time-limited dynamic perspective (Malan,
1977; Marziali 8 Sullivan, 1980; Marziali, 1984). Although
these studies are the most theoretically sophisticated of
those reviewed, they also restrict their definition of
interpretation to a greater extent than in other works, thus
reducing overall generalizability.

The Mount Zion Group (e.g., Silberschatz, Fretter, 8
Curtis, 1986; Weiss 8 Sampson, 1983) conducted research
utilizing the identification of patient themes in determining
interpretation accuracy. They found that suitability rather
than type of interpretation was most predictive of productive
patient response (Silberschatz, Fretter, 8 Curtis, 1986).
Their work also supported a definition of suitability based
on Freud's later structural model as compared to his earlier
topographic conceptualization (Weiss 8 Sampson, 1983).
Crits-Cristoph, Cooper, 8 Luborsky (1988) identified
interpretation adequacy in accordance with the Core

113

Conflictual Relationship Theme (CCRT), which "establishes
guidelines for clinical judgments about the content of
patients' central relationship patterns" (p. 491). In this
study, the authors found "a significant and moderately
strong" (p. 492) relationship between interpretation accuracy
and positive outcome. They further noted that their findings
corroborated the results of the Silberschatz et al. (1986)
study.

Another line of study heavily influenced by theory is
based on the writings of David Malan. His original work
(Malan, 1976) was criticized for its reliance on therapy
process notes rather than on audiotapes or session
transcripts. However, Marziali has replicated and extended
his findings in two separate investigations (Marziali 8
Sullivan, 1980; Marziali, 1984). She supported Malan's view
that interpretations are related to favorable outcome when
they focus on the patient's experience with parental figures
as it is emotionally re-experienced in the current
transference relationship.

.Sunnarxofonormrloa

Marziali (1984) complained that process research has
focused too heavily on ratings of global therapeutic actions
such as "therapist directiveness," and "number of
interpretations" (p. 301). This empirical review supports
her argument. Over the past 50 years, research has
discovered (somewhat equivocally) that interpretations
probably are more helpful than harmful, and that this state
of affairs is most likely influenced by some aspects of
interpretive quality such as depth or transference. In
contrast, most theorists considered the overall usefulness of
interpretation in psychotherapy to be a given. These
clinicians seemed more concerned with the stylistic issues of
interpretive technique, such as timing, tact, and dosage,
method of approach. Evidently, many clinicians continue to
regard interpretation as an important tool in therapy despite
the relative lack of consistent and detailed empirical

114

support for its use. It seems that this area has reached a
point in development not unlike that said of therapy process
research in general since the classic Smith, Glass, 8 Miller
(1981) meta-analysis: Now that we know that it usually
works, lets find out why.

Overall, it seems to us that prior empirical work on
interpretation in psychotherapy can be viewed in a similar,
but slightly different manner. That is, the use of
interpretation appears to result in productive patient
responses in many circumstances, and unproductive responses
in others. Certainly the use of interpretation has some
impact on the patient, since very few studies have found no
effect. Therefore, the question remains, what are the
'active ingredients' of interpretation? As Spiegel and Hill
(1989) recently stated, "Although interpretation is a
theoretically important and frequently used technique in
brief and time-limited individual therapy, the contribution
of the research has been limited because of several
methodological problems in the areas of (a) definitions, (b)
designs, (c) the search for a single underlying mechanism,
(e) measurement of the impact, (f) type, (g) the role of the
therapeutic relationship, and (h) timing" (p. 121).

Current Directions

Research on the effects of interpretation in
psychotherapy and psychoanalysis will progress as researchers
take into greater consideration the theoretical, operational,
and methodological complexities of interpretive technique.
In this sense, the search for the 'active ingredients' of
interpretation has already begun.

The Mount Zion research group has based their empirical
investigations on a well thought out theoretical rationale.
They have studied interpretation and other psychotherapy
process variables by contrasting Freud's early topographic
model and his later structural model. One aspect of their

115

research is to test the validity of each theoretical model.
According to Joseph Weiss of the Mount Zion group, pathogenic
beliefs play an important part in the development and
maintenance of repressions, inhibitions, and symptoms. They
are a part of the unconscious mind which is consistent with
Freud's ego psychology or structural theory (the higher
mental functioning hypothesis). It is hypothesized that
these beliefs need to be altered in order for change to
occur. Weiss compared this conceptualization with Freud's
topographic theory (the automatic functioning hypothesis)
where there are no unconscious beliefs of any kind. In
testing these two models, the research group assumed that the
nongratification of patient neurotic needs in the
transference of therapy will either produce frustration,
tension, and conflict (automatic functioning) or anxiety and
tension (higher mental functioning). With regard to
interpretation, Weiss et al. (1986) wrote, "The defenses are
weakened (undermined) by the analyst's interpretations. The
resolution of a transference, however, is conceptualized as
taking place by quite a different process. In this process
the ego is helped by analytic interpretations to gain insight
into the transference. The ego, as a consequence of such
insight, recognizes the transference as an irrational
repetition of childhood experiences and abolishes it" (p.
327). The empirical findings suggest that structural theory
is the more consistent model to explain what happens in
therapy and that interpretations influence the ego to bring
about change.

Other researchers connected with the group have expanded
on these theoretical ideas and tested them empirically
(Silberschatz et al., 1986; Silberschatz 8 Curtis, 1986;
Weiss et al., 1986; Weiss 8 Sampson, 1983; Curtis et al.,
1988; and Silberschatz et al., 1989). Pathogenic beliefs and
the patient's plan for therapy are two interesting constructs
that have been developed. Pathogenic beliefs are
unconscious, irrational, painful ideas that cause, and help

116

to maintain, psychological disturbance (Weiss, 1990; Weiss et
al., 1986). In psychotherapy, the patient attempts to
disprove these beliefs by unconsciously testing them out with
the therapist. The patient is thought to have a particular
unconscious plan for therapy, determined by these beliefs and
corresponding testing behavior. This plan, once it is
understood by the therapist, guides the therapist in making
interpretations that are helpful to the patient. Empirical
support for this viewpoint further strengthens the Mt. Zion
Groups' argument that the structural theory approach to
interpretation is more valid than the topographic
perspective.
Paramsrsrs pr intsrpretation

Another potentially fruitful avenue of investigation is
to more fully explore the meaningful aspects of therapist
interpretation. One approach that appears promising is
represented by our Interpretation Scoring Guide (ISG: Graham
8 May, 1989). The ISG is a pantheoretical instrument that
operationalizes interpretations along ten parameters and one
or more of seven levels. The parameters of the ISG are
thought to comprehensively define the meaningful categorical
boundaries of an interpretation as defined by theory and
prior research. Seven of the ten parameters also contain
dimensions which further specify the qualities of an
interpretation. The parameters and corresponding dimensions
of the ISG include: lnference Losation, Qausal Connect' ,
thssr (client only, therapist-client, parent-client, other-
client), Qpnrsnr (affective, behavioral, cognitive), Tenss
(past, present, future), immediacy (preceding segment, same

session, unscorable), Paprh (substitution, extension,
introduction), Tppis Psintrgguction, Spsgifisiry (specific,

general), and Pprm (tentative question, firm question,
tentative statement, firm statement). The ISG levels
operationalize the intent of an interpretation as defined by
psychoanalytic theory. ISG levels include: Resistance,

117

122121322. Trauma e ce. §____rharacte . 211211112 mam. Sonaflo.
and thsr interpretations.

The ISG has been designed to be a comprehensive,
flexible, and pantheoretical research instrument. Theory-
based hypotheses can be investigated by selectively choosing
a subset of ISG parameters and levels. Several studies are
currently under investigation and initial rater reliabilities
are promising.

1192 moinooolooiaa

In the past five to seven years a number of psychotherapy
process studies have been published that utilize newer, more
sophisticated methodologies. These studies often use
multiple predictors and dependent measures and base their
predictions on more well-defined theory, thus redressing many
prior complaints regarding process research (Greenberg, 1986;
Schaffer, 1982; 1983). Two promising approaches are the
detailed investigation of critical episodes in therapy (e.g.,
Elliott, 1983; Elliott, James, Reimschuessel, Cislo, 8 Sack,
1985) and the use of sequential analyses (e.g., Wampold 8
Kim, 1989; Wiseman 8 Rice, 1989). Elliott (1983) cited
several researchers and theorists who advocate for the
detailed investigation of critical episodes or significant
events in psychotherapy. A common thread of their complaints
about current process research is that there is an over-
reliance on 'frequency' methods of research, where
occurrences of something are tallied and correlated with a
single outcome measure (Russell 8 Trull, 1986; Schaffer,
1982). Researchers (Elliott, 1983; Elliott,et al., 1985)
have identified single episodes and employed a variety of
process measures ranging from global 'experiencing' to
literal speech disturbances. Other investigators have
applied sequential analyses to change events in
psychotherapy, "for studying therapist-client interactions in
the context of clinical microtheories of change events"
(Wiseman 8 Rice, 1989, p. 281). Wiseman 8 Rice (1989)
productively used this strategy to track a therapist's

118

response to a client's "problematic reaction point." While
these newer methodologies have not focused specifically on
the issue of therapist interpretation in psychotherapy, this
approach appears promising and complementary to past
frequency paradigms.

Conclusion

A gaping chasm currently exists between the development
of theory pertaining to the use of therapist interpretation
and the empirical investigation of this construct. Theorists
have relied on 'evidence' from their own idiosyncratic
experiences and the 'by fiat' authority of past analysts to
develop guidelines that vary widely. These guidelines reach
well beyond the available evidence obtained thus far by
psychotherapy process investigators.

In spite of this, recent research on interpretation
appears to be on the "comeback trail" (Kiesler, 1982) along
with the rest of psychotherapy process research. One
encouraging sign is the existence of research programs that
compare and contrast theoretical approaches in increasingly
sophisticated ways. In addition, new methodologies are
maturing and new comprehensive measures are being developed.
The empirical literature indicates that interpretation is
probably influenced by a number of factors and researchers
appear to be readying to meet this challenge. This new wave
of research is promising. Hopefully clinicians will find
these new investigations applicable to the actual practice of
psychotherapy.

119

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APPENDIX B

127

THE INTERPRETATION SCORING GUIDE

A manual fin' operationalizing intapretatiom

 

 

 

 

E

 

 

 

 

By

Robert Graham and Brett May
Michigan State University

128

Author Notes

Both authors contributed equally to the development of this guide. We are
indebted to Joseph Reyher for his unfailing guidance and continual support
during this project. We also thank Tim Cefai, Barb Clark, Dave Finke,
and Charlorte Miller for their time and their constructive comments during

the pilot study and subsequent work.

129

Table of Contents

THE INITIAL DEFINITION .................................................................................... 130
UNITS of SCORING ................................................................................................... 131
INTERPRETIVE PARAMETERS ............................................................................... 132
Inference Location ................................................................................................ 133
Causal Connection ................................................................................................ 133
ObjeCt .................................................................................................................. 134
Content ................................................................................................................. 134
Tense .................................................................................................................... 135
Immediacy ........................................................................................................... 137
Depth .................................................................................................................... 138
Specificity ............................................................................................................ 138
Topic Reintroduction ........................................................................................... 139
Form ..................................................................................................................... 139
LEVELS of INTERPRETATION ............................................................................... 140
Resistance Interpretation ...................................................................................... 141
Defense Interpretation .......................................................................................... 142
Transference Interpretation ................................................................................... 144
Character Interpretation ..................................................................................... . 145
Adaptive Context Interpretation .......................................................................... 147
Genetic Interpretation .......................................................................................... 147
Other Interpretations ............................................................................................ 148
COMPARISON of INTERPRETIVE LEVELS ......................................................... 148
SCORING THE ISG ..................................................................................................... 151
APPENDICES ................................................................................................................ 156
Appendix A: Basic Rules of Grammar ................................................................ 156
Appendix B: Quick Reference Sheet for ISG Levels ........................................... 158
RATER NOTES ............................................................................................................ 159

REFERENCES ................................................................................................................ 161

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THE INTERPRETATION SCORING GUIDE

.1 his guide contains a pantheoretical system for operationalizing interpretations. An

'attempt is made to minimize theoretical bias by defining all interpretations
according to their parameters. Parameters are those determining factors or characteristics
that are essential to the delineation of an interpretation. The more traditional approach of
using levels (or types) of interpretation is included as well. The ISG utilizes a hierarchical
approach where interpretations are initially identified and defined in the broadesr sense of
the term. Next, they are scored along ten operationally defined parameters, then
categorized on one (or more) of seven interpretive levels. This approach to defining
interpretations has the advantage of minimizing ambiguity and bias because it identifies
those factors within an interpretation that are thought to be important (e.g., depth, objecr
focus) and classifies the level of interpretation (e.g., transference, resistance, genetic). It
also results in a more useful and flexible instrument because potentially important
theoretical distinctions can be represented, thus increasing scientific knowledge and
enhancing the prospect of successful replication. The more traditional levels of
interpretation serve as an additional verification of parameter utility. The parameters
encompassed by this scoring guide include: Inference Location, Causal Connection,
Object, Content, Tense, Immediacy, Depth, Topic ReintroduCtion, Specificity, and
Form of interpretation.

The levels of interpretation represented in the ISG include: Resistance, Defense,
Transference, CharaCter, Adaptive Context, Genetic, and Other Interpretations. These
levels correspond to those aspects of interpretation that have been borh empirically and
theoretically postulated to be of some importance in the process of psychotherapy. The
term level (as opposed to type) is used in the ISG to recognize that these different aspecrs
of interpretations tend to be interrelated, rather than mutually occlusive. The level Other
Interpretation is an exploratory category. The purpose of this category is to identify other
interpretive levels not presently included in our scoring system that regularly occur within

the therapeutic contact.

The Initial Definition

:1 interpretation is defined as any therapist statement in a session that infers something
‘ about the client that the client has not explicitly (i. e., verbally) apressed This is a
broad conceptualization, encompassing very simple forms of interpretation as well as more

131
commonly considered complex ones. At the very simplest level any therapist comment

might be construed as an interpretation, as therapist comments in general are selective.
This selectivity in and of itself indirectly focuses the attention of the client to what the
therapiSt comments on. Korchin (1976) nores that even a simple “Tell me more” carries
the meaning that an issue is important and that more information and exploration is
desirable. If every therapist comment is defined this way, however, the term
”interpretation” loses its meaning (and therapist verbal behavior might better be studied).
Thus, while this definition is expansive it is important to nate that it is not all inclusive.
It does not, for example, include behavioral observation. It does encompass all therapist
statements where a direct inference is made about the meaning of the client’s behavior,
verbal or nonverbal. This includes but is not limited to: subsritution of nondenorative
words or statements with explicit ones; the connection of idcas that the client has stated but
not explicitly linked together; and any kind of behavioral, cognitive, or affeCtive
assumption by the therapist that the client may have implied but did no: explicitly
convey. So if, for example, the therapist states, ”When you said that you were upset, your
voice was shaking”, it is nor an interpretation but rather an observation of the client's
behavior. If that same therapist were to State, “Your voice was shaking when you said that.
You must have been angry.”, then the latter Statement, ”You must have been angry”, would
be scored as an interpretation due to the affective inference made. We think that the
critical distinction between any therapisr Statement and an interpretation is that in an
interpretation the therapist assumes knowledge of unstated meaning and provides it for the
client. There may be cases where the client interrupts the therapist, if an inference is
included in the therapist’s partial statement, then it is regarded as an interpretation. In a
noninferential therapist statement, attention may be focused selecrively, but it is still the
client who explores and uncovers the meaning of, say, a shaking voice. As you may nate,
this approach to definition is much broader than those commonly found in dynamically
oriented works that may focus interpretations exclusively on resistance, transference,
genetic, StruCtural, or Other unconscious processes (e.g., Malan, 1976). What all areas of
interpretation have in common, however, is that they all require the therapist to infer or
deduce something that the client is nor explicitly and verbally acknowledging.

Units of Scoring

fter an interpretation has been identified, it muSt be operationalized. To adequately

' capture the complexity and richness of interpretive Statements, basic units of

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meaning are delineated. These basic units are then combined into larger units. The ISG

separates units of meaning into clauses, sentences, and segments.8

The clause is considered here to be the fundamental unit of meaning. It is defined
as a group of words that has a subject and a predicate. There are two types of clauses,
independent and dependent. An independent clause can stand alone grammatically as a
sentence. In contrasr, a dependent clause cann0t stand alone as a sentence. Dependent
clauses are always preceded or followed by independent clauses, and are utilized in
conjuncrion with an independent clause to express a related idea.

A sentence may consist of a single clause or several clauses. A sentence expresses a
complete thought and consists of a subject and a predicate. (If either the subject or
predicate is n0t expressed, it muSt be readily undersrood from sentences that precede or
follow). In more complex sentences, it is not unusual to find a number of clauses
containing several inferences.

In some insrances a therapist may verbalize several sentences containing inferences
before a client responds. In this case, sentences are combined to form what are referred to
as segments. Segments are sentences containing at least one inference that fall between two
client verbalizations. This is a higher level unit of meaning representing all of the
therapist’s inferences verbalized before a client responds. Operationalization at this level
can become very complex. For example, a single therapist segment may consist of several
sentences containing interpretations that are proffered to the client. Each sentence will
contain one or more clauses that may include separate inferences. Additional inferences
about the client may exisr in the form of causal connecrions between clauses within a
sentence, and causal connections between sentences. Furthermore, these inferences often vary
in Depth, Object, Tense, Immediacy, etc. Each sentence may be representative of a
difl'erent level of interpretation as well. This is only one example of several possible
therapist segments within a single therapy session.

Interpretive Parameters

nterpretive parameters define the meaningful boundaries of an interpretation. Within

' every interpretation there are a number of porential parameters that may be
identified. In addition, there are a number of dimensions within each parameter. The

 

8We do not address quantification issues in this guide. How the ISG parameters and levels are valued
depends on both the theoretical focus and the hypotheses included in a particular study. (for a review of the
grammatical rules, see Shermr , 1986).

following eight parameters have been selecltegl on the basis of a review of the theoretical
and empirical literature. An interpretation is scored by clause or by sentence on the
dimensions within each of the ten parameters9. More than one dimension may be scored
for some parameters. Examples are provided when relevant. Note that some examples
contain dimensions defined by other parameters. This approach allows for a greater
degree of operational specificity regarding what was actually said by the therapist to the
client as compared to previous works which have focused on interpretation as one aspect of
therapist verbal behavior (Hill, 1978; Stiles, 1979). Other studies have restricted their
investigation to one or two parameters such as Object (Piper et al., 1986) or Depth
(Speisman, 1959).

Two general rules, the pronoun rule and the relationship rule, are often helpful in
determining how parameters are scored. Pronouns are often encountered (e.g., that) in the
therapist’s interpretations. When the material the pronoun refers to is readily identifiable in
the transcript, replace the pronoun with the material it represents”. Next score the
interpretation based on the revised sentence. The relationship rule is applied in a similar
manner. When a nonspecific reference is made to a relationship that is readily identifiable
in the transcript from previous verbalizations, then score the interpretation using the
specific reference. When the client interrupts the therapist’s interpretive statement and the
interpretation is completed in the next therapist verbalization, then the two statements are
considered one sentence.

Operational definitions for the ten parameters are provided below.

I. Inference Location: This parameter denores the presence or absence of an inference for
each clause in an interpretive sentence. When an interpretive sentence contains a single
clause, it is automatically scored. If an interpretive sentence consists of multiple clauses,
score only those clauses that contain inferences about the client. Do nor use specific pronoun
or relationship replacements for this parameter.

II. Causal Connection: The therapist’s interpretation introduces a connection(s) between
two or more ideas11 about the client. The therapist makes a causal inference in the form of

 

9The parameters Inference Location, Object, Content, Tense, and Immediacy are scored by clause; whereas
Depth, Topic Relatedness, Specificity, and Form are scored by sentence. Causal Connections can be scored
both between clauses and between sentences.

10An exception to this rule is when the therapist uses a pronoun in an interpretive sentence with the intent of
seeking agreement from the client about another part of the interpretation (e.g., is that it}, don’t you?, etc).
11An idea is defined in the ISG as a single unit of meaning. This is represented by an independent or '
dependent clause (see Units of Scoring). .

134
a linkage between these ideas. This parameter emphasizes the idea of causality.
Generally, but nor always, this is represented in a “Given this, then this” form, where one
idea follows causally from another”. The ideas may have been expressed by the client, but
the causal connection has not been specifically verbalized prior to the interpretation.
Connections can be made between clauses or between sentences. If the therapist’s

interpretation contains no causal connection”, this parameter is nOt scored.

T: The trouble you have described in relating to women stems from the competition with your
father you mentioned earlier.

T: You didn’t aetually say it, but your feelings of affecrion for your father are threatening because
of your mother} response

T: You loved your father but felt a need to compete with your mother for his afl’ection, so you still
compete with other women at work and in social situations, especially when there is a man involved.

III. Object: Objecr is identified in two ways. The firSt is when the client is the only
individual about whom the therapist makes an inference. The second is when the therapist
also includes a reference to anather person(s). In the first instance, the object dimension,
Client Only, would be scored. If no individuals are specified in an interpretation, then the
Client—Only dimension is Still scored, because interpretations, by definition, involve an
inference about the client. In the second case, object dimensions are scored as Therapist-
Client, Parent-Client, or Other-Client; depending on who the therapist is referring to. If
more than one person-client reference is verbalized by the therapist, then more than one
dimension is scored. In the case where a general reference is made about ‘relationships’ or
‘people,’ then Client-Only is scored. In contrast, when a reference is made to a specific and
readib' identifiable relationship or person then one of the other dimensions is scored.

A. Client Only: the client is the only individual mentioned in the therapist’s
interpretation. If no individuals are specified, then the Client—Only dimension is still
scored.

T: Emotional commitments still frighten you.

T: You used to have to prove that you weren’t castrated. I

¥

lee have noticed a tendency to change words in sentences that strongly £1an a causal connection but lacks an
overt causal inference. Use the interpretive sentence as it stands without restructuring it to score Causal
Connecrion.

13Interpretations often contain connecrions that do not specify a causal relationship. These connections are
Syntactic and most often a conjunction between the clauses of a sentence is present.

135
B. Therqist—Client' the therapist's interpretation includes a reference to the therapist
or the therapeutic relationship. The therapist must be presented as part of the
interpretation for the client to consider. If the therapist is only mentioned as part of a
verbal convenience (e.g., I think that . . ., I mean . . .), then Therapisr-Client is nor
scored.

T: You may also have experienced some anger towards me in here.

T: You look anxious now just talking about it with me.

C. Parent-Client: the therapist includes something about the client’s relationship with

the parent(s) in the interpretation. References to either parent, step-parents, or ‘parents’
are acceptable. This does not include general references about family or Other relatives.
In these instances, score Other-Client Relationship.

T: You took responsibility for your mother’s behavior.

T: It sounds like you fear your parents reaction to your decision.

D. Mer—Client: the therapist includes something about the client’s relationship with
someone other than a parent or the therapist.

T: You are concerned about what others think of you.

T: Social interactions with women make you nervous because they remind you of your sister.

IV. CONTENT: This parameter refers to the readily apparent subject domains of the
therapist’s interpretation (i.e., what dimension of the client’s experience the therapist is
addressing). Three content dimensions are defined below. Score the primary dimension
that the therapist is emphasizing in a given clause.” This parameter determines whether
the therapist is interpreting material based on the client’s affect, behavior, or cognitions.
Content is scored for each clause in an interpretive sentence. If more than one Content
dimension is present in a clause, score only the main ficus of the clause. The content
dimensions are:

 

14Because an interpretation by definition infers meaning, many affective and behavioral inferences will

also contain a cognitive component. Cognition is n0t scored in these cases. Cognition is scored only when it
is the primary focus ofthe clause.

136

A. Afictive: the therapiSt refers primarily to the affeCtive state of the client.15 The
particular afi’eCt is not labeled by the client prior to the therapist’s interpretation.
When the word ‘feeling’ is contained in an interpretation, this does not automatically
insure inclusion in this dimension“.

T: You seem to be angry.
T: You may also have experienced fiar.
B. Behavioral: the therapist’s interpretation refers to the client’s overt physical

behavior. Figurative behavior are scored in the cognitive dimension (e.g., “I noticed
that you pushed away your feelings just now.”).

T: Nomatter whatyoudidandgave, itendedas ifyou had nothingtogive.

T: I think your silence has some significance.
C. Cognitive: the therapist’s interpretation addresses the client’s thoughts, attitudes,
beliefs, or perceptions.

T: You thought you would die.

T: You believed your wish to sexually possess your mother was wrong and you feared possible
retaliation from your father.

V. TENSE: This refers to the verb form of the therapist’s interpretation. If a clause
contains more than one verb tense, score only the tense that is most closely related to the
subject of the clause. In the case where tense cannot be determined from the therapisr’s
statement, use a zero to denore that the parameter is unscorable. Tense can be:

A. Present Tense.
T: Emotional commitments still fiighten you.

T: You’re afraid that might happen again.

 

15A general guideline for deciding whether a word is a feeling or a cognition is to determine if the feeling
can be expressed facially. For example, resentment quickly brings to mind the specific facial characteristics
of frowning or grimacing. Resistance, on the other hand, does not bring specific facial features to mind
l6$ometimes therapists state thoughts in terms of feelings. For example, a therapist might say, “I feel that
this is a very important issue for you.” As a general rule, if you can replace feel or felt with think or thought
without losing meaning, the sentence contains a cognition and not a feeling (e.g., “I think that this is a very
important issue for you.”). At other times the therapist will preface interpretations with a phrase that is
misleading in terms of the content contained in the actual inference (e.g., “I would think that you would feel
angry in that situation.”). In this example, the interpretation would be scored for affective content (...you
would feel angry...) whereas the cognition (I would think...) does n0t contain an inference about the client.

137
B. Past Tense.17

T: You used to have to prove that you weren’t castrated.

T: You tooh responsibility for your mother’s behavior.

C. Future Tense.18
T: Soyouwillbeconfusedifshesaysyes.

T: The upcoming reunion will increase your level of anxiety.

VI. IMMEDIACY: This parameter refers to the temporal proximity of the content
dimension(s) contained in the therapist's interpretation to when the client last mentioned
them. The therapist is responding to something the client actually said (i.e., an object or
content dimension that can be specifically located in the transcript) at some point in the
course of therapy. If both Preceding Statement and Same Session can be scored, then score
Preceding Statement only. If it is not clear that the therapist’s interpretation is addressing
readily identifiable client verbalizations from the transcript, then use the dimension,
Unscorable .

A. Preceding Statement: the therapist's interpretation refers to specific objecr or
content dimensions contained in client verbalizations immediately before the
interpretation was given. These verbalizations are located between this interpretation
and the preceding therapist Statement.

B. Same Session: the therapisfls interpretation refers to specific objeCt or content
dimensions contained within the same session that the interpretation was given.

C. Unscorable: the therapist’s interpretation refers to material that cannor be
identified in prior client verbalizations.

 

17There are instances where an interpretation will be prefaced by a phrase in the present tense, followed by a
statement in the past or future tense (e.g., I think that you used to...; I wonder if you would feel that way next
time your...). These types of statements are scored according to the tense most closely related to the subject of
the clause in question.

.ISSome interpretations contain key words like again that would indicate future tense.

138

VII. DEPTH: The extent to which the therapist includes what the client explicitly stated
in an interpretation. This parameter consists of three mutually exclusive dimensions:
Substitution, Extension, and Introduction. There may be inStances where Depth is
unscorable. Denote these with a zero.

A. Substitution: the therapist replaces the client’s nondenorative word or phrase with a
more specific one. The therapist substitutes a more narrowly defined word(s) for a
client verbalization that has a broader meaning. This is similar to specifying a single
object from a class of objects (e.g., the client says flower, the therapist says tulip). If
it is unclear whether the therapist’s statement is a subset of the client’s verbalization,
then subStitution is not scored. The therapiSt’S interpretation muSt refer to client
material that is readily identifiable in the transcript. Importantly, synonyms are not
included in this dimension because they are restatements and do n0t include an
inference.

T: W you want people to understand you.

T: Yousayyoufeelhmhgmd, butyouseemangvyto me.

C. Extension: the therapist’s interpretation includes bath reference to what the client
has explicitly stated and additional material that has not been verbalized by the client.
In an Extension, the therapist adds material that goes beyond but is related to what the
client has previously expressed. The meaning of a client verbalization is either added
to or modified in some manner.

D. Introduction: the therapist ’S interpretation only contains ideas that the client has
not explicitly verbalized. The introduCtion of the new idea(s) by the therapist must
differ in meaning from what the client acrually said in the session. The therapist may
reintroduce an interpretation even though the client has not verbalized any of this
material after the firsr time it was presented. These interpretations are Still scored as
introductions.

VIII. SPECIFICITY: An interpretation is Specific when it contains references to behavior
or events that are distinct or idiosyncratic to the client. This dimension also includes
client relationships that refer to people who are specific and readily identifiable. A
general interpretation is scored if the therapist makes an inference that is devoid of

references that could distinguish one client from another. In the case where a reference is

139

made about nonspecific relationships, General is also scored. Specificity is dichoromous,
both dimensions cannot be scored for a Single interpretive statement.

A. Specific: an interpretation includes explicit references to Specific behavior
(including verbatim client verbalization), history, events, or readily identifiable
relationships that are attributed to the client”.

T: You feel you end up with men like Rod by chance when, in fact, you choose them because they
feel safe to you.

T: The common theme here seems to be your fear at succeeding at both your job and at school.

B. General: an interpretation that is applicable to other clients due to its nonspecific
nature. For example, the therapISt’s interpretation may refer to ‘relationships’, but
does not refer to a disrincr or particular relationship. General interpretations, when
read in isolation, lack a link to the client identified in the transcript. I

T: You are concerned about what others think of you.

T: You feel angry.

DC. TOPIC REINTRODUCT ION: This parameter operationalizes the therapist’s
repeated introduction of a Specific topic or theme. It is scored when an interpretive
statement contains a reintroduction of material that has been previously introduced or
interpreted by the therapist. The second interpretive Statement reiterates the primary
theme of the therapist’s previous interpretation. These statements must be separated by at
least one client verbalization. The specific topic or basic theme may continue to be
presented by the therapist “in subsequent interpretations, and Topic Reintroduction is
scored each time. The interpretation may be worded differently each subsequent time, but
the same basic topical meaning (within a Similar context) must be readily idennfiable from
the earlier therapist Statement.

X. FORM: Form describes the sentence type of a therapisr’s interpretation.
Interpretations have two dimensions and two manners of presentation. The dimensions are
question and statement. The therapist presents an interpretive question or Statement in

either a tentative or firm manner.

A. Question. the interpretation is in the form of a question.

 

l9When pronouns are encountered (e.g., that) in the therapist’s interpretation, Specific is scored if the
material the pronoun refers to is readily identifiable in. the transcript. Ifnot, General is scored.

140

B. Statement: the interpretation is in the form Of a Statement.

1. Tentative: the interpretation is in the form Of a question or declarative
Statement, but includes introduCtory phrases (e.g., It would seem to me that ...; I
think that ...; You feel that ...; etc.) or modifier wordS.(e.g., might, may, could be,
possibly, wonder if, etc.)2°.

T: I wonder if you feel fearful at those times?

T: I would think that you might feel fearful about that.

2. Firm: the interpretation is in the form Of a direcr question or statement.
T: Do emotional commitments frighten you?

T: You think that all womot are punishing, juSt like your mother was when you were growing
up.

Levels Of Interpretation

he literature on psychoanalysis and psychotherapy defines a number of different
l levels of interpretation that therapiSts proffer to their clients. These levels of

interpretation do not seem to be mutually occlusive as there is some overlap between the
various categories. For otample, the constructs Of transference and resistance as they appear
in the course Of the therapy session can be combined by the therapisr to make up a
transference—resistance interpretation. This section of the guide presents an operational
definition Of selected levels of psychodynamic interpretations followed by examples.21
Material from different theorists are then presented that illustrate the wide variation in
how interpretive levels have been defined. It is acknowledged that Other theoretical
perspectives otist and that there are Other levels of interpretation that may not be included
in the ISG at this time. We chose to start operationalizing levels Of interpretation from
the psychodynamic perspective because this is where the therapeutic technique Of
interpretation first originated. An exploratory level, Other Interpretations, is included in
this section to identify interpretive levels that are nOt presently included in the ISG, but

 

20Sometimes it is unclear whether words or phrases modify a sentence. If the suspected words can be left out
of the sentence without changing the meaning of that sentence, then the question or statement is scored as
tentative.

21 Examples in this section are from Levy’s (1984), Principles of Interpretation, and Kapelovitz's (1987), To
Love and to Work We acknowledge that these otamples are independent Of the therapeutic contort and may be

less meaningful.

141

are regularly utilized by therapisrs. The intent Of this category is to specify those levels of
interpretation that occur with a relatively high frequency in psychOtherapy.

Interpretations are scored on one or more of the six psychodynamic levels. If an
interpretation cannot be scored on one Of these levels, Other Interpretations is scored.
When identifying interpretations by level, raters should guard against inferring what the
therapist only implies. Operational definitions for the interpretive levels are provided

below.

I. RESISTANCE INTERPRETATION: The therapisr’s interpretation points out some
aspect Of the client's behavior that is interfering with the process of therapy. The behavior
the therapist interprets as impeding the client’s self-understanding varies in blatancy from
very overt behavior (e.g. missing sessions, saying that a topic is not important, etc.) to
subtle behavior (e.g. superficial content, changing topics, etc). In a resisrance
interpretation, the interpreted behavior itself is not Significant. It is the inference that the
behavior interferes with the therapy process that is relevant.

T: (Overt) From your Observation that you don’t always listen, we can surmise that you keep us from
both thinking about the same thing, from working together on a problem (p. 64).

T: (Subtle) By directing your attention to my interest in your sexual life, you avoid recognizing or
acknowledging your own sexual impulses yet engage me in a highly charged exchange in which sot
is at the center of things (p. 161).

Wm

0 The manifestation of a defense mechanism, in therapy, that most commonly occurs when
therapisr is making conscious, via an interpretation, an impulse, idea, or affect which the
defense mechanism was keeping unconscious (Kapelovitz, 1987).

0 That aspect of all behavior during treatment that stands in opposition to the therapeutic
process. An interpretation will Show ways that the patient protecrs or defends the self. A
way Of conceptualizing those aspects Of the patient's activity, conscious and unconscious;
which are used to counteract or interfere with therapeutic progress. Useful to include the
nation that the resistance is directed against therapeutic activities Of the therapist (Levy,
1984).

0 The tendency to oppose change, even when seeking it, and to maintain the neurOtic Status
quo. The defensive maneuvers which avert self-knowledge. Eg. blocks, periods of
silence, dwelling on trivia, avoidance Of topics, and similar behavior (Korchin, 1976).

0 ReSIStance impedes the progress Of treatment (Reich, 1949).

0 Patient resistance tO divulging the motives behind his/her feelings (Wolberg, 1977).

142

0 Patient is defensive or oppositional. Among many forms, he may express denial,
repudiation, exaggerated doubt, or hOStility to the therapist as manifestations of
resistance. He may try to disrort, evade, or change the subject (Luborsky et al., 1979).

0 Resistance is defense otpressed in the transference (Gill, 1981).

. Everything that prevents the patient from producing material derived from the
unconscious is resistance (Fenichel, 1945).

0 Any impediment within the patient to the work of therapy or analysis (Langs, 1982).

' Well, the resistance is the surest Sign tO us of a conflict. There must be a force here which
is seeking to express something and amber which is Striving to prevent its expression
(Freud, 1933).

- Resistances Of this kind [transference] should not be one—sidedly condemned. They
include so much Of the most important material from the patient’s past and bring it back
in so convincing a fashion that they become some of the best supports of the analysis if a
skillful technique knows how to give them the right turn. Nevertheless, it remains a
remarkable fact that this material is always in the service of the resistance to begin with
and brings to the fore a facade that is hostile to the treatment. Nor must you get an
impression that we regard the appearance of these resistances as an unforeseen risk to the
analytic influence. NO, we are aware that these resistances are bound to come tO light; in
fact we are dissatisfied if we cannot provoke them clearly enough and are unable to
demonsrrate them to the patient. Indeed we come finally tO undersrand that the
overcoming of these resistances is the essential function of analysis and is the only part of
our work which gives us an assurance that we have achieved something with the patient
(Freud, 1916).

0 Resistances (secondary defense) guard against the established ego defense, character
defensive trait, and neurosis (primary defense). Preserves self—defeating but desperately
clung to, symptom defenses. Often the more handicapping, the more isolated, and the
more prominent the symptom, the more grim and vigorous its (secondary) defense [i.e.,
resistance strength]. (Laughlin, 1983).

II. DWSE INTERPRETATION: The therapist interprets some aspect Of the client's ’
thoughts or behavior that operate to occlude from the client’s awareness dIStreSSing affect
(e.g. shame, guilt, disgust, fear, etc); or unacceptable thoughts, wishes, or impulses.

T: DO you think you have an impulse to do things that serves a purpose of some kind? (p. 719)

T: 50, by overeating, you could, at least in one area, defeat her control over you, while protecting
yourself from being accused Of being sexually provocative (p. 154).

143

W

0 A defense mechanism prevents the recognition Of painful affects (Korchin, 1976, p. 324).

° The therapiSt interprets the nature, purpose, manifestation, and origin of a defense
mechanism (Wolberg, 1977).

0 A defense connotes something intrapsychic whereas a resistance connOtcS something
interpersonal (Gill, 1982).

0 An interpretation Of a defense mechanism that is keeping an impulse, idea, or affect
unconscious (Kapelovitz, 1987).

0 Defensively—intended intrapsychic dynamisms. A mental mechanism, dynamism, or ego
defense is a specific defensive process, operating outside of and beyond conscious
awareness. It is automatically and unconsciously employed in the endeavor to secure
resolution of emOtional conflict, relief from emotional tension, and to avert or allay
anxiety. A given dynamism is evoked by the ego as an attempted means of coping with
an otherwise consciously intolerable situation (Laughlin, 1983).

0 All psychological efforts, Conscious and unconscious, by an individual that are designed
to protect him or her from danger situations, anxiety and other unpleasant affects,
unbearable conflict, disruptive introjects, and disturbing conscious realizations. Defenses
therefore constitute intrapsychically founded, protective psychological mechanisms
utilized by the ego in an effort to cope with disturbing external and internal realities,
and conscious and unconscious fantasy and perception constellations that pose any degree
of threat. Defenses may be pathological or nonpathological depending on their adaptive
aspeCts and the men: to which they disturb the functioning Of the user (Langs, 1982, p.
724).

0 Defenses are related to security needs and the more pathological aspects of behavior.
They include repression, isolation, reaction formation, projection, introjection,
rationalization, regression, and other particular ways in which we avert painful anxiety
(Langs, 1973, p. 73).

0 Systems of defence [Sic] are in use against the possible generation of anxiety (Freud,
1916). '

r The psychical mechanism Of defence as being ’unconscious’ (Freud, 1923).

0 The hypothesis of repression (or, more generally, of defence) as a mental funcrion....
(Freud, 1923).

144

III. TRANSFERENCE INTERPRETATION: The therapist infers that the client’s

current manner of relating to the therapist is a reenactment of past relationships with
significant Others.

T: Each time I begin to say something to you, you wince as though you expect me to say something to
hurt you just the way you always otpected your father would (p. 97).

T: Sometimes you struggle with me because you feel that Otherwise, you will not continue to feel
involved with me, which is how you have described feeling during periods when your mother
seemed depressed and uninterested in you (p. 104).

Ihtntttisallatkgtonnd:

0 The inappropriate repetition in the present of a relationship that was important in a
person's childhood. The distortion is in terms of time, person, and Situation and the
displacement is repetitive (Kapelovitz, 1987 ).

0 Transference is the manifestation, within the psychOtherapeutic relationship, Of the
ubiquitous distorting influence of the past relationships on current ones, intensified by the
regressive forces inherent in the treatment situation and clarified by the therapist's
neutrality, relative anonymity, and objectivity in the face Of the patients distorted view
of him. A means Of knowing the past by re—experiencing it in relation to the therapist
(Levy, p. 94).

0 Positive or negative feelings not generated in the present (therapy), but rather are brought
forward (transferred) from childhood experiences with key persons, especially parents
(Korchin, 1976, p. 328).

° The degree to which the patient is dealing with material that is related either overtly or
covertly to the analyst. This material Should be a manifestation or a displacement fiom
an early important object relationship. The previous object, however, does not have to be
mentioned; it may be inferred by the rarer because of the presence of distortion, Strong
affect, inappropriateness, etc (Luborsky et al. 1979).

0 The repetition Of previously acquired attitudes toward the analyst. The patient
misunderstands the present in terms Of the past; and then instead of remembering the
past, he Strives, without recognizing the nature of his aetion, to relive the past and to live
it more satisfacrorily than he did in childhood. He ”transfers" past attitudes to the
present. (the patient defends by reliving infantile conflicts rather than remembering
them. Transference also Offers an opportunity to Observe patient's past and understand
conflicts) (Fenichel, 1945, p. 29).

0 In all, transferences are repetitions of the past as it really happened, or was imagined or

idealized (Langs, 1983, p. 159).

145

0 Based on pathological unconscious fantasies, memories and introjects, transference
includes all distorted and inappropriate responses to and perceptions of the therapist
derived from these disruptive inner mental contents and the related mechanisms and
defenses. These distortions may be based on displacements from past genetic figures, as
well as on pathological interactional mechanisms (Langs, 1982, p. 746)

0 A transference of feelings on to the person of the physician, because we do nOt believe that
the Situation in the treatment can account for the origin of such feelings. [Transfer
repetition into recollection]. (Freud, 1912).

0 The process Of 'transferring' on to a contemporary object feelings which originally
applied, and Still unconsciously apply, to an infantile Object (Freud, 1905).

r Thus, in subtle, disguised, and convoluted ways, the patient relates to the therapist as a
personification from the past . In turn, this has the efi'ecr Of evoking certain affecrive
reactions that “pull for” particular, responses from the therapist (Strupp, 1989).

0 An emotional feeling is transferred, deflected, and redirected from its internal Object to
a substitute one. The emotional feeling is thus displaced to a new person, situation, or
object (Laughlin, 1983).

0 It refers to an infantile relationship with a significant person such as a parent or a Sibling
as being Similar to the patient's relationship with the analyst (Giovacchini, 1987).

IV. CHARACTER INTERPRETATION: The therapist makes the client aware of
well- established, ingrained, habitual modes of experiencing or responding. The therapist
interprets regular patterns about how the client makes sense of the world.

T: You feelyou end upwithsuch morbychancewhoi,infact,youchoose thernbecause they feelsafe
to you (p. 193).

T: That’s (1 can’t always let myself do what I want to do) a big part of your psychic Structure (p.
217).

W

0 The tOtality of the relatively stable personality traits and the usual mode of response of
the individual (Kapelovitz, 1987).

r A person’s typical ways of resolving tensions among conflicting mental trends. The
character structure is determined by various identifications, especially parental Objects
(Levy, 1984).

r The emphasis of characteristic behavior, stereotyped beliefs, repetitive aets, and Other
aspects of the functional personality as manifested in the life situation (Korchin, 1976).

146

° Characrer types = 1) Basic function is an armoring against the Stimuli of the outer world
and against the repressed inner impulses. 2) The otternal form of the armoring has its
specific historical determination (development or determinants) (Reich, 1949).

0 Character resistance such as affectless intellectualization (Luborsky et al. 1979). Some
enduring personality trait or disposition in the client that is manifested interpersonally.

0 Definition Of character: The individual’s usual, repetitive, largely ego—syntonic,
characteristic way of reacting, behaving, defending and gratifying himself (Langs, 1983).

0 The delineation Of constellations of consistent (persistent, characteriStic) human behavior
over time and situation. The stable ways in which the ego reconciles the inevitable
conflicts among the internal psychic StruCtureS and between those Structures and the
demands of the environment. [Long—standing, somewhat successful behavior patterns].
(Johnson, 1985).

0 Character Structure attitudes and patterns are molded out Of specific conditioning in
early interpersonal relationships Wolberg, 1977).

0 The concept of character evidently has a broader scope than “modes of defense anchored
in character.” The ego not only protects the organism from external and internal stimuli
by blocking its reactions. It also reacts. It Sifts and organizes Stimuli and impulses; it
permits some Of them to find expression directly, Others in a somewhat altered form.
The dynamic and economic organization of its positive actions and the ways in which the
ego combines its various tasks in order to find a satisfactory solution, all Of this goes to
make up “character.” Character as a habitual mode of bringing into harmony the tasks
presented by internal demands and by the orternal world, is necessarily a firnction Of the
constant, organized, and integrating part of the personality which is the ego (Fenichel,
1945, p. 466-7).

0 It may also be said that what is being mobilized for fighting againSt the alterations we
are Striving for are character—traits, attitudes of the ego. In this connection we discover
that these characrer-traits were formed in relation to determinants of the neurosis and in
reaction againSt its demands, and we come upon traits which cannOt normally emerge, or
nm to the same extent, and which may be described as latent (Freud, 1916).

0 Idea that identification is an important factor in the formation of character (Freud,
1933).

r The individual’s usual, repetitive, largely ego-syntonic, characrerisric way Of reacting,
behaving, defending, and gratifying himself. It develops out of innate givens and their
specific unfolding under the influence of, and in interaCtion with, his environment.
Pathological character formations are repetitive, maladaptive, ego—syntonic patterns
(Iangs, 1973, p. 245).

147

0 Character refleCts the ego's habitual modes of adjuSting to the id, superego, and the
external world, and as constituting the individual's enduring mode of relating and
adapting to others (Langs, 1982, p. 9).

V. ADAPTIVE CONTEXT INTERPRETATION: The therapist interprets the client’s
strivings, wishes, or needs as they are facilitated or frustrated by real life situations.

T: What you are really saying is that you are angry at me for not being here next week because you
feel you have nothing to say about it (my leaving) (p. 41).

T: What prevents you from expressing your opinions directly in business meetings in a way that gets
you the respeCt you desire is the fear that your boss won’t take you seriously.

Wild;

0 To interpret the patient's strivings as related to something that is happening to him in the
present helps provide him with a picture of his interpersonal attitudes in operation
(Wolberg, 1977).

0 The therapist believes that the more the patient accurately knows about himself, past and
present, the better are his chances for fashioning compromises among the many
conflicring forces within himself and in his environment that will improve his life.
Adaptation is a word sometimes used here (Levy, 1984).

0 The aim is to make the patient realize some of the ideas he has and the conflicts between
them that he did not know he possessed (Wisdom, 1963).

0 The way in which a psychic phenomenon relates to the environment (Kapelovitz, 1987).

0 Adaption in a dynamic sense means finding common solutions for the tasks represented
by inner impulses and outer (inhibiting and threatening) stimuli (Fenichel, 1945).

' Adaptive context is the specific reality that evokes an intrapsychic response (Langs,
1982).

VI. GENETIC INTERPRETATION: The therapist interprets early life morives or
strivings as they continue to influence present life experiences.

T: Although you feel like a victim in such situations, we have seen how you often provoke these
tirades by your husband, and then elect to suffer silently through them in order to feel mistreated in
a manner similar to the way your morher felt mistreated by your father (p. 193).

'1': At work, you’ve become like your father, doing to your employees what he did to you.

148

Iheamicalhckgmnnd;

° Refers to the constitutional factors and early life experiences which contribute to the
development of the phenomenon in question (Garduk 85 Haggard, 1972).

0 The infantile and childhood developmental experiences from which adult behavior,
personality, and psychic structure are derived (Kapelovitz, 1987).

0 A genetic interpretation explains a current reaction or feeling as the outcome of a past
relationship (Giovacchini, 1987).

0 Genetic interpretations aim at the establishment of a reciproeal relationship between the
present and the past (Loewenstein, 1957).

O Linking the meaning of present behavior to affectively significant events in the patient’s
past (Basch, 1980).

VII. OTHER INT ERPRETATIONS: This is an exploratory category for developing
levels of interpretation not included in the traditional levels operationalized above. The
intent of this category is to generate new levels of interpretation by asking raters to answer
the question, "What is the therapist inferring about the client?"

Comparison of Interpretive Levels

he levels of interpretation are not necessarily mutually exclusive. Given the natural

l overlap between different am of the levels, they are at times difficult to dis-
tinguish. For example, a client’s defense may also function to inhibit the process of
therapy. This would be scored as both a defense and a resistance interpretation. Four sets
of interpretive levels that display

 

common features are Resistance, Eignmj.

Defensg, and Charactcr; Similarities 8' Differences Between Resistance,
. Defense, 6' Character Interpretations

Transference and Genetic;

Transference and Resistance; and
Defense, Character, and Adaptive
Context. One exception to multio

ple scoring is the Other category,
which is rated separately. The pur—
pose of this section is to help raters
distinguish between related inter—
pretive levels with a higher degree
of confidence.

 

1: Defense serving as
a resistance.
2: Character defense.

3: Long-standing character
trait (not a defense) serving
resistance.

4: Character defense serving as a resistance to
the therapy process.

  
  

 

 

149

Resistance operates in the here-and—now to impede the progress of therapy.
Defenses exclude from the client’s awareness distressing thoughts, wishes, or impulses. A
defense can serve as a resistance. When this is the case, the act of excluding material from
awareness is interpreted to the client as inhibiting the therapy process. Character refers to
ingrained habitual modes of experiencing the world. A defense can be a part of the client’s
character. A Character-Defense interpretation occurs when defenses are interpreted as
having become so ingrained in the personality that they are habitually relied upon. Other
aspects of characrer may be interpreted as interfering with the therapy process. These
would be Character—Resistance interpretations. On rare oceasions all three levels may be
combined into one interpretation. In these instances, a characrer—defense is interpreted as
serving the resistance. Figure 1 illustrates the possible interactions between Resistance,
Defense, and Character interpretations.

A Genetic interpretation refers to early life motives or strivings and connects them
£81m

Similarities & Differences Between Transference

and Genetic Interpretations take something that influences the

client’s present life experience and

with the present. Genetic interpre—
tations can also be reversed and

connect it to the past. This type of
interpretation usually includes ref-
erences to significant people in the
client’s past (e.g., a parent), without

1: Parental elements included in a transference . ,
interpretation. any reference to the client s rela-

 

 

 

tionship with the therapist.
Transference interpretations do include a reference to the therapist. The material is
interpreted as a replay of past conflicts once again in the present. These two levels are
similar in that they both connect present material with past material. The major
difference is that the therapist is not

included in a genetic interpretation Rim

 

(see Figure 2), Similarities 8' Differences Between Transference

, . and Resistance Interpretations
The client can resrst explor—

ing the transference relationship.
The client can also utilize the trans—
ference relationship as a way to

resist exploration or uncovering

when conflicts are TC-CMCth rather I: Aspects of the transference as serving the
than worked through. The therapiSt ”fiance“

 

 

 

150

may interpret the resistance alone. A Transference—Resistance interpretation occurs when
the therapist interprets transference manifestations as impeding progress in therapy (see
Figure 3). Differences between transference and resistance interpretations include the focus
on the relationship with the therapist in the transference and the client’s behavior that
impedes therapeutic progress in the resistance. Transference is directed toward the
therapist. whereas resistance is directed toward the therapy itself.

Adaptive Context interpretations infer a relationship between the client’s inner
needs, wishes, and strivings and a specific external environmental reality. A Character—
Adaptive Context interpretation occurs when the therapist’s inference refers to ingrained
habitual ways of mediating between inner strivings, wishes, or needs and the outside world.
At times, a defense may be interpreted as performing these same mediating fiinCtions.
When this is the case, both Defense and Adaptive Context are scored. A rare but possible
interpretation may also occur where a character-defense is interpreted as mediating
between strivings and a specific environmental condition. In this instance, Adaptive
Context, Defense, and Character would be scored (see Figure 4).

Figure!
Similarities 8 Differences Between Adaptive
Context, Defense, 8 Character Interpretations

 

1: Defense mediating
strivings and reality.
2: Character defense.
3: Long-standing character
trait mediating between
strivings and the environment.

4: Character defense mediating between internal
strivings and outer reality .

  

 

 

 

Importantly, multiple scoring situations occur only when all qftbe definitions fir
each individual interpretive level are fidly satisfied The most common occurrence is when
only one of the levels are scored for an interpretive sentence. Level combinations are
relatively rare, and combinations other than those described may occur. Avoid the
inevitable temptation of inferring what the therapist only implies.

151

Scoring the ISG

0 identify and score interpretations with the ISG, a transcript of the therapy sessions

‘ from which the interpretations will be drawn is required. Initially, raters read
through the transcript and examine each therapist statement for the presence of an
inference”. Raters will sometimes encounter client verbalizations like “uh—huh” or “yeah”
that suggest acceptance of the therapisr’s interpretation. These minimal client statements
do not constitute explicit agreement with the interpretation. Later therapist statements
inferring similar material should be scored as inferences, even if there is prior minimal
agreement. After all inferences have been denoted, brackets are placed around each
interpretive sentence. These are referred to as “bracketed sentences.“ Each bracketed
sentence will contain at least one clause and in many instances, more than one clause. The
clause is the basic unit of scoring for six of the parameters contained in this guide.23 For
the interpretive levels and the orher three parameters, one bracketed sentence equals one
scoring unit. All scoring units between two client verbalizations are referred to in the ISG
as a “therapist segment.“ Each rater denotes with a “\I” in the margin where therapist
segments occur in the transcript. Next, rater transcripts are compared and those segments
containing bracketed sentences on which all raters agree are numbered sequentially for an
entire series of therapy sessions“. Throughout the scoring process, raters will now on a
separate sheet of paper any technical or procedural difficulties encountered while using the
ISG.

After interpretations have been identified at the sentence level, each sentence is
further divided into clauses. Raters meet as a group and divide bracketed sentences into
clauses by enclosing them in parentheses “( )." Discrepancies are resolved by discussion
and by referring to the grammatical rules in Appendix A. At this point, the raters also
identify the specific referents of pronouns that occur in the therapist’s and the client’s
verbalizations. In those cases where specific referents can be identified, the raters write
these above the pronouns in the transcript and the specific text is used in scoring rather than

 

2then the client interrupts the therapist’s interpretive statement and the interpretation is completed in the
next therapist verbalization, then the two statements are considered one sentence.

23T he parameters are Inference Location, Causal Connection, Object, Content, Tense, and Irnmediacy.
Causal Connection is also scored at the sentence level.

24We think 100% agreement is necessary for defining basic interpretive statements because each rater has to
score each bracketed sentence on a number of different parameters and levels of interpretation. If raters
cannot agree on basic interpretive statements, we see little reason to expect them to agree on the properties of
those statements.

152
the pronoun. If specific referents cannor be identified, a “G“ is placed nut to the pronoun
to signify that a specific referent could not be identified. Inference Location is an
uception to this rule. It is scored using the sentence as it is stated by the therapist. Figure
5 illustrates this method of delineation.

 

Eigntej
An example delineating basic units of inference”

the consequences of being hurt in a committed relationship
P: Perhaps I think about fir you know. Sometimes I say, what happens if, OK, I just

said, ”that: (3) it, I'll just commit myself to Lisa. Right, I'll go the full route and I'll
just be really open with her and spend as much time with her as I can.” Um, I guess
what I'm thinking is that once I do Will‘s? OWEWVbu‘kWM means
marriage. But I guess what I was thinking about . . .

T: [(I think to youfigmaflg Sscs‘iblgigs‘girfik means getting involved with
somebody, loving that person, caring about that person, feeling committed,)(and
then in one way or another you get shafted at the end of the story).] With Linda, she
left in, you know, sort of a hostile and malicious way. With Kate, she left through
dying. [(But nonetheless the consequences are the same:)(You're left).] [(You're

looking pretty sad).] What are you feeling?

 

The nut step is to represent the therapist’s interpretations on the ISG Scoring
Sheet. The Scoring Sheet is comprised of a Parameter Grid and a Level Grid. First,
therapy transcripts are quantified by session, segment, sentence, and clause. This is
represented on the Scoring Sheet in a 1.2.3.4 format. This denotes (following from right
to left) the fourth clause, in the third sentence, in the second segment, of the first session of
a therapy transcript. Session, segment, sentence, and clause numbers are recorded on the
Parameter Grid on the top four rows of the form. On the Level Grid, information at the
clause level is omitted and only the session, segment, and sentence information are
recorded. Within each bracketed sentence, all clauses are represented on the Parameter
Grid.“ Sentences that do n0t contain inferences about the client are n0t quantified. Figure

 

25Text excerpted from Budman at Gurmans’ (1988), Theory and Practice of Brief Therapy.

26livery clause within a bracketed sentence is scored on the Parameter Grid even though some clauses may nOt
contain an inference. Additionally, the parameters Depth, Topic Relatedness, Specificity, and Form are
quantified at the sentence level only.

153

4 provides an illustration of this method of denotation as it would be entered on the
Parameter Grid, using the sample transcript shown in Figure 5. Thus the therapist
statement, “You’re looking pretty sad” is represented as 2.14.4.1, that is, the first clause of
the fourth sentence in the 14th segment of the second session.

 

 

 

 

 

 

 

 

 

 

 

 

W After inter-
Recordtng Information on the ISG Parameter Gfld p ret ati 0 ns have
5855’“ fl 2 3 been represented
Segm t
Unit of Sen en 14 1 on the ISG
t
Inference cute 1 3 4 1 Scoring Sheets,
Clause 1 1 2 1 2 1 1 th
_ g , , _ ey are opera-
Inference Location a] " ' ‘ . .
tionalized by
Connection Causal
Clo t on] V r iii-g if. 3:3; - ., ;;1.}.§ I}: .333: parameter.
‘8“ g I r ‘1 4351. _- z" 13:." "Z" '53"
y Parameters are
Therapist - Client ,
Object scored indepen—
Parent - Client
dently for each
Other - Client ,
Aff t' e session. Raters
1V
ec score all brack—
Content Behavioral etc d sentences
C '6 . . .
08m ve ‘1 N, i, ‘l 4 Within a session

 

 

 

 

 

 

 

 

 

on each separate
parameter before moving on to the nut one. For the parameters Inference Location,
Object, Content, Tense, Immediacy, Depth, and Specificity, dimensions are denoted
with a “\l.’ Always score parameters in the order in which they occur on the ISG
Parameter Grid. For example, all clauses within a session should be examined for the
presence of an inference before the nut parameter, Causal Connection is scored (see Figure
5). Likewise, all Causal Connecrions are scored for that session before Object is
quantified. Each parameter should be fully operationalized for a given session before
moving on to the nut parameter. Additionally, all interpretations in a given session
should be quantified on all parameters before interpretive level is scored. Note that
Inference Location, Causal Connecrion, Object, Content, Tense, and Immediacy are
scored at the clause level and the parameters Depth, Causal Connection, Topic
Reintroduction, Specificity and Form are evaluated at the sentence level.
Causal Connecrion deserves special mention as the possibility of connections must
be investigated between clauses within sentences, and between sentences within a segment.
For the Causal ConneCtion parameter, connections are firsr operationalized by clause

before sentences are evaluated. Only the clauses within each bracketed sentence are uam—

154

ined for the presence of eausal connecrions. Similarly, only sentences within a given
segment are scored on the Causal Connecrion parameter. Additionally, connecrions
between clauses and between sentences are denoted difi'erently on the ISG Parameter Grid.
Connections between clauses are denoted with a “C” and a subscript indicating the clauses
to which they are eausally connected. Sentence connections are denored with an “S,” with
the subscript representing the sentence that it is conneCted to (see Figure 5). Remember
that all connections must be causal inferences to be scored.

Scoring procedures for the parameters Topic Reintroduction and Form are also
different from the other parameters. Topic Reintroduction between segments is denoted
numerically. Topic ReintroduCtion is scored by numbering each reintroducrion of a theme
with the sentence and segment number of that theme’s first introduction by the therapist.
The first introduction of a theme is not scored. For example, a rater identifies a theme
that has been reintroduced in the first sentence of the sixth segment of a session. The
original introduction was in the second segment’s first sentence. The denotation at the
point of reintroduction would then read, “2.1,” meaning that the theme was first verbalized
in the first sentence of the second segment. The first time a theme is reintroduced, raters
summarize the theme and write it on the back of the Scoring Sheet. When encountering
subsequent reintroductions, refer to the written theme for scoring Topic Reintroduction.
Form is evaluated first on the dimensions question and statement. After these dimensions
have been determined, raters use a “T” or an “F” to denote Form, depending on whether the
question or sentence is phrased in a tentative or firm manner.

After all clauses, sentences, and segments have been scored on all of the parameters
for a given session, the rater proceeds to code levels of interpretation. As previously
stated, coding of levels of interpretation is done by sentence. Firsr, the rater returns to the
beginning of the session and scores levels of interpretation on the ISG Level Grid,
independent of the previously coded dimensions and parameters. Oceasionally, sentences
may be scored on more than one interpretive level. For this reason, raters should uamine a
bracketed sentence for the presence of each of the first six interpretive levels before scoring
the next sentence. When identifying interpretations by level, raters should guard against
inferring what the therapist only implies. In general, if raters find themselves spending too
much time trying to decide if an interpretation belongs to a given level, it probably does
not. If an interpretation cannot be scored on any of the first six operationally defined
interpretive levels, then the uploratory level, Other Interpretation, is scored. After raters
mark Other Interpretation on the ISG Level Grid, they write out their response to the
question, “What is the therapist’s interpretation inferring about the client?” Responses to
this questions are recorded in the area below the Level Grid. The interpretation’s segment

155

and sentence numbers are denoted, followed by the response to the question. The rater may
use as much space as necessary to answer the question and begins the nut occurrence of
Other Interpretation on the line below.

156

Appendix A
Basic Rules of Grammar

In this appendix, we include those rules of grammar that are necessary to divide
therapy transcripts up into segments, sentences, and clauses as defined in the body of this
guide. These rules are a composite taken directly from three books on grammar: Indu to
English (Ebbitt & Ebbitt, 1977); lhe Elements of Grammar (Shertzer, 1986); and Elements
of Style (Strunk 8: White, 1979). Raters should refer to these books to resolve any conflicts
regarding the proper way to unitize a transcript when the appendix is unclear.

We offer some guidelines for raters use when delineating clauses within sentences:

I. Punctuation marks like commas, semi-colons, and colons as markers of a separation between
chases.

2. Cory'unctions such as: fir, as, and hat, or, so that, etc. (refit to list below) that join words,
phrases, or chases.

3. Chases contained in a sentence can stand alone. i.e., it is an independent chases. then
parentheses are phces around the chase. 3] reading sentences and loohingfbr independent
chases. the rash of identzfiing chases in a transcript is made easier.

4. All sentences will have at least one independent chase.

5. Nonrestrictive dependent chases are considered part of the independent chase fir
unitizing.

6. Be aware that therapy transcripts may not fillow the appropriate rules of grammar or style
due to improper use of the English hnguage when speaking.

It is assumed that raters will know the definitions of the basic elements in written
language (i.e., a noun, verb, etc). The following definitions are thought to be particularly
relevant and therefore are included in the appendix.

A sentence upresses a complete thought and consists of a subject and a predicate.
If either the subject or predicate is n0t upressed, it must be readily understood from
sentences that precede or follow. The subjecr of a sentence is the person, object, or idea
being described. The predicate is the uplanation of the aetion, condition, or efl’ecr of the
subject. So, the predicate of a sentence or clause is the verb with its modifiers and objects
or complements. Two verbs depending on one subject are known as a compound predicate.

A phrase is a group of words that are closely related but have no subject or
predicate. A phrase may be used as a noun, verb, adjective, or adverb. A phrase that is

157

essential to the meaning of the sentence is called restrictive. A phrase which is actually a
parenthetical comment is called nonrestrictive and is usually set off by commas.

A clause is a group of words which has a subject and a predicate. A main (or
independent) clause can stand alone as a sentence. A subordinate (or dependent) clause is
incomplete and is used with a main clause to upress a related idea.

Conjunctions are words that may signal a break between a dependent clause and an
independent clause. They are: after, although, and, as, as . . . as (e.g., as well as), as if, as
though, because, before, but, but that, ever since, even if, except that, for, how, if, if only, in
addition to, inasmuch as, in case, in order that, just as, more than, nor, now that, once, or,
provided, rather than, since, so that, so . . . as, such . . . that, than, though, till, together with,
unless, until, when, whenever, where, wherever, whereupon, whether, while, why, yet; and the
relative pronouns: who, which, that, what.

Nonrestrictive clauses do not limit or define, they merely add something. A
sentence containing a nonrestrictive clause can be split into two independent statements.
Restrictive clauses, by contrast, are not parenthetic and are not set off by commas. A
sentence containing a restrictive clause cannOt be split into two independent statements.
So, in a clause that modifies the meaning of a sentence, does the clause add something that
he sentence requires for its basic meaning (restrictive), or does it offer information—mo
matter how important—«hat could be omitted from that sentence without detracting from
its central message (nonrestrictive). Nonrestrictive clauses are included with the restrictive
clause when marking the units for scoring on the ISG. Dependent and independent clauses
are separated out.

158

Appendix B
Quich Reflrence Sheet fiir IS G Levels

This reference sheet is intended for use during the scoring of interpretive levels. It
is not meant as a substitute for the ISG. The purpose of this sheet is to simplify
the scoring process by allowing raters to easily compare the levels for each

interpretive sentence. Questions or conflicts should be resolved by referring to

main body of the guide.

I. RESISTANCE INTERPRETATION: The therapist's interpretation points out some
aspect of the client's behavior that is interfering with the process of therapy. The behavior
the therapist interprets as impeding the client’s self-undemanding varies in blatancy from
very overt behavior (e.g. missing sessions, saying that a topic is nor important, etc.) to
subtle behavior (e.g. superficial content, changing topics, etc.). In a resistance
interpretation, the interpreted behavior itself is not significant. It is the inference that the
behavior interferes with the therapy process that is relevant.

II. DEFENSE INTERPRETATION: The therapist interprets some aspect of the client's
thoughts or behavior that operate to uclude from the client's awareness distressing afl'ect
(e.g. shame, guilt, disgust, fear, etc); or unacceptable thoughts, wishes, or impulses.

III. TRANSFERENCE INTERPRETATION: The therapist infers that the client’s
current manner of relating to the therapist is a reenactment of past relationships with
significant others.

IV. CHARACTER INTERPRETATION: The therapist makes the client aware of
well— established, ingrained, habitual modes of uperiencing or responding. The therapist
interprets regular patterns about how the client makes sense of the world.

V. ADAPTIVE CONTEXT INTERPRETATION: The therapist interprets the client’s
strivings, wishes, or needs as they are facilitated or frustrated by real life situations.

VI. GENETIC INTERPRETATION: The therapist interprets early life morives or
srrivings as they continue to influence present life uperiences.

VII. OTHER INTERPRETATIONS: This is an uploratory category for developing
levels of interpretation n0t included in the traditional levels operationalized above. The
intent of this category is to generate new levels of interpretation by asking raters to answer

the quesrion, "What is the therapist inferring about the client?"

159

Notes
Rater Notes on Scoring the ISG

160

References

Basch. M. F. (1980). W. New York: Basic Books, Inc.

Budman, S. H. at Gurman.A. S. (1988). W. New York:
Guilford Press.

Ebbitt. W., & Ebbitt. D. (1977). W. Glenview, Il: Scort Foresman 8c Co.

Fenichel. O. (1945). W. London: Routledge 6c

Kegan Paul Ltd.
Freud. S. (1905). On psychorherapy. S.E. (Vol. 7. 256-281).

. (1912). The dynamics of the transference. 5.2. (Vol. 12, pp. 98—228).

. (1916). Introductory lectures on psychoanalysis. 5.2. (Vols. 15—16).

. (1923). The ego and the id. 5.2. (Vol. 19. pp. 3—107).

. (1933). New introductory lectures on psychoanalysis. LE. (Vol. 22, pp. 3—198).

Garduk. E. L., 8c Haggard. E. A. (1972). Immediate effecrs on patients of psychoanalytic
inwpmfions. Bmhnlnsimumes W28- 1-83.

Gill. M. (1982). mmmmmmmmmm New York-
International Universities Press, Inc.

Giovacchini, P. (1987). W. New Jersey: Jason
Aronson.

Hill. C. E. (1978). Development of a counselor verbal response category system. W

W 25(5). 461-468

Johnson. 5. (1985) Chmnnlnamlmfamafinnflehatdmkmmds New Yorlc
W. W. Norton Co.

Kapelovitz, L. (1987). W. New Jersey: Jason Aronson, Inc.

Korchin, S. J. (1976). W. New York: Basic Books.

Langs. R. (1983). IthechmnuflmdmambniLmhmhmpx (Vol. II). New York.
Jason Aronson. Inc.

Langs. R. (1982). BMW. New York: Jason Aronson, Inc.

hugs. R- (1973) Ihslsshniguuflflmhnanalmdmhmhmpx (Vol I) New York:
Jason Aronson. Inc.

Laughlin, H. (1983). W. New Jersey: Jason Aronson, Inc.

Levy, 5. (1984). W. New York: Jason Aronson, Inc.

Loewenstein. R. (1957). Some thoughts on interpretation in the theory and practice of

psychoanalysis. In L. Paul (Ed., 1963) WWW (pp.
162—188). London: Collier-Macmillan Ltd.

 

 

 

 

1 6 1
Luborsky. L., Bachrach, H., Graff. H., Pulver, 8., 8c Christoph. P. (1979). Preconditions

and consequences of transference interpretations: A clinical-quantitative
investigation. WWW. 16.2. 391-401.

Malan. D. H. (1976). W New
York: Plenum Press.

Piper. W. F., Debbane, E. G., Bienvieu, J.—P., Carufel, F., 8c Garant, J. (1986).
Relationships between the object focus of therapist interpretations and outcome in
short-term individual psychotherapy. WWII-WNW 12, 1—
ll.

Reich. W. (1949). W. New York: Orgone Institute Press, Inc.

Shertzer. M. (1986). W. New York: Macmillan Publishing Co.
Speisman, J. C. (1959). Depth of interpretation and verbal resistance in psychotherapy.
W22. 93.99. .

Stiles. W. B. (1979). Verbal response modes and psychorherapeutic technique. Bmmany,
52, 49-62.

Strunk, W., at White, B. B. (1979). W (3rd ed.). New York:
Macmillan Publishing Co.

Strupp, H. I-I.. (I989). Psychorherapy: Can the practitioner learn from the researcher?
Ammmthnlngim 55. 717—724.

Wisdom.J. (1963). Psycho-analytic technology (1956). In L. Paul (Ed.), Bmhmnabnig
WW (pp. 143-161). London: Collier-Macmillan Ltd.

Wolberg. L. (1977). MW: Ball. New York: Grune and

Stratton, Inc.

APPENDIX C

162

Ranked Scale of Constituent Security Operations
On either Sullivan's or Freud's views the items in

Table 1 are not homogeneous: Each item represents a distinct
behavior with unique underlying determinants. In fact, the
scale might be the ordering of three homogeneous scales that
might aptly be called Narcissistic Satisfaction (1-11),
Frustrated Narcissistic Strivings (12-18), and Narcissistic
Retreat (19-34). On the views of both Sullivan and Freud,
each of the items (behaviors) represents a distinctive
dynamic process that is the outcome of the self-system/ego.
In contrast, the ethological view simply pits an aggressive
behavior against fear of superior retaliation. Then again,
the behaviors might simply be regarded as mediating degree of
well-being.

The items permit rank ordering on the basis of the
degree to which the configuration of coefficients for each
item departs from the mastery-dominance criterion (the
coherent pattern of PPFP, HQ, and ASRS). Each of the
component correlations (variance accounted for) was squared,
and those which were discrepant were subtracted from those
that were not discrepant. For example, the PPFP, HQ, and
ASRS coefficients for Interrupting are .33, .35, and .24,
respectively, and since all conform to the mastery-dominance
criterion, the summed squares equals 2890. In contrast, all
three coefficients for Automatic Laughter, -.38, -.27, and
0.41 are discrepant, and the sum of their squares is 3854 x
10-4. Items from 21 to 34 turned out to be discrepant for
all three correlations: PPFP and HQ decrease while ASRS

increases. In regard to Changing Topic (11), note that only

163

HQ is descrepant from the mastery dominance criterion; thus,
its squared coefficient (121 x 10-4) is subtracted from the
sum of the remaining two: 121 x 10-4 + 169 x 10-4 - 121 x

10-4 = 169 x 10-4.

Table 1
Interpersonal Behaviors Depicting the Fate of

Narcissistic Strivings

Ranking of spontaneous behaviors (items) with respect to
departure from the Mastery-Dominance criterion: increasing
personal power (PPFP), increasing happiness (HQ), and
decreasing anxiety (ASRS).

Entries in the body of the table are point biserial

coefficients of correlation (users versus nonusers of each

 

item).
r2 (diff) r

PPFP HQ ASRS
l Interrupting 2890 .33 .35* -.24
2 Repartee 1941 .21 .27 -.26
3 Dramatization 1902 .10 .29 -.31*
4 Sentence finishing 1706 .13 .31* -.24
5 Teasing 1223 -.03 .39* .17
6 Turning tables 906 -.01 .28 .11
7 Humor 853 .23 -.10 -.18
8 Arm twisting 784 .09 .24 -.13
9 Pasted on smile 302 .05 .14 -.09
10 Incessant talking 204 .02 .10 -.10

11 Changing topic 169 .11 -.11 -.14

12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34

*P

Flashlight smile
Annoyance
Security blanket
Connecting
Placation
Headnod
Disparagement
Side-stepping
Headnod I
Dissembling
Obsequiousness
Character bldg I
Questioning
Diffidence
Qualifying
Exemption
Character bldg II
Self-justification
Character bldg III
Reassurance
Taciturn

Word substitution

Automatic laughter

< .05

Joseph Reyher
Copyright 12/92

164

r2 (diff)

 

125
102
101

000

-109
-195
-225
-499
-763
-765
-949

-1409

-1441

-1701

-l746

-2010

-2200

-2214

-2334

-3324

-3854

PPFP
.03
.02
.02
-.02
.18
-.02
-.13
-.13
-.12
-.15
-.03
-.02
-.02
-.24
-.27
-.36*
-.08
-.32*
-.3o*
-.07
-.41*
-.39*

-.38*

HQ
.04
-.07
.04
.07
.13
.12
-.14
-.01
.12
-.07
-.15
.19
.09
-.28
-.17
-.09
-.01
-.19
-.30*
-.22
-.13
-.17
-.27

ASRS
.10
-.07
.10
.07
.12
.15
-.14
.05
.15
.15
.23
.20
.31*
.07
.24
.18
.41*
.25
.20
.41*
.22
.21
.41*

APPENDIX D

165

Extended Security Operations Scale

1. figmgr: Speaker saying anything designed to elicit
laughter; allusions, jokes, puns, goofs and gaffes
(speaker usually laughs or smiles).

2. B_pgztg§: Saying anything to elaborate on what
speaker says and prompts speaker to reply in kind,
parEicular y wit and put down. Listener usually laughs or
sm1 es.

3. Iggg1ng: eaker says something designed to put
person Iisten1ng inS ad light ostensibly harm ess form. Or
speaker tempting a listener without prov1ding gratification
(speaker usually laughs or smiles).

4a. 1;;ping,$ng Tables: Listener reversing role of
listener and quest1oner or persecutor and defendant or
active and passive.

4b. gnow1ng: Listener or speaker provides answer or
insigHEa as be1ng r1ght - speaker or listener is proven right
or comment is considered to be right or correct.

5. Disparagement: Speaker saying anything to reduce
the esEeem 1n wh1ch the listener may hold someone or
something. Create a bad impression.

6. Iagitgrnzget1cegce: Neither 1nitiatin new topics
or eIaBorating on top1cs or questions 1ntroduce by speaker.
7. p1ssemb11ng (' '1'm a1r1ght"): Speaker or listener
saying anyth1ng to present oneself as be1ng "cool, "

"toge her, " "on top of things," when confronting or having

confronted a dystonia induc1ng or possible dystonia induc1ng
event or circumstance. Not feeling dystonia when he/she
ought to.

8. anessant Ta1king: Speaker continues to talk thus
prevenEing l1stener from saying something. Speaker will not
assume ro e of listener.

9. t n Something said by listener before
speaker f1n1shes sentence or makes point.

10. go gngcting (persona1. yea- say1n g): Listener saying
something to place self on good side of speaker. "I agree,"
"I approve," or "me too. " Listener Saying something to

formally impress speaker when comment 1s misdirected; "I know
him" or "I' ve been there."

11. Exgmpt1gn: Speaker or listener saying anything to
exclude self from evaluation.

12. N'est-ce paszAgm Twisting: Speaker forcing opinion
or statement on l1stener, e. g. "0. K. ?"; "You Know?"; "Isn't
that right?, Isn't it?" Usually in the form of a question
following an assertion.

166

13. §g1fi;gg§tig1gat1gg: Speaker saying anything to
revent self from be1ng cr1ticized or creating a bad
mpression in listener. E.g. rationalization, excuses.

14. Qua11§y13g= Speaker alifies own statement.
Listener qua11f1es statements 0 others.

15a. flgzg Subst1tut1og: Speaker replaces or rephrases
own/others words.

15b. figglliflg: Use of non-words like "uh" or "um" to
fill in space 0 de ay so speaker can consider the1r next
comment or response.

16. "I'm £19m uisgour1 (skeptic1sm): Listener not
accepting statement of speaker at face value.
17. Hgy1ng pg 'on Q: valges (facelessggss):

Speaker does not 1dent fy self w1th a position on topic,
particularly when asked.

18. gaggg1ng thg Topic: Listener introduces new topic
before completion of current topic.

19. e ' plgnkgt: Bootstrapping comment by speaker
(1) name dropp1ng, (2) prestige assoc1ation (clubs, cars,
boats), (3) calls attention to apparel and possess1ons, (4)
bragg1ng: calling attention to self in a favorable way.

20. c : Speaker casts lack of involvement in
a favorable l1ght.
21. gramgtiggtion: Inspire interest by colorful

description. Speaker's use of colorful language builds up
events by "putt1ng you there."

22. S1ge-Stepp1ng: Listener does not answer question
by taIking about something relevant but off the point.
23. Anngyancelepat1ence: Speaker acts displeased,

expresses annoyance or 1mpat1ence. Modulated expression of
anger.

24. Qggst1on1ngl¢onfrgnting: Speaker asks questions
which requ1re l1stener to just1fy what he/she is saying.
Meet the person head on, "explain yourself." Confront
others.

25. ElagatignzF1attery41ngratiat1gn: Unsolicited

comments by e1ther party des1gned to enhance other's self-
es eem.

26. Self-ngacement: Speaker devalues self in relation
:9 éistener. Speaker makes invidious comparisons in favor of
1s ener.

27. Autgmgtig Laughtegz Inappropriate laughter
nothing funny happened. '
28. Character Bu11ding 1: Speaker describes dystonia-

inducing past events (mishaps, misfortunes), inspires
adm1rat1on.

167

29- Character Building = (1) Make a good
igpre851on‘good works- SO 1n51ght: Comments which spec1fy

b avior t at denotes a striving to make a good impreSSion.
(2) Avoid bad impression- SO insight: Comment which specify
behavior denotes a conscious striv1ng to avoid making a bad
impression.

30. a e fin1lg1ng,111: Self-abnegation; speaker
devalues self to listener.
31. Q1££1ngnggz When listener responds to speaker by

placing speaker's needs, comfort, conven1ence first, with or
without justification. Defer to other.

32. gngegu1ousness: When listener initiates

comments or act1v1ty (e.g., getting chair, ashtray) in
absence of request or obvious cue (unsolicited) to provide
physical comfort (with or without justification). Includes
wanting to do favors.

33. Sgntence F1n1sn1 g: Listener finishes sentence
when 5e7she has not been asked or pressured to finish
sentence or have his/her opinion asked.

34. Reassunnnce: Speaker asked questions directly
soliciting reassurance from listener, e.g., "Am I doing all
right?" "Is this OK?"

35a. Tak1ng Chnng : Initate problem solving.

35b. §1ying 1nstruct1ons: Speaker tells listener how
to do something.

35c. Bgngngnnnng: A rational, logica1 way to oppose
someone; use of argument to reason someone into change.
35d. Offier1ng Suggestions: Speaker gives listener
suggestions about how to do or think about something.

36. Nonanswers 19 Questions: Listener does not respond
to questions asked by speaker.

37. Inconplete Sentences: Speaker does not complete
sentences or finish thought/idea.

38. Anglgg1g1ng: A formal justification, defense,
excuse.

39. "Xon now!"/"O.K.!": Not a question. Attempt to

 

put oft—disagreement or a questioning response from
istener.

40. §1lencgz Listener does not respond to speaker.

APPENDIX E

168

Personal Power Functions Profile

1. Enygiggl agtznctivgness 2.
_1. ugly
_2.
___3. plain
_4.
5. beautiful/

very handsome

3. Stgtune 4.
_1. frail
_2 . . . . .
_3 . medium build
_4 . . . . .
_5. very well built
5. v -F ' e 6.
___1. social dunce
_2 . . . . .
_3 . rough at the edges
_4 . . . . .
5. charmingly adroit

fle1gnt

_1. 5'0"

_2. 5'5"

_3. 5'10"

_4. 6'3"
5. 6'8"

K ow ed e Ab 't
_rm__Ge ane :2 19mm

___1. novice

2. ....

3. muddles through
4. ....

5. expert

Socio-Econon1c S us

1. lower class
2. ....

3. middle class
4. ....

5. upper class

7- ABEDQIiL! lQEQEEQEiQfll
1. bus boy
2. waitress, clerk
3. teacher
4. policeman
5. chairman of board,
president
9.5131113
1. street person
2. discount store
3. department store
4. specialty store
5. high fashion

11. Ennily Eamg (reputat1on,

shop; luxurious

§pc1a1, position)

1.

nobody

school

local community
regional

national

169

8. Educatien
_1. grade school
_2. high school
_3. technical
certificate
4. ordinary
college
5. prestige
college

10. Personal Fan;
(reputatipn)

12. Speech

nobody

school

local community
regional

national

stutter

stammer

halting, hesitant
fluid

eloquent

13. Ex; antnct

_1. 0%
_2 . 25%
_3 . 50%
_4 . 75%

5. 100%

15. Cazr1age

2. head bowed

Copyright Joseph Reyher,

1. slumped, head
bowed

170

3. slouches somewhat,
eyes downcast

4. erect body but head
not high

5. body erect and head
high (poised)

1979

14. 291ce

high-diminutive
moderate

full, overtones,
color

16. Enpness1on pf Ideas

uninformed and
illogical
presentation

moderate

highly informed
and logical
presentation

APPENDIX F

171

CONSENT FORM

Security Operations In The Therapy Interaction

You are invited to participate in a research study examining
the interpersonal interactions between therapists and clients
in actual short-term therapy sessions. You were selected to
rate the therapy sessions because you expressed interest in
the study. Robert Graham of Michigan State University is
conducting this study. Please read this entire form and ask
any questions you may have before agreeing to be a rater in
this study.

The purpose of this investigation is to explore the dynamics
of interpersonal communication between two people in an
established relationship. The therapy relationship was
chosen because there is a relationship already established
between the two individuals involved and there is a similar
pattern of communication in each of the client-therapist
pairs. This study also seeks to better understand the
interaction effects of verbal communications as well as their
self-protective or self-enhancing nature.

If you agree to be in this study, you would be asked to rate
the verbal communications in 24 therapy sessions on a
"security operations" scale that contains both self-
protective and self-enhancing mechanisms used in everyday
interpersonal communications. Tapes of therapy sessions
along with the corresponding transcripts will be used to make
the ratings. There will be an initial training period where
you will be taught to recognize and rate "security
operations." The training period and rating of the 24
therapy sessions will take approximately sixty-five hours to
complete.

You will not know what the hypotheses (predictions) are at
the beginning of this study. Hypotheses will be revealed
only after completion of the ratings.

You will benefit by receiving training to use a theory-based
rating scale to rate interpersonal interactions, gain a
better understanding of short-term dynamic therapy, and
acquire some research experience making ratings. The intent
is to provide you with an opportunity to learn more about
conducting research.

You will receive payment for your participation. $25 will be
paid after training is completed and the remaining $75 will
be paid after all the ratings are finished. You must
complete all the ratings to be eligible for the $75.

172

The data and records of this study will be kept private. All
identifying information will be removed so that the students
cannot be directly tied to their ratings. In any sort of
report we might publish, we will not include any information
that will make it possible to identify a participant. Only
the researchers will have access to the records. You will
also be asked to make a confidentiality vow to keep all
therapy tapes and materials you come in contact with
confidential and not reveal any information related to this
project to anyone outside the research group.

Your decision whether or not to participate will not affect
your current or future relations with the University of
Minnesota or Michigan State University. If you decide to
participate, you are free to withdraw anytime without
affecting those relationships.

You may ask any questions you have of the principle
investigator, Robert Graham, now. If you have questions or
concerns later, you may contact Robert at (612)-894-4788 or
his major advisor, Joseph Reyher of Michigan State
University, at (517)-355-0186.

You will be given a copy of this form to keep for your
records.

 

Statement QI QQE§§B£=

I have read the above information. I have asked questions
and have received satisfactory answers. I consent to
participate in the study.

Student Date

 

 

Investigator Date

 

 

173

Vow of Confidentiality

You will be listening to actual therapy sessions on
audiotapes. Because of the sensitive nature of this
material, you are asked to keep all the information you see
or hear about clients nng therapists confidential.

We, the undersigned, agree to maintain the confidentiality of
those participants who were involved in the psychotherapy
research project. We will not talk about the therapy
sessions or participants with anyone outside the research
group.

APPENDIX G

174

Educational Debriefing Form

The purpose of the present study was to explore the dynamics
of interpersonal communication within the therapy situation.
Given that everyone uses security operations as defined in
this study (Sullivan, 1953, 1954), it was thought that
certain interventions (i.e. interpretations) would elicit
security operations from both clients and therapists in the
therapy situation. Personal power and perceived roles in
interpersonal relationships has been shown to influence the
type of security operations used (Gavrilides, 1980). The
greater personal power an individual has, the more likely
they are to use a dominance-mastery type of security
operation. It was expected that therapist and client would
use security operations that were complementary in order to
preserve the relationship and maintain some level of self-
esteem. This pattern of relating was viewed as extending
beyond just the therapy context to other interpersonal
interactions.

References

Chapman, A. H. (1978). The Treatment Techniques of Henry
Stack Sullivan. New York: Brunner/Mazel, Publishers.

Gavrilides, G. (1980). The relationship of personal power
functions to general happiness, interpersonal risk,
interpersonally induced anxiety, and security operations.
Unpublished dissertation.

Sullivan, H. S. (1953). 1ne Interpersonal Ihegpy g;
Esycniatny. New York: W. W. Norton & Co.

Sullivan, H. S. (1954). The gsychiatric Interview.
New York: W. W. Norton & Co.

APPENDIX H

175

Examples of Security Operations (Therapy situations)

1. Humor

Client or therapist will tell a joke, use a pun or allusion,
etc. to make light of a serious situation or possibly
distract the other person from some issue. Client may
imitate something someone (friend, relative) does or says.
Therapist could joke with client about a situation that
happened in a previous therapy session, e.g. client maintains
a rigid view about something.

2. Repartee

Usually a light sparring with words between parties in
response to each other. Therapist will add a clever phrase
or word to elaborate of what client is saying and client
continues with a clever phrase of their own on the same theme
or topic.

3. Teasing

Therapist teases client about a habit they have (or vice
versa), i.e. client is always late to sessions, therapist has
a favorite chair, office is small, new hair style, etc.

4. Turning the tables (knowing)

Therapist asks client a direct question or is pursuing a
topic and client asks a (related) question of the therapist
in response or takes the topic up and turns it back on the
therapist. Therapist can also turn topic back on client when
it gets diverted. (Knowing)-Client or therapist presents
opinion or view as correct or right and beyond question.

5. Disparagement

Therapist or client will talk negatively about someone or
something in a way that reduces the value or esteem of that
object for the listener.

6. Taciturn-reticence

More likely to be used by client. Client gives brief
responses to questions with no elaboration.

7. "I'm alright" (dissembling)

Client saying, "My relationship is going to work itself out
and I'll be o.k." (when relationship is breaking up); My
father's death didn't affect me that much, I'm still
functioning.

176

8. Incessant talking

Therapist or client will usually try to get a word in while
the other is speaking but attempts are unsuccessful (may hear
filler words like ah or um or person begins sentence
unsuccessfully).

9. Interrupting

Therapist interrupts the client before the client has
completed their sentence or makes their point. They might
say something like "Let me stop you there."; ask a question;
or just say what they want regardless of whether the client
is speaking or not. Clients will also interrupt the
therapist but may use different words or phrases, e.g. "No,
that's not the case." (before therapist completes entire
thought); "That is very true for me." (Therapist still has
more to say and client continues speaking after interrupting
therapist.

10. Connecting (yea-saying)

May be as simple as Uh-huh (listen to voice tone, volume,
igfieeing with speaker and not being confronting,
oppositional.

11. "I'm just a housewife" (exemption)

"That's just the way I am."; "That doesn't apply to me."

12. N'est pas or arm twisting with ratification expected

Usually in the form of a question (Don't you agree form).
May repeat same question or comment stated previously.

13. Self-justifying

"I have always done things this way."; "It wasn't my fault
because..."; "You told me to do it that way." Not taking
responsibility for own actions.

14. Qualifying

"I'm not an expert in this area but..."; "I'm not sure about
what this means but..."; "I realize that you are making an
educated guess when you say that.""Well you just had that one
experience."

15. Word substitution (rephrasing)/(stalling)

"I mean..."; "You mean..."; "What I (you) am really saying
is..."; "Um, I am ah...:

177

16. "I'm from Missouri" (skepticism)

"I'm don't see it that way."; "There's more to that."; "Show
me what you mean by that."; (convince me attitude)

17. Having no opinions or values (facelessness)

Client may play out both sides of an issue without taking a
firm stance or making a choice about something. May use
examples to support both sides of an argument but doesn't own
either side as their personal position.

18. Changing topic

Therapist or client change topic of discussion when anxiety
is generated. For example, when client is experiencing some
emotion while discussing an issue, therapist will redirect
client and move away from dealing with the emotion.; or
Therapist will begin talking about the client's relationship
with mother and the client will say something like "Well that
reminds of an incident with my aunt where . . .; or Either
party says something totally out of the blue or unrelated to
previous topic of discussion.

19. Security Blanket

"So and so did this too."; "I worked with ..."; "I belong
to..."; "I led all employees in production this month."; "My
house is..."

20. Indifference

"Being active in politics doesn't get you anywhere."; "That
relationship is destructive anyway." (May not acknowledge
their part in relationship problems); "I can take it or leave
it..."

21. Dramatization

Very descriptive in presentation, client may tell stories,
therapist uses dramatic anecdotes to illustrate a point.

22. Side-stepping

Client goes off on a tangent; therapist digresses. One way
to avoid an issue. E.g. Client questions the therapist about
a termination date; client talks about mother's cooking
rather than their conflict at Thanksgiving.

23. Annoyance (impatience)

Listen to voice characteristics in addition to content.

178

24. Questioning (confronting)

"Why do you say that about your parents?"; "That doesn't make
sense to me."; "Weren't you quoted in the paper last week?"

25. Placating (flattery)

"You look nice today."; "You always make me feel good when I
leave these sessions."; "That was very insightful."

26. Self-effacement

"I'll never be able to see things as clearly as you do.";
"You are more ... than I am."; I wish I could ... like you
do.”

27. Automatic laughter

May be a nervous laughter. Laughing to ease the tension.
Ask yourself if client or therapist said anything funny.

28. Character Building I

"I helped this client even though I was ..."; "I was in this
one relationship where ... and I survived it."

29. Character Building II

"I always treat people at work with respect."; "I wasn't
trying to..."

30. Character Building III

"I'm just not thinking clearly today."; "I always have
trouble doing that."; "I never follow-through."

31. Diffidence

"Why don't you take my chair."; "No, you go first."; "You
seem uncomfortable. Why don't you ..."

32. Obsequiousness

"Let me get another chair for you."; "Let me get that for
you.";

"I will bring that in next week for you to see." (Not asked
to).

33. Sentence finishing

Therapist or client completes sentence for other;

179

34. Reassurance

Therapist-"Is the therapy progressing the way you wanted?"
Client-"Am I doing this the right way?"

35. Taking charge (giving instruction]remonstrate/offering
suggestions)

"Let's talk about your problems at home and what you have
tried to do about them."; "You just tell your roommate no!";
"You need to tell him you are angry because when you don't,
you end up feeling depressed and anxious."; "You could try to
get to work earlier." "Consider her motives before you take
action."

36. Nonanswers to questions

Therapist: "Was that fun?" Client: "I saw my sister."
37. Incomplete sentences

"I think ah."; "I mean I."; "When he said."

38. Apologizing

"I am so sorry...."; "I can't help myself, I am always like
that, please forgive me."; "I'll make it up to you."

39. You know (O.K.!)

"You know how it is."; "It was scary, you know."; "She was
there, OK, and I ignored her the whole night, OK!"

40. Silence

There is a pause in speech (5 seconds or more)

APPENDIX I

180

mm training material fer __Lingsco ' p__ers__on..a__1_ power
mm

WWWQW=

For therapist:
a. Training- All trained in same method.
b. Review Strupp and Binder (1984).
c. Education- 8 clinical psychologist vs 7 psychiatrists
d. Experience- 2-14 yrs.
e. Talent- Natural or innate capacity.

For client:
a. Previous therapy.
b. Exploring issues

Savpiz-Eaize:
Tact, Cleverness, Wits. Knowing how to do.
Capacity for appropriate action, esp. a polished sureness
in social behavior; poise; A keen sense of what to do or
say in order to maintain good relations; skill and grace in
dealing with others. Social dunce, socially clumsy.

Speech:

Manner of speaking:

a. Stutter- to speak with involuntary disruption or
blocking of speech.

b. Stammer- to make involuntary stops and repetitions in
speaking. To utter stumblingly.

c. Halting/Hesitant-Pause, delay, hold back in doubt or
indecision, waver, falter, stop.

d. Fluid- a smooth easy style, flowing, moves easily

e. Eloquent- discourse marked by force and
persuasiveness, forceful and fluent expression,
vividly or movingly expressive or revealing.

Vpige:

a. Range

b. Quality how does the voice sound? Tone quality.

c. Pitch- high; low; mid; low-rising; falling.

d. Vibration- Full of life, pulsating, responsive,
sensitive, resonant (richness, varied) vs diminutive,
flat.

e. Expressive Inflection- warm and expressive vs cold and
unfeeling.

f. Volume- soft to loud.

g. Vibration- diminutive to full.

Worker:
a. Difficult to understand.
b. Unclear, disjointed.
c. Can piece it together to make sense.
d. Clear, able to follow, makes sense for the most part.
e. Very easy to understand, clear and concise, knows of
what they are talking about.

APPENDIX J

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APPENDIX K

186

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