ABSTRACT

TEE ACCELERATION 0F CLIENT PROGRESS IN COUNSELING
AND PSYCHOTHERAPY THROUGH INTERPERSCNAL
PROCESS RECALL (IPR)

By

Paul G. Schauble

The purpose of this study was to investigate the effects
of affect simulation films together with stimulated recall on
client movement in counseling. A treatment program integrat-
ing simulation films and stimulated recall via videotape in
order to accelerate client growth in counseling was compared
with more traditional counseling methods.

Affect simulation is a technique wherein clients are con-
fronted with films which encourage them to simulate interper-
sonal relations, and client and film are videotaped while the
client watches the film. The videotape is then played back
while his counselor helps him examine his reactions to the
film. In some cases an actor directs affection or rejection
toward the viewer, in others the actor reacts as if he had
been rejected or seduced.

Interpersonal Process Recall (IPR) is a technique using
stimulated recall of videotape to accelerate client insight
and change during therapy. A videotape of a counseling session
is replayed to the client and a recall session is conducted by a
clinically trained "interrogator" who helps the client examine the

underlying dynamics of his interaction with the counselor. In

previous studies, IPR found to accelerate client movement in
counseling when the counselor is actively involved in the recall
process (Kagan, Krathwohl, et. a1., 1967).

In a pilot study conducted in 1967, the simulation and
IPR techniques were combined in an attempt to increase the
client's ability to recognize and understand his feelings
and responses interpersonal encounters. Three treatments
were compared: 1) counseling alone (control treatment);

2) counseling using first simulation films, or VRAS
(videotape recall of affect simulation) for three sessions,
then IPR for three sessions; 3) counseling using IPR
first and then VRAS. Judges' ratings of client movement
indicated that both treatment groups moved significantly
on four in-therapy behavior dimensions, while the control
group did not. Examination of vocational placement status
at the end of treatment also favored the treatment groups,
where 66% had been placed on jobs against 33% for the con-
trol group.

In the present study, the treatment program was designed
to integrate the VRAS and IPR into a sequential program of
treatment. The use of a sequential approach stemmed from the
data observed in the pilot study, suggesting the following
series of developmental experiences facing the client as he
undergoes counseling or therapy: a) the need for the client
to become aware of his feelings and reactive behavior in emo-

tional stress situations, b) the need to identify and

examine the feelings he has during the counseling relation-
ship itself, c) the need to experience and deal with these
feelings in the immediacy of the counseling relationship
itself. The experimental treatment consisted of three inte-
grated phases which were designed to meet these developmental
needs.

In the first - or VRAS - phase, the client was videotaped
while watching an affect simulation film. The video tape was
played back and the client's videotaped behavior served as the
focus for the counseling session. As the client examined his
reactions to the simulated confrontation, he was able to look
at his emotional reactions to others without having to be res-
ponsible for their impact and consequences, i.e., he was
dealing with interpersonal threat from a position of relative
safety. In the second - or IPR - phase, client and counselor
were videotaped while conducting a counseling session, the
videotape was replayed and a trained recall worker ("in-
terrogator") conducted an IPR session with the client while
the counselor observed through a one-way mirror. The recall
worker was essential in helping the client to examine his
feelings in relating to his counselor, since the client still
was not confronting the counselor and thus had a reduced re-
sponsiblility for the immediate consequences of his feelings.
Afther the recall, client and counselor resumed their coun-

seling session, incorporating the insights gained from the

recall. In the final phase, both client and counselor viewed
a replay of the counseling session together, while the in-
terrogator encouraged them to share their feelings as they
occurred during the interview. As counselor and client communi-
cation about their feelings and reactions during the video-
taped interview increased, the interrogator played a pro-
gressively less active role. When the interaction between
client and counselor moved from a focus on the videotape to
the immediacy of the reca11(when they had finished talking
about the videotape and were again engaged in face-to-face
discussion)session the interrogator left the room and coun-
selor and client continued the therapy session.

The control-group treatment consisted of traditional
counseling, i.e., no IPR interventions were used. Both the
counseling -- with-IPR and the traditional-counseling group
treatments were focused on effective client/counselor com-
munication. In the traditional-counseling groups, the thera-
pists concentrated on client/counselor interaction in an
attempt to help the client achieve greater self-awareness and
understanding of his own dynamics.

The clients in this study were twelve female undergraduate
students who had requested personal counseling from the uni-
versity counseling center, and who also agreed to participate

in the research. The two therapists were pre-doctoral interns

at the Counseling Center who had training and experience
in IPR techniques as well as in traditional counseling methods.

Each therapist was rated on scales measuring facilitative
behavior in therapy. One therapist was found to be functioning
at approximately 3.00 across dimensions on a five point scale
where a rating of 3.00 is considered the minimal level of coun-
selor performance if client growth is to occur. The second
therapist was functioning at an average of approximately 3.40
across dimensions.

Clients were assigned to therapist and treament groups on
a random basis. Each interivew was recorded for subsequent
rating by independent judges (two Ph.D. counseling psychol-
ogists) on four dimensions of client behavior in therapy con-
sidered characteristics of client growth: Owning of Feelings
(OF), Commitment to Change (CCh), Differentiation of Stimuli
(DS), and Depth of Self-exploration (DX). Ratings of the
intitial sessions served as the pre-test measure. Analysis
of ratings of the initial sessions indicated no significant
difference between groups on any of the dimensions, suggest-
ing that neither treatment group had a higher level of
functioning which might have affected their post-treatment
behavior.

Ratings of the sixth (final) session for each client on

the client growth scales served as a post measure of client

functioning. Each client also completed the Tennessee Self
Concept Scale and the Wisconsin Relationship Orientation Scale
before and after the treatment program. In addition, each
client and therapist completed a shortened form of the Therapy
Session Report (TSR) following each treatment session.

The anlysis of pre to post changes in client behavior during
therapy within each group by means of a 2 test for change
scores on the same sample indicated significant differences (.05
level) on each of the characteristics of client growth for the
counseling with IPR group, but not for the traditional-
counseling group. That is, after treatment the clients in
the treatment group were rated higher On the dimension of
OF, CL, DS, and BK. Ratings of clients in the traditional—
counseling group showed no differences, pre to post treatment.
Analysis of variance of change scores between groups also in-
dicated differences in the hypothesized direction (.05 level)
on each of the client growth dimension.

Analysis of pre to post changes in client ratings of coun-
selors on the WROS did not indicate significant change after
treatment for either group, but change scores between groups
were found to be significant and favored the experimental
treatment. Pre to post differences within groups for client
perceptions of treatment were found on only two dimensions:

client feelings about coming to the session and client feel-

 

ings about progress made in the session.' In both cases, the

 

differences were found only for the IPR group, with sig-
nificant between group differences on change score also
favoring the IPR group. Change score differences in thera-
pist perception of treatment were found only for the IPR
group's pre to post change on the variable of: therapist
looking forward to coming to the session. Finally, change
score difference on dimension of the Tennessee Self Concept
Scale were evenly divided between groups, and there was
little indication of any meaningful change in self-concept
score due to treatment.

The analysis of date suggests that the IPR treatment
had a significant accelerating affect on client movement in
therapy, as rated by independent judges. Clients in the IPR
group had a greater positive change difference in the degree
toOwhich they felt able to relate to their therapist, when
compared with the traditional counseling group. Clients in
the IPR group had more positive feelings about coming to their
treatment sessions, and about the progress that was made with?
ing these sessions. Therapists also were found to look for-
ward more positively to the IPR treatment sessions than the

traditional treatment sessions.

THE ACCELERATION OF CLIENT PROGRESS IN COUNSELING
AND PSYCHOTHERAPY THROUGH INTERPERSONAL

PROCESS RECALL (IPR)

BY

Paul G. Schauble

A THESIS

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

DOCTOR OF PHILOSOPHY

College of Education

1970

DEDICATION

To my father and his memory.....may
they both be proud.

ii

I am

ACKNOWLEDGEMENTS

grateful to:

.....Norm Kagan, who constantly kindled my motivation and
provided direction for my professional deveIOpment.

.....Dozier Thornton, Sam Plyer, and John Suehr for showing
their confidence in my ability by allowing me freedom
to go my own way.

.....Bill Kell, whose hand reached mine when I was most
afraid to reach out and find none there.

.....Dick Pierce, for demanding the best of himself, thereby
keeping me honest.

.....Art Resnikoff, just for being Art Resnikoff which is
more than enough in itself.

.....Bob Woody, who works harder at being honest than anyone
I know, while having less distance to travel....whose
faith and friendship have never been in doubt, even
though I was.

.....to Dave Erb....who let me know it was acceptable to
ask without giving.

.....to Laura, Steve, and Warren and all whom they represent
....whose loneliness I understood.....thereby making
mine more tolerable.

.....Mom, who has always been there.

.....Betty, who has shared my child, loved my adult, and

constantly validates me.
iii

TABLE OF CONTENTS

Page
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . iii
LIST OF TABLES . . . . . . . . . . . . . . . . . . . . vii
LIST OF FIGURES . . . . . . . . . . . . . . . . . . . . xii

LIST OF APPENDICES. o o o o o o o o o o o o o o o o o 0 x111

Chapter
I g m PROBLm O O O O O O O O O O O O O O O O O O O O 1

Purpose . . . . . . . . . . . .

Definition of Terms . . . . . . . . . . . . . . . . 4
Hypotheses O O O O O O O O O O O O O O O O O O O O 6
Theory . O C C O O O O O O O O O O O O O O O C O O 7
Client GrOWth O O C O C C O C O O O C I O O O O 7
Obstacles to Client Growth. . . . . . . . . . . 8
Development of Affect Simulatio . . . . . . . . 10
Treatment Program: A Theory of
Progressive Approximation. . . . . . . . . 12
Overview. . . . . . . . . . . . . . . . . . . . 16
II 0 “VIEW OF LITERATIJRE O C O O O O O O O O O I O O O O 17
IntrOduction C C O O O O O O O O O O O O O O O O O O 17
Client Movement . . . . . . . . . . . . . . . . . . 17
External Criteria . . . . . . . . . . . . . . . 18
Internal Criteria . . . . . . . . . . . . . . . 20
Acceleration of Client Movement . . . . . . . . . . 26
Group Counseling. . . . . . . . . . . . . . . . 28
Psychodrama . . . . . . . . . . . . . . . . . . 29
Multiple Therapy. . . . . . . . . . . . . . . . 31

Use of Videotape in Counseling. . . .
Stimulated Recall to Accelerate Client
Movement. . . . . . . . . . . . . . . . . . 38

iv

Chapter

III.

IV.

Simulation in Counseling. . . . . .

Conclusions and Implications of the
Literature. 0 O O O O O O O O O O O O O O 0

Simulation and Stimulated Recall:
a Case Study. . . . . . . . . . . . . . . . .

. smary o o o o o o o o o o o o o o o o o o 0

DESIGN AND METHODOLOGY

Description of the Experimental
Procedures. . . . . . . . . . . . . . . . .

Counseling With IPR . . . . . . . . . . .
Traditional Counseling (Without IPR). .
Physical Environment. . . . . . . . . . .

sample. C O O O O O O O O O O O O O O O O O

Therapists. . . . . . . . . . . . . . . .
Clients 0 I O O O O O O O O O O O O O O

Instrumentation . . . . . . . . . . . . . . .
Reliability of Rating Scales. . . . . . . . .
Rating of the Criterion Tapes . . . . . . . .
Analysis of Data. . . . . . . . . . . . .

Hypotheses. . . . . . . . . . . . . . . . . .
Summary . . . . . . . . . . . . . . . . . . .
ANALYSIS OF THE DATA,

Pre-treatment to Post-treatment differences
in Client Movement Within and Between Groups.

Differences in Client and Therapist Perceptions

Within and Between Groups . . . . . . . . . .
Client Movement on the COGS and BK by Time. .
TSCS -- Descriptive Analysis. . . . . . . . .

smary O O O O O O O O O O O O O O O O O O O

Page

43

48

50
52

54

56
56
62
63
65

65
66

67
75
78
81
82
82

84

85

95
113
119

120

Chapter Page

V. SUMMARY, DISCUSSION, IMPLICATIONS . . . . . . . . . 123

Summary . . . . . . . . . . . . . . . . . . . . . . 123
DiSCUBSiOno O O O O O C O O O O O O O O O O O O O 0 130
Observations and Implications . . . . . . . . . . . 137

Implications for Counseling and Therapy . . . . . . 150

Implications for Future Research. . . . . . . . . . 152

REFERENCES C O O O O O O O O O O O O O O O O O O I I O O 154

APPENDICES. O O O O O O O O O O O O O O O O I O O O O O 161

vi

Table

3.1

3.2

3.3

3.4

3.5

3.6

4.1a

4.1b

4.2a

4.2b

4.3a

LIST OF TABLES

Schematic Representation of the
Overall EXperimental Design. . . . . . . .

Summary of the Experimental
Procedures 0 C O O O O O O O O O O O O O O 0

Comparison of Treatment Groups
According to Mean Age, Mean G.P.A.,
and Class Standing . . . . . . . . . . . .

Reliability of Client Movement Scales
By Two Groups of Judges. . . . . . . . . . . .

Interjudge Reliability of Client Move-
ment Scales On Pilot Study Data. . . . . . . .

Intraclass Correlation Reliabilities of
Average Ratings Calculated for Judge's Ratings
of Client's Across Tapes One Each Dimension
of the COGS and 2;. . . . . . . . . . . . . .

2 tests of pre- to post-treatment differences
in client owning of feelings (9g) between

the Counseling-with-IPR group and the
traditional counseling group . . . . . . .

Analysis of variance of change score dif-
ferences in client 93 between groups . . . . .

D tests of pre- to post-treatment dif-
ferences in client committment to change

(CCh) between the Counseling-with-IPR

group and the traditional counseling

group . . . . . . . . . . . . . . . . . . . .

Analysis of variance of change score dif- ‘
ferences in CCh between groups.. . . . . . . .

D tests of pre- to post-treatment dif-
ferences in client differentiation of

stimuli (DS) between the counseling-with-

IPR group and the traditional counseling
group. . . . . . . . . . . . . . . . . . . . .

vii

Page

55

58

58

76

77

80

88

88

89

89

90

Table

4.3b

4.4a

4.4b

4.5

4.6

4.7a

4.7b

4.8a

4.8b

ANOVA of change score dif-
ferences in D8 between groups. . . .

D tests of pre- to post-treatment
differences in client depth of self-
exploration (2%) between the coun-
seling-with-IPR group and the
traditional counseling group . . . .

Analysis of variance of change score
differences in 2! between groups . .

Mean levels of functioning of
Therapists on Facilitative
Conditions by Counseling-with-

IPR and Traditional Counseling . . .

Direction of pre to post treatment
behavior change on the dimensions of
client movement by therapist and
treatment group. . . . . . . . . . .

D tests of pre to post treatment
differences in the Wisconsin Re-
lationship Orientation Scale (WROS)
between the Counseling-with-IPR

group and the traditional counseling .

ANOVA of change score differences

in WROS between groups . . . . . . . .

D tests of pre to post treatment
differences in client feelings about

session completed between the counseling-

with-IPR group and the traditional

counseling group . . . . . . . . . . . . . .

Analysis of variance of change score
differences in client feelings about

session completed between the counseling-

with-IPR group and the traditional-

counseling group . . . . . . . . . . . . .

viii

Page

90

91

91

93

95

98

98

99

99

Table

4.93

4.9b

4.10s

4.10b

4.113

4.11b

4.12s

4.12b

4.13s

D tests of pre to post treatment
differences in client feelings about
coming to the treatment sessions be-
tween the counseling-with-IPR group
and the traditional counseling group

ANOVA of change score differences in
client feelings about coming to the
treatment sessions between groups.

D tests of pre to post treatment
differences in client feelings about
progress made in session between the
counseling-with-IPR group and the
traditional counseling group . . . .

ANOVA of change score differences in
client feelings about progress made
in session between groups. . . . . .

D tests of pre to post treatment
differences in client feelings-
about-coping behavior between the
counseling-with-IPR group and the
traditional counseling group . . . .

ANOVA of change score differences
in client feelings-about-coping-
behavior between groups. . . . . .

D tests of pre to post treatment
differences in client perception-of-
therapist-understanding between the
counseling-with-IPR group and the
traditional counseling group . . . .

ANOVA of change score differences in

client perception-of-therapist-understanding

between groups . . . . . . . . . . .

D tests of pre to post treatment differences

in client perception of therapist helpfulness
between the counseling-with-IPR group and the
traditional treatment group. . . . . .

ix

Page

100

100

101

101

102

102

103

103

104

Table

4.13b

4.14s

4.14b

4.15s

4.15b

4.16a

4.16b

4.17s

4.1Zb

ANOVA of change score differences
in client perception-of-therapist-
helpfulness between groups . . . . .

D tests of pre to post differences
in therapist feelings about session
completed for the counseling-with-
IPR group and the traditional coun-
seling group . . . . . . . . . . . .

ANOVA of change score differences in
therapist feelings about session com-
pleted between groups. . . . . . . . .

D tests of pre to post treatment dif-

ferences in therapist perception of client

motivation for the counseling-with-IPR
group and the traditional counseling
group O O O O O O O O O O I O O O O O 0

ANOVA of change score differences in

therapist perception of client motivation

between treatment groups . . . . . . .

D tests of pre to post treatment dif-
ferences in therapist perception of
progress made for the counseling-with-
IPR group and the traditional treat-
ment group . . . . . . . . . . . . . .

ANOVA of change score differences in
therapist perception of progress made
between treatment groups . . . . . . .

D tests of pre to post treatment dif-
ferences in therapist perception of

client coping behavior for the counseling-
with IPR group and the traditional coun-
seling group . . . . . . . . . . . . . .

ANOVA of change score differences in
therapist perception of client coping

behavior between treatment groups. . . . .

Page

104

105

105

106

106

107

107

108

108

Table

4.18a

4.18b

4.19

4.20

Page

D tests of pre to post treatment dif-

ferences in therapist looking forward to

session for the counseling-with-IPR

group and the traditional treatment

group. . . . . . . . . . . . . . . . . . . . . . 109

ANOVA of change score differences in
therapist looking forward to session
between treatment groups. . . . . . . . . . . . . 109

Levels of client behavior on the dimensions

of client growth over six weeks for clients

receiving counseling-with-IPR or traditional
counseling. , . . . . . . . . . . . . . . ... . 110

‘Mean pre to post treatment Change score
ontheTSCSo0.000.000.0000...111

xi

Figure

3.1

4.2

4.3

LIST OF FIGURES

Page

Floor Plan of IPR Suite. . . . . . . . . .

Ratings of Client Behavior Over Time
On the Dimensions of Client Growth
for the Counseling-with-IPR Group. . . . . . . . 116

Ratings of Client Behavior Over Time
on the Dimensions of Client Growth
for the Traditional Counseling Group . . . . . . 117

Combined Ratings of Client Behavior

over Time for the Counseling-with-

IPR Group and the Traditional Coun-

seling Group . . . . . . . . . . . . . . . . . . 118

xii

Appendix

A Figures Depicting VRAS and IPR . . . . .

B. An application of Emotional Simulation
in Counseling to Accelerate Client
Movement: A Pilot Study . . . . . . .

C Referral Information Forms for Screening
Counselor and Clients. . . . . . . .

D Characteristics of Client Growth Scales.

E Depth of Self—exploration Scale. . . .

F Wisconsin Relationship Orientation Scale .

G Therapy Session Report . . . . . . . . .

LIST OF APPENDICES

xiii

Page

162

167

180
187
194
198

200

CHAPTER I
THE PROBLEM

This study is an evaluation of the effectiveness of a new
method to help people who have sought assistance from professional
counselors to deal with personality and/or adjustment problems.

In this particular study no distinction is made between counseling
and psychotherapy. This position is based on the conclusion

(that ".....There are no essential differences between counseling
and psychotherapy in the nature of the relationships, in the pro-
cess, in the methods or techniques, in goals or outcomes (broadly
conceived), or even in the kinds of clients involved." (Patterson,
1966, p. 3).

Counselors and therapists have recently been made painfully
aware that the effectiveness and justification of their profes-
sional activities must be seriously evaluated. Seventeen years
ago Eysenck (1952) drew and substantiated the conclusion that
psychotherapy was NOT effective in influencing client improvement
in adult neurotics. The response of "helping professionals" ranged
from an emotional sweeping-under-the-rug (Sanford, 1953) of this
"blasphemis" (Teuber and Powers, 1953) charge to a systematic
criticism of the design of the Eysenck study (Rozenweig, 1954;
DeCharms, Levy, and Werthermer, 1954).. After four years of active
debate, Levitt (1957) used a similar design and obtained results

"markedly similar" to Eysenck's study, i.e., "the results of the

present study fail to support the view that psychotherapy with
'neurotic' children is effective." These results of this second
study were not pOpularly received, but the reSponse of the pro-
fession was more constructive.

Bergin (1963) acknowledged the inadequacies in research
design of the Eysenck and Levitt accusations, but pointed to
their value.

"These vexations of the scientific spirit
appear on the verge of stimulating impor-
tant breakthroughs in the analysis of psy-
chotherapeutic effects, even though the
majority of findings are negative with re-
gard to the global question of the effects
of psychotherapy." (p. 254)

Breakthroughs in the analysis of psychotherapeutic effects
have indeed occurred. Psychotherapy has been demonstrated to
have positive effects on influencing client change, when related
to therapist functigning variables and specific interpersonal
behavior dimensions (Truax Carkhuff, 1966; Carkhuff and Berenson,
1967). The singularly most important contribution of such break-
throughs has been to acknowledge that counseling and psychotherapy
can have a positive effect; that counselors and therapists can
be effective, but that the therapeutic encounter can be "for
better or for worse." (Berenson and Carkhuff, 1967). This know-

ledge carries with it a mandate that the counseling profession

constantly examine and evaluate its theory and methodology in an

attempt to assure that the therapy situation be a valuable exper-
ience for the client.

This study is an effort to accelerate the positive impact
of counseling and therapy. Research has recently been conducted
to determine the usefulness of a specific method of video tech-
nology as an intervention in the counseling process. The method
is called Interpersonal Process Recall (IPR), and uses videotape
playback of the counseling situation to stimulate recall of the
underlying dynamics involved in the interpersonal interaction
between client and counselor. (Kagan, Schauble, Resnikoff, Danish,
and Krathwohl, 1969). The method has been shown to have potential
in accelerating client growth in therapy with prisoners (Kagan,
Krathwohl, et. a1., 1967), with disabled adults (Schauble, 1968;
Kagan, Krathwohl and Miller, 1963) and can be used in conjunction
with hypnosis (Woody, Kagan, Krathwohl, and Farquhar, 1965).

One of the outcomes of this research was a theory of client-
counselor interaction. This lead to the deveIOpment of simulated
confrontation procedures which are incorporated in a new method
for accelerating client growth. The problem of this study is to
provide a controlled examination of the value of the new method
for accelerating client growth in therapy.

If traditional counseling and psychotherapy ”may or may not"
influence a client positively, than the development and evaluation
of new approaches is sorely needed. Furthermore, there is an

intrinsic ethical obligation for counselors to help clients

change quickly as possible. This obligation also has a prag-
matic base, in that professionals are vastly outnumbered by the
clients they seek to serve. Counseling approaches must be judged,
then, by economy of time and effort as well as degree of "success"
achieved.

The use of simulation films and stimulated recall in coun-
seling appears to be a promising approach for accelerating the
counseling process. While pilot research has tended to support
the value of the methof, it is important to conduct a controlled
application in order to determine if accelerated client growth

does indeed occur.

m

The purpose of this study is to investigate the effects of
affect simulation films together with stimulated recall on client
movement in counseling. A treatment program which integrates
the simulation films and stimulated recall via videotape in order
to accelerate client growth in counseling is compared with a more

traditional counseling program.

Definition of Terms

Special terms used in this study are defined as follows:
1. Interpersonal Process Recall (IPR):
The term used to describe the process of recording

on videotape any interpersonal interaction (e.g.,

3.

the counseling relationship), and then playing-

back the videotape to enable either (or both) of

the participants to examine the interpersonal
dynamics of the original experience.

Stimulated Recall Session:

The phase of the IPR process where the videotape

of a counseling interview is played back and a
clinical "interrogator" helps to stimulate the
participant's examination of the underlying dynamics
of his interaction during the recorded counseling
session.

_ggerrogator:

The designation given to the third person (counselor
or therapist) whose function is to facilitate the
client's self-analysis of thoughts, feelings, images,
and general pattern of interaction with his counselor.
Since this person's clinical function is limited to
actively probing the immediate past (of the video-
tape), the name "interrogator" was selected to
describe his role.

Affect Simulation:

A technique using films which simulate various kinds
and intensities of emotional stress. The films are
structured to confront clients with various inter-

personal stress situations so that his reactions

to such situations can then be studies with his
counselor in order to develop understanding and
new and more satisfying ways of responding to the
kinds of stress simulated by the films.
5. Video Recall of Affect Simulation (VRAS):

Clients are videotaped while viewing the Affect
Simulation Films, and the client's videotaped be-
havior while watching the films becomes the focus

of a personal counseling session.

Hypotheses

 

Clients receiving personal counseling with IPR inter-
vention will make more positive movement within coun-
seling than will clients that receive personal counseling
alone.

Clients receiving IPR treatment will see their counselors
as more accessible and easier to talk with than will
clients not receiving IPR treatment.

Clients receiving IPR treatment will develop a more
improved self concept of themselves than will clients

not receiving IPR treatment.

Clients who receive IPR treatment will have a greater
level of agreement with their counselor about the coun-

seling process than clients not receiving IPR treatment.

Theory

The theory behind the treatment program used in this study
grew from observations and inferences about what constitutes
positive client movement in counseling. These observations will
therefore be reviewed, followed then by a description of theore-

tical model of treatment.

Client Growth

 

Recent literature in counseling and psychotherapy indicates
that clients typically enter the counseling relationship with
little access to many basic emotions. Instead, the clients have
frequently compressed his affective experiences, often because
he is afraid that they will become overwhelming in all aspects
of his life (Kell and Mueller, 1966). This inability to recognize
and deal with feelings is generally the crux of the client's pro-
blems. The clients is anxious and has difficulty coping because
he cannot identify and/or experience his feelings. Since he
cannot know and understand his feelings, it is impossible for
him to change the behavior they cause: behavior that is dissat-
isfying -- and whigh he wishes to changp.

It is generally agreed that the purpose of counseling is
to change people's behavior (Kell and Mueller, 1966). This is
typically accomplished (in insight therapy) by the client's

exploration of anxiety-laden areas with the counselor, beginning

at a "surface" or non-threatening level; as counseling progresses,
the client is able to handle greater and greater amounts of
"depth" exploration, usually of feelings and thought which are
frightening to him. This process of moving into "deeper" affec-
tive material is often referred to as "getting down to gut level."
Rogers (1958) proposes that this process of changing occurs
in seven stages, and the last stage -- the goal of therapy -- is
when
New feelings are experienced with immediacy
and richness of detail, both in the thera-
peutic relationship and outside . . . the
situation is experienced and interpreted in
its newness, not as in the past.
Client growth in counseling may be defined, then, as the
increased capacity of the client to gain access to, communicate,
and fully experience his feelings. The principal task of the

counselor is to increase client insight and understanding and

help the client experience his feelings (Orlinsky and Howard, 1968).
Obstacles to Client Growth

The counselor's task is made difficult by a number of client-
based obstacles.

The client's anxiety about the counseling process is often
so strong that his defense systems erect a "strong wall" which
makes it difficult for him to react spontaneously to his therapist

(Brammer and Shostrom, 1960). Moreover, involvement or partici-

pation in an emotional experience makes it extermely difficult
for a person to make precise, objective, unbiased observations
(Kubie, 1966). By the very nature of his involvement in his

emotional experiences, the client cannot easily label what he

feels, the precipitating conditions, etc., much less communicate

 

these to the counselor. Hence, the client's attempt to convey
prior emotional experience to the counselor may take on an
entirely different meaning -- distorted further by the lapse of
time, the client's compressive and repressive (or similarly
defensive) behaviors, and numerous other factors relating to
client, counselor, and relationship variables. These obstacles
may be overcome, but their resolution accounts for valuable
time in the initial stages of therapy.

Client growth in counseling is further complicated by the
fear of psychological closeness with the counselor, observed
an an approach-avoidance dynamic. Previous research with the
IPR process (Kagan, Krathwohl, et. a1., 1967), furnished fre-
quent evidence of this approach-avoidance counselor-client dynamic
in which the client seems to both approach and retreat from psy-
chological closeness with the counselor. It was observed that
while the client and the counselor were discussing specific
activities outside the counseling relationship, they were at the
same time experiencing conflicting feelings about the counseling
relationship itself. These feelings are typically evidenced in

the client's concerns that (l) the counselor might hurt or reject

10

him; (2) the counselor might make an affectionate, dependent,

or seductive approach toward him; (3) the client's own hostile
impulses toward the counselor might emerge; (4) the client's

own affectionate, dependent, or seductive impulses toward the
counselor might be expressed or acted out. These four basic
elements of client-counselor interactions seemed to be nearly
universal (though of varying intensity across different dyads).
This fear of closeness makes continued expression and exploration
of emotion unlikely in the early stages of the counseling rela-

tionships.
Development of Affect Simulation

In an attempt to identify the limitations of the traditional
IPR process, it was determined that the potency of the IPR method
for client learning and growth hinged at least partly on the
quality of the counseling session. If the session contained
intense counselor-client interaction over matters of concern to
the client, the recall seemed to have more effect than if the
counseling session consisted of bland exchanges. Recognition
of this limitation lead to the deveIOpment of a new system. It
was reasoned that if the client were exposed to various kinds
and degrees of emotional situations, if his reactions to these
situations were videotaped, and if after each such exposure he
were given the Opportunity to view his behavior with a counselor

via IPR, the client could be confronted with his own videotaped

11

reactions to a series of planned threatening behaviors of
another person. It seemed that this might serve as a sort of
microscope, focused on the type of interpersonal behavior so
stimulated. Furthermore, the counselor would be better able to
diagnose if he could observe a client's reactions to a Standard
stimulus situation and compare these reactions with those of
other clients to the same situation. It also seemed that a
counselor's efficiency in communication would be increased if
he and the client could discuss client behavior which they
observed together. A variety of intense interpe sonal encounters
compressed into a short period of time through simulation could
lead to valuable feedback on client behavior for both client
and counselor.

In successful IPR counseling experiences, the client usually
becomes aware of self-behaviors which reflect both bids for, and
responses to, counselor regard. In other words, when clients
make positive movement in counseling, they typically become
aware of their own conflicting, approach-avoidance behaviors as
described above. These behaviors are related to the client's
past experience and seem to be typical of most of his present
interpersonal relationships with significant others.

The four dimensions of this approach-avoidance dynamic were
thus considered an appropriate model from which to develop common
stimuli for interpersonal simulation which would be applicable

across a wide range of clients. A series of vignettes was created,

12

which protray interpersonal confrontations. In some cases,
the actor directs affection or rejection toward the viewer; in
others he reacts as if he was being rejected or seduced (e.g.,
with fear or anger). Each of the four emotions is contained in
several (from four to seven) filmed scenes which can be used
as discrete entities -- although they do progress from mild to
very intense degrees of feeling for each emotion. The four are
hostility, affection, fear of hostility, and fear of affection.
Treatment Program:
A Theory of Progressive ApprOximation

The treatment program developed for this study consists of
three phases. In the first phase -- designated Simulation Video
Recall (SVR) -- the client is shown a film designed to simulate
various interpersonal stress situations, and the client and film
are videotaped while the client watches the film. This videotape
is played back immediately to provide the client and his counselor
with what is assumed to be a sample of the client's reactive
behavior in actual emotional stress situations. This videotaped
behavior sample serves as the focal point for the ensuing coun-
seling session. In this phase, it is expected that the client
becomes increasingly more able to identify and deal with the
simulated emotional confrontation, and he becomes more at ease
with his own feelings and behavior. He becomes aware that he

and the counselor are both capable of dealing with his emotional

l3

stress, and openness and access to feelings are thus clearly
defined as desirable and attainable goals of the counseling
experience. As he examines his reactions to the simulated per-
son on the screen, it is expected that the client is in the
relatively "safe" position of looking at his emotional reactions
to others but yet without having to be responsible for their
impact or consequences. In a sense, then, the client is dealing
with interpersonal threat but from a position of relative safety.
When the client has completed this stage, he is assumed to
be ready to begin to look at the feelings he has about the coun-
seling relationship itself. This begins the second phase, or
Interpersonal Process Recall (IPR). The counselor and client
are videotaped while conducting a counseling session. Immediately
after the session is concluded, the counselor leaves the room
and a third person, or "interrogator,” conducts the recall session,
while the counselor observes through a one-way mirror. The third
person is instrumental in this phase. Most clients cannot relate
in recall certain feelings which they had during the interview
(e.g., affection for the counselor) directly to their counselor,
since he was (and is still) the object of their feelings. In
other words, at this stage many clients tend to avoid in recall
(with their counselors) the same areas they avoided during the
interview. The use of an "interrogator" tends to help the client
overcome this behavior by keeping the client's attention focused

on the videotape and in limiting disucssion to what had transpired

14

in the counseling session. The interrogator avoids establishing
another client-counselor relationship by trying to keep the
client focused on the feelings or content of the original rela-
tionship.1 In this manner the interrogator seems to help the
client move one step closer to achieving the need for concurrent,
"here and now" awareness of his affect.

The interaction in the interrogation process, then, is
structured to enable the client to become aware of his behavior
in relating to the counselor. The client learns how his feelings
originate and develOp; he learns what he likes and dislikes about
himself in the counseling interaction; and he learns to recognize
the feelings he has about the counselor and the ways he expects
or hopes the counselor will feel and act toward him. The anxiety
which normally attends recognizing such feelings is reduced, since
the client is still not confronting the counselor and thus still
has a minimal responsibility for the consequences of his feelings.

At this stage in treatment program, the client has had the
opportunity in the recall situation to examine the underlying
emotions influencing his behavior within the counseling situation,
and he is expected to be more ready to begin to deal with them
with his counselor. This is facilitated through the third phase

of interaction, designated the "mutual recall". The recall session

 

1For a detailed description of the role and function of the
"interrogator", see Kagan, N., Schauble, P. G., Resnikoff, A.,
Danish, S. J. and Krathwohl, D. R. Interpersonal process recall,
Journal of Nervous_apg Mental Diseases, 1969, 148, 4.

15

is begun as usual, but the counselor remains in the room -- albeit
in the background. As the client begins to identify affective
material in the videotaped session, the interrogator involves

the counselor by inviting him to comment on what hg-thought was
going on. As counselor and client communicate about their reactions
and feelings during the videotaped interview increases, the inter-
rogator plays a progressively less active role. When the inter-
action between client and counselor starts to move from the "then
and there" of the videotaped session to the "here and now" of

the recall session, the interrogator literally withdraws from

the session. The client is thus engaged with the counselor in

an honest, Open relationship in which it is expected he will

become aware of his feelings and behavior in the "here and now".

He is able to confront the counselor with his feelings, and he

is ready to accept reSponsibility for their consequences. It is
expected that at this stage the client is capable of beginning

to live and behave more efficiently. He is beginning to experience
immediate in-relationship feelings, and has reached the "working-
thru stage" (Brammer and Shostrom, 1960) where the greatest gains
are about to be made and consolidated.

The progressive approximation of client feelings in the three
phases thus proceeds from identification of generic feelings
(through SVR), to feelings about a particular relationship in the
"there and then" of the videotape recall (IPR), to the immediate

communicating of feelings in relationship (through mutual recall).

16

Following the third phase of the intervention program, counselor
and client are expected to be communicating openly and directly
about client feelings, providing an optimal therapeutic environ-

ment for client growth.

W

In this chapter, a statement of purpose, need, and theory
for this study were presented. In Chapter II, a review of
pertinent literature relating to client movement, simulation,
and stimulated recall will be reviewed. Chapter III contains
the resezrch design, treatments, and methodology used in collect-
ing and analyzing data. An analysis of data is presented in
Chapter IV. A summary of the study, including a discussion of
the results and implications for further research, is presented

in Chapter V.

CHAPTER II

REVIEW OF LITERATURE

Introduction

 

In the first chapter, the client growth system which serves
as the theoretical background for this study was presented. The
review of literature in Chapter II will be focused on the follow-
ing areas relevant to the study: 1) client movement; 2) acceler-
ation of client movement, including group counseling, psychodrama,
multiple counselings and use of videotape in counseling; 3) stimu-
lated recall to accelerate client movement; 4) simulation in
counseling; 5) conclusions and implications of the literature;

6) simulation and stimulated recall - a pilot study.
Client Movement

This study is an attempt to accelerate client movement in
short-term counseling. Before one can examine the "acceleration"
of client movement in counseling, it is necessary to consider if
counseling does or can, in fact, bring about positive client move-
ment. Whether or not counseling ”works" is a basic issue which
has not been entirely resolved. The findings of studies bearing
on the matter would distribute themselves along a curve.skewed
somewhat toward those studies reporting no change in a positive
direction. The two most frequently reported obstacles to satis-

factory measurement evaluation are (l) the inability of various

17

18

schools of counseling and psychotherapy to agree clearly upon
processes and specific goals and (2) the inability to put such
definitions as exist into operation so as to measure, adequately
and reliably, whether the goals have been obtained (Stollak,
Guerney, and Rothberg, 1966).

There are two types of criteria by which the impact of
therapy on client behavior can be evaluated, i.e., client behav-
ior outside the therapy situation - or external criteria, and

client behavior within the therapy situation - or internal criteria.
External Criteria

Positive behavior change in the client's behavior patterns
in his daily functioning outside of the therapy process is, of
course, the prima-facie of the process itself. Criteria relating
to such behavior would seem then to be extremely important in
measuring the influence of therapy. When one attempts to use
such criteria, however, he is beset by a variety of measurement
problems. The essence of the problem is that there is not:

.....the develOpment of criteria of sufficient
breadth that they are meaningful and represen-
tative of a wide range of functioning and yet,

at the same time, circumscribed enough to be
measured with reliability. (Zax and Klein, 1960,
p. 445)

Attempts have been made to observe change in narrow aspects

of functioning, and from these develOping implications for a

l9

wider range of behavior. An example of such research was that
performed by Teuber and Powers (1951). They compared a group

of potential juvenile delinquents who had received treatment with
a matched control group who had not. The criteria measure was
simply the number of court appearances for each group following
treatment. While this is obviously a meaningful criteria for
therapy with juvenile delinquents, it would have less relevance
as a criteria for evaluating therapy with graduate students in
psychology, coeds enrolled in undergraduate Special education
courses, or divinity students. Furthermore, the measurement
value of the specific criterion chosen has to be examined.) In
the Teuber and Powers study, for example, no significant differ-
ences in recidivism between groups were found. The questions
left in the mind of the reader are whether the treatment, the
criterion, or both were ineffective. These same criteria issues
are probably even more important when comparing results from one
study with another, where different populations, treatments, and
designs may have been used.

The assessment of broader areas of functioning has been
pretty much restricted to institutional settings, where the sub-
jects' range of behavior is limited. In such settings researchers
have used multiple but individually meaningful behaviors as their
criteria. These range from the number of times hospitalized psy-
chiatric patients required electronconvulsive maintenance shock,

to discharge from the hospital (Cowden, Zax, Hague, and Tinney,

20

1956); and reports from the prison chaplain, to return to prison
as a parole violater (Fox, 1954). It is evident that there is
no unifying framework in which to integrate these observations
for comparison across different client populations. The conse-
quence is that results are frequently fragmented, i.e., a variety
of behavioral changes as a result of therapy are reported, but
very few of these appear in any one study, and even fewer are
observed in more than one study. Hence, there may be a variety
of seemingly "valid" measures of therapy outcome, but each is
valid for certain specified purposes and not necessarily valid
for others. One must conclude that we do not have a satisfactory
criterion, set of criteria, or even conceptual framework with
which to adequately evaluate different forms of therapy with

different client populations.

Internal Criteria

The use of internal or intratherpeutic criteria based on
client behavior within the therapy process stems largely from
the client centered approach. Rogers and Dymond (1954) provided
data that indicated that the primary changes occurring during
the client-centered therapy consisted of changes in self-concept
rather than changes in behavior. This raises a potentially sticky
point. If the therapy process odes not consistently produce
observable behavior changes, can therapy be ju8tified by arguing

that at least client self-concept becomes more realistic or self-

21

satisfying as a result of therapy? In many cases research
results indicate that change in self concept does not occur.
In the Rogers and Dymond data, for example, no significant differ-
ences between behavior before and after therapy for the treatment
group were found, when the external criteria of observations and
reports by friends of the client were examined. Lp_addition,
however, no differences were found in change in self-concept
between patients receiving psychotherapy and those that did not!
The latter group were patients who, after waiting for psycho-
therapy, decided that they no longer felt in need of treatment.
In one analysis of data on self-concepts (using the Q-adjustment
scores), Dymond compared these no-treatment subjects with success-
fpl_psychotherapy patients. The results showed that the changes
in self-concept were equivalent in degree for both group_. Again,
the reader is not certain as to what could account for these re-
sults. Is it, as Dymond (1955) remarks later, that

....although positive adjustment changes

appear to take place in maladjusted persons

in the absence of psychotherapy, these are

not identical with the changes which occur

in equally maladjusted persons who complete

therapy (p. 107).
Here Dymond implies that no "deep" reorganization takes place -
and client (who has not received therapy) improvement is char-
acterized by "a strengthening of neurotic defenses and a denial

of the need for help". While this may be, it provides yet

another hypothesis that remains unsubstantiated.

22

Do the Dymond results reflect basic weaknesses in the Q-sort
as a criterion instrument? The Q-sort type of instrument has
enjoyed wide usage (Butler and Haigh, 1954; Cartwright, 1957;
Rosenthal, 1955; Dymond, 1953; Cartwright and Roth, 1957; Butler,
1960; and Lesser, 1961), but it has not provided for a consistent
or conclusive evaluation of the therapy process (Truax and Cark-
huff, 1966). Other instruments have been develOped which, like
the Q-sort, were intended to serve as outcome criteria through
use of client feedback. These include a Client Post-Therapy
Scale (Tucker, 1953), a Therapy Session Report (Orlinsky and
Howard, 1968) and self-rating scale (Fiedler, 1949). The client
has also provided evaluation of therapeutic progress through
use of open-ended follow-up interviews which were recorded and
evaluated by three judges as being "successful, progress, or
failure cases" (Cowen and Combs, 1950). It would seem, however,
that the greater the extent to which such evaluative approaches
depend on client feedback, the more evident is the fundamental
weakness of this phenomenological approach in obtaining reliable
assessments. These writers go on to indicate that when the
client enters treatment, he feel bound to justify seeking help
so that his problems are generally discussed freely. When ter-
minating counseling, he feels obligated (to himself and the
therapist) to prove he has indeed made movement. It is entirely

likely that any report or reduction in discomfort or of positive

23

Unfortunately, on close analysis, this decep-
tively simple procedure is seen to be fraught
with serious pitfalls. Standards for such
assessments will vary both among clients and
between client and researcher; clients will
vary in the extent to which they can report
what they feel; the reports of many clients
will be subject to many distortions; finally,
the client's evaluation of his condition may
be affected by conscious or semi-conscious
motives (Zax and Klein, 1960, p. 443).

growth would reflect this "hello-goodbye" effect (Hathaway, 1948).
The most promising approach for evaluating change in behavior
in counseling and therapy seems to be the rating of behavior
(usually verbal) by outside observers. This has been especially
true in the measurement of various dimensions of therapist be-
havior considered essential to effective counseling and therapy.
Rating scales have been developed for a variety of therapist
process dimensions, especially the "core" conditions of empathy,
positive regard, genuiness and concreteness. Substantial research
has shown that these variables can be reliably rated and con-
sistenly related to positive change in the client (Truax and
Carkhuff, 1967; Carkhuff and Berenson, 1967).
Rating of client behavior in therapy has, for the most part,

centered on the concept of self-exploration.

In successful therapy, both individual and

groups, the client spends much of his time

in self-exploration - attempting to under-

stand and define his own beliefs, values,

motives, and actions, while the therapist,

by reason of his training and knowledge, is

attempting to facilitate this process (Truax
and Carkhuff, 1967, p. 189).

24

A number of research studies tend to verify the significance for
outcome of the concept of self-exploration. Several examinations
of the degree of client self-exploration in client-centered
therapy indicated that more successful clients increasingly
explored their problems as therapy proceeded, while less success-
ful ones tended to decrease in the exploration of their problems
(Steele, 1948; Seaman, 1949; Blan, 1953). Wagstaff, Rice and
Butler (1960) also reported that patients with successful
outcomes in client-centered therapy tended to explore themselves
more in the course of therapy than did patients who could be
classified as therapeutic failures.

Truax and Carkhuff (1964a) used the Depth_g§ Intrapersonal

 

Exploration Scale with tape recordings of individual psycho—
therapy sessions with schizophrenics and found that patients
high in degree of self-exploration showed significantly greater
personality change than patients low in self-exploration. Their
overall analysis (including various psychological tests,
percentage of time hospitalized and a number of other specific
measures) indicated that patients engaging in a high level of
self-exploration showed an average improvement of one standard
deviation beyond that of patients low in self-exploration. The
Depth of Intrapersonal Exploration Scale has been revised
(Carkhuff and Berenson, 1967) and has been found to be a reliable

and promising research instrument (the scale is described in detail

25

in Chapter III). However, it remains a somewhat crude measure-
ment and has been criticized on the grounds that it is a global
measure of behavior, derived from a single--the client-centered--
therapeutic approach and has been used primarily by researchers
disposed toward client—centered precepts.

A possible solution to this problem has been proposed by
Kagan, et.a1. (1967), who devised a set of outcome criteria to
be used in the ongoing counseling process. These criteria had
the following characteristics:

1. They were not identified with a particular counseling
theory.

2. They were operationally definable and thus had research
utility.

3. They did not necessarily represent discreet entities,
i.e., a client might display two or more of the
Characteristics at a given moment.

4. They were not intended to describe everything that went
on in the counseling relationship.

 

The intent was to provide criteria for client change which
were acceptable to most theoretical positions without defining all
client change; the elements chosen represent some of the most
obvious tasks a client experiences in successfully moving through
the counseling process. They are:

l. The client owns his discomfort.

2. The client commits himself to change.

3. The client differentiates stimuli.

4. The client behaves differently.

26

These criteria were operationalized in a rating scale (the
Characteristics of Client Growth Scale; Kagan, Krathwohl, et.a1.,
1967) with which independent judges rate client behavior in
taped sessions. The scale has been found useful in scanning
client movement in a variety of individual counseling situations
(Resnikoff, Schauble and Kagan, 1969; Schauble, 1968; Kagan,
Krathwohl, et.a1., 1967), and has been found to be related to
pre- and post-therapy change scores on the MMPI (Pierce and
Behauble, 1969; the scale is further described in Chapter III).

Since it is reasonable to assert that the client establishes
the same kind of relationship with his therapist that he forms
with other people in his environment (in the sense that it
contains the same needs, values, etc.), it would follow that
observable behavior change in therapy would be a valuable source
for evaluating the success of the therapy process. In light of
the ambiguity surrounding research findings using external
criteria, it would seem that internal or "process measurements"
have at least as much value for attempting to evaluate the

influence of counseling or therapy on client movement.

Acceleration of Client Movement

Assuming that there are adequate criteria for measuring
client movement in counseling, are there ways of accelerating

such movement? Since the development of the one-to—one therapy

27

relationship pioneered by Freud and his associates, attempts
have continuously been made to demonstrate that one type of
therapy is superior to another. This is most evident in the
development of the various theoretical schools-of-thought.
Woody (1970) summarized various writings and indicated that
each of the major therapy approaches has had roughly a decade
when its impact has been prominent. The 1930's are generally
seen as the neo—analytic period. The 1940's were most heavily
influenced by the trait-and—factor theorists. The "client-
centered" approach was prominent in the 50's, the behavioristic
approach was most impactful during the 60's and all indications
are that the 70's will be the era of the humanistic therapists.
One would expect that the existence of different theoretical
models would imply observable differences in the therapeutic
treatment offered by the advocates of each model. There is
little support for this implication in professional literature.
Fiedler's (1950, 1951) early research indicated that theoretical
orientation was not a determinant of therapist behavior.
Instead, experienced therapists of different orientations
agreed with each other more closely than they did with beginning
therapists from their own orientation. Another study comparing
psychiatrists with clinical psychologists and social workers
found no differences in the goals set out for treatment related

to the discipline from.which the therapist came (Micheux and

28

Lorr, 1961). Other studies indicate that time and situation
limits are more likely to influence therapist behavior than is
theoretical orientation (Schlein, 1962; Wrenn, 1960).

If there is no clear difference in therapist's behavior
across theoretical approaches, one would not expect to find
differences in the behavior of their clients. Research evidence
using external criteria has not given a clear indication as to
superiority among the various approaches (Truax and Carkhuff,
1966), and where internal, or process, criteria have been used
to evaluate therapy, the level of functioning of the individual
therapist seems to account for client movement-~independent of
the particular orientation of the therapist (Carkhuff and
Berenson, 1967).

In addition to different theoretical constructs, we find a
variety of methods or techniques which seem to have as their
purpose the intensification of the therapy influence. Included
in these are group counseling and therapy, multiple therapy,

psychodrama and the use of videotape.

Group Counseling

 

Group counseling generally refers to the treatment of a
number of individuals assembled for therapeutic purposes (Bion,
1961). Proponents of group counseling cit a number of advantages

over the individual situation, e.e., the group situation brings

29

into focus the adequacy of the patients' interpersonal relation—
ships and provides an immediate opportunity for discovering new
and more satisfying ways of relating to peOple (Hobbs, 1958).
When the relative value of groups as compared with individual
counseling is subjected to research, however, the differences
in effectiveness tend not to be clear. The substantial body of
research in group counseling is summarized in reviews by Kagan
(1966); Wright (1960) and Hoyt and Moore (1960).
Possibly the most concise evaluation of group counseling

research to date is Kagan's statement that:

An increase during the past three years (1963-

1966) in the number of methodologically sound

studies on group procedures provides considerable

evidence for the conclusion that certain as yet

unspecified group procedures--at the hands of

some counselors, with some clients, in some

settings and at certain times--will result in

improved client grade point average, attitudes,

knowledge and behavior.
In light of research to date, it is not clear that group counseling
is superior to the individual counseling situation and its value

is apparently as difficult to demonstrate (Shaw and Whorton,

1965).

Psychodrama

 

An elaborate group therapeutic technique was developed by
Moreno (1946) in which the patient is encouraged to dramatize

situations spontaneously, and, in the role of actor, to relive

30

many of his conflicts, wishes, fears and attitudes. Through an
acting—out of his prOblem and giving vent to his feelings and
fantasies, the person is said to resolve many of his deeper
prOblems and conflicts. The technique sometimes uses a device
called an "auxiliary ego" assumed by a trained worker who
mimics the patient and reacts spontaneously by acting out
feelings and thoughts he believes the patient may not be able
to express. Or, the patient may play the role not only of
himself but also of a significant person in his life, such as

a parent or sibling. The material elicited during psychodrama
can be dealt with in the group format or used in individual
sessions with the therapist at a later time. This technique
appears to have an emotionally carthartic value for the patient,
and it is possible that the patient can gain understanding of
his prOblems as they are revealed in his expressed acts and
thoughts as reflected back to him by the "auxiliary-ego".
Clinical reports indicate that, with coordinate individual
therapy, the technique helps the patient to gain insight into
his disturbed behavioral patterns but this is as yet unsubstan-
tiated by controlled research. Anker and Welsh (1961), in a
study of the effectiveness of group therapy as opposed to drama
group-activity, found that the group engaged in drama activity
supposed to serve as a "control" group for purposes of

comparison) made consistently greater improvement than the

31

psychotherapy treatment group. Apparently the "acting-out” of
feelings in some sort of role-playing activity can have some
(heretofore unqualifiable) benefits for client movement. In
fact, many of the devices used in psychodrama are used in other
forms of group counseling, as well, e.g., role playing,
auxiliary or "alternate" egos, non-verbal communication, etc.
(Bradford, Gibb and Benne, 1964), but their value has yet to be

conclusively demonstrated through research.

Multiple Therapy

 

A relatively new technique uses two or more therapists and
is called co-therapy or ”multiple-therapy". The benefits of
this technique, according to Kell and Burow (1970) is that it
provides the opportunity for both conflict generation and
resolution that is not so available in dyadic therapy. This is
due to the multiplicity of possible relationships, e.e., between
each therapist and the client (or clients), between each therapist
and the client's interaction with the relationship between
therapists. One advantage of multiple therapy is that it
approximates the family situation (if male and female therapist
are used), thus evoking more conflicts related to the develOpmental
problems of the individual. The therapists involved seem to
experience a number of advantages, not the least of which is the

availability of in-therapy consultation with each other.

32

Impasse situations during treatment and

problems in the ending of therapy became much

less threatening, with the certainty that there

was a consultant available to share the respon—

sibility. Similarly, group psychotherapy

became a more intense experience for both

therapist and patients because we became less

afraid of 'transference-—non—transference'

gains (Warkentin, 1967).
Multiple therapy has become a popular and widely used technique
(Nunnally, 1968). Therapists who have participated in multiple
therapy groups reported it: Was effective; facilitated
expression of feelings regarding conflict with parents; helped
in resolving problems in sex role and education and influenced
the formation of healthy heterosexual relationships (Rabin,
1967; Mintz, 1963; Mints, 1965; Mullan and Sangliuliano, 1960).
These are descriptive data, however, and in those few studies
where an empirical evaluation of the technique was attempted,
there has been no indication that multiple therapy is any more

effective in accomplishing client movement than with one

therapist (Nunnally, 1968; Daniels, 1958 and Staples, 1959).
Use of Videotape in Counseling

A variety of techniques using videotape have been developed
and applied in counseling and psychotherapy. Most of these
studies have been focused on videotape in the training of
counselors and therapists but they do provide implications for

client movement as well.

33

Suess (1966) and Schiff and Reivich (1964) using psychiatric
supervision models, report the value of videotape in understanding
the interview dynamics of counselor and clinet--especially as a
record of the non-verbal communication within the interview which
is not available to the supervisor through the traditional
techniques of process notes or audiotapes. In discussing the
influence of videotape on the process of psychotherapy supervision,
Gruenberg, Liston and Wawae (1969) state that supervision becomes
more complete and honest, providing the necessary feedback with
which to determine the progress of the patient and therapist.
They cite several important contributions of the videotape.
First, before the advent of videotape, the supervisor felt no
genuine source of encounter with the patient. He often did not
see the patient and his knowledge depended on the subjective
reports of the therapist—in—training. Access to the videotaped
therapy session provides the supervisor with specific first-hand
knowledge of the client. Gruenberg, et.a1., claim that the
supervisor is able to become a more effective consultant, in
effect a "co-therapist" and is better able to help the therapist—
trainee arrive at a "therapeutic result". The quality of client
treatment logically should improve when the therapist is getting
"improved" and personalized supervision. With a greater degree
of involvement with the patient via the videotape, the supervisor

can protect him against anti-therapeutic maneuvers by the

34

therapist/trainee. Second, the therapist/trainee does not need
to concern himself taking notes, as the videotape provides a
record of the therapy for supervision. The authors claim this
alleviates therapist concern over completeness of notes, as
well as eliminating patient worries that the therapist is more
interested in notes than in him. Finally, they cite experience
indicating that the use of videotape seems to increase the tempo
of therapy.

The cessation and subsequent resumption of

videotaping were clearly related to the effective-

ness of therapeutic activity. Succintly stated,

when one is under intense scrutiny, whether it be

in doing psychotherapy or surgery, it is reasonable

to expect a more intense investment of attention

to the problem at hand. (Page.104)
The effect of this focusing and "investment of attention" would
seem to have potentially at least as much of an effect on the
client as on the therapist, i.e., if the client were aware that
his behavior and adequacy as a client participant were to undergo
"intensive scrutiny," his "performance" as a client might be
improved.

Two separate studies suggested that counselors-in-training
gained new insights and greater self awareness as a result of
viewing a videotape replay of their counseling behavior (Landsman
and Lane, 1963; Walz and Johnston, 1963). There was no evidence

as to whether or not these insights were translated into new or

effective counseling behaviors but if counselors can gain insight

35

and self awareness from watching their sessions on videotape,
it seems logical to expect clients could enjoy the same gains.
The use of videotapes of one's own behavior in therapy
might seem to contain the danger of evoking extreme threat
within the client, similar to the "psychic shock" reactions
Observed by Cornelison and Arsenian (1960) upon confronting
hospitalized psychiatric patients with motion pictures and
still photographs of themselves. Such increases in the level
of anxiety upon viewing a tape of oneself have been noted by
Moore, et.al. (1965), with hospitalized psychiatric patients
and Gurtsma and Reivich (1965) with a psychiatric out-patient.
This does not have to be the case, however, as demonstrated
by Poling (1968). Poling investigated the impact of video-
taping counseling interviews in three different environments.
While the counselors who participated in the project did not
perceive much difference in the three interview environments
used for videotaping, the clients involved actually viewed

the environments as less threatening and more conducive_tg

 

 

counseling than did their counselors:

...for each of the situations, counselees
rated the interview environments more
positively than did the counselors.
Statistical significance was observed in
each of the comparisons which tended to
support the conclusion that counselees
appeared to have been less threatened by
the videotaping of counseling interviews
than counselors. (Page 352)

36

While the different environments were not compared with a control
environment of no—videotaping in this study, the results tend to
confirm Poling's conclusion that when counseling was conducted

in a "professional manner,"

the physical environment had little
effect upon the degree of success of the interview. In another
continuing research project, little difference has been observed
in the behavior or anxiety level of clients in sessions where
they are videotaped as opposed to sessions in which they are not
(Kagan, Krathwohl, et.al., 1967).

In a few of the studies investigating the value of videotape
in the training of counselors, the client has been able to view
the videotape immediately after the counseling session (Schmeding,
1962; Pascal, 1967 and Walz and Johnston, 1963). It is unfortunate
that the effects or potential of this practice on influencing
client behavior were not examined by the writers involved,
although Ryan (1969) does report experience that suggests clients
are eager to view their videotapes. Ryan also suggests that the
client, counselor candidate and supervisor should work together
as a team in analyzing the session, but again he does not suggest
or evaluate the behavior or roles available in this situation and
their potential impact on client behavior.

In a carefully controlled study, Goldberg (1967) did use a
structured approach to replaying the client's videotaped interview

developed by Kagan, Krathwohl, et.al. (1967). In Goldberg's study

37

the counselor/trainee was able to observe the client's "stimulated
recall" of the completed counseling session through a one-way
mirror, thus maximizing the counselor's feedback as to client
perceptions of the therapy session. After a later session, the

"mutual" recall

client, counselor and supervisor engaged in a
session where counselor and client shared directly their
perceptions of the videotaped counseling session. Goldberg's
training program was found to result in significantly improved
counselor performance when compared to a control group of
trainees receiving intensive traditional supervision. The
trainees in both the treatment and the control groups were
rated as more affective, understanding, specific, exploratory
and effective, but positive behavior change in the videotape
treatment group was significantly greater than in the control
group.

There have been few studies which examine directly the
therapeutic potential of videotape on client movement in therapy.
Moore, Chenell and West (1965) report the procedure of having
patients see themselves on videotape in order that they might
gain a perspective of their own abnormal behavior. In that study,
patients who were exposed to interviews made over a period of
several weeks made more rapid changes in the "direction of health"
than those who were videotaped but did not see themselves. Paul

(1965) and Gurtsma and Reivich (1965) provide further descriptions

38

of the technique of exposing the patient to tapes of previous
behavior. These studies lacked adequate controls and did not
seem to make optimal use of videotape as a therapeutic tool.
In most uses, the videotape of a client's behavior was simply
played back for him to view. No attempt was made at helping
the client gain in—depth understanding of the dynamics under—
iyigg_the behavior. In contrast, in a series of studies Kagan,
et.a1., applied a structured method of stimulating immediate
client recall of videotapes made of the client's previous
counseling sessions. The results indicated that, with a
structured approach to examining the videotape, accelerated
client movement in counseling could be obtained (Kagan,
Krathwohl, et.al., 1967; Kagan, Krathwohl and Miller, 1963;
Resnikoff, Kagan and Schauble, 1970). This approach will be

discussed in the next section.

Stimulated Recall to Accelerate Client Movement

The technique of using stimulated recall by videotape as a
tool in accelerating client insight and Change during counseling
is part of the Interpersonal Process Recall (IPR) method developed
by Kagan, et.al. (1963, 1967, 1969). The technique was derived
from Bloom's (1954) use of stimulated recall as a means of
examining the thought processes of students and Nielsen's (1962)

investigation of perceptual change through self-confrontation.

39

A special value of the technique is that it contains a
clear formulation of the approach where in the videotape of the
client's own in-therapy behavior serves as the stimulus for
client investigation of the dynamics underlying that behavior.
It is from this method and the outcomes of several studies using
IPR that the present research develOped.

The initial research with IPR.was structured in the

following manner:

A counselor and client were videotaped in a
counseling interview (see Figure 1, Appendix
59. As soon as the interview was concluded,
the counselor left the room; and a second
trained clinician--designated an "interrogator"-—
entered the room, whereupon the playback of
the interview was conducted.* Then the
"interrogator", with the aid of a remote-
control stop-start unit, helped the client
probe for the underlying affective components
of the client-counselor communication (see
Figure 2, Appendix A).

An essential variable of the process was for
the counselor to directly observe the recall
session. Through the recall, the counselor
seemed to gain a great deal of understanding
of the nature of the client's problems and

of the client's interpersonal relationships

by observing the kind of interpersonal rela-
tionship the client had established with him.
That is, by observing the client's projections,
fears and aspirations about him (the counselor),
the counselor could more clearly understand

the client's interpersonal behavior and some

of the more central qualities of the client's
presenting—problem. At the same time the
client began to understand his own general
perceptions and reactions to people by
Observing the way in which he interacted with
the counselor.

40

In addition to intensive analysis of case studies (Kagan,
Kratthhl, Miller, 1963; Woody, Kagan, Krathwohl and Farquhar,
1964; Resnikoff, Kagan and Schauble, 1970) where the potential
of IPR for accelerating movement was indicated, controlled
studies (Kagan, Krathwohl, et.al., 1967) were conducted which
led to the following conclusions:

1. When IPR_i§ introduced as ea intervention i2 the

 

 

counseling process, client growth can be_accelerated

 

but onlijhen the counselor is actively involved in

 

the recall process. In a study examining the effects
of IPR with prison inmates, no differences in client
movement in therapy were observed after the interven-
tion of the IPR session, despite the fact that the
recall session where the client viewed and discussed
his behavior appeared extremely productive. It was
later determined that the counselors involved had not
viewed the client's recall session, and when they
resumed their counseling relationship with the client
they were oblivious to and seemed to discourage the
client's new found insights and exploratory behavior.

In a second study, the same counselors were required

 

*The role, function and training of the interrogator in the IPR
method is discussed in Kagan, N.; Schauble, P.; Resnikoff, A.;
Danish, S. and Krathwohl, D.; Interpersonal Process Recall,
Journal 2: Nervous and Mental Disease, 1969, 148, 4.

41

to remain with the client and interrogator during the
recall session. By remaining in the room and eventually
participating in the recall session, the counselor was
confronted directly with client feedback. This "mutual
recall" resulted in subsequent client growth in therapy.

2. Different variations of IPR intervention may 23

 

 

appropriate, based 23 the functioning level gf_the

 

 

therapist. In a study comparing the regular IPR session
with the mutual IPR session for two counselors, the
results indicated that the higher functioning counselor
(who was more effective than the other on all criteria
for each method of treatment) benefited more from the
regular IPR* than from the mutual IPR. For the lower
functioning counselor, these results were reversed. The
writers conclude:

The IPR procedure provides the client with
insights into his interpersonal behavior
but it is necessary that the counselor be
able to integrate these insights into his
ongoing relationship with the client if
growth is to be accelerated. It would
appear that the more competent counselors
under such conditions, gain new understand—
ing from studying the session between
interrogator and his client, and gain less
from taking part in the interrogation.

The less competent therapists, on the other

 

*Unlike the study with prison inmates, in the regular IPR session
in this study, the counselor was able to observe directly the
recall session through one-way glass.

42

hand, may either not understand the
dynamics uncovered in recall or may
not be able to implement them, thus
frustrating the client's new under-
standings-~perhaps even retarding
client growth. (Pages 319, 320)

The writers go on to say that the less competent counselor
becomes more effective with his client by participating directly
in the recall session, where the presence of the interrogator
may serve to reduce the anxiety of the counselor so that he is
more comfortable in dealing directly with the interpersonal
dynamics and conflicts between his client and himself.

There is support for this conclusion in other areas of
research, where it has been found that counselors functioning
at low facilitative levels have a negative effect on well
motivated clients (Piaget, Berenson and Carkhuff, 1967; Carkhuff
and Berenson, 1967) i.e., clients who attempt to deal with
interpersonal dynamics within the therapy relationship receive
negative reinforcement from low—functioning counselors to the
extent that such positive client activity in therapy eventually
disappears.

In summary, it appears that the use of stimulated recall
via videotape can be an effective influence in accelerating

client growth in therapy when counselor involvement and

functioning level are taken into account.

43

Simulation in Counseling

For many years simulation techniques have been successfully
employed in both the armed services and industry in training to
avoid damaging costly equipment or endangering human lives, e.g.,
astronaut training (Kersh, 1965), but it is only recently that
these techniques have been adopted in education and the social
sciences. There is no lack of logical rationale for the use of
simulation techniques in counseling. Greenalw, Huron, and Rawdon
(1962) describe the benefits of simulation in training as in-
cluding the condensening of time, whereby participants can in-
crease their understanding of the decision-making process and
sharpen analytic skills through immediate observation of the
results of their decisions. For many clients apg_counselors,
each decision is crucial and loaded with implications for the
future. If we assume that a major ingredient of the client's
coping difficulty is his lack of ability ot make apprOpriate
decisions and take action on them and/or his lack of confidence
in his ability, than a simulated situation where he can make and
examine various behavioral responses free from much of the fear
of disastrous consequences would seem an invaluable adjunct to
the therapy process. Indeed, the counseling situation itself
initially represents an unreal or simulated situation for many
clients in the sense that they are involving themselves in a
relationship and self-analytic behavior heretofore deprived them

in the “real world". Despite the available rationale, however,

44

there has been little research into the development of simulation
techniques in counseling. Of the work that has been done, most
involves the education and training of counselors, or related
personnel.

Simulation research in teacher education has led to programs
that prepare teachers: to more correctly assess each child's
functioning level (Utsey, Wallen, and Beldin, 1966); to develOp
referential categories in which to view different behaviors
(Wallen, 1966); to evaluate the impact of individual or innova-
tive approaches on the teaching process (Fattu, 1965). Each of
these qualities is readily interchangeable with the aims of
counselor educators. This position is adopted by Delaney (1969),
who submits a prOposal for developing the simulation approach
in counselor education. Delaney indicates that research to date
justifies the following conclusions:

1. Simulation is effective as an instructional technique.

2. The use of a television monitor for stimulus presenta-
tion is appropriate.

3. Realism is not a primary requirement for transfer of
learning.

4. Simulation positively affects actual performance.

5. Simulation provides economy of time and reduces long-
term expense.

6. The application of simulation techniques to counselor
education has shown to be feasible and effective (p. 185).

The application of simulation techniques to counselor education
has obvious implications but it has not as yet been empirically

validated. In one of the few attempts to provide research

45

evidence, Beaird and Standish (1964) obtained encouraging re-
sults. These writers used a simulated environment to train
practicum-student counselors to discriminate between cognitive
and affective client reSponses and then to use counselor reSponse
leads to facilitate more affective behavior in clients. This
study used audio recordings as simulation Stimuli within a pro-
grammed-learning instructional format. The results indicated
that the experimental groups demonstrated a significant perfor-
mance gain over the control group, as well as differences between
the experimental and control groups in post-training interview
performance.

If positive results can be obtained using an audio-simula-
tion approach, one wonders what the application of film or
video techniques could add. One study (Lougne, Zenner, and Gohman,
1968) did attempt to evaluate the influence of videotape on the
job interview situation; but the results were confusing. The
writers divided a group of neuropsychiatric in-patients into
three experimental groups: programmed materials group, programmed
materials with videotape group, and control group. The results
did not indicate that the programmed materials or materials with
videotape facilitated performance in the job interview situation,
in fact there was a noticeable (but non-significant) trend favor-
ing the control group. Among many methodological weaknesses in
this study was the fact that each client participated in a single

simulated interview, and was able to view himself on videotape

46

only once. The writers suggest that the self-confronting
nature of the videotape produces anxiety, thus the single video
session in this study may have done more hard than good.

In other words, what one may be dealing with

in the attempt to increase efficiency by sin-

gle-practice interview and subsequent group

and individual replay is this anxiety effect.

Whatever positive features might be gained

from the attempted modification of specific

bits of behavior is nullified by the self-

conscious anxiety which might contribute to

less able performance on both the application

blank and the later job interview. (p. 438)
There are two distinct notions expressed in this explanation:
1) That increased anxiety may lead to lower performance, and 2)
That the self-image is an anxiety producing stimulus. There is
little doubt that simulated situations can produce anxiety in
clients. "Stressor films" have been used in a laboratory situa-
tion to create and study psychological stress and anxiety
(Laxurus, Speisman, Mordkitt, and Davison, 1962), but this
approach calls only for vicarious involvement on the part of the
client. In other words, the subject views a filmed situation
which involves him only as a spectator (e.g., a vivid traffic
accident). Earlier in this chapter it was noted that, while
there is concern among some writers as to whether exposure to the
self image can have a deleterious effect on the client in therapy,

this rarely seems to be the case. It would seem apparent that

such self-confrontation can raise client anxiety, but there is

47

some evidence to suggest that this can be of positive value in
terms of stimulating client behavior that relates to his problem
area and can thus be dealt with in the therapy situation. Two
examples illustrate this point.

Cornelison and Arsenian (1960) took still photographs of
psychotic patients and later showed the pictures to the subjects.
Initial responses for most patients "conveyed an impression of
sudden psychic shock". The writers proceed to describe a variety
of intense reactive responses to the photographs, and conclude
that stimulating such behavior responses may be a potent "adjunct
to psychotherapy with disturbed persons", if the behavioral
response are integrated into the therapeutic diagnosis and setting
of goals.

Small (1967) recorded on audio-tape the comments of patients
who were experiencing delerium tremors. After five or six days,
when the patient was oriented again with most of tremulousness
gone and with the disappearance of hallucinations and delusions,
the tapes were played back to the patient. The tape had such a
realistic effect that it reinduced symptoms that he had experienced
just a week before when in the midst of his delerium. This was
carried out even to the extent where the patient would become
very suspicious again, and on occasion re-experience, on a tem-
porary basis, the visual hallucinations which he had previously
had. Small postulated that this technique could have therapeutic

benefit for chronic alcoholics if such tapes were replayed at

48

stated intervals - "in a sense recharging their therapeutic
batteries and in this way, perhaps, condition them against re-
turning to a chronic drinking pattern". While this idea has not
been validated through research, it has intriguing implications

for counseling and therapy.

Conclusions and Implications of the Literature

Despite the lack of controlled, definitive research in
many of the areas reviewed which relate to the acceleration of
client growth, there are a number of implications that can be
drawn from the literature.

There do not appear to be appropriate or satisfactory exter-
nal dimensions of client behavior by which to evaluate techniques
designed to accelerate client growth in therapy. A number of
internal or "process" dimensions have recently grown out of
Roger's work. Of the three potential sources of process data:
client, counselor, or independent observer, the most promising
seems to be the independent observer (Truax and Carkhuff, 1967;
Carkhuff and Berenson, 1967). Several dimensions of "desirable"
in-therapy behavior have been developed and operationalized into
apparently reliable rating scales, including client self eXplor-
ation (Truax and Carkhuff, 1967) owning of discomfort, committment
to change, and differentiation of stimuli (Kagan, Krathwohl, et.a1.,
1967; Schauble, 1967); these seem to have some validity and

research utility as criteria by which to evaluate client growth.

49

A variety of approaches have been developed to improve or
accelerate the influence of therapy on client growth. While each
has a seemingly sound theoretical rationale, however, there Simply
has not been consistent or conclusive empirical support that the
new approach works any better than the usual one-to-one therapy.
The innovations that seem to have considerable potential for
influencing client growth are videotape and simulation but these
have yet to be tried with clients. Most relevant research with
these techniques centers on their use in counselor-training. The
one method that has found direct application in counseling and
therapy has been stimulated recall through IPR (Kagan, Krathwohl,
et. a1., 1967; Resnikoff, Kagan and Schauble, 1970; Kagan, Krathwohl,
and Miller, 1963). This technique clearly formulates an approach
to maximize client participation and feedback, and has accom-
plished positive (if small scale) results in accelerating client
growth.

If the IPR method with videotape maximizes feedback to the
client about his behavior in the videotaped interaction, and if
Simulation experiences provide an Opportunity for stimulating a
variety of emotional reactions in the client (Cornelison and
Arsenian, 1960; Small, 1967), the logical question then develops:
can simulation techniques be developed which can be combined
with IPR methods to formulate a new approach to accelerating

observable client movement in therapy.

50

Simulation and Stimulated Recall:
A Pilot Study

During the Spring and summer of 1968 a pilot study was con-
ducted to determine if the simulation and IPR techniques could
be integrated into a viable treatment program. The nine clients
participating in this study were referred by a local community
rehabilitation agency for short-term intensive counseling. These
clients were referred because they were suffering from personal
and adjustment problems which substantially interferred with
rehabilitation service or vocational placement. Clients were
seen for six sessions of one and one-half hours each. The clients
were assigned to one of three treatments: 1) counseling (control
treatment); 2) counseling using VRAS (simulation films and video-
tapes) first, (three sessions) then IPR (interpersonal process
recall) (three sessions); 3) counseling using IPR first and then
VRAS.

The results indicated that clients receiving counseling which
included either combination of the simulation and videotape tech-
niques made more progress on four process measures of client
growth (using independent judges) than did control clients, and
clients receiving either innovation treatment were also judged
as having made more positive movement on variables relating to
change in the therapeutic process. In fact, control clients were
found to move negatively on the process variables used. This was

taken to indicate that positive movement within counseling is not

51

necessarily concommitant with counseling experience (a finding
which is consistent with the findings of Piaget, Carkhuff, and
Berenson, 1967; and Carkhuff and Berenson, 1967) and it was tenta-
tively concluded that the IPR intervention did have an "acceler-
ating" influence on growth in counseling. It was also found that
five of the six clients receiving counseling with simulation and
videotape achieved vocational placement within six weeks from
the beginning of their counseling contact, whereas this was true
for only one of the three control subjects.

Exposure to IPR and VRAS resulted in positive growth for
all clients, and there did not appear to be a measurable difference
in movement related to the order of presentation of the techniques.
However, it appeared there may be some advantages to beginning
the treatment program with the VRAS. When VRAS preceeded IPR
there seemed to be a more contigious ”building effect”. The
client seemed to learn the behavior of self-exploration of his
videotaped reactions to simulated confrontation, and was then
able to apply this exploratory behavior to recalling of confron-
tation in the counseling session via IPR.

In summary the pilot study led to three tentative conclusions:

1. VRAS and IPR can be integrated in a counseling inter-
vention treatment program.

2. This program can lead to observable client growth in
counseling.

3. There seems to be a practical rationale for beginning
the intervention program with affect simulation experiences.

52

These conclusions provided initial support for the hypothesis
reported in the following chapters. (A complete description of

the pilot study is included in Appendix B).

Summary

There is a paucity of controlled research in the area of
evaluation of counseling and psychotherapy. The most imposing
problem seems to have been the develOpment of adequate criteria.
There does not seem to be an acceptable or satisfactory system
for comparison of external evaluation criteria, so that positive
results for different therapy situations (in those instances
where they are found) after treatment is concluded cannot be
compared across studies. Internal or process criteria are more
stable and generalizable, but are still in the process of dev-
elopment and have not been used with any consistency to date.
The major obstacles in examining client movement within counseling
have been lack of definition of processes and goals, and the
inability to operationalize such goals as do exist. One poten-
tially valuable approach to this problem has been the develop-
ment of rating scales for those dimensions of client behavior
which seem to be essential to client movement or change. The
scales appear to have reliability and some evidence of validity,
and include the client behaviors of self-exploration, owning of
feelings, committment to change, and differentiation of stimuli.

With these scales providing the framework for examining client

53

progress in counseling, the accelerating effects of a counseling
intervention technique will be examined. The technique derives
from earlier research in Interpersonal Process Recall (IPR) and
affect simulation. Pilot research indicated that such a treat-
ment has potential for accelerating client growth in counseling,

and suggested a format for implementing the treatment.

CHAPTER III
DESIGN AND METHODOLOGY

An experimental research design was formulated which would
permit the testing of the hypotheses posited in Chapter 1, namely,
that: a) clients who receive counseling with IPR intervention
will make more positive movement within counseling than will
clients who receive personal counseling alone, b) clients re-
ceiving IPR treatment will perceive their counselors as more
accessible and easier to talk with than will clients not receiving
IPR treatment, c) clients receiving IPR treatment will develop
a more improved self concept than will clients not receiving IPR
treatment, and d) clients who receive IPR treatment will evaluate
themselves as having made more progress than clients not receiving
IPR treatment and counselor judgements will support these client
evaluations. In order to answer these questions, the design had
to permit comparisons of client interview behavior within exper-
imental groups over time and treatment. A schematic representa-
tion of this design is presented in Table 3.1.

A pre-post design was used as the framework for answering
the main research questions. Because the lcients participating
in this study were individuals presenting varying degrees and
kinds of personal and emotional problems, it was necessary to
have a measure of their initial level of functioning if an assess-
ment of the effectiveness of either type of treatment, counseling
with IPR or counseling alone, was to be made. The initial inter-

view provided a measure of base-line functioning for ascertaining

54

55

TABLE 3.1

Schematic Representation of the Overall

Experimental Design

 

Groups

A

IPR Treatment
Groups (N = 6)

Control Group
(N=6)

Treatments

01 Counseling with IPR
Intervention Techniques
(6 sessions)

D
1

0 Counseling Without IPR
Intervention Techniques
(6 sessions)

Analysis

0 01-0 = D

2 1 1

Analysis Between
Treatment

 

56

the degree of behavior change resulting from each type of coun-
seling experience.

The pre-training measures also served as an additional
check on the power of each of the counseling experiences. It
was necessary to determine if the counseling experience afforded
the group not receiving IPR intervention changed client behavior,
in order to determine the relative effectiveness of the IPR
intervention techniques.

Finally, judges' ratings of each client's initial inter-
view behavior afforded a means of investigating the possible
differential potential for change at varying levels of function-

ing.

Description of the Experimental Procedures

Counseling With IPR

The introductory and first treatment sessions were the
same for both the counseling with IPR group and the traditional
counseling group. The introductory session was necessary in
order to insure that each of the participants was fully ”informed"
as to the research aspects of the treatment, and willing to
engage in the various data gathering activities. The first
session served primarily to provide a pre-measure of each client's
functioning level at the onset of therapy.

As outlined in Table 3.2, the IPR treatment fell into three

distinct yet sequential phases. Phase 1, sessions 2 and 3,

57

combined video-recall and affect simulation filsm (VRAS). In
phase 2, sessions 4 and 5, the client went through a stimulated
recall session of a videotape of his in-counseling interaction
with his therapist (i.e., a traditional IPR session, conducted
by a trained interrogator). In phase 3, the therapist remained

with his client and a mutual recall was conducted.

Phase 1

During sessions 2 and 3, the first 30 minutes was conducted
as a "standard" personal counseling session and audiotaped for
subSequent rating by judges. The next 40 minutes centered
around the use of the simulation films. Not more than five
scenes were shown to a client in any one session and no scene
was longer than two minutes in length. As the client watched
the film, he and the film were videotaped to produce a split-
screen image with the client on one half of the screen and the
film on the other half. After the client had been videocaped
watching the films, the tape was played back and a recall of
client reaction to the films was conducted (VRAS session). The
remaining 20 minutes consisted of personal counseling without
the use of the simulation films; this was audio taped for sub-
sequent rating by judges. During the VRAS session, the counselor
attempted to help the client use the videotaped examples of his
reactive behavior to explore the nature of (and feelings about)

actual and existing interpresonal relationships. The actual

58

TABLE 3.2

Summary of the Experimental Procedures

Counseling With IPR Traditional Counselingu(no IPR)

Introduction Session: Thirty minute initial counseling session bet-
ween each client and the investigator.

a) The initial contact interview provided the opportunity to orient
the participating clients to the special circumstances of the
research project. It was explained that they would be involved
in a study which was designed to help define what went on in
counseling and therapy, from both the client's and the therapist's
point of view. To do this, it would be necessary for the client
to cooperate by: (l) Completing a paper/pencil self-concept
instrument before the first therapy session and after the sixth
session. (2) Fill out a questionnaire after each session des-
cribing their feelings about that particular session. (3) Permit
all sessions to be audio-recorded for subsequent rating by judges
and (4) meet for two hours per session, rather than the customary

one-hour session.

b) In addition, the IPR group was told that their sessions would be
videotaped and that these videotapes and specially developed
films would be used as a part of their treatment during the first

six weeks of their counseling.
Session #1

a) Ninety minute initial counseling a)
session with each client. This
initial interview in the treat-
ment program served as a measure
of each client's interpersonal
functioning level at the beginning
of therapy.

b) Thirty additional minutes allowed b)
for completion of relationships
inventory.

Sessipn #2

a) Thirty minute counseling inter- a)
view with each client.

Ninety minute initial coun-
seling session with each
client. This initial inter-
view in the treatment program
served as a measure of each
client's interpersonal func-
tioning level at the beginning
of therapy.

Thirty additional minutes al-
lowed for completion of rela-
tionships inventory.

Ninety minute intial coun-
seling session with each
client.

59

Counseling With IPR

b)

d)

Forty minute session in which
affect simulation films were
shown to client, videotape of
client reactions was made, tape
was then played back for coun-
selor and client to use in dis-
cussion of client reaction to
these stimuli.

Twenty minutes of counseling

interview were conducted without

use of videotape or film.

Twenty-Thirty minutes allowed for
completion of relationship inven-

tory.

Session #3

a)

b)

c) Twenty minutes of counseling inter-
view were conducted without use of

d) Twenty-Thirty minutes allowed for
completion of relationship inven-

Thirty minute counseling inter-
view with each client.

Forty minute session in which

affect simulation films were shown

to client, videotape of client

reactions was made, tape was then

played back for counselor and
client to use in exploration of
client behavior.

IPR.

tory.

Session #4

a)

b)

Thirty minute counseling inter-
view with each client.

Forty minute client recall of
videotape made of first 30 min-
utes.

Traditional Counseling (no IPR)

b) Thirty additional minutes
allowed for completion of
relationships inventory.

a) Ninety minute initial coun-
seling session with each
client.

6O

Counseling With IPR Traditional Counseling (no IPR)

c) Twenty minute counseling inter-
view conducted without use of IPR.

d) Twenty-thirty minutes allowed for
completion of relationship inven-

tory.

Session #5

a) Thirty minute counseling inter- a) Ninety minute initial coun-
view with each client. seling session with each
client.

b) Forty minute client recall of
videotape made of first 20
minutes.

c) Twenty minute counseling inter-
view conducted without use of
IPR.

d) Twenty-thirty minutes allowed
for completion of relationship

inventory.

Session #6

a) Thirty minute counseling inter- a) Ninety minute initial coun-
view with each client. seling session with each
client.

b) Forty minute client and counselor
(mutual) recall of videotape made
of first 20 minutes.

 

c) TWenty minute counseling inter-
view conducted without IPR.

61

videotaped sample of client behavior never exceeded ten minutes,
since the purpose of VRAS session was to explore the reaction
stimulated in the client by the simulation films, i.e., the
client's videotaped behavior served as the focus for a personal

counseling session.

Phase 2

For the second phase of IPR counseling, sessions 4 and 5,
the first 30 minutes was again conducted as a traditional coun-
seling session. In addition to being audiotaped for subsequent
judge rating, this 30 minutes was videotaped to produce a split
screen image with the client on one half and the counselor on
the other. At the end of the 30 minute interview the counselor
left the room; another counselor (trained in the recall or
"interrogation" technique) entered and conducted a recall of the
videotaped session while the counselor observed the recall process
through a one-way mirror. After a half-hour recall the interro-
gator left and the client was rejoined by his counselor for a
resumption of the counseling process. The last 20 minutes was
audiotaped for subsequent rating by judges. During the recall
(or IPR) session, the interrogator attempted to focus the client
on an exploration of his own behavior in the counseling relation-
ship. Through direct observation of the recall session, the
counselor was able to share the client's awareness of his behavior

and incorporate this information into the develOpment of the

62

counseling relationship.

Phase 3

The final phase of the IPR counseling treatment (session 6)
again began with 30 minutes conducted in a standard counseling
format which was audiotaped for subsequent rating by judges.
This session was also videotaped for playback to the client,
except that this time during the recall session, the counselor
remained in the room. The interrogator then conducted a ”mutual"
recall, where the client and counselor were first encouraged
to share their thoughts and feelings about the counseling inter-
action on videotape (the "then-and-there” of the transpired
session); this then developed into a more direct communication
about their immediate relationship (the "here-and-now" of their
counseling relationship). At some point in this process (but
always within forty minutes) the interrogator, who had become
less and less active in the recall session, left the counselor
and client and they continued the counseling session, the last

twenty minutes of which were audiotaped for subsequent rating.

Traditional Counseling,(Without IPR)

In order to equate client contact time in counseling and
to provide the most intensive "control" counseling experience
for this group, the clients receiving traditional counseling

were seen for Six counseling sessions of 1% hours each. The

63

goals of counseling for this group were the same as those for
the IPR group, i.e., the therapists concentrated on the client/
counselor interaction in an attempt to help the client in self-
exploration leading to greater self-awareness and understanding
of his own dynamics. These counseling procedures were responsive
to each client's needs and as intensive as possible.

A summary of the experimental procedures within the frame-

work of the overall design is presented in Table 3.2.

Physical Environment

 

Counseling sessions for the IPR treatment groups were held

in a specially constructed room equipped with pre-set television
cameras, an unconcealed micrOphone, and a monitor to receive the
replay. The cameras were located behind the wall connecting to
an adjoining room, and were clearly visible through thermOpane
windows . The adjacent (control) room was blackened during
sessions, however, and while the cameras when visible they were
quite unobstrusive. Between the windows for the television
cameras was a one-way mirror through which the therapist could
view the recall of IPR sessions. (See Figure 3.1)

The videotape facility was not located in the counseling
center building, nor was it always available to the traditional
counseling group, so to avoid unforseen environment changes,
control subjects were seen in the research studio in the coun-

seling center. This facility had the advantage of sophisticated

 

 

 

 

 

 

 

 

Figure 3.1 Floor plan of IPR suite. Upper half: counseling
studio with TV monitor for viewing playback. Lower
half: Recording room with videotape recorder (VTR),
special effects generator (for accomplishing split-
screen recording), cameras.aimes through clear thermo-
pane windows - separated by one-way mirror through
which recall session can be observed.

65

audio-recording equipment, and although it did not have tele-
vision cameras, monitors, or a one-way vision mirror, it was
obviously a research or "Special” interview area. As such, the
noverty or "Hawthorne" effect which might have an influence
were clients in the control group to meet in the counselor's
office (as Opposed to the ”Special” nature of the videotape

facility) was minimized.

Samp 1e

Therapists

 

Counseling of all clients in this study was conducted by
two Counseling Center Interns who had completed all requirements
but dissertation for the Ph.D. degree in Counseling Psychology.
While both therapists had received the bulk of their training
in the "traditional form of counseling and therapy, they were
also trained and had experience in the use of IPR procedures in
counseling. These therapists knew the research hypotheses, and
because of the obvious differences in counseling procedures,
knew the experimental group to which clients were assigned. Never-
theless, random assignment to these therapists of clients in both
treatment groups and reliance on their professional attitudes
seemed more advisable than using different counselors for each
treatment. The procedure also provided the advantage of assuring

a common frame of reference within therapists across treatment

66

groups. In this way, equality of therapist skill, background
and training was assured across treatments (neither therapist

was used as a judge for rating outcomes.
9.1.1.2231

The clients participating in this study were students who
were referred to the investigator by counselors on screening
duty at the MSU Counseling Center. When a student initially
requests counseling service from the counseling center, he/she
is seen immediately by a screening counselor, who attempts to
assay the client's needs and determine how the center's services
can be used to the best advantage in meeting the client's needs.
For purposes of this study, screening counselors were informed
of the existence and nature of the research, and were requested
to ask all clients seen in screening interviews over a three-
week period if they would be willing to participate (See Form
for Instruction of Screening Counselors, Appendix C). The only
restrictions posed by the investigator were that clients not
be requested to participate if they were potential suicide or
"cricis" cases, if they had primarily educational/vocational con-
cerns, or if they had been seen in therapy at the center at a
previous date. It happened that the clients making initial con-
tact during this period of time (Spring term, 1969) were pre-
dominantly female. In order to reduce the possibility of either

a treatment or therapist interaction effect with the sex variable,

67

12 clients were selected from the first 13 female screening
referrals, and then randomly assigned to both treatment and
therapist. They were then contacted by the investigator for a
30 minute interview in which the nature of the research project
was described to them, and they were asked if they were willing
to participate.

While the use of a volunteer sample might limit generaliz-
ability of results, it should be noted that only one of the
subjects asked if they were interested in participating in the
research declined to do so; when this individual was assigned to
a counselor through regular screening channels she failed to
keep scheduled appointments and was eventually terminated with
no further contact. It thus seems that in this study, the fact
that subjects had agreed to participate in no way differentiated
them from the other clients requesting and following through on
counseling services at that particular time.

The IPR counseling group and traditional counseling group
were compared on variables which might have influenced the out-
come of counseling, namely: 1) age, 2) grade point average (G.P.A.),
and 3) class standing. Summaries of this data are presented in

Table 3.3.

Instrumentation

 

Five measures were used as criteria in this study: 1) The

Characteristics of Client Growth Scales (COGS, Kagan, Krathwohl,

68

et. a1., 1967; Schauble and Pierce, 1969), 2) The Degree of Self~

Exploration Scales (D.X. Truax and Carkhuff, 1966; Carkhuff and

Berenson, 1967), 3) The Wisconsin Relationship Orientation Scale

(WROS, Steph, 1963), 4) The Therapy Session Report (Orlinsky

and Howard, 1966, and 5) The Tennessee Self-Concept Scale (Fitts,

1965).

TABLE 3.3

Comparison of Treatment Groups According To Mean
Age, Mean G.P.A., and Class Standing

 

MEAN
AGE

MEAN
GPA

MEAN
CLASS
STANDING

IPR Counseling Group

20 years, 6 months

2.74

10 terms*

Traditional Counseling
Group

20 years, 3 months

2.97

13 terms

 

*Term refers to one quarter of academic year.

The Characteristics of Client Growth Scales

The COGS consists of three separate scales which character-

69

. . . . . . 1 .
ize productive client behaVIOr in counseling. The client owns

his own feelings. Some clients in therapy are aware of their

 

inapprOpriate behaviors and discomfort, but others have only
vague feelings - not tied to specific problems or interactions
yet pervading much of their outlook on life. Progress in therapy
occurs when the client admits and "owns” his feelings as coming
from himself. The second characteristic is the client commits
himself to change. The client decides he wants to change, and

is willing to deal with his problems and face the consequences

of changing as evidenced by increased COOperation with his thera-
pist. The third characteristic is the client differentiates
stimuli. Clients who progress in counseling typically learn to
perceive more of the stimuli in their environment and to react to
these stimuli as discrete rather than stereotyped factors. They
are then better able to identify and differentiate their emotions
and reactions to these stimuli.

Each of these characteristics of client growth is operation-
alized into a five-point continuous scale with 1.0 the lowest
possible rating and 5.0 the highest rating. A rating of 3.0 is
defined as the minimal level at which constructive change can

take place.

 

1
See Appendix D.

70

At level 1 of the owning of feelings scale the client seems
to avoid accepting any feelings. He may remain Silent or deny
he feels anything. In sum, he seems to believe he is not part
of the world of feelings. At level 2 he may express feelings
but does so in a vague manner and they seem intellectualized
and distant. At level 3 the client identifies his feelings and
can usually tie them to their source but he does this in an
intellectual manner. At level 4 the client almost always acknow-
ledges his feelings and expresses them with emotional proximity
but at times has difficulty in connecting the feelings to their
source. At level 5 the client clearly expresses his feelings
with emotional proximity and at the same time demonstrates aware-
ness that they are tied to specific behavior of his own and others.
At level 1 of the committment to change scale the client
shows no motivation for change, and is resistive to the counselor's
attempts to accomplish change. This may take the form of complete
passivity or defensive hostile behavior. At level 2 the client
may express the desire to change but his committment is noticeably
questionable. He may be somewhat passive, evasive or seem more
interested in rationalizing his behavior than in changing it.
At level 3 the client vacillates between an overt desire to change
and the desire to resist change. He may deal with feelings which
are centrally involved with his problem but has some tendency to
rationalize or move from topic to topic. In sum, he varies in

his maintainence of motivation to change. At level 4, the client

71

expresses a desire to change, and while he may be reluctant at
times to experience painful feelings almost always actively cooper-
ates with the change process. At level 5 the first person actively
c00perates in the counseling process and continually engages in
confronting his problems and feelings directly.

At level 1 of the differentiation of stimuli scale the
first person seems unable to differentiate his problems, feelings,
or concerns and is unwilling or unable to move in this direction.
He tends to lump broad groups of differentiable stimuli into
stereotyped categories, e.g., all_adults, all young girls, 311_
bosses, etc. At level 2 the first person may talk about different
feelings and problems but he does so in an intellectualized manner
as if he had little grasp of any real differences among them and
their effect on him as an individual. At level 3 the first per-
son vacillates between discussing different stimuli and their
effect on him as a unique person, responding in a general, unclear
fashion. In other words he may start out making clear differen-
tiations but is unable to persist for very long, and often lapses
back into hazy generalizations. At level 4 the first person is
almost always aware of the differences between stimuli in his
world and he reSponds to them in a differential manner. He actively
attempts to become more aware of his various emotions and their
sources. At level 5 the first person seems always to perceive

the different stimuli in his world and reacts to them in a variety

of differential ways. He shows immediate awareness of his own

72

unique characteristics and the reactions he stimulates in others.

The Depth of Client Self Exploration
Scale (DX)

The importance of client self exploratory behavior was dis-
cussed in Chapter II. The DX Scale in its most recent form con-
sists of five levels, where a rating of one is the lowest possible
score and a rating of five the highest score. The scale incor-
porates several dimensions of client behavior including intra-
personal probing of matters of personal relevance, accompanied
by the immediate (or Spontaneous) expression of feelings.

At level 1 the client's behavior provides no evidence of
self exploration. At level 2 the client may respond to the intro-
duction of personally relevant material by the counselor, but does
so in a remote and mechanical manner. At level 3 the client may
introduce personally relevant material but does so without any

.
spontaneity or inward probing to discover new feelings and exper-
iences. At level 4 the client introduces personally relevant
discussions with spontaneity and emotional proximity, but without
a distinct tendency toward inward probing to newly discover feelings
and experiences. At level 5 the client is fully and actively
focusing upon himself and exploring himself and his world (The

complete DX Scale is included in Appendix E).

The Wisconsin Relationship Orientation Scale

The client's perception of the counselor is generally considered

73

a critical component of successful counseling. The Wisconsin
Relationship Orientation Scale (WROS; Steph, 1963) has been used
to determine the nature of the relationship existing between
counselor and client, as perceived by the latter. The client
indicates on a five-point scale how he feels about the counselor,
ranging from total avoidance to feeling free to discuss almost
anything with the counselor. Goldberg (1967) found that the
clients of counselors receiving IPR supervision rated their coun-
Selors as being easier to talk with than did clients in the trad-
itional supervision group, and Resnikoff (1968) notes significant
differences on the WROS between counselors rated high and low on
a counselor behavior scale. Ratings of counselors on the WROS

by clients in experimental and control groups will be compared

(The WROS is included in Appendix F).
The Therapy Session Report (BP)

An often neglected source of information in examining coun-
seling or psychotherapy outcomes has been feedback from the parti-
cipants in the therapy experience: How do clients and counselors
feel during their sessions? What are Ehgir.goals in counseling?
How do they evaluate the counseling process?

The Psychotherapy Session Project (Orlinsky and Howard, 1968)
devised two parallel questionnaires, one for patients and one for
therapists, to survey various aspects of the therapy experience.

The questionnaires are completed independently by each patient

74

and therapist, and consist of simple descriptions and evaluations
covering various dimensions of experience. These behavior reports
have resulted in a useful structure with which to examine the
therapy relationship. Modifications of these instruments were
used in this study in an attempt to evaluate the influence of

IPR treatment as seen by the counselor and client, on a session-
to-session basis. The 12 client and therapist perceptions and
feelings about the completed session: client motivation, progress
made, therapist attitudes and behavior, and anticipation of sub-
sequent sessions (See Appendix G for c0pies of items selected

from TSR).

The Tennessee Self Concept Scale

The notion of the "self-concept" has become a pOpular
reference for studying and understanding human behavior. People
who see themselves as being undesirable, inadequate, or inferior
often act accordingly; and those whose concept of self is unreal-
istic tend to deal with life in unrealistic ways. Thus a know-
ledge of how an individual perceives himself Should be useful in
evaluating or helping that individual. Accordingly, a positive
change in self-concept should be an index of movement in adjustment.
Fitts (1965) has develOped the Tennessee Self Concept Scale (TSCS),
which has been used for a variety of purposes - counseling, clin-
ical assessment, research in behavioral science, etc. The Scale

consists of 100 self-descriptive statements which the subject

75

uses to portray his own picture of himself. Test-retest re-
liability coefficients of all major scores range from .60 to
.92. The test has been shown to differentiate between and with-
in various diagnostic groups, and seems to correlate well with
such instruments as the Minnesota Multiphasic Personality Inven-
tory (MMPI).

Since the sample used in this population was small, a quan-
titative analysis was not feasible. Instead, a descriptive com-
parison of treatment and control group on the sub-scales of the
TSCS was performed.

Reliabiliry of Rating Scales:
Thg_§haracteristics of Client Growth Scales (COGS)

The COGS have been used in earlier research to measure
client change both within and between counseling sessions. When
the immediate effect of treatment on client behavior was to be
evaluated, the COGS was used to rate two segments of the same
interview. In one study (Kagan, Krathwohl, et. a1., 1967) each
client met with his counselor for one half-hour. This session
was immediately followed by one half-hour of one of the experimental
treatments, and the client then met with his counselor for a
final half-hour session. The half-hour counseling sessions were
videotaped and presented in pairs (lst half-hour and 2nd half-
hour with no indication of interviewing treatment) randomly to

judges. The judges watched the last 20 minutes of each of the

76

videotaped counseling session pairs, and rated differences in
client behavior on the COGS - using the first half-hour tape

as the "before" of client functioning. Each of the COGS was
rated on a four point differential (much, some, little, none).
Two groups of five judges were used in this study in order to
provide replication for determining the reliability of the COGS.
Reliability measures were obtained through use of Ebel's intra-

class correlation, as reported in Table 3.4.

TABLE 3.4

Reliability Of Client Movement Scales
By Two Groups Of Judges

 

 

Client Growth Scale Raters Raters
Group I Group II
(N=5) (N=5)
The client owns discomfort .87 .88
The client commits himself to change .82 .90
The client differentiates stimuli .83 .93

 

When it was desirable to examine change in client behavior
over a period of time and/or treatment, a similar approach was
used. In the pilot study (See Appendix B), video tapes of the
lst and 6th sessions (in between which experimental procedures
in counseling were being compared) were presented for rating to

three independent judges. The rating scales had been modified

77

for this study so that each of the COGS was rated over nine
points ranging from very markedly lessened to very markedly
improved. Interjudge reliability for the COGS as determined

by the Spearman-Brown is presented in Table 3.5. The COGS

scales had been expanded in this study, since the original four-
point scale did not permit scoring of the lessening of a behavior
dimension, i.e., negative movement. The revision of the scale
did appear to provide a more satisfactory measurement of client

behavior, but at the price of reduced interjudge reliability.

TABLE 3.5

Interjudge Reliability Of Client Movement Scales
On Pilot Study Data

 

 

Client Growth Scale Judges
(N=3)
Owning discomfort .75
Committment to change .69
Differentiation of stimuli .69

 

For purposes of the present study, the COGS were revised
again. The two principle goals of the revision were (1) To
provide a more clearly defined scale for each behavior dimension -
which would allow for more efficient and consistent evaluations
of client behavior across judges; (2) To provide a scale measuring

current functioning level for each client, rather than a change

78

score. Obviously, the importance (if not the degree) of client
behavior change from one point to another in therapy will

depend to some degree on his original level of functioning, i.e.,
the base-level of client coping behavior must be considered if
change in that behavior is to have relevance. The present form
of the COGS (as described earlier in this chapter) appears to
combine the previous scales' value as a change measure with the

quality of determining base levels of in-therapy behavior.

Rating Of Tapes

Two independent and experienced Ph.D. therapists served as
judges for this study. Both judges were experienced in the use
of counselor-behavior scales, and their ratings were known to
correlate well with one another. In addition, both judges had
themselves been rated as functioning at high levels (above 3.0)
of facilitative counselor behavior. Training sessions were
conducted with both judges and the investigator, and consisted
of 3 hours (approximately one hour for each of the COGS) of
listening to a variety of therapy tapes borrowed from the coun-
seling center research library. During the training sessions,
the tapes were stopped at various points and the ratings of the
judges were compared and discussed. By the end of the three
hour training session, there appeared to be good agreement among
the judges. Judges were not aware of the differences in exper-

imental procedure between groups, nor were they aware of group

79

assignment.

The tape ratings used in the present study were obtained in
the following manner: Each of the six sessions for the twelve
clients (in both groups) was audio recorded. From each of the
72 tapes obtained, four five-minute excerpts were presented to
the judges for rating. The excerpts were taken from the first
and last 20 minutes of each session - in order that the tapes
for the two groups could be compared on client behavior in
counseling when the IPR techniques were not being used. Each 20
minute segment was broken down into four five-minute units. The
second (6-10 minutes) and fourth (16-20) units were selected
for purpose of rating. Thus two excerpts for rating were obtained
from the beginning, and two from the end of each session. The
four excerpts for each session were then presented to the judges,
who were unaware of which clients were receiving IPR treatment,
or of which of the client's six sessions they were rating.

In order to obtain the interjudge reliability for this inves-
tigation, Ebel's intraclass correlation technique was used. This
technique offers the reliability of each judge's rating as well
as the average ratings for judges across tapes and individual
segments.

Since the average of the four ratings for each tape was used
as the unit of analysis for evaluating client-movement, the across-
tape (interview) reliability rather than the reliability of

individual segments was calculated. The reliability sample con-

80

sisted of the ratings of the 12 initial interview (pre-test)

tapes for the 12 clients in this study is presented in Table 3.10.

TABLE 3.6

Intraclass Correlation Reliabilities Of Average
Ratings Calculated For Judge's Ratings Of Clients Across
Tapes On Each Dimension Of The COGS and DX

 

Intraclass Correlation Dimension

 

 

Tapes N Owning Committment Differention Degree of
Discomfort To Change Of Stimuli Self
Exploration
Averaged
Ratings,
Pre-Tapes 12 .94 .93 .91 .88

 

The Depth Of Self Exploration Scale

The Q§_Scale has been found to have interjudge reliability
ranging from .59 to .91 (Truax and Carkhuff, 1967). The training
of raters on the 2; Scale and the rating procedure were identical
to the procedures followed for the COGS scales. The interjudge
reliability for Q§_in this study is also contained in Table 3.10.
The reliabilities reported in Table 3.10 range from .88 to .94,
indicating that the ratings are sufficiently reliable for further

analysis.

81

Analysis of Data

 

The following statistical analyses were performed on the

data obtained in this study:

1.

Client Growth Variables

Ratings on the QQQSDand Q§_were gathered on each session
for all clients. In order to test differences in change
scores within groups a Q_test of change score differences
for the same group was used. A 2 X 2 analysis of var-
iance (with equal frequency in each cell) of change
scores (pre to post sessions) on each scale was used to
test differences between groups. Patterns of movement
on each of the QQ§§_and Q§_scales were traced chronolog-
ically through the course of therapy by graphically re-
presenting ratings of each session.

The WROS and TSR

The same analysis procedure was followed for these vari-
ables as was followed for analysis 1 above. The analysis
of variance with equal frequency in each cell statistic
is the most powerful parametric test (Siegel, 1956),

and was appropriate for this study since there was no
evidence to indicate that the assumptions associated
with the statistical model had been violated. Since

the hypotheses related to analyses #1 and #2 are direc-
tional, a one-tailed test of significance at the .05

level was used in all cases.

The
research

1113

82

Tennessee Self Concept Scale
A descriptive analysis of within group change scores on

various subscales was attempted.

Hypotheses

specific hypotheses of this study are presented in
form.
The treatment receiving personal counseling with IPR

intervention will make more movement within counseling
than will a control group that receives personal coun~
seling alone.

Clients receiving IPR treatment in counseling will be
more satisfied with the counseling relationship and
process than will clients not receiving IPR treatment.
Clients receiving IPR treatment will see their counselors
as more accessible and easier to talk with than will
clients not receiving IPR treatment.

Clients receiving IPR treatment will develop a more
improved concept of themselves than will clients not

receiving IPR treatment.

M

Twelve female clients were randomly assigned to two treat-

ments:

1) counseling using IPR intervention techniques and 2)

traditional personal-social counseling. A randomized block

83

design incorporating change scores pre to post treatment was
used to measure the differences in change within and between
groups on: 1) Four dimensions of client growth in counseling
(Characteristics of Client Growth Scales, or g9§§_and Depth of
Self Exploration, or 2;), 2) The Wisconsin Relationship Orienta-
tion Scale, 3) The Therapy Sessions Report and 4) The Tennessee
Self Concept Scale (TSCS). Ratings on the client-growth scales
were made by two independent professional judges trained in the
use of the scales. Each client completed the TSR and WROS and
each therapist completed the TSR, after each session.

Interjudge reliability on the client movement scales was
found to range between .88 and .94, warranting their use as
reliable criteria instruments. Analyses were made of the mean
change score differences pre to post treatment for both groups
on all criteria. In addition, patterns of client behavior were
descriptively analyzed session by session on the client movement

dimensions and the TSR.

CHAPTER IV

ANALYSIS OF THE DATA

In Chapter IV, an analysis of the data is presented based

upon the methodology and statistical treatment outlined in

Chapter III.

Professional judges rated four five-minute excerpts

from each counseling session using the Characteristics of Client

Growth Scale (COGS) and the Degree of Self-Exploration Scale

(DX).

Each client and counselor completed the Therapy Session

Report (TSR) after each session, and clients completed the Wis-

consin Relationship Orientation Scale (WROS) after each session

in addition to taking the Tennessee Self-Concept Scale (TSCS)

before and after the treatment period. Results of the analysis

of this data are reported in the following sequence:

1.

(a)

(b)

(a)

2 tests of pre-treatment to post-treatment change
in ratings on each dimension of the COGS and DH

are compared for both the Counseling-With-IPR groups
and the Traditionally-Counseled groups to determine
the within group effect of each treatment on ob-
servable behavior change.

An analysis of variance of change score differences
between groups is presented for each of the COGS
and DX dimensions to determine change differences
between the two treatments.

Pre-treatment to post-treatment change scores on
the WROS and the TSR are compared for both treat-

ment groups to determine the within group effect

84

(b)

(b)

85

of each treatment on counselor and client per-
ceptions of treatment.

An analysis of variance of change score differences
between groups on the WROS and TSR is presented
to compare differences in change of counselor and
client perceptions of treatment.

Graphical representations of ratings of client
movement on the COGS and DX by time (from session
to session) are presented to indicate differences
in patterns of change between the two groups.

A descriptive analysis of pre-treatment to post-

treatment change scores on the TSCS is presented.

Pre-Treatment To Post-Treatment Differences In
Client Movement Within and Between Groups

The null hypotheses tested for the four dimensions of client

movement were:

Ho 1:

Ho 2:

There is no difference in ratings of client Owning
of Feelings for the Counseling-With-IPR group
between the pre-treatment and the post-treatment
measures.

There is no difference in ratings of client Owning
of Feelings for the Traditional-Counseling group
between the pre-treatment and post-treatment mea-

sures o

Ho

Ho

Ho

Ho

Ho

Ho

Ho

86

There is no difference in pre- to post-treatment
change in client Owning of Feelings between the
Counseling-With-IPR group and the Traditional-
Counseling group.

There is no difference in ratings of client Committ-
ment to Change for the Counseling-With-IPR group
between the pre-treatment and the post-treatment
measures.

There is no difference in ratings of client Committ-
ment to Change for the Traditional-Counseling group
between the pre-treatment and post-treatment measures.
There is no difference in pre- to post-treatment
change in client Committment to Change between

the Counseling-With-IPR group and the Traditional-
Counseling group.

There is no difference in ratings of client Differ-
entiation of Stimuli for the Counseling-With-IPR
group between the pre-treatment and the post-treat-
ment measures.

There is no differences in ratings of client Differ-
entiation of Stimuli for the Traditional-Counseling
group between the pre-treatment and post-treatment
measures.

There is no difference in pre- to post-treatment

change in client Differentiation of Stimuli between

87

the Counseling-With-IPR group and the Traditional-
Counseling group.

Ho 10: There is no difference in ratings of client Degree
of Self-Exploration for the Counseling-With-IPR
group between the pre-treatment and post-treatment
measures.

Ho 11: There is no difference in ratings of client Degree
of Self-Exploration for the Traditional-Counseling
group between the pre-treatment and post-treatment
measures.

Ho 12: There is no difference in pre- to post-treatment
change in client Degree of Self-Exploration between
the Counseling-With-IPR group and the Traditional-
Counseling group.

A Q_test for change scores on the same sample was computed
for each of the above hypotheses testing differences in means
pre to post for both the Counseling-With-IPR group and the Trad-
itional-Counseling group. In order to test differences in change
scores between groups, a 2 X 2 analysis of variance with equal
frequency in each cell was used. The results of these analyses
are presented in Tables 4.1 through 4.4.

A Q_value of 2.01 for a one-tailed test of significance
with 5 degrees of freedom in necessary before chance differences
within treatment groups can be rejected at the .05 level of con-

fidence. Inspection of Tables 4.1a, 4.2a, 4.3a and 4.4a indicate

88

TABLE 4.1 A

Q_Tests Of Pre To Post Treatment Differences In

Client Owning Of Feelings (OF) Between The
Counseling-With-IPR Group And The

Traditional Counseling Group

 

 

 

 

 

 

Pre Post Mean
Var iab 1e N Mean Mean Change 0" '5
CounS- 3 IPR 6 2.28 3.21 0.94 1.13 2.049:
Trad. Couns. 6 2.54 2.31 -O.22 0.64 -O.85
Therapist l 6 2.45 2.46 0.01 0.85 .03
Therapist 2 6 2.36 3.06 0.70 0.98 1.75
* Significant at .05 level

TABLE 4.1 B

Analysis Of Variance Of Change Score Differences
In Client QE_Between Groups

Source of Variance Sum of Squares df Mean Square F
Treatment 4.10 l 4.10 10.60*
Therapist 1.45 l 1.45 3.75
Interaction 0.03 1 0.03 0.08
Error 3.09 8 0.39
Totals 8.665 11
*Significant at .05 level

Q Tests Of Pre To Post Treatment Differences

TABLE 4.2 A

In Client Committment To Change (CCH)

Between The Counseling-With-IPR Group And

The Traditional Counseling Group

 

 

 

 

 

Pre Post Mean __
Variable N Mean Mean Change 4V pp
Couns. E IPR 6 2.01 3.15 1.14 1.21 2.33*
Trad. Couns. 6 2.23 2.19 -0.04 0.38 -0.25
Therapist l 6 2.18 2.53 0.35 0.82 1.06
Therapist 2 6 2.06 2.80 0.74 0.97 1.85
*Significant at .05 level

TABLE 4.2 B

Analysis Of Variance Of Change Score Differences
In QQ§_Between Groups

Source of Variance Sum of Square df Mean Square
Treatment 4.18 1 4.18 22.06*
Therapist 0.45 1 0.45 2.37
Interaction 0.01 l 0.01 0.05
Error 1.52 8 0.19
Totals 6.149 11

 

1':
Significant at .05 level

90

TABLE 4.3 A

Q Tests Of Pre To Post Treatment Differences In
Client Differentiation Of Stimuli (ES) Between The
Counseling-With-IPR Group And The
Traditional Counseling Group

 

 

Pre Post __
Variable N Mean Mean Change cr' D
Couns. E IPR 6 2.05 3.38 1.33 0.45 7.39*
Trad. Couns. 6 2.40 2.34 -0.06 -0.29 -0.50
Therapist 1 6 2.25 2.61 0.35 0.76 1.13
Therapist 2 6 2.20 3.12 0.92 1.25 1.80

 

*
Significant at .05 level

TABLE 4.3 B

ANOVA Of Change Score Differences In
DS Between Groups

 

Source of Variance Sum of Squares df Mean Square F

Treatment 5.81 l 5.81 40.97**
Therapist 0.95 l 0.95 6.67*
Interaction 0.21 l 0.21

Error 1.13 8 0.14

Totals 8.10 11

 

*1:
Significant at .05 level

*
Significant at .0005 level

91

TABLE 4.4 A

Q.Tests Of Pre To Post Treatment Differences In
Client Depth Of Self-Exploration (DH) Between
The Counseling-With-IPR Group And The
Traditional Counseling Group

 

 

 

 

 

Pre Post Mean
Var Lab 1e N Mean Mean Change 0' 1T
Couns. E'IPR 6 2.05 3.11 1.06 1.28 2.04*
Trad. Couns. 6 2.21 2.27 0.06 0.45 -0.33
Therapist l 6 2.23 2.43 0.20 0.56 0.87
Therapist 2 6 2.03 2.95 0.82 1.21 1.67
*

Significant at .05 level
TABLE 4.4 B
Analysis Of Variance Of Change Score Differences
In 2! Between Groups

Source of Variance Sum of Squares df Mean Square F
Treatment 3.56 1 3.56 12.35**
Therapist 1.17 l 1.17 4.04
Interaction 0.60 1 0.60 2.07
Error 2.31 8 0.29
Totals 7.64 11

 

**Significant at .008 level

92

Q values greater than 2.01 on each dimension of client movement
for the Counseling-With-IPR group. Thus the null hypotheses l,
4, 7, and 10 were rejected. No Q values have 2.02 were found
for the Traditional-Counseling group for any of the client move-
ment dimensions. Thus we fail to reject hypotheses 2, 5, 8,

and 11.

An E_value of 4.84 for a one-tailed test of significance
with 11 degrees of freedom is necessary before chance differ-
ences of mean change between treatment groups can be rejected
at the .05 level of confidence. The E_statistic reported in
Tables 4.1b, 4.2b, 4.3b, and 4.4b indicate significant differ-
ences exist between the Counseling-With-IPR group and the Trad-
itional-Counseling group on each of the client growth dimen-
sions. Null hypotheses 3, 6, 9, and 12 are thus rejected, since
the Counseling-With-IPR treatment was effective in bringing
about significantly greater positive client growth than was the
Traditional-Counseling treatment.

While there is no evidence of any treatment-therapist inter-
action, in Table 4.3b, the E_statistic for change differences
by therapist was found to be significant. The importance of
therapist functioning level on client movement was discussed
in earlier chapters. An assumption made in this study was that
both therapists were functioning at high, and approximately the
same, level of functioning in terms of providing "facilitative

conditions" for client growth. In order to determine if the

client behavior changes observed were influenced by differences
in therapist functioning level, the four tape segments from the
fourth therapy interview which had been rated previously for
client movement were submitted to the same independent judges,

who then rated therapist functioning on scales of facilitative

93

Empathy, Regard, Genuineness, and Concreteness.

reliability of these scales is reported in Truax and Carkhuff
(1967) and Carkhuff and Berenson (1967).

the Pearson r_for inter-rater correlation are presented in

Table 4.5.

Mean Levels Of Functioning Of Therapists On
Facilitative Conditions By Counseling-With IPR

TABLE 4.5

These ratings and

And Traditional-Counseling

Validity and

 

Treatment

Facilitative Conditions

 

Z

Empathy Regard Genuiness Concreteness

 

Therapist
#1

Therapist
#2

Interjudge
Reliability
(Pearson p)

IPR Counseling 3

Traditional
Counseling 3

IPR Counseling 3
Traditional
Counseling 3

12

3.08

3.03

3.41

3.40

.92

2.95

2.91

3.29

3.53

.89

2.94

2.97

3.31

3.39

.92

2.83

2.79

3.44

3.31

.93

 

94

Inspection of these ratings indicates that therapist #1
was functioning consistently at (or slightly below) level 3.0,
which is considered the minimum level of functioning for facil-
itating growth (Carkhuff and Berenson, 1967). Therapist #2 con-
sistently was functioning at well above the minimal 3.00 level.
In each case there were negligible differences in therapist func-
tioning level between treatments. The results thus indicated
there was a difference in functioning level between therapist
#1 and therapist #2, yet this difference was only indicated as
a significant factor in client movement by therapist (in both
treatments) on one dimension of the COGS -- Differentiation of
Stimuli. Because of the very small p for each treatment group
(3 pg) by therapist, no statistical procedure seemed appropriate
for further examination of possible therapist influence. How-
ever, inspection of pre to post differences for positive, nega-
tive, or no client movement (Table 4.6) provides additional
information on changed client behavior by therapist and treat-
ment group. All clients receiving Counseling-With-IPR made
positive progress on the client movement dimensions. Only one
of the three clients receiving Traditional-Counseling with thera-
pist #1 made positive movement. The remaining two clients were
rated as moving in a negative direction on the dimensions. Two
clients receiving Traditional-Counseling from therapist #2 made
positive movement, while the remaining client was seen as not

moving positively or negatively.

95

TABLE 4.6

Direction Of Pre To Post Treatment Behavior Change On
The Dimensions Of Client Movement By Therapist And
Treatment Group

 

 

Committment Differentiation Depth
Owning To Of Self-
Feelings Change Stimuli Exploration
Pos Neg None Pos Nengone Pos Neg None Pos Nengone
Therapist IPR 3 3 3 3
#1 Coun
(N=3)
Trad l 2 l 2 l 2 l 2
Coun
(N=3)
Therapist IPR 3 3 3 3
#2 Coun
(N=3)
Trad 3 2 l 2 l 2 l
Coun
(N=3)

 

Ere-Treatment to Post-Treatment Differences In
Client And Therapist Perceptions Within
and Between Groups

The null hypotheses tested for client and therapist perception

were:

Ho 13: There is no difference in pre- to post-treatment

change in scores on the WROS for clients who

receive Counseling-With-IPR.

Ho 14:

Ho 15:

96

There is no difference in pre- to post-treatment
change in scores on the WROS for clients who
receive Traditional-Counseling.

There is no difference in pre- to post-treatment
change in scores on the WROS between the Coun-
seling-With-IPR group and the Traditional-Coun-

seling group.

Twelve different items from the TSR were chosen to measure

client and therapist change in perception of the treatment pro-

cess. Since this would amount to 36 additional hypotheses if

stated individually, in the interest of Sparing the reader, one

hypothesis is stated for within group change for each treatment

group, and one is stated for between group change in therapy

perceptions.
individually.

Ho 16:

Ho 17:

Ho 18:

Each of the perceptions measured is then listed

There is no difference in pre- to post-treatment
change scores on the dimensions of client and coun-
selor perception of treatment within the Counseling-
With-IPR group.

There is no difference in pre- to post-treatment
change scores on the dimensions of client and
counselor perception of treatment within the Trad-

itional-Counseling group.

There is no difference in pre- to post-treatment

change in perception of treatment between the

Counseling-With IPR group and Traditional-Counseling

97

group.

The dimensions of client perception of treatment measured

WBIB:

6.

Client's feelings about the session just completed.
Client's feelings about coming to the session.
Client's feelings about the progress made in the session.

Client's feelings about how he is currently coping ("get-
ting along").

Client's perception of therapist understanding.
Client's perception of therapist helpfulness.

dimensions of therapist perception of treatment measured

Therapist's feelings about session completed.
Therapist's perception of client motivation.
Therapist's perception of progress made.

Therapist's perception of client's coping behavior (”get-
ting along").

Therapist's anticipation of ("looking forward to") the
session just completed.

Therapist's perception of his understanding of client
feelings.

A Q_test for change scores on the same sample was computed

for each of the above hypotheses testing differences in means

pre to post for both the Counseling-With-IPR group and the Trad-

itional-Counseling group. In order to test differences in change

scores between groups, a 2 X 2 analysis of variance with equal

frequency in each cell was used. The results of these analyses

are presented in Tables 4.7 through 4.20.

98

Q_Tests Of Pre To Post Treatment Differences In The
Wisconsin Relationship Orientation Scale (WROS)

Between The Counseling-With-IPR Group And The

Traditional Counseling Group

 

 

 

 

 

 

 

Pre Post Mean __
Variable N Mean Mean Change 0' D
Couns. E IPR 6 3.17 4.50 1.33 1.73 1.87
Trad. Couns. 6 3.17 3.17 0.00 0.57 0.00
Therapist l 6 3.33 4.00 0.67 1.29 1.26
Therapist 2 6 3.00 3.67 0.67 1.29 1.26
TABLE 4.7 B
ANOVA Of Change Score Differences In
W39§_Between Groups
Spp;gg_of Variance Sum of Squares df Mean Square F
Treatment 5.33 1 5.33 5.33*
Therapist 0.00 1 0.00 0.00
Interaction 1.33 l 1.33 1.33
Error 8.00 8 1.00
Totals 14.67 11
*Significant at .05 level

99

TABLE 4.8 A

Q_Tests Of Pre To Post Treatment Differences In

Client Feelings About Session Completed
Between The Counseling-With-IPR Group And The

Traditional Counseling Group

 

 

 

Pre Post Mean ‘_
Variable N Mean Mean Change 0’ D
Couns E IPR 6 5.00 5.50 0.50 1.22 1.00
Trad. Couns. 6 4.83 4.67 -0.17 .71 -0.58
Therapist l 6 5.17 5.67 0.50 .91 1.35
Therapist 2 6 4.67 4.50 -0.17 1.08 -0.39
TABLE 4.8 B

Analysis Of Variance Of Change Score Differences In Client
Feelings About Session Completed Between The Counseling-
With-IPR Group And The Traditional Counseling Group

 

 

Source of Variance Sum of Squares df Mean Square F
Treatment 1.33 1 1.33 1.23
Therapist 1.33 l 1.33 1.23
Interaction .33 1 .33 0.30
Error 8.67 8 1.08

Totals 11.67 11

 

100

TABLE 4.9 A

Q_Tests Of Pre To Post Treatment Differences In
Client Feelings About Coming To The Treatment Sessions

Between The Counseling-With-IPR Group And The

Traditional Counseling Group

 

 

 

 

 

 

Pre Post Mean _.

Variable N Mean Mean Change 0' D
Couns. E'IPR 6 2.17 4.50 2.33 2.71 2.10*
Therapist l 6 2.67 4.50 1.83 2.67 1.67
Therapist 2 6 3.33 .3.83 0.50 1.08 1.14
*

Significant at .05 level

TABLE 4.9 B
Q,Tests Of Pre To Post Treatment Differences In
Client Feelings About Coming To The Treatment Sessions
Between The Counseling-With-IPR Group And The
Traditional Counseling Group

Source of Variance Sum of Squares df Mean Square
Treatment 16.33 1 16.33 12.25**
Therapist 5.33 l 5.33 4.00
Interaction 1.33 1 1.00
Error 10.67 8 1.33
Totals 33.67 11
**

Significant at .008 level

101

TABLE 4.10 A

Q_Tests Of Pre To Post Treatment Differences In
Client Feelings About Progress Made In Session Between
The Counseling-With-IPR Group And The Traditional

Counseling Group

 

 

 

 

 

Pre Post Mean __
Variable N Mean Mean Change 0" D
Couns. 'c' IPR 6 3.00 4.67 1.67 1.91 2.142:
Trad. Couns. 6 4.00 4.17 0.17 1.08 0.38
Therapist 1 6 3.83 5.00 1.17 1.78 1.60
Therapist 2 6 3.17 3.83 0.67 1.29 1.26
*Significant at .05 level

TABLE 4.10 B

ANOVA Of Change Score Differences In Client

Feelings About Progress Made In Session Between Groups
Source of Variance Sum of Squares df Mean Square F
Treatment 6.75 l 6.75 5.79*
Therapist 0.75 l 0.75 0.64
Interaction 2.08 l 2.08 1.79
Error 9.33 8 1.17
Totals 18.92 11

 

*Significant at .05 level

102

TABLE 4.11 A

Q_Tests Of Pre To Post Treatment Differences In
Client Feelings-About-Coping-Behavior Between The

Counseling-With-IPR Group And The Traditional
Counseling Group

 

 

 

 

 

Pre Post Mean ._
Variable N Mean Mean Change (r’ D
Couns. E'IPR 6 3.67 4.17 0.50 0.71 1.72
Trad. Couns. 6 3.50 4.33 0.83 1.35 1.51
Therapist l 6 3.67 4.33 0.83 1.35 1.51
Therapist 2 6 3.50 4.17 0.50 0.71 1.72
TABLE 4.11 B
ANOVA Of Change Score Differences In Client
Feelings-About-Coping-Behavior Between Groups.
Source of Variance Sum of Squares df Mean Square F
Treatment 0.33 1 0.33 0.33
Therapist 0.33 l 0.33 0.33
Interaction 0.00 1 0.00 0.00
Error 8.00 8 1.00
Totals 8.67 11

 

103

TABLE 4.12 A

Q_Tests Of Pre To Post Treatment Differences In Client
Perception-Of-Therapist-Understanding Between The

Counseling-With-IPR Group And The Traditional
Counseling Group

 

 

 

 

 

Pre Post Mean ._
Variable N Mean Mean Change 9' D
Couns. E'IPR 6 3.83 3.83 0.00 0.57 0.00
Trad. Couns. 6 3.67 4.00 0.33 0.82 0.52
Therapist l 6 4.00 4.00 0.00 0.57 0.00
Therapist 2 6 3.50 3.83 0.33 0.82 0.52
TABLE 4.12 B
ANOVA Of Change Score Differences In Client
Perception-Of-Therapist-Understanding Between Groups
Source of Variance Sum of Squares df Mean Square "F
Treatment 0.33 1 0.33 0.57
Therapist 0.33 1 0.33 0.57
Interaction 0.33 l 0.33 0.57
Error 4.67 8 0.58
Totals 5.67 11

 

104

TABLE 4.13 A

Q_Tests Of Pre To Post Treatment Differences In
Client Perception Of Therapist Helpfulness For The

Counseling-With-IPR Group And The Traditional
Treatment Group

 

 

 

 

 

Pre Post Mean ..
Variable . N Mean. Mean Change 0' D
Couns. E IPR 6 3.83 4.67 0.83 1.58 1.30
Trad. Couns. 6 4.50 4.50 0.00 1.00 0.00
Therapist l 6 4.33 5.00 0.67 1.41 1.16
Therapist 2 6 4.00 4.17 0.17 1.22 0.34
TABLE 4.13 B
ANOVA Of Change Score Differences In Client
Perception-Of-Therapist-Helpfulness Between Groups
Source of Variance Sum of Squares df Mean Square F
Treatment 2.08 1 2.08 1.39
Therapist 0.75 1 0.75 0.50
Interaction 4.08 l 4.08 2.72
Error 12.00 8 1.50
Totals 18.92 11

 

TABLE 4.14 A

D Tests Of Pre To Post Differences In Therapist
Feelings About Session Completed For The Counseling-
With-IPR Group And The Traditional Counseling Group

 

 

 

 

 

Pre Post Mean ‘_
Variable N Mean. Mean Changg Sf D
Couns. E'IPR 6 4.33 4.17 -0.17 0.91 -0.46
Trad. Couns. 6 4.00 4.33 0.33 0.82 1.00
Therapist 1 6 4.33 4.50 0.17 0.71 0.59
Therapist 2 6 4.00 4.00 0.00 1.00 0.00
TABLE 4.14 B
ANOVA Of Change Score Differences In Therapist
Feelings About Session Completed Between Groups
Source of Variance Sum of Squares df Mean Square F
Treatment 0.75 l 0.75 1.00
Therapist 0.08 1 0.08 0.11
Interaction 2.08 1 2.08 2.78
Error 6.00 8 0.75
Totals 8.92 11

 

106

TABLE 4.15 A

D'Tests Of Pre To Post Treatment Differences In
Therapist Perception Of Client Motivation For The
Counseling-With-IPR Group And The Traditional

Treatment Group

 

 

 

 

 

Pre Post Mean ._
Variable N Mean Mean Change qr D
Couns. E'IPR 6 2.17 3.67 1.50 2.27 1.61
Trad. Couns. 6 2.82 3.33 0.50 0.71 1.72
Therapist 1 6 2.33 3.50 1.17 1.87 1.54
Therapist 2 6 2.67 3.50 0.83 1.47 1.38
TABLE 4.15 B
ANOVA Of Change Score Differences In Therapist
Perception Of Client Motivation Between Treatment Groups
Source of Variance Sum of Squares df Mean Square F
Treatment 3.00 l 3.00 1.80
Therapist 0.33 1 0.33 0.20
Interaction 5.33 1 5.33 3.20
Error 13.33 8 1.67
Totals 22.00 11

 

107

TABLE 4.16 A

D Tests Of Pre To Post Treatment Differences In
Therapist Perception Of Progress Made For The
Counseling-With-IPR Group And The Traditional Treatment Group

 

 

 

 

 

Pre Pos t Mean _
Var iab le N Mean Mean Change Cr D
Couns. E'IPR 6 3.50 4.50 1.00 1.53 1.61
Trad. Couns. 6 3.33 3.67 0.33 0.57 1.43
Therapist l 6 3.67 4.33 0.67 1.15 1.42
Therapist 2 6 3.17 3.83 0.67 1.15 1.42
TABLE 4.16 B
ANOVA Of Change Score Differences In Therapist
Perception Of Progress Made Between Treatment Group
Source of Variance Sum of Squares df Mean Square F
Treatment 1.33 1 1.33 1.33
Therapist 0.00 l 0.00 0.00
Interaction 1.33 1 1.33 1.33
Error 8.00 8 1.00
Totals 10.67 11

 

108

TABLE 4.17 A

D Tests Of Pre To Post Treatment Differences In
Therapist Perception 0f Client Coping Behavior For The
Counseling-With-IPR Group And The Traditional

' Treatment Group

 

 

 

 

 

Pre Post Mean ._
Variable N Mean ‘Mean Change tr D
Couns. E IPR 6 3.50 3.67 0.17 0.41 1.00
Trad. Couns. 6 3.67 3.83 0.17 0.41 1.00
Therapist l 6 3.50 3.83 0.17 0.41 1.00
Therapist 2 6 3.50 3.67 0.17 0.41 1.00
TABLE 4.17 B
ANOVA Of Change Score Differences In Therapist
Perception Of Client Coping Behavior Between
Treatment Groups
Source of Variance Sum of Squares df Mean Square F
Treatment 0.00 1 0.00 0.00
Therapist 0.00 1 0.00 0.00
Interaction 0.33 1 0.33 2.00
Error 1.33 8 0.17
Totals 1.67 11

 

109

TABLE 4.18 A

D Tests Of Pre To Post Treatment Differences In
Therapist Looking-Forward-To Session For
The Counseling-With-IPR Group And The
Treatment Group

 

 

 

 

 

Pre Post Mean _.
Var iab 1e N Mean Mean Change 0’ D
Couns. E'IPR 6 2.67 3.33 0.67 0.82 2.03*
Trad. Couns. 6 3.00 3.50 0.50 1.08 1.14
Therapist 1 6 3.33 3.83 0.50 0.91 1.35
Therapist 2 6 2.33 3.00 0.67 1.00 1.63
A

Significant at the .05 level
TABLE 4.18 B
ANOVA Of Change Score Differences In Therapist
Looking-Forward-To-Session Between
Treatment Groups

Source of Variance Sum of Squares df Mean Square F
Treatment 0.08 1 0.08 0.14
Therapist 0.08 l 0.08 0.14
Interaction 2.08 l 2.08 3.57
Error 4.67 8 0.58
Totals 6.92 11

 

110

TABLE 4.19

Levels Of Client Behavior On The Dimensions Of
Client Growth Over Six Weeks For Clients
Receiving Counseling-With-IPR Or
Traditional Counseling

 

 

 

 

Session Discomfort Committment Differentiation DX.Mean
Number ‘ 24233. r3393 r4319

IPR Trad IPR Trad IPR Trad IPR Trad
I 2.28 2.54 2.01 2.23 2.05 2.40 2.05 2.21
II 2.55 2.62 2.13 2.28 2.48 2.53 2.47 2.32
III 2.71 2.10 2.28 2.19 2.68 2.32 2.63 2.27
IV 3.10 2.23 2.58 2.11 2.80 2.30 2.90 2.29
V 3.31 2.60 3.20 2.16 3.20 2.35 3.05 2.35
VI 3.21 2.31 3.15 2.19 3.38 2.34 3.11 2.27

 

111

TABLE 4.20

Mean Pre To Post Treatment Change
Score On The TSCS

 

Mean Change Mean Change

 

 

IPR Traditional
Variable Treatment Treatment
5.33 -1.00
SC
T/F
Net Conflict
Total Conflict
Total Positive -7.67 -3.16
Row 1 - Identity -4.67 -1.50
2 - Self Satisfaction 0.83 2.67
3 - Behavior -3.83 -4.33
Col. A - Physical Self 0.00 1.83
B - Moral-Ethical -3.17 -0.33
C - Personal Self -4.17 0.17
D - Family Self -0.17 -1.17
E - Social Self -0.17 -2.50
Total V -0.50 -1.50
Col. Total V -l.17 0.83
Row Total V 0.67 -2.33
Distribution -5.33 -5.17
DP -3.50 2.00
GM -0.33 -2.00
PSY -1.33 2.17
PD -7.83 -0.50
N —2.17 0.17
PI -0.17 1.33

 

112

WROS, A Q_value of 2.01 for a one-tailed test of signi-
ficance with 5 degrees of freedom is necessary before chance
differences within treatment groups can be rejected at the .05
level of confidence. Inspection of Table 4.7a does not indicate
differences sufficient to reject the null hypothesis of no
change on the WROS for either treatment group. Inspection of
Table 4.7b, however, indicates that there is a difference in
changescore between treatments which is significant. The
difference favors the Counseling-With-IPR treatment group which
had a mean change of 1.33, while the Traditional-Counseling group
score remained the same.

Client Perception of Treatment. A Q_value of 2.01 for

 

a one-tailed test of significance with 5 degrees of freedom is
necessary before chance differences within treatment groups can
be rejected at the .05 level of confidence. Examination of the
change measures on the TSR indicates that significant change
within groups for client perception of treatment were found only
for gliept feglipgs about coming to sgssiop (Table 4.9a) and
cligp§_feelings about progress made in the session (Table 4.10a).
Since an §_value of 4.84 for a one-tailed test of significance
with 11 degrees of freedom is necessary before chance differences
can be rejected at the .05 level, these were also the only dimen-
sions where significant between group differences were obtained
(Tables 4.9b and 4.10b). At the same time, positive change in

measures of client perception were observed for five of the six

113

dimensions for the Counseling-With-IPR group, and on three of
the six for the Traditional-Counseling group.

Therapist Perception of Treatment. Inspection of Tables
4.14 through 4.19 indicates that significant change without
groups in therapist perception of treatment occurred on only one
dimension, that being the pre- to post-mean change for the Coun-
seling-With-IPR group on W
forward to) the session just completed (Table 4.18a). This find-
ing should be viewed with caution since there was no difference
between change scores for the two treatment groups. This could
be due, in part, to the positive change score observed for the
Traditional-Counseling group, but since this was the only one of
six therapist perception dimensions to reach significance for
pre-post change differences, it is possible the result is a

chance finding.

Client Movement On The COGS and Ex By Time

The treatments provided in this study to both groups of
clients consisted of more than a pre- and post-session. Each
of the six sessions for all clients were recorded and rated on
the dimensions of client movement in the same manner as the pre-
and post measures. Due to the fact that the N_involved in this
study is quite small, statistical procedures did not seem appro-
priate to describe session-by-session movement. However, in-

spection of the mean rating scores by session on each of the

114

Client movement dimensions provides useful information for com-
parison of movement trends between treatment groups (Table 4.19).
Both treatment groups showed positive change scores from

session I to session 11 on all dimensions of client movement.

The clients assigned to the Traditional-Counseling group appear

to be functioning higher on the pre-measure than clients assign-
ed to the Counseling-With-IPR group, but these differences were
not significant. The second session was the beginning of the
experimental treatment, starting with the simulation films.
Ratings of the second session showed that the Counseling-With-IPR
group had a greater increment of change than did the Traditional-
Counseling group, and in fact was rated higher on self-exploratory
behavior (DX) than the Traditional-Counseling group. From session
11 to session III the IPR group continued a steady gain on all
client movement dimensions, while the Traditional-Counseling

group showed negative movement (to varying degrees) on all dimen-
sions. At the end of the third session, neither group was func-
tioning at level 3.0 on any of the dimensions.

Between session III and session IV the IPR group again showed
positive gain on all client growth dimensions, and for the first
time was observed to be functioning above 3.0 on one dimension:
Owning of Feelings., The Traditional-Counseling group showed a
slight gain on Owning of Feelings and DX, but showed virtually

no change on either Committment to Change or Differentiation.

115

Between sessions IV and V clients in the IPR group showed
their best degree of positive gain on all dimensions, and for
the first time their mean functioning was above level 3.0 on
all dimensions. The Traditional-Counseling group also continued
positive gain on all dimensions and approached (Committment and
Differentiation) or surpassed (Owning and DX) their original
level of functioning as observed in session 1.

Between session V and session VI both groups seemed to
slip, with the IPR group showing slight negative movement on
all dimensions except Differentiation, which went from 3.20 to
3.38. The Traditional group showed a marked drop in Owning of
Feelings and no change or slight negative movement on the other
dimensions. Since both groups lost momentum at the sixth session,
there is the possibility that, because it was the final session
of the treatment, clients became more cautious and hesitant to
examine their feelings and behavior. Verbal reports indicated
that both therapists were influenced by the knowledge that this
would be the last session for most clients (at least for the
summer recess period), and they were reluctant to move into
new areas of client concern for which there would be insufficient
time to work with.

The movement in client behavior across dimensions can be
seen in Figure 4.1 for the Counseling-With-IPR group and Figure
4.2 for the Traditional-Counseling Group. In Figure 4.3 the

average growth on all dimensions over time is illustrated for

Rating 0f Behavior

3.5
3.4.
3.1.
3.24
3.1‘
3.0-
2.9“
2.8%
2.7‘
2.6-
2.5.
2.4'I
2.3'
2.2 ¥
2.1 s
2.0 .

v7

 

L

100'

116

FIGURE 4.1

Ratings Of Client Behavior Over Time On
The Dimensions Of Client Growth
For The Counseling-With-IPR Group

 

Number of Sessions

Legend:

 

3.5

Rating of Behavior

2.0

1.0

 

117

FIGURE 4.2

Ratings Of Client Behavior Over Time On
The Dimensions Of Client Growth
For The Traditional Counseling Group

db
(b

J A
' v

1 2 3 4

Number of Sessions

 

Legend:
92, = _i_
g§_= ---._._..-
S g ..........

n

118

FIGURE 4.3

Combined Ratings Of Client Behavior Over Time
For The Counseling-With-IPR Group And
The Traditional Counseling Group

3.5 d
3.4 '
3.3 '

 

3.2 '
3.1
3.0 ‘

2.9 ‘
2.8 '
2.7 .
2.6 ‘
2.5 1
2.4 '
2.3 i
2.2 '
2.1 .
2.0 ‘

 

‘----'--.

 

1.0

' I U

Number of Sessions

Legend:
IPR Group 8

 

Trad. C0un II --- - -- .0
Group

119

both groups. It appears that a crucial point in the eventual
post measurement differences in client movement came between
sessions 11 and 111, where the IPR group made positive gain
while the Traditional group showed negative movement.

TSCS - Descriptive Analysis. In the foregoing sections,
statistical evidence was presented to demonstrate the effects
of each treatment on client movement or perceptions in therapy.
A further question is: to what extent did the treatments effect
client self-concept? The TSCS was employed to measure possible
changes in self-concept, but it proved to be a confusing instru-
ment to relate to the present study. Statistical examination
of the twenty subscales of the instrument revealed only one
significant change, this being on the self-criticism subscale.
Since there is a probability that two to three of twenty such
measures will be significant on a chance basis, this finding
must be viewed with extreme caution.

In the interests of sparing the reader additional bulk, the
various statistical tests are not presented. Instead, the mean
change scores for both groups on the sub-scales of the T808 are
presented in Table 4.20. In nine of the twenty sub-scales re-
corded, the direction of change differences favored the IPR
treatment group. Two of the larger change score means were
found for the SC (self-criticism) and DP (defensive positive)

variables. Higher scores on SC "generally indicate a normal,

120

healthy openness and capacity for self-criticism." The SC score
is considered an obvious defensiveness score, whereas DP is a
subtle defensiveness score, i.e. a decrease in DP score could

be seen as a greater awareness of negative self-concepts, thus

having an inverse correlation with SC.

Summary

The hypotheses for client movement pre to post-treatment
were tested using a Q_test for change scores on the same sample.
Differences in change score between groups was tested using a
2 X 2 analysis of variance. The IPR-treatment-group changed
significantly on all dimensions of client movement, but signi-
ficant change was not found for the group receiving traditional
counseling. Change score differences between groups were
found to be significant and favoring the IPR treatment group.
Thus, clients in the Counseling-With-IPR group were rated as
changing significantly in owning their own discomfort, committ-
ment to change, differentiation of stimuli, and degree of self-
exploration. No therapist-treatment interaction was observed,
but one therapist was found to be functioning at (or slightly
below) a minimal facilitative level, while the second therapist
functioned considerably above the minimal level for facilita-
ting growth. All clients receiving IPR treatment made positive
movement on the dimensions of client growth; only three of the

clients receiving traditional counseling made positive movement.

121

The second series of hypotheses related to differences in
client and therapist perception of treatment. There was no pre-
to post-treatment difference within groups observed on client
ratings of their counselors using the Wisconsin Relationship
Orientation Scale, but a significant difference in change scores
between groups was found favoring the IPR treatment group. Pre-
to post-treatment differences for the IPR treatment group were
observed for two of the Therapy Session Report variables relating
to client perceptions: client feelings about coming to the
session and client feelings about progress made in the session.
Significant differences were also observed in change score com-
parison between groups on these two variables, indicating clients
felt more positive about coming to IPR treatment sessions and
saw themselves as making more progress within those sessions
than did clients receiving traditional counseling. A signifi-
cant pre- to post-treatment change difference was found for
therapist anticipation of (or looking forward to) IPR treatment
sessions, but change difference was not significant between
groups. The results did not support any other differences in
the way therapists viewed either treatment.

A descriptive comparison of client growth behavior for each
session was also undertaken. Both treatment groups showed positive
movement between the first and second therapy sessions. From
that point on, the IPR treatment group continued positive growth

through the fifth session, tapering off slightly at the sixth

122

and final treatment session. The Traditional-Couseling group
showed negative change between the second and third sessions,
then seemed to recover and show gradual positive growth through
the fifth session. This group also drOpped slightly between
the fifth and sixth sessions.

Finally, a description of change in self-concept scores
on the Tennessee Self Concept scale was presented. There was
no conclusive evidence that either treatment accomplished mean-

ingful change in dimensions of self concept.

CHAPTER V

SUMMARY, DISCUSSION, AND IMPLICATIONS

Summary

The purpose of this study was to investigate the effects
of affect simulation films together with stimulated recall on
client movement in counseling. A treatment program integrating
simulation films and stimulated recall via videotape in order
to accelerate client growth in counseling was compared with more
traditional counseling methods.

Interpersonal Process Recall (IPR) is a technique using
stimulated recall of videotape to accelerate client insight and
change during therapy. A videotape of a counseling session is
replayed to the client and a recall session is conducted by a
clinically trained "interrogator" who helps the client examine
the underlying dynamics of his interaction with the counselor.
In previous studies, IPR was found to accelerate client movement
in counseling when the counselor is actively involved in the
recall process (Kagan, Krathwohl, et. a1., 1967). The IPR pro-
cess was observed to be most valuable when the counseling or
therapy session being replayed dealt with intensive or immediate
experience of emotion, such as when counselor and client were
speaking about intensive feelings the client had toward the
counselor or when these feelings were existent although avoided
by either (or both) party during the therapy session. This

observation led to the development of the technique of affect

123

124

simulation. Clients are confronted with films which encourage
them to simulate interpersonal relations, and client and film
are videotaped while the client watches the film. The video
tape is then played back while his counselor helps him examine
his reactions to the film. In some cases an actor directs
affection or rejection toward the viewer, in others the actor
reacts as if he had been rejected or seduced.

In a pilot study conducted in 1967 the simulation and IPR
techniques were combined in an attempt to increase the client's
ability to recognize and understand his feelings and responses
to interpersonal encounters. Three treatments were compared:

1) counseling alone (control treatment); 2) counseling using
first simulation films, or VRAS (videotape recall of affect
simulation) for three sessions, then IPR for three sessions;

3) counseling using IPR first and then VRAS. Judges' ratings

of client movement indicated that both treatment groups moved
significantly on four in-therapy behavior dimensions, while the
control group did not. Examination of vocational placement
status at the end of treatment also favored the treatment groups,
where 66% had been placed on jobs against 33% for the control
group. The pilot study indicated that there might be some clinical
advantage for beginning the treatment program with the VRAS.
When VRAS preceded IPR there seemed to be a contigious "building
effect", where the client first learned the behavior of self-

exploration of his videotaped reactions to simulated confrontation

125

and was then able to apply this exploratory behavior to recalling
emotions in later counseling sessions via IPR.

In the present study, the treatment program was designed
to integrate the VRAS and IPR into a sequential program of treat-
ment. The use of a sequential approach stemmed from the data
observed in the pilot study, suggesting the following series of
developmental experiences facing the client as he undergoes
counseling or therapy: a) the need for the client to become
aware of his feelings and reactive behavior in emotional stress
situations, b) the need to identify and examine the feelings
he has during the counseling relationship itself, c) the need
to experience and deal with these feelings in the immediacy of
the counseling relationship itself. The experimental treatment
consisted of three integrated phases which were designed to meet
these developmental needs.

In the first - or VRAS - phase, the client was videotaped
while watching an affect simulation film. The video tape was
played back and the client's videotaped behavior served as the
focus for the counseling session. As the client examined his
reactions to the simulated confrontation, he was able to look
at his emotional reactions to others without having to be respon-
sible for their impact and consequences, i.e., he was dealing
with interpersonal threat from a position of relative safety.

In the second - or IPR - phase, client and counselor were video-

taped while conducting a counseling session, the videotape was

126

replayed and a trained recall worker ("interrogator") conducted
an IPR session with the client while the counselor observed
through a one-way mirror. The recall worker was essential in
helping the client to examine his feelings in relating to his
counselor, since the client still was not confronting the coun-
selor and thus had a reduced reSponsibility for the immediate
consequences of his feelings. After the recall, client and
counselor resumed their counseling session, incorporating the
insights gained from the recall. In the final phase, both
client and counselor viewed a replay of the counseling session
together, while the interrogator encouraged them to share their
feelings as they occurred during the interview. As counselor
and client communication about their feelings and reactions
during the videotaped interview increased, the interrogator
played a progressively less active role. When the interaction
between client and counselor moved from a focus on the video-
tape to the immediacy of the recall (when they had finished
talking about the videotape and were again engaged in face-to-
face discussion) session the interrogator left the room and
counselor and client continued the therapy session.

The control-group treatment consisted of traditional coun-
seling, i.e., no IPR interventions were used. Both the coun-
seling - with - IPR and the traditional - counseling group treat-
ments were focused on effective client/counselor communication.

In the traditional - counseling group, the therapists concentrated

127

on client/counselor interaction in an attempt to help the client
achieve greater self-awareness and understanding of his own
dynamics. The traditional counseling procedures were as respon-
sive to each client's needs and as intensive as possible, and
equal amounts of client contact were given to each group.

The clients in this study were twelve female undergraduate
students who had requested personal counseling from the univer-
sity counseling center, and who also agreed to participate in
the research. The two therapists were pre-doctoral interns at
the Counseling Center who had training and experience in IPR
techniques as well as in traditional counseling methods. Since
there is evidence that therapist functioning level has an
influence on client progress in therapy, each therapist was rated
on scales measuring facilitative behavior in therapy. One
therapist was found to be functioning at approximately 3.00
across dimensions on a five point scale where a rating of 3.00
is considered the minimal level of counselor performance if
client growth is to occur. The second therapist was functioning
at an average of approximately 3.40 across dimensions.

For the purposes of testing the research hypotheses a pre-
post design was used. Clients were assigned to therapist and
treatment groups on a random basis. Each interview was recorded
for subsequent rating by independent judges (two Ph.D. counseling
psychologists) on four dimensions of client behavior in therapy

considered characteristics of client growth: Owning of Feelings (OF),

128

Committment to Change (CCH), Differentiation of Stimuli (DS),
and Depth of Self-eXploration (DX). Ratings of the initial
sessions served as the pre-test measure. Analysis of ratings
of the initial sessions indicated no significant difference
between groups on any of the dimensions, suggesting that neither
treatment group had a higher level of functioning which might
have affected their post-treatment behavior.
Ratings of the sixth (final) session for each client on
the client growth scales served as a post measure of client
functioning. Each client also completed the Tennessee Self
Concept Scale and the Wisconsin Relationship Orientation Scale
before and after the treatment program. In addition, each client
and therapist completed a shortened form of the Therapy Session
Report (TSR) following each treatment session.
The basic hypotheses of this study were:
Hypothesis 1: Clients receiving personal counseling with
IPR intervention will make more positive
movement within counseling than will clients
who receive personal counseling alone.
Hypothesis II: Clients receiving IPR treatment will see
their counselors as more accessible and
easier to talk with than will clients not
receiving IPR treatment.
Hypothesis III: Clients who receive IPR treatment and their

therapists will report more positive percep-

tions of their counseling than clients and

129

their therapists not receiving IPR.

Hypothesis IV: Clients receiving IPR treatment will
develop a more improved self concept of
themselves than will clients not receiving
IPR treatment.

The analysis of pre to post changes in client behavior
during therapy within each group by means of a 2 test for change
scores on the same sample indicated significant differences
(.05 level) on each of the characteristics of client growth for
the counseling - with IPR group, but not for the traditional -
counseling group. That is, after treatment the clients in the
treatment group were rated higher on the dimensions of OF, CL,
DS, and DX. Ratings of clients in the traditional - counseling
group showed no differences, pre to post treatment. Analysis
of change scores between groups also indicated differences in
the hypothesized direction (.05 level) on each of the client
growth dimensions.

Analysis of pre to post changes in client ratings of coun-
selors on the WROS did not indicate significant change after
treatment for either group, but change scores between groups
were found to be significant and favored the experimental treat-
ment. Pre to post differences within groups for client percep-
tions of treatment were found on only two dimensions: client
feeligggiabout coming to the session and client feelings aboutgpro-

gress made in the session. In both cases, the differences were

130

found only for the IPR group, with significant between group
differences on change score also favoring the IPR group. Change
score differences in therapist perception of treatment were

found only for the IPR group's pre to post change on the variable
of: therapist looking forward to coming to the session. Finally,
change score difference on dimensions of the Tennessee Self
Concept Scale were evenly divided between groups, and there

was little indication of any meaningful change in self-concept
score due to treatment.

In essence, the IPR treatment had a significant acceler-
ating affect on client movement in therapy, as rated by indepen-
dent judges. Clients in the IPR group had a greater positive
change difference in the degree to which they felt able to relate
to their therapist, when compared with the traditional counseling
group. Clients in the IPR group had more positive feelings about
coming to their treatment sessions, and about the progress that
was made within these sessions. Therapists also were found to
look forward more positively to the IPR treatment sessions than

the traditional treatment sessions.

Discussion

 

Before conclusions can be drawn from the data in this study,
the critical question of therapist bias must be considered. The
traditional counseling treatment did not influence significant

change on any of the criteria examined, and in face there was a

131

slight negative (though non-significant) pre to post treatment
change observed on several dimensions (OF, CCH, D8) which may
have contributed to the finding of significant differences in
change scores between treatments. Could the differences that
were found between treatments be a function of therapist, rather
than treatment effect? It is true that the pre to post change
scores in behaviors of clients in the IPR group were significantly
different from those of the traditional counseling group, but

in order to assure equal therapist competency in each treatment,
the same therapists had been used for both groups. The fact
that the participating therapists knew the research hypotheses
and the group (IPR or traditional) to which the client had been
assigned must be considered in the interpretation of the results.
While the possibility of a bias effect cannot be discounted,
there are aspects of the data which tend to minimize the likeli-
hood of such therapist control. First, the time period chosen
for comparison of treatment effects (six weeks) is strikingly
brief in that short-term psychotherapy is rarely seen as less
than six months to a year in duration. The time period was made
short in order to examine the possible accelerating effects of
IPR in the initial stages of treatment. Any significant change
in client behavior in this period of time is noteworthy, since
the absence of such change is less the exception than the rule.
In a recent study examining forty different individual therapy

cases, positive change in client growth behavior before the 10th

132

session was observed in only seven cases - or less than 20 per
cent (Pierce and Schauble, 1970). Yet such growth was observed
in only six sessions for clients receiving IPR treatment.

If the therapists in this study were capable of accomplishing
such results without the use of IPR, one would have to assume
that they were most unusual therapists, capable of influencing

significant gains in some clients, but not in others. It seems

 

likely that such differences in therapist behavior would have
been readily observable when tapes of the sessions were compared,
and certainly would be evident in much higher scores when the
behavior of the therapists was rated on the "facilitative condi-
tions" scales. The judges rating tapes for client movement
reported no such extraordinary counselor behaviors, and it was
found that when therapist behavior was rated on the facilitative
conditions (Table 4.5) there were no differences in therapist
functioning level between treatments. When the direction of
client movement was examined (Table 4.6), it was observed that
three of the six clients receiving traditional counseling did
make positive movement on the growth dimensions. If the possibil-
ity of therapist bias is accepted, one would also have to assume
that the therapists involved exerted sufficient control to
accomplish some degree of change with the traditional counseling
group, but significantly more with the IPR group. In light of
our current state of knowledge about the therapy process, it

seems unlikely that the therapists involved could so control

 

133

their clients' behavior - even if they overtly or covertly were
motivated to do so.

There exists the possibility that the therapist's enthusiasm
or preference for the IPR treatment was conveyed to the clients,
thereby affecting their motivation. However, the records of
client participation show no evidence of greater interest and/or
motivation between groups. Clients regularly kept appointments,
and half of the clients in each group continued therapy contact
after termination of the treatment period. There is further
written feedback evidence that the clients in the traditional
counseling group perceived their experiences as being positive
and ”observed” noticeable changes in their coping behavior.
These self-reports are admittedly subject to a halo effect, yet
they suggest that the therapists communicated concern and inter-
est to clients regardless of the type of treatment involved.

It is also useful to note that many of the experiences which
serve as the core for the IPR treatment (e.g., examination of
immediacy of feelings of client toward therapist and vice versa)
may have increased therapist competency and hence were probably
integrated by the therapists into their counseling behavior with
clients in the traditional counseling group as well. It was
rust uncommon for either therapist to ask traditional-treatment
these clients, "How do you think ;_feel about that"...... and
"What did you want; me to think or feel”. In essence, the

therapdst adopted those aspects of the "interrogators" role that

 

 

 

134

were appropriate in the traditional counseling setting as well.
(This has been a common observation in the research done with
IPR, where the skills learned in becoming an effective interro-
gator are carried over into the therapy role - usually leading

to a more appropriate and effective behavior on the part of the
therapist (Kagan, Krathwohl, et. a1., 1967). In fact, the
acquisition of the "concrete" behaviors of the interrogatOr may
be one of the most potent influences in the successful applica-
tion of the IPR for training counselors [Gbldberg, 19617 ).
Finally, it should be noted that both therapists had received
much more extensive training in the traditional approaches to
therapy than in the IPR techniques. Both therapists described
themselves as eclectic in identification, and both used a variety
of techniques to augment the "relationship - therapy" approach,
e.g. visual imagery and learning theory techniques. In fact, a
criticiam of the IPR treatment suggested by both therapists was
that the step by step program delimited their freedom to respond
to their clients' individual needs. In other words, the research
dictated a rigid schedule of IPR experiences which did not take
into account the unique growth rate of each client; that is,

in the interest of uniform treatment within groups the therapist
was allowed no flexibility in varying the approach to meet client
needs. This criticism usually applied to cases where the thera-
pist felt his client moved more rapidly than expected, hence a

particular stage might have been eliminated (e.g., the second VRAS

l on.
I

 

135

session) to more effeciently capitalize on the client's gains.

This criticism might suggest more dissatisfaction with the IPR

treatment than with the traditional treatment, and yet the TSR

results indicate that the therapists became more positive about
their IPR sessions than their traditional treatment sessions.

Another possible bias effect might be increase in client
motivation due to the novelty of the treatment. An attempt was
made in the design of the study to minimize the halo effect by
arranging for clients in the traditional treatment group to be
seen in a Specially designed research studio, and while they
were informed that they were part of a "research study", they
were not aware of the IPR treatment group. There was thus no
observable reaction of "feeling cheated", and the clients in
both groups who continued treatment after the six weeks appeared
to maintain their initial level of involvement for the duration
of their contacts.

A final consideration relating to client motivation concerns
the voluntary participation of the sample. Should these clients
be considered somewhat different from the general population in
terms of interest and motivation because they agreed to partici-
pate in the research project? While this would not affect the
observed differences between groups, it might suggest that this
particular sample of clients were more receptive to either of
the treatment experiences, in essence that they were more "willing

to change". Of the clients who sought help at the Counseling

136

Center, only one of thirteen clients contacted and invited to
participate declined to do so, and she did not persist in her
later assignment to conventional therapy. There may well have
been some ”clinical screening" occurring in the referral process
from the Counseling Center screening counselors, whereby only

the lowest-risk clients were referred for consideration. How-
ever, the only selection criteria suggested to screening counselors
were that the client not have concerns of a "crisis" nature, or
problems relating solely to educational/vocational areas (see
Appendix C). Furthermore, if these clients were in fact more
motivated, it should be evident in the pre-treatment ratings of
their committment to change. Previous research has in fact
indicated that clients who are successful in therapy begin the
therapy process at higher levels of the characteristics of client
growth than do non-successful clients (Pierce and Schauble, 1970).
A comparison of pre-treatment mean §Q§_scores for each group
(Table 4.19) with the means reported in this earlier study indi-
cate that the pre-treatment QQH scores reported for the present
research sample (combined mean = 2.12) more closely approximate
the mean scores of non-successful clients (mean = 1.91) than
successful clients (means = 2.42). Regardless, it seems safe

to assume that there were no initial motivational differences
between groups which would contribute to the observed behavioral
differences existing between groups after treatment. Thus while

caution should be exercised in generalizing from a volunteer

137

university sample to the general population, it seems likely that
the conclusions about the superiority of one technique over the
other would apply to other samples as well. Naturally, this
assertion needs to be tested.

In summary, then, the differences observed in the behaviors
of clients in the two treatment groups, the client ratings of
their perceptions of change in the therapeutic relationship,
and change in client and therapist feelings about participation
in the treatment sessions strongly indicate that the sequential
treatment of VRAS and IPR experiences used in this study is a

viable and effective means of accelerating client movement in

counseling and psychotherapy.
Observations and Implications

In discussing the conclusions deriving from the results of
this study, it is appropriate to discuss some of the clinical
observations gleaned from a review of the therapy tapes and re-
call sessions as well. These clinical observations may help
answer the question of why the IPR treatment was successful in

accelerating client progress in therapy.

I. The Progressive IPR Treatment Program Is An Effective Means
Of Accelerating Client Progress In Therapy

When a client initiates therapy, he has generally arrived

at a state of dissatisfaction with his existing interpersonal

138

behaviors. It may be that he no longer feels able to cope with

his life situation without professional intervention, or he has
reached the point where he feels the need for assistance to

become a more effective person. Before the helping process can

result in new and appropriate behaviors the client must be moti-

vated to change, including recognition on his part of his reSpon-

sibility for his own condition. After he has "owned his feelings",

the client must then decide that he is willing to accept the con-
sequences for change at this point in time, in effect he must
committ himself to the therapy - or change - process. This
process necessarily entails the differentiation, exploration

and experiencing of feelings - however painful - in the immediacy

of the therapy relationship. Clients entering therapy will

differ in the degree to which they display the behavior so de-
scribed, but there is theoretical and research evidence to

suggest that until client behavior is characterized by high levels

of OF, CCH, DS, and DX, behavior change is improbable.

For those clients in the IPR treatment group, the VRAS
sessions where the client examined his reactions to the affect
simulation films were a concrete introduction to the goals of

therapy. Since the client was confronted with a simulated or

"unreal" situation, she was able to explore her emotional reactions

without having to be responsible for the consequences of her

reactions on others. While the VRAS tended to provide the

direction for self exploration within a context of relative

139

emotional "safety", it did not necessarily lessen the anxiety
associated with this delimited self-exploration. One client

had presented a very passive, inactive picture during her initial
interview, and in fact seemed deliberately hostile to any attempts
at communication from her counselor. During the first VRAS
session she remained inactive and appeared impervious to the
affect simulation films (in this particular session, The Aggression
I series was employed). When the videotape replay was begun and
she was confronted with he own image and behavior so that denial
of the impact of the "other” wasn't possible, she burst into

tears and asked that the replay be terminated. As she and her
therapist discussed her startling reaction to the videotape,

it became apparent that this client was so well defended against
recognizing her feelings that she had not been aware of exper-
iencing any emotion in the actual moment of watching the films.
When the videotape was replayed, however, she was able to identify
and acutely experience the feelings she had suppressed whilg_
watchingithe films. In other words, this client had no access

or awareness of her feelings until she was once removed from the
confrontation situation and enabled to observe herself, at which
point her feelings were so intense as to be overwhelming. There
is no way of estimating the time it might have taken to uncover
this insight through traditional therapy - if indeed it would

have been reached at all. This client had come from an intensely

fundamental religious background, and had been taught not to

140

recognize or own her feelings. The VRAS experience made her
aware, for the first time, of the degree to which she had isolated
herself from her emotions. It was also an invaluable aid for

her therapist in attempting to understand the dynamics of this
client. In a sense, the VRAS phase of treatment typically helped
the client to become increasingly more able to identify and deal
with her feelings and behavior, "preparing" her for new_learning
in the actual therapy experience.

The IPR sessions helped the client bridge the gap between
the indentification of feelings in the non-real interpersonal
simulation session between client and film to the identification
of her feelings during the real interaction in the therapy session.
During the videotape replay of the counseling session between
client and counselor, the interrogator helped the client identify
feelings she had had toward her therapist during the interview
but which had not been expressed. As has been found in previous
research, the interrogator's function was instrumental in client
identification of direct hostile or affectionate feelings toward
the therapist. The anxiety which prevented the expression of
these feelings in therapy was reduced, since the client was not
czonfronting her therapist but rather telling a third person (the
interrogator), and thus had less reSponsibility for the conse-
quences of her feelings. This appeared to be true despite the
fact: that the client was aware of the fact that her therapist

was watching the recall from behind a one-way mirror and would

 

 

 

141

nxmmntarily rejoin her for a continuation of the counseling

session. Two observations illustrate this point. In one in-

stance, the client frequently giggled during the therapy session

when personally relevant material was being discussed. During

the recall session it was learned that at each point on the
tape where she giggled and seemed to move away from the dis-
cussion, the client was actually experiencing a great deal of
hurt. When the inappropriateness of her laughter was pointed

out, the client was able to verbalize that she was afraid to

talk about painful things with her therapist: "I'm supposed

to be getting better, aren't I? If I don't let him know how

much he's helping me, he won't want me to come back." When
the therapy session was resumed subsequent to the recall, the

client ventilated considerable hostility toward the counselor

for "placing such pressure" on her to perform. This was the

first direct expression of feeling made by this client to her
therapist, and led to extensive exploration of her feelings of
of being exploited by all_the significant people in her life.
‘An excert from a different client illustrates the potential of

IPR for changing perceptions of feelings:

Interrogator: "Right here Mary, what were you feeling?"

"I don't remember, I was just talking."

Client:
Interrogator: 'Wmat about?"
(Ilient: "I don't know...you know, I really don't

know! I was just talking and talking and
...you know he just sat there and listened

 

 

 

 

142

Interrogator: "Uh-huh. And what was he feeling then?"
"He just listened. I was running all over
everywhere and he just listened and waited
for me to come back. Oh I am an ass! And
I didn't even think I could trust him.....
and he knew all along."

Client:

Interrogator: "So he was waiting...because he cares for

you?"

"He has to...to sit there...and listen...
I never thought...I am an ass!"

Client:
In both instances cited the client knew the therapist was observ-
ing the recall, but the fact that he was not physically present
made it easier to begin to examine the dynamics of the relation-
ship. This early investigation of underlying feelings apparently
helped the client identify her feelings toward the therapist

early in the therapy process. It also seems likely that the

overt expression of these feelings without having to confront the

therapist made it easier for the client to deal with them, thus

leading eventually to a more open and honest therapy communication.
During the final phase of treatment, the mutual recall, the

interrogator, therapist and client viewed the replay of the coun-

selixu; session together. This phase provided the client with an

opportunity to put what she had learned together in the here-and-

now of her experience. The session began by recalling and sharing

feelings related to the video taped counseling session, and
ended with a more Open, honest relationship in which the common

goal was to become aware of feelings and behavior in the immediacy

of the therapy encounter.

 

 

143

The progressive treatment program thus proceded from the
identflfication of generic feelings (through VRAS) to feelings
abouttme therapy relationship in the "there-and-then" of the

videotape recall (IPR), culminating in the immediate communicating

of feelings in relationship (mutual recall).

The IPR Intervention Is Most Useful In The Initial Stages

Of Therapy

II.

Previous research with IPR has indicated that the technique
has value in various stages of counseling and therapy (Kagan,
Krathwohl, and Miller, 1963; Woody, Kagan, Krathwohl and Farquhar,
1965, Resnikoff, Kagan, and Schauble, 1970), but the insights and
information gained from the approach (as described above) seem
especially appropriate for beginning the therapy process. When
used in the early stages of therapy, IPR made the client aware
that exploration of feelings and self is the task of counseling,
.and through the program of progressive approximation the client
developed confidence in her ability to survive such exploration
with the therapist.

In the pilot study it was observed that clients in the trad-
itituuil counseling group were found to show negative movement on
.pre -'post ratings of behavior change in therapy. The present
study showed similar results, in that slight negative change pre

to post was observed on three of the four behavior measures. Com-

paring session to session movement on the behavior scales provided

 

144

addfljonal insight into the pattern of client growth in therapy.

Theznmraged growth curves for both treatment groups over time

are represented in Figure 4.3. Both groups showed positive

nmwement between sessions I and II, but there was marked nega-
tive movement between sessions 11 and III for the traditional

counseling group. How can such negative movement be explained?

 

Brammer and Shostram (1960) suggest that "...psychotherapy
is analogous to the experience of going deeply into a pit. The
vertical dimension represents depth of involvement in the pro-

cess. The hori ontal dimension represents temporal stages in

the process." The authors go on to state that there are "critical

points" that must be dealt with at various points in the therapy
experience. Critical point number one occurs after the client

states his problem and begins to feel comfortable in the relation-

ship:

"This is the point where he (client)
plunges into more detailed exploration
of feelings which may not be a pleasant
experience. At this point he feels in-
secure, uncomfortable, and doubtful
whether the results will merit the psy-
chic pain which he is beginning to
experience. This point is labelled a
"critical point" because many clients
drop out here. Experienced therapists
view critical Point Number One §§_ghg_
place where the client'seems £g_gg£
better." (p. 99) (Emphasis my own)

This statement seems especially relevant to the data observed in

 

145

the current study. Positive movement was observed in the initial
stages of therapy (between sessions I and II). This might be
directly related to the experience for these clients to freely
and openly express the feelings they had regarding their "problems"
- perhaps for the first time. Following this "cartharsis" the
client had to confront the fact that her problems were not
suddenly resolved....and that she must begin the painful pro-
cess of attempting to differentiate anc change behavior. As
this realization sank home, the client felt the the pain and
doubt referred to by Brammer and Shostrom which was reflected
in her getting "worse before she gets better", as observed bet-
ween sessions 11 and 111.1

In contrast, the IPR treatment group showed continued positive
movement from session II to session III. It appeared that the

use of the VRAS had two facilitating effects on client movement.

 

1Brammer and Shostrom suggest a slightly different explanation
for the negative effects which may follow an initial therapeu-
tic catharsis:

"If allowed to 'ventilate' excessively,
the client may feel so good afterward
that he will feel it is unnecessary to
go on to the causes of his difficulties
and the steps necessary to change his
attitudes and acts". (p. 96)

While this explanation would also explain the decrease in positive
client behavior in therapy, clinical data suggested that, at
least in this study, clients seemed disillusioned by the persis-
tence of their problems beyond initial catharsis, and they were
ambivalent about experiencing more pain in further self-explora-
tion.

 

 

 

 

146

First,it clearly indicated to the client that there was further

areas which she needed to explore, as well as providing her with

Huzstimulus of her own behavior (via videotape). Second, by

fomuflmg on client feelings in reaction to the simulation situa-

tions,the client became aware that she and her therapist were

(capable of dealing with her emotional stress. By providing

 

both client and therapist with an example of client affect, the

VRAS led to a sharing of the client's experience of feeling,

making continuing exploration much more comfortable. White (1956)

writes of the importance of the therapists' support in client

self-exploration:

"To the extent that the patient is dominated
by anxieties, he may be likened to a frigh-
tened child. Alone he cannot face the threats
but in the company of the analyst he dares to
peek at them and finally approach them. The
patient becomes a little more daring because
he is not alone in the enterprise. This in-
crease of daring is at the heart of his cor-
rective emotional experience (p. 333)."

Inna "increase of daring" would seem to be a reflection of the

characteristics of client growth. In the VRAS, the client was

not "peeking at" she was confronted with the anxiety producing
situation, during which she was very much aware of the therapists'
Thus the

sharing of the experience with her in its immediacy.

"corrective emotional experience" that is therapy would seem

to be accelerated .

147

Figure 4.3 indicated that the traditional treatment group
began to make positive movement between session IV and V, and
in fact achieved a slightly higher level of functioning than
their pre—test measure. The IPR treatment group continued its
positive growth through session V. Both treatment groups lost
momentum between sessions V and VI, but this may well be more
a function of the research design than actual treatment effects.
All parties knew that the sixth session was to be the last in
the treatment program (while clients did have - and in six
cases followed through on - the option of continuing in therapy,
there was an academic term break of three weeks at this point),
and written feedback indicated that there was a marked reluctance
for both clients and therapists to begin new exploration or
involvement into areas for which there might not be sufficient
time to work through problems. This was eSpecially evident in
the mutual recall of the IPR treatment, where counselor and
client communicated openly and honestly and in several cases
verbalized their hesitancy about pushing further with limited
tinua. In retrospect, it is quite unfortunate that the treat-
ment program was so brief, for the IPR treatment clients had
runLy begun to function at productive levels on the characteris-
tirx; of client growth scale i.e., above the level of 3.0 defined

at; the minimal level of client behavior necessary before gain

 

 

lllll'.lall Ii.

148

in:huerpersonal functioning can occur.* Thus they were at the
stage where their progress within therapy could just begin to
result in new methods of behaving. The fact remains that they
did reach this stage in only six therapy sessions, and that the
drop in positive growth observed for the traditional treatment

group after the second session was not observed for the IPR

treatment group.

III. The IPR Treatment Program Has Varying Effects On Different
Individuals
This conclusion has several implications for the applica-
tion of IPR to accelerate client progress in therapy. Just as
there are individual rates for speed of learning, clients vary
in the level of functioning with which they enter therapy and
in the rate with which they can progress. Earlier it was noted
that both therapists voiced some reservations about the necessary
inflexability of the treatment schedule, suggesting that some
clients might become ready for a later stage in the progression

before it was in - fact scheduled. This conclusion had also been

 

* Research on the dimensions of facilitative therapist behavior
indicates that level 3.0 is the minimal therapist functioning
level necessary for client growth to occur (Carkhuff and Beren-
scni, 1967). The client growth dimensions used in this study
were conceptualized so that each of the levels of client behavior
vumrld coincide with the different levels of therapist behavior.
iLevel.3.0 is conceived as the minimal level of client inrtherapy
behavior necessary before behavior change can result.

149

suggested in the pilot study, where it appeared that clients
varied in their develOpmental ability to directly cope with

their feelings. At the same time, there are some decided advan-
tages to adhering to the treatment schedule, becuase there seems
to be value in the developmental schedule to b2£h_client and
therapist for suggesting a direction in which to proceed with
in-therapy activity. This would appear to be especially true
for the less effective therapist functioning at lower then
minimal levels of facilitative behavior. In this study, the
therapist who was rated as functioning at minimal levels on the
facilitative conditions was able to facilitate positive growth
with only one of the three clients he met in a traditional treat-
ment program, whereas the three clients he saw in IPR treatment
all made positive movement in therapy (Table 4.6). All clients
involved in IPR treatment with the second therapist (who was
functioning well above minimal levels) made positive movement,
but so did two of his three traditional treatment clients (also
note that the third client either made positive movement or
remained at the same levels, she did not show negative movement).
This data is consistent with previous research on IPR discussed
in Chapter II where it was observed that the more competent
therapist is able to use IPR profitably but is not dependent on
time technique, while the less competent therapist needs the IPR
strnuzture to aid in facilitating (or even to avoid retarding)

(:lient growth. When one considers the indications that many

150

professionals are in fact functioning at lower than minimally
facilitative levels (Carkhuff and Berenson, 1967), this becomes
a very critical point.

In essence, it seems evident that the IPR technique has
different effects on both client and counselor. While it is
conceivable that variations in the format of the intervention
program might be appropriate for particular situations, such
variations should be made with careful consideration of the
therapists' level of functioning as well as that of the client

and any new format should be evaluated in a controlled study.
Implications For Counseling And Therapy

In light of the changes observed in client behavior in
therapy as a result of the IPR intervention and the significant
differences between the behavior of clients in the IPR treatment
and the traditional treatment group, it is assumed that the IPR
procedures are a potentially potent tool for use in accelerating
client progress in therapy. Even in light of the limitations
of the small N_sample in this study, the fact that significant
differences were found in two separate studies in only gig.
sessions seems too meaningful to ignore.

Most theoretical schools in counseling and psychotherapy
agree that client behaviors which reflect owning of feelings or
discomfort (awareness of need for help), motivation and committ-

ment to change, deliniation and clarification of problem areas,

151

and self exploration are essential ingredients to client progress
in the therapy relationship. There are, of course, other dimen-
sions of the therapy process, but these seem to be basic. Since
these are identified as positive, "healthy", and necessary dimen-
sions, it would seem logical that not only are these reliable
indices of client functioning in therapy, but they are also
desirable gggls'gf_the therapy interaction. If these behavior
dimensions measure the ”good” client, then perhaps we should
”teach" clients appropriate behaviors as an integral part of

the therapy process. Clients request counseling or therapy
because they are dissatisfied with their current level of inter-
personal behavior, i.e., they are not effective. It is unlikely
that the client can suddenly become any more effective in dealing
with his problems in therapy than he has been in dealing with
them in his past, unless he is taught what these effective be-
haviors are. There is an abundance of evidence that validates
the concept that students in counselor training programs achieve
effective behaviors much more rapidly and successfully when

they are made aware of the behavioral correlates of effective
_practice (Geldberg, 1967; Ivey, et. a1., 1968; Carkhuff and
Berenson, 1967). There is every reason to believe that the

same is true for clients. The IPR treatment program may well
owe a substantial part of its success in accelerating client
movement to the fact that it is sequentially designed to help

the client become aware of (and develOp successful behavior in)

 

 

152

the characteristics of client growth.

Implications For Further Research

While the results of this study tend to indicate the effec-

tiveness of IPR as a means of accelerating client progress in

therapy, a number of questions were raised which should be the

subject of further investigation.

1.

Because of the need to control experimental procedure
for each group while controlling for therapist impact,
it was necessary to use a very small N, With an indi-
cation of the initial value of the program, ongoing
studies should be initiated which would provide more
substantial evidence as to whether or not the technique
results in accelerated movement in therapy.

While client progress in therapy apparently was acceler-
ated by the IPR treatment, there is little evidence of
whether such progress results in either shorter therapy
contracts or significantly different behavior outside
therapy. Longitudinal studies examining such criteria
could also provide data on the long range effectiveness
of more traditional treatment approaches.

Observations regarding the relationship of therapist
level of functioning and IPR indicate that the greatest
potential for the technique is with less effective

therapists. This hypothesis could be examined by setting

153

up two groups of therapists - effective and non-
effective and comparing the impact of both groups

with both IPR and traditional treatments.

An attempt should be made to identify client functioning
level when he first initiates therapy, and examine the

impact of the different phases of treatment on clients

at ' .m ‘7...

on varying levels of functioning. This would necessitate

 

III

a substantial N, but might result in a "readiness index"
wherein an individual treatment program could be designed
more scientifically, appropriately, and efficiently for h
each client.

Thus far the choice of sequence for the affect simula-
tion films has been made on the basis of clinical intu-
ition. Future research might compare the sequential
programming of simulation experience to determine if
there is a common pattern of exposure which might be

more efficient.

If the observations about the sequential series of IPR
experiences are correct, it is important to determine

the effects of each phase of the treatment procedure

on client behavior. By rating each treatment session
over a longer period of contact, the trends in movement
pattern observed in this study could be better evaluated,
and the particular impact of each phase of the program

could be determined.

 

 

 

 

Illnlilj

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Nielson,(3. Studies in Self-Confrontation: Viewing a Sound
Motion Picture of Self and Another Person in a Stressful
Interaction. Munksgaard, Copenhagen, 1962.

 

158

Nunnally, K. G. The use of multiple therapy in group counseling
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Pascal, G. R. et al., A methodological note on the use of video
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248-251.

Paul, N. L. Effects of playback on family members of their
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Psyghiatric Research Report 20, American Psychiatric
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Piaget, G., Berenson, B. G., Carkhuff, R. R. The differential
effects of the manipulation of therapeutic conditions by
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1967.

Pierce, R. W. and Schauble, P. G. Client in-therapy behavior--
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1970.

Poling, E. G. Video tape recordings in counseling practicum:
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Rabin, H. M. How does co-therapy compare with regular group
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Rogers, C. R., Dymond, Rosalind F. (Eds.) Psychotherapy and
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Rosenthal, D. Changes in some moral values following psycho-
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Schauble, P. G. Emotional simulation in personal counseling:
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Schiff, S. B. and Revich, R. Use of television as aid to

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159

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160

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APPENDICES

APPENDIX A:

Figures depicting VRAS and IPR

 

 

 

FIGURE 1:

Vflkm recording client and affect simulation films.

IPR ROOM

 

 

 

 

CONTROL ROOM

 

 

 

 

Videotape recorder

 

 

Figure 1:

Film of actor portraying emotion is projected on
screen for client in viewing room. Client's be-
havior while watching fihn is combined with the

fihm to provide a split screen videotape record-
ing for examination in recall.

163

 

l

164

FIGURE 2:

Videotape recall of affect simulation

IPR ROOM

 

 

 

 

 

 

CONTROL ROOM

 

 

Inn‘g

EM

 

 

 

1

Videotape recorder

 

 

 

Figure 2: Upon completion of a series of emotional vignettes,
client is joined by counselor. A split screen of
videotape of emotional vignette and client behavior
while watching the vignette is played back to the
viewing room. A sound tape to record client and
counselor interaction during replay is made. Video-

tape is started and stopped by remote control switch
by either counselor or c ient

165

FIGURE 3:

Videorecording Counseling Session

IPR ROOM

399%

.

 

 

 

 

 

 

CONTROL ROOM

 

 

__'MQ“ ;
LCb. I “j

Videotape recorder

 

 

 

 

 

 

Figure 3: Televising of counseling interview yields split-
screen videotape recording of counselor-client inter-
action. The TV cameras are behind one way glass
behind wall in control room, the TV monitor for play-
back is against the middle wall.

 

 

 

‘llllll'l. l.
ll'lllll 12"!" A
ll

|llllll

166

FIGURE 4:

Videotape playback for recall session

 

 

 

 

 

 

CONTROL ROOM

 

 

 

 

 

 

Videotape Recorder

 

 

Figure 4:

Upon completion of counseling interview (Fig. 1)
counselor leaves room and is replaced by inter-
rogator. The videotape is played back to viewing
room. A sound tape of selected incidents being
viewed is made. Videotape is started and stopped
by remote control switch by either interrogator or
client.

APPENDIX B:

An Application of Emotional Simulation in Counseling

to Accelerate Client Movement: A Pilot Study

 

\Illly iiilllllllllliili'ul .llll.‘ I- . AI
IIIII‘

An Application of Emotional Simulation in Counseling

to Accelerate Client Movement: A Pilot Study

PROBLEM
The purpose of this study was to evaluate the influence F
of IPR and simulation films on client growth in short-term per-

sonal counseling. Because this was a pilot study, designed to

f -A|.'Vl-.

 

work out wrinkles in methodology and evaluation procedures, it p,
was composed of a very small N; the result of the study has
been a more systematic and efficient design for further re-
search. The results reported herein are not considered conclu-
sive, but rather indicative of direction for subsequent hypo-
thesis testing studies.
METHOD
Nine clients were selected by professional staff from

Division of Vocational Rehabilitation (DVR) caseloads for re-
ferral to the IPR project.1 The clients selected for referral
were seen as suffering from personal and adjustment problems
which substantially interfered with rehabilitation service or
vocational placement. No attempt was made to control for
nautre of disability or personality characteristics; the cri-
terion was simply agreement by the DVR staff that prognosis
successful community placement for the client was very poor
1Appreciation is expressed to the staff of the Michigan Di-
vision of Vocational Rehabilitation (Lansing Office) for

their cooperation in this study.

168

 

In.l I 1“ ll,

169

unless he received personal counseling. Each referral was
assigned a project-Staff counselor and was.seen for six
sessions of one and one-half hours each. (N.b., While some
clients continued counseling beyond six sessions, the present
report concerns only the first six, since the goal was to es-
tablish the immediate effectiveness of IPR methods in accel-
erating short-term counseling).

The hypotheses tested were:

1. Clients receiving IPR treatment would make more

movement withing counseling than would clients

receiving counseling without IPR.

2. Clients receiving IPR treatment would make better
adjustment outside the counseling relationship.

3. Clients receiving IPR treatment would have better
placement prognosis.

PROCEDURE
Three clients were randomly assigned to each of three
treatments, which were:

Treatment 1:

 

Three sessions were held, the first 30 minutes of which
composed a regular counseling session. Each such ses-
sion was videotaped, and the remaining hour spent in
client recall of the videotape --stimulated by a cli-
nical "interrogator."

During the first 30 minutes of the remaining three

sessions, the client viewed four of the simulation films.

 

 

I'll 'Ill 5" IIIII I'llulllllll‘lll'llll It’ll-ll

170

(Maximum length of any four films was less than ten
minutes.) As he watched the films, a videotape was
made which produced a split-screen image of the client
(on one half of the screen) and the film (on the other
half). The remaining hour consisted of a counseling
session which focused on the client's videotaped re-
actions to the films.

Treatment II:

 

Reversed sequence of Treatment 1. The first three ses-
sions consisted of exposure to the simulation films (as
in the last three sessions of Treatment 1). The remain-
ing three sessions were spent in stimulated recall of
regular counseling sessions (as in the first three ses-
sions of Treatment I).

Control Treatment:

 

Six counseling sessions were conducted with no IPR
intervention.
The simulation films and traditional recall were varied
in Treatments I and II in order to provide clinical data on
any "sequence" effect that might occur, but both groups were
compared to the control group in evaluating movement from first
to sixth session. Each group was composed of two male clients

and one female client; client age ranged from 18 to 30 years

 

171

Prior to beginning the first session, a staff member met
with each client and explained the facilities and the research
orientation of the project. In the first through sixth ses-
sions, the client met with an assigned counselor.

Ratings

3
Three independent judges rated the pre- and post-

treatment videotapes for all subjects. The rating scales
used were developed in previous research (Kagan, Schauble,
Resnikoff, Danish, and Krathwohl, 1969); the first scale re-
quires judges to compare pre- and post-treatment tapes ac-
to four characteristics of client growth, which are:

cording

1. The client owns his discomfort;

2. The client commits himself to change;
3. The client differentiates stimuli; and
4. The client behaves differently.
Each of these characteristics was rated on a nine-point scale:
-4 Very markedly lessened
-3 Markedly lessened
-2 Somewhat lessened
-l Lessened a little
00 Remained the same
+1 Improved a little
+2 Improved somewhat
+3 Markedly improved
+4 Very markedly improved

2 The counselors used in this study were advanced Ph.D.

students in Counseling Psychology at Michigan State
University

The judges were advanced students in Counseling Psychology,
who had no knowledge of the types or assignment of treat-
ments.

172

In addition, the judges checked, on a five-point scale,
changes in therapeutic process and client behavior from pre-
and post-session. These items related to client insight,
lessening of defenses, ability to experience feeling, ability
to relate to the counselor, and overall therapeutic relation-

ship; the scale upon which each was rated was as follows:

Markedly lessened
Lessened somewhat
Remained the same
Improved somewhat
Improved markedly

LnJ-‘uNr-I
0

RESULTS

Interjudge reliability (as determined by the Spearman
Brown method) was found for the Characteristics of Client
Growth to be: client owns his discomfort, 0.75; commitment
to change, 0.69; differentiation of stimuli, 0.69; and be-
havior change, 0.73. The interjudge reliability on the
Therapeutic Process Variables was found to be: client ability
to gain insight, 0.59; lowering of defenses, 0.74; ability to
experience feeling, 0.66; ability to relate to therapist, 0.76;
and overall therapeutic relationship, 0.85.

There were no differences in ratings between the two treat-
ment groups, which were therfore combined for comparison with
the control group. '2 tests of differences between mean change
rates (pre- to post-session) for the treatment and control

groups were run.

173

The experimental subjects were found to progress more on
the four criteria -- owning of discomfort, commitment to change,
differentiation of stimuli, and behaving differently -- (at the

0.05 level) than the control subjects. (See Table I).

Table I
Mean Ratings (for three judges) of Change of Characteristics

of Client Growth from Session One to Session Six

Mean Rating of Change

 

Characteristic Exper. Control 5
95222 Group

Owning Discomfort +0.501 -l.1l3 1.930*

Commitment to Change +0.556 -0.553 2.495*

Differentiation of Stimuli +0.888 -0.890 2.877*

Behavior Difference +1.276 -1.113 2.967"

*Significant to .05 degree
"Significant to .01 degree

When compared to ratings of change in therapeutic pro-

cess and client behavior, it was found that each subject in

the experimental group either moved or remained at the same

level on every variable, whereas only one of the control sub-

jects made any positive movement or remained the same.

The re-

maining two control subjects were rated as moving negatively

on all five dimensions. (See Table II)

 

174

Table II

Changes in Client Behavior and Therapeutic Process

between Pre- and Post-Sessions

by Mean Change Ratings (for three judges)

Client ability to
gain insight

Client defenses
(lowering of)

Client ability to
experience feeling

IClient ability to
relate to therapist

Overall Therapeutic
relationship

Experimental

Control

Experimental

Control

Experimental

Control

Experimental

Control

Experimental

Control

Number of Clients

 

 

Positive No Negative
Movement Change Movement
4 2 -

- l 2
5 l -

l - 2
3 3 -

- 1 2
4 2 -

1 - 2
4 2 -

1 - 2

175

DISCUSSION

The dimensions of the scales on which judges attempted to
rate client behavior change are, by nature, vague and difficult
to quantify. While the interjudge reliability obtained was not
as high as desired, it is considered sufficient to indicate
that behavior on these dimensions can be reliably rated.

Those clients exposed to the IPR treament made signifi-
cantly more progress on the four characteristics of client
growth than did control clients. These results were found des-
pite the fact that the counselors had received their training
in traditional counseling procedures and had not used IPR or
IPR with simulation prior to this study. This was a de-
liberate pre-condition for these counselors, as the effective-
ness of the techniques for counselors with less enthusiasm and
familiarity than the regular research staff was to be ob-
served. The control sessions, then, were not "placebos" in the
traditional sense of the word; rather, they allowed a compari-
son of counseling with the IPR method to traditional counseling
by trained, advanced Ph.D. candidates in counseling.

Judges also rated the IPR clients as having more positive
change in the five variables ralating to change in therapeutic
process. Two of the control clients actually were rated as de-
creasing on these variables; and, in fact, all control clients

were judged to have moved negatively on the characteristics of

176

client growth. This indicates that positive movement is not
necessarily concommitant with counseling experience (at least
in the initial stages), and lends support to the "accelerating"
influence of the IPR intervention. The dimensions of client
behavior used as criteria in this study have been described as
seemingly necessary components of change for almost any theo-
retical approach to therapy (Kagan, Schauble, Resnikoff, Danish,
and Krathwohl, 1969). Within the limiations imposed by the
small N, it appears that the IPR treatments can be instrumental
in influencing psoitive change on these dimensions early in
the course of the counseling or therapy experience.

On the basis of these results, the first hypothesis, that
experimental subjects would make more movement within counseling
than would control subjects, was accepted.

The second hypothesis, that experimental subjects would
make better adjustment outside counseling than would control
subjects, was somewhat more difficult to evaluate. Employed
as criteria were subjective reports submitted to IPR by DVR
staff, family, and other personal contacts of the client.
Reports of five of the IPR clients were markedly favorable,
treating such areas as personal satisfaction on the job (or
training placement), a more suitable attitude toward the place-
ment situation and peer and supervisory staff, and social

interaction (and communication); the reports on the remaining

III".III¢IF It'll-ll

177

IPR client did not furnish enough information on which to
make a decision concerning movement.

Of the control subjects, on the other hand, one was re-
ported to have made marked improvement toward adjustment; the
remaining two were given negative reports. To quote one of
these:

The influence of your sessions with George was nil.

There was absolutely no noticeable change in behavior,
unless that he has become more stubborn and obstinate.
Interestingly, this quote refers to the one control subject who

was judged by raters as making progress within the counseling
relationship. In retrospect, it appears that--with the sup-
port of his counselor -- George was "risk-taking" in his place-
ment situation; but this type of behavior (while seemingly very
healthy activity for this man) was disruptive and was received
unsympathetically. The IPR treatment might have made consider-
able difference for this subject, in that if he had been able
to view and eal with his reactions to vaious interpersonal
situations (simulated or with his counselor), the inappro-
priateness of his "acting-out" behavior might have been re-
duced.

The final hypothesis, that experimental subjects would
have a better placement prognosis that would control subjects,
was also supported. Five of the six clients receiving IPR

counseling had been placed within a week after their sixth

session, but only one of the three clients receiving counseling

178

alone. While it is not suggested that contact with the IPR
project is solely responsible for vocational placement, it
remains that some of these individuals had been unsuccess-

fully seeking placement for more than a year.

179

REFERENCES

1.

Kagan, N., Krathwohl, D. R., 25 31. Studies in Human Inter-
action. 1967, East Lansing, Michigan: Michigan State
University, Educational Publication Services (Final Report,
Grant No. OE 7-32-0410-270).

Kagan, N., and Schauble, P. G. Affect simulation in
interpersonal process recall, Journal of Counseling
Psyphology, 1969.

 

 

Kagan, N., Schauble, P. G. Resnikoff, A., Danish, S. J.,
and Krathwohl, D. Interpersonal process recall, Journal
of Nervous and Mental Diseases, 1969 (in press)

APPENDIX C:

Referral Information Forms for Screening

Counselors and Clients

January, 1969

TO:
FROM:
SUBJECT:

PURPOSE:

SAMPLE:

PROCEDURE:

Screening Counslors
Paul Schauble

Referral of clients for research

To investigate the influence of Interpersonal Pro-
cess Recall (IPR) techniques on client growth in
therapy.

Twelve Counseling Center clients who request
personal-social counseling in screening. These
may be any clients who might ordinarily be
assigned to interns or senior staff by the screen-
ing committee.

Clients whom the screening counselor feels might
be appropriate for this study should be referred
to the two participating interns, Paul Schauble
and David Erb. Before referral, the screening
counselor will either present or read a brief
prepared statement (see the enclosed "letter").

If the client agrees to participate, Paul Schauble
will contact him by phone within a week.

Twelve clients will participate in this study.

Six will be assigned to the Treatment Group and

six to the Control Group. Two counselors (Schauble
and Erb) will each see two clients in each group.

 

 

Clients well be seen for (a minimum of) six sessions.
The format is as follows:

Treatment Group

 

(Session 1: Counseling session, pre-testing
[Session 2: Counseling session with ex-
posure to simulation films and

Films, video } videotape (approximately one

and one-half hours)
{Session 3: Same as #2

Session 4: Counseling session which is
videotaped, then played back

Video of cnslg for stimulated recall

session

UI

Session Same as #4
Session 6: Same as #5

181

Referral of

182

2
Synopsis: Each client receiving experimental
treatment is seen for six sessions,
five of which involve videotape
feedback.

clients for research

Control Group

 

Will be seen for six "traditional" counseling
interviews. The client will not be exposed to
IPR techniques, but will be seen for sessions of
one and one-half hours each and will then fill
out the interview rating forms.

183

Traditional Counseling Group

Michigan State University
Counseling Center

207 Student Services Building
East Lansing, Michigan 48823

Dear Student:

We at the counseling center believe that one of the ways we
can become increasingly helpful to students like yourself is
through careful study of your problems and our effectiveness
in helping you with them. We are presently in the process of
evaluating the use of longer contact sessions with students
as a possible means of facilitating "growth" in counseling.
We would like you to consider participating in this project.

If you agree to participate, commitment will consist of meeting
with your counselor for 1% hours for your first seven sessions,
(instead of 1 hour per session). Your counseling sessions
would be recorded on audiotape and you will also be asked to
complete some tests and inventories before and after counseling.

Ybur responses to the test material and the audiotapes made
are strictly_confidential. We can assure you that your responses
will be used anonymously in our research endeavors.

 

If you agree to participate, the project will take somewhat less
than fourteen hours for the seven weeks of contact. (Any
additional counseling contacts would be on the more common 1
hour per week basis.) We recognize that this is a considerable
investment of your time, but our experience indicates that it
will be of considerable value in our work together, as well as
in our research.

In summary, your participating--including time for testing--
would involve an additional seven hours over seven weeks. If
you agree to participate in (or have any questions about) this
project, you will be contacted in about a week.

Thank you for considering participating.

184

Sincerely,

Paul G. Schauble
Counseling Intern

William Mueller
Assistant Director for
Research

185

Counseling with IPR Group

Michigan State University
Counseling Center

207 Student Services Building
East Lansing, Michigan 48823

Dear Student:

We at the counseling center believe that one of the ways we
can become increasingly helpful to students like yourself is
through careful study of your problems and our effectiveness
in ehlping you with them. We are presently in the process

of evaluating the use of videotape in counseling with students
as a possible means of facilitating "growth" in counseling.

We would like you to consider participating in this project.

If you agree to participate, commitment will consist of meeting
with your counselor for 1% hours for your first

(instead of 1 hour per session). Portions of your counseling
sessions would be recorded on videotape and the additional

time is needed to allow you to view a playback of the video-
tape. You will also be asked to complete some tests and in-
ventories before and after counseling.

Your responses to the test material and the videotapes made are
strictly confidential. We can assure you that your responses
will be used anonymously in our research endeavors.

If you agree to participate, the project will take somewhat
less that fourteen hours for the seven weeks of contact. (Any
additional counseling contacts would be on the more common 1
hour per week basis). We recognize that this is a considerable
investment of your time, but our experience indicates that it
will be of considerable value in our work together, as well as
in our research.

In summary, your participating--including time watching video-
tapes and testing--would involve an additional seven hours over
seven weeks. If you agree to participate in (or have any
questions about) this project, you will be contacted in about

a week.

Thank you for considering participating.

186

Sincerely,

Paul G. Schauble
Counseling Intern

William Mueller
Assistant Director for
Research

APPENDIX D:

Characteristics of Client Growth Scales

Owning of Feelings in Interpersonal
Processes: A Scale for Measurement

Level 1

The client avoids accepting any of his feelings. When feelings
are expressed, they are always seen as belonging to others, or
entirely situational and outside of himself.

Example: The client avoids identifying or admitting to any
feelings by either remaining silent or denying he feels any-
thing at all.

In summary, the client seems to believe he is not a part of the
world of feelings.

Level 2

The client may express feelings vaguely, but they are not
really accepted as coming from within. Feelings are not tied
to himself or specific interactions but seem to pervade his
life. In general he shows little involvement with his feelings.

Example: The client discusses or intellectualizes about
feeling in a detached, abstract manner and gives little evidence
of knowing the origin of his feeling.

In summary, any expression of feeling appears intellectualized,
distant, and vague.

Lem

The client can usually identify his specific feelings and
their source but tends to express what he feels in an intel-
lectualized manner.

Example: The client seems to have an intellectual grasp of
his feelings and their origin but has little emotional proxi-
mity to them.

In summary, the client usually ties down and owns his feelings
in an intellectual manner. Level 3 constitutes the minimal
level for gain.

188

189

Level 4

The client almost always acknowledges his feelings and can
express them with emotional proximity but at times he has
difficulty in connecting the feelings to their source.

Example: The client shows immediate and free access to his
feelings but has some difficulty in understanding these
feelings or their connection to people or concerns in his
life.

In summary, the client owns his feelings fully but
seems to have some difficulty in linking them to specific
things in his life.

Level 5

The client clearly embraces his feelings with emotional
proximity, and at the same time shows awareness that his
feelings are tied to specific behavior of his own and
others.

Example: The client is completely in tune with his
feelings, expresses them in a genuine way, and is able
to identify their origin.

In summary, the client clearly owns his feelings and
accurately specifies their source.

190

Committment to Change in Interpersonal
Processes: A Scale for Measurement

Level 1

The client shows no motivation for change. He is resistive

to attempts by the second person to accomplish change or explore
the desirability of change. This may take either the form of
complete passivity or defensive hostile behavior.

Example: The client may question the efficacy of the helping
process and the helpfulness of the second person to an in-
appropriate degree, i.e., he seems to be attacking the change
process, or he is totally unreceptive and uncooperative to the
efforts of the second person.

In summary, the client gives no verbal or behavioral evidence
of a desire to change.

Level 2

While the client expresses the desire to change, his committ-
ment is noticeably questionable. The client seems to resist
the impact of the helping process, and is paséive or evasive
in his interaction with the second person.

Example: The client seems more involved in rationalizing or
defending his behavior than he is in working on changing it.
He may communicate the importance or necessity of change, but
there is little behavioral evidence of cooperation or real
committment to the change process.

In summary, there is some verbal committment to change but no
behavioral evidence of that committment.

Level 3

The client vacillates between an overt desire and/or committ-
ment to change, and the desire to resist or evade change in
order to avoid pain. He may express the desire to change and
attempt to confront his feelings but varies in his maintenance
of motivation to change.

Example: The first person deals with the feelings which are
centrally involved with his problem, but there is some ten-
dency to rationalize his behavior or move from topic to topic.

191

In summary, the client expresses the desire to change, but
vacillates in his committment to change and cooperation with
the second person. Level 3 is the minimal level for change
to take place.

Level 4

The client expresses a desire to change, and while at times
is reluctant to experience painful feelings involved in ex-
ploring his behavior, actively tries to cooperate with rather
resist the second person's efforts.

Example: The client continually returns to the task of
understanding his behavior and his role in it, although
he experiences (and may overtly express) hesitancy in
dealing with his painful feelings.

In summary, the client wants to change, and he cooperates
with the change process in a verbal and a behavioral manner.

Level 5

The client expresses a clear desire to change. He actively
cooperates with the second person in the counseling process,
even to the point of accepting painful feelings accompany-
ing the exploration of his problems. The client is deeply
involved in confronting his problems directly, and makes no
attempt to evade or resist the experiencing of feelings and
behaviors.

Example: The client pursues the exploration of his feelings
and behavior, attempting to gain a better understanding of
his behavior in order to change. He faces his problem
directly rather than avoiding it or changing the subject.

In summary, the client clearly expresses verbally and be-
haviorally a desire and committment to change his behavior.

192

Differentiation of Stimuli in Interpersonal
Processes: A Scale for Measurement

Level 1

The client seems unable to identify or differentiate his
problems, feelings, or concerns and is unwilling or unable
to move in this direction.

Example: The client may show either no grasp of his feelings
or problems or he seems to respond to everything in very much
the same way.

In summary, the client seems totally unable or unwilling to
make discriminations between his feelings or the people and
events in his life.

Level 2

The client may talk about different feelings and problems
but he shows little grasp of real differences among them or
of their effect on him as an individual.

Example: The client may respond in a rehearsed manner to
people and events as if his reactions were pre-determined
by stereotyped expectations.

In summary, the client seems to differentiate between his
feelings, people, or events at only a superficial level.

Level 3

The client vacillates between discussing different stimuli
and their effect on him (as a unique person) and responding
in a general unclear fashion.

Example: The client may initially make clear differentiations
about his world, but he is unable to productively maintain this
behavior and lapses into hazy generalizations which do not seem
to have immediate meaning to him.

In summary, the client clearly differentiates between discrete
stimuli, but is unable to develop his perceptions or use them
effectively. Level 3 constitutes the minimal level of dif-
ferentiation for growth.

193

Level 4

The client is almost always aware of the differences between
stimuli in his world, and he responds to them in a differential
manner. He actively attempts to become more aware of his
various emotions and their sources.

Example: The first person may show a strong desire to under-
stand himself as a unique and complex person and he attempts
to differentiate and identify the distict people and events
in his world.

In summary, the first person is actively involved in a suc-
cessive differentiation of his feelings and events in his
world.

Level 5

The client always perceives the different stimuli in his world
and reacts to them in a variety of differential ways. He is
fully aware of his own unique effect on the discrete stimuli
around him.

Example: The client may clearly differentiate among his
characteristics and those of others. He shows immediate
awareness of his own unique characteristics, and the re-
actions he stimulates in others.

In summary, the first person recongizes individuality in
himself and in others, and responds in an appropriate manner.

1 I I'll! III III I Illv .' Ill '1 l l '1' "II III 'I I" ll ill

APPENDIX E:

Degree of self exploration scale

‘ ill: III Ill 1' In ill III III I i

Scale VIII

HELPEE SELF-EXPLORATION IN INTERPERSONAL PROCESSES, II

A Scale for Measurement1

Level 1

The second person does not discuss personally relevant material,
either because he has had no opportunity to do such or because
he is actively evading the discussion even when it is intro-
duced by the client.

Example: The second person avoids any self-descriptions or
direct expression of feelings that would lead him
to reveal himself to the client.

In summary, for a variety of possible reasons, the second per-
son does not give any evidence of self-exploration.

Level 2

The second person responds with discussion to the introduction

of personally relevant material by the first person but does so
in a mechanical manner and without the demonstration of emotional
feeling.

Example: The second person simply discusses the material with-
out exploring the significance or meaning of the
material or attempting further exploration of the
feeling in our effort to uncover related feelings or
material.

In summary, the second person responds mechanically and re-

motely to the introduction of personally relevant material by
the first person.

Level 3

The second person voluntarily introduces discussions of per-
sonally relevant material but does so in a mechanical manner
and without the demonstration of emotional feeling.

195

196

Example: The emotional remoteness and mechanical manner
of the discussion give the discussion a quality of
being rehearsed.

In summary, the second person introduces personally relevant
material but does so without spontaneity or emotional proximity
and without an inward probing to newly discover feelings and
experiences.

Level 4

The second person voluntarily introduces discussions of per-
sonally relevant material with both spontaneity and emotional
proximity.

Example: The voice quality and other characteristics of the
second person are very much "with" the‘feelings and
other personal materials which are being verbalized.

In summary, the second person introduces personally relevant
disucssions with spontaneity and emotional proximity but with-
out a distinct tendency toward inward probing to newly dis-
cover feelings and experiences.

Level 5

The second person actively and spontaneously engages in an in-
ward probing to newly discover feelings and experiences about
himself and his world.

Example: The second person is searching to discover new
feelings concerning himself and his world even
though at the moment he may be doing so, perhaps,
fearfully and tentatively.

In summary, the second person is fully and actively focusing
upon himself and exploring himself and his world.

1The present scale "Self-exploration in interpersonal pro-
cesses" has been derived in part from “The measurement of
depth of intrapersonal exploration (Truax 1963) which has
been validated in extensive process and outcome research on
counseling and psychotherapy (Carkhuff and Truax, 1965, 1965a,
1965b; Rogers, 1962, Truax, 1963; Truax and Carkhuff, 1963,
1964, 1965). In addition, similar measures of similar con-
structs have received extensive support in the literature of

II 'II. ill III II I 'l ||| I I

197

counseling and therapy (Blau, 1953; Braaten, 1958; Peres,
1947; Seeman, 1949; Steele, 1948; Wolfson, 1949).

The present scale represents a systematic attempt to reduce
the ambiguity and increase the reliability of the scale. In
the process many important delineations and additions have
been made. For comparative purposes, Level 1 of the present
scale is approximately equal to Stage 1 of the earlier scale.
The remaining levels are approximately correspondent: Level
2 and Stages 2 and 3; Level 3 and Stages 4 and 5; Level 44
and Stage 6; Level 5 and Stages 7,8, and 9.

APPENDIX F:

WISCONSIN RELATIONSHIP ORIENTATION SCALE

II. 'I ill.‘ nlll'. I. I! ll . I [I l 1" III

WISCONSIN RELATIONSHIP ORIENTATION SCALE

DIRECTIONS: Check the item which best describes your feelings

1.

 

toward the counselor.

I would attempt to avoid any kind of interaction or
relationship with this person.

If no one else were available, I might consult this
person for specific information of a factual, e.g.,
educational or vocational nature, but I would avoid
any personal exposure.

I would be willing to talk with this person about
factual, e.g., educational or vocational concerns,
and some of the personal meanings connected with
these.

I would be willing to talk with this person about
many of my personal concerns.

I have the feeling that I could probably talk with
this person about almost anything.

199

APPENDIX C:

Therapy Session Report Items

Therapy Session Report Items*

This booklet contains six questions about the therapy session
which you have just completed. These questions have been
designed to make the description of your experiences in the
session simple and quick.

The questions have a series of numbered statements under them.
You should read each of these statements and select the one

which comes closest to describing your answer to that question.
Then circle the number in front of your answer.

BE SURE TO ANSWER EACH QUESTION.

Client Identification

Date of Session

 

*These items were selected from the Therapy Session Rgport,
Copyright by Psychotherapy Session Project, 1966. All property
rights reserved by the Psychotherapy Session Project, 907

South Wolcott Avenue, Chicago, Illinois, U.S.A.

201

1.

202

HOW DO YOU FEEL ABOUT THE SESSION WHICH YOU HAVE JUST
COMPLETED?

(Circle the one answer which best applies)

THIS SESSION WAS:

1. Very poor

2. Pretty poor

3. Fair

4. Pretty good

5. Very good

6. Excellent

7. Perfect

HOW MOTIVATED FOR COMING TO THERAPY WAS YOUR PATIENT
THIS SESSION?

1.‘ Had to make herself (himself) keep the appointment
2. Just kept her (his) appointment

3. Moderately motivated

4. Strongly motivated

5. Very strongly motivated

HOW MUCH PROGRESS DID YOUR PATIENT SEEM TO MAKE IN THIS
SESSION?

1. Seems to have gotten worse

2. Didn't get anywhere this session
3._ Some progress

4. ‘Moderate progress

5. Considerable progress

6. A great deal of progress

203

HOW WELL DOES YOUR PATIENT SEEM TO BE GETTING ALONG AT
THIS TIME?

1. Quite poorly; seems in really bad condition

2. Fairly poorly; having a rough time

3. 80-50; manages to keep going with some effort

4. Fairly well; has ups and downs

5. Quite well; no important complaints

6. Very well; seems in really good condition'

HOW MUCH WERE YOU LOOKING FORWARD TO SEEING YOUR PATIENT
THIS SESSION?

1.
2.

3.

5.

I anticipated a trying or somewhat unpleasant session
I felt neutral about seeing my patient this session

I had no particular anticipations but found myself
pleased to see my patient when the time came

I had some pleasant anticipation

I definitely anticipated a meaningful or pleasant
session

TO WHAT EXTENT WERE YOU IN RAPPORT WITH YOUR PATIENT'S

FEELINGS?

1. Little

2. Some

3. A fair amount

4. A great deal

5. Almost completely
6. Completely

204

Therapy Session Report Items*

This booklet contains six questions about the therapy session
which you have just completed. These questions have been
designed to make the description of your experiences in the
session simple and quick.

The questions have a series of numbered statements under them.
You should read each of these statements and select the one

which comes closest to describing your answer to that question.
Then circle the number in front of your answer.

BE SURE TO ANSWER EACH QUESTION.

Client Identification

 

Date of Session

 

*These items were selected from the Therapy Session Report,
Copyright by Psychotherapy Session Project, 1966. All property
rights reserved by the Psychotherapy Session Project, 907

South Wolcott Avenue, Chicago, Illinois, U.S.A.

1.

205

CLIENT FORM THERAPY SESSION REPORT

HOW DO YOU FEEL ABOUT THE SESSION WHICH YOU HAVE JUST
COMPLETED?
(Circle the one answer which best applies.)

THIS SESSION WAS:

1.

Very poor

Pretty poor

Fair

Pretty good

Very good

Excellent

Perfect

DID YOU FEEL ABOUT COMING TO THERAPY THIS SESSION?
Unwilling; felt I didn't want to come at all
Somewhat reluctant to come

Neutral about coming

Somewhat looking forward tocoming

Very much looking forward to coming

Eager; could hardly wait to get here

HOW MUCH PROGRESS DO YOU FEEL YOU MADE IN DEALING WITH
YOUR PROBLEMS THIS SESSION?

In some ways my problems seem to have gotten worse
this session.

Didn't get anywhere this session
Some progress

Moderate progress

Considerable progress

A great deal of progress

4.

206

HOW WELL DO YOU FEEL THAT YOU ARE GETTING ALONG, EMO-
TIONALLY AND PSYCHOLOGICALLY, AT THIS TIME?

I AM GETTING ALONG:

Quite poorly; can barely manage to deal with things
Fairly poorly; life gets pretty tough for me at times
So-so; manage to keep going with some effort

Fairly well; have my ups and downs

Quite well; no important complaints

Very well; much the way I would like to

HOW WELL DID YOUR THERAPIST SEEM TO UNDERSTAND WHAT YOU
WERE FEELING AND THINKING THIS SESSION?

MY THERAPIST:

l. Misunderstood how I though and felt

2. Didn't understand too well how I thought and felt

3. Understood pretty well, but there were some things he
(she) didn't seem to grasp.

4. Understood very well how I thought and felt

5. Understood exactly how I thought and felt

HOW HELPFUL DO YOU FEEL YOUR THERAPIST WAS TO YOU THIS

SESSION?

1. Not at all helpful

2. Slightly helpful

3. Somewhat helpful

4. Pretty helpful

5. Very helpful

6. Completely helpful

      

 

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3975