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. ' L.

L I B R A R I

Michigan State ‘
University

This is to certify that the

thesis entitled

Completed Psychotherapies: An Investigation
of the Communication of Values, Therapeutic Outcome,
and Selected Therapist Variables

presented by

Stephen B. Bondy

has been accepted towards fulfillment
of the requirements for ‘

Ph. D. degree inCounsel Ing

/ jcfl . ,é '

Major professor

Date June 5, 1969

0469

ABSTRACT

COMPLETED PSYCHOTHERAPIES: AN INVESTIGATION OF THE
COMMUNICATION OF VALUES, THERAPEUTIC OUTCOME,
AND SELECTED THERAPIST VARIABLES
By

Stephen B. Bondy

This investigation examined the communication of two
specific values and their relation to therapeutic outcome,
therapist experience and the focus of the therapists' state-
ment. The data for this investigation was taken from the
research library of the Counseling Center at Michigan State
University. The clients represent late adolescent males
and females who are self referred for treatment and agreed
to participate in a research project.

Twelve five-minute segments were randomly selected
from each of thirty-five completed psychotherapies. Each
therapist statement was scored on the basis of the values
communicated (Responsible and Trustful) and the focus of
the therapist statement. Inter—rater reliability was con-
sistently strong. Internalizing-Externalizing was scored
at .89; Responsible at .95; and Trustful at .88. The high
inter-rater reliability is attributed to two principle

factors: (1) intensive pre-training of the raters and

.P-Ia. .- aux.-

 

Stephen B. Bondy

(2) the investigator's identification of each therapist
statement in each five—minute segment.

The intent of the investigation was to examine
systematic differences between specific values communi-
cated by the therapist and therapeutic outcome as mea—
sured by pre— to post—changes in MMPI scores; the experi-
ence level of the therapist; and the focus of the
therapist's statement (i.e., internalizing-externalizing).
The data did not support the first two hypotheses. There
was no difference between values communicated, therapy
outcome, and therapist experience. There was a trend
toward significance between the value Trustful and the
externalizing focus of the therapist's statement. This
result suggests that values may be communicated in
reference to specific objects in the environment rather
than in a more generic way.

Conclusions suggested that future investigations
of values should be broader in scope rather than limited
to two specific values in a more abstract form. Tradi-
tional methods of dichotomizing (i.e., outcome and
therapist experience) may not be the best criteria for
examining the influence of values in psychotherapy.
Content analysis was shown to be a highly reliable
measure for studying verbal behaviors of the client

and/or the therapist.

COMPLETED PSYCHOTHERAPIES: AN INVESTIGATION OF THE
COMMUNICATION OF VALUES, THERAPEUTIC OUTCOME,

AND SELECTED THERAPIST VARIABLES
By

Stephen Bf Bondy

A THESIS

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

DOCTOR OF PHILOSOPHY

Department of Counseling, Personnel Services
and Educational Psychology

1969

 

r.
S.
i
‘1.
a
E
l
i
a

11

TO MARY
who shared doubts;
but remained confident

ACKNOWLEDGMENTS

I would like to expressly thank the Drs. Bill L.
Kell and Cecil Williams who assisted with the thesis well
after its inception: a time consuming task for them.
The other members of the thesis committee who deserve
special mention and my gratitude are Drs. Robert Ebel
and William Farquhar. Dr. Norman Abeles, originally the
thesis chairman, went on sabbatical shortly after the
thesis was begun, but his thinking and impact was con-
siderable in this investigation.

The raters of the tape segments deserve special
credit for long hours of work and sustaining my anxious
pressure: Kathy Scharf, Dave Harley, and John Mullen.

And to Joshua Hull and Frederick Eigenbrod who

walked beside me and helped me grow.

iii

TABLE OF CONTENTS

ACKNOWLEDGMENTS . . . . .

LIST OF TABLES.

INTRODUCTION . . . . . . . .
RELEVANT LITERATURE . . .

Definition of Values. . . . . . . .
The Impact of Values. . . . . . . . .
Measurement of Values . . . . . . . .
Content Analysis . .

Therapist Dimensions.

Client Dimension

EXPERIMENTAL HYPOTHESES. . . . . . . . .
Source of Data. . . . . . . . . . .
Selection of Cases . . . . . . . . .
Tape Segment Sampled. . . . . . . . .
Scoring Manual. . . . . . . . . . .

Scoring Reliability

RESULTS . . . . . . . . . . . . .
Reliability. . . . . . . .
Hypotheses . . . . . . . . . .

DISCUSSION . . . . . . . . .

Inter-rater Reliability.

Outcome . . . . . .
Therapist Experience. . . .
Focus of Therapist Statement .

Implications for Future Research. : : : I
SUMMARY . . . . . . . . . . . . .
REFERENCES . . . . . . . . . .
APPENDIX.

iv

Page
iii

\omwwH

lu
17
18
20

21
21

23
26

26
27

32
32
33
3M
35
37
39
Al

“7

 

pr
II
I.
3
l

 

Table

LIST OF TABLES

Inter-rate reliability of scoring categories

Analysis of variance of rater's frequencies
for the value: responsibility.

 

Analysis of variance of the rater's frequen-
cies for the value: trustful . .

Analysis of variance of ratings of ambiguity
for the value: responsibility. . .

 

Analysis of variance of the ratings of
ambiguity for the value: trustful

Correlation between responsibility and
trustful and the focus of the therapist's
statement and p value associated with the
difference between the correlation .

Page
27

28

28

29

29

3O

.- -51 Q.“ 1
fl

 

INTRODUCTION

Dimensions of therapist behavior which contribute
to successful psychotherapy have received considerable
attention. The literature is a plethora of data regard-
ing therapist behavior and selected aspects of the thera-
peutic process. Therapist behaviors such as Judgment
(VanderVeen and Stotler, 1960), rating of process (Gendlin
gt_al., 1960) and therapist reaction to dependency (Winder
§E_al,, 1962; and Snyder, 1953), have been examined in
View of therapeutic outcome. Therapist characteristics
within the therapy hour associated with success are
transparency (Truax and Carkhuff, 1965), empathy (Truax
g£_al., 1966), counselor verbal mode (Pallone and Grande,
1965), personality and value similarity (Carson and Heine,
1962; Cook, 1966; Welkowitz, Cohen, and Ortmeyer, 1967).

Historically, the nature of values and their rele-
vance to daily living has received the attention of
philosophers. It is given that values are central to
daily operations. Awareness of the values per g; may be
less than clear; but when pressed, the individual is able

to state values he espouses which guide his daily behavior.

Psychologists have stated that value Judgments
should not be made about clients. In many ways, the
intent was that value Judgments not be made on the basis
of behavior. It is naive to assume that values are not
operating within therapy, and these values have no im-
pact upon the client. Rosenthal (1955) examined the
value structure of the client in relation to the thera-
pist. The significant result of this study was that
clients who were described as successful had a value
structure more similar to the therapist than did clients
described as less successful.

It is the purpose of this investigation to examine
the communication of therapist values as a function of
specific therapist variables and outcome of therapy.
Focus of the therapist's statement (Internalizing-
Externalizing), ambiguity of the therapist's statement
in relation to the values expressed, and experience of

the therapist are the primary foci of the study.

 

RELEVANT LITERATURE

'Definition of Values

General discussions of values and value change in
psychotherapy scarcely have mentioned defining charac-
teristics. Katz (1960), Kluckhohn and Strodbeck (1961),
and Rokeach (1968) have addressed the problems of defining
values or value systems. These writers conclude that
values are central to attitude and belief systems. Dis-
cussions of value and value systems remain at abstract
levels and generally do not attempt to delineate intrinsic
qualities.

Woodruff and DiVesta (1948) used as their premise

that values are "a generalized condition of living which

the individual feels has an Important effect on his well {I
being." LoveJoy (1950) suggests "man is a habitually E
self Judging andself-appraising animal." In this con- A
text man is always evaluating himself in terms of what he ,
"should" or "ought" to do. Kluckhohn and Strodbeck (1961) A

define values in the following context:

Value orientations are complex but definitely
patterned (rank ordered) principles resulting
from the transactional interplay between three
analytically distinguishable elements of the
evaluative process--the cognitive, the affec-
tive, and the directive elements--which give

 

order and direction to the ever flowing stream

of human acts and thoughts as these relate to

the solution of 'common' human problems.

Wheelis (1958) shares similar Views with the above
definition. He feels that values are "a product of the
life process" and that values "cannot be lumped together,
for they exist on different levels. . . . Values are
structured in a hierarchy." In a broader sense, he
feels that identity and values cannot exist apart.

C. Kluckhohn (1951) feels "A value is a conception
explicit or implicit, distinctive of an individual or
characteristic of a group, of the desirable which influ-
ences behavior selections from available modes of action."
Rokeach (1968) states "a person's value system may thus be
said to represent a learned organization of rules for mak-

ing choices and resolving conflicts . . . between two or

more modes of behavior or between two or more end states

 

of existence." More precisely he states, "A value is a {T
type of belief, centrally located within one's total be- i

lief system about how one might or ought not to behave. '

. . . Values are thus abstract ideas positive or negative,

not tied to any attitude, obJect, or situation. . . ." g

Erlich and Weiner (1961) summarize succinctly the
various definitions of values offered by the social
sciences:

By and large, definitions of values, at least those
provided by social scientists have involved various
degrees of reference to: (a) their affective
dimension—~positive or negative tone; (b) the fact
that they may be either implicit or explicit; (c)

their desirability either in terms of long range

preferences or in terms of preferable alternatives

in a given situation; (d) their tendency to deter-
mine directionality of behavior, and also to

result in a certain consistency of responses to

recurrent situations; and (e) their aspect as both

means and goals of action.

Values are central to individual beliefs and atti—
tudes. The impact of these elements are felt in inter-
personal relationships. More specifically, they are felt
in psychotherapy relationships. The effect is not clear,
but the influence is denied by few. Decisions made
reflect values held. Such choices alter the sequence of

events.

The Impact of Values

 

The suggestion that the psychiatrist be guided by
these ethical goals of treatment is not intended
to supercede my initial suggestion that he must
safeguard against any interference with his pro-
fessional attitude by his personal set of ethical
values in terms of matters of Weltanschauung
(Fromm-Reichman, 1950).

 

The historically predominant View stated above has

—.‘ a... mi j

become increasingly untenable. Recent research has led to

LI 4: ’L:‘

the notion that this View is simplistic. Three years after
this statement, the American Psychological Association
rather clearly stated its position: "The attitudes,

values and ethical concepts of the psychologist are ex-
pressed in his clinical relationships and very directly
influence the directions taken by his client" (APA, 1953).
Subsequent research has supported this position. Much of

the work in this area remains theoretical. Empirical data

is lacking; consequently, only tentative notions are
brought forth.

London (196A), in one of the few books devoted to
the specific consideration of values in psychotherapy,
states:

Therapists have personal value systems, and it is

difficult to see how they could possibly form

relationships with clients even for the sole

purpose of understanding them, never mind helping

them, without being cognizant of their own values

and making implicit comparisons between themselves
and their values and those of their clients.

If the comparisons are implicit, the therapist may
not be sensitive to the communication of the values at a
specific moment. Even if he were fully aware of and with-
holding the values, it seems that this might lead to
therapeutic difficulty. London continues and states this
more precisely: "That the value involved for the thera—
pist is a technical rather than a moral one is beside the
point. It is his value, not the client's, and unless he
can communicate it, he cannot function therapeutically."

Warters' (1964) position is strong. It is her notion
that not only are values communicated, but they are "im-
posed" on the client. Her description of the communication
of values, however, leads one to believe that the state-
ment may be extreme. She concludes: "He (the counselor)
communicates his values through his ways of interacting

with students and others, through his own techniques of

living and life style, and even through his vocation."

Samler (1965) and Williamson (1962) concur with
Warters. Both feel that multilevel functioning of values
is inherent in the therapy process. The various levels
of awareness also affect the relative degree of clarity
of the values when they are communicated. Neither sug—
gest the consequences of such communication, but each
feels that the influence is unavoidable and undeniable.

Lowe (1962), in discussing the dilemma of values,
suggests that values be stated and clear in order to be
of maximum benefit to "special" interest groups which
might share similar values. Lowe arrives at his decision
by logic. He cites no research on the impact and nature
of values. The effect of values in psychology is a
philosophical given. Though many decisions have been
made by this method, it is a rather strong statement in
view of the paucity of research and the inconclusive re—
sults yielded from the available data.

Patterson's (1959) statement is easily conceptualized
in terms of the therapist values operating in the thera—
peutic contact. "Goals reflect values, and therapeutic
goals are no exception. The therapist has goals, either
specific or general, and these are influenced by his
values." Continuing, he states: "The therapist has no
choice in this since all behavior--all goals and methods

of therapy--are expressions of the therapist's values."

 

om . ...

 

'4'. 'aishr‘“ Jar...

 

From a theoretical position, values have an impact
on the course of events in therapy. The nature of this
impact and the communication of these values is yet to be
determined. Kessel and McBrearty (1967), in the most
recent and most comprehensive review of the literature on
values, suggest how values are communicated:

What the therapist hears or fails to hear, what he
chooses to interpret or not to interpret, his
questions, statements, and other reactions both
verbal and nonverbal, are all to a large extent
determined by the therapist's values. Since so
much of the therapist's activity is related to

his values, he cannot help but send value communi-

cations to the patient.

Word choice may reflect values. The general dis-
cussions of values all refer to rather global character—
istics, such as "life-style," "vocation," and "goals of
therapy." The discussions have implied, but not specifi-
cally stated, that verbal content may reflect the values
held. Samler (1965) approximates such a statement:
"Values are at the heart of the counseling relationship, I

and are reflected in its content and affect the process."

Bandura and Walters (1963) feel that the communi-

 

cation of values may be a peripheral activity and the

......

client may learn the values of the therapist even though
they were not intended to be transmitted. They feel that
the value communication may be secondary to the task of

assisting the client to resolve conflicts.

Measurement of Values

 

The most widely used instruments for measuring values

have been the Allport-Vernon—Lindzey Study of Values (1960)

 

and Morris' Ways of Life (1956). Both are based on broad

 

categorization and assume a relatively sophisticated audi—

ence. Buros (1965) suggests that the Study of Values has

 

many questionable characteristics which interfere with
adequate interpretation of specific values for individuals.
Erlich and Weiner (1961) make similar criticisms regarding

the Ways of Life. Specifically, they state:

 

Among other things, the language in which 'Ways'

is written appears to be too complex or abstract,

and the task of evaluating each 'way' too cumber-

some to allow effective administration of the

document. . . . Also, the problem of how to rate

the responses on the 'Ways' in terms of appropriate

factor loading does not appear easily resolvable.

Morris (1956) suggests that there are three basic
values: (a) object values--those things which are prefer-
able; (b) operative values—-those values which involve
goal directed behavior; and (c) conceived values—~prefer—
ences for symbolically inducted objects. As stated above,
the measurements of these values are a problem and are
not clear. Wheelis (1958) suggests a dichotomy of values:
Instrumental and Institutional values.

Instrumental values are "tool using" as a means of
attaining a desired object. The instrumental values are
founded on experimentation and observation. Within this

context, instrumental values are more secular in orien-

tation and subject to change with increased knowledge

 

f. a,
g

 

10

and technology. Institutional values, on the other hand,
are more concerned with the myths and mores of a society.
The interaction between these values is ipsative.

Rokeach (1968) has proposed a value instrument
which has specific values, both instrumental and terminal,
which are rank ordered by the individual. It is possible
by means of this instrument to assess the end state de-
sired by the individual values as a means to the end
state in the terminal value system.

Explaining further the notion of instrumental and
terminal values he states:

An instrumental value is therefore defined as a

single belief which always takes the following

form: 'I believe that such-and-such a mode of
conduct (e.g. honesty, courage) is personally

and socially preferable in all situations with

respect to all objects.' A terminal value takes

a comparable focus: 'I believe that such-and-

such an end—state of existence (e.g. salvation,

a world at peace) is personally and socially

worth striving for.’ Only those words and

phrases that can be meaningfully inserted into

the first sentence are instrumental values, and

only those words and phrases that can be mean-

ingfully inserted into the second sentence are
terminal values.

The Rokeach instrument is relatively new and has not
had sufficient use to make general conclusions. However,
Bondy (1968), in a preliminary study, compared counselors
and clients on_the Rokeach value survey. It was found
that, as far as terminal values were concerned, there

was a significant positive correlation between the values

of clients seen and the values of the counselors. With

 

ll

respect to the instrumental value, there was a lower, but
significant correlation between counselors and students
who continued therapy for three or more hours. Students
who discontinued contact prior to the third interview
had the only non—significant correlation. These data
suggest that students going to a university counseling
center ranked the terminal values essentially the same
as the counselors. With respect to instrumental values,
those who discontinued contact prior to the third inter-
view had ranked instrumental values which were different
from those of the counselors. It may be that values are
communicated relatively early in the therapeutic encounter.
Paivio and Steeves (1963) examined "personality
variables in selective perception and recall of speech
in a situation where more than one person was speaking

simultaneously." The authors used the Study of Values

 

as the instrument for assessing values of the subjects.

 

Two voices were recorded simultaneously containing words

from the theoretical and religious scales.

 

The subjects were instructed to listen to the tape

”A
t

recordings and to write all they could remember. The a?
results suggested that a greater number of words of

religious or theoretical value were retained in direct

relationship to the person's score on each of these

variables. Selective attention in such circumstances

12

may have some relevancy in the communication and retention
of values in the therapeutic setting.

The selective attention suggested by these results
would seem to imply, when interpolated to the therapy
session, that the client hears what is most familiar or
close to him. Perhaps the value similarity between the
therapist and the client is a relationship maintaining
variable. Welkowitz et_al, (1967) states, ". . . if
values are too divergent between two people, there may
be so much disequilibrium that they do not want to main-
tain the dyad."

Interpolating again from aligned research, Carson
and Heine (1962) suggest that similarities in personality
between therapist and client may be of a curvelinear form.
A great deal of similarity or considerable dissimilarity
may contribute to the dysfunction of therapy because of

the lack of communality of the participants. Lichtenstein

m -_.£. *1:
. _

(1966) failed to replicate the Carson and Heine study. 1
Cook (1966) states rather clearly some of the anx-

ieties in the examination of values in psychotherapy.

’ .1 .1 ~

 

"Some counselors suspect, others fear, that their values ,”
influence the client regardless of any intent on their

part to remain neutral; but little evidence exists to

indicate that this is actually the case." Comparisons

of client and counselor on the Semantic Differential and

the Allport-Vernon-Lindzey Study of Values resulted in a

 

 

13

medium degree of similarity between client and counselor.
The similarity of a moderate degree appeared to bring
about a more positive evaluation. In general, there is
a measurable impact of counselor values even in a brief
counseling contact.

Welkowitz, Cohen, and Ortmeyer (1967) found values
to be more alike between therapist and his patient than
randomly paired therapist—patient pairs. Concommitantly,
patients rated as most improved had values more similar
to their therapists than did patients rated as less im-
proved. These results are consistent with the findings
of Rosenthal (1955). What is not clear from these in-
vestigations is the manner in which the therapist communi-
cated these values.

Kessel and McBrearty (1967) conclude, from a rather

lengthy discussion of allied research, that "despite the

   
 

non-comparability of studies, it may be concluded that the

1 “.2

variable of similarity of therapist and patient, affects

m‘ ‘~

 

therapeutic outcome." More specifically they state: "it

 

can be concluded that the therapist communicates his values

‘ donmnnm‘h;
' a .'_ «mm...

to the patient . . . certain therapists are likely to be
more successful with certain patients because of the inter—
action of the therapist-patient value orientations. . . ."
Dukes (1955), in the earliest review of the litera-
ture, concluded that research had been confined to three

broad areas. The research conducted subsequent to his

14

article has not deviated from these areas. Value research
has been conducted primarily to discern: (a) the values
of groups of individuals and relating the data to other
groups of individuals; (b) the origin and development of
values within the individual; and (c) the influence of an
individual's values on his cognitive life. This investi-
gation is a departure from traditional research. The
communication of values from one individual to another

and the effect of the interaction of values is the focus.

Content Analysis

 

Lennard and Bernstein (1960) suggest, "At any given

time (we) can focus on . . . characteristics of communi-
cation, overt . . . characteristics or covert expectancies
and purposes accompanying its presentation." It is possi-

ble to focus on communications in such a way as to glean
from the counselors' statements values held. It may be
possible to determine values espoused and examine the
values in relation to specific therapist variables.
Dependency has been one of the more frequently
studied variables. Snyder (1962) intensively studied
therapy of two graduate students in clinical psychology.
He studied the therapists' approach to dependency and the
clients' responses to those behaviors. Bandura, Lipsher,
and Miller (1960) and Winder gt_§l, (1962) studied client

statements scored for content and the therapists' reactions

15

to the statements and the clients' responses to the thera-
pists. The interaction sequence has been the cornerstone
of subsequent research.

Kopplin (1965), elaborating on the basic system,
added content categories. Of interest to this investi-
gation is the variable of internalizing-externalizing,
referring to the therapists' responses and whether or not
they focused on the clients' feelings. Alexander (1967),
using the same basic system, also investigated this
dimension.

Criticisms of the content analysis method are polar.
Christie and Jahoda (195A) criticized the content analysis

of The Authoritarian Personality (Adorno, 1950) on the

 

basis that the coders knew the content prior to establish-
ing the categories. It was their recommendation that con—
tent analysis categories should be established a priori.

Harway and Iker (196“) are critical of a_priori categories.

 

They seem to feel that a better method would be to examine

I
‘4
E

verbatim transcripts by intercorrelational and factor

analytic methods. . :5

Inn-unna-
" ' .I‘

Despite the various criticisms leveled against con-
tent analysis, it is a viable method of research. Murray
(1956) devised a system that has been used in modified
forms for numerous studies. Meaningful results have been
attained which would suggest this as a suitable method
for studying tape recorded, intra-interview behavior of

the therapist and the client.

16

Therapist Dimensions

 

Therapy Experience.--Kell and Mueller (1966) discuss

 

therapist experience and the therapeutic encounter. It is
their belief that the more experienced therapists tend to
"hold back" in the initial encounter to allow the client
to maximally express himself. This "holding back" may
allow the patterns of client response to develop as he
learned early in his life to react with others.

Abeles (1962) and Mills and Abeles (1965) suggest
that therapist behaviors are differentiated on a continuum
of experience and training. The more experienced therapists
"set aside" some of their needs and did not rely on the
therapeutic encounter for the satisfaction of these needs.
Inexperienced therapists tended to use the client for the
satisfaction of some of their personal needs. Strupp
(1958), in reviewing the literature of experienced and in-
experienced therapists, found that experienced therapists
tended to be more alike regardless of theoretical orien-
tation. Inexperienced therapists tended to be less alike
even when compared to therapists of a similar orientation.

Mullen (1968), in reviewing the literature of exper—
ience of the therapist and the variable of liking for a
client, suggests that "the experienced therapist tends to
make 'wiser' use of communication of his emotional re-
actions to the client. . . ." If this be the case, then
the communication of the therapist's values will also be

a function of experience and training.

 

 

17

Focus of Statement.-—The internalizing-externalizing

 

dimension of the therapist statement was originated by
KOpplin (1965) and subsequently elaborated by Alexander
(1967). Both writers found this to be an important
dimension in the therapeutic process. Since this has
been demonstrated to be a reliable and viable construct,
it is included, with respect to the communication of

values, in the therapeutic process.

Client Dimension

 

Change vs. No—change.--Barron (1956), studying be-

 

havior versus measured differences in patients in an out—
patient setting, found no difference in an "improved"
group of clients. However, the "unimproved" group tended
to have elevated scores on the MMPI. Those patients who
were unimproved behaviorally also had deviant profiles on
the MMPI. Schofield (1956), in discussing test-retest
reliability, suggests that the reliability coefficient
could be viewed as an index of therapeutic success.

The relevance to this investigation is that rather
than a comparison between a therapy group (experimental)
and a non-therapy group (control), the investigation will
focus on possible differential qualities between two
groups each having therapy. In this sense, it is an
examination of process variables between groups (one

being defined as change and the other as no change).

A.” A- ‘n
-
. .-
'v
'.

 

EXPERIMENTAL HYPOTHESES

Hypothesis 1: Rosenthal (1955) and Cook (1966)
found that there was a measurable impact of the thera-
pist's values and the outcome of psychotherapy. Barron's
(1956) suggestion of change in MMPI scores as an index of
success is incorporated in this hypothesis. It is the
intent of this hypothesis to examine systematic differ-
ences between clients who change and those who do not
change on MMPI scores. It is specifically hypothesized:

la) Values will be communicated less frequently

in the change group than in the no-change
group.

lb) The change group will have less ambiguity

in the values communicated than will the
no-change group.

Hypothesis II is concerned with therapist experience
and the communication of values. Strupp (1960), Mullen

(1968), and Kell and Mueller (1966), feel that there are

 

differential behaviors between experienced and in-

 

experienced therapists. Kell and Mueller (1966) suggest
that experienced therapists tend to "hold back" in
therapy in order to allow maximal expression of the
client's dynamics. With respect to values, this "hold—
ing back" may be reflected. It is specifically hy-

pothesized:

l8

l9

Ila) Experienced therapists will express their
values less often than will inexperienced
therapists.

lib) Experienced therapists will state their
values more clearly than will the inexperi-
enced therapists.

Hypothesis 111 is concerned with the focus of the
therapist's statements (Kopplin, 1965; Alexander, 1967)
and the specific values of Responsibility and Trustful
as defined by Rokeach (1968) and Bondy (1968). Responsi-
bility, by definition, is intrapersonal in character.
Trustful, on the other hand, is interpersonal (see
Appendix A). Internalizing-Externalizing statements are
directed at the client's own feelings (internalizing) or
feelings of others (externalIZIng). It is, therefore,
specifically hypothesized:

IIIa) Responsibility will occur more frequently
than Trustful in statements scored as
internalizing.

IIIb) Trustful will occur more frequently than

Responsibility in statements scored as
externalizing.

 

 

 

METHODOLOGY

Source of Data

 

Forty counselors at the Counseling Center at Michigan
State University constitute the subjects for this investi-
gation. Experienced therapists include twelve psycho-
logists with Ph.D.s in clinical or counseling psychology,
with a range of post doctoral experience from one to
twenty years. Five second-year interns, with course work
requirements completed for the Ph.D., are also included in
the experienced group. The second—year interns have a
minimum of two years intensive individual therapy super-
vision including practicum. Twelve first-year interns and
seven practicum students constitute the inexperienced
counselors.

Four of the subjects in this investigation worked
with two clients. One client was randomly selected from

each of these counselors for an N of 36. One client was

 

later deleted due to poor quality of the recording for an ii

 

N of 35. While sex differences are not a factor in this
investigation, twenty-four were male counselors and eleven

were female counselors.

 

20

 

21

Selection of Cases

 

Clients present themselves at the Counseling Center
on a self—referral basis. The client has an initial inter-
view to determine the appropriateness of the presenting
problem and the availability of facilities at the Center.
If it is decided that the student is to be seen, then the
client is asked if he would be willing to participate in
the research project. If the client accepts, he is in—
cluded. The client is then assigned to a therapist on the
basis of availability of free hours and special competencies
of the therapist. The therapist has access to the initial
interview notes and can opt to see the client.

Additional selective factors in this study are (1) no
less than four therapy sessions, (2) a pre and post MMPI,
and (3) therapy conducted by only one therapist. (One
case was excluded on the basis that the client had seen

more than one therapist.)

Tape Segment Sampled

 

Across therapy interviews, Karl (1967) found that
there is a general increase of certain behaviors of the
therapist. Therefore, for this study an attempt was made
to control for these factors on the basis of sampling
procedures. An equal number of tape samples were drawn
from early, middle, and late stages of therapy. More
specifically, twelve five-minute randomly selected tape

segments were included from each client. Four of these

  

‘ wax." ”indirAL-TE‘L (573.211.! ~50

22

segments were from the early phase, four from the middle
phase, and four from the late phase of therapy.

Within a therapy hour, Karl (1967) found that the
initial and terminal segments yielded little data. There—
fore, the intra—hour data sampled was from the central
portion of interview material deleting the initial and
terminal ten minutes. This sampling procedure obviates
some problems often found in therapy research: it con-
trols for systematic differences that may occur across
therapy and within the therapy hour. Hopefully, most
systematic differences that may occur were controlled in

this design.

Scoring Manual

 

The scoring procedure used in this investigation is
similar to those used in other studies. (See Bandura e£_al.,
1960; Winder e£_al., 1962; Kopplin, 1965; Alexander, 1967.)
Unique to this study is the addition of the content vari-
ables of Responsibility and Trustful. These values are
taken from the instrumental values on the Rokeach (1968)
value survey. Each of these values, though not opera—
tionally defined by Rokeach, has operational characteris-
tics.

Also, the "level" or degree of clarity in the expres—
sion of the value is a consideration in this content
system. Four levels were established ranging from no

expression of value in the therapist's statement to the

 

23

value being clearly present in the sense that the word
"responsibility" or "trustful" is contained in the state-
ment. The precise scoring procedures are contained in

the manual (see Appendix A).

ScoringrReliability

Three advanced graduate students in clinical or
counseling psychology were used as raters in the study.
The raters were given extensive training in rating tapes.
For two weeks considerable time was spent in the discussion
of the variables included in the manual. The raters were
then asked to rate tape segments that were not included in
the data of the investigation. The investigator identi-
fied each interaction sequence for the raters in order to
clarify material to be rated.

The raters were asked to make three decisions about
each statement identified by the investigator. (1) Was.
the focus of the therapist's statement internalizing or
externalizing? (2) Is the value responsible present and,
if so, at which level is it present? (3) Is the value
trustful present and, if so, at which level is it pre-
sent? For each statement identified, a rating form was
prepared for each rater. The raters simply circled the
internal or external focus of the statement and the level
for each of the values.

Few problems were encountered in rating with respect

to the focus of the therapist's statement. This construct

 

2“

apparently was easy for the raters to assimilate and use
as they listened to the tape segments. Reliability on
this dimension was attained quickly. Responsibility as
a construct apparently was less clear and some diffi—
culty was encountered by the raters in making decisions
about this value. Similar difficulties were encountered
with the construct trustful.

Responsibility as defined for this investigation
involves the accountability for one's own conduct. How-
ever, when this is expressed by the therapist to the
client, there is a certain expectancy that the client will
"do" something with respect to the topic under consider-
ation. Problems were encountered by the raters when the
therapist asked a question and there was an expectancy for
a response. Initially, there was a tendency to rate any
question by the therapist at a low level on the value

responsible. This was clarified by further discussion

 

and the concensus of the raters and investigator that the
expectation of a response was not necessarily an expres-

sion of the value responsible. If it had been viewed in

 

this way, all statements the therapist made would have
been scored with the value responsible being present.
Similar difficulties were encountered with the
value trustful. This construct, defined in terms of
interpersonal interaction, was Viewed by the raters as

being the more difficult construct to conceptualize.

25

There was a tendency to rate this value at a low level
when interpersonal interaction was the topic under con-
sideration. As stated above, simply the discussion of
such tOpics does not necessarily mean that the value is
being communicated. Any expression by the therapist
involving confidence in, or reliance on, another person
was to be scored as trustful.

After minimal reliability was established, the
ratings were completed over a two-month period. The
raters worked independently on the data. The investi-
gator periodically checked the inter-rater reliability.
The ratings maintained the minimal reliability over the

time period.

 

RESULTS

Reliability

 

The estimation of reliability was determined by
analysis of variance as suggested by several authors
(i.e., Ebel, 1967; Hoyt, 1967; and Guilford, 1956). The
consistently strong reliability is attributed to two
principle factors: one, the extensive training of the
raters, and two, the identification by the investigator
of the statements to be scored. The latter reduced the
number of decisions each rater needed to make, and it
insured that each rater was scoring the same material.

All reliabilities were high, which suggests that
the variables were concise and the raters experienced
little confusion with respect to the decisions made. All
content categories were established a priori, and no
changes were made with respect to difficulties encountered
during the training phase.

Reliability estimates were based on the scores of
each variable within each five-minute segment from each
rater. The reliability was then determined on the basis
of twelve scores from each subject from each rater;

Table 1 summarizes the reliability coefficients for the

raters .

26

27

TABLE l.—-lnter-rater reliability of scoring categories.

 

Scoring Average Range of Reliability

 

Category Reliability Upper Lower

 

Focus of therapist
statement .8902 .9356 .7689

Value dimensions

 

Responsible .9539 .9758 .9122
Trustful .8896 .9298 .7887
Hypotheses

 

In Tables 2, 3, A, 5, and 6 are summarized the re-
sults of tested hypotheses. Hypotheses I and II focus on
the variables of outcome, therapist experience, and values
expressed. The tables presented overlap hypotheses, but
do not alter the nature of the hypotheses; only the order
is altered slightly. Hypothesis III examines the focus of
the therapist statement and its relationship with values
expressed.

Hypothesis Ia: Values will be communicated less

frequently in the change group than in the no-
change group.

 

Hypothesis Ila: Experienced therapists will
express their values less often than will in-
experienced therapists.

 

Neither of the hypotheses receive support from the
data. There are no differences between the frequency of
values expressed and the outcome of psychotherapy. Neither
are there any differences between the frequency of values

expressed and therapist experience. There was no

28

TABLE 2.--Analysis of variance

 

of rater's frequencies for

 

 

the value: responsibility.
Sum of Mean

Source Squares Df Square F p
Total 198838.5 34
Error 194250.6 31 6266.1
Client
Change 1542.9 1 1542.9 .25 .62
Therapist
Experience 602.4 1 602.4 .10 .76
Interaction 2515.5 1 2515.5 .40 .53

 

fir

TABLE 3.—-Analysis of variance

of the rater's frequencies

 

 

for the value: trustful.
Sum of Mean
Source Squares Df Square F p
Total 102752.? 34
Error 100774.l 31 3250.8
Client
Change 14.7 1 14.7 .00 .94
Therapist
Experience 335.7 1 335.7 .10 .75
Interaction 1719.4 1 1719.4 .53 .47

 

29

TABLE 4.—-Analysis of variance
the value: responsibility.

 

of ratings of ambiguity for

 

 

Sum of Mean
Source Squares Df Square F p
Total 308716.4 34
Error 294301.8 31 9493.6
Client
Change 6623.4 1 6623.4 .69 .41
Therapist
Experience 1036.6 1 1036.6 .11 .74
Interaction 7074.9 1 7074.9 .75 .39

 

TABLE 5.-—Analysis of variance
for the value: trustful.

of the ratings of ambiguity

 

Sum of

Mean

 

Source Squares Df Square F p
Total 146891.6 34
Error 142462.6 31 4595.6
Client
Change 185.5 1 185.5 .OA .84
Therapist
Experience 339.1 1 339.1 .07 .79
Interaction 4016.2 1 4016.2 .87 .36

 

 

30

TABLE 6.--Corre1ation between responsibility and trustful
and the focus of the therapist's statement and p value
associated with the difference between the correlations.

 

Measure (Focus of

 

* a
therapist statement) I a II b Zd P
Internalizing-

Externalizing .47 .58 .610 .27

 

la is the correlation between Internalizing—
Externalizing and the value responsibility.

Ila is the correlation between Internalizing-
Externalizing and the value trustful.

*both correlations are significant at the .01 level.

significant interaction between the frequency of values
expressed, outcome, and therapist experience.

Hypothesis lb: The change group will have less
ambiguity in the values communicated than will
the no-change group.

Hypothesis IIb: Experienced therapists will
state their values more clearly than will the
inexperienced therapists.

 

The data does not support the hypothesis of the
ambiguity of the value trustful or responsibility and out— '

come of therapy, nor does the data support the ambiguity

 

.. .’
1|
p

of values expressed and therapist experience. There was a!
no significant interaction between the ambiguity of

values expressed, outcome, and experience level of the

therapist. The ambiguity of values expressed is not

differential between the outcome or experience variables.

31

Hypothesis Illa: Responsibility will occur more
requently than trustful in statements scored as
internalizing.

Hypothesis IIIb: Trustful will occur more

frequently than responsibility in statements

scored as externalizing.

Hypotheses Illa and Illb are not supported by the
data. The positive correlation suggests that values are

more highly associated with externalizing statements.

There are no significant differences between the corre-

lations.

 

.
U
l
' .
r...
.
x
x
m
I
xi

 

Jfl

 

DISCUSSION

Inter-rater Reliability

Each dimension examined in this investigation was
consistently strong. This can, in part, be attributed to
the rather intensive training of the raters and the
identification by the investigator of all the therapists'
statements. The addition of relatively new and untested
variables (i.e., ReSponsible and Trustful) suggests that
the content analysis method can be profitably used in the
examination of yet other new undefined areas of therapy
research.

Other more traditional methods of research examine
the possible effects of the therapy process. These leave
the investigator with little knowledge of what transpires
in the therapeutic setting. Little is gained concerning
the verbal interaction which contributes to change.

The psychotherapeutic process is able to be examined
effectively by means of content analysis methods. The
high reliability calculated suggests this is a viable
method to examine substantive content within the therapy
hour. In fact, it is probably one of the best methods
for examining ip sipg verbal behaviors that may be

relevant to therapeutic process.

32

33

Outcome

Outcome criteria for this investigation were based
on changes in MMPI scores. No extra-interview behaviors
or therapist evaluations of the outcome of therapy were
used. The examination of process variables in view of
therapy outcome is necessary for advancement of theory
and research. However, when an outcome reasure which has
previously been associated with extra-interview behavior
(Barron, 1956; Schofield, 1956) is applied to process
variables and therapeutic outcome, there might be a
logical flaw.

Problems which seem intuitively present in such
criteria are encountered in the use of a self report.

The elevated scores in the no-change group could be an
index of the client's openness. The conscious suppression
of impulses which might govern the answering of questions
could be lessened; the individual might be less apt to
give socially appropriate answers. The reverse might also
be true of those whose scores changed in the direction of
less pathology.

Another assumption implicit in the choice of this
outcome criterion is that the changes in scores are due
in part to the therapeutic encounter. This assumption in
such a design as that used in this investigation may not
be warranted. Since pre-existing data were used, and

there was no control group in the more formalized sense,

3H

it is not known whether some of the changes were a result
of environmental factors. It is impossible to include
all such considerations in a design of this nature, but
it is necessary to keep such factors in mind when evalu—
ating the results of an investigation of this nature.
What constitutes outcome, particularly successful
outcome, is a problem. The subjective nature of the
therapeutic encounter is such that adequate means of
evaluation have yet to be refined to such an extent as
to be embraced by the profession as portraying what each

therapist feels has transpired with his particular client.

Therapist Experience

 

An implicit assumption of the experience factor is
that there are differential behaviors between experienced
and inexperienced therapists. The definition of experi-
ence is arbitrary. Experience may contribute to a greater
and more thorough knowledge of the theoretical aspects of
client dynamics. However, in the process of examining
behaviors such as those in this investigation, there may
be problems in differentiating the particular behaviors
of experienced and inexperienced therapists. There may
be no differences in the verbal behaviors that can be
consistently monitored, at least in respect to specific

values communicated.

35

Separating subjects on the basis of experience
implicitly suggests greater skill among those with more
experience. This is a difficult question to evaluate.
Dichotomizing on the basis of skill leads to greater
confounding factors since the subjective judgment of the
investigator has more influence than a relatively more
concrete criterion such as the number of years of experi-
ence. Problems of definition often have such confounding
characteristics. Such problems do not aid in the teasing
out of important dimensions in complex interacting vari—
ables.

The differential use of values between experienced
and inexperienced therapists received no support in this
investigation. This may be due in part to the selection
of specific values which did not occur with such regu-
larity to support the suggested theory. It also may be
due to the use of values by either group with sufficient
regularity that there are, in fact, no differences be—
tween experienced and inexperienced therapists in respect

to specific value dimensions.

Focus of Therapist Statement

In a conceptual framework, the internal or external
focus of the therapist's statement is the vehicle by which
the value is carried. This dimension was the only result
which had a trend toward significance in the predicted

direction. The hypothesized direction of the values with

. M
.

 

36

respect to this dimension suggests that values may be
communicated with respect to definite objects in the
environment.

Trustful, as defined and predicted, was in relation
to others in the environment. Responsible was defined in
terms of the self. While not significantly different from
Responsible, Trustful was more highly associated with an
externalizing focus of the therapist's statement. This
suggests that when this specific value was communicated,
it tended to be more frequent in relation to others in
the client's environment.

The relevance of this suggestion is that values,
per se, when communicated may need to be defined in terms
of the object choice rather than in terms of the theo-
retical construct of that value. This may, in part,
explain some of the differences between the results of
this investigation and the results of some of the other
investigations of values and psychotherapy. Rosenthal
(1955) ranked various activities and attitudes which were
specifically relevant to the client's environment and not
to theoretical abstractions. Cook's (1966) investigation
was also in reference to specific objects in the client's
environment. The investigation of more theoretical con-
structs may need to be in reference to specific objects

in the environment.

37

The therapist's reaction to those objects, within
the framework of the particular client, may be of greater
import in value communication than was the examination of
the value content of each specific therapist statement.
Value investigation in view of traditional criteria
(i.e., outcome and experience), may be premature in
view of the paucity of existing data on values. Values
may be communicated independently of these more tradi—
tional criteria. The effects of value communication may
effect the client in ways yet to be defined and measured.
It may be that values do not effect the course of therapy
and therapeutic outcome.

Implications for Future
Research

 

The results of this investigation lead to the con-
clusion that one must examine and differentiate values more

clearly in future investigations. It does seem warranted

 

to replicate this investigation using the same sampling
procedures, but with different subjects.

Outcome criteria used in this investigation may not

 

have been as definitive as other methods might be. In ii
future investigations outcome criteria for value studies

might be based on the change in values from pre to post

therapy. Other methods of outcome criteria might be

based on the therapist's and/or the client's evaluations

of the success of the encounter. This may not be of any

 

38

greater validity than the MMPI, but the subjective criteria
of change or no-change may lead to more precise research
with values. A given therapist's judgment regarding out-
come may reflect a value system which can be gleaned

from interview material.

Separating data on this basis may clarify the value
structure and its communication more adequately than does
the material in this investigation. A more detailed
examination of the value structure of both the client and
the therapist should not be abandoned on the basis of
research delving into an uncharted and still ambiguous
construct. In conclusion, an analysis of two specific
values applied to all subjects may not be the most appropri-
ate means of examining the impact and influence of values in

a more generic sense.

SUMMARY

This investigation examined the communication of
two specific values and their relation to therapeutic
outcome, therapist experience and the focus of the thera-
pists' statement. The data for this investigation was
taken from the research library of the Counseling Center
at Michigan State University. The clients represent late
adolescent males and females who are self referred for
treatment and agreed to participate in a research project.

vaelve five-minute segments were randomly selected
from each of thirty—five completed psychotherapies. Each
therapist statement was scored on the basis of the values
communicated (Responsible and Trustful) and the focus of
the therapist statement. Inter-rater reliability was
consistently strong. Internalizing-Externalizing was
scored at .89; Responsible at .95; and Trustful at .88.
The high inter—rater reliability is attributed to two
principle factors: (1) intensive pre-training of the
raters and (2) the investigator's identification of each
therapist statement in each five—minute segment.

The intent of the investigation was to examine

systematic differences between specific values

39

HO

communicated by the therapist and therapeutic outcome as
measured by pre— to post—changes in MMPI scores; the

experience level of the therapist; and the focus of the

therapist's statement (i.e., internalizing-externalizing).

The data did not support the first two hypotheses. There
was no difference between values communicated, therapy
outcome, and therapist experience. There was a trend
toward significance between the value Trustful and the
externalizing focus of the therapist's statement. This
result suggests that values may be communicated in refer—
ence to specific objects in the environment rather than
in a more generic way.

Conclusions suggested that future investigations of
values should be broader in s00pe rather than limited to
two specific values in a more abstract form. Traditional
methods of dichotomizing (i.e., outcome and therapist

experience) may not be the best criteria for examining

the influence of values in psychotherapy. Content analysis

was shown to be a highly reliable measure for studying

verbal behaviors of the client and/or the therapist.

1"?!

w

 

 

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"
g
i
.' I
.‘ 1
- s
I) fit.

 

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similarity: investigation of patient-therapist
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Norton and Co., Inc., 1958.

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Ru?” .1? _.

ni’r.

 

_.AI

APPENDIX

m". ‘3
sign-J‘-

 

A SCORING MANUAL

Scoring Unit and Interaction

Sequence:

A. Definition: A unit is the total verbalization
of one speaker bounded by the preceding and
succeeding speeches of the other speakers with
the exception of interruptions.

 

There are three types of scoring units: The "client
statement" (0. St.), the "therapist response" (T. R.), and
the "client response" (0. R.). A sequence of these three
units composes an "interaction sequence." The client
response not only completes the first interaction sequence,
but also initiates the next sequence and thereby becomes a

new client statement.

Examples:

C. "I can't understand how you can stand me."
(c. St.)

T. "You seem to be very aware of my feelings."
(T. R.)

C. "I am always sensitive to your feelings."

(c. R.)

B. Pause: If a speaker pauses between statements,
his verbalizations are not scored as separate
units. The verbalization before and after the
pause is considered one unit.

48

49

C. Interruptions: Statements of either therapist
or client which interrupt the other speaker will
be scored only if the content and/or temporal
continuity of the other speaker is altered by
the interruption. Then the interrupting verbali-
zation becomes another unit and is scored. A
non-scored interruption is never taken into
account in the continuation of the other
speaker.

 

Interruption scored as one unit:

C. "I asked him to help me and . . ."
T. "Why was that?"

0. "He refused to even try."

Non-interruption scored as three units, one inter-
action sequence:

C. "I asked him to help me and . . ."

T. "Why was that?"

C. "I don't know."

Verbalizations such as "Um-Hum," "Yes," "I see" are
ignored in scoring unless they are so strongly stated as
to convey more than a listening or receptive attitude.

Client requests for the therapist to repeat his
responses are considered interruptions and are not scored.
Therapist requests of this sort are scored as units except
for single requests to the clients to repeat a few words.

Internalizing or Externalizing
Responses:

 

Therapist responses are scored in one of two

mutually exclusive classes: internalizing or externaliz-

 

ing responses. When both types are present, score the
portion of the response which is designed to elicit a

response from the client.

 

(a)

(b)

50

Internalizing (I): In this category the focus
is on the client's concept of himself, his
feelings and reactions to the stimuli imping-
ing on him. The therapist is encouraging the
client to express his feelings. The therapist
may label the client's feelings; he may verbally
act them out with feeling or sensory words; he
may explore the feelings by eliciting the
client to discuss the idiosyncratic edges of
his feelings and the impulse edge of his
feelings.

T. "What would you like to talk about today?"

T. "You keep a pretty close check on those you
let yourself love because it's pretty
dangerous."

T. "You want to be a boy, but if you were, you
couldn't have children."

Externalizing (E): The distinction is between

a focus outside or inside the client. Here the
therapist joins with the client on focusing on
something that is "outside" the client or re—
sponds in such a way as to encourage the client
to focus on something outside himself. Response
may refer to the client and still be placed here
if it is a behavioral description of the client
as an external object. There is a clear absence
in this category of any focus on how the client
"feels."

T. "In a sense you are being compared to peOple
who are not doing things."

T. "How old is your sister?"

T. "What did your mother feel when you said
that?"

Note: In the case of certain avoidance re-
sponses, it may be impossible to score a re-
sponse as internalizing or externalizing.

Silence responses cannot be scored, but are
listed as E.

51

Topic transition responses are scored in re-
spect to the discussion they intended to
elicit, e.g., if a discussion is introduced,
score it also on the basis of whether it
attempts to internalize or externalize the
client's response, and not in regard to the
preceding client discussion.

C. "And so we went shopping."

T. "Let's go on to something else; how did
you feel about last week's hour?" (I)

Disapproval can be scored either internalizing
or externalizing.

Ignoring can be scored either internalizing
or externalizing on the basis of what the
therapist said which was ignored.

-- Mislabel can be scored either internalizing

or externalizing.

Scoring of Trustful:

 

people."

direction.

Any response which implies belief or confidence in
another individual or group is scored as trustful. The
emphasis is on the ability to recognize and utilize one's
notion of others in his activity with other persons. The
phrasing of the value in positive or negative terms is
not a consideration. For example, "You don't trust other
people," is scored the same as "You seem to trust other
The negative aspect of a value is assumed to

be as clear a statement of the value as is the positive

Examples:

"You're very close to her. Do you seem to
understand each other quite well?"

"Uh Huh, but now he's quite threatening to
you."

 

 

 

52
"So how does this feel to share with someone
your feelings?"
"But I think once you find out you're able
to trust me you'll find out talking about it

with someone, feeling that you don't have to
think about it alone."

Scoring of Responsibility:

Responsibility statements include any response which
the therapist makes which involves the implication that
the client "should" or "ought" to do something; clearly
making statements which place the client in a position
of initiating some activity. The following examples may
aid in the identification of such statements:

T. "Is that something you would like to talk about?"

T. "Mary, we have to deal with that somehow."

T. "What do you think are the possibilities? You

seem to have raised a number of logical possi-
bilities in our discussion."

T. "You seem to feel more responsible for what
happens to you."

Note: The positive or negative direction of the
value is not a consideration. If the concept is

present in negative terminology the scoring is
exactly the same. For example:

T. "You don't want to do that, do you?"
T. "That seems kind of irresponsible to me."

Clarity or Strength of
the Value:

 

Each therapist statement is to be scored on the

basis of the two values of trust or responsibility. The

53

rating of a value is to be on a four point system on which
the judge must rate the strength of that value.

Level I: Values scored at this level have essenti-
ally no presence of the value in the judgment of the
rater. Examples of such statements are statements of
fact or data unrelated to the therapy contact.

Examples:

"I see that it is 3:00."

"Where is your home town?"

"How many sisters do you have?"

Essentially, the responses scored at this level

have little or no apparent impact on the immediate

relevance to the topic under consideration.

Level II: Responses at this level are, to some
extent, suggesting the value, but the clarity is lacking.
Inference about the value is possible, but is weak.

Examples for Responsibility:

"You can find that in the occupational library."

"Your academic adviser may be able to assist you
with that."

Examples for Trustful:

"You seem to wonder about your roommate's
intentions."

"It doesn't seem as though you can be close to
other people."

Level III: At this level the expressions of the
therapist are such that there seems to be a relatively

clear statement of the therapist's expectation of the

client.

54

Examples for Responsibility:
"Why don't you tell them to quit bothering you."

"I wish you would stop listening to what your
mother keeps telling you."

The intention of the therapist's response is that
the client will act upon the therapist's wishes.

Examples for Trust:

"You really aren't too sure about other people,
are you?"

"Have you ever allowed yourself to depend on
anyone?"

The therapist's questioning leads the rater to

believe that there appears to be trust lacking on

the part of the client.

Level IV: The therapist's verbalization is such that
the value is unmistakably clear. The use of the term per
se will automatically include it at this level. Responsible,
Responsibility, Irresponsibility, Irresponsible, Trust,
Distrust, Mistrust, Untrustworthy—-a11 are at this level.

It is possible that both values could be included in
the therapist's verbalization. When this occurs, the
statement should be scored as though it were two separate
statements as far as level of value expressed is concerned.

Examples:

"As long as you don't feel responsible for your
behavior, it is easy for you not to trust other
people."

In this case, both values are scored at Level IV.

"You must have had some questions in mind that
you thought I might ask which were in some

ways kind of threatening for you. And I guess
if you and I are to work together to help you,

55

we really should take a look at the questions
which are hard for you."

Trust is implied in the statement at Level III.
Responsibility is at Level III in that the thera-
pist is fairly clear with his expectations.

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