oom'OA. ~7.—._ _._ _

CLIENT-THERAPIST COMPLEMENTARHY _
AND THERAPEUTIC OUTCOME

Thesis for thé Degree Of Ph.D. _ H

 

.MlCHiGAN, STATE U'NNERSlTY , ~ 7 ; ;

CLEASON S. DlETZEL
1971

 

 

  
  

1:3»!!qu n"min;ummrwuygw , {Ring},

293 10137 '

2 University

‘_.‘.. . , . V .s4. ‘ .- dfib -.*-~_—.—..~.1

Thisvlis to certify that the

thesis entitled

 

CLIENT-THERAPIST COMPLEMENTARITY
AND THERAPEUTIC OUTCOME

presented by

Cleason S. Dietzel

hes been accepted towards fulfillment
of the requirements for »

Ph.D. Aggy-gain P§yghQIng

MW Awe 1

7‘ V

 

 

U I

 

0-7639

 

 

 

MSU

LIBRARIES

 

 

RETURNING MATERIALS:
Place in book drop to
remove this checkout from
your record. FINES will

 

be charged if book is
returned after the date
stamped below.

,;

 

 

 

 

 

64¢

ABSTRACT

CLIENT-THERAPIST COMPLEMENTARITY
AND THERAPEUTIC OUTCOME

BY

Cleason S. Dietzel

This study investigated the varying levels of client
and therapist behavioral complementarity during the three
stages of psychotherapy for successful and unsuccessful
outcome groups. Behavioral complementarity, as defined
by Leary (1957) and Carson (1969), refers to the degree of
reward (i.e., interpersonal reinforcement) experienced by
both interaction participants as a result of the particular
behaviors exchanged. In terms of the Leary Interpersonal
Circumplex (1957), which was used to rate the interpersonal
behaviors of clients and therapists, complementarity occurs
on the basis of reciprocity on the dominance-submissive
axis [dominance complements (elicits and reinforces) sub-
missiveness; submissiveness complements dominance] and on
the basis of correspondence on the friendly—hostile axis
[friendly behaviors complement friendliness; hostility

complements hostility].

Cleason S. Dietzel

Complementarity Indices (Cl), for each therapeutic
dyad at three periods (early, middle, and later) in the
therapeutic relationship, were obtained by summing the
weighted proportions (the weightings--3, 2, and l-—reflected
the relative level of complementarity in the respective
interactions) of interactions in the sixteen cells of the
Complementarity Matrix. (The 4 x 4 matrix contained an
outcome cell for all possible interactions, given four
possible eliciting behaviors X four possible respondent
behaviors: (l) friendly-dominant, (2) friendly-submissive,
(3) hostile-submissive, (4) hostile-dominant.)

Therapeutic outcome was assessed via clinical
ratings of pre- to post-therapy MMPI profile changes; a
measure which was found to have relatively good reliability
and validity. Ten successful and ten unsuccessful outcome
cases were included in the sample.

The following hypotheses were investigated:
Hypothesis Ia: There will be significant differences
in the level of therapist complementarity between
the successful and unsuccessful psychotherapy groups.
Hypothesis Ib: There will be significant differences
in the level of client complementarity between the
successful and unsuccessful psychotherapy groups.

A global index of complementarity (the mean Cl

score representing the C1 scores from the three stages of
therapy) was used to test Hypotheses Ia and Ib. Neither

hypothesis was supported at a significant level by the data,

although there was a moderate trend for successful clients

Cleason S. Dietzel

and therapists to interact at a somewhat lower level of
complementarity than unsuccessful dyads.

Hypotheses II through V investigated client-
therapist complementarity patterns for successful and

unsuccessful cases during the three stages of psychotherapy.

Early Stage of Psychotherapy
‘Hypothesis II: During the early stage of psycho-
therapy, the level of therapist complementarity
will be directly related, at a significant level,
to the degree of manifest client maladjustment.
Hypothesis II was based on the assumption that clients who
enter therapy exhibiting a more restricted, narrow range
of interpersonal behaviors will be more invested in, and
capable of, eliciting highly complementary responses from
therapists. This assumption was supported by a rank order
correlation coefficient of .51 (p < .02).
Hypothesis IIIa: During the early stage of psycho-
therapy, there will be no significant differences
in the level of therapist complementarity between
the successful and unsuccessful psychotherapy groups.
Hypothesis IIIb: During the early stage of psycho-
therapy, there will be no significant differences
in the level of client complementarity between the
successful and unsuccessful psychotherapy groups.

It was assumed that during the early stage of the
therapeutic relationship, the levels of client-therapist
complementarity would not differ significantly relative
to outcome but would be moderately high in all dyads to

promote the relationship-building tasks that characterize

this stage of therapy. Both hypotheses were supported by

Cleason S. Dietzel

the data. The findings indicated that successful clients
and therapists, during this initial phase of therapy, were \/’
mutually interacting at a moderately high level of comple-
mentarity to the other's elicitations. It was suggested
that such complementarity levels were contributory to the
maintenance of security operations, minimal anxiety, and

the development of a vital working relationship. The
interactions of unsuccessful dyads, on the other hand, were
marked by differing levels of complementarity. Unsuccessful
clients responded at a moderately high level of comple-
mentarity to the therapist's elicitations but "unsuccessful"
therapists responded to the client's elicitations at a
moderately lower level of complementarity. It was suggested
that such differing complementary levels would contribute

to a premature reduction in client security Operations,

increased levels of anxiety, and more tenuous relationships.

Middle Stage of Therapy

 

Hypothesis IVa: During the.middle stage of psycho-
therapy, the level of therapist complementarity
will be significantly lower in the successful, as
opposed to unsuccessful, psychotherapy group.

 

Hypothesis IVb: During the middle stage of psycho—
therapy, the level of client complementarity will

be significantly lower in the successful, as opposed
to unsuccessful, psychotherapy group.

 

Hypotheses IVa and IVb tested the following theoretical
assumptions: Client-therapist interaction patterns, leading
to constructive client change, will reflect lower levels

of complementarity during this middle, or "working," phase

Cleason S. Dietzel

of therapy. The non-complementarity, disconfirming be—
havioral exchanges are prerequisite for behavior change.
Interaction patterns, leading to no change or deterioration
(unsuccessful), will be characterized by significantly

high levels of client and therapist complementarity. Both
hypotheses were confirmed, at high levels of significance,
by the data. These findings lend considerable support

to the Interpersonalists' position regarding the reciprocal
impact which client and therapist have on each other. In
addition, these findings clearly support Carson's (1969)
views concerning the differing complementarity patterns

leading to successful and unsuccessful behavior change.

Later Stage of Therapy

 

Hypothesis Va: During the later stage of therapy,
the leyel of therapist complementarity will be
Significantly higher in the successful, as opposed
to unsuccessful, psychotherapy group.

Hypothesis Vb: During the later stage of psycho-
therapy, the level of client complementarity will
be Significantly higher in the successful, as
opposed to unsuccessful, psychotherapy group.

These predictions were based on the assumption that
the interaction patterns for the "successful" dyads during
this later phase of therapy would be marked by high levels
of mutual complementarity resulting from the broadened range
of newly-acquired behaviors available to the client. Both
hypotheses were not supported by the data. There was, in

fact, a moderate trend in the opposite direction. Several

explanations were suggested. One, the emphasis on

Cleason S. Dietzel

“short-term therapy" in the present population results in
an extension of the "therapy work" right up to the time of
termination. Consequently, complementarity levels remain
lower where such is occurring. Secondly, early theoretical
formulations failed to consider the possibility that
complementarity levels in the "unsuccessful" dyads would
go so high.

An analysis of client behavioral coordinates re-
vealed the following results: In the successful group, 7
of the 10 clients exhibited movement (from early to later
stages of therapy) toward a more flexible, varied range
of interpersonal behaviors. Nine of the 10 successful
clients manifested no change 25 movement toward a more
rigid restricted behavioral repertoire. Five of the 9
unsuccessful clients fit the latter category and most

clearly represent client deterioration.

Exploratory Questions

 

In addition to the experimental hypotheses, several
exploratory questions were examined. The first, investi-
gated the patterns of complementarity over the three stages
of therapy within each outcome group. Between-stage differ-
ences were significant for the successful group but not for
the unsuccessful group.

Secondly, the pre- to post-therapy MMPI outcome
measure was compared with an outcome measure derived from

changes in client's behavioral coordinates from early to

Cleason S. Dietzel

later stages of therapy. A Phi coefficient of .61 (p < .01)
suggested a significant relationship between the two outcome
measures.

Thirdly, the relationship between changes in the
frequency (from early to later therapy stages) of specific
eliciting behaviors and the complementarity contingencies
associated with those behaviors, was examined and discussed.

Fourthly, complementarity levels in like-sex and
opposite-sex dyads were examined. No sex differences

were obtained.

References

 

Carson, R. C. Interaction concepts of personality. Chicago:
Aldine Pu51IShing Company, I969.

 

Leary, T. Interpersonal diagnosis of personality. New York:
Ronald Press,T1957i

Dissertation Committee

 

Chairman, Norman Abeles, Ph.D.
Bill Kell, Ph.D.
Mary Leichty, Ph.D.

Dozier Thornton, Ph.D. . v

CLIENT-THERAPIST COMPLEMENTARITY

AND THERAPEUTIC OUTCOME

BY
NJ
19y

Cleason SWVDietzel

A THESIS

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

DOCTOR OF PHILOSOPHY
Department of Psychology

1971

To Louise

who through her caring, support, patience,
and understanding assisted immeasurably
with the continuation and completion of
this study.

To Laurie
To Becky
To Beth

for their willingness to forego the evening
bike rides, the picnics in East Lansing
Park, frisbee on the back lawn, and the
other times with Dad.

ii

ACKNOWLEDGMENTS

I wish to express my deepest appreciation to Dr.
Abeles who, as my dissertation and guidance committees
chairman, provided the very best in scholarly guidance,
competent advice, warm encouragement, and never ending
patience. His behavior as a scholar, researcher, clinician,
and sensitive human being has served as the very finest
model for my own emerging identity and behavior as a
clinical psychologist.

I also want to express my deepest gratitude to Dr.
Bill Kell, Dr. Mary Leichty, and Dr. Dozier Thornton for
their suggestions, assistance, time, and support. Each,
in their own way, contributed significantly to the study.

I would also like to sincerely thank Ken Hall and
Tom Spierling who devoted so much of their summer time to
rating the psychotherapy tapes. Not only do I appreciate
the way that they worked so effectively and efficiently,
but more importantly I cherish the opportunity I had of
working with two very warm, sensitive, caring humans.

I am also deeply indebted to Miriam Smith and
Sandi Watts who competently provided the typing, grammatical,

and other stenographic services that were needed. Their

iii

willingness to tolerate the unreadable writing and last
minute revisions will not soon be forgotten.

I would also like to thank Dr. L. O'Kelly and
Roger Halley in the Department of Psychology for the
financial assistance provided in connection with rater
fees.

Last but not least, a word of thanks to Geraldine

Stornant who was always there to answer the many questions.

iv

TABLE OF CONTENTS

Page
INTRODUCTION 0 I O O O O O O O O O O O 1
REVIEW OF THE LITERATURE . . . . . . . . . S
Behavioral Analysis System . . . . . . . 5
Behavioral Complementarity . . . . . 6
Behavioral Complementarity and Interpersonal
Relations . . . . . . . . . . . 10
Client-Therapist Complementarity and
Therapeutic Outcome . . . . . . . . . 16
Client-Therapist Complementarity During
Various Stages of Psychotherapy and
Therapeutic Outcome . . . . . . . . . 22
Early Stage . . . . . . . . . . . . 24
Middle Stage . . . . . . . . . . . . 26
Later Stage . . . . . . . . . . . . 28
EXPERIMENTAL HYPOTHESES . . . . . . . . . 30
METHOD 0 O O O O O O I O O O O O O C 3 3
Source of Data . . . . . . . . . . . 33
Selection of Cases . . . . . . . . . . 34
Selection of Sessions . . . . . . . . 34
Behavioral Analysis System . . . . . . . 36
Reliability Sample . . . . . . . . . 38
Level of Client Maladjustment . . . . . . 39
Therapeutic Outcome. . . . . . . . . . 44
Reliability for MMPI Judges . . . . . . . 45
Concurrent Validity. . . . . . . . . . 47
RESULTS O O O O I O I O O O O O O O O 5 0
Complementarity Index . . . . . . . . . 50
The Experimental Hypotheses and Supporting
Data . . . . . . . . . 56
Hypotheses Concerning Stages of Psychotherapy . 59
Exploratory Questions . . . . . . . . . 64

DISCUSSION C O Q O O O O O Q I O O O O 7 0
Comments on the Complementarity Matrix. . . . 70
Differences in Client-Therapist Complementarity

Between Successful and Unsuccessful Cases . . 72
Early Stage of Therapy . . . . . . . . . 73
Middle Stage of Therapy. . . . . . . . . 79
Later Stage of Therapy . . . . . . . . . 82
Exploratory Questions . . . . . . . . 84
Sex Differences . . . . . . . . . . . 90

SUMMARY 0 O O O O O I O O I O O O 0 O 94
Early Stage of Psychotherapy . . . . . . 96
Middle Stage of Therapy. . . . . . . . . 97
Later Stage of Therapy . . . . . . . . 98
EXploratory Questions . . . . . . . . 100

LIST OF REFERENCES . . . . . . . . . . . 102

APPENDICES

Appendix
A. Study Cases . . . . . . . . . . . 105
B. MMPI Ratings . . . . . . . . . . . 106
C. Scoring Manual for the Interpersonal

Behavior Rating System . . . . . . . 107

vi

Table

1.

10.

ll.

12.

13.

LIST OF TABLES

Client-Therapist Characteristics and Number

of Sessions for Two Outcome Groups . .

Inter-Judge Agreement on Interpersonal
Ratings: Reliability Sample (N = 39) .

Intra-Judge Reliability of MMPI Ratings .
Inter-Judge Reliability of MMPI Ratings .

Pearson Correlations for Five Outcome
Measures. . . . . . . . . . .

A Goodness of Fit Test for the Three Cell
Categories . . . . . . . . . .

A "Best Fit" Test to Determine the Cell
Weightings Suggested by the Data. . .

The Mean Proportion of Interactions for
Each of the Three Cell Categories . .

A Goodness of Fit Test for the CI
Distribution . . . . . . . . .

Level of Therapist Complementarity and
Therapeutic Outcome . . . . . . .

Level of Client Complementarity and
Therapeutic Outcome . . . . . . .

The Relationship Between Therapist

Complementarity and Client Maladjustment

Level of Therapist Complementarity and
Therapeutic Outcome (Early Stage) . .

vii

Page

35

4O
46

47

49

53

55

56

57

58

58

60

61

Table Page

14. Level of Client Complementarity and
Therapeutic Outcome (Early Stage) . . . . 62

15. Level of Therapist Complementarity and
Therapeutic Outcome (Middle Stage). . . . 62

16. Level of Client Complementarity and
Therapeutic Outcome (Middle Stage). . . . 63

17. Level of Therapist Complementarity and
Therapeutic Outcome (Later Stage) . . . . 63

18. Level of Client Complementarity and
Therapeutic Outcome (Later Stage) . . . . 64

19. Changes in Level of Therapist Complementarity
Over the Three Stages of Therapy for the
Successful Outcome Group . . . . . . . 65

20. Changes in Level of Therapist Complementarity
Over the Three Stages of Therapy for the
Unsuccessful Outcome Group . . . . . . 66

21. Changes in Level of Client Complementarity
Over the Three Stages of Therapy for the
Successful Outcome Group . . . . . . . 68

22. Changes in Level of Client Complementarity
Over the Three Stages of Therapy for the
Unsuccessful Outcome Group . . . . . . 68

23. The Relationship Between Two Outcome
Measures: Pre- to Post-Therapy MMPI
Changes--vs-—Changes in Client Behavioral
Coordinates . . . . . . . . . . . 87

24. Therapist Complementarity in Male-Male and
Male-Female Dyads (N = 14) . . . . . . - 91

 

 

25. Client Complementarity in Male—Male and
Male-Female Dyads (N = 14) . . . . . . 92

 

26. Therapist Complementarity in Like—Sex and
Opposite-Sex Dyads (N = 20) . . . . . . 92

 

27. Client Complementarity in Like-Sex and
Opposite-Sex Dyads (N = 20) . . . . . . 93

viii

LIST OF FIGURES

Figure
1. Complementarity Matrix . . . . . . . .
2. The Interpersonal Circle . . . . . . .
3. Complementarity Matrix . . . . . . . .

4. Changes in the Level of Therapist Com—
plementarity Over the Three Stages of
Therapy for the Successful and Unsuccess-
ful Outcome Group . . . . . . . . .

5. Changes in the Level of Client Complemen—
tarity Over the Three Stages of Therapy
for the Successful and Unsuccessful Out—
come Groups . . . . . . . . . . .

6. Behavioral Coordinates Representing Two
Levels of Client Maladjustment: Severe
and Moderate. . . . . . . . . . .

7. Changes in Client-Therapist Complementarity
Over the Three Stages of Therapy for Two
Outcome Groups . . . . . . . . . .

8. Illustrations of "Successful" and "Unsuccess-
ful" Changes in Client Behavioral
Coordinates from Early to Later Stages

of Therapy . . . . . . . . . . .

ix

Page

38
50

67

69

74

80

86

INTRODUCTION

Psychotherapy continues to be an important area of
research activity in psychology. Although considerable
progress has been made, there is a continuing need to
investigate and understand the significant process di—
mensions in psychotherapy which predict, and relate to,
client change.

One of the significant trends in the current psycho-
logical literature is toward a social, interpersonal defi-
nition of behavior. In an increasing number of theoretical
and empirical studies, the search for the causal, or
motivational, antecedents of behavior has shifted from an
analysis of the individual and intrapsychic phenomena to a
consideration of interpersonal processes. At the same
time, there is a growing tendency to view psychopathology
not as an underlying personal disease but as an inter-
personal event which is activated and maintained between
or among individuals (Malone, 1970).

In psychotherapy research, this trend is reflected
in a number of studies (to be reviewed in the next chapter)
in which the focus has shifted to an analysis of the inter-

vpersonal behavior patterns of client and therapist. A

l

main objective, in these studies, has been to isolate and
identify important relationship dimensions which elucidate
the complex process of psychotherapy. With this emphasis
on relationship dimensions, psychotherapy is conceptualized
as an extended sequence of interactions between client and
therapist where each, by his own behavior, exerts some
impact on the subsequent behavior of the other (Kell &
Mueller, 1966).

Analyses of the sequential verbal interactions of
client and therapist have resulted in a compelling amount
of evidence in support of the reciprocal and complementary
principles of interpersonal behavior; principles which
have potential as significant relationship variables for
mapping therapeutic processes. The reciprocal principle,
outlined by Leary (1957), proposes that behavior has both
an eliciting value (i.e., the tendency for S's behavior
to stimulate, or "pull" behavior from the other person) and
a reinforcing value (i.e., the tendency for S's behavior
to confirm, or disconfirm, the preceding behavioral stance
of the other person). The closely related concept of
"behavioral complementarity," elaborated by Carson (1969),

suggests that particular behaviors tend to elicit, and

 

reinforce, other specific classes of behavior. In terms

 

of the Leary (1957) Circumplex model which was used in
the present study, behavioral "complementarity occurs on
the basis of reciprocity in respect to the dominance-

submissive axis (dominance tends to induce submission and

vice versa) and on the basis of correspondence in respect
to the love-hate axis (love induces love, and hate induces

hate)," (Carson, 1969, p. 112).

Assuming that interpersonal behaVIQr is governed
ngu MW ..

'k-v-s-a-w

in part by the prinCiples of reciprocity and complementarity,

‘0.— ‘M -( MW

it would follow theoretically that the therapist, as a
.result of his own varying behavioral stance, has the-
ability to influence (as an eliciting and reinforcing
agent) the subsequent behavior patterns of the client. For
therapy to succeed, it‘would follow that thetherapist must
avoid the adoption of an interpersonal position comple-
mentary to and confirmatory of the maladaptive (pre- therapy)
stance to which the client almost invariably attempts to
move in the course of the therapeutic interaction (CarSon,
#1969). . i *

One of the main objectives in the present study
was to relate the level of therapist complementarity during
various stages of the therapy relationship to therapy out-
come, i.e., successful--vs--unsuccessful cases. Secondly,
the study investigated changes in the level of client
complementarity (i.e., the extent to which the client
responds complementarily to the "eliciting" behaviors of
the therapist) during various stages of therapy for both
outcome groups. Except for a series of studies by Swenson

(1967), the relationship between client-therapist comple-

mentarity and therapeutic outcomes has not been investigated.

Thirdly, an attempt was made to examine what affect
the pre-therapy level of client "psychopathology" has on
therapist complementarity. One assumption is that severely
maladjusted clients are restricted to a narrower, more
rigid behavioral repertoire and consequently have a greater
"investment" in forcing the therapist into a complementary,

self-confirming behavioral stance.

REVIEW OF THE LITERATURE

Behavioral Analysis System

Before proceeding with a discussion of the theory
and research on complementarity and psychotherapy, it will
be helpful to briefly describe the behavioral scoring
system which will be used in the present study. Carson
(1969), after reviewing a majority of the systems which
have been developed to analyze and classify interpersonal
behaviors, presented the following conclusions:

On the whole, the conclusion seems justified that
major portions of the domain of interpersonal behavior
can profitably and reasonably accurately be conceived
as involving variations on two independent bipolar
dimensions. One of these may be called a dominance-
submission dimension; it includes dominant, assertive,
ascendant, leading, controlling (etc.) behaviors on

the one hand, and submissive, retiring, obsequious,
unassertive, following (etc.) behaviors on the other.
The poles of the second principle dimension are perhaps
best approximated by the terms hate versus love; the
former includes hateful, aggre531ve, rejective, pun-
ishing, attacking, disaffiliative (etc.) behaviors,
while the latter includes accepting, loving af-
fectionate, affiliative, friendly (etc.) social actions
(p. 102).

 

One of the recently developed behavioral rating
systems (composed of a circular grid defined by the two
orthogonally-positioned dimensions cited above) is the

Interpersonal Circumplex Model developed by Leary (1957)

and his research associates at the Kaiser Foundation. With
this model, interpersonal behaviors are rated and cate-
gorized into one of four quadrants outlined by the dominance-
submissive and friendly-hostile axes: (l) friendly-
dominant, (2) friendly-submissive, (3) hostile-submissive,

and (4) hostile-dominant.1

Behavioral Complementarity

 

The term "complementarity," as it will be used in
the present study, refers to the degree of reward (i.e.,
gratification, reinforcement) derived by both interaction
participants as a result of the behaviors exchanged. Inter-
personal theory and previous research (to be reviewed
shortly) suggest that the exchange of particular combi-
nations of behaviors results in varying degrees of reward.
Interactions which are deemed "rewarding" for both par-
ticipants are defined as complementary.

In terms of the Leary System, complementarity occurs
on the basis of reciprocity in respect to dominance-
submission and on the basis of correspondence in respect to
hostility-affection. To illustrate the principle of
complementarity let us assume that Client A and Therapist
B are interacting and their moment-by-moment behaviors
are being rated on the Leary Circumplex. If A emits a

friendly-submissive (F-S) response (let us say that A is

 

1A more detailed discussion of the Leary Circumplex
and rating procedures can be found in the Methods chapter
and Appendix C.

seeking advice about a problem--he is asking B a question),
and B responds in the friendly-dominant (F-D) mode (he

nurtures, instructs, etc.) the interaction is conceived as

 

mutually rewarding and therefore highly complementary.
(Later it will be pointed out that the level of "inferred"
reward is determined both by theoretical propositions and
also empirically in terms of the relative frequency of
particular reSponses to particular eliciting behaviors.)
Another way to view the interaction in our example is to
say that A, by his behavior, is defining his own stance
with B and is also, through this assumed stance, attempting

to elicit ("pull") a particular behavior (or stance) from

 

B. Thus, if A enacts F-S behavior, he is "inviting" B

to behave both friendly and dominant. If B responds to

the "invitation" (as he did in our example) both in terms

of the type of affect exchanged (friendliness with friendli-
ness) and from the position requested (dominance following
submissiveness), then the interaction is deemed most re—
warding and complementary.

If, following our example, B responds to A's F-S
behavior with either a hostile-dominant (H-D) or friendly-
submissive (F-S) response, the degree of inferred reward
(and complementarity) is less. With the H-D response, the
desired ascendant position is taken by B but the affective
exchange is non-rewarding. With the F-S response, the
desired affect is experienced but B has failed to take the

ascendant position "requested" by A. Thus, either of these

responses represent a mixed reward/cost outcome and the
interaction is viewed as less complementary.

Now assume that B responds to A's F—S behavior
with a hostile-submissive (H-S) response (suspicion,
withdrawal, sulking). If such an exchange occurs, A has
failed to acquire the "requested" behavior on both di-
mensions. It is assumed that such interactions are the
least rewarding and the most costly. (Later ggst_will be
equated with reduced security operations and anxiety.)

To follow another example, assume that A responds
from a H-S stance. A H—D response by B would be most
complementary whereas a F-S response would be least comple—
mentary. Either a F-D or H-S response would result in an
intermediate reward outcome for A.

One of the assumptions within this interpersonal
model, which derives in part from traditional learning
theory, is that B's highly complementary response (in the
first example-~F-D) will increase the probability of A's
eliciting behavior whereas a low complementary response
from B will decrease the probability of A's eliciting
behavior. Consequently, the varying patterns of comple-
mentarity (from high to low) within an extended sequence
of interactions should be related in predictable ways to

. . . 2
the subsequent behavioral patterns of either partic1pant.

 

2Notice that the same principles can be applied to
client as sender and therapist as respondent, or therapist
as sender and client as respondent.

To evaluate behavioral complementarity as a process
variable it was necessary to develop an Operationalized,
quantitative measure, or index, which would reflect the
level of complementarity over an extended sequence of
interactions. To accomplish this, a 4 x 4 matrix was con-
structed containing an "interaction cell" for all possible
interactional combinations (see Figure 1). All 16 cells
were assigned weightings (3, 2, or 1) to reflect the level
of complementarity represented in that interaction. Cells

representing interactions which are deemed complementary

Respondent Behaviors

 

 

 

 

 

 

 

 

 

 

 

 

(weighted) H-D F—D F-S H—s
proportions
(H-D)
Friendly-dominant
(Fm) (1)p um um (2)p
Friendly-submissive
ms) (2);) (3);: (2)p (1)p
Hostile-submissive
(H_S) (3)p (2)9 (1)p (2)P
Compligggiarity = IColumn + ZColumn + £Column + ZColumn

Figure l

Complementarity Matrix

10

on both dimensions [(1) FD-+FS, (3) HD-—»HS, (4) HS——+HD]
were weighted with a Factor 3. Cells representing inter-
actions which are non-complementary on both axes [(1)
HD-—+FD, (2) FD-—+HD, (3) FS-—+HS, (4) HS-—»FS] were
weighted by a Factor 1. Cells representing intermediate
levels of complementarity [(l) FD-—+FD, (2) HD——+HD,
(3) FS—+FS, (4) HS—r-HS, (5) FD—->HS, (6) Hs—AFD, (7)
HD——+FS, (8) FS-—»HD] were weighted by a Factor 2.
Inserting the proportions of interactions from a
given time segment into the respective cells, multiplying
by the apprOpriate weightings, and summing across the 16
cells, results in a "Complementarity Index" (Cl) which
reflects the levels of complementarity in the rated
session(s). Larger Cl scores reflect higher levels of
complementarity in the interaction sequence whereas smaller
Cl scores result from a series of exchanges where the
respondent was less complementary to the sender's elici—
tations. The distribution of Cl values therefore provided
the quantitative values for the process variable under
study.

Behavioral Complementarity
and Interpersonal RelatIOns

 

 

In any discussion of interpersonal behavior, one
invariably draws upon the contributions of H. S. Sullivan.
While a number of theorists (including Horney, Fromm, and

Erickson) incorporate social factors in their explanation

ll

of behavior, Sullivan (1953) was one of the earliest to
clearly define behavior from an interpersonal perspective.
(For several comprehensive summaries of Sullivanian theory,
the reader is referred to Ford and Urban [1963, Chapter 14],
Carson [1969, Chapter 2], and Mullahy [1970].)
Complementary interactions develop, according to
Sullivan, as a result of the individual's need for security
and interpersonal integration. In his "theorem of recipro-
cal emotion," Sullivan states: "Integration in an inter-
personal situation is a reciprocal process in which
(1) complementary needs are resolved, or aggravated; (2)
reciprocal patterns of activity are developed, or disin-
tegrated; and (3) foresight of satisfaction, or rebuff,
of similar needs are facilitated" (1953, p. 198). Carson
(1969), in an excellent analysis of interpersonal theory,
arrives at a similar conclusion: "The purpose of inter-
personal behavior, in terms of its security—maintenance
functions, is to induce from the other person behavior
that is complementary to the behavior preferred. It is
assumed that this induced, complementary behavior has
current utility for the person inducing it, in the sense

that it maximizes his momentary security" (p. 112). In

r"~
/ _

another place, Carson states: "The successful prompting of
complementary behavior in the other person may be assumed
to have a security-enhancing reward value, while the 1

failure of the other person to adopt a complementary stance

12

might threatenfior diminish security" (p. 144). It would

- “I“.
,.‘. 3... tr».
,«1

appear then that the basis for behavioral complementarity
resides in the individual's need to achieve interpersonal
security which, in turn, is enhanced through the mutual
gratification of underlying complementary needs.

What then are the complementary needs and the
reciprocal behavior patterns which develop in response to
those needs? Much of the research evidence points to the
following sequences: Complementarity occurs on the basis
of reciprocity in respect to the dominance-submissive axis
(dominance tends to induce submission, and vice versa) and
on the basis of correspondence in respect to the friendly-
hostile axis (friendly behavior induces friendliness, and
hostility induces hostility) (Carson, 1969).

Heller, Myers, and Kline (1963) trained four
client-actors to play the roles of (1) dominant-friendly,
(2) dependent-friendly, (3) hostile-dominant and (4)
dependent-hostile clients. Each client-actor was presented
in counter—balanced order to 34 interviewers-in-training
for half-hour interviews. Interviews were observed through
a one-way mirror by judges trained to rate the interviewer
behaviors on the Leary Circumplex. The results clearly
supported the four main hypotheses: (1) dependent behavior
evokes dominant behavior, (2) dominant behavior evokes
dependent behavior, (3) hostility elicits hostility, and

(4) friendliness pulls friendliness. Although the study

13

has some limitations (i.e., the use of actors and inex-
perienced interviewers restricts the generalizations that
are possible), it represents considerable support for the
principle of behavioral complementarity.

In a study by Raush, Dittman, and Taylor (1959),
the interpersonal behaviors of six "hyperaggressive" boys
(ages 8-10) from a residential treatment center were rated
with the Leary system during early and late phases of the
treatment program. In each phase, the children were ob-
served twice in each of six settings as they interacted
with each other and with various adults. Among the many
interesting findings reported, there was considerable
support for complementarity in both the peer-peer inter—
actions and child-adult exchanges. For peer-peer behaviors,
the most significant findings were "that passive aggression
evokes dominant aggression and dominant aggression evokes
passive aggression" (p. 25). In the child-adult inter-
actions, complementarity was again demonstrated but in
differing behavioral categories. Adults "sent" primarily
friendly-dominant responses (58%--ear1y phase, 72%--1ater
phase) and "received" primarily friendly-passive re-
Sponses (43%--ear1y phase, 63%--later phase) (pp. 23-24).
In addition to providing evidence for behavioral comple-
mentarity in a number of different interpersonal re-
lationships and settings, this study points out the

sequential impact which current behavior has on subsequent

14

response patterns (as reflected in the increasing levels
of complementarity from early to later stages of the
study.

In another study, Mackenzie (1968) rated the inter-
personal behaviors of normal and clinic family members
(mother-father, mother-son, father-son) during fifteen—
minute sessions as they discussed a predetermined topic.
Using the Leary system, she obtained results which es-
sentially support the complementary sequences cited previ-
ously. In the normal family group, the greatest proportion
of mother-son interactions (25%) involved friendly-
dominant behaviors followed by friendly—passive behaviors.
The highest proportion of son-mother interactions (24%)
included friendly-passive responses followed by friendly-
dominant responses. Similar patterns of complementarity
were evident in the normal group father-son and son-father
interactions.

With the clinic families, complementarity was also
exhibited but in different behavioral quadrants. The
highest proportion of mother-son exchanges (28%) in-
volved hostile-dominant behaviors followed by hostile-
passive behaviors. In turn, the greatest proportion of
son-mother interactions (27%) included the exchange of
hostile-passive and hostile-dominant responses. Clinic

father-son interactions were primarily friendly-dominant

15

(father) and hostile-passive (son). It is interesting
to note that the clinic mother-son relationship is

more complementary than the father-son relationship,
which is complementary on only the dominance-submission
axis.

Mueller (1969) scored and compared the inter-
personal responses of clients and therapists during initial
and later sessions of psychotherapy using the Leary model.
The proportions of behaviors in each quadrant for each
therapeutic dyad were then rank-order correlated for each
phase of treatment. Tables 3 and 4 (pp. 14-15) reveal
significant positive correlations between the complementary
quadrant behaviors whereas non—complementary quadrants are
generally marked by significant negative correlations.
Again, as in the Raush gt_al. (1959) study, the degree of
complementarity generally increased from initial to later
stages of therapy.

In general, these studies provide considerable
support for the principle of behavioral complementarity and
its occurrence in a broad variety of interpersonal situ—
ations and relationships. Moreover, it was noted that the
level of complementarity varied in relation to the personal
characteristics of both relationship participants as well
as to their interaction over time. As such, behavioral

complementarity would appear to be a viable, sensitive

16

relationship dimension for mapping the psychotherapeutic
processes which lead to successful, as opposed to, un-
successful outcome.

Client-Therapist Complementarity
and Therapeutic Outcome

 

The degree of complementarity which is present
early, or develops later, in a given therapeutic relation-
ship would appear to be governed to a great extent by the
unique pattern of needs and security-maintaining inter-
personal behaviors which each participant brings to, or
acquires in, the therapeutic encounter. Although the
therapist's behaviors are influenced in part by his
socially-defined role as "helper," it has become apparent
that much of his behavior during therapy reflects his own
unique pattern of needs and security operations, i.e.,
his personality (Swensen, 1967). Hopefully, the thera-
pist's security operations are flexible enough, and
sufficiently varied, to permit a "comfortable" assessment
of, and appropriate response to, the client's eliciting
behaviors. Where this is not the case, there is a greater
chance that the client's elicitations will lead to in-
creased anxiety in the therapist and a greater possibility
of impulsive, self-protective responses.

The client, likewise, brings to the relationship
a particular set of needs and security operations. In many

cases, the therapeutic candidate seeks help because his

l7

behavioral stance (personality) and behavioral repertoire
are constricted and limited as a result of his earlier
relationships with "significant others" (parents, siblings,
extended family members, teachers, and such). In therapy,
he hopes to have those experiences with the therapist
which will permit him to learn new, and more adequate,
appropriate ways of behaving in a variety of interpersonal
settings.

Leary (1957) and Carson (1969) have suggested that
the range of behaviors exhibited interpersonally reflect
the individual's level of personal adjustment, an idea
alluded to in the previous discussion of therapist be-
haviors. They point out that individuals, who in differing
situations and following various eliciting behaviors,
exhibit the same inflexible, inappropriate behavior can be
viewed as functioning toward the "severely maladjusted" end
of the adjustment continuum, whereas individuals who are
able, without an undue amount of anxiety, to respond ap-
propriately and complementarily to a broad range of inter—
personal situations and behaviors, are seen as being
psychologically healthy. It is assumed that the therapist
represents the "healthy" member of the therapy dyad and
consequently is in a position to utilize the principle of
complementarity to promote client growth rather than using

the client to validate his own behavior.

18

Both variables (i.e., personality and personal
adjustment) and their unique interaction can be expected
to exert considerable influence on the degree of client-
therapist complementarity. Obviously, the level of comple-
mentarity can range from very low to very high either
within a given relationship or across a number of client-
therapist dyads.

What, then, is the optimum level of complementarity
required to maximize the probability that psychotherapy
will be successful? Swensen (1967), who has done most of
the research in this area, predicted that the degree of
success in therapy would be directly related to the level
of client-therapist complementarity, with the assumption
that complementary relationships are the most "harmonious
and satisfying" for both participants and consequently most
successful (pp. 7-8). In the first of three reported
studies, Swensen utilized published data from a study by
Carson and Heine (1962) to test his predictions. Using a
formula developed by Leary (1957),3 he rescored MMPI pro-
files which were obtained from clients and therapists in
the original study and used the scores to categorize each

subject in one of the quadrants of the Leary Circumplex.

 

3Leary and his research associates developed the
formula to predict interpersonal behavior from the MMPI.
The formula, using T-scores from eight scales, yields a
dominance-submission score [(Ma - D) + (H5 - Pt)], and
a love-hate score [(K - F) + (Hy - Sc)].

19

Outcome measures were derived from supervising psychia—
trist's ratings of client improvement.

The results clearly supported his predictions:
"Group 1 had the lowest complementarity between client and
therapist and had the least success in therapy, and Group
IV had the greatest complementarity and had the greatest
success in therapy" (1967, p. 9). Groups II, III, and V
were intermediate on both the complementarity and outcome
dimensions.

Since the procedure in the initial study was
performed on data not originally collected to test the
complementarity hypothesis, Swensen (1967) conducted two
replicate studies again utilizing MMPI scores to assess
the interpersonal stances of clients and therapists. The
therapists were clinical psychology graduate students
enrolled in a therapy practicum and clients were people
seeking help in the University Psychological Service
Center. The outcome measure was therapist's ratings which
took into consideration changes in the client's school
grades, social activity, family conflicts, and symptom
status (p. 9). The findings again indicated "that more
clients improved when client and therapist were Opposite
on dominance-submission, but on the love-hate dimension
greater improvement was found when therapist and client

were the same on the love-hate dimensions" (p. 10).

20

Carson (1969) has presented an opposing hypothesis
that success in therapy is related to lower levels of
therapist complementarity. He suggests that successful
client change requires that the therapist avoid responding
in a complementary way to the maladjusted, constricted
behavioral patterns which the client brings to the relation-
ship. Although responding in a non-complementary way
threatens the client's security and consequently raises
anxiety, such therapist maneuvers are deemed necessary to
launch the client into the "therapeutic work" and ultimately
on to changed behavioral patterns. Carson offers the
following as a "cardinal therapeutic tactic": "the
therapist must avoid the adOption of an interpersonal po-
sition complementary to and confirmatory of the critical
Self-protective position to which the client will almost
invariably attempt to move in the course of the thera-
peutic interaction" (p. 280). He continues by saying,

”the therapist must be one person in the client's life--and
he will frequently be the only one in a sustained relation-
ship--who does not yield to the client's pressure to supply
confirmatory information to the latter's crippled Self"

(p. 280). Halpern (1965), writing from a slightly differ-
ent theoretical orientation but in basic agreement, states:
"For psychotherapy to succeed the therapist must avoid
becoming unwittingly ensnared in the disturbance-

perpetuating maneuvers of his patient" (p. 177). Beir (1966)

21

concurs: "one can see the therapeutic process as one in
which the therapist refuses to reinforce the patient's
present state of adjustment by refusing to make the response
the patient forcefully evokes in him" (p. 13).

Carson has failed to report any research which
would test his interesting hypothesis on complementarity
and therapeutic outcome. Swensen's findings, on the other
hand, are called into question by several methodological
limitations. The most serious limitation derives from
his use of the MMPI for defining the subject's inter-
personal stances. Leary and Coffey (1955) reported only
low to moderate correlations between the MMPI predictive
indices and the ratings of actual, observed interpersonal
behavior in two separate samples of group therapy patients
(N = 123). Correlations were in the .42 to .47 range on
the dominance-submission axis and in the .25 to .67 range
on the love-hate dimension. Secondly, Swensen collected
the MMPI data prior to therapy raising further questions
about the subject's actual quadrant positions during the
therapeutic relationship. Unfortunately, the validity
of the outcome measure which he used (supervising psychia-
trist's ratings) has also been questioned (Metzoff &
Kornreich, 1970).

As an initial part of the present study, the op-
posing hypotheses of Swensen and Carson will be re-

examined using an improved design. The level of behavioral

22

complementarity will be assessed by rating the actual
client-therapist behaviors in a representative sample of
audio—taped therapeutic sessions (using the Leary system)
and incorporating these ratings in the Complementarity
Matrix discussed on page 9. The present design, which
assesses the sequential interactions of client and therapist
during a given session and across sessions, permits one to
examine the process with client as "sender" and therapist
as "responder" (therapist complementarity) or vice versa
(client complementarity). Although the level of therapist
complementarity will receive the most attention, the re-
lationship between client complementarity and therapeutic
outcome will also be investigated.

The outcome measure, in the present study, which
categorized clients into (1) successful or (2) unsuccessful
therapy groups was derived from trained clinician's ratings
of the degree of improvement, or deterioration, evident

on pre- to post-therapy MMPI profiles.4

Client-Therapist Complementarity During
Various Stages of Psychotherapy and
Therapeutic Outcome

 

In an attempt to understand, and resolve, the
conflicting hypotheses of Swensen and Carson (the reader)
will recall that Swensen predicted a direct relationship

between the level of client-therapist complementarity and

 

4The data, to be reviewed in the Methods chapter,
bear out the reliability and validity of this outcome
measure.

23

the degree of therapeutic success whereas Carson proposed
an inverse relationship between the process and outcome
variables), the idea emerged that an analysis of psycho-
therapy stages, or phases, might reveal that pgth_hy-
potheses were valid but at different periods in the thera-
peutic relationship. Stated in another way, it seemed
theoretically possible that "successful" psychotherapy
processes would involve both higher and 12235 levels of
client-therapist complementarity but during different
stages of the relationship. In part, this thinking was
generated by the psychoanalytic literature regarding the
development and resolution of "transference" phenomenon
in successful therapeutic relations (Alexander & French,
1946). In addition, the following conceptualizations are
an outgrowth of the present experimenter's observations of
differing interactional patterns in psychotherapeutic re-
lationships leading to successful and unsuccessful outcome.
In most discussions on the phases or periods of
psychotherapy, there is considerable agreement for at least
three basic stages: (1) an early stage marked by
relationship-enhancing, rapport-building behaviors; (2)
a middle stage when much of the "therapeutic work" is
accomplished; and (3) a later stage devoted to integration,
resolution, and increased adjustment (Alexander & French,

1946; Crowder, 1970; Mullahy, 1970).

24

Early Stage

 

In considering the process dimensions of client
and therapist complementarity there was little reason to
believe that these dimensions would display divergent
patterns (for successful and unsuccessful cases) during the
early stage of therapy. It is likely, although there is
empirical evidence at present to support this prediction,
that therapist complementarity levels will be moderately
high in both outcome groups during the early part of the
relationship to enhance the relationship-building process
and to guarantee the maintenance of security operations.
Mullahy (1970) suggests that the interviewer, early in the
relationship, must "function so that no complicating
situation arises" (p. 561). Carson (1969) points out that
a reduction in the client's security operations too early
in the relationship drastically raises the possibility of
an early termination. Consequently, it would appear that
the therapist's task is to provide a sufficient proportion
of complementary, confirming responses for the client
while at the same time remaining alert to the possibility
of becoming overly—complementary and entrapped by the
client's disordered elicitations.

It is also likely that client complementarity is
moderately high during this early stage of therapy. Crowder
(1970) in his study on transference and transference dissi-

pation described the initial period of therapy as a time

25

of "reality-oriented behaviors" prior to the development of
the transference neurosis. As such, one would predict that
a greater proportion of the client's behaviors are in re-
sponse to the therapist's actual behaviors and are conse-
quently more complementary.

Carson (1969) presents the interesting thesis that
the degree of client maladjustment will directly influence
the level of therapist complementarity. He suggests that
clients who enter therapy with a severe degree of manifest
maladjustment (i.e., their behavioral repertoire is re-
stricted, or confined, to a small portion of the Circumplex)
have a stronger "investment" in obtaining and maintaining
a particular interpersonal stance. This strong interest
inaiparticular stance apparently results from the extreme
anxiety which, as a result of earlier relationships with
significant others, is associated with the other behavioral
positions in the interpersonal circle.

Because of his constricted stance, the maladjusted
client is also more invested in forcing the therapist into
a complementary stance and is willing, as Carson (1969)
suggests, to use "rule-breaking" behaviors (symptoms) to
accomplish this goal:

The disordered person, driven by powerful forces, is
likely to have acquired a very high degree of expertise
in moving others into the positions he needs them to be
in, and he is often quite prepared, if necessary, to

go to very extreme lengths in the exercise of power in
order to achieve his goals (p. 281). ‘

26

Thus, although it is unlikely that the early stage
of therapy will reveal differing patterns of client and
therapist complementarity in relationship to outcome, there
are indications that the degree of client maladjustment
will directly influence the level of therapist comple-

mentarity during this period of the relationship.

Middle Stage

 

Assuming that the preliminary relationship-building
tasks are successfully negotiated, the therapeutic process
will move into the middle, or "work" stage. It is during
this stage that the greatest differences in complementarity
patterns for the successful and unsuccessful cases, can
be expected.

With potentially successful cases, the therapist
will begin to respond in less complementary ways to the
client's maladjusted behaviors. Carson (1969) succinctly
states the role of the "successful" therapist: "By varying
his own stance toward the client in deliberate, planned
ways, making full and sensitive use of the prompts and
"reinforcements" available to him, he may succeed in ine
ducing the client to sample repeatedly portions of the
(interpersonal) matrix that he previously neglected or
avoided. The use of complementarity in the systematic way
indicated here would have the immediate effect of steering
the client toward new varieties of interpersonal experience"

(p. 288).

27

As a result of the therapist's non-complementary,
disconfirming behaviors, the client can be expected to
experience a loss of security and increased anxiety which
Sullivan (1956) believed served the constructive function
of "mobilizing the patient" for the therapeutic work.
During this period of heightened anxiety, the potentially
successful client is purported to exhibit the highest
level of "transference" (Mueller, 1969) or, in inter-
personalist's terms, "parataxic distortions":

The greatest complexity of the psychiatric interview

is brought about by the interviewee's substituting

for the psychiatrist a person or persons strikingly
different in most significant respects from the psychia-
trist. The interviewee addresses his behavior toward
this fictitious person who is temporarily in the
ascendancy over the reality of the psychiatrist, and

he interprets the psychiatrist's remarks and behavior

on the basis of this same fictitious person (Sullivan,

Sullivan makes it quite clear that the client
during this period of increased anxiety is responding to
the therapist on an "as if" basis (i.e., as if he were a
significant other from the past). One would predict in
such cases, that the level of client complementarity (to
the actual behaviors of the therapist) would be considerably
lower.

In the potentially unsuccessful relationships, one
would predict that the therapist will continue to provide
behaviors, of a highly complementary variety, to the client.

This unfortunate situation would most likely develop in

those relationships where the preferred behavioral stance

28

(personality) of the therapist happens to be complementary
to the disordered stance of the client. Such disorder-
enhancing responses could also result from the therapist
becoming inadvertently caught up in the "pull" of the
client's behavior; a therapeutic mistake which is easily
made because of the strong investment which the client

has in eliciting self-confirming behaviors from the
therapist. Where such highly complementary relationships
develop, one can expect an intensification of the client's
presenting difficulties and, subsequently, client deteri—

oration.

Later Stage

 

Toward the end of therapy (later stage), one can
expect "successful" relationships to be characterized by
relatively high levels of complementarity. Assuming that
the therapist, during the previous "working" stage, was
successful in helping the client to sample new portions of
the Circumplex, it should follow that the client's more
expanded, flexible behavior repertoire would permit him
to respond in more apprOpriate, complementarity ways to
the therapist's eliciting behaviors. It is also during
this later phase of treatment, following a resolution of
the transference neurosis, that the client can be seen
responding to the therapist as a real person (Alexander

& French, 1946). It can also be expected that therapist

29

complementarity will be higher as he (the therapist) attempts
to confirm, or validate, the newly-acquired behaviors which
the client is trying out.

In summary, the patterns of client and therapist
complementarity leading to successful therapeutic outcome
are conceptualized as decreasing from early to middle
stages of therapy, and increasing from middle to later
stages. In contrast, the patterns of client and therapist
complementarity leading to unsuccessful outcome are seen
as linear with little, or no, change over the three stages.

Since no previous research is available relating
complementarity patterns during the various stages of
therapy, to therapeutic outcome, the present study repre-

sents an initial attempt to validate these predictions.

HypothesiS‘I:

Ia:

Ib:

EXPERIMENTAL HYPOTHESES

There will be significant differences in
client-therpaist complementarity between
the successful and unsuccessful psycho-
therapy groups.

There will be significant differences in the
level of therapist complementarity between
the successful and unsuccessful psycho-
therapy groups.

 

There will be significant differences in the
level of client complementarity between the
successful and unsuccessful psychotherapy
group.

These hypotheses represent re-examination of the

Swensen and Carson predictions discussed on pages 12-15.

Predictions Concerning Stages of'Psyphotherapy

Hypothesis II:

 

During the early stage of psychotherapy,

the level of therapist complementarity will
be directly related, at a significant level,
to the degree of manifest client maladjust-
ment.

This prediction was made on the assumption that

therapists will tend, during the initial part (i.e., early

stage) of the therapeutic relationship, to function at a

higher level of behavioral complementarity with more

severely maladjusted clients.

30

Hypothesis III:

 

IIIa:

IIIb:

Hypothesis IV:

 

IVa:

IVb:

Hypothesis V:

 

Va:

31

During the early stage of psychotherapy,
there will be no significant differences
in the level of client-therapist comple—
mentarity between the successful and
unsuccessful psychotherapy groups.

During the earl stage of psychotherapy,
there will e no significant differences
in the level of therapist complementarity
between the successful and unsuccessful
psychotherapy groups.

 

During the earl stage of psychotherapy,
there will e no significant differences
in the level of client complementarity
between the successful and unsuccessful
psychotherapy groups.

During the middle stage of psychotherapy,
the level of client-therapist comple-
mentarity will be significantly lower in
the successful, as opposed to unsuccessful,
psychotherapy group.

During the middle stage of psychotherapy,
the level of therapist complementarity

will be significantly lower in the suc-
cessful, as opposed to unsuccessful, psycho-
therapy group.

 

During the middle stage of psychotherapy,
the level of client complementarity will
be significantly lower in the successful,
as Opposed to unsuccessful, psychotherapy
group.

During the later stage of psychotherapy, the
level of client-therapist complementarity
will be significantly higher in the suc-
cessful, as Opposed to unsuccessful, psycho-
therapy group.

During the later stage of psychotherapy,
the level of therapist complementarity will
be significantly Higher in the successful,
as Opposed to unsuccessful, psychotherapy
group.

 

32

Vb: During the later stage of psychotherapy,
the level of client complementarity will be
significantly Higher in the succesful, as
Opposed to unsuccessful, psychotherapy group.

The theoretical assumptions underlying these last

three predictions are discussed on pages 21-26.

METHOD

Source of Data

 

Psychotherapeutic cases for the present study were
Obtained from the research library at the Michigan State
University Counseling Center. All clients were late
adolescents, self-referrals, and undergraduates at the
university. Clients came to the Center seeking help pri-
marily for personal and social problems.

If, following the intake interview, it was mutually
agreed that the client would enter therapy (and they had
not been in therapy previously), they were asked to par-
ticipate in the research project.

Therapist assignments were made on the basis of
available time and matching client-therapist schedules.
The therapists represented two levels of experience: (1)
a staff group including 7 Ph.D. counseling and clinical
psychologists with 2 to 20 years of psychotherapy
experience, and (2) a therapist-in-training group composed
of 4 second-year interns, 8 first-year interns, and l
practicum student. Except for the practicum student, all

interns had completed their practicum experience with an

33

34

average of two years of supervision. A summary of client
and therapist characteristics, including number of sessions,

is presented in Table 1.

Selection of Cases

 

Therapy cases used to test the hypotheses were
selected from the tape library on the basis of two criteria.
The first criterion was that the client must have continued
in therapy for at least nine sessions. It was felt that
this minimum was necessary to provide some separation in
time between the three stages of therapeutic interaction
which were sampled and also to provide sufficient time for
the process variable, under scrutiny, to develop. Secondly,
it was necessary that both pre- and post-therapy MMPI pro-
files were available for each client since these data were

used to determine therapeutic outcome.

Selection Of Sessions

 

Data were selected from cases at three different
points to assess the interaction patterns during early,
middle, and later stages of therapy. The first and second

sessions (early stage), the pre-median and median sessions

 

(middle stage), and the second last and last sessions

 

(later stage) were selected. In all, six sessions per
case, for a total of 120 sessions, were selected for
analysis.

Six of the 120 tapes were not ratable because of

poor quality sound tracks (volume too low, distorted signal,

35

unmoHMflamHm uoc .mmm.s u up

ucmowmwcmflm no: .Nmm.a

#m

pompoum Esowuomum n v

“mGHOHCfi .H» and u m umcumucw .Hm cam u m «mmmum Hoacmm n H ume>mq mosmflnmmxm

 

 

 

ov.na om.H N m m m OH Hammmmoosmca
oo.ma om.m v w o v 0H Hsmmmooosm
bmcowmmmm wao>mq m z m S
no Hmnfioz mocoanmmxm xmm xom mommu mo msouw
com: com: pmfimonone ucmwau Hmnfisz

 

Aom u zv mmoOHo osoouco 039 MOM
chHmmom mo HmnEoz pom moaumfluouomumzo umwmmumnaluomwao

H OHQMB

36

and such). Where these difficulties were encountered,
adjacent sessions were substituted. For example, with one
case where sessions 19 and 20 were to be rated (and session
20 was unratable), session 18 was rated instead. In no
case, did the substitution result in a loss of stage
representation (i.e., in the above example, session 18
was still four sessions from the boundary dividing the
middle and later stages of therapy and eight sessions from
the median session which represented the middle stage).

In the studies discussed earlier (Chapter 1) where
the Leary System.was used, the usual procedure was to
rate a portion of a session and then regard the sample as
representative of the entire data. This procedure was used
in the present study as well. A lS-minute segment of each
selected session was rated. The rated segment was begun
at 15 minutes into the session and ended at 30 minutes
into the session. This particular segment was selected
to avoid the "hello" and "good-bye" interactions which
characteristically occupy the beginning and ending of
sessions and to focus on the intermediate portion where
the more typical, significant interaction patterns likely

oc cur .

Behavioral Analysis System

 

The method of tape analysis used in this study
involved the interpersonal system of behavioral analysis

developed by Freedman, Leary, Ossorio, and Coffey (1951),

37

elaborated by LaForge gt_al. (1954), LaForge and Suczek
(1955), Leary (1957), and LaForge (1963), and applied in

a variety of empirical settings by Crowder (1970), MacKenzie
(1968), Mueller (1969), Mueller and Dilling (1968), Raush
gt_al. (1959), Raush gt_al. (1960), and Swensen (1967).

According to this method, each response unit (an
uninterrupted speech) of client and therapist is scored
and located in one of four quadrants defined by two
orthogonally-positioned axes: a dominant-submissive axis
and an affiliative-disaffiliative (love-hate) axis.
Illustrative verbs for the four quardants include; (1)
dominate, teach, give, support (friendly-dominant); (2)
love, cooperate, trust, admire (friendly-submissive); (3)
submit, condemn self, distrust, complain (hostile-
submissive); and (4) hate, punish, reject, boast (hostile-
dominant) (see Figure 2).

An important aspect Of this method of behavioral
analysis requires that the rater examine and analyze the
interpersonal behaviors of both therapy participants as
attempts on the part of each to create an emotional state
in the interaction intended to evoke, or elicit, a pre-
dictable response from the other. As such, raters are to
empathize with the person who is responding from the
position of the person to whom the behavior is directed
(Freedman gt_al., 1951). Appendix C contains a more de-
tailed description of scoring procedures along with

illustrative examples.

38

Dominant

      
  

  

Hostile- Friendly-
dominant dominant

Hostile

 

  
      
    

Hostile? Friendly-
submiss1ve submissive

 

Submissive

Figure 2
/

The Interpersonal Circle

The 120 tape segments (including a reliability
sample of 39) were randomly assigned to, and rated by, two
judges following an extensive training period with tapes
from another source. Both judges were advanced graduate
students in counseling psychology (with two years of
supervised psychotherapy experience) and were well quali-
fied to perceive and assess the subtleties of thera—

peutic communications.

ReliabilityHSample
Thirty-nine of the 120 tape segments in the
total sample (32.5%) were selected to determine inter-

judge reliability on the Interpersonal Scoring System.

39

Segments were selected to be representative of the three
stages of therapy under study, i.e., early, middle, and
later stages (N = 13 for each stage). Aside from this
consideration both the selection of tapes and the timing
sequence for rating them were random across the entire
sample.

Independent ratings of the sequential client-
therapist behaviors were made by the raters as they listened
simultaneously to the tape(s). The only interaction
permitted during the rating was an infrequent check of
the specific "response number" that they were rating at a
given moment.

Table 2 lists the results from the reliability
sample. Since both raters served as primary raters on
separate samples, it was necessary to determine both the
degree to which Rater g agreed with Rater l, as well as
the degree to which Rater l agreed with Rater a.

Considering the fact that percent agreement at
the chance level would be 25%, the results in Table
2 point to the very acceptable reliability of the Inter-

personal Circumplex Rating procedure.

Level of Client Maladjustment

 

A measure for assessing the level of client malad-
justment (during the early stage of therapy) was needed
to test the hypothesis concerning therapist comple-

mentarity and client maladjustment. Leary (1957) and

4O

 

 

Hm.mm mvmm mmm mmem uqmsmmnma unmoumm cam:
m¢.¢n mvm mm mm” ucmaHsooumHfiumom
m¢.~m «an mas mam m>flmmflsnsmumaflumom
es.ee mam «mm mos m>fimmflsnsmnmapamsum
¢~.mm mama and «mas pcmcflsoaumapamflum
ummwwwmwa Hmuoe pmmummmno pmmuma mmcoommm

 

mmcflumm

m Houmm SuH3.M umumm mo
ucmsomumm ommucooumm How muasmom .<

“amaze mHQEMm speafinMnHmm
Hmn0fl>mnom HmcomummumucH so ucmsmonmd mmosnuuoucH

N manna

41

 

 

oo.~m ommm was mnem ucmsmmum< unmoumm cam:
mm.on mnm mos mom ucmcfleooumaflumom
mm.mn Hen «ma mmm m>flmmflsnsmumanumom
me.am «mm «he mes m>flmmflsnsmumapamflum
m~.mm Homfl mma mesa ucmcesooumapcmflum
ucofimmum<
usmouom Hmuoe OOOHmmeo Oomumfi mmcommmm

 

m umumm nuez_m umumm mo
usmsmmumm mmmusmoumm How muasmmm .m

pmscfiunoo u u wanna

42

Carson (1969) have proposed that the distance between the
client's behavioral coordinate (the point on the inter-
personal circle defined by the intersection Of the
dominance—submissive and love-hate scores), and the center
of the circle can be considered an indicator of personal
maladjustment. Behavioral coordinates which fall toward
the outer rim of the circle (a large index number) reflect
a relatively inflexible, rigid behavioral stance whereas
behavioral coordinates occurring toward the center of the
circle (a smaller index) reflect a rather broad, flexible
behavioral repertoire. (Coordinates in the center of the
interpersonal circle result from a fairly equal pro-
portion of behaviors in all four quadrants.)

To obtain a behavioral coordinate for each client
the following procedure was followed. Each scored client
response from the lS-minute segments of the figst and
second sessions (early stage) were tallied into dichotomous
dominant--vs--submissive and friendly--vs--hostile cate—
gories. These values were then converted to proportions

with the following formulas:

Xdom love

= p and —
+ xsub dom Xlove + xhate

 

xdom

The pdom and plove values were in turn converted
to standard scores and then to T-scores (mean = 50, stand-

ard deviation = 10) which were plotted on the two axes of

43

the interpersonal circle resulting in the client's be-
havioral coordinate. The distance from the center of the
circle to the behavioral coordinate (in millimeters)
provided a "behavioral maladjustment" index.

It was of interest to compare this "behavioral
maladjustment" index to a more traditionally accepted
measure of psychopathology; the Minnesota Multiphasic
Personality Inventory. To accomplish this, the pre-
therapy MMPI profiles for the 20 clients in the study were
rank ordered for degree of manifest maladjustment by two
clinically trained judges. Inter-judge reliability was
very acceptable (r = 0.927, df = 18, p < .001). A rank
correlation coefficient was then computed using the MMPI
rankings and the "behavioral maladjustment" index rankings
(r = 0.172, df = 18, p > .05). The results indicate that
the two measures are not significantly related although
the slight trend is in the expected direction. It should
be kept in mind that the MMPI Inventories were filled out
by the clients prior to entering therapy. Consequently,
in most cases there was a considerable time span between
their responses to the MMPI and their first and second
therapy sessions when the behavioral ratings were obtained.
In order to more accurately assess concurrent validity, an
additional study is needed where the data from both meas-

ures are collected at the same time.

44

The "behavioral maladjustment" index, although in-
adequately validated to date, has several characteristics
which suggest it as an assessment procedure. The index
is derived from reliable ratings of Observed, interpersonal
behaviors and is therefore not susceptible to many of the
problems inherent in self-report tests (where the subject
is able to conceal or modify his responses in self-
determined directions) or projective techniques (with
their reliability and validity problems). In addition, the

index assesses not only the frequency, but the range of

 

behaviors (behavioral repertoire) emitted in a given inter-
personal setting. As such, the index virtually represents
an Operational definition of adjustment or adaptiveness
that would be acceptable in many differing theoretical

circles.

Therapeutic Outcome

 

Client change (i.e., degree of improvement or
deterioration) was assessed via clinical ratings of
clients' pre- and post-therapy MMPI profiles. Three judges
who had considerable experience with MMPI interpretation
(two senior staff members at the Michigan State University
Counseling Center and an advanced graduate student in
counseling psychology) were given the following instructions
for making the clinical ratings:

Objective: To determine changes in the MMPI as an
indication of psychological change.

45

1. Compare pre-counseling and post-counseling
profiled MMPI scores for each subject.
Consider the nine common scales (Hs + .5K,
D, Hy, Pd + .4K, Mf, Pa, Pt + 1K, Ma + 2K:
Sc + 1K).

2. Score the change as follows:
satisfactory

partly satisfactory

no change

partly unsatisfactory
unsatisfactory

i-‘waU'I
II II II II II

3. In order to establish intra-judge relia-
bility please score each profile twice;
one week apart.

As a result of this scoring procedure, each client
received six ratings; two ratings per judge times three
judges. See Appendix B for the individual and average
ratings for each case.

The average ratings were used to place clients in
one of two dichotomous outcome groups; successful or un-
successful. An average rating of i 3.00 represented the
upper limit for the unsuccessful category with > 3.00 as
the lower limit for the successful category.

The final sample (N = 20) included 10 successful
and 10 unsuccessful cases. The mean MMPI rating for the
successful group was 4.55 whereas the mean MMPI rating
for the unsuccessful group was 2.43. A t—test for the
difference between group means yielded a t = 7.783,

significant beyond the .005 level (df = 18).

Reliability for MMPI Judges
Two separate reliability checks were made: (1)

an intra-judge reliability check to determine the agreement

46

between the two ratings (a week apart) for a given judge;
and (2) inter-judge reliability to determine how well the
three judges' ratings agreed for a given client.

To test intra-judge reliability, Pearson product-
moment correlations between the first and second ratings

of each judge were computed. Table 3 lists those results.

Table 3

Intra-Judge Reliability of MMPI
Ratings (N = 20)

 

 

 

Jud e Pearson t Computed From
9 Correlation Pearson Correlationa
Judge 1 .93 10.60*
Judge 2 .32 6.09*
Judge 3 .95 12.59*
at = __r____ (‘/n _ 2)

l 1 - r2

*p < .005, df = 18.

Inter-judge reliability, utilizing the average
ratings for each client, was checked using the intraclass
correlation formula (Ebel, 1951). Table 4 lists the

results.

47

Table 4

Inter-Judge (Three Judges) Reliability
of MMPI Ratings (N = 20)

 

Source df SS MS Reliability of
Average Ratingsa

 

Clients 19 87.42 4.60 .91}
Judges 2 6.16 3.08

Error 38 15.17 0.40

Total 59 108.75

 

MSclients"MSerror

MSclients

ar:

 

*p < .005, df = 18

It is apparent from Tables 3 and 4 that both intra-
judge and inter-judge reliabilities were significantly
higher than chance expectations, thus supporting the MMPI

ratings as reliable indicators of client change.

Concurrent Validity

 

Meltzoff and Kornreich (1970) argue that outcome in
therapy is multi-dimensional and, consequently, should be
assessed with more than one instrument or measure. However,
attempts to relate the process dimension, under study, to
more than one outcome indicator would drastically complicate
the study design. As a compromise, the author attempted

to select a single outcome measure which would correlate

48

significantly with several other recognized and em-
pirically validated outcome measures which were available
in the research library. In addition to the MMPI ratings,
four other measures were investigated: (1) Barron's (1953)
Ego Strength Scale, purported to be a measure of the
individual's general level of psychological functioning;
(2) Fitt's (1965) Self-Esteem Scale, which assesses the
person's phenomenological self-concept and related self-
evaluations; (3) the MMPI F—scale, which Dahlstromm and
Welsh (1960) prOpose as the best single indicator of
personal adjustment on the MMPI; and (4) therapist's
ratings of client change, which Meltzoff and Kornreich
(1970) question as biased and partially invalid.

Table 5 lists the Pearson product-moment corre-
lation coefficients which were Obtained among these five
outcome measures.

As Table 5 points out, the MMPI ratings were
significantly related, in the expected directions, to
Post Ego Strength (r = .68), Post Self-Esteem (r = .59),
and Post MMPI F-scale scores (r = -.66). Therapist ratings
were unrelated to any of the other four outcome measures;
a finding in accord with Meltzoff and Kornreich's (1970)
views.

The above results provided considerable support for
the selection of the MMPI ratings as a relatively valid

measure of client change during therapy.

49

Table 5

Pearson Correlations for Five Outcome Measures

 

Outcome (1) (2) (3) (4) (5)
Measure

 

1 Clinical
MMPI Ratings 1.00 .680 .59b -.66° -.03a

2 Post Ego
Strength Scores 1.00 .74c -.87C .39a

3 Post Self-
Esteem Scores 1.00 -.82° .36a

4 MMPI F-Scale
Scores 1.00 -.33a

5 Therapist
Outcome Ratings 1.00

 

aNot significant
bp < .01, df = 14

cp < .005, df = 14

RESULTS

Complementarity Index

 

The Complementarity index (C1), which provided the
quantitative values for the process variable under study
(client- and therapist-complementarity levels), was de-
rived by summing the weighted proportions of interactions

in each of the 16 cells of the interaction matrix (see

 

 

 

 

 

 

 

 

 

 

 

 

Figure 3).
Respondent Behaviors
(weighted) ” H-D F-D F-S H-S
proportions
Hostile-dominant (2)p (1)p (2)p (3)p
(H-D)
Friendly-dominant
(Fm) (1)p (2)p (3)p (2)9
Wriendly-submissive
(F_S) (2)p (3)p (”P (“P
Hostile-submissive
(H-S) (3)p (2)p (1)p (2)P
Complifiggiarity = ZCOlumn + EColumn + £Column + ZColumn

Complementarity Matrix

Figure 3

 

51

The cell weightings (3, 2, and l) were chosen to
reflect the relative degree (or level) of complementarity
in that given interaction. Interpersonal theory and
previous research (discussed in Chapter 1) suggested that
interactions which involve behaviors that are reciprocal
on the dominance-submissive axis (i.e., dominance followed
by submissiveness; submissiveness followed by dominance)
2E3 correspondent on the friendly-hostile axis (i.e.,
friendliness followed by friendliness; hostility followed
by hostility) have the highest probability of occurrence
and therefore represent the highest level of comple-
mentarity (i.e., have the highest reward value for both
participants in the interaction). These interactions: (1)
FD-+FS, (2) FS-+FD, (3) HD—+HS, (4) HS—+HD were therefore
weighted by a factor 3.

Secondly, interactions which involve behaviors
that are neither reciprocal on the dominance-submissive
axis (i.e., dominance followed by dominance; submissiveness
followed by submissiveness) EQE correspondent on the
friendly-hostile axis (i.e., friendliness followed by
hostility; hostility followed by friendliness) have the
lowest probability of occurrence and therefore represent
the lowest level of complementarity (i.e., have the lowest
reward value for both interaction participants). These
interactions: (1) FD—+HD, (2) HD—»FD, (3) FS—+HS, (4)

HS +FS were weighted the lowest with a factor 1.

52

Thirdly, interactions involving behaviors which are
complementary on either (but not both) of the axes occupy
an intermediate position in terms of probability of
occurrence (and level of complementarity) and were there-
fore given a weighting of factor 2. This category included
the remaining cells in the matrix: (1) FD—»FD, (2) FD—»HS,
(3) FS-*FS, (4) FS—+HD, (5) HS—+FD, (6) HS—+HS, (7) HD—+FS,
and (8) HD—éHD.

Inserting the proportions of interactions during a
given stage of therapy into the appropriate cells of the
matrix, multiplying by the appropriate weightings, and
summing across the 16 cells, results in a single Comple-
mentarity Index which reflects the particular pattern or
profile of interactions within the rated session(s).

Since the interaction matrix and assigned weightings
originated with the present study, it was of interest to
look at the validity of the assigned weightings and the
shape of the distribution of the resultant Cl scores.

One method for assessing the validity of the‘
assigned cell weightings would be to compare the observed
frequencies in the three weighting categories with the
expected frequencies derived from the weighting values
(3, 2, and 1). Table 6 lists those results.

As the results indicate, there is a significant
difference between the observed and expected cell frequen-

cies, given the weightings of 3, 2, and 1. In order to

53

.Hmmuomm .mm

.mmma .mmmmm

 

 

.Hoo. v a .N u up .mm.soa n mussam aso
mmmm mmmm Hmuoe
omoa mmoa mma. Name. maamo =H=
vmmm vmmv oom. mmmo. maaoo am:
vmmm mmam mum. hmmo. mHHmU =m=
hocmsomum mocmsomum coauuomoum HHOU Hmm
Om>ummno Omuoooxm O>Humaseso mcofluuomoum mmfluommamu
Omuommxm pmuommxm

 

mmfluomoumo HHOU mouse

0:» sou mummy has no mmmspooo a

m magma

54

ascertain which weighting values are suggested by the
collected data, an additional Goodness of Fit Test was
calculated using the observed frequencies in each of the
established cell categories to determine the expected
frequencies and proportions for the respective categories.
As Table 7 indicates, assigned cell weightings of 3, 7, 2,
and 1 would result in the best approximation to the ob-
tained data.

Although the absolute weighting values used in the
study do not exactly "fit" the obtained data, the relative
size of the weightings do correspond to the proportions
of scores falling in each category. As the figures in
Table 8 point out, the interaction cells considered to
be the most complementary (and therefore weighted the
highest) also were most frequently used in the therapeutic
sessions. In addition, the interaction cells deemed least
complementary (and least weighted) revealed the lowest
frequency. The remaining interaction cells defined as
intermediate for complementarity (and weighted inter-
mediately), received intermediate use in the therapy
sessions.

It was also of interest to assess whether the Cl
values were normally distributed in order to determine
whether various parametric statistical procedures could be
used to test the experimental hypotheses. To accomplish

this, a Goodness of Fit Test was used to compare the

ooo.o n mumsem aso

 

 

mmmm mmmm Hmuoa
omoa omoa vHH. mmo. maamu =H=
vmmm wmmm omv. hmo. mHHmU am:
vmmm vmmm omv. moa. mHHmU ah.m=
% mucosomum mucosomum cowuuomoum Hamo mom mucmEcmwmm¢
cocamuno Omcflmuco m>auma9850 chwuHomoum muomoumo

concomxm Oouomoxm

 

sumo on» an Omumommsm
mmcwunmwmz HHOU on» ocflfiumumo on some spam “mom: d

s manna

56

Table 8

The Mean Proportion of Responses for Each of
the Three Cell Categories

 

Category Mean Proportion of Responses
in That Category

 

"3" Cells .550
"2" Cells .290
"1" Cells .160

 

obtained distribution of scores to the expected distri-
bution of scores in the normal distribution.
As Table 9 points out, the observed distribution of

Cl scores does not differ significantly (Chi Square = 3.93)
from the expected distribution of scores in a normal
distribution. The assumption that the Cl scores are
normally distributed is therefore tenable.
The Experimental Hypotheses and
Supportipg_pata

Hypothesis I: There will be significant differences

in the client-therapist complementarity between the
successful and unsuccessful psychotherapy groups.

 

Since the present design required a separate analysis

of client and therapist complementarity, the above pre-

 

diction is tested as two separate hypotheses:

la: There will be significant differences in the level
5? therapist complementarity between the successful
and unsuccessful psychotherapy groups.

 

57

Table 9

A Goodness of Fit Test for the
C1 Distribution

 

 

Interval m -2.00 -l.00 0.00 1.00 2.00
limits to to to to to to
(z) -2.00 -l.00 0.00 1.00 2.00 m
p* .023 .1357 .3413 .3413 .1357 .023
Expected
frequency 4 15.6 40.4 40.4 15.6 4
Observed
frequency 6 15 36 39 17 7

 

Chi Square = 3.93, df = 5, p = .50, not significant
*p = proportion of expected values within a given
interval.

Since Hypotheses 1a and lb are a re-examination of
the opposing Swensen and Carson predictions (discussed on
pages 17-22), two-sided tests of significance were used.

As Table 10 indicates, there was no significant
difference in level of therapist complementarity between
the successful and unsuccessful groups. Hypothesis la
was therefore not supported by the data. Note, however,
the tendency for successful therapists to function at a
somewhat lower level of complementarity (to the client's
eliciting behaviors) than unsuccessful therapists.

1b: There will be significant differences in level of

client complementarity between the successful and un-
successful psychotherapy groups.

58

Table 10

Level of Therapist Complementarity and Therapeutic
Outcome (N = 20)

 

 

 

 

Group N Mean SD t df
Successful 10 47.17 10.23 1.309* 18
Unsuccessful 10 52.90 8.18

*p = .20, not significant

As Table 11 indicates, there was no significant
difference in the level of client complementarity between
the successful and unsuccessful psychotherapy groups.
Hypothesis 1p was therefore not supported by the data. The
results did indicate a marked tendency for successful
clients to interact at a lower level of complementarity
(to the therapist's elicitations) than unsuccessful clients.
The trend would have been significant if a l-tailed test

Of significance had been utilized.

Table 11

Level of Client Complementarity and Therapeutic
Outcome (N = 20)

 

 

Group N Mean SD ts df
Successful 10 46.39 8.79 1.812 18
Unsuccessful 10 53.72 8.38

 

*p < .10, (not significant with 2-tai1ed test.)

59

Hypotheses Concerning Stages of
Psychotherapy

 

Hypothesis II: During the earl stage of psycho-
therapy the level of therapist complementarity will
be directly related, at a significant level, to the
degree of manifest client maladjustment.

 

As Table 12 reveals, there is a significant direct
relationship (r = .51, p < .02) between the level of thera-
pist complementarity and degree Of manifest client malad-
justment during the initial phase of psychotherapeutic
relationship.

This finding points to a significant trend for
therapists to function at a higher level of complementarity
(to the client's eliciting behaviors) with clients who are
more severely maladjusted and at a lower complementarity
level with less maladjusted clients. Hypothesis II was

therefore confirmed, at a significant level, by the data.

 

Hypothesis IIIa: During the earl stage of psycho-
therapy, there will be no significant differences in
the level of therapist complementarity between the
successful and unsuccessful psychotherapy groups.

 

As the results in Table 13 indicate, there were no
significant differences in level of therapist comple-
mentarity between successful and unsuccessful cases during
the ga£1y_stage of therapy. Hypothesis IIIa is therefore
tenable.

Hypothesis IIIb: During the earl stage of psycho-
therapy, there will be no significant differences in

the level of client complementarity between the suc-
cessful and unsuccessful psychotherapy groups.

 

60

Table 12

The Relationship Between Therapist Complementarity
and Manifest Client Maladjustment (N = 20)

 

Client

 

 

NO. Rank Onea' Rank Twob (D) (D2)
818 10 9 1 1
026 5 10 5 25
024 11 15 4 16
011 8 12 4 16
037 4 19 15 225
845 6 7 1 1
044 19 13 6 36
050 12 11 1 1
848 3 6 3 9
847 17 14 3 9
031 20 17 3 9
043 13 16 3 9
016 14 18 4 16
042 15 3 12 144
843 2 5 3 9
817 16 8 8 64
039 9 2 7 49
823 7 4 3 9
831 18 20 2 4
830 1 1 0 0

£D2=652
2
r=1-3—§2—5 df=18

_ 1 _ 3912

- 7980

= 1 - .4902

r = .5098, p < .02

 

aRank One = Ranks of Therapist's Cl scores from
high to low.

bRank Two = Ranks of client's "Behavioral Maladjust-
ment" Indices from high to low.

61

Table 13

Level of Therapist Complementarity and Therapeutic
Outcome (Early Stage)

 

 

 

Group N Mean SD t df
Successful 10 52.83 10.91 0.716* 18
Unsuccessful 10 47.87 17.67

 

*p > .25, not significant.

As Table 14 indicates there were no significant
differences in level of client complementarity between
successful and unsuccessful cases, during the early stage
of therapy. Hypothesis IIIb is therefore supported by
the data.

Hypothesis -Va: During the middle stage of psycho-
therapy, the level Of therapiEtfeemplementarity will

be significantly lower in the successful, as Opposed
to unsuccessful, therapy group.

 

As Table 15 indicates, the successful therapists
are functioning at a very significantly lower level of
complementarity to the client's behaviors than the un-
successful therapists during the middle stage of therapy.
Hypothesis 122 is therefore supported at a very high level
of significance.

Hypothesis IVb: During the middle stage of psycho-
therapy, the level of client—Eemplementarity will be

significantly lower in the successful, as opposed to
unsuccessful, psychotherapy group.

 

62

Table 14

Level of Client Complementarity and Therapeutic
Outcome (Early Stage)

 

 

Group N Mean SD t df
Successful 10 53.32 9.35 0.171* 13
Unsuccessful 10 52.38 15.80

 

4
p > .25, not significant.
Table 15

Level of Therapist Complementarity and Therapeutic
Outcome (Middle Stage)

 

 

 

Group N Mean SD t df
Successful 10 42.00 11.03 3.026* 18
Unsuccessful 10 56.78 9.63

*p < .005.

As Table 16 points out, the level of client comple-
mentarity is significantly lower in the successful, as
opposed to unsuccessful, outcome group during the middle
stage of therapy. Hypothesis gyp_is therefore supported
at a high level of significance, by the data.

Hypothesis Va: During the later stage of psycho-
therapy the level of therapi§E_EOmplementarity will be

significantly higher 15 the successful, as Opposed to
unsuccessful, psychotherapy group.

 

63

Table 16

Level of Client Complementarity and Therapeutic
Outcome (Middle Stage)

 

 

 

Group N Mean SD t df
Successful 10 39.76 9.56 2.815* 18
Unsuccessful 10 54.28 12.18

*p < .010.

As Table 17 reveals, there were no significant
differences in the level of therapist complementarity
between the two outcome groups during the later stage Of
therapy.

The slight trend toward lower therapist Comple-
mentarity in the successful group was in the Opposite

direction from the hypothesis. Hypothesis Va was not

 

supported by the data.

Table 17

Level of Therapist Complementarity and Therapeutic
Outcome (Later Stage)

 

 

Group N Mean SD t df
Successful 10 48.25 11.77 1.189* 18
Unsuccessful 10 53.39 5.48

 

*p < .10, not significant.

64

Hypothesis Vb: During the later stage of psycho-
therapy, the level of client complementarity will be
significantly higher in the successful, as opposed
to unsuccessful, psychotherapy group.

 

As Table 18 indicates, there were no significant
differences in level of client complementarity between
the two outcome groups during the later stage of therapy.

Hypothesis Vb was therefore not supported.

Table 18

Level of Client Complementarity and Therapeutic
Outcome (Later Stage)

 

 

Group N Mean SD t df
*
Successful 10 45.96 12.29 1.203 18
Unsuccessful 10 52.66 5.93

 

*p < .10, not significant.

Exploratory Questions

Although no experimental hypotheses were formulated,
it was suggested earlier that the successful and un-
successful client-therapist interaction patterns would
differ over the three stages of therapy. It was suggested
that in the potentially successful client-therapist re-
lationships, the level of complementarity would drop
significantly from the early to middle stages and then
increase again significantly from the middle to later

stages of therapy. To evaluate these assumptions, it was

65

necessary to assess changes within the two outcome groups
over the three stages of therapy. To accomplish this a
"related t-test" of stage means was used. The results
for the successful outcome group appear in Table 19.

As Table 19 reveals, there is a significant decrease
in the level of therapist complementarity (for the suc—
cessful group) between the early and middle sessions
followed by a significant increase from the middle to

later sessions.

Table 19

Changes in Level Of Therapist Complementarity
Over the Three Stages of Therapy for the
Successful Outcome Group

 

N Early Stage Middle Stage

 

 

 

Mean Mean t df

10 52.83 42.00 2.410* 9
Middle Stage Later Stage

N Mean Mean t df

10 42.00 48.25 2.737* 9

 

p < .025 (t-test for related measures).

For the unsuccessful group, it was assumed that
therapist complementarity level would begin at a relatively
high level (early stage) and remain unchanged throughout
therapy. Table 20 lists the results for the unsuccessful

therapists.

66

Although the changes in therapist complementarity

levels, for the unsuccessful group, do not differ sig-

nificantly over the three periods of therapy, there is a

noticeable trend toward increased levels from early to

middle sessions followed by a sustained high from middle

to later sessions.

Table 20

Changes in the Level of Therapist Complementarity

Over the Three Stages of Therapy for the
Unsuccessful Outcome Group

 

Early Stage Middle Stage

 

 

 

N Mean Mean t df

10 47.87 56.78 1.470* 9

N Middle Stage Later Stage t df
Mean Mean

10 56.78 53.39 1.222** 9

 

*p < .10 (t-test for related measures).

*
*p > .10 (t-test for related measures).

Figure 4 depicts the differing patterns of comple-

mentarity over the various therapy stages for the

"successful" and "unsuccessful" therapists.

67

 

 

 

 

3 A Successful
.3 S Unsuccessful
m
> 60 F-
H
L)
u 55 -
U)
-H
a.
8 50 -
o
.c
a
g 45 -
m
m
2 4° '- l 1
1
Early Middle Later
Sessions

Figure 4
Changes in Therapist Complementarity Levels
Over the Three Stages of Therapy for

Successful and Unsuccessful
Outcome Groups

For client complementarity patterns, the expec-
tation was that successful clients would decrease from
early to middle sessions and then increase from middle to
later sessions, whereas, unsuccessful clients were expected
to begin therapy at higher complementarity levels and
remain unchanged throughout therapy. Tables 21 and 22,

and Figure 5, contain the results for successful and

unsuccessful client response patterns.

68

Table 21

Changes in Level of Client Complementarity
Over the Three Stages of Psychotherapy
for the Successful Outcome Group

 

 

 

 

 

 

 

 

 

' Early Stage Middle Stage
N Mean Mean t df
10 53.42 39.75 2.950* 9
N Middée Stage Later Stage t df
ean Mean
10 39.75 45.96 2.180** 9
*p < .01 (t—test for related measures).
**p < .05 (t-test for related measures).
Table 22
Changes in Level of Client Complementarity
Over the Three Stages of Therapy for
the Unsuccessful Outcome Group
N Early Stages Middle Stage t df
Mean Mean
10 52.37 54.28 0.642* 9
N Middle Stage Later Stage t df
Mean Mean
10 54.28 52.66 0.422* 9

 

*p > .25, not significant, (t-test for related

measures).

Mean Client Cl Values

60

55

50

45

40

 

69

 

 

 

A Successful
B Unsuccessful
,______________~__a
l 1 1
Early Middle Later
Sessions

Figure 5

Changes in the Level of Client Complementarity
Over the Three Stages of Therapy for the

Successful and Unsuccessful
Outcome Groups

DISCUSSION

Comments on the Complementaritnyatrix

There are several observations about the Comple-
mentarity Matrix which warrant comment. Firstly, an
analysis of the number and size of cell entries provides
an excellent picture of the type of client-therapist inter-
action pattern which occurred within a given session or
sessions. Secondly, comparing two or more matrices for
a given client-therapist dyad provides a picture of the
degree of stability or change in their interaction patterns.
Comparisons can also be made across a number of dyads at
one or more points in time.

Thirdly, a careful analysis of the matrices in the
present study revealed that the Complementarity Index (Cl)
is a sensitive indicator of the levels of complementarity
experienced by either client or therapist in relation to
their patterns of eliciting behaviors. This sensitivity
results from the fact that the matrix calculates the level
of complementarity experienced in ayagy interaction in the
rated portion of the session(s).

Consider the following example of a study case where

the client and therapist entered therapy functioning

7O

71

primarily from hostile—submissive and friendly-dominant
quadrants, respectively. Their early C1 scores were near
the mean. As therapy proceeded the therapist began to
respond more frequently (to the same client elicitations)
from the hostile-dominant quadrant resulting in higher Cl
scores. Toward the end of therapy, a greater proportion
of his responses were again from the friendly-dominant
stance, leading to lower Cl values. The varying Cl scores
(sensitively reflected the changing levels of complementarity
which both interaction participants experienced in relation
to their elicitations.

Fourthly, if one Operationally defines the level
of complementarity (interpersonal reinforcement) in a
given interaction in terms of the relative frequency with
which those interactions occur, then the results from the
present study support the following conclusions: inter-
actions involving behaviors which are reciprocal on the
dominance-submissive axis 229 correspondent on the friendly-
hostile axis are the most complementary or rewarding;
interactions involving behaviors which are correspondent
on the dominance-submissive axis app reciprocal on the
friendly-hostile axis are least complementary; and inter-
actions where the exchanged behaviors are either reciprocal
on the dominance-submissive axis 9; correspondent on the
friendly-hostile axis are of intermediate reward value.

These findings are in accord with theoretical expectations

72

(Carson, 1969) and previous research findings (Heller,
Myers, & Kline, 1963; Raush, Dittman, & Taylor, 1959; and
others reviewed in Chapter I, pp. 10-12)-

Finally, as was mentioned in the previous chapter,
the distribution of Cl values approximate a normal distri-
bution.

Differences in Client-Therapist Complementarity
Between Successful and Unsuccessful Cases

Hypothesis la, which predicted significant differ-
ences in the level of therapist complementarity between
the successful and unsuccessful outcome groups, was not
supported by the data. Likewise, Hypothesis lp_which
included the same prediction for client complementarity
levels, was not confirmed by the data. Although not
significant, there was a trend for successful clients and
therapists to interact at a somewhat lower level of
complementarity than unsuccessful dyads. This trend is in
accord with Carson's (1969) assumptions and in opposition
to Swensen's (1967) findings. In the subsequent
discussion of therapy stages it will become apparent why a
single global index (to represent the level of comple-
mentarity over the entire therapeutic relationship) failed
to differentiate between the complementarity levels leading
to successful and unsuccessful outcome. As will be pointed
out, the pattern of complementarity indices (representing

the levels of client-therapist complementarity) during the

73

three stages of therapy is curvilinear (for the successful
group) and cannot therefore accurately be represented by

a single estimate.

Early Stage of Therapy

 

Hypothesis II predicted that the level of therapist
complementarity, during the initial phase of therapy,
would be directly related to the degree of manifest client
maladjustment. [The degree of maladjustment was oper-
ationally defined as the distance from the client's be-
havioral coordinate to the center of the Interpersonal
Circumplex. The behavioral coordinate represents the
intersection, on the Circumplex grid, of the client's
dominance-submissive and friendly-hostile scores, derived
from his/her rated behaviors during the first and second
therapy sessions (early stage). Behavioral coordinates
which fall toward the outer rim of the Circumplex represent
a stereotypic, constricted response repertoire whereas
coordinates falling toward the center typify a more flexible,
varied response profile. Figure 6 includes examples of

severely and moderately maladjusted clients.]

 

Hypothesis II was supported by a rank order corre-
lation coefficient of 0.51 (p < .02). This finding sug—
gests that, during the initial phase of treatment, thera-
pists working with more severely maladjusted clients are
responding to their (the client's) behavioral elicitations

with a greater proportion of highly complementary behaviors.

74

Dominant

Hostile Friendly

nsR
n

 

(1) "Severe" client (2) "Moderate" client

 

 

Dom 10.00 ‘Dom 25.0
Love 70.00 Submissive Love 56.2
Figure 6

Behavioral Coordinates Representing Two
Levels of Client Maladjustment:
Severe and Moderate
Conversely, therapists' interactions with less severely
disturbed clients are characterized by responses of a less
complementary variety. These findings are in accord with
Carson's (1969) theoretical views and our own expectations.
Clients who enter relationships with a very restricted
range of ego-syntonic behaviors are not only more "invested"
in acquiring complementary responses from the other person
(for the purpose of maintaining already fragile security
operations) but are also better equipped with a variety
of within-quadrant maneuvers for "pulling" the desired
interpersonal responses. Consider the client who operates
almost exclusively from the hostile-submissive quadrant.
His initial attempts to elicit complementary hostile-
dominant (angry, rejecting) behaviors may take the form of
mild self-effacing comments. If this behavior fails to

evoke the desired response, he may become increasingly

75

bitter, distrustful, and suspicious. If these maneuvers
fail, he may become increasingly withdrawn and self-
destructive. At some point he will likely succeed in moving
the therapist into the complementary quadrant. A vivid
example of this involved a study case who entered therapy
severely restricted to the friendly-dominant quadrant.
During the first and second sessions he was successful in
moving the therapist out of his preferred stance in the
friendly-dominant quadrant iptg the friendly-submissive
quadrant. During the middle and later stages of therapy

the therapist again returned to the friendly-dominant
quadrant. The client, in turn, moved to a more submissive
part of the interpersonal circle late in therapy. The point
being emphasized here is that the client was able to elicit
a high level Of complementarity to his own restricted be-
havioral stance even though this meant moving the therapist
out Of the stance which he, and most other therapists,
strongly prefer.

Although both members Of the therapeutic dyad
possess the ability to influence the behavior of the other
(via complementarity pressures), the above findings would
seem to suggest that at least during the initial stage
of therapy, the client may have the greater influence on
the therapist's behavior; particularly within a group
of "relationship oriented" therapists. It may be, although

this is speculative, that during this early phase of the

76

relationship the therapist is more willing to follow the
elicitations of the client to prevent undue anxiety while
the relationship is being formed and strengthened. If
this is true, then with more severely maladjusted clients
who present more anxiety and relationship-building diffi-
culties, the therapist would have a tendency to respond at
even higher levels of complementarity. The results seem
to support these views.

Hypothesis IIIa predicted that there would be pp
significant differences in the level of therapist comple-
mentarity between the two outcome groups during this early
stage of therapy. Hypothesis IIIb involved the same
prediction for client complementarity levels. Both
hypotheses were supported by the data. The basis for the
first hypothesis included the assumption that, on the aver-
age, all therapists would function at a moderately high
level of complementarity during the initial phase of therapy
to facilitate the relationship-building tasks; tasks sup-
posedly undertaken by all therapists regardless of where
the relationship later moves to (i.e., type of outcome).
It was assumed, as Carson (1969) has suggested, that
moderately high levels of therapist complementarity will
facilitate the relationship-building tasks by providing a
sufficient level of gratification for existing behavior
patterns thereby preventing a premature drop in security

Operations.

77

In addition, it was assumed that the level Of client
complementarity would also be moderately high during this
phase of therapy when the client is exhibiting a higher
proportion Of "reality-oriented" behaviors (Crowder, 1970).
It also seemed reasonable to assume that the client has
some interest in seeing the relationship-building tasks
accomplished, and would respond more complementarily to
facilitate such.

The results indicated that clients, regardless of
outcome group behaved at the expected moderately high
level of complementarity during this stage of the re-
lationship.

Although not significantly different, there was a
trend for therapists of successful cases to be more comple-
mentary than the "unsuccessful" therapists. One expla-
nation for the slight difference might be that "successful"
therapists worked with more severely maladjusted clients
(this would follow from the findings with Hypothesis II).

A check of the data revealed however that, on the average,
the clients in the successful outcome group were somewhat
lapp maladjusted than the clients in the unsuccessful
group although the differences were small.

Another possible explanation might be that successful
therapists worked with a greater prOportion of clients
who entered therapy functioning in the friendly-submissive

quadrant. However, a check of client behavioral coordinates

78

revealed an equal number of successful and unsuccessful
clients in this highly complementary position.

One way to explain the differences in therapist
complementarity levels at this stage in therapy is to
assume that the "successful" therapists, as a result of
either conscious planning or beautiful intuition, are
providing more rewarding, complementary responses for
the client with the goal of promoting a more solid, en-
during relationship capable Of withstanding the subsequent
period of stress and anxiety which accompanies change.

The "unsuccessful" therapists, on the other hand, have
paid less attention to the relationship-building tasks

and have moved ahead, maybe prematurely, into the "therapy
work." (A check of Figure 7 revealed that the level of
complementarity for the "unsuccessful" therapists during
the aa51y_stage of therapy was quite similar to the level
of complementarity exhibited by "successful" therapists
during the middle stage of therapy.) If this interpre-
tation is accurate, then the therapeutic error for the
"unsuccessful" therapists results not so much from a
misconception of "gHap_ought to be done" but from a
miscalculation of "ngp’it is to be done"; a timing error.
In summary, the data points to the following conclusions
about the successful and unsuccessful interpersonal
processes during this stage of therapy. Successful clients

and therapists are mutually supplying behavior Of a

 

 

J 1" $.1-l11‘l {I I 2 I" t 0" all-Ill 1|...

79

moderately high complementary variety to the elicitations
of the other. In reinforcement terms, each participant
is positively reinforcing the behaviors of the other.
Such interactions should enhance the security Operations
of both individuals and contribute to the development of
a vital working relationship.

Unsuccessful relationships are characterized by an
unequal distribution of rewards. Clients are providing
behaviors of a highly complementary sort to the therapist's
elicitations but therapists are relatively non-complementary
to the client's elicitations.

It would follow that the unsuccessful clients are
experiencing a reduction in security operations and an
increase in anxiety at this early stage of therapy. The
unsuccessful interactions, during this early phase, are

also likely more disruptive and tenuous.

Middle Stage of Therapy

 

Hypotheses IVa and IVb predicted that during the
middle stage of therapy the levels of therapist and client
complementarity would be significantly lower in the
successful, as opposed to unsuccessful, therapeutic re-
lationships. Both hypotheses were supported at a very
significant level, by the data (see Figure 7).

Not only was there a significant difference in
complementarity levels between groups, but as Tables 19

and 21 reveal, there was a significant decrease in

80

Successful: T—A—, C—A—
Unsuccessful: T—D-—, c —[3__

60"
55..

50-
45..

Mean Cl Values

 

 

 

Early Middle Later

Figure 7
Changes in Client-Therapist Complementarity Levels
Over the Three Stages of Therapy for
the Two Outcome Groups
complementarity levels between early and middle stages
within the successful group. Whereas early interactions
were marked by moderately high levels of complementarity,
the results in line with our expectations indicate that
during this stage both therapeutic participants are
interacting at a relatively low level of complementarity.
In reinforcement terms, neither participant is positively
reinforcing the behaviors of the other. As a result of
reduced complementarity, it is likely that security
Operations are lower, anxiety is more intense, and the
relationship has become more disruptive and chaotic.
Complementarity levels in the unsuccessful client-

therapist interactions are significantly higher than in
the successful group. In addition as Tables 20 and 22

indicate "unsuccessful" therapists have become more

81

complementary from early to middle stages while "unsuc—
cessful" clients have remained at a moderately high comple-
mentary level. Interactions are mutually reinforcing and,
in Sullivanian terms, the unsuccessful dyads have moved
toward a state of interpersonal integration.

How was such a highly complementary pattern negotie
ated by the supposedly unsuccessful clients and therapists?
An analysis of individual matrices indicated two major
patterns. In one, the therapist moved to a more comple-

mentary quadrant relative to the client's unchanged stance.

 

An example of this is a study case in which the client
entered therapy in the hostile-submissive quadrant. A
high proportion of the therapist's responses during the
initial stage were from the friendly-dominant and friendly-
submissive stances. Unfortunately by middle stage, the
therapist had moved more into the highly complementary
hostile-dominant position and the client remained unchanged
in the hostile-submissive portion of the Circumplex.

The second pattern involved cases where the client
moved pgt to a more extreme position in the same quadrant.
An example of this involved a client who entered therapy
in the friendly-submissive quadrant (close to the center
of the Circumplex). The therapist, early in the relation-
ship responded quite frequently (76.5%) from the highly

complementary friendly-dominant quadrant. By middle stage,

82

both client and therapist were responding more frequently
from their respective complementary quadrants.

Thus, in the unsuccessful group, the more highly
complementary interactions are achieved either as a result
Of the therapist getting "caught up" by the client's early-
therapy behavioral elicitations or as a result of the
client's move toward a more restricted, rigid (but comple-
mentary) range of behaviors. The interpersonal integration
which has developed will likely make the therapy relation-
ship more harmonious and mutually rewarding, but it is

unlikely that it will lead to constructive client change.

Later Stage of Therapy

 

Hypotheses Va and Vb predicted that the levels of
therapist and client complementarity WOUId be Significantly
higher in the successful, as opposed to unsuccessful, cases.
Neither hypothesis was supported by the data. There was
in fact a trend in the opposite direction, approaching
significance.

Although the between group differences were not
significant, as Tables 19 and 21 point out, the expected
significant increase in successful client-therapist comple-
mentarity levels from the middle to later stages of
therapy was supported by the data.

In the successful dyads, interactions were charac-
terized by increased levels of mutual complementarity.

In addition, an analysis of the changes in early to later

83

client behavioral coordinates revealed that in 7 of the
10 successful cases, the increased levels of therapist
complementarity occurred in response to a more balanced,
flexible range of client behaviors. The slightly lower
level of complementarity exhibited by successful clients
resulted in part from the fact that they were responding
with a broader range of responses to a narrower range of
therapist elicitations.

Unsuccessful client-therapist interactions continued,
during the later stage of therapy, to be highly comple-
mentary. As Tables 20 and 22 indicate, complementarity
levels did not change significantly between middle and
later stages. In 9 of the 10 unsuccessful cases, there
was either minimal behavioral change from early to later
stages (as evidenced by the aaply_to latap behavioral
coordinates) or there was movement toward a more extreme
stance on the Circumplex. Five of the 9 unsuccessful
clients fit this latter category and represent most clearly
client deterioration.

Probably the single most important reason why
Hypotheses Va and Vb did not fit the data derives from our
failure to foresee the possibility that the unsuccessful
relationships would achieve such a relatively high level
of complementarity. In retrospect, it should have been
more obvious that the unproductive relationships would

be more mutually reinforcing. From almost any theoretical

84

perspective, those relationships which have stabilized and
are not undergoing change will be smoother and more re-
warding.

As the results from the present study suggest,
those relationships in which constructive changes occur
are characterized by periods in which the behaviors of both

participants are integrated, disintegrated, and reintegrated.

Exploratory Questions

 

In addition to the findings already discussed, it

was of interest to determine how well the Pre-Post MMPI

 

outcome ratings (successful and unsuccessful) compared
to outcome ratings derived from changes in the clients'

behavioral coordinates; changes from early to later stage

 

of therapy. As discussed on pages 39 and 73, the be-
havioral coordinate is the intersection point on the
Circumplex grid of the client's dominance—submissive and
friendly-hostile scores derived from the ratings of his/her
actual behaviors during a given stage of therapy. Two
behavioral coordinates for each client were calculated:
(1) the first reflected the client's repertoire of
behaviors during the aaply stage of therapy (first and
second sessions), and (2) the second reflected the range
of client behaviors during the lapap stage of therapy
(second last and last sessions). Both behavioral co-

ordinates for each client were then plotted on the

85

Circumplex. It was then possible to visually inspect the

direction and distance of client movement during therapy.
Using these two client behavioral coordinates,

clients were placed into one of two outcome groups

(successful and unsuccessful) on the basis of two criteria:

(1) The direction of movement: For successful, movement

 

was toward the center of the grid; for the unsuccessful,
movement was toward the outer rim of the grid. (2) The
distance traveled: Successful cases had to travel through
more than one "zone" (the Circumplex-~see Figure 8--was
marked off into zones by concentric circles which inter—
sected the two major axes at five equally spaced intervals
between the center and outer rim): movement through less
than one zone (unless it was toward the outer rim) was
considered unsuccessful.

Given these criteria, 8 cases were defined as
successful; 12 as unsuccessful. Seven of the 8 successful
and 9 of 12 unsuccessful cases were accurately predicted
by the MMPI measure. As Table 23 indicates there is a
significant relationship between the two outcome measures.
It seems possible then to tentatively conclude that the
differing patterns of client-therapist complementarity,
discussed previously, are leading not only to the changes
that were evident on Pre- to Post-Therapy MMPI profiles,

but also to changes in interpersonal behavioral patterns.

 

([1 I
[III ’li I‘ll. I I!!! I lil

Hate

Successful Client

Early Stage

Dom .21
Love ZIE
Later tage
Dom L11
Love .4

N

86

 

 

 

Sub

Unsuccessful Client
Early Stage
Dom .37
Love 111
Later Stage
Dom .10
Love :gg

Figure 8

Illustrations of Successful and Unsuccessful Client
Behavioral Coordinate Changes from Early
to Later Stage of Therapy

87

Table 23

The Relationship Between Two Outcome Measures:
Pre— to Post-Therapy MMPI Changes vs. Changes
in Client Behavioral Coordinates (N = 20)

 

Behavioral Index

 

 

 

 

 

 

 

Unsuccessful Successful
MMPI Index Successful 3 7 10
Unsuccessful 9 1 10
12 8 20
63 - 3
r -

 

 

¢ «(12) (8) (10) (10)

.612a

H
II

 

*p < .01.

One of the most stringent tests of the comple-
mentarity principle would include an analysis of the re-
lationship between changes in the frequency of a specific
behavior over time, and the complementarity contingencies
associated with that behavior. Theoretically, it would be
expected that eliciting behaviors which have been responded
to at a high level of complementarity over an extended
period of time would increase in frequency whereas be-
haviors which are followed by responses of a non-
complementary variety would decrease in frequency.

To appease curiosity, a sample of five successful

and five unsuccessful cases were selected for analysis.

88

The base rate (frequency) for each behavior (FD, FS, HS,
HD) was equal to the proportion of times it occurred in
the first and second sessions (early stage). Change
scores (positive or negative) were obtained by subtracting
the base rate from the frequency of the papa behavior
during the last two sessions (later stage). Change scores
ranged from a +43.0 to a -33.8. In order to work with
positive values, an additive transformation (K = 50) was
made resulting in a range of scores from 16.2 to 93.0.

Complementarity Indices, relative to a particular
behavior, were Obtained by the usual procedures; the number
of responses in the four response categories were converted
to proportions by dividing the number of responses in each
category by the total number of responses to that particular
stimulus behavior (for a given therapy stage). The four
proportions were then multiplied by the respective cell
weighting (3, 2, or 1) representing the levels of comple-
mentarity in the various interactions. The four weighted
proportions were then added, providing the Cl value which
indicated the level of behavioral complementarity expressed
in response to the specific stimulus behavior.

This procedure was followed with each of the four
stimulus behaviors for the 10 clients at the tppaa stages
of therapy. In order to use a single estimate of the
degree of complementarity, the mean Cl score for the three

"stage" Cl's was calculated.

89

This entire procedure was applied first to the
clients' behavior with therapist as respondent (reinforcer).
A product-moment correlation of .542 was obtained between
the behavioral change scores and the therapist Cl values.
The positive relationship suggests that eliciting behaviors
which experience higher levels of complementarity during
the therapeutic relationship tend to increase in frequency
whereas eliciting behaviors followed by low complementary
therapist responses tend to decrease in frequency.

The product moment correlations for the successful
and unsuccessful clients were +.43 and +.60 respectively.
These results seem to point to the tentative conclusion
that particular responses are more reinforcing than others
(in line with the complementarity principle) and that
client behavior is responsive to the differential inter-
personal rewards.

It was also of interest to determine if the thera-
pist's behaviors were susceptible to the clients' rein-
forcing efforts. The same mathematic calculations cited
above, were used to Obtain therapist behavior change
scores and client Cl values.

A product moment correlation of -0.018 was obtained
for the entire sample. This result suggests that changes
in therapist behaviors are unrelated to the level of
client reinforcement. An interesting trend developed

however when "successful" and "unsuccessful" therapists

90

were investigated separately. The correlation for the
successful therapists was -.19 representing a mild trend
in the opposite direction indicated by the comple-
mentarity principle. The correlation for the unsuccessful
therapists was +.29. This result suggests a moderate,
although not significant, trend for "unsuccessful" thera-
pists' behaviors to change in accord with the level of
client complementarity. Although a separate analysis is
needed, this finding that "unsuccessful" therapists are
more influenced by client behaviors than "successful"
therapists, may help to explain the shift toward more
complementary quadrants (relative to the client's stance)
which a number of "unsuccessful" therapists displayed

between the early and middle stages.

Sex Differences

 

Various studies have examined the interaction be-
tween the sex Of client and therapist and various process
dimensions, including "verbalized feelings" (Fuller, 1963),
therapist empathy (Cartwright & Lerner, 1963), and verbal
dependency expressions (Alexander & Abeles, 1969). The
majority of findings have indicated non-significant
differences for like- and opposite-sex dyads.

It was of interest to determine what effect, if
any, the sex of therapist and client had on complementarity
levels. In thinking about the differing role expectancies

for males and females (i.e., assertiveness and

‘llllllli‘lii‘
I‘ll

91

submissiveness) it became apparent that part of the vari-
ance in complementarity indices might be attributable to
the sex of therapist and client.

To examine this, complementarity scores from the
middle stage of therapy were utilized. Two analyses were
conducted. The first compared complementarity levels
for male-male and male-female (therapist-client) dyads.

Tables 24 and 25 list the results for therapist and client

 

complementarity levels, respectively.

Table 24

Therapist Complementarity in Male-Male and
and Male-Female Dyads (N = 14)

 

 

 

 

Sex of
Therapist-Client N Mean SD t df
Male-Male 8 46.77 9.22 0.164* 12
Male-Female 6 47.73 11.20

 

*Not significant (two-tailed test).

The second analysis compared complementarity levels
for like-sex (male-male; female-female) dyads and opposite-
sex (male-female; female-male) dyads. Tables 26 and 27

include the results for therapist and client comple-

 

mentarity, respectively.
As Tables 24-27 indicate, no significant sex

differences were found. These findings lend further support

92

Table 25

Client Complementarity in Male—Male and
Male-Female Dyads (N = 14)

 

 

 

 

 

 

 

 

Sex of
Therapist-Client N Mean SD t df
Male-Male 8 48.70 10.72 0.871* 12
Male-Female 6 43.62 8.97
*Not significant (two-tailed test).
Table 26
Therapist Complementarity in Like-Sex and
Opposite-Sex Dyads (N = 20)
Sex of
Therapist-Client N Mean SD t df
Male-Male (N = 8)
Female-Female (N = 5) 13 50.16 10.22 1.019* 18
Male-Female (N = 6)
Female-Male (N = l) 7 44.48 13.07

*Not significant (two-tailed test).

93

to our assumptions that the levels of complementarity in
the client-therapist interactions are occurring in relation

to the actual behaviors that are being exchanged.

 

Table 27

Client Complementarity in Like-Sex and
Opposite-Sex Dyads (N = 20)

 

Sex of
Therapist-Client N Mean SD t df

 

Male-Male (N = 8)
Female-Female (N = 5) 13 50.21 11.95 1.714* 18

Male-Female (N

6)
Female-Male (N 1) 7 40.09 11.98

 

*Not significant (two-tailed test).

SUMMARY

This study investigated the varying levels of
client and therapist behavioral complementarity during the
three stages of psychotherapy for successful and unsuc—
cessful outcome groups. Behavioral complementarity, as
defined by Leary (1957) and Carson (1969), refers to the
degree of reward (i.e., interpersonal reinforcement) ex-
perienced by both interaction participants as a result of
the particular behaviors exchanged. In terms of the Leary
Interpersonal Circumplex (1957), which was used to rate the
interpersonal behaviors of client and therapist, comple-
mentarity occurs on the basis of reciprocity on the
dominance-submissive axis [dominance complements (elicits
and reinforces) submissiveness; submissiveness complements
dominance] and on the basis of correspondence on the
friendly-hostile axis (friendly behaviors complement
friendliness; hostility complements hostility).

Complementarity Indices (Cl), for each therapeutic
dyad at three periods (early, middle, and later) in the
therapeutic relationship, were obtained by summing the

weighted proportions (the weightings--3, 2, and l--ref1ected

94

95

the relative level of complementarity in the respective
interactions) of interactions in the 16 cells of the
Complementarity Matrix. (The 4 x 4 matrix contained an
outcome cell for all possible interactions, given four
possible eliciting behaviors X for possible respondent
behaviors: (l) friendly-dominant, (2) friendly-submissive,
(3) hostile-submissive, (4) hostile-dominant.)

Therapeutic outcome was assessed via clinical
ratings of pre- to post-therapy MMPI profile changes; a
measure which was found to have relatively good reliability
and validity. Ten successful and 10 unsuccessful outcome
cases were investigated.

The first two hypotheses represented a re-examination
of the Opposing predictions of Swensen (1967) and Carson
(1969). Swensen has reported findings of a direct re-
lationship between the level of client-therapist comple-
mentarity and degree of therapeutic success, whereas Carson,
while failing to report empirical evidence, has presented a
thorough theoretical treatise for an inverse relationship
between the process and outcome variables.

Hypothesis Ia: There will be significant differences

in the level of therapist complementarity between the
successful and unsuccessful psychotherapy groups.

 

Hypothesis Ib: There will be significant differences
in the level of client complementarity between the
successful and unsuccessful psychotherapy groups.

 

A global index of complementarity (the mean C1 score

representing the Cl scores from the three stages of therapy)

96

was used to test Hypotheses Ia and IQ, Neither hypothesis
was supported at a significant level by the data, although
there was a moderate trend for successful clients and
therapists to interact at a somewhat lower level of comple-
mentarity than unsuccessful dyads. This trend was in the
direction predicted by Carson (1969) and in opposition to
Swensen's (1967) findings.

Hypotheses II through V investigated client-therapist
complementarity patterns for successful and unsuccessful

cases during the three stages of psychotherapy.

Early Stage of Psychotherapy
Hypothesis II: During the early stage of psycho-
therapy, the level of therapist complementarity will
be directly related at a significant level, to the
degree of manifest client maladjustment.

Hypothesis II was based on the assumption that
clients who enter therapy exhibiting a more restricted,
narrow range of interpersonal behaviors will be more
invested in, and capable of, eliciting highly comple-
mentary responses from therapists. This assumption was
supported by a rank order correlation coefficient of
.51 (p < .02).

Hypothesis IIIa: During the early stage of psycho-
therapy, there will be no significant differences in
the level of therapist complementarity between the
successful and unsuccessful psychotherapy groups.
Hypothesis IIIb: During the early stage of psycho—
therapy, there will be no significant differences in

the level of client complementarity between the suc-
cessful and unsuccessful psychotherapy groups.

97

It was assumed that during the early stage of the
therapeutic relationship, the levels of client-therapist
complementarity would not differ significantly relative
to outcome but would be moderately high in all dyads to
promote the relationship-building tasks that characterize
this stage of therapy. Both hypotheses were supported by
the data. The findings indicated that successful clients
and therapists, during this initial phase of therapy,
were mutually interacting at a moderately high level of
complementarity to the other's elicitations. It was
suggested that such complementarity levels were contribu-
tory to maintenance of security operations, minimal anxiety,
and the develOpment of a vital working relationship. The
interactions of unsuccessful dyads, on the other hand, were
marked by differing levels of complementarity. Unsuccessful
clients responded at a moderately high level of comple-
mentarity to the therapist's elicitations but 9unsuccessful"
therapists responded to the client's elicitations at a
moderately lower level of complementarity. It was suggested
that such differing complementary levels would contribute
to a premature reduction in client security operations,

increased levels of anxiety, and more tenuous relationships.

Middle Stage of Therapy

 

Hypothesis IVa: During the middle stage of psycho-
therapy, the level of therapist complementarity will
be significantly lower in the successful, as opposed
to unsuccessful, psychotherapy group.

 

98

Hypothesis IVb: During the middle stage of psycho-
tHerapy, the level of client complementarity will be
significantly lower in the successful, as opposed to
unsuccessful, psychotherapy group.

Hypotheses £22 and IVE tested the following theo-
retical assumptions: Client-therapist interaction patterns,
leading to constructive client change, will reflect lower
levels of complementarity during this middle, or "working,"
phase of therapy. The non-complementary, disconfirming
behavioral exchanges are prerequisite for behavior change.
Interaction patterns, leading to no change or deterioration
(unsuccessful), will be characterized by significantly
higher levels of client and therapist complementarity.

Both hypotheses were confirmed, at high levels of sig-
nificance, by the data. These findings lend considerable
support to the Interpersonalists' position regarding the
reciprocal impact which client and therapist have on each
other. In addition, these findings clearly support
Carson's (1969) views concerning the differing comple-

mentarity patterns leading to successful and unsuccessful

behavior change.

Later Stage of Therapy

 

Hypothesis Va: During the later stage of therapy,

the level of—therapist complementarity.will be sig-
nificantly higher in the successful, as opposed to

unsuccessful, psychotherapy group.

 

Hypothesis Vb: During the later stage of psycho-
therapy, the level of client complementarity will be
significantly higher in the successful, as opposed to
unsuccessful, psychotherapy group.

 

99

These predictions were based on the assumption that
the interaction patterns for the "successful" dyads during
this later phase of therapy would be marked by high levels
of mutual complementarity resulting from the broadened
range of newly-acquired behaviors available to the client.
Both hypotheses were not supported by the data. There
was, in fact, a moderate trend in the opposite direction.
Several explanations were suggested. One, the emphasis
on "short-term therapy" in the present population results
in an extension of the "therapy work" right up to the
time of termination. Consequently, complementarity levels
remain lower where such is occurring. Secondly, early
theoretical formulations failed to consider the possibility
that complementarity levels in the "unsuccessful" dyads
would go so high.

An analysis of client behavioral coordinates revealed
the following results: In the successful group, seven of
the 10 clients exhibited movement (from early to later
stages of therapy) toward a more flexible, varied range
of interpersonal behaviors. Nine of the 10 unsuccessful
clients manifested no change g£_movement toward a more
rigid, restricted behavioral repertoire. Five of the nine
unsuccessful clients fit the latter category and most

clearly represent client deterioration.

100

Exploratory_Questions

 

In addition to the experimental hypotheses, several
exploratory questions were examined. The first, investi-
gated the patterns of complementarity over the three stages
of therapy within each outcome group. For the successful
outcome group. levels of client and therapist comple-

mentarity decreased significantly from early to middle

 

stages, and then increased again significantly from middle

 

to later stages. For the unsuccessful group, there were
no significant changes in levels of complementarity over
the three stages of therapy, although there was a notice-
able trend for "unsuccessful" therapists to increase in
complementarity from early to middle stages and to remain

unchanged from middle to later stages of therapy.

 

Secondly, the pre- to post-therapy MMPI outcome
measure was compared with an outcome measure derived from
changes in clients' behavioral coordinates from early to
later stages of therapy. A Phi coefficient of .61 (p < .01)
suggested a significant relationship between the two out-
come measures.

Thirdly, the relationship between changes in the
frequency (from early to later therapy stages) of specific
eliciting behaviors and the complementarity contingencies
associated with those behaviors, was examined. The results
indicated that client behaviors which have experienced

high levels of therapist complementarity tend to increase

101

in frequency whereas behaviors followed by low comple-
mentary therapist responses tend to decrease in frequency.
These results were interpreted as supporting the comple-
mentarity principle.
Changes in therapist behaviors were unrelated to
the level of client complementarity although there was a
moderate trend (r = .29) for "unsuccessful" therapists'
behaviors to increase or decrease (in frequency) in direct
relationship to the level of client complementarity.
Fourthly, complementarity levels in like-sex opposite-

sex dyads were examined. No sex differences were obtained.

LI ST OF REFERENCES

LIST OF REFERENCES

Alexander, J., & Abeles, N. Psychotherapy process: Sex
differences and dependency. Journal of Counseling
Psychology, 1969, 16, 191—196.

 

Alexander, F., & French, T. Psychoanalytic therapy. New
York: Ronald Press, 1946.

 

Beier, E. G. The silent language of psychotherapy. \
Chicago: Aldine Publishing Company, 1966.

Carson, R. C. Interaction concepts of personalipy.
Chicago: Aldine Publishing Company, 1969.

Carson, R., & Heine, R. Similarity and success in

therapeutic dyads. Journal of Consulting Psychology,
1962, 26, 38-43.

Cartwright, R., & Lerner, B. Empathy, need to change, and
improvement with psychotherapy. Journal of Consulting
Psychology, 1963, 21, 138-144.

 

Crowder, J. E. Transference, transference dissipation,
and identification in successful vs. unsuccessful
psychotherapy. Unpublished doctoral dissertation,
Michigan State University, 1970.

Dahlstrom W., & Welsh, G. An MMPI Handbook. Minneapolis:
The University of Minnesota Press,_l960.

 

Ebel, R. L. Estimation of the reliability of ratings.
Psychometrika, 1951, 16, 407-424.

 

Ford, D. H., & Urban, H. B. Systems of psychotherapy.
New York: Wiley, 1963.

 

Freedman, M. B., Leary, T. F., Ossorio, A. G., & Coffey,
H. S. The interpersonal dimension of personality.
Journal of Personalipy, 1951, 22, 143-161.

102

103

Fuller, F. Influence of sex of counselor and of client on
client expressions of feeling. Journal of Counseling
Psychology, 1963, 10, 34-40.

 

 

Halpern, H. M. An essential ingredient in successful
psychotherapy. Psychotherapy, 1965, 2, 177-180.

 

Hays, W. L. Statistics for Psychologists. New York:
Holt, Rinehart, and Wifiston, 1963.

 

Heller, K., Myers, R. A., & Kline, L. V. Interviewer
behavior as a function of standardized client role.
Journal of Consulting Psychology, 1963, 21, 117-122.

Kell, B. L., & Mueller, W. J. Impact and change: A study
of counseling_relationships. New York: Appleton-
Century-Crofts, 1966.

 

LaForge, R. Research use of the ICL. Oregon Research
Institute: ORI Technical Report, 3, No. 4, 1963.

LaForge, R., Leary, T. F., Naboisek, H., Coffey, H. S., &
Freedman, M. B. The interpersonal dimension of
personality: 11. An objective study of repression.
Journal of Personality, 1954, 23, 129-153.

 

LaForge, R., & Suczek, R. The interpersonal dimension of
personality: III. An interpersonal checklist.
Journal of Personality, 1955, 24, 94-112.

 

Leary, T. Interpersonal diagnosis of personality. New
York: Ronald Press, 1957.

 

Leary, T., & Coffey, H. S. The prediction of interpersonal
behavior in group psychotherapy. Psychodrama & Group
Psychotherapy Monograph, 1955, No. 28.

 

 

MacKenzie, M. H. The interpersonal behavior of normal and
clinic family members. Unpublished doctoral disser-
tation. East Lansing: Michigan State University, 1968.

Malone, T. P. Encountering and groups. In Encounter, A.
Burton, (Ed.). San Francisco: Jossey—Bass Inc.,
Publishers, 1970.

 

Meltzoff, J. & Kornreich, M. Research in_psychotherapy.
New York: Atherton Press, 1970.

 

Mueller, W. J. Patterns of behavior and their reciprocal :4
impact in the family and in psychotherapy. Journal
of Counseling Psychology, 1969, 16, (2, Pt. 2).

 

104

Mueller, W. J., & Dilling, C. A. The usefulness of
studying interpersonal themes in psychotherapy research.
Journal of Counseling Psychology, 1968, 15, 50-58.

Mullahy, P. Psychoanalysis and interpersonal psychiatpy. *
New York: Science House, 1970.

Raush, H. L., Farbman, I., & Llewellyn, L. G. Person,
setting, and change in social interaction. Human
Relations, 1960, 13, 305-333.

 

Raush, H. L., Dittman, A. T., & Taylor, T. J. The inter-
personal behavior of children in residential treatment.
Journal of Abnormal and Social Psychology, 1959, 58,
9-260

Swensen, C. H. Psychotherapy as a special case of dyadic
interaction: some suggestions for theory and research.

Psychotherapy: Theory, Research, and Practice, 1967,
4' 7-130

Sullivan, H. S. The interpersonal theory of psychiatry,
(Eds.) Helen S. Perry and Mary L. Gawel. 'New York:
W. W. Norton and Company, 1953.

Sullivan, H. S. The_psychiatric interview. (Eds.) H. S.
Perry and M. L. GaWEI. New York: W. W. Norton and
Company, 1954.

APPENDICES

APPENDIX A

STUDY CASES

APPENDIX A

STUDY CASES

 

 

Client Therapist Client Number Therapist MMPI
No. Sex Sex Sessions Experience Outcome
Levela Ratingsb
011“ M F 18 3 S
016 M F 22 2 U
024" F M 12 1 S
026 F F 18 2 S
031 “ M M 19 3 U
037 / M M 17 3 S
039~/ M M 9 3 U
042“ M F 18 1 U
043’” M M 16 l U
044/ M M 14 1 S
050V’ M F 13 4 S
817“ F F 20 l U
818“ M F 16 3 S
823/ M F 21 2 U
830 F F 9 3 U
831“ M M 24 l U
843 M M 16 1 U
845“ F F 15 3 S
847 M M 15 3 S
848’ F F 12 2 S

 

a1 = Senior Staff; 2 = 2nd yr. intern; 3 = lst yr.
intern; 4 = practicum student.

bS = successful; U = unsuccessful

105

APPENDIX B

MMPI RATINGS

APPENDIX B

MMPI RATINGS

 

Client Judge 1 Judge 2 Judge 3 Average
No. Ratings Ratings Ratings Ratings
1st 2nd 1st 2nd lst 2nd of Judges

 

 

011 5 5 5 5 5 5 5.00
016 4 3 2 2 2 2 2.50
024 5 5 5 5 5 5 5.00
026 5 5 5 5 5 5 5.00
031 4 4 l 2 3 3 2.83
037 4 4 1 2 4 4 3.17
039 4 4 l 2 3 3 2.83
042 3 3 4 1 2 2 2.50
043 2 3 4 2 3 3 2.83
044 5 5 3 4 4 5 4.33
050 5 5 4 4 5 5 4.67
817 l 2 3 3 2 2 2.17
818 5 5 5 5 5 5 5.00
823 2 2 l 1 2 2 1.67
830 3 3 3 2 4 3 3.00
831 2 1 1 l 2 3 1.67
843 3 3 1 l 3 3 2.33
845 5 5 5 5 5 5 5.00
847 4 4 3 3 3 3 3.33
848 5 5 5 5 5 5 5.00
5 = satisfactory; 4 = partly satisfactory; 3 = no
change; 2 = partly unsatisfactory; l = unsatisfactory.

106

APPENDIX C

SCORING MANUAL FOR THE INTERPERSONAL

BEHAVIOR RATING SYSTEM

1.!

APPEND IX C

SCORING MANUAL FOR THE INTERPERSONAL
BEHAVIOR RATING SYSTEMl

General Considerations

The interpersonal Circumplex, as it will be used
in the present study, consists Of four categories or
quadrants into which all interpersonal behaviors may be
rated. The four quadrants are defined by two orthogonal
axes; a vertical axis representing the dimension of
cominance-submission, and a horizontal axis for the
affiliative-disaffiliative (friendly-hostile) dimension.

A behavior is judged into a specific category by
making dichotomous decisions on both axes. In addition,
descriptive terms and example statements, to be listed
subsequently, are available for each category.

In rating the responses, several problems arise.
One; affect and content (i.e., words) may, or may not be
congruent. For example, consider the client statement
"I like you." If this statement is genuine it would

be rated friendly-submissive (love). If it were stated

 

lFreedman, M. B., Leary, T. F., Ossorio, A. G., and
Coffey, H. S. The interpersonal dimensions Of personality,
Journal Of Personality, 1951, 20, 143-162.

 

107

108

in a sarcastic tone Of voice it would be rated hostile-
dominant (punish). If it came after an interpretation
which the client did not want to deal with it would be
rated hostile-submissive (complain).

To minimize the above problems, the following rule
was established: affect takes precedence over content.

Secondly; within a given unit(uninterrupted speech)
one or more shifts in feelings (emotional tone) are possible.
For example, the client may begin his/her speech with an
Openly hostile statement (hostile-dominant) and then shift
during the same speech to a self-condemning statement
(hostile-submissive). Where this occurs, multiple scorings
are required. For the above example, the scoring would be
as follows:

C : H-D ..... H-S

Where there are more than two shifts in the same unit, only
the initial and terminal behaviors will be rated. The
advantage of this procedure is that it permits a separate
analysis of client (or therapist) as (1) respondent to the
preceding elicitations Of the other party (here, the initial
response in the sequency is used), and (2) elicitor (stimu-
lus) Of subsequent response in the other (here the terminal
behavior is considered).

Thirdly; in various cases, raters may use different
levels Of interpretation. TO avoid this, interpretations

should not go beyond the immediate context.

109

Descriptive terms and example statements for each

category.‘

The following abbreviations will be used:

 

therapist = T
client = C

Friendly-dominant (F-D) Category.

 

To dominate, teach, give, support.

(1) Dominate (direct, command, diagnostic probe,
independent behavior).
T or C changes subject, begins new topic,
asks information-gathering questions, is
dominating, bossy.

(2) Teach (advise, give Opinion, inform).
T or C gives Opinion, acts as authority
on subject, instructs.

(3) Give (help, interpret beyond conscious feel-
ings).
Example: T: "If you feel uptight next
week we could meet twice." or "Your
relationship with your girlfriend appears
to be similar to the one you had with your
Mother."

(4) Support (sympathize, reflect feelings, reassure,
generalize conscious feelings, approve,

nurture, therapeutic probe).

 

2Many Of the example statements were Obtained from
J. Crowder, 1970, Appendix C, pp. 110-123.

110

As a general rule, reflecting feelings,
generalizing feelings, therapeutic probes
(when rated here) must come after a state-
ment which contained that data that is
reflected, generalized, etc. Support

and reassurance does not have this limi-

tation.

Friendly-Submissive (F-S) Category.
TO love, OOOperate, trust, admire.
(1) Love (affiliate, identify with).
Examples: "I really like you."
"I feel close to you."
(2) Cooperate (confide, agree, collaborate).
C cooperates with T, works on problem,
answers questions, elaborates on reflective
statements, agrees with.
(3) Trust (depend, ask for help).
Example: C: "This problem arose which I

hope you will help me with

(4) Admire (ask Opinion, praise).
Example: C: "What should I do?"

C: "You're the best therapist in

the Counseling Center."

111

Hostile-Submissive (H-S) Category.
TO submit, condemn self, distrust, complain.
(1) Submit (defer, Obey).

(a) Submission is more to avoid confron-
tation than to accept validity Of
statement (sometimes follows an argu-
ment).

(b) Also, when client expresses extreme
helplessness without belief that thera-
pist can help.

(c) A mere "Yeah" or "I guess so" response
when the therapist is attempting to
elicit an elaboration or after the
therapist has made a statement about
something.

(2) Condemn self (depressed, withdrawn).

C: "I feel worthless."

C: "I'm no good."

T: "If I were a good therapist, you

wouldn't have those feelings."
(3) Distrust (suspicious, skeptical).

(a) T or C expresses skepticism about other
person or his statements. A "What?"
following a very clear statement.

"Maybe."

112

(b) Suspicious about feelings, motives, etc.,
Of other party.

Example: "I don't know if you feel that way

about me or not."
(4) Complain (rebel, nag, sulk, passively resist).

(a) Includes defensive maneuvers, angry
withdrawals into silence, resistance
expressed in passive ways.

(b) Silences of 15 seconds or more where the
previous response would suggest that

the person is feeling hurt or angry.

Hostile-Dominant (H-D) Category,
To hate, punish, reject, boast.
(1) Hate (attack, disaffiliate).
C: "GO to hell."
(2) Punish (be sarcastic, threatening).
C: "People are going to keep bugging me
until I kill myself."
(3) Reject (withholding, competing, accusing).
(a) C or T rejects (in hostile tone) the
previous statement Of the other.
Example: "No, that's not so."
(b) C and T are arguing, competing,
accusing Openly.

(c) C or T refuses a previous directive.

113

(4) Boast (narcisistic, self-stimulating, intel-
lectualizing).

(a) Boastful statements.

Example: "I got the highest grade on that

last exam."

(b) Wandering, free-associating, conver-
sation in which the speaker provides
his own stimulation. Usually includes
"lists" Of events from the past week,
rambling statements, etc.

(c) C or T intellectualizes.

Examples: C: "I haven't worked out my

Oedipal conflict yet."
T: "What is it that's troubling

you?"

   

"ITlliillllllfllfllfllllll1|“