PERSPECTIVES ON PSYCHOTHERAPY
PROCESS: EFFECTS OF CONSISTENCY
OF THERAPEUTIC BEHAVIOR AND
THERAPIST CHARACTERISTICS

Thesis for the Degree of M. A.
MICHIGAN STATE UNIVERSITY
SHEILA BIENENFELD
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ABSTRACT

PERSPECTIVES ON PSYCHOTHERAPY PROCESS: EFFECTS
OF CONSISTENCY OF THERAPEUTIC BEHAVIOR
AND THERAPIST CHARACTERISTICS

 

By

Sheila Bienenfeld

The present study was designed to investigate the relation-
ship between therapist empathy and client experiencing. This relation-
ship was studied along the dimensions of actual therapist empathy and
client experiencing, and consistency of therapist empathy and client
experiencing. For the purposes of this study, consistency was defined
in terms of the variance in scores on the Accurate Empathy Scale (Truax,
l963), and The Experiencing Scale (Gendlin, l968). Both of these
scales derive from concepts postulated as being of some importance in
the process of psychotherapy (Rogers, l957).

Other areas studied were the level of therapist experience,
and the sex of both the client and the therapist. It was hypothesized
that these would be important moderator variables in the relationship
between therapist empathy and client experiencing. A total of I62
five minute tape segments from eighteen therapy cases drawn from the
tape libraries of the Michigan State University Counseling Center
comprised the data for this study. Of the eighteen cases studied,
nine of the clients were male and nine were female. The sample of
therapists consisted of nine therapists, each of whom saw both a male

and a female client. The nine therapists were counter balanced

Sheila Bienenfeld

according to both sex and level of experience, with five male therapists
and four female therapists. 0f the five male therapists, three were
senior staff members of the MSU counseling center, and two were interns
at the MSU counseling center. 0f the four female therapists, two were
senior staff members of the MSU counseling center, and two were interns
at the MSU counseling center. Thus,the data were drawn from nine,

five minute segments per each of eighteen cases studied.

Tape segments were rated in random order by two independent
raters, one male and one female, using both the Accurate Empathy Scale,
and the Experiencing Scale. After criterion levels of rater relia-
bility were reached the tapes were scored, and the average scores for
each segment on each scale were computed. These scores were used as
raw data for this study. Raw scores were used in testing hypotheses
concerning actual amounts of therapist empathy and client experiencing.
The variance over the nine rated segments per case was calculated and
these variance scores were used as a measure of variability in thera-
pist empathy and client experiencing. Variability was considered to
be a measure of consistency in both empathy and experiencing.

Results for data concerning variability indicated that
neither the sex nor the experience level of the therapists accounted
for differences in therapist variability in empathy provided. It was
found however that there was significant negative correlation between
variability of empathy and actual experiencing.

These findings were discussed as a possible indication that

consistency (as defined in terms of variability) is an important trait

Sheila Bienenfeld

indigenous to the personality of the therapist, and that efforts
toward increasing therapist consistency might be of use in the train-
ing of psychotherapists.

In addition it was found that while female clients tended to
receive more actual empathy than male clients, this empathy was sig-
nificantly more variable than the empathy received by male clients of
the same therapists. In discussion of this finding the author specu-
lated that female clients in this sample may have been treated in a more
stereotyped manner than male clients, with therapist empathy possibly
varying more for female clients as a function of therapist biases in
certain content areas presented by female clients. It was also noted
that data used in this study were collected between seven and twelve
years prior to the time of the present study, and that the present
findings may no longer hold true.

In light of the significant negative correlation between
variability of empathy and client experiencing, it was suggested that
experiencing, rather than being an independent client variable, might
be of some use as an outcome measure when used in conjunction with
variability of empathy as the independent variable.

Further research was suggested in the areas of consistency
of therapeutic conditions provided. Research was also suggested in

the area of sex of both the client and the therapist.

PERSPECTIVES ON PSYCHOTHERAPY PROCESS: EFFECTS
OF CONSISTENCY OF THERAPEUTIC BEHAVIOR
AND THERAPIST CHARACTERISTICS

By

Sheila Bienenfeld

A THESIS

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

MASTER OF ARTS

Department of Psychology

1975

ACKNOWLEDGMENTS

Most of all I would like to express my gratitude and appre-
ciation to my Chairman, Dr. Norman Abeles. During the course of a
project which often seemed mean, nasty, brutish, and interminable,
Dr. Abeles was a steadfast source of support, knowledge, guidance,
limit setting, and wry (but gentle) good humor. For this, and his
general excellence in his various roles as instructor and supervisor,
as well as thesis chairman and role model and/or transference figure,
I thank him.

I also wish to thank Drs. Bertram Karon and Dozier Thornton
for their valuable assistance and patience as members of my committee.

I especially wish to thank Dr. Larry Messé, who though not
a member of my committee, was tremendously helpful as both a friend
and statistical consultant way beyond the call of duty.

I also want to thank Mark Olshansky and my good friend
Katherine Anna DeVaux, who served as raters for the many hours of tape
that were rated as part of this study. Also, to Kate, my thanks for
those many sunrise sessions at Denny's.

There are many other people, who although they had nothing
directly to do with this thesis, have been, in their own ways and in
their own times, of enormous help to me. I wish I could mention all
of them, but alas that would be quite impossible. Collectively, they

comprise my "karass" and it is to them that I dedicate this thesis.

ii

TABLE OF CONTENTS

CHAPTER I. INTRODUCTION AND REVIEW OF LITERATURE

Introduction . . . . . . . . . .......
Therapy as a System of Reciprocal

Influence ........ . .......
Consistency . . . .............
Previous Research .............
Future Research ..............
Experience .................
Sex .................. a. .
Accurate Empathy . . . . ..........
Experiencing ................

CHAPTER II. METHOD . ...................

Selection of Subjects ........... '
Selection of Cases .............
Selection of Sample and Sampling of

Tapes ..................
Scoring and Reliability ..........

CHAPTER III. RESULTS ...................

Relationship Between Accurate Empathy
and Experiencing .............
Hypotheses Concerning Empathy .......
Experience Level Variables ........
Sex Variables ..............
Hypotheses Concerning Experience ......
Sex Variables . . . . ..........

CHAPTER IV. DISCUSSION ..................
Therapist Experience Variables ......

Sex Variables ..............

. Experiencing Variables ..........

CHAPTER V. SUMMARY AND CONCLUSIONS ...........

REFERENCES .........................

Page

APPENDICES
A. THE ACCURATE EMPATHY SCALE ............... 53
B. THE EXPERIENCING SCALE ................. 61

iv

Table

LIST OF TABLES

Pearson product-moment correlations between raters'
independent scoring of Accurate Empathy and Experi-

encing Scales ...... . . . . . . . . . . . . . .

Mean scores and consistency (variance) scores for

Empathy and Experiencing ..... . .........

Correlations between consistency and actual scores

on therapist Empathy and client Experiencing .....

Anova summary table for consistency of therapist

Empathy ....... . ...............

Anova summary table for actual therapist Empathy

Anova summary table for consistency of client

Experiencing . . . ........ . . . .......

Anova summary table for actual client Experiencing . .

Page

24

25

26
27

30
31

CHAPTER I
INTRODUCTION AND REVIEW OF LITERATURE

Introduction

Considerable research in psychotherapy has focused on client

characteristics, in an attempt to define those characteristics which
make some clients "good clients" and some clients "bad clients." A
picture of the good client emerged as the "YAVIS" or, young, attractive,
verbal, intelligent, successful individual who was most amenable to
psychotherapy (Kirtner and Cartwright, l958, Sullivan, gt_al,, l958,
Luborsky, l959, Knight, l94l). Other client characteristics were
identified which were thought to characterize the bad client. These
studies had an unfortunate side effect which was the widespread popu-
larization of the labeling of clients as poor risks. An example of
this was the notion that schizophrenics were bad risks and thus could
not be treated through psychotherapy. This notion was later revised
as psychotherapy researchers began to study characteristics of thera-
pists. Such instruments as the Whitehorn-Betz scale brought a dis-
tinction between "A Therapists" and "B Therapists," "A Therapists"
being those who tended to work successfully with schizophrenics, and
"B Therapists" being those who tended to work most successfully with
neurotics (Whitehorn and Betz, l954). Thus in more recent years,
psychotherapy researchers have come to the belief that therapy is a

process whereby one member of the therapeutic dyad exerts an influence

upon the other member, and that the strength of this influence is a
function of the "goodness of fit" as it were, between client and
therapist.

It is surprising that in much of the research on psycho-
therapy, the assumption has been made that the direction of influence
in psychotherapy is one-way, from therapist to client. In line with
this tendency, one sees such conclusions as those drawn by Frank and
Sweetland (l962), reaffirming the direction of influence in therapy
as being from therapist to client. In studying psychotherapy from a
verbal conditioning standpoint (Krasner, l959) it has also been amply
demonstrated that therapist verbalizations influence client verbali-
zations.

In a study of hostility in therapy, Bandura (Bandura, §t_al.,
l960) found that when therapists avoided the hostility responses of
clients, the clients tended to either drop the subject of hostility
or change the object of their hostility. This was not found to occur
when therapists approached their clients' hostility. In his study of
the variable of dependency in psychotherapy, Caracena (l965) found
that clients tended to discuss dependency if encouraged by the thera-
pist, and tended to avoid discussion of dependency, if this was dis-
couraged by the therapist. In their study of therapist offered
therapeutic conditions, Truax and Carkhuff (1965) reported, "a sig-
nificant relationship between therapist transparency or self congruence
and the patient's level of self-disclosure or self-exploration."

It is the opinion of the present author that research in

the field of psychotherapy, as it has traditionally been done, has

been a reflection of the acceptance of the "infectious disease" model
of mental "illness." In accepting the assumptions inherent in this
model, researchers first focused on the characteristics of the client.
Their findings were very similar to findings in the field of medicine,
i.e. one is most successful when one treats a patient who is relatively
healthy, and conversely, one is least successful in treating patients
who are very sick, in fact some patients are so sick that they cannot
be treated at all. The next step within this framework is to decide
what the treatment of preference is to be, and thus one sees studies
such as Fiedler's (1950, 1951) comparing different schools of therapy.
His results indicated that it was the individual therapist more than
the therapeutic school who determines the quality of the therapeutic
relationship. Thus there began an increasing emphasis on the charac-
teristics of the therapist as well as the client.

A common thread running through the above mentioned research
areas is the assumption that therapy is a one-way process. This
assumption derives from the view of the therapist as a healer (Frank,
1961), and possibly because of this underlying assumption, researchers
for many years did not focus on the question of whether psychotherapy
might be a reciprocal process. As Van der Veen (1965) states, ". . .
theory in psychotherapy has tended to consider psychotherapy primarily
in terms of how the therapist influences the patient, but has given
less systematic attention to the effects of the patient on the thera-
pist." The posing of the question, ". . . is the behavior of the
therapist in any way determined by the stimulus characteristics of

the client?" (Heller, et al., 1966) is a concomitant of the more and

more prevalent study of the client's effect on the behavior of the
therapist. When definitions of psychotherapy are not tied to the tra-
ditional healer-patient model, it becomes possible to define character-
istics uniquely different from those of the medical model, and very
much more characteristic of psychotherapy. Conceptualizing psychotherapy
as a process in which both parties serve as partial causes of each
other's behaviors broadens the definition of psychotherapy and the vari-
ables which can be studied. As Gendlin has pointed out, (Gendlin, 1969),
the application of psychotherapy in such "untreatable" populations as
children and psychotics has contributed to the development of psycho-
therapy with all types of clients.

It is not only the trend toward rejection of the medical
model which leads to a consideration of therapy as a system of recipro-
cal influence. Experiments by such people as Asch have shown that when
pairs or groups of subjects are exposed to certain stimuli, their
judgements of the stimulus will tend to converge (Asch, 1952). These
studies have demonstrated that through the phenomenon of convergence,
individuals tend to adjust their judgements to fit group norms. In a
paper discussing convergence as it applies to psychotherapy. Pepinsky
and Karst (1964) conceive of therapy as a process in which the client
learns a psychological grammar through which he adjusts his views to
approximate more closely the views of the therapist. While focusing
primarily on the influence of the therapist on the client, Pepinsky
and Karst, (1964) do state that, ". . . empirically, convergence is not
likely to be a strictly one-way phenomenon: i.e., part of the thera—

pist's grammar may be acquired from his client."

Therapy as a System of
Reciprocal Influence

While there have been relatively few studies dealing with
the mutuality of influence between client and therapist, in recent
years there have been some studies which have investigated the influence
of the client on the therapist. One of the first studies in this area
was done by Van der Veen (1965) who studied the interactions of three
chronic schizophrenic hospitalized patients who each saw five therapists
for at least two interviews. He found that, "The results supported the
general hypothesis that the therapist and patient influence each other's
therapeutic behavior as well as their own and that the therapeutic be-
havior of one is positively related to the therapeutic behavior of the
other." This study had certain limitations in that neither the patients
nor the therapists were selected randomly, and in addition to this,
since the data was drawn from only two sessions which were not part of
ongoing therapy, the generalizability of these findings to ongoing
therapy is limited.

Another study which demonstrated the influence which clients
can have on their therapists was done by Heller, gt_al,, (1966) who,
using Leary's Interpersonal system in an analogue study tested the
influences of dominant vs. dependent, and hostile vs. friendly client-
actor behavior on student counselors. Heller concludes that, "In
general the results of this study support the position that psychotherapy
should be viewed as a "reciprocally contigent interaction" (Jones and

Thibaut, 1950).

Heller (Heller, §t_al., 1966) also raises the issue of counter-
transference which is an issue which must inevitably arise when discuss-
ing therapists' reactions to clients. Heller differentiates between
countertransference and the reciprocal interaction which he observed,
in suggesting that, while countertransference is idiosyncratic to the
personality of the therapist, evoked behavior is a function of the
actual situation in therapy.

One of the most active researchers in this area is Moos, who
in a series of studies has focused on the effects of the situation and
the particular client on therapist behavior. In a study of the effect
of the setting on therapists, Moos and Daniels (1967) found that psy-
chiatric ward staff react differently in different ward settings. This
study, although not directly relevant to the effect that the client has
on the therapist, does demonstrate that therapist behavior is not a
unitary construct, consistent within each therapist, but a changing
group of behaviors which can vary from setting to setting.

Another study by Moos and Clemes (1967) was one in which
each of four therapists saw each of four clients, and were rated for
their behavior across clients. According to the authors, "The results
empirically demonstrate the necessity of conceptualizing the patient
and therapist as an interacting system in which both individuals mutually
influence each other." This study has certain limitations in general—
izability to ongoing therapy however, in that each therapist saw each
client for only one session.

In a study of value system change during therapy, Schonfield,

et al., (1969) raised the issue of whether the convergence between

the value systems of clients and therapists during therapy was due to
the patient's adopting the views of the therapist, or the therapist
adopting the views of the client. They report that the data they ob-
tained indicated that value change in therapy is a result of both oc-
currences.

In his conceptualization of the treatment relationship, Rosen
(1972) states his view that, " . . . dyadic interaction can be seen as
a situation of interdependence. where . . . each participant's outcome
is dependent to some extent on the responses of the other." In their
research into the variable of hostility in therapy, Bandura, gt_al.,
(1960) found that therapists were more likely to avoid discussion of
hostility when it was directed toward themselves, than when it was
directed toward others. As was pointed out earlier, these avoidance
responses tended to lead to the patient's dropping the discussion of
hostility. Thus we see that the patient's hostility responses to the
therapist, led these therapists to make avoidance responses, which in
turn led to the client's avoidance of further hostility responses.
Again, very clear evidence that the therapist and the client are an
interacting dyad, each exerting influence on each other's verbal be-

haviors in therapy.

Consistency

 

The results of the studies cited, despite their many limita—
tions, provide ample evidence that therapists are susceptible to the
influence of their clients. The next question that arises is how sub-

ject to influence and in what ways are therapists subject to the

influence of their clients. One way of approaching this issue seems
to lie in the measurement of therapist consistency of therapeutic con-
ditions offered in interactions with clients, for if one can obtain a
measure of therapist consistency of therapeutic conditions, it is
possible to judge the amount of variability which exists in the thera-
pist's therapeutic behavior. In essence, the question that arises is,
to what extent is therapist behavior in the therapy session, situation-
ally determined?

This is a question which has broad implications for the
field of psychotherapy research. One of the more apparent implications
concerns what Kiesler (1966) calls the "therapist uniformity assumption.
Kiesler uses this term in his discussion of psychotherapy research for
the assumption that different therapists do the same thing and are thus
comparable. As such, his is a valid criticism, and its ramifications
become even greater when we consider that he refers to intertherapist
uniformity, which in essence means that he believes it invalid to
generalize from the behavior of one therapist to another. If individual
therapists are themselves inconsistent in their therapeutic behaviors,
then Kiesler's therapist uniformity assumption can be expanded to in-
clude the false assumption of both inter and intrg_therapist uniformity.
If this can be demonstrated, it may suggest that it is invalid to gen-
eralize past the behavior of one therapist, with one client, at any
one time.

This author does not mean to suggest that therapists need to
be entirely consistent in their therapeutic behaviors with each client,

or that they need behave in the same manner with all clients. To be

sure, different clients require different types of responses from their
therapists at different times. In that sense, therapy must be "patient
specific." Nonetheless, it has been demonstrated in numerous studies
that certain conditions must be present in order for therapy to be
successful. Specifically, those conditions consist of Warmth, Genuine-
ness, and Empathy as discussed in the theory of Carl Rogers (Rogers,
1957, 1958). In discussing the consistency of therapeutic behavior,
this author refers not to the content of the therapist communications,
but to the consistency with which therapeutic conditions are offered.
Klein, gt_al., (1969), report a study done by Van den 305, of the con-
sistency of the above mentioned therapeutic conditions offered to a
sample of hospitalized schizophrenic patients. Van den 805 found that,
" . it is the consistency of the therapist behavior in all areas

that is correlated with experiencing."

Other implications of therapist consistency or inconsistency
bear upon the controversy between social psychologists and personality
psychologists. Some social psychologists maintain that behavior is
primarily situationally determined, while some personality psychologists
have to a large extent built their science upon the assumption of stable
personality traits. The consensus of opinion in this area seems to be
that both traits and situations operate in determining behavior, with
different individuals falling between different ends of a continuum
(Campus, 1970). The study of consistency of psychotherapeutic conditions
offered can provide valuable data contributing to the research relating
to the trait vs. state controversy, and the hypothesis that consistency
may itself be a trait mediated by such moderator variables as experi-

ence and sex, which will be discussed later.

10

Previous Research

There has been little research in the area of therapist con-
sistency, but what little research has been done indicates that this
is an important, though as yet fairly unexplored area. Moos and Clemes
(1967) state that, "It is possible that therapists might be relatively
consistent in emitting therapeutic behaviors across different clients.
It is also possible, however, that different patients might elicit dif-
ferent therapeutic behaviors in the same therapist."

Moos and MacIntosh (1970), in an expansion and replication of
the earlier study by Moos and Clemes (1967), touch on the trait vs.
state controversy in their finding that, "The results in support of
earlier findings by Moos and Clemes, imply that 'behavior trait' of a_
given tendency to be empathic or of a consistently applied therapeutic
technique, but rather are very importantly situationally or patient
determined."

In a study of therapist behaviors with three different clients,
Bohn (l965) underscores the importance of the stimulus situation in de-
termining counselors' responses. He points out that in the study of
the effect of counselor personality on counselor behavior, the client
variable must be taken into account. Strupp (1960) also points out
some of the factors which would explain therapist inconsistencies in
therapeutic responses to different clients. He foUnd an interaction
between the clinical observations of a therapist, his treatment recom-
mendations, and his attitude toward the patient. These factors in turn

exerted an influence upon the manner of the therapist's communications.

11

Rottschafer and Renzaglia (1962), found that six out of eight
counselors in their study were inconsistent in their style of inter-
viewing across different clients. Truax (1966) in analyzing data from
a case conducted by Carl Rogers found that the therapist (Rogers) re-
sponded differentially to different client behaviors studied i.e. he
did not respond in the same way to the same observed behaviors in his
client.

In addition to those studies which suggest that therapists
are often inconsistent in their approach to clients, there are other
studies which suggest that the level of therapeutic conditions (e.g.
empathy) offered by the therapist are stable across clients. In a
study designed to deal with the question, "Is it the therapist, or is
it the patient who determines the level of accurate empathy that will
occur in a given psychotherapy relationship?" Truax (1963) studied
the level of accurate empathy offered by eight different therapists to
each of twenty four different clients in a psychiatric ward. He found
that, "The data . . . suggest that it is the therapist who determines
the level of accurate empathy" rather than the client.

. In another study Truax gt_gl,, (1966) report that their data
support the previous findings indicating that the therapeutic conditions
of Accurate Empathy, Non-Possessive Warmth, and Genuineness, are pri-
marily a function of the therapist and not of the patient.

With regard to the hypothesis mentioned earlier, that con-
sistency is itself a personality trait, there is some evidence which
suggests that certain individuals are predictably consistent, while

others are predictably (or consistently) inconsistent (Campus, 1970).

12

Ellsworth (1963) in a study of therapist "feeling verbalization" both
in and out of therapy, found that, "The counselor's degree of feeling
verbalization in a group case conference is consistent with the degree
of feeling verbalization he shows in the individual counseling inter-
view." Buchheimer, (1963) in an anecdotal report, notes that, among
the counselor trainees whom he knows, differences can be seen between
the occasionally empathic and the consistently empathic trainee.
Trainees who are occasionally empathic seem to respond only to similar
situations while those who are consistently empathic seem to go beyond
similarity of experience, and seem to be freer of projection, and identi-
fication. Ellsworth too considers consistency to be an important vari-
able in therapeutic effectiveness, he states that, "The consistency of
the therapist's interpersonal interaction outside of the client-‘
counselor relationship is thought to be positively related to his
counseling effectiveness." (Ellsworth, 1963). His results may suggest
that those counselors who tend to react consistentyly, or those who are

less influenced by their situation, are more effective as therapists.

Future Research

 

All of the above mentioned studies have serious shortcomings
which limit the validity and generalizability of their findings. Few
of these studies are based on data taken from ongoing therapy with
several clients and with therapists of varying experience levels.
Level of experience may be a particularly important variable to study
when investigating consistency, as there is some evidence that consis-

tency tends to increase with age and level of experience (Mullen, 1969).

13

Another important variable which has not been adequately dealt with,
is the area of therapist sex, and client sex, both of which may also

have important implications in therapy research.

Experience

With regard to the issue of whether consistency increases
with age, Block (1968) offers the explanation that role variability as
opposed to role stability is due to a lack of what Erikson (1950) calls
"inner sameness and continuity." Thus it might be found that with in-
creasing age or experience within a given role, role stability increases
yielding greater consistency of behavior. In their discussion of a
therapeutic "grammar," Pepinsky and Karst (1964) note that there is
reason for believing that experienced therapists are more likely than
inexperienced ones to be consistent from client to client in the kind
of grammar they make available to their clients.

Although Heller et_al,, (1966) did not study the variable of
therapist experience as it relates to consistency he does state that
it is their subjective impression that more experienced interviewers
would experience the same personal reactions although they would be
better able to control their actual interview behavior.

Russel and Snyder (1963) found that hostile behavior on the
part of client-actors aroused anxiety in two groups of counselors, an
experienced group and in inexperienced group, however hostile behavior
aroused less anxiety in the experienced group. This finding lends

some support to the view expressed by Heller, who suggested that, while

l4

experiencing the same internal reactions as inexperienced interviewers,

experienced interviewers would be able to react more consistently.

Sea.

Another area which has not been adequately explored is the
variable of sex, of both client and therapist, in the process of ther-
apy. To date, this author has found no studies which deal specifically
with this variable, although there is much research that demonstrates
the importance of sex as a variable in dyadic interaction. In a study
of different responses obtained in Rorschach protocols, Curtis, et_al.,
(1951) report a significant difference between male and female examiners
on the number of records with sex responses. They conclude that, "It
appears necessary for each examiner to study his stimulus value, the
effect he has on the patients he examines."

In keeping with the notion that both therapist and client
influence each others' behaviors, Parker (1967) studied differences in
directive behavior when male therapists saw both male and female clients.
He found that, ". . . they (the therapists) gave significantly more
nondirective responses to female clients than to male clients."

Hiler (1958) studied therapist sex in his effort to determine
what factors lead to a client's early termination of therapy. His
findings indicate that, ". . . the sex of the therapist is a factor
determining whether a given type of patient will remain in treatment
or not." His findings underscore the importance of therapist sex in
that the female therapists were able to keep in treatment many of the

type of patients who tend to terminate when assigned to male therapists.

15

But he notes that female therapists also tend to lose more of the
productive patients than do the male therapists.

In a study of sex differences in a counseling situation (only
educational or vocational problems were discussed however) Fuller
(1963) found that, "More feeling was expressed in pairs including a
female regardless of whether the female was a client or a Counselor."
Other variables which were associated with the client's increased ex-
pression of feeling in the counseling situation, were the level of
counselor experience, and assignment in accordance with the preference
of the client regarding the sex of the therapist.

Thus, research results cited indicate that sex, as a stimulus
characteristic of both therapists and clients, has an effect on the
nature of the dyadic interaction, both in counseling and testing situa-
tions. In addition to this, there is some evidence that males and fe-
males are differentially susceptible to situational influence. Endler
and Hunt (1968) report that, "For both anxiousness and hostility, the
situation contributes more to the total variance for women than for
men. This may mean that women are more influenced by situational
factors than are men." These findings suggest that women may prove
to be less consistent (i.e. their behavior may be more situationally
determined than the behavior of men) in the level of therapeutic condi-
tions they offer in a counseling situation. To the extent that expres-
sion of feeling may be related to empathy, Fullerfs findings may sug-
gest that women will show higher levels of Accurate Empathy in the

counseling situation.

16

The purposes of the present study will be to investigate the
variables of consistency, experience, and sex, as they relate to

Accurate Empathy, and Experiencing, in therapy.

Accurate Empathy

The concept of Accurate Empathy derives from the work of
Carl Rogers (Rogers, 1957, 1958), and relates to, "a conception of
empathy which involves the sensitivity to current feelings, and, the
verbal facility to communicate this understanding in a language attuned
to the patient's current feeling." (Truax, 1963). Severalstudies
have been done which demonstrate the significance of this concept for
psychotherapy. Truax, who developed the Accurate Empathy Scale, studied
psychotherapy outcome in a group of schizophrenic patients, and found
that accurate empathy ratings were significantly higher for the more
successful cases than for the less successful.cases. .His findings
lead him to conclude that accurate empathy is important for successful
psychotherapy with even the most difficult patient populations.

In a study which has particular significance for the present
study, Truax and Carkhuff (l965) experimentally manipulated the con-
sistency of accurate empathy to be offered by the therapist. This study
demonstrates that when therapist offered conditions of accurate em-
pathy were intentionally lowered, “there is a consequent drop in the
patient's depth of interpersonal exploration.", and when the therapist's
level of Accurate empathy was raised to its previous level, the pa-
tient's depth of interpersonal exploration also returned to its pre-

viously higher level.

17

Truax and Wittmer (1971) again demonstrated the validity of
the Accurate Empathy scale in their finding that, "Overall improvement
measures significantly differentiated between high and low empathy
groups in favor of high empathy."

In his study of conditions which might effect ratings of
therapist empathy. Truax (1970) found a moderate positive relationship
between the average proportion of therapist talk and his level of
accurate empathy.

Further demonstrations of the validity of accurate empathy
as measured by the Accurate Empathy scale, were reported by Mullen and
Abeles (1971), and Shapiro (1968). Mullen and Abeles found significant
relationships between high conditions of empatHy over any stage of
therapy and successful outcome. They also found a clear relationship
between low conditions of empathy throughout all stages of therapy and
outcome categorized as unsuccessful. In his discussion of Shapiro's
findings, Truax reports that, "He (Shapiro) thereby concluded that the
Accurate empathy scale showed adequate construct validity since AE
ratings strongly correlated with what people in general thought of as

understanding-not understanding." (Truax, 1972).

Experiencing

The other area that will be studied will be the level of
experiencing as indicated by ratings of client verbalizations. The
variable of experiencing derives, as does accurate empathy, from the
theories of Carl Rogers. The experiencing scale, developed by Gendlin,

was designed to measure. ". . . the quality of an individual's

18

experiencing of himself, the extent to which his ongoing, bodily,

felt flow of experiencing is the basic datum of his awareness and com-
munications about himself, and the extent to which this inner datum is
integral to action and thought." (Klein, et_al., 1969).

Studies of experiencing have shown this measure to be a
valuable tool in the prediction of outcome and in the analysis of thera-
pist client interactions. Gendlin reports that Experiencing may be a
useful outcome predictor in his finding that a high degree of statisti-
cal significance is obtained when Experiencing ratings of only a few
four minute segments are used to predict success in therapy (Gendlin,
§t_al., l968).

Gendlin also points out the usefulness of the Experiencing
Scale in measuring the relationship between client experiencing and
therapist offered therapeutic conditions. Klein §t_al,, (1969), re-
port that the Experiencing Scale is sensitive to differences in client's
verbal behavior as a function of such factors as therapist empathy

and genuineness.

CHAPTER II
METHOD

Selection of Subjects

The subjects for the present study included nine psycho-
therapists at the MSU Counseling Center. This includes five male
therapists and four female therapists. 0f the five male therapists,
three were designated as "experienced" and two were designated as "in-
experienced." Of the four female therapists, two were designated as
"experienced," and two were designated as "inexperienced." For the
purposes of this study, an experienced therapist was defined as one who
was a senior member of the Counseling Center staff. Senior staff mem-
bers in this study had completed training and held Ph.D. degrees in
either Counseling or Clinical psychology, and had between one and
twenty years of post-Ph.D. experience as individual psychotherapists.
An inexperienced therapist was one who was either a first or second
year intern at the MSU Counseling Center. Both groups of interns used
in this study were Ph.D. students in either clinical or counseling
psychology, and had had at least two years of previous supervised
therapy training.

All therapists in this study worked with two clients, one
male and one female. Thus the total sample consisted of five experi-

enced therapists and four inexperienced therapists. Three male and two

19

20

female therapists comprised the experienced group and two male and two
female therapists comprised the inexperienced group, Eighteen clients

were studied, nine of whom were male and nine of whom were female.

Selection of Cases

Tape recordings of therapy cases used in this study were
selected from the tape libraries collected by the MSU Counseling Center.
These tapes consist of therapies conducted with undergraduates from
MSU who voluntarily came to the Counseling Center presenting psychologi-
cal problems for which they sought individual counseling. All clients
in this study had agreed to the use of the tapes made of their sessions
for research purposes. All of the clients who comprise the sample for
the present study were seen for a mean number of 19.4 interviews, with
a mean of 21.2 interviews for experienced therapists, and a mean of

17.6 interviews for the inexperienced therapists.

Selection of Sample and Sampling of Tapes

Eighteen therapy cases represent the total tape recorded
therapy sessions sampled in this study. Each therapy case was broken
down into three stages (early, middle, and late), and one five minute
segment was randomly selected from each stage of each therapy hour.
Thus each therapy case was represented by nine five minute recorded
segments, yielding a total of one hundred and sixty two, five minute
segments. Because this study was concerned with consistency (defined
as the amount of variation in rated therapist empathy and client ex-

periencing). this procedure allowed for sensitivity to intrasession

21

variability as well as inter-session variability. The one hundred and
sixty two segments were then transferred in random order to ten master

tapes which were rated independently.

Scoring and Reliability

This study used two raters for both scoring and reliability
purposes. One rater was a female third year graduate student in
Clinical psychology, and the second rater was a male with a B.A. in
psychology. Each rater was supplied with a scoring manual (see appendix)
for each of the two scales used in this study, and met with each other
and the writer to discuss the scoring systems and to score practice
tapes which were taken from the same tape libraries as the sample, but
which were not used in this study.

The Accurate Empathy scale devised by Truax and Carkhuff
(1963), by which the therapists' communications were rated, consists
of a nine point scale which ranges from a rating of 1 in which, "The
therapist seems completely unaware of even the most conspicuous of the
client's feelings . . ." to a rating of 9 in which, "The therapist
unerringly responds to the client's full range of feelings in their
exact intensity."

The Experiencing scale devised by Gendlin (1968), by which
the clients' communications were rated, consists of a seven point
scale which ranges from a rating of 1 in which the, "content or manner
of expression is impersonal," to a rating of 7, in which "The content
reveals the speaker's expanding awareness of his immediately present

feelings and internal processes."

22

When the criterion level of scorer reliability had been met
for both scales (see Table l), the data tapes were rated by both raters,

and the average of their two ratings were used as data for this study.

Table 1. Pearson product-moment correlations between raters' inde-
pendent scoring of Accurate Empathy and Experiencing Scales.

 

 

 

Scale # of # of # of
Clients Therapists Segments r
Accurate Empathy l8 9 162 .9168

Experiencing l8 9 162 .7151

 

CHAPTER III
RESULTS
Relationship Between Accurate
Empathy and Experiencing

The relationship between client experiencing and therapist
empathy was studied both in terms of actual Experiencing and actual
Accurate Empathy, and in terms of consistency of Experiencing and con-
sistency of Accurate Empathy. Consistency of empathy scores were
derived by computing the variance across the nine empathy ratings for
each therapy case. Consistency of experiencing scores were derived by
computing the variance across the nine experiencing ratings for each
therapy case. Both actual and consistency scores were used in all
analyses of the data. The data upon which all analyses were carried
out is summarized in Table 2.

Hypothesis 1. General Statement: Aspects of therapist empathy
and aspects of client experiencing interact in a positive linear
relationship.

Ia. Variability (consistency) of therapist empathy is posi-
tively related to variability (consistency) of client
experiencing.

Ib. Actual therapist empathy and actual client experiencing
are positively related.

Ic. Variability (consistency) of therapist empathy and actual

client experiencing are positively related.

23

24

Table 2. Mean scores and consistency (variance) scores for Empathy
and Experiencing.

 

 

 

 

. . . Em ath Ex eriencin
Therapist ClaSSification Client i Emp;pEmp{ Var: R EXp; Exp;gVar:
I Experienced
Male Male 4.22 .88 2.77 .20
I Male Female 5.88 1.29 2.88 .78
II Male Male 5.55 .90 2.88 .61
11 Male Female 5.88 1.62 3.33 .97
III Male Male 4.77 1.53 3.00 .47
III Male Female 4.11 1.73 2.55 .50
IV Experienced
Female Male 4.00 1.24 3.33 .76
IV Female Female 5.00 1.62 3.44 .96
V Female Male 4.00 .85 3.66 .02
V Female Female 5.22 1.70 3.22 .80
VI Experienced
Male Male 4.55 1.23 2.88 .62
VI Male Female 5.33 1.66 3.11 .96
VII Male Male 5.11 1.41 3.22 .08
VII Male Female 5.11 1.72 3.00 .59
VIII Inexperienced
Female Male 4.00 .83 3.33 .76
VIII Female Female 4.44 1.65 3.33 .72
IX Female Male 4.00 1.58 2.77 .51
IX Female Female 4.99 2.00 2.88 .10

 

25

Id. Actual therapist empathy and variability (consistency) of
client experiencing are positively related.
Hypothesis I was tested by examining the relationship between both
consistency (consistency was defined as the "variance" for each therapy
case, on the Accurate Empathy and Experiencing scales) scores and
actual scores on both scales, using the Pearson Product Moment Corre—
lation.

Table 3. indicates the relationships between variability of
empathy and client experiencing, and actual empathy and client experi-
encing. The results indicate that this hypothesis was not supported
by the data. In the case of sub-hypothesis Ic however, the relation-
ship between variability (i.e. consistency) of therapist empathy and
actual client experiencing was significant at the .05 level, although
in the direction opposite to that predicted. This indicates that
clients of the less consistenly empathic therapists showed less ex-
periencing than clients of the more consistently (less variably) em-
pathic therapists. It should be noted in this regard, that the data
did not support the postulated relationship between actual therapist
empathy and client experiencing.

Table 3. Correlations between consistency and actual scores on thera-
pist Empathy and client Experiencing.

 

 

Var. Em. Var. Exp. Act. Em. Act. Exp.

 

Variability of Empathy - - - - -.02 -.64* -.47*
Variability of Experiencing - - - - -.14 .26
Actual Empathy - - - - .00

Actual Experiencing - - - _

 

p < .01 p < .05

26

Hypotheses Concerninngmpathy
Experience Leyel Variables
Hypotheses concerning empathy were tested using a 2 x 2 x 2
Analysis of Variance with repeated measures on the last factor and an
unweighted means solution for unequal cell frequencies. Analyses of
variance were carried out on data concerning both consistency of em-

pathy and actual empathy. The results are summarized in Tables 4 and 5.

Table 4. Anova summary table for consistency of therapist Empathy.

 

 

 

Source SS df ms F
Therapist Experience (A) .004 l .004 .120
Therapist Sex (8) .038 l .038 1.06
A x B .0004 1 .0004 .012
Error I .1809 5 .0362 - - - -
C1ient Sex (C) .3763 1 .3763 17.644*
A x C .0041 1 .0041 .196
B x C .0020 1 .0020 .092
A x B x C .0007 1 .0007 .032
Error II .1067 5 .0213 - - - -

 

* p < .01

27

Table 5. Anova summary table for actual therapist Empathy.

 

 

 

 

Source SS df ms F
Therapist Experience (A) 130.69 1 130.69 4.68*
Sex of Therapist (B) 6.54 l 6.54 .002
A x B 2.61 1 2.61 .000
Error I 139.55 5 27.91 - - - -
Sex of Client (C) 130.69 1 130.69 5.09*
A x C 39.50 1 39.50 1.54
B x C 25.20 1 25.20 .98
A x B x C -16.46 1 -16.46 .64
Error 11 128.3 5 25.66 - - - -

*p < .10

Hypothesis II. General Statement: There will be a positive re-
lationship between the therapist's level of experience and
Accurate Empathy.

IIa. Experienced therapists will show more consistency (less
variability) in their levels of Accurate Empathy, than
inexperienced therapists.

IIb. Experienced therapists will show more actual empathy
than inexperienced therapists.

The results, as summarized in Table 4 do not support sub-
hypothesis IIa, indicating that experienced therapists in this study
were not significantly more consistent in their empathic behavior than

inexperienced therapists. The results for sub-hypothesis IIb, as

28

summarized in Table 5 however, do indicate partial support for the
predicted relationship between the experience level of the therapist
and the amount of actual empathy provided. The results indicate a I
trend (significant at the .10 level) in the predicted direction, indi-
cating that in this study, experienced therapists did tend to offer a

greater amount of actual empathy than did the inexperienced therapists.

Sex Variables

Hypothesis III. General Statement: There will be a relationship
between therapist empathy and the sex match of the client
therapist dyad.

IIIa. In same sex dyads there will be a higher level of
consistency of therapist empathy than in opposite sex
dyads.

IIIb. Therapist client dyads in which the client is female
will exhibit more consistent therapist empathy than
dyads in which the client is male.

IIIc. In same sex dyads there will be a higher level of
actual empathy than in opposite sex dyads.

IIId. Therapist client dyads in which the client is female
will exhibit a higher level of actual empathy than
dyads in which the client is male.

Table 4 summarizes the results for subhypotheses IIIa and
IIIb. As indicated in Table 4, data did not support subhypothesis
IIIa, this indicates that same sex dyads in this study were not sig-
nificantly different from opposite sex dyads in the consistency with

which therapists were able to behave empathically with their clients.

29

As summarized in Table 4, data did support subhypothesis
IIIb which was confirmed at the .01 level of significance. This indi-
cates that in this study, the therapists, regardless of sex or level
of experience were more variable in their empathic behavior with fe-
male clients than with male clients.

Table 5 summarizes the results for subhypotheses IIIc and
IIId. As summarized in Table 5, data did not support subhypothesis
IIIc. This indicates that in this study same sex dyads did not differ
from opposite sex dyads in the actual amount, or level, of empathy
offered by the therapist to the client.

As summarized in Table 5, data showed a trend in the direc-
tion predicted for subhypothesis IIId (p < .10). This trend suggests
that in this study all therapists, regardless of sex or experience
level tended to show more actual empathy with female clients than with

male clients.

Hypotheses Concerning_Experiencipg
Experience Level Variables

Hypotheses concerning Experiencing were tested using a
2 x 2 x 2 Analysis of variance with repeated measures on the last fac-
tor and an unweighted means solution for unequal cell frequencies.
The results are summarized in Tables 5 and 6.
Hypothesis IV. There will be a positive relationship between
therapist level of experience, and client experiencing.
IVa. Clients of experienced therapists will show more consis-
tency of experience than clients of inexperienced thera-

pists,‘ '

30

IVb. Clients of experienced therapists will show more actual

Experiencing than clients of inexperienced therapists.

Results, as summarized in Table 6 do not support subhypothesis

IVa. The data indicates that in this study the clients of experienced

therapists did not differ significantly from the clients of inexperi-

enced therapists in the consistency of their Experiencing.

Table 6. Anova summary table for consistency of client Experiencing.

 

 

 

Source SS df ms F
Therapist experience (A) .0094 1 .0094 .856
Therapist Sex (B) .0140 l .0140 1.272
A x B .000 1 0 0
Error 1 .0549 5 .0109 - - - -
Client Sex (C) .0015 1 .0015 .024
A x C .0667 1 .0067 1.136
B x C .0342 1 .0342 .584
A x B x C .0017 1 .0017 .028
Error II .2935 5 .0587 - - - -

 

Results, as summarized in Table 7 do not support subhypothesis

IVb. The data indicates that in this study clients of experienced

therapists did not differ in amount of actual Experiencing from clients

of inexperienced therapists.

31

Table 7. Anova summary table for actual client Experiencing.

 

 

 

Source SS ms F
Experience of Therapist (A) 50.92 50.92 .0042
Sex of Therapist (B) 101.83 101.83 .0087
A x B 2.72 2.72 .0002
Error I 581.83 116.37 - - - -
Sex of Client (C) 50.92 50.92 -.0004
A x C 31.24 31.24 -.0003
B x C -39.15 -39.15 .0039
A x B x C 131.32 131.32 -l.2813
Error II -512.83 -102.56 - - - -

 

Sex Variables

Hypothesis V. There will be a positive relationship between the

sex match of the client-therapist dyad and client Experiencing.

Va. In same sex dyads there will be a higher level of con-

sistency of client Experiencing than in opposite sex

dyads.

Vb. In same sex dyads there will be a higher level of actual

client Experiencing than in opposite sex dyads.

Vc. Female clients will show higher levels of consistency

in Experiencing than male clients.

Vd. Female clients will show higher levels of actual experi-

encing than male clients.

32

Results for sybhypothesis Va, as summarized in Table 6 indi-
cate that the hypothesis was not confirmed. This indicates that in
dyads in which both the therapist and the client were of the same sex,
client Experiencing was not more consistent than in dyads in which
the members were of opposite sex. (See Table 6.)

Results for subhypothesis Vc, as summarized in Table 6 indi-
cate that in this study the data did not support this hypothesis. In
this study, female clients did not show higher levels of consistency
in Experiencing than male clients.

Results for subhypothesis Vb, as summarized in Table 7, did
not support this hypothesis. This indicates that dyads in which both
members were of the same sex client Experiencing did not significantly
from client Experiencing in dyads in which the members were of opposite
sex. (See Table 7.)

Results for subhypothesis Vd, as summarized in Table 7 do
not support this hypothesis. This indicates that in this study, fe-
male clients did not show higher levels of actual Experiencing than

male clients.

CHAPTER IV
DISCUSSION

One of the major purposes of this study was to investigate
the relationship between therapist empathy and client experiencing.
Previous research has affirmed the validity of both the Accurate Empathy
scale, and the Experiencing Scale as process measures in psychotherapy
research (Truax, 1972, Klein, gt_al,, 1969). The Accurate Empathy
Scale was designed to quantify therapist behavior on the dimension of
empathy. Empathy, as defined by Truax (Truax, 1963) involves the
therapist's sensitivity to the client's feelings, as well as the thera-
pist's facility at communicating this sensitivity. The Experiencing
Scale (Gendlin, 1968) was designed to quantify the extent to which the
client is "in touch with," and able to verbalize his or her feelings
and internal awareness (see appendix).

Both the Accurate Empathy Scale and the Experiencing Scale
were designed to measure variables which are described (Rogers, 1957)
as being related to successful outcome of therapy. Because of the
theoretical link between the constructs of empathy and experiencing,
it was hypothesized that there would be a positive relationship be-
tween empathy and experiencing. The basis for this hypothesis being
the notion that the therapist's empathic behavior with the client
helps create an environment in which the client can explore his or

her feelings in their fullest range and depth (Jourard, 1964).

33

34

The relationship between therapist empathy and client experi-
encing was studied along two dimensions, that of actual therapist
empathy and actual client experiencing, and along the dimension of
consistency of therapist empathy and consistency of client experiencing.
Consistency was defined in terms of variance in repeated measures over
time on each scale. For the purposes of this study, "actual" empathy
and experiencing were defined as the amount of empathy and the amount
of experiencing which were measured across the nine rated taped seg-
ments of each therapy case. Consistency scores were defined as the
variance over time in therapist empathy and client experiencing for
each of the eighteen cases studied.

This study's focus on the issue of consistency derives from
the notion that the therapeutic environment in which self exploration
is facilitated, might best be promoted in interaction within a consis-
tent environment. By consistency however, the writer does not mean
rigidity or lack of responsiveness on the part of the therapist, but
rather the therapist's ability to focus consistently upon the feelings
of the client.

In this connection it should be noted that in the sample
studied, rated therapist empathy varied within a small range (see
Table 2.) This sample was culled from a college counseling center
which serves as both a service and a training institution. In such a
setting, therapist empathy would not be expected to fall much below
a moderately acceptable level and this was reflected in the data.

None of the therapists in this study were found to be consistently

non-empathic, rather, all therapists varied around a middle range of

35

empathy. It was the writer's belief that since there was a small jpte5;
therapist range in level of empathy provided, a possibly worthwhile

area of study would be jptxatherapist range in empathy provided. In
other words, how much did each therapist vary within his or her own
level of offered empathy, given that all therapists provided moderate
degrees of empathy over all.

The writer speculated that consistency of empathy might be
similar to Rogers' condition of unconditional positive regard, insofar
as the therapist can be said to be making a consistent effort to under-
stand and develop the relationship with the client. Empathy, as it
reflects a sensitivity to the client's feelings can be viewed as the
therapist's attempt to see the world from the client's perspective and
to communicate this to the client while retaining a capacity to be
objective and aware of his or her own perspective. The writer specu-
lated that a therapist who behaved in a consistently empathic manner,
even if the degree of empathy was not always maximal, might convey to
the client the feeling that the therapist did care and was making every
effort to understand the client's world-view in a consistent and non-
judgemental manner. In effect, the therapist would be saying to the
client, "Even though there are times when I don't quite understand
what you are feeling, I am always trying to understand, because your
feelings and perceptions are valuable and worthy of my effort."

This viewpoint derives in part from some of the research in
parenting which has demonstrated that it is not so much the content
of parental behavior, but. its consistency, which correlates with

parent effectiveness in promoting self-esteem in children (Coopersmith,

36

1968). If one subscribes to the notion that therapy may be seen as
reparenting, it should follow that just as the effective parent is
consistent with the child, so would the effective therapist be consis-
tent with the client.

It was the writer's view that therapeutic effectiveness might
not rest upon the therapist's ability to be maximally empathic, but
rather on the therapist's ability to convey a consistent attitude of
concern with the client's experience of the world. It was also ack-
nowledged that therapists who could convey a greater amount of empathy
should be more effective than therapists who were less empathic.

It was hypothesized that aspects of empathy (actual, and
consistency) would relate positively to aspects of experiencing (actual
and consistency). Similarly, consistency and amount of client ex-
periencing were expected to be positively related, as were consistency
and amount of therapist empathy.

Results supported the notion that consistency of empathy
was an important variable in this sample of cases studied. The sig-
nificant negative correlation between variability of empathy and actual
experiencing suggests that in those cases where the therapist was most
variable in his or her empathic responsiveness, the client showed
lower levels of experiencing.

The significant negative correlation between variability of
empathy and actual empathy lends further support to the notion that
consistency of empathy was an important variable in this sample. It

should be noted that the amount of actual empathy offered was not

37

significantly related to experiencing, thus underscoring the importance
of variability as an in-therapy process variable.

The small positive correlations between variability of ex-
periencing and actual experiencing scores suggest that variability
and amount of experiencing might be positively related. An explanation
of this might be that the client in exploring his or her inner self,
might be focusing inwardly to a greater extent as problems are "worked
through." Therefore experiencing might appear more variable due to
this inward focus as the individual struggles with defenses. Since
this finding was not statistically significant however, this is only

a speculation at this point.

Therapist Experience Variables

Another major focus of this study was to examine the rela-
tionship between the therapist's level of experience and the level of
empathy provided. As was the case with all variables under study,
empathy was examined in terms of variability as well as in terms of
actual amount. Previous research suggests that with greater experience,
therapists are able to maintain a more consistent approach to their
clients than inexperienced therapists. The greater role stability of
the experienced therapists may be thought of as contributing to this
greater.consistency. The inexperienced therapists, still in the pro-
cess of adapting to the role of therapist might tend to be more suscep—
tible to client manipulativeness, especially in more anxiety evoking

areas .

38

The findings of Russell and Snyder (1963), that inexperienced
therapists showed greater anxiety in the face of client hostility than
did experienced therapists, would seem to lend support to this notion.
Rice (1965) suggests that with greater experience, therapists develop
a "style of participation" which in her view may be "vehicles" by which
experienced therapists are able to develop more helpful relationships
with their clients.

Mullen and Abeles (1971) report findings which suggest that
the amount of therapist empathy may also increase with experience.

They found that inexperienced therapists at times behaved in ways that
were, "much less empathic than experienced therapists ever are." In
light of these kind of findings it was hypothesized that experienced
therapists would provide higher empathy, and would be less variable

in their empathic behavior.

Analysis of the data indicated that experienced therapists
did not differ from inexperienced therapists in variability of empathic
behavior. Experienced therapists did however provide more empathy
than inexperienced therapists.

This finding is of some interest in that it suggests that
while it appears that empathy can be increased through training and/or
experience, consistency of empathic behavior may be more indigenous
to the personality of the therapist. One might consider this in light
of the state-trait controversy in personality theory (Mischel, 1968)
discussed in the introduction. It would seem that since some thera-
pists were more consistent than others, and since these differences

were not attributable to either the experience level or the sex of the

39

therapist, perhaps, as suggested by Campus (1970), consistency is a
trait in itself. This would seem to be an area worthy of further study.
The implications of these findings for the training of psy-
chotherapists could prove to be manifold. Empathy training, in its
focus on increasing absolute levels of empathy could possibly benefit
from an additional focus on consistency. Consistency within a modicum
of empathy offered to clients, demonstrating the therapist's consistent
efforts toward placing one's self within the client's perspective
could be a valuable addition to training programs. Ultimately consist-
ency would hinge upon the therapist's learning to use his or her own
feelings as more of a guide in dealing with clients, in addition to

mastering a technique for communication of feelings or perceptions.

Sex Variables

 

The third major focus of this study was to examine the rela-
tionships between sex of both the therapists and the clients studied,
on the variables of therapist empathy and client experiencing. As
was the case with the other major variables already discussed. both
empathy and experiencing were examined in terms of both variability
and actual amount. It was hypothesized that same sex dyads would
exhibit both greater amounts and greater consistency of therapist em-
pathy (as defined in terms of variability) and client experiencing.

It was also hypothesized based on past research (Fuller,
1963) that among opposite sex dyads, those in which the client was
female would show greater therapist empathy and client experiencing.

Therefore, it was predicted that the highest amounts of therapist

4o

empathy and client experiencing would be evident in dyads in which both
the therapist and the client were female. Following these, in descend-
ing order would be, dyads in which the therapist was male and the
client female; therapist was male and client was male; and dyads in
which the therapist was female and the client was male. Of these pre-
dictions, only the one which predicted that dyads in which the client
was female would exhibit greater amounts of actual therapist empathy
than dyads in which the client was male, was supported by the data.

The prediction that female clients would receive more con-
sistent empathy reached statistical significance, in the direction
opposite to that predicted however. Females in this sample received
significantly less consistent therapist empathy than male clients of
the same therapists, regardless of the sex or experience level of the
therapist.

The above mentioned findings appear to have some further
relevance in light of the previously discussed finding that variability
of therapist empathy was significantly negatively related to client
experiencing, while the amount of empathy showed no relationship to
experiencing. Thus, it should follow that the females in this sample,
having received less consistent empathy, would have also showed less
experiencing than male clients. Analyses of variance for experiencing
however, did not demonstrate such a relationship. Several explanations
for this apparent inconsistency in the findings suggest themselves.

The most likely explanation for this inconsistency lies in
the analyses used to test the hypotheses for this study. It will be

recalled that the correlational analysis upon which the finding that

41

variability of therapist empathy was negatively related to client ex-
periencing was derived from correlation of the combined variability of
males and females for empathy and experiencing scores. The analysis of
variance, in determining the main effects, was not concerned with the
combined scores of both males and females. Therefore, while it cannot
be inferred from the data that women, who experienced more variable
empathy, also showed lower levels of experiencing, this possibility
seems worthy of further study, perhaps with a larger sample of female
clients.

The present data does indicate clearly that while female
clients tended to receive more actual empathy, that empathy was more
variable than the empathy offered by the same group of therapists to
male clients. One speculative interpretation of this finding is that
all therapists regardless of sex or level of experience, tended to
treat their female clients in a more socially stereotyped manner than
these same therapists treated their male clients. The data presented
in this study suggest the possibility that therapists may have been
less able to enter into a female client's inner experiential world
than into a male client's. While data provide no evidence to this
effect, one purely speculative explanation suggests that this possible
inability might manifest itself in the therapist's approaching the
female client with certain pre-conceived and stereotyped notions as
to her inner experience. If so, in those content areas in which the
therapists, both male and female, were unable to view the female client
as an individual, the ratings of Accurate empathy would tend to drop,

thereby contributing to greater variability of therapist empathy.

42

The apparent inability of female therapists regardless of
experience level, to be either more empathic, or more consistently em-
pathic with their female clients can be understood along several dimen-
sions. In terms of sexual identification women entering the field of
therapy, especially at the doctoral level, might be thought of as
pursuing socially unconventional roles for women. As such, female
therapists would be to an extent, outside the standard social definition
of the woman's role. Being in a sense "cross sex identified" accord-
ing to the variables traditionally used as being normative for feminine
identification, female therapists would not necessarily assume a basic
similarity between themselves and other women. While there might
surely be areas in which the women therapists in this sample could
identify with their female clients and use that identification in the
service of greater empathy, it is not unreasonable to suspect that there
would also be areas in which the female therapists in this sample would
react defensively with female clients. Thus, speculating from these
findings, social stereotypes regarding women and their accompanying
prejudices would seem to be no different for female therapists than for
male therapists.

It could be argued that male therapists are also "cross sex
identified," tending to score higher on femininity than the normative
sample used in devising scales for males' sexual identification. It
would seem then, that this would balance out the effects of female
therapists' cross sexual identification, and so leave the above men-
tioned findings unexplained. One solution seems to lie in the role

definition of the client. Female clients, by the fact of their seeking

43

help, in a sense, fit the stereotypic role of the female, i.e. passive,
dependent, needing guidance; all of which qualities female therapists
might seem by their choice of vocation, to have rejected, at least at
the conscious level. Male clients however, in seeking help, are in
this fact behaving in a way that can be seen as "cross sex," and there-
fore male therapists might have less of a need to disown aspects of
their male clients and might then tend to be less defensive and more
consistently accepting of the whole client.

It should be stressed here that the findings reported in this
study were based on data collected during the years 1963-64, and 1968-
69, therefore even the most recently collected therapy tapes analyzed
in this study were seven years old at the time this study was conducted.
The advent of the women's liberation movement may have had an impact on
both therapists and clients, and thus these findings might no longer

hold true, a possibility certainly worth investigating.

Experiencing_Variables

It was hypothesized that in all areas examined in this study,
client experiencing would co-vary with therapists empathy. Only one A
of the hypotheses concerning experiencing was supported by the data.
This would seem to support Gendlin's notion that experiencing is some—
what of an independent client variable rather than an outcome measure.
The one finding that did reach statistical significance however, was
that actual experiencing was negatively related to variability of
therapist empathy. The present findings, seeming as they do, to lend

support to the notion that it was consistency that was related to

44

experiencing rather than actual amount of empathy, suggest that con-
sistency might be a better independent variable than amount of empathy
when studying experiencing. Klein, EE;EL-: (1969) report similar
findings in concluding that it is consistency in the therapist's be-
haviors that is related to client experiencing, and that, ". . . the
therapist who can offer a stable relationship to his patient can induce

him to vary his experiencing."

CHAPTER V
SUMMARY AND CONCLUSIONS

The present study was designed to investigate the relation-
Iship between therapist empathy and client experiencing. This relation-
ship was studied along the dimensions of actual therapist empathy and
client experiencing, and consistency of therapist empathy and client
experiencing. For the purposes of this study, consistency was defined
in terms of the variance in scores on the Accurate Empathy Scale (Truax,
1963), and The Experiencing Scale (Gendlin, 1968). Both of these
scales derive from concepts postulated as being of some importance in
the process of psychotherapy (Rogers, 1957).

Other areas studied were the level of therapist experience,
and the sex of both the client and the therapist. It was hypothesized
that these would be important moderator variables in the relationship
between therapist empathy and client experiencing.

A total of 162 five minute tape segments from eighteen
therapy cases drawn from the tape libraries of the Michigan State
University Counseling Center comprised the data for this study. Of the
eighteen cases studied, nine of the clients were male and nine were
female. The sample of therapists consisted of nine therapists, each of
whom saw both a male and a female client. The nine therapists were
counter balanced according to both sex and level of experience, with

five male therapists and four female therapists. Of the five male

45

46

therapists, three were senior staff members of the MSU Counseling
Center, and two were interns at the MSU Counseling Center. Of the
four female therapists, two were senior staff members of the MSU Coun-
seling Center, and two were interns at the MSU Counseling Center.
Thus, the data were drawn from nine, five minute segments per each

of eighteen cases studied.

Tape segments were then rated in random order by two inde-
pendent raters, one male and one female, using both the Accurate Em-
pathy Scale, and the Experiencing Scale. After criterion levels of
rater reliability were established, the tapes were scored and the ave-
rage scores for each segment on each scale were computed. These scores
were used as raw data for this study. Raw scores were used in testing
hypotheses concerning actual amounts of therapist empathy and client
experiencing. The variance over the nine rated segments per case was
calculated and these variance scores were used as a measure of vari-
ability in therapist empathy and client experiencing. Variability was
considered to be a measure of consistency in both empathy and experi-
encing.

Results for data concerning variability indicated that
neither therapist sex nor experience level of the therapists accounted
for differences in therapist variability in empathy provided. It was
found, however that there was a significant negative correlation be-
tween variability of empathy and actual experiencing.

These findings were discussed as a possible indication that

consistency (as defined in terms of variability) is an important trait

47

indigenous to the personality of the therapist, and that efforts toward
increasing therapist consistency might be of use in the training of
psychotherapists.

In addition it was found that while female clients tended
to receive more actual empathy than male clients, this empathy was
significantly more variable than the empathy received by male clients
of the same therapists. In discussion of this finding it was suggested
that female clients in this sample were treated in a more stereotyped
manner than male clients, with therapist empathy possibly varying more
for female clients as a function of therapist biases in certain content
areas presented by female clients. It was also noted that data used
in this study were collected between seven and twelve years prior to
the time of the present study, and that the present findings may no
longer hold true.

In light of the significant negative correlation between
variability of empathy and client experiencing, it was suggested that
experiencing, rather than being an independent client variable, might
be of some use as a dependent variable and valid outcome measure,
when used in conjunction with variability of empathy as an independent
variable.

Further research was suggested in the areas of consistency
of therapeutic conditions provided. Research was also suggested in

the area of sex of both the client and the therapist.

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APPENDICES

APPENDIX A
THE ACCURATE EMPATHY SCALE

APPENDIX A
THE ACCURATE EMPATHY SCALE

At a low level of accurate empathy the therapist may go off
on a tangent of his own or may misinterpret what the patient is feel-
ing. At a very low level he may be so preoccupied and interested in
his own intellectual interpretations that he is scarcely aware of the
client's "being." The therapist at this low level of accurate empathy
may even be uninterested in the client, or may be concentrating on the
intellectual content of what the client says rather than what he "is"
at the moment, and so may ignore or misunderstand the client's current
feelings and experiences. At this low level of empathy the therapist
is doing something other than "listening," "understanding," or "being
sensitive;" he may be evaluating the client, giving advice, sermonizing,
or simply reflecting upon his own feelings or experiences. Indeed,
he may be accurately describing psycho-dynamics to the patient--but in
the wrong language for the client, or at the wrong time, when these
dynamics are far removed from the client's current feelings, so that
the interaction takes on the flavor of "teacher-pupil."

Stage 1: Therapist seems completely unaware of even the
most conspicuous of the client's feelings; his responses are not ap-
propriate to the mood and content of the client's statements. There
is no determinable quality of empathy, and hence no accuracy whatso-
ever. The therapist may be bored and disinterested or actively offer-
ing advice, but he is not communicating an awareness of the client's
current feelings.

Example:

C: I wonder if it's my educational background or if its me.
T: Mhm.

C: You know what I mean.

T: Yeah.

C: (Pause) I guess if I could just solve that I'd know just

about where to hit, huh?

T: Mhm, mhm. Now that you know, a way, if you knew for sure,
that your, your lack, if that's what it is--I can't be sure of that
yet.

(C: No) l

T: (Continuing) . . . is really so, that it, it might even feel
as though it's something that you just couldn't receive, that it, if,
that would be it?

C: Well--I-- didn't, uh, I don't quite follow you, clearly.

T: Well (pause), I guess, I was, I was thinking that--that you
perhaps thought that, that if you could be sure that, the, uh, that
there were tools that, that you didn't have, that, perhaps that could
mean that these--uh--tools that you had lacked--way back there in, um,
high.school.‘

53'

54

(C: Yah)

T: (Continuing) . . . and perhaps just couldn't perceive now and,
ah. . .

C: Eh, yes, or I might put it this way, um (pause). If I knew
that it was, um, let's just take it this way. If I knew that it was
my educational background, there would be a possibility of going back.

T: Oh, so, I missed that now, I mean now and, uh . . .

C: . . . and really getting myself equipped.

T: I see, I was--uh--I thought you were saying in some ways that,
um, um, you thought that, if, if that was so, you were just kind of

doomed. EI
C: No, I mean . . . L:
T: I see. '

C: Uh, not doomed. Well let's take it this way, um, as I said,
if, uh, it's my educational background, then I could go back and,
eaten myself up.

 

T: I see.
C: And come up. .
T: Um. t'

Stage 2: Therapist shows an almost negligible degree of
accuracy in his responses, and that only toward the client's most
obvious feelings. Any emotions which are not clearly defined he
tends to ignore altogether. He may be correctly sensitive to obvious
feelings and yet misunderstand much of what the client is really try-
ing to say. By his response he may block off or may misdirect the
patient. Stage 2 is distinguishable from Stage 3 in that the thera-
pist ignores feelings rather than displaying an inability to understand
them.

Example

C: You've got to explain so she can understand . . .

T: Mhm, mhm (in bored tone)

C: Without--uh--giving her the impression that she can get away
with it, too. (Excitedly)

T: Well, you've got a job satisfying all the things that--seem
important, for instance, being consistent, and yet keeping her--some-
what disciplined and telling her it's good for her. (Conversationally)

C: There's where the practical application of what we have just
mentioned comes into being. (laughs)

T: Mhm, mhm. (Sounding bored)

C: And when it's a theoretical plan--
T: Mhm.

C: It's beautiful! (Shrilly)

T: Mhm--mhm.

C: But.

T:

(Interrupting) Something else about it that I feel really
dubious about (banteringly)--what you can really do on the practical
level (inquiringly)--I sometimes say tha' t what--we' re most encouraged
about, too. (Mumbling)

55

C: (Chiming in loudly) Yes--uh--there are many--uh problems in
our lives in the practical application of--trying to be consistent.
(Informatively)

Sta e 3: Therapist often responds accurately to client's more
exposed aeelings. He also displays concern for the deeper, more
hidden feelings, which he seems to sense must be present, though he
does not understand their nature or sense their meaning to the patient.

Example:

C: Now that you're . . . know the difference between girls; I
think they were about 9 to 8 years old and, uh, they were just like
dolls, you know, and (laughs) un, I used to spend a lot of time with
'em. I used to go over there and would spend more time with these
kinds than what would with . . . .

T: Mhm, hm.

C: But nobody ever told me why I was dragged in here. And I
own my own place, I have my, my . . . and my farm, I think I still
own them. Because that, there was a little mortgage on it. And, uh,
(pause) my ex-wife but I don't seen how in the world they could change
that.

T: Mhm, hm.

C: But they sold my livestock and, uh, I, I worked with horses,
and they sold them all, and ah . . . .

T: I think probably, should I cross this microphone? (Noises)

C: And then I had a bunch of sheep.

T: Mhm, hm.

C: And that, which I know that I was not ill. Now, I'll tell
you what she might've meant in what way I was ill. Now I'll tell 'ya,
I batched it out there on the farm and I maybe just didn't get such
too good food at the time. Now, whether she wanted to call that ill,
or whether she wanted to call it mentally ill, that she didn't say.

T: Mhm, hm.

C: But she says I was ill, well, they could put that I was sick
that I didn't have the right kind of food because I gained quite a
bit of weight after I was brought in here.

T: Mhm, hm.

C: Yeah, but she didn't say which way she meant or how she
meant that.

T: Uh, huh.

C And she wouldn't give me any explanation and then I got mad
at her . . . .

T: Mhm, hm.

C: . . and of course I told her off. Then I asked her if
she, they kept from me for a long time that my stock was sold and I
thought quietly, anyhow, I says, I won't give my work.

Stage 4: Therapist usually responds accurately to the client's
more obvious feelings and occasionally recognizes some that are less
apparent. In the process of this tentative probing, however, he may

56

misinterpret some present feelings and anticipate some which are not
current. Sensitivity and awareness do exist in the therapist, but he
is not entirely "with" the patient in the current situation or experi-
ence. The desire and effort to understand are both present, but his
accuracy is low. This stage is distinguishable from Stage 3 in that
the therapist does occasionally recognize less apparent feelings. He
also may seem to have a theory about the patient and may even know how
or why the patient feels a particular way, but he is definitely not
"with" the patient. In short, the therapist may be diagnostically
accurate, but not empathically accurate in his sensitivity to the pa-
tient's current feelings.

Example:

C: If--if--they kicked me out, I--I don't know what I'd do--
because . . . .

T: Mhm.

‘C: I--I--I am really dependent on it. (Stammering)

T: Even though you hate this part--you--say, "My God, I--
I don't think I could-—possib1y exist without it either."

C: Mhm

T: And that's even the--that's the worst part of it. (Gently)

C: (Following lengthy pause) Seems that-~(cathches breath)
--sometimes I--uh, the only thing I want out of the hospital--s' tuh
have everyone agree with me . . .

T: Mhm, hm.

C: . . . that's--I--I--I guess that if (catches breath)-- every-
body agreed with me--that everybody's be in the same shape I was.
(Seriously, but ending with nervous laughter)

T: Mhm, well, this is sort of like--uh--feeling about the friend
who--didn't want to do what I wanted to do; that--even here--if you
agreed with me--this is what I want because if you don't agree with
me, it means you don't like me or something. (Reflectively)

C: Mmmmmmmmm (thoughtfully)--it means that I'm wrong!
(Emphatically, quick breathless laugh)

Stage 5: Therapist accurately responds to all of the client's
more readily discernible feelings. He also shows awareness of many
less evident feelings and experiences, but he tends to be somewhat
inaccurate in his understanding of these. However, when he does not
understand completely, this lack of complete understanding is communi-
cated without an anticipatory of jarring note. This misunderstandings
are not disruptive by their tentative nature. Sometimes in Stage 5
the therapist simply communicates his awareness of the problem of
understanding another person's inner world. This stage is the mid-
point of the continuum of accurate empathy.

Example:

C: I have her her opportunity . . . .
T: Mhm.
C: . and she kicked it over. (Heatedly)

57

T: Mhm--first time you ever gave her that chance, and--she
didn't take it? (Inquiring gently)

C: No! She came back and stayed less than two weeks--a little
more than a week--and went right straight back to it. (Shrilly) So
that within itself is indicative that she didn't want it. (excitedly)
(T answers "mhm" after each sentence).

T: Mhm, mhm--it feels like it's sort of thrown--right up in
your face. (Gently)

C: Yah--and now I would really be--crawling . . . .

T: Mhm.

C: . . . if I didn't demand some kind of assurances--that, that
things was over with. (Firmly)

T: Mhm, mhm, it would be--pretty stupid to--put yourself in
that--same position where it could be sort of--done to you all over
again. (Warmly)

C: Well, it could be--yes! I would be very stupid! (Shrilly)

T: Mhm.
C: . . . because if it's not him--it might be someone else.
(Emphatically)

Sta e 6: Therapist recognizes most of the client's present feel-
ings, including those which are not readily apparent. Although he
understands their content, he sometimes tends to misjudge the inten-
sity of these veiled feelings, so that his responses are not always
accurately suited to the exact mood of the client. The therapist
does deal directly with feelings the patient is currently experiencing
although he may misjudge the intensity of those less apparent. Al-
though sensing the feelings, he often is unable to communicate meaning
to them. In contrast to Stage 7, the therapist's statements contain
an almost static quality in the sense that he handles those feelings
that the patient offers but does not bring new elements to life. He
is “with" the client but doesn't encourage exploration. His manner
of communicating his understanding is such that he makes of it a
finished thing.

Example:

T: You're sort of--comparing--things you do do, things you have
done--with what it would take to be a priest--is that sort of--the
feeling? (Very gently)

C: (Following long pause) I don't know. (Meekly, then a long
pause

T: Suppose we mean right now feeling real guilty? (Softly)

C: (Sighs audibly) Real small. (Very softly--protracted
silence)--I can't see how I could feel any different--other than--
feeling small or had . . . .

T: Mhm.

C: . . . guilty (Softly)

T: Things you've done just--so totally wrong to you--totally
bad--you can't help sort of--hating yourself for it? (Assuming
client's tone)--is that the sort of quality? (Very gently, almost
inaudibly)

58

C: (Following pause)--And yet right now I feel as though I want
to laugh--be gay.

T: Mhm.

C I don't feel anything else. (monotonously)

g: éfipeaking with client) Right at this—-at this moment?

' m

T: So--it' 5 too much to really feel--very miserable and show
it? (Inquiringly)

C: Yeah, yeah (urgently). I--I--don't want to show it anyway.
(Haltingly)

Stage 7: Therapist responds accurately to most of the client's
present feelings and shows awareness of the precise intensity of most
of the underlying emotions. However, his responses move only slightly
beyond the client's own awareness, so that feelings may be present
with the client which neither the client nor therapist recognizes.

The therapist initiates moves toward more emotionally laden material,
and may communicate simply that he and the patient are moving towards
more emotionally significant material. Stage 7 is distinguishable
from Stage 6 in that often the therapist's response is a kind of pre-
cise pointing of the finger toward emotionally significant material.

Example:

C: Th--the last--several years--it's been the other way around--
I mean he'll say, "Well let's--go do this or that," and--and.I --
sometimes I actually wanted to, but I'd never go because--I feel like
I'm)getting my little bit of revenge or something. (Voice fades at
end

T: By God, he owed it to you, and,--if he didn't come through,
you'll just punish him now . . .

C: Yah.

T: . . now it's too late or--something. (Very softly)

C: (laughingly) Yah--that' s--uh--that' 5 just the way I--uh--
now it's too late--It' 5 your turn to take your medicine now. (Assum-
ing therapist's tone)

T: Mhm . . . it's pretty--that's a--pretty childish way to
think, but--I know uh--if I went home tomorrow, I'd do it tomorrow--
if I had the chance.

C: mhm, yeah--like that . . .

T:’ (Interrupting and overtalking client) One part of you could
say, "Well, this is stupid and childish 'cause I--I want to be with
him"--and yet--another part says, "No, you gotta make him pay for it--
you want him dangling there now." (Gently)

Stage 8: Therapist accurately interprets all the client's
present, acknowledged feelings. He also uncovers the most deeply
shrouded of the client's feelings, voicing meanings in the client's
experience of which the client is scarcely aware. Since the therapist
must necessarily utilize a method of trial and error in the new un-
charted areas, there are minor flaws in the accuracy of his understanding,

59

but these inaccuracies are held tentatively. With sensitivity and
accuracy he moves into feelings and experiences that the client has
only hinted at. The therapist offers specific explanations or addi-
tions to the patient's understanding so that underlying emotions are
both pointed out and specifically talked about. The content that
comes to life may be new but it is not alien.

Although the therapist in Stage 8 makes mistakes, these mistakes
are not jarring, because they are covered by the tentative character
of the response. Also, this therapist is sensitive to his mistakes
and quickly changes his response in midstream, indicating that he has
recognized what is being talked about and what the patient is seeking
in his own explorations. The therapist reflects a togetherness with
the patient in tentative trial and error exploration. His voice tone
reflects the seriousness and depth of his empathic grasp.

-2.

Example:

C: The way she wanted me and I was always terribly afraid that
she wouldn't put up with me, or would put me out, out (T: Yeah) I
guess I can get something else there, too, now I was always afraid
that she didn't really care.

C: I still think that though. (T: Mhm) 'Cause I don't know
for sure.

 

1' '.‘.--.‘ r

T: Mhm. And don't really know for sure whether she care or not.

C: (Pause) She's got so many other, uh, littler kids to think
about.

T: Mhm.

C: ThaV 5 why. .

T: Maybe she likes them better or . .

C: No, it's not that, I think she likes us all. (Pause) I

think seein' that I'm the black sheep but, uh, the only one that
served time and, that--' n got in the most trouble. Seein' that I
hurt her so much, that's why I think she's starting ta--she just
don't care for me anymore. (T interjects "Mhm" after most completed
thoughts).

T: You believe, maybe, "because I have hurt her so much, maybe
she's fed up with me, maybe she's gotten to the point where she just
doesn't care. " (Long pause)

Stage 9: The therapist in this stage unerringly responds to
the client's full range of feelings in their exact intensity. With-
out hesitation, he recognizes each emotional nuance and communicates
an understanding of every deepest feeling. He is completely attuned
to the client's shifting emotional content; he senses each of the
client's feelings and reflects them in his words and voice. With
sensitive accuracy, he expands the client's hints into a full-scale
(though tentative) elaboration of feeling or experience. He shows
precision both in understanding and in communication of this under-
standing, and expresses and experiences them without hesitance.

60

Example:

1: . . I s 'pose, one of the things you were saying there was
I may seem pretty hard on the outside to other people but I do have
feelings.

C: Yeah, I've got feelings. But most of 'em I don't let 'em off.

T: Mhm. Kinda hide them.

C: (Faintly) Yeah. (Long pause) I guess the only reason that
I try to hide 'em is, seein' that I'm small, I guess I got to be a
tough guy or somethin'.

T: Mhm.

C: That's the way I, think people might think about me.

T: Hm. Little afraid to show my feelings. They might think I
was weak, 'n take advantage of me or something. They might hurt me
if they--knew I could be hurt.

C: I think they'd try, anyway.

T: If they really knew I had feelings, they, they really might
try and hurt me. (Long pause)

C: I guess I don't want 'em to know that I got 'em. "

T: Mhm.

C: 'Cause then they couldn't if they wanted to.

T: So I'd be safe if I, if I seem like a, as though I was real
hard on the outside. If they thought I was real hard, I'd be safe.

.
-Lu

 

APPENDIX B
THE EXPERIENCING SCALE

APPENDIX B
THE EXPERIENCING SCALE

Experiencing

Stage 1: The chief characteristic of this stage is that the
content or manner of expression is impersonal. In some cases the
content is intrinsically impersonal, being a very abstract, general,
superficial, or journalistic account of events or ideas with no per-
sonal nature of the content, the speaker's involvement is impersonal,
so that he reveals nothing important about himself and his remarks
could as well be about a stranger or an object.

The content is not about_the speaker. The speaker tells a
story, describes other people or events in which he is not in-
volved, or presents a generalized or detached account of ideas.
Nothing makes the content personal.

The content is such that the speaker is identified with it
in some way but the association is not made clear. *The speaker
refers in passing to himself but his references do not establish
his involvement. First person pronouns only define the speaker
as an object, spectator, or incidental participant. Attention is
focused exclusively on external events. For example, "As I was
walking down the street I saw this happen . . ."; "I read a book
that said . . ."; "I put the lid on the box"; "He stepped on my
toe." The speaker does not supply his attitudes, feelings or
reactions. He treats himself as an object or instrument or in so
remote, matter-of-fact, or offhand, as in superficial social chit-
chat, or has a mechanical or rehearsed quality.

The content is a terse, unexplained refusal to participate
in an interaction, or an avoidance or minimizing of an interaction.
Minimal responses without spontaneous comments are at stage one.

Stage 2: The association between the speaker and the content is
explicit. Either the speaker is the central character in the narra-
tive or his interest is clear. The speaker's involvement, however,
does not go beyond the specific situation or content. All comments,
associations, reactions, and remarks serve to get the story or idea
across but do not refer to or define the speaker's feelings.

The content is a narrative of events in which the speaker
is personally involved. His remarks establish theTTmportance
of the content but make no reference to the quality of this in-
volvement. Remarks and associations refer to external facets of
the narrative; other people, the events, objects, the speaker's
actions; they do not give his inner reactions or perspective.
If the narrative includes the speaker's thoughts, opinions,

61

62

wishes, or attitudes, these only describe him intellectually or
superficially. Some speakers refer to ideas and thoughts as if
they were feelings: e.g., "I feel that I am a good farmer"; "I
feel that people should be more considerate." If terms like "I
think" or "I wish“ could be substituted for "I feel" without
changing the meaning, the remark is at stage two.

The events narrated are impersonal but the speaker expiicitLy
establishes that the content is important to him. For example,
he expresses interest in or evaluates an event,7but does not
show the quality or amount of his interest or concern.

The content is a self-description that is spperficial, ab-
stract, generalizedx_or intellectualized. No reference is made
to the speaker's feelings or internal perspective. The segment
presents the ideas, attitudes, opinions, moral judgments, wishes,
preferences, aspirations, or capacities that describe the speaker
from an external or peripheral perspective. One sees him from
the outside.

The content reveals the speaker's feelings and reactions
implicitly but not explicitly. If the speaker is emotionally
aroused, it is evident from his manner, not from his words. If
the content is the sort that ordinarily would be personally sig-
nificant, the speaker does not say so. If the speaker mentions
his feelings, he treats them abstractly, impersonally, as objects,
or attributes them to others. Third person pronouns, especially
"one feels" indicate depersonalization.

The content is an account of a dream,gfantasy, hallucination,
or free associatiop, These should be treated as narratives of
external events. They are at stage two if the speaker's remarks
associate him with the account but do not give his feeling
reactions to it.

Stage 3: The content is a narrative or a description of the
speaker in external or behavioral terms with added comments of his
feelings or private experiences. These remarks are limited to the
events or situation described, giving the narrative a personal touch
without describing the speaker more generally. Self-descriptions
restricted to a specific situation or role are also at stage three.

The content is a narrative of events or description of an
aspect of the speaker's environment I ast,4present,_or futuFE)
withxparenthetical‘personal remarks that give one of the follow-
ing:

 

l) The speaker's feelings at the time of the event or in retro-
spect about it. For example, "He didn't call me back and I was
angry" or "He didn't call me back; thinking about it now makes
me angry."

63

2) The personal significance or implications of the situation by
relating it to the speaker's private experience. For example,
"It reminded me of being scolded as a child"; "It was one of
those queer moods that comes on me when I get tired."

3) The speaker's state of awareness at the time of the event.
Such remarks include details of motives, consciousness, private
perceptions, or assumptions which are limited to the event. For
example, "I knew at the time that I was reacting too strongly";
"I was aware of wanting to defend myself"; "I did it even though
I sensed how foolish I was." Accounts of dreams, hallucinations,
fantasies, and free associations should be treated as narratives;
they are at stage three if feelings are mentioned.

The content is a self-description of circumscribed aspects
of the speaker's life style or role or of his feelings and re-
actions_presented only in behavioral terms. The speaker might,
for example, describe how he functions as a parent or in his job,
or tell what he does when he gets angry. Personal remarks enrich
the description of the situation or reaction to it, but are
limited to the immediate context.

In response to a direct qpestion, the_speaker tells what his
feelings are or were. The interviewer's words are not needetho
identify the feeling.

Stage 4: The content is a clear presentation of the speaker's
feelings, giving his personal, internal perspective or feelings about
himself. Feelings or the experience of events, rather than the events
themselves, are the subject of the discourse. By attending to and
presenting this experiencing, the speaker communicates what it is like
to be him. These interior views are presented, listed, or described,
but are not interrelated or used as the basis for systematic self-
examination or formulation.

The initial content is a specific situation that is widened
and deepened by the speakerls self-references to show what he is
like moreigenerally or more_personaliy. The speaker must describe
his feelings in great detail, refer to feelings as they occur in
a range of situations, provide personal reactions to specific
feelings, or relate reactions to his own self-image. The feelings
can be immediate responses or remembered responses to past situa-
tions. Self-description comments must deal with internal and
personal aspects of the speaker, not with moral evaluations or
external or behavioral characteristics.

The content is a story told completely from a_personal_point
of view. The details of’feelings, reactions, and assumptions are
integral to the narrative, so that what emerges is a detailed
picture of the speaker's personal experience of the events.

 

64

The content is a self-characterization in which the speaker
tells about his personal perspective. In talking about’himself
he makes explicit his feelings, personality, assumptions, motives,
goals, and private perceptions. By revealing these internal
parts of himself, the speaker gives a detailed picture of one or
more of his states of being. The material presented is not
analyzed or interrelated. The use of abstract terms or jargon
to describe elements of perSonality must be expanded with some
internal detail to warrant a rating of four. For example, the
statement "My ego was shattered" would need elaboration, such as
"I felt as if I was nothing, that no one would ever notice me."

Stage 5: The content is a purposeful exploration of the
speaker's feelings and experiencing. There are two necessary com-
ponents. First, the speaker must pose or define a problem or proposi-
tion about himself explicitly in terms of feelings. The problem or
proposition may involve the origin, sequence, or implications of
feelings or relate feelings to other private processes. Second, he
must explore or work with the problem in a personal way. The explora-
tion or elaboration must be clearly related to the initial proposition
and must contain inner references so that it functions to expand the
speaker's awareness of his experiencing. Both components, the prob-
lem and the elaboration, must be present.

The proposition or problem must be given clearly or strongly
and should include references to feelings or to the personal experience
at issue. If the internal basis of the problem is weak, as in refer-
ences to undesired behaviors or styles, propositions about the external
precipitants of behavior or feelings, or presentation of the temporal
sequence of feelings, then the exploration or elaboration must have
extensive inward references. It must be clear that the speaker is
{opusing on his inner experience rather than simply justifying his

e av1or.

.The problem or hypothesis about the self must be oriented to
feel1ngs, pr1vate reactions, or assumptions basic to the self-

1mage. It can be presented in different ways:

1) A feeling, reaction, or inner process, and in some cases a
behavior pattern, can be defined as problematic itself or as

seeming to conflict with other feelings or aspects of the self;
for example, "My anger is the problem" or "Why am I so angry?"

2) The speaker may wonder whether or to what extent he has a
specific feeling; not "What do I feel?" which would be three or
four, but "Do I really feel angry?” or "How angry am I, really?”

3) The problem or proposition can be defined in terms of the
personal implications, relationships, and inner ramifications of
a feel1ng, including its origins or causes, its place in a

 

Id

65

temporal sequence of feelings and inner events, its mode of ex-
pression, or its personal and private implications. For example:
"Do I get angry when I feel inadequate?" or "My getting angry
means I've lost control of myself" or "I get angry just the way
my mother used to."

4) Feelings, reactions, and internal processes may be compared.

All problems or propositions about the self must be explored
or elaborated with inner referents. Examples or illustrations
may shdw how the speaker experiences the problem or proposition
in different settings or at different times; if so, the pertinence
of the illustration to the problem must be explicit. The problem
or proposition may be related to other internal processes or re-
actions. Alternatively, through hypothesis, speculation, or
analogy the speaker clarifies the nature or private implication
of the central problem, its causes, or ramifications.

At Stage 5 the speaker is exploring or testing a hypothesis
about his experiencing. While he must define the subject of this
process clearly with inner references, his manner may be conditional,
tentative, hesitant, or searching.

Stage 6: The content is a synthesis of readily accessible,
newly recognized, or more fully realized feelings and experiences to
produce personally meaningful structures or to resolve issues. The
speaker's immediate feelings are integral to his conclusions about
his inner workings. He communicates a new or enriched self-experienc-
ing and the experiential impact of the changes in his attitudes or
feelings about himself. The subject matter concerns the speaker's
present and emergent experience. His manner may reflect changes or
insights at the moment of their occurrence. These are verbally elabo-
rated in detail. Apart from the specific content, the speaker conveys
a sense of active, immediate involvement in an experientially anchored
issue with evidence of its resolution or acceptance.

The feelings involved must be vividly, fullyx or concretely
presented. Past feelings or past changes in feelings are vividly
presented or relived as part of the speaker's current experience.

The structuring_process relates these immediately felt
events to other aspects of the speaker's private perspective.
Thus, a feeling might be related to the speaker's self-image, his
private perceptions, motives, assumptions, to another feeling,
or to more external facets of the speaker's life, such as his
behavior. In each case the nature of the relationship must be
defined so that details of how the speaker works inside the pre-
cise, internal impact of the changes is revealed. It is not
merely the existence of a relationship, nor a sequential listing
of feelings and inner experiences, but the nature and quality of
the association that is made clear.

 

66

The synthetic, structuring process leads to a new,_personally
meaningful inner experience or resolves an issue. As a result of
working with his feelings and other aspects of his private per-
spective, and exploring their relationship to each other, the
speaker has new inner experiences. These may be new feelings or
changed feelings, as when the speaker says, "Now I'm beginning
to see that my feeling of guilt is caused by my ideas about work,
and it makes me feel much less worried about that sense of guilt.
What a relief." Alternatively, an issue may be resolved: "You
know, I've always kept my anger bottled up because I've been
afraid of losing control of myself. Now I realize it wouldn't be
so bad if I did; maybe I'd yell or throw something, that's all."
If the speaker starts with a concrete external problem, the re-
lated feelings must be presented as part of his present experience
and the emergent formulation must change his perception of the
problem in some way. For example, "I never asked a girl out be-
cause I'm so short. I'm still kind of afraid a girl might call
me a shrimp or something, but I'm willing to take that risk now.
I guess it's because I realize that even if she did, it wouldn't
break me up. I wouldn't like her very much, but I'd feel better
about myself for having at least tried." Some elements in the
emergent structure may be external, behavioral, or intellectual,
as in a decision to act in.a different way. Still they must be
clearly grounded to immediate feelings. It is never sufficient
only to state that a resolution has taken place; the experiences
underlying the structuring process must be revealed or relived
to satisfy the criteria for stage six.

Stage 7: The content reveals the speaker's expanding aware-
ness of his immediately present feelings and internal processes. He
demonstrates clearly that he can move from one inner reference to
another, altering and modifying his conceptions of himself, his feel-
ings, his private reactions to his thoughts or actions in terms of
their immediately felt nuances as they occur in the present experien-
tial moment, so that each new level of self-awareness functions as a
springboard for further exploration.

Formulations about the self at stage seven meet the require-
ments for stage six with the additional stipulation that they be
applied to an expanding range of inner events or give rise to
new insights. The development may follow one of several different
patterns:

1) The speaker may start with an internally anchored problem,
explore it, and reach an internally anchored conclusion that he
then applies to a number of other problems.

2) He may arrive at several related solutions to a single prob--
lem and reintegrate them. Any self-analysis is followed by a
more comprehensive or extensive synthesis.

 

67

3) The speaker may use several different formulations about him-
self, each of which meets the requirements for Stage six, and
integrate, relate, or reduce them through a more basic or general
formulation.

4) He may start with one conclusion of the type reached in Stage
six and apply it to a range of situations, each with inner refer-
ents explicit, to show how the general principle applies to a
wide area of his experience.

Experiencing at stage seven is expansive, unfolding. The
speaker readily uses a fresh way of knowing himself to expand his ex-
periencing further. Manner at this stage is often euphoric, buoyant,
or confident; the speaker conveys a sense of things falling quickly
and meaningfully into place.

 

  

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