11111111111111111111111111111111111118111111111111111111 .‘gHFQCC 31293 1037 This is to certify that the thesis entitled THE USE OF THE INTERPERSONAL PROCESS RECALL (IPR) MODEL VIDEOTAPE AND STIMULUS FILM TECHNIQUES IN SHORT-TERM COUNSELING AND PSYCHOTHERAPY presented by Robert Ernest Tomory has been accepted towards fulfillment of the requirements for Ph .0. degree in Counseling. Personnel Services and Educa- tional Psychology /////(///(’4/V\ pfso Date JanuarL30, l979 0-7639 OVERDUE FINES: 25¢ per day per in. RETURNING L I BRARY MATERIALS : Place in book return to remove charge fro: circulation records THE USE OF THE INTERPERSONAL PROCESS RECALL (IPR) MODEL VIDEOTAPE AND STIMULUS FILM TECHNIQUES IN SHORT-TERM COUNSELING AND PSYCHOTHERAPY By Robert Ernest Tomory A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Counseling, Personnel Services and Educational Psychology 1979 ABSTRACT THE USE OF THE INTERPERSONAL PROCESS RECALL (IPR) MODEL VIDEOTAPE AND STIMULUS FILM TECHNIQUES IN SHORT-TERM COUNSELING AND PSYCHOTHERAPY By Robert Ernest Tomory The purpose of this study was to evaluate the effectiveness of using the Interpersonal Process Recall (IPR) model in counseling and psychotherapy. IPR videotape and stimulus film techniques were used as therapeutic interventions in combination with traditional dyadic treatment methods and compared with the use of the traditional treatment methods without IPR techniques. The basic question under- lying the research project was whether clients who experienced IPR interventions would improve more than clients who did not experience IPR techniques in a range of 4 to 15 sessions. The sample for this study consisted_of 50 volunteer undergradu- ate and graduate clients who had requested help with personal concerns from the staff of the Georgia State University Counseling Center dur- ing the l976/l977 academic year. Therapists were three counseling and clinical psychology staff interns and two staff therapists, all of whom regularly saw clients at the Center. The experimental design used was a pretest-posttest control group design. The experimental group consisted of 25 clients who Robert Ernest Tomory received traditional counseling with the addition of IPR videotape feedback and stimulus film techniques. The control group consisted of 25 clients who received traditional counseling alone. Each thera- pist saw l0 clients, 5 in each treatment group. Clients were matched according to sex and time of entry into treatment and then randomly assigned to the treatment groups. The number of 50-minute treatment sessions for each client ranged from 4 to l5. The mean number of sessions completed per client was l0.4 for IPR clients and 8.l for traditional clients. For the IPR treatment clients, therapists were allowed to select the IPR techniques which they believed best suited their clients' individual needs. During the first l0 sessions, IPR techniques had to be used in a minimum of 50% of the sessions, and they had to be used in at least every other session or in two consecutive sessions followed by two traditional sessions. During the lOth through the 14th sessions, an IPR technique had to be used at least once. The techniques could have been used more if desired. The measures used in this study included client self-report questionnaires and inventories, therapist questionnaires, and objec- tive tape ratings of in-therapy client verbal behaviors. The data were analyzed by multivariate and univariate analysis of variance procedures. Prior to the final between treatment group analyses, however, bivariate linear regression analyses for each sub- scale of each instrument were performed in order to obtain adjusted posttest scores free of pretest score differences. Significance testing was carried out at the .Ol level. The results of the analyses Robert Ernest Tomory indicated no significant differences between treatment groups on any of the six measures. Repeated measures multivariate and univariate analysis of vari- ance procedures were also performed on the pre to post raw scores. The results indicated that there was significant pre to post movement (p_< .00l) for clients in both treatment groups on measures of client and therapist satisfaction within the counseling sessions and on measures of client self-actualization, but not on the in-therapy measures of client verbal behaviors. Clients indicated that they achieved 76% of their goals, and therapists rated their clients as achieving 70% of their goals at the conclusion of their counseling sessions. IPR treatment clients who responded on a subjective comments form were generally very positive about the use of the videotape and stimulus films in their sessions. Therapists evaluated the IPR intervention techniques as beneficial, but they stated that maximum effectiveness from using the techniques can be achieved only with a great amount of therapeutic freedom and flexibility. To my parents, who both cared and valued education ii ACKNOWLEDGMENTS I express my appreciation and say thanks to the many individuals who have contributed directly and indirectly to the completion of this study and my doctoral degree. Norm Kagan, my committee chairman and dissertation advisor, gave me both the stimulus for this IPR study and his support and trust. He also taught me about the importance of making mental health assistance available to groups other than just the traditional clinical popula- tions. Sam Plyler, committee member, helped me keep the dissertation in perspective, and he taught me about interpersonal relationships and about therapy. I thank him most of all for understanding, for being genuine and strong, and for helping me be genuine and strong. Doug Miller, committee member, deserves special appreciation for the hours that we spent on the telephone when he helped me with the instrumentation and the statistical analyses of the data. I thank him for his respect and for the confidence that he showed in me while completing the dissertation. Bruce Burke, committee member, provided me with a steady source of support and encouragement throughout my graduate training. I appreciate his trust and his availability for assistance. John Schneider, committee member, has given me valuable advice and support, and he has set a worthy example by blending his competence iii and his love of his work with the broader and deeper issues of what life is about. Phil Nierson, Director of the GSU Counseling Center, provided extremely valuable assistance in making this study possible during my internship. I thank him for being patient, supportive, and accept- ing, and for making the Center a great place in which to work. I value our friendship. Gerry Linz, Assistant Director of the GSU Counseling Center, encouraged me and gave me special assistance with technical details involved in the implementation of the design. He also provided me with excellent therapy supervision. John Morrow and Chuck Melville were my psychology supervisors at the Georgia Mental Health Institute where I did a second year internship. They deserve special appreciation for the backing and help they provided me while writing the dissertation. The following therapists and inquirers in this study gave of their time and their skills: Narviar Barker, Leslie Brenner, Charlie Brooks, Chuck Cummings, Joe DiVito, Linda Frye, Gay Kahn, Janet Petzelt, Jan Rice, and Jerry Tate. Marjorie Paulk, psychometrist, and the other members of the test- ing office staff contributed immensely by helping with the testing procedures. I am grateful to the clients of the study who were willing to become involved, to risk, and to give as well as to take. iv Finally, I must say thanks to my many special friends who gave to me and who tolerated me while I invested a great deal of energy into completing the dissertation and my doctoral degree. I offer a most important and special thanks to Linda Frye for her emotional support, her patience, her humor, and her caring. TABLE OF CONTENTS LIST OF TABLES ........................ LIST OF FIGURES ........................ LIST OF APPENDICES ...................... INTRODUCTION ..................... Purpose ....................... The Problem ..................... Definition of Terms ................. Delimitations of the Study ............. Assumptions of the Study .............. General Hypotheses ................. Theory ....................... The Recall Process ................ The Inquirer Role ................. Stimulus Films .................. Overview ...................... REVIEW OF LITERATURE ................. Psychotherapy and Counseling Research ........ Evaluating Client Movement and Outcome ....... The Use of Videotape in Counseling and Psychotherapy . The Use of IPR Videotape and Stimulus Film Techniques in Counseling and Psychotherapy . Summary ....................... METHODOLOGY ...................... Sample ....................... Clients ...................... Subject Mortality ................. Therapists .................... Treatments ..................... Traditional Counseling Without IPR (Control Group) ..................... Counseling with IPR (Experimental Group) ..... vi Page ix xi xii Chapter Page IPR Techniques and Session Procedures ....... 6O Inquiry (Recall) Procedures and Inquirers ..... 63 Physical Environments ............... 64 Instrumentation ................... 65 ~ The Personal Orientation Inventory (POI) ..... 66 - The Therapy Session Report (TSR) ......... 7O - The Client Description of Problem Scale (CDPS) and The Progress of Counseling Rating Scale (PCRS) . 7l - The Characteristics of Client Growth Scales (COGS). 72 The Depth of Client Self-Exploration Scale (DX) . . 73 A Rating of Criterion Tapes ............. 74 Selection of Audiotape Segments for Rating . . . . 75 Reliability of Ratings .............. 76 Client Written Comments and Therapist Reactions . . 77 Collection of Data ................ 78 Research Design ................... 79 Hypotheses ..................... 80 Analysis of the Data ................ 82 Summary ....................... 84 IV. ANALYSIS OF THE DATA ................. 86 Results of the Analysis on the Adjusted Posttest Scores for Between Treatment Group Differences . . 86 POI MANOVA Results on Adjusted Posttest Scores . . 87 COGS and DX MANOVA Results on Adjusted Posttest Scores ...................... 9O TSR (Clients) MANOVA Results on Adjusted Posttest Scores ..................... 92 TSR (Therapists) MANOVA Results on Adjusted Posttest Scores ................. 93 CDPS/PCRS (Clients) ANOVA Results on Adjusted Posttest Scores ................. 95 CDPS/PCRS (Therapists) ANOVA Results on Adjusted Posttest Scores ................. 97 Results of the Analyses on the Pre and Post Raw Scores for Pre to Post Differences Within the IPR and Traditional Treatment Groups ....... 99 POI Pre to Post Repeated Measures MANOVA Results on Raw Scores .................. l02 COGS and DX Pre to Post Repeated Measures MANOVA Results on Raw Scores .............. l03 TSR (Clients) Pre to Post Repeated Measures MANOVA Results on Raw Scores .......... lOS TSR (Therapists) Pre to Post Repeated Measures MANOVA Results on Raw Scores .......... l06 vii Chapter Page CDPS/PCRS (Clients) Pre to Post Repeated Measures ANOVA Results on Raw Scores ...... lO7 CDPS/PCRS (Therapists) Pre to Post Repeated Measures ANOVA Results on Raw Scores ...... lO9 Subjective Client Comments ............. llO Subjective Therapist Comments ............ ll3 Summary ....................... ll6 V. SUMMARY AND CONCLUSIONS ................ ll9 Summary ....................... ll9 Conclusions ..................... l24 Discussion ..................... l26 Implications for Future Research .......... l39 APPENDICES .......................... l42 REFERENCES .......................... 190 viii Table II. 12. l3. I4. 15. LIST OF TABLES Comparison of Treatment Groups According to Sex, Mean Age, Mean GPA, and Mean Class Standing ..... Mean Number of Sessions and IPR Interventions (and Ranges) for Therapists and Treatments ........ Frequency of Conducted Recalls by Inquirers ...... Reliability Coefficients for Pretape and Posttape Ratings on the Client Dimensions of OF, CC, 05, and DX ........................ MANOVA of POI Adjusted Posttest Scores ......... POI Raw Score Means, Standard Deviations, and Adjusted Means ........................ MANOVA of COGS and DX Adjusted Posttest Scores ..... COGS and DX Raw Score Means, Standard Deviations, and Adjusted Means .................... MANOVA of TSR (Client Form) Adjusted Posttest Scores . . TSR (Client Form) Raw Score Means, Standard Deviations, and Adjusted Means ............ MANOVA of TSR (Therapist Form) Adjusted Posttest Scores ........................ TSR (Therapist Form) Raw Score Means, Standard Deviations, and Adjusted Means ............ ANOVA of CDPS/PCRS (Client Form) Adjusted Posttest Scores ........................ CDPS/PCRS (Client Form) Raw Score Means, Standard Deviations, and Adjusted Means ............ ANOVA of CDPS/PCRS (Therapist Form) Adjusted Posttest Scores ........................ ix Page 54 58 64 77 87 88 9O 91 93 94 95 96 97 98 99 Table Page l6. CDPS/PCRS (Therapist Form) Raw Score Means, Standard Deviations, and Adjusted Means ............ lOO l7. MANOVA of POI Pre- and Posttest Raw Scores ....... lO3 l8. MANOVA of COGS and DX Pre- and Posttest Raw Scores . . . lO4 l9. MANOVA of TSR (Client Form) Pre- and Posttest Raw Scores ........................ 106 20. MANOVA of TSR (Therapist Form) Pre- and Posttest Raw Scores ........................ l07 Zl. ANOVA of CDPS/PCRS (Client Form) Pre— and Posttest Raw Scores ...................... lO9 22. ANOVA of CDPS/PCRS (Therapist Form) Pre- and Posttest Raw Scores ...................... llO LIST OF FIGURES Figure Page 1. Research Design .................... 79 xi LIST OF APPENDICES Appendix Page A. THERAPY SESSION REPORT ITEMS ............. 143 B. CLIENT'S DESCRIPTION OF PROBLEM SCALE AND PROGRESS OF COUNSELING RATING SCALE ............. l53 C. CHARACTERISTICS OF CLIENT GRONTH SCALES AND DEGREE OF SELF-EXPLORATION SCALE .......... l66 D. CLIENT CONSENT FORM .................. 175 E. BIOGRAPHICAL DATA SHEET ................ 177 F. CLIENT COMMENTS FORM ................. l79 G. PROCEDURAL MEMOS TO THERAPISTS ............ l8l H. CLIENT CONTROL SHEETS ................. l87 xii CHAPTER I INTRODUCTION Purpose The purpose of this study is to evaluate the effectiveness of using Interpersonal Process Recall (IPR) videotape and stimulus film techniques along with traditional treatment methods in counseling and psychotherapy. This study is a modified replication of two earlier (investigations (Schauble, l970; Van Noord, l973; Van Noord & Kagan, 1976). It incorporates recommendations made by these two authors; e.g., the sample size has been increased, the range of sessions has been lengthened, and flexibility has been introduced into the treat- ment design. The use of the IPR model along with traditional treat- ment methods is compared with traditional treatment methods used alone. The Problem Individuals with mental health problems have sought and received assistance from "helping" professionals from as early as 4,000 to 5,000 years ago. A surgical procedure was performed at that time which consisted of boring a hole in the skull and removing a portion of the bone. It is believed that this was done to liberate evil spirits which were supposedly causing the undesirable symptoms. Some reports suggest that the mortality rate may have been as low as 10%! Although such treatment may have been acceptable 5,000 years ago, it was inevitable that intervention techniques would undergo certain refinements. Treatment methods advanced through shamanism and demon- ology to the nineteenth-century work of Joseph Breuer and Sigmund Freud, who found that certain key mental symptoms could be eliminated when patients talked of the circumstances surrounding the formation of the symptoms. This process was called a "talking cure? or "cathar- tic therapy." The ”talking cure" process developed into the different therapeutic styles and techniques that therapists offer their clients today, along with, of course, drug therapies and behavior therapies. While clients and therapists have offered convincing testimonials on the benefits of psychological treatment, it has been necessary that treatment methods be experimentally investigated in order that their effectiveness be proven. Many controlled evaluations of psycho- therapy and counseling have offered support that such treatment does in fact work, though the issue is still debated. Summaries of such \ research are reviewed in the next chapter. As an example, Smith and — Glass (1977) reviewed 400 controlled studies on psychotherapy and counseling and found that on the average the typical therapy client is better off than 75% of untreated controls. These authors did not find, however, any convincing evidence that one type of psychotherapy is better than another. Researchers today are, on the whole, no longer asking if psycho- therapy and counseling work, since this has been demonstrated. Rather, they are focusing upon the meaning of improvement with a stress on specificity (Bergin, l97l). What is needed today is further examinations into what patient, therapist, and technique variables are important as determinants of client movement and growth (Gomes- Schwartz, Hadley, & Strupp, 1978). As part of the trend toward specificity, new techniques need to be developed and their effective- ness demonstrated (Bergin & Strupp, 1970). Interpersonal Process Recall is a relatively new intervention model that has been used in counseling and psychotherapy. IPR includes the use of videotape feedback in the presence of an inquirer who facilitates the recall of thoughts, feelings, intentions, etc. It also includes the use of stimulus films to facilitate discussions of feelings, interpersonal stereotypes, and interpersonal problem areas. The original developmental research on IPR found that it was effective in accelerating and continuing client movement and growth (Kagan, Krathwohl et a1., 1967). Hartson and Kunce (1973) investigated the IPR model in group work and found it to be beneficial to socially inactive subjects who had low self-esteem. They did not find it to be significantly bene— ficial to socially active, high self-esteem subjects. Kingdon (1975) explored the use of IPR as a supervisory model and found that it significantly changed clients' levels of self-exploration over time, but that it did not produce differential effects in therapist empathy levels, client satisfaction, or clients' self-reported inhibition. Schauble (1970) did a controlled study with 12 female under- graduate college counseling center clients and found that a struc- tured sequencing of the IPR techniques did result in significantly greater client movement on process and relationship measures than was observed on control clients. This study was then replicated with minor variations without finding any significant results (Van Noord, 1973; Van Noord & Kagan, 1976). It is evident that the use of the IPR model in counseling and psychotherapy needs to be further examined. The current study is an attempt to replicate Van Noord's and Schauble's studies with certain major modifications, specifically, increasing the sample size, increas- ing the range of treatment sessions, and introducing flexibility in the use of the IPR techniques in an attempt to further our under- standing of the effectiveness of the IPR model as a therapeutic tool. It is hoped that this research will stimulate further investigations toward more specificity, such as examining which IPR techniques work best with what types of clients at which stages in the therapeutic process. Definition of Terms Special terms used in this study are defined as follows: 1. Interpersonal Process Recall (IPR): The term used to des- cribe the process of recording on videotape (e.g., the counseling relationship) and playing back the videotape for a recall and exami- nation of the original experience. An additional person in the role of the "inquirer" facilitates this process. In this study the IPR model includes both the use of videotape recall and the use of stimu- lus films. Specific components of IPR that were used are described below. 2. Stimulus Films: These are short vignettes which are designed to simulate various kinds and intensities of emotional stress. The films are structured so that a filmed actor looks at clients and confronts them with various interpersonal stress situations. Client reactions to such situations then become the focus of the counseling sessions. This technique has also been called affect simulation in previous research. 3. Videotape Recall of Stimulus Films: Clients are videotaped while viewing the stimulus films, and the clients' videotaped reac- tions to the films become the focus of the counseling sessions. 4. Client Recall: A counseling session is videotaped. The counselor then either leaves the session temporarily or watches the recall through a one-way mirror or from an unobtrusive position in the room. The client reviews the videotape of the session with the aid of an inquirer. 5. Mutual Recall: A counseling session is videotaped. The counselor and client both review and videotape with the aid of an inquirer. 6. Significant Other Recall: A client and a significant other (without the counselor) are videotaped while discussing something meaningful in their relationship. The therapist then enters the room and functions as an inquirer for either the client alone or both the client and significant other while the videotaped session is reviewed. 7. Inquirer: The third person whose function it is to facili- tate the videotape recall of a taped session. This person acts in an assertive yet nonjudgmental manner to assist either the client a1 Tl ‘Ll cu alone (client recall) or the client and counselor together (mutual recall) to discuss reactions and recalled feelings, thoughts, images, intentions, etc. In previous research this role has been termed "interrogator." Schauble (1973) has called it the "Interpersonal Process Consultant," and the terms "recaller" and "recall worker" are also used. 8. Counseling, Psychotherapy, and Therapy: While a distinction between these terms in certain settings is valuable, they are used synonymously in this study. For the nature of treatment received by clients in this study, it is believed that “. . . there is no differ- ence in the methods or techniques used" (Patterson, 1959, p. 11). Meltzoff and Kornreich (1970) have defined the treatment as follows: Psychotherapy is taken to mean the informed and planful application of techniques derived from established psycho- logical principles, by persons qualified through training and experience to understand these principles and to apply these techniques with the intention of assisting individuals to modify such personal characteristics as feelings, values, attitudes, and behaviors which are judged by the therapist to be maladaptive or maladjustive (p. 6). 9. Counselors and Therapists: These terms are used synonymously in this study. They refer to professionally trained mental health workers who administer treatment in the form of counseling and psycho- therapy. Delimitations of the Study The following factors delimit the generalization of the results of this study. 1. The subjects used in this study were undergraduate and graduate students enrolled at an urban southeastern university (Georgia State University, Atlanta, Georgia) who came to the Counseling Center for help with personal problems. Their ages ranged from 17 to 37 years, with mean age of approximately 25 years. 2. The subjects were volunteers, and, therefore, the sample does not represent a random selection from the university papulation of students who seek counseling center help. 3. The subjects' problem areas were personal-social in nature rather than educational, vocational, or academic. They were not considered to be actively suicidal, severaly confused or disorganized, or in an extreme crisis situation. 4. The subjects were seen in counseling sessions that ranged in number from 4 to 15. This represents very short-term treatment. 5. The therapists were volunteer staff counselors who were given a 5-hour training program on the use of IPR techniques in counseling. None of the therapists had prior experience with the IPR model in a therapeutic situation. 6. Although flexibility was allowed in the use of the IPR model, the study did not examine the differential effects of the treatment program on different individuals with specific personality characteristics and problems. Assumptions of the Study The following assumptions were made in the present study: 1. That clients are capable of emotional, cognitive, and behav- ioral learning and growth in the dyadic therapeutic process and consequently can be helped to change in a positive direction. 2. That client movement and growth can occur in short-term therapy within a range of 4 to 15 sessions. 3. That client movement and growth can be validly and reliably measured by client self-report questionnaires and inventories, thera- pist questionnaires, and tape ratings from audiotape samples of the therapy sessions. 4. That clients' intratherapeutic growth will generalize to their extratherapeutic environment. General Hypotheses General hypotheses for this study are stated here. Specific research hypotheses are stated in Chapters III and IV. 1. Clients who receive personal counseling combined with IPR interventions will score higher on a measure of self-actualization, a correlate of mental health, than will clients who receive personal counseling without IPR. 2. Clients who receive personal counseling with IPR interven- tions will evidence more growth on rated therapy session process dimensions than will clients who receive personal counseling with- out IPR. 3. Clients who receive personal counseling with IPR interven- tions will be more satisfied with their experiences in counseling than will clients who receive personal counseling without IPR. 4. Clients who receive personal counseling with IPR interven- tions will achieve a higher percentage of their goals in counseling than will clients who receive personal counseling without IPR. tal Theory The theoretical framework that is used with the IPR model is an interpersonal theory of communications. Theoretical constructs have been discussed by Kagan (1975b, 1976), who was primarily responsible for the development of the IPR film "package." These constructs were included in the film series as a means of providing a cognitive basis in order to increase skill development in IPR communication training programs. They are viewed by Kagan as helpful but not crucial to acquire learning from the model. In this section there will be a general discussion of interpersonal theories followed by a more spe- cific discussion of theoretical concepts which relate to different IPR videotape and stimulus film techniques that were used with the experimental counseling group in the current study. Traditional Freudian psychoanalytic theory stresses the impor- tance of an individual's early psychosexual development and the effect it has on later personality characteristics, the importance of basic instincts, and the irrational and unconscious sources of behavior. As the theory evolved through Jung, Adler, and Rank, however, con- temporary social conditions were increasingly believed to be addi- tional determinants of the personality structure. Karen Horney (1937), in noting differences in neurotic symptoms of 19th century Europe as compared with those of 20th century United States, became convinced that individual differences could not be explained on a purely biological and instinctual basis. Whereas Horney recognized the importance of parent-child relationships, she also believed that other interpersonal relationships were important IO and that problems in living evolve from emotional conflicts and anxieties in these relationships. The formation of the neurotic personality was viewed by her as involving both intrapsychic and interpersonal (cultural) factors. In reacting to feelings of loneli- ness, helplessness, and a potentially hostile world, Horney theorized that the child can develop interpersonal attitudes toward parents that are either compulsively submissive, aggressive, or detached. These attitudes can then develop into characterological defenses and interpersonal styles of either self-effacement, narcissism, or resig- nation, which function to avoid the experience of anxiety. Diffi- culties arise because such defenses prevent the interpersonal closeness through which basic interpersonal needs, such as love, affection, and security, can be satisfied. The individual who is best known for developing a theory of interpersonal relationships is Harry Stack Sullivan. Sullivan (1953) defined psychiatry as the study of interpersonal relations that are present in observable behaviors. Although he did not discount tra- ditional intrapsychic Freudian dynamics, he believed that an individ- ual could only be understood within the context of family, friends, and a broader social group. In treatment this theoretical basis is believed to be important because a client's responses to a therapist will be affected by past and present interpersonal relationships. The thoughts and feelings which are expressed toward the therapist will to some extent be displacements of thoughts and feelings from relationships not only with parents but also with other people. Sullivan believed that the therapist must become a participant and be ll actively involved in the client's exploratory process and yet simul- taneously be an observer of the interpersonal trends of which the client is unaware. Sullivan viewed anxiety similar to the way in which Horney did. He thought of it as being a basic determinant in the development of the personality structure. Sullivan particularly stressed the role that anxiety is believed to play in current interpersonal relation- ships. An individual's response to anxiety in the therapeutic process is assumed to be central to understanding defenses and interpersonal patterns. Kell and Mueller (1966) and Kell and Burrow (1970) also stressed the importance of understanding the role that anxiety plays in their theory of the interpersonal therapeutic situation. Kell and his associates believed that the therapist must become a participant with clients in the therapeutic process as well as an observer of inter- personal dynamics. The anxiety which clients experience with the therapist is seen as a usual accompaniment of behavioral change. Anxiety results from changes in the individual's emotional homeo- stasis, and such emotional changes with the accompanying anxiety are the initial stage for changes in attitudes, changes in cognition, and finally changes in behavior. Because the experience of anxiety is unpleasant to clients, however, they are theorized as being ambiva- lent about changing. They seem to present their typical defensive patterns to the therapist to resist changing until they are willing to be vulnerable and trust their therapist's adequacy. Clients are then likely to be ready to risk the intimacy which will hopefully 12 lead to new and positive emotional experiences followed by new and constructive interpersonal beliefs and behaviors. The interpersonal theories of personality change appear to pro- vide the most suitable theoretical rationale for the mechanisms by which the IPR techniques used in this study are believed to contribute to client movement and growth. Whereas these theories acknowledge the importance of early familial relationships in the development of the personality, they stress the client's present interpersonal rela- tionships, including the relationship with the therapist. Anxiety is viewed as central to the client's problems in interpersonal rela- tionships, with the client demonstrating ambivalence and approach- avoidance conflicts in an attempt to satisfy needs with the least amount of anxiety. Of particular importance in the interpersonal theories is the assumption that clients can change, and that change can occur as a result of the interpersonal therapeutic process through emotional, cognitive, and behavioral relearning. In the following section the recall process, the inquirer role, and the use of stimulus films are discussed with respect to relevant theoretical concepts. The Recall Process At the heart of the IPR methodology lies the recall process, in which a portion of the counseling session is videotaped and then immediately replayed for viewing by either the client alone (client recall) or the client and therapist together (mutual recall) with the aid of a third person who is called the inquirer. Possible reasons for the assumed effectiveness of recall are stated here. 13 One reason for using videotape recall is that it provides the client with what seems to be a neutral source of feedback. Although a therapist, family, and friends can also provide feedback, their statements can be more easily distorted due to transferential issues underlying the relationships. The videotape, on the other hand, is objective, and, if clients wish to examine it in depth, they can view their interactional behaviors and explore covert processes behind them. As the therapy progresses, clients can take risks and try out new ways of interacting with their therapist. Learning theory stresses the need for feedback in learning new behaviors, and the videotape appears to be an accurate way for the client to get such feedback. As mentioned above, interpersonal theories of personality focus on the interpersonal patterns and defenses of clients as manifested in the relationship with the therapist. For change to occur, these defenses must be weakened and anxiety experienced by clients in a trusting relationship with the therapist. This is assumed to allow for the possibility of emotional, cognitive, and behavioral relearn- ing. The videotape is believed to provide clients with a means of examining their relationship with their therapist with the safety of knowing the outcome, since the portion of the session they are examin- ing has already occurred. With the aid of the videotape, clients can pause, examine, and reflect upon the relationship that they have with their therapist. It is theorized that they can learn that they may focus much energy on current interactions with their therapist even though they may be l4 discussing third-party concerns outside the dyadic relationship. It is also theorized that they can learn that they may attempt to elicit certain responses from their therapist in order to control the way the therapist (and others) responds to them. Following this learning, it is assumed they can decide whether or not these eliciting behav- iors are effective or ineffective in satisfying their wants and needs and whether or not they want to change the behaviors. In client recall, it appears to be important that clients can examine their interpersonal patterns with the help of an inquirer but without the apparent threat of having to relate directly with their therapist. Although the therapist may be watching the session through a one-way mirror, and although clients are aware that the therapist is doing so, they are perhaps less likely to avoid areas of stress which were avoided in the original therapy session. They can review the videotaped session in a manner that is presumed to cause less anxiety, and, therefore, they are believed to be freer to be honest and own up to their covert processes. If the therapist does decide to observe the client's recall, the client's observations and dis- coveries can hopefully be integrated into therapeutic strategies for helping the client. In mutual recall, on the other hand, it is hoped that clients can risk describing to their therapist their observations about their relationship. In going over a previous portion of a session, clients can check out perceptions of why they believe their therapist relates to them in certain ways, and they can request verbal feedback from their therapist about the effects of their interpersonal patterns 15 and defenses at specific points on the videotape. Mutual recall fits well into the interpersonal theories because it appears to allow for a more egalitarian therapeutic relationship than was provided by traditional theories with more authoritarian and detached therapist styles. With the aid of the videotape and the inquirer, it is believed that trust can be developed sooner, and the client can then be more vulnerable to experience and differentiate prior emotions and thoughts which affect current interpersonal relationships. It is also believed that videotape can assist clients in internalizing and taking respon- sibility for their behaviors and behavioral changes because the feed- back appears to be more neutral and can, therefore, be less easily denied or rationalized. In significant other recall, where clients review a tape of an interaction between themselves and someone such as a spouse, parent, or close friend, it seems that clients can reflect upon and examine their interpersonal behaviors and the accompanying covert processes in an established relationship. Again, the videotape feedback appears to aid clients in internalizing and in taking responsibility for their interpersonal behaviors, as well as providing a tool for uncovering the meaning associated with approach-avoidance patterns and the anxieties underlying these patterns. The Inqurer Role Whereas videotape feedback is used as a therapeutic tool by many individuals in various ways (Berger, 1978), the inquirer role is l6 unique to the IPR model. The inquirer is a third person whose func- tion it is to facilitate the client's recall (or both the client's and the therapist's recall) and self-analysis of underlying feelings, thoughts, images, expectations, and risks in the therapeutic process. The role of the inquirer is theorized as being important because the inquirer is relatively neutral and does not attempt to enter into another ongoing relationship with the client. Rather, it is the inquirer's function to assist the client (or the client and the therapist) in recalling and examining the previous session between the client and therapist. It is intended that the inquirer will help the client learn from the recall through an active but nonjudgmental probing of the client's thoughts and feelings as they review the videotape. This procedure seems to channel the client's energy into self-analysis and self- learning. It is likely to bypass any effort the client may exert to manipulate and control the current relationship between the client and the inquirer, which, if it did occur, could be a further attempt by the client to externalize problems and avoid internal change. This process can bring forth anxious feelings in clients, however, because they must focus on the immediate past relationship with the therapist in an introspective manner. Clients are not allowed to ramble on about external relationships or material not discussed on the videotape as a possible defensive maneuver which could serve to avoid self-analysis. By examining the relationship with the thera- pist and avoiding another active ongoing relationship with their inquirer, it seems that clients can take the time to reflect upon 17 their behaviors and learn that they must take responsibility for changing their environment. The inquirer role fits into interpersonal theories because it appears to be a means of aiding the client in discovering patterns of relating, anxieties, and possible ineffective displacements of thoughts and feelings from past relationships into the current relationship with the therapist. In mutual recall the inquirer is intended to facilitate the logical movement from what seems to be the relative safety of the past, recalled interaction between the client and the therapist to the more risky current interaction between them. It is theorized that clients can then learn to discuss openly their feelings and thoughts about the therapist and the therapeutic relationship directly with the therapist. They hopefully can become more inti- mate, more vulnerable, less defensive, and then can experience the accompanying anxiety in a safe environment. With new emotional out- comes in the relationship with their therapist, it seems that clients can then restructure their belief systems and begin to try out new ways of behaving. Stimulus Films In addition to the videotape recall process, the IPR model as implemented in this study included the use of stimulus films. These films are a series of short vignettes made up of professional actors who look directly at the viewer and display different types of emo- tions with varying degrees of intensity. The initial development of the films (Danish & Kagan, 1969; Kagan, Krathwohl et a1., 1967; l8 Kagan & Schauble, 1969) occurred as a result of an evaluation of the IPR videotape recall process. It was observed that videotape recall was much more effective in those sessions where the client-therapist interaction was intense and where the client discussed problems and experienced feelings of a significant nature. For those sessions in which the client-therapist interactions were rather bland and lacking in emotional depth, it was speculated that it would be bene- ficial to first expose the client to various kinds and degrees of interpersonal risks. Whereas role playing and real-life acting may have been too risky for the clients, filmed actors seemed to be effective stimulants in getting the clients to discuss interpersonal problem areas and generalized stereotypes of interpersonal situations in which they did not discriminate or allow for differences between events or persons. It was theorized that the vignettes would help clients to experience feelings and discuss them with their therapists in the safety of the therapeutic environment. Clients could either view the vignettes and discuss their reactions with their therapist, or they could be videotaped while watching the vignettes and then use the tape for a recall of thoughts and feelings with the assistance of the therapist functioning in part as an inquirer. The stimulus films were used in this study with clients partly because they are an integral component of the IPR model, and it was the IPR model as used in counseling which was evaluated in this study. As with the original developers of the model, however, it was assumed by the investigator that the use of videotape recall may not be effective or appropriate with all clients, particularly at the 19 beginning stages of therapy. For those clients who appear to be too threatened by seeing themselves on videotape, or who seem to be unable to participate in the self-analysis process, the stimulus films are intended to provide a means for clients to gradually begin talking about and experiencing feelings. By responding to filmed actors, it is theorized that clients are allowed to maintain their defenses and their control of the therapeutic situation and yet begin movement toward becoming more vulnerable, less defensive, and more trusting with their therapist. During this time it is hoped that the therapist will convey to the client a willingness to deal with the client's affects in depth. It is likely that the therapist will also be able to use the films diagnostically to determine which areas of inter- personal stress seem to produce anxiety in the client. The use of the stimulus films in therapy can be supported by the theoretical framework of the interpersonal theories because of the emphasis on the need to look at a client's problem areas in terms of interper- sonal relationships, past and present. It is theorized that the stimulus films allow the clients to gradually let down their inter- personal defenses and experience anxiety with their therapist in order that they can undergo emotional, cognitive, and behavioral relearning, which is then followed by behavioral change. Overview In this chapter the purpose and problem were presented, terms were defined, and limitations, assumptions, and the general hypotheses were stated. The interpersonal theoretical framework underlying the 20 IPR model was discussed along with a description of theoretical con- cepts which are relevant to the recall process, the inquirer role, and the use of stimulus films in counseling. In Chapter II a review of pertinent literature and research relating to psychotherapy and counseling, the evaluation of client movement and outcome, the use of videotape in counseling and psycho- therapy, and the use of IPR videotape and stimulus film techniques in counseling and psychotherapy will be presented. Chapter 111 contains the methodology of the study, including descriptions of the client and therapist samples, the treatments, the instrumentation, the research design, and the data analysis. In Chapter IV the specific research hypotheses will be stated, followed by the results of the data analysis and a summary of client and therapist subjective comments. And in Chapter V there will be a summary, conclusion, and dis- cussion of the results, as well as implications for further research. CHAPTER II REVIEW OF LITERATURE The review of literature in this chapter will be focused on the following areas relevant to the present study: (a) psychotherapy and counseling research, (b) evaluating client movement and outcome, (c) the use of videotape in counseling and psychotherapy, (d) the use of IPR videotape and stimulus film techniques in counseling and psy- chotherapy, and (e) a summary, including implications of the litera- ture. Psychotherapy and Counseling Research Since 1952, when Professor Hans Eysenck made his original claim that there was no evidence that psychotherapy with neurotics was any more effective than no treatment at all (Eysenck, 1952), clinicians and researchers have been determined to reevaluate his conclusion through further investigation in order to find out if psychotherapy does in fact work. There have since been several major reviews of psychotherapy outcome studies, all of which have disputed Eysenck's original claim (Bergin, 1971; Bergin & Suinn, 1975; Gomes-Schwartz, Hadley, & Strupp, 1978; Luborsky, Chandler, Auerbach, Cohen, & Bachrach, 1971; Luborsky, Singer, & Luborsky, 1975; Meltzoff & Kornreich, 1970; Smith & Glass, 1977). 21 Bergin (1971) reviewed Eysenck's original and subsequent out- come evaluations in which Eysenck attempted to show that two-thirds of all neurotics who enter therapy improve within two years and that two-thirds of neurotics who do not enter therapy also improve within the same time period. Bergin found that much of the original data were ambiguous, and he demonstrated that different rates of improve- ment can be calculated depending upon one's particular bias. His results indicate that the average therapy improvement rate is 65% and the Spontaneous improvement rate is 30% (compared to Eysenck's 67% for both), which he believes is evidence for what he terms the "modest" positive effects of psychotherapy. Bergin then goes on to point out that many factors contribute to the so-called "spontaneous" remission phenomena, stating that subjects used in no-treatment control groups are really not controls at all because they often seek therapeutic help during the waiting period from other professionals (e.g., physicians, clergymen, teachers) and nonprofessionals (e.g., spouses, friends, fellow workers), as well as engaging in self-help procedures. In reviewing more recent outcome literature, Bergin (Bergin & Suinn, 1975) again finds evidence for the positive effects of psycho- therapy with the improvement rate averaging about 67%. He also states that there is a deterioration rate of about 10%. Compared with controls, there is a significant increase in the variability of cri- terion scores at posttesting in the treatment groups (Bergin, 1971). Thus, although psychotherapy has something unique about it that con- tributes to positive change in most clients, it can also cause 23 deterioration, which possibly would occur with fragile or very dis- turbed clients who are treated by inexperienced or incompetent thera- pists. More research needs to be done in this area, however, for there is no definitive evidence concerning which types of clients deteriorate under which types of treatment. Meltzoff and Kornreich (1970) reviewed 101 individual and group outcome studies, and they found that 80% yielded positive results. They conclude: In short, reviews of the literature that have concluded that psychotherapy has, on the average, no demonstrable effect are based upon an incomplete survey of the existing body of research and an insufficiently stringent appraisal of the data. We have encountered no comprehensive review of con- trolled research on the effects of psychotherapy that has led convincingly to a conclusion in support of the null hypothesis. 0n the contrary, controlled research has been notably successful in demonstrating significantly more beha- vioral change in treated patients than in untreated con- trols. In general, the better the quality of the research, the more positive the results obtained (p. 177). Luborsky et a1. (1971) reviewed 166 outcome studies of adult patients in individual psychotherapy for predictors of success. They found that although some improvement is made by all patients on the average, initially sicker patients do not improve with therapy as much as initially healthier patients. Other important patient vari- ables contributing to positive outcome are motivation, expectation, intelligence, the presence of strong affect (such as depression or anxiety), educational and social assets, and the ability to experi- ence feelings deeply and immediately in the therapeutic process. In a more recent review, Luborsky et a1. (1975) reach what they call the "dodo-bird verdict," a phrase from Alice in Wonderland 24 representing the belief that it is usually true that "everybody has won and all must have prizes." By this they mean that controlled comparative outcome studies indicate that a high percentage of patients who have psychotherapy do in fact benefit from it. However, they also state that there is no evidence that any one form of psycho- therapy treatment is any better than another. This, they suggest, may be a result of a common element in all treatments, e.g., that of the helping relationship with a therapist. Or it may be that when psychotherapies are compared with each other and they all achieve a high percentage of improved patients, it is difficult for any single form of psychotherapy to show a significant advantage. Smith and Glass (1977) reviewed 400 controlled evaluations of psychotherapy and counseling. Their results were similar to previous reviews, finding that on the average the typical therapy client is better off than 75% of untreated controls. And although they found evidence to support the claim that psychotherapy does help, they did not find any important differences in effectiveness among different types of therapies. There is a great deal of evidence, therefore, to dispute Eysenck's original claim that psychotherapy research does not support the effectiveness of psychotherapeutic treatment. Eysenck continues to be skeptical, however, for in the May 1978 issue of the American Psychologist, in a response to Smith and Glass (1977), he stated, "I would suggest that there is no single study in existence which does not show serious weaknesses, and until these are overcome I must 25 regretfully restate my conclusion of 1952, namely that there still is no acceptable evidence for the efficacy of psychotherapy" (p. 517). From the results of the above reviews of psychotherapy outcome research, it appears that something happens in psychotherapy and counseling to contribute to positive effects in treated clients, although the basic issue is still debated. What actually happens to bring about beneficial results, if any, is unclear. The current study assumes that therapy does in fact help clients change, and the main research question here focuses on the issue of therapeutic techniques; namely, will the addition of the Interpersonal Process Recall tech- niques of using videotape and stimulus films in traditional therapy contribute positively to the therapeutic process in order for signifi- cantly positive effects to be observed in the therapeutic outcome? Evaluating Client Movement and Outcome Among the many problems in conducting psychotherapy and counsel- ing research is the selection of suitable criteria for measuring client movement and outcome. Many criteria are currently being used for a variety of types of research, but there is no consensus con- cerning what are suitable or meaningful criteria (Garfield, Prager, & Bergin, 1971). If there were a common agreement on what criteria for change should be used in psychotherapy research, it would be much simpler to implement studies and compare results. Unfortunately, however, human behavior is extremely complex and complex behaviors are not easily measured. In addition to this, a researcher must make philosophical value judgments in determining phenomena to be observed 26 and measured (Zax & Klein, 1960), and researchers disagree concerning which phenomena are important and which can be evaluated to indicate positive change occurring as a result of the therapeutic experience. A common distinction made is between criteria based on the v‘/»L’Lr~‘-'F/¢(cz c (3227-. client' 5 behavior in the therapy situation, and criteria based on the client' 5 behaVioFJbfits1d; thewtherapy‘s1tuat1on (Zax & Klein, 1960). If therapy is to be effective, it is logical to expect that certain positive changes will occur in the client's extratherapeutic world, and yet valid and reliable measures of such changes have been particu- larly difficult to obtain. Perhaps the most-used extratherapeutic criteria are those that are focused on relatively circumscribed indi- vidual behaviors which are recognized as central to the person's dif- ficulty in living and easily recorded (Zax & Klein, 1960). For example, measures have been taken of job performance, school atten- dance, court appearances, grade point averages, and tranquilizer drug prescriptions filled. Such measures have generally been viewed as being the most relevant by the environmental or ecological psycholo- gists. Extratherapeutic measures are also particularly relevant in the behavior therapies with problems such as circumscribed phobias, anxieties, weight control, and unassertive behaviors. Currently, such measures are seen as being increasingly appropriate in the intensive study of single cases where specific extratherapeutic goals can be agreed upon before therapy and measured after therapy (Bergin & Strupp, 1970; Games-Schwartz, Hadley, & Strupp, 1978). In controlled process and outcome studies with a large number of clients in the traditional therapies, however, the use of 27 extratherapeutic measures has been very limited due to a host of philosophical issues involved concerning what constitutes meaningful extratherapeutic change, and also due to a wide variety of measurement problems. As Zax and Klein (1960) stated in their summary of psycho- therapy research criterion measures: "The central problem here is the development of criteria of sufficient breadth that they are meaningful and representative of a wide range of functioning and yet, at the same time, circumscribed enough to be measured with relia- bility (p. 445). For the current study, the literature was reviewed without find- ing extratherapeutic measures that are meaningful, reliable, and prac- tical, and, therefore, it was decided that only intratherapeutic measures would be used. Internal criterion measures that have been used in psychotherapy and counseling research have been reviewed by Bergin (1971), Meltzoff and Kornreich (1970), Zax and Klein (1960), and Buros (1972). As stated earlier, there is no consensus concerning what are the most suitable or the most meaningful criteria. A frequently used type of measure has been judgments or ratings of partial or overall client improvement made by the therapist (Garfield et a1., 1971). This has the potentiality of being subjective, particularly when therapists are invested in and biased toward a certain type of client, technique, or general mode of treatment. 0n the other hand, it can be said that it is the therapists who really have intimate knowledge of their clients due to their direct work with them over a period of time, and, therefore, a therapist measure of client change represents 28 a meaningful evaluation that should be included along with other measurements. Client self-evaluations have also frequently been used as mea- sures of outcome or improvement (Garfield et a1., 1971). These too have limitations due to possible distortions and inaccuracies that are both intentional and unintentional, consciously and unconsciously motivated (Meltzoff & Kornreich, 1970). Reviews of outcome criteria often mention Hathaway's "hello-goodbye effect," where clients attempt to exaggerate their problems at the beginning of therapy in order to get help, and then exaggerate how much they have improved at the end of therapy in order to rationalize their investment of time and money and to make their therapists feel good (Garfield et a1., 1971; Meltzoff & Kornreich, 1970; Zax & Klein, 1960). Not often mentioned are the special class of clients who attempt to minimize their prob- lems at the beginning of therapy in order to appear attractive and acceptable to their therapists, and then exaggerate their problems at the end of therapy in hopes of continuing the dependent relationship and/or to uphold their view of themselves as not being capable of improving, or not wanting to give up their symptoms due to secondary gains. Even with these limitations, however, the client is the per— son with the problem, and the consumer, it would seem, should be in a favored position to evaluate changes (Garfield et a1., 1971). More indirect client self-report measures have traditionally been used which are not as subject to distortion from social demands and response sets such as social desirability. The most frequently used of these in controlled outcome studies has been the MMPI, with the 29 Q, _P_tL, and S9 scales being most sensitive to client changes (Meltzoff & Kornreich, 1970). A more recent instrument, the Personal Orientation Inventory (Shostrom, 1963), has been used increasingly in evaluating client changes (Bergin, 1971). This instrument has the advantage of measuring health-oriented qualities, as opposed to the MMPI, which has subscales relating to pathological dimensions. The client-centered group of therapists and researchers developed more objective criteria of intratherapeutic verbal behaviors that can be rated by independent judges from audiotape samples of the therapy sessions. These have been used especially in measuring the so-called "core" therapist conditions of empathy, positive regard, and genuineness (Meltzoff & Kornreich, 1970). Although these criteria have been widely researched with significant results, the studies and the criteria have been increasingly criticized and the relationship of the "core" conditions to outcome has been questioned (Bergin & Suinn, 1975; Lambert & DeJulio, 1977). Client criteria that have been measured by audiotape rating scales are depth of self-exploration (Truax & Carkhuff, 1967); owning 0/ of feelings, commitment to change, and differentiation of stimuli (Kagan, Krathwohl et a1., 1967); experiencing (Gendlin, 1962); and openness and awareness (Wilkinson & Auld, 1975). Although these criteria represent areas thought to be important in client movement within therapy (process criteria), they are also believed to repre- sent important dimensions in the client's extratherapeutic relation- ships, and, therefore, are appropriate measures of client growth (outcome criteria). They have the advantage of being measured by 3O objective observers via rating scales of audiotapes, and they there- fore avoid some of the biasing limitations of therapist reports and client self-reports. The reason no single criterion or set of criteria has been used in psychotherapy research is simply that we do not know which cri- terion measures most accurately reflect the true state of a client's change or lack of change. In fact, agreement among a variety of measures in single studies is often low, and it is because of this and our lack of knowledge about what constitutes true change that research- ers often recommend utilizing a variety of measures in psychotherapy research (Bordin, 1974; Garfield et a1., 1971). The measures used in the current study included client self-report questionnaires and inventories, therapist questionnaires, and objective tape ratings. They will be described in detail in the next chapter. The Use of Videotape in Counseling and Psychotherapy In recent years there has been a steady increase in the use of videotape techniques in counseling and psychotherapy. Articles deal- ing with this topic have appeared in a variety of publications, and reference lists which previously were typically meager are beginning to grow in size. There have been several reviews of the literature in this area which have generally been quite favorable to the use of videotape techniques in therapy, but the reviewers have stressed the need for further controlled research (Alger, 1969; Bailey & Sowder, 1970; Berger, 1978; Danet, 1968; Griffiths, 1974; Sanborn, Pyke, & Sanborn, 1975). In this section, the general use of videotape in 31 counseling and psychotherapy will be reviewed, and in the following section, the use of the IPR model with videotape and stimulus film techniques will be reviewed. In the early 19405, phonographic recordings were used by Carl Rogers and others for clinical training and research (Covner, 1942). The introduction of audiotapes made it convenient for recorded therapy sessions to be used in supervision, and the use of audiotape record- ings in supervision steadily increased so that by the 19605 the video- tape recorder was standard equipment in clinical training programs. Recordings have also been used as part of the therapeutic process, and as early as 1948, Freed found that a recording of a session could be played back to a client immediately after it was made for a thera- peutic self-confrontation which then led to further discussion between client and therapist. He found this to be particularly effective with children in play therapy, and also in the treatment of character dis- orders because subtle nuances of interpersonal behavior could easily be seen by the client, nuances which the therapist had difficulty ver- balizing back to the client without the aid of recordings. Bailey and Sowder (1970) have reviewed several published articles on the use of audiotape techniques with a variety of types of clients and patients in several settings. They report that many of these articles are filled with personal testimonials saying that audiotape playback greatly expedites the therapeutic process. They conclude that even though many therapists are personally impressed with audio- tape techniques, the benefits have not been demonstrated experi- mentally. 32 Bailey mentioned his own study, in which 24 inmates at a federal women's prison were randomly assigned to either a playback group, a "regular" therapy group, or a nontherapy control group. No signifi- cant differences were found on outcome measures between groups. The playback group was, however, significantly more verbally productive than was the regular therapy group, suggesting that audiotape feed- back had an effect on the process of psychotherapy but not on the outcome in his experiment. The advent of videotape recording equipment in the 19605 allowed for the visual dimension to be added to the audio dimension in thera- peutic feedback techniques. And the more recent availability of high- quality, lower cost, portable videotape equipment has made the videotape recorder a common piece of hardware in university counseling centers, private and public institutional settings, and even in pri- vate practice clinics. Many enthusiastic personal reports about the beneficial uses of videotape recall techniques have appeared in the literature for the past 20 years, but controlled studies supporting these personal claims have been lacking. A pioneering study in the area of videotape playback was con- ducted by Moore, Chernelle, and West (1965) at a private psychiatric inpatient service at the University of Mississippi Medical Center. Eighty patients who were consecutively admitted were divided into an experimental group and a control group. The majority of these patients were depressive or schizophrenic women. Although both groups had psychiatric interviews which were videorecorded, only the experi- mental group patients viewed these recordings. The initial interviews 33 were 12 minutes, and subsequent interviews were 5 minutes. The experimental group always reviewed the current interview plus all previous videotaped interviews in sequence. Despite the fact that this “videotherapy” took an average total time during hospitalization of only 60 minutes, the results were impressive: whereas 47.5% of the experimental patients were dis- charged as cured or greatly improved, only 12.5% of the controls were discharged as such. The average length of hospitalization was also longer for the experimental group: 24 days compared to 18 days for the controls. It is unknown how this longer average length of stay may have confounded the results. There were many methodological defects to this study, but the results were certainly a stimulus to further investigation in the area of videotape recall in inpatient settings. Stoller (1967) has described the use of focused feedback with regressed hospitalized patients in groups, and he offers clini- cal evidence supporting the use of videotape recall techniques with this population. Danet (1968) has reviewed the use of videotape self-confrontation techniques in group psychotherapy, and he states that although the clinical work of therapists has demonstrated the effectiveness of videotape feedback as a therapeutic tool in group psychotherapy, there has been a "striking absence" of research studies. Danet men- tioned his own investigation of videotape feedback in groups under what he termed "relatively controlled conditions." His findings, although inconclusive, suggested that patients in the experimental group (N = 7) tended to be more anxious, more erratic in their 34 sociometric ratings, less positive in their self-evaluations, and lower in ratings of self-improvement than were patients in the con- trol group (N = 7). These data supported the possibility that the videotape playbacks had a disruptive influence on the group's pro- cesses. He hypothesized that the rigid method of presenting the playback material which he used at the beginning of each session in order to introduce experimental control resulted in the disruptive- ness and anxiety in the experimental group. And he states that the feedback process may not have been handled in a sensitive and skillful manner. He concludes that more research needs to be done to determine if there are in fact harmful effects from the use of videotape play- back. He asks the question: "For which individuals and under what conditions is exposure to one's self-image in this manner a beneficial experience?" (Danet, 1968, p. 256). Gelso (1974) has reviewed the research on the effects of making audio and video recordings on counselors and clients in counseling sessions. He notes that early research suggested no adverse effects, particularly on clients. And he states that there are common beliefs that (a) Counselors are often more disturbed by audio and video recording procedures than are their clients, (b) The inhibition that counselors think that therapy recordings produce in their clients is really a projection of their own disturbances, and (c) The slight dis- ruption that recordings may cause in clients will quickly disappear. Gelso questions these beliefs, and he cites some of his own research to indicate that audio recordings do in fact inhibit clients and that video recordings inhibit them even more. He concludes that this issue 35 is best viewed as a cost-benefit question in which the benefits of recordings must be weighed against the potentially adverse effects. It should be noted here, however, that Gelso's research was done with counseling sessions in which the audio and video recordings were used for counselor supervision of the client sessions, and that the record- ings were never used as therapeutic techniques within the sessions. This is drastically different from the use of videotape recall in the present study, where the clients and therapists immediately reviewed the videotapes in the sessions, and then erased them afterwards with- out anyone other than the inquirer seeing them. Sanborn, Pyke, and Sanborn (1975), in a more recent review of videotape playback in psychotherapy, have synthesized the results in the literature on some of the various techniques. They find that there is a consensus against concealing the camera and other equip- ment, that almost all therapists prefer an immediate replay rather than a delayed one, and that relatively short segments are better than longer ones. They conclude that the preponderance of research has found that self-confrontation via videotape recall is helpful, and that videotape has been successfully used as an adjunct with indi- vidual, group, marital, and family therapy. Griffiths (1974) is more cautious in his review of the videotape feedback literature. He sees a definite need for more objective assessments of the effectiveness of the use of feedback in therapy. He believes that individual differences in response to feedback need to be researched, and that an attempt must be made to determine mech- anisms which mediate changes related to feedback. This would allow 36 theoretical models of feedback to develop which would facilitate further empirical research and clinical application. Milton Berger (1978) summarized research and many different uses of videotaping in treatment and training in his edited work, Videotape Techniques in Psychiatric Training and Treatment (Revised Edition). Berger is extremely positive about the present and potential value of utilizing video recall in the therapeutic process. In one of the chapters, Norman Kagan (1978) discussed the utility of the IPR model and the research based on this model in various human interaction set- tings. The use of the IPR model in counseling and therapy will be discussed in the following section. The Use of IPR Videotape and Stimulus Film ‘TeEhniques in Counseling andEPsychOtherapy This section is a review of the research on the IPR model as it has been used in counseling and psychotherapy. The IPR model includes the use of both videotape recall and stimulus film techniques. IPR has been used in many different human interaction settings with a variety of types of professionals, paraprofessionals, and nonprofes- sionals. It has been used in training mental health workers, medical students and personnel, secondary school teachers, college faculty, prison employees, supervisory personnel, policemen, and other groups. The research based on IPR in areas other than in counseling and psycho- therapy will not be reviewed here, but a summary of such research with references is available (Kagan, 1975b). The use of IPR as a method to accelerate client progress in counseling and psychotherapy has been reported in the literature for 37 several years, both in intensive case study form and in controlled experimental research. The two controlled studies which are most similar to the current study are discussed in depth following a sum- mary of other related investigations. The initial development and research on IPR was reported by Kagan, Krathwohl et a1. (1967). IPR videotape recall techniques were studied with counselors and prison inmates. It was first found that client recall (without the counselor observing the session) did not result in client movement. When the experiment was repeated with the counselor joining the client in mutual recall, however, client movement did occur. This led to the tentative conclusion that client growth could be accelerated, but only if the counselor was actively involved in the recall process so that he could identify and understand client insights and then deal with them in subsequent counseling sessions. A related initial study was conducted by the same researchers with three college counseling center clients seen by two counselors for three sessions each. The first session included client recall, the second session included a discussion with the inquirer but with- out the use of videotape, and the third session included mutual recall. The results of this study indicated that one counselor was more effec- tive with clients than the other, and that the more effective coun- selor had significantly better results with client recall (in which the counselor watched the recall session from another room through a one-way mirror), whereas the less effective counselor had signifi- cantly better results with mutual recall (in which the counselor actively participated). Although the sample size and number of 38 sessions were very small in the study, the writers were able to make tentative conclusions: The IPR procedure provides the client with insights into his interpersonal behavior but it is necessary that the counselor be able to integrate these insights into his ongoing rela- tionship with the client if growth is to be accelerated. It would appear that the more competent counselors under such conditions, gain new understanding from studying the session between the interrogator* and his client, and gain less from taking part in the interrogation. The less competent thera- pists, on the other hand, may either not understand the dynamics uncovered in recall or may not be able to implement them, thus frustrating the client's new understandings-- perhaps even retarding client growth (Kagan, Krathwohl et a1., 1967, pp. 319-320). An early study using IPR recall in small counseling groups was conducted by Hurley (1967). In this experiment one IPR recall session was introduced during the fifth session of a lO-session counseling group. When compared with two control groups, the IPR intervention group did not result in any statistically significant advantage on measures of self-disclosure. An analysis of pre and post tape recordings and the observations of the group leaders indicated, how- ever, that the introduction of IPR did in fact alter the style of group interactions in a positive direction. It was concluded that repeated IPR treatments would have been necessary to result in sig- nificant differences on the criterion measures. In an early IPR case study (Kagan, Krathwohl, & Miller, 1963), separate client and therapist recalls were found to simulate client movement in a 38-year-old female who suffered from periods of depres- sion and a rigid, nonsexual relationship with her husband. After *The inquirer was originally called the interrogator. 39 5 months of counseling in which the client had made little progress, an IPR session was introduced which included both client and counselor recall. With the aid of the videotape and the inquirer, the client was able to talk about previously repressed affect and gain insights into her own behavior. As a result of the surfacing of repressed affect and new insights during recall, the woman's relationship with her husband became more spontaneous and her sexual relations with him were reactivated, and the counseling progressed significantly. Hypnosis was used to facilitate the recall process in a case study (Woody, Kagan, Krathwohl, & Farquhar, 1965) of a 21-year-old male counseling center client who had problems with dependency, social inadequacy, and sexual uncertainty. The use of hypnosis appeared to heighten the client's sensitivity to the videotape, increase his involvement in the recall procedure, and allow him to become more cooperative in the therapeutic process. The client stated that he felt the hypnotic IPR procedure facilitated his progress in counseling, and his relationship with his therapist improved follow- ing the IPR sessions. IPR has also been used with more severely disturbed clients. A case study was reported (Resnikoff, Kagan, & Schauble, 1970) in which client recall was introduced during the 12th treatment session. The client was an 18-year-old, bright, well-read, high school senior who suffered from mild to acute psychotic reactions. The IPR procedure was used during the 12th session to uncover underlying dynamics of depression that he was experiencing at the time. During the recall it was learned that the client (a) had a much richer imagery than he 40 had disclosed to his therapist, (b) had worked through much of the material previously presented without conveying this to his therapist, and (c) was much more committed to his therapist than he was previously willing to admit. The 9th through the 15th sessions were rated by judges who had no knowledge of the IPR session. The ratings of client movement on five variables following the IPR session increased posi- tively, and the protocols of the post-IPR sessions indicated a heightened psychological clarity and forcefulness in the client. Stimulus films (affect simulation) were added to the IPR tech- niques (Danish & Kagan, 1969; Kagan & Schauble, 1969) to facilitate the client's discussion of reactions to highly emotional interpersonal situations, to discover individual client stereotypes in interpersonal behaving, and to discover interpersonal emotional problem areas in which the client desires change. Vignettes from mild to intense degrees of affect were made in four general areas: (a) hostility, (b) fear of hostility, (c) affection, and (d) fear of affection. Observations were made of clients who were videotaped while watching the short filmed vignettes with their therapists, followed by a recall of the videotape which then became the focus of the counseling session. The therapist facilitated this recall by using inquirer leads. The stimulus films were also found to be beneficial when used without the aid of the videotape, and the process was found to be effective with counseling groups as well as with individual clients. It was believed that the films were especially helpful at the initial stages of coun- seling so that clients could learn that it was acceptable to talk about feelings and discuss interpersonal relationships. These films 41 have been used as an effective training tool in a variety of settings with a variety of clients, and they have been integrated into research on the physiological correlates of emotions (Archer, Fiester, Kagan, Rate, Spierling, & Van Noord, 1972). Hartson and Kunce (1973) used a combination of stimulus films, dyadic recall, and group recall techniques to assess the effective- ness of IPR in accelerating group psychotherapy in a controlled experi- mental study. They found that in six sessions the IPR treatment clients showed significantly higher changes in self-disclosure and readiness for group behavior and participated in significantly higher therapeutic interchanges than did clients in the traditional T groups. The T group clients, however, had significantly higher satisfaction scores. The study was conducted with two samples and there appeared to be a differential treatment effect: No treatment differences were observed between high self-esteem, socially active (YMCA) subjects, whereas the IPR self-confrontation methods were beneficial to low self-esteem, socially inactive (counseling center) subjects on whom the T group direct confrontation methods seemed to have an adverse effect. In a recent study, Kingdon (1975) did a controlled cost/benefit analysis of IPR used as a counselor supervisory technique. Cost was defined as the possible inhibitory effects of using videotape on client self-exploration, whereas benefit was defined as client satis- faction, increased supervisor ratings, and increased counselor empathy levels. Only three sessions of client and counselor recall were used in this study, and although inhibitory effects due to videotaping were 42 found during the second session, these effects began to dissipate during the third session with IPR clients self-exploring at a deeper level than traditional treatment clients. No significant results were found, however, on measures of empathic understanding, client satisfaction, and supervisory ratings of counselors' performance between the traditional and the IPR treatment clients. In another recent study, Grana (1977) investigated the effects of varying the frequency of videotape feedback during short-term counseling. This was not a true IPR study in that the therapist functioned as the inquirer during recall, rather than using a third- person inquirer who would have been more neutral in the therapeutic process. Grana had therapists act as their own inquirers because he believed the results would be more generalizable, since, in his opinion, bringing in outside inquirers was not practical. Twenty- four university students were assigned to one of four groups which met for five weekly l-hour sessions and varied in videotape recall frequencies, i.e., 0, 1, 3, or 5 recalls. No significant differences were observed. Grana suggested that the videotape feedback was an additional counseling technique which contributed only small amounts of variance to the change scores, resulting in small rather than large effects. He concluded from client evaluation statements that videotape feedback was either a neutral or beneficial factor in the counseling process, that a routine every-session approach to video' feedback was confining and possibly disruptive to a close client- counselor relationship, that video feedback may require a highly motivated and responsible client to achieve maximum effects, and that 43 the timing of the video feedback may be very important with its use being particularly effective at the stage when the client moves toward becoming more responsible for changing behaviors. In two intramodel analog studies designed to investigate the ability of individuals to accurately recall feelings of "comfort" and "discomfort" while watching a videotape of a previous session, Katz and Resnikoff (1977) found support for the validity of the basic IPR recall process. Results from studies of role-playing counseling students (Study 1) and intimate couples (Study 2) produced moderate correlations between self-ratings of in vivo feelings on an event recorder during a session and self-ratings of feelings recalled while viewing the videotape feedback. It was also found that a greater reliability of recall was obtained by playing the client rather than the counselor role (Study 1) and by having one's self-rated in vivo feelings disclosed to a partner during the original ongoing session (Study 2). This study is significant in that it examined and gave support to one of the basic components of the IPR model. The two most important IPR research projects with respect to the current study are Schauble's study on the use of IPR in therapy (Schauble, 1970) and Van Noord's modified replication of it (Van Noord, 1973; Van Noord & Kagan, 1976). Because of their specific relevance here, these studies will be covered in more detail than were previous studies. Initially, Schauble conducted a pilot study to determine if the IPR model could be successfully integrated into a therapeutic treatment program. Nine clients were assigned to either one of two IPR treatment 44 groups or to a traditional group and then seen for six individual sessions each. The results were encouraging, for the IPR treatment clients were found to make more progress on four process measures of client growth than did control clients. In Schauble's main study, he had a sample of 12 female counsel- ing center clients and two doctoral intern therapists. Each therapist treated three clients with IPR techniques in addition to traditional methods and three clients with traditional methods alone. Both treatments consisted of six sessions. The IPR treatment group fol- lowed a structured sequence: (a) session l--traditional, (b) ses- sions 2 and 3--videotape recall of stimulus films (affect simulation), (c) sessions 4 and 5--c1ient recall with counselor observation through a one-way mirror, and (d) session 6--mutual recall with client and therapist. The theory of this progression was (a) that the client needed to learn that it was apprOpriate to talk about feelings and examine them in emotionally stressful interpersonal situations, but to do it in a safe environment (videotape recall of stimulus films); (b) that the client needed to identify feelings experienced during the counseling relationship, but to do it with the safety of an objective third person (client recall); and (c) that the client needed to experience and deal with feelings in the immediacy of the counsel- ing relationship, progressing from the "there and then" of the video- tape to the "here and now" of the counseling session (mutual recall). Schauble used five dependent variables as pre and post measures: (a) the Characteristics of Client Growth Scales (COGS, Kagan, Krathwohl et a1., 1967; Schauble & Pierce, 1974), (b) the Depth of 45 Self-Exploration Scale (0X, Traux & Carkhuff, 1967; Carkhuff & Berenson, 1967), (c) the Wisconsin Relationship Orientation Scale (WROS, Steph, 1963), (d) the client and therapist forms of the Therapy Session Report (TSR, Orlinsky & Howard, 1966), and (e) the Tennessee Self-Concept Scale (TSCS, Fitts, 1965). Significant between group differences in favor of the IPR treatment clients were found on the three subscales of the COGS, as well as on the 0X and the WROS. Sig- nificant change scores within treatment groups, pre to post, were found on the COGS and the 0X for the IPR clients but not for the tra- ditional clients. Significant between group differences in favor of the IPR clients were found on two subscales of the client form of the TSR: client feelings about coming to the session, and client feel- ings about progress made in the session. Significant change scores within treatment groups, pre to post, were also found on these two client subscales of the TSR for IPR clients only. And a significant change score, pre to post, in favor of the IPR treatment clients was found on one subscale of the therapist form of the TSR: therapist looking forward to session. No other results were significant. Schauble (1970) concludes: In light of the changes observed in client behavior in therapy as a result of the IPR intervention and the significant dif- ferences between the behavior of clients in the IPR treatment and the traditional treatment group, it is assumed that the IPR procedures are a potentially potent tool for use in accel- erating client progress in therapy. Even in light of the limi- tations of the small N_in this study, the fact that significant differences were found in two separate studies in only gix_ sessions seems too meaningful to ignore (p. 150). Van Noord replicated Schauble's research with certain modifica- tions: (a) He used 12 therapists, each seeing only one client, half 46 of whom were in the IPR treatment group and half in the control group; (b) He used a posttest-only design and a multivariate analysis of covariance with five dependent variables and a covariate of thera- pist empathic understanding; (c) He used only the client form of the TSR without using the therapist form; and (d) He substituted the Miskimins Self-Goal-Other Discrepancy Scale (MSGO, Miskimins & Braucht, 1971) and his own Peer Information Questionnaire in place of the TSCS and the WROS. As with Schauble, Van Noord used a highly structured sequencing of the IPR model: (a) session 1--traditiona1, (b) session 2--stimulus films, (c) session 3--video recall of stimulus films, (d) sessions 4 and 5--client recall with counselor observa- tion through a one-way mirror, and (e) session 6--mutual recall. No significant differences were observed between groups on the total MANCOVA nor on separate ANCOVAs on individual measures. Subjective comments by clients, however, suggested that the IPR techniques were beneficial and helpful in self—exploration and in exploration of the client/counselor relationship. Van Noord (1973) concludes: The primary observation stemming from the results of the present study is that of the difference in outcome between this study and that of Schauble in 1970. An important implication of the fact that effects of IPR/affect simulation treatment were noted in the Schauble study but not in the present experiment is that those previous results must be looked upon with more skepti- cism than would be the case were this study not conducted. That is, while the results of either of those projects may be valid, the fact that differences between treatment groups were noted in the original project but not in the present one to some extent weakens the positive implications of results obtained in the Schauble study (p. 147). Both Schauble and Van Noord reported that a frequent therapist criticism focused on the imposition of structure in the IPR treatment 47 group. The rigid sequential use of the techniques was not always seen as helpful by the therapists because it did not take into account each individual client's unique growth rate and needs. Schauble (1970) stated, A criticism of the IPR treatment suggested by both therapists was that the step by step program delimited their freedom to respond to their clients' individual needs. In other words, the research dictated a rigid schedule of IPR experiences which did not take into account the unique growth rate of each client; that is, in the interest of uniform treatment within groups the therapist was allowed no flexibility in varying the approach to meet client needs (p. 134). Van Noord (1973) speculated on possible harmful results of using the rigid structure: “While the organization of the progressive movement was done on a logical basis, possibly there were negative effects resulting from not using specific techniques at differing points in the therapy process according to individual client needs as determined by each therapist" (p. 148). He goes on to recommend that further investigations be conducted in which therapists are allowed to use the different IPR techniques with more flexibility and where they are allowed to choose particular techniques for particular clients at par- ticular stages in the therapeutic process. He noted that mutual recall was thought to be especially helpful for several clients in his study. A suggestion by both Schauble and Van Noord for further research was that the impact of the IPR techniques in therapy should be studied over a longer period of time, hypothesizing that in a more extended therapy program the positive effects of the IPR techniques might be more fully realized. And both researchers noted that their 48 sample size was very small and they recommended that it be increased in further research. Summary A review of the literature on controlled studies in counseling and psychotherapy indicates that there is adequate evidence for the beneficial effects that clients receive from therapy when compared to untreated controls. Bergin (1971) has pointed out, however, that although psychotherapy has something unique about it that contributes to positive change in most clients, it can also cause deterioration in some clients who have not been treated in a competent manner. It is not surprising that if psychotherapy has the power to effect posi- tive change, it also has the power to effect negative change. Addi- tional research is needed, therefore, to determine what works best with whom under which conditions. As part of such research, there is a need to develop and test new techniques (Bergin & Strupp, 1970). Although controlled comparative outcome studies give evidence that a high percentage of clients who have therapy do in fact benefit from it, most reviewers have not found that there is evidence to support any one form of treatment as being better than another (Luborsky et a1. 1975; Smith 8 Glass, 1977). A major problem in counseling and psychotherapy research is the selection of suitable criteria for measuring client movement and out- come. Human behaviors are complex and not easily measured, and researchers cannot agree on the philosophical value judgments needed in deciding which phenomena are important and, therefore, which 49 phenomena should be measured to give evidence of positive change -occurring as a result of the therapeutic experience. With the cur- rent problems with process and outcome measures, it has been recom- mended that a variety of measures be used (Bordin, 1974; Garfield, Prager, & Bergin, 1971). The last two decades have seen a steady increase in the use of videotape recall as a therapeutic technique. Although therapists who use videotape in their treatments report that videotape can be a very effective tool, controlled research has had mixed results and there is a definite need for further investigations. The IPR model includes the use of videotape recall and stimulus films. It was originally developed by Kagan, Krathwohl et a1. (1967) for use in counselor education, but the model has also been developed into therapeutic intervention techniques. The use of IPR in counsel- ing and psychotherapy has been found to be effective in accelerating client movement in case studies and in some controlled studies, but the results have been inconsistent in the controlled studies. Research on the effectiveness of IPR in therapy is still in the initial stages, just as the use of IPR in therapy is still in the beginning phase of development. The current study was undertaken with the belief that, although research has proven that counseling and psychotherapy can effect positive changes in clients when compared to untreated controls, con- tinued research must be made on the effectiveness of new techniques in order to eventually gain specificity concerning what works best with whom under which conditions. The measures used in this study 50' included client self-report questionnaires and inventories, therapist questionnaires, and objective tape ratings of therapy sessions. The IPR model in this study was researched using IPR interven- tions in a therapeutic design that incorporated recommendations from two similar studies (Schauble, 1970; Van Noord, 1973; Van Noord & Kagan, 1976). In these two studies the sample size was 12, and in the current study it was 50. Whereas the previous number of sessions was limited to 6, the number of sessions in the current study ranged from 4 to 15, thus allowing for more flexibility and for the possi- bility of an increased exposure to IPR techniques. The range of sessions used in this research was somewhat arbitrary. It was the belief of this researcher, however, that significant results could be obtained on the average (allowing for individual differences) after four sessions in which two of the four sessions included IPR inter- ventions. And although it was possible that nonrepresentative growth data were obtained from some of the clients who had not terminated at the time of the 15th session (due to regression, negative trans- ference, etc.), these effects should have been randomized between treatment groups. Meltzoff and Kornreich (1970) have reviewed the literature on temporal variables and outcome, and they found evidence to support the assumption that client movement and growth can occur in short-term therapy. The range of these sessions also reflects the growing trend of actual practice in university counseling centers and mental health clinics to see clients in very short-term treatment. For those clients who continued beyond the 15th session, it was assumed that 51 IPR interventions would result in more client movement than would occur without the IPR interventions in the control group. The most important difference between the current study and those of Schauble and Van Noord was the use of IPR techniques on a flexible basis. This was designed so therapists could choose particular tech- niques for particular clients at particular stages in the therapeutic process. A detailed description of treatments along with the instru- ments used for measurement follows in Chapter III. CHAPTER III METHODOLOGY The following is a detailed description of the sample, treat- ments, instrumentation, design, hypotheses, and data analysis used in the study. Sample Clients Permission was first obtained from the research committee of the Georgia State University Counseling Center for the use of clients in this experiment. The 50 clients who participated in the study were undergraduate and graduate students at Georgia State University who had requested counseling at the Counseling Center during the l976/l977 academic year. In order to be asked to participate, a potential research client had to: (a) have a presenting problem that was primarily personal/ social in nature rather than educational, vocational, or academic; (b) not be considered actively suicidal or in an extreme crisis situa- tion; (c) be willing to make a commitment to at least four counseling sessions, and (d) be considered appropriate for traditional, dyadic counseling (e.g., clients who were most suitable for group counseling, anxiety reduction, assertiveness training, etc., were excluded). 52 53 Initial contacts with clients were made by either the investi- gator or one of the research therapists. This took place either in the intake session (if the investigator or research therapist was on intake duty), in a brief personal or telephone interview, or during the initial counseling session. Clients were told that counseling techniques were continually being evaluated at the Center to see if they were effective in meeting student needs. Then they were asked if they would be willing to participate in a research project in which videotape and films may or may not be used as part of the therapy procedures. Those who agreed signed a consent form. Prior to being contacted, all potential clients were assigned to either the experimental or control group. When asked to partici- pate, neither the client nor the therapist had knowledge of the group assignment. After the client agreed to participate, the therapist opened a sealed envelope with the group assignment inside and told the client whether or not videotape and/or stimulus films would be used in the sessions. It should be noted that this is not a random sample, but rather a volunteer sample. Approximately 15% of the potential clients who were asked to participate responded that they did not wish to be part of the research project. Although it is impossible to know the exact reasons for these refusals, it appeared that some of the unwilling clients feared an invasion of privacy due to the research measures, even though they were told that confidentiality would be maintained and that no names would be used in any of the reports. Other unwill- ing clients expressed a dissatisfaction with the idea of using specific 54 techniques, such as the videotape and stimulus films, and it appeared that some of these clients experienced the thought of using videotape and films as a loss of control over the therapeutic process. And a few clients indicated that they were unwilling to commit themselves to four sessions, preferring to sample a few sessions and then decide whether they wished to continue with therapy. The IPR and traditional groups were compared on the following demographic variables: sex, age, grade point average (GPA), and class standing. A summary of these data is presented in Table 1 below. Two-tailed trtests indicated that the differences between the IPR and traditional treatment groups on the variables of age (t[48] = 1.06, p_= .30), GPA (£I40] = .55, p_= .58), and class standing (£[48] = 1.86, p_= .07) were not significant at the .05 level. Table 1: Comparison of Treatment Groups According to Sex, Mean Age, Mean GPA, and Mean Class Standing IPR Traditional Counseling Group Counseling Group Sex 14 females/11 males 16 females/9 males Mean age 25.8 years 24.4 years Mean GPA 3.1 3.0 Mean class standing 3.7a 3.1 aBased on class standing when freshman = 1; sophomore - 2; junior = 3; senior = 4; and graduate = 5. 55 Subject Mortality A total of six clients who began the study terminated their counseling sessions without completing the research procedures. Four of these clients were in the control group and two were in the IPR group. The number of sessions completed for these clients before termination ranged from one to four. In one case of a traditional group client the person did not wish to continue, stating that the only reason he began was because one of his professors said he needed it and that he no longer agreed with his professor. In two cases (one in the traditional group and one in the IPR group) the clients dropped out of school and moved to another city. And in the remain- ing three cases (two traditional clients and one IPR client) the individuals stopped coming to the sessions and refused to complete the research procedures with no reasons given. An attempt was made to replace each of these clients with the next client of the same sex on the waiting list who agreed to partici- pate in the project. In two cases in the control group, however, male clients were replaced with female clients because only female clients were on the waiting list. This resulted in the final sex distribution within each of the groups being slightly unequal, with 14 females and 11 males in the IPR counseling group and 16 females and 9 males in the traditional counseling group, a difference which was unlikely to confound the results. 56 Therapists Five Georgia State University Counseling Center therapists were used in this study. Each therapist saw 10 clients, 5 of whom were in the IPR group and 5 in the traditional group. This was not a random sample of all the therapists at the GSU Counseling Center, for each therapist volunteered to participate in the research project. Three therapists were interns who had completed all requirements except the dissertation for the Ph.D. degree (two were in a clinical psychology program and one was in a counseling psychology program). One therapist was a senior staff, full-time employee at the Center. And one therapist was a doctoral student staff counselor who worked three-quarters time at the Center. Each of the therapists was trained in traditional styles of counseling and therapy and each was eclectic in using a variety of styles and techniques (e.g., intrapersonal, interpersonal, emotional, cognitive, behavioral). Only one of the therapists had previous experience with IPR, but none of them had ever used IPR techniques as an adjunct to traditional therapy. Therapists were given a 5-hour training program on the use of IPR in therapy. Three hours were spent on videotape recall procedures and 2 hours were spent on stimulus film procedures. During this time, therapists were instructed in the operation of the videotape recorder, the camera, the monitor, and the 16mm sound projector so that they could use this equipment without the assistance of a media technician. In addition to this formal training, therapists were given the IPR manual (Kagan, 1976) and were asked to read the chapters on affect simulation (stimulus films) and the inquirer role and function. 57 Treatments Clients who were research subjects in both the IPR and control groups completed between 4 and 15 counseling sessions before taking the posttests. The number of sessions within this range varied in order that flexibility could be maintained according to individual client needs as determined by the therapists and clients. Although clients could terminate at any time, they had to complete at least four sessions in order to be used in this study. For those clients who continued beyond 15 sessions, posttests were taken after the 15th session. Nine clients in the IPR treatment group and two clients in the traditional group continued counseling beyond the 15th session after completing the posttests. Of the total 462 counseling sessions completed in this study, 260 were for the IPR group clients and 202 were for traditional group clients. The mean number of sessions completed per client was 10.4 for IPR clients and 8.1 for traditional clients. A two-tailed t:test indicated that the difference between these two means is significant at the .05 level: 3(48) = 2.10, p.= .04. For a comparative summary of the mean number of sessions (and ranges) for therapists and treatments, see Table 2, p. 58. The initial sessions for clients in both groups were similar, allowing therapist and client to meet each other and begin identify- ing client concerns and goals. This time also gave the therapist the opportunity to answer any additional questions that the Client had about the research requirements or the counseling treatment. An audiotape was collected from the 50-minute session for subsequent rating by judges on the initial level of client functioning. 58 mE—Pw map -zewpm mo mppmumc omcw> N mZmumL Lmfio 23$?um m mppmumc Hemp—u op mspww mzpaewum em emcwnsou mppmumc szuss mm Amlmv m.e Ampuev «.op Ampuev _.m mumwamcmsu -< Auw>cmmnov Ppmumc ucmwpu F mepww map uaswum mo mppmumg omuw> m “5239. .550 “56:23..” m map?» mapzewpm m mpPauaL Fasuas o, Ao-mv e.m Am_-mv m.mp ANF-NV N.m m “magmamge mspwc m=P=s_am K appease _m=u=e ~_ AQ-NV m.m AmF-eV m Am -5v «.5 e basaaamep Eyed mspaswum F m_FaumL Pushes om Ao-~v ~.e Amp-mv «.o. Am_-¢v w m pmwaaamee me_wc mspaespm N mPqumL pmzpae n Aum>cmmno==v m_FaumL bemepo m Ao-~v o.m A_.-mv m Am -mv N N ammaaameh mepwe m:_=ewum m m_PauaL Fasuse mp Am-~v 5.4 Am_-mv __ Amp-mv o.~_ _ umwaaaagh mucmwpo maH Lo» mucwwpu maH mgcmrpu pmcowupu meowacm>cmucm Low mcopmmmm 1mg» Low meowmmwm umm: meowucm>cmch maH man do Ammcmm do “enema mo Ammcmm ucmv .oz cum: ccmv .oz cam: ccuv .oz :mmz mucoeummch ecu mumwamcmgp Lee Ammmcmm ucmv mcowucm>cmpca mgH use meowmmmm mo Lungsz cam: ”N «pomp 59 Traditional Counseling Without IPR (Control Group) The 25 clients of the five therapists who received the tradi- tional treatment alone had sessions that were conducted in no set pat- tern, which permitted the therapists to use their normal, eclectic, dyadic treatment methods. During these 50-minute sessions, thera- pists assisted their clients in working on both intrapersonal and interpersonal problem areas. Therapists were told to use their familiar methods of counseling interventions. In addition, they were told that it was allowable for the client to bring a significant other into the sessions to work on mutual problem areas. This was done in order to equate for the possible use of significant others in the mutual recall technique in the IPR experimental group as described below. Counseling with IPR (Experimental Group) The therapists treated their IPR group clients according to the following session framework and intervention techniques. During the first 10 sessions, an IPR technique had to be used in a minimum of 50% of the sessions; the techniques were used in at least every other session or in two consecutive sessions followed by two traditional sessions. The techniques could be used in more than 50% of the ses- sions if desired. During the 10th through the 14th sessions, an IPR technique had to be used at least once. Therapists were allowed to select the IPR technique which they believed was most suitable in facilitating each IPR client's growth 60 or problem-solving ability during a particular session. Therapists were encouraged to use as many of the techniques as possible, but there was no requirement that each technique had to be used. Also, any particular technique could be used as much as desired to facili- tate client movement as determined by each therapist for each client. Traditional counseling without IPR was used for all first and last sessions, allowing for audiotape recordings of sessions which were similar in structure to those in the traditional (control) treatment group. Traditional counseling was also used in those ses- sions where the therapist chose not to use an IPR technique within the limits of the guidelines stated above. As with the traditional group clients, these sessions were unstructured and conducted using the therapists' normal, eclectic, dyadic treatment methods. IPR Techniques and Session Procedures The specific IPR techniques which the therapists were allowed to choose from and the session procedures connected with these techniques are listed below. In using the techniques, therapists operated the videotape, camera, monitor, and the 16mm projector without the aid of a media technician. Stimulus films (effect simulation). Clients viewed at least five filmed vignettes which were selected by the therapist according to individual client problem areas. After viewing each vignette, the client discussed with the therapist those thoughts, feelings, images, memories, etc., that the client had while watching the vignette. The client's reactions to the vignettes became the focus of the counseling 61 session. Inquiry techniques were used by the therapists in facili- tating client reactions, but the therapist was not strictly limited to these techniques and used other intervention methods as well. This process took up either the whole session or part of it, with any remaining portion of the 50 minutes being Spent in traditional coun- seling procedures, the content of which was often stimulated by the films. The three IPR films used for this and the following proce- dure are part of the IPR film series (Kagan, 1975a). Videotape recall of stimulus films (affect simulation). Clients viewed at least five vignettes and were videotaped while watching them. The videotape was played back for the client (either after each vignette or after all of them) for a recall of the client's reactions to the vignettes. The therapist facilitated the client's recall through inquiry techniques, while not being limited to only these techniques. This recall became the focus of the counseling session, and it took up either the entire remainder of the session or part of it, with any remaining portion of the 50 minutes being spent in tradi- tional counseling procedures. Client recall. A traditional counseling session was videotaped for 10 to 15 minutes. An inquirer (someone other than the therapist) then entered the room and facilitated the client's recall of the initial period with the aid of the videotape for a period of 20 to 30 minutes. During this inquiry period the therapist could either: (a) watch the recall from an unobtrusive position in the room or through a one—way mirror in an adjoining room (with the client's knowledge that the therapist was watching) or (b) leave the session 62 completely and wait in another location until the inquiry time had elapsed. During the final 10 to 20 minutes of the 50-minute session, the inquirer left the room and the therapist returned for a final period of traditional counseling. Mutual recall. A traditional counseling session was videotaped for 10 to 15 minutes. An inquirer then entered the room and facili- tated the videotape recall of the initial period with both the client and the therapist actively involved in the recall for 20 to 30 minutes. After this recall period, the inquirer left the room and traditional counseling took place for the remaining 10 to 20 minutes of the 50-minute session. Significant other mutual recall. The client and a significant other (without the therapist) were both videotaped while talking about something that was meaningful to their relationship for 10 to 15 min- utes. The therapist then entered the room and functioned as an inquirer to facilitate the recall of the videotape by the client and the significant other for 20 to 30 minutes. The remaining 10 to 20 minutes of the 50-minute session was conducted as a traditional ses- sion with the therapist and either the client alone or the therapist and both the client and significant other together. The results of the actual IPR techniques selected by each thera- pist for their IPR clients as well as summary data are presented in Table 2, p. 58. Of the 107 IPR interventions that were completed in this study, 65 were mutual recalls, 24 were stimulus films, 10 were client recalls, 6 were significant other recalls, and 2 were video- tape recalls of stimulus films. 63 Inguiry (Recall) Procedures and Inquirers For the 65 mutual and 10 client recalls conducted in this study as part of the IPR interventions, objective, third-person inquirers or recallers were used for 20 to 30 minutes during the 50-minute IPR counseling sessions. The clients were always informed in advance about the inquirers, and brief introductions between clients and inquirers were made for initial meetings either prior to or at the beginning of the sessions. It was the inquirer's task to facilitate the client's recall during client recall or the client's recall and the therapists' recall during mutual recall of the previous 10- to lS-minute counsel- ing session. With the aid of the videotape, the inquirer kept the interaction primarily focused on the "there and then" of what actually already had happened prior to the inquirer's entry into the room. Thus, by avoiding “here and now" interactions between the inquirer and either the client or the therapist, the inquirer maintained a relatively neutral position and did not become another therapist who interpreted, confronted, reflected, etc. The inquirer facilitated the recall by asking either the client or the therapist short, explora- tory leads (e.g., "Do you remember what you were feeling?" or "What were you thinking at that time?“ or "What did you want from your therapist then?"). The inquirer role is explained in detail in the IPR instructor's manual (Kagan, 1976). Nine individuals served as inquirers for the recall sessions, including the investigator, a research assistant, two staff counselors, 64 two research therapists, two counseling psychology doctoral students, and one intern counselor. The inquirers were trained in the inquirer role for 5 hours after reading about it in the IPR instructor's manual. During this time they made practice videotapes of simulated counseling sessions and practiced the role with each other. The matching of inquirers with clients occurred primarily on the basis of scheduling and times available. A majority of clients experienced recall with more than one inquirer. Frequencies of conducted mutual and client recalls by inquirers are found in Table 3 below. Table 3: Frequency of Conducted Recalls by Inquirers Number of Recalls Inquirers Inquirer's Sex Conducted Male 28 Male 19 Female 1 Female Male Male Female Female Female OmeUT-th-H mmmmwpw Physical Environments All counseling sessions for both the IPR and traditional groups were held in rooms at the Georgia State University Counseling Center. The therapists used their own offices for all of the traditional 65 client counseling sessions and for those IPR client counseling ses- sions in which no IPR intervention technique was used. These offices were similar in design; each was relatively small, windowless, and typically contained a desk, three comfortable chairs, a bookshelf, and an unconcealed audiorecorder and microphone. All sessions for the IPR group where an IPR technique was used were conducted in a separate room used by all of the therapists. This room was also relatively small (15 ft. x 6 ft.) and windowless. It contained the necessary media equipment which was completely unconcealed: a SONY AV-3650 (half-inch tape, reel-to-reel) videotape recorder, a Shibadan camera, a portable TV monitor, a microphone, a Kodak 16mm autoload projector, and a screen that was attached to the wall. There was also a one-way-vision mirror through which client recalls could be observed from an adjoining room, but this mirror was always covered with a curtain unless an observed client recall was taking place. Instrumentation Five measures were used as criteria for the study: (a) the Personal Orientation Inventory (POI, Shostrom, 1963); (b) a modified version of the therapist and client forms of the Therapy Session Report (TSR, Orlinsky & Howard, 1966); (c) a modified version of the therapist and client forms of the Client Description of Problem Scale (pre) and the Progress of Counseling Rating Scale (post) (CDPS/PCRS, Seidam & June, 1972); (d) the Characteristics of Client Growth Scales, con- sisting of the three separate scales of Owning of Feelings (OF), 66 Commitment to Change (CC), and Differentiation of Stimuli (DS) (COGS, defined by Kagan, Krathwohl et a1., 1967; revised into a 5-point scale by Schauble & Pierce, 1974); and (e) the Depth of Self- Exploration Scale (0X, defined in a 9-point scale by Truax & Carkhuff, 1967; revised into a 5-point scale by Carkhuff & Berenson, 1967). In addition to these formal instruments, an informal "Comments" sheet was also included on which clients could give their personal thoughts and opinions about their counseling sessions. Therapists were interviewed after their clients had completed their research sessions in order to obtain their informal evaluations of the useful- ness of the IPR videotape and stimulus film techniques. The Personal Orientation Inventory (POI) The Personal Orientation Inventory is an instrument that has been widely used in counseling and psychotherapy research, both with individual clients and with groups. In addition to the information found in the P01 Manual (Shostrom, 1974), the many research studies based on the use of the POI and validity and reliability data are summarized in the Handbook for the P01 (Knapp. 1976). The theoretical structure of actualizing therapy used in the development of the POI is presented in Actualizing Therapy: Foundations for a Scientific Etpjp_(Shostrom, Knapp, & Knapp, 1976). Much of the following des- cription of the P01 was taken from these three primary sources. The P01 is made up of 150 two-choice, paired-opposite statements having to do with values, attitudes, and self-percepts. The examinees are asked to select one statement of each pair which they believe to 67 be most true of themselves. The initial item pool was collected from private therapists who formulated the statements on the basis of prob- lems of value judgment faced by their clients. The items selected for the 12 POI subscales were chosen by rational procedures according to the theoretical constructs of self-actualization. Writers in human- istic psychology associated with these constructs include Maslow, Reisman, Rogers, May, and Perls. Each item in the inventory is scored twice. The first scoring is for one of the first two subscales (Inner Directed and Time Compe- tent) with no item overlap. The second scoring is for the'Hlfollowing subscales, each measuring some relevant aspect of self-actualization. Shostrom (1976) states that this is not a forced choice instrument, and that the item format is better described as paired-opposites. The scale scores are normative rather than ipsative, and an individual can have high scores on all 12 scales or low scores on all 12 scales. Whereas one common method of handling the 150 items is simply to use the sum of the two major subscales as the overall measure of self- actualization (Damm, 1972), it was decided that each of the 12 sub- scale raw scores would be used as measures in this study since they relate to conceptually different aspects of self—actualization, each of which would seem to be important in this comparative counseling research. The first major subscale is Time Competent (lg with 23 items) and measures the degree to which a person can live primarily in the present without regrets and resentments from the past and without idealized expectations and goals for the future. The second major 68 subscale is Inner Directed (I_with 127 items), measuring the extent to which one can be primarily independent and self-supportive, guided by inner motivations rather than external influences. The third subscale is Self-Actualizing Value (SAy_with 26 items), measuring the degree to which an individual holds the general values of self-actualizing people. The fourth subscale is Existentiality (E5 with 32 items), measuring one's flexibility in applying values in life. The fifth subscale is Feeling Reactivity (f§_with 23 items), measuring the sensitivity of responsiveness to one's own needs and feelings. The sixth subscale is Spontaneity (§_with 18 items), measuring one's ability to freely express feelings behaviorally. The seventh scale is Self Regard (§5_with 16 items), measuring self- worth. The eighth subscale is Self Acceptance (§g_with 26 items), measuring the ability to accept oneself in spite of weaknesses. The ninth subscale is Nature of Man-~Constructive (Ng_with 16 items), measuring the degree to which one sees man as essentially good. The tenth subscale is Synergy (§y_with 9 items), measuring the ability to be synergistic and view the opposites of life as meaningfully related. The eleventh subscale is Acceptance of Aggression (p_with 25 items), measuring an individual's ability to accept anger within oneself as natural. The twelfth and final subscale is Capacity for Intimate Contact (9 with 28 items), measuring the degree to which one can have warm interpersonal relationships. A review of the instrument in Euros (1972) suggests that the content validity of the P01 scales is good, with a variety of content in the items used in the broadly defined scales. In the initial 69 predictive validation study reported by Shostrom (1964), doctoral- level psychologists nominated criterion samples of "self-actualizing" and "non-self—actualizing" individuals who then took the POI. When compared on their results, the "self-actualizing" group had higher mean scores that were statistically significant on 11 out of the 12 subscales, thus indicating a consistent difference between "self- actualizing" and "non-self—actualizing" groups on the POI. Other validation studies for individuals and groups are summarized in the Handbook for the POI and in the POI Manual. Test-retest reliability coefficients reported in the P01 Manual for a sample of 48 undergraduate college students on the two major subscales are .71 (Time Competent) and .77 (Inner Directed). Coeffi- cients for the other subscales for this sample ranged from .52 to .82. Use of the P01 in the present study seemed particularly approp- riate for the counseling center sample because the actualizing model is really an educational model in which responsibility for movement is shifted from the therapist to the client. As a measuring instru- ment, emphasis is placed on mental health rather than clinical pathology. Items are stated and scale constructs interpreted in a nonthreatening language which stresses the positive effects of therapy rather than focusing on the absence of illness or clinical symptoms. The time for taking the test (about 30 minutes) made it a feasible instrument to use along with other instruments for pre- and posttest- ing. And the normative data in the manual are geared to a college student population with the standard score profile sheet based on norms of 2,607 entering college freshmen. 70 The Therapy Session Report (TSR) The Therapy Session Report used in this study was a modified version of the two questionnaires, one for clients and one for thera- pists, devised for use in the Psychotherapy Session Project (Orlinsky & Howard, 1966). The modified forms (see Appendix A) were revised in order that they could be used as pretests and posttests, and the items used were similar to the items used by Schauble (1970) in his research on the use of IPR in counseling. Five of the six questions on the report are parallel for the therapists and clients, whereas one question on each of the therapist and client forms was dissimilar. This evaluation instrument gave an opportunity for clients to rate various dimensions of the therapeutic experience by answering the following six questions on the posttest forms (parallel questions were used for the pretest forms): (a) The last few sessions have been. . . ? (b) How do you feel about coming to the last few ses- sions? (c) How much progress do you feel you made in dealing with your problems during the last few sessions? (d) How well do you feel that you are getting along, emotionally and psychologically, at this time? (e) How well did your counselor seem to understand what you were feeling and thinking during the last few sessions? and (f) How helpful do you feel your counselor was to you during the last few sessions? The therapists evaluated the therapeutic experience similarly by independently answering the following six questions: (a) The last few sessions have been. . . ? (b) How motivated for coming to counsel- ing was your client during the last few sessions? (c) How much progress did your client seem to make in the last few sessions? (d) How well 71 does your client seem to be getting along at this time? (e) How much were you looking forward to seeing your client during the last few sessions? and (f) To what extent were you in rapport with your client's feelings lately? The Client Description of Problem Scale (COPS) and The Progress of Counseling Rating Scale (PCRS) Although the Therapy Session Report was included in this study as a measure of global satisfaction for various dimensions of the therapeutic experience, the investigator also wanted to use a more specific measure on which clients and therapists could rate the degree of achievement on individual counseling goals. The Client Descrip- tion of Problem Scale (pretest) and the Progress of Counseling Rating Scale (posttest) served this purpose. They are modified versions (see Appendix 8) of the originals which were developed for use in counsel- ing research by Seidam and June (1972). The CDPS and PCRS consist of the same items on the pretest and posttest on both the therapist and client forms. There are 18 pos- sible goals listed (e.g., improving my ability to have close rela- tionships with the opposite sex, dealing with unhappiness and depression, and becoming more aware of the true nature of my feel- ings), and there are also three open spaces where additional indi- vidual goals can be listed. Following each goal on the PCRS is a 9-point scale on which the clients and therapists rated the degree to which a particular goal was a problem (G) and the extent to which the goal was achieved (A) during the counseling sessions. The format 72 was similar on the initial CDPS, except that the degree to which it was hoped a goal would be achieved was marked on the 9-point scale. For the final analysis, a single index of perceived goal attain- ment was calculated by the investigator according to the following procedures. For both the CDPS and the PCRS, a ratio was calculated by taking the number marked on the 9-point scale for achievement of a goal (A) minus one, and dividing it by the number marked on the scale for the degree that a particular goal was a problem (G) minus one, summing these ratios, and then dividing by the total number of goal items marked: Z(A-l/G-l)/N. One was subtracted in each case in order that the first number in the 9-point scale could be interpreted as either no goal or no achievement on a goal, or, in other words, zero progress. In each case A_was not to exceed G, In the instances that A_did in fact exceed G, A_was actually calculated as being equal to G; that is, the goal was calculated as being totally achieved. The Characteristics of Client Growth Scales (COGS) The COGS consist of the three separate scales of Owning of Feelings (0F), Commitment to Change (CC), and Differentiation of Stimuli (DS). Whereas the other measures used in this study are self-report and therapist-report written instruments, the COGS have the advantage of being more objective measures since they are rating scales that were used by two judges who independently rated audio- tapes of first and last counseling sessions. Originally these scales were develOped by Kagan, Krathwohl et a1. (1967) to provide a method of measuring client progress in therapy with the following properties: 73 (a) They were not identified with any single counseling theory; (b) They were operationally definable and thus had objectivity and research utility, and the definable characteristics represented mean- ingful elements of counseling progress; (c) They were not necessarily exclusive of each other, thus the client could display two or more of the characteristics at any given moment; and (d) They were not intended to describe everything that went on in the counseling relationship. The criteria that were chosen for rating client progress represent obvious tasks that are necessary for client movement: (a) The client must own his discomfort and be aware of his feelings, (b) The client must commit himself to changing, and (c) The client must clearly dif- ferentiate stimuli in his world. The three scales used in this study (OF, CC, DS) were revised by Schauble and Pierce (1974) so that each scale consists of five con- tinuous levels where 1.0 is low and 5.0 is high. The complete scales with examples at each level can be found in Appendix C. The scales have been found to be valid and reliable instruments in several ther- apy research studies (Kagan, Krathwohl et a1., 1967; Resnikoff, Schauble, & Kagan, 1970; Schauble, 1970; Schauble & Pierce, 1974; Van Noord, 1973; Van Noord & Kagan, 1976). The Depth of Client Self- Exploration Scale (OX) The DX is a measure that is very similar in construction to the Owning of Feelings Scale, the Commitment to Change Scale, and the Differentiation of Stimuli Scale. It was used in this study along with the COGS as an objective measure of client progress in counseling 74 since it served as a rating scale for two judges who independently rated audiotapes of first and last counseling sessions. Originally it was constructed as a 9-point scale (Truax & Carkhuff, 1967); it was then later revised into a scale of five continuous levels (Carkhuff & Berenson, 1967), where 1.0 is low and 5.0 is high. The complete scale with examples at each level can be found in Appendix C. Another name that is used for this scale is Helpee Self-Exploration in Inter- personal Processes (Carkhuff, 1969). In order for clients to progress in counseling they must risk talking about personally relevant material with some degree of spon- taneity and emotional feeling. The DX measures the extent to which clients engage in self-exploration, ranging from no demonstrable intrapersonal exploration to a very high level of self-probing and exploration. Further descriptions of the scale along with reliability and validity data on outcome research can be found in the sources men- tioned above (Carkhuff, 1969; Carkhuff & Berenson, 1967; Truax & Carkhuff, 1967). Rating of Criterion Tapes Two independent judges were used to rate the audiotapes from the first and last counseling sessions on the clients' levels of owning of feelings (OF), commitment to change (CC), differentiation of stimuli (05), and depth of self-exploration (DX). Both judges were doctoral students in counseling psychology programs who were at the internship level in their training. Both had extensive previous 75 experience with behavioral rating scales which are used in process and outcome research. Training sessions in which the raters learned the OF, CC, 05, and 0X scales consisted of a total of 8 hours in three separate ses- sions. During this time the investigator provided a description of the scales and then had the judges make practice ratings on audio— tapes of counseling sessions that were similar to the research tapes. The practice tapes were stopped at various points and the judges' ratings were compared. A good deal of discussion occurred among the judges and investigator in order to delineate each of the five levels of each of the four rating scales. At the end of the practice ses- sions there appeared to be close interjudge agreement, as indicated by approximately four out of five ratings of perfect agreement. The judges rated the audiotapes independently. Neither judge had knowledge of the group, IPR experimental or traditional control, to which the clients had been assigned. This was accomplished through a totally random presentation of the taped segments on master tapes. Selection of Audiotape Segments for Rating A total of 50 clients participated in this study, resulting in a total of 100 audiotapes (50 from the initial counseling sessions and 50 from the final counseling sessions), each of which was approxi- mately 50 minutes long. Since it was impractical to rate every minute of all the tapes, it was necessary to decide on a segment sampling procedure. Several previous psychotherapy process research studies have explored the results of sampling audiotapes by different 76 procedures (Kiesler, 1966; Kiesler, Klein, & Mathieu, 1965; Kiesler, Mathieu, & Klein, 1964; Miller & Maley, 1969). This research indi- cated that segment sampling can accurately represent the total therapy session, that interrater and rerate reliabilities are unaffected by segment length, that the discriminatory power of the ratings is gen- erally independent of segment length, and that segments can be taken from the total tape in standard time periods or at random, but that for small samples random sampling produces the possibility of offer- ing unrepresentative data. With the above information in mind, the following sampling pro- cedures were used for this study: Three 4-minute segments were drawn from each pretape, and three 4-minute segments were drawn from each posttape; these three segments consisted of the 4 minutes immediately following the initial 5 minutes on the tape, the middle 4 minutes, and the 4 minutes immediately preceding the final 5 minutes of the tape. Thus, 4-minute segments were used from standard time periods. All segments, pre and post, experimental and control, were then randomly ordered and dubbed onto master cassette audiotapes (in dup- licate) for independent ratings by each judge. Ratings were made on each client statement within the 4-minute segments on the dimensions of OF, CC, 05, and DX. Reliability of Ratings Tinsley and Weiss (1975) have reviewed the different methods of calculating interjudge reliabilities. The interjudge reliabilities in this study were calculated according to Ebel's formula (Ebel, 1951), 77 using a two-way analysis of variance technique. Although each client statement was rated on each of the four dimensions of OF, CC, 05, and 0X, the reliabilities obtained were based on the average ratings of the three segments on each audiotape since this was the unit of analy- sis that was used in evaluating client movement. Interjudge reliabil- ity coefficients for the total audiotape sample (50 pretapes and 50 posttapes) are reported in Table 4 below. These reliabilities indi- cate that the ratings are sufficiently reliable for further analysis. For the final statistical procedures on these ratings, the averages of the two judges' ratings were used on each of the four dimensions. Table 4: Reliability Coefficients for Pretape and Posttape Ratings on the Client Dimensions of OF, CC, 05, and DX Dimension OF CC 05 DX Coefficient .81 .75 .79 .68 Client Written Comments and Therapist Reactions In addition to the formal measurements that were reviewed above, a "Comments" page was offered on an optional basis to the clients at the completion of their sessions. This allowed for an informal evaluation of the treatment programs. Clients were asked to indicate any impressions, reactions, or opinions that they wished to share about their counseling sessions. 78 Therapists were also asked for their informal evaluations of the research project during an audiotaped interview following the completion of their final research counseling sessions. During this time they made specific comments on the degree to which they believed the IPR videotape and stimulus film techniques were useful or not useful to them in helping their clients meet their goals. Collection of Data Audiotapes of the first and final research sessions were col- lected on each client; the tapes were then rated on the client dimen- sions of OF, CC, 05, and DX. After the initial session and prior to the second session, each client completed the POI, the CDPS, the TSR, and a brief biographical form for sex, GPA, and level in school. Following the final research session each client completed the P01, the PCRS, and the TSR, as well as the "Comments" form on an optional basis. These instruments were administered by testing personnel in the testing office of the Counseling Center at Georgia State Uni- versity. After the initial session of each client, the therapists com- pleted the CDPS and the TSR. After the final research session of each client, they completed the PCRS and the TSR. Informal reactions of therapists were obtained through an audiotaped interview after all 10 clients for each therapist had completed the research. It should be noted that although videotapes were used in the IPR experimental group as a counseling technique, they were not collected 79 for any form of data analysis; they were erased following recall to preserve confidentiality. Research Design The experimental design used in this study was the Pretest- Posttest Control Group Design; this is design 4 as described in Campbell and Stanley (1963). The illustration of this design is pre- sented in Figure 1. Group Pretest Posttest IPR Treatment (N=25) Ra 01 v 02 Traditional Control (N=25) R 03 Y 04 aR = random assignment of matched pairs. Figure 1. Research design A total of 50 subjects were used in this study. Each of the five research therapists saw 10 research clients, and, of these 10, 5 were assigned to the IPR experimental group and 5 to the tradi- tional control group. Although the five therapists maintained con- trol over which 10 clients they included in the research, the investigator maintained control over the assignment of clients to treatment groups. Clients were matched according to sex and time of entry into treatments and then randomly assigned to either the counseling with IPR group or the counseling without IPR group. Matching according 80 to sex was performed in order to have groups with corre5ponding numbers of each sex. Matching according to time of entry into treatments was performed in order to have clients begin counseling at corresponding times in each group. This was performed because initially there were not enough clients on the waiting list to ran- domly assign 50 clients to the groups, and, therefore, each client could not begin treatment at the same time. Thus, the first two males to begin treatment for each therapist were matched and randomly assigned to groups, and the first two females to begin treatment for each therapist were also matched and randomly assigned to groups, fol- lowed by the next two matched pairs, etc., until the groups were filled. Pretests (client self-reports, therapist reports, and audiotapes which were later rated by independent judges) were collected after the first sessions. This was done in order to control statistically for any possible initial differences in clients which might have con- founded final differences between the two groups, as well as to pro- vide for more powerful statistical analyses. Hypotheses The following hypotheses are stated directionally in favor of the IPR experimental group. This is done with the understanding that parallel null hypotheses were tested prior to the following alternative hypotheses. H]: Clients who receive personal counseling with IPR interven- tions will score higher on a measure of self-actualization, a correlate of mental health, as measured by higher adjusted Bl posttest subscale scores on the P01 than will clients who receive personal counseling without IPR. H2: Clients who receive personal counseling with IPR interven- tions will achieve a greater awareness of their feelings, a clearer motivation for growth-producing change, a more accurate ability to discriminate environmental stimuli, and a greater ability to engage in self-exploration in interpersonal situations as measured by higher adjusted posttest audiotape ratings on the scales of 0F, CC, 05, and 0X than will clients who receive personal counseling without IPR. H3: Clients who receive personal counseling with IPR interven- tions will be more satisfied with their experiences in counseling than will clients who receive personal counsel- ing without IPR as measured by higher client and therapist adjusted subscale scores on the TSR. H4: Clients who receive personal counseling with IPR interven- tions will achieve a higher percentage of their goals in counseling than will clients who receive personal counsel- ing without IPR as measured by higher client and therapist adjusted posttest scores on the PCRS. In the final statement of the specific research hypotheses in the next chapter, H3 and H4 will each be divided into parallel client and therapist hypotheses which will result in a total of six primary hypotheses. Additional informal hypotheses will also be stated in the next chapter predicting pre to post movement for clients in both treatment groups on the P01, on the COGS and DX, and on the client and therapist forms of the TSR. The null hypothesis (informal) will be stated for clients in both groups predicting no change pre to post on the client and therapist forms of the COPS/PCRS. These hypotheses are considered as being "informal" because they do not relate to the major design of the study, which is to compare the outcome effects of IPR treatment clients with traditional treatment clients. Also, the informal 82 hypotheses need to be viewed with some caution since there was no nontreatment or attention placebo control group. This type of group would have ruled out the possibility of pre to post outcome growth due to history and maturation effects without the aid of counseling. Analysis of the Data The data resulting from this investigation were analyzed for dif- ferences between the IPR experimental group and the traditional con- trol group by four MANOVA computer runs and two ANOVA computer runs. Prior to the final analyses, bivariate linear regression analyses for each subscale of each instrument were performed explaining the post- test in terms of the pretest. From these, a predicted posttest score for each participant on each subscale was computed. These predicted posttest scores were subtracted from actual posttest scores yielding "adjusted" or "residualized" change scores free from pretest score differences. The adjusted change scores were then analyzed in 2 x 5 (treatment by therapist) MANOVAs and ANOVAs according to the following division of the instruments: 1. £91_(clients): A 2 x 5 MANOVA (with equal cell frequencies) was used on the adjusted posttest raw scores for each of the 12 sub- scales to test for between group differences. 2. OF, CC, 05, and 0X (clients): The tape ratings made by the two independent judges on each one of these four subscales were aver- aged and then analyzed for between group differences by a 2 x 5 MANOVA (with equal cell frequencies) on the adjusted posttest scores. 83 3. CDPSZPCRS (clients): A 2 x 5 ANOVA (with equal cell fre- quencies) was used on the adjusted posttest scores on this scale to test for between group differences. 4. COPS/PCRS (therapists): A 2 x 5 ANOVA (with equal cell frequencies) was used on the adjusted posttest scores on this scale to test for between group differences. 5. I§R_(c1ients): A 2 x 5 MANOVA (with equal cell frequencies) was used on the adjusted posttest scores for each of the six sub- scales to test for between group differences. 6. I§R_(therapists): A 2 x 5 MANOVA (with equal cell frequen- cies) was used on the adjusted posttest scores for each of the six subscales to test for between group differences. The pretest data were collected in this study in order to adjust the posttest scores for initial differences. The hypotheses were then tested by the above statistical procedures on the adjusted posttest scores. In order to gather additional information, however, analyses were performed on the pre and post data in order to determine if the IPR and traditional treatment clients scored significantly higher on posttest scores than they did on pretest scores. To do this, two three-way ANOVAs and four three—way MANOVAs were used (treatment x therapist x time) with repeated measures on the last dimension. These six computer runs followed the division of instruments as stated above for the analyses on the adjusted posttest scores. These data were analyzed on a Univax 70/7 computer using programs taken from SPSSH, version 6.01, and BMD X69(12V). 84 If one total MANOVA had been used including all 30 subscale dependent variables, the significance level would have been set at .05. However, since six separate computer runs were performed on the adjusted posttest scores to test the hypotheses, the significance level was set at .01. This .01 level was also used for the six three-way repeated measures analyses performed to test for pre to post differences within groups. Subjective client and therapist comments were also examined non- statistically for between group differences of personal reactions to the treatment conditions. Summary The sample for this study consisted of 50 undergraduate and gradu- ate clients who had requested help with personal concerns from the staff of the Georgia State University Counseling Center during the l976-1977 academic year. Therapists were three counseling and clini- cal psychology staff interns and two staff therapists who, like the clients, volunteered to participate in the project. The experimental design used was a pretest-posttest control group design. The experimental group consisted of 25 clients who received traditional counseling with the addition of IPR videotape feedback and stimulus film techniques. The control group consisted of 25 clients who received traditional counseling alone. Clients were matched according to sex and time of entry into treatments and then randomly assigned to the groups. Each therapist saw 10 clients, 5 in each group. The number of 50-minute treatment sessions ranged from 85 4 to 15 for each client, and therapists were allowed to choose spe- cific IPR intervention techniques according to individual client needs. The five measures used as criteria for the study were the Personal Orientation Inventory (for clients), the Therapy Session Report (for clients and therapists), the Client Description of Problem Scale/the Progress of Counseling Rating Scale (for clients and therapists), the Characteristics of Client Growth Scales (for clients), and the Depth of Self-Exploration Scale (for clients). Ratings on these last two scales were made from audiotape samples from first and last sessions by two independent judges. Data from the first three instruments were collected after the first and last sessions. Subjective client and therapist comments were also obtained. Hypotheses were stated directionally in favor of the IPR experi- mental group. The data obtained in the study were analyzed for dif- ferences between the experimental and control group by four 2 x 5 (treatment by therapist) MANOVA and two 2 x 5 ANOVA computer runs. Prior to these final analyses, bivariate linear regression analyses for each subscale of each instrument were performed in order to obtain adjusted posttest scores free of pretest score differences. Addié tional analyses were performed to test for pre to post differences using four three-way MANOVAs and two three-way ANOVAs (treatment x therapist x time) with repeated measures on the last dimensions. The .01 level of significance was used in all cases. CHAPTER IV ANALYSIS OF THE DATA In this chapter an analysis of the data is presented based upon the methodology described in Chapter III. In the first section, the results of the analyses on the adjusted posttest scores for between treatment group differences are presented. In the second section, the results of the analyses in the pre and post raw scores for pre to post differences within the two treatment groups are presented. In the third and fourth sections, the results of a nonstatistical evaluation of client and therapist subjective comments about the treatments are presented. Results of the Analysis on the Adjusted Posttest Scores for Between Treatment Group Differences The results of the four MANOVA and two ANOVA computer runs on the adjusted posttest scores (free of pretest score differences) are pre- sented here. Although there are both treatment and therapist main effects, the hypotheses are concerned with the treatment effects. These hypotheses are stated directionally in favor of the IPR treat— ment group. Significance testing was carried out at the .01 level for each of the six computer runs. Summary MANOVA and ANOVA tables are included as well as tables of raw score pre and post means and standard deviations, and adjusted posttest means. 86 87 P01 MANOVA Results on Adjusted Posttest Scores H o 1. Clients who receive personal counseling with IPR interven- tions will score higher on a measure of self-actualization, a correlate of mental health, as measured by higher adjusted posttest subscale scores on the POI than will clients who receive personal counseling without IPR. Results: No significant difference in treatment effect between the IPR and traditional groups was found. Therefore, the null hypothe- sis was not rejected. An.£ (12,29) value of 2.87 is needed to reject the null at the .01 level. The §_obtained was 0.82, indicating very little between group differences on the P01 and no chance of significance. The thera- pist and the interaction effects were nonsignificant. The POI MANOVA summary information is presented in Table 5 below. Specific information about the raw score pre and post means and stan- dard deviations, and about the adjusted posttest means for each group, is presented in Table 6, pp. 88—89. Table 5: MANOVA of P01 Adjusted Posttest Scores Source fl 5 p Treatment 12/29 0.8194 p§_ Therapist 48/113.75 0.9018 1p; Interaction 48/113.75 0.9420 ns 88 Mwnw Facowu.e.ae wmnm H mmnw mmnm” wm.m mm w" Feco.u_ummw su.m=.p=oam M.“ Wm. WM. mm. m. .2. MW”... e. mum.“ “3 mm MW”... ”Mum Essen. 5:253»... mmnw _.=o.p.umah wwnm H wwnm mwumm ”mum mm M” .mco.p.emuw m=.~._.=uomo ccmucmum .mcmmz mcoum 28¢ Hon "m wpnmh 89 No”- Na. .NHN+ mm”. CNHON em”. NNHNP N.=o_N_NNLN pumacou m..2..=~ No + N. m+ NN m o. ON NN . no N_ mm. .o. Np.u.a.o mm Ease... Wm...” MK “MN...” mum ”WNW” sessmm .ommmwmww “mum _.=o..Nu..N mm” H ”WU” “WNW ”NH” “WNW _.=o.._ummw amgmcxm 2“... 2.2.5... mu“ a”. W: mm mm.” sass“... ..M......_W.N.........Mu N. N. N. .N N... N. N. NN N. N. N. N. 5%.“... afifiwwz as... N. m N. .2. so... 23.... umpmznu< suwz azoco com: ummpumoa ammumca ucmspmmcp um:e..=ou .N m.... 90 COGS and 0X MANOVA Results on Adjusted Posttest Scores H2: Clients who receive personal counseling with IPR interven- tions will achieve a greater awareness of their feelings, a clearer motivation for growth-producing change, a more accurate ability to discriminate environmental stimuli, and a greater ability to engage in self-exploration in interper— sonal situations as measured by higher adjusted posttest audiotape ratings on the scales of OF, CC, DS, and 0X than will clients who receive personal counseling without IPR. Results: No significant difference in treatment effect between the IPR and traditional groups was found. Therefore, the null hypothe- sis was not rejected. An f_(4,37) value of 3.88 is needed to reject the null at the .01 level. The [_value obtained was 2.79, indicating no significant between treatment group differences on the four tape process ratings of 0F, CC, 05, and 0X. The therapist and interaction effects were nonsignificant. The COGS and 0X MANOVA summary information is presented in Table 7 below. Specific information about the raw score pre and post means and standard deviations, and about the adjusted posttest means for each group, is presented in Table 8, p. 91. Table 7: MANOVA of COGS and 0X Adjusted Posttest Scores Source g_f_ f_ p Treatment 4/37.00 2.7907 pg? Therapist 16/113.67 1.1344 ng Interaction 16/113.67 0.4489 ns *.025 < p < .05. 91 N. N- N N. N N. .......N.NNN a”... 2.2.5.. a”... mm” mm”. mm M...” sass“... ......x”.._...._w.......m N... ages... a. N.” N...” m” mi Essen. ENE..." m”... 52...... mm M...” Wm mm” m. Essa. mg“... ummmwmom mammmwmmmwz mmcmso .mw .m .mw .a aaogw mpmumnsm umumsnu< cuvz usage cum: ammupmog ummumca Newsaomeh mcmmz umpmzwu< ecu .mcoppow>mo ccmucmum .mcmmz meoum 3mm xo use mwoo "w «pack 92 It should be noted that the E_value for the treatments on the cons and ox MANOVA is significant at the .05 level, but not at the .025 or .01 levels, and that the direction of the means favors the traditional group. Upon inspection of the univariate analyses of the four subscales, it was observed that most of the weight for this "trend toward significance" in the direction opposite that predicted came from the CF scale. The obtained OF scale ANOVA f_(1,40) value was 4.41, which is significant at the .05 but not at the .025 or .01 levels. The {_values for the ANOVAs on the CC and DS scales were both below 1.0, indicating no possibility for significance. And the f_(l,40) value for the ANOVA on the 0X scale was 1.69, which was nonsignificant at the .10 level. TSR (Clients) MANOVA Results on Adjusted Posttest Scores H3: Clients who receive personal counseling with IPR interven- tions will be more satisfied with their experiences in counseling than will clients who receive personal counsel- ing without IPR as measured by higher client adjusted sub- scale scores on the TSR. Results: No significant difference in treatment effect between the IPR and traditional groups was found. Therefore, the null hypothesis was not rejected. An [_(6,35) value of 3.37 is needed to reject the null at the .01 level. The E_va1ue obtained was 0.47, indicating very little between group differences and no chance for significance on the client form of the TSR. The therapist and the interaction effects were non- significant. 93 The TSR (clients) MANOVA summary information is presented in Table 9 below. Specific information about the raw score pre and post means and standard deviations, and about the adjusted posttest means for each group, is presented in Table 10, p. 94. Table 9: MANOVA of TSR (Client Form) Adjusted Posttest Scores Source fl 5 p Treatment 6/35 0.4675 ‘pg Therapist 24/123.3l 0.8500 up; Interaction 24/123.31 0.9589 ns TSR (Therapists) MANOVA Results on Adjusted Posttest Scores H4: Clients who receive personal counseling with IPR interven- t1ons w111 have more sat1sfy1ng and more productive coun- seling sessions than will clients without IPR as measured by higher therapist adjusted subscale scores on the TSR. Results: No significant difference in treatment effect between the IPR and traditional groups was found. Therefore, the null hypothesis was not rejected. An 5 (6,35) value of 3.37 is needed to reject the null at the .01 level. The [_value obtained was 0.86, indicating very little between treatment group differences and no possibility for signifi- cance on the therapist form of the TSR. The therapist effect was significant at the .001 level, indicating that at least two of the therapists significantly differed on the ratings that they gave to the counseling experience of all their clients, including both IPR 94 ...+ ... + .... N... .N.. N... .........e. ...- .........L. ... + .N. .... N... N... ... N ...- ... ... + .... N... ... N... ........... N ...+ .N. + ... N... ... N... ... N... ....+ .... .... .N. N... ........... ...- ........... ... + ... N... .N. .... ... . N..- ... ....+ .... .... ... .... .........g. . N... ....+ .N. N... N... .... ... ...- ... ... + N... N... N... N... .........L. N ...+ ... + ... .... .... .N.. ... ...- ... ... + .... N... ... N... .........g. . ...+ ... + ... .... .N. .... ... com mm... :8 1 I 1 1 ......u. ...: .3... z . a . meow: empmznu< new .mcomuem>mo nemucmum .mcmmz mcoum 3mm Ascot ucmw—uv am. "o. m.... 95 and traditional groups. The therapist effect does not relate to the above hypothesis (since there is no treatment x therapist interaction effect), which is concerned with between treatment group, not between therapist, differences. The TSR (therapists) MANOVA summary information is presented in Table 11 below. Specific information about the raw score pre and post means and standard deviations, and about the adjusted posttest means for each group, is presented in Table 12, p. 96. Table 11: MANOVA of TSR (Therapist Form) Adjusted Posttest Scores Source at f_ p Treatment 6/35 0.8625 p§_ Therapist 24/123.3l 2.7801 <.OOl Interaction 24/123.31 1.3340 ns COPS/PCRS (Clients) ANOVA Results on Adjusted Posttest Scores H5: Clients who receive personal counseling with IPR interven- tions will achieve a higher percentage of their goals in counseling than will clients who receive personal counsel- ing without IPR as measured by higher client adjusted posttest scores on the PCRS. Results: No significant difference in treatment effect between the IPR and traditional groups was found. Therefore, the null hypothe- sis was not rejected. An §_(l,40) value of 7.31 is needed to reject the null at the .01 level. The [_value obtained was 0.10, indicating very little 96 N..- ... NN. + .N. .N.. ... N... .........L. N N..+ N.. + N... .N.. .N. N... ... ....- ... . .N. + N... .N.. .... ...N ........... N ....+ .N. + N... .N.. ... N... .N. ...- .N. .N. + .N. N... .N. .... ........... . ...+ ....+ .N. .... .N. .N.. .N. N..- .N. N.. + .... .N.. .N. N... .........L. . N... ....+ .... N... .N. N... .N. ...- ... ... + .N. .N.. ... N... ........... N ...+ .N. + N.. N... .N. N... .N. ...- .N. .N. + .N. .N.. N.. .... .........g. . ...+ N.. + .... .... ... N... ... :Nm mac. :Nm 11- 1. .11 .- .....N.< ...: .3... . . . p . mcmmz cmumanc< ecu .mcowue.>mo ugeucmum .mcmmz mcoum 3mm Asgom um.amemghv mm. .N. mp... 97 between group differences on the client form of the COPS/PCRS and no possibility of significance. The therapist and interaction effects were nonsignificant. The COPS/PCRS client ANOVA summary information is presented in Table 13 below. Specific information about the raw score pre and post means and standard deviations, and about the adjusted posttest means for each group, is presented in Table 14, p. 98. Table 13: ANOVA of COPS/PCRS (Client Form) Adjusted Posttest Scores Source d_f_ _F_ p Treatment 1/40 .0995 up; Therapist 4/40 .3399 .pg Interaction 4/40 .7698 ‘pg COPS/PCRS (Therapists) ANOVA Results on Adjusted Posttest Scores H o 6' Clients who receive personal counseling with IPR interven— tions will achieve a higher percentage of their goals in counseling than will clients who receive personal counsel- ing without IPR as measured by higher therapist adjusted posttest scores on the PCRS. Results: No significant difference in treatment effect between the IPR and traditional groups was found. Therefore, the null hypothe- sis was not rejected. An f_(l,40) value of 7.31 is needed to reject the null at the .01 level. The [_value obtained was 0.10, indicating very little between group differences on the therapist form of the COPS/PCRS and 98 ...+ ...- ... ... ... .N. .........L. ........... ....N ...- N..- .N. ... N.. .N. ... ...-Mm”... mmmmuwmmmwz $.85 mm a .N.-m- m .395 m .333 umumanc< 39.3 azoso cmmz pmwpumo. ammumga ucmsummgh ....z ......N. ... ........>.. ......u. .....2 mg... 3.. .5... ......v ....NN... ... ..... 99 no possibility of significance. The interaction effect was nonsig- nificant. The therapist effect was significant at the .00l level, indicating that at least two of the therapists significantly differed on the ratings that they gave for goal achievement for all of their clients, including both the IPR and traditional treatment groups. This therapist effect does not relate to the above,hypothesis (since there is no treatment x therapist interaction effect), which is con- cerned with between treatment group, not between therapist, dif- ferences. The CDPS/PCRS therapist ANOVA summary information is presented in Table l5 below. Specific information about the raw score pre and post means and standard deviations, and about the adjusted posttest means for each group, is presented in Table l6, p. 100. Table l5: ANOVA of CDPS/PCRS (Therapist Form) Adjusted Posttest Scores Source 91 E p Treatment l/40 .l037 Q§_ Therapist 4/40 l4.910l <.OOl Interaction 4/40 1.6743 ns Results of the Analyses on the Pre and Post Raw 'Scores for Pre to Post Differences Within the IPR and Traditional Treatment Groups The hypotheses of this study were concerned with differences between the IPR and traditional treatment groups on the adjusted H 100 mo.- mo.- mp. cu. m_. mu. pmcoppwomgh mam mpmou oo.+ 50.- ap. ON. a.. nu. an” 2%... Aura“. .25 m a m a ...... 2...... nonmanu< guy: azogo :mwz pmwupmom ummpmga ucmswmmgh memo: umpmzwu< ucm .mcowumw>mo ugoucmum .mcmwz mgoum 3mm flexed unwamgmghv mmua\maou "oF mpamh lOl posttest scores. Additional informal hypotheses were formulated predicting clients in both groups to improve from pre to post testing. That is, clients in both treatment groups were expected to improve on the P01, on the COGS and DX, and on the client and therapist forms of the TSR. Since the goal instrument (COPS/PCRS) differs from the above instruments in that it has to do with predicting and then stating how many specific goals are achieved, no pre to post differences would be expected. This measure was important for the previous analy- sis in testing for between group differences, and, thus, the pre scores were important for adjusting the post scores for initial differences. Since the means for both client and therapist forms of this measure decreased pre to post, however, the results of the pre to post analyses are included here. The pre and post data were analyzed by two three-way ANOVAs and four three-way MANOVAs (treatment x therapist x time) with repeated measures on the last dimension. These computer runs follow the divi- sion of instruments as used above for the between group analyses. The .Ol level of significance was used with each of the six analyses. The results of these analyses must be considered with some cau- tion, however, because there was no nontreatment or attention placebo control group to compare the effects of counseling with no counsel- ing. 0n the P01 and TSR, test-retest issues could have been a prob- lem, but not on the COGS and DX since they were ratings by independent judges of taped sessions. History and maturation effects could have been a threat to internal validity, since it is not known whether 102 clients would have improved over time with no treatments or an attention placebo. POI Pre to Post Repeated Measures MANOVA Results on Raw Scores H7: Clients in both the IPR and traditional treatment groups will score higher on a measure of self-actualization, a correlate of mental health, at the end of their counseling sessions than at the beginning, as measured by higher post POI subscale scores. Results: A significant difference for both the IPR and tradi- tional treatment groups was found on the P01 (with post means higher than pre means). Thus, the null hypothesis was rejected and the alternative accepted. An §_(l2,29) value of 2.87 is needed to reject the null at the .01 level. The obtained {_value of 6.04 is significant at less than the .00l level. Since there was no treatment x time interaction effect, and since the means on each of the 12 subscales for both treatment groups were higher on the post scales (see Table 6, p. 88), it can be stated that both groups significantly improved over time. The therapist significant effect (2 less than .001) and the therapist x treatment significant effect (p_less than .00l) are not important here, but it indicates that clients of at least two therapists in the two treatment groups had significantly different responses on the P01, which included both the pre and post data. As stated earlier and summarized in Table 5, p. 87, the therapist x treatment interaction effect and the therapist effect on the adjusted posttest scores MANOVA had no possibility of being significant since the [_values are less than 1.00. 103 Each of the l2 subscale means on the P01 for each treatment contributed to the significant time effect since all the means increased pre to post. When the univariate analyses were examined for each of the l2 subscales, each had a significant time difference at the .01 level or less except for scale 9 (Nature of Man-- Constructive), which was significant at the .025 level. The POI pre to post MANOVA summary information is presented in Table l7 below. Table l7: MANOVA of P01 Pre- and Posttest Raw Scores Source 91: f_ p_ Time 12/29 6.0364 <.00l Treatment 12/29 l.ll02 'Qg Therapist 48/llB.75 2.8545 <.00l Time x Treatment 12/29 0.6926 TE Time x Therapist 48/ll3.75 0.9250 g§_ Treatment x Therapist 48/ll3.75 2.llll <.00l Time x Treatment x Therapist 48/ll3.75 l.0l65 g§_ COGS and DX Pre to Post Repeated Measures MANOVA Results on Raw Scores Clients in both the IPR and traditional treatment groups will achieve a greater awareness of their feelings, a clearer motivation for growth-producing change, a more accurate abil- ity to discriminate environmental stimuli, and a greater ability to engage in self-exploration in interpersonal situa- tions at the end of their counseling sessions than at the beginning, as measured by higher post subscale scores on the scales of 0F, CC, 05, and ox. H8: Results: No significant pre to post differences in either the IPR or traditional treatment groups were found on the process 104 dimensions of the COGS and DX. Thus, the null hypothesis was not rejected. An f_(4,37) value of 3.88 is needed to reject the null at the .01 level. The obtained §_value of 2.60 indicates no significant dif- ference (neither was this value significant at the .05 level). There was no treatment x time interaction effect (at the .01 or .05 levels). Thus, even though all four traditional group means increased slightly pre to post, and only one of the IPR group means increased pre to post (see Table 8, p. 91), these differences were not significant as an interaction. The COGS and DX pre to post summary information is pre- sented in Table 18 below. Table 18: MANOVA of COGS and DX Pre- and Posttest Raw Scores Source g: E p Time 4/37 2.5970 gs? Treatment 4/37 0.2279 .gg Therapist 16/113.67 1.9927 g§f* Time x Treatment 4/37 2.5449 g§f** Time x Therapist 16/113.67 1.0411 n§_ Treatment x Therapist 16/113.67 0.8629 .gg Time x Treatment x Therapist 16/113.67 0.3066 g§_ *.05 < p_< .10. **.01 < p_< .05. ***.05 < p_< .10. 105 TSR (Clients) Pre to Post Repeated Measures MANOVA Results on Raw Scores H9: Clients in both the IPR and traditional treatment groups will be more satisfied with their counseling seSSions at the end than at the beginning of their counseling as measured by higher post client TSR subscale scores. Results: A significant difference for both the IPR and tradi- tional treatment groups was found on the client form of the TSR (with means higher on posttests). Thus, the null hypothesis was rejected and the alternative accepted. An [_(6,35) value of 3.37 is needed to reject the null at the .01 level. The obtained f_value of 9.00 is significant at less than the .001 level of significance. Since there was no treatment x time interaction effect, and since the means increased for both treatments over time (see Table 10, p. 94), it can be stated that both treatment groups significantly improved over time. Each of the subscales contributed to this overall significant time difference as revealed by the increase in means on all subscales (except for scale 2 in the traditional group, see Table 10, p. 94). When the univariate analyses were examined for each of the levels of the TSR, subscales 1, 3, 4, and 6 were found to be significant at the .01 level or less, and scales 2 and 5 were nonsignificant at the .10 level. These subscales were described under instrumentation in Chapter III. The client TSR pre to post MANOVA summary information is presented in Table 19, p. 106. 106 Table 19: MANOVA of TSR (Client Form) Pre- and Posttest Raw Scores Source g: _li 3 Time 6/35 8.9962 <.001 Treatment 6/35 0.8132 15. Therapist 24/123.31 0.8965 E Time x Treatment 6/35 0.2274 .9; Time x Therapist 24/123.31 1.0194 .gg Treatment x Therapist 24/123.31 1.5201 gs? Time x Treatment x Therapist 24/123.31 1.0756 ns *.05 < p_< .lO. TSR (Therapists) Pre to Post Repeated Measures MANOVA Results on Raw Scores H10: Clients in both the IPR and traditional treatment groups will have more satisfying and more productive counseling sessions at the end of their treatment than at the begin- ning as measured by higher post therapist TSR subscale scores . Results: A significant difference for both the IPR and tradi- tional treatment groups was found on the therapist form of the TSR (with post means higher than pre means). was rejected and the alternative accepted. An f_(6,35) value of 3.37 is needed to reject the null at the .01 level. The obtained [_value of 13.79 is significant at less than the .001 level. Since there was no treatment x time interaction effect, and since the six subscale means increased for both treatment Thus, the null hypothesis groups, it can be stated that both groups significantly improved over time. The therapist significant effect is not important here, but it indicates that at least two of the therapists significantly differed 107 on the ratings that they gave to the pre and post counseling experi- ences of all their clients. Each of the subscales for both groups contributed to the overall significant time difference (see Table 12, p. 96). When the univari- ate analyses were examined for each of the six levels, subscales l, 3, 4, 5, and 6 were found to be significant at the .01 level or less, and scale 2 was nonsignificant at the .10 level. These subscales are described under instrumentation in Chapter III. The therapist TSR pre to post MANOVA summary information is presented in Table 20 below. Table 20: MANOVA of TSR (Therapist Form) Pre- and Posttest Raw Scores Source d_f_ _F_ p_ Time 6/35 13.7866 <.OOl Treatment 6/35 1.7414 .9; Therapist 24/123.31 4.2212 <.OOl Time x Treatment 6/35 1.3148 'Qg Time x Therapist 24/123.31 1.8311 gs} Treatment x Therapist 24/123.31 1.5222 n§f* Time x Treatment x Therapist 24/123.31 1.3476 gs *.01 < p < .05. **.05 < p_< .10. COPS/PCRS (Clients) Pre to Post Repeated Measures ANOVA Results on Raw Scores As stated at the beginning of this section, the COPS/PCRS goal instrument can not properly be viewed as a measure of pre-post 108 improvement. The pretest was most suitable for adjusting posttest scores for initial pretest score differences. The pretest measured the degree to which clients (and therapists) hoped to achieve their goals, and the posttest measured the degree to which clients (and therapists) believed they actually reached their goals in counseling at the time of the final research sessions. The results of the pre to post ANOVA analyses on the client and therapist forms of the CDPS/ PCRS are included here for additional information, with informal hypotheses predicting no pre to post differences. H1]: No difference will be observed in either the IPR or tradi- tional treatment groups between the clients' prediction of how much they hope to achieve their goals at the beginning of counseling on the CDPS and the degree to which they rate that they actually achieve their goals at the end of their counseling sessions on the PCRS. Results: A significant difference for both the IPR and tradi- tional treatment groups was found on the COPS/PCRS (with post means lower than pre means for both groups). Thus, the null hypothesis was rejected. Anifi (1,40) value of 7.31 is needed to reject the null at the .01 level. The obtained {_value of 7.45 was significant at this level. Since there was no treatment x time interaction effect, and since the means on this scale for each of the treatment groups dropped pre to post (see Table 14, p. 98), it can be stated that clients in both groups predicted the achievement of their goals to a signifi- cantly higher degree than they rated their final achievement of their goals. The COPS/PCRS (clients) pre to post ANOVA summary information is presented in Table 21, p. 109. 109 Table 21: ANOVA of COPS/PCRS (Client Form) Pre- and Posttest Raw Scores Source g f_ 3 Time 1/40 7.4530 <.Ol Treatment 1/40 0.0258 .fli Therapist 4/40 1.6720 .05 Time x Treatment 1/40 0.0716 gs Time x Therapist 4/40 0.8267 .fli Treatment x Therapist 4/40 0.7636 ‘ng Time x Treatment x Therapist 4/40 0.6519 ns COPS/PCRS (Therapists) Pre to Post Repeated Measures ANOVA Results on Raw Scores H12: No difference will be observed in either the IPR or tradi— tional treatment groups between the therapists' prediction of how much they believe their clients will achieve their goals at the beginning of counseling on the COPS and the degree to which they rate their clients as actually achiev- ing their goals at the end of their counseling sessions on the PCRS. Results: A significant difference for both the IPR and tradi- tional treatment groups was found on the COPS/PCRS (with post means lower than pre means for both groups). Thus, the null hypothesis was rejected. This statement must be made with caution, however, as des- cribed below. An §_(l,40) value of 7.31 is needed to reject the null at the .01 level. The obtained E value of 13.07 was significant at less than the .001 level. The means for both the IPR and traditional groups dropped pre to post (see Table 16, p. 100). There was, however, a therapist effect (.001 level) and a therapist x time interaction 110 effect (.001 level) but no treatment x time interaction effect. An investigation into the cell means revealed that one therapist rated both IPR and traditional treatment clients as having actually achieved their goals higher than he predicted they would on the pretest. Each of the other four therapists rated both groups of clients lower on the post. Overall, however, it can be stated that the therapists rated a significantly lower degree of achievement of their clients' goals than they predicted they would achieve at the beginning. The COPS/PCRS (therapist) pre to post ANOVA summary information is presented in Table 22 below. Table 22: ANOVA of COPS/PCRS (Therapist Form) Pre- and Posttest Raw Scores Source g: 5 p_ Time 1/40 13.0677 <.001 Treatment 1/40 0.1767 gs. Therapist 4/40 15.0289 <.OOl Time x Treatment 1/40 0.1767 ‘Qg Time x Therapist 4/40 11.5658 <.OOl Treatment x Therapist 4/40 0.8304 pg; Time x Treatment x Therapist 4/40 1.6750 Egg Subjective Client Comments In addition to the formal instruments which provided quantifiable data that could easily be analyzed, an informal "Comments" page was included in the posttesting for clients to make any statements about the treatments or the counseling process on an optional basis. 0f 111 the 25 IPR treatment clients in the research program, 19 chose to respond on this “Comments" page, and of the 25 traditional treatment clients, 18 chose to respond. A nonstatistical inspection of these comments revealed no differ- ences between the IPR and traditional treatment clients concerning their satisfaction with their counseling experiences. This cor- relates with the objective data on the TSR and on the COPS/PCRS which showed no significant differences in degree of satisfaction with counseling and goal attainment between clients in the two treatment groups. Almost all of the 37 clients who responded highly accentuated the positive aspects of their counseling experiences. Most of the comments were global rather than specific. Repre- sentative statements are: "The counseling sessions have been a great help to me," and "I think the Counseling Center is one of the best things about this University and provides a needed service." Three clients in each of the treatment groups stated that they would have preferred their sessions to continue for a longer period of time. One client stated that he wished his counselor had been more knowledge- able of the situation with which he was dealing, but he did not clarify this. Of the 19 IPR clients who responded on the "Comments" sheet, eight clients made at least one reference to the videotape and two clients made a reference to the stimulus films. One of the latter clients replied, "The most helpful and self-rewarding sessions were those in which we used the films as a basis for interaction and com- munication." The other client stated, "For my counselor the movie 112 clips seemed to be helpful, however they weren't very applicable to myself." 0f the eight clients who made statements on the use of video- tape feedback in their sessions, six were very positive, one was mixed, and one was negative. The negative comment was nonspecific about the videotape: "Several great people work at the Counseling Center that really 'vibrate' with happiness. The people here do much more than the machines, i.e., the biofeedback machine and the TV monitor. It is the discussions that are the most bright and not the machine." The mixed comment was: "Sometimes Ifelt that the videotaping was an interference with my sessions with [my therapist]. I held back most of what I wanted to say--dea1t with generalities rather than specifics. Sometimes it was helpful to review the tapes to better under- stand how [my therapist] was seeing me and to clarify things." Of the six clients who made positive comments on the use of videotape, one client said she "enjoyed the videotape sessions and felt that they were very revealing." She went on to say that she would have appreciated more feedback from the inquirers. Another client stated, "I feel as though the video sessions were very good and very helpful," and then went on to say that he wished he could have reviewed the tapes at a later date. The other four comments were as follows: I'I found the sessions in which videotaping was used very help- ful. I would have liked it to have been used more." "Taping of sessions eliminated the need to repeat information previously discussed and helped me believe that the counselor understood and was interested." 113 "I have wondered if the videotaping techniques have caused any changes that could be considered global as opposed to isolated behaviors. I think seeing myself on videotape made me realize how obnoxious my intellectualizing is and how hard and scat- tered I appear. And that led directly to my allowing myself to feel vulnerable which allows me to feel more of everything and, I think, appear softer and more real." "I found the video-taping quite helpful in underlining commu- nication. I had never really thought much about what happens (goes on) with myself or the person I'm interacting with, particularly wants, needs, and feelings in general." Subjective Therapist Comments A discussion was held with the research therapists after the completion of their final research sessions about the use of the IPR techniques. These discussions were audiotaped and then reviewed for writing the following subjective therapist comments. All of the therapists believed that the IPR videotape and stimu- lus film intervention techniques were helpful with their clients. They each stated that they were pleased to add the techniques to their repertoire of therapeutic skills, and that they planned to use them occasionally with their clients in the future. Three of the therapists, in fact, used the videotape recall technique with some of their nonresearch clients, and a fourth thera- pist used the stimulus films two times with an IPR research client after the final 15th research session when the posttests were taken. The client told her therapist that the films were important in helping her to share her feelings more openly with her friends, and that she no longer became "upset" at her friends when they did not simply know what she was feeling without her telling them. 114 Each of the therapists stated that they found the videotape recall to be helpful to themselves in improving their therapeutic styles. One therapist said the tapes helped him focus more on process and not get so caught up in content. Another therapist commented that he became more self-disclosing with his IPR clients through the use of the inquirer and the recall, and that he found this to be bene- ficial. He said that the videotape recall made it easier to convey to his clients that he did in fact understand them. Four of the therapists said they found the mutual recall tech- nique to be most effective because they could actively participate in the recall process, learn from it, and express themselves more openly with their clients. The fifth therapist found client recall to be most useful, and he said that he used it the most because it provided the best therapeutic intervention for the specific research clients that he saw. Four of these clients were women who had diffi- culties with men, and he wanted to give them a period of distance from him by viewing the videotape with the help of an inquirer but without his being in the room or watching through a one-way mirror. He noted that this brought up the issue of fears of abandonment and it proved to be a stimulus for therapeutic work on this underlying dynamic. Each of the therapists believed that the stimulus films were more effective with some clients and the videotape with others. One thera- pist in particular found no therapeutic value in using the videotape with one client, but found that the stimulus films were very beneficial in assisting her to talk about and label her feelings. Two of the 115 therapists noted that the therapeutic value of the videotape was in direct proportion to the extent that the clients wanted to see them- selves and to actively engage in learning about their interactions with their therapist. One client refused to look at herself on the videotape. Her therapist initially feared that this form of self- confrontation might have been harmful at that stage in her therapy, but the therapist reported that this client made a great deal of improvement in relating to her Openly and in raising her self-concept. Two of the therapists said they found the films and videotape valuable as an assessment tool, both for themselves and for their clients. The main criticism of the IPR techniques was that therapists did not like having to use them on a regular basis with their IPR clients (50% of the sessions during the first 10 sessions and once in the next 5). Two of the therapists believed that the techniques were occasionally intrusive and detracted from the sessions because they had to use them when they did not want to do so. As an example, one therapist said his client refused to get deeply involved in her painful feelings when she knew the session would be interrupted with an inquirer entering to do recall. Although the therapists recog- nized the need for the structure of the interventions due to the con- trolled research, they also were aware that this need for internal validity control detracted from their ability to be as effective with their clients at all times as they could have been without the struc- ture. One therapist said that he found a couple of his clients to be distracted and more anxious during the initial videotaping sessions 116 due to the presence of the equipment. But he went on to say that they became much more focused and less anxious during recall when they were allowed to see themselves on tape. He also said that this distraction effect occurred only during the initial videotape ses- sions. Summar In the initial section of this chapter, the results of the analyses on the adjusted posttest scores for between group differences were presented. Six hypotheses were stated predicting that higher adjusted posttest scores would be found with IPR treatment clients than with traditional treatment clients on the P01, the COGS and 0X, the client form of the TSR, the therapist form of the TSR, the client form of the COPS/PCRS, and the therapist form of the COPS/PCRS. Sig- nificance testing was carried out at the .01 level. The results of the six 2 x 5 (treatment x therapist) MANOVA and ANOVA computer runs indicated that there were no significant differences between treatment groups on any of the six measures. Thus, none of the null hypotheses were rejected. In the second section of this chapter, the results of the analy- ses on the pre and post raw scores for pre to post differences within the IPR and traditional treatment groups were presented. Four informal hypotheses were stated predicting that higher posttest over pretest raw scores would be found within both the IPR and traditional treatment groups on the P01, the COGS and OX, the client form of the TSR, and the therapist form of the TSR. Significance testing was carried out 117 at the .01 level. The results of the four three-way MANOVAs (treatment x therapist x time) with repeated measures on the last dimension indicated that there were pre to post significant differ- ences in both the IPR and traditional treatment groups on the POI and on the client and therapist forms of the TSR, but not on the COGS and 0X. Thus, the null hypotheses for the POI, the client form of the TSR, and the therapist form of the TSR were rejected and the alternatives accepted. For the COGS and 0X, however, the null hypothesis was not rejected. Two informal hypotheses were stated predicting no pre to post differences on the client form of the COPS/PCRS and the therapist form of the COPS/PCRS. Significance testing was carried out at the .01 level. The results of the two three-way ANOVAs (treatment x therapist x time) with repeated measures on the last dimension indicated that there were pre to post significant differences in both the IPR and traditional treatment groups (with the means decreasing pre to post) on both the client and therapist forms of the COPS/PCRS. Thus, the null hypotheses were rejected. This means that both clients and therapists (in both treatment groups) predicted at the beginning of counseling that they (the clients) would achieve their goals in counseling to a significantly higher degree than they rated that they actually achieved their goals at the end of counseling. In the third section of this chapter, a nonstatistical evalua- tion of client subjective comments was presented. Nineteen of the 25 IPR clients responded on a "Comments" form and 18 of the 25 tra- ditional clients responded. Almost all of the 37 clients made 118 statements stressing the positive benefits that they received from counseling. A nonstatistical evaluation between the two treatment groups showed no differences concerning their satisfaction with their counseling experiences. Most responses were global rather than spe- cific, such as "The counseling sessions have been a great help to me." Of the 19 IPR clients who responded 0n the "Comments" form, 2 made references to the stimulus film techniques and 8 made ref- erences to the videotape techniques. Of these 10 references to IPR interventions, l was slightly negative, 2 were mixed, and 7 were positive statements. In the fourth section of this chapter, an informal evaluation of therapist subjective comments about the use of IPR techniques was presented. Each of the therapists believed that the IPR videotape recall and stimulus film techniques were helpful to their clients, and each was pleased to add the techniques to their repertoire of therapeutic skills. Therapists fOund that the stimulus films worked better with some clients and the videotape recall better with others. Their primary criticism was in having to use the techniques on a regular basis (due to the structure of the research design) with each of their IPR clients. This, they believed, was not helpful at times and occasionally resulted in less effective treatment sessions. Thus, although therapists were positive in their statements about the use of IPR techniques, they believed that the most effective use of the interventions would require a great deal of therapeutic flexibility and freedom. CHAPTER V SUMMARY AND CONCLUSIONS ml The purpose of this study was to evaluate the effectiveness of using the Interpersonal Process Recall (IPR) model in counseling and psychotherapy. IPR videotape and stimulus film techniques were used as therapeutic interventions in combination with traditional dyadic treatment methods and compared with the use of the traditional treat- ment methods without IPR techniques. The basic question underlying the research project was whether clients who experienced IPR inter- ventions would improve more (as evidenced by higher scores on process and outcome measures) than clients who did not experience IPR tech- niques in a therapy series of 4 to 15 sessions. A review of the literature on controlled research studies in counseling and psychotherapy indicates that there is adequate evi- dence that clients who receive psychological treatment improve more than do untreated controls. Studies reveal (Smith & Glass, 1977) that the typical therapy client is better off than 75% of untreated controls. The research has not demonstrated, however, that any one form of psychotherapy treatment is better than another. Researchers are turning from the question of whether or not counseling and psycho- therapy works to the question of what works best with whom under which conditions. The current study is a step toward further specificity in 119 120 that it examines the effects of a particular treatment model when integrated into traditional dyadic counseling methods. It is hoped that this research will stimulate further investigations toward more specificity, such as examining which IPR techniques work best with what types of clients at which stages in the therapeutic process. The IPR model as used in this study was a modified replication of the model used in studies by Schauble (1970) and Van Noord (Van Noord, 1973; Van Noord & Kagan, 1976) which had inconsistent results. Schauble found that IPR interventions did result in significant posi- tive changes in client growth and outcome when compared to control clients, whereas Van Noord found no significant differences. The major recommendations from these previous studies that were incor- porated into the current study were as follows: (a) The sample size was increased from 12 to 50 clients, (b) The number of sessions was changed from a fixed 6 sessions to an allowable range of 4 to 15 ses- sions, and (c) Therapists were allowed more flexibility in the use of the IPR techniques according to individual client needs as determined by the therapists. The range of these sessions represents short-term counseling and psychotherapy, which reflects the growing trend across the country to use more shortened forms of treatment in university counseling centers and in community mental health clinics. The sample for this study consisted of 50 volunteer undergraduate and graduate clients who had requested help with personal concerns from the staff of the Georgia State University Counseling Center dur- ing the 1976/1977 academic year. Therapists were three counseling and 121 clinical psychology staff interns and two staff therapists, all of whom regularly saw clients at the Center. The experimental design used was a pretest-posttest control group design. The experimental group consisted of 25 clients who received traditional counseling in combination with IPR videotape feedback and stimulus film techniques. The control group consisted of 25 clients who received traditional counseling alone. Each therapist saw 10 clients, 5 in each group. Therapists retained control over which clients they saw, but not over the assignment lrf clients to treat- ment groups. Clients were matched according to sex and time of entry into treatment and then randomly assigned to the treatment groups. The number of 50-minute treatment sessions for each client ranged from 4 to 15. Of the total 462 counseling sessions completed in this study, 260 were for IPR treatment clients and 202 were for traditional treat- ment clients. The mean number of sessions completed per client was 10.4 for IPR clients and 8.1 for traditional clients. Nine clients in the IPR group and two clients in the traditional group continued counseling beyond the 15th session after completing the posttests. For the IPR treatment clients, therapists were allowed to select the IPR techniques which they believed best suited their clients' indi- vidual needs. During the first 10 sessions, IPR techniques had to be used in a minimum of 50% of the sessions, and they had to be used in at least every other session or in two consecutive sessions followed by two traditional sessions. During the 10th through the 14th ses- sions, an IPR technique had to be used at least once. The techniques could have been used more if desired. Therapists were allowed to 122 choose from the following five IPR techniques: stimulus films, video- tape recall of stimulus films, client recall, mutual recall, and sig- nificant other recall. Of the 107 interventions that were completed in this study, 65 were mutual recalls, 24 were stimulus films, 10 were client recalls, 6 were significant other recalls, and 2 were videotape recalls of stimulus films. For the mutual and client recalls, third-person inquirers were used to facilitate recall in the traditional IPR style. The measures used as criteria for this study were the Personal Orientation Inventory (POI), the client and therapist forms of the Therapy Session Report (TSR), the client and therapist forms of the Client Description of Problem Scale/the Progress of Counseling Rating Scale (COPS/PCRS), the Characteristics of Client Growth Scales (COGS), and the Depth of Self-Exploration Scale (DX). Data from the first three instruments were collected after the first and last sessions as written instruments. Data from the last two instruments were col- lected from audiotape samples of the first and last counseling ses- sions and then rated on four subscales by two independent judges. The six, specific, primary research hypotheses predicted more client growth and satisfaction for IPR clients than control clients as evidenced by higher adjusted posttest scores on the above instru- ments. The data were analyzed for differences between treatment groups by four 2 x 5 (treatment by therapist) MANOVA and two 2 x,5 ANOVA computer analyses. Prior to these analyses, bivariate linear regression analyses for each subscale of each instrument were per- formed in order to obtain the adjusted posttest scores free of pretest 123 score differences. Significance testing was carried out at the .01 level. The results of the analyses indicated no significant differ- ences between treatment groups on any of the six measures. Thus, the primary hypotheses were not confirmed. Informal hypotheses were also formulated predicting pre to post positive raw score differences for both treatment groups on the POI, on the COGS and DX, and on the client and therapist forms of the TSR. Significance testing was carried out at the .01 level. The results of the four three-way MANOVAs (treatment x therapist x time) with repeated measures on the last dimension indicated that there were pre to post significant positive differences on the P01 and on the client and therapist forms of the TSR for both groups, but not on the COGS and 0X. Two additional informal hypotheses predicted no pre to post differences for either treatment group on the client and therapist forms of the COPS/PCRS. The results of the two three-way ANOVAs (treatment x therapist x time) with repeated measures on the last dimension indicated that there were pre to post negative significant differences (with the means decreasing pre to post) on both the client and therapist forms of the COPS/PCRS. A nonstatistical evaluation of subjective client comments indi- cated no differences between treatment groups. Clients who responded on the Optional "Comments" form stressed the positive benefits that they received from counseling. Of the IPR clients who made state- ments about the IPR techniques, one was slightly negative, two were mixed, and seven were positive. All of the therapists made positive statements about the use of the IPR techniques with their clients, 124 and all said they planned to continue using the techniques occa- sionally. Their primary criticism was in having to use the techniques on a regular basis (due to the research design). They believed this was not always helpful with their clients, and they stated that a great deal of therapeutic flexibility with individual clients would be required to result in a maximum degree of effectiveness from the use of the stimulus film and videotape recall techniques. Conclusions The following conclusions relate to the primary hypotheses of the study: 1. The integration of IPR videotape and stimulus film tech- niques with traditional treatment methods did not result in clients scoring higher on a measure of self-actualization, a correlate of mental health, than was observed in control clients treated with tra- ditional methods alone. 2. The integration of IPR videotape and stimulus film techniques with traditional treatment methods did not result in clients evidencing more client growth as measured by in-therapy process dimensions than was observed by control clients treated with traditional methods alone. 3. The integration of IPR videotape and stimulus film techniques with traditional treatment methods did not result in clients becoming more satisfied with their experiences in counseling than was observed in control clients treated with traditional methods alone. 4. The integration of IPR videotape and stimulus film techniques with traditional treatment methods did not result in clients achieving 125 a higher percentage of their goals in counseling than was observed in control clients treated with traditional methods alone. The following conclusions relate to the additional informal hypotheses of the study: 5. Both clients who received the IPR interventions and clients who received only traditional interventions scored higher on a measure of self-actualization, a correlate of mental health, at the end of their counseling experiences. 6. Both clients who received the IPR interventions and clients who received only traditional interventions were more satisfied with their counseling sessions at the end than at the beginning of their counseling. 7. Neither clients who received the IPR interventions nor clients who received only traditional interventions evidenced more growth on in—therapy process dimensions at the end of their counseling sessions than at the beginning. 8. Both clients who received the IPR interventions and clients who received only traditional interventions predicted that they would achieve a higher percentage of their goals at the beginning of their counseling sessions than they actually did achieve. Clients said they achieved approximately 76% of their goals (and predicted 87%) and therapists said their clients achieved approximately 70% of their goals (and predicted 78%). All of the above conclusions resulted from an examination of the formal measurement data that came from the study. The following 126 conclusions resulted from an examination of client and therapist sub- jective comments about the study: 9. Clients who received the IPR interventions found the IPR videotape and stimulus film techniques helpful in their growth and problem solving. 10. Therapists found the use of the IPR videotape and stimulus film techniques beneficial in helping clients, but they believed that maximum effectiveness from using these interventions can be achieved only with a great amount of therapeutic freedom and flexibility. 11. Both clients who received the IPR interventions and clients who received only traditional interventions viewed their counseling sessions as satisfying and helpful in making changes. Discussion In reviewing the literature on the use of videotape feedback as a therapeutic tool in counseling and psychotherapy in Chapter II, it was noted that many therapists have reported that videotape feedback can be effective in helping clients change. It was also noted, however, that controlled studies have not, on the whole, demonstrated that the use of videotape adds appreciably to client growth and out- come when compared to the treatment of clients without the aid of videotape. It was stated that there is a great deal of evidence to support the claim that counseling and psychotherapy does in fact help clients change, but that there is little or no evidence to support the claim that any one form of psychotherapeutic treatment is better than another. The results of the present study do not contribute any 127 major new findings, but rather they support these observations from previous research. Therapists and clients in this study reported that IPR video- tape and stimulus film techniques were beneficial, but the use of these interventions did not result in any significant differences on any of the outcome measures between the IPR and traditional treatment groups. The analyses revealed that clients in both treatment groups made gains on a measure of self-actualization at a significant level (p_< .001), and that clients were more satisfied with their sessions at the end of counseling than at the beginning (p_< .001). Clients in both groups rated that they achieved approximately 76% of their goals in a mean of about nine sessions per client. Therapists rated their clients in both groups as achieving 70% of their goals in this amount of time. Both these percentages appear rather remarkable considering the fact that effective short-term therapy is often viewed as requiring at least 24 sessions (6 months). Thus, whereas growth was evidenced on all of the written outcome instruments for clients in both treatment groups, neither group demonstrated more growth than the other. It should be noted that the pre to post research design was not as valid as it would have been if there had been an untreated or placebo-attention control group to rule out the effects of history, maturation, and test-retesting. But the fact that pre to post dif— ferences on the POI and on the client and therapist forms of the TSR were highly significant, and that clients and therapists rated a mean achievement of 73% of client goals in such a short number of sessions, adds a great deal of weight to the probability that client growth did 128 occur over time and that clients and therapists found the sessions to be beneficial. It should be noted here that Hathaway's "hello- goodbye" effect predicts a certain degree of biased client ratings because clients may initially exaggerate symptoms and then exaggerate improvement at the end of therapy. This is perhaps due to a need on the part of clients to rationalize their investment of time and effort, as well as to present favorable results to make their therapists feel like they accomplished something. Even allowing for a certain amount of this, however, clients and therapists still rated a fairly high achievement percentage of client goals. It was stated earlier that clients and therapists both predicted that clients would achieve a higher percentage of their goals at the beginning of counseling than they were perceived to have achieved at the end of counseling. Clients in both treatment groups predicted that they would achieve 87% of their goals. Therapists predicted 77% for traditional clients and 79% for IPR clients. The final client ratings for goal achievement were 75% for the IPR group and 77% for the traditional group. The final therapist ratings were 70% for both groups. Although these pre to post differences were significant, the size of the pre-post difference really is not large. It is not uncommon, perhaps, that clients and even therapists would be somewhat optimistic about the possibilities for change. A moderate amount of optimism may be helpful, in fact, for as Luborsky et a1. (1971) pointed out, studies have shown that the amount of expectation and/or motiva- tion tends to be positively related to outcome. The short number of sessions (N_= 10.4 for IPR clients and 8.1 for traditional clients) 129 would certainly be a factor in clients not achieving as many goals as they had planned. It is not surprising, then, that clients pre- dicted that they would achieve a higher percentage of goals than they finally achieved. What is surprising is that both clients and their therapists said they achieved such a high percentage of their goals in such a short number of sessions. This suggests that client growth can occur in short-term counseling and therapy. The group of subscales on which no significant pre to post move- ment was found was on the three subscales of the Characteristics of Client Growth Scales (COGS) and the Depth of Self-Exploration Scale (DX). These scales were somewhat different than the other measures in that they were ratings by two independent judges of audiotape samples of client verbal behaviors from the first and last sessions. Although they were used as outcome measures in this study, they can more properly be considered to be process measures of what actually happens within therapy. The written measures, however, can more clearly be thought of as outcome measures. The hypothesis which related to the pre to post analysis of the COGS and 0X raw score data predicted that clients in both the IPR and traditional treatment groups would achieve a greater awareness of their feelings, a clearer motivation for growth-producing change, a more accurate ability to discriminate environmental stimuli, and a greater ability to engage in self-exploration of interpersonal situations at the end of coun- seling than at the beginning, as measured by higher posttest scores on the scales of Owning of Feelings (0F), Commitment to Change (CC), Differentiation of Stimuli (DS), and Depth of Self-Exploration (DX). 130 This hypothesis was not confirmed. Neither was the primary hypothesis confirmed predicting higher adjusted posttest scores on the OF, CC, OS, and 0X scales for IPR clients than for traditional clients. The mean changes on pre to post raw scores were very small for clients in both treatment groups (see Table 8, p. 91). The means for the IPR group dropped slightly for the OF, CC, and 0X scales, whereas the means for the traditional group increased slightly on all four scales. These differences in the direction of mean changes between treatment groups were not large enough to cause a treatment by time interaction effect (see Table 18, p. 104). Nor were they large enough to cause a significant difference on the adjusted posttest scores between the treatment groups (see Table 7, p. 90). Thus, the within session ver- bal behaviors of the clients did not change for either group pre to post. It is unclear why no significant pre to post movement was found on the COGS and 0X for clients in either of the treatment groups. One possible answer is that the clients in this study began their initial sessions with a fairly high degree of owning of feelings, commitment to change, differentiation of stimuli, and self-exploration (pre-COGS = 2.58 and pre-DX = 3.17), suggesting a more intense involvement in the initial sessions than occurred during the final sessions. This could have resulted because final sessions included termination topics which were more superficial than initial presenting problems, particu- larly due to the fact that this was short-term therapy without the development of an in-depth client-therapist relationship. As a com- parison, both pre and post scores (post-COGS = 2.66 and post-0X = 3.20) 131 in this study were higher than post scores in Van Noord‘s (Van Noord, 1973; Van Noord & Kagan, 1976) study (post-COGS = 2.37 and post-0X = 2.28). The average age of clients in this study was higher than in Van Noord's study (25 years compared to 21 years), which may have con- tributed to clients in this study speaking of their problems in more depth during the first sessions, while ”winding down" and becoming less involved during the last sessions. This comparison also holds true for Schauble's (1970) study (pre-COGS = 2.25 and pre-DX = 2.13; post-COGS = 2.76 and post-0X = 2.69), with Schauble's average client age of 20 years, although Schauble's average post-COGS score was I higher than in this study. The fact that different raters were used in these studies means that these comparisons must be made with caution. It is quite possible that the COGS and 0X were not the most suitable instruments for use as posttest measures in this study. It is reasonable to think that a client's verbal behaviors will reveal lower ratings on owning of feelings, commitment to change, differen- tiation of stimuli, and depth of self-exploration during the termina- tion session than during ongoing sessions, which are likely to include verbal behaviors indicating more involvement with more intense issues than those covered in the termination session. An investigation which would include several periodic ratings on the COGS and DX scales for several sessions of the same client from beginning to end would offer solutions to this problem. Also, in this study 22% of the clients continued beyond the 15th session, but it is possible that they behaved less openly knowing that 132 their final research session was being taped and would be listened to by someone else for rating. What is more important, perhaps, is that pre to post written measures demonstrated client growth and client satisfaction with the counseling experiences. The main pur- pose of the within-therapy process measures (COGS and 0X) was to see if there were any between group differences at the end of the treat- ments. There were no significant between treatment group differences on these process measures at the .01 or .025 levels. This is similar to the results of the other five outcome measures. The analyses of the data from the five written outcome measures for treatment effects resulted in [_values that were all less than 1.00, indicating very little differences and no possibilities for significance. Although the level of significance was set at .01 for all analyses, and the COGS and 0X MANOVA of adjusted posttest scores resulted in a treat- ment effect that was not significant at this level, it was signifi- cant at the .05 level, and, therefore, deserves some discussion. An inspection of the pre and post means of the OF, CC, 05, and 0X scales (see Table 8, p. 91) reveals that the traditional treatment clients made slight gains on all four scales whereas the IPR clients made slight losses on three of the four scales. An inspection into the univariate analyses of these four scales, however, indicates that it was the OF scale which gave most of the weight for the overall MANOVA to be significant at the .05 level. A further inspection of the pre and post means on this scale for the clients of each of the five therapists revealed that for four out of the five therapists the 133 means decreased slightly for the IPR treatment clients and increased slightly for the traditional treatment clients. For the fifth thera- pist the means of clients in both treatment groups increased slightly. It is unknown why the IPR clients decreased on the 0F scale means (mean change = -.14 on a scale of l to 5) whereas the traditional treatment clients increased (mean change = +.25) with a very small but similar trend on two of the other three process scales. As men- tioned earlier, nine of the IPR clients continued counseling beyond the 15th session, whereas only two of the traditional clients con- tinued beyond the 15th session. Perhaps the posttest audiotapes caused more of a negative effect on the clients who were continuing, and, since there were more of such clients in the IPR group, this could be one cause for the lower IPR group means. Gelso (1974) has demonstrated that audiotaping, when not used as a therapeutic tool, can indeed have an inhibiting effect on clients. It is interesting to note than Van Noord's IPR clients also scored slightly lower (but not significantly lower) on the COGS and 0X posttest scores than did the traditional clients in his study. Perhaps the use of media techniques in the initial stages of therapy does contribute to some negative effects which showed up on the in- therapy process measures. This suggestion, however, conflicts with the results of Schauble (1970) and Kingdon (1975), for in their studies the IPR clients scored significantly higher than traditional clients on similar process measures. It is obvious that no defini- tive statements can be made about this issue based on the controlled research up to this point in time. 134 The final and most important question that must be addressed here is why the IPR treatment clients did not score significantly higher on the adjusted posttest scores on any of the six measures than the traditional treatment clients as predicted. One possible answer is that therapists need to have previous experience with the IPR model before it can be implemented by them with the degree of clinical skill required to cause significant treatment differences. Although all of the therapists stated that they felt comfortable with the IPR techniques after reading about them and then going through a 5-hour training course, it can not be expected that they were as comfortable with these interventions or were as therapeutically skill- ful with them as they were with their traditional treatment methods. Although one of the therapists had previous experience with the IPR model in other settings, none of the therapists had ever used the techniques in therapy prior to these research sessions. Under more ideal conditions, therapists would have had the opportunity to experi- ment with the IPR techniques with their regular clients for a year or so before beginning the research sessions. An argument can be made that with therapists who were relatively inexperienced in IPR interventions, it is significant that IPR treat- ment clients did not score any worse than traditional treatment cli- ents on the adjusted posttest scores. And it is certainly important that the use of IPR techniques did not result in any negative treat- ment effects. It should be noted that one of the advantages of the IPR model is that it can easily be taught to therapists in a relatively short period of time. After the initial training, however, therapists 135 need to practice using the techniques to become familiar with them and to integrate them into their own therapeutic styles. Did clients of one or more of the research therapists benefit from the IPR techniques more than clients of the other therapists? The results of the MANOVAs and ANOVAs of the adjusted posttest scores indicate that the answer is no, for there were no significant therapist by treatment interaction effects on any of the six measures. Even though the mean number of treatment sessions varied for therapists and treatments (see Table 2, p. 58), no significant differences were found as a result of these variations. Nor were there differences found in client and therapist subjective comments. The average IPR client was seen for 10.4 sessions with an average of 4.3 IPR interventions. Was this too little or too much to cause significant positive differences? Therapists had the opportunity to use the techniques more often than required, but none of them elected to do so. When therapists were asked why they did not use the tech- niques more, they responded that they needed time alone with their clients without videotapes, films, and inquirers. And they suggested that they would have preferred to have used the techniques somewhat less than required, particularly during sessions when there was a great deal of intense client involvement, when, they believed, no additional techniques were needed beyond the traditional methods. This suggests that IPR (and particularly the stimulus film technique) may be most helpful during those sessions when clients are not highly disclosing, or with clients who have difficulty expressing feelings. 136 There is always the possibility of regional differences in the approach that clients take to counseling. Perhaps typical southern clients need more time to test out their therapists and develop trust. Could the videotape and stimulus films have interfered with this initial trust development rather than aid it as predicted? If so, it is likely that these interventions would have been more effec- tively used later on in therapy, particularly in longer term therapy, to assist clients in learning more about their eliciting behaviors, their ways of relating to their therapists, and in trying out new behaviors after several initial sessions of trust building have elapsed without the use of the techniques. It needs to be noted that clients in the IPR group had sessions that went on longer than those in the traditional group (10.4 sessions per IPR client compared to 8.1 sessions per traditional client), and that nine IPR clients continued counseling after the final 15th research sessions, whereas only two traditional clients went beyond this number with their therapists. Research studies, on the whole, have not determined any average set number of sessions needed to cause change in clients, and it is likely that this varies a great deal for different clients and treatments. Meltzoff and Kornreich (1970), in their review of several relevant studies, stated that an optimal point was found to range anywhere from the 5th to the 65th interview, depending on the type of patient and the mode of therapy. They concluded that about half of the studies showed a positive rela- tionship between outcome and the number of client sessions (that is, the more sessions, the better the outcome), with the remaining studies 137 showing either no relationship or a curvilinear relation with improve- ment fading when treatment continues for hundreds of hours. The fact that seven more IPR clients than control clients continued therapy beyond the 15th session can be seen as a positive indication that IPR techniques contributed to clients becoming more involved with their therapeutic issues and working on them in more depth. Although it seems probable that for several types of clients more treatment ses- sions are likely to lead to more positive and lasting personality changes, it is also probable that IPR intervention techniques can assist therapists by helping their clients in working on issues over a longer period of time with the result that positive therapeutic changes are more lasting. It should also be noted that four clients in the control group dropped out of counseling before the fifth session, whereas only two dropped out in the IPR group. This suggests, at least, that the IPR techniques did not scare clients away in the initial sessions. An important observation made from this study was that therapists believed that the mutual recall technique was by far the most useful, whereas the stimulus films technique was the second most useful inter- vention. The client and significant other recalls were also found to be useful, but with a more limited range of clients. And the video recall of stimulus films was believed to be the least useful technique, in large part, perhaps, due to the complicated media operations involved. Another observation was that therapists believed that flexi- bility in using both the videotape and stimulus films is an absolute 138 necessity for maximum effectiveness. This was also a conclusion in Van Noord's and in Schauble's studies. Although the therapists in this study showed an interest in learning and using the IPR techniques, they were not committed to them as proven effective change interventions. This was as it should have been, in that the therapists were not biased in favor of IPR, and they were, therefore, less likely to bias the outcome measures. However, it is probable that therapists who use the techniques regu- larly, are comfortable with them, and are committed to them will be more effective in using them. It is also probable that therapists will function most effectively with IPR techniques when they do not have to use them on a regular schedule or when they are forced to follow certain guidelines. Resistance to structured sessions is as common to therapists as it is to clients, and such resistance prob- ably was a factor in this study, although there were no major com- plaints by therapists other than the ones already mentioned. It appears that what Luborsky et a1. (1975) have termed the "dodo bird verdict" (a term from Alice in Wonderland) was upheld in this study: "Everybody had won and all must have prizes." Previous research has, on the whole, found insignificant differences between different forms of therapy. One reason for this is that when all clients improve to a significant degree, as demonstrated by the analyses of the written outcome pre to post change scores in this study, it is statistically difficult for one form of treatment to show any advantage over another because there is less room at the t0p of the scales used for significant differences to occur between 139 treatments. Another possible reason for no treatment differences in this study is that a major common element in both forms of treat- ment, such as the basic helping relationship with a therapist, may have contributed the most to client changes, with the IPR techniques contributing only small amounts of variance to change scores result- ing in small effects rather than large effects. Finally, controlled research as carried out in this study has some basic drawbacks. As Bergin (1971) has pointed out, process and outcome studies do not give us information about the individual dif- ferences which tend to be averaged out in the group means. It was predicted that IPR clients would make greater gains than traditional clients; that is, on the average, IPR clients would do better than traditional clients. It is quite possible that some clients benefited from the IPR techniques, perhaps to a large extent, whereas for other clients the effects of the techniques were either neutral or even detrimental, and that overall the differences were averaged out to result in no apparent differences. ~Therapists reported that the tech- niques were indeed helpful, but not at all times with all of the IPR clients. Further research needs to be done to investigate the effects of the IPR model with more specificity, thus giving us more accurate information concerning which of the techniques work best with what types of clients at which stages in the therapeutic process. Implications for Future Research 1. Because inconsistent results have been obtained from studies on the use of IPR videotape and stimulus film techniques in counseling 140 and psychotherapy, further investigations into the use of these inter- ventions in short-term and in long-term therapy are recommended. 2. Since past IPR research has indicated that subjective com- ments about the use of the IPR model in therapy are beneficial to some clients at certain stages, attention should be focused more on indi- vidual differences. This would be a move toward specificity concern- ing which IPR techniques work best with what types of clients at which stages in counseling. _{3. To implement recommendation number 2, a major effort should be invested into the intensive study of single cases in which specific client, therapist, technique, and socio-environmental variables can be examined. 4. Ideally it would be best if,in future research on the IPR model in therapy research, therapists could have a year or more experi- ence using the techniques with their regular clients prior to begin- ning the research in order to become as comfortable and skillful with the techniques as they are with their traditional methods of inter- vention. 5. Studies should examine the effects of using the model at the initial stages of therapy compared to using the model at later stages in therapy to see if the techniques have more effect when used beyond a certain number of initial trust-building sessions. [4(6. It would be advantageous to look at the effects 0f the model 1- 4 'il ‘ x41 {mgr‘rg- .s'r- ‘4 on different personality types, for example, introverts compared to extroverts, high-esteem clients compared to low-esteem clients, or 141 clients with a poor body image compared to clients with a good body image. 7. The "significant other" mutual recall technique should be examined further with couples and families since there is a growing trend toward using videotape as a therapeutic tool in couples and family therapy. 8. Because many therapists believe the use of an outside inquirer to facilitate the videotape recall is not practical in terms of scheduling and heavy caSeloads, the use of the therapists as their own inquirers should be examined and compared to the use of third- person inquirers to see if there are differential effects. APPENDICES 142 APPENDIX A THERAPY SESSION REPORT ITEMS 143 APPENDIX A THERAPY SESSION REPORT ITEMS* This booklet contains six questions about the counseling session or sessions which you have just completed. These questions have been designed to make the description of your experiences in the session(s) simple and quick. The questions have a series of numbered statements under them. You should read each of these statements and select the ONE which comes closest to describing your answer to that question. _Then circle the number in front of your answer. BE SURE TO ANSWER EACH QUESTION. Counselor Identification Client Identification Date *These items were selected and modified from the Therapy Session Report, copyright by Psychotherapy Session Project, 1966. All property rights reserved by the Psychotherapy Session Project, 907 South Wolcott Avenue, Chicago, Illinois, U.S.A. 144 145 CLIENT FORM (PRE) OF THERAPY SESSION REPORT Circle the one answer which best applies. 1. HOW DO YOU FEEL ABOUT THE SESSION WHICH YOU HAVE JUST COMPLETED? This session was: HOW Oimth—I U boom—- 0 o o o o o H o o o o D Very poor 5 , d 6. 32:32:. Fair 7, Perfect Pretty good YOU FEEL ABOUT COMING TO COUNSELING THIS SESSION? Unwilling; felt I didn't want to come at all Somewhat reluctant to come Neutral about coming Somewhat looking forward to coming Very much looking forward to coming Eager; could hardly wait to get here HOW MUCH PROGRESS DO YOU FEEL YOU MADE IN DEALING WITH YOUR PROBLEMS THIS SESSION? 1. 0301th In some ways my problems seem to have gotten worse this session Didn't get anywhere this session Some progress Moderate progress Considerable progress A great deal of progress HOW WELL DO YOU FEEL THAT YOU ARE GETTING ALONG, EMOTIONALLY AND PSYCHOLOGICALLY, AT THIS TIME? I am getting along: OUT-kWNT‘ . C C O O Quite poorly; can barely manage to deal with things Fairly poorly; life gets pretty tough for me at times So-so; manage to keep going with some effort Fairly well; have my ups and downs Quite well; no important complaints Very well; much the way I would like to HOW WELL DID YOUR COUNSELOR SEEM TO UNDERSTAND WHAT YOU WERE FEELING AND THINKING THIS SESSION? My counselor: 01-h (”NH 0 o o o o Misunderstood how I thought and felt Didn't understand too well how I thought and felt Understood pretty well, but there were some things he/she didn't seem to grasp Understood very well how I thought and felt Understood exactly how I thought and felt 146 6. HOW HELPFUL DO YOU FEEL YOUR COUNSELOR WAS TO YOU THIS SESSION? 1. Not helpful at all 4. Pretty helpful 2. Slightly helpful 5. Very helpful 3. Somewhat helpful 6. Completely helpful 147 CLIENT FORM (POST) 0F THERAPY SESSION REPORT Circle the one answer which best applies: 1. THE LAST FEW SESSIONS HAVE BEEN? 1. 2. 3. 4. 2. HOW DID 1. 2. 3. 4. 5. 6. Very poor Pretty poor 22 :53323: Fair 7. Perfect Pretty good YOU FEEL ABOUT COMING TO THE LAST FEW SESSIONS? Unwilling; felt I didn't want to come at all Somewhat reluctant to come Neutral about coming Somewhat looking forward to coming Very much looking forward to coming Eager; could hardly wait to get here 3. HOW MUCH PROGRESS DO YOU FEEL YOU MADE IN DEALING WITH YOUR PROBLEMS DURING THE LAST FEW SESSIONS? mmth—a o o o o o o In some ways my problems seem to have gotten worse lately Didn't get anywhere these last few sessions Some progress Moderate progress Considerable progress A great deal of progress 4. HOW WELL DO YOU FEEL THAT YOU ARE GETTING ALONG, EMOTIONALLY AND PSYCHOLOGICALLY, AT THIS TIME? 1. 2. 3. 4. 5. 6. Quite poorly: can barely manage to deal with things Fairly poorly; life gets pretty tough for me at times So-so; manage to keep going with some effort Fairly well: have my ups and downs Quite well; no important complaints Very well; much the way I would like to 5. HOW WELL DID YOUR COUNSELOR SEEM TO UNDERSTAND WHAT YOU WERE FEELING AND THINKING DURING THE LAST FEW SESSIONS? My counselor: 01b LON-J o o o o o Misunderstood how I thought and felt Didn't understand too well how I thought and felt Understood pretty well, but there were some things he/she didn't seem to grasp Understood very well how I thought and felt Understood exactly how I thought and felt 148 6. HOW HELPFUL DO YOU FEEL YOUR COUNSELOR WAS TO YOU DURING THE LAST FEW SESSIONS? 1. Not helpful at all 4. Pretty helpful 2. Slightly helpful 5. Very helpful 3. Somewhat helpful 6. Completely helpful 149 COUNSELOR FORM (PRE) OF THERAPY SESSION REPORT Circle the one answer which best applies: 1. HOW DO YOU FEEL ABOUT THE SESSION WHICH YOU HAVE JUST COMPLETED? This session was: 1. 2. 3. 4. Very poor 5 . v d Pretty POOr 6. EiEZnggt Fair 7. Perfect Pretty good HOW MOTIVATED FOR COMING TO COUNSELING WAS YOUR CLIENT THIS SESSION? 2. 3. 4. 5. Had to make herself (himself) keep the appointment Just kept her (his) appointment Moderately motivated Strongly motivated Very strongly motivated HOW MUCH PROGRESS DID YOUR CLIENT SEEM TO MAKE IN THIS SESSION? aim-puma I o o o o o Seems to have gotten worse Didn't get anywhere this session Some progress Moderate progress Considerable progress A great deal of progress HOW WELL DOES YOUR CLIENT SEEM TO BE GETTING ALONG AT THIS TIME? mmpr—J o o o o o o Quite poorly; seems in really bad condition Fairly poorly; having a rough time So-so; manages to keep going with some effort Fairly well; has ups and downs Quite well; no important complaints Very well; seems in really good condition HOW MUCH WERE YOU LOOKING FORWARD TO SEEING YOUR CLIENT THIS SESSION? (fl-5 “NH 0 I o o o I anticipated a trying or somewhat unpleasant session I felt neutral about seeing my patient this session I had no particular anticipations but found myself pleased to see my patient when the time came I had some pleasant anticipation I definitely anticipated a meaningful or pleasant session 150 6. TO WHAT EXTENT WERE YOU IN RAPPORT WITH YOUR CLIENT'S FEELINGS? 1. Little 4. A great deal 2. Some 5. Almost completely 3. A fair amount 6. Completely 151 COUNSELOR FORM (POST) 0F THERAPY SESSION REPORT Circle the one answer which best applies: 1. THE LAST FEW SESSIONS HAVE BEEN: 1. Very poor 5 2- Pretty p... 6: 1.325823 3' F31r 7. Perfect 4. Pretty good 2. HOW MOTIVATED FOR COMING TO COUNSELING WAS YOUR CLIENT DURING THE LAST FEW SESSIONS? 1. Had to make herself/himself keep the appointment 2. Just kept her/his appointment 3. Moderately motivated 4. Strongly motivated 5. Very strongly motivated 3. HOW MUCH PROGRESS DID YOUR CLIENT SEEM TO MAKE IN THE LAST FEW SESSIONS? Seems to have gotten worse Didn't get anywhere these last few sessions Some progress Moderate progress Considerable progress A great deal of progress 001%de o o o o o o 4. HOW WELL DOES YOUR CLIENT SEEM TO BE GETTING ALONG AT THIS TIME? Quite poorly; seems in really bad condition Fairly poorly; having a rough time So-so; manages to keep going with some effort Fairly well; has ups and downs Quite well, no important complaints Very well; seems in really good condition aim-puma o o o o o o 5. HOW MUCH WERE YOU LOOKING FORWARD TO SEEING YOUR CLIENT DURING THE LAST FEW SESSIONS? l. I anticipated a trying and somewhat unpleasant few sessions I felt neutral about seeing my patient I had no particular anticipations but found myself pleased to see my patient when the times came I had some pleasant anticipation I definitely anticipated a meaningful or pleasant few sessions 01-h DON 152 6. T0 WHAT EXTENT WERE YOU IN RAPPORT WITH YOUR CLIENT'S FEELINGS LATELY? 1. Little 4. A great deal 2. Some 5. Almost completely 3. A fair amount 6. Completely APPENDIX B CLIENT'S DESCRIPTION OF PROBLEM SCALE AND PROGRESS OF COUNSELING RATING SCALE 153 APPENDIX B CLIENT'S DESCRIPTION OF PROBLEM SCALE AND PROGRESS OF COUNSELING RATING SCALE Client's Description of Problem Scale Client Form (A) Below are listed a number of areas which people sometimes mention as goals in counseling. Each goal is followed by numbers 1-9. After each possible goal you are to place two ratings. EIRSI, place the letter "G" above the number which indicates how important this par- ticular area is a gggl_for you in counseling at this time. For example, if the particular goal has nothing to do with you, place a "G" over number 1, If it is a very important goal for you, place the "G" over number §_or 9, If it is moderately important, place the "G" somewhere in the middle. SECOND, place the letter "A" on the number which indicates the degree to which you hope to achieve this goal in counseling. Thus, for example, if you hope to make a great deal of progress toward a very important goal, place an "A" on or near the high number above which you have placed the "G." An "A" on number 1_indicates that you do not plan to make progress toward that goal. And if, for example, you hope to make a moderate degree of progress on a very important goal, place an "A" on one of the middle numbers. 154 155 Client identification Counselor identification Place the letter "G" above the number which indicates how impor- tant a goal this particular area is for you in counseling at this time. AND, place the letter "A" on the number which indicates the degree to Date Client Form A which you hope to achieve this goal in your counseling sessions. 1. 10. 11. 12. 13. 14. 15. 16. Improving my ability to have close relationships with the opposite sex Dealing with unhappiness and depression Becoming more aware of the true nature of my feelings Relieving tension and anxiety Discovering "who I am"--my identity Dealing with panic reactions to such things as tests Improving my relationships with people in general Changing specific behavior (what behavior) Resolving problems with my parents Dealing with sexual problems Improving my ability to control my emotions Dealing with feelings of embarrassment Making new and/or real friends Dealing with self-blame or self- criticism Dealing with how to be a better conversationalist Dealing with my feelings of inadequacies 2 3 4 5 6 7 8 17. 18. 19. 20. 21. 156 Improving my ability to sleep To become less lonely Other (specify) Other (specify) Other (specify) 157 Progress of Counseling Rating Scale Client Form(B) We would like to have you rate your progress or lack of progress in the following specific areas which people sometimes mention as goals in counseling. Each goal is followed by numbers 1-9. After each possible goal, you are to place two ratings. flfiSI, place the letter "G" above the number which indicates how important this par- ticular area has, at any time in your counseling sessions, been one of your ggglg, For example, if the particular goal had nothing to do with you, place a ”G" over number 1, If it was a very important goal for you, place the "G" over number §_or 2, If it was moderately important, place the "G" somewhere in the middle. SECOND, place the letter "A" on the number which indicates the degree to which you feel you have achieved this goal in counseling. Thus, for example, if you have made a great deal of progress toward a very important goal, place the letter "A" on or near the high number above which you have placed the "G." An "A" on number 1 indicates no progress toward that goal. 158 Client identification Date Counselor identification Client Form B Place the letter "G" above the number which indicates how impor- tant this particular area has at any time in your counseling sessions been one of your goals. Place the letter "A" on the number which indicates the degree to which you feel you have achieved this goal in your counseling sessions. 1. Improving my ability to have close relationships with the opposite sex 1 2 3 4 5 6 7 8 2. Dealing with unhappiness and depression 1 2 3 4 5 6 7 8 3. Becoming more aware of the true nature of my feelings l 2 3 4 5 6 7 8 4. Relieving tension and anxiety 1 2 3 4 5 6 7 8 5. Discovering "who I am"--my identity 1 2 3 4 5 6 7 8 6. Dealing with panic reactions to such things as tests 1 2 3 4 5 6 7 8 7. Improving my relationships with people in general 1 2 3 4 5 6 7 8 8. Changing specific behavior (what behavior) 1 2 3 4 5 6 7 8 9. Resolving problems with my parents 1 2 3 4 5 6 7 8 10. Dealing with sexual problems 1 2 3 4 5 6 7 8 11. Improving my ability to control my emotions l 2 3 4 5 6 7 8 12. Dealing with feelings of embarrassment l 2 3 4 5 6 7 8 13. Making new and/or real friends 1 2 3 4 5 6 7 8 l4. Dealing with self-blame or self- criticism 1 2 3 4 5 6 7 8 15. Dealing with how to be a better conversationalist 1 2 3 4 5 6 7 8 16. 17. 18. 19. 20. 21. 159 Dealing with my feelings of inadequacies Improving my ability to sleep To become less lonely Other (specify) Other (specify) Other (specify) 160 Client's Description of Problem Scale Counselor Form (A) Below are listed a number of areas which clients sometimes men- tion as goals in counseling. Each goal is followed by numbers 1-9. After each possible goal you are to place two ratings. ESNSI, place the letter "G" above the number which indicates how important you believe this particular gggl_is for your client in counseling at this time. For example, if the particular goal has nothing to do with your client, place a "G" over number 1, If it is a very important goal, place the "G" over number §_or D, If it is moderately important, place the "G" somewhere in the middle of the scale. SECOND, place the letter "A" on the number which indicates the degree to which you think your client will achieve this goal in coun- seling. Thus, for example, if you believe your client will make a great deal of progress toward a very important goal, place an "A" on or near the high number above which you have placed the "G." An "A" on number 1 indicates that you do not expect your client to make any progress in that goal. And, for example, if you believe your client will make a moderate degree of progress on a very important goal, place an "A" on one of the middle numbers. 161 Client Identification Date Counselor Identification Counselor Form A Place the letter "G" above the number which indicates how impor- tant this particular goal is for your client in counseling at this time. AND place the letter "A" on the number which indicates the degree to which you expect your client to achieve this goal in your counseling sessions. 1. Improving my ability to have close relationships with the opposite sex 3 4 5 6 7 2. Dealing with unhappiness and depression 3 4 5 6 7 3. Becoming more aware of the true nature of my feelings 3 4 5 6 7 4. Relieving tension and anxiety 3 4 5 6 7 5. Discovering “who I am"--my identity 3 4 5 6 7 6. Dealing with panic reactions to such things as tests 3 4 5 6 7 7. Improving my relationships with people in general 3 4 5 6 7 8. Changing specific behavior (what behavior) 3 4 5 6 7 9. Resolving problems with my parents 3 4 5 6 7 10. Dealing with sexual problems 3 4 5 6 7 ll. Improving my ability to control my emotions 3 4 5 6 7 12. Dealing with feelings of embarrassment 3 4 5 6 7 13. Making new and/or real friends 3 4 5 6 7 l4. Dealing with self-blame or self- criticism 3 4 5 6 7 15. Dealing with how to be a better conversationalist 3 4 5 6 7 16. 17. 18. 19. 20. 21. 162 Dealing with my feelings of inadequacies Improving my ability to sleep To become less lonely Other (specify) Other (specify) Other (specify) 163 Progress of Counseling Rating Scale Counselor Form (B) We would like to have you rate your client's progress or lack of progress in the following specific areas which people sometimes mention as goals in counseling. Each goal is followed by numbers 1-9. After each possible goal, you are to place two ratings. ‘EENSI, place the letter "G" above the number which indicates how important this par- ticular area has been, at any time in your counseling sessions, one of your client's ggglg. For example, if the particular goal had nothing to do with your client, place the "G" over number 1, If it was a very important goal for your client, place the "G" over number §_or D, If it was moderately important, place the "G" somewhere in the middle. SECOND, place the letter "A" on the number which indicates the degree to which you feel your client has achieved this goal in coun- seling. Thus, for example, if your client made a great deal of progress toward a very important goal, place the letter "A" on or near the high number above which you have placed the "G." An "A" on number l_indicates no progress toward that goal. 164 Client identification Counselor identification goals in your counseling sessions. Date 2 Counselor Form B Place the letter "G" above the number which indicates how impor- tant this particular area has been, at any time, one of your client's Place the letter "A" on the number which indicates the degree to which you feel your client has achieved this goal in your counseling sessions. 1. 10. 11. 12. 13. 14. 15. Improving my ability to have close relationships with the opposite sex Dealing with unhappiness and depression Becoming more aware of the true nature of my feelings Relieving tension and anxiety Discovering "who I am"--my identity Dealing with panic reactions to such things as tests Improving my relationships with people in general Changing specific behavior (what behavior) Resolving problems with my parents Dealing with sexual problems Improving my ability to control my emotions Dealing with feelings of embarrassment Making new and/or real friends Dealing with self-blame or self- criticism Dealing with how to be a better conversationalist 1 2 3 4 5 6 7 8 9 16. 17. 18. 19. 20. 21. 165 Dealing with my feelings of inadequacies Improving my ability to sleep To become less lonely Other (specify) Other (specify) Other (specify) APPENDIX C CHARACTERISTICS OF CLIENT GROWTH SCALES AND DEGREE OF SELF-EXPLORATION SCALE 166 APPENDIX C CHARACTERISTICS OF CLIENT GROWTH SCALES AND DEGREE OF SELF-EXPLORATION SCALE Owning of Feelings in Interpersonal Processes: A Scale for Measurement Level 1 The client avoids accepting any of his feelings. When feelings are expressed, they are always seen as belonging to others, or entirely situational and outside of himself. Example: The client avoids identifying or admitting to any feelings by either remaining silent or denying he feels anything at all. In summary, the client seems to believe he is not a part of the world of feelings. Level 2 The client may express feelings vaguely, but they are not really accepted as coming from within. Feelings are not tied to himself or to specific interactions but seem to pervade his life. In general he shows little involvement with his feelings. Example: The client discusses or intellectualizes about feelings in a detached, abstract manner and gives little evidence of knowing the origin of his feelings. In summary, any expression of feelings appears intellectualized, dis- tant, and vague. Level 3 The client can usually identify his specific feelings and their source but tends to express what he feels in an intellectualized manner. Example: The client seems to have an intellectual grasp of his feelings and their origin but has little emotional proximity to them. In summary, the client usually ties down and owns his feelings in an intellectual manner. Level 3 constitutes the minimum level for gain. 167 168 Level 4 The client almost always acknowledges his feelings and can express them with emotional proximity but at times he has difficulty in con- necting the feelings to their source. Example: The client shows immediate and free access to his feelings but has some difficulty in understanding these feelings or their con- nection to people or concerns in his life. In summary, the client owns his feelings fully but seems to have some difficulty in linking them to specific things in his life. Level 5 The client clearly embraces his feelings with emotional proximity, and at the same time shows awareness that his feelings are tied to specific behaviors of his own and others. Example: The client is completely in tune with his feelings, expresses them in a genuine way, and is able to identify their origin. In summary, the client clearly owns his feelings and accurately speci- fies their source. 169 Commitment to Change in Interpersonal Processes: A Scale for Measurement Level 1 The client shows no motivation for change. He is resistive to attempts by the second person to accomplish change or explore the desirability of change. This may take either the form of complete passivity or defensive hostile behavior. Example: The client may question the efficacy of the helping process and the helpfulness of the second person to an inappropriate degree; i.e., he seems to be attacking the change process, or he is totally unreceptive and uncooperative to the efforts of the second person. In summary, the client gives no verbal or behavioral evidence of a desire to change. Level 2 While the client expresses the desire to change, his commitment is noticeably questionable. The client seems to resist the impact of the helping process, and is passive or evasive in his interaction with the second person. Example: The client seems more involved in rationalizing or defending his behavior than he is in working on changing it. He may communicate the importance or necessity of change, but there is little behavioral evidence of cooperation or real commitment to the change process. In summary, there is some verbal commitment to change but no beha- vioral evidence of that commitment. Level 3 The client vacillates between an overt desire and/or commitment to change, and the desire to resist or evade change in order to avoid pain. He may express the desire to change and attempt to confront his feelings but varies in his maintenance of motivation to change. Example: The first person deals with the feelings which are cen- trally involved with his problem, but there is some tendency to rationalize his behavior or move from topic to topic. In summary, the client expresses the desire to change, but vacillates his commitment to change and cooperation with the second person. Level 3 is the minimal level for change to take place. 170 Level 4 The client expresses a desire to change, and while at times is reluc- tant to experience painful feelings involved in exploring his behavior, actively tries to cooperate with rather than resist the second person's efforts. Example: The client continually returns to the task of understanding his behavior and his role in it, although he experiences (and may overtly express) hesitancy in dealing with his painful feelings. In summary, the client wants to change, and he cooperates with the change process in a verbal and behavioral manner. Level 5 The client expresses a clear desire to change. He actively cooperates with the second person in the counseling process, even to the point of accepting painful feelings accompanying the exploration of his problem. The client is deeply involved in confronting his problems directly, and makes no attempt to evade or resist the experiencing of feelings and behaviors. Example: The client pursues the exploration of his feelings and behavior, attempting to gain a better understanding of his behavior in order to change. He faces his problem directly rather than avoid- ing it or changing the subject. In summary, the client clearly expresses verbally and behaviorally a desire and commitment to change his behavior. 171 Differentiation of Stimuli in Interpersonal Processes: A Scale for Measurement Level 1 The client seems unable to identify or differentiate his problems, feelings, or concerns and is unwilling or unable to move in this direction. Example: The client may show either no grasp of his feelings or prob- lems or he seems to respond to everything in very much the same way. In summary, the client seems totally unable or unwilling to make discriminations between his feelings or the people and events in his life. Level 2 The client may talk about different feelings and problems but he shows little grasp of real differences among them or of their effect on him as an individual. Example: The client may respond in a rehearsed manner to people and events as if his reactions were predetermined by stereotyped expec- tations. In summary, the client seems to differentiate between his feelings, people, or events at only a superficial level. Level 3 The client vacillates between discussing different stimuli and their effect on him (as a unique person) and responding in a general unclear fashion. Example: The client may initially make clear differentiations about his world, but he is unable to productively maintain this behavior and lapses into hazy generalizations which do not seem to have imme- diate meaning to him. In summary, the client clearly differentiates between discrete stimuli, but is unable to develop his perceptions or use them effectively. Level 3 constitutes the minimal level of differentiation for growth. 172 Level 4 The client is almost always aware of the differences between stimuli in his world, and he responds to them in a differential manner. He actively attempts to become more aware of his various emotions and their sources. Example: The first person may show a strong desire to understand himself as a unique and complex person and he attempts to differen- tiate and identify the distinct people and events in his world. In summary, the first person is actively involved in a successive dif- ferentiation of his feelings and events in his world. Level 5 The client always perceives the different stimuli in his world and reacts to them in a variety of differential ways. He is fully aware of his own unique effect on the discrete stimuli around him. Example: The client may clearly differentiate among his character- istics and those of others. He shows immediate awareness of his own unique characteristics, and the reactions he stimulates in others. In summary, the first person recognizes individuality in himself and in others, and responds in an appropriate manner. 173 DEGREE OF SELF-EXPLORATION SCALE Helpee Self-Exploration in Interpersonal Processes: A Scale for Measurement* Level 1 The second person does not discuss personally relevant material, either because he has had no opportunity to do such or because he is actively evading the discussion even when it is introduced by the first person. Example: The second person avoids any self-descriptions or self- exploration or direct expression of feelings that would lead him to reveal himself to the first person. In summary, for a variety of possible reasons the second person does not give any evidence of self-exploration. Level 2 The second person responds with discussion to the introduction of per- sonally relevant material by the first person but does so in a mechani- cal manner and without the demonstration of emotional feelings. Example: The second person simply discusses the material without exploring the significance or the meaning of the material or attempt- ing further exploration of that feeling in an effort to uncover related feelings or material. In summary, the second person responds mechanically and remotely to the introduction of personally relevant material by the first person. *This scale is derived in part from "The Measurement of Depth of Intrapersonal Exploration" (Truax & Carkhuff, 1967), which has been validated in extensive process and outcome research on counseling and psychotherapy. In addition, similar measures of similar constructs have received extensive support in the literature of counseling and therapy. The present scale represents a systematic attempt to reduce ambiguity and increase reliability. In the process, many important delineations and additions have been made. For comparative pur- poses, level 1 of the present scale is approximately equal to stage 1 of the earlier scale. The remaining levels are approximately cor- respondent: level 2 and stages 2 and 3: level 3 and stages 4 and 5; level 4 and stage 6; level 5 and stages 7, 8, and 9. 174 Level 3 The second person voluntarily introduces discussions of personally relevant material but does so in a mechanical manner and without the demonstration of emotional feeling. Example: The emotional remoteness and mechanical manner of the dis- cussion give the discussion a quality of being rehearsed. In summary, the second person introduces personally relevant material but does so without spontaneity or emotional proximity and without an inward probing to discover new feelings and experiences. Level 4 The second person voluntarily introduces discussions of personally relevant material with both spontaneity and emotional proximity. Example: The voice quality and other characteristics of the second person are very much "with" the feelings and other personal materials that are being verbalized. In summary, the second person introduces personally relevant discus- sions with spontaneity and emotional proximity but without a distinct tendency toward inward probing to discover new feelings and experi- ences. Level 5 The second person actively and spontaneously engages in an inward probing to discover new feelings and experiences about himself and his world. Example: The second person is searching to discover new feelings concerning himself and his world even though at the moment he may perhaps be doing so fearfully and tentatively. In summary, the second person is fully and actively focusing upon himself and exploring himself and his world. APPENDIX D CLIENT CONSENT FORM 175 APPENDIX D CLIENT CONSENT FORM 1, , understand that various counseling techniques such as videotaping and stimulus films may be used in some of my counseling sessions. I understand that some of my sessions will be audiotaped and that some of these tapes will be analyzed for research purposes. I understand that my counselor and I will be asked to complete a few short questionnaires and that these will be analyzed for research purposes. Permission to use this information is given with the understanding that all information will be used in a professional manner, that adequate safeguards will be taken to insure anonymity, and that my name will not be used in any reports. Signed Date 176 APPENDIX E BIOGRAPHICAL DATA SHEET 177 APPENDIX E BIOGRAPHICAL DATA SHEET Client identification number Date Male Female Age Grade Point Average Level in School: Freshman Sophomore Junior Senior Masters Ph.D. Other 178 APPENDIX F CLIENT COMMENTS FORM 179 APPENDIX F CLIENT COMMENTS FORM Comments Sometimes multiple-choice inventories do not provide an opportu- nity to express opinions or comments in exactly the way that a person would like to express them. Please feel free to use this space to indicate any impressions, reactions, or opinions you may have had to the counseling research project which you have completed. Any such comments that you make will be appreciated. Thank you very much for your cooperation and participation in this project. Client identification Counselor identification Date 180 APPENDIX G PROCEDURAL MEMOS TO THERAPISTS 181 APPENDIX G PROCEDURAL MEMOS TO THERAPISTS September 16, 1976 MEMO TO: Therapists involved in client research project FROM: Bob Tomory Counseling with IPR During the first 10 sessions, an IPR technique must be used in a minimum of 50% of the sessions; the techniques must be used in at least every other session or in two consecutive sessions followed by two tra- ditional sessions. The techniques can be used in more than 50% of the sessions if desired. During the 10th through the 14th sessions, an IPR technique must be used at least once. You may select the IPR technique which you believe is most suitable to facilitate each indi- vidual client's growth at a particular moment in time. One possible sequence of techniques is presented below. You are encouraged to use as many of the techniques as possible, but there is no requirement that each of the techniques be used. Also, any particular technique may be used as much as is desired. In summary, techniques will be selected according to individual client needs. Clients used in this study must complete at least four sessions with at least two sessions of IPR techniques. If a client is termi- nated for any reason without meeting these minimal requirements, the next client on the waiting list of the same sex will be asked to par- ticipate to replace the terminated client. For those clients who 182 183 continue therapy beyond the 15th session, posttests will be taken during the 15th session. Clients, therefore, may terminate at any time, but in order to be used in this study they must complete at least four sessions. Traditional counseling without IPR will be used for the first and the last sessions. If a session continues beyond the 15th session, a traditional session will be used on the 15th session. Audiotapes will record the first and the last, or the first and the 15th sessions. Sessions will last for 50 minutes in accordance with normal session length at Georgia State. You will be asked to complete a minimum of 50 minutes in each session in order to control for an equal amount of time in both IPR and traditional counseling sessions. Traditional Counseling Without IPR The five clients who receive the traditional treatment alone will have sessions that are unstructured and are conducted using your nor- mal, eclectic, dyadic treatment methods. Each session will last 50 minutes. Audiotapes will be collected from the first and last, or first and 15th sessions. IPR Techniques and Session Procedures Stimulus films. Clients view at least five filmed vignettes which are selected by you according to individual client problem areas. After viewing each vignette, the client discusses with you those thoughts, feelings, images, memories, etc., that he had while watch- ing the vignette. The client's reactions to the vignettes become the focus of the counseling session. This process can take up the whole 184 session or part of it, with any remaining portion of the 50 minutes being spent in traditional counseling procedures. Videotape recall of stimulus films. Clients view at least five vignettes and are videotaped while watching them. The videotape is played back for the client and you for a recall of the client's reactions to the film. You facilitate the client's recall of the tape, and this recall becomes the focus of the counseling session. This process can take up the whole session or part of it, with any remain- ing portion of the 50 minutes being spent in traditional counseling procedures. Client recall. A traditional counseling session is taped for 10 to 15 minutes. An inquirer then facilitates the client in his recall of the session for a period of 20 to 30 minutes while you watch the recall from an unobtrusive position in the room, through a one- way mirror, or you may leave the session completely and wait in another location until the inquiry time has elapsed. If you watch the recall, the client is aware that you are doing so. During the final 10 to 20 minutes of the session, the inquirer leaves the room and you return for a final period of traditional counseling. Mutual recall. A traditional counseling session is videotaped for 10 to 15 minutes. An inquirer then facilitates the recall for both you and the client for 20 to 30 minutes. The inquirer then leaves and a traditional session follows for the remainder of the hour. Significant other client or mutual recall. The client and sig- nificant other are both videotaped while talking about something that 185 is meaningful to their relationship for 10 to 15 minutes. You then enter the room and act as an inquirer to facilitate the recall of the tape by either the client alone or by both the client and the signifi- cant other for 20 to 30 minutes. The remainder of the session is a traditional counseling session with either the client alone or both the client and the significant other. MEMO TO: FROM: 186 September 16, 1976 Therapists involved in client research project Bob Tomory Following the initial session: 1. 2. 3 Collect an audio tape (which I have supplied) of the session Have client sign consent form Ask client to go to the testing office to fill out question- naires before the next session (preferably immediately fol- lowing the first session) Fill out the Counselor Form (Pre) of the Therapy Session Report and the Counselor Form (A) of the Client's Description of Problems Scale Return the audio tape, consent form, and two inventories to me Following the final or the 15th session: Collect an audio tape (which I have supplied) of the session Ask client to go to the testing office to fill out question- naires Fill out the Counselor Form (Post) of the Therapy Session Report and the Counselor Form (B) of the Progress of Counsel- ing Rating Scale Return the audio tape, client schedule sheet, and two inven- tories to me APPENDIX H CLIENT CONTROL SHEETS 187 APPENDIX H CLIENT CONTROL SHEETS Traditional Treatment Clients Client identification number Beginning date Termination date or date of 15th session Number of sessions Comments concerning the treatment of this client: Client identification number Beginning date Termination date or date of 15th session Number of sessions Comments concerning the treatment of this client: Client identification number Beginning date Termination date or date of 15th session Number of sessions Comments concerning the treatment of this client: Client identification number Beginning date Termination date or date of 15th session Number of sessions Comments concerning the treatment of this client: Client identification number Beginning date Termination date or date of 15th session Number of sessions Comments concerning the treatment of this client: 188 1239 “apo:o_uaov acmwpu mg» mo ucwsumocu wsu o» mcwcweucmn cowumscowcm pucowupvn< __eum¢ coguo occuccccm_m .o AuQPLUmwaxu Soc; * spww mc:_u=pv ms_we m=_=scam co _pauoa oaaoomc_> .m Auawcummnxu soc» . e__c au=_u=_v ms_,e m=.=s.um .e Acmcwsucm mo mam: mus—ucpv p—momz poses: .m oz\mm> ~a=_ce=o=. we» «scamac so» ewe Acocpzacw we use: mus—ucwv ppmomm acme—o .~ xpco pmcowupumch .— Ampv A¢_V Am_v A~_V A_.v Ao_v Amy Amy Amy mzo~mmmm Amy Amv Avv Amy ANV A_V hzmzk use cocmaccp $8 can: ma—g xoa muowcaocane use a? ccvmmwm use me want we» ugoumc mmem—a co_u~uwc_3=ou_ “ewe—u mucmm—u acmEuomLh ma~ copwmcaou mo use: REFERENCES 190 REFERENCES Alger, 1. 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