Counselors' reactions to depressed and borderline personality disordered clients

MISSING IMAGE

Material Information

Title:
Counselors' reactions to depressed and borderline personality disordered clients
Physical Description:
ix, 150 leaves : ; 29 cm.
Language:
English
Creator:
McIntyre, Cheryl Martin, 1950-
Publication Date:

Subjects

Subjects / Keywords:
Counselor Education thesis Ph. D
Dissertations, Academic -- Counselor Education -- UF
Genre:
bibliography   ( marcgt )
non-fiction   ( marcgt )

Notes

Thesis:
Thesis (Ph. D.)--University of Florida, 1994.
Bibliography:
Includes bibliographical references (leaves 140-149)
Statement of Responsibility:
by Cheryl Martin McIntyre.
General Note:
Typescript.
General Note:
Vita.

Record Information

Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
aleph - 002045398
oclc - 33393135
notis - AKN3322
System ID:
AA00011849:00001


This item is only available as the following downloads:


Full Text












COUNSELORS' REACTIONS TO DEPRESSED AND
BORDERLINE PERSONALITY DISORDERED CLIENTS







By

CHERYL MARTIN McINTYRE




















A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY

UNIVERSITY OF FLORIDA

1994














ACKNOWLEDGMENTS

There are many people in my life who have supported and

encouraged me in the formidable task of earning my doctoral

degree.

My two beautiful and extraordinary daughters, Selena

and Lindsey, made numerous sacrifices so that I might accom-

plish this goal. There have been many times when they

sacrificed my company so that I might work "on my paper."

They did this unselfishly and with a grace that belied their

years. I am very grateful to Jack, my husband, for his

support, reassurance, and willingness to assume added re-

sponsibilities so that I might pursue this goal. My "sis-

ter" Ina has been unfailing in her encouragement, motiva-

tion, and sympathy, even at times when I considered abandon-

ing the whole undertaking. My parents and brother have

been resolute in their belief that I would accomplish this

goal.

To Dr. Larry Loesch, I offer my heartfelt thanks for

his learned and accurate guidance through this process. He

is truly a perceptive and kind man and an extraordinary

mentor. I would not have completed this process were it not

for his advice, understanding, and sensitivity to "real

life" concerns.











To Dr. Marshall Knudson I offer thanks for the expert

training, experience, and supervision I obtained under his

guidance at the Alachua County Crisis Center. The

experience taught me about suicidal and borderline personal-

ity disordered clients and also allowed me to "find my

niche" in counseling. The knowledge acquired there has

proven to be invaluable in many settings, both professional

and personal.

I would also like to thank Shawn Prichard, who, in all

his "statistical wisdom," helped me to understand the re-

sults obtained in this study.

And finally, I would like to thank all of the Licensed

Mental Health Counselors in Florida who were willing partic-

ipants in this study. They received a packet with a request

from a stranger but volunteered their time and energy to

assist me with this study and to further counseling re-

search.















TABLE OF CONTENTS


page

ACKNOWLEDGMENTS . ii

LIST OF TABLES . ... vi

ABSTRACT . . .. v.iii

CHAPTER

I INTRODUCTION . ... 1

Overview . 5
Theoretical Framework . 9
Statement of the Problem .. .13
Need for the Study .. .14
Purpose of the Study .. .16
Rationale for the Approach ... .17
Hypotheses . .. .18
Definition of Terms .. .20
Overview of the Remainder of the Paper 23

II REVIEW OF RELATED LITERATURE

Need for the Study .. .24
Depressive Disorder .. 24
Borderline Personality Disorder 28
Counselors . .. .37
Counselor Attributes .. .38
Theoretical Framework .. .42
Interpersonal Theory .. .42
Counseling Relationships ... .46
Self-Efficacy Theory .. .51
Self-Efficacy and
Maladaptive Behavior .. .54
Support for the Approach .. .55
Support for the Measurement Technique 57
Impact Message Inventory ... .57
Stress Appraisal Scale .. .59
Summary . .. 60









III METHODOLOGY


Delineation of Variables .. .62
Variables . ... 62
Population . .. .63
Sampling Procedures .. .65
Research Procedures ..... .66
Assessment Instrument .. .68
Impact Message Inventory ... .68
Stress Appraisal Scale .. .69
Description of the Nature
of the Data . .. .71


IV RESULTS 72

V DISCUSSION

Limitations . .. .88
Discussion . .. .89
Implications . .. .99
Theory . .. 99
Training . .. .100
Practice . .. 100
Research . .. .101
Recommendations . .102
Theory . .. .103
Training . .. .104
Practice . ... .104
Research . .. .105
Summary . .. .106

APPENDICES

A LETTER TO SUBJECTS .. .107

B DEMOGRAPHIC INVENTORY . 108

C TYPESCRIPT OF INTERVIEW WITH MISS A 109

D TYPESCRIPT OF INTERVIEW WITH MISS C 123

E IMPACT MESSAGE INVENTORY .. .132

F STRESS APPRAISAL SCALE .. .137

G REMINDER LETTER . .. 139


REFERENCES . .. .140















LIST OF TABLES

Table page

1 Frequencies of Subjects by Group 72

2 Means and Standard Deviations of
Likelihood by Client Type, Counselor
Degree, and Subject Gender ... .73

3 Means and Standard Deviations of
Years of Experience by Client Type,
Counselor Degree, and Subject
Gender . ... 74

4 Means and Standard Deviations of IMI
Dominant Scale By Client Type,
Counselor Degree, and Subject
Gender . 75

5 Means and Standard Deviations of IMI
Hostile Scale by Client Type,
Counselor Degree, and Subject
Gender . ... 76

6 Means and Standard Deviations of IMI
Submissive Scale by Client Type,
Counselor Degree, and Subject
Gender . ... 76

7 Means and Standard Deviations of IMI
Friendly Scale by Client Type,
Counselor Degree, and Subject
Gender . .. 77

8 Means and Standard Deviations of SAS
Salience Scale by Client Type,
Counselor Degree, and Subject
Gender . ... 77

9 Means and Standard Deviations of SAS
Difficulty Scale by Client Type,
Counselor Degree, and Subject
Gender . ... 78








10 Means and Standard Deviations of SAS
Secondary Appraisal Scale by Client Type,
Counselor Degree, and Subject
Gender . ... 78

11 Analysis of Variance of Dominance by
Client Type, Counselor Degree, and
Subject Gender . .. 79

12 Analysis of Variance of Hostility by
Client Type, Counselor Degree, and
Subject Gender . .. 79

13 Analysis of Variance of Submissiveness by
Client Type, Counselor Degree, and
Subject Gender . .. 80

14 Analysis of Variance of Friendliness by
Client Type, Counselor Degree, and
Subject Gender . .. 80

15 Analysis of Variance of Salience by
Client Type, Counselor Degree, and
Subject Gender . .. 82

16 Analysis of Variance of Difficulty by
Client Type, Counselor Degree, and
Subject Gender . .. 82

17 Analysis of Variance of Secondary Appraisal
by Client Type, Counselor Degree, and
Subject Gender . .. 83

18 Correlations Between Years of Experience
and Scores on the Impact Message
Inventory for Subjects with DCs 84

19 Correlations Between Years of Experience
and Scores on the Impact Message
Inventory for Subjects with BPDCs 85

20 Correlations Between Years of Experience
and Scores on the Stress Appraisal
Scale for Subjects with DCs ... .86

21 Correlations Between Years of Experience
and Scores on the Stress Appraisal
Scale for Subjects with BPDCs 87








Abstract of Dissertation Presented to the
Graduate School of the University of Florida
in Partial Fulfillment of the Requirements
for the Degree of Doctor of Philosophy

COUNSELORS' REACTIONS TO DEPRESSED AND
BORDERLINE PERSONALITY DISORDERED CLIENTS

By

Cheryl Martin McIntyre

December, 1994


Chairman: Dr. Larry C. Loesch
Major Department: Counselor Education


The purpose of this study was to examine the differen-

tial impacts of depressed clients (DCs) and borderline

personality disordered clients (BPDCs) upon counselors.

Counselors' perceptions of the level of stress incurred in

counseling clients from these two groups were examined.

Counselor degree, gender, and years of experience also were

considered as moderating variables.

Subjects in this study were licensed mental health

counselors in Florida. The sample included 155 counselors;

80 responded to a DC while 75 reacted to a BPDC. Of these

155 subjects, 44 were male and 100 were female. Four sub-

jects did not report their gender. Subjects were mailed a

packet including a (a) letter of introduction, (b) demo-

graphic inventory, (c) audiotaped interview with either a DC

or a BPDC, (d) Impact Message Inventory, (e) Stress Apprais-

al Scale, and (f) a self-addressed, stamped envelope.


viii








Results were analyzed using factorial analyses of

variance and Pearson product-moment correlation

coefficients. There was a significant finding for client

type on the variables (a) dominance, (b) hostility,

(c) submissiveness, (d) friendliness, and (e) salience.

No significant main effect was found by client type on task

difficulty or secondary appraisal. Subjects with a master's

degree who responded to the DC found her to be significantly

more submissive than those with the same degree responding

to a BPDC. Counselor degree was not a factor of signifi-

cance for the variables of (a) dominance, (b) hostility,

(c) friendliness, (d) salience, (e) difficulty, or

(f) secondary appraisal. There were no significant findings

based on subject gender, and the only significant correla-

tion between years of experience and subscale scores was

that for the dominant and difficulty scale of subjects

responding to the DC.

It was concluded that there were few differences in

counselors' reactions to DCs and BPDCs and that the lack of

differences is contrary to what has been proposed in the

professional literature. Recommendations for counselors'

professional preparation and practice were provided.















CHAPTER I
INTRODUCTION

The pain of depression is known to some degree by
most of us on both personal and professional lev-
els. It seems literally impossible for one to be
in clinical practice without encountering de-
pressed individuals routinely. What is the effect
of the prevalence of depression? The cost in
human lives, suffering, damaged relationships,
lost work, and lost personal time, as well as in
other areas, is incalculable. (Yapko, 1988, p. 7)

Before we can do anything for borderline
patients, we must understand what they do to
us. (Kramer & Weiner, 1983, p. 70)

If one wayward child can impair the morale of a
whole family, it therefore stands to reason that
ten disturbed patients are going to take their
toll on the therapist. (English, 1976, p. 197)

Counseling is a profession wherein counselors must be

attentive, caring, and supportive (almost) regardless of

their personal feelings and life circumstances. They are

taught that skilled counselors create an atmosphere of

empathy, warmth, and unconditional caring (Rogers, 1957).

Relatedly, Greben (1984) specified six attributes that

characterize an effective counselor: (a) empathic concern,

(b) respectfulness, (c) realistic hopefulness, (d) self-

awareness, (e) reliability, and (f) strength. Guy (1987)

also described psychotherapists (and counselors):

Such individuals seem to possess a patient, caring
attitude about others, often accompanied by a tolerant,
nonjudgmental demeanor which allows them to accept

1










people as they are. Rather than being a rehearsed,
artificial caring, this valuing is profoundly genuine
and sincere. Such people are able to defer to others
in the service of providing comfort, support, or
nurturance (p. 12).

These qualities describe individuals who are extremely

altruistic, and (presumably) not governed by their emotions.

However, because counselors are human, it is unlikely that

they are able to exhibit these characteristics at all times

and in the face of all types of clients.

Counselors' relationships with clients are character-

ized by intimacy, intensity, and selflessness. By defini-

tion, people in the counseling profession have relationships

with dysfunctional people who are experiencing distressing

lives. Clients disclose events of their lives during coun-

seling sessions and confront counselors with painful infor-

mation and intense emotions (Deutsch, 1984). Counselors

listen to and feel empathy for their clients and (often

attempt to) neglect their own feelings and reactions in the

process. Unfortunately, such functioning often leads to

counselor stress.

Some of the more common stressors for counselors are

(a) professional isolation and loneliness, (b) oppressive

and overwhelming responsibility, (c) need to control per-

sonal emotions, (d) necessity to remain (constantly) em-

pathic and provide nonreciprocated attentiveness,








(e) doubts about progress and effectiveness, and (f) lack of

therapeutic success (Bermak, 1977; Daniels, 1974; Farber &

Heifetz, 1982; Kline, 1972; London, 1977; McCarley, 1975).

These stressful working conditions lead to counselors'

stress reactions such as depression, divorce, job dissatis-

faction, professional burnout, and suicide. In an attempt

to reduce this stress, counselors often begin to treat

clients differentially. That is, through experience, they

develop differential expectations about clients and about

how helpful they can be to them. Because of these expecta-

tions, their willingness to counsel some groups of clients

may be greater or lesser than their willingness to treat

other groups. However, the nature of counselors' responses

to (or expectations for interactions with) various types of

clients are not well understood. Therefore, this research

explored counselors' expectations about depressed clients

(DCs) and borderline personality disordered clients (BPDCs),

two client groups with whom counselors often work.

In regard to DCs, counselors often react with comfort,

support, and a helpful attitude. Depressed clients typical-

ly communicate heightened dependency, and counselors feel

effective and necessary to the clients' healing process.

Depressed clients also typically are responsive to change

due to their confusion and extreme emotional discomfort.

Therefore, counseling DCs is often rewarding, and their

recovery rate is high (Maxmen, 1986). Yalom (1989) de-

scribed his reaction to a client who suffered from depression:









Marie was of Spanish descent and had emigrated
from Mexico City eighteen years before .
She concealed her depression well. No one could
have guessed that she felt her life was over; that
she was desperately lonely; that she wept every
night; that in the seven years since her husband
died, she had not once had a relationship, even a
personal conversation, with a man. Marie was
a forbidding presence and most people felt daunted
and distanced by her beauty and hauteur. I, on
the other hand, was strongly drawn toward her. I
was moved by her, I wanted to comfort her.
(p. 168)

In contrast, BPDCs elicit a different response.

Counselors who treat BPDCs complain of feelings of frustra-

tion, confusion, anger, fear, and desire to end the counsel-

ing relationship. Counseling relationships with BPDCs are

difficult because of their (i.e., clients') inability to

trust, instability of affect, impulsive behavior, and

heightened suicidal risk. Many professionals have reported

that the course of counseling BPDCs often involves years,

and the recovery rate is low (Kernberg, 1975; Maxmen, 1986;

Stone, in Cooper, Frances, & Sacks, 1986; Waldinger &

Gunderson, 1987). Yalom (1989) described his encounter with

a client he calls "Marge." He eventually counseled Marge

for 18 months, but initially reported some serious reserva-

tions. He wrote of his first encounter with her:

Her sagging head and shoulders said "depression;"
her gigantic eye pupils and restless hands and
feet said "anxiety." Everything else about her--
multiple suicide attempts, eating disorder, early
sexual abuse by her father, episodic psychotic
thinking, twenty-three years of therapy--shouted
"borderline," the word that strikes terror in the
heart of the middle-aged comfort-seeking psychia-
trist. (p. 213)









He went on to describe how Marge behaved during the initial

session: smoking furiously, unable to sit still, pacing the

room, and even curling up in the corner of his office at one

point. He also revealed his reaction to her behavior:

My first impulse was to get the hell away, far
away--and not see her again. Use an excuse, any
excuse: my time all filled, leaving the country
for a few years, embarking on a full-time research
career. But soon I heard my voice offering her
another appointment. (p. 214)

From personal, anecdotal reports it is evident that

counselors have different opinions about and reactions to

DCs and BPDCs. This may be a professionally significant

difference given the numbers of DCs and BPDCs, and the

situations associated with their conditions. Therefore,

study of counselors' differential expectations for and

reactions to DCs and BPDCs is warranted.

Overview

Depressive disorders are the most common psychiatric

diagnosis treated by mental health professionals (U.S.

Department of Health and Human Services, 1988). The condi-

tion causes severe impairment in clients' abilities to

function in their jobs and with their families. Often,

clients who suffer from depression lose time from work due

to (a) inability to concentrate, (b) intense feelings of fa-

tigue, (c) loss of interest in activities that once were

enjoyable, (d) diminished feelings of self-worth, and









(e) frequent preoccupation with suicidal thoughts. De-

pressed clients also report problems with their families due

to (a) constant feelings of sadness, (b) loss of energy,

(c) inability to experience pleasure, and (d) diminished

sexual desire (American Psychiatric Association, 1987).

Depression is a progressive illness, and there are many

treatment issues that warrant consideration. The increase

in the number of clients suffering from depression has

caused a greater need for counseling services. Additional-

ly, there is considerable demand for crisis intervention for

depressed clients, particularly those who are suicidal. At

times DCs' depressive symptoms can become so distressing

that medication and/or hospitalization is recommended. For

example, 54.8% of clients in 1985 who were suffering from

depression were prescribed psychotropic medication to

relieve their symptoms. In 1987, 565,000 patients suffering

from depressive disorders were admitted to short-term

psychiatric hospitals for treatment (U.S. Department of

Health and Human Services, 1988). These figures illustrate

that treatment of DCs is of considerable concern for mental

health providers in terms of both energy expended and

financial cost.

Kernberg (1982) suggested that clients who fit the

criteria for borderline personality disorder make up approx-

imately 10% of the population. It was reported that 13% of

patients admitted to psychiatric hospitals were diagnosed as

BPD (Gunderson & Singer, 1975), although only 3% of current









treatment requests involve BPDCs (U.S. Department of Health

and Human Services, 1988). It also has been suggested that

borderline personality disorder is the most frequently

reported of all DSM-III-R personality disorders (Pollack,

1986).

Oftentimes BPDCs are committed involuntarily to a

psychiatric facility due to a suicidal threat or gesture.

Thus, because of their tendency to threaten suicide repeat-

edly, they may be hospitalized at a disproportionately high

rate (Gutheil, 1985).

Borderline personality disordered clients lead extreme-

ly disordered and confusing lives. They have problems at

work due to (a) difficulty getting along with others,

(b) impulsive behavior, (c) substance abuse, (d) moodiness

and unpredictability, (e) difficulty controlling anger,

(f) uncertainty about career choice and long-term goals

manifested by a lack of investment in the job, (g) suicidal

threats, and (h) chronic feelings of boredom. The family

life of BPDCs also is troubled due to their (a) inability to

maintain stable relationships, (b) questions about self

image including issues of sexual orientation, type of

friends desires, preferred values, (c) polymorphous sexuali-

ty, (d) frantic efforts to avoid real or imagined abandon-

ment, (e) bizarre attempts at self harm, and (f) suicidal

threats (American Psychiatric Association, 1987).

Treatment issues surrounding BPDCs differ from DCs in

that treatment for BPD is long-term, intensive, and









extremely unpredictable. Clients suffering from this

disorder typically seek treatment at a greater rate than do

other clients, and often seek treatment from many providers

at one time (Pollack, 1986). They also are inclined to

"play" one counselor against another so that their treatment

becomes unfocused and confused. Because treatment for BPDCs

is long-term, it is very expensive and requires major

personal and professional investments on the part of coun-

selors. The lives of BPDCs are fraught with "ongoing"

crises; therefore, the need for crisis intervention counsel-

ing also is increased.

The role of the counselor is a difficult one. In

present society, counselors are viewed as those individuals

who are responsible for the emotional well-being and safety

of its members. As Guy (1987) reported, "Such individuals

[counselors] have traditionally been assigned the task of

bringing relief to both individual and community suffering.

Currently, it is the psychotherapist who is expected to

unlock the mysteries of human pain (p. 1)."

There are approximately 11,550 members of the American

Mental Health Counselors Association working as counselors

in the United States (AACD, 1989). Additionally, there are

approximately 29,000 psychiatrists, 26,000 clinical psychol-

ogists, and 31,000 psychiatric social workers in this

country who also treat clients with various mental illnesses

(Guy, 1987). The approximate total number of clinicians









available to treat mental health clients, therefore, is

97,500. This is a substantial number of people who are

impacted by clients. Based on the estimates of clients'

problem classifications (i.e., 29.4% for DCs and 3% for

BPDCs), it can be suggested that counselors who treat

clients with depressive or borderline personality disorders

will spend approximately one-third (32.4%) of their time

treating a member of one of those two groups.

Theoretical Framework

Interpersonal psychology is an area wherein the focus

of study is on human transactions, not on individual behav-

ior (Anchin & Kiesler, 1982). The theoretical foundation

for this approach is drawn from the work of Harry Stack

Sullivan (1953) who suggested that human personality is

developmental and evolves through interpersonal transac-

tions. He believed that psychopathology results from

disordered interpersonal relationships, and can be observed

through disordered communication. He also proposed that

relationships are characterized by continuous negotiation of

complementary needs through a reciprocal process (Sullivan,

1953).

Sullivan's concepts have been extended by Donald

Kiesler (Anchin & Kiesler, 1982) who presented his basic

theoretical assumptions for any interpersonal approach:

(a) Interpersonal study focuses on human transac-
tions, not on the behavior of individuals;







10

(b) In interpersonal explanations the construct of
self occupies a central theoretical position.
This self is social, interpersonal, and transac-
tional in its development and functioning through-
out life;

(c) A person's recurrent pattern of interpersonal
situations represents distinct combinations of two
to three basic dimensions of interpersonal behav-
ior: control, affiliation and inclusion;

(d) Interpersonal theory takes an interactionist
position in which a person's social behaviors are
a function of both his or her predispositions
toward transactions and situation/environmental
events;

(e) Interpersonal theorists adopt a notion of
"circular" rather than linear causality; and

(f) The vehicle for human transactions is communi-
cation, including linguistic and nonverbal messag-
es. (Kiesler, in Anchin & Kiesler, 1982, pp. 5-11)


Kiesler viewed the counseling relationship as the

variable of interest, and he observed and measured communi-

cation to evaluate it. He suggested that clients may have

difficulty in relationships due to rigidity in their styles

of interacting, i.e., a style that the client is either

unwilling or unable to modify. The message communicated is

that the client has only one way of operating in a relation-

ship, and the other person can "take it or leave it"

(Kiesler, 1979). As Leary (1957) suggested,

[The abnormal person] tends to overdevelop a
narrow range of one or two interpersonal
responses. They are expressed intensely and
often, whether appropriate to the situation
or not The more extreme and rigid the
person, the greater [his/her] interpersonal
"pull"--the stronger [his/her] ability to
shape the relationship with others. (p. 126)









Suggested in this theory is the notion that relation-

ships between clients and counselors are an important area

of study. A counselor's interactions with BPDCs would be

expected to be marked by rigidity and resistance to change.

This would imply that the client is shaping the course of

the counseling relationship, which could result in that

relationship evolving much like the client's other relation-

ships--impaired and unrewarding. In contrast, the behavior

of DCs is characterized by passivity and hopelessness. In

this context, it is difficult for a substantial counseling

relationship to form, and the deficit would severely thwart

the counseling process.

The impact of a defective counseling relationship upon

the counselor is significant. It is important that counsel-

ors feel effective in their professional roles. The "suc-

cess" or "failure" of the counseling relationship often

serves as an indicator to the counselor of how worthwhile

counseling sessions have been, and may reflect the

counselor's feelings of self-efficacy. Self-efficacy refers

to personal judgement of how well one can perform in situa-

tions that may be new, unpredictable, and stressful

(Bandura, 1977). Counselors' self-efficacy impacts directly

on the many decisions they are called upon to make in the

course of their work.

Self-efficacy also affects choice of activities and

environments. People who do not feel effective in a situa-

tion are more inclined to avoid it. However, successful









experience in difficult situations strengthens sense of

self-efficacy and motivates undertaking similar challenges

in the future. In counseling, the "difficult situation" may

be working with trying (i.e., "difficult") clients. If

counselors have unpleasant experiences which do not increase

their feelings of self-efficacy in their roles, the result

may be that they avoid similar clients in the future.

Self-efficacy theory also proposes that feelings of

competence determine how much energy is expended, as well as

the degree of persistence maintained in a laborious situa-

tion (Bandura, 1982). Therefore, counselors may accept some

difficult clients in their caseloads but be likely to expend

less energy and time with them than with other clients. The

outcome of this approach is unsatisfactory for "difficult"

clients, and further diminishes counselors' sense of self-

efficacy.

Diminished self-efficacy affects an individual's

thoughts and emotions (Bandura, 1982). People who feel

ineffective in a given situation may worry about their

performance and experience increased levels of stress in

their lives (Beck, 1976). Counselors who worry excessively

about their counseling performance experience self-doubt

which decreases their ability to cope with situations effec-

tively (Schunk & Carbonari, 1984).

When people feel ineffective, they spend a great deal

of time and energy evaluating their ability to cope and

forecasting potential outcomes. For counselors, this is









time spent trying to anticipate what might happen in a

counseling session with a difficult client and then planning

how to contend with it. Conversely, counselors who feel

able to cope with difficult clients do not feel compelled to

engage in this behavior because they are more confident in

their ability to manage clients effectively.

Statement of the Problem

The problem addressed in this study is that the impacts

of depressed clients and borderline personality disordered

clients upon counselors is unknown. A large number of

clients exhibit symptoms of these diagnoses; consequently,

counselors spend a substantial amount of time counseling DCs

or BPDCs. Therefore, it is important to determine the

impacts these clients have on counselors. One method of

assessing these impacts is to examine some of counselors'

perceptions related to working with DCs and BPDCs.

Some clients may use the counseling relationship to

dominate or control their counselors. They view counseling

sessions as a competitive environment and expend energy

struggling for control rather than addressing the concerns

which originally brought them into counseling. Others may

exhibit opposite behavior and be very passive and submissive

in an attempt to gain counselors' acceptance. They may be

exceptionally self-effacing and dependent. Others might

display hostility to counselors, communicated through criti-

cism, mistrust, and lack of engagement.









Counselors' self-perceived levels of competence are a

factor in their interpersonal relationships with clients.

Areas of significance include how (a) counselors feel about

their performance and the potential outcomes of working with

these clients, (b) difficult and stressful they believe

their tasks to be, and (c) they evaluate their skills and

resources relative to meeting the demands of this endeavor.

It was unknown (a) whether counselors' interpersonal

experience with DCs and BPDCs vary in regard to the vari-

ables of dominance, submissiveness, hostility, or friendli-

ness, (b) whether there was a difference in counselors'

perceived levels of self-efficacy in counseling clients from

either of these groups, (c) how counselors assessed their

skills and resources specific to working with DCs or BPDCs,

(d) if there was a difference in their prediction of the

outcomes of the undertakings, and (e) whether there were

differences in the impacts of DCs and BPDCs on counselors'

perceived levels of stress and success as a function of

their degree levels and years of experience. Therefore,

these factors were addressed in this study.

Need for the Study

If the impacts of DCs and BPDCs on counselors were

known, there would be important implications for the coun-

seling profession in the areas of theory, training, prac-

tice, and research. One goal of this study was to examine

the validities and applicabilities of interpersonal theory

and self-efficacy theory. The information derived in regard









to counselors' perceptions of clients may or may not lend

support to interpersonal theory. For example, if the

results of this study are consistent with those predicted by

the theory, the focus of counseling research may shift from

the content and outcome of counseling sessions to the

counseling relationship. However, if this research does not

lend support to this theory, then the significance of study-

ing counseling relationships may diminish.

Self-efficacy theory also was examined in this re-

search. If predictions evolved from self-efficacy theory

are supported, there would be far-reaching implications for

the counseling profession. For example, perhaps counselors

would seek new career opportunities because of their dimin-

ished sense of competence in working with difficult clients.

Relatedly, training for counselors working with these two

groups would be influenced.

Currently, many counselors do not receive substantial

training in diagnosis and differentially responding to

clients, particularly in regard to their personal reactions

to clients. If the results of this study show that DCs and

BPDCs do impact counselors differently, counselors might be

taught to be sensitive to this dynamic and use it as valu-

able information in counseling relationships. Counselor

preparation programs thus might be advised to add training

which would enable counselors to distinguish between client

groups based on symptoms, to evaluate personal responses to

clients, and to view these responses as important variables







16

in the counseling process. Educators in crisis intervention

also might utilize information from this study to modify

their approaches to teaching techniques in working with DCs

and BPDCs (Martin, 1991). Additionally, counselor prepara-

tion programs might use this information in person-

al/professional stress management and goal setting.

The results from this study also may assist counselors

in practice to establish better working relationships with

DCs and BPDCs. Counselors may be advised to use different

techniques and have different expectations in working with

clients from these groups. The ultimate result would be

that DCs and BPDCs and their counselors have more rewarding

and successful experiences when working with each other.

The information from this study also will facilitate

further research. For example, if it is found that there

are no significant differences between the groups, further

research need not divide these clients but rather include

them as one group. However, if differences are found, it

might be important that future researchers treat these two

groups as separate and distinct.

Purpose of the Study

The primary purpose of this study was to examine

empirically if there are differential impacts of depressed

clients and borderline personality disordered clients upon

counselors. In addition, counselors' perceptions of the

stress level of the respective counseling tasks and their

self-perceptions of their abilities to counsel these two









groups of clients was examined. Counselors' gender were

considered as a variable of importance. Counselors' earned

degree and years of experience also were considered as

moderating variables.

Rationale for the Approach

There are various modes in which to conduct research

and several factors which must be considered in a

researcher's decisions. The experimental approach is the

one of choice in this study. Kerlinger (1986) defined

experimental research as "an investigation in which the

experimenter manipulates and controls one or more indepen-

dent variables and observes the dependent variable or

variables for variation concomitant to the manipulation of

the independent variables (p. 293)." This method was chosen

because it allows the researcher to examine cause and effect

and to have greater control over relevant variables.

Another significant benefit of experimental research is

replicability.

The stimulus for the subjects in this study was

audiotaped interviews with clients from the two groups

(i.e., DCs and BPDCs). The reasons for using audiotapes

rather than transcripts include (a) the presence of auditory

cues which are not available in a transcript and (b) the

availability and wide acceptance of these tapes as valid

examples of DCs' and BPDCs' behavior. Another approach

might have been to conduct actual interviews with clients,









but such an approach would introduce numerous variables

which could not be controlled.

The paper-and-pencil assessment instruments used in

this project were chosen due to low cost, administrative

expediency, and ease of scoring. Another method of assess-

ing variables might have been use of structured interviews,

but that technique was judged to be too expensive and time

consuming.

The subjects in this enterprise were counselors who

volunteered to participate. There are several factors which

discriminate volunteers from those who do not volunteer.

Voluntary subjects generally are found to have (a) more

education, (b) a higher occupational status, and (c) higher

scores on IQ tests than those who do not volunteer

(Rosenthal & Rosnow, 1969). They also are found to have a

higher need for regard and appreciation. Therefore, this

factor limits the generalizability of the results to people

who share these characteristics. However, these character-

istics also apply to the majority of people who become coun-

selors (Guy, 1987). It also must be noted that most sub-

jects in research experiments are indeed volunteers

(Rosenthal & Rosnow, 1969).

Hypotheses

The following null hypotheses were tested in this

study:

1. There are no differences in counselors'

reactions to depressed clients and borderline







19

personality disordered clients in regard to scores

on the Impact Message Inventory (IMI).

2. There is no significant interaction between

client type and counselor degree in regard to

scores on the IMI.

3. There is no significant interaction between

client type and counselor gender in regard to

scores on the IMI.

4. There is no significant interaction effect

between client type and degree and gender on the

scores on the IMI.

5. There is no correlation between years of

experience and scores on the IMI among those

working with depressed clients.

6. There is no correlation between years of

experience and scores on the IMI among those

working with borderline personality disordered

clients.

7. There are no differences in counselors' per-

sonal stress appraisal in counseling depressed

clients and borderline personality disordered cli-

ents in regard to scores on the Stress Appraisal

Scale (SAS).

8. There is no significant interaction between

client type and counselor degree in regard to

scores on the SAS.









9. There is no significant interaction between

client type and counselor gender in regard to

scores on the SAS.

10. There is no significant interaction effect

between client type and degree and gender on the

scores on the SAS.

11. There is no correlation between years of

experience and scores on the SAS among those

working with depressed clients.

12. There is no correlation between years of

experience and scores on the SAS among those

working with borderline personality disordered

clients.

Definition of Terms

In order for a study to be empirically sound, it is

necessary to define significant terms operationally. This

is especially true for words which have several definitions

and/or connotations. For this study, the meanings of the

terms listed are limited to those presented.

Mental health counselors are defined as those who are

licensed by their state as Mental Health Counselors, Li-

censed Professional Counselors, or equivalent title. They

have a minimum of a master's degree from a counselor prepa-

ration program, met academic and clinical supervision

requirements, and passed a licensing examination.









Highest degree attained is established by

self-report as Master's, Specialist in Education (or Certif-

icate of Advanced Studies; CAS), or Doctorate.

Years of experience as a practicing mental health

counselor is determined by self-report as completed, post-

graduation years of practice as a counselor.

Gender of counselor is established by self-report as

either male or female.

Depressed clients (DCs) are those mental health coun-

seling clients who experience the symptoms of depression

listed in the DSM-III-R. They will be represented in this

study by the client on an audiotaped interview.

Borderline Personality Disordered clients (BPCDs)

are those clients who suffer symptoms of Borderline person-

ality disorder as outlined in the DSM-III-R. They will be

represented in this study by the client on an audiotaped

interview.

Emotional impact is defined by cluster scores on the

Impact Measure Inventory (IMI) (Kiesler, Anchin, Perkins,

Chirico, Kyle, & Federman, 1976). The IMI is a 90-item,

paper-and-pencil measure of an individual's typical inter-

personal style. The clusters include (a) dominance,

(b) submissiveness, (c) hostility, and (d) friendliness.

Dominance is defined as the need to lead, direct,

control or influence others. The score on this cluster is

the sum of the scores on three scales: (a) exhibitionistic,

(b) dominant, and (c) competitive.









Exhibitionistic refers to behavioral traits such as

seeking attention, gaining notice, and approval from others.

Dominant alludes to the tendency to lead or direct, the

desire or need to influence or control others. Competitive

attributes include the need to seek and compete for recogni-

tion and status.

Submissiveness is the characteristic of behaving in a

passive and docile manner in order to appease others and

gain approval. This cluster of scores is composed of the

indices on the abasive, submissive, and succorant-seeking

scales. Abasive refers to the quality of accepting blame,

self-belittling, and constant apologizing for behavior.

Submissive tendencies are those wherein one acts in a

passive or docile manner in order to placate others.

Succorant-seeking behaviors include the preference for

allowing others to make one's decisions, a helpless, depen-

dent position in which the person surrenders responsibility

for choices to another person.

Hostility is measured by combining the scores of the

subscales of (a) hostility, (b) mistrusting, and (c) de-

tached. Hostility includes proclivity to criticize, ridi-

cule, punish, or agress against another person. Mistrusting

is the quality of doubting or suspecting the attitudes,

feelings, and intentions of others. Detached is a desire to

remain isolated from others.








Friendliness is derived from the agreeable, nurturant,

and affiliative subscales. To be agreeable is to be cooper-

ative, helpful, considerate, and equalitarian with others.

One who is nurturant is likely to support others actively,

and be sympathetic and helpful to them. A person who scores

high on the affiliative subscale will exhibit the qualities

of liking others, warmth, and friendship.

Appraisal of stress level is defined by measures on

several factors assessed by the Stress Appraisal Scale (SAS)

(Carpenter & Suhr, 1988). It is a 24-item, paper-and-pencil

test which measures self-perception of ability to perform a

specific task. The subscales yield information in six

areas: (a) caring about one's reaction and performance,

(b) recognition that process and outcome have important

consequences for self, (c) belief that the demands of the

stressor are significant, (d) perception of feelings of

stress, (e) evaluation of one's skills/resources for han-

dling the demands of the task, and (f) the prediction of the

outcome and one's success in meeting the stressor (Carpenter

& Suhr, 1988).

Overview of the Remainder of the Paper

The remainder of the study is divided into four sec-

tions. Chapter II is a review of the related literature

while the methodology is presented in Chapter III. The

results of the study are reported in Chapter IV, and Chapter

V includes conclusions, implications, and recommendations.














CHAPTER II
REVIEW OF THE RELATED LITERATURE

The review of literature in this chapter includes

support for the need for the study, followed by

overviews of clients diagnosed with a depressive

disorder, clients diagnosed as borderline personality

disordered, and counselors. In addition, interpersonal

theory and self-efficacy theory are reviewed. Finally,

support for the psychometric properties of the

assessment instruments and the approach to the study

are provided.

Need for The Study

Depressed [clients] see the world through de-
pressed glasses. To them, everything is bleak--
their life, their world, their future, and their
treatment. (Maxmen, 1986, p. 175)

Depressive Disorder

Depressive disorders rank as the current leading mental

health problem (Goodwin & Guze, 1988; Wetzel, 1984), having

an incidence in the United States (U.S.) estimated at be-

tween 10 and 20 million people. Therefore, approximately 1

in 20 people in the U.S. is diagnosed as experiencing a

significant depression at least once in their lifetime

(Cancro, 1985). It has been found that major depression is







25
more common in women than in men; in fact, women suffer this

disorder twice as often as do men.

Some clinicians contend that depression is psychogenic,

i.e., it is caused by psychic, mental, or emotional factors

and not by detectable organic or somatic influences. Others

maintain that the origin is inherent or constitutional,

while still others believe the cause to be from environmen-

tal, familial, or social influences. In addition, there are

those who maintain that depressive disorders are caused by a

combination of all of the above (e.g., Wetzel, 1984).

Researchers do agree, however, that single events are not

the source of depressive disorders. Rather, clusters of

negative events are more likely to cause this condition

(Wetzel, 1984).

Assessment of depressive disorders can be divided into

four symptom areas: (a) affective, (b) cognitive, (c) behav-

ioral, and (d) physical functioning (Wetzel, 1984). Affec-

tive symptoms include (a) dysphoria (i.e., sad, dejected, or

blue), (b) fearfulness, (c) anxiety, (d) feelings of inade-

quacy, (e) anger, (f) guilt, (g) confusion, and (h) a sense

of hopelessness, and irritability. Cognitive indications of

depression are (a) a negative outlook, (b) irrational be-

liefs, (c) recurrent thoughts of helplessness, hopelessness,

and worthlessness, (d) self-reproach, (e) low self-esteem,

(f) indecisiveness, (g) denial, (h) slow thinking,

(i) disinterest in activities, people, and pleasurable

events, (j) confused thought, (k) poor concentration,








(1) agitation, and (m) recurrent thoughts of death or sui-

cide. Suicidal ideation is a major concern in treating

depressed clients. It has been estimated that 15% of the

people who suffer from a depressive disorder eventually

commit suicide and, conversely, that approximately two-

thirds of people who commit suicide have a depressive ill-

ness (Black & Winkour, 1986, cited in Maris, Berman,

Maltsberger, & Yufit, 1992).

Depression also affects behavioral activity. Some

common indicators include (a) overdependence (e.g., relying

on other people to take control and make decisions),

(b) submissiveness, (c) nonassertiveness, (d) poor communi-

cation skills, (e) crying, (f) withdrawal, (g) inactivity,

(h) carelessness in appearance, (i) slowed motor response

(i.e., poverty of speech, slowed body movement), and

(j) agitated motor response (i.e., pacing, handwringing, or

pulling at hair or clothing).

A person suffering from a depressive disorder may also

experience changes in physical functioning. The symptoms

may include (a) listlessness, (b) weakness, (c) fatigue,

(d) change in sleep patterns (e.g., insomnia or hypersomnia,

(e) weight loss, (f) appetite loss, (g) indigestion,

(h) muscle aches and headaches, (i) tension, (j) agitated or

slowed psychomotor reflexes, and (k) decreased sexual de-

sire.









There also are some less conventional methods of diag-

nosing depressive disorders. For example, Cancro (1985)

reported,

The symptoms that are necessary include the
triad of reduced capacity to experience pleasure
(anhedonia), reduced interest in the environment
(withdrawal), and reduced energy (anergia). This
triad is of great diagnostic utility and can be
utilized even in the absence of demonstrable mood
changes. (p. 761)


Maxmen (1986) recounted another method of assessing depres-

sive disorders,

Virtually diagnostic of major depression is that
relatives will devote hours reassuring the [cli-
ent], but to no avail; no matter how effective or
frequent their pleas, nothing they say sticks for
more than a minute. Loved ones soon become impa-
tient or furious at the [client]; they realize
he's ill, but feel he's spurned their advice and
does nothing to help himself. (p. 175)

Many counselors perceive depressed clients as passive,

dependent, and sometimes manipulative. Often these clients

will surrender responsibility for decision making to coun-

selors expect counselors to "have the answers." If counsel-

ors succumb to this role, they often will be blamed by

clients for giving less than adequate advice. Thus, the

practice of using an attitude of "firm kindness" is prefera-

ble because it encourages the client to become involved in

physical and emotional activity while providing necessary

support. Using this type of approach, the symptoms of

depressive disorder typically will diminish as the client

begins to improve (Reid, 1989).








Unfortunately, there is very little information in the

literature concerning counselors' attitudes and perceptions

of working with depressed clients. However, Farber (1983)

suggested that there is a phenomenon called "transfer of

pathology" from the client to the counselor. This terminol-

ogy suggests that clients' conditions are actually conta-

gious; counselors who work with depressed clients might

indeed develop symptoms of depression. In fact, Chessick

(1978) reported that the condition of depression and despair

(a condition termed "soul sadness") is highly contagious.

He explained that

after laboring for long hours for many years
with chronically anguished patients, psycho-
therapists tend to take the anguish to bed with
them at night and grieve about it in their dreams;
it remains like a gnawing theme in the back of
their minds. (p. 5)


These authors suggest that counseling with some clients can

put counselors at risk for the onset of personal emotional

problems. Therefore, there is a need to study the impact of

depressed clients on counselors, and the outcome of these

relationships. This is important not only for the client's

well-being but also for the counselor as well.

Borderline Personality Disorder

Unless God speaks to me directly about the defini-
tion of borderline personality disorders, it is
probably foolhardy to venture into the area at
this time. (Leichtman, 1989, p. 229)


The Diagnostic and Statistical Manual of Mental Disorders

(Revised) (DSM-III-R) identifies the diagnosis of borderline









personality (BPD) as the most prevalent personality disor-

der. In addition, it reports this disorder to be more

common in females than in males by a ratio of between 2:1

and 3:1 (American Psychiatric Association, 1987). Estimates

of the percentage of the general population suffering from

this disorder range from 10-30% (Gunderson, 1984; Stone,

1987) and from 15-20% (Kroll, Carey, Sines, & Roth, 1982).

In hospitalized populations, Kroll et al. (1982) found that

borderline personality disordered clients (BPDCs) comprise

between 15-20% of the inpatient population in the United

Kingdom and the United States. Tarnopolsky (Tarnopolsky &

Berelowitz, 1987) reported findings that clients with this

disorder represented about 15-25% of those inpatients diag-

nosed as personality disordered. Perlmutter (1982) deter-

mined that BPDCs utilize a disproportionate amount of crisis

services and that they are often very difficult to manage in

times of crisis.

The etiology of this disorder has long been a subject

for debate. The majority of the literature concerned with

the origin of BPD subscribes to psychoanalytic theory (Camp-

bell, 1982; Cooper, Frances, & Sacks, 1986; Goldstein, 1988;

Gunderson, 1984; Kernberg, 1967; Kroll, 1988; Masterson &

Klein, 1989; Pollack, 1986; Stone, 1990). It has been

argued that this disorder is "determined by multiple biolog-

ical, psychological, and social factors--only more so"

(Leichtman, 1989, p. 242). Both genetic and environmental








influences have been implicated as variables in this

condition. In addition, clients who have been diagnosed as

borderline personality disordered may have (a) a predisposi-

tion to schizophrenic, affective, and anxiety disorders,

(b) attention deficit disorders, (c) hyperactivity disor-

ders, and (d) other forms of organic dysfunction. Environ-

mental factors include (a) abuse and neglect, (b) separation

and loss, and (c) being an object of patterns of dysfunc-

tional parenting (Leichtman, 1989).

Assessment of BPD is difficult. As Sweeney (1987)

cautioned,

The outpatient clinician confronted with a [cli-
ent] in whom borderline personality disorder must
be ruled out is facing a situation analogous to
the well-known problem faced by the blind men
confronted with the elephant. Isolated features
do not present an overall view. (p. 32-33)


Personality disorders are differentiated from other disor-

ders in the DSM-III-R as conditions with an early onset and

a long enduring course. A personality disorder diagnosis

requires that the maladaptive behavior is present in a wide

range of social and personal contexts and thus not an iso-

lated reaction to one particular stressor (Cooper, Frances,

& Sacks, 1986).

Hallmark indicators of borderline personality disorder

include instability of the client's functional, emotional,

interpersonal, and intrapsychic capacities and activities

beginning in early adulthood. The DSM-III-R classification









as BPD requires that at least five of the following eight

criteria be met:

(a) a pattern of unstable and intense interperson-
al relationships characterized by alternating
between extremes of overidealization and devalua-
tion;

(b) impulsiveness in at least two areas that are
potentially self-damaging, eg. spending, sex,
substance use, shoplifting, reckless driving,
binge eating (not to include suicide or self-muti-
lating behavior);

(c) affective instability: marked shifts from
baseline mood to depression, irritability, or
anxiety, usually lasting a few hours and only
rarely more than a few days;

(d) inappropriate, intense anger or lack of con-
trol of anger, e.g., frequent displays of temper,
constant anger, recurrent physical fights;

(e) recurrent suicidal threats, gestures, or be-
havior, or self-mutilating behavior;

(f) marked and persistent identity disturbance
manifested by uncertainty about at least two of
the following: self-image, sexual orientation,
long-term goals or career choice, types of friends
desires, preferred values;

(g) chronic feelings of emptiness or boredom;

(h) frantic efforts to avoid real or imagined
abandonment (not to include suicidal or self-muti-
lating behavior) (American Psychiatric Associa-
tion, 1987, p. 347).

Pollack (1986) defined BPD characteristics by sepa-

rating them into areas concerning the self and self in

interaction with others. Symptoms surrounding the issue of

self include (a) a noncohesive sense of stable identity,

with the attendant inability to tolerate feeling or being

alone; (b) transient psychotic episodes which typically

occur when the client is under severe stress; (c) impulsive








behaviors such as sexual promiscuity and deviance utilized

in an addictive manner; and (d) uncomfortable affect includ-

ing anger, rage, and a painful emptiness. The symptoms

relating to the self in interaction with others consist of

(a) unstable and intense interpersonal relationships wherein

the use of devaluation, overidealization, and manipulation

are common; (b) self-destructive behavior often with the

intent of forcing a significant other to intervene; and

(c) the inability to effectively apply their talents. As

Pollack (1986) contended, "One of the major motivations for

treating borderline personality disorders is the tragic

waste of [their] talents and skills. Vocational rehabilita-

tion is an important issue" (p. 107).

Linehan (1987) viewed BPDCs' characteristics from a

behavioral viewpoint, and classified BPD behavioral patterns

as organized along three poles: (a) emotional vulnerability

versus invalidation, (b) active passivity versus the appar-

entlv competent person, and (c) unrelenting crises versus

inhibited grieving.

Emotional vulnerability is defined as the inability to

regulate emotional responses. As Linehan (1987) suggested,

"They [BPDCs] appear exquisitely sensitive to any kind of

stimuli respond intensely to even low-level stimuli,

and have difficulty regulating the return to an emotional

baseline" (p. 263). Included in this trait is emotional

liability and problems with anger.









Invalidating syndrome refers to clients' tendency to

invalidate their own affective experiences and to oversim-

plify solving life's problems. These clients have difficul-

ty learning to adequately label and control emotional reac-

tions and do not learn to trust their emotional responses.

They also learn that extreme emotional displays are often

necessary to provoke a helpful response from others.

Active passivity refers to active efforts on the BPDC's

part to elicit problem solving from others while remaining

passive in the process of solving personal problems. This

is evidenced by the BPDC's tendency to approach problems

passively and helplessly. Sometimes they demand active

problem solving from someone else in their environment when

they are feeling overwhelmed.

ApDarentlv competent person syndrome describes the

circumstance wherein although many BPDCs appear highly

competent, their (apparent) competencies do not generalize

across all relevant situations. "In reality, they

often need large amounts of encouragement, emotional sup-

port, advice, and active assistance in coping with situa-

tions which to them are unmanageable" (Linehan, 1987, p.

268).

Unrelenting crises in the life of BPDCs cause an "ero-

sion of the spirit" and often are the origin of suicidal and

parasuicidal behaviors or other impulsive, dysfunctional

acts. The difficulty for these clients is that, in their









lives, crisis is not an infrequent event but rather an

almost daily occurrence.

Inhibited grieving syndrome is the inclination to

inhibit the experience and expression of extremely painful,

emotional reactions. "The inhibited grieving syndrome

refers to the pattern of repetitive, significant trauma and

loss, together with an inability to experience and personal-

ly integrate these events" (Linehan, 1987, p. 270). Linehan

(1987) reported that "the borderline individual often vacil-

lates between an intense overreaction (unrelenting crises)

and an equally intense underreation (inhibited grieving)"

(p. 271).

Horwitz (1987) listed BPDC characteristics as

(a) demandingness; an insatiable need for affirma-
tion and validation including a sense of entitle-
ment;

(b) egocentrism: focus on their own needs to the
exclusion of the needs of others, and see other
people in terms of their potential for the BPDC's
personal gratification and not as individuals with
their own needs, aspirations, and constraints;
narcissistically sensitive but interpersonally
insensitive;

(c) socially isolated and withdrawn: they often
suffer from social shyness, fear close relation-
ships, and avoid intimacy; and

(d) socially deviant behavior which often elicits
irritation and ridicule from others, often re-
flects a gross insensitivity to the impact on
others, and often leads to the shunning of the
BPDC; this behavior might include rebelliousness,
negativism, avoidance of a mature role,
overpowering personal needs, gross blind spots in
reading social cues, and failures in empathy (pp.
253-258).









Goldstein (1988) summarized the experience of BPDCs:

The borderline patient is easily frustrated by
separation, loss, change, and closeness. Addi-
tionally, [they] are especially vulnerable
to perceived slights, rejection, rebuffs, and
disappointments. These frustrations, no matter
how subtle, can produce very uncomfortable feel-
ings, along with disruptive behavior. The feeling
of anger or rage is most common, but other uncom-
fortable feeling states include embarrassment,
shame, humiliation, excitement, and grandiosity.
[They] often defend themselves against dys-
phoric feelings by a variety of self-soothing
and acting-out behaviors, such as increased
activities of many sorts, including stimulat-
ing and dangerous acts, perverse sexuality,
and alcohol and drug abuse (p. 569).

The risk of a suicidal gesture or attempt is very real

for BPDCs. In fact, Stone (1990) reported that the risk of

suicide is significantly higher in those clients who meet

the criteria for BPD. These criteria include self-damaging

acts, impulsivity, and rage, all of which are associated

with an increased suicidal risk. Indeed, Stone, Stone, and

Hurt (1987) found a 9.5% rate of completed suicide in BPDCs

in a 15-20 year follow-up. Gunderson also reported that 75%

of a sample of borderline personality disordered inpatients

had made at least one previous suicidal gesture. It has

been estimated that 10% of BPDCs who attempt suicide eventu-

ally succeed (Fyer, Frances, Sullivan, Hurt, & Clarkin,

1988). Indeed, "a suicide attempt is often the manner in

which a borderline enters treatment" (Snyder, Pitts, &

Pokorny, 1986, p. 29).

Suicide attempts of BPDCs are not always a communi-

cation of a wish to die, however. Perlmutter (1982)








reported that a BPDC will often "attempt suicide in an

attempt to coerce and punish [a significant other] who may

be exhausted but enmeshed" (p. 191). Linehan (1987) argued

that "suicidal behaviors and other impulsive, dysfunctional

behaviors are usually maladaptive responses to overwhelming,

uncontrollable, intensely painful negative affect" (p. 263).

She also viewed suicidal behavior as "a response to a state

of chronic, unrelenting, and overwhelming crisis" (1987,

p. 263). This emotional state is so debilitating to the

client not because of any one event, but "by virtue of both

the individual's high reactivity and the chronicity of the

stress" (Linehan, 1987, p. 269).

Much has been written on counselors' emotional reac-

tions to BPDCs. Given the diagnostic criteria, it is

understandable that they are difficult clients for counsel-

ors. As Kroll (1988) suggested, "the borderline's special

combination of emotional intensity, use of splitting, dis-

guised and overt victimization themes, suggestibility and

acting-out propensities makes for a dramatic and difficult

therapy" (p. 183). Borderline personality disordered

clients often elicit negative emotional reactions in those

who care for them. Perlmutter (1982) reported, "The visit

of the borderline to the psychiatric emergency department is

unparalleled in its capacity to elicit feelings of guilt,

anger, hate, love and rejection" (p. 191). He also reported

that, after interacting with the BPDC in crisis, staff









members (including counselors) are left "feeling anxious,

overinvolved, enraged, and perplexed" (p. 192).

Goldstein (1988) has suggested that BPDCs have the

ability to sense counselors' weaknesses and will subtly

attack the counselor through these areas. As this becomes a

pattern, the counselor may become engaged in a subtle battle

with the client or might become overtly angry, discouraged,

or confused. One method of coping with BPDCs is to remain

neutral as much as possible. Goldstein (1988) acknowledged

that the "'as much as possible' needs to be emphasized,

because it is virtually agreed upon by all that, with

borderline [clients], this can be next to impossible at

times" (p. 566).

Clearly, there is a great deal of evidence that the

relationship between borderline personality disordered

clients and their counselors is one fraught with difficulty

and confusion. Therefore, it is important to examine this

relationship to gain information which might improve it.

Counselors

It really is a strange business that leads a
person to sit in a room with complete strangers
and listen to their intimate problems and worries
in what is an essentially one-way flow of personal
information. (Street, 1989, p. 134)


Counselors enter the counseling profession for a variety of

reasons. Some report their motivation was to help people

(Storr, 1979; Street, 1989) while others report they were









influenced by a natural curiosity and an interest in human

behavior (Guy, 1987; Storr, 1979).

Counselor Attributes

characteristically a 'good therapist' is warm,
interested, accepting, and respectful toward the
[client]. (Strupp, Fox, & Lessler in Rudy,
McLemore, & Gorsuch, 1985, p. 278.)

In addition to these qualities, there are other necessary

attributes for counselors to have to be effective. They

must be comfortable with conversation and able to listen

(Guy, 1987). For example, Marston (1984) believed it

important for counselors to appreciate the simple enjoyment

of good conversation.

Counselors also must be able to exhibit warmth and

caring for their clients (Guy, 1987; Storr, 1979). However,

although they must be empathic and understanding, they also

must be capable of a certain degree of detachment and

objectivity (Storr, 1979). As Jaffe (1986) noted, "Empathy

is a natural process, but the health professional must learn

to temper that with professional demeanor that has been

termed 'detached concern'" (p. 195). Counselors often

encounter clients who are different from them, so it also is

important that they are able to be empathic with a wide

range of client personalities and behaviors. Storr (1980)

wrote "the psychotherapist must have an interest in people

who, at first sight, may not resemble themselves or share

their interests" (p. 169). Effective counseling also

requires the counselor to understand the client as a person









rather than to focus on abolishing symptoms (Storr, 1979).

Thus, it is important that the focus of the counseling be on

the client's experience of the situation and not the solu-

tion of a particular problem.

There is also a need for counselors to be open to

emotions--not only those of the client but also their own

because their respective emotions are intertwined. Storr

(1979) speculated that counselors are drawn to the profes-

sion because the expression of emotion is not only not

forbidden but is actually encouraged. However, counselors

must be tolerant and comfortable with unpleasant emotions as

well. Therefore, it is important for a counselor to be

comfortable enough to allow tears or anger without trying to

intercede (Storr, 1979).

Self-understanding and introspection also are attrib-

utes of counselors.

Understanding other human beings requires
that the observer does not simply note their
behavior as if they were machines or totally
different from himself, but demands that he make
use of his own understanding of himself, his own
feelings, thoughts, intentions, and motives in
order to understand others (Storr, 1979, p. 168).

Counselors also must possess the quality of psychological-

mindedness. This quality "may be considered a trait which

has at its core the disposition to reflect upon the meaning

and motivation of behavior, thoughts, and feelings in

oneself and others" (Farber, 1985, p. 170). The nature of

the counseling role requires counselors to attend to and









process information in this manner in order to be optimally

effective (Farber, 1985).

The counseling relationship differs from other inter-

personal relationships in that it is unidirectional. The

focus of the relationship is on the client, and counselors

are charged with withholding their feelings in the interest

of meeting clients' needs. This demands considerable

control and emotional self-denial. The counselor's goal is

to be aware of personal feelings but to use these feelings

as a guide to understanding the client and not as a way of

demonstrating how kind, how loving, or how sympathetic the

counselor is toward the client (Storr, 1979). It also

requires counselors to be flexible within themselves and

with their clients.

In addition, counselors must be able to withhold some

of their unique qualities in the interests of their clients

(Greben, 1975; Storr, 1979). Storr (1979) reported of the

counselor that "his [her] own personality is never fully

expressed, but always oriented toward the needs of the

other" (p. 171).

The role of the counselor also requires a tolerance for

ambiguity. As Guy (1987) asserted, "The therapist must be

comfortable with the unknown, partial answers, and incom-

plete explanations" (p. 12). Counselors also must be

reluctant to "take over," give solutions, or problem solve.

The counseling process requires patience to allow clients to

resolve their own difficulties.









The counseling relationship also is a psychologically

intimate one, and counselors must be comfortable with this

intimacy. It also is important for counselors to be able to

laugh with their clients and at themselves (Guy, 1987).

There also are values essential for a counselor to hold

to remain effective and ethical. As Strupp and Binder

(1984) maintained,

The therapist's attitude should consistently
reflect interest, respect, a desire not to hurt
(even when provoked), a suspension of criticism
and moral judgment, and a genuine commitment to
help (within the limits set by the therapeutic
role and by being human). (p. 41)

It is important that counselors value clients as

people and that counselors have a fundamental respect

for clients' freedom to know, shape, and determine

their personal attitudes and behavior. Another value

expressed to the client assumes that the client's

freedom is not only in the area of self-development,

but also includes responsibility to others. A final

crucial value is genuineness. The counselor's genuine

attitude is so deeply a part of the counselor that it

should be obvious to everyone with whom the counselor

has contact (Boy & Pine, 1990).

Storr (1979) summarized that

[counselors are people] who are open both to their
own emotions and to those of others; able to
identify with a wide range of people; tolerant of
the expression of both grief and range; warm and
sympathetic without being sentimental; predomi-
nantly non-assertive, but capable of quietly
maintaining their own position; able to put them-
selves at the patient's service, and to accept









that the rewards for doing so may be both long-
delayed and indirect. (p. 174)


Counselors are people with varying motivations and charac-

teristics for entering their chosen profession. However,

like people involved in other careers, counselors are

concerned that they are competent and effective with their

clients. Therefore, it is important to explore the rela-

tionship between clients and counselors and how this rela-

tionship and counselors' reactions to clients influences

their ability to be useful.

Theoretical Framework

Interpersonal Theory

Interpersonal psychology is based on the work of Harry

Stack Sullivan (1953) who provided theories regarding the

development of personality and also the origin of psychopa-

thology. He described interpersonal psychology as "the

field of interactions and transactions between the individu-

al and others, actual or fantasized" (Kaplan & Saddock,

1985, p. 427). He defined personality as "the relatively

enduring pattern of recurrent interpersonal situations which

characterize a human life" (Sullivan, 1953, p. 111) and pro-

posed that personality is constantly evolving and matures

through the process of social interaction. He suggested

"Human personality is not a static reification. It is

reflective of the organization of experience at successive

stages of development and is also subject to modification








under appropriate circumstances as long as one is alive"

(Kaplan & Saddock, 1985, p. 427). He introduced six periods

of interpersonal development (a) infancy, focusing on the

relationship with the mother; (b) childhood, beginning to

incorporate attachments to other children; (c) juvenile

years, adjusting to peers and spreading of authority beyond

the family; (d) preadolescence, learning to form and main-

tain emotionally intimate relationships with others;

(e) adolescence, learning to cope with new interest in

sexuality; and (f) maturity, incorporating sexuality and

mature affection in relationships (Kaplan & Saddock, 1985;

Smith, 1983).

In addition, Sullivan proposed that abnormal behavior

(i.e., psychopathology) is the result of habitual interac-

tion patterns which are ineffective. He addressed this

concept, writing that "it is the extraordinary dependence of

a personality on a particular dynamism that is the

fundamental conception to have in mind in thinking of mental

disorder" (Sullivan, 1956, p. 6). He defined dynamism as

"a relatively enduring configuration of energy which mani-

fests itself in characterizable processes in interpersonal

relations" (Kaplan & Saddock, 1985, p. 427). More simply,

it is behavior characteristically used in social interac-

tions. To illustrate, consider a person who consistently

responds to another with anger and distrust whenever asked a

question, even though the question is innocuous and asked in







44

a nonthreatening manner. The resultant interaction between

these two people is likely to be ineffective and unreward-

ing.

Building on Sullivan's theory, Kiesler (1979) wrote

that emotionally pathological individuals communicate using

a "rigid template" by which they define themselves and

others. He believed they are unwilling and/or unable to

modify this template despite verbal or nonverbal social cues

which might encourage change. He suggested that abnormal

behavior consists of an unyielding and extreme pattern of

behavior and for a person who consistently engages others in

this manner. This interaction usually elicits similarly

intense and aversive reaction from others. The abnormal

person does not assume responsibility for these reactions

and is puzzled as to why they consistently occur. Inter-

personal theory thus proposes that people will view their

environment in ways which serve to maintain their interper-

sonal difficulties (Kivlighan & Angelone, 1992). Certainly

the notion of the self-fulfilling prophesy (i.e., what one

expects to happen does occur) is a central construct in

interpersonal theory (Carson, 1983).

Conversely, Carson (1969) concluded that emotionally

healthy individuals have a sufficiently broad definition of

themselves and others as to be flexible in their interac-

tions. They are able to individualize their responses based

on the person with whom they are interacting. As Carson

reports, "For abnormal individuals, in contrast, this









ability to modify their definitions of both themselves and

others in line with situational factors seems strikingly

absent" (Carson, 1969, in Anchin & Kiesler, 1982, p. 13).

A postulate of Sullivan's theory is that psychopa-

thology can by assessed by observing communication patterns.

Indeed, any observation of an interaction yields informa-

tion. One of the primary decisions to be made when given

the opportunity to interact is whether to proceed or to

remain separate. While people may or may not act in inter-

personal situations, it is impossible not to communicate:

activity or inactivity, words or silence, all have message

value (Watzlawick, Peaving, & Jackson, 1967). How one

person engages another is important. Sullivan did extensive

work studying communication involving both verbal and non-

verbal messages. Sullivan and his followers maintained that

one of the most reliable ways of measuring interpersonal

style is to assess the covert responses of other persons

(Kiesler, Anchin, Perkins, Chirco, Kyle, Federman, 1976;

Sullivan, 1953). As Kiesler (1979) proposed, "One person's

interpersonal style can be reliably measured by assessing

the covert responses of other persons" (p. 304). He submit-

ted that human communication contains two levels of messages

sent by the sender. These levels are the denotative level

(i.e., manifest content, information content) and the

connotative-relationship level (i.e., relationship engage-

ment, self-presentational impact). He further asserted that

the message sender's pattern of verbal and nonverbal







46
behavior elicit emotional, cognitive, and imaginal responses

and represents the sender's attempt to define the relation-

ship in a way that is congruent with the sender's relation-

ship template (i.e., self-image).

One of the major research benefits of Sullivan's theory

is the concrete nature of the data. These communication

patterns can be observed and measured. As Haley (1963)

reported, "What is potentially most scientific about the

interpersonal approach is its emphasis upon observable data.

The ways in which people interact with each other can be ob-

served" (p. 87).

Counseling Relationships

The study of the counseling relationship has been an

interest of many professionals who have proposed that it is

necessary for researchers to study the interaction between

clients and counselors in an effort to improve the therapeu-

tic process. Strupp (1989) suggested that "instead of

focusing on disembodied techniques, we must study and seek a

better understanding of the human relationship between a

particular patient and particular therapist and of the

transactions occurring between them" (p. 717). He suggested

that the following counselor activities are curative:

(a) being aware of personal reactions to patient's communi-

cations, on cognitive and emotional levels, (b) attempting

to understand the client's engagement with the counselor,

and how that applies to the client's "outside"







47

relationships, (c) refusing to perform in the typical manner

of those engaged in a relationship with the client, and

(d) relaying this information to the client in such as way

as to help the client change this pattern. Strupp also

asserted that "beyond 'providing a good relationship', the

crux of the therapeutic enterprise lies in the [counselor's]

ability to recognize, organize, and clarify the [client's]

jumbled experience as it emerges in the current context of

the two-person interaction" (1989, p 719). However, this

process is difficult, particularly when counseling manipula-

tive and controlling clients. Strupp (1989) reported on his

experience with counselors:

I had assumed--erroneously, as it turned out--that
trained therapists should be able to identify,
behind the patient's unpleasant face, a suffering
individual who was in urgent need of professional
help but who, as a function of his personality
make-up, could only ask for it in ways that imme-
diately put the respondent [counselor] on the
defensive. The client does so by evoking negative
and hostile reactions that were subtly and almost
immediately translated in communications that had
the effect of becoming a self-fulfilling prophecy
for the patient -- another episode of rejection
and defeat, which no doubt had been central fea-
tures of his [her] life. (p. 720)


Strupp further noted that counselors have a particularly

difficult time with personality disordered clients because

they are inclined to enact unresolved interpersonal diffi-

culties which elicit negative emotions from counselors. He

suggested that this difficulty stems from not only the

intensity, chronicity, and pervasiveness of these negative

interactions but also is partially due to some negative








emotions elicited from counselors (e.g., anger, frustration,

and animosity toward the client) which assists counselors in

becoming "conspirators" in this interaction.

Kiesler extended Sullivan's theory with the following

assumptions:

(1) Interpersonal study focuses on human transac-

tions, not on the behavior of individuals. Laing

(1964) also believed that the study of human relation-

ships must involve studying the participants within the

relationship, not the individuals.

(2) In interpersonal explanations the construct of

self occupies a central theoretical position. The self

is social, interpersonal, and transactional in its

development and functioning throughout life. Leary

(1957) proposed "the purpose of interpersonal behavior

is to induce reactions from the other person that are

'complementary' to the behavior presented" (p. 6-7).

In essence, this proposition promotes the idea that

people interact to elicit a familiar response

which validates their self-concept. These interactions are

habitual, and have differing degrees of intent, awareness,

or attention. Beier (1966) elaborated,

The more aware the person, the more the relation-
ship message can be called "persuasive;" the less
aware, the more the claim can be described as an
"evoking" message. The goal of either is to
impose a condition to the respondent under which
[s]he behaves as the sender wishes without being
aware that he had been led to that particular
choice with a certain message. The sender
increases the probability of the occurrence of a







49
specific response by constricting the respondent's
response activity. (p. 11)

(3) A person's recurrent pattern of interpersonal

situations represents distinct combinations of two to three

basic dimensions of interpersonal behavior: (a) control

(dominance or submission), (b) affiliation (love or hate),

and (c) inclusion (degree of importance in one's life).

(4) Interpersonal theory takes an interactionist posi-

tion in which a person's social behaviors are a function of

both his or her predisposition toward transactions and

situational/environmental events. Two important refinements

which apply to this assumption are as follows: (a) Situa-

tional factors relevant to a person's behavior are environ-

mental events as perceived by the person, and (b) The most

important class of situations for human behavior is that of

other persons, in contrast to impersonal situations.

(5) Interpersonal theorists adopt a notion of "circu-

lar" rather than linear causality. Human behavior is viewed

in the context of a "feedback loop" rather than direct

causality. As Danziner (1976) explains, "Two individuals in

interaction are simultaneously the causes and the effects of

each others' behavior" (p. 184).

(6) The vehicle for human transactions is communica-

tion, including linguistic and nonverbal messages. There

are two levels of communication addressed: (a) denotative--









the manifest content of speech and (b) connotative-rela-

tionship level--the emotional level (Anchin & Kiesler, 1982,

pp. 5-11). Kiesler (1979) summarizes,

The hard work of therapy, then, involves this
metacommunicative task. Most important, the
therapist must break the vicious circle by not
continuing to be 'hooked' or trapped by the
client's engagement or pull. The therapist must
'disengage' from his impact responses before they
build to an intensity whereby the therapy also
countercommunicates aversively or incongruently to
the client. It is essential that the therapist
not respond in the same locked-in an
overdetermined manner as have others in the
client's life. (p. 307)


Although there has been much research involving coun-

selor and client relationships, much more needs to be done.

Interpersonal theory lends itself to this research question

because (a) this theory addresses interactions and relation-

ships, not individuals, and (b) the measurement techniques

focus on external behaviors, not motivation, feeling states,

cognitions, or other covert events. In addition,

counselors' personal reactions to clients often (a) occur

quickly and (b) contaminate diagnostic impressions, judg-

ments regarding likelihood of success, and directions for

treatment (Wallach & Strupp, 1960). Several researchers

have suggested a need for more empirical support for inter-

personal theory (Kiesler, 1983; Kiesler & Goldston, 1988;

McLemore & Benjamin, 1979; Perkins, Kiesler, Anchin,

Chirico, Kyle, & Federman, 1979; Strupp, 1989) and the

necessity of further examining counselor-client relation-

ships (Bahrick, Russell, & Salmi, 1991; Carson, 1983; Gelso,









Hill, & Kivlighan, 1991; Kiesler, 1979, 1986; Kiesler, Van

Denburg, Sikes-Nova, Larsus, & Goldston, 1990; Robbins &

Dupont, 1992; Rudy, McLemore, & Gorsuch, 1985; Strupp,

1989).

Self-Efficacy Theory

Self-efficacy theory was proposed in 1977 by Albert

Bandura. He submitted that personal perceptions of abili-

ties directly impacts personal performance. Bandura (1977)

asserted, "It is hypothesized that expectations of personal

efficacy determine whether coping behavior will be initiat-

ed, how much effort will be expended, and how long it will

be sustained in the face of obstacles and aversive experi-

ences" (p. 191). Self-efficacy is described by Schunk and

Carbonari (1984) as "the sense of 'I can do'" (p. 230).

Bandura elaborated on this definition: "Self-efficacy refers

to personal judgments of how well one can organize and

implement patterns of behavior in situations that may

contain novel, unpredictable, and stressful elements"

(Bandura, 1981, in Schunk and Carboni, 1984, p. 231).

Smedslund (1978) presented a "common-sense" explanation of

this theory,

(a) This theory presents one way of explaining and
predicting how people change as a result of being
treated in different ways. (p. 1)

(b) It is proposed that the way in which people
are treated changes their beliefs in what they can
do and how strongly they believe it. They deter-
mine the difficulty of a given task by two sourc-
es: (a) social norms, and (b) objective task
demands. If it is "understood" by the subjects'
peers that this task is difficult, it will be









perceived in that manner. In addition, if the
person confronted with the task realistically
understands the demands of the task, they will
perceive it as difficult. (p. 1)

(c) It is thought that your beliefs in what you
can do determine whether you will try to do it,
how hard you will try, and how long you will keep
trying, even though encountering obstacles and
unpleasant experiences. (p. 2)

(d) If you keep on doing something that is felt to
be dangerous, but turn out to be relatively safe,
you get an experience of mastery, and you come to
believe you can do more than you thought before,
and also you tend not to avoid that activity as
strongly as before. (p. 2) Success at a task that
is perceived as difficult will raise perceptions
of efficacy more than success at a task perceived
to be easy (Schunk & Carbonari, 1984).

(e) It is argued that your belief in what you can
do stems from what you have yourself accomplished
before, from watching others do that same task,
from what others tell you that you do, and from
your bodily feelings at the time. (p. 2)

(f) The more you think you can rely on your expe-
riences, the more these experiences determine what
you think you can do in the future. (p. 2)

(g) A number of circumstances are identified that
influence your beliefs in what you can do, as they
arise from what you have accomplished before, from
watching others, from being told what you can do by
others, and from your feelings. (p. 2) Glynn and
Ruderman (1986) caution, "The self-efficacy construct
is a judgment of one's capability, not a judgment of
one's strivings" (p. 106).


Individuals' perceptions of the ability to master a

task affects their problem-solving ability. If someone

feels incompetent to accomplish a task successfully, that

person might spend a great deal of time worrying about the

task (Bandura, 1982). This anxiety can be extremely









stressful (Beck, 1976). However, those who believe that

they can accomplish the task will be less resistant to

undertake it and will be better able to cope with any

problems which arise. In addition, a generalized feeling of

competence in a given area will help individuals confidently

undertake a new situation without experiencing the need to

spend a sizeable amount of time evaluating the situation and

how well they can accomplish the task.

People develop a sense of self-efficacy in a given area

by (a) performance attainments, (b) vicarious experiences,

(c) social persuasion, and (d) physiological indices (Schunk

& Carbonari, 1984). When people undertake a task, whether

they succeed or fail impacts their perception of their

ability to complete that task (performance attainments).

Individuals are also able to learn by watching someone else

successfully complete a given task (vicarious experiences).

A sense of competence is created by the realization that, if

someone else is able to complete this task, then the observ-

er might be capable of completing it also. Social persua-

sion is effective in changing one's sense of competence by

suggesting that they are able to accomplish the task. For

example, a woman might tell her brother that she thinks he

would be a good parent. From this interaction, the brother

may have greater confidence in his ability to rear a child

than he had before their conversation. Often one's body

will lend credence to a decision. When people enter diffi-

cult situations, they have a physiological response to the









perceived danger in the situation. These responses may be

aversive, and will lower the individual's sense of their

ability to cope with the situation. However, sometimes

physiological responses are positive, such as when people

notice that they are responding in a less anxious way than

past, their sense of self-efficacy to cope with that circum-

stance may be heightened.

Self-Efficacy and Maladaptive Behavior

This concept has important implications for counseling

because counselors' decisions will be impacted directly by

their self-efficacy. Bandura (1977) suggested that individ-

uals who are engaged in difficult but relatively safe tasks

will continue. However, those who retain a low sense of

mastery are likely to avoid it.

The implications are many for counseling difficult

clients. Self-efficacy impacts decisions, including choice

of activities and environment. Those who have a low sense

of efficacy to cope with a specific situation (i.e., coun-

seling a difficult client) may be inclined to avoid it.

In addition, personal sense of self-efficacy guides how much

energy is expended in any given task. The stronger the

sense of self-efficacy, the more powerful the effort to

succeed (Schunk & Carbonari, 1984). In accordance with this

theory, it follows that counselors who are faced with the

decision to counsel a difficult client may (a) avoid seeing

the client altogether, (b) counsel the client for a limited

time, or (c) treat the client but expend limited energy with









resultant diminished effectiveness. Self-efficacy theory

suggests that any of these choices will further the

counselor's sense of low self-efficacy in working with

difficult clients. Counselors who have a diminished sense

of competence to work with a particular type of client also

will experience greater levels of stress when encountered

with these decisions. They will feel less effective in

their work and will experience a diminished ability to cope

effectively.

There has been a great deal of research supporting

self-efficacy theory (Bandura & Schunk, 1981; Johnson,

Baker, Kopala, Kiselica, & Thompson, 1989; Larson, Suzuki,

Gillespie, Potenza, Bechtel, & Toulouse, 1992; Lopez,

Watkins, Manus, & Hunton-Shoup, 1992; Multon, Brown, & Lent,

1991). However, there are very few studies which have

explored self-efficacy theory in the counseling relationship

(Glynn & Ruderman, 1986). Clearly,there is a need for

further research in this area (Bandura, 1977; Johnson,

Baker, Kopala, Kiselica, & Thompson, 1989; Kiesler &

Goldston, 1988; Lopez, Watkins, Manus, & Hunton-Shoup, 1992;

Multon, Brown, & Lent, 1991).

Support for the Approach to the Study

Counseling research has been conducted using a variety

of techniques. In order to examine (a) counselor-client

relationships and (b) counselors' perceived self-efficacy in

working with these clients, there is a need for either a

real counselor-client interview or a simulation.









Several current studies have made use of videotapes as the

stimulus to elicit responses (Costanzo & Philpott, 1986;

Hess & Street, 1991; Johnson, Baker, Kopala, Kiselica, &

Thompson, 1989; Kiesler & Goldston, 1988; Kiesler,

VanDenburg, Sikes-Nova, Larus, & Goldston, 1990; Schneider,

1992). Audiotapes are used less frequently, but still are

considered an effective technique (Bahrick, Russell, &

Salmi, 1991; Roffers, Cooper, & Sultanoff, 1988). The

audiotapes used in this study were obtained from a psychiat-

ric training series (Frances, 1988; Frances, 1989). It was

assumed that these interviews were representative of BPDCs

and DCs. Utilizing "mock interviews" in studies such as

this one has been done with success (e.g., Larson, Suzuki,

Gillespie, Potenza, Bechtel, & Toulouse, 1992). There is

the danger of excluding visual information when using

audiotaped interviews instead of videotapes, but it was

determined that the former method was a better use of time

and limited financial resources.

From among the many choices available, paper-and-pencil

tests were chosen to gather data in this study. For purpos-

es here, these tests are effective, efficient, and cost

effective. Many research projects of this type make use of

paper-and-pencil instruments (Costanzo & Philpott, 1986;

Larson, Suzuki, Gillespie, Potenza, Bechtel, & Toulouse,

1992; Lopez, Watkins, Manus, & Hunton-Shoup, 1992; Johnson,

Baker, Kopala, Kiselica, & Thompson, 1989). It is possible

to elicit this information through face-to-face interviews









or more subjective writing (essays), but it was determined

that this was not feasible. The considerations in this

decision concerned (a) financial constraints, (b) time

restrictions, (c) and difficulty in standardizing subject

responses.

Support for the Measurement Technique

Impact Message Inventory

The Impact Message Inventory (IMI) (Appendix E) is used

to examine the interpersonal style of individuals by measur-

ing the interpersonal consequences of their behavior as they

interact with others. "It was constructed on the assumption

that the interpersonal or evoking style of one person

(A) can be validly defined and measured by assessing the

covert responses of "impact messages" of another person

(B) who has interacted with or observed A" (Kiesler, 1987,

p. 1). It is assumed that the impact that A (the client)

has upon B (the counselor) will influence the counseling

relationship.

This paper-and-pencil instrument consists of 90 items

on which respondents record the impact the client produces

in them following an interaction or observation of the

client. These 90 items are grouped to include 30 each

designed to elicit (a) direct feelings, (b) action tenden-

cies, and (c) cognitive attributions. Each item describes a

covert reaction characteristically elicited by the client's

interpersonal style on one of the fifteen categories of

interpersonal behavior. If a specific item is scored









strongly by the subject, then the client receives a high

score on the corresponding interpersonal style category.

The sum of the six-item scores for a given IMI scale indi-

cate the relative strength of the corresponding interperson-

al style of the client as experienced by the subject

(Kiesler, 1987).

The 15 interpersonal categories are (a) dominant,

(b) competitive, (c) hostile, (d) mistrustful, (e) detached,

(f) inhibited, (g) submissive, (h) succorant-seeking,

(i) abasive, (j) deferent, (k) agreeable, (1) nurturant,

(m) affiliative, (n) sociable, and (o) exhibitionistic.

Researchers using this instrument are able to cluster these

categories into (a) dominant: exhibitionistic + dominant +

competitive, (b) hostile: hostile + mistrusting + detached,

(c) submissive: abasive + submissive + succorant, and

(d) friendly: agreeable + nurturant + affiliative

(Kiesler, 1987).

The IMI was chosen because it clearly examines the

relationship between clients and counselors. Although

similar data could be obtained by interviewing counselors

after they listened to the client, such methodology would be

(a) expensive, (b) time-consuming, and (c) impractical.

This instrument has been used in many studies, and has the

advantage of a broad literature base from which to draw.









Stress Appraisal Scale

The Stress Appraisal Scale (SAS) (Appendix F) is

designed to measure subjects' perceptions of the amount of

stress involved in an assigned task. This 36-item

instrument is administered following the introduction of

some potential stressor (to be determined by the examiner),

and the subject rates feelings on a 4-point Likert scale

ranging from "very true of me" to "very untrue of me." The

SAS yields information in three clusters: (a) salience,

(b) difficulty, and (c) secondary appraisal. The salience

cluster includes measures on (a) caring about one's ability

to perform the task and (b) consequences, which concerns

one's recognition that process and outcomes of the task have

important consequences. The difficulty cluster includes

measures on (a) the beliefs that the demands of the stressor

are significant and (b) the subjects' perception of feelings

of stress which performing the assigned task. The secondary

appraisal cluster consists of (a) evaluation of one's

skill/resources to handle the demands of the stressor and

(b) prediction of the outcome and one's success in meeting

the stressor (Carpenter, 1988).

The Stress Appraisal Scale was chosen because

(a) it permits the examiner to define the task to be evalu-

ated by the subject on level of stress and (b) it investi-

gates variables which lend themselves to further insight

about the relationship between counselors and clients.

Individual interviews could have been conducted to arrive at









similar conclusions, but it was determined that the inter-

view method would be too time-consuming and costly.

Summary

Many clients who present for counseling are suffering

from a depressive disorder. These clients complain of

symptoms in four areas: (a) affective, (b) cognitive,

(c) behavioral, and physical functioning (Wetzel, 1984).

This condition is usually situational, and many depressed

clients improve with counseling. Many counselors consider

these clients to be passive, vulnerable, dependent, and

needy.

Another group of clients often seen by counselors are

those suffering from Borderline Personality Disorder. These

clients report their lives are fraught with instability and

crisis. Clients with this condition have usually suffered

this instability for most of their lives, and require a long

period of counseling for improvement. Counselors often

perceive these clients to be demanding, egocentric, manipu-

lative, and socially deviant. The suicide

threat/gesture/rate among these clients is also very high.

There is a need for counselors to project warmth,

interest, empathy, acceptance, and respect toward their

clients. They must also be capable of self-understanding

and introspection. There is also a need for them to remain

objective and somewhat detached from their clients and their

problems.









Interpersonal theorists consider that interactions

between people is the important unit of study. Sullivan

(1953) asserted that psychopathology can be assessed by

observing communication patterns. The communication pat-

terns of emotionally healthy individuals typically are

dynamic; maladaptive clients lack the flexibility to modify

their patterns (even in the face of cues from others) which

thwarts changes and improvement in their lives.

The study of counseling relationships has long been of

interest to interpersonal psychologists. They assert that

the goal in studying this relationship is to improve

counselors' effectiveness with their clients. To that end,

it is important to know (a) how one reacts to a client,

(b) how and if that reaction is representative of reactions

the client elicits in other relationships, (c) how not to

respond in the usual manner to a client's behavior, and

(d) how to communicate this valuable information to the

client. In addition, counselors' sense of self-efficacy is

a necessary subject of study. Bandura (1977) declared that

personal perceptions of abilities directly impacts perfor-

mance. He suggested that people who are engaged in diffi-

cult but relatively safe tasks will continue, but those who

have developed a low sense of mastery of a task will avoid

it. The tenets of this theory foster implications for

counseling difficult clients.














CHAPTER III
METHODOLOGY


The differential impact of depressed clients and bor-

derline personality disordered clients on mental health

counselors was examined in this study. Their perceptions of

degree of stress involved in counseling the two groups was

also explored. Years of counseling experience and degree

level were considered in the analysis of the results.

Delineation of the Variables

Variables

The independent variables in this study relating to the

subjects include (a) highest degree attained, (b) years of

experience, and (c) gender. The independent variables

relating to the treatment conditions include: (a) depressed

clients (DCs) and (b) borderline personality disordered

clients (BPDCs).

The dependent variables are derived from the Imact

Message Inventory (IMI) and the Stress Appraisal Scale

(SAS). The IMI provides information about counselors'

emotional reactions to clients. This information is clus-

tered into four groups: (a) dominant, (b) submissive,

(c) hostile, and (d) friendly.










Population

The subjects for this study were drawn from among

Licensed Mental Health Counselors (LMHCs) in Florida. The

criteria for Mental Health Counseling licensure in Florida

include (a) master's degree (or equivalent as determined by

the licensure board) in counseling, (b) 3 years of clinical

experience (which includes 1500 hours of supervised clinical

experience), and (c) successful completion of a licensed

mental health counselor examination authorized by the De-

partment of Professional Regulation (DPR, 1991).

Licensed Mental Health Counselors in Florida have

similar credentials to comparable licensed professionals in

other states. Most states have requirements that an appli-

cant (a) acquire a master's degree (or equivalent),

(b) undergo a period of clinical experience with supervi-

sion, and (c) successfully complete the application and

examination process required for the desired license. Other

parallels include (a) requirement for payment of application

fee and annual renewal fee, (b) lack of criminal history, or

other "negative" attributes which might hinder one from the

practice of professional counseling, and (c) licensure

awarded for a specified length of time (Vacc & Loesch,

1994).

As of September, 1993, there were 2,652 LMHCs in Flori-

da. An attempt was made to acquire demographic information

on these subjects (i.e., gender, ethnic origin, years of









experience). Unfortunately, this information was unavail-

able through (a) the Florida Department of Regulation,

(b) the American Counseling Association, or (c) the American

Mental Health Counselors Association. However, approximate

discrimination by gender estimates were made by reviewing

the list of LMHCs from the Florida Department of Profession-

al Regulation (DPR). It was determined from this examina-

tion that there are approximately 855 (32.25%) male LMHCs

and approximately 1,727 (65.15%) female LMHCs in Florida.

This was determined by discriminating those with a "typical-

ly" male given name (i.e., Steve, Bruce, or John) from those

with a given name usually given to a female (i.e., Carol,

Jane, or Susan). In the case of 69 (2.6%) of these LMHCs,

it was impossible to estimate gender by given name. No

attempt was made to categorize this population by ethnic

origin or years of experience from the list of LMHCs fur-

nished by the Florida Department of Professional Regulation.

Although there are differences between members of this

group, there are also some similarities. All of these

subjects, by definition, have met the requirements for

licensure. They are all practicing counselors in Florida

and also have some personality traits in common. Greben

(1984) specified six attributes that characterize an effec-

tive counselor: (a) empathic concern, (b) respectfulness,

(c) realistic hopefulness, (d) self awareness, (e) reliabil-

ity, and (f) strength. They also are all concerned

with helping people with problems, with prevention of







65

difficulties, and with acceleration in development" (Vacc &

Loesch, 1994, p. 2) Mental health counselors work in a

variety of settings including mental health clinics, hospi-

tals, or private practice. Their work may be diverse; some

may specialize in working with couples and families, while

others may work with chronically mentally ill clients. The

common element of all counselors is that they are committed

to the goal of helping people to "cope" with their circum-

stances (Vacc & Loesch, 1994).

Sampling Procedures

The Florida DPR reports 2,652 LMHCs in Florida in 1993.

Subjects were selected by choosing every tenth name from

this list, and, at the end of the list (having chosen 265

subjects), subjects were then selected by going to the

beginning and choosing the fifth name, and every tenth name

after that to establish the resultant mailing list of 372.

Because of the costs involved in duplication, distribution,

and retrieval of the tapes, an initial set of 50 tapes (25

for each client type) was projected to be mailed in Febru-

ary, 1994. However, this initial mailing was completed at

the beginning of March, 1994. As the tapes and inventories

were returned, they were mailed to the next names on the

list as appropriate. Initially this process was planned for

6 months, but the sample of 155 subjects was attained in

just over 4 months.

A total sample of approximately 150 was proposed for

this study. This process continued until a sample of 155









was achieved. Of this total, 80 subjects responded to the

depressed client and 75 responded to the borderline person-

ality disordered client. The expectation was that this

procedure would yield a random sample including approximate-

ly 50 (roughly 1/3) male subjects and 100 (roughly 2/3)

female subjects. In actuality, this sample is composed of

44 male subjects (28%) and 100 female subjects (roughly

2/3). Four of the 155 subjects did not answer the question

regarding gender on the demographic information; this number

accounts for the remaining 3% of the sample. Although

information regarding additional demographic variables was

not available, it can be assumed, due to the sampling proce-

dure, that this sample is representative of LMHCs in Flori-

da.

Research Procedures

Each subject selected was mailed a letter of intro-

duction (Appendix A), a Demographic Inventory (Appendix B),

an audiotape of either Miss A or Miss C (typescript in

Appendix C & D), an Impact Message Inventory (Appendix E), a

Stress Appraisal Scale (Appendix F), and a self-addressed,

stamped envelope to return materials to the researcher.

Every even-numbered subject received an audiotaped interview

with a depressed client, and each odd-numbered subject re-

ceived an audiotaped interview with a borderline personality

disordered client. The interviewer for both tapes is male,

and the client is female (Frances, 1989). Approximately 2







67
weeks after the initial packet was mailed, a reminder letter

was sent to the subjects (Appendix G).

The instruction letter requested the subject (a) listen

to the audiotape, (b) complete the instruments in the order

requested [(1) Demographic Inventory, (2) Impact Message

Inventory and (3) Stress Appraisal Scale], and (c) return

all the materials (including the audiotape) to the research-

er in the envelope provided.

The audiotapes to be used are marketed by Dr. A. J.

Frances in two sets titled (a) DSM-III personality disor-

ders: Diagnosis and treatment and (b) Depression: Diagnosis

and treatment. The DC portrayed exhibits the following DSM-

III-R symptoms of depression: (a) depressed mood, (b) dimin-

ished interest in daily activities, (c) feelings of worth-

lessness and excessive, inappropriate guilt, (d) diminished

ability to think and indecisiveness, and (e) recurrent

thoughts of death and suicide (American Psychiatric Associa-

tion, 1987).

The BPDC characterized demonstrates the following DSM-

III-R diagnostic criteria: (a) a pattern of unstable inter-

personal relationships, (b) impulsiveness, (c) emotional

instability, (d) inappropriate and intense anger, (e) recur-

rent suicidal threats, gestures, and self-mutilating behav-

ior, (f) persistent identity disturbance, (g) chronic

feelings of emptiness or boredom, and (h) frantic efforts to

avoid real or imagined abandonment (American Psychiatric

Association, 1987).









Assessment Instrument

The major requirements of any measure used in
scientific research are that it: (a) be chosen
wisely, (b) show appropriate forms of
generalizability (reliability and validity), and
(c) be adequately direct. (Cone & Foster, 1993,
p. 148)

The Impact Message Inventory

The Impact Message Inventory (IMI) was chosen over

several similar instruments because the variables

examined correspond to the variables of interest in

this study. The IMI was tested for internal consisten-

cy using a randomly determined split-half method (using

an undergraduate sample) which elicited reliability

coefficients ranging from .722 to .954. This result

suggests a stable instrument. The internal consistency

of each of the scales is high, with the mean coeffi-

cients ranging from .80 to .99. Mean values for each

of the subscales ranged from 2.20 to 3.19 on a 4-point

scale, with a median of 2.94. "Each of the 15

subscales shows a high level of internal consistency

reliability" (Kiesler, 1987, p. 366).

"A direct measure is one which assesses the behavior

of interest at the time and place the behavior occurs natu-

rally" (Cone & Foster, 1993, p. 149). The IMI was present-

ed to subjects immediately after they listened to an inter-

view designed to elicit their responses to the client par-

ticipating in the interview.









The Impact Message Inventory contains 90 items and

yields data on 12 subscales. The range of scores on these

items is from (1) not at all to (4) very much so. These

subscales include (a) dominant, (b) competitive,

(c) hostile, (d) mistrustful, (e) detached, (f) inhibited,

(g) submissive, (h) succorant-seeking, (i) abasive,

(j) deferent, (k) agreeable, (1) nurturant, (m) affiliative,

(n) sociable, and (o) exhibitionistic. These subscales may

be clustered into four combined subscales: (a) dominant:

exhibitionistic + dominant + competitive, (b) hostile:

hostile + mistrusting + detached, (c) submissive: abasive +

submissive + succorant, and (d) friendly: agreeable +

nurturant + affiliative (Kiesler, 1987). Only the combined

subscales are used in this study.

The directions on the instrument asked the subject to

react to the items based on the statement "When I am with

this person, she makes me feel. .. The instrument has two

different forms for male and female targets. Because the

client in the interview is a woman, Form IIA (Form for

Female Targets) was used.

The Stress Appraisal Scale

The Stress Appraisal Scale was chosen in lieu of anoth-

er instrument because of a seemingly perfect "fit" between

the variables being studied and those extracted from the

SAS. The task assessed by the subjects was to examine their

ability to enter into an effective counseling relationship

with the client on the audiotape. A replication sample









yielded coefficient alphas for the six subscales ranging

from .79 to .92, which suggests high internal consistency.

In this study, the SAS was administered promptly after the

Impact Message Inventory was given. This practice allowed

the subject to appraise the level of stress perceived di-

rectly after the exposure to the client in question.

The Stress Appraisal Scale contains 36 items and gener-

ates scores on six subscales. These item scores range from

(1) very untrue to me to (4) very true of me. The primary

subscales include (a) caring (about one's reaction or per-

formance), (b) consequences (recognition that process and

outcome have important consequences for self), (c) demands

(beliefs that the demands of the stressor are significant,

(d) perception (feelings of stress), (e) skill/resources

(evaluation of one's skill/resources for handling the de-

mands of the stressor, and (f) success (prediction of the

outcome and one's success in meeting the stressor). These

six subscales were combined into secondary subscales: (a)

Salience: caring + consequences, (b) Difficulty: demands +

perception, and (c) Secondary appraisal: skill/resources +

success (Carpenter & Suhr, 1988).

The SAS yields information about subjects' perceptions

of their ability to perform a task. This information is

summarized in the following areas: (a) salience, (b) diffi-

culty, and (c) secondary appraisal. The salience scale is

comprised of the score on subscales: (a) caring about per-

formance and (b) consequences or potential outcomes.









The subscales which reflect the difficulty score are

(a) demands and (b) perception. The secondary appraisal

score arises from the scores on (a) skill/resources and

(b) success subscales. The stressor assessed was defined as

"how you (the subject) feel about the task of entering into

a counseling relationship with the client you heard in the

audiotaped interview". This assignment was presented in the

instructions on the instrument (Appendix D).

Description of the Nature of the Data

Data were gathered on gender (male or female), years of

experience and highest degree attained. A series of four 2

x 2 x 2 (client type by counselor degree by counselor gen-

der) factorial analyses of variance, one for each of the

dependent variables from the IMI, was computed to allow for

evaluation of Hypotheses 1, 2, 3, and 4. A similar series

of three 2 x 2 x 2 factorial ANOVAs, one for each of the

dependent variables from the SAS, were be computed to allow

for evaluation of Hypotheses 7, 8, 9, and 10.

Hypotheses 5 and 6 were be evaluated through computa-

tion of two series (i.e., one for each client type) of

Pearson product-moment correlation coefficients between

years of experience and the four variables from the IMI.

Similar series of correlation coefficients were be computed

between years of experience and the six variables from the

SAS to allow for evaluation of Hypotheses 11 and 12. The

p = .05 level of statistical significance was used for all

evaluations.















CHAPTER IV
RESULTS

The subjects involved in this study were 155 licensed

mental health counselors in Florida. There were 80 (52%)

subjects who responded to the depressed client (DC) and 75

(48%) who responded to the borderline personality disordered

client (BPDC). Of these subjects, 44 (28%) were male and

107 (69%) were female. Four subjects (3%) did not report

their gender. Table 1 shows frequencies of subjects by

group.


Table 1

Frequencies of


Subjects by Group


DC BPDC


80 75


Master's Doctorate Master's Doctorate


60 12 59 14


M F M F M F M F


16 44 4 8 16 43 7 7


Frequencies of SUbignts bY G-n









Each subject was asked to report the likelihood

of encountering clients similar to the clients portrayed in

the respective interviews. Subjects were asked to rate this

variable from 1 (low) to 5 (high), and the range of respons-

es was from 1 to 5. The results are reported in Table 2.



Table 2

Means and Standard Deviations of Likelihood by Client
Type. Counselor Degree. and Subject Gender



DC BPDC


3.54 3.59
(1.35) (1.42)


Master's Doctorate Master's Doctorate


3.63 3.08 3.68 3.21
(1.35) (1.34) (1.37) (1.63)


M F M F M F M F


3.52 3.67 4.00 2.67 3.07 3.89 3.14 3.29
(1.55) (1.28) (1.41) (1.15) (1.38) (1.31) (1.86) (1.50)




In addition, subjects were asked to report years of

counseling experience accrued. The range reported was from

1 to 27 years, and results are presented in Table 3.









Table 3

Means and Standard Deviations of Years of
Experience By Client Type. Counselor Degree, and
Subject Gender



DC BPDC


12.43 12.32
(6.67) (5.68)


Master's Doctorate Master's Doctorate


12.05 14.27 12.18 12.93
(6.51) (7.41) (5.19) (7.63)


M F M F M F M F


12.41 11.93 10.13 16.11 13.06 11.86 13.14 12.71
(7.47) (6.21) (7.10) (7.15) (4.61) (5.40) (9.62) (5.79)




Dependent variable data were drawn from the Impact

Message Inventory (IMI) and the Stress Appraisal Scale

(SAS). The IMI yielded scores for the subscales (a) Domi-

nant, (b) Hostile, (c) Submissive, and (d) Friendly, whereas

the SAS generated scores for the subscales (a) Salience,

(b) Difficulty, and (c) Secondary Appraisal.

The Statistical Analysis System (SAS) was used to

compute analyses of variance (ANOVAs) and correlational

analyses for the dependent and independent variables.









The level of significance for all analyses was set at

E = .05. This chapter includes the results of the data

analyses for testing the 12 hypotheses.

Tables 4 through 7 provide means and standard

deviations by client type, counselor degree, and sub-

subject gender for the four IMI subscales. Tables 8

through 10 provide similar information for the three

SAS subscales.



Table 4

Means and Standard Deviations for IMI Dominant Scale
By Client Type. Counselor Degree. and Subject Gender



DC BPDC


1.49 1.86
(0.45) (0.46)


Master's Doctorate Master's Doctorate


1.94 1.72 2.23 2.12
(0.47) (0.44) (0.42) (0.65)


M F M F M F M F


1.59 1.51 1.27 1.29 1.86 1.89 1.85 1.86
(0.50) (0.44) (0.38) (0.43) (0.48) (0.43) (0.58) (0.56)









Table 5

Means and Standard Deviations for IMI Hostile Scale by
Client Type. Counselor Degree, and Subject Gender

DC BPDC

1.91 2.21
(0.48) (0.47)

Master's Doctorate Master's Doctorate

1.94 1.72 2.23 2.12
(0.47) (0.53) (0.42) (0.65)

M F M F M F M F

2.03 1.91 1.65 1.75 2.14 2.26 2.20 2.05
(0.56) (0.43) (0.40) (0.62) (0.41) (0.43) (0.72) (0.62)




Table 6

Means and Standard Deviations for IMI Submissive Scale
By Client Type. Counselor Degree. and Subject Gender


DC BPDC

2.20 1.88
(0.37) (0.35)

Master's Doctorate Master's Doctorate

2.23 2.06 1.91 1.74
(0.39) (0.22) (0.33) (0.41)

M F M F M F M F

2.32 2.20 2.07 2.06 1.84 1.94 1.79 1.68
(0.43) (0.38) (0.26) (0.22) (0.34) (0.32) (0.46) (0.39)









Table 7

Means and Standard Deviations for IMI Friendly Scale by
Client Type. Counselor Degree. and Subject Gender


DC BPDC

1.62 1.43
(0.34) (0.29)

Master's Doctorate Master's Doctorate

1.61 1.68 1.45 1.33
(0.35) (0.26) (0.29) (0.24)

M F M F M F M F

1.83 1.52 1.65 1.70 1.46 1.45 1.35 1.32
(0.43) (0.29) (0.22) (0.29) (0.36) (0.27) (0.16) (0.32)




Table 8

Means and Standard Deviations for SAS Salience Scale by
Client TDye. Counselor Degree. and Subject Gender


DC BPDC

36.72 34.80
(4.17) (3.97)

Master's Doctorate Master's Doctorate

36.51 37.75 35.11 33.46
(4.34) (3.17) (3.89) (4.20)

M F M F M F M F

35.63 36.84 38.00 37.63 33.38 35.78 33.57 33.33
(3.42) (4.63) (2.16) (3.70) (3.34) (3.91) (3.69) (5.09)









Table 9

Means and Standard Deviations for SAS Difficulty Scale
by Client Type. Counselor Degree, and Subject Gender


DC BPDC

30.63 31.60
(5.13) (6.04)

Master's Doctorate Master's Doctorate

30.61 30.75 31.88 30.38
(5.32) (4.31) (6.50) (3.23)

M F M F M F M F

30.94 30.49 30.25 31.00 32.00 31.83 30.71 30.00
(6.18) (5.03) (1.50) (5.29) (4.27) (7.23) (1.11) (4.82)




Table 10

Means and Standard Deviations for SAS Secondary
Appraisal Scale by Client Type. Counselor Degree, and
Subject Gender


DC BPDC

19.23 21.03
(5.40) (6.34)

Master's Doctorate Master's Doctorate

19.27 19.00 21.51 18.92
(5.54) (4.82) (6.54) (5.09)

M F M F M F M F

18.63 19.51 15.50 20.75 20.63 21.85 19.00 18.83
(4.81) (5.82) (3.51) (4.56) (5.50) (6.93) (6.16) (4.07)









A series of four 2 X 2 X 2 (client type by counselor

degree by subject gender) factorial analyses of variance,

one for each of the dependent variables from the IMI, was

computed to allow for evaluation of Hypotheses 1, 2, 3, and

4. The results of these analyses are furnished in Tables 11

through 14.


Table 11

Analysis of Variance for Dominance by Client Type.
Counselor Degree. and Subject Gender


Source DF SS MS F Value PR > F

Model 7 5.86 0.84 3.99 0.00
Error 137 28.76 0.21
Corrected Total 144 34.63
Type 1 3.10 3.10 14.78 0.00*
Degree 1 0.73 0.73 3.47 0.06
Gender 1 0.04 0.04 0.20 0.66
Type*Degree 1 0.13 0.13 0.61 0.44
Type*Gender 1 0.01 0.01 0.04 0.85
Type*Degree*Gender 2 0.14 0.07 0.34 0.71

* p < .05


Table 12

Analysis of Variance for Hostility by Client TvDe.
Counselor Degree. and Subject Gender


Source DF SS MS F Value PR > F

Model 7 4.35 0.62 2.71 0.01
Error 137 31.49 0.23
Corrected Total 144 35.85
Type 1 2.06 2.06 8.95 0.00*
Degree 1 0.58 0.58 2.50 0.12
Gender 1 0.00 0.00 0.01 0.91
Type*Degree 1 0.18 0.18 0.80 0.37
Type*Gender 1 0.00 0.00 0.01 0.99
Type*Degree*Gender 2 0.28 0.14 0.61 0.54

* p < .05









Table 13

Analysis of Variance for Submissiveness by Client
Type, Counselor Dearee. and Subject Gender


Source DF SS MS F Value PR > F


Model 7 4.76 0.68 5.25 0.00
Error 137 17.75 0.13
Corrected Total 144 22.51
Type 1 2.33 2.33 18.00 0.00*
Degree 1 0.59 0.59 4.53 0.04*
Gender 1 0.03 0.03 0.23 0.63
Type*Degree 1 0.01 0.01 0.06 0.80
Type*Gender 1 0.03 0.03 0.23 0.63
Type*Degree*Gender 2 0.15 0.07 0.58 0.56


* p < .05



Table 14

Analysis of Variance of Friendliness by Client Type,
Counselor Degree. and Subject Gender



Source DF SS MS F Value PR > F


Model 7 2.66 0.38 4.11 0.00
Error 137 12.69 0.09
Corrected Total 144 15.35
Type 1 1.55 1.55 16.78 0.00*
Degree 1 0.07 0.07 0.75 0.39
Gender 1 0.11 0.11 1.15 0.29
Type*Degree 1 0.07 0.07 0.71 0.40
Type*Gender 1 0.05 0.05 0.58 0.45
Type*Degree*Gender 2 0.28 0.14 1.50 0.23


* p < .05


Subjects responding to the DC rated them significantly

different from those reacting to the BPDC on the IMI

subscales of Dominance, Hostility, Submissiveness, and









Friendliness. Subjects considered the BPDC to be more

dominant and hostile and less submissive and friendly than

the DC. There were no significant differences for client

dominance, hostility, and friendliness based on counselor

degree or subject gender. However, subjects who held a

master's degree rated the DC as the most submissive, fol-

lowed by ratings of the DC by doctorate level counselors.

Master's-prepared subjects rated the BPDC as third in sub-

missiveness, and the BPDC was rated as the least submissive

by subjects who had earned a doctoral degree. There was no

significant difference in subjects' assessment of Submis-

siveness to the BPDC and the DC based on subject gender.

Therefore, Hypothesis 1 was rejected, but Hypotheses 2, 3,

and 4 were not rejected.

In addition, there were no significant interactions

between client type and counselor degree on IMI subscales

(a) Dominance, (b) Hostility, (c) Submissiveness, and

(d) Friendliness. There was no significant interaction

between client type and subject gender in regard to IMI

subscales, and there was no significant interaction between

client type, counselor degree, and subject gender on the IMI

subscales.

Another series of 2 X 2 X 2 (client type by counselor

degree by subject gender) factorial analyses of variance,

one for each of the dependent variables from the SAS, was

computed to allow for evaluation of Hypotheses 7, 8, 9, and

10. The results are provided in Tables 15 through 17.









Table 15

Analysis of Vari


of Salience by Cli n-


selor Degree. and Subject Gender



Source DF SS MS F Value PR > F


Model 7 257.97 36.85 2.25 0.03
Error 133 2177.31 16.37
Corrected Total 140 2435.28
Type 1 168.75 168.75 10.31 0.00*
Degree 1 0.97 0.97 0.06 0.81
Gender 1 10.53 10.53 0.64 0.42
Type*Degree 1 34.19 34.19 2.09 0.15
Type*Gender 1 2.06 2.06 0.13 0.72
Type*Degree*Gender 2 23.10 11.55 0.71 0.50


* p < .05



Table 16

Analysis of Variance of Difficulty by Client Type.
Counselor Degree, and Subject Gender



Source DF SS MS F Value PR > F


Model 7 62.52 8.93 0.27 0.96
Error 133 4329.67 32.55
Corrected Total 140 4392.18
Type 1 4.07 4.07 0.13 0.72
Degree 1 12.63 12.63 0.39 0.53
Gender 1 0.40 0.40 0.01 0.91
Type*Degree 1 10.08 10.08 0.31 0.58
Type*Gender 1 1.64 1.64 0.05 0.82
Type*Degree*Gender 2 3.87 1.93 0.06 0.94


anum









Table 17

Analysis of Variance of Secondary Appraisal by
Client Type. Counselor Degree, and Subject Gender



Source DF SS MS F Value PR > F


Model 7 286.25 40.89 1.17 0.32
Error 133 4640.70 34.89
Corrected Total 140 4926.95
Type 1 40.96 40.96 1.17 0.28
Degree 1 49.78 49.78 1.43 0.23
Gender 1 60.45 60.45 1.73 0.19
Type*Degree 1 8.88 8.88 0.25 0.61
Type*Gender 1 30.04 30.04 0.86 0.36
Type*Degree*Gender 2 46.23 23.11 0.66 0.52




Subjects rated the task of counseling the DC as more

salient than counseling the BPDC. Salience is composed of

subjects' (a) caring about performance, and (b) recognition

that the outcome of the task has important consequences for

the subject. There were no significant differences based on

client type on the SAS Difficulty and Secondary Appraisal

Scales.

In addition, there were no significant interactions

found between client type and counselor degree in regard to

SAS subscales (a) Salience, (b) Difficulty, and (c) Second-

ary appraisal. There were also no significant interactions

between client type and subject gender in regard to SAS

scores, and there was found to be no significant interaction

between client type, counselor degree, and subject gender on

SAS subscales. Because results on only one of the three









subscales yielded significant findings and there were no

significant interactions, Hypotheses 7, 8, 9, and 10 were

not rejected.

Table 18 provides the correlations between years

of experience and scores on the IMI for subjects re-

sponding to the DC. The data indicate a significant

relationship between dominance and years of experience.

These findings suggest that the more years of experi-

ence counselors have accrued, the less likely the

impact of the dominant variable in DCs. Although the

results do not indicate significance with the variables

hostility, submissiveness, and friendliness, all of

these variables were negatively correlated with years

of experience. In addition, the data show that submis-

siveness is the variable least impacted by experience,

followed by hostility and then friendliness, with de-

pressed clients. Because only one of the four corre-

lations is significant, Hypothesis 5 was not rejected.


Table 18

Correlations Between Years of Experience and Scores on
the Impact Message Inventory for Subjects with DCs


Dominant Hostile Submissive Friendly
r -0.26 -0.14 -0.08 -0.19
Prob.
> r 0.03* 0.24 0.48 0.12


N 73 73 73 73

* p < .05









Although Table 19 provides information which does not

indicate significance in relating years of experience and

IMI scores for the BPDC, there is information from the

direction of the correlations. This analysis yielded all

negative correlations which suggests that the more experi-

ence subjects had accrued, the less likely they were to be

impacted by the BPDC on these variables. The subjects

assessed were impacted least by the perceived friendliness

of the client, followed by the submissiveness, hostility,

and finally dominance. However, Hypothesis 6 was not

rejected because the correlations were not statistically

significant.



Table 19

Correlations Between Years of Experience and Scores on
the Impact Message Inventory for Subjects with BPDCs

Dominant Hostile Submissive Friendly
r -0.23 -0.15 -0.15 -0.10
Prob.
> r 0.05 0.20 0.20 0.40


N 73 73 73 73




Table 20 indicates a significant correlation suggesting

that as subjects' experience level increases, their per-

ceived level of difficulty counseling a DC decreases. Al-

though the correlations between years of experience and

salience and secondary appraisal of the task were not









significant, there is noteworthy information. All of the

correlations were negative, which indicates that as

counselors' years of experience increased, the level of

stress in counseling depressed clients in these two areas

decreased, although not to statistical significance. The

subjects' level of salience decreased more than their level

of secondary appraisal as years of experience increased.

Therefore, Hypothesis 11 is not rejected.



Table 20

Correlations Between Years of Experience and Scores on
the Stress Appraisal Scale of Subiects' Responses to
DCs


Salience Difficulty Sec. Appraisal
R -0.19 -0.27 -0.10
Prob. >
R 0.11 0.02* 0.38


N 72 72 72


* p < .05



Table 21 indicates that there were no significant

correlations between years of experience and scores on the

SAS among those responding to the BPDC. However, the

ranking of these subscales does yield information. This

group perceived that as they gained more years of experi-

ence, their perception of salience of the task was less,

their perception of difficulty was greater, and their







87
realization of secondary appraisal was the greatest. All of

these were negatively correlated to the years of experience

the counselors reported. However, Hypothesis 12 was not

rejected because these correlations were not statistically

significant.



Table 21

Correlations Between Years of Experience and Scores on
the Stress Appraisal Scale of Subjects Responding to
BPDCs

Salience Difficulty Sec. Appraisal
R -0.01 -0.08 -0.08
Prob.
> R 0.23 0.49 0.52


N 70 70 70




In summary, Hypothesis 1 was rejected, and

Hypotheses 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12

were not rejected.














CHAPTER V
DISCUSSION


"I see [clients] like this all the time and now
this comes in the mail in my spare time!"

"I recently divorced my wife of 11 years who is
borderline personality disordered and severely
alcoholic. Hope I was objective. Hope this note
doesn't invalidate this instrument."

"This borderline woman is either Tammy Faye Bakker
or a damn good actress. She should be given an
oscar for her performance."


These are some of the unsolicited comments from the

respondents in this study, all of whom were licensed mental

health counselors in Florida. Groups were composed of male

and female subjects, and all subjects had earned a master's

or doctorate degree in counseling. There were differing

levels of experience and also varying levels of likelihood

that the subjects would encounter clients similar to those

portrayed in the respective interviews.

Limitations

This study may have been limited due to threats to

criterion validity of the Stress Appraisal Scale as an

instrument to test Self-efficacy theory. Another instrument

might have been selected which more effectively validates

this theory. Therefore, this study is limited in that it

does not support nor refute Self-efficacy theory.

88







89
There may also have been limitations due to the differ-

ential presentation of clients to which subjects responded.

BPDCs may have been perceived as creating a greater sense of

urgency than DCs, which may have impacted subjects' respons-

es.

Discussion

Subjects may have been resistant to the task of listen-

ing to the audiotape of the BPDC interview due to a warning

in the introductory letter concerning the profane language

used by the client. This reluctance was not assessed, so it

is not known what effect this had upon the results.

Counselors surveyed in this study were asked to respond

to one of two client types: (a) a depressed clients (DC) or

(b) a borderline personality disordered clients (BPDC).

They reported the BPDC to be more dominant than the DC,

indicating that they perceived the BPDC to be more

(a) exhibitionistic, (b) attention seeking, and (c) hungry

for approval from others than the DC. This information is

consistent with diagnostic criteria for depressive disorder

and borderline personality disorder. Depressed clients are

characterized by symptoms of sadness, fearfulness, hopeless-

ness, listlessness, and fatigue (Wetzel, 1984).

Persons having these characteristics would likely score low

on the IMI dominant scale. Borderline personality disor-

dered clients show symptoms such as (a) insatiable need for

affirmation, (b) egocentrism, and (c) a sense of entitlement







90

(Horwitz, 1987), which were reflected in high scores on the

IMI dominant scale.

Subjects who responded to the BPDC rated her higher

than the DC on the IMI hostility scale. This scale measures

the tendency to (a) criticize, ridicule or punish others;

(b) doubt or suspect the attitudes, feelings, or intentions

of others; and (c) detach from others and minimize emotional

investment in others. Again, characteristics of DCs do not

fit this pattern. Depressed clients were more inclined to

(a) seek help from others, (b) be indecisive, (c) exhibit

signs of low self esteem and worthlessness, and (d) become

overdependent on those they consider more capable than

themselves (Wetzel, 1984). Borderline personality disor-

dered clients, conversely, often appear to be antagonistic

due to their high levels of (a) emotional intensity,

(b) lack of control of their anger, (c) inability to trust

others, and (d) history of failed interpersonal relation-

ships (American Psychiatric Association, 1987).

The DC was viewed as more submissive than the BPDC by

the subjects in this study. The submissive subscale

measured clients' (a) willingness to accept blame,

(b) tendency to belittle oneself and apologize to others,

(c) proclivity for passive behavior, (d) preference of

yielding responsibility for problem solving to others, and

(e) appearance of helplessness. Clients suffering from

depressive disorders are often experiencing feelings of









(a) inadequacy, (b) hopelessness, (c) vulnerability, (d)

confusion, and (e) inability to concentrate (Wetzel, 1984).

The BPDCs, however, are much less trusting and avoid relin-

quishing any control to another person. They often appear

to be asking for help but are unable to trust others who

might be of assistance to them (Linehan, 1987).

The counselors in this study perceived the DC to be

more friendly than the BPDC. Friendliness is defined as

(a) being agreeable, cooperative, and considerate; (b) show-

ing active support and sympathy to others; and (c) display-

ing fondness, warmth, and friendship to others. The DCs,

because of their lack of self esteem and feelings of help-

lessness and hopelessness, would be inclined to demonstrate

more of these characteristics than would BPDCs. The charac-

teristic (a) affective instability, (b) anger and inability

to control anger, (c) lack of trust, and (d) socially devi-

ant behavior of BPDCs would lead to the belief that they

would score low on this variable (Horwitz, 1987).

Subjects found the task of counseling a DC to be more

salient than counseling a BPDC. Salience is defined as

caring about one's reaction or performance and recognition

that the process and outcome of the task have important

consequences for self. This response might reflect

subjects' awareness that counseling DCs often produces more

immediate results and rewards, while counseling BPDCs is

often a long and frustrating process, and has a limited

chance for success (Kroll, 1988).




Full Text
xml version 1.0 encoding UTF-8
REPORT xmlns http:www.fcla.edudlsmddaitss xmlns:xsi http:www.w3.org2001XMLSchema-instance xsi:schemaLocation http:www.fcla.edudlsmddaitssdaitssReport.xsd
INGEST IEID E378JHMNG_7QBRHV INGEST_TIME 2012-09-24T14:00:19Z PACKAGE AA00011849_00001
AGREEMENT_INFO ACCOUNT UF PROJECT UFDC
FILES