<%BANNER%>

The Relationship between Therapists' Epistemology and Their Therapy Style, Working Alliance, and Use of Specific Interve...


PAGE 1

THE RELATIONSHIP BETWEEN THERAPISTS EPISTEMOLOGY AND THEIR THERAPY STYLE, WORKING A LLIANCE, AND USE OF SPECIFIC INTERVENTIONS By JOCELYN A. SAFERSTEIN A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLOR IDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2006

PAGE 2

Copyright 2006 by Jocelyn A. Saferstein

PAGE 3

iii ACKNOWLEDGMENTS I extend special thanks to my husband and all of my friends and family for their constant love and support. I am also gratef ul to Dr. Ken Rice for his unending patience in answering all of my many questions. I could not have completed this dissertation project without the gu idance of my extraordinary supervisor, Dr. Greg Neimeyer.

PAGE 4

iv TABLE OF CONTENTS page ACKNOWLEDGMENTS.................................................................................................iii LIST OF TABLES............................................................................................................vi ABSTRACT.....................................................................................................................vii CHAPTER 1 INTRODUCTION........................................................................................................1 2 LITERATURE REVIEW.............................................................................................3 Epistemic Style.............................................................................................................3 Assessing Epistemic Style.....................................................................................6 Epistemology and Rationalist-Constructivist Therapies.......................................7 Epistemic Style and Preferences...........................................................................9 Therapy Style..............................................................................................................10 Working Alliance........................................................................................................14 Therapy Interventions.................................................................................................18 3 METHODS.................................................................................................................23 Participants.................................................................................................................23 Procedures...................................................................................................................25 Measures.....................................................................................................................25 Therapist Attitudes Questionnaire-Short Form...................................................25 Constructivist Assumptions Scale (CAS)............................................................26 Personal Style of the Therapist Questionnaire (PST-Q)......................................26 Working Alliance Inventory-Short Form (WAI-S).............................................27 Techniques List (TL)...........................................................................................28 4 RESULTS...................................................................................................................32 Descriptive and Preliminary Analyses........................................................................32 Measurement Reliability.....................................................................................32 Correlational Analyses........................................................................................33 Regression Analyses...................................................................................................35 Hypothesis 1........................................................................................................35 Instructional style.........................................................................................36

PAGE 5

v Expressive style............................................................................................36 Engagement style.........................................................................................37 Attentional style...........................................................................................37 Operative style..............................................................................................38 Hypothesis 2........................................................................................................38 Task..............................................................................................................38 Goal..............................................................................................................39 Bond.............................................................................................................39 Hypothesis 3........................................................................................................40 Cognitive behavioral techniques..................................................................40 Constructivist techniques.............................................................................41 5 DISCUSSION.............................................................................................................45 Summary of the Results..............................................................................................45 Discussion of Results within the Context of Current Literatures...............................48 Therapists Epistemology and Therapy Style......................................................48 Therapists Epistemology and Working Alliance...............................................52 Therapists Epistemology and Sele ction of Specific Techniques.......................53 Limitations and Future Research................................................................................55 Conclusion..................................................................................................................57 APPENDIX A THERAPIST ATTITUDE QUESTI ONNAIRE SHORT FORM (taq-sf)..................59 B CONSTRUCTIVIST ASSU MPTIONS SCALE (cas)...............................................61 C PERSONAL STYLE OF TH E THERAPIST (PST-Q)..............................................62 D WORKING ALLIANCE INVENTORY SHORT FORM (wai-s).............................64 E TECHNIQUES LIST..................................................................................................66 F DEMOGRAPHIC INFORMATION..........................................................................68 LIST OF REFERENCES...................................................................................................69 BIOGRAPHICAL SKETCH.............................................................................................73

PAGE 6

vi LIST OF TABLES Table page 3-1 Personal style of the therapist questi onnaire (PST-Q): subscale directions.............31 4-1 Internal consistencies for the CAS, TAQ-SF, WAI-S, PST-Q, and techniques list........................................................................................................................... ..42 4-2 Pearson correlations for therapy style, working alliance, techniques & years of experience ................................................................................................................43 4-3 Means and standard deviations fo r epistemology, therapy style, working alliance, and intervention selection..........................................................................44

PAGE 7

vii Abstract of Dissertation Pres ented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy THE RELATIONSHIP BETWEEN THERAPISTS EPISTEMOLOGY AND THEIR THERAPY STYLE, WORKING A LLIANCE, AND USE OF SPECIFIC INTERVENTIONS By Jocelyn A. Saferstein December 2006 Chair: Greg J. Neimeyer Major Department: Psychology The current study examined the relationship between therapists epistemic style and their (1) therapy style, (2) emphasis on the working alliance, and (3) use of specific interventions. The study aimed to discover whet her or not therapists epistemologies can predict how therapists repor t their practice of therapy (e.g., therapy style, working alliance, and use of therapy techniques). The most robust findings provide provisiona l support for the notion that there are specific differences in the personal style of the therapist according to the therapists epistemic assumptions (rationalist versus constructivist). Additionally, therapist epistemology was a significant predictor of their emphasis on the working alliance (Bond subscale), as well as, their us e of specific interventions (cognitive behavioral versus constructivist). The current study extends the developing literature inves tigating the translation of epistemology in to practice, specifically look ing at therapists self-reports. Further work

PAGE 8

viii is needed to see if client reports corroborat e therapists se lf-report and to investigate whether or not therapists epistemology affects the outcome of therapy work.

PAGE 9

1 CHAPTER 1 INTRODUCTION A growing area of interest in counsel ing psychology research explores the philosophical underpinnings of different a pproaches to counseling and psychotherapy (Beronsky, 1994; DisGiuseppe & Linscott, 1993; Erwin, 1999; Lyddon, 1990; Mahoney, 1991; Mahoney & Gabriel, 1987; Mahone y & Lyddon, 1988; Okun, 1990; Polkinghorne, 1991; Vasco, 1994). More specifically, recent literature has investig ated the translation of epistemology into practice, explori ng the relationship between philosophical commitments on the one hand, and theories and c oncepts related to change processes, on the other (Arthur, 2000; Botella & Gall ifa, 1995; Chiari & Nuzzo, 1996; Lyddon, 1989, 1988). One expression of this work looks at the epistemic assumptions that underpin the theory and practice of cognitive therapy (Lyddon, 1991). In particular, a developing literature addresses the distinct differences between contemporary cognitive therapies according to their epistemic assumptions: ra tionalist, empiricist, and constructivist epistemologies (Hollon & Beck, 1986; Lyddon, 1991). The notion that counselors maintain differe nt perspectives regarding the processes and methods of human change due to di ffering philosophical commitments has been considered in the epistemic style litera ture (Lyddon, 1989). Personal epistemological commitments have been linked to a variety of different features in psychotherapy, such as preferences for particular t ypes of therapy (Arthur, 2000; DisGiuseppe & Linscott, 1993; Lyddon, 1989; Mahoney & Gabriel, 1987; G. Neimeyer & Morton, 1997) and specific

PAGE 10

2 therapeutic interventions (Granvold, 1996; Mahoney & Lyddon, 1988; Winter & Watson, 1999). The link between personal epistemologies a nd particular therapist behaviors is just beginning to receive atte ntion. In fact, there has been rela tively little empirical research addressing the translation of therapist ep istemological leanin gs into corresponding therapeutic practices. The purpose of such exploration would be to gain a better understanding of therapist epis temic style and how it relates to the methods and processes of therapy. In particular, there is reason to believe that specific epistemic commitments would be related to, and potenti ally direct, a) particular ps ychotherapeutic styles, b) the structuring of particular t ypes of therapeutic relationshi ps, and c) the selection of particular forms of psyc hotherapy interventions. To develop these ideas, a review of the epistemic style literature in general will be conducted first, followed by a specific review of the literature i nvestigating therapist epistemic style as a predictor of therapist variables, including therapy style, the therapeutic relationship and th e selection of specific therap eutic interventions. This literature review will conclude w ith a set of specific predictions regarding the relationship between epistemic style and these various ther apeutic behaviors. This will be followed, in turn, by a description of th e methods used to test these predictions, the results of the study and, finally a discussion that provides an understanding of the studys findings within the context of the existing literature highlighting its implicat ions and limitations, as well.

PAGE 11

3 CHAPTER 2 LITERATURE REVIEW This chapter provides a review of the lit eratures that support specific predictions regarding the relationship between epistemic styl e and a range of therapist variables. The review first provides a broader overview of the epistemic styl e literatures and then, more specifically, the translation of epistemology into the practice of therapy. Next will be a review of research looking at conceptual diffe rences in therapists therapy style according to their epistemic assumptions, followed by an overview of the working alliance literature and, more specifically, how different episte mological assumptions maintain notable differences in the nature of the working allian ces they form with thei r clients. Finally, there will be a discussion of the relationship between specific therapeutic interventions and the epistemic commitments that may inform or direct their select ion. Each section of this literature review will end with an outline of specific predictions concerning epistemic style and aspects of therapist style, work ing alliance, and therapeutic interventions, respectively. Epistemic Style Royce has developed a long-standing line of research investigating peoples ways of knowing (1964; Diamond & Royce, 1980; Royce & Powell, 1983). Throughout this extensive program of research, Royce and hi s colleagues have developed a conceptual model that specifies three fundamental classes of knowing. These three primary approaches to knowing are referred to as the three epistemic styles: rationalism, empiricism, and metaphorism.

PAGE 12

4 Rationalism maintains the dominant asser tion that thought has superiority over the senses with regards to obtaining knowledge. Those with a rational epistemic style are devoted to testing their views of reality in terms of logical consistency. The primary underlying cognitive processes for the rational epistemic style includes clear thinking and rational analysis, as well as synthesizing different no tions (Diamond & Royce, 1980; Vincent & LeBow, 1995). Rationalists view psychopathology as stemming from irrational emotions or behaviors that can be controlled by rational thought. Cognitiverational therapy depicts this process of deductively analyzing and rejecting personal beliefs and arguments, while instead preferri ng a more rational option. In other words, rationalism is the epistemological worldvi ew that underlies cognitive-rational therapy (Lyddon, 1989; Mahoney, 1991). Empiricism is primarily concerned with sensory experience as the main way of knowing, where people know to the extent that they perceive accurately. The empirical view of knowledge is primarily inductive and determined mo stly by the reliability and validity of observations (Diamond & R oyce, 1980; Vincent & LeBow, 1995). Psychological problems are considered as learned and measurable dysfunctional behavior, where the reduction of psychol ogical distress would be attained through behavioral contracting or conditioning which empiricists believe promotes changes in affect and cognitions. In other words, empiri cism is the epistemol ogical worldview that underlies behavioral therapy (Ma honey, 1991; Schacht & Black, 1985). The metaphorist perspective sees knowledge neither as firm nor rigid, but rather as more flexible, and as embedded within indi vidually and socially constructed symbolic processes. Metaphorism thus takes the stance th at reality is personal and mutable, rather

PAGE 13

5 than fixed, and that individua ls construct their bases of knowledge from their personal learning histories, external experience, and their own pers onally constructive processes (Vincent & LeBow, 1995). Metaphorists are further described as testing the soundness of their perspectives in relationship to the vi ability, or pragmatic utility within a given context. In addition, for the metaphorist, cogni tive processes are symbolic in nature, with both conscious and unconscious component s (Diamond & Royce, 1980; Lyddon, 1989). Metaphorical epistemic styles cast psychologica l dysfunction as an unsuccessful effort to change or develop, or an inability to adequate ly adjust to a situation or circumstance. From this perspective, psychological dysfunc tion is viewed as a perturbance in an individuals customary way of knowing, with emotional di stress reflecting a persons limited ability to adapt to life circumstances. The emphasis is placed on adjustment and the novel construction of new ways of knowing within an ongoing process of developmental change, rather than the correct ion of dysfunction or the restoration of a more valid correspondence between reality a nd ones view of that reality (Mahoney, 1991; Vincent & LeBow, 1995). In other wo rds, metaphorism is the epistemological worldview that underlies constructivi st therapy (Lyddon, 1989; Mahoney, 1991; G. Neimeyer, Prichard, Lyddon, & Sherrard, 1993; R. Neimeyer, 1993b; Schacht & Black, 1985). Royces conceptual framework holds th at the processes of conceptualizing, perceiving, and symbolizing are interdepe ndent processes, where the meaningful convergence of these three processes makes up a persons view of reality or worldview. Although interdependent, people tend to show a leaning towards a dominant epistemic style (Royce & Mos, 1980; Royce & Po well, 1983). Thus, although knowing is

PAGE 14

6 comprised of rational, empiri cal, and metaphorical compone nt processes, there is a hierarchical order to which people use these proc esses, with one of the three tending to be relatively dominant for each individual. Assessing Epistemic Style The research program following from Roy ce (1964) demonstrates support for these three basic theories of knowledge: rationa lism, empiricism, and metaphorism. Initial research looked at the relationship between an individuals epistemic style and their occupations (Royce & Mos, 1980). Using th e instrument developed to assess these epistemic styles (The Psychological-Epis temological Profile, Royce & Mos, 1980), rationalists tended to be repres ented in the occupations of mathematicians and theoretical physicists, empiricists tended to be represen ted in the occupations of biologists and chemists, and metaphorists tended to be repr esented in the occupations of professional musicians and dramatists. Further research on epistemic style investigated how philosophical commitments relate to the theories, methods and approaches to therapeutic change (Botella & Gallifa, 1995; Lyddon, 1988, 1989, 1990; Mahoney, 1991; R. Ne imeyer, 1993b). Research based on Royces (1964) taxonomy of epistemic styles suggests that therap ists with different epistemic styles demonstrate differences in their theoretical orient ations (Arthur, 2000). Schacht and Black (1985), for example, found th at behavioral therapis ts were found to be more inclined towards an empirical epistemic style, while psychoanalytic therapists revealed a greater commitment to a metaphorical epistemic style. Additionally, Arthur (2000) looked at a sample of therapists and how their epistemic style differed according to their therapy orientation (cognitive behavioral versus psychoanalytic). In this study, ps ychoanalytic therapists scored significantly

PAGE 15

7 higher on the metaphorist scale compared to the cognitive behavioral therapists. Cognitive behavioral therapists were found to pr efer thinking to feeling and to be more reliant on reason, logic, and re ducing emotional input, whereas psychoanalytic therapists relied more on their feelings to understand a client. Thus, results from this study supported the notion of differences between psychoanalytic and cognitive behavioral therapists according to their epistemic styles. Mahoney (1991) has further distinguished between rationalist and constructivist epistemologies, underscoring some of the distinctions outlin ed by Royce and his colleagues, and has provided the groundwor k for additional investigations of the relationship between epistemic st yle and therapy orientation. Epistemology and RationalistConstructivist Therapies Mahoney (1991) distinguishes between, and extends, epistemic style research by suggesting that current cognitive therapie s are distinguished by their differing epistemological commitments (rationalism and constructivism). Rationalism argues that there is a single, stable, external reality, and that thoughts are held s uperior to the senses when determining the accuracy of knowledge (Mahoney, 1991; Mahoney & Gabriel, 1987, Mahoney & Lyddon, 1988). Winter and Wats on (1999) further depict rationalists as believing that individuals passively perceive an independe ntly existing reality, and that with regards to therapy, clients are seen as making cognitive errors, which causes them to have a less accurate perception of reality. The therapists role is thus to instruct the client to think more rationally, increasing the correspondence between an individuals perceptions and the reality of the events th ey are confronted wit h. Thus, rationalist therapies are more persuasive, analytical and technically instructive than the constructivist therapies (R. Neimeyer, 1993b). Successful rationalist therapy occurs

PAGE 16

8 when clients are able to control their negative emotions thro ugh rational thinking (Mahoney & Lyddon, 1988). Ellis Rational Emotive Therapy (RET) has been considered the approach that best depict s the rationalist perspective (DisGiuseppe & Linscott, 1993). Lyddon (1989) further notes th at rationalist cognitive theories, due to their epistemological commitment to reason and logical-analytic processes, depict a rational epistemic style. Constructivism, however, ar gues that individuals are pr oactive in their personal constructions of their realities. From th is point of view, knowledge is comprised of meaning making processes where the individual is in charge of organizing his or her experiences. Constructivists believe that real ity is not single, stab le, or external, and instead assert that individual s feelings and actions cannot be meaningfully separated from human thought (Lyddon, 1988; Mahone y, 1991; Mahoney & Gabriel, 1987; Mahoney & Lyddon, 1988). Unlike rationalist th erapists, Winter and Watson (1999) point out that constr uctivist therapists see clients as taking a proactive position in constructing their own personal realities. Thus, constructivist therapies are more personal, reflective, and elaborative than the rationalist therapie s (R. Neimeyer, 1993b). Additionally, Lyddon (1990) notes the differe ntial role that emotions play in psychotherapy for rational and constructivist therapists. Rationalists view negative emotions as representing problems that need to be controlled, or eliminated, whereas constructivist therapists see emotion as play ing a functional role in the change process and encourage emotional experience, expres sion, and exploration (p.124). Thus, constructivist therapists attempt to facilitate clients personal construction of new meanings in the context of a safe and car ing relationship. Lyddon (1989) further notes

PAGE 17

9 that constructivist cognitive theories, due to the primacy placed on the construction and alteration of personal meanings, is most repres entative of a constructivist epistemic style. Epistemic Style and Preferences The influence of epistemic style on pref erence for rational an d constructivist therapies have been noted in recent res earch (Arthur, 2000; DisG iuseppe & Linscott, 1993; Lyddon, 1989; Mahoney & Gabriel, 1987; G. Neimeyer & Morton, 1997). The primary implications of this research reveal an existi ng match between the rational epistemic style and rational therapies, as well as a match between the constructivist epistemic style and constructivist therapies. Lyddon (1989) noted that, for example, people with a dominant rational epistemic style tend to prefer rationa list therapy because rational therapy facilitates clients approaching emotiona l and personal troubles in a rational and logical way that is congruent with their ways of dealing with difficulties in other aspects of their lives. Thus, when considering the findings of Royce and Mos (1980), that people tend to have a leaning towards a dominant ep istemic style, it naturally follows that a match would exist between th erapists epistemology and their theoretical orientation, reflected in the underlying epis temology of that therapy orientation (Lyddon, 1989). In considering the epistemology literature a much broader range of theoretical, strategic, and technical distin ctions have been conceptua lized in relation to differing epistemological positions than have actually been documented in research literatures (Mahoney & Lyddon, 1988; R. Neimeyer, 1993b). Th ese conceptual differences include expected differences in the ch aracteristic style of therapy, differences in the nature and enactment of the therapeutic relationship (R Neimeyer, 1995), and differences in the actual interventions associat ed with different therapy orientations (Lyddon, 1990).

PAGE 18

10 Despite the many different conceptual differences that have been note d, relatively few of these have received careful empirical documen tation (G. Neimeyer, Saferstein, & Arnold, 2005). Working on the basis of current conceptual di stinctions that have been made in the literature, it is possible to identify and te st expected differences between rational and constructivist therapists in relation to (1) therapy style (2) the th erapeutic relationship, and (3) the selection of specific therapeutic in terventions. Each of these three therapist variables (style, relationship, and interventions ) will now be discussed in further detail in relation to the respective epistemological differences (rationalist versus constructivist) noted in the literature. Therapy Style There has been some literature investigating conceptual differences in therapists therapy style according to their epistemic a ssumptions. Granvold (1996), for example, suggests that traditional cognitive behavioral therapists tend to target irrational beliefs for modification, educate the client, guide the clie nt, and take an active and directive position with the client. On the othe r hand, a constructivist therapy style is characterized by the therapist being less directive, providing less in formation to clients, and engaging in more exploratory interaction in thei r behavior with clients. More specifically, R. Neimeyer (2005) i ndicates that constr uctivist therapists invoke a sense of openness which he describes more specifically here: I mean not overly structuring the agenda for the session by my own preconceptions of what my client requires, pa rticularly to the extent that such an agenda is driven by some diagnostic or classificatory syst em about the experience of an abstract group of people who report some of the same symptoms or difficulties. (p. 78)

PAGE 19

11 This highlights the importance of less versus more structure when considering cognitive behavioral versus constr uctivist therapies, respectively. In addition, provisional empiri cal work has begun to explore differences in therapy style according to epistemic assumptions For example, Winter & Watson (1999) conducted an empirical investigation looking at the differences between constructivist and rationalist therapists. They looked at the work of four personal construct therapists (i.e., constructivist) and six ra tionalist therapists across a rang e of clients in an outpatient mental health setting. Both types of ther apy were conducted on the basis of a 12-session renewable contract. Results from audio taped recordings of the sessions revealed an interesting perspective on the distinctive pr ocedural and relational components of these two orientations. In general, the rationalist therapists show ed a more negative attitude towards their clients, while the personal construct therapists showed greater regard for them. Additionally, clients involved in persona l construct therapy s howed greater overall involvement in therapy. These differen ces are in line with the credulous and collaborative nature of the personal constr uct therapist originally depicted by Kelly (1955). In another study (G. Neimeyer & Mort on, 1997), 49 practicing psychotherapists were recruited to investigate the relationshi p between therapy orientation and epistemic style. Two samples of therapists were recruited in this st udy, one group of rationalemotive therapists who were members in th e Institute of Rational Emotive Therapy, and one group of personal construct therapists, who were members of the International Network of Personal Construct Theorists. Therapists from both groups were asked to do three things. First, therapists were asked to complete a copy of the Therapist Attitude

PAGE 20

12 Questionnaire (TAQ) created by DisGiuseppe and Linscott (1993) to assess Mahoney's distinction between ratio nalist and constructivis t therapy orientations. Second, therapists were asked to compare their own therapy orie ntations to six prominent psychotherapists known for their predominantly rationalis t (e.g., Aaron Beck, Albert Ellis) or constructivist (e.g., George Kelly ; Michael Mahoney) orientati ons. And third, therapists were asked to rate their therapeutic style al ong descriptors associated with a rationalist orientation (e.g., logical, direc tive, educational) and with a constructivist orientation (e.g., symbolic, metaphorical, meaning-oriented). Results from this study were consistent with the translation of epistemic commitments into the practice of therapy. For example, personal construct therapists demonstrated a significantly higher commitme nt to a constructivis t epistemology, and a lower commitment to a rationalist perspect ive, compared with rational-emotive therapists. Additionally, pe rsonal construct therapists demonstrated a stronger identification with notable cons tructivist therapis ts, and had a tendency to depict their therapeutic styles along dimensions more cl osely aligned with c onstructivist therapy. Further efforts to build upon these findings can be developed in relation to the conceptualization by Fernandez-Alvaraez, Garcia, Bianco, & Santoma (2003) of therapists personal style. These authors descri be therapists personal style as the, . . imprint left by each professional in his work and note that it has a relevant impact on the outcomes of the treatment (p. 117). Give n that therapy style is a general principle for any theoretical orientation, Fernandez-Alva raez et al. (2003) defi ne the personal style of the therapist as, the set of characteristics that each therapist applies in every psychotherapeutic situation, shaping its basic attributes. It is made up of the peculiar conditions that

PAGE 21

13 lead the therapist to behave in a particular way in th e course of his professional work. (p.117) This definition can be considered in relation to how therapy style manifests differently in various theoretical approach es. For example, Granvold (1996) notes the marked differences between cognitive beha vioral and constructiv ist therapy styles regarding how these different orientations view treatment goals. Whereas cognitive behavioral therapists target cognitions fo r modification and subs equently educate the client on the impact of cognitions in functi oning and change in a more directive manner, constructivist therapists are less directive, more exploratory, less problem-focused, and more experiential (Granvold, 1996). While th ese differences in therapy style according to cognitive behavioral versus constructivist therapy orientati ons have been noted in the literature, their has not been a clear inve stigation and discussion in the literature regarding the connection between differences in therapists' epistemic styles (rationalist versus constructivist) and how that may transl ate into differences in therapists therapy style. Such differences in therapy style have b een measured by an instrument designed to assess the set of characteristics (FernandezAlvaraez et al., 2003) of each therapist that make up their therapy style. Fernandez-Alvara ez et al. (2003) created such a measure of therapists personal style (Per sonal Style of the Therapist Questionnaire) that measures five specific dimensions of therapists style (Instructional, flexibility-rigidity; expressive, distance-closeness; engagement lesser degree-greater degree; attentional, broad focusednarrow focused; operative, spontaneous-planned) This measure is used in the current study to investigate the influence of ther apists epistemic styl e (rationalist versus constructivist) on their therapy styl e according to these subscales.

PAGE 22

14 Thus, the first hypothesis makes predictions regarding the influence of therapist epistemology on therapists particular ther apy style. According to these authors definitions, our first hypothesis is that th erapist epistemology will be a significant predictor of their therapy style. More specifically, therapists with rational epistemologies would have a therapy style depicting more ri gidity on the Instructional subscale, more distance on the expressive subscale, a lesser degree of engagement, more narrow focus on the attentional subscale, and more planne d on the operative subscale, compared to therapists with a construc tivist epistemology. By co mparison, therapists with constructivist epistemologies w ould have a therapy style refl ecting more flexibility on the Instructional subscale, more closeness on the expressive subscale, a greater degree of engagement, more broad focus on the attenti onal subscale, and more spontaneous on the operative subscale compared to therapists with rationalist epistemologies. This first hypothesis is based on the notion that rationalist ther apists tend to be more instructive, persuasive, analytical, and t echnically instructive than th e constructivist therapies (R. Neimeyer, 1993b). Additionally, constructiv ist therapies are thought to be more personal, reflective, and elaborative than th e rationalist therapies, with constructivist therapists attempting to facilitate clients personal construction of new meanings in the context of a safe and car ing relationship. (Lyddon, 1990). Working Alliance These differences in therapy style reflect broader differences regarding the nature and role of the therapeutic relationship. In addition to therapy style, cognitive behavioral and constructivist therapies maintain notable differences in the nature of the working alliances they form with their clients. The notion of the working alliance is pantheoretical, with working alliance being considered a common factor in different

PAGE 23

15 types of therapies (Horvath & Luborsky, 1993) While therapy st yle refers to the characteristic patterns of be havior that typify the ther apists behavior, the working alliance specifically addresses the nature of the interaction and relationship occurring between the therapist an d their clients. Working alliance is defined by Bordin (1979) as the combination of (a) client and therapist agreement on goals (Task), (b) client and therapist agreement on how to achieve the goals (Goal), and (c) the development of a personal bond between the client and therapist (Bond). According to Bordin (1979), Tasks are the therapeutic pr ocesses that take place during each session, with the deve lopment of the Task component occurring when the therapist and client both comp rehend significance and effectiveness of the tasks. Goals are stated to be the mutually agreed upon outcomes of therapy by the client and therapist. The Bond component repres ents the key elements of rapport: trust, acceptance, and confidence. Bordins (1979) definition underlies a measure of working alliance developed by Horvath & Greenberg (1 986), which assess these three specific dimensions of the working alliance in counseling and psychotherapy. While rationalist and constructivist therapies both value the working alliance, empirical literature has sugge sted that rationalist and c onstructivist therapies value different qualities within the working alliance. For example, a con ceptual depiction of the differences between cognitive behavioral and constructivist therapists in the therapeutic relationship comes from Beck, Ru sh, Shaw, and Emery (1979), who state that the therapist is a guide who helps the client understand how beliefs and attitudes influence affect and behaviour (p.301). This assertion highlights the differences

PAGE 24

16 between cognition, affect and behavior in B ecks approach, compar ed to the holistic perspective maintained in the constructivist approach. Faidley and Leitner (1993) further no te that in constructivist therapy, the therapist is not the guru leading the client to health. Both the client and therapist embark on an uncharted journey that will require them to enter unknown territory, to struggle, to bear fear and pain, and hope fully, to grow. (p. 6-7) Further empirical studies have addres sed key distinctions between cognitive behavioral and constructivist therapies with regard to emphasis on working alliance. For example, a study by Winter and Watson (1999) provided support for the assertion that there are, in fact, differences between constr uctivist and rationalist cognitive therapies in relation to therapist pe rceptions of the therapeutic relati onship. These authors found that constructivist therapists were less negatively confrontative, intimidating, authoritarian, lecturing, defensive, and judgmental (p.17). In addition, constructivist therapists had greater use of exploration, silence, open que stions and paraphrase, along with lower use of approval, information and direct guidance, compared to cognitive behavioral therapists. Another example comes from Mahoney & Lyddon (1988) who point out key conceptual differences between rationalist and constructivist therapies in relation to the working alliance. These authors suggest th at rationalist therapists conceptualize the therapeutic relationship as invol ving the service or delive ry of direct guidance and technical instruction (p. 221). Thus, for rationalist therapists, G. Neimeyer et al. (2005) suggest that the therapeutic relationship is oriented mo re towards the delivery of guidance, technical instruction, and beha vioral rehearsal regarding the role of cognitions in the development and maintenance of emo tional distress. The use of therapistdirected exercises, structured interven tions, and directed homework assignments

PAGE 25

17 illustrates the relative emphasis placed on the development of technical skills. . (p. 14) Additionally, the working alli ance has been noted to have an important role in cognitive behavioral therapy (Raue, Gold fried, & Barkham, 1997). Beck (1995), for example, has stipulated that Cognitive th erapy requires a sound th erapeutic alliance (Beck, 1995, p. 5). Further, consensus on the tasks and goals of therapy is inherent in Becks (1979) basic notion of collabora tive empiricism, which highlights the collaboration between client and therap ist in achieving therapeutic gains. This component of the working alliance that is highly valued within the rationalist therapies falls in line with Bordins (1979) definitions of the Task and Goal components of the working alliance. Alternatively, Mahoney & Lyddon (1988) depi ct constructivist therapists as viewing the human connection within the therap eutic relationship as a crucial component of therapeutic change, a connection that f unctions as a safe and supportive home base from which the client can expl ore and develop relationship with self and world (p. 222). Similarly, Granvold (1996) notes that The development of a quality therapeutic relationship with such characteristics as acceptance, understanding, trust and caring is a prime objective of constructivists. (p. 350) This is directly in line with Bordins (1979) depiction of the Bond component of the working alliance, as comprising the key el ements of rapport: tr ust, acceptance, and confidence. Additionally, constructivists tend to have less narrowly defined tasks or goals compared to cognitive behavior al therapists (Granvold, 1996). Thus, there are key distinctions between rationalist and constructivist therapists conceptualizations regarding the nature and role of the therapeutic relationship or

PAGE 26

18 working alliance in negotiating the therapeutic cha nge. While both cognitive behavioral and constructivist therapies promote a collabora tive relationship with the client, there are noted differences in how this manifests in these two therapy orientations (Granvold, 1996). Thus, the second hypothesis in the current study concerns the re lationship between therapist epistemology and their perceived leve ls of working allian ce, according to the subscales of Task, Goal, and Bond. We hypothe size that therapist ep istemology will be a significant predictor of work ing alliance (Task, Bond, and Go al). More specifically, therapists with rationalist epistemologies wi ll have higher scores on the Task and Goal subscales and lower on the Bond subscale th an the constructivist epistemologies. Therapy Interventions Both rationalist and constructivist ther apies view psychotherapy as occurring within a therapeutic relations hip, however the nature of this relationship is somewhat different (e.g., instruction vers us exploration, correction versus creation, etc.). Thus, the specific techniques use by rationa list and constructivist therapists might be expected to fit within these broad rela tionship differences. For example, Mahoney and Lyddon (1988) point out that rationa list interventions tend to focus on the control of the current problems and th eir symptomatology (p.217). In contrast, constructivist interventions tend to focus on developmental history and current developmental challenges (p.217). Th ey highlight the key differences between these two therapy interventions as reflecting a problem-versus-proce ss distinction that itself is reflected in the implicit and explic it goals of these two types of therapy. Rationalists are noted to guide the direction of therapy according to the presenting issues

PAGE 27

19 and particular goals, compared to constructivists who are more inclined to permit the selforganizing processes of the client to impact the path of therapy. Additionally, Granvold (1996) notes that c ognitive behavioral techniques have a more firm application of methodology and a mo re directive approach of techniques than constructivist techniques. Trad itional cognitive behavioral interventions are geared at controlling, altering or termin ating negative emotions (e.g., anxiety, depression, anger, worry, etc.). In contrast, constructivist in terventions maintain more creative than corrective interv entions (e.g., exploration, examin ation, and experience). Empirical evidence for these conceptual di stinctions between cognitive behavioral and constructivist therapy t echniques have been noted by Winter and Watson (1999). These authors found that the distinctivene ss of the two therapeu tic approaches was provided by the blind classificati on of the therapy transcripts (p. 17). More specifically, the authors provided transcript s of 2 different types of therapy sessions, rationalist cognitive therapy or personal construct ther apy, which were blindl y differentiated by leading proponents of the therap ies concerned (p. 1). Findi ngs indicated that cognitive behavioral therapists used in terventions that seemed to be more challenging, directive and to be offering interpretations that do not always lead direc tly from what the client has said (p. 17). Additionally, cons tructivist therapists were much looser in their construing; ask questi ons rather than make statements; and use interpretation more as a way of checking out their own construi ng or as a means of helping the client elaborate hi s or her construing. (p.17) Therefore, there is tentative empirical wo rk that seems to support the conceptual distinctions made between th e underlying epistemologies of these two orientations and possible differences in the techniques used in practice that follow from the different perspectives.

PAGE 28

20 Thus, the third and final hypothesis is in relation to the therap ist use of specific therapeutic techniques. When considering tr aditional cognitive behavioral therapies, interventions are geared at controlling, altering or termin ating negative emotions (e.g., anxiety, depression, anger, worry, etc.). In contrast, the construc tivist approach tends towards interventions that are more process oriented compared to cognitive behavioral therapies being more focused on surface-stru cture problem resolution. Constructivist interventions are considered more creative compared to cognitive behavioral interventions being more correct ive. Additionally, the cogniti ve behavioral approach is noted to have a more distinct problem orient ation, a stricter adhere nce to the application of methodology, and a more directive approach, compared to the constructivist approach. Whereas constructivist therapists are cons idered more metaphoric, approximate, exploratory and intuitive in therapy technique s compared to the cognitive behavioral approach (Granvold, 1996). Winter and Watson (1999) additionally cite empirical evidence for the distinction between cognitive behavioral and constructivist therapy techniques. In particular, findings suggested that cognitive behavioral therapists used more challenging and directive interventions compared to cons tructivist therapist. On the other hand, constructivist therapists asked more questi ons and used interpretation as a means of exploration of the clients meaning making system. Consequently, psychotherapy research i nvestigations have found a theoretical allegiance according to what techniques therapis ts use in their practi ce. In particular, there have been distinctions noted between cognitive behavioral and constructivist therapies in this regard (Winter & Wats on, 1999). For example, personal construct

PAGE 29

21 therapists showed less negative attitudes towa rd their clients. . were less negatively confrontative, intimidating, au thoritarian, lecturing, defensiv e, and judgmental (p. 17) compared to rationalist therapists. Personal construct therapists were also found to use techniques that had greater us e of exploration, open questi ons, and paraphrase, compared to rationalists. The current study plans to ex tend this line of research according to therapist epistemology. Thus, for the third hypothesis, epistemol ogy will be a significant predictor of therapy techniques used by the therapists in the sample. More specifically, therapists with rationalist epistemologies are expected to report using techni ques associated with cognitive behavioral therapy (e.g., advi ce giving) more than constructivist epistemologies, and therapists with constr uctivist epistemologies will report using techniques associated with constructivist th erapy (e.g., emotional processing) more than therapists with rationalist epistemologies. One purpose of the current work is to further examine these differences to determine whethe r these epistemological differences relate to the selection of specific interventions that fit more with the corrective and directive orientation of rationalist therapists or exploratory and crea tive orientation of constructivist therapists. Thus, in the present study, we investigated the potential influence of epistemic style (rational versus constructivist) on therapist therapy style, natu re of the working alliance, and use of specific interventions. These therapist variables were included according to their noted importance in translating episte mology into practice (G. Neimeyer, et al. 2005). The specific relationship between these va riables and therapists epistemic styles are summarized below.

PAGE 30

22 Overall, the current study seeks to inve stigate therapist ep istemology (rationalist versus constructivist) as a predictor of (1 ) therapy style: therapists with rational epistemologies might show more rigidity on the Instructional subscale, more distance on the expressive subscale, a lesser degree of engagement, more narrow focus on the attentional subscale, and more planned on the operative subscale, compared to therapists who might tend towards a therapy style reflec ting more flexibility on the Instructional subscale, more closeness on the expressive subscale, a greater degree of engagement, more broad focus on the attentional subscal e, and more spontaneous on the operative subscale; (2) emphasis on working alliance: therapists with rationalist epistemologies will have higher scores on the Task and Goal s ubscales and lower on the Bond subscale than the constructivist epistemologies; (3) use of specific therapy techniques: rationalist epistemologies are expected to report us ing techniques associated with cognitive behavioral therapy (e.g., advice giving) and th erapists with constructivist epistemologies will report using techniques associated w ith constructivist therapy (e.g., emotional processing) more. The expected direction of the findings is in accordance with the literature discussed that warrants poten tial distinctions according to therapist epistemology.

PAGE 31

23 CHAPTER 3 METHODS Participants Participants were primarily profession al psychologists recruited online through membership in different prof essional organizations. Participants were mostly recruited from the American Psychological Associat ion (APA) Practice Organization online practitioner directory (a pproximately 15,057 members). Participant solicitation emails were al so sent to APA Division 17 (Counseling Psychology, 355 members), APA Division 29 (Psychotherapy, approximately 224 members), APA Division 32 (Humanistic Ps ychology, approximately 130 members), The North American Personal Construct Netw ork (NAPCN) list serve (approximately 95 members), the Albert Ellis Institute email lis t (approximately 57 members), in addition to a number of APA-approved couns eling centers. The solicitati on email also encouraged participants to forward the email survey on to other eligible practit ioners; therefore the response rate of approximately 13.5% has to be considered with reservations. Therapist participation was voluntary and a ll participants were required to provide informed consent form prior to participat ing in this study. All inventories were completed online and submitted to an online database. It took therapists approximately 30 minutes to complete the instruments, a nd the study was conducted in accordance with APA ethical guidelines. See procedures below. The sample consisted of 1151 therapists (733 female, 418 male) with a mean age of 45.09 (SD = 12.54). The sample was primarily Caucasian, 88.8% (N = 1030), followed

PAGE 32

24 by Multiracial, 2.9% (N = 34), Hispanic, 2.7% (N = 31), African American, 2.4% (N = 28), Asian American, 2.1% (N = 24 ), and Other, 1.1% (N = 13). Participants were asked to indicate th e level of their highest degree, which consisted of primarily PhDs, 60.1% (N = 700), followed by MA/MS, 18.6% (N = 216), PsyD, 11.0% (N = 128), BA/BS, 4.3% (N = 50), EdD, 1.7% (N = 20), MSW, 1.4% (N = 16), and Other, 2.9% (N = 34). Additionally, th e average year partic ipants obtained their highest degree was 1992.55 (SD = 11.1), along with the average total number of years spent in clinical practice be ing 14.01 (SD = 11.03). The majority of participants were no longer in school, 93.5% (N = 1105) and only 6.5% (N = 77) we re graduate students. Participants were additionally asked about their specialty areas with the majority indicating that they were psychologists, 80.8% (N = 939) followed by mental health counselors, 6.0% (N = 70), marriage and fa mily therapists, 2.2% (N = 26), social workers, 1.0% (N = 12), graduate students, 5.2% (N = 60), and Othe r, 4.8% (N = 55). When asked about their primary employm ent setting, the largest percentage of participants indicate d they were in private practice, 40.4% (N = 466), followed by a university academic department, 11.4% (N = 132), hospital, 10.8% (N = 125), university service delivery department, 10.6% (N = 122), mental health care, 7.7% (N = 89), community center, 4.0% (N = 46), school, 3.4% (N = 39), and other, 11.7% (N = 134). In addition, participants were asked their dominant theoretical orientation and most participants indicated that their dominant th eoretical orientation was cognitive behavioral, 35.9% (N = 414), followed by integrative, 18.1% (N = 209), psychodynamic, 15.2% (N = 175), interpersonal, 7.6% (N = 88), humanistic, 7.2% (N = 83), constructivist, 3.2% (N =

PAGE 33

25 37), existential, 2.2% (N = 25) rational emotive, 1.7% (N = 20), gestalt, 0.7% (N = 8), and other, 8.2% (N = 95). Procedures Members from these divisions or organi zations were sent an online survey containing an informed consent, a brief dem ographics sheet, and the five aforementioned measures (TAQ-SF, CAS, PST-Q, WAI-S, & TL). Participants were asked to read and sign the informed consent form. Once participants completed the surveys and submitted their responses, they were directed to read a short debriefing that described the nature of the study. Participants answered one of four different versio ns of the main questionnaire where the questions were ordered differently to test for the possibili ty of order effects. Participants were debriefed at the end of the study and were provided with the contact information for further inquiries. Measures Therapist Attitudes Ques tionnaire-Short Form The TAQ-SF, developed by G. Neimeyer a nd Morton (1997), is a revision of the Therapist Attitudes Questionnaire (TAQ) devel oped by DisGiuseppe and Linscott (1993). The TAQ-SF measures philosophical, theoretica l, and technical dimensions of rationalist and constructivist therapies. The instrument is self-administered, contains 16 items, eight items pertaining to a Rationa list commitment (e.g., Reality is singular, stable and external to human experience) and eight items pertaining to a Constructivist commitment, (e.g., Reality is relative. R ealities reflect indi vidual or collective constructions of order to ones experiences ), and requires approxi mately 5 minutes to complete. Respondents are asked to rate the degree to which they agreed or disagreed with each item on a 5-point Likert scale rang ing from 1 (strongly disagree) to 5 (strongly

PAGE 34

26 agree). The TAQ-SF replicates the basic fact or structure of the original TAQ and has shown its predictive validity by predicting the therapeutic iden tifications and descriptions of a group of practicing professionals (G. Ne imeyer & Morton, 1997). TAQ-SF scores in the present study yielded a Chronbachs alpha of .72 for ratio nalist scale and a Chronbachs alpha of .63 for the constructivist scale. Constructivist Assumptions Scale (CAS) The Constructivist Assumptions Scale (C AS) was developed by Berzonsky (1994), and was designed to assess constructivist epis temological assumptions (e.g., Truth is relative. What is true at one point in time may not be true at another). This is a 12-item self-report measure with each item being ra ted on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The CAS has internal reliability estimated to be .61, and a 2-month test-ret est reliability (N = 78) of .68. CAS scores in the present study yielded a Chronbachs alpha of .72. Personal Style of the Therapist Questionnaire (PST-Q) The Personal Style of the Therapist Questionnaire (PST-Q) was developed by Fernandez-Alvarez et al. (2003), and was created to assess the set of characteristics that each therapist applies in every psychother apeutic situation, thus shaping the main attributes of the therapeutic act (p.117). The questionn aire assesses five different dimensions: flexibility-rigidity (Instructiona l subscale), distance-closeness (expressive subscale), lesser engagement-greater engageme nt (engagement subscale), broad focusednarrow focused (attentional subscale) and s pontaneous-planned (operative subscale), see Table 3-1.

PAGE 35

27 This measure is a 36-item self-report measure intended to be filled out by therapists with answers rated on a scale ra nging from 1 to 7, where re presents total disagreement and represents total agr eement with each statement. The measure has shown a testretest reliability of .79, with Chronbachs re liability coefficients for each subscale, as follows; Instructional, .69; expressive, .75; engagement, .78; attenti onal, .80; operative, .78. Factor Analysis revealed a KMO = .756. Working Alliance Inventory-Short Form (WAI-S) The Working Alliance Inventory (WAI), developed by Horvath & Greenberg (1986), is a 36-item questionnaire that can be administered to both clients and therapists and is rated on a 7-point Likert type scale with (1 = never, 7 = always). Ratings on this measure yield Task, Goal, and Bond subscale scores (12 items for each subscale), along with a total score that consists of the av erage across all items. Horvath & Greenberg (1986) demonstrated adequate reliability for th e WAI, with internal consistency estimates of alpha = .93 for overall client score (with subscale alphas of .85 to .88) and .87 for the overall therapist score (with subscale alpha s of .68 to .87). Content validity has been supported through both rational (e xpert raters agreed that the items reflect the three constructs) and empirical (multi-trait multi-method analyses) methods. Tracey and Kokotovic (1989) proposed a client and ther apist Working Alliance Inventory-Short Form (WAI-S), which contains 4 items per subscale (Task, Goal, and Bond), as well as average overall WAI-S scores, demonstrating high reliability with alpha levels similar to, and even better than the WAI for the client subscales and overall average scores (Task, alpha = .90; Bond, alpha = .92; Goal, alpha = .90; and General Alliance, alpha = .98) and therapist subscales and overall average sc ores (Task, alpha = .83; Bond, alpha = ..91; Goal, alpha = .88; and Gene ral Alliance, alpha = .95).

PAGE 36

28 The WAI highlights the collaborative effort s of the client and therapist, and has three parallel forms: Client, Therapist, and Rater (or observer). In the current study, we are interested in a therapist sample and will focus exclusively on the therapists selfreport on this measure. The strengths of the WAI are its usefulness in different therapeutic methods, lack of outcome-related items, and exte nsive use in th e literature (Vandyke, 2003). The WAI-S is used in this study. Techniques List (TL) The Techniques List measure was adapted from Hollis (1995), who catalogued an extensive list of counseling and psychothera py techniques representi ng a broad spectrum of philosophical bases. In order to refine th is extensive list according to techniques used specifically by cognitive behavi oral and constructivist therap y orientations, we recruited counseling psychology graduate students to read through the tota l list of 108 therapy techniques and rate the extent to which each technique is used by each therapeutic approach (cognitive behavioral and constructivis t), using a 5-point Likert type scale (1 = Never or Almost Never; 5 = Al ways or Almost Always). Sixteen counseling psychology graduate stude nts participated in these ratings (6 males, 10 females), with the average ag e = 28.44 (SD = 2.67). Results of a paired differences analysis for all 108 items indica ted that there were 77 techniques rated as being used with significantly differentia l frequency by cognitive behavioral and constructivist therapies. We then divided this distribution of 77 tec hniques into quartiles and retained the top and bottom quartiles. Th is resulted in 20 cognitive behavioral techniques (e.g., advice giving, rational restru cturing) and 20 cons tructivist techniques (e.g., emotional processing, reflection) that were rated most si gnificantly different (cognitive behavioral versus constructivist). This final list of 40 items of therapy

PAGE 37

29 techniques (20 cognitive behavi oral techniques; 20 constructi vist techniques) was used in the current study. These 40 items were listed alphabetically a nd participants were asked to rate the extent to which they use each technique in their practice of therapy along a 5-point scale (1 = Never or Almost Never; 5 = Always or Almost Always). The ratings of the 20 rationalist items were summed and a mean was calculated to reflect the average frequency of using rationalist in terventions (possible range = 1 5), and the same procedure was applied in rela tion to the 20 constructivist in terventions (possible range = 1 5). The raw data was used to conduct a confir matory factor analysis on the Techniques List measure. The current analysis was examined for multivariate normalcy and the assumptions were met. All kurtosis estimat es for the variables fell between 1 and variables except constructivist items 12, 13, 16, and 20 and cognitive behavioral item 3, which had a kurtosis values between 2 and -2. Consequently, these five items were removed from the measure prior to runni ng the confirmatory factor analysis. A Confirmatory factor analysis was utilized to fit a model of 2 types of therapy technique factors: constructivist therapy techniques and cognitive behavioral therapy techniques. Thirty-five i ndicators were included in the model (16 constructivist techniques and 19 cognitive behavioral techni ques). After running the analysis with the 35 items, and two factors (constructivist techniques and cognitive behavioral techniques), factor loadings revealed 8 items (6 construc tivist items and 2 cogniti ve behavioral items) loading at less than .40. These 8 items we re removed and the confirmatory factor analysis was then re-run with the remaining 27 items (10 constructi vist and 17 cognitive

PAGE 38

30 behavioral items). No further model modi fications were made because there was no other compelling theoretical rationale for a dditional changes and these 27 items were used in all subsequent analyses using this m easure. Items were constrained to load only on to their respective factors (constructivist techniques and cognitive behavioral techniques), and the two factor s were allowed to correlate. The measurement model was examined ut ilizing LISREL (8.7) and was evaluated based on multiple goodness of fit indices (standardized root mean square residual (SRMR), normed fit index (NFI), comparativ e fit index (CFI) and the root-mean-square error of approximation (RMSEA)), with the maximum likelihood as the estimation method. Examination of the results revealed th at the fit of the mode l was a fairly good fit although not necessarily supe rior fit for the data, 2 (323, N = 914), = 2249.37, p < .001, SRMR = .066, RMSEA = .08, NFI = .91, and CFI = .93. Values greater than .90 are generally accepted as support fo r a well-fitting model for goodness of fit indices CFI, and NFI (Grimm & Yarnold, 1998), with a good-fitt ing model suggested when the SRMR is .08 or less (Hu & Bentler, 1999). Values of th e RMSEA of .05 or less indicate a close fit and values from .05 to .08 indicate a fair fit. The final standardized solution factor loadings were all significant ( p < .05) and ranged from .40 to .81 for the constructivist techniques and from .47 to .71 for the cogniti ve behavioral techni ques. The correlation between the two factors was -.30. p < 03.

PAGE 39

31 Table 3-1 Personal style of th e therapist questionnaire (PST -Q): subscale directions Subscales Low High 1. Instructional Flexibility Rigidity 2. Expressive Distance Closeness 3. Engagement Lesser degree Greater Degree 4. Attentional Broad focus Narrow focus 5. Operative Spontaneous Planned

PAGE 40

32 CHAPTER 4 RESULTS Results from the current study are described below. First, I will discuss measurement issues, followed by sample de scriptives, then general correlations, and finally the regression analyses that address each of the predictions concerning therapist style, therapeutic relationship and therapeutic interventions in relation to epistemic style. Descriptive and Preliminary Analyses Multivariate analyses of va riance were conducted on the 5 measures used in the current study (CAS, TAQ-SF, PST-Q, WAI-S, and TL) suggested that there were no differences in the mean scores of the vari ables of interest amo ng the four types of questionnaire forms (all ps > .003). Thus for a ll analyses, the data from four different forms were combined. Measurement Reliability Measurement reliabilities for the CAS, TAQ-SF, PST-Q, WAI-S and techniques list scores appear in Table 4-1. Chronbachs coefficient alpha for the CAS of .72, was comparable to Berzonskys (1994) finding (ranging from .61 .65). Reliability findings for the TAQ-S were alpha of .72 for the rationa list subscale and .63 for the constructivist subscale. This is comparable to prev ious reports (G. Neim eyer & Morton, 1997). Reliability for the PST-Q indicated an alpha level of .65 for the Instructional subscale, .65 for the expressive subscale, .68 for the engagement subscale, .38 for the attentional subscale, and .75 for the operative su bscale. This is comparable to FernandezAlvarez et al. (2003) (Instruc tional, .69; expressive, .75; engagement, .78; attentional,

PAGE 41

33 .80; operative, .78) with the excep tion of the attentional subs cale, which was lower in the current study. Due to the weak nature of the alpha level on the attentional subscale, attempts were made to improve the internal reliability by removi ng poorly inter-related items. However, the removal of any single weak performing item failed to increase the alpha level above a .47. Thus, a decision was ma de to use the modified 5 item attentional subscale with an alpha level of .47 in all analyses in the study. Reliability findings for the WAI-S revealed a Chronbachs coefficient alpha of .75 for the overall score, .80 on the Task subscal e, .71 on the Bond subscale and .61 on the Goals subscale (all at the p < .001 level). This is also comparable to Tracey and Kokotovic (1989) findings (therapist subscal es and overall average scores: General Alliance, alpha = .95; Task, alpha = .83; Bond, alpha = .91; and Goal, alpha = .88). Finally, reliability for the Techniques List revealed a Chronbachs coefficient alpha of .91 for the Cognitive Behavioral Technique s subscale and .84 for the Constructivist Techniques. This was the first reliab ility estimate on this new measure. Correlational Analyses Person Product Moment correlations, using a criterion level of .05 (1-tailed), were computed between the two epistemology subs cales (Rationalist and Constructivist) and each of the criterion variables in an attempt to confirm that the relationships were in the predicted directions. A Pearson Product Mo ment correlation was fi rst conducted between the CAS and the TAQ-SF to verify that therapis ts with higher scores on the constructivist epistemology subscale scored higher on the CAS compared to therapists with higher scores on the rationalist epistemology subscale. Results were in the predicted directions, revealing a significant positive correlation between the TAQ-SF constructivist subscale and the CAS, r = 0.30, P 0.001 and a significant negativ e correlation between the TAQ-

PAGE 42

34 SF rationalist subscale an d the CAS, r = -0.36, P .001. Additionally, a Pearson Product Moment correlation was conducted on th e TAQ-SF rationalist and constructivist subscales to justify their use as two se parate continuous subscale scores, r = -.09, P .001. For therapist style, the rationalist subscale was significantly negatively correlated with the expressive (r = -0.21, P .001) and engagement (r = -0.26, P .001) subscales, which were in the predicted directions. Th e rationalist subscale was also significantly positively correlated with the Instructional (r = 0.07, P .028), attentional (r = 0.41, P .001), and the operativ e subscale (r = 0.48, P .001), which were also in the predicted directions. The constructivist subscale was significantly negatively correlated with the Instructional (r = 0.10, P .001), attentional (r = -0.15, P .001), and operative subscales (r = -0.22, P .001), all in the predicted di rections. The constructivist subscale was additionally signifi cantly positively correlated to the expressive (r = 0.34, P .001) and engagement subscales(r = 0.14, P .001) in the predicted directions. See Table 4-2. For the WAI-S, rationalist epistemologies were not significantly correlated with any of the WAI-S subscales (e.g., Task, Bond, and Goal), however, the constructivist epistemology was significantly positivel y correlated with the Task (r = 0.12, P .001), Bond (r = 0.19, P .001), and Goal (r = 0.08, P .012) subscales of the WAI-S, with subscales in the predicted direction. Finally, when looking at types of tech niques therapists use in therapy, the rationalist epistemology was significantly negatively correlated with the use of constructivist techniques (r = -0.32, P .001) and significantly positively correlated with

PAGE 43

35 the use of cognitive behavioral techniques (r = 0.43, P .001), which was in the predicted directions. On the other hand, cons tructivist epistemologies were significantly positively correlated with the use of constructivist techniques (r = 0.22, P .001), which was in the predicted direction; however, cons tructivist epistemology was not significantly correlated with cognitive behavioral techniques. See Table 4-2. Regression Analyses In order to assess the capacity of the data to be in line with the normality assumptions of multiple regression, the data was subjected to tests of skewness and kurtosis. Results of these analyses indicate that the assumptions for multivariate normalcy were met. All skewness and kurtosis estimates for the variables fell between 1 and except for the cons tructivist subscale which ha d a kurtosis value of 1.569. In addition, alpha levels were protect ed by conducting Bonferroni corrections (dividing the conventional al pha of .05 by the number of criterion variables), which results in a more conservative test of they hypotheses. Please see Table 4-3 for overall means and standard deviations for each of the measures. Hypothesis 1 The first hypothesis concerned therapist epistemology as a predictor of therapy style. More specifically, that therapists with rational epistemologies would have a therapy style depicting more rigidity on the Instructional subscale, more distance on the expressive subscale, a lesser degree of engagement, more narrow focus on the attentional subscale, and more planned on the operative subscale compared to therapists with a constructivist epistemology. Thus, for the fi rst hypothesis, a multiple linear regression analysis was conducted to determine if ther apist epistemology was a significant predictor

PAGE 44

36 of the criterion variables (the rapist therapy style) using the five subscales of the PST-Q (Instructional subscale, expre ssive subscale, engagement s ubscale, attentional subscale, and operative subscale). Separate regression an alyses were conducted for each of the five PST-Q scores measuring therapy style. As was previously described, epistemology will be operationalized as two separate c ontinuous subscale scores (rationalist and constructivist) in all regression analyses. Instructional style The epistemology scores accounted for si gnificant variation in Instructional (therapy style) scores, F (2, 1061) = 7.06, p < .001 ( R = .013). The standardized beta coefficient for the rationalist epistemology ( = .053) was in the positive direction, but was not significant, t (1061) = 1.73, p < .084. The standardized beta coefficient for the constructivist epistemology ( = -0.097) was significant and in the negative direction for the Instructional subscale, t (1061) = -3.15, p < .002. The direction of effect indicated that the more a therapist endorsed constr uctivist epistemology, the less likely that therapist was to use an inst ructional approach to thera py. This supported the hypothesis that a constructivist epistemology tends to ward the direction of flexibility on the Instructional subscale, however, the small eff ect size of approximately 1% of the variance needs to be considered. Expressive style Epistemology was also a significant pred ictor of the ther apy style along the expressive subscale (e.g., amount of distance vers us closeness), F (2, 1080) = 94.27, p < .001 ( R = .15). The standardized beta coefficient ( = -0.177) was significant for the rationalist epistemology t (1080) = -6.28, p < .0001 and in the negative direction, whereas the significant standardized beta coeffici ent for the constructivist epistemology ( =

PAGE 45

37 0.326), was significant t (1080) = 11.56, p < .0001 and in the positive direction along the expressive subscale. This s upported the hypothesis that the ra tionalist epistemology tends towards distance on the expressive subscale, whereas, the constructivist epistemology tends towards greater closeness on the expressive subscale. Engagement style Epistemology was also significant pred ictor of the therapy style along the engagement subscale, F (2, 1096) = 47.26, p < .001 ( R = .08). The significant standardized beta coefficient ( = -0.245) for the rationalist epistemology, t (1096) = 8.42, p < .001, was in the opposite direction compar ed to the significant standardized beta coefficient ( = 0.119) for the constr uctivist epistemology, t (1096) = 4.08, p < .001, along the engagement subscale. This s upported the hypothesis th at the rationalist epistemology tends towards a lesser degree of engagement on the engagement subscale and the constructivist epistemology tends towa rds a greater degree of engagement on the engagement subscale. Attentional style Epistemology was also significant pred ictor of the therapy style along the attentional subscal e (e.g., broad versus narrow focus), F (2, 1096) = 118.33, p < .001 ( R = .18). The significant standa rdized beta coefficient ( = 0.396) for the rationalist epistemology t (1096) = 14.41, p < .001, was in the positive direction; whereas the significant standardized beta coefficient ( = -0.129) for the cons tructivist epistemology t (1096) = -4.12, p < .001, which was in the negative direction along the attentional subscale. This supported the hypothesis that the rationalist epistemology has more of a leaning towards a narrow focus on the atte ntional subscale, and the constructivist epistemology leans more towards a broad focus on the attentional subscale.

PAGE 46

38 Operative style Lastly, epistemology was a significant pr edictor of the ther apy style along the operative subscale (e.g., spont aneous versus planned), F (2, 1093) = 187.86, p < .001 ( R = .256). The standardized beta coefficient ( = 0.461) for the rationalist epistemology was significant, t (1093) = 17.61, p < .0001 and in the positive direction, compared to the significant standardized beta coefficient ( = -0.170), for the cons tructivist epistemology, t (1093) = -6.50, p < .0001, which was in the negative direction along the operative subscale. This supported the hypothesis that the rationalist epistemology tends towards more planning on the operative subscale a nd the constructivist epistemology tends towards more spontaneity on the operative subscale. Hypothesis 2 According to the second hypothesis (therapi sts with rationalist epistemologies will score higher on the Task and Goal subscales and lower on the Bond subscale than the constructivist epistemologies), another multip le linear regression model was conducted to determine if the same predictor variable (the rapist epistemology) will influence therapists ratings of the criterion variables (working a lliance) according to therapists scores on the three subscales (Task, Goal, & Bond). Task Epistemology was a significant predictor of therapist emphasis on the working alliance along the Task subscale (e.g., client and therapist agreement on goals), F (2, 1080) = 8.34, p < .001 ( R = .015). The standardized beta coefficient for the rationalist epistemology ( = 0.042) was in the positive direction, but was not significant t (1080) = 1.39, p < .164. The significant standardized beta coefficient ( = 0.120) for the constructivist epistemology, t (1080) = 3.96, p < .0001, was also in the positive direction

PAGE 47

39 along the Task subscale. This was inconsiste nt with the hypothesis that the rationalist epistemology would place a greater empha sis on the Task subscale in the working alliance than therapists with a constructivist epistemology. However, the small effect size of approximately 2% of the variance need s to be considered when interpreting these findings. Goal Epistemology was also a significant predic tor of therapist emphasis on the working alliance along the Goal subscale (e.g., client and therapist agreement on how to achieve the goals), F (2, 1093) = 4.92, p < .007 ( R = .009). The significant standardized beta coefficient ( = 0.065) for the rationalist epistemology t (1093) = 2.16, p < .031, was in the positive direction. The significant standardized beta coefficient ( = 0.075) for the constructivist epistemology t (1093) = 2.47, p < .014, was also in the positive direction along the Goal subscale. This was again inco nsistent with the pr oposed hypothesis that the rationalist epistemology would have strong er leanings towards the Goal subscale in the therapist emphasis on working alliance comp ared to therapists with a constructivist epistemology. Bond Lastly, epistemology was also a significan t predictor of the therapist emphasis on the working alliance along the Bond subscal e (the development of a personal bond between the client and therapist), F (2, 1089) = 19.49, p < .001 ( R = .035). The standardized beta coefficient for the rationalist epistemology ( = -0.034) was in the negative direction, but was not significant, t (1089) = -1.15, p < .249. For the constructivist epistemo logy, the standardized beta coefficient ( = 0.179) was significant t (1089) = 5.99, p < .0001, and in the positive direction along the Bond subscale. This

PAGE 48

40 supported the hypothesis that the rationalist epistemology is less inclined towards therapist emphasis on worki ng alliance on the Bond subscale than the constructivist epistemology. Hypothesis 3 The third and final analysis is designed to address the predic tion that epistemology will be a predictor of therapist use of specific therapy techniques. More specifically, that the rationalist epistemology will report us ing techniques associ ated with cognitive behavioral therapy (e.g., advice giving) more than constructivist epistemologies, and therapists with constructivist epistemologies will report using techniqu es associated with constructivist therapy (e.g., em otional processing) more than therapists with rationalist epistemologies). A multiple linear regression analysis was conducted to determine if the predictor variable (therapist ep istemology) will influence ther apist ratings of the criterion variables (therapy techniques). Cognitive behavioral techniques Epistemology was a significant predic tor of cognitive behavioral therapy techniques (e.g., advice giving), F (2, 993) = 112.34, p < .001 ( R = .185). The standardized beta coefficient for the rationalist epistemology ( = 0.430) was significant, t (993) = 14.96, p < .001 and in the positive direction. The standardized beta coefficient for the constructivist epistemology ( = 0.057) was significant and in the positive direction t (993) = 1.98, p < .05. This supported the hypothe sis that the rationalist epistemology would have stronger leanings of therapist use of cognitive behavioral techniques when conducting therapy th an constructivist epistemologies.

PAGE 49

41 Constructivist techniques Finally, epistemology was a significant predic tor of construc tivist therapy techniques (e.g., emotional processing), F (2, 1012) = 80.82, p < .001 ( R = .138). The standardized beta coefficient for the rationalist epistemology ( = -0.297) was significant t (1012) = 10.09, p < .0001 and in the negative direction. The standardized beta coefficient for the cons tructivist epistemology ( = 0.195) was significant t (1012) = 6.63, p < .0001, and in the positive direction. This supported the hypothesis that the constructivist epistemology would place a stronger emphasis on therapist use of constructivist techniques when conducting therapy than ra tionalist epistemologies.

PAGE 50

42 Table 4-1. Internal consistencies for the CAS, TAQ-SF, WAI-S, PST -Q, and techniques list. Scale N Alpha P-Value CAS 1113 0.70 .001 TAQ-Rational 1130 0.72 .001 TAQ-Constructivist 1138 0.63 .001 WAI-S-Total 1107 0.75 .001 WAI-S-Task 1146 0.80 .001 WAI-S-Bond 1145 0.71 .001 WAI-Goals 1149 0.61 .001 PST-Q-Instructional 1114 0.65 .001 PST-Q-Expressive 1135 0.65 .001 PST-Q-Engagement 1148 0.68 .001 PST-Q-Attentional 1148 0.47 .001 PST-Q-Operative 1146 0.75 .001 CBT Techniques 1033 0.91 .001 CON Techniques 1054 0.84 .001

PAGE 51

43 Table 4-2 Pearson correlations for therapy st yle, working alliance, techniques & years of experience Instructional Subscale Expressive Subscale Engagement Subscale Attentional Subscale Operative Subscale Rationalist Epistemology Correlation Sig. (2-tailed) N .07 .03 1074 -.21 .00 1093 -.26 .00 1109 .41 .00 1109 .48 .00 1105 Constructivist Epistemology Correlation Sig. (2-tailed) N -.10 .001 1085 .34 .001 1104 .14 .001 1120 -.15 .001 1118 -.22 .001 1117 Task Subscale Bond Subscale Goals Subscale CognitiveBehavioral Constructivist Techniques Rationalist Epistemology Correlation Sig. (2-tailed) N .03 .36 1104 -.06 .05 1105 .05 .07 1109 .43 .001 1004 -.32 .001 1024 Constructivist Epistemology Correlation Sig. (2-tailed) N .12 .001 1112 .19 .001 1111 .08 .01 1115 .03 .40 1011 .22 .001 965 Years of Experience Rationalist Epistemology Correlation Sig. (2-tailed) N -.10 .00 1096 Constructivist Epistemology Correlation Sig. (2-tailed) N -.07 .00 1105

PAGE 52

44 Table 4-3 Means and standard deviations for epistemology, therapy style, working alliance, and intervention selection. Rationalist Epistemology Constructivist Epistemology Instructional Subscale Expressive Subscale Engagement Subscale Attentional Subscale Operative Subscale Mean SD N 22.11 5.12 1130 32.74 3.42 1138 30.76 6.17 1114 41.25 6.18 1135 29.16 5.11 1148 18.13 3.66 1148 21.55 5.83 1146 Task Subscale Bond Subscale Goals Subscale CognitiveBehavioral Techniques Constructivist Techniques Mean SD N 21.04 2.65 1146 23.09 2.20 1145 17.35 1.80 1149 61.39 11.85 1024 53.89 10.36 983

PAGE 53

45 CHAPTER 5 DISCUSSION The discussion section is structured accordi ng to three parts. First, a discussion of the hypotheses and findings of the study ar e reviewed. Second, a more specific explanation of the findings is given with re sults interpreted within the context of the current literature on therapists epistemology in relation to their therapy style, working alliance, and selection of particular therap eutic techniques. Finally, limitations and the implications of the current study were re ported, along with suggestions for future research. Summary of the Results This study investigated the relationshi p between therapists epistemological assumptions (rationalist versus constructivist) and their therapy styl e, working alliance, and use of particular therapeutic interventions The specific questions in this study were whether therapist epis temology was a predictor of (1) th erapy style, particularly, the extent of rigidity versus flex ibility, distance versus closenes s, lesser versus greater degree of engagement, narrow versus broad focus, and spontaneous versus planned styles of working with clients, (2) working alliance, in particular, agreement on tasks and goals and the development of a personal bond betw een the client and therapist, and (3) selection of particular ther apeutic interventions, i.e., c ognitive behavioral versus constructivist interventions. Each of these three questions will now be discussed in further detail in relation to the current findi ngs, however; overall, mo st of the results of the current study supported the hypothese s in the predicted directions.

PAGE 54

46 Epistemology (rationalist versus construc tivist) was found to be a significant predictor of therapy style. In particular the most robust findings provide provisional support for the notion that there are specific differences in the personal style of the therapist according to the therapists episte mic assumptions. More specifically, the current study found that therap ists with rationalist epistemologies tended towards more distance, a lesser degree of engagement, more narrow focus, and more planning in their sessions with clients, whereas, the construc tivist epistemology tended towards having a greater degree of closeness, a greater degree of engagement, more broad focus, and more spontaneity in thei r therapy sessions. Additionally, there was some support fo r the notion that therapists with constructivist epistemologies tend toward the dir ection of flexibility rather than rigidity in their therapy style; however this was not a pa rticularly strong finding in the current study. These findings are helpful when consideri ng the potentially inherent differences maintained by rationalist versus constructivist epistemologies according to therapy style. More specifically, current fi ndings support the notion that cognitive-behavioral therapies, which represent the best depiction of the rationalist epistemol ogy, maintain an activedirective and systematic approach to ther apy (Granvold, 1988) with specific goals used to plan the course of th e session (Mahoney & Lyddon, 1988). Additionally, the current study supported the depiction of cognitive-be havioral therapy style as distancing or attempting to control emotional communica tion between client and therapist through logical analysis (G. Neimeyer et al., 2005) On the other hand, R. Neimeyer (2005) describes the process of c onstructivist psychotherapy, whic h represents the clearest depiction of the construc tivist epistemology, as,

PAGE 55

47 The process is something like two hikers laboring together through a deep wood along a footpath that winds gradually up the side of a steep knoll. And suddenly, at a moment that cannot be fully predicted by either hiker, they break upon a clearing that affords a panoramic view of the path they have taken and its relationship to the surrounding terrain. (p. 80) This metaphorical representation of a cons tructivist psychotherapists approach to therapy or therapy style highlights the im portance of flexibility and spontaneity. Additionally, R. Neimeyer (2005) uses this metaphor to suggest the constructivist therapists emphasis on the therapists engageme nt or involvement with the client on the therapy endeavor, with the depic tion of the therapist and client laboring together. This image thus extends to the differences found according to epistemology and the therapists emphasis on the working alliance. An additional finding in the current study indicated that therapist epistemology (rational versus constructivist) was a significant predictor of at least some aspects of the working alliance. The strongest finding was in relation to the devel opment of a personal bond between the client and ther apist (Bond subscale). Therap ists with a constructivist epistemology tended to place more emphasi s on the personal bond in the therapeutic relationship compared to therapists with a rationalist epistemology. This supports the notion in the literature that constructivist th erapists place a greater emphasis on building a quality therapeutic relationship characteri zed by, acceptance, understanding, trust, and caring. Lastly, findings in the current study rega rding therapists ep istemology (rationalist versus constructivist) and their use of specifi c interventions (cognitive behavioral versus constructivist) revealed that therapists with rationalist epistemologies tended to favor the use of cognitive behavioral techniques and also tended to reject the use of constructivist

PAGE 56

48 techniques. Similarly, therapists with constructivist epistemo logies tended to favor the use of constructivist t echniques in their practice of ther apy; however they did not as strongly reject the use of c ognitive behavioral techniques. This notion is supported by literature that suggests that constructivist ther apists value havi ng a rich set of possibilities that can be enga ged at any moment depending on the clients need (R. Neimeyer, 2005, p. 83). Thus, findings from the current study may suggest that while the constructivist therapist is more likely to us e constructivist therapy techniques, they are also more open to using other techniques depe nding on the individual client compared to rationalist therapists. Discussion of Results within th e Context of Current Literatures Therapists Epistemology and Therapy Style The literature notes several studies sugges ting potential differences in therapists epistemology and their therapy style (Granvold, 1996; Lyddon, 1990; G. Neimeyer & Morton, 1997; R. Neimeyer, 1993b; Winter & Watson, 1999). Granvold (1996) suggests specific distinctions between rationalist and constructivist therapists epistemologies such that rationalist therapists te nd to target cognitions for m odification and subsequently educate the client on the impact of cogniti ons in functioning and change in a more directive manner, whereas constructivist therap ists are less directiv e, more exploratory, less problem-focused, and more experiential. A key goal in the current study was to examine the relationship between therapis t epistemology and their therapy style according to the asserted hypotheses and in dir ections dictated by associated literatures. Overall, the hypotheses were supported in the predicted directions. One of the more robust findings came from the component s of therapy style that Fernandez-Alvarez et al. (2003) term expressive which is described as th e actions carried out by the

PAGE 57

49 therapist to ensure emotiona l communication with the patient (p. 118). Therapists with constructivist epistemologies scored higher on this scale in the positive direction; whereas, therapists with rationalist epistemol ogies scored lower on th is scale and in the negative direction. This finding highlights what the current literature suggests regarding differences between constructivist and rationa list epistemology in relation to close emotional communication with the clie nt (e.g., Granvold, 1996; Mahoney & Lyddon, 1988). More specifically, Granvol d (1996) suggests that rati onalist therapists seek to control, alter, or terminate emotions. . emo tions are regarded as negative. . Emotional expressions are considered the problem and faulty cognitions the cause (p.348). Constructivist therapists, on the other hand, c onsider emotions to be integral to the personal-meaning process in whichthe indivi dual continuously evol ves (p. 348). In addition, Guidano (1987) suggests that for the constructivist th erapist, emotional expressions are promoted for the function of second order change. Thus, in the current study this core component of both the rationa list and constructivis t epistemology showed through in their therapy style. The engagement subscale, which FernandezAlvarez et al. (2003) term the set of explicit and implicit behavior connected to the therapists commitment to. . his patients (p.119), revealed a nother important finding that supports key distinctions between rationalist and construc tivist therapists therapy st yle. In the present study, rationalist therapists scored lower and in the negative direction (e.g., lesser degree of engagement), compared to constructivist ther apists who scored higher and in the positive direction (e.g., greater degree of engagement). R. Neimeyer (2005) depicts his degree of engagement as a constructivist therapist as,

PAGE 58

50 Moments of intensive therapeutic engageme nt are simply a special instance of a larger set of relational experiences in which the more ty pical subject-object boundaries that constrain our sense of self and other can be transcended to permit something akin to a joint experience. (p. 82) He further notes that when a client is experiencing deep emotions that, as a therapist, if I dont at least have moisture in my eyes, then something is wrong (p. 81). This highlights constructivi st therapists core commitment to a high degree of engagement with a client. In contrast, rationali st therapists consider their role in therapy to be that of an educator, instructor and to exclude or control emoti on via logical analysis (Mahoney & Lyddon, 1988; G. Neimeyer et. al., 2005). A study by Winter and Watson (1999) suggested that rationalist therapists showed a more ne gative attitude towards their clients and their clients had less overall i nvolvement in therapy compared to clients receiving constructivis t therapy. Thus, the current study supports and extends previous research by suggesting that c onstructivist ther apists tend to report a greater degree of engagement in their therapy style compared to rationalist therapists by endorsing more emotional closeness with clients, more i nvolvement in therapy, and more personal concern for clients. Another strong finding in the current study came from the component of therapy style that Fernandez-Alvarez et al. (2003) term attentiona l (e.g., more broad versus narrow focus) or either st ressing his receptive capacity for the information that the patient gives or taking a more ac tive role in order to elicit sp ecific information (p.119). The rationalist therapists in the current study endorsed a stronger leaning towards a more narrow focus in therapy; whereas the construc tivist therapists reported a stronger leaning towards a more broad focus in their therapy st yle. These findings are consistent with the current literature that has investigated di fferences between rati onal and constructivist

PAGE 59

51 therapies suggesting that rationalist therapists prefer a more problem focused approach to therapy, however constructivists take a more open and exploratory approach to therapy (Granvold, 1996; G. Neimeyer et. al., 2005). Lastly, the most robust finding for therapy style in the curre nt study is in regards to the operative subscale, which is described as the actions directly connected to the specific therapeutic interven tions (p. 119). Thus, how spontaneous or planned a therapist is in their procedur es of therapy. The current study highlighted the distinct differences in rationalist and constructivist epistemologies f ound in current literature with rationalist therapists scoring higher and in the positive direction (e.g., reporting a more planned procedure of therapy) compared to constructivist therapists who scored lower and in the negative direction (e.g., reporting a more spontaneous procedure of therapy). This notion is expressed in the work of Mahoney and Lyddon (1988) who suggest, Rationalists tend to guide the course of therapy according to presenting problems and specific goals (p.217), whereas, R. Neimey er (2005) indicates that constructivist therapists aim in, not overly structuring the agenda for the session by my own prec onceptions of what my client requires, particular ly to the extent that such an agenda is driven by some diagnostic or classificatory system. . (p.78) Again, a core facet of both rationalist a nd constructivist therapists epistemology was supported in the current study regardi ng how planned versus spontaneous they reported their therapy style to be. These core epistemic assumptions and how they translate into the practice of therapy, also extend into the domain of the working alliance, concentrated on in the next section.

PAGE 60

52 Therapists Epistemology and Working Alliance Another important goal of the present study was to investigate the relationship and potential difference between therapists epistemologies and their emphasis on the working alliance. Results from the current study did not reveal particularly strong connections between therapist epistemol ogy and working alliance. Perhaps one explanation for why there was not a strong re lationship between ther apist epistemology and the working alliance subscales of Task a nd Goal in the current study is because both of these subscales focus on client and th erapist general agreement on tasks (e.g., My counselor and I agree about the things that I need to do in therapy to help improve my situation) and goals (e.g., We have esta blished a good understanding of the kind of changes that would be good for me), rather than specific qualities of the tasks and goals. For example, both rationalist a nd constructivist ther apist may endorse that they agree with their client about how to help impr ove the clients situ ation but how they specifically go about determining that agreem ent in the working alliance may be very different. For example, the literature suggests that rationalist therapis ts tend to guide the client towards understanding or agreement on th e tasks and goals of therapy (Beck et al., 1979), whereas, the constructivis t therapist may tend towards offering more exploration of tasks and goals in therapy and less di rect guidance (Winter & Watson, 1999). Thus, the use and/or development of a measure of working alliance that includes more specific items in relation to tasks and goals that would better dist inguish between rationalist and constructivist therapists epistemologies w ould be an avenue of future research. Additionally, future work may adapt the set of directions for the participant such that participants are prompted to consider their current client load, and one client that they feel they have a good working relationship with or the most recent clients that they

PAGE 61

53 have seen at least three times, or some ot her instructions that are more specific to particular clients they are work ing with rather than general. Results for the working alliance subscale, Bond however, do provide a preliminary understanding of therapist inc linations by epistemology. For example, the most robust finding was in relation to the Bond subscale of the working al liance, and suggested that therapists with constructivist epistemologies more strongly endorsed the importance of the bond component in their practice of therapy compared to therapists with rationalist epistemologies. This finding is supported by conceptual literature that suggests that constructivist therapist values a working al liance characterized by mutual respect (R. Neimeyer, 2005), acceptance, understanding, trust, and caring (Granvold, 1996). Mahoney and Lyddon (1988) indicated that For the rationalist, a professional counse ling relationship is one that primarily involves the service or deliv ery of direct guidance and technical instruction. In effective rational psychotherapy it is th e imparting of knowledge and information that takes precedence over the therapeutic relationship. (p. 221) These authors also highlight that when th is type of knowledge can be given through audiovisual and mechanical means the in significance of the human relationship in therapy is evident (as c ited in Mahoney & Lyddon, 1988). Overall, the present study continues to support key distin ctions between rationalist and constructivist therapist in the working alliance, however further research could aim to find more specific measures geared towards the bond component of the wo rking alliance to further tease apart these distinctions. Therapists Epistemology and Sel ection of Specific Techniques Finally, the last goal in the current st udy was to better understand the relationship between therapists epistemologies (rationalis t versus constructivist) and their use of

PAGE 62

54 specific techniques (cognitive behavioral vers us constructivist) in their practice of therapy. In particular, the purpose was to examine whether th ese epistemological differences relate to the selection of specific interventions that fit more with the corrective and directive orient ation of rationalist therapists or exploratory and creative orientation of constructivist therapists. It was hypothesized that ra tionalist therapists would report using more cognitive behavi oral techniques than therapists with constructivist epistemologies and that constr uctivist therapists would report using more constructivist techniques compared to therap ists with rationalist epistemologies. Winter and Watson (1999) cite both em pirical and theoretical support for a theoretical allegiance to the us e of particular techniques, no ting key distinctions between rationalists use of techni ques (e.g., more challenging a nd directive interventions) compared to constructivist therapists use of techniques (e.g., ask more questions and use interpretation as a means of exploration of the clients meaning making system). While these hypotheses held true in the current study, an interesting additional finding was that constructivist therapists were more open to the use of cognitive behavioral techniques than rationalist epistemologies were of constr uctivist techniques. This notion is further supported by R. Neimeyer (2005) who suggest s that, In my view, nothing in this practice is incompatible with a constructivist therapy ( p. 93). Similarly, Kelly (1969) suggests, The relationships between therap ists and clients and the techniques they employ may be as varied as the whole human repertory of relationships and techniques (p. 223). For therapists with rationalist epistemologies, Granvold (1996) suggests that rationalist therapists tend to stick to a problem focus and tend to have a stricter adherence to methodology compared to cons tructivist therapists This supported th e findings in the

PAGE 63

55 current study that suggests that therapis ts with rationalist epistemologies not only favored the use of cognitive behavioral techniqu es in their practice, but they also tended to reject the use of constr uctivist techniques in their practice of therapy, whereas therapists with constructivist epistemologi es, while favoring constructivist techniques, were also more open to the use of cognitive behavioral techniques. Limitations and Future Research This study is not without limitations. For example, the characteristics of participants in the current study may have comp romised the external va lidity. This study was conducted on a voluntary basis and those who volunteered to pa rticipate may have been a biased sample. Rosenthal and Rosnow (1975) suggest that volun teers tend to differ from non-volunteers in behavioral resear ch regarding their level of education, intelligence and desire of social approval. Additionally, the data collection procedure may have compromised the external validity of the current study. For example, the data collection was conducted via the Internet which may further distinguish the characteristics of the participants who volunt eered to participate in the study from nonvolunteers. However, in light of these limita tions, having an overall sample size of over one thousand practicing psychologists in the fifty United States ma y have improved the representativeness of the samp le and subsequently, the gene ralizability of the findings. In addition, greater confidence in the repres entativeness of the sa mple in the current study is found by using the closest approxima tion to what would be a comparison with the bulk of our sample (e.g., psychologists) to members of the American Psychological Association along demographic dimensions (e.g., gender, ethnicity, and age). For example, in the current study, 64 % of the sample was female and 36% of the sample was male, which is roughly comparable to APA me mbers reported to be approximately 53%

PAGE 64

56 female and 47% male. In the current study, th e mean age of participants was 45.09 (SD = 12.54), which is again roughly comparable to APA members mean age reported as 53.30 (SD = 13.6). The ethnicities in the current study were Caucasian, 88.8%, Multiracial, 2.9%, Hispanic, 2.7%, African American, 2.4%, and Asian American, 2.1%. Again, this is roughly comparable the APA members reported ethnicities as Caucasian, 67.6%, Multiracial, 0.3%, Hispanic, 2.1%, African American, 1.7%, and Asian American, 1.9% ( http://research.apa .org/profile2005t1.pdf 2005). Another limitation regarding the generalizab ility of the findings in the current study is the self-report nature of the study. Rosenthal and Rosnow (1991) indicate that selfreports are subject to distorti on and social desirability eff ects. In addition, self-reports may not correlate well with pa rticipants actu al behavior. It is also important to high light the fact that the findings in the current study are associations between the variables of intere st and do not imply cau sal relationships. For example, therapists with constructivist epistemologies may tend to place more of an emphasis on the personal bond component of the working alliance, but this does not mean that we can indicate that therapists constructivist epistemologies cause them to place more of an emphasis on the personal bond component of the working alliance. It may be that the therapists emphasis on a personal bond predisposed them towards endorsing greater constructivist leanings, or that a third variable accounted for the relationship between personal bond and construc tivist commitments. Therefore, current results can only suggest potential re lationships and cannot imply causality. Further research could aim to investig ate clients perceptions of cognitivebehavioral and constructivist therapists therapy style, em phasis on the working alliance,

PAGE 65

57 and use of particular therapeutic interventions to see if clients corr oborate therapists selfreported styles with their experience of the therapists style. Finally, while the fit of the two factors (constructivist techniques and cognitive behavioral techniques) to the Techniques List was relatively good, future work on the Techniques List measure might also benefit fr om some revision of th e current instrument and additional psychometrics. Overall, these finding contri bute to the literature addressing the translation of epistemology into practice. The current st udy provides provisional support for the notion that therapists with rationalist epistemologies are consistently different in their approach to therapy, emphasis on the therapeutic relati onship, and use of par ticular interventions compared to therapists with a constructivis t epistemology, in ways consistent with the epistemological underpinnings of these approaches to therapy. The current findings are important because they (1) demonstrate the translation of epistemology into practices; (2) provide inform ation that could be useful to clients in selecting a therapist whose orientation may en able them to anticipate stylistic features; and (3) provide the opportunity to further study the translation of these perceptions into actual behaviors and behaviors into different impacts or outcomes. Conclusion In conclusion, the present study examined the relationshi p between epistemic style and therapists therapy style, working allian ce, and selection of pa rticular therapeutic interventions. Results of the study suggest ed that therapists epistemologies were associated with the levels flexibility versus rigidity, distance versus closeness, degree of engagement, broad versus narrow focus, and spontaneous versus planned components of their therapy style. Therapists with stronge r constructivist or rationalist epistemologies

PAGE 66

58 tended to score higher on these subscales accord ing to the nature of their epistemological commitments. Results of the study also revealed that ther apists with construc tivist epistemologies were associated with a great er degree of emphasis on the Bond subscale of the working alliance, whereas, both constr uctivist and rationalist episte mologies tended to place a greater degree of emphasis on the Goal subsca le of the working al liance. Additionally, therapists with constructivist epistemologies tended to use more particularly constructivist techniques in their therapy practice, whereas, therapists rationalist epistemologies tended to use more rationalis t techniques in their practice of therapy. The current study extended the developing li terature on therapists epistemology as a factor relating to psychother apists practice of therapy. Further, more outcome related research is required to understand ho w therapists epistemology impacts the successfulness of work with clients. Th e current study was the first empirical investigation of therap ists epistemology and the specific translation of epistemology into the practice of therapy in relation to therap ists style, working alliance, and use of specific techniques. While some of the result s failed to support the expected directions for the specified subscales, most results were in the expected di rections supporting the overall coherence of the epistemological co mmitment with therapeutic enactments. Further work may benefit from focusing on how therapists epistemologies might affect the effectiveness of practicing psychotherapy in accordance with therapists epistemic commitments.

PAGE 67

59 APPENDIX A THERAPIST ATTITUDE QUESTI ONNAIRE SHORT FORM (TAQ-SF) 1 2 3 4 5 Strongly Moderately Neither agree Moderately Strongly disagree disagree nor di sagree agree agree 1. Reality is singular, stable and external to human experience. 2. Knowledge is determined to be valid by logic and reason. 3. Learning involves the contiguous or cont ingent chaining of discrete events. 4. Mental representations of reality involve accurate, explicit and extensive copies of the external world, which are encoded in memory. 5. It is best for psychotherapists to focus tr eatment on clients current problems and the elimination or control f these problems. 6. Disturbed affect comes from irrational, i nvalid, distorted or/and unrealistic thinking. 7. Clients resistance to change reflects a lack of motivation, ambivalence or motivated avoidance and such resistance to change is an impediment to therapy, which the psychotherapist works to overcome. 8. Reality is relative. Realities reflect indi vidual or collective constructions of order to ones experiences. 9. Learning involves the refinement and transformation (assimilation and accommodation) of mental representation. 10. Cognition, behavior and affect are interdep endent expressions of holistic systemic processes. The three are functiona lly and structurally inseparable. 11. Intense emotions have a disorganizing eff ect on behavior. This disorganization may be functional in that it initiates a reor ganization so that more viable adaptive constructions can be formed to meet the environmental demands. 12. Psychotherapists should encourage em otional experience, expression, and exploration.

PAGE 68

60 13. Clinical problems are current or recurr ent discrepancies between our external environmental challenges and internal adaptive capacities. Problems can become powerful opportunities for learning. 14. Awareness or insight is one of many stra tegies for improvement, however, emotional and/or behavioral enactments are also very important. 15. Therapists relationship with clients is best c onceptualized as a professional helping relationship, which entails the service and delivery of techni cal, instructional information or guidance. 16. Psychotherapists relationshi p with clients can best be conceptualized as a unique social exchange, which provides the clients a safe supportive context to explore and develop relationships with themselves and the world. Reprinted with permission from Neimeyer G.J., & Morton, R. J. (1997). Personal epistemologies and preferences fo r rationalist versus constructivist psychotherapies. Journal of Constructivist Psychology, 10 109-123.

PAGE 69

61 APPENDIX B CONSTRUCTIVIST ASSU MPTIONS SCALE (CAS) Please indicate the degree to which you agr ee or disagree with the following statements using the following scale: 1 = Strongly Disagree 2 = Disagree 3 = Neutral 4 = Agree 5 = Strongly Agree 1. Facts speak for themselves. 2. Our understanding of the natural, physical world is influenced by our social values. 3. Scientific facts are universal truths; they do not change over time. 4. Nothing is really good or bad, it al ways depends upon how we think about it. 5. What we see with our own eyes is influenced by our expectations. 6. Truth is relative. What is true at one point in time ma y not be true at another. 7. Scientific investigations are objective; they are not in fluenced by social values. 8. We never see the world as it really is. Wh at we perceive depends on what we believe and want to see. 9. Our understanding of human behavior is influenced by our social values. 10. Nothing is really importan t by itself. A thing is impor tant if we think it is. 11. Seeing is believing. 12. The more people know, the more they ar e bound to feel that they cannot be completely sure about anything. Reprinted with permission from Berzonsky, Mi chael (1994). Individu al differences in self construction: the ro le of constructivist ep istemological assumptions. Journal of Constructivist Psychology 7 263-281.

PAGE 70

62 APPENDIX C PERSONAL STYLE OF TH E THERAPIST (PST-Q) Directions : Please rate the following question alo ng the scale the following 7-point scale: 1 2 3 4 5 6 7 Total Disagreement.Total Agreement represents total disagreement with the statement and means total agreement. 1. I tend to be open-minded and receptive in listening rather th an narrow-minded and restrictive. 2. I try to get patients to adjust to the regular format of my work. 3. As a therapist I prefer to indicate to pa tients what they should do in each session. 4. I keep a low profile of involvement with patients in order to be more objective. 5. I find changes in the setting quite exciting. 6. The emotions the patient arouses in me are key to the course of the treatment. 7. Im more inclined to accomp any the patient in exploring th an to point out the steps to follow. 8. I avoid communicating through gestures or deeply emotional expressions. 9. I tend to demand strict compliance with schedules. 10. I place little value on planned treatments. 11. Expressing emotions is a power ful tool leading to changes. 12. Many important changes that occur during treatment require the therapist to respond without expressing much emotion. 13. I dont think about patie nts outside sessions. 14. Changing offices has a negative impact on treatment. 15. Real changes take place during highly emotional sessions. 16. I believe I am a therapis t with a flexible setting. 17. I find it useful to reveal something personal about myself during sessions. 18. I like to feel surprised by what each patient brings to the session without having preconceived notions. 19. I often attend patients outside the office. 20. The best intervention in a treatment occurs spontaneously. 21. Whatever happens to my patients ha s little influence on my own life. 22. My intervention is mostly directive. 23. I think quite a lot about my job even in my spare time. 24. I avoid revealing my emotions to my patients. 25. I can plan an entire treatment from the very outset. 26. Keeping emotional distance from patients favors change.

PAGE 71

63 27. I never change how long a session lasts, unless absolutely necessary. 28. If something bothers me dur ing a session I can express it. 29. Emotional closeness with patients is es sential to bring about therapeutic change. 30. I prefer to know in advance what things I should pay attention to in sessions. 31. I prefer treatments wher e everything is programmed. 32. I like working with patients who have clearly focused problems. 33. I can give my entire attention to ev erything that takes place during sessions. 34. I think about patients pr oblems even after sessions. 35. Im quite flexible with schedules. 36. Right from the beginning of the se ssion I allow my attention to float. Reprinted with permission from Fernandez-Al varez, H., Garcia, F., Bianco. J. L., & Santoma, S. C. (2003). Assessment ques tionnaire on the Pers onal Style of the therapist PST-Q. Clinical Psychology and Psychotherapy, 10 116-125 .

PAGE 72

64 APPENDIX D WORKING ALLIANCE INVENT ORY SHORT FORM (WAI-S) Following are sentences that describe some of the different ways a person might think or feel about his or her clients. As you read the sentences mentally consider the clients that constitute your current client load. Using the following 7-point scale, pleas e indicate how you feel about your relationship with your clients. If the statement describes the way you always feel (or think) mark the number 7; if it never applies to you mark the number 1. Use the numbers in between to describe the vari ations between these extremes. Please respond to every item with your first impressions 1 2 3 4 5 6 7 Never Rarely Occasionally Sometimes Often Very Often Always 1. My clients and I agree about the st eps to be taken to improve his/her situation. 2. My clients and I both feel confiden t about the usefulness of our current activity in therapy. 3. I believe my clients like me. 4. I have doubts about what my client s and I are trying to accomplish in therapy. 5. I am confident in my ability to help my clients. 6. My clients and I are work towards mutually agreed upon goals. 7. I appreciate my clients as a people. 8. My clients and I agree on what is important for this client to work on. 9. My clients and I have built a mutual trust. 10. My clients and I have different idea s on what his/her real problems are.

PAGE 73

65 11. My clients and I establish a good unde rstanding between us of the kind of changes that would be good for this client. 12. My clients believe the way we work with their problem is correct. Reprinted with permission from Horvath, A. O., & Greenberg, L. S. (1986). Development and validation of the Work ing Alliance Inventory. Journal of Counseling Psychology, 36 223-233.

PAGE 74

66 APPENDIX E TECHNIQUES LIST Directions: Please rate the extent to which you use each therapy technique in your practice of therapy. 1 2 3 4 5 Never or Seldom Sometimes Often Always or Almost Never Almost Always Technique active imagination 1 2 3 4 5 advice giving 1 2 3 4 5 alter ego 1 2 3 4 5 analyzing symbols 1 2 3 4 5 assertive training 1 2 3 4 5 aversion-aversive conditioning 1 2 3 4 5 behavior modification 1 2 3 4 5 catharsis 1 2 3 4 5 conditioning techniques 1 2 3 4 5 contractual agreements 1 2 3 4 5 crying 1 2 3 4 5 desensitization 1 2 3 4 5 diagnosing 1 2 3 4 5 dream interpretation 1 2 3 4 5 dreaming 1 2 3 4 5 environmental manipulation 1 2 3 4 5 fantasizing 1 2 3 4 5 first memory 1 2 3 4 5 free association 1 2 3 4 5 homework 1 2 3 4 5

PAGE 75

67 irrational behavior identification 1 2 3 4 5 modeling 1 2 3 4 5 negative reinforcement 1 2 3 4 5 play therapy 1 2 3 4 5 problem solving 1 2 3 4 5 processing 1 2 3 4 5 psychodrama 1 2 3 4 5 rational 1 2 3 4 5 reciprocity of affect 1 2 3 4 5 reflection 1 2 3 4 5 reinforcement 1 2 3 4 5 reward 1 2 3 4 5 self-monitoring 1 2 3 4 5 shaping 1 2 3 4 5 sociodrama 1 2 3 4 5 systematic desensitization 1 2 3 4 5 transference 1 2 3 4 5 value clarification 1 2 3 4 5 value development 1 2 3 4 5 warmth 1 2 3 4 5 Reprinted with permission from Hollis, J. W., (1995). Techniques used in counseling and psychotherapy. In Practicum and Internship Textbook, 17 3-177.

PAGE 76

68 APPENDIX F DEMOGRAPHIC INFORMATION Please tell us a little about yourself. This in formation will be used only to describe the sample as a group. 1. Gender: Male Female 2. Age: 3. Ethnic background: White/Cau casian, Black/African-American, Hispanic/Latino/a Black, Hispanic/Latino/a White, Asian-American-Pacific Islander, American Indian /Native-American, Multiracial, Other. 4. Name of your highest degree: BA/B S, MA/MS, MSW, PsyD, PhD, Other 5. The year you obtained your highest degree (e.g., 1985): 6. Total number of years you sp ent in clinical practice: 7. Specialty area: Psychologist Mental Health Counselor, Ma rriage and Family therapist, Social worker, Psychiatrist, Other 8. Primary job responsibility: Practice/ Clinical work, Research, Academic, Administrative, Other. 9. Primary employment setting: Private pr actice, University academic department, University service delivery department Hospital, Mental health care, School setting, Research setting, Community Center, Other. 10. Please state your dominant therapy orient ation: Psychodynamic, Humanistic/Person centered, Cognitive Behavioral, Rational Emotive, Constructivists, Interpersonal, Existential, Gestalt, Integrative, Other. 11. Average number of clients you see weekly: 12. Country you live in: US, Canada, Other.

PAGE 77

69 LIST OF REFERENCES American Psychological Association Website Demographic characteristics of APA members by membership status, 2005, http://research.apa.org/profile2005t1.pdf 04/06. Arthur, A. R. (2000). The personality and cognitive-epistemological traits of cognitive behavioral and psychoanalytic psychotherapists. British Journal of Medical Psychology, 73 243 257. Beck, A. T., Rush, A. J., Shaw, B. F. & Emery, G. (1979). Cognitive therapy of depression New York: Guilford. Beck, A. T. (1995). Cognitive therapy: Basics and beyond New York: Guilford. Beronsky, M. D. (1994). Individual differen ces in self-construc tion: the role of constructivist epistemological assumptions. Journal of Constructivist Psychology, 7 263 281. Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice, 16 252 260. Botella, L., & Gallifa, J. (1995). A constr uctivist approach to the development of personal epistemic assumptions and word views. Journal of Constructivist Psychology, 8 1 18. Chiari, G., & Nuzzo, M. L. (1996). Psychol ogical constructivism: A metatheoretical differentiation. Journal of Construc tivist Psychology, 9 163 184. Diamond, S. R., & Royce, J.R. (1980). Cognitive abilities as expressions of three "ways of knowing." Multivariate Behavioral Research, 15(1), 31 56. DisGiuseppe, R. & Linscott, J. (1993). Philosophical differences among cognitive behavioral therapists: Rationalis m, constructivism, or both? Journal of Cognitive Psychotherapy, 7 117 130. Erwin, E. (1999). Constructivist epistemologies and therapies. British Journal of Guidance & Counselling, 27 353 364. Faidley, A. J., & Leitner, L. M. (1993). Asse ssing experience in psychotherapy: Personal construct alternatives. Westport, CT: Praeger.

PAGE 78

70 Fernandez-Alvarez, H. Garcia F., Bianco, J. L., Santoma, S. C. (2003). Assessment questionnaire on the personal st yle of the therapist PST-Q. Clinical Psychology and Psychotherapy, 10, 116 125. Granvold, D. K. (1996). Cons tructivist psychotherapy. Families in Society: The Journal of Contemporary Human Services, 77 (6), 345 359. Guidano, V.F. (1987). Complexity of the self New York: Guilford. Hollis, J. W. (1995). Techniques used in couns eling and psychotherapy. In J. C. Boylan, P. B. Malley, & J. Scott (Eds), Practicum and internship: Textbook for counseling and psychotherapy (pp. 182 189). Washington, DC: Taylor & Francis. Hollon, S. D. & Beck, A.T. (1986). Research on cognitive therapies. In S. L. Garfield & A. E. Bergin (Eds.), Handbook of ps ychotherapy and behavior change (3rd ed., pp. 443 482). New York: Wiley. Horvath, A. O., & Greenberg, L. S. (1986). The development of the working alliance inventory. In L. S. Greenberg & W. M. Pinsof (Eds.), The psychotherapeutic process: A research handbook (pp. 529 556). New York: Guilford. Hu, L., & Bentler, P. M. (1999). Cutoff crite ria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6 1 55. Kelly, G. (1955). The psychology of personal constructs. New York: Norton. Kelly, G. A. (1969). The psychotherapeutic relationship. In B. Maher (Ed.). Clinical Psychology and Personality: The se lected papers of George Kelly New York: Wiley. Lyddon, W. J. (1988). Information-processing and constructivist models of cognitive therapy: A philosophical divergence. The Journal of Mind and Behavior 9 137 166. Lyddon, W. J. (1989). Pers onal epistemology and pr eference for counseling Journal of Counseling Psychology, 36 423 429. Lyddon, W. J. (1990). Firstand second-orde r change: Implications for rationalist and constructivist cogni tive therapies. Journal of Counseling & Development, 69 122 127. Lyddon, W. J. (1991). Epistemic style: imp lications for cognitive psychotherapy. Psychotherapy, 28 588 597. Mahoney, M. J. (1991). Human change processes. New York: Basic Books, Inc.

PAGE 79

71 Mahoney, M. J., & Gabriel, T. J. (1987). Psychotherapy and the c ognitive sciences: An evolving alliance. Journal of Cognitive Therapy: An International Quarterly, 1 39 59. Mahoney, M. J., & Lyddon, W. J. (1988). Recent developments in cognitive approaches to counseling and psychotherapy. The Counseling Psychologist, 16 190 234. Neimeyer, G. J., Saferstein, J. and Arnold, W. (2005). Personal construct psychotherapy: Epistemology and practice. In D. Winter and L. Viney (Eds.) Advances in personal construct psychotherapy London: Whurr Publishers. Neimeyer, G. J., & Morton, R. J. (1997). Pe rsonal epistemologies and preferences for rationalist versus constr uctivist psychotherapies. Journal of Constructivist Psychology, 10 109 123. Neimeyer, G. J., Prichard, S., Lyddon, W. J., & Sherrard, P. A. D. (1993). The role of epistemic style in counseling preference and orientation. Journal of Counseling and Development, 71 515 523. Neimeyer, R. A. (2005). The construction of change: Personal reflections on the therapeutic process. Constructivism in the Human Sciences, 10 77 98. Neimeyer, R. A. (1995). Constructivist ps ychotherapies: Feat ures, foundations, and future directions. In R. A. Neimeyer & M. J. Mahoney (Eds.) Constructivism in psychotherapy (pp.11 38). Washington DC: Ameri can Psychological Association. Neimeyer, R. A. (1993). Constructivism and the cognitive psychotherapies: Some conceptual and strategic contrasts. Journal of Cognitive Psychotherapy, 7, 159 171. Okun, B. F. (1990). Seeking connections in psychotherapy. San Francisco: Jossey-Bass Publishers. Polkinghorne, D. E. (1991). Two conflic ting calls for met hodological reform. The Counseling Psychologist, 19 103 114. Raue, P.J., Goldfried, M.R., & Barkham, M. (1997). The therapeutic alliance in psychodynamic-interpersonal and cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 65(4), 582 587. Rosenthal, R., & Rosnow, R.L. (1991). Essentials of behaviora l research: Methods and data analyses (2nd Edition). Boston: McGraw-Hill. Rosenthal, R., & Rosnow, R.L. (1975). The volunteer subject New York: John Wiley. Royce, J. R. (1964). The encapsulated man: An inte rdisciplinary search for meaning. Princeton, NJ: Van Nostrand.

PAGE 80

72 Royce, J. R., & Mos, L. P. (1980). Psycho-epistemological profile manual. Edmonton, Canada: University of Alberta Press. Royce, J. R., & Powell, A. (1983). Theory of personality and personal differences: Factors, systems, processes. E nglewood Cliffs, NJ: Prentice Hall. Schacht, T. E., & Black, D. A. (1985). Epis temological commitments of behavioral and psychoanalytic therapists. Professional Psychology: Research and Practices, 16 316 323. Tabachnick, B. G., & Fidell, L. S. (2001). Using multivariate statistics (4th ed.). New York: Harper Collins. Tracey, T. J. & Kokotovic, A. M. (1989). Factor structure of the Working Alliance Inventory. Psychological Assessment, 1, 207 210. Vandyke, M. M. (2003). Contribution of the working alliance to manual-based treatment of social anxiety disorder. Dissert ations and Abstracts, DAI-B 63/09, p. 4390. Vasco, B. (1994). Correlates of constr uctivism among Portuguese therapists. Journal of Constructivist Psychology, 7 1 16. Vincent, N., & LeBow, M. (1995). Treatment preference and acceptability: Epistemology and locus of control. Journal of Construc tivist Psychology, 8 81 96. Winter, D. A., & Watson, S. (1999). Persona l construct psychotherapy and the cognitive therapies: Different in theory but can they be differentiated in practice? Journal of Constructivist Psychology, 12 1 22.

PAGE 81

73 BIOGRAPHICAL SKETCH Jocelyn A. Saferstein was born in Cleveland, Ohio, on December 15, 1978. In 1982 her family moved to St. Petersburg, Fl orida, where she resided until she was eighteen years old. She attended the University of Flor ida in 1997 majoring in psychology as an undergraduate. In 2001, she graduated earning highest honors with a Bachelor of Science in psychology and a minor in education. She joined the Department of Psychology at the University of Florida as a counseling psychology graduate student in A ugust of 2001. She completed her Master of Science degree in May of 2003 and her Doctor of Philosophy in December of 2006.


Permanent Link: http://ufdc.ufl.edu/UFE0015141/00001

Material Information

Title: The Relationship between Therapists' Epistemology and Their Therapy Style, Working Alliance, and Use of Specific Interventions
Physical Description: Mixed Material
Copyright Date: 2008

Record Information

Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
System ID: UFE0015141:00001

Permanent Link: http://ufdc.ufl.edu/UFE0015141/00001

Material Information

Title: The Relationship between Therapists' Epistemology and Their Therapy Style, Working Alliance, and Use of Specific Interventions
Physical Description: Mixed Material
Copyright Date: 2008

Record Information

Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
System ID: UFE0015141:00001


This item has the following downloads:


Full Text












THE RELATIONSHIP BETWEEN THERAPISTS' EPISTEMOLOGY AND THEIR
THERAPY STYLE, WORKING ALLIANCE, AND USE OF SPECIFIC
INTERVENTIONS















By

JOCELYN A. SAFERSTEIN


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
2006



























Copyright 2006

by

Jocelyn A. Saferstein















ACKNOWLEDGMENTS

I extend special thanks to my husband and all of my friends and family for their

constant love and support. I am also grateful to Dr. Ken Rice for his unending patience

in answering all of my many questions. I could not have completed this dissertation

project without the guidance of my extraordinary supervisor, Dr. Greg Neimeyer.















TABLE OF CONTENTS

page

A C K N O W L E D G M E N T S ...................................................................... .....................iii

LIST OF TABLES .............. ........... .. ....... ... .............. .. vi

A B STRA C T ..................... ................................................ ................ vii

CHAPTER

1 INTRODUCTION ............... .................................................... 1

2 LITERA TURE REVIEW .......................................................... ..............3

E pistem ic Style .................................................................. ...... .........3
Assessing Epistem ic Style ........................... .... .. ......................................... 6
Epistemology and Rationalist-Constructivist Therapies .....................................7
Epistem ic Style and Preferences ........................................ ........ ............... 9
T h erapy Sty le ........................................................................ 10
W working A alliance .................. ........................................ .. .. ............ 14
Therapy Interventions ............................................... ........ ................. 18

3 M E T H O D S ........................................................................................................... 2 3

P a rtic ip a n ts ........................................................................................................... 2 3
P ro c e d u re s .......................................................................................2 5
M easu res .................................... .. ........................................... 2 5
Therapist Attitudes Questionnaire-Short Form ..................................... 25
Constructivist Assumptions Scale (CAS) .....................................................26
Personal Style of the Therapist Questionnaire (PST-Q).................. .. 26
Working Alliance Inventory-Short Form (WAI-S) ..........................................27
T ech n iqu es L ist (T L ) ..................................................................................... 2 8

4 R E S U L T S .............................................................................3 2

Descriptive and Preliminary Analyses................................ ..... ........ 32
Measurement Reliability .................................................32
Correlational A nalyses ................................................. ........ 33
Regression Analyses ................................. ........................... .... .......... 35
H y p o th e sis 1 ................................................................3 5
Instructional style ........................... ..... ....... ................................36









E x pressiv e sty le ............ ......................................................... .... .. .... .. 36
Engagem ent style ..................................... ............... ..... ..... 37
A attention al sty le ................................................. ... ........ .................37
Operative style.................... ............... ... ............. 38
H y p oth esis 2 ................................................................3 8
T a sk .................................................................................................... 3 8
G o al ................................................................... 3 9
B o n d ....................................................... 3 9
H hypothesis 3 ........................................40
Cognitive behavioral techniques ...................................... ........... ....40
C onstructivist techniques ....................................................... 4 1

5 D IS C U S S IO N ....................... ................. .. ..............................................4 5

Summary of the Results ................. ............ ....................45
Discussion of Results within the Context of Current Literatures .............. ...........48
Therapists' Epistemology and Therapy Style......................... ............... 48
Therapists' Epistemology and Working Alliance ........................................52
Therapists' Epistemology and Selection of Specific Techniques ....................53
Lim stations and Future Research................................................... ............... ... 55
C on clu sion ............................................................................................ 57

APPENDIX

A THERAPIST ATTITUDE QUESTIONNAIRE SHORT FORM (taq-sf)...............59

B CONSTRUCTIVIST ASSUMPTIONS SCALE (cas) .............. .... ............ ........61

C PERSONAL STYLE OF THE THERAPIST (PST-Q) ...........................................62

D WORKING ALLIANCE INVENTORY SHORT FORM (wai-s) .............................64

E T E C H N IQ U E S L IST ................................ ................................................66

F DEMOGRAPHIC INFORMATION .................................................................... 68

L IST O F R EFER EN CE S .............................................................. .... .........................69

BIOGRAPHICAL SKETCH ................................ .................. ...............73
















LIST OF TABLES


Table page

3-1 Personal style of the therapist questionnaire (PST-Q): subscale directions.............31

4-1 Internal consistencies for the CAS, TAQ-SF, WAI-S, PST-Q, and techniques
list. ........ ........ ........................................................................ 4 2

4-2 Pearson correlations for therapy style, working alliance, techniques & years of
experience..................................................................... ..... ....... ...... 43

4-3 Means and standard deviations for epistemology, therapy style, working
alliance, and intervention selection. .............................................. ............... 44















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

THE RELATIONSHIP BETWEEN THERAPISTS' EPISTEMOLOGY AND THEIR
THERAPY STYLE, WORKING ALLIANCE, AND USE OF SPECIFIC
INTERVENTIONS

By

Jocelyn A. Saferstein

December 2006

Chair: Greg J. Neimeyer
Major Department: Psychology

The current study examined the relationship between therapists' epistemic style and

their (1) therapy style, (2) emphasis on the working alliance, and (3) use of specific

interventions. The study aimed to discover whether or not therapists' epistemologies can

predict how therapists report their practice of therapy (e.g., therapy style, working

alliance, and use of therapy techniques).

The most robust findings provide provisional support for the notion that there are

specific differences in the personal style of the therapist according to the therapists'

epistemic assumptions (rationalist versus constructivist). Additionally, therapist

epistemology was a significant predictor of their emphasis on the working alliance (Bond

subscale), as well as, their use of specific interventions (cognitive behavioral versus

constructivist).

The current study extends the developing literature investigating the translation of

epistemology in to practice, specifically looking at therapists' self-reports. Further work









is needed to see if client reports corroborate therapists' self-report and to investigate

whether or not therapists' epistemology affects the outcome of therapy work.














CHAPTER 1
INTRODUCTION

A growing area of interest in counseling psychology research explores the

philosophical underpinnings of different approaches to counseling and psychotherapy

(Beronsky, 1994; DisGiuseppe & Linscott, 1993; Erwin, 1999; Lyddon, 1990; Mahoney,

1991; Mahoney & Gabriel, 1987; Mahoney & Lyddon, 1988; Okun, 1990; Polkinghorne,

1991; Vasco, 1994). More specifically, recent literature has investigated the translation

of "epistemology into practice," exploring the relationship between philosophical

commitments on the one hand, and theories and concepts related to change processes, on

the other (Arthur, 2000; Botella & Gallifa, 1995; Chiari & Nuzzo, 1996; Lyddon, 1989,

1988). One expression of this work looks at the epistemic assumptions that underpin the

theory and practice of cognitive therapy (Lyddon, 1991). In particular, a developing

literature addresses the distinct differences between contemporary cognitive therapies

according to their epistemic assumptions: rationalist, empiricist, and constructivist

epistemologies (Hollon & Beck, 1986; Lyddon, 1991).

The notion that counselors maintain different perspectives regarding the processes

and methods of human change due to differing philosophical commitments has been

considered in the epistemic style literature (Lyddon, 1989). Personal epistemological

commitments have been linked to a variety of different features in psychotherapy, such as

preferences for particular types of therapy (Arthur, 2000; DisGiuseppe & Linscott, 1993;

Lyddon, 1989; Mahoney & Gabriel, 1987; G. Neimeyer & Morton, 1997) and specific









therapeutic interventions (Granvold, 1996; Mahoney & Lyddon, 1988; Winter & Watson,

1999).

The link between personal epistemologies and particular therapist behaviors is just

beginning to receive attention. In fact, there has been relatively little empirical research

addressing the translation of therapist epistemological leanings into corresponding

therapeutic practices. The purpose of such exploration would be to gain a better

understanding of therapist epistemic style and how it relates to the methods and processes

of therapy. In particular, there is reason to believe that specific epistemic commitments

would be related to, and potentially direct, a) particular psychotherapeutic styles, b) the

structuring of particular types of therapeutic relationships, and c) the selection of

particular forms of psychotherapy interventions.

To develop these ideas, a review of the epistemic style literature in general will be

conducted first, followed by a specific review of the literature investigating therapist

epistemic style as a predictor of therapist variables, including therapy style, the

therapeutic relationship and the selection of specific therapeutic interventions. This

literature review will conclude with a set of specific predictions regarding the relationship

between epistemic style and these various therapeutic behaviors. This will be followed,

in turn, by a description of the methods used to test these predictions, the results of the

study and, finally a discussion that provides an understanding of the study's findings

within the context of the existing literature, highlighting its implications and limitations,

as well.














CHAPTER 2
LITERATURE REVIEW

This chapter provides a review of the literatures that support specific predictions

regarding the relationship between epistemic style and a range of therapist variables. The

review first provides a broader overview of the epistemic style literatures and then, more

specifically, the translation of epistemology into the practice of therapy. Next will be a

review of research looking at conceptual differences in therapists' therapy style according

to their epistemic assumptions, followed by an overview of the working alliance literature

and, more specifically, how different epistemological assumptions maintain notable

differences in the nature of the working alliances they form with their clients. Finally,

there will be a discussion of the relationship between specific therapeutic interventions

and the epistemic commitments that may inform or direct their selection. Each section of

this literature review will end with an outline of specific predictions concerning epistemic

style and aspects of therapist style, working alliance, and therapeutic interventions,

respectively.

Epistemic Style

Royce has developed a long-standing line of research investigating people's "ways

of knowing" (1964; Diamond & Royce, 1980; Royce & Powell, 1983). Throughout this

extensive program of research, Royce and his colleagues have developed a conceptual

model that specifies three fundamental classes of knowing. These three primary

approaches to knowing are referred to as the three epistemic styles: rationalism,

empiricism, and metaphorism.









Rationalism maintains the dominant assertion that thought has superiority over the

senses with regards to obtaining knowledge. Those with a rational epistemic style are

devoted to testing their views of reality in terms of logical consistency. The primary

underlying cognitive processes for the rational epistemic style includes clear thinking and

rational analysis, as well as synthesizing different notions (Diamond & Royce, 1980;

Vincent & LeBow, 1995). Rationalists view psychopathology as stemming from

irrational emotions or behaviors that can be controlled by rational thought. Cognitive-

rational therapy depicts this process of deductively analyzing and rejecting personal

beliefs and arguments, while instead preferring a more rational option. In other words,

rationalism is the epistemological worldview that underlies cognitive-rational therapy

(Lyddon, 1989; Mahoney, 1991).

Empiricism is primarily concerned with sensory experience as the main way of

knowing, where people know to the extent that they perceive accurately. The empirical

view of knowledge is primarily inductive and determined mostly by the reliability and

validity of observations (Diamond & Royce, 1980; Vincent & LeBow, 1995).

Psychological problems are considered as learned and measurable dysfunctional

behavior, where the reduction of psychological distress would be attained through

behavioral contracting or conditioning which empiricists believe promotes changes in

affect and cognitions. In other words, empiricism is the epistemological worldview that

underlies behavioral therapy (Mahoney, 1991; Schacht & Black, 1985).

The metaphorist perspective sees knowledge neither as firm nor rigid, but rather as

more flexible, and as embedded within individually and socially constructed symbolic

processes. Metaphorism thus takes the stance that reality is personal and mutable, rather









than fixed, and that individuals construct their bases of knowledge from their personal

learning histories, external experience, and their own personally constructive processes

(Vincent & LeBow, 1995). Metaphorists are further described as testing the soundness of

their perspectives in relationship to the viability, or pragmatic utility within a given

context. In addition, for the metaphorist, cognitive processes are symbolic in nature, with

both conscious and unconscious components (Diamond & Royce, 1980; Lyddon, 1989).

Metaphorical epistemic styles cast psychological dysfunction as an unsuccessful effort to

change or develop, or an inability to adequately adjust to a situation or circumstance.

From this perspective, psychological dysfunction is viewed as a perturbance in an

individual's customary way of knowing, with emotional distress reflecting a person's

limited ability to adapt to life circumstances. The emphasis is placed on adjustment and

the novel construction of new ways of knowing within an ongoing process of

developmental change, rather than the correction of dysfunction or the restoration of a

more valid correspondence between reality and one's view of that reality (Mahoney,

1991; Vincent & LeBow, 1995). In other words, metaphorism is the epistemological

worldview that underlies constructivist therapy (Lyddon, 1989; Mahoney, 1991; G.

Neimeyer, Prichard, Lyddon, & Sherrard, 1993; R. Neimeyer, 1993b; Schacht & Black,

1985).

Royce's conceptual framework holds that the processes of conceptualizing,

perceiving, and symbolizing are interdependent processes, where the meaningful

convergence of these three processes makes up a person's view of reality or worldview.

Although interdependent, people tend to show a leaning towards a dominant epistemic

style (Royce & Mos, 1980; Royce & Powell, 1983). Thus, although knowing is









comprised of rational, empirical, and metaphorical component processes, there is a

hierarchical order to which people use these processes, with one of the three tending to be

relatively dominant for each individual.

Assessing Epistemic Style

The research program following from Royce (1964) demonstrates support for these

three basic theories of knowledge: rationalism, empiricism, and metaphorism. Initial

research looked at the relationship between an individual's epistemic style and their

occupations (Royce & Mos, 1980). Using the instrument developed to assess these

epistemic styles (The Psychological-Epistemological Profile, Royce & Mos, 1980),

rationalists tended to be represented in the occupations of mathematicians and theoretical

physicists, empiricists tended to be represented in the occupations of biologists and

chemists, and metaphorists tended to be represented in the occupations of professional

musicians and dramatists.

Further research on epistemic style investigated how philosophical commitments

relate to the theories, methods and approaches to therapeutic change (Botella & Gallifa,

1995; Lyddon, 1988, 1989, 1990; Mahoney, 1991; R. Neimeyer, 1993b). Research based

on Royce's (1964) taxonomy of epistemic styles suggests that therapists with different

epistemic styles demonstrate differences in their theoretical orientations (Arthur, 2000).

Schacht and Black (1985), for example, found that behavioral therapists were found to be

more inclined towards an empirical epistemic style, while psychoanalytic therapists

revealed a greater commitment to a metaphorical epistemic style.

Additionally, Arthur (2000) looked at a sample of therapists and how their

epistemic style differed according to their therapy orientation (cognitive behavioral

versus psychoanalytic). In this study, psychoanalytic therapists scored significantly









higher on the metaphorist scale compared to the cognitive behavioral therapists.

Cognitive behavioral therapists were found to prefer thinking to feeling and to be more

reliant on reason, logic, and reducing emotional input, whereas psychoanalytic therapists

relied more on their feelings to understand a client. Thus, results from this study

supported the notion of differences between psychoanalytic and cognitive behavioral

therapists according to their epistemic styles.

Mahoney (1991) has further distinguished between rationalist and constructivist

epistemologies, underscoring some of the distinctions outlined by Royce and his

colleagues, and has provided the groundwork for additional investigations of the

relationship between epistemic style and therapy orientation.

Epistemology and Rationalist-Constructivist Therapies

Mahoney (1991) distinguishes between, and extends, epistemic style research by

suggesting that current cognitive therapies are distinguished by their differing

epistemological commitments (rationalism and constructivism). Rationalism argues that

there is a single, stable, external reality, and that thoughts are held superior to the senses

when determining the accuracy of knowledge (Mahoney, 1991; Mahoney & Gabriel,

1987, Mahoney & Lyddon, 1988). Winter and Watson (1999) further depict rationalists

as believing that individuals passively perceive an independently existing reality, and that

with regards to therapy, clients are seen as making cognitive errors, which causes them to

have a less accurate perception of reality. The therapists' role is thus to instruct the client

to think more rationally, increasing the correspondence between an individual's

perceptions and the reality of the events they are confronted with. Thus, rationalist

therapies are more persuasive, analytical, and technically instructive than the

constructivist therapies (R. Neimeyer, 1993b). Successful rationalist therapy occurs









when clients are able to control their negative emotions through rational thinking

(Mahoney & Lyddon, 1988). Ellis' Rational Emotive Therapy (RET) has been

considered the approach that best depicts the rationalist perspective (DisGiuseppe &

Linscott, 1993). Lyddon (1989) further notes that rationalist cognitive theories, due to

their epistemological commitment to reason and logical-analytic processes, depict a

rational epistemic style.

Constructivism, however, argues that individuals are proactive in their personal

constructions of their realities. From this point of view, knowledge is comprised of

meaning making processes where the individual is in charge of organizing his or her

experiences. Constructivists believe that reality is not single, stable, or external, and

instead assert that individuals' feelings and actions cannot be meaningfully separated

from human thought (Lyddon, 1988; Mahoney, 1991; Mahoney & Gabriel, 1987;

Mahoney & Lyddon, 1988). Unlike rationalist therapists, Winter and Watson (1999)

point out that constructivist therapists see clients as taking a proactive position in

constructing their own personal realities. Thus, constructivist therapies are more

personal, reflective, and elaborative than the rationalist therapies (R. Neimeyer, 1993b).

Additionally, Lyddon (1990) notes the differential role that emotions play in

psychotherapy for rational and constructivist therapists. Rationalists view negative

emotions as representing problems that need to be controlled, or eliminated, whereas

constructivist therapists see emotion as playing a functional role in the change process

and "encourage emotional experience, expression, and exploration" (p.124). Thus,

constructivist therapists attempt to facilitate client's personal construction of new

meanings in the context of a safe and caring relationship. Lyddon (1989) further notes









that constructivist cognitive theories, due to the primacy placed on the construction and

alteration of personal meanings, is most representative of a constructivist epistemic style.

Epistemic Style and Preferences

The influence of epistemic style on preference for rational and constructivist

therapies have been noted in recent research (Arthur, 2000; DisGiuseppe & Linscott,

1993; Lyddon, 1989; Mahoney & Gabriel, 1987; G. Neimeyer & Morton, 1997). The

primary implications of this research reveal an existing match between the rational

epistemic style and rational therapies, as well as a match between the constructivist

epistemic style and constructivist therapies. Lyddon (1989) noted that, for example,

people with a dominant rational epistemic style tend to prefer rationalist therapy because

rational therapy facilitates clients approaching emotional and personal troubles in a

rational and logical way that is congruent with their ways of dealing with difficulties in

other aspects of their lives. Thus, when considering the findings of Royce and Mos

(1980), that people tend to have a leaning towards a dominant epistemic style, it naturally

follows that a match would exist between therapists' epistemology and their theoretical

orientation, reflected in the underlying epistemology of that therapy orientation (Lyddon,

1989).

In considering the epistemology literature, a much broader range of theoretical,

strategic, and technical distinctions have been conceptualized in relation to differing

epistemological positions than have actually been documented in research literatures

(Mahoney & Lyddon, 1988; R. Neimeyer, 1993b). These conceptual differences include

expected differences in the characteristic style of therapy, differences in the nature and

enactment of the therapeutic relationship (R. Neimeyer, 1995), and differences in the

actual interventions associated with different therapy orientations (Lyddon, 1990).









Despite the many different conceptual differences that have been noted, relatively few of

these have received careful empirical documentation (G. Neimeyer, Saferstein, & Arnold,

2005).

Working on the basis of current conceptual distinctions that have been made in the

literature, it is possible to identify and test expected differences between rational and

constructivist therapists in relation to (1) therapy style (2) the therapeutic relationship,

and (3) the selection of specific therapeutic interventions. Each of these three therapist

variables (style, relationship, and interventions) will now be discussed in further detail in

relation to the respective epistemological differences (rationalist versus constructivist)

noted in the literature.

Therapy Style

There has been some literature investigating conceptual differences in therapists'

therapy style according to their epistemic assumptions. Granvold (1996), for example,

suggests that traditional cognitive behavioral therapists tend to target irrational beliefs for

modification, educate the client, guide the client, and take an active and directive position

with the client. On the other hand, a constructivist therapy style is characterized by the

therapist being less directive, providing less information to clients, and engaging in more

exploratory interaction in their behavior with clients.



More specifically, R. Neimeyer (2005) indicates that constructivist therapists

invoke a sense of"openness" which he describes more specifically here:

I mean not overly structuring the agenda for the session by my own preconceptions
of what my client requires, particularly to the extent that such an agenda is driven
by some diagnostic or classificatory system about the experience of an abstract
group of people who report some of the same symptoms or difficulties. (p. 78)









This highlights the importance of less versus more structure when considering

cognitive behavioral versus constructivist therapies, respectively.

In addition, provisional empirical work has begun to explore differences in therapy

style according to epistemic assumptions. For example, Winter & Watson (1999)

conducted an empirical investigation looking at the differences between constructivist

and rationalist therapists. They looked at the work of four personal construct therapists

(i.e., constructivist) and six rationalist therapists across a range of clients in an outpatient

mental health setting. Both types of therapy were conducted on the basis of a 12-session

renewable contract. Results from audio taped recordings of the sessions revealed an

interesting perspective on the distinctive procedural and relational components of these

two orientations. In general, the rationalist therapists showed a more negative attitude

towards their clients, while the personal construct therapists showed greater regard for

them. Additionally, clients involved in personal construct therapy showed greater overall

involvement in therapy. These differences are in line with the credulous and

collaborative nature of the personal construct therapist originally depicted by Kelly

(1955).

In another study (G. Neimeyer & Morton, 1997), 49 practicing psychotherapists

were recruited to investigate the relationship between therapy orientation and epistemic

style. Two samples of therapists were recruited in this study, one group of rational-

emotive therapists who were members in the Institute of Rational Emotive Therapy, and

one group of personal construct therapists, who were members of the International

Network of Personal Construct Theorists. Therapists from both groups were asked to do

three things. First, therapists were asked to complete a copy of the Therapist Attitude









Questionnaire (TAQ) created by DisGiuseppe and Linscott (1993) to assess Mahoney's

distinction between rationalist and constructivist therapy orientations. Second, therapists

were asked to compare their own therapy orientations to six prominent psychotherapists

known for their predominantly rationalist (e.g., Aaron Beck, Albert Ellis) or

constructivist (e.g., George Kelly; Michael Mahoney) orientations. And third, therapists

were asked to rate their therapeutic style along descriptors associated with a rationalist

orientation (e.g., logical, directive, educational) and with a constructivist orientation (e.g.,

symbolic, metaphorical, meaning-oriented).

Results from this study were consistent with the translation of epistemic

commitments into the practice of therapy. For example, personal construct therapists

demonstrated a significantly higher commitment to a constructivist epistemology, and a

lower commitment to a rationalist perspective, compared with rational-emotive

therapists. Additionally, personal construct therapists demonstrated a stronger

identification with notable constructivist therapists, and had a tendency to depict their

therapeutic styles along dimensions more closely aligned with constructivist therapy.

Further efforts to build upon these findings can be developed in relation to the

conceptualization by Fernandez-Alvaraez, Garcia, Bianco, & Santoma (2003) of

therapists' personal style. These authors describe therapists' personal style as the, ". .

imprint left by each professional in his work" and note that it "has a relevant impact on

the outcomes of the treatment" (p. 117). Given that therapy style is a general principle

for any theoretical orientation, Fernandez-Alvaraez et al. (2003) define the personal style

of the therapist as,

the set of characteristics that each therapist applies in every psychotherapeutic
situation, shaping its basic attributes. It is made up of the peculiar conditions that









lead the therapist to behave in a particular way in the course of his professional
work. (p. 117)

This definition can be considered in relation to how therapy style manifests

differently in various theoretical approaches. For example, Granvold (1996) notes the

marked differences between cognitive behavioral and constructivist therapy styles

regarding how these different orientations view treatment goals. Whereas cognitive

behavioral therapists target cognitions for modification and subsequently educate the

client on the impact of cognitions in functioning and change in a more directive manner,

constructivist therapists are less directive, more exploratory, less problem-focused, and

more experiential (Granvold, 1996). While these differences in therapy style according

to cognitive behavioral versus constructivist therapy orientations have been noted in the

literature, their has not been a clear investigation and discussion in the literature

regarding the connection between differences in therapists' epistemic styles (rationalist

versus constructivist) and how that may translate into differences in therapists' therapy

style.

Such differences in therapy style have been measured by an instrument designed to

assess "the set of characteristics" (Fernandez-Alvaraez et al., 2003) of each therapist that

make up their therapy style. Fernandez-Alvaraez et al. (2003) created such a measure of

therapists' personal style (Personal Style of the Therapist Questionnaire) that measures

five specific dimensions of therapists' style (Instructional, flexibility-rigidity; expressive,

distance-closeness; engagement, lesser degree-greater degree; attentional, broad focused-

narrow focused; operative, spontaneous-planned). This measure is used in the current

study to investigate the influence of therapists' epistemic style (rationalist versus

constructivist) on their therapy style according to these subscales.









Thus, the first hypothesis makes predictions regarding the influence of therapist

epistemology on therapists' particular therapy style. According to these authors'

definitions, our first hypothesis is that therapist epistemology will be a significant

predictor of their therapy style. More specifically, therapists with rational epistemologies

would have a therapy style depicting more rigidity on the Instructional subscale, more

distance on the expressive subscale, a lesser degree of engagement, more narrow focus on

the attentional subscale, and more planned on the operative subscale, compared to

therapists with a constructivist epistemology. By comparison, therapists with

constructivist epistemologies would have a therapy style reflecting more flexibility on the

Instructional subscale, more closeness on the expressive subscale, a greater degree of

engagement, more broad focus on the attentional subscale, and more spontaneous on the

operative subscale compared to therapists with rationalist epistemologies. This first

hypothesis is based on the notion that rationalist therapists tend to be more instructive,

persuasive, analytical, and technically instructive than the constructivist therapies (R.

Neimeyer, 1993b). Additionally, constructivist therapies are thought to be more

personal, reflective, and elaborative than the rationalist therapies, with constructivist

therapists attempting to facilitate clients' personal construction of new meanings in the

context of a safe and caring relationship. (Lyddon, 1990).

Working Alliance

These differences in therapy style reflect broader differences regarding the nature

and role of the therapeutic relationship. In addition to therapy style, cognitive behavioral

and constructivist therapies maintain notable differences in the nature of the working

alliances they form with their clients. The notion of the working alliance is

pantheoretical, with working alliance being considered a common factor in different









types of therapies (Horvath & Luborsky, 1993). While therapy style refers to the

characteristic patterns of behavior that typify the therapists' behavior, the working

alliance specifically addresses the nature of the interaction and relationship occurring

between the therapist and their clients.

Working alliance is defined by Bordin (1979) as the combination of (a) client and

therapist agreement on goals (Task), (b) client and therapist agreement on how to achieve

the goals (Goal), and (c) the development of a personal bond between the client and

therapist (Bond). According to Bordin (1979), Tasks are the therapeutic processes that

take place during each session, with the development of the Task component occurring

when the therapist and client both comprehend significance and effectiveness of the

tasks. Goals are stated to be the mutually agreed upon outcomes of therapy by the client

and therapist. The Bond component represents the key elements of rapport: trust,

acceptance, and confidence. Bordin's (1979) definition underlies a measure of working

alliance developed by Horvath & Greenberg (1986), which assess these three specific

dimensions of the working alliance in counseling and psychotherapy.

While rationalist and constructivist therapies both value the working alliance,

empirical literature has suggested that rationalist and constructivist therapies value

different qualities within the working alliance. For example, a conceptual depiction of

the differences between cognitive behavioral and constructivist therapists in the

therapeutic relationship comes from Beck, Rush, Shaw, and Emery (1979), who state that

the therapist is a "guide who helps the client understand how beliefs and attitudes

influence affect and behaviour" (p.301). This assertion highlights the differences









between cognition, affect and behavior in Beck's approach, compared to the holistic

perspective maintained in the constructivist approach.

Faidley and Leitner (1993) further note that in constructivist therapy,

the therapist is not the guru leading the client to health. Both the client and
therapist embark on an uncharted journey that will require them to enter unknown
territory, to struggle, to bear fear and pain, and hopefully, to grow. (p. 6-7)

Further empirical studies have addressed key distinctions between cognitive

behavioral and constructivist therapies with regard to emphasis on working alliance. For

example, a study by Winter and Watson (1999) provided support for the assertion that

there are, in fact, differences between constructivist and rationalist cognitive therapies in

relation to therapist perceptions of the therapeutic relationship. These authors found that

constructivist therapists were "less negatively confrontative, intimidating, authoritarian,

lecturing, defensive, and judgmental" (p. 17). In addition, constructivist therapists had

greater use of exploration, silence, open questions and paraphrase, along with lower use

of approval, information and direct guidance, compared to cognitive behavioral

therapists.

Another example comes from Mahoney & Lyddon (1988) who point out key

conceptual differences between rationalist and constructivist therapies in relation to the

working alliance. These authors suggest that rationalist therapists conceptualize the

therapeutic relationship as involving "the service or delivery of direct guidance and

technical instruction" (p. 221). Thus, for rationalist therapists, G. Neimeyer et al. (2005)

suggest that the

therapeutic relationship is oriented more towards the delivery of guidance,
technical instruction, and behavioral rehearsal regarding the role of cognitions in
the development and maintenance of emotional distress. The use of therapist-
directed exercises, structured interventions, and directed homework assignments









illustrates the relative emphasis placed on the development of technical skills. .. (p.
14)

Additionally, the working alliance has been noted to have an important role in

cognitive behavioral therapy (Raue, Goldfried, & Barkham, 1997). Beck (1995), for

example, has stipulated that "Cognitive therapy requires a sound therapeutic alliance"

(Beck, 1995, p. 5). Further, consensus on the tasks and goals of therapy is inherent in

Beck's (1979) basic notion of collaborative empiricism, which highlights the

collaboration between client and therapist in achieving therapeutic gains.

This component of the working alliance that is highly valued within the rationalist

therapies falls in line with Bordin's (1979) definitions of the Task and Goal components

of the working alliance.

Alternatively, Mahoney & Lyddon (1988) depict constructivist therapists as

viewing the human connection within the therapeutic relationship as a crucial component

of therapeutic change, a connection that "functions as a safe and supportive home base

from which the client can explore and develop relationship with self and world" (p. 222).

Similarly, Granvold (1996) notes that

The development of a quality therapeutic relationship with such characteristics as
acceptance, understanding, trust and caring is a prime objective of constructivists.
(p. 350)

This is directly in line with Bordin's (1979) depiction of the Bond component of

the working alliance, as comprising the key elements of rapport: trust, acceptance, and

confidence. Additionally, constructivists tend to have less narrowly defined tasks or goals

compared to cognitive behavioral therapists (Granvold, 1996).

Thus, there are key distinctions between rationalist and constructivist therapists'

conceptualizations regarding the nature and role of the therapeutic relationship or









working alliance in negotiating the therapeutic change. While both cognitive behavioral

and constructivist therapies promote a collaborative relationship with the client, there are

noted differences in how this manifests in these two therapy orientations (Granvold,

1996).

Thus, the second hypothesis in the current study concerns the relationship between

therapist epistemology and their perceived levels of working alliance, according to the

subscales of Task, Goal, and Bond. We hypothesize that therapist epistemology will be a

significant predictor of working alliance (Task, Bond, and Goal). More specifically,

therapists with rationalist epistemologies will have higher scores on the Task and Goal

subscales and lower on the Bond subscale than the constructivist epistemologies.

Therapy Interventions

Both rationalist and constructivist therapies view psychotherapy as occurring

within a therapeutic relationship, however the nature of this relationship is somewhat

different (e.g., instruction versus exploration, correction versus creation, etc.). Thus, the

specific techniques use by rationalist and constructivist therapists might be expected to fit

within these broad relationship differences.

For example, Mahoney and Lyddon (1988) point out that rationalist interventions

tend to focus on the "control of the current problems and their symptomatology" (p.217).

In contrast, constructivist interventions tend to focus on "developmental history and

current developmental challenges" (p.217). They highlight the key differences between

these two therapy interventions as reflecting a "problem-versus-process" distinction that

itself is reflected in the implicit and explicit goals of these two types of therapy.

Rationalists are noted to guide the direction of therapy according to the presenting issues









and particular goals, compared to constructivists who are more inclined to permit the self-

organizing processes of the client to impact the path of therapy.

Additionally, Granvold (1996) notes that cognitive behavioral techniques have a

more firm application of methodology and a more directive approach of techniques than

constructivist techniques. Traditional cognitive behavioral interventions are geared at

controlling, altering or terminating negative emotions (e.g., anxiety, depression, anger,

worry, etc.). In contrast, constructivist interventions maintain more creative than

corrective interventions (e.g., exploration, examination, and experience).

Empirical evidence for these conceptual distinctions between cognitive behavioral

and constructivist therapy techniques have been noted by Winter and Watson (1999).

These authors found that "the distinctiveness of the two therapeutic approaches was

provided by the blind classification of the therapy transcripts" (p. 17). More specifically,

the authors provided transcripts of 2 different types of therapy sessions, rationalist

cognitive therapy or personal construct therapy, which were "blindly differentiated by

leading proponents of the therapies concerned" (p. 1). Findings indicated that cognitive

behavioral therapists used interventions that seemed to be "more challenging, directive

and to be offering interpretations that do not always lead directly from what the client has

said" (p. 17). Additionally, constructivist therapists were

much looser in their construing; ask questions rather than make statements; and use
interpretation more as a way of checking out their own construing or as a means of
helping the client elaborate his or her construing. (p. 17)

Therefore, there is tentative empirical work that seems to support the conceptual

distinctions made between the underlying epistemologies of these two orientations and

possible differences in the techniques used in practice that follow from the different

perspectives.









Thus, the third and final hypothesis is in relation to the therapist use of specific

therapeutic techniques. When considering traditional cognitive behavioral therapies,

interventions are geared at controlling, altering or terminating negative emotions (e.g.,

anxiety, depression, anger, worry, etc.). In contrast, the constructivist approach tends

towards interventions that are more process oriented compared to cognitive behavioral

therapies being more focused on surface-structure problem resolution. Constructivist

interventions are considered more creative compared to cognitive behavioral

interventions being more corrective. Additionally, the cognitive behavioral approach is

noted to have a more distinct problem orientation, a stricter adherence to the application

of methodology, and a more directive approach, compared to the constructivist approach.

Whereas constructivist therapists are considered more metaphoric, approximate,

exploratory and intuitive in therapy techniques compared to the cognitive behavioral

approach (Granvold, 1996).

Winter and Watson (1999) additionally cite empirical evidence for the distinction

between cognitive behavioral and constructivist therapy techniques. In particular,

findings suggested that cognitive behavioral therapists used more challenging and

directive interventions compared to constructivist therapist. On the other hand,

constructivist therapists asked more questions and used interpretation as a means of

exploration of the client's meaning making system.

Consequently, psychotherapy research investigations have found a theoretical

allegiance according to what techniques therapists use in their practice. In particular,

there have been distinctions noted between cognitive behavioral and constructivist

therapies in this regard (Winter & Watson, 1999). For example, personal construct









therapists "showed less negative attitudes toward their clients. .. were less negatively

confrontative, intimidating, authoritarian, lecturing, defensive, and judgmental" (p. 17)

compared to rationalist therapists. Personal construct therapists were also found to use

techniques that had greater use of exploration, open questions, and paraphrase, compared

to rationalists. The current study plans to extend this line of research according to

therapist epistemology.

Thus, for the third hypothesis, epistemology will be a significant predictor of

therapy techniques used by the therapists in the sample. More specifically, therapists

with rationalist epistemologies are expected to report using techniques associated with

cognitive behavioral therapy (e.g., advice giving) more than constructivist

epistemologies, and therapists with constructivist epistemologies will report using

techniques associated with constructivist therapy (e.g., emotional processing) more than

therapists' with rationalist epistemologies. One purpose of the current work is to further

examine these differences to determine whether these epistemological differences relate

to the selection of specific interventions that fit more with the corrective and directive

orientation of rationalist therapists or exploratory and creative orientation of

constructivist therapists.

Thus, in the present study, we investigated the potential influence of epistemic style

(rational versus constructivist) on therapist therapy style, nature of the working alliance,

and use of specific interventions. These therapist variables were included according to

their noted importance in translating epistemology into practice (G. Neimeyer, et al.

2005). The specific relationship between these variables and therapists' epistemic styles

are summarized below.









Overall, the current study seeks to investigate therapist epistemology (rationalist

versus constructivist) as a predictor of (1) therapy style: therapists with rational

epistemologies might show more rigidity on the Instructional subscale, more distance on

the expressive subscale, a lesser degree of engagement, more narrow focus on the

attentional subscale, and more planned on the operative subscale, compared to therapists

who might tend towards a therapy style reflecting more flexibility on the Instructional

subscale, more closeness on the expressive subscale, a greater degree of engagement,

more broad focus on the attentional subscale, and more spontaneous on the operative

subscale; (2) emphasis on working alliance: therapists with rationalist epistemologies will

have higher scores on the Task and Goal subscales and lower on the Bond subscale than

the constructivist epistemologies; (3) use of specific therapy techniques: rationalist

epistemologies are expected to report using techniques associated with cognitive

behavioral therapy (e.g., advice giving) and therapists with constructivist epistemologies

will report using techniques associated with constructivist therapy (e.g., emotional

processing) more. The expected direction of the findings is in accordance with the

literature discussed that warrants potential distinctions according to therapist

epistemology.














CHAPTER 3
METHODS

Participants

Participants were primarily professional psychologists recruited online through

membership in different professional organizations. Participants were mostly recruited

from the American Psychological Association (APA) Practice Organization online

practitioner directory (approximately 15,057 members).

Participant solicitation emails were also sent to APA Division 17 (Counseling

Psychology, 355 members), APA Division 29 (Psychotherapy, approximately 224

members), APA Division 32 (Humanistic Psychology, approximately 130 members), The

North American Personal Construct Network (NAPCN) list serve (approximately 95

members), the Albert Ellis Institute email list (approximately 57 members), in addition to

a number of APA-approved counseling centers. The solicitation email also encouraged

participants to forward the email survey on to other eligible practitioners; therefore the

response rate of approximately 13.5% has to be considered with reservations.

Therapist participation was voluntary and all participants were required to provide

informed consent form prior to participating in this study. All inventories were

completed online and submitted to an online database. It took therapists approximately 30

minutes to complete the instruments, and the study was conducted in accordance with

APA ethical guidelines. See procedures below.

The sample consisted of 1151 therapists (733 female, 418 male) with a mean age of

45.09 (SD = 12.54). The sample was primarily Caucasian, 88.8% (N = 1030), followed









by Multiracial, 2.9% (N = 34), Hispanic, 2.7% (N = 31), African American, 2.4% (N=

28), Asian American, 2.1% (N = 24), and Other, 1.1% (N = 13).

Participants were asked to indicate the level of their highest degree, which

consisted of primarily PhDs, 60.1% (N = 700), followed by MA/MS, 18.6% (N = 216),

PsyD, 11.0% (N = 128), BA/BS, 4.3% (N = 50), EdD, 1.7% (N = 20), MSW, 1.4% (N =

16), and Other, 2.9% (N = 34). Additionally, the average year participants obtained their

highest degree was 1992.55 (SD = 11.1), along with the average total number of years

spent in clinical practice being 14.01 (SD = 11.03). The majority of participants were no

longer in school, 93.5% (N = 1105) and only 6.5% (N = 77) were graduate students.

Participants were additionally asked about their specialty areas with the majority

indicating that they were psychologists, 80.8% (N = 939) followed by mental health

counselors, 6.0% (N = 70), marriage and family therapists, 2.2% (N = 26), social

workers, 1.0% (N = 12), graduate students, 5.2% (N = 60), and Other, 4.8% (N = 55).

When asked about their primary employment setting, the largest percentage of

participants indicated they were in private practice, 40.4% (N = 466), followed by a

university academic department, 11.4% (N = 132), hospital, 10.8% (N = 125), university

service delivery department, 10.6% (N = 122), mental health care, 7.7% (N = 89),

community center, 4.0% (N = 46), school, 3.4% (N = 39), and other, 11.7% (N = 134).

In addition, participants were asked their dominant theoretical orientation and most

participants indicated that their dominant theoretical orientation was cognitive behavioral,

35.9% (N = 414), followed by integrative, 18.1% (N = 209), psychodynamic, 15.2% (N=

175), interpersonal, 7.6% (N = 88), humanistic, 7.2% (N = 83), constructivist, 3.2% (N=









37), existential, 2.2% (N = 25), rational emotive, 1.7% (N = 20), gestalt, 0.7% (N = 8),

and other, 8.2% (N= 95).

Procedures

Members from these divisions or organizations were sent an online survey

containing an informed consent, a brief demographics sheet, and the five aforementioned

measures (TAQ-SF, CAS, PST-Q, WAI-S, & TL). Participants were asked to read and

sign the informed consent form. Once participants completed the surveys and submitted

their responses, they were directed to read a short debriefing that described the nature of

the study. Participants answered one of four different versions of the main questionnaire

where the questions were ordered differently to test for the possibility of order effects.

Participants were debriefed at the end of the study and were provided with the contact

information for further inquiries.

Measures

Therapist Attitudes Questionnaire-Short Form

The TAQ-SF, developed by G. Neimeyer and Morton (1997), is a revision of the

Therapist Attitudes Questionnaire (TAQ) developed by DisGiuseppe and Linscott (1993).

The TAQ-SF measures philosophical, theoretical, and technical dimensions of rationalist

and constructivist therapies. The instrument is self-administered, contains 16 items, eight

items pertaining to a Rationalist commitment (e.g., "Reality is singular, stable and

external to human experience") and eight items pertaining to a Constructivist

commitment, (e.g., "Reality is relative. Realities reflect individual or collective

constructions of order to one's experiences"), and requires approximately 5 minutes to

complete. Respondents are asked to rate the degree to which they agreed or disagreed

with each item on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly









agree). The TAQ-SF replicates the basic factor structure of the original TAQ and has

shown its predictive validity by predicting the therapeutic identifications and descriptions

of a group of practicing professionals (G. Neimeyer & Morton, 1997). TAQ-SF scores in

the present study yielded a Chronbach's alpha of .72 for rationalist scale and a

Chronbach's alpha of .63 for the constructivist scale.

Constructivist Assumptions Scale (CAS)

The Constructivist Assumptions Scale (CAS) was developed by Berzonsky (1994),

and was designed to assess constructivist epistemological assumptions (e.g., "Truth is

relative. What is true at one point in time may not be true at another"). This is a 12-item

self-report measure with each item being rated on a 5-point Likert scale ranging from 1

(strongly disagree) to 5 (strongly agree). The CAS has internal reliability estimated to be

.61, and a 2-month test-retest reliability (N = 78) of .68. CAS scores in the present study

yielded a Chronbach's alpha of .72.



Personal Style of the Therapist Questionnaire (PST-Q)

The Personal Style of the Therapist Questionnaire (PST-Q) was developed by

Fernandez-Alvarez et al. (2003), and was created to assess "the set of characteristics that

each therapist applies in every psychotherapeutic situation, thus shaping the main

attributes of the therapeutic act" (p. 117). The questionnaire assesses five different

dimensions: flexibility-rigidity (Instructional subscale), distance-closeness (expressive

subscale), lesser engagement-greater engagement (engagement subscale), broad focused-

narrow focused (attentional subscale) and spontaneous-planned (operative subscale), see

Table 3-1.









This measure is a 36-item self-report measure intended to be filled out by therapists

with answers rated on a scale ranging from 1 to 7, where '1' represents total disagreement

and '7' represents total agreement with each statement. The measure has shown a test-

retest reliability of .79, with Chronbach's reliability coefficients for each subscale, as

follows; Instructional, .69; expressive, .75; engagement, .78; attentional, .80; operative,

.78. Factor Analysis revealed a KMO = .756.

Working Alliance Inventory-Short Form (WAI-S)

The Working Alliance Inventory (WAI), developed by Horvath & Greenberg

(1986), is a 36-item questionnaire that can be administered to both clients and therapists

and is rated on a 7-point Likert type scale with (1 = never, 7 = always). Ratings on this

measure yield Task, Goal, and Bond subscale scores (12 items for each subscale), along

with a total score that consists of the average across all items. Horvath & Greenberg

(1986) demonstrated adequate reliability for the WAI, with internal consistency estimates

of alpha = .93 for overall client score (with subscale alphas of .85 to .88) and .87 for the

overall therapist score (with subscale alphas of .68 to .87). Content validity has been

supported through both rational (expert raters agreed that the items reflect the three

constructs) and empirical (multi-trait multi-method analyses) methods. Tracey and

Kokotovic (1989) proposed a client and therapist Working Alliance Inventory-Short

Form (WAI-S), which contains 4 items per subscale (Task, Goal, and Bond), as well as

average overall WAI-S scores, demonstrating high reliability with alpha levels similar to,

and even better than the WAI for the client subscales and overall average scores (Task,

alpha = .90; Bond, alpha = .92; Goal, alpha = .90; and General Alliance, alpha= .98) and

therapist subscales and overall average scores (Task, alpha = .83; Bond, alpha= ..91;

Goal, alpha = .88; and General Alliance, alpha = .95).









The WAI highlights the collaborative efforts of the client and therapist, and has

three parallel forms: Client, Therapist, and Rater (or observer). In the current study, we

are interested in a therapist sample and will focus exclusively on the therapists' self-

report on this measure. The strengths of the WAI are its usefulness in different

therapeutic methods, lack of outcome-related items, and extensive use in the literature

(Vandyke, 2003). The WAI-S is used in this study.

Techniques List (TL)

The Techniques List measure was adapted from Hollis (1995), who catalogued an

extensive list of counseling and psychotherapy techniques representing a broad spectrum

of philosophical bases. In order to refine this extensive list according to techniques used

specifically by cognitive behavioral and constructivist therapy orientations, we recruited

counseling psychology graduate students to read through the total list of 108 therapy

techniques and rate the extent to which each technique is used by each therapeutic

approach (cognitive behavioral and constructivist), using a 5-point Likert type scale (1 =

Never or Almost Never; 5 = Always or Almost Always).

Sixteen counseling psychology graduate students participated in these ratings (6

males, 10 females), with the average age = 28.44 (SD = 2.67). Results of a paired

differences analysis for all 108 items indicated that there were 77 techniques rated as

being used with significantly differential frequency by cognitive behavioral and

constructivist therapies. We then divided this distribution of 77 techniques into quartiles

and retained the top and bottom quartiles. This resulted in 20 cognitive behavioral

techniques (e.g., advice giving, rational restructuring) and 20 constructivist techniques

(e.g., emotional processing, reflection) that were rated most significantly different

(cognitive behavioral versus constructivist). This final list of 40 items of therapy









techniques (20 cognitive behavioral techniques; 20 constructivist techniques) was used in

the current study.

These 40 items were listed alphabetically and participants were asked to rate the

extent to which they use each technique in their practice of therapy along a 5-point scale

(1 = Never or Almost Never; 5 = Always or Almost Always). The ratings of the 20

rationalist items were summed and a mean was calculated to reflect the average

frequency of using rationalist interventions (possible range = 1-5), and the same

procedure was applied in relation to the 20 constructivist interventions (possible range =

1-5).

The raw data was used to conduct a confirmatory factor analysis on the Techniques

List measure. The current analysis was examined for multivariate normalcy and the

assumptions were met. All kurtosis estimates for the variables fell between 1 and -1

variables except constructivist items 12, 13, 16, and 20 and cognitive behavioral item 3,

which had a kurtosis values between 2 and -2. Consequently, these five items were

removed from the measure prior to running the confirmatory factor analysis.

A Confirmatory factor analysis was utilized to fit a model of 2 types of therapy

technique factors: constructivist therapy techniques and cognitive behavioral therapy

techniques. Thirty-five indicators were included in the model (16 constructivist

techniques and 19 cognitive behavioral techniques). After running the analysis with the

35 items, and two factors (constructivist techniques and cognitive behavioral techniques),

factor loadings revealed 8 items (6 constructivist items and 2 cognitive behavioral items)

loading at less than .40. These 8 items were removed and the confirmatory factor

analysis was then re-run with the remaining 27 items (10 constructivist and 17 cognitive









behavioral items). No further model modifications were made because there was no

other compelling theoretical rationale for additional changes and these 27 items were

used in all subsequent analyses using this measure. Items were constrained to load only

on to their respective factors (constructivist techniques and cognitive behavioral

techniques), and the two factors were allowed to correlate.

The measurement model was examined utilizing LISREL (8.7) and was evaluated

based on multiple goodness of fit indices (standardized root mean square residual

(SRMR), normed fit index (NFI), comparative fit index (CFI) and the root-mean-square

error of approximation (RMSEA)), with the maximum likelihood as the estimation

method. Examination of the results revealed that the fit of the model was a fairly good fit

although not necessarily superior fit for the data, x2 (323, N = 914), = 2249.37, p < .001,

SRMR = .066, RMSEA = .08, NFI = .91, and CFI = .93. Values greater than .90 are

generally accepted as support for a well-fitting model for goodness of fit indices CFI, and

NFI (Grimm & Yarnold, 1998), with a good-fitting model suggested when the SRMR is

.08 or less (Hu & Bentler, 1999). Values of the RMSEA of .05 or less indicate a close fit

and values from .05 to .08 indicate a fair fit. The final standardized solution factor

loadings were all significant (p < .05) and ranged from .40 to .81 for the constructivist

techniques and from .47 to .71 for the cognitive behavioral techniques. The correlation

between the two factors was -.30. p < .03.






31


Table 3-1 Personal style of the therapist questionnaire (PST-Q): subscale directions


Subscales

1. Instructional

2. Expressive

3. Engagement

4. Attentional

5. Operative


Low

Flexibility

Distance

Lesser degree

Broad focus

Spontaneous


High

Rigidity

Closeness

Greater Degree

Narrow focus

Planned














CHAPTER 4
RESULTS

Results from the current study are described below. First, I will discuss

measurement issues, followed by sample descriptives, then general correlations, and

finally the regression analyses that address each of the predictions concerning therapist

style, therapeutic relationship and therapeutic interventions in relation to epistemic style.

Descriptive and Preliminary Analyses

Multivariate analyses of variance were conducted on the 5 measures used in the

current study (CAS, TAQ-SF, PST-Q, WAI-S, and TL) suggested that there were no

differences in the mean scores of the variables of interest among the four types of

questionnaire forms (all ps > .003). Thus for all analyses, the data from four different

forms were combined.

Measurement Reliability

Measurement reliabilities for the CAS, TAQ-SF, PST-Q, WAI-S and techniques

list scores appear in Table 4-1. Chronbach's coefficient alpha for the CAS of .72, was

comparable to Berzonsky's (1994) finding (ranging from .61-.65). Reliability findings

for the TAQ-S were alpha of .72 for the rationalist subscale and .63 for the constructivist

subscale. This is comparable to previous reports (G. Neimeyer & Morton, 1997).

Reliability for the PST-Q indicated an alpha level of .65 for the Instructional

subscale, .65 for the expressive subscale, .68 for the engagement subscale, .38 for the

attentional subscale, and .75 for the operative subscale. This is comparable to Fernandez-

Alvarez et al. (2003) (Instructional, .69; expressive, .75; engagement, .78; attentional,









.80; operative, .78) with the exception of the attentional subscale, which was lower in the

current study. Due to the weak nature of the alpha level on the attentional subscale,

attempts were made to improve the internal reliability by removing poorly inter-related

items. However, the removal of any single weak performing item failed to increase the

alpha level above a .47. Thus, a decision was made to use the modified 5 item attentional

subscale with an alpha level of .47 in all analyses in the study.

Reliability findings for the WAI-S revealed a Chronbach's coefficient alpha of .75

for the overall score, .80 on the Task subscale, .71 on the Bond subscale and .61 on the

Goals subscale (all at thep < .001 level). This is also comparable to Tracey and

Kokotovic (1989) findings (therapist subscales and overall average scores: General

Alliance, alpha = .95; Task, alpha = .83; Bond, alpha = .91; and Goal, alpha = .88).

Finally, reliability for the Techniques List revealed a Chronbach's coefficient alpha

of .91 for the Cognitive Behavioral Techniques subscale and .84 for the Constructivist

Techniques. This was the first reliability estimate on this new measure.

Correlational Analyses

Person Product Moment correlations, using a criterion level of .05 (1-tailed), were

computed between the two epistemology subscales (Rationalist and Constructivist) and

each of the criterion variables in an attempt to confirm that the relationships were in the

predicted directions. A Pearson Product Moment correlation was first conducted between

the CAS and the TAQ-SF to verify that therapists with higher scores on the constructivist

epistemology subscale scored higher on the CAS compared to therapists with higher

scores on the rationalist epistemology subscale. Results were in the predicted directions,

revealing a significant positive correlation between the TAQ-SF constructivist subscale

and the CAS, r = 0.30, P < 0.001 and a significant negative correlation between the TAQ-









SF rationalist subscale and the CAS, r = -0.36, P < .001. Additionally, a Pearson Product

Moment correlation was conducted on the TAQ-SF rationalist and constructivist

subscales to justify their use as two separate continuous subscale scores, r = -.09, P <

.001.

For therapist style, the rationalist subscale was significantly negatively correlated

with the expressive (r = -0.21, P < .001) and engagement (r = -0.26, P < .001) subscales,

which were in the predicted directions. The rationalist subscale was also significantly

positively correlated with the Instructional (r = 0.07, P < .028), attentional (r = 0.41, P <

.001), and the operative subscale (r = 0.48, P < .001), which were also in the predicted

directions. The constructivist subscale was significantly negatively correlated with the

Instructional (r = 0.10, P < .001), attentional (r = -0.15, P < .001), and operative

subscales (r = -0.22, P < .001), all in the predicted directions. The constructivist

subscale was additionally significantly positively correlated to the expressive (r = 0.34, P

< .001) and engagement subscales(r = 0.14, P < .001) in the predicted directions. See

Table 4-2.

For the WAI-S, rationalist epistemologies were not significantly correlated with

any of the WAI-S subscales (e.g., Task, Bond, and Goal), however, the constructivist

epistemology was significantly positively correlated with the Task (r = 0.12, P < .001),

Bond (r = 0.19, P < .001), and Goal (r = 0.08, P < .012) subscales of the WAI-S, with

subscales in the predicted direction.

Finally, when looking at types of techniques therapists use in therapy, the

rationalist epistemology was significantly negatively correlated with the use of

constructivist techniques (r = -0.32, P < .001) and significantly positively correlated with









the use of cognitive behavioral techniques (r = 0.43, P < .001), which was in the

predicted directions. On the other hand, constructivist epistemologies were significantly

positively correlated with the use of constructivist techniques (r = 0.22, P < .001), which

was in the predicted direction; however, constructivist epistemology was not significantly

correlated with cognitive behavioral techniques. See Table 4-2.

Regression Analyses

In order to assess the capacity of the data to be in line with the normality

assumptions of multiple regression, the data was subjected to tests of skewness and

kurtosis. Results of these analyses indicate that the assumptions for multivariate

normalcy were met. All skewness and kurtosis estimates for the variables fell between 1

and -1 except for the constructivist subscale which had a kurtosis value of 1.569.

In addition, alpha levels were protected by conducting Bonferroni corrections

(dividing the conventional alpha of .05 by the number of criterion variables), which

results in a more conservative test of they hypotheses. Please see Table 4-3 for overall

means and standard deviations for each of the measures.

Hypothesis 1

The first hypothesis concerned therapist epistemology as a predictor of therapy

style. More specifically, that therapists with rational epistemologies would have a

therapy style depicting more rigidity on the Instructional subscale, more distance on the

expressive subscale, a lesser degree of engagement, more narrow focus on the attentional

subscale, and more planned on the operative subscale compared to therapists with a

constructivist epistemology. Thus, for the first hypothesis, a multiple linear regression

analysis was conducted to determine if therapist epistemology was a significant predictor









of the criterion variables (therapist therapy style) using the five subscales of the PST-Q

(Instructional subscale, expressive subscale, engagement subscale, attentional subscale,

and operative subscale). Separate regression analyses were conducted for each of the five

PST-Q scores measuring therapy style. As was previously described, epistemology will

be operationalized as two separate continuous subscale scores (rationalist and

constructivist) in all regression analyses.

Instructional style

The epistemology scores accounted for significant variation in Instructional

(therapy style) scores, F(2, 1061) = 7.06, p < .001 (R2 = .013). The standardized beta

coefficient for the rationalist epistemology (l = .053) was in the positive direction, but

was not significant, t(1061) = 1.73, p < .084. The standardized beta coefficient for the

constructivist epistemology (f = -0.097) was significant and in the negative direction for

the Instructional subscale, t(1061) = -3.15,p < .002. The direction of effect indicated

that the more a therapist endorsed constructivist epistemology, the less likely that

therapist was to use an instructional approach to therapy. This supported the hypothesis

that a constructivist epistemology tends toward the direction of flexibility on the

Instructional subscale, however, the small effect size of approximately 1% of the variance

needs to be considered.

Expressive style

Epistemology was also a significant predictor of the therapy style along the

expressive subscale (e.g., amount of distance versus closeness), F(2, 1080) = 94.27, p <

.001 (R2 = .15). The standardized beta coefficient (P = -0.177) was significant for the

rationalist epistemology t(1080) = -6.28, p < .0001 and in the negative direction, whereas

the significant standardized beta coefficient for the constructivist epistemology (P =









0.326), was significant t(1080) = 11.56, p < .0001 and in the positive direction along the

expressive subscale. This supported the hypothesis that the rationalist epistemology tends

towards distance on the expressive subscale, whereas, the constructivist epistemology

tends towards greater closeness on the expressive subscale.

Engagement style

Epistemology was also significant predictor of the therapy style along the

engagement subscale, F(2, 1096) = 47.26, p < .001 (R2 = .08). The significant

standardized beta coefficient (f = -0.245) for the rationalist epistemology, t(1096) = -

8.42, p < .001, was in the opposite direction compared to the significant standardized

beta coefficient (8 = 0.119) for the constructivist epistemology, t(1096) = 4.08, p < .001,

along the engagement subscale. This supported the hypothesis that the rationalist

epistemology tends towards a lesser degree of engagement on the engagement subscale

and the constructivist epistemology tends towards a greater degree of engagement on the

engagement subscale.

Attentional style

Epistemology was also significant predictor of the therapy style along the

attentional subscale (e.g., broad versus narrow focus), F(2, 1096) = 118.33, p < .001 (R2

=.18). The significant standardized beta coefficient (f = 0.396) for the rationalist

epistemology t(1096) = 14.41, p < .001, was in the positive direction; whereas the

significant standardized beta coefficient (f = -0.129) for the constructivist epistemology

t(1096) = -4.12, p < .001, which was in the negative direction along the attentional

subscale. This supported the hypothesis that the rationalist epistemology has more of a

leaning towards a narrow focus on the attentional subscale, and the constructivist

epistemology leans more towards a broad focus on the attentional subscale.









Operative style

Lastly, epistemology was a significant predictor of the therapy style along the

operative subscale (e.g., spontaneous versus planned), F(2, 1093) = 187.86, p < .001 (R2

= .256). The standardized beta coefficient (f = 0.461) for the rationalist epistemology

was significant, t(1093) = 17.61, p < .0001 and in the positive direction, compared to the

significant standardized beta coefficient (f = -0.170), for the constructivist epistemology,

t(1093) = -6.50, p < .0001, which was in the negative direction along the operative

subscale. This supported the hypothesis that the rationalist epistemology tends towards

more planning on the operative subscale and the constructivist epistemology tends

towards more spontaneity on the operative subscale.

Hypothesis 2

According to the second hypothesis (therapists with rationalist epistemologies will

score higher on the Task and Goal subscales and lower on the Bond subscale than the

constructivist epistemologies), another multiple linear regression model was conducted to

determine if the same predictor variable (therapist epistemology) will influence therapists

ratings of the criterion variables (working alliance) according to therapists' scores on the

three subscales (Task, Goal, & Bond).

Task

Epistemology was a significant predictor of therapist emphasis on the working

alliance along the Task subscale (e.g., client and therapist agreement on goals), F(2,

1080) = 8.34, p < .001 (R2 = .015). The standardized beta coefficient for the rationalist

epistemology (f = 0.042) was in the positive direction, but was not significant t(1080) =

1.39, p < .164. The significant standardized beta coefficient (f = 0.120) for the

constructivist epistemology, t(1080) = 3.96, p < .0001, was also in the positive direction









along the Task subscale. This was inconsistent with the hypothesis that the rationalist

epistemology would place a greater emphasis on the Task subscale in the working

alliance than therapists with a constructivist epistemology. However, the small effect

size of approximately 2% of the variance needs to be considered when interpreting these

findings.

Goal

Epistemology was also a significant predictor of therapist emphasis on the working

alliance along the Goal subscale (e.g., client and therapist agreement on how to achieve

the goals), F(2, 1093) = 4.92, p < .007 (R2 = .009). The significant standardized beta

coefficient (f = 0.065) for the rationalist epistemology t(1093) = 2.16, p < .031, was in

the positive direction. The significant standardized beta coefficient (8 = 0.075) for the

constructivist epistemology t(1093) = 2.47, p < .014, was also in the positive direction

along the Goal subscale. This was again inconsistent with the proposed hypothesis that

the rationalist epistemology would have stronger leanings towards the Goal subscale in

the therapist emphasis on working alliance compared to therapists with a constructivist

epistemology.

Bond

Lastly, epistemology was also a significant predictor of the therapist emphasis on

the working alliance along the Bond subscale (the development of a personal bond

between the client and therapist), F(2, 1089) = 19.49, p < .001 (R2 = .035). The

standardized beta coefficient for the rationalist epistemology (8 = -0.034) was in the

negative direction, but was not significant, t(1089) = -1.15,p < .249. For the

constructivist epistemology, the standardized beta coefficient (f = 0.179) was significant

t(1089) = 5.99, p < .0001, and in the positive direction along the Bond subscale. This









supported the hypothesis that the rationalist epistemology is less inclined towards

therapist emphasis on working alliance on the Bond subscale than the constructivist

epistemology.

Hypothesis 3

The third and final analysis is designed to address the prediction that epistemology

will be a predictor of therapist use of specific therapy techniques. More specifically, that

the rationalist epistemology will report using techniques associated with cognitive

behavioral therapy (e.g., advice giving) more than constructivist epistemologies, and

therapists with constructivist epistemologies will report using techniques associated with

constructivist therapy (e.g., emotional processing) more than therapists with rationalist

epistemologies). A multiple linear regression analysis was conducted to determine if the

predictor variable (therapist epistemology) will influence therapist ratings of the criterion

variables (therapy techniques).

Cognitive behavioral techniques

Epistemology was a significant predictor of cognitive behavioral therapy

techniques (e.g., advice giving), F(2, 993) = 112.34,p < .001 (R2 = .185). The

standardized beta coefficient for the rationalist epistemology (f = 0.430) was significant,

t(993) = 14.96, p < .001 and in the positive direction. The standardized beta coefficient

for the constructivist epistemology (f = 0.057) was significant and in the positive

direction t(993) = 1.98, p < .05. This supported the hypothesis that the rationalist

epistemology would have stronger leanings of therapist use of cognitive behavioral

techniques when conducting therapy than constructivist epistemologies.









Constructivist techniques

Finally, epistemology was a significant predictor of constructivist therapy

techniques (e.g., emotional processing), F(2, 1012) = 80.82, p < .001 (R2= .138). The

standardized beta coefficient for the rationalist epistemology ( = -0.297) was significant

t(1012) = 10.09, p < .0001 and in the negative direction. The standardized beta

coefficient for the constructivist epistemology (f = 0.195) was significant t(1012) = 6.63,

p < .0001, and in the positive direction. This supported the hypothesis that the

constructivist epistemology would place a stronger emphasis on therapist use of

constructivist techniques when conducting therapy than rationalist epistemologies.









Table 4-1. Internal consistencies for the CAS, TAQ-SF, WAI-S, PST-Q, and techniques
list.
Scale N Alpha P-Value
CAS 1113 0.70 .001
TAQ-Rational 1130 0.72 .001
TAQ-Constructivist 1138 0.63 .001
WAI-S-Total 1107 0.75 .001
WAI-S-Task 1146 0.80 .001
WAI-S-Bond 1145 0.71 .001
WAI-Goals 1149 0.61 .001
PST-Q-Instmctional 1114 0.65 .001
PST-Q-Expressive 1135 0.65 .001
PST-Q-Engagement 1148 0.68 .001
PST-Q-Attentional 1148 0.47 .001
PST-Q-Operative 1146 0.75 .001
CBT Techniques 1033 0.91 .001
CON Techniques 1054 0.84 .001










Table 4-2 Pearson correlations for therapy style, working alliance, techniques & years of
experience.
Instructional Expressive Engagement Attentional Operative
Subscale Subscale Subscale Subscale Subscale

Rationalist Correlation .07 -.21 -.26 .41 .48
Epistemology Sig. (2-tailed) .03 .00 .00 .00 .00
N 1074 1093 1109 1109 1105
Constructivist Correlation -.10 .34 .14 -.15 -.22
Epistemology Sig. (2-tailed) .001 .001 .001 .001 .001
N 1085 1104 1120 1118 1117


Task Bond Goals Cognitive- Constructivist
Subscale Subscale Subscale Behavioral Techniques

Rationalist Correlation .03 -.06 .05 .43 -.32
Epistemology Sig. (2-tailed) .36 .05 .07 .001 .001
N 1104 1105 1109 1004 1024


Constructivist Correlation .12 .19 .08 .03 .22
Epistemology Sig. (2-tailed) .001 .001 .01 .40 .001
N 1112 1111 1115 1011 965


Years of
Experience

Rationalist Correlation -.10
Epistemology Sig. (2-tailed) .00
N 1096


Constructivist Correlation -.07
Epistemology Sig. (2-tailed) .00
N 1105










Table 4-3 Means and standard deviations for epistemology, therapy style, working
alliance, and intervention selection.
Rationalist Constructivist Instructional Expressive Engagement Attentional Operative
Epistemology Epistemology Subscale Subscale Subscale Subscale Subscale




Mean 22.11 32.74 30.76 41.25 29.16 18.13 21.55
SD 5.12 3.42 6.17 6.18 5.11 3.66 5.83
N 1130 1138 1114 1135 1148 1148 1146



Task Bond Goals Cognitive- Constructivist
Subscale Subscale Subscale Behavioral Techniques

Techniques


Mean 21.04 23.09 17.35 61.39 53.89
SD 2.65 2.20 1.80 11.85 10.36
N 1146 1145 1149 1024 983














CHAPTER 5
DISCUSSION

The discussion section is structured according to three parts. First, a discussion of

the hypotheses and findings of the study are reviewed. Second, a more specific

explanation of the findings is given with results interpreted within the context of the

current literature on therapists' epistemology in relation to their therapy style, working

alliance, and selection of particular therapeutic techniques. Finally, limitations and the

implications of the current study were reported, along with suggestions for future

research.

Summary of the Results

This study investigated the relationship between therapists' epistemological

assumptions (rationalist versus constructivist) and their therapy style, working alliance,

and use of particular therapeutic interventions. The specific questions in this study were

whether therapist epistemology was a predictor of (1) therapy style, particularly, the

extent of rigidity versus flexibility, distance versus closeness, lesser versus greater degree

of engagement, narrow versus broad focus, and spontaneous versus planned styles of

working with clients, (2) working alliance, in particular, agreement on tasks and goals

and the development of a personal bond between the client and therapist, and (3)

selection of particular therapeutic interventions, i.e., cognitive behavioral versus

constructivist interventions. Each of these three questions will now be discussed in

further detail in relation to the current findings, however; overall, most of the results of

the current study supported the hypotheses in the predicted directions.









Epistemology (rationalist versus constructivist) was found to be a significant

predictor of therapy style. In particular, the most robust findings provide provisional

support for the notion that there are specific differences in the personal style of the

therapist according to the therapists' epistemic assumptions. More specifically, the

current study found that therapists with rationalist epistemologies tended towards more

distance, a lesser degree of engagement, more narrow focus, and more planning in their

sessions with clients, whereas, the constructivist epistemology tended towards having a

greater degree of closeness, a greater degree of engagement, more broad focus, and more

spontaneity in their therapy sessions.

Additionally, there was some support for the notion that therapists with

constructivist epistemologies tend toward the direction of flexibility rather than rigidity in

their therapy style; however this was not a particularly strong finding in the current study.

These findings are helpful when considering the potentially inherent differences

maintained by rationalist versus constructivist epistemologies according to therapy style.

More specifically, current findings support the notion that cognitive-behavioral therapies,

which represent the best depiction of the rationalist epistemology, maintain an "active-

directive" and systematic approach to therapy (Granvold, 1988) with specific goals used

to plan the course of the session (Mahoney & Lyddon, 1988). Additionally, the current

study supported the depiction of cognitive-behavioral therapy style as distancing or

attempting to control emotional communication between client and therapist through

logical analysis (G. Neimeyer et al., 2005). On the other hand, R. Neimeyer (2005)

describes the process of constructivist psychotherapy, which represents the clearest

depiction of the constructivist epistemology, as,









The process is something like two hikers laboring together through a deep wood
along a footpath that winds gradually up the side of a steep knoll. And suddenly, at
a moment that cannot be fully predicted by either hiker, they break upon a clearing
that affords a panoramic view of the path they have taken and its relationship to the
surrounding terrain. (p. 80)


This metaphorical representation of a constructivist psychotherapists' approach to

therapy or therapy style highlights the importance of flexibility and spontaneity.

Additionally, R. Neimeyer (2005) uses this metaphor to suggest the constructivist

therapists' emphasis on the therapists' engagement or involvement with the client on the

therapy endeavor, with the depiction of the therapist and client "laboring together." This

image thus extends to the differences found according to epistemology and the therapists'

emphasis on the working alliance.

An additional finding in the current study indicated that therapist epistemology

(rational versus constructivist) was a significant predictor of at least some aspects of the

working alliance. The strongest finding was in relation to the development of a personal

bond between the client and therapist (Bond subscale). Therapists with a constructivist

epistemology tended to place more emphasis on the personal bond in the therapeutic

relationship compared to therapists with a rationalist epistemology. This supports the

notion in the literature that constructivist therapists place a greater emphasis on building a

quality therapeutic relationship characterized by, "acceptance, understanding, trust, and

caring.

Lastly, findings in the current study regarding therapists' epistemology (rationalist

versus constructivist) and their use of specific interventions (cognitive behavioral versus

constructivist) revealed that therapists' with rationalist epistemologies tended to favor the

use of cognitive behavioral techniques and also tended to reject the use of constructivist









techniques. Similarly, therapists' with constructivist epistemologies tended to favor the

use of constructivist techniques in their practice of therapy; however they did not as

strongly reject the use of cognitive behavioral techniques. This notion is supported by

literature that suggests that constructivist therapists value having "a rich set of

possibilities that can be engaged at any moment depending on the client's need" (R.

Neimeyer, 2005, p. 83). Thus, findings from the current study may suggest that while the

constructivist therapist is more likely to use constructivist therapy techniques, they are

also more open to using other techniques depending on the individual client compared to

rationalist therapists.

Discussion of Results within the Context of Current Literatures

Therapists' Epistemology and Therapy Style

The literature notes several studies suggesting potential differences in therapists'

epistemology and their therapy style (Granvold, 1996; Lyddon, 1990; G. Neimeyer &

Morton, 1997; R. Neimeyer, 1993b; Winter & Watson, 1999). Granvold (1996) suggests

specific distinctions between rationalist and constructivist therapists' epistemologies such

that rationalist therapists tend to target cognitions for modification and subsequently

educate the client on the impact of cognitions in functioning and change in a more

directive manner, whereas constructivist therapists are less directive, more exploratory,

less problem-focused, and more experiential. A key goal in the current study was to

examine the relationship between therapist epistemology and their therapy style

according to the asserted hypotheses and in directions dictated by associated literatures.

Overall, the hypotheses were supported in the predicted directions. One of the

more robust findings came from the components of therapy style that Fernandez-Alvarez

et al. (2003) term expressive which is described as the "actions carried out by the









therapist to ensure emotional communication with the patient" (p. 118). Therapists' with

constructivist epistemologies scored higher on this scale in the positive direction;

whereas, therapists with rationalist epistemologies scored lower on this scale and in the

negative direction. This finding highlights what the current literature suggests regarding

differences between constructivist and rationalist epistemology in relation to close

"emotional communication" with the client (e.g., Granvold, 1996; Mahoney & Lyddon,

1988). More specifically, Granvold (1996) suggests that rationalist therapists seek to

"control, alter, or terminate emotions. .. emotions are regarded as 'negative... Emotional

expressions are considered the 'problem' and faulty cognitions the cause" (p.348).

Constructivist therapists, on the other hand, "consider emotions to be integral to the

personal-meaning process in which...the individual continuously evolves" (p. 348). In

addition, Guidano (1987) suggests that for the constructivist therapist, emotional

expressions are promoted for the function of second order change. Thus, in the current

study this core component of both the rationalist and constructivist epistemology showed

through in their therapy style.

The engagement subscale, which Fernandez-Alvarez et al. (2003) term "the set of

explicit and implicit behavior connected to the therapist's commitment to. ... his

patients" (p. 119), revealed another important finding that supports key distinctions

between rationalist and constructivist therapists' therapy style. In the present study,

rationalist therapists scored lower and in the negative direction (e.g., lesser degree of

engagement), compared to constructivist therapists who scored higher and in the positive

direction (e.g., greater degree of engagement). R. Neimeyer (2005) depicts his degree of

engagement as a constructivist therapist as,









Moments of intensive therapeutic engagement are simply a special instance of a
larger set of relational experiences in which the more typical subject-object
boundaries that constrain our sense of self and other can be transcended to permit
something akin to a joint experience. (p. 82)


He further notes that when a client is experiencing deep emotions that, as a

therapist, "if I don't at least have moisture in my eyes, then something is wrong" (p. 81).

This highlights constructivist therapists' core commitment to a high degree of

engagement with a client. In contrast, rationalist therapists' consider their role in therapy

to be that of an educator, instructor and to exclude or control emotion via logical analysis

(Mahoney & Lyddon, 1988; G. Neimeyer et. al., 2005). A study by Winter and Watson

(1999) suggested that rationalist therapists showed a more negative attitude towards their

clients and their clients had less overall involvement in therapy compared to clients

receiving constructivist therapy. Thus, the current study supports and extends previous

research by suggesting that constructivist therapists tend to report a greater degree of

engagement in their therapy style compared to rationalist therapists by endorsing more

emotional closeness with clients, more involvement in therapy, and more personal

concern for clients.

Another strong finding in the current study came from the component of therapy

style that Fernandez-Alvarez et al. (2003) term attentional (e.g., more broad versus

narrow focus) or "... either stressing his receptive capacity for the information that the

patient gives or taking a more active role in order to elicit specific information" (p. 119).

The rationalist therapists in the current study endorsed a stronger leaning towards a more

narrow focus in therapy; whereas the constructivist therapists reported a stronger leaning

towards a more broad focus in their therapy style. These findings are consistent with the

current literature that has investigated differences between rational and constructivist









therapies suggesting that rationalist therapists prefer a more problem focused approach to

therapy, however constructivists take a more open and exploratory approach to therapy

(Granvold, 1996; G. Neimeyer et. al., 2005).

Lastly, the most robust finding for therapy style in the current study is in regards to

the operative subscale, which is described as the "actions directly connected to the

specific therapeutic interventions" (p. 119). Thus, how spontaneous or planned a

therapist is in their procedures of therapy. The current study highlighted the distinct

differences in rationalist and constructivist epistemologies found in current literature with

rationalist therapists scoring higher and in the positive direction (e.g., reporting a more

planned procedure of therapy) compared to constructivist therapists who scored lower

and in the negative direction (e.g., reporting a more spontaneous procedure of therapy).

This notion is expressed in the work of Mahoney and Lyddon (1988) who suggest,

"Rationalists tend to guide the course of therapy according to presenting problems and

specific goals..." (p.217), whereas, R. Neimeyer (2005) indicates that constructivist

therapists aim in,

not overly structuring the agenda for the session by my own preconceptions of what
my client requires, particularly to the extent that such an agenda is driven by some
diagnostic or classificatory system. .. (p.78)

Again, a core facet of both rationalist and constructivist therapists' epistemology

was supported in the current study regarding how planned versus spontaneous they

reported their therapy style to be. These core epistemic assumptions and how they

translate into the practice of therapy, also extend into the domain of the working alliance,

concentrated on in the next section.









Therapists' Epistemology and Working Alliance

Another important goal of the present study was to investigate the relationship and

potential difference between therapists' epistemologies and their emphasis on the

working alliance. Results from the current study did not reveal particularly strong

connections between therapist epistemology and working alliance. Perhaps one

explanation for why there was not a strong relationship between therapist epistemology

and the working alliance subscales of Task and Goal in the current study is because both

of these subscales focus on client and therapist general agreement on tasks (e.g., My

counselor and I agree about the things that I need to do in therapy to help improve my

situation) and goals (e.g., We have established a good understanding of the kind of

changes that would be good for me), rather than specific qualities of the tasks and goals.

For example, both rationalist and constructivist therapist may endorse that they agree

with their client about how to help improve the client's situation but how they

specifically go about determining that agreement in the working alliance may be very

different. For example, the literature suggests that rationalist therapists tend to guide the

client towards understanding or agreement on the tasks and goals of therapy (Beck et al.,

1979), whereas, the constructivist therapist may tend towards offering more exploration

of tasks and goals in therapy and less direct guidance (Winter & Watson, 1999). Thus,

the use and/or development of a measure of working alliance that includes more specific

items in relation to tasks and goals that would better distinguish between rationalist and

constructivist therapists' epistemologies would be an avenue of future research.

Additionally, future work may adapt the set of directions for the participant such

that participants are prompted to consider their current client load, and one client that

they feel they have a good working relationship with or the most recent clients that they









have seen at least three times, or some other instructions that are more specific to

particular clients they are working with rather than general.

Results for the working alliance subscale, Bond, however, do provide a preliminary

understanding of therapist inclinations by epistemology. For example, the most robust

finding was in relation to the Bond subscale of the working alliance, and suggested that

therapists with constructivist epistemologies more strongly endorsed the importance of

the bond component in their practice of therapy compared to therapists with rationalist

epistemologies. This finding is supported by conceptual literature that suggests that

constructivist therapist values a working alliance characterized by mutual respect (R.

Neimeyer, 2005), acceptance, understanding, trust, and caring (Granvold, 1996).

Mahoney and Lyddon (1988) indicated that

For the rationalist, a professional counseling relationship is one that primarily
involves the service or delivery of direct guidance and technical instruction. In
effective rational psychotherapy it is the imparting of knowledge and information
that takes precedence over the therapeutic relationship. (p. 221)


These authors also highlight that when this type of knowledge can be given through

"audiovisual and mechanical means" the insignificance of the human relationship in

therapy is evident (as cited in Mahoney & Lyddon, 1988). Overall, the present study

continues to support key distinctions between rationalist and constructivist therapist in

the working alliance, however further research could aim to find more specific measures

geared towards the bond component of the working alliance to further tease apart these

distinctions.

Therapists' Epistemology and Selection of Specific Techniques

Finally, the last goal in the current study was to better understand the relationship

between therapists' epistemologies (rationalist versus constructivist) and their use of









specific techniques (cognitive behavioral versus constructivist) in their practice of

therapy. In particular, the purpose was to examine whether these epistemological

differences relate to the selection of specific interventions that fit more with the

corrective and directive orientation of rationalist therapists or exploratory and creative

orientation of constructivist therapists. It was hypothesized that rationalist therapists

would report using more cognitive behavioral techniques than therapists' with

constructivist epistemologies and that constructivist therapists would report using more

constructivist techniques compared to therapists with rationalist epistemologies.

Winter and Watson (1999) cite both empirical and theoretical support for a

theoretical allegiance to the use of particular techniques, noting key distinctions between

rationalists' use of techniques (e.g., more challenging and directive interventions)

compared to constructivist therapists' use of techniques (e.g., ask more questions and use

interpretation as a means of exploration of the client's meaning making system). While

these hypotheses held true in the current study, an interesting additional finding was that

constructivist therapists were more open to the use of cognitive behavioral techniques

than rationalist epistemologies were of constructivist techniques. This notion is further

supported by R. Neimeyer (2005) who suggests that, "In my view, nothing in this

practice is incompatible with a constructivist therapy" (p. 93). Similarly, Kelly (1969)

suggests, "The relationships between therapists and clients and the techniques they

employ may be as varied as the whole human repertory of relationships and techniques"

(p. 223). For therapists with rationalist epistemologies, Granvold (1996) suggests that

rationalist therapists tend to stick to a problem focus and tend to have a stricter adherence

to methodology compared to constructivist therapists. This supported the findings in the









current study that suggests that therapists' with rationalist epistemologies not only

favored the use of cognitive behavioral techniques in their practice, but they also tended

to reject the use of constructivist techniques in their practice of therapy, whereas

therapists with constructivist epistemologies, while favoring constructivist techniques,

were also more open to the use of cognitive behavioral techniques.

Limitations and Future Research

This study is not without limitations. For example, the characteristics of

participants in the current study may have compromised the external validity. This study

was conducted on a voluntary basis and those who volunteered to participate may have

been a biased sample. Rosenthal and Rosnow (1975) suggest that volunteers tend to differ

from non-volunteers in behavioral research regarding their level of education,

intelligence and desire of social approval. Additionally, the data collection procedure

may have compromised the external validity of the current study. For example, the data

collection was conducted via the Internet, which may further distinguish the

characteristics of the participants who volunteered to participate in the study from non-

volunteers. However, in light of these limitations, having an overall sample size of over

one thousand practicing psychologists in the fifty United States may have improved the

representativeness of the sample and subsequently, the generalizability of the findings.

In addition, greater confidence in the representativeness of the sample in the current

study is found by using the closest approximation to what would be a comparison with

the bulk of our sample (e.g., psychologists) to members of the American Psychological

Association along demographic dimensions (e.g., gender, ethnicity, and age). For

example, in the current study, 64 % of the sample was female and 36% of the sample was

male, which is roughly comparable to APA members reported to be approximately 53%









female and 47% male. In the current study, the mean age of participants was 45.09 (SD =

12.54), which is again roughly comparable to APA members mean age reported as 53.30

(SD = 13.6). The ethnicities in the current study were Caucasian, 88.8%, Multiracial,

2.9%, Hispanic, 2.7%, African American, 2.4%, and Asian American, 2.1%. Again, this

is roughly comparable the APA members reported ethnicities as Caucasian, 67.6%,

Multiracial, 0.3%, Hispanic, 2.1%, African American, 1.7%, and Asian American, 1.9%

(http://research.apa.org/profile2005tl.pdf, 2005).

Another limitation regarding the generalizability of the findings in the current study

is the self-report nature of the study. Rosenthal and Rosnow (1991) indicate that self-

reports are subject to distortion and social desirability effects. In addition, self-reports

may not correlate well with participants' actual behavior.

It is also important to highlight the fact that the findings in the current study are

associations between the variables of interest and do not imply causal relationships. For

example, therapists with constructivist epistemologies may tend to place more of an

emphasis on the personal bond component of the working alliance, but this does not

mean that we can indicate that therapists' constructivist epistemologies cause them to

place more of an emphasis on the personal bond component of the working alliance. It

may be that the therapist's emphasis on a personal bond predisposed them towards

endorsing greater constructivist leanings, or that a third variable accounted for the

relationship between personal bond and constructivist commitments. Therefore, current

results can only suggest potential relationships and cannot imply causality.

Further research could aim to investigate client's perceptions of cognitive-

behavioral and constructivist therapists' therapy style, emphasis on the working alliance,









and use of particular therapeutic interventions to see if clients corroborate therapists' self-

reported styles with their experience of the therapists' style.

Finally, while the fit of the two factors (constructivist techniques and cognitive

behavioral techniques) to the Techniques List was relatively good, future work on the

Techniques List measure might also benefit from some revision of the current instrument

and additional psychometrics.

Overall, these finding contribute to the literature addressing the translation of

epistemology into practice. The current study provides provisional support for the notion

that therapists with rationalist epistemologies are consistently different in their approach

to therapy, emphasis on the therapeutic relationship, and use of particular interventions

compared to therapists with a constructivist epistemology, in ways consistent with the

epistemological underpinnings of these approaches to therapy.

The current findings are important because they (1) demonstrate the translation of

epistemology into practices; (2) provide information that could be useful to clients in

selecting a therapist whose orientation may enable them to anticipate stylistic features;

and (3) provide the opportunity to further study the translation of these perceptions into

actual behaviors and behaviors into different impacts or outcomes.

Conclusion

In conclusion, the present study examined the relationship between epistemic style

and therapists' therapy style, working alliance, and selection of particular therapeutic

interventions. Results of the study suggested that therapists' epistemologies were

associated with the levels flexibility versus rigidity, distance versus closeness, degree of

engagement, broad versus narrow focus, and spontaneous versus planned components of

their therapy style. Therapists with stronger constructivist or rationalist epistemologies









tended to score higher on these subscales according to the nature of their epistemological

commitments.

Results of the study also revealed that therapists with constructivist epistemologies

were associated with a greater degree of emphasis on the Bond subscale of the working

alliance, whereas, both constructivist and rationalist epistemologies tended to place a

greater degree of emphasis on the Goal subscale of the working alliance. Additionally,

therapists with constructivist epistemologies tended to use more particularly

constructivist techniques in their therapy practice, whereas, therapists' rationalist

epistemologies tended to use more rationalist techniques in their practice of therapy.

The current study extended the developing literature on therapists' epistemology as

a factor relating to psychotherapists' practice of therapy. Further, more outcome related

research is required to understand how therapists' epistemology impacts the

successfulness of work with clients. The current study was the first empirical

investigation of therapists' epistemology and the specific translation of epistemology into

the practice of therapy in relation to therapists' style, working alliance, and use of

specific techniques. While some of the results failed to support the expected directions

for the specified subscales, most results were in the expected directions supporting the

overall coherence of the epistemological commitment with therapeutic enactments.

Further work may benefit from focusing on how therapists' epistemologies might affect

the effectiveness of practicing psychotherapy in accordance with therapists' epistemic

commitments.














APPENDIX A
THERAPIST ATTITUDE QUESTIONNAIRE SHORT FORM (TAQ-SF)

1 2 3 4 5
Strongly Moderately Neither agree Moderately Strongly
disagree disagree nor disagree agree agree

1. Reality is singular, stable and external to human experience.

2. Knowledge is determined to be valid by logic and reason.

3. Learning involves the contiguous or contingent chaining of discrete events.

4. Mental representations of reality involve accurate, explicit and extensive copies of the
external world, which are encoded in memory.

5. It is best for psychotherapists to focus treatment on clients' current problems and the
elimination or control f these problems.

6. Disturbed affect comes from irrational, invalid, distorted or/and unrealistic thinking.

7. Clients' resistance to change reflects a lack of motivation, ambivalence or motivated
avoidance and such resistance to change is an impediment to therapy, which the
psychotherapist works to overcome.

8. Reality is relative. Realities reflect individual or collective constructions of order to
one's experiences.

9. Learning involves the refinement and transformation (assimilation and
accommodation) of mental representation.

10. Cognition, behavior and affect are interdependent expressions of holistic systemic
processes. The three are functionally and structurally inseparable.

11. Intense emotions have a disorganizing effect on behavior. This disorganization may
be functional in that it initiates a reorganization so that more viable adaptive
constructions can be formed to meet the environmental demands.

12. Psychotherapists should encourage emotional experience, expression, and
exploration.









13. Clinical problems are current or recurrent discrepancies between our external
environmental challenges and internal adaptive capacities. Problems can become
powerful opportunities for learning.

14. Awareness or insight is one of many strategies for improvement, however, emotional
and/or behavioral enactments are also very important.

15. Therapists' relationship with clients is best conceptualized as a professional helping
relationship, which entails the service and delivery of technical, instructional information
or guidance.

16. Psychotherapists' relationship with clients can best be conceptualized as a unique
social exchange, which provides the clients a safe supportive context to explore and
develop relationships with themselves and the world.






















Reprinted with permission from Neimeyer, G.J., & Morton, R. J. (1997). Personal
epistemologies and preferences for rationalist versus constructivist
psychotherapies. Journal of Constructivist Psychology, 10, 109-123.














APPENDIX B
CONSTRUCTIVIST ASSUMPTIONS SCALE (CAS)


Please indicate the degree to which you agree or disagree with the following statements
using the following scale:

1 = Strongly Disagree
2 = Disagree
3 = Neutral
4 = Agree
5 = Strongly Agree

1. Facts speak for themselves.
2. Our understanding of the natural, physical world is influenced by our social values.
3. Scientific facts are universal truths; they do not change over time.
4. Nothing is really good or bad, it always depends upon how we think about it.
5. What we see with our own eyes is influenced by our expectations.
6. Truth is relative. What is true at one point in time may not be true at another.
7. Scientific investigations are objective; they are not influenced by social values.
8. We never see the world as it really is. What we perceive depends on what we believe
and want to see.
9. Our understanding of human behavior is influenced by our social values.
10. Nothing is really important by itself. A thing is important if we think it is.
11. Seeing is believing.
12. The more people know, the more they are bound to feel that they cannot be
completely sure about anything.








Reprinted with permission from Berzonsky, Michael (1994). Individual differences in
self construction: the role of constructivist epistemological assumptions. Journal of
Constructivist Psychology, 7, 263-281.














APPENDIX C
PERSONAL STYLE OF THE THERAPIST (PST-Q)


Directions: Please rate the following question along the scale the following 7-point scale:

1 2 3 4 5 6 7

Total Disagreement ............................. ...........Total Agreement

'1' represents total disagreement with the statement and '7' means total agreement.

1. I tend to be open-minded and receptive in listening rather than narrow-minded and
restrictive.
2. I try to get patients to adjust to the regular format of my work.
3. As a therapist I prefer to indicate to patients what they should do in each session.
4. I keep a low profile of involvement with patients in order to be more objective.
5. I find changes in the setting quite exciting.
6. The emotions the patient arouses in me are key to the course of the treatment.
7. I'm more inclined to accompany the patient in exploring than to point out the steps to
follow.
8. I avoid communicating through gestures or deeply emotional expressions.
9. I tend to demand strict compliance with schedules.
10. I place little value on planned treatments.
11. Expressing emotions is a powerful tool leading to changes.
12. Many important changes that occur during treatment require the therapist to respond
without expressing much emotion.
13. I don't think about patients outside sessions.
14. Changing offices has a negative impact on treatment.
15. Real changes take place during highly emotional sessions.
16. I believe I am a therapist with a flexible setting.
17. I find it useful to reveal something personal about myself during sessions.
18. I like to feel surprised by what each patient brings to the session without having
preconceived notions.
19. I often attend patients outside the office.
20. The best intervention in a treatment occurs spontaneously.
21. Whatever happens to my patients has little influence on my own life.
22. My intervention is mostly directive.
23. I think quite a lot about my job even in my spare time.
24. I avoid revealing my emotions to my patients.
25. I can plan an entire treatment from the very outset.
26. Keeping emotional distance from patients favors change.









27. I never change how long a session lasts, unless absolutely necessary.
28. If something bothers me during a session I can express it.
29. Emotional closeness with patients is essential to bring about therapeutic change.
30. I prefer to know in advance what things I should pay attention to in sessions.
31. I prefer treatments where everything is programmed.
32. I like working with patients who have clearly focused problems.
33. I can give my entire attention to everything that takes place during sessions.
34. I think about patients' problems even after sessions.
35. I'm quite flexible with schedules.
36. Right from the beginning of the session I allow my attention to float.
























Reprinted with permission from Fernandez-Alvarez, H., Garcia, F., Bianco. J. L., &
Santoma, S. C. (2003). Assessment questionnaire on the Personal Style of the
therapist PST-Q. Clinical Psychology andP yh, I/ithe/itr/, 10, 116-125















APPENDIX D
WORKING ALLIANCE INVENTORY SHORT FORM (WAI-S)

Following are sentences that describe some of the different ways a person might
think or feel about his or her clients. As you read the sentences mentally consider the
clients that constitute your current client load.
Using the following 7-point scale, please indicate how you feel about your
relationship with your clients. If the statement describes the way you always feel (or
think) mark the number 7; if it never applies to you mark the number 1. Use the numbers
in between to describe the variations between these extremes.

Please respond to every item with your first impressions.


1 2 3 4 5 6 7
Never Rarely Occasionally Sometimes Often Very Often Always

1. My clients and I agree about the steps to be taken to improve his/her
situation.

2. My clients and I both feel confident about the usefulness of our current
activity in therapy.

3. I believe my clients like me.

4. I have doubts about what my clients and I are trying to accomplish in
therapy.

5. I am confident in my ability to help my clients.

6. My clients and I are work towards mutually agreed upon goals.

7. I appreciate my clients as a people.

8. My clients and I agree on what is important for this client to work on.

9. My clients and I have built a mutual trust.

10. My clients and I have different ideas on what his/her real problems are.










11. My clients and I establish a good understanding between us of the kind of
changes that would be good for this client.

12. My clients believe the way we work with their problem is correct.
































Reprinted with permission from Horvath, A. O., & Greenberg, L. S. (1986). Development
and validation of the Working Alliance Inventory. Journal of Counseling
Psychology, 36, 223-233.















APPENDIX E
TECHNIQUES LIST


Directions:
Please rate the extent to which you use each therapy technique in your practice of
therapy.

1 2 3 4 5
Never or Seldom Sometimes Often Always or
Almost Never Almost
Always


Technique

active imagination 1 2 3 4 5
advice giving 1 2 3 4 5
alter ego 1 2 3 4 5
analyzing symbols 1 2 3 4 5
assertive training 1 2 3 4 5
aversion-aversive conditioning 1 2 3 4 5

behavior modification 1 2 3 4 5

catharsis 1 2 3 4 5
conditioning techniques 1 2 3 4 5
contractual agreements 1 2 3 4 5
crying 1 2 3 4 5

desensitization 1 2 3 4 5
diagnosing 1 2 3 4 5
dream interpretation 1 2 3 4 5
dreaming 1 2 3 4 5

environmental manipulation 1 2 3 4 5

fantasizing 1 2 3 4 5
first memory 1 2 3 4 5
free association 1 2 3 4 5

homework 1 2 3 4 5






67



irrational behavior identification 1 2 3 4 5

modeling 1 2 3 4 5

negative reinforcement 1 2 3 4 5

play therapy 1 2 3 4 5
problem solving 1 2 3 4 5
processing 1 2 3 4 5
psychodrama 1 2 3 4 5

rational 1 2 3 4 5
reciprocity of affect 1 2 3 4 5
reflection 1 2 3 4 5
reinforcement 1 2 3 4 5
reward 1 2 3 4 5

self-monitoring 1 2 3 4 5
shaping 1 2 3 4 5
sociodrama 1 2 3 4 5
systematic desensitization 1 2 3 4 5

transference 1 2 3 4 5

value clarification 1 2 3 4 5
value development 1 2 3 4 5

warmth 1 2 3 4 5






Reprinted with permission from Hollis, J. W., (1995). Techniques used in counseling and
psychotherapy. In Practicum and Internship Textbook, 173-177.














APPENDIX F
DEMOGRAPHIC INFORMATION

Please tell us a little about yourself. This information will be used only to describe the
sample as a group.

1. Gender: Male Female

2. Age:

3. Ethnic background: White/Caucasian, Black/African-American, Hispanic/Latino/a
Black, Hispanic/Latino/a White, Asian-American-Pacific Islander, American
Indian /Native-American, Multiracial, Other.

4. Name of your highest degree: BA/BS, MA/MS, MSW, PsyD, PhD, Other

5. The year you obtained your highest degree (e.g., 1985):

6. Total number of years you spent in clinical practice:

7. Specialty area: Psychologist, Mental Health Counselor, Marriage and Family therapist,
Social worker, Psychiatrist, Other

8. Primary job responsibility: Practice/Clinical work, Research, Academic,
Administrative, Other.

9. Primary employment setting: Private practice, University academic department,
University service delivery department, Hospital, Mental health care, School
setting, Research setting, Community Center, Other.

10. Please state your dominant therapy orientation: Psychodynamic, Humanistic/Person
centered, Cognitive Behavioral, Rational Emotive, Constructivists, Interpersonal,
Existential, Gestalt, Integrative, Other.

11. Average number of clients you see weekly:

12. Country you live in: US, Canada, Other.















LIST OF REFERENCES


American Psychological Association Website, Demographic characteristics of APA
members by membership status, 2005, http://research.apa.org/profile2005tl.pdf,
04/06.

Arthur, A. R. (2000). The personality and cognitive-epistemological traits of cognitive
behavioral and psychoanalytic psychotherapists. British Journal of Medical
Psychology, 73, 243-257.

Beck, A. T., Rush, A. J., Shaw, B. F. & Emery, G. (1979). Cognitive therapy of
depression. New York: Guilford.

Beck, A. T. (1995). Cognitive therapy: Basics and beyond. New York: Guilford.

Beronsky, M. D. (1994). Individual differences in self-construction: the role of
constructivist epistemological assumptions. Journal of Constructivist Psychology,
7,263-281.

Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working
alliance. P ~yi. hhel,,qy Theory, Research andPractice, 16, 252-260.

Botella, L., & Gallifa, J. (1995). A constructivist approach to the development of
personal epistemic assumptions and word views. Journal of Constructivist
Psychology, 8, 1-18.

Chiari, G., & Nuzzo, M. L. (1996). Psychological constructivism: A metatheoretical
differentiation. Journal of Constructivist Psychology, 9, 163-184.

Diamond, S. R., & Royce, J.R. (1980). Cognitive abilities as expressions of three "ways
of knowing." Multivariate Behavioral Research, 15(1), 3 1-56.

DisGiuseppe, R. & Linscott, J. (1993). Philosophical differences among cognitive
behavioral therapists: Rationalism, constructivism, or both? Journal of Cognitive
P ~yJh,,theiugy, 7, 117-130.

Erwin, E. (1999). Constructivist epistemologies and therapies. British Journal of
Guidance & Counselling, 27, 353-364.

Faidley, A. J., & Leitner, L. M. (1993). Assessing experience in psychotherapy: Personal
construct alternatives. Westport, CT: Praeger.






70


Fernandez-Alvarez, H. Garcia, F., Bianco, J. L., Santoma, S. C. (2003). Assessment
questionnaire on the personal style of the therapist PST-Q. Clinical Psychology
and Psychotherapy, 10, 116-125.

Granvold, D. K. (1996). Constructivist psychotherapy. Families in Society: The Journal
of Contemporary Human Services, 77(6), 345-359.

Guidano, V.F. (1987). Complexity of the self. New York: Guilford.

Hollis, J. W. (1995). Techniques used in counseling and psychotherapy. In J. C. Boylan,
P. B. Malley, & J. Scott (Eds), Practicum and internship: Textbook for counseling
andpyh1,,1hiiqj'y (pp. 182-189). Washington, DC: Taylor & Francis.

Hollon, S. D. & Beck, A.T. (1986). Research on cognitive therapies. In S. L. Garfield &
A. E. Bergin (Eds.), Handbook of psychotherapy and behavior change (3rd ed., pp.
443-482). New York: Wiley.

Horvath, A. O., & Greenberg, L. S. (1986). The development of the working alliance
inventory. In L. S. Greenberg & W. M. Pinsof (Eds.), The psychotherapeutic
process: A research handbook (pp. 529-556). New York: Guilford.

Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure
analysis: Conventional criteria versus new alternatives. Structural Equation
Modeling, 6, 1-55.

Kelly, G. (1955). The psychology of personal constructs. New York: Norton.

Kelly, G. A. (1969). The psychotherapeutic relationship. In B. Maher (Ed.). Clinical
Psychology and Personality: The selected papers of George Kelly. New York:
Wiley.

Lyddon, W. J. (1988). Information-processing and constructivist models of cognitive
therapy: A philosophical divergence. The Journal of Mind and Behavior 9, 137-
166.

Lyddon, W. J. (1989). Personal epistemology and preference for counseling. Journal of
Counseling Psychology, 36, 423-429.

Lyddon, W. J. (1990). First- and second-order change: Implications for rationalist and
constructivist cognitive therapies. Journal of Counseling & Development, 69,
122-127.

Lyddon, W. J. (1991). Epistemic style: implications for cognitive psychotherapy.
PyhL hIthely, 28, 588-597.

Mahoney, M. J. (1991). Human change processes. New York: Basic Books, Inc.









Mahoney, M. J., & Gabriel, T. J. (1987). Psychotherapy and the cognitive sciences: An
evolving alliance. Journal of Cognitive Therapy: An International Quarterly, 1,
39-59.

Mahoney, M. J., & Lyddon, W. J. (1988). Recent developments in cognitive approaches
to counseling and psychotherapy. The Counseling Psychologist, 16, 190-234.

Neimeyer, G. J., Saferstein, J. and Arnold, W. (2005). Personal construct psychotherapy:
Epistemology and practice. In D. Winter and L. Viney (Eds.) Advances inpersonal
construct p,)%L h hel, ii ,py. London: Whurr Publishers.

Neimeyer, G. J., & Morton, R. J. (1997). Personal epistemologies and preferences for
rationalist versus constructivist psychotherapies. Journal of Constructivist
Psychology, 10, 109-123.

Neimeyer, G. J., Prichard, S., Lyddon, W. J., & Sherrard, P. A. D. (1993). The role of
epistemic style in counseling preference and orientation. Journal of Counseling
and Development, 71, 515-523.

Neimeyer, R. A. (2005). The construction of change: Personal reflections on the
therapeutic process. Constructivism in the Human Sciences, 10, 77-98.

Neimeyer, R. A. (1995). Constructivist psychotherapies: Features, foundations, and
future directions. In R. A. Neimeyer & M. J. Mahoney (Eds.) Constructivism in
p*)Li hI/wtli q (pp. 11-38). Washington DC: American Psychological Association.

Neimeyer, R. A. (1993). Constructivism and the cognitive psychotherapies: Some
conceptual and strategic contrasts. Journal of Cognitive P.1Il, hithe'ipy, 7, 159
171.

Okun, B. F. (1990). Seeking connections in p hy, I htill /, y'. San Francisco:
Jossey-Bass Publishers.

Polkinghome, D. E. (1991). Two conflicting calls for methodological reform. The
Counseling Psychologist, 19, 103-114.

Raue, P.J., Goldfried, M.R., & Barkham, M. (1997). The therapeutic alliance in
psychodynamic-interpersonal and cognitive-behavioral therapy. Journal of
Consulting and Clinical Psychology, 65(4), 582-587.

Rosenthal, R., & Rosnow, R.L. (1991). Essentials of behavioral research: Methods and
data analyses (2nd Edition). Boston: McGraw-Hill.

Rosenthal, R., & Rosnow, R.L. (1975). The volunteer subject. New York: John Wiley.

Royce, J. R. (1964). The encapsulated man: An interdisciplinary search for meaning.
Princeton, NJ: Van Nostrand.









Royce, J. R., & Mos, L. P. (1980). Psycho-epistemological profile manual. Edmonton,
Canada: University of Alberta Press.

Royce, J. R., & Powell, A. (1983). Theory of personality and personal differences:
Factors, systems, processes. Englewood Cliffs, NJ: Prentice Hall.

Schacht, T. E., & Black, D. A. (1985). Epistemological commitments of behavioral and
psychoanalytic therapists. Professional Psychology: Research and Practices, 16,
316-323.

Tabachnick, B. G., & Fidell, L. S. (2001). Using multivariate statistics (4th ed.). New
York: Harper Collins.

Tracey, T. J. & Kokotovic, A. M. (1989). Factor structure of the Working Alliance
Inventory. Psychological Assessment, 1, 207-210.

Vandyke, M. M. (2003). Contribution of the working alliance to manual-based treatment
of social anxiety disorder. Dissertations and Abstracts, DAI-B 63/09, p. 4390.

Vasco, B. (1994). Correlates of constructivism among Portuguese therapists. Journal of
Constructivist Psychology, 7, 1-16.

Vincent, N., & LeBow, M. (1995). Treatment preference and acceptability:
Epistemology and locus of control. Journal of Constructivist Psychology, 8,
81-96.

Winter, D. A., & Watson, S. (1999). Personal construct psychotherapy and the cognitive
therapies: Different in theory but can they be differentiated in practice? Journal of
Constructivist Psychology, 12, 1-22.















BIOGRAPHICAL SKETCH

Jocelyn A. Saferstein was born in Cleveland, Ohio, on December 15, 1978. In

1982 her family moved to St. Petersburg, Florida, where she resided until she was

eighteen years old.

She attended the University of Florida in 1997 majoring in psychology as an

undergraduate. In 2001, she graduated earning highest honors with a Bachelor of Science

in psychology and a minor in education.

She joined the Department of Psychology at the University of Florida as a

counseling psychology graduate student in August of 2001. She completed her Master of

Science degree in May of 2003 and her Doctor of Philosophy in December of 2006.