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Psychotherapeutic interactions in multiple and individual therapy.

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Psychotherapeutic interactions in multiple and individual therapy.
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Kosch-Graham, Sharon Jennette, 1945-
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Analysis of variance ( jstor )
Empathy ( jstor )
Gene therapy ( jstor )
Group facilitation ( jstor )
Group psychotherapy ( jstor )
Individual therapy ( jstor )
Love ( jstor )
Medical treatment ( jstor )
Psychotherapy ( jstor )
Standard deviation ( jstor )

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PSYCHOTHERAPEUTIC INTERACTIONS
IN MULTIPLE AND INDIVIDUAL THERAPY












By

SHARON JENNETTE KOSCH-GRAHAM



















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




UNIVERSITY OF FLORIDA
1972































Copyright by

Sharon Jennette Kosch-Graham

1972




















In Memoriam:


Atman


(P. Atman, Hiccipus, Liccipus, Puppy-do-dog) One of the finest friends I have known.













ACKNOWLEDGMENTS


My warmest thanks and appreciation go to Dr. Harry Grater, who chaired my dissertation committee. He was always abundantly supportive and almost totally nondirective, leaving me with the feeling that the project was truly my own. He did a lot to decrease my ever-ready anxiety barometer when it would start to rise.

I especially wish to thank Dr. Hugh Davis for his contributions; being my most verbal critic, he definitely helped me to formulate more precise statements about the research. And the liking and respect that he communicated for me as a psychologist were greatly appreciated.

I am grateful to Dr. Vernon Van De Reit for his support and understanding during my time of "dissertation distress." I am also thankful for his willingness to read the manuscript when he had a million things to do.

I am eternally indebted to Dr. Madelaine Ramey for her highly skilled aid with the statistics involved in this study; I feel that she is truly a wizard in this field, and I would not have had a polished dissertation without her assistance. I am greatly appreciative of the amount of her own time that she devoted to helping me, and for her genuine interest in the project.




iv









I extend many thanks to Dr. James Millikan for joining my committee at such a late stage (when I really needed him!) and for being a good "sounding board" while I was writing the manuscript.

I want to express my sincere gratitude to the twelve

therapists who participated in the study: Jaquie and Mike, Cindy and Bill, Karen and Jim, Pat and John, and Judy and Linwood. I thank each of you for your patience in filling out those seemingly endless forms and for taping the sessions. I also thank all of the twenty-four clients who agreed to let their counseling involvement be studied.

I heartily thank four of the Counseling Center secretaries: Adrienne, Edith, Harriet, and Muriel. Each of them helped by typing, administering, or scoring test forms, as well as caring about me and the project. I am grateful also to the editorial skills of Sue Kirkpatrick, who typed the final manuscript.

And, of those not mentioned, I would like to thank Lauren, Roger, and Gary for serving as judges for two of the scales.

I would also like to express my gratitude to Drs. David Orlinsky and Kenneth Howard for their permission to use items from the Therapy Session Report.

I am especially thankful that my co-researcher, Chuck, was willing to share the ordeals of research with me.

Personally, I am grateful to my two therapists, Pat

and Paul, and to many friends, for helping me preserve enough of my sanity to write this dissertation.

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And finally, I am very grateful to my husband, Richard, for his kind understanding and help during the time that I was working on this project.

















































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PREFACE


The report contained in this dissertation, concerned with multiple and individual therapy from the therapist's perspective, was part of a joint research project conducted with Charles A. Reiner. His dissertation, to be completed in 1973, will focus on multiple and individual therapy from the client's viewpoint.



































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TABLE OF CONTENTS


Page

ACKNOWLEDGMENTS . . ....... .. . . iv

PREFACE ... .................. vii

LIST OF TABLES. . . . . x

ABSTRACT ............. .... ... xiii

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

Advantages for Therapists .......... . 3
Training .. . . . .... . ... 3
Growth . . . . . . . . . . 6
Better Therapeutic Interactions . ... . . 7

The Multiple Therapy Relationship ....... 15
Characteristics of a Good Relationship . . 15 Prerequisites and Matching .. ........ 16
Relationship Problems and Solutions .... . 19

Research .................. .. 24

METHOD . . . . . . . . . . . 29

Subjects . . . . . . . . 29
Counselors ..... ............. . 29
Clients . . . . . . . . . . 29

Design . . . . . . . .. . . 30
Conditions and Groups ............. 30
Comparisons ..... ............ . 32

Procedure .............. . . 33
Counselors ....... ........ . .. 33
Clients . . . . . . . . . .. 34

Instruments .... ............. ... 35
Therapy Session Report ............. 35
Comparative Therapy Scale ......... . 37
The Carkhuff Process Scales . . . . . 39
Caring Relationship Inventory ......... 42




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Page

Personal Orientation Inventory ........ 43 Multiple Therapy Rating Scale ......... 44 Myers-Briggs Type Indicator ......... 48

Hypotheses ......... .......... 49
Multiple Versus Individual Therapy ...... 50 The Multiple Condition ............ 51

RESULTS . . . . . . . . . . 54

Comparison of Multiple and Individual Conditions 54
Number of Sessions .............. 54
TSR Data ............. .... . 55
CTS Data ................... . 69
Carkhuff Process Scales Data .......... 75

The Multiple Condition . . . . . . 83
CRI Data . . . . . . . . . . 83
POI Data . . . . ............... 87
The Multiple Relationship and Client Outcome . 89

DISCUSSION . . . . . . . .. 99

Comparison of the Conditions ...... .... 99
Therapists' Report of Interactions ..... 99 Therapist Attitudes About the Two Conditions 104 Judges' Ratings of Therapist Behavior ... 105 Comments on the Comparison of the Conditions . 108

The Phenomenon of Multiple Therapy ....... 113
The Caring of the Therapist Pairs ..... 113 Growth ................... . 117
MTRS Reliability and Validity .. ....... 118

An Area for Future Research . . . . . 121

APPENDICES .... .......... . .. . . 123

A. Therapists' Research Instruction Sheet . 124 B. Therapy Session Report ......... 125
C. Comparative Therapy Scale . . . . 137 D. Carkhuff Scales . . . . ... . 141
E. The Scales of the Caring Relationship Inventory ..... .......... ... . 149
F. Four Scales of the Personal Orientation Inventory . . . . . . . . 150
G. The Multiple Therapy Rating Scale ... 151 H. Numerical Raw Data and Summaries ... . 157

REFERENCES ..................... . 171

BIOGRAPHICAL SKETCH ............... 178

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LIST OF TABLES


Table Page

1. Percentages of Agreement Among Four Judges
Regarding the Multiple Therapy Rating Scale 46

2. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Items 1 and 2
for Multiple and Individual Conditions . 56

3. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Items 1-5 for
Multiple and Individual Conditions .... 57

4. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Items 6 and 9
for Multiple and Individual Conditions . 58

5. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 17 for
Multiple and Individual Conditions ..... 59

6. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 21 for
Multiple and Individual Conditions .... 60

7. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 25 for
Multiple and Individual Conditions . . 61

8. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 29 for
Multiple and Individual Conditions .... 62

9. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 31 for
Multiple and Individual Conditions .... 63



x










Table Page

10. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 32 for
Multiple and Individual Conditions . . . 63

11. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 35 for
Multiple and Individual Conditions ..... 65

12. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 36 for
Multiple and Individual Conditions ..... 66

13. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 37 for
Multiple and Individual Conditions ...... 67

14. Therapist-Client Agreement Scores for Multiple
and Individual Conditions: Correlations Between Their Responses to 24 TSR Items . . 68

15. Means, Modes, and Ranks of the Therapists'
Response Pattern on the 32-Item Comparative
Therapy Scale . . . . . . . . 71

16. Wilcoxon Matched-Pairs Signed-Ranks Test for
Testing Differences in Therapists' Attitudes
About Multiple and Individual Therapy . . 74

17. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists' Pre and Post Empathy Scores for Multiple and
Individual Conditions . . . . ... 77

18. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists' Pre and Post Respect Scores for Multiple and
Individual Conditions ........... 78

19. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists' Pre and Post Genuineness Scores for Multiple
and Individual Conditions . ........ 80





xi










Table Page

20. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists' Pre and Post Concreteness Scores for Multiple
and Individual Conditions .......... 82

21. Pre- and Posttest Means and Standard Deviations
of the Therapists' CRI Scale Scores . .. 84

22. Means and Standard Deviations of Shostrom's
Sample of Successfully Married, Troubled, and
Divorced Couples on the CRI Scales . . . 87

23. Means and Standard Deviations of the Therapists' Pre and Post POI Scores ....... 88

24. Rank Orders of Each Therapist's Relationship
Quality Scores for Both Multiply Seen Cases 92

25. Rank Orders of the Agreement Scores of Each
Therapist's Responses on the TSR and His
Partner's Corresponding MTRS Responses for
Both Multiply Seen Cases .......... 93

26. Rank Orders of the Therapists' Scores on Four
CRI Scales .............. . . 94

27. Test-Retest Reliabilities of Relationship
Quality and Co-therapist Agreement from the
MTRS . . . . . . . . . . 95

28. Spearman Rank-Order Correlations Between
Relationship Quality and Co-therapist Agreement and Between These Scales and Scales of
the CRI . . . . . . . . . 95

29. Rank Orders of the Total Composite Co-therapist
Agreement and Relationship Quality Scores from the MTRS and Their Client's Post S-A Scale and
POI Scales Time-Competence (Tc) and InnerDirected (I) . . . . . . . . 97












xii









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

PSYCHOTHERAPEUTIC INTERACTIONS
IN MULTIPLE AND INDIVIDUAL THERAPY By

Sharon Jennette Kosch-Graham December, 1972

Chairman: Harry A. Grater, Jr. Major Department: Psychology

This study investigated the psychotherapeutic interactions of therapists in multiple and individual therapy. One aim was to illuminate any significant differences between the two conditions as far as (a) the therapists' report of their own and their clients' behavior, (b) the therapists' general attitudes about the two treatment modalities, and (c) judges' evaluations of the therapists' level of functioning on core facilitative dimensions. The second goal was to probe various aspects of multiple therapy itself in regard to the relationships of the co-therapist pairs: (a) their level of caring for their partners,

(b) their ratings of the quality of their relationships,

(c) their agreement as to their perceptions and behavior during the sessions, and (d) the relation of the foregoing aspects to client outcome.

Three intern-level and three staff-level heterosexual

therapist pairs were formed from counselors at the University


xiii









of Florida Counseling Center; they conducted therapy with 24 unmarried female students who were randomly assigned to conditions. Each co-therapist pair saw two clients multiply and each therapist saw one client individually, yielding a total of 12 multiple and 12 individual cases. Each therapist provided his own matched control for purposes of comparing the two conditions.

The results of the therapists' responses to a Comparative Therapy Scale (modified from Rabin) generally confirmed the prediction that the therapists would have more favorable attitudes about multiple than individual therapy. When the therapists rated their clients' and their own behavior after completing their first and their last multiple and individual sessions, however, the expected differences in favor of multiple therapy were not apparent. The only significant difference between the conditions derived from the therapists' responses to selected Therapy Session Report items (from Orlinsky and Howard) was that clients tended to agree with the therapists' comments more in individual than in multiple therapy. Two highly trained judges rated the therapists' levels of the core facilitative dimensions of empathy, respect, genuineness, and concreteness (from Carkhuff) during the initial and terminal sessions of both conditions. On all dimensions, the therapists offered equivalent facilitative levels in both conditions during the first session. At therapy's end, however, they offered



xiv









significantly higher levels in the individual condition than they had in that condition during the pretesting or than they did in the multiple condition during the final session.

Regarding the multiple condition itself, the therapist pairs were shown to become more caring for each other over the course of therapy on Shostrom's Caring Relationship Inventory (CRI). The therapists made gains in selfactualization on one Personal Orientation Inventory scale; three others showed no gains. A Multiple Therapy Rating Scale, designed to tap two major areas of the co-therapist relationship (co-therapist agreement and relationship quality), was devised by the author and a co-researcher (Reiner). The scale's two parts were shown to have significant test-retest reliabilities. Some evidence of concurrent and predictive validity was obtained for co-therapist agreement as it was positively correlated with some CRI scales and with client level of self-actualization. Neither of these types of validity was demonstrated for relationship quality.

The results were interpreted as supporting the literature's claim that therapists have better attitudes toward multiple than individual therapy, but as not substantiating the assumption that the actual psychotherapeutic interactions are better. Some beliefs regarding co-therapy were confirmed; the co-therapists: became closer, evinced growth, and one aspect of their rapport was related to client outcome. Because of some characteristics of the counselors and



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their co-therapy relationships, the applicability of the results for multiple therapy in general was qualified and an area for future research suggested.
















































xvi














INTRODUCTION


The focus of this report is a therapeutic phenomenon wherein two or more helping persons simultaneously engage in psychotherapy with individual persons, families, or groups. The presence of multiple therapists has been said to have a markedly different effect on the counseling interactions than does one therapist. The differences between multiple and individual therapy have been one major area of concentration for all who have used and written about multiple therapy. The other predominant theme in the literature has to do with the characteristics of the phenomenon itself, including its different versions styled by therapists with diverse goals and emphases.

Various titles have been given to this counseling

approach, with very little agreement among the authors as to exactly what the differences and similarities between them are. Those less often used include: cooperative team approach (Lott, 1957), dual leadership (Linden, 1954), joint interview (Reeve, 1939), role-divided therapy (listed by Randolph, 1970),team counseling (Mallars, 1968), and three-cornered therapy (Bock, Lewis, and Tuck, 1954). In regard to the present research, the "use of two therapists with one client is what we mean by multiple therapy" (Haigh



1





2



and Kell, 1950, p. 659). The name multiple therapy is also preferred by the present author to emphasize the distinguishing characteristic of this term, that of "the use of two therapists who are involved intimately, affectively, and spontaneously with each other and their patient(s)" (Treppa, 1971, p. 452). Co-therapy (Lundin and Aronov, 1952) is probably the most frequently encountered term in the literature, and in many instances is used as synonymous with multiple therapy. Some critical differentiating features between these two have been drawn, however, and are primarily concerned with using contrived roles in cotherapy versus the emphasis on the therapist as a person in multiple therapy (Mullan and Sanguiliano, 1960). Not denying that these differences are important, the terms multiple therapists and co-therapists will be used interchangeably here, as most authors have not separated them so distinctly. Treppa's definition of multiple therapy is, in a sense, an ideal to work toward. It is doubtful that most of the articles on the interactions between therapists are based on relationships with that high a level of involvement. So, although the present author concurs that the dissimilar qualities implied by the various titles are germane to a discussion of the new method itself, when comparing this technique to a standard approach these differences will oftentimes be ignored.

There have been instances of using considerably more

than two therapists, as many as nine or ten with one client





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(Hayward, Peters, and Taylor, 1952; Warkentin, Johnson, and Whitaker, 1951). So far, there has not been any reported advantage or disadvantage of utilizing such a glut of expertise over that of two therapists, although it would seem that this might create a rather unwieldy situation. Again, even though some of the literature considered does not conform to the definition employed here, any relevant findings are reported. And, notwithstanding that the current study specifically involves this approach in use with individual clients, its application in conjoint and group therapies is also included in the discussion.

Granting that many possible advantages for clients

have also been propounded, the practice of multiple therapy was initially employed by many for the benefit of the therapists. The present discussion will center on multiple therapy from the therapists' perspective; the interested reader may refer to other sources that expatiate upon this method in regard to its recipients (Dreikurs, Schulman, and Mosak, 1952b; Hill and Strahl, 1968; Kell and Burow, 1970; Mintz, 1963a; Treppa, 1971).


Advantages for Therapists

Training

The purported advantages of multiple therapy for the therapists, derived from counselors' personal experiences and subsequent theorizing, are numerous. The potential use of the multiple setting for training purposes was the





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first to receive recognition. It is easy to see why many practitioners felt that this method offered an ideal situation in which to prepare new helping persons. It provides an apprenticeship atmosphere where a trainee can observe actual therapy and learn the techniques and styles of an accomplished therapist. This assuredly seems to be a marked improvement over textbook or classroom presentations of how one conducts a psychotherapeutic interview.

The earliest reported use of two persons in a therapy setting is cited as being at the Vienna Child Guidance Clinic by Alfred Adler and his associates (Dreikurs, 1950; Spitz and Kopp, 1963). Usually the persons involved were a psychiatrist and a social worker or a teacher, an imbalanced therapeutic team which may have set the stage for later pairings of a similar nature. A psychiatrist and a social worker were used by Reeve (1939) in his "joint interview" technique which he felt could offer a beneficial training experience for psychiatric social workers. As a step toward avoiding the prevalent maltreatment of psychoneurotics by physicians, advanced medical students attended group therapy sessions led by a psychiatrist. Hadden (1947) reported that this procedure was of great positive significance in the medical students' preparation.

The use of the multiple approach for discovering how to teach psychotherapy was an essential concern in the first few years of experimentation by Whitaker, Warkentin, and Johnson (1949). At the inception of their use of this





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method, one of the therapists merely observed; they later modified this so that both actively participated, resulting in greater gratification for all concerned. Dreikurs (1950) emphasized the involvement of both therapists in a joint interview, although only one therapist saw the patient continuously and carried the major responsibility. Dreikurs felt that this approach had great training potential for teams consisting of either a senior and a junior therapist or two experienced colleagues. Haigh and Kell (1950) stated that the meaningfulness of the multiple experience for a student was directly related to his degree of involvement in the treatment process. They cited the advantages that the actual practice of therapy can be introduced earlier in a students' schooling, and that the experience should be less threatening than seeing a client alone, due to the support that the senior therapist can offer. Dreikurs, Schulman, and Mosak (1952a) lauded this technique as an "invaluable teaching method," and stated that each therapist can expand his scope through watching the other. Hayward, Peters, and Taylor (1952) also proclaimed that multiple therapy was a good tool for training. Slavson (1953) saw the use of a co-therapist as a response to insecurities and inadequacies of therapists; Gans (1957) felt that these could be ameliorated when a supporting colleague proffered assistance. Various other authors have concurred that this approach is of great significance





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in situations of imbalanced therapeutic teams (Dyrud and Rioch, 1953; Feldman, 1968; Gans, 1962; Kell and Burow, 1970; Lott, 1957; MacLennan, 1965).

It is noteworthy that the Atlanta group, who had been one of the early proponents of multiple therapy for training purposes, reversed their position and stated that the pairing of novice and experienced therapists is not wise (Malone and Whitaker, 1965; Whitaker, Malone, and Warkentin, 1956). The later opinion of these authors underlined the deleterious influences of status differences which would affect both therapists and clients. Growth

One of the first goals of using multiple therapy as

formulated by the Atlanta group concerned its potential for developing the capacity of the therapist (Warkentin, Johnson, and Whitaker, 1951; Whitaker, Malone, and Warkentin, 1956; Whitaker, Warkentin, and Johnson, 1949). This was also mentioned by Solomon, Loeffler, and Frank (1954); it is a training goal, in a sense, but refers to the opportunity for continued personal and professional growth of experienced therapists. Mintz (1963a) feels that co-therapy offers this benefit to a therapist by his being put in a learning situation with his colleague. The observation of

-the other therapist regarding his, and the client's reactions widens his understanding of himself. He can also be exposed to different approaches and techniques, thus expanding his professional ability.





7



Mullan and Sanguiliano (1960) state that experience in multiple therapy can lead to greater maturity in the counselors and increase their enthusiasm for doing therapy. They, along with others, have thought that its use results in better working relations among staff members of a therapeutic center (Dyrud and Rioch, 1953; Malone and Whitaker, 1965). It does seem apparent that this provides a good opportunity for staff members to grow more together, as they share directly in their main pursuit--the helping of other persons. Mintz (1963a) commented that co-therapy is also a way of alleviating the isolation associated with private practice. The growth-enhancing characteristic of multiple therapy is, in the opinion of Randolph (1970), largely responsible for the recent increased use of it.


Better Therapeutic Interactions

In addition to the two aforementioned advantages which were related to therapist training and growth, there has been extensive discussion of how the multiple setting provides for more effective and comfortable therapeutic interactions than does individual therapy.

Sharing of responsibility.--One of the most essential of the interaction advantages is the sharing of responsibility. Having a partner in the therapy situation tends to lessen the therapist's "effort syndrome," his attempt to effect a positive therapeutic outcome (Warkentin, Johnson, and Whitaker, 1951). Kell and Burow (1970) report that





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therapists feel less burdened and have more fun when doing multiple therapy, and thus find their work less taxing. Part of this sharing of responsibility is the direct support a therapist gets from his colleague (Gans, 1957; Miller and Bloomberg, 1968; Solomon, Loeffler, and Frank, 1953). This support certainly is an advantage during stressful times in therapy (Linden, Goodwin, and Resnik, 1968), when the client may require a good deal of support. Along with this, multiple therapy seems especially useful for therapists when the entire course of counseling is likely to be strenuous because the client is a difficult one (Cameron and Steward, 1955; Greenback, 1964; Mullan and Sanguiliano, 1964; Warkentin and Taylor, 1968). However, this approach has been found to be helpful with only some types of problem clients, and is contraindicated with others (Kell and Burow, 1970). Sharing responsibility tends to lessen the frustrations and difficulties of a therapist (Dreikurs, 1950) and makes it easier to pinpoint therapist problems (Mullan, 1955). The support element is important in improving the therapist's image of himself, as many feel that they have a greater capacity to work with clients (Warkentin, Johnson, and Whitaker, 1951).

Wider range of roles.--Another important advantage of multiple therapy in regard to the therapeutic interactions is that it enables the therapist to have a greater variety of roles (Adler and Berman, 1960; Demarest and Teicher, 1954). Gans (1957) stated that the therapist can (1) be





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an observer, (2) be observed, and (3) actively participate when he has a co-therapist. Because of this, therapy is less monotonous (Dreikurs, 1950), and thus probably keeps the therapist more alert. Dreikurs (1950) emphasized that the therapists will incline to serve in different role functions naturally, as the dissimilarities in their personalities will be complementary to each other. Besides these natural roles, the therapists can also assume different roles, one being nondirective; the other, directive (Dreikurs, Schulman, and Mosak, 1952a; Solomon, Loeffler, and Frank, 1954). Mintz (1963b) suggested that usually in co-therapy, one therapist plays an authoritative role and represents the superego, while the other portrays the ego's integrative function (Adler and Berman, 1960). Or, she described how a social worker took the role of the reality principle in helping plan for the future and relegated all interpretations to her psychiatrist co-therapist. Mintz also talked about how a male and female team could intentionally present themselves as masculine and feminine stereotypes. In addition to the assuming of different roles by the therapists, simulated role-playing between a therapist and the client is easier when two therapists are present. One therapist can handle the therapeutic functions (reflecting, directing, supporting, interpreting, etc.) while the other can take the part of a person to whom the client is relating. Such role-playing can also be done in individual therapy, of course, but it is somewhat more difficult, for





10



the therapist must switch in and out of the role to comment on what is happening. Godenne (1964) reported satisfactory results with a procedure wherein both therapists of a team participated in the psychodrama activities of a group.

The deliberate donning of different roles by the therapists has been one area of dispute among various theorists. Mullan and Sanguiliano (1960, 1964) have stated that one of the main discriminating features between what they distinguish as co-therapy and multiple therapy is the use of contrived role-playing in the former. Treppa (1971) concurs with them that this is not a beneficial technique:

The usual situation in co-therapy is for one therapist to act in a supportive, passive, and good manner while the other plays an aggressive, dominant role. Such an approach: (1) is artificial in nature; (2) limits the
therapists' freedom to be themselves and thus grow;
(3) depersonalizes the patient by depersonalizing the
therapists; (4) may prove to the patient what he has always thought--that he is inadequate in his attempt to change his environment, since he cannot change his
therapists; and (5) encourages our cultural stereotype about how a man and a woman should be and feel [p, 453] These criticisms concern deliberate role-playing, however, and these authors would not deny that one of the advantages of multiple therapy has to do with the broader array of possible interpersonal interactions.

Freedom.--The multiple situation can also foster

greater therapist freedom. It is easier to take risks in confronting the client when the therapist knows that his co-therapist can assist the client if necessary (Warkentin, Johnson, and Whitaker, 1951). Greenback (1964) said that clients feel freer in discussing certain topics with one









therapist when there is a "chaperone" present. This is equally true for the counselors, and having another therapist in attendance is likely to increase counselor spontaneity. Kell and Burow (1970) state that the presence of a therapeutic partner enables a counselor "to feel, fantasy, and image more and do it more easily" [p. 216]. Whitaker, Malone, and Warkentin (1956) theorized that perhaps the most important benefit of multiple therapy over individual therapy is that it gives

greater freedom on the part of each therapist to
be personally involved both professionally and
emotionally. Therefore, the approach allows for greater variability and even innovations in technique. One therapist provides the control, the other
the variable, at any given time in therapy [p. 211]. Others have agreed that the way in which multiple therapy offers more freedom and flexibility is that it confers greater stability for both clients and therapists (Buck and Grygier, 1952; Dyrud and Rioch, 1953; Sonne and Lincoln, 1966).

Greater comfort and confidence.--Another group of

supposed advantages has to do with the therapist feeling more confident or better about his therapeutic interactions. The multiple situation gives the therapist a higher probability of success due to the fact that his blind spots will be ameliorated by another and different helping person (Lundin and Aronov, 1952). The counselor also has the benefit of constant consultation with another professional, which will increase his accuracy of diagnosis and





12



interpretation (Dreikurs, Schulman, and Mosak, 1952a), as well as his understanding of the client (Mullan and Sanguiliano, 1960). The latter authors also cited various reports which claimed that not only are interpretations reinforced, but different ones are given at an earlier time in therapy. The client will be more likely to accept impressions of the therapists when they both agree (Dreikurs, 1950), which speeds the overcoming of resistance and the therapeutic progress. This aspect of multiple therapy is similar to a "consensual validation" effect. Another advantage related to this is that the counselor seems to be less "on the spot" when he has a partner, and he thus has more time to consider his comments. He most likely talks less and when he does, he is able to state things more adequately and accurately. Also, he probably stays in touch with the process better and is inclined to drop out his less helpful responses. In addition, the counselor can feel assured that his countertransference tendencies of being overprotective, oversympathetic, or hostile will be reduced in the co-therapy setting (Greenback, 1964; Solomon, Loeffler, and Frank, 1954). Or, at least, having an observer in the room makes it easier to discriminate between reality and transference reactions (Demarest and Teicher, 1954) or mutual client-therapist distortions (Sonne and Lincoln, 1966). It has also been related that problems about transferring (Buck and Grygier, 1952) or





13



terminating (Mullan and Sanguiliano, 1960) are less awkward to deal with in the multiple situation.

Again, however, Mullan and Sanguiliano (1960) take

issue with other users of multiple therapy when they state that they see the method as adding to the discomfort of the therapists. They include a second therapist to

. add to the total insecurity present in the psychotherapy; to add to our own anxiety; to confront us with our own limitations; to indicate to us our everpresent tendency, of which we are so frequently unaware, to use the patient; and finally, to add depth and cross-sectional possibilities to the transaction.
We do not add the additional therapist to make us
feel more secure, nor to make us more certain of our
interpretations . [p. 557].

These theorists feel that the multiple setting forces a therapist to minimize the use of learned techniques and rely on his own resources as a person. It is understandable that the beginning multiple therapist might be quite uncomfortable with the added insecurity. However, as he found the method to be conducive to growth, learning, and the client's progress, he might actually welcome the uncertainty and find it quite comfortable.

Less difficulty with impasses.--Lastly, due to having another person and another perspective, impasses are easier to resolve (Hayward, Peters, and Taylor, 1952; Spitz and Kopp, 1963) or avoid (Dreikurs, Schulman, and Mosak, 1952b). "Commonly, in dyadic therapy, a conflict generates to impasse rather than resolution ." because changes are harder for a therapist than in multiple therapy (Kell and





14



Burow, 1970, p. 238). Whitaker, Warkentin, and Johnson (1950) presented a detailed analysis of the etiology of impasses in individual therapy, underlining that they signal a deterioration in the relationship between the therapist and the client. They state that the relationship has lost its "emotional voltage" for both client and therapist; that the therapist feels frustrated and his subsequent interventions are not likely to lead to progress. Their statements about introducing a second therapist to aid in the dissolution of the impasse go beyond just the addition of another viewpoint:

The presence of the consultant is also valuable because he is also able to carry part of the responsibility for the patient, so that the therapist can
express what he had suppressed from fear of his own
immaturity [p. 644].

Besides fearing his own immaturity, the therapist may feel that it would be difficult for the client to handle his expressions without some support. Miller and Bloomberg (1968) affirmed the Atlanta group's observations in their own experiment in impasse-breaking. They felt that the addition of a second therapist gave the first emotional and physical support and allowed him to verbalize his anger, fears, and sorrows to his psychotically violent patient. As a result of the interaction advantages mentioned previously, impasses do not occur as frequently when there are two therapists present from the inception of treatment. In addition, it has been noted that the client does not





15



become extremely dependent on one therapist when two are involved (Mintz, 1965), which is a further protection against a stalemate in therapeutic movement.


The Multiple Therapy Relationship

Given that there have been many purported advantages of multiple therapy for the therapists, many of them probably are actualized only when there is a good relationship between the participating therapists. Poor co-therapist rapport may well signal their absence or create the atmosphere in which the possible disadvantages of this technique thrive. The dynamics of the multiple therapy relationship thus warrant a thorough examination.


Characteristics of a Good Relationship

Kell and Burow (1970) claim that "collaboration" between the counselors is the crucial aspect in forming a co-therapist relationship. Specifically, they feel that

. mutual respect, awareness, and acceptance of
differences, owning of one's own competency, freedom to feel and express feelings, both affectionate ones
and those that are less positive, are the primary
elements which make up a good multiple therapy relationship [p. 233].

Mullan and Sanguiliano cite "mutuality" as being the

key aspect of the therapists' relationship noting that "the relationship becomes mutual as both therapists express their need to be together not only as a team but also as unique individuals with definite growth strivings" (1964, p. 175). They. further emphasize that the ideal multiple





16



therapy relationship is an intimate one which encourages interchanges between the therapists on a transactional and phenomenological level (Mullan and Sanguiliano, 1960).

Randolph (1970) states that the above authors, in

conjunction with Whitaker, Malone, and Warkentin (1956), "concur in citing authenticity, mutuality, relatedness, equality, spontaneity, affective involvement, autonomy and interdependency as essential to the multiple therapists' relationship" [p. 11]. These, then, are the major characteristics of a good multiple therapy relationship. The following discussion elaborates on how such an interaction can be attained and what problems prevent its realization.


Prerequisites and Matching

One obvious dimension to be considered in the pairing of co-therapists is their general orientation or approach. Solomon, Loeffler, and Frank (1954) state that an optimal pairing can be achieved when the "orientations of the cotherapists are flexible enough to permit considerable variance along the active-passive, directive-nondirective continuae" [p. 177]. They surmised that there are probably various ways to match on these dimensions that will prove to be successful combinations. They felt that until these combinations are known, however, therapists should be matched with regard to their goals and techniques. It would be a catastrophe to place two therapists in the same room who are extremely different and rigid in their beliefs





17



(Rockberger, 1966). This would likely lead to a battle of each trying to prove the superiority of his method. As an extreme example, it is very perplexing to imagine how an orthodox Freudian and someone who patterned his style after Rogers could work together to the benefit of the person they were seeing. Within limits, though, some variation in approach between the therapists is desirable.

Kell and Burow (1970) think that counselor similarity is necessary as far as basic beliefs about life and human values. For instance, they feel that it would be very difficult for a pessimist and an optimist to work together constructively. They would agree with others, however, that differences in opinion regarding intrapsychic processes or tactical differences between therapists are positive catalysts to therapeutic progress (Dreikurs, 1950; Hulse, Lulow, William, Rindsberg, and Epstein, 1956).

Mullan and Sanguiliano (1960) state that there is

always resistance on the part of therapists in entering a multiple therapy situation, as well as experiencing during a particular treatment hour. They note that there is likely to be less resistance by therapists who emphasize process rather than content. It follows, then, that therapists who are relationship-oriented and flexible in orientation may be best suited to be members of a multiple pair.

Furthermore, it has been stressed that the therapists should be of equal capacity (Whitaker, Malone, and





18



Warkentin, 1956) or, at least, that neither be "in a position of greater authority or dominance . even if one therapist is a student" (Solomon, Loeffler, and Frank, 1954, p. 171). Warkentin, Johnson, and Whitaker (1951) reported that the inexperienced therapists in their study were sometimes anxious and lacking in spontaneity, as they were concerned about making positive impressions upon their cotherapists. Extending this further, Malone and Whitaker (1965) feel that it may be impossible to establish a good multiple therapy relationship.in a teacher-student situation. Gans (1962) also stated that many disruptive problems are created when there is a great dissimilarity in the therapeutic resources of the co-therapy participants. For most theorists in this area, however, the important point is that the co-therapists be able to establish an egalitarian relationship, regardless of their levels of experience or status (Haigh and Kell, 1950).

Often-cited personal characteristics deemed to be prerequisite for a multiple therapist were listed by Greenback (1964). These are maturity (Whitaker, Malone, and Warkentin, 1956), being able to freely communicate with another therapist (Rockberger, 1966), lack of competitiveness (Dyrud and Rioch, 1953), and ability to trust. Mullan and Sanguiliano (1960) regarded considerable trust between the therapists as being necessary to achieve mutuality. Along with Greenback, other authors feel that the co-therapists should





19



usually be of opposite sexes (Hill and Strahl, 1968; Mintz, 1963, 1965; Nunnelly, 1968; Rabin, 1967; Singer and Fischer, 1967), thus simulating a familial situation and facilitating certain therapeutic interactions. Some authors have carried the family milieu idea to the extent of using a wife (Fink, 1958), a son (Solomon and Solomon, 1963), or even a dog (Weigel and Straumfjord, 1970) as co-therapist. Warkentin, Johnson, and Whitaker (1951) required their multiple therapists to have had therapy themselves, and stated as criteria for successful pairing that each therapist would feel free to be' the patient or the therapist of the other.

Gans (1962) warned that two inexperienced therapists were worse than one and held that ample individual work should be prerequisite to doing co-therapy. Given two accomplished therapists, Gans felt that there was no particular advantage in teaming up over seeing patients individually. Apparently, then, he was focusing mainly on the technical rather than the relationship aspects of co-therapy, and his demand for experience should be considered in this light. Undoubtedly, therapeutic ability might interact with the quality of the co-therapist relationship; but whether ability is solely determined by experience is questionable.


Relationship Problems and Solutions

Discussion of Problems.--MacLennan (1965) emphatically






20



stated that the relationship between co-therapists is very complicated, and may even contain so many difficulties that a therapist would be better off working singly. In addition to meeting the prerequisites and being properly matched, a good multiple therapy team is formed by participants who can work through problems in their relationship. When and how are the difficulties to be discussed? Some types of obstacles can be handled during the sessions. For example, when the therapists have divergent opinions about what is going on with the client (Dreikurs, 1950) or there are tactical differences between the counselors, these can be revealed and discussed in the client's presence. It has been emphasized that this should be done with an air of respect, and the therapists should be able to be comfortable with their disagreement. Other difficulties, such as "neurotic conflicts between co-therapists, have to be recognized and dealt with appropriately outside . ." of the sessions (Hulse, Lulow, William, Rindsberg, and Epstein, 1956, p. 435). Routine meetings of the therapists between the sessions are considered to be essential (Lundin and Aronov, 1952). In this regard, Haigh and Kell (1950) recommend that the therapists go over a tape of the therapy:

It is in this situation that attitudes and feelings
existing between the two participating therapists
become crystallized and clearcut and the emotional growth and learning for both can reach their maximum [p. 660].

It has also been suggested that the two therapists meet with a third party who can act as a moderator or supervisor





21



(Solomon, Loeffler, and Frank, 1954). It is essential that the counselors be able to freely communicate with one another in order to work through any of their problems in interacting.

Competitiveness and hostility.--Mintz (1965) claimed that the "possibility of personal friction between the therapists is certainly the greatest hazard of this type of treatment" [p. 299]. Competitiveness (Dyrud and Rioch, 1953; Lott, 1957) is probably the most deleterious factor to the formation of a good multiple therapy relationship. Kell and Burow(1970) emphasized that it requires conscious effort for counselors to form a collaborative relationship, because there is "little in the professional therapists' training which prepares them for building a co-worker relationship which can be helpful and meaningful both to them and the client" [p. 213]. These authors prefer pairing male and female counselors, hoping to avoid the competition so prevalent between men. Competitiveness may well still be an issue, however, and the participants will need to be aware of this potential tendency and counteract it. Lundin and Aronov (1952) state that if a patient "senses the same lack of respect, disharmony, and infantile competition . ." similar to those between his parents, ". the basic purpose of the co-therapy method has been lost" [p. 79]. MacLennan (1965) spotlighted such a possible area of dissension with male and female therapists--their





22



being engulfed in an oedipal struggle where the male relates to all the girls in a group; the female, to all the boys. Solomon, Loeffler, and Frank (1954) believed that the therapists, if conscious of hostility between them, could work out their difficulties without affecting the patient. However, they feared that the anger might be displaced to the patient if the therapists were unaware of their feelings.

Competency and respect.--It is important that the

therapists be able to feel competent without being competitive, and desirable that they encourage and enhance each other's competence. Gans (1962) stressed that each therapist should accentuate the other's assets and not let the expression of his limitations be pronounced. Mintz (1965) related that it is crucial that both therapists feel competent; otherwise, the patient may be able to play one therapist against the other, or the therapists may misunderstand the relationship of the patient to each of them. Mutual respect must also be present to develop a positive multiple therapy relationship (Lundin and Aronov, 1952; Warkentin, Johnson, and Whitaker, 1951). This respect should involve appreciation of the other's differences, including sexual role dissimilarities when the counselors are male and female (Kell and Burow, 1970; Mintz, 1963a). Each therapist should also "know of and accept the other's peculiarities and neuroticisms" (Rockberger, 1966, p. 288). Finally, in this regard, Demarest and Teicher (1954) felt that each co-therapist should emotionally accept the other and understand his methods of working in therapy.





23



Autonomy and dependency.--Kell and Burow (1970) further thought it important that the therapists be able to be both autonomous from and dependent on each other. They felt that counselors are trained to be independent, possibly to the extreme, so that they cannot easily, genuinely, and appropriately depend on one another. It is critical that they do this in order to share responsibility for the therapy and form good models for their clients regarding expression of dependency.

Intimacy and caring.--Solomon, Loeffler, and Frank (1954) postulated that the ideal multiple therapy pair establish an intimate association which unites them and betters their therapy. Mullan and Sanguiliano (1960) felt that the therapists need to develop a deep meaning for one another, come to care for each other, so that they react to the patient in a meaningful and integrated way. Many theorists in the field have stated that a good multiple therapy relationship would contain the same ingredients as a good marriage (Kamerschen, 1969; Linden, 1954; Rabin, 1967; Sonne and Lincoln, 1966; and Treppa, 1969). Randolph (1970) agreed with this view of the relationship and investigated aspects that she felt were especially important. She was interested in how much the co-therapists (1) disclosed to one another, (2) were satisfied with each other, and (3) expressed affection to one another. The present author concurs that the development of an intimate and caring





24



relationship between the counselors is one of the most important facets of multiple therapy.

Research

Although many theorists have praised the multiple

technique for providing an atmosphere conducive to conducting unobtrusive research (Buck and Grygier, 1952; Dreikurs, 1952b; Haigh and Kell, 1950; Whitaker, Malone, and Warkentin, 1956), few have actually done more than draw conclusions from their own experiences with the method. There is a bounty of success claims in the literature (Fink, 1958; Mintz, 1965; Solomon, Loeffler, and Frank, 1954), but very few empirical facts to support it.

The first attempt at a "study" of multiple therapy was that of Warkentin, Johnson, and Whitaker (1951), who looked at case studies of 25 patients and reported positive results for them; such as feeling safer and thus freer to express both positive and negative feelings, and more satisfactory termination experiences. The participating therapists derived the supposed benefits of personal growth, increased enthusiasm for therapy, and a greater capacity to work with patients.

Other research projects have also concentrated some

attention on multiple therapy from the therapist's perspective. Rabin (1967) at least improved on the previously cited study of the Atlanta group by giving 38 therapists a questionnaire which asked them to rate the relative efficacy






25



of co-therapy versus individual therapy. (A modified form of his questionnaire is shown in Appendix C.) He found that the therapists valued the "general therapeutic efficacy of co-therapy," and felt that it led to more "positive therapeutic movement . and working through, in general" [p. 2491.

Mallars (1968) reported that her 24 student counselors, their clients, and their supervisors were significantly more satisfied with a counseling team approach than with a standard method. These results are based on the participants' responses to a counseling rating scale administered after the first and the last counseling sessions.

Kamerschen (1969), in studying 23 heterosexual therapist pairs, found that self-disclosure and a personalimpersonal dimension of co-therapist selection were significantly related to therapist satisfaction within the multiple therapy relationship. Pair flexibility, congruence of self-co-therapist flexibility, and attitudes toward the opposite sex were not shown to be significantly related to pair satisfaction. Kamerschen's co-researcher, Randolph (1970), found self-disclosure to be positively related to satisfaction and the physical expression of affection in therapist pairs. The results also indicated that those therapists who acted on their desire to verbally express affection were more satisfied than those who did not, while therapist pairs who expressed both verbal and physical affection were more satisfied than those who used only one.






26



The studies that have used various measures of client change in comparing an individual with a multiple group method have yielded equivocal results. Daniels (1958) and Staples (1959) found that for groups of eighth grade boys and girls, respectively, the heterosexual co-therapy team generally produced negative behavior changes in their clients. The members of groups led by either a male or a female therapist, contrarily, tended to improve on the outcome measures of teachers' ratings and psychologists' assessments. Nunnelly (1969) discovered no significant differences between groups led by multiple therapists versus those led by individual therapists in regard to client outcome, e.g., perceptions of parent acceptance, selfacceptance, or ego strength. Singer and Fischer (1967) reported that although little progress was being made with a group of male homosexuals run by two male therapists, when a female co-therapist was added, the process changed remarkably for the better. After one year of heterosexual leadership, the majority of the members of the group had improved on several behavioral measures; such as lessened amount of homosexual activities, dating heterosexually, and increased work productivity. In all of these studies, however, no data were gathered on how the therapists related to one another. This is of critical importance, as was discussed before, as a poor co-therapist relationship could very likely produce worse client outcomes than an individual therapist.





27



Swander (1971) attempted to investigate one such area of the therapists'relationship as it affects client outcome. In an analogue study using undergraduate students as both therapists and clients, she manipulated the level of therapist functioning in multiple pairs. She concluded that

. two therapists of higher levels of nonfacilitative core conditions may work together with no negative effect on each other's functioning level and
with no negative effect on their client's level of self-exploration. When, on the other hand, a lowfunctioning nonfacilitative therapist works with
another nonfacilitative therapist, there will not only be a negative effect on each other's functioning level
but on the level of client self-exploration as well
[pp. 34-35].

Although Swander's sample was limited in that there were no facilitative helpers included, there were still definite differences in helpee self-exploration resulting from higher or lower nonfacilitative levels of functioning. These results underline the importance of inspecting the relationship between co-therapists. It is difficult to evaluate the studies concerned with the relative efficacy of individual versus multiple therapy when this examination has been omitted.

As listed above, previous studies have been concerned with (1) how therapists and clients felt about multiple therapy as compared to individual therapy, (2) some essential ingredients of a satisfying co-therapy relationship, (3) the relative efficacy of multiple versus individual therapy in regard to client outcome, and (4) the effect of the level





28



of functioning of the co-therapists on client selfexploration. The present study combined these types of designs to collect various data from therapists, clients, and independent judges regarding multiple therapy as compared to individual therapy, as well as the multiple situation itself.

The current report includes two main categories of

hypotheses in reference to therapists, which correspond to the,two main themes in the literature. The first of these is centered around differences in how the therapists operate and perceive therapeutic process in each condition; the second, with various facets of the co-therapist relationship and the possible effect of some of these on clients. The specific research hypotheses are listed in the succeeding chapter. Predictions and results of the project which focus primarily on client experiences in the two conditions are to be reported in the dissertation of the writer's co-researcher (Reiner, 1973).













METHOD


Subjects

Counselors

The aforementioned prerequisites and criteria for matching were taken into consideration in selecting the therapists. All of the therapists--counselors at the University of Florida Counseling Center--were of the "eclectic" variety and thought to be fairly flexible in orientation. The pairing of six male and six female therapists for the multiple condition was made by joint agreement of the members of each team and the two researchers. When .a therapist had agreed to participate in the study, he (or she) was then asked if he thought he would work well with the other counselor whom the researchers, in conjunction with the center's director, had determined would be an appropriate partner. Each therapist had to reply affirmatively for the pair to be formed. There were three experienced pairs, with from three to five years' therapy experience, and three intern-level teams, averaging six months to one year of counseling work.


Clients

The 24 clients were unmarried female students at the University of Florida between the ages of 18 and 23; all



29





30



had presenting problems concerned with interpersonal difficulties. Every unmarried female student coming to the counseling center for personal counseling during the duration of the study was asked to participate in the project. The one exception to this was in the case of a student who had had counseling in the past. Previous therapy is one variable consistently shown to influence therapeutic interactions (Meltzoff and Kornreich, 1970), and thus these students were excluded.


Design

The following discussion sketches the overall design of the project and elaborates upon the aspects crucial to the material of the present report. Granted, there are .myriad other considerations and analyses possible to pursue with the data that have been gathered.


Conditions and Groups

Therapists.--The same therapists saw clients individually and multiply during the same time period; thus, they provided their own matched control. Each therapist saw one client in individual sessions and two with the same cotherapist partner throughout the course of therapy. The counseling of two clients multiply was necessitated by the desire to have 12 clients undergoing treatment in each condition. The use of the same team of therapists for two cases yielded a sample size of six pairs, rather than the 12 that could have been attained by different pairings for





31



each case. This was not ideal in that the multiple condition was not comprised of somewhat more independent pairs, but it was not possible to re-corrine the therapists into six more couples that the researchers and the counselors felt would be compatible ones.

To adapt this design for some of the data analysis, one of the clients for each therapist pair was assigned at random to the female therapist and the other to the male. This was decided by tossing a coin to see which therapist would be the one aligned with the first or second client seen multiply (again, the choice of a coin flip).

Clients.--The subjects were randomly assigned to counselors, in so far as possible. A schedule was arranged wherein the order of assignment to each pair of therapists was randomized, as was the order of assignment to individual therapy with the male therapist of a pair, individual therapy with the female therapist, or one of the two multiple sets. As students agreed to participate, they were relegated to therapists according to this order on a "first come, first serve'" basis. When a subject dropped out of therapy before completing four sessions, this was considered first priority, however, and the vacated space was filled before continuing with the random assignment. Although the clients were naturally matched in some respects as they were drawn from the same population, their random designation to conditions assured independent groups.





32



Comparisons

First and last sessions.--All data were collected for initial and terminal interviews, enabling comparisons to be made between the participants' pre- and posttests for both conditions. Although tape recordings were made of all sessions for future reference, only the first and final ones were utilized. The number of interviews per case varied from four upward; any students discontinuing therapy before four sessions were excluded from the study. It was decided that natural termination was preferable to administering posttests after a specific number of sessions, as it seems somewhat presumptuous to assume that clients have had equal therapeutic exposure or possible progress in the same number of sessions.

Individual versus multiple process.--A Comparative Therapy Scale, which taps attitudes toward multiple and individual therapy, was administered to the counselors. The therapists answered the same process forms (Therapy Session Report) for individual and multiple sessions so that their perceptions and reported behaviors during the two situations could be easily compared. Similar self-report forms (Therapy Session Report) regarding the process of the therapy sessions were completed by therapists and clients, so that their agreement or lack of it could be ascertained. Process was was also rated by two clinicians who listened to taperecorded segments of the sessions (as per the scales developed by Berenson, Carkhuff, and Truax).




33



Quality of the co-therapists' relationships.--The present design incorporated several approaches aimed at describing the quality of the multiple therapists' relationships. One method was a direct one of having the therapists rate each other as far as their relationship on two measures (Caring Relationship Inventory; Multiple Therapy Rating Scale) designed or adapted for this purpose. Another involved perceptual agreement as to how the therapy sessions proceeded; this specifically involved a therapist rating his partner (on the Multiple Therapy Rating Scale) on the latter's behavior and perceptions which he had also selfrated (on the Therapy Session Report). The relevance of good and poor co-therapist rapport measured by the above instruments for client outcome (self-actualization) was also investigated.

Possible therapist growth.--The Personal Orientation Inventory was administered to the therapists at the inception and the conclusion of their involvement in the research project to detect any change in self-actualization resulting from the experience. There was no control condition for this analysis, however, so any results could only be suggestive.


Procedure

Counselors

Before commencing their first therapy session, the counselors were given the Myers-Briggs Type Indicator





34



if they had not previously taken it and a Personal Orientation Inventory. The experimenter gave all participating therapists the Therapists' Research Instructions Sheet (Appendix A). After the first and the last sessions in both conditions, the therapists filled out a Therapy Session Report; after multiple sessions, they also completed a Multiple Therapy Rating Scale. After the very first and the very last multiple interviews, they also answered a Caring Relationship Inventory. It was the therapists' responsibility to tape all sessions. After their last multiple session, the counselors were again given the Personal Orientation Inventory. After finishing all counseling, the therapists completed the Comparative Therapy Scale. Clients

The clients were initially seen for a half-hour intake interview, as are all students coming to the counseling center. They were told in regard to referral that the intake person had one or two other counselors in mind and that he would make the best referral possible. The clients were also told that multiple therapy with both a male and a female counselor was a frequent practice of the center.

The client's name was then given to one of the researchers who contacted the client by telephone, explained the nature of the study, and asked the client to participate. If she agreed, the researcher asked her to come to the center





35



to take the pretests as soon as possible; told her the name(s) of her counselor(s); and said that she would be given an appointment as soon as she had completed the testing. The pretests were the Personal Orientation Inventory; a self-rated scale of self-actualization, the Self-Actualization Scale (S-A Scale); and a specific Problems List, on which the client listed three problems on which she wanted to work in counseling. (These measures will be described in the dissertation of Reiner, 1973.) After the final therapy session, the client again completed all of the above scales, the S-A Scale and the Problems List being the posttest versions.


Instruments

Therapy Session Report

The Therapy Session Report (TSR), which was developed by Orlinsky and Howard (1966b), has been used extensively in psychotherapy research by these authors to determine how clients and therapists perceive and behave during therapy hours (Orlinsky and Howard, 1966b, 1967). Similar forms for the client and the therapist were designed, enabling easy comparisons of their experiences and feelings about the process of the sessions.

The current researchers selected items from the original scales and used these in the forms for therapists and clients (Appendix B). The items that were parallel for the therapists and clients have the item numbers of the therapist





36



form after the items on the client form. The items were all multiple choice, and inquired into the participants' feelings and actions during the sessions, how the therapists and clients. viewed-each other, and how they evaluated certain aspects of the process of the sessions. All items require that the participants rate a statement regarding one of the above areas.

Some items are judged on a scale of 0 to 2; for

example, "What did your patient seem to want this session? A chance to let go and express feelings." The therapist assigned one of the following scores:

0: No

1: Some

2: A lot

The second scoring plan is exemplified by the item, "During this session, how much did your patient tend to agree with or accept your comments or suggestions?" The therapist rated his client's behavior according to the following scale:

0: Slightly or not at all

1: Some

2: Pretty much

3: Very much

The third type of item utilized a 5- or 6-point scale. The therapist had the following choices in regard to the question, "To what extent did you reveal your spontaneous





37



impressions or reactions to your patient this session?":

1: Considerably

2: Moderately

3: Somewhat 4: Slightly

5: Not at all

This last type of item was presented on the forms to the testee in the opposite direction from which it was scored: the "1" choice was given a score of 5, while the "5" choice was scored as 1.

For purposes of hypothesis testing, some of the items were grouped together for scoring. When this was done, the scoring scheme was changed so that each response rereived a 0 for "no," and a 1 for either "some" or "a lot." The scores for all relevant responses were then summed to give a composite total for the group of items. The topics involved are listed in the section dealing with hypotheses. The remainder of the items were used singly to test hypotheses. No attempt was made to obtain a score over the entire inventory since the aspects of counseling covered by the items are so diverse.


Comparative Therapy Scale

Rabin (1967), as already mentioned, was a pioneer in the empirical investigation of therapist attitudes toward co-therapy and regular group therapy. His original Co-Therapy Rating Scale consisted of 50 items regarding the






38



nature of therapy interactions and progress. His therapist subjects rated 32 of the topics as being meaningfully different in co-therapy than in regular therapy. Thirty of these items were used in the Comparative Therapy Scale (CTS) in the present study (Appendix C). Rabin's item, "Your general preference when therapy in a group is the only treatment," was changed to "Your general preference." Another item that dealt with an issue specific to group therapy was deleted. The present author also added the last item of the CTS, "Resolution of impasses," as the literature lists this as an important advantage of multiple therapy over individual therapy.

The directions for the CTS asked the therapists to

compare multiple therapy and individual therapy (with individual clients) on the 32 topics. Two columns, one for multiple therapy and one for individual therapy, provided the levels of comparison which were scored as follows:

1: Slightly more

2: Moderately 3: Much more

A check in the "No difference" column, placed between the ones for multiple and individual therapy, was not scored. Several items which indicated negative differences between the methods were rescored to be in the same direction (these are indicated by an asterisk in the left magrin); and item number 22 was omitted from this scoring scheme (indicated






39



by a "O" in the margin), since its scoring direction was indeterminable. The scores of each therapist in the multiple and individual columns were then summed, providing a total score over all items for individual and multiple therapy. In addition, the mean and modal score of each item using Rabin's (1967) scoring pattern--"l" for "much more" in multiple therapy to "4" for "no difference" through "7" for much more in individual therapy---was computed from the scores of the 12 therapists on each item. The Carkhuff Process Scales

It is now widely accepted that certain core conditions of therapists' level of functioning are crucial to some of the events that take place during therapy. Carkhuff (1969) described the scoring procedures for his process scales designed to evaluate: (1) empathetic understanding,

(2) respect, (3) faciliative genuineness, and (4) concreteness or specificity of expression in interpersonal processes. These scales shall be referred to in the text as: Empathy, Respect, Genuineness, and Concreteness. The form of these scales used to train the judges and rate the taped excerpts from therapy sessions of the study are given in Appendix D. It seems advisable to describe the version presently used because all of the scales have progressed through several stages as research indicated that alterations or refinements were necessary.

These process scales, along with a scale that measures depth of client self-exploration, have been shown to be





40



reliable instruments and have been validated in numerous psychotherapy research projects (as reported in Carkhuff, 1968; Carkhuff and Berenson, 1967; and Truax and Carkhuff, 1967). It has been noted, however, that higher reliability and predictive validity have been obtained when the raters using the scales are themselves high-level functioning counselors (Carkhuff and Berenson, 1967). Interjudge reliability coefficients as high as .80 and above have been found using such raters (Swander, 1971); whereas the use of naive undergraduate students could be expected to give coefficients closer to .50 (Truax and Carkhuff, 1967).

Taped excerpts were taken from the initial and the

terminal therapy interviews of the 12 multiple and the 12 individual cases. Each of these therapy sessions was divided into thirds, and one segment was taken from the first, the middle, and the last third of the session. The order in which these 144 segments were presented to the judges was completely randomized, so that they did not know if any particular segment was from the first or last session, nor from what portion of the interview. Because of the nature of the conditions, however, the raters were able to discern whether an excerpt was from the multiple or the individual condition. Master tapes with the excerpts given in their random sequence and identified by a number, along with 144 numbered 3 x 5 cards, were given to the judges. The cards had columns for male therapist, female therapist, and client.






41



The judges were instructed to rate all four of the therapist scales in the same order--Empathy, Respect, Genuineness, and Concreteness--and then the client scale. The ratings on all of the scales for any given segment were executed simultaneously.

Two intern-level counselors who were themselves highfunctioning (averaging above 3.0 on all scales) and had attained an interjudge reliability of above .80 in previous research (Swander, 1971) were used as raters. Pearson product-moment correlations were computed over the independent ratings of the two judges for 15 randomly selected segments of the 144 segments of the present study. There were 7 segments that were selected from the multiple condition,and the ratings of both therapists were used in the calculation of the correlations; the coefficients thus reflect the agreement of the judges over 22 ratings. The Pearson product-moment correlations were .89 for Empathy, .91 for Respect, .93 for Genuineness, and .93 for Concreteness.

For each relevant session, the scoring scheme for any one of the scales called for three ratings (first, middle, and last segments) by two judges. The score of each therapist for a session was to be an average of these six ratings. Unexpectedly, however, there were several segments in the multiple condition in which the female therapist did not talk at all, and thus she was not rated. The specific





42



number and the meaning of these occurrences will be discussed further in succeeding sections (Results and Discussion). It should be noted here, though, that in these cases the scores for that therapist were based on an average of the segments that were rated.


Caring Relationship Inventory

As previously stated, many theorists in the area have

stated that an effective multiple therapy relationship would contain the same ingredients as a good marriage. Kamerschen (1969) and Randolph (1970) used a modified form of van der Veen's Family Concept Q-Sort to create their Co-Therapist Inventory. Shostrom's Caring Relationship Inventory (CRI was designed for relationships ranging from the dating stage to marriage (1966a). The CRI consists of 83 true-false items that concern feelings and attitudes that the members of a heterosexual dyad have toward each other. The inventory is comprised of five basic scales and two subscales. The major scales, given the titles Affection, Friendship, Eros, Empathy (M)* and Self-Love, supposedly measure different aspects of love. The subscales purport to describe whether the respondent's love is one based on need (Deficiency Love) or is metamotivated (Being Love). A description of these scales, along with their identifying symbols and the number of items on which they are based, is given in Appendix E.


*The symbol for the CRI scale of Empathy, "M," will
follow the scale's title, to distinguish it from the process scale of Empathy.





43


This instrument attempts to measure many aspects of a relationship which the present researcher deemed to be important for co-therapists.

Shostrom (1966a) presents split-half reliability findings on a sample of 272 persons who were successfully married, had a troubled marriage, or were divorced. The reliability coefficients for the basic scales ranged from .74 to .87, while those for the subscales were .66 (Deficiency Love) and .82 (Being Love). As evidence that this is a valid test, Shostrom further reported that all of the scales can significantly discriminate between successfully married., troubled, and divorced couples. There have been no sex differences found on any of the scales.

The directions for the CRI were altered so that the respondents would rate their co-therapist as they saw him or her, and then rate their ideal co-therapist. The completed inventories were scored with the standard scoring keys provided by the Educational and Industrial Testing Service. Hypotheses were formulated about the therapists' responding on all of the scales except Eros, as it was felt that this aspect of a relationship was not an important dimension for co-therapists.


Personal Orientation Inventory

Shostrom's Personal Orientation Inventory (POI) is a forced-choice, 150-item questionnaire that purports to measure various aspects of self-actualization (Shostrom,






44



1966b). Responses to these items yield scores for two main scales and 10 subscales, 4 of which are listed and described in Appendix F, along with the scale symbols.

This instrument has been shown to have test-retest reliabilities as high as .93 and .91 (Shostrom, 1964). Other test-retest coefficients are reported as .71 and .84 for the basic orientation scales (Time-Competence and Inner-Directed), and as ranging from .55 to .85 for the subscales (Klaveter and Magar, 1967). Validity for each of the POI scales has been examined by its ability to differentiate between groups of individuals who were reportedly selfactualizing, normal, or not self-actualizing (Fox, 1965; Shostrom, 1964).

The pre and post scores of the therapists on the two major scales of personal orientation (Time Competence and Inner-Directed) and two of the subscales were used to detect possible therapist growth during their involvement with multiple therapy. The two subscales chosen were ones thought most likely to change on the basis of theory in the literature (Spontaneity and Capacity for Intimate Contact). The standard scoring keys distributed by the Educational and Industrial Testing Service were used.


Multiple Therapy Rating Scale

The Multiple Therapy Rating Scale (MTRS) was devised by the author and her co-researcher (Reiner) to tap areas not covered by the other scales regarding the co-therapists' perceptions of each other and their relationship.





45



Co-therapist agreement.--This instrument included

eight items that paralleled some items of the TSR. (These items are designated in Appendix G by having the item number of the TSR to which they correspond immediately following the item.) In completing the MTRS, then, each therapist rated his partner on aspects of the latter's behavior for which the partner had also rated himself. These items were used as an indix of agreement between the therapists as to how they saw each other and themselves during the sessions. It was postulated that close agreement was indicative of a good relationship, while discrepant views meant something was askew in the relationship.

For the first and last session of each case, the scoring of this part of the scale consisted of summing the number of exact agreements out of the eight topics on which each therapist rated himself and was rated by his partner. This yielded an agreement score for each individual therapist. A composite score for the couple was derived by adding the two scores of the co-therapists. In addition, a total composite score for each case was computed by summing the pre and post composite scores.

Quality of the co-therapist relationship.--The remainder of the items were ones that inquired about other perceptions of the therapists concerning the events of the sessions. The topics were ones that the co-researchers thought were important as to how the therapists worked together. Four





46



intern-level psychology graduate students were asked to evaluate the items and the responses of this section of the scale (see Directions for Rating the MTRS, Appendix G). First, the judges rated all of the items in regard to their relevancy for the formation of a co-therapist relationship. All of the judges agreed in identifying 13 of the 14 pertinent items as being relevant. They also all concurred that the items describing the other therapist's behavior (the topics similar to the TSR ones discussed above) and the final item were not relevant ingredients of the co-therapist relationship. The second item, that only one judge felt was relevant, was omitted for scoring purposes. The percentages of agreement between the judges in regard to the relevancy of the questions are shown in Table 1.

TABLE 1

PERCENTAGES OF AGREEMENT AMONG FOUR JUDGES REGARDING
THE MULTIPLE THERAPY RATING SCALE


Judges B C D


Relevancy of the Items
A 1.0000 1.0000 .9285 B 1.0000 .9285 C .9285 Scoring Direction of the Responses
A .7777 .7619 .7936 B .8095 .7460 C .6667





47



Secondly, the judges rated each item as to whether it was indicative of the formation of a good, neutral, or poor co-therapist relationship. The scoring pattern for each judge over all the items is recorded in Table 30, Appendix G. In most cases, only those responses rated in the same direction by at least three out of the four judges were used for scoring purposes. Due to the equivocal judgments regarding the responses of items 1 and 16, these items were thrown out. Three of the other responses to questions where most of the responses were rated similarly by the judges were retained and scored "zero" (4d, 5c, and 6c)--the original scoring direction determined by the two co-researchers. These responses were chosen infrequently by the present sample of therapists, so it was decided to retain these items. Because of the nature of one item of the questionnaire (22), where each response was somewhat separate from the others, several choices were eliminated, while retaining the rest of the responses. These deletions resulted in the total of 11 items being used for scoring in this part of the scale, with 25 responses being scored in the positive direction, 7 in the neutral, and 22 in the negative. Responses were scored +1, 0, and -1 as to whether they indicated good, neutral, or poor rapport between the therapists. A total score for each therapist was obtained by summing all of the positive responses and subtracting the negative ones. A composite score for each therapist pair was obtained by adding their





48



respective scores together, and a total composite score was obtained by summing the pre and post composite scores.

An investigation of the test-retest reliability of the two parts of the MTRS was proposed. It would seem likely that the therapists would rate their relationship similarly after seeing their first multiple case together and after seeing their second. It would also appear likely that their level of agreement as to the events of the session would remain stable for their two first multiple sessions. It was also planned to see if either the level of agreement or the rated quality of the co-therapist relationship scores for each therpist correlated with those of his Caring Relationship Inventory as a concurrent validity check. Also, it would be expected that these indices would be related to outcome of the multiply seen clients. High agreement and high quality should be paired with good outcomes, low agreement and low quality with poor outcomes. If the data suggested a trend in this direction, it would provide a crude case for predictive validity of the MTRS.


Myers-Briggs Type Indicator

The Myers-Briggs Type Indicator is a 166-item, forcedchoice instrument that categorizes testees according to Jung's typology. Information regarding the composition and scoring of the test can be obtained from the Educational and Industrial Testing Service, San Diego, California.






49



According to Isabel Briggs Myers, who with her mother developed the instrument, research has shown that clinical psychologists are predominantly Introverted or Extraverted Intuitive Types with Feeling and Perception being strongest. She also feels that these are the types best suited for counseling work.*

The use of this test in the present study was purely descriptive; the types of each therapist are indicated in Table 36, Appendix H. A homogeneous pool of therapists according to their types would be desirable; however, the present sample contained people of varied types. As shown, 7 of the 12 therapists are either of the two aforementioned types; two differ only in that they have Judging predominant over Perception, and in one of these cases the score was barely into the Judging zone. The other three, however, are Extraverted or Introverted Sensing Types with Thinking and Judging dominant. It would be interesting to note whether those of the "noncounselor" types have different scoring patterns from the others on the Carkhuff Process Scales.


Hypotheses

The specific research hypotheses fall into two major

categories: (a) those regarding differences between multiple and individual therapy, and (b) those concerned with the



*Personal communication, November 18, 1970.





50



multiple condition itself. The instruments by which a hypothesis was tested, along with item numbers when appropriate, are given below. The hypotheses are numbered consecutively through both categories.


Multiple Versus Individual Therapy

TSR.--The therapists will report that the therapeutic interactions differed in the two conditions. Compared to individual therapy, they will rate the clients in multiple therapy as

1. Having talked more about relations with persons
of both sexes (Items 1 and 2).

2. Having discussed a greater variety of topics
(Items 1-5).

3. Having wanted more to express or explore feelings
(Items 6 and 9).

4. Having had their feelings more stirred up (Item 17).

5. Agreeing with and/or accepting more of their
comments or suggestions (Item 21).

6. Having shown more progress (Item 25).

Similarly, the therapists will be apt in multiple therapy to rate themselves as:

7. More revealing of their spontaneous impressions or
reactions (Item 29).

8. More understanding of what their patients said and
did (Item 31).

9. Being more helpful to their patients (Item 32).

10. Being more critical or disapproving to their clients
(Item 35).

11. Being more warm and friendly toward their clients
(Item 36).






51



12. Expressing more feeling (Item 37).

13. It is expected that the client-therapist agreement
as to the events of the sessions will be higher in multiple therapy than in individual therapy (on 24
items of the therapist and client forms of the TSR).

Comparative Therapy Scale.--More therapists will rate multiple therapy over individual therapy as:

14. Being conducive to self-understanding of the therapist (Item 6).

15. Being useful in training therapists (Item 10).

16. Offering more personal gratification (enjoyment or
"fun") for the therapist (Item 11).

17. Being their general preference (Item 24).

18. Fostering the resolution of impasses (Item 32).

19. The therapists generally will express a more positive
attitude toward multiple therapy than toward
individual therapy (Items 1-32).

Carkhuff Process Scales.--The therapists will offer

higher levels of therapeutic conditions more consistently in multiple therapy than in individual therapy. It is hypothesized that the therapists will offer higher facilitative core conditions as measured by the scales of:

20. Empathy.

21. Respect.

22. Genuineness.

23. Concreteness.


The Multiple Condition

CRI.--Only one of the therapist pairs had done therapy together previously and this had not been an extensive






52



collaboration. It was thought, then, that the relationships of the pairs would change toward greater intimacy and caring over time. It was hypothesized that the following scales would show increases:

24. Affection.

25. Friendship.

26. Empathy.

27. Being Love.

28. Deficiency Love.

Also, it appeared possible that as the therapists' relationships became more collaborative, their focus on themselves in the association would decrease. The scale of Self Love on the CRI measures the amount of concern about oneself or one's tendency to be an independent person, a "top dog" in the relationship.

29. The scores on the scale of Self Love were hypothesized
to decrease from the first to the last session.

POI.--The therapists should show some growth during the time they are involved in multiple therapy. It was hypothesized that the counselors would show increases in selfactualization on the following scales:

30. Time-Competence.

31. Inner-Directed.

32. Capacity for Intimate Contact.

33. Spontaneity.

The multiple relationship and client outcome.--It was hypothesized that there would be a relationship between






53



client outcome and certain aspects of the multiple therapy

relationship. First of all, it was postulated that

34. There will be a positive correlation between the
self-actualization of the clients (as measured by the major POI scales of Time-Competence and InnerDirected) and the level of caring of the therapists (as measured by the CRI scales of Affection,
Friendship, and Empathy).

Secondly, it was planned to compare the clients' scores on

the S-A Scale with their therapists' scores on the MTRS to

test the following hypotheses:

35. The quality of the co-therapist relationship will
be positively related to the client level of selfactualization (as measured by the S-A Scale).

36. There will be a positive relationship between agreement of the co-therapists as to how they behaved
and perceived during the sessions and the level of
self-actualization of the clients (on the S-A Scale).













RESULTS


Comparison of Multiple and Individual Conditions Number of Sessions

As mentioned previously, the therapists had to have at least four sessions with a client for that case to be included in the study. Of the seven cases where clients were terminated before the fourth session, six were in the individual and one in the multiple condition. A sign test determined the probability of this occurrence as being .062. Table 31 in Appendix H lists the total number of sessions for the individual condition as 7.75, the mode 5. For the multiple condition, the mean was 7.50 and the mode 6. As heretofore explained, one of the multiples in which each therapist participated was selected at random for purposes of comparing measures of that therapist in the multiple condition to those of his in the individual condition. The other multiple in which he participated was relegated to his partner. A Wilcoxon matched-pairs signed-ranks test was calculated between the number of sessions that each therapist had with his client in the individual condition and and number he had with his client in the multiple condition This test yielded nonsignificant results (T = 16.5, p > .05, critical value = 11), suggesting that the groups were matched on this variable.


54





55



TSR Data

All of the hypotheses aligned with the TSR instrument, concerning the predictions that the counselors would report differing therapeutic interactions in individual and multiple therapy, were tested similarly. In each case, a randomized block factorial design (Kirk, 1969, pp. 237-244) was used to assess the differences between conditions (multiple and individual) and time of measurement (initial or terminal interview). The test employed was a two-way analysis of variance with repeated measures on both variables, as the same therapists participated in both conditions and pre and post data were collected on them.

Hypothesis l.--Compared to individual therapy, the therapists will rate the clients in multiple therapy as having talked more about relations with persons of both sexes (Items 1 and 2). As shown in Table 2, the analysis of variance of the therapists' scores on the first two items yielded no significant F ratio for blocks, condition, time, or the interaction of condition and time. Hypothesis 1 was not supported.

Hypothesis 2.--Compared to individual therapy, the therapists will rate the clients in multiple therapy as having discussed a greater variety of topics (Items 1-5). As shown in Table 3, the F ratio for blocks was significantly greater than zero, meaning that there were individual differences between the therapists, as might be expected.






56



TABLE 2

MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST
RESPONSES TO TSR ITEMS 1 AND 2 FOR MULTIPLE
AND INDIVIDUAL CONDITIONS


Multiple Individual
Pre Post Pre Post 2.5833 2.1660 2.5000 2.0000 (.9962 (.3892) (.6742) (1.0415)

Source df MS F


Blocks 11 .4147 .55 Treatments 3

Condition (A) 1 .1875 .25 Time (B) 1 2.5275 3.33 Ax B. 1 .0201 .03 Residual 33 .7582

Total 47

Note: The standard deviations are in parentheses.

Hypothesis 3.--Compared to individual therapy, the therapists will rate the clients in multiple therapy as having wanted more to express and explore feelings (Items

6 and 9). Table 4 lists a significant blocks ratio, again indicating that there were individual differences among the therapists as to how they responded. The effect of condition was not significant,'and Hypothesis 3 was not substantiated. A significant ratio was obtained for time, with the initial interview means being larger than those of the






57



terminal interview. The therapists, then, felt that their clients wanted to express and explore feelings more during the first session than they did during the last.

TABLE 3

MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST
RESPONSES TO TSR ITEMS 1-5 FOR MULTIPLE AND
INDIVIDUAL CONDITIONS


Multiple Individual
Pre Post Pre Post

3.2500 3.2500 3.2500 3.0833
(.8660) (1.1382) (.9653) (1.2401)

Source df MS F Blocks 11 1.9469 2.27* Treatments 3

Condition (A) 1 .0833 .10 Time (B) 1 .0833 .10 Ax B 1 .0834 .10 Residual 33 .8560

Total 47

Note: The standard deviations are in parentheses.
*p < .05.

Hypothesis 4.--Compared to individual therapy, the therapists will rate the clients in multiple therapy as having had their feelings more stirred up (Item 17). This hypothesis was rejected, as the F ratio for condition was not significant. A perusal of the data to detect a possible






58



TABLE 4

MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUJAMMARY TABLE FOR THE THERAPISTS' PRE AND POST
RESPONSES TO TSR ITEMS 6 AND 9 FOR MULTIPLE
AND INDIVIDUAL CONDITIONS


Multiple Individual
Pre Post Pre Post
1.6660 1.2500 1.7500 1.4166 (.6513) (.8660) (.4523) (.7930)

Source df MS F


Blocks 11 1.0208 3.10** Treatments 3

Condition (A) 1 .1874 .57 Time (B) 1 1.6874 5.13* Ax B 1 .0209 .06 Residual 33 .3289

Total 47

Note: The standard deviations are in parentheses.
*p < .05.
**p < .01.


negative bias in the test seemed worthwhile, since the ratio for time obtained by using the mean square for residual was close to significance (F = 3.59, p < .10). As an inspection of the data suggested that there might be an interaction between blocks and treatments, the residual error was partitioned into its component parts and new F ratios were computed. As shown in Table 5, however, none of the F ratios were significant.






59



TABLE 5

MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES TO TSR ITEM 17 FOR MULTIPLE AND INDIVIDUAL CONDITIONS


Multiple Individual
Pre Post Pre Post
1.6666 1.1666 1.5833 1.4166 (.6513) (.3892) (.6686) (.7930)

Source df MS F


Blocks 11 .5378 1.45 Treatments 3

Condition (A) 1 .0833 .48 Time (B) 1 1.3333 4.00 Ax B 1 .3334 .55 Residual 33 .3712 A x blocks 11 .1742 B x blocks 11 .3333 AB x blocks 11 .6062

Total 47

Note: The standard deviations are in parentheses.

Hypothesis 5.--Compared to individual therapy, the therapists will rate the clients in multiple therapy as agreeing with and/or accepting more of their comments or suggestions (Item 21). This hypothesis was rejected when, in fact, the results showed (Table 6) that the means were significantly higher both pre and post for the individual than the multiple condition. The therapists, then, felt that their





60



clients agreed with and/or accepted more of their comments or suggestions in the individual condition. None of the other F ratios were significant.

TABLE 6

MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES TO TSR ITEM 21 FOR MULTIPLE AND INDIVIDUAL CONDITIONS


Multiple Individual
Pre Post Pre Post

1.2500 1.3333 1.6666 1.9166 (.6216) (.7785) (.4924) (.6686)

Source df MS F Blocks 11 .5378 1.41 Treatments 3

Condition (A) 1 2.9999 7.87** Time (B) 1 .3333 .87 Ax B 1 .0835 .22 Residual 33 .3813

Total 47

Note: The standard deviations are in parentheses.
**p < .01.

Hypothesis 6.--Compared to individual therapy, the therapists will rate the clients in multiple therapy as having shown more progress (Item 25). As evinced by the results in Table 7, this hypothesis was not supported, and the F ratios for blocks, time, and the interaction of time and condition were also nonsignificant.





61



TABLE 7

MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUIWARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES TO TSR ITEM 25 FOR MULTIPLE AND INDIVIDUAL CONDITIONS


Multiple Individual
Pre Post Pre Post
2.2416 2.7500 2.5833 2.6666 (.5149) (1.0553) (.6686) (.4924)

Source df MS F


Blocks 11 .2026 .33 Treatments 3

Condition (A) 1 .0208 .03 Time (B) 1 .5208 .84 Ax B 1 .1876 .30 Residual 33 .6218

Total 47

Note: The standard deviations are in parentheses.

Hypothesis 7.--The therapists will be apt in multiple therapy to rate themselves as more revealing of their spontaneous impressions or reactions than in individual therapy (Item 29). As listed in Table 8, no significant F ratios resulted from the analysis of variance of the scores involved in this prediction. Hypothesis 6 was not supported.

Hypothesis 8.--The therapists will be apt in multiple therapy to rate themselves as more understanding of what their patients said and did than in individual therapy (Item 31). The analysis of variance summary table reported





62



TABLE 8

MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES TO TSR ITEM 29 FOR MULTIPLE AND INDIVIDUAL CONDITIONS


Multiple Individual
Pre Post Pre Post

3.3330 3.8333 3.7500 3.8333 (.9847) (1.0299) (.8660) (.9374)

Source df MS F


Blocks 11 1.4147 1.890 Treatments 3

Condition (A) 1 .5208 .70 Time (B) 1 1.0208 1.37 Ax B 1 .5209 .70 Residual 33 .7481

Total 47

Note: The standard deviations are in parentheses.
op < .10.

in Table 9 shows a significant F ratio for blocks, indicating that there were individual differences between the therapists on this item. The ratios for condition, time, and the interaction of time and condition were nonsignificant. Hypothesis 8, then, was not supported.

Hypothesis 9.--The therapists will be apt in multiple therapy to rate themselves -as being more helpful to their patients than in individual therapy (Item 32). This hypothesis was not substantiated; Table 10 includes no significant F ratios.





63



TABLE 9

MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES TO TSR ITEM 31 FOR MULTIPLE AND INDIVIDUAL CONDITIONS


Multiple Individual
Pre Post Pre Post

4.0388 4.2500 3.8333 3.6666 (.9003) (.7538) (1.0299) (1.3027)


Source df MS F


Blocks 11 1.8106 3.16** Treatments 3

Condition (A) 1 .7500 1.31 Time (B) 1 .3333 .58 A x B 1 .0000 .00 Residual 33 .5732

Total 47


Note: The standard deviations are in parentheses.
** p < .01.


TABLE 10

MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES
TO TSR ITEM 32 FOR MULTIPLE AND INDIVIDUAL CONDITIONS


Multiple Individual
Pre Post Pre Post

3.1666 3.3333 3.0000 3.5000 (.8348) (1.0731) (1.0445) (1.3817)





64



TABLE 10--(continued)



Source df MS F


Blocks 11 .7935 .72 Treatments 33

Condition (A) 1 1.0208 .92 Time (B) 1 1.0208 .92 Ax B 1 .1876 .17 Residual 33 1.1066

Total 47

Note: The standard deviations are in parentheses.

Hypothesis 10.--The therapists will be apt in multiple therapy to rate themselves as being more critical or disapproving to their clients than in individual therapy (Item 35). Again, the only significant F ratio shown in Table 11 was that of blocks signifying that there were individual differences among the therapists as far as their self-report of how much they expressed their critical or disapproving thoughts to their clients was concerned. It is noteworthy that all of the means included in Table 11 are very low-very few of the therapists rated themselves as being negative or critical at all. As there was not a significant F ratio that concerned condition, Hypothesis 10 was rejected.

Hypothesis ll.--The therapists will be apt in multiple therapy to rate themselves as being more warm and friendly





65



TABLE 11

MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES TO TSR ITEM 35 FOR MULTIPLE AND INDIVIDUAL CONDITIONS


Multiple Individual
Pre Post Pre Post .3333 .5454 .3333 .4166 (.4924) (.6876) (.4924) (.5149)


Source df MS F


Blocks 11 .6420 3.02** Treatments 3

Condition (A) 1 .0207 .10 Time (B) 1 .1875 .88 Ax B 1 .0209 .10 Residual 33 .2127

Total 47

Note: The standard deviations are in parentheses.
**p < .01.

toward their clients than in individual therapy (Item 36). This hypothesis was not supported, as the ratio for condition was not significant; neither were the ratios for time and the interaction of condition and time. Table 12 shows that the ratio for blocks was appreciably greater than zero, indicating the existence of individual differences between the therapists on this item.

Hypothesis 12.--The therapists will be apt in multiple therapy to rate themselves as expressing more feeling than in individual therapy (Item 37). This hypothesis was not





66



supported, as a nonsignificant ratio for condition was obtained. The ratios for time and the interaction of condition and time were also below the .05 level of significance, while that of blocks was above (Table 13). There were individual differences among the therapists, then, as to how much feeling they rated themselves as expressing.


TABLE 12

MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES TO TSR ITEM 36 FOR MULTIPLE AND INDIVIDUAL CONDITIONS


Multiple Individual
Pre Post Pre Post

2.1666 2.0833 2.2500 2.3333 (.3892) (.6686) (.6216) (.6513)


Source df MS F


Blocks 11 .6742 2.75* Treatments 3

Condition (A) 1 .3333 1.36 Time (B) 1 .0000 .00 Ax B 1 .0834 .34 Residual 33 .2449

Total 47


Note: The standard deviations are in parentheses.
*p < .05.






67



TABLE 13

MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES TO TSR ITEM 37 FOR MULTIPLE AND INDIVIDUAL CONDITIONS


Multiple Individual
Pre Post Pre Post

1.3333 1.5833 1.6666 1.5833 (.4924) (.6686) (.6513) (.6686)


Source df MS F


Blocks 11 .7329 2.59* Treatments 3

Condition (A) 1 .1875 .66 Time (B) 1 .0208 .07 Ax B 1 .1875 .66 Residual 33 .2834

Total 47

Note: The standard deviations are in parentheses.
*p < .05.


Hypothesis 13.--It is expected that the therapist-client agreement as to the events of the sessions will be higher in multiple than in individual therapy (on 24 selected items listed in Tables 31 and 32, Appendix H). Table 14 lists the Pearson product-moment correlations computed between the scores of the therapists and those of their clients with whom they were paired. As shown, for the initial interview, nine of the therapists have higher agreement





68



scores in the multiple than in the individual condition. A sign test (two-tailed) determined that this difference was nonsignificant (p = .146). For the terminal session, seven of the therapists had a higher correlation between their scores and those of their clients in individual than multiple therapy--this was also not a significant difference (p = .774). As far as client-therapist agreement, then, no descriptive evidence of a difference between the conditions was found; Hypothesis 13 was thus not supported.

TABLE 14

THERAPIST-CLIENT AGREEMENT SCORES FOR MULTIPLE
AND INDIVIDUAL CONDITIONS: CORRELATIONS
BETWEEN THEIR RESPONSES TO 24 TSR ITEMS

Multiple Individual
Therapist- Therapistclient client
pair Pre Post pair Pre Post A-10 .76 .47 A-7 .52 .46 B-8 .83 .80 B-12 .65 .41 C-16 .64 .51 C-17 .81 .66 D-14 .79 .71 D-29 .68 .88 E-25 .91 .43 E-39 .75 .49 F-20 .49 .91 F-22 .78 .70 G-37 .82 .73 G-23 .62 .65 H-26 .84 .81 H-21 .97 .82 1-33 .80 .83 1-38 .77 .87 J-31 .67 .41 J-30 .57 .62 K-35 .90 .88 K-34 .78 .81 L-36 .78 .30 L-40 .60 .46





69



In inspecting the agreement scores for the first and the last session, it is noteworthy that 17 of the 24 cases had higher therapist-client agreement scores for the pretest than the posttest. A binomial test (two-tailed) showed this difference to be nonsignificant (p = .064 at the .05 level). In breaking this down into groups, in 10 out of the 12 multiple cases the posttest agreement scores were lower than the pretest scores (p = .038); while in the individual group, only 7 out of 12 were lower (p = .774). As far as the difference between pre- and posttesting, then, the two groups appear dissimilar. In the multiple condition, the agreement between the therapists and their clients was significantly greater during the initial interview than it was during the terminal interview. In the individual condition, there was not a significant difference between therapist-client agreement at the end, as compared to the beginning, of therapy.


CTS Data

As per the prior explanation (see Method section), the mean and the modal scoresof the therapists on the 32 items of the CTS were determined. Means and modes of 1 to 3 designate topics that the therapists felt typified multiple therapy, while 4 indicated no difference, and 5 to 7 signified statements thought to be true of individual therapy. The mean scores of the 32 items were used to rank order the topics, as shown in Table 15. The smaller ranks






70



thus designate statements that the therapists felt were definitely more applicable to multiple therapy than to individual therapy. There were three means that were above

4.00, and all of these items were negative ones; that is, "years of experience necessary to do effective therapy," "difficulties by the therapist in 'handling' intense transference reactions," and "emotional demands experienced by the therapist." The following hypotheses (14-18) were not tested per se, but were considered to be confirmed if the mean and the modal score were 3.0 or less. As statistical tests were not performed, the conclusions are considered to be suggestive.

Hypothesis 14.--The therapists will rate multiple

therapy over individual therapy as being conducive to selfunderstanding of the therapist (Item 6). This hypothesis was supported as the mean score of 2.667 and the mode of 2 indicated that the therapists felt that multiple therapy was slightly to moderately more conducive to self-understanding than was individual therapy.

Hypothesis 15.--The therapists will rate multiple

therapy over individual therapy as being useful in training therapists (Item 10). The results substantiate this hypothesis, as the therapists rated multiple therapy as being moderately to much more useful in training therapists. The mean and mode scores on this item were 2.083 and 1, respectively.






71



TABLE 15

MEANS, MODES, AND RANKS OF THE THERAPISTS' RESPONSE PATTERN
ON THE 32-ITEM COMPARATIVE THERAPY SCALE

Item
no. Rank Mean Mode

32. Resolution of impasses. 1 2.000 2

10. Useful in training therapists. 2.5 2.083 1

14. Useful with marital couples. 2.5 2.083 1

4. Opportunity to work out anxieties with a therapist of the more
dreaded sex. 4 2.167 2

3. Transference of the original family situation. 5 2.333 2

8. Understanding of countertransference. 6.5 2.417 2

28. Your general preference with a
patient who ferociously clings to
persons of one sex. 6.5 2.417 2

i. Understanding, by the therapist, of the transference. 8 2.583 3

6. Self-understanding of the therapist enhanced. 9 2.667 2

11. Personal gratification (enjoyment
or "fun") for the therapist. 10 2.727 3

30. Your general preference for working out and through a patient's
very intense "negative" transference. 11.5 2.750 3

31. Your general preference for working
out and through a patient's very
sticky "positive" transference. 11.5 2.750 3

18. Working out and through problems
of masculinity and feminity. 13 2.833 2

20. Opportunity for patients of both
sexes to identify with a reasonably
healthy person of the same sex. 14.5 2.917 3





72


TABLE 15--(continued) Item
no. Rank Mean Mode 26. Your general preference with a
patient who is expecially fearful
of heterosexual relations. 14.5 2.917 3 12. Useful with very "acting out"
patients. 16.5 3.000 3 24. Your general preference. 16.5 3.000 3 16. Positive therapeutic movement,
in general. 19 3.167 4 17. Working through, in general. 19 3.167 3 19. Working out and through problems
of hostility and assertiveness. 19 3.167 3 21. Understanding of resistance. 21 3.250 3 25. Your general preference with a patient who is very mistrustful of
authority, especially of one sex. 22.5 3.333 3 29. Your general preference when only
short-term therapy, i.e., 6 months
or less is available. 22.5 3.333 4 22. More complex patterns of resistance. 24.5 3.500 4 27. Your general preference with a
patient who is especially fearful
of homosexual longings. 24.5 3.500 4 23. Eliciting of oedipal dynamics. 26 3.727 4 13. Useful with borderline schizophrenics. 27.5 3.750 4 15. Useful with "oral characters." 27.5 3.750 4

2. Completeness of transference patterns. 29 3.909 4

*9. Years of experience necessary to do
effective therapy. 30 4.333 4

*5. Difficulties by the therapist in
"handling" intense transference
reactions. 31.5 4.917 5





73


TABLE 15--(continued)

Item
no. Rank Mean Mode

*7. Emotional demands experienced
by the therapist. 31.5 4.917 5



Hypothesis 16.--The therapists will rate multiple therapy over individual therapy as offering more personal gratification (enjoyment or "fun") for the therapist (Item 11). The therapists did feel that multiple therapy offered slightly to moderately more personal gratification, thus supporting Hypothesis 16.

Hypothesis 17.--The therapists will rate multiple therapy over individual therapy as being their general preference (Item 24). Although not being one of the highest-ranked topics, Table 15 shows a mean and mode score of 3 on this item, signifying that the therapists felt multiple therapy to be slightly more their general preference.

Hypothesis 18.--The therapists will rate multiple therapy over individual therapy as fostering the resolution of impasses (Item 32). This hypothesis was supported, as the therapists felt that multiple therapy was moderately more effective in fostering the resolution of impasses. The mean score of 2.00 was the highest of any item; the mode on this topic was also

2.

Hypothesis 19.--The therapists generally will express a more positive attitude toward multiple therapy than toward





74



individual therapy (Items 1-32). To test this hypothesis, a total score for each therapist regarding his attitudes toward multiple and toward individual therapy was obtained (see Method section). Basically, the responses of the therapists on each item were scored from "slightly more"

(1) to "much more" (3) for both regular and co-therapy, with the "no difference" column being omitted. As shown in Table 16, a Wilcoxon matched-pairs signed-ranks test (Seigel, 1956) detected that the differences were significant, thus confirming Hypothesis 19.

TABLE 16

WILCOXON MATCHED-PAIRS SIGNED-RANKS TEST FOR TESTING
DIFFERENCES IN THERAPISTS' ATTITUDES ABOUT
MULTIPLE AND INDIVIDUAL THERAPY


Multiple Individual Rank Rank with less Therapist therapy therapy d of d frequent sign
A 70 4 66 11
B 30 1 29 8.5 C 28 1 27 6.5 D 28 1 27 6.5
E 19 0 19 2
F 31 2 29 8.5
G 21 13 8 1 H 22 2 20 3 I 23 1 22 4 J 83 0 83 12 K 39 4 35 10 L 30 4. 26 5

T = 0*

*p < .005.





75



Carkhuff Process Scales Data

The average ratings that the therapists received on

the core facilitative conditions were to be based on ratings by two judges of three segments from each first and last session. It should be mentioned, however, that in the multiple condition there were eight instances where the female co-therapist did not talk during one or two excerpt(s) and her average rating for that session was based on two or one segment(s), respectively. There were not any segments from the individual condition where this occurred, nor was a male co-therapist silent during a 5-minute segment from the multiple condition. Of the ratings that were used to assess the differences between the therapists' offered levels of the core facilitative dimensions, two ratings are based on one segment and two are based on two excerpts (as noted in Table 35, Appendix H). The following results must be qualified, then, by the statement that the average ratings were not all compiled from the same number of excerpts.

For each of the four process scales, a randomized block factorial design (Kirk, 1969) was used to test the differences between condition (multiple and individual) and time of measurement (first or last interview). In three instances, there were no significant F ratios when these were computed using the residual error term. As an inspection of the data suggested a possible interaction between blocks





76



and treatments, which could result in a negative bias being present in the test, new F ratios were computed using the component parts of the residual error. Although directional hypotheses had been postulated in regard to conditions, an attempt was made to explain the significant interactions resulting from the analyses of variance. Thus, the simple main effects tests used were two-tailed t tests, which allowed for the testing of significant differences in either direction.

Hypothesis 20.--The therapists will offer higher levels of empathy in multiple therapy than in individual therapy. Table 17 lists a significant ratio for blocks, indicating the presence of individual differences among the therapists as to.their offered level of empathy. The main effects of condition and time were nonsignificant, while that of the interaction of condition and time was significant at the .05 level. A simple main effects test (Kirk, 1969) on the means involved showed that the therapists offered significantly higher levels during the terminal session than during the initial interview in the individual condition (t = 2.70, df = 22, p < .02), while the slightly larger pretest mean in the multiple condition was not significantly different from the posttest mean (t = 1.31, df = 22, p > .10). Contrary to Hypothesis 20, the therapists were higher on the Empathy scale in the individual condition during the terminal session than in the multiple condition (t = 3.43, df = 22,





77



p > .01). The means suggest that the levels offered in the two conditions were fairly equivalent at the onset of therapy, but increased as therapy proceeded in the individual condition while remaining the same in the multiple.

TABLE 17

MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST EMPATHY
SCORES FOR MULTIPLE AND INDIVIDUAL CONDITIONS


Multiple Individual
Pre Post Pre Post
2.772 6.608 2.653 3.041 (.475) (.449) (.630) (.448)

Source df MS F


Blocks 11 .462 2.46* Treatments 3

Condition (A) 1 .296 1.58 Time (B) 1 .151 .80 Ax B 1 .916 4.87* Residual 33 .188

Total 47

Note: The standard deviations are in parentheses.
*p < .05.

Hypothesis 21.--The therapists will offer higher levels of respect in multiple therapy than in individual therapy. Table 18 shows that, similar to the results of the Empathy scale, the analysis of variance of the scores on the Respect scale yielded significant blocks and interaction ratios,






78



TABLE 18

MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPECT
SCORES FOR MULTIPLE AND INDIVIDUAL CONDITIONS


Multiple Individual
Pre Post Pre Post 2.702 2.622 2.702 3.048 (.434) (.488) (.572) (.447)

Source df MS F


Blocks 11 .536 3.82** Treatments 3

Condition (A) 1 .546 2.73 Time (B) 1 .213 1.95 A x B 1 .547 5.01* Residual 33 .140 A x blocks 11 .200 B x blocks 11 .109 AB x blocks 11 .109

Total 47

Note: The standard deviations are in parentheses.
*p < .05.
**p < .01.


while those of condition and time were nonsignificant. Again, the posttest mean in the individual condition differed significantly from the pretest mean of that condition (t = 3.64, df = 22, p < .002) and from the posttest mean of the multiple condition (t = 4.48, df = 22, p < .002). The pretest means of the two conditions were equal, and the





79



difference between the pre and post means in the multiple condition did not reach significance (t = .84, df = 22, p > .20). Again, then, the therapists offered a comparable level of a facilitative core dimension in both conditions at the beginning of therapy, but a higher level in the individual condition at therapy's end. Hypothesis 21 was rejected.

Hypothesis 22.--The therapists will offer higher levels of genuineness in multiple therapy than in individual therapy. Neither of the main effects, condition or time, was found to be significant when the scores on the Genuineness scale were analyzed (Table 19). Individual differences between the therapists were indicated by a significant blocks ratio; and a significant interaction between condition and time was detected. A simple main effects test on the relevant means again determined that the post mean for the individual condition was significantly different from the pre mean for the individual condition (t = 4.46, df = 22, p < .002), and the post mean for the multiple condition (t = 4.82, df = 22, p < .002). Again, the difference between the slightly larger pre mean of the multiple condition and the post mean was not significant (t = .50, df = 22, p > .50). Since this difference was larger than that between the pre means of the multiple and individual conditions, the latter difference was also known to be nonsignificant. The therapists were shown to significantly





80


raise their offered level of genuineness in the individual condition over the course of therapy, while the level in the multiple condition remained static. Hypothesis 22 was not supported when the results indicated the only significant difference between the conditions to be that of individual being higher than multiple during the terminal session.

TABLE 19

MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST
GENUINENESS SCORES FOR MULTIPLE AND INDIVIDUAL CONDITIONS

Multiple Individual
Pre Post Pre Post 2.693 2.658 2.683 2.993 (.400) (.460) (.534) (.417)

Source df MS F


Blocks 11 .375 2.47* Treatments 3

Condition (A) 1 .327 1.27 Time (B) 1 .219 1.58 A x B 1 .348 6.00* Residual 33 .152 MSA x blocks 11 .258 MSB x blocks 11 .139 MSAB x blocks 11 .058

Total 47

Note: The standard deviations are in parentheses.
*p < .05.





81



Hypothesis 23.--The therapists will offer higher levels of concreteness in multiple therapy than in individual therapy. Table 20 shows that a significant F ratio was obtained for the interaction of time and condition when the scores of the therapists on the Concreteness scale were analyzed by the randomized block factorial design. The ratios for blocks, and the main effects of condition and time were nonsignificant at the .05 level. A simple main effects test again determined that the difference between the pretest and posttest means in the individual condition was significant (t = 2.97, df = 22, p < .01), as was that between the posttest means of the individual and multiple conditions (t = 3.74, df = 22, p < .002). Again, in comparing the pretest mean of the multiple condition with the posttest mean of that condition and the pretest mean of the individual condition, the larger difference was shown to be nonsignificant (t = 1.29, df = 22, p > .20). In regard to the offered levels of concreteness, then, the therapists showed a pattern similar to the results of the other scales. The conditions were not significantly discrepant at the initiation of therapy. At termination, however, the therapists offered higher levels of concreteness in the individual condition than they had at therapy's beginning and than they did at the end of multiple therapy.

Conditions and therapist type.--In comparing the types of the therapists on the Myers-Briggs Type Indicator and






82



TABLE 20

MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST
CONCRETENESS SCORES FOR MULTIPLE AND INDIVIDUAL CONDITIONS


Multiple Individual
Pre Post Pre Post 2.721 2.608 2.675 2.993 (.427) (.470) (.588) (.415)

Source df MS F


Blocks 11 .360 1.930 Treatments 3

Condition (A) 1 .347 1.22 Time (B) 1 .126 .68 A x B 1 .558 6.07* Residual 33 .187 MSA x blocks 11 .284 MSB x blocks 11 .186 MSAB x blocks 11 .092

Total 47

Note: The standard deviations are in parentheses.
*p < .05.
op < .10.

their obtained ratings on the Carkhuff scales, it did not appear that there was any consistent pattern among the "counselor" and the "noncounselor" types. Table 36 in Appendix H shows the types of the therapists along with the rank orders of their scores on the Carkhuff scales of





83



Empathy, Respect, Genuineness, and Concreteness. The rank orders were obtained by using the average of the judges' ratings for each therapist across both conditions, pre and post, as listed in Table 35, Appendix H.

Of the 12 therapists, there were three women (Counselors B, D, and F) and one male (K) who were consistently rated as offering high facilitative levels (average over 3.0) of the core conditions. The three female counselors were all "counselor" types, dominant in Intuition, Feeling, and Perception, whether Introverted or Extraverted. The one male was also strongest on Intuition and Feeling. Although his score on the Judging-Perceiving dimension indicated that Judging was dominant, the score was so close to the midpoint, it is difficult to be certain of his preference.

The next three highest-scoring counselors on the

Carkhuff scales (E and L on Empathy and Respect and H on Genuineness and Concreteness) were all "noncounselor" types. Three of the therapists receiving ranks of 9.5, 10, 11, and 12 were "counselor" types (A, I, and J), while two were "noncounselor" types (G and H).


The Multiple Condition

CRI Data

The hypotheses aligned with the CRI data concerned

the general prediction that the relationships of the pairs of co-therapists would change toward greater intimacy and caring over time. Table 21 shows the mean pre- and posttest





84



scores and their standard deviations for the 12 therapists on four of the major scales and two subscales of the CRI. For each scale, the difference between the pre and post means was tested using a matched-group t test (df = 11), and the obtained values are also reported in Table 21. The obtained levels of significance are those for a one-tailed test, as directional hypotheses were postulated in all instances.

TABLE 21

PRE- AND POSTTEST MEANS AND STANDARD DEVIATIONS
OF THE THERAPISTS' CRI SCALE SCORES


Scale or subscale Pretest Posttest t Affection 7.416 8.667 1.92* (1.786) (1.775)

Friendship 10.583 11.917 2.46** (1.929) (2.109)

Empathy 11.750 13.250 2.24** (2.094) (1.658)

Self Love 13.500 12.833 -1.20 (1.883) (1.337)

Being Love 12.000 13.333 3.09*** (1.206) (.779)

Deficiency Love 2.750 3.000 .67 (1.603) (1.537)

Note: The standard deviations are in parentheses.
*p < .05.
**p < .025.
***p < .01.

Hypothesis 24.--The therapists' scores on the scale of Affection will be higher at the end of therapy than at the




Full Text
139
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7. Emotional demands
experienced by the
therapist.
8. Understanding of
countertrans ference.
9. Years of experience
necessary to do
effective therapy.
10. Useful in training
therapists.
11. Personal gratifica
tion (enjoyment or
"fun") for the
therapist.
12. Useful with very
"actingout" patients.
13. Useful with border
line schizophrenics.
14. Useful with marital
couples.
15. Useful with "oral
characters."
16. Positive therapeutic
movement, in general.
17. Working through, in
general.
18. Working out and
through problems of
masculinity and
feminity.


102
therapy. It was felt that this situation would speed the
overcoming of resistance and the therapeutic progress. The
clients in the current study were rated by the therapists
as making no more progress in one condition than the other
(Hypothesis 6). Also, the therapists felt that the clients
were significantly more likely to accept or agree with their
comments or suggestions in individual than in multiple
therapy. (This finding resulted from the testing of Hy
pothesis 5, which predicted the inverse direction.) Pos
sibly, the co-therapists in the present study did not unite
with or support each others comments, which would lower
their client's tendency to agree with each of them. It is
also plausible that, even with high co-therapist agreement,
multiple therapy provides a milieu wherein client disagree
ment is more acceptable or encouraged. Kell and Burow
(1970) cite one of the major advantages of multiple therapy as
being the opportunity for the client to learn that disagree
ment can be healthy and enhancing, rather than destructive.
Although it may sometimes add to the therapists comfort to
have his client agree with him, disagreement may be indica
tive of more positive therapeutic movement. Even though
the hypothesis was disproved that multiple therapy offers
the therapist the advantage of higher client cooperation,
then, this finding may not be a strike against co-therapy.
The therapists' behavior.--Whitaker, Malone, and
Warkentin (1956) espoused the tenet that multiple therapy


106
It was felt that the therapists would be higher on
empathy (Hypothesis 20), for example, as the presence of two
counselors would increase the likelihood that the client
would be really understood--that one of the counselors would
have had similar experiences or feelings. As to respect
(Hypothesis 21), it was felt that the use of two therapists
would assure that at least one of the therapists would be
caring about the client at any one point in therapy. When
seeing clients alone, it may often be difficult for a
therapist to maintain a high level of caring or respect
from the start of the hour to its finish--if for no other
reason than occasional fatigue or lapse in attention span.
Due to the greater freedom supposedly afforded the counselor
by having a therapeutic partner, it was hypothesized that
higher levels of genuineness would be offered in co-therapy
than regular therapy (Hypothesis 22). And finally, as the
literature has claimed that the therapeutic interactions of
multiple therapy are more frequently emotion-packed than
those of individual therapy, it was predicted that the
therapists would guide the clients to a deeper discussion of
personally relevant material; that is, that higher levels
of concreteness -would be proffered (Hypothesis 23) .
The results of the analyses of the therapists' scores
on the scales of Empathy, Respect, Genuineness, and Con
creteness (Carkhuff, 1969) did not substantiate the
prediction that the therapists would offer higher


REFERENCES
Adler, J., and Berman, I. R. Multiple leadership in group
treatment of delinquent adolescents. International
Journal of Group Psychotherapy, 1960, 1_0, 213-225.
Bock, J. C., Lewis, D. J., and Tuck, J. Role-divided three-
cornered therapy. Psychiatry, 1954, 17, 227-282.
Buck, A. E., and Grygier, T. A new attempt in psychotherapy
with juvenile delinquents. American Journal of Psy
chotherapy 1952, 6_, 711-724.
Cameron, J. L., and.Stewart, R. A. Y. Observations on group
psychotherapy with chronic psychoneurotic patients in a
mental hospital. International Journal of Group Psycho
therapy 1955, 5_, 346-360 .
Carkhuff, R. R. The counselor's contribution to facilitative
processes. Mimeographed manuscript, State University
of New York at Buffalo, 1968.
Carkhuff, R. R. Helping and human relations, Vol. II. New
York: Holt, Rinehart, and Winston, Inc., 1969.
Carkhuff, R. R., and Berenson, B. G. Beyond counseling and
therapy. New York: Holt, Rinehart,and Winston, Inc.,
1967.
Daniels, M. The influence of the sex of the therapist and of
the co-therapist technique in group psychotherapy with
boys: An investigation of the effectiveness of group
psychotherapy with eighth-grade, behavior-problem boys,
comparing results achieved by a male therapist, by a
female therapist, and by two therapists in a combina
tion. (Dissertation Abstracts, 1958, 1_8, 1489).
Demarest, E. W., and Teicher, A. Transference in group
therapy. Psychiatry, 1954 17_, 187-202.
Dreikurs, R. Techniques and dynamics of multiple psycho
therapy. Psychiatric Quarterly, 1950, 24_, 788-799.
171


73
TABLE 15-~ (continued)
Item
no.
Rank
Mean
Mode
*7. Emotional demands experienced
by the therapist.
31.5
4.917
5
Hypothesis 16.The therapists
will rate
multiple
therapy
over individual therapy as offering more personal gratifica
tion (enjoyment or "fun") for the therapist (Item 11). The
therapists did feel that multiple therapy offered slightly
to moderately more personal gratification, thus supporting
Hypothesis 16.
Hypothesis 17.--The therapists will rate multiple therapy
over individual therapy as being their general preference
(Item 24). Although not being one of the highest-ranked
topics, Table 15 shows a mean and mode score of 3 on this
item, signifying that the therapists felt multiple therapy
to be slightly more their general preference.
Hypothesis 18.The therapists will rate multiple therapy
over individual therapy as fostering the resolution of impasses
(Item 32). This hypothesis was supported, as the therapists
felt that multiple therapy was moderately more effective in
fostering the resolution of impasses. The mean score of 2.00
was the highest of any item; the mode on this topic was also
2.
Hypothesis 19.The therapists generally will express a
more positive attitude toward multiple therapy than toward


34
if they had not previously taken it and a Personal Orien
tation Inventory. The experimenter gave all participating
therapists the Therapists' Research Instructions Sheet
(Appendix A). After the first and the last sessions in both
conditions, the therapists filled out a Therapy Session
Report; after multiple sessions, they also completed a
Multiple Therapy Rating Scale. After the very first and
the very last multiple interviews, they also answered a
Caring Relationship Inventory. It was the therapists' re
sponsibility to tape all sessions. After their last mul
tiple session, the counselors were again given the Personal
Orientation Inventory. After finishing all counseling, the
therapists completed the Comparative Therapy Scale.
Clients
The clients were initially seen for a half-hour intake
interview, as are all students coming to the counseling
center. They were told in regard to referral that the in
take person had one or two other counselors in mind and
that he would make the best referral possible. The clients
were also told that multiple therapy with both a male and
a female counselor was a frequent practice of the center.
The client's name was then given to one of the re
searchers who contacted the client by telephone, explained
the nature of the study, and asked the client to participate.
If she agreed, the researcher asked her to come to the center


74
individual therapy (Items 1-32). To test this hypothesis,
a total score for each therapist regarding his attitudes
toward multiple and toward individual therapy was obtained
(see Method section). Basically, the responses of the
therapists on each item were scored from "slightly more"
(1) to "much more" (3) for both regular and co-therapy, with
the "no difference" column being omitted. As shown in
Table 16, a Wilcoxon matched-pairs signed-ranks test
(Seigel, 1956) detected that the differences were signifi
cant, thus confirming Hypothesis 19.
TABLE 16
WILCOXON MATCHED-PAIRS SIGNED-RANKS TEST FOR TESTING
DIFFERENCES IN THERAPISTS' ATTITUDES ABOUT
MULTIPLE AND INDIVIDUAL THERAPY
Multiple Individual Rank Rank with less
Therapist therapy therapy d of d frequent sign
A
70
4
66
11
B
30
1
29
8.5
C
28
1
27
6.5
D
28
1
27
6.5
E
19
0
19
2
F
31
2
29
LO

00
G
21
13
8
1
H
22
2
20
3
I
23
1
22
4
J
83
0
83
12
K
39
4
35
10
L
30
4 .
26
5
T = 0*
*p < .005.


ACKNOWLEDGMENTS
My warmest thanks and appreciation go to Dr. Harry
Grater, who chaired my dissertation committee. He was
always abundantly supportive and almost totally nondirec
tive, leaving me with the feeling that the project was
truly my own. He did a lot to decrease my ever-ready anxiety-
barometer when it would start to rise.
I especially wish to thank Dr. Hugh Davis for his con
tributions; being my most verbal critic, he definitely
helped me to formulate more precise statements about the
research. And the liking and respect that he communicated
for me as a psychologist were greatly appreciated.
I am grateful to Dr. Vernon Van De Reit for his support
and understanding during my time of "dissertation distress."
I am also thankful for his willingness to read the manu
script when he had a million things to do.
I am eternally indebted to Dr. Madelaine Ramey for her
highly skilled aid with the statistics involved in this
study; I feel that she is truly a wizard in this field, and
I would not have had a polished dissertation without her
assistance. I am greatly appreciative of the amount of her
own time that she devoted to helping me, and for her
genuine interest in the project.
IV


TABLE 39
EACH THERAPIST'S RELATIONSHIP QUALITY SCORES FOR BOTH MULTIPLY SEEN CASES
First
case
Second
case
Both ca
ses combined
Therapist
and client
pair
Pre
Post
Total
Therapist
and client
pair
Pre
Post
Total
Therapist
Pre
Post
Total
A-8
1
8
9
A-10
0
10
10
A
1
18
19
B-8
15
6
21
B-10
11
8
19
B
26
14
40
C-14
11
7
18
C-16
11
12
23
C
22
19
41
D-l 4
5
9
14
D-16
5
9
14
D
10
18
28
E-20
11
5
16
E-25
9
16
25
E
20
21
41
F-20
14
12
26
F-25
11
14
25
F
25
26
51
G-26
13
17
30
G-37
13
16
29
G
26
33
59
H-26
10
13
23
H-37
13
14
27
H
26
27
50
1-31
2
2
4
1-33
6
4
10
I
8
6
14
J-31
7
13
20
J-33
10
13
23
J
17
26
43
K-35
12
20
32
K-36
12
20
32
K
24
40
64
L-35
0
8
8
L-36
5
4
9
L
5
12
17
168


9
an observer, (2) be observed, and (3) actively participate
when he has a co-therapist. Because of this, therapy is
less monotonous (Dreikurs, 1950), and thus probably keeps
the therapist more alert. Dreikurs (1950) emphasized that
the therapists will incline to serve in different role
functions naturally, as the dissimilarities in their per
sonalities will be complementary to each other. Besides
these natural roles, the therapists can also assume differ
ent roles, one being nondirective; the other, directive
(Dreikurs, Schulman, and Mosak, 1952a; Solomon, Loeffler,
and Frank, 1954). Mintz (1963b) suggested that usually in
co-therapy, one therapist plays an authoritative role and
represents the superego, while the other portrays the ego's
integrative function (Adler and Berman, 1960). Or, she
described how a social worker took the role of the reality
principle in helping plan for the future and relegated all
interpretations to her psychiatrist co-therapist. Mintz
also talked about how a male and female team could inten
tionally present themselves as masculine and feminine stereo
types. In addition to the assuming of different roles by
the therapists, simulated role-playing between a therapist
and the client is easier when two therapists are present.
One therapist can handle the therapeutic functions (reflec
ting, directing, supporting, interpreting, etc.) while the
other can take the part of a person to whom the client is
relating. Such role-playing can also be done in individual
therapy, of course, but it is somewhat more difficult, for


13
terminating (Mullan and Sanguiliano, 1960) are less awkward
to deal with in the multiple situation.
Again, however, Mullan and Sanguiliano (1960) take
issue with other users of multiple therapy when they state
that they see the method as adding to the discomfort of
the therapists. They include a second therapist to
. . add to the total insecurity present in the psy
chotherapy; to add to our own anxiety; to confront us
with our own limitations; to indicate to us our ever
present tendency, of which we are so frequently un
aware, to use the patient; and finally, to add depth
and cross-sectional possibilities to the transaction.
We do not add the additional therapist to make us
feel more secure, nor to make us more certain of our
interpretations . [p. 557].
These theorists feel that the multiple setting forces a thera
pist to minimize the use of learned techniques and rely on
his own resources as a person. It is understandable that
the beginning multiple therapist might be quite uncomfort
able with the added insecurity. However, as he found the
method to be conducive to growth, learning, and the client's
progress, he might actually welcome the uncertainty and
find it quite comfortable.
Less difficulty with impasses.Lastly, due to having
another person and another perspective, impasses are easier
to resolve (Hayward, Peters, and Taylor, 1952; Spitz and
Kopp, 1963) or avoid (Dreikurs, Schulman, and Mosak, 1952b).
"Commonly, in dyadic therapy, a conflict generates to
impasse rather than resolution ..." because changes are
harder for a therapist than in multiple therapy (Kell and


173
Hill, F., and. Strahl, G. Two against an impasse. Voices:
The Art and .Science of Psychotherapy, 1968 4_, 96-104 .
Hulse, W. C., Lulow, W. V., William, V., Rindsberg, B. K.,
and Epstein, N. B. Transference reactions in a group
of female patients to male and female coleaders.
International Journal of Group Psychotherapy, 1956,
6, 430-435.
Kamerschen, K. S. Multiple therapy: Variables relating to
co-therap.ist satisfaction. Doctoral dissertation,
Michigan State University, 1969.
Kell, B. L., and Burow, J. M. Developmental counseling and
therapy. Boston: Houghton Mifflin Company, 1970,
pp. 201-268.
Kirk, R. Experimental design: Procedures for the behavioral
sciences Belmont, Cal ."7 Brooks/Cole 196 9.
Klaveter, R. E., and Magar, R. E. Stability and internal
consistency of a measure of self-actualization. Psy
chological Reports, 1967, _2, 422-424.
Linden, M. E. The sign of dual leadership in gerontolog.ic
group psychotherapy: Studies in gerontological human
relations. III. International Journal of Group
Psychotherapy, 1954 4_, 262-273.
Linden, M. E., Goodwin, H. M., and Resnik, H. Group psycho
therapy of couples in marriage counseling. Interna
tional Journal of Group Psychotherapy, 196 8 1_8_, 313-32 4.
Lott, G. M. The training of nonmedical, cooperative psycho
therapists by multiple psychotherapy. American Journal
of Psychotherapy, 1952 _6 440-448.
Lott, G. M. Multiple psychotherapy: The efficient use of
psychiatric treatment and training time. Psychiatric
Quarterly Supplement, 1957, 31, 277-294.
Lundin, W. H., and Aronov, M. The use of co-therapists in
group psychotherapy. Journal of Consulting Psychology,
!952, 16 76-80.
MacLennan, B. W. Co-therapy. International Journal of
Group Psychotherapy, 1965, 15, 154-166.
Mallars, P. B. Team counseling in counselor education.
Personnel and Guidance Journal, 1968 46_, 981-983.
Malone, T. P., and Whitaker, C. A. A community of psycho
therapists. International Journal of Group Psycho-
therapy, 1965, 15, 23-26.


162
TABLE 34
RAW SCORES USED TO DETERMINE THERAPIST-CLIENT AGREEMENT ON THE TSR
FOR THE INDIVIDUAL CONDITION, PRE- AND POSTTESTINGS
Thera-
Therapist-client
pair
J'P 2. o t- 1 O T
item no. A-
7
B-
12
C-
17
D-
29
E-
39
F-
22
A
5-3
4-3
3-4
2-2
4-4
3-5
3-4
5-3
4-4
3-3
5-4
4-3
1
1-1
1-1
2-2
1-1
2-1
1-1
1-0
0-0
2-1
1-1
2-1
1-2
2
2-2
1-2
1-1
1-1
2-2
2-2
2-2
0-0
0-1
1-1
1-1
1-1
4
2-1
0-1
1-0
0-1
0-1
0-1
0-0
0-0
0-1
0-0
0-2
1-2
9
0-2
0-2
2-2
2-1
2-2
1-2
2-1
0-0
1-2
1-2
1-1
2-2
10
1-0
1-1
2-0
2-1
1-2
1-0
1-1
0-0
1-1
1-2
1-0
1-1
11
2-1
1-2
2-1
1-2
1-1
1-0
2-1
0-0
2-2
1-2
1-2
1-2
12
0-0
0-1
0-1
0-0
1-0
1-2
1-1
0-0
0-0
0-0
0-0
0-0
13
2-0
1-1
2-1
2-2
2-2
1-0
0-1
0-0
1-1
1-2
0-2
1-1
14
2-2
2-2
2-3
3-2
3-3
2-3
3-2
2-2
2-3
2-3
2-3
2-3
15
2-3
1-3
3-2
2-3
2-1
2-2
2-0
3-2
2-3
2-3
1-2
3-3
16
1-2
2-2
3-3
2-2
3-3
2-3
2-1
1-2
2-1
2-2
2-2
2-2
17
1-2
1-2
2-1
2-3
1-2
1-3
2-1
1-1
2-2
1-2
2-2
2-3
18
1-3
1-3
2-3
2-2
1-2
2-2
3-1
2-2
1-3
2-3
1-2
1-3
23
1-2
1-2
0-1
2-1
1-0
2-0
1-1
3-3
1-0
2-2
1-0
1-1
24
2-2
2-3
2-3
1-3
2-2
2-2
3-5
3-4
2-1
3-1
4-5
2-2
25
4-3
3-2
4-4
3-1
4-5
3-3
3-4
3-2
4-4
3-1
4-4
3-2
26
5-3
2-2
5-3
3-3
3-5
2-2
3-3
1-2
3-3
2-2
4-3
3-3
32
5-2
3-3
3-3
2-2
4-5
2-3
3-2
4-1
5-3
2-2
5-3
4-2
33
1-2
1-2
1-1
2-2
2-0
2-1
2-2
2-2
1-1
2-1
1-1
1-1
34
3-3
2-2
3-3
3-2
3-3
3-2
3-3
2-3
2-3
3-3
1-3
2-3
35
0-0
0-0
0-0
0-0
0-0
0-0
0-0
0-0
1-1
1-0
0-0
0-0
36
3-2
3-2
3-2
3-2
2-2
2 -1
3-3
3-3
2-1
2-2
2-2
2-3
37
3-2
2-2
2-1
2-1
2-0
2-0
2-2
2-2
1-1
2-3
1-2
1-3
Note:
The'
nrst
S C O IT 0
under
eacii
tnerapis c-ciient
pair
indicates
their
respective
pretest scores on the
item
in ques
tion
; the
second
score
, their
respective posttest
scores
. In
all cases,
the s
core
of thi
therapist is given first, followed by a hyphen and the client's score.


In Memoriam:
Atman
(P. Atman, Hiccipus, Liccipus, Puppy-do-dog)
One of the finest friends I have known.


60
clients agreed with and/or accepted more of their comments
or suggestions in the individual condition. None of the
other F ratios were significant.
TABLE 6
MEANSi STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS PRE AND POST RESPONSES
TO TSR ITEM 21 FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
1.2500
1.3333
1.6666
1.9166
(.6216)
(.7785)
(.4924)
(. 6686)
Source
df
MS
F
Blocks
11
.537 8
1.41
Treatments
3
Condition (A)
1
2.9999
7.87**
Time (B)
1
.3333

CO
'-J
A x B
1
.0835
.22
Residual
33
.3813
Total
47
Note: The standard deviations are in parentheses.
**p < .01.
Hypothesis 6.Compared to individual therapy, the thera
pists will rate the clients in multiple therapy as having
shown more progress (Item 25). As evinced by the results
in Table 7, this hypothesis was not supported, and the F
ratios for blocks, time, and the interaction of time and
condition were also nonsignificant.


87
very close to the successfully married couples. And, on
the Deficiency Love scale, the therapists scored consider
ably lower than all of the couples in Shostrom's sample.
Many of these comparisons suggest a trend for the relation
ships of the co-therapists to become more caring and
healthier over their term of working together.
TABLE 22
MEANS AND STANDARD DEVIATIONS OF SHOSTROM'Sa SAMPLE OF
SUCCESSFULLY MARRIED, TROUBLED, AND DIVORCED COUPLES
ON THE CRI SCALES
Successfully
married
Troubled
Divorced
Scale or subscale
couples
couples
couples
Affection
11.0
8.4
7.0
(2.2)
(2.9)
(3.4)
Friendship
12.9
8.4
6.6
(2.2)
(3.1)
(3.6)
Empathy (M)
12.9
12.2
10.5
(2.2)
(2.9)
(4.1)
Self Love
11.1
8.3
7.4
(2.9)
(3.1)
(3.9)
Being Love
13.5
10.9
8.7
(2.1)
(3.1)
(4.0)
Deficiency Love
6.1
5.6
5.2
(2.3)
(2.4)
(2.6)
Note: The standard deviations are in parentheses.
aShostrom (1966b).
POI Data
The hypotheses concerning the expectation that the
therapists would evince a positive change in self-actualization


63
TABLE 9
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS 5 PRE AND POST RESPONSES
TO TSR ITEM 31 FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
4.0388
(.9003)
4.2500
(.7538)
3.8333
(1.0299)
3.6666
(1.3027)
Source
df
MS
F
Blocks
11
1.8106
3.16**
Treatments
3
Condition (A)
1
.7500
1.31
Time (B)
1
. 3333
.58
A x B
1
.0000
.00
Residual
33
.5732
Total
47
Note: The standard deviations are in parentheses.
** p < .01.
TABLE 10
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES
TO TSR ITEM 32 FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Multiple Individual
Pre Post Pre Post
3.1666
(.8348)
3.3333
(1.0731)
3.0000
(1.0445)
3.5000
(1.3817)


164
TABLE 35
THE THERAPISTS' AVERAGE RATINGS ON THE CARKHUFF SCALES FOR
THEIR INITIAL AND TERMINAL SESSIONS WITH
AN INDIVIDUALLY AND MULTIPLY SEEN CLIENT
Multiple Individual
Therapist- Therapist-
client client
pair
Pre
Post
pair
Pre
Post
A-10
2.50
2.50
Empathy
A-7
1.58
2.67
B-8
3.50a
3.08
B-12
2.83
3.58
C-16
2.75
2.67
C-17
2.25
2.58
D-14
2.92
3.00
D-29
3.67
3.00
E-25
3.50
2.58
E-39
2.92
2.58
F-20
2.50b
3.13b
F-22
3.25
3.83
G-37
1.92
2.50
G-23
2.67
3.08
H-26
3.00a
2.00
H-21
2.00
2.67
1-33
2.33
1.58
1-28
3.17
3.00
J-31
2.75
2.75
J- 30
1.83
2.75
K-35
3.17
2.92
K-34
3.08
3.75
L-36
2.42
2.58
L-40
2.58
3.00
A-10
2.33
2.58
Respect
A-7
1.83
2.58
B-8
3.00a
3.00
B-12
2.92
3.42
C-16
2.67
2.67
C-17
2.33
2.58
D-14
2.92
3.00
D-29
3.67
3.25
E-25
3.42
2.58
E-39
2.92
2.75
F-20
2.50b
3.13b
F-22
3.25
3.83
G-37
1.92
2.33
G-23
2.58
2.92
H-26
3.00a
2.00
H-21
2.17
2.58
1-33
2.25
1.50
1-38
3.00
2.92
J-31
2.58
2.75
J-30
1.83
2.92
K-35
3.25
3.17
K-34
3.17
3.83
L-36
2.58
2.75
L-40
2.75
3.00


38
nature of therapy interactions and. progress. His therapist
subjects rated 32 of the topics as being meaningfully differ
ent in co-therapy than in regular therapy. Thirty of these
items were used in the Comparative Therapy Scale (CTS) in
the present study (Appendix C). Rabin's item, "Your general
preference when therapy in a group is the only treatment,"
was changed to "Your general preference." Another item that
dealt with an issue specific to group therapy was deleted.
The present author also added the last item of the CTS,
"Resolution of impasses," as the literature lists this as
an important advantage of multiple therapy over individual
therapy.
The directions for the CTS asked the therapists to
compare multiple therapy and individual therapy (with indi
vidual clients) on the 32 topics. Two columns, one for
multiple therapy and one for individual therapy, provided
the levels of comparison which were scored as follows:
1: Slightly more
2: Moderately
3: Much more
A check in the "No difference" column, placed between the
ones for multiple and individual therapy, was not scored.
Several items which indicated negative differences between
the methods were rescored to be in the same direction (these
are indicated by an asterisk in the left magrin); and item
number 22 was omitted from this scoring scheme (indicated


96
Table 29 lists the x*ank orders of the 12 multiple
clients on the S-A Scale and on the posttest POI major scales
of Inner-Directed and Time Competence. Also listed are the
ranks of the therapists' total composite relationship quality
and co-therapist agreement scores. A composite score for both
therapists of a pair was obtained by summing both of their
scores (on relationship quality or agreement) for a particular
session. For each of their two clients, a total quality and
a total agreement score was then computed by summing their
composite ratings pre and post. The rank of each therapist
pair pertaining to each of their clients for relationship
quality is listed opposite from the client number, as is
their rank for co-therapist agreement.
Hypothesis 35.--The quality of the co-therapist relation
ship will be positively related to the client level of self-
actualization (as measured by the S-A Scale). A Spearman
rank-order correlation between the relationship quality score
of each therapist pair and their client's level of self-
actualization (on the S-A Scale) resulted in a nonsignificant
rho of -.31. Quality of the co-therapist relationship was
then negatively related, although not significantly, to
client self-actualization, and Hypothesis 35 was rejected.
Hypothesis 36.There will be a positive relationship
between agreement of the therapists as to how they behaved
and perceived during the sessions and the level of self-
actualization of the clients (on the S-A Scale). A Spearman
rank-order correlation coefficient computed between the


142
what may be going on, but these are not congruent
with the expressions of the second person.
In summary, the first person tends to respond to other
than what the second person is expressing or indicating.
Level 3
The expressions of the first person in response to the
expressed feelings of the second person(s) are essentially
interchangeable with those of the second person in that
they express essentially the same affect and meaning.
Example: The first person responds with accurate under
standing of the surface feelings of the second
person but may not respond to or may misinterpret
the deeper feelings.
In summary, the first person is responding so as
neither to subtract from nor add to the expressions of the
second person; but he does not respond accurately to how
that person really feels beneath the surface feelings.
Level 3 constitutes the minimal level of facilitative inter
personal functioning.
Level 4
The responses of the first person add noticeably to
the expressions of the second person(s) in such a way as
to express feelings a level deeper than the second person
was able to express himself.
Example: The facilitator communicates his understanding
of the expressions of the second person at a
level deeper than they were expressed, and thus
enables the second person to experience and/or
express feelings he was unable to express pre
viously.
In summary, the facilitator's responses add deeper feel
ing and meaning to the expressions of the second person.
Level 5
The first person's responses add significantly to the
feeling and meaning of the expressions of the second person(s)
in such a way as to (1) accurately express feelings levels
below what the person himself was able to express or (2) in
the event of ongoing deep self-exploration on the second
person's part, to be fully with him in his deepest moments.


31
each case. This was not ideal in that the multiple condi
tion was not comprised of somewhat more independent pairs,
but it was not possible to re-combine the therapists into
six more couples that the researchers and the counselors
felt would be compatible ones.
To adapt this design for some of the data analysis, one
of the clients for each therapist pair was assigned at
random to the female therapist and the other to the male.
This was decided by tossing a coin to see which therapist
would be the one aligned with the first or second client
seen multiply (again, the choice of a coin flip).
Clients. ---The subjects were randomly assigned to coun
selors, in so far as possible. A schedule was arranged wherein
the order of assignment to each pair of therapists was ran
domized, as was the order of assignment to individual therapy
with the male therapist of a pair, individual therapy with
the female therapist, or one of the two multiple sets. As
students agreed to participate, they were relegated to thera
pists according to this order on a "first come, first serve'"
basis. When a subject dropped out of therapy before com
pleting four sessions, this was considered first priority,
however, and the vacated space was filled before continuing
with the random assignment. Although the clients were
naturally matched in some respects as they were drawn from
the same population, their random designation to conditions
assured independent groups.


26
The studies that have used various measures of client
change in comparing an individual with a multiple group
method have yielded equivocal results. Daniels (1958) and
Staples (1959) found that for groups of eighth grade boys
and girls, respectively, the heterosexual co-therapy team
generally produced negative behavior changes in their
clients. The members of groups led by either a male, or a
/
female therapist, contrarily, tended to improve on the out
come measures of teachers' ratings and psychologists'
assessments. Nunnelly (1969) discovered no significant
differences between groups led by multiple therapists versus
those led by individual therapists in regard to client out
come, e.g., perceptions of parent acceptance, self-
acceptance, or ego strength. Singer and Fischer (1967)
reported that although little progress was being made with
a group of male homosexuals run by two male therapists,
when a female co-therapist was added, the process changed
remarkably for the better. After one year of heterosexual
leadership, the majority of the members of the group had
improved on several behavioral measures; such as lessened
amount of homosexual activities, dating heterosexually,
and increased work productivity. In all of these studies,
however, no data were gathered on how the therapists related
to one another. This is of critical importance, as was
discussed before, as a poor co-therapist relationship could
very likely produce worse client outcomes than an individ
ual therapist.


98
total composite co-therapist agreement of each pair and
their client's level of self-actualization on the S-A Scale
yielded a rho of .54, significant at the .05 level. A
significant association was found, then, between co
therapist agreement in the multiple condition and client
outcome, and Hypothesis 36 was supported. As a further
check on this finding, rank-order correlations were computed
between the co-therapist agreement ranks for each case and
the client's relative rank on the posttest POI scales of
Time-Competence and Inner-Directed. The coefficient for
Time-Competence (rho = .29) was nonsignificant, while that
of Inner-Directed (rho = .60) was significant at the .05
level (one-tailed). This latter correlation substantiates
the finding that co-therapist agreement is positively related
to client outcome.


3
(Hayward, Peters, and Taylor, 1952; Warkentin, Johnson,
and Whitaker, 19 51) So far, there has not been any reported
advantage or disadvantage of utilizing such a glut of exper
tise over that of two therapists, although it would seem
that this might create a rather unwieldy situation. Again,
even though some of the literature considered does not con
form to the definition employed here, any relevant findings
are reported. And, notwithstanding that the current study
specifically involves this approach in use with individual
clients, its application in conjoint and group therapies
is also included in the discussion.
Granting that many possible advantages for clients
have also been propounded, the practice of multiple therapy
was initially employed by many for the benefit of the
therapists. The present discussion will center on multi
ple therapy from the therapists perspective; the inter
ested reader may refer to other sources that expatiate
upon this method in regard to its recipients (Dreikurs,
Schulman, and Mosak, 1952b; Hill and Strahl, 1968; Kell
and Burow, 1970; Mintz, 1963a; Treppa, 1971).
Advantages for Therapists
Training
The purported advantages of multiple therapy for the
therapists, derived from counselors' personal experiences
and subsequent theorizing, are numerous. The potential
use of the multiple setting for training purposes was the


100
found with the presently used instruments and with the
present sample of therapists. It should be noted that
the TSR often only provides for a negative answer or a two-
or three-level positive answernot a very wide range of
possible responses. As the analyses were computed for
single or small groups of items, the range was very con
stricted. It is possible, then, that the instrument was
not sensitive enough to record some differences. The fact
that two analyses did yield significant results suggests
that the scale was able to detect some differences even
with this small range of scores.
The clients' behavior.--Advocates of co-therapy have
stated that the therapists' task is often accomplished more
easily and quickly because clients behave differently when
there are two therapists than when there is one. The data
gathered in the present study did not substantiate this
assumption, as the counselors did not rate their clients'
behavior as being consistently different in the two condi
tions .
There has been extensive theorizing that the presence
of opposite-sexed therapists contributes to the better
understanding of sexual roles and better formation of sexual
identity on the part of the client (Kell and Burow, 1970;
Mintz, 1963b]. For this understanding and identification
to take place, it would seem necessary for there to be some
discussion of same-sex and opposite-sex relations, albeit


147
Leve1 2
The first person frequently leads or allows even
discussions of material personally relevant to the second
person(s) to be dealt with on a vague and abstract level.
Example: The first person and the second person may dis
cuss the "real" feelings but they do so at an
abstract intellectualized level.
In summary, the first person does not elicit discus
sion of most personally relevant feelings and experiences
in specific and concrete terms.
Level 3
The first person at times enables the second person
to discuss personally relevant material in specific and
concrete terminology.
Example: The first person will make it possible for the
discussion with the second person(s) to center
directly around most things that are personally
important to the second person(s), although there
will continue to be areas not dealt with con
cretely and areas in which the second person
does not develop fully in specificity.
In summary, the first person sometimes guides the
discussions into consideration of personally relevant
specific and concrete instances, but these are not always
fully developed. Level 3 constitutes the minimal level of
facilitative functioning.
Level 4
The facilitator is frequently helpful in enabling the
second person(s) to fully develop in concrete and specific
terms almost all instances of concern.
Example: The facilitator is able on many occasions to
guide the discussion to specific feelings and
experiences of personally meaningful material.
In summary, the facilitator is very helpful in ena
bling the discussion to center around specific and concrete
instances of most important and personally relevant
feelings and experiences.


131
Client Form
Directions
This booklet contains a series of questions about the
therapy session which you have just completed. These ques
tions have been designed to make the description of your
experiences in the session simple and quick. There are two
types of questions.
One type of question is followed by a series of numbers
on the righthand side of the page. After you read each of
the questions, you should circle the number "0" if your
answer is "no"; circle the number "1" is your answer is
"some"; etc.
The other questions have a series of numbered state
ments under them. You should read each of these statements
and select the one which comes closest to describing your
answer, to that question. Then circle the number in front
of your answer.
Once you have become familiar with the questions
through regular use, answering them should only take a few
minutes. Please feel free to write additional comments on
a page when you want to say things not easily put into the
categories provided.
BE SUPE TO ANSWER EACH QUESTION
Identification
Date of Session


TABLE 25
RANK ORDERS OF THE AGREEMENT SCORES OF EACH THERAPIST'S RESPONSES ON THE TSR AND
HIS PARTNER'S CORRESPONDING MTRS RESPONSES FOR BOTH MULTIPLY SEEN CASES
First
case
Second
case
Both cases combined
Therapist
and client
pair
Pre
Post
Total
Therapist
and client
pair
Pre
Post
Total
Therapist
Pre
Post
Total
A-8
5
12
8.5
A-10
11
6
9
A
6
10
9
B-8
9
3
3.5
B-10
9.5
1.5
2.5
B
9.5
2
2
C-14
11.5
9.5
10.5
C-16
5
11.5
7.5
C
6
12
10
D-14
4
1
1
D-16
7.5
1.5
1
D
1
1
1
E-20
1.5
3
3.5
E-25
2.5
6
5.5
E
6
4
4.5
F-20
3
7
6.5
F-25
1
3.5
2.5
F
2.5
5
3
G-26
1.5
3
3.5
G- 37
2.5
3.5
5.5
G
9.5
3
4.5
H-26
9
9.5
12
H-37
5
9
10.5
H
11.5
10
11.5
1-31
9
5.5
6.5
1-33
7.5
9
7.5
I
6
6
7
J-31
6.5
5.5
3.5
J-33
9.5
11.5
10.5
J
6
7.5
8
K-35
6.5
9.5
8.5
K-36
5
6
4
K
2.5
7.5
6
L-35
11.5
9.5
10.5
L-36
12
9
12
L
11.5
10
11.5
Note: Rankings for each measure are over all 12 therapists,
score was ranked 1; the lowest, 12.
On each, the highest
u>


101
some of the growth would occur on a nonverbal level. In the
current investigation, the therapists did not rate their
clients as having talked more about relations to persons of
both sexes in multiple than individual therapy (Hypothesis 1).
The therapists also did not feel that their clients
conversed about a greater variety of topics in one treatment
than* the other (Hypothesis 2) although it has been postu
lated that the presence of a "chaperone" would increase the
breadth of discussion (Greenback, 1964). Furthermore, the
counselors did not believe that their clients expressed or
explored feelings (Hypothesis 3) or had their feelings
stirred up (Hypothesis 4) more when being seen multiply
rather than individually. Apparently, then, the supposed
greater stability that multiple therapy affords (Buck and
Grygier, 1952; Sonne and Lincoln, 1966) did not enable the
present sample of clients to explore and express feelings
more deeply. The therapists did state that, in both con
ditions, the clients wanted to v?ork on their feelings more
during the first than the last session. This finding makes
sense in that clients usually enter therapy at somewhat of
a crisis point; while termination is a time of reiterating
the progress that has been made, and is thus less emotionally
laden.
Dreikurs (1950) stated that, at least when the
therapists agree, the client will be more likely to accept
impressions of the therapists in co-therapy than regular


PREFACE
The report contained in this dissertation, concerned
with multiple and individual therapy from the therapists
perspective, was part of a joint research project conducted
with Charles A. Reiner. His dissertation, to be completed
in 1973, will focus on multiple and individual therapy
from the client's viewpoint.
vi 1


113
counselors in psychotherapy might be worse than one. The
present data do lend some credibility to the statements of
MacLennan (1965), indicating that the problems of a co
therapy relationship may outweigh its potential benefits.
The Phenomenon of Multiple Therapy
As far as being validated, the hypotheses regarding
the multiple condition itself fared better than those con
cerned with the differences between the multiple and indi
vidual conditions. The co-therapists' relationships were
shown to become more caring over time; there was some evi
dence of therapist growth occurring while they were involved
in multiple therapy; and some aspects of the co-therapist
relationship were positively related to client outcome.
The Caring of the Therapist Pairs
Change in caring over time.Mullan and Sanguiliano
(1960) have stressed that the establishing of mutuality
a deep caring and meaningbetween pairs of co-therapists
is very important for their own, as well as their clients'
growth. Generally, the results of the CRI comparisons
showed that the relationships of the therapist pairs changed
toward greater intimacy and caring over the course of
therapy.
Interdependency was cited by Kell and Burow (1970) as
being essential to a good co-therapy relationship. The
therapists of the present study significantly increased


of Florida Counseling Center; they conducted therapy with
24 unmarried female students who were randomly assigned to
conditions. Each co-therapist pair saw two clients multiply
and each therapist saw one client individually, yielding a
total of 12 multiple and 12 individual cases. Each therapist
provided his own matched control for purposes of comparing
the two conditions.
The results of the therapists' responses to a Compara
tive Therapy Scale (modified from Rabin) generally confirmed
the prediction that the therapists would have more favor
able attitudes about multiple than individual therapy. When
the therapists rated their clients' and their own behavior
after completing their first and their last multiple and
individual sessions, however, the expected differences in
favor of multiple therapy were not apparent. The only signifi
cant difference between the conditions derived from the
therapists' responses to selected Therapy Session Report
items (from Orlinsky and Howard) was that clients tended to
agree with the therapists' comments more in individual than
in multiple therapy. Two highly trained judges rated the
therapists' levels of the core facilitative dimensions of
empathy, respect, genuineness, and concreteness (from
Carkhuff) during the initial and terminal sessions of both
conditions. On all dimensions, the therapists offered equi
valent facilitative levels in both conditions during the
first session. At therapy's end, however, they offered
xiv


PSYCHOTHERAPEUTIC INTERACTIONS
IN MULTIPLE AND INDIVIDUAL THERAPY
By
SHARON JENNETTE KOSCH-GRAHAM
A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
1972


8
therapists feel less burdened and have more fun when doing
multiple therapy, and thus find their work less taxing.
Part of this sharing of responsibility is the direct support
a therapist gets from his colleague (Gans, 1957; Miller
and Bloomberg, 1968; Solomon, Loeffler, and Frank, 1953).
This support certainly is an advantage during stressful
times in therapy (Linden, Goodwin, and Resnik, 1968), when
the client may require a good deal of support. Along with
this, multiple therapy seems especially useful for thera
pists when the entire course of counseling is likely to be
strenuous because the client is a difficult one (Cameron
and Steward, 1955; Greenback, 1964; Mullan and Sanguiliano,
1964; Warkentin and Taylor, 1968). However, this approach
has been found to be helpful with only some types of problem
clients, and is contraindicated with others (Kell and Burow,
1970) Sharing responsibility tends to lessen the frustra
tions and difficulties of a therapist (Dreikurs, 1950) and
makes it easier to pinpoint therapist problems (Mullan,
1955). The support element is important in improving the
therapist's image of himself, as many feel that they have
a greater capacity to work with clients (Warkentin,
Johnson, and Whitaker, 1951).
Wider range of roles.Another important advantage of
multiple therapy in regard to the therapeutic interactions
is that it enables the therapist to have a greater variety
of roles (Adler and Berman, 1960; Demarest and Teicher,
1954). Gans (1957) stated that the therapist can (1) be


52
collaboration. It was thought, then, that the relationships
of the pairs would change toward greater intimacy and caring
over time. It was hypothesized that the following scales
would show increases:
24. Affection.
25. Friendship.
26. Empathy.
27. Being Love.
28. Deficiency Love.
Also, it appeared possible that as the therapists' relation
ships became more collaborative, their focus on themselves
in the association would decrease. The scale of Self Love
on the CRI measures the amount of concern about oneself or
one's tendency to be an independent person, a "top dog" in
the relationship.
29. The scores on the scale of Self Love were hypothesized
to decrease from the first to the last session.
ROI.--The therapists should show some growth during the
time they are involved in multiple therapy. It was hypothe
sized that the counselors would show increases in self-
actualization on the following scales:
30. Time-Competence.
31. Inner-Directed.
32. Capacity for Intimate Contact.
33. Spontaneity.
The multiple relationship and client outcome.--It was
hypothesized that there would be a relationship between


43
This instrument attempts to measure many aspects of a rela
tionship which the present researcher deemed to be impor
tant for co-therapists.
Shostrom (1966a) presents split-half reliability find
ings on a sample of 272 persons who were successfully
married, had a troubled marriage, or were divorced. The
reliability coefficients for the basic scales ranged from
.74 to .87, while those for the subscales were .66 (Defici
ency Love) and .82 (Being Love). As evidence that this is
a valid test, Shostrom further reported that all of the
scales can significantly discriminate between successfully
married, troubled, and divorced couples. There have been
no sex differences found on any of the scales.
The directions for the CRI were altered so that the
respondents would rate their co-therapist as they saw him
or her, and then rate their ideal co-therapist. The completed
inventories were scored with the standard scoring keys
provided by the Educational and Industrial Testing Service.
Hypotheses were formulated about the therapists' responding
on all of the scales except Eros, as it was felt that this
aspect of a relationship was not an important dimension for
co-therapists.
Personal Orientation Inventory
Shostrom's Personal Orientation Inventory (POI) is a
forced-choice, 150-item questionnaire that purports to
measure various aspects of self-actualization (Shostrom,


19
usually be of opposite sexes (Hill and Strahl, 1968; Mintz,
1963, 1965; Nunnelly, 1968; Rabin, 1967; Singer and Fischer,
1967), thus simulating a familial situation and facilitating
certain therapeutic interactions. Some authors have carried
the family milieu idea to the extent of using a wife (Fink,
1958), a son (Solomon and Solomon, 1963), or even a dog
(Weigel and Straumfjord, 1970) as co-therapist. Warkentin,
Johnson, and Whitaker (1951) required their multiple thera
pists to have had therapy themselves, and stated as criteria
for successful pairing that each therapist would feel free
to be' the patient or the therapist of the other.
Gans (1962) warned that two inexperienced therapists
were worse than one and.held that ample individual work
should be prerequisite to doing co-therapy. Given two
accomplished therapists, Gans felt that there was no particu
lar advantage in teaming up over seeing patients individu
ally. Apparently, then, he was focusing mainly on the
technical rather than the relationship aspects of co-therapy,
and his demand for experience should be considered in this
light. Undoubtedly, therapeutic ability might interact
with the quality of the co-therapist relationship; but
whether ability is solely determined by experience is ques
tionable .
Relationship Problems and Solutions
Discussion of Problems.--MacLennan (1965) emphatically


42
number and the meaning of these occurrences will be dis
cussed further in succeeding sections (Results and Discussion)*
It should be noted here, though, that in these cases the
scores for that therapist were based on an average of the
segments that were rated.
Caring Relationship Inventory
As previously stated, many theorists in the area have
stated that an effective multiple therapy relationship would
contain the same ingredients as a good marriage. Kamerschen
(1969) and Randolph (1970) used a modified form of van der
Veen's Family Concept Q-Sort to create their Co-Therapist
Inventory. Shostrom's Caring Relationship Inventory (CRI
was designed for relationships ranging from the dating stage
to marriage (1966a). The CRI consists of 83 true-false
items that concern feelings and attitudes that the members
of a heterosexual dyad have toward each other. The inventory
is comprised of five basic scales and two subscales. The
major scales, given the titles Affection, Friendship, Eros,
Empathy (M)* and Self-Love, supposedly measure different
aspects of love. The subscales purport to describe whether
the respondent's love is one based on need (Deficiency Love)
or is metamotivated (Being Love). A description of these
scales, along with their identifying symbols and the number
of items on which they are based, is given in Appendix E.
*The symbol for the CRI scale of Empathy, "M," will
follow the scale's title, to distinguish it from the process
scale of Empathy.


158
TABLE 32
RAW SCORES OF THE THERAPISTS FOR BOTH INDIVIDUAL (I)
AND MULTIPLE CONDITIONS (M) ON THE TSR ITEMS
INVOLVED IN HYPOTHESES 1-11
Thera
pist
A
B
C
D
E
F
G
H
I
J
K
L
1-2 1-5
I M I M
3 2 4 2
3 2 3 2
3 3 4 2
3 0 3 2
'2 2 2 3
3 2 2 2
2 3 2 2
3 2 2 2
2 0 4 2
3 3 13
2 2 2 2
13 2 2
4 4 4 2
4 3 4 5
4 5 4 4
4 0 4 4
13 4 4
3 3 2 2
4 4 4 3
3 3 2 3
2 2 2 1
3 3 3 4
4 4 3 4
3 3 3 3
Item number(s)
6 & 9
IM
10 2 0
22 2 1
2 2 2 1
2 0 2 2
2 2 2 2
2 2 2 2
12 2 1
2 1 10
2 2 12
2 1 2 2
11 0 0
2 2 2 2
17
I M
11 11
2 2 11
11 2 2
2 1 2 1
2 1 2 2
2 2 11
122 1
102 1
2 3 11
112 1
11 11
3 2 3 1
21
I M
11 12
2 2 2 2
12 11
2 3 2 2
12 12
2 1 2 1
2 2 11
2 2 11
1212
2 2 2 2
2 3 0 0
2 1 10
25
I M
2 3 2 4
3 2 2 4
2 3 3 2
3 3 3 3
2 3 2 4
2 3 2 2
4 3 3 1
3 3 2 2
2 2 3 3
3 2 2 4
3 3 0 2
2 2 3 2
Note: the first number under each condition is the pretest score;
the second, the posttest score.


85
beginning. This hypothesis was supported, as the posttest
mean was significantly larger than the pretest mean (t =
1.92, p < .05).
Hypothesis 25.--The therapists' scores on the scale
of Friendship will be higher at the end of therapy than at
the beginning. On the Friendship scale, the posttest mean
was significantly higher than the pretest mean (t = 2.46,
p < .025) thus supporting Hypothesis 25.
Hypothesis 26.---The therapists' scores on the scale
of Empathy (M) will be higher at the end of therapy than at
the beginning. The results substantiated this prediction,
as the pretest mean was significantly smaller than the post
test mean (t = 2.24, p < .025).
Hypothesis 27.--The therapists' scores on the scale of
Being Love will be higher at the end of therapy than at the
beginning. The posttest mean was significantly higher
than the pretest mean on the scale of Being Love (t = 3.09,
p < .01), thus supporting Hypothesis 28.
Hypothesis 28.The therapists' scores on the scale
of Deficiency Love will be higher at the end of therapy
than at the beginning. This hypothesis was rejected, as
the results showed a nonsignificant difference between the
pre- and posttest means (t = .67, p > .10). The difference
was in the predicted direction.
Hypothesis 29.--The therapists' scores on the scale of
Self Love will be lower at the end of therapy than at the


78
TABLE 18
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPECT
SCORES FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Mu1tipi
e
Individual
Pre
Post
Pre
Post
2.702
2.622
2.702
3.048
(.434)
(.488)
(.572)
(.447)
Source
df
MS
F
Blocks
11
.536
3.82**
Treatments
3
Condition (A)
1
.546
2.73
Time (B)
1
.213
1.95
A x B
1
.547
5.01*
Residual
33
.140
A x blocks
11
.200
B x blocks
11
,109
AB x blocks
11
.109
Total
4 7
Note: The
standard
deviations are in
parentheses.
*p < .05.
**p < .01.
while those of condition and time were nonsignificant.
Again, the posttest mean in the individual condition differed
significantly from the pretest mean of that condition
(t = 3.64, df = 22, p < .002) and from the posttest mean of
the multiple condition (t = 4.48, df = 22, p < .002). The
pretest means of the two conditions were equal, and the


And finally, I am very grateful to my husband, Richard,
for his kind understanding and help during the time that I
was working on this project.
vi


2
and Kell, 1950, p. 659). The name multiple therapy is also
preferred by the present author to emphasize the distin
guishing characteristic of this term, that of "the use of
two therapists who are involved intimately, affectively,
and spontaneously with each other and their patient(s)"
(Treppa, 1971, p. 452). Co-therapy (Lundin and Aronov,
1952) is probably the most frequently encountered term in
the literature, and in many instances is used as synony
mous with multiple therapy. Some critical differentiating
features between these two have been drawn, however, and
are primarily concerned with using contrived roles in co
therapy versus the emphasis on the therapist as a person in
multiple therapy (Mullan and Sanguiliano, 1960). Not deny
ing that these differences are important, the terms multiple
therapists and co-therapists will be used interchangeably
here, as most authors have not separated them so distinctly.
Treppa's definition of multiple therapy is, in a sense, an
ideal to work toward. It is doubtful that most of the
articles on the interactions between therapists are based
on relationships with that high a level of involvement. So,
although the present author concurs that the dissimilar
qualities implied by the various titles are germane to a
discussion of the new method itself, when comparing this
technique to a standard approach these differences will
oftentimes be ignored.
There have been instances of using considerably more
than two therapists, as many as nine or ten with one client


APPENDIX B
THERAPY SESSION REPORT
1
Therapist Form
Directions
This booklet contains a series of questions about the
therapy session which you have just completed. These ques
tions have been designed to make the description of your
experiences in the session simple and quick. There are two
types of questions.
One type of question is followed by a series of numbers
on the righthand side of the page. After you read each of
the questions, you should circle the number "0" if your
answer is "no"; circle the number "1" if your answer is
"some"; etc.
The other questions have a series of numbered state
ments under them. You should read each of these statements
and select the one which comes closest to describing your
answer to that question. Then circle the number in front
of your answer.
Once you have become familiar with the questions
through regular use, answering them should take only a few
minutes. Please feel free to write additional comments on
a page when you want to say things not easily put into the
categories provided.
BE SURE TO ANSWER EACH QUESTION
Patient Identification
Date of Session
1
From Orlinsky and Howard
(1966b).
125


84
scores and their standard deviations for the 12 therapists
on four of the major scales and two subscales of the CRI.
For each scale, the difference between the pre and post
means was tested using a matched-group t test (df = 11),
and the obtained values are also reported in Table 21. The
obtained levels of significance are those for a one-tailed
test, as directional hypotheses were postulated in all
instances.
TABLE 21
PRE- AND POSTTEST MEANS AND STANDARD DEVIATIONS
OF THE THERAPISTS' CRI SCALE SCORES
Scale or subscale
Pretest
Posttest
t
Affection
7.416
(1.786)
8.667
(1.775)
1.92*
Friendship
10.583
(1.929)
11.917
(2.109)
2.46**
Empathy
11.750
(2.094)
13.250
(1.658)
2.24**
Self Love
13.500
(1.883)
12.833
(1.337)
-1.20
Being Love
12.000
(1.206)
13.333
(.779)
3.09***
Deficiency Love
2.750
(1.603)
3.000
(1.537)
.67
Note: The standard deviations are in parentheses.
*p < .05.
**p < .025.
***p < .01.
Hypothesis 24.--The therapists' scores on the scale of
Affection will be higher at the end of therapy than at the


become extremely dependent on one therapist when two are
involved (Mintz, 1965), which is a further protection
against a stalemate in therapeutic movement.
The Multiple Therapy Relationship
Given that there have been many purported advantages
of multiple therapy for the therapists, many of them prob
ably are actualized only when there is a good relationship
between the participating therapists. Poor co-therapist
rapport may well signal their absence or create the atmo
sphere in which the possible disadvantages of this tech
nique thrive. The dynamics of the multiple therapy rela
tionship thus warrant a thorough examination.
Characteristics of a Good Relationship
Kell and Burow (1970) claim that "collaboration" be
tween the counselors is the crucial aspect in forming a
co-therapist relationship. Specifically, they feel that
. . mutual respect, awareness, and acceptance of
differences, owning of one's own competency, freedom
to feel and express feelings, both affectionate ones
and those that are less positive, are the primary
elements which make up a good multiple therapy rela
tionship [p. 233].
Mullan and Sanguiliano cite "mutuality" as being the
key aspect of the therapists' relationship noting that "the
relationship becomes mutual as both therapists express
their need to be together not only as a team but also as
unique individuals with definite growth strivings" (1964,
p. 175). They, further emphasize that the ideal multiple


and treatments, which could result in a negative bias being
present in the test, new F ratios were computed using the
component parts of the residual error. Although directional
hypotheses had been postulated in regard to conditions, an
attempt was made to explain the significant interactions
resulting from the analyses of variance. Thus, the simple
main effects tests used were two-tailed t tests, which
allowed for the testing of significant differences in either
direction.
Hypothesis 20.--The therapists will offer higher levels
of empathy in multiple therapy than in individual therapy.
Table 17 lists a significant ratio for blocks, indicating
the presence of individual differences among the therapists
as to.their offered level of empathy. The main effects of
condition and time were nonsignificant, while that of the
interaction of condition and time was significant at the
.05 level. A simple main effects test (Kirk, 1969) on the
means involved showed that the therapists offered signifi
cantly higher levels during the terminal session than during
the initial interview in the individual condition (t = 2.70,
df = 22, p < .02), while the slightly larger pretest mean
in the multiple condition was not significantly different
from the posttest mean (t = 1.31, df = 22, p > .10). Con
trary to Hypothesis 20, the therapists were higher on the
Empathy scale in the individual condition during the terminal
session than in the multiple condition (t = 3.43, df = 22,


134
21.HOW DID YOU FEEL ABOUT COMING TO THERAPY THIS SESSION?
(24)
1. Eager; could hardly wait to get here.
2. Very much looking forward to coming.
3. Somewhat looking forward to coming.
4. Neutral about coming.
5. Somewhat reluctant to come.
6. Unwilling; felt I didnt want to come at all.
22.HOW MUCH PROGRESS DO YOU FEEL YOU MADE IN DEALING
WITH YOUR PROBLEMS THIS SESSION? (25)
1. A great deal of progress.
2. Considerable progress.
3. Moderate progress.
4. Some progress.
5. Didn't get anywhere this session.
6. In some ways my problems seem to have gotten
worse this session.
23.HOW WELL DO YOU FEEL THAT YOU ARE GETTING ALONG,
EMOTIONALLY AND PSYCHOLOGICALLY, AT THIS TIME? (26)
I AM GETTING ALONG:
1. Very well; much the way I would like to.
2. Quite well; no important complaints.
3. Fairly well; have my ups and downs.
4. So-so; manage to keep going with some effort.
5. Fairly poorly; life gets pretty rough for me at
times.
6. Quite poorly; can barely manage to deal with
things.
24.TO WHAT EXTENT ARE YOU LOOKING FORWARD TO YOUR NEXT
SESSION?
1. Intensely; wish it were much sooner.
2. Very much; wish it were sooner.
3. Pretty much; will be pleased when the time comes.
4. Moderately; it is scheduled and I guess I'll be
there.
5. Very little; I'm not sure I will want to come.
WHAT DO YOU FEEL THAT YOU GOT OUT OF THIS SESSION? (For
each item, circle the answer which best applies.)


TABLE 29
RANK ORDERS OF THE TOTAL COMPOSITE CO-THERAPIST AGREEMENT AND RELATIONSHIP QUALITY
SCORES FROM THE MTRS AND THEIR CLIENT'S POST S-A SCALE AND POI SCALES
TIME-COMPETENCE (Tc) AND INNER-DIRECTED (I)
Therapists
Total composite
co-therapist
agreement rank
Total composite
relationship
quality rank
Client
S-A Scale
rank
POI
Tc I
AB
7
10
8
11
7
8.5
AB
4
11
10
2
2.5
3
CD
2
9
14
3
12
7
CD
2
7
16
7
8
4.5
EF
5.5
3
20
9
6
8.5
EF
2
4
25
5
1
2
GH
11
1
26
12
11
12
GH
8.5
2
37
4
2.5
1
IJ
5.5
8
31
1
4.5
4.5
IJ
10
12
33
6
10
11
KL
12
6
35
10
9
10
KL
8.5
5
36
8
4.5
6
Note: The rankings for each measure are over all 12 cases. On each, the highest
score was ranked 1; the lowest, 12.
'vD
-U


72
TABLE 15(continued)
item
no Rank Mean Mode
26.
Your general preference with a
patient who is expecially fearful
of heterosexual relations.
14.5
2.917
3
12.
Useful with very "acting out"
patients.
16.5
3.000
3
24.
Your general preference.
16.5
3.000
3
16.
Positive therapeutic movement,
in general.
19
3.167
4
17.
Working through, in general.
19
3.167
3
19.
Working out and through problems
of hostility and assertiveness.
19
3.167
3
21.
Understanding of resistance.
21
3.250
3
25.
Your general preference with a pa
tient who is very mistrustful of
authority, especially of one sex.
22.5
3.333
3
29.
Your general preference when only
short-term therapy, i.e., 6 months
or less is available.
22.5
3.333
4
22.
More complex patterns of resistance.
24.5
3.500
4
27.
Your general preference with a
patient who is especially fearful
of homosexual longings.
24.5
3.500
4
23.
Eliciting of oedipal dynamics.
26
3.727
4
13.
Useful with borderline schizo
phrenics .
27.5
3.750
4
15.
Useful with "oral characters."
27.5
3.750
4
2.
Completeness of transference
patterns.
29
3.909
4
*9.
Years of experience necessary to do
effective therapy.
30
4.333
4
*5.
Difficulties by the therapist in
"handling" intense transference
reactions.
31.5
4.917
5


22
being engulfed in an oedipal struggle where the male relates
to all the girls in a group; the female, to all the boys.
Solomon, Loeffler, and Frank (1954) believed that the thera
pists, if conscious of hostility between them, could work
out their difficulties without affecting the patient. How
ever, they feared that the anger might be displaced to the
patient if the therapists were unaware of their feelings.
Competency and respect.It is important that the
therapists be able to feel competent without being competi
tive, and desirable that they encourage and enhance each
other's competence. Gans (1962) stressed that each thera
pist should accentuate the other's assets and not let the
expression of his limitations be pronounced. Mintz (1965)
related that it is crucial that both therapists feel com
petent; otherwise, the patient may be able to play one
therapist against the other, or the therapists may misunder
stand the relationship of the patient to each of them.
Mutual respect must also be present to develop a positive
multiple therapy relationship (Lundin and Aronov, 1952;
Warkentin, Johnson, and Whitaker, 1951). This respect
should involve appreciation of the other's differences,
including sexual role dissimilarities when the counselors
are male and female (Kell and Burow, 1970; Mintz, 1963a).
Each therapist should also "know of and accept the other's
peculiarities and neuroticisms" (Rockberger, 1966, p. 288).
Finally, in this regard, Demarest and Teicher (1954) felt
that each co-therapist should emotionally accept the other
and understand his methods of working in therapy.


47
Secondly, the judges rated each item as to whether it
was indicative of the formation of a good, neutral, or poor
co-therapist relationship. The scoring pattern for each
judge over all the items is recorded in Table 30, Appendix
G. In most cases, only those responses rated in the same
direction by at least three out of the four judges were used
for scoring purposes. Due to the equivocal judgments regard
ing the responses of items 1 and 16, these items were thrown
out. Three of the other responses to questions where most
of the responses were rated similarly by the judges were re
tained and scored "zero" (4d, 5c, and 6c)--the original scor
ing direction determined by the two co-researchers. These
responses were chosen infrequently by the present sample of
therapists, so it was decided to retain these items. Because
of the nature of one item of the questionnaire (22), where
each response was somewhat separate from the others, several
choices were eliminated, while retaining the rest of the re
sponses. These deletions resulted in the total of 11 items
being used for scoring in this part of the scale, with 25
responses being scored in the positive direction, 7 in the
neutral, and 22 in the negative. Responses were scored
+1, 0, and -1 as to whether they indicated good, neutral,
or poor rapport between the therapists. A total score for
each therapist was obtained by summing all of the positive
responses and subtracting the negative ones. A composite
score for each therapist pair was obtained by adding their


APPENDIX D
CARKHUFF SCALES1
Empathic Understanding in Interpersonal Processes:
A Scale for Measurement
Level 1
The verbal and behavioral expressions of the first
person either do not attend to or detract significantly
from the verbal and behavioral expressions of the second
person(s) in that they communicate significantly less of
the second person's feelings than the second person has
communicated himself.
Examples: The first person communicates no awareness of
even the most obvious, expressed surface feel
ings of the second person. The first person
may be bored or uninterested or simply operat
ing from a preconceived frame of reference which
totally excludes that of the other person(s).
In summary, the first person does everything but
express that he is listening, understanding, or being
sensitive to even the feelings of the other person in such
a way as to detract significantly from the communications
of the second person.
Level 2
While the first person responds to the expressed feel
ings of the second person(s), he does so in such a way that
he subtracts noticeable affect from the communications of
the second person.
Examples: The first person may communicate some awareness
of obvious surface feelings of the second person,
but his communications drain off a level of the
affect and distort the level of meaning. The
first person may communicate his own ideas of
'''From Carkhuff (1969 ).
141


140
Multiple
therapy-
individual
therapy
>i 0
>1 CD
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t
t
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CD 0
t
O
£
g
-P g
Pi g
Xi g
P g
g
g
rtf
tn
p
tn
rtf
P
H
CD
H
U
0
i{
4-1
i1
CD
P
CO
44
in
P
0
H
0
g
P
g
27. Your general prefer
ence with a patient
who is especially
fearful of homo
sexual relations.
28. Your general prefer
ence with a patient
who ferociously
clings to persons of
one sex.
29. Your general prefer
ence when only
short-term therapy,
i.e., 6 months or
less, is available.
30. Your general prefer
ence for working out
and through a
patient's very in
tense "negative"
transference.
31. Your general prefer
ence for working out
and through a
patient's very
sticky "positive"
trans ference.
32. Resolution of
impasses.


TABLE OF CONTENTS
Page
ACKNOWLEDGMENTS iv
PREFACE ........ vii
LIST OF TABLES x
ABSTRACT xiii
INTRODUCTION 1
Advantages for Therapists 3
Training 3
Growth 6
Better Therapeutic Interactions 7
The Multiple Therapy Relationship 15
Characteristics of a Good Relationship ..... 15
Prerequisites and Matching 16
Relationship Problems and Solutions 19
Research ...... 24
METHOD ........ 29
Subjects 29
Counselors 29
Clients 29
Design 30
Conditions and Groups 30
Comparisons 32
Procedure 33
Counselors 33
Clients ...... 34
Instruments 35
Therapy Session Report ..... 35
Comparative Therapy Scale 37
The Carkhuff Process Scales 39
Caring Relationship Inventory 42
viii


significantly higher levels in the individual condition than
they had in that condition during the pretesting or than
they did in the multiple condition during the final session.
Regarding the multiple condition itself, the therapist
pairs were shown to become more caring for each other over
the course of therapy on Shostrom's Caring Relationship
Inventory (CRI). The therapists made gains in self-
actualization on one Personal Orientation Inventory scale;
three others showed no gains. A Multiple Therapy Rating
Scale, designed to tap two major areas of the co-therapist
relationship (co-therapist agreement and relationship quality),
was devised by the author and a co-researcher (Reiner). The
scale's two parts were shown to have significant test-retest
reliabilities. Some evidence of concurrent and predictive
validity was obtained for co-therapist agreement as it was
positively correlated with some CRI scales and with client
level of self-actualization. Neither of these types of
validity was demonstrated for relationship quality.
The results were interpreted as supporting the litera
ture's claim that therapists have better attitudes toward
multiple than individual therapy, but as not substantiating
the assumption that the actual psychotherapeutic interac
tions are better. Some beliefs regarding co-therapy were
confirmed; the co-therapists: became closer, evinced growth,
and one aspect of their rapport was related to client out
come. Because of some characteristics of the counselors and
xv


112
case in prior reports (Rabin, 1967). The clients in the
present research were assigned at random to the multiple
or the individual condition. Justly, it could be argued
that exploring the relative merits of an approach with
clients for whom that approach was not required or even
contraindicated is an unfair test of the technique.
Furthermore, it is important to note that more clients
terminated therapy before the fourth session in the indi
vidual than the multiple condition (six to one, respectively).
It is possible that the clients with whom the therapists
had especially poor rapport terminated early in the indi
vidual, but not in the multiple, condition. Kell and Burow
(1970) would not find this surprising, feeling that clients
frequently have more difficulty maintaining resistances with
the help of two caring persons than with that of one. Of
the clients who were included in the study, then, the
possibility exists that those in the multiple condition were
of a qualitatively higher level of difficulty for the thera
pists than those in the individual condition. This situation
might have influenced the results in favor of individual
therapy. - - *
The results delineated herein, however, should place
some doubts in the minds of those who have heralded multiple
therapy as being always a superior technique to individual
therapy. It might be wise for therapists to heed the
caution of Gans (1962), who felt that two inexperienced


APPENDIX E
THE SCALES OF THE CARING RELATIONSHIP INVENTORY1
Identification
Description
Scales
A
Affeetionhelping, nurturing form of love.
It involves unconditional giving and accep
tance of the kind that characterizes the
love of a parent for a child.
F
Friendship--a peer love based on appreci
ation of common interests and respect for
each others equality.
E
Erosa possessive, romantic form of love
which includes features such as inquisitive
ness, jealousy, exclusiveness.
M
Empathy"agape," a charitable, altruistic
form of love which feels deeply for the
other individual as another unique human
being. It involves compassion, appreciation,
and tolerance.
S
Self Love--the ability to accept, in the
relationship rated, one's weaknesses as well
as to appreciate one's individual, unique
sense of personal worth. It includes the accep
tance of one's full range of positive and
negative feelings toward the person rated.
Sub Scales
B
Being Lovethe ability to have and accept the
other person as he or she is. Being love in
cludes aspects of loving another for the good
seen in him (her). It is an admiring,
respectful love, an end in itself.
D
Deficiency Lovethe love of another for what
he (she) can do for the person. Deficiency
love is an exploiting, manipulating love of
another as a means to an end.
1From Shostrom (1966a).
149


58
TABLE 4
MEANS¡ STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST
RESPONSES TO TSR ITEMS 6 AND 9 FOR MULTIPLE
AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
1.6660
(.6513)
1.2500
(.8660)
1.7500
(.4523)
1.4166
(.7930)
Source
df
MS
F
Blocks
11
1.0208
3.10**
Treatments
3
Condition (A)
1
.1874
.57
Time (B)
1
1.6874
5.13*
A x B
1
.0209
.06
Residual
33
.3289
Total
47
Note: The standard deviations are in parentheses.
*p < .05.
**p < .01.
negative bias in the test seemed worthwhile, since the ratio
for time obtained by using the mean square for residual was
close to significance {F = 3.59, p < .10). As an inspec
tion of the data suggested that there might be an interaction
between blocks and treatments, the residual error was
partitioned into its component parts and new F ratios were
computed. As shown in Table 5, however, none of the F ratios
were significant.


91
posttest.; and total for each case, are shown in Table 24,
while those of the agreement scores of each therapist and
his partner as to the events of the session are given in
Table 25. As reported in Table 27, the test-retest reli
abilities for relationship quality between the pretest
ranks of each therapist for his two cases, between the post
test ranks of each therapist for his two cases, and between
the ranks of the combined pre- and posttest scores of one
case compared to the other were all significant beyond the
.05 level. For co-therapist agreement, likewise, the
test-retest reliabilities were significant.
As an attempt to establish concurrent validity for the
MTRS, the rank orders of the therapists' scores on four
CRI scales (Table 26) were correlated with their relation
ship quality and co-therapist agreement ranks. As shown in
Table 28, co-therapist agreement did correlate significantly
with the pretest Affection scale ranks and the posttest
Empathy (M) scale ranks. No others were significant. The
relationship quality scores did not correlate significantly
with any of the CRI scale scores. The two parts of the
MTRS also viere not significantly correlated with each other,
suggesting that each measures a different aspect of the
co-therapist relationship. If either of the last two hy
potheses were to be confirmed, a crude case for predictive
validity of the MTRS scale would be formed. It was thought
that co-therapist agreement and relationship quality should
be positively related to client outcome.


152
6.
How well did you understand what the other therapist
was doing during the session?
a. Completely
b. Very well
c. Fairly
d. Poorly
e. Very poorly
Did you feel the other therapist made any real mistakes
during the session?
a. Yes, many
b. Yes, a few
c. Yes, one
d. No, not at all
8.Were you ever hesitant to say something to the client
because of the presence of the other therapist?
a.
Yes, many
times
b.
Yes, a few
times
c.
Yes, once
d.
No, not at
all
9.If you answered "yes" to the preceeding question, was
this because you thought the other therapist would view
your statement as: (Check any that are appropriate.)
a. foolish?
b. inappropriate?
c. irrelevant?
d. reflecting your incompetency?
10.Did you ever consider the other therapist more than
the client in making a statement?
a. Yes, many times
b. Yes, a few times
c. Yes, once
d. No, not at all
11.If you answered "yes" to the above question, was this
because:
a. you were trying to please the other therapist?
b. you were trying to impress the other therapist
c. you were trying to clarify something for the other
therapist?
d. you said what you thought the other therapist
expected you to say?


10
the therapist must switch in and out of the role to comment
on what is happening, Godenne (1964) reported satisfactory
results with a procedure wherein both therapists of a team
participated in the psychodrama activities of a group.
The deliberate donning of different roles by the thera
pists has been one area of dispute among various theorists.
Mullan and Sanguiliano (1960, 1964) have stated that one of
the main discriminating features between what they distin
guish as co-therapy and multiple therapy is the use of con
trived role-playing in the former. Treppa (1971) concurs
with them that this is not a beneficial technique:
The usual situation in co-therapy is for one therapist
to act in a supportive, passive, and good manner while
the other plays an aggressive, dominant role. Such an
approach: (1) is artificial in nature; (2) limits the
therapists' freedom to be themselves and thus grow;
(3) depersonalizes the patient by depersonalizing the
therapists; (4) may prove to the patient what he has
always thoughtthat he is inadequate in his attempt
to change his environment, since he cannot change his
therapists; and (5) encourages our cultural stereotype
about how a man and a woman should be and feel [p. 453] .
These criticisms concern deliberate role-playing, however,
and these authors would not deny that one of the advantages
of multiple therapy has to do with the broader array of
possible interpersonal interactions.
Freedom.The multiple situation can also foster
greater therapist freedom. It is easier to take risks in
confronting the client when the therapist knows that his
co-therapist can assist the client if necessary (Warkentin,
Johnson, and Whitaker, 1951). Greenback (1964) said that
clients feel freer in discussing certain topics with one


37
impressions or reactions to your patient this session?":
1: Considerably
2: Moderately
3: Somewhat
4: Slightly
5: Not at all
This last type of item was presented on the forms to
the testee in the opposite direction from which it was
scored: the "1" choice was given a score of 5, while the
"5" choice was scored as 1.
For purposes of hypothesis testing, some of the items
were grouped together for scoring. When this was done,
the scoring scheme was changed so that each response re
reived a 0 for "no," and a 1 for either "some" or "a lot."
The scores for all relevant responses were then summed to
give a composite total for the group of items. The topics
involved are listed in the section dealing with hypotheses.
The remainder of the items were used singly to test hypotheses.
No attempt was made to obtain a score over the entire inven
tory since the aspects of counseling covered by the items
are so diverse.
Comparative Therapy Scale
Rabin (1967), as already mentioned, was a pioneer in
the empirical investigation of therapist attitudes toward
co-therapy and regular group therapy. His original
Co-Therapy Rating Scale consisted of 50 items regarding the


Abstract of Dissertation Presented to the Graduate Council
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy
PSYCHOTHERAPEUTIC INTERACTIONS
IN MULTIPLE AND INDIVIDUAL THERAPY
By
Sharon Jennette Kosch-Graham
December, 1972
Chairman: Harry A. Grater, Jr.
Major Department: Psychology
This study investigated the psychotherapeutic inter
actions of therapists in multiple and individual therapy.
One aim was to illuminate any significant differences be
tween the two conditions as far as (a) the therapists'
report of their own and their clients' behavior, (b) the
therapists' general attitudes about the two treatment
modalities, and (c) judges' evaluations of the therapists'
level of functioning on core facilitative dimensions. The
second goal was to probe various aspects of multiple therapy
itself in regard to the relationships of the co-therapist
pairs: (a) their level of caring for their partners,
(b) their ratings of the quality of their relationships,
(c) their agreement as to their perceptions and behavior
during the sessions, and (d) the relation of the foregoing
aspects to client outcome.
Three intern-level and three staff-level heterosexual
therapist pairs were formed from counselors at the University
xiii


36
form after the items on the client form. The items were
all multiple choice,, and inquired into the participants'
feelings and actions during the sessions, how the therapists
and clients, viewed''each other, and how they evaluated cer
tain aspects of the process of the sessions. All items
require that the participants rate a statement regarding
one of the above areas.
Some items are judged on a scale of 0 to 2; for
example, "What did your patient seem to want this session?
A chance to let go and express feelings." The therapist
assigned one of the following scores:
0: No
1: Some
2: A lot
The second scoring plan is exemplified by the item,
"During this session, how much did your patient tend to
agree with or accept your comments or suggestions?" The
therapist rated his client's behavior according to the
following scale:
0: Slightly or not at all
1: Some
2: Pretty much
3: Very much
The third type of item utilized a 5- or 6-point scale.
The therapist had the following choices in regard to the
question, "To what extent did you reveal your spontaneous


Table Page
20. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Concreteness Scores for Multiple
and Individual Conditions 82
21. Pre- and Posttest Means and Standard Deviations
of the Therapists' CRI Scale Scores 84
22. Means and Standard Deviations of Shostrom's
Sample of Successfully Married, Troubled, and
Divorced Couples on the CRI Scales 87
23. Means and Standard Deviations of the Thera
pists' Pre and Post POI Scores 88
24. Rank Orders of Each Therapist's Relationship
Quality Scores for Both Multiply Seen Cases 92
25. Rank Orders of the Agreement Scores of Each
Therapist's Responses on the TSR and His
Partner's Corresponding MTRS Responses for
Both Multiply Seen Cases 93
26. Rank Orders of the Therapists' Scores on Four
CRI Scales 94
27. Test-Retest Reliabilities of Relationship
Quality and Co-therapist Agreement from the
MTRS 95
28. Spearman Rank-Order Correlations Between
Relationship Quality and Co-therapist Agree
ment and Between These Scales and Scales of
the CRI 95
29. Rank Orders of the Total Composite Co-therapist
Agreement and Relationship Quality Scores from
the MTRS and Their Client's Post S-A Scale and
POI Scales Time-Competence (Tc) and Inner-
Directed (I) 97
Xll


their co-therapy relationships, the applicability of the
results for multiple therapy in general was qualified and
an area for future research suggested.
xvi


159
TABLE 32(extended)
29
31
32
35
36
37
I M
I M
I M
I M
I M
I M
4 4 2 5 2 3.
4 4 4 4 5 5
5 5 4 5 4 5
3 3 5 4 5 4
3 4 3 4 4 5
4 3 4 4 4 4
4 4 3 2 4 3
4 3.2 2 4 5
5 4 2 4 2 3
1 5 4 5 4 5
3 5 3 4 3 2
2 2 4 3 5 4
2 4 2 4 2 4
4 4 5 4 3 4
5 3 3 5 4 2
55 4 3 3 3
4 5 2 5 3 5
5 4 2 3 4 3
3 3 4 4 4 2
5.5 3 3 2 3
4 5 4 2 3 5
4 5 4 5 4 4
4 4 3 5 2 2
4 4 4 2 4 3
0 0 0 0 3 3
0 0 0 0 3 3
0 0 0 2 2 2
0 0 0 0 3 3
1110 2 2
0 0 0 1 2 2
1111 12
1111 2 2
0 0 0 0 2 2
0 1 0 0 2 3
0 0 0 0 2 3
0 0 0 0 3 1
3 3 3 2 1 3
2 2 2 2 2 2
2 2 2 2 2 2
3 2 2 2 2 1
2 3 1 2 2 2
2 2 1111
2 1 12 2 1
2 2 2 1 1 1
2 2 1111
2 3 2 2 1 2
2 1 2 2 11
2 2 10 12


18
Warkentin, 1956) or, at least, that neither be "in a posi
tion of greater authority or dominance . even if one
therapist is a student" (Solomon, Loeffler, and Frank, 1954,
p. 171). Warkentin, Johnson, and Whitaker (1951) reported
that the inexperienced therapists in their study were some
times anxious and lacking in spontaneity, as they were
concerned about making positive impressions upon their co
therapists. Extending this further, Malone and Whitaker
(1965) feel that it may be impossible to establish a good
multiple therapy relationship in a teacher-student situation.
p
Gans (1962) also stated that many disruptive problems are
created when there is a great dissimilarity in the thera
peutic resources of the co-therapy participants. For most
theorists in this area, however, the important point is
that the co-therapists be able to establish an egalitarian
relationship, regardless of their levels of experience or
status (Haigh and Kell, 1950).
Often-cited personal characteristics deemed to be pre
requisite for a multiple therapist were listed by Greenback
(1964). These are maturity (Whitaker, Malone, and Warkentin,
1956), being able to freely communicate with another thera
pist (Rockberger, 1966), lack of competitiveness (Dyrud
and Rioch, 1953), and ability to trust. Mullan and Sangui-
liano (1960) regarded considerable trust between the thera
pists as being necessary to achieve mutuality. Along with
Greenback, other authors feel that the co-therapists should


LIST OF TABLES
Table Page
1. Percentages of Agreement Among Four Judges
Regarding the Multiple Therapy Rating Scale 46
2. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Items 1 and 2
for Multiple and Individual Conditions ... 56
3. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Items 1-5 for
Multiple and Individual Conditions 57
4. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Items' 6 and 9
for Multiple and Individual Conditions ... 58
5. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 17 for
Multiple and Individual Conditions 59
6. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 21 for
Multiple and Individual Conditions 60
7. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 25 for
Multiple and Individual Conditions 61
8. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 29 for
Multiple and Individual Conditions 62
9. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 31 for
Multiple and Individual Conditions 63
x


104
Similar to the therapists! ratings of their clients' be
havior, the therapists did not rate their own behavior in
co-therapy as being significantly better than their actions
in regular therapy.
Therapist Attitudes About the Two Conditions
The consensus of the currently studied counselors was
that multiple therapy was generally better than individual
therapy (Hypothesis 19), when they were asked to rate the
two therapeutic forms in the abstract. Many of the findings
of Rabin (1967) were supported by the response patterns of
the present therapists to the CTS (a modified version of
Rabin's scale).
The therapists agreed with Mintz (1963a) that co
therapy was conducive to their self-understanding (Hypothe
sis 14), and with Kell and Burov/ (1970) that it offers more
personal gratification or "fun" for the therapist (Hypothe
sis 16). The attitudes of the counselors were similar to
those of the earliest proponents of co-therapy (Reeve, 1939;
Hadden, 1947) in that they felt the technique was useful
in training therapists (Hypothesis 15). And the praise of
multiple therapy as being better than individual therapy
for the resolution of impasses (Hayward, Peters, and Taylor,
1952) was given by the present counselors (Hypothesis 18).
The investigation of the therapists' attitudes also found
that multiple therapy was slightly more their general
preference over individual therapy (Hypothesis 17).


I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
H t e r
Professor /of
Jr., Chairman
Psychology
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
Professor of Clinical
Psychology
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
. a a. r
/ft.
Madeleine Carey Ramey
Assistant Professor
sychology
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
Vernon D. Van De Reit
Associate Professor of Clinical
Psychology


23
Autonomy and dependency.Kell and Burow (1970) further
thought it important that the therapists be able to be both
autonomous from and dependent on each other. They felt
that counselors are trained to be independent, possibly to
the extreme, so that they cannot easily, genuinely, and
appropriately depend on one another. It is critical that
they do this in order to share responsibility for the
therapy and form good models for their clients regarding
expression of dependency.
Intimacy and caring.Solomon, Loeffler, and Frank
(1954) postulated that the ideal multiple therapy pair
establish an intimate association which unites them and
betters their therapy. Mullan and Sanguiliano (1960) felt
that the therapists need to develop a deep meaning for one
another, come to care for each other, so that they react
to the patient in a meaningful and integrated way. Many
theorists in the field have stated that a good multiple
therapy relationship would contain the same ingredients as
a good marriage (Kamerschen, 1969; Linden, 1954; Rabin,
1967; Sonne and Lincoln, 1966; and Treppa, 1969). Randolph
(1970) agreed with this view of the relationship and inves
tigated aspects that she felt were especially important.
She was interested in how much the co-therapists (1) dis
closed to one another, (2) were satisfied with each other,
and (3) expressed affection to one another. The present
author concurs that the development of an intimate and caring


144
Example: The first .person communicates respect and concern
for the second person's ability to express him
self and to deal constructively with his life
situation.
In summary, in many ways the first person communicates
that who the second person is and what he does matter to the
first person. Level 3 constitutes the minimal level of
facilitative interpersonal functioning.
Level 4
The facilitator clearly communicates a very deep
respect and concern for the second person.
Example: The facilitator's responses enable the second
person to feel free to be himself and to experi
ence being valued as an individual.
In summary, the facilitator communicates a very deep
caring for the feelings, experiences, and potentials of the
second person.
Level 5
The facilitator communicates the very deepest respect
for the second person's worth as a person and his poten
tials as a free individual.
Examples: The facilitator cares very deeply for the human
potentials of the second person.
In summary, the facilitator is committed to the value
of the other person as a human being.
Facilitative Genuineness in Interpersonal Processes:
A Scale for Measurement
Level 1
The first person's verbalizations are clearly unrelated
to what he is feeling at the moment, or his only genuine
responses are negative in regard to the second person(s)
and appear to have a totally destructive effect upon the
second person.
Example: The first person may be defensive in his inter
action with the second person(s) and this


I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
James D. Millikan
Assistant Professor of Philosophy
This dissertation was submitted to the Department of
Psychology in the College of Arts and Sciences and to the
Graduate Council, and was accepted as partial fulfillment
of the requirements for the degree of Doctor of Philosophy.
December, 1972
Dean, Graduate Schoo1


16
therapy relationship is an intimate one which encourages
interchanges between the therapists on a transactional and
phenomenological level (Mullan and Sanguiliano, 1960).
Randolph (1970) states that the above authors, in
conjunction with Whitaker, Malone, and Warkentin (1956),
"concur in citing authenticity, mutuality, relatedness,
equality, spontaneity, affective involvement, autonomy and
interdependency as essential to the multiple therapists'
relationship" [p. 11]. These, then, are the major character
istics of a good multiple therapy relationship. The follow
ing discussion elaborates on how such an interaction can be
attained and what problems prevent its realization.
Prerequisites and Matching
One obvious dimension to be considered in the pairing
of co-therapists is their general orientation or approach.
Solomon, Loeffler, and Frank (1954) state that an optimal
pairing can be achieved when the "orientations of the co
therapists are flexible enough to permit considerable
variance along the active-passive, directive-nondirective
continuae" [p. 177]. They surmised that there are probably
various ways to match on these dimensions that will prove
to be successful combinations. They felt that until these
combinations are known, however, therapists should be
matched with regard to their goals and techniques. It
would be a catastrophe to place two therapists in the same
room who are extremely different and rigid in their beliefs


20
stated that the relationship between co-therapists is very
complicated, and may even contain so many difficulties that
a therapist would be better off working singly. In addition
to meeting the prerequisites and being properly matched, a
good multiple therapy team is formed by participants who
can work through problems in their relationship. When and
how are the difficulties to be discussed? Some types of
obstacles can be handled during the sessions. For example,
when the therapists have divergent opinions about what is
going on with the client (Dreikurs, 1950) or there are
tactical differences between the counselors, these can be
revealed and discussed in the client's presence. It has
been emphasized that this should be done with an air of
respect, and the therapists should be able to be comfort
able with their disagreement. Other difficulties, such as
"neurotic conflicts between co-therapists, have to be
recognized and dealt with appropriately outside . ."of
the sessions (Hulse, Lulow, William, Rindsberg, and Epstein,
1956, p. 435). Routine meetings of the therapists between
the sessions are considered to be essential (Lundin and
Aronov, 1952). In this regard, Haigh and Kell (1950)
recommend that the therapists go over a tape of the therapy:
It is in this situation that attitudes and feelings
existing between the two participating therapists
become crystallized and clearcut and the emotional
growth and learning for both can reach their maxi
mum [p. 660].
It has also been suggested that the two therapists meet
with a third party who can act as a moderator or supervisor


55
TSR Data
All of the hypotheses aligned with the TSR instrument,
concerning the predictions that the counselors would report
differing therapeutic interactions in individual and mul
tiple therapy, were tested similarly. In each case, a
randomized block factorial design (Kirk, 1969, pp. 237-244)
was used to assess the differences between conditions (multiple
and individual) and time of measurement (initial or terminal
interview). The test employed was a two-way analysis of
variance with repeated measures on both variables, as the
same therapists participated in both conditions and pre
and post data were collected on them.
Hypothesis 1.--Compared to individual therapy, the
therapists will rate the clients in multiple therapy as
having talked more about relations with persons of both
sexes (Items 1 and 2). As shown in Table 2, the analysis of
variance of the therapists' scores on the first two items
yielded no significant F ratio for blocks, condition, time,
or the interaction of condition and time. Hypothesis 1
was not supported.
Hypothesis 2.--Compared to individual therapy, the
therapists will rate the clients in multiple therapy as
having discussed a greater variety of topics (Items 1-5).
As shown in Table 3, the F ratio for blocks was significantly
greater than zero, meaning that there were individual dif
ferences between the therapists, as might be expected.


Sharon
Copyright by
ennette Kosch-Graham
1972


BIOGRAPHICAL SKETCH
Sharon Jennette Kosch-Graham was born June 13, 1945,
in Ukiah, California. She was graduated with honors from
Ukiah Union High School, in June, 1963. The following
September she entered San Jose State College (now California
State University at San Jose), San Jose, California, where
she participated in the Humanities Program, a liberal arts
curriculum, during her first two years of study. She was
awarded the degree of Bachelor of Arts with great distinc
tion and honors in psychology in June, 1967. The Phi Beta
Kappa members of the faculty at San Jose State College also
elected her to membership in the Key Club upon her gradu
ation. She remained at this institution for one year of
graduate study in the Psychology Department. In September,
1968, she entered the Department of Psychology at the
University of Florida. From 1968 to 1970, she held a depart
mental teaching assistantship, and from 1970 to 1971, a
U.S.P.H.S. traineeship. During 1971 and 1972, she completed
a fifteen-month internship in clinical and counseling
psychology at the University of Florida, with placements at
the University Counseling Center and Alachua Mental Health
Services.
Sharon Jennette Kosch-Graham, who is married to Richard
Jason Kosch, is a member of Psi Chi.
178


77
p > .01). The means suggest that the levels offered in the
two conditions were fairly equivalent at the onset of
therapy, but increased as therapy proceeded in the indi
vidual condition while remaining the same in the multiple.
TABLE 17
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST EMPATHY
SCORES FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
2.772
6.608
2.653
3.041
(.475)
(.443)
(.630)
(.448)
Source
df
MS
F
Blocks
11
.462
2.46*
Treatments
3
Condition (A)
1
.296
1.58
Time (B)
1
.151
o
CO

A x B
1
.916
4.87*
Residual
33
.188
Total
47
Note: The standard deviations are in parentheses.
*p < .05.
Hypothesis 21.--The therapists will offer higher levels
of respect in multiple therapy than in individual therapy.
Table 18 shows that, similar to the results of the Empathy
scale, the analysis of variance of the scores on the Respect
scale yielded significant blocks and interaction ratios,


INTRODUCTION
The focus of this report is a therapeutic phenomenon
wherein two or more helping persons simultaneously engage
in psychotherapy with individual persons, families, or
groups. The presence of multiple therapists has been said
to have a markedly different effect on the counseling
interactions than does one therapist. The differences be
tween multiple and individual therapy have been one major
area of concentration for all who have used and written about
multiple therapy. The other predominant theme in the
literature has to do with the characteristics of the phe
nomenon itself, including its different versions styled by
therapists with diverse goals and emphases.
Various titles have been given to this counseling
approach, with very little agreement among the authors as
to exactly what the differences and similarities between
them are. Those less often used include: cooperative team
approach (Lott, 1957), dual leadership (Linden, 1954),
joint interview (Reeve, 1939), role-divided therapy (listed
by Randolph, 1970), team counseling (Mallars, 1968), and
three-cornered therapy (Bock, Lewis, and Tuck, 1954). In
regard to the present research, the "use of two therapists
with one client is what we mean by multiple therapy" (Haigh
1


83
Empathy,. Respect, Genuineness, and Concreteness. The rank
orders were obtained by using the average of the judges'
ratings for each therapist across both conditions, pre and
post, as listed in Table 35, Appendix H.
Of the 12 therapists, there were three women (Counselors
B, D, and F) and one male (K) who were consistently rated as
offering high facilitative levels (average over 3.0) of the
core conditions. The three female counselors were all
"counselor" types, dominant in Intuition, Feeling, and
Perception, whether Introverted or Extraverted. The one
male was also strongest on Intuition and Feeling. Although
his score on the Judging-Perceiving dimension indicated
that Judging was dominant, the score was so close to the
midpoint, it is difficult to be certain of his preference.
The next three highest-scoring counselors on the
Carkhuff scales (E and L on Empathy and Respect and H on
Genuineness and Concreteness) were all "noncounselor" types.
Three of the therapists receiving ranks of 9.5, 10, 11, and
12 were "counselor" types (A, I, and J), while two were
"noncounselor" types (G and H).
The Multiple Condition
CRI Data
The hypotheses aligned with the CRI data concerned
the general prediction that the relationships of the pairs
of co-therapists would change toward greater intimacy and
caring over time. Table 21 shows the mean pre- and posttest


APPENDIX C
COMPARATIVE THERAPY SCALE
1
Name Date
We would like to find out how you feel about multiple
versus individual therapy. After reading an item, please
rate the relative merits of multiple as opposed to indi
vidual therapy by checking one of the seven columns.
Multiple Individual
therapy therapy
.c
CD
>1 0
>i a)
0 0
>i 0
>i 0
d
0
o
U
1 M
i! V-l
S u
i1 5-4
o
5-4
p
o
0 O
P 0
a
-P 0
0 O
p
0
a
s
-p e
a s
0
d B
-P 6
a
B
P
tn
P
Cp
nj
U
H
0
H
u
0
iI
<4-1
r4
0
mi
to
<4-4
m
0
*r-{
0
a
d
a
1. Understanding, by
the therapist of
the transference.
2. Completeness of
transference
patterns.
3. Transference of the
original family
situation.
4. Opportunity to work
out anxieties with
a therapist of the
more dreaded sex.
5. Difficulties by the
therapist in
"handling" intense
transference
reactions.
6. Self-understanding
of the therapist
enhanced.
1From Rabin (1967).
137


61
TABLE 7
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES
TO TSR ITEM 25 FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
2.2416
(.5149)
2.7500
(1.0553)
2.5833
(.6686)
2.6666
(.4924)
Source
df
MS
F
Blocks
11
.2026
.33
Treatments
3
Condition (A)
1
.0208
.03
Time (B)
1
.5208
.84
A x B
1
.1876
.30
Residual
33
.6218
Total
47
Note: The standard deviations are in parentheses.
Hypothesis 7.--The therapists will be apt in multiple
therapy to rate themselves as more revealing of their spon
taneous impressions or reactions than in individual therapy
(Item 29). As listed in Table 8, no significant F ratios
resulted from the analysis of variance of the scores in
volved in this prediction. Hypothesis 6 was not supported.
Hypothesis 8.The therapists will be apt in multiple
therapy to rate themselves as more understanding of what
their patients said and did than in individual therapy
(Item 31). The analysis of variance summary table reported


129
3. I had no particular anticipations but found
myself pleased to see my patient when the time
came.
4. I felt neutral about seeing my patient this
session.
5. I anticipated a trying or somewhat unpleasant
session.
28.TO WHAT EXTENT DID YOUR OWN STATE OF MIND OR PERSONAL
REACTIONS TEND TO INTERFERE WITH YOUR THERAPEUTIC
EFFORTS DURING THIS SESSION?
1. Considerably.
2. Moderately.
3. Somewhat.
4. Slightly.
5. Not at all.
29.TO WHAT EXTENT DID YOU REVEAL YOUR SPONTANEOUS IMPRES
SIONS OR REACTIONS TO YOUR PATIENT THIS SESSION?
1. Considerably.
2. Moderately.
3. Somewhat.
4. Slightly.
5. Not at all.
30.TO WHAT EXTENT WERE YOU IN RAPPORT WITH YOUR PATIENT'S
FEELINGS?
1. Completely.
2. Almost completely.
3. A great deal.
4. A fair amount.
5. Some.
6. Little.
31.HOW MUCH DO YOU FEEL YOU UNDERSTOOD OF WHAT YOUR
PATIENT SAID AND DID?
1. Everything.
2. Almost all.
3. A great deal.
4. A fair amount.
5. Some.
6. Little.


167
TABLE 37
PRE AND POST SCORES OF THE THERAPISTS ON SIX CRI SCALES
Scale
i 1 - Cl k-/ _L ti L
A
F
M S
D
B
A
9
8
8
10
8
12
13
12
1
2
10
14
B
6
9
8
7
9
15
14
14
1
2
12
12
C
11
8
8
11
14
11
12
13
2
1
13
13
D
8
11
9
15
15
15
14
13
3
4
13
14
E
8
11
12
14
14
16
15
15
6
7
12
15
F
9
10
13
13
11
13
16
15
4
4
12
13
G
5
6
12
13
12
12
12
11
1
3
12
13
H
7
8
12
12
12
12
14
12
3
2
13
13
I
7
11
11
13
10
12
13
12
4
2
11
13
J
8
. 8
13
13
12
12
15
13
1
3
14
13
K
6
11
10
11
11
14
9
13
3
3
12
14
L
5
8
11
11
13
15
15
11
4
3
10
13
Note:
The first
score
under each scale
indicates
the
thera
pist's
pretest
. score;
the
second
his
(her)
posttest
score.
TABLE 38
PRE
AND POST SCORES
OF
THE THERAPISTS
ON
FOUR
POI
SCALES
Scale
TC
I
S
C
A
21
23
101
107
17
14
26
25
B
23
23
108
108
18
18
24
24
C
3
19
112
107
18
16
23
25
D
21
20
106
104
18
18
23
22
E
19
18
100
108
16
15
24
25
F
21
20
115
113
18
18
26
23
G
18
20
89
93
16
13
21
19
H
14
17
89
96
12
13
17
22
I
19
21
111
113
17
16
23
25
J
16
18
102
104
17
17
26
27
K
18
22
100
108
13
14
23
26
L
15
15
86
85
14
14
19
22
Note: The first score under each scale indicates the thera
pist's pretest score; the second, his (her) posttest score.


40
reliable instruments and have been validated in numerous
psychotherapy research projects (as reported in Carkhuff,
1968; Carkhuff and Berenson, 1967; and Truax and Carkhuff,
1967). It has been noted, however, that higher reliability
and predictive validity have been obtained v/hen the raters
using the scales are themselves high-level functioning
counselors (Carkhuff and Berenson, 1967). Interjudge re
liability coefficients as high as .80 and above have been
found using such raters (Swander, 1971); whereas the use of
naive undergraduate students could be expected to give co
efficients closer to .50 (Truax and Carkhuff, 1967).
Taped excerpts were taken from the initial and the
terminal therapy interviews of the 12 multiple and the 12
individual cases. Each of these therapy sessions was divided
into thirds, and one segment was taken from the first, the
middle, and the last third of the session. The order in
which these 144 segments were presented to the judges was
completely randomized, so that they did not know if any
particular segment was from the first or last session, nor
from what portion of the interview. Because of the nature
of the conditions, however, the raters were able to discern
whether an excerpt was from the multiple or the individual
condition. Master tapes with the excerpts given in their
random sequence and identified by a number, along with 144
numbered 3x5 cards, were given to the judges. The cards
had columns for male therapist, female therapist, and client.


67
TABLE 13
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES
TO TSR ITEM 37 FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Mult
iple
Individual
Pre
Post
Pre
Post
1.3333
(.4924)
1.5833
(.6686)
1.6666
(.6513)
1.5833
(.6686)
Source
df
MS
F
Blocks
11
.7329
2.59*
Treatments
3
Condition (A)
1
. 1875
.66
Time (B)
1
.0208
.07
A x B .
1
.1875
.66
Residual
33
.2834
Total
47
Note: The standard deviations are in parentheses.
*p < .05.
Hypothesis 13.It is expected that the therapist-client
agreement as to the events of the sessions will be higher
in multiple than in individual therapy (on 24 selected
items listed in Tables 31 and 32, Appendix H). Table 14
lists the Pearson product-moment correlations computed be
tween the scores of the therapists and those of their clients
with whom they were paired. As shown, for the initial
interview, nine of the therapists have higher agreement


RESULTS
Comparison of Multiple and Individual Conditions
Number of Sessions
As mentioned previously, the therapists had to have
at least four sessions with a client for that case to be
included in the study. Of the seven cases where clients were
terminated before the fourth session, six were in the
individual and one in the multiple condition. A sign test
determined the probability of this occurrence as being .062.
Table 31 in Appendix H lists the total number of sessions
for the individual condition as 7.75, the mode 5. For
the multiple condition, the mean was 7.50 and the mode 6.
As heretofore explained, one of the multiples in which each
therapist participated was selected at random for purposes
of comparing measures of that therapist in the multiple
condition to those of his in the individual condition. The
other multiple in which he participated was relegated to
his partner. A Wilcoxon matched-pairs signed-ranks test
was calculated between the number of sessions that each
therapist had with his client in the individual condition and
and number he had with his client in the multiple condition
This test yielded nonsignificant results (T = 16.5, p > .05,
critical value = 11), suggesting that the groups were
matched on this variable.
54


120
The co-therapist agreement scores of each therapist
were shown to positively correlate with his CRI scale scores
on the pretest of Affection, while the posttest did not; and
the posttest of Empathy (M), while the pretest did not. None
of the correlations between agreement level and the Friend
ship or Being Love scales were significant. So, the case
for concurrent validity of co-therapist agreement with caring
as far as affection and empathy is inconclusive. Co
therapist agreement was also not related to relationship
quality, suggesting that these two aspects of the co
therapist relationship are distinct from one another.
Co-therapist agreement was shown to be positively re
lated to client outcome (Hypothesis 36), when the coefficient
computed between the total composite agreement score of each
co-therapist pair and their client's S-A Scale score was
significant. As a further check on this finding, the ranks
of each client on the posttest POI scales of Time-Competence
and Inner-Directed were correlated with her co-therapist
pair's agreement score rank. Although the comparison with
Time-Competence was nonsignificant, each client's level of
being inner-directed was significantly related to the level
of agreement of her co-therapists. A strong case, then,
for the predictive validity of co-therapist agreement scores
was foundhigh co-therapist agreement is likely to be
aligned with good client outcomes; low co-therapist agreement,
with low outcomes.


153
12. During the session, did you come to the other thera
pist's aid when there was an "interactional difficulty"
between the client and the therapist?
a.
Yes, many
times
b.
Yes, a few
times
c.
Yes, once
d.
No, not at
all
13.
14.
15.
16 .
During this session, how much was your patient warm
and friendly towards the other therapist? (19)
a. Slightly
b. Some
c. Pretty much
d. Very much
How much, during the session, did your patient tend to
agree with or accept the other therapist's comments
or suggestions? (21)
a. Slightly or not at all
b. Some
c. Pretty much
d. Very much
During this session, how much was your patient negative
or critical towards the other therapist? (22)
a. Slightly or not at all
b. Some
c. Pretty much
d. Very much
As far as determining the course of the session, did
you think that the other therapist was:
a. more dominant than you?
b. less dominant than you?
c. about the same?
17. To what extent do you think that the other therapist's
state of mind or personal reactions tended to interfere
with therapeutic efforts during the session? (28)
a. Considerably
b. Moderately
c. Somewhat
d. Slightly
e. Not at all


128
SLIGHTLY
OR NOT
AT ALL
SOME
PRETTY
MUCH
VERY
MUCH
21.
DID YOUR PATIENT TEND TO
AGREE WITH OR ACCEPT YOUR
COMMENTS OR SUGGESTIONS?
0
1
2
3
22 .
WAS YOUR PATIENT NEGATIVE
OR CRITICAL TOWARDS YOU?
0
1
2
3
23.
WAS YOUR PATIENT SATISFIED
OR PLEASED WITH HIS (HER)
OWN BEHAVIOR?
0
1
2
3
24.HOW MOTIVATED FOR COMING TO THERAPY WAS YOUR PATIENT
THIS SESSION?
1. Very strongly motivated.
2. Strongly motivated.
3. Moderately motivated.
4. Just kept his (her) appointment.
5. Had to make himself (herself) keep the appointment.
25.HOW MUCH PROGRESS DID YOUR PATIENT SEEM TO MAKE THIS
SESSION?
1. A great deal of progress.
2. Considerable progress.
3. Moderate progress.
4. Some progress
5. Didn't get anywhere this session.
26.HOW WELL DOES YOUR PATIENT SEEM TO BE GETTING ALONG
AT THIS TIME?
1. Very well; seems in really good condition.
2. Quite well, no important complaints.
3. Fairly well; has ups and downs.
4. So-so; manages to keep going with some effort.
5. Fairly poorly; having a rough time.
27.HOW MUCH WERE YOU LOOKING FORWARD TO SEEING YOUR
PATIENT THIS SESSION?
1. I definitely anticipated a meaningful or pleasant
session.
2. I had some pleasant anticipation.


176
Solomon, A,, Loeffler, F. J., and Frank, G. H. An analysis
of co-therapist interaction in group psychotherapy.
International Journal, of Group Psychotherapy, 1954,
3_, 171-180.
Solomon, J. C., and Solomon, G. F. Group psychotherapy
with father and son as co-therapists. International
Journal of Group Psychotherapy, 1963 1^3, 133-140.
Sonne, J. C., and Lincoln, G. The importance of hetero
sexual co-therapy relationship in the construction of
a family image. Psychiatric Research Report, 1966, 20,
196-205.
Spitz, H. H., and Copp, S. R. Multiple psychotherapy. In
M. Rosenbaum and M. Berger (Eds.) Group psychotherapy
and group function. New York: Basic Books, 1963.
Staples, E. J. The influence of sex of the therapist and
of the co-therapist technique in group psychotherapy
with girls: An investigation of the effectiveness of
group psychotherapy with eighth-grade, behavior-
problem girls, comparing results achieved by a male
therapist, by a female therapist, and by two therapists
in combination. (Dissertation Abstracts, 1959, 19(2),
2154).
Swander, K. K. An analogue study of the effects of thera
pists' level of functioning on co-therapists' level of
functioning and activity level within a multiple therapy
situation. Unpublished masters thesis, University of
Florida, 1971.
Treppa, J. A. An investigation of some of the dynamics of
the interpersonal relationship between pairs of mul
tiple therapists. Doctoral dissertation. (Dissertation
Abstracts 1969 30_, 1909B) .
Treppa, J. A. Multiple therapy: Its growth and importance.
Am historical survey. American Journal of Psychotherapy,
1971, 25., 447-455. "
Truax, C. B., and Carkhuff, R. R. Toward effective coun-
seling and psychotherapy. Chicago: A1die Publishing
Co'. 19 6 7 .
Warkentin, J., Johnson, N. L., and Whitaker, C. A. A com
parison of individual and multiple psychotherapy.
Psychiatry, 1951, 14, 415-418.
Warkentin, J., and Taylor, J. E. Physical contact in mul
tiple therapy with a schizophrenic patient. Voices:
The Art and Science of Psychotherapy, 1968, 4., 53-60.


14
Burow, 1970, p. 238). Whitaker, Warkentin, and Johnson
(1950) presented a detailed analysis of the etiology of
impasses in individual therapy, underlining that they sig
nal a deterioration in the relationship between the thera
pist and the client. They state that the relationship has
lost its "emotional voltage" for both client and therapist;
that the therapist feels frustrated and his subsequent
interventions are not likely to lead to progress. Their
statements about introducing a second therapist to aid in
the dissolution of the impasse go beyond just the addition
of another viewpoint:
The presence of the consultant is also valuable be
cause he is also able to carry part of the responsi
bility for the patient, so that the therapist can
express what he had suppressed from fear of his own
immaturity [p. 644].
Besides fearing his own immaturity, the therapist may feel
that it would be difficult for the client to handle his
expressions without some support. Miller and Bloomberg
(1968) affirmed the Atlanta group's observations in their
own experiment in impasse-breaking. They felt that the
addition of a second therapist gave the first emotional
and physical support and allowed him to verbalize his anger,
fears, and sorrows to his psychotically violent patient.
As a result of the interaction advantages mentioned pre
viously, impasses do not occur as frequently when there are
two therapists present from the inception of treatment.
In addition, it has been noted that the client does not


143
Examples: The facilitator responds with accuracy to all
of the person's deeper as well as surface feel
ings. He is "together" with the second person
or "tuned in" on his wave length. The facili
tator and the other person might proceed
together to explore previously unexplored areas
of human existence.
In summary, the facilitator is responding with a full
awareness of who the other person is and a comprehensive
and accurate empathic understanding of his deepest feelings.
The Communication of Respect in Interpersonal Processes:
A Scale for Measurement
Level 1
The verbal and behavioral expressions of the first
person communicate a clear lack of respect (or negative
regard) for the second person(s).
Example: The first person communicates to the second per
son that the second person's feelings and experi
ences are not worthy of consideration or that the
second person is not capable of acting construc
tively. The first person may become the sole
focus of evaluation.
In summary, in many ways the first person communicates
a total lack of respect for the feelings, experiences, and
potentials of the second person.
Level 2
The first person responds to the second person in such
a way as to communicate little respect for the feelings,
experiences, and potentials of the second person.
Example: The first person may respond mechanically or
passively or ignore many of the feelings of the
second person.
In summary, in many ways the first person displays a
lack of respect or concern for the second person's feelings,
experiences, and potentials.
Level 3
The first person communicates a positive respect and con
cern for the second person's feelings, experiences, and
potentials.


121
These results substantiate the literature's claim that
good co-therapist rapport is crucial for clients. Possibly,
the previous results of the differences between multiple and
individual therapy were confounded by the fact that the
present sample of co-therapists included pairs of both high
and low agreement levels. The lack of consistent differences
between the conditions might be akin to the findings re
ported in Truax and Carkhuff (1967) for individual therapy in
general. On the average, clients get no better or worse
than controls; however, the clients of facilitative helpers
get better, while those of nonfacilitative counselors get
worse. On the average, then, no consistent differences
between multiple and individual therapy were found--whether
by the therapists' report of their own and their clients'
behavior or by judges' ratings of the therapists' behavior.
However, it is possible that multiple therapy relationships
with high agreement between the counselors would be shown to
foster better therapeutic interactions than individual therapy,
while those with low co-therapist agreement would produce
worse interactions than individual therapy.
An Area for Future Research
An area deserving of subsequent investigation has been
pinpointed by the immediately preceding discussion of the
effect of high and low co-therapist agreement on the thera
peutic interactions. Also considering the previous discussion
of the level of facilitative conditions, it would be


25
of co-therapy versus individual therapy. (A modified form
of his questionnaire is shown in Appendix C.) He found that
the therapists valued the "general therapeutic efficacy of
co-therapy," and felt that it led to more "positive thera
peutic movement . and working through, in general" [p. 249].
Mallars (1968) reported that her 24 student counselors,
their clients, and their supervisors were significantly
more satisfied with a counseling team approach than with a
standard method. These results are based on the partici
pants 1 responses to a counseling rating scale administered
after the first and the last counseling sessions.
Kamerschen (1969) in studying 23 heterosexual thera
pist pairs, found that self-disclosure and a personal-
impersonal dimension of co-therapist selection were signifi
cantly related to therapist satisfaction within the multiple
therapy relationship. Pair flexibility, congruence of
self-co-therapist flexibility, and attitudes toward the
opposite sex were not shown to be significantly related to
pair satisfaction. Kamerschen's co-researcher, Randolph
(1970), found self-disclosure to be positively related to
satisfaction and the physical expression of affection in
therapist pairs. The results also indicated that those
therapists who acted on their desire to verbally express
affection were more satisfied than those who did not, while
therapist pairs who expressed both verbal and physical
affection were more satisfied than those who used only one.


130
32. HOW HELPFUL DO YOU FEEL THAT YOU WERE TO YOUR PATIENT
THIS SESSION?
1. Completely helpful.
2. Very helpful.
3. Pretty helpful.
4. Somewhat helpful.
5 Slightly helpful.
SLIGHTLY
OR NOT PRETTY VERY
AT ALL
SOME
MUCH
MUCH
33.
DID YOU TALK?
0
1
2
3
34 .
WERE YOU ATTENTIVE TO
WHAT YOUR PATIENT WAS
TRYING TO GET ACROSS?
0
1
2
3
DURING THIS SESSION, HOW MUCH:
35.
WERE YOU CRITICAL OR
DISAPPROVING TOWARDS
YOUR PATIENT?
0
1
2
3
36 .
WERE YOU WARM AND FRIENDLY
TOWARDS YOUR PATIENT?
0
1
2
3
37.
DID YOU EXPRESS FEELING?
0
1
2
3
IF YOU WISH, GIVE A BRIEF FORMULA!ION OF THE SIGNIFICANT
EVENTS OR DYNAMICS OF THIS SESSION:
ADDITIONAL COMMENTS:


65
TABLE 11
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES
TO TSR ITEM 35 FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
.3333
. 5454
. 3333
.4166
(.4924)
(.6876)
( .4924)
(.5149)
Source
df
MS
F
Blocks
11
.6420
3.02**
Treatments
3
Condition (A)
1
.0207
o
11

Time (B)
1
.1875
. 88
A x B
1
.0209
.10
Residual
33
. 2127
Total
47
Note: The standard deviations are in parentheses.
**p < .01.
toward their clients than in individual therapy (Item 36).
This hypothesis was not supported, as the ratio for condi
tion was not significant; neither were the ratios for time
and the interaction of condition and time. Table 12 shows
that the ratio for blocks was appreciably greater than
zero, indicating the existence of individual differences
between the therapists on this item.
Hypothesis 12.The therapists will be apt in multiple
therapy to rate themselves as expressing more feeling than
in individual therapy (Item 37). This hypothesis was not


177
Weigel, R. G., and Straumfjord, A. A. The dog as a thera
peutic adjunct in group treatment. Voices: The Art
and Science of Psychotherapy, 1970, 6_ {2) 108-110.
Whitaker, C. A., Malone, T. P., and Warkentin, J. Multiple
therapy and psychotherapy. In F. Fromm-Reichmann and
J. L. Moreno (Eds.), Progress in psychotherapy. Vol. I,
New York: Grue and Stratton, 1956, pp. 210-216.
Whitaker, C. A., Warkentin, J., and Johnson, N. L.
A philosophical basis for brief psychotherapy.
Psychiatric Quarterly, 194 9 2_3, 439-443.
Whitaker, C. A., Warkentin, J., and Johnson, N. L. The
psychotherapeutic impasse. American Journal of Ortho-
psychiatry, 1950, 20, 641-647^


116
Love scale, suggesting that they were more self-involved in
the relationships than were the couples. They did, however,
decrease their scores on this scale over time, moving more
toward the means for successfully married couples. And, as
the therapists were lower than any of the couples on the
Deficiency Love scale, it was felt that they cared for the
other person less than the couples as far as what their
partner could do for them. Over time, the therapists became
more caring than the successfully married couples on the
scale of Empathy (M) and approximated these couples on the
scales of Being Love and Friendship. This was after having
begun their association at mean levels between divorced
and troubled couples for Empathy (M), and between troubled
and successfully married couples for the other two scales.
As far as Affection, the co-therapists were initially close
to divorced couples and improved their caring to slightly
over that of troubled couples. In general, then, the thera
pists would appear to create a happier, healthier familial
milieu at the conclusion than at the inception of their
counseling together.
Caring and client outcome.There were no significant
correlations between the posttest scores of the therapists
and the POI scores of the client with whom he was paired on
the scales of Time Competence or Inner-Directed. This
finding led to the refutation of the hypothesis regarding a
positive relation between the caring of the therapists and
outcome of the clients (Hypothesis 34).


41
The judges were instructed to rate all four of the therapist
scales in the same order--Empathy, Respect, Genuineness,
and Concretenessand then the client scale. The ratings
on all of the scales for any given segment were executed
simultaneously.
Two intern-level counselors who were themselves high-
functioning (averaging above 3.0 on all scales) and had
attained an interjudge reliability of above .80 in previous
research (Swander, 1971) were used as raters. Pearson
product-moment correlations were computed over the indepen
dent ratings of the two judges for 15 randomly selected
segments of the 144 segments of the present study. There
were 7 segments that were selected from the multiple con
dition, and the ratings of both therapists were used in the
calculation of the correlations; the coefficients thus
reflect the agreement of the judges over 22 ratings. The
Pearson product-moment correlations were .89 for Empathy,
.91 for Respect, .93 for Genuineness, and .93 for Concrete
ness .
For each relevant session, the scoring scheme for any
one of the scales called for three ratings (first, middle,
and last segments) by two judges. The score of each thera
pist for a session was to be an average of these six ratings.
Unexpectedly, however, there were several segments in the
multiple condition in which the female therapist did not
talk at all, and thus she was not rated. The specific


138
Multiple
therapy
Individual
therapy
&
(1)
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>i o
A
0

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11 p
rH P
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P 0
CD 0
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£
+> £
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r! £
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tn
P
CP
id
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-H
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19 Working out and
through problems
of hostility and
assertiveness.
20. Opportunity for
patients of both
sexes to identify
with a reasonably
healthy person of
the same sex.
21. Understanding of
resistance.
22. More complex
patterns of resis
tance .
23. Eliciting of oedipal
dynamics.
24. Your general prefer
ence .
25. Your general prefer
ence with a patient
who is very mistrust
ful of authority,
especially of one
sex.
26. Your general prefer
ence with a patient
who is especially
fearful of hetero
sexual relations.


80
raise their offered level of genuineness in the individual
condition over the course of therapy, while the level in
the multiple condition remained static. Hypothesis 22 was
not supported when the results indicated the only signifi
cant difference between the conditions to be that of
individual being higher than multiple during the terminal
session.
TABLE 19
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST
GENUINENESS SCORES FOR MULTIPLE AND
INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
2.693
2.658
2.683
2.993
(.400)
( .460)
(.534)
(.417)
Source
df
MS
F
Blocks
11
.375
2.47*
Treatments
3
Condition (A)
1
. 327
1.27
Time (B)
1
.219
1.58
A x B
1
.348
6.00*
Residual
33
.152
^A x blocks
11
.258
MSB x blocks
11
.139
^AB x blocks
11
.058
Total
47
Note: The
standard
deviations are in
parentheses.
*p < .05.


Mullan and Sanguiliano (1960) state that experience
in multiple therapy can lead to greater maturity in the
counselors and increase their enthusiasm for doing therapy.
They, along with others, have thought that its use results
in better working relations among staff members of a thera
peutic center (Dyrud and Rioch, 1953; Malone and Whitaker,
1965). It does seem apparent that this provides a good
opportunity for staff members to grow more together, as
they share directly in their main pursuitthe helping of
other persons. Mintz (1963a) commented that co-therapy is
also a way of alleviating the isolation associated with
private practice. The growth-enhancing characteristic of
multiple therapy is, in the opinion of Randolph (1970),
largely responsible for the recent increased use of it.
Better Therapeutic Interactions
In addition to the two aforementioned advantages which
were related to therapist training and growth, there has
been extensive discussion of how the multiple setting pro
vides for more effective and comfortable therapeutic inter
actions than does individual therapy.
Sharing of responsibility.--One of the most essential
of the interaction advantages is the sharing of responsi
bility. Having a partner in the therapy situation tends to
lessen the therapist's "effort syndrome," his attempt to
effect a positive therapeutic outcome (Warkentin, Johnson',
and Whitaker, 1951). Kell and Burow (1970) report that


127
WHAT DID YOUR PATIENT SEEM TO BE CONCERNED ABOUT THIS
SESSION? (For each item, circle the answer which best
applies.)
THIS SESSION MY PATIENT WAS CONCERNED
ABOUT:
NO
SOME
A LOT
10.
BEING DEPENDENT ON OTHERS.
0
1
2
11.
BEING LONELY OR ISOLATED.
0
1
2
12 .
SEXUAL FEELINGS AND EXPERIENCES.
0
1
2
13.
EXPRESSING HER (HIS) SELF TO
OTHERS.
0
1
2
SLIGHTLY
OR NOT
DURING THIS SESSION, HOW AT ALL
MUCH:
SOME
PRETTY
MUCH
VERY
MUCH
14.
DID YOUR PATIENT TALK?
0
1
2
3
15.
WAS YOUR PATIENT ABLE TO
FOCUS ON WHAT WAS OF PRES
ENT CONCERN TO HIM (HER)?
0
1
2
3
16.
DID YOUR PATIENT TAKE INI
TIATIVE IN BRINGING UP THE
SUBJECTS THAT WERE TALKED
ABOUT?
0
1
2
3
17.
WERE YOUR PATIENTS FEELINGS
STIRRED UP?
0
1
2
3
18.
DID YOUR PATIENT TALK ABOUT
WHAT SHE (HE) WAS FEELING?
0
1
2
3
DURING THIS SESSION HOW MUCH:
19 .
WAS YOUR PATIENT WARM AND
FRIENDLY TOWARDS YOU?
0
1
2
3
20.
WAS YOUR PATIENT ATTENTIVE
TO WHAT YOU WERE TRYING TO
GET ACROSS?
0
1
2
3


118
On one of the two major scales of the POI, Time
Competence, the counselors were shown to increase their
scores significantly from before their experience in co
therapy to after their exposure (Hypothesis 30). The
difference between the pre and post scores of the coun
selors on the scale of Inner-Directed reached significance
at the .10 level, alluding to a tendency for the therapists
to become more inner-directed. As the difference was not
conclusively large, Hypothesis 31 was rejected.
The counselors were not shown to increase their capacity
for intimate contact (Hypothesis 32), as might have been
predicted by Kell and Burow (1970) Mullan and Sanguiliano
(1960) stated that multiple therapy enables counselors to
be mor spontaneous. The therapists in the present study,
however, did not significantly increase their scores on the
scale of Spontaneity (Hypothesis 33).
MTRS Reliability and Validity
The two parts of the MTRS, developed by the present
author and her co-researcher (Reiner), were both shown to
have significant test-retest reliabilities. The patterns
as far as concurrent and predictive validity for co-therapist
agreement and relationship quality were dissimilar.
Relationship quality.--The ratings of each therapist
of the quality of his co-therapy relationship during his
initial session with one client were positively related to


APPENDIX H
NUMERICAL RAW DATA AND SUMMARIES
TABLE 31
WILCOXON MATCHED-PAIRS SIGNED-RANKS TEST BETWEEN THE NUMBER
OF SESSIONS EACH THERAPIST HAD WITH A CLIENT IN
THE MULTIPLE AND THE INDIVIDUAL CONDITION
Multiple
Individual
d
Rank
of d
Rank with
less fre
quent sign
Therapist-
client
pair
No. of
sessions
Therapist
client
pair
No. of
sessions
A-10
6
A- 7
5
-1
-1.5
B-8
6
B-12
22
16
8
8
C-16
9
C-17
5
-4
-4
D-14
5
D-29
5
0
E-25
9
E-39
10
1.5
1.5
1.5
F-20
7
F-22
15
8
7
7
G-37
4
G-23
4
0
H-2 6
4
H-21
4
0
1-33
12
1-38
5
-7
-6
J-31
15
J-30
9
-6
-5
K-35
7
K-34
7
0
L-36
6
L-4 0
4
-2
-3
T = 16.5
Note:
The value needed
for significance
at the
.05 level
is T = 11.
157


57
terminal interview. The therapists, then, felt that their
clients wanted to express and explore feelings more during
the first session than they did during the last.
TABLE 3
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS PRE AND POST
RESPONSES TO TSR ITEMS 1-5 FOR MULTIPLE AND
INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
3.2500
3.2500
3.2500
3.0833
(.8660)
(1.1382)
(.9653)
(1.2401)
Source
df
MS
F
Blocks
11
1.9469
2.27*
Treatments
3
Condition (A)
1
.0833
.10
Time (B)
1
. 0833
.10
A x B
1
.0834
.10
Residual
33
.8560
Total
47
Note: The
*p < .05.
standard
deviations are in
parentheses.
Hypothesis
4.--Compared to individual
therapy, the
therapists will
rate the
clients in multiple therapy as
having had their feelings
more stirred up
(Item 17). This
hypothesis was
rejected,
as the F ratio for condition was
not significant. A perusal of the data to detect a possible


DISCUSSION
Comparison of the Conditions
In comparing individual and multiple therapy, the
present study investigated three major areas. The first
aspect was the therapists' report of their clients' and their
own behavior in both conditions. The second involved the
therapists' attitudes about the two treatment forms in the
abstract; the third, the judges' ratings of the therapists'
behavior in both conditions as far as facilitative core
dimensions. Regarding the hypothesized differences between
the psychotherapeutic interactions in multiple and individual
therapy, the results disconfirmed the existence of any actual
advantages of multiple over individual therapy--whether by
the therapists' own report or that of the judges. In fact,
there was some evidence to the contrary--that individual
therapy was more likely to contain ingredients thought to
be helpful in counseling. The data did support the claim
that the therapists would express a more positive attitude
toward multiple therapy and would believe it to be more
advantageous than individual therapy.
Therapists' Report of Interactions
The findings regarding the interactions in multiple
and individual therapy pertain, of course, to the results
99


155
23. Did the client react differently to the male thera
pist than to the female therapist?
a. Yes
b. No
Judges' Directions for Rating the MTRS
A. Please rate which of the following items are, in your
opinion, relevant to the formation of a good or poor
co-therapist relationship by placing an "R" in the
margin next to the item number. Please go through all
22 items consecutively.
B. Then for each choice of the items please place:
1. a plus (+) by the responses that would lead to a
good relationship.
2. a minus (-) by the responses that would lead to a
poor relationship, and
3. a zero (0) by the responses that you consider to
make no difference to the therapeutic relationship.
TABLE 30
RESPONSE PATTERNS OF THE FOUR JUDGES FOR THE MTRS ITEMS
CONSIDERED TO BE RELEVANT TO THE
CO-THERAPIST RELATIONSHIP
Item or
choice
number
Judge
Scoring
direction
used
Item or
choice
number
Judge
Scoring
direction
used
A
B
C
D
A
B
C
D
1.
R
R
R
R
4.
R
R
R
R
a.
-
0
0
+
a.
4*
+
+
+
+
b.
-
0
0
+
b.
+
+
+
+
+
c.
+
+
+
+
c.
-
-
-
-
-
d.
-
0
0
-
zero
2.
R
e.
-
-
-
-
-
a.
-
b.
-
5.
R
R
R
R
c.
+
-
a.
+
+
+
+
+
b.
+
+
+
+
+
3.
R
R
R
R
c.
+
-
0
+
zero
a.
+
+
+
+
+
d.
-
-
-
-
-
b.
-
-
-
-
-
e.
-
-
-
-
-
c.
+
+
+
+
d.
-
-
-
-
-


122
interesting to replicate some aspects of the present study-
using only pairs of therapists high on both co-therapist
agreement and the core facilitative dimensions. Add to
this the condition that the clients to be seen multiply are
ones for whom this approach is thought to be especially
appropriate. This situation would appear to represent
multiple therapy in a more ideal form than may have been
existent in the current project. It might still be the case
that the resulting multiple therapy would be shown to be no
better than, or inferior to, individual therapy conducted
by the same therapists on similar types of clients. If this
occurred, the bountiful and varied testimonials of the
superiority of multiple therapy as compared to individual
therapy would have to be reconsidered. If the data leaned
the other way, with co-therapy being evaluated as producing
better therapeutic interactions, then the results of the
current investigation could be viewed as representing the
effects of multiple therapy at a nonoptimal or atypical
level.


TABLE 33
RAW SCORES USED TO DETERMINE THERAPIST-CLIENT AGREEMENT ON THE TSR
FOR THE MULTIPLE CONDITION, PP.E- AND POSTTESTINGS
Ther;
pist
item
3
TSR
Therapist-
-client
pair
no. A-
-10
B-
8
C-
-16
D-
14
£-
-25
F-
20
A
5-4
3-2
4-3
4-3
4-5
5-3
3-4
4-4
4-4
3-2
4-2
5-5
1
2-2
1-2
1-0
1-0
2-0
0-0
1-0
0-0
1-1
1-1
0-2
0-0
2
2-2
1-2
2-1
1-0
2-1
2-2
2-1
2-2
1-1
2-2.
2-2
2-2
4
1-1
0-1
1-1
2-2
0-0
1-0
1-2
1-2
1-2
0-2
0-0
0-0
9
2-2
0-2
1-0
1-2
1-0
1-1
1-2
1-2
1-2
1-2
2-2
1-1
10
1-2
2-2
1-1
1-1
2-1
1-2
2-2
1-0
2-2
2-1
1-2
0-0
11
2-1
1-1
2-1
1-1
2-1
2-1
1-0
1-1
2-2
1-0
1-1
0-1
12
0-0
0-0
0-1
0-0
2-2
2-2
0-0
2-2
0-0
0-0
1-2
0-0
13
2-2
1-2
1-0
1-2
1-1
1-1
1-0
2-2
1-0
2-0
2-2
1-2
14
2-3
2-3
3-3
2-3
3-2
2-3
3-3
3-3
2-3
3-3
3-3
2-2
15
2-2
2-2
2-2
1-1
3-2
1-2
2-2
2-3
2-2
2-3
2-2
1-2
16
2-2
1-2
2-3
1-1
3-1
1-2
1-2
2-0
2-2
2-3
2-2
1-2
17
1-1
1-2
1-1
1-2
2-2
2-3
2-2
1-2
2-3
2-1
1-2
1-1
18
0-2
1-2
1-2
1-2
1-2
2-2
1-2
2-1
2-3
3-2
1-2
1-2
23
0-2
2-2
2-2
2-2
0-1
0-2
2-2
1-2
1-1
2-2
1-1
2-1
24
2-2
2-1
5-4
3-3
2-4
4-3
2-3
2-3
2-2
1-2
2-2
3-5
25
4-4
2-2
4-4
3-3
3-3
4-1
3-4
3-3
4-4
2-2
4-1
4-5
26
5-3
2-2
5-3
3-4
3-3
3-3
3-3
3-3
4-5
3-2
4-4
2-3
32
5-3
3-1
4-5
3-3
3-4
5-1
4-4
4-3
4-5
2-2
3-1
4-5
33
1-1
2-2
2-2
2-1
2-2
1-2
2-0
2-1
1-1
1-2
1-1
1-1
34
3-3
2-3
2-2
3-2
3-2
1-3
3-2
3-2
2-2
3-3
3-3
3-3
35
0-0
0-1
0-0
0-1
0-1
2-1
0-1
0-0
1-1
0-1
0-1
1-1
36
3-2
3-3
2-3
2-1
2-2
2-2
3-3
2-2
2-2
3-3
2-2
2-2
37
1-2
3-2
2-2
2-1
2-2
2-3
2-1
1-2
2-1
2-2
1-1
1-1
Note:
The
first score
under
each
therapist-client
pair
indicates
their respective pretest scores on the item in question; the second score
their respective posttest scores. In all cases, the score of the thera
pist is given first, followed by a hyphen and the client's score.


70
thus designate statements that the therapists felt were
definitely more applicable to multiple therapy than to
individual therapy. There were three means that were above
4.00, and all of these items were negative ones; that is,
"years of experience necessary to do effective therapy,"
"difficulties by the therapist in 'handling' intense
transference reactions," and "emotional demands experienced
by the therapist." The following hypotheses (14-18) were
not tested per se, but were considered to be confirmed if
the mean and the modal score were 3.0 or less. As statis
tical tests were not performed, the conclusions are con
sidered to be suggestive.
Hypothesis 14."The therapists will rate multiple
therapy over individual therapy as being conducive to self
understanding of the therapist (Item 6). This hypothesis
was supported as the mean score of 2.667 and the mode of 2
indicated that the therapists felt that multiple therapy was
slightly to moderately more conducive to self-understanding
than was individual therapy.
Hypothesis 15.The therapists will rate multiple
therapy over individual therapy as being useful in training
therapists (Item 10). The results substantiate this hy
pothesis, as the therapists rated multiple therapy as being
moderately to much more useful in training therapists. The
mean and mode scores on this item were 2.083 and 1, respec
tively.


132
Items
A. HOW DO YOU FEEL ABOUT THE SESSION WHICH YOU HAVE JUST
COMPLETED? (Circle the one answer which best applies.)
(A)
THIS SESSION WAS:
i.
Perfect.
ii.
Excellent.
iii.
Very good.
iv.
Pretty good.
V.
Fair.
vi.
Pretty poor.
vii.
Very poor.
WHAT SUBJECTS DID YOU TALK ABOUT DURING THIS SESSION?
(For each subject, circle the answer which best applies.)
DURING THIS SESSION I TALKED ABOUT:
1. RELATIONS WITH OTHERS OF THE SAME SEX.
(1)
2. RELATIONS WITH THE OPPOSITE SEX. (2)
3. STRANGE OR UNUSUAL IDEAS AND EXPERI
ENCES. (4)
4. ATTITUDES OR FEELINGS TOWARD MY
THERAPIST.
NO SOME A LOT
0 12
0 12
0 12
0 12
Be sure that you have checked every item.
WHAT DID YOU WANT OR HOPE TO GET OUT OF THIS
SESSION? (For each item, circle the answer
which best applies.)
THIS SESSION I HOPED OR WANTED TO:
5. GET SOME REASSURANCE ABOUT HOW I'M 0
DOING.
6. GET CONFIDENCE TO TRY NEW THINGS, 0
TO BE A DIFFERENT KIND OF PERSON.
7. FIND OUT WHAT MY FEELINGS REALLY
ARE, AND WHAT I REALLY WANT. (9)
1 2
1 2
0
1
2


4ETH0D
Subjects
Counselors
The aforementioned prerequisites and criteria for
matching were taken into consideration in selecting the
therapists. All of the therapistscounselors at the
University of Florida Counseling Centerwere of the
"eclectic" variety and thought to be fairly flexible in
orientation. The pairing of six male and six female thera
pists for the multiple condition was made by joint agreement
of the members of each team and the two researchers. When
.a therapist had agreed to participate in the study, he (or
she) was then asked if he thought he would work well with
the other counselor whom the researchers, in conjunction
with the center's director, had determined would be an appro
priate partner. Each therapist had to reply affirmatively
for the pair to be formed. There were three experienced
pairs, with from three to five years' therapy experience,
and three intern-level teams, averaging six months to one
year of counseling work.
Clients
The 24 clients were unmarried female students at the
University of Florida between the ages of 18 and 23; all
29



PAGE 1

PSYCHOTHERAPEUTIC INTERACTIONS IN MULTIPLE AND INDIVIDUAL THERAPY By SHARON JENNETTE KOSCH-GRAHAM A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 1972

PAGE 2

Copyright by Sharon Jennette Kosch-Graham 1972

PAGE 3

In Memoriam: Atman (P. Atman, Hiccipus, Liccipus Puppy-do-dog) One of the finest friends I have known.

PAGE 4

ACKNOWLEDGMENTS My warmest thanks and appreciation go to Dr. Harry Grater, who chaired my dissertation committee. He was always abundantly supportive and almost totally nondirective, leaving me xvith the feeling that the project was truly my own. He did a lot to decrease my ever-ready anxiety barometer when it would start to rise. I especially wish to thank Dr. Hugh Davis for his contributions; being my most verbal critic, he definitely helped me to formulate more precise statements about the research. And the liking and respect that he communicated for me as a psychologist were greatly appreciated. I am grateful to Dr. Vernon Van De Reit for his support and understanding during my time of "dissertation distress." I am also thankful for his willingness to read the manuscript when he had a million things to do. I am eternally indebted to Dr. Madelaine Ramey for her highly skilled aid with the statistics involved in this study; I feel that she is truly a wizard in this field, and I would not have had a polished dissertation without her assistance. I am greatly appreciative of the amount of her own time that she devoted to helping me, and for her genuine interest in the project. IV

PAGE 5

I extend many thanks to Dr. James Millikan for joining my committee at such a late stage (when I really needed him!) and for being a good "sounding board" while I was writing the manuscript. I want to express my sincere gratitude to the twelve therapists who participated in the study: Jaguie and Mike, Cindy and Bill. Karen and Jim, Pat and John, and Judy and Linwood. I thank each of you for your patience in filling out those seemingly endless forms and for taping the sessions. I also thank all of the twenty-four clients who agreed to let their counseling involvement be studied. I heartily thank four of the Counseling Center secretaries: Adrienne, Edith, Harriet, and Muriel. Each of them helped by typing, administering, or scoring test forms, as well as caring about me and the project. I am grateful also to the editorial skills of Sue Kirkpatrick, who typed the final manuscript. And, of those not mentioned, I would like to thank Lauren, Roger, and Gary for serving as judges for two of the scales. I would also like to express my gratitude to Drs. David Orlinsky and Kenneth Howard for their permission to use items from the Therapy Session Report. I am especially thankful that my co-researcher, Chuck, was willing to share the ordeals of research with me. Personally, I am grateful to my two therapists, Pat and Paul, and to many friends, for helping me preserve enough of my sanity to write this dissertation. V

PAGE 6

And finally, I am very grateful to my husband, Richard, for his kind understanding and help during the time that I was v/orking on this project. VI

PAGE 7

PREFACE The report contained in this dissertation, concerned with multiple and individual therapy from the therapist's perspective, was part of a joint research project conducted with Charles A. Reiner. His dissertation, to be completed in 1973, will focus on multiple and individual therapy from the client's viewpoint. VI 1

PAGE 8

TABLE OF CONTENTS Page ACKNOWLEDGMENTS iv PREFACE vii LIST OF TABLES x ABSTRACT xiii INTRODUCTION 1 Advantages for Therapists 3 Training 3 Growth 6 Better Therapeutic Interactions .... 7 The Multiple Therapy Relationship 15 Characteristics of a Good Relationship ..... 15 Prerequisites and Matching 16 Relationship Problems and Solutions 19 Research 24 METHOD 29 Subjects 29 Counselors 29 Clients 29 Design 30 Conditions and Groups 30 Comparisons 32 Procedure 33 Counselors 33 Clients 34 Instruments 35 Therapy Session Report ..... 35 Comparative Therapy Scale 37 The Carkhuff Process Scales 39 Caring Relationship Inventory 42 Vlll

PAGE 9

Page Personal Orientation Inventory 4 3 Multiple Therapy Rating Scale ......... 44 Myers-Briggs Type Indicator 4 8 Hypotheses -. 49 Multiple Versus Individual Therapy 50 The Multiple Condition 51 RESULTS 54 Comparison of Multiple and Individual Conditions 54 Number of Sessions 54 TSR Data 55 CTS Data 69 Carkhuff Process Scales Data .... 75 The Multiple Condition 83 CRI Data 8 3 POI Data 87 The Multiple Relationship and Client Outcome 89 DISCUSSION ....... 99 Comparison of the Conditions 99 Therapists' Report of Interactions 99 Therapist Attitudes About the Two Conditions 104 Judges' Ratings of Therapist Behavior 105 Comments on the Comparison of the Conditions 108 The Phenom.enon of Multiple Therapy 113 The Caring of the Therapist Pairs 113 Growth 117 MTRS Reliability and Validity 118 An Area for Future Research 121 APPENDICES 123 A. Therapists' Research Instruction Sheet 124 B. Therapy Session Report 125 C. Comparative Therapy Scale 137 D. Carkhuff Scales 141 E. The Scales of the Caring Relationship Inventory 149 F. Four Scales of the Personal Orientation Inventory 150 G. The Multiple Therapy Rating Scale 151 H. Numerical Raw Data and Summaries 157 REFERENCES 171 BIOGRAPHICAL SKETCH 178 ix

PAGE 10

LIST OF TABLES Table 1. 3. 5. 6. 8. 9. Percentages of Agreement Among Four Judges Regarding the Multiple Therapy Rating Scale Means, Standard Deviations, and the Analysis of Variance Summary Table for the Therapists Pre and Post Responses to TSR Items 1 and 2 for Multiple and Individual Conditions Means, Standard Deviations, and the Analysis of Variance Summary Table for the Therapists Pre and Post Responses to TSR Items 1-5 for Multiple and Individual Conditions .... Means, Standard Deviations, and the Analysis of Variance Summary Table for the Therapists Pre and Post Responses to TSR Items 6 and 9 for Multiple and Individual Conditions Means, Standard Deviations, and the Analysis of Variance Summary Table for the Therapists Pre and Post Responses to TSR Item 17 for Multiple and Individual Conditions .... Means Standard Deviations and the Analysis of Variance Summary Table for the Therapists Pre and Post Responses to TSR Item 21 for Multiple and Individual Conditions .... Means, Standard Deviations, and the Analysis of Variance Summary Table for the Therapists Pre and Post Responses to TSR Item 25 for Multiple and Individual Conditions .... Means, Standard Deviations, and the Analysis of Variance Summary Table for the Therapists Pre and Post Responses to TSR Item 29 for Multiple and Individual Conditions .... Means, Standard Deviations, and the Analysis of Variance Summary Table for the Therapists Pre and Post Responses to TSR Item 31 for Multiple and Individual Conditions .... Page 46 56 57 58 59 60 61 62 63 ...^ .-4*y^-rt.i

PAGE 11

Table Page 10. Means, Standard Deviations, and the Analysis of Variance Summary Table for the Therapists' Pre and Post Responses to TSR Item 32 for Multiple and Individual Conditions 63 11. Means, Standard Deviations, and the Analysis of Variance Summary Table for the Therapists' Pre and Post Responses to TSR Item 35 for Multiple and Individual Conditions 65 12. Means, Standard Deviations, and the Analysis of Variance Summary Table for the Therapists Pre and Post Responses to TSR Item 36 for Multiple and Individual Conditions 66 13. Means, Standard Deviations, and the Analysis of Variance Summary Table for the Therapists' Pre and Post Responses to TSR Item 37 for Multiple and Individual Conditions 67 14. Therapist-Client Agreement Scores for Multiple \ and Individual Conditions: Correlations BeI tween Their Responses to 24 TSR Items .... 68 [ r 15. Means, Modes, and Ranks of the Therapists' Response Pattern on the 32-Item Comparative Therapy Scale 71 16. Wilcoxon Matched-Pairs SignedRanks Test for Testing Differences in Therapists Attitudes About Multiple and Individual Therapy .... 74 17 Means, Standard Deviations, and the Analysis of Variance Summary Table for the Therapists' Pre and Post Empathy Scores for Multiple and Individual Conditions 77 18. Means, Standard Deviations, and the Analysis of Variance Summary Table for the Therapists' Pre and Post Respect Scores for Multiple and Individual Conditions 78 19 Means Standard Deviations and the Analysis of Variance Summary Table for the Therapists Pre and Post Genuineness Scores for Multiple and Individual Conditions 80 XX n— -"i,'f>ii-'fi^f s*-^ *-i-

PAGE 12

Table Page 20. Means, Standard Deviations, and the Analysis of Variance Summary Table for the Therapists' Pre and Post Concreteness Scores for Multiple and Individual Conditions 82 21. Preand Posttest Means and Standard Deviations of the Therapists' CRI Scale Scores 84 22. Means and Standard Deviations of Shostrom's Sample of Successfiilly Married, Troubled, and Divorced Couples on the CRI Scales 87 23. Means and Standard Deviations of the Therapists' Pre and Post POI Scores 88 24. Rank Orders of Each Therapist's Relationship Quality Scores for Both Multiply Seen Cases 92 25. Rank Orders of the Agreement Scores of Each Therapist's Responses on the TSR and His Partner's Corresponding MTRS Responses for Both Multiply Seen Cases 9 3 26. Rank Orders of the Therapists' Scores on Four CRI Scales 94 27. Test-Retest Reliabilities of Relationship Quality and Co-therapist Agreement from the MTRS 95 28. Spearman Rank-Order Correlations Between Relationship Quality and Co-therapist Agreement and Between These Scales and Scales of the CRI 95 29. Rank Orders of the Total Composite Co-therapist Agreement and Relationship Quality Scores from the MTRS and Their Client's Post S-A Scale and POI Scales Time-Competence (Tc) and InnerDirected (I) 97 XI 1

PAGE 13

Abstract of Dissertation Presented to the Graduate Council of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy PSYCHOTHERAPEUTIC INTERACTIONS IN MULTIPLE AND INDIVIDUAL THEPJVPY By Sharon Jennette Kosch-Graham December, 1972 Chairman: Harry A. Grater, Jr. Major Department: Psychology This study investigated the psychotherapeutic interactions of therapists in multiple and individual therapy. One aim was to illuminate any significant differences between the two conditions as far as (a) the therapists' report of their own and their clients' behavior, (b) the therapists' general attitudes about the tv/o treatment modalities, and (c) judges' evaluations of the therapists' level of functioning on core facilitative dimensions. The second goal was to probe various aspects of multiple therapy itself in regard to the relationships of the co-therapist pairs: (a) their level of caring for their partners, (b) their ratings of the quality of their relationships, (c) their agreement as to their perceptions and behavior during the sessions, and (d) the relation of the foregoing aspects to client outcome. Three intern-level and three staff-level heterosexual therapist pairs were formed from counselors at the University Xlll

PAGE 14

of Florida Counseling Center; they conducted therapy v/ith 24 unmarried female students who were randomly assigned to conditions. Each co-therapist pair saw tv/o clients multiply and each therapist saw one client individually, yielding a total of 12 multiple and 12 individual cases. Each therapist provided his own matched control for purposes of comparing the two conditions The results of the therapists' responses to a Comparative Therapy Scale (modified from Rabin) generally confirmed the prediction that the therapists would have more favorable attitudes about multiple than individual therapy. When the therapists rated their clients' and their own behavior after completing their first and their last multiple and individual sessions, however, the expected differences in favor of multiple therapy were not apparent. The only significant difference between the conditions derived from the therapists' responses to selected Therapy Session Report items (from Orlinsky and Howard) was that clients tended to agree with the therapists' comments more in individual than in multiple therapy. Two highly trained judges rated the therapists' levels of the core facilitative dimensions of empathy, respect, genuineness, and concreteness (from Carkhuff) during the initial and terminal sessions of both conditions. On all dimensions, the therapists offered equivalent facilitative levels in both conditions during the first session. At therapy's end, however, they offered XIV

PAGE 15

significantly higher levels in the individual condition than they had in that condition during the pretesting or than they did in the multiple condition during the final session. Regarding the multiple condition itself, the therapist pairs v/ere shown to become more caring for each other over the course of therapy on Shostrom's Caring Relationship Inventory (CRI) The therapists made gains in selfactualization on one Personal Orientation Inventory scale; three others shovzed no gains. A Multiple Therapy Rating Scale, designed to tap two major areas of the cotherapist relationship (co-therapist agreement and relationship quality) was devised by the author and a co-researcher (Reiner) The scale's two parts x7ere shown to have significant test-retest reliabilities. Some evidence of concurrent and predictive validity was obtained for co-therapist agreement as it was positively correlated with some CRI scales and with client level of self-actualization. Neither of these types of validity was demonstrated for relationship quality. The results were interpreted as supporting the literature's claim that therapists have better attitudes tov/ard multiple than individual therapy, but as not substantiating the assumption that the actual psychotherapeutic interactions are better. Some beliefs regarding co-therapy were confirmed; the co-therapists : became closer, evinced growth, and one aspect of their rapport was related to client outcome. Because of some characteristics of the counselors and XV

PAGE 16

their co-therapy rel.a.tionships the applicability of the results for multiple therapy in general was qualified and an area for future research suggested. XVI

PAGE 17

INTRODUCTION The focus of this report is a therapeutic phenomenon wherein two or more helping persons simultaneously engage in psychotherapy with individual persons, families, or groups. The presence of multiple therapists has been said to have a markedly different effect on the counseling interactions than does one therapist. The differences between multiple and individual therapy have been one major area of concentration for all who have used and written about multiple therapy. The other predominant theme in the literature has to do with the characteristics of the phenomenon itself, including its different versions styled by therapists with diverse goals and emphases. Various titles have been given to this counseling approach, with very little agreement among the authors as to exactly what the differences and similarities between them are. Those less often used include: cooperative team approach (Lott, 1957) dual leadership (Linden, 1954) joint interview (Reeve, 1939) role-divided therapy (listed by Randolph, 1970) team counseling (Mallars, 1968), and three-cornered therapy (Bock, Lewis, and Tuck, 1954). In regard to the present research, the "use of two therapists with one client is what we mean by multiple therapy" (Haigh

PAGE 18

and Kell, 1950,p, 659). The name multiple therapy is also preferred by the present author to emphasize the distinguishing characteristic of this term, that of "the use of two therapists vvho are involved intimately, affectively, and spontaneously V7ith each other and their patient (s)" (Treppa, 1971, p. 452). Co~therapy (Lundin and Aronov, 1952) is probably the most frequently encountered term in the literature, and in many instances is used as synonymous with multiple therapy. Some critical differentiating features between these two have been drawn, however, and are primarily concerned with using contrived roles in cotherapy versus the emphasis on the therapist as a person in multiple therapy (Mullan and Sanguiliano, 1960) Not denying that these differences are important, the terms multiple therapists and co-therapists will be used interchangeably here, as most authors have not separated them so distinctly. Treppa 's definition of multiple therapy is, in a sense, an ideal to work toward. It is doubtful that most of the articles on the interactions between therapists are based on relationships with that high a level of involvement. So, although the present author concurs that the dissimilar qualities implied by the various titles are ge2rmane to a discussion of the new method itself, when comparing this technique to a standard approach these differences will oftentimes be ignored. There have been instances of using considerably more than two therapists as many as nine or ten with one client

PAGE 19

(Hayward, Peters, and Taylor, 1952; Warkentin, Johnson, and Whitaker, 19 51) So far, there has not been any reported advantage or disadvantage of utilizing such a glut of expertise over that of two therapists, although it would seem that this might create a rather unwieldy situation. Again, even though some of the literature considered does not conform to the definition employed here, any relevant findings f are reported. And, notwithstanding that the current study specifically involves this approach in use with individual clients, its application in conjoint and group therapies i is also included in the discussion. I I Granting that many possible advantages for clients [, have also been propounded, the practice of multiple therapy was initially employed by many for the benefit of the therapists. The present discussion will center on multiple therapy from the therapists' perspective; the interested reader may refer to other sources that expatiate upon this method in regard to its recipients (Dreikurs, Schulman, and Mosak, 1952b; Hill and Strahl, 1968; Kell and Burow, 1970; Mintz, 1963a; Treppa, 1971). Advantages for Therapists Training The purported advantages of multiple therapy for the therapists, derived from counselors' personal experiences and subsequent theorizing, are numerous. The potential use of the multiple setting for training purposes was the

PAGE 20

first to receive recognition. It is easy to see why many practitioners felt that this method offered an ideal situation in which to prepare nev/ helping persons. It provides an apprenticeship atmosphere where a trainee can observe actual therapy and learn the techniques and styles of an accomplished therapist. This assuredly seems to be a marked improvement over textbook or classroom presentations of how one conducts a psychotherapeutic interview. The earliest reported use of two persons in a therapy setting is cited as being at the Vienna Child Guidance Clinic by Alfred Adler and his associates (Dreikurs, 1950; Spitz and Kopp, 19 6 3) Usually the persons involved were a psychiatrist and a social worker or a teacher, an imbalanced therapeutic team which may have set the stage for later pairings of a sim.ilar nature. A psychiatrist and a social worker were used by Reeve (1939) in his "joint interview" technique which he felt could offer a beneficial training experience for psychiatric social workers. As a step toward avoiding the prevalent maltreatment of psychoneurotics by physicians, advanced medical students attended group therapy sessions led by a psychiatrist. Hadden (1947) reported that this procedure was of great positive significance in the medical students' preparation. The use of the multiple approach for discovering how to teach psychotherapy was an essential concern in the first few years of experimentation by Whitaker, Warkentin, and Johnson (1949) At the inception of their use of this

PAGE 21

method, one of the therapists merely observed; they later modified this so that both actively participated, resulting in greater gratification for all concerned. Dreikurs (1950) emphasized the involvement of both therapists in a joint interview, although only one therapist saw the patient continuously and carried the major responsibility. Dreikurs felt that this approach had great training potential for teams consisting of either a senior and a junior therapist or two experienced colleagues. Haigh and Kell (1950) stated that the meaningfulness of the multiple experience for a student was directly related to his degree of involvement in the treatment process. They cited the advantages that the actual practice of therapy can be introduced earlier in a students' schooling, and that the experience should be less threatening than seeing a client alone, due to the support that the senior therapist can offer. Dreikurs, Schulman, and Mosak (1952a) lauded this technique as an "invaluable teaching method," and stated that each therapist can expand his scope through watching the other. Hayward, Peters, and Taylor (1952) also proclaimed that multiple therapy was a good tool for training. Slavson (1953) saw the use of a co-therapist as a response to insecurities and inadequacies of therapists; Gans (1957) felt that these could be ameliorated when a supporting colleague proffered assistance. Various other authors have concurred that this approach is of great significance

PAGE 22

in situations of inibalanced therapeutic teams (Dyrud and Rioch, 1953; Feldman, 1968; Cans, 1962; Kell and Burow, 1970; Lott, 1957; MacLennan, 1965). It is notev/orthy that the Atlanta group, who had been one of the early proponents of multiple therapy for training purposes, reversed their position and stated that the pairing of novice and experienced therapists is not wise (Malone and Whi taker, 1965; Whitaker, Malone, and Warkentin, 1956) The later opinion of these authors underlined the deleterious influences of status differences which would affect both therapists and clients. Growth One of the first goals of using multiple therapy as formulated by the Atlanta group concerned its potential for developing the capacity of the therapist (Warkentin, Johnson, and ^\Tiitaker, 19 51; Whitaker, Malone, and Warkentin, 1956; Whitaker, Warkentin, and Johnson, 1949). This was .also mentioned by Solomon, Loeffler, and Frank (1954) ; it is -a training goal, in a sense, but refers to the opportunity for continued personal and professional growth of experienced therapists. Mintz (1963a) feels that co-therapy offers this benefit to a therapist by his being put in a ^-learning situation with his colleague. The observation of .the other therapist regarding his. and the client's reactions widens his understanding of himself. He can also be exposed to different approaches and techniques, thus expanding his professional ability.

PAGE 23

Mullan and Sanguiliano (1960) state that experience in multiple therapy can lead to greater maturity in the counselors and increase their enthusiasm for doing therapy. They, along v/ith others, have thought that its use results in better working relations among staff members of a therapeutic center (Dyrud and Rioch, 19 53; Malone and Whitaker, 1965) It does seem apparent that this provides a good opportunity for staff members to grow more together, as they share directly in their main pursuit — the helping of other persons. Mintz (1963a) commented that co-therapy is also a way of alleviating the isolation associated v/ith private practice. The growth -enhancing characteristic of multiple therapy is, in the opinion of Randolph (1970), largely responsible for the recent increased use of it. Better Therapeutic Interactions In addition to the two aforementioned advantages which were related to therapist training and growth, there has been extensive discussion of how the multiple setting provides for more effective and comfortable therapeutic interactions than does individual therapy. Sharing of responsibility — One of the most essential of the interaction advantages is the sharing of responsibility. Having a partner in the therapy situation tends to lessen the therapist's "effort syndrome," his attempt to effect a positive therapeutic outcome (Warkentin, Johnson, and Whitaker, 1951) Kell and Burow (1970) report that

PAGE 24

therapists feel less burdened and have more fun when doing multiple therapy, and thus find their work less taxing. Part of this sharing of responsibility is the direct support a therapist gets from his colleague (Cans, 1957; Miller and Bloomberg, 1968; Solomon, Loeffler, and Frank, 1953). This support certainly is an advantage during stressful times in therapy (Linden, Goodwin, and Resnik, 1968) when the client may require a good deal of support. Along with this, multiple therapy seems especially useful for therapists when the entire course of counseling is likely to be strenuous because the client is a difficult one (Cameron and Steward, 19 55; Greenback, 19 64; Mullan and Sanguiliano, 1964; Warkentin and Taylor, 1968). However, this approach has been found to be helpful with only some types of problem clients, and is contraindicated with others (Kell and Burow, 1970) Sharing responsibility tends to lessen the frustrations and difficulties of a therapist (Dreikurs, 1950) and makes it easier to pinpoint therapist problems (Mullan, 1955) The support element is important in improving the therapist's image of himself, as many feel that they have a greater capacity to v/ork with clients (Warkentin, Johnson, and Whitaker, 19 51) Wider range of roles — Another important advantage of multiple therapy in regard to the therapeutic interactions is that it enables the therapist to have a greater variety of roles (Adler and Berman, 1960; Demarest and Teicher, 1954) Cans (1957) stated that the therapist can (1) be

PAGE 25

an observer, (2) be observed, and (3) actively participate when he has a co-therapist. Because of this, therapy is less monotonous (Dreikurs, 1950), and thus probably keeps the therapist more alert. Dreikurs (1950) emphasized that the therapists will incline to serve in different role functions naturally, as the dissimilarities in their personalities will be complementary to each other. Besides these natural roles, the therapists can also assume different roles, one being nondirective; the other, directive (Dreikurs, Schulman, and Mosak, 19 52a; Solomon, Loeffler, and Frank, 1954). Mintz (1963b) suggested that usually in COtherapy, one therapist plays an authoritative role and represents the superego, while the other portrays the ego's integrative function (Adler and Berman, 1960) Or, she described hov/ a social worker took the role of the reality principle in helping plan for the future and relegated all interpretations to her psychiatrist co-therapist. Mintz also talked about how a male and female team could intentionally present themselves as masculine and feminine stereotypes. In addition to the assuming of different roles by the therapists, simulated role-playing between a therapist and the client is easier when two therapists are present. One therapist can handle the therapeutic functions (reflecting, directing, supporting, interpreting, etc.) while the other can take the part of a person to whom the client is relating. Such role-playing can also be done in individual therapy, of course, but it is somewhat more difficult, for

PAGE 26

10 the therapist must switch in and out of the role to coiranent on what is happening. Godenne (1964) reported satisfactory results V7ith a procedure wherein both therapists of a team participated in the psychodrama activities of a group. The deliberate donning of different roles by the therapists has been one area of dispute among various theorists. Mullan and Sanguiliano (1960, 1964) have stated that one of the main discriminating features between what they distinguish as co-therapy and multiple therapy is the use of contrived role-playing in the formier. Treppa (1971) concurs with them that this is not a beneficial technique: The usual situation in co-therapy is for one therapist to act in a supportive, passive, and good manner while the other plays an aggressive, dominant role. Such an approach: (1) is artificial in nature; (2) limits the therapists' freedom to be themselves and thus grow; (3) depersonalizes the patient by depersonalizing the therapists; (4) may prove to the patient what he has always thought — that he is inadequate in his attempt to change his environment, since he cannot change his therapists; and (5) encourages our cultural stereotype about how a man and a woman should be and feel [p. 453] These criticisms concern deliberate role-playing, however, and these authors would not deny that one of the advantages of multiple therapy has to do with the broader array of possible interpersonal interactions. Freedom — The multiple situation can also foster greater therapist freedom. It is easier to take risks in confronting the client when the therapist knows that his co-therapist can assist the client if necessary (Warkentin, Johnson, and Whitaker, 1951) Greenback (1964) said that clients feel freer in discussing certain topics with one ^-.^...---, ir-

PAGE 27

11 therapist when there is a "chaperone" present. This is equally true for the counselors and having another therapist in attendance is likely to increase counselor spontaneity. Kell and Burow (1970) state that the presence of a therapeutic partner enables a counselor "to feel, fantasy, and image more and do it more easily" [p. 216] Whitaker, Malone, and Warkentin (1956) theorized that perhaps the most important benefit of multiple therapy over individual therapy is that it gives greater freedom on the part of each therapist to be personally involved both professionally and emotionally. Therefore, the approach allows for greater variability and even innovations in technique. One therapist provides the control, the other the variable, at any given time in therapy [p. 211] Others have agreed that the v;ay in which multiple therapy offers more freedom and flexibility is that it confers greater stability for both clients and therapists (Buck and Grygier, 1952; Dyrud and Rioch, 19 53; Sonne and Lincoln, 1966). Greater comfort and confidence — Another group of supposed advantages has to do with the therapist feeling more confident or better about his therapeutic interactions. The multiple situation gives the therapist a higher probability of success due to the fact that his blind spots will be ameliorated by another and different helping person (Lundin and Aronov, 19 52) The counselor also has the benefit of constant consultation with another professional, which will increase his accuracy of diagnosis and -:V,-f -.(.JJ—'n'--''

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12 interpretation (Dreikurs, Schulman, and Mosak, 1952a), as well as his understanding of the client (Mullan and Sanguiliano, 19 60) The latter authors also cited various reports which claimed that not only are interpretations reinforced, but different ones are given at an earlier time in therapy. The client will be more likely to accept impressions of the therapists when they both agree (Dreikurs, 1950) which speeds the overcoming of resistance and the therapeutic progress. This aspect of multiple therapy is similar to a "consensual validation" effect. Another advantage related to this is that the counselor seems to be less "on the spot" when he has a partner, and he thus has more time to consider his comments. He most likely talks less and when he does, he is able to state things more adequately and accuratelyAlso, he probably stays in touch with the process better and is inclined to drop out his less helpful responses. In addition, the counselor can feel assured that his countertransf erence tendencies of being overprotective, oversympathetic or hostile will be reduced in the co-therapy setting (Greenback, 1964; Solomon, Loeffler, and Frank, 1954). Or, at least, having an observer in the room makes it easier to discriminate between reality and transference reactions (Demarest and Teicher, 1954) or mutual client-therapist distortions (Sonne and Lincoln, 1966) It has also been related that problems about transferring (Buck and Grygier, 19 52) or

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13 terminating (Mullan and Sanguiliano, 19 60) are less awkv/ard to deal with in the multiple situation. Again, however, Mullan and Sanguiliano (1960) take issue with other users of multiple therapy when they state that they see the method as adding to the discomfort of the therapists. They include a second therapist to add to the total insecurity present in the psychotherapy; to add to our own anxiety; to confront us with our own limitations; to indicate to us our everpresent tendency, of which we are so frequently unaware, to use the patient; and finally, to add depth and cross-sectional possibilities to the transaction. We do not add the additional therapist to make us feel more secure, nor to make us more certain of our interpretations [p. 557] These theorists feel that the multiple setting forces a therapist to minimize the use of learned techniques and rely on his own resources as a personIt is understandable that the beginning multiple therapist might be quite uncomfortable with the added insecurity. Howe-ver, as he found the method to be conducive to growth, learning, and the client's progress, he might actually welcome the uncertainty and find it quite comfortable. Le ss difficulty with impasses --Lastly due to having another person and another perspective, impasses are easier to resolve (Hayward, Peters, and Taylor, 19 52; Spitz and Kopp, 1963) or avoid (Dreikurs, Schulman, and Mosak, 1952b). "Commonly, in dyadic therapy, a conflict generates to impasse rather than resolution ..." because changes are harder for a therapist than in multiple therapy (Kell and

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14 Burow, 1970, p. 238). Whitaker, Warkentin, and Johnson (1950) presented a detailed analysis of the etiology of impasses in individual therapy, underlining that they signal a deterioration in the relationship between the therapist and the client. They state that the relationship has lost its "emotional voltage" for both client and therapist; that the therapist feels frustrated and his subsequent interventions are not likely to lead to progress. Their statements about introducing a second therapist to aid in the dissolution of the impasse go beyond just the addition of another viewpoint: The presence of the consultant is also valuable because he is also able to carry part of the responsibility for the patient, so that the therapist can express what he had suppressed from fear of his own immaturity [p. 644] Besides fearing his own imraaturity, the therapist may feel that it would be difficult for the client to handle his expressions without some support. Miller and Bloomberg (1968) affirmed the Atlanta group's observations in their own experiment in impasse-breaking. They felt that the addition of a second therapist gave the first emotional and physical support and allov/ed him. to verbalize his anger, fears, and sorrows to his psychotically violent patient. As a result of the interaction advantages mentioned previously, impasses do not occur as frequently when there are two therapists present from the inception of treatment. In addition, it has been noted that the client does not

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15 become extremely dependent on one therapist v/hen two are involved (Mintz 1965), which is a further protection against a stalemate in therapeutic movement. The Multiple Therapy Relationship Given that there have been many purported advantages of multiple therapy for the therapists, many of them probably are actualized only when there is a good relationship between the participating therapists. Poor co-therapist rapport may well signal their absence or create the atmosphere in V7hich the possible disadvantages of this technique thrive. The dynamics of the multiple therapy relationship thus warrant a thorough examination. Characteristics of a Good Relationship Kell and Burow (1970) claim that "collaboration" between the counselors is the crucial aspect in forming a co-therapist relationship. Specifically, they feel that mutual respect, awareness, and acceptance of differences, ov/ning of one's own competency, freedom to feel and express feelings, both affectionate ones and those that are less positive, are the primary elements which make up a good multiple therapy relationship [p. 233] Mullan and Sanguiliano cite "mutuality" as being the key aspect of the therapists' relationship noting that "the relationship becomes mutual as both therapists express their need to be together not only as a team but also as unique individuals v/ith definite growth strivings" (1964, p. 175) They, further emphasize that the ideal multiple • •r>" ---m—

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16 therapy relationship is an intimate one which encourages interchanqGs betv/een the therapists on a transactional and phenomenological level (Mullan and Sanguiliano, I960). Randolph (1970) states that the above authors, in conjunction v/ith Whitaker, Malone, and Warkentin (1955), "concur in citing authenticity, mutuality, relatedness, equality, spontaneity, affective involvement, autonomy and interdependency as essential to the multiple therapists' relationship" [p. 11]. These, then, are the major characteristics of a good multiple therapy relationship. The following discussion elaborates on how such an interaction can be attained and v/hat problems prevent its realization. Prerequ isi tes and Matching One obvious dimension to be considered in the pairing of co-therapists is their general orientation or approach. Solomon, Loeffler, and Frank (1954) state that an optimal pairing can be achieved when the "orientations of the cotherapists are flexible enough to permit considerable variance along the active-passive, directive-nondirective continuae" [p. 177] They surmised that there are probably various ways to m.atch on these dimensions that will prove to be successful combinations. They felt that until these combinations are known, however, therapists should be matched with regard to their goals and techniques. It would be a catastrophe to place two therapists in the same room who are extremely different and rigid in their beliefs

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17 (Rockberger, 1966) This would likely lead to a battle of each trying to prove the superiority of his method. As an extreme example, it is very perplexing to imagine how an orthodox Freudian and someone v/ho patterned his style after Rogers could work together to the benefit of the person they were seeing. Within limits, though, some variation in approach betv;een the therapists is desirable. Kell and Burow (1970) think that counselor similarity, is necessary as far as basic beliefs about life and human values. For instance, they feel that it would be very difficult for a pessimist and an optimist to work together constructively. They would agree with others, however, that differences in opinion regarding intrapsychic processes or tactical differences between therapists are positive catalysts to therapeutic progress (Dreikurs, 1950; Hulse, Lulow, William, Rindsberg, and Epstein, 1956) Mullan and Sanguiliano (1960) state that there is alv/ays resistance on the part of therapists in entering a multiple therapy situation, as well as experiencing during a particular treatment hour. They note that there is likely to be less resistance by therapists who emphasize process rather than content. It follows, then, that therapists who are relationship-oriented and flexible in orientation may be best suited to be members of a multiple pair. Furthermore, it has been stressed that the therapists should be of equal capacity (Whitaker, Malone, and

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18 Warkentin, 1956) or, at least, that neither be "in a position of greater authority or dominance even if one therapist is a student" (Solomon, Loeffler, and Frank, 1954, p. 171) Warkentin, Johnson, and l-Thitaker (1951) reported that the inexperienced therapists in their study v/ere sometimes anxious and lacking in spontaneity, as they v/ere concerned about making positive impressions upon their cotherapists. Extending this further, Malone and Whitaker (1965) feel that it may be impossible to establish a good multiple therapy relationship in a teacher-student situation. Cans (1962) also stated that many disruptive problems are created when there is a great dissimilarity in the therapeutic resources of the co-therapy participants. For most theorists in this area, however, the important point is that the co-therapists be able to establish an egalitarian relationship, regardless of their levels of experience or status (Haigh and Kell, 1950). Often-cited personal characteristics deemed to be prerequisite for a multiple therapist were listed by Greenback (1964) These are maturity (V'Thitaker, Malone, and Warkentin, 1956) being able to freely communicate with another therapist (Rockberger, 1966) lack of competitiveness (Dyrud and Rioch, 1953) and ability to trust. Mullan and Sanguiliano (1960) regarded considerable trust between the therapists as being necessary to achieve mutuality. Along with Greenback, other authors feel that the co-therapists should

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19 usually be of opposite sexes (Hill and Strahl, 196 8; Mintz 1963, 1965; Nunnelly, 1968; Rabin, 1967; Singer and Fischer, 1967) thus simulating a familial situation and facilitating certain therapeutic interactions. Some authors have carried the family milieu idea to the extent of using a wife (Fink, 1958), a son (Solomon and Solomon, 1963), or even a dog (Weigel and Straumfjord, 1970) as co-therapist. Warkentin, Johnson, and Whitaker (1951) required their multiple therapists to have had therapy themselves, and stated as criteria for successful pairing that each therapist would feel free to be' the patient or the therapist of the other. Cans (1962) warned that two inexperienced therapists were worse than one and, held that ample individual work should be prerequisite to doing co-therapy. Given two accomplished therapists, Cans felt that there was no particular advantage in teaming up over seeing patients individually. Apparently, then, he was focusing mainly on the technical rather than the relationship aspects of co-therapy, and his demand for experience should be considered in this light. Undoubtedly, therapeutic ability might interact with the quality of the co-therapist relationship; but whether ability is solely determined by experience is questionable. Relationship Problems and Solutions Discussion of Problems. — MacLennan (19 65) emphatically

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20 stated that the relationship between co-therapists is very complicated, and may even contain so many difficulties that a therapist would be better off working singly. In addition to meeting the prerequisites and being properly matched, a good multiple therapy team is formed by participants who can work through problems in their relationship. When and how are the difficulties to be discussed? Some types of obstacles can be handled during the sessions. For example, when the therapists have divergent opinions about what is going on with the client (Dreikurs, 1950) or there are tactical differences between the counselors, these can be revealed and discussed in the client's presence. It has been emphasized that this should be done with an air of respect, and the therapists should be able to be comfortable with their disagreement. Other difficulties, such as "neurotic conflicts between cotherapists have to be recognized and dealt with appropriately outside ."of the sessions (Hulse, Lulow, William, Rindsberg, and Epstein, 1956, p. 435). Routine meetings of the therapists between the sessions are considered to be essential (Lundin and Aronov, 1952). In this regard, Haigh and Kell (1950) recommend that the therapists go over a tape of the therapy: It is in this situation that attitudes and feelings existing between the two participating therapists become crystallized and clearcut and the emotional growth and learning for both can reach their maximum [p. 660] It has also been suggested that the two therapists meet with a third party who can act as a moderator or supervisor

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21 (Solomon, Loeffler, and Frank, 1354). It is essential that the counselors be able to freely coiraTiunicate with one another in order to work through any of their problems in interacting. Competitiveness and h o s tility -Mint z (1955) cla imed that the "possibility of personal friction between the therapists is certainly the greatest hazard of this type of treatment" [p. 299] Competitiveness (Dyrud and Rioch, 1953; Lott, 1957) is probably tlie most deleterious factor to the formation of a good multiple therapy relationship. Kell and Burow (1970) emphasized that it requires conscious effort for counselors to form a collaborative relationship, because there is "little in the professional therapists' training which prepares them, for building a co-worker relationship which can be helpful and meaningful both to them and the client" [p. 213] These authors prefer pairing male and female counselors, hoping to avoid the competition so prevalent between w.en. Com.petitiveness may well still be an issue, however, and the participants will need to be aware of this potential tendency and counteract it. Lundin and Aronov (19 52) state that if a patient "senses the same lack of respect, disharmony, and infantile competition ..." similar to those between his parents, ". the basic purpose of the co-therapy method has been lost" [p. 79] MacLennan (1965) spotlighted such a possible area of dissension with male and female therapists — their t ^-i."'

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22 being engulfed in an oedipal struggle where the male relates to all the girls in a group; the female, to all the boys. Solomon, Loeffler, and Frank (1954) believed that the therapists, if conscious of hostility between them, could work out their difficulties without affecting the patient. However, they feared that the anger might be displaced to the patient if the therapists were unaware of their feelings. Competency and respect — It is important that the therapists be able to feel competent without being competitive, and desirable that they encourage and enhance each other's competence. Cans (1962) stressed that each therapist should accentuate the other's assets and not let the expression of his limitations be pronounced. Mintz (1965) related that it is crucial that both therapists feel competent; otherv^ise, the patient may be able to play one therapist against the other, or the therapists may misunderstand the relationship of the patient to each of them. Mutual respect must also be present to develop a positive multiple therapy relationship (Lundin and Aronov, 1952; Warkentin, Johnson, and Whitaker, 1951) This respect should involve appreciation of the other's differences, including sexual role dissimilarities when the counselors are male and female (Kell and Burow, 1970; Mintz, 1963a). Each therapist should also "know of and accept the other's peculiarities and neuroticisms" (Rockberger, 1966, p. 288). Finally, in this regard, Demarest and Teicher (1954) felt that each co-therapist should emotionally accept the other and understand his methods of working in therapy.

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23 A utonomy and dependency — Kell and Burow (1970) further thought it important that the therapists be able to be both autononious from and dependent on each other. They felt that counselors are trained to be independent, possibly to the extreme, so that they cannot easily, genuinely, and appropriately depend on one another. It is critical that thoy do this in order to share responsibility for the therapy and form, good models for their clients regarding expression of dependency. Intimacy and caring — Solomon, Loeffler, and Frank (1954) postulated that the ideal multiple therapy pair establish an intimate association which unites them and betters their therapy. Mullan and Sanguiliano (1960) felt that the therapists need to develop a deep meaning for one another, come to care for each other, so that they react to the patient in a meaningful and integrated v/ay. Many theorists in the field have stated that a good multiple therapy relationship would contain the same ingredients, as a good marriage (Kamerschen, 1969; Linden, 19 54; Rabin, 1967; Sonne and Lincoln, 1966; and Treppa, 1969). Randolph (1970) agreed with this view of the relationship and inves' tigated aspects that she felt were especially important. She was interested in how much the cotherapists (1) disclosed to one another, (2) were satisfied with each other, and (3) expressed affection to one another. The present author concurs that the development of an intimate and caring

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24 relationship betv/een the counselors is one of the most important facets of multiple therapy. Research Although many theorists have praised the multiple technique for providing an atmosphere conducive to conducting unobtrusive research (Buck and Grygier, 19 52; Dreikurs 1952b; Haigh and Kell, 1950; Whitaker, Malone, and Warkentin, 19 56) few have actually done more than draw conclusions from their own experiences with the method. There is a bounty of success claims in the literature (Fink, 1958; Mintz, 1965; Solomon, Loeffler, and Frank, 1954), but very fev; empirical facts to support it, The first attempt at a "study" of multiple therapy was that of Warkentin, Johnson, and Whitaker (1951) v/ho looked at case studies of 25 patients and reported positive results for, them; such as feeling safer and thus freer to express both positive and negative feelings, and more satisfactory termination experiences. The participating therapists derived the supposed benefits of personal growth, increased enthusiasm for therapy, and a greater capacity to f work with patients. Other research projects have also concentrated some attention on multiple therapy from the therapist's perspective. Rabin (1967) at least improved on the previously cited study of the Atlanta group by giving 38 therapists a questionnaire which asked them to rate the relative efficacy

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25 of co-therapy versus individual therapy. (A modified form of his questionnaire is shov/n in Appendix C.) He found that the therapists valued the "general therapeutic efficacy of co-therapy," and felt that it led to more "positive therapeutic movement and working through, in general" [p. 24 9] Mallars (1968) reported that her 24 student counselors, their clients, and their supervisors were significantly more satisfied v/ith a counseling team approach than with a standard method. These results are based on the participants' responses to a counseling rating scale administered after the first and the last counseling sessions. Kamerschen (1969) in studying 23 heterosexual therapist pairs, found that self-disclosure and a personalimpersonal dimension of co-therapist selection were significantly related to therapist satisfaction within the multiple therapy relationship. Pair flexibility, congruence of self-co-therapist flexibility, and attitudes toward the opposite sex were not shown to be significantly related to pair satisfaction. Kamerschen 's co-researcher, Randolph (1970), found self-disclosure to be positively related to satisfaction and the physical expression of affection in therapist pairs. The results also indicated that those therapists who acted on their desire to verbally express affection were more satisfied than those who did not, while therapist pairs who expressed both verbal and physical affection were more satisfied than those who used only one.

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26 The studies that have used various measures of client change in comparing an individual with a multiple group method have yielded equivocal results. Daniels (19 58) and Staples (19 59) found that for groups of eighth grade boys and girls, respectively, the heterosexual co-therapy team generally produced negative behavior changes in their clients. The members of groups led by either a male, or a female therapist, contrarily, tended to improve on the outcome measures of teachers' ratings and psychologists' assessments. Nunnelly (19 69) discovered no significant dif.ferences between groups led by multiple therapists versus those led by individual therapists in regard to client outcome, e.g., perceptions of parent acceptance, selfacceptance, or ego strength. Singer and Fischer (1967) reported that although little progress was being made with a group of male homosexuals run by two male therapists, when a female co-therapist was added, the process changed remarkably for the better. After one year of heterosexual leadership, the majority of the members of the group had improved on several behavioral measures; such as lessened amount of homosexual activities, dating heterosexually and increased work productivity. In all of these studies, however, no data were gathered on how the therapists related to one another. This is of critical importance, as was discussed before, as a poor co-therapist relationship could very likely produce worse client outcomes than an individual therapist.

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27 Swander (1971) attempted to investigate one such area of the therapists' relationship as it affects client outcome. In an analogue study using undergraduate students as both therapists and clients, she manipulated the level of therapist functioning in multiple pairs. She concluded that two therapists of higher levels of nonfacili. tative core conditions may work together v/ith no negative effect on each other's functioning level and with no negative effect on their client's level of self -exploration. When, on the other hand, a lowfunctioning nonf acilitative therapist works with another nonf acilitative therapist, there will not only be a negative effect on each other's functioning level but on the level of client self-exploration as well [pp. 34-35] Although Swander 's sample v/as limited in that there were no facilitative helpers included, there were still definite differences in helpee self-exploration resulting from higher or lower nonf acilitative levels of functioning. These results underline the importance of inspecting the relationship between co-therapists. It is difficult to evaluate the studies concerned with the relative efficacy of individual versus multiple therapy when this examination has been omitted. As listed above, previous studies have been concerned with (1) how therapists and clients felt about multiple therapy as compared to individual therapy, (2) some essential ingredients of a satisfyingco-therapy relationship, (3) the relative efficacy of multiple versus individual therapy in regard to client outcome, and (4) the effect of the level

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28 of functioning of the co-therapists on client selfexploration The present study coinbined these types of designs to collect various data from therapists, clients, and independent judges regarding multiple therapy as compared to individual therapy, as well as the multiple situation itself. The current report includes two main categories of hypotheses in reference to therapists, which correspond to the, two main themes in the literature. The first of these is centered around differences in how the therapists operate and perceive therapeutic process in each condition; the second, with various facets of the co-therapist relationship and the possible effect of some of these on clients, The specific research hypotheses are listed in the succeeding chapter. Predictions and results of the project which focus primarily on client experiences in the two conditions are to be reported in the dissertation of the writer's co-researcher (Reiner, 1973).

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r-IETHOD Subjects Counselors The aforementioned prerequisites and criteria for matching were taken into consideration in selecting the therapists. All of the therapists — counselors at the University of Florida Counseling Center — were of the "eclectic" variety and thought to be fairly flexible in orientation. The pairing of six male and six female therapists for the multiple condition was made by joint agreement of the members of each team and the two researchers. When .a therapist had agreed to participate in the study, he (or she) was then asked if he thought he would work well with the other counselor whom the researchers, in conjunction with the center's director, had determined would be an appropriate partner. Each therapist had to reply affirmatively for the pair to be formed. There were three experienced pairs, with from three to five years' therapy experience, and three internlevel teams, averaging six months to one year of counseling work. Clients The 24 clients were unmarried female students at the University of Florida between the ages of 18 and 23; all 29

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30 had presenting problems concerned with interpersonal difficulties. Every unmarried female student coming to the counseling center for personal counseling during the duration of the study was asked to participate in the project. The one exception to this was in the case of a student who had had counseling in the past. Previous therapy is one variable consistently shown to influence therapeutic interactions (Meltzoff and Kornreich, 1970), and thus these students were excluded. Design The following discussion sketches the overall design of the project and elaborates upon the aspects crucial to the material of the present report. Granted, there are myriad other considerations and analyses possible to pursue with the data that have been gathered. Conditions and Groups Therapists — The same therapists saw clients individually and multiply during the same time period; thus, they provided their own matched control. Each therapist saw one client in individual sessions and two with the same cotherapist partner throughout the course of therapy. The counseling of two clients multiply was necessitated by the desire to have 12 clients undergoing treatment in each condition. The use of the same team of therapists for two cases yielded a sample size of six pairs, rather than the 12 that could have been attained by different pairings for j^-4l* ^ -Ikt^ itrumm

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31 each case. This v/eis not ideal in that the multiple condition was not coiaprised of somev/hat more independent pairs, but it was; not possible to re-cor;ibine the therapists into six more couples that the researchers and the counselors felt would be compatible ones. To adapt this design for some of the data analysis, one of the clients for each therapist pair V7as assigned at random to the female therapist and the other to the male. This was decided by tossing a coin to see which therapist would be the one aligned v/ith the first or second client seen multiply (ageiin, the choice of a coin flip). Clients ---The subjects were randomly assigned to counselors, in so far as possible. A schedule was arranged wherein the order of assignment to each pair of therapists was randomized, as v/as the order of assignment to individual therapy with the male therapist of a pair, individual therapy with the female therapist, or one of the two multiple sets. As students agreed to participate, they were relegated to therapists according to this order on a "first come, first serve'" basis. When a subject dropped out of therapy before completing four sessions, this was considered first priority, however, and the vacated space was filled before continuing with the random assignment. Although the clients were naturally matched in some respects as they were drawn from the same population, their random designation to conditions assured independent groups.

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32 Comparisons Fir st and last s es sions — All data v/ere collected for initial and terrainsil interviev/s enabling comparisons to be made between the participants preand posttests for both conditions. Although tape recordings v/ere made of all sessions for future reference only the first and final ones were utilized. The number of interviews per case varied from four upward; any stu.dents discontinuing therapy before four sessions were excluded from the study. It was decided that natural termination was preferable to administering posttests after a specific number of sessions, as it seems somewhat presumptuous to assume that clients have had equal therapeutic exposure or possible progress in the same number of sessions. Individual versus multiple process — A Comparative Therapy Scale, which taps attitudes toward multiple and individual therapy, was administered to the counselors. The therapists answered the same process forms (Therapy Session Report) for individual and multiple sessions so that their perceptions and reported behaviors during the two situations could be easily compared. Similar self-report forms (Therapy Session Report) regarding the process of the therapy sessions were completed by therapists and clients, so that their agreement or lack of it could be ascertained. Process was was also rated by two clinicians who listened to taperecorded segments of the sessions (as per the scales developed by Berenson, Carkhuff and Truax)

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33 QMJ:A£y-^£_Lhe_co -therapists relationships .— The present design incorporated several approaches aimed at describing the quality of the multiple therapists' relationships. One method was a direct one of having the therapists rate each other as far as their relationship on tv/o measures (Caring Relationship Inventory; Multiple Therapy Rating Scale) designed or adapted for this purpose. Another involved perceptual agreement as to how the therapy sessions proceeded; this specifically involved a therapist rating his partner (on the Multiple Therapy Rating Scale) on the Matter's behavior and perceptions which he had also selfrated (on the Therapy Session Report) The relevance of good and, poor co-therapist rapport measured by the above instruments for client outcome (self-actualization) was also investigated. Possible therapist growth .— The Personal Orientation Inventory was administered to the therapists at the inception and the conclusion of their involvement in the research project to detect any change in self-actualization resulting from the experience. There was no control condition for this analysis, however, so any results could only be suggestive. Procedure Counselors Before commencing their first therapy session, the counselors were given the Myers-Briggs Type Indicator P|fe-Jg-;^.!gSI^,jL^-;g! ?i^

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34 if they had not previously taken it and a Personal Orientation Inventory. The experimenter gave all participating therapists the Therapists' Research Instructions Sheet (Appendix A) After the first and the last sessions in both conditions, the therapists filled out a Therapy Session Report; after multiple sessions, they also completed a Multiple Therapy Rating Scale. After the very first and the very last multiple interviews, they also answered a Caring Relationship Inventory. It was the therapists' responsibility to tape all sessions. After their last multiple session, the counselors were again given the Personal Orientation Inventory. After finishing all counseling, the therapists completed the Comparative Therapy Scale. Clients The clients were initially seen for a half-hour intake interview, as are all students coming to the counseling center. They were told in regard to referral that the intake person had one or two other counselors in mind and that he would make the best referral possible. The clients were also told that multiple therapy with both a male and a female counselor was a frequent practice of the center. The client's name was then given to one of the researchers who contacted the client by telephone, explained the nature of the study, and asked the client to participate. j If she agreed, the researcher asked her to come to the center 1

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35 to take the pretests as soon as possible; told her the nap:ie(s) of her counselor (s) ; and said that she v/ould be given an appointment as soon as she had completed the testing. The pretests were the Personal Orientation Inventory; a self-rated scale of self-actualization, the Self-Actualization Scale (S-A Scale) ; and a specific Problem.s List, on which the client listed three problems on which she wanted to work in counseling. (These measures v;ill be described in the dissertation of Reiner, 1973.) After the final therapy session, the client again completed all of the above scales, the S-A Scale and the Problems List being the posttest versions Instriiments Therapy Session Report The Therapy Session Report (TSR) which was developed by Orlinsky and Howard (1956b) has been used extensively in psychotherapy research by these authors to determine how clients and therapists perceive and behave during therapy hours (Orlinsky and Howard, 1966b, 1967). Similar forms for the client and the therapist were designed, enabling easy comparisons of their experiences and feelings about the process of the sessions. The current researchers selected items from the original scales and used these in the forms for therapists and clients (Appendix B) The items that were parallel for the therapists and clients have the item numbers of the therapist

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36 form after the items on the client form. The items were all multiple choice,, and inquired into the participants' feelings and actions during the sessions, how the therapists and clients, viewed "each other, and how they evaluated certain aspects of the process of the sessions. All items require that the participants rate a statement regarding one of the above areas. Some items are judged on a scale of to 2; for example, "What did your patient seem to want this session? A chance to let go and express feelings," The therapist assigned one of the follov/ing scores: 0: No 1 : Some 2: A lot The' second scoring plan is exemplified by the item, "During this session, how much did your patient tend to agree with or accept your comments or suggestions?" The therapist rated his client's behavior according to the following scale: 0: Slightly or not at all 1 : Some 2 : Pretty much 3 : Very much The third type of item utilized a 5or 6-point scale. The therapist had the following choices in regard to the question, "To what extent did you reveal your spontaneous

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1 37 impressions or reactions to your psitient this session?": 1: Considerably 2: Modereitely 3: Somev/hat 4: Slightly 5: Not at all This last type of item v/as presented on the forms to the testee in the opposite direction from which it was scored: the "1" choice was cjiven a score of 5, while the "5" choice v/as scored as 1, For purposes of hypothesis testing, some of the items were grouped together for scoring. When this was done, the scoring scheme was changed so that each response rereived a for "no," and a 1 for either "some" or "a lot." The scores for all relevant responses were then summed to give a composite total for the group of items. The topics involved are listed in the section dealing with hypotheses. The remainder of the items were used singly to test hypotheses. No attempt was made to obtain a score over the entire inventory since the aspects of counseling covered by the items are so diverse. Comparative Therapy Scale Rabin (19 67) as already mentioned, was a pioneer in the empirical investigation of therapist attitudes toward co-therapy and regular group therapy. His original Co-Therapy Rating Scale consisted of 50 items regarding the

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38 nature of therapy interactions and. progress His therapist subjects rated 32 of the topics as being meaningfully different in co"therapy than in regular therapy. Thirty of these items were used in the Comparative Therapy Scale (CTS) in the present study (Appendix C) Rabin's item, "Your general preference when therapy in a group is the only treatment," was changed to "Your general preference." Another item that dealt with an issue specific to group therapy was deleted. The present author also added the last item of the CTS, "Resolution of impasses," as the literature lists this as an important advantage of multiple therapy over individual therapy. The directions for the CTS asked the therapists to compare multiple therapy and individual therapy (with individual clients) on the 32 topics. Two columns, one for multiple therapy and one for individual therapy, provided the levels of comparison which were scored as follows: 1: Slightly more 2: Moderately 3: Much more A check in the "No difference" column, placed between the ones for multiple and individual therapy, was not scored. Several items which indicated negative differences between the methods were rescored to be in the same direction (these are indicated by an asterisk in the left magrin) ; and item number 2 2 was omitted from this scoring scheme (indicated

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39 by a "0" in the margin) since its scoring direction was indetenainable The scores of each therapist in the multiple and individual columns were then suinined, providing a totcil score over all items for individual and multiple therapy. In addition, the mean and modal score of each item using Rabin's (1967) scoring pattern--" 1" for "much more" in multiple therapy to "4" for "no difference" through "7" for much m.ore in individual therapy---v7as computed from the scores of the 12 therapists on each item. The Carkhuff Proces s Sc^Il es It is nov7 widely accepted that certain core conditions of therapists' level of functioning are crucial to some of the events that take place during therapy. Carkhuff (1969) described the scoring procedures for his process scales designed to evaluate: (1) empathetic understanding, (2) respect, (3) faciliative genuineness, and (4) concreteness or specificity of expression in interpersonal processes. These scales shall be referred to in the text as: Empathy, Respect, Genuineness, and Concreteness The form of these scales used to train the judges and rate the taped excerpts from therapy sessions of the study are given in Appendix D. It seems advisable to describe the version presently used because all of the scales have progressed through several stages as research indicated that alterations or refinements were necessary. These process scales, along v/ith a scale that measures depth, of client self -exploration, have been shown to be

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40 reliable instruments and have been validated in numerous psychotherapy research projects (as reported in Carkhuff, 1968; Carkhuff and Berenson, 19 67; and Truax and Carkhuff, 1967). It has been noted, hovrever, that higher reliability and predictive validity have been obtained v/hen the raters using the scales are themselves high-level functioning counselors (Carkhuff and Berenson, 1967). Interjudge reliability coefficients as high as .80 and above have been found using such raters (Swander, 1971) ; whereas the use of naive undergraduate students could be expected to give coefficients closer to .50 (Truax and Carkhuff, 1967). Taped excerpts v;ere taken from the initial and the terminal therapy interviews of the 12 multiple and the 12 individual cases. Each of these therapy sessions was divided into thirds, and one segment was taken from the first, the middle, and the last third of the session. The order in which these 14 4 segments v/ere presented to the judges was completely randomized, so that they did not know if any particular segment was from the first or last session, nor from what portion of the interview. Because of the nature of the conditions, however, the raters were able to discern whether an excerpt was from the multiple or the individual i I' condition. Master tapes with the excerpts given in their random sequence and identified by a niamber, along with 144 niombered 3x5 cards, were given to the judges. The cards li f had columns for male therapist, female therapist, and client.

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41 The judges were instructed to rate all four of the therapist scales in the same order-Empathy Respect, Genuineness, and Concreteness — and then the client scale. The ratings on all of the scales for any given segment v;ere executed simultaneously. Two intern-level counselors v/ho were themselves highfunctioning (averaging above 3.0 on all scales) and had attained an inter judge reliability of above .80 in previous research (Swander, 19 71) were used as raters. Pearson product-moment correlations v/ere computed over the independent ratings of the two judges for 15 randomly selected segments of the 144 segments of the present study. There were 7 segments that were selected from the multiple condition, and the ratings of both therapists were used in the calculation of the correlations; the coefficients thus reflect the agreement of the judges over 22 ratings. The Pearson product-moment correlations were .89 for Empathy, .91 for Respect, .93 for Genuineness, and .93 for Concreteness. For each relevant session, the scoring scheme for any one of the scales called for three ratings (first, middle, and last segments) by two judges. The score of each therapist for a session was to be an average of these six ratings. Unexpectedly, however, there were several segments in the multiple condition in which the female therapist did not talk at all, and thus she was not rated. The specific

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42 number and the meaning of these occurrences v^ill be discussed further in succeeding sections (Results and Discussion) It should be noted here, though, that in these cases the scores for that therapist were based on an average of the segments that v/ere rated. Caring Relationship Inv e ntory As previously stated, many theorists in the area have stated that an effective multiple therapy relationship v/ould contain the same ingredients as a good marriage. Kamerschen (1969) and Randolph (1970) used a modified form of van der Veen's Family Concept Q-Sort to create their Co-Therapist Inventory. Shostrom's Caring Relationship Inventory (CRI was designed for relationships ranging from the dating stage to marriage (1966a) The CRI consists of 83 true-false items that concern feelings and attitudes that the members of a heterosexual dyad have toward each other. The inventory is comprised of five basic scales and two subscales The major scales, given the titles Affection, Friendship, Eros, Empathy (M) and Self-Love, supposedly measure different aspects of love. The subscales purport to describe whether the respondent's love is one based on need (Deficiency Love) or is metamotivated (Being Love) A description of these scales, along with their identifying symbols and the number of items on which they are based, is given in Appendix E. *The symbol for the CRI scale of Empathy, "M," will follow the scale's title, to distinguish it from the process scale of Empathy.

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43 This instrument attempts to measure many aspects of a relationship v/hich the present researcher deemed to be imiportant for co-therapists. Shostrom (1966a) presents split-half reliability findings on a sample of 272 persons who v/ere successfully married, had a troubled marriage, or were divorced. The reliability coefficients for the basic scales ranged from .74 to .87, while those for the subscales were .66 (Deficiency Love) and .82 (Being Love). As evidence that this is a valid test, Shostrom further reported that all of the scales can significantly discriminate between successfully married, troubled, and divorced couples. There have been no sex differences found on any of the scales. The directions for the CRI were altered so that the respondents would rate their co-therapist as they saw him or her, and then rate their ideal co-therapist. The completed inventories v/ere scored with the standard scoring keys provided by the Educational and Industrial Testing Service. Hypotheses were formulated about the therapists' responding on all of the scales except Eros, as it was felt that this aspect of a relationship was not an important dimension for co-therapists. Personal Orientation Inventory Shostrom' s Personal Orientation Inventory (POI) is a forced-choice, 150-item questionnaire that purports to measure various aspects of self-actualization (Shostrom,

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44 1966b) Responses to these items yield scores for two main scales and 10 subscales, 4 of V7hich are listed and described in Appendix F, along \7ith the scale symbols. This instrument has been shown to have test-retest reliabilities as high as .93 and .91 (Shostrom, 1964). Other test-retest coefficients are reported as .71 and .84 for the basic orientation scales (Time-Competence and Inner-Directed), and as ranging from .55 to .85 for the subscales (Klaveter and Magar 1967). Validity for each of the POI scales has been examined by its ability to differentiate between groups of individuals who were reportedly selfactualizing, normal, or not self-actualizing (Fox, 1965; Shostrom, 1964) The pre and post scores of the therapists on the two major scales of personal orientation (Time Competence and Inner-Directed) and two of the subscales were used to detect possible therapist grov/th during their involvement with multiple therapy. The tv/o subscales chosen were ones thought most likely to change on the basis of theory in the literature (Spontaneity and Capacity for Intimate Contact) The standard scoring keys distributed by the Educational and Industrial Testing Service were used. Multiple Therapy Rating Scale The Multiple Therapy Rating Scale (MTRS) was devised by the author and her co-researcher (Reiner) to tap areas not covered by the other scales regarding the co-therapists' perceptions of each other and their relationship.

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45 Co-therapist agreement ---This instrument included eight items that paralleled som.e items of the TSR. (These items are designa.ted in Appendix G by having the item number of the TSR to which they correspond immediately following the item.) In completing the MTRS then, each therapist rated his partner on aspects of the latter 's behavior for which the partner had also rated himself. These items were used as an indix of agreemient between the therapists as to how they saw each other and themselves during the sessions. It was postulated that close agreement was indicative of a good relationship, while discrepant views meant something was askew in the relationship. For the first and last session of each case, the scoring of this part of the scale consisted of summing the number of exact agreements out of the eight topics on which each therapist rated himself and was rated by his partner. This yielded an agreement score for each individual therapist. A composite score for" the couple was derived by adding the two scores of the co-therapists. In addition, a total composite score for each case was computed by summing the pre and post composite scores. Quality of the co-therapist relationship — The remainder of the items were ones that inquired about other perceptions of the therapists concerning the events of the sessions. The topics were ones that the co-researchers thought were important as to how the therapists worked together. Four

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46 intam-level pisychology graduate students were asked to evaluate the items and the responses of this section of the scale (see Directions for Rating the MTRS Appendix G) First, the judges rated all of the items in regard to their relevancy for the formation of a co-therapist relationship. All of the judges agreed in identifying 13 of the 14 pertinent items as being relevant. They also all concurred that the items describing the other therapist's behavior (the topics similar to the TSR ones discussed above) and the final item were not relevant ingredients of the co-therapist relationship. The second item, that only one judge felt was relevant, was omitted for scoring purposes. The percentages of agreement between the judges in regard to the relevancy of the questions are shown in Table 1. TABLE 1 PERCENTAGES OF AGREEMENT AMONG FOUR JUDGES REGARDING THE MULTIPLE THERAPY RATING SCALE Judges B C D Relevancy of the Items A 1.0000 1.0000 .9285 B 1.0000 .9285 C .9285 Scoring Direction of the Responses A .7777 .7619 .7936 B .8095 .7460 C .6667

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47 Secondly,, the judges .rated each item as to whether it was indicative of the formation of a good, neutral, or poor co-therapist relationship. The scoring pattern for each judge over all the items is recorded in Table 30, Appendix G. In most cases, only those responses rated in the same direction by at least three out of the four judges were used for scoring purposes. Due to the equivocal judgments regarding the responses of items 1 and 16, these items were thrown out. Three of the ohher resiJonses to questions where most of the responses v/ere rated similarly by the judges were retained and scored "zero" (4d, 5c, and 6c) — the original scoring direction determined by the tv/o co-researchers. These responses were chosen infrequently by the present sample of therapists, so it was decided to retain these items. Because of the nature of one item, of the questionnaire (22) where each response v/as somewhat separate from the others, several choices were eliminated, v/hile retaining the rest of the responses. These deletions resulted in the total of 11 items being used for scoring in this part of the scale, with 25 responses being scored in the positive direction, 7 in the neutral, and 2 2 in the negative. Responses were scored +1 0, and -1 as to v/hether they indicated good, neutral, or poor rapport between the therapists. A total score for each therapist was obtained by summing all of the positive responses and subtracting the negative ones. A composite score for each therapist pair was obtained by adding their

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48 respective scores together, and a total composite score was obtained by suixm-iing the pre and post ccmposite scores. An investigation of the test-retcst reliability of the tv7o parts of the MTRS v/as proposed. It 'would seem likely that the therapists v/ould rate their relationship similarly after seeing their first multiple case together and after seeing their second. It v/ould also appear likely that their level of agreement as to the events of the session would remain stable for their tv/o first multiple sessions. It was also planned to see if either the level of agreement or the rated quality of the co-therapist relationship scores for each therpist correlated with those of his Caring Relationship Inventory as a concurrent validity check. Also, it would be expected that these indices would be related to outcome of the multiply seen clients. High agreement and high quality should be paired V7ith good outcomes, low agreement and low quality with poor outcomes. If the data suggested a trend in this direction, it would provide a crude case for predictive validity of the MTRS. Myers-Briggs Type Indicator The Myers-Briggs Type Indicator is a 166~item, forcedchoice instr-ument that categorizes testees according to Jung's typology. Information regarding the composition and scoring of the test can be obtained from the Educational and Industrial Testing Service, San Diego, California.

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49 According to Isabel Briggs Myers, who v/ith her mother developed the instrument, research has shovzn that clinical psychologists are predominantly Introverted or Extraverted Intuitive Types v/ith Feeling and Perception being strongest. She also feels that these are the types best suited for counseling v;ork.* The use of this test in the present study was purely descriptive; the types of each therapist are indicated in Table 36, Appendix H. A homogeneous pool of therapists according to their types would be desirable; hov/ever the present sample contained people of varied types. As shown, 7 of the 12 therapists are either of the two aforementioned types; two differ only in that they have Judging predominant over Perception, and in one of these cases the score v;as barely into the Judging zone. The other three, however, are Extraverted or Introverted Sensing Types with Thinking and Judging dominant. It would be interesting to note v/hether those of the "noncounselor" types have different scoring patterns from the others on the Carkhuff Process Scales. Hypotheses The specific research hypotheses fall into two major categories: (a) those regarding differences between multiple and individual therapy, and (b) those concerned with the *Personal communication, November 18, 1970.

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50 multiple condition itself. The instruments by which a hypothesis was tested ^ along with item numbers when appropriate, are given belov?. The hypotheses are numbered consecutively through both categories Multiple Versus Individual Therapy TSR. — The therapists will report that the therapeutic interactions differed in the two conditions. Compared to individual therapy, they v/ill rate the clients in multiple therapy as 1. Having talked more about relations with persons of both sexes (Items 1 and 2) 2. Having discussed a greater variety of topics (Items 1-5) 3. Having wanted more to express or explore feelings (Items 6 and 9) 4. Having had their feelings more stirred up (Item 17) 5. Agreeing with and/or accepting more of their comments or suggestions (Item 21) 6. Having shown more progress (Item 25) Similarly, the therapists will be apt in multiple therapy to rate themselves as : 7. More revealing of their spontaneous impressions or reactions (Item 29) 8. More understanding of what their patients said and did (Item 31) 9. Being more helpful to their patients (Item 32). 10, Being more critical or disapproving to their clients (Item 35) 11. Being more warm and friendly toward their clients (Item 36) "^:*o"~ ^ <'

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51 12. Expressing more feeling (Item 37) 13. It is expected that the client-therapist agreement as to the events of the sessions will be higher in multiple therapy than in individual therapy (on 24 items of the therapist and client forms of the TSR) Comparative Therap y Scale --More therapists will rate multiple therapy over individual therapy as : 14. Being conducive to self -understanding of the therapist (Item 6) 15. Being useful in training therapists (Item 10). 16. Offering more personal gratification (enjoyment or "fun") for the therapist (Item 11). 17. Being their general preference (Item 24) 18. Fostering the resolution of impasses (Item 32). 19. The therapists generally will express a more positive attitude toward multiple therapy than tov/ard individual therapy (Items 1-32) Carkhuff Process Scales --The therapists will offer higher levels of therapeutic conditions more consistently in multiple therapy than in individual therapy. It is hypothesized that the therapists will offer higher facilitative core conditions as measured by the scales of: 20. Empathy. 21. Respect. 22. Genuineness. 23. Concreteness The Multiple Condition CRI — Only one of the therapist pairs had done therapy together previously and this had not been an extensive ••— <3J*

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52 collaboration. It v/as thought, then, that the relationships of the paiirs v?ould change toward greater intiraacy and caring over timcc It was hypothesized that the following scales would shovT increases : 24. Affection. 25. Friendship. 26. Empathy. 27. Being Love. 28. Deficiency Love. Also, it appeared possible that as the therapists' relationships became more collaborative, their focus on themselves in the association would decrease. The scale of Self Love on the CRI measures the amount of concern about oneself or one's tendency to be an independent person, a "top dog" in the relationship, 29. The scores on the scale of Self Love were hypothesized to decrease from the first to the last session. POI .---The therapists should show some grov/th during the time they are involved in multiple therapy. It was hypothesized that the counselors would show increases in selfactualization on the following scales: 30. Tim.e-Com.petence. 31. Inner-Directed. 32. Capacity for Intimate Contact. 33. Spontaneity. The multiple relationship and client outcome --It was hypothesized that there would be a relationship between

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client outcome and certain aspects of the multiple therapy relationship. First of all, it v/as postulated that 34. There will be a positive correlation between the self-actualization of the clients (as measured by the major POI scales of Time-Com,petence and InnerDirected) and the level of caring of the thera-pists (as measured by the CRI scales of Affection, Friendship, and Empathy) Secondly, it was planned to compare the clients' scores on the S--A Scale v/ith their therapists scores on the MTRS to test the following hypotheses : 35. The quality of the co-therapist relationship will be positively related to the client level of selfactualization (as measured by the S-7\ Scale) 36. There v;ill be a positive relationship between agreem.ent of the cotherapists as to how they behaved and perceived during the sessions and the level of self-actualization of the clients (on the S-A Scale)

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RESULTS Comparison of Multiple and Individual Conditions Number of Sessions As mentioned previously, the therapists had to have at least four sessions with a client for that case to be included in the study. Of the seven cases where clients were terminated before the fourth session, six were in the individual and one in the multiple condition, A sign test determined the probability of this occurrence as being .062. Table 31 in Appendix H lists the total number of sessions for the individual condition as 7.75, the mode 5. For the multiple condition, the mean was 7.50 and the mode 6. As heretofore explained, one of the multiples in which each therapist participated was selected at random for purposes of comparing measures of that therapist in the multiple condition to those of his in the individual condition. The other multiple in which he participated was relegated to his partner. A Wilcoxon matched-pairs signed-ranks test was calculated between the number of sessions that each therapist had with his client in the individual condition and and number he had with his client in the multiple condition This test yielded nonsignificant results (T = 16.5, p > .05, critical value = 11) suggesting that the groups were matched on this variable. 54

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55 TSR Data All of the hypotheses aligned with the TSR instrument, concerning the predictions that the counselors would report differing therapeutic interactions in individual and multiple therapy, were tested similarly. In each case, a randomized block factorial design (Kirk, 1969, pp. 237-244) was used to assess the differences between conditions (multiple and individual) and time of measurement (initial or terminal interview). The test employed was a two-v/ay analysis of variance with repeated measures on both variables, as the same therapists participated in both conditions and pre and post data were collected on them. Hypothesis 1 --Compared to individual therapy, the therapists v/ill rate the clients in multiple therapy as having talked more about relations with persons of both sexes (Items 1 and 2). As shown in Table 2, the analysis of variance of the therapists' scores on the first two items yielded no significant F ratio for blocks, condition, time, or the interaction of condition and time. Hypothesis 1 was not supported. Hypothesis 2 --Compared to individual therapy, the therapists will rate the clients in multiple therapy as having discussed a greater variety of topics (Items 1-5) As shown in Table 3, the F ratio for blocks was significantly greater than zero, meaning that there were individual differences between the therapists, as might be expected.

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56 TABLE 2 MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMI^?\RY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES TO TSR ITEMS 1 AND 2 I'OR MULTIPLE AND INDIVIDUAL CONDITIONS Multiple Indivi dual Pre Post Pre Post 2.5833 2.1660 2.5000 2.0000 (.9962 (.3892) (.6742) (1.0415) Source df MS P Blocks 11 .4147 .55 Treatments 3 Condition (A) 1 .1875 .25 Time (B) 1 2.5275 3.33 A X B 1 .0201 .03 Residual 33 .7582 Total 47 Note: The standard deviations are in parentheses. Hypothesis 3 — Compared to individual therapy, the therapists v;ill rate the clients in multiple therapy as having wanted more to express and explore feelings (Items 6 and 9). Table 4 lists a significant blocks ratio, again indicating that there were individual differences among the therapists as to how they respondedThe effect of condition was not significant,' and Hypothesis 3 was not substantiated. A significant ratio was obtained for time, with the initial interview means being larger than those of the

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57 terminal interviev/. The therapists, then, felt that their clients wanted to express and explore feelings more during the first session than they did during the last. TABLE 3 MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMr4ARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES TO TSR ITEMS 1-5 FOR MULTIPLE AND INDIVIDUAL CONDITIONS Multiple Individual Pre Post Pre Post 3.2500 (.8660) 3.2500 (1.1382) 3.2500 (.9653) 3.0833 (1.2401) Source df MS Blocks Treatments 11 3 Condition (A) Time (B) A X B Residual Total 1 1 1 33 47 1.9469 .0833 .0833 .0834 .8560 2.27* .10 .10 .10 Note: The standard deviations are in parentheses. *p < .05. Hypothesis 4 --Compared to individual therapy, the therapists will rate the clients in multiple therapy as having had their feelings more stirred up (Item 17) This hypothesis was rejected, as the F ratio for condition was not significant. A perusal of the data to detect a possible

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58 TABLE 4 MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMJ^IARY TABLE FOR THE THERAPISTS PRE AND POST RESPONSES TO TSR ITEMS 6 AND 9 FOR MULTIPLE AND INDIVIDUAL CONDITIONS Multiple Pre 1.6660 (.6513) Source Post 1.2500 (.8660) df Individual Pre 1.7500 (.4523) MS Post 1.4166 (.7930) F Blocks 11 Treatments 3 Condition (A) 1 Time (B) 1 A X B 1 Residual 33 Total 47 1.0208 .1874 1.6874 .0209 .3289 3.10** .57 5.13* .06 Note: The standard deviations are in parentheses. *p < .05. **p < .01. negative bias in the test seemed worthwhile, since the ratio for time obtained by using the mean square, for residual was close to significance (F = 3.59, p < .10) As an inspection of the data suggested that there might be an interaction between blocks and treatments, the residual error was partitioned into its component parts and new F ratios were computed. As shown in Table 5, however, none of the F ratios were significant. •I tai.iaj ..•;•..,_

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59 TABLE 5 MEANS, STANDARD DEVIATIONS, ?:.ND THE ZINALYSIS OF VARIANCE SUM^.RY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES TO TSR ITEM 17 FOR MULTIPLE AND INDIVIDUAL CONDITIONS Multiple Pre Post Individual Pre Post 1.6666 (.6513) 1.1666 (.3892) 1.5833 (.6686) 1.4166 (.7930) Source df MS Blocks 11 Treatments 3 Condition (A) 1 Time (B) 1 A X B 1 Residual 33 A X blocks 11 B X blocks 11 AB X blocks 11 Total 47 .5378 .0833 1.3333 .3334 .3712 .1742 .3333 .6062 1.45 .48 4.00 .55 Note: The standard deviations are in parentheses. Hypothesis 5 --Compared to individual therapy, the therapists will rate the clients in multiple therapy as agreeing with and/or accepting more of their comments or suggestions (Item 21) This hypothesis v/as rejected when, in fact, the results showed (Table 6) that the means were significantly higher both pre and post for the individual than the multiple condition. The therapists, then, felt that their

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60 clients agreed v/ith and/or accepted more-i of their coiranents or suggestions in the individual condition. None of the other F ratios v/ere significant. TABLE 6 MEAlsfS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUiXLMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES TO TSR ITEM 21 FOR MULTIPLE AND INDIVIDUAL CONDITIONS Blocks 11 Treatments 3 Condition (A) 1 Time (B) 1 A X B 1 Residual 33 Total 47 Mult ipl e Ind ivid ual Pre Post Pre Post 1.2500 (.6216) 1.3333 (.7785) 1,6666 (.4924) 1.9166 (.6686) Source df MS F .537 8 2.9999 .3333 .0835 .3813 1.41 7.87** .87 .22 Note: The standard deviations are in parentheses. **p < .01. Hypothesis 6 — Compared to individual therapy, the therapists will rate the clients in multiple therapy as having shown more progress (Item 25) As evinced by the results in Table 7, this hypothesis V7as not supported, and the F ratios for blocks, time, and the interaction of time and condition were also nonsignificant. ;

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61 TABLE 7 MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMMiiRY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES TO TSR ITEM 25 FOR MULTIPLE AND INDIVIDUAL CONDITIONS Multiple Prt Post Individual Pre Post 2.2415 (.5149) 2.7500 (1.0553) 2.5833 (.6686) 2.6666 (.4924) Source df MS Blocks 11 Treatments 3 Condition (A) 1 Time (B) 1 A X B 1 Residual 33 Total 47 .2026 .0208 .5208 .1876 .6218 .33 .03 .84 .30 Note: The standard deviations are in parentheses. Hypothesis 7 --The therapists will be apt in multiple therapy to rate themselves as more revealing of their spontaneous impressions or reactions than in individual therapy (Item 29). As listed in Table 8, no significant F ratios resulted from the analysis of variance of the scores involved in this prediction. Hypothesis 6 was not supported. Hypothesis 8 — The therapists will be apt in multiple therapy to rate themselves as more understanding of what their patients said and did than in individual therapy (Item 31) The analysis of variance summary table reported

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62 TABLE 8 MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARI7\NCE SUMI4ARY TABLE FOR THE THERAPISTS PRE AND POST RESPONSES TO TSR ITEM 29 FOR MULTIPLE AND INDIVIDUAL CONDITIONS Multiple Pre Post Individual Pre Post 3.3330 (.9847) 3.8333 (1.0299) 3.7500 (.8660) 3.8333 (.9374) Source df MS Blocks 11 Treatments 3 Condition (A) 1 Time (B) 1 A X B 1 Residual 33 Total 47 1.4147 .5208 1.0208 .5209 .7481 1.89 .70 1.37 .70 o Note: The standard deviations are in parentheses. Op < .10. in Table 9 shov/s a significant F ratio for blocks, indicating that there were individual differences between the therapists on this item. The ratios for condition, time, and the interaction of time and condition were nonsignificant. Hypothesis 8, then, was not supported. Hypothesis 9 — The therapists will be apt in multiple therapy to rate themselves -as being more helpful to their patients than in individual therapy (Item 32) This hypothesis was not substantiated; Table 10 includes no significant F ratios.

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63 TABLE 9 MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMMARY TABLE FOR THE THE.R.APISTS PRE AND POST RESPONSES TO TSR ITEM 31 FOR MULTIPLE AND INDIVIDUAL CONDITIONS Multip le Pre 4.0388 (.9003) Source Post 4.2500 (.7538) df Individual Pre 3.8333 (1.0299) MS Post 3.6666 (1.3027) Blocks 11 Treatments 3 Condition (A) 1 Time (B) 1 A X B 1 Residual 33 Total 47 1.8106 .7500 .3333 .0000 .5732 3.16** 1.31 .58 00 Note: The standard deviations are in parentheses. ** p < .01. TABLE 10 MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUM]}4ARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES TO TSR ITEM 32 FOR MULTIPLE AND INDIVIDUAL CONDITIONS Multiple Pre 3.1666 (.8348) Post 3.3333 (1.0731) Individual Pre 3.0000 (1.0445) Post 3.5000 (1.3817)

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64 TABLE 1.0— (continued) Source df MS Blocks 11 Treatments 33 Condition (A) 1 Time (B) 1 A X B 1 Residual 33 Total 47 .7935 .72 1.0208 .92 1.0208 .92 .1876 .17 1.1066 Note: The standard deviations are in parentheses. Hypothesis 10 — The therapists will be apt in multiple therapy to rate themselves as being more critical or disapproving to their clients than in individual therapy (Item 35) Again, the only significant F ratio shown in Table 11 was that of blocks signifying that there were individual differences among the therapists as far as their self-report of how much they expressed their critical or disapproving thoughts to their clients was concerned. It is noteworthy that all of the means included in Table 11 are very low — very few of the therapists rated themselves as being negative or critical at all. As there was not a significant F ratio that concerned condition, Hypothesis 10 was rejected. Hypothesis 11 — The therapists will be apt in multiple therapy to. rate themselves as being more warm and friendly

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65 TABLE 11 MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUI^iARY T/iBLE FOR THE THERAPISTS' PRE AND POST RESPONSES TO TSR ITEM 35 FOR MULTIPLE AND INDIVIDUAL CONDITIONS Multiple Pre Post Individual Pre Post .3333 (.4924) .5454 (.6876) .3333 (.4924) .4166 (.5149) Source df MS Blocks 11 Treatments 3 Condition (A) 1 Time (B) 1 A X B 1 Residual 33 Total 47 .6420 .0207 .1875 .0209 .2127 3.02** .10 .10 Note: The standard deviations are in parentheses. **p < .01. toward their clients than in individual therapy (Item 36) This hypothesis was not supported, as the ratio for condition was not significant; neither v/ere the ratios for time and the interaction of condition and time. Table 12 shows that the ratio for blocks was appreciably greater than zero, indicating the existence of individual differences between the therapists on this item. Hypothesis 12 — The therapists will be apt in multiple therapy to rate themselves as expressing more feeling than in individual therapy (Item 37) This hypothesis was not

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66 supported, as a nonsignificant ratio for condition was obtained. The ratios for time and the interaction of condition and time were also below the .05 level of significance, V7hile that of blocks v/as above (Table 13) There were individual differences among the therapists, then, as to how much feeling they rated themselves as expressing. TABLE 12 MEANS, STAND7\RD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMMARY TABLE FOR THE THERAPISTS PRE AND POST RESPONSES TO T3R ITEM 36 FOR MULTIPLE AND INDIVIDUAL CONDITIONS Multiple Pre Posi Individual Pre Post 2.1666 (.3892) 2.0833 (.6686) 2.2500 (.6216) 2.3333 (.6513) Source df MS Blocks 11 Treatments 3 Condition (A) 1 Time (B) 1 A X B 1 Residual 33 Total 47 .6742 .3333 .0000 .0834 .2449 2.75* 1.36 .00 .34 Note: The standard deviations are in parentheses. p < .05.

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67 TABLE 13 MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SURMARY TABLE FOR THE THERAPISTS' PRE AND POST PvESPONSES TO TSR ITEM 37 FOR MULTIPLE AND INDIVIDUAL CONDITIONS Multiple Pre Post Individual Pre Post 1.3333 (.4924) 1.5833 (.6686) 1.6666 (.6513) 1,5833 (.6686) Source df MS Blocks 11 Treatments 3 Condition (A) 1 Time (B) 1 A X B 1 Residual 33 Total 47 .7 329 .1875 .0208 .1875 .2834 2.59* .66 .07 .66 Note: The standard deviations are in parentheses. *p < .05. Hypothesis 13 — It is expected that the therapist-client agreement as to the events of the sessions will be higher in multiple than in individual therapy (on 24 selected items listed in Tables 31 and 32, Appendix H) Table 14 lists the Pearson product-moment correlations computed between the scores of the therapists and those of their clients with whom they were paired. As shown, for the initial interview, nine of the therapists have higher agreement

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68 scorers in the multiple than in the individual condition. A sign test (tv/o-tailed) determined that this difference was nonsignificant (p = .146). For the terminal session, seven of the therapists had a higher correlation between their scores and those of their clients in individual than multiple therapy — -this was also not a significant difference (p = .774). As far as client-therapist agreement, then, no descriptive evidence of a difference betv;een the conditions V7as found; Hypothesis 13 was thus not supported. TABLE 14 THERAPIST-CLIENT AGREEMENT SCORES FOR MULTIPLE AND INDIVIDUAL CONDITIONS: CORRELATIONS BETWEEN THEIR RESPONSES TO 24 TSR ITEMS Multiple Individual Therapistclient pair Pre Post Therapistclient pair Pre Post A10 .76 .47 A7 .52 .46 B-8 .83 .80 B-12 .65 .41 C-16 .64 .51 C-17 .81 .66 D-14 .79 .71 D-29 .68 .88 E-2 5 .91 .43 E-39 .75 .49 F-20 .49 .91 F-22 .78 .70 G-37 .82 .73 G-23 .62 .65 H~26 .84 .81 H-21 .97 .82 1-33 .80 ,83 1-38 .77 .87 J31 .67 .41 J-30 .57 .62 K-35 .90 .88 K-34 .78 .81 L-36 .78 .30 L-40 .60 .46 *^kt^t,^l;t.*,..

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69 In inspecting the agreement scores for the first and the last session, it is noteworthy that 17 of the 2 4 cases had higher therapist-client agreement scores for the pretest than the posttest. A binomial test (two-tailed) showed this difference to be nonsignificant (p = .064 at the .05 level). In breaking this down into groups, in 10 out of the 12 multiple cases the posttest agreement scores were lower than the pretest scores {p = .038); while in the individual group, only 7 out of 12 were lower (p = .774). As far as the difference between preand posttesting, then, the two groups appear dissimilar. In the multiple condition, the agreement between the therapists and their clients was significantly greater during the initial interview than it was during the terminal interview. In the individual condition, there V7as not a significant difference between therapist-client agreement at the end, as compared to the beginning, of therapy. CT5 Data As per the prior explanation (see Method section) the mean and the modal scores of the therapists on the 32 items of the CTS were determined. Means and modes of 1 to 3 designate topics that the therapists felt typified multiple therapy, while 4 indicated no difference, and 5 to 7 signified statements thought to be true of individual therapy. The mean scores of the 3 2 items were used to rank order the topics, as shown in Table 15. The smaller ranks

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70 thus designate statements that the therapists felt were definitely more applicable to multiple therapy than to individual therapy. There were three means that were above 4.00, and all of these items v/ere negative ones; that is, "years of experience necessary to do effective therapy," "difficulties by the therapist in 'handling' intense transference reactions," and "em.otional demands experienced by the therapist." The following hypotheses (14-18) were not tested per se, but were considered to be confirmed if the mean and the modal score were 3.0 or less. As statistical tests were not performed, the conclusions are considered to be suggestive. Hypothesis 14 --The therapists will rate multiple therapy over individual therapy as being conducive to selfunderstanding of the therapist (Item 6) This hypothesis was supported as the mean score of 2.667 and the mode of 2 indicated that the therapists felt that multiple therapy was slightly to moderately more conducive to self-understanding than was individual therapy. Hypothesis 15 — The therapists will rate multiple therapy over individual therapy as being useful in training therapists (Item 10) The results substantiate this hypothesis, as the therapists rated multiple therapy as being moderately to much more useful in training therapists. The mean and mode scores on this item were 2.083 and 1, respectively.

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71 TABLE 15 MEANS, MODES, AND RANKS OF THE THERAPISTS' RESPONSE PATTERN ON THE 3 2ITEM COMPARATIVE THERAPY SC^^XE 1 2.000 2 2.5 2.083 1 2.5 2.083 1 4 2.167 5 2.333 6.5 2.417 Item no. Rank Mean Mode 32. Resolution of impasses. 10. Useful in training therapists. 14. Useful with marital couples. 4. Opportunity to work out anxieties with a therapist of the more dreaded sex. 3. Transference of the original family situation. 8. Understanding of countertransference. 28. Your general preference with a patient who ferociously clings to persons of one sex. 6.5 2.417 1. Understanding, by the therapist, of the transference. 8 2.583 6. Self-understanding of the therapist enhanced. 9 2.667 11. Personal gratification (enjoyment or "fun") for the therapist. 10 2.727 30. Your general preference for working out and through a patient s very intense "negative" transference. 11.5 2.750 31. Your general preference for working out and through a patient's very sticky "positive" transference. 11,5 2.750 18. Working out and through problems of masculinity and feminity. 13 2.833 20. Opportunity for patients of both sexes to identify with a reasonably healthy person of the same sex. 14.5 2.917

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TABLE 15-(continued) 72 item no. Rank Mean Mode 16.5 3.000 3 16.5 3.000 3 19 3.167 4 19 3.167 3 19 3.167 3 21 3.250 3 26. Your general preference with a patient who is expecially fearful of heterosexual relations. 14.5 2.917 12. Useful v/ith very "acting out" patients 24. Your general preference. 16. Positive therapeutic movement, in general. 17. Working through, in general. 19. Working out and through problems of hostility and assertiveness 21. Understanding of resistance. 25. Your general preference with a patient who is very mistrustful of authority, especially of one sex. 22.5 29. Your general preference when only short-term therapy, i.e., 6 months or less is available. 22.5 22. More complex patterns of resistance. 24.5 27. Your general preference with a patient who is especially fearful of homosexual longings. 23. Eliciting of oedipal dynamics. 13. Useful with borderline schizophrenics 15. Useful with "oral characters." 2. Completeness of transference patterns. *9. Years of experience necessary to do effective therapy. *5. Difficulties by the therapist in "handling" intense transference reactions. 31.5 4.917 3.333 3 3.333 4 3.500 4 24.5 3.500 4 26 3.727 4 27.5 3.750 4 27.5 3.750 4 29 3.909 4 30 4.333 4

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73 TABLE 15 — (continued) Item ^o Rank Mean Mod( *7. Emotional demands experienced by the therapist. 31.5 4.917 Hypothesis 16 — The therapists will rate multiple therapy over individual therapy as offering more personal gratification (enjoyment or "fun") for the therapist (Item 11). The therapists did feel that multiple therapy offered slightly to moderately more personal gratification, thus supporting Hypothesis 16. Hypothesis 17 --The therapists will rate multiple therapy over individual therapy as being their general preference (Item 24) Although not being one of the highestranked topics, Table 15 shows a mean and mode score of 3 on this item, signifying that the therapists felt multiple therapy to be slightly more their general preference. Hypothesis 18 .— The therapists will rate multiple therapy over individual therapy as fostering the resolution of impasses (Item 32) This hypothesis was supported, as the therapists felt that multiple therapy was moderately more effective in fostering the resolution of impasses. The mean score of 2.00 was the highest of any item; the mode on this topic was also 2. Hypothesis 19 — The therapists generally will express a more positive attitude toward multiple therapy than toward

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74 individual therapy (Items 1-32). To test this hypothesis, a total score for each therapist regarding his attitudes toward multiple and toward individual therapy was obtained (see Method section). Basically, the responses of the therapists on each itera v/ere scored from "slightly mox-e" (1) to "much more" (3) for both regular and co-therapy, with the "no difference" column being omitted. As shown in Table 16, a Wilcoxon matched-pairs signed-ranks test (Seigel, 19 56) detected that the differences v/ere significant, thus confirming Hypothesis 19. TABLE 16 WILCOXON MATCHED-PAIRS SIGNED-RANKS TEST FOR TESTING DIFFERENCES IN THERAPISTS' ATTITUDES ABOUT MULTIPLE AND INDIVIDUAL THERAPY Multiple Individual Rank Rank with less Therapist therapy therapy d of d frequent sign A 70 4 66 11 B 30 1 29 8.5 C 28 1 27 6.5 D 28 1 27 6.5 E 19 19 2 F 31 2 29 8.5 G 21 13 8 1 H 22 2 20 3 I 23 1 22 4 J 83 83 12 K 39 4 35 10 L 30 4 26 5 T = 0005,

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75 Carkhuf f Process Scales Data The average ratings that the therapists received on the core facilitative conditions were to be based on ratings by two judges of three segments from each first and last session. It should be mentioned, hov/ever, that in the multiple condition there were eight instances where the female co-therapist did not talk during one or two excerpt (s) and her average rating for that session was based on two or one segment (s), respectively. There were not any segments from the individual condition where this occurred, nor was a male co-therapist silent during a 5-minute segment from the multiple condition. Of the ratings that were used to assess the differences between the therapists' offered levels of the core facilitative dimensions, two ratings are based on one segment and two are based on two excerpts (as noted in Table 35, Appendix H) The following results must be qualified, then, by the statement that the average ratings were not all compiled from the same number of excerpts For each of the four process scales, a randomized block factorial design (Kirk, 1969) was used to test the differences between condition (multiple and individual) and time of measurement (first or last interview) In three instances, there were no significant F ratios when these were computed using the residual error term. As an inspection of the data suggested a possible interaction between blocks

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76 and treatments v/hich could result in a negative bias being present in the test, new F ratios were computed using the cornponent parts of the residual error. Although directional I hypotheses had been postulated in regard to conditions, an attempt was made to explain the significant interactions resulting from the analyses of variance. Thus, the simple main effects tests used were tv70~tailed t tests, which allov/ed for the testing of significant differences in either direction. j Hypothesis 20 --The therapists v/ill offer higher levels of em.pathy in multiple therapy than in individual therapy. Table 17 lists a significant ratio for blocks, indicating f the presence of individual differences among the therapists ,. I as to. their offered level of empathy. The main effects of condition and time were nonsignificant, while that of the interaction of condition and time was significant at the .05 level. A simple main effects test (Kirk, 1969) on the means involved showed that the therapists offered significantly higher levels during the terminal session than during the initial interview in the individual condition (t = 2.70, df = 22, p < .02), while the slightly larger pretest mean in the multiple condition was not significantly different from the posttest mean (t = 1.31, df = 22, p > .10). Contrary to Hypothesis 20, the therapists were higher on the Empathy scale in the individual condition during the terminal session than in the multiple condition (t = 3.43, df = 22,

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77 p > .01). The means suggest that the levels offered in the tv70 conditions were fairly equivalent at the onset of therapy, but increased as therapy proceeded in the individual condition v/hile remaining the same in the multiple. TABLE 17 MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST EMPATHY SCORES FOR MULTIPLE AND INDIVIDUAL CONDITIONS Multiple Individual Pre Post Pre Post 2.772 (.475) 6.608 (.449) 2.653 (.630) 3.041 (.448) Source df Blocks 11 Treatments 3 Condition (A) 1 Time (B) 1 A X B 1 Residual 33 Total 47 MS ,462 ,296 ,151 916 188 2.46* 1.58 .80 4.87* Note: The standard deviations are in parentheses. *p < .05. Hypothesis 21 --The therapists will offer higher levels of respect in multiple therapy than in individual therapy. Table 18 shows that, similar to the results of the Empathy scale, the analysis of variance of the scores on the Respect scale yielded significant blocks and interaction ratios.

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78 TABLE 18 MEANS, STANDARD DEVIATIONS, Al^ID THE MJALYSIS OF VARIANCE SUI-'lf'lARY TABLE FOR THE THERAPISTS' PRE A>JD POST PvESPECT SCORES FOR MULTIPLE AND INDIVIDUAL CONDITIONS Mu Itipl Individual Pre Post Pre Post 2.702 (.434) 2.622 (.488) 2.702 (.572) 3 ( .048 .447) Source df MS F Blocks 11 .536 3.82** Treatments 3 .546 Condition (A) 1 2.73 Time (B) 1 .213 1.95 A X B 1 .547 5.01* Residual 33 .140 A X blocks 11 .200 B X blocks 11 .109 AB X blocks 11 .109 Total 4 7 Note: The standard deviations are in parentheses. *p < .05. **p < .01. while those of condition and time v/ere nonsignificant. Again, the posttest mean in the individual condition differed significantly from, the pretest mean of that condition (t = 3.64, df = 22, p < .002) and from the posttest mean of the multiple condition (t = 4 48 df = 22 p < .002). The pretest means of the two conditions were equal, and the

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79 difference between the pre and post means in the multiple condition did not reach significance (t = ,84, df = 22, p > .20). Again, then, the therapists offered a comparable level of a facilitative core dimension in both conditions at the beginning of therapy, but a higher level in the individual condition at therapy's end. Hypothesis 21 was rejected. Hypothesis 22 — The therapists v/ill offer higher levels of genuineness in multiple therapy than in individual therapy. Neither of the main effects, condition or time, was found to be significant when the scores on the Genuineness scale v/ere analyzed (Table 19) Individual differences between the therapists were indicated by a significant blocks ratio;, and a significant interaction betv>7een condition and time was detected. A sim.ple main effects test on the relevant means again determined that the post mean for the individual condition was significantly different from the pre mean for the individual condition (t = 4.46, df = 22, p < .002) and the post mean for the multiple condition (t 4.82, df = 22, p < .002). Again, the difference between the slightly larger pre mean of the multiple condition and the post mean was not significant (t = .50, df = 22, p > .50). Since this difference was larger than that between the pre means of the multiple and individual conditions, the latter difference was also known to be nonsignificant. The therapists v/ere shown to significantly

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80 raise their offered level of genuineness in the individual condition over the course of therapy, vjhile the level in the raultiple condition remained static. Hypothesis 2 2 was not supported when the results indicated the only significant difference between the conditions to be that of individual being higher than multiple during the terminal session. TABLE 19 MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMMP.RY TABLE FOR THE THERAPISTS' PRE AND POST GENUINENESS SCORES FOR MULTIPLE AND INDIVIDUAL CONDITIONS Mul tiple Ind ividual Pre Post Pre Post 2.693 (.400) 2.658 (.460) 2.683 (.534) 2.993 (.417) Source df MS F Blocks 11 Treatments 3 Condition (A) 1 Time (B) 1 A X B 1 Residual 33 A X blocks 11 MS B X blocks 11 MS^„ AB X blocks 11 Total 47 .375 .327 .219 .348 .152 .258 .139 .058 2.47* 1.27 1.58 6.00* Note: The standard deviations are in parentheses, *p < .05.

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81 Hypothesis 23 --The therapists will offer higher levels of concreteness in multiple therapy than in individual therapy. Table 20 shovrs that a significant F ratio was obtained for the interaction of time and condition when the scores of the therapists on the Concreteness scale were analyzed by the randoraized block factorial design. The ratios for blocks and the main effects of condition and time were nonsignificant at the ,05 level. A simple main effects test again determined that the difference between the pretest and posttest means in the individual condition was significant (t = 2.97, df = 22, p < .01), as was that between the posttest means of the individual and multiple conditions (t = 3.74, df = 22, p < .002). Again, in comparing the pretest mean of the multiple condition with the posttest mean of that condition and the pretest mean of the individual condition, the larger difference was shown to be nonsignificant (t == 1.29, df = 22, p > .20). In regard to the offered levels of concreteness, then, the therapists showed a pattern similar to the results of the other scales. The conditions v/ere not significantly discrepant at the initiation of therapy. At termination, however, the therapists offered higher levels of concreteness in the individual condition than they had at therapy's beginning and than they did at the end of multiple therapy. Conditions and therapist type --In comparing the types of the therapists on the Myers-Briggs Type Indicator and

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82 TABLE 20 MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE SUMJMARY TABLE FOR THE THERAPISTS' PRE AND POST CONCRETENESS SCORES FOR MULTIPLE AND INDIVIDUAL CONDITIONS Multiple Pre Post Individual Pre Post 2.721 (.427) 2.608 (.470) 2.675 (.588) 2.99 3 (.415) Source df MS Blocks 11 Treatments 3 Condition (A) 1 Time (B) 1 A X B 1 Residual 33 A X blocks 11 ^^B X blocks 11 AB X blocks 11 Total 47 360 347 126 558 187 ,284 ,186 ,092 1.93 1.22 .68 6.07* Note: The standard deviations are in parentheses. *p < .05. Op < .10. their obtained ratings on the Carkhuff scales, it did not appear that there was any consistent pattern among the "counselor" and the "noncounselor" types. Table 36 in Appendix H shows the types of the therapists along with the rank orders of their scores on the Carkhuff scales of 1 — ^-%' — "im -fti'T"1't 'I'i*'— fc ,.

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Empathy, Respect, Genuineness, and Concreteness The rank orders were obtained by using the average of the judges' ratings for each therapist across both conditions, pre and post, as listed in Table 35, Appendix H. Of the 12 therapists, there were three women (Counselors B, D, and F) and one male (K) who were consistently rated as offering high facilitative levels (average over 3.0) of the core conditions The three female counselors were all "counselor" types, dominant in Intuition, Feeling, and Perception, whether Introverted or Extraverted. The one male was also strongest on Intuition and Feeling. Although his score on the Judging-Perceiving dimension indicated that Judging v/as dominant, the score was so close to the midpoint, it is difficult to be certain of his preference. The next three highest-scoring counselors on the Carkhuff scales (E and L on Empathy and Respect and H on Genuineness and Concreteness) were all "noncounselor" types. Three of the therapists receiving ranks of 9.5, 10, 11, and 12 were "counselor" types (A, I, and J), while two were "noncounselor" types. (G and H) The Multiple Condition CRI Data The hypotheses aligned with the CRI data concerned the general prediction that the relationships of the pairs of co-therapists would change toward greater intimacy and caring over time. Table 21 shows the mean preand posttest

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84 scores and their standard deviations for the 12 therapists on four of the major scales and two subscales of the CRI For each scale, the difference between the pre and post means v/as tested using a m.atched-group t test (df = 11) and the obtained values are also reported in Table 21. The obtained levels of significance are those for a one-tailed | test, as directional hypotheses were postulated in all instances TABLE 21 I PREAND POSTTEST MEANS AND STANDARD DEVIATIONS I OF THE THERAPISTS' CRI SCALE SCORES Scale or subscale Pretest Posttest t !,. Affection 7.416 8.667 1.92* (1.786) (1.775) Friendship 10.583 11.917 2.46** (1.929) (2.109) Empathy 11.750 13.250 2.24** (2.094) (1.658) Self Love 13.500 12.833 -1.20 (1.883) (1.337) Being Love 12.000 13.333 3.09*** (1.206) (.779) Deficiency Love 2.750 3.000 .67 (1.603) (1.537) Note: The standard deviations are in parentheses. *p < .05. **p < .025. ***p < .01. Hypothesis 24 --The therapists' scores on the scale of Affection will be higher at the end of therapy than at the o-.-^^SSfc^'Si.SS!-,

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85 beginning. This hypothesis v/as s'apportad, as the posttest mean v/as significantly larger tlian the pretest mean (t = 1.92, p < .05) Hypothesis 2 5 --The therapi:sts' scores on the scale of Friendship will be higher at the end of therapy than at the beginning. On the Frie^ndship scale, the posttest mean was significantly higher than the pretest mean (t = 2.46, p < .025) thus supporting Hypothesis 25. H ypothesis 26 --The thei'anists' scores on the scale of Empathy (M) v/ill be higher at the end of therapy than at the beginning. The results substantiated this prediction, as the pretest mean was significantly smaller than the posttest mean (t = 2.24, p < .025). Hypothesis 27 --The therapists' scores on the scale of Being Love will be higher at the end of therapy than at the beginning. The posttest mean vvas significantly higher than the pretest mean on the scale of Being Love (t = 3.09, p < .01), thus supporting Hypothesis 28. Hypothesis 28 --The therapists' scores on the scale of Deficiency Love will be higher at the end of therapy than at the beginning. This hypothesis v/as rejected, as the results showed a nonsignificant difference between the preand posttest means (t .67, p > ,10). The difference was in the predicted direction. Hypothesis 29 — The therapists' scores on the scale of Self Love will be lower at the end of therapy than at the

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86 beginning. Although the direction of the difference betvjeen the pre and post means on the Self Love scale was in the predicted direction, the difference was nonsignificant (t = -1.20, p > .10) thus disconfirming Hypothesis 29. It is also interesting to compare the means of the therapists' CRI scores to those published by Shostrom (1966b) for successfully m.arried couples, troubled couples, and divorced couples (Table 22) This comparison might suggest how caring the relationships betv/een the therapists v/ere The pretest m.ean score of the therapists on the Affection scale was close to that of divorced couples, v/hile the posttest was above that of troubled couples. The means for both preand posttestings on the Friendship scale lay between those of troubled couples and successfully married couples. The therapists scored betvreen divorced couples and troubled couples at the beginning of their counseling together on the Empathy (M) scale; but by the end of their work, they were higher than the successfully married couples. On the Self Love scale, the therapists scored higher than the successfully married couples on both preand posttestings. In this instance, it would appear that they v/ere less caring than any of the couples as they were much more concerned with themselves in the relationships The mean of the therapists on the Being Love scale for the pretest was between those of troubled couples and successfully married couples, while the posttesting showed the therapists to be

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87 very close to the successfully married couples. And, on the Deficiency Love scale, the therapists scored considerably lower than all of the couples in Shostrom's sample. Many of these comparisons suggest a trend for the relationships of the co-therapists to become more caring and healthier over their term of working together. TABLE 2 2 MEANS AND STANDARD DEVIATIONS OF SHOSTROM'S^ SAt'IPLE OF SUCCESSFULLY MARRIED, TROUBLED, AND DIVORCED COUPLES ON THE CRI SCALES Scale or subscale Successfully married couples Troubled couples Divorced couples 7 (3 4) 6 6 (3 .6) 10 5 (4 .1) 7 .4 (3 9) 8 .7 (4 .0) 5 2 (2 .6) Affection Friendship Empathy (M) Self Love Being Love Deficiency Love 11.0 (2.2) 12.9 (2.2) 12.9 (2.2) 11.1 (2.9) 13.5 (2.1) 6.1 (2.3) 8.4 (2.9) 8.4 (3.1) 12.2 (2.9) 8.3 (3.1) 10.9 (3.1) 5.6 (2.4) Note: The standard deviations are in parentheses ^Shostrom (19 56b) POI Data The hypotheses concerning the expectation that the therapists would evince a positive change in self-actualization

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88 during the time that they were involved in multiple therapy were all tested similarly. In each instance, the difference between the pre and post mean of a POI scale was tested for significance by means of a matched-group t test. Table 23 lists the means and standard deviations of the therapists' pre and post scores on four POI scales. TABLE 23 MEANS AND STANDARD DEVIATIONS OF THE THERAPISTS' PRE AND POST POI SCORES Scale Pre Posl Time-Competence 17,333 (5.246) 19.750 (2.454) 1.84* Inner-Directed 101.583 (9.549) 103.833 (8.387) 1.78 Capacity for Intimate Contact 22.917 (2.778) 23.750 (2.221) 1.24 Spontaneity 16.167 (2.082) 15.500 (1.931) -1.69 Note: The standard deviations are in parentheses, *P < -05. Op < .10. Hypothesis 30 — The therapists will be more timecompetent at the end of therapy than at therapy's beginning. This hypothesis was supported, as the posttest mean was found to be significantly larger than the pretest miean on the scale of Time-Competence (t = 1.84, p < .05).

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Hyp othesis 31 — The therapists vjill be more innerdirected at the end of therapy than at therapy's beginning. The posttest mean of the therapists on the scale of InnerDirected v;as larger than the pretest mean, but the difference did not reach significance at the. .05 level (t = 1.78, p < .10). Hypothesis 31 vras not supported. Hypothesis 32.--~The therapists will shov/ a greater capacity for intimate contact at the end of therapy than at therai:y's beginning. The therapists' scores on the scale of Capacity for Intimate Contact did not differ significantly from preto posttesting (t == 1.24, p > .10), so Hypothesis 32 was rejected. Hypothesis 33 --The therapists vvfill shovT a greater amount of spontaneity at the end of therapy than at therapy's beginning. As the posttest mean on the scale of Spontaneity was actually smaller than the pretest mean, though not significantly (t = -1.69, p > .10), this hypothesis v/as rejected. The Multiple Relationship and Client Outcome The last three hypotheses postulated significant relationships between client outcome in the multiple condition and certain aspects of the cotherapy relationship. Hypothesis 34 --There will be a positive correlation between the self-actualization of the clients (as measured by the miajor POI scales of Time-Competence and Inner-Directed) and the level of caring of the therapists (as m.easured by

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90 the CRI scales of Affection, Friendship, and Empathy) Pearson product-moment correlations v/ere computed between the post CRI scores of each therapist on Affection, Friendship, and Empathy (M) and the post POI scores of the client with whom he was paired for purposes of data analysis. The scores on vzhich these correlations were based are given in 'Appendix H, Tables 37 and 41. None of the correlations, which ranged from -.2 8 for Affection and Time-Competence to .39 for Friendship and Time-Competence, were significant at the .05 level. Hypothesis 34 v/as not supported. A discussion of the attem.pt to establish test-retest reliability and concurrent validity of the MTRS is in order, before considering the use of this instrument in testing the last tv70 hypotheses. It was thought that the same therapists should rate his relationship to his co-therapist similarly on tv/o separate, but temporally close, occasions. Positive correlations betv/een these two separate ratings were predicted. Test-retest reliabilities were computed for both co-therapist agreement and the therapists' rating of their relationship quality by correlating each therapist's scores on these from his sessions with one client to those from his sessions with his other client. As the distribution of relationship quality scores was not normally distributed. Spearman rank-order correlations were used, when appropriate, with the correction for ties. The rank orders of each therapist's relationship quality scores, pretest.

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91 posttest, and total for each case, are shown in Table 24, v/hile those of the agreement scores of each therapist and his partner as to the events of the session are given in Table. 25. 7\s reported in Table 27, the test-retest reliabilities for relivtionship quality between the pretest ranks of each therapist for his two cases, between the posttest ranks of each therapist for his tv/o cases, and between the ranks of the combined preand posttest scores of one case coittpared to the other vj&re all significant beyond the .05 level. Forco-therapist agreement, likewise, the test-retest reliabilities v;ere significant. As an tittempt to establish concurrent validity for the MTRS, the rank orders of the therapists' scores on four CRI scales (Table 26) v/ere correlated with their relationship quality and co-therapist agreement ranks. As shown in Table 28, co-therapist agreement did correlate significantly with the pretest Affection scale ranks and the posttest Empathy (M) scale ranks. No others were significant. The relationship quality scores did not correlate significantly with any of the CRI scale scores. The two parts of the MTRS also V7ere not significantly correlated with each other, suggesting that each measures a different aspect of the co-therapist relationship. If either of the last two hypotheses v/ere to be confirmed, a crude case for predictive validity of the MTRS scale would be formed. It was thought that co-therapist agreement and relationship quality should be positively related to client outcome.

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92 o u H i a P-i CO H H CO f< S O O H 13 H W < M -:i CO W Pi >^ CO P^ H B B CO kJ H D ft g K O Eh m K Pi U O < fn W .H (d -p o E^ 'd QJ f::! 4J -H cn ^ o E Ph o o 0) CO !^ 0) Ph Cf3 rd U -P m ^ •H -P a (ti pa M 0) Xi B 0) u Id c o o (U CO 4J -P c in Q) H -H ^^ CXiH -H nj O m B (ti 0) CO tci u +J CQ }-) H -P -P fi Cfi Q) H -H rtt O to 5-1 Oj EH rti 5-1 in in oco^Da^vo^ocs'^oalnr-!^^ LO < m iH in (ti • -P o H tH P m CO ft 0) !-i ft CN 00 I (ti -P o O rH &H 4J in tn r-ft CD u ft iH in CO < 00 i m in in in OOOr-COVjD'^CvJf^CN'^HiH .-1 iH rH CMtNVDCTir-'S^CNrvlOOOLnr-l O P H h in O VD I I P3 O I O K en in in • • rr "i^ CN CO r-i I Q in in CN CN I I m CO I I o^ O on VD in (Ti CO H iH in in m in (N CN ^ in CM cn rH Q o o CM CM i H P4 OJ CN i I CD m in o in in in in in o iH rcri m og "^ • in • rH in in o 00 in rH H X) CO I 1-:] in CM iH in CO •P -a o (ti o m -p tn -H (ti M -P CM H rH H (ti SH (U > Q) U CM (ti tH ^ 0) 5^ S-i ^ U CO CO rti +J tn O ^ r-t o (ti 0) (1) x: 4-) o iH iH to Ti tn (1) C -5^ •H (ti (U o o (U [0 P O -P Is to (D •H

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93 H UO in m U) (u •' • • 4J cr^ CM o H ^ m "^ rH rCO KD rH O rH rH T-\ Q Eh 4-1 m in 4-) to CD P5 H CO • • Xi en CO CO O O H CN CN rH rH •^ in cn O rH CD r-rO rH •H Xi O 0) in in in in in in a) xi 4J B s en 0) UD • >£) rH v^ CN • CT^ • ^X) U to CD O w CO W tH ^ •rH CO 1^ 4-> O (0 < m o D w fo CD !il H l-D iJ O H w in Aj Eh a) CO 1^ ^ m C3 tH S s; • CO CO m 4-1 Eh Eh O cn cq H m in in in in in m in to -H to H (0 • • • • • ft Pi 4-1 O^ CN rH in CN in o ro "nJ* CN !h !< O K fo EH rH rH rH 4J W CO Eh M 4J in m in in in in CN cn 0) CO • • • • • • r-i W IS CO o V£) .H rH rH EH CO p:; Q) 4-1 H Eh cn 4-J C 0) p:; X CO 0) o H -H J4 O o VX3 VD in in rr^ cn cn C£) CD u u o P^rH -H rH iH rH rH CN oa cn cn cn cn cn cn to en IS H (t! O to 5h a 1 1 1 Q 1 1 fo 1 C5 1 1 H 1 1-3 1 1 :h measure >st, 12. tH Q 0) "Ti S S x: c H O Eh fO S PM M CO Pi Pi O Pi ri: o !H in in in in in in in in in in to IS W CO tO • a • • • • • • 0) 4-1 CO CO o f-{ cn VD cn CM V£) cn 00 o H fo w Eh ,-4 H •-i Vl G) •4H^ 4-J CO ^g 4-) in in in in in in en Pi CD CO • • • • • tn • Pi rt! CO
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94 IJ3 CM CO u CO H Pi u o O CO w c o CJ CO CO CO H A) m EH W Eh O CO w D P^ O (U -p > m l-q Oi b^ fH -H Q) 0) CQ M Oi -IJ ,~, CD S Cm >i j::; 4J ( ft g 0) w M Cu -P U] ft O •H fll X^ W 'd c; -H ^1 CD Pm U ft -P cn d o ft •H -P O cu M-l m <: 0) ^ ft -p w H ft (0 ^ CU x; F^ 1 en m CTl CN in CM rH t^ n in in <: m ooroi— icocxDCOCOConco o-^ ro r-t-^ r-ro o iH OJ o^ iH U CO in <^ en en cr\ in in in • • • rH CN rH CM CO rH VD H rH in in CO en in 0^ ro "* in Cn^iH'^^VDrHCOVX) in in COCN(M"!a O ^ (U U O (H O rH 4-) fd CO o cu Ui ^ u fO 0) 0) ^ 4-1 U o m rH en ^d Cn 0) d ,y •H d ^ (0 d 5h M m (D & &H --

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TABLE 27 TEST-RETEST RELIABILITIES OF RELATIONSHIP QUALITY AND CO-THERAPIST AGREEMENT FROM THE MTRS 95 Pre Post Total Re lationsh i p quality ,84** .61** .89*-Co-therapist agreement .55* .54* .61* *p < .05. **p < .01. TABLE 28 SPEARIvIAN RANK-ORDER CORRELATIONS BETWEEN RELATIONSHIP QUALITY AND CO -THERAPIST AGREEMENT AND BETWEEN THESE SCALES 7\ND SCALES OF THE CRI Relationship quality Co-therapist agreement Comparison Pre Post Pre Post Cotherapist agreement Pre Post -.14 02 Affection Pre Post .25 .17 .53' 35 Friendship Pre .23 Post Empathy (M) Pre -.05 Post .16 -.14 -.05 .08 .48 56' Being Love Pre Post .41 tp < .05. as .16 .02

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96 Table 29 lists the rank orders of the 12 multiple clients on the S-A Scale and on the posttest POI n-Lajor scales of Inner-Directed and Time Competence. Also listed are the ranks of the therapists' total composite relationship quality and co-therapist agreement' scores. A composite score for both therapists of a pair was obtained by summing both of their scores (on relationship quality or agreement) for a particular session. For each of their two clients, a total quality and a total agreement score was then computed by summing their composite ratings pre and post. The rank of each therapist pair pertaining to each of their clients for relationship quality is listed opposite from the client number, as is their rank for co-therapist agreement. Hypothesis 35 — The quality of the cotherapist relationship will be positively related to the client level of selfactualization (as measured by the S-A Scale) A Spearman rank-order correlation between the relationship quality score of each therapist pair and their client's level of selfactualization (on the S-A Scale) resulted in a nonsignificant rho of -.31. Quality of the co-therapist relationship was then negatively related, although not significantly, to client self-actualization, and Hypothesis 35 was rejected. Hypothesis 36. — There will be a positive relationship between agreement of the therapists as to how they behaved and perceived during the sessions and the level of selfactualization of the clients (on the S-A Scale) A Spearman rank-order correlation coefficient computed between the

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97 >H E^ H i-:| < D a w p^ w H J ii: < w u s CO o H H E-i o <; fi( vA w Q Pi ^ rii — Q H § hi ^^-' <: Q B u W S UD EH W U s rf: w M 1 w CO H Cti Q o M 1 < CO O H &H CU S en 2 H CO H CT) PL( CM ^ g w WW : >A a H eq &^ i-:i ,-^ <; 1 u U Eh O tH O P^ H m H w Eh ffi u M Eh Es CO w o Q B Ph •s W s < O) o s u CO o Pi u i-q ^ 1 < s M Eh s O H H Eh EH EH W K S Eh O Pi Em fe O CO cn M PJ H O O U Pi CO o 1^ s H o ft 0) H D ri4 CO C <; M I CO 4J a CD •H rH U 0) -p -H Ch^ CO H c x: i o •rH -P -P •rH iH tti iH (d H !ti 4-1 0) ;-! ^4 IT Eh 0) -P M -H -P c m CO fd H Sh a Cu g (Ci -P o n C o (D (D ^ g rH -P 0) tc! 1 0) P (H O O tP Eh fd cn +J CO •H & n 5-i EH in CO n in CN rin in • ^ CO Oi CN! OJ rH in CN lO in r-H O C?v H CN n r^ o^ m (N -* rH vn o o ^ VD O CN in CN CN H in o cr\ ro ^ CN CO CN "^ CN CM in in CN in 00 in in o CN H <^ in cn in in a o Q h H H 1-D H p to 0) x: H 411 (U -P U (d (D C O CO Q) tn td u CN iH H td (U > o }H td 0) u CO td • CN xi H o Id • 0) -P to M (D O 5 MH O H CO tn 0) H H-> c! •Id rH M (U (D Eh (D CO P O Id Sh o o CO

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98 total composite co-therapist agreement of each pair and their client's level of self -actualization on the S-A Scale yielded a rho of .54, significant at the ,05 level. A significant association was found, then, between cotherapist agreement in the multiple condition and client outcome, and Hypothesis 36 was supported. As a further check on this finding, rank-order correlations were computed between the co-therapist agreement ranks for each case and the client's relative rank on the posttest POI scales of Time-Competence and Inner-Directed. The coefficient for Time-Competence (rho = .29) was nonsignificant, v/hile that of Inner-Directed (rho = .60) v/as significant at the .05 level (one-tailed) This latter correlation substantiates the finding that co-therapist agreement is positively related to client outcome.

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DISCUSSION Compari son of the Conditions In comparing individual and multiple therapy, the present study investigated three major areas. The first aspect w'as the therapists' report of their clients' and their ov.'n behavior in both conditions. The second involved the therapists attitudes about the two treatment forms in the abstract; the third, the judges' ratings of the therapists' behavior in both conditions as far as facilitative core dimensions. Regarding the hypothesized differences between the psychotherapeutic interactions in multiple and individual therapy, the results disconfirmed the existence of any actual advantages of multiple over individual therapy — whether by the therapists' own report or that of the judges. In fact, there v/as some evidence to the contrary — that individual therapy was more likely to contain ingredients thought to be helpful in counseling. The data did support the claim that the therapists would express a more positive attitude toward multiple therapy and would believe it to be more advantageous than individual therapy. Therapists' Report of Interactions The findings regarding the interactions in multiple and individual therapy pertain, of course, to the results 99

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100 found with the presently used instruments and v^ith the present sample of therapists. It should be noted that the TSR often only provides for a negative answer or a twoor three-level positive answer — not a very wide range of possible responses. As the analyses v/ere computed for single or small groups of items, the range was very constricted. It is possible, then, that the instrument was not sensitive enough to record some differences. The fact that two analyses did yield significant results suggests that the scale was able to detect some differences even with this small range of scores. The clients' behavior — Advocates of co-therapy have stated that the therapists' task is often accomplished more easily and quickly because clients behave differently when there are two therapists than when there is one. The data gathered in the present study did not substantiate this assumption, as the counselors did not rate their clients' behavior as being consistently different in the two conditions. There has been extensive theorizing that the presence of opposite-sexed therapists contributes to the better understanding of sexual roles and better formation of sexual identity on the part of the client (Kell and Burow, 1970; Mintz, 1963b) For this understanding and identification to take place, it would seem necessary for there to be some discussion of same-sex and opposite-sex relations, albeit

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101 some of the growth would occur on a nonverbal level. In the current investigation, the therapists did not rate their clients as having talked more about relations to persons of both sexes in multiple than individual therapy (Hypothesis 1) The therapists also did not feel that their clients conversed about a greater variety of topics in one treatment thari the other (Hypothesis 2) alt]:ough it has been postulated that the presence of a "chaperone" would increase the breadth of discussion (Greenback, 1964). Furthermore, the counselors did not believe that their clients expressed or explored feelings (Hypothesis 3) or had their feelings stirred up (Hypothesis 4) more when being seen multiply rather than individually. Apparently, then, the supposed greater stability that multiple therapy affords (Buck and Grygier, 1952; Sonne and Lincoln, 1966) did not enable the present sample of clients to explore and express feelings more deeply. The therapists did state that, in both conditions, the clients wanted to work on their feelings more during the first than the last session. This finding makes sense in that clients usually enter therapy at somewhat of a crisis point; while termination is a time of reiterating the progress that has been made, and is thus less emotionally laden. Dreikurs (1950) stated that, at least when the therapists agree, the client will be more likely to accept impressions of the therapists in co-therapy than regular

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102 therapy. It v;as felt that this situation would speed the overcoming of resistance and the therapeutic progress. The clients in the current study were rated by the therapists as making no more progress in one condition than the other (Hypothesis 6), Also, the therapists felt that the clients were significantly more likely to accept or agree with their comments or suggestions in individual than in multiple therapy. (This finding resulted from the testing of Hypothesis 5, which predicted the inverse direction.) Possibly, the co-therapists in the present study did not unite with or support each other s comments which would lower their client's tendency to agree with each of them. It is also plausible that, even with high co-therapist agreement, multiple therapy provides a m.ilieu wherein client disagreement is more acceptable or encouraged. Kell and Burow (1970) cite one of the major advantages of multiple therapy as being the opportunity for the client to learn that disagreement can be healthy and enhancing, rather than destructive. Although it may sometimes add to the therapist's comfort to have his client agree with him, disagreement may be indicative of more positive therapeutic movement. Even though the hypothesis was disproved that multiple therapy offers the therapist the advantage of higher client cooperation, then, this finding may not be a strike against co-therapy. The therapists' behavior — Whi taker, Malone, and Warkentin (1956) espoused the tenet that multiple therapy

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103 offers the therapist greater freedom to be personally and emotionally involved than does individual therapy. The counselors here under study did not take advantage of this freedom — if they felt it existed — to be more revealing of their spontaneous impressions (Hypothesis 7), be more warm and friendly to their clients (Hypothesis 11) nor to express more feeling (Hypothesis 12) in multiple than individual counselingNeither did the present sample support the contention that therapists would be more likely to be confrontive in multiple than in individual therapy (Warkentin, Johnson, and Whitaker, 1951), as they said that they were no more critical or disapproving in one condition than the other (Hypothesis 10) Lundin and Aronov (1952) listed one benefit for the therapist to be derived from co-therapy as the amelioration of his blind spots. Dreikurs, Schulman, and Mosak (1952a) similarly felt that the therapist's accuracy of diagnosis and interpretation would be increased when he had the opportunity of constant consultation with a colleague. This should lead to a better understanding of the patient on the part of the therapist; however, the counselors who participated in the current research did not rate their understanding of their clients as being superior in one treatment modality than the other (Hypothesis 8). Finally, the therapists did not feel that they were more helpful to their clients in one condition than the other (Hypothesis 9)

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104 Similar to the therapists' ratings of their clients' behavior, the therapists did not rate their own behavior in co-therapy as being significantly better than their actions in regular therapy. Therapist Attit udes About the Two Cond itions The consensus of the currently studied counselors was that multiple therapy was generally better than individual therapy (Hypothesis 19), when they were asked to rate the two therapeutic forms in the abstract. Many of the findings of Rabin (19 67) were supported by the response patterns of the present therapists to the CTS (a modified version of Rabin' s scale) The therapists agreed with Mintz (1963a) that cotherapy was conducive to their self-understanding (Hypothesis 14), and with Kell and Burow (1970) that it offers more personal gratification or "fun" for the therapist (Hypothesis 16). The attitudes of the counselors were similar to those of the earliest proponents of co-therapy (Reeve, 1939; Hadden, 1947) in that they felt the technique was useful in training therapists (Hypothesis 15) And the praise of multiple therapy as being better than individual therapy for the resolution of impasses (Hayward, Peters, and Taylor, 1952) was given by the present counselors (Hypothesis 18). The investigation of the therapists' attitudes also found that multiple therapy was slightly more their general preference over individual therapy (Hypothesis 17)

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105 It is the opinion of the present researcher that the claims in the literature regarding the greater value 'of multiple therapy than individual therapy are based on the therapists' general attitudes about their work in the two conditions. As noted above, the current sample of therapists also believed multiple therapy to be more advantageous than individual therapy. Whan various hypothesized advantages were subjected to a soraewhat more empirical probing — how the therapists rated their clients' and their ov/n behavior on specific topics after completing both multiple and individual sessions---the much-discussed differences were not apparent. Judges' Ratings of Th erapist BehaYior This research project investigated differences between multiple and individual therapy in an area that heretofore has not received attention. This area concerns the evaluation of the therapeutic process by judges; specifically in this instance, the therapists' level of functioning on the facilitative core dim.ensions of empathy, respect, facilitative genuineness, and concreteness It was generally thought that, due to the sharing of responsibility in co-therapy (Cans, 1957; Miller and Bloomberg, 1968) and the supposed increased capacity of the therapist (Warkentin, Johnson, and Whi taker, 1951), the therapists should offer higher levels of these core dimensions in multiple than in individual therapy.

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106 It was felt that the therapists would be higher on empathy (Hypothesis 20) for example, as the presence of two counselors v/ould increase the likelihood that the client would be really understood--that one of the counselors would have had similar experiences or feelings. As to respect (Hypothesis 21) it v/as felt that the use of two therapists would assure that at least one of the therapists would be caring about the client at any one point in therapy. When seeing clients alone, it may often be difficult for a therapist to maintain a high level of caring or respect from the start of the hour to its finish--if for no other reason than occasional fatigue or lapse in attention span. Due to the greater freedom, supposedly afforded the counselor by having a therapeutic partner, it was hypothesized that higher levels of genuineness would be offered in co-therapy than regular therapy (Hypothesis 22) And finally, as the literature has claimed that the therapeutic interactions of multiple therapy are more frequently emotion-packed than those of individual therapy, it was predicted that the therapists would guide the clients to a deeper discussion of personally relevant material; that is, that higher levels of concreteness would be proffered (Hypothesis 23) The results of the analyses of the therapists scores on the scales of Empathy, Respect, Genuineness, and Concreteness (Carkhuff, 1969) did not substantiate the prediction that the therapists would offer higher

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107 facilitative core conditions in multiple than in individual therapy. The pattern on all of the scales was the same: the counselors had comparable levels of the core dimensions in both conditions at the outset of therapy. By termination, hov/ever, they had significantly increased their level of functioning in the individual condition, while remaining the same in the multiple. Their interactions with their clients that they were seeing alone became more empathetic, respectful, genuine, and concrete; while those with their multiple clients did not. The conclusion to be drawn from the judges' ratings of the present sample of therapists, then, is that they were likely to become more facilitative over time when doing therapy individually, but not when working as part of a COtherapy team. Considering the results of Swander's (1971) analogue study and the overall level of functioning of the present therapists, the current data are not surprising. Although Swander's undergraduate student helpers were all in the nonfacilitative range, the findings of their one-half-hour sessions of individual and multiple "counseling" are interesting. Both partners of a higher nonfacilitative helper coupled with a lower nonfacilitative helper and both of a lower nonfacilitative, helper coupled with another lower nonfacilitative helper decreased their levels of core conditions when working together. Swander also found that two helpers of higher nonfacilitative levels did not

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108 significantly change their level of functioning when working together As shown in Table 35 (Appendix H) the present sample of therapist pairs were all of the high-low or low-low variety, when an average of above 3.0 was considered to be high and an average of below 3.0 was thought to be low. As stated previously, the therapists were not significantly lower in the multiple condition than the individual condition during the first session; thus they did not reflect the general trend found in Swander s study. After working together for some time, however, the counselors did exhibit this pattern of offering lower levels in co-therapy than regular therapy. Possibly, experienced counselors are not as easily influenced by the functioning level of a co. therapist as are undergraduate students, and it takes some time for this influence to alter their behavior. Comments on the Comparison of the Conditions The judges corroborated the evidence from the therapists' report of their own behavior — that the actual interactions of the therapists were not significantly superior in multiple than in individual therapy. In fact, at the end of therapy, the raters judged the counselors to be functioning worse in co-therapy than in regular therapy. If the therapists were not interacting more therapeutically in multiple than individual counseling, it would follow that they would not experience significant differences

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109 in their clients' behavior. The therapists did not, in fact, feel that the multiple condition produced more beneficial client actions. The only significant difference in their ratings was that clients were more likely to agree with their comments in the individual condition. Another finding of the study was that, as far as the agreement of the therapists and their clients as to the events of the session, the multiple condition was also not superior to the individual (Hypothesis 13) Although the differences were not significant, it is interesting to note that in the pretesting there were more therapists who had higher therapist-client agreement in the multiple than the individual condition; while for the posttest, the reverse was true. In the multiple condition, the level of agreement between each therapist and the client with whom he was paired was significantly lower for the terminal than the initial session. In the individual condition, meanwhile, there was not a significant decrease in therapistclient agreement. From the first to the last session, then, the level of facilitative conditions offered by the therapists got significantly better in the individual condition, while the level of therapist-client agreement remained static. In the multiple condition, contrarily, the level of core dimensions remained the same from the initial to the terminal interview, but the agreement between the therapists

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110 and their clients deteriorated. It is difficult to ascertain exactly what these findings may raean in relation to one another. However, these data suggest that the interactions between the presently studied therapists and their clients were better in the individual than the multiple condition at therapy s end It is crucial to call attention to some facts about the present research project that may qualify its applicability as a test of the multiple therapy so often lauded in the literature. First of all, the experience level of the therapists as a whole was low, ranging from six months to five years; and none of them had had extensive experience with multiple therapy. Also, none of the multiple therapists who participated in this research had done previous therapy together with an individual client, and only one pair had collaborated before at all — as group co-therapists for a single group. Longstanding advocates of multiple therapy, e.g., the Atlanta group or Elizabeth Mintz, based their statements on many years' exposure to the technique, often working with the same partners. Furthermore, the results~-at least on the process scales — might have been quite different if all high-functioning counselors had been included, or even if there had been some high-high pairs. The implication of Swander s (1971) findings would be that the partners would not change their level of functioning in the multiple condition if — (i-rt->V-<*''''^-')— ~^^^

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I „ 111 they were both facilitative helpers. Also, it is noteworthy that three of the counselors (B, D, and F) who were highfunctioning — all females — may not have been as active during the multiple sessions as they were during the individual sessions. Although activity ratings as such were not included in the study, a lower activity level was alluded to when these counselors did not talk during one or two of the random segments of the multiple sessions. They may not have been as influential on their low-functioning male cotherapists, then, as the men were on theirs and the overall ratings of the counselors were subsequently lower in the multiple than the individual condition. Possibly, then, the co-therapists were not adequately matched on the activepassive, continuum, as the males seemed to be somewhat more active. Had it been the males who were high-functioning, different data might have been obtained. As there were no apparent consistent dissimilarities of the facilitative levels of "counselor" and "noncounselor" types (on the Myers-Briggs) the inclusion of all "counselor" types probably would not influence the results found with these scales. However, it is possible that the exclusive use of "counselor" types might yield different results on the other scales. Likewise, the multiple therapy of the current study was not undertaken because it was felt to be especially appropriate for the clients, as has frequently been the

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112 case in prior reports (Rabin, 1967). The clients in the present research were assigned at random to the multiple or the individual condition. Justly, it could be argued that exploring the relative merits of an approach with clients for whom that approach was not required or even contraindicated is an unfair test of the technique. Furthermore, it is important to note that more clients terminated therapy before the fourth session in the individual than the multiple condition (six to one, respectively). It is possible that the clients with whom the therapists had especially poor rapport terminated early in the individual, but not in the multiple, condition. Kell and Burow (1970) would not find this surprising, feeling that clients frequently have more difficulty maintaining resistances with the help of two caring persons than with that of one. Of the clients who were included in the study, then, the possibility exists that those in the multiple condition were of a qualitatively higher level of difficulty for the therapists than those in the individual condition. This situation might have influenced the results in favor of individual therapy • ---.-_..--..-. '" The results delineated herein, however, should place Vome doubts in the minds of those who have heralded multiple therapy as being always a superior technique to individual therapy. It might be wise for therapists to heed the caution of Gans (1962) who felt that two inexperienced

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113 counselors in psychotherapy might be worse than one. The present data do lend some credibility to the statements of MacLennan (1965) indicating that the problems of a cotherapy relationship may outweigh its potential benefits. The Phenomenon of Multiple Therapy As far as being validated, the hypotheses regarding the multiple condition itself fared better than those concerned with the differences between the multiple and individual conditions. The co-therapists' relationships were shown to become more caring over time; there was some evidence of therapist growth occurring while they were involved in multiple therapy; and some aspects of the co-therapist relationship were positively related to client outcome. The Caring of the Therapist Pairs Change in caring over time — Mullan and Sanguiliano (1960) have stressed that the establishing of mutuality — a deep caring and meaning — between pairs of co-therapists is very important for their own, as well as their clients' growth. Generally, the results of the CRI comparisons showed that the relationships of the therapist pairs changed toward greater intimacy and caring over the course of therapy. Interdependency was cited by Kell and Burow (1970) as being essential to a good co-therapy relationship. The therapists of the present study significantly increased

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114 their scores on the scale of Affection (Hypothesis 24) from the beginning of therapy to its end. As listed in Appendix E, Shostrom feels that Affection is a helping, nurturing form of love. As far as each partner's willingness to nurture the other, then, there were significant gains. It was felt that changes in each team's relationship toward greater dependency on each other might be reflected by an increase on the scale of Deficiency Love (Hypothesis 27). The results, however, showed that the co-therapists did not significantly increase their scores on this scale from the first to the terminal session. Both pre and post means of the counselors on this scale were very low in comparison to Shostrom' s sample of couples who were or had been married. Possibly, due to the fact that this scale measures the very manipulative aspects of caring as well as the partners' need for each other, it did not tap the type of dependency that would be found between co-therapists. Many authors (Dyrud and Rioch, 1953; Lundin and Aronov, 1952; and ^vVhitaker Malone, and Warkentin, 1956) have underlined that the co-therapists should respect each other as being competent and equal, and should not be competitive. The finding that the co-therapists increased their scores on the scale of Friendship (Hypothesis 25) over time indicates that they grew to respect each other's equality more. The significant increases on the scales of Empathy (M) (Hypothesis 26) and Being Love (Hypothesis 28) suggest that

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115 the co-therapists became more appreciative and tolerant of their partners as unique individuals worthwhile and complete as they v/ere. It would also appear, then, that the cotherapists were more likely to accentuate the other's assets and strengths (Cans, 1962) at the end than at the beginning of therapy. Finally, it v/as predicted that the therapists would decrease their scores on the scale of Self Love (Hypothesis 29) over time, as it was believed that their involvement with themselves in the co-therapy relationship would diminish as the association became closer. Although the scores of the therapists on this scale did decrease from preto posttesting, the difference was nonsignificant. Practitioners of multiple therapy have stated that one of its advantages is the improvement of staff relations in a mental health center (Dyrud and Rioch, 1953; Malone and Whitaker, 1965). Although only describing the relationships of dyads, these findings regarding the increased caring of the counselors lend some empirical support to this assumption. Change toward healthier relations — Not only did the therapists increase their caring relative to themselves, as was explained above, but also they improved on many scales in relation to Shostrom's norms for successfully married, troubled, and divorced couples. It is notable that the therapists were higher than any of the couples on the Self

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116 Love scale, suggesting that they were more self -involved in the relationships than were the couples. They did, however, decrease their scores on this scale over time, moving more toward the means for successfully married couples. And, as the therapists were lower than any of the couples on the Deficiency Love scale, it was felt that they cared for the other person less than the couples as far as what their partner could do for them. Over time, the therapists became more caring than the successfully married couples on the scale of Empathy (M) and approximated these couples on the scales of Being Love and Friendship. This was after having begun their association at mean levels between divorced and troubled couples for Empathy (M) and between troubled and successfully married couples for the other two scales. As far as Affection, the co-therapists were initially close to divorced couples and improved their caring to slightly over that of troubled couples. In general, then, the therapists would appear to create a happier, healthier familial milieu at the conclusion than at the inception of their counseling together. Caring and client outcome — There were no significant correlations between the posttest scores of the therapists and the POI scores of the client with whom he was paired on the scales of Time Competence or Inner-Directed. This finding led to the refutation of the hypothesis regarding a positive relation between the caring of the therapists and outcome of the clients (Hypothesis 34).

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117 This finding may reflect that there is actually no association between the level of caring of the therapists and their clients' outcome. The nonsignificant results could also be due to other reasons. First of all, the group of therapists was a very homogeneous one in regard to their level of caring. The range of the therapists' scores on the CRI was very constricted, thus making it more difficult to get a significant correlation. Secondly, in this instance the client outcome was compared to only one of this therapist's scores--the one with whom he was paired at random for purposes of comparisons. Had a scale been used which assessed the total caring of each pair of therapists and the scores from this scale been correlated with the outcome scores of their clients, different results might have ensued. Growth It has been hypothesized that the experience of multiple therapy leads to growth in therapists (Solomon, Loeffler, and Frank, 1954; Warkentin, Johnson, and Whitaker, 1951). It was proposed that the counselors who participated in the present research would show positive increases in selfactualization (as measured by selected scales of the POI) during the time that they were involved in multiple therapy. Ideally, a control condition — testing the therapists over the same time period while they were not involved in cotherapy — would have been included. As it was not, the results can only be suggestive.

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118 On one of the two major scales of the POI, Time Competence, the counselors were shown to increase their scores significantly from before their experience in cotherapy to after their exposure (Hypothesis 30) The difference between the pre and post scores of the counselors on the scale of Inner-Directed reached significance at the .10 level, alluding to a tendency for the therapists to become more inner-directed. As the difference was not conclusively large. Hypothesis 31 was rejected. The counselors were not shown to increase their capacity for intimate contact (Hypothesis 32) as might have been predicted by Kell and Burow (1970). Mullan and Sanguiliano (1960) stated that multiple therapy enables counselors to be more spontaneous. The therapists in the present study, however, did not significantly increase their scores on the scale of Spontaneity (Hypothesis 33) MTRS Reliability and Validity The two parts of the MTRS, developed by the present author and her co-researcher (Reiner) were both shown to have significant test-retest reliabilities. The patterns as far as concurrent and predictive validity for co-therapist agreement and relationship quality were dissimilar. Relationship quality — The ratings of each therapist of the quality of his co-therapy relationship during his initial session with one client were positively related to

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119 his rating of that relationship during his first session with the second client; the same was true of the association between the ratings of both terminal sessions. Also, the total relationship quality ratings of one case (over both preand posttestings) were significantly and positively related to the ratings of the second case. The relationship quality scores of the therapists were compared to their scores on the CRI scales of Affection, Friendship, Empathy (iM) and Being Love, as a way of investigating concurrent validity. There were no significant correlations found between the ranks of the therapists' scores on the CRI scales and the ranks of the relationship quality scores, and, thus no case for concurrent validity. Also, there was no evidence that the relationship quality scores had a potential for prediction, as the total composite scores of the co-therapist pairs on this measure were negatively and nonsignif icantly correlated with the S-A Scale scores of their clients (Hypothesis 35) Co-therapist agreement — To determine the test-retest reliability of the co-therapist agreement scores, the same three comparisons — pre, post, and total — were made of these scores for the sessions with the first and the second multiply seen client of each therapist. Again, all of these correlations were significant, indicating that the measure of co-therapist agreement was a reliable one.

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120 The co-therapist agreement scores of each therapist were shown to positively correlate with his CRI scale scores on the pretest of Affection, while the posttest did not; and the posttest of Empathy (M) while the pretest did not. None of the correlations between agreement level and the Friendship or Being Love scales were significant. So, the case for concurrent validity of co-therapist agreement with caring as far as affection and empathy is inconclusive. Cotherapist agreement was also not related to relationship quality, suggesting that these two aspects of the cotherapist relationship are distinct from one another. Co-therapist agreement v/as shown to be positively related to client outcome (Hypothesis 36), when the coefficient computed between the total composite agreement score of each co-therapist pair and their client's S-A Scale score was significant. As a further check on this finding, the ranks of each client on the posttest POI scales of Time-Competence and Inner-Directed were correlated with her co-therapist pair's agreement score rank. Although the comparison with Time-Competence was nonsignificant, each client's level of being inner-directed was significantly related to the level of agreement of her co-therapists. A strong case, then, for the predictive validity of co-therapist agreement scores was found — high co-therapist agreement is likely to be aligned with good client outcomes; low cotherapist agreement, with low outcomes

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12; These results substantiate the literature's claim that good co-therapist rapport is crucial for clients. Possibly, the previous results of the differences between multiple and individual therapy were confounded by the fact that the present sample of co-therapists included pairs of both high and low agreement levels. The lack of consistent differences between the conditions might be akin to the findings reported in Truax and Carkhuff (19 67) for individual therapy in general. On the average, clients get no better or worse than controls; however, the clients of facilitative helpers get better, while those of nonfacilitative counselors get worse. On the average, then, no consistent differences between multiple and individual therapy were found--whether by the therapists' report of their own and their clients' behavior or by judges' ratings of the therapists' behavior. However, it is possible that multiple therapy relationships with high agreement between the counselors would be shown to foster better therapeutic interactions than individual therapy, while those with low co-therapist agreement would produce worse interactions than individual therapy. An Area for Future Research An area deserving of subsequent investigation has been pinpointed by the immediately preceding discussion of the effect of high and low co-therapist agreement on the therapeutic interactions. Also considering the previous discussion of the level of facilitative conditions, it would be

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122 interesting to replicate some aspects of the present studyusing only pairs of therapists high on both co-therapist agreement and the core facilitative dimensions. Add to this the condition that the clients to be seen multiply are ones for whom this approach is thought to be especially appropriate. This situation would appear to represent multiple therapy in a more ideal form than may have been existent in the current project. It might still be the case that the resulting multiple therapy would be shown to be no better than, or inferior to, individual therapy conducted by the same therapists on similar types of clients. If this occurred, the bountiful and varied testimonials of the superiority of multiple therapy as compared to individual therapy would have to be reconsidered. If the data leaned the other way, with co-therapy being evaluated as producing better therapeutic interactions, then the results of the current investigation could be viewed as representing the effects of multiple therapy at a nonoptimal or atypical level.

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APPENDICES

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APPENDIX A THERAPISTS' RESEARCH INSTRUCTIONS SHEET Your participation will not really involve too much work. Since I won't always be around to monitor the research, however, I'm giving you this list so that you will know what to do. All that is necessary is to complete the following: 1) A POI before therapy starts. ^ 2) A Myers-Briggs before therapy starts, or if you have already taken one, submit your type to me. 3) After your first and last individual counseling session, a Therapy Session Report. 4) After your first and last multiple counseling sessions: a) A Therapy Session Report b) A Multiple Therapy Rating Scale 5) After the very first and after the very last multiple counseling session, a Caring Relationship Inventory. 6) At the end of all counseling, a Comparative Therapy Scale. 7) Please tape every session, using 5" reels when possible. Please use both sides of a tape for the same client. You need only tape the first hour of the session; if you run over by a little bit, you can cease taping. PLEASE REMEr-IBER TO MARK ALL SCALES AND TAPES WITH THE DATE AND SESSION NUMBER, YOUR NAME, AND THE CLIENT'S UMAE OR IDENTIFICATION NUMBER. 8) Please have your client see the testing secretary after the first session to complete a Therapy Session Report, and after the last session to fill out the posttests. Thank youl If you have any questions, please ask. Shae Graham 124

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APPENDIX B THERAPY SESSION REPORT Therapist Form Directions This booklet contains a series of questions about the therapy session which you have just completed. These questions have been designed to make the description of your experiences in the session simple and quick. There are two types of questions One type of question is followed by a series of numbers on the righthand side of the page. After you read each of the questions, you should circle the number "0" if your answer is "no"; circle the number "1" if your answer is "some"; etc. The other questions have a series of numbered statements -under them. You should read each of these statements and select the one which com.es closest to describing your answer to that question. Then circle the number in front of your answer. Once you have becom.e familiar with the questions through regular use, answering them should take only a few minutes. Please feel free to write additional comments on a page when you want to say things not easily put into the categories provided. BE SURE TO ANSWER EACH QUESTION Patient Identification^ Date of Session From Orlinsky and Howard {1966b) 125

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126 I terns A. HOW DO YOU FEEL ABOUT THE SESSION ^\JHICH YOU HAVE JUST COMPLETED? (Circle the one answer which best applies.) THIS SESSION WAS: i. PERFECT. ii. EXCELLENT. iii. VERY GOOD, iv. PRETTY GOOD. I V. FAIR. I vi. PRETTY POOR, vii. VERY POOR. WHAT SUBJECTS DID YOUR PATIENT TALK ABOUT DURING THE SESSION? (For each subject, circle the answer which best applies.) DURING THE SESSION MY PATIENT TALKED ABOUT: NO SOME A LOT 1. ILLATIONS WITH OTHERS OF THE SAME SEX. 12 2. REIATIONS WITH THE OPPOSITE SEX. 12 3. FEELINGS ABOUT SPOUSE OR ABOUT BEING 12 MJVRRIED 4. STPJ^GE OR UNUSUAL IDEAS AND EXPERT12 ENCES. 5. PERCEPTIONS OR FEELINGS ABOUT ME. 12 Be sure that you have checked every item WHAT DID YOUR PATIENT SEEM TO WANT THIS SESSION? (For each item, circle the ansv/er v/hich best applies.) 6. A CHANCE TO LET GO AND EXPRESS FEEL1 2 INGS. 7. REASSURANCE, SYMPATHY OR APPROVAL FROM 12 ME. 8. TO EVADE OR WITHDRAW FROM EFFECTIVE 12 CONTACT WITH ME. 9. TO EXPLORE EI^RGING FEELINGS AND 12 EXPERIENCES.

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127 WHAT DID YOUR PATIENT SEEM TO BE CONCERNED ABOUT THIS SESSION? (For each item, circle the answer which best applies.) THIS SESSION MY PATIENT WAS CONCERNED ABOUT: 10. BEING DEPENDENT ON OTHERS. 11. BEING LONELY OR ISOLATED. 12. SEXUAL FEELINGS AND EXPERIENCES. 13. EXPRESSING HER (HIS) SELF TO OTHERS NO SOME A LOT 12 12 12 12 DURING THIS SESSION, HOW MUCH : SLIGHTLY OR NOT AT ALL SOME 14. DID YOUR PATIENT TALK? 15. WAS YOUR PATIENT ABLE TO FOCUS ON WHAT WAS OF PRESENT CONCERN TO HIM (HER)? 16. DID YOUR PATIENT TAKE INITIATIVE IN BRINGING UP THE SUBJECTS THAT WERE TALKED ABOUT? 17. WERE YOUR PATIENT'S FEELINGS STIRRED UP? 18. DID YOUR PATIENT TALK ABOUT WHAT SHE (HE) WAS FEELING? 1 1 1 PRETTY VERY MUCH MUCH 2 2 2 DURING THIS SESSION HOW MUCH: 19 WAS YOUR PATIENT WARM AND FRIENDLY TOWARDS YOU? 20. WAS YOUR PATIENT ATTENTIVE TO WHAT YOU WERE TRYING TO GET ACROSS?

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128 SLIGHTLY OR NOT PRETTY VERY AT ALL SOME MUCH MUCH 21. DID YOUR PATIENT TEND TO AGREE VJITH OR ACCEPT YOUR COrmENTS OR SUGGESTIONS? 22. WAS YOUR PATIENT NEGATIVE OR CRITICAL TOWARDS YOU? 23. WAS YOUR PATIENT SATISFIED OR PLEASED WITH HIS (HER) OWN BEHAVIOR? 24. HOW MOTIVATED FOR COMING TO THERAPY WAS YOUR PATIENT THIS SESSION? 1. Very strongly motivated. 2. Strongly motivated. 3. Moderately motivated. 4. Just kept his (her) appointment. 5. Had to make himself (herself) keep the appointment. 25. HOW MUCH PROGRESS DID YOUR PATIENT SEEM TO MAKE THIS SESSION? 1. A great deal of progress. 2. Considerable progress. 3. Moderate progress. 4. Some progress 5. Didn't get anywhere this session. 26. HOW V7ELL DOES YOUR PATIENT SEEM TO BE GETTING ALONG AT THIS TIME? 1. Very well; seems in really good condition. 2. Quite well, no important complaints. 3. Fairly well; has ups and downs. 4. So-so; manages to keep going with some effort. 5. Fairly poorly; having a rough time. 27. HOW MUCH WERE YOU LOOKING FORWARD TO SEEING YOUR PATIENT THIS SESSION? 1. I definitely anticipated a meaningful or pleasant session 2. I had some pleasant anticipation.

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129 3. I had no particular anticipations but found myself pleased to see my patient when the time came. 4. I felt neutral about seeing my patient this session. 5. I anticipated a trying or somewhat unpleasant session. 28. TO WHAT EXTENT DID YOUR OWN STATE OF MIND OR PERSONAL REACTIONS TEND TO INTERFERE WITH YOUR THERAPEUTIC EFFORTS DURING THIS SESSION? 1. Considerably. 2. Moderately, 3 Somewhat 4. Slightly. 5. Not at all. 29. TO WHAT EXTENT DID YOU REVEAL YOUR SPONTANEOUS IMPRESSIONS OR REACTIONS TO YOUR PATIENT THIS SESSION? 1. Considerably. 2. Moderately. 3. Somewhat. 4. Slightly. 5. Not at all. 30. TO WHAT EXTENT WERE YOU IN RAPPORT WITH YOUR PATIENT'S FEELINGS? 1. Completely 2. Almost completely. 3. A great deal. 4. A fair amount. 5 Some 6. Little. 31. HOW MUCH DO YOU FEEL YOU UNDERSTOOD OF WHAT YOUR PATIENT SAID AND DID? 1Everything. 2 Almost all 3. A great deal. 4. A fair amount. 5 Some 6. Little.

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130 32 HOW HELPFUL DO YOU FEEL THAT YOU WERE TO YOUR PATIENT THIS SESSION? 1. Completely helpful. 2. Very helpful. 3. Pretty helpful. 4. Somev/hat helpful. 5. Slightly helpful. SLIGHTLY OR NOT AT ALL SOME PRETTY VERY MUCH MUCH 33. DID YOU TALK? 34. WERE YOU ATTENTIVE TO WHAT YOUR PATIENT WAS TRYING TO GET ACROSS? 2 DURING THIS SESSION, HOW MUCH: 35. WERE YOU CRITICAL OR DISAPPROVING TOWARDS YOUR PATIENT? 36. WERE YOU WARJ4 AND FRIENDLY TOWARDS YOUR PATIENT? 37 DID YOU EXPRESS FEELING? 1 1 2 2 3 3 IF YOU WISH, GIVE A BRIEF FORiMULATION OF THE SIGNIFICANT EVENTS OR DYNAMICS OF THIS SESSION: ADDITIONAL COMMENTS;

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131 Client Form Directions This booklet contains a series of questions about the therapy session v/hich you have just completed. These questions have been designed to make the description of your experiences in the session simple and quick. There are two types of questions. One type of question is followed by a series of numbers on the righthand side of the page. After you read each of the questions, you should circle the number "0" if your answer is "no"; circle the number "1" is your answer is The other questions have a series of numbered statements under them. You should read each of these statements and select the one v/hich comes closest to describing your answer, to that question. Then circle the number in front of your ansvzer. Once you have become familiar with the questions through regular use, answering them should only take a few minutes. Please feel free to v/rite additional comments on a page when you V7ant to say things not easily put into the categories provided. BE SURE TO ANSWER EACH QUESTION Identification Date of Session

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132 Items A. HOW DO YOU FEEL ABOUT THE SESSION VffilCH YOU HAVE JUST COMPLETED? (Circle the one answer which best applies.) (A) THIS SESSION WAS: i. Perfect. ii Excellent. iii. Very good XV. Pretty good. V. Fair. vi. Pretty poor. vxx. Very poor. WHAT SUBJECTS DID YOU TALK ABOUT DURING THIS SESSION? (For each subject, circle the answer which best applies.) DURING THIS SESSION I TALKED ABOUT: NO SOME A LOT 1. RELATIONS WITH OTHERS OF THE SAME SEX. 12 (1) 2. RELATIONS WITH THE OPPOSITE SEX. (2) 12 3. STRANGE OR UNUSUAL IDEAS AND EXPERI12 ENCES. (4) 4. ATTITUDES OR FEELINGS TOWARD MY 12 THERAPIST. Be sure that you have checked every item WHAT DID YOU WANT OR HOPE TO GET OUT OF THIS SESSION? (For each item, circle the answer which best applies.) THIS SESSION I HOPED OR WANTED TO: 5. GET SOME PsEASSURANCE ABOUT HOW I'M 1 2 DOING. 6. GET CONFIDENCE TO TRY NEW THINGS, 12, TO BE A DIFFERENT KIND OF PERSON. 7. FIND OUT VJHAT MY FEELINGS REALLY ARE AND ^fflAT I REALLY WANT ( 9 ) 1 2

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133 VTHAT PROBLEMS OR FEELINGS WERE YOU CONCERNED ABOUT THlS SESSION? (For each item, circle the answer vrhich best applies. ) DURING THIS SESSION I WAS CONCEl^NED ABOUT: NO SOME A LOT 8. BEING DEPENDENT UPON OTHERS. (10) 1 2 9. BEING LONELY OR ISOLATED. (11) 1 ,2 10. SEXUAL FEELINGS AND EXPERIENCES. (12) 1 2 11. EXPRESSING OR EXPOSING MYSELF TO 1 2 OTHERS. (13) DURING THIS SESSION, HOW MUCH: 12. DID YOU TALK? (14) 12 13. WERE YOU ABLE TO FOCUS ON WHAT 1 2 WAS OF REAL CONCERN TO YOU? (15) 14. DID YOU TAKE INITIATIVE IN BRING12 ING UP THE SUBJECTS THAT WERE TALKED ABOUT? (16) 15. WERE YOUR EMOTIONS OR FEELINGS 12 STIRRED UP? (17) 16. DID YOU TALK ABOUT WHAT YOU WERE 12 FEELING? (18) DURING THIS SESSION, HOW MUCH: 17. FRIENDLINESS OR RESPECT DID YOU 12 SHOW TOWARDS YOUR THERAPIST? 18. WEPvE YOU ATTENTIVE TO WHAT YOUR 12 THERAPIST WAS TRYING TO GET ACROSS TO YOU? 19. WERE YOU NEGATIVE OR CRITICAL 12 -TOWARDS YOUR THERAPIST? 20. WERE YOU SATISFIED OR PLEASED' 12 WITH YOUR OWN BEHAVIOR? (23)

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134 21 HOW DID YOU FEEL ABOUT COMING TO THERAPY THIS SESSION? (24) 1. Eager; could hardly wait to get here. 2. Very much looking forward to coming. 3. Somewhat looking forward to coming. 4. Neutral about coming. 5. Somewhat reluctant to come. 6. Unwilling; felt I didn't want to come at all. 22. HOW MUCH PROGRESS DO YOU FEEL YOU MADE IN DEALING WITH YOUR PROBLEMS THIS SESSION? (25) 1. A great deal of progress. 2. Considerable progress. • 3. Moderate progress. 4. Some progress. 5. Didn't get anyv/here this session. 6. In some ways my problems seem to have gotten worse this session. 23. HOW WELL DO YOU FEEL THAT YOU ARE GETTING ALONG, EMOTIONALLY AND PSYCHOLOGICALLY, AT THIS TIME? (26) I AM GETTING ALONG: 1. Very well; much the way I would like to. 2. Quite well; no important complaints. 3. Fairly well; have my ups and downs. 4. So-so; manage to keep going with some effort. 5. Fairly poorly; life gets pretty rough for me at times 6. Quite poorly; can barely manage to deal with things 24. TO WHAT EXTENT ARE YOU LOOKING FORWARD TO YOUR NEXT SESSION? 1. Intensely; wish it were much sooner. 2. Very much; wish it were sooner. 3. Pretty much; will be pleased when the time comes 4. Moderately; it is scheduled and I guess I'll be there 5. Very little; I'm not sure I will want to come. WHAT DO YOU FEEL THAT YOU GOT OUT OF THIS SESSION? (For each item, circle the answer which best applies.)

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135 I FEEL THAT I GOT: NO SOME A LOT 25. A CHANCE TO LET GO AND GET 12 THINGS OFF MY CHEST. 26. HOPE: A FEELING THAT THINGS 12 CAN WORK OUT FOR ME27. HELP IN TALKING ABOUT WHAT 12 WAS REALLY TROUBLING ME. 28. RELIEF FROM TENSIONS OR 12 UNPLEASANT FEELINGS. 29. MORE UNDERSTANDING OF THE '•012 REASONS BEHIND MY BEHAVIOR AND FEELINGS. 30. REASSURANCE AND ENCOURAGEMENT 12 ABOUT HOW I'M DOING. 31. CONFIDENCE TO TRY TO DO THINGS 12 DIFFERENTLY. 32. MORE ABILITY TO FEEL MY FEELINGS, 12 TO KNOW WHAT I REALLY WANT. 33. IDEAS FOR BETTER WAYS OF DEALING 12 WITH PEOPLE AND PROBLEMS. 34. MORE OF A PERSON-TO-PERSON 12 RELATIONSHIP WITH MY THERAPIST. 35. BETTER SELF-CONTROL OVER MY 12 MOODS AND ACTIONS. WHAT DO YOU FEEL THAT YOU GOT OUT OF THIS SESSION? (for each item, circle the answer which best applies.) 36. A MORE REALISTIC EVALUATION OF MY 1 2 THOUGHTS AND FEELINGS. 37. NOTHING IN PARTICULAR; I FEEL THE 12 SAME AS I DID BEFORE THE SESSION. 38. HOW WELL DID YOUR THERAPIST (S) SEEM TO UNDERSTAND WHAT YOU WERE FEELING AND THINKING THIS SESSION? MY THERAPIST (S) : 1. Understood exactly how I thought and felt. 2. Understood very well how I thought and felt.

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136 3. Understood pretty well, but there were some things he (she) didn't seem to grasp. 4. Didn't understand too well how I thought and felt. 5. Misunderstood how I thought and felt. 39. HOW HELPFUL DO YOU FEEL YOUR THERAPIST (S) WAS (WERE) TO YOU THIS SESSION? (32) 1. Completely helpful. 2. Very helpful. 3. Pretty helpful. 4. Somewhat helpful. 5. Slightly helpful. 6. Not at all helpful. SLIGHTLY OR NOT AT ALL 40. DID YOUR THERAPIST (S) TALK? (33) 41. WAS (WERE) YOUR THERAPIST (S) ATTENTIVE TO WHAT YOU WERE TRYING TO GET ACROSS? (34) 42. WAS (WERE) YOUR THERAPIST (S) NEGATIVE OR CRITICAL TOWARDS YOU? (35) 43. WAS (WERE) YOUR THERAPIST (S) FRIENDLY AND WARM TOWARDS YOU? (36) 44. DID YOUR THERAPIST (S) SHOW FEELING? (37) SOME 1 PRETTY VERY MUCH MUCH 3 3 ADDITIONAL COMMENTS :

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APPENDIX C COMPAEATIVE THEPJVPY SCALE' Name Date We would like to find out how you feel about multiple versus individual therapy. After reading an item, please rate the relative merits of multiple as opposed to individual therapy by checking one of the seven columns. 1. 2. 5. Understanding, by the therapist of the transference. Multiple Indi vidual therapy the rapy Xi ii i(D >i(U ^ Q) V M rH u H U S o r^ u rH M U S-l p Q) o +J d +J (DO :3 s: e +J e Xi g (P -i:^ g -P g s g nj &i u tji fd H •H 0) •H i-i f-i m rH 0) -0 m m CO 'd M t! S Completeness transference patterns of Transference of the original family situation. Opportunity to work out anxieties with a therapist of the more dreaded sex. Difficulties by the therapist in "handling" intense transference reactions Self -understanding of the therapist enhanced. From Rabin (1967) 137

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138 Multiple Individual therapy therapy ^ (D >( (D >i 0) O (D >i (D >i (U ^ (D o u .H m H ^-1 S O rH ^! r-4 M U M 13 O CD A-i fH -P 0) 3 O s g 4J g x^ e (U x; £ -P g S fa n5 &> u tp fd M •H (D •H M
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139 7. Multiple Individual therapy therapy >i >! CU >1 >1 4:; CI) iH 0) r-l 0) rH 0) y^ (D ^ Q) S-i (D M -P H 7-. c; -P k (D !-l M 13 -P J3 CIJ -C3 4J ^3 s e fO fi tJlg VI &1 g (ti g s g M -H QJ H M 0) H m r-i QJ t3 CQ m CO T3 •rH g ra S Emotional demands experienced by the therapist. Understanding of counter trans f erence 9. Years of experience necessary to do effective therapy. 10. Useful in training therapists 11. Personal gratification (enjoyment or "fun") for the therapist. 12. Useful with very "actingout" patients. 13. Useful with borderline schizophrenics. 14. Useful with marital couples 15. Useful with "oral characters 16. Positive therapeutic movement, in general 17. Working through, in general. 18. Working out and through problems of masculinity and feminity

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140 Multiple Individual therapy therapy si Q) >i Q) >i 0) O (U >i Q) >i OJ r: 0) o U rH u rH M S u H ^ -H ^ CJ !^ :i CD +J r; -p o 0) O 3 O S g ^ g S^ g 0) -a g 4J g s g fd tn ^ tn n u •H Q) •H u H M-1 rH (U d W IH LO 'd -H s ^ S 27. Your general preference with a patient who is especially fearful of homosexual relations. 28. Your general preference with a patient who ferociously clings to persons of one sex. 29 Your general preference when only short-term therapy, i.e., 6 months or less, is available. 30. Your general preference for working out and through a patient's very intense "negative" transference. 31. Your general preference for working out and through a patient's very sticky "positive" trans f erence 32. Resolution of impasses

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APPENDIX D CARKHUFF SCALES"'' Empathic Unclersta nding in Interpersonal Processes : A Scale for Measurement Level 1 The verbal and behavioral expressions of the first person either do not attend to or detract significantly from the verbal and behavioral expressions of the second person (s) in that they communicate significantly less of the second person's feelings than the second person has communicated himself. Examples: The first person communicates no awareness of even the most obvious, expressed surface feelings of the second person. The first person may be bored or uninterested or simply operating from a preconceived frame of reference which totally excludes that of the other person(s). In summary, the first person does everything but express that he is listening, understanding, or being sensitive to even the feelings of the other person in such a way as to detract significantly from the communications of the second person. Level 2 While the first person responds to the expressed feelings of the second person(s), he does so in such a way that he subtracts noticeable affect from the communications of the second person. Examples: The first person may communicate some awareness of obvious surface feelings of the second person, but his communications drain off a level of the affect and distort the level of meaning. The first person may communicate his own ideas of '"From Carlchuff (1959). 141

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142 what may be going on, but these are not congruent with the expressions of the second person. In summary, the first person tends to respond to other than what the second person is expressing or indicating. Level 3 The expressions of the first person in response to the expressed feelings of the second person (s) are essentially interchangeable with those of the second person in that they express essentially the same affect and meaning. Example: The first person responds with accurate understanding of the surface feelings of the second person but may not respond to or may misinterpret the deeper feelings. In summary, the first person is responding so as neither to subtract from nor add to the expressions of the second person; but he does not respond accurately to how that person really feels beneath the surface feelings. Level 3 constitutes the minimal level of facilitative interpersonal functioning. Level 4 The responses of the first person add noticeably to the expressions of the second person (s) in such a way as to express feelings a level deeper than the second person was able to express himself. Example: The facilitator communicates his understanding f of the expressions of the second person at a level deeper than they were expressed, and thus t, enables the second person to experience and/or \ express feelings he was unable to express previously, i In summary, the facilitator's responses add deeper feel| ing and meaning to the expressions of the second person. | f Level 5 ; The first person's responses add significantly to the feeling and meaning of the expressions of the second person (s) I in such a way as to (1) accurately express feelings levels f below what the person himself was able to express or (2) in the event of ongoing deep self-exploration on the second person's part, to be fully with him in his deepest moments.

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143 Examples: The facilitator responds with accuracy to all of the person's deeper as well as surface feelings. He is "together" with the second person or "tuned in" on his v/ave length. The facilitator and the other person might proceed together to explore previously unexplored areas of human existence. In summary, the facilitator is responding with a full awareness of v/ho the other person is and a comprehensive and accurate empathic understanding of his deepest feelings, The Communication of Respect in Interpersonal Processes : A Scale for Measurement Level 1 The verbal and behavioral expressions of the first person communicate a clear lack of respect (or negative regard) for the second person(s). Example: The first person communicates to the second person that the second person's feelings and experiences are not worthy of consideration or that the second person is not capable of acting constructively. The first person may become the sole focus of evaluation. In summary, in many ways the first person communicates a total lack of respect for the feelings, experiences, and potentials of the second person. Level 2 The first person responds to the second person in such a way as to communicate little respect for the feelings, experiences, and potentials of the second person. Example: The first person may respond mechanically or passively or ignore many of the feelings of the second person. In summary, in many ways the first person displays a lack of respect or concern for the second person's feelings, experiences, and potentials. Level 3 The first person communicates a positive respect and concern for the second person's feelings, experiences, and potentials

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144 Example: The first person corninunicates respect and concern for the second person's ability to express himself and to deal constructively with his life situation. In summary, in m.any v/ays the first person communicates that who the second person is and what he does matter to the first person. Level 3 constitutes the minimal level of facilitative interpersonal functioning. Level 4 The facilitator clearly communicates a very deep respect and concern for the second person. Example: The facilitator's responses enable the second person to feel free to be him.self and to experience being valued as an individual. In sum.mary, the facilitator communicates a very deep caring for the feelings, experiences, and potentials of the second person. Level 5 The facilitator communicates the very deepest respect for the second person's worth as a person and his potentials as a free individual. Examples: The facilitator cares very deeply for the human potentials of the second person. In summary, the facilitator is committed to the value of the o'ther person as a human being. Facilitative Genuineness in Interpersonal Processes : A Scale for Measurement Level 1 The first person's verbalizations are clearly unrelated to what he is feeling at the moment, or his only genuine responses are negative in regard to the second person (s) and appear to have a totally destructive effect upon the second person. Example: The first person may be defensive in his interaction with the second person (s) and this

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145 • defensiveness may be demonstrated in the content of his words or his voice quality. Where he is defensive he does not employ his reaction as a basis for potentially valuable inquiry into the relationship. In summary, there is evidence of a considerable discrepancy between the inner experiencing of the first person and his current verbalizations. Where there is no discrepancy, the first person's reactions are employed solely in a destructive fashion. Level 2 The first person's verbalizations are slightly unrelated to what he is feeling at the moment, or when his responses are genuine they are negative in regard to the second person; the first person does not appear to know how to employ his negative reactions constructively as a basis for inquiry into the relationship. Example: The first person may respond to the second person (s) in a "professional" manner that has a rehearsed quality or a quality concerning the v/ay a helper "should" respond in that situation. In summary, the first person is usually responding according to his prescribed role rather than expressing what he personally feels or means. When he is genuine his responses are negative and he is unable to employ them as a basis for further inquiry. Level 3 The first person provides no "negative" cues between what he says and what he feels, but he provides no positive cues to indicate a really genuine response to the second person (s) Example: The first person may listen and follow the second person (s) but commits nothing more of himself. In summary, the first person appears to make appropriate responses that do not seem insincere but that do not reflect any real involvement either. Level 3 constitutes the minimal level of facilitative interpersonal functioning, Level 4 The facilitator presents some positive cues indicating

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146 a genuine response (whether positive or negative) in a nondestructive manner to the second person{s). Example: The facilitator's expressions are congruent with his feelings although he may be somewhat hesitant about expressing them fully. In summary, the facilitator responds with many of his own feelings, and there is no doubt as to whether he really means what he says. He is able to employ his responses, whatever their emotional content, as a basis for further inquiry into the relationship. Level 5 The facilitator is freely and deeply himself in a nonexploitative relationship with the second person (s). Example: The facilitator is completely spontaneous in his interaction and open to experiences of all types, both pleasant and hurtful. In the event of hurtful responses the facilitator's comments are employed constructively to open a further area of inquiry for both the facilitator and the second person. In summary, the facilitator is clearly being himself and yet employing his own genuine responses constructively. Personally Relevant Concreteness or Specificity of Expression in Interpersonal ProcesseF : A Scale for Measurement Level 1 The first person leads or allows all discussion with the second person (s) to deal only with vague and anonymous generalities Example: The first person and the second person discuss everything on strictly an abstract and highly intellectual level. In summary, the first person makes no attempt to lead the discussion into the realm of personally relevant specific situations and feelings.

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147 Leve 1 2 The first person frequently leads or allows even discussions of material personally relevant to the second person (s) to be dealt with on a vague and abstract level. Example: The first person and the second person may discuss the "real" feelings but they do so at an abstract intellectualized level. In summary, the first person does not elicit discussion of most personally relevant feelings and experiences in specific and concrete terms. Level 3 The first person at times enables the second person to discuss personally relevant material in specific and concrete terminology. Example: The first person will make it possible for the discussion with the second person (s) to center directly around most things that are personally important to the second person (s), although there will continue to be areas not dealt with concretely and areas in which the second person does not develop fully in specificity. In summary, the first person sometimes guides the discussions into consideration of personally relevant specific and concrete instances, but these are not always fully developed. Level 3 constitutes the minimal level of facilitative functioning. Level 4 The facilitator is frequently helpful in enabling the second person (s) to fully develop in concrete and specific terms almost all instances of concern. Example: The facilitator is able on many occasions to guide the discussion to specific feelings and experiences of personally meaningful material. In summary, the facilitator is very helpful in enabling the discussion to center around specific and concrete instances of most important and personally relevant feelings and experiences.

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148 Level 5 The facilitator is alv/ays helpful in guiding the discussion, so that the second person (s) may discuss fluently, directly, and completely specific feelings and experiences. Example: The first person involves the second person in discussion of specific feelings, situations, and events, regardless of their emotional content. In summary, the facilitator facilitates a direct expression of all personally relevant feelings and experiences in concrete and specific terms.

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APPENDIX E THE SCALES OF THE CARMG RELATIONSHIP INVENTORY"'" Identification Description Scales A Af fection--helping, nurturing form of love. It involves unconditional giving and acceptance of the kind that characterizes the love of a parent for a child. F Friendship--a peer love based on appreciation of common interests and respect for each other's equality. E Eros — a possessive, romantic form of love which includes features such as inquisitiveness, jealousy, exclusiveness • • M Empathy — "agape," a charitable, altruistic form of love which feels deeply for the other individual as another unique human being. It involves compassion, appreciation, and tolerance. S Self Love — the ability to accept, in the relationship rated, one's weaknesses as well as to appreciate one's individual, unique sense of personal worth. It includes the acceptance of one's full range of positive and negative feelings toward the person rated. Sub Scales B Being Love — the ability to have and accept the other person as he or she is. Being love includes aspects of loving another for the good seen in him (her) It is an admiring, respectful love, an end in itself. D Deficiency Love — the love of another for what he (she) can do for the person. Deficiency love is an exploiting, manipulating love of another as a means to an end. From Shostrom (1966a) 149

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APPENDIX F FOUR SCALES OF THE PERSONAL ORIENTATION INVENTORY''Symbol Description T /T TIME RATIO Time Incompetence/ Time Competence-measures degree to which one is "present" oriented. O/I SUPPORT RATIO Other/Inner — measures whether reactivity orientation is basically toward others or self. S SPONTANEITY Measures freedom to react spontaneously or to be oneself. C CAPACITY FOR INTIMATE CONTACT Measures ability to develop contactful intimate relationships with other human beings, unencumbered by expectations and obligations. From Shostrom (19 66b) 150

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APPENDIX G THE MULTIPLE THERAPY PvATING SCALE Items 1. Do you think the psychotherapeutic effectiveness of the session was due mostly to the interaction of the client with: a. yourself? b. the other therapist? c. both therapists? 2. Do you think that the other therapist was a. more involved with the patient than you were? b. less involved? c. about the same? 3. Were your feelings toward the other therapist divulged: during the session? outside of the session? a. Yes c. Yes b. No d. No 4. How do you feel that stating or not stating these feelings affected the therapy? a. Helped it greatly b. Somewhat helped it • c. Hindered it somewhat d. Made no difference e. Hindered it greatly 5. How did you and the other therapist work together during the session? a. Excellently b. Very well c. Fairly d. Poorly e. Very poorly 151

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152 6. How well did you understand v/hat the other therapist was doing during the session? a. Completely b. Very well c. Fairly d. Poorly e. Very poorly 7. Did you feel the other therapist made any real m.istakes during the session? a. Yes, many b Yes a few c. Yes, one d. No, not at all 8. Were you ever hesitant to say something to the client because of the presence of the other therapist? a. Yes, many times b. Yes, a few times c. Yes, once d. No, not at all 9. If you answered "yes" to the preceeding question, was this because you thought the other therapist would view your statement as: (Check any that are appropriate.) a. foolish? b. inappropriate? c. irrelevant? d. reflecting your incompetency? 10. Did you ever consider the other therapist more than the client in making a statement? a. Yes, many times b. Yes, a few times c. Yes, once d. No, not at all 11. If you answered "yes" to the above question, was this because: a. you were trying to please the other therapist? b. you were trying to impress the other therapist c. you were trying to clarify something for the other therapist? d. you said what you thought the other therapist expected you to say?

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153 12. During the session, did you come to the other therapist's aid when there v/as an "interactional difficulty" between the client and the therapist? a Yes many times b Yes a few times c. Yes, once d. No, not at all 13. During this session, hov; much was your patient warm and friendly towards the other therapist? (19) I a. Slightly b. Some c. Pretty much d. Very much 14. How much, during the session, did your patient tend to agree v/ith or accept the other therapist's comments j, or suggestions? (21) I \ a. Slightly or not at all | b Some c Pretty much d. Very much 15. During this session, hov7 much vras your patient negative or critical towards the other therapist? (2 2) a. Slightly or not at all b Some c. Pretty much d. Very much 16. As far as determining the course of the session, did you think that the other therapist was; a. more dominant than you? b. less dominant than you? c. about the same? 17. To what extent do you think that the other therapist's state of mind or personal reactions tended to interfere with therapeutic efforts during the session? (28) a. Considerably b. Moderately c Somewhat d. Slightly e. Not at all

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154 18. To what extent do you think the other therapist revealed his (her) spontaneous impressions or reactions to the patient this session? (29) a. Considerably b. Moderately c Somev/hat d. Slightly e. Not at all 19. How much do you think the other therapist was attentive to what the patient was trying to get across? (34) a. Slightly or not at all b. Some c. Pretty much d. Very much 20. How much do you th.ink the other therapist was critical or disapproving towards the patient? (35) a. Slightly or not at all b Some c. Pretty much d. Very much 21. To what extent do you think the other therapist was warm and friendly towards your patient? (36) a. Slightly or not at all b Some c. Pretty much d. Very much 22. In your fantasies regarding the other therapist, which of the following would you entertain as being pleasant? a. Play sports with them b. Go out for a beer with them c. Have as a next door neighbor d. Be in the same social club with them e. Date them, e.g., go to a movie with them f. Have your child raised by them g. Have lunch with them h. Have your brother or sister married to them i. Loan your car to them j Be engaged or married to them k. Have as a friend 1. .Have as a brother or sister m. Work very closely v/ith them n. Have over to your house for dinner

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155 23. Did the client react differently to the male therapist thatn to the female therapist? a b Yes No J udges Directions for Rating the MTRS A. Plecise rate which of the following items are, in your opinion, relevant to the formation of a good or poor co-therapist relationship by placing an "R" in the margin next to the item number. Please go through all 22 items consecutively. B. Then for each choice of the items please place: 1. a plus (+) by the responses that would lead to a good relationship. 2. a minus (-) by the responses that would lead to a poor relationship, and 3. a zero (0) by the responses that you consider to make no difference to the therapeutic relationship, TABLE 30 RESPONSE PATTERNS OF THE FOUR JUDGES FOR THE MTRS ITEMS CONSIDERED TO BE RELEVANT TO THE CO-THERAPIST RELATIONSHIP Item or choice number A Judge B C D Scoring direction used Item or choice number A Judge B C D Scoring direction used 1. R R R R 4. R R R R a. + a. + + + + + b. + b. + + + + + c. + + + + c d. ^ ^ zero 2. R e. a. b. 5. R R R R c. + a. b. + + + + + + + + + + 3. R R R R c. + + zero a. + + + + + d. b. e — — c. + + + + + d. —

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TABLE 30— (continued) 15< It era or choice number Judqe A B D Scoring direction used Item or choice number Judge B D Scoring direction used 6. a. R A R R + + 111 R R R b. + + + + c. + -1d. -e. — — — — 7. R R R R a. b. + c. + d. + + + + 8. R R R R a. b. c. d. + + + + 9. R R R R a. -b. ~ — c. d. — — 0. R R R R a. b. ~ + c. d. + + + + + zero + + + a. b. c. + + d. 12. a. b. d. d. 22. R R R R + + + + + + + R 16. R R R a. b. c. +00+ R R R R + + a. + + + + b. + + + + + c. + + + + + d. + + e. + + + + + f. + + + + + g+ + fa. + + + + 1. + + + + 1+ + + + + Jc. + + + + + 1. + + + + + m. + + + + + n. + + Note: When there is a blank space beside a choice under "Scoring direction used," this choice was not scored, as there was not agreement among at least three of the judges as to the scoring direction. The only exception to this were the three choices designated by the word "zero," which were scored as such. "This was the scoring direction originally determined by the two researchers, which was not consistently corroborated by the judges.

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APPENDIX H NUMERICAL RAW DATA AND SUMMJvRIES TABLE 31 WILCOXON MATCHED-PAIRS SIGNEDRANKS TEST BETWEEN THE NUMBER OF SESSIONS EACH THERAPIST HAD WITH A CLIENT IN THE MULTIPLE AND THE INDIVIDUAL CONDITION Mult iple Individua il d Rank with Rank less freof d guent sign Therapis client pair tNo. of sessions Therapistclient pair No. of sessions A-10 6 A7 5 -1 -1.5 B-8 6 B-12 22 16 8 8 C-16 9 C-17 5 -4 -4 D-14 5 D-29 5 E-25 9 E-39 10 1,5 1.5 1.5 F-20 7 F-22 15 8 7 7 G-37 4 G-23 4 H-26 4 H-21 4 1-33 12 1-38 5 -7 -6 J-31 15 J-30 9 -6 -5 K-35 L-36 7 6 K-34 L-40 7 4 -2 -3 T = 16.5 Note: The value needed for significance at the .05 level is T = 11. 157

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15S \ TABLE 32 RAW SCORES OF THE THEPJVPISTS FOR BOTH INDIVIDUAL (I) AND MULTIPLE CONDITIONS (M) ON THE TSR ITEMS INVOLVED IN HYPOTHESES 1-11 Item number (s) TheraPist 1-2 1-5 6 & 9 17 21 25 IH'IM IM IM IM IM A 32 4 2 4442 1020 1111 1112 2324 B 32 32 43 45 22 21 22 11 22 22 32 24 C 33 42 45 4 4 22 21 1122 12 11 23 32 D 30 32 40 44 20 22 212123 22 33 33 E '2 223 1344 2222 2122 1212 2324 P. 3 2 22 33 22 22 22 22 11 2121 23 22 G 2322 4443 1221 1221 2211 4331 H32 2.2 33 23.2110 10 21 22 11 33 22 I 2042 222 1 2212 2311 1212 2233 J 3 313 3334 2122 1121 22 22 3224 K 2222 4434 1100 1111 23 00 3302 I. 13 2-2 3333 2222 3231 2110 2232 Note: the first number under each condition is the pretest score; the second, the posttest score.

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159 TABLE 32 — (extended) 29 31 32 35 36 37 1 M I M I M I M I M I M 44 25 2 3, 24 24 24 00 00 33 33 32 13 44 44 55 44 54 34 00 00 3322 22 22 55 45 45 5 3 35 42 00 02 22 22 22 22 33 54 54 55 43 33 00 00 33 32 22 21 3 4 34 4545 25 35 1110 22 23 12 22 4 3 44 44 54 23 43 00 0122 22 1111 44 32 43 33 44 4 2 1111 12 21 12 21 43.22 45 5.5 33 23 1111 22 22 2111 54 24 23 45 42 35 00 00 22 22 1111 1545 4545 4544 0100 2323 2212 35 34 32 44 35 22 00 00 23 21 22 11 2243 54 44 42 43 00 00 3122 10 12

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160 TABLE 33 RAW SCORES USED TO DETERMINE THERAPIST-CLIENT AGREFJ-ffiNT ON THE TSR FOR THE MULTIPLE CONDITION, PREM
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161 TABLE 33 — (extended) G-37 H-26 1-33 J-31 K-35 L-36 3-3 5-4 5-4 5-6 3-3 3-3 3-3 3-2 4-5 5-6 3-5 2-3 1-1 1-1 Q-0 1-1 2-1 0-0 1-1 2-1 1-1 1-1 1-1 1-1 1-1 1-1 2-2 1-1 2-1 2-2 0-0 1-1 1-1 1-1 1-1 1-2 1-2 1-2 0-1 0-0 0-2 0-0 1-1 1-2 0-0 0-0 0-0 0-0 2-2 1-1 0-2 0-2 0-2 1-1 1-2 2-2 0-2 0-1 2-2 1-2 L 2-2 2-2 2-2 2-2 0-1 0-1 1-0 1-1 1-1 0-2 1-0 1-0 2-2 2-1 1-2 2-2 1-2 0-2 1-0 2-2 0-0 1-1 2-2 0-2 | 1-1 0-0 0-1 1-0 1-1 2-2 0-0 0-1 1-1 0-1 0-0 0-0 | 2-2 2-2 .1-1 1-1 0-1 1-1 2-0 2-2 0-1 1-2 2-1 1-2 ; 2-2 2-2 3-3 3-1 3-3 2-2 3-3 2-2 2-3 1-2 2-2 2-2 2-2 1-2 2-1 2-1 2-3 3-2 2-3 3-3 1-2 1-0 2-1 2-2 ^^ 2-1 2-2 3-2 2-1 3-3 3-3 3-3 3-2 1-3 0-1 2-2 2-2 2-2 1-2 2-3 1-2 1-1 1-1 2-2 1-3 1-2 1-0 3-2 1-3 '2-2 1-2 1-2 1-1 0-1 2-2 1-1, 2-3 1-1 0-1 2-2 2-2 1-1 1-0 1-2 1-1 2-3 2-2 1-3 1-2 0-1 0-0 1-0 3-1 2-3 4-5 3-3 3-5 4-5 2-2 2-3 2-2 5-5 4-4 2-5 3-3 3-3 5-2 4-4 4-5 3-2 3-2 4-3 2-2 4-5 4-5 3-6 4-1 3-4 3-3 4-5 3-5 5-5 3-3 3-2 3-2 3-3 4-3 3-3 2-2 3-3 5-2 5-4 4-5 4-2 2-2 3-2 3-1 5-5 5-5 1-1 4-2 1-2 2-2 1-1 1-2 1-2 1-1 1-2 2-2 1-1 1-1 2-2 1-2 2-3 2-3 1-3 2-2 2-3 2-3 3-3 3-3 3-2 2-2 0-0 2-3 1-0 1-0 1-1 1-1 0-0 0-0 0-0 0-1 0-1 0-1 2-1 0-1 2-3 1-2 1-1 1-0 2-3 2-3 3-3 3-3 2-1 1-1 1-1 2-2 2-2 1-2 1-2 1-1 1-3 1-3 1-2 2-3 1-1 1-1 1-1 2-3

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162 TABLE 34 RAW SCORES USED TO DETERiMTNE THEPjvPIST-CLIENT AGREEMENT ON THE TSR FOR THE INDIVIDUAL CONDITION, PREAND POSTTESTINGS Therapist TSR Th erap Lst-cl lent pair item no. A-7 BL2 CL7 D>9 E39 F22 A 5-3 4-3 3-4 2-2 4-4 3-5 3-4 5-3 4-4 3-3 5-4 4-3 1 1-1 1-1 2-2 1-1 2-1 1-1 1-0 0-0 2-1 1-1 2-1 1-2 2 2-2 1-2 1-1 1-1 2-2 2-2 2-2 0-0 0-1 1-1 1-1 1-1 4 2-1 0-1 1-0 0-1 0-1 0-1 0-0 0-0 0-1 0-0 0-2 1-2 9 0-2 0-2 2-2 2-1 2-2 1-2 2-1 0-0 1-2 1-2 1-1 2-2 10 1-0 1-1 2-0 2-1 1-2 1-0 1-1 0-0 1-1 1-2 1-0 1-1 11 2-1 1-2 2-1 1-2 1-1 1-0 2-1 0-0 2-2 1-2 1-2 1-2 12 0-0 0-1 0-1 0-0 1-0 1-2 1-1 0-0 0-0 0-0 0-0 0-0 13 2-0 1-1 2-1 2-2 2-2 1-0 0-1 0-0 1-1 1-2 0-2 1-1 14 2-2 2-2 2-3 3-2 3-3 2-3 3-2 2-2 2-3 2-3 2-3 2-3 15 2-3 1-3 3-2 2-3 2-1 2-2 2-0 3-2 2-3 2-3 1-2 3-3 16 1-2 2-2 3-3 2-2 3-3 2-3 2-1 1-2' 2-1 2-2 2-2 2-2 17 1-2 1-2 2-1 2-3 1-2 1-3 2-1 1-1 2-2 1-2 2-2 2-3 18 1-3 1-3 2-3 2-2 1-2 2-2 3-1 2-2 1-3 2-3 1-2 1-3 23 1-2 1-2 0-1 2-1 1-0 2-0 1-1 3-3 1-0 2-2 1-0 1-1 24 2-2 2-3 2-3 1-3 2-2 2-2 3-5 3-4 2-1 3-1 4-5 2-2 25 4-3 3-2 4-4 3-1 4-5 3-3 3-4 3-2 4-4 3-1 4-4 3-2 26 5-3 2-2 5-3 3-3 3-5 2-2 3-3 1-2 3-3 2-2 4-3 3-3 32 5-2 3-3 3-3 2-2 4-5 2-3 3-2 4-1 5-3 2-2 5-3 4-2 33 1-2 1-2 1-1 2-2 2-0 2-1 2-2 2-2 1-1 2-1 1-1 1-1 34 3-3 2-2 3-3 3-2 3-3 3-2 3-3 2-3 2-3 3-3 1-3 2-3 35 0-0 0-0 0-0 0-0 0-0 0-0 0-0 0-0 1-1 1-0 0-0 0-0 36 3-2 3-2 3-2 3-2 2-2 2 -1 3-3 3-3 2-1 2-2 2-2 2-3 37 3-2 2-2 2-1 2-1 2-0 2-0 2-2 2-2 1-1 y,'' J_ 2-3 1-2 1-3 their respective pretest scores on the item in question; the second score, their respective posttest scores. In all cases, the score of the therapist is given first, follov/ed by a hyphen and the client's score.

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163 TABLE 34— (extended) G-23 n-21 1-38 J-30 -34 3-5 3-3 1-0 1-0 1-0 2-2 1-1 0-0 1-1 2-1 2-0 1-0 2-1 1-2 0-0 1-0 1-1 2-1 2-1 3-2 2-0 2-1 1-1 2-0 1-1 2-3 2-2 2-0 2-1 2-1 3-3 3-2 2-5 3-5 2-2 2-1 3-3 3-4 2-1 1-1 2-3 2-2 1-0 1-1 1-1 2-0 1-1 2-0 4-4 3-5 2-2 1-1 1-1 1-0 0-0 0-0 1-2 1-1 0-0 0-1 2-2 1-2 0-0 0-0 2-2 2-1 1-1 2-1 2-2 2-1 1-1 1-1 1-1 0-0 2-2 1-2 1-1 2-2 3-3 3-4 3-4 3-4 3-3 2-3 3-3 3-5 2-2 2-2 2-3 2-2 1-1 1-1 2-1 2-1 2-1 1-1 4-4 5-5 0-1 0-1 2-2 0-1 1-1 1-1 1-2 1-2 1-1 0-1 2-1 1-2 0-0 0-0 2-2 2-2 2-2 1-1 1-2 1-1 2-2 1-0 2-2 3-2 1-3 1-2 2-1 0-1 3-2 4-5 4-4 4-3 3-3 4-3 3-2 5-3 2-2 1-3 2-3 3-3 0-1 0-0 2-1 2-2 1-1 1-24-2 3-2 1-1 1-0 2-2 2-2 0-0 0-1 2-2 0-2 2-2 1-0 1-0 0-1 0-1 0-0 1-2 1-1 2-2 2-1 2-3 3-3 2-2 2-2 1-1 1-1 1-3 1-3 2-3 3-3 3-3 1-2 3-2 4-3 2-3 1-2 3-1 2-1 1-1 1-1 3-3 3-3 0-0 1-0 2-3 3-3 2-2 2-3 3-4 2-2 1-1 1-0 1-1 1-1 2-2 1-2 2-1 1-0 0-0 0-0 1-0 0-0 0-0 0-0 2-2 0-0 2-2 2-2 2-2 3-3 2-2 2-2 1-3 1-2 3-2 2-3 2-2 3-3 3-3 1-2 3-3 3-2 2-3 2-1 4-4 2-2 1-1 2-2 3-3 3-3 0-0 0-0 2-2 3-3 2-2 2-2 L-4 3-4 5-3 1-1 1-2 1-1 2-1 0-0 0-0 2-1 2-0 2-2 ?.-2 2-1 1-2 0-1 0-0 1-2 1-2 2-2 3-3 2-1 1-2 2-0 2-3 3-3 2-3 1-1 0-3 1-0 1-2 2-6 4-2 4-3 .4-3 3-3 2-1 3-3 5-2 1-2 1-1 2-2 2-2 0-0 0-0 3-3 1-3 1-2 0-3

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164 Ti^iBLE 35 THE THERAPISTS' AVERAGE RATINGS ON THE CARKHUFF SCALES FOR THEIR INITIAL AND TERMINAL SESSIONS WITH AN INDIVIDUALLY AND MULTIPLY SEEN CLIENT Multiple Therapistclient pair Pre Post Individual Therapistclient pair Pre Post Empathy A-IO B-8 C-16 D-14 E-25 F-20 G-37 H-26 1-33 J-31 K-35 L-36 A-10 B-8 C-16 D-14 E-25 F-20 G-37 H-26 1-33 J-31 K-35 L-36 2.50 2.50 A7 3.50^ 3.08 B-12 2.75 2.67 C-17 2.92 3.00 D-29 3.50 2.58 E-39 2.50^* 3.13b F-22 1.92 2.50 G-23 3.00^ 2.00 H-21 2.33 1.58 1-28 2.75 2.75 J30 3.17 2.92 K-34 2.42 2.58 Respect L-40 2.33 3.00^ 2.67 2.92 3.42 2.50^ 1.92 3.00' 2.25 2.58 3.25 2.58 2, 3. 2, 3, 2. 3. 2 2 58 00 67 00 58 13^ 33 00 1.50 2.75 3.17 2.75 A7 B-12 C-17 D-29 E-39 F-22 G-23 H-21 1-38 J-30 K-34 L-40 1.58 2.67 2.83 3.58 2.25 2.58 3.67 3.00 2.92 2.58 3.25 3.83 2.67 3.08 2.00 2.67 3.17 3.00 1.83 2.75 3.08 3.75 2.58 3.00 1.83 2.58 2.92 3.42 2.33 2.58 3.67 3.25 2.92 2.75 3.25 3.83 2.58 2.92 2.17 2.58 3.00 2.92 1.83 2.92 3.17 3.83 2.75 3.00

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TABLE 35 — (continued) 165 Multiple Therapistclient pair Pre Individual Post Therapistclient pair Pre Post Genuineness A10 B-18 C-16 D-14 E-2 5 F-20 G-37 H-26 1-33 J-31 K-35 L-36 A10 B-8 C-16 D-14 E-25 F-20 G-37 H-26 1-33 J-31 K-35 L-36 2.58 2,58 3.00^ 3.00 2„67 2.92 3.00 3.08 3.25 2.58 2.50^ 3.00^ 1.83 2.33 3.00^ 2,25 2.25 1.50 2.58 2.83 3.08 3.08 2.58 2.75 C( 2.58 2.50 3.00^ 3.00 2,75 2.75 3.00 3.00 3.33 2.58 2.50^ 3.13^ 1.83 2.58 3.00^ 2.25 2.25 1.33 2.58 2.67 3.25 2.83 2.58 2.67 b A7 B-12 C-17 D-29 E-39 F-22 G-23 H-21 1-38 J-30 K-34 L-40 Concreteness A-7 B-12 C-17 D-29 E-39 F-22 G-23 H-21 1-38 J-30 K-34 L-40 1.75 2.50 2.75 3.33 2.17 2.42 3.67 3.25 2.92 2.75 3.00 3.75 2.67 3.00 2.42 2.92 3.25 2,92 2.08 2.92 3.00 3,58 2.58 2,58 1.58 2.50 2.67 3.42 2.17 2.50 3.67 3.00 2.92 2.58 3.08 3.67 2.58 3.00 2.42 3.08 3.50 3.00 2.17 2.83 2.92 3.67 2.42 2.67 Note: Except as noted, all of the average ratings are based on three 5-minute segments. 3-The average rating of the two judges on one segment. ^The average rating of the two judges on two segments.

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166 in tn m ^ • • U3 tn C CM 'T CTi rH in rn rH MD o 00 rH r0) xi !ji4J (d M MH CD > n3 rH Ki < H rH H xn 4-1 0) .H ^ a:! ^ x; Sh (1) & tp 2: tJi ^ D-i & 15 & ^ tn & u U > O •n^ -H -ri O H Cn fi (D H .c; iH Si rH .C r-\ rH rH rH x; r-1 O h^ I — 1 4J (d CO s 0) C 10 ^ IS rH n w w G O CO CN r-(U X! 4J 4J 0) ^ CO Q) ^ H (d U U to >i x; 0) 0) fd rH rH rH O H ^ ^ A X! ^ m 13 0) & tn & Cn & tn ^ & 15 & tn 15 tn QJ c > •H O -H o rH o o •rl \^ H (U 0) rH -d rH ^ H A H H r-\ T-\ X! H g (0 U o 1^ o UH o > (d Q) CD tn C (d O in > • (d 4-1 C CO Id •H (d fd shx; :s UH in in <: 13 M • • ^ a CN '^ r(N in n a^ CJI ^ OD H U3 ,^^ ^ 4-1 (d iH rH IS !h o o (d 0) K^ u Oj en H ^ x; rC -a Pi O •H w rl O H VD cu iH ^ rH ^ rH ^ H rH rH rH x: rH 3LE 3 (HIGH K^ ^ in in x; P::! 4-> +J CN CO H -H 0. <-K Id H Sh (d 0) XJ Sh eh 0) > Eh cn -i^ • 1^ c CN iH r^ in ro 00 H o^ CN VD w >1 fd H 1-4 > 4J (d ^ ^ -c: X! -G K e 0) ^ &i 5 tn 5 tn 5: ^ 5 ^ &i 5 w w > O •H •rl H •H H 1 S S S S w S cn U2 S s S s >H M +J H H w w H W H H H H H H. S 0) \ \ >i H H CO E-I en s H 4J 05 (U 0) s 4J ^ C • S (d cn H CO (d fd D IS cn Eh pa EH fd Eh <: m u Q M Ph o w H h) 1^

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167 TABLE 37 PRE AND POST SCORES OF THE THERAPISTS ON SIX CRI SCALES Therapist Scale A I F L S D B A 9 8 8 10 8 12 13 12 1 2 10 14 B 6 9 8 7 9 15 14 14 1 2 12 12 C 11 8 8 11 14 11 12 13 2 1 13 13 D 8 11 9 15 15 15 14 13 3 4 13 14 E 8 11 12 14 14 16 15 15 6 7 12 15 F 9 10 13 13 11 13 16 15 4 4 12 13 G 5 6 12 13 12 12 12 11 1 3 12 13 H 7 8 12 12 12 12 14 12 3 2 13 13 I 7 11 11 13 10 12 13 12 4 2 11 13 J 8 :8 13 13 12 12 15 13 1 3 14 13 K 6 11 10 11 11 14 9 13 3 3 12 14 L 5 8 11 11 13 15 15 11 4 3 10 13 Note: The first score under each scale indicates the therapist's pretest score; the second, his (her) posttest score. TABLE 38 PRE AND POST SCORES OF THE THERAPISTS ON FOUR POI SCALES Therapist ^ Scale A 21 23 101 107 17 14 26 25 B 23 23 108 108 18 18 24 24 C 3 19 112 107 18 16 23 25 D 21 20 106 104 18 18 23 22 E if 18 100 108 16 15 24 25 F 2:1 20 115 113 18 18 26 23 G 18 20 89 93 16 13 21 19 H 14 17 89 96 12 13 17 22 I 19 21 111 113 17 16 23 25 J 16 18 102 104 17 17 26 27 K 18 22 100 108 13 14 23 26 L 15 15 86 85 14 14 19 22 Note: The first score under each scale indicates the therapist's pretest score; the second, his (her) posttest score.

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168 w U w w >^ i-q pj H Eh h^ K Eh O m c o fa w p:; o u CO >^ Eh H D O Pa H ffi CO •z o H EH < CO Eh CO H A4 W K EH m u <; Q) ^ •H o O tn (U CO o -a -p o m 0) CO u o o CO rci O Eh 4J o P4 i-> o Eh -P O -P O (1) CM +J -P c W 0) •H -H (C! U u Eh fd !h H fd CD CO (d o p u fa fd -P O Eh 4-) CO O U -P 4J d to x>cor-'^Ln OJOiiHCNCNCNCM iHCN <;pauQWfaOWHi^!^hq ocr>. t^'*incr)vD'^vD"!a''^t^O'=r H H rHrHHrH iHCN or-iHLncTirHnroi^ocNin O O VD H r-l H 1 1 < ffl u I Q in w in I fa en I o I ro m I H m VD U3 fo ro ro I I I 1^ h:]
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169 o pa Eh CO m H CO u Q § !3 (< W w p::; CO CO Hi W (^ W H E-i H Hi 12 D O S CO K W Eh CO O ^ m O CO O Pi CO CO H CO EH 2 CO o H P^ fo CO H K CO Eh Pi EH ix! 2 i< o H fa Q O 13 O CO P^ W CO P^ w o p:; O Pi CO Eh H W W PJ o o tci o Eh 4-! W o Ph 0) ft -P CO •H o. 03 5-1 0) -C Eh -P -P C W 0) •H -M n3 O u Eh fC +J O Eh 0) m u +J m u H fa -P tn o ft ft p -p fi m CD a^ U &H rd ^oror-coi^Ln H rH tH CTlCOCr\CNCriiH,COLOO^O^rHLn tH t-i iH rt:p3UPWfaOEHl-3MiJ iH td r^ <-i CO CN ro vo +J H H rH tH Eh +J ^ rCN r<:l' in W ft en CO in o^ ^ CN CO CTi ^ in CN in in CN ro iH ** 'S' o o U5 VD ,-^ H in in (d 00 CO r-{ iH CN CN CN CN 1 1 m 00 1 fO 1 1 < I m U 1 Q 1 H 1 fa 1 CD 1 1 H 1 1 1

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170 w w B >i H -:t ) Qi tfi -P QJ g C -H S-j M O -H (0 U 4-) r3 Cfi H rd ty fd iH -P 0) o u Eh OJ -P •H -P CO Cfi -P O -H C! Dj a 0) 0) B ^ B U !h 0) U 0) cu u x; 5^ CO rH 4-) Dl rd 1 td 4-1 U Eh m 4J CO •H cu rS M CU ^ Eh -0 1 1 o rH iH CM I^ <-{ (Ti fO O IT) CM vo ro ro ^ LO in ro '^ o CN ^ O O CN CN rH o < u u pLi Ci-i in ffi w w CJ CJ t^ I-) i-q i-q H H t^ ti^ cNnLnDr-^co >X30>oinr^rHCNC7\oorO'* rHHrHHHCNrHHHrHH ID rm in CTi rH [^ CM rH "* m CN ro n ro '^ CN n o rH ^ a> in KD CN (N CN rrH ro in U3 n 00 ro n m -P Cfi 0) 4:; tn H u 0) o en (U CO o CN (0 Sh 0) >H (0 CD u • d CS tn H rd 0) *• g OJ n ^ (CJ CO +J ^H CO (D MH 5 tn rH tn G 0) •H ji; M -P C (C • • Sh H Q) ^ xi (U Eh ^ c (ti • • u (U -P CQ •H 2: a) M u w

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REFERENCES Adler, J., and Berman, I. R. Multiple leadership in group treatment of delinquent adolescents. International Journal of Group Psychotherapy 1960, 1_0, 213-225. Bock, J. C. Lewis, D. J., and Tuck, J. Role-divided threecornered therapy. Psychiatry 1954, 11_, 227-282. Buck, A. E., and Grygier, T. A new attempt in psychotherapy with juvenile delinquents. American Journal of Psy chotherap y, 1952, 6, 711-724. Cameron, J. L. and. Stewart, R. A. Y. Observations on group psychotherapy with chronic psychoneurotic patients in a mental hospital. Inte rnational Journal of Group Psycho therapy 1955, 5, 346-360. Carkhuff, R. R. The counselor's contribution to facilitative processes. Mimeographed manuscript, State University of New York at Buffalo, 1968. Carkhuff, R. R. Helping and human relations Vol. II. New York: Holt, Rinehart, and Winston, Inc., 1969. Carkhuff, R. R., and Berenson, B. G. Beyond counseling and therapy New York: Holt, Rinehart, and Winston, Inc., 1967. Daniels, M. The influence of the sex of the therapist and of the co-therapist technique in group psychotherapy with boys: An investigation of the effectiveness of group psychotherapy with eighth-grade, behavior-problem boys, comparing results achieved by a male therapist, by a female therapist, and by two therapists in a combination. ( Dissertation Abstracts 1958, 1_8, 1489). Demarest, E. W. and Teicher, A. Transference in group therapy. Psychiatry 1954, 17_, 187-202. Dreikurs, R. Techniques and dynamics of multiple psychotherapy. Psychiat r ic Quarterly 1950, 24_, 788-799. 171

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172 Dreikurs, R. Schulman, B. H. and Mosak, H. Patienttherapist relationship in multiple psychotherapy: I. Its advantages to the therapist. Psychiatric Quarterly 1952, 26_, 219-227 (a) Dreikurs, R. Schulman, B. H. and Mosak, H. Patienttherapist relationship in multiple psychotherapy: II. Its advantages for the patient. Psychiatric Quarterly 1952, 2_6, 590-596 (b) Dyrud, J, E., and Rioch, M. Multiple therapy in the treatment program of a mental hospital. Psychiatry 1953, 16 21-26. Feldraan, T. The tripartite session: A nev; approach in psychiatric social work consultations. Psychiatric Quarterly 1968, 4_2, 48-61. Fink, H. K. Adaptation of the family constellation in group psychotherapy. Acta Psychoth erapy, 1958, 6_, 43-54. Fox, J. On the clinical use of the Personal Orientation Inventory (POI) Mimeographed report, 1965. Gans, R. W. The use of group co-therapists in the teaching of psychotherapy. American Journal of Psychotherapy 1957, 11, 618-624. Gans, R. W. Group co-therapists in the therapeutic situation: A critical evaluation. International Journal of Group Psychotherapy 1952, 1_2, 82-88. Godenne, G. D. Outpatient adolescent group psychotherapy: I. Review of the literature on the use of co-therapists, psychodrama, and parent group therapy. American Journal of Psychotherapy 1954, 18, 584-593. Greenback, R. K. Psychotherapy using two therapists. American Journal of Psychotherapy 1964, 18_, 488-499. Hadden, S. B. The utilization of a therapy group in teaching psychotherapy. American Journal of Psychiatry 194 7, 103 544-688. Haigh, G., and Kell, B. L. Multiple therapy as a method for training and research in psychotherapy. Journal of Abnormal and Social Psychology 1950, 45_, 659-666. Hayward, M. L., Peters, J. J., and Taylor, J. E. Some values of the use of multiple therapists in the treatment of psychoses. Psychiatric Quarterly 1952, 26, 244-249.

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173 Hill, F., and. Strahl, G. Two against an impasse. V oices : The Art and Sc ience of Psychotherapy 1968, 4_, 96-104. Hiilse, W, C, Lulow, W, V., V^illiam, V., Rindsberg, B. K., and Epstein, N. B. Transference reactions in a group of female patients to male and fem.ale coleaders. Interna tional Journal of Group P syc hotherapy 19 56, 6, 430-435. Kamerschen, K. S. Multiple therapy; Variabl es relating to co-therapist satisfaction Doctoral dissertation, Michigan State University, 1969. Kell, B. L., and Burow, J. M. Developmental counseling and therapy Boston: Houghton Mifflin Company, 1970, pp. "201-268. Kirk, R F^xperimental d es ign: Proc edu res for the behavioral sciences Belmont, Cal : Brooks/Cole, 1969. Klaveter, R. E., and Magar R. E. Stability and^internal consistency of a measure of self -actualization. Psychological Reports 1967, 2_, 4 22-4 24. Linden, M. E. The sign of dual leadership in gerontologic group psychotherapy: Studies in gerontological human relations. III. Intern at ional Journ al of Group Psychotherapy 1954, 4_, 262-273. Linden, M. E., Goodwin, H. M. and Resnik, H. Group psychotherapy of couples in marriage counseling. interna tiona l Journal o f Group Ps ychotherapy 1968, 18_, 313-324. Lott, G. M. The training of nonmedical, cooperative psychotherapists by multiple psychotherapy. Amer ican Journal of Ps ychotherapy 1952, 6, 440-448. Lott, G. M. Multiple psychotherapy: The efficient use of psychiatric treatment and training time. Psychiatric Qu arterly Supplement 1957, 3_1, 277-294. Lundin, W. H. and Aronov, M. The use of co-therapists in group psychotherapy. Journal of Consulting Psychology 1952, 1_6, 76-80. MacLennan, B. W. Cotherapy. Intern ational Journal of Group Psychotherapy 1965, 1_5_, 154-166. Mallars, P. B. Team counseling in counselor education. Personnel an d Guidance Journal 1968, 4^, 981-983. Malone, T. P., and Whitaker, C. A. A community of psychotherapists. Internationa l Journal of Gro up Psycho therapy, 195 5, 15, 2 3-26.

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174 Meltzoff, u,and Kornreich, M. Research in psychotherapy New York: Atherton, 19 70. — — — t^ Miller, R. L. ; and Blooriil^erg, L. I. Breaking through the procesD impasse. Voices : The Art and Science of £? y£?l-i^_il?.=i^.P}: 1 9 6 S" "' £ 3 3-36. ~~~ Mintz E. Special values of co-therapists in group psychotherapy. Internatio nal Journal of Group Psychotherapy, 1963, 13, 127-132 Ta)": ~ ^ Mintz, E. Transference in co-therapy groups. Journal of Consulting Psychology 1963, 21_, 34-39 (b)"; Mintz, E, Male-female cotherapists : Some values and some problems, American Journal of Psychotherapy, 1965, __9_, 29 3-301. Mullan, H. The group analyst's creative function. American Journ al of Psychotherapy 1955, 9_, 320-334. Mullan, H., and Sanguiliano, I. Multiple psychotherapeutic practice: Preliminary report. American Journal of Psycho therpay 1960, 1_4, 550-564"^ Mullan, H-, and Sanguiliano, I. The therapist's contribu t ion to the treatment process^ Springfield, 111.: Charles C. Thomas, 19 64. Nunnelly, K. G. The use of multiple therapy in group coun se ling and psychotherapy Doctoral dissertation, Michigan State University, 1969. Orange, A. J. A note on brief psychotherapy with psychotic patients. International Jou rnal of Group Psychotherapy, 1955, 5, 80=^83": "" ^ Orlinsky, D. E., and Howard, K. I. The experience of psychotherapy: A prospectus on the psychotherapy session project. Chicago: Institute for Juvenile Research, research report, 1966, 3, 8 (a). Orlinsky, D. E., and Howard, K. I. Therapy session report Fo rm P and Form T Chicago: Institute for Juvenile Research, 1966 (b) Orlinsky, D. E., and Howard, K. I. The good therapy hour: Experimental correlates of patients' and therapists' evaluations of therapy sessions. Archives of General Psychiatry, 1967, 16_, 621-632.

PAGE 191

175 Pine, I., Todd, W. E. and Boenheim, C. Signs of countertransference problems in co-therapy groups. Psycho somatics 1955, 6_, 79-83. Rabin, H. M. How does co--therapy compare with regular group therapy? Araerican J ournal of Ps ycho t_he_rapy, 1967, 21(2)", 244-255. Randolph, C. C, Multiple thera py: Co-t herapist satisfac t i on as related t o th e variables of affection and self discl osure Doctoral dissertation, .Michigan State University, 1970. Reeve, G. H. Trends in therapy: V. A. method of coordinated treatment. American Journal of O rthopsychiatry 1939, 9, 743-747. Rockberger, H. The role of an eclectic affect theory in multiple therapy. P sychoanalytic Review 1965, 53, 28 3-29 2. Sabath, G. Intertransf erence : Transference relationship betv/een members of the psychotherapy team. International Journal of Group Psychotherapy 1962, l._2_, 492-495. Seigel, F. NonparamLet ric statist ic s for the behavioral sc iences New York: McGrav/-Hill 1956. Shostrom, E. L. An inventory for the measurement of selfac tual i z a tion Educat ional and Psycho lo gical Measure ment 1954, 2^, 207-2'r8. Shostrom, E. L. Manua 1_ : Car i n g Re 1 a t i o n s h i p I n ve n t o r y San Diego: Educational and Industrial Testing Service, 1966 (a) Shostrom, E. L. Manu al: Per s onal O rie ntation Inven tory. San Diego: Educational and Industrial Testing Service, 1966 (b)". Singer, M. and Fischer, R. Group psychotherapy of male homosexuals by a male and female co-therapy team. In t ernational Journal of Group Psychothe rapy 19 67, TT;' 44-52. Slavson, S. R. Sources of countertransf erence and groupinduced anxiety. Inte rnat ional Jo u rnal o f Group Psychotherap y, 1953, 3, 373-388. Slavson, S. R. Discussion. Internation al J o urnal of Gro up P sychotherap y, 1960, 10, 225-226'.

PAGE 192

176 Soloraon, A., Loeffler, F. J., and Frank, G. H. An analysis of COtherapist interaction in group psychotherapy. Internati onal Joux'na l of Group Psych o therapy ,19 54, 3^, 171-186. '~^' ^ ^' Solomon, J. C,, and Solomon, G. F. Group psychotherapy V7ith father and son as co-therapists Inter national Journal o f Group Psychotherapy 1963, 13^ 13 3-140. Sonne, J. C, and Lincoln, G. The importance of heterosexual co-therapy relationship in the construction of a family image. Psychi atric Research Report 19 66, 20 195--205, Spitz, H. H. and Copp S. B. Multiple psychotherapy. In M. Rosenbaura and M, Berger (Eds.) Group psychotherapy and gro up function New York: Basic Books, 1963. Staples, E. J. The influence of sex of the therapist and of the co-therapist technique in group psychotherapy with girls: An investigation of the effectiveness of group psychotherapy with eighth-grade, behaviorproblem girls, comparing results achieved by a male therapist, by a female therapist, and by two therapists in combination. ( Dissertation Ab s tracts 1959, 19(2), 2154) Swander, K. K, An analogue study of the effects of therapists' level of functioning on co-therapists' level of functioning and activity level within a multiple therapy situation. Unpublishe;d masters thesis, University of Florida, 1971. Treppa, J. A. An investigation of some of the dynamics of the interpersonal relationship between pairs of multiple therapists. Doctoral dissertation. ( Disserta tion Abstracts, 1969, 30.' 1909B) Treppa, J, A. Multiple therapy: Its growth and importance. An historical survey. American Journal of Psychotherapy 1971, 2_5, 447-455. ^~~ Truax, C. B., and Carkhuff, R, R. Towa rd effective c oun selJ^ng a nd psycho therapy. Chicago": Aidine Publishing Co"' T9 6 7 Warkentin, J. Johnson, N. L. and Whi taker, C. A. A comparison of individual and multiple psychotherapy. ^-I^iJ-ililX' 1951, 14., 415-418. Warkentin, J., and Taylor, J. E. Physical contact in multiple therapy v/ith a schizophrenic patient. Voices: Th.e_ Art and Science of Psychotherapy, 1968, 4, 58-60.

PAGE 193

177 Weigel, R. G. and Strauraf jord A. A. The dog as a therapeutic adjunct in group treatraent. V oices: The Art and Science of Psychotherapy 1970, 6l2), 108-110. Whitaker, C. A,, Malone, T. P., and Warkentin^ J. Multiple therapy and psychotherapy. In F. Fromm-Reichmann and J. L. F-loreno (Eds.), Progres s in psych otherap y. Vol. I, Nev/ York: Grune and Stratton, 195""6, pp. 210-216. Vfliitaker, C. A., Warkentin, J., and Johnson, N. L. A philosophical basis for brief psychotherapy. Psychia tric Quar terly, 1949, 2^, 439-443. Whitaker, C. A., Warkentin, J., and Johnson, N. L. The psychotherapeutic impasse. American Journal of Ortho psychiatry," 19 50, 20", 641-647.

PAGE 194

BIOGRAPHICAL SKETCH Sharon Jennette Kosch-Graham was born June 13, 1945, in Ukiah, California. She was graduated with honors from Ukiah Union High School in June, 1963. The following September she entered San Jose State College (nov7 California State University at San Jose), San Jose, California, where she participated in the Humanities Program, a liberal arts curriculum, during her first two years of study. She was awarded the degree of Bachelor of Arts vzith great distinction and honors in psychology in June, 19 67. The Phi Beta Kappa members of the faculty at San Jose State College also elected her to membership in the Key Club upon her graduation. She remained at this institution for one year of graduate study in the Psychology Department. In September, 1968, she entered the Department of Psychology at the University of Florida. From 1968 to 1970, she held a departmental teaching assistantship, and from 1970 to 1971, a U.S.P.H.S. traineeship. During 1971 and 1972, she completed a fifteen-month internship in clinical and counseling psychology at the University of Florida, with placements at the University Counseling Center and Alachua Mental Health Services. Sharon Jennette Kosch-Graham, who is married to Richard Jason Kosch, is a member of Psi Chi. 178

PAGE 195

I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate in scope and quality, as a dissertation for the degree of Doctor of Philosophy. U^'ri^y'l.'. G/ater, Jr., Ch^irlnan Professor /of Psychology I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Philosophy. Hugh C^ Davis, Jr. Professor of Clinical Psychology I certify that I have read this study and that in my opinion it conform.s to acceptable standards of scholarly presentation and is fully adequate, 2. n scope and quality. as a dissertation for the degree of Doctor of Philosophy ^^7 ^ ^., M£.-.i..-f ../£ Madelarne Carey Ramey Assistant Professor sychology I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Philosophy. ,/ / ^/' y/ y .. Vernon D. Va.n De Rert Associate Professor of Clinical Psychology

PAGE 196

I certify that I have read this study and that in my opinion it conforms to acceptable standards of scliolarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Philosophy. ^)mp^T)lAjJI,_ Y.OA^ James D.'Millikan Assistant Professor of Philosophy This dissertation was submitted to the Department of Psychology in the College of Arts and Sciences and to the Graduate Council, and was accepted as partial fulfillment of the requirements for the degree of Doctor of Philosophy, Decem)er, 19 7 2 Dean, Graduate School


90
the CRI scales of Affection, Friendship, and Empathy).
Pearson product-moment correlations were computed between
the post CRI scores of each therapist on Affection, Friend
ship, and Empathy (M) and the post POI scores of the client
with whom he was paired for purposes of data analysis. The
scores on which these correlations were based are given
in'Appendix H, Tables 37 and 41. None of the correlations,
which ranged from -.28 for Affection and Time-Competence to
.39 for Friendship and Time-Competence, were significant at
the .05 level. Hypothesis 34 was not supported.
A discussion of the attempt to establish test-retest
reliability and concurrent validity of the MTRS is in order,
before considering the use of this instrument in testing
the last two hypotheses. It was thought that the same
therapists should rate his relationship to his co-therapist
similarly on two separate, but temporally close, occasions.
Positive correlations between these two separate ratings
were predicted. Test-retest reliabilities were computed for
both co-therapist agreement and the therapists' rating of
their relationship quality by correlating each therapist's
scores on these from his sessions with one client to those
from his sessions with his other client. As the distribu
tion of relationship quality scores was not normally dis
tributed, Spearman rank-order correlations were used, when
appropriate, with the correction for ties. The rank orders
of each therapist's relationship quality scores, pretest,


Hypothesis 31.The therapists will be more inner-
directed, at the end of therapy than at therapy's beginning.
The posttest mean of the therapists on the scale of Inner-
Directed was larger than the pretest mean, but the difference
did not reach significance at the .05 level (t = 1.78,
p < .10). Hypothesis 31 was not supported.
Hypothesis 32.--The therapists will show a greater
capacity for intimate contact at the end of therapy than at
therapy's beginning. The therapists' scores on the scale of
Capacity for Intimate Contact did not differ significantly
from pre- to posttesting (t = 1.24, p > .10), so Hypothesis
32 was rejected.
Hypothesis 33.--The therapists will show a greater
amount of spontaneity at the end of therapy than at therapy's
beginning. As the posttest mean on the scale of Spontaneity
was actually smaller than the pretest mean, though not
significantly (t = -1.69, p > .10), this hypothesis was
rejected.
The Multiple Relationship and Client Outcome
The last three hypotheses postulated significant re
lationships between client outcome in the multiple condition
and certain aspects of the co-therapy relationship.
Hypothesis 34.--There will be a positive correlation
between the self-actualization of the clients (as measured
by the major POI scales of Time-Competence and Inner-Directed)
and the level of caring of the therapists (as measured by


103
offers the therapist greater freedom to be personally and
emotionally involved than does individual therapy. The
counselors here under study did not take advantage of this
freedomif they felt it existedto be more revealing of
their spontaneous impressions (Hypothesis 7), be more warm
and friendly to their clients (Hypothesis 11), nor to
express more feeling (Hypothesis 12) in multiple than
individual counseling. Neither did the present sample
support the contention that therapists would be more likely
to be confrontive in multiple than in individual therapy
(Warkentin, Johnson, and Whitaker, 1951), as they said that
they were no more critical or disapproving in one condition
than the other (Hypothesis 10).
Lundin and Aronov (1952) listed one benefit for the
therapist to be derived from co-therapy as the amelioration
of his blind spots. Dreikurs, Schulman, and Mosak (1952a)
similarly felt that the therapist's accuracy of diagnosis
and interpretation would be increased when he had the oppor
tunity of constant consultation with a colleague. This
should lead to a better understanding of the patient on the
part of the therapist; however, the counselors who partici
pated in the current research did not rate their under
standing of their clients as being superior in one treatment
modality than the other (Hypothesis 8). Finally, the
therapists did not feel that they were more helpful to
their clients in one condition than the other (Hypothesis 9).


105
It is the opinion of the present researcher that the
claims in the literature regarding the greater value of
multiple therapy than individual therapy are based on the
therapists' general attitudes about their work in the two
conditions. As noted above, the current sample of thera
pists also believed multiple therapy to be more advantageous
than individual therapy. When various hypothesized advan
tages were subjected to a somewhat more empirical probing
how the therapists rated their clients' and their own
behavior on specific topics after completing both multiple
and individual sessionsthe much-discussed differences
were not apparent.
Judges' Ratings of Therapist Behavior
This research project investigated differences between
multiple and individual therapy in an area that heretofore
has not received attention. This area concerns the evalua
tion of the therapeutic process by judges; specifically
in this instance, the therapists' level of functioning on
the facilitative core dimensions of empathy, respect,
facilitative genuineness, and concreteness. It was gen
erally thought that, due to the sharing of responsibility
in co-therapy (Gans, 1957; Miller and Bloomberg, 1968) and
the supposed increased capacity of the therapist (Warkentin,
Johnson, and Whitaker, 1951), the therapists should offer
higher levels of these core dimensions in multiple than in
individual therapy.


28
of functioning of the co-therapists on client self
exploration. The present study combined these types of
designs to collect various data from therapists, clients,
and independent judges regarding multiple therapy as com
pared to individual therapy, as well as the multiple situ
ation itself.
The current report includes two main categories of
hypotheses in reference to therapists, which correspond to
the,two main themes in the literature. The first of these
is centered around differences in how the therapists
operate and perceive therapeutic process in each condition;
the second, with various facets of the co-therapist rela
tionship and the possible effect of some of these on clients.
The specific research hypotheses are listed in the succeed
ing chapter. Predictions and results of the project which
focus primarily on client experiences in the two conditions
are to be reported in the dissertation of the writer's
co-researcher (Reiner, 1973) .


12
interpretation (Dreikurs, Schulman, and Mosak, 1952a), as
well as his understanding of the client (Mullan and San-
guiliano, 1960). The latter authors also cited various
reports which claimed that not only are interpretations re
inforced, but different ones are given at an earlier time
in therapy. The client will be more likely to accept
impressions of the therapists when they both agree (Dreikurs,
1950), which speeds the overcoming of resistance and the
therapeutic progress. This aspect of multiple therapy is
similar to a "consensual validation" effect. Another advan
tage related to this is that the counselor seems to be less
"on the spot" when he has a partner, and he thus has more
time to consider his comments. He most likely talks less
and when he does, he is able to state things more ade
quately and accurately. Also, he probably stays in touch
with the process better and is inclined to drop out his
less helpful responses. In addition, the counselor can
feel assured that his countertransference tendencies of
being overprotective, oversympathetic, or hostile will be
reduced in the co-therapy setting (Greenback, 1964; Solomon,
Loeffler, and Frank, 1954). Or, at least, having an
observer in the room makes it easier to discriminate be
tween reality and transference reactions (Demarest and
Teicher, 1954) or mutual client-therapist distortions
(Sonne and Lincoln, 1966). It has also been related that
problems about transferring (Buck and Grygier, 1952) or


TABLE 24
RANK ORDERS OF EACH THERAPIST'S RELATIONSHIP QUALITY SCORES
FOR BOTH MULTIPLY SEEN CASES
First
case
Second
case
Both cases <
combined
Therapist
and client
pair
Pre
Post
Total
Therapist
and client
pair
Pre
Post
Total
Therapist
Pre
Post
Total
A-8
11
7.5
10
A-10
12
8
10.5
A
12
8.5
10
B-8
1
10
5
B-10
5
10
8
B
2
10
8
C-14 .
5.5
9
7
C-16
5
7
7.5
C
6
7
6.5
D-14
9
6
9
D-16
10.5
9
9
D
9
8.5
9
E-20
5.5
11
8
E-25
8
2.5
4.5
E
7
6
6.5
F-20
2
5
3
F-25
5
4.5
4.5
F
4
4.5
3
G-26
3
2
2
G-37
1.5
2.5
2
G
2
2
2
H-26
7
3.5
4
H-37
1.5
4.5
3
H
2
3
4
1-31
10
12
12
1-33
9
11.5
10.5
I
10
12
12
J-31
8
3.5
6
J-33
7
6
7.5
J
8
4.5
5
K-35
4
1
1
K-36
3
1
1
K
5
1
1
L-35
12
7.5
11
L-36
10.5
11.5
12
L
11
11
11
Mote:
The
rankings for
each measure
are over all 12
therapists.
On
each,
the
highest score was ranked 1; the lowest score, 12.


TABLE 36
THE THERAPISTS' MYERS-BRIGGS TYPES, LEVELS (HIGH OR LOW) AND RANKS ON THE CARKHUFF SCALES
Therapist
Myers-Briggs
type
Carkhuff
Scales
Empathy
Respect
Genuineness
Concreteness
Level
Rank
Level
Rank
Level
Rank
Level
Rank
A
INFP
low
12
low
12
low
12
low
12
B
INFP
high
1
high
4
high
4
high
4
C
ENFP
low
7
low
7
low
9
low
9
D
I/ENFP
high
4
high
2
high
1
high
1.5
E
ESTJ
low
5
low
5
low
5
low
5
F
ENFP
high
3
high
3
high
3
high
3
G
ISTJ
low
8
low
9.5
low
11
low
11
H
ISTJ
low
11
low
9.5
low
6
low
6
I
E/INFP
low
9.5
low
11
low
10
low
10
J
INFP
low
9.5
low
8
low
8
low
8
K
INFJ/P
high
2
high
1
high
2
high
1.5
L
ENFJ
low
6
low
6
low
7
low
7
Note: The rankings are over all 12 therapists. On each scale, the lowest average
was ranked 12; the highest, 1. Therapist E had an average very close to 3 on all of the
scales.
166


56
TABLE 2
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST
RESPONSES TO TSR ITEMS 1 AND 2 FOR MULTIPLE
AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
2.5833
2.1660
2.5000
2.0000
(.9962
(.3892)
(.6742)
(1.0415)
Source
df
MS
F
Blocks
11
.4147
.55
Treatments
3
Condition (A)
1
.1875
.25
Time (B)
1
2.5275
3.33
A x B .
1
.0201
.03
Residual
33
.7582
Total
47
Note: The standard deviations are in parentheses.
Hypothesis 3.Compared to individual therapy, the
therapists will rate the clients in multiple therapy as
having wanted more to express and explore feelings (Items
6 and 9). Table 4 lists a significant blocks ratio, again
indicating that there were individual differences among the
therapists as to how they responded. The effect of con
dition was not significant,' and Hypothesis 3 was not sub
stantiated. A significant ratio was obtained for time, with
the initial interview means being larger than those of the


174
Meltzoff. J., and Kornreich, M. Research in psychotherapy.
New York: Atherton, 1970.
Mill or f R L < r and Bloomberg, L. I. Breaking through the
process imp a s s e. Voices: The Art and Science of
Psychotherapy, 1968 4_, 33-36.
Mintz, E. Special values of co-therapists in group psycho
therapy, International Journal of Group Psychotherapy,
1963, 13, 127-132 (a).
Mintz, E. Transference in co-therapy groups. Journal of
Consulting Psychology, 1963, 27_, 34-39 (b)~
Mintz, E. Male-female cotherapists: Some values and some
problems. American Journal of Psychotherapy, 1965,
19, 293-301.
Mullan, H. The group analyst's creative function. American
Journal of Psychotherapy, 1955, 9_, 320-334.
Mullan, H., and Sanguiliano, I. Multiple psychotherapeutic
practice: Preliminary report. American Journal of
Psychothsrpay, 1960 1_£, 550-564.
Mullan, H., and Sanguiliano, I. The therapist's contribu
tion to the treatment process^ Springfield, Ill.:
Charles C. Thomas, 1964.
Nunnelly, K. G. The use of multiple therapy in group coun
seling and psychotherapy. Doctoral dissertation,
Michigan State University, 1969.
Orange, A. J. A note on brief psychotherapy with psychotic
patients. International Journal of Group Psychotherapy,
1955, 5, 80-83.
Orlinsky, D. E., and Howard, K. I. The experience of
psychotherapy: A prospectus on the psychotherapy
session project. Chicago: Institute for Juvenile
Research, research report, 1966, 3_, 8 (a).
Orlinsky, D. E., and Howard, K. I. Therapy session report,
Form P and Form T. Chicago: Institute for Juvenile
Research, 1966 (b).
Orlinsky, D. E., and Howard, K. I. The good therapy hour:
Experimental correlates of patients' and therapists'
evaluations of therapy sessions. Archives of General
Psychiatry, 1967, 16, 621-632.


39
by a "0" in the margin), since its scoring direction was
indeterminable. The scores of each therapist in the mul
tiple and. individual columns were then summed, providing a
total score over all items for individual and multiple therapy
In addition, the mean and modal score of each item using
Rabins (1967) scoring pattern-1" for "much more" in mul
tiple therapy to "4" for "no difference" through "7" for
much more in individual therapy--was computed from the
scores of the 12 therapists on each item.
The Carkhuff Process Scales
It is now widely accepted that certain core conditions
of therapists' level of functioning are crucial to some of
the events that take place during therapy. Carkhuff (1969)
described the scoring procedures for his process scales
designed to evaluate: (1) empathetic understanding,
(2) respect, (3) faciliative genuineness, and (4) concrete
ness or specificity of expression in interpersonal processes.
These scales shall be referred to in the text as: Empathy,
Respect, Genuineness, and Concreteness. The form of these
scales used to train the judges and rate the taped excerpts
from therapy sessions of the study are given in Appendix D.
It seems advisable to describe the version presently used
because all of the scales have progressed through several
stages as research indicated that alterations or refine
ments were necessary.
These process scales, along with a scale that measures
depth of client self-exploration, have been shown to be


156
TABLE 30-- (continued)
Item or
choice
number
Judge
Scoring
direction
used
Item or
choice
number
Judge
Scoring
direction
used
A
B
c
D
A
B
c
D
6 .
R
R
R
R
11:
R
R
R
R
a.
+
4
+
+
+
a.
-
-
0
-
-
b.
4*
+
4*
4*
+
b.
-
-
0
-
-
c.
+
4-
-
-
zero
c.
+
-
+
+
4-
d.
-
-
-
-
-
d.
-
-
-
-
-
e.
-
-
-
-
-
12.
R
R
R
R
7.
R
R
R
. R
a.
-
-
+
-
-
a.
_
-
-
-
-
b.
+
+
0
+
+
b.
0
0
0
+
0
c.
+
+
0
+
4"
c.
0
0
0
4-
0
d.
-
-
-
-
-
d.
+
+
+
+
4-
16.
R
R
R
R
8.
R
R
R
R
a.
-
0
0
-
a.
-
-
-
-
-
b.
-
0
0
-
b.
-
-
-
-
-
c.
+
0
0
+
c.
-
0
0
0
0
d.
+
+
+
4*
+
22.
R
R
R
R
a.
+
+
+
0
+
9.
R
R
R
R
b.
4-
+
+
+
+
a.
--
-
-
-
-
c.
+
+
+
+
+
b.
-
-
--
-
-
d.
+
0
+
0
c.
-
-
-
-
-
e .
+
+
+
+
+
d.
-
-
-
-
-
f.
+
+
+
+
+
g-
+
0
+
0

O
i1
R
R
R
R
h.
+
0
+
+
+
a.
-
-
-
-
-
i.
+
+
+
0
+
b.
-
-
-
+
-
j -
4"
+
+
+
+
c.
-
0
0
0
0
k.
+
+
+
+
+
d.
+
+
+
-
+
1.
+
+
+
4*
4*
m.
+
+
+
4-
+
n.
+
0
+
0
Note: When there is a blank space beside a choice
under "Scoring direction used," this choice was not scored,
as there was not agreement among at least three of the
judges as to the scoring direction. The only exception to
this were the three choices designated by the word "zero,"
which were scored as such. This was the scoring direction
originally determined by the two researchers, which was not
consistently corroborated by the judges.


148
Level 5
The facilitator is always helpful in guiding the dis
cussion, so that the second person(s) may discuss fluently
directly, and completely specific feelings and experiences
Example: The first person involves the second person in
discussion of specific feelings, situations, and
events, regardless of their emotional content.
In summary, the facilitator facilitates a direct
expression of all personally relevant feelings and experi
ences in concrete and specific terms.


TABLE 41
RAW SCORES OF TOTAL COMPOSITE CO-THERAPIST AGREEMENT AND RELATIONSHIP QUALITY FROM THE
MTRS AND THEIR CLIENTS' S-A SCALE AND POI SCALES OF
TIME COMPETENCE AND INNER-DIRECTED
Client
S-A Scale
POI
Therapists
Total composite
co-therapist
agreement
score
Total composite
relationship
quality
score
Time
Competence
Inner-
Directed
8
- 5
16
82
AB
16
10
10
37
19
96
AB
18
11
14
23
10
83
CD
20
32
16
35
15
95
CD
20
37
20
9
17
82
EF
17
50
25
31
21
99
EF
20
42
26
- 7
12
56
GH
13
56
37
32
19
112
GH
15
53
31
41
18
95
IJ
17
33
33
24
13
64
IJ
14
24
35
3
14
76
KL
12
40
36
17
18
89
KL
15
41
Note: The
rankings for each measure
are over all
12 cases. On each,
the highest
score is
ranked
1;
the lowest score, 12.
170


21
(Solomon, Loeffler, and Frank, 1954). It is essential that
the counselors be able to freely communicate with one
another in order to work through any of their problems in
interacting.
Competitiveness and hostility.Mintz (1965) claimed
that the "possibility of personal friction between the
therapists is certainly the greatest hazard of this type of
treatment" [p. 299]. Competitiveness (Dyrud and Rioch,
1953; Lott, 1957) is probably the most deleterious factor
to the formation of a good multiple therapy relationship.
Kell and Burow(1970) emphasized that it requires conscious
effort for counselors to form a collaborative relationship,
because there is "little in the professional therapists'
training which prepares them for building a co-worker
relationship which can be helpful and meaningful both to
them and the client" [p. 213]. These authors prefer pair
ing male and female counselors, hoping to avoid the compe
tition so prevalent between men. Competitiveness may well
still be an issue, however, and the participants will need
to be aware of this potential tendency and counteract it.
Lundin and Aronov (1952) state that if a patient "senses
the same lack of respect, disharmony, and infantile compe
tition ..." similar to those between his parents, ". .
the basic purpose of the co-therapy method has been lost"
[p. 79]. MacLennan (1965) spotlighted such a possible
area of dissension with male and female therapiststheir


Page
Personal Orientation Inventory 43
Multiple Therapy Rating Scale ......... 44
Myers-Briggs Type Indicator 48
Hypotheses 49
Multiple Versus Individual Therapy 50
The Multiple Condition 51
RESULTS 54
Comparison of Multiple and Individual Conditions 54
Number of Sessions 54
TSR Data 55
CTS Data 69
Carkhuff Process Scales Data .... 75
The Multiple Condition 83
CRI Data 8 3
POI Data 87
The Multiple Relationship and Client Outcome . 89
DISCUSSION ....... 99
Comparison of the Conditions 99
Therapists' Report of Interactions 99
Therapist Attitudes About the Two Conditions . 104
Judges Ratings of Therapist Behavior 105
Comments on the Comparison of the Conditions . 108
The Phenomenon of Multiple Therapy 113
The Caring of the Therapist Pairs 113
Growth 117
MTRS Reliability and Validity 118
An Area for Future Research 121
APPENDICES 123
A. Therapists Research Instruction Sheet . 124
B. Therapy Session Report 125
C. Comparative Therapy Scale 137
D. Carkhuff Scales 141
E. The Scales of the Caring Relationship Inven
tory 149
F. Four Scales of the Personal Orientation In
ventory 150
G. The Multiple Therapy Rating Scale 151
H. Numerical Raw Data and Summaries 157
REFERENCES 171
BIOGRAPHICAL SKETCH 178
ix


32
Comparisons
First and last sessions.--All data were collected for
initial and terminal interviews, enabling comparisons to be
made between the participants' pre~ and posttests for both
conditions. Although tape recordings were made of all
sessions for future reference, only the first and final ones
were utilized. The number of interviews per case varied
from four upward; any students discontinuing therapy before
four sessions were excluded from the study. It was decided
that natural termination was preferable to administering
posttests after a specific number of sessions, as it seems
somewhat presumptuous to assume that clients have had equal
therapeutic exposure or possible progress in the same number
of sessions.
Individual versus multiple process.A Comparative
Therapy Scale, which taps attitudes toward multiple and
individual therapy, was administered to the counselors. The
therapists answered the same process forms (Therapy Session
Report) for individual and multiple sessions so that their
perceptions and reported behaviors during the two situations
could be easily compared. Similar self-report forms (Therapy
Session Report) regarding the process of the therapy sessions
were completed by therapists and clients, so that their
agreement or lack of it could be ascertained. Process was
was also rated by two clinicians who listened to tape-
recorded segments of the sessions (as per the scales developed
by Berenson, Carkhuff, and Truax).


135
I FEEL THAT I GOT:
25. A CHANCE TO LET GO AND GET
THINGS OFF MY CHEST.
26. HOPE: A FEELING THAT THINGS
CAN WORK OUT FOR ME.
27. HELP IN TALKING ABOUT WHAT
WAS REALLY TROUBLING ME.
28. RELIEF FROM TENSIONS OR
UNPLEASANT FEELINGS.
29. MORE UNDERSTANDING OF THE
REASONS BEHIND MY BEHAVIOR AND
FEELINGS.
30. REASSURANCE AND ENCOURAGEMENT
ABOUT HOW I'M DOING.
31. CONFIDENCE TO TRY TO DO THINGS
DIFFERENTLY.
32. MORE ABILITY TO FEEL MY FEELINGS,
TO KNOW WHAT I REALLY WANT.
33. IDEAS FOR BETTER WAYS OF DEALING
WITH PEOPLE AND PROBLEMS.
34. MORE OF A PERSON-TO-PERSON
RELATIONSHIP WITH MY THERAPIST.
35. BETTER SELF-CONTROL OVER MY
MOODS AND ACTIONS.
NO SOME A LOT
0 12
0 12
0
0
1
1
2
2
WHAT DO YOU FEEL THAT YOU GOT OUT OF
THIS SESSION? (for each item, circle the
answer which best applies.)
36.A MORE REALISTIC EVALUATION OF MY 0 1 2
THOUGHTS AND FEELINGS.
37.NOTHING IN PARTICULAR; I FEEL THE
SAME AS I DID BEFORE THE SESSION.
0 12
38.HOW WELL DID YOUR THERAPIST(S) SEEM TO UNDERSTAND WHAT
YOU WERE FEELING AND THINKING THIS SESSION?
MY THERAPIST(S):
1. Understood exactly how I thought and felt.
2. Understood very well how I thought and felt.


69
In inspecting the agreement scores for the first and
the last session, it is noteworthy that 17 of the 24 cases
had higher therapist-client agreement scores for the pre
test than the posttest. A binomial test (two-tailed)
showed this difference to be nonsignificant (p = .064 at
the .05 level). In breaking this down into groups, in 10
out of the 12 multiple cases the posttest agreement scores
were lower than the pretest scores (p = .038); while in the
individual group, only 7 out of 12 were lower (p = .774).
As far as the difference between pre- and posttesting, then,
the two groups appear dissimilar. In the multiple condi
tion, the agreement between the therapists and their clients
was significantly greater during the initial interview than
it was during the terminal interview. In the individual,
condition, there was not a significant difference between
therapist-client agreement at the end, as compared to the
beginning, of therapy.
CTS Data
As per the prior explanation (see Method section), the
mean and the modal scores of the therapists on the 32 items
of the CTS were determined. Means and modes of 1 to 3
designate topics that the therapists felt typified multiple
therapy, while 4 indicated no difference, and 5 to 7
signified statements thought to be true of individual
therapy. The mean scores of the 32 items were used to rank
order the topics, as shown in Table 15. The smaller ranks


145
defensiveness may be demonstrated in the content
of his words or his voice quality. Where he is
defensive he does not employ his reaction as a
basis for potentially valuable inquiry into the
relationship.
In summary, there is evidence of a considerable dis
crepancy between the inner experiencing of the first
person and his current verbalizations. Where there is
no discrepancy, the first persons reactions are employed
solely in a destructive fashion.
Level 2
The first person's verbalizations are slightly un
related to what he is feeling at the moment, or when his
responses are genuine they are negative in regard to the
second person; the first person does not appear to know
how to employ his negative reactions constructively as a
basis for inquiry7 into the relationship.
Example: The first person may respond to the second person(s)
in a "professional" manner that has a rehearsed
quality or a quality concerning the way a helper
"should" respond in that situation.
In summary, the first person is usually responding
according to his prescribed role rather than expressing
what he personally feels or means. When he is genuine his
responses are negative and he is unable to employ them as a
basis for further inquiry.
Leve1 3
The first person provides no "negative" cues between
what he says and what he feels, but he provides no positive
cues to indicate a really genuine response to the second
person(s).
Example: The first person may listen and follow the second
person(s) but commits nothing more of himself.
In summary, the first person appears to make appro
priate responses that do not seem insincere but that do not
reflect any real involvement either. Level 3 constitutes
the minimal level of facilitative interpersonal functioning.
Level 4
The facilitator presents some positive cues indicating


133
WHAT PROBLEMS OR FEELINGS WERE YOU CONCERNED ABOUT THIS
SESSION? (For each item, circle the answer which best
applies.)
DURING THIS SESSION I WAS CONCERNED ABOUT: NO SOME
8. BEING DEPENDENT UPON OTHERS. (10) 0 1
9. BEING LONELY OR ISOLATED. (11) 0 1
10. SEXUAL FEELINGS AND EXPERIENCES. (12) 0 1
11. EXPRESSING OR EXPOSING MYSELF TO 01
OTHERS. (13)
A LOT
2
2
2
2
DURING THIS SESSION, HOW MUCH:
12. DID YOU TALK? (14) 0
13. WERE YOU ABLE TO FOCUS ON WHAT 0
WAS OF REAL CONCERN TO YOU? (15)
14. DID YOU TAKE INITIATIVE IN BRING- 0
ING UP THE SUBJECTS THAT WERE TALKED
ABOUT? (16)
15. WERE YOUR EMOTIONS OR FEELINGS 0
STIRRED UP? (17)
16. DID YOU TALK ABOUT WHAT YOU WERE 0
FEELING? (18)
1 2
1 2
1 2
1 2
1 2
DURING THIS SESSION, HOW MUCH:
17. FRIENDLINESS OR RESPECT DID YOU
SHOW TOWARDS YOUR THERAPIST?
18. WERE YOU ATTENTIVE TO WHAT YOUR
THERAPIST WAS TRYING TO GET
ACROSS TO YOU?
19. WERE YOU NEGATIVE OR CRITICAL
-TOWARDS YOUR THERAPIST?
20. WERE YOU SATISFIED OR PLEASED
WITH YOUR OWN BEHAVIOR? (23)
0 12
0 12
0 12
0 12


TABLE 26
RANK ORDERS OF THE THERAPISTS SCORES ON FOUR CRI SCALES
Affection
Friendship
Empathy (M)
Being
Love
Therapist
Pre
Post
Pre
Post
Pre
Post
Pre
Post
A
2.5
8
11
11
12
9
11.5
3
B
9.5
5
11
12
11
3
7
12
C
1
8
11
9
2.5
12
3
8.
D
5
2
9
1
1
3
3
3
E
5
2
4
2
2.5
1
7
1
F
2.5
4
1.5
4.5
8.5
6
7
8
G
11.5
11.5
4
4.5
6
9
7
8
H
7.5
8
4
7
6
9
3
8
I
7.5
11.5
6.5
4.5
10
9
10
8
J
5
8
1.5
4.5
6
9
1
8
K
9.5
2
8
9
8.5
5
7
3
L
11.5
8
6.5
9
4
3
11.5
8
Note: The rankings
highest score was ranked
for
1; '
each scale
the lowest
are over
score, 12.
all 12
therapists.
On each,
the


115
the co-therapists became more appreciative and tolerant of
their partners as unique individuals worthwhile and complete
as they were. It would also appear, then, that the co
therapists were more likely to accentuate the other's assets
and strengths (Gans, 1962) at the end than at the beginning
of therapy.
Finally, it was predicted that the therapists would
decrease their scores on the scale of Self Love (Hypothesis
29) over time, as it was believed that their involvement with
themselves in the co-therapy relationship would diminish as
the association became closer. Although the scores of the
therapists on this scale did decrease from pre- to post
testing, the difference was nonsignificant.
Practitioners of multiple therapy have stated that one
of its advantages is the improvement of staff relations in
a mental health center (Dyrud and Rioch, 1953; Malone and
Whitaker, 1965). Although only describing the relationships
of dyads, these findings regarding the increased caring of
the counselors lend some empirical support to this assump
tion .
Change toward healthier relations.Not only did the
therapists increase their caring relative to themselves, as
was explained above, but also they improved on many scales
in relation to Shostrom's norms for successfully married,
troubled, and divorced couples. It is notable that the
therapists were higher than any of the couples on the Self


146
a genuine response (whether positive or negative) in a non
destructive manner to the second person(s).
Example: The facilitator's expressions are congruent with
his feelings although he may be somewhat hesitant
about expressing them fully.
In summary, the facilitator responds with many of his
own feelings, and there is no doubt as to whether he really
means what he says. He is able to employ his responses,
whatever their emotional content, as a basis for further
inquiry into the relationship.
Level 5
The facilitator is freely and deeply himself in a non-
exploitative relationship with the second person(s).
Example: The facilitator is completely spontaneous in his
interaction and open to experiences of all types,
both pleasant and hurtful. In the event of
hurtful responses the facilitator's comments are
employed constructively to open a further area of
inquiry for both the facilitator and the second
person.
In summary, the facilitator is clearly being himself
and yet employing his own genuine responses constructively.
Personally Relevant Concreteness or Specificity of
Expression in Interpersonal Processes:
A Scale for Measurement
Level 1
The first person leads or allows all discussion with
the second person(s) to deal only with vague and anonymous
generalities.
Example: The first person and the second person discuss
everything on strictly an abstract and highly
intellectual level.
In summary, the first person makes no attempt to lead
the discussion into the realm of personally relevant
specific situations and feelings.


Table Page
10. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the 'Therapists
Pre and Post Responses to TSR Item 32 for
Multiple and Individual Conditions 63
11. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists
Pre and Post Responses to TSR Item 35 for
Multiple and Individual Conditions ...... 65
12. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists1
Pre and Post Responses to TSR Item 36 for
Multiple and Individual Conditions 66
13. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 37 for
Multiple and Individual Conditions 67
14. Therapist-Client Agreement Scores for Multiple
and Individual Conditions: Correlations Be
tween Their Responses to 24 TSR Items .... 68
15. Means, Modes, and Ranks of the Therapists'
Response Pattern on the 32-Item Comparative
Therapy Scale 71
16. Wilcoxon Matched-Pairs Signed-Ranks Test for
Testing Differences in Therapists' Attitudes
About Multiple and Individual Therapy .... 74
17 Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Empathy Scores for Multiple and
Individual Conditions 77
18. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Respect Scores for Multiple and
Individual Conditions 78
19. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Genuineness Scores for Multiple
and Individual Conditions 80
xi


48
respective scores together, and a total composite score was
obtained by summing the pre and post composite scores.
An investigation of the test-retest reliability of the
two parts of the MTRS was proposed. It would seem likely
that the therapists would rate their relationship similarly
after seeing their first multiple case together and after
seeing their second. It would also appear likely that their
level of agreement as to the events of the session would
remain stable for their two first multiple sessions. It was
also planned to see if either the level of agreement or the
rated quality of the co-therapist relationship scores for
each therpist correlated with those of his Caring Relation
ship Inventory as a concurrent validity check. Also, it
would be expected that these indices would be related to
outcome of the multiply seen clients. High agreement and
high quality should be paired with good outcomes, low agree
ment and low quality with poor outcomes. If the data sug
gested a trend in this direction, it would provide a crude
case for predictive validity of the MTRS.
Myers-Briggs Type Indicator
The Myers-Briggs Type Indicator is a 166-item, forced-
choice instrument that categorizes testees according to
Jung's typology. Information regarding the composition and
scoring of the test can be obtained from the Educational
and Industrial Testing Service, San Diego, California.


4
first to receive recognition. It is easy to see why many
practitioners felt that this method offered an ideal situ
ation in which to prepare new helping persons. It provides
an apprenticeship atmosphere where a trainee can observe
actual therapy and learn the techniques and styles of an
accomplished therapist. This assuredly seems to be a
marked improvement over textbook or classroom presentations
of how one conducts a psychotherapeutic interview.
The earliest reported use of two persons in a therapy
setting is cited as being at the Vienna Child Guidance
Clinic by Alfred Adler and his associates (Dreikurs, 1950;
Spitz and Kopp, 1963) Usually the persons involved were
a psychiatrist and a social worker or a teacher, an
imbalanced therapeutic team which may have set the stage
for later pairings of a similar nature. A psychiatrist and
a social worker were used by Reeve (1939) in his "joint
interview" technique which he felt could offer a benefi
cial training experience for psychiatric social workers.
As a step toward avoiding the prevalent maltreatment of
psychoneurotics by physicians, advanced medical students
attended group therapy sessions led by a psychiatrist.
Hadden (1947) reported that this procedure was of great
positive significance in the medical students' preparation.
The use of the multiple approach for discovering how
to teach psychotherapy was an essential concern in the
first few years of experimentation by Whitaker, Warkentin,
and Johnson (1949). At the inception of their use of this


11
therapist when there is a "chaperone" present. This is
equally true for the counselors, and having another thera
pist in attendance is likely to increase counselor spontane
ity. Kell and Burow (1970) state that the presence of a
therapeutic partner enables a counselor "to feel, fantasy,
and image more and do it more easily" [p. 216]. Whitaker,
Malone, and Warkentin (1956) theorized that perhaps the
most important benefit of multiple therapy over individual
therapy is that it gives
. . greater freedom on the part of each therapist to
be personally involved both professionally and
emotionally. Therefore, the approach allows for
greater variability and even innovations in tech
nique. One therapist provides the control, the other
the variable, at any given time in therapy [p. 211].
Others have agreed that the way in which multiple therapy
offers more freedom and flexibility is that it confers
greater stability for both clients and therapists (Buck and
Grygier, 1952; Dyrud and Rioch, 1953; Sonne and Lincoln,
1966) .
Greater comfort and confidence.--Another group of
supposed advantages has to do with the therapist feeling
more confident or better about his therapeutic interactions.
The multiple situation gives the therapist a higher proba
bility of success due to the fact that his blind spots will
be ameliorated by another and different helping person
(Lundin and Aronov, 1952). The counselor also has the
benefit of constant consultation with another professional,
which will increase his accuracy of diagnosis and


117
This finding may reflect that there is actually no
association between the level of caring of the therapists
and their clients' outcome. The nonsignificant results could
also be due to other reasons. First of all, the group of
therapists was a very homogeneous one in regard to their
level of caring. The range of the therapists' scores on
the CRI was very constricted, thus making it more difficult
to get a significant correlation. Secondly, in this in
stance the client outcome was compared to only one of this
therapist's scores--the one with whom he was paired at random
for purposes of comparisons. Had a scale been used which
assessed the total caring of each pair of therapists and the
scores from this scale been correlated with the outcome
scores of their clients, different results might have ensued.
Growth
It has been hypothesized that the experience of multiple
therapy leads to growth in therapists (Solomon, Loeffler,
and Frank, 1954; Warkentin, Johnson, and Whitaker, 1951).
It was proposed that the counselors who participated in the
present research would show positive increases in self-
actualization (as measured by selected scales of the POI)
during the time that they were involved in multiple therapy.
Ideally, a control conditiontesting the therapists over
the same time period while they were not involved in co
therapywould have been included. As it was not, the
results can only be suggestive.


108
significantly change their level of functioning when
working together.
As shown in Table 36 (Appendix H), the present sample
of therapist pairs were all of the high-low or low-low
variety, when an average of above 3.0 was considered to be
high and an average of below 3.0 was thought to be low. As
stated previously, the therapists were not significantly
lower in the multiple condition than the individual con
dition during the first session; thus they did not reflect
the general trend found in Swander's study. After working
together for some time, however, the counselors did exhibit
this pattern of offering lower levels in co-therapy than
regular therapy. Possibly, experienced counselors are not
as easily influenced by the functioning level of a co
therapist as are undergraduate students, and it takes some
time for this influence to alter their behavior.
Comments on the Comparison of the Conditions
The judges corroborated the evidence from the thera
pists' report of their own behaviorthat the actual inter
actions of the therapists were not significantly superior
in multiple than in individual therapy. In fact, at the
end of therapy, the raters judged the counselors to be
functioning worse in co-therapy than in regular therapy.
If the therapists were not interacting more thera
peutically in multiple than individual counseling, it would
follow that they would not experience significant differences


53
Client outcome and certain aspects of the multiple therapy
relationship. First of all, it was postulated that
34. There will be a positive correlation between the
self-actualization of the clients (as measured by
the major POI scales of Time-Competence and Inner-
Directed) and the level of caring of the thera
pists (as measured by the CRI scales of Affection,
Friendship, and Empathy).
Secondly, it was planned to compare the clients' scores on
the S-A Scale with their therapists' scores on the MTRS to
test the following hypotheses:
35. The quality of the co-therapist relationship will
be positively related to the client level of self-
actualization (as measured by the S-A Scale).
There will be a positive relationship between agree
ment of the co-therapists as to how they behaved
and perceived during the sessions and the level of
self-actualization of the clients (on the S-A Scale).
36.


TABLE 40
AGREEMENT SCORES OF EACH THERAPISTS RESPONSES ON THE TSR AND HIS PARTNER'S
CORRESPONDING MTRS RESPONSES FOR BOTH MULTIPLY SEEN CASES
First
case
Second
case
Both cases
combined
Therapist
and client
pair
Pre
Post
Total
Therapist
and client
pair
Pre
Post
Total
Therapist
Pre
Post
Total
A-8
6
1
7
A-10
3
4
7
A
9
5
14
B-8
4
5
9
B-10
4
7
11
B
8
12
20
C-14
3
2
5
C-16
6
2
8
C
9
4
13
D-14
7
8
15
D-16
5
7
12
D
12
15
27
E-20
9
5
14
E-25
9
4
13
E
9
9
18
F-20
8
3
11
F-25
11
5
16
F
11
8
19
G-2 6
9
5
14
G-37
9
5
14
G
8
10
18
H-26
4
2
6
G-37
6
3
9
H
5
5
10
1-31
4
4
8
1-33
5
3
8
I
9
7
16
J-31
5
4
9
J-33
4
2
6
J
9
6
15
K-35
5
2
7
K-36
6
4
10
K
11
6
17
L-35
3
2
5
L-36
2
3
5
L
5
5
10
169


49
According to Isabel Briggs Myers, who with her mother
developed the instrument, research has shown that clinical
psychologists are predominantly Introverted or Extraverted
Intuitive Types with Feeling and Perception being strongest.
She also feels that these are the types best suited for
counseling work.*
The use of this test in the present study was purely
descriptive; the types of each therapist are indicated in
Table 36, Appendix H. A homogeneous pool of therapists
according to their types would be desirable; however, the
present sample contained people of varied types. As shown,
7 of the 12 therapists are either of the two aforementioned
types; two differ only in that they have Judging predominant
over Perception, and in one of these cases the score was
barely into the Judging zone. The other three, however, are
Extraverted or Introverted Sensing Types with Thinking and
Judging dominant. It would be interesting to note whether
those of the "noncounselor" types have different scoring
patterns from the others on the Carkhuff Process Scales.
Hypotheses
The specific research hypotheses fall into two major
categories: (a) those regarding differences between multiple
and individual therapy, and (b) those concerned with the
*Personal communication, November 18, 1970,


TABLE 35(continued)
Multiple
Individual
Therapist-
client
pair
Pre
Post
Therapist-
client
pair
Pre
Post
Genuineness
A-10
2.58
2.58
A-7
1.75
2.50
B-18
3.00a
3.00
B-12
2.75
3.33
C-16
2.67
2.92
C-17
2.17
2.42
D-14
3.00
3.08
D-29
3.67
3.25
E-25
3.25
2.58
E-39
2.92
2.75
F-20
2.50b
3.00b
F-22
3.00
3.75
G-37
1.83
2.33
G-2 3
2.67
3.00
H-26
3.00a
2.25
H-21
2.42
2.92
1-33
2.25
1.50
1-38
3.25
2.92
J-31
2.58
2.83
J-30
2.08
2.92
K-35
3.08
3.08
K-34
3.00
3.58
L-36
2.58
2.75
L-4 0
2.58
2.58
Concreteness
A-10
2.58
2.50
A-7
1.58
2.50
B-8
3.00a
3.00
B-12
2.67
3.42
C-16
2.75
2.75
C-17
2.17
2.50
D-14
3.00
3.00
D-29
3.67
3.00
E-25
3.33
2.58
E-39
2.92
2.58
F-20
2.50b
3.13b
F-22
3.08
3.67
G-37
1.83
2.58
G-23
2.58
3.00
K-26
3.00a
2.25
H-21
2.42
3.08
1-33
2.25
1.33
1-38
3.50
3.00
J-31
2.58
2.67
J-30
2.17
2.83
K-35
3.25
2.83
K-34
2.92
3.67
L-36
2.58
2.67
L-40
2.42
2.67
Note: Except as noted, all of the average ratings are
based on three 5-minute segments.
aThe average rating of the two judges on one segment.
t*The average rating of the two judges on two segments.


163
TABLE 34(extended)
G-
23
H-
21
I-
33
J-
30
K-
34
L-
4 0
3-5
3-3
4-4
3-5
4-4
5-5
4-2
3-2
3-4
2-2
3-4
5-3
1-0
1-0
2-2
1-1
0-1
0-1
1-1
1-0
1-1
1-0
1-1
1-2
11
l
O
2-2
1-1
1-0
2-2
0-1
2-2
2-2
1-1
1-1
1-1
2-1
l-i
0-0
0-0
0-0
1-1
1-1
0-0
0-1
2-2
1-2
0-0
0-0
l-l
2-1
1-2
1-1
1-2
1-2
2-2
0-2
2-1
1-0
2-1
2-0
2-0
1-0
0-0
0-1
1-1
0-1
2-2
1-0
0-0
0-0
2-2
2-2
2-1
1-2
2-2
1-2
2-1
1-2
1-0
0-1
1-0
0-0
2-1
2-2
0-0
1-0
0-0
0-0
0-0
0-0
0-1
0-0
0-0
0-0
0-1
0-0
1-1
2-1
2-2
2-1
2-2
2-2
1-2
1-1
2-2
0-0
1-2
1-2
2-1
3-2
1-1
2-1
2-2
1-1
2-2
2-1
2-2
2-2
2-2
3-3
o
1
CM
2-1
2-2
2-1
1-2
1-1
2-3
3-3
2-2
3-3
2-1
1-2
1-1
2-0
1-1
1-1
2-2
1-0
2-2
2-2
2-2
2-2
2-0
2-3
1-1
2-3
1-1
0-0
2-2
3-2
1-1
1-1
1-3
1-2
3-3
2-3
2-2
2-0
2-2
1-2
1-3
1-2
1-3
1-3
3-2
2-3
1-1
0-3
2-1
2-1
1-1
2-2
2-1
0-1
2-3
3-3
2-2
3-3
1-0
1-2
3-3
3-2
3-3
3-4
3-2
4-5
3-3
1-2
3-3
1-2
2-6
4-2
2-5
3-5
3-4
3-4
4-4
4-3
3-2
4-3
3-3
3-2
4-3
4-3
2-2
2-1
3-3
2-3
3-3
4-3
2-3
1-2
2-3
2-1
3-3
2-1
3-3
3-4
3-3
3-5
3-2
5-3
3-1
2-1
4-4
2-2
3-3
5-2
2-1
1-1
2-2
2-2
2-2
1-3
1-1
1-1
1-1
2-2
1-2
1-1
2-3
2-2
2-3
2-2
2-3
3-3
3-3
3-3
3-3
3-3
2-2
2-2
1-0
1-1
1-1
1-1
0-1
0-0
0-0
1-0
0-0
0-0
0-0
0-0
1-1
2-0
2-1
2-1
2-1
2-2
2-3
3-3
2-2
3-3
3-3
1-3
1-1
2-0
2-1
1-1
1-1
1-2-
2-2
2-3
2-2
2-2
1-2
0-3


Ill
they were both facilitative helpers. Also, it is noteworthy
that three of the counselors (B, D, and F) who were high-
functioningall femalesmay not have been as active during
the multiple sessions as they were during the individual
sessions. Although activity ratings as such were not in
cluded in the study, a lower activity level was alluded to
when these counselors did not talk during one or two of the
random segments of the multiple sessions. They may not have
been as influential on their low-functioning male co
therapists, then, as the men were on theirs and the overall
ratings of the counselors were subsequently lower in the
multiple than the individual condition. Possibly, then, the
co-therapists were not adequately matched on the active-
passive. continuum, as the males seemed to be somewhat more
active. Had it been the males who were high-functioning,
different data might have been obtained.
As there were no apparent consistent dissimilarities
of the facilitative levels of "counselor" and "noncounselor"
types (on the Myers-Briggs), the inclusion of all "coun
selor" types probably would not influence the results found
with these scales. However, it is possible that the ex
clusive use of "counselor" types might yield different
results on the other scales.
Likewise, the multiple therapy of the current study
was not undertaken because it was felt to be especially
appropriate for the clients, as has frequently been the


APPENDIX F
FOUR SCALES OF THE PERSONAL ORIENTATION INVENTORY1
Symbol
Description
Ti/Tc
TIME RATIO
Time Incompetence/
Time Competence--measures
degree to which one is
"present" oriented.
o/i
SUPPORT RATIO
Other/Inner--measures
whether reactivity
orientation is basically
toward others or self.
S
SPONTANEITY
Measures freedom to react
spontaneously or to be
oneself.
c
CAPACITY FOR INTIMATE
CONTACT
Measures ability to develop
contactful intimate relation
ships with other human
beings, unencumbered by
expectations and obligations.
1From Shostrom (1966b).
150


114
their scores on the scale of Affection (Hypothesis 24) from
the beginning of therapy to its end. As listed in Appendix
E, Shostrom feels that Affection is a helping, nurturing
form of love. As far as each partner's willingness to
nurture the other, then, there were significant gains. It
was felt that changes in each team's relationship toward
greater dependency on each other might be reflected by an
increase on the scale of Deficiency Love (Hypothesis 27).
The results, however, showed that the co-therapists did not
significantly increase their scores on this scale from the
first to the terminal session. Both pre and post means of
the counselors on this scale were very low in comparison
to Shostrom's sample of couples who were or had been married.
Possibly, due to the fact that this scale measures the very
manipulative aspects of caring as well as the partners' need
for each other, it did not tap the type of dependency that
would be found between co-therapists.
Many authors (Dyrud and Rioch, 1953; Lundin and Aronov,
1952; and Whitaker, Malone, and Warkentin, 1956) have under
lined that the co-therapists should respect each other as
being competent and equal, and should not be competitive.
The finding that the co-therapists increased their scores
on the scale of Friendship (Hypothesis 25) over time indi
cates that they grew to respect each other's equality more.
The significant increases on the scales of Empathy (M)
(Hypothesis 26) and Being Love (Hypothesis 28) suggest that


18.
154
To what extent do you think the other therapist
revealed his (her) spontaneous impressions or reac
tions to the patient this session? (29)
a. Considerably
b. Moderately
c. Somewhat
d. Slightly
e. Not at all
19. How much do you think the other therapist was atten
tive to what the patient was trying to get across? (34)
a. Slightly or not at all
b. Some
c. Pretty much
d. Very much
20. How much do you think the other therapist was critical
or disapproving towards the patient? (35)
a. Slightly or not at all
b. Some
c. Pretty much
d. Very much
21. To what extent do you think the other therapist was
warm and friendly towards your patient? (36)
a. Slightly or not at all
b. Some
c. Pretty much
d. Very much
22.In your fantasies regarding the other therapist, which
of the following would you entertain as being pleasant?
a.
b.
c.
d.
e.
f.
g-
h.
i.
3
k.
l.
m.
n.
Play sports with them
Go out for a beer with them
Have as a next door neighbor
Be in the same social club with them
Date them, e.g., go to a movie with them
Have your child raised by them
Have lunch with them
Have your brother or sister married to them
Loan your car to them
Be engaged or married to them
Have as a friend
.Have as a brother or sister
Work very closely with them
Have over to your house for dinner


71
TABLE 15
MEANS, MODES, AND RANKS OF THE THERAPISTS' RESPONSE PATTERN
ON THE 32-ITEM COMPARATIVE THERAPY SCALE
Item
no.
Rank
Mean
Mode
32.
Resolution of impasses.
1
2.000
2
10.
Useful in training therapists.
2.5
2.083
1
14.
Useful with marital couples.
2.5
2.083
1
4.
Opportunity to work out anxieties
with a therapist of the more
dreaded sex.
4
2.167
2
3.
Transference of the original
family situation.
5
2.333
2
8.
Understanding of countertrans
ference .
6.5
2.417
2
28.
Your general preference with a
patient who ferociously clings to
persons of one sex.
6.5
2.417
2
1.
Understanding, by the therapist,
of the transference.
8
2.583
3
6.
Self-understanding of the thera
pist enhanced.
9
2.667
2
11.
Personal gratification (enjoyment
or "fun") for the therapist.
10
2.727
3
30 .
Your general preference for work
ing out and through a patient's
very intense "negative" transfer
ence .
11.5
2.750
3
31.
Your general preference for working
out and through a patient's very
sticky "positive" transference.
11.5
2.750
3
18.
Working out and through problems
of masculinity and feminity.
13
2.833
2
20.
Opportunity for patients of both
sexes to identify with a reasonably
healthy person of the same sex.
14.5
2.917
3


27
Swander (1971) attempted to investigate one such area
of the therapists' relationship as it affects client out
come. In an analogue study using undergraduate students as
both therapists and clients, she manipulated the level of
therapist functioning in multiple pairs. She concluded
that
. . two therapists of higher levels of nonfacili-
tative core conditions may work together with no nega
tive effect on each other's functioning level and
with no negative effect on their client's level of
self-exploration. When, on the other hand, a low-
functioning nonfacilitative therapist works with
another nonfacilitative therapist, there will not only
be a negative effect on each other's functioning level
but on the level of client self-exploration as well
[pp. 34-35].
Although Swander's sample was limited in that there were no
facilitative helpers included, there were still definite
differences in helpee self-exploration resulting from
higher or lower nonfacilitative levels of functioning.
These results underline the importance of inspecting the
relationship between co-therapists. It is difficult to
evaluate the studies concerned with the relative efficacy
of individual versus multiple therapy when this examination
has been omitted.
As listed above, previous studies have been concerned
with (1) how therapists and clients felt about multiple
therapy as compared to individual therapy, (2) some essential
ingredients of a satisfying- co-therapy relationship, (3) the
relative efficacy of multiple versus individual therapy in
regard to client outcome, and (4) the effect of the level


PSYCHOTHERAPEUTIC INTERACTIONS
IN MULTIPLE AND INDIVIDUAL THERAPY
By
SHARON JENNETTE KOSCH-GRAHAM
A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
1972

Sharon
Copyright by
ennette Kosch-Graham
1972

In Memoriam:
Atman
(P. Atman, Hiccipus, Liccipus, Puppy-do-dog)
One of the finest friends I have known.

ACKNOWLEDGMENTS
My warmest thanks and appreciation go to Dr. Harry
Grater, who chaired my dissertation committee. He was
always abundantly supportive and almost totally nondirec
tive, leaving me with the feeling that the project was
truly my own. He did a lot to decrease my ever-ready anxiety-
barometer when it would start to rise.
I especially wish to thank Dr. Hugh Davis for his con
tributions; being my most verbal critic, he definitely
helped me to formulate more precise statements about the
research. And the liking and respect that he communicated
for me as a psychologist were greatly appreciated.
I am grateful to Dr. Vernon Van De Reit for his support
and understanding during my time of "dissertation distress."
I am also thankful for his willingness to read the manu
script when he had a million things to do.
I am eternally indebted to Dr. Madelaine Ramey for her
highly skilled aid with the statistics involved in this
study; I feel that she is truly a wizard in this field, and
I would not have had a polished dissertation without her
assistance. I am greatly appreciative of the amount of her
own time that she devoted to helping me, and for her
genuine interest in the project.
IV

I extend many thanks to Dr. James Millikan for joining
my committee at such a late stage (when I really needed him!)
and for being a good "sounding board" while I was writing
the manuscript.
I want to express my sincere gratitude to the twelve
therapists who participated in the study: Jaguie and Mike,
Cindy and Bill, Karen and Jim, Pat and John, and Judy and
Linwood. I thank each of you for your patience in filling
out those seemingly endless forms and for taping the sessions.
I also thank all of the twenty-four clients who agreed to let
their counseling involvement be studied.
I heartily thank four of the Counseling Center secre
taries: Adrienne, Edith, Harriet, and Muriel. Each of
them helped by typing, administering, or scoring test forms,
as well as caring about me and the project. I am grateful
also to the editorial skills of Sue Kirkpatrick, who typed
the final manuscript.
And, of those not mentioned, I would like to thank Lauren,
Roger, and Gary for serving as judges for two of the scales.
I would also like to express my gratitude to Drs. David
Orlinsky and Kenneth Howard for their permission to use
items from the Therapy Session Report.
I am especially thankful that my co-researcher, Chuck,
was willing to share the ordeals of research with me.
Personally, I am grateful to my two therapists, Pat
and Paul, and to many friends, for helping me preserve enough
of my sanity to write this dissertation.
v

And finally, I am very grateful to my husband, Richard,
for his kind understanding and help during the time that I
was working on this project.
vi

PREFACE
The report contained in this dissertation, concerned
with multiple and individual therapy from the therapists
perspective, was part of a joint research project conducted
with Charles A. Reiner. His dissertation, to be completed
in 1973, will focus on multiple and individual therapy
from the client's viewpoint.
vi 1

TABLE OF CONTENTS
Page
ACKNOWLEDGMENTS iv
PREFACE ........ vii
LIST OF TABLES x
ABSTRACT xiii
INTRODUCTION 1
Advantages for Therapists 3
Training 3
Growth 6
Better Therapeutic Interactions 7
The Multiple Therapy Relationship 15
Characteristics of a Good Relationship ..... 15
Prerequisites and Matching 16
Relationship Problems and Solutions 19
Research ...... 24
METHOD ........ 29
Subjects 29
Counselors 29
Clients 29
Design 30
Conditions and Groups 30
Comparisons 32
Procedure 33
Counselors 33
Clients ...... 34
Instruments 35
Therapy Session Report ..... 35
Comparative Therapy Scale 37
The Carkhuff Process Scales 39
Caring Relationship Inventory 42
viii

Page
Personal Orientation Inventory 43
Multiple Therapy Rating Scale ......... 44
Myers-Briggs Type Indicator 48
Hypotheses 49
Multiple Versus Individual Therapy 50
The Multiple Condition 51
RESULTS 54
Comparison of Multiple and Individual Conditions 54
Number of Sessions 54
TSR Data 55
CTS Data 69
Carkhuff Process Scales Data .... 75
The Multiple Condition 83
CRI Data 8 3
POI Data 87
The Multiple Relationship and Client Outcome . 89
DISCUSSION ....... 99
Comparison of the Conditions 99
Therapists' Report of Interactions 99
Therapist Attitudes About the Two Conditions . 104
Judges Ratings of Therapist Behavior 105
Comments on the Comparison of the Conditions . 108
The Phenomenon of Multiple Therapy 113
The Caring of the Therapist Pairs 113
Growth 117
MTRS Reliability and Validity 118
An Area for Future Research 121
APPENDICES 123
A. Therapists Research Instruction Sheet . 124
B. Therapy Session Report 125
C. Comparative Therapy Scale 137
D. Carkhuff Scales 141
E. The Scales of the Caring Relationship Inven
tory 149
F. Four Scales of the Personal Orientation In
ventory 150
G. The Multiple Therapy Rating Scale 151
H. Numerical Raw Data and Summaries 157
REFERENCES 171
BIOGRAPHICAL SKETCH 178
ix

LIST OF TABLES
Table Page
1. Percentages of Agreement Among Four Judges
Regarding the Multiple Therapy Rating Scale 46
2. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Items 1 and 2
for Multiple and Individual Conditions ... 56
3. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Items 1-5 for
Multiple and Individual Conditions 57
4. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Items' 6 and 9
for Multiple and Individual Conditions ... 58
5. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 17 for
Multiple and Individual Conditions 59
6. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 21 for
Multiple and Individual Conditions 60
7. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 25 for
Multiple and Individual Conditions 61
8. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 29 for
Multiple and Individual Conditions 62
9. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 31 for
Multiple and Individual Conditions 63
x

Table Page
10. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the 'Therapists
Pre and Post Responses to TSR Item 32 for
Multiple and Individual Conditions 63
11. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists
Pre and Post Responses to TSR Item 35 for
Multiple and Individual Conditions ...... 65
12. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists1
Pre and Post Responses to TSR Item 36 for
Multiple and Individual Conditions 66
13. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Responses to TSR Item 37 for
Multiple and Individual Conditions 67
14. Therapist-Client Agreement Scores for Multiple
and Individual Conditions: Correlations Be
tween Their Responses to 24 TSR Items .... 68
15. Means, Modes, and Ranks of the Therapists'
Response Pattern on the 32-Item Comparative
Therapy Scale 71
16. Wilcoxon Matched-Pairs Signed-Ranks Test for
Testing Differences in Therapists' Attitudes
About Multiple and Individual Therapy .... 74
17 Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Empathy Scores for Multiple and
Individual Conditions 77
18. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Respect Scores for Multiple and
Individual Conditions 78
19. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Genuineness Scores for Multiple
and Individual Conditions 80
xi

Table Page
20. Means, Standard Deviations, and the Analysis
of Variance Summary Table for the Therapists'
Pre and Post Concreteness Scores for Multiple
and Individual Conditions 82
21. Pre- and Posttest Means and Standard Deviations
of the Therapists' CRI Scale Scores 84
22. Means and Standard Deviations of Shostrom's
Sample of Successfully Married, Troubled, and
Divorced Couples on the CRI Scales 87
23. Means and Standard Deviations of the Thera
pists' Pre and Post POI Scores 88
24. Rank Orders of Each Therapist's Relationship
Quality Scores for Both Multiply Seen Cases 92
25. Rank Orders of the Agreement Scores of Each
Therapist's Responses on the TSR and His
Partner's Corresponding MTRS Responses for
Both Multiply Seen Cases 93
26. Rank Orders of the Therapists' Scores on Four
CRI Scales 94
27. Test-Retest Reliabilities of Relationship
Quality and Co-therapist Agreement from the
MTRS 95
28. Spearman Rank-Order Correlations Between
Relationship Quality and Co-therapist Agree
ment and Between These Scales and Scales of
the CRI 95
29. Rank Orders of the Total Composite Co-therapist
Agreement and Relationship Quality Scores from
the MTRS and Their Client's Post S-A Scale and
POI Scales Time-Competence (Tc) and Inner-
Directed (I) 97
Xll

Abstract of Dissertation Presented to the Graduate Council
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy
PSYCHOTHERAPEUTIC INTERACTIONS
IN MULTIPLE AND INDIVIDUAL THERAPY
By
Sharon Jennette Kosch-Graham
December, 1972
Chairman: Harry A. Grater, Jr.
Major Department: Psychology
This study investigated the psychotherapeutic inter
actions of therapists in multiple and individual therapy.
One aim was to illuminate any significant differences be
tween the two conditions as far as (a) the therapists'
report of their own and their clients' behavior, (b) the
therapists' general attitudes about the two treatment
modalities, and (c) judges' evaluations of the therapists'
level of functioning on core facilitative dimensions. The
second goal was to probe various aspects of multiple therapy
itself in regard to the relationships of the co-therapist
pairs: (a) their level of caring for their partners,
(b) their ratings of the quality of their relationships,
(c) their agreement as to their perceptions and behavior
during the sessions, and (d) the relation of the foregoing
aspects to client outcome.
Three intern-level and three staff-level heterosexual
therapist pairs were formed from counselors at the University
xiii

of Florida Counseling Center; they conducted therapy with
24 unmarried female students who were randomly assigned to
conditions. Each co-therapist pair saw two clients multiply
and each therapist saw one client individually, yielding a
total of 12 multiple and 12 individual cases. Each therapist
provided his own matched control for purposes of comparing
the two conditions.
The results of the therapists' responses to a Compara
tive Therapy Scale (modified from Rabin) generally confirmed
the prediction that the therapists would have more favor
able attitudes about multiple than individual therapy. When
the therapists rated their clients' and their own behavior
after completing their first and their last multiple and
individual sessions, however, the expected differences in
favor of multiple therapy were not apparent. The only signifi
cant difference between the conditions derived from the
therapists' responses to selected Therapy Session Report
items (from Orlinsky and Howard) was that clients tended to
agree with the therapists' comments more in individual than
in multiple therapy. Two highly trained judges rated the
therapists' levels of the core facilitative dimensions of
empathy, respect, genuineness, and concreteness (from
Carkhuff) during the initial and terminal sessions of both
conditions. On all dimensions, the therapists offered equi
valent facilitative levels in both conditions during the
first session. At therapy's end, however, they offered
xiv

significantly higher levels in the individual condition than
they had in that condition during the pretesting or than
they did in the multiple condition during the final session.
Regarding the multiple condition itself, the therapist
pairs were shown to become more caring for each other over
the course of therapy on Shostrom's Caring Relationship
Inventory (CRI). The therapists made gains in self-
actualization on one Personal Orientation Inventory scale;
three others showed no gains. A Multiple Therapy Rating
Scale, designed to tap two major areas of the co-therapist
relationship (co-therapist agreement and relationship quality),
was devised by the author and a co-researcher (Reiner). The
scale's two parts were shown to have significant test-retest
reliabilities. Some evidence of concurrent and predictive
validity was obtained for co-therapist agreement as it was
positively correlated with some CRI scales and with client
level of self-actualization. Neither of these types of
validity was demonstrated for relationship quality.
The results were interpreted as supporting the litera
ture's claim that therapists have better attitudes toward
multiple than individual therapy, but as not substantiating
the assumption that the actual psychotherapeutic interac
tions are better. Some beliefs regarding co-therapy were
confirmed; the co-therapists: became closer, evinced growth,
and one aspect of their rapport was related to client out
come. Because of some characteristics of the counselors and
xv

their co-therapy relationships, the applicability of the
results for multiple therapy in general was qualified and
an area for future research suggested.
xvi

INTRODUCTION
The focus of this report is a therapeutic phenomenon
wherein two or more helping persons simultaneously engage
in psychotherapy with individual persons, families, or
groups. The presence of multiple therapists has been said
to have a markedly different effect on the counseling
interactions than does one therapist. The differences be
tween multiple and individual therapy have been one major
area of concentration for all who have used and written about
multiple therapy. The other predominant theme in the
literature has to do with the characteristics of the phe
nomenon itself, including its different versions styled by
therapists with diverse goals and emphases.
Various titles have been given to this counseling
approach, with very little agreement among the authors as
to exactly what the differences and similarities between
them are. Those less often used include: cooperative team
approach (Lott, 1957), dual leadership (Linden, 1954),
joint interview (Reeve, 1939), role-divided therapy (listed
by Randolph, 1970), team counseling (Mallars, 1968), and
three-cornered therapy (Bock, Lewis, and Tuck, 1954). In
regard to the present research, the "use of two therapists
with one client is what we mean by multiple therapy" (Haigh
1

2
and Kell, 1950, p. 659). The name multiple therapy is also
preferred by the present author to emphasize the distin
guishing characteristic of this term, that of "the use of
two therapists who are involved intimately, affectively,
and spontaneously with each other and their patient(s)"
(Treppa, 1971, p. 452). Co-therapy (Lundin and Aronov,
1952) is probably the most frequently encountered term in
the literature, and in many instances is used as synony
mous with multiple therapy. Some critical differentiating
features between these two have been drawn, however, and
are primarily concerned with using contrived roles in co
therapy versus the emphasis on the therapist as a person in
multiple therapy (Mullan and Sanguiliano, 1960). Not deny
ing that these differences are important, the terms multiple
therapists and co-therapists will be used interchangeably
here, as most authors have not separated them so distinctly.
Treppa's definition of multiple therapy is, in a sense, an
ideal to work toward. It is doubtful that most of the
articles on the interactions between therapists are based
on relationships with that high a level of involvement. So,
although the present author concurs that the dissimilar
qualities implied by the various titles are germane to a
discussion of the new method itself, when comparing this
technique to a standard approach these differences will
oftentimes be ignored.
There have been instances of using considerably more
than two therapists, as many as nine or ten with one client

3
(Hayward, Peters, and Taylor, 1952; Warkentin, Johnson,
and Whitaker, 19 51) So far, there has not been any reported
advantage or disadvantage of utilizing such a glut of exper
tise over that of two therapists, although it would seem
that this might create a rather unwieldy situation. Again,
even though some of the literature considered does not con
form to the definition employed here, any relevant findings
are reported. And, notwithstanding that the current study
specifically involves this approach in use with individual
clients, its application in conjoint and group therapies
is also included in the discussion.
Granting that many possible advantages for clients
have also been propounded, the practice of multiple therapy
was initially employed by many for the benefit of the
therapists. The present discussion will center on multi
ple therapy from the therapists perspective; the inter
ested reader may refer to other sources that expatiate
upon this method in regard to its recipients (Dreikurs,
Schulman, and Mosak, 1952b; Hill and Strahl, 1968; Kell
and Burow, 1970; Mintz, 1963a; Treppa, 1971).
Advantages for Therapists
Training
The purported advantages of multiple therapy for the
therapists, derived from counselors' personal experiences
and subsequent theorizing, are numerous. The potential
use of the multiple setting for training purposes was the

4
first to receive recognition. It is easy to see why many
practitioners felt that this method offered an ideal situ
ation in which to prepare new helping persons. It provides
an apprenticeship atmosphere where a trainee can observe
actual therapy and learn the techniques and styles of an
accomplished therapist. This assuredly seems to be a
marked improvement over textbook or classroom presentations
of how one conducts a psychotherapeutic interview.
The earliest reported use of two persons in a therapy
setting is cited as being at the Vienna Child Guidance
Clinic by Alfred Adler and his associates (Dreikurs, 1950;
Spitz and Kopp, 1963) Usually the persons involved were
a psychiatrist and a social worker or a teacher, an
imbalanced therapeutic team which may have set the stage
for later pairings of a similar nature. A psychiatrist and
a social worker were used by Reeve (1939) in his "joint
interview" technique which he felt could offer a benefi
cial training experience for psychiatric social workers.
As a step toward avoiding the prevalent maltreatment of
psychoneurotics by physicians, advanced medical students
attended group therapy sessions led by a psychiatrist.
Hadden (1947) reported that this procedure was of great
positive significance in the medical students' preparation.
The use of the multiple approach for discovering how
to teach psychotherapy was an essential concern in the
first few years of experimentation by Whitaker, Warkentin,
and Johnson (1949). At the inception of their use of this

5
method, one of the therapists merely observed; they later
modified this so that both actively participated, resulting
in greater gratification for all concerned. Dreikurs (1950)
emphasized the involvement of both therapists in a joint
interview, although only one therapist saw the patient con
tinuously and carried the major responsibility. Dreikurs
felt that this approach had great training potential for
teams consisting of either a senior and a junior therapist
or two experienced colleagues. Haigh and Kell (1950)
stated that the meaningfulness of the multiple experience
for a student was directly related to his degree of in
volvement in the treatment process. They cited the advan
tages that the actual practice of therapy can be introduced
earlier in a students' schooling, and that the experience
should be less threatening than seeing a client alone, due
to the support that the senior therapist can offer.
Dreikurs, Schulman, and Mosak (1952a) lauded this technique
as an "invaluable teaching method," and stated that each
therapist can expand his scope through watching the other.
Hayward, Peters, and Taylor (1952) also proclaimed that
multiple therapy was a good tool for training. Slavson
(1953) saw the use of a co-therapist as a response to
insecurities and inadequacies of therapists; Gans (1957)
felt that these could be ameliorated when a supporting
colleague proffered assistance. Various other authors
have concurred that this approach is of great significance

6
in situations of imbalanced therapeutic teams (Dyrud and
Rioch, 1953; Feldman, 1968; Gans, 1962; Kell and Burow,
1970; Lott, 1957; MacLennan, 1965).
It is noteworthy that the Atlanta group, who had been
one of the early proponents of multiple therapy for train
ing purposes, reversed their position and stated that the
pairing of novice and experienced therapists is not wise
(Malone and Whitaker, 1965; Whitaker, Malone, and Warkentin,
1956). The later opinion of these authors underlined the
deleterious influences of status differences which would
affect both therapists and clients.
Growth
One of the first goals of using multiple therapy as
formulated by the Atlanta group concerned its potential for
developing the capacity of the therapist (Warkentin,
Johnson, and Whitaker, 1951; Whitaker, Malone, and Warkentin,
1956; Whitaker, Warkentin, and Johnson, 1949). This was
also mentioned by Solomon, Loeffler, and Frank (1954); it is
a training goal, in a sense, but refers to the opportunity
for continued personal and professional growth of experi
enced therapists. Mintz (1963a) feels that co-therapy
offers this benefit to a therapist by his being put in a
learning situation with his colleague. The observation of
the other therapist regarding his and the client's reactions
widens his understanding of himself. He can also be
exposed to different approaches and techniques, thus expanding
his professional ability.

Mullan and Sanguiliano (1960) state that experience
in multiple therapy can lead to greater maturity in the
counselors and increase their enthusiasm for doing therapy.
They, along with others, have thought that its use results
in better working relations among staff members of a thera
peutic center (Dyrud and Rioch, 1953; Malone and Whitaker,
1965). It does seem apparent that this provides a good
opportunity for staff members to grow more together, as
they share directly in their main pursuitthe helping of
other persons. Mintz (1963a) commented that co-therapy is
also a way of alleviating the isolation associated with
private practice. The growth-enhancing characteristic of
multiple therapy is, in the opinion of Randolph (1970),
largely responsible for the recent increased use of it.
Better Therapeutic Interactions
In addition to the two aforementioned advantages which
were related to therapist training and growth, there has
been extensive discussion of how the multiple setting pro
vides for more effective and comfortable therapeutic inter
actions than does individual therapy.
Sharing of responsibility.--One of the most essential
of the interaction advantages is the sharing of responsi
bility. Having a partner in the therapy situation tends to
lessen the therapist's "effort syndrome," his attempt to
effect a positive therapeutic outcome (Warkentin, Johnson',
and Whitaker, 1951). Kell and Burow (1970) report that

8
therapists feel less burdened and have more fun when doing
multiple therapy, and thus find their work less taxing.
Part of this sharing of responsibility is the direct support
a therapist gets from his colleague (Gans, 1957; Miller
and Bloomberg, 1968; Solomon, Loeffler, and Frank, 1953).
This support certainly is an advantage during stressful
times in therapy (Linden, Goodwin, and Resnik, 1968), when
the client may require a good deal of support. Along with
this, multiple therapy seems especially useful for thera
pists when the entire course of counseling is likely to be
strenuous because the client is a difficult one (Cameron
and Steward, 1955; Greenback, 1964; Mullan and Sanguiliano,
1964; Warkentin and Taylor, 1968). However, this approach
has been found to be helpful with only some types of problem
clients, and is contraindicated with others (Kell and Burow,
1970) Sharing responsibility tends to lessen the frustra
tions and difficulties of a therapist (Dreikurs, 1950) and
makes it easier to pinpoint therapist problems (Mullan,
1955). The support element is important in improving the
therapist's image of himself, as many feel that they have
a greater capacity to work with clients (Warkentin,
Johnson, and Whitaker, 1951).
Wider range of roles.Another important advantage of
multiple therapy in regard to the therapeutic interactions
is that it enables the therapist to have a greater variety
of roles (Adler and Berman, 1960; Demarest and Teicher,
1954). Gans (1957) stated that the therapist can (1) be

9
an observer, (2) be observed, and (3) actively participate
when he has a co-therapist. Because of this, therapy is
less monotonous (Dreikurs, 1950), and thus probably keeps
the therapist more alert. Dreikurs (1950) emphasized that
the therapists will incline to serve in different role
functions naturally, as the dissimilarities in their per
sonalities will be complementary to each other. Besides
these natural roles, the therapists can also assume differ
ent roles, one being nondirective; the other, directive
(Dreikurs, Schulman, and Mosak, 1952a; Solomon, Loeffler,
and Frank, 1954). Mintz (1963b) suggested that usually in
co-therapy, one therapist plays an authoritative role and
represents the superego, while the other portrays the ego's
integrative function (Adler and Berman, 1960). Or, she
described how a social worker took the role of the reality
principle in helping plan for the future and relegated all
interpretations to her psychiatrist co-therapist. Mintz
also talked about how a male and female team could inten
tionally present themselves as masculine and feminine stereo
types. In addition to the assuming of different roles by
the therapists, simulated role-playing between a therapist
and the client is easier when two therapists are present.
One therapist can handle the therapeutic functions (reflec
ting, directing, supporting, interpreting, etc.) while the
other can take the part of a person to whom the client is
relating. Such role-playing can also be done in individual
therapy, of course, but it is somewhat more difficult, for

10
the therapist must switch in and out of the role to comment
on what is happening, Godenne (1964) reported satisfactory
results with a procedure wherein both therapists of a team
participated in the psychodrama activities of a group.
The deliberate donning of different roles by the thera
pists has been one area of dispute among various theorists.
Mullan and Sanguiliano (1960, 1964) have stated that one of
the main discriminating features between what they distin
guish as co-therapy and multiple therapy is the use of con
trived role-playing in the former. Treppa (1971) concurs
with them that this is not a beneficial technique:
The usual situation in co-therapy is for one therapist
to act in a supportive, passive, and good manner while
the other plays an aggressive, dominant role. Such an
approach: (1) is artificial in nature; (2) limits the
therapists' freedom to be themselves and thus grow;
(3) depersonalizes the patient by depersonalizing the
therapists; (4) may prove to the patient what he has
always thoughtthat he is inadequate in his attempt
to change his environment, since he cannot change his
therapists; and (5) encourages our cultural stereotype
about how a man and a woman should be and feel [p. 453] .
These criticisms concern deliberate role-playing, however,
and these authors would not deny that one of the advantages
of multiple therapy has to do with the broader array of
possible interpersonal interactions.
Freedom.The multiple situation can also foster
greater therapist freedom. It is easier to take risks in
confronting the client when the therapist knows that his
co-therapist can assist the client if necessary (Warkentin,
Johnson, and Whitaker, 1951). Greenback (1964) said that
clients feel freer in discussing certain topics with one

11
therapist when there is a "chaperone" present. This is
equally true for the counselors, and having another thera
pist in attendance is likely to increase counselor spontane
ity. Kell and Burow (1970) state that the presence of a
therapeutic partner enables a counselor "to feel, fantasy,
and image more and do it more easily" [p. 216]. Whitaker,
Malone, and Warkentin (1956) theorized that perhaps the
most important benefit of multiple therapy over individual
therapy is that it gives
. . greater freedom on the part of each therapist to
be personally involved both professionally and
emotionally. Therefore, the approach allows for
greater variability and even innovations in tech
nique. One therapist provides the control, the other
the variable, at any given time in therapy [p. 211].
Others have agreed that the way in which multiple therapy
offers more freedom and flexibility is that it confers
greater stability for both clients and therapists (Buck and
Grygier, 1952; Dyrud and Rioch, 1953; Sonne and Lincoln,
1966) .
Greater comfort and confidence.--Another group of
supposed advantages has to do with the therapist feeling
more confident or better about his therapeutic interactions.
The multiple situation gives the therapist a higher proba
bility of success due to the fact that his blind spots will
be ameliorated by another and different helping person
(Lundin and Aronov, 1952). The counselor also has the
benefit of constant consultation with another professional,
which will increase his accuracy of diagnosis and

12
interpretation (Dreikurs, Schulman, and Mosak, 1952a), as
well as his understanding of the client (Mullan and San-
guiliano, 1960). The latter authors also cited various
reports which claimed that not only are interpretations re
inforced, but different ones are given at an earlier time
in therapy. The client will be more likely to accept
impressions of the therapists when they both agree (Dreikurs,
1950), which speeds the overcoming of resistance and the
therapeutic progress. This aspect of multiple therapy is
similar to a "consensual validation" effect. Another advan
tage related to this is that the counselor seems to be less
"on the spot" when he has a partner, and he thus has more
time to consider his comments. He most likely talks less
and when he does, he is able to state things more ade
quately and accurately. Also, he probably stays in touch
with the process better and is inclined to drop out his
less helpful responses. In addition, the counselor can
feel assured that his countertransference tendencies of
being overprotective, oversympathetic, or hostile will be
reduced in the co-therapy setting (Greenback, 1964; Solomon,
Loeffler, and Frank, 1954). Or, at least, having an
observer in the room makes it easier to discriminate be
tween reality and transference reactions (Demarest and
Teicher, 1954) or mutual client-therapist distortions
(Sonne and Lincoln, 1966). It has also been related that
problems about transferring (Buck and Grygier, 1952) or

13
terminating (Mullan and Sanguiliano, 1960) are less awkward
to deal with in the multiple situation.
Again, however, Mullan and Sanguiliano (1960) take
issue with other users of multiple therapy when they state
that they see the method as adding to the discomfort of
the therapists. They include a second therapist to
. . add to the total insecurity present in the psy
chotherapy; to add to our own anxiety; to confront us
with our own limitations; to indicate to us our ever
present tendency, of which we are so frequently un
aware, to use the patient; and finally, to add depth
and cross-sectional possibilities to the transaction.
We do not add the additional therapist to make us
feel more secure, nor to make us more certain of our
interpretations . [p. 557].
These theorists feel that the multiple setting forces a thera
pist to minimize the use of learned techniques and rely on
his own resources as a person. It is understandable that
the beginning multiple therapist might be quite uncomfort
able with the added insecurity. However, as he found the
method to be conducive to growth, learning, and the client's
progress, he might actually welcome the uncertainty and
find it quite comfortable.
Less difficulty with impasses.Lastly, due to having
another person and another perspective, impasses are easier
to resolve (Hayward, Peters, and Taylor, 1952; Spitz and
Kopp, 1963) or avoid (Dreikurs, Schulman, and Mosak, 1952b).
"Commonly, in dyadic therapy, a conflict generates to
impasse rather than resolution ..." because changes are
harder for a therapist than in multiple therapy (Kell and

14
Burow, 1970, p. 238). Whitaker, Warkentin, and Johnson
(1950) presented a detailed analysis of the etiology of
impasses in individual therapy, underlining that they sig
nal a deterioration in the relationship between the thera
pist and the client. They state that the relationship has
lost its "emotional voltage" for both client and therapist;
that the therapist feels frustrated and his subsequent
interventions are not likely to lead to progress. Their
statements about introducing a second therapist to aid in
the dissolution of the impasse go beyond just the addition
of another viewpoint:
The presence of the consultant is also valuable be
cause he is also able to carry part of the responsi
bility for the patient, so that the therapist can
express what he had suppressed from fear of his own
immaturity [p. 644].
Besides fearing his own immaturity, the therapist may feel
that it would be difficult for the client to handle his
expressions without some support. Miller and Bloomberg
(1968) affirmed the Atlanta group's observations in their
own experiment in impasse-breaking. They felt that the
addition of a second therapist gave the first emotional
and physical support and allowed him to verbalize his anger,
fears, and sorrows to his psychotically violent patient.
As a result of the interaction advantages mentioned pre
viously, impasses do not occur as frequently when there are
two therapists present from the inception of treatment.
In addition, it has been noted that the client does not

become extremely dependent on one therapist when two are
involved (Mintz, 1965), which is a further protection
against a stalemate in therapeutic movement.
The Multiple Therapy Relationship
Given that there have been many purported advantages
of multiple therapy for the therapists, many of them prob
ably are actualized only when there is a good relationship
between the participating therapists. Poor co-therapist
rapport may well signal their absence or create the atmo
sphere in which the possible disadvantages of this tech
nique thrive. The dynamics of the multiple therapy rela
tionship thus warrant a thorough examination.
Characteristics of a Good Relationship
Kell and Burow (1970) claim that "collaboration" be
tween the counselors is the crucial aspect in forming a
co-therapist relationship. Specifically, they feel that
. . mutual respect, awareness, and acceptance of
differences, owning of one's own competency, freedom
to feel and express feelings, both affectionate ones
and those that are less positive, are the primary
elements which make up a good multiple therapy rela
tionship [p. 233].
Mullan and Sanguiliano cite "mutuality" as being the
key aspect of the therapists' relationship noting that "the
relationship becomes mutual as both therapists express
their need to be together not only as a team but also as
unique individuals with definite growth strivings" (1964,
p. 175). They, further emphasize that the ideal multiple

16
therapy relationship is an intimate one which encourages
interchanges between the therapists on a transactional and
phenomenological level (Mullan and Sanguiliano, 1960).
Randolph (1970) states that the above authors, in
conjunction with Whitaker, Malone, and Warkentin (1956),
"concur in citing authenticity, mutuality, relatedness,
equality, spontaneity, affective involvement, autonomy and
interdependency as essential to the multiple therapists'
relationship" [p. 11]. These, then, are the major character
istics of a good multiple therapy relationship. The follow
ing discussion elaborates on how such an interaction can be
attained and what problems prevent its realization.
Prerequisites and Matching
One obvious dimension to be considered in the pairing
of co-therapists is their general orientation or approach.
Solomon, Loeffler, and Frank (1954) state that an optimal
pairing can be achieved when the "orientations of the co
therapists are flexible enough to permit considerable
variance along the active-passive, directive-nondirective
continuae" [p. 177]. They surmised that there are probably
various ways to match on these dimensions that will prove
to be successful combinations. They felt that until these
combinations are known, however, therapists should be
matched with regard to their goals and techniques. It
would be a catastrophe to place two therapists in the same
room who are extremely different and rigid in their beliefs

17
(Rockberger, 1966). This would likely lead to a battle of
each trying to prove the superiority of his method. As an
extreme example, it is very perplexing to imagine how an
orthodox Freudian and someone who patterned his style after
Rogers could work together to the benefit of the person
they were seeing. Within limits, though, some variation in
approach between the therapists is desirable.
Kell and Burow (1970) think that counselor similarity
is necessary as far as basic beliefs about life and human
values. For instance, they feel that it would be very dif
ficult for a pessimist and an optimist to work together
constructively. They would agree with others, however,
that differences in opinion regarding intrapsychic processes
or tactical differences between therapists are positive
catalysts to therapeutic progress (Dreikurs, 1950; Hulse,
Lulow, William, Rindsberg, and Epstein, 1956).
Mullan and Sanguiliano (1960) state that there is
always resistance on the part of therapists in entering a
multiple therapy situation, as well as experiencing during
a particular treatment hour. They note that there is likely
to be less resistance by therapists who emphasize process
rather than content. It follows, then, that therapists who
are relationship-oriented and flexible in orientation may
be best suited to be members of a multiple pair.
Furthermore, it has been stressed that the therapists
should be of equal capacity (Whitaker, Malone, and

18
Warkentin, 1956) or, at least, that neither be "in a posi
tion of greater authority or dominance . even if one
therapist is a student" (Solomon, Loeffler, and Frank, 1954,
p. 171). Warkentin, Johnson, and Whitaker (1951) reported
that the inexperienced therapists in their study were some
times anxious and lacking in spontaneity, as they were
concerned about making positive impressions upon their co
therapists. Extending this further, Malone and Whitaker
(1965) feel that it may be impossible to establish a good
multiple therapy relationship in a teacher-student situation.
p
Gans (1962) also stated that many disruptive problems are
created when there is a great dissimilarity in the thera
peutic resources of the co-therapy participants. For most
theorists in this area, however, the important point is
that the co-therapists be able to establish an egalitarian
relationship, regardless of their levels of experience or
status (Haigh and Kell, 1950).
Often-cited personal characteristics deemed to be pre
requisite for a multiple therapist were listed by Greenback
(1964). These are maturity (Whitaker, Malone, and Warkentin,
1956), being able to freely communicate with another thera
pist (Rockberger, 1966), lack of competitiveness (Dyrud
and Rioch, 1953), and ability to trust. Mullan and Sangui-
liano (1960) regarded considerable trust between the thera
pists as being necessary to achieve mutuality. Along with
Greenback, other authors feel that the co-therapists should

19
usually be of opposite sexes (Hill and Strahl, 1968; Mintz,
1963, 1965; Nunnelly, 1968; Rabin, 1967; Singer and Fischer,
1967), thus simulating a familial situation and facilitating
certain therapeutic interactions. Some authors have carried
the family milieu idea to the extent of using a wife (Fink,
1958), a son (Solomon and Solomon, 1963), or even a dog
(Weigel and Straumfjord, 1970) as co-therapist. Warkentin,
Johnson, and Whitaker (1951) required their multiple thera
pists to have had therapy themselves, and stated as criteria
for successful pairing that each therapist would feel free
to be' the patient or the therapist of the other.
Gans (1962) warned that two inexperienced therapists
were worse than one and.held that ample individual work
should be prerequisite to doing co-therapy. Given two
accomplished therapists, Gans felt that there was no particu
lar advantage in teaming up over seeing patients individu
ally. Apparently, then, he was focusing mainly on the
technical rather than the relationship aspects of co-therapy,
and his demand for experience should be considered in this
light. Undoubtedly, therapeutic ability might interact
with the quality of the co-therapist relationship; but
whether ability is solely determined by experience is ques
tionable .
Relationship Problems and Solutions
Discussion of Problems.--MacLennan (1965) emphatically

20
stated that the relationship between co-therapists is very
complicated, and may even contain so many difficulties that
a therapist would be better off working singly. In addition
to meeting the prerequisites and being properly matched, a
good multiple therapy team is formed by participants who
can work through problems in their relationship. When and
how are the difficulties to be discussed? Some types of
obstacles can be handled during the sessions. For example,
when the therapists have divergent opinions about what is
going on with the client (Dreikurs, 1950) or there are
tactical differences between the counselors, these can be
revealed and discussed in the client's presence. It has
been emphasized that this should be done with an air of
respect, and the therapists should be able to be comfort
able with their disagreement. Other difficulties, such as
"neurotic conflicts between co-therapists, have to be
recognized and dealt with appropriately outside . ."of
the sessions (Hulse, Lulow, William, Rindsberg, and Epstein,
1956, p. 435). Routine meetings of the therapists between
the sessions are considered to be essential (Lundin and
Aronov, 1952). In this regard, Haigh and Kell (1950)
recommend that the therapists go over a tape of the therapy:
It is in this situation that attitudes and feelings
existing between the two participating therapists
become crystallized and clearcut and the emotional
growth and learning for both can reach their maxi
mum [p. 660].
It has also been suggested that the two therapists meet
with a third party who can act as a moderator or supervisor

21
(Solomon, Loeffler, and Frank, 1954). It is essential that
the counselors be able to freely communicate with one
another in order to work through any of their problems in
interacting.
Competitiveness and hostility.Mintz (1965) claimed
that the "possibility of personal friction between the
therapists is certainly the greatest hazard of this type of
treatment" [p. 299]. Competitiveness (Dyrud and Rioch,
1953; Lott, 1957) is probably the most deleterious factor
to the formation of a good multiple therapy relationship.
Kell and Burow(1970) emphasized that it requires conscious
effort for counselors to form a collaborative relationship,
because there is "little in the professional therapists'
training which prepares them for building a co-worker
relationship which can be helpful and meaningful both to
them and the client" [p. 213]. These authors prefer pair
ing male and female counselors, hoping to avoid the compe
tition so prevalent between men. Competitiveness may well
still be an issue, however, and the participants will need
to be aware of this potential tendency and counteract it.
Lundin and Aronov (1952) state that if a patient "senses
the same lack of respect, disharmony, and infantile compe
tition ..." similar to those between his parents, ". .
the basic purpose of the co-therapy method has been lost"
[p. 79]. MacLennan (1965) spotlighted such a possible
area of dissension with male and female therapiststheir

22
being engulfed in an oedipal struggle where the male relates
to all the girls in a group; the female, to all the boys.
Solomon, Loeffler, and Frank (1954) believed that the thera
pists, if conscious of hostility between them, could work
out their difficulties without affecting the patient. How
ever, they feared that the anger might be displaced to the
patient if the therapists were unaware of their feelings.
Competency and respect.It is important that the
therapists be able to feel competent without being competi
tive, and desirable that they encourage and enhance each
other's competence. Gans (1962) stressed that each thera
pist should accentuate the other's assets and not let the
expression of his limitations be pronounced. Mintz (1965)
related that it is crucial that both therapists feel com
petent; otherwise, the patient may be able to play one
therapist against the other, or the therapists may misunder
stand the relationship of the patient to each of them.
Mutual respect must also be present to develop a positive
multiple therapy relationship (Lundin and Aronov, 1952;
Warkentin, Johnson, and Whitaker, 1951). This respect
should involve appreciation of the other's differences,
including sexual role dissimilarities when the counselors
are male and female (Kell and Burow, 1970; Mintz, 1963a).
Each therapist should also "know of and accept the other's
peculiarities and neuroticisms" (Rockberger, 1966, p. 288).
Finally, in this regard, Demarest and Teicher (1954) felt
that each co-therapist should emotionally accept the other
and understand his methods of working in therapy.

23
Autonomy and dependency.Kell and Burow (1970) further
thought it important that the therapists be able to be both
autonomous from and dependent on each other. They felt
that counselors are trained to be independent, possibly to
the extreme, so that they cannot easily, genuinely, and
appropriately depend on one another. It is critical that
they do this in order to share responsibility for the
therapy and form good models for their clients regarding
expression of dependency.
Intimacy and caring.Solomon, Loeffler, and Frank
(1954) postulated that the ideal multiple therapy pair
establish an intimate association which unites them and
betters their therapy. Mullan and Sanguiliano (1960) felt
that the therapists need to develop a deep meaning for one
another, come to care for each other, so that they react
to the patient in a meaningful and integrated way. Many
theorists in the field have stated that a good multiple
therapy relationship would contain the same ingredients as
a good marriage (Kamerschen, 1969; Linden, 1954; Rabin,
1967; Sonne and Lincoln, 1966; and Treppa, 1969). Randolph
(1970) agreed with this view of the relationship and inves
tigated aspects that she felt were especially important.
She was interested in how much the co-therapists (1) dis
closed to one another, (2) were satisfied with each other,
and (3) expressed affection to one another. The present
author concurs that the development of an intimate and caring

24
relationship between the counselors is one of the most
important facets of multiple therapy.
Research
Although many theorists have praised the multiple
technique for providing an atmosphere conducive to conduc
ting unobtrusive research (Buck and Grygier, 1952; Dreikurs,
1952b; Haigh and Kell, 1950; Whitaker, Malone, and Warkentin,
1956), few have actually done more than draw conclusions
from their own experiences with the method. There is a
bounty of success claims in the literature (Fink, 1958;
Mintz, 1965; Solomon, Loeffler, and Frank, 1954), but very
few empirical facts to support it.
The first attempt at a "study" of multiple therapy was
that of Warkentin, Johnson, and Whitaker (1951), who looked
at case studies of 25 patients and reported positive re
sults for them; such as feeling safer and thus freer to
express both positive and negative feelings, and more satis
factory termination experiences. The participating thera
pists derived the supposed benefits of personal growth,
increased enthusiasm for therapy, and a greater capacity to
work with patients.
Other research projects have also concentrated some
attention on multiple therapy from the therapist's perspec
tive. Rabin (1967) at least improved on the previously
cited study of the Atlanta group by giving 38 therapists a
questionnaire which asked them to rate the relative efficacy

25
of co-therapy versus individual therapy. (A modified form
of his questionnaire is shown in Appendix C.) He found that
the therapists valued the "general therapeutic efficacy of
co-therapy," and felt that it led to more "positive thera
peutic movement . and working through, in general" [p. 249].
Mallars (1968) reported that her 24 student counselors,
their clients, and their supervisors were significantly
more satisfied with a counseling team approach than with a
standard method. These results are based on the partici
pants 1 responses to a counseling rating scale administered
after the first and the last counseling sessions.
Kamerschen (1969) in studying 23 heterosexual thera
pist pairs, found that self-disclosure and a personal-
impersonal dimension of co-therapist selection were signifi
cantly related to therapist satisfaction within the multiple
therapy relationship. Pair flexibility, congruence of
self-co-therapist flexibility, and attitudes toward the
opposite sex were not shown to be significantly related to
pair satisfaction. Kamerschen's co-researcher, Randolph
(1970), found self-disclosure to be positively related to
satisfaction and the physical expression of affection in
therapist pairs. The results also indicated that those
therapists who acted on their desire to verbally express
affection were more satisfied than those who did not, while
therapist pairs who expressed both verbal and physical
affection were more satisfied than those who used only one.

26
The studies that have used various measures of client
change in comparing an individual with a multiple group
method have yielded equivocal results. Daniels (1958) and
Staples (1959) found that for groups of eighth grade boys
and girls, respectively, the heterosexual co-therapy team
generally produced negative behavior changes in their
clients. The members of groups led by either a male, or a
/
female therapist, contrarily, tended to improve on the out
come measures of teachers' ratings and psychologists'
assessments. Nunnelly (1969) discovered no significant
differences between groups led by multiple therapists versus
those led by individual therapists in regard to client out
come, e.g., perceptions of parent acceptance, self-
acceptance, or ego strength. Singer and Fischer (1967)
reported that although little progress was being made with
a group of male homosexuals run by two male therapists,
when a female co-therapist was added, the process changed
remarkably for the better. After one year of heterosexual
leadership, the majority of the members of the group had
improved on several behavioral measures; such as lessened
amount of homosexual activities, dating heterosexually,
and increased work productivity. In all of these studies,
however, no data were gathered on how the therapists related
to one another. This is of critical importance, as was
discussed before, as a poor co-therapist relationship could
very likely produce worse client outcomes than an individ
ual therapist.

27
Swander (1971) attempted to investigate one such area
of the therapists' relationship as it affects client out
come. In an analogue study using undergraduate students as
both therapists and clients, she manipulated the level of
therapist functioning in multiple pairs. She concluded
that
. . two therapists of higher levels of nonfacili-
tative core conditions may work together with no nega
tive effect on each other's functioning level and
with no negative effect on their client's level of
self-exploration. When, on the other hand, a low-
functioning nonfacilitative therapist works with
another nonfacilitative therapist, there will not only
be a negative effect on each other's functioning level
but on the level of client self-exploration as well
[pp. 34-35].
Although Swander's sample was limited in that there were no
facilitative helpers included, there were still definite
differences in helpee self-exploration resulting from
higher or lower nonfacilitative levels of functioning.
These results underline the importance of inspecting the
relationship between co-therapists. It is difficult to
evaluate the studies concerned with the relative efficacy
of individual versus multiple therapy when this examination
has been omitted.
As listed above, previous studies have been concerned
with (1) how therapists and clients felt about multiple
therapy as compared to individual therapy, (2) some essential
ingredients of a satisfying- co-therapy relationship, (3) the
relative efficacy of multiple versus individual therapy in
regard to client outcome, and (4) the effect of the level

28
of functioning of the co-therapists on client self
exploration. The present study combined these types of
designs to collect various data from therapists, clients,
and independent judges regarding multiple therapy as com
pared to individual therapy, as well as the multiple situ
ation itself.
The current report includes two main categories of
hypotheses in reference to therapists, which correspond to
the,two main themes in the literature. The first of these
is centered around differences in how the therapists
operate and perceive therapeutic process in each condition;
the second, with various facets of the co-therapist rela
tionship and the possible effect of some of these on clients.
The specific research hypotheses are listed in the succeed
ing chapter. Predictions and results of the project which
focus primarily on client experiences in the two conditions
are to be reported in the dissertation of the writer's
co-researcher (Reiner, 1973) .

4ETH0D
Subjects
Counselors
The aforementioned prerequisites and criteria for
matching were taken into consideration in selecting the
therapists. All of the therapistscounselors at the
University of Florida Counseling Centerwere of the
"eclectic" variety and thought to be fairly flexible in
orientation. The pairing of six male and six female thera
pists for the multiple condition was made by joint agreement
of the members of each team and the two researchers. When
.a therapist had agreed to participate in the study, he (or
she) was then asked if he thought he would work well with
the other counselor whom the researchers, in conjunction
with the center's director, had determined would be an appro
priate partner. Each therapist had to reply affirmatively
for the pair to be formed. There were three experienced
pairs, with from three to five years' therapy experience,
and three intern-level teams, averaging six months to one
year of counseling work.
Clients
The 24 clients were unmarried female students at the
University of Florida between the ages of 18 and 23; all
29

30
had presenting problems concerned with interpersonal dif
ficulties. Every unmarried female student coming to the
counseling center for personal counseling during the dura
tion of the study was asked to participate in the project.
The one exception to this was in the case of a student who
had had counseling in the past. Previous therapy is one
variable consistently shown to influence therapeutic inter
actions (Meltzoff and Kornreich, 1970), and thus these
students were excluded.
Design
The following discussion sketches the overall design
of the project and elaborates upon the aspects crucial to
the material of the present report. Granted, there are
myriad other considerations and analyses possible to pursue
with the data that have been gathered.
Conditions and Groups
Therapists.The same therapists saw clients individu
ally and multiply during the same time period; thus, they
provided their own matched control. Each therapist saw one
client in individual sessions and two with the same co
therapist partner throughout the course of therapy. The
counseling of two clients multiply was necessitated by the
desire to have 12 clients undergoing treatment in each
condition. The use of the same team of therapists for two
cases yielded a sample size of six pairs, rather than the
12 that could have been attained by different pairings for

31
each case. This was not ideal in that the multiple condi
tion was not comprised of somewhat more independent pairs,
but it was not possible to re-combine the therapists into
six more couples that the researchers and the counselors
felt would be compatible ones.
To adapt this design for some of the data analysis, one
of the clients for each therapist pair was assigned at
random to the female therapist and the other to the male.
This was decided by tossing a coin to see which therapist
would be the one aligned with the first or second client
seen multiply (again, the choice of a coin flip).
Clients. ---The subjects were randomly assigned to coun
selors, in so far as possible. A schedule was arranged wherein
the order of assignment to each pair of therapists was ran
domized, as was the order of assignment to individual therapy
with the male therapist of a pair, individual therapy with
the female therapist, or one of the two multiple sets. As
students agreed to participate, they were relegated to thera
pists according to this order on a "first come, first serve'"
basis. When a subject dropped out of therapy before com
pleting four sessions, this was considered first priority,
however, and the vacated space was filled before continuing
with the random assignment. Although the clients were
naturally matched in some respects as they were drawn from
the same population, their random designation to conditions
assured independent groups.

32
Comparisons
First and last sessions.--All data were collected for
initial and terminal interviews, enabling comparisons to be
made between the participants' pre~ and posttests for both
conditions. Although tape recordings were made of all
sessions for future reference, only the first and final ones
were utilized. The number of interviews per case varied
from four upward; any students discontinuing therapy before
four sessions were excluded from the study. It was decided
that natural termination was preferable to administering
posttests after a specific number of sessions, as it seems
somewhat presumptuous to assume that clients have had equal
therapeutic exposure or possible progress in the same number
of sessions.
Individual versus multiple process.A Comparative
Therapy Scale, which taps attitudes toward multiple and
individual therapy, was administered to the counselors. The
therapists answered the same process forms (Therapy Session
Report) for individual and multiple sessions so that their
perceptions and reported behaviors during the two situations
could be easily compared. Similar self-report forms (Therapy
Session Report) regarding the process of the therapy sessions
were completed by therapists and clients, so that their
agreement or lack of it could be ascertained. Process was
was also rated by two clinicians who listened to tape-
recorded segments of the sessions (as per the scales developed
by Berenson, Carkhuff, and Truax).

33
Quality of the co-therapists 1 relationships.The pres
ent design incorporated several approaches aimed at de
scribing the quality of the multiple therapists' relation
ships. One method was a direct one of having the therapists
rate each other as far as their relationship on two measures
(Caring Relationship Inventory; Multiple Therapy Rating
\
Scale) designed or adapted for this purpose. Another in
volved perceptual agreement as to how the therapy sessions
proceeded; this specifically involved a. therapist rating
his partner (on the Multiple Therapy Rating Scale) on the
.latter's behavior and perceptions which he had also self-
rated (on the Therapy Session Report). The relevance of good
and.poor co-therapist rapport measured by the above instru
ments for client outcome (self-actualization) was also
investigated.
Possible therapist growth.--The Personal Orientation
Inventory was administered to the therapists at the incep
tion and the conclusion of their involvement in the research
project to detect any change in self-actualization result
ing from the experience. There was no control condition
for this analysis, however, so any results could only be
suggestive.
Procedure
Counselors
Before commencing their first therapy session, the
counselors were given the Myers-Briggs Type Indicator

34
if they had not previously taken it and a Personal Orien
tation Inventory. The experimenter gave all participating
therapists the Therapists' Research Instructions Sheet
(Appendix A). After the first and the last sessions in both
conditions, the therapists filled out a Therapy Session
Report; after multiple sessions, they also completed a
Multiple Therapy Rating Scale. After the very first and
the very last multiple interviews, they also answered a
Caring Relationship Inventory. It was the therapists' re
sponsibility to tape all sessions. After their last mul
tiple session, the counselors were again given the Personal
Orientation Inventory. After finishing all counseling, the
therapists completed the Comparative Therapy Scale.
Clients
The clients were initially seen for a half-hour intake
interview, as are all students coming to the counseling
center. They were told in regard to referral that the in
take person had one or two other counselors in mind and
that he would make the best referral possible. The clients
were also told that multiple therapy with both a male and
a female counselor was a frequent practice of the center.
The client's name was then given to one of the re
searchers who contacted the client by telephone, explained
the nature of the study, and asked the client to participate.
If she agreed, the researcher asked her to come to the center

35
to take the pretests as soon as possible; told her the
name(s) of her counselor (s) ; and said that she would be
given an appointment as soon as she had completed the test
ing. The pretests were the Personal Orientation Inventory;
a self-rated scale of self-actualization, the Self-Actuali
zation Scale (S-A Scale); and a specific Problems List, on
which the client listed three problems on which she wanted
to work in counseling. (These measures will be described in
the dissertation of Reiner, 1973.) After the final therapy
session, the client again completed all of the above scales,
the S-A Scale and the Problems List being the posttest
versions.
Instruments
Therapy Session Report
The Therapy Session Report (TSR), which was developed
by Orlinsky and Howard (1966b), has been used extensively
in psychotherapy research by these authors to determine how
clients and therapists perceive and behave during therapy
hours (Orlinsky and Howard, 1966b, 1967). Similar forms
for the client and the therapist were designed, enabling
easy comparisons of their experiences and feelings about the
process of the sessions.
The current researchers selected items from the original
scales and used these in the forms for therapists and clients
(Appendix B). The items that were parallel for the thera
pists and clients have the item numbers of the therapist

36
form after the items on the client form. The items were
all multiple choice,, and inquired into the participants'
feelings and actions during the sessions, how the therapists
and clients, viewed''each other, and how they evaluated cer
tain aspects of the process of the sessions. All items
require that the participants rate a statement regarding
one of the above areas.
Some items are judged on a scale of 0 to 2; for
example, "What did your patient seem to want this session?
A chance to let go and express feelings." The therapist
assigned one of the following scores:
0: No
1: Some
2: A lot
The second scoring plan is exemplified by the item,
"During this session, how much did your patient tend to
agree with or accept your comments or suggestions?" The
therapist rated his client's behavior according to the
following scale:
0: Slightly or not at all
1: Some
2: Pretty much
3: Very much
The third type of item utilized a 5- or 6-point scale.
The therapist had the following choices in regard to the
question, "To what extent did you reveal your spontaneous

37
impressions or reactions to your patient this session?":
1: Considerably
2: Moderately
3: Somewhat
4: Slightly
5: Not at all
This last type of item was presented on the forms to
the testee in the opposite direction from which it was
scored: the "1" choice was given a score of 5, while the
"5" choice was scored as 1.
For purposes of hypothesis testing, some of the items
were grouped together for scoring. When this was done,
the scoring scheme was changed so that each response re
reived a 0 for "no," and a 1 for either "some" or "a lot."
The scores for all relevant responses were then summed to
give a composite total for the group of items. The topics
involved are listed in the section dealing with hypotheses.
The remainder of the items were used singly to test hypotheses.
No attempt was made to obtain a score over the entire inven
tory since the aspects of counseling covered by the items
are so diverse.
Comparative Therapy Scale
Rabin (1967), as already mentioned, was a pioneer in
the empirical investigation of therapist attitudes toward
co-therapy and regular group therapy. His original
Co-Therapy Rating Scale consisted of 50 items regarding the

38
nature of therapy interactions and. progress. His therapist
subjects rated 32 of the topics as being meaningfully differ
ent in co-therapy than in regular therapy. Thirty of these
items were used in the Comparative Therapy Scale (CTS) in
the present study (Appendix C). Rabin's item, "Your general
preference when therapy in a group is the only treatment,"
was changed to "Your general preference." Another item that
dealt with an issue specific to group therapy was deleted.
The present author also added the last item of the CTS,
"Resolution of impasses," as the literature lists this as
an important advantage of multiple therapy over individual
therapy.
The directions for the CTS asked the therapists to
compare multiple therapy and individual therapy (with indi
vidual clients) on the 32 topics. Two columns, one for
multiple therapy and one for individual therapy, provided
the levels of comparison which were scored as follows:
1: Slightly more
2: Moderately
3: Much more
A check in the "No difference" column, placed between the
ones for multiple and individual therapy, was not scored.
Several items which indicated negative differences between
the methods were rescored to be in the same direction (these
are indicated by an asterisk in the left magrin); and item
number 22 was omitted from this scoring scheme (indicated

39
by a "0" in the margin), since its scoring direction was
indeterminable. The scores of each therapist in the mul
tiple and. individual columns were then summed, providing a
total score over all items for individual and multiple therapy
In addition, the mean and modal score of each item using
Rabins (1967) scoring pattern-1" for "much more" in mul
tiple therapy to "4" for "no difference" through "7" for
much more in individual therapy--was computed from the
scores of the 12 therapists on each item.
The Carkhuff Process Scales
It is now widely accepted that certain core conditions
of therapists' level of functioning are crucial to some of
the events that take place during therapy. Carkhuff (1969)
described the scoring procedures for his process scales
designed to evaluate: (1) empathetic understanding,
(2) respect, (3) faciliative genuineness, and (4) concrete
ness or specificity of expression in interpersonal processes.
These scales shall be referred to in the text as: Empathy,
Respect, Genuineness, and Concreteness. The form of these
scales used to train the judges and rate the taped excerpts
from therapy sessions of the study are given in Appendix D.
It seems advisable to describe the version presently used
because all of the scales have progressed through several
stages as research indicated that alterations or refine
ments were necessary.
These process scales, along with a scale that measures
depth of client self-exploration, have been shown to be

40
reliable instruments and have been validated in numerous
psychotherapy research projects (as reported in Carkhuff,
1968; Carkhuff and Berenson, 1967; and Truax and Carkhuff,
1967). It has been noted, however, that higher reliability
and predictive validity have been obtained v/hen the raters
using the scales are themselves high-level functioning
counselors (Carkhuff and Berenson, 1967). Interjudge re
liability coefficients as high as .80 and above have been
found using such raters (Swander, 1971); whereas the use of
naive undergraduate students could be expected to give co
efficients closer to .50 (Truax and Carkhuff, 1967).
Taped excerpts were taken from the initial and the
terminal therapy interviews of the 12 multiple and the 12
individual cases. Each of these therapy sessions was divided
into thirds, and one segment was taken from the first, the
middle, and the last third of the session. The order in
which these 144 segments were presented to the judges was
completely randomized, so that they did not know if any
particular segment was from the first or last session, nor
from what portion of the interview. Because of the nature
of the conditions, however, the raters were able to discern
whether an excerpt was from the multiple or the individual
condition. Master tapes with the excerpts given in their
random sequence and identified by a number, along with 144
numbered 3x5 cards, were given to the judges. The cards
had columns for male therapist, female therapist, and client.

41
The judges were instructed to rate all four of the therapist
scales in the same order--Empathy, Respect, Genuineness,
and Concretenessand then the client scale. The ratings
on all of the scales for any given segment were executed
simultaneously.
Two intern-level counselors who were themselves high-
functioning (averaging above 3.0 on all scales) and had
attained an interjudge reliability of above .80 in previous
research (Swander, 1971) were used as raters. Pearson
product-moment correlations were computed over the indepen
dent ratings of the two judges for 15 randomly selected
segments of the 144 segments of the present study. There
were 7 segments that were selected from the multiple con
dition, and the ratings of both therapists were used in the
calculation of the correlations; the coefficients thus
reflect the agreement of the judges over 22 ratings. The
Pearson product-moment correlations were .89 for Empathy,
.91 for Respect, .93 for Genuineness, and .93 for Concrete
ness .
For each relevant session, the scoring scheme for any
one of the scales called for three ratings (first, middle,
and last segments) by two judges. The score of each thera
pist for a session was to be an average of these six ratings.
Unexpectedly, however, there were several segments in the
multiple condition in which the female therapist did not
talk at all, and thus she was not rated. The specific

42
number and the meaning of these occurrences will be dis
cussed further in succeeding sections (Results and Discussion)*
It should be noted here, though, that in these cases the
scores for that therapist were based on an average of the
segments that were rated.
Caring Relationship Inventory
As previously stated, many theorists in the area have
stated that an effective multiple therapy relationship would
contain the same ingredients as a good marriage. Kamerschen
(1969) and Randolph (1970) used a modified form of van der
Veen's Family Concept Q-Sort to create their Co-Therapist
Inventory. Shostrom's Caring Relationship Inventory (CRI
was designed for relationships ranging from the dating stage
to marriage (1966a). The CRI consists of 83 true-false
items that concern feelings and attitudes that the members
of a heterosexual dyad have toward each other. The inventory
is comprised of five basic scales and two subscales. The
major scales, given the titles Affection, Friendship, Eros,
Empathy (M)* and Self-Love, supposedly measure different
aspects of love. The subscales purport to describe whether
the respondent's love is one based on need (Deficiency Love)
or is metamotivated (Being Love). A description of these
scales, along with their identifying symbols and the number
of items on which they are based, is given in Appendix E.
*The symbol for the CRI scale of Empathy, "M," will
follow the scale's title, to distinguish it from the process
scale of Empathy.

43
This instrument attempts to measure many aspects of a rela
tionship which the present researcher deemed to be impor
tant for co-therapists.
Shostrom (1966a) presents split-half reliability find
ings on a sample of 272 persons who were successfully
married, had a troubled marriage, or were divorced. The
reliability coefficients for the basic scales ranged from
.74 to .87, while those for the subscales were .66 (Defici
ency Love) and .82 (Being Love). As evidence that this is
a valid test, Shostrom further reported that all of the
scales can significantly discriminate between successfully
married, troubled, and divorced couples. There have been
no sex differences found on any of the scales.
The directions for the CRI were altered so that the
respondents would rate their co-therapist as they saw him
or her, and then rate their ideal co-therapist. The completed
inventories were scored with the standard scoring keys
provided by the Educational and Industrial Testing Service.
Hypotheses were formulated about the therapists' responding
on all of the scales except Eros, as it was felt that this
aspect of a relationship was not an important dimension for
co-therapists.
Personal Orientation Inventory
Shostrom's Personal Orientation Inventory (POI) is a
forced-choice, 150-item questionnaire that purports to
measure various aspects of self-actualization (Shostrom,

44
1966b). Responses to these items yield scores for two main
scales and 10 subscales, 4 of which are listed and described
in Appendix F, along with the scale symbols.
This instrument has been shown to have test-retest
reliabilities as high as .93 and .91 (Shostrom, 1964).
Other test-retest coefficients are reported as .71 and .84
for the basic orientation scales (Time-Competence and
Inner-Directed), and as ranging from .55 to .85 for the sub
scales (Klaveter and Magar, 1967). Validity for each of the
POI scales has been examined by its ability to differentiate
between groups of individuals who were reportedly self-
actualizing, normal, or not self-actualizing (Fox, 1965;
Shostrom, 1964).
The pre and post scores of the therapists on the two
major scales of personal orientation (Time Competence and
Inner-Directed) and two of the subscales were used to
detect possible therapist growth during their involvement
with multiple therapy. The two subscales chosen were ones
thought most likely to change on the basis of theory in the
literature (Spontaneity and Capacity for Intimate Contact).
The standard scoring keys distributed by the Educational and
Industrial Testing Service were used.
Multiple Therapy Rating Scale
The Multiple Therapy Rating Scale (MTRS)' was devised
by the author and her co-researcher (Reiner) to tap areas
not covered by the other scales regarding the co-therapists'
perceptions of each other and their relationship.

45
Co-therapist agreement.--This instrument included
eight items that paralleled some items of the TSR. (These
items are designated in Appendix G by having the item number
of the TSR to which they correspond immediately following
the item.) In completing the MTRS, then, each therapist
rated his partner on aspects of the latter's behavior for
which the partner had also rated himself. These items were
used as an indix of agreement between the therapists as to
how they saw each other and themselves during the sessions.
It was postulated that close agreement was indicative of a
good relationship, while discrepant views meant something
was askew in the relationship.
For the first and last session of each case, the scor
ing of this part of the scale consisted of summing the number
of exact agreements out of the eight topics on which each
therapist rated himself and was rated by his partner. This
yielded an agreement score for each individual therapist.
A composite score foz* the couple was derived by adding the
two scores of the co-therapists. In addition, a total com
posite score for each case was computed by summing the pre
and post composite scores .
Quality of the co-therapist relationship.The remainder
of the items were ones that inquired about other perceptions
of the therapists concerning the events of the sessions.
The topics were ones that the co-researchers thought were
important as to how the therapists worked together. Four

intern-level psychology graduate students were asked to
evaluate the items and the responses of this section of the
scale (see Directions for Rating the MTRS, Appendix G).
First, the judges rated all of the items in regard to their
relevancy for the formation of a co-therapist relationship.
All of the judges agreed in identifying 13 of the 14 perti
nent items as being relevant. They also all concurred that
the items describing the other therapist's behavior (the
topics similar to the TSR ones discussed above) and the final
item were not relevant ingredients of the co-therapist
relationship. The second item, that only one judge felt was
relevant, was omitted for scoring purposes. The percentages
of agreement between the judges in regard to the relevancy
of the questions are shown in Table 1.
TABLE 1
PERCENTAGES OF AGREEMENT AMONG FOUR JUDGES REGARDING
THE MULTIPLE THERAPY RATING SCALE
Judges
B
C
D
Relevancy of the Items
A
1.0000
1.0000
9285
B
1.0000
9285
C
9285
Scoring Direction of the Responses
A
.7777
B
C
.7619
. 8095
.7936
.7460
.6667

47
Secondly, the judges rated each item as to whether it
was indicative of the formation of a good, neutral, or poor
co-therapist relationship. The scoring pattern for each
judge over all the items is recorded in Table 30, Appendix
G. In most cases, only those responses rated in the same
direction by at least three out of the four judges were used
for scoring purposes. Due to the equivocal judgments regard
ing the responses of items 1 and 16, these items were thrown
out. Three of the other responses to questions where most
of the responses were rated similarly by the judges were re
tained and scored "zero" (4d, 5c, and 6c)--the original scor
ing direction determined by the two co-researchers. These
responses were chosen infrequently by the present sample of
therapists, so it was decided to retain these items. Because
of the nature of one item of the questionnaire (22), where
each response was somewhat separate from the others, several
choices were eliminated, while retaining the rest of the re
sponses. These deletions resulted in the total of 11 items
being used for scoring in this part of the scale, with 25
responses being scored in the positive direction, 7 in the
neutral, and 22 in the negative. Responses were scored
+1, 0, and -1 as to whether they indicated good, neutral,
or poor rapport between the therapists. A total score for
each therapist was obtained by summing all of the positive
responses and subtracting the negative ones. A composite
score for each therapist pair was obtained by adding their

48
respective scores together, and a total composite score was
obtained by summing the pre and post composite scores.
An investigation of the test-retest reliability of the
two parts of the MTRS was proposed. It would seem likely
that the therapists would rate their relationship similarly
after seeing their first multiple case together and after
seeing their second. It would also appear likely that their
level of agreement as to the events of the session would
remain stable for their two first multiple sessions. It was
also planned to see if either the level of agreement or the
rated quality of the co-therapist relationship scores for
each therpist correlated with those of his Caring Relation
ship Inventory as a concurrent validity check. Also, it
would be expected that these indices would be related to
outcome of the multiply seen clients. High agreement and
high quality should be paired with good outcomes, low agree
ment and low quality with poor outcomes. If the data sug
gested a trend in this direction, it would provide a crude
case for predictive validity of the MTRS.
Myers-Briggs Type Indicator
The Myers-Briggs Type Indicator is a 166-item, forced-
choice instrument that categorizes testees according to
Jung's typology. Information regarding the composition and
scoring of the test can be obtained from the Educational
and Industrial Testing Service, San Diego, California.

49
According to Isabel Briggs Myers, who with her mother
developed the instrument, research has shown that clinical
psychologists are predominantly Introverted or Extraverted
Intuitive Types with Feeling and Perception being strongest.
She also feels that these are the types best suited for
counseling work.*
The use of this test in the present study was purely
descriptive; the types of each therapist are indicated in
Table 36, Appendix H. A homogeneous pool of therapists
according to their types would be desirable; however, the
present sample contained people of varied types. As shown,
7 of the 12 therapists are either of the two aforementioned
types; two differ only in that they have Judging predominant
over Perception, and in one of these cases the score was
barely into the Judging zone. The other three, however, are
Extraverted or Introverted Sensing Types with Thinking and
Judging dominant. It would be interesting to note whether
those of the "noncounselor" types have different scoring
patterns from the others on the Carkhuff Process Scales.
Hypotheses
The specific research hypotheses fall into two major
categories: (a) those regarding differences between multiple
and individual therapy, and (b) those concerned with the
*Personal communication, November 18, 1970,

50
multiple condition itself. The instruments by which a
hypothesis was tested, along with item numbers when appro
priate, are given below. The hypotheses are numbered con
secutively through both categories.
Multiple Versus Individual Therapy
TSR.The therapists will report that the therapeutic
interactions differed in the two conditions. Compared to
individual therapy, they will rate the clients in multiple
therapy as
1. Having talked more about relations with persons
of both sexes (Items 1 and 2).
2. Having discussed a greater variety of topics
(Items 1-5).
3. Having wanted more to express or explore feelings
(Items 6 and 9).
4. Having had their feelings more stirred up (Item 17).
5. Agreeing with and/or accepting more of their
comments or suggestions (Item 21).
6. Having shown more progress (Item 25).
Similarly, the therapists will be apt in multiple therapy to
rate themselves as:
7. More revealing of their spontaneous impressions or
reactions (Item 29).
8. More understanding of what their patients said and
did (Item 31).
9. Being more helpful to their patients (Item 32).
10. Being more critical or disapproving to their clients
(Item 35).
11. Being more warm and friendly toward their clients
(Item 36).

51
12. Expressing more feeling (Item 37).
13. It is expected that the client-therapist agreement
as to the events of the sessions will be higher in
multiple therapy than in individual therapy (on 24
items of the therapist and client forms of the TSR) .
Comparative Therapy Scale.--More therapists will rate
multiple therapy over individual therapy as:
14. Being conducive to self-understanding of the thera
pist (Item 6).
15. Being useful in training therapists (Item 10).
16. Offering more personal gratification (enjoyment or
"fun") for the therapist (Item 11).
17. Being their general preference (Item 24).
18. Fostering the resolution of impasses (Item 32).
19. The therapists generally will express a more positive
attitude toward multiple therapy than toward
individual therapy (Items 1-32) .
Carkhuff Process Scales.--The therapists will offer
higher levels of therapeutic conditions more consistently in
multiple therapy than in individual therapy. It is hypothe
sized that the therapists will offer higher facilitative core
conditions as measured by the scales of:
20. Empathy.
21. Respect.
22. Genuineness.
23. Concreteness.
The Multiple Condition
CRI.--Only one of the therapist pairs had done therapy
together previously and this had not been an extensive

52
collaboration. It was thought, then, that the relationships
of the pairs would change toward greater intimacy and caring
over time. It was hypothesized that the following scales
would show increases:
24. Affection.
25. Friendship.
26. Empathy.
27. Being Love.
28. Deficiency Love.
Also, it appeared possible that as the therapists' relation
ships became more collaborative, their focus on themselves
in the association would decrease. The scale of Self Love
on the CRI measures the amount of concern about oneself or
one's tendency to be an independent person, a "top dog" in
the relationship.
29. The scores on the scale of Self Love were hypothesized
to decrease from the first to the last session.
ROI.--The therapists should show some growth during the
time they are involved in multiple therapy. It was hypothe
sized that the counselors would show increases in self-
actualization on the following scales:
30. Time-Competence.
31. Inner-Directed.
32. Capacity for Intimate Contact.
33. Spontaneity.
The multiple relationship and client outcome.--It was
hypothesized that there would be a relationship between

53
Client outcome and certain aspects of the multiple therapy
relationship. First of all, it was postulated that
34. There will be a positive correlation between the
self-actualization of the clients (as measured by
the major POI scales of Time-Competence and Inner-
Directed) and the level of caring of the thera
pists (as measured by the CRI scales of Affection,
Friendship, and Empathy).
Secondly, it was planned to compare the clients' scores on
the S-A Scale with their therapists' scores on the MTRS to
test the following hypotheses:
35. The quality of the co-therapist relationship will
be positively related to the client level of self-
actualization (as measured by the S-A Scale).
There will be a positive relationship between agree
ment of the co-therapists as to how they behaved
and perceived during the sessions and the level of
self-actualization of the clients (on the S-A Scale).
36.

RESULTS
Comparison of Multiple and Individual Conditions
Number of Sessions
As mentioned previously, the therapists had to have
at least four sessions with a client for that case to be
included in the study. Of the seven cases where clients were
terminated before the fourth session, six were in the
individual and one in the multiple condition. A sign test
determined the probability of this occurrence as being .062.
Table 31 in Appendix H lists the total number of sessions
for the individual condition as 7.75, the mode 5. For
the multiple condition, the mean was 7.50 and the mode 6.
As heretofore explained, one of the multiples in which each
therapist participated was selected at random for purposes
of comparing measures of that therapist in the multiple
condition to those of his in the individual condition. The
other multiple in which he participated was relegated to
his partner. A Wilcoxon matched-pairs signed-ranks test
was calculated between the number of sessions that each
therapist had with his client in the individual condition and
and number he had with his client in the multiple condition
This test yielded nonsignificant results (T = 16.5, p > .05,
critical value = 11), suggesting that the groups were
matched on this variable.
54

55
TSR Data
All of the hypotheses aligned with the TSR instrument,
concerning the predictions that the counselors would report
differing therapeutic interactions in individual and mul
tiple therapy, were tested similarly. In each case, a
randomized block factorial design (Kirk, 1969, pp. 237-244)
was used to assess the differences between conditions (multiple
and individual) and time of measurement (initial or terminal
interview). The test employed was a two-way analysis of
variance with repeated measures on both variables, as the
same therapists participated in both conditions and pre
and post data were collected on them.
Hypothesis 1.--Compared to individual therapy, the
therapists will rate the clients in multiple therapy as
having talked more about relations with persons of both
sexes (Items 1 and 2). As shown in Table 2, the analysis of
variance of the therapists' scores on the first two items
yielded no significant F ratio for blocks, condition, time,
or the interaction of condition and time. Hypothesis 1
was not supported.
Hypothesis 2.--Compared to individual therapy, the
therapists will rate the clients in multiple therapy as
having discussed a greater variety of topics (Items 1-5).
As shown in Table 3, the F ratio for blocks was significantly
greater than zero, meaning that there were individual dif
ferences between the therapists, as might be expected.

56
TABLE 2
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST
RESPONSES TO TSR ITEMS 1 AND 2 FOR MULTIPLE
AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
2.5833
2.1660
2.5000
2.0000
(.9962
(.3892)
(.6742)
(1.0415)
Source
df
MS
F
Blocks
11
.4147
.55
Treatments
3
Condition (A)
1
.1875
.25
Time (B)
1
2.5275
3.33
A x B .
1
.0201
.03
Residual
33
.7582
Total
47
Note: The standard deviations are in parentheses.
Hypothesis 3.Compared to individual therapy, the
therapists will rate the clients in multiple therapy as
having wanted more to express and explore feelings (Items
6 and 9). Table 4 lists a significant blocks ratio, again
indicating that there were individual differences among the
therapists as to how they responded. The effect of con
dition was not significant,' and Hypothesis 3 was not sub
stantiated. A significant ratio was obtained for time, with
the initial interview means being larger than those of the

57
terminal interview. The therapists, then, felt that their
clients wanted to express and explore feelings more during
the first session than they did during the last.
TABLE 3
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS PRE AND POST
RESPONSES TO TSR ITEMS 1-5 FOR MULTIPLE AND
INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
3.2500
3.2500
3.2500
3.0833
(.8660)
(1.1382)
(.9653)
(1.2401)
Source
df
MS
F
Blocks
11
1.9469
2.27*
Treatments
3
Condition (A)
1
.0833
.10
Time (B)
1
. 0833
.10
A x B
1
.0834
.10
Residual
33
.8560
Total
47
Note: The
*p < .05.
standard
deviations are in
parentheses.
Hypothesis
4.--Compared to individual
therapy, the
therapists will
rate the
clients in multiple therapy as
having had their feelings
more stirred up
(Item 17). This
hypothesis was
rejected,
as the F ratio for condition was
not significant. A perusal of the data to detect a possible

58
TABLE 4
MEANS¡ STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST
RESPONSES TO TSR ITEMS 6 AND 9 FOR MULTIPLE
AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
1.6660
(.6513)
1.2500
(.8660)
1.7500
(.4523)
1.4166
(.7930)
Source
df
MS
F
Blocks
11
1.0208
3.10**
Treatments
3
Condition (A)
1
.1874
.57
Time (B)
1
1.6874
5.13*
A x B
1
.0209
.06
Residual
33
.3289
Total
47
Note: The standard deviations are in parentheses.
*p < .05.
**p < .01.
negative bias in the test seemed worthwhile, since the ratio
for time obtained by using the mean square for residual was
close to significance {F = 3.59, p < .10). As an inspec
tion of the data suggested that there might be an interaction
between blocks and treatments, the residual error was
partitioned into its component parts and new F ratios were
computed. As shown in Table 5, however, none of the F ratios
were significant.

59
TABLE 5
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES
TO TSR ITEM 17 FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
1.6666
1.1666
1.5833
1.4166
(.6513)
(.3892)
(.6686)
(.7930)
Source
df
MS
F
Blocks
11
.5378
1.45
Treatments
3
Condition (A)
1
. 0833
.48
Time (B)
1
1.3333
4.00
A x B
1
. 3334
.55
Residual
33
.3712
A x blocks
11
.1742
B x blocks
11
.3333
AB x blocks
11
.6062
Total
47
Note: The standard deviations are in parentheses.
Hypothesis 5.--Compared to individual therapy, the thera
pists will rate the clients in multiple therapy as agreeing
with and/or accepting more of their comments or suggestions
(Item 21), This hypothesis was rejected when, in fact, the
results showed (Table 6) that the means were significantly
higher both pre and post for the individual than the
multiple condition- The therapists, then, felt that their

60
clients agreed with and/or accepted more of their comments
or suggestions in the individual condition. None of the
other F ratios were significant.
TABLE 6
MEANSi STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS PRE AND POST RESPONSES
TO TSR ITEM 21 FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
1.2500
1.3333
1.6666
1.9166
(.6216)
(.7785)
(.4924)
(. 6686)
Source
df
MS
F
Blocks
11
.537 8
1.41
Treatments
3
Condition (A)
1
2.9999
7.87**
Time (B)
1
.3333

CO
'-J
A x B
1
.0835
.22
Residual
33
.3813
Total
47
Note: The standard deviations are in parentheses.
**p < .01.
Hypothesis 6.Compared to individual therapy, the thera
pists will rate the clients in multiple therapy as having
shown more progress (Item 25). As evinced by the results
in Table 7, this hypothesis was not supported, and the F
ratios for blocks, time, and the interaction of time and
condition were also nonsignificant.

61
TABLE 7
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES
TO TSR ITEM 25 FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
2.2416
(.5149)
2.7500
(1.0553)
2.5833
(.6686)
2.6666
(.4924)
Source
df
MS
F
Blocks
11
.2026
.33
Treatments
3
Condition (A)
1
.0208
.03
Time (B)
1
.5208
.84
A x B
1
.1876
.30
Residual
33
.6218
Total
47
Note: The standard deviations are in parentheses.
Hypothesis 7.--The therapists will be apt in multiple
therapy to rate themselves as more revealing of their spon
taneous impressions or reactions than in individual therapy
(Item 29). As listed in Table 8, no significant F ratios
resulted from the analysis of variance of the scores in
volved in this prediction. Hypothesis 6 was not supported.
Hypothesis 8.The therapists will be apt in multiple
therapy to rate themselves as more understanding of what
their patients said and did than in individual therapy
(Item 31). The analysis of variance summary table reported

62
TABLE 8
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS s PRE AND POST RESPONSES
TO TSR ITEM 29 FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
3.3330
3.8333
3.7500
3.8333
(.9847)
(1.0299)
(.8660)
(.9374)
. Source
df
MS
F
Blocks
11
1.4147
1.89
Treatments
3
Condition (A)
1
.5208
.70
Time (B)
1
1.0208
1.37
A x B
1
.5209
.70
Residual
33
.7481
Total
47
Note: The standard deviations are in parentheses.
p < .10.
in Table 9 shows a significant F ratio for blocks, indi
cating that there were individual differences between the
therapists on this item. The ratios for condition, time,
and the interaction of time and condition were nonsignifi
cant. Hypothesis 8, then, was not supported.
Hypothesis 9.The therapists will be apt in multiple
therapy to rate themselves -as being more helpful to their
patients than in individual therapy (Item 32). This
hypothesis was not substantiated; Table 10 includes no
significant F ratios.

63
TABLE 9
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS 5 PRE AND POST RESPONSES
TO TSR ITEM 31 FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
4.0388
(.9003)
4.2500
(.7538)
3.8333
(1.0299)
3.6666
(1.3027)
Source
df
MS
F
Blocks
11
1.8106
3.16**
Treatments
3
Condition (A)
1
.7500
1.31
Time (B)
1
. 3333
.58
A x B
1
.0000
.00
Residual
33
.5732
Total
47
Note: The standard deviations are in parentheses.
** p < .01.
TABLE 10
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES
TO TSR ITEM 32 FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Multiple Individual
Pre Post Pre Post
3.1666
(.8348)
3.3333
(1.0731)
3.0000
(1.0445)
3.5000
(1.3817)

64
TABLE 1.0~ (continued)
Source
df
MS
F
Blocks
11
.7935
.72
Treatments
33
Condition (A)
1
1.0208
.92
Time (B)
1
1.0208
.92
A x B
1
.1876
.17
Residual
33
1.1066
Total
47
Note: The standard deviations are in parentheses.
Hypothesis 10.The therapists will be apt in multiple
therapy to rate themselves as being more critical or dis
approving to their clients than in individual therapy (Item
35). Again, the only significant F ratio shown in Table 11
was that of blocks signifying that there were individual
differences among the therapists as far as their self-report
of how much they expressed their critical or disapproving
thoughts to their clients was concerned. It is noteworthy
that all of the means included in Table 11 are very low
very few of the therapists rated themselves as being negative
or critical at all. As there was not a significant F ratio
that concerned condition, Hypothesis 10 was rejected.
Hypothesis 11.The therapists will be apt in multiple
therapy to rate themselves as being more warm and friendly

65
TABLE 11
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES
TO TSR ITEM 35 FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
.3333
. 5454
. 3333
.4166
(.4924)
(.6876)
( .4924)
(.5149)
Source
df
MS
F
Blocks
11
.6420
3.02**
Treatments
3
Condition (A)
1
.0207
o
11

Time (B)
1
.1875
. 88
A x B
1
.0209
.10
Residual
33
. 2127
Total
47
Note: The standard deviations are in parentheses.
**p < .01.
toward their clients than in individual therapy (Item 36).
This hypothesis was not supported, as the ratio for condi
tion was not significant; neither were the ratios for time
and the interaction of condition and time. Table 12 shows
that the ratio for blocks was appreciably greater than
zero, indicating the existence of individual differences
between the therapists on this item.
Hypothesis 12.The therapists will be apt in multiple
therapy to rate themselves as expressing more feeling than
in individual therapy (Item 37). This hypothesis was not

66
supported, as a nonsignificant ratio for condition was
obtained. The ratios for time and the interaction of con
dition and time were also below the .05 level of signifi
cance, while that of blocks was above (Table 13). There
were individual differences among the therapists, then, as
to how much feeling they rated themselves as expressing.
TABLE 12
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES
TO T3R ITEM 36 FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
2.1666
2.0833
2.2500
2.3333
(.3892)
(.6686)
(.6216)
(.6513)
Source
df
MS
F
Blocks
11
.6742
2.75
Treatments
3
Condition (A)
1
. 3333
1.36
Time (B)
1
.0000
o
o

A x B
1
.0834
.34
Residual
33
.2449
Total
47
Note: The
standard
deviations are in
parentheses.
* p < .05.

67
TABLE 13
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES
TO TSR ITEM 37 FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Mult
iple
Individual
Pre
Post
Pre
Post
1.3333
(.4924)
1.5833
(.6686)
1.6666
(.6513)
1.5833
(.6686)
Source
df
MS
F
Blocks
11
.7329
2.59*
Treatments
3
Condition (A)
1
. 1875
.66
Time (B)
1
.0208
.07
A x B .
1
.1875
.66
Residual
33
.2834
Total
47
Note: The standard deviations are in parentheses.
*p < .05.
Hypothesis 13.It is expected that the therapist-client
agreement as to the events of the sessions will be higher
in multiple than in individual therapy (on 24 selected
items listed in Tables 31 and 32, Appendix H). Table 14
lists the Pearson product-moment correlations computed be
tween the scores of the therapists and those of their clients
with whom they were paired. As shown, for the initial
interview, nine of the therapists have higher agreement

68
scores in the multiple than in the individual condition. A
sign test (two-tailed) determined that this difference was
nonsignificant (p = .146). For the terminal session, seven
of the therapists had a higher correlation between their
scores and those of their clients in individual than mul
tiple therapythis was also not a significant difference
(p = .774). As far as client-therapist agreement, then, no
descriptive evidence of a difference between the conditions
was found; Hypothesis 1.3 was thus not supported.
TABLE 14
THERAPIST-CLIENT AGREEMENT SCORES FOR MULTIPLE
AND INDIVIDUAL CONDITIONS; CORRELATIONS
BETWEEN
THEIR RESPONSES TO 24 TSR
ITEMS
Multiple
Individual
Therapist-
client
pair
Pre
Post
Therapist-
client
pair
Pre
Post
A-10
.76
.47
A-7
.52
.46
B-8
.83
.80
B-12
.65
.41
C-16
.64
.51
C-17
.81
. 6 6
D-14
.79
.71
D-29
.68
. 88
E-25
.91
.43
E-39
.75
.49
F-2.0
.49
.91
F-22
.78
.70
G-37
.82
.73
G-23
.62
.65
H-26
.84
. 81
H-21
.97
.82
1-33
.80
. 83
1-38
.77
.87
J-31
.67
.41
J-30
.57
. 62
K-3 5
.90
.88
K-34
.78
. 81
L-36
.78
. 30
L-4 0
.60
.46

69
In inspecting the agreement scores for the first and
the last session, it is noteworthy that 17 of the 24 cases
had higher therapist-client agreement scores for the pre
test than the posttest. A binomial test (two-tailed)
showed this difference to be nonsignificant (p = .064 at
the .05 level). In breaking this down into groups, in 10
out of the 12 multiple cases the posttest agreement scores
were lower than the pretest scores (p = .038); while in the
individual group, only 7 out of 12 were lower (p = .774).
As far as the difference between pre- and posttesting, then,
the two groups appear dissimilar. In the multiple condi
tion, the agreement between the therapists and their clients
was significantly greater during the initial interview than
it was during the terminal interview. In the individual,
condition, there was not a significant difference between
therapist-client agreement at the end, as compared to the
beginning, of therapy.
CTS Data
As per the prior explanation (see Method section), the
mean and the modal scores of the therapists on the 32 items
of the CTS were determined. Means and modes of 1 to 3
designate topics that the therapists felt typified multiple
therapy, while 4 indicated no difference, and 5 to 7
signified statements thought to be true of individual
therapy. The mean scores of the 32 items were used to rank
order the topics, as shown in Table 15. The smaller ranks

70
thus designate statements that the therapists felt were
definitely more applicable to multiple therapy than to
individual therapy. There were three means that were above
4.00, and all of these items were negative ones; that is,
"years of experience necessary to do effective therapy,"
"difficulties by the therapist in 'handling' intense
transference reactions," and "emotional demands experienced
by the therapist." The following hypotheses (14-18) were
not tested per se, but were considered to be confirmed if
the mean and the modal score were 3.0 or less. As statis
tical tests were not performed, the conclusions are con
sidered to be suggestive.
Hypothesis 14."The therapists will rate multiple
therapy over individual therapy as being conducive to self
understanding of the therapist (Item 6). This hypothesis
was supported as the mean score of 2.667 and the mode of 2
indicated that the therapists felt that multiple therapy was
slightly to moderately more conducive to self-understanding
than was individual therapy.
Hypothesis 15.The therapists will rate multiple
therapy over individual therapy as being useful in training
therapists (Item 10). The results substantiate this hy
pothesis, as the therapists rated multiple therapy as being
moderately to much more useful in training therapists. The
mean and mode scores on this item were 2.083 and 1, respec
tively.

71
TABLE 15
MEANS, MODES, AND RANKS OF THE THERAPISTS' RESPONSE PATTERN
ON THE 32-ITEM COMPARATIVE THERAPY SCALE
Item
no.
Rank
Mean
Mode
32.
Resolution of impasses.
1
2.000
2
10.
Useful in training therapists.
2.5
2.083
1
14.
Useful with marital couples.
2.5
2.083
1
4.
Opportunity to work out anxieties
with a therapist of the more
dreaded sex.
4
2.167
2
3.
Transference of the original
family situation.
5
2.333
2
8.
Understanding of countertrans
ference .
6.5
2.417
2
28.
Your general preference with a
patient who ferociously clings to
persons of one sex.
6.5
2.417
2
1.
Understanding, by the therapist,
of the transference.
8
2.583
3
6.
Self-understanding of the thera
pist enhanced.
9
2.667
2
11.
Personal gratification (enjoyment
or "fun") for the therapist.
10
2.727
3
30 .
Your general preference for work
ing out and through a patient's
very intense "negative" transfer
ence .
11.5
2.750
3
31.
Your general preference for working
out and through a patient's very
sticky "positive" transference.
11.5
2.750
3
18.
Working out and through problems
of masculinity and feminity.
13
2.833
2
20.
Opportunity for patients of both
sexes to identify with a reasonably
healthy person of the same sex.
14.5
2.917
3

72
TABLE 15(continued)
item
no Rank Mean Mode
26.
Your general preference with a
patient who is expecially fearful
of heterosexual relations.
14.5
2.917
3
12.
Useful with very "acting out"
patients.
16.5
3.000
3
24.
Your general preference.
16.5
3.000
3
16.
Positive therapeutic movement,
in general.
19
3.167
4
17.
Working through, in general.
19
3.167
3
19.
Working out and through problems
of hostility and assertiveness.
19
3.167
3
21.
Understanding of resistance.
21
3.250
3
25.
Your general preference with a pa
tient who is very mistrustful of
authority, especially of one sex.
22.5
3.333
3
29.
Your general preference when only
short-term therapy, i.e., 6 months
or less is available.
22.5
3.333
4
22.
More complex patterns of resistance.
24.5
3.500
4
27.
Your general preference with a
patient who is especially fearful
of homosexual longings.
24.5
3.500
4
23.
Eliciting of oedipal dynamics.
26
3.727
4
13.
Useful with borderline schizo
phrenics .
27.5
3.750
4
15.
Useful with "oral characters."
27.5
3.750
4
2.
Completeness of transference
patterns.
29
3.909
4
*9.
Years of experience necessary to do
effective therapy.
30
4.333
4
*5.
Difficulties by the therapist in
"handling" intense transference
reactions.
31.5
4.917
5

73
TABLE 15-~ (continued)
Item
no.
Rank
Mean
Mode
*7. Emotional demands experienced
by the therapist.
31.5
4.917
5
Hypothesis 16.The therapists
will rate
multiple
therapy
over individual therapy as offering more personal gratifica
tion (enjoyment or "fun") for the therapist (Item 11). The
therapists did feel that multiple therapy offered slightly
to moderately more personal gratification, thus supporting
Hypothesis 16.
Hypothesis 17.--The therapists will rate multiple therapy
over individual therapy as being their general preference
(Item 24). Although not being one of the highest-ranked
topics, Table 15 shows a mean and mode score of 3 on this
item, signifying that the therapists felt multiple therapy
to be slightly more their general preference.
Hypothesis 18.The therapists will rate multiple therapy
over individual therapy as fostering the resolution of impasses
(Item 32). This hypothesis was supported, as the therapists
felt that multiple therapy was moderately more effective in
fostering the resolution of impasses. The mean score of 2.00
was the highest of any item; the mode on this topic was also
2.
Hypothesis 19.The therapists generally will express a
more positive attitude toward multiple therapy than toward

74
individual therapy (Items 1-32). To test this hypothesis,
a total score for each therapist regarding his attitudes
toward multiple and toward individual therapy was obtained
(see Method section). Basically, the responses of the
therapists on each item were scored from "slightly more"
(1) to "much more" (3) for both regular and co-therapy, with
the "no difference" column being omitted. As shown in
Table 16, a Wilcoxon matched-pairs signed-ranks test
(Seigel, 1956) detected that the differences were signifi
cant, thus confirming Hypothesis 19.
TABLE 16
WILCOXON MATCHED-PAIRS SIGNED-RANKS TEST FOR TESTING
DIFFERENCES IN THERAPISTS' ATTITUDES ABOUT
MULTIPLE AND INDIVIDUAL THERAPY
Multiple Individual Rank Rank with less
Therapist therapy therapy d of d frequent sign
A
70
4
66
11
B
30
1
29
8.5
C
28
1
27
6.5
D
28
1
27
6.5
E
19
0
19
2
F
31
2
29
LO

00
G
21
13
8
1
H
22
2
20
3
I
23
1
22
4
J
83
0
83
12
K
39
4
35
10
L
30
4 .
26
5
T = 0*
*p < .005.

75
Carkhuff Process Scales Data
The average ratings that the therapists received on
the core facilitative conditions were to be based on ratings
by two judges of three segments from each first and last
session. It should be mentioned, however, that in the
multiple condition there were eight instances where the
female co-therapist did not talk during one or two excerpt(s)
and her average rating for that session was based on two
or one segment(s), respectively. There were not any seg
ments from the individual condition where this occurred, nor
was a male co-therapist silent during a 5-minute segment
from the multiple condition. Of the ratings that were used
to assess the differences between the therapists' offered
levels of the core facilitative dimensions, two ratings
are based on one segment and two are based on two excerpts
(as noted in Table 35, Appendix H). The following results
must be qualified, then, by the statement that the average
ratings were not all compiled from the same number of
excerpts.
For each of the four process scales, a randomized block
factorial design (Kirk, 1969) was used to test the differ
ences between condition (multiple and individual) and time
of measurement (first or last interview). In three in
stances, there were no significant F ratios when these were
computed using the residual error term. As an inspection
of the data suggested a possible interaction between blocks

and treatments, which could result in a negative bias being
present in the test, new F ratios were computed using the
component parts of the residual error. Although directional
hypotheses had been postulated in regard to conditions, an
attempt was made to explain the significant interactions
resulting from the analyses of variance. Thus, the simple
main effects tests used were two-tailed t tests, which
allowed for the testing of significant differences in either
direction.
Hypothesis 20.--The therapists will offer higher levels
of empathy in multiple therapy than in individual therapy.
Table 17 lists a significant ratio for blocks, indicating
the presence of individual differences among the therapists
as to.their offered level of empathy. The main effects of
condition and time were nonsignificant, while that of the
interaction of condition and time was significant at the
.05 level. A simple main effects test (Kirk, 1969) on the
means involved showed that the therapists offered signifi
cantly higher levels during the terminal session than during
the initial interview in the individual condition (t = 2.70,
df = 22, p < .02), while the slightly larger pretest mean
in the multiple condition was not significantly different
from the posttest mean (t = 1.31, df = 22, p > .10). Con
trary to Hypothesis 20, the therapists were higher on the
Empathy scale in the individual condition during the terminal
session than in the multiple condition (t = 3.43, df = 22,

77
p > .01). The means suggest that the levels offered in the
two conditions were fairly equivalent at the onset of
therapy, but increased as therapy proceeded in the indi
vidual condition while remaining the same in the multiple.
TABLE 17
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST EMPATHY
SCORES FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
2.772
6.608
2.653
3.041
(.475)
(.443)
(.630)
(.448)
Source
df
MS
F
Blocks
11
.462
2.46*
Treatments
3
Condition (A)
1
.296
1.58
Time (B)
1
.151
o
CO

A x B
1
.916
4.87*
Residual
33
.188
Total
47
Note: The standard deviations are in parentheses.
*p < .05.
Hypothesis 21.--The therapists will offer higher levels
of respect in multiple therapy than in individual therapy.
Table 18 shows that, similar to the results of the Empathy
scale, the analysis of variance of the scores on the Respect
scale yielded significant blocks and interaction ratios,

78
TABLE 18
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPECT
SCORES FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Mu1tipi
e
Individual
Pre
Post
Pre
Post
2.702
2.622
2.702
3.048
(.434)
(.488)
(.572)
(.447)
Source
df
MS
F
Blocks
11
.536
3.82**
Treatments
3
Condition (A)
1
.546
2.73
Time (B)
1
.213
1.95
A x B
1
.547
5.01*
Residual
33
.140
A x blocks
11
.200
B x blocks
11
,109
AB x blocks
11
.109
Total
4 7
Note: The
standard
deviations are in
parentheses.
*p < .05.
**p < .01.
while those of condition and time were nonsignificant.
Again, the posttest mean in the individual condition differed
significantly from the pretest mean of that condition
(t = 3.64, df = 22, p < .002) and from the posttest mean of
the multiple condition (t = 4.48, df = 22, p < .002). The
pretest means of the two conditions were equal, and the

79
difference between the pre and post means in the multiple
condition did not reach significance (t = .84, df = 22,
p > .20). Again, then, the therapists offered a comparable
level of a facilitative core dimension in both conditions
at the beginning of therapy, but a higher level in the
individual condition at therapy's end. Hypothesis 21 was
rejected.
Hypothesis 22.The therapists will offer higher levels
of genuineness in multiple therapy than in individual
therapy. Neither of the main effects, condition or time,
was found to be significant when the scores on the Genuine
ness scale were analyzed (Table IS). Individual differences
between the therapists were indicated by a significant blocks
ratio;, and a significant interaction between condition and
time was detected. A simple main effects test on the
relevant means again determined that the post mean for the
individual condition was significantly different from the
pre mean for the individual condition (t = 4.46, df = 22,
p < .002), and the post mean for the multiple condition
(t = 4.82, df = 22, p < .002). Again, the difference
between the slightly larger pre mean of the multiple con
dition and the post mean was not significant (t = .50,
df = 22, p > .50). Since this difference was larger than
that between the pre means of the multiple and individual
conditions, the latter difference was also known to be non
significant. The therapists were shown to significantly

80
raise their offered level of genuineness in the individual
condition over the course of therapy, while the level in
the multiple condition remained static. Hypothesis 22 was
not supported when the results indicated the only signifi
cant difference between the conditions to be that of
individual being higher than multiple during the terminal
session.
TABLE 19
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST
GENUINENESS SCORES FOR MULTIPLE AND
INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
2.693
2.658
2.683
2.993
(.400)
( .460)
(.534)
(.417)
Source
df
MS
F
Blocks
11
.375
2.47*
Treatments
3
Condition (A)
1
. 327
1.27
Time (B)
1
.219
1.58
A x B
1
.348
6.00*
Residual
33
.152
^A x blocks
11
.258
MSB x blocks
11
.139
^AB x blocks
11
.058
Total
47
Note: The
standard
deviations are in
parentheses.
*p < .05.

81
Hypothesis 23,---The therapists will offer higher levels
of concreteness in multiple therapy than in individual
therapy. Table 20 shows that a significant F ratio was
obtained for the interaction of time and condition when the
scores of the therapists on the Concreteness scale were
analyzed by the randomized block factorial design. The
ratios for blocks, and the main effects of condition and
time were nonsignificant at the .05 level. A simple main
effects test again determined that the difference between
the pretest and posttest means in the individual condition
was significant (t = 2.97, df = 22, p < .01), as was that
between the posttest means of the individual and multiple
conditions (t = 3.74, df = 22, p < .002). Again, in com
paring the pretest mean of the multiple condition with the
posttest mean of that condition and the pretest mean of
the individual condition, the larger difference was shown
to be nonsignificant (t = 1.29, df = 22, p > .20). In
regard to the offered levels of concreteness, then, the
therapists showed a pattern similar to the results of the
other scales. The conditions were not significantly dis
crepant at the initiation of therapy. At termination, how
ever, the therapists offered higher levels of concreteness
in the individual condition than they had at therapy's
beginning and than they did at the end of multiple therapy.
Conditions and therapist type.--In comparing the types
of the therapists on the Myers-Briggs Type Indicator and

82
TABLE 20
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST
CONCRETENESS SCORES FOR MULTIPLE AND
INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
2.721
(.427)
2.608
(.470)
2.675
(.588)
2.99 3
(.415)
Source
df
MS
F
Blocks
11
. 360
1.93
Treatments
3
Condition (A)
1
.347
1.22
Time (B)
1
.12 6
.68
A x B
1
.558
6.07*
Residual
33
.187
MSA x blocks
11
. 284
M^B x blocks
11
.186
^AB x blocks
11
.092
Total
47
Note: The standard deviations are in parentheses.
*p < .05.
p < .10.
their obtained ratings on the Carkhuff scales, it did not
appear that there was any consistent pattern among the
"counselor" and the "noncounselor" types. Table 36 in
Appendix H shows the types of the therapists along with
the rank orders of their scores on the Carkhuff scales of

83
Empathy,. Respect, Genuineness, and Concreteness. The rank
orders were obtained by using the average of the judges'
ratings for each therapist across both conditions, pre and
post, as listed in Table 35, Appendix H.
Of the 12 therapists, there were three women (Counselors
B, D, and F) and one male (K) who were consistently rated as
offering high facilitative levels (average over 3.0) of the
core conditions. The three female counselors were all
"counselor" types, dominant in Intuition, Feeling, and
Perception, whether Introverted or Extraverted. The one
male was also strongest on Intuition and Feeling. Although
his score on the Judging-Perceiving dimension indicated
that Judging was dominant, the score was so close to the
midpoint, it is difficult to be certain of his preference.
The next three highest-scoring counselors on the
Carkhuff scales (E and L on Empathy and Respect and H on
Genuineness and Concreteness) were all "noncounselor" types.
Three of the therapists receiving ranks of 9.5, 10, 11, and
12 were "counselor" types (A, I, and J), while two were
"noncounselor" types (G and H).
The Multiple Condition
CRI Data
The hypotheses aligned with the CRI data concerned
the general prediction that the relationships of the pairs
of co-therapists would change toward greater intimacy and
caring over time. Table 21 shows the mean pre- and posttest

84
scores and their standard deviations for the 12 therapists
on four of the major scales and two subscales of the CRI.
For each scale, the difference between the pre and post
means was tested using a matched-group t test (df = 11),
and the obtained values are also reported in Table 21. The
obtained levels of significance are those for a one-tailed
test, as directional hypotheses were postulated in all
instances.
TABLE 21
PRE- AND POSTTEST MEANS AND STANDARD DEVIATIONS
OF THE THERAPISTS' CRI SCALE SCORES
Scale or subscale
Pretest
Posttest
t
Affection
7.416
(1.786)
8.667
(1.775)
1.92*
Friendship
10.583
(1.929)
11.917
(2.109)
2.46**
Empathy
11.750
(2.094)
13.250
(1.658)
2.24**
Self Love
13.500
(1.883)
12.833
(1.337)
-1.20
Being Love
12.000
(1.206)
13.333
(.779)
3.09***
Deficiency Love
2.750
(1.603)
3.000
(1.537)
.67
Note: The standard deviations are in parentheses.
*p < .05.
**p < .025.
***p < .01.
Hypothesis 24.--The therapists' scores on the scale of
Affection will be higher at the end of therapy than at the

85
beginning. This hypothesis was supported, as the posttest
mean was significantly larger than the pretest mean (t =
1.92, p < .05).
Hypothesis 25.--The therapists' scores on the scale
of Friendship will be higher at the end of therapy than at
the beginning. On the Friendship scale, the posttest mean
was significantly higher than the pretest mean (t = 2.46,
p < .025) thus supporting Hypothesis 25.
Hypothesis 26.---The therapists' scores on the scale
of Empathy (M) will be higher at the end of therapy than at
the beginning. The results substantiated this prediction,
as the pretest mean was significantly smaller than the post
test mean (t = 2.24, p < .025).
Hypothesis 27.--The therapists' scores on the scale of
Being Love will be higher at the end of therapy than at the
beginning. The posttest mean was significantly higher
than the pretest mean on the scale of Being Love (t = 3.09,
p < .01), thus supporting Hypothesis 28.
Hypothesis 28.The therapists' scores on the scale
of Deficiency Love will be higher at the end of therapy
than at the beginning. This hypothesis was rejected, as
the results showed a nonsignificant difference between the
pre- and posttest means (t = .67, p > .10). The difference
was in the predicted direction.
Hypothesis 29.--The therapists' scores on the scale of
Self Love will be lower at the end of therapy than at the

86
beginning. Although the direction of the difference be-
tv7een the pre and post means on the Self Love scale was in
the predicted direction, the difference was nonsignificant
(t = -1.20, p > .10), thus disconfirming Hypothesis 29.
It is also interesting to compare the means of the
therapists CRI scores to those published by Shostrom (1966b)
for successfully married couples, troubled couples, and
divorced couples (Table 22). This comparison might suggest
how caring the relationships between the therapists were.
The pretest mean score of the therapists on the Affec
tion scale was close to that of divorced couples, while the
posttest was above that of troubled couples. The means for
both pre- and posttestings on the Friendship scale lay
between those of troubled couples and successfully married
couples. The therapists scored between divorced couples
and troubled couples at the beginning of their counseling
together on the Empathy (M) scale; but by the end of their
work, they were higher than the successfully married couples.
On the Self Love scale, the therapists scored higher than
the successfully married couples on both pre- and posttest
ings. In this instance, it would appear that they were less
caring than any of the couples, as they were much more
concerned with themselves in the relationships. The mean
of the therapists on the Being Love scale for the pretest
was between those of troubled couples and successfully married
couples, while the posttesting showed the therapists to be

87
very close to the successfully married couples. And, on
the Deficiency Love scale, the therapists scored consider
ably lower than all of the couples in Shostrom's sample.
Many of these comparisons suggest a trend for the relation
ships of the co-therapists to become more caring and
healthier over their term of working together.
TABLE 22
MEANS AND STANDARD DEVIATIONS OF SHOSTROM'Sa SAMPLE OF
SUCCESSFULLY MARRIED, TROUBLED, AND DIVORCED COUPLES
ON THE CRI SCALES
Successfully
married
Troubled
Divorced
Scale or subscale
couples
couples
couples
Affection
11.0
8.4
7.0
(2.2)
(2.9)
(3.4)
Friendship
12.9
8.4
6.6
(2.2)
(3.1)
(3.6)
Empathy (M)
12.9
12.2
10.5
(2.2)
(2.9)
(4.1)
Self Love
11.1
8.3
7.4
(2.9)
(3.1)
(3.9)
Being Love
13.5
10.9
8.7
(2.1)
(3.1)
(4.0)
Deficiency Love
6.1
5.6
5.2
(2.3)
(2.4)
(2.6)
Note: The standard deviations are in parentheses.
aShostrom (1966b).
POI Data
The hypotheses concerning the expectation that the
therapists would evince a positive change in self-actualization

88
during the time that they were involved in multiple therapy
were all tested similarly. In each instance, the differ
ence between the pre and post mean of a POI scale was
tested for significance by means of a matched-group t test.
Table 23 lists the means and standard deviations of the
therapists' pre and post scores on four POI scales.
TABLE 23
MEANS AND STANDARD DEVIATIONS OF THE THERAPISTS'
PRE AND POST POI SCORES
Scale
Pre
Post
t
Time-Competence
17.333
(5.246)
19.750
(2.454)
1.84*
Inner-Directed
101.583
(9.549)
103.833
(8.387)
1.78
Capacity for
Intimate Contact
22.917
(2.778)
23.750
(2.221)
1.24
Spontaneity
16.167
(2.082)
15.500
(1.931)
-1.69
Note: The standard deviations are in parentheses.
*p < .05.
p < .10.
Hypothesis 30.The therapists will be more time-
competent at the end of therapy than at therapy's beginning.
This hypothesis was supported, as the posttest mean was
found to be significantly larger than the pretest mean on
the scale of Time-Competence (t = 1.84, p < .05).

Hypothesis 31.The therapists will be more inner-
directed, at the end of therapy than at therapy's beginning.
The posttest mean of the therapists on the scale of Inner-
Directed was larger than the pretest mean, but the difference
did not reach significance at the .05 level (t = 1.78,
p < .10). Hypothesis 31 was not supported.
Hypothesis 32.--The therapists will show a greater
capacity for intimate contact at the end of therapy than at
therapy's beginning. The therapists' scores on the scale of
Capacity for Intimate Contact did not differ significantly
from pre- to posttesting (t = 1.24, p > .10), so Hypothesis
32 was rejected.
Hypothesis 33.--The therapists will show a greater
amount of spontaneity at the end of therapy than at therapy's
beginning. As the posttest mean on the scale of Spontaneity
was actually smaller than the pretest mean, though not
significantly (t = -1.69, p > .10), this hypothesis was
rejected.
The Multiple Relationship and Client Outcome
The last three hypotheses postulated significant re
lationships between client outcome in the multiple condition
and certain aspects of the co-therapy relationship.
Hypothesis 34.--There will be a positive correlation
between the self-actualization of the clients (as measured
by the major POI scales of Time-Competence and Inner-Directed)
and the level of caring of the therapists (as measured by

90
the CRI scales of Affection, Friendship, and Empathy).
Pearson product-moment correlations were computed between
the post CRI scores of each therapist on Affection, Friend
ship, and Empathy (M) and the post POI scores of the client
with whom he was paired for purposes of data analysis. The
scores on which these correlations were based are given
in'Appendix H, Tables 37 and 41. None of the correlations,
which ranged from -.28 for Affection and Time-Competence to
.39 for Friendship and Time-Competence, were significant at
the .05 level. Hypothesis 34 was not supported.
A discussion of the attempt to establish test-retest
reliability and concurrent validity of the MTRS is in order,
before considering the use of this instrument in testing
the last two hypotheses. It was thought that the same
therapists should rate his relationship to his co-therapist
similarly on two separate, but temporally close, occasions.
Positive correlations between these two separate ratings
were predicted. Test-retest reliabilities were computed for
both co-therapist agreement and the therapists' rating of
their relationship quality by correlating each therapist's
scores on these from his sessions with one client to those
from his sessions with his other client. As the distribu
tion of relationship quality scores was not normally dis
tributed, Spearman rank-order correlations were used, when
appropriate, with the correction for ties. The rank orders
of each therapist's relationship quality scores, pretest,

91
posttest.; and total for each case, are shown in Table 24,
while those of the agreement scores of each therapist and
his partner as to the events of the session are given in
Table 25. As reported in Table 27, the test-retest reli
abilities for relationship quality between the pretest
ranks of each therapist for his two cases, between the post
test ranks of each therapist for his two cases, and between
the ranks of the combined pre- and posttest scores of one
case compared to the other were all significant beyond the
.05 level. For co-therapist agreement, likewise, the
test-retest reliabilities were significant.
As an attempt to establish concurrent validity for the
MTRS, the rank orders of the therapists' scores on four
CRI scales (Table 26) were correlated with their relation
ship quality and co-therapist agreement ranks. As shown in
Table 28, co-therapist agreement did correlate significantly
with the pretest Affection scale ranks and the posttest
Empathy (M) scale ranks. No others were significant. The
relationship quality scores did not correlate significantly
with any of the CRI scale scores. The two parts of the
MTRS also viere not significantly correlated with each other,
suggesting that each measures a different aspect of the
co-therapist relationship. If either of the last two hy
potheses were to be confirmed, a crude case for predictive
validity of the MTRS scale would be formed. It was thought
that co-therapist agreement and relationship quality should
be positively related to client outcome.

TABLE 24
RANK ORDERS OF EACH THERAPIST'S RELATIONSHIP QUALITY SCORES
FOR BOTH MULTIPLY SEEN CASES
First
case
Second
case
Both cases <
combined
Therapist
and client
pair
Pre
Post
Total
Therapist
and client
pair
Pre
Post
Total
Therapist
Pre
Post
Total
A-8
11
7.5
10
A-10
12
8
10.5
A
12
8.5
10
B-8
1
10
5
B-10
5
10
8
B
2
10
8
C-14 .
5.5
9
7
C-16
5
7
7.5
C
6
7
6.5
D-14
9
6
9
D-16
10.5
9
9
D
9
8.5
9
E-20
5.5
11
8
E-25
8
2.5
4.5
E
7
6
6.5
F-20
2
5
3
F-25
5
4.5
4.5
F
4
4.5
3
G-26
3
2
2
G-37
1.5
2.5
2
G
2
2
2
H-26
7
3.5
4
H-37
1.5
4.5
3
H
2
3
4
1-31
10
12
12
1-33
9
11.5
10.5
I
10
12
12
J-31
8
3.5
6
J-33
7
6
7.5
J
8
4.5
5
K-35
4
1
1
K-36
3
1
1
K
5
1
1
L-35
12
7.5
11
L-36
10.5
11.5
12
L
11
11
11
Mote:
The
rankings for
each measure
are over all 12
therapists.
On
each,
the
highest score was ranked 1; the lowest score, 12.

TABLE 25
RANK ORDERS OF THE AGREEMENT SCORES OF EACH THERAPIST'S RESPONSES ON THE TSR AND
HIS PARTNER'S CORRESPONDING MTRS RESPONSES FOR BOTH MULTIPLY SEEN CASES
First
case
Second
case
Both cases combined
Therapist
and client
pair
Pre
Post
Total
Therapist
and client
pair
Pre
Post
Total
Therapist
Pre
Post
Total
A-8
5
12
8.5
A-10
11
6
9
A
6
10
9
B-8
9
3
3.5
B-10
9.5
1.5
2.5
B
9.5
2
2
C-14
11.5
9.5
10.5
C-16
5
11.5
7.5
C
6
12
10
D-14
4
1
1
D-16
7.5
1.5
1
D
1
1
1
E-20
1.5
3
3.5
E-25
2.5
6
5.5
E
6
4
4.5
F-20
3
7
6.5
F-25
1
3.5
2.5
F
2.5
5
3
G-26
1.5
3
3.5
G- 37
2.5
3.5
5.5
G
9.5
3
4.5
H-26
9
9.5
12
H-37
5
9
10.5
H
11.5
10
11.5
1-31
9
5.5
6.5
1-33
7.5
9
7.5
I
6
6
7
J-31
6.5
5.5
3.5
J-33
9.5
11.5
10.5
J
6
7.5
8
K-35
6.5
9.5
8.5
K-36
5
6
4
K
2.5
7.5
6
L-35
11.5
9.5
10.5
L-36
12
9
12
L
11.5
10
11.5
Note: Rankings for each measure are over all 12 therapists,
score was ranked 1; the lowest, 12.
On each, the highest
u>

TABLE 26
RANK ORDERS OF THE THERAPISTS SCORES ON FOUR CRI SCALES
Affection
Friendship
Empathy (M)
Being
Love
Therapist
Pre
Post
Pre
Post
Pre
Post
Pre
Post
A
2.5
8
11
11
12
9
11.5
3
B
9.5
5
11
12
11
3
7
12
C
1
8
11
9
2.5
12
3
8.
D
5
2
9
1
1
3
3
3
E
5
2
4
2
2.5
1
7
1
F
2.5
4
1.5
4.5
8.5
6
7
8
G
11.5
11.5
4
4.5
6
9
7
8
H
7.5
8
4
7
6
9
3
8
I
7.5
11.5
6.5
4.5
10
9
10
8
J
5
8
1.5
4.5
6
9
1
8
K
9.5
2
8
9
8.5
5
7
3
L
11.5
8
6.5
9
4
3
11.5
8
Note: The rankings
highest score was ranked
for
1; '
each scale
the lowest
are over
score, 12.
all 12
therapists.
On each,
the

35
TABLE 27
TEST-RETEST RELIABILITIES OF RELATIONSHIP QUALITY
AND CO-THERAPIST AGREEMENT FROM THE MTRS
Pre
Post
Total
Relationship quality
. 84**
.61**
. 89**
4
Co-therapist agreement
. 55*
.54*
. 61*
*p < .
**p < .
05.
01.
TABLE 28
SPEARMAN RANK-ORDER CORRELATIONS BETWEEN RELATIONSHIP
QUALITY AND CO-THERAPIST AGREEMENT AND BETWEEN
THESE SCALES AND SCALES OF THE CRI
Relationship quality
Co-therapist agreement
Comparison
Pre
Post
Pre Post
Co-therapist
agreement
Pre
Post
-.14
.02
Affection
Pre
Post
.25
.17
.53*
.35
Friendship
Pre
Post
.23
.16
-.05
.48
Empathy (M)
Pre
Post
-.05
-.14
.08
.56*
Being Love
Pre
Post
.41
.15
.16
.02
*p < .05.

96
Table 29 lists the x*ank orders of the 12 multiple
clients on the S-A Scale and on the posttest POI major scales
of Inner-Directed and Time Competence. Also listed are the
ranks of the therapists' total composite relationship quality
and co-therapist agreement scores. A composite score for both
therapists of a pair was obtained by summing both of their
scores (on relationship quality or agreement) for a particular
session. For each of their two clients, a total quality and
a total agreement score was then computed by summing their
composite ratings pre and post. The rank of each therapist
pair pertaining to each of their clients for relationship
quality is listed opposite from the client number, as is
their rank for co-therapist agreement.
Hypothesis 35.--The quality of the co-therapist relation
ship will be positively related to the client level of self-
actualization (as measured by the S-A Scale). A Spearman
rank-order correlation between the relationship quality score
of each therapist pair and their client's level of self-
actualization (on the S-A Scale) resulted in a nonsignificant
rho of -.31. Quality of the co-therapist relationship was
then negatively related, although not significantly, to
client self-actualization, and Hypothesis 35 was rejected.
Hypothesis 36.There will be a positive relationship
between agreement of the therapists as to how they behaved
and perceived during the sessions and the level of self-
actualization of the clients (on the S-A Scale). A Spearman
rank-order correlation coefficient computed between the

TABLE 29
RANK ORDERS OF THE TOTAL COMPOSITE CO-THERAPIST AGREEMENT AND RELATIONSHIP QUALITY
SCORES FROM THE MTRS AND THEIR CLIENT'S POST S-A SCALE AND POI SCALES
TIME-COMPETENCE (Tc) AND INNER-DIRECTED (I)
Therapists
Total composite
co-therapist
agreement rank
Total composite
relationship
quality rank
Client
S-A Scale
rank
POI
Tc I
AB
7
10
8
11
7
8.5
AB
4
11
10
2
2.5
3
CD
2
9
14
3
12
7
CD
2
7
16
7
8
4.5
EF
5.5
3
20
9
6
8.5
EF
2
4
25
5
1
2
GH
11
1
26
12
11
12
GH
8.5
2
37
4
2.5
1
IJ
5.5
8
31
1
4.5
4.5
IJ
10
12
33
6
10
11
KL
12
6
35
10
9
10
KL
8.5
5
36
8
4.5
6
Note: The rankings for each measure are over all 12 cases. On each, the highest
score was ranked 1; the lowest, 12.
'vD
-U

98
total composite co-therapist agreement of each pair and
their client's level of self-actualization on the S-A Scale
yielded a rho of .54, significant at the .05 level. A
significant association was found, then, between co
therapist agreement in the multiple condition and client
outcome, and Hypothesis 36 was supported. As a further
check on this finding, rank-order correlations were computed
between the co-therapist agreement ranks for each case and
the client's relative rank on the posttest POI scales of
Time-Competence and Inner-Directed. The coefficient for
Time-Competence (rho = .29) was nonsignificant, while that
of Inner-Directed (rho = .60) was significant at the .05
level (one-tailed). This latter correlation substantiates
the finding that co-therapist agreement is positively related
to client outcome.

DISCUSSION
Comparison of the Conditions
In comparing individual and multiple therapy, the
present study investigated three major areas. The first
aspect was the therapists' report of their clients' and their
own behavior in both conditions. The second involved the
therapists' attitudes about the two treatment forms in the
abstract; the third, the judges' ratings of the therapists'
behavior in both conditions as far as facilitative core
dimensions. Regarding the hypothesized differences between
the psychotherapeutic interactions in multiple and individual
therapy, the results disconfirmed the existence of any actual
advantages of multiple over individual therapy--whether by
the therapists' own report or that of the judges. In fact,
there was some evidence to the contrary--that individual
therapy was more likely to contain ingredients thought to
be helpful in counseling. The data did support the claim
that the therapists would express a more positive attitude
toward multiple therapy and would believe it to be more
advantageous than individual therapy.
Therapists' Report of Interactions
The findings regarding the interactions in multiple
and individual therapy pertain, of course, to the results
99

100
found with the presently used instruments and with the
present sample of therapists. It should be noted that
the TSR often only provides for a negative answer or a two-
or three-level positive answernot a very wide range of
possible responses. As the analyses were computed for
single or small groups of items, the range was very con
stricted. It is possible, then, that the instrument was
not sensitive enough to record some differences. The fact
that two analyses did yield significant results suggests
that the scale was able to detect some differences even
with this small range of scores.
The clients' behavior.--Advocates of co-therapy have
stated that the therapists' task is often accomplished more
easily and quickly because clients behave differently when
there are two therapists than when there is one. The data
gathered in the present study did not substantiate this
assumption, as the counselors did not rate their clients'
behavior as being consistently different in the two condi
tions .
There has been extensive theorizing that the presence
of opposite-sexed therapists contributes to the better
understanding of sexual roles and better formation of sexual
identity on the part of the client (Kell and Burow, 1970;
Mintz, 1963b]. For this understanding and identification
to take place, it would seem necessary for there to be some
discussion of same-sex and opposite-sex relations, albeit

101
some of the growth would occur on a nonverbal level. In the
current investigation, the therapists did not rate their
clients as having talked more about relations to persons of
both sexes in multiple than individual therapy (Hypothesis 1).
The therapists also did not feel that their clients
conversed about a greater variety of topics in one treatment
than* the other (Hypothesis 2) although it has been postu
lated that the presence of a "chaperone" would increase the
breadth of discussion (Greenback, 1964). Furthermore, the
counselors did not believe that their clients expressed or
explored feelings (Hypothesis 3) or had their feelings
stirred up (Hypothesis 4) more when being seen multiply
rather than individually. Apparently, then, the supposed
greater stability that multiple therapy affords (Buck and
Grygier, 1952; Sonne and Lincoln, 1966) did not enable the
present sample of clients to explore and express feelings
more deeply. The therapists did state that, in both con
ditions, the clients wanted to v?ork on their feelings more
during the first than the last session. This finding makes
sense in that clients usually enter therapy at somewhat of
a crisis point; while termination is a time of reiterating
the progress that has been made, and is thus less emotionally
laden.
Dreikurs (1950) stated that, at least when the
therapists agree, the client will be more likely to accept
impressions of the therapists in co-therapy than regular

102
therapy. It was felt that this situation would speed the
overcoming of resistance and the therapeutic progress. The
clients in the current study were rated by the therapists
as making no more progress in one condition than the other
(Hypothesis 6). Also, the therapists felt that the clients
were significantly more likely to accept or agree with their
comments or suggestions in individual than in multiple
therapy. (This finding resulted from the testing of Hy
pothesis 5, which predicted the inverse direction.) Pos
sibly, the co-therapists in the present study did not unite
with or support each others comments, which would lower
their client's tendency to agree with each of them. It is
also plausible that, even with high co-therapist agreement,
multiple therapy provides a milieu wherein client disagree
ment is more acceptable or encouraged. Kell and Burow
(1970) cite one of the major advantages of multiple therapy as
being the opportunity for the client to learn that disagree
ment can be healthy and enhancing, rather than destructive.
Although it may sometimes add to the therapists comfort to
have his client agree with him, disagreement may be indica
tive of more positive therapeutic movement. Even though
the hypothesis was disproved that multiple therapy offers
the therapist the advantage of higher client cooperation,
then, this finding may not be a strike against co-therapy.
The therapists' behavior.--Whitaker, Malone, and
Warkentin (1956) espoused the tenet that multiple therapy

103
offers the therapist greater freedom to be personally and
emotionally involved than does individual therapy. The
counselors here under study did not take advantage of this
freedomif they felt it existedto be more revealing of
their spontaneous impressions (Hypothesis 7), be more warm
and friendly to their clients (Hypothesis 11), nor to
express more feeling (Hypothesis 12) in multiple than
individual counseling. Neither did the present sample
support the contention that therapists would be more likely
to be confrontive in multiple than in individual therapy
(Warkentin, Johnson, and Whitaker, 1951), as they said that
they were no more critical or disapproving in one condition
than the other (Hypothesis 10).
Lundin and Aronov (1952) listed one benefit for the
therapist to be derived from co-therapy as the amelioration
of his blind spots. Dreikurs, Schulman, and Mosak (1952a)
similarly felt that the therapist's accuracy of diagnosis
and interpretation would be increased when he had the oppor
tunity of constant consultation with a colleague. This
should lead to a better understanding of the patient on the
part of the therapist; however, the counselors who partici
pated in the current research did not rate their under
standing of their clients as being superior in one treatment
modality than the other (Hypothesis 8). Finally, the
therapists did not feel that they were more helpful to
their clients in one condition than the other (Hypothesis 9).

104
Similar to the therapists! ratings of their clients' be
havior, the therapists did not rate their own behavior in
co-therapy as being significantly better than their actions
in regular therapy.
Therapist Attitudes About the Two Conditions
The consensus of the currently studied counselors was
that multiple therapy was generally better than individual
therapy (Hypothesis 19), when they were asked to rate the
two therapeutic forms in the abstract. Many of the findings
of Rabin (1967) were supported by the response patterns of
the present therapists to the CTS (a modified version of
Rabin's scale).
The therapists agreed with Mintz (1963a) that co
therapy was conducive to their self-understanding (Hypothe
sis 14), and with Kell and Burov/ (1970) that it offers more
personal gratification or "fun" for the therapist (Hypothe
sis 16). The attitudes of the counselors were similar to
those of the earliest proponents of co-therapy (Reeve, 1939;
Hadden, 1947) in that they felt the technique was useful
in training therapists (Hypothesis 15). And the praise of
multiple therapy as being better than individual therapy
for the resolution of impasses (Hayward, Peters, and Taylor,
1952) was given by the present counselors (Hypothesis 18).
The investigation of the therapists' attitudes also found
that multiple therapy was slightly more their general
preference over individual therapy (Hypothesis 17).

105
It is the opinion of the present researcher that the
claims in the literature regarding the greater value of
multiple therapy than individual therapy are based on the
therapists' general attitudes about their work in the two
conditions. As noted above, the current sample of thera
pists also believed multiple therapy to be more advantageous
than individual therapy. When various hypothesized advan
tages were subjected to a somewhat more empirical probing
how the therapists rated their clients' and their own
behavior on specific topics after completing both multiple
and individual sessionsthe much-discussed differences
were not apparent.
Judges' Ratings of Therapist Behavior
This research project investigated differences between
multiple and individual therapy in an area that heretofore
has not received attention. This area concerns the evalua
tion of the therapeutic process by judges; specifically
in this instance, the therapists' level of functioning on
the facilitative core dimensions of empathy, respect,
facilitative genuineness, and concreteness. It was gen
erally thought that, due to the sharing of responsibility
in co-therapy (Gans, 1957; Miller and Bloomberg, 1968) and
the supposed increased capacity of the therapist (Warkentin,
Johnson, and Whitaker, 1951), the therapists should offer
higher levels of these core dimensions in multiple than in
individual therapy.

106
It was felt that the therapists would be higher on
empathy (Hypothesis 20), for example, as the presence of two
counselors would increase the likelihood that the client
would be really understood--that one of the counselors would
have had similar experiences or feelings. As to respect
(Hypothesis 21), it was felt that the use of two therapists
would assure that at least one of the therapists would be
caring about the client at any one point in therapy. When
seeing clients alone, it may often be difficult for a
therapist to maintain a high level of caring or respect
from the start of the hour to its finish--if for no other
reason than occasional fatigue or lapse in attention span.
Due to the greater freedom supposedly afforded the counselor
by having a therapeutic partner, it was hypothesized that
higher levels of genuineness would be offered in co-therapy
than regular therapy (Hypothesis 22). And finally, as the
literature has claimed that the therapeutic interactions of
multiple therapy are more frequently emotion-packed than
those of individual therapy, it was predicted that the
therapists would guide the clients to a deeper discussion of
personally relevant material; that is, that higher levels
of concreteness -would be proffered (Hypothesis 23) .
The results of the analyses of the therapists' scores
on the scales of Empathy, Respect, Genuineness, and Con
creteness (Carkhuff, 1969) did not substantiate the
prediction that the therapists would offer higher

107
facilitative core conditions in multiple than in individual
therapy. The pattern on all of the scales was the same: the
counselors had comparable levels of the core dimensions in
both conditions at the outset of therapy. By termination,
however, they had significantly increased their level of
functioning in the individual condition, while remaining the
*
same in the multiple. Their interactions with their clients
that they were seeing alone became more empathetic, respect
ful, genuine, and concrete; while those with their multiple
clients did not. The conclusion to be drawn from the judges'
ratings of the present sample of therapists, then, is that
they were likely to become more facilitative over time when
doing therapy individually, but not when working as part of
a co-therapy team.
Considering the results of Swander's (1971) analogue
study and the overall level of functioning of the present
therapists, the current data are not surprising. Although
Swander's undergraduate student helpers were all in the
nonfacilitative range, the findings of their one-half-hour
sessions of individual and multiple "counseling" are inter
esting. Both partners of a higher nonfacilitative helper
coupled with a lower nonfacilitative helper and both of a
lower nonfacilitative.helper coupled with another lower
nonfacilitative helper decreased their levels of core
conditions when working together. Swander also found that
two helpers of higher nonfacilitative levels did not

108
significantly change their level of functioning when
working together.
As shown in Table 36 (Appendix H), the present sample
of therapist pairs were all of the high-low or low-low
variety, when an average of above 3.0 was considered to be
high and an average of below 3.0 was thought to be low. As
stated previously, the therapists were not significantly
lower in the multiple condition than the individual con
dition during the first session; thus they did not reflect
the general trend found in Swander's study. After working
together for some time, however, the counselors did exhibit
this pattern of offering lower levels in co-therapy than
regular therapy. Possibly, experienced counselors are not
as easily influenced by the functioning level of a co
therapist as are undergraduate students, and it takes some
time for this influence to alter their behavior.
Comments on the Comparison of the Conditions
The judges corroborated the evidence from the thera
pists' report of their own behaviorthat the actual inter
actions of the therapists were not significantly superior
in multiple than in individual therapy. In fact, at the
end of therapy, the raters judged the counselors to be
functioning worse in co-therapy than in regular therapy.
If the therapists were not interacting more thera
peutically in multiple than individual counseling, it would
follow that they would not experience significant differences

109
in their clients' behavior. The therapists did not, in
fact, feel that the multiple condition produced more bene
ficial client actions. The only significant difference in
their ratings was that clients were more likely to agree
with their comments in the individual condition.
Another finding of the study was that, as far as the
agreement of the therapists and their clients as to the
events of the session, the multiple condition was also not
superior to the individual (Hypothesis 13). Although the
differences were not significant, it is interesting to note
that in the pretesting there were more therapists who had
higher therapist-client agreement in the multiple than
the individual condition; while for the posttest, the re
verse was true. In the multiple condition, the level of
agreement between each therapist and the client with whom
he was paired was significantly lower for the terminal than
the initial session. In the individual condition, mean
while, there was not a significant decrease in therapist-
client agreement.
From the first to the last session, then, the level of
facilitative conditions offered by the therapists got
significantly better in the individual condition, while the
level of therapist-client agreement remained static. In
the multiple condition, contrarily, the level of core
dimensions remained the same from the initial to the
terminal interview, but the agreement between the therapists

110
and their clients deteriorated. It is difficult to ascer
tain exactly what these findings may mean in relation to one
another. However, these data suggest that the interactions
between the presently studied therapists and their clients
were better in the individual than the multiple condition
at therapy's end.
It is crucial to call attention to some facts about
the present research project that may qualify its applica
bility as a test of the multiple therapy so often lauded in
the literature. First of all, the experience level of the
therapists as a whole was low, ranging from six months to
five years; and none of them had had extensive experience
with multiple therapy. Also, none of the multiple thera
pists who participated in this research had done previous
therapy together with an individual client, and only one
pair had collaborated before at all--as group co-therapists
for a single group. Longstanding advocates of multiple
therapy, e.g., the Atlanta group or Elizabeth Mintz, based
their statements on many years' exposure to the technique,
often working with the same partners.
Furthermore, the results--at least on the process
scales--might have been quite different if all high-func
tioning counselors had been included, or even if there had
been some high-high pairs. The implication of Swander's
(1971) findings would be that the partners would not change
their level of functioning in the multiple condition if

Ill
they were both facilitative helpers. Also, it is noteworthy
that three of the counselors (B, D, and F) who were high-
functioningall femalesmay not have been as active during
the multiple sessions as they were during the individual
sessions. Although activity ratings as such were not in
cluded in the study, a lower activity level was alluded to
when these counselors did not talk during one or two of the
random segments of the multiple sessions. They may not have
been as influential on their low-functioning male co
therapists, then, as the men were on theirs and the overall
ratings of the counselors were subsequently lower in the
multiple than the individual condition. Possibly, then, the
co-therapists were not adequately matched on the active-
passive. continuum, as the males seemed to be somewhat more
active. Had it been the males who were high-functioning,
different data might have been obtained.
As there were no apparent consistent dissimilarities
of the facilitative levels of "counselor" and "noncounselor"
types (on the Myers-Briggs), the inclusion of all "coun
selor" types probably would not influence the results found
with these scales. However, it is possible that the ex
clusive use of "counselor" types might yield different
results on the other scales.
Likewise, the multiple therapy of the current study
was not undertaken because it was felt to be especially
appropriate for the clients, as has frequently been the

112
case in prior reports (Rabin, 1967). The clients in the
present research were assigned at random to the multiple
or the individual condition. Justly, it could be argued
that exploring the relative merits of an approach with
clients for whom that approach was not required or even
contraindicated is an unfair test of the technique.
Furthermore, it is important to note that more clients
terminated therapy before the fourth session in the indi
vidual than the multiple condition (six to one, respectively).
It is possible that the clients with whom the therapists
had especially poor rapport terminated early in the indi
vidual, but not in the multiple, condition. Kell and Burow
(1970) would not find this surprising, feeling that clients
frequently have more difficulty maintaining resistances with
the help of two caring persons than with that of one. Of
the clients who were included in the study, then, the
possibility exists that those in the multiple condition were
of a qualitatively higher level of difficulty for the thera
pists than those in the individual condition. This situation
might have influenced the results in favor of individual
therapy. - - *
The results delineated herein, however, should place
some doubts in the minds of those who have heralded multiple
therapy as being always a superior technique to individual
therapy. It might be wise for therapists to heed the
caution of Gans (1962), who felt that two inexperienced

113
counselors in psychotherapy might be worse than one. The
present data do lend some credibility to the statements of
MacLennan (1965), indicating that the problems of a co
therapy relationship may outweigh its potential benefits.
The Phenomenon of Multiple Therapy
As far as being validated, the hypotheses regarding
the multiple condition itself fared better than those con
cerned with the differences between the multiple and indi
vidual conditions. The co-therapists' relationships were
shown to become more caring over time; there was some evi
dence of therapist growth occurring while they were involved
in multiple therapy; and some aspects of the co-therapist
relationship were positively related to client outcome.
The Caring of the Therapist Pairs
Change in caring over time.Mullan and Sanguiliano
(1960) have stressed that the establishing of mutuality
a deep caring and meaningbetween pairs of co-therapists
is very important for their own, as well as their clients'
growth. Generally, the results of the CRI comparisons
showed that the relationships of the therapist pairs changed
toward greater intimacy and caring over the course of
therapy.
Interdependency was cited by Kell and Burow (1970) as
being essential to a good co-therapy relationship. The
therapists of the present study significantly increased

114
their scores on the scale of Affection (Hypothesis 24) from
the beginning of therapy to its end. As listed in Appendix
E, Shostrom feels that Affection is a helping, nurturing
form of love. As far as each partner's willingness to
nurture the other, then, there were significant gains. It
was felt that changes in each team's relationship toward
greater dependency on each other might be reflected by an
increase on the scale of Deficiency Love (Hypothesis 27).
The results, however, showed that the co-therapists did not
significantly increase their scores on this scale from the
first to the terminal session. Both pre and post means of
the counselors on this scale were very low in comparison
to Shostrom's sample of couples who were or had been married.
Possibly, due to the fact that this scale measures the very
manipulative aspects of caring as well as the partners' need
for each other, it did not tap the type of dependency that
would be found between co-therapists.
Many authors (Dyrud and Rioch, 1953; Lundin and Aronov,
1952; and Whitaker, Malone, and Warkentin, 1956) have under
lined that the co-therapists should respect each other as
being competent and equal, and should not be competitive.
The finding that the co-therapists increased their scores
on the scale of Friendship (Hypothesis 25) over time indi
cates that they grew to respect each other's equality more.
The significant increases on the scales of Empathy (M)
(Hypothesis 26) and Being Love (Hypothesis 28) suggest that

115
the co-therapists became more appreciative and tolerant of
their partners as unique individuals worthwhile and complete
as they were. It would also appear, then, that the co
therapists were more likely to accentuate the other's assets
and strengths (Gans, 1962) at the end than at the beginning
of therapy.
Finally, it was predicted that the therapists would
decrease their scores on the scale of Self Love (Hypothesis
29) over time, as it was believed that their involvement with
themselves in the co-therapy relationship would diminish as
the association became closer. Although the scores of the
therapists on this scale did decrease from pre- to post
testing, the difference was nonsignificant.
Practitioners of multiple therapy have stated that one
of its advantages is the improvement of staff relations in
a mental health center (Dyrud and Rioch, 1953; Malone and
Whitaker, 1965). Although only describing the relationships
of dyads, these findings regarding the increased caring of
the counselors lend some empirical support to this assump
tion .
Change toward healthier relations.Not only did the
therapists increase their caring relative to themselves, as
was explained above, but also they improved on many scales
in relation to Shostrom's norms for successfully married,
troubled, and divorced couples. It is notable that the
therapists were higher than any of the couples on the Self

116
Love scale, suggesting that they were more self-involved in
the relationships than were the couples. They did, however,
decrease their scores on this scale over time, moving more
toward the means for successfully married couples. And, as
the therapists were lower than any of the couples on the
Deficiency Love scale, it was felt that they cared for the
other person less than the couples as far as what their
partner could do for them. Over time, the therapists became
more caring than the successfully married couples on the
scale of Empathy (M) and approximated these couples on the
scales of Being Love and Friendship. This was after having
begun their association at mean levels between divorced
and troubled couples for Empathy (M), and between troubled
and successfully married couples for the other two scales.
As far as Affection, the co-therapists were initially close
to divorced couples and improved their caring to slightly
over that of troubled couples. In general, then, the thera
pists would appear to create a happier, healthier familial
milieu at the conclusion than at the inception of their
counseling together.
Caring and client outcome.There were no significant
correlations between the posttest scores of the therapists
and the POI scores of the client with whom he was paired on
the scales of Time Competence or Inner-Directed. This
finding led to the refutation of the hypothesis regarding a
positive relation between the caring of the therapists and
outcome of the clients (Hypothesis 34).

117
This finding may reflect that there is actually no
association between the level of caring of the therapists
and their clients' outcome. The nonsignificant results could
also be due to other reasons. First of all, the group of
therapists was a very homogeneous one in regard to their
level of caring. The range of the therapists' scores on
the CRI was very constricted, thus making it more difficult
to get a significant correlation. Secondly, in this in
stance the client outcome was compared to only one of this
therapist's scores--the one with whom he was paired at random
for purposes of comparisons. Had a scale been used which
assessed the total caring of each pair of therapists and the
scores from this scale been correlated with the outcome
scores of their clients, different results might have ensued.
Growth
It has been hypothesized that the experience of multiple
therapy leads to growth in therapists (Solomon, Loeffler,
and Frank, 1954; Warkentin, Johnson, and Whitaker, 1951).
It was proposed that the counselors who participated in the
present research would show positive increases in self-
actualization (as measured by selected scales of the POI)
during the time that they were involved in multiple therapy.
Ideally, a control conditiontesting the therapists over
the same time period while they were not involved in co
therapywould have been included. As it was not, the
results can only be suggestive.

118
On one of the two major scales of the POI, Time
Competence, the counselors were shown to increase their
scores significantly from before their experience in co
therapy to after their exposure (Hypothesis 30). The
difference between the pre and post scores of the coun
selors on the scale of Inner-Directed reached significance
at the .10 level, alluding to a tendency for the therapists
to become more inner-directed. As the difference was not
conclusively large, Hypothesis 31 was rejected.
The counselors were not shown to increase their capacity
for intimate contact (Hypothesis 32), as might have been
predicted by Kell and Burow (1970) Mullan and Sanguiliano
(1960) stated that multiple therapy enables counselors to
be mor spontaneous. The therapists in the present study,
however, did not significantly increase their scores on the
scale of Spontaneity (Hypothesis 33).
MTRS Reliability and Validity
The two parts of the MTRS, developed by the present
author and her co-researcher (Reiner), were both shown to
have significant test-retest reliabilities. The patterns
as far as concurrent and predictive validity for co-therapist
agreement and relationship quality were dissimilar.
Relationship quality.--The ratings of each therapist
of the quality of his co-therapy relationship during his
initial session with one client were positively related to

119
his rating of that relationship during his first session
with the second client; the same was true of the association
between the ratings of both terminal sessions. Also, the
total relationship quality ratings of one case (over both
pre- and posttestings) were significantly and positively
related to the ratings of the second case.
The relationship quality scores of the therapists were
compared to their scores on the CRI scales of Affection,
Friendship, Empathy (M), and Being Love, as a way of in
vestigating concurrent validity. There were no significant
correlations found between the ranks of the therapists'
scores on the CRI scales and the ranks of the relationship
quality scores, and,thus, no case for concurrent validity.
Also, there was no evidence that the relationship
quality scores had a potential for prediction, as the total
composite scores of the co-therapist pairs on this measure
were negatively and nonsignificantly correlated with the
S-A Scale scores of their clients (Hypothesis 35).
Co-therapist agreement.--To determine the test-retest
reliability of the co-therapist agreement scores, the same
three comparisons--pre, post, and total--were made of these
scores for the sessions with the first and the second multiply
seen client of each therapist. Again, all of these corre
lations were significant, indicating that the measure of
co-therapist agreement was a reliable one.

120
The co-therapist agreement scores of each therapist
were shown to positively correlate with his CRI scale scores
on the pretest of Affection, while the posttest did not; and
the posttest of Empathy (M), while the pretest did not. None
of the correlations between agreement level and the Friend
ship or Being Love scales were significant. So, the case
for concurrent validity of co-therapist agreement with caring
as far as affection and empathy is inconclusive. Co
therapist agreement was also not related to relationship
quality, suggesting that these two aspects of the co
therapist relationship are distinct from one another.
Co-therapist agreement was shown to be positively re
lated to client outcome (Hypothesis 36), when the coefficient
computed between the total composite agreement score of each
co-therapist pair and their client's S-A Scale score was
significant. As a further check on this finding, the ranks
of each client on the posttest POI scales of Time-Competence
and Inner-Directed were correlated with her co-therapist
pair's agreement score rank. Although the comparison with
Time-Competence was nonsignificant, each client's level of
being inner-directed was significantly related to the level
of agreement of her co-therapists. A strong case, then,
for the predictive validity of co-therapist agreement scores
was foundhigh co-therapist agreement is likely to be
aligned with good client outcomes; low co-therapist agreement,
with low outcomes.

121
These results substantiate the literature's claim that
good co-therapist rapport is crucial for clients. Possibly,
the previous results of the differences between multiple and
individual therapy were confounded by the fact that the
present sample of co-therapists included pairs of both high
and low agreement levels. The lack of consistent differences
between the conditions might be akin to the findings re
ported in Truax and Carkhuff (1967) for individual therapy in
general. On the average, clients get no better or worse
than controls; however, the clients of facilitative helpers
get better, while those of nonfacilitative counselors get
worse. On the average, then, no consistent differences
between multiple and individual therapy were found--whether
by the therapists' report of their own and their clients'
behavior or by judges' ratings of the therapists' behavior.
However, it is possible that multiple therapy relationships
with high agreement between the counselors would be shown to
foster better therapeutic interactions than individual therapy,
while those with low co-therapist agreement would produce
worse interactions than individual therapy.
An Area for Future Research
An area deserving of subsequent investigation has been
pinpointed by the immediately preceding discussion of the
effect of high and low co-therapist agreement on the thera
peutic interactions. Also considering the previous discussion
of the level of facilitative conditions, it would be

122
interesting to replicate some aspects of the present study-
using only pairs of therapists high on both co-therapist
agreement and the core facilitative dimensions. Add to
this the condition that the clients to be seen multiply are
ones for whom this approach is thought to be especially
appropriate. This situation would appear to represent
multiple therapy in a more ideal form than may have been
existent in the current project. It might still be the case
that the resulting multiple therapy would be shown to be no
better than, or inferior to, individual therapy conducted
by the same therapists on similar types of clients. If this
occurred, the bountiful and varied testimonials of the
superiority of multiple therapy as compared to individual
therapy would have to be reconsidered. If the data leaned
the other way, with co-therapy being evaluated as producing
better therapeutic interactions, then the results of the
current investigation could be viewed as representing the
effects of multiple therapy at a nonoptimal or atypical
level.

APPENDICES

APPENDIX A
THERAPISTS' RESEARCH INSTRUCTIONS SHEET
Your participation will not really involve too much
work. Since I won't always be around to monitor the re
search, however, I'm giving you this list so that you will
know what to do. All that is necessary is to complete the
following:
1) A POI before therapy starts. *
2) A Myers-Briggs before therapy starts, or if you have
already taken one, submit your type to me.
3) After your first and last individual counseling session,
a Therapy Session Report.
4) After your first and last multiple counseling sessions:
a) A Therapy Session Report
b) A Multiple Therapy Rating Scale
5) After the very first and after the very last multiple
counseling session, a Caring Relationship Inventory.
6) At the end of all counseling, a Comparative Therapy
Scale.
7) Please tape every session, using 5" reels when possible.
Please use both sides of a tape for the same client.
You need only tape the first hour of the session; if you
run over by a little bit, you can cease taping.
PLEASE REMEMBER TO MARK ALL SCALES AND TAPES WITH THE DATE
AND SESSION NUMBER, YOUR NAME, AND THE CLIENT'S NAME OR
IDENTIFICATION NUMBER.
8) Please have your client see the testing secretary after
the first session to complete a Therapy Session Report,
and after the last session to fill out the posttests.
Thank you I If you have any questions, please ask.
Shae Graham
124

APPENDIX B
THERAPY SESSION REPORT
1
Therapist Form
Directions
This booklet contains a series of questions about the
therapy session which you have just completed. These ques
tions have been designed to make the description of your
experiences in the session simple and quick. There are two
types of questions.
One type of question is followed by a series of numbers
on the righthand side of the page. After you read each of
the questions, you should circle the number "0" if your
answer is "no"; circle the number "1" if your answer is
"some"; etc.
The other questions have a series of numbered state
ments under them. You should read each of these statements
and select the one which comes closest to describing your
answer to that question. Then circle the number in front
of your answer.
Once you have become familiar with the questions
through regular use, answering them should take only a few
minutes. Please feel free to write additional comments on
a page when you want to say things not easily put into the
categories provided.
BE SURE TO ANSWER EACH QUESTION
Patient Identification
Date of Session
1
From Orlinsky and Howard
(1966b).
125

126
Items
A. HOW DO YOU FEEL ABOUT THE SESSION WHICH YOU HAVE JUST
COMPLETED? (Circle the one answer which best applies.)
THIS SESSION WAS:
i.
PERFECT.
ii.
EXCELLENT.
iii.
VERY GOOD.
iv.
PRETTY GOOD
V.
FAIR.
vi.
PRETTY POOR
vii.
VERY POOR.
WHAT SUBJECTS DID YOUR PATIENT TALK ABOUT DURING THE
SESSION? (For each subject, circle the answer which best
applies.)
DURING THE SESSION MY PATIENT TALKED ABOUT: NO SOME A LOT
1.RELATIONS WITH OTHERS OF THE SAME SEX. 0 12
2.RELATIONS WITH THE OPPOSITE SEX.
0 12
3. FEELINGS ABOUT SPOUSE OR ABOUT BEING 012
MARRIED.
4. STRANGE OR UNUSUAL IDEAS AND EXPERI- 012
ENCES.
5.PERCEPTIONS OR FEELINGS ABOUT ME. 0 1
Be sure that you have checked every item.
2
WHAT DID YOUR PATIENT SEEM TO WANT THIS
SESSION? (For each item, circle the
answer which best applies.)
6. A CHANCE TO LET GO AND EXPRESS FEEL- 0
INGS.
7. REASSURANCE, SYMPATHY OR APPROVAL FROM 0
ME.
8. TO EVADE OR WITHDRAW FROM EFFECTIVE 0
CONTACT WITH ME.
1 2
1 2
1 2
9.
TO EXPLORE EMERGING FEELINGS AND
EXPERIENCES.
0
1
2

127
WHAT DID YOUR PATIENT SEEM TO BE CONCERNED ABOUT THIS
SESSION? (For each item, circle the answer which best
applies.)
THIS SESSION MY PATIENT WAS CONCERNED
ABOUT:
NO
SOME
A LOT
10.
BEING DEPENDENT ON OTHERS.
0
1
2
11.
BEING LONELY OR ISOLATED.
0
1
2
12 .
SEXUAL FEELINGS AND EXPERIENCES.
0
1
2
13.
EXPRESSING HER (HIS) SELF TO
OTHERS.
0
1
2
SLIGHTLY
OR NOT
DURING THIS SESSION, HOW AT ALL
MUCH:
SOME
PRETTY
MUCH
VERY
MUCH
14.
DID YOUR PATIENT TALK?
0
1
2
3
15.
WAS YOUR PATIENT ABLE TO
FOCUS ON WHAT WAS OF PRES
ENT CONCERN TO HIM (HER)?
0
1
2
3
16.
DID YOUR PATIENT TAKE INI
TIATIVE IN BRINGING UP THE
SUBJECTS THAT WERE TALKED
ABOUT?
0
1
2
3
17.
WERE YOUR PATIENTS FEELINGS
STIRRED UP?
0
1
2
3
18.
DID YOUR PATIENT TALK ABOUT
WHAT SHE (HE) WAS FEELING?
0
1
2
3
DURING THIS SESSION HOW MUCH:
19 .
WAS YOUR PATIENT WARM AND
FRIENDLY TOWARDS YOU?
0
1
2
3
20.
WAS YOUR PATIENT ATTENTIVE
TO WHAT YOU WERE TRYING TO
GET ACROSS?
0
1
2
3

128
SLIGHTLY
OR NOT
AT ALL
SOME
PRETTY
MUCH
VERY
MUCH
21.
DID YOUR PATIENT TEND TO
AGREE WITH OR ACCEPT YOUR
COMMENTS OR SUGGESTIONS?
0
1
2
3
22 .
WAS YOUR PATIENT NEGATIVE
OR CRITICAL TOWARDS YOU?
0
1
2
3
23.
WAS YOUR PATIENT SATISFIED
OR PLEASED WITH HIS (HER)
OWN BEHAVIOR?
0
1
2
3
24.HOW MOTIVATED FOR COMING TO THERAPY WAS YOUR PATIENT
THIS SESSION?
1. Very strongly motivated.
2. Strongly motivated.
3. Moderately motivated.
4. Just kept his (her) appointment.
5. Had to make himself (herself) keep the appointment.
25.HOW MUCH PROGRESS DID YOUR PATIENT SEEM TO MAKE THIS
SESSION?
1. A great deal of progress.
2. Considerable progress.
3. Moderate progress.
4. Some progress
5. Didn't get anywhere this session.
26.HOW WELL DOES YOUR PATIENT SEEM TO BE GETTING ALONG
AT THIS TIME?
1. Very well; seems in really good condition.
2. Quite well, no important complaints.
3. Fairly well; has ups and downs.
4. So-so; manages to keep going with some effort.
5. Fairly poorly; having a rough time.
27.HOW MUCH WERE YOU LOOKING FORWARD TO SEEING YOUR
PATIENT THIS SESSION?
1. I definitely anticipated a meaningful or pleasant
session.
2. I had some pleasant anticipation.

129
3. I had no particular anticipations but found
myself pleased to see my patient when the time
came.
4. I felt neutral about seeing my patient this
session.
5. I anticipated a trying or somewhat unpleasant
session.
28.TO WHAT EXTENT DID YOUR OWN STATE OF MIND OR PERSONAL
REACTIONS TEND TO INTERFERE WITH YOUR THERAPEUTIC
EFFORTS DURING THIS SESSION?
1. Considerably.
2. Moderately.
3. Somewhat.
4. Slightly.
5. Not at all.
29.TO WHAT EXTENT DID YOU REVEAL YOUR SPONTANEOUS IMPRES
SIONS OR REACTIONS TO YOUR PATIENT THIS SESSION?
1. Considerably.
2. Moderately.
3. Somewhat.
4. Slightly.
5. Not at all.
30.TO WHAT EXTENT WERE YOU IN RAPPORT WITH YOUR PATIENT'S
FEELINGS?
1. Completely.
2. Almost completely.
3. A great deal.
4. A fair amount.
5. Some.
6. Little.
31.HOW MUCH DO YOU FEEL YOU UNDERSTOOD OF WHAT YOUR
PATIENT SAID AND DID?
1. Everything.
2. Almost all.
3. A great deal.
4. A fair amount.
5. Some.
6. Little.

130
32. HOW HELPFUL DO YOU FEEL THAT YOU WERE TO YOUR PATIENT
THIS SESSION?
1. Completely helpful.
2. Very helpful.
3. Pretty helpful.
4. Somewhat helpful.
5 Slightly helpful.
SLIGHTLY
OR NOT PRETTY VERY
AT ALL
SOME
MUCH
MUCH
33.
DID YOU TALK?
0
1
2
3
34 .
WERE YOU ATTENTIVE TO
WHAT YOUR PATIENT WAS
TRYING TO GET ACROSS?
0
1
2
3
DURING THIS SESSION, HOW MUCH:
35.
WERE YOU CRITICAL OR
DISAPPROVING TOWARDS
YOUR PATIENT?
0
1
2
3
36 .
WERE YOU WARM AND FRIENDLY
TOWARDS YOUR PATIENT?
0
1
2
3
37.
DID YOU EXPRESS FEELING?
0
1
2
3
IF YOU WISH, GIVE A BRIEF FORMULA!ION OF THE SIGNIFICANT
EVENTS OR DYNAMICS OF THIS SESSION:
ADDITIONAL COMMENTS:

131
Client Form
Directions
This booklet contains a series of questions about the
therapy session which you have just completed. These ques
tions have been designed to make the description of your
experiences in the session simple and quick. There are two
types of questions.
One type of question is followed by a series of numbers
on the righthand side of the page. After you read each of
the questions, you should circle the number "0" if your
answer is "no"; circle the number "1" is your answer is
"some"; etc.
The other questions have a series of numbered state
ments under them. You should read each of these statements
and select the one which comes closest to describing your
answer, to that question. Then circle the number in front
of your answer.
Once you have become familiar with the questions
through regular use, answering them should only take a few
minutes. Please feel free to write additional comments on
a page when you want to say things not easily put into the
categories provided.
BE SUPE TO ANSWER EACH QUESTION
Identification
Date of Session

132
Items
A. HOW DO YOU FEEL ABOUT THE SESSION WHICH YOU HAVE JUST
COMPLETED? (Circle the one answer which best applies.)
(A)
THIS SESSION WAS:
i.
Perfect.
ii.
Excellent.
iii.
Very good.
iv.
Pretty good.
V.
Fair.
vi.
Pretty poor.
vii.
Very poor.
WHAT SUBJECTS DID YOU TALK ABOUT DURING THIS SESSION?
(For each subject, circle the answer which best applies.)
DURING THIS SESSION I TALKED ABOUT:
1. RELATIONS WITH OTHERS OF THE SAME SEX.
(1)
2. RELATIONS WITH THE OPPOSITE SEX. (2)
3. STRANGE OR UNUSUAL IDEAS AND EXPERI
ENCES. (4)
4. ATTITUDES OR FEELINGS TOWARD MY
THERAPIST.
NO SOME A LOT
0 12
0 12
0 12
0 12
Be sure that you have checked every item.
WHAT DID YOU WANT OR HOPE TO GET OUT OF THIS
SESSION? (For each item, circle the answer
which best applies.)
THIS SESSION I HOPED OR WANTED TO:
5. GET SOME REASSURANCE ABOUT HOW I'M 0
DOING.
6. GET CONFIDENCE TO TRY NEW THINGS, 0
TO BE A DIFFERENT KIND OF PERSON.
7. FIND OUT WHAT MY FEELINGS REALLY
ARE, AND WHAT I REALLY WANT. (9)
1 2
1 2
0
1
2

133
WHAT PROBLEMS OR FEELINGS WERE YOU CONCERNED ABOUT THIS
SESSION? (For each item, circle the answer which best
applies.)
DURING THIS SESSION I WAS CONCERNED ABOUT: NO SOME
8. BEING DEPENDENT UPON OTHERS. (10) 0 1
9. BEING LONELY OR ISOLATED. (11) 0 1
10. SEXUAL FEELINGS AND EXPERIENCES. (12) 0 1
11. EXPRESSING OR EXPOSING MYSELF TO 01
OTHERS. (13)
A LOT
2
2
2
2
DURING THIS SESSION, HOW MUCH:
12. DID YOU TALK? (14) 0
13. WERE YOU ABLE TO FOCUS ON WHAT 0
WAS OF REAL CONCERN TO YOU? (15)
14. DID YOU TAKE INITIATIVE IN BRING- 0
ING UP THE SUBJECTS THAT WERE TALKED
ABOUT? (16)
15. WERE YOUR EMOTIONS OR FEELINGS 0
STIRRED UP? (17)
16. DID YOU TALK ABOUT WHAT YOU WERE 0
FEELING? (18)
1 2
1 2
1 2
1 2
1 2
DURING THIS SESSION, HOW MUCH:
17. FRIENDLINESS OR RESPECT DID YOU
SHOW TOWARDS YOUR THERAPIST?
18. WERE YOU ATTENTIVE TO WHAT YOUR
THERAPIST WAS TRYING TO GET
ACROSS TO YOU?
19. WERE YOU NEGATIVE OR CRITICAL
-TOWARDS YOUR THERAPIST?
20. WERE YOU SATISFIED OR PLEASED
WITH YOUR OWN BEHAVIOR? (23)
0 12
0 12
0 12
0 12

134
21.HOW DID YOU FEEL ABOUT COMING TO THERAPY THIS SESSION?
(24)
1. Eager; could hardly wait to get here.
2. Very much looking forward to coming.
3. Somewhat looking forward to coming.
4. Neutral about coming.
5. Somewhat reluctant to come.
6. Unwilling; felt I didnt want to come at all.
22.HOW MUCH PROGRESS DO YOU FEEL YOU MADE IN DEALING
WITH YOUR PROBLEMS THIS SESSION? (25)
1. A great deal of progress.
2. Considerable progress.
3. Moderate progress.
4. Some progress.
5. Didn't get anywhere this session.
6. In some ways my problems seem to have gotten
worse this session.
23.HOW WELL DO YOU FEEL THAT YOU ARE GETTING ALONG,
EMOTIONALLY AND PSYCHOLOGICALLY, AT THIS TIME? (26)
I AM GETTING ALONG:
1. Very well; much the way I would like to.
2. Quite well; no important complaints.
3. Fairly well; have my ups and downs.
4. So-so; manage to keep going with some effort.
5. Fairly poorly; life gets pretty rough for me at
times.
6. Quite poorly; can barely manage to deal with
things.
24.TO WHAT EXTENT ARE YOU LOOKING FORWARD TO YOUR NEXT
SESSION?
1. Intensely; wish it were much sooner.
2. Very much; wish it were sooner.
3. Pretty much; will be pleased when the time comes.
4. Moderately; it is scheduled and I guess I'll be
there.
5. Very little; I'm not sure I will want to come.
WHAT DO YOU FEEL THAT YOU GOT OUT OF THIS SESSION? (For
each item, circle the answer which best applies.)

135
I FEEL THAT I GOT:
25. A CHANCE TO LET GO AND GET
THINGS OFF MY CHEST.
26. HOPE: A FEELING THAT THINGS
CAN WORK OUT FOR ME.
27. HELP IN TALKING ABOUT WHAT
WAS REALLY TROUBLING ME.
28. RELIEF FROM TENSIONS OR
UNPLEASANT FEELINGS.
29. MORE UNDERSTANDING OF THE
REASONS BEHIND MY BEHAVIOR AND
FEELINGS.
30. REASSURANCE AND ENCOURAGEMENT
ABOUT HOW I'M DOING.
31. CONFIDENCE TO TRY TO DO THINGS
DIFFERENTLY.
32. MORE ABILITY TO FEEL MY FEELINGS,
TO KNOW WHAT I REALLY WANT.
33. IDEAS FOR BETTER WAYS OF DEALING
WITH PEOPLE AND PROBLEMS.
34. MORE OF A PERSON-TO-PERSON
RELATIONSHIP WITH MY THERAPIST.
35. BETTER SELF-CONTROL OVER MY
MOODS AND ACTIONS.
NO SOME A LOT
0 12
0 12
0
0
1
1
2
2
WHAT DO YOU FEEL THAT YOU GOT OUT OF
THIS SESSION? (for each item, circle the
answer which best applies.)
36.A MORE REALISTIC EVALUATION OF MY 0 1 2
THOUGHTS AND FEELINGS.
37.NOTHING IN PARTICULAR; I FEEL THE
SAME AS I DID BEFORE THE SESSION.
0 12
38.HOW WELL DID YOUR THERAPIST(S) SEEM TO UNDERSTAND WHAT
YOU WERE FEELING AND THINKING THIS SESSION?
MY THERAPIST(S):
1. Understood exactly how I thought and felt.
2. Understood very well how I thought and felt.

136
3. Understood pretty well, but there were some things
he (she) didn't seem to grasp.
4. Didn't understand too well how I thought and felt.
5. Misunderstood how I thought and felt.
39.HOW HELPFUL DO YOU FEEL YOUR THERAPIST(S) WAS (WERE)
TO YOU THIS SESSION? (32)
1. Completely helpful.
2. Very helpful.
3. Pretty helpful.
4. Somewhat helpful.
5. Slightly helpful.
6. Not at all helpful.
SLIGHTLY
OR NOT PRETTY VERY
AT ALL SOME MUCH MUCH
40. DID YOUR THERAPIST(S) TALK? 0
(33)
41. WAS (WERE) YOUR THERAPIST(S)
ATTENTIVE TO WHAT YOU WERE
TRYING TO GET ACROSS? (34) 0
42. WAS (WERE) YOUR THERAPIST(S)
NEGATIVE OR CRITICAL TOWARDS
YOU? (35) 0
12 3
12 3
12 3
43.WAS (WERE) YOUR THERAPIST(S)
FRIENDLY AND WARM TOWARDS
YOU? (36) 0 123
44.DID YOUR THERAPIST(S) SHOW
FEELING? (37) 0
12 3
ADDITIONAL COMMENTS:

APPENDIX C
COMPARATIVE THERAPY SCALE
1
Name Date
We would like to find out how you feel about multiple
versus individual therapy. After reading an item, please
rate the relative merits of multiple as opposed to indi
vidual therapy by checking one of the seven columns.
Multiple Individual
therapy therapy
.c
CD
>1 0
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1. Understanding, by
the therapist of
the transference.
2. Completeness of
transference
patterns.
3. Transference of the
original family
situation.
4. Opportunity to work
out anxieties with
a therapist of the
more dreaded sex.
5. Difficulties by the
therapist in
"handling" intense
transference
reactions.
6. Self-understanding
of the therapist
enhanced.
1From Rabin (1967).
137

138
Multiple
therapy
Individual
therapy
&
(1)
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19 Working out and
through problems
of hostility and
assertiveness.
20. Opportunity for
patients of both
sexes to identify
with a reasonably
healthy person of
the same sex.
21. Understanding of
resistance.
22. More complex
patterns of resis
tance .
23. Eliciting of oedipal
dynamics.
24. Your general prefer
ence .
25. Your general prefer
ence with a patient
who is very mistrust
ful of authority,
especially of one
sex.
26. Your general prefer
ence with a patient
who is especially
fearful of hetero
sexual relations.

139
Multiple Individual
therapy therapy
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7. Emotional demands
experienced by the
therapist.
8. Understanding of
countertrans ference.
9. Years of experience
necessary to do
effective therapy.
10. Useful in training
therapists.
11. Personal gratifica
tion (enjoyment or
"fun") for the
therapist.
12. Useful with very
"actingout" patients.
13. Useful with border
line schizophrenics.
14. Useful with marital
couples.
15. Useful with "oral
characters."
16. Positive therapeutic
movement, in general.
17. Working through, in
general.
18. Working out and
through problems of
masculinity and
feminity.

140
Multiple
therapy-
individual
therapy
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27. Your general prefer
ence with a patient
who is especially
fearful of homo
sexual relations.
28. Your general prefer
ence with a patient
who ferociously
clings to persons of
one sex.
29. Your general prefer
ence when only
short-term therapy,
i.e., 6 months or
less, is available.
30. Your general prefer
ence for working out
and through a
patient's very in
tense "negative"
transference.
31. Your general prefer
ence for working out
and through a
patient's very
sticky "positive"
trans ference.
32. Resolution of
impasses.

APPENDIX D
CARKHUFF SCALES1
Empathic Understanding in Interpersonal Processes:
A Scale for Measurement
Level 1
The verbal and behavioral expressions of the first
person either do not attend to or detract significantly
from the verbal and behavioral expressions of the second
person(s) in that they communicate significantly less of
the second person's feelings than the second person has
communicated himself.
Examples: The first person communicates no awareness of
even the most obvious, expressed surface feel
ings of the second person. The first person
may be bored or uninterested or simply operat
ing from a preconceived frame of reference which
totally excludes that of the other person(s).
In summary, the first person does everything but
express that he is listening, understanding, or being
sensitive to even the feelings of the other person in such
a way as to detract significantly from the communications
of the second person.
Level 2
While the first person responds to the expressed feel
ings of the second person(s), he does so in such a way that
he subtracts noticeable affect from the communications of
the second person.
Examples: The first person may communicate some awareness
of obvious surface feelings of the second person,
but his communications drain off a level of the
affect and distort the level of meaning. The
first person may communicate his own ideas of
'''From Carkhuff (1969 ).
141

142
what may be going on, but these are not congruent
with the expressions of the second person.
In summary, the first person tends to respond to other
than what the second person is expressing or indicating.
Level 3
The expressions of the first person in response to the
expressed feelings of the second person(s) are essentially
interchangeable with those of the second person in that
they express essentially the same affect and meaning.
Example: The first person responds with accurate under
standing of the surface feelings of the second
person but may not respond to or may misinterpret
the deeper feelings.
In summary, the first person is responding so as
neither to subtract from nor add to the expressions of the
second person; but he does not respond accurately to how
that person really feels beneath the surface feelings.
Level 3 constitutes the minimal level of facilitative inter
personal functioning.
Level 4
The responses of the first person add noticeably to
the expressions of the second person(s) in such a way as
to express feelings a level deeper than the second person
was able to express himself.
Example: The facilitator communicates his understanding
of the expressions of the second person at a
level deeper than they were expressed, and thus
enables the second person to experience and/or
express feelings he was unable to express pre
viously.
In summary, the facilitator's responses add deeper feel
ing and meaning to the expressions of the second person.
Level 5
The first person's responses add significantly to the
feeling and meaning of the expressions of the second person(s)
in such a way as to (1) accurately express feelings levels
below what the person himself was able to express or (2) in
the event of ongoing deep self-exploration on the second
person's part, to be fully with him in his deepest moments.

143
Examples: The facilitator responds with accuracy to all
of the person's deeper as well as surface feel
ings. He is "together" with the second person
or "tuned in" on his wave length. The facili
tator and the other person might proceed
together to explore previously unexplored areas
of human existence.
In summary, the facilitator is responding with a full
awareness of who the other person is and a comprehensive
and accurate empathic understanding of his deepest feelings.
The Communication of Respect in Interpersonal Processes:
A Scale for Measurement
Level 1
The verbal and behavioral expressions of the first
person communicate a clear lack of respect (or negative
regard) for the second person(s).
Example: The first person communicates to the second per
son that the second person's feelings and experi
ences are not worthy of consideration or that the
second person is not capable of acting construc
tively. The first person may become the sole
focus of evaluation.
In summary, in many ways the first person communicates
a total lack of respect for the feelings, experiences, and
potentials of the second person.
Level 2
The first person responds to the second person in such
a way as to communicate little respect for the feelings,
experiences, and potentials of the second person.
Example: The first person may respond mechanically or
passively or ignore many of the feelings of the
second person.
In summary, in many ways the first person displays a
lack of respect or concern for the second person's feelings,
experiences, and potentials.
Level 3
The first person communicates a positive respect and con
cern for the second person's feelings, experiences, and
potentials.

144
Example: The first .person communicates respect and concern
for the second person's ability to express him
self and to deal constructively with his life
situation.
In summary, in many ways the first person communicates
that who the second person is and what he does matter to the
first person. Level 3 constitutes the minimal level of
facilitative interpersonal functioning.
Level 4
The facilitator clearly communicates a very deep
respect and concern for the second person.
Example: The facilitator's responses enable the second
person to feel free to be himself and to experi
ence being valued as an individual.
In summary, the facilitator communicates a very deep
caring for the feelings, experiences, and potentials of the
second person.
Level 5
The facilitator communicates the very deepest respect
for the second person's worth as a person and his poten
tials as a free individual.
Examples: The facilitator cares very deeply for the human
potentials of the second person.
In summary, the facilitator is committed to the value
of the other person as a human being.
Facilitative Genuineness in Interpersonal Processes:
A Scale for Measurement
Level 1
The first person's verbalizations are clearly unrelated
to what he is feeling at the moment, or his only genuine
responses are negative in regard to the second person(s)
and appear to have a totally destructive effect upon the
second person.
Example: The first person may be defensive in his inter
action with the second person(s) and this

145
defensiveness may be demonstrated in the content
of his words or his voice quality. Where he is
defensive he does not employ his reaction as a
basis for potentially valuable inquiry into the
relationship.
In summary, there is evidence of a considerable dis
crepancy between the inner experiencing of the first
person and his current verbalizations. Where there is
no discrepancy, the first persons reactions are employed
solely in a destructive fashion.
Level 2
The first person's verbalizations are slightly un
related to what he is feeling at the moment, or when his
responses are genuine they are negative in regard to the
second person; the first person does not appear to know
how to employ his negative reactions constructively as a
basis for inquiry7 into the relationship.
Example: The first person may respond to the second person(s)
in a "professional" manner that has a rehearsed
quality or a quality concerning the way a helper
"should" respond in that situation.
In summary, the first person is usually responding
according to his prescribed role rather than expressing
what he personally feels or means. When he is genuine his
responses are negative and he is unable to employ them as a
basis for further inquiry.
Leve1 3
The first person provides no "negative" cues between
what he says and what he feels, but he provides no positive
cues to indicate a really genuine response to the second
person(s).
Example: The first person may listen and follow the second
person(s) but commits nothing more of himself.
In summary, the first person appears to make appro
priate responses that do not seem insincere but that do not
reflect any real involvement either. Level 3 constitutes
the minimal level of facilitative interpersonal functioning.
Level 4
The facilitator presents some positive cues indicating

146
a genuine response (whether positive or negative) in a non
destructive manner to the second person(s).
Example: The facilitator's expressions are congruent with
his feelings although he may be somewhat hesitant
about expressing them fully.
In summary, the facilitator responds with many of his
own feelings, and there is no doubt as to whether he really
means what he says. He is able to employ his responses,
whatever their emotional content, as a basis for further
inquiry into the relationship.
Level 5
The facilitator is freely and deeply himself in a non-
exploitative relationship with the second person(s).
Example: The facilitator is completely spontaneous in his
interaction and open to experiences of all types,
both pleasant and hurtful. In the event of
hurtful responses the facilitator's comments are
employed constructively to open a further area of
inquiry for both the facilitator and the second
person.
In summary, the facilitator is clearly being himself
and yet employing his own genuine responses constructively.
Personally Relevant Concreteness or Specificity of
Expression in Interpersonal Processes:
A Scale for Measurement
Level 1
The first person leads or allows all discussion with
the second person(s) to deal only with vague and anonymous
generalities.
Example: The first person and the second person discuss
everything on strictly an abstract and highly
intellectual level.
In summary, the first person makes no attempt to lead
the discussion into the realm of personally relevant
specific situations and feelings.

147
Leve1 2
The first person frequently leads or allows even
discussions of material personally relevant to the second
person(s) to be dealt with on a vague and abstract level.
Example: The first person and the second person may dis
cuss the "real" feelings but they do so at an
abstract intellectualized level.
In summary, the first person does not elicit discus
sion of most personally relevant feelings and experiences
in specific and concrete terms.
Level 3
The first person at times enables the second person
to discuss personally relevant material in specific and
concrete terminology.
Example: The first person will make it possible for the
discussion with the second person(s) to center
directly around most things that are personally
important to the second person(s), although there
will continue to be areas not dealt with con
cretely and areas in which the second person
does not develop fully in specificity.
In summary, the first person sometimes guides the
discussions into consideration of personally relevant
specific and concrete instances, but these are not always
fully developed. Level 3 constitutes the minimal level of
facilitative functioning.
Level 4
The facilitator is frequently helpful in enabling the
second person(s) to fully develop in concrete and specific
terms almost all instances of concern.
Example: The facilitator is able on many occasions to
guide the discussion to specific feelings and
experiences of personally meaningful material.
In summary, the facilitator is very helpful in ena
bling the discussion to center around specific and concrete
instances of most important and personally relevant
feelings and experiences.

148
Level 5
The facilitator is always helpful in guiding the dis
cussion, so that the second person(s) may discuss fluently
directly, and completely specific feelings and experiences
Example: The first person involves the second person in
discussion of specific feelings, situations, and
events, regardless of their emotional content.
In summary, the facilitator facilitates a direct
expression of all personally relevant feelings and experi
ences in concrete and specific terms.

APPENDIX E
THE SCALES OF THE CARING RELATIONSHIP INVENTORY1
Identification
Description
Scales
A
Affeetionhelping, nurturing form of love.
It involves unconditional giving and accep
tance of the kind that characterizes the
love of a parent for a child.
F
Friendship--a peer love based on appreci
ation of common interests and respect for
each others equality.
E
Erosa possessive, romantic form of love
which includes features such as inquisitive
ness, jealousy, exclusiveness.
M
Empathy"agape," a charitable, altruistic
form of love which feels deeply for the
other individual as another unique human
being. It involves compassion, appreciation,
and tolerance.
S
Self Love--the ability to accept, in the
relationship rated, one's weaknesses as well
as to appreciate one's individual, unique
sense of personal worth. It includes the accep
tance of one's full range of positive and
negative feelings toward the person rated.
Sub Scales
B
Being Lovethe ability to have and accept the
other person as he or she is. Being love in
cludes aspects of loving another for the good
seen in him (her). It is an admiring,
respectful love, an end in itself.
D
Deficiency Lovethe love of another for what
he (she) can do for the person. Deficiency
love is an exploiting, manipulating love of
another as a means to an end.
1From Shostrom (1966a).
149

APPENDIX F
FOUR SCALES OF THE PERSONAL ORIENTATION INVENTORY1
Symbol
Description
Ti/Tc
TIME RATIO
Time Incompetence/
Time Competence--measures
degree to which one is
"present" oriented.
o/i
SUPPORT RATIO
Other/Inner--measures
whether reactivity
orientation is basically
toward others or self.
S
SPONTANEITY
Measures freedom to react
spontaneously or to be
oneself.
c
CAPACITY FOR INTIMATE
CONTACT
Measures ability to develop
contactful intimate relation
ships with other human
beings, unencumbered by
expectations and obligations.
1From Shostrom (1966b).
150

APPENDIX G
THE MULTIPLE THERAPY RATING SCALE
Iteras
1. Do you think the psychotherapeutic effectiveness of
the session was due mostly to the interaction of the
client with:
a. yourself?
b. the other therapist?
c. both therapists?
2. Do you think that the other therapist was
a. more involved with the patient than you were?
b. less involved?
c. about the same?
3.Were your feelings toward
during the session?
a. Yes
b. No
the other therapist divulged:
outside of the session?
c. Yes
d. No
4. How do you feel that stating or not stating these
feelings affected the therapy?
a. Helped it greatly
b. Somewhat helped it
c. Hindered it somewhat
d. Made no difference
e- Hindered it greatly
5. How did you and the other therapist work together during
the session?
a. Excellently
b. Very well
c. Fairly
d. Poorly
e. Very poorly
151

152
6.
How well did you understand what the other therapist
was doing during the session?
a. Completely
b. Very well
c. Fairly
d. Poorly
e. Very poorly
Did you feel the other therapist made any real mistakes
during the session?
a. Yes, many
b. Yes, a few
c. Yes, one
d. No, not at all
8.Were you ever hesitant to say something to the client
because of the presence of the other therapist?
a.
Yes, many
times
b.
Yes, a few
times
c.
Yes, once
d.
No, not at
all
9.If you answered "yes" to the preceeding question, was
this because you thought the other therapist would view
your statement as: (Check any that are appropriate.)
a. foolish?
b. inappropriate?
c. irrelevant?
d. reflecting your incompetency?
10.Did you ever consider the other therapist more than
the client in making a statement?
a. Yes, many times
b. Yes, a few times
c. Yes, once
d. No, not at all
11.If you answered "yes" to the above question, was this
because:
a. you were trying to please the other therapist?
b. you were trying to impress the other therapist
c. you were trying to clarify something for the other
therapist?
d. you said what you thought the other therapist
expected you to say?

153
12. During the session, did you come to the other thera
pist's aid when there was an "interactional difficulty"
between the client and the therapist?
a.
Yes, many
times
b.
Yes, a few
times
c.
Yes, once
d.
No, not at
all
13.
14.
15.
16 .
During this session, how much was your patient warm
and friendly towards the other therapist? (19)
a. Slightly
b. Some
c. Pretty much
d. Very much
How much, during the session, did your patient tend to
agree with or accept the other therapist's comments
or suggestions? (21)
a. Slightly or not at all
b. Some
c. Pretty much
d. Very much
During this session, how much was your patient negative
or critical towards the other therapist? (22)
a. Slightly or not at all
b. Some
c. Pretty much
d. Very much
As far as determining the course of the session, did
you think that the other therapist was:
a. more dominant than you?
b. less dominant than you?
c. about the same?
17. To what extent do you think that the other therapist's
state of mind or personal reactions tended to interfere
with therapeutic efforts during the session? (28)
a. Considerably
b. Moderately
c. Somewhat
d. Slightly
e. Not at all

18.
154
To what extent do you think the other therapist
revealed his (her) spontaneous impressions or reac
tions to the patient this session? (29)
a. Considerably
b. Moderately
c. Somewhat
d. Slightly
e. Not at all
19. How much do you think the other therapist was atten
tive to what the patient was trying to get across? (34)
a. Slightly or not at all
b. Some
c. Pretty much
d. Very much
20. How much do you think the other therapist was critical
or disapproving towards the patient? (35)
a. Slightly or not at all
b. Some
c. Pretty much
d. Very much
21. To what extent do you think the other therapist was
warm and friendly towards your patient? (36)
a. Slightly or not at all
b. Some
c. Pretty much
d. Very much
22.In your fantasies regarding the other therapist, which
of the following would you entertain as being pleasant?
a.
b.
c.
d.
e.
f.
g-
h.
i.
3
k.
l.
m.
n.
Play sports with them
Go out for a beer with them
Have as a next door neighbor
Be in the same social club with them
Date them, e.g., go to a movie with them
Have your child raised by them
Have lunch with them
Have your brother or sister married to them
Loan your car to them
Be engaged or married to them
Have as a friend
.Have as a brother or sister
Work very closely with them
Have over to your house for dinner

155
23. Did the client react differently to the male thera
pist than to the female therapist?
a. Yes
b. No
Judges' Directions for Rating the MTRS
A. Please rate which of the following items are, in your
opinion, relevant to the formation of a good or poor
co-therapist relationship by placing an "R" in the
margin next to the item number. Please go through all
22 items consecutively.
B. Then for each choice of the items please place:
1. a plus (+) by the responses that would lead to a
good relationship.
2. a minus (-) by the responses that would lead to a
poor relationship, and
3. a zero (0) by the responses that you consider to
make no difference to the therapeutic relationship.
TABLE 30
RESPONSE PATTERNS OF THE FOUR JUDGES FOR THE MTRS ITEMS
CONSIDERED TO BE RELEVANT TO THE
CO-THERAPIST RELATIONSHIP
Item or
choice
number
Judge
Scoring
direction
used
Item or
choice
number
Judge
Scoring
direction
used
A
B
C
D
A
B
C
D
1.
R
R
R
R
4.
R
R
R
R
a.
-
0
0
+
a.
4*
+
+
+
+
b.
-
0
0
+
b.
+
+
+
+
+
c.
+
+
+
+
c.
-
-
-
-
-
d.
-
0
0
-
zero
2.
R
e.
-
-
-
-
-
a.
-
b.
-
5.
R
R
R
R
c.
+
-
a.
+
+
+
+
+
b.
+
+
+
+
+
3.
R
R
R
R
c.
+
-
0
+
zero
a.
+
+
+
+
+
d.
-
-
-
-
-
b.
-
-
-
-
-
e.
-
-
-
-
-
c.
+
+
+
+
d.
-
-
-
-
-

156
TABLE 30-- (continued)
Item or
choice
number
Judge
Scoring
direction
used
Item or
choice
number
Judge
Scoring
direction
used
A
B
c
D
A
B
c
D
6 .
R
R
R
R
11:
R
R
R
R
a.
+
4
+
+
+
a.
-
-
0
-
-
b.
4*
+
4*
4*
+
b.
-
-
0
-
-
c.
+
4-
-
-
zero
c.
+
-
+
+
4-
d.
-
-
-
-
-
d.
-
-
-
-
-
e.
-
-
-
-
-
12.
R
R
R
R
7.
R
R
R
. R
a.
-
-
+
-
-
a.
_
-
-
-
-
b.
+
+
0
+
+
b.
0
0
0
+
0
c.
+
+
0
+
4"
c.
0
0
0
4-
0
d.
-
-
-
-
-
d.
+
+
+
+
4-
16.
R
R
R
R
8.
R
R
R
R
a.
-
0
0
-
a.
-
-
-
-
-
b.
-
0
0
-
b.
-
-
-
-
-
c.
+
0
0
+
c.
-
0
0
0
0
d.
+
+
+
4*
+
22.
R
R
R
R
a.
+
+
+
0
+
9.
R
R
R
R
b.
4-
+
+
+
+
a.
--
-
-
-
-
c.
+
+
+
+
+
b.
-
-
--
-
-
d.
+
0
+
0
c.
-
-
-
-
-
e .
+
+
+
+
+
d.
-
-
-
-
-
f.
+
+
+
+
+
g-
+
0
+
0

O
i1
R
R
R
R
h.
+
0
+
+
+
a.
-
-
-
-
-
i.
+
+
+
0
+
b.
-
-
-
+
-
j -
4"
+
+
+
+
c.
-
0
0
0
0
k.
+
+
+
+
+
d.
+
+
+
-
+
1.
+
+
+
4*
4*
m.
+
+
+
4-
+
n.
+
0
+
0
Note: When there is a blank space beside a choice
under "Scoring direction used," this choice was not scored,
as there was not agreement among at least three of the
judges as to the scoring direction. The only exception to
this were the three choices designated by the word "zero,"
which were scored as such. This was the scoring direction
originally determined by the two researchers, which was not
consistently corroborated by the judges.

APPENDIX H
NUMERICAL RAW DATA AND SUMMARIES
TABLE 31
WILCOXON MATCHED-PAIRS SIGNED-RANKS TEST BETWEEN THE NUMBER
OF SESSIONS EACH THERAPIST HAD WITH A CLIENT IN
THE MULTIPLE AND THE INDIVIDUAL CONDITION
Multiple
Individual
d
Rank
of d
Rank with
less fre
quent sign
Therapist-
client
pair
No. of
sessions
Therapist
client
pair
No. of
sessions
A-10
6
A- 7
5
-1
-1.5
B-8
6
B-12
22
16
8
8
C-16
9
C-17
5
-4
-4
D-14
5
D-29
5
0
E-25
9
E-39
10
1.5
1.5
1.5
F-20
7
F-22
15
8
7
7
G-37
4
G-23
4
0
H-2 6
4
H-21
4
0
1-33
12
1-38
5
-7
-6
J-31
15
J-30
9
-6
-5
K-35
7
K-34
7
0
L-36
6
L-4 0
4
-2
-3
T = 16.5
Note:
The value needed
for significance
at the
.05 level
is T = 11.
157

158
TABLE 32
RAW SCORES OF THE THERAPISTS FOR BOTH INDIVIDUAL (I)
AND MULTIPLE CONDITIONS (M) ON THE TSR ITEMS
INVOLVED IN HYPOTHESES 1-11
Thera
pist
A
B
C
D
E
F
G
H
I
J
K
L
1-2 1-5
I M I M
3 2 4 2
3 2 3 2
3 3 4 2
3 0 3 2
'2 2 2 3
3 2 2 2
2 3 2 2
3 2 2 2
2 0 4 2
3 3 13
2 2 2 2
13 2 2
4 4 4 2
4 3 4 5
4 5 4 4
4 0 4 4
13 4 4
3 3 2 2
4 4 4 3
3 3 2 3
2 2 2 1
3 3 3 4
4 4 3 4
3 3 3 3
Item number(s)
6 & 9
IM
10 2 0
22 2 1
2 2 2 1
2 0 2 2
2 2 2 2
2 2 2 2
12 2 1
2 1 10
2 2 12
2 1 2 2
11 0 0
2 2 2 2
17
I M
11 11
2 2 11
11 2 2
2 1 2 1
2 1 2 2
2 2 11
122 1
102 1
2 3 11
112 1
11 11
3 2 3 1
21
I M
11 12
2 2 2 2
12 11
2 3 2 2
12 12
2 1 2 1
2 2 11
2 2 11
1212
2 2 2 2
2 3 0 0
2 1 10
25
I M
2 3 2 4
3 2 2 4
2 3 3 2
3 3 3 3
2 3 2 4
2 3 2 2
4 3 3 1
3 3 2 2
2 2 3 3
3 2 2 4
3 3 0 2
2 2 3 2
Note: the first number under each condition is the pretest score;
the second, the posttest score.

159
TABLE 32(extended)
29
31
32
35
36
37
I M
I M
I M
I M
I M
I M
4 4 2 5 2 3.
4 4 4 4 5 5
5 5 4 5 4 5
3 3 5 4 5 4
3 4 3 4 4 5
4 3 4 4 4 4
4 4 3 2 4 3
4 3.2 2 4 5
5 4 2 4 2 3
1 5 4 5 4 5
3 5 3 4 3 2
2 2 4 3 5 4
2 4 2 4 2 4
4 4 5 4 3 4
5 3 3 5 4 2
55 4 3 3 3
4 5 2 5 3 5
5 4 2 3 4 3
3 3 4 4 4 2
5.5 3 3 2 3
4 5 4 2 3 5
4 5 4 5 4 4
4 4 3 5 2 2
4 4 4 2 4 3
0 0 0 0 3 3
0 0 0 0 3 3
0 0 0 2 2 2
0 0 0 0 3 3
1110 2 2
0 0 0 1 2 2
1111 12
1111 2 2
0 0 0 0 2 2
0 1 0 0 2 3
0 0 0 0 2 3
0 0 0 0 3 1
3 3 3 2 1 3
2 2 2 2 2 2
2 2 2 2 2 2
3 2 2 2 2 1
2 3 1 2 2 2
2 2 1111
2 1 12 2 1
2 2 2 1 1 1
2 2 1111
2 3 2 2 1 2
2 1 2 2 11
2 2 10 12

TABLE 33
RAW SCORES USED TO DETERMINE THERAPIST-CLIENT AGREEMENT ON THE TSR
FOR THE MULTIPLE CONDITION, PP.E- AND POSTTESTINGS
Ther;
pist
item
3
TSR
Therapist-
-client
pair
no. A-
-10
B-
8
C-
-16
D-
14
£-
-25
F-
20
A
5-4
3-2
4-3
4-3
4-5
5-3
3-4
4-4
4-4
3-2
4-2
5-5
1
2-2
1-2
1-0
1-0
2-0
0-0
1-0
0-0
1-1
1-1
0-2
0-0
2
2-2
1-2
2-1
1-0
2-1
2-2
2-1
2-2
1-1
2-2.
2-2
2-2
4
1-1
0-1
1-1
2-2
0-0
1-0
1-2
1-2
1-2
0-2
0-0
0-0
9
2-2
0-2
1-0
1-2
1-0
1-1
1-2
1-2
1-2
1-2
2-2
1-1
10
1-2
2-2
1-1
1-1
2-1
1-2
2-2
1-0
2-2
2-1
1-2
0-0
11
2-1
1-1
2-1
1-1
2-1
2-1
1-0
1-1
2-2
1-0
1-1
0-1
12
0-0
0-0
0-1
0-0
2-2
2-2
0-0
2-2
0-0
0-0
1-2
0-0
13
2-2
1-2
1-0
1-2
1-1
1-1
1-0
2-2
1-0
2-0
2-2
1-2
14
2-3
2-3
3-3
2-3
3-2
2-3
3-3
3-3
2-3
3-3
3-3
2-2
15
2-2
2-2
2-2
1-1
3-2
1-2
2-2
2-3
2-2
2-3
2-2
1-2
16
2-2
1-2
2-3
1-1
3-1
1-2
1-2
2-0
2-2
2-3
2-2
1-2
17
1-1
1-2
1-1
1-2
2-2
2-3
2-2
1-2
2-3
2-1
1-2
1-1
18
0-2
1-2
1-2
1-2
1-2
2-2
1-2
2-1
2-3
3-2
1-2
1-2
23
0-2
2-2
2-2
2-2
0-1
0-2
2-2
1-2
1-1
2-2
1-1
2-1
24
2-2
2-1
5-4
3-3
2-4
4-3
2-3
2-3
2-2
1-2
2-2
3-5
25
4-4
2-2
4-4
3-3
3-3
4-1
3-4
3-3
4-4
2-2
4-1
4-5
26
5-3
2-2
5-3
3-4
3-3
3-3
3-3
3-3
4-5
3-2
4-4
2-3
32
5-3
3-1
4-5
3-3
3-4
5-1
4-4
4-3
4-5
2-2
3-1
4-5
33
1-1
2-2
2-2
2-1
2-2
1-2
2-0
2-1
1-1
1-2
1-1
1-1
34
3-3
2-3
2-2
3-2
3-2
1-3
3-2
3-2
2-2
3-3
3-3
3-3
35
0-0
0-1
0-0
0-1
0-1
2-1
0-1
0-0
1-1
0-1
0-1
1-1
36
3-2
3-3
2-3
2-1
2-2
2-2
3-3
2-2
2-2
3-3
2-2
2-2
37
1-2
3-2
2-2
2-1
2-2
2-3
2-1
1-2
2-1
2-2
1-1
1-1
Note:
The
first score
under
each
therapist-client
pair
indicates
their respective pretest scores on the item in question; the second score
their respective posttest scores. In all cases, the score of the thera
pist is given first, followed by a hyphen and the client's score.

161
TABLE 33(extended)
G-
37
H-
26
I-
33
J-
31
K-
35
L-
-36
3-3
5-4
5-4
5-6
3-3
3-3
3-3
3-2
4-5
5-6
3-5
2-3
1-1
1-1
0-0
1-1
2-1
0-0
1-1
2-1
1-1
1-1
1-1
1-1
1-1
1-1
2-2
1-1
2-1
2-2
0-0
1-1
1-1
1-1
1-1
1-2
1-2
1-2
0-1
0-0
0-2
0-0
1-1
1-2
0-0
0-0
0-0
0-0
2-2
1-1
0-2
0-2
0-2
1-1
1-2
2-2
0-2
0-1
2-2
1-2
2-2
2-2
2-2
2-2
0-1
0-1
1-0
1-1
1-1
0-2
1-0
1-0
2-2
2-1
1-2
2-2
1-2
0-2
1-0
2-2
0-0
1-1
2-2
0-2
1-1
0-0
0-1
1-0
1-1
2-2
0-0
0-1
1-1
0-1
0-0
0-0
2-2
2-2
.1-1
1-1
o-i
1-1
2-0
2-2
0-1
1-2
2-1
1-2
2-2
2-2
3-3
3-1
3-3
2-2
3-3
2-2
2-3
1-2
2-2
2-2
2-2
1-2
2-1
2-1
2-3
3-2
2-3
3-3
1-2
1-0
2-1
2-2
2-1
2-2
3-2
2-1
3-3
3-3
3-3
3-2
1-3
0-1
2-2
2-2
2-2
1-2
2-3
1-2
1-1
1-1
2-2
1-3
1-2
1-0
3-2
1-3
2-2
1-2
1-2
1-1
0-1
2-2
1-1,
2-3
1-1
0-1
2-2
2-2
1-1
1-0
1-2
1-1
2-3
2-2
1-3
1-2
0-1
0-0
1-0
3-1
2-3
4-5
3-3
3-5
4-5
2-2
2-3
2-2
5-5
4-4
2-5
3-3
3-3
5-2
4-4
4-5
3-2
3-2
4-3
2-2
4-5
4-5
3-6
4-1
3-4
3-3
4-5
3-5
5-5
3-3
3-2
3-2
3-3
4-3
3-3
2-2
3-3
5-2
5-4
4-5
4-2
2-2
3-2
3-1
5-5
5-5
l-l'
4-2
1-2
2-2
1-1
1-2
1-2
1-1
1-2
2-2
1-1
1-1
2-2
1-2
2-3
2-3
1-3
2-2
2-3
2-3
3-3
3-3
3-2
2-2
0-0
2-3
1-0
1-0
1-1
1-1
0-0
0-0
0-0
0-1
0-1
0-1
2-1
0-1
2-3
1-2
1-1
1-0
2-3
2-3
3-3
3-3
2-1
1-1
1-1
2-2
2-2
1-2
1-2
1-1
1-3
1-3
1-2
2-3
1-1
1-1
1-1
2-3

162
TABLE 34
RAW SCORES USED TO DETERMINE THERAPIST-CLIENT AGREEMENT ON THE TSR
FOR THE INDIVIDUAL CONDITION, PRE- AND POSTTESTINGS
Thera-
Therapist-client
pair
J'P 2. o t- 1 O T
item no. A-
7
B-
12
C-
17
D-
29
E-
39
F-
22
A
5-3
4-3
3-4
2-2
4-4
3-5
3-4
5-3
4-4
3-3
5-4
4-3
1
1-1
1-1
2-2
1-1
2-1
1-1
1-0
0-0
2-1
1-1
2-1
1-2
2
2-2
1-2
1-1
1-1
2-2
2-2
2-2
0-0
0-1
1-1
1-1
1-1
4
2-1
0-1
1-0
0-1
0-1
0-1
0-0
0-0
0-1
0-0
0-2
1-2
9
0-2
0-2
2-2
2-1
2-2
1-2
2-1
0-0
1-2
1-2
1-1
2-2
10
1-0
1-1
2-0
2-1
1-2
1-0
1-1
0-0
1-1
1-2
1-0
1-1
11
2-1
1-2
2-1
1-2
1-1
1-0
2-1
0-0
2-2
1-2
1-2
1-2
12
0-0
0-1
0-1
0-0
1-0
1-2
1-1
0-0
0-0
0-0
0-0
0-0
13
2-0
1-1
2-1
2-2
2-2
1-0
0-1
0-0
1-1
1-2
0-2
1-1
14
2-2
2-2
2-3
3-2
3-3
2-3
3-2
2-2
2-3
2-3
2-3
2-3
15
2-3
1-3
3-2
2-3
2-1
2-2
2-0
3-2
2-3
2-3
1-2
3-3
16
1-2
2-2
3-3
2-2
3-3
2-3
2-1
1-2
2-1
2-2
2-2
2-2
17
1-2
1-2
2-1
2-3
1-2
1-3
2-1
1-1
2-2
1-2
2-2
2-3
18
1-3
1-3
2-3
2-2
1-2
2-2
3-1
2-2
1-3
2-3
1-2
1-3
23
1-2
1-2
0-1
2-1
1-0
2-0
1-1
3-3
1-0
2-2
1-0
1-1
24
2-2
2-3
2-3
1-3
2-2
2-2
3-5
3-4
2-1
3-1
4-5
2-2
25
4-3
3-2
4-4
3-1
4-5
3-3
3-4
3-2
4-4
3-1
4-4
3-2
26
5-3
2-2
5-3
3-3
3-5
2-2
3-3
1-2
3-3
2-2
4-3
3-3
32
5-2
3-3
3-3
2-2
4-5
2-3
3-2
4-1
5-3
2-2
5-3
4-2
33
1-2
1-2
1-1
2-2
2-0
2-1
2-2
2-2
1-1
2-1
1-1
1-1
34
3-3
2-2
3-3
3-2
3-3
3-2
3-3
2-3
2-3
3-3
1-3
2-3
35
0-0
0-0
0-0
0-0
0-0
0-0
0-0
0-0
1-1
1-0
0-0
0-0
36
3-2
3-2
3-2
3-2
2-2
2 -1
3-3
3-3
2-1
2-2
2-2
2-3
37
3-2
2-2
2-1
2-1
2-0
2-0
2-2
2-2
1-1
2-3
1-2
1-3
Note:
The'
nrst
S C O IT 0
under
eacii
tnerapis c-ciient
pair
indicates
their
respective
pretest scores on the
item
in ques
tion
; the
second
score
, their
respective posttest
scores
. In
all cases,
the s
core
of thi
therapist is given first, followed by a hyphen and the client's score.

163
TABLE 34(extended)
G-
23
H-
21
I-
33
J-
30
K-
34
L-
4 0
3-5
3-3
4-4
3-5
4-4
5-5
4-2
3-2
3-4
2-2
3-4
5-3
1-0
1-0
2-2
1-1
0-1
0-1
1-1
1-0
1-1
1-0
1-1
1-2
11
l
O
2-2
1-1
1-0
2-2
0-1
2-2
2-2
1-1
1-1
1-1
2-1
l-i
0-0
0-0
0-0
1-1
1-1
0-0
0-1
2-2
1-2
0-0
0-0
l-l
2-1
1-2
1-1
1-2
1-2
2-2
0-2
2-1
1-0
2-1
2-0
2-0
1-0
0-0
0-1
1-1
0-1
2-2
1-0
0-0
0-0
2-2
2-2
2-1
1-2
2-2
1-2
2-1
1-2
1-0
0-1
1-0
0-0
2-1
2-2
0-0
1-0
0-0
0-0
0-0
0-0
0-1
0-0
0-0
0-0
0-1
0-0
1-1
2-1
2-2
2-1
2-2
2-2
1-2
1-1
2-2
0-0
1-2
1-2
2-1
3-2
1-1
2-1
2-2
1-1
2-2
2-1
2-2
2-2
2-2
3-3
o
1
CM
2-1
2-2
2-1
1-2
1-1
2-3
3-3
2-2
3-3
2-1
1-2
1-1
2-0
1-1
1-1
2-2
1-0
2-2
2-2
2-2
2-2
2-0
2-3
1-1
2-3
1-1
0-0
2-2
3-2
1-1
1-1
1-3
1-2
3-3
2-3
2-2
2-0
2-2
1-2
1-3
1-2
1-3
1-3
3-2
2-3
1-1
0-3
2-1
2-1
1-1
2-2
2-1
0-1
2-3
3-3
2-2
3-3
1-0
1-2
3-3
3-2
3-3
3-4
3-2
4-5
3-3
1-2
3-3
1-2
2-6
4-2
2-5
3-5
3-4
3-4
4-4
4-3
3-2
4-3
3-3
3-2
4-3
4-3
2-2
2-1
3-3
2-3
3-3
4-3
2-3
1-2
2-3
2-1
3-3
2-1
3-3
3-4
3-3
3-5
3-2
5-3
3-1
2-1
4-4
2-2
3-3
5-2
2-1
1-1
2-2
2-2
2-2
1-3
1-1
1-1
1-1
2-2
1-2
1-1
2-3
2-2
2-3
2-2
2-3
3-3
3-3
3-3
3-3
3-3
2-2
2-2
1-0
1-1
1-1
1-1
0-1
0-0
0-0
1-0
0-0
0-0
0-0
0-0
1-1
2-0
2-1
2-1
2-1
2-2
2-3
3-3
2-2
3-3
3-3
1-3
1-1
2-0
2-1
1-1
1-1
1-2-
2-2
2-3
2-2
2-2
1-2
0-3

164
TABLE 35
THE THERAPISTS' AVERAGE RATINGS ON THE CARKHUFF SCALES FOR
THEIR INITIAL AND TERMINAL SESSIONS WITH
AN INDIVIDUALLY AND MULTIPLY SEEN CLIENT
Multiple Individual
Therapist- Therapist-
client client
pair
Pre
Post
pair
Pre
Post
A-10
2.50
2.50
Empathy
A-7
1.58
2.67
B-8
3.50a
3.08
B-12
2.83
3.58
C-16
2.75
2.67
C-17
2.25
2.58
D-14
2.92
3.00
D-29
3.67
3.00
E-25
3.50
2.58
E-39
2.92
2.58
F-20
2.50b
3.13b
F-22
3.25
3.83
G-37
1.92
2.50
G-23
2.67
3.08
H-26
3.00a
2.00
H-21
2.00
2.67
1-33
2.33
1.58
1-28
3.17
3.00
J-31
2.75
2.75
J- 30
1.83
2.75
K-35
3.17
2.92
K-34
3.08
3.75
L-36
2.42
2.58
L-40
2.58
3.00
A-10
2.33
2.58
Respect
A-7
1.83
2.58
B-8
3.00a
3.00
B-12
2.92
3.42
C-16
2.67
2.67
C-17
2.33
2.58
D-14
2.92
3.00
D-29
3.67
3.25
E-25
3.42
2.58
E-39
2.92
2.75
F-20
2.50b
3.13b
F-22
3.25
3.83
G-37
1.92
2.33
G-23
2.58
2.92
H-26
3.00a
2.00
H-21
2.17
2.58
1-33
2.25
1.50
1-38
3.00
2.92
J-31
2.58
2.75
J-30
1.83
2.92
K-35
3.25
3.17
K-34
3.17
3.83
L-36
2.58
2.75
L-40
2.75
3.00

TABLE 35(continued)
Multiple
Individual
Therapist-
client
pair
Pre
Post
Therapist-
client
pair
Pre
Post
Genuineness
A-10
2.58
2.58
A-7
1.75
2.50
B-18
3.00a
3.00
B-12
2.75
3.33
C-16
2.67
2.92
C-17
2.17
2.42
D-14
3.00
3.08
D-29
3.67
3.25
E-25
3.25
2.58
E-39
2.92
2.75
F-20
2.50b
3.00b
F-22
3.00
3.75
G-37
1.83
2.33
G-2 3
2.67
3.00
H-26
3.00a
2.25
H-21
2.42
2.92
1-33
2.25
1.50
1-38
3.25
2.92
J-31
2.58
2.83
J-30
2.08
2.92
K-35
3.08
3.08
K-34
3.00
3.58
L-36
2.58
2.75
L-4 0
2.58
2.58
Concreteness
A-10
2.58
2.50
A-7
1.58
2.50
B-8
3.00a
3.00
B-12
2.67
3.42
C-16
2.75
2.75
C-17
2.17
2.50
D-14
3.00
3.00
D-29
3.67
3.00
E-25
3.33
2.58
E-39
2.92
2.58
F-20
2.50b
3.13b
F-22
3.08
3.67
G-37
1.83
2.58
G-23
2.58
3.00
K-26
3.00a
2.25
H-21
2.42
3.08
1-33
2.25
1.33
1-38
3.50
3.00
J-31
2.58
2.67
J-30
2.17
2.83
K-35
3.25
2.83
K-34
2.92
3.67
L-36
2.58
2.67
L-40
2.42
2.67
Note: Except as noted, all of the average ratings are
based on three 5-minute segments.
aThe average rating of the two judges on one segment.
t*The average rating of the two judges on two segments.

TABLE 36
THE THERAPISTS' MYERS-BRIGGS TYPES, LEVELS (HIGH OR LOW) AND RANKS ON THE CARKHUFF SCALES
Therapist
Myers-Briggs
type
Carkhuff
Scales
Empathy
Respect
Genuineness
Concreteness
Level
Rank
Level
Rank
Level
Rank
Level
Rank
A
INFP
low
12
low
12
low
12
low
12
B
INFP
high
1
high
4
high
4
high
4
C
ENFP
low
7
low
7
low
9
low
9
D
I/ENFP
high
4
high
2
high
1
high
1.5
E
ESTJ
low
5
low
5
low
5
low
5
F
ENFP
high
3
high
3
high
3
high
3
G
ISTJ
low
8
low
9.5
low
11
low
11
H
ISTJ
low
11
low
9.5
low
6
low
6
I
E/INFP
low
9.5
low
11
low
10
low
10
J
INFP
low
9.5
low
8
low
8
low
8
K
INFJ/P
high
2
high
1
high
2
high
1.5
L
ENFJ
low
6
low
6
low
7
low
7
Note: The rankings are over all 12 therapists. On each scale, the lowest average
was ranked 12; the highest, 1. Therapist E had an average very close to 3 on all of the
scales.
166

167
TABLE 37
PRE AND POST SCORES OF THE THERAPISTS ON SIX CRI SCALES
Scale
i 1 - Cl k-/ _L ti L
A
F
M S
D
B
A
9
8
8
10
8
12
13
12
1
2
10
14
B
6
9
8
7
9
15
14
14
1
2
12
12
C
11
8
8
11
14
11
12
13
2
1
13
13
D
8
11
9
15
15
15
14
13
3
4
13
14
E
8
11
12
14
14
16
15
15
6
7
12
15
F
9
10
13
13
11
13
16
15
4
4
12
13
G
5
6
12
13
12
12
12
11
1
3
12
13
H
7
8
12
12
12
12
14
12
3
2
13
13
I
7
11
11
13
10
12
13
12
4
2
11
13
J
8
. 8
13
13
12
12
15
13
1
3
14
13
K
6
11
10
11
11
14
9
13
3
3
12
14
L
5
8
11
11
13
15
15
11
4
3
10
13
Note:
The first
score
under each scale
indicates
the
thera
pist's
pretest
. score;
the
second
his
(her)
posttest
score.
TABLE 38
PRE
AND POST SCORES
OF
THE THERAPISTS
ON
FOUR
POI
SCALES
Scale
TC
I
S
C
A
21
23
101
107
17
14
26
25
B
23
23
108
108
18
18
24
24
C
3
19
112
107
18
16
23
25
D
21
20
106
104
18
18
23
22
E
19
18
100
108
16
15
24
25
F
21
20
115
113
18
18
26
23
G
18
20
89
93
16
13
21
19
H
14
17
89
96
12
13
17
22
I
19
21
111
113
17
16
23
25
J
16
18
102
104
17
17
26
27
K
18
22
100
108
13
14
23
26
L
15
15
86
85
14
14
19
22
Note: The first score under each scale indicates the thera
pist's pretest score; the second, his (her) posttest score.

TABLE 39
EACH THERAPIST'S RELATIONSHIP QUALITY SCORES FOR BOTH MULTIPLY SEEN CASES
First
case
Second
case
Both ca
ses combined
Therapist
and client
pair
Pre
Post
Total
Therapist
and client
pair
Pre
Post
Total
Therapist
Pre
Post
Total
A-8
1
8
9
A-10
0
10
10
A
1
18
19
B-8
15
6
21
B-10
11
8
19
B
26
14
40
C-14
11
7
18
C-16
11
12
23
C
22
19
41
D-l 4
5
9
14
D-16
5
9
14
D
10
18
28
E-20
11
5
16
E-25
9
16
25
E
20
21
41
F-20
14
12
26
F-25
11
14
25
F
25
26
51
G-26
13
17
30
G-37
13
16
29
G
26
33
59
H-26
10
13
23
H-37
13
14
27
H
26
27
50
1-31
2
2
4
1-33
6
4
10
I
8
6
14
J-31
7
13
20
J-33
10
13
23
J
17
26
43
K-35
12
20
32
K-36
12
20
32
K
24
40
64
L-35
0
8
8
L-36
5
4
9
L
5
12
17
168

TABLE 40
AGREEMENT SCORES OF EACH THERAPISTS RESPONSES ON THE TSR AND HIS PARTNER'S
CORRESPONDING MTRS RESPONSES FOR BOTH MULTIPLY SEEN CASES
First
case
Second
case
Both cases
combined
Therapist
and client
pair
Pre
Post
Total
Therapist
and client
pair
Pre
Post
Total
Therapist
Pre
Post
Total
A-8
6
1
7
A-10
3
4
7
A
9
5
14
B-8
4
5
9
B-10
4
7
11
B
8
12
20
C-14
3
2
5
C-16
6
2
8
C
9
4
13
D-14
7
8
15
D-16
5
7
12
D
12
15
27
E-20
9
5
14
E-25
9
4
13
E
9
9
18
F-20
8
3
11
F-25
11
5
16
F
11
8
19
G-2 6
9
5
14
G-37
9
5
14
G
8
10
18
H-26
4
2
6
G-37
6
3
9
H
5
5
10
1-31
4
4
8
1-33
5
3
8
I
9
7
16
J-31
5
4
9
J-33
4
2
6
J
9
6
15
K-35
5
2
7
K-36
6
4
10
K
11
6
17
L-35
3
2
5
L-36
2
3
5
L
5
5
10
169

TABLE 41
RAW SCORES OF TOTAL COMPOSITE CO-THERAPIST AGREEMENT AND RELATIONSHIP QUALITY FROM THE
MTRS AND THEIR CLIENTS' S-A SCALE AND POI SCALES OF
TIME COMPETENCE AND INNER-DIRECTED
Client
S-A Scale
POI
Therapists
Total composite
co-therapist
agreement
score
Total composite
relationship
quality
score
Time
Competence
Inner-
Directed
8
- 5
16
82
AB
16
10
10
37
19
96
AB
18
11
14
23
10
83
CD
20
32
16
35
15
95
CD
20
37
20
9
17
82
EF
17
50
25
31
21
99
EF
20
42
26
- 7
12
56
GH
13
56
37
32
19
112
GH
15
53
31
41
18
95
IJ
17
33
33
24
13
64
IJ
14
24
35
3
14
76
KL
12
40
36
17
18
89
KL
15
41
Note: The
rankings for each measure
are over all
12 cases. On each,
the highest
score is
ranked
1;
the lowest score, 12.
170

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1963, 13, 127-132 (a).
Mintz, E. Transference in co-therapy groups. Journal of
Consulting Psychology, 1963, 27_, 34-39 (b)~
Mintz, E. Male-female cotherapists: Some values and some
problems. American Journal of Psychotherapy, 1965,
19, 293-301.
Mullan, H. The group analyst's creative function. American
Journal of Psychotherapy, 1955, 9_, 320-334.
Mullan, H., and Sanguiliano, I. Multiple psychotherapeutic
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Charles C. Thomas, 1964.
Nunnelly, K. G. The use of multiple therapy in group coun
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Michigan State University, 1969.
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Orlinsky, D. E., and Howard, K. I. The experience of
psychotherapy: A prospectus on the psychotherapy
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Form P and Form T. Chicago: Institute for Juvenile
Research, 1966 (b).
Orlinsky, D. E., and Howard, K. I. The good therapy hour:
Experimental correlates of patients' and therapists'
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Psychiatry, 1967, 16, 621-632.

175
Pine, I., Todd, W. E., and Boenheim, C. Signs of counter
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2_1 (2)", 244-255.
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disclosure Doctoral dissertation, Michigan State
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Reeve, G. H. Trends in therapy: V. A. method of coordinated
treatment. American Journal of Orthoosvchiatry, 1939,
9, 743-747.
Rockberger, H. The role of an eclectic affect theory in
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283-292.
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Seigel, F. Nonparametric statistics for the behavioral
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Shostrom, E. L. An inventory for the measurement of self-
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Shostrom, E. L. Manual: Personal Orientation Inventory.
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177
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BIOGRAPHICAL SKETCH
Sharon Jennette Kosch-Graham was born June 13, 1945,
in Ukiah, California. She was graduated with honors from
Ukiah Union High School, in June, 1963. The following
September she entered San Jose State College (now California
State University at San Jose), San Jose, California, where
she participated in the Humanities Program, a liberal arts
curriculum, during her first two years of study. She was
awarded the degree of Bachelor of Arts with great distinc
tion and honors in psychology in June, 1967. The Phi Beta
Kappa members of the faculty at San Jose State College also
elected her to membership in the Key Club upon her gradu
ation. She remained at this institution for one year of
graduate study in the Psychology Department. In September,
1968, she entered the Department of Psychology at the
University of Florida. From 1968 to 1970, she held a depart
mental teaching assistantship, and from 1970 to 1971, a
U.S.P.H.S. traineeship. During 1971 and 1972, she completed
a fifteen-month internship in clinical and counseling
psychology at the University of Florida, with placements at
the University Counseling Center and Alachua Mental Health
Services.
Sharon Jennette Kosch-Graham, who is married to Richard
Jason Kosch, is a member of Psi Chi.
178

I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
H t e r
Professor /of
Jr., Chairman
Psychology
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
Professor of Clinical
Psychology
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
. a a. r
/ft.
Madeleine Carey Ramey
Assistant Professor
sychology
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
Vernon D. Van De Reit
Associate Professor of Clinical
Psychology

I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
James D. Millikan
Assistant Professor of Philosophy
This dissertation was submitted to the Department of
Psychology in the College of Arts and Sciences and to the
Graduate Council, and was accepted as partial fulfillment
of the requirements for the degree of Doctor of Philosophy.
December, 1972
Dean, Graduate Schoo1



126
Items
A. HOW DO YOU FEEL ABOUT THE SESSION WHICH YOU HAVE JUST
COMPLETED? (Circle the one answer which best applies.)
THIS SESSION WAS:
i.
PERFECT.
ii.
EXCELLENT.
iii.
VERY GOOD.
iv.
PRETTY GOOD
V.
FAIR.
vi.
PRETTY POOR
vii.
VERY POOR.
WHAT SUBJECTS DID YOUR PATIENT TALK ABOUT DURING THE
SESSION? (For each subject, circle the answer which best
applies.)
DURING THE SESSION MY PATIENT TALKED ABOUT: NO SOME A LOT
1.RELATIONS WITH OTHERS OF THE SAME SEX. 0 12
2.RELATIONS WITH THE OPPOSITE SEX.
0 12
3. FEELINGS ABOUT SPOUSE OR ABOUT BEING 012
MARRIED.
4. STRANGE OR UNUSUAL IDEAS AND EXPERI- 012
ENCES.
5.PERCEPTIONS OR FEELINGS ABOUT ME. 0 1
Be sure that you have checked every item.
2
WHAT DID YOUR PATIENT SEEM TO WANT THIS
SESSION? (For each item, circle the
answer which best applies.)
6. A CHANCE TO LET GO AND EXPRESS FEEL- 0
INGS.
7. REASSURANCE, SYMPATHY OR APPROVAL FROM 0
ME.
8. TO EVADE OR WITHDRAW FROM EFFECTIVE 0
CONTACT WITH ME.
1 2
1 2
1 2
9.
TO EXPLORE EMERGING FEELINGS AND
EXPERIENCES.
0
1
2


68
scores in the multiple than in the individual condition. A
sign test (two-tailed) determined that this difference was
nonsignificant (p = .146). For the terminal session, seven
of the therapists had a higher correlation between their
scores and those of their clients in individual than mul
tiple therapythis was also not a significant difference
(p = .774). As far as client-therapist agreement, then, no
descriptive evidence of a difference between the conditions
was found; Hypothesis 1.3 was thus not supported.
TABLE 14
THERAPIST-CLIENT AGREEMENT SCORES FOR MULTIPLE
AND INDIVIDUAL CONDITIONS; CORRELATIONS
BETWEEN
THEIR RESPONSES TO 24 TSR
ITEMS
Multiple
Individual
Therapist-
client
pair
Pre
Post
Therapist-
client
pair
Pre
Post
A-10
.76
.47
A-7
.52
.46
B-8
.83
.80
B-12
.65
.41
C-16
.64
.51
C-17
.81
. 6 6
D-14
.79
.71
D-29
.68
. 88
E-25
.91
.43
E-39
.75
.49
F-2.0
.49
.91
F-22
.78
.70
G-37
.82
.73
G-23
.62
.65
H-26
.84
. 81
H-21
.97
.82
1-33
.80
. 83
1-38
.77
.87
J-31
.67
.41
J-30
.57
. 62
K-3 5
.90
.88
K-34
.78
. 81
L-36
.78
. 30
L-4 0
.60
.46


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17
(Rockberger, 1966). This would likely lead to a battle of
each trying to prove the superiority of his method. As an
extreme example, it is very perplexing to imagine how an
orthodox Freudian and someone who patterned his style after
Rogers could work together to the benefit of the person
they were seeing. Within limits, though, some variation in
approach between the therapists is desirable.
Kell and Burow (1970) think that counselor similarity
is necessary as far as basic beliefs about life and human
values. For instance, they feel that it would be very dif
ficult for a pessimist and an optimist to work together
constructively. They would agree with others, however,
that differences in opinion regarding intrapsychic processes
or tactical differences between therapists are positive
catalysts to therapeutic progress (Dreikurs, 1950; Hulse,
Lulow, William, Rindsberg, and Epstein, 1956).
Mullan and Sanguiliano (1960) state that there is
always resistance on the part of therapists in entering a
multiple therapy situation, as well as experiencing during
a particular treatment hour. They note that there is likely
to be less resistance by therapists who emphasize process
rather than content. It follows, then, that therapists who
are relationship-oriented and flexible in orientation may
be best suited to be members of a multiple pair.
Furthermore, it has been stressed that the therapists
should be of equal capacity (Whitaker, Malone, and


109
in their clients' behavior. The therapists did not, in
fact, feel that the multiple condition produced more bene
ficial client actions. The only significant difference in
their ratings was that clients were more likely to agree
with their comments in the individual condition.
Another finding of the study was that, as far as the
agreement of the therapists and their clients as to the
events of the session, the multiple condition was also not
superior to the individual (Hypothesis 13). Although the
differences were not significant, it is interesting to note
that in the pretesting there were more therapists who had
higher therapist-client agreement in the multiple than
the individual condition; while for the posttest, the re
verse was true. In the multiple condition, the level of
agreement between each therapist and the client with whom
he was paired was significantly lower for the terminal than
the initial session. In the individual condition, mean
while, there was not a significant decrease in therapist-
client agreement.
From the first to the last session, then, the level of
facilitative conditions offered by the therapists got
significantly better in the individual condition, while the
level of therapist-client agreement remained static. In
the multiple condition, contrarily, the level of core
dimensions remained the same from the initial to the
terminal interview, but the agreement between the therapists


35
to take the pretests as soon as possible; told her the
name(s) of her counselor (s) ; and said that she would be
given an appointment as soon as she had completed the test
ing. The pretests were the Personal Orientation Inventory;
a self-rated scale of self-actualization, the Self-Actuali
zation Scale (S-A Scale); and a specific Problems List, on
which the client listed three problems on which she wanted
to work in counseling. (These measures will be described in
the dissertation of Reiner, 1973.) After the final therapy
session, the client again completed all of the above scales,
the S-A Scale and the Problems List being the posttest
versions.
Instruments
Therapy Session Report
The Therapy Session Report (TSR), which was developed
by Orlinsky and Howard (1966b), has been used extensively
in psychotherapy research by these authors to determine how
clients and therapists perceive and behave during therapy
hours (Orlinsky and Howard, 1966b, 1967). Similar forms
for the client and the therapist were designed, enabling
easy comparisons of their experiences and feelings about the
process of the sessions.
The current researchers selected items from the original
scales and used these in the forms for therapists and clients
(Appendix B). The items that were parallel for the thera
pists and clients have the item numbers of the therapist


24
relationship between the counselors is one of the most
important facets of multiple therapy.
Research
Although many theorists have praised the multiple
technique for providing an atmosphere conducive to conduc
ting unobtrusive research (Buck and Grygier, 1952; Dreikurs,
1952b; Haigh and Kell, 1950; Whitaker, Malone, and Warkentin,
1956), few have actually done more than draw conclusions
from their own experiences with the method. There is a
bounty of success claims in the literature (Fink, 1958;
Mintz, 1965; Solomon, Loeffler, and Frank, 1954), but very
few empirical facts to support it.
The first attempt at a "study" of multiple therapy was
that of Warkentin, Johnson, and Whitaker (1951), who looked
at case studies of 25 patients and reported positive re
sults for them; such as feeling safer and thus freer to
express both positive and negative feelings, and more satis
factory termination experiences. The participating thera
pists derived the supposed benefits of personal growth,
increased enthusiasm for therapy, and a greater capacity to
work with patients.
Other research projects have also concentrated some
attention on multiple therapy from the therapist's perspec
tive. Rabin (1967) at least improved on the previously
cited study of the Atlanta group by giving 38 therapists a
questionnaire which asked them to rate the relative efficacy


161
TABLE 33(extended)
G-
37
H-
26
I-
33
J-
31
K-
35
L-
-36
3-3
5-4
5-4
5-6
3-3
3-3
3-3
3-2
4-5
5-6
3-5
2-3
1-1
1-1
0-0
1-1
2-1
0-0
1-1
2-1
1-1
1-1
1-1
1-1
1-1
1-1
2-2
1-1
2-1
2-2
0-0
1-1
1-1
1-1
1-1
1-2
1-2
1-2
0-1
0-0
0-2
0-0
1-1
1-2
0-0
0-0
0-0
0-0
2-2
1-1
0-2
0-2
0-2
1-1
1-2
2-2
0-2
0-1
2-2
1-2
2-2
2-2
2-2
2-2
0-1
0-1
1-0
1-1
1-1
0-2
1-0
1-0
2-2
2-1
1-2
2-2
1-2
0-2
1-0
2-2
0-0
1-1
2-2
0-2
1-1
0-0
0-1
1-0
1-1
2-2
0-0
0-1
1-1
0-1
0-0
0-0
2-2
2-2
.1-1
1-1
o-i
1-1
2-0
2-2
0-1
1-2
2-1
1-2
2-2
2-2
3-3
3-1
3-3
2-2
3-3
2-2
2-3
1-2
2-2
2-2
2-2
1-2
2-1
2-1
2-3
3-2
2-3
3-3
1-2
1-0
2-1
2-2
2-1
2-2
3-2
2-1
3-3
3-3
3-3
3-2
1-3
0-1
2-2
2-2
2-2
1-2
2-3
1-2
1-1
1-1
2-2
1-3
1-2
1-0
3-2
1-3
2-2
1-2
1-2
1-1
0-1
2-2
1-1,
2-3
1-1
0-1
2-2
2-2
1-1
1-0
1-2
1-1
2-3
2-2
1-3
1-2
0-1
0-0
1-0
3-1
2-3
4-5
3-3
3-5
4-5
2-2
2-3
2-2
5-5
4-4
2-5
3-3
3-3
5-2
4-4
4-5
3-2
3-2
4-3
2-2
4-5
4-5
3-6
4-1
3-4
3-3
4-5
3-5
5-5
3-3
3-2
3-2
3-3
4-3
3-3
2-2
3-3
5-2
5-4
4-5
4-2
2-2
3-2
3-1
5-5
5-5
l-l'
4-2
1-2
2-2
1-1
1-2
1-2
1-1
1-2
2-2
1-1
1-1
2-2
1-2
2-3
2-3
1-3
2-2
2-3
2-3
3-3
3-3
3-2
2-2
0-0
2-3
1-0
1-0
1-1
1-1
0-0
0-0
0-0
0-1
0-1
0-1
2-1
0-1
2-3
1-2
1-1
1-0
2-3
2-3
3-3
3-3
2-1
1-1
1-1
2-2
2-2
1-2
1-2
1-1
1-3
1-3
1-2
2-3
1-1
1-1
1-1
2-3


79
difference between the pre and post means in the multiple
condition did not reach significance (t = .84, df = 22,
p > .20). Again, then, the therapists offered a comparable
level of a facilitative core dimension in both conditions
at the beginning of therapy, but a higher level in the
individual condition at therapy's end. Hypothesis 21 was
rejected.
Hypothesis 22.The therapists will offer higher levels
of genuineness in multiple therapy than in individual
therapy. Neither of the main effects, condition or time,
was found to be significant when the scores on the Genuine
ness scale were analyzed (Table IS). Individual differences
between the therapists were indicated by a significant blocks
ratio;, and a significant interaction between condition and
time was detected. A simple main effects test on the
relevant means again determined that the post mean for the
individual condition was significantly different from the
pre mean for the individual condition (t = 4.46, df = 22,
p < .002), and the post mean for the multiple condition
(t = 4.82, df = 22, p < .002). Again, the difference
between the slightly larger pre mean of the multiple con
dition and the post mean was not significant (t = .50,
df = 22, p > .50). Since this difference was larger than
that between the pre means of the multiple and individual
conditions, the latter difference was also known to be non
significant. The therapists were shown to significantly


81
Hypothesis 23,---The therapists will offer higher levels
of concreteness in multiple therapy than in individual
therapy. Table 20 shows that a significant F ratio was
obtained for the interaction of time and condition when the
scores of the therapists on the Concreteness scale were
analyzed by the randomized block factorial design. The
ratios for blocks, and the main effects of condition and
time were nonsignificant at the .05 level. A simple main
effects test again determined that the difference between
the pretest and posttest means in the individual condition
was significant (t = 2.97, df = 22, p < .01), as was that
between the posttest means of the individual and multiple
conditions (t = 3.74, df = 22, p < .002). Again, in com
paring the pretest mean of the multiple condition with the
posttest mean of that condition and the pretest mean of
the individual condition, the larger difference was shown
to be nonsignificant (t = 1.29, df = 22, p > .20). In
regard to the offered levels of concreteness, then, the
therapists showed a pattern similar to the results of the
other scales. The conditions were not significantly dis
crepant at the initiation of therapy. At termination, how
ever, the therapists offered higher levels of concreteness
in the individual condition than they had at therapy's
beginning and than they did at the end of multiple therapy.
Conditions and therapist type.--In comparing the types
of the therapists on the Myers-Briggs Type Indicator and


I extend many thanks to Dr. James Millikan for joining
my committee at such a late stage (when I really needed him!)
and for being a good "sounding board" while I was writing
the manuscript.
I want to express my sincere gratitude to the twelve
therapists who participated in the study: Jaguie and Mike,
Cindy and Bill, Karen and Jim, Pat and John, and Judy and
Linwood. I thank each of you for your patience in filling
out those seemingly endless forms and for taping the sessions.
I also thank all of the twenty-four clients who agreed to let
their counseling involvement be studied.
I heartily thank four of the Counseling Center secre
taries: Adrienne, Edith, Harriet, and Muriel. Each of
them helped by typing, administering, or scoring test forms,
as well as caring about me and the project. I am grateful
also to the editorial skills of Sue Kirkpatrick, who typed
the final manuscript.
And, of those not mentioned, I would like to thank Lauren,
Roger, and Gary for serving as judges for two of the scales.
I would also like to express my gratitude to Drs. David
Orlinsky and Kenneth Howard for their permission to use
items from the Therapy Session Report.
I am especially thankful that my co-researcher, Chuck,
was willing to share the ordeals of research with me.
Personally, I am grateful to my two therapists, Pat
and Paul, and to many friends, for helping me preserve enough
of my sanity to write this dissertation.
v


6
in situations of imbalanced therapeutic teams (Dyrud and
Rioch, 1953; Feldman, 1968; Gans, 1962; Kell and Burow,
1970; Lott, 1957; MacLennan, 1965).
It is noteworthy that the Atlanta group, who had been
one of the early proponents of multiple therapy for train
ing purposes, reversed their position and stated that the
pairing of novice and experienced therapists is not wise
(Malone and Whitaker, 1965; Whitaker, Malone, and Warkentin,
1956). The later opinion of these authors underlined the
deleterious influences of status differences which would
affect both therapists and clients.
Growth
One of the first goals of using multiple therapy as
formulated by the Atlanta group concerned its potential for
developing the capacity of the therapist (Warkentin,
Johnson, and Whitaker, 1951; Whitaker, Malone, and Warkentin,
1956; Whitaker, Warkentin, and Johnson, 1949). This was
also mentioned by Solomon, Loeffler, and Frank (1954); it is
a training goal, in a sense, but refers to the opportunity
for continued personal and professional growth of experi
enced therapists. Mintz (1963a) feels that co-therapy
offers this benefit to a therapist by his being put in a
learning situation with his colleague. The observation of
the other therapist regarding his and the client's reactions
widens his understanding of himself. He can also be
exposed to different approaches and techniques, thus expanding
his professional ability.


59
TABLE 5
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES
TO TSR ITEM 17 FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
1.6666
1.1666
1.5833
1.4166
(.6513)
(.3892)
(.6686)
(.7930)
Source
df
MS
F
Blocks
11
.5378
1.45
Treatments
3
Condition (A)
1
. 0833
.48
Time (B)
1
1.3333
4.00
A x B
1
. 3334
.55
Residual
33
.3712
A x blocks
11
.1742
B x blocks
11
.3333
AB x blocks
11
.6062
Total
47
Note: The standard deviations are in parentheses.
Hypothesis 5.--Compared to individual therapy, the thera
pists will rate the clients in multiple therapy as agreeing
with and/or accepting more of their comments or suggestions
(Item 21), This hypothesis was rejected when, in fact, the
results showed (Table 6) that the means were significantly
higher both pre and post for the individual than the
multiple condition- The therapists, then, felt that their


intern-level psychology graduate students were asked to
evaluate the items and the responses of this section of the
scale (see Directions for Rating the MTRS, Appendix G).
First, the judges rated all of the items in regard to their
relevancy for the formation of a co-therapist relationship.
All of the judges agreed in identifying 13 of the 14 perti
nent items as being relevant. They also all concurred that
the items describing the other therapist's behavior (the
topics similar to the TSR ones discussed above) and the final
item were not relevant ingredients of the co-therapist
relationship. The second item, that only one judge felt was
relevant, was omitted for scoring purposes. The percentages
of agreement between the judges in regard to the relevancy
of the questions are shown in Table 1.
TABLE 1
PERCENTAGES OF AGREEMENT AMONG FOUR JUDGES REGARDING
THE MULTIPLE THERAPY RATING SCALE
Judges
B
C
D
Relevancy of the Items
A
1.0000
1.0000
9285
B
1.0000
9285
C
9285
Scoring Direction of the Responses
A
.7777
B
C
.7619
. 8095
.7936
.7460
.6667


APPENDIX A
THERAPISTS' RESEARCH INSTRUCTIONS SHEET
Your participation will not really involve too much
work. Since I won't always be around to monitor the re
search, however, I'm giving you this list so that you will
know what to do. All that is necessary is to complete the
following:
1) A POI before therapy starts. *
2) A Myers-Briggs before therapy starts, or if you have
already taken one, submit your type to me.
3) After your first and last individual counseling session,
a Therapy Session Report.
4) After your first and last multiple counseling sessions:
a) A Therapy Session Report
b) A Multiple Therapy Rating Scale
5) After the very first and after the very last multiple
counseling session, a Caring Relationship Inventory.
6) At the end of all counseling, a Comparative Therapy
Scale.
7) Please tape every session, using 5" reels when possible.
Please use both sides of a tape for the same client.
You need only tape the first hour of the session; if you
run over by a little bit, you can cease taping.
PLEASE REMEMBER TO MARK ALL SCALES AND TAPES WITH THE DATE
AND SESSION NUMBER, YOUR NAME, AND THE CLIENT'S NAME OR
IDENTIFICATION NUMBER.
8) Please have your client see the testing secretary after
the first session to complete a Therapy Session Report,
and after the last session to fill out the posttests.
Thank you I If you have any questions, please ask.
Shae Graham
124


66
supported, as a nonsignificant ratio for condition was
obtained. The ratios for time and the interaction of con
dition and time were also below the .05 level of signifi
cance, while that of blocks was above (Table 13). There
were individual differences among the therapists, then, as
to how much feeling they rated themselves as expressing.
TABLE 12
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST RESPONSES
TO T3R ITEM 36 FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
2.1666
2.0833
2.2500
2.3333
(.3892)
(.6686)
(.6216)
(.6513)
Source
df
MS
F
Blocks
11
.6742
2.75
Treatments
3
Condition (A)
1
. 3333
1.36
Time (B)
1
.0000
o
o

A x B
1
.0834
.34
Residual
33
.2449
Total
47
Note: The
standard
deviations are in
parentheses.
* p < .05.


33
Quality of the co-therapists 1 relationships.The pres
ent design incorporated several approaches aimed at de
scribing the quality of the multiple therapists' relation
ships. One method was a direct one of having the therapists
rate each other as far as their relationship on two measures
(Caring Relationship Inventory; Multiple Therapy Rating
\
Scale) designed or adapted for this purpose. Another in
volved perceptual agreement as to how the therapy sessions
proceeded; this specifically involved a. therapist rating
his partner (on the Multiple Therapy Rating Scale) on the
.latter's behavior and perceptions which he had also self-
rated (on the Therapy Session Report). The relevance of good
and.poor co-therapist rapport measured by the above instru
ments for client outcome (self-actualization) was also
investigated.
Possible therapist growth.--The Personal Orientation
Inventory was administered to the therapists at the incep
tion and the conclusion of their involvement in the research
project to detect any change in self-actualization result
ing from the experience. There was no control condition
for this analysis, however, so any results could only be
suggestive.
Procedure
Counselors
Before commencing their first therapy session, the
counselors were given the Myers-Briggs Type Indicator


45
Co-therapist agreement.--This instrument included
eight items that paralleled some items of the TSR. (These
items are designated in Appendix G by having the item number
of the TSR to which they correspond immediately following
the item.) In completing the MTRS, then, each therapist
rated his partner on aspects of the latter's behavior for
which the partner had also rated himself. These items were
used as an indix of agreement between the therapists as to
how they saw each other and themselves during the sessions.
It was postulated that close agreement was indicative of a
good relationship, while discrepant views meant something
was askew in the relationship.
For the first and last session of each case, the scor
ing of this part of the scale consisted of summing the number
of exact agreements out of the eight topics on which each
therapist rated himself and was rated by his partner. This
yielded an agreement score for each individual therapist.
A composite score foz* the couple was derived by adding the
two scores of the co-therapists. In addition, a total com
posite score for each case was computed by summing the pre
and post composite scores .
Quality of the co-therapist relationship.The remainder
of the items were ones that inquired about other perceptions
of the therapists concerning the events of the sessions.
The topics were ones that the co-researchers thought were
important as to how the therapists worked together. Four


175
Pine, I., Todd, W. E., and Boenheim, C. Signs of counter
transference problems in co-therapy groups. Psycho-
somatics, 1965, 6_, 79-83.
Rabin, H. M. How does co-therapy compare with regular group
therapy? American Journal of Psychotherapy, 1967,
2_1 (2)", 244-255.
Randolph, C. C. Multiple therapy: Co-therapist satisfac-
tion as related to the variables of affection and self
disclosure Doctoral dissertation, Michigan State
University, 1970.
Reeve, G. H. Trends in therapy: V. A. method of coordinated
treatment. American Journal of Orthoosvchiatry, 1939,
9, 743-747.
Rockberger, H. The role of an eclectic affect theory in
multiple therapy. Psychoanalytic Review, 1966, 53,
283-292.
Sabath, G. Intertransference: Transference relationship
between members of the psychotherapy team. International
Journal of Group Psychotherapy, 1962, 12, 492-495.
Seigel, F. Nonparametric statistics for the behavioral
sciences. New York: McGraw-Hill 1956.
Shostrom, E. L. An inventory for the measurement of self-
actualization. Educational and Psychological Measure
ment 1964 .24 207-218 .
Shostrom, E. L. Manual: Caring Relationship Inventory.
San Diego: Educational and Industrial Testing
Service, 1966 (a).
Shostrom, E. L. Manual: Personal Orientation Inventory.
San Diego: Educational and Industrial Testing Service,
1966 (b) .
Singer, M., and Fischer, R. Group psychotherapy of male
homosexuals by a male and female co-therapy team.
International Journal of Group Psychotherapy, 1967,
17, 44-52.
Slavson, S. R. Sources of countertransference and group-
induced anxiety. International Journal of Group
Psychotherapy, 1953, _3, 373-388 .
Slavson, S. R. Discussion. International Journal of Group
Psychotherapy, 1960, 10, 225-226.


86
beginning. Although the direction of the difference be-
tv7een the pre and post means on the Self Love scale was in
the predicted direction, the difference was nonsignificant
(t = -1.20, p > .10), thus disconfirming Hypothesis 29.
It is also interesting to compare the means of the
therapists CRI scores to those published by Shostrom (1966b)
for successfully married couples, troubled couples, and
divorced couples (Table 22). This comparison might suggest
how caring the relationships between the therapists were.
The pretest mean score of the therapists on the Affec
tion scale was close to that of divorced couples, while the
posttest was above that of troubled couples. The means for
both pre- and posttestings on the Friendship scale lay
between those of troubled couples and successfully married
couples. The therapists scored between divorced couples
and troubled couples at the beginning of their counseling
together on the Empathy (M) scale; but by the end of their
work, they were higher than the successfully married couples.
On the Self Love scale, the therapists scored higher than
the successfully married couples on both pre- and posttest
ings. In this instance, it would appear that they were less
caring than any of the couples, as they were much more
concerned with themselves in the relationships. The mean
of the therapists on the Being Love scale for the pretest
was between those of troubled couples and successfully married
couples, while the posttesting showed the therapists to be


30
had presenting problems concerned with interpersonal dif
ficulties. Every unmarried female student coming to the
counseling center for personal counseling during the dura
tion of the study was asked to participate in the project.
The one exception to this was in the case of a student who
had had counseling in the past. Previous therapy is one
variable consistently shown to influence therapeutic inter
actions (Meltzoff and Kornreich, 1970), and thus these
students were excluded.
Design
The following discussion sketches the overall design
of the project and elaborates upon the aspects crucial to
the material of the present report. Granted, there are
myriad other considerations and analyses possible to pursue
with the data that have been gathered.
Conditions and Groups
Therapists.The same therapists saw clients individu
ally and multiply during the same time period; thus, they
provided their own matched control. Each therapist saw one
client in individual sessions and two with the same co
therapist partner throughout the course of therapy. The
counseling of two clients multiply was necessitated by the
desire to have 12 clients undergoing treatment in each
condition. The use of the same team of therapists for two
cases yielded a sample size of six pairs, rather than the
12 that could have been attained by different pairings for


APPENDIX G
THE MULTIPLE THERAPY RATING SCALE
Iteras
1. Do you think the psychotherapeutic effectiveness of
the session was due mostly to the interaction of the
client with:
a. yourself?
b. the other therapist?
c. both therapists?
2. Do you think that the other therapist was
a. more involved with the patient than you were?
b. less involved?
c. about the same?
3.Were your feelings toward
during the session?
a. Yes
b. No
the other therapist divulged:
outside of the session?
c. Yes
d. No
4. How do you feel that stating or not stating these
feelings affected the therapy?
a. Helped it greatly
b. Somewhat helped it
c. Hindered it somewhat
d. Made no difference
e- Hindered it greatly
5. How did you and the other therapist work together during
the session?
a. Excellently
b. Very well
c. Fairly
d. Poorly
e. Very poorly
151


50
multiple condition itself. The instruments by which a
hypothesis was tested, along with item numbers when appro
priate, are given below. The hypotheses are numbered con
secutively through both categories.
Multiple Versus Individual Therapy
TSR.The therapists will report that the therapeutic
interactions differed in the two conditions. Compared to
individual therapy, they will rate the clients in multiple
therapy as
1. Having talked more about relations with persons
of both sexes (Items 1 and 2).
2. Having discussed a greater variety of topics
(Items 1-5).
3. Having wanted more to express or explore feelings
(Items 6 and 9).
4. Having had their feelings more stirred up (Item 17).
5. Agreeing with and/or accepting more of their
comments or suggestions (Item 21).
6. Having shown more progress (Item 25).
Similarly, the therapists will be apt in multiple therapy to
rate themselves as:
7. More revealing of their spontaneous impressions or
reactions (Item 29).
8. More understanding of what their patients said and
did (Item 31).
9. Being more helpful to their patients (Item 32).
10. Being more critical or disapproving to their clients
(Item 35).
11. Being more warm and friendly toward their clients
(Item 36).


107
facilitative core conditions in multiple than in individual
therapy. The pattern on all of the scales was the same: the
counselors had comparable levels of the core dimensions in
both conditions at the outset of therapy. By termination,
however, they had significantly increased their level of
functioning in the individual condition, while remaining the
*
same in the multiple. Their interactions with their clients
that they were seeing alone became more empathetic, respect
ful, genuine, and concrete; while those with their multiple
clients did not. The conclusion to be drawn from the judges'
ratings of the present sample of therapists, then, is that
they were likely to become more facilitative over time when
doing therapy individually, but not when working as part of
a co-therapy team.
Considering the results of Swander's (1971) analogue
study and the overall level of functioning of the present
therapists, the current data are not surprising. Although
Swander's undergraduate student helpers were all in the
nonfacilitative range, the findings of their one-half-hour
sessions of individual and multiple "counseling" are inter
esting. Both partners of a higher nonfacilitative helper
coupled with a lower nonfacilitative helper and both of a
lower nonfacilitative.helper coupled with another lower
nonfacilitative helper decreased their levels of core
conditions when working together. Swander also found that
two helpers of higher nonfacilitative levels did not


51
12. Expressing more feeling (Item 37).
13. It is expected that the client-therapist agreement
as to the events of the sessions will be higher in
multiple therapy than in individual therapy (on 24
items of the therapist and client forms of the TSR) .
Comparative Therapy Scale.--More therapists will rate
multiple therapy over individual therapy as:
14. Being conducive to self-understanding of the thera
pist (Item 6).
15. Being useful in training therapists (Item 10).
16. Offering more personal gratification (enjoyment or
"fun") for the therapist (Item 11).
17. Being their general preference (Item 24).
18. Fostering the resolution of impasses (Item 32).
19. The therapists generally will express a more positive
attitude toward multiple therapy than toward
individual therapy (Items 1-32) .
Carkhuff Process Scales.--The therapists will offer
higher levels of therapeutic conditions more consistently in
multiple therapy than in individual therapy. It is hypothe
sized that the therapists will offer higher facilitative core
conditions as measured by the scales of:
20. Empathy.
21. Respect.
22. Genuineness.
23. Concreteness.
The Multiple Condition
CRI.--Only one of the therapist pairs had done therapy
together previously and this had not been an extensive


64
TABLE 1.0~ (continued)
Source
df
MS
F
Blocks
11
.7935
.72
Treatments
33
Condition (A)
1
1.0208
.92
Time (B)
1
1.0208
.92
A x B
1
.1876
.17
Residual
33
1.1066
Total
47
Note: The standard deviations are in parentheses.
Hypothesis 10.The therapists will be apt in multiple
therapy to rate themselves as being more critical or dis
approving to their clients than in individual therapy (Item
35). Again, the only significant F ratio shown in Table 11
was that of blocks signifying that there were individual
differences among the therapists as far as their self-report
of how much they expressed their critical or disapproving
thoughts to their clients was concerned. It is noteworthy
that all of the means included in Table 11 are very low
very few of the therapists rated themselves as being negative
or critical at all. As there was not a significant F ratio
that concerned condition, Hypothesis 10 was rejected.
Hypothesis 11.The therapists will be apt in multiple
therapy to rate themselves as being more warm and friendly


35
TABLE 27
TEST-RETEST RELIABILITIES OF RELATIONSHIP QUALITY
AND CO-THERAPIST AGREEMENT FROM THE MTRS
Pre
Post
Total
Relationship quality
. 84**
.61**
. 89**
4
Co-therapist agreement
. 55*
.54*
. 61*
*p < .
**p < .
05.
01.
TABLE 28
SPEARMAN RANK-ORDER CORRELATIONS BETWEEN RELATIONSHIP
QUALITY AND CO-THERAPIST AGREEMENT AND BETWEEN
THESE SCALES AND SCALES OF THE CRI
Relationship quality
Co-therapist agreement
Comparison
Pre
Post
Pre Post
Co-therapist
agreement
Pre
Post
-.14
.02
Affection
Pre
Post
.25
.17
.53*
.35
Friendship
Pre
Post
.23
.16
-.05
.48
Empathy (M)
Pre
Post
-.05
-.14
.08
.56*
Being Love
Pre
Post
.41
.15
.16
.02
*p < .05.


75
Carkhuff Process Scales Data
The average ratings that the therapists received on
the core facilitative conditions were to be based on ratings
by two judges of three segments from each first and last
session. It should be mentioned, however, that in the
multiple condition there were eight instances where the
female co-therapist did not talk during one or two excerpt(s)
and her average rating for that session was based on two
or one segment(s), respectively. There were not any seg
ments from the individual condition where this occurred, nor
was a male co-therapist silent during a 5-minute segment
from the multiple condition. Of the ratings that were used
to assess the differences between the therapists' offered
levels of the core facilitative dimensions, two ratings
are based on one segment and two are based on two excerpts
(as noted in Table 35, Appendix H). The following results
must be qualified, then, by the statement that the average
ratings were not all compiled from the same number of
excerpts.
For each of the four process scales, a randomized block
factorial design (Kirk, 1969) was used to test the differ
ences between condition (multiple and individual) and time
of measurement (first or last interview). In three in
stances, there were no significant F ratios when these were
computed using the residual error term. As an inspection
of the data suggested a possible interaction between blocks


172
Dreikurs, R., Schulman, B. H. and Mosak, H. Patient-
therapist relationship in multiple psychotherapy: I.
Its advantages to the therapist. Psychiatric Quarterly,
1952, 2_6, 219-227 (a) .
Dreikurs, R., Schulman, B. H., and Mosak, H. Patient-
therapist relationship in multiple psychotherapy: II.
Its advantages for the patient. Psychiatric Quarterly,
1952, 2_6, 590-596 (b) .
Dyrud, J. E., and Rioch, M. Multiple therapy in the treat
ment program of a mental hospital. Psychiatry, 1953,
16, 21-26.
Feldman, T. The tripartite session: A new approach in
psychiatric social work consultations. Psychiatric
Quarterly, 1968, 42_, 48-61.
Fink, H. K. Adaptation of the family constellation in group
psychotherapy. Acta Psychotherapy, 1958, 6_, 43-54.
Fox, J. On the clinical use of the Personal Orientation
Inventory (POI). Mimeographed report, 1965.
Gans, R. W. The use of group co-therapists in the teaching
of psychotherapy. American Journal of Psychotherapy,
1957, 11, 618-624.
Gans, R. W. Group co-therapists in the therapeutic situa
tion: A critical evaluation. International Journal of
Group Psychotherapy, 1962, 12, 82-88.
Godenne, G. D. Outpatient adolescent group psychotherapy:
I. Review of the literature on the use of co-therapists,
psychodrama, and parent group therapy. American Journal
of Psychotherapy, 1964, 18_, 584-593.
Greenback, R. K. Psychotherapy using two therapists.
American Journal of Psychotherapy, 1964 18_, 488-499.
Hadden, S. B. The utilization of a therapy group in teaching
psychotherapy. American Journal of Psychiatry, 1947,
103, 644-688.
Haigh, G., and Kell, B. L. Multiple therapy as a method for
training and research in psychotherapy. Journal of
Abnormal and Social Psychology, 1950, £5_, 659-666 .
Hayward, M. L., Peters, J. J., and Taylor, J. E. Some
values of the use of multiple therapists in the treat
ment of psychoses. Psychiatric Quarterly, 1952, 26,
244-249.


APPENDICES


82
TABLE 20
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS' PRE AND POST
CONCRETENESS SCORES FOR MULTIPLE AND
INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
2.721
(.427)
2.608
(.470)
2.675
(.588)
2.99 3
(.415)
Source
df
MS
F
Blocks
11
. 360
1.93
Treatments
3
Condition (A)
1
.347
1.22
Time (B)
1
.12 6
.68
A x B
1
.558
6.07*
Residual
33
.187
MSA x blocks
11
. 284
M^B x blocks
11
.186
^AB x blocks
11
.092
Total
47
Note: The standard deviations are in parentheses.
*p < .05.
p < .10.
their obtained ratings on the Carkhuff scales, it did not
appear that there was any consistent pattern among the
"counselor" and the "noncounselor" types. Table 36 in
Appendix H shows the types of the therapists along with
the rank orders of their scores on the Carkhuff scales of


62
TABLE 8
MEANS, STANDARD DEVIATIONS, AND THE ANALYSIS OF VARIANCE
SUMMARY TABLE FOR THE THERAPISTS s PRE AND POST RESPONSES
TO TSR ITEM 29 FOR MULTIPLE AND INDIVIDUAL CONDITIONS
Multiple
Individual
Pre
Post
Pre
Post
3.3330
3.8333
3.7500
3.8333
(.9847)
(1.0299)
(.8660)
(.9374)
. Source
df
MS
F
Blocks
11
1.4147
1.89
Treatments
3
Condition (A)
1
.5208
.70
Time (B)
1
1.0208
1.37
A x B
1
.5209
.70
Residual
33
.7481
Total
47
Note: The standard deviations are in parentheses.
p < .10.
in Table 9 shows a significant F ratio for blocks, indi
cating that there were individual differences between the
therapists on this item. The ratios for condition, time,
and the interaction of time and condition were nonsignifi
cant. Hypothesis 8, then, was not supported.
Hypothesis 9.The therapists will be apt in multiple
therapy to rate themselves -as being more helpful to their
patients than in individual therapy (Item 32). This
hypothesis was not substantiated; Table 10 includes no
significant F ratios.


119
his rating of that relationship during his first session
with the second client; the same was true of the association
between the ratings of both terminal sessions. Also, the
total relationship quality ratings of one case (over both
pre- and posttestings) were significantly and positively
related to the ratings of the second case.
The relationship quality scores of the therapists were
compared to their scores on the CRI scales of Affection,
Friendship, Empathy (M), and Being Love, as a way of in
vestigating concurrent validity. There were no significant
correlations found between the ranks of the therapists'
scores on the CRI scales and the ranks of the relationship
quality scores, and,thus, no case for concurrent validity.
Also, there was no evidence that the relationship
quality scores had a potential for prediction, as the total
composite scores of the co-therapist pairs on this measure
were negatively and nonsignificantly correlated with the
S-A Scale scores of their clients (Hypothesis 35).
Co-therapist agreement.--To determine the test-retest
reliability of the co-therapist agreement scores, the same
three comparisons--pre, post, and total--were made of these
scores for the sessions with the first and the second multiply
seen client of each therapist. Again, all of these corre
lations were significant, indicating that the measure of
co-therapist agreement was a reliable one.


88
during the time that they were involved in multiple therapy
were all tested similarly. In each instance, the differ
ence between the pre and post mean of a POI scale was
tested for significance by means of a matched-group t test.
Table 23 lists the means and standard deviations of the
therapists' pre and post scores on four POI scales.
TABLE 23
MEANS AND STANDARD DEVIATIONS OF THE THERAPISTS'
PRE AND POST POI SCORES
Scale
Pre
Post
t
Time-Competence
17.333
(5.246)
19.750
(2.454)
1.84*
Inner-Directed
101.583
(9.549)
103.833
(8.387)
1.78
Capacity for
Intimate Contact
22.917
(2.778)
23.750
(2.221)
1.24
Spontaneity
16.167
(2.082)
15.500
(1.931)
-1.69
Note: The standard deviations are in parentheses.
*p < .05.
p < .10.
Hypothesis 30.The therapists will be more time-
competent at the end of therapy than at therapy's beginning.
This hypothesis was supported, as the posttest mean was
found to be significantly larger than the pretest mean on
the scale of Time-Competence (t = 1.84, p < .05).


136
3. Understood pretty well, but there were some things
he (she) didn't seem to grasp.
4. Didn't understand too well how I thought and felt.
5. Misunderstood how I thought and felt.
39.HOW HELPFUL DO YOU FEEL YOUR THERAPIST(S) WAS (WERE)
TO YOU THIS SESSION? (32)
1. Completely helpful.
2. Very helpful.
3. Pretty helpful.
4. Somewhat helpful.
5. Slightly helpful.
6. Not at all helpful.
SLIGHTLY
OR NOT PRETTY VERY
AT ALL SOME MUCH MUCH
40. DID YOUR THERAPIST(S) TALK? 0
(33)
41. WAS (WERE) YOUR THERAPIST(S)
ATTENTIVE TO WHAT YOU WERE
TRYING TO GET ACROSS? (34) 0
42. WAS (WERE) YOUR THERAPIST(S)
NEGATIVE OR CRITICAL TOWARDS
YOU? (35) 0
12 3
12 3
12 3
43.WAS (WERE) YOUR THERAPIST(S)
FRIENDLY AND WARM TOWARDS
YOU? (36) 0 123
44.DID YOUR THERAPIST(S) SHOW
FEELING? (37) 0
12 3
ADDITIONAL COMMENTS:


110
and their clients deteriorated. It is difficult to ascer
tain exactly what these findings may mean in relation to one
another. However, these data suggest that the interactions
between the presently studied therapists and their clients
were better in the individual than the multiple condition
at therapy's end.
It is crucial to call attention to some facts about
the present research project that may qualify its applica
bility as a test of the multiple therapy so often lauded in
the literature. First of all, the experience level of the
therapists as a whole was low, ranging from six months to
five years; and none of them had had extensive experience
with multiple therapy. Also, none of the multiple thera
pists who participated in this research had done previous
therapy together with an individual client, and only one
pair had collaborated before at all--as group co-therapists
for a single group. Longstanding advocates of multiple
therapy, e.g., the Atlanta group or Elizabeth Mintz, based
their statements on many years' exposure to the technique,
often working with the same partners.
Furthermore, the results--at least on the process
scales--might have been quite different if all high-func
tioning counselors had been included, or even if there had
been some high-high pairs. The implication of Swander's
(1971) findings would be that the partners would not change
their level of functioning in the multiple condition if


5
method, one of the therapists merely observed; they later
modified this so that both actively participated, resulting
in greater gratification for all concerned. Dreikurs (1950)
emphasized the involvement of both therapists in a joint
interview, although only one therapist saw the patient con
tinuously and carried the major responsibility. Dreikurs
felt that this approach had great training potential for
teams consisting of either a senior and a junior therapist
or two experienced colleagues. Haigh and Kell (1950)
stated that the meaningfulness of the multiple experience
for a student was directly related to his degree of in
volvement in the treatment process. They cited the advan
tages that the actual practice of therapy can be introduced
earlier in a students' schooling, and that the experience
should be less threatening than seeing a client alone, due
to the support that the senior therapist can offer.
Dreikurs, Schulman, and Mosak (1952a) lauded this technique
as an "invaluable teaching method," and stated that each
therapist can expand his scope through watching the other.
Hayward, Peters, and Taylor (1952) also proclaimed that
multiple therapy was a good tool for training. Slavson
(1953) saw the use of a co-therapist as a response to
insecurities and inadequacies of therapists; Gans (1957)
felt that these could be ameliorated when a supporting
colleague proffered assistance. Various other authors
have concurred that this approach is of great significance


44
1966b). Responses to these items yield scores for two main
scales and 10 subscales, 4 of which are listed and described
in Appendix F, along with the scale symbols.
This instrument has been shown to have test-retest
reliabilities as high as .93 and .91 (Shostrom, 1964).
Other test-retest coefficients are reported as .71 and .84
for the basic orientation scales (Time-Competence and
Inner-Directed), and as ranging from .55 to .85 for the sub
scales (Klaveter and Magar, 1967). Validity for each of the
POI scales has been examined by its ability to differentiate
between groups of individuals who were reportedly self-
actualizing, normal, or not self-actualizing (Fox, 1965;
Shostrom, 1964).
The pre and post scores of the therapists on the two
major scales of personal orientation (Time Competence and
Inner-Directed) and two of the subscales were used to
detect possible therapist growth during their involvement
with multiple therapy. The two subscales chosen were ones
thought most likely to change on the basis of theory in the
literature (Spontaneity and Capacity for Intimate Contact).
The standard scoring keys distributed by the Educational and
Industrial Testing Service were used.
Multiple Therapy Rating Scale
The Multiple Therapy Rating Scale (MTRS)' was devised
by the author and her co-researcher (Reiner) to tap areas
not covered by the other scales regarding the co-therapists'
perceptions of each other and their relationship.