Citation
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

Material Information

Title:
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
Creator:
Swander, Karen Keck, 1943- ( Dissertant )
Lister, James L. ( Thesis advisor )
Tolbert, E. L. ( Reviewer )
Grater, Harry ( Reviewer )
Kline, William E. ( Reviewer )
Place of Publication:
Gainesville, Fla.
Publisher:
University of Florida
Publication Date:
Copyright Date:
1971
Language:
English
Physical Description:
x, 77 leaves. ; 28 cm.

Subjects

Subjects / Keywords:
Empathy ( jstor )
Group facilitation ( jstor )
Group psychotherapy ( jstor )
Medical treatment ( jstor )
Psychological counseling ( jstor )
Psychotherapy ( jstor )
Ratings ( jstor )
Research facilities ( jstor )
Standard deviation ( jstor )
Undergraduate students ( jstor )
Counselor Education thesis Ph. D
Dissertations, Academic -- Counselor Education -- UF
Group counseling ( lcsh )
Group psychotherapy ( lcsh )
Genre:
bibliography ( marcgt )
non-fiction ( marcgt )

Notes

Abstract:
The purpose of this analogue study was to investigate the effects of therapists' level of functioning as determined by the core facilitative conditions—empathy, respect, genuineness, and concreteness—on their co-therapists' level of functioning and level of activity within multiple therapy. While numerous studies have investigated the importance of facilitative conditions in individual and group therapy, no studies have been reported considering these dimensions within a multiple therapy situation. Seventy-six undergraduate students were given the Counselor Simulation Inventory and their responses v/ere rated by three judges on the Carkhuff scales for empathy, respect, genuineness, and concreteness. Twenty students rated highest and 20 students rated lowest were selected to participate in the study. These 40 therapists were paired ii-U, H-L, and L-L. The purpose of this analogue study was to investigate the effects of therapists' level of functioning as determined by the core facilitative conditions—empathy, respect, genuineness, and concreteness—on their co-therapists' level of functioning and level of activity within multiple therapy. While numerous studies have investigated the importance of facilitative conditions in individual and group therapy, no studies have been reported considering these dimensions within a multiple therapy situation. Seventy-six undergraduate students were given the Counselor Simulation Inventory and their responses v/ere rated by three judges on the Carkhuff scales for empathy, respect, genuineness, and concreteness. Twenty students rated highest and 20 students rated lowest were selected to participate in the study. These 40 therapists were paired ii-U, H-L, and L-L. 3. When a high-functioning non-facilitative therapist and a low- functioning non-facilitative therapist were placed together, their functioning levels decreased significantly (p<.05), the H therapist decreased significantly (p<'.05) in his activity level while the L therapist's activity level remained unchanged, and their client's level of self-exploration decreased. 4. When two low-functioning non-facilitative therapists worked together, their functioning leve].s decreased significantly (p<',05), their activity levels remained unchanged, and their client's level of self-exploration decreased. 5. Client self-exploration in the multiple session of the L-L condition was significantly lower than in the II-H condition (p < .01) . Conclusions and implications from these findings were discussed and suggestions for further research were given.
Thesis:
Thesis--University of Florida.
Bibliography:
Bibliography: leaves 71-75.
Additional Physical Form:
Also available on World Wide Web
General Note:
Manuscript copy.
General Note:
Vita.

Record Information

Source Institution:
University of Florida
Holding Location:
University of Florida
Rights Management:
Copyright [name of dissertation author]. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
Resource Identifier:
029443200 ( AlephBibNum )
AEG6258 ( NOTIS )
014258190 ( OCLC )

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Full Text










An Analoque Stud., of che Effects o"
Therapists' L'evel of Functionir.c on Co-t!her:- oI2t'
Level of Functionring :.rd Ac't'vity Le-:el Within
a Multiple Therapy Situat ion










ByE

Kar-n Keck S-.'an.dler










A D l .SSERT. T Ti PRESE;'iTED TO THZ GEF..DU.k.- ClOl:: L.
OF THE PiTT S.J S T. O' F LC' .i',;. :: 1'AF.T' -.L
FUL 'ILL.-L:.;:' O,-c THE Rf ,',UILF.?.h.:;; FO P'2-
DECG EE F D'I.L'-"? Or" T! IL ;SF:i-Y










UN'"'SIT T' OF FL'ORIDA
1971














ACKNOWLEDGMENTS


The author gratefully acknowledges the aid and support

of the following people for helping to make this dissertation

possible:

Dr. James L. Lister, Chairman of the supervisory com-

mittee, for his general assistance, encouragement, and edi-

torial aid.

Dr. E. L. Tolbert, Co-Chairman of the supervisory com-

mittee, for his generous support and genuine concern.

Dr. Harry Grater, Jr., member of the supervisory com-

mittee, for his encouragement, gentle prodding, and for being

a caring, trusting friend.

Dr. William Kline, member of the supervisory committee,

for his helpful suggestions and continual support.

Dr. Paul Schauble, for his invaluable aid in formulating

the topic and training the raters, and for his concern and

encouragement throughout the project.

Dr. William B. Ware, for his assistance in the design

and analysis of the study, and for his friendly interest in

the author's progress.








Cindy De-.'cy', GCaty i Klukken, and Li.n.'ood Simall., for thoc.1.

chorish,.ed friendships an d their many lvhours sp-nrit in rating

the .data.

The students for tLheir pari-ticipation in this study'.

MLsc. '.oncile SandeLrs, for typing the manuscript.

A cerL7t iin airline, for not .deterLinr the author fLrom her

jgraidua te carcee .

i-lost important_ y., to Jim, .,'hose lo'.'e and infinite en-

coiurag.men t made tlhe ciathIo's griadluate program and this

d.isscrtation a rea:lit-'.














TABLE OF CONTENTS





ACKNOWLEDGMENTS . . . . . . . . . .

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

ABSTRACT . . . . . . . . . . .

CHAPTER

I. INTRODUCTION . . . . . . . .

Statement of the Problem . . . .
Definition of Terms . . . .

II. REVIEW OF RELATED RESEARCH . . . .

History of Multiple Therapy. . .
Research Studies in Multiple
Therapy . . . . . . .

III. PROCEDURE. . . . . . . . .

Subjects . . . . . . . .
Instruments . . . . . .
Raters . . . . . . . .
Method . . . . . . . .
Research Hypotheses . . . .
Analysis of Data . . . . . .

IV. ANALYSIS AND INTERPRETATION OF DATA. . .

Analysis . . . . . . . .
Interpretation of Data . . . .

V. SUM.MARY . . . . . . . . .

APPENDICES . . . . . . . . . . .


Paoe

ii


vi

viii.




1

4
5

6

6

12

18

18
18
21
22
26
27

29

29
40

47

51








TA''.ILE OF CONTENTS (Continued)


P ta e


i L IOGr PHY. . . . .

BIOGr:PH TCAL SKETCH .. ..













LIST OF TABLES


Table Page

1. Ranges and Means on the CSI of Low-
and High-functioning Therapists. . . ... 30

2. Ranges and Means on the Individual
Session Ratings of Low- and High-
functioning Therapists . . . . .. 31

3. Means and Standard Deviations of Level
of Facilitative Conditions of 11 Low-
functioning Therapists in Individual
Sessions and in Multiple Sessions with
Iigh-functioning Co-therapists ...... .32

4. Means and Standard Deviations of Level
of Facilitative Conditions of 11 High-
functioning Therapists in Individual
Sessions and in Multiple Sessions with
Low-functioning Co-therapists . . ... 33

5. Means and Standard Deviations of Level
of Facilitative Conditions of Eight
High-functioning Therapists in Individual
Sessions and in Multiple Sessions with
High-functioning Co-therapists . .. ... 34

6. Means and Standard Deviations of Level
of Facilitative Conditions of Eight
Low-functioning Therapists in Individual
Sessions and in multiple Sessions '.ith
L,o..- functioning Co--lthc- rapis ts . . . .35

7. [-.1K-- s .ind Stan-daid Deviations of Acti" ity
Lev1.' of 11 Lo:.'-funrctioning Therapists in
Inl i'.id .:l S --.sions an(d in i ii l] ti: l.o
Sc:-.si.ons -...ith ih-i.lh-functlio n ng Co-
hepis . . . . . . . .. 35








LIST OF TALES (Continuet:U)


Table Page

3. Means and1 Standard De"iations of Activi.ty
Le.el of 11 High-functioning Therapists
in Indi-.id.ual Scssions and in NlMultiple
Sessions ...ith Lo'.'-functioning Co-
th-rapists . . . . . . . .36

9. M-leans and: Standard Deviat'ions of Acti' ity
Le.'el of Eight [ligh-functioning Therapists
in incli"i.dua Scssions an31 in Multliple
Sessions with -lighl-funEtioning Co-
therapis ts . . . . . . . .7

10. M-eans and] Standard De'.'iations of :crti'.-it
Le''el of Eight Lo'..'-functioning Therr apists
in Individu.ial Sessions and in Mfiitiple
Sessions v.'ith Low-functioning Co-


11. [Mean C.I.ient Self-eploca L ion /ithin

Three Conditions of Therapist Functioning
Lev. el . . . . . . . . ... 39

12. Summarv o of AnalIsis of Va'.riance Compar ing
Client Self-ex;ploration Scores Undr Three
Conditions of Therapist Fu.nctioning
Level . . . . . . . . ... .39


'i i







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

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


By

Karen Keck Swander

December, 1971

Chairman: Dr. James L. Lister
Co-Chairman: Dr. E. L. Tolbert
Major Department: Counselor Education

The purpose of this analogue study was to investigate

the effects of therapists' level of functioning as deter-

mined by the core facilitative conditions--empathy, respect,

genuineness, and concreteness--on their co-therapists' level

of functioning and level of activity within multiple therapy.

While numerous studies have investigated the importance of

facilitative conditions in individual and group therapy, no

studies have been reported considering these dimensions within

a multiple therapy situation.

Seventy-six undergraduate students were given the Coun-

selor Simulation Inventory and their responses .:.'ce rated by

three judges on the Carkhuff scales for enpathy, LopectC,

genuineness, and concretene'33. T'..'ernty lst:ucnts fated highest

ariid 20 students rated lowest '.-ere scrl?._ed to r.pa' 11icirato in

the study. These 40 th 'apis : '..'eLe p: i rc-1 n-if, H-L, and L-L.

'I i







T\'ent. additional students volunteered d to be clients and '..ere

randocmly assigned to the therapist pairs. lach therapist of

the pair sa..,' their client individually fc ollo'.-ed lb a multiple

sess ion.

Ei-ght research Il .potlthses '.-ere generatedd to examine the

fol lowing quns t ions. what are the effects on iheirap[ists'

level of functioning overalll rating on the core faci litative

dimensions of empathy,, respect, genuineness, and concreteness)

'.wlhen placed in multiple situations with high- and lo'.--func-

tio ning ce-tlhe-rapists? W-hat are the effects on therapists'

activity' lev1 el '.-hen placed in multiple situations '.'ith high-

and o'.'--fuanctioning. co-tIherapists? The hypotheses w.ere

fo1Trmulated on the assumption that the study would include

hiigh-fu.nctioningl therapists, those above le.el 3 on the Cark-

huff scales. Since, ho'. 'er, the functioning le'.'ls of the

participants only r.-inged from 1.0Ci to 2.45, the therapists

were actually h'',igh- and lo..'-funct ioningg, nonfacili .tat i'e

therapy sts.

The findings of this study 'w.er-e as follow'...':

1. The CSI ratings correlated .17 (p )..05) with the
indi'.'i.dul.a 1 session tape ratings. Its use in pre-
dict ng function j rig level '.-.'ithin this range .-.'as
found to be ques t .onable.

?. 'When t'-'o high--fu.nliticn ing nonfat ili La ti .e _LL -.aipi ts
w.ork.ad together, their functioning l-'.'el.s remained
unchang,.d, I.heir acti'.'itL level docr-_ased signifi-
cantly (p(<.'-S ) andLl their client's le'.el of self-
ex;ploratiion 'did not change.







3. When a high-functioning non tieci. 1Ltativ.e therapist
and a low-functioning non [-icilitative therapist
were placed together, their functioning levels
decreased significantly (p .05), the H therapist
decreased significantly (p <.05) in his activity
level while the L therapist's activity level re-
mained unchanged, and their client's level of
self-exploration decreased.

4. When two low-functioning nonfacilitative therapists
worked together, their functioning levels decreased
significantly (p< .05), their activity levels re-
mained unchanged, and their client's level of self-
exploration decreased.

5. Client self-exploration in the multiple session of
the L-L condition was significantly lower than in
the H-H condition (p <.01).

Conclusions and implications from these findings were

discussed and suggestions for further research were given.













CHAPTER I

INTRODUCE ION


As the helping professions of counseling and pscho-

therapy develop, innovative and effecti'.'e approaches facili-

tating psychological health are continuous ly. bcng sought.

One method to arouse interest recently is multiple therapy.

As is often the case in the de.-elopment of a ne'-.' approach,

multiple therapy comes under many namees--o-therapy (Lu'ndin

& Aronov, 1952) three-cornered therapy (Bock, L,:..is Tuck,

1954), cooperative psychotherapy (Lott, 1952) d-Hl l-:.dr-

ship (Linden, 1954), and team counseling (iMilar, 193).

The practice of multiple therapy has no sta.idard pr:c,?e..:u;es

other than t1. in''ol'es more than one th-rais t. Thus, there

ha.-. bee: as many as nine (Hay-...ar, Petecs & Taylor, 1952) or

10 ("rent in John-onr & Whitak.er, 1951) therapists :.-oking

.*.'th on.- -n.-i:.vi : ual. In addition to using this mie ih- 1 ...'ith

.e iardiaj ;a t..'. therat ,ist ha. also colloboratL.e to '. .ork

wit! group-. (Euck & Grygier, 1952), couples (Lin:ien, Go:,d-...'in

& Rcc.--.ik, 3) and a fa i lies (Son:.e S, Linico].r. 19,65).

-:hil- :lul lan ,1and Sanguiliar. (196'' define mu.ltipl therapy

a ":.he sirmul -ane.-us thera peuti: approach by t'o or more







separate yet related therapists to a single patient, mL-aricd

couple, family or patient group," Whitakor, Ma-ilone and War-

kentin (1956) more specifically define it as "The treatment

of a single patient by two (or more) psychotherapists who make

up a therapeutic unit." For the purposes of this study, the

latter definition of multiple therapy is used.

One of the more frequent questions asked of supporters

of this approach is how they can justify the use of two pro-

fessionals for one individual when therapeutic skill is at

such a premium. Kell and Burow (1970) respond by stating that

in addition to providing additional learning, multiple therapy

is effective in some situations such as when a therapist and

client have reached a standstill or impasse, and with some

problem areas such as parental conflicts where dyadic therapy

would either not succeed or would take a longer time to

succeed. Whitaker, Malone and Warkentin (1956) concur when

they conclude that "in a considerable number of cases, it

appears that the total financial cost to the patient is less

than the cost with similar cases due to the comparative

brevity of multiple therapy." Further justification of this

approach is given by those who claim its values lie not only

iln I-lh.i tbler.. pu: tic._ c gain for the cli ent bu.t .also that it is

considei.le to be an effect .e anid efficient technique for u.se

in t J.i-ing a d *su er'.is Lon (D'._ud Rioch, 953 ; G c- enl.ank,







1964; Haigh & Kell, 1950; Hay..'ard, Peters & Taylor, 1952- Nel1

& Burow, 1970; and P.osenberg, Rubin & Finzi, 196.) and is

claimed tc be an inobtruciv.e and effective m .eans for con-

ducting research (Haigh & I'ell, 1950; Whitaker, Malone &

Warkentin, 1956). The need remains to experimentally '.-1li-

date these clinical jud-gements; however, for the purpose of

this study, the assumption is made thAt the multiple approach

is a valid one.

For man,,y years the therapeutic relationship retained an

almost sacred status. .'ery. little self or outside critical

evaluation w.as conducted on the processes or outcomes of

therapy. What little evaluation did take place .-.'as usually

subjective and based on clinical judgements by the therapists

and/or self-reports of the clients. Evsenck (1952, 1960,

1965) and Lev'itt (1957, 1963) provided data challenging the

efficacy of psychotherapy by show.'ing Lthere were no avera..ie

differences of change betw..'een treated and non-treated groups.

Their results provided the much needed impetus for numerous

critical and evaluative studies conducted over the past t.'o

decades. Recent research (carkhuff, 1969 a, b; Carkhuff &

Berenson, 19--'7; Trua; & Carkhuff, 1967) has in part explained

sonec of th:- Eycenck and Levitt findings.

The clients of those counselors offe:rinq
the highest levels of facilitati.ve dimensions
improvee', -.h1hle those of counselors offerinri








the lo'..' e t levels IdeL ior at e Ccnmpi sis
in the original on -a varie ty of ind-e::e:s;
tha: is, '..'i th both inprit:ientis and out-
patients, those heIlpiing processes inv.ol'v-
ing the highest levels of counselor empathy,
positive regard, genuineness, concreteness,
and other dimensions, elicit the greatest
therapeutic process movement and ultimately,
the greatest constructive client gains or
changes...Furthermore, since the conditions
of change are not the exclusive property of
professional practitioners, they are available
from non-professional sources (Carkhuff &
Berenson, 1967, p. 23).

Thus, the differential effects of high- and low-functioning

counselors would average out to no differences as shown in

the Eysenck and Levitt studies. Moreover, it is highly pro-

bable that many of the untreated individuals sought help from

high-- and low-functioning non-professionals.


Statement of the Problem

Although there exists substantial amounts of evidence

oi the imptort-ince of fCciliita ive conditions in dyadic and

group [theLpy (Cinrk:huff, 1969 a, b; CnLrkh'iff & Cerenson, 1967;

TL ::.: C-nr khuff, 1967) no studies hli-vye been cornd uc.ted h..;ich

Iha .'e cons idL ered the.e dimensions '..'i th ir ,.i multiple 3 L si untion.

The pLresent stud.yl then, had as its a:im the invest iga t:ion of

the effects of a therapist 's scLre f.ci lit-itive condi t ions--

.,p-l -y, -espect ge!ui i-n.?-ess, and concr:etencss--on his co-

theC:ap : is t's core f-_;lcilit-tiveC con-iditions anid Ievcl of --cti.vity

.'i.-hi .n me:liple the, py Th~er.--,:isi activity level is do i-ned







simply as the total number of responses, including such attend-

ing responses as "urn hmr" cgi"en by the their -pist. t lore speci-

ficalli, the present study, examined the follo'.:ing questions:

1. What are the effects on t-ierapists le.el of
functioning overalll rating on tl-e core facili-
tati.'e dimensions of empTi-tizl', respect, gcenuine-
ness, aind concreteness) %.-hen placed in multiple
sitL.ations A.ri th hicgh- and low-functioni ng co-
th ora pis ts?

2. What are the effects on therapists' acti'.ity
le'el :'..hen placed in multiple situations .-.ith
high- and low-functioning co-therapists?



Definition of Terms

lMultiple therapy the treatment of one indi'"idual 1.by t'wo
therapists.

The:r:apist pe-ron functioning as a h-eipcr in a .co'1,s; l ing
s itua it ion.

FunctioningI le'.'eL therapist's o-.-erall rating on the
Carkhuff core facilitatI.,v dimensions of empathy,
respect, cjenuineness, and: concretene.ss.

Acti.-ity level total nLumber of responses, including
attending responses such as "um hmm, gie.n by
the therapist.

Li'.el of sel f-e:-ploration rating on tIe CarIhuff scale
used to measure the amount and manner in w..hich a
clients discusses personally rele:?nt ciIia trial.













CHAPTER II

REVIEW OF RELATED RESEARCH


The present chapter has been divided into two sections:

(1) history of multiple therapy and (2) research studies in

multiple therapy.


History of Multiple Therapy

The beginnings of multiple therapy are claimed to be

found in the early work of Alfred Adler and his co-workers

at the Vienna Child Guidance Clinics (Dreikurs, 1950; Spitz

& Kopp, 1963). Adler's procedure consisted simply of a

frank discussion between Adler and his co-workers of the

patient's problems in the presence of the patient. Although

the patient did not participate in the discussion, this pro-

cedure appeared to have a therapeutic effect upon him.

Ree.'e (1939) using a social worker and a ps'Ychiatr ist,

,-pp1a-red to be the first to use the joint inter i.ie'.. '.ith one

indi.'idual as a '.:ay, of reducing the i ndli 'idual's distortions

that cLan occur in indi.'idual chei-rapy as a.'well as pro.id ing

'. a1 ul:.le -L in-ini g Cbenefits for the less-experienced thei- pis t.

T.-ainin rg bene fits '.'ore also emphasizec-d 1b [Iladden in 1947 w..'hen







he allo, ced interns and residents to attend group therapy

sessions. Later they '.:ere permitted to participate in the

group interaction and ev.entua lly to alternate as leaders.

Having experimented for three years with "full term"

Imultip le therapy, Wlhitaker, Warkentin, and Johnson (1949)

stated their primary aim w.as to develop the capacity of the

therapist since they- consider the dynamics of psychotherapy

to be in the "person of the therapist." Their long-range

goal consisted of de-"eloping concepts '..'hich would d facilitate

the teaching of psychotherapy. When they fist implemented

this procedure, one therapist sat in the session primarily

as an observer. Ho'-'e"er, this pro.'ed to be unsatisfactory

for both therapists, and the procedure w.,as, therefore, modi-

fied to allow.. both therapists to become acti'.ely invol.ed.

The ne'..' procedure not only alleviated the dissatisfaction

of the therapists, but also ...ras sid to ha'.e facilitated the

therapeutic process. The au-thors felt that the resolution

of disagreements both during and after the interviews made

possible a more complete perception of the therapeutic pro-

cess with the resultant effects of impro.'ing the patient's

progress rnd providing personal and professional growth for

the t heraps i :s. One of the unique aspects of their focus on

professional g.ro'.'th was the fact that the grow.,th 'was intended

for both of the equall-. experienced therapists rather than








primarily for a trainee's professional growth in the more com-

mon supervisor-trainee multiple therapy situations. Continu-

ing their interest in multiple therapy, Whitaker, Warkentin,

and Johnson (1950) introduced another use for the multiple

situation, that of surmounting the inevitable therapeutic

impasses. This "intervention" multiple therapy differed from

their "full term" procedure in that the inclusion of the

second therapist was generally only required for one or, at

most, a few sessions.

While concurring with many of the earlier writers on the

use of multiple therapy as an effective training procedure,

Haigh and Kell (1950) in addition stressed that this approach

can be useful as a psychotherapy research tool. They sug-

gested that the multiple situation would enable the researcher

to hold client variables constant since both therapists are

working with the same client while studying such areas as the

effects of counselor personality on client behavior or the

effects of differing counselor theoretical orientation upon

client behavior.

Dreikurs' (1950) interest in multiple therapy had an

unusual beginning as a result of two incidents. He, with the

patient present, discussed the case of this difficult p.:tient

wit". a class of medical students and, to his surprise, the

patient responded favorably and b-ygan to cooperate in furLther







interviews. The second incident occurred when Creikurs, due

Co an emergency situation necessitating the transfer of his

patients to other therapists, used joint sessions for the

purpose of smoothing but the transfer process. Since this

procedure also proved to be an effective t]-.eL-apeut-ic tech-

nique, he continued to use multiple sessions on a consulta-

tive basis approximately every three sessions e'.-en after the

emergency had abated. In 1952, Dreikurs, Shulma-n, and Mosak

published two articles on the advantages of multiple therapy

for the therapist (1952 a) and for the patient (1952 b).

Their articles also cautioned about the possible pitfalls

which may be encountered by this approach. One such pitfall

is the possibility of competition bet'.'een ther'apists.

Hayward, Peters, and Taylor (1952) suggested that the

multiple procedure, in addition to clearing therapeutic im-

passes and training less-e:-:perienced therapists, can also be

used profitably when dealing .*.'itn the intense ambiv'.lence of

schizophrenic patients. Buck and Grygier (1952) cite as an

advantage of the multiple -:pproach .-.'ith juvenile delinquents,

the increased security and stability' for both delinquents and

therapists. They, furthermore, add the possibilities of com-

bining rese.-rct- '..'ith psychotherapy.

Impro.'-c, -..'or"kincj relationships among staff members in a

mnrital h1._z: tal '..-ere cited as major advantage by Dyrud arid







Rioch (1953). Working out covert competitiveness resulted in

better staff relationships. They also emphasized the use of

multiple therapy for rapid and effective clarification of

difficult transference and countertransference problems, for

use in impasse situations, and as an effective supervisory

technique.

Whitaker, Malone, and Warkentin (1956) broadened their

exploration of multiple therapy to include a thorough exami-

nation of the relationship between the therapists. Prior to

this time, most writers in the field focused on the outcome

aspects by viewing it primarily as a method for training new

therapists, conducting research, promoting therapeutic gains

for the individual, and providing personal and professional

growth for the therapists. By focusing on the process of

multiple therapy and how it differed from individual therapy,

they provided additional information in the area.

In a preliminary report of multiple psychotherapeutic

practice, Mullan and Sangiuliano (1960) suggested that the

use of this method as a symbolic family can be especially

beneficial when working with a child. Some empirical research

(Daniels, 1958; Staples, 1959) shows, however, that Mullan

and Sangiuliano's suggestion does not hold true for groups

of eighth-graders led by male-female co-therapists. Perhaps

it may be correct for children in individual therapy. Mullan







and Sangiuliano further claimed that multiple therapy is

appropriate when the patient and initial therapist are of the

same sex and the patient's difficulty lies in his relation-

ship with the opposite sex.

Five developmental problem areas are presented by Hill

and Strahl (1968) as being especially appropriate for the

multiple therapy approach. They use "multiples" with clients

whose parents' behavior has been inconsistent w.;ith their

feelings, with homosexual clients, with hysterics, with

clients who have an excessive dependence on one parent, ard,

finally, with clients who have been deprived of both parer.ts.

A current book to devote a major portion to mulLiple

therapy was recently published by Kell and Burov..' (1970,.

Having worked with "multiples" for over 1, years, they cocn-

tributed some specific answers to such questions as: Whenr

do you initiate multiple therapy? What type of client can

benefit from this type of therapy? What characteristics con--

tribute to an effective multiple team? and What is the process

of multiple therapy and how does it differ from d.yadic therapy?

Having begun as an occasional technique, multiple therapy

has developed inco, a common approach for specific problem

areas. M:an'. therapists use the approach regularly (HiiJ &

Strahl, 1 6S'3 Kell & Buroi., 19-0,; !Whitaker, 1970) In addi-

c~rOn, se'.,r L coun e in. center. incl '.~.!jin the Un :.r si_- ty of







Florida and Michigan State University routinely employ mul-

tiple sessions as an effective therapeutic tool and for

training purposes.


Research Studies in Multiple Therapy

Only three empirical studies have been conducted using

two therapists with one individual. These studies are pre-

sented below.

Using 24 student counselors and 60 clients, Mallars (1968)

conducted a study comparing the results of a counseling team

approach with those of a standard counseling approach. She

used client, counselor, and supervisor satisfaction as the

criterion of effective counseling. A counseling rating scale,

devised by Mallars and consisting of 25 items "selected from

the literature emphasizing desired goals and methods of coun-

seling," was presented to all clients, counselors, and super-

visors shortly after the terminal interview. They were asked

to evaluate the counseling interaction both for initial and

terminal interviews.

Significant differences of satisfaction
were found between groups using the two
counseling approaches. Client, counselor,
and supervisor were significantly more
satisfied with the team approach than with
the standard approach. Female clients were
found to be significantly more satisfied
than males with the team approach. Males
were significantly more satisfied than females
with the standard approach (pp. 982-983).







Eased on the pr emise that l1e effecti'.'en'ess of multiple

therapy' is largely dependent upon t th the-rapists' satis-

faction '.-.,it each other, Kaimerschen (1 99) and Randolph- (1970)

conducted studies on variablese s '.. within the mrulLiple situation

as related to cc-therapist sat isfacltion. Using 23 therapist

pairs, Kimerschen found the Co-therapist In.entoir, a modifica-

tion of -an dec '..'en 's Famil Concept Q-Socrt, to be a more

direct and sensitive measure of the therapists' relationship

than the InL.etpersonal Check List, a measure devised by the

researcher. She also concluded tiat self-disclosure as

measur-ed b Journrd's Self Disclosure Questionnaire and the

personal, -impersonal dimension of co-therapist selection as

measured by'. a scale de'.-ised by the researchers are '.'ar ables

rele'.'ant tco a therapist's satisfaction with the co--therapy

relationship. Pandclph concluded that: (1) a male therapist's

an-iount of self-disclosure is most indicati'.e of his le.'el of

satisfaction 'with his co-therapist; (2) a female therapist's

beh a'..ic in the, area of .'erbal e:.:pression of affection is

most predict i'.'e of he-rr le-.-l of .a L.isfaction w'.ith her co-

therapist; and (3) multiple therapists' combined le-.el of

self-d.iscclo.ure is most indicativ.'e of their le'.'el of satis-

fact:ion .-. ith each other.

:: though the pre-sent study '..as concerned "-with multiple

situations 'with one indi .idual, a fe.., case studies and








research using two therapists in groups are also mentioned.

The findings in the first two articles (Warkentin, Johnson

& Whitaker, 1951; Singer & Fischer, 1967) are the subjective

impressions of the researchers who presumably were also the

therapists.

Warkentin, Johnson, and Whitaker (1951) studied 25

patients whose number of multiple therapy sessions ranged

from five to 30. The number of therapists varied from two

to 10 but for any given patient the therapists remained the

same throughout. The authors concluded that the patients re-

acted to several therapists in much the same way as patients

do with individual therapists. In some cases, the patients

seemed much more free than in individual therapy to act out

their feelings, both positive and negative. Feeling that his

work with several therapists approximated cultural acceptance,

one patient felt safer in his dependency and less guilty

about his feelings. For some patients, termination took on

more importance, as if they were once outnumbered but now

felt strong enough to face the therapists and leave. Another

conclusion derived from this study was

the personal gro'.'th of the thei-apists
and the corresponding increase in their
enthl.jsiasm for psYchotlhcrap,, are rnajor
b'-prod,.iu ts of this method.. As the
relationship of the therapists to each
other becomes more int-Linate, they develop







a greater therapeutic capacity in their
individual w-..ork w.-ith patients (p. 418).

The use of a male and a female therapist %w-.ith a group

of male homosexual s ..'as reporLted to have positi.-e results

(Sinr-ger & Fischer, 1967). The gr oup had been running for

ocne year v..lith t'..'o male therapists '.w.hen they decided to bring

in a female therapist. "This concrete representation of the

parental dyad allowed for transference distortions to occur

and consequen tly be :.-worked through." After one year, they

reported, the majority of the group members had decreased

their hlomose:
Some we.':re dating ...omen for the first time on a consistent

basis. In addition, 'he majoLrit had increased their work

efficiency and greatly decreased their self-destructive be-

h a io r .

Using "multiple therapy in group counseling and psycho-

therapy.," l"unnelly (19,39) hypothesized that multLiple therapy

groups w',.ould be better than individual l led groups on: (1)

perceptions of father acceptance; (2) perceptions of mother

acceptance; (3) increase in ego strength; (4) increase in self-

acceptance; and (5) decrease in social in tro.ers ion. ie

found no stati.stLical support for hypotheses 2-5. For the

first hy' po t'i: s i :, he Found the mull tiple g-roIup to be sicj-gifi-

cantly better thin the male therapist group but no different








from the female therapist group. The scales he used in the

study were: the Father Acceptance and Mother Acceptance

scales of the Family Relations Inventory, the Total Positive

scale of the Tennessee Self Concept Scale and the Ego Strength

and Social Introversion scales of the Minnesota Multiphasic

Personality Inventory.

In a study of eighth-grade behavior problem boys,

Daniels (1958) found that the male-female co-therapist group

had negative behavior changes while the male-led group and

the female-led group both showed improvement. The boys in

the co-therapist group became more hostile toward school,

more anxious, less confident in themselves and the future,

more reluctant to adopt a male sexual role, and tended to

have more emotional disturbance in general. Using the same

procedure except with eighth-grade girls, Staples (1959)

found that the group led by male-female co-therapists de-

teriorated more than the male therapist group. The male

therapist group, although showing improvement according to

teacher ratings, was found to have deteriorated on adjustment

ratings by psychologists. The female therapist group showed

some improvement on both the teacher ratings and the psycho-

logiss.' rcaLings. Both studies attributed their: results to

the "'t-eplic.:iL ior- of the farmiily constellation ...'iLh its Oedipal

o e.'C o :_oies "








lost of tile material .'it ten on multiple therapy is

theoretical, philosophical or the descriptive impressions

gathered from case studies. Little empirical research has

been conducted on lthlis therapy approach. The research %.which

has been perfoLrmed using tw.'o therapists v.'ith one individual

focused primarily on the satisfaction betw.'een co-therapists

or on the client's satisfaction w'..'ith the therapists. There

have been no studies whichc h have compared ind i'.idual therapy

w..'ith multiple therapy on outcome measures or -v.'hich have

examined the core facilitative i.e conditions of multiple thera-

pists. Despite the impressions of some authors, the research

on multiple therapy v.'ith groups has failed to sho-.' any ad.van-

tage ii ha'.-ing two:o therapists. In some cases, co-therapist

groups e.'re found to ha.-e deleterious effects on group mem-

bers. As the practice of multiple therapy is increasingly

being employed, it becomes evident that e'.a lua ti'.'e research

is gcreatl y needed.














CHAPTER III

PROCEDURE


Subjects

All of the participants in the experiment were University

of Florida (UF) and Santo Fe Junior College (SFJC) under-

graduate students. The "therapists" were selected from the

UF Psychology 300, 309 and Foundations in Education 345 classes

while the "clients" volunteered from SFJC psychology classes

and UF Psychology 201. The decision to use undergraduate

students was based on their availability and their naivete

to counseling techniques. Since the primary purpose of this

study was to examine the effects of therapists' levels of

facilitative conditions within a multiple situation and since

Carkhuff and Berenson (1967) have stated that the core facili-

tative conditions are available from non-professionals as

well as from professionals, it was concluded that students

functioning at the various levels could be used.



Instruments

The Coninselor Simulation Inventory (CSI Appendix A),

administered to students from Psy 300, 309 -and EDF 345, '.-.'as


18







used to determine initial functioning level of the therapists.

This instrument developed by Cannon (1971) is an easily ad-

ministered collection of 13 counseling excerpts which can be

rated for each of the four facilitative dimensions-empathy,

respect, genuineness, and concreteness. Although no validity

information is available on the CSI, Cannon had "surveyed

counselors at Pennsylvania State University, Michigan State

University, and West Virginia University and found levels of

functioning consistent with those reported for professionals

in Beyond Counseling and Therapy by Carkhuff and Berenson"

(Cannon, 1971). Since the respondents are asked to give as

helpfi l a response as possible, it is assume that t;-he..r re-

sponses -..:ill gi.'e a a accurate sample of their .overall le.el]

of funccioninc in a helping situation. Supporting this a-surip-

tion, Greenberg (1969) found the correlation bet:.eei- :.-: itte,

re-spcn-_s to standard client stimuli and responses ..'hen caist

in a -helping role to be positi'.'e, high, and stati-sricall -.

sign fj caii t.

Thei- Carkliuff scales for ermpath"', respect, genuir.er.e.s,

anc. conLeteness (A.ppenrdix E) '.-'er used to rate the therapist's

le-el of functioning. On these 5-point scales, level] 3 is

d ined as t.he minimally facilitativ le .'e of interr.-?e: :l

fur.cticnr._g. -The empathY-, respect, and genuineness scales








were derived in part from "A Scale for
the Measurement of Accurate Empathy,"
"A Tentative Scale for the Measurement
of Therapist Unconditional Positive Re-
gard" and "A Tentative Scale for the
Measurement of Therapist Genuineness or
Self Congruence" respectively, which have
been validated in extensive process and
outcome research on counseling and psy-
chotherapy (summarized in Truax & Cark-
huff, 1967) and in part from an earlier
version that has similarly been validated
(summarized in Carkhuff, 1968; Carkhuff
& Berenson, 1967) (Carkhuff, 1969 b, p.
315).

The concreteness scale was "derived from earlier work (sum-

marized in Truax & Carkhuff, 1967) and has received support

in research on training and counseling (summarized in Cark-

huff, 1968; Carkhuff & Berenson, 1967)" (Carkhuff, 1969 b,

p. 323).

Theoretically and clinically, self-exploration has been

demonstrated to be an antecedent to psychotherapeutic outcome

(Truax & Carkhuff, 1967); therefore, Carkhuff's helpee self-

exploration scale was used to assess the client's level of

functioning. "This scale, derived in part from 'The Measure-

ment of Depth of Intrapersonal Exploration' (Truax & Cark-

huff, 1967), has been validated in extensive process and

outcome research on couiI-.cc-ling and ps .chothe ra-op' (Car.ikhuff,

1')63; C-irkh.irFf Eei.-enson, 1j67; Tl-rua:< C rk1:huff, 1965, 1967) "

(*r-r hui[e 196(9 b, p. 326).








PRaters

Doctoral students in psychology and counselor education

'.ho v.'olunteeed to be trained a s aters, submitted a t-ipe to

a nenber of the Univer-sity of Florida Counseling Center staff

to be rated on the core facilitative dimensions. Those '..ho

scored at level 3 or above on overall le'.'el of functioning

'.ere selected for training. The staff member, '..'ho himself

has proven to be high-funct ioning and has been trained in the

Car-khuff scales, conducted the training sessions. Tapes of

helping situations '.with naive indi'.'iduals :...'ere included in

the training procedure in order to provide the raters '..'ith

experience rating the type of situation used in this study.

Three judges, ..'ho obtained interjudge reliabilities of .30

or abov.'e on the analysis of variance method of determining

interjudge reliabilities (Winer, 1962), w,..ere selected from

the pool of trained students to rate all of the CSI responses

and the tape segments. accordingn g to Carkhuff and Berenson

(1967), there is extensive evidence for the predictive validity

of the scales ..'hcn conducted by high-level f-unctioning helpers.

Furthermore, Carkhuff (1969 b) stated,

From the criterion of meaning, only
individuals '.who are themselves func-
tioning at high levels can rate effec-
tive]y... To develop clinically meaning-
ful earnings it may be necessary for
the rater to listen to the hel]per-helpee







interactions in sequence so that he can
be sensitively attuned to the subtle
nuances in the exchange. In addition, it
is often felt that experienced helpers,
who have themselves demonstrated that
they are functioning at high levels on
the relevant dimensions, are justified
in rating the excerpts simultaneously on
all the relevant scales involved (pp. 232-234).

The judges followed this procedure of rating the interactions

in sequence and of rating the excerpts simultaneously on all

the core facilitative conditions.


Method

Students in Psy 300, 309, and EDF 345 volunteered to

take the CSI within a specified time period early in the

spring quarter of the 1970-1971 academic year. After ratings

on the CSI using the Carkhuff scales were obtained on the

responses, the students who scored 3.0 and above on the over-

all level of functioning (average score on the core facili-

tative dimensions--empathy, respect, genuineness, and concrete-

ness) were designated high-functioning "therapists" while

those who scored below 3.0 were considered to be low-function--

ing "therapists." Twenty highs and 20 lows were selected and

paired into five pairs of highs with highs (H-H), 10 of highs

and lows (H-L), and five of lows with lows (L-L) yielding

data on: 10 H working with an H, 10 H working with an L, 10

L working with an H, and 10 L working with an L.







Twenty "clients,: '.oluriteers from the Psy'chology 201 and

SFJC psychology classes ';ho .'ere '..illing to discuss a real

problem, .we-e then randomly assign-ed to the co-therapist

pair s .

An overvie..' of the method for ea-h pair of tw..'o therapists

is: Therapist A sa'.'w client fr a half-huur. Then thZ r-oist

B sa'.' the same client for a hIalf-hour. Ther-apicts A and B

spent a half-hour together ..'ithout the client, follo-..'ed by a

multiple session of therapists A and B seeing the client for

another half-hour. All individual and multiple sessions :..'er

tape recorded. A more specific procedure discussion fallc..'s:

Five groups of pairs '.ore rrun each ev'enincg for four days.

The follo'...'ing instructions were given verbally to the thera-

pists by the ex:perimenter arnd to the clients by anothe--

doctor-sl student. Half of the therapists .'were asked to re-

port 30 iiir:utes later than the others so that they ..'would

receive their instructions just prior to seeing the client.

In half of the H-L pairs, the high-functioning therapist had

his indi'.-idual session first and in the remaining pairs the

lo..- f.-unctionirLn therapist went first to counter any possible

order effects.

rTher apists

The purpose of this study is to look
aL wa.'ys people help others. Each of '.ou
w..'ill b- seeing a stEudent who -..ill be








discussing his or her problem. Your
role will be to respond to this person
in as helpful a way as possible. The
half-hour session will be tape recorded
and later the tapes will be coded so
that only I will know who the specific
people are on each tape. I will be
giving you additional instructions
after the session is over.

Clients

The purpose of this study is to look
at ways people help others. You have
volunteered to discuss a real problem
with another person. You will be talking
with this person for a half-hour and the
session will be tape recorded. The tapes
will later be coded so that only I will
know who the specific people are on each
tape. I will be giving you additional
instructions after the session is over.

When the first individual session was concluded, the

client received further instructions:

You have just completed a half-hour
session speaking about your problem with
one individual. I would now like you to
see another person and discuss this same
problem with him (or her).

After each of the two therapists had seen the client for

a session, they spent a half-hour together without the client

to enable them to discuss the client's problem and to get to

know one another. Specific instIructions '...ere:

Each of you hav.'e just spent a half-
hour helping another student ...'ith a
personal pr(cblem. 'ou eachi sa'.-' thr same
student. Foc the nc:-:t half-hourir you may
discuss the student, the student's problem,
and get to kno..' a little clbotL each other.







This will not be rape reco-deJ You
will then be seeinr. the student once
again but this time together.

While the two therapists wei-e in the informal sessior.

further instructions were given to the client:

You ha'.'e just completed tw.o half-
hour sessions. You ':-ill n'.. hav.-e abcut
half-hour in w..hich you ma do some
studyinrgr or look at a magazine or just
relax. In a short while you will have
another half-hour to continue talking
about your problerr, this time withh both
of the persons together.

When this final multiple session w'.as finished, all of

the participant? received the following concluding comments:

Thank you for taking the time to
participate in this study. Since the
experiment will be running for two weeks,
I'd greatly: appreciate your not discuss-
ing the study with- anyone until after
that time. You are also asked to keep
the specific information given in the
sessions in confidence as I'm sure you
would in any helping relationship. In
two weeks, I'd be most happy to explain
the study to you if you are interested.
You may phone me, Karen S..' rander, 392-15-5,
anytime between 9 and 5 here at the
Counseling Center. In addition, if any
of you would wish to speak wi.h a counselor,
I'd be happy to make the necessary, arrarne-
ments. Thanks aa in: 'you '".e been ros L
helpful.

Three three-minute secmencs were randomly selected from

the nmiddl- 26 minutes of each session. Since the first

arnd I.:-t t.-.o nmirnutes of each sessic:n. typically consist of

con -. -r. = ti .r, tl, introd.t ct o. arnd con I.udJir-j rerr.arks, they







were eliminated. On each segment ratings by three judges

were conducted on each therapist's level of empathy, respect,

genuineness, and concreteness and on the client's level of

self-exploration.

The total number of therapist responses in each segment

were counted to derive the activity level of each therapist

in each segment. The overall therapist activity level then

was obtained by averaging the total number of responses given

in the three segments of each session. Any verbal response

including such attending responses as "um hmm" were tabulated.

Since this study was concerned with the interactive effects

of high- and low-functioning therapists, it was necessary

to determine their activity level. Although these are gross

measures of activity and although there are no established

optimal levels of therapist activity, it seems evident for

one therapist to have an effect upon another, this would have

to be reflected to some extent in his activity level.


Research Hvootheses

1. There will be an increase in overall level of core
facilitative conditions offered by a low-functioning
therapist when placed in a multiple therapy situation
with a high-functioning therapist.

2. There will be an increase in overall level of core
facilitative conditions offered by a high-functioning
therapist when placed in a multiple therapy situation
with a low-functioning therapist.







3. There b'..ill be no change in overall level of core
faci li tati'.e condi ions offered by a high-functioning
therapist when placed in a multiple therapy situation
..:ith anoth-er ]igh-functioning therapist.

4. There will be no change in overall le.'el of cr're
faciliitatiLv.e conditions offered by a lo'.'-functioning
therapist when placed in a multiple therapy situation
w..ith another low.-functioning therapist.

5. There '.ill be a decrease in the activity level of a
low- functioning therapies t when placed in a multiple
therapy situation w..ith a high-functioning therapist.

6. There '-ill be an increase in the activity le.'el of a
high-functioning therapist 'h.-en placed in a multiple
therapy situation t.with a clow-functioning therapist.

7. There .ill be a decrease in the activity level of a
hi.gh-functioning therapist '.Ahen placed in a multiple
therapy, situation with another high-functioning
therapist.

3. There will be no change in activity level of a low-
funcLtic.ning therapist 'hen placed in a multiple therapy
situation .with another lo..'.-functioning therapist.

The effects of high- and lo:.'-level multiple therapy'

situations on client level of self-exploration ..'ere al-o

examined; how'..'ever, since this '..'as not a major focus of the

study,i directional hypotheses were not stated. A des-cripti .'e

analysis is presented.



Analysis of Data

The research hypotheses as stated are in a mixed mode;

some are stated in a directional form while others are stated

in a null formE. iowe'.er, all hypolIthesese express the expecta-

tions of results from this stud,'.







All eight hypotheses were analyzed by comparing ,iealns of

dependent samples with a two-tailed t test (Wyatt Bridges,

1967). The level of significance considered to be acceptable

for this study was p<-.05. In all cases, the null form of

the hypotheses was submitted to statistical analysis. Two-

tailed tests were completed even though some of the research

hypotheses were directional. This unusual procedure was used

because of the practical importance of detecting differences

in a direction other than that stated in the respective re-

search hypotheses.














CHAPTER IV'

AN.AL'YS:IS ANID TIITERPRETATIO. OF DATA


The first section of this chapter presents information

or the judges' ratings of therapists' functioning loe.el, the

analysis of each of the eight hypotheses, and the analysis

of client self-e:ploration. Only minimum comments are in-

cluded. The second part of the chapter concerns the inter-

pretation of the obtained data.



Anal s is

Although the original design of the study defined high-

functioning therapists as those wh-o were abo-.e le-.'el 3 on the

Counselor Simulation Invent.ry, (CSI) and low.-functioning

therapists as those .w;ho were belov.. level 3, the range of the

76 '.-olunteer-s '..'as 1.0 to 2.38 with a mean of 1.39. Thus, the

top 2) volunteers s cbcarre the high-functioning therapists and

the bottom 20, the lo.,-functioning therapists. The ranges

and means on the CSI for each group are given in the follow,-

ing table.







Table 1

Ranges and Means on the CSI of Low- and
High-Functioning Therapists


N Range Mean

Low-functioning 20 1.0 1.19 1.10

High-functioning 20 1.45 2.38 1.78




Three judges were used to rate the functioning levels of

the therapists on the CSI. The analysis of variance method

of interjudge reliability (Winer, 1962) was used with the

resultant interjudge reliabilities: Empathy, .96; Respect,

.96; Genuineness, .94; and Concreteness, .96. The figures

derived by this method estimate correlations between the

average ratings of these judges with the average ratings of

another set or three judges selected at random.

The purpose in using the CSI was to predict therapist

functioning level in order to pair individuals into co-therapy

pairs of H-H, H-L and L-L for the study. However, using a

Pearson product moment coefficient of correlation (Kirk, 1968),

the 40 CSI ratings in this study were found to correlate .17

(p-y.05) with the 40 individual session tape ratings. Thus,

when the individuals' sessions were rated, 18 of the 40 thera-

pists were misclassified as to whether they were high or low.








Perhaps the CSI is not a predicti.'e measure w'.-hen the range

of functioning le.'el is as narrow as w.-as present in this

study. For t:he purpose of analyzing the data, then, the co-

therapist pairs '.-.ere redesignated H-H, H-L, and L-L on the

basis of their individual session tape ratings. Instead of

fi.'e H-H pairs, 10 H-L pairs, and fi'.'e L-L pairs, there ..-.e-e

four H-H pa-irs, 12 H-L pairs, and four L-L pairs. Further-

more, one of the H-L pairs had to be eliminated from the

study since their multiple session inad.'ertently '..'as not tape

recorded.

The range of functioning le.'els of the 40 therapists

w-.as 1.06 2.483 .*ith an o'.,erall mean of 1.8. The ranges and

means for each group as determined by indi.'idual session rat-

ings ar-e gi'.ven in Table 2.



Table 2

Panges and ileans on the Indi'.'idual Session
Ratings of Low- and High-functioning Therapists



N Range Mlean

Lo'.w-functioning 20 1.06 1.81 1.47

High-functioning 20 1.82 2.48 2.12




Again three judges w.:ere used to rate the therapists'

functioning lev'.els and, in addition, the clients' le.'els of








self-exploration. Using the analysis of variance method to

estimate reliability, the interjudge reliabilities were:

Empathy, .86; Respect, .88; Genuineness, .76; Concreteness,

.74; and Self-exploration, .78.

In presenting the results, each hypothesis will be

stated followed by a table showing the means and standard

deviations of individual session ratings and multiple session

ratings for the group of therapists included in the hypothesis.

All eight hypotheses were analyzed using two-tailed t tests

for the significance of the difference between two means for

correlated samples (Wyatt & Bridges, 1967).


Hypothesis 1

There will be an increase in overall level of core

facilitative conditions offered by a low--functioning thera-

pist when placed in a multiple situation with a high-function-

ing therapist.



Table 3

Means and Standard Deviations of Level of Facilitative
Conditions of 11 Low-functioning Therapists in Individual
Sessions and in Multiple Sessions with High-functioning
Co-therapists


Individual Multiple

;lean 1.59 1.29

Standard De'.iaLion 0.22 0.27







The results of e he test of significance contrasting

these tw.'o means indicated significant differences (t = 5.1777,

df = 10, p .05). It should Le noted that the observed

difference was a decrease; thus, lhypothlesis I ..'as not sup-

por ted.


H e.pot hesis 2

There w',ill be an increase in o'.erall le.'el of core

facilitati.ve conditions offered by a high-functioning thcra-

pist w'.hen placed in a multiple therapy situation with a low-

functioning therapist.



Table 4

Means and Stand-rd De.'iations of Level of Facilitati've
Conditions of 11 High-functioning Therapists in Individual
Sessions and in Multiple Sessions with Lo'.:-functioning
Co-therapis ts


Ind i.'idua 1 Mul t iple

Mean 2.13 1.59

Standard De nation 0.28 0.41




The results of the test of significance comparing these

tv.'o neans indicated significant differences (t = 4.6508,

df = 10, p (.05). It should be noted that the observed

difference '...'as a decrease; thus, hypothesis 2 ...as not sup-

ported.








Hypothesis 3

There will be no change in overall level of core facili-

tative conditions offered by a high-functioning therapist

when placed in a multiple therapy situation with another high-

functioning therapist.


Table 5

Means and Standard Deviations of Level of Facilitative
Conditions of Eight High-functioning Therapists in
Individual Sessions and in Multiple Sessions with
High-functioning Co-therapists

Individual Multiple

Mean 2.08 1.89

Standard Deviation 0.17 0.27




The results of the test of significance contrasting

these two means indicated no significant differences (t =

2.2285, df = 7, p) .05). Thus, the data from this study pro-

vided no evidence contradicting hypothesis 3 and it was not

rejected.


Hypothesis 4

There .-.'ill be no change in o'.'erall le'.el of core facili-

tL ti'.'e conditions offered by a lo'..'-fun clioning therapist ..'hen

placed in a mul.i iple therapy situation :.ith another low-

functioning therapist.








Table 6

lMeans and Standard Deviations of Level of Facilitativ'e
onditonions of Eiglht Lo'.:-functioning Tiherapists in
Individual Sessions and in Multiple Sessions '..'ith
Lo'.-.'-funct ion ing Co-therapists



Individual M1ultiple

Mean 1.34 1.14

Standard Do"iatLion 0.24 0.19




The results of the test of significance comparing these

t'.o means indicated significant differences (t = 3.0704,

df = 7, p <.05) ; thus, hypothesis 4 :..'as rejected.


IHyp'othesis 5

There '.ill be a decrease in activity level of a lo'.-

functioning therapist. when placed in a multiple therapy situa-

tion '..'ith a high-function ing therapist.



Table 7

Means and Standard Deviati.ons of Activity Level of
11 Lo'w-functioning Therapists in Individual Sessions
and in multiple Sessions with High-functioning
Co-Therapists


Individual Multiple

IMean 7.4 3.9

Standard Deviation 2.32 2.23








The results of the Lost of significance contrasting

these two means indicated no significant difference (t =

1.9870, df = 10, p) .05); therefore, hypothesis 5 was not

supported.


Hypothesis 6

There will be an increase in the activity level of a

high-functioning therapist when placed in a multiple therapy

situation with a low-functioning therapist.



Table 8

Means and Standard Deviations of Activity Level of
11 High-functioning Therapists in Individual Sessions
and in Multiple Sessions with Low-functioning
Co-therapists


Individual Multiple

Mean 7.4 3.9

Standard Deviation 2.32 2.23




The results of the test of significance comparing these

two means indicated significant differences (t = 4.0481,

df = 10, p<.05). It should be noted that the observed

difference was a decrease; thus, hypothesis 6 was not sup-

ported.







iy'pothesis 7

There will be a decrease in the activity level of a

high-functioning therapist v.hen placed in a multiple therapy

situation with another high-functioning therapist.



Table 9

leans and Standard Deviations of Acti'.'itv Lev-el of
Eight High-funct ioningq Therapists in Indiv.'id.ual
Sessions and in rMultiple Sessions '.,ith
High-function ing Co-therapists


Individual ilultiple

MIean 5.8 4 .5

Standard Deviation 1.66 1.36




The results of the test of significance contrasting

these two means indicated significant differences (t = 4.3108,

df = 7, p ..05) ; therefore, hypothesis 7 '.-.as supported.


Hypothesis 8

There '.ill be no change in activity level of a low-

functioning therapist .-when placed in a multiple therapy, situn-

tion with another low-functioning therapist.








Table 10

Means and Standard Deviations of Activity Level of Eight
Low-functioning Therapists in Individual Sessions and
in Multiple Sessions with Low-functioning
Co-therapists


Individual Multiple

Mean 5.8 4.5

Standard Deviation 1.66 1.36



The results of the test of significance comparing these

two means indicated no significant differences (t = 1.5613,

df = 7, p> .05). Thus, the data from this study provided

no evidence contradicting hypothesis 8 and it was not re-

jected.

The client level of self-exploration was also examined

although directional hypotheses were not stated since this

was not a major focus of the study. The means are given in

Table 11.








Table 11

Mean Client Self-exploration Within Individual and
Multiple Sessions Under Three Conditions of
Therapist Functioning Level


First Second Individual with Individual with
Therapist Therapist First Therapist Second Therapist Multiple


High High


High -


Low.-


Low Low


An analysis of variance (Kirk, 1968) '.-'as performed on

the levels of client self-exploration ..'ithin the multiple

therapy sessions.


Table 12

Summary of Analysis of .'ariance Comparing Client
Self-exploration Scores under Three Conditions
of Therapist Functioning Level


Source of Sum of Degrees -lean
aviationn Squares of Freedom Squares F

Among Groups 2.6796 2 1.3398 6.57*

Within Groups 3.2627 16 .2039

Total 5.9423 18


*-p <.01


2.64

2.65

1.90


2.48

2.44

1.93


2.63

2.05

1.43







Thus, significant differences at the .01 level were

found among the three groups, H-H, H-L, and L-L, for levels

of client self-exploration in the multiple therapy sessions.

Sheffe's S Method (Kirk, 1968) for pairwise comparison among

the means was performed and the following F's were obtained:

High-High with High-Low F = 4.84 nonsignificant

High-Low with Low-Low F = 4.67 nonsignificant

High-High with Low-Low F = 12.97 p <.01.

Consequently, the significant variance in client self-

exploration was between the H-H and L-L clients. The highest

mean level of client self-exploration was obtained by clients

having two high-functioning therapists, followed next by those

having one high- and one low-functioning therapist, and,

lastly, by those having two low-functioning therapists. The

decreasing trend in client self-exploration, therefore, is

evident in addition to the significant differences found be-

tween the H-H and L-L multiple situations.


Interpretation of Data

One of the significant results of this study concerns

the predictive validity of the CSI. The CSI was intended to

give "very rough estimates of the respondent's overall level

of facilitative functioning" (Cannon, 1971). Although no

validity information was available on the instrument, Cannon







"sur -ey e counselors at Pennsyl'-.ani a State Uni''ersit s flichi-

gan Sta.te Uni'.-ersity and West "'irginia Uni'.-ers it-, and found

le-'els of functioning consistent 'w.'ith those reported foc pro-

fession.als in Ec-ond Counseling ri and TheitrL by Carkhuff and

DEcrenson" (Cannon, 1971)

The CSI ratings in this stud '. w.re found to c-orrelate

.17 (p> .05) w.ith indi.-idual session tape Latingjs; thus, its

use is questionable as a predictive measure '...ith individuals

'w.'hose functioning levels aie apt to be withinn a 1.0 to 2.45

canjge. Some supp(or-t for this finding can be found in a

recent: stu-y conducted by Eellan ti (1971) at Penns',L-.-ni.a

State Uni'-eLsitv. He collected pre-and post-CSI r-ating3 and

coached-client inter-.ie..' tape ratings (CCI) on 87 indi-iduals

in an encounteLr group e:-:perience. Their range of functioning

le'.els '..'as 1.0 to 1.9. A though he obtained significant

changes on the CCI ratings, the CSI ratings did not change

significantly indicating that the CSI is not a sensitive

instrumennt i '..,ith this r:-ange. Perhaps the _CSI would ha .e more

predictive or concurrent validity if tie range of functioning

le'-els in this study had included high-functioning indi'.iducals.

Further research is needed to replica te or re fute. the finding

in this study as '..'ell as to in'rostigate the CSI's '.-al.li yt,

'..'ith a w:ider range of therapist functioning le-.els.







There were considerable differences between the CSI

interjudge reliabilities and the individual session tape

interjudge reliabilities. On the CSI, the therapists gave

one response per excerpt whereas during the individual

sessions the therapists gave as many as 11 responses per

three-minute segment. It would seem likely that the raters

would have a higher possibility of agreement when rating

one response rather than many responses.

The eight research hypotheses were generated on the

premise that high-functioning therapists--those who score

about 3.0 on the Carkhuff scales--as well as low-functioning

therapists--those below 3.0--would participate in the study.

Since, however, the range of overall functioning levels of

the 76 volunteers was only 1.0 to 2.38, all of the therapists

were actually low-functioning in terms of the Carkhuff scales.

The mean level of functioning for the 40 therapists was 1.8

which is similar to the mean functioning levels of under-

graduate students found in other studies, 1.87 (Kratochvil,

Aspy, & Carkhuff, 1967), 1.9 (Carkhuff, Piaget, & Pierce,

1968), 2.03 (Holder, Carkhuff, & Berenson, 1967), and 2.06

(Piaget, Berenson, & Carkhuff, 1967). In view of this, the

hypotheses must be interpreted while considering that the

high- and low.-functioning therapists were, in actuality,

high- and low'.-functioning, nonfacilitativ.e therapists. In







the discussion to follow'..', H therapist sh.all refer to high-

functioning, .onfacilitatijve therapist: like-.'ise L thcrspist

shall refer to low-functioning, nonfacil tati'.,e therapist.

The first four hypotheses '..ere concerned with tne effects

on therapists' functioning level when placed in multiple

situations '' itih high- and lo'.-functioin.in co-therapists. When

an L therapist w'as 'with an H therapist, his functioning level

decreased significantly. An H therapist with an L therapist

decreased significantly in his overall lev-el of functicning.

In addition, an L therapist's functioning level while working

w..'ith another L therapist also decreased significantly. These

results indicate that the presence of an L therapist has a

negative effect on the co-therapist and a cumultie'. nega-

tiv.e effect since his o'..'n functioning level also decreases.

However, '.;hen an H therapist worked with another H therapist,

there -..was no significant change in his functioning le'.el. It

appears, then, that no additional harm is dor.e '..'-en tw.'o H

therapists choose to work togeth-r but that there is signifi-

cEnt ne.-.a.tirve change ..'ith an H therapist and an L therapi.st

or .'-he-i t..'o L therapists w..'ork together.

The last four hypotheses w...ere concerned twhith the effects

on therapists' activity le-.el '.when placed in multiDle situa-

tions '...'ith high- and low'-funictioning co-therapists. When an

, ther :pi;Ci w,.'as working w..'ith an H therapist, there '..a.. no







change in his activity level. Apparently the H therapist was

not functioning high enough to have an effect on the activity

level of the L therapist. When, however, an H therapist was

placed with an L therapist, his activity level decreased

significantly. The H therapist, unable to withstand the nega-

tive effect by the L therapist on his functioning level,

decreased in his activity. in a multiple situation where an

H therapist was working with another H therapist, his activity

level decreased significantly. Since there had been no change

in the H therapist's functioning levels in this situation,

they were both pulling about equal weight in the session re-

sulting in a decrease in activity level. When, however, an L

therapist worked with another L therapist, there was no change

in his activity level. Thus, it appears that in this situa-

tion where the L therapists decreased in their functioning

levels, they persisted in their activity levels. This could

result in having a cumulative negative effect on client

functioning level and activity within therapy. While further

research needs to be done to determine optimal activity

levels, it would seem that the more responses a client re-

ceives from a nonfacilitative therapist or therapists, the

greater the possibility of destructive consequences.

The results of client self-exploration (DX) support the

conclusions derived from the therapist data. In the H-H







multiple situation, the therapists' functioning levels re-

mained unchanged from individual to multiple sessions, and

the level of client DX also remained the same. In the H-L

condition, both therapists decreased in functioning level

and vwh-ile client DX w..as somew..'hat higher in the H indi.'idual

session than the L individual session, it decreased con-

siderably in the multiple session. In the L-L situation,

both therapists decreased in functioning Lev.el, and client

DX, already low in the individual sessions, dropped even

further in the multiple session. Client DX .was highest in

the H-H condition, next in the H-L, and lowest in the L-L

si tua tion.

The results of the three multiple therapy situations

may be summarized as follows:

High with High

1. Functioning level of both therapists
remained unchanged.

2. Activity level of both therapists
decreased.

3. Impact upon client self-exploration
unchanged.

High with Low

1. Both therapists decreased in functioning
level .

2. H therapist decreased in activity level.







3. L therapist's activity level unchanged.

4. Negative effect on client self-exploration.

Low and Low

1. Both therapists decreased in functioning
level.

2. Both therapists remained the same on
activity level.

3. Negative impact on client self-exploration.

Since the functioning levels of most professionals in

the helping services also are below level 3 (Carkhuff & Beren-

son, 1967; Lister, 1970), the results of this study have

direct implications for those who practice multiple therapy.

Two therapists of higher nonfacilitative levels of core con-

ditions may work together with no negative effect on each

others functioning levels and with no negative effect on the

level of client self-exploration. When, however, one 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.













CHAPTER V

SUMMARY


Although numerous studies have investigated the impor-

tance of facilitative conditions in individual and group

therapy (Carkhuff, 1969 a, b; Carkhuff & Berenson, 1967; Trua::

& Carkhuff, 1967), no studies have been reported considering

these dimensions within a multiple therapy situation. There-

fore, the purpose of this analogue study was to investigate

the effects of therapists' le'.-el of functioning as determined

by the core facilitative conditions--empath', respect,

genuineness, and concreteness--on their co-therapist's level

of functioning and le'.el of acti'.iity within n multiple therapy .

Sev'ent.y-six urndergraduate students wer-e giv'.en the Coun-

seicr Simr'. n:-tion Inv.enltori' and- their responses .'ere rated

by three judges on the Carkhuff scales for emp:ithy, respect,

9enuinene3=, and concr.eten-.ss. Tw.enty students rated highest

and 20 Zstui-:-:nt rated lo'.-.est :.were selected to participate in

the study. These 40 therapists :.'ere paired H-H, H-L, and

L-L. T'.-.'.n-' add ition c: rl scuents volunteered to be clients

and -..re r:,.dc ly as ,igi-ed to tihe ther:ipist pairs. Each








therapist of the pair saw their client individually followed

by a multiple session.

Eight research hypotheses were generated to examine the

following questions. What are the effects on therapists'

level of functioning (overall rating on the core facilitative

dimensions of empathy, respect, genuineness, and concrete-

ness) when placed in multiple situations with high- and low-

functioning co-therapists? What are the effects on thera-

pists' activity level when placed in multiple situations with

high- and low-functioning co-therapists? The hypotheses were

formulated on the assumption that the study would include

high-functioning therapists, those above level 3 on the Cark-

huff scales. Since, however, the functioning levels of the

participants only ranged from 1.06 to 2.45, the therapists

were actually high- and low-functioning, nonfacilitative

therapists.

The findings of this study were as follows:

1. The CSI ratings correlated .17 (p) .05) with the
individual session tape ratings. Its use in pre-
dicting functioning level within this range was
found to be questionable.

2. When two high-functioning nonfacilitative therapists
worked together, their functioning levels remained
unchanged, their activity level decreased signifi-
cantly (p <.05) and their client's level of self-
exploration did not change.








3. When a high-functioning nonfacilitative therapist
and a low- functioning nonfacilitative therapist
were placed together, their functioning levels
decreased significantly (p < .05), the H therapist
decreased significantly (p <.05) in his activity
level while the L therapist's activity level re-
mained unchanged, and their client's level of
self-exploration decreased.

4. When two low-.-functioning nonfacilit at ie therapists
worked together, their functioning levels decreased
significantly (p < .05), their activity levels re-
mained unchanged, and their client's level of self-
exploration decreased.

5. Client self-exploration in the multiple session
of the L-L condition wvas significantly low'.er than
in the H-H condition (p <.01).

From these results, it was concluded that two therapists

of higher nonfacilitative levels of core conditions may .work

together .-.ith no negative effect on each others functioning

level and w',ith no negative effect on their client's level of

self-exploration. When, on the other hand, a lo'.-functioning

nonfacilitati'.'e therapist works with another nonfacilitative

therapist, there will not only be a negative effect on each

others functioning level, but on the level of client self-

exploration as well.

This study examined some of the effects of high- and low-

functioning therapists in terms of their level of functioning

and activity levels. Since there are no established optimal

levels of activity for therapists, additional studies could

be conducted focusing on the effects of varying amounts and








types of activity within therapy. The use of the CSI was

found to be questionable with this range of individual func-

tioning levels. Further research should investigate the use

of the CSI or similar written response inventories for use

in therapy research, not only for this range of functioning

levels, but with high-functioning therapists as well. One

of the limitations inherent in this study concerns the length

of available time for the sessions. It would be of interest

to see if these or varying results are obtained over a longer

period of time. Additional research is suggested to replicate

the results of this analogue study using actual therapists

instead of undergraduate students. Furthermore, research

should be conducted on multiple therapy which includes high-

functioning individuals.







































APPENDICES














APPENDIX A

COUNSELOR SIMULATION INVENTORY


Following are 13 excerpts containing statements made by

students in individual counseling interviews.

The statements are taken from different students, so do

not attempt to relate any of the excerpts when formulating

your responses.

Your role is that of a person who is trying to be as

helpful as possible to this student who has come tdoyou in a

time of need.

For each excerpt, imagine that the student is sitting

across from you, that he (she) is speaking directly to you,

and that there is no one else in the room.

For each excerpt, write out in the space provided what

you would say to this student. Please use the exact wording

you would use if you were actually speaking to the student.








Exce-rpt 1



She is so phony I can't believe it' She's w.-orn that fake
smile the ,whole tl.wo months we'.'e been rooming together. And
then--behind my back--she spreads rumors about me and mv boy-
friend, and tells other kids ho'./ she can't sta nd to room with
me. Boy, I'd like to just .'ipe that smile off her face and
really tell her what I think of her.


(Your Response)


Excerpt 2



Gee, I don' t know what I'm gonna do. I've been here almost
three months now, and I haven't made a single friend. I talk
with the kids in my classes, and I cjo to the mixers, but no-
body seams to like me. I just want to -go home and forget
about stupid old college.

(Response) 2.


_ _


--









Excerpt 3


That little bitch: Oh, I could rip her eyes out: She's been
wearing my pin for six weeks now, and yesterday I find out
she's been dating at least two other guys steadily. She tells
me she loves me and talks about marriage, and now I find out
that after I took her home she would go out with another guy.
God! I could wring her cheating little neck!


(Response)


Excerpt 4


Who do you think you are?! You call yourself a sensitive
person: Damn! Here I am spilling my guts out to you and all
you do is look at the clock. You don't even hear what I say.
Your responses aren't attuned to what I'm saying. You're so
wrapped up in your own world. I never heard of such helping.
I--ah--it makes me so god damn mad:


(Response) 4.









Excerpt 5


I finally found some kids I can really get along with.
They're just natural and real, and they really understand me.
I can hardly wait to be with them. I don't know, it's like
I can really be myself. Nlo criticism, no phoniness. They're
just great:--it's the best thing that's happened to me since
I came to college.


(Response)


Excerpt 6


Boy, if that Dr. wasn't a professor and an old man,
I'd smash him right in the mouth' He gave me a week's ex-
tension on this term paper, because I had to go home, and then
he lowered my grade from a B to a D because he said the paper
was late regardless of the extension. Ah--I'm so mad I could
tear this whole school apart.


(Response) 6.


~









Excerpt 7


I'm so disappointed. I thought we could get along so well
together and you could help me. But you don't understand me.
You don't know I'm here. I don't even think you care for me.
You don't really hear me when I talk; you seem to be some-
where else. Your responses are independent of anything I
have to say. I don't know where to turn. I'm just so--dog-
gone it--I don't know what to do, but I know you can't help
me. There is just no hope.


(Response)


Excerpt 8


I really don't know what to do. I slept with Jerry because
I thought I really loved him. Now, he's dating other girls
and I find out I'm pregnant. I don't want to tell him and I
just can't tell my parents. Oh--I wish I was dead.

(Response) 8.










Excerpt 9



I'mn so glad I found a person like you. I really didn't think
any existed. You're al:.'ays right with me; you seem to under-
stand e:-:actly ho'.: I'm feeling. It's just great' I feel like
I'm coming aliv'.e again.


(Response)


Excerpt 10



Wow--I feel like a new '..'oman. We're so much in lo'e. I
never knew: sex could be so beautiful. I feel like Alice in
Wonderland--like there's a whole beautiful world out there I
didn't know existed.


(Response) 10.


~


__




_ ~~









Excerpt 11


I just don't know what to do. I have all my exams in three
days next week, and I can't possibly do all the reading by
then. I just wish I could quit and say to hell with the
whole thing. I've never felt so low.


(Response)


11.


Excerpt 12


It's fantastic. As soon as I finish exams, I've got a job
with a summer stock company. What a chance to try out my
wings: It's like the whole future is opening up to me, and
I just know I can make the most of it.


(Response) 12.




59



Excerpt 13


Silence. (Student does not speak; simply' looks nervous and
moves aboul in chair)

(Response) 13.














APPENDIX B


SCALE 1
EMPATHIC UNDERSTANDING IN INTERPERSONAL PROCESSES:
A SCALE FOR MEASUREMENT


Level 1

The verbal and behavioral expressions of the first per-
son either do not attend to or detract significantly from the
verbal and behavioral expressions of the second persons) in
that they communicate significantly less of the second per-
son's feelings than the second person has communicated him-
self.

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 pre-
conceived frame of reference which totally ex-
cludes that of the other personss.

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 de-
tract significantly from the communications of the second per-
son.


Level 2

While the first person responds to the expressed feel-
ings of the second personss, 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 surfaccl feelings of the second person, but
his communications drain off a level of the affect
and distort the level of meaning. The first person




61


may communicate his o...n ideas of '.'hat may be
going on, but these are not con.ruent '..ith the
expressions of the second person.

In summary, the first person tends to respond to other
than ''hat the second person is expressing or indicating.


Level 3

The expressions of the first person in response to the
expressed feelings of the second persons) 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 understand-
ing 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 to
neither 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 facilitativ.e interpersonal
funct ioning.


Le.el 4

The responses of the first person add noticeably to the
expressions of the second persons) in such a way as to ex-
press feelings a level deeper than the second person '.-.as 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 .-.'as unable to express previously.

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 persons)
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 on going deep self-exploration on the second
person's part, to be fully with him in his deepest moments.

Examples: The facilitator responds with accuracy to all of
the person's deeper as well as surface feelings.
lie is "together" with the second person or "tuned
in" on his wave 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 who the other person is and a comprehensive and
accurate empathic understanding of his deepest feelings.




SCALE 2
THE COMMUNICATION OF RESPECT IN INTERPERSONAL
PROCESSES:
A SCALE FOR MEASUREMENT


Level 1

The verbal and behavioral expressions of the first per-
son communicate a clear lack of respect (or negative regard)
for the second personss.

Example: The first person communicates to the second person
that the second person's feelings and experiences
are not worthy y of consideration or that the second
person is not capable of acting constructively.
The first person may become the sole focus of
eva lua t ion.

In summary, in many v.'ays the first person communicates
a total lack of respect for the feelings, experiences, and
potentials of the second person.




63


Level 2

The first person responds to the second person in such a
w'.ayv as to communicate little respect for the feelings, ex-
periences, 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 w.'ays 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 po-
tentials.

Example: The first person communicates respect and concern
for the second person's ability to express himself
and to deal constructively 1.'ith 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 enables the second per-
son to feel free to be himself and to experience
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 potentials
as a free individual.

Example: 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.




SCALE 3
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 re-
sponses are negative in regard to the second persons) 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 persons) and this 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 persons)
and his current verbalizations. Where there is no discrepancy,
the first person's reactions are employed solely in a des-
tructive fashion.


Level 2

The first person's veerbalizations are slightly unrelated
to what he is feeling at the moment, or when his responses
ace genuine they ate negative in cegard to the second person;




65



the first person does not appear to kno.. how' to employ his
negative reactions constructively as a basis for inquiry into
the relationship.

Example: The first person may respond to the second persons)
in a "professional" manner that has a rehearsed
quality or a quality concerning the '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 re-
sponses are negative and he is unable to employ them as a
basis for further inquiry.


Level 3

The first person provides no "negati'.'e" cues between
'.-.hat he says and '..what he feels, but he provides no positive
cues to indicate a really genuine response to the second
personss.

Example: The first person mayl' listen and follow the second
persons) 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
ant, real involvement either. Le'.'el 3 constitutes the minimal
level of facilitative interpersonal functioning.


Level 4

The facilitator presents some positive cues indicating
a genuine response (v.hether positive or negative) in a non-
destructive manner to the second personss.

Example: The facilitator's expressions are congruent with
his feelings, although he mayi be somew..ha.t hesitant
about expressing them fully.

Tn summary, the facilitator responds '.with many of his
ow.n feelings, and there is no doubt as to whthther he really
means w.'hat he says. He is able to employ his responses,
..'hate-.ver 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 personss.


Example:


The facilitator is completely spontaneous in his
interaction and open to experiences of all types,
both pleasant and hurtful. In the event of hurt-
ful 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.




SCALE 5
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 persons) to deal only with vague and anonymous
generalities.


Example:


The first person and the second person discuss
everything on strictly an abstract and highly in-
tellectual lev.el.


In summary, the first person makes no attempt to lead
the discussion into the realm of personally relevant specific
situations and feelings.


Level 2

The first person frequently' leads or allow..'s even discus-
sion of material personally cele'.ant to the second persons)
to be dealt '..'ith on a .vaue and abstract lev.el.

Example: The first person and the second person may dis-
cuss the "real" feelings but they do so at an







abstract, intellectualized le-.el.

In summary, the first person does not elicit discussion
of most personally rele-.ant feelings and experienLces in spe-
cific and concrete terms.


Level 3

The first person at times enables the second persons)
to discuss personally rele'.'ant material in specific and
concrete terminology.


Example:


The first person will make it possible for the
discussion w:ith the second persons) to center
directly around most things that are personally
important to the second personss, although
there w-,ill continue to be areas not dealt with
concretely and areas in which the second person
does not dev'.elop fully in specificity.


In summary, the first person sometimes guides the dis-
cussions into consideration of personally relevant specific
and concrete instances, but these are not always fully
developed. Level 3 constitutes the minimal level of facili-
tati.'e functioning.


Level 4

The facilitator is frequently helpful in enabling the
second persons) 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 ex-
periences.








Level 5

The facilitator is always helpful in guiding the dis-
cussion, so that the second persons) 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 ex-
pression of all personally relevant feelings and experiences
in concrete and specific terms.




SCALE 8
HELPEE SELF-EXPLORATION IN INTERPERSONAL PROCESSES:
A SCALE FOR MEASUREMENT


Level 1

The second person does not discuss personally relevant
material, either because he has had no opportunity to do such
or because he is actively evading the discussion even when
it is introduced by the first person.

Example: The second person avoids any self-descriptions or
self-exploration or direct expression of feelings
that would lead him to reveal himself to the first
person.

In summary, for a variety of possible reasons the second
person does not give any evidence of self-exploration.


Level 2

The second person responds with discussion to the intro-
duction of personally relevant material by the first person
but does so in a mechanical manner and ..'ithoi.t the demonstra-
tion of emotional feelings.

Example: The second person simply discusses the material
without exploring the significance or the meaning
of the material or attempting further exploration








of that feeling in an effort to uncover related
feelings or material.

In summary, the second person responds mechanical ly and
remotely to the introduction of personally relevant material
by the first person.


Level 3

The second person voluntarily introduces discussions of
personally relevant material but does so in a mechanical
manner and without the demonstration of emotional feeling.

Exiimple: The emotional remoteness and mechanical manner of
the discussion give the discussion a quality of
being rehearsed.

In summary, the second person introduces personally
relevant material but does so without spontaneity or emotional
proximity and withoutut an in;.ward probing to discover new feel-
ings and experiences.


Level 4

The second person voluntarily introduces discussions of
person-lly relevant material with both spontaneity and eno-
tional proximity.

Example: The voice quality and other characteristics of the
second person are very much "w.'ith" the feelings and
other personal materials that are being verbalized.

In summary, the second person introduces personally
relevant discussions wiith spontaneity and emotional proximity
]but withoutou t a distinct tendency tow..ard i n'.ard prob-ing to dis-
cover new.,' feelings and experiences.


Level 5

The second person actively and spontaneously engages in
an inward probing to discover new.., feelings and experiences
about himself and his world.

Example: The second person is searching to discover new




70


feelings concerning himself and his world even
tlhoui.-j at the moment he ma' perhaps be doing so
fearfully and tentati'vely.

In summaLry, the second person is fully' and actively
focusing upon himself and explor-ing himself and his '.w.oL-d.














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BIOGRAPHICAL SKETCH


Karen Keck Swander was born July 26, 1943 in Watertown,

Wisconsin. In August, 1968, she married James E. Swander.

In June, 1961, she was graduated from Oconomowoc High

School. After attending the University of Wisconsin and

Wisconsin State University at LaCrosse, she received her

Bachelor of Education degree from Wisconsin State University

at Whitewater in January, 1966. From January, 1966, to

June, 1966, she was employed in the New Berlin, Wisconsin

school system as a seventh grade English and Social Studies

teacher. After attending summer school at the University of

Wisconsin at Milwaukee, she enrolled in the Department of

Counselor Education at the University of Florida where she

received her Master of Education degree in August, 1967.

During this time, she was employed as a graduate assistant

in the Department of Curriculum and Instruction and as a

resident assistant for the Division of Housing. From Septem-

ber, 1967, to June, 1968, she was employed as a teacher-

counselor in the Department of Comprehensive Logic '..'hile con-

tinuing her doctoral studies. During the summer of 1968, she







worked as a vocationall counselor at the University of Florida

Counseling Center follo'..'ed by' a counseling internship there

from September, 1969 to June, 1969. Since September, 1969,

she has been employed as a counseling psychologist at the

Uni.'ersitv of Florida Counseling Center.

Mrs. S'..'ander is a member of Kappa Delta Pi, an associate

member of the American Psychological Association, and a stu-

dent member of the Association for Women in Psycholo.gy, the

American Personnel and Guidance Association and the Associa-

tion for Counselor Education and Supervision.














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.






amy 'L. Lister, Chairman
Professor of Education





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.



I I


E. L. Tolbert, Co-Chairman
Associate Professor of Education





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.






Harry Grater, Jr.
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..






Willia.1 E. 1l-, e
Associate Professor of Educationi





This dissertation was submitted to the Pean of the Coll]e-e
of Education and to the Gra:duate Co.!ncil, and '.:.': accepted
as partial fulfillment of the requirerment-s for 'the ldegree of
Doctor of Philosophy.

December, 1971



Dean, Coll. .. ,1 uct1 t n

Dean, Colleqe- o/f F.ducati1On


Dearn, Graduate School




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PAGE 1

An Analogue Study of the Effects of Therapists' Level of Functioning on Co-thsrapis ts ' Level of Functioning and Activity Level Vj'ithin a Multiple Therapy Situation By Karen Keck Swander A DISSERTATIOW PRESENTED TO THE GRADUATE COUi.'CIL OF THE milWiRSlTY OF FLCRIIDA IN PARTIAL FUI.FILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UN1\/SRSITY OF FLORIDA 1971

PAGE 2

ACKNOWLEDGMENTS The author gratefully acknowledges the aid and support of the following people for helping to make this dissertation possible: Dr. James L. Lister, Chairman of the supervisory committee, for his general assistance, encouragement, and editorial aid. Dr. E. L. Tolbort, Co-Chairman of the supervisory committee, for his generous support and genuine concern. Dr. Harry Grater, Jr., member of the supervisory committee, for his encouragement, gentle prodding, and for being a caring, trusting friend. Dr. William Kline, member of the supervisory committee, for his helpful suggestions and continual support. Dr. Paul Schauble, for his invaluable aid in formu.lating the topic and training the raters, and for his concern and encouragement throughout the project. Dr. William B. Ware, for his assistance in the design and analysis of the study, and for his friendly interest in the author's progress. IX

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Cindy Dewey, Gary Klukken, and Linwood Small, for their cherished friendships and their many hours spent in rating the data. The students for their participation in this study. Mrs. Voncile Sanders, for typing the manuscript, A certain airline, for not deterring the author from her graduate career. Most importantly, to Jim, v/hose love and infinite encouragement made the author's graduate program and this dissertation a reality. Ill

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TABLE OF CONTENTS Page ACKNOVvLEDGMENTS ii LIST OF TABLES ,^i ABSTRACT viii CHAPTER I. INTRODUCTION 1 Statement of the Problem 4 Definition of Terms 5 II. REVIEW OF RELATED RESEARCH 6 History of Multiple Therapy 6 Research Studies in Multiple Therapy 12 III. PROCEDURE 18 Subjects 18 Instruments 18 Raters 21 Method 22 Research Hypotheses 26 Analysis of Data 27 IV. ANALYSIS AND INTERPRETATION OF DATA. ... 29 Analysis 29 Interpretation of Data 40 VSUMMARY 47 APPENDICES 51 IV

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TABLE OF CONTENTS (Continued) Page BIBLIOGRAPHY ji BIOGRAPHICAL SKETCH 75

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LIST OF TABLES Table Page 1. Ranges and Means on the CSI of Lowand High-functioning Therapists 30 2. Ranges and Means on the Individual Session Ratings of Lowand Highfunctioning Therapists 31 3. Means and Standard Deviations of Level of Facilitative Conditions of 11 Lowfunctioning Therapists in Individual Sessions and in Multiple Sessions with High-functioning Co-therapists 32 4. Means and Standard Deviations of Level of Facilitative Conditions of 11 Highfunctioning Therapists in Individual Sessions and in Multiple Sessions with Low-functioning Co-thcrapis ts 33 5. Means and Standard Deviations of Level of Facilitative Conditions of Eight High-functioning Therapists in Individual Sessions and in Multiple Sessions with High-functioning Co-therapists 34 6. Means and Standard Deviations of Level of Facilitative Conditions of Eight Lowfunctioning Therapists in Individual Sessions and in Multiple Sessions with Lowfunctioning Co-thorapists 35 7. Means and Standard Deviations of Activity Level of 11 Lov/functioning Therapists in Individual Sessions and .in Multiple Sessions with High-functioning Cotherapists 35 VI

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LIST OF TABLES (Continued) Table 8. 9. 12 Level Summary of Analysis of Variance Comparing Client Self-exploration Scores Under Three Conditions of Therapist Functioning Level Page_ Means and Standard Deviations of Activity Level of 11 High-functioning Therapists in Individual Sessions and in Multiple Sessions with Low-functioning Cotherapists ^^ Means and Standard Deviations of Activity Level of Eight High-functioning Therapists in Individual Sessions and in Multiple Sessions with High-functioning Cotherapists o^ 10. Means and Standard Deviations of Activity Level of Eight Lowfunctioning Therapists in Individual Sessions and in Multiple Sessions with Low-functioning Cotherapists no 11. Mean Client Self-exploration Within individual and Multiple Sessions Under Three Conditions of Therapist Functioning 39 39 Vll

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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 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 By Karen Keck Swander December, 1971 Chairman: Dr. James L. Lister co-chairman: Dr. E. L. Tolbert Major Department: Counselor Education The purpose of this analogue study was to investigate the effects of therapists' level of functioning as determined by the core facilitative conditions— empathy, respect, genuineness, and concreteness— on their co-therapists' level of functioning and level of activity within multiple therapy. While numerous studies have investigated the importance of facilitative conditions in individual and group therapy, no studies have been reported considering these dimensions v/ithin a multiple therapy situation. Seventy-six undergraduate students were given the Counselor Simulation Inventory and their responses v/ere rated by three judges on the Carkhuff scales for empathy, respect, genuineness, and concreteness. Tv/enty students rated highest and 20 students rated lov/est were selected to pari:icipate in the study. These 40 therapists were paired ii-U, H-L, and L-L. V i i i

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Twenty additional students volunteered to be clients and were randomly assigned to the therapist pairs. Each therapist of the pair saw their client individually followed by a multiple session, ve Eight research hypotheses were generated to examine the following questions. what are the effects on therapists' level of functioning (overall rating on the core facilitati dimensions of empathy, respect, genuineness, and concreteness) when placed in multiple situations with highand low-functioning co-therapists? what are the effects on therapists' activity level v/hen placed in multiple situations with highand low-functioning co-therapists? The hypotheses were formulated on the assumption that the study would include high-functioning therapists, those above level 3 on the Carkhuff scales. Since, hov/ever, the functioning levels of the participants only ranged from 1.06 to 2.45, the therapists were actually highand lowfunctioning, nonf acilitative therapists. The findings of this study were as follows: 1. The CSI ratings correlated .17 (p > .05) with the individual session tape ratings. its use in predicting functioning level within this range was found to be questionable. 2, When tv/o high-functioning nonfacili tati ^/e therapists worked together, their functioning levels remained unchanged, their activity level decreased significantly (p<.05) and their client's level of selfexploration did not change. ix

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3. When a high-functioning nonfacilitative therapist and a lowfunctioning nonfacilitative therapist were placed together, their functioning levels decreased significantly (p<.05), the H therapist decreased significantly (p<'.05) in his activity level while the L therapist's activity level remained unchanged, and their client's level of self-exploration decreased. 4. VJhen two low-functioning nonfacilitative therapists worked together, their functioning leve].s decreased significantly (p<',05), their activity levels remained unchanged, and their client's level of selfexploration decreased. 5. Client self-exploration in the multiple session of the L-L condition was significantly lower than in the II-H condition (p < .01) . Conclusions and implications from these findings \\?ere discussed and suggestions for further research were given. X

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CHAPTER I INTRODUCTION As the helping professions of counseling and psychotherapy develop, innovative and effective approaches facilitating psychological health are continuously being sought. One method to arouse interest recently is multiple therapy. As is often the case in the development of a new approach, multiple therapy comes under many names--co-therapy (Lundin & Aronov, 1952) , three-cornered therapy (Bock, Lewis & Tuck, 1954) , cooperative psychotherapy (Lott, 1952) , dual leadership (Linden, 1954) , and team counseling (Mallars, 195S) . The practice of multiple therapy has no standard procedures other than it involves more than one therapist. Thus, there have been as many as nine (Ha^-ward, Peters & Taylor, 1952) or 10 (Warkentin, Johnson & Whitaker, 1951) therapists working with one individual. In addition to using this method v/ith one individual, tv;o therapists ha\-e also colloborated to work with groups (Buck & Grygier, 1952) , couples (Linden, Goodv;in & Resnik, 1968) , and families (Sonne & Lincoln, 1955) . While Mullan and .Sanguiliano (I960) define multiple therapy as "the simiultaneous therapeutic approach by two or more

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separate yet related therapists to a single patient, married couple, family or patient group, " Whitaker, Malone and Warkentin (1956) more specifically define it as "The treatment of a single patient by two (or more) psychotherapists who make up a therapeutic unit." For the purposes of this study, the latter definition of multiple therapy is used. One of the more frequent questions asked of supporters of this approach is how they can justify the use of two professionals for one individual when therapeutic skill is at such a premium. Kell and Burow (1970) respond by stating that in addition to providing additional learning, multiple therapy is effective in some situations such as when a therapist and client have reached a standstill or impasse, and with some problem areas such as parental conflicts v/here dyadic therapy would either not succeed or would take a longer time to succeed. V/hitaker, Malone and Warkentin (1956) concur when they conclude that "in a considerable number of cases, it appears that the total financial cost to the patient is less than the cost v/ith similar cases due to the comparative brevity of multiple therapy. " Further justification of this approach is given by those v/ho claim its values lie not only in the therapeutic gain for the client, but also that it is considered to be an effective and efficient technique for use in training and supervision (Dyrud & Rioch, 1953; Greenbank,

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1954; Haigh & Kell, 1950; Hayv/ard, Peters & Taylor, 1952 r Kell & Burov/, 1970; and Rosenberg, Rubin & Finzi, 1968) and is claimed to be an inobtrusive and effective means for conducting research (Haigh & Kell, 1950; Whi taker, Malone & Warkentin, 1956) , The need remains to experimentally validate these clinical judgements; however, for the purpose of this study, the assumption is made that the multiple approach is a valid one. For many years the therapeutic relationship retained an almost sacred status. Very little self or outside critical evaluation was conducted on the processes or outcomes of therapy. What little evaluation did take place was usually subjective and based on clinical judgements by the therapists and/or self-reports of the clients. Eysenck (1952, 1960, 1965) and Levitt (1957, 1963) provided data challenging the efficacy of psychotherapy by showing there were no average differences of change between treated and non-treated groups. Their results provided the much needed impetus for numerous critical and evaluative studies conducted over the past two decades. Recent research (Carkhuff, 1969 a, b; Carkhuff & Berenson, 1967; Truax & Carkhuff, 1967) has in part explained some of the Eysenck and Levitt findings. TJ?A '^ ^iei'^ts of those counselors of fering the highest levels of facilitative dimensions imp rove , whi le_jyaoj_e__o_^^cour£seljDrs offerin g

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the lowest levels deter iorate fomphasis in the original^ on a variety of indexes; that is, with both inpatients and outpatients, those helping processes involving the highest levels of counselor empathy, positive regard, genuineness, concreteness , and other dimensions, elicit the greatest therapeutic process movement and ultimately, the greatest constructive client gains or changes ., .Furthermore, since the conditions of change are not the exclusive property of professional practitioners, they are available from non-professional sources (Carkhuff & Berenson, 1967, p. 23) . Thus, the differential effects of highand lowfunctioning counselors would average out to no differences as shovm in the Eysenck and Levitt studies. Moreover, it is highly probable that many of the untreated individuals sought help from high-and lov/-f unctioning non--prof ossionals . Statement of the Problem Although there exists substantial amounts of evidence on the importance of facilitative conditions in dyadic and group therapy (Carkhuff, 1969 a, b; Carkhuff & Berenson, 1967; Truax & Carkhuff, 1967) , no studies have been conducted which have considered these dimensions within a multiple situation. The present study, then, had as its aim the investigation of the effects of a therapist's core facilitative conditions — empathy, respect, genuineness, and concretenoss--on his cotherapist's core facilitative conditions and level of activity v/ithin multiple therapy. Therapist activity level is defined

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simply as the total number of responses, including such attending responses as "urn hnim" given by the therapist. More specifically, the present study examined the following questions! 1. What are the effects on therapists' level of functioning (overall rating on the core facilitative dimensions of empathy, respect, genuineness, and concreteness) when placed in multiple situations with highand low-functioning cotherapists? 2. What are the effects on therapists' activity level when placed in multiple situations with highand low-functioning co-therapists? Definition of Terms Multiple therapy the treatment of one individual by two therapists . Therapist person functioning as a helper in a counseling situation. Functioning level therapist's overall rating on the Carkhuff core facilitative dimensions of empathy, respect, genuineness, and concreteness. Activity level total number of responses, including attending responses such as "um hmra, " given by the therapist. Level of self-exploration rating on the Carkhuff scale used to measure the amount and manner in which a client discusses personally relevant material.

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CHAPTER II REVIEW OF RELATED RESEARCH The present chapter has been divided into two sections: (1) history of multiple therapy and (2) research studies in multiple therapy. History of Multiple Therap y The beginnings of multiple therapy are claimed to be found in the early v/ork of Alfred Adler and his co-workers at the Vienna Child Guidance Clinics (Droikurs, 1950; Spitz & Kopp, 1963). Adler 's procedure consisted simply of a frank discussion between Adler and his co-workers of the patient's problems in the presence of the patient. Although the patient did not participate in the discussion, this procedure appeared to have a therapeutic effect upon him. Reeve (1939), using a social worker and a psychiatrist, appeared to be the first to use the joint interview with one individual as a v/ay of reducing the individual's distortions that can occur in individual therapy, as v/ell as providing valuable training benefits for the less-experienced therapist. Training benefits v/ere also emphasized by Hadden in 1947 when

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he allov/ed interns and residents to attend group therapy s essions. Later they were permitted to participate in the group interaction and eventually to alternate as leaders. Having experimented for three years with "full terra" multiple therapy, Whi taker, Warkentin, and Johnson (1949) stated their primary aim was to develop the capacity of the therapist since they consider the dynamics of psychotherapy to be in the "person of the therapist." Their long-range goal consisted of developing concepts which would facilitate the teaching of psychotherapy. when they first implemented this procedure, one therapist sat in the session primarily as an observer. However, this proved to be unsatisfactory for both therapists, and the procedure was, therefore, modified to allow both therapists to become actively involved. The new procedure not only alleviated the dissatisfaction of the therapists, but also was said to have facilitated the therapeutic process. The authors felt that the resolution of disagreements both during and after the interviews made possible a more complete perception of the therapeutic process with the resultant effects of improving the patient's progress and providing personal and professional growth for the therapists. One of the unique aspects of their focus on professional growth v/as the fact that the growth was intended for both of the equally experienced therapists rather than

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8 primarily for a trainee's professional growth in the more common supervisor-trainee multiple therapy situations. continuing their interest in multiple therapy, Whitaker, Warkentin, and Johnson (1950) introduced another use for the multiple situation, that of surmounting the inevitable therapeutic impasses. This "intervention" multiple therapy differed from their "full term" procedure in that the inclusion of the second therapist was generally only required for one or, at most, a few sessions. While concurring with many of the earlier writers on the use of multiple therapy as an effective training procedure, Haigh and Kell (1950) in addition stressed that this approach can be useful as a psychotherapy research tool. They suggested that the multiple situation would enable the researcher to hold client variables constant since both therapists are working with the same client while studying such areas as the effects of counselor personality on client behavior or the effects of differing counselor theoretical orientation upon client behavior. Dreikurs' (1950) interest in multiple therapy had an unusiial beginning as a result of two incidents. He, with the patient present, discussed the case of this difficult patient with a class of medical students and, to his surprise, the patient responded favorably and began to cooperate in further

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interviews. The second incident occurred when Breikurs, due to an emergency situation necessitating the transfer of his patients to other therapists, used joint sessions for the purpose of smoothing out the transfer process. Since this procedure also proved to be an effective therapeutic technique, he continued to use multiple sessions on a consultative basis approximately every three sessions even after the emergency had abated. in 1952, Dreikurs, Shulman, and Mosak published two articles on the advantages of multiple therapy for the therapist (1952 a) and for the patient (1952 b) . Their articles also cautioned about the possible pitfalls which may be encountered by this approach. One such pitfall is the possibility of competition between therapists. Hayward, Peters, and Taylor (1952) suggested that the multiple procedure, in addition to clearing therapeutic impasses and training less-experienced therapists, can also be used profitably when dealing with the intense ambivalence of schizoplirenic patients. Buck and Grygier (1952) cite as an advantage of the multiple approach v/ith juvenile delinquents, the increased security and stability for both delinquents and therapists. They, furthermore, add the possibilities of combining research with psychotherapy. Im.proved v/orking relationships among staff members in a mental hospital were cited as major advantage by Dyrud and

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10 Rioch (1953). Working out covert compet i,tiveness resulted in better staff relationships. They also emphasized the use of multiple therapy for rapid and effective clarification of difficult transference and countertransference problems, for use in impasse situations, and as an effective supervisory technique. Whitaker, Malone, and VJarkentin (1955) broadened their exploration of multiple therapy to include a thorough examination of the relationship between the therapists. Prior to this time, most writers in the field focused on the outcome aspects by viewing it primarily as a method for training new therapists, conducting research, promoting therapeutic gains for the individual, and providing personal and professional growth for the therapists. By focusing on the process of multiple therapy and how it differed from individual therapy, they provided additional information in the area. In a preliminary report of multiple psychotherapeutic practice, Mullan and Sangiuliano (1960) suggested that the use of this method as a s^/rnbolic family can be especially beneficial when working v;ith a child. Some empirical research (Daniels, 1958; Staples, 1959) shov;s, hov/ever, that Mullan and Sangiuliano ' s suggestion does not hold true for groups of eighth-graders led by male-female co-therapists. Perhaps it may be correct for children in individual therapy. Mullan

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11 and Sangiuliano further claimed that multiple therapy is appropriate v/hen the patient and initial therapist are of the same sex and the patient's difficulty lies in his relationship with the opposite sex. Five developmental problem areas are presented by Hill and Strahl (1968) as being especially appropriate for the multiple therapy approach. They use "multiples" with clients whose parents' behavior has been inconsistent with their feelings, v^ith homosexual clients, with hysterics, with clients who have an excessive dependence on one parent, and, finally, v;ith clients who have been deprived of both parents. A current book to devote a major portion to multiple therapy was recently published by Kell and Burow ' ( 1970) . Having worked with "multiples" for over 10 years, they contributed some specific answers to such questions as: When do you initiate multiple therapy? what type of client can benefit from this type of therapy? what characteristics contribute to an effective multiple team? and What is the process of multiple therapy and how does it differ from dyadic therapy? Having begun as an occasional technique, multiple therapy has developed into a common approach for specific problem areas. Many therapists use the approach regularly (Hill & Strahl, 1968Kell & Burow, 1970; Whitaker, 1970). m addition, sever=il counseling centers including the University of

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12 Florida and Michigan State University routinely employ multiple sessions as an effective therapeutic tool and for training purposes. Research Studies in Multiple Therapy Only three empirical studies have been conducted using two therapists with one individual. These studies are presented below. Using 24 student counselors and 60 clients, Mallars (1968) conducted a study comparing the results of a counseling team approach with those of a standard counseling approach. She used client, counselor, and supervisor satisfaction as the criterion of effective counseling, A counseling rating scale, devised by Mallars and consisting of 25 items "selected from the literature emphasizing desired goals and methods of counseling," was presented to all clients, counselors, and supervisors shortly after the terminal interview. They were asked to evaluate the counseling interaction both for initial and terminal interviews. Significant differences of satisfaction v/ere found between groups using the two counseling approaches. Client, counselor, and supervisor were significantly more satisfied \^/ith the team approach than with the standard approach. Female clients were found to be significantly more satisfied than males v;i th the team approach. Males 'rfere significantly more satisfied than females with the standard approach (pp. 982-333) .

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13 Based on the premise that the effectiveness of multiple therapy is largely dependent upon the therapists' satisfaction with each other, Kamerschen (1969) and Randolph (1970) conducted studies on variables within the multiple situation as related to co-therapist satisfaction. Using 23 therapist pairs, Kamerschen found the Co-therapist Inventory, a modification of van der Veen's Family Concept Q-Sort, to be a more direct and sensitive measure of the therapists' relationship than the Interpersonal chock List, a measure devised by the researcher. She also concluded that self-disclosure as measured by Jourard ' s Self Disclosure Questionnaire and the personal-impersonal dimension of co-therapist selection as measured by a scale devised by the researchers are variables relevant to a therapist's satisfaction with the co-therapy relationship. Randolph concluded that: (1) a male therapist's amount of self-disclosure is most indicative of his level of satisfaction with his co-therapist; (2) a female therapist's behavior in the area of verbal expression of affection is most predictive of her level of satisfaction with her cotherapist; and (3) m>ultiple therapists' combined level of self-disclosure is most indicative of their level of satisfaction with each other. Although the present study was concerned v/ith multiple situations v/ith one individual, a few case studies and

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14 research using two therapists in groups are also mentioned. The findings in the first two articles (Warkentin, Johnson & Whitaker, 1951; Singer & Fischer, 1967) are the subjective impressions of the researchers who presumably were also the therapists . Warkentin, Johnson, and Whitaker (1951) studied 25 patients whose number of multiple therapy sessions ranged from five to 30. The number of therapists varied from two to 10 but for any given patient the therapists remained the same throughout. The authors concluded that the patients reacted to several therapists in much the same way as patients do with individual therapists, in some cases, the patients seemed much more free than in individual therapy to act out their feelings, both positive and negative. Feeling that his work with several therapists approximated cultural acceptance, one patient felt safer in his dependency and less guilty about his feelings. For some patients, termination took on more importance, as if they were once outnumbered but now felt strong enough to face the therapists and leave. Another conclusion derived from this study was the personal grov/th of the therapists and the corresponding increase in their enthusiasm for psychotherapy are major by-products of this method. . . As the relationship of the therapists to each other becomes more intimate, they develop

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15 a greater therapeutic capacity in their individual work with patients (p, 418) . The use of a male and a female therapist with a group of male homosexuals was reported to have positive results (Singer & Fischer, 1967) . The group had been running for one year with two male therapists when they decided to bring in a female therapist. "This concrete representation of the parental dyad allowed for transference distortions to occur and consequently be worked through." After one year, they reported, the majority of the group members had decreased their homosexual activity and some had stopped completely. Some v/ere dating v/oraen for the first time on a consistent basis. In addition, the majority had increased their work efficiency and greatly decreased their self-destructive behavior . Using "multiple therapy in group counseling and psychotherapy, " Nunnelly (1969) hypothesized that multiple therapy groups would be better than individually led groups on: (1) perceptions of father acceptance; (2) perceptions of mother acceptance; (3) increase in ego strength; (4) increase in selfacceptance; and (5) decrease in social introversion. He found no statistical support for hypotheses 2-5. For the first hypothesis, he found the multiple group to be significantly better than the male therapist group but no different

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16 from thG female therapist group. The scales he used in the study were: the Father Acceptance and Mother Acceptance scales of the Family Relations Inventory, the Total Positive scale of the Tennessee Self Concept Scale and the Ego Strength and Social Introversion scales of the Minnesota Multiphasic Personality Inventory. In a study of eighth-grade behavior problem boys, Daniels (1958) found that the male-female co-therapist group had negative behavior changes while the male-led group and the female-led group both shov/ed improvement. The boys in the co-therapist group became more hostile toward school, more anxious, less confident in themselves and the future, more reluctant to adopt a male sexual role, and tended to have more emotional disturbance in general. Using the same procedure except with eighth-grade girls. Staples (1959) found that the group led by male-female co-therapists deteriorated more than the male therapist group. The male therapist group, although showing iraprovem.ent according to teacher ratings, was found to have deteriorated on adjustment ratings by psychologists. The female therapist group shov/ed some improvement on both the teacher ratings and the psychologists' ratings. Both studies attributed their results to the "replication of the family constellation with its Oedipal overtones . "

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17 Most of the material written on multiple therapy is theoretical, philosophical or the descriptive impressions gathered from case studies. Little empirical research has been conducted on this therapy approach. The research which has been performed using two therapists with one individual focused primarily on the satisfaction between co-therapists or on the client's satisfaction with the therapists. There have been no studies v/hich have compared individual therapy with multiple therapy on outcome measures or which have examined the core facilitative conditions of multiple therapists. Despite the impressions of some authors, the research on multiple therapy with groups has failed to show any advantage in having two therapists. in some cases, co-therapist groups were found to have deleterious effects on group members. As the practice of multiple therapy is increasingly being employed, it becomes evident that evaluative research is greatly needed.

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CHAPTER III PROCEDURE S ubjects All of the participants in the experiment were University of Florida (UF) and Sante Fe Junior College (SFJC) undergraduate students. The "therapists" were selected from the UP Psychology 300, 309 and Foundations in Education 345 classes while the "clients" volunteered from SFJC psychology classes and UF Psychology 201. The decision to use undergraduate students was based on their availability and their naivete to counseling techniques. Since the primary purpose of this study was to examine the effects of therapists' levels of facilitative conditions v/ithin a multiple situation and since Carkhuff and Berenson (1967) have stated that the core facilitative conditions are available from non-professionals as v/ell as from professionals, it was concluded that students functioning at the various levels could be used. I nstruments The Counselor Simulation Inventory (CSI Appendix A) , administered to students from Psy 300, 309 and EDF 345, was 18

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19 used to determine initial functioning level of the therapists. This instrument developed by Cannon (1971) is an easily administered collection of 13 counseling excerpts which can be rated for each of the four facilitative dimensions-empachy , respect, genuineness, and concreteness . Although no validity information is available on the CSI, Cannon had "surveyed counselors at Pennsylvania State University, Michigan State University, and West Virginia University and found levels of functioning consistent with those reported for professionals ^^ Beyon d Counseling and__T_hera_py_ by Carkhuff and Berenson" (Cannon, 1971) . Since the respondents are asked to give as helpful a response as possible, it is assumed that their responses will give an accurate sample of their overall level of functioning in a helping situation. Supporting this assumption, Greenberg (1969) found the correlation between -written responses to standard client stimuli and responses when cast in a helping role to be positive, high, and statistically significant. The Carkhuff scales for empathy, respect, genuineness, and concreteness (Appendix B) were used to rate the therapist's level of functioning. On these 5-point scales, level 3 is defined as the minimally facilitative level of interpersonal functioning. The empathy, respect, and genuineness scales

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20 were derived in part from "A Scale for the Measurement of Accurate Empathy, " "A Tentative Scale for the Measurement of Therapist Unconditional Positive Regard" and "A Tentative Scale for the Measurement of Therapist Genuineness or Self Congruence" respectively, which have been validated in extensive process and outcome research on counseling and psychotherapy (summarized in Truax & Carkhuff, 1967) and in part from an earlier version that has similarly been validated (summarized in Carkhuff, 1958; Carkhuff & Berenson, 1967) (Carkhuff, 1969 b, p. 315) . The concreteness scale was "derived from earlier work (summarized in Truax & Carkhuff, 1967) and has received support in research on training and counseling (summarized in Carkhuff, 1968; Carkhuff & Berenson, 1967) " (Carkhuff, 1969 b, p. 323) . Theoretically and clinically, self-exploration has been demonstrated to be an antecedent to psychotherapeutic outcome (Truax & Carkhuff, 1967); therefore, Carkhuff 's helpee selfexploration scale was used to assess the client's level of functioning. "This scale, derived in petrt from 'The Measurement of Depth of Intrapersonal Exploration' (Truax & Carkhuff, 1957) , has been validated in extensive process and outcome research on couiiseling and psychotherapy (Carkhviff, 1953; Carkhuff & Berenson, 1967; Truax & Carkhuff, 1955, 1967)" (Carkhuff, 1969 b, p. 326) .

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21 Raters Doctoral students in psychology and counselor education who volunteered to be trained as raters, submitted a tape to a member of the University of Florida Counseling Center staff to be rated on the core facilitative dimensions. Those who scored at level 3 or above on overall level of functioning were selected for training. The staff member, who himself has proven to be high-functioning and has been trained in the Carkhuff scales, conducted the training sessions. Tapes of helping situations with naive individuals were included in the training procedure in order to provide the raters with experience rating the type of situation used in this study. Three judges, who obtained interjudge reliabilities of .80 or above on the analysis of variance method of determining interjudge reliabilities (Winer, 1962) , were selected from the pool of trained students to rate all of the CSI responses and the tape segments. According to Carkhuff and Berenson (1957), there is extensive evidence for the predictive validity of the scales when conducted by high-level functioning helpers. Furthermore, Carkhuff (1959 b) stated. From the criterion of meaning, only individuals who are themselves functioning at high levels can rate effectively... To develop clinically meaningful learnings it may be necessary for the rater to listen to the helper-helpee

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22 interactions in sequence so that he can be sfensitively at caned to the subtle nuances in the exchange. In addition, it is often felt that experienced helpers, who have themselves demonstrated that they are functioning at high levels on the relevant dimensions, are justified in rating the excerpts simultaneously on all the relevant scales involved (pp. 232-234) . The judges followed this procedure of rating the interactions in sequence and of rating the excerpts simultaneously on all the core facilitative conditions. Method Students in Psy 300, 309, and EDF 345 volunteered to take the CSI within a specified time period early in the spring quarter of the 1970-1971 academic year. After ratings on the CSI using the Carkhuff scales were obtained on the responses, the students v/ho scored 3.0 and above on the overall level of functioning (average score on the core facilitative dimensions — empathy, respect, genuineness, and concreteness) were designated high-functioning "therapists" while those who scored below 3,0 v.-ere considered to be lowfunctioning "therapists." Twenty highs and 20 lows were selected and paired into five pairs of highs with highs (H-H) , 10 of highs and lows (H-L) , and five of lows v/ith lows (L-L) yielding data on: 10 H working v/ith an H, 10 H working with an L, 10 L v/crking with an H, and 10 L working with an L.

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23 Twenty "clients,^' volunteers from the Psychology 201 and SFJC psychology classes who were willing to discuss a real problem, were then randomly assigned to the co-therapist pairs. An overview of the method for each pair of two therapists is: Therapist A saw client for a half-hour. Then therapist B saw the same client for a half-hour. Therapists A and B spent a half-hour together without the client, followed by a multiple session of therapists A and B seeing the client for another half-hour. All individual and multiple sessions were tape recorded. A more specific procedure discussion follows: Five groups of pairs were run each evening for four days. The following instructions were given verbally to the therapists by the experimenter and to the clients by another doctoral student. Half of the therapists were asked to report 30 minutes later than the others so that they would receive their instructions just prior to seeing the client. In half of the H-L pairs, the high-functioning therapist had his individual session first and in the remaining pairs the lov/functioning therapist went first to counter any possible order effects. Therapists The purpose of this study is to look at ways people help others. Each of you will be seeing a student who will be

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24 discussing his or her problem. Your role will be to respond to this person in as helpful a way as possible. The half-hour session will be tape recorded and later the tapes will bo coded so that only i will know who the specific people are on each tape. i will be giving you additional instructions after the session is over. C lients The purpose of this study is to look at ways people help others. You have volunteered to discuss a real problem with another person. You will be talking with this person for a half-hour and the session v/ill be tape recorded. The tapes will later be coded so that only i v/ill know who the specific people are on each tape. I will be giving you additional instructions after the session is over. When the first individual session v/as concluded, the client received further instructions: You have just completed a half-hour session speaking about your problem with one individual. i would now like you to see another person and discuss this same problem with him (or her) . After each of the two therapists had seen the client for a session, they spent a half-hour together without the client to enable them to discuss the client's problem and to get to know one another. Specific instructions v/ere: Each of you have just spent a halfhour helping another student v/ith a personal problem. You each saw the same student. For the next half-hour you may discuss the student, the student's problem, and get to know a little about each other.

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25 This will not be tape rectirdecl. You will then be seeing the student once again but this time together. While the two therapists were in the informal session, further instructions were given to the client: You have just completed two lialfhour sessions. You will now have about a half-hour in which you may do some studying or look at a magazine or just relax. In a short while you wi.ll have another half-hour to continue talking about your problem, this tim.e with both of the persons together. When this final multiple session was finished, all of the participants received the following concluding comments: Thank you for taking the time to participate in this study. Since the experiment will be running for two weeks, I'd greatly appreciate your not discussing the study with anyone until after that time. You are also asked to keep the specific information given in the sessions in confidence as I'm sure you would in any helping relationship. In two weeks, I'd be most happy to explain the study to you if you are interested. You may phone me, Karen Swander, 392-1575, anytime between 9 and 5 here at the Counseling Center. In addition, if any of you would wish to speak with a counselor, I ' d be happy to make the necessary arrangements. Thanks again; you've been most helpful , Three three-minute segments were randomly selected from the middle 26 minutes of each session. Since the first and last two m.inutes of each session typically consist of conversational, introductory and concluding rem.arks, they

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26 were eliminated. _ On each segment ratings by three judges were conducted on each therapist's level of empathy, respect, genuineness, and concreteness and on the client's level of self-exploration . The total number of therapist responses in each segment were counted to derive the activity level of each therapist in each segment. The overall therapist activity level then was obtained by averaging the total number of responses given in the three segments of each session. Any verbal response including such attending responses as "um hmm" were tabulated. Since this study was concerned with the interactive effects of highand low-functioning therapists, it was necessary to determine their activity level. Although these are gross measures of activity and although there are no established optimal levels of therapist activity, it seems evident for one therapist to have an effect upon another, this would have to be reflected to some extent in his activity level. Research HvDotheses 1. There will be an increase in overall level of core facilitative conditions offered by a lowfunctioning therapist when placed in a multiple therapy situation with a high-functioning therapist, 2. There will be an increase in overall level of core facilitative conditions offered by a high-functioning therapist when placed in a multiple therapy situation with a lowfunctioning therapist.

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27 3. There will be no change in overall level of core facilitative conditions offered by a high-functioning therapist when placed in a multiple therapy situation with another high-functioning therapist. 4. There will be no change in overall level of core facultative conditions offered by a low-functioning therapist when placed in a multiple therapy situation with another low-functioning therapist. 5. There will be a decrease in the activity level of a low-functioning therapist when placed in a multiple therapy situation with a high-functioning therapist. 6. There will be an increase in the activity level of a high-functioning therapist when placed in a multiple therapy situation with a lowfunctioning therapist. 7. There will be a decrease in the activity level of a high-functioning therapist when placed in a multiple therapy situation with another high-functioning therapist. 8. There will be no change in activity level of a lowfunctioning therapist when placed in a multiple therapy situation with another low-functioning therapist. The effects of highand low-level multiple therapy situations on client level of self-exploration were also examined; however, since this was not a major focus of the study, directional hypotheses were not stated. A descriptive analysis is presented. Analysis of Dat a^ The research hypotheses as stated are in a mixed mode; some are stated in a directional form while others are stated in a null form. However, all hypotheses express the expectations of results from this study.

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28 All eight hypotheses were analyzed by comparing means of dependent samples with a two-tailed _t test (Wyatt & Bridges, 1967) . The level of significance considered to be acceptable for this study was p^.05. In all cases, the null form of the hypotheses was submitted to statistical analysis. Twotailed tests were completed even though some of the research hypotheses were directional. This unusual procedure was used because of the practical importance of detecting differences in a direction other than that stated in the respective research hypotheses.

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CHAPTER IV ANALYSIS AND INTERPRETATION OF DATA The first section of this chapter presents information on the judges' ratings of therapists' functioning level, the analysis of each of the eight hypotheses, and the analysis of client self-exploration. Only minimum comments are included. The second part of the chapter concerns the interpretation of the obtained data. Analysis Although the original design of the study defined highfunctioning therapists as those who were above level 3 on the Counselor Simulation Inventory (CSI) and low-functioning therapists as those who v/ere below level 3, the range of the 76 volunteers was 1.0 to 2.38 with a mean of 1.39. Thus, the top 20 volunteers became the high-functioning therapists and the bottom 20, the low-functioning therapists. The ranges and means on the CSI for each group are given in the following table. 29

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30 Table 1 Ranges and Means on the CSI of Lowand High-Functioning Therapists N Range Mean LOWfunctioning 20 1.0-1.19 1.10 High-functioning 20 1.45 2.38 1.78 Three judges v/ere used to rate the functioning levels of the therapists on the CSI. The analysis of variance method of interjudge reliability (Winer, 1962) was used with the resultant interjudge reliabilities: Empathy, .96; Respect, .96; Genuineness, .94; and Concreteness , .96. The figures derived by this method estim.ate correlations between the a verage ratings of these judges with the average ratings of another set or three judges selected at random. The purpose in using the CSI was to predict therapist functioning level in order to pair individuals into co-therapy pairs of H-H, H-L and L-L for the study. However, using a Pearson product mom.ent coefficient of correlation (Kirk, 1968) , the 40 CSI ratings in this study were found to correlate .17 (p-p^.OB) with the 40 individual session tape ratings. Thus, when the individuals' sessions were rated, 18 of the 40 therapists v/cre misclassif ied as to whether they were high or low.

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31 Perhaps the CSI is not a predictive measure when the range of functioning level is as narrow as was present in this study. For the purpose of analyzing the data, then, the cotherapist pairs were redesignated H-H, H-L, and L-L on the basis of their individual session tape ratings. instead of five H-H pairs, 10 H-L pairs, and five L-L pairs, there were four H-H pairs, 12 H-L pairs, and four L-L pairs. Furthermore, one of the H-L pairs had to be eliminated from the study since their multiple session inadvertently was not tape recorded. The range of functioning levels of the 40 therapists was 1.05 2.48 with an overall mean of 1.8. The ranges and means for each group as determined by individual session ratings are given in Table 2. Table 2 Ranges and Means on the Individual Session Ratings of Lowand High-functioning Therapists Lowfunctioning High -functioning N

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32 self-exploration. using the analysis of variance method to estimate reliability, the inter judge reliabilities were: Empathy, .86; Respect, .88; Genuineness, .75; Concreteness, .74; and Self-exploration, .78. In presenting the results, each hypothesis will be stated follov/ed by a table showing the means and standard deviations of individual session ratings and multiple session ratings for the group of therapists included in the hypothesis All eight hypotheses were analyzed using tv/otailed _t tests for the significance of the difference between two means for correlated samples (Wyatt & Bridges, 1967) . Hypothesis 1 There will be an increase in overall level of core facilitative conditions offered by a low-functioning therapist when placed in a multiple situation with a high-functioning therapist. Table 3 Means and Standard Deviations of Level of Facilitative Conditions of 11 Lowfunctioning Therapists in Individual Sessions and in Multiple Sessions with High-functioning Co-therapis ts Individual Multiple Mean I.59 ^^.29 Standard Deviation p. 22 0.27

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33 The results of the test of significance contrasting these tv/o means indicated significant differences (_t = 5.1777, df = 10, p<.05). It should be noted that the observed difference was a decrease ; thus, hypothesis 1 was not supported. Hypothesis 2 There will be an increase in overall level of core facilitative conditions offered by a high-functioning therapist when placed in a multiple therapy situation with a lowfunctioning therapist. Table 4 Means and Standard Deviations of Level of Facilitative conditions of 11 High-functioning Therapists in Individual Sessions and in Multiple Sessions with Low-functioning Co-therapists Mean Standard Deviation Individual 2.13 0.28 Multiple 1.59 0.41 The results of the test of significance comparing these tv/o means indicated significant differences (_t = 4.6508, df = 10, p <.05). It should be noted that the observed difference was a decrease; thus, hypothesis 2 was not supported.

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34 Hy pothesis 3 There will be no change in overall level of core facilitative conditions offered by a high-functioning therapist when placed in a multiple therapy situation with another highfunctioning therapist. Table 5 Means and Standard Deviations of Level of Facilitative Conditions of Eight High-functioning Therapists in Individual Sessions and in Multiple Sessions with High-functioning Co-therapists Individual Multiple Mean ^ 2,08 1.89 Standard Deviation 0.17 0.27 The results of the test of significance contrasting these two means indicated no significant differences (_t = 2.2285, df = 7, p _^ .05). Thus, the data from this study provided no evidence contradicting hypothesis 3 and it was not rejected. Hy potl^esis 4 There will be no change in overall level of core facilitative conditions offered by a lov/functioning therapist when placed in a multiple therapy situation with another lowfunctioning therapist.

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35 Table 6 Means and Standard Deviations of Level of Facilitative Conditions of Eight Low-functioning Therapists in individual Sessions and in iMultiple Sessions with Low-functioning Co-therapists Mean 1,34 Standard Deviation 0.24 Individual Multiple 1.14 0.19 The results of the test of significance comparing these two means indicated significant differences (t = 3.0704, df = 7, p<.05); thus, hypothesis 4 was rejected. Hypothesis 5 There will be a decrease in activity level of a lowfunctioning therapist when placed in a multiple therapy situation with a high-functioning therapist. Table 7 Means and Standard Deviations of Activity Level of 11 Low-functioning Therapists in Individual Sessions and m Multiple Sessions with High-functioning Co-Therapists Individual Multiple ^^^" 7.4 3.9 Standard Deviation 2.32 2 23

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36 The results of the test of significance contrasting these tv/o means indicated no significant difference (t = 1.9870, df = 10, py ,05) ; therefore, hypothesis 5 was not supported. Hypothesis 6 There will be an increase in the activity level of a high-functioning therapist when placed in a multiple therapy situation with a low-functioning therapist. Table 8 Means and Standard Deviations of Activity Level of 11 High-functioning Therapists in Individual Sessions and in Multiple Sessions with Lowfunctioning Co-therapists Individual Multiple Mean 7.4 3.9 Standard Deviation 2.32 2.23 The results of the test of significance comparing these two means indicated significant differences (_t = 4.0481, df = 10, p<^.05). It should be noted that the observed difference v/as a decrease ; thus, hypothesis 6 was not supported.

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37 Hypoth esis 7 There will be a decrease in the activity level of a high-functioning therapist when placed in a multiple therapy situation with another high-functioning therapist. Table 9 Means and Standard Deviations of Activity Level of Eight High-functioning Therapists in Individual Sessions and in Multiple Sessions with High-functioning Co-therapists individual Multiple Mean 5,8 4.5 Standard Deviation 1.65 1.36 The results of the test of significance contrasting these two means indicated significant differences {t = 4.3108, df = 7, p<.05); therefore, hypothesis 7 was supported. Hypothesis 8 There will be no change in activity level of a lowfunctioning therapist when placed in a multiple therapy situation with another low-functioning therapist.

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38 Table 10 Means and Standard Deviations of Activity Level of Eight Low-functioning Therapists in Individual Sessions and in Multiple Sessions with Lov/-functioning Co-therapis ts Individual Multiple Mean 5,8 4.5 Standard Deviation 1.66 1.36 The results of the test of significance comparing these two means indicated no significant differences (_t = 1.5613, df = 7, py .05). Thus, the data from this study provided no evidence contradicting hypothesis 8 and it v/as not rejected. The client level of self-exploration was also examined although directional hypotheses were not stated since this was not a major focus of the study. The means are given in Table 11.

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39 Table 11 Mean Client Self-exploration Within Individual and Multiple Sessions Under Three Conditions of Therapist Functioning Level First Second Individual with Individual with Therapist Therapist First Therapist Second Therapist Multiple High High High Low Low Low 2.64 2,65 1.90 2.48 2.44 1.93 2.63 2.05 1.43 An analysis of variance (Kirk, 1968) was performed on the lev'ils of client self-exploration within the multiple therapy sessions. Table 12 Summary of Analysis of Variance Comparing Client Self-exploration Scores under Three Conditions of Therapist Functioning Level Source of Variation S urn o f Squares Among Groups 2,67 96 Within Groups 3.2627 Total 5.9423 Degrees of Freedom 2 16 18 Mean Squares 1.3398 .2039 F 6.57* *p <.01

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40 Thus, significant differences at the ,01 level were found among the three groups, H-H, H-L, and L-L, for levels of client self-exploration in the mul.tiple therapy sessions. Sheffe's S Method (Kirk, 1968) for pairwise comparison among the means was performed and the following F's were obtained: High-High with High-Low F = 4.84 nonsignificant High-Lov/ with Low-Low F = 4.67 nonsignificant High-High with Low-Low F = 12.97 p<',Cl. Consequently, the significant variance in client selfexploration was between the H-H and L-L clients. The highest mean level of client self-exploration was obtained by clients having two high-functioning therapists, followed next by those having one highand one low-functioning therapi.st, and, lastly, by those having two low-f unct ioning therapists. The decreasing trend in client self-exploration, therefore, is evident in addition to the significant differences found between the H-F and L-L multiple situations. Int erpretation of Data One of the significant results of this study concerns the predictive validity of the CSI. The CSI was intended to give "very rougli estimates of the respondent's overall level of facilitative functioning" (Cannon, 1971). Although no validit\information was available on the instrum.ent. Cannon

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41 "surveyed counselors at Pennsylvania State University, Michigan State University and West Virginia University and found levels of functioning consistent with those reported for professionals in Beyond Counseling and Therapy by Carkhuff and Berenson" (Cannon, 1971) . The CSI ratings in this study were found to correlate .17 (p> .05) with individual session tape ratings; thus, its use is questionable as a predictive measure with individuals whose functioning levels are apt to be within a 1.0 to 2.45 range. Some support for this finding can be found in a recent study conducted by Bellanti (1971) at Pennsylvania State University. He collected pre-and post-csi ratings and coached-client interview tape ratings (CCI) on 87 individuals in an encounter group experience. Their range of functioning levels was 1.0 to 1.9. Although he obtained significant changes on the CCI ratings, the CSI ratings did not change significantly indicating that the CSI is not a sensitive instrument with this range. Perhaps the CSI would have more predictive or concurrent validity if the range of functioning levels in this study had included high-functioning individuals, Further research is needed to replicate or refute the finding in this study as well as to investigate the CSI's validity v/ith a wider range of therapist functioning levels.

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42 There were considerable differences between the CSI interjudge reliabilities and the individual session tape inter judge reliabilities. On the CSI, the therapists gave one response per excerpt whereas during the individual sessions the therapists gave as many as 11 responses per three-minute segment. it would seem likely that the raters would have a higher possibility of agreement when rating one response rather than many responses. The eight research hypotheses were generated on the premise that high-functioning therapis ts--those who score about 3.0 on the carkhuff scales--as well as lov/-functioning therapis ts--those below 3.0--would participate in the study. Since, however, the range of overall functioning levels of the 76 volunteers was only 1.0 to 2.38, all of the therapists were actually low-functioning in terms of the Carkhuff scales, The mean level of functioning for the 40 therapists was 1.8 which is similar to the mean functioning levels of undergraduate students found in other studies, 1.87 (Kratochvil, Aspy, & carkhuff, 1967), 1.9 (Carkhuff, Piaget, & Pierce, 1968), 2.03 (Holder, Carkhuff, & Berenson, 1967), and 2.06 (Piaget, Berenson, & Carkhuff, 1967) . In view of this, the hypotheses must be interpreted while considering that the highand lowfunctioning therapists were, in actuality, highand low-functioning, nonf acilitative therapists. In

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43 the discussion to follow, H therapist shall refer to highfunctioning, nonfacilitative therapist; likewise L therapist shall refer to low-functioning, nonfacilitative therapist. The first four hypotheses were concerned with the effects on therapists' functioning level when placed in multiple situations with highand low-functioning co-therapists. When an L therapist was with an H therapist, his functioning level decreased significantly. An H therapist with an L therapist decreased significantly in his overall level of functioning. In addition, an L therapist's functioning level while working with another l therapist also decreased significantly. These results indicate that the presence of an L therapist has a negative effect on th.e co-therapist and a cumulative negative effect since his ovm functioning level also decreases. However, when an H therapist worked with another H therapist, there was no significant change in his functioning level. It appears, then, that no additional harm is done when two H therapists choose to work together but that there is significant negative change with an H therapist and an L therapist or when two L therapists work together. The last four hypotheses were concerned with the effects on therapists' activity level when placed in multiple situations with highand lowfunctioning co-therapists. when an L therapist was working with an H therapist, there was no

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44 change in his activity level. Apparently the H therapist was not functioning high enough to have an effect on the activity level of the L therapist. When, however, an H therapist was placed with an L therapist, his activity level decreased significantly. The H therapist, unable to withstand the negative effect by the L therapist on his functioning level, decreased in his activity. in a multiple situation where an H therapist was working with another H therapist, his activity level decreased significantly. Since there had been no change in the H therapist's functioning levels in this situation, they were both pulling about equal weight in the session resulting in a decrease in activity level. When, however, an L therapist worked with another L therapist, there was no change in his activity level. Thus, it appears that in this situation where the L therapists decreased in their functioning levels, they persisted in their activity levels. This could result in having a cumulative negative effect on client functioning level and activity within therapy. while further research needs to be done to determine optimal activity levels, it would seem that the more responses a client receives from a nonf acilitative therapist or therapists, the greater the possibility of destructive consequences. The results of client self-exploration (DX) support the conclusions derived from the therapist data. in the H-H

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45 multiple situation, the therapists' functioning levels remained unchanged from individual to multiple sessions, and the level of client DX also remained the same. in the H-L condition, both therapists decreased in functioning level and while client DX was somewhat higher in the H individual session than the L individual session, it decreased considerably in the multiple session. in the L-L situation, both therapists decreased in functioning level, and client DX, already low in the individual sessions, dropped even further in the multiple session. Client DX was highest in the H-H condition, next in the H-L, and lowest in the L-L situation. The results of the three multiple therapy situations may be summarized as follows; High with High 1. Functioning level of both therapists remained unchanged. 2. Activity level of both therapists decreased. 3. Impact upon client self-exploration unchanged. High with Low 1. Both therapists decreased in functioning level. 2. H therapist decreased in activity level.

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46 3. L therapist's activity level unchanged. 4. Negative effect on client self-exploration. Low and Low 1. Both therapists decreased in functioning level. 2. Both therapists remained the same on activity level. 3. Negative impact on client self-exploration. Since the functioning levels of most professionals in the helping services also are below level 3 (Carkhuff & Berenson, 1967; Lister, 1970), the results of this study have direct implications for those who practice multiple therapy. Two therapists of higher nonfacilitative levels of core conditions may work together with no negative effect on each others functioning levels and vv'ith no negative effect on the level of client self-exploration. When, however, one 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.

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CHAPTER V SUMMARY Although numerous studies have investigated the importance of facilitative conditions in individual and group therapy (Carkhuff, 1969 a, b; Carkhuff & Berenson, 1967; Truax & Carkhuff, 1967) , no studies have been reported considering these dimensions within a multiple therapy situation. Therefore, the purpose of this analogue study was to investigate the effects of therapists' level of functioning as determined by the core facilitative conditions — empathy, respect, genuineness, and concreteness--on their co-therapist's level of functioning and level of activity within multiple therapy. Seventy-six undergraduate students were given the Counselor Simulation Inventory and their responses were rated by three judges on the Carkhuff scales for empathy, respect, genuineness, and concreteness . Twenty students rated highest and 20 students rated lov/est were selected to participate in the study. These 40 therapists were paired H-H, H-L, and L-L. Twenty additional students volunteered to be clients and were randomly assigned to the therapist pairs. Each 47

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48 therapist of the pair saw their client individually followed by a multiple session. Eight research hypotheses were generated to examine the following questions. What are the effects on therapists' level of functioning (overall rating on the core facilitative dimensions of empathy, respect, genuineness, and concreteness) when placed in multiple situations with highand lowfunctioning co-therapists? what are the effects on therapists' activity level when placed in multiple situations with highand low-functioning co-therapists? The hypotheses were formulated on the assumption that the study would include high-functioning therapists, those above level 3 on the Carkhuff scales. Since, however, the functioning levels of the participants only ranged from 1.06 to 2.45, the therapists were actually highand low-functioning, nonfaci litative therapists. The findings of this study were as follows: 1. The CSI ratings correlated .17 {pj^ ,05) with the individual session tape ratings. its use in predicting functioning level within this range was found to be questionable. 2. When two high-functioning nonfacilitative therapists worked together, their functioning levels remained unchanged, their activity level decreased significantly (p
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49 3. When a high-functioning nonfaci litative therapist and a lowfunctioning nonfacilitative therapist were placed together, their functioning levels decreased significantly (p <.05), the H therapist decreased significantly (p<.05) in his activity level while the L therapist's activity level remained unchanged, and their client's level of self-exploration decreased. 4. When two lowfunctioning nonfacilitative therapists worked together, their functioning levels decreased significantly (p<.05), their activity levels remained unchanged, and their client's level of selfexploration decreased. 5. Client self-exploration in the multiple session of the L-L condition was significantly lower than in the H-H condition (p <.01) . From these results, it was concluded that two therapists of higher nonfacilitative levels of core conditions may work together with no negative effect on each others 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 others functioning level, but on the level of client selfexploration as well. This study examined some of the effects of highand lowfunctioning therapists in terms of their level of functioning and activity levels. Since there are no established optimal levels of activity for therapists, additional studies could be conducted focusing on the effects of varying amounts and

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50 types of activity within therapy. The use of the CSI was found to be questionable with this range of individual functioning levels. Further research should investigate the use of the CSI or similar written response inventories for use in therapy research, not only for this range of functioning levels, but with high-functioning therapists as well. One of the limitations inherent in this study concerns the length of available time for the sessions. It would be of interest to see if these or varying results are obtained over a longer period of time. Additional research is suggested to replicate the results of this analogue study using actual therapists instead of undergraduate students. Furthermore, research should be conducted on multiple therapy which includes highfunctioning individuals.

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APPENDICES

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APPENDIX A COUNSELOR SIMULATION INVENTORY Following are 13 excerpts containing statements made by students in individual counseling interviews. The statements are taken from different students, so do not attempt to relate any of the excerpts when formulating your responses. Your role is that of a person who is trying to be as helpful as possible to this student who has come to" you in a time of need. For each excerpt, imagine that the student is sitting across from you, that he (she) is speaking directly to you, and that there is no one else in the room. For each excerpt, write out in the space provided what you would say to this student. Please use the exact wording you would use if you were actually speaking to the student. 52

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53 Excerpt 1 She is so phony I can't believe it: She's worn that fake smile the whole two months we've been rooming together. And then--behind my back — she spreads rumors about me and ray boyfriend, and tells other kids how she can't stand to room with me. Boy, I'd like to just wipe that smile off her face and really tell her what I_ think of her. (Your Response) 1. Excerpt 2 Gee, I don't know what I'm gonna do. I've been here almost three months now, and i haven't made a single friend. I talk with the kids in my classes, and I go to the mixers, but nobody seems to like me. i just want to go home and forget about stupid old college. (Response) 2.

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54 Excerpt 3 That little bitch: Oh, I could rip her eyes out: She's been wearing my pin for six weeks now, and yesterday i find out she's been dating at least two other guys steadily. she tells me she loves me and talks about marriage, and now I find out that after I took her home she would go out with another guy. God: I could wring her cheating little neck! (Response) 3. Excerpt 4 Who do you think you are?: You call yourself a sensitive person: Damn: Here I am spilling my guts out to you and all you do is look at the clock. You don't even hear what I say. Your responses aren't attuned to what I'm saying. You're so wrapped up in your own world. I never heard of such helping. I — a.h — it makes me so god damn mad! (Response) 4.

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55 Excerpt 5 I finally found some kids l can really get along with. They're just natural and real, and they really understand me. I can hardly wait to be with them. i don't know, it's like I can really be myself. No criticism, no phoniness. They're just great! --it's the best thing that's happened to me since I came to college. (Response) 5. Excerpt 6 Boy, if that Dr. wasn't a professor and an old man, I'd smash him right in the mouth: He gave me a week's extension on this term paper, because I had to go home, and then he lowered my grade from a B to a D because he said the paper was late regardless of the extension. Ah— I'm so mad I could tear this whole school apart. (Response) 6.

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56 Excerpt 7 I'm so disappointed. I thought we could get along so well together and you could help me. But you don't understand me, You don't know I'm here. I don't even think you care for me, You don't really hoar me when I talk; you seem to be somewhere else. Your responses are independent of anything I have to say. i don't know where to turn. I'm just so--doggone it--l don't know what to do, but I know you can't help me. There is just no hope. (Response) 7. Excerpt 8 I really don't know what to do. I slept with Jerry because I thought I really loved himi. Now, he's dating other girls and I find out I'm pregnant. I don't want to tell him and I just can ' t tell my parents. Oh — I wish I was dead. (Response) 8 .

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57 Excerpt 9 I'm so glad I found a person like you. I really didn't think any existed. You're always right with me; you seem to understand exactly how I'm feeling. it's just great: i feel like I'm coming alive again. (Response) 9. Excerpt 10 Wow — I feel like a new woman. We're so much in love. I never knew sex could be so beautiful. i feel like Alice in Wonderland — like there's a whole beautiful world out there I didn't know existed. (Response) 10.

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58 Excerpt II I just don't know v;hat to do. I have all my exams in three days next week, and I can't possibly do all the reading by then. I just wish I could quit and say to hell with the whole thing. I've never felt so low. (Response) 11 . Excerpt 12 It's fantastic. As soon as I finish exams, I've got a job with a summer stock company. What a chance to try out my wings! It's like the whole future is opening up to me, and I just know I can make the most of it. (Response) 12.^

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59 Excerpt 13 Silence . (Student does not speak; simply looks nervous and moves about in chair) . (Response) 13

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APPENDIX B SCALE 1 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 signif icantly 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 60

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61 may communicate his own ideas of 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 to neither 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 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 previously. In summary, the facilitator's responses add deeper feeling and meaning to the expressions of the second person.

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62 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 on going deep self-exploration on the second person's part, to be fully with him in his deepest moments. 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 wave 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 who the other person is and a comprehensive and accurate empathic understanding of his deepest feelings. SCALE 2 THE COMiMUNICATION 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.

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53 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 . Example: The first person communicates respect and concern for the second person's ability to express himself 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 enables the second person to feel free to be himself and to experience being valued as an individual. In summary, the facilitator communicates a very deep caring for the feelings, experiences, and potentials of the second person.

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64 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. Example: 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. SCALE 3 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 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 (s) 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;

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65 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 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. 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 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.

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66 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 ov/n genuine responses constructively. SCALE 5 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. Level 2 The first person frequently leads or allows even discussion 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

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67 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 (s) 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 per3on(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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68 LevGl 5 The facilitator is always 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. SCALE 8 HELPEE SELF -EXPLORATION IN INTERPERSONAL PROCESSES A SCALE FOR MEASUREMENT Level 1 The second person does not discuss personally relevant material, either because he has had no opportunity to do such or because he is actively evading the discussion even when it is introduced by the first person. Example: The second person avoids any self-descriptions or self-exploration or direct expression of feelings that would lead him to reveal himself to the first person. In summary, for a variety of possible reasons the second person does not give any evidence of self-exploration. Level 2 The second person responds with discussion to the introduction of personally relevant material by the first person but does so in a mechanical manner and without the demonstration of emotional feelings. Example: The second person simply discusses the material without exploring the significance or the meaning of the material or attempting further exploration

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69 of that feeling in an effort to uncover related feelings or material. In summary, the second person responds mechanically and remotely to the introduction of personally relevant material by the first person. Level 3 The second person voluntarily introduces discussions of personally relevant material but does so in a mechanical manner and without the demonstration of emotional feeling. Example: The emotional remoteness and mechanical manner of the discussion give the discussion a quality of being rehearsed. In summary, the second person introduces personally relevant material but does so without spontaneity or emotional proximity and without an inward probing to discover new feelings and experiences. Level 4 The second person voluntarily introduces discussions of personally relevant material with both spontaneity and emotional proximity. Example: The voice quality and other characteristics of the second person are very much "v/ith" the feelings and other personal materials that are being verbalized. In summary, the second person introduces personally relevant discussions with spontaneity and emotional proximity but without a distinct tendency toward inward probing to discover new feelings and experiences. Level 5 The second person actively and spontaneously engages in an inward probing to discover new feelings and experiences about himself and his world. Example: The second person is searching to discover new

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70 feelings concerning himself and his world even though at the moment he may perhaps be doing so fearfully and tentatively. In summary, the second person is fully aiid actively focusing upon himself and exploring himself and his world.

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BIBLIOGRAPI-IY Bellanti, j. Personal communication, 1971. Bock, J. c, Lewis, D. J., & Tuck, J. Role-divided threecornered therapy. Psychiatry, 1954, 12, 277-2S2. Buck, A. E., & Grygier, T. A. A new attempt in psychotherapy with juvenile delinquents. American Journal of Psychotherapy , 1952, 6, 711-724. Cannon, j. R. Personal communication, 1971. Carkhuff, R. R. Th e counselor's contribution to faci litative processes . Mimeographed manuscript. State University of New York at Buffalo, 1968. w Carkhuff, R. R. Helping and human rela tions .^^jyol . i. Ne-, York: Holt, Rinehart, and Winston, Inc., 1969'! (a) Carkhuff, R. R. Helping and human relations. Vol . II. NewYork: Holt, Rinehart, and Winston, Inc., 1959. (b) carkhuff, R, r., & Berenson, B. G. Bej^o nd___co u n s e 1 i n g and therapy. New York : Holt, Rinehart, and Winston, Inc., 1967. Carkhuff, R. R., piaget, G., & Pierce, R. The development of skills in interpersonal functioning. Coun selor Educali-Q.-l ^"'3 Supervisio n, 1968, 1_, 102-106. Daniels, M. The influence of the sex of the therapist and of 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 combination. Disse rtation Abstract s, 19 58, 18, 1489. Dreikurs, R. Technique and dynamics of mu]. tiple psychotherapy, iL?ychiatr_ic__Quar_terly_, 1950, 24, 788-7 99. 71

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72 Dreikurs, R., Shulman, B. H., &Mosak, H. Patient-theraoist relationship: i. its advantages to the therapist." P£y-£j?ij^£i^ Quart erlj^, 1952, 2^, 219-22 7. (a) Dreikurs, R., Shulman, B. H., & Mosak, H. Patient-therapist relationship: n. its advantages to the patient. Psychiatric Quarter ly, 1952, 26, 590-595. (b) Dyrud, J. E., & Rioch, m. Multiple therapy in the treatment program of a mental hospital. Psychiatry, 1953 16 21-26. " ' — ' Eysenck, H. J. The effects of psychotherapy: An evaluation. Jou rnal of Consulting Psychology , 1952, _11, 319-324. Eysenck, H. J. The effects of psychotherapy. m H. J. Eysenck (Ed.). H andbook of abnormal psycho logy. New York: Basic Books, 1960. Pp 697-726. Eysenck, H. J. The effects of psychotherapy. international iZOHIJl^,^. Qf Psychotherapy , 1965, 1^, 99-178. Greenbank, R. k. Psychotherapy using two therapists. American Journal of Psychotherapy , 1954, 18_, 4B8-499. Greenberg, B. The differential effects of responding orally, and in writing to client stimuli, and in the helping role. Abstract in Carkhuff, R. R. Helpi ng and the human relations, vol. n . New York: Holt, Rinehart, and V7inston, Inc., 1969, p. 312. Hadden, s. B. The utilization of a therapy group in teaching psychotherapy. American Journal of Psychiatry , 19^-7 103, 644-548. Haigh, G. & Kell, B. L. Multiple therapy as a method for training and research in psychotherapy. Journal of Abnorm al Socia l Psychology , 1950, 45_, 659-666. Hayward, M. L . , Peters, j. j. , & Taylor, j. E. Some values of the use of multiple therapists in the treatment of psychoses. Psychia tr ic Quar terly, 1952, 26, 244-249. Hill, F. & Strahl, G. Two against an impass. Voices: T he Art a nd Science of Ps y chotherapy , 1958, 4, 96-104.

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73 Holder, T., Carkhuff, R. R,, & Berenson, B. G. The differential effects of the manipulation of therapeutic conditions upon high and low functioning clients. Journal of Counseling Psychology , 1967, lA^, 63-66. Kamerschen, K. S. Multiple therapy: Variables relating to co-therapist satisfaction. Doctoral dissertation, Michigan State University, 1969. Kell, B. L. & Burow, J. M. Developmental counseling and therapy . Boston: Houghton Mifflin Co., 1970. Kirk, R. E. Experimental design: Procedures for the be havioral sciences . Belmont, California: Brooks/cole, 1968. Kratochvil, D., Aspy, D., & Carkhuff, R. R. The differential effects of absolute level and the direction of counselor change in level of functioning over counseling upon client level of functioning. Journal of Clinical Psy chology , 1967, 2_3, 216-218. Levitt, E. E. The results of psychotherapy with children. Journal of Consulting Psychology , 1957, 2_1_, 189-196. Levitt, E. E. Psychotherapy with children: A further evaluation. Behavior Research and Therapy , 1963, 1_, 45-51. Linden, M. E. The significance of dual leadership in gerontolic human relations. III. I nternational Journal of Group Psychotherapy , 1954, 4_, 262-273. Linden, M. E., Goodwin, H. M. , & Resnik, H, Group psychotherapy of couples in marriage counseling. International Jour nal of Group Psychotherapy , 1968, 18_, 313-324. Lister, J. L. School counseling: For better or for worse? Canadian Counselor , 1970, 4(1) , 33-39. Lott, G. M. The training of non-medical, cooperative psychotherapists by multiple psychotherapy. American Journal of psycho therapy, 1952, 6_, 440-448. Lundin, W. H. and Aronov, M. The use of co-therapists in group psychotherapy. Journal of Consulting Psychology , 1952, 16, 76-80.

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74 Malicirs, p. B. Team counseling in counselor education. Personnel and Guidance Journal , 1968, 4_5, 981-983. Mullan, H. & Sangiuliano, i. Multiple psychotherapeutic practice: Preliminary report. American Journa l of Psy chotherapy , 1950, 1_4, 550-565. Nunnelly, K. The use of multiple therapy in group counseling and psychotherapy. Disser t ation Abstracts , 1969, 30 , 387B. Piaget, G., Berenson, B. G., & Carkhuff, R. R. The differential effects of the manipulation of therapeutic conditions by high and low functioning counselors upon high and low functioning clients. journal of Consultin g Psychology, 1967, 3_1.(5) / 481-486. Randolph, C. C. Multiple therapy: Co-therapist satisfaction as related to the variables of affection and selfdisclosure. Doctoral dissertation, Michigan State University, 1970. Reeve, G. H. Trends in therapy: v. A. method of coordinated treatment. American journal of Orthopsychiatry , 1939, 9, 743-747. Rosenberg, l. M. , Rubin, S. S., & Finzi, H. Participantsupervision in the teaching of psychotherapy. Ame rican Journ al of Psychotherapy , 1968, _22, 280-295. Singer, m. & Fischer, R. Group psychotherapy of male homosexuals by a male and female co-therapy team. Inter national Journal of Group Ps'/chotherapy , 196 7, _1 7 , 44-52. Sonne, J. c. & Lincoln, G. Heterosexual co-therapy relationship and its significance in family therapy. In A. S. Friedman, Psy chotherapy for t he whole family . New York; Springer Publishing Co., 1965. Pp. 213-217." Spitz, H. H. & Kopp, S. B. Multiple psychotherapy. in M. Rosenbaura & M. Berger, Gro up psy choth erapy. New York: Basic Books, 1963. Pp 295-311. 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

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75 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 Abstrac ts, 1959, 19^(2), 2154. Treppa, j. A. An investigation of some of the dynamics of the interpersonal relationship between pairs of multiple therapists. Dissertation Ab stracts, 1969, 30, 1909B. Truax, C. B., & Carkhuff, R. R. The experimental manipulation of therapeutic conditions. Journal of Consu lting Psychology, 1955, 29.. 119-124. Truax, c. B., & Carkhuff, R. R. Toward effective counseling and psychothe rap y: Training a n d practice . Chicago: Aldine Publishing Co., 1957. VJarkentin, j., Johnson, N. L., & Whitaker, C. A. A comparison of individual and multiple psychotherapy. Psychiatr y, 1951, L4, 415-418. Whitaker, C. A. Comments given in Family Therapy session. American Psychological Association Convention, Miami Beach, 1970. Whitaker, c. A., Malone, T. P., &Warkentin, J. Multiple therapy and psychotherapy. in F. Fromra-Reichmann & J. L. Moreno, Progress in psyc hother_apy. New York: Grune & Stratton, 1955. Pp. 210-215. Whitfeker, c. A., Warkentin, J., & Johnson, N. L. A philosophical basis for brief psychotherapy. Psy c hiatri c Quar terly , 1949, 23_, 439-443. ""' Whitaker, c. A., Warkentin, J., & Johnson, N. L, The psychotherapeutic impasse. Americ an Journa l of Ortho ps ychiatry , 1950, 20, 541-547. '' Winer, B. J. Statistical p rincipl es in experimenta l design. New^ York: McGraw-Hill, 1962. " Wyatt, W. W., & Bridges, C. M. Statistics for the beha vioral sci ence s. Boston: D. C. Heath & Co., 1967.

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BIOGRAPHICAL SKETCH Karen Keck Swander was born July 26, 1943 in Water town, Wisconsin. in August, 1968, she married James E. Swander. In June, 1961, she was graduated from Oconomowoc High School. After attending the University of Wisconsin and Wisconsin State University at Lacrosse, she received her Bachelor of Education degree from Wisconsin State University at Whitewater in January, 1966. From January, 1966, to June, 1966, she wqs employed in the New Berlin, Wisconsin school system as a seventh grade English and Social Studies teacher. After attending summer school at the University of Wisconsin at Milwaukee, she enrolled in the Department of counselor Education at the University of Florida where she received her Master of Education degree in August, 1967. During this time, she was employed as a graduate assistant in the Department of Curriculum and Instruction and as a resident assistant for the Division of Housing. From September, 1967, to June, 1968, she was employed as a teachercounselor in the Department of Comprehensive Logic while continuing her doctoral studies. During the summer of 1968, she 76

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77 worked as a vocational counselor at the University of Florida Counseling Center followed by a counseling internship there from September, 1968 to June, 1969. Since September, 1969, she has been employed as a counseling psychologist at the University of Florida Counseling Center. Mrs. Swander is a member of Kappa Delta pi, an associate member of the American Psychological Association, and a student member of the Association for Women in Psychology, the American Personnel and Guidance Association and the Association for Counselor Education and Supervision.

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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, J^mp^ L. Lister, Chairman Professor of Education 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, in scope and quality, as a dissertation for the degree of Doctor of Philosophy. E. L. Tolbert, Co-Chairraan Associate Professor of Education I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholar ].y presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Philosophy. H^rry Grate/ir, Jr Professor of Psychology JL

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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. .=:^^aLt£Z William E. Klirri^ Associate Professor of Education This dissertation was submitted to the Dean of the College of Education and to the Graduate Council, and was accepted as partial fulfillment of the requirements for the degree of Doctor of Philosophy. December, 1971 3 iM4 A W6f%/^ Dean, College ot Education Dean, Graduate School

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1° 14 6.8 0.