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Epistemology as a Predictor of Psychotherapists' Self-Care and Coping

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Epistemology as a Predictor of Psychotherapists' Self-Care and Coping
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BRUCATO, BRITTANY ( Author, Primary )
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2008

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Burnout ( jstor )
Cognitive psychology ( jstor )
Constructivism ( jstor )
Emotional support ( jstor )
Epistemology ( jstor )
Psychological counseling ( jstor )
Psychological research ( jstor )
Psychotherapists ( jstor )
Psychotherapy ( jstor )
Rationalism ( jstor )

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University of Florida
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University of Florida
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Copyright Brittany Brucato. 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.
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5/31/2008
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660161431 ( OCLC )

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1 EPISTEMOLOGY AS A PREDICTOR OF PSYCHOTHERAPISTS’ SELF-CARE AND COPING By BRITTANY BRUCATO A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLOR IDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE UNIVERSITY OF FLORIDA 2007

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2 Copyright 2007 by Brittany Brucato

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3 TABLE OF CONTENTS page LIST OF TABLES................................................................................................................. ..........4 ABSTRACT....................................................................................................................... ..............5 INTRODUCTION................................................................................................................... ........6 Epistemic Style................................................................................................................ .........6 Self-Care & Coping............................................................................................................. .....7 LITERATURE REVIEW.............................................................................................................. 10 MATERIALS AND METHODS...................................................................................................15 Participants................................................................................................................... ..........15 Measures....................................................................................................................... ..........15 Procedure...................................................................................................................... ..........18 RESULTS........................................................................................................................ ..............19 DISCUSSION..................................................................................................................... ...........23 LIST OF REFERENCES............................................................................................................. ..28 BIOGRAPHICAL SKETCH.........................................................................................................31

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4 LIST OF TABLES Table page 4-1 Intercorrelations between subscales...................................................................................21 4-2 Means and standard deviations for variables.....................................................................22

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5 Abstract of Thesis Presen ted to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Science EPISTEMOLOGY AS A PREDICTOR OF PSYCHOTHERAPISTS’ SELF-CARE AND COPING By Brittany Brucato May 2007 Chair: Greg Neimeyer Major Department: Psychology The present study examines whether the strengt h of psychotherapists’ epistemic leanings predicts the number of self-care strategies and coping m echanisms engaged in by experienced therapists. Self-care is seen as a preventative measure against stress, while coping is viewed as an individual’s adaptive re sponse to stress or difficulties. This study puts forward the following hypotheses: (1) stronger constructivis t epistemic leanings will be mo re likely to predict a greater number of self-care strategies among psychothe rapists; (2) greater c onstructivist epistemic leanings will be associated with the coping stra tegies of positive reframing and seeking social support for emotional reasons; and (3) greater rati onalist epistemic leanings will be associated with the coping strategies of planning, seeki ng social support for inst rumental reasons and rational/cognitive coping. Our results showed evidence confirming the first hypothesis that those with stronger constructivist epistemic commitment s report engaging in a more fre quent utilization of self-care strategies. The results did not show consiste nt support for the hypotheses regarding differential coping styles. These findings are discussed in relation to the contemporary literature on the translation of epistemology into pr actice; limitations and future dire ctions of this work are noted.

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6 CHAPTER 1 INTRODUCTION The aim of this study is to examine whether different epistemological positions predispose therapists to different levels of self-care and different methods of coping. In order to pave the foundation for the present study, a review was conduc ted on the existing literature on epistemic style, self-care and coping. Epistemic Style Epistemic style can be thought of as an indivi dualÂ’s prevailing set of assumptions about the way in which knowledge is acquired, organized and developed. Another way to conceptualize epistemology is the philosophical assumptions that underlie how people cons true reality and test the validity of their be liefs (Neimeyer, Prichar d, Lyddon & Sherrard, 1993). RoyceÂ’s (1964) taxonomy of epistemic styles suggests that there are three different styl es of knowing, which are referred to as rational, metaphorical and empirical . A rational style involves relating to the world using oneÂ’s rational and analytic skills or conc eptual cognitive abilities. A metaphorical style reflects relating to the world through symbolic representation or using symbolizing cognitive abilities. Lastly, an empirical style involves interact ing with the world using oneÂ’s senses and observations or perceptual cognitiv e abilities. Individua ls are likely to use all epistemic styles, although one specific epistemic style will tend to be dominant. Epistemic style has been associated with pe rsonality characteristics of psychotherapists, with how a therapist conceptualizes and prac tices psychology, as well as the impact of conducting psychotherapy on the therapist. Episte mic style has been shown to correlate with several different therapy-related variable s (Johnson, Germer, Efran, & Overton, 1988; Lyddon, 1989; Mahoney & Gabriel, 1987; Neimeyer et al ., 1993). Previous studies have found that epistemic styles correlate with preferences for specific counseling ap proaches. Those with

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7 dominant rational epistemologies tend to prefer rationalist c ounseling approaches, such as Rational Emotive Behavior Therapy (Lyddon, 1989, Ne imeyer et al., 1993). On the other hand, therapists with dominant metaphorical epistemol ogies tend to prefer c onstructivist counseling approaches, such as Personal Construct Th erapy (Lyddon, 1989, Neimeyer et al., 1993). As such, in the recent psychotherapy literature it has become common to refer to epistemology through the dichotomy of rationalis m and constructivism (Mahoney, 1991). A rationalist epistemology assumes that indivi duals passively percei ve an independently existing real world, which is universal, stab le and potentially k nowable. Conversely, a constructivist epistemology posits that each individual actively crea tes his or her own reality. This unique and individual real ity is created as a byproduct of personal and social interaction processes. Consequentially, it can only be know n indirectly and cannot be separated from the reality of what a particular individual perc eives (Neimeyer, et al., 1993). Although both rationalist and constructivist approaches are co mmonly considered within the rubric of cognitive therapy, there are several differences in the way practitioners of each appr oach conceptualize and implement the practice of psychotherapy. In ra tionalist therapy approach es, the therapist is assumed to perceive reality more accurately than the client and therefore corrects the client’s “cognitive errors.” In contrast, the focus in c onstructivist therapy approa ches is centered on the process, emotion and meaning behind the client’s feelings, rather than on changing client cognitions (Winter & Watson, 1995). Self-Care & Coping Self-care describes the degree to which an i ndividual maintains his or her health through proper diet, exercise, personal hygiene, or va rious other health pr omoting activities. Additionally, self-care can describe the pursuit of a range of ac tivities, running the gamut from pleasure reading, hobbies, vacations, and recreations , to participation in personal therapy or

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8 meditation (Mahoney, 1997). Self-care can be seen as a preventative measure to defend against the deleterious effects of stress. It is very im portant for all individuals to embrace multiple selfcare strategies, no matter which theoretical orient ation dominates or is preferred (Norcross, 2000). Therapists must realize that in many cases, “P ossessing a particular skill in one’s arsenal is less important than having a variety of self-change skills” (Nor cross, 2000, p. 711). While self-care can help prevent stress or mitigate the effects of such, coping can be seen as a person’s response to stress or difficulties. A large number of coping methods exist, which include planning, positive reframing, seeking soci al support for instrumental reasons, seeking social support for emotional reasons, active coping, denial, venting, rational/cognitive coping, wishful thinking, humor and multiple additional coping styles (Carver, 1997, Folkman & Lazarus, 1985). The following five coping stra tegies evaluated in this study, functionally defined below, were chosen because of their rele vance to mental health professionals: (1) The first coping method, seeking social support, can be delineated into two specific categories, according to Carver (1997). Social support soug ht for emotional reasons is based on receiving sympathy or emotional support from another. (2 ) In comparison, seeking social support for instrumental reasons involves the intention to receive assistance, information, or advice from others about an optimal response or course of action. (3) Another common coping modality is planning, where an individual re sponds by developing an implementation plan on how to best confront the stressor. (4) The coping style of positive re framing involves optimism, and readdressing a stressor to extract the good from the situation, while viewi ng the event in a more favorable light. (5) Finally, an individual ma y choose to dissect, comprehend, and use their cognitive skills to solve a stressf ul situation, which is labeled the rational/cognitive approach to coping (Osipow & Davis, 1988).

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9 For the purpose of this study self-care was defi ned as a preventative measure against stress, while coping was defined as a response to stress, although the dichotomy is not always this clear cut. It is important to note that it is po ssible for self-care and coping to function as both preventative and/or responsive to stress depe ndent on the circumstances. For example, meditation is defined as a type of self-care ac tivity, but just as medita tion can be a behavior engaged in prior to feeling stressed, it can also be a way to cope with stress.

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10 CHAPTER 2 LITERATURE REVIEW Mahoney (1997) found that in terms of how psychot herapists engage in self-care, the most commonly reported activities included pleasure r eading, exercise, hobbies, and vacations. Peer supervision, prayer or meditation, and volunteer work were the second predominant group of activities. Nondoctoral therapists were more likely to have enga ged in personal therapy in the preceding year, with women participating significan tly more frequently than men. Overall, the study shows that psychotherapists are generally happy, healthy, and regularly engage in various forms of self-care. However, this study di d not address the relati onship of theoretical orientations or epistemologies to overall self-care. This same study (Mahoney, 1997) also addresse d psychotherapistsÂ’ pe rsonal problems and concomitant self-care patterns. The results indi cated that the most commonly reported issues for therapists were emotional exhaustion and fatigue , precursors to burnout. Bu rnout is a type of prolonged response to chronic interpersonal and emotional stressors on the job. More specifically, it is a condition of emotional exha ustion, depersonalization, and reduced personal accomplishment (Maslach & Goldberg, 1998). Stress th at is not dealt with effectively can lead to burnout, which can present with symptoms including overworking (along with delaying or canceling vacations), chronic fatigue , irritability, social withdraw al, declining sense of humor, increased physical complaints, changes in job performance or even self-medication . The lack of proper self-care can increase an individuals risk for burnout (Patrick, 1981). Other studies have found that a large percentage of psychot herapists, between 79 and 82 percent, had, in fact, reported experiencing psyc hological distress within the three years prior to the survey (Prochaska & Norcross, 1983; No rcross, Prochaska & Diclemente, 1986). A nationwide survey of 318 psychotherapists f ound that 74.3% indicated experiencing personal

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11 distress in the last three years prior to the study. Of those w ho reported a distressing episode, 36.7% stated that it had lowered the quality of cl ient care, and 4.6% admitted that it resulted in deficient treatment (Guy, Poelstra, & Stark, 1989). The inability to cope with stress effectively can contribute to a decreased energy level, performance failures, and health problems (Long, 1988). Mahoney’s (1997) work also revealed that doctoral level psychoth erapists reported less overall satisfaction w ith their sleep than nondoctoral therapists. Self-care and coping are important ways of addressing, treating, and preventing therapist burnout. Moreover, self-care can replace negative coping strategies, such as substance abuse, psychophysiological illness, escape, avoidance and other maladap tive defense mechanisms often used to battle burnout (Muldary, 1983). Burnout can even become an ethical issue if it produces symptoms that threaten ethical therapeutic practice (Wityk, 2002). The American Psychological Association code of ethical principles and conduct explicitly st ates, “psychologists have an oblig ation to be alert to signs of, and to obtain assistance for, their personal proble ms at an early stage, in order to prevent significantly impaired performance” (APA, 1992, 1.13.b). Self-care protects the client by reducing risks associated with ethical violations of practic e while promoting and modeling personal growth and well being, which can furthe r serve to enhance therapy. Additionally, it provides protection for the therapist from occupa tional hazards including burnout (Porter, 1995). Although a matter of seemingly equal importance, the issue of the therap ists’ welfare and wellbeing seems to be left out of the APA ethical code . It appears that therap ists who are trained to care for others frequently ove rlook their own need for self-c are (O’Halloran & Linton, 2000). “Although understandable and explicable on many levels, the paucity of systematic study on psychotherapists’ self-care is uns ettling” (Norcross & Brown, 2000, p.710).

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12 There is a heightened awareness towards self -care in constructivist psychotherapies. In Constructivism in Psychotherapy , Neimeyer and Mahoney (1991) highlight the psychological demands of being a constructivist therapist, as well as the central priority of self-care for practitioners. Additionally, in cons tructivist therapies, the therapist is seen as an instrument of inquiry for the client and it theref ore logically follows that that in strument needs to be cared for in order for the therapist to give ideal care (Guy, 1987). Feminist theory, which is based on the d econstruction and reconstruction of broader relational patterns, can be concep tualized as a constructivist theo ry. In the past 30 years, feminism and social constructionism have achie ved a dovetailing of goals based on their joint challenges of assumed social tr uths about sex and gender, wh ich stem from an objectivist psychological perspective (Guyer & Rowell, 1997). Feminist ther apy has a solid foundation of awareness and guidelines for self-car e and coping incorporated into the theory. Self-care is built into the feminist therapy code of ethics, which discusses the im portance of preserving self-care in terms of both the pers onal and professional consequences for the therapist. A feminist therapist engages in self-care activities in an ongoing manner outside the work setting. She recognizes her own need s and vulnerabilities as well as the unique stresses inherent in this work. . . . She is also willing to self nurtu re in appropriate and self-empowering ways. (Feminist Therapy Institute, 2000, IV.E.) Feminist therapy emphasizes that therapists take proper care of themselves in their personal lives in order to prevent harming clients, but does not neglect the fact that therapistÂ’s personal needs are equally important to balance so as to achiev e the most positive therapeutic environment. At this point, feminist therapy has proven to be the only theory which explicitly states in its ethical code the importance of self-care for the well-bei ng of the therapist. (Porter, 1995; Faunce, 1990).

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13 This study is largely exploratory as prior studies have not measured the relationship between epistemology, self-care and coping. Ther efore, predictions in the present study are conceptually rather than empirically based. This study proposes that episte mic styles may predict or guide particular styles of coping because proponents of each may be predisposed to approach and deal with stress in differing ways; furthermore to cope in the ways that they teach others to cope. For example, an epistemic style that pr omotes rationalism may predispose a therapist to cope with feelings through logi cal analysis, rational disputation, or emotional distancing in an effort to minimize the impact of powerful nega tive emotions experienced in the course of conducting therapy. Constructivis t leanings, by comparison, might predispose the therapist towards greater emotional attunement, looking fo r the "meaning behind the feelings", talking with others to gain perspective on the feelings, or even amplifying the f eelings to understand the nature of the messages they may carry regardi ng relational aspects of the emotion between the client and himself/herself (Mahoney, 1991). To date there is no empirical evidence that links different epistemic styl es to varying levels of self-care or different ways of coping. Therefore, the first aim of this study is to assess whether the strength of epistemic leanings, constructivist or rationalist, will predict the utilization of selfcare strategies among psychotherapists. Th e present study hypothe sizes that greater constructivist epistemic leanings will predict the mo re frequent utilization of a variety of selfcare strategies. The second aim of this study is to determine if the strength of epistemic leanings, constructivist or rationa list, predicts qualitatively differe nt ways of coping. The second hypothesis predicts that greater constructivist ep istemic leanings will be associated with the coping strategies of positive reframing and seek ing social support for emotional reasons. The third hypothesis of this study posits that greater rationalist epistemic leani ngs will be associated

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14 with the coping strategies of planning, seeki ng social support for inst rumental reasons and rational/cognitive coping. In conclusion, the importance of using multiple se lf-care strategies is clear. This study has implications for the training of therapists in all theoretical approaches/orientations. Future directions include the po ssibility of facilitating greater awareness of and training for self-care and effective coping being built into different theoretical approaches.

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15 CHAPTER 3 MATERIALS AND METHODS Participants Participants came from a database with the email addresses of 10,000 psychotherapists from across the United States. Approximately 855 of the emails bounced back, so in total it went out to about 9,115 people. The sample consisted of 151 participants, 85 females and 66 males. The average age was 47, but ranged from 27 to 72. The racial, ethnic breakdown was 93.4% white/Caucasian, 2% black, 2% Multiracial, 1.3% American Indi an/ Native American .7%Asian American / Pacific Islander and .7% Hispanic/L atino. The average experience level for this sample was 15 years of practice as a psychotherapi st, and the participants reported working with an average of 16 clients weekly. Eighty-four pe rcent of the sample was comprised of doctoral level practitioners with the remainder being ma sters level therapists. The primary employment setting of this sample was private prac tice (39.3%), followed by university academic departments (14.7%), University service delivery department (12.7%), Hospitals (10.7%), with the remaining participants spread between ment al health care, community center, schools and research settings. The theoretical orientat ion breakdown was 32% Cogni tive Behavioral, 20.4% Integrative, 19% Psychodynamic, 10.9% other, 9.5% Interpersonal, 4.1% Humanistic, 2% Constructivist, 1.4% Existential, and .7% Rational/Emotive. Measures Occupational Stress Inventory-Revised (Osipow, 1998). The rational/cognitive coping and self-care subscales of the OS I-R were utilized. Each subscale has 10 items rated on a 5 point Likert-type scale with 1 = rarely or never a nd 5 = most of the time. The rational/cognitive subscale measures the extent to which the person possesses and uses cognitive skills in the face of work related stresses; only 2 questions were selected from this subscale based on their

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16 relevance. A sample item is “When faced with a problem I use a systematic approach.” The selfcare subscale measures the extent to which the person engages in activi ties for health purposes, such as diet, exercise, sleep, meditation and re laxation etc. A sample item is “I exercise regularly.” Internal consistency of these subscales are shown w ith Cronbach alpha coefficients equal to .78 and .73 respectively. Validity of th e OSI-R was shown by correlations ranging from .63 to .9 when compared to the OSI, the previous version. Furthermore, the OSI-R was related in predictable ways to data examining the Employe e Assistance Program I nventory and the Career Attitudes and Strategies Inventory which confirm its convergent validity. Cronbach alpha’s were calculated for this data and found to be .713 for the self-care subscale and .591 for rational/cognitive coping subscale. Previous-year self-care patterns. This is a 10 item subscale from the measure developed by Mahoney for his (1997) study titled Psychot herapists’ Personal Problems and Self-care Patterns. This scale assesses potential self-car e activities such as recr eation, vacations, hobbies, and personal therapy. A sample item includes ques tions such as, “in the previous year have you been a client in personal thera py.” The Cronbach alpha was calcul ated from this data and was found to be .701. The Brief COPE (Carver, 1997). The Brief COPE ha s 14 subscales with 2 items each, each measuring a different way of coping. Each it em is rated on a 4 point Likert-type scale with 0 = I haven’t been doing this at all and 3 = I’ve be en doing this a lot. Only the subscales of 1) positive reframing, 2) planning, 3) social support fo r instrumental reasons and 4)social support for emotional reasons were used in this study. Some sample items are “I’ve been trying to come up with a strategy about what to do” and “I’ve been trying to see it in a different light, to make it seem more positive.” The Brief COPE has shown internal reliability with alpha scores of the

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17 subscales ranging from .6 to .9. Also, exploratory factor analysis showed a factor structure that was generally consistent with the full COPE, confirming the validity of the scale. From the current data, the following Cronbach alphas were calculated for each way of coping, with social support for emotional reasons netting .856, instru mental reasons .838, positive reframing .760 and planning at .797. Perceived Stress Scale (Cohen, Kamarck & Merlmestein, 1983). The PSS is a 10 item measure designed to assess the degree to which one's life situations and circumstances are perceived as stressful. Each item is rated on a 5 point Likert-type scale, with 0 = Never and 4 = very often. A sample item is “In the last m onth, how often have you felt confident about your ability to handle your personal problems.” The P SS has shown internal re liability with alpha coefficients ranging from .84 to .86. Validity is shown through its correlates with physical and depressive symptomatology which were m easured between .52 and .70, and .65 and .76, respectively . The Cronbach alpha for the data from this study was .077. Therapist Attitude Questionnaire Short-Form (Neimeyer & Morton, 1995). The TAQSF is a 16 item measure, with 8 questions m easuring rationalist epistemic leanings and 8 questions measuring constructivist epistemic lean ings. Each question is measured on a 5 point Likert-type scale with 1 = strongly disagree and 5 = strongly agree . A sample item from the rationalist subscale is “psychot herapists should encourage emoti onal experience, expression, and exploration.” A sample item from the constructivist subscale is “it is best for psychotherapists to focus treatment on clients’ personal problems and the elimination or control of these problems”. The validity of this measure ha s been shown as it correlates with transcripted adjective descriptions of rationalist and c onstructivist identification. Relia bility of the TAQ-SF has been verified by Cronbach alpha coefficients of .72 for the rationalist scale and .64 for the

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18 constructivist scale. Cronbach al pha coefficients were calculated from the data in this study and found to be .723 for rationalism, and .671 for constructivism. Procedure An email was sent out to all psychotherapists in the database soliciting their participation. The email had a hotlink that forwarded participants to a website where they completed the survey. Participants first completed the informed consent. Then, they completed the survey, demographics questionnaire, and finally the debriefing.

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19 CHAPTER 4 RESULTS A difference score was created to capture th e differences in commitment to either rationalist or constructivist epis temic styles. It was calculated by subtracting rationalist scores form constructivist scores; therefore a higher po sitive number reflected a stronger constructivist commitment and a higher negative number refl ected a stronger rationalis t commitment. This difference variable was used as the independent variable in all subsequent analyses. Exploratory analyses were conducted through a correlation matrix incl uding self-care, each way of coping, the difference variable, years of experience and perceived stress. Significant correlations were found between the difference variable and MahoneyÂ’s self-care scale (r = .204), OsipowÂ’s self-care scale (r = .239) and social support fo r emotional reasons (r = .222). Social support for emotional and instrumental reasons were also highly correlated with each other (r = .589). Additional relati onships are depicted in Table 1. The first hypothesis that great er constructivist epistemic le anings would predict more frequent utilization of a variet y of self-care strategies was ex amined using two separate linear regressions. A Bonferroni adjust ed alpha level of .025 was applied to these analyses to protect from the accumulated familywise error associ ated with running serial analyses. The first regression which utilized the di fference scores as the predic tor and the overall score on MahoneyÂ’s self-care scale as the out come variable was significant ( r2 = .042, F = 6.458, p = 0.12). Since the outcome variable had a positive beta weight (b = .202) we know that those with a higher commitment to constructivism engaged in the more frequent utilization of self-care strategies. The second regression between the same difference score predictor with the overall score on OsipowÂ’s self-care scale as the outcome variable was also significant ( r2 = .057, F = 9.047, p = .003). Again, the outcome variable had a pos itive beta weight (b= .240) showing that

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20 higher constructivist commitments were predicting more frequent use of self-care. All means and standard deviations are given in Table 2. For the second and third hypotheses regarding co ping styles, five linea r regressions were performed with the difference variable as the pr edictor for each and one of various ways of coping as the outcome variables. A Bonferrroni adjusted alpha le vel of .01 was applied to these analyses. The first regression using social support for instrume ntal reasons as the outcome variable was not significant ( r2 = .032, F = 4.851, p =.029). The next regression examined positive reframing as the dependent variable and also did not reach significance ( r2 = .033, F = 5.035, p =.026). The third regression looked at planning and was also not significant ( r2 = .002, F = .274, p =.601). And the fourth regression evalua ted rational/cognitive coping and also was not significant ( r2 = .011, F = 1.608, p =.207). Finally, the fifth and la st regression utilized social support for emotional reasons as the outc ome variable and it was significant ( r2 = .049, F = 7.697, p = .006). Social Support for emotional reas ons had a positive beta weight thus this finding confirms that those with higher constructivi st commitments are more likely to use this as a coping style. For a post hoc analysis, social support for inst rumental reasons was combined with social support for emotional reasons into a total social support variable . A regression was performed on this total social support vari able and found to be significant ( r2 = .049, F = 7.676, p = .006) with a positive beta weight, i ndicating that those w ith higher constructivist commitments were more likely to engage in overall so cial support as a coping mechanism.

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21 Table 4-1. Intercorrela tions between subscales Subscale 1 2 3 4 5 6 7 8 9 10 1. Difference variable __ .204 .239 .178 .222 .181 -.043 -.103 .107 .173 2. Self-care (Mahoney) __ .373 .289 .318 .208 .074 .125 .149 .188 3. Self-care (Osipow) __ .178 .249 .213 .052 .221 .153 -.026 4. Social support instrumental __ .589 .412 .459 .175 -.293 .140 5. Social support emotional __ .399 .225 .181 -.153 .115 6. Positive reframing __ .401 .209 -.073 .124 7.Planning __ .377 -.244 .145 8.Rational/cognitive coping __ -.030 .164 9.Years of experience __ -.064 10. Perceived stress level __

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22 Table 4-2. Means and standard deviations for variables Variable Mean Standard deviation Constructivism 33.93 3.35 Rationalism 21.03 5.15 Self-care (Mahoney) 27.24 6.9 Self-care (Osipow) 32.62 6.82 Social support instrumental 5.6 1.64 Social support emotional 6.53 1.41 Positive reframing 6.25 1.43 Planning 6.38 1.53 Rational/cognitive 8.11 1.52 Years of experience 14.9 10.8 Perceived stress level 16.7 2.74

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23 CHAPTER 5 DISCUSSION Based on the results of this study, it a ppears that epistemic styles do seem to translate to self-care strategies, as those w ith stronger constructivist epistemi c leanings report engaging in a more frequent utilization of self-care. These results provide evid ence that the fundamental importance given to self-care in constructivist therapies does seem to translate to the perceived behavior of practitioners. These findings have important imp lications for the avoidance of therapist burnout, a common compla int of practitioners, wherein it appears that those with constructivist epistemic leanings are more likely to practice more frequent self-care, essential to burnout prevention. Burnout is a serious issue for the well-being of both th e therapist and client (Wityk, 2002). These findings also have applica tions for the training of psychotherapists. Specifically, it points to the need for traini ng programs with different theoretical and epistemological orientations to specifically target an awareness of the n eed to practice self-care to avoid burnout and mini mize the effects of stress. The results with regard to coping style reveal ed that there was a hi gher likelihood for those with stronger constructivist epis temic leanings to use social su pport. Interestingly, it was found that constructivists were more likely than rationalists to use so cial support for both emotional and instrumental reasons. It was hypot hesized that those with higher rational epistemic commitments would be more likely to use so cial support for instrumental reas ons, when in fact the opposite was found to be true. This finding highlights the f act that social support in general may be an important coping mechanism for those who are hi gh in constructivist epistemic commitment. There are several possible explanations for th e lack of other copi ng style effects. One likely factor involves the fact that the average overall score on the Pe rceived Stress Scale was relatively low (a mean of 16.8), as the majority of subjects were endorsin g responses of “almost

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24 never” to “sometimes” on questions regarding thei r level of perceived stress. Consequently, it seems that on average this sample was not expe riencing significant stress. In the absence of significant stress, the utilization of coping strategies may not be as critical, and therefore the hypothesized effects of differences would be more difficult to detect, washed out by circumstances where very few in the sample need ed to perform coping behaviors. High stress situations might be more likely to require the ut ilization of coping strategies, and for that reason those contexts might better reflect the differentia l utilization of different forms of coping as a function of different epis temological orientations. In order to test this possibility, individuals with the lowest overall stress scores were eliminated, to see if our coping effects would be more robust with those experiencing stress at higher levels. To identify which scores to e liminate, a mean score was calculated along the Perceived Stress Scale (M = 16.8), and all scor es below the mean (i.e., 15 or lower) were removed from the analyses. With this change, the regression analysis using positive reframing as the dependent variable became significant ( r2 = .068, F = 7.989, p < .006), in addition to the significant effects noted above for Social Suppo rt (Instrumental and Emotional). The positive beta weight associated with this finding (b = .053) confirms that among those experiencing higher levels of stress, those with higher cons tructivist commitments were more likely to use positive reframing as a coping style. This provide s some tentative support for the likelihood that the relationship between epistemological comm itments and coping styles may become more pronounced under conditions of higher levels of st ress. Future work might be directed to replicating and generalizing this effect in relation to more seve rely stressed psychotherapists. Notwithstanding these positive effects, it is st ill the case that stronge r rationalist leanings were not associated with distinctive coping styl es. Contrary to predictions, level of cognitive

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25 coping and planning, for example, were not predic ted by rationalist commitments. A number of interpretations are possible in this regard. First, it is possible that rati onalist epistemic styles do not translate to coping styles, regardless of the ther apists’ overall levels of stress. Past research has shown that epistemology is associated with various therapy-relate d variables, regarding relationships and interactions within the therapeutic context (Johnson et al., 1988; Lyddon, 1989a; Mahoney & Gabriel, 1987; Neimeyer et al., 1993), but this may not extend to the personal behavior of the therapis t. In other words, rationalist epistemic styles may affect the therapeutic relationship and in teractions, but may not carry over to the self. On the other hand, since only five coping styles were explored in this study out of the universe of possible coping styles, it is possible that re lationships in the pr edicted direction may exist for other coping strategies, behaviors or mech anisms that are more clearly tied to features of rationalist epistemology. That is , it is possible that the lack of significant results may just be a function of the subset of specific coping styles chosen for this st udy. Another possibility is that the particular measures utilized were not sensi tive enough to detect differences in coping styles between therapists holding construc tivist versus rationalis t styles. Or perhaps the scales chosen identified coping styles in a general rather than example specific way, which minimized the likelihood of finding effects. For example, one of the rational/cognitiv e coping questions was, “when faced with a problem I use a systematic ap proach,” which could clearly be interpreted in many different ways and therefore easily endor sed by therapists from a wide variety of orientations. It is recommended that future re searchers in this domain utilize survey questions with much more specific examples, which coul d help to more accurately capture predicted differences between epistemic styles. Additionall y, it is possible that differences may exist along other dimensions, and these questio ns require further investigation .

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26 In sum, a growing literature has associated, epistemologies with personality characteristics of psychotherapists, how a therapist conceptual izes and practices psychology, as well as the impact of conducting psychotherapy on the therapist (Johnson et al., 1988; Lyddon, 1989a; Mahoney & Gabriel, 1987; Neimeyer et al., 1993). The findings of the current study add to this expanding body of literature on the tran slation from epistemology to practice . This research represents the beginning of exam ining how epistemic styles may affect behavioral outcomes like therapist self-care and coping. It is important to note that the data are corr elational in nature and thus preclude direct evidence that constructivist epistemic leanings are specifically causing diff erential use of selfcare. Another important limitation of this st udy is the use of self -report measures and concomitant lack of any behavior al indicators. That is, how do we know that therapists were actually engaging in the self care behaviors as claimed, or at the frequency reported. Additionally, the methodology involved an online sampling technique and therefore lacked control over the setting in which participants comple ted the survey. Furthermore, it is likely that the sample may be biased to those who are mo re computer savvy, or those who have enough free discretionary time to voluntarily participate in a re search survey. The latter could very well skew the sample to those who are less stressed (i.e., le ss busy), as therapists who are very busy are more likely to be more highly stressed and less likely to have the time or energy to participate in a study of this type. This is counterbalanced by the fact that in an online survey, the anonymity may make participants feel more comf ortable disclosing personal information (Gosling et. al., 2004). Furthermore, this study could have benefite d from the addition of more measures or indicators of stress level and burnout as well as measures of stress hardin ess characteristics (to

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27 parcel out a potential covariate) so that the relationship between self-care, coping and stress could have been better understood. In conclusion, within the context and limitati ons, this study contribu tes to a growing body of literature on the translation of epistemology to aspects of professional practice. Self-care and burnout are extremely important issues for therap eutic practice and deserve more attention in current research. The hope of this research is to spur both furthe r and more specific investigation into the benefits of self-care practices and their relationship to epistemology.

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28 LIST OF REFERENCES Carver, C. S. (1997). You want to measure c oping but your protocols to o long: Consider the brief COPE. International Journal of Behavioral Medicine, 4 , 92–100. Cohen, S., Kamarck, T., Mermelstein, R. (1983) . A global measure of perceived stress. Journal of Health and Social Behavior , 24 , 385–396. Faunce, P. S. (1990). Self-care and wellness of fe minist therapists. In H. Lerman & N. Porter (Eds.), Feminist ethics in psychotherapy . (pp. 123–130). New York: Springer Publishing Co. Feminist Therapy Inst itute, Inc. (2000) Feminist therapy code of ethics . Denver: Feminist Therapy Institute Inc. Folkman, S., & Lazarus, R. S. (1985). If it chan ges it must be a process: Study of emotion and coping during three stages of a college examination. Journal of Personality and Social Psychology, 48 , 150–170. Gosling, S. D. Vazire, S., Srivastava, S. & John, O. P., (2004) Should we trust web-based studies? A comparative analysis of six preco nceptions about internet questionnaires. American Psychologist , 59 , 93–103. Guyer, L.T., & Rowell, L.L. (1997). Gender, social constructioni sm, and psychotherapy: Deconstructing feminist social constructions. In T. L Se xton & B. L. Griffin (Eds.), Constructivist thinking in counsel ing practice, research, and training . (pp. 58–97). New York: Teachers College, Columbia University. Guy, J. D. (1987) The personal life of the psychotherapist . Toronto: John Wiley & Sons, Inc. Guy, J. D., Poelstra, P. L., & Stark, M. J. (1989 ). Personal distress and th erapeutic effectiveness: National survey of psychologist s practicing psychotherapy. Professional Psychology: Research and Practice, 20 , 48–50. Johnson, J. A., Germer, C. K., Efran, J. S., & Over ton, W. F. (1988). Personality as the basis for theoretical predilections . Journal of Personalit y and Social Psychology, 55, 824–835. Long, B. C. (1988). Work-related stress and co ping strategies of professional women. Journal of Employment Counseling, 25 , 37–44. Lyddon, W. J. (1989). Personal epistemo logy and preference for counseling. Journal of Counseling Psychology, 36 , 423–429. Mahoney, M. J. (1997). Psychotherapists’ pe rsonal problems and self-care patterns. Professional Psychology: Research & Practice, 28 , 14–16.

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29 Mahoney, M. J., & Gabriel, T. J. (1987). Psychot herapy and the cognitive sciences: An evolving alliance. Journal of Cognitive Psychotherapy, 1 , 39–59. Maslach, C., & Goldberg, J. (1988). Pr evention of burnout: New perspectives. Applied & Preventative Psychology, 7 , 63–74. Muldary, T. W. (1983). Burnout and health professionals: Manifestations and management . Garden Grove: Capistrano Press, Ltd. Neimeyer, R. A., & Mahoney, M. J. (1991). Constructivism in psychotherapy . Washington, DC: American Psychological Association. Neimeyer, G. J., Prichard, S., Lyddon, W. J., & Sh errard, A. D. (1993). The role of epistemic style in counseling pref erence and orientation. Journal of Counseling & Development, 71 , 515–522. Neimeyer, G. J., & Morton, R. J. (1997) Person al epistemologies and pr eferences for rationalist versus constructivist psychotherapies. Journal of Constructivist Psychology, 10, 109–123. Norcross, J. C., & Brown, R. A. (2000). Psychothe rapist self-care: Practi tioner-tested, researchinformed strategies. Professional Psychology: Research and Practice , 31 , 710–713. Norcross, J. C., Prochaska, J. O., & Diclemen te, C. C. (1986). Self -change of psychological distress: Laypersons' vs. psyc hologists' coping strategies. Journal of Clinical Psychology , 42 , 834–840. Osipow, S. H., & Davis, A. S. (1988). The re lationship of coping resources to occupational stress and strain. Journal of Vocational Behavior , 32, 1–15. Osipow, S. H. (1998). The occupational stress inventory revised edition . Odessa: Psychological Assessment Resources Inc. Patrick, R. K. S. (1981). Healthcare worker burnout: Wh at it is what to do about it ? Chicago: Blue Cross Association. Porter, N. (1995). Therapist self-care: A proactiv e ethical approach. In E. J. Rave & C. C. Larsen (Eds.), Ethical decision making in th erapy: Feminist perspectives . (pp. 247–266). New York: The Guilford Press. Prochaska, J. O., & Norcross, J. C. (1983). Psyc hotherapists' perspectives on treating themselves and their clients for psychic distress. Professional Psychology: Research & Practice, 14, 642–655.

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30 Royce, J. R., & Smith, W. A. (1964). A note on the development of the psycho-epistemological profile (PEP). Psychological Reports, 14 , 297–298. Winter, D. A., & Watson, S. (1999). Persona l construct psychotherapy and the cognitive therapies: Different in theory but ca n they be differentiated in practice? Journal of Constructivist Psychology, 12 , 1–22. Wityk, T. L. (2002) Burnout and the ethics of self-care for therapis ts. Symposium paper presented at Linking Research to Educational Practice II. Calgary.

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31 BIOGRAPHICAL SKETCH Brittany Brucato was born on September 5, 1983 in Cleveland Ohio. She moved to Miami Florida, when she was five years old, wher e she attended Palmetto Senior High School. She graduated from the University of Florida in 2005, where she received her B.S. in psychology. She is currently completing her graduate studies in counseling psychology at the University of Florida.