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Me Now, Me Then

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Title:
Me Now, Me Then Therapists and Constructions of their Epistemic Journey
Creator:
Toska, Gizem
Place of Publication:
[Gainesville, Fla.]
Florida
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University of Florida
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Language:
english
Physical Description:
1 online resource (129 p.)

Thesis/Dissertation Information

Degree:
Doctorate ( Ph.D.)
Degree Grantor:
University of Florida
Degree Disciplines:
Counseling Psychology
Psychology
Committee Chair:
Neimeyer, Greg J.
Committee Members:
Farrar, Michael J.
Rice, Kenneth G.
Sherrard, Peter A.
Graduation Date:
8/9/2008

Subjects

Subjects / Keywords:
Cognitive psychology ( jstor )
Cognitive therapy ( jstor )
Conceptualization ( jstor )
Constructivism ( jstor )
Epistemology ( jstor )
Medical treatment ( jstor )
Psychology ( jstor )
Psychotherapists ( jstor )
Psychotherapy ( jstor )
Rationalism ( jstor )
Psychology -- Dissertations, Academic -- UF
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bibliography ( marcgt )
theses ( marcgt )
government publication (state, provincial, terriorial, dependent) ( marcgt )
born-digital ( sobekcm )
Electronic Thesis or Dissertation
Counseling Psychology thesis, Ph.D.

Notes

Abstract:
Our study investigated the epistemic change processes of psychotherapists and attempted to identify the nature of the epistemic journey of this group. We conducted a retrospective study where therapists were asked to reflect on their current and past epistemic commitments as well as theoretical orientations and therapeutic styles. This method provided us with a unique set of data where we learned about the therapists? personal constructions of their epistemic journeys and other professional change processes accompanying this journey. Findings suggested that when reflected on their current experiences and their initial experiences as blossoming practitioners, therapists perceived their commitment to constructivist epistemology as amplified, and their commitment to rationalist epistemology as reduced over their practice. The cohort effects failed to explain these changes or to differentiate therapists' initial constructivist commitments. The obtained results also indicated that the perceived change in epistemic commitments predicted therapists? theoretical and stylistic commitments. Our study facilitated our understanding of the developmental trajectory of therapists' epistemic commitments as they perceive it and it provided empirical data with respect to how therapists construe the professional change processes that accompany their epistemic change. ( en )
General Note:
In the series University of Florida Digital Collections.
General Note:
Includes vita.
Bibliography:
Includes bibliographical references.
Source of Description:
Description based on online resource; title from PDF title page.
Source of Description:
This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Thesis:
Thesis (Ph.D.)--University of Florida, 2008.
Local:
Adviser: Neimeyer, Greg J.
Electronic Access:
RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2010-08-31
Statement of Responsibility:
by Gizem Toska.

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Copyright Toska, Gizem. 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.
Embargo Date:
8/31/2010
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Second, Radeke and Mahoney (2000) compared the impact of their work for psychologists

who were primarily involved with research and psychologists who were primarily identified as

practitioners. This study revealed that compared to researchers, therapists experienced a stronger

impact of their work on their personal problems as well as their personal life. Practitioner

therapists were more likely to acknowledge feeling emotionally exhausted, anxious, and

depressed. Impact of work on personal life included reports of becoming a better and wiser

person with increased self-awareness, increased appreciation for relationships and increased

ambiguity tolerance. In general, psychotherapists reported more change experiences in various

forms than researchers did.

These studies focused on or provided answers for how psychotherapists' personal lives and

experiences changes through their lives as professional practitioners. Goldfried (2001a)'s edited

work, on the other hand, provided information on the therapists' professional change

experiences.

In Goldfried (2001a)'s work, a group of seasoned practitioners individually reflected on

their professional change processes. These narrations revealed intricate yet shared ways in which

practitioners change as they conducted therapy. Summarizing the common points of the

narrations of 16 seasoned psychotherapists, Goldfried (200 b) concluded that conducting

psychotherapy with a mindset of being helpful to clients often demanded therapists to change the

ways in which they understand and approach certain conditions and that impacted the way they

approached to their clients and the way they conducted therapy.

Sporadic interviews with established psychotherapists (such as DeAngelis, 2006) and

infrequent publications where psychologists told their personal stories (such as Hoyt, 2005 and

Brown, 2005) make the last group of resources that can shed light into the process of change









APPENDIX A
THERAPIST ATTITUDE QUESTIONNAIRE-SHORT FORM (TAQ-SF)

Please rate the following items along the following 5-point scale. In considering yourself
"NOW", we are interested in how you currently view yourself and your professional practice
today. In considering yourself "THEN", we are interested in how you view yourself when you
first started practicing following the completion of your graduate training.


2
Moderately
disagree


Neither agree
nor disagree


Moderately
agree


NO\\


I Reality\ is siniuilar. stable and eternal to hiuiman experience

2 Kno\\ ledue s determined to be \alid b\ louic and reason

3 Learimni, In\ ol\ es the contiuOltisi oi continent chaliminu of
discrete e\ ents

4 Nlental representations of realmit\ in\ol\ e accurate. e\pilicit
and e\tensi\ e couples of tie e\teirnal \\ 0ord. \\ hlclc are encoded
in memory\
III Ille11101A

5 It is best for ps chllil.erapists to focI'u treatment on clients
current problems and the el 1min atlon or control of these
problems

11 Disturbed affect comes from irrational. I\ alild. distorted
or and i inirealistic tlhnlkin

SClients reistance to chanlle reflects a lack of lmoti\ nation.
ambi\ alence oo moti acted a\ oidalnce and such resistance to
challne is an Imlpedilment to therapy \\h ch tle 1is\ chlotlherapist
\\ oirk to o\ ercome

S Reality\ is relati\ e Realities reflect lndli\ dual or collect\ e
construction of order to one' experiences

0 Leartnin in\ ol\ es thle refinement and transformation
(assilnlationl and accommllodation of mIental representation

10 Coun'ition. beha\ 101or and affect are interdependent
expressions of holistic s\ steic processes The three are
fLinctionall\ and structl rall\ Inseparable


1 2 3 4 5 1 2 3 4 5

1 2 3 4 5 1 2 3 4 5


1 2 3 4 5 1 2 3 4 5



1 2 3 4 5 1 2 3 4 5



1 2 3 4 5 1 2 3 4 5



1 2 3 4 5 1 2 3 4 5



2345 12345
1 2 3 1 2 3 4



1 2 3 4 5 1 2 3 4 5


1 2 3 4 5 1 2 3 4 5



1 2 3 4 5 1 2 3 4 5


1
Strongly
disagree


5
Strongly
agree


SHEN









precisely defined realities and embrace complexity and flexibility in the ways they understood

and reached out to their clients. The current study indicates that psychotherapists also perceive

this trend of increasing commitment to constructivist epistemology within themselves.

Rationalist and constructivist epistemologies are largely complementary and their

differences reflect upon the way therapy is conceived and conducted (Lyddon, 1988; Mahoney &

Gabriel, 1987; Mahoney & Lyddon, 1988). Rationalist epistemologies tend to assume a stable,

single, universal reality and therapists' commitment to rationalist epistemology translates into

their practice with an aim to correct the client's faulty cognitions of reality through a relatively

straightforward approach (Nagae & Nedate, 2001; Vasco, 1994; Viney, 1994; Winter & Watson,

1999). Higher levels of rationalist commitments were also linked to lower levels of self-

exploration, openness, and tolerance in therapists (Neimeyer & Aksoy, 2005).

Career development studies have indicated that therapists tend to reject precisely defined

realities, and embrace complexity and flexibility in the ways they conceptualized and conducted

therapy over the course of their development as professional practitioners (Ronnestad &

Skovholt, 2003). These changes are consistent with a greater alignment with constructivist

commitments. We might expect that therapists' increasing commitment to constructivist

epistemologies across the course of their development would be associated with corresponding

decreases in complementary epistemologies such as rationalism. Hence, the finding of perceived

weakening in therapists' rationalist commitments is consistent with overall increase in

constructivist leanings in the current study.

The current study reveals that lay psychotherapists also perceive this trend of increasing

commitment to constructivist epistemology within themselves. When therapists reflected on their

current and initial experiences, they observed an increase in their constructivist commitments









theoretical plurality. Data indicated a significant increase in therapists employing a greater

variety of theoretical orientations in their practice with a partial-eta squared of .38. Hence,

therapists' reported increase not only in their constructivist leanings but also in their theoretical

eclecticism i.e. plurality. Data also indicated a significant reduction in therapists' perceived

commitment to rationalist epistemology across their practice.

Therapists' change in their theoretical orientation can be understood further by comparing

individual theoretical orientation ratings for now and then. We conducted a series of repeated

measures ANOVA, with now-versus-then (i.e. time factor) as the within-subjects factor and

seven theoretical orientations as the dependent variables, to investigate whether there were

significant reported changes in the therapists' commitment to these specific theoretical

orientations over the course of their practice. Bonferroni adjustment was employed within the

analyses to guard against the Type I error, and alpha level was established at .007 (.05/7), which

is the original alpha level (.05) divided by the number of statistical tests. Table 4-4 summarizes

the obtained coefficients.

With respect to theoretical orientation changes within therapists, data indicated statistically

and clinically significant increase in therapists' commitment to cognitive, constructivist and

feminist-multicultural therapies. There was also a significant increase in behavioral therapy, and

systemic-family therapies although these changes were failed to be clinically meaningful

suggested by their low effect size indices. Data failed to indicate change for therapists'

commitment to psychodynamic and humanistic-existential-gestalt orientations.

An overall change in therapists' theoretical perspectives is also evident when we compare

their initial and current theoretical base. When therapists were asked to choose one theoretical

orientation as their main base among the eight options (cognitive, behavioral, humanistic -









psychotherapy that shares similar assumptions? Next, we will investigate the literature

supporting this link between individuals' epistemic style and psychotherapy preferences.

Epistemic Style and Preferences for Psychotherapy

Following the idea that psychotherapy theories are systematically related to certain

epistemic viewpoints, researchers explored the impact of epistemic style on preferences of

psychotherapy approach. The results suggested that individuals' epistemic framework play at

least a moderate role in guiding their psychotherapy preferences (Lyddon, 1989a; Neimeyer et

al., 1993; Neimeyer & Morton, 1997; Schacht & Black, 1985).

Lyddon (1989a) measured epistemic styles of potential clients and asked them to evaluate

audiotaped presentations of behavioral, rationalist, and constructivist approaches to

psychotherapy. Results suggested that participants with empirical, rational, and metaphorical

epistemic styles preferred behaviorist, rationalist, and constructivist therapy approaches

respectively. Lyddon and Adamson (1992) extended the findings of Lyddon (1989a) to Pepper's

root-metaphor theory. Participants with an organismic worldview indicated preference for the

constructivist approach, while participants with a mechanistic worldview preferred the

behavioral approach. Overall, lay people reported preference for the therapy approaches that

were congruent with their own epistemological framework suggesting that individuals' dominant

epistemological commitments had an impact on their therapy preferences.

These findings were extended for counselor trainees and mental health practitioners

(Arthur, 2000; Neimeyer et al., 1993; Neimeyer & Morton, 1997; Schacht & Black, 1985).

Despite the differences among various studies, the overall findings confirmed a moderate

relationship between epistemological commitments and psychotherapy preferences for therapists.

Organismic worldview and metaphorical epistemic style predicted a preference for constructivist

therapies. The empirical epistemic style was linked to a preference for a behavioral approach.









haphazard. On the contrary, processes of change reflect a certain career trajectory where the

experiences of therapists are defined by the stage of their developmental stage. The current study

focuses on the systemic change of two professional therapist variables, namely theoretical

orientation and therapy style. Following sections will clarify the existing literature on

psychotherapists' change experiences in their theoretical orientation and therapy style.

Theoretical Orientation Change

As we noted above, change is a constant in the field of psychotherapy. The field has been

changing, practitioners have been changing and the change in practitioners' theoretical

orientation is among the most noticeable and cited changes. Today it is suggested that "the

average practitioner changes theoretical orientations 2 or 3 times during his or her career"

(DeAngelis, 2006, p. 59). Mahoney (2001), for instance, has described how he transformed from

a behaviorist, to a cognitivist and then to a constructivist in his theoretical adherence, as

mentioned above.

Various theoretical orientations such as cognitive and constructive theories are gaining

more popularity over others such as psychoanalytic theories. Reports of the 62 psychotherapy

experts who participated at the Delphi Poll at 2002 suggested that this shift was expected to carry

on (Norcross et al., 2002). Specifically, experts anticipated that cognitive-behavior, culture-

sensitive, cognitive and eclectic/integrative theories to become more frequent, whereas classical

psychoanalysis, solution focused theories and transactional analysis would become less frequent

(Norcross et al., 2002).

Moreover, the field is increasingly open to theoretical integration and technical

eclecticism. As much as the idea of integration has been rejected by certain groups of people

who were strictly adhered to their theoretical orientation (see Goldfried, 2001a and Mahoney,

2001 for striking instances of opposing psychotherapy integration), increasing number of









implied that therapy style is related to years of experience and that therapy style could change

over the course of professional development. Recognizing the cross-sectional nature of this

study, one might speculate that the obtained differences between beginner and expert therapists

could indicate a cohort effect where the field and/or contemporary training models locate

distinctive demands on recently graduated therapists. Yet, the findings on therapist professional

development (Jennings & Skovholt, 1999; Martin et al., 1989; Ronnestad & Skovholt, 2003;

Skovholt & Jennings, 2004) support the conclusion that the stylistic differences between

beginner and expert therapists was a reflection of professional change experiences. The therapist

career development studies and Castafieiras et al.'s (2006) study concur that therapists relax in

their style, broaden their attentional perspective, and become skillful in communicating their

emotions as they season in the profession and gain expertise.

Specifically, Martin et al. (1989) differentiated novice practitioners from experienced

practitioners in their conceptualizations of client issues. Novice counselors were more likely to

present a preoccupation with procedural concepts. On the other hand, experienced counselors

tended to conceptualize their clients at a broader level and in a more inclusive manner. These

findings can be translated to the PST terminology employed by Castafieiras et al. (2006) where

novice counselors had narrow attentional focus and planned way of conducting therapy

interventions guided by their "how to" knowledge, while experienced counselors had broader

focus, openness to wide-range of client material and willing to incorporate spontaneous

interventions. Martin et al. (1989) provided an early evidence for the assumption that therapy

style, in particular with the dimensions of attentional and operative, differ with respect to

therapists' level of experience. The more recent research on master therapists and professional









I error, and the alpha level for the overall regression analyses for each dependent variable was set

at .01 (.05/5), which is the original alpha level (.05) divided by the number of statistical tests.

Effect size indices for multiple regression analyses was defined as the R2 divided by one

minus R2. The obtained/s were evaluated according to the Cohen's (1992) operational definition

of small (.02), medium (.15) and large (.35) effects.

To assess for the presence of multicollinearity, the variation inflation factor (VIF) statistics

across the independent variables were examined. Myers (1990) pointed out that a VIF value

above 10 indicates concern for the presence of multicollinearity. In our regression equation, VIF

statistics ranged from 1.00 to 1.01, suggesting that multicollinearity was not present.

Examination of residual plots indicated normality, linearity, and homoscedasticity of residuals in

the models. Durbin-Watson coefficient ranged from 2.01 to 2.17 suggesting the independence of

observations.

The results of the hierarchical multiple regression analysis for the four dependent variables

are presented in Table 4-7. The results indicated significant regression equations (i.e.,p < .01 for

the overall F ratio at the last step) for all of the dependent variables: theoretical change,

theoretical plurality, expressive, operative and attentional scores.

In the first step of the models, covariates age and number of clients seen weekly were

significantly related to four different variables of interest. Age accounted for 3% of variance in

both theoretical change index and expressive score, while number of clients seen weekly

accounted for 2% of variance in operative score and for 4% of variance in attentional score.

Where the theoretical change was the dependent variable, the model at Step 2 explained

5% of the variance and the inclusion of rationalist commitment change into the model at the Step

3 improved the model by 2%. Overall, the model explained %7 of the variance in the dependent









On the other hand, participants who shifted in their epistemic journey towards increasing

rationalism tended to experience less theoretical orientation change. The nature of rationalistic

epistemology can be defined as relatively determined, definitive, and confident in understanding

and helping clients (Mahoney & Gabriel, 1987). Similarly, higher levels of rationalist

commitments predicted lower levels of self-exploration and openness in therapists (Neimeyer &

Aksoy, 2005). Hence, therapists with increasing rationalist commitments might be less

compelled to explore other theoretical orientations and change their theoretical commitments. It

is also important to note that the data indicated a decrease in rationalist epistemology in general

which would translate to further increase in practitioners' theoretical change experiences.

Rationalism change experience did not account for the degree to which therapists have

integrated different theoretical orientations. For our participants, changes in their rationalistic

commitments did not translate to their tendency to integrate a number of theoretical orientations.

Considering the nature of the rationalist epistemology, one might expect to find decreasing

plurality with increasingly higher levels of commitment to rationalism. The failure of the data to

indicate such might be a result of other influences dominating the field. For instance, increasing

valuing for and occurrence of theoretical integration might have outweighed the possible impact

of rationalist epistemology despite the nature of rationalist epistemology might conflict with the

use of a variety of lenses in conceptualizing therapy.

Epistemic and Stylistic Change

Epistemology has been associated with therapy style. Therapists conducting rationalist and

constructivist therapies differed in the way they set the direction of the therapy, related to client,

and conceptualized and worked through clients' emotional distress, relapse and regression

(Nagae & Nedate, 2001; Vasco, 1994; Viney, 1994; Winter & Watson, 1999). Moreover,









therapeutic styles. The data failed to indicate an overall change in therapists' perceived

engagement style in therapy; post-hoc analyses (see below) extended our understanding of this

finding.

The results also suggested that perceived change in epistemology predicted therapists'

current professional standings after accounting for their initial standings. After accounting for

therapists' initial standings and rationalist-change scores, increase in therapists' constructivist

commitments predicted increased levels of adherence to theoretical integration and increased

levels of emotional expressiveness, operative spontaneity, and attentional range of therapists.

After accounting for therapists' initial standings and constructivism-change scores, decrease in

their rationalist commitments predicted increased change in theoretical commitments as well as

increasing levels of emotional expressiveness, operative spontaneity, and attentional range of

therapists.

Epistemic Journey Constructions of Psychotherapists

The field of psychology and particularly psychotherapy has changed dramatically over

years (Farber, 2005). Mahoney (1995a, 1995b) considered epistemic change among the

experiences of change that the field has experienced. Substantial anecdotal, conceptual, and case-

based information (such as Ellis, 1993, 1995; Goldfried, 2001a) supported Mahoney's suggestion

that the field of psychotherapy has become increasingly constructivist over the course of the last

20 years. Mahoney (1995b) also noted that given the dialectical interaction between the field and

its practitioners, changes in the field would impact the way psychotherapists' practice and also

perceive their practice, while their practice would impact the field, in return.

The primary aim of the present study was to investigate whether psychotherapists perceive

such an epistemic shift within themselves as a reflection of the epistemic shift in the field. We









primary analyses as covariates when subsequent analyses involved the above-mentioned

variables.

Primary Analyses

The final set of analyses utilized three sets of analyses. First, repeated ANOVA analyses

were conducted to examine whether there was a perceived change in therapists' epistemic

leanings, theoretical orientation, and therapy styles of expressive, engagement, operative, and

attentional across the course of their practice. It was hypothesized that compared to their initial

levels, therapists would report increasingly higher levels of commitment to constructivist

epistemologies, plurality in their therapeutic orientation. In addition, they were expected to have

higher levels of expressive and engagement dimensions in the therapeutic styles and lower levels

of operative and attentional dimensions. Second, regression analyses were conducted to

investigate whether the participants' cohort of graduation would account for some of the

variance in the epistemic shift in the field of psychotherapy. In other words, we wanted to

determine whether the shifts towards greater constructivism were the result of the influx of new

constructivist therapists trained in recent years, versus perceived developmental changes

occurring within longstanding psychotherapists. No predictions were specified for this research

question. Third, regression analyses were conducted to examine whether change in

epistemological commitments predicted the therapists' current levels of theoretical orientation,

adherence to theoretical integration, and therapy styles of expressive, engagement, operative, and

attentional dimensions, above and beyond what their initial standing was. Increasing

commitment to constructivist epistemologies was expected to predict higher levels of theoretical

change and plurality, higher levels of expressive and engagement styles, and lower levels of

operative and attentional styles.









Moreover, the literature on the association between epistemology and personality provides

additional support for the above-mentioned conceptualizations. For instance, social tolerance and

openness to experience were found to be positively related to organismic worldview and

negatively related to the mechanistic worldview (Babbage & Ronan, 2000; Johnson et al., 1988)

supporting the expectation that therapists with constructivist standpoints would be more likely to

have higher levels of social tolerance and openness. Organismically-oriented individuals were

more likely to be empathic (Johnson et al., 1988) and cognitively flexible (Botella & Gallifa,

1995) supporting the proposition that therapists with constructivist standpoints would be more

likely to have higher levels attendance to emotions and ambiguity tolerance that increase the

ability to deal with complexity (Beitel, Ferrer, & Cecero, 2004).

Neimeyer and Aksoy (2005) provided empirical evidence supporting the theoretical

conceptualization of Mahoney (1995c) and others (Lyddon, 1988; Mahoney & Gabriel, 1987;

Mahoney & Lyddon, 1988). Their findings suggested that commitment to constructivist

epistemology predicted higher levels of pursuit of self-awareness, attending to emotions,

ambiguity tolerance, social tolerance for individual diversity and openness to experience,

whereas commitment to rationalist epistemology predicted lower levels of these characteristics.

The developing literature on epistemology confirms that therapists' epistemic standpoint relates

to their personal characteristics.

Overall, the literature suggests that epistemology has been conceptually and empirically

related to the theories of psychotherapy, to therapy preferences of prospective clients and

prospective and practicing psychotherapists, to the forms of intervention and to the personal

qualities of psychotherapists.









We then conducted a series of hierarchical multiple regression analyses to study the main

effects of the two independent variables on each of the four dependent variables while

controlling for gender (dummy coded: 1 = male, and 0 = female), age, and average number of

clients seen weekly. The independent variables were the initial scores for the theoretical and

stylistic commitment variables, constructivism difference score, and the rationalism difference

score. The dependent variables were five professional variables: theoretical change index,

current theoretical plurality score, and current expressive, operative, and attentional scores. For

each regression analysis, gender, age, and average number of clients were entered in Step 1,

initial scores for the dependent variable for that particular analysis was entered in Step 2,

constructivism difference score was entered in Step 3, and rationalism difference score was

entered in Step 4. In the analysis where theoretical change index was the dependent variable, the

independent variables were entered in the same order but without the initial score, given that

theoretical change index has been rated only once from current perspective. Hence, only this

analysis was composed of 3 steps while the other analyses were composed of 4 steps.

Gender, age, and average number of clients were entered in the first step as covariates.

When it was applicable, the initial scores for the independent variable were entered in the second

step. Constructivism difference scores were entered in the next step to reveal whether change in

therapists' constructivist epistemology explains the variance on the select current professional

commitments over and beyond what initial commitments explain; and this would be the focal

point answering our research question #2. Rationalism difference scores were entered in the last

step to examine whether change in therapists' rationalist epistemology explains variance on the

select professional variables over and beyond that of their initial commitments and change in

constructivist epistemology. A Bonferroni adjustment was employed to protect against the Type









Research Question #1: How Do Therapists Change in Their Epistemic
Commitment and in Professional Characteristics across the Course of Their
Professional Practice? ................................................... .... ... .. .. ..... ......... .....68
Research Question #2: Do Cohort Effects Explain Changes in Therapists'
Epistemic Commitments? ......................... .. ....... ......................72
Research Question #3: What Is the Relationship between Therapists' Epistemic and
Professional Change Experiences? ........................................ ......................... 74

5 D ISCU SSION ..................................... .......................................86

Sum m ary of R esults................................ ...... ........................ .............. .. .............. 86
Epistemic Journey Constructions of Psychotherapists ..................................................... 87
Cohort Effect on Perceived Changes on Epistemic Leanings .........................................90
Theoretical and Stylistic Change Constructions of Psychotherapists...............................92
T heoretical C hange................. .... ................................ .. .. .............. ..... ...... .. 92
Stylistic C change ................................................................................................ .... 94
Association between Epistemic and Professional Change Constructions ............................101
Epistemic and Theoretical Change............... .............................. .................. 102
Epistem ic and Stylistic C change ............................ .............................. ............... 104
Limitations ............... ....... ......... .. ....... .......... ....... 107
Significance and Directions for Future Research................................................. ...........111
C o n clu sio n ...... ... ................... ......... .......................................................1 13

APPENDIX

A THERAPIST ATTITUDE QUESTIONNAIRE-SHORT FORM (TAQ-SF) ......................115

B THEORETICAL ORIENTATION RATINGS ......................................... ......................117

C DEM OGRAPHIC INFORM ATION ........................................................ .......... .....120

L IST O F R E F E R E N C E S ..................................................................................... ..................12 1

BIOGRAPHICAL SKETCH ............................................................. ...........129









for the analysis including therapists' current theoretical orientation, one-tailedF(1, 479) = 0.06,

p = .405, and for the analysis including therapists' initial theoretical orientation, one-tailedF(1,

479) = 0.00, p = .496. Thus, there was no substantial mean change in engagement scores over

therapists' practice. Yet, the analyses revealed a significant interaction between engagement

now-versus-then scores and theoretical orientation, for therapists' current theoretical orientation,

F(7,479) = 3.30, p = .002, partial eta squared= .046, for therapists' initial theoretical

orientation, F(7,479) = 2.35, p = .023, partial eta squared = .033. Table 4-6 depicts the post-hoc

results locating the interaction for both of the analyses.

Data indicated that engagement levels have declined across the practice of therapists that

identified their current theoretical commitment as cognitive and integrative, while no significant

changes appear for therapists with other theoretical commitments. Data also suggested a decline

for therapists that identified their initial theoretical orientation as behavioral, humanistic-

existentialist-gestalt, and integrative. The engagement levels seemed to increase across the

practice only for therapists that identified their initial theoretical orientation as

narrative/constructivist.

Research Question #2: Do Cohort Effects Explain Changes in Therapists' Epistemic
Commitments?

As a part of this study we wanted to provide a tentative answer to the question regarding

whether cohort effects may have accounted for the epistemic shift in the field of psychotherapy.

Answering this question in a satisfactory manner is beyond the scope of this project, yet we

attempted to provide a preliminary answer to this question through conducting hierarchical

regression analyses where the number of years that therapists' had been in the field was utilized

as a continuous indicator of the cohort.









between therapist and the client to understand the cognitive and emotional processes of his

clients.

The appreciation of complexity is among the basic tenets of constructivist epistemologies.

Constructive metatheory "promotes a complex systems model in which thought, feeling, and

behavior are interdependent expressions of a life span developmental unfolding of interactions

between self and (primarily social) systems" (Mahoney, 1995b, p. 8). Similarly, paying attention

to complex affective experiences that are present in the therapy room and inviting clients to

"actively experience, explore and express a much broader range" of emotions are central to

constructivist therapies (Mahoney, 1995b, p. 9). Practitioners' increasing appreciation of

complexity as well as increasing emphasis on emotionality and experiential processes may

reflect a change in their epistemic style where they have become increasingly more committed to

constructivist epistemology.

Moreover, Ronnestad and Skovholt (2003) suggested that therapists' career development

involved increased understanding of knowledge as a construction. Experienced practitioners

were more likely to reject "precisely defined realities in understanding matter of human

interaction" (p. 31). The authors' focus was on themes concerning therapists' career development

and yet their findings provided implicit support for the proposition that therapists engage in

increasingly more constructivist processing of the therapy room and of the world as they

seasoned. Therapists' increasing commitment to constructivist epistemology may be a related

theme of their career development.

All in all, individual narrations of certain psychotherapists directly and indirectly speak to

an ongoing epistemic shift in the field and imply the epistemic shift was a result of personal

change processes, at least to some degree. Nonetheless, the field is lacking empirical evidence of









tolerant of ambiguous circumstances, to be more socially tolerant of diversity and to be more

open to new experiences.

Constructivist worldview assumed that individuals' understandings are limited by their

perceptions, emotions are primitive knowing systems, the direction and outcome of therapy

gradually emerge from the context and individuals' experiences are informed by the social,

historical and cultural contexts. Hence, therapists holding these assumptions were expected to

seek self-awareness to understand the ways in which their constructs shape their perceptions.

Therapists with constructivist commitment would attend to emotions to learn from them. The

complex way that they construe therapy and clients' reality would ask for tolerating ambiguity as

well as social differences and being open to experience and learning (Mahoney, 1995c;

Neimeyer & Aksoy, 2005).

Rationalist approaches, on the other hand, present as largely complementary views and the

differences between the two epistemic commitments reflect upon the conceptualization and

practice of psychotherapy (Lyddon, 1988; Mahoney & Gabriel, 1987; Mahoney & Lyddon,

1988). Rationalist therapists tend to operate assuming that they are objective observers of the

stable and single reality and they can correct their clients' faulty cognitions of reality and hence

their clients' negative emotions through change processes that are presumed to be uniform and

universal. The processes and direction involved in rationalist therapy would be clear and

straightforward. Hence, therapists with rationalist commitments were expected to have lower

levels of self-awareness, personal attending to emotions, ambiguity tolerance, social tolerance

and openness to experience given that these characteristics would not be necessitated by their

epistemic commitment.









negatively related to the theoretical change index (f = -0.14), and to expressive scores (f = -

0.21). Therapists increasing commitment to rationalism predicted higher scores on operative (i.e.

less spontaneous) and attentional (i.e. narrower focus), and lower scores on expressive and

theoretical change index. As therapists' commitments to rationalist epistemology increased, they

tended to rate their current practice as low on theoretical orientation change, emotionally

expressive, spontaneity and range of focus in information gathering. Therapists' increasing

commitment to rationalist epistemology failed to relate to their theoretical plurality scores.

The addition of the rationalism difference score to the models revealed certain changes in

the variance accounted by the constructivism difference scores for four dependent variables. Beta

coefficients for constructivism difference score decreased for the variables of theoretical change,

expressive, operative, and attentional once the rationalism difference scores were entered to the

model. These changes are summarized at Table 4-8. For the theoretical change index, the decline

in the beta coefficient resulted in failure for constructivism difference scores to significantly

account for the variance on this dependent variable. The results indicated that the inclusion of

both spectrums of epistemic commitment, constructivism as well as rationalism, strengthened

our understanding of the complex interaction between therapists' epistemic and professional

change experiences. Moreover, the results suggested that change in therapists' commitment to

rationalist epistemology was a better predictor of operative and attentional scores compared to

change in participants' commitment to constructivist epistemology.

The magnitudes of the effect sizes of the main analyses, between 0.07 and 0.98, correspond

to small to large effects (Cohen, 1992). Obtained effect sizes suggested that results have some

practical significance in addition to statistical significance for the variables of theoretical

plurality and therapy style. Effect sizes suggested that constructivism and rationalism difference









findings. First, the obtained data might have been provided by a biased sample and its

generalizability must be questioned. Those who volunteered to participate in this study might

have been different from non-volunteers in the characteristics of interest as indicated by the

behavioral research (Rosenthal & Rosnow, 1991). Furthermore, the collecting data via Internet

through online survey may have widened the gap between those who volunteered to participate

and those who did not. However, research failed to find difference in participant responses when

compared to online data collection methods to paper-pencil methods (Gosling et al., 2004).

We cannot determine the representativeness of our population as a sample due to the

information restrictions as well as the snowballing that might have happened through invited

professionals forwarding the invitation email to other colleagues. Yet, our population that was

mainly composed of practitioner psychologists has a strong resemblance to the demographic

make-up of the members of the American Psychological Association (APA) that identified

themselves as practitioners (http://research.apa.org/prac_profile_12-7-07.pdf, 2007). In 2007,

APA members reported to be approximately 57.8% female and 42.2% male, and similarly 59.5%

of the population of the current study was female and 40.5% of the sample was male. APA

members' mean age was reported as 50.4 (SD = 10.7), and in the current study, the mean age of

participants was 50.36 (SD = 11.7), which is again comparable. Ethnicities in the current study

were Caucasian, 88.6% (vs. 93.3% of APA), Hispanic, 3.6% (vs. 2.7%), African-

American/Black, 2.4% (vs. 1.3%), Asian-American, 1.2% (vs. 1.8%), and multiracial, 1.2% (vs.

0.6%). Such similarities in the demographic composition of a part of the sample (i.e.

psychologists) and obtained population is encouraging with respect to external validity of the

obtained findings.









therapist expressive, and theoretical plurality, while rationalist leanings were negatively

associated with these variables. Levels of constructivism were generally negatively related to

narrower levels of attentional focus, and operative spontaneity (reflecting higher levels of plan-

induced approach to therapy), while rationalist leanings were positively associated with these

variables. Similarly, conceptually linked variables showed low to moderate associations. For

example, attentional and operative dimensions were positively associated with one another, as

were levels of expressive and engagement factors, and these two groups of variables were

negatively associated with one another.

Preliminary analyses investigating whether the scores on the dependent variables were

different across demographic variables revealed that certain variables of interest were different

across the levels of gender, age, and average number of clients seen weekly. T-test analyses

revealed gender differences in constructivism-now (t = -3.98, p < .001), constructivism-then (t =

-2.98, p < .003), and rationalism-now (t = 3.61, p < .001) scores. Males scored significantly

higher than females in their current commitment to rationalist epistemology (males, M = 23.41,

SD = 5.71, females, M= 21.84, SD = 4.90); whereas females scored significantly higher than

males in their current (males, M= 32.83, SD = 3.95, females, M= 33.99, SD = 3.17); and past

commitment to constructivist epistemology (males, M= 30.62, SD = 4.25, females, M= 31.57,

SD = 3.52). Regression analyses revealed that age significantly accounted for variance in

engagement-now (F(1, 492) = 9.51, p = .002; f = -.14), and attentional-then (F(1, 494) = 11.41,

p = .001; f = -.15) scores, and theoretical orientation change index (F(1, 504) = 13.01, p = .000;

f =. 16). The average number of clients seen weekly accounted for significant variance in

attentional-now scores (F(1, 630) = 11.20, p = .001; f = -.13). Hence, these three demographic

variables (i.e., gender, age, and average number of clients seen weekly) were entered into the









existential gestalt, narrative/constructivist, systemic family, psychodynamic, feminist -

multicultural, and integrationist), the cumulative picture of primary commitments showed

perceived differences over time (See Table 4-5). Cochran-Mantel-Haenszel statistics were used

to test the significance of the observed differences. The results suggested that the now and then

percentages were statistically different from one another for this cross-tabulation (y2 = 124.56, p

< .001).

These percentages are consistent with the previous findings concerning theoretical shifts.

Commitments to cognitive, narrative-constructivist, feminist-multicultural, and integrationist

perspectives as primary theoretical bases have strengthened, while commitment to behavioral,

humanistic-existential-gestalt, systemic-family, and psychodynamic perspectives as therapists'

primary theoretical bases have weakened.

Results of the analyses for therapy style variables are depicted in Table 4-3. Data indicated

a statistically and clinically significant increase in the expressive subscale that assesses emotional

communication, where higher scores represent greater emotional closeness. Data supported our

hypothesis that therapists would perceive increased closeness and emotional expressive in their

therapy styles across time. There was a statistically significant decrease in operative subscale

that assesses spontaneity in implementing interventions, where lower scores represent more

spontaneity in conducting therapy. Hence, the results supported our prediction of perceived

decrease in operative style, indicating that therapists perceived themselves as increasing in

spontaneity across time. There was also a decrease in attentional scores that assesses therapists'

range of attention and activity in gathering information, where lower scores represent broader

focus. Data supported our prediction that therapists perceived themselves as having increasingly









ways. Next, we summarize what the current study revealed about therapists' perceived change

experiences in the ways in which they conduct therapy.

Stylistic Change

Preliminary evidence suggesting the change in therapy style across the years of practice

was provided by Castafieiras et al.'s (2006) study where expert and beginner therapists showed

differences in certain aspects of their therapy styles. Therapist professional development studies

(Jennings & Skovholt, 1999; Martin et al., 1989; Rannestad & Skovholt, 2003; Skovholt &

Jennings, 2004) and personal narratives of seasoned therapists (Goldfried, 2001a) also supported

the assumption that therapists' styles might change with experience.

The aim of the present study was to investigate whether psychotherapists perceive such

stylistic shifts within themselves and to provide further support for the existing literature. We

specifically hypothesized increasingly higher levels of perceived expressive and engagement

scores, and lower levels of perceived operative and attentional scores as therapists became more

experienced. In other words, we expected therapists to perceive themselves to have increased in

their (a) expressing emotions to their clients, (b) commitment to therapy and clients, (c)

spontaneity in the way of implementing intervention, and (d) range of attention when gathering

information from clients.

Results supported three of the four hypotheses. Therapists reported increases in their

expressive and decreases in their operative and attentional dimensions of therapy styles. In other

words, across the course of their practice therapists perceived statistically significant and robust

increases in their emotional closeness and expressiveness to their clients, increases in the

spontaneity with which they conducted therapy and increases in the range of attention and

activity in gathering information. Results failed to indicate any change in therapists' degree of









Table 4-2. Intercorrelations among the variables of interest.
Variable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1. TAQ-R-Now -
2. TAQ-R-Then 0.7** -
3. TAQ-C-Now -0.2** -0.1**-
4. TAQ-C-Then -0.1* -0.3** 0.5** -
5. TCI -0.1 0.1 0.1* -0.1* -
6. TP-Now -0.1* -0.1* 0.3** 0.2** 0.1 -
7. TP-Then -0.1* -0.1** 0.1* 0.3**-0.2** 0.6** -
8. EX-Now -0.3**-0.2**. 03** 0.2** 0.1* 0.2** 0.1 -
9. EX-Then -0.2**-0.3** 0.1** 0.4**-0.1** 0.1 0.2** 0.5** -
10. EN-Now -0.2**-0.1** 0.1 0.0 0.0 0.1* 0.0 0.4** 0.2** -
11. EN-Then -0.2**-0.1** 0.1* 0.1 0.0 0.0 0.1 0.2** 0.3** 0.6** -
12. AT-Now 0.3** 0.3**-0.3**-0.2** 0.0 -0.2**-0.1* -0.3**-0.1** 0.0 0.0 -
13. AT-Then 0.2** 0.4** 0.0 -0.2** 0.2** 0.0 -0.1**-0.1 -0.3** 0.0 0.0 0.5** -
14. OP-Now 0.5** 0.3**-0.3**-0.2** 0.1 -0.1** 0.0 -0.3**-0.2**-0.2**-0.1** 0.5** 0.3** -
15. OP-Then 0.3** 0.5**-0.1**-0.3** 0.1 -0.1 -0.1 -0.2** -0.3** -0. -0.1* 0.3** 0.5** 0.6** -
Note. TAQ-R = Therapist Assumption Scale Rationalism; TAQ-C = Therapist Assumption
Scale Constructivism; TCI = Theoretical Change Index; TP = Theoretical plurality; EX =
Expressive; EN = Engagement; AT = Attentional; OP = Operative; Now = Therapists' current
view of themselves today; Then = Therapists' view of themselves when they first started
practicing following the completion of their graduate training.
aListwise N =537;
*p <.05 **p < .01

Table 4-3. Repeated measures ANOVA summary table for perceived epistemic and stylistic
commitment differences across time.
Variable N M SD Df F Partial eta-squared
Now Then Now Then
1. TAQ-C 642 33.51 31.18 3.55 3.86 1,640 173.90** 0.22
2. TAQ-R 636 22.47 24.47 5.30 5.29 1,634 107.78** 0.15
3. EX 625 41.24 36.62 6.41 6.44 1,624 327.83** 0.34
4. EN 491 27.49 28.40 5.80 5.32 1,489 0.25 0.00
5. AT 482 21.61 24.06 4.19 4.53 1,479 12.09** 0.03
6. OP 641 21.89 23.58 6.36 6.98 1,640 48.68** 0.07
7. TP 649 22.60 19.91 3.72 3.94 1,648 395.92** 0.38
Note. TAQ-R = Therapist Assumption Scale Rationalism; TAQ-C = Therapist Assumption
Scale Constructivism; EX = Expressive; EN = Engagement; AT= Attentional; OP = Operative;
TP = Theoretical plurality; Now = Therapists' current view of themselves today; Then =
Therapists' view of themselves when they first started practicing following the completion of
their graduate training.
**p <.001









Epistemic Style and Psychotherapy

Various studies demonstrated that epistemic style is related to theories, practice and

practitioners of psychotherapy. Understanding the relationship between epistemology and

psychotherapy provides the groundwork of the present study. This section illustrates the ways in

which epistemic style is linked to these psychotherapy variables.

Studying epistemic commitments has enhanced our understanding of psychotherapy

practice and practitioners. The psychotherapy variables that relate to epistemic style can be

studied under four categories: Theories of psychotherapy (Lyddon, 1989b; 1991), preferences for

psychotherapy (Lyddon, 1989a; Neimeyer et al., 1993; Neimeyer & Morton, 1997; Schacht &

Black, 1985), practices of psychotherapy (Lyddon, 1988; Mahoney & Gabriel, 1987; Mahoney &

Lyddon, 1988; Neimeyer & Saferstein, 2006, and personal characteristics of psychotherapists

(Neimeyer & Aksoy, 2005).

Epistemic Style and Theories of Psychotherapy

Theories of psychotherapy reflect a certain way of understanding the world and they can be

conceptually tied to epistemic worldviews that had been identified in the literature. Lyddon

(1989b, 1991) identified epistemological framework of the various therapy approaches

suggesting that psychotherapy theories were related to the epistemologies in systematic ways.

Lyddon employed both Pepper's (1946) Root-Metaphor Theory and Royce's (1964; Royce &

Powell, 1983) Theory of Knowledge to identify these relationships.

Lyddon (1989b) suggested that trait models of personality and psychiatric diagnostic

practices were supported byformistic worldviews because they both utilized the matters'

similarity to establish their reality. Both trait taxonomies and psychiatric diagnostic systems

classify traits or disorders based on the presence and absence of certain characteristics or









symptoms. They ignore temporal and contextual factors and assume stability of the nature of

their subject matter as well as of their similarities to others.

Behavioral, rationalist cognitive and psychodynamic approaches to psychotherapy have

been linked to Pepper's mechanistic worldview because they assumed a machine-like

deterministic view of human psyche. Behavioral approach assumes that behaviors of human

beings are determined by antecedent conditions and they objectively study these behaviors to

understand human psychology. Rationalist cognitive therapies suggest that human emotions are

determined by antecedent beliefs and thoughts and they focus on such linear relationships

between thoughts and feelings to understand human psychology. Psychodynamic therapies

regard mind in mechanistic terms and they focus on the linear interactions among psychological

forces to understand human mental processes (Grof, 1985, as cited in Lyddon, 1989b). All of

these three approaches to psychotherapy analyze parts of human psychology and assume that an

observer, a psychologist, can objectively identify these causal linear interactions among aspects

of human experiences and processes.

Bandura's revised social-learning theory, Rice and Greenberg's change processes and

existential theories have been identified as reflecting the contextualist worldview since these

theories seek to understand human experience in its context and focus on the synthesis of wholes

rather than analysis of parts. Bandura's social learning theory highlights the importance of

context in learning. Rice and Greenberg focus on context of client-therapist interaction to

understand and facilitate clients' change processes. Existential theories study human experience

through individuals' "being-in-the-world" where they act on the world as the world acts on them.

Developmental theories, humanistic and transpersonal movements, and systems thinking

were linked to the organicist worldview. They all focus on universal principles that govern the









practitioners move away from their original theoretical orientation towards utilizing various

perspectives (Goldfried, 2001a). Today, eclecticism is the modal theoretical orientation for

American psychotherapists (Norcross, 2005).

Ronnestad and Skovholt (2003) observed therapist integration of personal self and

professional self among the 14 themes of therapist development. As therapists seasoned, they

reported increasing consistency between who they were personally (e.g. their values, belief

systems and such) and the ways in which they have conducted therapy. Eagle (2001) provided an

example to this theme from his personal experiences suggesting that he had become more

authentic and genuine as a person and this personal development reflected on his professional

work:

"Comparing my early way of practicing with my current ways brings to mind the
awkwardness I felt when I first began doing therapy. I felt that I was role-playing and the
person I was when I was doing therapy was radically different from the person I was when
I was not doing therapy. I would say that washing away that marked discrepancy between
person as therapist and just person and the accompanying reduction in my awkwardness -
replaced by a greater sense of ease and naturalness- are the most important ways in which I
have changed as a therapist. I think I have become more so with the years" (p. 49).

Ronnestad and Skovholt (2003) conceptualized therapists' changing their theoretical

orientation as an indicator of such an increased integration and congruency. They further

suggested that as their theoretical adherence shifted, the ways in which they connect with their

clients and assign responsibilities within the therapeutic relationship have changed.

Next, we investigate the nature and development of psychotherapists' therapy style that

includes the way therapists related to their clients.

Therapy Style Change

Knowing that therapist variables account for a significant portion of therapy outcome,

research in therapist variables gained momentum. Fernandez-Alvarez, Garcia, Lo Bianco, and

Corbella (2003) suggested that therapy style could be among the therapist variables influencing









Winter, D. A., & Watson, S. (1999). Personal construct psychotherapy and the cognitive
therapies: Different in theory but can they be differentiated in practice? Journal of
Constructivist Psychology, 12, 1-22.

Zeig, J. K. (1992). The Evolution ofpyi% Irirhi /, py The second conference. New
York: Brunner/Mazel.









BIOGRAPHICAL SKETCH

I was born in Ankara, Turkey, in 1981. In 1995 my family moved to Istanbul, Turkey. I

attended the Bogazici University in Istanbul, double-majoring in guidance and psychological

counseling and psychology programs, as an undergraduate. In 2003, I graduated, ranking first in

the Department of Education.

I joined the Department of Psychology at the University of Florida as a counseling

psychology graduate student in August 2003. I completed my Master of Science degree in

December 2005. I completed my Doctor of Philosophy degree in August 2008.









changed in their epistemic, theoretical and stylistic commitments across their professional

journey. Therapists reported that they have become increasingly constructivist and decreasingly

rationalist in their epistemic commitment, increasingly pluralist in their theoretical commitment

and increasingly expressive, spontaneous, and attentive to a broad spectrum of information in

their therapeutic styles. Results of the study also suggested that cohort effects did not account for

the levels of therapists' initial epistemic commitments or epistemic change experiences.

Moreover, results of the study revealed that therapists' increasing commitment to constructivist

epistemologies and decreasing commitment to rationalist epistemology together were perceived

to be associated with their current theoretical and stylistic commitments. Epistemological change

processes predicted where therapists have reached in their theoretical and stylistic commitments

even after accounting for their initial commitments.

The current study is a significant contribution to the field given that it was the first study

empirically investigating the epistemic change processes of therapists. It extended the developing

literature on epistemology as a factor relating to psychotherapists' professional change.

Additional and ideally, longitudinal work is needed to clarify the nature and correlates of

therapists' epistemic journeys. It also opens up a fertile area of research to extend our

understanding of practitioners' epistemic change processes, which may increase our

effectiveness in dealing with the changes that our profession generates.









theoretical orientations reflected an underlying epistemic commitment (Lyddon, 1989b) and

certain dimensions of therapy style have already linked to epistemic commitments of therapists

(Neimeyer & Saferstein, 2006), it is reasonable to expect therapist epistemic change to account

for or to align with therapists' stylistic change experiences. Hence, any increase in therapists'

commitment to constructivist epistemologies might correlate with increase in certain dimensions

of therapeutic style, specifically therapeutic closeness, engagement, spontaneity, and focus.

Castafieiras et al. (2006) did not include epistemology as a variable, nor did they group

their participants into groups of epistemically divergent categories of theoretical orientation.

Rather it is safe to assume that these categories were fairly generic, each involving a wide range

of theories and practices. As this literature review suggested, cognitive therapy is an umbrella

term combining a variety of approaches (Lyddon, 1988; Mahoney, 1991). The current study

aimed to further our understanding between the therapy style and theoretical orientation by

separating how epistemic commitments underlying theoretical orientations related to levels of

and changes in therapy style. Recognizing the ways in which epistemology is linked to therapy

style could improve our understanding of these significant therapist variables.

Overall, the existing literature provides a cogent rationale to pursue and expect

association between therapists' epistemic and professional journeys. This relationship would be a

complex one, impacting one another at different levels through different dynamics. Uncovering

this multifaceted association starts with simply establishing that therapists perceive their

epistemic and professional change processes to correlate. This basic question of whether and if

so, to what extent psychotherapists' perceived epistemic change accounts for where therapists

stand in their theoretical stylistic journey has remained to be answered, and was identified among

the inquiries of the present study. The purpose of the present work was to help lay the foundation











APPENDIX C
PERSONAL STYLE OF THE THERAPIST (PST-Q)

Directions: Please rate the following items along the following 7-point scale. In considering
yourself "NOW", we are interested in how you currently view yourself and your professional
practice today. In considering yourself "THEN", we are interested in how you view yourself
when you first started practicing following the completion of your graduate training.


Total Disagreement 1


2 3 4 5 6 7 Total Agreement


'1' represents total disagreement with the statement and '7' means total agreement.


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Table 4.7. Continued.
Variable 8 T R2 F Df df2 AR2 F2
Dependent Variable: Attentional Now
Step 1
Gender 0.09 1.87
Age -0.11 -2.32
Weekly clients -0.15 -3.21** 0.04 5.88** 3 456 0.04 0.04
Step 2
Gender 0.10 2.50
Age -0.03 -0.71
Weekly clients -0.12 -3.08*
Attentional Then 0.53 13.48** 0.31 51.59** 4 455 0.28 0.45
Step 3
Gender 0.09 2.31
Age -0.02 -0.46
Weekly clients -0.12 -3.02*
Attentional Then 0.57 14.39**
Constructivism difference -0.17 -4.40** 0.34 46.80** 5 454 0.03 0.52
Step 4
Gender 0.08 2.19
Age -0.01 -0.33
Weekly clients -0.11 -2.95*
Attentional Then 0.62 15.64**
Constructivism difference -0.11 -2.86*
Rationalism difference 0.21 5.24** 0.38 45.84** 6 453 0.04 0.61
*p <.01 **p<.001


Table 4-8. Hierarchical regression beta coefficients
2, 3, and 4.


for constructivism difference scores at steps


Step 2/3 Step 3/4
Dependent Variable P T P T
Theoretical Change Index 0.14 3.17* 0.10 2.05
Theoretical Plurality Now 0.21 5.61** 0.23 5.84**
Expressive Now 0.27 6.74** 0.22 5.26**
Operative Now -0.22 -5.81** -0.12 -3.30*
Attentional Now -0.17 -4.40** -0.11 -2.86*
*p<.01 **p<.001









CHAPTER 2
REVIEW OF THE LITERATURE

This chapter provides a literature review that supports specific predictions regarding

psychotherapists' epistemic journeys and related professional change experiences. First, the

review introduces and explains the notion of epistemic style, which is followed by the

examination of the ways in which epistemic style is linked to psychotherapy-related attitudes and

practices. Next, the literature on the change of the field of psychotherapy is explored. Within this

section, the review first focuses on the epistemic journey of the field and of certain well-known

psychotherapists and then it explores psychotherapists' theoretical and stylistic change

experiences and why such professional change experiences might align with therapists'

epistemic journey. The literature review ends with an outline of the study's overarching

questions and specific predictions.

Epistemic Style

Personal epistemology is one's theory about knowing and knowledge. Epistemic style

refers to an individual's way of testing the validity of his or her knowledge. Pepper's (1942)

Root-Metaphor Theory and Royce's (1964) Theory of Knowledge have been the most

predominant ways of conceptualizing and studying the implications of epistemic style.

Root-Metaphor Theory

Pepper's (1942) Root-Metaphor Theory is composed of four root metaphors that are basic

analogies for the four distinct ways in which we see the world and organize experience. Pepper

(1967) suggested that individuals engage in analyses of their root metaphors to make sense of the

world and to solve problems. One's root metaphor implies certain ways of dealing with events

and generates possible solutions to existing problems. Categories of hypothesis that arise from

such analysis of root metaphors are unrestricted by the field of inquiry, and such a hypothesis "is









broader literature regarding therapists' increasing spontaneity over the course of their

professional development and practice.

Castafieiras et al. (2006) found that beginning integrative and psychoanalytic therapists

endorsed a significantly narrower focus and search for a specific realm of knowledge than their

expert counterparts. Experienced therapists tended to conceptualize their clients at a broader

level and in a more inclusive manner (Martin et al., 1989). The internally-based flexible

professional functioning of expert therapists was also aligned with therapists' being more

broadly focused and open-minded while listening to client material. In their narrations,

practitioners also reflected on their professional change processes where they have increased in

flexibility, and broadened their understanding and appreciation of client concerns (Goldfried,

2001 a). Overall, the finding of therapists' increasing range of attention in information gathering

across their practice is consistent with the literature. Yet, it is important to note the low reliability

rates obtained for the current and initial attentiveness scores since these rates raise questions

regarding the validity and interpretation of the obtained findings.

We expected therapists to report increased commitment to therapy and to their clients

across their practice, yet the data failed to support our expectations of increased engagement

scores across years. One plausible explanation may be the relatively high initial ratings of

engagement dimension of therapy style. Within the possible range of 6 to 42, participants'

average engagement-now score was 27.49 and engagement-then score was 28.40. Although there

was potential for them to score higher, no other dimensions of therapy style in the study has

passed the 65 to 67 % rating figure that was achieved by the engagement scores. In other words,

the data's failure to indicate any increase in engagement dimension of therapy style might stem

from the fact that therapists perceived themselves highly committed to therapy and engaged with









The majority of the participants had a Ph.D. degree, 68.9% (N = 449), followed by a

Psy.D., 16% (N = 104), M.A. or M.S., 8.4% (N = 55), Ed.D., 1.8% (N= 12), M.S.W., 1.5% (N=

10), or other degrees, 3.4% (N= 22), as their highest degree. The majority of the participants

were self-identified as psychologist, 87.4% (N= 577), followed by mental health counselor,

4.2% (N= 28), marriage and family therapist, 2.4% (N= 16), and social worker, 1.2% (N= 8).

The remaining participants designated themselves as Other, 4.7% (N = 31).

The majority of the participants defined their primary responsibility as practice/clinical

work, 80.2% (N= 528), followed by academic, 8.2% (N= 54), administrative, 4.1% (N= 27),

research, 1.2% (N= 8) and other, 2.7% (N= 18). The remaining 23 participants designated

themselves as being equally involved in multiple responsibilities, 3.5%. The majority of the

participants indicated their primary employment setting as private practice, 47.0% (N= 309),

followed by hospital, 10.8% (N= 71), mental health care, 10.2% (N= 67), university academic

department, 8.5% (N= 56), university service delivery department, 6.1% (N= 40), community

center, 3.8% (N= 25), school, 2.7% (N= 18), correctional facility, 1.7% (N = 11), and other,

9.1% (N = 60). Mean number of years spent in clinical practice was 18.66, and ranged between 1

and 52 (SD = 10.94). The mean number of clients seen weekly was 17.38, and ranged between 1

and 61 (SD = 10.69).

The majority of the participants identified integrative as their primary theoretical

orientation at the present time, 32.2% (N = 213), followed by cognitive, 27% (N = 179),

psychodynamic, 17.1% (N= 113), humanistic-existential-gestalt, 8% (N= 53), systemic-family,

4.7% (N= 31), behavioral, 4.7% (N= 31), narrative/constructivist, 4.2% (N= 28), and feminist-

multicultural, 2.1% (N= 14). Psychodynamic theory was the most common primary theoretical

orientation designated by therapists at the time that they started practice after graduation, 26.5%









practice seems to be consistent with the personal characteristics that mirrors the assumptions of

constructivist epistemologies.

It is important to note that when both epistemologies were entered into the analyses, the

results were more robust and somewhat different than the results of analyses with only

constructivist epistemology. For instance, after including rationalist commitment change score,

constructivist commitment change score lost some of its power to account for the variance in the

professional variables of interest. For theoretical change index, the change was substantial

enough for the constructivism-change score to lose its statistical significance. Moreover,

rationalist-change journey of therapists seemed to be a better predictor of operative and

attentional dimensions of therapy style than their constructivist-journey. Decrease in rationalist

commitment across therapists' course of practice predicted the increase in spontaneity and range

of focus much strongly than increase in constructivist commitment did.

Our focus on the distinction between constructivist and rationalist epistemologies aimed to

enhance our understandings of the ways in which epistemological change accounted for

professional commitments. As Mahoney (1995b) suggested, our interest was on "the potential

contribution that rationalist-constructivist contrast may offer to emerging theory and research

relating the cognitive sciences and clinical services" (p. 9). Complementary ways of acquiring

and evaluating knowledge and understanding the world are equally valuable (Lyddon, 1989b),

and as it is shown in this study, the rationalist-constructivist contrast serves us with a better

understanding of how epistemic worldview relates to theoretical and stylistic commitments.

Limitations

In this section, we noted some significant sampling, instrumental, procedural and

methodological limitations of this study that might have hindered the external validity of the









Ronnestad, M. H., & Skovholt, T. M. (2001). Learning arenas for professional development:
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Fernindez-Alvarez et al. (2003) suggested that these dimensions appear in an integrated

manner through therapists' work. They also suggested that all combinations in personal style

were valuable, and some combinations would be more convenient or beneficial than others for

specific clinical situations. In order to investigate the nature of this construct further, Fernandez-

Alvarez et al. (2003) developed a self-administered questionnaire measuring these five

dimensions of the therapist style, called the Personal Style of the Therapist Questionnaire (PST-

Q). They have further employed this questionnaire to study the relationships between personal

style of the therapist, theoretical orientation, years of professional experience and length of

treatment for a group of Argentinian psychotherapists (Castafieiras, Garcia, Lo Bianco &

Fernindez-Alvarez, 2006). The findings of this study informed the aims of the current study and

we will explore these findings in depth. In general, the findings suggested that therapy style was

associated with these identified therapist variables in complex and dynamic ways. Most

importantly, preliminary evidence suggested the stable yet flexible nature of the PST construct.

The therapy style was conceptualized as a stable variable over the time, yet Fernindez-Alvarez et

al. (2003) had also claimed that PST could withstand minor or major changes as therapists

endure significant changes in their life or work circumstances. Castafieiras et al. (2006)

supported this assumption by showing significant PST differences for therapists with different

levels of experience.

Castafieiras et al. (2006) first assigned therapists into three different theoretical adherence

categories based on participants' self-descriptions, and therapists were classified into the groups

of psychoanalytic therapy, cognitive therapy, and integrative therapy with respect to their

theoretical orientation. They identified beginner level therapists as the therapists with up to 5

years of experience and expert therapists as the therapists who had 15 years of experience or









reported increased flexibility, broadened understanding and appreciation of client concerns and

enriched ways of reaching out to their clients. Most importantly, each narrative described ways

of breaking free from original teachings and developing integrative, expansive, pliable ways of

being and doing in their therapeutic work. Even though these practitioners did not employ the

PST framework or language, they were clearly providing further evidence from their own

perspective on how they have changed in their therapy style as they seasoned as therapists.

Castafieiras et al.'s (2006) study was significant as it provided empirical support for the

usefulness of the PST construct, for the sensitivity and specificity of the PST-Q, and most

importantly, for the change processes of dimensions of therapy style. Combined with the

therapist development studies (Jennings & Skovholt, 1999; Ronnestad & Skovholt, 2003;

Skovholt & Jennings, 2004) and personal narratives of seasoned therapists (Goldfried, 2001a),

the findings of Castafieiras et al. (2006) suggest that therapists' style in which they engage with

therapy might change with experience. The current study aims to clarify whether therapists

perceive stylistic change as a part of their professional development and growth experiences, and

if so what the direction of change would be for the participating therapists. In line with the

above-mentioned findings, we expect to find increase in therapists' emotional expressiveness,

engagement, attentional focus and spontaneity. This clarification would be a significant edition

to the limited literature on psychotherapists' change experienced in therapy style.

Epistemic and Professional Change

Our literature review studied two change processes regarding psychotherapists, namely

epistemic change and professional change. We agree with Stricker (2001) who conceptualized

change as a "synergist" and suggested that "change of any sort can facilitate other changes" (p.

79). Hence, once we have accumulated information with respect to therapists' change

experiences in epistemology, theoretical orientation and therapy style, then we shall investigate









year they obtained their highest degree, total number of years they have spent in clinical practice,

specialty area, primary employment setting, primary job responsibility, average number of

clients seen weekly and the country they live in.

Table 3-1. Personal Style of the Therapist Questionnaire (PST-Q): Subscale directions
Subscales Low High
1. Instructional Flexibility Rigidity
2. Expressive Distance Closeness
3. Engagement Lesser degree Greater degree
4. Attentional Broad focus Narrow focus
5. Operative Spontaneous Planned









ME NOW, ME THEN: THERAPISTS AND CONSTRUCTIONS OF THEIR EPISTEMIC
JOURNEY



















By

GIZEM TOSKA


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

UNIVERSITY OF FLORIDA

2008









while therapists conducting constructivist cognitive therapies were more successful in

establishing rapport with their clients (Nagae & Nedate, 2001).

Studies of Vasco (1994), Viney (1994), Winter and Watson (1999), and Nagae and Nedate

(2001) inferred the impact of epistemology on practice through investigating practice of

therapists conducting constructivist or rationalist cognitive therapies. Neimeyer and Saferstein

(2007), on the other hand, conducted a self-report study that measured psychotherapists'

epistemic commitments. This methodology provided the authors with an opportunity to study the

relationship between epistemology and practice independent of the name of the conducted

therapy.

Neimeyer and Saferstein (2007) focused on therapists' emphasis on therapy style and

working alliance. Their results were consistent with the assumptions of Mahoney and Gabriel

(1987) and the findings of the preceding studies. Therapists with higher levels of constructivist

epistemology were more likely to pursue closeness, broad focus, engagement, and spontaneity in

therapy. Commitment to constructivist epistemology was also positively associated with

therapists' emphasis on the personal bond in the therapeutic relationship. Overall, their results

supported the assumptions that commitment to constructivist epistemology may influence the

ways in which therapy is conducted and therapeutic relationship is built and maintained.

Altogether, these conceptual and empirical studies suggested that epistemologies influence

how therapists construct therapy variables, how they conduct therapy, how they relate to their

clients and what kind of results they pursue. Next, we clarify the ways in which epistemology

relates to personal characteristics of psychotherapists.

Epistemic Style and Characteristics of Psychotherapists

Mahoney (1995c) had suggested that basic tenets of constructivist therapies may reinforce

therapists to value and pursue self-awareness, to be more attuned to personal feelings, to be more









increase across their practice. Possible explanations of these effects were drawn from the

literature.

Overall, findings supported the explanation that therapists' stylistic changes may be

moderated by their theoretical commitments (Castafieiras et al., 2006), masking the engagement

changes when combining responses of therapists with different theoretical commitments. The

obtained results revealed that the therapy style changes happen in a complicated fashion, where

different theoretical orientations, currently held or held in the past, may impact perceived

changes in therapy styles in different ways.

While Castafieiras et al. found that expert level integrationist therapists had higher levels of

engagement scores than beginners, our findings indicate that therapists who were initially or

currently identified their theoretical orientation as integrative perceived themselves to have

decreasing levels of engagement across years. The difference might be a result of the

methodological differences between the two studies. First, the two studies differ in the ways in

which therapists' theoretical commitments were determined. Castafieiras et al. assigned

theoretical orientation to the therapists who participated based on their descriptions of how they

conduct therapy; on the other hand, in the current study, it was the participants themselves

(rather than the researchers) who identified their main theoretical commitments with no

descriptions of how they conduct therapy or what these orientations that they selected

particularly mean to them. Second, the two studies differed in the number of theoretical

orientations that were included in the analyses. Castafieiras et al. grouped theoretical orientation

into 3 orientations; on the other hand, the current study expanded the options to 7 orientations

that might have captured the complexity of the interaction in-depth. Third, the two studies differ

in their comparison groups and conducted analyses. Castafieiras et al. compared expert









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epistemic journey interacts with their personal qualities which may also be moderating and/or

mediating the ways in which epistemic and professional journeys interact.

Most importantly, future studies can investigate further implications of the link between

therapists' epistemic journey and their professional experiences. Kramen-Kahn and Hansen

(1998) suggested that therapists perceived their change processes among the rewards of their

work. The current study can also be continued by exploring how these changes in therapists'

epistemic, theoretical and stylistic commitments translate to therapists satisfaction, and perhaps,

effectiveness of their work. Future research can investigate how epistemic and professional

changes of therapists are perceived by their clients and facilitated their change processes.

This study also partially validated the expectations that therapists' career development

processes play a significant role in their epistemic journey. It is known that therapists' personal

and professional lives are impacted by their conducting psychotherapy in multiple and complex

ways. Yet, more research is needed to understand the underlying dynamics of therapists'

epistemic journeys. Future research can also explore which individual processes facilitated

therapists' epistemic and professional change. Narrations of certain psychotherapists (such as

Goldfried, 2001a) highlighted why therapists change and what aspects of their personal life and

career have impacted their developmental process. Studies can investigate if therapists' epistemic

journey interacts with such personal accounts for reasons of change.

Conclusion

In conclusion, the present study examined the perceived epistemic changes of

psychotherapists, the impact of cohort on these change processes and the ways in which such

processes relate to therapists' professional standings in theoretical orientation and style of

conducting psychotherapy. Results of the study suggested that therapists perceive that they have









2005; Neimeyer, Prichard, Lyddon, & Sherrard, 1993). However, the literature regarding the

nature of the epistemic development and change in therapists or in any other groups is scarce.

A brief overview of the topics, content, and framework of the published articles reveals

that the field of psychology and particularly psychotherapy became increasingly constructivist

over the course of the last 20 years (Mahoney, 1995a; 1995b). Such a change in the field's

understanding might be reflection of the infusion of a new generation of therapists who were

steeping in post-modern epistemologies and psychotherapies. Yet the personal writings of some

longstanding prominent psychotherapists also reflect this epistemic journey towards

constructivism, suggesting that this development may also be the result of a shift within the

current field of practitioners, in addition to the inclusion of a new generation of post-modern

therapists. Psychotherapists such as Ellis (1993; 1995), Meichenbaum (1993), and Mahoney

(1991; 2001) have repeatedly reported and described their epistemic journey where they have

become increasingly constructivist in their epistemic commitment. Goldfried's (2001a) work

where he collected personal change narrations of 15 seasoned psychotherapists also reveals a

similar journey where they pursued a path from relative certainty and simplicity to increasing

complexity in their worldview.

Nonetheless, research is scarce concerning epistemic shifts within the field and its

practitioners. Although substantial anecdotal, conceptual, and case-based information is on hand,

strikingly little empirical research is available that documents this shift in the field across time or

traces these changes over time in relation to particular practitioners. As a result, not only is the

field lacking empirical evidence of its putative epistemic shift, but it also remains unclear

whether this shift is due to the infusion of new, post-moder therapists or significant

developmental shifts among its current practitioners in the field. Thus; to explore any perceived









Personal Examples of Epistemic Change

Albert Ellis

Albert Ellis (1990; 1995), the founder of rational emotive behavior therapy (REBT) clearly

projects a personal and professional pathway where his theory and practice moved to become

more constructivist and humanistic in nature. Ellis (1995) distinguished between general RET

and preferential REBT where the former stands for general cognitive-behavioral therapy and the

latter stands for what Ellis has practiced for past 15 years. Ellis clarified that both his practice

and the empirical work of the fellow psychologists such as Beck and Meichenbaum made an

impact on his conceptualization of REBT and pushed him in more constructivist directions. Ellis

(1990; 1993) strongly suggested that not only the theory of REBT, but also the practice of REBT

is constructivist.

Ellis has used various publications to draw attention to the fact that the term rational had

been misunderstood by the field. He suggested that in REBT, rational referred to effective

cognitions rather than empirically and logically valid cognition (Ellis, 1999). Ellis (1999)

emphasized that "What is deemed rational by one person, group, or community can easily be

considered irrational by others" (p. 154) suggesting his commitment to constructivist metatheory.

Ellis (1992a) even claimed that his therapy "is probably the most constructivist of all cognitive

behavioral therapies" (p. 122).

Donald Meichenbaum

Donald Meichenbaum has been considered among the fathers of cognitive therapy and he

is among the leaders of cognitive revolution. Meichenbaum (1990; 1993) advocated for

constructivist perspective encouraging fellow practitioners to help their clients in their

identifying the ways in which they construe reality and then affected by their constructions and

in developing coherent and adaptive narrations that would enable change and growth.









thought errors and perceive client resistance, relapse and regression as indicators of client failure

in maintenance and generalization of therapy outcomes. Constructivist therapies, on the other

hand, tend to define client problems as indicators of the discrepancies between external

challenges and internal capacities, view negative emotions as an indicator of clients' current

functioning, perceive client resistance, relapse and regression as indicators of clients' self-

preservation efforts (Mahoney & Gabriel, 1987; Mahoney & Lyddon, 1988). Frankel and Levitt

(2006) recently detailed the postmodern strategies for working with resistance, demonstrating the

similarities across the rich ways that constructivist therapies conceptualize and work with client

resistance.

Sixth, rationalist and constructivist therapies were differentiated in their conceptualization

of change. Rationalist approaches to therapy tend to seek first-order change that is defined as

surface-level change achieved without disturbing the existing systems. Therapies with

constructivist commitments, on the other hand, tend to facilitate change entailing fundamental

restructuring of the existing systems that is recognized as second-order change (Lyddon, 1990).

Empirical studies supported that rationalist and constructivist cognitive therapies differed

in direction of the therapy, relationship with client, conceptualization of clients' emotional

distress, relapse, and regression and approaching such client variables in the context of therapy

(Nagae & Nedate, 2001; Vasco, 1994; Viney, 1994; Winter & Watson, 1999).

The empirical evidence supporting the link between epistemology and practice were

mainly in-depth studies of therapy transcripts (Nagae & Nedate, 2001; Vasco, 1994; Viney,

1994; Winter & Watson, 1999) with a recent addition of a self-report study of psychotherapists

(Neimeyer & Saferstein, 2006). These studies supported the assumptions that rationalist and

constructivist cognitive therapies differed in direction of the therapy, relationship with client,









and experienced counselors engaged in more complex and richer cognitive conceptualizations in

their distinctions.

Jennings and Skovholt (1999; Skovholt & Jennings, 2004) studied not only cognitive, but

also emotional and relational characteristics of master therapists. They have conducted

interviews with 10 therapists who were nominated by their peers as "masters" of their work.

Jennings and Skovholt identified significant personality characteristics shared by master

therapists and proposed a CER model of master therapist that referred to the triad of cognitive,

emotional and relations expertise on the part of master therapists. Master therapists demonstrated

cognitive complexity, openness and desire for continuous learning, emotional receptivity and

maturity, and interpersonal skillfulness. This work was criticized for its lack of a comparison

group that would allow the reader to infer the distinctive characteristics of master therapists

(Orlinsky, 1999). Moreover, the authors did not provide an initial definition of "master

therapist". That combined with their attention to uniformities and neglecting the individual

differences across therapists might create a fictional ideal with little understanding of what being

a master therapist really entails (Orlinsky, 1999). Still, this study provided a sense of what

experience could promote in therapists and stimulated research on full spectrum of therapist

development.

Ronnestad and Skovholt carried out a qualitative study where they have conducted cross-

sectional as well as longitudinal interviews with 100 American psychotherapists at different

experience levels. Their findings were placed in the literature at different instances (Ronnestad &

Skovholt, 1991; Ronnestad & Skovholt, 2001; Skovholt & Ronnestad, 1992). Recently, they

have provided a "reformulation" of the main conclusions (Ronnestad & Skovholt, 2003). They

structured their findings into a phase model of therapist career development that were identified









APPENDIX D
DEMOGRAPHIC INFORMATION

Please tell us a little about yourself. This information will be used only to describe the sample as
a group.


1. Gender: Male Female

2. Age:

3. Ethnic background: White/Caucasian, Black/African-American, Hispanic/Latino/a -
Black, Hispanic/Latino/a White, Asian-American-Pacific Islander, American Indian
/Native-American, Multi-racial, Other

4. Name of your highest degree: BA/BS, MA/MS, MSW, PsyD, PhD, EdD,
Other

5. Years of college and higher education in total:

6. The year you obtained your highest degree:

7. Total number of years you spent engaging in clinical practice:

8. Specialty area: Psychologist, Mental Health Counselor, Marriage and Family therapist,
Social worker, Psychiatrist, Other

9. Primary job responsibility: Practice/Clinical work, Research, Academic, Administrative,
Other

10. Primary employment setting: Private practice, University academic department,
University service delivery department, Hospital, Mental health care, School setting,
Research setting, Community Center, Other

11. Number of clients you see weekly on average. Please count each group you work with as
1 client.

12. Country you live in: Drop Down Menu: List of Countries









TABLE OF CONTENTS

page

A C K N O W L E D G M E N T S ..............................................................................................................4

L IS T O F T A B L E S ................................. ............................................ ............... 7

ABSTRAC T ...........................................................................................

CHAPTER

1 INTRODUCTION ............... ............................ .................................9

2 REV IEW OF TH E LITERA TU RE .......................................................................... ....... 13

E p istem ic S ty le ...................................... ................................................... 13
Root-M metaphor Theory .................. ....................................... .. ............ 13
Theory of K now ledge .................. ................................. ....... .. .......... .. 16
Epistem ic Style and Psychotherapy.................................................................................. 18
Epistemic Style and Theories of Psychotherapy .................................. ...............18
Epistemic Style and Preferences for Psychotherapy ................................................. 21
Epistemic Style and Practices of Psychotherapy.........................................................22
Epistemic Style and Characteristics of Psychotherapists.........................................27
E p istem ic C h an g e ......................................................... .............. ................ 3 0
Epistem ic Change of the Field ............................... ............................... ...................30
Personal Examples of Epistem ic Change............................................... .................. 32
A lb e rt E llis ...............................................................................................................3 2
D onald M eichenbaum ........................................... .................. ............... 32
M ichael J. M ahoney .............. ... .................................. .. ... ..... ..... ..... ....... .... 33
Narrations of other psychotherapists including Aaron "Tim" Beck ......................34
Professional Change as a Counterpart of Epistemic Change............................................... 37
T heoretical O orientation C change ........................................................... .....................43
Therapy Style Change .................................... ..... .......... .............. .. 44
Epistem ic and Professional Change ........................................ .......................... 51
P u rp o se of Study ............................................................................... 55

3 METHODS .........................................58

P artic ip an ts .........................................................................5 8
P ro c e d u re .............. .... ...............................................................5 8
In stru m en ts .........................................................................5 9

4 R E SU L T S .............. ... ................................................................63

D em o g rap h ics .................. ................... ............................................................. ............... 6 3
Descriptives and Preliminary Analyses ............................................................. ............ 65
P rim ary A naly ses ................................................................................ 67









Table 4-7. Hierarchical regression analyses showing amount of unique variance in therapists'
current professional standing accounted for by their initial standing and epistemic
commitments.
Variable / T R F df D2 AR2 R /
Dependent Variable: Theoretical Change Index
Step 1
Gender 0.03 0.64
Age 0.15 3.27*
Weekly clients 0.04 0.87 0.03 4.49* 3 468 0.03 0.03
Step 2
Gender 0.04 0.80
Age 0.15 3.23*
Weekly clients 0.04 0.80
Constructivism difference 0.14 3.17* 0.05 5.95** 4 467 0.02 0.05
Step 3
Gender 0.04 0.91
Age 0.15 3.29*
Weekly clients 0.04 0.77
Constructivism difference 0.10 2.05
Rationalism difference -0.14 -2.86* 0.07 6.47** 5 466 0.02 0.07
Dependent Variable: Theoretical Plurality Now
Step 1
Gender -0.07 -1.44
Age 0.00 0.07
Weekly clients 0.07 1.50 0.01 1.34 3 461 0.01 0.01
Step 2
Gender -0.01 -0.12
Age -0.01 -0.14
Weekly clients 0.01 0.34
Theoretical plurality Then 0.57 14.82** 0.33 56.35** 4 460 0.32 0.49
Step 3
Gender 0.01 0.25
Age -0.01 -0.25
Weekly clients 0.00 0.09
Theoretical Plurality Then 0.61 16.03**
Constructivism difference 0.21 5.61** 0.37 54.37** 5 459 0.04 0.59
Step 4
Gender 0.01 0.20
Age -0.01 -0.26
Weekly clients 0.00 0.12
Theoretical Plurality Then 0.61 16.04**
Constructivism difference 0.23 5.84**
Rationalism difference 0.06 1.60 0.37 45.89** 6 458 0.00 0.58
Dependent Variable: Expressive Now
Step 1
Gender -.040 -0.84









scores accounted for 9% to 41% of the variability in the theoretical plurality and therapy style

scores. On the other hand, effects sizes suggested limited practical significance for the theoretical

change index. Constructivism and rationalism difference scores accounted for 4% of the

variability in this variable.

Table 4-1. Summary statistics of variables of interest.
Possible Sample n of
Variable N M SD S Skewness Kurtosis n of
Range Range items
Now 675 22.43 5.30 8-40 8-38 -0.05 -0.12 8 0.69
1. TAQ-R
Then 673 24.46 5.25 8-40 8-39 -0.33 0.11 8 0.70
Now 683 33.51 3.55 8-40 19-40 -0.53 0.46 8 0.58
2. TAQ-C
Then 680 31.20 3.82 8-40 16-40 -0.32 0.49 8 0.64
3. TCI 663 3.05 1.12 1-5 1-5 -0.20 -0.95 1
Now 653 22.61 3.72 7-35 12-34 0.05 -0.00 7
4. TP
Then 650 19.92 3.94 7-35 9-33 0.15 -0.22 7
Now 630 41.26 6.41 9-63 22-60 0.02 -0.01 9 0.59
5. EX
Then 628 36.61 6.43 9-63 15-59 0.12 0.40 9 0.57
Now 659 27.49 5.78 6-42 8-42 -0.30 -0.15 6 0.66
6. EN
Then 656 28.43 5.31 6-42 12-42 -0.30 0.19 6 0.61
Now 660 21.64 4.20 6-42 7-35 -0.16 0.33 6 0.35
7. AT
Then 659 24.16 4.60 6-42 10-37 -0.10 0.13 6 0.45
Now 646 21.87 6.37 7-49 7-45 0.41 0.14 7 0.74
8. OP
Then 646 23.57 6.97 7-49 7-47 0.400 0.000 7 0.75
Note. TAQ-R = Therapist Assumption Scale Rationalism; TAQ-C = Therapist Assumption
Scale Constructivism; TCI = Theoretical Change Index; TP = Theoretical plurality; EX =
Expressive; EN = Engagement; AT = Attentional; OP = Operative; Now = Therapists' current
view of themselves today; Then = Therapists' view of themselves when they first started
practicing following the completion of their graduate training.









CHAPTER 4
RESULTS

The results section is composed of three sections. First, the sample characteristics of the

participants are provided. Second, the descriptive information concerning the overall scores,

psychometrics and relationships among the primary variables of interest are presented. And last,

the three primary analyses are reported. A series of repeated measures ANOVA first address the

primary questions regarding the ways in which therapists regard themselves as changing in

relation to their theoretical orientations and therapy styles (expressive, engagement, operative,

and attentional) across the course of their practice. Next, multiple regression analyses are

reported to address the question regarding whether cohort effects (i.e. the year of entry to the

profession) accounted for therapists' perceptions regarding their initial epistemic commitments

and epistemic shifts. And third, a series of multiple regression analyses are reported to address

the question regarding whether change in therapists' epistemic leanings predict levels of

therapists' current theoretical and stylistic commitments, above and beyond their initial

commitments.

Demographics

The sample consisted of 702 participants of which 94.2% designated their demographic

information. Among those who responded, 59.5% women and 40.5% men, with a mean age of

50.36 (SD = 11.7, age range = 25-84 years). The majority of the participants were Caucasian,

88.6% (N= 584), followed by Hispanic, 3.6% (N= 24), African-American/Black, 2.4% (N= 16),

Asian-American, 1.2% (N= 8), multiracial, 1.2% (N= 8), and Other, 2.9% (N= 19). The

majority of the participants reported to be from the U.S., 96% (N = 630), whereas 4% (N = 26) of

the participants were from other countries.









Generalizability of the findings was hampered by the self-report nature of the present

study. Self-reports are subject to distortion and social desirability. The postmodern zeitgeist

might prompt therapists to provide answers in line with the constructivist viewpoint even though

they might not have internalized this standpoint or transferred their assumptions to therapy room.

Moreover, self-reports may not correlate well with the participants' actual behavior or

experience (Rosenthal & Rosnow, 1991). It is important to consider that what therapists claim

they do in therapy setting might be quite different from what they actually do. The personal

narrations of certain well-known therapists could facilitate our understanding in this matter. For

instance, Albert Ellis noted repeatedly that he was committed to constructivist epistemology and

his therapy was constructivist in nature. Yet other researchers such as Mahoney and

Meichenbaum (see Zeig, 1992) had suggested that a closer inspection to the basic assumptions

and operations of REBT, and Ellis's himself, indicated the contrary. The variables of interest in

the current study such as epistemic commitment, theoretical orientation and therapy style are

subject to such misconstructionss" where self-reports do not correlate with behavior.

The current study asks participants to provide self-reports for not only their current

experiences but also for their experiences that took place during the time frame that they have

first started practice after graduation from their highest degree. Hence the limitations of self-

report studies might have been further complicated by memory biases. The literature on

cognitive psychology, specifically on recall, indicated that our memory is far from impartial and

subject to bias (Schacter, 1999). Certain facts can be "construed" as years move on and more

experience is gained. Hence, it must be clear to our reader that this study is based on the

constructions of professional practitioners as they had "recalled" themselves to be in their









their clients starting the beginning of their careers, leaving less of a room for growth or increase

on this domain. The ceiling effect may also explain the reduction on the average of the

engagement score from then to now, although this difference failed to be clinically significant. If

therapists had hit the maximum of their care and concern for their clients starting their careers,

they might experience a slight decline in their engagement level across the course of their

practice.

Castafieiras et al.'s (2006) study may also aid our understanding of the data's failure to

support our hypothesis regarding increased therapist engagement across practice. Specifically,

Castafieiras et al.'s (2006) study indicated that differences across experience levels emerged for

the dimension of engagement only for those therapists who were identified as integrationist, but

not for psychoanalytic or cognitive therapists. In our analyses, we investigated the change

experiences of all participated therapists without controlling for their theoretical commitment,

and that might have masked the therapy style changes for therapists with specific theoretical

commitments.

Post-hoc analyses were utilized to investigate if differences across experience levels

emerge for the dimension of engagement only for those therapists with certain theoretical

orientation. Data confirmed the interaction between theoretical commitments and time on

therapists' levels of engagement. For therapists that identify their current theoretical commitment

as cognitive and integrative, engagement levels have declined across their practice while no

significant changes appear for therapists with other theoretical commitments. For therapists that

identified their initial theoretical orientation as behavioral, humanistic-existentialist-gestalt, and

integrative, engagement levels have declined across their practice. For therapists that identified

their initial theoretical orientation as narrative/constructivist, their engagement levels seemed to









for developing an increased understanding of therapists' developmental processes and the place

of epistemic commitment within that framework, as construed by therapists' themselves.

Taken as a whole, the literature indicates psychotherapist theory preferences as well as

therapeutic conceptualizations and behavior are colored by their epistemic commitments. Yet

such professional attitudes and behaviors as well as the epistemic commitments are subject to

development and growth. Moreover, these change processes are likely to interact with one

another: Any change experienced in the way we perceive the world and test the validity of

knowledge as psychotherapists are likely to mark the growth and change in our therapy-related

attitudes and behaviors. Overall, the complex associations between epistemic worldview and

psychotherapy preferences and behaviors have been yet to be clarified within a developmental

framework that supposes change and growth in both aspects.

Purpose of Study

As the literature review points out, the psychotherapy literature suggests that the field has

experienced an epistemic shift where its members have become increasingly more constructivist,

and numerous seasoned psychotherapists endorsed this shift through narrating their own

epistemic change. However, despite the general acceptance of the notion in the current literature,

there is no empirical evidence documenting that today's practitioners have in fact experienced an

epistemic shift in their perspective and practice, apart from the anecdotal evidence of selected

prominent practitioners in the field. The "increasingly constructivist" landscape of contemporary

psychotherapy could be an indicator of a cohort effect rather than an indicator of therapists'

developmental changes across time. For instance, early-career therapists might have stronger

commitments to constructivism than therapists of the previous generations, and/or therapists who

entered the field at different times have different epistemic trajectories. The dynamics underlying









and a decrease in their rationalist commitments. Next, we investigated the degree to which cohort

effects underlie epistemic changes of the therapists and the field.

Cohort Effect on Perceived Changes on Epistemic Leanings

Existing literature agrees that the field is shifting in its epistemic commitments (Mahoney,

1995a, 1995b) and the current study provides support for this claim from the perspective of

practicing psychotherapists. Changes in the field and the changes of its members are reciprocal.

The change in the field impacts its existing members as well as those who enter the field

recently, while the existing members' change processes further impacts the field. As Farber et al.

(2005) noted, the changes in the field impacts therapists such that those who enter the field at a

certain time might be different than others who have entered the field at an earlier era. Therapists

entering the field recently might differ from seasoned therapists in their motivations or

aspirations (Farber et al., 2005). Similarly the epistemic commitments of those therapists who

entered the field recently might be different than their seasoned colleagues as a part of the

epistemic change of the field of psychotherapy. In fact, it can be suggested that the epistemic

journey of the field with its increasingly post-modernist perspective can be a reflection of the

recent cohorts' greater commitment to constructivism and postmodernism.

At the same time, a review of studies on career development of practitioners suggested that

individual change processes of the members of the field are systematic in nature, are independent

from the cohort to which practitioners belong to or their experience level (R0nnestad &

Skovholt, 2003), and include themes of increasing commitment to constructivist epistemology.

In other words, from the perspective of career development theories, the field's epistemic

journey might be a reflection of the therapists' individual change processes. It is also possible

that such individual change processes are subject to cohort effects such that certain groups of









Question 3. What is the relationship between therapists' epistemic and professional

change experiences? In other words, to what extent can therapists' epistemic journeys account

for their current standing with their therapeutic orientation and style after accounting for their

initial standing with these variables? We hypothesized that increases in therapists' constructivist

commitments would predict (1) greater changes in their theoretical orientation throughout their

professional lifetime; (2) greater levels of theoretical plurality, indicating greater adherence to

theoretical integration and eclecticism; (3) greater levels of expressive and engagement

dimensions of therapy style, indicating greater adherence to emotional expressiveness with and

engagement to clients; and (4) lower levels of operative and attentional dimensions of therapy

style, indicating greater levels of spontaneity in implementing interventions and wider range of

attention in collecting information from the clients.









CHAPTER 5
DISCUSSION

The discussion section is composed of three sub-sections. First, the hypotheses and

findings of the study are summarized. Second, a detailed interpretation of the findings in the light

of literature on epistemology and therapists' professional experiences is provided. And last,

limitations as well as implications of the present study and suggestions for future studies are

presented.

Summary of Results

Overall, the results of the present study supported the primary hypotheses regarding the

change processes of therapists' epistemic commitment. Therapists' ratings of their epistemic

commitments reflected a greater current commitment to constructivism (Now) than when they

began their careers (Then). Conversely, they perceived themselves as having become less

committed to rationalist epistemology across the course of their practice. The data failed to find

significant cohort effects for therapists' initial epistemic commitments and their epistemic

change scores. In other words, the data suggested that therapists' perceived epistemic

commitments, shifting towards greater constructivism (and less rationalism) across time, were

not a function of when they entered the field, but rather reflected perceived changes across the

course of their careers, regardless of the nature of their initial epistemic leanings.

The results also supported the hypotheses regarding the therapists' change processes in

selected professional characteristics. These professional characteristics included their theoretical

orientation, theoretical plurality, and expressive, operative and attentional dimensions of therapy

styles. Therapists' ratings of these characteristics indicated that they perceived themselves as

becoming more pluralistic, i.e. integrationist, in their theoretical orientation, and more

emotionally expressive, more operatively spontaneous, and broader in attention in their









Research Question #1: How Do Therapists Change in Their Epistemic Commitment and in
Professional Characteristics across the Course of Their Professional Practice?

Within this broad research question, we have specifically hypothesized that when

compared to their initial standing, therapists would have (1) increasingly higher levels of

commitment to constructivist epistemologies; (2) increasingly higher levels of plurality in their

therapeutic orientation; and (3) increasingly higher levels of expressive and engagement

subscales, and lower levels of attentional and operative subscale. We conducted a series of

repeated measures ANOVA, with now-versus-then (i.e. time factor) as the within-subjects factor,

and epistemology, theoretical orientation, and therapeutic style scores as the dependent variables,

to investigate whether there were significant reported changes in the therapists' epistemic

commitments and identified professional variables over the course of their practice.

Gender was entered as a covariate to the analyses involving the variables of constructivism

and rationalism. Age was entered as a covariate in the analyses regarding engagement, attention,

and theoretical orientation change. In addition to age, the average number of clients seen weekly

was entered into the analysis involving the attention variable. A Bonferroni adjustment was

employed within the analyses to guard against the Type I error, and alpha level was established

at .007 (.05/7), which is the original alpha level (.05) divided by the number of statistical tests.

Obtained partial eta-squared scores were reported as effect size indices. Table 4-3 summarizes

the obtained coefficients.

Findings indicated statistically significant changes in therapists' epistemic leanings,

therapy styles and theoretical plurality. Consistent with our hypotheses, analyses revealed an

increase in therapists' perceived commitment to constructivist epistemology. This finding was

not only statistically significant, but also modestly robust, as indicated by a partial-eta squared of

.21. Another statistically and clinically significant finding was therapists' perceived change in









whether these perceived epistemic trends could be explained through cohort effects; (3) whether

therapists' perceived epistemic change was associated with their self-reported theoretical

orientations or therapeutic styles in coherent ways.









established that more the therapists are committed to constructivist epistemology, less they lean

on therapeutic structure and direction.

Overall, our data extended the translation of epistemology into practice by suggesting that

therapists' epistemic journey in the form of increasing commitment to constructivism and

decreasing commitment to rationalism would account for where therapists finalized their journey

on expressive, operative, and attentional dimensions of therapy style.

Discussion of how our findings are supported by the literature may be strengthened by

utilizing the literature associating therapists' personal characteristics with their epistemic

commitments where higher levels of constructivist commitments predicted higher levels of self-

exploration, attending to emotions, ambiguity tolerance and openness in therapists, and yet

higher rationalism scores predicted lower levels of these characteristics (Neimeyer & Aksoy,

2005). Therapists' personal characteristics may facilitate therapists' change processes. For

instance, increasingly constructivist therapists may tend to have strengthened commitment to

self-understanding as well as attendance to their emotional processes, which might facilitate their

emotional expressiveness in the session and emotional closeness to their clients as well.

Similarly, those who are more increasingly open to and tolerant of ambiguity may be more likely

to welcome a broad attention to variety of areas and concerns in their information gathering

processes and may operate with increasing spontaneity in their therapeutic work.

Therapists' increasing commitment to constructivism and decreasing commitment to

rationalism, then, may translate to higher levels of expressive, operative, and attentional through

facilitating individual change processes that might relate to stylistic commitments (and future

studies can explore this). Overall, the finding that increased constructivism predicts emotional

expressiveness, spontaneity and range of attention positively across the course of therapists'









the years of practice (f = 0.15), and negatively related to participants expressive scores (f = -

0.13). The standardized beta coefficients suggested that with increased age, participants tended

to rate their theoretical change higher, and rate their expressive lower. Average number of clients

seen weekly was negatively related to both operative and attentional scores (f = -0.13; f = -

0.15), suggesting that as participants' caseload increased, they tended to rate their operative and

attentional dimensions lower.

The second step of the models for the current theoretical plurality, expressive, operative,

and attentional variables, revealed that participants' initial standing with these variables were

positively related to the dependent variables. Initial ratings were positively related to current

ratings of the variables; for theoretical plurality, f = 0.57, for expressive, f = 0.49, for operative,

f = 0.60, and for attentional, f = 0.53. Higher initial ratings for the variables predicted higher

scores for the current ratings of the variables.

The next step of the models revealed that participants' increasing adherence to

constructivist epistemology were positively related to three of the dependent variables and

negatively related to the other two. Increasingly higher constructivism scores were positively

related to theoretical change index (f = 0.14), theoretical plurality (f = 0.21), and expressive (f =

0.27), and negatively related to operative (f = -0.12) and attentional dimensions (f = -0.17).

Consistent with our expectations, therapists' increasing commitment to constructivist

epistemology predicted increasing change in their theoretical orientation, as well as higher levels

of theoretical plurality, emotional expressive, spontaneity in conducting therapy and broadened

focus in gathering information in therapy in their current practice.

The last step of the models revealed that therapists' increasing adherence to rationalist

epistemology was positively related to operative (f = 0.32) and attentional (f = 0.21) scores and









commitment to therapy and engagement with clients, i.e. engagement dimension of therapy

styles.

The obtained results were mostly consistent with the literature. Castafieiras et al.'s (2006)

study on differences between expert and beginner therapists in therapy style, therapist

professional development studies (Jennings & Skovholt, 1999; Martin et al., 1989; Ronnestad &

Skovholt, 2003; Skovholt & Jennings, 2004), and personal narratives of seasoned therapists

(Goldfried, 2001a) concluded that therapists become more emotionally expressive, operatively

spontaneous, and broader in their therapeutic attention across the course of their practice.

Castafieiras et al. (2006) found that expert therapists who were identified with cognitive

orientation were more emotionally closed towards their clients compared to beginners.

Additionally, Jennings & Skovholt (1999; Skovholt & Jennings, 2004) described master

therapists as having strong emotional skills such as emotional receptiveness, ability to attend to

self and other's emotions and recognition of the ways in which their own emotions impact their

work. These findings supported the findings noting that therapists perceived their emotional

expressiveness to strengthen over the course of their practice.

Castafieiras et al. (2006) found that expert integrative therapists were more spontaneous

in implementing interventions compared to beginners. Likewise, Ronnestad and Skovholt (2003)

suggested that as therapists matured, they gradually developed an internally-based flexible

professional functioning. This inferred flexibility across professional development was aligned

with the findings that expert therapists were more spontaneous in implementing interventions.

The narrations of 16 experienced psychotherapists also described their process of breaking free

from their original teachings and developing integrative, expansive, pliable ways of being and

doing in their therapeutic work (Goldfried, 200 la). Overall, the results of our study support the









fundamental ways of knowing, namely empiricism, rationalism, and metaphorism. Royce

derived these epistemologies from the dominant cognitive process that can be employed by

individuals. According to Royce (1964), people utilize perceptual, conceptual, and symbolic

processes during their daily pursuits and one of these three cognitive processes would be

dominantly employed over the others. This dominantly used cognitive process would indicate the

individuals' dominant way of knowing the world.

Empiricism reflects dominant use of perceptual cognitive processes. Empiricists seek out

sensory experience. They engage in induction and test reality in terms of reliability and validity

of their perceptions and sensory experiences. Rationalism reflects dominant use of conceptual

cognitive processes. Rationalists seek out rational analyses of ideas. They engage in deduction

and test reality by its logical consistency. Metaphorism reflects dominant use of symbolic

cognitive processes. Metaphorists emphasize the symbolizing nature of events arguing that

knowledge is constructed symbolically. Hence, they seek viability of knowledge rather than its

validity and they engage in information analysis through making use of analogies (Royce, 1964;

Royce & Mos, 1980; Royce & Powell, 1983). Empiricism and rationalism reflect the epistemic

style of the modem era, while metaphorism reflects the epistemic framework of the postmodern

era.

Individuals' commitment to Royce's (1964) three epistemologies can be measured by

Psycho-Epistemological Profile (Royce & Mos, 1980; PEP). PEP has been frequently employed

in investigating the ways in which epistemic style related to the theory and practice of

psychology.































2008 Gizem Toska









broader focus in the way they have collected data during therapy. But the low partial eta squared

for the change in operative and attentional raised question into the magnitude of these findings.

The data failed to support our hypothesis of increased engagement across years. Higher

levels of engagement represent higher degrees of engagement with clients. We expected

therapists to report increased commitment to therapy and their clients across their practice. The

obtained results, on the other hand, suggested therapists viewed their engagement level as

remained stable across time. Due to these findings, engagement as a therapy style variable was

excluded from the analyses investigating the relationship between therapists' epistemic and

professional change experiences.

In order to understand the data's failure to support our hypothesis regarding increased

therapist engagement across practice, we conducted exploratory post-hoc analyses. Specifically

we investigated if differences across experience levels emerge for the dimension of engagement

only for those therapists with certain theoretical orientation and we engaged in the post-hoc

analysis by entering therapists' current and initial theoretical orientations into the model. In the

post-hoc analysis, we used a repeated measures ANOVA, with now-versus-then as the within-

subjects factor, theoretical orientation as the between-subjects factor, age as the covariate and the

engagement scores as the dependent variable to examine whether there was significant increase

in the engagement scores over the course of therapists' practice. We conducted this analysis

twice, once current theoretical orientation as the between-subjects factor and once initial

theoretical orientation as the between-subjects factor.

A total of 488 therapists were included in both of the analyses, with engagement-then

scores (M= 28.4, SD = 5.34) higher than engagement-now scores (M= 27.5, SD = 5.70). This

less than 1-point score difference failed to represent a significant change in both of the analyses,









the ways in which these change processes facilitate one another. The existing literature suggests

that these two processes are associated; yet this interaction remains to be studied.

As we have clarified above, certain schools of thought and theoretical orientations have

been associated with certain epistemic styles. Conceptually, rational epistemic style was linked

to rationalistic cognitive therapies whereas metaphorical epistemic style was linked to

constructivist cognitive therapies (Lyddon, 1991). Consistent with these conceptual links,

epistemic style moderately accounted for individuals' attitudes and preferences for theories of

psychotherapy (Lyddon, 1989a; Lyddon & Adamson, 1992; Neimeyer et al., 1993; Neimeyer &

Morton, 1997; Schacht & Black, 1985): Participants preferred theoretical orientations that were

consistent with their own epistemic view.

Considering that the epistemic style of a therapist accounts for his or her theoretical

orientation preferences, it is reasonable to expect that a change in a therapist's epistemic

commitment would reflect on the therapist's choice of theoretical orientation. It can be argued

that therapists' epistemic change experiences would be related to the quantitative and qualitative

changes in their theoretical orientation. In other words, as the psychotherapists see the world

differently, they may adhere to new theories that capture their most recent worldview. We

assume that psychotherapists' change in the epistemic commitment can predict the change in

their theoretical orientation. The more psychotherapists experience an epistemic shift, the more

likely they may be to report a change in their theoretical orientation.

As constructivist metatheory reflects recognition of complexity in human processes,

epistemic shift of practitioners towards constructivism may further encourage practitioners to

integrate various forms of therapy. Alternatively (and additionally), the ongoing integrationist

movement might have endorsed a more constructivist framework on its members. In other









levels of the variance in the dependent variables, constructivism and rationalism difference

scores, was explained by the years that therapists had entered the profession.

Our data also allowed us to investigate whether the epistemic shift in the field is the result

of the infusion of new therapists who were more committed to the constructivist epistemology to

begin with than the seasoned therapists. To investigate this question, we compared therapists'

initial constructivist commitments in five cohorts (1954 to 1969, N= 21; 1970 to 1979, N= 94;

1980-1989, N= 150; 1990-1999, N= 197; 2000-2008, N= 191). We conducted a one-factor

ANOVA, with cohort groups as the between-subjects factor and therapists' initial constructivism

scores as the dependent variable. There was no significant main effect of cohort, F(4,638) = 1.55,

p = .185, partial eta squared= .01. The data failed to show any significant differences in

therapists' initial constructivist commitments across cohort groups, again suggesting that cohort

effects did not account for the epistemic shifts observed in our sample across time.

Research Question #3: What is the Relationship between Therapists' Epistemic and
Professional Change Experiences?

We conducted a series of regression analyses to examine whether changes in therapists'

epistemological commitments were related to the levels of change in their theoretical orientation,

the plurality of their theoretical orientations, or therapy styles (expressive, operative, and

attentional dimensions). In other words, we investigated to what extent therapists' perceived

epistemic shifts would explain their current theoretical and stylistic commitments above and

beyond their initial standing.

To conduct this set of analyses, we first computed change scores for the epistemic

variables where the THEN scores were subtracted from the NOW scores. This index was

computed for the commitment to constructivist and rationalist epistemology variables.









Our initial hypothesis of increasing engagement across practice held true only for those

therapists who were initially identified with narrative/constructivist orientation.

Association between Epistemic and Professional Change Constructions

Epistemology has been associated with certain schools of thought and theoretical

orientations (Lyddon, 1989a; Lyddon & Adamson, 1992; Neimeyer et al., 1993; Neimeyer &

Morton, 1997; Schacht & Black, 1985). Epistemology has also been associated with the ways in

which therapists conducted therapy (Nagae & Nedate, 2001; Vasco, 1994; Viney, 1994; Winter

& Watson, 1999), including the therapy style dimensions of expressive, engagement, operative,

and attentional (Neimeyer & Saferstein, 2006).

The literature indicated that epistemic, theoretical and stylistic commitments were

associated. The current study indicated that therapists' epistemic, theoretical, and stylistic

commitments were perceived to change across the course of their practice. Given that "change of

any sort can facilitate other changes" (Stricker, 2001, p. 79), we intended to explore if epistemic

change accounts for or aligns with therapists' theoretical and stylistic change experiences.

We hypothesized that increases in therapists' constructivist commitments would predict (1)

greater changes in their theoretical orientation throughout their career; (2) greater adherence to

theoretical integration and eclecticism; and (3) therapy styles marked by higher levels of

expressiveness, client engagement, attentional focus and operative spontaneity. Since the data

failed to indicate engagement differences across the years of practice, we excluded this variable

from the analyses. Results were mostly consistent with our expectations. After accounting for

demographic variables and initial standings, therapists' increasing commitment to constructivist

epistemology predicted high ratings for theoretical orientation change scale, as well as higher

levels of theoretical plurality, higher levels of emotional expressiveness and operative









Table 4-4. Repeated measures ANOVA summary table for perceived theoretical commitment
differences across time.
partial
N M SD Df F eta-
Variable squared
Now Then Now Then
1. Cognitive 661 4.08 3.34 1.00 1.31 1,660 202.06** 0.23
2. Behavioral 661 3.48 3.10 1.19 1.41 1,660 5,718.19** 0.07
3. Humanistic Existential Gestalt 658 3.35 3.22 1.19 1.34 1,657 9.11 0.01
4. Narrative/constructivist 652 2.44 1.92 1.32 1.15 1,651 163.32** 0.20
5. Systemic- Family 659 3.13 2.82 1.21 1.30 1,658 43.89** 0.06
6. Psychodynamic 660 3.05 2.98 1.38 1.50 1,659 2.46 0.00
7. Feminist Multicultural 659 3.10 2.54 1.29 1.33 1,658 169.24** 0.21
**p <.001


Table 4-5. Current and initial theoretical orientation endorsements.
Variable Valid Percentage
Now Then
1. Cognitive 27.0 23.9
2. Behavioral 4.7 12.4
3. Humanistic Existential Gestalt 8.0 16.9
4. Narrative/constructivist 4.2 1.5
5. Systemic Family 4.7 6.4
6. Psychodynamic 17.1 26.5
7. Feminist Multicultural 2.1 1.1
8. Integrationist 32.2 11.3


Table 4-6. Post-hoc analyses examining the moderating effect of the theoretical commitment on
perceived engagement differences across time.
Main theoretical orientation Current Initial


M F M F
Now Then Now Then
Cognitive 25.76 27.31 13.70** 26.57 27.20 2.12
Behavioral 29.00 28.86 0.02 27.68 29.22 6.36*
Humanistic Existential Gestalt 28.49 28.88 0.28 27.24 28.81 9.72*
Narrative/Constructivist 29.01 27.61 2.11 32.06 26.63 6.87*
Systemic Family 26.62 25.47 1.31 25.76 27.17 2.59
Psychodynamic 28.83 29.34 1.08 29.18 29.47 0.51
Feminist- Multicultural 30.73 28.40 1.87 27.15 29.44 0.98
Integrationist 27.32 29.01 21.71** 26.25 27.70 5.63*
*p <.01, **p <.001









ACKNOWLEDGMENTS

I would like to thank my advisor and committee chair Dr. Greg J. Neimeyer, and my

beloved husband Ferit Toska, for their extensive guidance, support, and encouragement. I thank

my dear friend Burhan Ouit for his guidance in the conduct of the statistical analyses of this

project. I thank to my dear father Yalcin Aksoy for his help in improving the quality of writing.

I am thankful for the assistance given to me by my committee members, Dr. Kenneth Rice, and

Dr. Michael Farrar. I am grateful to my family and my friends in Turkey and in Gainesville for

their love and support. I could not have done this project without their help.









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

ME NOW, ME THEN: THERAPISTS AND CONSTRUCTIONS OF THEIR EPISTEMIC
JOURNEY

By

Gizem Toska

August 2008

Chair: Greg J. Neimeyer
Major: Counseling Psychology

Our study investigated the epistemic change processes of psychotherapists and attempted

to identify the nature of the epistemic journey of this group. We conducted a retrospective study

where therapists were asked to reflect on their current and past epistemic commitments as well as

theoretical orientations and therapeutic styles. This method provided us with a unique set of data

where we learned about the therapists' personal constructions of their epistemic journeys and

other professional change processes accompanying this journey.

Findings suggested that when reflected on their current experiences and their initial

experiences as blossoming practitioners, therapists perceived their commitment to constructivist

epistemology as amplified, and their commitment to rationalist epistemology as reduced over

their practice. The cohort effects failed to explain these changes or to differentiate therapists'

initial constructivist commitments. The obtained results also indicated that the perceived change

in epistemic commitments predicted therapists' theoretical and stylistic commitments.

Our study facilitated our understanding of the developmental trajectory of therapists'

epistemic commitments as they perceive it and it provided empirical data with respect to how

therapists construe the professional change processes that accompany their epistemic change.









words, it is likely that the field's increasing commitment to constructivism and the increasing

theoretical integration on the part of psychotherapists may be related to and promoting one

another. Hence, we expect that increase in therapists' commitment to constructivist

epistemologies might correlate with their engagement in more integrated ways of conducting

therapy.

Epistemic style has also been employed to understand the differences among

psychotherapy practices. Therapists conducting rationalist and constructivist therapies differed in

the way they set the direction of the therapy, related to client, and conceptualized and worked

through clients' emotional distress, relapse, and regression (Nagae & Nedate, 2001; Vasco, 1994;

Viney, 1994; Winter & Watson, 1999). Therapists with different epistemic commitments

appeared to have different styles in their therapeutic closeness, focus, engagement, and

spontaneity as well as different emphasis on bonding with their clients (Neimeyer & Saferstein,

2006).

Moreover, Castafieiras et al. (2006) demonstrated the complex ways in which therapy

style, experience, and theoretical orientation interacted. Their findings indicated that the ways in

which therapy style related to theoretical orientations (psychoanalytic, cognitive, and integrative)

was different across the two levels of experience (beginners with less than five years of

experience and experts with 15 years of experience or more). Overall, the findings indicated that

adherence to cognitive and integrative theories was associated with similar levels of attentional,

operative and expressive, and psychoanalytical therapists had lower scores on each of these three

dimensions of therapy style compared to cognitive and integrative therapists.

Castafieiras et al.'s (2006) findings indicated that the therapy style was associated with

theoretical orientation in different ways depending on therapists' experience level. Given that









spontaneity in conducting therapy and broader focus in gathering information in therapy in their

current practice.

Although no specific predictions were made, the ways in which changes in rationalist

commitments predict therapists' professional standings were also investigated. Results suggested

that therapists' increasing commitment to rationalist epistemology predicted lower ratings on

theoretical orientation change scale, lower levels of emotional expressiveness and operative

spontaneity and narrower focus in information gathering. Rationalist change scores accounted for

the variance in these variables even after the constructivist change scores were entered into

analyses, suggesting that, taken together, therapists' epistemic journeys better explained the ways

in which therapists ended up on their theoretical and stylistic dimensions than did either

epistemic orientation alone.

Overall, epistemological change processes predicted where therapists have reached in their

theoretical and stylistic commitments even after accounting for their initial commitments. These

results are consistent with the literature. The findings are explored in depth, first for theoretical

and next for stylistic commitments of therapists.

Epistemic and Theoretical Change

Epistemology has been associated with theoretical orientation. Not only certain epistemic

commitments were conceptually tied to certain theoretical orientations (Lyddon, 1991), but also

epistemic commitments accounted for therapists' theoretical orientation preferences (Lyddon,

1989a; Lyddon & Adamson, 1992; Neimeyer et al., 1993; Neimeyer & Morton, 1997; Schacht &

Black, 1985). The results of the current study supported and extended the relationship between

theoretical orientation and epistemology by indicating that as therapists have perceived greater

commitment to constructivism across the course of their practice, they indicated higher levels of

theoretical orientation change and higher levels of theoretical plurality.









therapists with different epistemic commitments appeared to have different styles in their

therapeutic closeness, focus, engagement, and spontaneity (Neimeyer & Saferstein, 2006).

The results of the current study supported and extended the relationship between therapy

style and epistemology by indicating that therapists' epistemic journey predicted their current

stylistic standings. As therapists have perceived greater commitment to constructivism across the

course of their practice, they indicated higher levels of emotional expressiveness with clients,

higher levels of spontaneity in conducting therapy and broader focus in gathering information.

Moreover, perceived decrease in their commitment to rationalism across the course of their

practice accounted for additional variance in predicting higher levels of expressiveness and

spontaneity and broader focus.

These findings are consistent with the literature investigating the relationship between

epistemology and therapy style. Expressive, operative, and attentional dimensions of therapy

style have been associated therapists' epistemic commitments. Neimeyer and Saferstein (2006)

established that higher constructivist commitments related to higher levels of expressive (i.e.

increased emotional openness and closeness to clients), lower levels of operative (i.e. increased

operative spontaneity in conducting therapy) and lower levels of attentional (i.e. broader range of

attention in therapeutic information gathering).

Other studies further supported the link between epistemology and therapy style. With

respect to expressive dimension, Viney (1994) suggested that therapists conducting constructivist

cognitive therapies tended to acknowledge their clients' negative emotions more compared to

rationalist cognitive therapists. Moreover, Winter and Watson (1999) suggested that

constructivist therapists might tend to be more communicative of unconditional positive regard

to their clients than rationalist therapists. With respect to operative dimension, Vasco (1994)









conceptualization of clients' emotional distress, relapse and regression, and approaching such

client variables in the context of therapy.

Vasco (1994) observed therapy sessions of Portuguese therapists with constructivist

commitments. The results of his study suggested that therapists conducting constructivist

therapies tended to reject therapeutic structure and directive helping styles yet they were

technically eclectic compared to rationalistic cognitive therapists. Constructivist commitment

was negatively associated with therapists' focus on clients' problems.

Viney (1994) sampled and content analyzed therapy transcripts of five therapists with five

different orientations including personal construct, client centered, and rational emotive

therapies. Therapist conducting constructivist cognitive therapy, i.e. personal construct therapy

acknowledged the negative emotions of their clients more compared to therapists conducting

rationalist cognitive therapy, i.e. rational-emotive therapy.

Winter and Watson (1999) studied the therapy session transcripts of the two therapists, one

adhered to personal construct therapy that is identified as a constructivist cognitive therapy, and

the other adhered to rationalist cognitive therapy. Their in-depth analyses revealed that

constructivist therapist was more empathic of clients, more communicative of unconditional

positive regard towards the client and more engaging in complex levels of processing during

therapy. Rationalist therapist, on the other hand, was more directive in therapy. Moreover, in

dealing with client's failure to complete a given assignment, rationalist therapists were more

likely to encourage clients to go through with it, while constructivist therapists strived to

understand the dynamics of client's resistance.

Nagae and Nedate (2001) extended these results to Japanese therapists. Therapists engaged

in rationalist cognitive therapies were more likely to engage in psycho-educational instruction,









variable. Only for this model, constructivism difference score failed to account for significant

levels of variance after the rationalism difference score was entered into the analysis. At the third

step of this model, the F value for constructivism difference score could no longer meet the alpha

of.01.

For the other dependent variables of theoretical plurality, expressive, operative, and

attentional, the models at the Step 2, at which the initial standings were entered into the model,

accounted for a significant amount of variance in the dependent variables after controlling for the

variance explained by gender, age, and average number of clients. The models accounted for

variances in four dependent variables between 27% and 36%. At Step 3, the model accounted for

a significant amount of variance in all of the four dependent variables after controlling for the

variance explained by gender, age, average number of clients, and initial standings. The

inclusion of constructivism difference scores into the model at Step 3 increased the accounted

variances between 3% and 7%. The model at Step 4 accounted for a significant amount of

variance only in three therapy style variables after controlling the variance explained by gender,

age, average number of clients, initial standings, and constructivism difference scores. For the

theoretical plurality, inclusion of rationalism difference scores failed to improve the variance

explained in the dependent variable. For the three therapy style variables, the inclusion of

rationalism difference into the model at Step 4 increased the accounted variances between 4%

and 9%. The overall models accounted for variances in four dependent variables between 37%

and 50%.

To identify the location and direction of the effects on each of these dependent variables,

we examined a standardized beta coefficient for each predictor. At the first step, the results

indicated that age was positively related to participants' ratings of their theoretical change across









experienced by therapists although they do not include a comparison among one another nor they

provide a tentative conclusion.

For instance, DeAngelis' (2006) interviews with psychotherapists as well as a series of

articles published in the Journal of Clinical Psychology under the title of 'Why I became a

psychotherapist' tapped on the transformations that practitioners have undergone. Some

conceptualized their growth and change not only as an outcome of conducting therapy but also as

a requirement of it and at least some conceptualized the change as a source of motivation to

become and remain as a therapist (see Brown, 2005). Similarly, a group of practitioners that

participated in a study investigating occupational hazards and rewards facing psychotherapists

cited their opportunity to learn and grow as well as their increased self understanding among the

rewards of their work (Kramen-Kahn & Hansen, 1998) suggesting that they have changed

throughout their career and that change process was rewarding for them.

Overall, the results implied that psychotherapists go through a complex change process and

at least some aspects of their change were tied to their work. Different groups of

psychotherapists already reported that personal change (Farber, 1983; Radeke & Mahoney,

2000) and a smaller group implied that their professional attitudes and experiences were not

spared from the process of change (Goldfried, 2001 a).

Recently there has been an increased attention on the change experiences of practitioners

from the developmental perspective. A group of researchers such as Orlinsky, Ronnestad,

Skovholt and Jennings started to study the career trajectories of mental health practitioners from

various parts of the world. They maintained that therapists not just change; their change

processes are systematically organized and they involve progression over time (Ronnestad &

Skovholt, 2003). Combined with the studies on expertise in counseling and psychotherapy









based" approach to therapy, Beck developed an empirically-driven practice that aimed to explore

the cognitive processes underlying human suffering, namely Cognitive Therapy (Bloch, 2004).

His approach was criticized for its mechanical, over-simplified nature yet in his recent

arguments, Beck claimed that the change processes facilitated by the cognitive therapy can be

complex (Bloch, 2004), while cognitive therapy is much richer than mechanical treatment

(Bloch, 2004) and individually designed considering the client and presenting concern at the

hand (Beck, n.d.).

Beck (Bloch, 2004) also questioned if applying certain techniques would ever be enough to

conduct effective therapy. He suggested that treating a presenting concern in a mechanical way

would not work especially with complex cases. "Therapists who are good at the technical end of

cognitive therapy fall flat on their faces when it comes to the more complex cases. Empathy,

sensitivity, considerateness together with the ability to put them together with technical aspects

is the combination needed." (para. 107).

Moreover, Beck demonstrated constructivist commitment through his conceptualization

and utilization of emotions, personally and professionally. In a paper written in his honor, Beck

was praised for his attention to his emotional processes and his willingness to learn from them in

his personal and professional life (Padesky, 2002). Beck (2002) himself suggested that emotional

arousal and expression were essential parts of cognitive therapy since he assumed that the

expression of emotion would have certain meaning to client and "the interaction taking place can

provide an experiential for of reframing (similar to what Franz Alexander terms "The Corrective

Emotional Experience")" (para. 2). Beck (n.d.) also referred to other strategies that parallel

constructivist therapy strategies such as guided discovery and he encouraged collaboration









the process of change and recovery for the clients. They have contributed to the literature by

conceiving the Personal Style of the Therapist (PST) construct and providing a detailed

description this understudied variable.

Fernandez-Alvarez et al. (2003) defined PST as "the set of characteristics that each

therapist applies in every psychotherapeutic situation, shaping its basic attributes" (p. 117). In

other words, PST is the collection of conditions that guide the therapist's therapeutic behavior.

They conceptualized style of the therapist as composed of five bipolar dimensions of

instructional, expressive, engagement, attentional, and operative, and this conceptualization was

validated empirically (Fernandez-Alvarez et al., 2003).

First dimension was identified as instructional, and it referred to therapists' ways of

establishing and regulating the rules of therapy such as scheduling and ways of negotiating

change. It was defined within the bipolarity of flexibility-rigidity. Second dimension was

identified as expressive, and it referred to therapists' level of expressing emotions to their clients.

It was defined within the bipolarity of distance-closeness. Third dimension was identified as

engagement, and it referred to therapists' level of commitment to therapy and clients. It was

defined within the bipolarity of lesser degree-greater degree. Fourth dimension was identified as

attentional, and it referred to therapists' range of attention when gathering information from

clients, and associated level of activity in the search of certain client information. It was defined

within the bipolarity of broad focused-narrow focused. Broad focus accompanied therapist

receptiveness as well as lacking preconceived expectation of what client may bring to session,

while narrow focus accompanied therapists' active pursuit of certain realms of knowledge. Fifth

dimension was identified as operative, and it referred to therapists' way of implementing

intervention. It was defined within the bipolarity of spontaneous-planned.









therapists' therapy style to beginner level therapists' therapy style, where beginner was defined

as therapists with up to 5 years of experience and experts as therapists with 15 years of

experience or more. However, the current study compared the same therapists' ratings of their

initial and current therapy style that included an average of 20 years of experience (ranging from

1 year to 52 years).

Decreasing levels of engagement that were found for therapists who were initially

committed to behavioral, humanistic, integrative and currently committed to cognitive and

integrative therapies was mostly inconsistent with the literature. But this finding may be

explained with the literature of therapist distress and burnout. Conducting psychotherapy can be

a distressing endeavor due to various sources of distress ranging from economic uncertainty to

working with complex issues where it is difficult to define success (Kramen-Kahn & Hansen,

1998). Conducting therapy has been recognized among factors contributing to the burnout

(Kestnbaum, 1984; Grosch & Olsen, 1994) that has been defined as "to fail, wear out, or become

exhausted by making excessive demands on energy, strength or resources" (Freudenberger,

1974, p. 159). Depersonalization that refers to uncaring and unfeeling attitudes towards others,

especially clients was identified among the central features of burnout (Maslach, Jackson, &

Leiter, 1996). The reduced commitment to therapy and clients may be related to an increase in

therapists' depersonalization experience that may follow the taxing years of practice.

It is important to note that previous research on burnout has failed to demonstrate a direct

relation between burnout experience and theoretical orientation (Raquepaw & Miller, 1989). Yet

researchers argue that certain therapeutic approaches can be contributing to the therapists' levels

of stress through their demands and effectiveness (Horner, 1993). Similarly, our findings of

decreased levels of engagement for therapists with initial commitments to behavioral,









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functioning of human psychology, namely the processes of self-evolution, self-actualization,

self-transcendence, and self-organization. They define these processes as organs: They evolve

over time with increasing differentiation and integration and they study these dialectically

constructed processes to understand our psychological functioning.

Royce's theory of knowledge (Royce, 1964) was also associated with the psychotherapy

theories. Royce's (1964; Royce & Powell, 1983) empirical, rational, and metaphorical epistemic

styles were associated with behavioral, rationalist and constructivist approaches respectively.

Lyddon (1989a) suggested that behavioral approaches to psychotherapy were founded on

empiricism considering behaviorist therapists' emphasis on sensory experiences. Behaviorists

assume that the true nature of the human psychology can be understood from our objective

observations of human beings and they engage in induction to reach the truth. Rationalist

cognitive psychotherapies were tied to rational epistemic styles evident in rationalist therapists'

emphasis on conceptual cognitive abilities (Lyddon, 1991). Rationalist therapists tend to analyze

their clients' logical consistency, challenge their clients' irrational thinking and invite their

clients to a reality that is defined by logical consistency. Constructivist psychotherapies were

associated with metaphorical epistemic style considering that constructivist therapists tend to

construct client experiences symbolically. Constructivist psychologists try to understand their

clients' experiences through making use of analogies and they explore and facilitate clients'

developmental processes (Lyddon, 1991).

After arguing the ways in which psychotherapy theories are systematically tied to

epistemic styles, it remains important to understand the implications of these ties on our attitudes

and experiences of psychotherapy. Given that theories on which psychotherapies are built are

tied to certain epistemologies, would individuals' epistemic style guide them to seek a form of









(Jennings & Skovholt, 1999; Kivlighan & Quigley, 1991; Martin, Slemon, Hiebert, Hallberg, &

Cummings, 1989; Skovholt & Jennings, 2004), these studies provided an alternative, systemic

way of conceptualizing change experiences of therapists.

Qualitative studies on master, expert, and/or experienced therapists (Jennings & Skovholt,

1999; Kivlighan & Quigley, 1991; Martin et al., 1989; Skovholt & Jennings, 2004) and on

American practitioners at different experience levels (Ronnestad & Skovholt, 2001; Skovholt &

Ronnestad, 1992; Ronnestad & Skovholt, 2003), as well as an international quantitative study of

development of 5000 psychotherapists from different countries (Orlinsky et al., 1999) revealed

insight into the career paths that psychotherapists pursue.

Martin et al. (1989) studied the differences between novice and experienced counselors by

studying the counselors' conceptual associations regarding the therapy process. Their study

included 23 counselors. Experienced counselors had at least 4 years of experience in university

counseling centers and novice counselors were interns in the 2nd year of a counseling master's

program. Their findings differentiated novices from experienced practitioners in their

conceptualizations of client issues as well as their ways of proceeding. They established that

novice counselors were more likely to pay attention to procedural, "how to", aspects of

counseling; whereas experienced counselors tend to conceptualize their clients at a broader level

in a more inclusive manner.

Kivlighan and Quigley (1991) further supported such cognitive differences between novice

and experienced group counselors. They identified novice counselors as graduate students and

expert counselors were professional counselors with more than 1,000 hours of active group

leadership. In that study, 30 group counselors, half novice and half expert, were asked to

differentiate between the members of a counseling group after watching a session of the group









as the phases of the lay helper, the beginning student, the advanced student, the novice

professional, the experienced professional and the senior professional. They have also

established 14 themes of therapist development describing central processes of therapist

development. The themes addressed various issues such as processes of personal and profession

integration and shifts in attentional focus and emotional functioning. A more detailed account of

these themes will be provided across this literature review in relation with the professional

variables of interest, namely theoretical orientation and therapeutic style.

Ronnestad and Skovholt (2003) have also highlighted certain constants that emerged

across the therapists' professional developmental span. Most importantly, interpersonal

interactions in both personal and professional realms of life have been found as a consistent

contributor to therapists' professional development. Moreover, commitment to learn as well as

the experience of professional growth was invariable for therapists of all experience levels.

Personal and professional growth never ceased for practitioners regardless of the length of their

journey.

Orlinsky and his colleagues' (1999) findings from 5,000 international psychotherapists

confirmed the constancy of growth experience. Although therapist reports of perceived mastery

increased as therapists' years in practice increase, the experience of professional growth was

independent of years spent in practice. Novice and veteran therapists did not differ in the amount

of perceived growth. Even after two decades of practice, therapists reported improvement in their

skills as well as growth in their enthusiasm. The authors suggested that the very experience of

growth provided therapists with the motivation to continue their work.

In this section, we have introduced the literature suggesting that therapists do change

personally and professionally. We have also established that therapists' change processes are not









(N= 175), followed by cognitive, 23.9% (N= 158), humanistic-existential-gestalt, 16.9% (N=

112), behavioral, 12.4% (N= 82), integrative, 11.3% (N= 75), systemic-family, 6.4% (N= 42),

narrative/constructivist, 1.5% (N= 10), and feminist-multicultural, 1.1% (N= 7).

Descriptives and Preliminary Analyses

In order to assess the potential impact associated with the various orderings of the

questionnaires used in this study, one-way ANOVAs were conducted along the six different

orderings, using each of the questionnaire scores as dependent variables in the analysis. These

analyses suggested that there were no difference in the mean scores of the variables of interest

among the six types of questionnaire forms (all ps > .01). Thus for all analyses, the data from six

different forms were combined.

Table 4-1 depicts summary statistics of the primary variables used in this study. This

includes the measures of rationalism and constructivism derived from the Therapist Attitudes

Questionnaire (TAQ), the therapeutic change index, the measure of therapeutic plurality, and the

measures of therapy styles of (a) expressive, (b) engagement, (c) attentional, and (d) operative,

scores indicated separately according to their current (now) and initial (then) ratings from the

practitioners. All scores were normally distributed. Skewness and kurtosis values were in the

acceptable range for appropriate distribution. The epistemology scores obtained from TAQ were

consistent with the scores reported by Neimeyer and Morton (1997). Overall, the scales yielded

low to moderate reliability coefficients.

Table 4-2 depicts the Pearson Product-Moment correlation coefficients among the

variables of interest. Consistent with previous distinctions outlined in the literature, a number of

therapist qualities were associated with epistemic leanings in theoretically consistent ways.

Levels of constructivism, for example, were generally positively related to greater levels of









2001a; Norcross et al., 2002; Norcross, 2005; Norcross, Hedges, & Prochaska, 2002).

Recognizing the ways in which our understanding of the world, clinical practice and change

processes are linked to one another would be beneficial given the continuing change that the

field as well as its members experience.

This study also supports the claims of Mahoney (1995b) who suggested focusing on the

ways in which rationalist-constructivist contrast may be useful for clinical work and studies.

Constructivism and rationalism presents complementary ways of acquiring and evaluating

knowledge and understanding the world, and "... none of these worldviews provides the

'correct' or 'best' frame of reference. They simply suggest different forms of understanding,

inquiry and theory." (Lyddon, 1989b, p. 446). Together they extend our understanding of the

"complexities of human experience" (Mahoney & Lyddon, 1988, p. 223). Our findings in

general exemplify how the rationalist-constructivist contrast would extend our knowledge when

employed together and it encourages researchers to make use of such epistemological contrasts

sensibly.

The present study also contributes to the literature through opening up a fertile area of

research to investigate various dimensions of therapists' epistemic change processes. To begin

with; future research can extend our understanding by studying impacts and/or correlates of

therapists' changing epistemologies. As this study is focused on the association between

epistemological, theoretical and stylistic change experiences; future studies can explore how

change in epistemological commitments is associated with change in other sets of professional

characteristics. Therapists' epistemic commitments were not only associated with their

professional qualities but also with certain personal qualities such as self-exploration, openness

and tolerance (Neimeyer & Aksoy, 2005). Future research can also investigate how therapists'









experiences; however we cannot claim that change in therapists' epistemologies cause them to

have increasing experiences of theoretical change. Obtained results only suggest relationship, not

necessarily causality.

Significance and Directions for Future Research

Despite the apparent limitations detailed above, the present study is an important addition

to the current literature on epistemology and psychotherapist experiences for a variety of reasons.

In this section, first we highlight the contributions of this study to the field and then we explore

the directions that future research can pursue following the lead of this study.

The current study is the first study investigating therapists' epistemic journey. Our findings

present empirical support for the claims of Mahoney (1995a, 1995b) and extend the literature on

epistemology as participated therapists perceived themselves to become increasingly

constructivist and decreasingly rationalist across the course of their practice. The current study

also presents a preliminary empirical exploration for the dynamics underlying therapists'

epistemic shifts. Specifically, it suggests that therapists' career development trajectories, rather

than their year of entry to the profession, color their epistemic journey. Moreover, it provides the

first empirical argument against the claim that the field's increasing commitment to

constructivism is a reflection of the infusion of therapists with stronger constructivist

commitments. This study also extends our understanding of the ways in which therapists'

epistemic journey is related to their professional experiences, specifically their theoretical and

stylistic commitments.

As Meichenbaum (1993) suggested, the story on which the theory and practice of

psychotherapy has been based "continues to unfold and to change" (p. 204). Field continues to

rely increasingly constructivist principles, cultural values and theoretical integration (Goldfried,









Mahoney (2001) described his intellectual and emotional journey as a therapist where he

identified his starting point as a behaviorist psychologist. Mahoney noted that as he faced the

limitations of this approach in dealing with the complexity introduced by his clients and as he

was involved in the quest of human change processes, he was immersed in the function of

cognitions and he eventually participated in the cognitive revolution and identified himself as a

cognitivist. His involvement in the depth of human cognition, his personal therapy as a client and

his interactions with his colleagues and with different cultures opened up novel ways of thinking

and practicing and Mahoney (2001) had developed an increasing interest in constructivism and

has contributed to our understanding of constructivist metatheory through his intensive work as a

researcher, practitioner, and editor.

Narrations of other psychotherapists including Aaron "Tim" Beck

Interested in the change that psychotherapists' themselves had gone through, Goldfried

(2001a) asked 15 seasoned psychotherapists to narrate their personal change and growth

experiences as a result of their personal and professional interactions. In their personal accounts,

various contributors mentioned their path where they had started their practice being adhered to

one camp of theoretical orientation and moved towards more eclectic and complex ways of

approaching their clients as their learning experiences challenged their limited ways of looking at

the world of psychotherapy. One of the contributors, Greenberg (2001), summarized a shared

process in the title of his narration as he named his story as "My change process: From certainty

through chaos to complexity".

A related example comes from the communications provided by Aaron "Tim" Beck and

his colleagues that highlighted his increasing appreciation and pursuit of complexity in his work.

Beck's professional journey towards complexity could have started through his "rebellion"

against the autocratic nature of psychoanalysis (Bloch, 2004). Instead of following that "faith-









To avoid a likely frustration on the part of participants that may stem from answering

several questions twice, the study was set-up such that the items would appear only one time

asking therapist to respond to the given item once from their current standing point and once

from their initial standing point. We anticipated that this set-up would shorten the time spent on

reading and answering the questions twice and lessen the likely frustration. Yet, attending to

same item considering "now" and "then" side by side would provide participants' with an

immediate opportunity to compare their ratings for their past and present, and hence, might

artificially stretch the gap between two ratings.

A pilot study conducted with 34 professional practitioners and practitioners in training

failed to support such possibility. When half of the participants responded to ratings of past and

present side by side, the other half responded to such items separately. The obtained findings

failed to indicate a significant difference between the two groups' ratings; hence encouraged us

to believe that reflecting on items side by side had minimum or no considerable impact on the

participants' ratings.

Participants were also debriefed at the end of the study and they were provided with the

contact information of the primary investigator for further inquiries.

Instruments

Epistemic commitments: Therapists' epistemic commitments were measured with the

Therapist Attitude Questionnaire .- h,, t Form (TAQ-SF). This scale assesses the degree of

participants' commitments to rationalist and constructivist epistemologies. DiGiuseppe and

Linscott (1993) developed the Therapist Attitude Questionnaire (TAQ) to measure the

philosophical, theoretical, and technical dimensions of the rationalist and constructivist positions.

Neimeyer and Morton (1997) developed the short version of the TAQ, named Therapist Attitude









Therapist style: Therapist style was measured with the Personal Style of the Therapist

Questionnaire (PST-Q). This questionnaire assesses therapists' characteristics ways of

conducting psychotherapy. Fernandez-Alvarez et al. (2003) developed the questionnaire to

measure the ways in which therapists engage in therapy and shape the conduct of their

therapeutic work. The questionnaire is composed of five subscales that were designed to assess

five different dimensions of therapist style. (1) Instructional subscale assesses flexibility in

establishing and regulating the therapy setting; higher scores represent greater rigidity vs.

flexibility. (2) Expressive subscale assesses emotional communication; higher scores represent

greater closeness vs. distance. (3) Engagement subscale assesses level of commitment to therapy

and client, higher scores represent greater degree vs. lesser degree. (4) Attentional subscale

assesses therapists' range of attention and activity level in gathering information; higher scores

represent narrower focus vs. broad focus. (5) Operative subscale assesses spontaneity in

implementing interventions; higher scores represent more planned vs. spontaneous. See Table 3-

1. PST-Q is a 36-item self-report measure. The respondents rate how accurately each statement

described their practice on a seven-point scale ranging from 1 (total disagreement) to 7 (total

agreement). The questionnaire have yielded the following Cronbach's alpha scores for each

subscale: Instructional, .69; expressive, .75; engagement, .78; attentional, .80; operative, .78. The

measure has shown adequate 4-month test-retest reliability (instructional, r = .82; expressive, r =

.76; engagement, r = .78; attentional, r = .81; and operative, r = .78). Theoretical validity is

established through obtained factorial composition, and further supported by the work of

Castafieiras et al. (2006).

Demographics: Participants were asked to give information about their demographic

information. These included gender, age, ethnic background, name of their highest degree, the









Martin, J., Slemon, A. G., Hiebert, B., Hallberg, E. T., & Cummings, A. L. (1989).
Conceptualizations of novice and experienced counselors. Journal of Counseling
Psychology, 36, 395-400.

Maslach, C., Jackson, S.E. & Leiter. M. (1996). MBIManual (3rd ed.). Palo Alto, CA:
Consulting Psychologists Press.

McCann, I. L., & Pearlman, L. A. (1990). Vicarious traumatization: A framework for
understanding the psychological effects of working with victims. Journal of Traumatic
Stress, 3, 131-149.

Meichenbaum, D. (1990). Evolution of cognitive behavior therapy: Origins, tenets and clinical
examples. In J. Zeig (Ed.), The evolution ofpyh1i1theli'iq (pp. 96-115). New York:
Brunner/Mazel.

Meichenbaum, D. (1993). Changing conceptions of cognitive behavior modification: Retrospect
and prospect. Journal of Consulting and Clinical Psychology, 61, 202-204.

Myers, R. (1990). Classical and modern regression i/ ith applications (2nd ed.). Boston:
Duxbury Press.

Nagae, N., & Nedate, K. (2001). Comparison of constructive cognitive and rationalist cognitive
psychotherapies for students with social anxiety. Constructivism in the Human Sciences,
6, 41-49.

Neimeyer, G. J., & Aksoy, G. (2005). Epistemology and psychotherapists: Clarifying the link
among epistemic style, experience, and therapist characteristics. Unpublished manuscript,
University of Florida.

Neimeyer, G. J., & Morton, R. J. (1997). Personal epistemologies and preferences for rationalist
versus constructivist psychotherapies. Journal of Constructivist Psychology, 10, 109-123.

Neimeyer, G. J., Prichard, S., Lyddon, W. J., & Sherrard, P. A. D. (1993). The role of epistemic
style in counseling preference and orientation. Journal of Counseling and Development,
71, 515-523.

Neimeyer, G. J., & Saferstein, J. (2003). Personal epistemologies and psychotherapists'
preferences. Unpublished manuscript, University of Florida.

Neimeyer, G. J., & Saferstein, J. (2006). The relationship between therapists' epistemology and
their therapy style, working alliance, and use of specific interventions. Unpublished
manuscript, University of Florida.

Neimeyer, R. A. (1993). Constructivism and the cognitive psychotherapies: Some conceptual
and strategic contrasts. Journal of Cognitive PyL h,1the/I /qy, 7, 159-172.









epistemic shifts in the field and examine the correlates of these shifts in relation to the years that

therapists have entered to the field was the focus of the current research project.

In our efforts to understand the nature of the epistemic change experienced by

psychotherapists, another interesting inquiry would be the investigation of the factors that

contributes to or accompany the epistemic change. Investigations of the personal reports of

above-mentioned psychologists offer some insight into the subject. For instance, these authors

comment on their change in theoretical orientation and therapeutic style that accompanied their

epistemic journey (see Goldfried, 2001a; 2001b).

Recent qualitative and quantitative studies focused on the career development of the

psychotherapists that they defined as the organized systemic change of psychotherapists that

involves succession over time (Ronnestad & Skovholt, 2003). These studies also revealed the

sources influencing therapists' organized change processes, i.e. their career development

(Orlinsky et al., 1999; Ronnestad & Skovholt, 2003). Moreover, Jennings and Skovholt (1999;

Skovholt & Jennings, 2004) collected further narrations from master therapists to explore their

developmental processes. These studies collectively suggested that practitioners do develop, as

documented in their successive changes in systemic ways across their professional lifetimes.

Professional development included, but was not limited to, change in therapists' theoretical

adherence and therapeutic style. Yet whether or to what extent psychologists' theoretical

orientation and their professional activities were related to their epistemic journey remained

unknown.

The current study aimed to investigate the epistemic change processes of the

psychotherapists as they perceive it. Specifically, we investigated (1) whether therapists

perceived their epistemic commitments as being shifted as they become more experienced; (2)









its claimed epistemic shift and it is unclear to what extent this shift can be attributed to the

individual change processes of psychotherapists in time and/or to cohort effect facilitated by the

inclusion of post-modern therapists to the field. The current study aims to explore any perceived

epistemic shifts in the field and its underlying dynamics.

Professional Change as a Counterpart of Epistemic Change

Change concerning therapists is not limited to their personal epistemologies.

Psychotherapists change professionally as they conduct therapy. This section highlights

psychotherapists' change processes and then focuses on two professional variables that may

complement therapists' epistemic journey: Theoretical orientation and therapeutic style.

Psychotherapists do change as they practice; at least, they report they do. The scarce

literature on therapist change is built on psychotherapists' self-report collected in various forms.

Interviews, questionnaires, as well as personal narrations were employed to understand their

personal and professional journey as psychotherapists (Farber, 1983; Goldfried, 2001a; Radeke

& Mahoney, 2000).

First, Farber (1983) conducted one-hour semi-structured interviews with 60

psychotherapists and pooled their answers together in order to understand the effects of

psychotherapy practice on psychotherapists. Their results suggested that psychotherapists

believed their personal characteristics as well as social relations had changed since they have

began conducting therapy and they attributed some of this change experience into the their

therapeutic work as therapists. Overall, Farber (1983) suggested that "the effects of therapeutic

work is not confined within the office, but rather have a substantial impact on therapists' outside

behavior and self-identity" (p. 180).









Rationalist epistemologies reflect belief in a-priori truths and in a singular, universal, and

historical reality (Mahoney & Gabriel, 1987). This reality can be passively and objectively

perceived through thought processes (Mahoney, Lyddon, & Alford, 1989). Modern cognitive

therapies show commitment to rational theories of knowledge and assume reasoning and logical-

analytic processes are fundamental means of validating knowledge (Lyddon, 1988; Mahoney &

Gabriel, 1987; Mahoney & Lyddon, 1988). Modern cognitive therapies such as Ellis' Rational

Emotive Therapy (RET) seek to replace clients' irrational thoughts with rational ones to set them

free from their negative experiences (DiGiuseppe & Linscott, 1993; Lyddon, 1990).

Constructivist epistemologies challenge the basic assumptions of rationalistic

epistemologies suggesting that knowing is a much more complex process than rationalist

epistemology sustained (Mahoney & Gabriel, 1987). Constructivist epistemologies assume that

individuals actively construct their realities and hence, reality is multiple, contextual, historical,

and paradigmatic. Postmodern cognitive therapies show commitment to constructivist

epistemology (Mahoney & Gabriel, 1987). Constructivist cognitive therapies such as Kelly's

Personal Construct Therapy (Neimeyer, 1995) seek viability of knowledge over validity and they

explore the ways in which clients' organizations of personal knowing systems (Lyddon, 1988;

Neimeyer, 1993).

The ways in which epistemology reflected on practice and differentiated rationalist and

constructivist therapies were identified conceptually and sustained empirically. Conceptually,

rationalist and constructivist therapies were differentiated in numerous aspects, such as

therapists' thinking style, focus and direction of therapy, conceptualization of therapeutic

concepts such as therapeutic relationship, client problems, resistance, emotional distress, relapse

and regression (Mahoney & Gabriel, 1987) and level of intervention (Lyddon, 1990).









significantly higher on engagement dimension than the psychoanalytical therapists; expert

integrationists reported higher levels of commitment to the act of therapy and to their actual

clients.

Overall, the findings indicated that adherence to cognitive and integrative theories was

associated with similar levels of attentional, operative, and expressive, and psychoanalytical

therapists had a broader focus, more spontaneity and more distance than cognitive and

integrative therapists. The findings indicated that the therapy style is associated with theoretical

orientation in different ways depending on therapists' experience level (Castafieiras et al., 2006).

Then, Castafieiras et al. (2006) compared beginner level therapists to expert therapists on

their PST scores for each theoretical orientation group separately. Among cognitive therapists,

differences between beginners and experts emerged for the domains of instructional and

expressive: Beginner level cognitive therapists were more rigid in setting and maintaining rules

regarding therapy (instructional) and more emotionally distant towards clients (expressive)

compared to experts. Among integrative therapists, differences across experience level emerged

for the dimensions of attentional, operative, and engagement. Beginner level integrative

therapists were more narrowly focused, actively searching for a specific realm of knowledge

(attentional), more planned in implementing interventions (operative), and yet less committed to

therapy and client (engagement) as compared to expert integrationist. Among psychoanalytic

therapists, differences between beginners and experts emerged for the dimension of attentional:

Beginner level psychoanalytic therapists endorsed significantly narrower focus (attentional) than

their expert counterparts.

The authors concluded that years of experience partially modulated the evolution of

therapist style in each specific theoretical orientation (Castafieiras et al., 2006). These findings









Researchers such as Berzonsky (1994) and Botella and Gallifa (1995) further studied

Pepper's (1942) root metaphors and consolidated our knowledge of personal worldviews. Their

studies introduced more condensed categorizations of epistemic style following Pepper's four

root metaphors and worldviews. In general, these studies reflected the dichotomous nature of

contextualism and organicism versus formism and mechanism.

Berzonsky (1994) conceptualized three core epistemological assumptions that were named

as formistic, social-deterministic, and constructivist worldviews. Formistic worldview is parallel

to Pepper's formistic view and social-deterministic worldview is congruent with Pepper's

mechanistic view. Constructivist worldview embodies Pepper's contextualist and organismic

views. Berzonsky's (1994) Constructivist Assumption Scale (CAS) measures the degree to

which one endorses constructivist epistemological assumptions as opposed to formistic and

social-deterministic worldviews.

As a part of a comprehensive study, Botella and Gallifa (1995) employed Berzonsky's

CAS as well as Germer et al.'s (1982) OMPI among other measures in a factor-analytic study

and revealed two main and opposing views underlying the above-mentioned worldviews and

epistemic assumptions: Constructivist Complex Worldview and Objectivist Simple Worldview.

The Constructivist Complex Worldview was related to the Pepper's organismic worldview that

characterized the world as a living organism and to Berzonsky's constructivist epistemic

assumptions that emphasized human beings' active construction of their own reality. Participants

operating from this worldview rejected formism and mechanism and rather they "construe

knowledge in a multidimensional way" (Botella & Gallifa, 1995, p. 15).

Theory of Knowledge

Royce's "Theory of Knowledge" (Royce, 1964; Royce & Powell, 1983) is another well-

known and valuable conceptualization of personal epistemologies. Royce (1964) identified three




Full Text

PAGE 1

1 ME NOW, ME THEN: THERAPISTS AND CONSTRUCTIONS OF THEIR EPISTEMIC JOURNEY By GIZEM TOSKA A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLOR IDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2008

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2 2008 Gizem Toska

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3 To Michael J. Mahoney, for inviting me to a ppreciate the complexity of life, and to my academic and clinical supervisors, Drs. Greg Neimeyer, Michael Murphy, Roberta Seldman, Elizabeth M. Koshy, Marshall L. Knudson, and Pa ul Schauble, for their everlasting impact on my journey. I am grateful that my path crossed with the minds and hearts of these incredible individuals.

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4 ACKNOWLEDGMENTS I would like to thank m y advisor and comm ittee chair Dr. Greg J. Neimeyer, and my beloved husband Ferit Toska, for their extensive guidance, support, and encouragement. I thank my dear friend Burhan t for his guidance in the conduct of the statistical analyses of this project. I thank to my dear father Yal n Aksoy for his help in improving the quality of writing. I am thankful for the assistance given to me by my committee members, Dr. Kenneth Rice, and Dr. Michael Farrar. I am grateful to my family and my friends in Turkey and in Gainesville for their love and support. I could not have done this project without their help.

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5 TABLE OF CONTENTS page ACKNOWLEDGMENTS...............................................................................................................4 LIST OF TABLES................................................................................................................. ..........7 ABSTRACT.....................................................................................................................................8 CHAP TER 1 INTRODUCTION....................................................................................................................9 2 REVIEW OF THE LITERATURE........................................................................................ 13 Epistemic Style................................................................................................................ .......13 Root-Metaphor Theory....................................................................................................13 Theory of Knowledge......................................................................................................16 Epistemic Style and Psychotherapy........................................................................................18 Epistemic Style and Theories of Psychotherapy............................................................. 18 Epistemic Style and Preferences for Psychotherapy....................................................... 21 Epistemic Style and Practices of Psychotherapy............................................................. 22 Epistemic Style and Characteristics of Psychotherapists................................................ 27 Epistemic Change............................................................................................................... ....30 Epistemic Change of the Field........................................................................................30 Personal Examples of Epistemic Change........................................................................ 32 Albert Ellis............................................................................................................... 32 Donald Meichenbaum..............................................................................................32 Michael J. Mahoney................................................................................................. 33 Narrations of other psychotherapi sts including Aaron Tim Beck........................ 34 Professional Change as a Counterpart of Epistemic Change..................................................37 Theoretical Orientation Change...................................................................................... 43 Therapy Style Change.....................................................................................................44 Epistemic and Professional Change................................................................................ 51 Purpose of Study.....................................................................................................................55 3 METHODS.............................................................................................................................58 Participants.............................................................................................................................58 Procedure................................................................................................................................58 Instruments.................................................................................................................... .........59 4 RESULTS...............................................................................................................................63 Demographics.........................................................................................................................63 Descriptives and Preliminary Analyses.................................................................................. 65 Primary Analyses............................................................................................................... .....67

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6 Research Question #1: How Do Therapists Change in Their Epistemic Comm itment and in Professional Charact eristics across the Course of Their Professional Practice?..................................................................................................68 Research Question #2: Do Cohort Eff ects Explain Changes in Therapists Epistem ic Commitments?............................................................................................ 72 Research Question #3: What Is the Relationship between Therapists Epistemic and Professional Change Experiences? ..............................................................................74 5 DISCUSSION.........................................................................................................................86 Summary of Results............................................................................................................. ...86 Epistemic Journey Constructi ons of Psychotherapists ........................................................... 87 Cohort Effect on Perceived Changes on Epistemic Leanings................................................90 Theoretical and Stylistic Change C onstructions of Psychotherapists ..................................... 92 Theoretical Change.......................................................................................................... 92 Stylistic Change...............................................................................................................94 Association between Epistemic and Professional Change Constructions ............................ 101 Epistemic and Theoretical Change................................................................................ 102 Epistemic and Stylistic Change.....................................................................................104 Limitations.................................................................................................................... ........107 Significance and Directions for Future Research................................................................. 111 Conclusion............................................................................................................................113 APPENDIX A THERAPIST ATTITUDE QUESTI ONNAIRE -SHORT FORM (TAQ-SF)...................... 115 B THEORETICAL ORIENTATION RATINGS.................................................................... 117 C DEMOGRAPHIC INFORMATION.................................................................................... 120 LIST OF REFERENCES.............................................................................................................121 BIOGRAPHICAL SKETCH.......................................................................................................129

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7 LIST OF TABLES Table page 3-1 Personal Style of the Therapist Ques tionnaire (PST-Q): Subscale directions ................... 62 4-1 Summary statistics of the variables of interest.................................................................. 80 4-2 Intercorrelations among the variables of interesta..............................................................81 4-3 Repeated measures ANOVA summary tabl e for perceived epistem ic and stylistic commitment differences across time.................................................................................81 4-4 Repeated measures ANOVA summary table for perceived theoretical co mmitment differences across time....................................................................................................... 82 4-5 Current and initial theoretic al orientation endorsem ents...................................................82 4-6 Post-hoc analyses examining the moderating effect of the theoretical comm itment on perceived engagement differences across time.................................................................. 82 4-7 Hierarchical regression analyses showi ng am ount of unique vari ance in therapists current professional standing accounted for by their initial standing and epistemic commitments......................................................................................................................83 4-8 Hierarchical regression beta coefficients for constructivism difference scores at steps 2, 3, and 4...........................................................................................................................85

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8 Abstract of Dissertation Pres ented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy ME NOW, ME THEN: THERAPISTS AND CONSTRUCTIONS OF THEIR EPISTEMIC JOURNEY By Gizem Toska August 2008 Chair: Greg J. Neimeyer Major: Counseling Psychology Our study investigated the epistemic change processes of psychotherapists and attempted to identify the nature of the epistemic journe y of this group. We conduc ted a retrospective study where therapists were asked to reflect on their cu rrent and past epistemic commitments as well as theoretical orientations and therapeutic styles. This method provide d us with a unique set of data where we learned about the therapists personal constructions of their epistemic journeys and other professional change processes accompanying this journey. Findings suggested that when reflected on th eir current experiences and their initial experiences as blossoming practitioners, therapis ts perceived their commitment to constructivist epistemology as amplified, and their commitment to rationalist epistemology as reduced over their practice. The cohort effects failed to explain these changes or to differentiate therapists initial constructivist commitments. The obtained resu lts also indicated that the perceived change in epistemic commitments predicted therapis ts theoretical and stylistic commitments. Our study facilitated our unders tanding of the developmental trajectory of therapists epistemic commitments as they perceive it and it provided empirical data with respect to how therapists construe the profe ssional change processes that accompany their epistemic change.

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9 CHAPTER 1 INTRODUCTION Epistem ic style refers to an individuals prev ailing set of assumptions regarding the way in which knowledge is acquired, organized, and deve loped and it can be summarized within the dichotomy of rationalist and cons tructivist epistemologies that has become common within the recent psychotherapy lite ratures (Mahoney, 1991). On the one hand, rationalist epistemologies assume that human beings are passive recipients of a reality external to themselves that is itself stable, universal, and potentially knowable. They value the validity of knowledge and knowledge is considered valid to the extent to which it matches external reality (Neimeyer, 1993). Rationalist epistemologies can include those identified as a Mechanistic Worldview (P epper, 1942), social-deterministic worldview (Berzonsky, 1994), Objectivist Simple Worldview (Botella & Gallifa, 1995) or simply Rationalism (Royce, 1964). Constructivist epistemologies, on the other hand, assume that human beings actively construe their own reality and that this reality is dyna mic and contextual (Lyddon, 1988; Mahoney & Lyddon, 1988). Individuals can only know reality indirect ly and cannot be separated from the reality that they perc eive. Constructivists seek viable knowledge that is internally consistent and consensually validated (Neime yer, 1993). Constructivist epistemologies may include Organicism (Pepper, 1942), Constructivi st Complex Worldview (Botella & Gallifa, 1995), and Metaphorism (Royce, 1964). Previous research has linked epistemology to psychotherapy and to psychotherapists. Specifically, therapists epistemic style was related to therapists theoretical inclinations, therapeutic behavior, and pers onal characteristics (e.g. Johnson Germer, Efran, & Overton, 1988; Lyddon, 1989a; Lyddon & Adamson, 1992; Mahoney & Gabriel, 1987; Neimeyer & Aksoy,

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10 2005; Neimeyer, Prichard, Lyddon, & Sherrard, 1993) However, the literature regarding the nature of the epistemic development and change in therapists or in any other groups is scarce. A brief overview of the topics, content, and framework of the published articles reveals that the field of psychology and particularly psychotherapy became increasingly constructivist over the course of the last 20 years (Mahoney, 1995a; 1995b). Such a change in the fields understanding might be reflection of the infusion of a new generation of therapists who were steeping in post-modern epistemologies and psyc hotherapies. Yet the personal writings of some longstanding prominent psychotherapists also reflect this epistemic journey towards constructivism, suggesting that this development may also be the result of a shift within the current field of practitioners, in addition to the inclusion of a new generation of post-modern therapists. Psychotherapists such as Ellis (1993; 1995), Meichenbaum (1993), and Mahoney (1991; 2001) have repeatedly reported and descri bed their epistemic journey where they have become increasingly constructivis t in their epis temic commitment. Goldfrieds (2001a) work where he collected personal change narrations of 15 seasoned psychothera pists also reveals a similar journey where they pursued a path from relative certainty and simplicity to increasing complexity in their worldview. Nonetheless, research is s carce concerning epistemic shifts within the field and its practitioners. Although substantial anecdotal, conceptual, and case-based information is on hand, strikingly little empirical research is available that documents this shift in the field across time or traces these changes over time in relation to partic ular practitioners. As a result, not only is the field lacking empirical evidence of its putative epistemic shift, but it also remains unclear whether this shift is due to the infusion of new, post-modern therapists or significant developmental shifts among its curre nt practitioners in the field. Thus; to explore any perceived

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11 epistemic shifts in the field and examine the correlat es of these shifts in relation to the years that therapists have entered to the field was the focus of the current research project. In our efforts to understand the nature of the epistemic change experienced by psychotherapists, another intere sting inquiry would be the inve stigation of the factors that contributes to or accompany the epistemic change Investigations of the personal reports of above-mentioned psychologists offer some insight into the subject. For instance, these authors comment on their change in theoretical orienta tion and therapeutic style that accompanied their epistemic journey (see Goldfried, 2001a; 2001b). Recent qualitative and quantitative studies focused on the career development of the psychotherapists that they define d as the organized systemic ch ange of psychotherapists that involves succession over time (R nnestad & Skovholt, 2003). These studies also revealed the sources influencing therapists organized change processes, i.e. their career development (Orlinsky et al., 1999; Rnnestad & Skovholt, 2003). Moreover, Jenni ngs and Skovholt (1999; Skovholt & Jennings, 2004) collected further narrations from master therapists to explore their developmental processes. These studies collectiv ely suggested that practitioners do develop, as documented in their successive changes in syst emic ways across their professional lifetimes. Professional development included, but was not limited to, change in therapists theoretical adherence and therapeutic style. Yet whether or to what extent psychologists theoretical orientation and their professional activities were related to their epistemic journey remained unknown. The current study aimed to investigate th e epistemic change processes of the psychotherapists as they percei ve it. Specifically, we investigated (1) whether therapists perceived their epistemic commitments as being sh ifted as they become more experienced; (2)

PAGE 12

12 whether these perceived epistemic trends could be explained through cohort effects; (3) whether therapists perceived epistemic change was asso ciated with their self -reported theoretical orientations or therapeutic styles in coherent ways.

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13 CHAPTER 2 REVIEW OF THE LITERATURE This chapter provides a literatu re review that supports sp ecific predictions regarding psychotherapists epistem ic journeys and relate d professional change experiences. First, the review introduces and explains the notion of epistemic styl e, which is followed by the examination of the ways in which epistemic styl e is linked to psychotherapy-related attitudes and practices. Next, the literature on th e change of the field of psychothe rapy is explored. Within this section, the review first focuses on the epistemic journey of the field and of certain well-known psychotherapists and then it explores psychothe rapists theoretical and stylistic change experiences and why such professional change experiences might align with therapists epistemic journey. The literature review ends with an outline of the studys overarching questions and specific predictions. Epistemic Style Personal epistem ology is ones theory a bout knowing and knowledge. Epistemic style refers to an individuals way of testing the validity of his or her knowledge. Peppers (1942) Root-Metaphor Theory and Royces (1964) Th eory of Knowledge have been the most predominant ways of conceptualizing and studyi ng the implications of epistemic style. Root-Metaphor Theory Peppers (1942) Root-Metaphor Theory is com posed of four root m etaphors that are basic analogies for the four distinct ways in which we see the world and organize experience. Pepper (1967) suggested that individuals en gage in analyses of their root metaphors to make sense of the world and to solve problems. Ones root metaphor implies certain ways of dealing with events and generates possible solutions to existing problems. Categories of hypothesis that arise from such analysis of root metaphors are unrestricted by the field of inquiry, and such a hypothesis is

PAGE 14

14 responsible for the interpretation of any item of criticism proffered (Pepper, 1967, p. 3). In other words, ones dominant root metaphor pr ovides an intuitive sense of reality. The first metaphor, form (or similarity ), focuses on similarities among entities and it reflects the formistic way of seeing the world and organizing experience. Formism perceives reality within the set of predet ermined universal forms and type s. An objects essence can be discovered via understanding its similarity to other objects through categorical analysis of objects. Similarly, formistic individuals w ould make sense of an experience through understanding its similarity to and differences from other experiences. In psychology, formistic thinking underlies trait models of personality and psychiat ric diagnostic practices (Lyddon, 1989b). The second metaphor, machine, focuses on similarity betwee n machines and world and it reflects mechanistic way of seeing the world a nd organizing experience. Mechanism assumes a machine-like deterministic universe in which obs ervable effects are caused by natural factors, and it focuses on this linear cause-effect relations hip to understand the world and experiences. In psychology, mechanistic thinking underlies behaviorism, rationa list cognitive therapies and certain aspects of Freudian theory (Lyddon, 1989b). The third metaphor, context, focuses on historic events and it reflects a contextualistic way of seeing the world and organizing experience. Contextualism assumes that meaning is embedded in the context and hence, context would determine the ways in which events would be experienced. Like historic events make sense only when they are considered in their context, an experience can be understood only in its cont ext. While formism and mechanism focus on analysis of parts, contextualism tends to focus on synthesis of wholes. In psychology,

PAGE 15

15 contextualistic thinking underlie s Banduras revised social-lea rning perspective, Rice and Greenbergs change process research progr am and existential theories (Lyddon, 1989b). The fourth metaphor, organ, focuses on integration of expe riences of living organisms and it reflects organismic way of seeing the world an d organizing experience. Organicism assumes that reality is dialectically-constructed and that it evolves over time with increasing differentiation and integration. In contrast to cont extualism, organicism s uggests universal and/or teleological principles govern th e functioning of the phenomena and it strives to understand these principles (Lyddon, 1989b). Organic worldview seeks to understa nd integrative associations among the various aspects of a phenomenon. In psychology, organicist thinking underlies developmental, humanistic, and transpersonal m ovements as well as systems thinking and selforganizational processes (Lyddon, 1989b). Pepper (1942) suggested that contextualistic and organismic worldviews were very similar to one another in nature while mechanisti c worldview could be considered an opposing worldview. While contextualism and organicism have been associat ed with the worldview of the postmodern era, mechanism has represented the do minant worldview of the modern era. Pepper (1942) claimed that each root metaphor and related worldview provides a different lens to interpret the reality and he encour aged individuals to be able to employ a number of lenses to understand a given phenomenon. Different measures have been constructed to assess individuals worldviews as Pepper defined them. The Organicism-Mechanism Para digm Inventory (Germer, Efran, & Overton, 1982; OMPI) has been designed and employed to assess organismic and mechanistic worldviews of the individuals. Peppers four world hypothe ses can also be meas ured through Kramers Worldview Beliefs Measure (Kramer, Kahlbaugh, & Goldston, 1992).

PAGE 16

16 Researchers such as Berzonsky (1994) and Botella and Gallifa (1995) further studied Peppers (1942) root metaphors and consolidated our knowledge of personal worldviews. Their studies introduced more condensed categorizatio ns of epistemic style following Peppers four root metaphors and worldviews. In general, thes e studies reflected the dichotomous nature of contextualism and organicism ve rsus formism and mechanism. Berzonsky (1994) conceptualized three core ep istemological assumptions that were named as formistic, social-deterministic, and constructivi st worldviews. Formistic worldview is parallel to Peppers formistic view and social-deterministic worl dview is congruent with Peppers mechanistic view. Constructivist worldview embodies Peppers contextualist and organismic views. Berzonskys (1994) Cons tructivist Assumption Scale (C AS) measures the degree to which one endorses constructivist epistemologi cal assumptions as opposed to formistic and social-deterministic worldviews. As a part of a comprehensive study, Bote lla and Gallifa (1995) employed Berzonskys CAS as well as Germer et al.s (1982) OMPI am ong other measures in a factor-analytic study and revealed two main and opposing views underlying the above-mentioned worldviews and epistemic assumptions: Constructivist Complex Worldview and Objectivist Simple Worldview. The Constructivist Complex Worldview was related to the Peppers organismic worldview that characterized the world as a living organism and to Berzonskys constructivist epistemic assumptions that emphasized human beings active construction of their ow n reality. Participants operating from this worldview rejected formis m and mechanism and rather they construe knowledge in a multidimensional way (Botella & Gallifa, 1995, p. 15). Theory of Knowledge Royces Theory of Knowledge (Royce, 1964; R oyce & Powell, 1983) is another wellknown and valuable conceptualiza tion of personal epistemologies. Royce (1964) identified three

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17 fundamental ways of knowing, namely empi ricism, rationalism, and metaphorism. Royce derived these epistemologies from the dominan t cognitive process that can be employed by individuals. According to Royce (1964), people utilize perceptual, conc eptual, and symbolic processes during their daily pursuits and one of these three cognitive processes would be dominantly employed over the others. This dominan tly used cognitive pro cess would indicate the individuals domi nant way of knowing the world. Empiricism reflects dominant use of perceptual cognitive processes. Empiricists seek out sensory experience. They engage in induction and te st reality in terms of reliability and validity of their perceptions and sensor y experiences. Rationalism reflects dominant use of conceptual cognitive processes. Rationalists seek out rational analyses of id eas. They engage in deduction and test reality by its logical consistency. Metaphorism refl ects dominant use of symbolic cognitive processes. Metaphorists emphasize the symbolizing nature of events arguing that knowledge is constructed symbolically. Hence, they seek viability of know ledge rather than its validity and they engage in information analys is through making use of analogies (Royce, 1964; Royce & Mos, 1980; Royce & Powell, 1983). Empiricism and rationalism reflect the epistemic style of the modern era, while metaphorism refl ects the epistemic framework of the postmodern era. Individuals commitment to Royces (1964) three epistemologies can be measured by Psycho-Epistemological Profile (Royce & Mos, 1 980; PEP). PEP has been frequently employed in investigating the ways in which epistemic style related to the theory and practice of psychology.

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18 Epistemic Style and Psychotherapy Various studies dem onstrated that epistemic style is related to theories, practice and practitioners of psychothera py. Understanding the relations hip between epistemology and psychotherapy provides the groundwork of the presen t study. This section illustrates the ways in which epistemic style is linked to these psychotherapy variables. Studying epistemic commitments has enha nced our understanding of psychotherapy practice and practitioners. The psychotherapy variab les that relate to epistemic style can be studied under four categories: Theories of psychotherapy (Lyddon, 1989b; 1991), preferences for psychotherapy (Lyddon, 1989a; Neimeyer et al., 1993; Neimeyer & Morton, 1997; Schacht & Black, 1985), practices of psychotherapy (Lyddon, 1988; Mahoney & Gabriel, 1987; Mahoney & Lyddon, 1988; Neimeyer & Saferstein, 2006, and pers onal characteristics of psychotherapists (Neimeyer & Aksoy, 2005). Epistemic Style and Theories of Psychotherapy Theories of psychotherapy reflect a certain way of understandi ng the world and they can be conceptually tied to epistem ic worldviews that had been identi fied in the l iterature. Lyddon (1989b, 1991) identified epistemological framew ork of the various therapy approaches suggesting that psychotherapy theo ries were related to the episte mologies in systematic ways. Lyddon employed both Peppers (1946) Root-Met aphor Theory and Royces (1964; Royce & Powell, 1983) Theory of Knowledge to identify these relationships. Lyddon (1989b) suggested that trait models of personality and psyc hiatric diagnostic practices were supported by formistic worldviews because they bot h utilized the matters similarity to establish their reality. Both trait ta xonomies and psychiatric diagnostic systems classify traits or disorders based on the pres ence and absence of certa in characteristics or

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19 symptoms. They ignore temporal and contextual f actors and assume stability of the nature of their subject matter as well as of their similarities to others. Behavioral, rationalist cognitive and psychodyna mic approaches to psychotherapy have been linked to Peppers mechanistic worldview because they assumed a machine-like deterministic view of human psyche. Behavioral approach assumes that behaviors of human beings are determined by antecedent conditions and they objectively study these behaviors to understand human psychology. Rationalist cognitive th erapies suggest that human emotions are determined by antecedent beliefs and thoughts a nd they focus on such linear relationships between thoughts and feeli ngs to understand human psychology. Psychodynamic therapies regard mind in mechanistic terms and they focu s on the linear interactions among psychological forces to understand human mental processe s (Grof, 1985, as cited in Lyddon, 1989b). All of these three approaches to psychotherapy analyze parts of human psychology and assume that an observer, a psychologist, can objec tively identify these causal linear interactions among aspects of human experiences and processes. Banduras revised social-learning theory, Rice and Greenbergs change processes and existential theories have been identified as reflecting the contextualist worldview since these theories seek to understand human experience in its context and focus on the synthesis of wholes rather than analysis of parts. Banduras soci al learning theory high lights the importance of context in learning. Rice and Greenberg focus on context of client-therapist interaction to understand and facilitate clients change processes. Existential th eories study human experience through individuals being-in-the-w orld where they act on the worl d as the world acts on them. Developmental theories, humanistic and tran spersonal movements, and systems thinking were linked to the organicist worldview. They all focus on univers al principles that govern the

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20 functioning of human psychology, namely the pro cesses of self-evolutio n, self-actualization, self-transcendence, and self-organization. They de fine these processes as organs: They evolve over time with increasing differentiation and in tegration and they study these dialectically constructed processes to understa nd our psychological functioning. Royces theory of knowledge (Royce, 1964) wa s also associated w ith the psychotherapy theories. Royces (1964; Royce & Powell, 1983) em pirical, rational, and metaphorical epistemic styles were associated with behavioral, rati onalist and constructivist approaches respectively. Lyddon (1989a) suggested that behavioral a pproaches to psychotherapy were founded on empiricism considering behaviorist therapists emphasis on sensory experiences. Behaviorists assume that the true nature of the human psychology can be understood from our objective observations of human beings and they engage in induction to reach the truth. Rationalist cognitive psychotherapies were tied to rational epistemic styles evident in rationalist therapists emphasis on conceptual cognitive abilities (Lyddon, 1991). Rationalist therapists tend to analyze their clients logical consistenc y, challenge their clients irrati onal thinking and invite their clients to a reality that is defined by logical consistency. Cons tructivist psychotherapies were associated with metaphorical epistemic style cons idering that constructiv ist therapists tend to construct client experiences symbolically. C onstructivist psychologists try to understand their clients experiences through maki ng use of analogies and they e xplore and facilitate clients developmental processes (Lyddon, 1991). After arguing the ways in which psychothe rapy theories are systematically tied to epistemic styles, it remains important to understand the implications of these ties on our attitudes and experiences of psychothera py. Given that theories on whic h psychotherapies are built are tied to certain epistemologies, w ould individuals epistemic style guide them to seek a form of

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21 psychotherapy that shares similar assumptions ? Next, we will invest igate the literature supporting this link between individuals episte mic style and psychotherapy preferences. Epistemic Style and Preferences for Psychotherapy Following the idea that psychotherapy theories a re systematically related to certain epistemic viewpoints, researchers explored th e impact of epistemic style on preferences of psychotherapy approach. The result s suggested that individuals epistemic framework play at least a moderate role in gu iding their psychotherapy prefer ences (Lyddon, 1989a; Neimeyer et al., 1993; Neimeyer & Morton, 1997; Schacht & Black, 1985). Lyddon (1989a) measured epistemic styles of pote ntial clients and asked them to evaluate audiotaped presentations of behavioral, rationalist, and c onstructivist approaches to psychotherapy. Results suggested that participants with empirical, rational, and metaphorical epistemic styles preferred beha viorist, rationalist, and constructivist therapy approaches respectively. Lyddon and Adamson (1992) extended the findings of Lyddon (1989a) to Peppers root-metaphor theory. Participants with an or ganismic worldview indicated preference for the constructivist approach, while participants with a mechanistic worldview preferred the behavioral approach. Overall, lay people reported preference for the therapy approaches that were congruent with their own epistemological framework suggesting that individuals dominant epistemological commitments had an impact on their therapy preferences. These findings were extended for counselor tr ainees and mental health practitioners (Arthur, 2000; Neimeyer et al., 1993; Neimeyer & Morton, 1997; Schacht & Black, 1985). Despite the differences among various studies, the overall fi ndings confirmed a moderate relationship between epistemological commitments and psychotherapy preferences for therapists. Organismic worldview and metaphorical epistemic style predicted a prefer ence for constructivist therapies. The empirical epistemic style was linked to a preference for a behavioral approach.

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22 Rationalistic epistemic style was linked to the preference for rationalist therapies (Neimeyer et al., 1993; Neimeyer & Morton, 1997). Psychoana lysts tended towards organicism and metaphorical orientation, whereas cognitive-beha vioral therapists tended towards mechanism and empiricism in their dominant worl dviews (Arthur, 2000; Schacht & Black, 1985). Taken together, empirical evidence strength ened the link between epistemic style and preference for different psychothera peutic approaches for future cl ients, future therapists and seasoned practitioners. Epistemic Style and Practices of Psychotherapy Epistem ic commitments underlie theories of psychotherapy and at least moderately account for therapists psychotherapy prefer ences. Epistemology was also linked to psychotherapy practices. The mindset underlyi ng psychotherapy practi ces was studied to understand the practical differences among differen t forms of therapy, especially among different forms of cognitive therapies (Lyddon, 1988; Mahoney & Gabriel, 1987; Mahoney & Lyddon, 1988). Cognitive therapy is an umbrella term coveri ng a variety of approaches to psychotherapy. Lyddon (1988) and Mahoney (1991) s uggested that we could differe ntiate cognitive therapies from one another through studying the epistemi c assumptions underlying these approaches. A continuum of epistemic worldviews have b een employed in this purpose where cognitive approaches fall along the continuum of rationalis m and constructivism (D iGiuseppe & Linscott, 1993). Differences between rationalist and constr uctivist epistemologies in their understanding of reality and knowledge reflect upon the ways in which cognitive therapies are conceptualized and conducted. Hence, understanding how epistemologies underlying cognitive therapies impact psychotherapy practices help differentiating di fferent cognitive approaches to therapy.

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23 Rationalist epistemologies reflec t belief in a-priori truths and in a singular, universal, and historical reality (Mahoney & Gabriel, 1987). This reality can be passively and objectively perceived through thought processes (Mahone y, Lyddon, & Alford, 1989). Modern cognitive therapies show commitment to ra tional theories of knowledge and assume reasoning and logicalanalytic processes are fundamental means of validating knowledge (Lyddon, 1988; Mahoney & Gabriel, 1987; Mahoney & Lyddon, 1988). Modern cognitive therapies such as Ellis Rational Emotive Therapy (RET) seek to replace clients irrational thoughts with ra tional ones to set them free from their negative experiences (DiGiuseppe & Linscott, 1993; Lyddon, 1990). Constructivist epistemologies challenge the basic assumptions of rationalistic epistemologies suggesting that knowing is a much more complex process than rationalist epistemology sustained (Mahoney & Gabriel, 1987) Constructivist epistemo logies assume that individuals actively construct their realities and he nce, reality is multiple, contextual, historical, and paradigmatic. Postmodern cognitive therapies show commitment to constructivist epistemology (Mahoney & Gabriel, 1987). Constr uctivist cognitive therapies such as Kellys Personal Construct Therapy (Neime yer, 1995) seek viability of know ledge over validity and they explore the ways in which cl ients organizations of pe rsonal knowing systems (Lyddon, 1988; Neimeyer, 1993). The ways in which epistemology reflected on practice and differentiated rationalist and constructivist therapies were identified conceptu ally and sustained empi rically. Conceptually, rationalist and constructivist therapies were differentiated in numerous aspects, such as therapists thinking style, focus and direction of therapy, conceptualiz ation of therapeutic concepts such as therapeutic relationship, client problems, resistance, emotional distress, relapse and regression (Mahoney & Gabriel, 1987) and level of intervention (Lyddon, 1990).

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24 First, rationalist and constructivist therapies were differentiated in therapists thinking style. Rationalist cognitive therap ies tend to utilize a basic thinking style and to follow a simple format with clear-cut methods, while constructivist cognitive therap ies tend to have a complicated thinking style and to follow a complex format with unclear methods (Mahoney & Gabriel, 1987). Second, rationalist and construc tivist therapies were differentiated in therapy focus. Rationalist cognitive therapies tend to focus on the clients present problem as it roots from clients irrational thoughts. Constructivist cognitive therapies, on the other hand, tend to shift the focus from presenting problems to clients way of processing life within their given history (Mahoney & Gabriel, 1987; Mahoney et al., 1989). Third, rationalist and constructivist therapies were differentiated in the direction of the therapy. Rationalist cognitive therapies tend to follo w a set specific client goals determined at the very beginning of the therapy, while constructivist c ognitive therapies refrain from following a pre-determined route and conceptualize therapy as a journey without a set itinerary (Mahoney & Gabriel, 1987). Fourth, rationalist and constructivist therapies we re differentiated in the kind of the clienttherapist relationship that they value and seek. Rationalist therapies tend to value objective relationships where therapists maintain an analy tical stance, while constructivist therapies tend to seek personal and emotionally intense relations hips between therapists and clients (Mahoney & Gabriel, 1987). Fifth, rationalist and constructivist therapies were differentiated in their conceptualization of certain therapeutic concepts. Rationalist c ognitive therapies tend to conceptualize client problems as cognitive dysfunctions, view negative emotions as a problematic outcome of such

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25 thought errors and perceive client resistance, relapse and regression as indicators of client failure in maintenance and generalization of therapy out comes. Constructivist th erapies, on the other hand, tend to define client problems as indicat ors of the discrepancies between external challenges and internal capacities, view negative emotions as an indicator of clients current functioning, perceive client resist ance, relapse and regression as indicators of clients selfpreservation efforts (Mahoney & Gabriel, 1987; Mahoney & Lyddon, 1988). Frankel and Levitt (2006) recently detailed the postmodern strategies for working with resistance, demonstrating the similarities across the rich ways that constructivist therapies con ceptualize and work with client resistance. Sixth, rationalist and constructivist therapies were differentiated in their conceptualization of change. Rationalist approaches to therapy tend to seek first-or der change that is defined as surface-level change achieved without distur bing the existing systems. Therapies with constructivist commitments, on th e other hand, tend to facilitate change entailing fundamental restructuring of the existing systems that is recognized as secondorder change (Lyddon, 1990). Empirical studies supported that rationalist and cons tructivist cognitive therapies differed in direction of the ther apy, relationship with client, concep tualization of clients emotional distress, relapse, and regression and approaching such client vari ables in the context of therapy (Nagae & Nedate, 2001; Vasco, 1994; Viney, 1994; Winter & Watson, 1999). The empirical evidence supporting the link between epistemology and practice were mainly in-depth studies of therapy transc ripts (Nagae & Nedate, 2001; Vasco, 1994; Viney, 1994; Winter & Watson, 1999) with a recent additi on of a self-report study of psychotherapists (Neimeyer & Saferstein, 2006). These studies su pported the assumptions that rationalist and constructivist cognitive th erapies differed in direction of th e therapy, relationship with client,

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26 conceptualization of clients emotional distress, relapse and regression, and approaching such client variables in the context of therapy. Vasco (1994) observed therapy sessions of Portuguese therapists with constructivist commitments. The results of his study suggest ed that therapists c onducting constructivist therapies tended to reject therapeutic structur e and directive helping styles yet they were technically eclectic compared to rationalistic cognitive therapists. Constructivist commitment was negatively associated with therap ists focus on clients problems. Viney (1994) sampled and content analyzed thera py transcripts of five therapists with five different orientations including personal construct, client centered, and rational emotive therapies. Therapist conducting constructivist cognitive therapy, i.e. personal construct therapy acknowledged the negative emotions of their c lients more compared to therapists conducting rationalist cognitive therapy, i.e. rational-emotive therapy. Winter and Watson (1999) studied the therapy se ssion transcripts of the two therapists, one adhered to personal construct ther apy that is identified as a constructivist cognitive therapy, and the other adhered to rationalist cognitive therapy. Their in-depth analyses revealed that constructivist therapist was more empathic of clients, more comm unicative of unconditional positive regard towards the client and more e ngaging in complex levels of processing during therapy. Rationalist therapist, on the other hand, was more directive in therapy. Moreover, in dealing with clients failure to complete a given assignment, rationalist therapists were more likely to encourage clients to go through with it, while constructivist ther apists strived to understand the dynamics of clients resistance. Nagae and Nedate (2001) extended these result s to Japanese therapists. Therapists engaged in rationalist cognitive therapies were more likely to engage in psycho-educational instruction,

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27 while therapists conducting constructivist c ognitive therapies were more successful in establishing rapport wi th their clients (N agae & Nedate, 2001). Studies of Vasco (1994), Vine y (1994), Winter and Watson (1999), and Nagae and Nedate (2001) inferred the impact of epistemology on practice through inve stigating practice of therapists conducting constructivist or rationalist cognitive therapies. Neimeyer and Saferstein (2007), on the other hand, conducted a self-report study that measured psychotherapists epistemic commitments. This methodology provided the authors with an opportunity to study the relationship between epistemology and practice independent of the name of the conducted therapy. Neimeyer and Saferstein (2007) focused on therapists emphasis on therapy style and working alliance. Their results were consistent with the assumptions of Mahoney and Gabriel (1987) and the findings of the pr eceding studies. Therapists with higher levels of constructivist epistemology were more likely to pursue closene ss, broad focus, engagement, and spontaneity in therapy. Commitment to constructivist episte mology was also positively associated with therapists emphasis on the persona l bond in the therapeutic relati onship. Overall, their results supported the assumptions that commitment to constructivist epistemology may influence the ways in which therapy is conducted and therap eutic relationship is built and maintained. Altogether, these conceptual and empirical studi es suggested that epis temologies influence how therapists construct therapy variables, how they conduct therapy, how they relate to their clients and what kind of results they pursue. Next, we clarify the ways in which epistemology relates to personal characteristics of psychotherapists. Epistemic Style and Characteristics of Psychotherapists Mahoney (1995c) had suggested that basic tenets of constructiv ist therapies m ay reinforce therapists to value and pursue self -awareness, to be more attuned to personal feelings, to be more

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28 tolerant of ambiguous circumstances, to be more socially tolerant of dive rsity and to be more open to new experiences. Constructivist worldview assumed that individuals understandings are limited by their perceptions, emotions are primitive knowing syst ems, the direction and outcome of therapy gradually emerge from the context and individu als experiences are informed by the social, historical and cultural contexts. Hence, therapists hol ding these assumptions were expected to seek self-awareness to understand the ways in which their constructs shape their perceptions. Therapists with constructivist commitment would attend to emotions to learn from them. The complex way that they construe therapy and clients r eality would ask for tolerating ambiguity as well as social differences and being open to experience and learning (Mahoney, 1995c; Neimeyer & Aksoy, 2005). Rationalist approaches, on the other hand, present as largely complementary views and the differences between the two epistemic commit ments reflect upon the conceptualization and practice of psychotherapy (Lyddon, 1988; Ma honey & Gabriel, 1987; Mahoney & Lyddon, 1988). Rationalist therapists tend to operate assuming that they ar e objective observers of the stable and single reality and they can correct their clients faulty cognitions of reality and hence their clients negative emotions through change processes that ar e presumed to be uniform and universal. The processes and direction involved in rationalist thera py would be clear and straightforward. Hence, therapists with rationali st commitments were expected to have lower levels of self-awareness, persona l attending to emotions, ambiguity tolerance, social tolerance and openness to experience given that these char acteristics would not be necessitated by their epistemic commitment.

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29 Moreover, the literature on the association be tween epistemology and personality provides additional support for the above-mentioned conceptua lizations. For instance, social tolerance and openness to experience were found to be positiv ely related to organismic worldview and negatively related to the mechanistic worldvi ew (Babbage & Ronan, 2000; Johnson et al., 1988) supporting the expectation that therapists with co nstructivist standpoints woul d be more likely to have higher levels of social tolerance and openness. Organismi cally-oriented individuals were more likely to be empathic (Johnson et al., 1988) and cognitively flexible (Botella & Gallifa, 1995) supporting the proposition that therapists with constructivist standpoints would be more likely to have higher levels attendance to emoti ons and ambiguity tolerance that increase the ability to deal with complexity (Beitel, Ferrer, & Cecero, 2004). Neimeyer and Aksoy (2005) provided empi rical evidence supporti ng the theoretical conceptualization of Mahoney (1995c) and others (Lyddon, 1988; Mahoney & Gabriel, 1987; Mahoney & Lyddon, 1988). Their findings suggested that commitment to constructivist epistemology predicted higher levels of pursu it of self-awareness, at tending to emotions, ambiguity tolerance, social tolerance for individual diversity and ope nness to experience, whereas commitment to rationalist epistemology pr edicted lower levels of these characteristics. The developing literature on epistemology confirms that therapists epistemic standpoint relates to their personal characteristics. Overall, the literature suggest s that epistemology has been conceptually and empirically related to the theories of psychotherapy, to th erapy preferences of pr ospective clients and prospective and practicing psychotherapists, to the forms of intervention and to the personal qualities of psychotherapists.

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30 Epistemic Change Epistem ic change experiences of the field of psychotherapy can be studied by examining the general directions the field has undertaken as well as by studying specific examples of psychotherapists who had experien ced an epistemic shift. This section highlights the literature that indicated how the field of psychotherapy is changing with respect to its epistemic commitment in general and it provides specific examples from seasoned psychotherapists where these experts convey their own epistemic journe y that parallels the journey of the field. Epistemic Change of the Field The world of psychotherapy has faced multiple changes such as increase in the number of distinguishable psychotherapies, increase in integration a nd collaboration and expanse of information (Mahoney, 1995a). Farber and his coll eagues (2005) also note d the dramatic change the field of psychotherapy endured over the pa st three or four decades, suggesting that psychotherapy now tends to be short-term, problem-focused, cogniti vely oriented and psychopharmacologically influenced (p. 1018). Ellis (1992b) noted the change as well in his writings: When I started RET in 1955, psychologi sts were mainly split into conflicting psychotherapy camps, most of which violently fought each other. Those who followed the theories and practices of Freud, Jung, Adler, Rogers, Perls, and Skinner were dogmatically tied to their own schools and only rare eclectics, su ch as Frederick Thorne, were multimodal and integrated. (p. 9). The field was increasingly interested in the integration of diverse forms of psychotherapy. Cognitive and constructivist therapies assumed an active role in psychotherapy integration movement providing a rich avenue for in tegration (Mahoney, 1995b). Cognitive therapies mushroomed to more than 20 different types in a period of 40 years a nd through its development and growth, cognitive therapies encouraged productive exchanges with behavioral, humanistic,

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31 and psychodynamic traditions (Mahoney, 1995b). Cognitive therapies have been found to be the most frequent theoretical contributor to integr ative practice at least among clini cal psychologists (Norcross, Karpiak, & Lister, 2005). Mahoney (1995b) pointed out to the dialectical interaction between the field and its practitioners and he suggested th at such changes in the field impact the way psychotherapists practice. That, in return, further facilitate th e conceptual developments within the cognitive psychotherapies, and hence, within the field. On e of the major conceptu al developments was recognized as the differentiation of rationalist and c onstructivist approaches to cognition (Mahoney, 1995b). Development of constructivism or constructiv e metatheory has been recognized as a revolution within the cognitive revolution (Mahoney, 1995a; 1995b). Constructivist metatheory has developed rapidly; it conti nues to expand and today it is international in scope (Mahoney, 1995b). The field experiences a shift towards in creasingly embracing cons tructivist metatheory and epistemologies. Moreover, prac titioners expect the field to ch ange further in this direction. According to the Delhi Poll that Norcross and his colleagues conducted at 2002, 62 experts predicted growth of culturally sensitive and multicultural therapies which rely more on constructivist principles and cultural values that seek to protect the experiences of minority groups from being dominated by the worldviews of powerful groups that do minate the discourse of mental health. (Norcross, Hedges, & Prochaska, 2002, p. 321). And this ongoing shift is further evident in a nd could be the partially attributed to the individual work of prominent cogni tive psychologists (Mahoney, 1995b).

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32 Personal Examples of Epistemic Change Albert Ellis Albert Ellis (1990; 1995), the founder of rational em otive beha vior therapy (REBT) clearly projects a personal and professional pathway where his theory and practice moved to become more constructivist and humanistic in nature. Ellis (1995) distinguished between general RET and preferential REBT where the former stands for general cognitive-behavioral therapy and the latter stands for what Ellis has practiced for past 15 years. Ellis clarified that both his practice and the empirical work of the fellow psychologi sts such as Beck and Meichenbaum made an impact on his conceptualization of REBT and pushe d him in more constructivist directions. Ellis (1990; 1993) strongly suggested that not only the theory of REBT, but also the practice of REBT is constructivist. Ellis has used various publications to draw at tention to the fact that the term rational had been misunderstood by the field. He suggested that in REBT, rational referred to effective cognitions rather than empirica lly and logically valid cogni tion (Ellis, 1999). Ellis (1999) emphasized that What is deemed rational by one person, group, or community can easily be considered irrational by others ( p. 154) suggesting his commitment to constructivist metatheory. Ellis (1992a) even claimed that his therapy is probably the most constr uctivist of all cognitive behavioral therapies (p. 122). Donald Meichenbaum Donald Meichenbaum has been considered among the fathers of cognitive therapy and he is among the leaders of cognitive revoluti on. Meichenbaum (1990; 1993) advocated for constructivist perspective encouraging fellow pr actitioners to help their clients in their identifying the ways in which th ey construe reality and then a ffected by their constructions and in developing coherent and adaptive narrati ons that would enable change and growth.

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33 Meichenbaums analysis of the past and future of cognitive behavior modification shed further light onto the epistemic change cogni tive-behavior practitioners had experienced. Meichenbaum (1993) noted that psychotherapists adhered to cognitive-behaviorist theory has been going through a change process where the way they conceptualize the role of cognition in behavior change has shifted. He utilized three guiding metaphors, namely, conditioning, information processing and constructive narrat ives to illuminate the shift experienced by cognitive-behaviorists practi tioners including himself. At first, client cognitions were viewed as conditioned responses, c overt behaviors that control overt behavior and hence, treatment focused on deconditioning and reconditioning. Subsequently, human mind was equated to computer s where the individuals were the architects of their experiences through the way they collec ted and processed data and treatment focused on helping clients to learn the way their mind pr ocess and the ways of interrupting cognitivebehavioral-affective chains. Meichenbaum (1993 ) suggested that the idea that clients are architects of their mind led to the use of constr uctivist metaphor where cognitions are believed to be active constructions of individuals. He identi fied that cognitive-behaviorist practitioners are increasingly committed to constructivist worldview where therapists function as a coconstructivist helping clients to alter their stories (p. 24). Meichenbaum (1993) expected the change to continue for cognitive-behaviorist practitioners. He suggested that not only himsel f but also the field of CBM has come a long way since its inception. The story continues to unfold and to change as new metaphors are adopted and new narratives constr ucted. (Meichenbaum, 1993, p. 204). Michael J. Mahoney Mahoney (1991) is also am ong the prominen t psychologists who had taken a journey headed towards constructivism even tough he st arted his practice as a committed behaviorist.

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34 Mahoney (2001) described his inte llectual and emotional journe y as a therapist where he identified his starting point as a behaviorist psychol ogist. Mahoney noted that as he faced the limitations of this approach in dealing with the complexity introduced by his clients and as he was involved in the quest of human change proc esses, he was immersed in the function of cognitions and he eventually participated in the cognitive revolution and identified himself as a cognitivist. His involvement in th e depth of human cognition, his pers onal therapy as a client and his interactions with his colle agues and with different culture s opened up novel ways of thinking and practicing and Mahoney (2001) had developed an increasing interest in constructivism and has contributed to our understand ing of constructivist metatheory through his intensive work as a researcher, practitioner, and editor. Narrations of other psychotherapi sts including Aaron Tim Beck Interested in the change th at psychotherapists themselv es had gone through, Goldfried (2001a) asked 15 seasoned psychotherapists to narrate their personal change and growth experiences as a result of their personal and professional interac tions. In their personal accounts, various contributors mentioned thei r path where they had started their practice being adhered to one camp of theoretical orient ation and moved towards more eclectic and complex ways of approaching their clients as their learning experien ces challenged their limited ways of looking at the world of psychotherapy. One of the contribut ors, Greenberg (2001), summarized a shared process in the title of his narration as he named his story as My change process: From certainty through chaos to complexity. A related example comes from the communi cations provided by Aaron Tim Beck and his colleagues that highlighted hi s increasing appreciation and pursu it of complexity in his work. Becks professional journey towards complexity could have started th rough his rebellion against the autocratic nature of psychoanalysis (Bloch, 2004). Instead of following that faith-

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35 based approach to therapy, Beck developed an empirically-driven practice that aimed to explore the cognitive processes underlying human suffering, namely Cognitive Therapy (Bloch, 2004). His approach was criticized for its mechanical, over-simplified nature yet in his recent arguments, Beck claimed that the change processes facilitated by the cognitive therapy can be complex (Bloch, 2004), while cognitive therapy is much richer than mechanical treatment (Bloch, 2004) and individually designed consider ing the client and presenting concern at the hand (Beck, n.d.). Beck (Bloch, 2004) also questioned if applying certain techniques would ever be enough to conduct effective therapy. He sugge sted that treating a presenting concern in a mechanical way would not work especially with complex cases. Therapists who are good at the technical end of cognitive therapy fall flat on their faces when it comes to the more complex cases. Empathy, sensitivity, considerateness together with the abi lity to put them together with technical aspects is the combination ne eded. (para. 107). Moreover, Beck demonstrated constructivis t commitment through his conceptualization and utilization of emotions, personally and profe ssionally. In a paper written in his honor, Beck was praised for his attention to hi s emotional processes and his will ingness to learn from them in his personal and professional li fe (Padesky, 2002). Beck (2002) himself suggested that emotional arousal and expression were essential parts of cognitive therapy since he assumed that the expression of emotion would have certain meaning to client and the interaction taking place can provide an experiential fo r of reframing (similar to what Franz Alexander terms The Corrective Emotional Experience) (para. 2). Beck (n.d.) also referred to other stra tegies that parallel constructivist therapy strategies such as guided discovery and he encouraged collaboration

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36 between therapist and the client to understand the cognitive and emotional processes of his clients. The appreciation of complexity is among the ba sic tenets of construc tivist epistemologies. Constructive metatheory promotes a complex systems model in which thought, feeling, and behavior are interdependent expressions of a life span developmental unfolding of interactions between self and (primarily so cial) systems (Mahoney, 1995b, p. 8) Similarly, paying attention to complex affective experiences that are presen t in the therapy room and inviting clients to actively experience, explore and express a much broader range of emotions are central to constructivist therapies (Mahoney, 1995b, p. 9). Practitioners increasing appreciation of complexity as well as increasing emphasis on emotionality and experiential processes may reflect a change in their epistemic style where they have become increasingly more committed to constructivist epistemology. Moreover, Rnnestad and Skovholt (2003) suggest ed that therapists career development involved increased understanding of knowledge as a constructi on. Experienced practitioners were more likely to reject precisely defined realities in understanding matter of human interaction (p. 31). The authors focus was on themes concerning therapists career development and yet their findings provided implicit support fo r the proposition that th erapists engage in increasingly more constructivis t processing of the therapy room and of the world as they seasoned. Therapists increasing commitment to constructivist epistemology may be a related theme of their career development. All in all, individual narrations of certain psychotherapists di rectly and indire ctly speak to an ongoing epistemic shift in the field and imply the epistemic shift was a result of personal change processes, at least to some degree. Nonetheless, the field is lackin g empirical evidence of

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37 its claimed epistemic shift and it is unclear to what extent this shift can be attributed to the individual change processes of psychotherapists in time and/or to cohort effect facilitated by the inclusion of post-modern therapists to the field. The current study aims to explore any perceived epistemic shifts in the field and its underlying dynamics. Professional Change as a Counterpart of Epistemic Change Change concerning ther apists is not limited to their personal epistemologies. Psychotherapists change profe ssionally as they conduct ther apy. This section highlights psychotherapists change processes and then focuses on two professiona l variables that may complement therapists epistemic journey: Theoretical orientation and therapeutic style. Psychotherapists do change as th ey practice; at least, they report they do. The scarce literature on therapist change is built on psychotherapists self-repor t collected in various forms. Interviews, questionnaires, as well as persona l narrations were empl oyed to understand their personal and professional journe y as psychotherapists (Farber, 1983; Goldfried, 2001a; Radeke & Mahoney, 2000). First, Farber (1983) conducted one-hour semi-structu red interviews with 60 psychotherapists and pooled their answers toge ther in order to understand the effects of psychotherapy practice on psychothe rapists. Their results sugg ested that psychotherapists believed their personal characteristics as well as social relations had changed since they have began conducting therapy and they attributed some of this ch ange experience into the their therapeutic work as therapists. Overall, Farber (1983) suggested th at the effects of therapeutic work is not confined within the office, but rather have a substantial impact on therapists outside behavior and self-i dentity (p. 180).

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38 Second, Radeke and Mahoney (2000) compared the impact of their work for psychologists who were primarily involved w ith research and psyc hologists who were primarily identified as practitioners. This study revealed that compared to researchers, therapists experienced a stronger impact of their work on their personal problems as well as their personal life. Practitioner therapists were more likely to acknowledge feeling emotionally exhausted, anxious, and depressed. Impact of work on personal life included reports of becoming a better and wiser person with increased self-awareness, increase d appreciation for relationships and increased ambiguity tolerance. In general, psychotherapist s reported more change experiences in various forms than researchers did. These studies focused on or provided answers for how psychotherapist s personal lives and experiences changes through their lives as professional practitione rs. Goldfried (2001a)s edited work, on the other hand, provided information on the therapists professional change experiences. In Goldfried (2001a)s work, a group of seasone d practitioners indivi dually reflected on their professional change processes. These narrations revealed intr icate yet shared ways in which practitioners change as they conducted th erapy. Summarizing the common points of the narrations of 16 seasoned psychotherapists, Goldfried (2001b) conc luded that conducting psychotherapy with a mindset of being helpful to clients often demanded therapists to change the ways in which they understand and approach cert ain conditions and that impacted the way they approached to their clients and the way they conducted therapy. Sporadic interviews with established ps ychotherapists (such as DeAngelis, 2006) and infrequent publications where ps ychologists told thei r personal stories (such as Hoyt, 2005 and Brown, 2005) make the last group of resources that can shed light into the process of change

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39 experienced by therapists alt hough they do not include a compar ison among one another nor they provide a tentative conclusion. For instance, DeAngelis (2006) interviews with psychotherapists as well as a series of articles published in the Journal of Clinical Psychology under the title of Why I became a psychotherapist tapped on the transformations that practitioners have undergone. Some conceptualized their growth and change not only as an outcome of conducti ng therapy but also as a requirement of it and at least some conceptua lized the change as a s ource of motivation to become and remain as a therap ist (see Brown, 2005). Similarly, a group of practitioners that participated in a study investigating occupati onal hazards and rewards facing psychotherapists cited their opportunity to learn and grow as well as their incr eased self understanding among the rewards of their work (Kramen-Kahn & Hanse n, 1998) suggesting that they have changed throughout their career and that chan ge process was rewarding for them. Overall, the results implied that psychothera pists go through a complex change process and at least some aspects of their change were tied to their work. Different groups of psychotherapists already reporte d that personal change (Farber, 1983; Radeke & Mahoney, 2000) and a smaller group implied that their pr ofessional attitudes and experiences were not spared from the process of change (Goldfried, 2001a). Recently there has been an incr eased attention on the change experiences of practitioners from the developmental perspective. A group of researchers such as Orlinsky, Rnnestad, Skovholt and Jennings started to study the career traj ectories of mental hea lth practitioners from various parts of the world. They maintained th at therapists not just change; their change processes are systematically organized and th ey involve progression over time (Rnnestad & Skovholt, 2003). Combined with the studies on expertise in counse ling and psychotherapy

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40 (Jennings & Skovholt, 1999; Kivlighan & Quigle y, 1991; Martin, Slemon, Hiebert, Hallberg, & Cummings, 1989; Skovholt & Jennings, 2004), these st udies provided an alternative, systemic way of conceptualizing change experiences of therapists. Qualitative studies on master, expert, and/or experienced therapists (Jennings & Skovholt, 1999; Kivlighan & Quigley, 1991; Martin et al., 1989; Skovholt & Jennings, 2004) and on American practitioners at different experience levels (Rnnestad & Skovholt, 2001; Skovholt & Rnnestad, 1992; Rnnestad & Skovholt, 2003), as we ll as an internationa l quantitative study of development of 5000 psychotherapists from differ ent countries (Orlinsky et al., 1999) revealed insight into the career paths that psychotherapists pursue. Martin et al. (1989) studied the differences between novice and experienced counselors by studying the counselors conceptu al associations regarding th e therapy process. Their study included 23 counselors. Experience d counselors had at least 4 year s of experience in university counseling centers and novice couns elors were interns in the 2nd year of a counseling masters program. Their findings differe ntiated novices from experienced practitioners in their conceptualizations of client issues as well as their ways of proceeding. They established that novice counselors were more likely to pay atte ntion to procedural, how to, aspects of counseling; whereas experienced counselors tend to conceptualize their clients at a broader level in a more inclusive manner. Kivlighan and Quigley (1991) further supporte d such cognitive differences between novice and experienced group counselors. They identified novice counselors as graduate students and expert counselors were professional counselors with more than 1,000 hours of active group leadership. In that study, 30 group counselors, half novice and half expert, were asked to differentiate between the members of a couns eling group after watchi ng a session of the group

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41 and experienced counselors engaged in more comple x and richer cognitive conceptualizations in their distinctions. Jennings and Skovholt (1999; Skovholt & Jennings, 2004) studied not only cognitive, but also emotional and relational characteristics of master therapists. They have conducted interviews with 10 therapists who were nominat ed by their peers as masters of their work. Jennings and Skovholt identified significant pe rsonality characteristic s shared by master therapists and proposed a CER model of master th erapist that referred to the triad of cognitive, emotional and relations expertise on the part of ma ster therapists. Master therapists demonstrated cognitive complexity, openness and desire for continuous learning, emotional receptivity and maturity, and interpersonal skillfulness. This wo rk was criticized for its lack of a comparison group that would allow the reader to infer the di stinctive characteristics of master therapists (Orlinsky, 1999). Moreover, the authors did not provide an initial de finition of "master therapist". That combined with their atten tion to uniformities and neglecting the individual differences across therapists might create a fictio nal ideal with little understanding of what being a master therapist really entails (Orlinsky, 1999). Still, this study provided a sense of what experience could promote in therapists and stimulated research on full spectrum of therapist development. Rnnestad and Skovholt carried out a qualitati ve study where they have conducted crosssectional as well as longitudinal interviews with 100 American psychotherapists at different experience levels. Their findings we re placed in the literature at different instances (Rnnestad & Skovholt, 1991; Rnnestad & Skovholt, 2001; S kovholt & Rnnestad, 1992). Recently, they have provided a reformulation of the main conclusions (Rnnestad & Skovholt, 2003). They structured their findings into a phase model of therapist career de velopment that were identified

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42 as the phases of the lay helper, the beginning student, the advanced student, the novice professional, the experienced professional and the senior professiona l. They have also established 14 themes of therapist developmen t describing central processes of therapist development. The themes addressed various issues such as processes of personal and profession integration and shifts in atten tional focus and emotional functi oning. A more detailed account of these themes will be provided across this lite rature review in relation with the professional variables of interest, namely theoretical orientation and th erapeutic style. Rnnestad and Skovholt (2003) have also high lighted certain constants that emerged across the therapists professional developmen tal span. Most importantly, interpersonal interactions in both personal and professional realms of life have been found as a consistent contributor to therapists profe ssional development. Moreover, commitment to learn as well as the experience of professional growth was invariable for therap ists of all experience levels. Personal and professional growth never ceased for practitioners rega rdless of the length of their journey. Orlinsky and his colleagues (1999) findings from 5,000 international psychotherapists confirmed the constancy of growth experience. Although therapist reports of perceived mastery increased as therapists years in practice increa se, the experience of professional growth was independent of years spent in practice. Novice and veteran therapists did not differ in the amount of perceived growth. Even after two decades of practice, therapis ts reported improvement in their skills as well as growth in their enthusiasm. The authors suggested that the very experience of growth provided therapists with the motivation to continue their work. In this section, we have intr oduced the literature suggesti ng that therapists do change personally and professionally. We have also estab lished that therapists ch ange processes are not

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43 haphazard. On the contrary, processes of change reflect a certain career trajectory where the experiences of therapists are de fined by the stage of their devel opmental stage. The current study focuses on the systemic change of two professi onal therapist variables, namely theoretical orientation and therapy style. Following sect ions will clarify the existing literature on psychotherapists change experiences in thei r theoretical orientat ion and therapy style. Theoretical Orientation Change As we noted above, change is a constant in the field of psychotherapy. The field has been changing, practitioners have been changing a nd the change in practitioners theoretical orientation is am ong the most noticeable and cite d changes. Today it is suggested that the average practitioner changes theoretical orienta tions 2 or 3 times during his or her career (DeAngelis, 2006, p. 59). Mahoney (2001), for instance, has described how he transformed from a behaviorist, to a cognitivist and then to a constructivist in his theoretical adherence, as mentioned above. Various theoretical orientations such as cognitive and constructive theories are gaining more popularity over others such as psychoana lytic theories. Reports of the 62 psychotherapy experts who participated at the Delphi Poll at 2002 suggested that th is shift was expected to carry on (Norcross et al., 2002). Specifically, experts anticipated that cognitivebehavior, culturesensitive, cognitive and eclectic/integrative theories to become more frequent, whereas classical psychoanalysis, solution focused th eories and transactional analys is would become less frequent (Norcross et al., 2002). Moreover, the field is increasingly open to theoretical integration and technical eclecticism. As much as the idea of integration has been rejected by certain groups of people who were strictly adhered to their theoretical orientation (see Goldfried, 2001a and Mahoney, 2001 for striking instances of opposing psychot herapy integration), increasing number of

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44 practitioners move away from th eir original theoretical orientation towards utilizing various perspectives (Goldfried, 2001a). Today, eclecticism is the moda l theoretical orientation for American psychotherapists (Norcross, 2005). Rnnestad and Skovholt (2003) observed therap ist integration of personal self and professional self among the 14 themes of therapist development. As therapists seasoned, they reported increasing consistency between who they were personally (e.g. their values, belief systems and such) and the ways in which they have conducted therapy. Eagle (2001) provided an example to this theme from his personal expe riences suggesting that he had become more authentic and genuine as a pers on and this personal developmen t reflected on his professional work: Comparing my early way of practicing with my current ways brings to mind the awkwardness I felt when I first began doing ther apy. I felt that I was role-playing and the person I was when I was doing therapy was radi cally different from the person I was when I was not doing therapy. I would say that wash ing away that marked discrepancy between person as therapist and just person and th e accompanying reduction in my awkwardness replaced by a greater sense of ease and naturalnessare the mo st important ways in which I have changed as a therapist. I think I have become more so with the years (p. 49). Rnnestad and Skovholt (2003) c onceptualized therapists changing their theoretical orientation as an indicator of such an incr eased integration and congruency. They further suggested that as their theoreti cal adherence shifted, the ways in which they connect with their clients and assign responsibilities within the therapeutic relationship have changed. Next, we investigate the nature and development of psychothe rapists therapy style that includes the way therapists related to their clients. Therapy Style Change Knowing that therapist variables account fo r a significant portion of therapy outcome, resea rch in therapist variables gained moment um. Fernndez-lvarez, Garca, Lo Bianco, and Corbella (2003) suggested that therapy style could be among the therapist variables influencing

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45 the process of change and recove ry for the clients. They have contributed to the literature by conceiving the Personal Style of the Therapis t (PST) construct and providing a detailed description this understudied variable. Fernndez-lvarez et al. (2003) defined PST as the set of char acteristics that each therapist applies in ever y psychotherapeutic situation, shaping its basic attributes (p. 117). In other words, PST is the collection of conditions that guide the therapist s therapeutic behavior. They conceptualized style of the therapist as composed of five bipolar dimensions of instructional, expressive, engage ment, attentional, a nd operative, and this conceptualization was validated empirically (Fern ndez-lvarez et al., 2003). First dimension was identified as instructional and it referred to th erapists ways of establishing and regulating the ru les of therapy such as scheduling and ways of negotiating change. It was defined within the bipolarity of flexibility-rigidit y. Second dimension was identified as expressive, and it referred to therapists level of expressing emotions to their clients. It was defined within the bipolar ity of distance-closeness. Thir d dimension was identified as engagement and it referred to therapists level of co mmitment to therapy and clients. It was defined within the bipolarity of lesser degree-gre ater degree. Fourth dimension was identified as a ttentional and it referred to therapists range of attention when gathering information from clients, and associated level of activity in the search of certain client information. It was defined within the bipolarity of broa d focused-narrow focused. Broad focus accompanied therapist receptiveness as well as lacking preconceived exp ectation of what client may bring to session, while narrow focus accompanied therapists active pursuit of certain realms of knowledge. Fifth dimension was identified as operative and it referred to therapists way of implementing intervention. It was defined within the bipolarity of spontaneous-planned.

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46 Fernndez-lvarez et al. (2003) suggested that these dimensions appear in an integrated manner through therapists work. Th ey also suggested that all co mbinations in personal style were valuable, and some combinations would be more convenient or benefi cial than others for specific clinical situations. In or der to investigate the nature of this construct further, Fernndezlvarez et al. (2003) developed a self-administered questionnaire measuring these five dimensions of the therapist style, called the Pers onal Style of the Therapist Questionnaire (PSTQ). They have further employed this questionnai re to study the relationships between personal style of the therapist, theoreti cal orientation, years of professi onal experience and length of treatment for a group of Argentinian psychothe rapists (Castaeiras, Garca, Lo Bianco & Fernndez-lvarez, 2006). The findings of this study informed the aims of the current study and we will explore these findings in depth. In genera l, the findings suggested that therapy style was associated with these identified therapist variables in complex and dynamic ways. Most importantly, preliminary evidence suggested the stab le yet flexible nature of the PST construct. The therapy style was conceptualized as a stable variable over the time, yet Fernndez-lvarez et al. (2003) had also claimed that PST could withstand minor or major changes as therapists endure significant changes in their life or work circumstan ces. Castaeiras et al. (2006) supported this assumption by showing significant PST differences fo r therapists with different levels of experience. Castaeiras et al. (2006) first assigned therapists into three different theoretical adherence categories based on participants self-descriptions, and therapists were classified into the groups of psychoanalytic therapy, cogniti ve therapy, and integrative th erapy with respect to their theoretical orientation. They identi fied beginner level therapists as the therapists with up to 5 years of experience and expert therapists as th e therapists who had 15 years of experience or

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47 more. Then, they analyzed how PST, experience and theoretical orientation relate to one another by slicing their findings in different ways. First, we will present the findings that focused on PST differences across theoretical orientations. Th en we will present the comparisons between beginner and expert therapists on their PST sc ores for each theoretical orientation group separately. Castaeiras et al. (2006) f ound significant PST differences between therapists with different theoretical orientati ons. They studied the association between style and theoretical orientation separately for begi nners and experts since level of experience was found to be a modulating factor. For beginners, there were no difference in therapists level of expressiveness and engagement across three orientation groups; participat ed beginners were fairly committed to and emotionally expressive with their client s regardless of their th eoretical orientation. Instructional rigidity separated beginner cognitive therapists from beginner integrative therapists: Cognitive therapists were more rigid in their establishing and maintaining the rules and regulations relating to thera py than integrative therapists. At the both levels of experience, cognitive and integrative therapists were similar in the dimensions of attentional and operative, and scored significantly higher than the psychoanalytic therapists. Compared to psychoa nalytical therapists, cognitive a nd integrative therapists were significantly more active in eliciting information and narrower in their focus and they were more planned in the implementation of therapeutic interventions. For experts, the cognitive and integrative therapists also score significantly higher on expressive dimension of style than psychoanalytical therapists; expert cognitive and integrative therapists reported more emotional presence and communication with their clients compared to expert psychoanalytical therapists. And for the expertise level, integrative therapists scored

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48 significantly higher on engagement dimension than the psychoanalytical therapists; expert integrationists reported higher le vels of commitment to the act of therapy and to their actual clients. Overall, the findings indicated that adheren ce to cognitive and integrative theories was associated with similar levels of attentional, operative, and expressi ve, and psychoanalytical therapists had a broader focus, more spontaneity and more distance than cognitive and integrative therapists. The findings indicated that the therapy style is asso ciated with theoretical orientation in different ways depending on therapists experience level (Castaeiras et al., 2006). Then, Castaeiras et al. (2006) compared beginner level therap ists to expert therapists on their PST scores for each theore tical orientation group separatel y. Among cognitive therapists, differences between beginners and e xperts emerged for the domains of instructional and expressive : Beginner level cognitiv e therapists were more rigid in setting and maintaining rules regarding therapy (instructional) and more emotionally distant towards clients (expressive) compared to experts. Among integrative therapis ts, differences across e xperience level emerged for the dimensions of attentional operative, and engagement Beginner level integrative therapists were more narrowly focused, activel y searching for a specif ic realm of knowledge (attentional), more planned in implementing interventions (operative), and yet less committed to therapy and client (engagement) as compared to expert integrationi st. Among psychoanalytic therapists, differences between beginners and experts emerged for the dimension of attentional : Beginner level psychoanalytic therapists endorsed significantly narrower focus (attentional) than their expert counterparts. The authors concluded that years of experi ence partially modulated the evolution of therapist style in each specific theoretical orientati on (Castaeiras et al ., 2006). These findings

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49 implied that therapy style is related to years of experience and that therapy style could change over the course of professional development. R ecognizing the cross-sectio nal nature of this study, one might speculate that th e obtained differences between be ginner and expert therapists could indicate a cohort effect where the fiel d and/or contemporary training models locate distinctive demands on recently graduated therapists. Yet, the findings on therapist professional development (Jennings & Skovholt, 1999; Martin et al., 1989; Rnnestad & Skovholt, 2003; Skovholt & Jennings, 2004) support the conclusion that the stylistic differences between beginner and expert therapists was a reflection of prof essional change experiences. The therapist career development studies and Cast aeiras et al.s (2006) study concur that therapists relax in their style, broaden their attentional perspec tive, and become skillful in communicating their emotions as they season in the profession and gain expertise. Specifically, Martin et al. ( 1989) differentiated novice prac titioners from experienced practitioners in their co nceptualizations of client issues. Novice couns elors were more likely to present a preoccupation with pro cedural concepts. On the other hand, experienced counselors tended to conceptualize their clients at a br oader level and in a more inclusive manner These findings can be translated to the PST terminol ogy employed by Castaeiras et al. (2006) where novice counselors had narrow attentional focu s and planned way of conducting therapy interventions guided by their how to knowledge, while experienced counselors had broader focus, openness to wide-range of client mate rial and willing to incorporate spontaneous interventions. Martin et al. (1989) provided an early evidence for the assumption that therapy style, in particular w ith the dimensions of attentional and operative, differ with respect to therapists level of experience. The more recent research on master therapists and professional

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50 development provided more compelling evidence s upporting stylistic change of therapists with experience. Likewise, Rnnestad and Skovholt (2003) suggest ed that therapists reported increased professional flexibility throughout their career development. As therapists seasoned, they have confronted various challenges that facilitated a gradual disillusi onment with training. With this disillusionment, the practitioners attention gradually shifted from what their training solicited to an internally-based flexible professional functioning. This inferred flexibility across professional development was aligned with the findings that expe rt therapists were significantly more flexible in setting and maintaining rules regarding therapy (instructional ), more broadly focused and open-minded while listening to client material ( attentional ) and more spontaneous in implementing interventions ( operative ), at least for the expert therapists with certain theoretical commitments (Castaeiras et al., 2006). Additionally, Jennings and S kovholt (1999; Skovholt & Jennings, 2004) found that master therapists were strong in their emotional and re lational skills Specifical ly, among other qualities, emotional receptiveness, ability to attend to self and others emotions, recognition of the ways in which their own emotions impact their work, rela tional skillfulness, strong adherence to working alliance and exceptional use of re lational skills in therapy were among the qualities shared by and hence define the master therapists. These find ings were supportive of the findings that expert therapists had higher scores on the dimensions of engagement and expressive compared to beginner therapists, at least for master ther apists with certain theoretical commitments (Castaeiras et al., 2006). The narrations of 16 seasoned psychotherap ists further confirmed these findings (Goldfried, 2001a). These practitioners that re flected on their professi onal change processes

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51 reported increased flexibility, broadened understa nding and appreciation of client concerns and enriched ways of reaching out to their clients. Most importantly, each narrative described ways of breaking free from original teachings and deve loping integrative, expansive, pliable ways of being and doing in their therapeutic work. Ev en though these practitioners did not employ the PST framework or language, they were clearly providing further evidence from their own perspective on how they have changed in their th erapy style as they seasoned as therapists. Castaeiras et al.s (2006) study was significant as it provided empirical support for the usefulness of the PST construct, for the sensi tivity and specificity of the PST-Q, and most importantly, for the change processes of dimens ions of therapy style. Combined with the therapist development studies (Jennings & Skovholt, 1999; Rnnestad & Skovholt, 2003; Skovholt & Jennings, 2004) and pers onal narratives of seasoned therapists (Gol dfried, 2001a), the findings of Castaeiras et al. (2006) suggest that therapists st yle in which they engage with therapy might change with experience. The current study aims to clarif y whether therapists perceive stylistic change as a part of their professional development and growth experiences, and if so what the direction of change would be fo r the participating therapists. In line with the above-mentioned findings, we expect to find incr ease in therapists emotional expressiveness, engagement, attentional focus and spontaneity. This clarification would be a significant edition to the limited literature on psychotherapists change experienced in therapy style. Epistemic and Professional Change Our literature review studied two change pr ocesses regarding psychotherapists, nam ely epistemic change and professional change. We agree with Stricker (2001) who conceptualized change as a synergist and suggested that change of any sort can facili tate other changes (p. 79). Hence, once we have accumulated informa tion with respect to therapists change experiences in epistemology, theore tical orientation and therapy style, then we shall investigate

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52 the ways in which these change processes facilitate one another. The existing literature suggests that these two processes are associated; yet this interaction remains to be studied. As we have clarified above, certain schools of thought and theoretica l orientations have been associated with certain epistemic styles. Conceptually, rational epistemic style was linked to rationalistic cognitiv e therapies whereas metaphorical epistemic style was linked to constructivist cognitive therapies (Lyddon, 1991). Consistent with these conceptual links, epistemic style moderately accounted for individual s attitudes and preferences for theories of psychotherapy (Lyddon, 1989a; Lyddon & Adamson, 1992; Neimeyer et al., 1993; Neimeyer & Morton, 1997; Schacht & Black, 1985) : Participants prefe rred theoretical orient ations that were consistent with their own epistemic view. Considering that the epistemic style of a therapist accounts for his or her theoretical orientation preferences, it is reasonable to ex pect that a change in a therapists epistemic commitment would reflect on the therapists choi ce of theoretical orientation. It can be argued that therapists epistemic change experiences would be related to the quan titative and qualitative changes in their theoretical orientation. In other words, as th e psychotherapists see the world differently, they may adhere to new theories that capture their most recent worldview. We assume that psychotherapists change in the ep istemic commitment can predict the change in their theoretical orientation. The more psychothera pists experience an epis temic shift, the more likely they may be to report a change in their theoretical orientation. As constructivist metatheory reflects rec ognition of complexity in human processes, epistemic shift of practitioners towards constr uctivism may further enc ourage practitioners to integrate various forms of therapy. Alternativel y (and additionally), the ongoing integrationist movement might have endorsed a more constr uctivist framework on its members. In other

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53 words, it is likely that the fields increasi ng commitment to constructivism and the increasing theoretical integration on the part of psychotherapists may be related to and promoting one another. Hence, we expect that increase in therapists commitment to constructivist epistemologies might correlate with their enga gement in more integrated ways of conducting therapy. Epistemic style has also been employed to understand the differences among psychotherapy practices. Therapists conducting rationalist and constructivist therapies differed in the way they set the direction of the therapy, re lated to client, and conceptualized and worked through clients emotional distress, relapse, and regression (Nagae & Nedate, 2001; Vasco, 1994; Viney, 1994; Winter & Watson, 1999). Therapists with different epistemic commitments appeared to have different st yles in their therapeutic clos eness, focus, engagement, and spontaneity as well as different emphasis on bon ding with their clients (Neimeyer & Saferstein, 2006). Moreover, Castaeiras et al. (2006) demonstr ated the complex ways in which therapy style, experience, and theoretical orientation interacted. Their findi ngs indicated that the ways in which therapy style related to theoretical orientat ions (psychoanalytic, cognitive, and integrative) was different across the two levels of experien ce (beginners with less than five years of experience and experts with 15 years of experience or more). Overall, the findings indicated that adherence to cognitive and integrat ive theories was associated with similar levels of attentional, operative and expressive, and psychoanalytical th erapists had lower scores on each of these three dimensions of therapy style compared to cognitive and inte grative therapists. Castaeiras et al.s (2006) findings indicated that the therap y style was associated with theoretical orientation in differe nt ways depending on therapists experience level. Given that

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54 theoretical orientations reflected an u nderlying epistemic commitment (Lyddon, 1989b) and certain dimensions of therapy style have alrea dy linked to epistemic commitments of therapists (Neimeyer & Saferstein, 2006), it is reasonable to expect therapist epistemic change to account for or to align with therapists stylistic change experiences. Hence, any increase in therapists commitment to constructivist epistemologies might correlate with increase in certain dimensions of therapeutic style, specifically therapeutic closeness, engagement, spontaneity, and focus. Castaeiras et al. (2006) did not include epistemology as a variable, nor did they group their participants into groups of epistemically divergent categor ies of theoretical orientation. Rather it is safe to assume that these categorie s were fairly generic, each involving a wide range of theories and practices. As this literature review suggested, c ognitive therapy is an umbrella term combining a variety of approaches (Lyddon, 1988; Mahoney, 1991). The current study aimed to further our understanding between the therapy style and theoretical orientation by separating how epistemic commitments underlying theo retical orienta tions related to levels of and changes in therapy style. Recognizing the wa ys in which epistemology is linked to therapy style could improve our understanding of these significant therapist variables. Overall, the existing literature provides a cogent rationale to pursue and expect association between therapists epistemic and prof essional journeys. This relationship would be a complex one, impacting one another at different levels through differe nt dynamics. Uncovering this multifaceted association starts with simply establishing that therapists perceive their epistemic and professional change processes to correlate. This basic question of whether and if so, to what extent psychotherapists perceive d epistemic change accounts for where therapists stand in their theoretical stylis tic journey has remained to be answered, and was identified among the inquiries of the present study. The purpose of the present work was to help lay the foundation

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55 for developing an increased understanding of ther apists developmental pr ocesses and the place of epistemic commitment within that framew ork, as construed by therapists themselves. Taken as a whole, the literatur e indicates psychotherapist theory preferences as well as therapeutic conceptualizations and behavior are colored by their epistemic commitments. Yet such professional attitudes and behaviors as well as the epistemic commitments are subject to development and growth. Moreover, these change processes are likely to interact with one another: Any change experienced in the way we perceive the world a nd test the validity of knowledge as psychotherapists are likely to mark the growth and change in our therapy-related attitudes and behaviors. Overall, the complex associations between epistemic worldview and psychotherapy preferences and behaviors have been yet to be clarified within a developmental framework that supposes change and growth in both aspects. Purpose of Study As the literature review points out, the psychotherapy literature suggests that the field has experienced an epis temic shift where its members have become increasingly more constructivist, and numerous seasoned psychotherapists endors ed this shift thr ough narrating their own epistemic change. However, despite the general a cceptance of the notion in the current literature, there is no empirical evidence documenting that toda ys practitioners have in fact experienced an epistemic shift in their perspective and practice, apart from the anecdotal evidence of selected prominent practitioners in the fi eld. The "increasingly constructivist" lands cape of contemporary psychotherapy could be an indicator of a cohort effect rather than an indicator of therapists developmental changes across time. For instance, early-career th erapists might have stronger commitments to constructivism than therapists of the previous generations, and/or therapists who entered the field at different times have differe nt epistemic trajectories. The dynamics underlying

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56 the fields and its practitioners increasing co mmitment to constructivism have yet to be empirically investigated. The literature also indica tes that therapists change in their theoretical orientation and therapy style in so mewhat consistent ways and that therapists epistemic journeys might relate to these professional change experiences. Yet, these in teractions have also remained to be investigated empirically. The present work was an expl oratory study investigating the epistemic change experiences of practitioners, as therapists perceived them. This study attempted to answer three umbrella questions including specif ic hypotheses following two of the questions. The main questions and accompanying hypotheses are specified as followed. Question 1. How do therapists perceive themselves to change in their (a) epistemic worldview, (b) theoretical orient ation characteristics, and (c) therapeutic style across their professional lifetime? Specifically we expected that (1) when compared to their initial epistemic commitments, therapists would report having increasingly higher levels of commitment to constructivist epistemologies; (2) when compared to the plurality, i.e. eclecticism of their initial commitments, therapists would report having increasingly higher levels of plurality in their therapeutic orientation; and (3) when compared to their initial levels, therapists would indicate increasingly higher levels of (a ) expressiveness, (b) engagement, (c) attentional focus, and (d) operative spontaneity in their therapeutic st yles across the course of their practice. Question 2. What are the reasons behind the fields increasing commitment to constructivist epistemol ogy? More specifically, to what extent do cohort effects account for the epistemic shift in the field of psychotherapy? As an exploratory analysis, we attempted to clarify how much of the variance in therapists initial epistemic commitments as well as their epistemic trajectories can be explaine d by the time in which they have entered the field.

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57 Question 3. What is the relationship between th erapists epistemic and professional change experiences? In other words, to what ex tent can therapists epis temic journeys account for their current standing with th eir therapeutic orientation and style after accounting for their initial standing with thes e variables? We hypothesized that incr eases in therapis ts constructivist commitments would predict (1) greater changes in their theoretical orie ntation throughout their professional lifetime; (2) greater levels of theo retical plurality, indicati ng greater adherence to theoretical integration and eclecticism; (3) gr eater levels of expres sive and engagement dimensions of therapy style, indicating greater adherence to emotional expressiveness with and engagement to clients; and (4) lower levels of operative and attentional dimensions of therapy style, indicating greater levels of spontaneity in implementing interventions and wider range of attention in collecting information from the clients.

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58 CHAPTER 3 METHODS Participants Participants were professiona l psychologists and they were recruited online from the American Psychological Association (APA) Practice Organization (www.apapractice.org) online practitioner directory (approximately 13,000 members). The solicitation email also encouraged participants to forward the survey invitation on to other eligible practitioners. Procedure An Internet survey was conducted w here partic ipants were invited to complete a set of questionnaires online that requ ired approximately 25 minutes to complete on average. Participants were informed that the study aims to understand their descriptions of themselves as therapists at different stages of their career. We refrained from using the word change to limit the potential bias that might be introduced by the nature of th is word. Informed consent was required before the survey appeared on the screen. The survey was anonymous and the confidentiality of completed surveys was insured. In the survey, participants were asked to answer some sets of questions twice with different directions. Participants rated certain items once reflecting on th eir current experiences and once reflecting on their past, specifica lly on the time where they had started post-graduate practice of psychotherapy. The order of these two sets of directions were alternated, half of the participants reflecting on their past first, and their current selves later, and the other half of the participants reflecting on their today first and their past later. This enabled us to test and if necessary control the possible operation of any order effects as we detailed in the results section.

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59 To avoid a likely frustration on the part of participants that may stem from answering several questions twice, the st udy was set-up such that the it ems would appear only one time asking therapist to respond to the given item once from their current standing point and once from their initial standing point. We anticipated that this set-up would shorten the time spent on reading and answering the questions twice and lessen the likely frustration. Yet, attending to same item considering now and then side by side would provide participants with an immediate opportunity to compare their ratings for their past and presen t, and hence, might artificially stretch the gap between two ratings. A pilot study conducted with 34 professional practitioners and practitioners in training failed to support such possibility. When half of the participants responded to ratings of past and present side by side, the other half responded to such items separately. The obtained findings failed to indicate a significant difference between the two groups ratings; hence encouraged us to believe that reflecting on items side by side had minimum or no considerable impact on the participants ratings. Participants were also debrie fed at the end of the study and they were provided with the contact information of the primary in vestigator for further inquiries. Instruments Epistemic c ommitments: Therapists epistemic commitments were measured with the Therapist Attitude Questionnaire Short Form (TAQ-SF). This scale assesses the degree of participants commitments to rationalist and c onstructivist epistemol ogies. DiGiuseppe and Linscott (1993) developed the Therapist At titude Questionnaire (TAQ) to measure the philosophical, theoretical, and technical dimensions of the rationalist and constructivist positions. Neimeyer and Morton (1997) developed the short ve rsion of the TAQ, named Therapist Attitude

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60 Questionnaire Short Form (TAQ-SF). The TAQSF measures the same constructs the TAQ measures using a total of 16 items. Eight items represents rationalist pos itions and the other 8 items represents constructivist pos itions. As in the TAQ, the re spondents determine the degree to which they endorse the statements on a five-point scale ranging from 1 (strongly disagree) to 5 (strongly agree). Sample items include Realit y is singular, stable and external to human experience and Reality is relative Realities reflect individual or collective constructions of order to ones experiences. Higher rationalism and construc tivism scores reflect higher commitments to rationalist a nd constructivist epistemologies The TAQ-SF was found to reproduce the basic factor stru cture of the TAQ. Predictive validity of the measure was established as it predicted the th erapeutic identifications and desc riptions of a group of practicing professionals (Neimeyer & Morton, 1997). Theoretical orientation: Theoretical orientation was measured by asking therapists to rate their orientation on a list of seven categories of analyt ic-psychodynamic-neo-analytic, behavioral, cognitive, humanistic -existential, systemic, construc tivist-narrative, and feministmulticultural. The respondents were asked to rate each orientation on a five-point scale ranging from 1 (not a part of my practice) to 5 (a ve ry significant part of my practice). Then, the respondents were asked to identify their main th eoretical orientation from a menu that included the above-mentioned orientations and integrationi st orientation. At last the respondents were asked to rate the extent to which they perceive their theoretical orient ation has remained the same, or changed on a five-point scale ranging from 1 (same) to 5 (changed). The plurality, i.e. eclecticism, of theore tical orientation was defined based on the cumulative number endorsed on the theoretical or ientation ratings. Higher numbers indicated higher plurality. Therapists indica tion of their main theoretical base was used as an anchor.

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61 Therapist style: Therapist style was measured with the Personal Style of the Therapist Questionnaire (PST-Q) This questionnaire assesses therapists characteristics ways of conducting psychotherapy. Fernnd ez-lvarez et al. (2003) deve loped the questionnaire to measure the ways in which therapists engage in therapy and shape the conduct of their therapeutic work. The questionnaire is composed of five subscales that were designed to assess five different dimensions of th erapist style. (1) Instructional subscale assesses flexibility in establishing and regulating the th erapy setting; higher scores represent greater rigidity vs. flexibility. (2) Expressive subscale assesses em otional communication; higher scores represent greater closeness vs. distance. (3) Engagement s ubscale assesses level of commitment to therapy and client, higher scores repres ent greater degree vs. lesser de gree. (4) Attentional subscale assesses therapists range of attention and activity level in gathering info rmation; higher scores represent narrower focus vs. broad focus. (5) Operative subscale assesses spontaneity in implementing interventions; higher scores repres ent more planned vs. spontaneous. See Table 31. PST-Q is a 36-item self-report measure. The respondents rate how accurately each statement described their practice on a seve n-point scale ranging from 1 (tot al disagreement) to 7 (total agreement). The questionnaire have yielded th e following Cronbachs alpha scores for each subscale: Instructional, .69; expressive, .75; engagement, .78; attentional, .80; operative, .78. The measure has shown adequate 4-month te st-retest reliability (instructional, r = .82; expressive, r = .76; engagement, r = .78; attentional, r = .81; and operative, r = .78). Theoretical validity is established through obtained factorial compos ition, and further supported by the work of Castaeiras et al. (2006). Demographics: Participants were asked to give information about their demographic information. These included gender, age, ethnic background, name of thei r highest degree, the

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62 year they obtained their highest de gree, total number of years they have spent in clinical practice, specialty area, primary employment setting, primary job responsibil ity, average number of clients seen weekly and the country they live in. Table 3-1. Personal Style of the Therapist Qu estionnaire (PST-Q): Subscale directions Subscales Low High 1. Instructional Flexibility Rigidity 2. Expressive Distance Closeness 3. Engagement Lesser degree Greater degree 4. Attentional Broad focus Narrow focus 5. Operative Spontaneous Planned

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63 CHAPTER 4 RESULTS The results s ection is composed of three sectio ns. First, the sample characteristics of the participants are provid ed. Second, the descriptive informa tion concerning the overall scores, psychometrics and relationships among the primary variables of interest are presented. And last, the three primary analyses are reported. A series of repeated measures ANOVA first address the primary questions regarding the ways in which therapists regard themselves as changing in relation to their theoretical orientations and th erapy styles (expressive engagement, operative, and attentional) across the course of their pr actice. Next, multiple regression analyses are reported to address the question regarding whether cohort effects (i.e. the year of entry to the profession) accounted for therapis ts perceptions regarding their initial epistemic commitments and epistemic shifts. And third, a series of multip le regression analyses are reported to address the question regarding whether ch ange in therapists epistemic leanings predict levels of therapists current theoretical and stylistic commitments, above and beyond their initial commitments. Demographics The sam ple consisted of 702 participants of which 94.2% designated their demographic information. Among those who responded, 59.5% women and 40.5% men, with a mean age of 50.36 ( SD = 11.7, age range = 25-84 years). The majority of the participants were Caucasian, 88.6% ( N = 584), followed by Hispanic, 3.6% ( N = 24), African-American/Black, 2.4% ( N = 16), Asian-American, 1.2% ( N = 8), multiracial, 1.2% ( N = 8), and Other, 2.9% ( N = 19). The majority of the participants repo rted to be from the U.S., 96% ( N = 630), whereas 4% ( N = 26) of the participants were from other countries.

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64 The majority of the participan ts had a Ph.D. degree, 68.9% ( N = 449), followed by a Psy.D., 16% ( N = 104), M.A. or M.S., 8.4% ( N = 55), Ed.D., 1.8% ( N = 12), M.S.W., 1.5% ( N = 10), or other degrees, 3.4% ( N = 22), as their highest degree. Th e majority of the participants were self-identified as psychologist, 87.4% ( N = 577), followed by mental health counselor, 4.2% ( N = 28), marriage and family therapist, 2.4% ( N = 16), and social worker, 1.2% ( N = 8). The remaining participants designated themselves as Other, 4.7% ( N = 31). The majority of the participants defined thei r primary responsibility as practice/clinical work, 80.2% ( N = 528), followed by academic, 8.2% (N = 54), administrative, 4.1% ( N = 27), research, 1.2% (N = 8) and other, 2.7% (N = 18). The remaining 23 participants designated themselves as being equally involved in multiple responsibilities, 3.5%. The majority of the participants indicate d their primary employment sett ing as private practice, 47.0% ( N = 309), followed by hospital, 10.8% ( N = 71), mental hea lth care, 10.2% ( N = 67), university academic department, 8.5% ( N = 56), university service delivery department, 6.1% ( N = 40), community center, 3.8% ( N = 25), school, 2.7% ( N = 18), correctional facility, 1.7% ( N = 11), and other, 9.1% ( N = 60). Mean number of years spent in clinical practice was 18.66, and ranged between 1 and 52 ( SD = 10.94). The mean number of clients seen weekly was 17.38, and ranged between 1 and 61 ( SD = 10.69). The majority of the participants identified integrative as their primary theoretical orientation at the present time, 32.2% (N = 213), followed by cognitive, 27% ( N = 179), psychodynamic, 17.1% ( N = 113), humanistic-exist ential-gestalt, 8% ( N = 53), systemic-family, 4.7% ( N = 31), behavioral, 4.7% ( N = 31), narrative/constructivist, 4.2% ( N = 28), and feministmulticultural, 2.1% ( N = 14). Psychodynam ic theory was the most common primary theoretical orientation designated by therapists at the time that they started practice after graduation, 26.5%

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65 ( N = 175), followed by cognitive, 23.9% ( N = 158), humanistic-exist ential-gesta lt, 16.9% ( N = 112), behavioral, 12.4% ( N = 82), integrative, 11.3% (N = 75), systemic-family, 6.4% ( N = 42), narrative/construc tivist, 1.5% ( N = 10), and feminist-multicultural, 1.1% ( N = 7). Descriptives and Preliminary Analyses In order to a ssess the potential impact asso ciated with the vari ous orderings of the questionnaires used in this study, one-way ANOVAs were c onducted along the six different orderings, using each of the questionnaire scores as dependent variables in the analysis. These analyses suggested that there were no difference in the mean scores of the variables of interest among the six types of questionnaire forms (all p s > .01). Thus for all analyses, the data from six different forms were combined. Table 4-1 depicts summary sta tistics of the primar y variables used in this study. This includes the measures of rationalism and cons tructivism derived from the Therapist Attitudes Questionnaire (TAQ), the therapeutic change index, the measure of therapeutic plurality, and the measures of therapy styles of (a) expressive, (b ) engagement, (c) attentio nal, and (d) operative, scores indicated separately according to their cu rrent (now) and initial (t hen) ratings from the practitioners. All scores were normally distributed. Skewness and kurtosis values were in the acceptable range for appropriate distribution. The epistemology scores obtained from TAQ were consistent with the scores reported by Neimeyer and Morton (1997). Overall, the scales yielded low to moderate reliability coefficients. Table 4-2 depicts the Pearson Product-Mo ment correlation coefficients among the variables of interest. Consistent with previous dis tinctions outlined in the literature, a number of therapist qualities were associated with epistemic leanings in theoretically consistent ways. Levels of constructivism, for example, were ge nerally positively related to greater levels of

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66 therapist expressive, and theoretical pluralit y, while rationalist lean ings were negatively associated with these variables. Levels of c onstructivism were generally negatively related to narrower levels of attentional focus, and operati ve spontaneity (reflecting higher levels of planinduced approach to therapy), while rationalist l eanings were positively associated with these variables. Similarly, conceptually linked variab les showed low to mode rate associations. For example, attentional and operative dimensions we re positively associated with one another, as were levels of expressive a nd engagement factors, and thes e two groups of variables were negatively associated with one another. Preliminary analyses investigating whether the scores on the dependent variables were different across demographic variab les revealed that certain variab les of interest were different across the levels of gender, age, and average nu mber of clients seen weekly. T-test analyses revealed gender differences in constructivism-now ( t = -3.98, p < .001), constructivism-then ( t = -2.98, p < .003), and rationalism-now ( t = 3.61, p < .001) scores. Males scored significantly higher than females in their current comm itment to rationalist epistemology (males, M = 23.41, SD = 5.71, females, M = 21.84, SD = 4.90); whereas females scored significantly higher than males in their current (males, M = 32.83, SD = 3.95, females, M = 33.99, SD = 3.17); and past commitment to constructivist epistemology (males, M = 30.62, SD = 4.25, females, M = 31.57, SD = 3.52). Regression analyses revealed that age significantly accounted for variance in engagement-now ( F (1, 492) = 9.51, p = .002; = -.14), and attentional-then ( F (1, 494) = 11.41, p = .001; = -.15) scores, and theoretical orientation change index ( F (1, 504) = 13.01, p = .000; = .16). The average number of clients seen weekly accounted for significant variance in attentional-now scores ( F (1, 630) = 11.20, p = .001; = -.13). Hence, these three demographic variables (i.e., gender, age, and average number of clients se en weekly) were entered into the

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67 primary analyses as covariates when subsequent analyses involved the above-mentioned variables. Primary Analyses The final set of analyses utilized three sets of analyses. First, repeated ANOVA analyses were conducted to exam ine whether there was a perceived change in therapists epistemic leanings, theoretical orientati on, and therapy styles of expres sive, engagement, operative, and attentional across the cour se of their practice. It was hypothesized that comp ared to their initial levels, therapists would report increasingly higher levels of commitment to constructivist epistemologies, plurality in their therapeutic orie ntation. In addition, they were expected to have higher levels of expressive and engagement dimens ions in the therapeutic styles and lower levels of operative and attentional dimensions. S econd, regression analyses were conducted to investigate whether the participants cohort of graduation would account for some of the variance in the epistemic shift in the field of psychotherapy. In other words, we wanted to determine whether the shifts towards greater constr uctivism were the result of the influx of new constructivist therapists trained in recent ye ars, versus perceived developmental changes occurring within longstanding psycho therapists. No predictions were specified for this research question. Third, regression analyses were conducted to examine whether change in epistemological commitments predicted the therapis ts current levels of theoretical orientation, adherence to theoretical integra tion, and therapy styles of expressive, engagement, operative, and attentional dimensions, above and beyond what their initial standing was. Increasing commitment to constructivist epis temologies was expected to predic t higher levels of theoretical change and plurality, higher levels of expressive and engagement styles, and lower levels of operative and attentional styles.

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68 Research Question #1: How Do Therapists Ch ange in Their Epistemic Commitment and in Professional Characteristics across the Co urse of Their Professional Practice? W ithin this broad research question, we ha ve specifically hypothesized that when compared to their initial sta nding, therapists would have (1) increasingly higher levels of commitment to constructivist epistemologies; (2) increasingly higher levels of plurality in their therapeutic orientation; and (3) increasingly hi gher levels of expres sive and engagement subscales, and lower levels of attentional and operative subscale. We conducted a series of repeated measures ANOVA, with now-versus-then (i.e. time factor) as the within-subjects factor, and epistemology, theoretical orientation, and therapeutic style scores as the dependent variables, to investigate whether there were significant reported changes in the therapists epistemic commitments and identified professional variab les over the course of their practice. Gender was entered as a covariate to the analys es involving the variable s of constructivism and rationalism. Age was entered as a covariate in the analyses regarding engagement, attention, and theoretical orientation change. In addition to age, the average number of clients seen weekly was entered into the analysis involving the at tention variable. A Bonferroni adjustment was employed within the analyses to guard against the Type I error, and alpha level was established at .007 (.05/7), which is the orig inal alpha level (.05) divided by the number of statistical tests. Obtained partial eta-squared sc ores were reported as effect size indices. Table 4-3 summarizes the obtained coefficients. Findings indicated statistically significant changes in therapists epistemic leanings, therapy styles and theoretical pl urality. Consistent with our hypot heses, analyses revealed an increase in therapists perceived commitment to constructivist epistemology. This finding was not only statistically significant, but also modestly robust, as indi cated by a partialeta squared of .21. Another statistically and clin ically significant finding was ther apists perceived change in

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69 theoretical plurality. Data indi cated a significant increase in therapists employing a greater variety of theoretical orientati ons in their practice with a pa rtial-eta squared of .38. Hence, therapists reported increase not only in their constructivist leanings but also in their theoretical eclecticism i.e. plurality. Data al so indicated a significant reduction in therapists perceived commitment to rationalist episte mology across their practice. Therapists change in their theoretical orienta tion can be understood further by comparing individual theoretical orientati on ratings for now and then. We conducted a series of repeated measures ANOVA, with now-versus-then (i.e. ti me factor) as the with in-subjects factor and seven theoretical orientations as the dependent variables, to investigate whether there were significant reported changes in the therapists commitment to these specific theoretical orientations over the course of their practice. Bonferroni adjustment was employed within the analyses to guard against the Type I error, and alpha level was established at .007 (.05/7), which is the original alpha level (.05) divided by the number of statistical test s. Table 4-4 summarizes the obtained coefficients. With respect to theoretical orientation changes within therapists, data indicated statistically and clinically significant increa se in therapists commitment to cognitive, constructivist and feminist-multicultural therapies. There was also a significant increase in behavioral therapy, and systemic-family therapies although these changes were failed to be clinically meaningful suggested by their low effect size indices. Da ta failed to indicate ch ange for therapists commitment to psychodynamic and humanis tic-existentialgestalt orientations. An overall change in therapists theoretical pe rspectives is also evident when we compare their initial and current theoretical base. When th erapists were asked to choose one theoretical orientation as their main base among the eigh t options (cognitive, behavioral, humanistic

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70 existential gestalt, narrativ e/constructivist, systemic family, psychodynamic, feminist multicultural, and integrationist), the cumulative picture of primary commitments showed perceived differences over time (See Table 4-5). Cochran-Mantel-Haenszel statistics were used to test the significance of the observed differences The results suggested that the now and then percentages were statistically different from one another for this cross-tabulation ( 2 = 124.56, p < .001). These percentages are consistent with the pr evious findings concerning theoretical shifts. Commitments to cognitive, narrative-constructivi st, feminist-multicultural, and integrationist perspectives as primary theoretical bases have strengthened, while commitment to behavioral, humanistic-existential-gestalt, systemic-family, and psychodynamic perspectives as therapists primary theoretical bases have weakened. Results of the analyses for therapy style variables are depicted in Table 4-3. Data indicated a statistically and clinically significant increase in the expressive subscale that assesses emotional communication, where higher scores represent great er emotional closeness. Data supported our hypothesis that therapists would pe rceive increased closeness and emotional expressive in their therapy styles across time. There was a statistically significant decrease in operative subscale that assesses spontaneity in im plementing interventions, where lower scores represent more spontaneity in conducting therapy. Hence, the results supported our pr ediction of perceived decrease in operative style, in dicating that therapists perceived themselves as increasing in spontaneity across time. Ther e was also a decrease in attentional scores that assesses therapists range of attention and activity in gathering information, where lower scores represent broader focus. Data supported our prediction that therap ists perceived themselves as having increasingly

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71 broader focus in the way they have collected da ta during therapy. But the low partial eta squared for the change in operative and attentional raised question into the magnitude of these findings. The data failed to support our hypothesis of increased engagement across years. Higher levels of engagement represent higher degrees of engagement with clients. We expected therapists to report increased commitment to th erapy and their clients acr oss their practice. The obtained results, on the other hand, suggested therapists viewed their engagement level as remained stable across time. Due to these finding s, engagement as a therapy style variable was excluded from the analyses investigating the relationship between therapists epistemic and professional change experiences. In order to understand the da tas failure to support our hypothesis regarding increased therapist engagement across practice, we conducted exploratory post-hoc analyses. Specifically we investigated if differences across experience levels emerge for the dimension of engagement only for those therapists with certain theoretic al orientation and we engaged in the post-hoc analysis by entering therapists current and initial theoretical orientations into the model. In the post-hoc analysis, we used a repeated measures ANOVA, with now-versus-then as the withinsubjects factor, theoretical orie ntation as the between-subjects fact or, age as the covariate and the engagement scores as the dependent variable to examine whether there was significant increase in the engagement scores over the course of th erapists practice. We c onducted this analysis twice, once current theoretical orientation as the between-subjects factor and once initial theoretical orientation as the between-subjects factor. A total of 488 therapists were included in both of the analyses, with engagement-then scores ( M = 28.4, SD = 5.34) higher than engagement-now scores ( M = 27.5, SD = 5.70). This less than 1-point score difference failed to repres ent a significant change in both of the analyses,

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72 for the analysis including therapis ts current theoretical orientation, one-tailed F (1, 479) = 0.06, p = .405, and for the analysis including ther apists initial theoretical orientation, one-tailed F (1, 479) = 0.00, p = .496. Thus, there was no substantial mean change in engagement scores over therapists practice. Yet, the analyses reveal ed a significant interaction between engagement now-versus-then scores and theore tical orientation, for therapists current theoreti cal orientation, F (7,479) = 3.30, p = .002, partial eta squared = .046, for therapists initial theoretical orientation, F (7,479) = 2.35, p = .023, partial eta squared = .033. Table 4-6 depicts the post-hoc results locating the interacti on for both of the analyses. Data indicated that engagement levels have de clined across the practice of therapists that identified their current theoretical commitment as cognitive and integrative, while no significant changes appear for therapists with other theoreti cal commitments. Data also suggested a decline for therapists that identified their initial th eoretical orientation as behavioral, humanisticexistentialist-gestalt, and integrative. The enga gement levels seemed to increase across the practice only for therapists that identified their initial theoretical orientation as narrative/constructivist. Research Question #2: Do Cohort Effects Exp lain Changes in Therapists Epistemic Commitments? As a part of this study we wanted to provide a tentative answer to the question regarding whether cohort effects may have accounted for th e epistemic shift in th e field of psychotherapy. Answering this question in a sa tisfactory manner is beyond the scope of this project, yet we attempted to provide a preliminary answer to this question through conducting hierarchical regression analyses where the number of years that therapists had been in the field was utilized as a continuous indica tor of the cohort.

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73 To conduct this set of analyses, we first computed change scores for the epistemic variables where the THEN scores were subt racted from the NOW scores. Specifically, a constructivist-change score was computed such that we subtracted participants original constructivist commitment score from their current constructivist commitment score. This computation provided us with an index of cha nge, with higher scores indicating therapists increasing commitment to cons tructivist epistemologies. To investigate if the entry-year to the field, numerated by the years that therapists had been in the field, account for their epistemic change, we conducted a series of hierarchical regression analyses where the independent va riable was number of years therapists had after their entry to the field following as graduates and the dependent variable was the therapists epistemic change score. Gender (dummy coded: 1 = male, and 0 = fe male) was entered into the analyses in Step 1 and years after graduation was entered in Step 2 to examine whether the year entry to the field explains variance on therapists epistemic changes when the effect of gender was controlled for. To guard against alpha inflati on, a Bonferroni correction was em ployed to establish the alpha level at .025 (.05/2), which is th e original alpha level (.05) divided by the number of statistical tests. In these regression equations, VIF statistic s ranged from 1.00 to 1.08, suggesting that multicollinearity was not present in the analyses (Myers, 1990). Examination of residual plots indicated normality, linearity, a nd homoscedasticity of residual s in the model. Durbin-Watson coefficient was 1.97 indicating independence of observations. The model failed to account for therapists changing epistemic commitments; for constructivism change score, F (2,634) = 2.19, p > .05, R2 = 0.01; for rationalism change score, F (2,627) = 2.44, p > .05, R2 = 0.01. No significant

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74 levels of the variance in the dependent vari ables, constructivism and rationalism difference scores, was explained by the years that therapists had entered the profession. Our data also allowed us to investigate whether the epistemic shift in the field is the result of the infusion of new therapists who were more committed to the constructivist epistemology to begin with than the seasoned therapists. To investigate this question, we compared therapists initial constructivist commitments in five cohorts (1954 to 1969, N = 21; 1970 to 1979, N = 94; 1980-1989, N = 150; 1990-1999, N = 197; 2000-2008, N = 191). We conducted a one-factor ANOVA, with cohort groups as the between-subjects factor and ther apists initial constructivism scores as the dependent variable. There wa s no significant main effect of cohort, F (4,638) = 1.55, p = .185, partial eta squared = .01. The data failed to show any significant differences in therapists initial cons tructivist commitments across cohort gr oups, again suggesting that cohort effects did not account for the epistemic sh ifts observed in our sample across time. Research Question #3: What is the Relati onship betw een Therapists Epistemic and Professional Change Experiences? We conducted a series of regression analyses to examine whether changes in therapists epistemological commitments were related to the le vels of change in thei r theoretical orientation, the plurality of their theoretical orientations or therapy styles (e xpressive, operative, and attentional dimensions). In other words, we inve stigated to what extent therapists perceived epistemic shifts would explain their current theoretical and stylistic commitments above and beyond their initial standing. To conduct this set of analyses, we first computed change scores for the epistemic variables where the THEN scores were subtra cted from the NOW scores. This index was computed for the commitment to constructivist and rationalist epistemology variables.

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75 We then conducted a series of hierarchical multiple regression analyses to study the main effects of the two independent variables on ea ch of the four depe ndent variables while controlling for gender (dummy coded: 1 = male, a nd 0 = female), age, and average number of clients seen weekly. The independe nt variables were the initial scores for the theoretical and stylistic commitment variables, constructivism difference score, and the rationalism difference score. The dependent variables were five professional variable s: theoretical change index, current theoretical plurality score, and current ex pressive, operative, and attentional scores. For each regression analysis, gender, age, and averag e number of clients were entered in Step 1, initial scores for the dependent variable for that particular an alysis was entered in Step 2, constructivism difference score was entered in Step 3, and rationalism difference score was entered in Step 4. In the analysis where theoretic al change index was the dependent variable, the independent variables were entered in the same order but without the initial score, given that theoretical change index has been rated only once from current perspective. Hence, only this analysis was composed of 3 steps while the ot her analyses were composed of 4 steps. Gender, age, and average number of clients we re entered in the first step as covariates. When it was applicable, the initial scores for the independent vari able were entered in the second step. Constructivism difference scores were entered in the next step to reveal whether change in therapists constructivist epistemology explains the variance on the select current professional commitments over and beyond what initial commitmen ts explain; and this would be the focal point answering our research que stion #2. Rationalism difference scor es were entered in the last step to examine whether change in therapists rati onalist epistemology explains variance on the select professional variables ove r and beyond that of th eir initial commitments and change in constructivist epistemology. A Bonferroni adjustment was employed to protect against the Type

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76 I error, and the alpha level for the overall regres sion analyses for each dependent variable was set at .01 (.05/5), which is the orig inal alpha level (.05) divided by the number of statistical tests. Effect size indices for multiple regression analyses was f2, defined as the R2 divided by one minus R2. The obtained f2s were evaluated according to the Cohens (1992) operational definition of small (.02), medium (.15) and large (.35) effects. To assess for the presence of multicollinearity, the variation inflation factor (VIF) statistics across the independent variables were examine d. Myers (1990) pointed out that a VIF value above 10 indicates concern for the presence of multicollinearity. In our regression equation, VIF statistics ranged from 1.00 to 1.01, suggesti ng that multicollinearity was not present. Examination of residual plots indicated normality, linearity, and homoscedasticity of residuals in the models. Durbin-Watson coefficient ranged from 2.01 to 2.17 suggesting the independence of observations. The results of the hierarchical multiple regression analysis for the four dependent variables are presented in Table 4-7. The results indi cated significant regres sion equations (i.e., p < .01 for the overall F ratio at the last step) for all of the dependent variables: theoretical change, theoretical plurality, expressive, operative and attentional scores. In the first step of the models, covariates age and number of clients seen weekly were significantly related to four different variables of interest. Age accounted for 3% of variance in both theoretical change index and expressive score, while number of clients seen weekly accounted for 2% of variance in operative score a nd for 4% of variance in attentional score. Where the theoretical change was the dependent variable, the model at Step 2 explained 5% of the variance and the inclusion of rationalist commitment cha nge into the model at the Step 3 improved the model by 2%. Overall, the model explained %7 of the variance in the dependent

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77 variable. Only for this model, constructivism difference score failed to account for significant levels of variance after the rationalism difference score was entered into the analysis. At the third step of this model, the F valu e for constructivism difference scor e could no longer meet the alpha of .01. For the other dependent variables of theore tical plurality, expre ssive, operative, and attentional, the models at the Step 2, at which th e initial standings were entered into the model, accounted for a significant amount of variance in the dependent variables after controlling for the variance explained by gender, age, and average nu mber of clients. The models accounted for variances in four dependent va riables between 27% and 36%. At Step 3, the model accounted for a significant amount of variance in all of the f our dependent variables af ter controlling for the variance explained by gender, age, average num ber of clients, and initial standings. The inclusion of constructivism diffe rence scores into the model at Step 3 increased the accounted variances between 3% and 7%. The model at Step 4 accounted for a significant amount of variance only in three therapy style variables afte r controlling the variance explained by gender, age, average number of clients, initial standi ngs, and constructivism difference scores. For the theoretical plurality, inclusion of rationalism difference scores failed to improve the variance explained in the dependent variable. For the th ree therapy style variables, the inclusion of rationalism difference into the model at Step 4 increased the accounted variances between 4% and 9%. The overall models accounted for varian ces in four dependent variables between 37% and 50%. To identify the location and dire ction of the effects on each of these dependent variables, we examined a standardized beta coefficient for each predictor. At the first step, the results indicated that age was positively related to particip ants ratings of their theoretical change across

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78 the years of practice ( = 0.15), and negatively related to pa rticipants expressive scores ( = 0.13). The standardized beta coefficients suggested that with increased age, participants tended to rate their theoretical change higher, and rate their expressive lower. Average number of clients seen weekly was negatively related to both operative and atte ntional scores ( = -0.13; = 0.15), suggesting that as participan ts caseload increased, they tende d to rate their operative and attentional dimensions lower. The second step of the models for the curren t theoretical plurality, expressive, operative, and attentional variables, revealed that participants initial standing with these variables were positively related to the dependent variables. Init ial ratings were positively related to current ratings of the variables; for theoretical plurality, = 0.57, for expressive, = 0.49, for operative, = 0.60, and for attentional, = 0.53. Higher initial ratings for the variab les predicted higher scores for the current rati ngs of the variables. The next step of the models revealed that participants increasing adherence to constructivist epistemology were positively related to three of the dependent variables and negatively related to the other two. Increasingly higher constructivism scores were positively related to theoreti cal change index ( = 0.14), theoretical plurality ( = 0.21), and expressive ( = 0.27), and negatively related to operative ( = -0.12) and atten tional dimensions ( = -0.17). Consistent with our expecta tions, therapists increasing commitment to constructivist epistemology predicted increasing change in their theoretical orientation, as well as higher levels of theoretical plurality, emotional expressive, spontaneity in conducting therapy and broadened focus in gathering information in th erapy in their current practice. The last step of the models revealed that therapists increasing adherence to rationalist epistemology was positively related to operative ( = 0.32) and attentional ( = 0.21) scores and

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79 negatively related to the th eoretical change index ( = -0.14), and to expressive scores ( = 0.21). Therapists increasing commitment to rationa lism predicted higher scores on operative (i.e. less spontaneous) and attentional (i.e. narrower focus), and lower scores on expressive and theoretical change index. As therapists commit ments to rationalist epis temology increased, they tended to rate their current practice as low on theoretical orientation change, emotionally expressive, spontaneity and range of focus in information gathering. Therapists increasing commitment to rationalist epistemology failed to relate to their theoretical plurality scores. The addition of the rationalism difference score to the models revealed certain changes in the variance accounted by the constr uctivism difference scores for four dependent variables. Beta coefficients for constructivism difference score d ecreased for the variables of theoretical change, expressive, operative, and attentional once the ra tionalism difference scores were entered to the model. These changes are summarized at Table 48. For the theoretical change index, the decline in the beta coefficient resulted in failure for c onstructivism difference scores to significantly account for the variance on this dependent variable The results indicated that the inclusion of both spectrums of epistemic commitment, constructivism as well as rationalism, strengthened our understanding of the complex interaction between therapists epistemic and professional change experiences. Moreover, the results sugges ted that change in therapists commitment to rationalist epistemology was a better predictor of operative and attentional scores compared to change in participants commitment to constructivist epistemology. The magnitudes of the effect sizes of the main analyses, between 0.07 and 0.98, correspond to small to large effects (Cohen, 1992). Obtained e ffect sizes suggested th at results have some practical significance in addition to statistical significance for the variables of theoretical plurality and therapy style. Effect sizes suggest ed that constructivism and rationalism difference

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80 scores accounted for 9% to 41% of the variability in the theore tical plurality and therapy style scores. On the other hand, effects sizes suggested limited practical significan ce for the theoretical change index. Constructivism and rationalism difference scores accounted for 4% of the variability in this variable. Table 4-1. Summary statistics of variables of interest. Variable N M SD Possible Range Sample Range SkewnessKurtosis n of items Now 675 22.43 5.30 8-40 8-38 -0.05 -0.12 8 0.69 1. TAQ-R Then 673 24.46 5.25 8-40 8-39 -0.33 0.11 8 0.70 Now 683 33.51 3.55 8-40 19-40 -0.53 0.46 8 0.58 2. TAQ-C Then 680 31.20 3.82 8-40 16-40 -0.32 0.49 8 0.64 3. TCI 663 3.05 1.12 1-5 1-5 -0.20 -0.95 1 Now 653 22.61 3.72 7-35 12-34 0.05 -0.00 7 4. TP Then 650 19.92 3.94 7-35 9-33 0.15 -0.22 7 Now 630 41.26 6.41 9-63 22-60 0.02 -0.01 9 0.59 5. EX Then 628 36.61 6.43 9-63 15-59 0.12 0.40 9 0.57 Now 659 27.49 5.78 6-42 8-42 -0.30 -0.15 6 0.66 6. EN Then 656 28.43 5.31 6-42 12-42 -0.30 0.19 6 0.61 Now 660 21.64 4.20 6-42 7-35 -0.16 0.33 6 0.35 7. AT Then 659 24.16 4.60 6-42 10-37 -0.10 0.13 6 0.45 Now 646 21.87 6.37 7-49 7-45 0.41 0.14 7 0.74 8. OP Then 646 23.57 6.97 7-49 7-47 0.40 0.00 7 0.75 Note. TAQ-R = Therapist Assumption Scale Ra tionalism; TAQ-C = Therapist Assumption Scale Constructivism; TCI = Theoretical Cha nge Index; TP = Theoretical plurality; EX = Expressive; EN = Engagement; AT = Attentional; OP = Operative; Now = Therapists current view of themselves today; Then = Therapists view of themselves when they first started practicing following the completion of their graduate training.

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81 Table 4-2. Intercorrelations am ong the variables of interesta. Variable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1. TAQ-R-Now 2. TAQ-R-Then 0.7** 3. TAQ-C-Now -0.2** -0.1** 4. TAQ-C-Then -0.1* -0.3** 0.5** 5. TCI -0.1 0.1 0.1* -0.1* 6. TP-Now -0.1* -0.1* 0.3** 0.2** 0.1 7. TP-Then -0.1* -0.1** 0.1* 0.3**-0.2** 0.6** 8. EX-Now -0.3** -0.2** 03** 0.2** 0.1* 0.2** 0.1 9. EX-Then -0.2** -0.3** 0.1** 0.4**-0.1** 0.1 0.2** 0.5** 10. EN-Now -0.2** -0.1** 0.1 0.0 0.0 0.1* 0.0 0.4** 0.2** 11. EN-Then -0.2** -0.1** 0.1* 0.1 0.0 0.0 0.1 0.2** 0.3** 0.6** 12. AT-Now 0.3** 0.3** -0.3** -0.2** 0.0 -0.2**-0.1* -0.3**-0.1** 0.0 0.0 13. AT-Then 0.2** 0.4** 0.0 -0.2** 0.2** 0.0 -0.1**-0.1 -0.3** 0.0 0.0 0.5** 14. OP-Now 0.5** 0.3** -0.3** -0.2** 0.1 -0.1** 0. 0 -0.3**-0.2**-0.2** -0.1** 0.5** 0.3** 15. OP-Then 0.3** 0.5** -0.1** -0.3** 0.1 -0.1 -0.1 -0.2**-0.3**-0.1 -0.1* 0.3** 0.5** 0.6** Note. TAQ-R = Therapist Assumption Scale Rationalism; TAQ-C = Therapist Assumption Scale Constructivism; TCI = Th eoretical Change Index; TP = Theoretical plurality; EX = Expressive; EN = Engagement; AT = Attentional; OP = Operative; Now = Therapists current view of themselves today; Then = Therapists view of themselves when they first started practicing following the completion of their graduate training. aListwise N = 537; *p < .05 **p < .01 Table 4-3. Repeated measures ANOVA summary ta ble for perceived epistemic and stylistic commitment differences across time. Variable N M SD Df F Partial eta-squared Now Then Now Then 1. TAQ-C 642 33.51 31.18 3.55 3.86 1,640 173.90** 0.22 2. TAQ-R 636 22.47 24.47 5.30 5.29 1,634 107.78** 0.15 3. EX 625 41.24 36.62 6.41 6.44 1,624 327.83** 0.34 4. EN 491 27.49 28.40 5.80 5.32 1,489 0.25 0.00 5. AT 482 21.61 24.06 4.19 4.53 1,479 12.09** 0.03 6. OP 641 21.89 23.58 6.36 6.98 1,640 48.68** 0.07 7. TP 649 22.60 19.91 3.72 3.94 1,648 395.92** 0.38 Note. TAQ-R = Therapist Assumption Scale Rationalism; TAQ-C = Therapist Assumption Scale Constructivism; EX = E xpressive; EN = Engagement; AT= Attentional; OP = Operative; TP = Theoretical plurality; Now = Therapists current view of themselves today; Then = Therapists view of themselves when they fi rst started practicing fo llowing the completion of their graduate training. **p .001

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82 Table 4-4. Repeated measures ANOVA summary ta ble for perceived theoretical commitment differences across time. Variable N M SD Df F partial etasquared Now Then Now Then 1. Cognitive 6614.08 3.34 1.00 1.31 1,660 202.06** 0.23 2. Behavioral 6613.48 3.10 1.19 1.41 1,660 5,718.19**0.07 3. Humanistic Existential Gestalt6583.35 3.22 1.19 1.34 1,657 9.11 0.01 4. Narrative/constructivist 6522.44 1.92 1.32 1.15 1,651 163.32** 0.20 5. Systemic Family 6593.13 2.82 1.21 1.30 1,658 43.89** 0.06 6. Psychodynamic 6603.05 2.98 1.38 1.50 1,659 2.46 0.00 7. Feminist Multicultural 6593.10 2.54 1.29 1.33 1, 658 169.24** 0.21 **p < .001 Table 4-5. Current and initial theo retical orientation endorsements. Variable Valid Percentage Now Then 1. Cognitive 27.0 23.9 2. Behavioral 4.7 12.4 3. Humanistic Existential Gestalt 8.0 16.9 4. Narrative/constructivist 4.2 1.5 5. Systemic Family 4.7 6.4 6. Psychodynamic 17.1 26.5 7. Feminist Multicultural 2.1 1.1 8. Integrationist 32.2 11.3 Table 4-6. Post-hoc analyses examining the mode rating effect of the theoretical commitment on perceived engagement differences across time. *p .01, **p < .001 Main theoretical orientation Current Initial M F M F Now Then Now Then Cognitive 25.76 27.31 13.70**26.57 27.20 2.12 Behavioral 29.00 28.86 0.02 27.68 29.22 6.36* Humanistic Existential Gestalt 28.49 28.88 0.28 27.24 28.81 9.72* Narrative/Constructivist 29.01 27.61 2.11 32.06 26.63 6.87* Systemic Family 26.62 25.47 1.31 25.76 27.17 2.59 Psychodynamic 28.83 29.34 1.08 29.18 29.47 0.51 Feminist Multicultural 30.73 28.40 1.87 27.15 29.44 0.98 Integrationist 27.32 29.01 21.71**26.25 27.70 5.63*

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83 Table 4-7. Hierarchical regressi on analyses showing amount of unique variance in therapists current professional standing accounted for by their initial standing and epistemic commitments. Variable T R2 F df1 Df2 R2 f2 Dependent Variable: Theoretical Change Index Step 1 Gender 0.03 0.64 Age 0.15 3.27* Weekly clients 0.04 0.87 0.03 4.49* 3 468 0.03 0.03 Step 2 Gender 0.04 0.80 Age 0.15 3.23* Weekly clients 0.04 0.80 Constructivism difference 0.14 3.17* 0.05 5.95** 4 467 0.02 0.05 Step 3 Gender 0.04 0.91 Age 0.15 3.29* Weekly clients 0.04 0.77 Constructivism difference 0.10 2.05 Rationalism difference -0.14 -2.86* 0.07 6.47** 5 466 0.02 0.07 Dependent Variable: Theoretical Plurality Now Step 1 Gender -0.07 -1.44 Age 0.00 0.07 Weekly clients 0.07 1.50 0.01 1.34 3 461 0.01 0.01 Step 2 Gender -0.01 -0.12 Age -0.01 -0.14 Weekly clients 0.01 0.34 Theoretical plurality Then 0.57 14.82** 0.33 56.35** 4 460 0.32 0.49 Step 3 Gender 0.01 0.25 Age -0.01 -0.25 Weekly clients 0.00 0.09 Theoretical Plurality Then 0.61 16.03** Constructivism difference 0.21 5.61** 0.37 54.37** 5 459 0.04 0.59 Step 4 Gender 0.01 0.20 Age -0.01 -0.26 Weekly clients 0.00 0.12 Theoretical Plurality Then 0.61 16.04** Constructivism difference 0.23 5.84** Rationalism difference 0.06 1.60 0.37 45.89** 6 458 0.00 0.58 Dependent Variable : Expressive Now Step 1 Gender -.040 -0.84

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84 Table 4-7. Continued. Variable T R2 F Df1 df2 R2 F2 Age -0.13 -2.75* Weekly clients 0.10 2.04 0.03 4.24* 3 438 0.03 0.03 Step 2 Gender -0.01 -0.30 Age -0.10 -2.31 Weekly clients 0.06 1.34 Expressive Then 0.49 11.90** 0.27 39.60** 4 437 0.24 0.36 Step 3 Gender 0.01 0.17 Age -0.10 -2.49* Weekly clients 0.04 1.13 Expressive Then 0.56 13.77** Constructivism difference 0.27 6.74** 0.34 43.98** 5 436 0.07 0.50 Step 4 Gender 0.02 0.37 Age -0.10 -2.50* Weekly clients 0.04 1.02 Expressive Then 0.60 14.87** Constructivism difference 0.22 5.26** Rationalism difference -0.21 -5.01** 0.37 42.85** 6 435 0.04 0.59 Dependent Variable: Operative Now Step 1 Gender 0.05 1.09 Age -0.06 -1.16 Weekly clients -0.13 -2.65* 0.02 2.99 3 447 0.02 0.02 Step 2 Gender 0.03 0.84 Age 0.01 0.35 Weekly clients -0.06 -1.47 Operative Then 0.60 15.54** 0.36 63.82** 4 446 0.34 0.57 Step 3 Gender 0.02 0.55 Age 0.03 0.68 Weekly clients -0.05 -1.25 Operative Then 0.64 16.98** Constructivism difference -0.22 -5.81** 0.41 61.55** 5 445 0.05 0.69 Step 4 Gender 0.01 0.39 Age 0.03 0.87 Weekly clients -0.03 -0.96 Operative Then 0.70 19.65** Constructivism difference -0.12 -3.30* Rationalism difference 0.32 8.71** 0.50 72.54** 6 444 0.09 0.98

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85 Table 4.7. Continued. Variable T R2 F Df1 df2 R2 F2 Dependent Variable: Attentional Now Step 1 Gender 0.09 1.87 Age -0.11 -2.32 Weekly clients -0.15 -3.21** 0.04 5.88** 3 456 0.04 0.04 Step 2 Gender 0.10 2.50 Age -0.03 -0.71 Weekly clients -0.12 -3.08* Attentional Then 0.53 13.48** 0.31 51.59** 4 455 0.28 0.45 Step 3 Gender 0.09 2.31 Age -0.02 -0.46 Weekly clients -0.12 -3.02* Attentional Then 0.57 14.39** Constructivism difference -0.17 -4.40** 0.34 46.80** 5 454 0.03 0.52 Step 4 Gender 0.08 2.19 Age -0.01 -0.33 Weekly clients -0.11 -2.95* Attentional Then 0.62 15.64** Constructivism difference -0.11 -2.86* Rationalism difference 0.21 5.24** 0.38 45.84** 6 453 0.04 0.61 *p .01 **p < .001 Table 4-8. Hierarchical regression beta coefficients for constructivism difference scores at steps 2, 3, and 4. Step 2/3 Step 3/4 Dependent Variable T T Theoretical Change Index 0.14 3.17* 0.10 2.05 Theoretical Plurality Now 0.21 5.61** 0.23 5.84** Expressive Now 0.27 6.74** 0.22 5.26** Operative Now -0.22 -5.81** -0.12 -3.30* Attentional Now -0.17 -4.40** -0.11 -2.86* *p < .01 **p < .001

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86 CHAPTER 5 DISCUSSION The discussion section is com posed of three sub-sections. First, the hypotheses and findings of the study are summarized. Second, a detail ed interpretation of th e findings in the light of literature on epistemology and therapists pr ofessional experiences is provided. And last, limitations as well as implications of the present study and suggestions for future studies are presented. Summary of Results Overall, the results of the present study supported the prim ary hypotheses regarding the change processes of therapists epistemic comm itment. Therapists ratings of their epistemic commitments reflected a greater current commitme nt to constructivism (Now) than when they began their careers (Then). Conversely, they perceived themselves as having become less committed to rationalist epistemology across the cour se of their practice. The data failed to find significant cohort effects for therapists initia l epistemic commitments and their epistemic change scores. In other words, the data s uggested that therapists perceived epistemic commitments, shifting towards gr eater constructivism (and less rationalism) across time, were not a function of when they entered the field, but rather reflected per ceived changes across the course of their careers, regardless of the na ture of their initial epistemic leanings. The results also supported the hypotheses regard ing the therapists change processes in selected professional characteristics. These prof essional characteristics included their theoretical orientation, theoretical plurality, and expressive, operative and atte ntional dimensions of therapy styles. Therapists ratings of these characteristic s indicated that they perceived themselves as becoming more pluralistic, i.e. integrationist in their theoretical orientation, and more emotionally expressive, more operatively spontaneous, and broader in attention in their

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87 therapeutic styles. The data failed to indicate an overall change in therapists perceived engagement style in therapy; post-hoc analyses (see below) extended our understanding of this finding. The results also suggested that perceived ch ange in epistemology predicted therapists current professional standings af ter accounting for their initia l standings. After accounting for therapists initial standings and rationalist-change scores, increase in therapists constructivist commitments predicted increased levels of adhe rence to theoretical integration and increased levels of emotional expressivene ss, operative spontaneity, and a ttentional range of therapists. After accounting for therapists initial standings and constructivism-change scores, decrease in their rationalist commitments predicted increased change in theoretical commitments as well as increasing levels of emotional expressiveness, operative spontaneity, a nd attentional range of therapists. Epistemic Journey Constructions of Psychotherapists The field of psychology and particularly psyc hotherapy has changed dram atically over years (Farber, 2005). Mahoney (1995a, 1995b) considered epistemic change among the experiences of change that the field has experi enced. Substantial anecdotal, conceptual, and casebased information (such as Ellis, 1993, 1995; Goldfried, 2001a) supported Mahoneys suggestion that the field of psychotherapy has become increasi ngly constructivist over th e course of the last 20 years. Mahoney (1995b) also noted that given th e dialectical interacti on between the field and its practitioners, changes in the field would impa ct the way psychotherapi sts practice and also perceive their practice, while their pract ice would impact the field, in return. The primary aim of the present study was to i nvestigate whether psyc hotherapists perceive such an epistemic shift within themselves as a reflection of the epistemic shift in the field. We

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88 specifically hypothesized increasing levels of perceived commitment to constructivist epistemology as therapists continued to develop across time. Results were consistent with this hypothesis. Therapists perceived an increase in their commitment to constructivist epistemology when they reflected on their init ial and current perspectives. Thei r perceived change experiences also entailed a reduction in th eir commitment to rationalist epis temology across their practice. These findings can be interpreted analyzi ng Mahoneys (1995a, 1995b) assumptions, as well as the available literature supporting Ma honey. The constructivist worldview assumes complexity and interdependency of human experi ences and social systems. Therapies guided by constructivist epistemology are committed to appreciation of complexity, and in-depth processing of client emotions and experi ences (Nagae & Nedate, 2001; Vasco, 1994; Viney, 1994; Winter & Watson, 1999), and they tend to have higher levels of self-exploration, attendance to emotions, openness and tolerance in therapists (Neimeyer & Aksoy, 2005). Various prominent psychotherapists, such as Albert Ellis (1992a, 1999), Donald Meichenbaum (1993), Aaron Tim Back (2002; Bloch, 2004), and Michael Mahoney (1991), had suggested their increasing levels of constructivism implicitly in their descriptions of their own professional development across time, with prac tices becoming more eclectic and complex in relation to their work with their clients. At cer tain times, they explicitly identified their change processes as reflecting an epistemic shift a nd an increasing commitme nt to constructivist epistemology (Ellis, 1990, 1995; Meichenbaum, 1990; Mahoney, 2001). Studies conducted on therapis ts career developments also have recounted change processes that indicated the de velopment of characteristics acro ss years that might parallel increasing commitment to constructivist epis temology (Rnnestad & Skovholt, 2003). Increased practice and experience in the field translated to therapists increasi ng likelihood to reject

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89 precisely defined realities and embrace complexity and flexibility in the ways they understood and reached out to their clients. The current st udy indicates that psychotherapists also perceive this trend of increasing commit ment to constructivist epistemology within themselves. Rationalist and constructivi st epistemologies are largely complementary and their differences reflect upon the way therapy is conceived and conducted (Lyddon, 1988; Mahoney & Gabriel, 1987; Mahoney & Lyddon, 1988). Rationalist epistemologies tend to assume a stable, single, universal reality and therapists commitme nt to rationalist epistemology translates into their practice with an aim to corre ct the clients faulty cogniti ons of reality through a relatively straightforward approach (Nagae & Nedate, 200 1; Vasco, 1994; Viney, 1994; Winter & Watson, 1999). Higher levels of rationalist commitments we re also linked to lower levels of selfexploration, openness, and tolerance in therapists (Neimeyer & Aksoy, 2005). Career development studies have indicated that therapists tend to reject precisely defined realities, and embrace complexity and flexibility in the ways they conceptualized and conducted therapy over the course of their developmen t as professional pract itioners (Rnnestad & Skovholt, 2003). These changes are consistent with a greater alignment with constructivist commitments. We might expect that therapis ts increasing commitment to constructivist epistemologies across the course of their deve lopment would be associated with corresponding decreases in complementary epistemologies such as rationalism. Hence, the finding of perceived weakening in therapists rationa list commitments is consistent with overall increase in constructivist leanings in the current study. The current study reveals that la y psychotherapists also percei ve this trend of increasing commitment to constructivist epistemology within themselves. When therapists reflected on their current and initial experiences, they observed an increase in their constructivist commitments

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90 and a decrease in their rationalist commitments. Next, we inves tigated the degree to which cohort effects underlie epistemic changes of the therapists and the field. Cohort Effect on Perceived Changes on Epistemic Leanin gs Existing literature agrees that the field is shifting in its epistemi c commitments (Mahoney, 1995a, 1995b) and the current study pr ovides support for this clai m from the perspective of practicing psychotherapists. Changes in the field and the changes of its members are reciprocal. The change in the field impacts its existing me mbers as well as those who enter the field recently, while the existing members change processes further impacts the field. As Farber et al. (2005) noted, the changes in the field impacts therap ists such that those w ho enter the field at a certain time might be different than others who have entered the field at an earlier era. Therapists entering the field recently might differ from seasoned therapis ts in their motivations or aspirations (Farber et al., 2005). Similarly the epistemic commitments of those therapists who entered the field recently might be different than their seasoned colleagues as a part of the epistemic change of the field of psychotherapy. In fact, it can be suggested that the epistemic journey of the field with its increasingly postmodernist perspective can be a reflection of the recent cohorts greater commitment to constructivism and postmodernism. At the same time, a review of studies on caree r development of practi tioners suggested that individual change processes of th e members of the field are system atic in nature, are independent from the cohort to which practitioners bel ong to or their experience level (Rnnestad & Skovholt, 2003), and include themes of increasin g commitment to constructivist epistemology. In other words, from the perspective of career development theories, the fields epistemic journey might be a reflection of the therapists individua l change processes. It is also possible that such individual change processes are subject to cohort effects such that certain groups of

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91 practitioners who entered the fiel d at a certain era might have a different epistemic journey due to the nature of the field at that time. Given the lack of empirical l iterature on this topi c, the current study aimed to provide an initial understanding of the complex dynamics unde rlying the fields and therapists epistemic shift. The current study explored to what extent the perceived epis temic shifts can be attributed to cohort effect facilitated by th e more recent infusion of post-modern therapists to the field versus the perceived individual change processes of psychotherapists across time. Within the limits of the current study, we focused our attenti on to two specific areas that might shed light on the proposed question. First, we examined whet her or not different cohort groups predicted differences in the levels of th erapists initial levels of cons tructivist commitments. If cohort effects were strong, this might suggest that the overall shift in the field towards greater constructivism was due to the more infusion of ne w therapists into the field, who carried with them greater constructivist commitments. Relate dly, we examined the data to see whether the different cohort groups predicted the ways in whic h therapists changed in their epistemic shifts, in order to understand the degr ee to which the entry year to profession colors the epistemic change processes of therapists (did older, or younger therapists change more, for example?). The results failed to suggest sign ificant cohort effects either fo r therapists in itial epistemic commitments or for their epistemology change scores. Therapists initial commitment to constructivism, as they construed it, has been similar across the ye ars of entry to the field. Hence our data indicates that the fi elds increasing commitment to c onstructivist epistemology cannot be explained via the influx of those therapists with post-mode rn tendencies and/or trainings. Therapists initial commitment to rationalism has also been sim ilar across years suggesting that

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92 therapists epistemic commitments at the time that they have entered the field cannot be differentiated by the time in which they have entered the field. Data also failed to support if therapists year of entry to the field colored their epistemic journey. For the group of therapists in this study, therapists change in their epistemic commitments was independent from the era in wh ich they have been trained and entered the profession. The results failed to support the notion that cohort effects might underlie epistemic change processes of therapists and of the field. Overall the obtained results may imply that therapists individual processes play a dominant role in therapis ts epistemic journey rather than the cohort effects. This is consistent with our review of the career development literature, where greater constructivist commitment appeared to be a part of pract itioners professional change pr ocesses. For instance, Rnnestad and Skovholt (2003) suggested that therapists career development involved increased conceptualization of knowledge as a construction and decreased use of precisely defined realities in understanding clients, which are not only consis tent with constructivist perspective, but also indicative of increasing commitment to construc tivist epistemology across the therapists course of practice. Theoretical and Stylistic Change Constructions of Psychotherapists Change concerning ther apists is not limited to their personal epistemo logies but includes professional attributes as well. When they re flected on their initial and current experiences, therapists revealed change in certain professi onal aspects such as theoretical plurality and therapy style. Theoretical Change Theoretical change acro ss practic e is considered a widespread experience for contemporary psychotherapists (DeAngelis, 2006, p. 59). This trend was also evident in the current study.

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93 Overall, therapists perceived st atistically significant and mode stly robust increases in their commitments to cognitive, constructivist, and femi nist-multicultural therapies. There were also significant increases in behavioral and decreases in commitment to systemic-family therapies, although these changes were failed to be robust, as suggested by th eir low effect size indices. When therapists were asked to identify one theo retical orientation as their primary orientation, a similar trend has emerged where commitments to cognitive, narrative-cons tructivist, feministmulticultural and integrationist perspectives strengthened over time. These results are consistent with the current trends where cognitive, constructi vist, multicultural, and integrationist theories are more prevalent for therapists as their main base (Norcross et al., 2002). The most notable change in the realm of theo retical orientation is the fields increasing openness to theoretical integra tion and technical eclecticism (G oldfried, 2001a; Norcross et al., 2002; Norcross, 2005). One of the aims of the present study was to investigate whether psychotherapists perceive such a theoretical shift within themselves. We specifically hypothesized increasing levels of perceived theoretical plurality as therapists developed across time. Results consistently supported this hypothe sis. Therapists report ed statistically and clinically significant increases in the variety of theoretical orientations that they employed in their practice. Rnnestad and Skovholt (2003) provided an explanation for therapists theoretical shift that mostly entails integration of a number of theoretical orientations. Increasing practice in psychotherapy enhances the congruity between th erapists personality a nd their the ways in which they conduct therapy. Therapists changing th eir theoretical orientati on can be an indicator of such an increased integration and congr uency. Rnnestad and Skovholt (2003) further suggested that as therapists theo retical adherence shifte d, their therapy style may shift in certain

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94 ways. Next, we summarize what the current study revealed about therapists perceived change experiences in the ways in which they conduct therapy. Stylistic Change Preliminary evidence suggesting the change in therapy style across the years of practice was provided by Castaeiras et al .s (2006) study where expert a nd beginner therapists showed differences in certain aspects of their therapy styles. Therapist professional development studies (Jennings & Skovholt, 1999; Martin et al ., 1989; Rnnestad & S kovholt, 2003; Skovholt & Jennings, 2004) and personal narrat ives of seasoned therapists (Goldfrie d, 2001a) also supported the assumption that therapists styles might change with experience. The aim of the present study was to investigate whether psychotherapists perceive such stylistic shifts within themselves and to provide further support for the existing literature. We specifically hypothesized increasing ly higher levels of perceived expressive and engagement scores, and lower levels of percei ved operative and attentional scor es as therapists became more experienced. In other words, we expected therapists to perceive themselves to have increased in their (a) expressing emotions to their clients, (b) commitment to therapy and clients, (c) spontaneity in the way of implementing interven tion, and (d) range of attention when gathering information from clients. Results supported three of the four hypotheses. Therapists reported increases in their expressive and decreases in their operative and attentional dimensi ons of therapy styles. In other words, across the course of thei r practice therapists perceived statistically significant and robust increases in their emotional closeness and expr essiveness to their clients, increases in the spontaneity with which they conducted therapy and increases in the ra nge of attention and activity in gathering information. Results failed to indicate any ch ange in therapists degree of

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95 commitment to therapy and engagement with c lients, i.e. engagement dimension of therapy styles. The obtained results were mostly consistent with the literature. Castaeiras et al.s (2006) study on differences between expe rt and beginner therapists in therapy style, therapist professional development studies (Jennings & S kovholt, 1999; Martin et al., 1989; Rnnestad & Skovholt, 2003; Skovholt & Jenni ngs, 2004), and personal narratives of seasoned therapists (Goldfried, 2001a) concluded that therapists become more emoti onally expressive, operatively spontaneous, and broader in their therapeutic attention across the course of their practice. Castaeiras et al. (2006) found th at expert therapists who were identified with cognitive orientation were more emotionally closed to wards their clients compared to beginners. Additionally, Jennings & Skovholt (1999; Skovho lt & Jennings, 2004) described master therapists as having strong emotional skills such as emotional receptiveness, ability to attend to self and others emotions and r ecognition of the ways in which their own emotions impact their work. These findings supported the findings noting that therapists perceived their emotional expressiveness to strengthen over th e course of their practice. Castaeiras et al. (2006) found th at expert integrative therap ists were more spontaneous in implementing interventions compared to be ginners. Likewise, Rnnestad and Skovholt (2003) suggested that as therapists matured, they grad ually developed an internally-based flexible professional functioning. This inferred flexibil ity across professional development was aligned with the findings that expert therapists were more spontaneous in implementing interventions. The narrations of 16 experienced psychotherapists also described their process of breaking free from their original teachings and developing inte grative, expansive, pliable ways of being and doing in their therapeutic work (Goldfried, 2001a). Overall, the results of our study support the

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96 broader literature regarding therapists increasing spontane ity over the course of their professional development and practice. Castaeiras et al. (2006) found that beginning integrative an d psychoanalytic therapists endorsed a significantly narrower focus and search for a specific realm of knowledge than their expert counterparts. Experienced therapists tended to conceptua lize their clients at a broader level and in a more inclusive manner (Martin et al., 1989). The internally-based flexible professional functioning of expert therapists was also aligned with therapists being more broadly focused and open-minded while listening to client material In their narrations, practitioners also reflected on their professional change processes where they have increased in flexibility, and broadened their understanding and a ppreciation of client concerns (Goldfried, 2001a). Overall, the finding of therapists increasing ra nge of attention in information gathering across their practice is consistent with the literature. Yet, it is im portant to note the low reliability rates obtained for the current and initial attent iveness scores since these rates raise questions regarding the validity and interpreta tion of the obtained findings. We expected therapists to report increased commitment to therapy and to their clients across their practice, yet the data failed to support our expectations of increased engagement scores across years. One plausible explanati on may be the relatively high initial ratings of engagement dimension of therapy style. Within the possible range of 6 to 42, participants average engagement-now score was 27.49 and engagement-then score was 28.40. Although there was potential for them to score higher, no other dimensions of therapy style in the study has passed the 65 to 67 % rating figure that was achie ved by the engagement scores. In other words, the datas failure to indicate any increase in engagement dimension of therapy style might stem from the fact that therapists perceived themselves highly committed to therapy and engaged with

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97 their clients starting the beginning of their careers, leaving less of a room for growth or increase on this domain. The ceiling effect may also explain the reduction on the average of the engagement score from then to now, although this di fference failed to be clin ically significant. If therapists had hit the maximum of their care a nd concern for their client s starting their careers, they might experience a slight decline in thei r engagement level across the course of their practice. Castaeiras et al.s (2006) study may also aid our understandi ng of the datas failure to support our hypothesis regarding increased therapis t engagement across practice. Specifically, Castaeiras et al.s (2006) study indicated that differences acro ss experience levels emerged for the dimension of engagement only for those therap ists who were identified as integrationist, but not for psychoanalytic or cognitive therapists. In our analyses, we investigated the change experiences of all participated therapists without controlling for their theoretical commitment, and that might have masked the therapy style ch anges for therapists with specific theoretical commitments. Post-hoc analyses were utili zed to investigate if differences across experience levels emerge for the dimension of engagement only fo r those therapists with certain theoretical orientation. Data confirmed the interaction between theoretical commitments and time on therapists levels of engagement. For therapists that identify their current theoretical commitment as cognitive and integrative, engagement levels have declined across their practice while no significant changes appear for therapists with other theoretical commitments. For therapists that identified their initial theoretical orientation as behavioral, humanistic-exi stentialist-gestalt, and integrative, engagement levels have declined acro ss their practice. For therapists that identified their initial theoretical orientation as narrative/co nstructivist, their engagement levels seemed to

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98 increase across their practice. Possible explana tions of these effects were drawn from the literature. Overall, findings supported the explanation that therapists stylistic changes may be moderated by their theoretical commitments (Castaeiras et al ., 2006), masking the engagement changes when combining responses of therapists with different theoretical commitments. The obtained results revealed that the therapy style changes happen in a complicated fashion, where different theoretical orientations currently held or held in the past, may impact perceived changes in therapy styles in different ways. While Castaeiras et al. found that expert level integrationist th erapists had higher levels of engagement scores than beginners our findings indicate that therapists who were initially or currently identified their theoretical orientation as integrative perceived themselves to have decreasing levels of engagement across years. The difference might be a result of the methodological differences between the two studies. First, the two studies differ in the ways in which therapists theoretical commitments were determined. Castaeiras et al. assigned theoretical orientation to the therapists who par ticipated based on their de scriptions of how they conduct therapy; on the other hand, in the curr ent study, it was the participants themselves (rather than the researchers) who identified their main theoretical commitments with no descriptions of how they conduc t therapy or what these orient ations that th ey selected particularly mean to them. Second, the two st udies differed in the number of theoretical orientations that were included in the analyses. Castaeiras et al. grouped theoretical orientation into 3 orientations; on the other hand, the current study expanded the options to 7 orientations that might have captured the complexity of the interaction in-depth. Thir d, the two studies differ in their comparison groups and conducted analyses. Castaeiras et al. compared expert

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99 therapists therapy style to beginner level therapists therapy st yle, where beginner was defined as therapists with up to 5 years of experience and experts as therapists with 15 years of experience or more. However, the current study co mpared the same therapists ratings of their initial and current therapy style that included an average of 20 y ears of experience (ranging from 1 year to 52 years). Decreasing levels of engagement that were found for therapists who were initially committed to behavioral, humanistic, integrat ive and currently committed to cognitive and integrative therapies was mostly inconsistent with the literature. But this finding may be explained with the literature of therapist distress and burnout. Conducting psychotherapy can be a distressing endeavor due to various sources of distress ranging from economic uncertainty to working with complex issues where it is diffi cult to define success (Kramen-Kahn & Hansen, 1998). Conducting therapy has been recognized among factors contribut ing to the burnout (Kestnbaum, 1984; Grosch & Olsen, 1994) that has been defined as to fail, wear out, or become exhausted by making excessive demands on ener gy, strength or resour ces (Freudenberger, 1974, p. 159). Depersonalization that refers to uncaring and un feeling attitudes towards others, especially clients was identif ied among the central features of burnout (Maslach, Jackson, & Leiter, 1996). The reduced commitment to therapy and clients may be related to an increase in therapists depersonalization experience that may follow the taxing years of practice. It is important to note that pr evious research on burnout has failed to demonstrate a direct relation between burnout experien ce and theoretical orientati on (Raquepaw & Miller, 1989). Yet researchers argue that certain ther apeutic approaches can be contri buting to the therapists levels of stress through their demands a nd effectiveness (Horner, 1993) Similarly, our findings of decreased levels of engagement for therapis ts with initial commitments to behavioral,

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100 humanistic, integrative therapy, and current commitments to cogni tive and integrative therapy might be a result of the distress and minor experien ces of burnout for partic ipated therapists. The hypothesis of the study that predicted incr easing levels of engagement across practice was supported only for the therapists who were iden tified their initial theo retical orientation as narrative/constructivist. Those therapists were th e only group of therapists in the study that perceived their commitment to therapy and client s increasing across the y ears of their practice. The nature of narrative-construc tivist therapies can be explored to understand this outcome. Constructivist therapies refrain fr om one-way construction of the et iology and cure of the client concerns, they promote experiential as well as cognitive growth, and they value a highly humanized relationship with clie nts that is subjective, personal and emotional (Mahoney & Gabriel, 1987; Mahoney, Lyddon & Alford, 1989). Th ese qualities can buffer against the distress of conducting therapy and can facili tate therapists commitment to therapy and their levels of engagement with their clients as they have been seasoned in their practice (F reudenberger, 1974; Norcross, 2000). Overall, our results concur with Castaeira s et al.s (2006) study and therapist career development studies that therapists become skillful in communicating their emotions, relax in their style and become more spontaneous in the wa y they operate as therapists and broaden their attentional focus in collecting data as they season in the profession and gain expertise. Change in therapists levels of engagement was more complex for therapists such that their theoretical orientations colored their change experiences. For therapists curre ntly identified with cognitive and integrative orientations, and initially identi fied with behavioral, humanistic-existentialistgestalt and integrative orientati ons, engagement levels reportedly declined across their practice.

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101 Our initial hypothesis of increasing engagement across practice held true only for those therapists who were initially identified with narrative/constructivist orientation. Association between Epistemic and Pr ofessional Change Constructions Epistem ology has been associated with certain schools of thought and theoretical orientations (Lyddon, 1989a; Lyddon & Adamson, 1992; Neimeyer et al., 1993; Neimeyer & Morton, 1997; Schacht & Black, 1985). Epistemology has also been associated with the ways in which therapists conducted therapy (Nagae & Nedate, 2001; Vasco, 1994; Viney, 1994; Winter & Watson, 1999), including the therapy style dimens ions of expressive, engagement, operative, and attentional (Neimeyer & Saferstein, 2006). The literature indicated that epistemic, th eoretical and stylistic commitments were associated. The current study indi cated that therapists epistemi c, theoretical, and stylistic commitments were perceived to change across the course of their practice. Given that change of any sort can facilitate other cha nges (Stricker, 2001, p. 79), we in tended to explore if epistemic change accounts for or aligns with therapists theoretical and stylisti c change experiences. We hypothesized that increases in therapists cons tructivist commitments would predict (1) greater changes in thei r theoretical orientati on throughout their career; (2 ) greater adherence to theoretical integration and eclecticism; and (3) therapy styles marked by higher levels of expressiveness, client engageme nt, attentional focus and operative spontaneity. Since the data failed to indicate engagement diff erences across the years of practi ce, we excluded this variable from the analyses. Results were mostly consiste nt with our expectati ons. After accounting for demographic variables and initia l standings, therapists increasing commitment to constructivist epistemology predicted high ratings for theoretical orientation change scale, as well as higher levels of theoretical plural ity, higher levels of emotiona l expressiveness and operative

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102 spontaneity in conducting therapy and broader focus in gathering in formation in therapy in their current practice. Although no specific predictions were made, th e ways in which changes in rationalist commitments predict therapists professional standings were also investigated. Results suggested that therapists increasing commitment to ra tionalist epistemology pr edicted lower ratings on theoretical orientation change scale, lower le vels of emotional expr essiveness and operative spontaneity and narrower focus in information ga thering. Rationalist change scores accounted for the variance in these variables even after the co nstructivist change scores were entered into analyses, suggesting that, taken together, therapis ts epistemic journeys better explained the ways in which therapists ended up on their theoretical and stylistic dimensions than did either epistemic orientation alone. Overall, epistemological change processes pred icted where therapists have reached in their theoretical and stylistic commitments even after accounting for their initial commitments. These results are consistent with the literature. The fi ndings are explored in depth, first for theoretical and next for stylistic commitments of therapists. Epistemic and Theoretical Change Epistem ology has been associated with theore tical orientation. Not only certain epistemic commitments were conceptually tied to certain theoretical orientati ons (Lyddon, 1991), but also epistemic commitments accounted for therapists theoretical orientation preferences (Lyddon, 1989a; Lyddon & Adamson, 1992; Neimeyer et al., 1993; Neimeyer & Morton, 1997; Schacht & Black, 1985). The results of th e current study supported and exte nded the relationship between theoretical orientation and epistemology by indicati ng that as therapists have perceived greater commitment to constructivism across the course of their practice, they indicated higher levels of theoretical orientation change and high er levels of theoretical plurality.

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103 Those therapists, who shift in their epistemic journey towards increased constructivism tended to experience more change in their theore tical commitments and they were more likely to integrate a variety of theoretical orientations in their conceptualizations. Constructivist metatheory recognizes the complexity of human processes (Mahoney & Gabriel, 1987). Similarly, higher levels of constructivist co mmitments predicted hi gher levels of selfexploration, openness, and tolerance in therapists (Neimeyer & Aksoy, 2005). Therapists becoming increasingl y constructivist might mean in creasing appreciation of the complexity of human processes, increasing tole rance for the complexity and increasing openness to integrate different perspectives on their part Such changes, then, would be consistent with their openness to change the ways in which they have framed their work and to integrate a variety of theoretical orientat ions in their therapeutic work. As therapists constructivist commitments grow stronger, their openness for sampling different theoreti cal orientations and for integrating different orient ations might grow stronger. It is significant to note that the current st udy establishes an associa tion between the fields two significant trends, namely its increasi ng commitment to constructivist epistemology (Mahoney, 1995a, 1995b) and theore tical integration (Goldfrie d, 2001a; Norcross et al., 2002; Norcross, 2005). Although it is be yond the scope of this project to attain causality to this interaction, it is most likely that a dialectical relationship exists between these trends. As therapists embraces the complexity human change processes, they might utilize complementary orientations in junction to facilitate clients change processes. The c onstructivist mindset would allow therapists to combine various orientations in idiosyncratic ways. Increasing theoretical plurality, in return, might lead to increased appreciation of dive rsity and complexity of involved processes, and hence may solidify therapists constructivist commitments.

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104 On the other hand, participants who shifted in their epistemic jour ney towards increasing rationalism tended to experience less theoretical orientation change. The nature of rationalistic epistemology can be defined as relatively determined, definitive, and confident in understanding and helping clients (Mahoney & Gabriel, 1987) Similarly, higher levels of rationalist commitments predicted lower leve ls of self-exploration and ope nness in therapists (Neimeyer & Aksoy, 2005). Hence, therapists with increa sing rationalist commitments might be less compelled to explore other theoreti cal orientations and change thei r theoretical commitments. It is also important to note that th e data indicated a decrease in rationalist epistemology in general which would translate to further increase in pr actitioners theoretical change experiences. Rationalism change experience did not account for the degree to which therapists have integrated different theoretical orientations. Fo r our participants, changes in their rationalistic commitments did not translate to their tendency to integrate a number of theoretical orientations. Considering the nature of the rationalist epistemology, one might expect to find decreasing plurality with increasingly higher levels of com mitment to rationalism. The failure of the data to indicate such might be a result of other influences dominating the field. For instance, increasing valuing for and occurrence of th eoretical integration might have outweighed the possible impact of rationalist epistemology despite the nature of rationalist epistemology might conflict with the use of a variety of lenses in conceptualizing therapy. Epistemic and Stylistic Change Epistem ology has been associated with thera py style. Therapists conducting rationalist and constructivist therapies differed in the way they set the direction of the therapy, related to client, and conceptualized and worked through clients emotional distress, relapse and regression (Nagae & Nedate, 2001; Vasco, 1994; Viney, 1994; Winter & Watson, 1999). Moreover,

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105 therapists with different epistemic commitments appeared to have diffe rent styles in their therapeutic closeness, focus, engagement, and spontaneity (Neimeyer & Saferstein, 2006). The results of the current study supported a nd extended the relationship between therapy style and epistemology by indicati ng that therapists ep istemic journey predicted their current stylistic standings. As therapists have perceive d greater commitment to constructivism across the course of their practice, they indicated higher levels of emoti onal expressiveness with clients, higher levels of spontaneity in conducting ther apy and broader focus in gathering information. Moreover, perceived decrease in their commitment to rationalism across the course of their practice accounted for additional variance in predicting higher levels of expressiveness and spontaneity and broader focus. These findings are consistent with the liter ature investigating th e relationship between epistemology and therapy style. Expressive, operative, and attentional dimensions of therapy style have been associated ther apists epistemic commitments. Neimeyer and Saferstein (2006) established that higher c onstructivist commitments related to higher levels of expressive (i.e. increased emotional openness and closeness to clie nts), lower levels of ope rative (i.e. increased operative spontaneity in conducting therapy) and lower levels of a ttentional (i.e. broader range of attention in therapeutic information gathering). Other studies further supporte d the link between epistemology and therapy style. With respect to expressive dimension, Viney (1994) suggested that therapists conduc ting constructivist cognitive therapies tended to acknowledge their clients negative emotions more compared to rationalist cognitive therapists. Moreover, Winter and Watson (1999) suggested that constructivist therapists might tend to be more communicative of unconditional positive regard to their clients than rationalist therapists. With respect to operative dimension, Vasco (1994)

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106 established that more the therapists are committe d to constructivist epistemology, less they lean on therapeutic structure and direction. Overall, our data extended the translation of epistemology into practice by suggesting that therapists epistemic journey in the form of increasing commitment to constructivism and decreasing commitment to rationalism would account for where therapists fi nalized their journey on expressive, operative, and attentional dimensions of therapy style. Discussion of how our findings are supported by the literature may be strengthened by utilizing the literature associat ing therapists personal characteristics with their epistemic commitments where higher levels of constructivist commitments pr edicted higher levels of selfexploration, attending to emotions, ambiguity tolerance and openness in therapists, and yet higher rationalism scores predicted lower leve ls of these characteris tics (Neimeyer & Aksoy, 2005). Therapists personal characteristics may f acilitate therapists change processes. For instance, increasingly constructivist therapists may tend to have strengthened commitment to self-understanding as well as attend ance to their emotional processes, which might facilitate their emotional expressiveness in the session and em otional closeness to their clients as well. Similarly, those who are more incr easingly open to and tolerant of ambiguity may be more likely to welcome a broad attention to variety of areas and concerns in their information gathering processes and may operate w ith increasing spontaneity in their therapeutic work. Therapists increasing commitment to constructivism and decreasing commitment to rationalism, then, may translate to higher levels of expressive, operative, and attentional through facilitating individual change proc esses that might relate to stylistic commitments (and future studies can explore this). Overa ll, the finding that increased constructivism predicts emotional expressiveness, spontaneity and range of atten tion positively across the course of therapists

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107 practice seems to be consistent with the personal characteristics that mirrors the assumptions of constructivist epistemologies. It is important to note that when both episte mologies were entered into the analyses, the results were more robust and so mewhat different than the re sults of analyses with only constructivist epistemol ogy. For instance, after including rati onalist commitment change score, constructivist commitment change score lost some of its power to account for the variance in the professional variables of intere st. For theoretical change inde x, the change was substantial enough for the constructivism-change score to lo se its statistical si gnificance. Moreover, rationalist-change journey of therapists seemed to be a better predictor of operative and attentional dimensions of therapy style than th eir constructivist-journey. Decrease in rationalist commitment across therapists cour se of practice predic ted the increase in s pontaneity and range of focus much strongly than increase in constructivist commitment did. Our focus on the distinction betw een constructivist and rationa list epistemologies aimed to enhance our understandings of the ways in which epistemological change accounted for professional commitments. As Mahoney (1995b) s uggested, our interest was on the potential contribution that rationali st-constructivist contra st may offer to emerging theory and research relating the cognitive sciences and clinical se rvices (p. 9). Complementary ways of acquiring and evaluating knowledge and understanding th e world are equally valuable (Lyddon, 1989b), and as it is shown in this st udy, the rationalist-constr uctivist contrast serv es us with a better understanding of how epistemic worldview relates to theoretical and stylistic commitments. Limitations In this section, we noted som e significan t sampling, instrumental, procedural and methodological limitations of this study that might have hindered the exte rnal validity of the

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108 findings. First, the obtained data might have been provided by a biased sample and its generalizability must be questioned. Those who volunteered to participate in this study might have been different from non-volunteers in the ch aracteristics of interest as indicated by the behavioral research (Rosenthal & Rosnow, 1991). Furthermore, the collec ting data via Internet through online survey may have widened the gap between those who volunteered to participate and those who did not. However, research failed to find difference in part icipant responses when compared to online data collection methods to paper-pencil methods (Gosling et al., 2004). We cannot determine the representativeness of our population as a sample due to the information restrictions as we ll as the snowballing that might have happened through invited professionals forwarding the in vitation email to other colleague s. Yet, our population that was mainly composed of practitioner psychologists has a strong resemblance to the demographic make-up of the members of the American Psyc hological Association (APA) that identified themselves as practitioners (http://research.apa.o rg/prac_profile_12-7-07.pdf, 2007). In 2007, APA members reported to be approximately 57.8% female and 42.2% male, and similarly 59.5% of the population of the current study was fe male and 40.5% of the sample was male. APA members mean age was reported as 50.4 ( SD = 10.7), and in the current study, the mean age of participants was 50.36 ( SD = 11.7), which is again comparable. Ethnicities in the current study were Caucasian, 88.6% (vs. 93.3% of APA) Hispanic, 3.6% (vs. 2.7%), AfricanAmerican/Black, 2.4% (vs. 1.3%), Asian-America n, 1.2% (vs. 1.8%), and multiracial, 1.2% (vs. 0.6%). Such similarities in the demographic composition of a part of the sample (i.e. psychologists) and obtained population is encouragi ng with respect to exte rnal validity of the obtained findings.

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109 Generalizability of the findings was hamper ed by the self-report na ture of the present study. Self-reports are subject to distortion and social desirab ility. The postmodern zeitgeist might prompt therapists to provide answers in line with the constructiv ist viewpoint even though they might not have internalized this standpoint or transferred their assumptions to therapy room. Moreover, self-reports may not correlate well wi th the participants actual behavior or experience (Rosenthal & Rosnow, 19 91). It is important to consider that what therapists claim they do in therapy sett ing might be quite different from what they actually do. The personal narrations of certain well-known therapists could f acilitate our understandi ng in this matter. For instance, Albert Ellis noted repeatedly that he was committed to constructivist epistemology and his therapy was constructivist in nature. Yet other researchers such as Mahoney and Meichenbaum (see Zeig, 1992) had s uggested that a closer inspec tion to the basic assumptions and operations of REBT, and Ellis s himself, indicated the contrar y. The variables of interest in the current study such as epistemic commitment, theoretical orientation and therapy style are subject to such misconstructions where se lf-reports do not correlate with behavior. The current study asks participants to provi de self-reports for not only their current experiences but also for their experiences that took place during the time frame that they have first started practice afte r graduation from their highest degr ee. Hence the limitations of selfreport studies might have been further compli cated by memory biases. The literature on cognitive psychology, specifically on recall, indicated that our memo ry is far from impartial and subject to bias (Schacter, 1999) Certain facts can be construe d as years move on and more experience is gained. Hence, it must be clear to our reader that this study is based on the constructions of professional prac titioners as they had recalled themselves to be in their

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110 professional start point and as of today, and caution must be exerted while interpreting the obtained findings to not to equate these findi ngs as the reality of the practitioners. Another significant methodological limitation of the study is the number and nature of the measures employed to collect th e data regarding the variables of interest. Our understanding of how therapists epistemic journeys parallel th eir professional journey could be improved through employing additional measures or indicators of therapy style and theoretical orientation as well as measures of other professional variables. Providing an operational definition for the theoretical orientations cited on the survey would also further th e depth in which we interpreted the findings. Such engagements would also enhan ce the validity and viabil ity of the findings. Another limiting factor to the current study is its efforts to approximate a longitudinal research question through a cross-sectional research design. A lthough collecting data regarding the times that practitioners first started thei r professional journey pr ovides us with a quasilongitudinal data, the present study was far from detailing practitioners journey, which threatens its validity. Moreover, we have da ta regarding the two positions across therapists practice with little or no information regarding the trajectories that took place between thei r initial and current experiences. Ideally, the inquiries posed in this study would be answered by longitudinal studies with multiple data collection points. The logistical difficulties and limitations associated with the longitudinal studies did not allow us to conduct a longitudinal study where we would be able to track psychotherapists from the beginning of their practice for year s. Such studies are needed in the future to deepen our unde rstanding of practitioners epis temic and professional journey. It is also important to note that the obtained findings are simply associations between the variables of interest and do not imply causal relationships. For in stance, perceived decrease in therapists rationalist commitment was associated with increase in their theoretical change

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111 experiences; however we cannot claim that change in therapists epistemologies cause them to have increasing experiences of theoretical change Obtained results only suggest relationship, not necessarily causality. Significance and Directions for Future Research Despite the apparent lim itations detailed above, the present study is an important addition to the current literature on epistemology and psyc hotherapist experiences for a variety of reasons. In this section, first we highlight the contributions of this study to the field and then we explore the directions that future research can pursue following the lead of this study. The current study is the first study investigating therapists epistemic journey. Our findings present empirical support for th e claims of Mahoney (1995a, 1995b) and extend the literature on epistemology as participated therapists pe rceived themselves to become increasingly constructivist and decreasingly ra tionalist across the course of their practice. The current study also presents a preliminary empirical expl oration for the dynamics underlying therapists epistemic shifts. Specifically, it suggests that therapists career development trajectories, rather than their year of entry to th e profession, color their epistemic journey. Moreover, it provides the first empirical argument against the claim that the fields increasing commitment to constructivism is a reflection of the infusion of therapists with stronger constructivist commitments. This study also extends our understandi ng of the ways in which therapists epistemic journey is related to their professional experiences, sp ecifically their theoretical and stylistic commitments. As Meichenbaum (1993) suggested, the stor y on which the theory and practice of psychotherapy has been based continues to unfold and to change (p. 204) Field continues to rely increasingly constructivist principles, cultura l values and theoretical integration (Goldfried,

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112 2001a; Norcross et al., 2002; Norcross, 2005; Norcross, Hedges, & Prochaska, 2002). Recognizing the ways in which our understanding of the world, clinical practice and change processes are linked to one another would be beneficial given the continuing change that the field as well as its members experience. This study also supports the claims of Mahoney (1995b) who suggested focusing on the ways in which rationalist-constructivist contrast may be useful for clinical work and studies. Constructivism and rationalism presents comp lementary ways of acquiring and evaluating knowledge and understanding the world, and none of these worldviews provides the correct or best frame of reference. They simply suggest different forms of understanding, inquiry and theory. (Lyddon, 1989b, p. 446). Togeth er they extend our u nderstanding of the complexities of human experience (M ahoney & Lyddon, 1988, p. 223). Our findings in general exemplify how th e rationalist-constr uctivist contrast would extend our knowledge when employed together and it encourag es researchers to make use of such epistemological contrasts sensibly. The present study also contribu tes to the literatu re through opening up a fertile area of research to investigate various dimensions of therapists episte mic change processes. To begin with; future research can extend our understand ing by studying impacts and/or correlates of therapists changing epistemologies. As this study is focused on the association between epistemological, theoretical and stylistic change experiences; future studies can explore how change in epistemological commitments is associat ed with change in othe r sets of professional characteristics. Therapists epistemic commitments were not only associated with their professional qualities but also with certain pers onal qualities such as self-exploration, openness and tolerance (Neimeyer & Aksoy, 2005). Future research can also invest igate how therapists

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113 epistemic journey interacts with their personal qualities which may also be moderating and/or mediating the ways in which epistemic and professional journeys interact. Most importantly, future studies can investigate further imp lications of the link between therapists epistemic journey and their profes sional experiences. Kramen-Kahn and Hansen (1998) suggested that therapists perceived their change proce sses among the rewards of their work. The current study can also be continued by exploring how these changes in therapists epistemic, theoretical and stylistic commitments tr anslate to therapists sa tisfaction, and perhaps, effectiveness of their work. Future research can investigate how epistemic and professional changes of therapists are perceived by their cl ients and facilitated thei r change processes. This study also partially validated the expect ations that therapis ts career development processes play a signific ant role in their episte mic journey. It is known that therapists personal and professional lives are impacted by their c onducting psychotherapy in multiple and complex ways. Yet, more research is needed to understand the underlying dyna mics of therapists epistemic journeys. Future research can also explore which individual processes facilitated therapists epistemic and professional change. Na rrations of certain psychotherapists (such as Goldfried, 2001a) highlighted why therapists change and what aspects of their personal life and career have impacted their developmental process. Studies can investigate if therapists epistemic journey interacts with such persona l accounts for reasons of change. Conclusion In conclusion, the presen t study examined the percei ved epistem ic changes of psychotherapists, the impact of cohort on these change processe s and the ways in which such processes relate to therapists professional stan dings in theoretical or ientation and style of conducting psychotherapy. Results of the study suggested that therapis ts perceive that they have

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114 changed in their epistemic, theoretical and stylistic commitments across their professional journey. Therapists reported that they have b ecome increasingly constructivist and decreasingly rationalist in their epistemic commitment, increa singly pluralist in their theoretical commitment and increasingly expressive, spontaneous, and attentive to a broad spectrum of information in their therapeutic styles. Results of the study also suggested that cohort effects did not account for the levels of therapists initial epistemic commitments or epistemic change experiences. Moreover, results of the study re vealed that therapists increa sing commitment to constructivist epistemologies and decreasing commitment to ra tionalist epistemology toge ther were perceived to be associated with their curr ent theoretical and stylistic comm itments. Epistemological change processes predicted where therapists have reache d in their theoretical and stylistic commitments even after accounting for their initial commitments. The current study is a significant contribution to the field gi ven that it was the first study empirically investigating the epistemic change pr ocesses of therapists. It extended the developing literature on epistemology as a factor relating to psychothe rapists professional change. Additional and ideally, longitudinal work is needed to clarify the nature and correlates of therapists epistemic journeys. It also opens up a fertile area of re search to extend our understanding of practitioners epistemic ch ange processes, which may increase our effectiveness in dealing with the ch anges that our prof ession generates.

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115 APPENDIX A THERAPIST ATTITUDE QUESTIONNAIRE -SHORT FORM (TAQ-SF) Please rate the following items along the followi ng 5-point scale. In considering yourself NOW, we are interested in how you currently view yourself and your professional practice today. In considering yourself THEN, we are interested in how you view yourself when you first started practicing fo llowing the completion of your graduate training. 1 2 3 4 5 Strongly Moderately Neither agree M oderately Strongly disagree disagree nor disagree agree agree NOW THEN 1. Reality is singular, stable a nd external to human experience. 1 2 3 4 5 1 2 3 4 5 2. Knowledge is determined to be valid by logic and reason. 1 2 3 4 5 1 2 3 4 5 3. Learning involves the contiguous or contingent chaining of discrete events. 1 2 3 4 5 1 2 3 4 5 4. Mental representations of r eality involve accurate, explicit and extensive copies of the external world, which are encoded in memory. 1 2 3 4 5 1 2 3 4 5 5. It is best for psychotherapist s to focus treatment on clients current problems and the elim ination or control of these problems. 1 2 3 4 5 1 2 3 4 5 6. Disturbed affect comes from irrational, invalid, distorted or/and unrealistic thinking. 1 2 3 4 5 1 2 3 4 5 7. Clients resistance to change reflects a lack of motivation, ambivalence or motivated avoidance and such resistance to change is an impediment to therapy, which the psychotherapist works to overcome. 1 2 3 4 5 1 2 3 4 5 8. Reality is relative. Realities reflect individual or collective constructions of order to ones experiences. 1 2 3 4 5 1 2 3 4 5 9. Learning involves the refi nement and transformation (assimilation and accommodation) of mental representation. 1 2 3 4 5 1 2 3 4 5 10. Cognition, behavior and affect are interdependent expressions of holistic system ic processes. The three are functionally and structur ally inseparable. 1 2 3 4 5 1 2 3 4 5

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116 11. Intense emotions have a diso rganizing effect on behavior. This disorganization may be f unctional in that it initiates a reorganization so that more viable adaptive constructions can be formed to meet the environmental demands. 1 2 3 4 5 1 2 3 4 5 12. Psychotherapists should encourage emotional experience, expression, and exploration. 1 2 3 4 5 1 2 3 4 5 13. Clinical problems are current or recurrent discrepancies between our external environm ental challenges and internal adaptive capacities. Problems can become powerful opportunities for learning. 1 2 3 4 5 1 2 3 4 5 14. Awareness or insight is one of many strategies for improvement, however, emotional and/or behavioral enactments are also very important. 1 2 3 4 5 1 2 3 4 5 15. Therapists relationship with clients is best conceptualized as a professional helping relationship, which entails the service and delivery of technical, in structional information or guidance. 1 2 3 4 5 1 2 3 4 5 16. Psychotherapists relationshi p with clients can best be conceptualized as a unique social exchange, which provides the clients a safe supportive c ontext to explore and develop relationships with them selves and the world. 1 2 3 4 5 1 2 3 4 5

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117 APPENDIX B THEORETICAL ORIENTATION RATINGS Directions: Below you will find a list of theoretical or ientations. You can list a variety of orientations. Please rate yourself along the provided scale iden tifying the extent to which the given theoretical orientation is and w as a part of your clinical practice. In considering yourself NOW, we are interested in how you currently view yourself and your professional practice today. In considering yourself THEN, we are interested in how you view yourself when you first started practicing fo llowing the completion of your graduate training. Not a Part 1 2 3 4 5 A Significant Part of My Therapy of My Therapy NOW THEN 1 Cognitive 1 2 3 4 5 1 2 3 4 5 2 Behavioral 1 2 3 4 5 1 2 3 4 5 3 Humanistic Existential Gestalt 1 2 3 4 5 1 2 3 4 5 4 Narrative/constructivist 1 2 3 4 5 1 2 3 4 5 5 Systemic Family 1 2 3 4 5 1 2 3 4 5 6 Psychodynamic 1 2 3 4 5 1 2 3 4 5 7 Feminist Multicultural 1 2 3 4 5 1 2 3 4 5 8 If you would have to choose only one theoretical orientation as your main base, which one would that be? Drop Down Menu Saying Please Select 1. Cognitive 2. Behavioral 3. Humanistic Existential Gestalt 4. Narrative/constructivist 5. Systemic Family 6. Psychodynamic 7. Feminist Multicultural 8. Integrationist Drop Down Menu Saying Please Select 1. Cognitive 2. Behavioral 3. Humanistic Existential Gestalt 4. Narrative/constructivist 5. Systemic Family 6. Psychodynamic 7. Feminist Multicultural 8. Integrationist 9 When you consider your ther apeutic orientation across time, to what extent do you see that orientation has having remained the same, or changed? Same 1 2 3 4 5 Changed

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118 APPENDIX C PERSONAL STYLE OF THE THERAPIST (PST-Q) Directions : Please rate the following items along the following 7-point scal e. In considering yourself NOW, we are interested in how you currently view yourself and your professional practice today. In considering yourself THEN, we are interested in how you view yourself when you first started practicing following the completion of your graduate training. Total Disagreement 1 2 3 4 5 6 7 Total Agreement represents total disagreement with the statement and means total agreement. NOW THEN 1. I tend to be open-minded and receptive in listening rather than narrow-minded and restrictive. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 2. I try to get patients to adjust to the regular format of my work. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 3. As a therapist I prefer to indicate to patients what they should do in each session. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 4. I keep a low profile of involvement with patients in order to be more objective. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 5. I find changes in the setting quite exciting. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 6. The emotions the patient arouses in me are key to the course of the treatment. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 7. Im more inclined to accompany the patient in exploring than to point out the steps to follow. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 8. I avoid communicating through gestures or deeply emotional expressions. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 9. I tend to demand strict compliance with schedules. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 10. I place little value on planned treatments. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 11. Expressing emotions is a powerful tool leading to changes. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 12. Many important changes that occur during treatment require the therapist to respond without expressing much emotion. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 13. I dont think about patients outside sessions. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 14. Changing offices has a negative impact on treatment. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 15. Real changes take place during highly emot ional sessions. 1 2 3 4 5 6 7 1 2 3 4 5 6 7

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119 16. I believe I am a therapist with a flexible setting. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 17. I find it useful to reveal something personal about myself during sessions. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 18. I like to feel surprised by what each patient brings to the session without having preconceived notions. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 19. I often attend patients outside the office. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 20. The best intervention in a treatment occurs spontaneously. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 21. Whatever happens to my patients has little influence on my own life. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 22. My intervention is mostly directive. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 23. I think quite a lot about my job even in my spare time. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 24. I avoid revealing my emotions to my patients. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 25. I can plan an entire treatment from the very outset. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 26. Keeping emotional distance from patients favors change. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 27. I never change how long a session lasts, unless absolutely necessary. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 28. If something bothers me during a session I can express it. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 29. Emotional closeness with patients is essential to bring about therapeutic change. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 30. I prefer to know in advance what things I should pay attention to in sessions. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 31. I prefer treatments where everything is programmed. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 32. I like working with patients who have clearly focused problems. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 33. I can give my entire attention to everything that takes place during sessions. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 34. I think about patients problems even after sessions. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 35. Im quite flexible with schedules. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 36. Right from the beginning of the session I allow my attention to float. 1 2 3 4 5 6 7 1 2 3 4 5 6 7

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120 APPENDIX D DEMOGRAPHIC INFORMATION Please tell us a little about yourse lf. This information will be used only to describe the sam ple as a group. 1. Gender: Male Female 2. Age: 3. Ethnic background: White/Caucasian, Black/A frican-American, Hispanic/Latino/a Black, Hispanic/Latino/a White, Asian-Amer ican-Pacific Islander, American Indian /Native-American, Multi-racial, Other __________ 4. Name of your highest degree: BA/BS, MA/MS, MSW, PsyD, PhD, EdD, Other__________ 5. Years of college and higher education in total: 6. The year you obtained your highest degree: 7. Total number of years you spent engaging in clinical practice: 8. Specialty area: Psychologist, Mental Health Counselor, Marriage a nd Family therapist, Social worker, Psychiatrist, Other ___________. 9. Primary job responsibility: Practice/Clinical work, Research Academic, Administrative, Other ___________ 10. Primary employment setting: Private practice, University academic department, University service delivery department, Hospital, Mental health care, School setting, Research setting, Community Center, Other _____________ 11. Number of clients you see weekly on average. Please count each group you work with as 1 client. 12. Country you live in: Drop Down Menu: List of Countries

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121 LIST OF REFERENCES Am erican Psychological Association Website (2008). 2007 psychology practitioner profile. Retrieved January 2, 2008, from http: //research.apa.org/prac_profile_12-7-07.pdf. Arthur, A. R. (2000). The personality and c ognitive-epistemological traits of cognitive behavioral and psychoanalytic psychotherapists. British Journal of Medical Psychology, 73, 243-257. Babbage, D. R., & Ronan, K. R. (2000). Philosophical worldview and personality factors in traditional and social scientists: Studying the world in our own image. Personality and Individual Differences, 28 405-420. Beck, A. T. (2002, June). Emoti onal arousal in cognitive therapy. Beck Institute Newsletter, 7 Retrieved April 15, 2007, from http://www.beckinstitute.org/InfoID/78/RedirectPath/Add1/FolderID/168/SessionID/%7 B002A9969-B2FE-49A9-B0EC34BEF53B311B %7D/InfoGroup/Main/InfoType/ Article/PageVars/Library/InfoManage/Zoom.htm. Beck, A. T. (n.d.). Retrieved April 15, 2007. Aaron T. Beck writes in: Early response to CT, and current success. Cognitive Therapy Today, Beck Institutes Blog. Retrieved April 15, 2007, from http://cttoday.org/?p=91. Beitel, M., Ferrer E., Cecero, J.J. (2004). Psychological mindedness and cognitive style. Journal of Clinical Psychology, 60 567-582. Berzonsky, M. D. (1994). Individual differences in self-construction: The role of constructivist epistemological assumptions. Journal of Construc tivist Psychology, 7 263-281. Bloch, S. (2004) An interview with Aaron (Tim) Beck. Retreived April 15, 2007, from http://www.beckinstitute.org/Library/InfoManage/Zoom.asp?InfoID=304&RedirectPath= Add1&FolderID=208&SessionID={CA5E7FE1-9C4B-4AEA-978E-5EADA 0B35B0A}&InfoGroup=Main&InfoType=Article&SP=2. Botella, L., & Gallifa, J. (1995) A constructivist approach to the development of personal epistemic assumptions and worldviews. Journal of Constructi vist Psychology, 8, 1-18. Brown, L. S. (2005). Dont be a sheep: How this eldest daughter became a feminist therapist. Journal of Clinical Psychology, 61 949-956. Castaeiras, C., Garca, F., Lo Bianco, J., Fern ndez-Alvarez, H. (2006) Modulating effect of experience and theoretical-techni cal orientation on the person al style of the therapist. Psychotherapy Research, 16 595-603. Cohen, J. (1992). A power primer. Psychological Bulletin, 112 155-159.

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122 DeAngelis, T. (2006). Finding focus. Monitor on Psychology, 37 59-61. DiGuiseppe, R., & Linscott, J. (1993). Philo sophical differences among cognitive behavioral therapists: Rationalism, constructivism, or both? Journal of Cognitive Psychotherapy: An International Quarterly, 7 117-130. Eagle, M. N. (2001). Reflections of a psychoana lytic therapist. In Goldfried, M. R. (Ed.), How therapists change: Personal and professional reflections (p. 37-53). Washington, DC: American Psychological Association. Ellis, A. (1990). Is rational-emotive thera py (RET) rationalist or constructivist? Journal of Rational-Emotive & Cognitive-Behavior Therapy, 8 169-193. Ellis, A. (1992a). Discussion by Albert Ellis, Ph.D. In Zeig, J. K. (Ed), The Evolution of psychotherapy: the second conference New York: Brunner/Mazel. Ellis, A. (1992b). My early experiences in developing the practice of psychology. Professional Psychology: Research and Practice, 23 7-10. Ellis, A. (1993). Constructivism and rational-emotive therapy: A critique of Richard Wesslers critique. Psychotherapy, 30 531-532. Ellis, A. (1995). Reflections on rational-e motive therapy. In M. J. Mahoney (Ed), Cognitive and constructive psychotherapies: Theory, research, and practice (pp. 69-73). New York: Springer. Ellis, A. (1999). Why rational-emotive therapy to rational emotive behavior therapy? Psychotherapy, 36 154-159. Farber, B. A. (1983). The effects of psychot herapeutic practice upon psychotherapists. Psychotherapy Theory, Research and Practice, 20 174-182. Farber, B. A., Manevich, I., Metzger, J., & Saypol, E. (2005). Choosing psychotherapy as a career: Why did we cross that road? Journal of Clinical Psychology, 61 1009-1031. Fernndez-lvarez, H., Garca, F ., Lo Bianco, J. L., & Corbella Santoma, S. (2003). Assessment questionnaire on the personal st yle of the therapist PST-Q. Clinical Psychology and Psychotherapy, 10, 116 125. Frankel, Z., & Levitt, H. M. (2006). Postmodern strategies for working with resistance: problem resolution or self-revolution? Journal of Constructivist Psychology, 19 219-250. Freudenberger, H. J. (1977). Burn-out: Occ upational hazard of the child care worker. Child Care Quarterly, 6 90-99. Germer, C. K., Efran, J. S., & Overton, W. F. (1982). The Organisicm-Mechanism Paradigm Inventory: Toward the measurement of meta physical assumptions. Paper presented at the 53rd Annual Meeting of the Eastern Psychological Association, Baltimore, MD.

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124 Lyddon, W. J. (1989a). Personal epistemo logy and preference for counseling Journal of Counseling Psychology, 36, 423-429. Lyddon, W. J. (1989b). Root metaphor theory: A philosophical framework for counseling and psychotherapy. Journal of Counseling & Development, 67 442-448. Lyddon, W. J. (1990). Firstand second-order change: Implications for rationalist and constructivist cogni tive therapies. Journal of Counseling & Development, 69 122-127. Lyddon, W. J. (1991). Epistemic style: Imp lications for cognitive psychotherapy. Psychotherapy, 28, 588-597. Lyddon, W. J., & Adamson, L. E. (1992). Worldv iew and counseling preference: An analogue study. Journal of Counseling and Development, 71 41-47. Mahoney, M. J. (1988). Constructive metatheo ry: II. Implications for Psychotherapy. International Journal of Pe rsonal Construct Psychology, 1, 299-315. Mahoney, M. J. (1991). Human change processes: The scien tific foundations of psychotherapy. New York: Basic. Mahoney, M. J. (Ed). (1995a). Cognitive and constructive psychot herapies: Theory, research, and practice New York: Springer. Mahoney, M. J. (1995b). Theoretical developm ents in the cognitive psychotherapies. In Mahoney, M. J. (Ed), Cognitive and constructive psychot herapies: Theory, research, and practice (pp. 3-19). New York: Springer. Mahoney, M. J. (1995c). The Psychological Demands of Being a Constructive Psychotherapist. In R. A. Neimeyer & M. J. Mahoney (Eds.), Constructivism in psychotherapy (pp. 385399). Washington, DC: American Psychological Association. Mahoney, M. J. (2001). Behaviorism, cognitivism, and constructivism: Reflections on people and patterns in my intellectual deve lopment. In Goldfried, M. R. (Ed.), How therapists change: Personal and professional reflections (pp. 183-200). Washington, DC: American Psychological Association. Mahoney, M. J., & Gabriel, T. J. (1987). Psychotherapy and the cognitive sciences: An evolving alliance. Journal of Cognitive Therapy: An International Quarterly, 1 39-59. Mahoney, M. J., & Lyddon, W. J. (1988). Recent developments in cognitive approaches to counseling and psychotherapy. The Counseling Psychologist, 16 190-234. Mahoney, M. J., Lyddon, W. J., & Alford, D. J. (1989). An evaluation of rational-emotive theory of psychotherapy. In M. E. Bernard & R. DiGiuseppe (Eds.), Inside Rational-Emotive Therapy. A Critical Appraisal of the Theory and Therapy of Albert Ellis. (pp. 69-94). San Diego, CA: Academic Press.

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125 Martin, J., Slemon, A. G., Hiebert, B., Hallberg, E. T., & Cummings, A. L. (1989). Conceptualizations of novice and experienced counselors. Journal of Counseling Psychology, 36, 395. Maslach, C., Jackson, S.E. & Leiter. M. (1996). MBI Manual (3rd ed.). Palo Alto, CA: Consulting Psychologists Press. McCann, I. L., & Pearlman, L. A. (1990). Vi carious traumatization: A framework for understanding the psychological eff ects of working with victims. Journal of Traumatic Stress, 3, 131-149. Meichenbaum, D. (1990). Evolution of cognitive behavior therapy: Origins, tenets and clinical examples. In J. Zeig (Ed.), The evolution of psychotherapy (pp. 96-115). New York: Brunner/Mazel. Meichenbaum, D. (1993). Changi ng conceptions of cognitive behavior modification: Retrospect and prospect. Journal of Consulting and Clinical Psychology, 61 202-204. Myers, R. (1990). Classical and modern regr ession with applications (2nd ed.). Boston: Duxbury Press. Nagae, N., & Nedate, K. (2001). Comparison of constructive cognitive and rationalist cognitive psychotherapies for students with social anxiety. Constructivism in the Human Sciences, 6, 41-49. Neimeyer, G. J., & Aksoy, G. (2005). Epistemol ogy and psychotherapists: Clarifying the link among epistemic style, experience, and therap ist characteristics. Unpublished manuscript, University of Florida. Neimeyer, G. J., & Morton, R. J. (1997). Personal epistemologies and pr eferences for rationalist versus constructivi st psychotherapies. Journal of Constructi vist Psychology, 10 109-123. Neimeyer, G. J., Prichard, S., Lyddon, W. J., & She rrard, P. A. D. (1993). The role of epistemic style in counseling pref erence and orientation. Journal of Counseling and Development, 71, 515-523. Neimeyer, G. J., & Saferstein, J. (2003). Personal epistemologies and psychotherapists preferences. Unpublished manuscrip t, University of Florida. Neimeyer, G. J., & Saferstein, J. (2006). The re lationship between therapists epistemology and their therapy style, working alliance, a nd use of specific interventions. Unpublished manuscript, University of Florida. Neimeyer, R. A. (1993). Constructivism and the cognitive psychotherapies: Some conceptual and strategic contrasts. Journal of Cognitive Psychotherapy, 7 159-172.

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129 BIOGRAPHICAL SKETCH I was born in Ankara, Turkey, in 1981. In 1995 my fa mily moved to Istanbul, Turkey. I attended the Bogazici Univer sity in Istanbul, double-majoring in guidance and psychological counseling and psychology programs, as an unde rgraduate. In 2003, I graduated, ranking first in the Department of Education. I joined the Department of Psychology at th e University of Flor ida as a counseling psychology graduate student in August 2003. I co mpleted my Master of Science degree in December 2005. I completed my Doctor of Philosophy degree in August 2008.