A COMPARISON OF AN INTEGRATED DIDACTIC AND …/67531/metadc... · integrated didactic and...

A COMPARISON OF AN INTEGRATED DIDACTIC AND

EXPERIENTIAL APPROACH WITH THE TRADITIONAL

APPROACH IN THE PREPARATION OF COUNSELORS

APPROVED:

Graduate Committee: \

Maior Professor

,d: "inor Prof essoir

V n •£( t>\ Committee fn ember

tr-Committee Member

Dean of the School of Educatd?on

•f- *f~ V\ s~\ (~1 v n /ii i 4- C* 1 v Dean of the Graduate School

A COMPARISON OF AN INTEGRATED DIDACTIC AND

EXPERIENTIAL APPROACH WITH THE TRADITIONAL

APPROACH IN THE PREPARATION OF COUNSELORS

DISSERTATION

Presented to the Graduate Council of the

North Texas State University in Partial

Fulfillment of the Requirements

For the Degree of

DOCTOR OF PHILOSOPHY

By

Joyce^Buj^kner, B.A., M.S.E,

Denton, Texas

June, 1970

Copyright by-

Joyce Pannell Buckner

1970

TABLE OF CONTENTS'

Page

LIST OF TABLES V

Chapter

I. INTRODUCTION 1 Statement of the Problem . Hypotheses Background and Significance Definition of Terms Limitations of the Study Basic Assumptions

II. REVIEW OF THE LITERATURE 25

The Importance of the Therapeutic Triad in Causing Constructive Behavioral Change in Clients

The Source of the Therapeutic Conditions Within a Counseling or Therapy Session

Methods of Teaching the Therapeutic Triad

III. METHOD AND PROCEDURES . . 58

Subjects Description of Practicums" Procedure for Collecting Data Description of the Instruments Procedure for Treating Data

IV. STATISTICAL ANALYSIS OF RESULTS AND DISCUSSION 78

Analysis of Data Discussion of the Results

i n

Chapter Page

V. SUMMARY, FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS 9 8

Summary Findings Conclusions Recommendations

APPENDIX 1 0 6

BIBLIOGRAPHY 1 2 8

XV

LIST OF TABLES

Table Page

I. An Overview of Findings on the Therapeutic Effectiveness of Accurate Empathy, Non-possessive Warmth and Genuineness: All Measures of Outcome 7

II. Findings on the Therapeutic Effectiveness of Accurate Empathy 9

III. Findings on the Therapeutic Effectiveness of Genuineness 11

IV. Findings on the Therapeutic Effectiveness of Nonpossessive Warmth 13

V. Tests of Significance on Outcome Between Control, All Counseling Combined and High and Moderate Levels of Therapeutic Conditions Separately 37

VI. Mean Scale Values of Therapy Process Variables for Groups of Trainees and Experienced Therapists . 48

VII. t. Tests for Significant Differences of Therapy Process Variables for Groups of Trainees and Experienced Therapists . 48

VIII. Direction of Changes of Gross Ratings of Patient Behavior by Ward Personnel . . . 51

IX. Reliabilities of Rating Scales for Accurate Empathy, Nonpossessive Warmth, and Genuineness from Specific Studies . . . . . . . 70

X. Summary of Analysis of Covariance on the Accurate Empathy Scale . . . . . . . 79

XI. Summary of Analysis of Covariance on the Accurate Empathy Scale for Subgroups A . . . . . . . . . . . . . . . 80

XII. Summary of Analysis of Covariance on the Accurate Empathy Scale for Subgroups B . . . . 80

v

Table

XIII. Summary of Analysis of Covariance on the Accurate Empathy Scale for Subgroups C . . . c . . . . . . .

XIV. Summary of Analysis of Covariance on the Accurate Empathy Scale for Experimental Subgroups

XV. Summary of Analysis of Covariance on the Accurate Empathy Scale for Control Subgroups .

XVI. Summary of Analysis of Covariance on the Nonpossessive Warmth Scale

XVII. Summary of Analysis of Covariance on the Nonpossessive Warmth Scale for Subgroups A

XVIII. Summary of Analysis of Covariance on the Nonpossessive Warmth Scale for Subgroups B

XIX. Summary of Analysis of Covariance on the Nonpossessive Warmth Scale for Subgroups C . . ,

XX. Summary of Analysis of Covariance on the Nonpossessive Warmth Scale for Experimental Subgroups . . ,

XXI. Summary of Analysis of Covariance on the Nonpossessive Warmth Scale for Control Subgroups . . . . . .

XXII. Summary of Analysis, of Covariance on the Therapist Genuineness Scale .

XXIII. Summary of Analysis of Covariance on the Therapist Genuineness Scale for Subgroups A

XXIV. Summary of Analysis of Covariance on the Therapist Genuineness Scale for Subgroups B

XXV. Summary of Analysis of Covariance on the Therapist Genuineness Scale for Subgroups C

Page

81

82

82

84

85

85

86

86

87

89

89

90

90

vi

Table Page

XXVI. Summary of Analysis of Covariance on the Therapist Genuineness Scale for Experimental Subgroups 91

XXVII. Summary of Analysis of Covariance on the Therapist Genuineness Scale for Control Subgroups 92

VI1

CHAPTER I

INTRODUCTION

Although a number of approaches to educating counselors

are being practiced, evidence of the efficacy of most educa-

tive procedures is nonexistent. The reluctance of counselor

educators to make systematic inquiries into the process and

outcome of training is likely due in part to the previous

lack of consensual empirical evidence concerning the proper

goals of counselor education. That counseling is aimed at

producing constructive behavioral and personality change in

the client is evident, but the precise ingredients of the

therapeutic encounter that actually effect positive behavioral

change have, until recently, remained somewhat obscure.

A growing mass of relatively recent research spearheaded

by Carl Rogers, Charles B. Truax, and Robert Carkhuff has

sifted out three interpersonal skills—accurate empathy, non-

possessive warmth, and therapist genuineness (self-congruence).

—that are common to all counselors or therapists, regardless

of theoretical orientation, who effect positive behavioral

change in their clients. Conversely, research has shown

negative behavioral change in the clientele of counselors in

whom these attributes are absent (5, 6, 7, 9, 11, 18, 24, 36,

37, 38, 41, 42, 43, 44, 45). Although it seems logical

that an effective counselor should have a storehouse of

"expert" knowledge such as familiarity with the client

population with which he plans to work, some grasp of social

phenomena, human growth and development, norms and their

predictive deviations, and educational and occupational

information, research has shown that in order for this

"storehouse" to be conducive to positive client outcome, the

knowledge must be couched within a counselor who is . .

first and foremost an expert in interpersonal relationships"

(39, p. 222).

Truax asserts:

Surely, since accurate empathy, nonpossessive warmth and'genuineness appear to be central ingre-dients (common to a wide variety of theories and even more central to effective practice in counsel-ing and psychotherapy), training programs should at least initially focus most of their attention on the understanding and implementation of these therapeutic conditions (39, p. 223).(

Statement of the Problem

The problem was to compare the effectiveness of an

integrated didactic and experiential approach in the training

of graduate counseling practicum students with that of 'the

traditional approach in counseling practicum training.

The specific purposes to be investigated were

1. To determine the extent and direction of change in

ability to convey accurate empathy within ,the counseling'

relationship of graduate practicum students enrolled in- the

traditional practicum training class.


ability to convey nonpossessive warmth within the counseling

relationship of graduate practicum students enrolled in the

traditional practicum training class.


ability to convey genuineness (self-congruence) within the

counseling relationship of graduate practicum students en-

rolled in the traditional practicum training class.


ability to convey accurate empathy within the counseling fe-

lationship of graduate practicum students enrolled in the

integrated didactic and experiential approach to training

class.


ability to convey nonpossessive warmth within the counseling

relationship of graduate practicum students enrolled in the


class.


ability to convey genuineness (self-congruence) within the

counseling relationship of graduate practicum students en-

rolled in the integrated didactic and experiential approach

to training class.

Hypothe se s

The following hypotheses were tested:

1. Practicum students who have attended thirty hours

of class sessions in which the integrated didactic and ex-

periential training approach has been used will demonstrate

a statistically significant mean increase on the Accurate

Empathy Scale ratings as compared with practicum students

who have attended an equal number of traditional practicum

classes.




a statistically significant mean increase on the Nonposses-

sive Warmth Scale ratings as compared with practicum students


classes.




a statistically significant mean increase on the Therapist

Genuineness (or Self-Congruence) Scale ratings as compared

with practicum students who have attended an equal number of

traditional practicum classes.

Background and Significance

The essential question to be asked about counseling is

"What do we do as counselors that effects constructive be-

havioral change in our clients?" The answer to this question

should facilitate the establishing of an efficient, effective

training program for counselors.

From a review of the literature, central ingredients

have been found to exist in the form of common threads that

weave their way through almost every major theory of psycho-

therapy and counseling. Psychoanalytic (1, 16, 17, 28),

client-centered (12, 18, 23, 25), and eclectic theorists

(22, 29, 31, 32) have all emphasized the importance of the

counselor's ability to accurately and sensitively under-

stand the client. They have all emphasized the importance

of the counselor's ability to provide a non-threatening,

accepting atmosphere. In addition, they all stress that the

therapist be integrated and genuine within the relationship.

In summary, three characteristics of an effective counselor

emerge from the psychoanalytic, client-centered, and eclectic

viewpoints:

(1) An effective therapist is integrated, nondefensive, and authentic or genuine in his therapeutic encounters.

(2) An effective therapist can provide a non-threatening, safe, trusting or secure at-mosphere by his acceptance, unconditional posi-tive regard, love, or nonpossessive warmth for the client.

(3) An effective therapist is able to 'be with,' 'grasp the meaning of,* or accurately and emphathically understand the client on a moment-by-moment basis (39, p. 1).

Although many other theorists had stressed these three

sets of characteristics at an earlier date, Carl Rogers, in

1957, was the first leading theorist to consider the theo-

retic specification of empathic understanding, unconditional

positive regard, and congruence as both "necessary and suffi-

cient" conditions for client therapeutic change (25). Al-

though the terms "necessary" and "sufficient" are rather

strong terms and difficult to prove empirically, Roger's

stand has served as the primary impetus for the researching

of these three ingredients (39, p. 80). Due to the personal

and interpersonal nature of these attributes, they have

proved difficult to objectify. It was not until reliable

scales were developed by Charles B. Truax for the measuring

of the three important aspects of the psychotherapeutic re-

lationship—accurate empathy (33), nonpossessive warmth (35),

and therapist's self-congruence (34)—that scientific investi-

gation could be actualized.

A number of research studies with varied populations and

assorted measures of outcome have been completed in'an attempt

to investigate the importance of this triad in effecting

therapeutic change in clients. As is evidenced in Tables I -

IV, where the results from all studies known to Truax and

Carkhuff, both published and unpublished, are tabulated, the

present research findings consistently show empathy, • warmth,

and genuineness to be characteristic of human encounters that

produce positive behavioral change in people.

TABLE I . .

AN OVERVIEW OF FINDINGS ON THE THERAPEUTIC EFFECTIVENESS OF ACCURATE EMPATHY, NON-

POSSESSIVE WARMTH AND GENUINENESS: ALL MEASURES OF OUTCOME*

r~{ fd 0

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to -p a a) •HI tH u H-l o u Qi "B

Truax (1963) Truax, Wargo, Frank, Imber, Battle, Hoehn-Saric, Nash & Stone (1966a)

Truax & Wargo (1966c) Truax & Wargo (1966b) Truax, Wargo & Carkhuff (1966)

Dickenson & Truax (1966) Truax, Wargo & Silber (1966) Carkhuff & Truax (1965b) Truax, Silber & Wargo (1966b) Aspy (1965)

Totals

Ind

Ind Grp Grp Grp Grp

Grp Grp Grp

Hospital

.Outpatient Hospital Delinquent Outpatient College counselees Delinquent Hospital Hospital Elementary students

28

40 160 80 80

48 70 150 74

120

850

•Source: Truax, Charles B. and R. R. Carkhuff, Toward Effective Counseling and Psychotherapy: Training'and Prac-tice, Chicago, Aldine Publishing Company, 1968, p. 124.

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TABLE II

FINDINGS ON THE THERAPEUTIC EFFECTIVENESS OF ACCURATE EMPATHY*

Study-

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Truax, Carkhuff & Kodman (1965) Truax & Wargo (1966c) Truax & Wargo (1966b) Truax, Wargo, & Carkhuff (1966) Truax (1966a)

Totals

Ind Ind Ind Ind

Ind Grp Grp Grp Grp Grp

Hospital Hospital Outpatient Hospital

Outpatient Hospital Hospital Delinquent Outpatient Hospital Delinquent

8 14 14 14

40 40 160

80 80 40 40

530

•Source: Truax, Charles B. and R. R. Carkhuff, Toward Effective Counseling and Psychotherapy: Training and Practice, Chicago, Aldine Publishing Company, 1968, p. 125.

TABLE II —Continued

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TABLE III

FINDINGS ON THE THERAPEUTIC EFFECTIVENESS OF GENUINENESS* •

Study

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Truax (1963) Truax, Wargo, Frank, Imber, Battle, Hoehn-Saric, Nash, & Stone (1966a)

Truax, Carkhuff & Kodman (1965) Truax & Wargo (1966c) Truax & Wargo (1966b) Truax, Wargo & Carkhuff (1966) Truax (1966a)

Totals

Ind


Hospital


14

40 40

160 80 80 40 40

494

*Source: Truax, Charles B. and R. R. Carkhuff, Toward Effective Counseling and Psychotherapy; Training and Practice, Chicago, Aldine Publishing Company, 1968, p. 126.

TABLE III--Continuec3

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TABLE IV

FINDINGS ON THE THERAPEUTIC EFFECTIVENESS OF NONPOSSESSIVE WARMTH*

Study

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Truax, Carkhuff & Kodman (1965) Truax & Wargo (1966c) Truax & Wargo (1966b) Truax, Wargo & Carkhuff (1966) Truax (1966a)

Totals

Ind Ind


Hospital Outpatient


14 14

40 40 160 80 80 40 40

508

•Source: Truax, Charles B. and R. R. Carkhuff, Toward Effective Counseling and Psychotherapy: Training and Practice, Chicago, Aldine Publishing Company, 1968, p. 127.

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Using the above theoretical basis, some researchers

turned their focus onto the following question: Can the

therapeutic triad be taught, and, if so, what method of

training is most efficient and effective?

That the majority of the existing approaches to training

have tended to produce, on the average, ineffective practi-

tioners has been shown by two lines of evidence. The first

line of suspicion grew out of the controversy instigated by

Eysenck (10, 13, 14, 15, 19, 20, 26, 27, 30) in which he

asserted that psychotherapeutic approaches were not effective

in helping either the disturbed child, the neurotic, or the

disabled adult. A careful review of the relevant research

literature indicates that Eysenck was

. . .essentially correct in saying that average counseling and psychotherapy as it is currently practiced does not result in average client im-provement greater than that observed in clients who receive no special counseling or psychothera-peutic treatment (39, p. 5).

The second line of evidence emerges from three recent

studies in which the relationship between existing training

programs and the ability to communicate high levels of

accurate empathy by the trainees has been studied (2, 4, 21).

These studies, taken together, offer strong support for the

suspicion that training programs in counseling and psycho-

therapy are ". . .aimed at theory rather than implementation,

and at psychodynamics rather than psychotherapy" (39, p. 225).

16

In view of the lack of evidence for the efficacy of

present training methods, a program for applying the research

instruments designed to measure the therapeutic triad to the

training of professional and lay persons was set forth by

Truax, Carkhuff, and Douds (40). Since the inception of the

integrated didactic and experiential approach to training,

research evidence has suggested that specific training can

lead to relatively effective communication of accurate

empathy, nonpossessive warmth, and genuineness (3, 8, 9, 42).

Although the combined research that has attempted to

evaluate the integrated didactic and experiential approach

to training suggests that constructive behavioral change can

be effected when the "helper" exhibits high levels of the

therapeutic triad, and, conversely, deteriorative change in

their absence, and that this triad can be taught, the evidence

is meager and represents only a beginning step toward speci-

fying the nature of the antecedents to constructive or

deteriorative personality and behavioral change. Truax and

Carkhuff assert: :

Future research must be aimed. . .at devel-oping further evidence to define more solidly the contexts within which these three conditions are indeed ingredients in effective psychotherapy, learning, education, and human development. . . (39, p. 141).

Truax said, in a personal conversation about this study,

that the study should be most worthwhile, particularly as a

means of helping to determine if the integrated didactic and

17

experiential approach to training can effectively be imple-

mented by persons other than himself and his co-workers

(November, 1968). For, in order for the method of training

to be appropriately recommended widely, evidence of the

results obtained by a variety of trainers, other than fairly

well-known personalities, must be known.

Definition of Terms

The following definitions apply to certain selected

terms used throughout the study:

1. Accurate empathy.—The counselor's sensitivity to

current feelings of his client in conjunction with his verbal

facility to communicate this understanding in a language

attuned to the client's current feelings. At a high level

of accurate empathy the message "I am with you" is unmistaken-

ly clear. The criterion for measuring levels of accurate

empathy is the Accurate Empathy Scale (33).

2. Nonpossessive warmth.—The acceptance of the client

as a person with human potentialities. It involves a non-

possessive caring for the client as a separate person along

with a willingness to share equally his joys and aspirations

or his depressions and failures. In addition, the client is

valued as a person without contamination from an evaluation

of his behavior or thoughts. The counselor's response to the

client's thoughts or behavior is a search for their meaning or

value within the client rather than an expression of approval

18

or disapproval. The criterion for measuring levels of

nonpossessive warmth is the Nonpossessive Warmth Scale (35).

3* Therapist genuineness.—At the moment, the therapist

is really whatever his response denotes. It does not mean

that the therapist must disclose his total self, but only

that whatever he does show is a real aspect of himself. Thus

the therapist's response must be sincere, not one that grows

out of defensiveness; nor is it a merely "professional"

response that has been learned and repeated. In essence, to

be "genuine" is to lack defensiveness. The criterion for

measuring levels of therapist genuineness is the Therapist

Genuineness Scale (34).

4. Therapeutic triad.—Accurate empathy, nonpossessive

warmth, and genuineness as defined in this study.

5. An integrated didactic and experiential training

approach.—The approach to training counselors and psycho-

therapists that is set forth in Toward Effective Counseling

and Psychotherapy; Training and Practice by Truax and

Carkhuff. The three elements central to the approach are

(1) a therapeutic context in which the supervisor himself

provides high levels of therapeutic conditions; (2) a highly

specific didactic training in the implementation of the

therapeutic conditions; and, (3) a quasi-group therapy exper-

ience where the trainee can explore his own existence, and his

own individual therapeutic self can emerge.

19'

6* The traditional approach to training.—The content

of the traditional approach was outlined by the supervisors

of the control group (Appendix A, B, C). The critiquing of.

the trainee's taped counseling sessions by focusing on how

the trainee felt about his session along with general

suggestions from the supervisor and the other trainees was

the central aspect of the traditional approach.

Limitations of the Study

1. This study was limited to the thirty-one students

who enrolled in the practicum in counseling at North Texas

State University in the spring of 1969. This limitation was

imposed because this was the total number of graduate counsel-

ing practicum students available. There is no known reason

to suppose that the practicum students who enroll in other

sessions would differ in significant ways from those

included in the study.

2. Variables other than the training procedures used

within the weekly class period could possibly have operated

to change the levels on the three measuring instruments.

This limitation is imposed because it was not possible to

control all environmental factors. There is no known

reason to suppose that random sampling would not cancel out

these effects.

20

Basic Assumptions

1. It was assumed that differences in the personal-

ities of the practicum supervisors would not have an

appreciable effect upon the results of the study. Each

supervisor subscribed to a client-centered philosophy of

counseling. It was assumed that any measured differences

would result from differences in the approaches used in the

practicums rather than to differences in the philosophies or

personalities of the supervisors.

2. It was assumed that the thirty-hour integrated

didactic and experiential approach to training was adequately

implemented by the experimental supervisor. According to

Truax, the one week of intensive training attended by the

experimental supervisor was sufficient to develop trainers

who could cooperate in research activities and the training

of others.

3. It was assumed that, at the' given point in time,

the pre- and posttests were typical of the trainees' level

of development on the three interpersonal skills.

4. It was assumed that the instruments used in the

study were sufficiently valid.

5. It was assumed that the raters who scored the pre-

and posttests were sufficiently accurate i~n their judgments.

The raters used were professional raters trained by Truax

and his staff in the use of the interpersonal scales.

BIBLIOGRAPHY

1. Alexander, F., Fundamentals of Psychoanalysis, New York, W. W. Norton, 1948.

2. Baldwin, T. and Joan Lee, "Evaluation of Programmed Instruction in Human Relations," American Psy-chologist, XX (1965), 20.

3. Berenson, B. G., R. R. Carkhuff, and Pamela Myrus, "The Interpersonal Functions and Training of College Students," Journal of Counseling Psychology, XIII (1966), 4.

4. Bergin, A. E. and Sandra Solomon, "Personality and Performance Correlates of Empathic Understanding in Psychotherapy," unpublished paper read before the American Psychological Association, Philadelphia, September, 1963.

5. Carkhuff, R. R., "On the Necessary Conditions of Therapeutic Personality Change," Discussion Papers, Wisconsin Psychiatric Institute, University of Wisconsin, no. 47, 1963.

6. , editor, The Counselor's Contribution to Facilitative Processes, Urbana, Illinois, Parkinson, 1967.

7. , "Toward A Comprehensive Model of Facilitative Interpersonal Processes," Journal of Counseling Psychology, XIV (1967), 67-72.

8. , and C. B. Truax, "Lay Mental Health Counseling: The Effects of Lay Group Counseling," Journal of Consulting Psychology, XXIX (1965), 426-431.

9. and , "Training in Counseling and Psychotherapy: An Evaluation of An Integrated Didactic and Experiential Approach," Journal of Consulting Psychology, XXIX (1965), 333-336.

10. DeSharmes, R., J. Levy, and M. Wertheimer, "A Note on Attempted Evaluations of Psychotherapy," Journal of Clinical Psychology, X (1954), 233-235.

21

22

11. Dickenson, W. A. and C. B. "fruax, "Group Counseling with College Underachievers: Comparisons with A Control Group and Relationship to Empathy, Warmth, and Genuineness," unpublished manuscript, University of Kentucky, 1965.

12. Dymond, Rosalind, "A Scale for the Measurement of Empathic Ability," Journal of Consulting Psychology, XIII (1949), 127-133.

13. Eysenck, H. J., editor, "The Effects of Psychotherapy," Handbook of Abnormal Psychology, New York, Basic Books, Inc., 1961.

14. Eysenck, H. J., "The Effects of Psychotherapy: An Evaluation," Journal of Consulting Psychology, XVI (1952), 319-324.

15. , "The Effects of Psychotherapy: A Reply," Journal of Abnormal Social Psychology, L (1955), 147-148.

16. Ferenczi, S., "The Principle of Relaxation and Neo-catharsis," International Journal of Psychoanalysis, XI (1930), 428-443.

17. Halpern, H. and Leona Lesser, "Empathy in Infants, Adults, and Psychotherapists," Psychoanalysis and the Psychoanalytic Review, XLVII (1960), 32-42.

18. Jourard, S., "I-Thou Relationship Versus Manipulation in Counseling and Psychotherapy," Journal of Individual Psychology, XV (1959), 174-179.

19. Luborsky, L., "A Note on Eysenck's Article 'The Effects of Psychotherapy: An Evaluation'," British Journal of Psychology, XLV (-1954), 129-131.

20. Meehl, P. E., "Psychotherapy," Annual Review of Psy-chology, VI (1955), 357-378.

21. Melloh, R. A., "Accurate Empathy and Counselor Effec-tiveness, " unpublished doctoral dissertation, University of Florida, 1964.

22. Raush, H. L. and E. S. Bordin, "Warmth in Personality Development and in Psychotherapy," Psychiatry: Journal Study of Interpersonal Processes, XX (November, 1957), no. 4.

23. Rogers, Carl R., Client-Centered Therapy, Cambridge, Massachusetts, Riverside Press, 1951.

23

24. , "The Interpersonal Relationship: The Core of Guidance," Harvard Educational Review, XXXII (1962), 416-429.

25. , The Necessary and Sufficient Conditions of Therapeutic Personality Change," Journal of • • Consulting Psychology, XXI (1957), 95-103.'

26. Rosenzweig, S., "A Transvaluation of Psychotherapy: A Reply to Hans Eysenck," Journal of Abnormal Social Psychology, XLIX (1954), 298-304.

27. Sanford, N., "Clinical Methods: Psychotherapy," Annual Review of Psychology, V (1954), 311-336.

28. Schafer, R., "Generative Empathy in the Treatment Situation," Psychoanalytic Quarterly, XXVIII (1959), 342-373.

29. Shoben, E. J., Jr., "Psychotherapy as a Problem in Learning Theory," Psychological Bulletin, XLVI (1949), 366-392.

30. : , "Counseling," Annual Review of Psychology, VII (1956), 147-172.

31. Strunk, O., Jr., "Empathy: A Review of Theory and Research," Psychological Newsletter, IX (1957), 47-57.

32. Strupp, H. H., "Nature of Psychotherapist's Contribution to the Treatment Process," Archeological and Genetic Psychiatry, III (1960), 219-231.

33. Truax, Charles B., "A Scale for the Measurement of Accurate Empathy," Psychiatric Institute Bulletin, Wisconsin Psychiatric.Institute, University of Wisconsin, 1961, 1, no. 10 (c).

34. , " Tentative Scale for the Measurement of Therapist Genuineness or Self-Congruence," Discussion Papers, Winconsin Psychiatric Institute, University of Wisconsin, no. 35, 1962.

35. , "A Tentative Scale^for the Measurement of Unconditional Positive Regard,'" Psychiatric Institute Bulletin, Wisconsin Psychiatric Institute, University of Wisconsin, 1962, 2, no. 1.

36. , "Therapeutic Conditions," Psychiatric Institute Bulletin 13, Wisconsin Psychiatric Insti-tute, University of Wisconsin, 1961.

24

37. Truax, Charles B. and R. R. Carkhuff, "For Better or for Worse. . . .The Process of Psychotherapeutic Personality Change," chapter in Recent Advances in the Study of Behavior Change, Montreal, McGill University Press, 1964, 118-163.

38. and , "The Experimental Manipulation of Therapeutic Conditions," Journal of Consulting Psychology, XXIX (1965), 119-124.

39 . and , Toward Effective Counseling and Psychotherapy; Training and Practice, Chicago, Aldine Publishing Company, 1968.

40. , , and J. Douds, "Toward an Integration of the Didactic and Experiential Approaches to Training in Counseling and Psychotherapy," Journal of Counseling Psychology, XI (1964), 240-247.

41. , , and F. Kodman, "Relationships between Therapist-Offered Conditions and Patient Change in Group Psychotherapy," Journal of Clinical Psychology, XXI (1965), 327-329.

42 . , L. D. Silber, and R. R. Carkhuff, "Accurate Empathy, Non-Possessive Warmth, Genuine-ness and Therapeutic Outcome in Lay Group Coun-seling, " unpublished manuscript, University of Arkansas, 1966.

43. and D. G. Wargo, "Antecedents to Out-come in Group Psychotherapy with Juvenile Delinquents: Effects of Therapeutic Conditions, Alternate Sessions, Vicarious Therapy Pretraining, and Patient Self-Exploration, " unpublished manuscript, University of Arkansas, 1966.

44. and , "Antecedents to Out-come in Group Psychotherapy with Hospitalized Mental Patients: Effects of Therapeutic Conditions, Alternate Sessions, Vicarious Therapy Pretraining, and Patient Self-Exploration," unpublished manuscript, University of Arkansas, 1966.

45. , , and R. R. Carkhuff, "Antecedents to Outcome in Group Psychotherapy with Outpatients: Effects of Therapeutic Conditions, Alternate Sessions, Vicarious Therapy Pretraining and Patient Self-Exploration," unpublished manuscript, University of Arkansas, 1966.

CHAPTER II

REVIEW OF THE LITERATURE

The Importance of the Therapeutic Triad in Causing Constructive Behavioral Change in Clients

That the counselor who effects positive behavioral change

in his clients is genuine, nonpossessively warm, and accurate-

ly empathic has been proposed over the years by various theo-

rists. Among the theorists who have specified these three

ingredients are psychoanalytic theorists such as Alexander (1),

Ferenczi (15), Halpern and Lesser (17), and Schafer (29);

client-centered theorists such as Rogers (25, 26), Dymond (11),

Jourard (20), and Truax (34); eclectic theorists such as

Raush and Bordin (24), Shoben (30), Strunk (32), and Strupp

(33), and even a behavioristic theorist such as Wolpe (53, p.

106).

Early research which tended to confirm the theoretic

importance of the three therapist ingredients grew out of the

work of Strupp (33) and the work and writings of Rogers.

Rogers served as the primary impetus for research interest in

the therapeutic triad by his theoretic statement in 1957 in

which he proposed empathic understanding, unconditional posi-

tive regard, and congruence to be both "necessary and suffi-

cient" conditions for client therapeutic change (26).

25

26

A prerequisite to empirical investigation was the

development of reliable measuring instruments that would

assess degree of therapist accurate empathy, nonpossessive

warmth, and genuineness. Reliable scales were developed by

Charles B. Truax during 1961 and the early part of 1962 to

assess these three dimensions of the therapeutic encounter

(35, 36, 37).

Studies of Client or Patient- Outcome in Cases Receiving Relatively High Levels of the

Therapeutic Conditions Contrasted with Those Receiving Relatively

Low Levels

Halkides (16) conducted one of the first .studies that

attempted to relate the therapist's level of the therapeutic

triad to patient outcome. Brief samples from early and late

therapy sessions from the ten most successful and the ten

least successful therapy cases were rated, using a brief

scale based upon Rogers* writings (26), on therapist levels

of empathic understanding, unconditional positive regard, and

self-congruence. She reported that the most successful cases

showed significantly higher levels of these three conditions

than did the least successful cases.

Two years later Hart (18) replicated that study, however,

and, using the same data and similar procedures but different

judges, failed to confirm Halkides' findings. Truax suggests

that the discrepancy in findings on identical data

. . . might be due to the scales used by Halkides and Hart, which were primarily global and implic-itly defined, relying heavily on the raters*

27

knowledge of what constitutes empathy, warmth, and therapist congruence. In this connection it might be noted that the ratings in Halkides' study were made by experienced client-centered therapists . . ., while Hart used raters less experienced within the client-centered orientation (41, pp. 82-83).

In a study of group psychotherapy with hospitalized

patients, Truax (34) found accurate empathy, warmth, and

genuineness to all be significantly related to the patients'

engagement in the process of therapy, self-revelation, and

self-exploration.

The Wisconsin Schizophrenic Project;.—A number of

studies have resulted from an extensive study of psycho-

therapy with sixteen hospitalized schizophrenic patients

begun in 1958 at the University of Wisconsin under the

leadership of Carl Rogers.

In 1961, an initial study (40) compared the level of

accurate empathy communicated by the therapists of four

hospitalized patients who showed definite improvement on a

variety of personality tests with the level communicated by

the therapists of four patients who showed definite deterio-

ration after six months of intensive psychotherapy. The

findings showed that the therapists of test-improved patients

rated consistently higher on accurate empathy than those with

test-deteriorated cases (p<.01).

Two years later, Truax completed studies (38) involving

fourteen schizophrenic patients who had been involved in

28

intensive psychotherapy for periods ranging from six months

to four and one-half years. A four-minute tape-recorded

sample was selected from every fifth interview in the course

of treatment and rated by trained raters on the Accurate

Empathy, the Nonpossessive Warmth, and the Genuineness Scales.

The correlation between accurate empathy and case outcome, as

measured by the Final Outcome Criteria (which included psycho-

logical test change data, diagnostic evaluations of personal-

ity change, and a measure of time actually spent in the

hospital since initiation of therapy), was .77 (p<.01); be-

tween nonpossessive warmth and case outcome, .73 (p<̂ .01);

and between therapist genuineness and case outcome, .66

(p< . 01).

In an attempt to extend the findings obtained with

hospitalized schizophrenics to an outpatient population,

Truax (38) obtained fourteen additional cases (seven relative

successes and seven relative failures) from the University of

Chicago and Stanford University. Using samples obtained from

early and late interviews with the fourteen hospitalized and

fourteen outpatient cases, the therapist-offered level of

accurate empathy was found to be significantly higher for

successful cases than for failures (p< .01) in both the

hospitalized and the outpatient groups.

More recent studies.--In a further attempt to cross-

validate the findings reported with hospitalized schizophren-

ics with data from a very different therapist population, a

29

study was completed in 1966 (49) in which forty outpatients

were treated by resident psychiatrists at the Phipps Psychia-

tric Clinic at Johns Hopkins. Analysis of the findings indi-

cated statistically significant improvement for patients of

therapists offering high levels of the therapeutic triad over

patients receiving relatively lower levels of these conditions,

ton the measure of improvement that was available for all forty

patients, there was an overall improvement rate of 70 per cent,

which roughly approximates the average improvement rate re-

ported by Eysenck (13) as characteristic for treated as well

as control populations. However, the therapists who provided

high levels of conditions produced a 90 per cent improvement

rate, whereas the therapists who communicated relatively low

levels on conditions produced a rate of only 50 per cent im-

provement .

The Hopkins data indicated that psychotherapy can be

harmful as well as helpful depending 6n the level of thera-

peutic conditions offered by the therapist. When each of the

three conditions of accurate empathy, nonpossessive warmth,

and genuineness was analyzed individually, the data showed

that patients receiving high levels of empathy and genuineness

tended to show more positive change than patients receiving

low levels. The reverse tendency was noted in regard to

nonpossessive warmth. Truax attempts to explain this seeming

discrepancy as follows:

This puzzling finding seems to be explained by the interrelationships between the three

30

conditions themselves in that sample of ther-apists: the ranking of therapists on empathy and genuineness was identical (Rho = 1.00), while nonpossessive warmth was negatively re-lated to both the other conditions (Rho = -.40). The Hopkins data, then, suggests that when one of the three conditions is negatively related to the other two in any given sample of thera-pists, then patient outcome is best predicted by whichever two conditions are most closely related to each other. In general form, this idea suggests that when any two of the three therapeutic conditions are sufficiently high, positive patient or client change will occur (41, p. 91).

A study by Truax, Carkhuff and Kodman (43) attempted to

extend the generality of the three therapeutic ingredients by

studying their relationships to outcome in group psychothera-

py. That study involved forty relatively chronic hospitalized

mental patients who participated in group therapy sessions

two times a week for a three-month period. The Minnesota

Multiphasic Personality Inventory was administered before and

after therapy. When the patients were divided according to

whether or not they had been offered relatively high or low

levels of accurate empathy, the patients who had received

high levels showed improvement on all of the MMPI subscales

equal to or greater than that of the patients receiving

relatively low levels. Statistically significant differences

occurred on the Pt scale, the Sc scale, and the Welsch Anxiety

Index obtained from the MMPI. When the patients were divided

into high and low therapist-provided levels of nonpossessive

warmth, the data showed significant differences favoring

greater improvement in patients receiving the highest levels

31

of communicated therapist warmth on the Pt scale, the Sc

scale, and, the Welsch Anxiety Index from the MMPI. Differ-

ences in improvement on all clinical scales favored the high

group. Essentially, the data on nonpossessive warmth came

out very similar to that for communicated accurate empathy.

The data on therapist genuineness, when compiled in the

same manner as that given for warmth and empathy, came out in

the opposite direction. That is, there was a uniform tendency

on all subscales of the MMPI for the patients who had received

relatively high levels of therapist genuineness to show less

improvement than those receiving low levels. Statistically

significant differences favoring low genuineness were found

on the Pd scale, the Pt scale, the Sc scale, the Si scale,

and the sum of clinical scales. Thus, the findings support

the generality of the therapist-offered qualities of accurate

empathy and nonpossessive warmth, but do not support previous

findings in individual therapy of the therapeutic importance

of therapist genuineness. Truax responds to these findings

as follows: ;

It is of considerable interest to note that in the Truax, Carkhuff and Kodman group therapy study, there was a strong positive correlation between empathy and warmth, but genuineness was negatively related to both empathy and warmth. Thus, as in the Hopkins data on individual psychotherapy, the findings in group therapy suggest that when two conditions of the thera-peutic triad are highly related but the third is negatively related, the prediction of out-come should be based on the two that are most highly related (41, p. 92).

X

32

A study in which 160 hospitalized patients received 24

sessions of group psychotherapy over a three-month period

was reported by Truax and Wargo in 1966 (47). Pre- and post-

treatment personality and behavioral measures were used.

Analysis of covariance was used to control for any possible

differences in initial patient status that could have differ-

entially affected outcome. Significant differences in im-

provement favoring patients receiving relatively high levels

of empathy, warmth, and genuineness combined were obtained

on Q-sort measures- of self concept, the MMPI subscales of Mf

and Sc, the Welsch Anxiety Index, time spent out of the

hospital during one-year followup, and the Final Outcome

Criterion, which included several measures of psychological

test change as well as the hospitalization rate data. Fur-

thermore, .as a group, patients who received relatively low

levels of conditions tended to show greater deteriorative

change than did those patients who received higher levels.

When the findings were analyzed separately, the same general

pattern held individually for levels of accurate empathy, non-

possessive warmth, and genuineness.

Eighty institutionalized juvenile delinquents who re-

ceived three months of group counseling were the subjects of

another study by Truax and Wargo (46). Analysis of covari-

ance was used to control for any possible differences in

initial patient status that could have differentially affected

outcome. The reported findings again indicated significant

33

association between the levels of empathy, warmth, and gen-

uineness offered by the group counselor and the degree of

personality and behavioral change exhibited by the juvenile

delinquents. On the nineteen specific measures of therapeu-

tic outcome available, the delinquents who received high

levels on all conditions showed above-average improvement on

eighteen measures and below-average improvement on only one

measure. In contrast, those delinquents receiving low

levels of conditions showed above-average improvement on

only one measure and below-average improvement on eighteen

measures (p< .001).

Truax, Wargo, and Carkhuff (48), in a replication of the

same basic design as used in the foregoing study, studied an

original population of eighty outpatients who received group

psychotherapy for a three-month period. The results revealed

essentially similar findings for all conditions combined. On

the twenty-three individual measures of therapeutic outcome

available, the outpatients who received high levels on all'

conditions showed above-average improvement on twenty-one

measures and below-average improvement on two measures; the

reverse was found for patients receiving relatively low

conditions (p^ .001).

Studies of Conditions and Outcome Utilizing Control Groups

The previously cited studies, taken as a whole, support

the theoretical position that the levels of nonpossessive

34

warmth, accurate empathy, and therapist genuineness are

positively related to constructive change in clients. How-

ever, the research reported above is limited to a study of

those cases that were relatively successful or unsuccessful.

In 1952, Eysenck (13) asserted the accusation that psycho-

therapeutic approaches were likely not significantly superior

to no treatment. Such as accusation points up the necessity

of control groups in research. A limited number of studies

have been completed in which control groups were a part of

the design.

The Wisconsin Schizophrenic Project.—Truax (38) reports

a study involving fourteen schizophrenics receiving individ-

ual psychotherapy and fourteen carefully matched control

patients who received no therapy. The patients were randomly

assigned to either therapy or control conditions within the

matched pairs, and a complete battery of psychological tests

was administered to the total sample both before and after

treatment. The therapy patients underwent a minimum of 30

individual therapy sessions and a maximum of 280 sessions

throughout a three and one-half year period. Samples of tape-

recorded psychotherapy sessions were independently rated for

therapist accurate empathy, nonpossessive warmth, and genuine-

ness. Upon examination of the mean value for each case, the

therapy patients were divided at the closest significant gap

in level of conditions, so as to divide the treated group in

l/

35

halves—those having received relatively high levels of

conditions and those having received relatively low levels.

Six patients were the recipients of relatively high conditions,

and eight, the recipients of relatively low conditions. Using

the clinician's "blind" analysis of pre- and posttest battery

information to establish levels of overall psychological

functioning, the findings showed that patients receiving high

levels of the three conditions exhibited an overall gain in

psychological functioning. Those patients who received

rather low levels Showed a loss in psychological functioning.

The control patients showed moderate gains. An overall test

of the differences proved statistically significant.

In another study from the Wisconsin project, Wargo (52)

A studied the effects of accurate empathy, positive regard, and

unconditional positive regard upon the Barron Ego Strength

Scale, developed to predict psychotherapeutic outcome, and

the LH^ scale developed by Meeker to predict length of hospi-

talization. Wargo's_findings showed that change in ego

strength was significantly greater in a positive direction for

patients receiving high conditions for all three measures.

Differences were in the same direction for the LH^ scale, but

reached statistical significance only with the unconditional

.positive regard scale. No significant differences in change

on either scale were found when all therapy cases (both high

and low conditions) were compared with control cases.

36

More recent studies.--Dickenson and Truax (10), working \j

with a matched therapy and control population of forty-eight

emotionally disturbed college underachievers, investigated

the effects of time-limited group counseling upon college

academic achievement. Those students receiving group

counseling showed significant improvement over the control

students. It is interesting to note, however, that when

those receiving counseling were divided according to the •

levels of therapeutic conditions they were offered during

therapy, the findings indicated that only those receiving

relatively high levels of empathy, warmth and genuineness

showed improvement over the controls. Those students re-

ceiving only moderate levels showed grade-point averages and

changes approximating those in the control group. These

findings are shown in Table V. /

Truax, Wargo and Silber (51) studied the effects of y

high levels of accurate empathy, nonpossessive warmtn, and

genuineness in group counseling with female juvenile delin-

quents. The unique attribute of this study was that only

therapists who had been recognized by prior research as high-

level-conditions therapists were used. Seventy institution-

alized delinquents were randomly assigned—thirty girls to

the control group and forty girls to the therapy group. The

treatment population received twenty-four group psychotherapy

sessions, but otherwise received the same institutional

treatment as the control population. Analysis of covariance

37

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trol group on all twelve measures obtained before and after

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ward perceiving parents and other authority figures as more

reasonable and less threatening. Perhaps the most important

finding was that the therapy group showed significant superi-

ority over the control group on a psychological test measure

specifically designed to differentiate between delinquents

and nondelinquents. In addition, a one-year follow-up of the

girls' ability to stay out of institutions significantly

favored the delinquents who had received high conditions in

group therapy.

As is evidenced in Tables I-IV, where the results

from all studies known to Truax and Carkhuff, both published

and unpublished, are tabulated, the present research findings

consistently show that therapists or counselors who are

accurately empathic, nonpossessively warm, and genuine are

effective in direct proportion to the level of the elements

communicated in the therapeutic encounter. That is, generally

speaking, the more warm, empathic, and genuine the counselor,

the greater the degree of constructive behavioral change in

the client. These findings seem to hold irrespective of the

training and theoretic orientation of the therapist or

39

counselor and with a divergent clientele, including college

under-achievers, hospitalized schizophrenics, juvenile delin-

quents, college counselees, mild to severe outpatient neurot-

ics, and elementary students. Furthermore, these findings

are evidenced in a variety of settings and in both group and

individual psychotherapy or counseling.

The Source of the Therapeutic Conditions Within A Counseling or Therapy Session

In view of the research which supports the theoretical

assumption that the therapeutic triad is necessary for con-

structive behavioral change in clients, a logical next step

seems to hinge upon the determination of who in the therapeu-

tic encounter is responsible for causing the levels of the

therapeutic triad. Is the source of the therapeutic conditions

the counselor, the client, or is their level determined by a

complex interaction between the two. A review of the litera-

ture reveals several approaches that have been used in an

attempt to determine the source of the triad in a counseling

session.

One way that the question of causation has been

approached was to make the clientele a constant by using

identical patients for several therapists. The rationale

behind this procedure is that if the level of conditions is

different for different therapists even when seeing the same

patients, then it must be the therapist who determines the

level of the conditions.

40

Truax and Carkhuff report a study (41, p. 101) which was

aimed at clarifying the source of accurate empathy. The

study included twenty-four patients at Mendota State Hospital,

where eight different therapists offered psychotherapy to all

patients on a demand basis. Samples were selected from the

tape recordings of interviews in which the same eight thera-

pists saw the same eight patients in a balanced incomplete

block design. The design permitted the researchers to deter-

mine whether or not the therapist had affected the level of

accurate empathy and, separately, whether or not the patient

had affected the level of accurate empathy. The findings

indicated that different therapists did produce different

levels of accurate empathy, even when interacting with the

same set of patients (p<f.01). Because the therapist-offered

level of accurate empathy showed up independently of the

client's, the ability to empathize seemed to be part of the

therapist's makeup and not a manifestation of the client. In

contrast, there was not significant difference in the levels

of accurate empathy that were communicated to different

patients by the same therapist.

When the data from this same study was analyzed for

levels of nonpossessive warmth and therapist genuineness,

quite similar findings were revealed; that is, different thera-

pists produced significantly different levels of both nonpos-

sessive warmth (p< .01) and genuineness (p<T.05), but when

being seen by the same set of therapists, different patients

41

did not evoke different levels of either nonpossessive

warmth (p^*.40) or genuineness (p<,50). It would seem from

this study that patients received each individual therapist's m

own level of the three conditions without contamination as a

result of the patient's influence (41, p. 101).

In another study by Truax (39), a single standard inter-

viewer saw each patient periodically throughout the course of

therapy. It was thought that if the patient influenced the

level of conditions to any appreciable degree, significant

correlations would' exist between the level of conditions

communicated in the patient's therapy and the level communi-

cated in his interview with the single standard interviewer.

Thus, if one patient were easier to empathize with than

another, he should have a relatively high level of accurate

empathy evidenced in both his therapy an<3 his standard inter-

view, whereas a patient who was less able to elicit empathic

understanding would receive relatively lower levels in both

his therapy and his standard interview. No significant

correlation between the level of accurate empathy and genuine-

ness communicated in the therapy sessions as compared with

the standard interview was found. Therefore, neither accurate

empathy nor genuineness seemed to be significantly affected

.by the patient. In regard to the findings concerning non-

possessive warmth,' however, a moderate positive relationship

(P< .05) was found which suggested that the patient does to

some extent affect the level of nonpossessive warmth that

occurs in the relationship.

42

A similar study (50) was performed but with the patient

randomly assigned to one of two different psychiatrists who .

served as screening interviewers. The two differed from each

other significantly on both accurate empathy (p<.001) and

therapist self-congruence (p<.01), but not on nonpossessive

warmth. The findings clearly indicated that the interviewer,

not the patient, determined the levels of empathy and congru-

ence. Truax hypothesizes that the nonsignificant findings

with warmth may mean that the patient as well as the therapist

affects warmth or that the results pointed up that the two

interviewers were providing equal levels of warmth (41, p. 102).

Another similar study compared the level of conditions

offered by four therapists (41, p. 102). The findings showed

that the different therapists offered significantly different

levels of accurate empathy (p<.001), nonpossessive warmth

(p<.05), and genuineness (p<.001) to their patients even

though the patients had been randomly assigned.

Several additional studies completed in 1966 (3, 19) also

support the notion that the counselor rather than the client

determines the level of the three conditions in the therapeu-

tic encounter.

On the basis of the research that has been completed up

to the present which has attempted to determine the source of

the therapeutic triad in the counseling relationship, the

results have, without exception, shown that the counselor and

not the client determines the levels of accurate empathy and

43

genuineness. The findings are not uniform concerning the

source of nonpossessive warmth. The research has indicated

that in therapeutic interviews the therapist is the primary-

source of warmth, but that in non-therapeutic interviews

(such as the standard sampling interviews and the screening

interviews) the patient has a significant effect upon the

level of nonpossessive warmth offered by the interviewer.

Truax and Carkhuff offer the following hypothesis concerning

the differential findings:

It may be that in nontherapeutic inter-views the interviewer has not made a personal commitment to the patient or client's welfare, and is thus more susceptible to the likable and dislikable characteristics of the client as symptoms of the patient. We might speculate, then, that in the therapeutic relationship, where the therapist or counselor has already made a personal commitment to the patient, he regards dislikable characteristics as symptoms or transient qualities that both he and the client are committed to change as one of the goals of therapy (41, p. 103).

Methods, of Teaching the Therapeutic Triad

The present research findings consistently show that

empathy, warmth, and genuineness are characteristic of human

encounters that produce positive behavioral change in people,

and that it is the counselor who determines the levels of

empathy and genuineness. Warmth may be influenced by the

patient in certain previously described situations. In view

of these findings, a question concerning the possibility of

teaching the three therapeutic ingredients arises.

44

The Traditional Approaches to Training

Many counselor educators have felt that good therapists

and counselors " . . . are born, not made" (41, p. 107).

Whether this or other reasons are responsible, several areas

of research have indicated that the majority of existing

approaches to training have tended to produce, on the average,

ineffective practitioners. The first line of suspect grew

out of the controversy instigated by Eysenck (9, 12, 13, 14,

21, 22, 27, 28, 31) in which he asserted that psychotherapeutic

approaches were not' effective in helping either the disturbed

child, the neurotic, or the disabled adult. A careful review

of the relevant research literature indicates that Eysenck was

. . . essentially correct in saying that average counseling and psychotherapy as it is currently practiced does not result in average.client im-provement greater than that observed in clients who receive no special counseling or.psychothera-peutic treatment (41, p. 5).

The second line of evidence emerges from three recent

studies in which the relationship between existing training

programs and the ability to communicate high levels of

accurate empathy by the trainees has been studied.

The first, a study conducted by Bergin and Solomon (5),

measured the level of communicated accurate empathy in tape-

recorded psychotherapy sessions from eighteen post-internship

students at a major training institution in clinical psychol-

ogy. Each student was placed at random in one of six super-

visory groups. The range of accurate empathy was found to be

45

from 1.91 to 3.84 on the Accurate Empathy Scale, with an

average level of 2.50. These findings indicate that the

training programs that had produced these therapists had not

raised their ability to communicate accurate empathy even up

to the intermediate levels on the Accurate Empathy Scale.

The actual level of accurate empathy of the trainee correlated

-.17 and -.16 respectively with his practicum and academic

grades, which would seem to suggest that effective communica-

tion of accurate empathy was not heavily weighed as a desir-

able criterion for grading. Although the obtained correlation

between the supervisor's rating of the students' effectiveness

and their actual level of accurate empathy in therapy was

significant (.41, p<.01), even the supervisor's evaluation

of a student's therapeutic effectiveness correlated negative-

ly with academic grades (-.14) and practicum grades (-.22).

Melloh conducted a second study (23) which focused on

accurate empathy in twenty-eight post-practicum counselor

trainees who were being trained in one of the major training

institutions for counselors. An average level of 2.46 on the

Accurate Empathy Scale was found, which supports the Bergin

and Solomon study in suggesting that counselors being produced

were mostly low or average in the communication of empathy.

No relationship was found between the level of accurate

empathy provided by the trainees in their sessions and their

grades in the practicum (r = -.008).

46

In the third study, Baldwin and Lee (2) compared the use

of an informal didactic group, therapy experience with pro-

grammed teaching machine instructions for the purpose of

training undergraduate college students in effective inter-

personal relationships. Tape-recorded, two-person interac-

tions were rated on the Accurate Empathy Scale both before

and after training. The findings showed no change in

measured empathic ability (2.7 pretherapy and 2.7 posttherapy)

among students who had participated in the teaching machine

approach to training; whereas the students who received

informal, didactic group therapy did show significant improve-

ment in empathic ability (2.4 pretraining and 3.2 posttraining).

It should be noted that the initial level of empathic

skill demonstrated by the undergraduate college students in

the Baldwin and Lee study (2) approximates that shown by the

advanced counselor trainees in Melloh's study (23) as well as

those in clinical training in Bergin and Solomon's study (5).

These studies, taken together, offer strong support for

the suspicion that traditionally, training programs in

counseling and psychotherapy have been " . . . aimed at theory

rather than implementation, and at psychodynamics rather than

psychotherapy" (41, p. 225).

The Integrated Didactic and Experiential Approach to Training

In view of the lack of evidence for the efficacy of

present training methods, a- program for applying the research

47

instruments designed to measure the therapeutic triad to the

training of professional and lay persons was set forth by

Truax, Carkhuff, and Douds (42). Since the inception of the

integrated didactic and experiential approach to training,

research evidence has suggested that specific training can

lead to relatively effective communication of accurate

empathy, nonpossessive warmth, and genuineness (4, 7, 8, 45).

In one of the first studies (8), a trainee group which

was composed of twelve graduate students in clinical and

counseling psychology and five lay counselors was compared

with fifteen highly experienced counselors and psychothera-

pists such as Carl Rogers, Albert Ellis, Rollo May, Julius

Seeman, and Carl Whitaker. After slightly less than one

hundred hours of training, extending over a four-month period,

the levels- of accurate empathy and nonpossessive warmth were

not significantly different between the trainee and contrast

groups. With respect to therapist genuineness, however, the

experienced therapists showed a significantly higher level

than did the lay trainees, while the psychology trainees had

an intermediate level. The findings are presented in Tables

VI and VII. The average scale value was 4.8 for the experi-

enced therapists, 4.6 for the lay trainees, and 4.5 for the

psychology trainees. A considerable difference in favor of

the integrated didactic and experiential approach to training

is shown when a comparison is made between the data on average

accurate empathy demonstrated after training in the Melloh and

48

TABLE VI

MEAN SCALE VALUES OF THERAPY PROCESS VARIABLES FOR GROUPS OF TRAINEES

AND EXPERIENCED THERAPISTS

Scale No. of Points

Lay* (N=5) SD

Students* (N=12) SD

Experi-enced (N=15) SD

AE (9) 4.58 .30 5.14 .69 5.22 .84 NPW (5) 2.82 .62 3.05 .32 3.16 .40 GEN (7) 4.86 .35 5.23 .48 5.51 .45 DX (9) 4.66 .30 4.56 .60 4.86 .56

*Personnel involved in training program. Source: From Carkhuff, R. R. and Truax, C. B. "Training in Counseling and Psychotherapy: An Evaluation of An Integrated Didactic and • Experiential Approach." Journal of Consulting Psychology, 1965(a), 29, 333-336.

TABLE VII

t TESTS FOR SIGNIFICANT DIFFERENCES OF THERAPY PROCESS VARIABLES FOR GROUPS OF TRAINEES

AND EXPERIENCED THERAPISTS

Students Students Lay vs. vs. vs,

Scale Lay Experienced Experienced

AE 1.750 .267 1.641 NPW 1.045 .786 1.417 GEN .487 1.556 2.955* DX .357 1.340 .741

•Significant at the .01 level. Source: From Carkhuff, R. R. and Truax, C. B. "Training in Counseling and Psychother-.apy: An Evaluation of an Integrated Didactic and Experiential Approach." Journal of Consulting Psychology, 1965(a), 29, 333-336.

49

the Bergin and Solomon studies where the average level

attained was 2.50 with the average level of 5.14 attained by

the trainees with the integrated.didactic and. experiential

approach. These data suggest that these ingredients can be

learned.

In a cross-validation on a new group of sixteen graduate

student trainees (44) similar results were found. The evalua-

tion of the effectiveness of the training was extended in this

study by randomly assigning patients to the trainees for a

"one-shot therapeutic interview" early in the training program

and repeating this with different patients late in the program.

The trainees had received fourteen class hours of training

prior to the early interview, and they received an additional

thirty-four to thirty-six hours of training before the late

interview. An evaluation of the trainees' change in level of

conditions was made. The analysis indicated significant gains

in the levels of accurate empathy (p>.05) and genuineness

(p>.01), but a non-significant gain in nonpossessive warmth

over the nine-week period of additional training.

Another study (7) aimed at evaluating Truax and Carl-chuff's

training approach was concerned with the effectiveness that

lay trainees had in producing behavioral and personality change

in chronic hospitalized mental patients. Information about the

population revealed that, on the average, they were fifty years

old, had spent thirteen and one-half years in their current

hospitalization, had had one previous period of hospitalization,

50

and had a seventh grade education. These 144 subjects were

randomly divided into a control group and a treatment group.

The patients were seen twice a week over a three-month period

for a total of twenty-four sessions in time-limited group

counseling led by the lay trainees. The only orientation to

training that the lay counselors received was in terms of

providing high levels of the therapeutic conditions. All of

the patients in both groups were rated before and after treat-

ment on the short form "gross ratings of patient behavior" (6)

which is a series of scales assessing four critical areas:

(1) "degree of psychological disturbance," (2) "degree of con-

structive interpersonal concern," (3) "degree of constructive

intrapersonal concern," and (4) "degree of overall improve-

ment over the past three months." As can be seen from Table VIII,

all scale differences between treatment and control groups were

statistically significant.

Truax, Silber, and Carkhuff (45) analyzed the data from

the study cited above in a different way. They compared the

level of conditions, (high, medium, or low) actually provided

in the group counseling sessions by the lay counselors with the

degree of patient outcome. The findings showed that patients

who received low levels of the therapeutic triad did not im-

prove" significantly more than the patients in the control

group on any of the four measures of outcome. In contrast, the

treatment groups that received moderate or high levels of the

therapeutic conditions improved significantly over the control

group on all four measures (p<.05).

51

TABLE VIII

DIRECTION OF CHANGES OF GROSS RATINGS OF PATIENT BEHAVIOR BY WARD PERSONNEL

Treatment

PATIENT GROUPS

Control

Overall improvement (N= 7 4) (N=70) (Posttherapy ratings only) Improved • 38 19 Deteriorated 1 X^=2!l.47*** 12 Unchanged 35 39

Psychological disturbance (N=74) (N=50) (Pre- and post-Therapy ratings) Improved 28

0 8 Deteriorated 19 X =17.28*** 5 Unchanged 27 37

Interpersonal concerns (N= 7 4) (N=50) (Pre- and post-therapy ratings) Improved 33

X2=11.23** 16

Deteriorated 14 X2=11.23** 2 Unchanged 27 32

Intrapersonal concerns (N= 7 4 ) (N= 5 0) Pre- and post-therapy ratings) Improved 28 15 Deteriorated 16 X2= 6.79* 4 Unchanged 30 31

*Significant at the .05 level.

**Significant at the .01 level.

***Significant at the .001 level.

Source: Carkhuff, R. R. and Truax, C. B. "Lay Mental Health Counseling: The Effects of Lay Group Counseling." Journal of Consulting Psychology, 1965(b), 29, 426-431.

52

The effects of the integrated approach to training on

undergraduate dormitory counselors was studied by Berenson,

Carkhuff, and Myrus (4). Thirty-six student volunteers were

randomly assigned to one of three groups: (1) the training

group proper, (2) a control group in which the same number

of hours were spent in training but the training employed

did not utilize the therapeutic conditions research scales

or the quasi-group therapy experience, and (3) a control

group which received no specific training in therapeutic

practice. Significantly greater change (p<.05) on each of

the therapeutic conditions was evidenced by the trainees who

were in the training group proper as compared to the two

control groups.

When considering that an impressive mass of research

evidence indicates that " . . . the majority of existing

approaches to training tend to produce, on the average, in-

effective practitioners . . . " (41, p. 225), the available

evidence just reviewed concerning the effectiveness of the


seems even stronger.

BIBLIOGRAPHY

Alexander, F., Fundamentals of Psychoanalysis, New York, W, W. Norton, 1948.

Baldwin, T. and Joan Lee, "Evaluation of Programmed Instruction in Human Relations," American Psychol-ogist* XX (1965), 20.

Banks, G., B. G. Berenson, and R. R. Carkhuff, "The Effects of Counselor Race and Training Upon Counsel-ing Process with Negro Clients in Initial Inter-views, " Journal of Clinical Psychology, XXIII (1967), 70-72.

Berenson, B. G., R. R. Carkhuff, and Pamela Myrus, "The Interpersonal Functions and Training of College Students," Journal of Counseling Psychology, XIII - ' '• . i -I .. . uii.j.iir "i« -in-,, i.fflC.iH ———i— I i I !•••«• r—,,, m*

(1966), 4.

Bergin, A. E. and Sandra Solomon, "Personality and Performance Correlates of Empathic Understanding in Psychotherapy," unpublished paper read before the American Psychological Association, Philadelphia, .September, 1963.

Carkhuff, R. R. and R. DeBurger, "Gross Ratings of Patient Behavior," unpublished manuscript, Univer-of Kentucky, 1964.

and C. B. Truax, "Lay Mental Health Counseling: The Effects of Lay Group Counseling," Journal of Consulting Psychology, XXIX (1965). 426-431.

an<^ > "Training in Counseling and Psychotherapy: An Evaluation of An Integrated Didactic and Experiential Approach," Journal of Consulting Psychology, XXIX (1965), 333-336.

9. - DeSharmes, R., J. Levy, and M. Wertheimer, "A Note on ' Attempted Evaluations of Psychotherapy," Journal of Clinical Psychology, X (1954), 233-235^

10. Dickenson, W. A. and C. B. Truax, "Group Counseling with College Underachievers: Comparisons with A Control Group and Relationship to Empathy, Warmth, and Genuineness," unpublished manuscript, University of Kentucky, 1965.

53

54

11. Dymond, Rosalind, "A Scale for the Measurement of Empathic Ability," Journal of Consulting Psychology, XIII (1949), 127-133.

12. Eysenck, H. J., editor, "The Effects of Psychotherapy," Handbook of Abnormal Psychology, New York, Basic Books, Inc., 1961.

13. , "The Effects of Psychotherapy: An Evaluation," Journal of Consulting Psychology, XVI (1952), 319-324.

14. , "The Effects of Psychotherapy: A Reply," Journal of Abnormal Social Psychology, L (1955), 147-148.

15. Ferenczi, S., "The Principle of Relaxation and Neo-catharsis," International Journal of Psychoanalysis, XI (1930), 428-443.

16. Halkides, G., "An Experimental Study of Four Conditions Necessary for Therapeutic Change," unpublished doctoral dissertation, University of Chicago, 1958.

17. Halpern, H. and Leona Lesser, "Empathy in Infants, Adults, and Psychotherapists," Psychoanalysis and the Psychoanalytic Review, XLVII (1960), 32-42.

18. Hart, J. T., "A Replication of the Halkides Study," unpublished manuscript, University of Wisconsin, 1960.

19. Hirshberg, F., R. R. Carkhuff, and B. G. Berenson, "The Differential Effectiveness of Counselors and Thera-pists with In-patient Schizophrenics and Counseling Center Clients, Discussion Papers, Arkansas Rehabilitation Research and Training Center, University of Arkansas, 1966, 1 (Whole No. 6).


21. Luborsky, L., "A Note on Eysenck's Article 'The Effects of Psychotherapy: An Evaluation'," British Journal of Psychology, XLV (1954), 129-131.

22. Meehl, P. E., "Psychotherapy," Annual Review of Psychol-ogy, VI (1955), 357-378.

23. Melloh, R. A., "Accurate Empathy and Counselor Effective-ness, " unpublished doctoral dissertation, University of Florida, 1964.

55

24. Raush, H. L. and E. S. Bordin, "Warmth in Personality Development and in Psychotherapy," Psychiatry: Journal Study of Interpersonal Processes, XX (November, 1957), no. 4.

25. Rogers, Carl R., Client-Centered Therapy, Cambridge, Massachusetts, Riverside Press, 1951.

26. , "The Necessary and Sufficient Conditions of Therapeutic Personality Change," Journal of Consulting Psychology, XXI (1957), 95-103.

27. Rosenzweig, S., "A Transvaluation on Psychotherapy: A Reply to Hans Eysenck," Journal of Abnormal Social Psychology, XLIX (1954), 298-304.

28. Sanford, N., "Clinical Methods: Psychotherapy," Annual Review of Psychology, V (1954), 311-336.

29. Schafer, R., "Generative Empathy in the Treatment Situation," Psychoanalytic Quarterly, XXVIII (1959), 342-373.

30. Shoben, E. J., Jr., "Psychotherapy as a Problem in Learning Theory," Psychological Bulletin, XLVI (1949), 366-392.

31. , "Counseling," Annual Review of Psychology, VII (1956), 147-172.

32. Strunk, O., Jr., "Empathy: A Review of Theory and Research," Psychological Newsletter, IX (1957), 47-57.

33". Strupp, H. H., "Nature of Psychotherapist's Contribution to the Treatment Process," Archeological and Genetic Psychiatry, III (1960), 219-231.

34. Truax, Charles B., "The Process of Group Psychotherapy," Psychological Monograph, LXXV, no. 14 (1961).

35. , "A Scale for the Measurement of Accurate Empathy," Psychiatric Institute Bulletin, Wisconsin Psychiatric Institute, University of Wisconsin, 1961, 1,'no. 10 (c).

36. , "A Tentative Scale for the Measure-ment of Therapist Genuineness or Self—Congruence," Discussion Papers, Wisconsin Psychiatric Institute, University of Wisconsin, no. 35, 1962.

56

37. Truax, Charles B., "A Tentative Scale for the Measure-ment of Unconditional Positive Regard," Psychiatric Institute Bulletin, Wisconsin Psychiatric Institute, University of Wisconsin, 1962, 2, no. 1.

38. . * , "Effective Ingredients in Psycho-therapy: An Approach to Unraveling the Patient-Therapist Interaction," Journal of Counseling Psychology. X (1963), 256-263.

39. , "The Sampling Interview: A Method of Assessment of Psychotherapeutic Personality Change," Brief Research Reports, Wisconsin Psychi-

. atric Institute,: University of Wisconsin, 1962, 18.

40. , "Therapeutic Conditions," Psychiatric Institute Bulletin 13, Wisconsin Psychiatric Institute, University of Wisconsin, 1961.

*41. and R. R. Carkhuff, Toward Effective Counseling and Psychotherapy: Training and Practice, Chicag^, Aldine Publishing Company, 1968.

42 . , R. R. Carkhuff, and J. Douds, "Toward an Integration of the Didactic and Experiential Approaches to Training in Counseling and Psycho-therapy, " Journal of Counseling Psychology, XI (1964), 240-247.

43 . , R. R. Carkhuff, and F. Kodman, "Relationships between Therapist-Offered Conditions and Patient Change in Group Psychotherapy," Journal of Clinical Psychology, XXI (1965), 327-329.

44. and L. D. Silber, "Personality and Psychotherapeutic Skills, " unpublished manuscript, University of Arkansas, 1966.

45. , L. D. Silber, and R. R. Carkhuff, "Accurate Empathy, Non-Possessive Warmth, Genuine-ness and Therapeutic Outcome in Lay Group Counseling," unpublished manuscript, University of Arkansas, 1966.

46. and D. G. Wargo, "Antecedents to Outcome in Group Psychotherapy with Juvenile Delinquents: Effects of Therapeutic Conditions, Alternate Ses-sions, Vicarious Therapy Pretraining, and Patient Self-Exploration" unpublished manuscript, Univer-sity of Arkansas, 1966.

57

47. Truax, Charles B, and D. G. Wargo, "Antecedents to Out-come in Group Psychotherapy with Hospitalized Mental Patients: Effects of Therapeutic Conditions, Alternate Sessions, Vicarious Therapy Pretraining, and Patient Self-Exploration," unpublished manu-script, University of Arkansas, 1966.

48. , D. G. Wargo, and R. R. Carkhuff, "Antecedents to Outcome in Group Psychotherapy with Outpatients: Effects of Therapeutic Conditions, Alternate Sessions, Vicarious Therapy Pretraining and Patient Self-Exploration," unpublished manuscript, University of Arkansas, 1966.

49. , D. G. Wargo, J. D» Frank, S. D. Imber, C. C. Battle, R. Hoehn-Saric, E. H. Nash, and A. R. Stone, "Therapist Empathy, Genuineness, and Warmth and Patient Therapeutic Outcome," Journal of Con-sulting Psychology, XXX (1966), 395-401.

50. , D. G. Wargo, J. D. Frank, S. D. Imber, C. C. Battle, R. Hoehn-Saric, E. H. Nash, and A. R. Stone, "Therapist's Contribution to Accurate Empa-thy, Non-Possessive Warmth and Genuineness in Psychotherapy, Journal of Clinical Psychology, XXII (1966), 331-334.

51. , D. G. Wargo, and L. D. Silber, "Effects of High Accurate Empathy and Non-Possessive Warmth During Group Psychotherapy Upon Female Institutionalized Delinquents," Journal of Abnormal Psychology, 71 (1966), 267-274.

52. Wargo, D. G., "The Barron Ego Strength and LH^ Scales As Predictors and Indicators of Change in Psycho-Therapy, " Brief Research Reports, Wisconsin Psychi-atric Institute, University of Wisconsin, 1962, 21.

53. Wolpe, J., Psychotherapy by Reciprocal Inhibition, Stanford, California, Stanford University Press, 1958.

CHAPTER III

METHOD AND PROCEDURES

This study was conducted to compare the effectiveness

of the integrated didactic and experiential approach with

the traditional approach in the counseling practicum.

Effectiveness was determined by comparing the extent and

direction of change in ability to convey empathy, nonposses-

sive warmth, and therapist genuineness within the counseling

relationship between students enrolled in practicums utiliz-

ing the two different approaches.

Subjects

The subjects for the study were those graduate students

who enrolled in the counseling practicum classes at North

Texas State University during the Spring semester of 1969.

Two supervisors had ten practicum students each and a third

supervisor had eleven students, making the total sample con-

sist of thirty-one students. The students enrolled in each

practicum were assigned by random selection as follows:

1. Fifteen students, five from each practicum,

were assigned to the integrated didactic and experiential

training sessions. This group served as the experimental

group.

2. Sixteen students, five from two practicums and

six from the third practicum, were assigned to the traditional

58

59

weekly training sessions. This group served as the control

group.

The proqedure by which the students were randomly

divided was this: by means of the official class roll,

every other student was assigned to the experimental group—

the odd numbers were placed in the control group and the

even numbers in the experimental group. The control group

consisted of six males and ten females with an age range of

from twenty-five through fifty-three years and an average

age of thirty-nine years. Similarly, the experimental group

was composed of seven males and eight females with an age

range of from twenty-two through fifty-two years and an

average age of thirty-seven years. Both groups contained

students from a variety of occupations ranging from full-

time student through counselor, teacher,- minister, nurse,

and businessman.

Description of Practicums

The division of the intact classes resulted in six

separate sections—three control subgroups and three experi-

mental subgroups. The subgroups were not combined for

training purposes. Each of the six sections, including

both the control and the experimental subgroups, met in a

group session two. and one-half hours per week for a twelve-

week period, making a total of thirty hours of training

time for all subjects.

60

To facilitate clarity, the original intact classes were

labeled as Class A, Class B, and Class C and the resultant

control and experimental classes labeled as Control A,

Experimental A, Control B, Experimental B, etc. (Hereafter

"control group" will refer to a composite of the three control

subgroups, whereas reference to a specific subgroup will be

specified. The same will apply for the term "experimental

group").

The North Texas State University Graduate Bulletin

specifies that twenty hours of counseling is required in the

practicum course. Although this study was concerned only

with the class sessions that took place, the fact that

additional requirements were fulfilled within the limits of

the academic course necessitated mention. The subjects in

Class A and Class B fulfilled the counseling requirement in

an on-campus setting with the regularly assigned supervisor

in charge of both the control and the experimental subjects

in his class. That is, the subjects in Experimental A and

Experimental B classes were under the direction of the

supervisor of the respective control group in actual super-

vision of counseling experience just the same as were Control

A and Control B classes. The supervisor of the experimental

group assisted in the supervision of Experimental A and

Experimental B classes whereas two other graduate students

assisted the regular professors in the counseling practicum

experience of Control A and Control B classes. The subjects

61

in Class C fulfilled the counseling requirement in various

approved off-campus settings. No direct supervision was

maintained over the off-campus counseling except that which

was a part of the weekly group sessions either in the Control

C or the Experimental C section. Therefore, unlike Experi-

mental A and Experimental B classes, the subjects in the

Experimental C class received total supervision from the

experimental supervisor during the regular class meeting.

The Integrated Didactic and Experiential Approach Practicum

During the twelve-week period of the study the subjects

in the experimental group were taught by the integrated

didactic and experiential training approach set forth in

chapters seven through twelve of Toward Effective Counseling

and Psychotherapy; Training and Practice, by Truax and

Carkhuff.

A doctoral-level counseling student who had received

one week of intensive training in the integrated approach

with Truax and his staff conducted the class sessions for the

three sections of five students each which made up the exper-

imental group. According to Truax, the one-week training

course attended by the supervisor of the experimental group

was sufficient to . . develop trainers who can cooperate

in research activities and the training of others" (Truax,

personal correspondence, September, 1968). It should be

noted that the control supervisor of Control A class sat in

62

on ten of the twelve Experimental A class sessions. The

control supervisor of Control B class, visited the Experimen-

tal B class sessions intermittently. Experimental C class

had no contact with the control supervisor of Control C class

during the course of the study.

A brief outline of the integrated didactic and exper-

iential training approach follows (14, pp. 244-246):

Initial experience.—The trainees were provided with an

extensive reading list of selections from a wide variety of

leading theorists and therapists as required reading. A

copy of the specific instructions for outside reading along

with the bibliography provided are found in Appendix D and

Appendix E. The trainees were also required to listen to

some twenty-five hours of individual and group psychotherapy

from the tape library within the first six weeks of the

training.

The purpose of the outside reading and tape-listening

was to provide a large general catalog and storehouse of

therapeutic responses, tactics, and approaches which the

trainees might incorporate. The tape listening, especially,

was for the purpose of increasing the response repertoire of

the beginning therapist or counselor.

The trainees were given copies of the Accurate Empathy

Scale (Appendix A), the Nonpossessive Warmth Scale (Appendix

B), and the Genuineness Scale (Appendix C), and were asked

to attempt to rate specific excerpts as they listened to

63

the experienced therapists on tapes from the tape library.

This requirement forced the trainee to focus his attention

on the specific therapeutic conditions while he listened to

the experienced therapists. Practice in discriminating

different levels of therapeutic conditions was also afforded.

The trainees were also asked to rate specific brief

samples of counseling that had already been rated by experi-

enced raters on audio tapes, and so gained some experience

in becoming raters themselves.

After the initial experience, the trainees had to some

degree learned to recognize and discriminate different levels

of accurate empathic understanding, nonpossessive warmth,

and genuineness.

Empathy training.—The trainees were presented as a

group with a series of tape-recorded statements from a

variety of counselees; they listened to the statements and

then were asked to reformulate verbally the essential

communication made by the counselee, in terms of both the

feeling and the content of that communication. After a few

"round-robin" series of this sort, the trainees were asked

to respond whenever the supervisor pointed to them (which he

did randomly), so that each trainee had to listen intently.

The empathy training is aimed at sharpening the begin-

ning counselor's sensitivity and skills in both understanding

and communicating the client's essential meaning. The rapid,

64

public, competitive, and random nature of the situation

tended to cause shaping of responses rather quickly.

Warmth training.—As the empathy training proceeded to

the point where trainees were grasping and communicating the

meaning of the client's communications, the training moved

on to warmth training. The trainees were then asked to con-

centrate, not on just what they were saying in their

responses, but upon how they were saying it. The emphasis

was upon low-pitched, full vocal tones in a slowed rate of

speech, communicating the intentness and seriousness of the

counselor's response (if these were the appropriate qualities)

The training in vocal qualities moved the tone as well as the

content of the trainee's response toward a more studied

attempt to communicate warmth.

Genuineness training.—At this point, the responses

clearly sounded mechanical, rehearsed, or imitated, which

they were. The trainees were now encouraged to be more him-

self in his responding. Direct shaping of the trainee's

responses (using the Genuineness Scale), aimed at making

them more authentically an expression of his own person was

carried out in much the same fashion as described in empathy

training above.

Quasi-group therapy sessions.—These sessions were

begun during the sixth week of the program. The aim of the

quasi-group therapy experience was, first, to give trainees

65

experiential meaning for the role of the counselor by their

own participation as clients; and second, to provide an

opportunity for self-exploration of their own goals, values,

and experiences in relation to their emerging role as coun-

selor. Such firsthand experience in the human encounter of

counseling from the client's viewpoint also allowed them to

move toward integrating their own personality, values, and

goals with the didactic and cognitive learnings.

Final experience.—After spending several sessions in

role-playing, the trainee was given appointments with a num-

ber of real clients for single therapeutic interviews. His

goal in such interviews was to facilitate deep self-explora-

tion by the client and to establish a good therapeutic

relationship. These single interviews were tape-recorded so

that selected samples could be played in the supervisory

sessions and rated by the trainee himself, his peers, and

his supervisor. The aim of this procedure was to provide

concrete feedback with a number of clients so that the trainee

could learn what about himself contributes to a therapeutic

relationship and what impedes or detracts from that

relationship.

Finally, the trainee began to counsel clients on a con-

tinuing basis. These sessions were also tape-recorded and

brought to the supervisory sessions where random samples were

selected to be rated on the therapeutic conditions scales by

the supervisor, the trainee, and his peers.

66

The Traditional Practicum

Within the twelve-week period of the study each of the

three control subgroups was taught in the traditional manner

by a regularly assigned practicum supervisor who is a member

of the counseling staff at North Texas State University.

Each of the control subgroups was supervised by a different

staff member. Each of the three staff members had a graduate

assistant who helped supervise in his control group. All

three supervisors hold the doctorate degree in counseling.

An outline of the content of the traditional approach

as practiced by the supervisors of the control group can be

found in Appendix F and G. The subjects in this practicum

listened to some of each other's tapes in class sessions and

evaluated them. The evaluation was primarily in terms of

the kind of rapport that the counselor was able to establish

in the counseling session, the methods and approaches that

were used within the session, and suggestions as to how the

trainee might improve his counseling.

In addition to evaluating each other's tapes, the con-

trol trainees observed and evaluated their supervisor and

graduate assistant in counseling sessions. The trainees also

participated'in role-playing in which they took turns playing

roles of counselor, counselee, and observer.

iL Comparison of the Two Approaches

A comparison of the outlines of the procedures to be

used in the control and the experimental groups revealed

67

three procedures common to both groups—the outside reading

assignment, the quasi-group therapy sessions (referred to as

sensitivity training in the traditional approach), and role-

playing. All procedures outlined on the preceding pages for

the experimental group other than these three common ones are

different from the procedures that were used in the control

group. Although role-playing and critiquing of the trainee's

taped sessions were used in both the traditional and the

experimental approaches, they are not used in the same manner

as in the experimental approach. The primary difference in

the use of these techniques involves the use of the three

therapeutic scales as the primary focus of evaluation in the

experimental group. The therapeutic scales were not used at

all in the traditional approach.

Procedure for Collecting Data

Students were handed a mimeographed notice before they

registered for the counseling practicum that read as follows:

This semester we are participating in an ex-perimental study that will seek to compare and evaluate various methods of training counselors. In order that the design of the study is not con-taminated, it will be necessary for you to be randomly assigned to a supervisor for the duration of the study. This means that you may or may not be under the direct supervision of the super-visor that you find listed on the Schedule of Classes.

During the second week of the semester of training each

student had a single interview with each of two persons which

was recorded on audio tape. The instructions that were given

68

in the assigning of the taped interviews were stated in the

following manner:

This week you are to make two tapes of initial <3r second counseling interviews with two different persons. Do not choose a per-sonal friend or relative to counsel with. You are to spend approximately thirty minutes with each person trying to be helpful and trying to get to know him.

During the twelfth and final week of the study two addi-

tional tapes were required. The instructions given for the

securing of the post-test tapes were the same as those given

for the pre-test tapes. From the four tapes of each student

in both the control and the experimental groups, eight four-

minute excerpts were selected, two excerpts from each tape.

The excerpts to be rated were those exchanges that occurred

within the four-minute segments starting.at five and.at

fifteen minutes into the session.

Description of the Instruments

T^ e Accurate Empathy Scale was developed in 1961 and the

Nonpossessive Warmth and Therapist Genuineness Scales in 1962

by Charles B. Truax (9, 10, 11). The impetus for the develop-

ment of the scales grew out of a seminar with Carl Rogers

during the early part of 1957. Although the instruments are

highly inferential and rather crude in construction, they

represent a beginning attempt to provide more concrete

specifications, along quantified dimensions, of the three

seemingly common central ingredients of effective therapeutic

encounters.

69

The scales were designed primarily to be used to rate

live observations or tape recordings of counseling or therapy-

interviews, although they have also been used with a slight

loss in reliability on typescripts. The scales have been

applied to samples of counseling and therapy interviews

varying from a minimum of two minutes to a maximum of sixteen

minutes in length (14, p. 44).

The Accurate Empathy Scale is a nine-point scale

attempting to specify stages along a continuum. At the

lowest stage, for example, " . . . the therapist seems com-

pletely unaware of even the most conspicuous of the client's

feelings . . . ." At the highest stage, Stage 9, the thera-

pist " . . . unerringly responds to the client's full range

of feelings in their exact intensity . . . ."

The Nonpossessive Warmth Scale is a five-point scale

extending from the lowest stage, Stage 1, where " . . . the

therapist is actively offering advice or giving clear nega-

tive regard . . ."to the highest stage, Stage 5, where

". . . the therapist communicates warmth without restriction."

The Therapist Genuineness Scale consists of a five-point

scale where Stage 1 is indicated by a therapist who conveys

" . . . explicit evidence of a very considerable discrepancy

between what he says and what he experiences" and Stage 5 is

descriptive of a therapist who ". . .is freely and deeply

himself in the relationship."

In regard to the reliability of the scales, Table IX

presents the correlation between different raters' ratings

70

on the scales for the same samples of therapeutic transactions

in twenty-eight different studies which involved a variety of

therapist and client populations. These studies have indi-

cated that most often a moderate to high degree of reliabil-

ity is obtained with the scales whether measurement be of

counseling or therapy, group or individual.

TABLE IX

RELIABILITIES OF RATING SCALES FOR ACCURATE EMPATHY, NONPOSSESSIVE WARMTH, AND GENUINENESS FROM SPECIFIC STUDIES*

w

0) > 4J •H m

w to I—1 W w

to +J as CO <D 0) d a u 3 a) <D a H CD 0 *0 •P >i CQ 0 a •H V-t •H ,C CO a 6 4J a) Qj > S-l 4J 0 -P •H

<TJ £ 3 -H 3 (0 ft g 0

w EH 0 U u a

O Ot O g

c: u

O ICS a

<D

Study a a a 0 H <tj w a is a

Truax (1961) 384 8 7 ind .87 • » • •

Truax & Carkhuff (1963) 297 14 10 Ind .89 . 50a • 40a Truax & Carkhuff- (1963) 112 28 24 Ind .69a . 55a • *

Truax (1962) 448 14 10 Ind . 69a « • • •

Bergin & Solomon (1963) 28 28 18 Ind .79a • • « «

Melloh (1964) 56 28 28 Ind .62a • • • •

Truax,Wargo,Frank,Imber, Battle,Hoehn-Saric,Nash, and Stone (1966a) 182 40 4 Ind .63 .59 .60

Truax,Carkhuff & Kodman(1965) 192 40 4 Grp .87 .91 .72 Truax & Wargo (1966c) 698 160 15 Grp .81 .76 .80 Truax & Wargo (1966b) 366 80 6 Grp .95 .90 .95 Truax,Wargo & Carkhuff(1966) 89 80 8 Grp .88 .77 .41 Wargo (1962) 297 14 10 Ind .89 .50a « •

Dickenson & Truax (1966) 72 48 1 Grp .83 .75 .25 Truax, Wargo & Silber (1966) 192 40 2 Grp .93 .81 .56 Truax & Carkhuff (1963) 64 8 8 Ind .57a * 62 s .45a Truax (1962e) 104 26 1 Ind . 69a • 55a .40a

71

TABLE IX—Continued

W A> -P >

CQ W •H w CO -P •H 1—I CQ m <D 04 FT* W <D

<D RD U 3 A) A) a & •H u 0 -p TN 0 g -P 0) •H RTS RC 01 £ a aS (0 rC A, > M -P 0 -P •H CO CU EH 3 -H

0 VJ 2 id U QI

a g a u 0

a Study £ S %

u a O H S? s w 0 rd a s

0 0

Truax,Wargo,Frank,Imber, Battle,Hoehn-Saric,Nash, and Stone (1966b)

(Screening Interviews) 80 40 2 Ind .75a .57a . 55a (Therapy Interviews) 182 * • 4 • * .63 .59 .60

Truax (1966b) (Edited) 50 5 5 Ind . 66a • 84a « •

'(Non-Edited) 50 .76a • 81a • «

Truax (1966a) (TPT) 283 63 • • • * .84 .86 .81 (PTP) 305 65 8 Grp .89 .85 .73-(Time) 384 80 • • • • .92 .95 .95

Truax & Carkhuff (1965a) 45 3 1 Ind .78 .70 .83 Carkhuff & Truax (1965) 151 70 28 Ind .43a .48a . 62a Truax & Silber (1966) 144 48 16 Ind .54 .52 .46 Truax,Silber & Carkhuff(1965) 342 80 5 Grp .50 .71 .48 Truax (1966) 161 30 4 Grp .59 .84 .85

aAverage Pearson correlations. All others are Ebel intraclass reliabilities for the pooled data used in analysis of findings.

*Source: Truax, Charles B. and R. R. Carkhuff, Toward Effective Counseling and Psychotherapy; Training and Practice, Chicago, Aldine Publishing Company, 1968, p. 45.

The matter of validity is difficult to assess. The face

validity of the scales can be determined by the reader. Be-

yond that, research in which the scales have played a major

role has indicated that whatever is being measured by the

scales is significantly related to a variety of client thera-

peutic outcomes (1, 2, 3, 4, 5, 6, 7, 8, 12, 13, 15, 16, 17,

72

18, 19, 20). Truax and Carkhuff conclude their discussion

of the scales as follows:

Moreover, what the scales do indeed measure is what the fields of counseling and therapy-should make central aspects of training.and practice. In fact, the reader should become quite familiar with the scales themselves, for when theory or clinical description enlarges upon them, then we move to that degree toward supposition and belief and away from the hard evidence. It is for this precise reason that the scales themselves are used as an essential and integral part of training (14, p. 44).

Procedure for Treating Data

The data collected in this study were treated statisti-

cally by the Data Processing Center, North Texas State

University. A significance level of .05 was used to accept

the hypothe s e s.

Immediately following the twelve-week training session,

the selected segments from pre- and posttests for both the

control and the experimental groups were transferred onto a

master tape. The tape segments were coded so that blind

rating was assured. The master tape was sent to the Arkansas

Rehabilitation Research and Training Center at the University

of Arkansas to be rated by professional raters trained by

Truax and his staff in the use of the therapeutic scales.

Eight four-minute segments, four segments from the pre-

test and four from the posttest, were rated for each subject.

Each of the four-minute segments of tape was rated by three

independent raters on each of the three therapeutic scales—

Accurate Empathy Scale, Nonpossessive Warmth Scale, and

Therapist Genuineness Scale.

73

On the basis of the Accurate Empathy Scale, each rater

gave each segment a rating of from 1 to 9. Stage 1 is the

lowest level where . . the therapist seems completely

unaware of even the most conspicuous of the client's

feelings . . . At the highest stage, Stage 9, the ther-

apist . . unerringly responds to the client's full range

of feelings in their exact intensity . . . ."

Each rater scored each segment from 1 to 5 on the five-

point Nonpossessive Warmth Scale. This scale extends from

Stage 1 where " . . . the therapist is actively offering

advice or giving clear negative regard . . ." to the highest,

Stage 5, where ". . . the therapist communicates warmth with-

out restriction."

The Therapist Genuineness Scale allows a rating of from

Stage 1, in which the therapist conveys " . . . explicit

evidence of a very considerable discrepancy between what he

says and what he experiences" to Stage 5 which describes a

therapist who ". . .is freely and deeply himself in the

relationship." Each segment was scored on one of the five

levels by each rater.

The coefficient of agreement among raters on the

Accurate Empathy Scale was .73, on the Nonpossessive Warmth

Scale, .82, and on the Therapist Genuineness Scale, .81.

These coefficients were computed using the following chi

square solution:

74

(A--NP-.5)2 + (D-N-NP-.5)2 NP N-NP

(A--NP-.5)2 + (D-N-NP-.5)2 +

NP N-NP

when A = number of 'hgree",*D = number of "disagree"; N = total

number of segments rated; P = .23 for nonpossessive warmth

and for genuineness, and P = .16 for accurate empathy.

Whether or not a set of scores is regarded as an "agree" or

a "disagree" is determined as follows: Two points or more

discrepancy among the three raters on a given segment is

scored as a "disagree." Less than a two point discrepancy

among the three raters on a given segment is scored as an

"agree."

The mean of the three raters' scores was computed for

each segment. The result was eight mean scores for each

person on each scale, four from the pretest and four from

the posttest. To obtain a single pretest score for a scale,

the four pretest segment means were averaged. A single

posttest score was obtained in the same manner.' An analysis

of covariance was then run to compare the difference between

the pre- and posttest scores. In addition, a t test for

correlated means was computed to determine if significant

difference had occurred.

BIBLIOGRAPHY

1. Carkhuff, R. R., "On the Necessary Conditions of Thera-peutic Personality Change," Discussion Papers, Wisconsin Psychiatric Institute, University of Wisconsin, no. 47, 1963.

editor, The Counselor* s Contribution to Facilitative Processes. Urbana, Illinois, Parkinson, 1967.

"Toward A Comprehensive Model of Facili-tative Interpersonal Processes," Journal of Counsel-ing Psychology, XIV (1967), 67-72.

4 . and C. B. Truax, "Training in Counseling and Psychotherapy: An Evaluation of An Integrated Didactic and Experiential Approach," Journal of Consulting Psychology, XXIX (1965), 333-336.

5. Dickenson, W. A. and C. B. Truax, "Group Counseling with College Underachievers: Comparisons with A Control Group and Relationship to Empathy, Warmth, and Genuineness," unpublished manuscript, University of Kentucky, 1965.


7. Rogers, Carl R., "The Interpersonal Relationship: The Core of Guidance," Harvard Educational Review, XXXII (1962), 416-429.

8. , "The Necessary and Sufficient Conditions of Therapeutic Personality Change," Journal of Con-sulting Psychology, XXI (1957), 95-103.

9. Truax, Charles B., "A Scale for the Measurement of Accurate Empathy," Psychiatric Institute Bulletin, Wisconsin Psychiatric Institute, University of Wisconsin, 1961, 1, no. 10 (c).

10. , "A Tentative Scale for the Measure-ment of Therapist Genuineness or Self-Congruence," Discussion Papers, Wisconsin Psychiatric Institute, University of Wisconsin, no. 35, 1962.

75

76

11. Truax, Charles B., "A Tentative Scale for the Measure-ment of Unconditional Positive Regard, " Psychiatric Institute Bulletin, Wisconsin Psychiatric Institute, University of Wisconsin, 1962, 2, no. 1.

12. , "Therapeutic Conditions," Psychiatric Institute Bulletin 13, Wisconsin Psychiatric Institute, University of Wisconsin, 1961.

13. and R. R. Carkhuff, "Fox- Better or for Worse. . . .The Process of Psychotherapeutic Person-ality Change," chapter in Recent Advances in the Study of Behavior Change, Montreal, McGill Univer-sity Press, 1964, 118-163.

14 . and R. R. Carkhuff, Toward Effective Counseling and Psychotherapy: Training and Practice, Chicago, Aldine Publishing Company, 1968.

15. , R. R. Carkhuff, and F. Kodman, "Relationships between Therapist-Offered Conditions and Patient Change in Group Psychotherapy," Journal of Clinical Psychology, XXI (1965), 327-329.

16. , L. D. Silber, and R. R. Carkhuff, "Accurate Empathy, Non-Possessive Warmth, Genuine-ness and Therapeutic Outcome in Lay Group Counsel-ing, " unpublished manuscript, University of Arkansas, 1966.

17. and D. G. Wargo, "Antecedents to Out-come in Group Psychotherapy with Juvenile Delin-quents: Effects of.Therapeutic Conditions, Alternate Sessions, Vicarious Therapy Pretraining, and Patient Self-Exploration," unpublished manu-script, University of Arkansas, 1966.

18. and D. G. Wargo, "Antecedents to Out- • come in Group Psychotherapy with Hospitalized Mental Patients: Effects of Therapeutic Conditions, Alternate Sessions, Vicarious Therapy Pretraining, and Patient Self-Exploration," unpublished manu-script, University of Arkansas, 1966.

19. , D. G. Wargo, and R. R. Carkhuff, "Antecedents to Outcome in Group Psychotherapy with Outpatients: Effects of Therapeutic Conditions, Alternate Sessions, Vicarious Therapy Pretraining and Patient Self-Exploration," unpublished manu-script, University of Arkansas, 1966.

77

20. Truax, Charles B., D. G. Wargo, J. D. Frank, S. D. Imber, C. C. Battle, R. Hoehn-Saric,. E. H. Nash, and A. R. Stone, "Therapist Empathy, Genuineness, and Warmth and Patient Therapeutic Outcome," Journal of Consulting Psychology, XXX (1966), 395-401.

CHAPTER IV

STATISTICAL ANALYSIS OF RESULTS AND DISCUSSION

Analysis of Data

The data were analyzed statistically on the basis of

their relevance to the hypotheses. The analyses of the

results were obtained through two statistical procedures:

analysis of covariance and t. test for correlated means. A

significance level of .05 was required for the acceptance

of the hypotheses.

Accurate Empathy

Hypothesis I predicted that practicum students who had

attended thirty hours of class sessions in which the inte-

grated didactic and experiential training approach had been

used would demonstrate a statistically significant mean in-

crease on the Accurate Empathy Scale ratings as compared with

practicum students who had attended an equal number of tradi-

tional practicum classes. (The Accurate Empathy Scale is a

nine-point scale attempting to specify stages of empathy

along a continuum from the lowest stage, stage one, to the

highest, stage nine.) The results of the analysis of covar-

iance computed to test this hypothesis are shown in Table X.

78

79

The obtained F ratio of 1.1247 was not acceptable at the .05

level of significance; therefore, Hypothesis I was not

supported. This would indicate that the experimental group

did not demonstrate a statistically significant greater mean

increase in empathy than did the control group.

TABLE X

SUMMARY OF ANALYSIS OF COVARIANCE ON THE ACCURATE EMPATHY SCALE

Kind of Sum of Mean Variation Squares df Square F

Between means .2420 1 .2420 1.1247

Within means 6.0253 28 .2151

Total 6.2674 29 t « t * • •

The adjusted mean scores on the Accurate Empathy Scale were

3.4182 for the experimental group and 3.2380 for the control

group.

Summaries of the analysis of covariance on the Accurate

Empathy Scale for the various subgroups (Control A, Experi-

mental A; Control B, Experimental Bj. Control C, Experimental

C) are shown in Tables XI, XII, and XIII.

TABLE XI

SUMMARY OF ANALYSIS OF COVARIANCE ON THE ACCURATE EMPATHY SCALE FOR SUBGROUPS A

80


Between means .0593 1 .0593 .2604

Within means 1.8220 8 .2277

Total 1.8813 9 • * • « « #


3.2664 for the Experimental A Subgroup and 3.4168 for the

Control A Subgroup.

TABLE XII

SUMMARY OF ANALYSIS OF COVARIANCE ON THE ACCURATE EMPATHY SCALE FOR SUBGROUPS B

Kind of Sum of Mean Variation Squares df • Square F

Between means 1.4338 1 1.4338 12.3704*

Within means .8113 7 .1159

Total 2.2452 8 • # • • • •

*p <. 01


3.5116 for the Experimental B Subgroup and 2.6883 for the

Control B Subgroup.

TABLE XIII

SUMMARY OF ANALYSIS OF COVARIANCE ON THE ACCURATE EMPATHY SCALE FOR SUBGROUPS C

81

Kind of Variation

Sum of Squares df

M$an Square F

Between means

Within means

.0499

.5347

1

7

.0499

.0763 .6545

Total .5847 8 • « • * • •


3.5965 for the Experimental C Subgroup and 3.4534 for the

Control C Subgroup.

It will be noted that the F ratios for the mean scores

for Subgroups A and C on the Accurate Empathy Scale did not

reach a significant level. The F ratio for the mean scores

for Subgroup B was significant at the .01 level. This would

indicate that the subjects in Experimental B did increase

their mean level of accurate empathy more than did the sub-

jects in Control B. . .

The results of analysis of covariance on the Accurate

Empathy Scale for the Experimental Subgroups A, B, and C are

found in Table XIV.

TABLE XIV

SUMMARY OF ANALYSIS OF COVARIANCE 0 N T H E ACCURATE EMPATHY SCALE FOR EXPERIMENTAL SUBGROUPS

82


Between means .3152 2 .1576 1.4905

Within means 1.1633 11 .1057

Total 1.4786 13 t » i


3.2700 for Experimental A Subgroup, 3.3718 for Experimental B

Subgroup, and 3.6247 for Experimental C Subgroup. As shown

by Table XIV, there was no significant difference between

experimental subgroups on the Accurate Empathy Scale.

Table XV presents similar findings for the Control Sub-

groups A, B, and C:

TABLE XV

SUMMARY OF ANALYSIS OF COVARIANCE ON THE ACCURATE EMPATHY SCALE

FOR CONTROL SUBGROUPS


Between means 1.1539 2 .5769 2.0455

Within means 3.3846 12 .2820

Total 4.5386 14 • • • • • »

83

The adjusted mean scores on the Accurate Empathy Scale

were 3.4069 for Control A Subgroup, 2.8305 for Control B

Subgroup, and 3.4312 for Control C Subgroup. No significant

difference was found between control subgroups on the

Accurate Empathy Scale.

In addition to the above findings, a t test for

correlated means was computed to determine the difference

between the pre- and posttest mean scores on the Accurate

Empathy Scale. When computed for the total sample, a t of

.04772 was obtained} for the experimental group, t = .08394;

and for the control group, t = .00000. It is clearly evident

that no significant change occurred on level of empathy as

measured by the Accurate Empathy Scale during the course

of the study for either the group as a whole or for the

separate control and experimental groups.

Nonpossessive Warmth

It was stated in Hypothesis II that practicum students

who had attended thirty hours.of class sessions in which

the integrated didactic and experiential training approach had

been used would demonstrate a statistically significant mean

increase on the Nonpossessive Warmth Scale ratings as com-

pared with practicum students who had attended an equal num-

ber of traditional practicum classes. (The Nonpossessive.

84

Warmth Scale is a five-point scale attempting to specify

stages of nonpossessive warmth along a continuum from the

lowest stage, stage one, to the highest, stage five.) The

data, as revealed in Table XVI, do not sustain the hypothesis,

This would indicate that the experimental group did not

demonstrate a statistically significant greater mean increase

in nonpossessive warmth than did the control group.

TABLE XVI

SUMMARY OF ANALYSIS OF COVARIANCE ON THE NONPOSSESSIVE WARMTH SCALE


Between means .0146 1 .0146 .2057

Within means 1.9909 28 .0711

Total 2.0055 29 « « • • • c

The adjusted mean scores on the Nonpossessive Warmth Scale

were 3.6948 for the experimental group and 3.7391 for the

control group.

Summaries of the analysis of covariance on the Nonposses-

sive Warmth Scale for the various subgroups (Control A,

Experimental A; Control B, Experimental B; Control C, Experi-

mental C) are shown in Tables XVII, XVIII, and XIX.

TABLE XVII


FOR SUBGROUPS A

85


Between means .2442 1 .2441 3.3899


Total .8201 9 * • * • • •


were 3.5822 for the Experimental A Subgroup and 3.8897 for

the Control A Subgroup.

TABLE XVIII


FOR SUBGROUPS B


Between means .1059 1 .1059 2.9785


Total .3550 8 • • • • • •


were 3.7871 for the Experimental B Subgroup and 3.5795 for

the Control B Subgroup.

TABLE XIX


FOR SUBGROUPS C

86


Between means .0000 1 .0000 .0000


Total .5199 8 ' 0 0 0 0 0 0


were 3.7173 for.the Experimental C Subgroup and 3.7159 for

the Control C Subgroup.

The F ratios for the mean scores on the Nonpossessive

Warmth Scale for Subgroups A, B, and C did not reach a

significant level.

The results of analysis of covariance on the Nonposses-

sive Warmth Scale for the Experimental Subgroups A, B, and C

are found in Table XX.

TABLE XX

SUMMARY OF ANALYSIS OF COVARIANCE ON THE NONPOSSESSIVE WARMTH SCALE FOR EXPERIMENTAL SUBGROUPS

Kind of Sum of Mean Variation Squares df Square F '

Between means .0575 2 .0287 .2537

Within means 1.2482 11 .1134

Total 1.3058 13 • • • • • •

37


were 3.6023 for Experimental A Subgroup, 3.7547 for Experi-

mental B Subgroup, and 3.6928 for Experimental C Subgroup.

Similar findings are reported in Table XXI for the

Control Subgroups A, B, and C;

TABLE XXI




Between means .2112 2 .1056 2.6999


Total .6808 14 « # * * « *


were 3.8723 for Control A Subgroup, 3.5942 for Control B

Subgroup, and 3.7589 for Control C Subgroup. No significant

difference was, therefore, found between control subgroups on

the Nonpossessive Warmth Scale.

The reported results showed no significant difference in

mean change between the experimental and control groups on

nonpossessive warmth. A t test for correlated means was

therefore computed to determine whether or not any signifi-

cant change occurred during the study. The results follow:

A t of -.36437 was obtained when the total sample pre- and

88

post-means were compared. A t of .09994 resulted when only

the pre- and posttest scores for the experimental group were

used, and t = -.73246 when the same procedure included only

the control group. The insignificant level of the t values

obtained indicated that no significant change occurred

between the pre- and posttest on level of nonpossessive

warmth.

Therapist Genuineness

In Hypothesis III it was predicted that practicum

students who had attended thirty hours of class sessions in

which the integrated didactic and experiential training

approach had been used would demonstrate a statistically

significant mean increase on the Therapist Genuineness

(or Self-Congruence) Scale ratings as compared with practicum

students who had attended an equal number of traditional

practicum classes. (The Therapist Genuineness Scale is a

five-point scale attempting to specify stages of genuineness

along a continuum from the lowest stage, one, to the highest,

stage five.) The results shown in Table XXII do not support

Hypothesis III. This would imply that the experimental

group did not demonstrate a statistically significant

greater mean increase in therapist genuineness than did

the control group.

TABLE XXII

SUMMARY OF ANALYSIS OF COVARIANCE ON THE THERAPIST GENUINENESS SCALE

89


Between means .0644 1 .0644 .8861

Within means 2.0370 28 .0727

Total 2.1015 29 • « • • • •

The adjusted mean scores on the Therapist Genuineness Scale

were 3.3265 for the experimental group and 3.4334 for the

control group.

Summaries of the analysis of covariance on the Therapist

Genuineness Scale for the various subgroups (Control A, Exper-

imental A; Control B, Experimental Bj Control C, Experimental

C) are shown in Tables XXIII, XXIV, and XXV.

TABLE XXIII •

SUMMARY OF ANALYSIS OF COVARIANCE ON THE THERAPIST GENUINENESS SCALE .

FOR SUBGROUPS A


Between means .0220 1 .0220 - .2535


Total .7183 9 • 0 0 • • •

90


were 3.3902 for the Experimental A Subgroup and 3.4803 for

the Control A Subgroup.

TABLE XXIV


FOR SUBGROUPS B

Kind of Variation

Sum of Squares df

Mean Square F

Between means

Within means

.0002

.1337

1

7

.0002

.0191 .0112

Total .1339 8 i t * • # •


were 3.2568 for the Experimental B Subgroup and 3.2765 for

the Control B Subgroup.

TABLE.XXV


FOR SUBGROUPS C


Between means .0005 1 .0005 .0043


Total . 9456 8 • i» i l l

91


were 3.4211 for the Experimental C Subgroup and 3.4027 for

the Control C Subgroup.

It is evidenced that the F ratios for the mean scores

for all three subgroups (Subgroups A, Subgroups B, and Sub-

groups C) did not reach a level of significance. Therefore,

the subjects in the experimental subgroups did not increase

their mean level of therapist genuineness significantly more

than did the subjects in the respective control subgroups.

The results of analysis of covariance on the Therapist

Genuineness Scale for the Experimental Subgroups A, B, and C

are found in Table XXVI.

TABLE XXVI


FOR EXPERIMENTAL SUBGROUPS


Between means .1522 2 .0761 2.2929


Total .5174 13 * • • • « •


were 3.4380 for Experimental A Subgroup, 3.2331 for Experi-

mental B Subgroup, and 3.4788 for Experimental C Subgroup.

As indicated by Table XXVI, there was no significant difference

92

between experimental subgroups on the Therapist Genuineness

Scale.

No significant difference between Control Subgroups A,

B, and C on the Therapist Genuineness Scale is shown in

Table XXVII.

TABLE XXVII

SUMMARY OF ANALYSIS OF COVARIANCE ON T H E THERAPIST GENUINENESS SCALE



Between means .0790 2 .0395 .3294 •

Within means 1.4390 12 .1199

Total 1.5180 14 • • • • • •


were 3.4248 for Control A Subgroup, 3/2700 for Control B

Subgroup, and 3.4367 for Control C Subgroup.

Finally, a t test for correlated means was- computed for

the total sample to determine if significant change had

occurred between the pre- and posttests on therapist genuine-

ness. The obtained t of 2.79080 is significant at the .01

level, which would indicate that when the total sample was

considered there was a significant gain in therapist genuine-

ness during the course of the study.

The total sample was then divided into the separate

experimental and control groups and t. tests of correlated

93

means computed for each of these groups. An insignificant t_

of .00000 resulted when only the experimental group was ana-

lyzed, which indicated no change on therapist genuineness

within the wxperimental group. On the other hand, a signifi-

cant jt of 4.08185 (p <.001) resulted from analysis of the

control group, which implied significant gain in therapist

genuineness among this group.

Discussion of the Results

This discussion is restricted to the implications of the

statistical results just presented. The research findings upon

which this study was theoretically based have consistently

shown that therapists or counselors who are accurately em-

pathic, nonpossessively warm, and genuine effect positive be-

havioral change in their clients in direct proportion to the

level of the qualities communicated in the therapeutic encoun-

ter. That is, generally speaking, the more warm, empathic,

and genuine the counselor, the greater the degree of con-

structive behavioral change in the client. Since these three

interpersonal skills appear to be basic to effective counsel-

ing, and because there seems to be general agreement that the

goal of the counseling practicum is to increase the effective-

ness of prospective counselors, it would seem that the practi-

cum, if productive, should increase the levels of the thera-

peutic triad within the counselor trainees.

The three hypotheses tested in this study pertained to

change in counselor trainee's ability to convey accurate

9 4 '

empathy, nonpossessive warmth, and genuineness as the result

of two different approaches to supervising the counseling

practicum. The results tend to indicate that neither approach

was significantly superior to the other in effecting change in

the interpersonal skills. Although there was an indication

that Hypothesis I was partially supported by the results, the

reported difference seems to be spurious. A review of the pre-

and posttest mean scores revealed such minor differences that

a t test for correlated means was computed to determine if any

change as measured by the therapeutic scales had occurred dur-

ing the course of the study. The result was that no signifi-

cant change was reported for any of the groups on accurate

empathy and nonpossessive warmth. However, the counselor

trainees did show significant positive change on therapist

genuineness.

It was predicted in Hypothesis I that practicum students

who had attended thirty hours of class sessions in which the

integrated didactic and experiential training approach had

been used would demonstrate a statistically significant mean

increase on the Accurate Empathy Scale ratings as compared

with practicum students who had attended an equal number of

traditional practicum classes. Although this hypothesis was

supported in one subgroup, it was not generally supported for

the total sample. The lack of general suport is inconsistent

with the literature regarding the effectiveness of the inte-

grated didactic and experiential approach as compared with the

95

effectiveness of the traditional approach to training. It

would be noted that not only was there no significant differ-

ence in the amount of change within the experimental group as

compared with the control group, but there was no significant

change in empathy between the pre- and posttests for either

group.

One explanation could be the ratings that were obtained

by the counselor trainees on the Accurate Empathy Scale. The

pre-test ratings on this measure revealed that the subjects

in this study were appreciably higher on accurate empathy at

the beginning of the practicum experience than were the sub-

jects in studies reported in the literature where significant

positive change occurred as the result of the experimental

approach. In fact, only two studies reported in the litera-

ture resulted in a higher final level of accurate empathy

than was reported in this study. Of those two, one consisted

of forty-eight hours of training and the other, one hundred

hours of training. Thus, it would seem that causing positive

change in accurate empathy beyond the level attained prior to

the practicum by the subjects in this study might require a

more extended training program than the thirty-hour program.

The significant difference in empathy change reported

in favor of Experimental Subgroup B as compared with Control

Subgroup B is difficult to explain in light of the insignifi-

cant differences reported for the other two subgroups. Upon

checking the raw data, two of the five subjects in Control

Subgroup B were given a zero rating on all four of their

96

posttest segments by one of the raters. These ratings were

inconsistent with those given by the other two independent

raters which is reflected in the lower coefficient of correla-

tion on empathy as compared with the correlation coefficient

on the other scales. This apparent significant difference,

therefore, seems to be spurious.

Hypothesis II stated that practicum students who had

attended thirty hours of class sessions in which the inte-

grated didactic and experiential training approach had been

used would demonstrate a statistically significant mean in-

crease on the Nonpossessive Warmth Scale ratings as compared

with practicum students who had attended an equal number of

traditional practicum classes. The hypothesis was not sus-

tained. This lack of significance is inconsistent with the

literature, but, as was reported previously for empathy, it

is important to consider that there was no significant change

evidenced in levle of nonpossessive warmth between the pre-

and posttests for either group.

Again, the possible explanation could rest in the rela-

tively high pre-test ratings received by the subjects at the

beginning of the practicum. Although no significant change

occurred, only one study reported in the literature resulted

in a higher final mean level of nonpossessive watiuth (and that

a slight mean difference of .16) than was evidenced in this

study. Therefore, it would seem that after a certain level

is reached on nonpossessive warmth, a plateau might be

attained that is difficult to surpass.

97

Hypothesis III predicted that practicum students who had

attended thirty hours of class sessions in which the integrated

didactic and experiential training approach had been used would

demonstrate a statistically significant mean increase on the

Therapist Genuineness Scale ratings as compared with practicum

students who had attended an equal number of traditional prac-

ticum classes. The hypothesis was not supported.

This result is also inconsistent with the literature.

Although significant change in therapist genuineness occurred

during the course of the study, neither approach caused more

significant change than did the other. As seemed plausible in

the previous discussion of empathy and nonpossessive warmth,

perhaps the explanation lies in the relatively high pre-test

ratings received on genuineness at the beginning of the prac-

ticum. Although several studies in the literature reported

posttest scores higher than those obtained in this study, the

training programs were considerably longer than the thirty-

hour program used herein. It may be more difficult to effect

significant positive movement on genuineness through the exper-

imental approach after a certain level has been reached.

That change occurred during the course of the study in

genuineness but not in empathy or warmth is not in keeping with

the reviewed literature. It is possible that this inconsistency

is also due to the relatively high pre-test ratings. Since

genuineness is usually the most difficult, and the last inter-

personal skill to increase, perhaps the level obtained in em-

pathy and warmth prior to the practicum allowed the increase.

CHAPTER V

SUMMARY, FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS

Summary

The problem of this study was to compare the effective-

ness of an integrated didactic and experiential approach in

the preparation of graduate counseling students with that of

the traditional approach in counselor education. The purposes

were (1) to determine the extent and direction of change in

ability to convey empathy, nonpossessive warmth, and therapist

genuineness within the counseling relationship of graduate

practicum students enrolled in the traditional practicum

class, and (2) to determine the extent and direction of change

in ability to convey empathy, nonpossessive warmth, and ther-

apist genuineness within the counseling relationship of

graduate practicum students enrolled in the integrated

didactic and experiential approach class.

The hypotheses were stated as follows:

I. Practicum students who have attended thirty hours


periential training approach has been used will demonstrate •

a statistically significant mean increase on the Accurate.

Empathy Scale ratings as compared with practicum students


classes.

98

99

II. Practicum students who have attended thirty hours



a statistically significant mean increase on the Nonposses-

sive Warmth Scale ratings as compared with practicum students


classes.

III. Practicum students who have attended thirty hours



a statistically significant mean increase on the Therapist

Genuineness (or Self-Congruence) Scale ratings as compared

with practicum students who have attended an equal number of

traditional practicum classes.

Subjects for the study were the thirty-one students who

enrolled in the three graduate counseling practicum classes

on the campus of North Texas State University during a spring

semester. Each of the three intact classes was randomly

divided as follows:

1. Fifteen students, five from each practicum, were

assigned to the integrated didactic and experiential training

sessions. This group served as the experimental group.

2. Sixteen students, five from each of two practicums

and six from the third practicum, were assigned to the tra-

ditional weekly training sessions. This group served as the

control group.

100

The experimental subgroups were each taught by a

doctoral-level counseling student through the use of an

integrated didactic and experiential training approach set

forth in Toward Effective Counseling and Psychotherapy:

Training and Practice, by Truax and Carkhuff. The control

subgroups were each taught in a traditional manner by one of

three regularly assigned practicum supervisors who were mem-

bers of the counseling staff. The primary difference between

the two approaches was that the experimental group members

were exposed to immediate feedback on their counseling tech-

niques by their being rated on three interpersonal skills

rating scales developed by Truax (1, 2, 3); the control group

did not use the scales.

The study ran for twelve consecutive weeks, with each

group meeting two and one-half hours per week for a total of

thirty hours of training. During the second week of training,

each subject was required to have a single thirty-minute

counseling session, in a private setting, with each of two

clients. The sessions were recorded on audio tape. Two

additional tapes of similar sessions were required during

the last week of the study. Segments from these tapes

served as pre- and posttests and were sent to the Arkansas

Rehabilitation Research and Training Center at the

University of Arkansas to be rated by professional raters

trained by Truax and his staff. The following scales were

101

used for the ratings: the Accurate Empathy Scale, the

Nonpossessive Warmth Scale, and the Therapist Genuineness

Scale.

Following the rating of the pre- and posttests, the

results were treated by two statistical procedures: an

analysis of covariance on the difference between the pre-

and posttest scores, and a jt test for correlated means to

determine if significant difference had occurred. The sta- »

tistical analysis of the data revealed the following:

Hypothesis I was not confirmed. There were

no significant differences between the groups on

amount of.change in ratings on the Accurate

Empathy Scale.

Hypothesis II was not sustained. There were


amount of change in ratings on the Nonpossessive

Warmth Scale.

Hypothesis III was not supported. There were


the Therapist Genuineness Scale.

Findings

The integrated didactic and experiential approach to

training did not significantly increase the counselor trainee's

ability to convey accurate empathy, nonpossessive warmth, or

genuineness more than did the traditional approach to training

counselors in the practicum experience. There was, in fact,

102

no significant change reported for either group on accurate

empathy or nonpossessive warmth. The counselor trainees did

show significant positive change on therapist genuineness.

Possible explanations of findings follow:

One explanation for the lack of more positive findings

may be that the subjects had reached a relatively high level

on the interpersonal skills before reaching the practicum.

Whatever the reason for the relatively high level of inter-

personal skills among the subjects, it may be that further

increase in the skills would require a longer or more

intensive practicum experience.

Another explanation for the lack of significant results

may be the difference in the professional status enjoyed by

the supervisors. All three of the control supervisors were

regular staff members who had the doctorate degree. That the

supervisor of the experimental group was a doctoral student

may have tended to lessen the impact of his influence. A

factor which may have compounded the effect of the unequal

status of the supervisors was'the subject's knowing that the

control supervisor had final and official responsibility for

grades, recommendations, etc., for both the control and the

experimental groups. This may have resulted in increased

incentive on the part of the subjects in the control group

to identify with and attempt to earn the approval of their

supervisor.

103

Conclusions

1. It may be concluded that practicum students in the


classes

a. did not demonstrate a statistically significant

mean increase in accurate empathy as compared with

practicum students who had attended the traditional

classes,

b. did not demonstrate a statistically significant

mean increase in accurate empathy,

c. did not demonstrate a statistically significant

mean increase in nonpossessive warmth as compared with


classes,

d. did not demonstrate a statistically significant

mean increase in nonpossessive warmth,

e. did not demonstrate a statistically significant

mean increase in therapist genuineness as compared with


classes,

f. did not demonstrate a statistically significant

mean increase in therapist genuineness.

2. It may be concluded that practicum students in the

traditional approach to training classes

a. did not demonstrate a statistically significant

mean increase in accurate empathy as compared with

104

practicum students who attended the integrated didactic

and experiential approach to training classes,

b. did not demonstrate a statistically significant

mean increase in accurate empathy,

c. did not demonstrate a statistically significant

mean increase in nonpossessive warmth as compared with

practicum students who had attended the integrated

didactic and experiential approach to training classes,

d. did not demonstrate a statistically significant

mean increase in nonpossessive warmth,

e. did not demonstrate a statistically significant

mean increase in therapist genuineness as compared with

practicum students who had attended the integrated

didactic and experiential approach to training classes,

f. did demonstrate a statistically significant

mean increase in therapist genuineness.

Recommendations

In view of the findings of the study, the- following

recommendations are made:

1. That further study be considered to determine if a

longer practicum might produce more change in counselor

ability to convey accurate empathy, nonpossessive warmth, and

genuineness.

2. That further study be considered to determine if

training could more effectively raise the interpersonal skills

if the practicum or a pre-practicum were placed earlier in

the training program.

105

3. That further study be considered to determine the

extent to which change on the interpersonal skills might

result if the integrated didactic and experiential approach

were utilized by a regular staff member.

4. That further research be directed toward determining

the effectiveness of the integrated didactic and experiential

approach to training with regard to initial status of subjects

on the three interpersonal skills. That is, the effect that

a person's initial level on empathy, warmth, and genuineness

has on the probability of his increasing these skills through

training in the integrated approach needs to be explored.

APPENDIX A

A TENTATIVE SCALE FOR THE MEASUREMENT

OF ACCURATE EMPATHY

General Definition

Accurate empathy involves more than just the ability of

of the therapist to sense the client or patient's "private

world" as if it were his own. It also involves more than

just his ability to know what the patient means. Accurate

empathy involves both the therapist's sensitivity to current

feelings and his verbal facility to communicate this under-

standing in a language attuned to the client's current

feelings.

It is not necessary—indeed it would seem undesirable—

for the therapist to share the client's feelings in any sense

that would require him to feel the same emotions. It is

instead an appreciation and a sensitive awareness of those

feelings. At deeper levels of empathy, it also involves

enough understanding of patterns of human feelings and ex-

perience to sense feelings that the client only partially

reveals. With such experience and knowledge, the therapist

can communicate what the client clearly knows as well as

meanings in the client's experience of which he is scarcely

aware.

106

107

A t a high level of accurate empathy the message "I am

with you" is unmistakably clear—the therapist's remarks fit

perfectly with the client's mood and content. His responses

not only indicate his sensitive understanding of the obvious

feelings, but also serve to clarify and expand the client's

awareness of his own feelings or experiences. Such empathy

is communicated by both the language used and all the voice

qualities, which unerringly reflect the therapist's serious-

ness and depth of feeling. The therapist's intent concentra-

tion upon the client keeps him continuously aware of the

client's shifting emotional content so that he can shift his

own reponses to correct for language or content errors when

he temporarily loses touch and is not "with" the client.

At a low level of accurate empathy the therapist may go

off on a tangent of his own or may misinterpret what the

patient is feeling. At a very low level he may be so pre-

occupied and interested in his own intellectual interpretations

that he is scarcely aware of the client's "being." The ther-

apist at this low level of accurate empathy may even be unin-

terested in the client, or may be concentrating on the intel-

lectual content of what the client says rather than what he

"is" at the moment, and so may ignore or misunderstand the

client's current feelings and experiencesAt this low level

of empathy the therapist is doing something other than

"listening," "understanding," or "being sensitive"; he may be

evaluating the client, giving advice, sermonizing, or simply

108

reflecting upon his own feelings or experiences. Indeed, he

may be accurately describing psychodynamics to the patient—

but in the wrong language for the client, or at the wrong

time, when these dynamics are far removed from the "client's

current feelings, so that the interaction takes on the flavor

of "teacher-pupil."

Stage 1

Therapist seems completely unaware of even the most con-spicuous of the client's feelings; his responses are not appropriate to the mood and content of the client's state-ments. There is no determinable quality of empathy, and hence no accuracy whatsoever. The therapist may be bored and dis-interested or actively offering advice, but he is not commu-nicating an awareness of the client's current feelings.

Stage 2

Therapist shows an almost negligible degree of accuracy in his responses, and that only toward the client's most obvious feelings. Any emotions which are not clearly defined he tends to ignore all together. He may be correctly sensi-tive to obvious feelings and yet misunderstand much of what the client is really trying to say. By his response he may block off or may misdirect the patient. Stage 2 is distin-guishable from Stage 3 in that the therapist ignores feelings rather than displaying an inability to understand them.

Stage 3

Therapist often responds accurately to client's more exposed feelings. He also displays concern for the deeper, more hidden feelings, which he seems to sense must be present, though he does not understand their nature or sense their meaning to the patient.

Stage 4

Therapist usually responds accurately to the client's more obvious feelings and occasionally recognizes some that are less apparent. In the process of this tentative probing, however, he may misinterpret some present feelings and

109'

anticipate some which are not current. Sensitivity and awareness do exist in the therapist, but he is not entirely "with" the patient in the current situation or experience. The desire and effort to understand are both present, but his accuracy is low. This stage is distinguishable from Stage 3 in that the therapist does occasionally recognize less appar-ent feelings. He also may seem to have a theory about the patient and may even know how or shy the patient feels a particular way, but he is definitely not "with" the patient. In short, the therapist may be diagnostically accurate, but not emphatically accurate in his sensitivity to the patient's current feelings.

Stage 5

Therapist accurately responds to all of the client's more readily discernible feelings. He also shows awareness of many less evident feelings and experiences, but he tends to be somewhat inaccurate in his understanding of these. However, when he does not understand completely, this lack of complete understanding is communicated without an antici-patory or jarring note. His misunderstandings are not disruptive by their tentative nature. Sometimes in Stage 5 the therapist simply communicates his awareness of the problem of understanding another person's inner world. This stage is the midpoint of the continuum of accurate empathy.

Stage 6

Therapist recognizes most of the client's present feel-ings, including those which are not readily apparent. Al-though he understands their content, he sometimes tends to misjudge the intensity of these veiled feelings, so that his responses are not always accurately suited to the exact mood of the client. The therapist.does deal directly with feelings the patient is currently experiencing although he may mis-judge the intensity of those less apparent. Although sensing the feelings, he often is unable to communicate meaning to them. In contrast to Stage 7, the therapist's statements contain an almost static quality in the sense that he handles those feelings that the patient offers but does not bring new elements to life. He is "with" the client but doesn't en-courage exploration. His manner of communicating his under-standing is such that he makes of it a finished thing..

Stage 7

Therapist responds accurately to most of the client's present feelings and shows awareness of the precise intensity

110

of most of the underlying emotions. However, his responses move only slightly beyond the client's, own awareness, so that feelings may be present which neither the client nor thera-pist recognizes. The therapist initiates moves toward more emotionally laden material, and may communicate simply that he and the patient are moving towards more emotionally sig-nificant material. Stage 7 is distinguishable from Stage 6 in that often the therapist's response is a kind of precise pointing of the finger toward emotionally significant material.

Stage 8

Therapist accurately interprets all the client's present, acknowledged feelings. He also uncovers the most deeply shrouded of the client's feelings, voicing meanings in the client's experience of which the client is scarcely aware. Since the therapist must necessarily utilize a method of trial and error in the new uncharted areas, there are minor flaws in the accuracy of his understanding, but these inaccu-racies are held tentatively. With sensitivity and accuracy he moves into feelings and experiences that the client has only hinted at. The therapist offers . specific explanations or additions to- the patient's understanding so that under-lying emotions are both pointed out and specifically talked about. The content that comes to life may be new but it is not alien.

Although the therapist in Stage 8 makes mistakes, these mistakes are not jarring because they are covered by the tentative character of the response. Also, this therapist is sensitive to his mistakes and quickly changes his response in midstream, indicating that he has recognized what is being talked about and what the patient is seeking in his own explorations. The therapist reflects a togetherness with the patient in tentative trial and error exploration. His voice tone reflects the seriousness and depth of his .empathic grasp.

Stage 9

The therapist in this stage unerringly responds to the client's full range of feelings in their exact intensity. Without hesitation, he recognizes each emotional nuance and communicates an understanding of every deepest feeling. He-is completely attuned to the client's shifting emotional content; he senses each of the client's feelings and reflects them in his words and voice. With.sensitive accuracy, he ex-pands the client's hints into a full-scale (though tentative) elaboration of feeling or experience. He shows precision both in understanding and in communication of this under-standing, and expresses and experiences them without hesitancy.

APPENDIX B

A TENTATIVE SCALE FOR THE MEASUREMENT

OF NONPOSSESSIVE WARMTH

General Definition

The dimension of nonpossessive warmth or unconditional

positive regard, ranges from a high level where the therapist

warmly accepts the patient's experience as part of that per-

son, without imposing conditions; to a low level where the

therapist evaluates a patient or his feelings, expresses dis-

like or disapproval, or expresses warmth in a selective and

evaluative way.

Thus, a warm, positive feeling toward the client may

still rate quite low in this scale if it is given condition-

ally. Nonpossessive warmth for the client means accepting

him as a person with human potentialities. It involves a

nonpossessive caring for him as a separate person and, thus,

a willingness to share equally his joys and aspirations or

his depressions and failures. It involves valuing the patient

as a person, separate from any evaluation of his behavior or

thoughts. Thus, a therapist can evaluate the patient's be-

havior or his thoughts but still rate high on warmth if it is

quite clear that his valuing of the individual as a person is

uncontaminated and unconditional. At its highest level this

unconditional warmth involves a nonpossessive caring for the

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In-

patient as a separate person who is allowed to have his own

feelings and experiences; a prizing of the patient for him-

self regardless of his behavior.

Stage 1

The therapist is actively offering advice or giving clear negative regard. He may be telling the patient what would be "best for him," or in other ways actively approving or disapproving of his behavior. The therapist's actions make himself the locus of evaluation? he sees himself as responsible for the patient.

Stage 2

The therapist responds mechanically to the client, in-dicating little positive regard and hence little nonposses-sive warmth. He may ignore the patient or his feelings or display a lack of concern or interest. The therapist ignores client at times when a nonpossessively warm response would be expected; he shows a complete passivity that communicates almost unconditional lack of regard.

Stage 3

The therapist indicates a positive caring for the patient or client, but it is a semipossessive caring in the sense that he communicates to the client that his behavior matters to him. That is, the therapist communicates such things as "It is not all right if you act immorally," "I want you to get along at work," or "It's important to me that you get along with the ward staff." The therapist sees himself as responsible for the client.

Stage 4

The therapist clearly communicates a very deep interest and concern for the welfare of the patient, showing a non-evaluative and unconditional warmth in almost all areas of his functioning. Although there remains some conditionality in the more personal and private areas, the patient is given freedom to be himself and to be liked as himself. There is' little evaluation of thoughts and behaviors. In deeply per-sonal areas, however, the therapist may be conditional and communicate the idea that the client may act in any way he wishes--except that it is important to the therapist that he'

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be more mature or not regress in therapy or accept and like the therapist. In all other areas, however, nonpossessive warmth is communicated. The therapist sees himself as responsible to the client.

Stage 5

At stage 5, the therapist communicates warmth without restriction. There is a deep respect for the patient's worth as a person and his rights as a free individual. At this level the patient is free to be himself even if this means that he is regressing, being defensive, or even dis-liking or rejecting the therapist himself. At this stage the therapist cares deeply for the patient as a person, but it does not matter to him how the patient chooses to behave. He genuinely cares for and deeply prizes the patient for his human potentials, apart from evaluations of his behavior or his thoughts. He is willing to share equally the patient's joys and aspirations or depressions and failures. The only channeling by the therapist may be the demand that the patient communicate personally relevant material.

APPENDIX C

A TENTATIVE SCALE FOR THE MEASUREMENT OF THERAPIST

GENUINENESS OR SELF-CONGRUENCE

General Definition

Perhaps the most difficult scale to develop has been

that of therapist genuineness. However, though there are

notable points of inconsistency in the research evidence,

there is also here an extensive body of literature supporting

the efficacy of this construct in counseling and therapeutic

processes.

This scale is an attempt to define five degrees of ther-

apist genuineness, beginning at a very low level where the

therapist presents a facade or defends and denies feelings;

and continuing to a high level of self-congruence where the

therapist is freely and deeply himself. A high level of

self-congruence does not mean that the therapist must overtly

express his feelings but only that he does not deny them.

Thus, the therapist may be actively reflecting, interpreting,

analyzing, or in other ways functioning as a therapist; but

this functioning must be self-congruent, so that he is being

himself in the moment rather than presenting a professional

facade. Thus the therapist's response must be sincere rather

than phony; it must express his real feelings or being rather

than defensiveness.

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11 c

"Being himself" simply means that at the moment the ther-

apist is really whatever his response denotes. It does not

mean that the therapist must disclose his total self, but

only that whatever he does show is a real aspect of himself,

not a response growing out of defensiveness or a merely

"professional" response that has been learned and repeated.

Stage 1

The therapist is clearly defensive in the interaction, and there is explicit evidence of a very considerable dis-crepancy between what he says and what he experiences. There may be striking contradictions in the therapist's statements, the content of his verbalization may contradict the voice qualities or nonverbal cues (. . ., the upset therapist stating in a strained voice that he is "not bothered at all" by the patient's anger).

Stage 2

The therapist responds appropriately but in a profession-al rather than a personal manner, giving the impression that his responses are said because they sound good from a distance but do not express what he really feels or means. There is a somewhat contrived or rehearsed quality or air of profes-sionalism present.

Stage 3

The therapist is implicitly either defensive or profes-sional, although there is no explicit evidence.

r»

Stage 4

There is neither implicit nor explicit evidence of defensiveness or the presence of a facade. The therapist shows no self-incongruence.

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Stage 5

The therapist is freely and deeply himself in the relationship. He is open to experiences and feelings of all types—both pleasant and hurtful—^without traces of defensiveness or retreat into professionalism. Although• there may be contradictory feelings, these are accepted or recognized. The therapist is clearly being himself in all of his responses, whether they are personally meaningful or trite. At stage 5 the therapist need not express personal feelings, but whether he is giving advice, reflecting, interpreting, or sharing experiences, it is clear that he is being very much himself, so that his verbalizations match his inner experiences.

APPENDIX D

OUTLINE OF THE INTEGRATED DIDACTIC

AND EXPERIENTIAL APPROACH

I. Initial experience. A. Reading selections from a wide variety of leading

theorists and therapists is required. (Refer to the bibliography).

B. Listening to some 25 hours of individual and group counseling from the tape library is to be completed in the first six weeks of training. A sign-up list will be maintained to ascertain this. (Copies of the Accurate Empathy Scale, the Nonpossessive Warmth Scale, and the Genuineness Scale will be provided so that each student can attempt to rate specific excerpts as he is listening to the tapes).

II. Empathy Training.

III. Warmth Training.

IV. Genuineness Training.

V. Quasi-group therapy sessions.

VI, Counseling clients with supervision.

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APPENDIX E

BIBLIOGRAPHY

FOR 569 (Practicum in Counseling)

INTEGRATED DIDACTIC AND EXPERIENTIAL APPROACH

I. Required Readings:

Blocher, Donald H., Developmental Counseling, The Ronald Press, 1966.

New York:

*Harper, Robert A., Psychoanalysis and Psychotherapy; 36 Systems, Englewood Cliffs, N. J.: Prentice-Hall, Inc., 1959. Chapters 5-10.

•Patterson, C. H., Theories of Counseling and Psychother-apy, New York: Harper & Row, 1966. (Examples of varied approaches to counseling).

*Truax, Charles B. and Robert R. Carkhuff, Toward Effective Counseling and Psychotherapy: Training and Practice, Chicago: Aldine Publishing Co., 1968. Chapters 2, 3, 6, 7.

II. Additional Sources for Selective Reading: **(A minimum of 500pp must be read and reported on 5 x 8

cards. At least 250 of the required 500 must be from articles—each article will count 25 pp. The form to be used in reporting the readings follows:

Front:

Name Date

Bibliographical data

Personal response or evaluation

No. pp

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Back: Short summary

Sources other than those listed may be used with the approval of the supervisor).

Sources listed in the bibliographies of any of the re-quired readings.

Mimeographed articles obtained from the supervisor.

RC Arbuckle, Dugald S., Counseling and Psychotherapy: An 480 Overview. New York: McGraw Hill Book Co., 1967. .A7 (Chapters 9 and 10)

Berenson, Bernard G. and Robert R. Carkhuff, Sources of Gain in Counseling and Psychotherapy. New York: Holt,'Rinehart, & Winston, Inc., 1967.

Brammer, L. M. and E. L. Shostrom, Therapeutic Psycholr-ogy; Fundamentals of Counseling and Psychotherapy. Englewood Cliffs, N. J.: Prentice-Hall, 1964.

Krumboltz, John D. (ed.), Revolution in Counseling: Implications of Behavioral Science. Boston: Houghton-Mifflin Co., 1966.

LB Patterson, C. H., The Counselor in the School: Selected 1027.5 Readings. New York: McGraw.Hill Book Co., 1967.

(Chapter 28)

*To be completed within the first six weeks (no later than March 22, 1969).

**To be completed within the first ten weeks (no later than April 19, 1969).

APPENDIX F

COUNSELOR EDUCATION PROGRAM NORTH TEXAS STATE UNIVERSITY

DENTON, TEXAS

REQUIREMENTS AND GOALS

Education 569: Practicum in Guidance and Counseling

Course Description;

Practicum in Guidance and Counseling - 569. Supervised practice in counseling and guidance. Practicum is con-ducted in selected public school counseling offices or other approved counseling situations. In the case of an on-campus practicum, facilities will be provided on the NTSU campus. Twenty hours of counseling is required plus additional activities. Pre-requisite: Education 568 and permission of instructor.

Objectives:

1. Development of increased competence as a counselor. 2. Development of increased familiarity and skill with

tests as tools in counseling. 3. Opportunity for application and integration of

counseling skills and information learned in prior course work.

4. Development of greater sensitivity to the dynamics of the counseling process.

5. Opportunity to relate the various theoretical counseling orientations to counseling practice.

6. Development of a better basis for self-evaluation of one's counseling.

Methods:

1. Counseling interviews with elementary, high school, and/or college students and, when possible, parents/ adults.

2. Analysis of the recordings made of the interviews. 3. Analysis of other counselors based on observation

and monitoring.

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4. Class discussion of cases and counseling topics based on interviews as well as readings.

5. Write up of case notes of interviews as well as final summary case reports.

Content

1. Twenty hours of interpersonal relationships with counselees (and parents when possible) is the minimum requirement.

2. Eight hours of observation of counseling interviews is the minimum requirement. When possible, one observation a week should be completed. Each obser-vation is written up (use one of the forms provided) and given to the Practicum instructor. You should attempt to observe as many different counselors as possible. Each interview should be observed in its entirety? if this is not possible, the amount of time spent observing that interview should be noted on the form. Observers and counselors benefit most when the counseling interaction can be discussed immediately following the conclusion of the interview.

3. Role playing with two other counselors is required before your counseling assignment. Alternate three ways: observer, counselor, counselee.

All materials belonging to NTSU are to remain in the counseling lab except with special permission of your Practicum instructor. Folders, case notes, tests, etc. that you might need to carry off campus during the week should be handled with extreme care with respect to confidentiality.

5. Do not discuss counseling cases with your colleagues or supervisors in reception areas or places where you might be overheard. Find a private room to discuss cases.

6. Counseling notes are to be written up for each counselee and placed in a folder to be turned in at the end of the semester. The following procedure should be observed: A. Write up each interview briefly as soon as you

can after it occurs—it's amazing what important things about the counselee will be forgotten if you don't. Use your tape recording to do this. The write-up should be brief—general description of what took place along with your perceptions of the counselee. Use the COUNSELING INTERVIEW NOTES form for your weekly write-ups.

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B. At the end of each interview write-up, develop a few working hypotheses. This will give you direction and strategy for the next interview. Each time you should sharpen up your observations —some hypotheses will remain, others will be discarded for better ones.

C. A summary should be written at the conclusion of each case (use the CASE SUMMARY FORM provided.) The purpose of this summary report is to synthesize and draw together in a global manner your observa-tions of the total counseling contact with that particular counselee. This report form should be typed and signed by you. In many cases, this summary is sent out to agencies, schools, etc. (i.e., where the counselee gives his permission.)

D. Permission to release information should be ob-tained wherever possible from each counselee at the last interview (use the form provided). This policy applies only to those counselees who come into the NTSU counseling facilities, not coun-selees you might have outside. The purpose of this Release Form is to have on record what the counselee wants done with his confidential materials, and, also, to reinforce with the coun-selee that any information pertinent to him "belongs" to him and that only he has the right to decide what should be done with it.

E. Test profiles (if testing is done) should also be included in the folder. If the counselee wants a copy of his profile(s), make up a duplicate for him.

F. The tab on your folder should be completed in the following manner:

Counselee-Date—

Doe, John Dallas Spring '69 Jones

—Res.of counselee —Counselor

7. Case presentations and small group participation: Each counselor will present one or more of his coun-seling cases, with tape examples, to his small group. Of course, each small group meeting will also be used to discuss any immediate problems arising in your counseling. "Many heads are better than one." Sincere assistance to each other along with an atti-tude of acceptance of each other are practicum goals.

.8. Sensitivity training may be an activity depending on your instructor's requirements and your own particu-lar interest. Sensitivity training consists of small (5-9 members) group encounters during the semester. The discussion content is the group

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interaction itself. The purpose of sensitivity training is to increase one's awareness of himself (values, attitudes, needs, feelings, etc.) as well as other group members. Another goal is to become sensitive to how you think you communicate yourself to other people as compared with.how they interpret your communication. Sensitivity groups are led (i.e., kept on a productive level).by a member of the practicum staff. Groups typically are free to determine when and for how long they will meet.

9. Testing and test interpretation: Hopefully, you will gain experience in administering, scoring, and interpreting tests. Unless you are an expert, you should consult with a supervisor for choice of test and, when possible, role-play your test interpreta-tion before you actually give it. • Test interpreta-tion can be a valuable counseling tool when used wisely.

10* Supervision and critique of your interviews: All supervisors are available to sit down with you and help you with your counseling. They will not force themselves on you, hence you must take the initia-tive for arranging for a critique. If you are sin-cerely interested in becoming a better counselor, you can't help but discuss your counseling with a supervisor and your Practicum instructor.

11. Experimentation: This is a laboratory situation— try out different approaches, techniques, test interpretations, etc. Hopefully, you will make mis-takes—then you can know what to "correct." Hope-fully, also, you will discover some new methods of operating. One theoretical approach is not taught in the Practicum. You are free to develop the counseling approach or style that "works" best for you.

12. Upgrading of theoretical background: Material and techniques will be presented from time to time. "Try out" of counseling techniques, such as rational, behavioristic, client-centered, existential approaches is encouraged.

13. Periodic readings will be assigned from the attached bibliography and summarizations will be required in the form of annotated bibliography cards.

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14. The student will be expected to secure, administer, score and evaluate tests from the areas of scholas-tic aptitude, educational achievement, general and/or specific aptitudes as warranted, interest, personality and/or adjustment.

15. Additional requirements will be added at the discre-tion of the instructor.

BIBLIOGRAPHY

Required Texts:

Blocher, Donald H. Developmental Counseling, New York: The Ronald Press, 1966.

Harper, Robert A. Psychoanalysis and Psychotherapy: 36 Systems. Englewood Cliffs, N. J.: Prentice-Hall, Inc., 1959.

Additional Readings:

Arbuckle, Dugald S. Counseling: Philosophy, Theory and Practice. Boston: Allyn and Bacon, Inc., 1965.

Bentley, Joseph C. The Counselor's Role: Commentary and Readings. Boston: Houghton-Mifflin Company, 1968.

Bordin, E. S. Psychological Counseling. New York: Appleton-Century-Crofts, 1968. (2nd Edition.)

Kemp, C. G. Intangibles in Counseling. Boston: Houghton-Mifflin Company, 1967.

Krumboltz, John. (ed.) Revolution in Counseling: Im-plications of Behavioral Science. Boston: Houghton-Mifflin Company, 1966.

McGowan, John F. and Schmidt, Lyle D. Counseling: Readings in Theory and Practice. New York: Holt, Rinehart and Winston, Inc., 1962.

Shertzer, Bruce and Stone, Shelley C. Fundamentals of Counseling. Boston: Houghton-Mifflin Company, 1968.

Warters, Jane. Techniques of Counseling. New York: McGraw-Hill Book Company, 1964. „ (2nd Edition. )

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APPENDIX G

COUNSELOR EDUCATION PROGRAM NORTH TEXAS STATE UNIVERSITY

DENTON, TEXAS

ANALYSIS OF COUNSELING INTERVIEWS

I. The Client

A. What is the client like - based on his behavior, the content of what he talks about, and the infer-ences you draw from what he says and does?

B. What does the client want?

1. Indicate his stated purpose in counseling.

2. Indicate anything in the content of the inter-view or the behavior of the client which suggests that his needs are other than those he initially stated. What substantiation have you for this?

C. How does the client feel about the counseling relationship? What inferences can be made about feelings or attitudes. Based on what?

D. Do you notice any changes in the client?

1. What evidence is there?

2. How do you account for this?

II. The Counselor

A. How successful has the counselor been in establish-ing a desirable counseling relationship?

1. How would you characterize the relationship?

2. What type of psychological climate lias been established?

3. Were there any instances where the relationship brlke down? What happened?

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B. How does the counselor feel about the client? (Positive, negative, indifferent) What inferences do you base this on?

C. What is the counselor trying to do?

1. How does he perceive the client's problem(s)?

2. Should the counselor change his goals? Why?

3. Does he know what he is trying to do, or is he just stumbling along?

D. How effective is the counselor in reaching his goals? Why do you think so?

Ill. Summary

In retrospect, how might the counselor have better handled some of these issues?

BIBLIOGRAPHY

Books

Alexander, F., Fundamentals of Psyehoanalysis, New York, W. W. Norton, 1948.

Carkhuff, R. R., editor, The Counselor's Contribution to Facilitative Processes, Urbana, Illinois, Parkinson, 1967.

Eysenck, H. J., editor, "The Effects of Psychotherapy," Handbook of Abnormal Psychology, New York, Basic Books, Inc., 1961.

Rogers, Carl R., Client-Centered Therapy, Cambridge, Massachusetts, Riverside Press, 1951.

Truax, Charles B. and R. R. Carkhuff, "For Better or for Worse. . . .The Process of Psychotherapeutic Personality Change," chapter in Recent Advances in the Study of Behavior Change, Montreal, McGill University Press, 1964, 118-163.

and , Toward Effective Counseling and Psychotherapy: Training and Practice, Chicago, Aldine Publishing Company, 1968.

Wolpe, J., Psychotherapy by Reciprocal Inhibition, Stanford, California, Stanford University Press, 1958.

Articles

Baldwin, T. and Joan Lee, "Evaluation of Programmed Instruc-tion in Human Relations," American Psychologist, XX (1965), 20.

Banks, G., B. G„ Berenson, and R. R. Carkhuff, "The Effects of Counselor Race and Training Upon Counseling Process with Negro Clients in Initial Interviews," Journal of Clinical Psychology. XXIII (1967), 70-72. • "

Berenson, B. G., R. R. Carkhuff, and Pamela Myrus, "The Inter-personal Functions and Training of College Students," Journal of Counseling Psychology, XIII (1966), 4.

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Carkhuff, R. R., "Toward a Comprehensive Model of Facilitative Interpersonal Processes," Journal of Counseling Psychol-ogy, XIV (1967), 67-72.

Carkhuff, R. R. and C. B. Truax, "Lay Mental Health Counsel-ing: The Effects of Lay Group Counseling," Journal of Consulting Psychology, XXIX (1965), 42.6-431.

and , "Training in Counseling and Psychotherapy: An Evaluation of an Integrated Didactic and Experiential Approach," Journal of Consulting Psychology, XXIX (1965), 333-336.

DeSharmes, R., J. Levy, and M. Wertheimer, "A Note on Attempted Evaluations of Psychotherapy," Journal of Clinical Psychology, X (1954), 233-235.

Dymond, Rosalind, "A Scale for the Measurement of Empathic Ability," Journal of Consulting Psychology, XIII (1949), 127-133.

Eysenck, H. J., "The Effects of Psychotherapy: An Evaluation," Journal of Consulting Psychology, XVI (1952), 319-324.

_, "The Effects of Psychotherapy: A Reply," Journal of Abnormal Social Psychology, L (1955),, 147-148.

Ferenczi, S., "The Principle of Relaxation and Neocatharsis," International Journal of Psychoanalysis, XI (1930), 438-443.

Halpern, H. and Leona Lesser, "Empathy in Infants, Adults, and Psychotherapists," Psychoanalysis and the Psycho-analytic Review, XLVII (1960), 32-42.

Jourard, S., "I-Thou Relationship Versus Manipulation in Counseling and Psychotherapy," Journal of Individual Psychology, XV (1959), 174-179.

Luborsky, L., "A Note on Eysenck*s Article 'The Effects of Psychotherapy: An Evaluation'," British Journal of Psychology, XLV (1954), 129-131.

Meehl,.P. E., ."Psychotherapy," Annual Review of Psychology, VI (1955), 357-378.

Raush, H. L. and E. S. Bordin, "Warmth in Personality Development and in Psychotherapy," Psychiatry: Journal Study of Interpersonal Processes, XX (November, 1957), no. 4.

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Rogers, Carl R., "The Interpersonal Relationship: The Core of Guidance," Harvard Educational Review, XXXII (1962). 416-429.

"The Necessary and Sufficient Conditions ' of Therapeutic Personality Change," Journal of Consult-ing Psychology. XXI (1957), 95-103.

Rosenzweig, S., "A Transvaluation on Psychotherapy: A Reply to Hans Eysenck," Journal of Abnormal Social Psychology, XLIX (1954), 298-304.

Sanford, N., "Clinical Methods: Psychotherapy," Annual Re-view of Psychology, V (1954), 311-336.

Schafer, R., "Generative Empathy in the'Treatment Situation," Psychoanalytic Quarterly, XXVIII (1959), 342-373.

Shoben, E. J., Jr., "Psychotherapy as a Problem in Learning Theory," Psychological Bulletin, XLVI (1949), 366-392.

"Counseling," Annual Review of Psychol-ogy, VII (1956), 147-172.

Strunk, 0., Jr., "Empathy: A Review of Theory and Research," Psychological Newsletter. IX (1957), 47-57.

Strupp, H. H., "Nature of Psychotherapist's Contribution to the Treatment Process," Archeological and Genetic Psychiatry, III (1960), 219-231.

M. S. Wallach, and M. VJogan, "Psychotherapy Experience in Retrospect: Questionnaire Survey of Former Patients and Their Therapists," Psychology Monogram, LXXVIII, no. 11 (1964), Whole No. 588.

Truax, Charles B., "The Process of Group Psychotherapy," Psychological Monograph. LXXV, no. 14 (1961).

> "Effective Ingredients in Psychotherapy: An Approach to Unraveling the Patient-Therapist Inter-action, " Journal of Counseling Psychology. X (1963), 256-263.

__ and R. R. Carkhuff, "The-Experimental-Manipulation of Therapeutic Conditions," Journal of Consulting Psychology. XXIX (1965), -119-124.

R. R. Carkhuff, and J. Douds, "Toward an Integration of the Didactic and Experiential'Approaches to Training in Counseling and Psychotherapy," Journal of o Psychology. XI (1964), 240-247.

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Truax, C. B., R. R. Carkhuff, and F. Kodman, "Relationships between Therapist-Offered Conditions and Patient Change in Group Psychotherapy," Journal of Clinical Psychology, XXI (1965), 327-329. : "

" and D. G. Wargo, "Psychotherapeutic Encounters That Change Behavior: For Better or for Worse," American Journal of Psychotherapy, XXII (1966), 499-520.

, D. G. Wargo, J. D. Frank, S. D. Imber, C. C. Battle, R. Hoehn-Saric, E. H. Nash, and A. R. Stone, "Therapist Empathy, Genuineness, and Warmth and Patient Therapeutic Outcome," Journal of. Consulting Psychology, XXX (1966), 395-401.

, D. G. Wargo, J. D. Frank, S. D. Imber, C. C. Battle, R. Hoehn-Saric, E. H. Nash, and A. R. Stone, "Therapist's Contribution to Accurate Empathy, Non-possessive Warmth and Genuineness in Psychotherapy, Journal of Clinical Psychology, XXII (1966), 331-334.

, D. G. Wargo and L. D. Silber, "Effects of High Accurate Empathy and Nonpossessive Warmth During Group Psychotherapy upon Female Institutionalized Delinquents," Journal of Abnormal Psychology, 71 (1966), 267-274.

Publications of Learned Organizations

Carkhuff, R. R., "On the Necessary Conditions of Therapeutic Personality Change," Discussion Papers, Wisconsin Psychiatric Institute, University of Wisconsin, no. 47, 1963.

Hirshberg, F., R. R. Carkhuff, and B. G. Berenson, "The Differential Effectiveness of Counselors and Therapists with In-patient Schizophrenics and Counseling Center Clients, Discussion Papers, Arkansas Rehabilitation Research and Training Center, University of Arkansas, 1966, 1 (Whole No. 6).

Truax, Charles B., "A Scale for the Measurement of Accurate Empathy," Psychiatric Institute Bulletin, Wisconsin Psychiatric Institute, University of Wisconsin, 1961, 1, no. 10 (c).

; . , "A Tentative Scale for the Measurement of Therapist Genuineness or Self-Congruence," Discussion Papers, Wisconsin Psychiatric Institute, University of Wisconsin, no. 35, 1962.

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Truax, Charles B., "A Tentative Scale for the Measurement of Unconditional Positive Regard," Psychiatric Institute Bulletin, Wisconsin Psychiatric Institute, University of Wisconsin, 1962, 2, no. 1.

"The Sampling Interview: A Method of Assessment of Psychotherapeutic Personality Change," Brief Research Reports, Wisconsin Psychiatric Institute, University of Wisconsin, 1962, 18.

, "Therapeutic Conditions," Psychiatric Institute Bulletin 13, Wisconsin Psychiatric Institute, University of Wisconsin, 1961.

Unpublished Materials

Bergin, A. E. and Sandra Solomon, "Personality and Performance Correlates of Empathic Understanding in Psychotherapy," unpublished paper read before the American Psychological Association, Philadelphia, September, 1963.

Carkhuff, R. R. and R. DeBurger, "Gross Ratings of Patient Behavior," unpublished manuscript, University of Kentucky, 1964.

Dickenson, W. A. and C. B. Truax, "Group Counseling with College Underachievers: Comparisons with a Control Group and Relationship to Empathy, Warmth, and Genuine-ness, " unpublished manuscript, University of Kentucky, 1965.

Halkides, G., "An Experimental Study of Four Conditions Necessary for Therapeutic Change," unpublished doctoral dissertation, University of Chicago, 1958.

Hart, J. T., "A Replication of the Halkides Study," unpub-lished manuscript, University of Wisconsin, 1960.

Melloh, R. A., "Accurate Empathy and Counselor Effectiveness," unpublished doctoral dissertation, University of Florida, 1964.

Truax, Charles B. and L. D. Silber, "Personality and Psycho-therapeutic Skills," unpublished manuscript, University of Arkansas, 1966.

L. D. Silber, and R. R. Carkhuff, "Accurate Empathy, Nonpossessive Warmth, Genuineness and Thera-peutic Outcome in Lay Group Counseling," unpublished manuscript, University of Arkansas, 1966.

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Truax, Charles B. and D. G. Wargo, "Antecedents to Outcome in Group Psychotherapy with Juvenile Delinquents: Effects of Therapeutic Conditions, Alternate Sessions, Vicarious Therapy Pretraining, and Patient Self-Explora-tion, " unpublished manuscript, University of Arkansas, 1966.

and , "Antecedents to Outcome in Group Psychotherapy with Hospitalized Mental Patients: Effects of Therapeutic Conditions, Alternate Sessions, Vicarious Therapy Pretraining, and Patient Self-Explora-tion, " unpublished manuscript, University of Arkansas, 1966.

, , and R. R. Carkhuff, "Antecedents to Outcome in Group Psychotherapy with Out-patients : Effects of Therapeutic Conditions, Alternate Sessions, Vicarious Therapy Pretraining and Patient Self-Exploration," unpublished manuscript, University of Arkansas, 1966.

Wargo, D. G., "The Barron Ego Strength and LH^ Scales as Predictors and Indicators of Change in Psychotherapy," Brief Research Reports, Wisconsin Psychiatric Institute, University of Wisconsin, 1962, 21.

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