Testing The Integrative Psychotherapy Model - An Integration of Ps
Testing The Integrative Psychotherapy Model - An Integration of Ps
Testing The Integrative Psychotherapy Model - An Integration of Ps
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Walden Dissertations and Doctoral Studies
2014
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Walden University
Lindsay Sterious
Review Committee
Dr. Martha Giles, Committee Chairperson, Psychology Faculty
Dr. Tom Diebold, Committee Member, Psychology Faculty
Dr. Kimberley Cox, University Reviewer, Psychology Faculty
Walden University
2014
Abstract
by
Lindsay Parsons-Sterious
Doctor of Philosophy
Clinical Psychology
Walden University
October 2014
Abstract
into a treatment methodology. This model is new and untested; therefore, its therapeutic
effectiveness is unknown. The purpose of this study was to measure the treatment
effectiveness of IPM using Bells Object Relations and Reality Testing Inventory, the
Constructive Thinking Inventory, and the Working Alliance Inventory. Participants in the
study included 19 undergraduate psychology students volunteering for extra credit and 11
posttest, nonequivalent group study involved 9 sessions of IPM for the treatment group
and 9 classes in a general psychology course for the comparison group. An analysis of
covariance using the pre-post testing of object relations and reality testing, productive
and unproductive thinking, and working alliance measured changes in these constructs
and determined the therapeutic effectiveness of IPM. Results revealed that there were no
differences were demonstrated when comparing pre and post testing, this study
demonstrated that 9 sessions of IPM did not harm those who underwent the treatment;
this finding is positive given the need for further research to potentially validate the IPM
similar study be repeated with more seasoned IPM therapists, a longer treatment period,
by
Lindsay Parsons-Sterious
Doctor of Philosophy
Clinical Psychology
Walden University
October 2014
Acknowledgments
There are several people I would like to acknowledge and express my gratitude towards.
Without the support of these people, I would not have been able to finish this process.
I owe a very special thanks to Dr. Giles. It has been an honor being your student and
having you as the chairwoman for my dissertation. Learning from the wisdom and
experience you bring to the classroom has enriched my time as a student at Walden.
Thank you Dr. Diebold for your enthusiastic love for statistics. Without your
knowledgebase and desire to teach I would not have been able to complete this process.
I am appreciative for the love and support of my friends and colleagues. Thank you Dr.
White for your guidance and mentorship over the years. Thank you for birthing the
qualitative aspects of this project. Thanks to Dr. Malone, your influence over the years
keeps my mind reaching for the depths thanks for the inspiration. And thanks to my
dear Paula Padget, your love and encouragement, and laughter has made this difficult
process a bit easier. Dr. Stokes Simms thanks for your encouragement over the years.
To my family Rachel Morin, Laura Hardin, Bill and Deanna Sterious, Chris and Despe
Sterious, Uncle John and Aunt Vas Gianopulos, without your love support and prayers
this feat would not be possible. Thank you.
And to my parents, Mike and Jan Parsons, you have inspired me to learn, grow, and
achieve for as long as I can recall. Your support in my education has carried me through
this long process. I am forever grateful for your love and encouragement.
And last but certainly not least, my husband, Ted Sterious, thank you for your faithful
Saturday mornings distracting our kids. The kids were not missing me while I was busy
doing my schoolwork; they were excited to be with their Dad. When I started on this
journey, it was my choice, but in the end I could not have completed this journey without
your support and help.
Table of Contents
Introduction ....................................................................................................................1
Psychoanalysis ........................................................................................................ 6
Humanism ............................................................................................................... 7
Definition of Terms......................................................................................................13
Summary ......................................................................................................................17
Introduction ..................................................................................................................19
i
Short-Term Restructuring Psychotherapy............................................................. 25
Introduction ..................................................................................................................53
Procedures ............................................................................................................. 58
Instrumentation ..................................................................................................... 59
Analysis................................................................................................................. 63
ii
Chapter 4: Results ..............................................................................................................67
Introduction ..................................................................................................................67
Results ..........................................................................................................................69
Summary ......................................................................................................................73
Introduction ..................................................................................................................74
Recommendations ........................................................................................................80
Implications..................................................................................................................83
Conclusion ...................................................................................................................84
References ..........................................................................................................................85
iii
List of Tables
Table 2. BORRTI and Subscale Descriptive Statistics for Total Sample, Comparison
Group, and Treatment Group .................................................................................... 70
Table 3. Constructive Thinking Inventory (CTI) and Working Alliance Inventory (WAI) .. 71
Table 4. Adjusted Posttest Means [95% CI] and ANCOVA Results ............................... 72
iv
List of Figures
v
1
Introduction
symptom presentation and to engage longer-term changes within the clients relational
world (Magnavita, Critchfield, & Castonguay, 2010). When a client presents with
complaints about a depressed mood and problems within his or her relationships, a
practitioner chooses to conceptualize that clients symptom and relational concerns based
on a theory or set of theories and begins to use techniques and interventions to alleviate
that are fueling other problems (author, year). A psychoanalytic approach could be used
an attempt to resolve unhealthy relationships from the past (McWilliams, 2004). There
are many possible approaches to take when conceptualizing and developing a plan for
helping clients who seek psychotherapy to alleviate the discomfort in his or her life.
Balancing the art and science aspects of the therapeutic encounter has been an
ongoing challenge in the field of counseling and clinical psychology. The push for
empirically validated treatments (EVTs) is called upon in the field, yet the application of
these treatments does not exist among practitioners (Steir, Losta, & Christensen, 2007).
2
According to Steir et al. (2007), 23% of doctoral level psychologists reportedly use EVTs
75% to 100% of the time, while 17% use EVTs 25% to 50% of the time and another 17%
use EVTs seldom or never. The largest percentage of practitioners (41%) in the study of
Steir et al. (2007) did not identify whether they used EVTs, which means the treatment
largely unknown. If 41% of doctoral level psychologists from Steirs study failed to
report whether they use EVTs is added to the 17% of practitioners who seldom or never
use EVTs, a majority, or 58%, of practitioners are admitting to working with clients
methodology, and help techniques are being used to render help to psychotherapy clients.
If the additional 17% of practitioners who use EVTs 25% to 50% of the time are
added to the aforementioned 58%, 75% of practitioners who worked with clients in
Steirs study did not inform what methodology he or she used to aide psychotherapy
clients 50% of the time or less. Steirs research results highlight the practitioner-science
gap. The practitioner-science gap is that which occurs between scientific research related
(Mumma, 2014). When practitioners fail to use ETVs and do not report the theories and
if not impossible, to measure what is effective for psychotherapy clients and why.
According to Consoli and Jester (2005), about 75% of practitioners are identified as
eclectic or integrative, while few programs offer specific training for psychotherapy
in psychotherapy integration and indicated that such training only partially exists. Those
who responded to the survey reported that they had training in at least four theoretical
orientations (33%), while a smaller percentage of programs (15%) offer student training
in only two theoretical orientations (author, year). Fifty-four percent of those surveyed
reported that the training program mandated training in more than one theoretical
orientation: 33% reported mandatory training in all five theories, 17% in three theories,
The need for EVT approaches is significant given the dynamic needs of those
practitioners work from either an eclectic or integrative orientation, and few programs of
that a large percentage of those who integrate are self-taught. Lampropoulos and Dixon
(2007) reported that many who claim to use an integrative theory are self-taught, which
can lead to a potential lack of empirical support for how they are working with clients.
These questions and concerns further highlight the need for researchers to validate
practitioners to integrate is essential to bring to light how practitioners are working with
modalitys effectiveness when comparing treatment and non-treatment groups given that
inter-treatment comparisons have not supported any one modality over another.
4
Regardless of an individuals stance on the push for EVTs (Steir et al., 2007) or a
and non-treatment groups (Duncan, 2002), the propensity of practitioners who claim
Dixon 2007) highlights a need for validated and/or supported integration in the field. A
move toward the validation of integrative modalities could have implications for the
training, education, and practice of clinical and counseling psychology (Boswell et al.,
2009).
There are several social benefits to identifying effective integrative therapy models.
Sound and valid integrative models used by trained professionals can create a fiscally
seeking such services, and third party reimbursement companies (Duncan, 2002).
Improvements in the quality of care could include a comprehensive approach that meets
the dynamic needs of those who seek treatment while ensuring the approach being used
to promote health and stability actually does so (Tan, 2008). Finally, using
comprehensive modalities that combine theory and technique from past practices in the
field of psychology may both deepen and broaden our understanding of the particular
and clinical practice (Anchin, 2008, p. 19). When researchers are aware and able to study
the application of integrative therapies, practitioners in the field are better able to use
findings from research to modify, enhance, and perfect integrative theory and technique.
5
The focus of this study was to test the treatment effectiveness of the integrative
psychotherapy model (IPM; White, 2002). Counselors and clinical psychologists benefit
from therapeutic modalities that result in lasting change. Several faculty members in the
psychotherapy model was born after nearly a decade. The IPM weaves psychoanalytic,
Prior to testing the IPMs ability to result in lasting change, its initial treatment
effectiveness must be empirically supported. The IPM is untested and, therefore, its
methodology.
The process of psychoanalysis has existed for over 100 years. Currently,
psychoanalysis is still practiced in its original form, as well as in modern forms (Leary,
2007; Renik, 2006). Both humanism and cognitive therapy have been rooted in the fields
of clinical and counseling psychology for the past 66 (Duncan, 2002; Rogers 1942;
Rogers, 1951) and 48 years respectively (Butler, Chapman, Forman, & Beck, 2006;
McEvoy & Nathan, 2007). The IPM has not yet been tested. Although it is based on
6
theories that have been tested in the field, the theoretical application of these techniques
in clinical practice are held to a different standard and therefore should be tested. All
treatment modalities should have founded treatment effectiveness. In the current study,
programs and use an integrative approach in their practice (Boswell et al., 2009; Boswell
et al., 2010; Consoli & Jester, 2005). Few graduate programs offer training on the
integration of theory and technique (Consoli & Jester, 2005; Lampropoulos & Dixon,
2007), which leaves little room for monitoring and measuring empirically-validated
treatments. The researcher examined the pre-post assessment of three theoretical prongs
of the IPM: object relations, cognitive behavioral, and humanistic. Additionally, the
researcher compared the pre-post testing results of the treatment and comparison groups;
this comparison was used to determine the overall effectiveness of the IPM as an
integrative psychotherapy model. Measuring the effectiveness of the IPM could add an
empirically founded integrative therapy model to the field, which allows for practitioners
who borrow from integrative theory to use this model in their own therapeutic
applications.
Psychoanalysis
Freud was not the first to theorize about the unconscious, he popularized the term in the
7
field of psychological practice and everyday life (Lothane, 2006). Freuds (1953, 1955)
including the conscious, preconscious, and unconscious (Shevrin, 1998). Each layer
delves deeper into the unknown of an individuals psyche. The developers of the IPM
Cognitive Theory
Cognitive theory and therapy are most known due to Becks conceptualization of
schema (Beck, 1991; Calvete, Estvez, Arroyabe, & Ruiz, 2005). According to cognitive
theory, each individual has a template for how he or she experiences him or herself,
others, and the world. This template has firm boundaries; however, it is not fixed, and it
is used to determine how that individual filters information to confirm beliefs about him
or herself and others. Nix (2001) and White (2002) used Becks conceptualization to
Humanism
individual tells his or her life story. The therapist listens to track and reflect the clients
thoughts, feelings, and behaviors at the preconscious level of awareness. The therapist
can then attune to the clients stories using accurate empathy and tracking (Kahn &
8
Rachman, 2000). These attunement and empathy skills are borrowed from the humanistic
perspective (Rogers, 2007). Through the therapeutic relationship, the client and therapist
can form a healthy attachment and implement change strategies that elicit long-term,
characterological change.
The IPM is a therapy model that integrates humanism, cognitive behaviorism, and
object relations with the goal of reframing deep beliefs about the self, others, and the
world and thus transforming a clients character. According to Blatt, Auerback, and Levy
(1997), the goal of psychotherapy is to uncover and understand the distorted self and
object representations, and to use the therapy to recreate and shape new patterns for
viewing oneself and others. Over time and through the therapeutic relationship, patterns
of thoughts, feelings, and behaviors are uncovered at all levels of consciousness (White,
2002). When global beliefs about the self and others are identified, the therapist uses a
reframing technique to elicit change (White, 2002). The therapeutic reframe is key to the
This technique does not replace the old view-of-self with a new one; rather, it lends a
new perspective to how the original view-of-self was set in place and opens the
Freud addressed how early influences shape and foster the superegos
adulthood. However, at one point, they were parental and environmental persuasions that
served to guide, nurture, and frustrate the developing child (Hyttinen, 2002). Beck (1991)
9
agreed that early influences contribute to and foster an individuals development; Beck
focused on how these experiences and influences aide in the cognitive and schema
development of the individual (Calvete et al., 2005). Freud and Beck agreed that
personality dynamics form through repeated experiences which can shape an individuals
which can eventually lead to psychopathology (Blatt et al., 1997). Profound and
inappropriate demands can warp or even halt the development of self-agency, self-
coherence, and self-continuity) comprise an individuals core sense of self and must
develop. If these constructs fail to develop, psychopathology will result (Stern, 1985). In
the case of severe psychopathology such as psychosis, one or more of these self
and early frustrations can result in rigid and inflexible patterns of affect, behavior, and
character styles (Johnson, 1994). Johnson (1994) extrapolated from the cognitive-
character style has a set of affective, behavioral, and cognitive patterns that are germane
to that character style. Furthermore, each character style has a basic view-of-self, view-
world, it may seem harsh, dismal, and even depressing to the affected individual. These
deep views-of-self, others, and the world are formed around deficits in attunement,
engagement, and attachment (Stern, 2000; White, 1984). In the midst of these deficits,
infants and children learn to self-regulate and adapt their self-presentation to influence
others responses to them (Higgins, 1996). Therefore, the deep and typically negative
Representations of deep views-of-self, others, and the world are the aspects of an
inevitable, healthy, adaptive ways of experiencing the world (p. 96). It is when defenses
become overused or insufficient that techniques to uncover, reframe, and restructure deep
representations of deep views-of-self serve an adaptive purpose, they also frustrate the
Like the early experiences that initially shape and influence behavior, therapeutic
experiences attempt to reroute maladaptive behavioral patterns into healthier ones for
to bring into awareness the view-of-self that drives behavioral, affective, and cognitive
responses. This raising of awareness begins to reshape the individuals character and
In this study, the researcher sought to measure the effectiveness of the IPM by
using pretesting and post-testing with participants who either received the IPM treatment
(treatment group), or with those who received a series of classes in a general psychology
course (comparison group). The treatment group consisted of volunteer clients who
agreed to participate in the study. Graduate level students being trained in the IPM
applied the treatment; such an arrangement allowed for treatment adherence and the
participate in the study for extra credit in the course. Both the treatment and comparison
groups completed pretesting of object relations and reality testing, productive and
unproductive thinking, and working alliance prior to the beginning of either a course of
the IPM treatment or their general psychology course. The same testing was repeated
nine sessions or classes later. An analysis of covariance was used to track differences
between the two groups and pointed to the IPMs effectiveness or lack thereof.
The following research questions and hypotheses were developed given the
and working alliance. A more detailed outline of the studys methodology is provided in
Chapter 3.
12
1. What effect does the application of the IPM have on a treatment group
those who do not receive the IPM, but rather receive a series of classes in
general psychology?
between those participants who receive an application of the IPM and those who take a
between those participants who receive an application of the IPM and those who take a
between those participants who receive an application of the IPM and those who take a
between those participants who receive an application of the IPM and those who take a
3. What effect does the application of the IPM have on therapeutic alliance, as
between those participants who receive an application of the IPM and those who take a
between those participants who receive an application of the IPM and those who take a
Definition of Terms
technique on thinking and behavior patterns to understand and alter thinking and
view of thinking about a situation or view-of-self. This alternative view does not replace
the original thought; however, it does seek to offer an alternative explanation for the
Conscious: Patterns of thinking, behaving, and feeling that are within the
psychology to best meet the immediate needs of a client in the moment of therapy
and the world that are unconscious and out of the immediate awareness of the client
(Josephs, 1995).
and the world that are conscious and within the immediate awareness of the client
(Josephs, 1995).
and exercises empathy, unconditional positive regard towards a client, and genuineness
from the therapist as techniques that foster change in the therapeutic process.
Integrative: The weaving together of theories and techniques that span the waves
that offers new and unconscious information and gently brings to light information that
differentiates itself from analysis by its proclamation that the ethos of human motivation
Pattern analysis: The therapeutic technique that links together three or more
Schema: A cognitive template for thinking about oneself, others, and the world
(Young, 2005).
Tracking and reflecting: A therapeutic technique that uses attentive listening and
empathic attunement to accurately communicate the feeling and content of a clients story
(White, 2002).
Studying the treatment effectiveness of any modality has the potential to increase
treatment effectiveness and quality of care. Such studies broaden the availability of
effective treatment modalities. Testing the treatment effectiveness of the IPM may
16
provide opportunities for future researchers to determine what is or is not effective about
the IPM. If the IPM is found to make a positive difference in a clients object relations,
constructive thinking, and the therapeutic alliance, psychologists can claim another
technique integration, IPM can serve as an empirically validated guide for those who may
not have been specifically trained on integration. Validating the IPM may improve the
overall quality of treatment for clients, thus helping them to become and remain healthy.
In this study, the researcher assumed the existence of the unconscious, and that
exist. Although these constructs cannot be verified, behavioral science has collected
evidence through research and literature that substantiates and allows for such
assumptions (Blanton & Stapel, 2008; Calvete et al., 2005; Johnson, 1994; Leone, 2008;
Ruys, Spears, Gordijn, & de Vries, 2007; Turner, Rose, & Cooper, 2005). Because the
IPM is an insight-oriented model of therapy, it may be too stimulating for the severely
mentally ill. Modifications of the IPM could be used to establish and maintain a clients
stability; however, the IPM in its original form may not be fitting for clients who are
Another limitation of this study was the treatment integrity of the IPM therapists-
in-training. In an attempt to accommodate for this limitation, only the data gathered from
therapists-in-training who earned a passing grade (83% and above) as assessed by his/her
field training instructor were included in the study. The therapists-in-training who applied
17
the IMP to the treatment group were systematically trained in the IPMs use throughout
techniques course, the individuals acquired several skills outlined in the courses syllabus
and grading rubrics. Please see Appendices A and B through E for copies of the course
also limiting, as these students were learning how to develop a therapeutic relationship
and conduct therapy and were thus less developed in gauging the nuances of therapy.
Summary
orientation (Consoli & Jester, 2005), there is a need in the field for integrative treatments
that are scientifically sound (Boswell, Castonguay, & Pincus, 2009; Tan, 2008). Few
(Consoli & Jester); therefore, researchers must test the effectiveness of integrative
approaches in preparation for appropriately training and equipping practitioners to use the
In this study, the researcher aimed to test the effectiveness of the IPM, a model
that integrates psychoanalysis, cognitive behaviorism, and humanism with the aim of
conduct pre/post testing on clients who either received a course of the IMP or received a
series of classes in a general psychology course. In Chapter 2, the researcher reviews and
summarizes the most current research related to the IPM, as well as that which is related
18
to the theory and techniques that the IPM uses to create its model. In Chapter 3, the
researcher describes the objectives of the study and outlines the methodological approach
used to measure the IPMs effectiveness. In Chapter 4, the researcher reviews the
statistical findings of this study. Finally, Chapter 5 summarizes the study and makes
Introduction
The field of psychology has been evolving since its original birth from
Integrative psychology incorporates the best of all prior theoretical quests. The
theories and techniques. Blending existing theories and techniques bridges the barriers
between theoretical orientations, increases the opportunity for holistic healing, increases
The IPM is an integrative model that includes three theoretical orientations and
creates a cohesive model for case conceptualization and therapeutic practice. White
(2002), one the developers of the IPM, proposed that the model is a foundational base on
deserves. One possible explanation is the fact that the vast majority of the current
orientation and evolved their own integrative stance after their primary training.
(p. 359)
Because the integrative psychotherapy movement is in its infancy, most practitioners who
use the approach learn how to integrate it through trial and error after formal training. A
experimentation to develop.
In the literature review, the researcher summarizes the seminal and current
research in psychotherapy integration, reviews the theories and techniques that the IPM
integrates, and describes the IPM as an integrative training model. The IPM integrates
The literature used for this review was derived from books on character styles,
spirituality, psychoanalytic theory and technique, schemas, and schema therapy. The
articles used for this literature review were peer-reviewed and retrieved through
PsycARTICLES, and PsycINFO. The researcher used several local university libraries to
obtain literature for this chapter. The articles range in date from 1984 to 2010. The search
terms used to locate these articles included the following: client-centered technique,
The integrative movement was established nearly 24 years ago and is still
growing today (Norcross & Goldfried, 2005). The Society for the Exploration of
Psychotherapy Integration (SEPI) was founded in 1983 (Magnavita & Carlson, 2003;
Norcross & Goldfried). Over the last 15 years, the integrative movement has gained
interest in the field and has continued growing since (Magnavita & Carlson, 2003).
Jensen, Bergin, and Greaves (1990) reported that up to 75% of practitioners practice from
programs that offer specific training on integrative psychotherapy (Consoli & Jester,
2005).
Consoli and Jester (2005) are two of the leaders encouraging the transformation of
how integrative psychotherapy is taught. There are several pioneers in the field of
(1966), and London (1964) began developing concepts which Consoli and Jester (2005)
used later to teach integrative psychotherapy theory. Consoli and Jester (2005)
so as to:
22
Move the student beyond the dualistic thinking of good versus evil, right versus
wrong, to a new intellectual stance that can tolerate ambiguity and understand personal
and social truths as moderately contextual and tentativeto redress reductionism and
invite students to explore the role of authority and habits in settling issues. (p. 366)
The ultimate goal of the process is to help students adopt a both/and versus the historical
either/or stance when learning about theory. The goal is to blend the commonalities and
strengths that span theories and techniques versus pitting one against another; such a
There are several disadvantages associated with training programs that only teach
one theory and its corresponding techniques for psychotherapy. Feldman and Powel
(1992) discussed the disadvantages of training programs using only one theoretical
orientation (as cited in Norcross & Goldfried, 2005). Practitioners who are not trained on
how to integrate theory and practice generally enter the real world of therapeutic practice
and haphazardly use techniques with no true integration and rationale. Such practices do
not help the client; instead, they are created in the moment based on a practitioners
subjective ideas. Haphazard eclecticism also fails to have a method for integration and
thus cannot be studied and measured for effectiveness. As practitioners are trained and
graduate into the fields of counseling and clinical psychology, developing their
integrative style, the need for quality management becomes evident (Feist, 2006). With
few training programs that emphasize methodological integration, practitioners are left to
Roughly 90% of therapeutic outcomes are due to factors such as client resources;
a clients sense of hope, faith, and expectancy in the therapeutic process; and other extra
therapeutic factors (Beutler et al., 1987; Sperry, Carlson, & Kjos, 2003). Despite the
empirical data to support which factors influence positive therapeutic outcomes, training
programs and outcomes research tend to focus on teaching and measuring the
integration is a healthy alternative that may clarify how therapy is taught and its
client with a specific therapy (Frances, Clarkin, & Perry, 1984). Rather than fitting a
particular client with an existing theory and technique of therapy, the approach should be
transformed to fit the needs of a particular client; this is the essence of integration.
Magnavita and Carlson (2003) stated that using differential therapeutics allows the
practitioner to custom fit theories and techniques to best meet the needs of the client, and
delivers a more collaborative and streamline tactic to best serve the client.
Therapists who create their own integrative practices tend to borrow from three
and humanistic (Moursund & Erskine, 2004). Therapists borrowing conceptions from the
driven by long-standing emotional and relational patterns (Moursund & Erskine, 2004).
The focus of therapy is on bringing to awareness such patterns of emoting and relating,
demands of managed care companies and empirical science (Moursund & Erskine, 2004).
Cognitive behavioral techniques are measurable and quantifiable and can therefore be
measured for effectiveness. Cognitive behavioral techniques are gleaned from rational
emotive and cognitive therapy to shed light on maladaptive cognitive and behavioral
therapeutic encounter (Boswell et al., 2010; Miller, Duncan, Sorrell, & Brown, 2005).
There are three main approaches to integration. Magnavita and Carlson (2003)
claimed that the three approaches to integration include finding common factors across
Practitioners who integrate using the common factors method do not necessarily
to determine the common practices that span various theories and techniques and borrow
from those common threads to practice therapy (Magnavita & Carlson, 2003). For
confronts a client with an interpretation that provides meaning for unconscious wishes,
theory and therapy, the therapist may confront the client with inconsistencies in the false
and true self (Rogers, 1951). Regardless of the rationale for confrontation, the technique
25
spans various theoretical orientations and provides common factors for therapeutic
practice.
Technical eclecticism uses theory, research, and experience to guide how and
when certain therapeutic techniques are applied with a particular client (Magnavita &
Carlson, 2003). Theoretical integration aims to weave theories together to create a sound
that serve as a firmer foundation when compared to that of any one theory (Magnavita &
Carlson).
case against theoretical integration stating that it had the potential to become a haphazard
combination of theories with no true rationale or reasoning. Lazarus (2005) promoted the
notion of adhering to one particular theoretical orientation and one may then borrow,
purchase, pilfer, and import methods and techniques (not theories) from diverse sources
so as to harness their specific power (p. 150). Despite the pleas for integration and the
warning against its potential downfalls, the evolution of psychology and psychotherapy
& Carlson, 2003). According to the researchers, several biopsychosocial factors such as
these factors is necessary for treatment. Given the diversity of developmental factors and
The first step in the treatment process is the assessment of the client. Determining
the clients fitness for short versus long-term psychotherapy is essential. Assessing where
in the assessment is whether the clients defensive system serves to protect him or her
from intimacy and closeness or there is attachment disturbance (p. 278). Clients who are
assessed as being in the neurotic-borderline range are more fit for short-term restructuring
psychotherapy. Clients who reside in the borderline-psychotic range are more fit for a
Understanding a clients interpersonal relating tracks his or her patterns of doing so. The
triangle of person (Malan, 1979) conceptualizes a clients anxieties and cognitive and
behavioral responses to identified anxieties. Tracking the individuals anxieties and fears,
while noting his or her cognitive and behavioral responses to the identified fears, brings
restructuring process (Magnavita & Carlson, 2003). Magnavita and Carlson also stated
that the outcomes research for the integrative STRP model is not well documented;
27
Castonguay et al. (2004) investigated the stylistic nuances of therapeutic techniques and
the recovery rates of clients in previous cognitive therapy trails. The researcher noted that
empathic failures were met with stricter adherence to treatment manual protocols. Further
research called for an investigation of injecting tenets from humanism to tend to empathic
failures in the midst of cognitive therapy clinical trials. Castonguay et al. (2004) sought to
(WL). All participants met the criteria for Major Depressive Disorder according the
Diagnostic and Statistical Manual for Mental Disorders (2001), and scored at least a 20
on the Beck Depression Inventory (BDI). Individuals diagnosed with a comorbid mental
illness, including substance abuse/dependence, were ruled out of the study. In total, there
were 11 participants in the ICT group and 10 participants in the WL group. Pre/post
correlations of the BDI scores, Hamilton Depression Rating Scale (HDRS) scores, and
the p < .001 level on all three measures in the ICT group. Correlations for the WL group
28
showed differences in the pre/post comparisons significant at the p < .05 level. A further
analysis of the data used an analysis of covariance (ANCOVA) for each dependent
measure (BDI, HDRS, GAF), and found the ICT group to be favored as efficacious with
After the application of the first wave of treatments, some of the individuals
originally assigned to the WL control group asked to be treated using the ICT model.
Findings from the therapeutic application of ICT to the WL group were similar to those
of the original ICT group. Such findings indicated that the integration of humanistic and
empathic techniques with cognitive therapy has positive treatment outcomes when using
pre/post depression and global assessment of functioning measures. Due to the small
sample size in the first and second wave of treatment applications, findings should be
interpreted with caution. The need for further research using a larger sample size may
yield more accurate results; such findings err on the side of integration.
cognitive approach (Bamber, 2004). The researcher became curious about the difference
between individuals who responded to cognitive therapy and those who did not. Young
coined the concept of early maladaptive schemas (EMSs) and compared them to Becks
(1991) concept of schemas: Early maladaptive schemas are broad pervasive themes or
patterns regarding oneself and ones relationships that are dysfunctional to a significant
degree (Bamber, 2004, p. 425). While Becks (1991) concept of schema is seen as a
29
more malleable, cognitive framework for experiencing oneself, others, and the world
(Beck, 1991), EMSs are schemas that develop early in life and are inflexible beliefs
referencing an individuals self-worth, self agency, and social desirability (Beck, 1991;
Young, 2003).
Schema focused therapy is appropriate for individuals who have complex cases,
EMSs, and a chronicity of symptoms that have been resistant to other forms of treatment
(Bamber 2004; Young, 2005). The process of SFT begins with assessing an individuals
adaptive and maladaptive schemas, which can be done using the Young Schema
can be developed through early and repeated experiences with caregivers (Young, 2005).
Schema focused therapy invites the client to give a title to the schema modes; more
negative modes are not permitted to have a positive name (Bamber, 2004).
In the initial phases of therapy, the client is asked to use imagery and dialogues,
allowing their internalized modes interact with one another (Bamber, 2004; Young,
2005). The goal of this technique is to develop a heighted sense of how each mode
functions within the individual. Furthermore, learning to transition from one mode to
another with ease is a sign of personality integration, a goal of SFT (Bamber, 2004).
Once the clients modes are known, understood, and used in imagery techniques, the
eventually emotional regulation skills (Young, 2005). The three main goals of the therapy
30
are to simultaneously develop healthy bonding with others, develop emotional regulation,
practice (Bamber, 2004; Young, 2005). Most of the researchers studying SFT use case
studies which may be considered anecdotal. There is a need for the study of SFT in a
psychoanalysis, cognitive behaviorism, and humanism. For the past decade, several
been developing the IPM. Borrowing theoretical concepts and techniques from
within the framework of neurology (Fancher, 1973). His goal was to find the neurology
functioning (Wallerstein, 2003). His efforts were stunted by the boundaries of technology
when he attempted to track the neurology of fantasy (Fancher, 1973). Given the current
functioning though neurology was accurate (Reppen, 2006). His efforts to understand
personality and psychological functioning were not in vain; the limitations in technology
31
inspired him to develop the theory of psychoanalysis. From this, he developed theoretical
(Wallerstein, 2003).
Several concepts from psychoanalysis and theories born out of psychoanalysis are
broad term that includes the analytic offspring object relations, ego psychology, and self-
psychology (Johnson, 1994). All of these theories conceptualize the development of the
psyche within a relational context. Drive theory postulates that the root of human
behavior lies in biological drives and sexual energy, and these forces fuel human
behavior. Object relations theory individuates from drive theory and postulates that the
root of human motivation and behavior is in the need for and the seeking of relationships
(White, 1984). White proposed that humanity cannot truly be understood apart from
understanding which seeks to view people as they exist in relationship to others (p. 286).
The object relations theory lays the foundation for the case conceptualization in the IPM.
defensive functioning are concepts borrowed from analytic theory and integrated into the
IPM. Corresponding techniques to work with such concepts including interpretation are
Winnicott are often named as the founders of the object relations school of analytic
thought. In this theory, early interactions with caregivers create mental introjects that
shape ones relational interactions (Klein, 1946, 1994). Object relations theory assumes
32
certain aspects of the human condition. For example, infants are born into a complete
state of dependence on the caregiver. The quality and consistency of early relationships is
essential for the healthy development of the psyche. Caregivers who offer optimal
attunement and engagement to the infants needs foster the development of conscious
attachment (Blatt et al., 1997; Stern, 1985, 2000). Around the age of two years, the child
develops a sense of separateness from the caregiver; this process is called separation
individuation (Blatt et al., 1997). This psychological process is used to support evidence
psychopathology, thus the anxious clinging of the child to the caregiver so as to maintain
self and object constancy; without such clinging, the child would psychologically cease
Attunement, engagement, and attachment lay the foundation for the development
and formation of mental representations (Blatt et al., 1997). Within the first two months
of life, the demands of the infant are primitive and geared towards the basic needs for
food, shelter, and love. As time progresses, the needs and demands of the infant grow
more complex. This increasing complexity leaves more room for a caregiver to fail to
meet the demands of the infant. The lack of seamless attunement, engagement, and
attachment coupled with the instinctual reaction to idealize the caregiver protects the
survival instinct and becomes the relational nuance that shapes and influences the
developing view-of-self (Stern, 1985, 2000). Repeated patterns of relating in the budding
view-of-other. Furthermore, these patterns in relating become the dynamics that shape
understand the meanings of past events that have shaped the present patterns of
thought, emotion, and behavior that bring a client to the therapists office. (p. 10)
situations (Berk & Anderson, 2000); however, therapy provides the opportunity to
explore the phenomenon further. The client will naturally displace past relational drama
onto the therapist, and the client expects the therapist to react in a similar fashion to past
objects (Berk & Anderson, 2000). At any time during the therapeutic encounter, the
therapist can become experienced as an important figure from the clients past (White,
2002). In addition, the therapist can have thoughts and feelings about a client that are
The goal for the therapeutic interaction is using both transference and countertransference
Countertransference has previously been frowned upon in the research community, and
has been viewed as a hindrance to the therapeutic process; however, it is now viewed as
encounter (Clarkson & Nuttall, 2000). According to the analytic tradition, transference
unconscious; however, he did take the notion of the unconscious and created a theory to
understand human motivation (Freud, 1953). Through this theory, he articulated that the
interpretations of the unconscious, theorists believed that the unconscious was a reservoir
of past experiences waiting to be activated (Hunt, 1993). According to Hunt, Freud took a
He envisioned the mind as having three levels of functioning: the conscious, the
preconscious, and the unconscious. The last was the largest and the most
influential part; far from being a warehouse of inactive material, it was an area of
highly active and powerful primitive drives and forbidden wishes that constantly
unconscious protectors of the ego that attempt to satisfy impulses and negotiate between
what is wished for and the reality of what truly is (McWilliams, 1994; McWilliams,
memories and events, although out of awareness, influence overt behavior. Freud stated
that the path to healing is the uncovering of repressed material, bringing it into conscious
35
shift affect from one object to another. Displacement occurs in the therapeutic encounter
through making the unknown known or offering insight into the awareness of an
psychiatry. Beck was trained in the psychoanalytic tradition; however, he grew tired of
believing that the process of change needed to be a long and painful one. During the
guides an individuals thoughts and fuels his or her affective and behavioral reactions
(Beck & Weishaar, 1989). The IPM borrows the cognitive behavioral concepts of
schema, core beliefs, and automatic thoughts to understand a clients intrapersonal and
Schema. Schemas are cognitive templates that serve as a filter for incoming
information (Rector, Segal, & Gemar, 1998; Robins & Hayes, 1993). Schemas direct
patterns of thinking about oneself and others while also guiding information processing
and governing behavior (White, 2002). Schemas interpret, shape, reinforce, focus
36
attention, and activate memories (Rector et al., 1998). Interpersonal schemas are created
and shaped by past relationships (Robins & Hayes, 1993). Schemas function much like a
screen filtering all incoming information, and therefore can serve to guide future
cognitive, affective, behavioral, and relational patterns (Blatt et al., 1997; Rector et al.,
1998; Robins & Hayes, 1993). Interpersonal schemas are templates that shape, maintain,
and reinforce patterns for interpersonal relating (Robins & Hayes, 1993). For example,
individuals who themselves in the same kind of destructive relationship are acting out
of those significant adults to the infant and form the basis of the interpersonal
schemata that influence the individuals relationships later in life. (p. 211)
Schemas are formed in reaction to environmental triggers and persuasions (Blatt et al.,
1997). Over time, an individuals needs and demands from the environment grow more
complex, and thus schemas must accommodate for increasingly complex needs and
structures (Blatt et al., 1997). In general, schemas (cognitive templates for filtering
incoming information) are driven by core beliefs (global beliefs and blanket statements)
about the self, others, and the world. Judith Beck (1998) stated that: schemas act as
way that is consistent with these negative beliefs, readily incorporating data that confirm
the core belief but discounting, ignoring, or disregarding contradictory data (p. 174).
37
Core beliefs. Core beliefs are global statements about oneself, others, and the
world (Beck, 1991); they are cognitions that guide an individuals relational dynamics,
the existence of the unconscious; rather, core beliefs are found at the lowest point of
awareness (Beck, 1998). Through the process of therapy, such non-conscious information
can be known and altered during the therapeutic process. The middle layer of awareness
is the assumptive level (Beck, 1998). This level of awareness harbors the individuals
guidelines and rules for living and the assumptions about the self, others, and the world
(Millon, 1999). This is the level where compensatory strategies are discovered. These can
tactics used to create a sense of internal stability. Core beliefs trigger internal dissonance,
while compensatory strategies offer a false sense of resolve. For example, a core belief
that an individual is empty at the schema level may be compensated through repeated acts
Automatic thoughts are also referred to as self-talk, a cognitive script that is influenced
maladaptive information processing (Beck, 1991). Compensatory strategies that are either
over or underdeveloped protect and preserve dysfunctional thinking. The cognitive model
influences mood and behavior. The goal of therapy is to evaluate and modify thinking to
influence these factors. Lasting improvements aim to identify and alter underlying
several tenets within PCT including honoring the actualizing potential of an individual,
being genuine with a client, using empathic attunement to understand, and working
towards congruence between the clients ideal self and real self (Rogers, 1956). Past
researchers have postulated that psychopathology arises from the incongruence between
the perceived expectations of oneself (ideal self) and the actual view of oneself (real self).
Individuals develop defenses to protect him/herself from being fully aware of the gap
encourage the individual to talk more freely and deeply about the differences between the
real and ideal self (Rogers, 1949). The goal of therapy is to use unconditional positive
regard, acceptance, and empathy to soften ones defenses and promote self acceptance:
It appears that when the person comes to see himself as the perceiving, organizing agent,
than the reorganization of perception and consequent change in patterns of reaction take
place (Rogers, 1947, p. 361). The IPM borrows the concepts of using empathy to soften
defenses to reveal gaps between a real self and a wished-for view-of-self (White, 2002).
emotionally transport themself into the viewpoint of another individual without having
lived the same experience (Rogers, 1959). Empathy is the capacity to attune to another
39
and share an emotional experience. Curiosity in the field of psychology has led to
understand it (Miville, Carlozzi, Gushue, Schara, & Ueda, 2006). Researchers have
delineated that empathy is a complex cognitive, emotional, and social experience that
the viewpoint of others (Miville et al., 2006). Individuals who are highly developed in
their own emotional experience are more likely to remain grounded in their ability to be
Real self and ideal self. Uncovering the internal discrepancies between the
manner a client presents to others in the world and the manner in which a client wishes to
present in the world involves attuned listening and a non-judgmental stance towards
anything a client may share during the therapy relationship (Rogers, 1947). According to
Rogers (1947; 1949; 1956; 1959), the more accepting a therapist is toward a client, the
more freely a client can begin to share his or her story with less reservation. Being able to
share emotional experiences that feel threatening with a therapist who has demonstrated
(Goldfried & Davila, 2005). A corrective emotional experience allows the client to
reconnect with his or her real self while exploring the wished-for ideal self (Goldfried &
Davila, 2005). Outside of the context of a safe and secure therapeutic relationship, a
client may feel too threatened to explore the gaps between how and who one is versus
how and who one wishes to be (Rogers, 1992). Psychological health is experienced when
40
the gap between the real self and the ideal self becomes less of a gap and more congruent
and to work towards characterological change. The IPM borrows the analytic
the levels of consciousness, the conception of schema, core beliefs, and the technique of
empathy and creating a safe therapeutic relationship to fully explore a clients perception
for therapeutic interaction that aims to rework and reframe a clients view-of-self and
interpersonal relationships.
Case Conceptualization
Morris (2003) reviewed a meta model for theories of psychotherapy to define the
underlying constructs of a theory and its corresponding techniques. The researcher broke
the concept for analysis into two distinct processes: one for case conceptualization and
one for treatment application. Case conceptualization begins with an assumption about
originators and are played out resulting in psychological problems. For example,
41
attempt to cope with such dysfunction by developing and using defense mechanisms
(process for playing out dysfunction), which result in symptoms that mask and mimic
from repeated deficits in early relational experiences (White, 2002). Object relations
relationship (Blatt et al., 1997; Stern, 1985, 2000). Because perfect attunement,
attachment are interpreted by the infant and shape the view-of-self. When demands in the
al., 1997). Profound and inappropriate demands can warp or even halt the development of
agency, self-coherence, and self-continuity) comprise ones core sense of self and must
(Stern, 1985). Furthermore, severe and early frustrations can result in rigid and inflexible
patterns of affect, behavior, and cognitions, much like the inflexibility demonstrated in
known as character styles (Johnson, 1994). Johnson extrapolated from the cognitive-
Each character style has a set of affective, behavioral, and cognitive patterns that are
germane to that character style. Furthermore, each character style has a basic view-of-
According to Stern (1985), around the age of three years old the toddler and
caregiver work together to create a narrative self. This narrative self is the aspect of the
self that begins to collect a working history and cohesive story for his or her life. The
narrative self is developed when the family system begins to create a story and a shared
history together [which] provides a framework for each individual family member to
understand and integrate shared events into their own individual life stories (Bohanek,
Marin, Fivush, & Duke, 2006, p. 39). The development of the narrative self and
collaboration between family members creates the history of the childs experience. With
the assistance of the caregiver, a child is able to create a cohesive story and assign the
story emotional meaning (Stern, 2000). In the following section, the current researcher
provides ten character styles and offers an etiological background for their development.
parents who are experienced as harsh, cold, and distant, and/or overbearing, smothering,
and over-involved, the needs of the infant are buried (Hendrix, 1992; Johnson, 1994).
There is an assumption that the caregiver will not attend appropriately if the needs are
43
expressed, and therefore the child disassociates from them and carries on as if without
needs (Johnson, 1994). The view-of-self becomes I am alien; I am alone; and I have no
right to exist (Johnson, 1994). The schizoid character cannot live with this dismal view-
one who is overly intellectual or even spiritual (Johnson, 1994). Adopting this more
acceptable presentation to the world keeps the harsh views-of-self at bay and explains
this individuals inherent detachment to others. Others are viewed as powerful, rejecting,
and threatening (Johnson, 1994). The world is seen in a similar light as being dangerous
and harsh; these views (of self, others, and the world) stem from early experiences of
unattuned caregivers.
parents who usually condemn and disconfirm the childs reality (McWilliams, 1994). The
individual with a paranoid character style is always on guard to defend against being
sneaky, and malicious (McWilliams, 1994). An individual with a paranoid character style
views the world as dangerous, which causes the individual to be defensive, often feeling
suspicious of others and on-guard at all times. Underneath this harsh view of others and
the world, the paranoid character views themself as vulnerable, powerless, and impotent
(McWilliams, 1994). On a more conscious level, a character style of this sort may present
as a vindicator for the weak and an advocate for others (McWilliams, 1994).
major fear of being rejected by others. Early experiences include feeling criticized and
44
rejected by an important other, typically the caregiver (Hendrix, 1992). Others are viewed
as critical, uncaring, uninterested, and rejecting (Hendrix, 1992; Johnson, 1994). The
world is seen as risky with the potential to reject, which causes the style to manifest itself
in behaviors of blending in, withholding, withdrawing. However, the individual will still
have a conscious desire for closeness (Hendrix, 1992; Johnson, 1994; McWilliams,
others as either predators or prey. In response to this dog-eat-dog mentality, this character
style causes the individual to work ferociously to prevent being exploited by others and to
prevent being viewed as weak (McWilliams, 1994). In the effort to avoid being exploited
and being viewed as weak, the psychopathic character style will attack and exploit others
character style causes the individual to view the self as weak, a victim, and impotent
grandiose (McWilliams, 1994). There are developmental factors influencing this type of
character style that point to the probability of a biological substrate for the higher levels
of affective and predatory aggression (McWilliams, 1994, p.152). In addition, the early
experiences of an individual with this character type are laden with the chaos of harsh
life. Early experiences include loss and discouraged mourning (Johnson, 1994). An
45
individual with a depressive character style fears being abandoned and disappointed by
others (Johnson, 1994). A depressive view of others is abandoning, neglecting, and good
(Hendrix, 1992), while the self is viewed as bad, hopeless, helpless, and guilty. In every
style. The view-of-self for a symbiotic character is incomplete and unable (Young,
Klosko, & Weishaar, 2003). Due to a deep belief about the self as lacking the defensive
behavior, the individual will cling in an attempt to find completeness (Johnson, 1994).
Others are viewed as more powerful, strong, and abandoning (Johnson, 1994). The
illusion of the other as powerful draws the symbiotic character to connection, and the fear
that the other will abandon prompts the symbiotic to cling (Gabbard, 1994). The world is
experienced as cold and lonely. At the conscious level, the symbiotic character presents
as helpful while experiencing others as needy and in need of the symbiotic (Johnson,
1994). This character style is shaped by either premature separation with a caregiver or a
Johnson, 1994).
character style can be varied. There are several child-caregiver dynamics that predispose
a child to present as superior, special, admirable, and worthy of approval (Johnson, 1994;
Young et al., 2003). Narcissistically oriented parents can use the child to mirror and meet
the unmet needs of the caregiver (Johnson, 1994; McWilliams, 1994). Cold, critical, and
46
hostile parents can deprive a child of the normal need for mirroring which results in the
childs unquenchable need for mirroring from the world (Johnson, 1994). Caregivers who
praise and adore the child through over-mirroring, even when positive feedback should
be withheld, can result in an attitude of entitlement of praise from others (Johnson, 1994).
(Hendrix, 1992; Johnson, 1994; McWilliams, 1994; McWilliams, 1999). Others are
McWilliams, 1994). The individual with this character style will view the world as
For example, a child learns to suffer in order to receive care from others; the view-of-self
is defeated, weak, and dependent, while the view-of-others is critical, abusive, and
defeating and keeps the individual in bondage (Hendrix, 1992; Johnson, 1994).
as the disciplined child. This character style lacks spontaneity and displays of emotion
(Gabbard, 1994; Johnson, 1994; McWilliams, 1994; McWilliams, 1999). The individual
1994). Underneath the surface, the obsessive-compulsive character views the self as
defective, bad, and rejectable, while others are seen as demanding, condemning,
view-of-self, others, and the world by being organized, beyond blame, striving for
experiences that shape this character style include chaotic or controlling caregivers, or
rigid, moralistic, and controlling parenting styles (Johnson, 1994; McWilliams, 1994).
power differentials are present (Johnson, 1994; McWilliams, 1994). It is common that
some kind of abuse, usually sexual exploitation, occurs in these situations (Johnson,
1994). Caregivers of a histrionic character are experienced as cold and competitive, and
send messages that love is contingent on ones physical presentation (Johnson, 1994;
individual who fears being viewed as insignificant, inadequate, and guilty (Gabbard,
1994; Johnson, 1994; McWilliams, 1994). Others are viewed as powerful, seductive,
performance-based and rife with seduction, which is enticing and revolting at the same
time (Gabbard, 1994). Histrionic characters fear being ignored or being seen as boring;
48
therefore, their behavior manifests as fun and bubbly to captivate others, yet superficial to
The various views of self, views of others, and views of the world may seem
harsh, dismal, and depressing; these deep views-of-self, others, and the world are formed
around deficits in attunement, engagement, and attachment (Stern, 2000; White, 1984). In
the midst of these deficits, infants and children learn to self-regulate and adapt their self-
presentation to influence others responses to them (Higgins, 1996). Therefore, the deep
and usually negative aspects of ones view-of-self must be reframed into a more
Representations of deep views-of-self, others, and the world can also prompt
to uncover, reframe, and restructure deep views-of-self are warranted (Greenberger &
purpose, they also frustrate the individuals needs from being met.
interventions that will resolve and revise the personality characteristics of the client and
list specific treatment goals. Breaking the treatment application process into three distinct
subsections differentiates interventions from goals, and how these factors influence a
client. In psychodynamic terms, the interventions used are interpretation, free association,
transference resolution, working with resistance, and dream work. These techniques are
used to bring unconscious conflicts into consciousness, thus giving the client insight. The
49
increase the clients ability to love and work more freely (Morris, 2003).
Like the early experiences that initially shape and influence behavior, therapeutic
experiences are used to reroute maladaptive behavioral patterns into healthier patterns of
relating. Therapeutic strategies such as tracking and reflecting ones deep view-of-self
serve to bring into awareness the view-of-self that drives behavioral, affective, and
cognitive responses. This raising of awareness begins to reshape the character style and
creates new patterns for relating. Therapeutic interventions can aim to compensate for
these gaps through therapeutic attunement, engagement, and attachment. In the process of
therapy, the client can disclose these memories and engage in the process of self-
revelation with the therapist. The therapist can then attune to the clients stories using
accurate empathy and tracking (Kahn & Rachman, 2000). Through the therapeutic
relationship, the client and therapist can form a healthy attachment. According to Blatt et
interpersonal schemas, then constructive interactions between patient and therapist should
facilitate revisions of impaired or distorted representations of self and object and lead to
the development of more integrated and mature objects and self-schemas. Stern (1985)
prompted therapists to roam with the patient across the ages and through the domains of
senses of self (p. 257). Allowing the client to roam freely through the memory of
experience allows the therapist the opportunity to join the client and attune to the stories
that construct this history. In the IPM, the client begins the session and does his/her best
50
to put all thoughts into words. The challenge of the therapeutic relationship is the
transference pull from the client. The client may expect and even set up scenarios for the
therapist to enact the dance of the clients interpersonal drama (Robbins & Hayes, 1993).
The role of the therapist is to remain engaged with the client, but to not participate in
repetitions of the clients past drama. Helping the client to understand these patterns will
help to communicate an unconditional acceptance of the client (Kahn & Rachman, 2000;
Robbins & Hayes, 1993). This improves the quality of attachment in the therapeutic
without resistance (Markus & Nurius, 1986); in fact, individuals set up situations that
reinforce their view-of-self and will avoid situations that may communicate a different
message about the self (Markus & Nurius, 1986). Despite an individuals resistance to a
shift in his or her view-of-self, Marcus and Nurius (1986) purported that much research
supports that the self-concept is highly, perhaps infinitely, malleable (p. 964).
McWilliams (1994) agreed, although the researcher also stated that character cannot be
changed, only modified. Again, the IPM uses the analytic constructs of the unconscious,
The therapeutic reframe is a technique that shifts the perspective of ones view-of-
self. This technique does not replace the old view-of-self with a new view of self; rather,
it lends a new perspective as to how the original view-of-self was set in place. It also
allows for the opportunity to entertain other, more positive views-of-self. There are
helps the client to empathize with the seemingly immature cognitions, behaviors, and
51
emotions that are part of the old view-of-self (Johnson, 1994). This empathy and self-
acceptance can prompt more positive patterns for relating (Johnson, 1994). The reframe
also has other positive effects on the client, including the fact that the therapeutic
1999; White, 2002). The target of change is the clients deep core beliefs and schema
data, testing hypothesis, and summarizing (Beck, 1995 p. 9). See Figure 1 for a visual
cognitive behavioral, and humanistic theory and techniques into the IPM in her doctoral
dissertation. The IPM is untested; testing the IPM provided an opportunity for the field of
to its repertoire. Chapter 3 offers an outline of the first step in validating the IPM.
Chapters 4 and 5 report on the findings of this study and offer suggestions for future
research.
52
Therapy Skill: Tracking Content (repeat for each story) Seeking affective attunement
Express matched empathy for four bases:
1) Situation (when. . .) 3) Thought/cognition(you think . . .)
2) Behavior (you do . . .) 4) Feeling (you feel . . .)
Therapy Skill: Pattern Analysis of Automatic Thoughts Helping the client see what s/he values
1. Make summary statement of repetitive automatic thought/cogn itive distortion
(Whenever a situation occurs where he/she does . . . You end up thinking . . . And feeling . . .)
2. Give evidence from stories- make links (I say this because . . . Story 1, story 2, story 3, etc.)
Introduction
In Chapter 3, the researcher outlines this studys design and methodology. The
researcher describes the purpose of the study, research design and approach, setting and
sample, instrumentation, data analysis, and ethical considerations. This study, measuring
the treatment effectiveness of the IPM, is justified given the existing research on other
integrative psychotherapy models. In this chapter, the researcher reviews the research
design and demographics of the participants in both the treatment and control groups. An
Finally, overviews of the data analysis used to calculate the statistical effectiveness and
The purpose of this study was to measure the effectiveness of the IPM. The IPM
companies and science call upon the standard for empirically validated treatments.
Although the three theoretical foundations of the IPM are not new to the field of
psychotherapy, the manner in which the model weaves techniques from each theory is
novel and untested. In order to measure the effectiveness of the IPM, the researcher used
tools that measure what it seeks to integrate into its cohesive model for psychotherapeutic
practice. The IPM conceptualizes a case from an object relations perspective, which was
born out of the psychoanalytic tradition. This model focuses on the clients view-of-self
and view-of-others, which are concepts borrowed from the object relations and client-
54
centered approach. The IPM is used to identify and reframe schema frameworks and core
create a holding environment for the client to explore his or her defensive structure and
psychoanalytic approaches. Given the integrative nature of the IPM, it is feasible to use
tools that measure the three theoretical foundations of the model. Bells (1995) BORRTI
was used to measure an individuals object relations and to assess for potential confounds
such as poor reality testing and psychosis. The CTI was used to measure an individuals
view-of-self and others and how his or her view-of-self and others influences behaviors
(Epstein, 2001). The WAI (client form) was used to measure perception in the therapeutic
individuals object relations, thinking patterns, and perceived working alliance was
influenced by an application of the IPM. The design included a within and between
relations), CTI (measuring constructive thinking), and the WAI (measuring working
alliance).
group) pretest-posttest design is less desirable when compared to designs that include a
control, comparison, or contrast group (Campbell & Stanley, 1963). Campbell and
Stanley (1963) and Cook and Campbell (1979) presented the one-group pretest-posttest
55
testing, and instrumentation. Control, comparison, or contrast groups control for these
begin to rule out what may have contributed to treatment effectiveness. Because random
assignment from a common population is not practical and could, perhaps, have some
group design is a suitable alternative to control for internal validity threats (Campbell &
Stanley, 1963; Cook & Campbell, 1979). The fact that the nonequivalent controls are
from a benign population further ensures that the difference for the control group
between pretest and posttest is not likely due to the effect of unreported treatment, as
might be the case for controls clinically equivalent to the treatment group.
The two groups being compared were the treatment and control groups. The
treatment group consisted of volunteers who underwent nine sessions of IPM; the IPM
therapy was applied by therapists-in-training who were learning how to apply the IPM.
because the therapists were assessed and graded on their adherence to the IPM. The
therapists-in-training were required to audiotape each session that was conducted with the
client; the course instructor could have reviewed any of these sessions at any time. For
transcribe and meet specific skills according to the IPM. Sessions 2, 5, and 8 were
transcribed and evaluated by the course instructor, a therapist trained in the IPM.
56
The comparison group did not receive treatment; however, they did participate in
nine classes in a general psychology course. Pretesting of the comparison and treatment
groups began after the first therapy session, or after the first class of general psychology.
Post testing occurred after nine therapy sessions or classes of general psychology.
Matching the number of therapy sessions with the classes of general psychology reduced
the threat of internal validity and, therefore, reduced the possibility of external factors
nonequivalent group design (NEGD) compared the results from the BORRTI, CTI, and
WAI prior to the treatment or psychology course application and after. A comparison of
the difference within and between groups determined the change effectiveness of the
IPM.
between groups at the time of pretesting. It was used to calculate an accurate measure of
groups post treatment (Trochim, 2002). About 30 participants were expected in each the
adequate sample size with power of .8 to detect a posttest medium effect size (i.e.,
Cohens d = .5) at a .05 alpha level after controlling for a pretest correlated with posttest
The participants for this study were individuals who were either seeking mental
general psychology at Eastern University. Those participants who agreed to undergo nine
sessions of the IPM were in the treatment group. Those students who were enrolled in a
general psychology course and consented to participate in this study were members of the
within and between groups. See Appendix F for the treatment and comparison group
demographics survey.
Treatment Group
To best reflect a mental health setting, the participants were permitted to undergo
medication treatment under the supervision of a psychiatrist. Clients were not excluded
based on the comorbid diagnoses. It is likely that comorbidity exists in real life, as clients
rarely present with a single diagnosis. Individuals who participated were not permitted to
therapy, or group therapy. Other forms of psychotherapy were likely to confound the
results. The participants were permitted to seek case management assistance if needed.
Participants eligible for participation were any nonpsychotic adult aged 18 or older who
was seeking individual psychotherapy or who wished to volunteer for nine sessions of the
IPM therapy.
Comparison Group
University had the opportunity to earn extra credit by participating in this study. Any
student enrolled in the general psychology course who was willing was able to
participate. Those students who wished to participate were not permitted to undergo any
58
counseling or psychotherapy if they were placed in the control group. In the brief
demographics questionnaire, students were asked if they had undergone any form of
counseling or therapy during the course of the semester. Those participants who
the study. Participants in the comparison group were permitted to take psychiatric
Procedures
The therapists-in-training who applied the IPM were practicum and internship
students at Eastern University. These students were trained in this integrative approach.
conducted various mental health services including individual therapy. With permission
from each internship site and the individual clients, the therapists-in-training
patterns, and working alliance levels of their clients. Over the course of the IPM therapy,
the students were supervised by their course instructors as well as evaluated on their
ability to apply the model. Each session was audio-recorded. Throughout the course of
the sessions, the students were required to evidence their adherence to the IPM by
demonstrated the skills outlined in the model. These skills are outlined in the course
grading rubrics (see Appendices B through E for a copy of the grading rubrics). Students
who earned an 83% on each transcript qualified as adhering to the treatment application.
59
The students who earned less than 83% were not included in the study. Using this
supervisory approach ensured that the therapist was adhering to the treatment application.
Both practicum and internship students were applying the IPM with their clients
at various internship sites. These sites spanned several cultural components, including
rural and suburban, lower and middle socioeconomic status, and the clinics serving
clients of various ethnic, educational, and religious backgrounds. Due to the nature of
convenience sampling, this study could not ensure cultural equality. An appropriate
assessment of the demographic information of the participants was included to ensure the
Instrumentation
the participants in both control and comparison groups. This questionnaire assessed for
information related to age, gender, ethnicity, and level of education; current (if relevant)
designed to measure an individuals object relations and reality testing. This inventory
has 90 true/false prompts, with 45 items in each subsection assessing the clients object
relations and reality testing. There are seven scales on the inventory: four designated to
relations scales), and three scales to measure reality distortion, uncertainty of perception,
and hallucination and delusions (reality testing scales). A T-score of 60 or higher on any
60
of the subtests deems a clinically significant score and indicates impairment in ones
assessments indicate consistent correlations between individual items and the scale with
which they are associated (Bell, 1995). All correlations rated in the good to excellent
range; the lowest correlation for both the Cronbachs Alpha and the Spearman Split-half
reliability was .78, with the highest correlation at .90 (Bell, 1995). Correlations in this
range indicate that the items on the object relations scale and the reality testing scale in
The theoretical substantiation of the BORRTI was born in response to Bellak and
Abramss (1997) projective measures that aimed to gather similar interpersonal and
information on all ego functions, Bell (1995) chose to focus on object relations and
reality testing. A process of factor analysis was used for scale/subscale development and
item selection. According to Bell (1995), the broad nomological network of the
also denotes the robustness of the underlying constructs (p. 32). The BORRTI has been
published in many studies with varied subjects ranging from psychopathology, child
non-clinical personality, and development (Bell, 1995). According to Alpher (1990) the
BORRTI is a reliable and valid measure of object relations and reality testing.
61
assesses patterns of thinking. When taking the CTI, clients are asked to respond to each
question using the following a five-point Likert-type scale, 1 (definitely false), 2 (mostly
false), 3 (undecided or equally false and true), 4 (mostly true), 5 (definitely true).
Patterns of thinking constructed from ones experiences are divided into nine
scales and several subscales. Only the composite scores from the main scales were
included in the analysis of data for this study. These main scales include global
Constructive Thinking (GCT), Emotional Coping (EC), Behavioral Coping Scale (BC),
(NO), and the two remaining main scales measuring for defensiveness towards taking the
The average range T scores attained on the CTI fell between 45 and 50, with high
scores ranging from 56 to 65 and low scores range from 35 to 44 (Epstein, 2001). A very
high score is above 65 and a very low score is below 35. High scores are interpreted as a
sign of positive adaptation on the following scales and their coordinating subscales of the
GCT, EC, and BC. Lower scores are interpreted as more desirable on the PST, CT, ET,
The reliability ratings for the main scales are reported to be satisfactory (ranging
from .67 to .94); however, some of the reliability ratings for the subscales are lower
(ranging from .44 to .86) and should thus be interpreted with caution (Epstein, 2001).
Factor analysis studies have supported the factorial validity of five of the six main scales
on the CTI (Hoyer, 1983; Epstein, 1992). According to Epstein (2001), the CTI, with the
62
exception of the Personal Superstitious Thinking, has strong factorial validity as both the
item and subscale level (p. 23). In addition to factorial validity, multiple studies have
correlated the CTI with personality inventories and inventories that measure the clients
WAI (client form). The Working Alliance Inventory (WAI) (client form) is a 36-
item questionnaire that seeks to measure the task, bond, and goal in the therapeutic
relationship (Horvath & Greenberg, 1994). Clients rate these scales on a Likert-type scale
often, 6 = very often, 7 = always). The task scale refers to the in-therapy activities that
form the substance of the therapeutic process (Horvath & Greenberg, 1994, p. 111).
Higher scores on the task scale indicate therapist-client agreement that the focus of
therapy is both relevant and effective; this scale also measures the level of mutual
investment and responsibility towards the therapy process. The goal scale measures the
mutuality of the aim, outcome, and tailored interventions used to attain the desired
outcomes of the therapeutic process (Horvath & Greenberg, 1994). The bond scale
measures the interpersonal connectedness between the therapist and client (Horvath &
Greenberg, 1994). This scale measures the positive interactions of trust in the therapist
and therapy, feelings of acceptance by the therapist, and confidence in feeling understood
by the therapist (Horvath & Greenberg, 1994). Overall, the WAI measures the perceived
Given the close relationship of the content rating and Bordins description of the
alliance construct, the WAI is said to have content validity (Horvath, 1994). Correlational
comparisons between the WAI and other established alliance measures (California
Psychotherapy Alliance Scale, Helping Alliance, and the Vanderbilt scales) all yielded
ranged from .93 to .84 and determined the entire WAI instrument to have item
homogeneity (Horvath, 1994). An analysis of the three subscales on the WAI yielded
lower correlations than the overall instrument, however correlations still ranged from .92
to .68 (Horvath, 1994). Test-retest correlations yielded .80 after a three-week stay prior to
retesting. All considerations and consistent correlations related to the WAI support this
Analysis
account for the initial difference between groups, an ANCOVA was used to temper initial
differences and more accurately measure true differences (Trochim, 2002). The
composite scores for each variable were used to determine the overall significance. The
subscale scores could be used secondarily to determine which are of interest and the
contributing factors to the overall significance or lack thereof. The research questions and
Research Question #1
(BORRTI); how does this effect compare to those who do not receive the IPM, but do
by the BORRTI between those participants who receive an application of the IPM and
measured by the BORRTI between those participants who receive an application of the
IPM and those who take a series of classes in a general psychology course.
Research Question #2
psychology course?
measured by the CTI between those participants who receive an application of the IPM
measured by the CTI between those participants who receive an application of the IPM
Research Question #3
What effect does the application of the IPM have on therapeutic alliance, as
measured by the Working Alliance Inventory (WAI) (client form); does this effect
65
psychology course?
measured by the WAI between those participants who receive an application of the IPM
measured by the WAI between those participants who receive an application of the IPM
The BORRTI and CTI were computer scored, while the WAI (client form) was
hand scored. The Statistical Package for Social Sciences (SPSS) was used for the data
analysis. Composite scores from the BORRTI, CTI, and WAI (client form) were
determine differences among the treatment and control groups on the pre/post testing.
the BORRTI, CTI, and WAI determined differences between treatment groups. The
independent variable has two levels, the application of the IPM or a general psychology
class. The three dependent variables included a clients object relations, constructive
thinking, and working alliance before the application of the IPM or general psychology
class and after the application of the IPM. The BORRTI, CTI, and WAI provided an
interval measure of each clients object relations, constructive thinking, and working
alliance. The pre/post comparisons of the BORRTI, CTI and WAI scores measured the
66
IPMs effectiveness in being able to improve object relations, constructive thinking, and
working alliance.
Ethical Considerations
With any kind of therapeutic application there is always some risk involved.
There were several measures taken to ensure the safety of the participants in this study. In
addition to onsite supervisors, the therapists-in-training had at least two IPM supervisors
who monitored therapy adherence and participant safety. All therapy sessions were
audio-recorded and a supervisor could review any session to ensure participant safety.
The participants had the right to withdraw from therapy and/or the study at any time. The
findings of the study were provided to the therapists-in-training and participants upon
request. If the results reflected that the IPM was significantly less effective when
compared to other treatment outcomes established in the field, the participants had the
Participants in the comparison group had the right to withdraw from the study at
any time without penalty as well. These participants also had the right to seek therapy at
Chapter 4: Results
Introduction
The purpose of this study was to quantitatively examine whether the IPM was an
psychology classes. Three measures were used to quantify effectiveness: the BORRTI
(measures object relations), the CTI (measures constructive thinking), and WAI
account for the effect of the pretest means. In this chapter, the researcher summarizes the
Sample Demographics
The data collection portion of this study was conducted at Eastern University.
psychology undergraduate students who agreed to fill out the same three questionnaires
and comparison group participants signed the informed consents and took pretesting
packets indicating a willingness to participate in this study. After nine weeks of either
IPM or general psychology classes, post testing packets were dispensed to the previously
consenting participants in both the treatment and comparison groups. Of the 15 treatment
participants fully completed the three measures. Incomplete questionnaire sets were not
included in the final data analysis. Table 1 summarizes the demographic makeup of this
studys participant pool. The information was analyzed using SPSS. The dependent
constructive thinking; either nine sessions of the IPM therapy or nine classes in an
Table 1
Age Bracket
18-20 6 55 17 90
21-30 3 27 1 5
31-40 2 18 1 5
Ethnicity
African American 1 9 3 16
Asian 1 9 -- --
Caucasian 9 82 16 84
Education
GED 1 9 -- --
High School diploma 9 82 19 100
Associates Degree 1 9 -- --
The treatment group participants included 27% (three) male participants and 73%
(eight) female participants. The comparison group included 26% (five) male participants
and 74% (14) female participants. More than one half (55%) of the treatment group
participants were between the ages of 18 and 20; 27% and 18% respectively were
69
between the ages of 21 and 30 and 31-40. The ages of those participants in the
comparison group were 18-20 (90%), 21-30 (5%), and 31-40 (5%).
82% (treatment group) and 84% (comparison group). The treatment group consisted of
those in the comparison group identified as African American. The diversity in both
treatment and comparison groups was lacking, as the majority of participants identified as
European American. All of the participants in both groups were enrolled in classes at a 4-
year university. The educational achievement of the treatment group participants was
reported to be 82% having earned a high school diploma, 9% having earned a general
equivalency diploma, and 9% having earned an associates degree. All of the comparison
group participants reported earning a high school diploma, while both the treatment and
Results
thinking when comparing groups who either underwent nine sessions of the IPM therapy
and those who participated in nine classes of an undergraduate psychology course. The
mean score differences between the comparison and treatment groups did not achieve a
therapeutic alliance, and constructive thinking; see Tables 2 and 3). All of the variables
were examined for severe skewness and kurtosis, and all proved to be within normal
limits. Using the z value of 3.29, which is the critical z at alpha = .001, all values less
70
than + 1.5, all z-value ratios of skewness to its standard error, and kurtosis to its standard
Table 2
BORRTI and Subscale Descriptive Statistics for Total Sample, Comparison Group, and
Treatment Group
BORRTI
Mean 50.09 49.56 50.32 49.84 49.96 49.39
SD 7.61 7.51 8.40 8.44 7.35 7.15
Min. 37.75 37.50 38.50 37.50 37.75 38.50
Median 50.88 49.50 49.00 47.75 51.50 51.25
Max. 66.25 65.50 66.25 65.50 62.00 60.50
Alienation
Mean 50.47 48.13 51.91 48.64 49.63 47.84
SD 8.91 7.33 9.28 7.09 8.83 7.64
Min. 33.00 32.00 34.00 37.00 33.00 32.00
Median 52.00 46.50 54.00 48.00 49.00 45.00
Max. 69.00 61.00 69.00 61.00 69.00 61.00
Insecure attachment
Mean 50.27 48.93 50.46 50.09 50.16 48.26
SD 10.68 10.86 12.25 12.77 10.02 9.91
Min. 30.00 30.00 30.00 30.00 33.00 33.00
Median 49.50 48.50 46.00 50.00 50.00 47.00
Max. 72.00 73.00 72.00 73.00 68.00 71.00
Egocentricity
Mean 50.37 50.63 48.46 49.91 51.47 51.05
SD 9.31 9.00 9.18 9.77 9.44 8.78
Min. 33.00 36.00 35.00 37.00 33.00 36.00
Median 50.00 49.50 50.00 37.00 42.00 59.00
Max. 67.00 70.00 62.00 70.00 67.00 66.00
Social incompetence
Mean 49.27 50.53 50.46 50.73 48.58 50.42
SD 10.19 9.95 10.93 9.19 9.97 10.61
Min. 34.00 34.00 34.00 38.00 34.00 34.00
Median 50.00 52.00 54.00 51.00 50.00 52.00
Max. 76.00 78.00 65.00 65.00 76.00 78.00
71
Table 3
Descriptive Statistics for Total Sample, Comparison Group, and Treatment Group
The results of the ANCOVA supported the null hypotheses when responding to
all three of the null hypotheses. The first null hypothesis stated that there would be no
difference in object relations as measured by the BORRTI when comparing those who
underwent nine sessions of the IPM and those who took nine classes in general
psychology. The second null hypothesis purported that there would be no difference in
constructive thinking as measured by the CTI between those who received nine sessions
of the IPM and nine classes in general psychology. The third and final null hypothesis
(client form) between those participants who received an application of the IPM and
those who took a series of classes in a general psychology class. An ANCOVA was used
to test the adjusted posttest means to ensure for equal error variances. Levenes is not
72
significant, which validates the assumption of equal error variances. Controlling for
pretest, the posttest BORRTI (object relations measure) was not statistically significant,
F(1,27) = 0.009, p = .924, partial eta squared < .001. Controlling for prettest, the posttest
WAI (therapeutic alliance measure) and CTI (constructive thinking measure) were not
statistically significant, F(1.27) =1.195, p = .284, partial eta squared < .042 and F(1,27)
= 3.22, p = .084, partial eta squared < .107, respectively. Each of the statistical analyses
produced no statistical significance between those who underwent nine sessions of the
IPM therapy and those who attended nine classes in an undergraduate psychology course.
The result of the study was a failure to reject the null hypothesis.
Table 4
49.6 49.5
BORRTI 0.009 .924 <.001
[47.3, 52.0] [47.7, 51.3]
47.7 48.4
Alienation 0.148 .704 .005
[44.8, 50.6] [46.2, 50.6]
49.9 48.4
Insecure attachment 0.458 .505 .017
[46.1, 53.7] [45.5, 51.3]
51.5 50.1
Egocentricity 0.518 .478 .019
[48.4, 54.6] [47.8, 52.5]
49.9 50.9
Social incompetence 0.159 .693 .006
[45.6, 54.2] [47.6, 54.2]
49.6 46.7
Constructive Thinking Inventory 1.195 .284 .042
[45.2, 54.0] [43.3, 50.0]
158.4 149.6
Working Alliance Inventory 3.221 .084 .107
[150.5, 166.4] [143.6, 155.6]
Note. CI = confidence interval. p2 = partial eta squared, a measure of effect size with .01 a small effect, .06 a medium
effect, and .14 a large effect.
73
Summary
constructive thinking as measured by the BORRTI, WAI, and CTI, respectively between
participants who underwent nine sessions of IPM therapy and those who attended nine
be rejected.
In Chapter 4, the researcher reported that the methods used in this current study
failed to validate the IPM. Although the researcher failed to achieve statistical validation
of the IPM, there are several recommendations for future research that could offer
explores potential improvements to the current study for the betterment of future
research.
74
Introduction
This study was carried out to test the treatment effectiveness of the IPM.
Treatment effectiveness was measured by pre and post testing of therapeutic alliance,
object relations, and constructive thinking. The researcher sought to validate the use of
the IPM as an effective integrative model for psychotherapeutic treatment. The researcher
used the WAI, BORRTI, and the CTI to measure the effectiveness of the IPM. The
eligible to earn extra credit in their general psychology course. All participants consented
to participation and filled out pre and post testing forms using the WAI, BORRTI, and
CTI.
Testing the treatment effectiveness of the IPM offers the field of counseling
integration to help clients. According to Consoli and Jester (2005), 75% of practitioners
Lampropoulos and Dixon (2007) and Boswell et al. (2009), there is a lack of masters
level training programs that equip practitioners to integrate both theory and technique.
framework for practicing from an integrative approach. In this study, the researcher tested
Interpretation of Findings
The IPM weaves both theory and technique from the psychoanalytic, cognitive
behavioral, and humanistic traditions (White, 2002). Moursund and Erskine (2004)
reported that integrative therapists tend to borrow from three theoretical orientations
Carlson (2003) reviewed several approaches to integration, and two of those approaches
included finding common factors that span psychotherapeutic practice and theoretical
integration. The IPM includes both integrative approaches in its theoretical and technical
framework. The IPM tracks similarities and assimilates commonalities in theory and
technique from the psychoanalytic tradition, cognitive behaviorism, and humanism. Both
to repetitious relational dynamics with important figures in that persons life. The notion
element in the IPM. Psychoanalysis purports that every individual has a complex layering
individuals layered levels of awareness; however, it does not endorse the notion of the
unconscious (Millon, 1999). The humanistic tradition speaks of the classic battle between
the ideal and real self, a layered presentation of the wished for self, and the true and more
76
accurate self (Rogers, 1947). The psychoanalytic, cognitive behavioral, and humanistic
(cognitive behaviorism) and highlighting the ideal self at the expense of the individuals
The IPM includes theoretical integration when melding the analytic notion of
character styles and the cognitive behavioral notion of schemas. Both the analytic and
concepts of character styles (Blatt et al., 1997) and schema (Rector et al., 1998) share
The IPM gleans both theory and technique from classic psychology. The
theoretical underpinnings of the IPM are not new to the field of counseling psychology.
The implementation of the IPM in its unique melding of theory and technique offers a
different perspective for the field of psychotherapy. Lampropoulos and Dixon (2005) and
Steir et al. (2007) noted the need for more empirically validated integrative models for
psychotherapeutic practice. In this study, the researcher explored the validity and
reliability of the IPM as a potential integrative option for the field of psychotherapy. The
research questions posed in this study were used to track differences in object relations,
constructive thinking, and working alliance when comparing participants who either
attended nine classes of general psychology or underwent nine sessions of IPM therapy.
The researcher did not find statistically significant differences in working alliance,
77
constructive thinking, or object relations when comparing the treatment and comparison
groups.
There were several factors that may have contributed to the lack of significant
results in this study, including the decreased participant pool, the use of therapists-in-
training, the length of treatment application, the use of practicum versus intern students,
comparison and treatment group (power analysis computations based on Wuensch (n.d.).
A total of n=60 (30 in each group) would allow for differences in comparison and
volunteered to implement the IPM to undergraduate level students seeking therapy. The
Participation in the comparison group was slightly higher, with 19 participants. Although
higher than the treatment group, this amount of participants did not meet the desired
number. Several of the pre and posttests sets in the comparison group were deemed
invalid due to missing data. If these data had been included, it would have invalidated the
measuring treatment adherence, as these therapists were closely assessed and monitored
78
adherence was met. Although there is accountability and a strong measure for treatment
adherence, this same adherence monitoring approach used therapists learning how to
conduct therapy for the first time. Using a more seasoned therapist trained in the IPM
would have been the ideal scenario. Given time and monetary constraints, using
therapists-in-training was the next best option for the initial testing of the IPM.
outcomes within the initial 26 sessions of treatment. Howard cautioned that: this, of
course, does not mean that such patients have achieved maximum treatment benefits.
However, 26 sessions might be used as a rational time limit (p. 163). Magnavita,
and its negative effects on a positive treatment outcome. In this study, the researcher
measured changes in therapeutic alliance, cognitive thinking, and object relations after
nine sessions of treatment. Past researchers have suggested (Howard et al., 1986) that
participant involvement, the researcher used volunteers who were limited to participating
for only nine sessions. Ideally, this study would have taken the maximum time
transformation.
79
level students implementing the IPM with volunteer clients to test the treatment
effectiveness of the model. These practicum level practitioners were bound to the
requirement to meet with a volunteer student for a total of nine sessions to measure the
effectiveness of implementing the IPM for a course grade. It would have been more ideal
to use internship level therapists in training who were further along in their graduate
studies. However, only one internship level therapist volunteered to have her client
undergo pre-post testing and participate in this study. Due to neglecting to properly fill
out the post testing assessments, this participants information had to be excluded from
the participant pool. A more ideal scenario would have used a seasoned therapist who
was trained in the IPM to measure the effectiveness of the model. Due to time and money
limitations, using practicum level therapists in training was the most feasible option for
this study.
constructive thinking, and object relation for pre/post testing comparison scores. Given
the timing of the post-testing coupled with the therapeutic skills being practiced in the 7-9
sessions of the IPM, it is possible that the clients transference reaction could have
skewed the outcome results of this study (Gelso et al., 2005; 1997). The therapeutic skills
being practiced and implemented in the latter part of this study delved into the dystonic
view-of-self, others, and the world. Given the defensive level and sometimes negative
aspects of these unconscious self and object experiences, a negative transference could
80
have developed for some participants and influenced the outcome results of the study.
Ideally, a measure could have been put into place to account for such an unintended
influence. The most ideal research scenario would have lengthened the therapeutic
implementation of the IPM to work through the dystonic aspects of the model and then
conduct post-testing. This would have reduced or eliminated the potential influence of
alliance, thinking, and object relations scores measures the change that takes place within
the three theoretical prongs of the IPM. Essentially, this study was an attempt to answer
the question: does the IPM influence change within therapeutic alliance, constructive
thinking and object relations? It might have been more advantageous to measure the pre-
post symptom presentation of the clients who either underwent nine sessions of the IPM
might have been a simplified way to measure the potential effectiveness of the IPM. The
original idea for this study might have been better reserved for future research.
Recommendations
validated integrative model. The field of counseling psychology lacks graduate programs
practice. The lack of programs that teach practitioners how to develop integrative
framework, which leaves the field at a disadvantage to empirically measure the aspects of
the psychotherapeutic encounter as efficacious or not. Being able to rely on validated and
effective integrative frameworks would offer practitioners the foundation upon which to
wrote about her attempt to research helpful versus harmful psychotherapeutic practices.
The researcher interviewed psychiatric nurses who worked with clients in an inpatient
setting. Smoyak (2007) was unable to formalize her research project because of the
articulate the interventions used with inpatient clients. Such therapist-specific practices
approach to combatting haphazard and harmful therapies. The researcher called for: a
heightened emphasis on PHTs [potentially harmful therapies] which should narrow the
scientist-practitioner gap and safeguard mental health consumers against harm (p. 53).
The purpose of this study was to measure the treatment effectiveness of the IPM.
The shortcomings of the study failed to reject the null hypotheses. In other words, the
thinking, and object relations after nine sessions of IPM. Although there were no
significant findings evidencing positive changes in the three theoretical prongs of the
IPM, there was also no evidence of an inverse connection between alliance, thinking, and
82
object relations. Future researchers may conclude that undergoing nine sessions of the
IPM does not harm clients in the areas of alliance, constructive thinking, and object
relations. The results of this study did not evidence harm in the areas it sought to
measure. Although no evidence of positive change occurred in this particular study, there
Although this current study did not validate the IPM as a model for therapeutic
practice, the theoretic underpinnings of the IPM align with those of classic psychological
theory, and this warrants continued research to determine whether the IPM is a valid and
reliable integrative model for psychotherapeutic practice. Future research should consider
The researcher could have used volunteer participants who placed themselves into
the comparison or experimental groups. The purest of the scientific processes would have
Using seasoned therapists trained in the IPM could increase the validity of the
therapists-in-training assured that the therapists were implementing the IPM; however,
these therapists were also learning to implement the IPM as a requirement for their
coursework. Using seasoned therapists trained in IPM could offer participants a richer
therapeutic encounter given that a seasoned therapist is more likely to be attuned to the
yield a more accurate depiction of change. The focus of interest would shift from
measuring changes in the three theoretical prongs of the IPM to measuring pre and post
The final recommendation for future research would be to increase the number of
change can occur within the initial 26 sessions of therapy (Howard et al., 1986). Future
researchers investigating the effectiveness of the IPM should take advantage of this 26-
Implications
therapy model are vast. Potential positive contributions to psychology include adding a
valid and reliable integrative framework for therapists to use when working with clients.
Providing evidence that a psychotherapeutic model prompts positive client change can
offer hope and help for those who seek meaningful change from a therapeutic process.
The outcome results of this study did not validate the IPM in a statistically
significant manner. The positive social implications resulting from this study are limited.
The creed when working with people is always to do no harm. Although the results from
this study did not evidence a statistically significant outcome, the findings did not
indicate that the IPM resulted in a decline or harm in object relations, constructive
thinking, or working alliance. In other words, this study provided preliminary evidence
84
course, the IPM does no harm. Such findings prompt scientific curiosity and invite
further research to more thoroughly test the validity of the IPM. Further research could
offer the opportunity to fully realize the potential positive social implications of the IPM.
Conclusion
Although statistical significance was not achieved to determine whether the IPM
is a valid and reliable form of integrative psychotherapy, this study did not provide
evidence that it is a harmful form of treatment. The IPM could still be a valid and reliable
future research test the IPM as a viable methodology for prompting characterological
transformation. The results of this study do not rule out the IPM as an option for
practitioners; rather, the results of this study urge future research to continue the quest for
References
219-240. doi:10.1037/1053-0479.13.3-4.219
doi:10.1037/1053-0479.18.1.1
Bamber, M. (2004). 'The good, the bad and defenseless Jimmy --A single case study of
doi:10.1002/cpp.422
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of
Beck, J. S. (1998). Complex cognitive therapy treatment for personality disorder patients.
http://www.guilford.com
Blatt, S. J., Auerbach, J. S., & Levy, K. N. (1997). Mental representations in personality
Bohanek, J. G., Marin, K. A., Fivush, R., & Duke, M. P. (2006). Family narrative
doi:10.1111/j.1545-5300.2006.00079.x
Boswell, J. F., Nelson, D. L., Nordberg, S. S., McAleavey, A. A., & Castonguay, L. G.
doi:10.1037/a0018848
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status
Calvete, E., Estvez, A., Lpez de Arroyabe, E., & Ruiz, P. (2005). The Schema
Castonguay, L. G., Schut, A. J., Aikens, D. E., Constantino, M. J., Laurenceau, J.,
Bologh, L., & Burns, D. D. (2004). Integrative cognitive therapy for depression:
doi:10.1037/1053-0479.14.1.4
Consoli, A. J., & Jester, C. M. (2005). A model for teaching psychotherapy theory
358-373. doi:10.1037/1053-0479.15.4.358
analysis issues for field settings. Boston, MA: Houghton Mifflin Company.
Duncan, B. L. (2002). The legacy of Saul Rosenzweig: The profundity of the dodo bird.
0479.12.1.32
Montada, S. H. Filipp, & M. J. Lerner (Eds.), Life crises and experiences of loss
Assessment Resources.
Feist, G. J. (2006). The past and future of the psychology of science. Review of General
Frances, A., Clarkin, J., & Perry, S. (1984). Differential therapeutics in psychiatry: The
Freud, S. (1953). The interpretation of dreams. In J. Strachey (Ed. and Trans.), The
Freud, S. (1955). Group psychology and psychology and the analysis of the ego.
psychological works of Sigmund Freud (Vol. 18, pp. 69143). London: Hogarth
Gelso, C. J., Kelley, F. A., Fuertes, J. N., Marmarosh, C., Holmes, S. E., Costa, C., &
649. doi:10.1037/0022-0167.52.4.640
Gelso, C. J., Kivlighan, D. M., Wine, B., Jones, A., & Friedman, S. C. (1997).
Goldfried, M. R., & Davila, J. (2005). The role of relationship and technique in
421-430. doi:10.1037/0033-3204.42.4.421
Theory, research, and practice (pp.109-128). Oxford, England: John Wiley &
Sons.
89
Horavth, A. O., & Greenberg, L. S. (1994). The working alliance: Theory, research, and
Horvath, A. O., & Symonds, B. (1991). Relation between working alliance and outcome
139-149. doi:10.1037/0022-0167.38.2.139
Hoyer, J., Averbeck, M., Heidenreich, T., Stangier, U., Phlmann, K., & Rssler, G.
Howard, K. I., Kopta, S., Krause, M. S., & Orlinsky, D. E. (1986). The doseeffect
doi:10.1037/0003-066X.41.2.159
Hunt, M. (1993). Explorer of the depths: Sigmund Freud. In The story of psychology.
Hyttinen, R. (2002). The archaic superego: The guard of instincts from childhood to
doi:10.1080/01062301.2002.10592725
Jaccard, J., & Becker, M. A. (2002). Statistics for the behavioral sciences. Independence,
Jensen, J. P., Bergin, A. E., & Greaves, D. W. (1990). The meaning of eclecticism: New
Johnson, S. (1994). Character styles. New York, NY: W. W. Norton & Company.
(Ed.), Object relations theory and practice. Lanham, MD: Jason Aronson Inc.
Leone, C. (2008). Couple therapy from the perspective of self psychology and
doi:10.1037/0736-9735.25.1.79
Lenzenweger, M. F., Clarkin, J. F., Kernberg, O. F., & Foelsch, P. A. (2001). The
Lieb, K., Zanarini, M. C., Schmahl, C., Linehan, M. M., & Bohus, M. (2004). Borderline
Livesley, W., Schroeder, M. L., Jackson, D. N., & Jang, K. L. (1994). Categorical
Lothane, Z. (2006). Freud's legacy - Is it still with us? Psychoanalytic Psychology, 23(2),
285-301. doi:10.1037/0736-9735.23.2.285
Magnavita, J. J., Critchfield, K. L., & Castonguay, L. G. (2010). Treatment planning and
London: Butterworth.
McEvoy, P. M., & Nathan, P. (2007). Effectiveness of cognitive behavior therapy for
006X.75.2.344
McWilliams, N. (1994). Psychoanalytic diagnosis. New York, NY: The Guilford Press.
92
McWilliams, N. (1999). Psychoanalytic case formulation. New York, NY: The Guilford
Press.
Miller, S. D., Duncan, B. L., Sorrell, R., & Brown, G. S. (2005). The partners for change
doi:10.1002/jclp.20111
Millon, T. (1999). Personality-guided therapy. New York, NY: John Wiley & Sons.
Miville, M. L., Carlozzi, A. F., Gushue, G. V., Schara, S. L., & Ueda, M. (2006). Mental
http://www.amhca.org/news/journal.aspx
18. doi:10.1002/cpp.351
Moursund, J. P., & Erskine, R. G. (2004). Integrative psychotherapy: The art and science
doi:10.1037/1053-0479.15.4.392
Principe, J. M., Marci, C. D., Glick, D. M., & Ablon, J. (2006). The relationship among
doi:10.1037/0033-3204.43.2.238
Rector, N. A., Segal, Z. V., & Gemar, M. (1998). Schema research in depression: A
213-224. doi:10.1037/h0087064
Renik, O. (2006). Practical psychoanalysis for therapists and patients. New York, NY:
Other Press.
006X.61.2.205
115-120. doi:10.1037/h0046548
doi:10.1037/0033-3204.44.3.240
Reppen, J. (2006). The relevance of Sigmund Freud for the 21st century. Psychoanalytic
Ruys, K. I., Spears, R., Gordijn, E. H., & de Vries, N. K. (2007). Automatic contrast:
Evidence that automatic comparison with the social self affects evaluative
doi:10.1348/000712606X132949
95
2909.103.2.147
Association.
Sperry, L., Carlson, J., & Kjos, D. (2003). Becoming an effective therapist. Boston, MA:
A & B.
Steir, M., Lasota, M., & Christensen, C. (2007). Empirically validated treatments.
http://www.apa.org/pubs/databases/psycinfo/index.aspx
Stern, D. (1985/2000). The interpersonal world of the infant: A view from psychoanalysis
http://www.socialresearchmethods.net/kb/statnegd.htm4
Turner, H. M., Rose, K. S., & Cooper, M. J. (2005). Schema and parental bonding in
White, S. A. (1984). Imago Dei and object relations theory: Implications for a model of
http://core.ecu.edu/psyc/wuenschk/MV/LSANOVA/Power-ANCOV.doc
Young, J., & Brown, G. (2001). Young schema questionnaire. New York, NY:
Young, J. E. (2005). Schema-focused cognitive therapy and the case of Ms. S. Journal
Young, J., Klosko, J., & Weishaar, M. (2003). Schema therapy: A practitioner's guide.
COURSE SYLLABUS
Course Number and Title: CNSL625 Practicum in Psychotherapy Integration (Section 11)
Academic Program(s): Community/Clinical Counseling
School or department: Counseling Psychology
Semester or term: Spring 2009
Meeting time/place: Eagle Learning Center (ELC) 102, Thursdays 4:30-7:00 pm
COURSE DESCRIPTION: This advanced clinical skills course builds upon the foundations of
previous theoretical courses and the basic skills introduced in CNSL602. The focus is on forming
interventions that enrich the clinical dialogue through integration and application of techniques
from across the field of counseling practice. Skills will be demonstrated and practiced in class,
and students will conduct a course of psychotherapy with a volunteer client. The course also
requires a field placement of 100 hours in an approved clinical setting. A grade of B or better is
required.
COURSE OBJECTIVES: Upon successful completion of this course, students will demonstrate
competency in:
1. Therapy Alliance Skills: as evidenced by students ability to establish and maintain a positive
therapeutic relationship with a practicum or practice client through a course of 9 therapy sessions.
2. Tracking Skills: as evidenced by accurate, gender-, cultural- and spiritual-sensitive tracking and
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3. Empathizing Skills: as evidenced by accurate reflecting of client affect over the 9-week therapy
course.
4. Insight-Giving Skills: as evidenced by appropriate interpretations of client wishes and fears over
the 9-week therapy course.
5. Introspection Skills: as evidenced by written self- and peer-critique of therapy sessions including
accurate labeling of therapy dialogues, assessment of impact of interventions with alternatives
generated, and reflection upon ones own thoughts, feelings, and reactions elicited by the
therapeutic encounter.
6. Professional Role: this includes ethical practice with the client such as (but not limited to)
informed consent, confidentiality, and appropriate termination. Additionally productive use of
feedback will be demonstrated across the transcript assignments, and field work responsibilities
completed satisfactorily (as evidenced by at least average ratings by site supervisor).
PA STATE REGULATIONS FOR LPC MET IN THIS CLASS: 4.9-8 and 4.9-9
PREREQUISITES:
Teaching Method and Attendance: Eastern University uses the Blackboard Learning Platform
as the learning environment for this course. Using your Eastern University username and
password, you can access the site for this course at http://eastern.blackboard.com.
This course consists of at least 14 hours of instructional time for each credit awarded. Attendance at all
scheduled sessions is considered a critical element in the accomplishment of learning outcomes.
Furthermore, attendance records are maintained and are essential to comply with government regulations
for recipients of financial aid and assistance programs, as well as accreditation standards.
This is an interactive course with in-class practice and feedback from instructors and fellow students as
integral to skill attainment. We will be using multiple methods to facilitate skill acquisition, including
lecture, discussion, demonstrations, film excerpts, and student role plays. Your attendance is essential to
your success in this class. Please contact the instructor in advance if you will be late or unable to attend a
class. Students are responsible for missed material and should obtain notes/handouts from a peer if they are
absent from class. More than one unexcused absence will result in a half-grade reduction (i.e. A to A-);
more than two may result in failure of the course. This includes accumulated lateness. Please plan your
schedule accordingly.
Smarthinking Tutorial Assistance: The instructor for this course assumes that all students are prepared
for the level of instruction appropriate for the course number and placement in the academic program.
Students requiring or desiring additional academic support or preparation may utilize the Smarthinking
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system. This system of on-line tutorials, including writing assistance, can be accessed directly from the
Blackboard course site (use the Tools feature).
Student Disability Policy: Students with documented disabilities are encouraged to work with the
Cushing Center for Counseling and Academic Support (CCAS): 610-341-5837 to submit a written request
for accommodations specific to this course. To receive accommodations, the instructor must receive a
written request from CCAS. A student must update accommodations requests with CCAS prior to each
academic session.
University Policies: Please note that all university policies pertaining to academic dishonesty,
drop/add procedures, and grade appeal apply in this course. These are outlined in the CCGPS
Graduate Catalog, and students are expected to be familiar with and follow them. In addition, as
professionals in training, students in this class are expected to adhere to standards of ethical behavior
and professional demeanor as outlined in the disciplines ethical codes (e.g., ACA, CAPS). Failure to
do so can be cause for dismissal from the program.
Emergency and Crisis Information: In the case of an emergency event, we ask that all community
members use their best judgment. We also recommend that each member of this community become
familiar with emergency procedures. Call Campus Security at 610-341-1737 for emergencies on the St.
Davids campus.
Inclement Weather: Decisions to cancel class due to inclement weather will be made by 3:30 p.m. on a
weekday and 6:00 a.m. on Saturdays. Use your own judgment regarding travel conditions from your area.
If you determine that it is unsafe to travel and the class has not been cancelled, CCGPS or departmental
attendance policies will apply. If the University is closed or classes are delayed due to inclement weather,
there are two convenient ways for you to stay informed:
The CCGPS Information Bulletin Board. Please call the voice mail system at 610-225-5055; once
you hear Repartee Messaging System, dial 2834 and the recorded message will begin. (For
those making long distance calls, please feel free to dial 1-800-732-7669; at the menu, dial 2834.)
The Eastern University Website: School closing information can be seen at www.eastern.edu
by clicking on School Closing Info under the EU Quick Links drop-down menu at the top of
the page.
Radio: A radio announcement will be made on KYW news radio, 1060 AM (our school closing
number1207--is listed in Delaware County) and on WARM 103 FM (in Central Pennsylvania).
REQUIRED TEXTS:
Baird, B.N. (2008). The internship, practicum, and field placement handbook (5th ed). New Jersey:
Prentice Hall. ISBN-10: 0132238802
Martin, D.G. (2000) Counseling and therapy skills (2nd ed). Long Grove, IL: Waveland Press. ISBN-10:
1577660684
RECOMMENDED READINGS:
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McMinn, M.R., & Campbell, C.D. (2007). Integrative Psychotherapy: Toward a Comprehensive
Christian Approach. Downers Grove, IL: InterVarsity Academic Press. (ISBN# 978-0-8308-
2830-2)
1. Field Work
placement site in activities the site supervisor deems appropriate. One hour of
Supervisor Evaluation form must be completed by the site supervisor and submitted
completed, signed by the site supervisor, and submitted at the end of the semester.
instructors)
Grading Value: 5%
Description and Parameters: Students will listen to a peers tape and email feedback (using format to
be distributed in class). Grading rubric posted on Blackboard.
GRADING POLICIES:
98-100 A+
93-97 A
90-92 A-
88-89 B+
83-87 B
80-82 B-
78-79 C+
73-77 C
70-72 C-
69 and below F
3. Taping and Transcribing Parameters - Students will conduct a 9-session course of weekly
psychotherapy with a client from the field placement site or from Easterns undergraduate pool.
Permission from the client to tape the sessions is mandatory. Please tape ALL sessions throughout the
entire 45-50 minutes of the session, as this is less disruptive to the client, and having the tapes available
for review is highly beneficial to your training.
***USE 120 MINUTE TAPES to eliminate the need to turn the tape over during the counseling
sessions. Any tape that contains a stop and start will not be accepted.
Students will be evaluated based upon the entire (45-50 minute) session for all taped assignments.
However, to alleviate the burden of transcribing, students are only required to transcribe part of the session
for the assignments (see previous section for amount required for each assignment). Students transcribe at
least the minimum requirement for each of the tapes, but are welcome to transcribe more if they believe
skills are demonstrated in other parts of the session. Please submit transcripts and the audio tape in a large
envelope with your name on the outside as well as on each of the parts of the assignment, including the
tape. DO NOT INCLUDE YOUR CLIENTS NAME ON ANY MATERIALS. Be sure your tapes are
cued to the beginning of the session.
Transcripts should be typed double-spaced to allow room for your handwritten labeling of the dialogue and
for instructor feedback. Use one inch margins and 12 point font. The clients responses should be labeled
C1, C2, C3, etc. and your responses should be listed as T1, T2, T3, etc. This numbering provides a quick
way to summarize specific examples of skill demonstration. See exemplar (posted on Blackboard) of the
transcribing format.
PLEASE NOTE: Because we rely heavily on accurate tapes and transcripts of student counseling
sessions, any falsification of tapes/transcripts will result in automatic failure of the course. Falsification
includes, but is not limited to:
Turning in a tape that does not record an actual counseling session with the client youve indicated you
are working with. Recording a session that did not emerge spontaneously (i.e., coaching your client to
say things in the session to help you demonstrate required skills). Please note: this is exploitation of
the client and is expressly forbidden by the ethics codes of the counseling profession.
Altering the tape in any fashion, including shutting the tape off and restarting it during the session. If
for some reason, the tape is stopped you must use a different tape that is continuous from a different
session for assignment credit.
Failing to transcribe the taped session exactly as recorded. If something is not able to be understood,
please indicate this by the phrase: (. . . unclear). One or two instances of a brief phase that is unclear
on a transcript are acceptable. If you have more unclear sections of the transcript it will be considered
inaudible and the tape will be failed. Client silences should be indicated by the phrase: (long/short
silence). Please do not transcribe simple repeated CLIENT expressions, such as uh and like which
103
are used as filler and are hard to read unless you feel such expressions help to demonstrate client
dynamics. Such THERAPISTS expressions must be transcribed.
In order to understand the flow of the therapeutic dialogue it is necessary that the audio tape be clear and
the transcript accurate. Please check tapes for audibility before submitting them. No more than three
unclear sections in one transcript will be accepted. If the instructor cannot hear the flow of dialogue
between the student and the client(s), the first tape will be returned, ungraded. If another tape is submitted
that is not audible, the student will receive a 0 for the assignment.
4. Self Critique Parameters: Becoming an effective therapist requires not only sound client assessment
and intervention skills but also skills internal to the person of the therapist. The use of self is foundational
in the counseling relationship, and thus we are looking for students capacity for self-awareness, self-
critique and openness to feedback. These personal self-reflection skills will be evaluated in self-critiques of
your work with your client. See exemplar (posted on Blackboard) .
First, typing in bold font immediately after the word or phrase, label the clients disclosures:
Second, typing in bold font immediately after the word or phrase, label your interventions:
Third, in bold font just below your interventions (single-spaced), type self-critique comments. Comments
can include a reflection of what was occurring during the dialogue (including
transference/countertransference), discussion of the impact of your interventions, and suggested alternative
interventions. (See sample transcript for reference).
Fourth, please fill out a grading rubric on your work, noting where you believe you have accomplished the
skill set from the rubric. For example under Tracking and Reflecting Skills on the rubric you might list: T4,
T5, T8, T10, T12, etc.
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Session #2 Tape/Transcript (5 pages): Alliance Building (eliciting client disclosure by attending, probes;
neutrality), Tracking/Reflecting and Empathizing (4 bases), Pattern Analysis at the automatic thought level;
labeling/self-critique skills
Tracking/ Student shows poor Student shows Student shows clear Student shows
Reflecting apprehension of rough apprehension of clear
with client apprehension of client apprehension of
Empathy communications client communications client
Skills: reflections back to communications reflections back to communications
4 Bases client may: reflections back client are: reflections back
to client may: to client are:
- miss major - usually complete
elements of the - miss some with occasional - usually
clients disclosure elements of the missed elements complete with
(situations, clients disclosure (situations, consistent
cognitions, affect, (situations, cognitions, affect, tracking
behavior) cognitions, affect, behavior (situations,
- distort the behavior) cognitions, affect,
meanings of the - usually accurate in and behavior)
clients disclosures - be off capturing meaning.
(e.g., sometimes in - with keen grasp
misunderstands capturing Usually obtains of cultural and
cultural, spiritual or meaning. match. spiritual nuances.
other nuances of
the situations client Occasionally Some difficulty Frequently
describes, obtains match. revising reflection, obtains match.
misinterprets one however, when
feeling for another, match is not given.
mistakes feelings Has difficulty Easily revises
for thoughts, revising reflections when
misperceives reflections when match is not
clients automatic match not given. given.
thoughts and/or
mislabels clients
behaviors).
Rarely obtains
match. Has great
difficulty revising
reflections when
match not given.
- inappropriate
personal
disclosures
- handling
Christian issues in
a nontherapeutic
manner
demonstrated:
- Client - Some client - Client
disclosures not disclosures not - Client disclosures
labeled or largely labeled or disclosures labeled
inaccurately inaccurately usually labeled throughout and
labeled labeled accurately. with consistent
- Therapist - Some therapist - Therapist accuracy.
interventions not interventions not interventions - Therapist
labeled or largely labeled or usually labeled interventions
inaccurately inaccurately accurately. labeled
labeled. labeled. throughout and
with consistent
- Rubric with self- - Rubric accuracy.
assessment incomplete (no Awareness of self
missing references to where in therapy Awareness of self
skills are dialogue: in therapy
Awareness of self demonstrated; no dialogue:
in therapy scoring) - Several
dialogue: reflections given - Several
Awareness of self which show reflections given
- Little or no in therapy growing which show deep
reflection on dialogue: awareness of awareness of
personal personal personal
strengths/weaknes - Some brief strengths/weaknes strengths/weaknes
ses (including reflection given on ses (including ses (including
counter- personal counter- counter-
transference) strengths/weakness transference) transference)
observed in es (including observed in the observed in the
therapy encounter. counter- therapy encounter. therapy encounter.
transference)
observed in the Efforts to improve
therapy encounter, skills: Efforts to improve
but with very little skills:
Efforts to improve elaboration - Several good
skills: attempts at - Many alternate
Efforts to improve generating interventions
- very few or no skills: alternate generated, and
attempts at interventions, and these are on target
generating - A few attempts at these are on target
alternate generating alternate
interventions interventions, but
these lack
elaboration or
remain off target
110
Session #5 Tape/Transcript (5 pages): Previous tape skills; Self-syntonic Interpretation; Identifying and
Empathizing with Defenses; labeling/self-critique
Student shows
poor Student shows Student shows Student shows
apprehension of rough clear clear
Tracking/ client apprehension of apprehension of apprehension of
Reflecting communications client client client
with reflections communications communications communications
Empathy may: reflections reflections are reflections are
Skills - miss major may: usually complete usually complete
elements of the with occasional (i.e., tracks the
clients - miss some misses elements bases) and
disclosure elements of the (situations, accurate with
- distort the clients cognitions, keen grasp of
meanings of the disclosure affect, behavior) cultural and
clients (situations, spiritual nuances.
disclosures (e.g., cognitions, affect, - usually
misunderstands behavior) accurate in - attends well to
cultural, spiritual capturing clients reaction to
or other nuances - be off in meaning reflections.
of the situations capturing Easily revises
client describes, meaning. - usually attends when match not
misinterpret one to clients given.
feeling for - shows some reaction to
another, awareness of reflections and
misperceive clients reactions backs up when
clients to reflections, but match not given.
automatic shows difficulty
thoughts and/or backing up when
mislabel clients match is not
behaviors) given.
Syntonic
Student does not Student Student adequately Student
Pattern
adequately link beginning to link links client stories: effectively links
Analysis
client stories: client stories: client stories:
- identifies
- makes no - attempts to psychologically - easily identifies
attempts at identify relevant themes for psychologically
summarizing psychologically pattern analysis relevant themes
pattern relevant themes for pattern
- summary is
- has difficulty for pattern analysis
accurate
identifying analysis
- usually gives - summary is
psychologically
- at times is off adequate evidence accurate
relevant themes
target in of pattern - gives clear
for pattern
summary - usually attends to evidence of
analysis
- gives some clients reaction to pattern
- is off target in
evidence of pattern analysis and - attends well to
summary
pattern backs up when clients reaction to
- gives little or
- shows some match not given pattern analysis.
no evidence of
awareness of Easily revises
pattern
clients reactions when match not
- does not attend
to pattern given.
to clients
analysis, but
reaction to
shows difficulty
pattern analysis
backing up when
match is not
given.
113
NEW SKILLS:
__Student
rarely obtains
match for
interpretations
and has great
difficulty
responding
when match not
given.
Dystonic
Student shows Student shows Student shows good Student shows
Pattern
poor rough apprehension of exceptionally
Analysis
apprehension of apprehension of client defenses: clear
client defenses: client defenses: apprehension of
(Identifying &
__Consistent and client defenses
Empathizing
__Occasional and usually accurate
with Defenses)
__No attempts usually accurate identification of __ Very
or inaccurate attempts at repetitive affective consistent and
identifying of identifying states, assumptions accurate
repetitive repetitive and behavior. identification of
affective states, affective states, repetitive
assumptions or assumptions, or __Student shows affective states,
behavior (which behavior. sufficient empathy assumptions and
serve to prevent when presenting behavior.
dystonic fears). __Student lacks defenses to client
sufficient empathy (i.e., usually __Student shows
when presenting connects defenses to clear empathy
__When defenses to client self-object longings, when presenting
attempts are (i.e., fails to perceptions or defenses to client
made to identify connect defenses expectations). (i.e., consistently
defenses, to self-object connects defenses
student lacks longings, __Client usually to self-object
sufficient perceptions or appears to consider longings,
empathy (i.e., expectations). these seriously as perceptions or
fails to connect indicated by expectations).
defenses to self- __Client may frequency of match.
object longings, evidence feeling __Client often
perceptions or exposed, attacked __When match is appears to
expectations). or shamed. not obtained, student consider these
has difficulty seriously as
__If match is following clients indicated by
__Client may obtained, it is lead. frequency of
evidence occasional/partial. match.
feeling exposed,
attacked or __Student easily
shamed. responds when
match is not given
__Match is not
obtained.
115
Student shows
poor Student shows Student shows Student shows
apprehension of rough apprehension clear apprehension clear apprehension
Tracking/ client of client of client of client
Reflecting communications communications communications communications
with reflections reflections may: reflections are reflections are
Empathy may: usually complete usually complete
Skills - miss major - miss some with occasional (i.e., tracks the
elements of the elements of the misses elements bases) and
clients clients disclosure (situations, accurate with keen
disclosure (situations, cognitions, affect, grasp of cultural
- distort the cognitions, affect, behavior) and spiritual
meanings of the behavior) nuances.
clients - usually accurate
disclosures (e.g., - be off in in capturing - attends well to
misunderstands capturing meaning. meaning clients reaction to
cultural, spiritual reflections. Easily
or other nuances - shows some - usually attends to revises when match
of the situations awareness of clients reaction to not given.
client describes, clients reactions to reflections and
misinterpret one reflections, but backs up when
feeling for shows difficulty match not given.
another, backing up when
misperceive match is not given.
clients
automatic
thoughts and/or
mislabel clients
behaviors)
- does not attend
to clients
reaction to
reflections.
(0 72) (73 82) (83 92) (93 100)
Syntonic
Student does not Student beginning to Student adequately Student effectively
Pattern link client stories:
adequately link links client stories: links client stories:
Analysis
client stories: - attempts to - identifies - easily identifies
- makes no identify psychologically psychologically
attempts at psychologically relevant themes for relevant themes for
summarizing relevant themes for pattern analysis pattern analysis
pattern pattern analysis
- summary is - summary is
- has difficulty - at times is off accurate accurate
identifying target in summary
- usually gives - gives clear
psychologically - gives some
adequate evidence evidence of pattern
relevant themes evidence of pattern
- shows some
of pattern - attends well to
for pattern
awareness of - usually attends to clients reaction to
analysis
clients reactions to clients reaction to pattern analysis.
- is off target in
pattern analysis, but pattern analysis Easily revises
summary
shows difficulty and backs up when when match not
- gives little or
backing up when match not given given.
no evidence of
match is not given.
119
pattern
- does not attend
to clients
reaction to
pattern analysis
Dystonic
Student shows Student shows Student shows Student shows
Pattern
poor rough good apprehension exceptionally clear
Analysis
apprehension of apprehension of of client defenses: apprehension of
120
Alliance
__Student shows __Student shows __Student shows __Student shows
Deepenin
poor weakness in clear apprehension of clear apprehension
g Skills/
apprehension of apprehension of in- in-the-moment of in-the-moment
Advanced
in-the-moment the-moment relational dynamics relational dynamics
Defensive
relational relational dynamics (immediacy work) (immediacy work)
Work
dynamics (immediacy work): by: by:
(Immedia
(immediacy __ responding to
cy
work). __ occasional __ usually relational crises/
& Process
attempts at process responding to opportunities and/or
Comment For example,
comments in relational crises/ nonverbal clues with
s) student:
response to opportunities and/or process comments.
relational nonverbal clues with __Student shows
crises/opportunities process comments. sufficient empathy
__misses and/or nonverbal when presenting
relational clues __Student can relational issues to
crises/opportuniti
improve in showing client (i.e.,
es (such as
__student lacks sufficient empathy consistently
negative
sufficient empathy when presenting connects negative
transference when presenting relational issues to transference to
reactions from relational issues client (i.e. connecting clients overall
client, therapist
client (i.e., fails to negative transference relational pattern;
errors and/or
connect negative to clients overall takes full
nonverbal clues)
transference to relational pattern responsibility for
.
clients overall more clearly; taking own therapy errors
relational pattern or responsibility for and skillfully
fails to take therapy errors). assesses their impact
__ fails to make responsibility for __Client appears to on client).
appropriate own therapy consider these __Client often
process errors). process comments appears to consider
comments which seriously as indicated these process
would allow the __ Client may by frequency of comments seriously
alliance to evidence feeling match. However, as indicated by
deepen. exposed, attacked when match is not frequency of match.
or shamed. If obtained, student has __Student easily
match is obtained, difficulty following responds to clients
it is occasional and clients lead. lead when match is
partial. not given
Raises termination in opening, and raises it again at mid-session if client does not
address ending (10 points)
Invites client directly to discuss therapy course, tracks and reflects clients disclosures
(20 points)
Please fill out the survey to the best of your ability. Either circle the appropriate response
or fill in the blank with the appropriate response.
7. Have you ever been diagnosed with a mental illness?: Yes__ No__
10. Are you currently taking medication for mental health reasons?: Yes__ No ___
12. Are you currently undergoing any other forms of therapy?: Yes ____ No ____
(for example, couples therapy, family therapy, group therapy)
13. Do you expect that therapy will be helpful for you?: Yes ____ No ____
Thank you for taking the time to participate. I appreciate your honesty and time.
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Curriculum Vitae
Academic Experience:
08/00-05/01 Created and developed youth program for 6th through 12th grade
Sunday school students at a new church plant.