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In our studies of process research in client-centered therapy we examined:
In our conception of client-centered therapy we assume that the essential goal of therapy involves the explication of the client's internal frame of reference in regard to his relevant problems. This goal is already implicit in the scale of "intrapersonal exploration" (Truax, 1961; see also Sachse, 1984, 1986x, 1986b, 1987, 1988x, 1988b; Sachse & Maus, 1987, 1989). The essential aspects of the internal frame of reference are considered as "personal relevant meaning structures or schemata" (see Herrmann, 1972, 1982; Crocker et al., 1984; Schank & Abelson, 1977; Kuhl, 1983; Sachse, 1989) which contain evaluations or emotions. Their activation leads to feelings or felt meanings (Bower, 1981).
A clarification or explication process requires a client to face the relevant parts of his meaning structures by putting forward relevant questions. These questions first aim at describing a problem, but later aim at clarifying the client's feelings and the felt meanings determined by aspects of the problem. Eventually, these questions aim at explication of the problem-determined meaning structures (Sachse, 1986a, 1986b, 1988a, 1988b).
These questions, whether explicitly or implicitly mentioned by the client, are described as the client's processing modes. A processing scale with eight levels has been suggested; a client can go through it in the explication of his meaning structures (Sachse, 1986a, 1988a, 1988b, Sachse & Maus, 1987).
The scale differentiates eight processing stages or levels, which range from "shallow processing" to "explication of relevant structures of meaning", so-called "deep processing."
Levels are determined by the asking of specific questions, which the client tries to answer implicitly or explicitly:
|Level 1:||No discernible processing of relevant contents|
|The client asks no relevant questions.|
||How do I explain that ? Which theory can I use?|
||Using "knowledge" without reference to own feelings or personal data.|
||What actually happened? What was the concrete situation or behavior?|
||Concrete description without explicit reference to opinions, evaluations and feelings.|
|Question:||How is the content assessed?|
||By assessment labeling (for example: "A is stupid" or "behavior B is bad.") The assessment is seen as a characteristic of the content.|
|Level 5:||Personal assessment|
|Question:||How do I assess the content?|
||The client assesses the content and recognizes that it is a part of his own frame of reference.|
|Level 6:||Personal meaning|
||Which feelings or felt meanings does the content arouse in me?|
||The client senses a feeling or felt meaning about the content and says so explicitly.|
|Level 7:||Explication of relevant structures of meaning|
|Question:||What makes me feel like this in this context?|
||The client explicates (verbalizes) aspects of meaning which he recognizes in himself with regard to the content being processed.|
||Can I find any connections with other aspects of meaning?|
||The client draws connections between the explicated aspects of meaning and other aspects. He finds similarities or contradictions.|
The changes in the client's processing mode are above all of relevance here.
We have analyzed so-called "triplets." A triplet is a unit which consists of a client's
(complex) statement, a therapist's intervention and then again a client's resulting
If one considers the changes in the processing level of the client from the first to the second statement of the triplet, there are three possible cases:
- constant level: The client's processing mode does not change.
- deepening: The client's processing mode is of a higher level (is deeper) in the second statement than in the first.
- flattening: The processing mode in the client's second statement is flatter (is of a lower level) than in the first.
CHANGES IN THE PROCESSING MODE (example):
|Level 3 ==>||Level 2:
constant level (=)
The therapist can support the client's explication process by raising questions in his interventions either explicitly or implicitly. By doing so, he gives the client hints on how this process can be carried on.
If a client is willing to accept these offers, he will proceed in the direction of the activated questioning. In order to determine which proposal a therapist gives with each statement - bound to certain contents - we developed a scale for processing proposals (Sachse & Maus, 1987, 1989). This scale is parallel to the client's processing scale. The parallelism of these two scales allows an interactional analysis (see Pfeiffer, 1976) on a microlevel of psychotherapy (Baumann & Von Wedel, 1981; Baumann et al., 1984).
The absolute processing proposal is not as important as the relative proposal in regard to the support given to a client's explication process. This means: How does the therapist's proposal relate to the mode of processing the client realizes in the directly preceeding sequence.
The relation between the processing level of the client and the therapeutic offer may be:
|- constant level:||The therapist matches the client's processing mode.|
||The therapist exceeds the client's processing level (for example: stimulating personal assessment whereas the client is still on the level of reporting events).|
||The therapist's proposal keeps a lower level in comparison to the client's just realized level (e.g. stimulation to report whereas the client has already reached a level of personal assessment).|
Let us have a look now at the effects of the therapist's proposal on the client's
processing in terms of what modifications can be observed between the statements before
and after the therapist's intervention: The effects on the client's processing mode can
therefore be constant, deepening or flattening.
The therapeutic process must be examined in its psycholinguistic aspects in order to explain the effects of processing proposals on the client.
Both therapist and client take turns in speaking and listening. They alternately have to translate what they mean into language and to work out the partner's verbal communication in order to understand one another (see Hörmann, 1976, 1983; Herrmann, 1985; Engelkamp, 1984). An essential assumption in linguistic psychology is that a speaker potentially always exerts influence on his listener with what he says. In Hörman's (1976) terms, the speaker directs the awareness of a listener. The speaker changes what a listener is conscious or aware of and thus changes what he can do, experience, and think, on the basis of that awareness.
The effect of language as an agent capable of directing consciousness at least in the short-term, has often been validated (see Bransford et al., 1972; Barclay et al., 1974; Loftus & Palmer, 1974; Jörg, 1974). However this is not always the case: A listener can quite possibly "defend" himself against control, for example by just ignoring the speaker's statement (Jörg, 1984). Nonetheless, there should be a high probability of this effect, which means that the listener accepts the speaker's proposals. If we transfer this onto the therapist's relative processing proposals for the client, we are led to make the assumption that there is a strong control-effect on the client's explication process: A therapist is supposed to direct the client's consciousness at least for a short period. He directs the consciousness of the client to the questions, the proposals he had raised. That is, constant-level, deepening or flattening processing proposals should be accepted by the client at a very high rate.
We called this assumption the "directional hypothesis."
We analyzed sessions from the middle phase of therapy of 152 clients (91 female and 61 male). 56 Therapists (28 male and 28 female) contributed a maximum of three tapes. >From each tape, ten non-overlapping triplets were selected (C-statement, T-statement, C-statement), starting after the first five minutes of the session. In this way, a total of 1.520 triplets were analyzed. Table 1 shows the results.
Results concerning the directional hypothesis; based on figures of the first
Sachse and Maus study (1987)
|Relation between T's proposal and C's level||Effects on the client's explication level|
The directional hypothesis can be directly tested with the help of DEL-analyses (Hildebrand et al., 1977a, 1977b).
The DEL-coefficient of this analysis shows the "quality of prediction" of a certain hypothesis (a DEL-coefficient of 1 means an optimal prediction: All data observed correspond to the hypothesis). In this case, the DEL-coefficient can be considered as "a measure of the directional effect": The higher the DEL- coefficient, the stronger the directional effect of processing proposals on the client's mode of processing.
If we apply this analysis on our data (Sachse & Maus, 1989) we get a DEL-result of 0.212 (p < .001). The hypothesis is confirmed: The directing effect of a therapist's processing proposal on the explication level of the client is demonstrated. In addition to this a further differential reflection of these effects with a Chi-square comparison allows further statements (for details, see Sachse & Maus, 1987):
Looking at the strong directing effect of the therapist's processing proposals on the client's process, especially the risk of impeding the explication process, it seems clear that a therapist must be a "process expert" (Gerl, 1981). What a therapist actually does is not at all irrelevant; quite the contrary: It is of great significance. Therefore, a therapist must carefully consider his actions and his processing proposals to the client in order to adequately adapt to the client's prevailing processing level. The therapist must therefore not only understand the contents of what the clients say, but also understand the achieved processing level of these contents and must adapt his interventions flexibly (Sachse, 1985). For this, he needs intervention rules that indicate which proposals have a high probability of leading to what effects.
This study concerning the hypothesis of directional influence has been replicated in a second study (Sachse & Maus, 1989) on a sample of 800 triplets, stemming from 80 clients and 30 therapists (see Table 2).
1989 Results of the second study of Sachse and Maus.
|Relation between T's proposal and C's level||Effects on the client's explication level|
A DEL-analysis of these data yields a DEL of .417 (p < .001). According to these data the directing effect is even more pronounced than in our first study.
This result led us to the hypothesis that the "directing effect" will be stronger when the client's level of "intrapersonal exploration" is higher; this hypothesis has been confirmed in a study we just completed.
It is interesting, too, that flattening proposals are accepted to a greater extent
than deepening ones; deepening in 78,5% and flattening in 87.5% of the cases.
A second question was whether keeping or enhancing the quality of the explication process presents different degrees of difficulty for clients in various sections of the processing mode (Sachse & Maus, 1989). In raising this question, we can divide the whole spectrum of the explication process, the eight levels of the processing mode, into three processing sections:
- the "flat section": levels 1 and 2
- the "middle section": levels 3, 4 and 5
- the "deep section": levels 6, 7 and 8.
The question then arises: Are there different degrees of difficulty for clients in deepening, or in avoiding a flattening of the processing mode, depending on the circumstances - whether they happen to be in the "flat section" (1 and 2), in the "middle section" (3, 4 and 5) or in the "deep section" (6, 7 and 8)?
On the basis of our data (see Table 3) we were able to confirm the following hypotheses (Consider that the following data result from the splitting of the total data from Table 2 into the three levels):
1.1 Acceptance of deepening processing proposals decreases from the "flat" to the "deep" sections: Whereas in the "flat" section 88,5% of the deepening proposals are accepted and 70,8% in the middle section, in the deep section only 42,9% are accepted.
1.2 Similarly, the deepening arising from the client's own initiative, i.e. following a constant-level proposal of a therapist, decreases in correspondence to the depth of the achieved level: Whereas clients deepen their explication level on their own following constant-level proposals at a rate of 88,6% in the "flat" section, 34,2% achieve this in the "middle" section and only 4,9% do so in the "deep" section (these differences are highly significant). This indicates that the deeper the level at which clients are already working, the more difficult it is for them to deepen the explication process further.
2.1 Clients tend to accept more flattening proposals if they are working at a deeper level: they accept flattening proposals in 63,2% of cases in the "middle" section (in the "flat" section no flattening proposals were found); in the "deep" section, 93% of these proposals were accepted.
2.2 The clients' tendency to flatten the processing level on their own increases the deeper the processing section they are in: Thus clients flatten in spite of constant-level proposals at a rate of 1,0% in the "flat" section, 15,5% in the "middle" section and 37,4% in the "deep" section.
These results indicate that clients in the "deep processing" sections are very
irritable: Inadequate interventions, especially in these sections, have a strong effect.
It is also difficult for clients to remain in the "deep processing" section. It is
interesting to see that clients leave the "deep" level of their own initiative only in
37,4% of cases, whereas they accept 93% of the therapist's flattening proposals: The
tendency to leave the "deep" level of intrapersonal exploration cannot simply be
interpreted as a "bottom-effect." (It must also be considered that leaving the deep
level at times may be useful for the therapy process on the whole).
We assumed the directing effect of the therapist's proposals as more pronounced when the client's actual explication level is deeper: The more difficult the explication process is for clients, the more therapist prompting and support will deepen the process (Sachse & Maus, 1989).
In testing the directing hypothesis (see Table 3) we applied separate DEL-analyses for the three processing sections and found broad confirmation supporting the hypothesis: A DEL of -.005 (n.s.) is found in the "flat" section, whereas the "middle" section shows a DEL of. 189 (p < .001); in the "deep" section, the DEL-value equals .326 (p < .001).
The directing effect thus clearly increases: The deeper the clients happen to work, the more their explication process is influenced by the therapist's proposals. In other words, the relevance of the therapist's concrete intervention increases the deeper the client already has progressed in the explication process.
Number and percentage of deepening effects (first value)
In relation to the number of deepening and non-deepening proposals
second value), separately for the three starting levels;
same for flattening effects
|Starting Level||Deepening effects following deepening proposals||Deepening effects following other proposals||Flattening effects following flattening proposals||Flattening effects following other proposals|
Differences between the deepening effects of deepening and non-deepening proposals are significant in the "middle" and "deep" sections (for the "middle" section: Chi-square = 44.5, df = 1, p < .001; for the "deep" section: Chi-square = 17.4, df = 1, p < .001).
Looking at flattening effects (Table 3), we can see that the acceptance of flattening proposals strongly increases from the "middle" to the "deep" sections; spontaneous flattening also increases but flattening effects appear significantly more often in the "middle" and "deep" sections following flattening proposals than they do spontaneously (for the "middle" section: Chi-square = 29.1, df = 1, p < .001; in the "deep" section: Chi-square = 20.1, df = 1, p < .001).
This makes it quite clear that therapists, at this specific point, exert strongly destructive directing effects. They can easily get the client out of constructive process sections.
Our studies allow us to state the following conclusions:
These results support a concept of action-oriented client-centered therapy in which processing rules and processing aims are of great significance.
Barclay, J.R., Bransford, J.D., Franks, J.J., McCarrell, N.S., & Nitsch, K. (1974). Comprehension and semantic flexibility. Journal of Verbal Learning and Verbal Behavior, 13, 471-481.
Baumann, U., Hecht, Ch., & Mackinger, H. (1984).
Unterschiedliche Perspektiven. In U. Baumann (Ed.), Makro-Mikroperspektive (pp. 3-28). Göttingen: Hogrefe.
Baumann, U., & Wedel, B. V. (1981). Stellenwert der Indikationsfrage im Psychotherapiebereich. In U. Baumann (Ed.), Indikation zur Psychotherapie (pp. 1-36). München: Urban & Schwarzenberg.
Bower, G.H. (1981). Mood and memory. American Psychologist, 36, 129-148.
Bransford, J.D., Barclay, J.R., & Franks, J.J. (1972). Sentence memory: A constructive versus interpretative approach. Cognitive Psychology, 3, 193202.
Crocker, J., Fiske, S.T., & Taylor, S.E. (1984). Schematic bases of
In J.R. Eiser (Ed.), Attitudinal judgment. New York: Springer.
Engelkamp, J. (1984). Verstehen als Informationsverarbeitung. In J. Engelkamp
(Ed.), Psychologische Aspekte des Verstehens (pp. 31-53). Berlin: Springer.
Gerl, W. (1981). Zum Aspekt der "Lenkung" in der psychotherapeutischen
Kommunikation. GwG-Info, no. 44, 15-22.
Herrmann, Th. (1972). Einfuhrung in die Psychologie: Sprache. Frankfurt: Akademische Verlagsgesellschaft.
Herrmann, Th. (1982). Sprechen and Situation. Berlin: Springer.
Herrmann, Th. (1984). "Sprachverstehen" and das Verstehen von Sprechern. In J. Engelkamp (Ed.), Psychologische Aspekte des Verstehens (pp. 15-30). Berlin: Springer.
Herrmann, Th. (1985). Allgemeine Sprachpsychologie. Grundlagen and Probleme. München: Urban & Schwarzenberg.
Hildebrand, D.K., Laing, J.D., & Rosenthal, H. (I977a). Analysis of ordinal data. Beverly Hills: Sage.
Hildebrand, D.K., Laing, J.D., & Rosenthal, H. (1977b). Prediction analysis of cross classifications. New York: Wiley.
Hörrmann, H. (1976). Meinen and Verstehen,. Grundzüge einer sprachpsychologischen Semantik. Frankfurt: Suhrkamp.
Hörrmann, H. (1983). Was tun die Wörter miteinander im Satz? oder: wieviele sind einige, mehrere and ein paar? Göttingen: Hogrefe.
Jörg S. (1984). Möglichkeiten and Grenzen der Bewusstseinslenkung beim Hörer. In J. Engelkamp (Ed.), Psychologische Aspekte des Verstehens (pp. 91-109). Berlin: Springer.
Kuhl, J. (1983). Motivation, Konflikt and Handlungskontrolle. Berlin: Springer.
Loftus, E.F., & Palmer, J.C. (1974). Reconstruction of automobile destruction: An example of the interaction between language and memory. Journal or Verbal Learning and Verbal behavior, 13, 585-589.
Pfeiffer, W.M. (1976). Zur Erfassung des therapeutischen Prozesses mit Hilfe komplexer Skalen. In Gesellschaft fur wissenschaftliche Gesprächspsychotherapie (Ed.), Die klientenzentrierte Gesprächspsychotherapie (pp. 155-161). Frankfurt: Fischer.
Sachse, R. (1984). Vertiefende Interventionen in der klientenzentrierten Psychotherapie. Partnerberatung, 2, 106-113.
Sachse, R. (1986a). Gesprächspsychotherapie. Hagen: Fernuniversität Hagen. Kurseinheit zum Kurs "Formen der Psychotherapie" im Projekt "Wege zum Menschen. "
Sachse, R. (I986b). Selbstentfaltung in der Gesprächspsychotherapie mit vertiefenden Interventionen. Zeitschrift fur Person enzentrierte Psychologie and Psychotherapie, S, 183193.
Sachse, R. (1987). Wat betekent "zelfexploratie" en hoe kan een therapeut het zelfexploratie-proces van de client bevorderen? Psychotherapeutisch Paspoort, 4, 71-93.
Sachse, R. (1988a). Das Konzept des empathischen Verstehens: Versuch einer sprachpsychologischen Klärung and Konsequenzen fur das therapeutische Handeln (23). In Gesellschaft fur wissenschaftliche Gesprächspsychotherapie (Ed.), Orientierung an der Person: Diesseits and Jenseits von Psychotherapie (Vol. 2, pp. 162-174). Körn: GwG.
Sachse, R. (1988b). From attitude to action: On the necessity of an actionoriented approach in client-centered therapy. Bochum: Ruhr Universität. Berichte aus der Arbeitseinheit Klinische Psychologie, Fakultät fur Psychologie, no 64.
Sachse, R. (1989). Zur allgemeinpsychologischen Fundierung von Klientenzentrierter Therapie: Die Theorie zur "Konzeptgesteuerten Informationsverarbeitung" and ihre Bedeutung für den Verstehensprozess. In R. Sachse & J. Howe (Eds.), Zukunft der Klientenzentrierten Psychotherapie (pp. 76-101). Heidelberg: Asanger.
Sachse, R., & Maus, C. (1987). Einfluss differentieller Bearbeitungsangebote auf den Explizierungsprozess von Klienten in der Klientenzentrierten Psychotherapie, Zeitschrift fur Personenzentrierte Psychologie and Psychotherapie, 6, 75-86.
Sachse, R., & Maus, C. (1989). Zielorientiertes Handeln in der Gesprächspsychotherapie. Versuch einer Neukonzeption klientenzentrierter Psychotherapie (in press).
Schank, P.C., & Abelson, R.P. (1977). Scripts, plans, goals and understanding. Hillsdale: Erlbaum.
Truax, C.B. (1961). A tentative scale for the measurement of depth of intrapersonal exploration. Wisconsin University: Psychiatric Institute Discussion Papers.