VALUES, THERAPEUTIC ALLIANCE, AND MARITAL THERAPY
A STUDY OF THE THERAPIST-CLIENT RELATIONSHIP
IN MARITAL THERAPY
by
E. MADOC THOMAS, A.B., M.Div.
A DISSERTATION
IN
MARRIAGE AND FAMILY THERAPY
Submitted to the Graduate Faculty of Texas Tech University in
Partial Fulfillment of the Requirements for
the Degree of
DOCTOR OF PHILOSOPHY
Approved
Accepted
May, 1994
AC do I
110. ^ ̂
At /T
Copyright 1994, E. Madoc Thomas
ACKNOWLEDGEMENTS
I am grateful to many persons who are part of this study. Dr.
Ed Glenn, the chairperson of my committee, has contributed personal
and professional support as well as specific directive; Dr. Richard
Wampler has taught both by personal therapeutic effect and by formal
instruction; Dr. Judy Fischer has provided varied and long-term
support in learning the research process; Dr. Ed Anderson has opened
new ways of thinking statistically; and Dr. Debi Overton has
encouraged through professional and personal support. Special thanks
are due to Dr. Nancy Ratliff who first introduced the potential
importance of values in clinical research and to the members of ray
class who have been a consistent and essential aspect of my learning,
motivation, and confidence. And many others faculty, students,
parents and siblings, church, and clients have supported,
encouraged, and taught me.
This study is dedicated to ray primary teachers in the value of
human life, ray family: John has taught humor and flexibility; Paul
has taught imagination and untestable intelligence and kindness;
Chris has stood with me in wonder on the trails and mountains, and in
the valleys, of the journey; and Calder, my wife, has walked with me
and entreated me to discover an unabandoned experience of ray own
value, of our value, of the value of Life araong us.
11
TABLE OF CONTENTS
ACKNOWLEDGEMENTS i i
ABSTRACT vi
LIST OF TABLES vii
LIST OF FIGURES xi
CHAPTER
I. INTRODUCTION 1
No Value-Free Therapy 1
The Problems 4
II. LITERATURE, QUESTIONS, AND HYPOTHESES 9
Values 9
Definition 9
Distinctions 10
Therapeutic Alliance 11
Definition 11
Dimensions for Marriage
and Family Therapy 12
Values in Therapeutic Alliance 16
The Questions 16
Values Similarity and Outcome 18
Remaining Questions for Marriage
and Family Therapy 21
Therapist Values and Therapeutic Alliance ... 23
Hypotheses 25
111
A Taxonomy of Values in
Therapeutic Alliance 28
Unit of Analysis Question 28
The Taxonomy of Beutler et al. (1986) .. 29
A Taxonomy for this Study 31
III. METHODS 36
Recruitment Procedures 36
Sample . 40
Measures 41
Demographic Information 41
Value Survey 42
Therapeutic Alliance 43
Scoring 45
Analysis Plan 46
IV. RESULTS 59
Preliminary Analysis 59
Control Variable Analysis 59
Modified Analysis Plan 63
Primary Analysis 66
Hypothesis 1: Similarity of therapist and client terminal values will be negatively related to therapeutic alliance 66
Hypothesis 2: Sirailarity of therapist and client instrumental values will be positively related to therapeutic alliance 72
Hypothesis 3: There are therapist values which predict therapeutic alliance 76
iv
V. DISCUSSION AND CONCLUSION 114
Theoretical and Hypothetical Context 114
Limitations of the Study 118
Review and Interpretation of Results 121
Value Similarity and Therapeutic Alliance; Hypotheses 1 and 2 122
Therapist Values in Therapeutic
Alliance; Hypothesis 3 130
Conclusion 134
REFERENCES 142
APPENDIX
A. DEMOGRAPHIC INFORMATION 150
B. ROKEACH VALUE SURVEY 155
C. COUPLE THERAPEUTIC ALLIANCE SCALE 159
D. INVITATION TO PARTICIPATE 166
ABSTRACT
This study has examined some of the interpersonal variables
which affect therapeutic process through therapist use of self and
choice among treatment alternatives. The research and theoretical
work of Rokeach (1973) and of Beutler (1971, 1979, 1981, 1983) led to
the identification of therapist values and therapist/client value
similarity as two of the interpersonal variables which affect
therapy. The therapeutic alliance (Catherall & Pinsof, 1986) was
identified as a viable process variable through which to examine the
effect of values on therapy.
The study hypothesized a negative relation of therapist/client
terminal value similarity to the therapeutic alliance, a positive
relation of instrumental values to the alliance, following research
based expectations (Arizmendi, 1983). The study further hypothesized
that a set of therapist values exists which would predict therapeutic
alliance. The results showed a positive correlation between
therapist/client value similarity and therapeutic alliance, upholding
theoretical expectations but questioning some research findings.
Positive therapeutic alliance was predicted by therapist values which
reflect the value placed on the client system and the therapist's
value of her or his own well-being.
VI
LIST OF TABLES
3.1 Therapist Frequencies 50
3.2 Client Frequencies 52
3.3 Scale Reliabilities 54
3.4 Variable Descriptives: Terminal Value Similarity . 55
3.5 Variable Descriptives: Instrumental Value Similarity 56
3.6 Variable Descriptives: Therapeutic Alliance 57
4.1 Gender as Control Variable: ANOVA of Individual Alliance, Bond, Goal, Task, Terminal Similarity, Instrumental Similarity by Client Gender 79
4.2 Therapist Gender as Control Variable: ANOVA of Couple Alliance, Bond, Goal, Task, Terminal Similarity, Instrumental Similarity by Therapist Gender 80
4.3 Therapist Gender as Control Variable: ANOVA of Group Alliance, Bond, Goal, Task, Terminal Similarity, Instrumental Similarity by Therapist Gender 81
4.4 Length of Therapist Marriage as Control Variable: Correlation of Therapist Years Married with Individual and Group Alliance, Bond, Goal, and Task Scores 82
4.5 Client Importance of Religion as Control: ANOVA of Client Scores on Alliance, Bond, Goal, Task, Terminal Similarity, Instrumental Similarity by Religious Importance Grouping 83
4.6 Therapist Importance of Religion as Control: ANOVA of Couple Scores on Alliance, Bond, Goal, Task, Terminal Similarity, Instrumental Similarity by Therapist Religious Importance Grouping 84
vii
4.7 Length of Time in Therapy as Control: ANOVA of Individual and Couple Terminal and Instrumental Similarity by Groups with More than Twenty and Less than Twenty Sessions 85
4.8 Length of Time in Therapy as Control: Correlation of Length of Time in Therapy with Individual and Couple Terminal and Instrumental Similarity 86
4.9 Hypothesis 1: Summary Table of the Relation of Individual/Therapist Terminal Value Similarity and the Therapeutic Alliance 87
4.10 Hypothesis 2: Summary Table of the Relation of Individual/Therapist Instrumental Value Similarity and the Therapeutic Alliance 88
4.11 Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alliance with No Control Variables 89
4.12 Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alliance Controlling for Gender through Partial Correlation 90
4.13 Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alliance Controlling for Client Gender through Sample Selection 91
4.14 Hypotheses 1 and 2: Critical Values for Test of Significance of Difference of Correlations for Male and Female Clients 92
4.15 Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alliance Controlling for Therapist Gender through Sample Selection 93
Vlll
4.16 Hypotheses 1 and 2: Critical Values for Test of Significance of Difference of Correlations for Male and Female Therapists 95
4.17 Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alliance Controlling for Therapist and Client Gender through Sample Selection 96
4.18 Hypotheses 1 and 2: Critical Values for Test of Significance of Difference of Correlations for Male and Female Therapists with Male and Female Alliance 98
4.19 Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alli:iiice Controlling for Length oi Therpaist's Marriage by Partial Correlation 99
4.20 Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alliance Controlling for Importance of Religion by Partial Correlation 100
4.21 Hypotheses 1 and 2: Correlational Tests of Relation of Value Sirailarity and Therapeutic Alliance Controlling for Client Importance of Religion through Sample Selection 101
4.22 Hypotheses 1 and 2: Critical Values for Test of Significance of Difference of Correlational Values for Client Importance of Religion 102
4.23 Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alliance Controlling for Therapist Importance of Religion through Sample Selection 103
4.24 Hypotheses 1 and 2: Critical Values for Test of Significance of Difference of Correlational Values for Therapist Importance of Religion 105
IX
4.25 Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alliance Controlling for Length of Time in Therapy 106
4.26 Hypothesis 3: Correlational Tests of Relation of Therapist's Values and Individual Therapeutic Alliance 107
4.27 Hypothesis 3: Intercorrelation of Therapist Values Significantly Correlated with Therapeutic Alliance 108
4.28 Hypothesis 3: Mean Therapist Ranking of Values Significantly Correlated with Therapeutic Alliance 109
4.29 Hypothesis 3: Correlational Tests of Relation of Therapist's Values and Couple and Group Therapeutic Alliance 110
4.30 Hypothesis 3: Standard Multiple Regression Analysis of the Prediction of Therapeutic Alliance from Demographics and Therapist Values Significantly Correlated with Individual Therapeutic Alliance Ill
4.31 Hypothesis 3: Standard Multiple Regression Analysis of the Prediction of Therapeutic Alliance from Demographics and Therapist Values Correlated with Couple Therapeutic Alliance 112
4.32 Hypothesis 3: Standard Multiple Regression Analysis of the Prediction of Therapeutic Alliance from Demographics and Therapist Values Correlated with Group Therapeutic Alliance 113
LIST OF FIGURES
2.1 Therapist Characteristics 34
2.2 A Taxonomy of Values in the Therapeutic Alliance 35
XI
CHAPTER I
INTRODUCTION
Family therapy emerged in part from the
revolutionary affirmation that one can not avoid
communication (Watzlawick, Weakland, & Jackson, 1967).
The foundational assumption of this paper is based on
existing psychotherapy literature and applies this
concept of communication to the realm of values,
affirming that one can not avoid communicating values in
psychotherapy. There is no value-free therapy. The
question in this inquiry concerns the ways in which
values affect the relationship between therapist and
client system.
No Value-Free Therapy
There is a dual theoretical base of the
understanding that there is no value free therapy: (a)
one cannot avoid the involvement of the self in therapy
(Keeney, 1983) and (b) to function as a self includes
necessary choice among alternatives (Lankton k Lankton,
1983). The use of self in therapy, although it may be
more or less deliberate, is a necessary aspect of being
with other people (Beutler, Crago, & Arizmendi, 1986).
Choice among alternatives would include listening or
speaking, directing or reflecting, focusing on behavior
or affect or cognition, and deciding on therapeutic
goals. Both the involvement of the self and choice among
alternatives indicate the operation of values, beliefs in
good expressed in attachments and rules. The dominant
values in a given school of therapy may emerge from the
client (Watzlawick, Weakland, & Fisch, 1974), from a
training context (Liddle, Breunlin, & Schwartz, 1988),
from a system of pathology (Becvar & Becvar, 1988), from
religion (Bergin, 1980), from sexism or from feminist
correctives (Walters, Carter, Papp, & Silverstein, 1988),
or from many other sources. But where there is
involvement of the self and choice among alternatives,
there is by definition no value-free therapy.
The understanding that therapist personal
characteristics, values, and attitudes do affect therapy
is supported by a number of studies (Doherty & Boss,
1991; Horvath & Luborsky, 1993). Alexander, Barton,
Schiavo, & Parsons (1976) found that therapist personal
characteristics accounted for 60% of the outcome variance
in their study of behavioral interventions in families
with delinquints. Jacobson (1988) has suggested that the
outcome variance accounted for by therapist and/or client
characteristics may be so great that their suppression
(in order to get clear treatment effects) may be quite
difficult.
Two studies (Catherall & Pinsof, 1987; Winter &
Aponte, 1987) draw on theoretical and research literature
as well as case material to indicate that there is a
relation between therapists' personal life and
therapeutic process. The study by Catherall and Pinsof
(1987) examined family roles, emotional atmosphere,
extent of triangulation, degree of differentiation,
unresolved interpersonal conflicts, and coping styles.
Theoretical considerations as well as a review of
relevant literature suggested a significant impact of
these aspects of personal life on the therapeutic
process.
A more empirically based study (Piercy & Wetchler,
1986; Wetchler & Piercy, 1987) of professionally derived
stressors and enhancers of family therapists' family life
may suggest that a lack of valued fulfillment in personal
life would have a negative effect on therapeutic process.
For example, absence of personal intimacy fulfillment
could contribute to therapists' dysfunctionally
addressing intimacy needs through work.
There are significant personal variables in the
therapeutic process (Beutler et al., 1986) which can be
and have been productively addressed. Examples which
have been carefully studied would include gender and
ethnicity (Gurman, Kniskern, & Pinsof, 1986). The realm
of internal, extra-therapy characteristics such as
personality patterns, attitudes, and values is largely
missing from family therapy literature (Beutler et al.,
1986; Nichols, 1984), although these studies are emerging
as a major trend in individual psychotherapy literature
(Bergin, 1985). As Walrond-Skinner (1987) stated, "There
are no value-free therapists and no value-free
interventions" (Walrond-Skinner, 1987, p. 6; cf.
Alexander, Barton, Waldron, & Mas, 1983; Aponte, 1985;
London, 1964). A survey (Norcross & Wogan, 1983, 1987)
of American psychotherapists (N=319) of diverse
persuasions found 89% agreeing that "values of the
therapist have a direct influence on therapy" while 94%
agreed that "values are inextricably involved in therapy"
(Norcross & Wogan, 1987, p.6).
The Problems
These studies support the understanding that values
affect therapy, but there is debate as to whose values
affect therapy. Among marriage and family therapists the
active presence of values in therapy may seem commonplace
to some and a point of serious debate to others. The
Women's Project (Walters et al., 1988) encountered
considerable resistance, for example, in unearthing the
sexist values implicit in much of marriage and family
therapy. The members of the Women's Project found that
professionals, including those who engage in values
clarification, become accustomed to doing things
according to the rules and attachments which express a
set of values. These values become more covert the
longer they are in place. Thus sexist values, or the
values surrounding family as a place of child nurture, or
the freedom of the adult individual, are difficult to
tease out of their cultural embeddedness. Values
clarifying persons may meet with suspicious, defensive,
even denying criticism from others; these difficulties
are as recent as feminism or as old as ancient prophets
or philosophers.
However, there is also a quite legitimate
theoretical question concerning which values should
impact therapeutic process and outcome. Marriage and
family therapists have sometimes made non-invasive (M.
Bobele, 1988) therapy a hallmark of systemic therapy and
have spelled out the ethical dangers of covert imposition
of values on clients (Aponte, 1985; Haley, 1976).
Perhaps due in part to an ethical "value phobia" (Ryder,
1985), non-invasive therapists might appear to shun
values issues. The concern of non-invasive therapy
would not, however, be to eliminate values from therapy;
the logical and theoretical inconsistency of such a
position is inherent in the definition of values. The
concern is, rather, with the unethically covert
imposition of an academically, religiously, medically, or
otherwise predefined value set which may violate the
clients' values.
An example of this concern can be seen in the
treatment of alcoholism recommended by the Brief Therapy
Center of the Mental Research Institute (Fisch, 1985).
The important point from a values standpoint is that
...the model is non-normative and importance is not attached to standards of "mental health," "functional family homeostasis" and the like. Instead it is a complaint-based model...and the standard for terminating "treatment" that the complainant no longer has the complaint. (Fisch, 1985, pp.41,42)
In the case example in this study, a woman who presented
a history of excessive drinking came with a desire to
drink normally, although the values imposed by many
treatment approaches had told her that this was not
possible. At the Brief Therapy Center, her values were
built into the case plan, and although she was
discouraged from being too hopeful she did in fact learn
to drink normally. The goal of this model is, then, the
neutralization of therapist or other values not based on
the complaint in order that the complainant's values
might at least be primary.
Certainly the concern for respecting the client is a
hallmark of marriage and family therapy (Becvar & Becvar,
1988; Nichols, 1984; Lankton & Lankton, 1983). But it
would be a distortion of respect for clients to assume
the clinical wisdom of disregarding therapist values as
if they are not important when they are not imposed. A
systemic understanding of values in therapy would seek to
clarify and utilize both therapist and client values; it
would turn to a positive utilization of values rather
than a reluctant confession that they are not easily
shaken off. This can take place through an examination
of the process question: how do therapist and client
values affect their allied interaction in therapy?
The process question concerns just how values
permeate therapeutic process, and is framed in light of
related debates concerning the relative impact of
therapist and client values. The therapeutic alliance
provides a viable variable (Pinsof, 1988) for the study
of how therapist and client values affect therapy. The
alliance is one aspect of therapy which has emerged as
consistently significant and necessary for any and all
other aspects of the therapeutic process to be effective
(Horvath & Luborsky, 1993), and so will be examined as a
likely dependent variable for the study of values impact.
The review of literature pertinent to the question of
values interaction in therapeutic process will outline
(a) the social scientific study of values, (b) the
identification of the therapeutic alliance as a viable
process variable for the study of marriage and family
therapy, and (c) research findings relevant to the role
of values in the therapeutic alliance.
8
CHAPTER II
LITERATURE, QUESTIONS, AND HYPOTHESES
Values
Definition
The working definition of values in this paper
derives from existing definitions (Kessel & McBrearty,
1967; Seymoure, 1982) and is specifically linked to
Rokeach's (1973) definition and measure of values:
A value is an enduring belief that a specific mode of conduct or end-state of existence is personally or socially preferable to an opposite or converse mode of conduct or end-state of existence. (Rokeach, 1973, p. 5)
Values are defined for this study as beliefs in ultimate
or instrumental good which are expressed in affective and
behavioral attachments and rules by a valuing system.
A family's gathering for ritual activity such as a
Thanksgiving meal illustrates the definition. The family
in this case is the valuing system, which believes in the
good of gathering for this meal. Instrumental values
might include the belief that it is good to have turkey,
or a new kitchen, or to set the table with old china;
these might be important instruments of valued behavior.
The behaviors, perceptions of good, and the feelings
surrounding a valued activity are not random but are
expressed in attachments and rules which indicate the
relative intensity of a value. A disruption of the
attachments or rules represents value-loss within the
system. It may not be too important to have turkey, for
example, but the absence of a grandparent or a departing
young adult from the meal could represent a serious
value-loss. The defining elements are a valuing system,
belief in ultimate or instrumental good, and expression
through affective and behavioral attachments and rules.
Distinctions
Rokeach (1973) distinguishes two kinds of values:
terminal and instrumental. Terminal values represent
desirable end-states of existence; they concern the
purpose or perceived goal of a person's existence. These
values include such concepts as comfort, happiness,
peace, or salvation. Instrumental values, on the other
hand, are preferred modes of existence, represented by
concepts such as politeness, courage, honesty, or love.
Values, in this understanding, may be distinguished
from beliefs and attitudes (Rokeach, 1973). Attitudes
are object or situation-focused whereas values are
expressed in numerous situations, in relation to many
possible objects. Beliefs, on the other hand, can exist
10
apart from behavioral expression, whereas values
represent choices, the behavioral expression of beliefs
(Allport, 1961).
Rokeach (1973) mentions two aspects of values as
acted beliefs which are important to this study. First,
values guide self-presentation, both in the disclosed and
concealed aspects of the self. Second, values direct the
process of persuasion. These two combine to indicate the
theoretical impact of values on the communication process
of psychotherapy.
These defining elements underline the foundational
assumption of this study, that there is no value-free
therapy. The permeation of therapeutic process by
therapist and client values becomes apparent from the
defining elements of values: systemic beliefs and rules,
choice among percieved good, and attachments.
Therapeutic Alliance
Definition
The therapeutic alliance is the relationship of
therapist and client system which can be understood as
the basic ingredient of therapeutic change (Strupp,
1973a, 1973b). Indeed, the therapeutic alliance "...may
be the primary mediating variable that determines the
11
outcome of discrete interventions" (Pinsof & Catherall,
1986, p. 138). Pinsof and Catherall (1986), in a
landmark work for making the alliance accessible for
marriage and family therapists, defined the concept as
"...that aspect of the relationship between the therapist
system and the patient system that pertains to their
capacity to mutually invest in, and collaborate on,
therapy" (p. 139).
This is a psychoanalytically grounded concept,
unpalatable to some marriage and family theorists who are
variously concerned about therapist distance and
maneuverability from outside the client system (Fisch,
Weakland, & Segal, 1982). But the work of Bordin (1979)
made the working or therapeutic alliance available to
systems and other theoretical perspectives.
Dimensions for Marriage and Family Therapy
The landmark article of Bordin (1979) describes the
alliance in terms of its goal, task, and bond dimensions
and indicates ways in which these dimensions might differ
yet be quite significant in various modes of therapy.
The goals of therapy, for example, might be quite broad
and long term in psychoanalytic work, and more narrowly,
specifically defined in behavioral therapies, yet
12
essential to both modes of therapy. The task dimension,
which concerns the active/passive, interpretive, self-
disclosing, etc., roles of therapist and client, would be
different but equally significant in different therapies.
The bond dimension adds the question of responsibility
for therapeutic change as well as the affiliative quality
of the therapist/client relationship.
The bond dimension is most reminiscent of the
concept of joining (Becvar & Becvar, 1988; Fisch et al.,
1982; Minuchin & Fishman, 1982) which is a more prevalent
concept in marriage and family therapy than therapeutic
alliance. The differences between the two concepts are
primarily semantic when examined in light of Bordin's
analysis. Joining in marriage and family therapy is the
establishment of a relationship (bond) for the purpose of
carrying out various tasks toward the achievement of
system goals. Hence, in terms of semantic analysis, the
therapeutic alliance lies at the heart of marriage and
family therapy. Recent efforts have begun to make the
significance of the alliance clear.
The recent efforts of Pinsof and Catherall (1986;
cf. Catherall & Pinsof, 1987) have extended measures of
the alliance to the family therapy context. Pinsof
(1988) summarizes the findings from individual research
studies:
13
The robustness of the alliance-outcome link across different research settings with different research groups using different instruments for measuring the alliance has been particularly impressive in a field with so few, consistent process-outcome findings, (p. 169)
The possibilities for similar results for the family
therapy field are promising, although different levels of
the alliance with various individuals and subsystems will
make matters necessarily complex (Pinsof, 1988).
The three content dimensions of the alliance in the
Pinsof and Catherall (1986) measure include bonds, tasks,
and goals. These components derive from Bordin's (1979)
work and give further definition of the alliance and
clarify its importance for values issues. The bonds
dimension includes the clients' experience of caring,
both by and for the therapist, and is closely related to
transference conceptualization of the alliance. The task
dimension has to do with the clients' sense that the
therapist's method, technique, and ability are directly
connected with the clients' difficulty and desire to
change. The goal component is closely related to tasks,
but concerns the relation of presenting problems and the
goals of therapy. These dimensions have practical
values-oriented utility concerning evaluation of outcome
and decisions concerning termination. They also imply
14
some unique strengths which marriage and family
therapists can bring to the therapeutic alliance.
There are aspects of family therapy theory which
lend themselves to a positive therapeutic alliance and
reflect the mutual value contributions of therapists and
clients to the alliance. These would include positive
reframing of the meaning of problems (Fish et al., 1982),
ascertaining and affirming the positive connotation of
family behavior (Tomm, 1984), respecting the importance
of the family's presenting problem (Nichols, 1984),
maintaining and communicating confidence in the
resilience of the family system (Minuchin & Fishman,
1982), retrieval of family resources which the family
itself may have devalued (Lankton & Lankton, 1983), and
of course, the importance of joining the system (Minichin
& Fishman, 1982) discussed earlier. These are a few
examples of the family therapy tradition of a caring
response to the client system--expressing concern for,
identification with, responsiveness to, and at the same
time maintaining distance enough to provide an empowering
hand toward the family in pain. This is the heart of the
therapeutic alliance created, nurtured, and maintained by
mutual contributions of therapist and client.
15
Values in Therapeutic Alliance
The Questions
There are three question areas which can guide
inquiry into the role of values in therapeutic alliance.
The first question is suggested by existing literature
(Beutler et al., 1986; Pinsof, 1988) but has not been
studied. What is the contribution of therapist/client
system value similarity or difference to the therapeutic
alliance? Is it important to the therapeutic alliance,
as common sense might indicate, that clients who value
Twelve Step programs or intellectual pursuits or a
particular understanding of Christian lifestyle be
matched with therapists of like values? The therapeutic
alliance concerns mutual investment and collaboration.
In what ways and to what extent does value similarity
affect that investment and collaboration? This question
will form a major focus of this study.
The second question has been implied in some
theoretical literature on values in therapy (e.g.,
Bergin, 1980, 1985; Frank, 1973; Strupp, 1973b, 1980) but
has not been studied empirically. Is there a set of
therapist values which contributes to or detracts from
therapeutic alliance with client systems? For example,
it is assumed in the general milieu of psychotherapy that
16
highly rigid values detract from the therapeutic process
(Lerner, 1973) and that at least some form of positive
regard (Rogers, 1957) for the client system makes a
positive value contribution. But can this be
demonstrated empirically?
A third question in the relation of values and
therapeutic alliance has been examined theoretically and
empirically with results which demonstrate the practical
utility of research in this area. This is the basic
question of client resistance to or compliance with
therapeutic process. The question, in terms of the
variables in this study, is whether there is a set of
client values which contribute to (compliance) or detract
from (resistance) the therapeutic alliance? The
literature on this question is both ample and growing
(Anderson &. Stewart, 1983; Davonloo, 1980; Garfield,
1986; Greenson, 1967).
There has been little work focusing on the questions
of therapist/client value similarity and therapist value
sets in relation to the therapeutic alliance, although
these issues are posed by existing literature. This
study examines the relation of values and the therapeutic
alliance via the relation of therapist/client value
similarity and therapist value sets to that alliance.
17
Values Similarity and Outcome
The relation of values to therapy has been partially
addressed in initial studies of the relation of
therapist/client value similarity and difference to
outcome (Beutler et al., 1986). Reviews of the
literature (Arizmendi, 1983) indicate that dissimilarity
of therapist and client terminal values is consistently
and positively related to global improvement in
treatment. Theoretical considerations and clinical
experience continue to suggest, however, that at least
some similarity of therapist and client values would be
related to positive results in therapy (Aponte, 1985;
Bergin, 1985).
This expectation was partially confirmed in findings
(Arizmendi, 1983) that pretreatment similarity of
therapist/client instrumental values is related to
positive outcome. The further study of Arizmendi,
Beutler, Shanfield, Crago, and Hagaman (1985) provides
clarification beyond the general categories of terminal
and instrumental value systems. The results, from the
standpoint of therapist's ratings of client improvement,
summarize the most recent findings on the question of the
relation of therapist/client similarity to outcome:
18
...the most effective patient-therapist matches were those in which there was a clear discrepancy between the participants in the degree to which they valued the terminal goals of accomplishment, wisdom, and happiness while at the same time sharing similar degrees of emphasis both on the instrumental values of courage and politeness, and on the terminal values of excitement and national security (i.e., patriotism.) ...patient-therapist dissimilarity in the amount of emphasis placed on upward mobility and intellectual pursuits along with similarity in more general humanistic-existential values combined to promote high ratings of therapeutic change. (Arizmendi et al., 1985, p. 19)
This study lends some support to the conclusion of
Beutler et al. (1986) that positive outcome is associated
with dissimilarity in social attachment and separation
values and similarity of humanistic, abstract, or
philosophical values.
Two theoretical observations concerning the relation
of therapeutic alliance and value similarity in the
therapist/client system are suggestive for this study.
On the one hand the therapeutic alliance depends on
trust, and client perception of the trustworthiness of
the therapist may be associated with instrumental values
which convey respect. This could be related to recent
indications (Horvath & Luborsky, 1993; Kiesler & Watkins,
1989) that therapist/client complementarity could be a
significant variable in therapeutic alliance. The
possible link between value similarity and therapeutic
19
alliance as a possible instance of complementarity has
not been tested.
On the other hand, the client system must experience
a sense of challenge (Minuchin & Fishman, 1982) or
cognitive dissonance (Festinger, 1957) or some other kind
of difference that makes a difference (Bateson, 1972) as
part of the change process. Similarity addresses the
need for a relational basis for change; difference
addresses the need for a stimulus for or perturbation
toward (Keeney, 1983) change. It would be reasonable to
assume that a combination of similarity and dissimilarity
would foster this trust/challenge experience. Beutler
(1979) suggested possible studies along this line. No
studies have specifically examined the potentially
interesting link between value similarity between
therapist and client and the therapeutic alliance in
family therapy. This inquiry addresses that deficiency.
The extensive research and theoretical work of
Beutler (1971, 1979, 1981, 1983; Beutler et al., 1986;
Beutler, Arizmendi, Crago, Shanfield, & Hagaman, 1983;
Beutler, Dunbar, & Baer, 1980; Beutler, Pollack, & Jobe,
1978) has shown that in individual psychotherapy
"...patients seem to adopt the beliefs of their
therapists during successful treatment" (Beutler, 1981,
20
p.79) and that this adoption leads to a convergence of
therapist and client values during the course of
treatment. Although the acceptance need not be complete
for these findings to hold (Beutler et al. , 1978), the
finding is that clients do not acquire necessarily more
mature values, but specifically the values of their
therapists (Beutler, 1979).
Remaining Questions for Family Therapy
As promising as these findings are, there are
several critical questions remaining concerning value
convergence for the family therapist. In one relatively
early piece of work (Beutler, 1971) Beutler found that in
cases of marital therapy there was convergence of the
values of the marital dyad rather than of the
therapist/client system. Thus, in one of his earliest
works, Beutler's findings seem to be saying that things
might well be quite different in marriage and family
therapy than in individual therapy.
Another possible explanation for some of the
discrepancy between studies as well as the difference
between theoretical expectations and actual findings
could lie in mediating process variables such as length
of time in therapy at time of measurement, the value
21
intensive quality of the culture in which therapy takes
place (university, seminary, medical school, etc.) or the
quality of the therapeutic alliance. This study proposes
the study of the relation of values and the therapeutic
alliance, a variable consistently linked with outcome
(Pinsof, 1988), as an opening of inquiry into the field
of values in systemic therapy.
Pinsof and Catherall (1986) address this issue in
part by developing individual, couple, and family
versions of the therapeutic alliance scales. The family
therapist can develop an intact alliance, with equivalent
collaboration by each part of a subsystem, or a split
alliance, unbalancing (Minuchin & Fishman, 1982) the
subsystems. A split alliance is, indeed, often
reflective of systemic conflicts and of the therapist
being drawn into these conflicts. In these kinds of
conflicted situations, an alliance nurtured by the values
of one person might be quite undermined by the values of
another. The possibility that values might contribute to
or detract from the therapeutic alliance in relation to a
particular client system is related to but distinct from
the other question in this study: Is there a set of
therapist values which is consistently related to
positive therapeutic alliance?
22
Therapist Values and Therapeutic Alliance
It is in relation to this question and its ethical
dimension that values appear as the "enfant terrible"
(Weisskopf-Joelson, 1980) of psychotherapy. There have
been attempts to demonstrate the theoretical beneficence
of therapist values which reflect democratic principles
(Lerner, 1973), unconditional positive regard (Rogers,
1957), gender equity (Hare-Mustin, 1978; Walters et al.,
1988), theistic realism (Bergin, 1980), or humanism
(Strupp, 1973b, 1980), or other sets of values (Seymour,
1982). Some of these analyses have made useful
suggestions about ways therapist values might be utilized
in the psychotherapy process. Aponte's (1985) discussion
of the need to negotiate values in therapy, for example,
is clinically useful. And Strupp's (1980) distinctions
among essential (e.g., child safety), optional (e.g.,
child physical education), and idiosyncratic (e.g., child
swimming lessons at the YWCA) values is instructive.
What is dramatically lacking in these reflections is an
empirical study of whether or not there are, in fact,
therapist values which are positively or negatively
correlated with the therapeutic alliance.
Some of the reluctance (Patterson, 1989) to attempt
changing client values is undoubtedly tied to the concern
23
that therapists "first do no harm" (Becvar, Becvar, &
Bender, 1982) to family systems. In that there is no
evidence that therapist values would be superior to those
of the client, the field has been loathe to consider that
such possibilities might deliberately be chosen. And yet
the research of Beutler et al. (1981, 1986) has shown
that in the course of successful therapy clients tend to
take on their therapist's values! The question is
whether therapists might do more harm with unknown or
unacknowledged values than with values which are known,
owned, and perhaps even cultivated as empirically
associated with positive psychotherapy processes.
The primary thrust of the ethical concern about
therapist values in the literature is, indeed, that
therapist values should be known to the therapist so that
they can be made known to clients (Aponte, 1985; Bergin,
1980, 1985; Lebow, 1981). Ryder (1985) may have been
describing individual more than family therapists in
speaking of value phobia, but the plea of several recent
articles (Aponte, 1985; Bergin, 1985; Lebow, 1981;
Seyraor, 1982) for values clarification is directed toward
marriage and family therapists. Since values function in
a process context, this study addresses the need for
24
clarification of which values configurations contribute
to what kinds of therapeutic alliance.
Hypotheses
Thus the therapeutic alliance and convergence
literature, as well as the literature concerning the
ethical dimension of therapist values in therapy, suggest
studies of the operation of values in marriage and family
therapy. This study examines the relation of values to
the therapeutic alliance, a specific, viable process
window for the questions in the study. The questions
which might be examined in the relation of values and the
therapeutic alliance are examined from a taxonomical
standpoint below along with the methodological reasons
for those selected in this study. Two of these questions
are studied
therapist/cl
therapeutic
in
ien
all
this inquiry: '
it system
iance and
value
what
what is the
similarity
is the
relation
to the
relation of
of
therapist values to that alliance? The literature
outlined above points to the following hypotheses
concerning the first and parameters of exploration for
the second question.
First, it is hypothesized that similarity of
therapist and client terminal values will be negatively
25
related to therapeutic alliance. There has been a
resilient theoretical assumption implicit in values
literature (Bergin, 1980, 1985; Frank, 1973; Patterson,
1989; Strupp, 1980) that there is a set of values which,
if shared by the therapist and client system, would
contribute positively to therapeutic process and outcome.
However, this assumption has not been supported
empirically. Research findings (Beutler, 1981; Beutler
et al., 1986) indicate that difference, not similarity,
correlates with convergence of therapist and client
values and with positive outcome. The first hypothesis
will examine this theoretical assumption by testing the
contradictory hypothesis, suggested by research to date,
that terminal value similarity will correlate negatively
with therapeutic alliance.
Second, it is hypothesized that similarity of
therapist and client instrumental values will be
positively related to therapeutic alliance. The
literature (Arizmendi et al., 1985) leads to the
hypothesis that instrumental value similarity will lead
to a positive outcome and will be positively related to
process variables contributing to the positive outcome.
Third, the theoretical literature suggests the
following specific inquiries concerning sets of therapist
26
values and therapeutic alliance. (a) Is there a positive
relation of therapist person-centered values (forgiving,
loving, helpful, honest, polite, family security, mature
love, true friendship) with therapeutic alliance (Rogers,
1957)? (b) Is there a negative relationship of therapist
self-focused values (comfortable life, pleasure, exciting
life, social recognition, ambition) to the therapeutic
alliance (Rokeach, 1973)? These questions will be
examined in light of the third hypothesis: there are
therapist values which predict positive therapeutic
alliance.
A Taxonomy of Values in Therapeutic Alliance
Unit of Analysis Question
One of the major methodological problems in the
study of multidimensional variables such as values or
therapeutic alliance is unspecified units of analysis
(Beutler et al., 1986). Values have been defined in this
study as beliefs in ultimate or instrumental good which
are expressed in affective and behavioral attachments and
rules by a valuing system. The therapeutic alliance has
been defined as the therapeutically collaborative
relationship of the therapist and client system. These
defining elements contribute to a taxonomical analysis of
27
values in the therapeutic alliance and suggest several
organizing questions.
First, are the values in question those of the
client, the therapist, or of a therapeutic system
(Catherall & Pinsof, 1987) made up of client and
therapist? Who makes up the valuing system? Is the
client system individual, couple, or family? (This study
will focus on one limited unit of analysis, the married
or cohabiting heterosexual couple.)
Second, are the values in question terminal or
instrumental (Rokeach, 1973)? Do they represent ends or
means? Furthermore, are therapist and client values
similar or dissimilar in their terminal and instrumental
dimensions?
Third, what are the specific attachments or rules
which express these values? Do these attachments and
rules involve places (e.g., a farm), things (e.g., a
dining room table), or people? Are these attachments and
rules congruent or conflicted? What is their relation to
family of origin, nuclear family, and the surrounding
culture? Are they adhered to flexibly or rigidly?
Fourth, what is the quality and nature of the
therapeutic alliance? Is it more intact or split?
28
What is the relative strength of the alliance in its
bond, goal, and task dimensions?
The Taxonomy of Beutler et al. (1986)
These questions suggest a taxonomy similar to the
one developed by Beutler et al. (1986) in their review of
the literature on therapist variables in individual
psychotherapy (see Figure 2.1). They utilize two
intersecting continua: extra-therapy/therapy-specific and
externally observed/inferred, internal characteristics
(Beutler et al., 1986, p.258). Values and attitudes are
seen as extra-therapy and internal characteristics. Yet
values are at times quite therapy specific and externally
observed. An example would be the value of child
welfare, a value protected legally and ethically by
therapists' obligation to report cases of suspected child
abuse. Beutler et al. (1986), in fact, acknowledge that
the boundaries of their taxonomy are often blurred and
seem to imply the limitations of any taxonomy. A
discussion of these limitations can contribute some
underlying principles important to values studies.
There are vulnerabilities in taxonomical
categorization of multidimensional, systemically
understood variables. One of these is failure to
29
acknowledge variable overlap (or the correlation between
variables such as therapist and client values). This
neglect could lead researchers to obscure the convergence
phenomena repeatedly observed by Beutler (1981, 1983) and
colleagues (Beutler et al., 1986).
A related limitation concerns the neglect of
variable synergy. Whereas the intercorrelation of
variables can be teased apart statistically, the creation
of wholes greater than the added parts is vulnerable to
distortion and definitional alteration in analysis.
Specifically, there are times (e.g., in hypnosis, prayer,
or medical interaction with psychological interventions)
when values operate in synergistic rather than additive
ways. These are not captured by taxonomical analysis
alone. Other limitations emerge from imposition of
linear analysis on organismic phenomena and are familiar
to readers of systemic research (cf. Becvar & Becvar,
1988). Granted that these limitations should inform the
use of a taxonomical framework, they do not eliminate the
usefulness of punctuating the various aspects of values
in the therapeutic alliance.
30
A Taxonomy for this Study
There are at least six dimensions of values in
marriage and family therapy process which might form a
part of the analysis. These are defined or implied in
the previous discussion but should be listed for clear
taxonomical analysis. Pinsof and Catherall (1986)
include two dimensions of the therapeutic alliance: the
individual-couple-family dimension and the task-bond-goal
dimension. The values sphere could add any of four or
more additional dimensions: the terminal-instrumental
dimension, the similarity-dissimilarity dimension, the
flexibility-rigidity dimension, and the
intergenerational-intragenerational dimension. Other
possible variables might emerge from locus of control,
medical, financial, or other sources. A primary
challenge in this kind of analysis is determining which
variables will be chosen (Pinsof, 1988), knowing the
choice must be limited.
The ways in which these variables might be arranged
depends primarily on the research and clinical questions
of concern. A question concerning the impediments to
therapeutic alliance in relation to the values in force
in court mandated cases would suggest an analysis in
terms of flexibility/rigidity of values. A question
31
concerning the function of family structural values would
have to include the intergenerational and
intragenerational dimension. Other questions would lead
to other variable selection.
The reviews of values in the individual
psychotherapy literature (Beutler, 1981; Kessell &
McBrearty, 1967; Patterson, 1989) and in marriage and
family therapy (Beutler et al., 1986) as well as the
therapeutic alliance literature indicate two dominant
questions, which lead in turn to the taxonomical matrix
suggested here (see Figure 2.2). First, is there a
relationship between similarity of therapist and client
values and a positive therapeutic alliance? Such a
finding might be used, for example, in matching clients
and therapists, clients and therapeutic value selection,
or in decisions to refer. It would be useful above all
in therapist awareness of potential difficulties in or
resources for the therapeutic alliance in light of
therapist/client value structure. Second, are there
therapist terminal or instrumental values which predict
the therapeutic alliance or any of its dimensions?
The matrix in Figure 2.2 is limited for utility as
well as for research focus. It is designed for use in
couples therapy, although it could be used for
32
individuals or families as well. And it is designed to
suggest sampling and analytical processes for addressing
the two questions in the study.
33
Externally Observed
Characteristics
Age
Gender
Ethnicity
Socioec. status
Extratherapy
characteristics
Personality patterns
Emotional well-being
Attitudes and values
Professional background
Therapeutic style
Therapeutic interventions
Therapy-
specific
characteristics
Relationship attitudes
Social influence attributes
Expectations
Inferred, Internal
Characteristics
Figure 2.1: Therapist characteristics (Beutler et al., 1986, p.258)
34
Terminal
Instrumental
imilar
Dissimilar
F i g u r e 2 . 2 : A l l i a n c e
A Taxonomy of Va lues i n t h e T h e r a p e u t i c
35
CHAPTER III
METHODS
The questions, literature, and the hypotheses led to
the adoption of a methodology which focused primarily on
couple therapy, therapist and client values, a measure of
therapeutic alliance for the client system, and a sample
adequate to provide for the testing of hypotheses. These
parameters led to the recruitment of a sample of
therapists and clients, the adoption of values and
alliance measures, and an analysis plan which would test
results from the standpoint of individual clients, couple
clients, clients of each therapist as a group, and
therapists as a group. The following nomenclature was
adopted for clarity: "individuals" referred to individ'ial
clients as a whole; "couples" referred to couples as Cx
whole; "group" referred to the scores of each therapist's
clients as a group; "therapists" referred to the scores
of therapists as a whole.
Recruitment Procedures
The recent work of Arizmendi et al. (1985) and
Bei'tler et al. (1986), as well as preliminary research on
the therapeutic alliance in couples therapy (Pinsof &
36
Catherall, 1986), indicated six variables for the first
two hypotheses: therapist/couple terminal value
similarity, therapist/couple instrumental value
similarity, and the overall, bond, goal, and task
dimensions of the therapeutic alliance. A minimum of
five couples per variable therefore required a sample
size of 30 couples. The study sought participation by
two to five couples per therapist but accepted one couple
for analysis, following precedents from previous studies
(Arizmendi et al., 1985).
The third hypothesis was more exploratory and
various kinds of inquiry could have been performed with
various sample sizes. It was decided to limit tests to
those which were statistically possible with the required
sample size for the first two hypotheses. Sample
selection therefore sought a minimum of 30 couples and 30
therapists.
The study was conducted in two phases, the first of
which provided initial data and indicated the necessary
recruiting parameters for adequate sampling. The first
phase involved recruiting private practitioners from
northwest Texas as well as student and faculty therapists
from four universities with marriage and family therapy
training programs. This resulted in data suitable for
37
analysis from 11 therapists, 14 couples, and 33
individual clients. These were recruited on an
individual basis from a population of over 100 therapists
who were doing couple therapy. It became apparent in
this phase that recruiting therapists and couples
together would constitute a considerable challenge and
that paying participants would expedite data collection
to reach the desired sample size.
Consequently phase two began with 2611 letters
(Appendix D) to clinical, student, and associate members
of the American Association for Marriage and Family
Therapy. These letters were sent to eight states,
selected for broad geographical representation, in the
Northeast, Atlantic Coast, Southeast, South Central,
Midwest, Southwest, and Northwest of the contiguous
United States. Recipients were invited to earn $25 for
participation in a study of values, therapeutic alliance,
and marital therapy if they were confident they could
appropriately recruit two couples who would be willing to
take part. Participants indicated willingness to join
the study by returning a four by six card with their name
and address. The response rate to these letters was low
(as anticipated from phase one) but resulted in 70
packets of material being sent to therapists willing to
38
participate. Each packet contained material for
therapist and two couples with self-addressed envelopes
for separate return. At least one of the surveys was
returned from over 50% of the packets. There was a
return of 40% from a therapist and at least one
individual, 37% from a therapist and at least one couple,
and 17% from a therapist and both couples.
Confidentiality was assured by preserving the
anonymity of the subjects through numbered identification
of the data forms; the numbering system facilitated
linking clients with their therapist and not another
while preserving confidentiality. Participants were
asked not to place their names on the forms, which were
returned directly to the investigator in pre-addressed
envelopes.
The rigors of systemic clinical research became
evident in aquiring an adequate sample of therapists and
couples. Many of the studies which have been conducted
in the area of values operation in therapy have been
limited to one category of practitioner such as
psychiatric residents (Arizmendi et al., 1985) using
small samples of individual clients. This has limited
the usefulness of results for systemic therapists and
leaves specific unanswered questions, suggested by
39
research (Beutler, 1979), for the marital therapist. The
focus on marital therapy in this sample tested
theoretical and research findings in a systems context
without neglecting a comparison of findings with
individual psychotherapy research.
Sample
The total sample which resulted from these
procedures consisted of 40 therapists, 53 client couples,
and 120 individual clients. The therapists (cf. Table
3.1) were primarily married (N=26, 65%) for an average of
11 years with 2 children, and were Protestant/Christians
in religious affiliation (N=25, 63%). A majority (N=30,
75%) of the therapists indicated that religion was
strongly important to them. Most had received graduate
training (N=36, 90%) and were clinical (N=24, 60%) or
student (N=13, 33%) members of the American Association
for Marriage and Family Therapy. Primary work settings
were training programs (faculty, N=19, 48%; students N=9,
23%) and private practice (N=9, 23%) with an average fee
of $43 and a 14 session average length of couple therapy.
There was equivalent representation of male (N=18, 45%)
and female (N=22, 55%) therapists. The average age was
44 years.
40
The client population (cf. Table 3.2 for summary of
client population description) was composed of nearly
equal numbers of male (N=58, 49%) and female (N=62, 51%)
clients. The average client age was 38 and average
number of years married was 11. There was an average of
2 children per couple with an average of 1.5 children
living at home. Educational achievement was primarily
above high school level (87%) and 45% listed occupation
as professional. Religious affiliation was 18% Catholic,
62% Protestant/Christian, and 17% other (usually written
as Church of Jesus Christ of Latter Day Saints) for whom
religion was very (52%) or moderately (23%) important.
The length of time in therapy was between 11 and 20
sessions.
Measures
Measures included demographic information (Appendix
A ) , the Rokeach (1973) Value Survey (Appendix B) and The
Couple Therapy Alliance Scale (Pinsof & Catherall, 1986;
Appendix C ) .
Demographic Information
Demographic information for both therapists and
clients included date of birth, marital status, number of
41
times married, length of present marriage, number of
children, number of children living at home, education
level, occupation, religious affiliation, length of time
in therapy, previous therapy, and number of sessions in
therapy. Therapists were asked, in addition, their
professional affiliation, theoretical orientation,
training and experience level, practice setting, fee, and
average length of treatment for couples in marital
therapy.
Value Survey
The Rokeach Value Survey was discussed above from a
theoretical standpoint (cf. pp. 10-12, 17-26). This
survey is used widely in social persuasion research
(Martini, 1978; Townsend, 1978) and has been used in
previous studies of therapist values. Test-retest
reliability (cf. Table 3.3 for summary of reliabilities)
in one study (Rokeach, 1973) of Form E, used in this
study, was .74 for terminal values and .65 for
instrumental values (N=189). In another study (Hormant,
1970) reliability for terminal values was again .74 and
for instrumental values reliability was .70 (N=77).
Reliabilities have generally been lower for instrumental
than for terminal values, although each is adequately
42
reliable for social science research (Rokeach, 1973).
Although data collection costs and logistics precluded
the possibility of repeating test-retest analysis of
reliability, previously demonstrated reliabilities in the
literature were accepted as adequate for this study.
Therapeutic Alliance
The Couple Therapeutic Alliance Scale (Pinsof &
Catherall, 1986) is a 29-item scale with scores derived
from answers to a seven-point Likert scale. There are
seven possible scale scores for this instrument: the
overall alliance, the goal alliance, the task alliance,
the bond alliance, the alliance of the individual, the
alliance of the partner, and the overall alliance of the
couple. The instrument is conceived as a measure of
alliance as an evolving state more than a stable trait.
Therefore, reliability expectations might reasonably be
high but not perfect (Pinsof & Catherall, 1986).
An early (Pinsof & Catherall, 1986; cf. Table 3.3
for a summary of scale reliabilities) study showed a
rate-rerate Pearson correlation coefficient of .84
(p<.005), but there was considerable skew toward a
positive representation of the alliance. The later
seven-point version, used in the present study, did
43
result in more normal distribution, but there was still
sufficient skewness that distribution could, if repeated
in any given study, indicate the need for transformation
(Tabachnik & Fidel, 1989) in the analysis. The overall
rate-rerate Pearson correlation coefficient for the
overall couple score in this study was .79 (p<.005).
The Couple Therapeutic Alliance Scale (Pinsof &
Catherall, 1986), although reliable in these earlier
studies, was retested using the sample in this study.
The results of those tests in the sample (N=119) in this
study were quite high: Cronbach's alpha for the
therapeutic alliance scale was .95, for the bond subscale
.89, for the goal subscale .78, and for the task subscale
.93. These reliabilities compare favorably with those in
previous studies.
The descriptive statistics for the Terminal Value
Similarity (Table 3.4), Instrumental Value Similarity
(Table 3.5), and Therapeutic Alliance (Table 3.6) scores
are within normal limits. There was no remarkable
skewness, kurtosis, or outliers with the exceptions of
one therapist and one couple whose data were dropped from
the analysis due to missing items. The normal
distribution of the descriptive statistics obviated the
need for transformation of the scores for analysis.
44
Scoring
These measures are capable of producing reliable
results as outlined above, but their usefulness for this
study depended on scoring protocols which would make
hypotheses amenable to testing. Similarity scores have
been achieved in three ways in literature using the
Rokeach Value Survey (1973). Beutler et al. (1983) used
a rank order correlation coefficient as a measure of
similarity. In an earlier work, Beutler et al. (1978)
had used a measure of the number of actual statements
between the therapist's and patient's position on each
scale. Most recently, Arizmendi et al. (1985) measured
similarity as therapist ranking minus the patient ranking
on each scale item. The Kendall (Siegel, 1956)
coefficient of concordance was chosen for this study due
to its capacity to generate similarity scores for any
number of raters of items on a rank ordered scale such as
the Rokeach Value Survey (1973). Pilot data analysis
indicated the utility of the Kendall for establishing the
value similarity scores needed for this study.
Scoring protocols for the Therapeutic Alliance Scale
were standardized by the scale authors (Pinsof &
Catherall, 1986). The couple version of the scale
45
utilized the 10, 6, and 13 items designated as measuring
the bond, goal, and task dimensions of the alliance as
well as the overall mean representing the alliance as a
whole. The scoring method used means of the individual,
couple, and therapist group scores on these dimensions to
provide the data with which to relate values and
therapeutic alliance in the subjects.
Analysis Plan
The analysis reflected the unit of analysis issues
discussed above, the scales used in the study, the
questions, and an awareness that results might be
different at individual, group, and couple levels.
Therefore tests were conducted for therapist and
individual, therapist and couple, and therapist and that
therapist's clients as a group. This meant that separate
scores were generated for therapist/individual,
therapist/couple, and therapist/group on each of the
terminal similarity, instrumental similarity, and
alliance scores.
A preliminary analysis of the data examined the
value and alliance characteristics of the groups of
subjects in the study. Questions in the preliminary
analysis included whether there were significant group
46
differences among, for example, students and the
professional population on similarity scores with
clients' values, client scores on the alliance, or scores
on values to be tested for correlation with the alliance.
The purpose of this preliminary analysis was to identify
control variables extraneous to the hypotheses under
study. Due to some of the difficulties in factor
analysis of an ipsative scale (Hicks, 1970; Rokeach,
1973) such as the Rokeach, the exploratory dimensions of
the study were primarily conducted by standard multiple
regression analysis of the predictive relation of
therapist values and therapeutic alliance.
The first hypothesis (regarding the hypothesized
negative relation of terminal value similarity and the
therapeutic alliance) was tested by Pearson correlational
analysis to determine the magnitude, significance, and
direction of any relation between therapist/client
similarity of terminal values and therapeutic alliance.
This correlation was run not only for the couple but also
for individual clients in relation to the therapist and
for the group of clients associated with each therapist,
and correlation comparisons were noted and included in
the analysis. Hypothesis confirmation or disconfirmation
examined not only direction, magnitude, and significance
47
of correlation but also any specific demographic
parameters with which the hypothesis was confirmed or
disconfirmed. Specific attention was focused on tests at
individual, couple, and group levels. The hypothesis was
considered disconfirmed if the weight of the statistical
evidence not only did not support but indicated the
opposite of the hypothesized result. The exploratory
dimension of each of the hypotheses, particularly in
relation to contrasting expectations from theoretical and
empirical literature, led to the inclusion of these
parameters of disconfirmation supporting the opposite of
hypothesized results.
The tests of the second hypothesis (regarding the
hypothesized positive relation of instrumental value
similarity and the therapeutic alliance) were similar to
the first, using Pearson correlational analysis to test
the hypothesized positive relation of therapist/client
instrumental value similarity with therapeutic alliance.
Tests confirming or disconfirming the hypothesis were the
same as for the first hypothesis, although in relation to
instrumental rather than terminal values.
The third dimension of the study (hypothesizing a
set of therapist values with a positive relation to the
therapeutic alliance) was primarily exploratory, whereas
48
the first two were primarily confirmatory. The questions
in this third hypothesis were explored through
correlational, as well as multiple regression, analysis
to determine relationships between therapist values and
aspects of the therapeutic alliance. Of particular
interest were the relation of self-focused (e.g.,
comfort, social recognition), and person-focused (e.g.,
forgiveness, love, family security, helpfulness) values
to the alliance.
49
Table 3.1: Therapist Frequencies (N=40)
Gender:
Male 18
Female 22
Source:
Texas Tech 5
Abilene Christian U 5
St. Mary Univ. 1
Private Practice 1
Mail Recruitment 28
Age:
Minimum 23
Maximum 63
Mean 44
Marital Status:
Single 6
Divorced 6
Widowed 2
Married 26
Years Married:
Mean 10
Previous Marriages:
Mean • ̂
Number of Children
Mean- 1 .9
Number Children at Home:
Mean- .73
Education:
College (Some)--l
College-
Graduate 38
Occupation:
Manager-
Student- 13
Professional 2 5
Religious Affiliation:
Catholic
Christian- 25
Other- 8
Importance of Religion
None-
Mild-
Moderate
Very- 30
50
Table 3.1: Continued
Professional Status:
Lie. Prof. Counselor 3
Psychologist 2
LMFT 15
Social Work 4
Other 15
AAMFT Status:
Student Member 13
Clinical Member 24
Supervisor 3
Training:
Masters 21
Doctorate 18
Other 1
Theory:
Behavioral 5
Structural 1
Psychodynamic 2
Interactional 5
Integrated 20
Other '7
Average Fee:
Minimum- 0
Maximum- 100
Mean- 43
Length of Therapy:
Minimum-
Maximum- 48
Mean- 13
Practice Setting
Student
Faculty- 19
Private Pract-10
Agency
51
Table 3.2: Client Frequencies (N=120)
Gender: Number of Children:
Male 58 Mean- 2.2
Female 62 Number Children at Home
Source: Mean- 1.5
Texas Tech- 17 Education
Abilene Christian U--12 Elementary-
St. Mary Univ. High School 15
Private Practice- College (some)--54
Mail Recruitment 81 College (deg) 27
Age Graduate- 23
Minimum- 22 Occupation:
Maximum- 74 Unemployed- 8
Mean- 38 Manager- 10
Years Married: Clerical 10
Mean- 11 Professional 54
Previous Marriages: Student-
Mean- .48 Home maker 14
Other- 28
52
Table 3.2: Continued
Religious Affiliation:
Catholic 22
Prot/Christian 74
Jewish 3
Other 21
Importance of Religion:
None 10
Mild 24
Moderate 2 5
Very 61
Length of Therapy:
One to Four 18
Five to Ten 39
Eleven to Twenty 14
More than Twenty 47
53
Table 3.3: Scale Reliabilities
Rokeach Value Survey:
Terminal Values
Terminal Values
Study
Hormant, 1970 (N=77)
Rokeach, 1973 (N=189)
Instrumental Values Hormant, 1970 (N=77)
Instrumental Values Rokeach, 1973 (N=189)
Cronbach's alpha
.74
.74
.70
.65
Therapeutic Alliance Scale
Alliance
Bond
Goal
Task
Thomas, 1994 (N=119)
Thomas, 1994 (N=119)
Thomas, 1994 (N=119)
Thomas, 1994 (N=119)
.95
.89
.78
.93
54
Table 3.4: Variable Descriptives: Terminal Value Similarity
Group Scores (N=39)
Couple Scores (N=52)
Mean Range
51 62
58 60
Individual Scores (N=122) 68
Skewness Kurtosis Std. Dev
67
-.30
-.50
-.70
.03
.27
.29
14
13
14
55
Table 3.5: Variable Descriptives: Instrumental Value Similarity
Mean Range Skewness Kurtosis Std. Dev.
Group Scores (N=39) 43 58 .19 .29 14
Couple Scores (N=52) 51 69 -.09 -.04 14
Individual Scores (N=122) 64 79 -.42 .38 14
56
Table 3.6: Variable Descriptives: Therapeutic Alliance
Overall Alliance:
Mean Range Skewness Kurtosis Std. Dev.
Group Scores (N=39) 168 77 -.37 -.47 19
Couple Scores (N=52) 170 79 -.35 -.78 21
Individual Scores (N=123) 170 101 -.43 -.46 24
Bond Dimension:
Group Scores (N=39) 61 21 -.37 -1.01 6
Couple Scores (N=52) 61 24 -.56 -.76 7
Individual Scores (N=123) 61 27 -.47 -.46 8
57
Table 3.6: Continued
Goal Dimension:
Mean Range Skewness Kurtosis Std. Dev. Group Scores (N=39) 34 17 .07 -.81 4
Couple Scores (N=52) 34 17 .09 -1.12 5
Individual Scores (N=123) 34 21 .09 -1.06 6
Task Dimension:
Group Scores (N=39) 74 39 .49 -.10 10
Couple Scores (N=52) 75 40 -.35 -.57 10
Individual Scores (N=123) 75 55 -.67 .26 12
58
CHAPTER IV
RESULTS
Preliminary Analysis
Control Variable Analysis
Data from demographic material was analyzed by
analysis of variance (ANOVA) and Pearson correlation to
determine the existence of control variables. Discrete
variables such as gender and marital status were analyzed
by analysis of variance (ANOVA); continuous variables
such as age and years married were analyzed by Pearson
correlation. These analyses were conducted to determine
any significant group differences or correlations with
scores on the variables under study: therapist/client
terminal value similarity, therapist/client instrumental
value similarity, or therapeutic alliance in any
dimension. There were significant group differences or
correlations with the variables under study in gender,
the length of therapist marriage, the importance of
religion, and the length of time in therapy.
Gender group (cf. Table 4.1; male clients, N=58,
female clients, N = 61 ) differences were significant in
relation to individual scores on the therapeutic
alliance, F=6.27 (1,119) p<.05, bond subscale, F=7.12
59
(1,119) p<.01, goal subscale, F=6.35 (1,119) p<.05, and
task subscale, F=4.10 (1,119) p<.05, of the alliance.
Interestingly, however, gender was not significant in
scores of terminal or instrumental value similarity.
Although therapist gender was not significant in couple
or group scores on either the overall therapeutic
alliance or any of the subscales (cf. Tables 4.2, 4.3),
this insignificance could have derived from small male
therapist sample size. The contrasting beta weights for
male (-5.25) and female (4.99) clients on therapeutic
alliance scores combined with the nonsignificance of
therapist gender indicates that female clients form a
stronger alliance with therapists than male clients,
regardless of the gender of the therapist. This
suggested that the analysis would have to control for
gender in tests of individual scores on all dimensions of
the therapeutic alliance. There was, then, a discrepancy
between insignificance of therapist gender in relation to
couple and group scores by ANOVA and the significance of
client gender by the same test. In spite of this
discrepancy, there was sufficient strength of gender
group differences in the sample as a whole to suggest
separate correlational tests for male and female
60
therapists on the first two hypotheses and also suggested
controlling for gender on third hypothesis explorations.
Another variable, therapist number of years married,
was surprisingly significant in scores on the therapeutic
alliance scale (cf. Table 4.4.) Tests of marital status
indicated that therapist marital status was
insignificantly related to the variables under study.
Length of client marriage was not significantly
correlated with therapeutic alliance scores or value
similarity with therapists. But the length of a
therapist's marriage was negatively correlated with
group and individual therapeutic alliance scores. The
number of years a therapist had been married was
negatively correlated with group alliance (r=-.34,
p<.05), group bond (r=-.38, p<.05), group task (r=-.33,
p<.05), individual alliance (r=-.29, p<.05), individual
bond (r=-.26, p<.01), and individual task (r=-.31, p<.01)
scores. There was, however, no significant correlation
between couple scores and length of therapist marriage.
These findings indicated the need to control for length
of therapist marriage in tests involving individual and
group alliance scores.
Another variable which was significant enough for
consideration as a control measure was the importance of
61
religion (cf. Table 4.5.) The client population was
divided for this analysis into equivalent groups of those
for whom religion was very important (N=62) and those for
whom it was moderately or less important (N=59). This
grouping was significant for scores on the goal dimension
of the individual alliance, F=4.6 (1,119) p<.05, as well
as both individual terminal (F=6.98 (1,110) p<.01) and
individual instrumental (F=4.2 (1,110) p<.05)
therapist/client value similarity. And therapist
importance of religion groupings were significant (F=4.7
(1,49) p<.05) for couple similarity with therapist
terminal values. It also failed to show significant
relation to any of the group scores. It therefore was
considered marginally important as a control variable in
tests of individual and couple scores.
In the same way, length of time in therapy was
marginally significant as a control variable (cf. Table
4.7.) The client population was divided into those with
more than (N=42) and less than (N=72) 20 sessions in
therapy. The groups differed significantly in
individuals' similarity with therapist terminal, F=6.98
(1,110) p<.01, and instrumental, F=4.2 (1,110) p<.05,
values. When tested as a continuous variable the length
of time was significantly correlated with individual
62
terminal (r=.23, p<.05) and instrumental (r=.19, p<.05)
value similarity between therapist and client. Along
similar lines the average length of couple therapy for
therapists correlated with the bond dimension of the
therapeutic alliance (r=.32, p<.05) on a group level.
And couple scores on similarity of terminal values with
therapists were significantly (F=5.13 (1,47) p<.05)
different for groups with more and less than 20 sessions
of therapy. Length of time in therapy was positively
correlated (r=.40, p<.01) with therapist/couple terminal
value similarity. These results indicated a marginally
important control variable in tests involving individual
clients and the group of each therapists' clients.
Modified Analysis Plan
The analysis plan was modified in light of this
preliminary analysis. The controls introduced into tests
for the first two hypotheses were identical since the
variables in these hypotheses showed significant
influence from virtually the same sources (i.e., gender,
therapist years married, importance of religion, and
length of therapy).
There are several ways to manage control variables
in demographic data (Tabachnik & Fidell, 1989) including
63
analysis of covariance (ANCOVA) with group differences,
partial correlation or stepwise regression with
continuous data, or performance of separate tests for
subsamples selected around control variables. The
strength of the control variables, particularly gender
and years married, and the structure of the data in this
study suggested reporting both uncontrolled results and
results controlled by partial correlation and sample
selection. Variables were reduced to the primary items
of interest to adjust for reduction of sample size in
selected (e.g., male therapists) subsamples. The
individual therapist/client tests were run both without
controls and controlling for both therapist and client
gender, therapist years married, therapist and client
importance of religion, and length of time in therapy.
The couple scores were tested both without controls and
controlling for therapist gender and the therapist
importance of religion. The scores for the group of each
therapist's clients as a whole were tested with no
controls and controlling for therapist gender, years
married, and average length of therapy. Where
differences were observed between the correlations for
these control variables these differences were tested for
significance. Hypothesis confirmation or disconfirmation
64
was retained as outlined in the original analysis plan,
although at this point the specific demographic
parameters formed a specific statistical context within
which hypothesis tests were conducted.
The analysis plan for the third hypothesis included
demographic variables through regression analysis (forced
entry method). The therapist value scores were included
in the data files of each individual client in order to
ascertain the relation of the therapist's values and that
client's alliance with the therapist. Therapist value
variable selection was made through correlational
analysis without controls in order to ascertain
significant variables to include in the regression.
Regression analysis through forced entry, using both
significant demographics and therapist values as
independent variables, assessed the contribution of
therapist values after demographic effects were removed.
One exception to this plan involved regression analysis
of therapist values as predictors of group therapeutic
alliance. Due to the smaller (N=39) sample size of this
subset the analysis entered only those demographics and
values which were significant for couple or individual
analyses: years married, importance of religion,
comfortable life, ambitious, and forgiving.
65
Primary Analysis
Hypothesis 1: Similarity of therapist and client terminal values will be negatively related to therapeutic alliance.
This hypothesis was derived from empirical studies
and framed against the theoretical background which would
anticipate the opposite, that there is a positive
relation of terminal value similarity and therapeutic
alliance. The first hypothesis was partially
disconfirmed, with results which found against the
empirically based hypothesis while supporting theoretical
expectations.
A summary table (Table 4.9) provides an overview of
the results of the first hypothesis and gives clear
comparisons of the significance, magnitude, and direction
of the correlations with and without controls. These
results, both in significant correlations and in the
nonsignificant correlations of notable magnitude, show a
positive correlation between therapist/client terminal
value similarity and the therapeutic alliance; this
correlation is largest in magnitude and/or most often
significant with male therapists for whom religion is
less than very important. The correlation diminishes
with length of therapist marraige and increases with the
66
number of sessions of the clients' therapy at the time of
testing. The following analysis provides more detailed
analysis.
The first test, with no control variables (Table
4.11), revealed a small but significant positive
correlation between individual terminal similarity and
therapeutic alliance as a whole (r=.20, p<.05) and the
bond (r=.18, p<.05) and goal (r=.22, p<.01) dimensions of
the therapeutic alliance. At couple and group levels
there was no significant correlation possibly due to the
smaller size of the group (N=39) and couple (N=48) as
opposed to the individual (N=120) scores.
The tests controlling for gender revealed similar
results by partial correlation (Table 4.12). The
individual results were not appreciably different.
Significant correlations were found between terminal
value similarity and the goal (r=.26, p<.05) dimension on
couple alliance and the bond (r=.23, p<.05) and goal
(r=.27, p<.05) dimensions of group scores.
The tests by sample selection of male and female
therapists and clients revealed marked gender differences
in the relation of value similarity to therapeutic
alliance (Tables 4.13-4.18). These differences were
observed both in terms of the raw contrast between the
67
correlations and the results of a test of the
significance of difference between the correlations.
There were significant correlations between terminal
value similarity and overall therapeutic alliance (r=.37,
p<.01), and the bond (r=.33, p<.01), goal (r=.39, p<.01)
and task (r=.34, p<.01) dimensions of the alliance for
male clients (N=59), but no significant or large
correlation for female clients (N=63) on the same scores.
There were large, significant results of correlational
tests of the relation of terminal value similarity and
overall therapeutic alliance for male therapists (r=.53,
p<.001, N=52 for individual scores; r=.48, p<.05, N=21
for couple scores; r=.57, p<.01, N=17 for group scores).
But there were no significant correlations for female
therapists. The results were similar in tests matching
therapist and client gender. Particularly noteworthy is
the fact that the only negative correlation in all tests
of the first hypothesis, though nonsignificant, was for
female therapists matched with female clients (Table
4.17. )
The tests of significance of difference between
these correlations limited the difference to therapists
(Tables 4.14, 4.16, 4.18). There were no significant
differences between the correlations for male and female
68
clients, although the difference between male and female
clients for the correlation between terminal value
similarity and the overall therapeutic alliance
approached significance (critical value of 1.93). But
there were consistent significant differences in the
correlations of terminal value similarity for male and
female therapists at the level of individual client
scores (Tables 4.16, 4.18).
The tests controlling for the length of marriage by
partial correlation were generally similar to results
with no controls (Table 4.19). The results of
controlling for length of therapist marriage in the group
scores, however, showed increase in both magnitude and
significance of correlation between terminal value
similarity and the overall (r=.27, p<.05), bond (r=.30,
p<.05), and goal (r=.31, p<.05) dimensions of the
alliance.
Partial correlations with importance of religion as
a control were not markedly different from uncontrolled
results; but tests by sample selection again showed both
tested and untested differences (Tables 4.21-4.24).
There was a definite disconfirmation of the first
hypothesis in relation to clients (N=60) and therapists
(N=26) for whom religion was moderately or less
69
important. These clients' correlations were both larger
and more significant than with no controls. Among
therapists for whom religion was less than very important
(N=26) there was a large (r=.58, p<.01) correlation
between terminal similarity and overall alliance scores.
Value similarity scores did not correlate with
therapeutic alliance when either clients or therapists
considered religion to be very important. When these
differences were tested for significance, however, the
client differences were eliminated but therapist
differences were significant at individual, couple, and
group levels (Tables 4.22, 4.24).
Partial correlations controlling for the length of
time in therapy produced a greater difference in the
correlations of terminal similarity and therapeutic
alliance than similar tests of other control variables
(Table 4.25). The correlations in both individual and
couple scores decreased by an average of .04 or 20% while
retaining similar significance due to the decline in
degrees of freedom. Length of time in therapy was
controlled in group scores by a partial correlation using
the therapist's average length of marital therapy as the
control. This increased rather than decreased the
correlation and brought two of the correlations to a
70
significant level (N=35; bond dimension r=.29, p<.05;
goal dimension r=.31, p<.05). These contradictory
findings suggested that client reported length of therapy
was not the same as therapist average length of couple
therapy. This control variable did not produce an
appreciable change in results.
The first hypothesis was partially disconfirmed (cf.
Tables 4.9-4.25). The results showed a positive rather
than a negative correlation between terminal value
similarity and therapeutic alliance. This correlation
was more often significant in the individual than in
couple or group scores for statistical (i.e., sample size
differences) reasons, but the hypothesis was also
significantly disconfirmed in 25% of correlations in
couple and group scores. The magnitude of significant
correlations ranged from r=.14 (correlation of individual
bond score and terminal similarity controlling for length
of time in therapy by partial correlation) to r=.58
(correlation of individual overall alliance score and
terminal similarity in the subsample for whom religion
was less than very important). There was a significant
correlation between overall alliance and terminal
similarity in 40% of the tests; 67% of the goal and only
24% of the task correlations were significant. Although
71
the disconfirmation was not unanimous it was considered
supportive of the theoretical expectation that terminal
value similarity would correlate positively with
therapeutic alliance.
Hypothesis 2: Similarity of therapist and client instrumental values will be positively related to therapeutic alliance
The second hypothesis was partially confirmed. A
summary table (Table 4.9) provides an overview of the
results of the second hypothesis and gives clear
comparisons of the significance, magnitude, and direction
of the correlations with and without controls. These
results, both in significant correlations and in the
nonsignificant correlations of notable magnitude, show a
partial positive correlation between therapist/client
instrumental value similarity and the therapeutic
alliance; this correlation is largest in magnitude and/or
most often significant with male therapists for whom
religion is less than very important. The correlation
diminishes with length of therapist marraige and
increases with the number of sessions of the clients'
therapy at the time of testing. The following provides
more detailed analysis.
72
The first test, with no control variables (Table
4.11, N=120), found a significant positive correlation
between individual instrumental similarity and
therapeutic alliance in the overall (r=.18, p<.05), bond
(r=.18, p<.05), and goal (r=.24, p<.01) dimensions of the
therapeutic alliance. At the level of couple scores
(N=48) there was a significant correlation only at the
goal level (r=.30, p<.05). There was no significance at
the group level.
The tests controlling for gender by partial
correlation produced similar results (Table 4.12) to
those with no controls. The individual results were not
appreciably different. Significant correlations were
found between instrumental value similarity and the
overall alliance (r=.26, p<.05), the goal (r=.30, p<.05),
and the task (r=.27, p<.05) dimension of couple scores.
There was no significance in the group scores.
The tests for the second hypothesis by sample
selection by gender were not as dramatic as in the first
hypothesis (Tables 4.13-4.18), although the results
continued to demonstrate the importance of gender
differences in the relation of value similarity and
therapeutic alliance. These differences were observed as
both raw contrasts and were tested for significance.
73
There were significant correlations between instrumental
value similarity and the bond (r=.27, p<.05) and goal
(r=.33, p<.01) dimensions of the alliance only for male
clients (N=59). There were no significant or large
correlations for female clients (N=63) on the same
scores. There was a large, significant correlation
between instrumental value similarity and overall
therapeutic alliance for male therapists on individual
scores (r=.49, p<.001, N = 52 ) . But there were no
significant correlations for couple or group scores and
there were no significant correlations for female
therapists. The results were similar in tests matching
therapist and client gender.
The tests of significance of difference between
these correlations limited the difference to therapists
(Tables 4.14, 4.16, 4.18). There were no significant
differences between the correlations for male and female
clients, although the magnitude of the difference was
worth noting. But there were consistent significant
differences in the correlations of instrumental value
similarity for male and female therapists at the level of
individual client scores (Tables 4.16, 4.18).
The tests controlling for the length of therapist
marriage by partial correlation were generally similar to
74
results with no controls. The couple scores produced
slightly larger and more significant results;
instrumental similarity was correlated with the overall
(r=.25, p<.05), goal (r=.30, p<.05), and task (r=.26,
p<.05) dimensions of the alliance. There was no
significance at the group level.
The hypothesis was tested finally by controlling for
importance of religion by partial correlation and sample
selection of those for whom religion was less than very
important (clients, N=60; therapists N=9) and those for
whom it was very important (clients N=62; therapist N=30;
cf. Tables 4.20-4.24). There were no appreciable
differences in the results of partial correlational
tests. There were larger, significant correlations
between instrumental value similarity and therapeutic
alliance among clients (N=60) for whom religion was less
than very important, particularly at the goal dimension
of individual scores (r=.41, p<.001), than with no
controls. When tested for significance, the difference
between the correlations of clients for whom religion was
very important and less than very important at the goal
dimension of the alliance was significant (p<.05). Among
therapists, however, there were no significant scores
indicating influence of the importance of religion for
75
instrumental similarity/therapeutic alliance
correlations.
The second hypothesis was partially confirmed. The
results showed a positive correlation between
instrumental value similarity and therapeutic alliance.
This correlation was again significant more frequently in
the individual than in couple or group scores. As in the
first hypothesis the greater degrees of freedom for
individual than for couple and group scores affected the
results. The second hypothesis was nevertheless
significantly confirmed in 19% of the correlations in
couple and group scores. There was a significant
correlation between overall alliance and instrumental
similarity in 29% of the tests; 62% of the goal and only
10% of the task correlations were significant. The
second hypothesis was partially confirmed.
Hypothesis 3: There are therapist values which predict positive therapeutic alliance
The third hypothesis was confirmed. Variable
selection was made through correlational tests of
significant relation between therapist values and
therapeutic alliance. The tests of individual scores
(Table 4.26; N=123) indicated that therapists' values of
a comfortable life (r=.25, p<.01), forgiveness (r=.22,
76
P<.05), and intellectual qualities (r=.19, p<.05) were
positively related to the alliance. There was a negative
relation of the therapist values of a sense of
accomplishment (r=-.22, p<.01), social recognition (r=-
.28, p<.01), and ambition (r=-.19, p<.05) to the
alliance. The values which were positively correlated
with therapeutic alliance were negatively correlated with
each other and those which were negatively correlated
with the alliance were positively correlated with each
other (Table 4.27). The mean therapist ranking (Table
4.28) did not seem to relate to the correlations,
although it is noteworthy that the rankings ranged in the
midrange of therapist value rankings, from 6.5 (for
forgiveness) to 13.7 (for social recognition). Similar
results were found in the couple and group scores (Table
4.29), although smaller sample size (N=51 for couples;
N=39 for therapists) diminished significance levels.
The six significant therapist values and control
variables were tested for a predictive relation to the
alliance by standard multiple regression analysis (Tables
4.30-4.32). The results in tests of individual scores
(N=123) indicated positive prediction of therapeutic
alliance by therapists' values of a comfortable life
(beta=.32, p<.001) and forgiveness (beta=.42, p<.001)
77
with the R squared in both cases indicating explanation
of 40% of the variance (p<.001). The analysis also
showed a predictive positive relation of therapists'
value of intellectual qualities (beta=.43, p<.05) to
couple overall alliance and a negative relation of
ambition (beta=-.18, p<.05) to the individual alliance
scores. The predictive relation in individual scores was
greatest in the task dimension of the alliance (R
squared=.53, p<.001) for both comfortable life (beta=.34,
p<.001) and forgiveness (beta=.46, p<.001). The
predictive relation of these values was similar in couple
and group scores. The significant beta values for a
comfortable life ranged from .30 (bond dimension of both
individual and group scores) to .42 (overall alliance
couple score) for the various subsamples and dimensions
of the alliance. The range of beta weights for
forgiveness was from .28 (bond dimension of individual
scores) to .68 (task dimension of couple scores).
Forgiveness was the strongest predictor of therapeutic
alliance of any of the variables in the equation,
including demographic variables.
78
Table 4.1: Client Gender as Control Variable: ANOVA of Individual Alliance, Bond, Goal, Task, Terminal Similarity, Instrumental Similarity by Client Gender (M = 58; F = 62 )
Variable
Alliance
Bond
Goal
Task
Terminal Sim.
Instrumental Sim.
Deg. Freedom
1,119
1,119
1,119
1,119
1,118
1,118
Sig. of F
6.27 .014**
7.12 .009**
6.35 .013**
4.10 .045*
1.08 n.s.
.55 n.s.
*=p<.05; **=p<.01; ***=p<.001
79
Table 4.2: Therapist Gender as Control Variable: ANOVA of Couple Alliance, Bond, Goal, Task, Terminal Similarity, Instrumental Similarity by Therapist Gender (M=21; F=30)
Variable
Alliance
Bond
Goal
Task
Terminal Sim.
Instrumental Sim.
Deg. Freedom
1,49
1,49
1,49
1,49
1 ,50
1,50
Sig. of F
.02
.05
.10
.00
3.24
.53
n. s .
n. s .
n. s .
n. s .
n. s .
n. s .
80
Table 4.3: Therapist Gender as Control Variable: ANOVA of Group Alliance, Bond, Goal, Task, Terminal Similarity, Instrumental Similarity by Therapist Gender (M=18; F=22):
Variable
Alliance
Bond
Goal
Task
Terminal Sim.
Instrumental Sim.
Deg. Freedom
1,38
1,38
1,38
1,38
1,38
1,38
F
. 00
. 06
. 0 9
. 00
.35
.76
S i g . of F
n . s .
n . s .
n . s .
n . s .
n . s .
n . s .
81
Table 4.4: Length of Therapist Marriage as Control Variable Correlation of Therapist Years Married with Individual and Group Alliance, Bond, Goal, and Task Scores (N=40)
Individual Client Scores
Variable Alliance Bond Goal Task
Length of Therapist
Marriage -.26** -.23* -.20* -.26**
Group Client Scores
Variable Alliance Bond Goal Task
Length of Therapist
Marriage -.34* -.38* -.25 -.33*
*=p<.05; **=p<.01; ***=p<.001
82
Table 4.5: Client Importance of Religion as Control: ANOVA of Client Scores on Alliance, Bond, Goal, Task, Terminal Similarity, Instrumental Similarity by Religious Importance Grouping (Moderately or Less Important, N=59; Very Important, N=62)
Variable
Alliance
Bond
Goal
Task
Terminal Sim.
Instrumental Sim.
Deg. Freedom
,119
,119
,119
,119
,118
,118
F
2.48
1.41
5.05
1.65
4.76
5.11
Sig. of F
n. s .
n. s .
.026*
n. s .
.031*
.026*
*=p<.05; **=p<.01; ***=p<.001
83
Table 4.6: Therapist Importance of Religion as Control: ANOVA of Couple Scores on Alliance, Bond, Goal, Task, Terminal Similarity, Instrumental Similarity by Therapist Religious Importance Grouping (Moderately or Less Important N=10; Very Important, N=39)
Variable
Alliance
Bond
Goal
Task
Terminal Sim.
Instrumental Sim.
Deg. Freedom
1,47
1,47
1,47
1,47
1,49
1,49
F
2.63
2.71
.83
3.23
4.73
.662
Sig. of F
n . s .
n. s .
n. s .
n. s .
.034*
n . s .
*=p<.05; **=p<.01; ***=p<.001
84
Table 4.7: Length of Time in Therapy as Control: ANOVA of Individual and Couple Terminal and Instrumental Similarity by Groups with More than Twenty (Couple N=16; Individual N=49) and Less than Twenty (Couple N=33; Individual N=66) Sessions
Variable
Individual Terminal Similarity
Individual Instrumental Similarity
Couple Terminal Similarity
Couple Instrumental Similarity
Deg. Freedom F
1,113 7.25
1,113 4.99
1,47
1,47
5. 13
1.56
Sig. of F
.008**
.027*
.028*
n. s .
*=p<.05; **=p<.01; ***=p<.001
85
Table 4.8: Length of Time in Therapy as Control: Correlation of Length of Time in Therapy with Individual and Couple Terminal and Instrumental Similarity (N=49)
Variable Length of Time
in Therapy
Individ. Terminal Similarity .24**
Individ. Instrumental Similarity .21*
Couple Terminal Similarity .40**
Couple Instrumental Similarity . 27
*=p<.05; **=p<.01; ***=p<.001
86
Table 4.9: Hypothesis 1: Summary Table of Relation of Individual/Therapist Terminal Value Similarity and Therapeutic Alliance
Control Variable Alliance Bond Goal Task
None (N=48) .20* .18* .22* .17
Gender (N=117) .18* .17* .21** .16*
Male Clients (N=59) .37** .33** .39** .34**
Female Clients (N=63) .03 .02 .08 .01
Male Therapist (N=52) .53*** .40*** .55*** .52***
Female Therapist (N=70).01 .05 .02 -.02
Length Therapist
Marraige (N=112) .21** .19* .23** .18**
Importance of Religion (N=117) .18** .17* .19* .15
Less Religious Client (N=60) .33* .29* .32* .29*
Very Religious Client (N=62) .05 .04 .08 .03
Less Religious Therapist (N=26) .58**
Very Religious Therapist (N=96) .11
Length Therapy (N=117) .16* .14* .19* .14
*=p<.05; **=p<.01; ***=p<.001
87
Table 4.10: Hypothesis 2: Summary Table of Relation of Individual/Therapist Instrumental Value Similarity and Therapeutic Alliance:
Control Variable Alliance Bond Goal Task
None (N=48) .18* .18* .24** . 14
Gender (N=117) .17* .17* . 23** .13
Male Clients (N=59) .24 .27* . 33** .15
Female Clients (N=63) .09 .04 .13 .08
Male Therapist (N=52) .49*** .52*** .44*** .42**
Female Therapist (N=70)-.03 -.06 .08 -.06
Length Therapist Marraige (N=112) .18* .17* .24** .13
Importance of Religion (N=117) .17* . 17* . 22** .12
Less Religious Client (N=60) .30* 30* .41*** .20
Very Religious Client (N=62) .02 01 .02 .03
Less Religious Therapist (N=26) .18
Very Religious Therapist (N=96) .16
Length Therapy (N=117) .15* .14* .22* .10
*=p<.05; **=p<.01; ***=p<.001
88
Table 4.11: Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alliance with No Control Variables
Variable Alliance Bond Goal Task
Individ. Terminal Similarity (N=120) .20* .18* .22** .17
Individ. Instrumental Similarity (N=120) .18* .18* .24** .14
Couple Terminal Similarity (N=48) .20 .16 .27 .20
Couple Instrumental Similarity (N=48) .25 .20 .30* .24
Group Terminal Similarity (N=39) .21 .24 .27 .17
Group Instrumental Similarity (N=39) -.08 -.09 -.10 -.07
*=p<.05; **=p<.01; ***=p<.001
89
Table 4.12: Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alliance Controlling for Gender through Partial Correlation
Variable Alliance Bond Goal Task
Individ. Terminal Similarity (N=117) .18* .17* .21** .16*
Individ. Instrumental Similarity (N=117) .17* .17* .23** .13
Couple Terminal Similarity (N=42) .18 .14 .26* .18
Couple Instrumental Similarity (N=42) .26* .20 .30* .27*
Group Terminal Similarity (N=36) .21 .23* .27* .17
Group Instrumental Similarity (N=36) -.08 -.08 -.10 -.07
*=p<.05; **=p<.01; ***=p<.001
90
Table 4.13: Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alliance Controlling for Client Gender through Sample Selection
Male Individual Clients:
Alliance Bond Goal Task
Terminal Similarity (N=59) . 37** .33** .39** . 34**
Instrumental Similarity (N=59) .24 .27* . 33** . 15
Female Individual Clients:
Alliance Bond Goal Task
Terminal Similarity (N=63) .03 .02 .08 .01
Instrumental
Similarity (N=63) .09 .04 .13 .08
*=P<.05; **=p<.01; ***=p<.001
91
Table 4.14: Hypotheses 1 and 2: Critical Values for Test of Significance of Difference of Correlational Values for Male and Female Clients (Male N=59; Female N=63)
Variable Alliance Bond Goal Task
Terminal Similarity 1.93 1.74 1.79 1.85
Instrumental Similarity .83 1.27 1.41 .38
92
Table 4.15: Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alliance Controlling for Therapist Gender through Sample Selection
Male Therapists:
Alliance Bond Goal Task
Individ. Terminal Similarity (N=52) .53*** .40** .55*** . 52***
Individ. Instrumental Similarity (N=52) .49*** .52*** .44*** .42**
Couple Terminal Similarity (N=21) .48*
Couple Instrumental Similarity (N=21) .41
Group Terminal Similarity (N=17) .57**
Group Instrumental Similarity (N=17) .25
*=p<.05; **=p<.01; ***=p<.001
93
Table 4.15: Continued
Female Therapists:
Alliance Bond Goal Task
Individ. Terminal Similarity (N=70) .01 .05 .02 -.02
Individ. Instrumental Similarity (N=70) -.03 -.06 .08 -.06
Couple Terminal Similarity (N=29) .00
Couple Instrumental Similarity (N=29) .14
Group Terminal Similarity (N=22) .01
Group Instrumental Similarity (N=22) -.24
94
Table 4.16: Hypotheses 1 and 2: Critical Values for Test of Significance of Difference of Correlational Values for Male and Female Therapists (Male N=52; Female N=70)
Variable Alliance Bond Goal Task
Terminal Similarity 3.10 2.00 3.20 3.19
Instrumental Similarity 3.03 3.40 2.10 2.72
95
Table 4.17: Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alliance Controlling for Therapist and Client Gender through Sample Selection
Male Therapist, Male Client:
Alliance Bond Goal Task
Terminal Similarity (N=26) .51**
Instrumental Similarity (N=26) . 59***
Male Therapist, Female Client:
Terminal Similarity (N=26) .52**
Instrumental Similarity (N=26) .37
*=p<.05; **=p<.01; ***=p<.001
96
Table 4.17: Continued
Female Therapist, Male Client:
Alliance Bond Goal Task
Terminal Similarity (N=33)
Instrumental Similarity (N=33)
.30
.02
Female Therapist, Female Client
Terminal Similarity (N=37) -.23
Instrumental Similarity (N=37) -.10
*=p<.05; **=p<.01; ***=p<.001
97
Table 4.18: Hypotheses 1 and 2: Critical Values for Test of Significance of Difference of Correlational Values for Male and Female Therapists with Male and Female Alliance
Variable Male Alliance Female Alliance
Terminal Similarity .93 4.61
Instrumental Similarity 2.42 1.63
98
Table 4.19: Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alliance Controlling for Length of Therpaist's Marriage by Partial Correlation
Variable Alliance Bond Goal Task
Individ. Terminal Similarity (N=112) .21** .19* .23** .18*
Individ. Instrumental Similarity (N=112) .18* .17* .24** .13
Couple Terminal Similarity (N=42) .21 .17 .30* .21
Couple Instrumental Similarity (N=42) .25* .19 .30* .26*
Group Terminal Similarity (N=35) .27* .30* .31* .22
Group Instrumental Similarity (N=39) -.08 -.09 -.09 -.07
*=p<.05; **=p<.01; ***=p<.001
99
Table 4.20: Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alliance Controlling for Importance of Religion by Partial Correlation
*=p<.05; **=p<.01; ***=p<.001
Variable Alliance Bond Goal Task
Individ. Terminal Similarity (N=117) .18** .17* .19* .15
Individ. Instrumental Similarity (N=117) .17* .17* .22** .12
Couple Terminal Similarity (N=43) .13 .08 .25* .13
Couple Instrumental Similarity (N=43) .23 .17 .28* .23
Group Terminal Similarity (N=36) .14 .17 .21 .09
Group Instrumental Similarity (N=36) -.16 -.15 -.16 -.14
100
Table 4.21: Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alliance Controlling for Client Importance of Religion through Sample Selection
Religion Moderately or Less Important:
Alliance Bond Goal Task
Individ. Terminal Similarity (N=60) . 33** .29* . 32** .29*
Individ. Instrumental Similarity (N=60) .30* .30* .41*** .20
Religion Very Important:
Individ. Terminal Similarity (N=62) .05 .04 .08 .03
Individ. Instrumental Similarity (N=62) .02 .01 .02 .03
*=p<.05; **=p<.01; ***=p<.001
101
Table 4.22: Hypotheses 1 and 2: Critical Values for Test of Significance of Difference of Correlational Values for Client Importance of Religion
Variable Alliance Bond Goal Task
Terminal Similarity 1.57 1.39 1.35 1.44
Instrumental Similarity 1.55 1.60 2.22 .93
102
Table 4.23: Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alliance Controlling for Therapist Importance of Religion through Sample Selection
Religion Moderately or Less Important
Alliance
Individ. Terminal Similarity (N=26) .58**
Individ. Instrumental Similarity (N=26) .18
Couple Terminal Similarity (N=9) .52
Couple Instrumental Similarity (N=9) .04
Group Terminal Similarity (N=9) .54
Group Instrumental Similarity (N=9) -.08
*=p<.05; **=p<.01; ***=p<.001
103
Table 4.23: Continued
Religion Very Important:
Alliance
Individ. Terminal Similarity (N=96) .11
Individ. Instrumental Similarity (N=96) .16
Couple Terminal Similarity (N=41) .11
Couple Instrumental Similarity (N=41) .30
Group Terminal Similarity (N=30) .01
Group Instrumental Similarity (N=30) -.23
*=P<.05; **=p<.01; ***=p<.001
104
Table 4.24: Hypotheses 1 and 2: Critical Values for Test of Significance of Difference of Correlational Values for Therapist Importance of Religion
Variable Individual Alliance
Couple Alliance
Group Alliance
Terminal Similarity 2.40 2.41 2.91
Instrumental Similarity .39 1.35 . 74
105
Table 4.25: Hypotheses 1 and 2: Correlational Tests of Relation of Value Similarity and Therapeutic Alliance Controlling for Length of Time in Therapy
Variable Alliance Bond Goal Task
Individ. Terminal Similarity (N=117) .16* .14* .19* .14
Individ. Instrumental Similarity (N=117) .15* .14 .22** .10
Couple Terminal Similarity (N=45) .14 .11 .23 .12
Couple Instrumental Similarity (N=45) .21 .16 .27* .20
Group Terminal Similarity (N=35) .26 .29* .31* .20
Group Instrumental Similarity (N=35) -.03 -.03 -.06 -.01
*=P<.05; **=p<.01; ***=p<.001
106
Table 4.26: Hypothesis 3: Correlational Tests of Relation of Therapist's Values and Individual Therapeutic Alliance
Variable Alliance (N=123)
Terminal Values
Comfortable Life
Sense of Accomplishment
Social Recognition
Instrumental Values:
Ambitious
Forgiving
Intellectual
.25**
-.22**
-.28**
-.31***
.22*
.19*
*=p<.05; **=p<.01; ***=p<.001
107
Table 4.27: Hypothesis 3: Intercorrelation of Therapist Values Significantly Correlated with Therapeutic Alliance
Comfort Forgive Intel Sense Social Ambition
Lif
Comfort Lif
Accomp Rec
-.23** -.20** .26** .11 .07
Forgive
Intel
-.54*** -.10 -.24** -.29***
.16* -.13 .09
Sense Accomp .19* . 27***
Social Rec . 51***
*=p<.05; **=p<.01; ***=p<.001
Comfort Lif = Comfortable Life; Forgive = Forgiveness ; Intel=Intellectual; Sense Accomp=Sense of Accomplishment; Social Rec=Social Recognition
108
Table 4.28: Hypothesis 3: Mean Therapist Ranking of Values Significantly Correlated with Therapeutic Alliance (N=39; Highest Rank=l, Lowest=-18)
Mean Rank
Terminal Values:
Comfortable Life 12.7
Sense of Accomplishment 8.7
Social Recognition 13.7
Instrumental Values:
Ambitious 11.9
Forgiving 6 . 5
Intellectual 11.9
109
Table 4.29: Hypothesis 3: Correlational Tests of Relation of Therapist's Values and Couple and Group Therapeutic Alliance
Couple Group
Therapist
Terminal Values:
Alliance (N=51) Alliance (N=39)
Comfortable Life .26* . 39**
Sense of Accomplishment -.27* -.25
Social Recognition -.30* -.36*
Therapist
Instrumental Values
Ambitious
Forgiving
Intellectual
-.31**
.27*
.16
-.35*
.27
-.28
*=p<.05; **=p<.01; ***=p<.001
110
Table 4.30: Hypothesis 3: Standard Multiple Regression Analysis of the Prediction of Therapeutic Alliance from Therapist Demographics and Values Significantly Correlated with Individual Therapeutic Alliance (N=123)
Alliance Bond Goal Task
Demographic Variables:
G®^^®^ -.09 -.12 -.05 -.08
Years Married -.30*** -.27** -.23* -.31***
Importance of Religion -.27** -.18 -.23* -.30***
Length of Therapy .10 .14 .09 .08
Terminal Values:
Comfortable Life .32*** .30** .21* .34***
Sense of Accomplishment -.13 -.14 -.10 -.12
Social Recognition -.10 -.16 -.05 -.08
Instrumental Values:
Ambitious -.18* -.21* -.13 -.17
Forgiving .42*** .28* .40** .46***
Intellectual .18 .18 .09 .20
R .63 .60 .51 .64
R Squared .40*** .36*** .26*** .40***
Adjusted R Squared .35 .30 .20 .35
*=P<.05; **=p<.01; ***=p<.001
111
Table 4.31: Hypothesis 3: Standard Multiple Regression Analysis of the Prediction of Therapeutic Alliance from Therapist Demographics and Values Correlated with Couple Therapeutic Alliance (N=51):
Alliance Bond Goal
Demographic Variables:
Gender . n
Years Married -.33**
Importance of Religion -.34*
Length of Therapy
Terminal Values:
Comfortable Life
.14
.42**
Sense of Accomplishment -.26
Social Recognition
Instrumental Values
Ambitious
Forgiving
Intellectual
-.02
-.19
.68***
.43*
.14
.38*
.26
-.09
Task
. 13
- . 3 2 *
- . 2 8
- . 1 2
- . 3 2 *
- . 2 5
- . 0 9
- . 3 2 *
- . 3 9 * *
-.18
.50**
.14
.40**
-.24
-. 14
.40
-.25
. 68**
.44*
.17
.41**
-.25
-.05
-.20
.68***
.38
R
R Squared
Adjusted R Squared
.72
.51***
.39
.67
. 44**
.30
.65
.43**
.29
.72
.53***
.41
*=P<.05; **=p<.01; ***=p<.001
112
Table 4.32: Hypothesis 3: Standard Multiple Regression Analysis of the Prediction of Therapeutic Alliance from Therapist Demographics and Values Correlated with Group Therapeutic Alliance (N=39)
Alliance Bond Goal Task
Demographic Variables:
Years Married -.31** -.33** -.24 -.29*
Importance of Religion -.46*** -.40** -.46** -.45***
Terminal Values:
Comfortable Life .34* .30* .24 .38**
Instrumental Values:
Ambitious -.23 -.26 -.20 -.18
Forgiving .52*** .39** .53** .54***
R .77 .72 .68 .77
R Squared .60***.51*** .39*** .60***
Adjusted R Squared .53 .44 .39 .53
*=p<.05; **=p<.01; ***=p<.001
113
CHAPTER V
DISCUSSION AND CONCLUSION
This study has examined some of the interpersonal
variables which inevitably affect therapist/client system
interaction through therapist use of self (Keeney, 1983)
and choice among treatment alternatives (Alexander et
al., 1976; Beutler, Crago, & Arizmendi, 1986; Lankton &
Lankton, 1983; Watzlawick, Weakland, & Fish, 1967). The
final chapter will review and discuss the theoretical and
hypothetical context of the study, its limitations,
possible interpretations of the results, and concluding
reflections for therapeutic process, training, and
therapist development.
Theoretical and Hypothetical Context
A number of both theoretical and empirical studies
have demonstrated that there is no value-free therapy
(Alexander et al., 1983; Aponte, 1985; Bergin, 1985;
London, 1954; Nichols, 1984; Norcross & Wogan, 1987;
Walrond-Skinner, 1987) as reviewed by Beutler, Crago, and
Arizmendi (1986) and most recently by Doherty and Boss
(1991). The studies to date have left unanswered
questions concerning whose values affect therapy, which
114
ese
values should be allowed or affirmed in the therapeutic
process, and especially how values affect therapy. Th
questions have become more specific in light of existing
research in therapeutic process and outrome (Wynne,
1988), values operation in human interaction (Rokeach,
1973), and attecipts to identify viable process variables
for clinical study (Pinsof, 1988).
The theoretical and research context of values
operation in this study was provided by research
utilizing the Rokeach (1973) Value Survey, most notably
the research of Beutler (1971, 1979, 1981, 1983) and
colleagues (Beutler et al., 1983; Beutler et al., 1986;
Beutler, Dunbar, & Baer, 1980; Beutler, Pollack, & Jobe,
1978). These studies and theoretically generated
expectations concerning the operation of values in
therapy (Bergin, 1980, 1985; Frank, 1973; Strupp, 1973b,
1980) have led to increasing focus on therapist/client
value similarity as a potentially significant variable in
therapy. The ambiguities remaining from these studies
(Arizmendi et al., 1985) led to one of the two questions
underlying this study: what is the contribution of
therapist/client system value similarity to the
therapeutic process? But this left an unspecified
115
question concerning the operational identification of a
variable representing therapeutic process.
The theoretical and research context of process
variable identification was provided by the extensive
study (Horvath & Luborsky, 1993) of the therapeutic
alliance, a process variable which has been associated
with outcome with remarkable consistency (Pinsof, 1988).
The alliance became amenable to systemic study by way of
the theoretical work of Bordin (1976) and took form in
specific measures through the work of Pinsof and
Catherall (1986). These advances gave more specific form
to the question in this study: what is the contribution
of therapist/client system value similarity to the
therapeutic alliance?
The therapeutic alliance literature also led to a
specific form of the question concerning which values
should affect therapeutic process. The difficult issue
in this regard concerned the overriding interest of
therapists that harm be avoided (Becvar, Becvar, &
Bender, 1982) and that any values endorsed in therapeutic
process be acknowledged honestly rather than imposed
covertly (Aponte, 1985; Bergin, 1985; Lebow, 1981;
Seymor, 1982). Clearly, from the research on the
therapeutic alliance, if a set of therapist values
116
predicts a robust contributor to client well being, the
therapeutic alliance, those values could at least be
suggestive for further study and perhaps tentatively
endorsed as a positive factor in therapeutic process. Is
there then a set of therapist values which predicts
therapeutic alliance?
The hypotheses were generated from these questions
and existing research. The impact of value similarity
was examined in light of distinctions between the
differential effect of terminal (end states of existence)
and instrumental (behavioral or attitudinal means to
desired ends) value similarity in the outcome studies of
Beutler (1971, 1979, 1981, 1983) and colleagues (Beutler
et al., 1983; Beutler et al., 1986; Beutler, Dunbar, &
Baer, 1980; Beutler, Pollack, & Jobe, 1978). Although
this research has found for the positive effect of
therapist/client value dissimilarity, theoretical
literature (e.g., Bergin, 1985) has consistently
supported the expectation that similarity of values would
contribute to positive outcome.
These contradictory results of theoretical and
empirical work left difficulties in formulating the
hypothesized direction of results. Analyses by Arizmendi
(1983) suggested that a combination of similarity of
117
instrumental and dissimilarity of terminal values would
contribute to positive outcome. Hypotheses for this
study were formulated around these analyses. First, it
was hypothesized that therapist/client terminal value
similarity would be negatively related to therapeutic
alliance. Second, it was hypothesized that
therapist/client instrumental value similarity would be
positively related to the alliance. And third, it was
hypothesized that there are therapist values which
predict therapeutic alliance.
Limitations of the Study
A review and interpretation of the results of this
research must take into account some important
limitations in the study. These include limitations in
sampling, demographic distributions, and the number of
control variables necessary to test for results.
The sample is large in terms of frequently
encountered samples in similar studies involving less
than thirty therapists paired with one client unit each
(Alexander & Luborsky, 1986; Arizmendi et al., 1985;
Pinsof & Catherall, 1986), but there were sampling
limitations which should be noted. The therapists were
drawn exclusively from AAMFT clinical, student, and
118
associate members, which omits large segments of couple
therapists such as ministers, professional counselors,
psychologists, social workers and others who may not be
associated with AAMFT. This could account for some
skewness in demographic distribution. For example, 75%
of therapists considered religion very important compared
with 50% of the client sample; it is not impossible that
this represents a difference in the AAMFT membership from
which the sample was drawn.
There was also a limitation imposed by the use of
inducement in recruitment. This could have affected the
kind of therapeutic alliance represented in the sample.
Pinsof and Catherall (1986) report a generally positive
skew in existing studies, whereas in this study there was
a slight negative skew. Therapists involved in
recruiting their clients may have conveyed a sense of
impatience (the award of the inducement was limited to
the first 35 participants) which affected the alliance.
The primary sampling limitation was one which is
almost inherent in this kind of extensive clinical
research. There were four demographic variables for
which test controls were necessary in order to achieve a
balanced statistical picture of results, and the relation
of these variables to the variables under study is
119
discussed below. The existence of these variables,
particularly in light of their strength and significance
relative to the primary research variables, must be
considered as part of the overall interpretation of the
data. Indeed, demographic significance does not, in a
clinical study of this kind, come as a surprising but
rather as an expected part of the overall matrix of the
therapeutic enterprise.
This is the nature of clinical research conducted
from a systemic perspective (Pinsof, 1988), in which
multiple therapist, client, and environmental factors
affect the process and outcome of therapy. Indeed,
recent concensus among marriage and family therapy
researchers (Wynne, 1988) has called for studies which
are not only confirmatory but exploratory in design. The
proliferation of the variables affecting therapy
emphasizes the need to define through these explorations
the operational parameters of clinical research.
Although the design of the present study is primarily
confirmatory, the strength and significance of these four
demographic variables is an example of the kind of
discovery available in the exploratory dimension of any
clinical process research.
120
The limitation imposed by demographic significance
as well as limitations of sample size and distribution in
clinical research do call for increased emphasis on the
value of repetition, variation, and expansion in
research. The systemic clinical researcher must, due to
the multifactorial nature of the objects of inquiry, be
aware that this research is itself part of a process of
ongoing questioning, discovery, testing, and correction
of results. This means, very specifically in terms of
this study, that the results must be taken seriously as
suggestions for further study and for cautious clinical
application but can not be taken as widely generalizable
indications of dogmatic research based prescription.
Review and Interpretation of Results
The study found that there are positive
relationships between therapist/client value similarity
and therapeutic alliance and that there are therapist
values which predict therapeutic alliance. The first two
hypotheses concern value similarity in relation to
therapeutic alliance and the third concerns therapist
values in relation to the alliance. Since these
represent two different but related sets of issues they
will be discussed separately. The demographic findings
121
will be discussed in terms of their relevance to the
hypotheses and primary variables in the study.
Value Similarity and Therapeutic Alliance: Hypotheses 1 and 2
Tests of the first and second hypotheses found a
moderately positive relationship between value similarity
and therapeutic alliance, disconfirming the first and
partially confirming the second hypotheses. The findings
in relation to the first hypothesis are somewhat
surprising from the standpoint of the research of Beutler
(1971, 1979, 1981, 1983) and colleagues (Beutler et al.,
1983; Beutler et al., 1986; Beutler, Dunbar, & Baer,
1980; Beutler, Pollack, & Jobe, 1978) who have found that
initial disparity between therapist and client values
along with convergence between therapist and client
values predict or correlate with various aspects of
positive outcome. This study indicates that similarity
rather than disparity is associated with a positive
therapeutic variable such as therapeutic alliance.
There is one aspect of the demographic findings
which may contribute to a raproachment of these two
conclusions. The significant difference between the
terminal and instrumental value similarity of those with
more (N=42) and less (N=72) than 20 sessions of therapy
122
may tend to confirm the findings of previous research
concerning convergence of therapist and client values in
the course of treatment. There was no relation between
length of therapy and the therapeutic alliance,
confirming previous studies (Gutterman, 1984; Horvath &
Luborsky, 1993) which indicated that the alliance can be
ruptured and repaired (Bordin, 1979) but is relatively
stable. The relation of time to value similarity,
however, could could have depressed terminal value
dissimilarity between therapist and client in the early
stages of therapy. From this standpoint, then, any
suggestion of results contrary to Beutler's (1971, 1979,
1981, 1983) would necessitate not only measures of
similarity but of convergence, of differences of
similarity at different times in the therapeutic process.
The differences between the theoretical and research '
based expectations, and between hypothesized and actual
results in this study, may also be interpreted in light
of a systemic understanding of therapist and client
interaction. The results of this study in combination
with the work of Beutler (1971, 1979, 1981, 1983) and
colleagues (Beutler et al., 1983; Beutler et al., 1986;
Beutler, Dunbar, & Baer, 1980; Beutler, Pollack, & Jobe,
1978) and the theoretical work on the relation of values
^
123
and therapeutic process (Bergin, 1980, 1985; Frank, 1973;
Patterson, 1989; Strupp, 1980) leads to conclusions very
similar to those of Arizmendi and colleagues (1985).
There is a relation of therapist/client value similarity
and positive therapeutic process as represented in a
variable such as therapeutic alliance. But what is the
place of this similarity in the process, in relation to
which specific values, for which persons?
The data in this study contribute a major answer to
some of the questions in terms of the goal formation of
therapy. It is striking among the number of tests
performed on the data that value similarity consistently,
without one exception, correlates most highly and
significantly with the goal dimension of therapeutic
alliance. That this would be expected does not diminish
the importance of this finding, which strongly suggests
that a part of therapeutically and perhaps ethically
effective therapy should include an assessment of the
goodness of fit (Lerner & Lerner, 1983) between therapist
and client regarding the goals of therapy. The ^
importance of value similarity for this dimension of the
alliance not only indicates the need for this kind of
clinical honesty but could also explain many cases of
early attrition from therapy.
124
The positive dimension of value similarity in
therapeutic alliance may not represent the whole picture,
however. Are there cases in which values similarity may
have a negative as well as positive effect on the
therapeutic alliance, cases in fact where a high degree
of values similarity could seriously erode the alliance?
Might it be difficult, for example, for a military
counselor and a previously AWOL client to form a trusting
therapeutic alliance if they each placed high value on
loyalty to the military organization which prescribes
punishment of AWOL soldiers? Or value similarity could
be destructive to the goals of the alliance if the values
a client shares with a therapist are those of a parent
and the client is struggling with differentiation issues
(Bowen, 1978).
It is at these and similar points in the therapeutic
process important that the therapist also present the
challenge (Minuchin, 1982) of a cognitive (Festinger,
1957), spiritual (Bergin, 1985), or other value
difference as a stimulus to change. There are times when
this change may be represented by movement from
inconsistency to consistency between behavior and
existing values (Johnson, 1980). But the change must
also include a "difference that makes a difference"
125
(Bateson, 1972) between therapist and client in some
crucial value alternative.
The possible importance of value differences does
not eradicate the positive effect of value similarity,
but the interaction of similarity and difference
definitely suggests explicitly processed understanding of
the role of specific values in the therapeutic alliance.
It is at this point that Aponte's (1985) suggestion that
values be negotiated in therapy could be particularly
useful. In addition to his suggestion, other values
assessment could be useful. This could include
assessment of values contradictions (e.g., mature love as
a high terminal value while loving is a low instrumental
value), the exclusion of a group of values (e.g., no
value placed on pleasure), the obsession or compulsions
revolving around a value (e.g., national security) at the
expense of others' well being, or a conflict between
needs (e.g., to eat and pay bills) and value sets (e.g.,
low value on work with high value on pleasure).
The issue of interacting similarity and difference
suggest that values function systemically, as indicated
in the taxanomical discussion in Chapter III, in
interactional synergy and mutual interdefinition. Such
an understanding would not lead to the expectation of a
126
clearly defined existence of similarity or dissimilarity
alone in positive correlation with therapeutic alliance.
Systemic perspective would lead one to expect the kind of
results found in this study, that value similarity is
positively correlated with therapeutic alliance but that
elements of value difference are also important in the
therapeutic process.
The relation of the three significant demographic
variables to the hypotheses is important for
interpretation of results in two directions. On the one
hand these demographics may indicate the predisposition
of some therapists toward stronger therapeutic alliance
than others. On the other hand, some demographic effects
may mitigate the strength of the results somewhat. The
relation of gender, importance of religion, and the
length of the therapist's marriage may combine to
indicate the need in therapy to focus on the relationship
with the client rather than a program for the client.
The study is not inconsistent with the suggestions
in other studies (Bem, 1975; Petry & Thomas, 1986) that
androgeny contributes positively to therapeutic
relationships. It is possible that female therapists
convey a more nurturant quality to clients than male
therapists or that female therapists are more capable of
127
demonstrating the role flexibility which some (Beutler,
Crago, & Arizmendi, 1986; Petry & Thomas, 1986) have
found to be important to effective therapy. Some studies
(Gilbert, 1981; Taylor & Hall, 1982) have questioned the
utility of androgeny in assessing therapeutic
relationships. Long (1989) suggested study of gender
roles in terms of dominant (masculine) and nurturant
(feminine) qualities. The results of this study suggest
that an androgenous incorporation of nurturant values
flexibility in male therapists could enhance the
therapeutic relationship.
It is possible also that length of marriage
contributes to an actual or perceived rigidity in the
therapist which could detract from the alliance
considerably. The experience of Twelve Step approaches
to recovery processes have demonstrated (Nace, 1992) that
commonality of therapist/client experience can be an
important ingredient in the therapeutic process. The
length of marriage could detract from couple therapeutic
alliance, specifically, by decreasing the chronological
proximity of the therapist's life situation from that of
the client; the client of a therapist with longer
marriage may feel less kinship in marital struggles than
with a newly or recently married therapist.
128
It is interesting that the importance of religion
has effects opposite those one might expect from popular
perceptions linking religiosity with rigidity. Araong
those for whom religion was less important, terminal
value similarity was highly correlated with therapeutic
alliance; among more religious persons there was no
significant correlation. The results suggest that there
is a kind of importance of religion which contributes to
therapeutic alliance regardless of value differences
between therapist and client. Perhaps further research
may find what has been suggested in some alcohol recovery
(Brown, 1985; Prezioso, 1987) and other studies (Fowler,
1981; Worthington, 1989), that beyond a certain point of
maturation spirituality contributes to rather than
detracts from flexibility and capacity to relate to
others regardless of similarity or difference of values.
Indeed there are those (Tillich, 1963a, 1963b) who would
affirm that genuine spirituality fosters the ability to
transcend one's values for a higher value. This
demographic variable may reflect that possibility.
The interaction of demographic variables and the
results of the study are suggestive for the client
perception of therapeutic process as well. Client
characteristics which contribute to positive (compliance
129
based) or negative (resistance oriented) experiences of
therapy have been studied extensively elsewhere
(Garfield, 1986). The effects of therapist
characteristics such as religiosity, length of marriage,
and perhaps even gender may also indicate the existence
of client predisposition to experience therapeutic
alliance differently in relation to these therapist
characteristics.
Therapist Values in Therapeutic Alliance: Hypothesis 3
The study found that there are values which are
positive and negative predictors of the therapeutic
alliance. From a positive standpoint, client therapeutic
alliance scores can be predicted by therapists' value of
their own safety needs (Maslow, 1970) and well being
(comfortable life), acceptance (forgiveness), and a
studied response to life (intellectual). From a negative
standpoint, social ascendency values (Beutler, Crago, &
Arizmendi, 1986) represented by a sense of
accomplishment, social recognition, and ambition are
negative predictors of the alliance.
One of the most striking results is the fact that
the task dimension of the therapeutic alliance is
consistently most powerfully predicted, across
130
s individual, couple, and group scores, by the therapist'
value of comfortable life and particularly forgiveness.
It is necessary to recall that for Catherall and Pinsof
(1986) the task dimension of the alliance measures the
clients' perception of therapist skills and ability to
collaborate with the therapist in the tasks of therapy.
At times, marriage and family therapy has been technique-
oriented perhaps to increase client confidence in
systemic skills. This study lends weight to previous
indications (Beutler, Crago, & Arizmendi, 1986) that
therapist personal factors such as values are at least as
important in client perception of skill as technique.
Indeed, these personal factors accounted in this study
for at least 40% of the variance in the skill-measuring
dimension of the therapeutic alliance. Specifically, the
therapist's value of well being (comfortable life) and
acceptance (forgiveness) predict client positive scores
on the skill dimension of the therapeutic alliance.
One important factor in the interpretation of the
findings from the third hypothesis is the understanding,
developed by Rokeach (1973), that these values achieve
meaning in relation to one another rather than in
isolation. Thus, for example, both Churchill and Hitler
might place a high value on freedom. But Hitler would
131
place a very low value on equality whereas Churchill
would place high value on equality, along with freedom.
Freedom would have very different meanings in the two
cases.
This is especially important in relation to the
meaning of the negative and positive predictors of
therapeutic alliance in this study. A sense of
achievement, for example, can be a very positive
contributor to relationships, certainly a value one would
expect to predict positive therapeutic alliance. It is
in relation to the other two negative predictors, social
recognition and ambition, that valuing a sense of
achievement becomes meaningful as a negative predictor of
the alliance. Taken together, these values would
represent a perception of clients as means to the ends of
achieving the therapist's own gratification.
The positive predictors of the alliance are
important in their relation to one another as well as
independently. For example, forgiveness, if valued for
itself and in isolation, represent the kind of acceptance
without challenge which could leave clients feeling
discounted in their desire to change or grow rather than
allied with the therapist around the therapeutic task.
Taken in relation to each other, however, the values of
132
forgiveness, comfortable life, and intellectual qualities
represent an interdependent acceptance, affirmation, and
reflective pursuit of human fulfillment both in oneself
and in clients. These values taken as a whole are
somewhat suggestive of what Rogers (1957) called "The
necessary and sufficient conditions of therapeutic
personality change" (Rogers, 1957, p.95) in an
unconditional but studied positive regard for oneself and
for the client.
One might press the matter of value synergy and
interdefinition even further to say that the negative and
positive predictors of the alliance combine to point to
respect for the client and for oneself as salient
features of therapist values which contribute to the
alliance. The predictive power of these values in
combination suggest that the most important therapist
value in therapeutic alliance is the value of oneself and
of other persons. And in combination with the
significance of various demographics as discussed above,
this study leads one to conclude that the strongest
therapeutic alliance is related to therapists' placing
higher value on persons than on values themselves, on
well being than on prescriptions, and on life development
than on life regulation.
133
Conclusion
This study examined the person of the therapist in
therapeutic process in marital therapy with the intention
of identifying salient areas for the improvement of
therapeutic health care delivery. These areas of study
were specified in terms of variables which research
and/or theoretical considerations found important to the
fulfillment of this intention. The variables were value
similarity, therapist values, and therapeutic alliance.
The study showed that values are significant in
therapeutic alliance. It demonstrated specifically that
value similarity is positively related to therapeutic
alliance. The study found that therapist values which
represent acceptance, well being, and reflective life
predict positive therapeutic alliance. And the findings
are consistent with the the therapeutic importance of a
transcendance of values in the value of the person.
There are two major suggestions which emerge from
this study for marriage and family therapy training and
for further study. These concern the person of the
therapist and the therapist's valuing of the client
respectively.
134
First, the person of the therapist is indeed a
factor in the therapeutic process and must be cared for
as such. And this raises a large spectrum of questions
for further study in the areas of training, clinical
research, and therapist well being. If the person of the
therapist is, in relation to values and other variables,
important to the therapeutic process, in what ways might
training programs successfully and ethically assist the
therapist's personal as well as professional development"?
Could the model of the scientist-practitioner have
neglected value development of the person involved in
both science and practice?
This first conclusion attests to the need for
therapist personal growth and well being (Piercy &
Wetchler, 1986). This is not a demand for psychological
or any other kind of perfectionism, however. The study
is rather consistent with an understanding that the very
imperfection, the very joining of the client at the edges
of the authenticating and healing work of persuing human
fulfillment, may be important for positive therapeutic
processes. It has long been the experience of Alcoholics
Anonymous (Anonymous, 1939) that the recovery process
depends on the inner experience of unity between helper
and helped. This study indicates that the person of the
135
therapist, precisely at the points of growth and
development, can contribute to therapeutic alliance and
so to therapeutic process.
The ways in which therapeutic use of self can be
productively activated in therapy remains for other
studies. Whether therapist involvement in the
therapeutic process should be deliberate or inadvertent,
explicit or implied in the milieu of interactional
respect, directive by use of personal example or
nondirective are important questions arising from this
study. And whether the explicit advocation of therapist
values (e.g., for responsibility or family security)
would be positive or negative in therapy may depend on
the client and perhaps on value similarity, but this
remains also to be seen. What this study has shown is
that the self of the therapist in the form of therapist
values will be a part of the therapeutic process and that
the self of the therapist is inextricably intertwined
with the quality of the therapeutic alliance. Therefore,
these values should be both cared for and be part of the
conscious awareness of the therapist in her or his work.
Therapists must be increasingly aware of their own
value biases. Values which are inadvertently or
deliberately obscured will, as in any communication
136
process (Watzlawick, Weakland, & Fisch, 1967), affect the
therapeutic alliance and so the therapy in ways which are
unwieldy, inaccessible to ethical or other reflection,
and possibly inadvertently destructive to the therapeutic
process. This awareness of one's values could take forms
such as an investigation of values drawing on the best
resources of social science and philosophy (Schwarz,
1989, 1990), a utilization of supervisory training to
unearth value influence, or simply therapist reflection
on the influence of values in one's practice. But as
recent contributions of the feminist movement have
demonstrated (Walters, Carter, Papp, & Silverstein,
1988), covertly impacted but unacknowledged value
influence can be highly destructive.
This awareness would lead necessarily to a new
perspective on some of the traditionally difficult
ethical questions for marriage and family therapy,
especially questions of deception or concealment of
material germane to client well-being. As stated in a
recent review (Douherty & Boss, 1991) of ethical and
value issues therapy:
Given the universality of therapist influence on clients, and given the therapist's continual decisions about what to disclose, what are the ethics of concealment? (Douherty & Boss, 1991, p. 617).
137
In previous discussions (cf., e.g., Becvar & Becvar,
1982; Watzlawick, Weakland, & Fisch, 1974) concerning
manipulation in therapy, writers have pointed out that it
is impossible not to manipulate in ways which at least
partly conceal the full range of the therapist's
information, assessment, technique, or intention. But
the clear influence of therapist values in therapeutic
alliance demonstrated in this study strongly suggests
that at some level the best of therapeutic ethics would
demand value disclosure to clients just as surely as the
same ethical considerations demand training or fee
disclosure.
The second conclusion of this study is that the
therapist's value of the person, both of oneself and of
the client, is directly and positively linked to
effective therapeutic process as represented in
therapeutic alliance. This conclusion is drawn not only
the results of this study but from the overall conclusion
of marriage and family therapy that points to the value
of the person as a theoretically and empirically
demonstrated sine qua non of effective therapy. Several
factors in this study are consistent with this
understanding. The absence of significant relations
between value similarity and therapeutic alliance in
138
females may suggest the importance of nurturance beyond
value similarities or differences. The absence of a
significant relation between value similarity and the
strongly religious suggests a spiritual perspective of
the client which transcends value differences. The
negative relation of possible client-perceived rigidity
in longer married therapists may indicate the need for a
relation with clients which goes beyond the defined value
sets perhaps characteristic of therapists with longer
marriages. The prediction of lower therapeutic alliance
scores in therapists with social ascension values and
higher scores from values reflecting care for and the
value of self and others strongly suggests the importance
of values which transcend material, social, or other
concerns for the value of the person. These findings
combine to suggest the importance of valuing the client
above a rigid set of values imposed from outside the
client's life, perspective, needs, and resources.
This conclusion indicates that none of a wide
variety of value sets is more important in therapy than
the value of the person. An explicit elevation of the
value of the client above other therapist values,
particularly in areas where there are value differences,
could be clinically essential to positive therapeutic
139
alliance. The importance of maintaining the value of the
client above other therapist values could also be an
indicator of cases where referral would be more
appropriate than attempting to force an alliance in a
situation where value differences are likely to threaten
the higher value of the client. It is also possible that
this ability to value the person above idiosyncratic
liberal or conservative, material or spiritual,
Republican, Democratic, or other value sets could
indicate those who show the most promise as therapists.
This submission of some values to the higher value
of the person would represent the incorporation into
therapeutic process of the dynamic interaction of values
found in nearly all human helping interaction. This can
be seen in a military medic who hates screams of pain but
cares for a wounded soldier, a mother who detests her
child's messiness but cares for the child more than for
household order, or the therapist who may hate the
substance abuse of a client but respond to the cient as
more valuable even than the abstinence the therapist also
values.
Such an explicit transcendance of values for the
value of the person could retrieve some of the most long
standing traditions of effective healing and therapeutic
140
presence. It could bring echoes of others who have
affirmed the value of the person greater than the value
of caste (Ghandi), greater than the values of cultural
repression (Freud), greater than the value of unending
peace (Lincoln), even greater than the value of
righteousness itself (Jesus).
141
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APPENDIX A
DEMOGRAPHIC QUESTIONS
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1-7 Participant Number;
INSTRUCTIONS: Thank you for participating in this research! Your answers will
be completely confidential and is assured by the anonymous numbering system. There are no right or wrong answers, only what is true for you, but hopefully your honest answers will help therapists who read the results of this study to provide more effective service. It is important that you answer each question, although you may find some of the answers difficult to decide. Thank you for your time and contribution to marital therapy!
8 Your sex:
male female
9-10 Date of birth: L L
11 Marital status:
_single divorced widowed married
12-13 Date of marriage (if married): L L
14 Previous marriages (number):
15-16 Number of children:
17-18 Number of children living with you:
19 Education (highest level):
elementary high school • -, .. x professional (e.g., nursing, electrical, etc.) college (some) college (degree) graduate
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20-21 Your present occupation:
.not employed
.sales
.clerical
.manager
.student
.professional
.farmer/rancher
.blue collar
.homemaker
.student part time, work part time
22 Present religious affiliation or preference:
Catholic Protestant/Chri Sti an Jewish Other (specify)
23 To what extent is religion important to you?
not at all mildly mode rate1y strongly
24 Number of sessions in therapy:
one to four five to ten eleven to twenty more than twenty
25 Length of previous therapy:
none .one year or less more than one year
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(The following questions are to be completed by therapists only.)
26 Professional status:
LPC psychologist psychiatrist LMFT social work other (specify)
27 AAMFT status:
.does not apply
.student member
.clinical member
.supervisor
28-29 Training:
in progress (specify Ph. D., M.S., etc.) M.S. Ph.D. .M.D. .other (specify)
30 Theoretical orientation:
.behavior focus (strategic, solution focused, MRI, etc.) structure focus (structural, feminist, exchange based, etc, .psychodynamic focus (psychoanalytic, developmental) .interaction focus (communication, experiential) .spiritual focus (pastoral care, twelve step) .integrated .other (specify)
31 Primary practice setting:
.training program
.private practice
.agency (MHMR, counseling agency, etc.)
.institutional (hospital, treatment center, etc.)
.other (specify)
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32 Secondary practice setting:
training program private practice agency (MHMR, counseling agency, etc.) institutional (hospital, treatment center, etc.) other (specify)
33-35 Average collected fee:
36-37 Average length of marital therapy:
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APPENDIX B
ROKEACH VALUE SURVEY
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Instructions. On the next page are 18 values listed in
alphabetical order. Your task is to number them in order of their
importance to YOU, as guiding principles in YOUR life.
Study the list carefully and pick out the one value which is most
important for you. Write the number 1 in the space next to that value.
Then pick out the value which is second most important for you.
Write the number 2 in the space next to that value. Then follow the
same procedure for each of the remaining values. The value which is
least important to you is numbered 18.
Work slowly and think carefully. If you change your mind, feel
free to change your answers. The end result should truly show how you
really feel.
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Terminal values:
_ A comfortable life (a prosperous life)
. An exciting life ( a stimulating, active life)
A sense of accomplishment (lasting contribution)
A world at peace (free of war and conflict)
A world of beauty (beauty of nature and the arts)
Equality (brotherhood, equal opportunity for all)
Family security (taking care of loved ones)
Freedom (independence, free choice)
Happiness (contentedness)
Inner harmony (freedom from inner conflict)
Mature love (sexual and spiritual intimacy)
National security (protection from attack)
Pleasure (an enjoyable, leisurely life)
Salvation (saved, eternal life)
Self-respect (self-esteem)
Social recognition ( respect, admiration)
True friendship (close companionship)
Wisdom (a mature understanding of life)
(Go on to the next page only after you have finished this page)
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Below is another list of 18 values. Arrange them in order of
importance to YOU, the same as before.
Instrumental values:
Ambitious (hard-working, aspiring)
Broadminded (open-minded)
_ Capable (competent, effective)
Cheerful (lighthearted, joyful)
Clean (neat, tidy)
Courageous (standing up for your beliefs)
Forgiving (willing to pardon others)
Helpful (working for the welfare of others)
Honest (sincere, truthful)
Imaginative (daring, creative)
Independent (self-reliant, self-sufficient)
Intellectual (intelligent, reflective)
Logical (consistent, rational)
Loving (affectionate, tender)
Obedient (dutiful, respectful)
Polite (courteous, well-mannered)
Responsible (dependable, reliable)
Self-controlled (restrained, self-disciplined)
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APPENDIX C
COUPLE THERAPEUTIC ALLIANCE
SCALE
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Form number:
Couple Therapeutic Alliance Scale
Instructions. This scale is designed to provide research
information which will assist marital therapists in the effectiveness of
their service. We thank you for your participation in this project, on
behalf of the researchers and those who will benefit.
Husbands should fill out the form with an "H" as the last letter
in the data number above; wives should fill out the form with a "w" as
the last letter.
The following statements refer to your feelings and thoughts about
your therapist right NOW. Each statement is followed by a seven point
scale. Please rate the extent to which you agree or disagree with each
statement AT THIS TIME.
If you completely agree with the statement, circle the number 7.
If you completely disagree with the statement, circle the number 1. Use
the numbers in-between to describe the variations between the extremes.
Completely Strongly Agree Neutral Disagree Strongly Completely
Agree Agree Disagree Disagree
7 6 5 4 3 2 1
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Please work quickly. We are interested in your FIRST impressions.
Your ratings are CONFIDENTIAL. They will not be shown to your therapist
or partner and will only be used for research purposes.
Although some of the statements appear to be similar or identical,
each statement is unique. PLEASE BE SURE TO RATE EACH STATEMENT.
When you have finished, please place your response in the stamped
envelope provided and put it in the mail. DO NOT GIVE YOUR RESPONSE TO
YOUR THERAPIST, but place it in the mail when you have finished.
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Completely Strongly Agree Neutral Disagree Strongly Completely
Agree Agree Disagree Disagree
7 6 5 4 3 2 1
1. The therapist cares about 7 6 5 4 3 2 1
me as a person.
2. The therapist and I are not 7 6 5 4 3 2 1
in agreement about the goals
for this therapy.
3. I trust the therapist. 7 6 5 4 3 2 1
4.The therapist lacks the skills and 7 6 5 4 3 2 1
ability to help my partner and
myself with our relationship.
5. My partner feels accepted by 7 6 5 4 3 2 1
the therapist.
6. The therapist does not understand 7 6 5 4 3 2 1
the relationship between my
partner and myself.
7. The therapist understands my 7 6 5 4 3 2 1
goals in therapy.
8. The therapist and my partner are 7 6 5 4 3 2 1
not in agreement about the goals
for this therapy.
9. My partner cares about the 7 6 5 4 3 2 1
therapist as a person.
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Completely Strongly Agree Neutral Disagree Strongly Completely
Agree Agree Disagree Disagree
7 6 5 4 3 2 1
10. The therapist does not understand 7 6 5 4 3 2 1
the goals that my partner and I have
for ourselves as a couple in this therapy.
11. My partner and the therapist 7 6 5 4 3 2 1
are in agreement about the way
the therapy is being conducted.
12. The therapist does not 7 6 5 4 3 2 1
understand me.
13. The therapist is helping my 7 6 5 4 3 2 1
partner and me with our relationship.
14. I am not satisfied with the therapy. 7 6 5 4 3 2 1
15.The therapist understands my 7 6 5 4 3 2 1
partner's goals for this therapy.
16. I do not feel accepted 7 6 5 4 3 2 1
by the therapist.
17. The therapist and I are 7 6 5 4 3 2 1
in agreement about the way
the therapy is being conducted.
18. The therapist is not helping me. 7 6 5 4 3 2 1
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Completely Strongly Agree Neutral Disagree Strongly Completely
Agree Agree Disagree Disagree
7 6 5 4 3 2 1
19. The therapist is in agreement with 7 6 5 4 3 2 1
goals that my partner and I have for
ourselves as a couple in this therapy.
20. The therapist does not care 7 6 5 4 3 2 1
about my partner as a person.
21. The therapist has the skills 7 6 5 4 3 2 1
and ability to help me.
22. The therapist is not helping 7 6 5 4 3 2 1
my partner.
23. My partner is satisfied 7 6 5 4 3 2 1
with the therapy.
24. I do not care about the therapist 7 6 5 4 3 2 1
as a person.
25. The therapist has the skills and 7 6 5 4 3 2 1
ability to help my partner.
26. My partner distrusts the therapist. 7 6 5 4 3 2 1
27. The therapist cares about the 7 6 5 4 3 2 1
relationship between my partner
and myself.
28. The therapist does not 7 6 5 4 3 2 1
understand my partner.
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Completely Strongly Agree Neutral Disagree Strongly Completely
Agree Agree Disagree Disagree
7 6 5 4 3 2 1
29. The therapist does not appreciate 7 6 5 4 3 2 1
how important the relationship between
and myself is to me.
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APPENDIX D
INVITATION TO PARTICIPATE
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Dear Colleague:
This is an invitation for you to receive $25 for participating in a study of "Values, Therapeutic Alliance, and Marital Therapy." The data for the study is being compiled through survey forms which will take about 15 minutes for you as a therapist and about 20 minutes for two of your client couples; they will be returned by stamped, addressed envelope and the first 35 TAMFT therapists from whom I receive all five (therapist and four spouses) forms will receive a money order for $25.
This project is a dissertation study of the relation of values and the therapeutic alliance (i.e. the relation of therapist and couple which enables their collaboration on therapeutic work.) The scales used in the survey are the Rokeach Values Inventory and the Couple Therapeutic Alliance Scale and are not time consuming to complete. The study will hopefully be a step toward answering some questions in the literature about the impact of values on the relationships therapists form with clients.
If you have an interest in participating and are reasonably confident that you have at least two couples who will complete the forms, please return the enclosed card with your name and address printed on the back. The first 100 persons to return the snclosed postcard will be sent a packet of materials for the study. The $25 payment will then be sent to the first 35 whose completed forms are all returned.
Thank you for your interest, and I hope you're among the first 35!
Sincerely, E. Madoc Thomas, M.Div., LMFT
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