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ABSTRACT
This study addresses the impact of therapists’ personalities on psychotherapy
process within the context of relational psychodynamic theory. The differential role of
therapists’ interpersonal schemas of their mothers verses their fathers were assessed in
relation to their ability to form a working alliance, and work through alliance ruptures.
The role of the father tends to be less understood than that of the mother, with limited
research addressing how therapists’ relationships with their fathers may impact their
relational schemas and consequent impact on psychotherapeutic process. This study
draws on findings from the child-development literature suggesting that fathers are
important in the formation of conflict resolutions skills, and considers therapists’
interpersonal schemas of their fathers in relation to rupture resolution. Therapists
interpersonal schemas of their mothers and fathers are assessed using the interpersonal
schema questionnaire (N = 96), and then calculated along four different kinds of
situations; Hostile, friendly, submissive and dominant. Interpersonal schemas along
these four dimensions for mothers and fathers are then assessed in relation to therapists
and patients reports of working alliance (Working Alliance Inventory), rupture resolution
(Post-Session-Questionnaire), and session smoothness and depth of experience (Session
Evaluation Questionnaire) across the first five psychotherapy sessions. Therapist
introjects using the Intrex questionnaire were also assessed in relation to working and
alliance and rupture resolution variables as a point of comparison to the interpersonal
schema questionnaire. All therapists and patients were seen as part of the Brief
Psychotherapy Research Program. Each therapist was seen by multiple and varying
numbers of patients (ranging from 1-8, with a total of 186 patients in the overall sample).
Multilevel modeling was employed to account for this “nesting,” while assessing the
relationship between independent and dependent variables. Findings suggested that
therapists’ interpersonal schemas of their fathers and mothers in friendly and dominant
situations are predictive of rupture resolution. However, only the father was predictive of
both patient and therapist ratings, as well as perceived smoothness and depth of
experience during rupture sessions. Findings also suggested that therapists’ affiliative
introjects are predictive of rupture resolution. Theoretical and clinical implications are
discussed.
THERAPISTS’ CONTRIBUTION TO THE WORKING ALLIANCE AND RUPTURE
RESOLUTION:
THE DIFFERENTIAL ROLE OF THERAPISTS’ INTERPERSONAL
SCHEMAS OF THEIR MOTHERS AND FATHERS IN PSYCHOTHERAPY
by
Melanie Fox-Borisoff
Dissertation Submitted to the
New School for Social Research of New School University
in Partial Fulfillment of the Requirements for the
Degree of Doctor of Philosophy
November 2009
Dissertation Committee:
Jeremy D. Safran, Ph.D.
J. Christopher Muran, Ph.D.
Howard Steele, Ph.D.
Claudia, Barrachi Ph.D.
Table of Contents
List of Tables ..................................................................................................................... iv
Introduction ..........................................................................................................................1
CHAPTER 1: INTRODUCTION AND THEORETICAL BACKGROUND.....................3
The Role of the Therapist in Psychotherapy Process: The Working Alliance, Ruptures,
and the Internalization of Self-Other Interactions ...........................6
The Working Alliance and the Therapist’s Contribution to
Psychotherapy Process .........................................................3
A Two-Person Psychology: Me-You Representations ................................13
Sullivan’s Personifications of Self and Other: An Introduction
Two Person Psychology.......................................................13
Internal Working Models .................................................................17
Representations of Interactions that have been Internalized............18
Interpersonal Schema Theory ..........................................................19
The Interpersonal Circumplex: A Model for Psychotherapy Research
Within the Framework of A Two-Person Psychology...........22
Structural Analysis of Social Behavior: The Intrex .........................23
Kiesler’s Interpersonal Transaction Cycles and Circumplex
Model ...................................................................................25
Assessing Therapists’ Me-You Representations .........................................29
The Interpersonal Schema Questionnaire ........................................29
Reliability and Validity of the ISQ ......................................32
Relevant Studies Applied to Psychotherapy Process .......................33
The Role of the Father and Interpersonal Schemas .........................36
CHAPTER II: CHILD DEVELOPMENT, THE ROLE OF THE FATHER, AND
CONFLICT RESOLUTION ....................................................................................38
Child-Father Attachment Style and Children’s Social Competence............38
Father-Child Conflict and Conflict Resolution with Peers ..........................51
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Affect-Regulation and Conflict Resolution: The Role of the Father ...........58
Summary of Father vs. Mother Influences in Child Development ..............63
CHAPTER III: STATEMENT OF PURPOSE AND HYPOTHESES................................64
Statement of Purpose ...................................................................................64
Hypotheses ...................................................................................................66
CHAPTER IV: METHOD ...................................................................................................67
Overview ......................................................................................................67
The Brief Psychotherapy Research Program ...............................................69
Participants ...................................................................................................71
Therapists .........................................................................................71
Patients .............................................................................................72
Measures of Therapist Internal Process (Independent Variables) ...............73
Interpersonal Schema Questionnaire (ISQ) .....................................73
Intrex Questionnaire.........................................................................74
Measures of Psychotherapy Process (Dependent Variables) .......................75
Working Alliance Inventory (WAI).................................................75
Post Session Questionnaire and Rupture Section ............................76
Session Evaluation Questionnaire (SEQ) ........................................76
Procedures ....................................................................................................77
Pilot Study........................................................................................77
Current Study ...................................................................................83
CHAPTER V: ANALYSES ................................................................................................82
CHAPTER VI: RESULTS ...................................................................................................87
Descriptives of Ratings ................................................................................87
Multilevel Modeling ....................................................................................88
Hypothesis I: Therapist ISQ, Working Alliance and Rupture
Resolution. ......................................................................................88
Hypothesis II: Therapist ISQ and Session Smoothness and Depth .97
Hypothesis III: Therapists’ Introjects .............................................101
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Random Effects ...........................................................................................103
Summary of Regression Coefficients .........................................................104
CHAPTER VII: DISCUSSION ..........................................................................................105
Rupture Resolution .....................................................................................105
Working Alliance ........................................................................................108
Therapist Introjects and Rupture Resolution ..............................................109
Limitations and Future Directions ..............................................................110
Conclusion ..................................................................................................113
REFERENCES ...................................................................................................................116
APPENDIX A .....................................................................................................................133
APPENDIX B .....................................................................................................................136
APPENDIX C .....................................................................................................................138
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LIST OF TABLES
Table 1:
Preliminary Results for Therapist ISQ and Rupture Resolution ..................79
Table 2:
Preliminary Results for Therapist ISQ and Working Alliance .....................80
Table 3:
Summary of Dependent Variable Ratings ....................................................87
Table 4:
Summary of Therapist-ISQ Quadrant Ratings for Desirability ....................88
Table 5:
ISQ-Mother in Friendly Situations and Therapist/Patient Rupture
Resolution ....................................................................................................90
Table 6:
ISQ Mother in Dominant Situations and Therapist/Patient Rupture
Resolution ....................................................................................................92
Table 7:
ISQ Father in Friendly Situations and Therapist/Patient Rupture
Resolution ....................................................................................................94
Table 8:
ISQ Father in Dominant Situations and Therapist/Patient Rupture
Resolution ....................................................................................................96
Table 9:
ISQ-Father in Dominant Situations and Perceived Session Smoothness ....98
Table 10: ISQ-Father in Friendly Situations and Depth of Experience in Session .....100
Table 11: Therapists’ Affiliative Introjects and Rupture Resolution ..........................102
Table 12: Summary of Regression Coefficients for all Main Effects of ISQ/Intrex…104
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Introduction
Psychotherapy research has for the most part devoted it’s time to assessing patient
characteristics and patient contributions to psychotherapy process. However, there is a
burgeoning interest in how the therapist’s personality impacts psychotherapy process.
Although these studies are still limited, there is evidence supporting further research in
this area and that therapist’s interpersonal histories may impact their effectiveness as
psychotherapists. In particular, preliminary studies have demonstrated on a couple of
occasions that therapists’ relationships with their fathers are important determinates of
psychotherapy therapy process and outcome (Nelson, 2000; Fox-Borisoff, unpublished
MA thesis). In particular, therapists’ interpersonal schemas (expectations in social
interactions) with their fathers may be important predictors of their ability to resolve
ruptures (moments of tension or deterioration of therapist-patient communication) with
patients during therapy, while the relationship with the mother may be more important for
the formation of the therapeutic alliance. Convergent with these findings, recent research
within the child development domain is suggesting that fathers may play an important
and distinct role in the formation of mental structures that help maintain healthy
relationships. For example, research is suggesting that fathers’ are particularly important
for the formation of social competency skills, particularly conflict resolution, while
mothers may be more important to the development of feelings and skills such as
empathy that aid in the initial formation of relationships. The first chapter reviews the
history of the working alliance concept and the role of the therapist, interpersonal theory,
and reviews a few studies addressing how therapists’ own interpersonal schemas of their
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fathers’ verses their mothers’ affect psychotherapy process. In the second chapter, a
review of the child development literature on social competency formation supports and
hopefully deepens the understanding of the relationship between fathers verses mothers,
interpersonal schema formation, and subsequent abilities to establish trusting
relationships and confront conflict in everyday life as well as in psychotherapy.
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Chapter I
The Role of the Therapist in Psychotherapy Process: The Working Alliance, Ruptures,
and Internalization of Self-Other Interactions
The Working Alliance and the Therapist’s Contribution to Psychotherapy Process
The concept of the therapeutic alliance can be traced back to Freud (1912) who
suggested that the analyst maintain “serious interest” and “sympathetic understanding” of
their patient so that the patient’s healthy self can form a positive relationship with their
analyst. Freud initially hypothesized that this accepting stance of the therapist, and the
patient’s attachment to therapist would result in a “positive transference” that needs to be
interpreted. For example, Freud believed that the patient would begin to associate their
positive relationship with their therapist to other affectionate people in their life, and
although beneficial, this would not reflect the real relationship between the patient and
the therapist. However, in his later writing, Freud seemed to modify his view of the
“positive transference” and suggested that a positive attachment to the therapist could be
based in reality and may in fact facilitate the healing process.
Despite Freud’s statement that the therapist should maintain a position of
sympathetic understanding towards the patient, Freud also warned against
countertransference and ardently advised analysts to go through their own analysis so that
they could maintain neutrality with the patient, and essentially act as a mirror capable of
reflecting the patient’s neurosis. This contradiction has led theorists to argue what the
actual extent of the therapist’s contribution to the formation of an alliance is and should
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be, verses how much of this alliance is as Freud originally proposed, a “positive
transference” resulting from the patient’s personality (e.g., Brenner, 1979).
Zetzel (1956) introduced the term “therapeutic alliance” in describing the
relationship between the patient and therapist, and is generally credited as being the first
to map out this concept. She viewed the therapeutic alliance as distinct from transference
neurosis and believed that it was a recapitulation of the infant-mother relationship,
whereas the patient turns to the therapist for help like an infant turns to the mother for
help. Zetzel proposed that the alliance differs from transference neurosis in that the
alliance is based upon a patient’s solid object relations from infancy, and consists of the
non-neurotic component of the patient-therapist relationship. She argued that a healthy
analysis consists of the patient oscillating between moments dominated by the working
alliance and moments dominated by the transference, and that the alliance allows the
patient to step back and reflect upon differences between relationships with others, verses
the real nature of the relationship with the therapist. Overall, Zetzel emphasizes the
impact of the patient’s personality for forming a patient-therapist relationship, rather than
how the therapist’s qualities may contribute to this process. Zetzel acknowledges the role
of the therapist in the formation of the alliance, for example, she proposes that the analyst
be like a good mother creating a supportive environment that fosters underlying trusts,
and is capable of making “intuitive adaptive responses”. However, she does not consider
that the therapist’s object relation development may also be important for a real
relationship to occur.
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Greenson (1965) was the first to use the term “working alliance”. He extended
Zetzel’s work in suggesting that the transference neurosis and the working alliance were
separate concepts, both requiring equal attention. Greenson argued that a positive
working alliance needs to be present in order for transference neurosis to be analyzed.
He stated that “for a working alliance to take place, the patient must have the capacity to
form object relations since all transference reactions are a special variety of them” and
that the patient’s contribution to the working alliance depends on adequate ego strength.
For example, he stated that working alliance depends on “his [the patient’s] capacity to
maintain contact with the reality of the analytic situation and also his willingness to risk
regressing into his fantasy world. It is the oscillation between these two positions that is
essential for analytic work.” However, Greenson also considered the therapist’s
contribution to the formation and maintenance of the working alliance. For example, he
argued that analysts often take Freud’s suggestion of maintaining neutrality to an extreme
and consequently come across as cold, authoritarian and rigid, smug and aloof to their
patients. Greenson argued that in order for an alliance to form, analysts need to work in a
manner that is “realistic and reasonable” and to maintain respect for patients as humans,
and show “consistent concern for the rights of the patient throughout the analysis.”
In contrast to those who proposed that the working alliance is a distinct construct,
several theorists (e.g., Brenner,1979; Curtis, 1979; and Hanly,1992) criticized the above
ego psychologists and felt that it is purposeless, and at times counterproductive to
consider an alliance as separate from the transference. For example, Brenner (1979) felt
that the alliance concept may lead analysts to leave important material unexplored and
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ultimately limit the therapeutic process. Similarly, Hanly (1992) suggested that the
alliance concept may result in an overvaluation of rational therapeutic processes, while
leaving unconscious material unattended too (In Safran & Muran, 2000). Overall, these
theorists believed that the alliance concept may mask resistances and unconscious
conflicts such as a wish for the therapist to be like a parental figure, or an attempt to
maintain equal ground with the therapist.
Athough the concept (and the controversy over) the therapeutic working alliance
has generally arisen out of the psychodymanic school of thought, other areas of
psychology have hinted at similar ideas, and place an increased emphasis on the role of
the therapist. For example, interpersonalists such as Harry Stack Sullivan (1953), and
Clara Thompson (1964) emphasized the importance of the real relationship between the
patient and the therapist. In addition, by assuming a two-person psychology where the
therapist is embedded in the therapeutic process, interpersonalists were in a way
expressing an implicit concern for a working alliance without mentioning the term itself.
Relational psychoanalysis forgoes the concept of real verses unreal relations and
argues that there are multiple truths at any given time and based on social construction,
thus the idea that there are real verses unreal aspects of the therapeutic relationship is a
“meaningless concept” (Safran and Muran, 2000). According to Safran and Muran, the
therapeutic emphasis in relational psychoanalysis is more on mutuality, enactments and
spontaneity than it is on neutrality and objectivity. They suggest that for this reason the
working alliance concept is not as necessary to relational psychotherapists, however, they
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also suggest that is essentially what underlies mutuality between therapist and patient,
and that most analysts take it for granted as a primary medium for change.
Zetzel and Greenson acknowledged the need for the therapist to be supportive and
respectful of their patients in order for an alliance to form. However, they assumed that
given this even, and as some would argue maternal-like stance (Zetzel, 1966; Friedman,
1969, Sandler and Colleagues, 1969) the patient’s ego capacities would ultimately
determine the outcome of the alliance. Interpesonalists, and relational analysts place more
emphasis on the role of the therapist, however, traditionally they have only considered
the working alliance insomuch as an implicit part of the change process. In contrast,
Edward Bordin’s (1979) conceptualization of the working alliance offered a pantheoretical application of the concept and has been responsible in part for renewed
interest in the topic, as well as a closer look at the contribution of the therapist in terms of
the alliance across psychotherapy modalities. Bordin’s broad definition builds on
Zetzel’s and Greenson’s earlier work in further clarifying the distinction between the
working alliance and the patient’s unconscious projections, and proposed that the
working alliance is essential for therapeutic change regardless of the modality. In
addition, his formulation emphasized the positive collaboration between the patient and
the therapist. He identified three components of the alliance: tasks, bonds, and goals. In
defining tasks, Bordin expanded on Menninger’s (1958) concept of a contract between
patient and therapist. Bordin defined the tasks of therapy as the specific activities or
behaviors that both the patient and therapist engage in. The specific tasks may differ
according to the therapeutic modality. For example, in gestalt therapy the patient is asked
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to attend to action, in psychoanalysis the patient is asked to fee associate. The specific
tasks of the therapist may also differ depending on the modality. For example, relational
therapy may ask for more self-disclosure, whereas humanistic therapy may require more
empathic support. In order for the alliance to be strong, both parties must view the
therapeutic tasks as efficacious. The goals of therapy are generally agreed upon desired
outcomes. Again, the goals may differ depending on the therapeutic modality whereas
cognitive-behavioral therapy may have a goal to reduce a specific behavioral symptom,
and psychoanalysis may aim to resolve underlying conflicts. The bond includes elements
of mutual trust and acceptance and confidence and reflects the overall quality of the
patient-therapist relationship. Overall, Bordin’s broad conceptualization of the alliance
offers a flexible definition that can be applied across modalities and across individual
patient and therapist characteristics. Bordin acknowledged differences between therapy
types and that each one varies in emphasis on tasks, goals, and bond. He suggested that
the extent to which the therapist and patient agreed upon these emphases would
determine the strength of the alliance. In addition, Bordin recognized the importance of
interpersonal negotiation between the patient and the therapist for the formation of the
alliance, and that each patient and therapist has varying styles and needs.
In addition to Bordin’s conceptualization of the alliance bringing renewed
attention to the topic, psychotherapy research also began suggesting that psychotherapy
outcome does not significantly differ amongst various modalities (Luborsky, Singer &
Luborsky, 1975; Stiles, Shapiro & Elliot, 1986). Researchers took this to mean that there
may be underlying factors, such as the alliance, common to all forms of therapy that are
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responsible for change (Horvath & Luborsky, 1993). Given the importance of the
alliance for psychotherapeutic change, breaches in the alliance become a major concern
for the efficacy of therapy (Safran & Muran, 20000). Binder and Strupp (1997)
conducted a meta-analysis of negative process in psychotherapy and concluded that
negative processes were unavoidable in forms of psychotherapy, and that positive
outcomes rely on the therapist’s ability to effectively handle these alliance ruptures (In
Ackerman & Hilsenroth, 2001). However, much of the research that addresses this issue
focuses on only the patient’s personality, thus reflecting previous thinking that the quality
of the alliance is ultimately an intra-psychic process, (rather than a transactional process)
dependent on the patient’s personality. Several reasons have been given for this one-sided
focus, for example, there are simply many more patients than therapists making it much
more efficient to look at patient variables, and there are logistical difficulties with
collecting confidential data from therapists (Najavits & Strupp, 1994). In addition to
these more practical reasons though, Kiesler (1996) suggests that therapist’s are often not
studied due to an assumption that therapists are all conducting “psychotherapy”, and are
thus more or less interchangeable in research (Kiesler, 1996). In addition, Strupp (1982)
suggests that many researchers may mistakenly believe that therapists are essentially
superior to patients in their adaptive functioning. Nonetheless, there have been some
seminal studies that have addressed how therapists’ characteristics impact the therapeutic
alliance.
In order to examine how therapists respond to in-session negative process, Strupp
(1960) asked experienced therapists to respond to therapy situations that were initially
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presented in written form, and then later in a film. Strupp found that therapists were
immediately less capable of maintaining adequate levels of empathy when the patient was
portrayed as hostile, angry or provocative. Strupp and Williams (1960) also found that
therapists expressed more positive attitudes towards patients who appeared highly
motivated for treatment. Strupp pointed out that these types of immediate reactions to
patients could have serious consequences for the therapeutic relationship. Suh, O’Malley
and Strupp (1986) assessed changes in the working alliance over the course of therapy.
They found that the fate of the working alliance could be predicted in the first few
sessions of therapy by therapists’ negative responses to their patients’ provocative
behavior. Strupp (1980) conducted qualitative analyses of therapist-patient dyads where
each therapist was assessed in one good outcome case, and one bad outcome case. He
found that therapists displayed a preference for one patient over the other, and that poor
outcome cases consisted of more hostile communications, a steady decline in patient
involvement, a lack of therapist focus on important content, less warmth and friendliness
displayed by the therapist, and overall interpersonal disengagement from both parties.
These findings contributed to Strupps reconstructed view that therapists need to do more
than provide an “average acceptable interpersonal climate” and that the formation of the
working alliance is a collaborative interpersonal process, rather than an intra-psychic
process primarily determined by the patient’s personality. Strupp stated: “…major
deterrents to the foundation of a good working alliance are not only the patient’s
characterological distortions and maladaptive defenses but-at least equally important-the
therapist’s personal reactions.” Several studies expanded on these findings and assessed
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interpersonal processes in psychotherapy, particularly how therapists often risk being
pulled into patient’s unconscious and often hostile patterns as co-participants (Henry,
Schacht and Strupp, 1986; Klee, Abeles & Muller, 1990; Kiesler and Watkins, 1989;
Tasca and McMuller, 1992).
Other studies have looked at therapists’ in-session characteristics and how they
may contribute to the therapeutic alliance. Hartley and Strupp (1983) identified
particular therapist behaviors that negatively impact the working alliance. For example,
they found that therapists who foster dependency, and make irrelevant interpretations are
more likely to have negative working alliances as reported by therapists. Marmar, Weiss
and Gaston assessed therapists using the California Therapeutic Alliance Rating System
and found that therapists who were rigid, self-focused and critical were perceived by
patients as being less empathic, and as provoking more hostile resistance. Eaton, Abeles
and Gutfreund (1993) coded therapist-patient dyads in insight oriented psychotherapy
using the Therapeutic Alliance Rating System and the Vanderbilt Negative Indicator
Scale. They found that therapists with poor working alliances across all stages of therapy
(beginning, middle and end) tended to be exploitive, critical, moralistic, defensive, and
lacking in warmth, respect and confidence. Additional studies have suggested that
therapists who are not confident in their ability to help patients, tense or uncertain are less
likely to form a positive working alliance (Sexton, Hembre & Kvarme, 1006; Eaton,
Abeles & Gutfreund, 1993).
Overall, psychotherapy research has made a firm argument for the importance of
the working alliance for therapeutic change, and that difficulties in the alliance are
11
inevitable in the course of treatment, regardless of the theoretical approach (Binder and
Strupp, 1997; Safran and Muran, 2000). The studies mentioned thus far primarily
address therapist characteristics that impact the working alliance, however, there is also a
body of research suggesting that therapists ability to handle breaches in the alliance
(ruptures) once they have occurred has strong implications for the overall success of the
therapy.
For example, Castonguay, Goldfried, Wiser, Raue and Hayes (1996) assessed
therapists’ use of cognitive strategies with depressed patient in relation to the working
alliance in the first half of treatment. They found that therapists’ rigid adherence to
cognitive treatment strategies inhibited the resolution of alliance ruptures, thus suggesting
the importance of therapists need to be flexible and spontaneous. In addition, Safran and
Muran (1996; 2000) have defined alliance ruptures as moments of conflict, tension or
deteriorations in the working alliance, and have a proposed a therapeutic model for
detecting and resolving such ruptures. Safran and Muran view ruptures as an expected
part of therapy, and see them as a window of opportunity for core therapeutic change to
take place. They suggest that ruptures occur when therapists unwittingly engage in
patients’ maladaptive interpersonal cycles. During these cycles, patients pulls for
behaviors in another in order to confirm expectations (even if these expectations are
negative), and thus help avoid anxiety and abandonment in social interactions. From this
perspective, moments of tension can be viewed as “windows into patient’s relational
schemas”. They suggest that identifying and working through these ruptures with an
acceptance of one’s (the therapist’s) own contribution to the impasse, and techniques
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such as metacommunication by means of non-judgmental self-disclosure, mindfulness,
and a focus on the here and now, may lead to changes in patient’s core beliefs. They state
that while therapists are human, and therefore likely to respond to patients threats and
attacks with hostility, they should stay mindful and aware of these difficult feelings, and
be willing to “stick with the patient and to work toward understanding what is going on
between them in the face of whatever difficult feelings emerge for both of them.” In this
way patients are provided an opportunity to feel a real connection to another person as
both parties explore painful feelings together, while at the same time learning how to
negotiate their own needs and emotions in a more effective way. In sum, Safran and
Muran’s model assumes a two person psychology where the therapist’s participation is
equally central to maintaining an effective working alliance:
A therapist who responds to a hostile patient with counter-hostility confirms the
patient’s view of others as hostile and obstructs the development of a good
therapeutic alliance. The therapist who responds to a withdrawn patient by
distancing confirms the patient’s view of others as emotionally unavailable,
thereby perpetuating a vicious cycle. (Safran and Muran, 2000, p.448)
A Two Person Psychology: Me-You Representations
Sullivan’s Personifications of Self and Other: An Introduction to Two-Person Psychology
Harry Stack Sullivan, often considered the father of interpersonal psychology,
broke away from the more traditional Freudian concept of a self-contained, intra-psychic
mind. He opened the door for many subsequent theories of mind that acknowledge the
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importance of social interactions. In Sullivan’s view, the individual cannot be understood
outside of an interpersonal context, and interpersonal interactions shape people’s
perceptions of themselves and others.
A central concept of Sullivan’s concerns mental structures or personifications that
are acquired through time and guide interpersonal perception. Sullivan (1953) postulated
two different types of personifactions: those that apply to the perception of the self, and
those that apply to the perception of others. As for self-personifications, Sullivan
believed that people come to understand themselves in terms of characteristics that
belong to a good me, bad me or not me. He hypothesized that the good me results from
childhood experiences and characteristics that were rewarded and highly regarded by
caretakers, while aspects of the bad me and the not me consists of characteristics that
were not accepted or provoked negative responses from caretakers. The distinction
between the bad me and the not me is the degree of anxiety that is associated with early
social interactions. For example, psychological experiences and behaviors that produced
moderate levels of anxiety for the child are still regarded by the individual as pertaining
to the Self, however, they are negatively viewed and become associated with the bad self.
However, early social interactions that evoked extreme levels of anxiety by significant
others become associated with the not me remaining unacknowledged by the individual,
and becoming personified at only a rudimentary level. According to Sullivan this anxiety
results not only from punishment, but can be transmitted directly from the care-taker to
the infant. For example, if a mother felt anxiety while breast feeding, the infant also
comes to feel anxious and therefore develops a bad me or in extreme cases not me
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personification. Conversely, if the mother feels secure, the infant internalizes feelings of
safety and security which result in a good me personification.
Sullivan (1956) expanded on his theory by stating that the good me (as it is
associated with feelings of security) is directly related to self-esteem, while the bad me
and the not me, as they are associated with anxiety, are inversely related to self-esteem.
In an effort to maintain a feeling of security and protect ones esteem, the individual will
engage in what Sullivan (1953) termed security operations that protect one from anxietyprovoking experiences. An important security operation is selective inattention, which
consists of a process of selectively unattending to information with which one does not
want to be associated with. Social cognition research has also lent support to Sullivan’s
concept of personifications of others. For example, research in the field of social
cognition has suggested that people actively seek social feedback that confirms their selfconceptualizations in preference to information that does not (Swann & Reade, 1981). In
a similar vein, Sullivan suggested that in an effort to avoid anxiety and maintain one’s
self-esteem, people actively elicit self-confirmatory information, and avoid nonconfirmatory feedback (feedback that does not confirm one’s personified good me).
In addition to self-personifications, Sullivan’s theory concerns the way that
people form expectations (or personifications) regarding others. Sullivan believed that
humans organize information about people in terms of expectations that have formed
from past relationships. These expectations provide a structure that guides and facilitates
the processing of new social information. However, they may also impose rigid ways of
interpreting new information. As a result, people may distort their perception of others.
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For example, someone who had a rejecting mother may come to expect and therefore
view all women as rejecting. Sullivan (1954) referred to this phenomenon as a parataxic
distortion.
Overall, Sullivan (1940) believed that self understanding is ultimately an
interpersonal phenomenon, made up of reflected appraisals. Reflected appraisals consist
of a feedback process that is based on how the care-taker communicates and responds to
the infant’s needs, and results in self-worth contingencies (rules for how one should
behave in order to feel loveable). As a consequence of these reflected appraisals, the
infant develops a perceived understanding of what aspects of interpersonal behavior will
maximize the possibility of human relatedness and self-esteem. More specifically, in an
effort to remain securely related to others, Sullivan postulated that people acquire me-you
patterns of representations that consists of the self and other interacting in a
complementary fashion. For example, an aspect of an individuals’ good-me
personification may consist of a belief that he or she must act submissive in social
situations. At the same time, the individual may personify the “other” in a
complementary dominant or controlling way. In this case the “me” is associated with
submissiveness and the “other” is associated with dominance. These representations
provide a sense of safety as they predict and guide future social interactions in a way that
the individual believes will preserve interpersonal relationships. In summary, self/other
personifications for Sullivan are not two different schemas, rather, these representations
operate together in an interpersonal representation of self and other, where the self pulls
for others to reciprocally respond.
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In Sullivan’s formulation of a two-person, or relational psychology, the therapists’
personality is a central component of the therapeutic process. For example, Sullivan
suggested that therapists’ me-you representations and patients’ me-you representations
inevitably interact, and are continually guiding one another in subsequent interactions.
Unlike a one-person psychology where the role of therapists is typically perceived as
only observing patients’ behaviors, Sullivan coined the term participant-observer, which
recognizes therapists as being simultaneous participants and observers in all therapy
interactions, meaning, therapists engage in the patient’s interpersonal patterns, yet
maintain an objective stance so as to monitor his or her own feelings and response
tendencies.
Internal Working Models
Like Sullivan’s interpersonal theory, John Bowlby’s theory of attachment argues
that humans are relational by nature, and the definition of the self forms through
interactions with caretakers. In a similar fashion to Sullivan’s concept of
personifications, Bowlby (1969) proposed the concept of internal working models
(IWMs). IWM’s, like personifications are formed through early attachment experiences,
and become rough drafts or cognitive-affective schemas of self-other experiences that
play a central role in maintaining proximity with others by allowing the infant to predict
self-other interactional contingencies. For example, if an infant experiences
abandonment when expressing feelings of anger, the infant will learn to inhibit this
feeling in order to maintain proximity with his or her caregiver (Safran, 1990). The
17
infant will then incorporate the message ‘expressing anger leads to being alone’ into an
IWM and continue to inhibit this feeling in future relationships. Both Sullivan and
Bowlby postulate that connection and proximity to others are important for survival and
that any cue that poses a potential threat to this interpersonal relationship will result in
anxiety for the individual. Sullivan suggested in his theorem of tenderness that this need
for connection is shared by the infant’s complete dependent state and the mothers desire
to provide such care. However, he was not exactly sure how much of this connection was
based on the infants needs (Cortina, 2001). Bowlby goes one step further in explaining
this need for connection in arguing that humans are genetically pre-disposed to a wired-in
biological form of feedback that evokes anxiety in the face of separation, and provides a
template to guide proximity seeking actions.
Representations of Interactions that Have Been Internalized
Stern (1985) articulates a related concept that he terms Representations of
Interactions that have been Generalized (RIGs). He argues that infants develop
prototypical representations of self-other interactions through a series of events with
attachment figures. He suggests that overtime similar episodes are averaged in memory.
In the process, details relevant to the individual events are abstracted and stored in
prototypical mental structures. For example, an infant may average a series of episodes
at the mother’s breast while abstracting critical details. Consequently, the infant forms a
prototype of this type of interaction (Safran, Segal, Hill & Whiffen, 2001).
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Stern argues that his concept of RIGs are similar to Bowlby’s concept of IWM’s,
only more specific. An IWM can be viewed as an aggregate of RIGs that are averaged
together to form a more generalized abstract representation of interpersonal interactions.
For example, the prototype that has formed of the infant at the mother’s breast may be
averaged with other types of interactions that occur with the mother to form a more
generalized internal working model of self-mother relationship. Theoretically, and as
supported by research (Bretherton, 1985) people would develop several different working
models for different types of people in their lives (e.g., a prototype for mother, a
prototype of lover). Continuing with this line of thinking, it can be reasoned that IWMs
are themselves then averaged again forming an even more abstract interpersonal schema
(e.g. a representation of self with controlling other or self with submissive other).
Interpersonal Schema Theory
Interpersonal schema theory (Safran, 1990) emerges out of Sullivan’s
interpersonal psychology and is similar in nature to Bowlby’s (1969) internal working
models, in that it forms through early interactions with caretakers, and serves as an
adaptive mechanism allowing for the prediction of social patterns. Interpersonal schemas
contain generalized representations of self-other interactions, as opposed to isolated
representations of self and other, and are therefore relational in nature. They can be
thought of as programs for maintaining relatedness that include beliefs in the format that
if I behave in x way, the other person will do y, for example, “if I become angry, others
will become distant”. Like Bowlby’s attachment theory, interpersonal schema theory
19
suggests that people have a biologically wired-in propensity for feeling connected to
others. Through experience the schema forms more precise goals, action plans and ifthen contingencies (e.g. if I act controlling then the other will act submissive) relevant to
maintaining this relatedness. Thus, the interpersonal schema can be thought of as a
program for maintaining relatedness in which the primary goal (to maintain closeness) is
biologically wired in, and the principles employed to attain this goal are learned through
early interpersonal relationships. Although these interpersonal schemas are initially
formed in the context of attachment relationships, they become internalized and are later
applied to more general interpersonal situations and continue to play a central role in
shaping thoughts, feelings, and behaviors in social interactions (Main et al., 1985).
More specifically, interpersonal schemas are an elaboration of Bowlby’s IWMs
that are represented at different levels of abstraction and function in a hierarchical
fashion. The lowest or most specific representations of the interpersonal schema (which
would be similar in nature to RIGs) contain images and episodic memories of
interpersonal situations (such as episodes at the mothers breast), and expressive motor
and autonomic responses evoked by those events. Higher level representations, on the
other hand, contain rules, strategies and beliefs (concerning the self and others) that have
been abstracted from early experiences and function to maintain relatedness. For
example, a young child who was ignored when he or she made mistakes, may come to
believe that he or she needs to “be perfect at everything I do” in order to maintain close
relationships with others. Similar to RIGs, people are thought to develop various
interpersonal schemas for different attachment figures. For example, an interpersonal
20
schema with the mother is formed through interactions with the mother and therefore
may contain different beliefs and strategies than an interpersonal schema relating to the
father.
Moreover, interpersonal schema theory like attachment theory suggests that early
interpersonal experiences with care-takers have an emotional component providing
survival relevant information of the self in interaction with the environment. These
emotions are rooted in expressive motor-responses and remain in the form of
unarticulated meaning (as opposed to symbolic meaning). Thus, interpersonal schemas
can be thought of as cognitive-affective schemas that are encoded and represented at least
partially in the form of implicit, procedural knowledge that is experienced at an
unarticulated bodily felt level (Leventhal, 1984). When new interpersonal encounters
occur, cognitive and affective components of an existing schema are triggered,
experienced and appraised, and any new information is assimilated into the already
existing structure. Thus, these cognitive-affective schemas are continuously elaborated
upon in ways to maximize continuing relatedness.
Under normal circumstances, interpersonal schemas are formed through mutual
reciprocity between the child and caretaker, where the child’s emotional expressions pull
for complementary efforts in the mother to attune to and satisfy her child’s needs
(Bowlby, 1969; Tronick, 1989). However, in a maladaptive early environment, this
healthy reciprocal pattern may be disrupted and the child learns that to be interpersonally
engaged and to ensure social connection means to be neglected, controlled, or somehow
mistreated. Thus, a maladaptive interpersonal schema may form that continues into
21
adulthood, where for instance the individual may expect to be controlled by others, and
act in an overly submissive manner that confirms this neglect. According to Safran &
Muran, (1996) pathogenic interpersonal patterns (i.e., schemas) may play themselves out
in the context of therapy resulting in moments of tension or ruptures in the therapeutic
relationship. During these strong interpersonal processes, therapists’ own expectations
may become a major contributing force, and ultimately determine the outcome of the
rupture. As mentioned above, Safran & Muran (2000) suggest that working through
ruptures with patients may play an important role in changing maladaptive interpersonal
expectations. Thus, the therapists’ own object relations become an important mediator
for change, and therefore an important area of research.
The Interpersonal Circumplex: A Model for Psychotherapy Research Within the
Framework of a Two-Person Psychology
Influenced from Sullivan’s theory regarding interpersonal behavior, particularly
the notion that people engage in repeated patterns of behavior with others, coupled with
an interest in defining and treating psychopathology within the context of maladaptive
interpersonal cycles, interpersonalists began conceptualizing personality as falling within
a circular dimension. The work of the Kaiser Group and later Timothy Leary’s (1957)
book Interpersonal Diagnosis of Personality brought the concept of an interpersonal
circumplex to fruition. The interpersonal circumplex was originally outlined by Leary
(1957) in an effort to capture his view of personality which consists of predictable and
reciprocal patterns in relationship functioning. Expanding on Sullivan’s theory that
interpersonal behaviors exert a pull on others to respond in a complementary fashion,
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Leary proposed that interpersonal acts could best be conceptualized as falling somewhere
on a circle. For example, Leary’s interpersonal circumplex plots individual interpersonal
acts by Cartesian coordinates within a two dimensional space, where control equals the yaxis reflecting a continuum of dominant to submissive behaviors and affiliation equals
the x-axis reflecting a continuum of hostile to friendly behaviors. Thus, social behaviors
can be plotted on the interpersonal circumplex according to their overall degree of
affiliation and control. In addition, traits are scattered around the circumplex in a
complementary fashion so that the control axis pulls for ‘opposite responses’ and the
affliation axis pulls for ‘similar responses’ (e.g., hostility begets hostility, control begets
submissiveness). In sum, Leary’s circumplex model allows for measurement and
prediction of interpersonal functioning according to what he called the “principle of
interpersonal relations”. As the interpersonal circumplex systematically defines
interpersonal behaviors, it lends itself well to research based on interpersonal theory
(Wiggens, 1982). Consequently, the interpersonal circumplex model has been revised in
several different ways amongst various researchers, and studies have burgeoned that use
various versions of the circumplex to assess personality, psychopathology and
psychotherapy process and outcome (Benjamin, 1974; Coady & Marziali, 1994; Henry,
Schact & Strupp, 1986; Najavits & Strupp, 1994).
Structural Analysis of Social Behavior: The Intrex
Benjamin’s Structural Analysis of Social Behavior (SASB; Benjamin, 1974) is
one example of an influential development of the interpersonal circumplex model. The
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SASB model differs from the traditional circumplex in that it measures social behavior
on three dimensions or surfaces, as opposed to just one. The first two planes represent
interpersonal processes, whereas the first plane is organized around a focus on the ‘other’
and describes prototypically transitive behaviors directed by the ‘other’ person, and the
second plane is organized around a focus on the Self and describes reactions to the
‘other’s’ behaviors. For example, if the ‘other’ person endorses freedom, then the Self
that is interacting with that other will feel autonomous and behave in ways that reflect
“freely coming and going”. The third plane represents actions turned inwards and reflects
Sullivan’s principle of introjects, or self-representations resulting from interactions with
others. For example, if the other person behaves in an attacking manner, the self that is
interacting with that other person will develop an introject which is self-attacking in
nature. Conversely, if the other person behaves lovingly, the self that is interacting with
that other person will have an introject that is actively self-loving. Unlike the first two
planes, this plane reflects beliefs about the Self and as Benjamin (1974) states, “…is
important for connecting self-concept to the social milieu”. Each of the three dimensions
are built upon an x and y axis and are broken into 36 interpersonal behaviors reflecting
degrees of affiliation and autonomy. The 36 behaviors are typically broken down into
octants, with each octant consisting of 4-5 items. While Benjamin’s x-axis is similar to
previous circumplex models in that it represents a continuum of affliation (Love to Hate),
Benjamin re-structured the control (vertical) axis so that control and submit are on the
same side of the pole (at the bottom) and are opposite to emancipate and separate
respectively. In making this change, Benjamin created an axis that represents
24
interdependence, or interpersonal control with varying degrees of independence and
differentiation represented at the top half of the circumplex, and levels of interpersonal
enmeshment at the bottom half.
The SASB model employs both a coding system (Benjamin and Cushing, 2000)
for measuring overt behaviors, as well as a self-report Intrex Questionnaire. The coding
method can be used for all three surfaces (Self, Other, Introject), however it is typically
used in research to describe individuals’ behaviors along the first two interpersonal
dimensions, and consists of having trained coders assign two numbers to each thought
unit (a speech act containing one idea). The first number represents the surface (either
Self or Other) of the thought unit, and the second number represents which octant of the
circumplex the thought unit falls in. The Intrex Questionnaire has several versions (a
short, medium and long form) pertaining to the three axis. Generally, the self-report
intrex is used for assessing individuals introjects (the third plane), and for the assessment
of representations of others behaviors, such as mother, father and significant other (focus
on other). However, the intrex can be arranged in wording so that items represent the
Self in relation to others (focus on Self) as well. Each version requires the person to rate
the subject of focus at best and at worst.
Kiesler’s Interpersonal Transaction Cycles and Circumplex Model
Kiesler (1979, 1983), another key contributor to interpersonal theory, developed a
version of the interpersonal circumplex based on his earlier work concerning
communication in psychopathology and in psychotherapy, or more specifically, the
25
process of “ongoing dyadic interpersonal transactions”. He described the communicative
process between two people as consisting of two principle constructs: One being an
“evoking message” -a term coined by Beier (1966)- that is delivered from the “encoder”
(the person sending the message), and the second being what Kiesler himself called an
“impact message” (the message that is received and decoded by the other person in the
transaction). He described the “evoking message” as consisting of overt verbal and nonverbal behaviors emitted by the “encoder”. The impact message, on the other hand, is
thought to consist of the covert cognitive and affective reactions that are unconsciously
experienced by the person on the receiving end. Kiesler argued that impact messages
leads to reciprocal overt responses from the receiving person that confirm the encoders’
initial expectations of social interactions. In a similar vein to the interpersonal schema,
he hypothesized that this interpersonal transaction cycle is mostly an automatic process
consisting of a cognitive and affective component that remains out of awareness unless
attended too. Kiesler argued that feelings of self-worth, anxiety and depression result
when people, outside their level of awareness, send unaccountable impact messages that
elicit aversive responses from others and therefore engages others in maladaptive
communicative processes. For example, a person who is depressed may send out an
impact message that he is disinterested. The person receiving the impact message may
respond with similar dislike, leading to an unhappy interaction confirming the depressed
person’s initial pessimistic expectations.
In terms of psychotherapy, Kiesler recognized that therapists are not immune to
patients’ evoking messages, and emphasized the importance of therapists’ abilities to
26
attend to their own emotional and cognitive reactions. He suggested that therapists can
challenge maladaptive interpersonal transaction cycles by maintaining close awareness of
covert and overt reactions elicited by the patient’s verbal and non-verbal behaviors. For
example, a therapist may notice feeling patronized by a patient. Upon this recognition,
the therapist may link this feeling to particular expressive-motor mannerisms on the
patient’s part, such as arrogant tilts of the head and a condescending tone of voice
(Safran, 1998). Once identified, these markers provide an entry way into exploring and
ultimately understanding maladaptive interpersonal schemas.
Kiesler used the interpersonal circumplex as a base to operationalize his
communication theory. He formulated his own 1982 version in an effort to revise the
interpersonal circumplex in a way that would capture the overt behaviors involved in his
theory of interpersonal transactions. Previous versions of the circumplex consisted, for
the most part, of ambiguous or static descriptions of personality styles. Conversely,
Kiesler used transitive verbs and unambiguous adjectives that describe overt behaviors as
much as possible in order to clarify the boundaries of each circumplex segment, and
provide accurate behavioral descriptions (descriptions that are more interactional in
nature than previous circumplex descriptions). Thus, he formulated an action-based
circumplex conducive to evaluating interpersonal behavioral transactions in relationships,
as opposed to evaluating interpersonal styles outside the relational context.
In addition, Kiesler’s 1982 version of the circumplex more fully integrates
complementarity theory (Carson, 1969; Foa, 1961; Leary, 1957; Wiggins, 1982). A
primary postulate of interpersonal theory is that behaviors pull for particular behavioral
27
responses from others that confirm expectations and therefore perpetuate one’s selfdefinition (Sullivan 1953; Leary, 1957; Benjamin, 1974). According to complementarity
theory, behaviors are mapped onto the interpersonal circle according to either the
complementarity law of correspondence, or the complementarity law of reciprocity.
Correspondence is represented on the affiliation (horizontal) axis and behaviors pull for
like behaviors, whereas hostility begets hostility and friendliness begets friendliness.
Reciprocity is reflected on the control (vertical) axis and behaviors pull for opposite
behaviors, whereas dominance begets submissiveness and vice versa. Previous theorists,
while recognizing complementarity, failed to explicitly and/or thoroughly systematize its
inherent rules within the context of a circular model. To this end, Kiesler advanced the
notion of complementarity by organizing each behavior around the circumplex in a
bipolar fashion. For example, his circumplex model consists of eight axis and opposite
behaviors residing at each end of the pole, equaling a total of 16 behavioral situations
varying in degrees of control and affilitiation. Kiesler thoroughly articulated semantic
opposites for each interpersonal transaction style. In doing so, he provided a foundation
for systematically placing behaviors around the circumplex so that all coordinates
corresponding to each other on the horizontal plane pull for corresponding (“like”)
reactions, and all corresponding to one another on the vertical plane pull for reciprocal
(“opposite”) reactions. Thus, one can more precisely map out, for example, how a person
who is controlling and hostile will pull a submissive and hostile response from the other
person. In summary, Kiesler advanced the circumplex model into an even more relational
realm, operationalized the interactive processes taking place in interpersonal cycles, and
28
provided a base for systematically predicting behaviors according to theoretically
coherent laws.
Assessing Therapists’ Me-You Represenstations
Interpersonal Schema Questionnaire
In order to assess interpersonal schemas, Hill & Safran (1994) developed the
interpersonal schema questionnaire (ISQ). The ISQ is designed to assess expectations
about how three important people (mother, father and significant other/close friend) will
respond in various interpersonal situations.
Kieslers’ version was chosen as a basis for the development of the ISQ because it
samples the full range of interpersonal behaviors in a rigorous and theoretically guided
fashion (Hill & Safran, 1994). His version was also chosen because of his use of
transitive verbs and unambiguous adjective in describing overt behavior. In other words,
Kiesler’s action-based circumplex model was conducive to evaluating behavioral
transactions in relationships, as opposed to interpersonal styles outside of a relational
context. This use of overt behavioral descriptions made it easier for Hill and Safran to
develop a self-report measure in which individuals could imagine themselves in actual
interpersonal interactions (Hill & Safran, 1994). (Refer to Appendix A for examples of
Kiesler’s circumplex model).
The ISQ consists of 16 interpersonal situations, which are anchored along Kiesler’s
interpersonal circumplex model. For each situation, respondents are asked to imagine
themselves in the interaction in a way that matches the behavior description from the
29
interpersonal Circle. For example, a controlling situation would entail the respondent
imagining himself behaving in a controlling way towards his mother or father. The
respondent would then be asked to chose from 8 different kinds of behavioral responses
that they might expect from mother or father. Each of these 8 responses contains varying
degrees of control and affiliation. Through the act of imagining these situations and their
own behaviors with these three different people, memories and expectations that are
associated with the specific close relationship are elicited. Consequently, response ratings
should represent the generalized rules, goals, contingencies or strategies that comprise the
respondent’s interpersonal schema for each of these types of relationships.
The 8 responses that they chose from are based on Kiesler’s octant version of the
circumplex, which is formed by collapsing adjacent segments of the 16 scenario version.
The reason for doing this was simply to make the response process more manageable for
those filling out the questionnaire. For each situation, respondents are also asked to rate
the desirability of the expected response from other on a scale of 1-7.
16 Situations: Controlling, self assured, spontaneous, outgoing, compliant, warm,
trusting, respectful, docile, dependent, inhibited, aloof, hostile, cold, mistrusting,
competitive
8 Responses: assured/ dominant (PA); competive/mistrusting (BC); cold/hostile
(HD); detached/inhibited (FG); unassured/submissive (HS); deferenet/trusting
(JK); warm/friendly (FS); sociable/exhibitionistic (NO)
Example: Hostile situation= Imagine yourself feeling very angry and
argumentative towards ____. Respondent now chooses how the important other
would respond in this situation from the examples above, then the respondent
rates the desirability of that response.
30
The ISQ yields three key indices scores for mother, father and significant other:
affiliation and control (with mean scores ranging from –1 to +1) and desirability of the
expected outcomes (ranging from 1-7). On the affiliation axis (x-axis) +1 equals
friendly, -1 equals hostility and 0 equals neutrality. On the control axis (y-axis) +1
equals dominant, -1 equals submissive and 0 is equal to neutrality. For example, an
anticipated response such as, “Would be warm and friendly” is almost purely affiliative
in nature and therefore would receive a score of +1 on the affiliation (x) axis. However,
this same response is rather neutral with respect to beliefs regarding control, and would
therefore receive a score of 0 on the control (y) axis. However, subjects anticipated
responses often consist of some combination of affiliation and control. For example, the
response, “Would respect me, or trust me” is considered partially submissive and
partially friendly, and would be scored -.5 for control and +.5 for affiliation.
The individual responses on the ISQ as well as the desirability scale can be
combined in many different ways to yield different types of scores. One can look at
someone’s total level of expected control and affiliation across all 16 situations, for
mother, father, and significant other separately, or combined. Similarly, it is possible look
at someone’s overall desirability of expected outcomes across all situations. However, as
some situations may be more predictive of someone’s interpersonal schema, it is
worthwhile to break down the 16 situations into different subgroups- or subscales. For
example, subscales are often broken down into the four quadrants of the circumplex:
*The quadrants are made up of the following situations:
Hostile: hostile, detached, mistrusting, inhibited, cold
31
Friendly: friendly, sociable, trusting, exhibitionist, warm
Submissive: submissive, deferent, inhibited, trusting, unassured
Dominant: dominant, competitive, mistrusting, exhibitionist, assured
In this way, researchers can examine interpersonal expectations in the various kinds of
situations that reflect the various behavioral descriptions on the circumplex.
Reliability and Validity of the ISQ
Hill and Safran (1994) conducted a study with 344 university students in order to
assess the reliability and validity of the ISQ. Through correlating subjects’ control and
affiliation scores Hill and Safran confirmed that these two indices were orthogonal, or
uncorrelated (r=.07). This supports the validity of the measure as these two axes are
inherently distinct and unrelated properties. For example, the level of affiliation that one
expects from others is un-related to the level of control that that same person anticipates
from others. Hill and Safran assessed the internal consistency of the measure through
calculating Cronbach’s alpha. High internal consistency was found for both the
affiliation and desirability indices (αs = .81, .90 respectively). However, the control
dimension did not demonstrate high internal consistency (αs = .62). Consistent with
these findings, Hill and Safran (1994), found that test-retest correlation coefficients for 34
students (of the original 344) who re-rated the ISQ after a 4-week period were high for
affiliation and desirability, but not for control (rs = .88, .87, .44, respectively). These
findings suggest that interpersonal schemas in normal populations are relatively defined
for affiliative interactions, but not for situations pertaining to control. Hill and Safran
(1994) point out that the lack of consistency for the control index may reflect a tendency
32
for psychologically healthy individuals to be flexible in their anticipation of these types
of interactions. For example, individuals with solid interpersonal skills may form
expectations that are dependent on the given situation, rather than employ one
interpersonal strategy across all of these kinds of situations. Given this reasoning, the
control index may prove to be more meaningful (and consistent) with a more depressed
sample.
Hill and Safran’s (1994) results of overall good validity along with poor reliability
on the control index were replicated in two Turkish studies. In a cross cultural validation
study of the ISQ in Turkey, Boyacioglu and Savasir (1995) assessed the content validity
of the measure through factor analysis and found consistent and strong factorial pattern
amongst the represented interpersonal situations. In addition, 93 university students
independently judged and gave high ratings of suitability for each dimension of the scale
in congruence with its situational category. Boyacioglu and Savasir found good test retest reliability with correlations ranging from .66 to .88 on the desirability and situational
sub-scales (e.g., friendly, hostile, dominant, submissive). However, Soygut and Savasir
(2001) conducted a follow-up reliability study of 378 Turkish students and found lower
internal consistency across all of the situational subscales (friendly, hostile, dominant,
submissive), particularly the control (dominant) subscale (αs = .62, .61, .40, .63
respectively) while the desirability index continued to demonstrate high consistency for
all situations (α = .90).
Relevant Studies applied to Psychotherapy Process
33
The study of the impact of therapists’ defensive processes, or interpersonal
schemas on the therapeutic alliance as well as in-session therapeutic processes is
relatively rare. However, there has been some seminal work regarding this topic. Henry,
Schact and Strupp (1990) examined therapists’ internalized self-representations
(introjects) on interpersonal process and differential psychotherapy outcome. Before
treatment both therapists’ and patients’ introjects were assessed by Lorna Benjamin
Smiths (1988) Intrex questionnaire, which assesses self representations within an
interpersonal context. Henry et al then separated good and bad outcome cases based on
changes in patients’ self representations as evidenced by the Intrex. They found that (i)
poor outcome cases were related to interpersonal behaviors by therapists that confirmed
negative patient introjects; (ii) the number of therapists’ statements that were hostile or
controlling correlated with the number of self blaming statements by the patients, and (iii)
therapists’ with hostile introjects were more likely to engage in interpersonal processes
that have been associated with poor outcome. Henry & Strupp (1994) later concluded
that these findings may suggest a link between therapists’ early relationships with their
parents, the formation of the therapists’ adult introjects, and the consequent “vulnerability
to counter-therapeutic techniques.”
A previous study by Nelson (2000) also provides preliminary research on this
topic. In addition, she looks specifically at therapists’ interpersonal schemas and how
they play themselves out in the context of alliance ruptures. Nelson evaluated the
interpersonal expectations of therapists using the ISQ. She then examined the
relationship between the ISQ ratings with (i) SASB ratings of in-session behavior during
34
rupture segments and (ii) treatment outcome. Nelson found that therapists who expected
to elicit hostile responses from their fathers, as measured by the ISQ, also tended to
engage in hostile behaviors with their patients, as rated by the SASB. Interestingly, this
hostility did not predict negative outcome. This may have to do with the fact that sessions
were rated based on rupture segments, and may indicate a relationship between hostility
and techniques employed when working through ruptures. Therapists’ expectations of
affiliation with their mothers as well as with significant others in their lives did not
predict their behavior with their patients.
In a more recent study, Fox-Borisoff (unpublished MA thesis) also found that the
mother and father may contribute distinct characteristics to the formation of interpersonal
schemas. For example, Fox-Borisoff assessed therapists’ interpersonal schemas using the
desirability index on the ISQ. Desirability for each therapist was broken into the 4
quadrants or subscales as described above (hostile, friendly, submissive and dominant) in
order to see if desirability of particular kinds of situations predicts in-session processes as
well as therapists’ ability to form a positive working alliance. Desirability for these
quadrants was assessed for both mother and father independently. Little discrepancy was
found between the quadrants themselves- desirability in affiliative situations were not
particularly more or less predictive of working alliance or the resolution of ruptures than
controlling situations. This was true for both patient and therapist perspectives.
However, there was evidence suggesting a difference between the types of interpersonal
behaviors that may arise from the relationship with the mother verses the father. In
particular, the findings suggest that therapists who have positive interpersonal schemas
35
with their fathers (i.e. they expect desirable outcomes, regardless of the situations, when
interacting with their fathers’), are more likely to resolve ruptures. However, a positive
interpersonal schema with ones mother seems to predict therapists’ ability to establish a
positive working alliance. In summary, the quality of one’s relationship with their father
seems to predict interpersonal techniques necessary for working through conflict,
whereas the quality of one’s relationship with their mother seems to predict interpersonal
techniques necessary for establishing a positive working alliance.
The Role of the Father and Interpersonal Schemas
Both Nelson and Fox-Borisoff’s studies suggest an important role for the father in
interpersonal schema formation. Previous research regarding the relationship with the
therapist and his or her father and how that affects the therapeutic process in particular is
limited. However, Mallinckrodt, Coble & Gant (1995) conducted a relevant study
examining the role of early attachment experiences on adults’ internal representations of
social competency, and how these beliefs in turn, affect patients abilities for establishing
therapeutic working alliances. They used the adult attachment scale to assess parental
bonds (i.e., expected degree of parental warmth and emotional responsiveness versus
expected degree of parental control), and the self-efficacy scale to assess social
competency. They looked at both of these scales in relation to the working alliance in 76
adult females and found that parental bonds with fathers exclusively predicted social
competency. They also found that parental bonds with fathers negatively predicted
working alliance (patients with the poorest working alliances were those most likely to
36
characterize their fathers as over-involved, controlling, and emotionally over-bearing),
whereas strong maternal bonds positively predicted working alliance. Interestingly, this
negative correlation between fathers and working alliance was stronger than the positive
correlation they found between maternal bonds and working alliance. Similar in nature to
Fox-Borisoff’s findings, these finding suggest that fathers may be particularly important
in the formation of social skills, and that there may be a relationship between paternal
attachment style and therapeutic processes.
There are a few other studies that have touched upon the relationship between the
father and the formation of interpersonal schemas in general. For example, Hill & Safran
(1994), in their validation study of the ISQ (1994) found that university students expected
more hostile responses from their fathers and more friendly responses from their mothers.
In another study, Boyacioglu and Savasir (1995) categorized subjects into low, medium
and high depressive symptomatology groups and than assessed their interpersonal
expectations of the mother and father by using the ISQ. They found that individuals in
the ‘high’ group expected more hostile responses from their fathers in hostile situations
than subjects in the low and medium symptomatology groups. This finding suggests a
relationship between fathers’ hostility in conflict situations and depression in children.
However, the nature of this relationship is unclear. For example, while it may be that
hostile fathers cause depression, depressed individuals may simply be more likely to
perceive non-threatening behaviors as hostile. Regardless of the nature of this
relationship, the lack of findings with the mother variable against the relatively strong
37
findings with the father variable, suggest that fathers play a particularly important role on
the formation of interpersonal schemas related to depressive symptoms.
Chapter II
Child Development, the Role of the Father, and Conflict Resolution Strategies
Research regarding child development may point towards a difference in the roles that
mothers verses fathers play in the formation of interpersonal schemas. In particular, and
consistent with Fox-Borisoff’s findings stated above (that a therapist’s relationship with
his or her father predicts that persons ability to resolve ruptures, whereas a therapist’s
relationship with his or her mother predicts that personal ability to establish a working
alliance) the child development literature reveals an interesting trend in that fathers seem
to strongly affect a child’s ability for social behaviors, such as displays of confidence in
negotiating interpersonal situations, including conflict, whereas mothers seem to be more
relevant to children’s abilities to form trusting, warm and supportive relationships. In
addition, the child development literature supports this hypothesis across a variety of
theoretical frameworks in that it includes attachment theory, social information
processing theory, and social learning theory.
Child-Father Attachment Style and Children’s Social Competence
According to attachment theory, infants develop internal cognitive-affective
representations of interactions with caregivers, or internal working models (IWMs).
38
IWMs play a central role in maintaining proximity with others by allowing the infant to
predict self-other interactional contingencies, or rough drafts of self-other experiences
that help guide and plan future social interactions (Bowlby, 1969). For example, if an
infant experiences abandonment when expressing feelings of anger, the infant will learn
to inhibit this feeling in order to maintain proximity with his or her caregiver (Safran,
1990). The infant will then incorporate the message ‘expressing anger leads to being
alone’ into an IWM and continue to inhibit this feeling in future relationships.
Overall, Bowlby’s (1969) research suggests that people develop a predominant
attachment style through these early formative experiences that determine the quality of
future significant relationships and feelings of self-worth. For example, a secure working
model of a person’s attachment relationship with the mother is thought to have positive
expectations regarding the mother’s availability and responsiveness, along with a
subsequent sense of being loveable and high self-regard. These individuals will come to
expect positive responses from others, and may be more likely to reach out and form
healthy relationships. Conversely, a child with an insecure attachment style is assumed
to have a working model of the parent as rejecting or unresponsive, resulting in feelings
of low self-worth or a belief that he or she is unlovable. These children may come to
anticipate rejection and rely on either aggression or withdrawal (Ainsworth et al., 1978).
Child development researchers have often considered attachment theory to be one of the
most influential theories in explaining the relationship between social and emotional
development and parental style (e.g., Hamilton & Howes; Sroufe, 1983). In the past,
child development researchers and attachment theorists (Bowlby, 1969, Ainsworth, 1973)
39
Main, Kaplan & Cassidy, 1985; Cohn, 1999) have typically focused on the mother as the
primary caregiver, and how this relationship shapes emotional and behavioral
components of future relationships. However, findings suggesting that children develop
a distinct attachment style to fathers at 18 months of age (Schaffer and Emerson, 1964;
Lamb, 1997), has led to an increased interest in the independent influences of father-child
attachment on healthy development. In addition, past research has often considered the
effects of father-child attachment to be contingent upon mother-child attachment quality,
or to merely create an “averaging effect” with mother-child attachment. However, more
recent findings have suggested that invalid methodology may have contributed to past
limited findings regarding the importance of the father. Thus, there has been a reconsideration of the role of father-child attachment. For example, previous research has
typically relied on the same methodological tools for assessing father-child attachment
that is used for mother-child attachment research. Research has suggested that fatherchild attachment has different consequences on development than that of mother-child
attachment, thus, assessing these two different attachment relationships in the same way
may be miss-leading. For example, the "strange situation” is often used to assess motherchild attachment, and measures a child’s response in a new environment under a mildly
distressing situation (the mother leaves her child alone). Children who are securely
attached will curiously explore the environment and happily welcome the mother back
when she returns. This secure attachment is thought to be the result of adequate tender
loving care of mothers (Grossman et al., 2002). Conversely, Grossman et al (2005) found
that measures that assess sensitivity in terms of emotional support and gentle challenges
40
in play situations better capture father-child attachment quality. The idea that play time
offers a better medium for assessing children’s attachments to their fathers is consistent
with previous research suggesting that fathers widen children’s experience and help them
adapt to new situations beyond the family environment (In Grossman et al., 2002:
Hewlett, 1992; Harkness and Super, 1992). For example, through their active play and
advice giving, fathers are thought to provide their children with a sense of safety in new
and challenging experiences (Murphy, 1977; Parke, 1995), and as Lamb (1975)
suggested, linking their children to the outside world. In sum, a secure attachment to the
father may reflect a father’s ability to sensitively challenge and support the slightly older
toddler’s exploration of the social environment and new experiences, as opposed to
reflecting the kind of tender loving care that a mother expresses and that contributes to
feelings of safety upon separation in infancy.
Overall, attachment research is currently suggesting that the quality of fatherchild attachment has its own unique value in child development (Verschueren &
Marcoen, 1999). Several of these studies use alternatives to the “strange situation” for
assessing father-child attachment (however, it is unclear if this was done because of the
question of predictive validity with the “strange situation” in terms of father-attachment,
or simply because of the practicality of these other measures). A pattern is beginning to
emerge in these studies suggesting that father-child attachment relationships are more
relevant to children’s socioemotional development including social-efficacy and conflict
resolution skills in particular, while mother-child attachment relationships are more
relevant to issues of inward emotional experiences, warmth, trust and empathy (the same
41
characteristics necessary for a strong working alliance). The following studies address
these differences:
Verschueren and Marcoen (1999), argued against the idea that father-child
attachment merely offers an “averaging” affect (Bretherton, 1991) in predicting selfesteem and social competence. They hypothesized that working models for mothers and
fathers may remain partially unintegrated and influence different aspects and
relationships in children’s lives. They conducted a study consisting of forty girls and
forty boys between fifty-five and seventy-seven months of age to assess the differential
and combined predictive power of children’s internal working models for mother and
father. Like Main & Westin (1981) they found that children with secure working models
of the father and the mother (as measured by the attachment story completion task based
on Bretherton et al., 1990; and Cassidy, 1988) fared better than those children who only
had a secure attachment to the mother. However, they also found that the relative
predictive power of mother-child and father-child attachments differed depending on the
domain of child functioning that was assessed. For example, they found that the motherchild attachment style was predictive of self-representation including feelings of selfworth (as measured by the puppet interview developed by Cassidy, (1988) and
Verschuruen et al., (1996), whereas father-child attachment style was predictive of peer
social competence and behavioral displays of self-confidence {as measured by
kindergarten teachers’ ratings on the pre-school social and behavior questionnaire
(Tremblay, Vitaro, Gagnon, Piche & Royer, 1992) and a popularity and peer acceptance
six point scale developed for the study}. In particular, father-child attachment style was a
42
uniquely powerful predictor of children’s anxious and avoidant behaviors. For example,
children with secure attachments to their fathers demonstrated less anxious and
withdrawn behaviors, better social adjustment and more social competence with peers
than children with insecure (ambivalent, hostile/bizarre) attachments to their fathers.
Overall, Verschueren and Marcoen (1999) demonstrated that internal working models of
fathers uniquely influence outward displays of social behavior including avoidant and
anxious behaviors, whereas internal working models of mothers uniquely influence
inward feelings of self-representation, including feelings of self-esteem, perceived
competence and likelihood of peer acceptance.
Steele and Steele (2005) found similar results to Verschueren and Marcoen (1999)
with regards to the unique contributions of mother-child and father-child attachment
style, where the former is relevant to the understanding of inward feelings, and the latter
to the negotiation of outward displays of emotion. Steele and Steele (2005) assessed the
attachment styles of expectant mothers and fathers arising from their own childhoods
(through conducting the Adult Attachment Interview (AAI) (Main, Goldwyn & Hesse,
2003)), and then related these findings to the quality of parent-child attachment of such
parents’ newborn children at infancy. They assessed the infant’s attachment style to the
mother at one year, and the infant’s attachment style to the father at eighteen months. For
both of these assessments they used the “strange situation.” They then conducted
longitudinal studies of eighty-six children to track and assess emotional development at
five, six and eleven years of age. When the children were five, they looked at their
abilities to understand emotional conflict in the nuclear family by presenting eleven
43
different story stems from the MacArthur Story Stem Battery (Emde, Wolf, &
Oppenheimer, 2003) to the children. The story stems used dolls to depict domestic
emotional conflict, as well as story beginnings requiring the child to “show me and tell
me what happens next”. When the children were six years old, Steele and Steele assessed
their abilities to understand others’ emotional reactions of others. They administered a
series of cartoons depicting social interactions involving emotional conflict. The children
were asked to report how the characters were feeling, and were encouraged to provide
narratives that explained their reasoning. At eleven years of age, Steele & Steele
administered the “friends and family interview” (Steele & Steele, 2004) to further assess
emotional and social development. This interview asked questions regarding feelings
that arise within family and peer relationships.
With regards to mother-child attachment, Steele and Steele’s results suggest that
both the mothers’ own attachment style measured prior to giving birth, and infant-mother
attachment quality at one year of age are independently important for healthy emotional
development. For example, they found that mothers’ AAI’s during pregnancy were
predictive of their infants’ attachment styles. More specifically, expectant mothers who
spoke coherently about their own childhood experiences (whether good or bad) had
children who were securely attached to them at one year of age. They also found that
mother’s with coherently organized (autonomous-secure) AAIs from before giving birth
had five year old children who were more likely to reference the limit-setting statements
of an authoritative parent when exposed to emotionally conflictual scenarios. These
limit-setting statements are viewed as positive methods for containing overwhelming
44
emotions in children, and thus their internalization it thought to be part of healthy
emotional development (Steele & Steele, 2005). With regards to their follow-up
assessments at six years of age, Steele and Steele found that both attachment to mothers
at one year of age, and mothers’ prenatal AAI’s were predictors of children’s abilities to
understand mixed emotions, and the emotional reactions of others. Taken together,
Steele and Steele interpret these findings to suggest that maternal attachment style prior
to giving birth, and mother-child attachment at infancy are important determinates for a
child’s ability to regulate and understand their own emotions, and other’s emotions. This
early ability to understand their own, and others’ mixed emotional states may be the
bedrock for what is later referred to as empathy.
At the eleven year follow-up, Steele and Steele found that “truthfulness” was the
most reliable aspect between expectant mothers’ AAI responses and children’s responses
on the friends and family interview. For example, mothers with secure AAI responses
from years ago were more likely to have children who provided honest accounts of their
views of themselves and others. Truthfulness seems to require a certain degree of
personal acceptance and emotional awareness. Thus, it is not surprising that mothers
who are secure in their own right, would somehow influence their children’s sense of
self-acceptance and honesty. Interestingly, Steele and Steele also found that fathers’
secure AAIs were predictive of their sons’ truthfulness on the friends and family
interview, however, not their daughters’ (mothers predicted both genders). Steele and
Steele turn to Chodorow (1978) to explain this discrepancy. For example, they suggest
that boys require the immediate involvement of both the mother and the father for
45
forming a coherent and secure self-identity. However, daughters can continue to turn to
the mother as a source for forming their own self-understanding and therefore do not
involve the father to any significant level.
Despite the inconsistent effects found with regards to father attachment style prior
to giving birth, and father-child attachment style at eighteen months, the eleven year
follow-up yielded some strong and unique findings with regards to fathers’ own
attachment styles and their children’s socioemotional development (they still failed to
find any significant effects for father-child attachment at eighteen months, which may be
due to the fact that they used the “strange situation” to assess the child’s attachment to the
father, which as mentioned above may not be a valid measure for father-child attachment
style). Steele and Steele (2005) found that father’s AAI responses before their children
were born were uniquely predictive of both their sons and daughters ability to resolve and
negotiate social disagreements. For example, fathers with secure-autonomous AAI’s
from years before had eleven year old children who were more likely to provide coherent
and resourceful accounts of how to resolve social conflicts (as presented by the Friends
and Family measure). Steele and Steele suggest that these fathers may have played an
important role in helping their children handle emotions that come up in social
relationships, beyond the sphere of the primary mother-child relationship. Steele and
Steele (2005) also found that fathers who provided insecure AAI responses many years
before were more likely to have children with behavioral problems such as conduct
disorder, hyperactivity and difficulties in peer relations (as reported by the children).
Overall, Steele and Steele interpret their findings to suggest that mothers may uniquely
46
contribute to children’s understanding and resolution of emotional conflict within
themselves (which may lead to such qualities as empathic understanding and truthful
accounts of their feelings), whereas fathers may uniquely contribute to children’s ability
to maintain socially appropriate behaviors with others, and to understand and resolve
interpersonal emotional conflict.
Coleman (2003) examined the relationship between children’s social selfefficacy, peer victimization, and quality of peer relationships with the level of secure
attachment to their mothers and fathers during middle childhood. In addition, she
examined social self-efficacy as a moderator linking parental attachment quality to peer
attachment quality. Interestingly, Coleman does not consider internal working models as
a mediator between parental attachment and future attachment relationships. For
example, she highlights a definitional congruence between internal working models, and
social self-efficacy beliefs, which are defined by Bandura (1997) as consisting of (i)
knowledge of appropriate social behaviors, (ii) confidence in one’s ability to respond
competently in interpersonal situations and (iii) beliefs that the responses from others in
one’s social environment will be supportive of one’s effort to engage in the interaction.
In essence, she argues that these two constructs are comparable in that they both involve
relatively stable, yet potentially modifiable internal representations, that develop from
past relationships with caretakers, and that likely influence affective and behavioral
responses to social interactions. In making this connection, Coleman provides a
theoretical grounding for comparing findings from social learning theory and attachment
47
theory, and provides a basis for her own work in examining social self-efficacy within the
context of attachment theory.
Coleman examined sixty-seven fifth and sixth graders (thirty-one girls and thirtysix boys) at a small public school in the Southeastern US. She used the Inventory of
Parent and Peer Attachment (IPPA), developed by Armsten and Greenberg (1987) to
assess children’s attachments to their mothers, fathers and peers. More specifically, this
measure asks questions pertaining to children’s self-perceptions of mutual trust,
communication quality, acceptance, and the degree of anger and alienation within the
context of their peer relationships. In order to assess interpersonal functioning, Coleman
administered the social self-efficacy subscale of the Children’s Self-Efficacy Scale
(CSES) developed by Bandura et al (1996). An example item from this subscale includes
“How well can you make and keep friends?”
Coleman’s findings suggest that only mother-child attachment predicts the quality
of peer attachment, whereas only father-child attachment predicts social self-efficacy.
For example, she found a significant relationship between children with secure
attachments to their fathers and reports of high levels of social self-efficacy with peers.
In contrast, attachment to the mother was not predictive of children’s social self-efficacy,
however, it was significantly related to the quality (e.g., warmth, trust) of children’s
attachments with their peers. She also found evidence suggesting that mothers and
fathers effects on children exist across genders. For example, she did not find any
interactions between child gender and parent-child attachment relevant to peerattachment, or social self-efficacy. Coleman interprets her findings to suggest that
48
attachment related behaviors to the mothers and fathers are relevant to children’s
likelihood of having successful relationships however, they are related in different ways.
She states that mother-child attachment relationships may be uniquely relevant to
children’s ability to show sensitivity and concern for others, and to be able to display
emotions that merit trust and commitment in close relationships, whereas father-child
attachment relationships may be uniquely relevant to children’s feelings of worth and
competency in social situations. While Colman’s study does not look at conflict
resolution per se, it is easy to imagine that elements of social self-efficacy are required
for such behaviors. In addition, many child development researchers argue that conflict
resolution is the most encompassing standard for measuring social competency
(McDowell, Parke and Spitzer, 2002). For example, if one does not hold the belief that
they are effective in the interpersonal domain, than it is most likely the case that that
person would also believe they are ineffective in threatening social situations, such as
conflict.
Kern and Barth (1995) found that a secure attachment to the mother was related to
boys’ and girls’ abilities to engage in play, whereas secure attachment to the father was
related to particular ways of handling friendships once they were established. For
example, children with secure attachments to their fathers displayed friendly cooperative
behavior including using more directives and making more suggestions and positive
responses. Once again, this study suggests a distinction between the contributory roles of
the mother and the father, where the mother is involved with factors pertaining to a
49
child’s ability to establish a relationship, and a father is involved in factors that may
pertain to conflict resolution and social negotiation.
Lieberman, Doyle and Markiewicz (1999) examined the effects of middle
childhood attachment security (including dependency and parental availability) to both
mother and father on concurrent peer relations with 274 elementary school students and
267 high school aged students. They administered the friendship quality questionnaire
(Bukowski et al., 1994) to assess the degree of security, closeness, companionship, help
and conflict between peers, and the Kerns Security Scale (Kerns et al., 1996) to assess the
degree of perceived parental availability and dependency (e.g., the degree to which
children believe they can turn to their parents in stressful situations). They found that
attachment to the father on the availability dimension in particular was the strongest
predictor of peer conflict. The father’s availability seemed to be a critical factor in
middle-childhood conflict with peers, whereas the more available the father (as perceived
by the child) the less conflict that occurred between the child and his or her peers (again
as perceived by the child). Lieberman, Doyle and Markiewicz explain this relationship
by suggesting that available fathers may engage in the kinds of interactions (such as
playful activities) that provide opportunities for teaching their children conflict resolution
strategies. Lieberman, Doyle and Markiewicz also found that child-mother and childfather secure attachment predicted better quality peer relationships, including higher
reports of closeness, help and security. However, they found that the relationship of
child-mother dependency to child positive friendship qualities uniquely varied as a
function of maternal availability. For example, children who perceived their mothers to
50
be available when needed, and have developed a healthy degree of autonomy (i.e., they
are not dependent on their mothers) reported greater closeness, support and security in
their friendships. This may suggest that mothers are particularly relevant to their
children’s experience of an individual-self, which is relevant in establishing secure,
trusting relationships. Overall, these findings suggest that mother verses father
attachment security may play distinct roles in the formation of children’s social
competence whereas (i) the father’s availability seems to be more involved with factors
regarding conflict and conflict resolution and (ii) mothers seem to be relevant to
children’s experience of an autonomous, individual-self capable of forming healthy
adolescent-peer relationship.
Father-Child Conflict and Conflict Resolution with Peers
The above studies suggest that secure paternal attachment is an important predictor of a
child’s peer relationships, and that secure attachment to the father, a father’s own secure
attachment style (as seen in Steele and Steele, 2005) along with father availability may be
particularly important in the development of conflict resolution strategies. In terms of the
nature of the pathways that explain this relationship, the above literature points generally
to internal working models and to a lesser extent social self-efficacy beliefs (i.e.,
Coleman) as possible mediating factors that may account for the transfer of social
behaviors from parent to child. However, attachment literature in general focuses more
on how the quality of the father-child attachment relates to child social competence, as
opposed to what behaviors and attitudes transpire during actual interactions between the
father and the child (Parke et al., 2002). Several studies within the child development
51
literature focus specifically on conflict resolution situations between the father and the
child, and more precisely suggest that the strategies that fathers employ in these particular
interactions may be most influential in the transfer of information, and formation of
cognitive structures that guide conflict resolution and social competence skills in
children.
For example, McDowell, Park & Spitzer (2002) assessed mediating components
such as goals and strategies that account for the transfer of behaviors from familial
contexts to peer situations. More specifically, they looked at the relationship between
parental goals and strategies with children’s goals and strategies relevant to social
competence and conflict resolution. They administered an open ended vignette of a
conflict situation to ninety-seven kindergarten children and their mothers and fathers.
The vignettes were then coded for goals and strategies. Goals (e.g., the desired outcome
for a social encounter) and strategies (e.g., the actions taken to achieve the goal) were
defined in terms of social information processing theory (Crick and Dodge, 1994) and
formed into the following two composites: (i) Relational-Prosocial which was
comprised of prosocial and relational strategies thought to minimize conflict and (ii)
instrumental –confrontational which was comprised of avoidant, confrontational, and
instrumental components that are self-serving and facilitate “getting one’s way.” In order
to assess children’s social competence, teachers were asked to fill out a twelve item
children’s competence questionnaire developed by Cassidy and Asher (1992), and
children were asked a variety of questions regarding their peers’ social behaviors (i.e.,
friendliness, exclusiveness vs. inclusiveness with others, aggressiveness, willingness to
52
help and share). Their findings suggested that kindergartners’ pro-social/instrumental
goals and strategies in conflict situations, closely resembled the interpersonal goals and
strategies that father’s employ in conflict situations. Likewise, they also found that
fathers’ goals and strategies were better predictors then mothers’ goals and strategies for
children’ social competence. According to McDowell, Parke and Spitzer fathers’ social
representations may be important correlates of children’s own social information
processing. However, McDowell, Parke and Spitzer point out that the pathways through
which fathers’ cognitive representations effect children’s social competence remains
unclear. For example, they conducted a mediational analysis to assess the extent to
which children’s goals and strategies (cognitive representations) that are acquired through
interactions with their fathers’ mediate such children’s social competence. Contrary to
their predictions, they found only minimal evidence suggesting that children’s strategies
may mediate this relationship, and no evidence that children’s goals are a mediating
variable. They interpret this lack of findings as a possible indication that children’s
social competence skills are either non-mediated, or mediated from father to child
through non-cognitive pathways such as emotional-regulatory mechanisms,
reinforcement, teaching, or modeling.
McDowell, Parke and Spitzer (2002) explain the salience of the father in
predicting children’s social competence by suggesting that perhaps mothers are more
relevant to social domains related to pro-social issues such as making friends, whereas
fathers are more influential in conflict laden situations. In addition, they highlight that
this difference between mothers and fathers is consistent with previous research that has
53
suggested that mothers may be more relevant to children’s internalizing behaviors,
whereas fathers may be more relevant to children’s externalizing behaviors (Cowan,
Cowan, Schulz and Heming, 1994).
Another study by McDowell, Parke and Wang (2003) assessed the relationship
between parental advice giving in conflict situations and middle childhood social
competence. The authors arranged triadic advice giving sessions where mothers, fathers,
teachers and their third grader discussed how to handle various problems that their child
had when socializing with peers. Fathers’ approaches to advice giving in these sessions
were the strongest concurrent and one year later predictor of child social competence.
Interestingly parental style, which McDowell, Parke and Wang define as the degree of
control and warmth expressed by the parent during the advice giving interaction,
appeared to be a stronger predictor of children’s social competency than the actual
feasibility of the solution provided by the parent. In particular, fathers’ controlling styles
in conflict situations predicted negative social competency ratings by both teachers and
peers. Thus, father’s behaviors in conflict situations are particularly salient predictors of
children’s social behavior. McDowell, Parke and Wang explain these findings by
suggesting that perhaps mothers are more likely than fathers to provide advice in
everyday settings, thus when a father provides advice in particularly problematic
situations it is that much more salient to the child.
McDowell, Parke and Wang (2003) found evidence suggesting that a controlling
and cold approach to advice giving may also result in feelings of depression and
loneliness in children. More specifically, a controlling style by both the mother and the
54
father predicted depressive symptoms and loneliness. However, only a mother’s lack of
warmth predicted childhood loneliness. Assuming loneliness results from difficulties
forming close friendships, this latter finding suggests that a mother’s warmth is an
important predictor of a child’s likelihood of establishing close bonds with peers. Again,
this supports the notion that mothers are particularly relevant to children’s abilities to
establish close relationships.
There is also evidence that father-child interactions are more predictive of child
social competence and aggression than mother-child interactions (Parke et al 1989). For
example, Pakaslahti et al (1996) examined parents’ social problem solving strategies with
their sons (daughters were not included in the study) and found that only the father’s (and
not the mother’s) resolution strategies were related to aggressiveness in their sons. For
example, parents who were passive and cold, diverted authority or were punitive towards
their sons in dealing with problematic situations had sons who were more aggressive.
However, a mother’s attempt to be active in problem solving with their sons did not help
their children’s pro-social behavior with peers. Only a father’s active involvement,
including strategies such as helping the boy to come up with conflict resolution plans,
engaging in discussion, providing advice, and in particular encouraging their sons to
consider problems from multiple perspectives helped to enhance their sons’ social
capabilities (McDowell et al., 2002; Parke et al., 1989; Pakaslahti et al 1996). Consistent
with social information processing theory, they suggest that parents transmit their own
problem solving strategies to their children, which in turn, affects elements of children’s
behaviors.
55
Reese, Weber and Marchand (2001) examined conflict resolution strategies
between mother - adolescent and father – adolescent dyads with late adolescents’
romantic relationships. They administered the Managing Affect and Differences Scale
developed by Arellano and Markman (1995) and independently assessed male and female
late adolescents for each of these two dyads. Reese, Weber and Marchand predicted that
adolescents would identify with and therefore engage in resolution strategies most similar
to their same sex parent. They supported this hypothesis through social learning theory,
which predicts that children are more likely to imitate the behaviors’ of role models with
whom they share important characteristics such as gender (Bandura, 1989). However,
their findings did not completely coincide with this prediction. Reese-Weber and
Marchand found that positive and negative conflict resolution strategies with the father
predicted both male and female adolescents’ resolution strategies with romantic partners
(albeit the degree of this relationship was weaker for females); whereas strategies
employed in mother-adolescent dyads were only related to female resolution strategies
with romantic partners. For example, females who reported more positive conflict
resolution behaviors with their mother and their father were more likely to report positive
resolution strategies with their romantic partners, whereas females who experienced more
negative resolutions behaviors with both the mother and the father, were more likely to
experience negative conflict resolution behaviors with romantic partners. For males, only
reports of positive and negative conflict resolution behaviors with the father (and not the
mother) were related to their reports of conflict resolution with partners. In sum,
interactions with the father had predictive value across genders, whereas the predictive
56
value of conflict situations with the mother was limited to females. These finding
suggests that the role of the father in conflict resolution strategies may involve more than
imitation of same sex parents. These findings may be interpreted in light of research
suggesting that conflict with fathers occurs less frequently than conflict mothers (Allison,
B, 2000, Furman & Buhrmester, 1992, Laursen, 1995, Laursen and Collins, 1994,
Montenmayer, 1982). Thus, when conflict with the father occurs it may be emotionally
arousing to daughters as well as sons and therefore more memorable, and influential for
both genders. Reese Weber and Marchand’s slightly stronger findings with father-son
conflict may indicate some combined effect of imitation of same sex parent along with
the powerful nature of father’s involvement in conflict situations.
Ricaud-Droisy and Zaouche-Gaudron (2003) conducted a study in Toulouse,
France and found a positive relationship between fathers who are highly involved and
play a distinct role (from the mother’s) in raising their children with those children’s
abilities to use productive conflict resolution skills with peers. Ricaud-Droisy and
Zaouche-Gaudron described these nursery school aged children as working towards
mutual understanding through seeking dialogue and verbal negotiation in conflictual
interactions. They also suggest that these children seem to be in a position to explain to
peers their own perspectives as well as be able to listen to others’ points of view. In
contrast, Ricaud-Droisy and Zaouche-Gaudron also found that children with fathers who
regard their role as less implicated and less differentiated from that of the mother’s tend
to engage in more aggressive conflict with their peers. In a third condition, they found
that children with father’s who do regard their role as having implications on the child’s
57
social development, however, as not being distinct from the mother’s role are likely to
abandon conflict and seek refuge with an adult. Overall these findings suggest that it is
important for the father to not only be involved, but contribute a unique quality in raising
the child. Ricaud-Droisy and Zaouche-Gaudron performed an ascending hierarchical
method and found that dealings with authority, respect of rules, and firmness in times of
conflict (e.g., when the child requires structure and rule-enforcement) seem to be some of
the primary characteristics of this distinct role.
Finally, Daniel T. L. Shek and Hing Keung Ma (2001) conducted a longitudinal
cross cultural study amongst Chinese female and male adolescents and found consistent
results to those stated above. They administered the Conflict Behavior Questionnaire
(Robin & Foster, 1989) to assess parent-adolescent conflict, and the Adolescent Behavior
Questionnaire (Ma et al., 1996) to assess adolescent social behavior at various intervals to
students in grades seven through eleven. Their results suggested that over time fatheradolescent conflict uniquely predicted female and male adolescent pro-social behaviors,
and was overall a better predictor of adolescent anti- social behaviors. These findings
suggest that fathers continue to have an influence on children’s conflict resolution
strategies well into late teenage years.
Affect-Regulation and Conflict Resolution: The Role of the Father
Both the attachment literature and social information processing literature have
suggested that affect regulation may play a mediating role between father characteristics
and child social competency. Several studies within the attachment literature suggest that
58
parental emotional availability and emotional sensitivity mediates the formation of
internal working models which in turn influences children’s abilities to regulate their own
emotions leading to feelings of self worth and quality of interpersonal functioning (Wei,
Tsun-Yao Ku and Zakalik, 2005). For example, caretakers who are inconsistent in their
emotional availability and are insufficient in handling their children’s distressing
emotions, result in children developing an insecure attachment style linked to emotional
distress, nervousness and negative affect, interpersonal difficulties including hostility
towards others, and increased feelings of loneliness. In contrast, caretakers who are
emotionally available and sufficient in handling their children’s affect have children who
develop secure attachments linked to positive self-regard and interpersonal successes
(Wei et al., 2005). In addition, Bowlby (1982) proposed that intense emotional
expression is part of the process by which internal working models form. Steele & Steele
(2005) go on to hint at the importance for healthy affect regulation strategies with regards
to fathers when they hypothesize that a father’s ability to handle his child’s emotions
during social interactions predicts the quality of the father-child attachment style.
Several researchers within the social information processing domain have
acknowledged the relationship between children’s social competence and affect
regulation (Barth & Parke, 1995, Carson & Parke, 1996). Researchers suggest that a
child’s ability to meet the demands of a social situation requires adequate response and
reading of other’s emotions, as well as the ability to regulate one’s own emotions
(Eisenberg et al., 1993; Roberts and Strayer, 1987). Parents are thought to transmit
emotion regulation skills to children through children’s modeling of emotion regulation,
59
parental control verses acceptance of their children’s emotions, or through parental
coaching in distressing and conflict situations (Eisenberg et al, 1998; Gottman, Katz &
Hooven, 1997; Isley et al., 1999; McDowell & Parke, 2000; McDowell & Parke, 2005;
Roberts, 1999).
With regards to the father, Parke (2000) directly suggests that affect regulation
may mediate the relationship between fathers’ goals and strategies in conflict situations
and children’s social competence. Although Parke (2000) does not offer an explanation
for this, perhaps it is because conflict situations occur so infrequently with fathers that
when these emotionally-laden situations do occur, they become a medium for
transmitting meaningful emotional experiences to the child, which then influence the
child’s affect regulatory abilities, which in turn, influences the child’s social competence.
In addition, Parke (2000) and Roberts (1999) highlight that (i) the quality of emotions
displayed by fathers and (ii) how fathers respond to their children’s distressing emotions
are important predictors of children’s social competence and conflict resolution skills.
These findings are consistent with general theories of psychology which often recognize
the importance of parental emotional availability and emotional sensitivity for healthy
child development. However, many of these theories primarily address the influence of
the mother’s affective response strategies and emotional availability on child
development. For example, Tronick (1998) emphasizes the importance of a mother’s
ability to adjust or “attune” to her child’s emotions, through a series of affective misscoordination and repairs. Tronick (1998) suggests that the process of oscillating back and
forth between states of affective miss-coordination and repair helps the infant develop a
60
belief that the caretaker is available even in moments of disconnect, resulting in a sense
of safety and ability to withstand difficult moments. In addition, Stern (1985) argues that
the process of affect attunement plays a central role in a person’s ability to communicate
his or her emotional experience. He argues that through the mother’s affective
attunement children come to experience their emotions at a bodily felt level, and because
they experience emotions at a bodily felt level, as opposed to being cut off from
experience, they are able to appropriately express their emotions and communicate with
others what they are feeling (Safran, 1990). Shore (2001, 2003) additionally posits that a
mother’s adequate emotional stimulation (that is not over-stimulating or understimulating) facilitates the maturation of the orbitofrontal system, which plays an
essential role in the regulation of emotion. Self-psychologists such as Kohut (1971,
1977) suggest that a mother’s ability to empathically respond to her child’s emotions is
necessary for the child’s development of Self. Kohut suggests that the Self acquires
psychological structure through the process of a mother’s attunement and a mother’s
empathic failures, where the gap between these two is sufficiently small and the infant
can take over meeting his or her own needs. Overall, these theories suggest that the
mother’s emotional availability and sensitivity is relevant to her child’s development of a
cohesive Self, and her child’s ability to handle his or her own inner emotional
experiences in the absence of the mother.
In contrast, recent studies are confirming that a father’s emotional availability and
sensitivity may become particularly relevant to child development after infancy, when
social interactions become a central experience to the child. Congruent with the findings
61
from the attachment literature and the social-information processing literature, current
research is suggesting that a father’s ability to handle his own emotions and his child’s
emotions may be particularly relevant to the child’s ability to handle outward displays of
emotion, conflict resolution skills, and social competence:
Roberts (1999) asked mothers and fathers to complete the Child Rearing Practices
Q-Sort (Block, 1995) and found that fathers who reported using problem resolving
techniques in response to children’s distressing emotions during conflicts, had children
who used more resourceful and flexible behaviors in social interactions (as measured by
pre-school teachers’ ratings on the Ego Strength Questionnaire developed by Waters,
Wippman and Sroufe, 1979). It is possible that paternal problem solving techniques
provide the child with a tool for containing overwhelming emotions through providing
structure and concrete guidance. In addition, Parke & O’Neil (1997) found that father’s
who reported responding to their children’s expressions of negative affect with distress,
were more likely to have children who used anger and other negative emotions to deal
with distressing events. Conversely, Fathers who reported using emotion- and problemfocused reactions to negative emotions had children who were more likely to use
reasoning strategies for dealing with distressing situations. These children were
described as less aggressive and more cooperative by teachers. Similarly, O’neil and
Parke (2000) found that fathers who use anger and criticism in social interactions had
children who had more difficulty controlling negative emotions as well a children who
resorted to avoidance of negative emotions all together. Both the avoidant coping strategy
as well as the difficulties controlling emotions resulted in social conflict behaviors.
62
Gottman, Katz and Hooven (1997) also found that fathers’ assistance, acceptance and
ability to withstand their children’s anger and sadness at age three were related to positive
peer relationships at age six. Gottman, Katz and Hooven also examined the affect of
mothers’ responses to children’s negative emotions. Overall, mothers’ responses were
less predictive of their children’s future social behavior. Similarly, Roberts (1994) found
that fathers’ who are accepting and comforting of their children’s negative emotions have
children with more positive peer relationships. McDowell and Parke (2005) found that
fathers’ positive affect and control of emotional expression were related to children’s
behavior in the disappointing situations. Finally, Carson and Parke (1996) found that
pre-school children whose fathers engaged in reciprocal exchanges of negative feelings
were rated by their teachers as engaging aggressive and low in sharing. In addition, they
found that the more anger fathers expressed in verbal exchanges during an emotionally
arousing game, the more likely their children would be rejected by their peers.
Summary of Father vs. Mother Influences in Child Development
Fathers seem to play a critical role in children’s (both girls and boys)
development of social competence and conflict resolution skills. In addition, there is
some evidence that these findings are cross cultural (Shek & Ma, 2001). Overall,
mothers’ influences are seen early on in infancy, and continue to shape children’s
feelings of security, warmth and trust in the world. These feeling are most likely
important for establishing a solid sense of self, lasting relationships, and being able to
empathically connect to others. Although fathers may be important at infancy, their
63
influence on children’s development becomes apparent around pre-school age, where
social competence and conflict resolution become central to children’s experience.
Father characteristics such as, attachment style, ability to form an attachment with his
child, how he handles his own emotions and his children’s emotions, and quality of
conflict resolution strategies in conflict situations all seem to influence the child’s social
competence and conflict resolution skills. Social competence, in turn fosters positive
self-regard and self-esteem. Thus, both the mother and father seem to affect feelings of
self-worth, however, they may affect different components of this construct (albeit that
are constantly interacting with one another and highly interconnected), whereas the
mother influences children’s innermost feelings of love and security, and the father
influences children’s feelings of self-efficacy and competency in social environments.
The former is required to establish a relationship in the first place (to make and desire
connection), whereas the second is required for maintaining the relationship by resolving
interpersonal struggles as they occur.
Chapter III
Statement of Purpose and Hypotheses
Statement of Purpose
Psychotherapy researchers often acknowledge that therapists’ personalities play
an important role in determining the quality of the therapeutic alliance, and that tension in
the alliance is unavoidable across all therapeutic modalities. Researchers also recognize
the importance of the alliance for therapeutic change to occur, and that ruptures in the
64
alliance may provide windows into patients’ maladaptive interpersonal patterns thereby
providing an opportunity for important therapeutic work. However, as Safran and Muran
(2000) suggest, therapists’ own interpersonal schemas may play themselves out in the
context of strong interpersonal cycles with patients. For example, therapists expecting
hostility and ultimately abandonment in the face of conflict may avoid confronting and
working through ruptures with their patients. The current study expands on FoxBorisoff’s pilot study and further examines how the therapist’s personality impacts
psychotherapy process, particularly the formation of the working alliance and their ability
to work through breaches (ruptures) in the alliance. In addition to expanding upon the
psychotherapy process research literature, this study utilizes findings from child
development research as a base for understanding how therapist’ past attachment
experiences may influence their current abilities to form positive working relationships
and effectively resolve conflict with their patients. For example, the child development
literature suggests that early experiences with the mother may influence a child’s ability
to form trusting, and empathic relationships (such as are required characteristics to form a
working alliance), whereas childhood experiences with the father may be more relevant
to conflict resolution skills such as feelings of confidence in social interactions, and
ability to compromise, collaborate and accept responsibility for one’s own behaviors in
relationships (such as are required characteristics to resolve ruptures with patients).
Thus, in addition to contributing to psychotherapy process research, this study highlights
the emerging role of the father as an important and unique predictor of personality
formation. An additional aim of this study uses the intrex questionnaire to assess the
65
effects of therapists’ introjects on psychotherapy process, and is to an extent meant to
provide a point of comparison concerning the usefulness of the ISQ as a measure of
psychotherapy process. Finally, an independent study is included as an annex that takes
advantage of the large quantity of ISQ data available by examining its psychometric
properties. This separate study is not included in the primary hypothesis, or analyses
sections and is intended to inform future uses of the ISQ.
Hypotheses
Given the findings from Fox-Borisoff’s study along with the child development literature
the primary hypothesis of this study is that:
Therapists’ interpersonal schemas of their mothers will contribute to those
therapists’ abilities to establish a working alliance as perceived by both the patient
and the therapist, whereas therapists’ interpersonal schemas of their fathers will
contribute to those therapists likelihood of confronting and resolving ruptures in
the alliance when they occur, as perceived by both the patient and the therapist.
The second hypothesis addresses the relationship between therapists’ interpersonal
schemas with the quality of rupture resolution:
Therapists’ interpersonal schemas of their fathers will be a more valuable
predictor than that of mothers with regards to the degree of smoothness and depth
of experience perceived by patients and therapists during rupture sessions.
66
The third hypothesis attempts to shed a deeper understanding on how therapists’
personalities affect psychotherapeutic process, and how the interpersonal schema
questionnaire compares to an alternative schema construct (introjects) in its contribution
to psychotherapy process variables:
Therapists’ introjects of themselves in worst case scenarios will predict those
therapists’ abilities to establish a working alliance and resolve ruptures with
patients.
CHAPTER IV
Method
Overview
This study is based on relational theory of psychoanalysis, including Safran and
Muran’s concept of the working alliance as consisting of an on-going negotiation
between both the therapist and the patient. The study addresses how therapists’ internal
processes contribute to psychotherapy process, and how their relationship with their
mothers and fathers may independently contribute to this relationship. Therapists’
internal processes are assessed through the interpersonal schema construct, and the
introject construct. Interpersonal schemas with their mothers and fathers are assessed in
terms of the desirability index of the ISQ which assesses the degree to which therapists’
expect desirable outcomes with their mothers and fathers in various kinds of social
situations, Therapist introjects are measured by the Intrex Questionnaire according to
67
how therapists view themselves in their worst case scenarios. Psychotherapy process is
measured according to therapist and patient ratings of the working alliance and various
aspects of rupture resolution across the first five sessions of therapy. Therapist-Patient
dyads are selected based on the completion of therapists’ ISQ and Intrex Questionnaires.
The first five Post-Session Questionnaires (PSQs), which contains a 12-item version of
the Working Alliance Inventory (WAI) and sections regarding the occurrence, degree and
quality of rupture resolution are collected for each patient and each therapist. The raw
scores for the WAI are averaged to attain a total working alliance score, single-item data
is collected reporting the occurrence of ruptures, and the degree to which ruptures are
resolved as perceived by both the therapist and the patient, and data from a 10-item
questionnaire is averaged into two separate scores reflecting the degree of smoothness
and depth of experience perceived by patients and therapists during rupture sessions.
The pilot study consists of only those therapists who had seen three or more
patients. Three patients were randomly selected if the therapist had seen more than this
required number. Correlations were conducted to examine the relationship between
therapists’ interpersonal schemas of their mothers and fathers in hostile, friendly,
controlling and submissive situations with those therapists’ in-session working alliance
ratings and ruptures resolution scores as perceived by both the therapist and the patient
(note: the smoothness and depth of experience questionnaire was not used in this study).
Findings suggested that therapists’ interpersonal schemas of their mothers (they
anticipated desirable responses from their mothers across social situations) predicted
therapists’ likelihood of establishing a working alliance, whereas therapists’ interpersonal
68
schemas of their fathers (they anticipated desirable responses from their fathers across
social situations) predicted their likelihood of resolving ruptures with patients. In the
current study, the sample is expanded to include 96 therapists and all the patients they
have seen at BPRP. In addition, the 10-item smoothness and depth of experience
questionnaire is added as a dependent variable in order to provide a more meaningful and
comprehensive measurement of rupture resolution. More advanced and sensitive statistics
are also applied, and finally, the therapists’ introjects (as measured by the Intrex
Questionnaire) are examined as an independent variable affecting the therapists’
likelihood of establishing a working alliance, and resolving ruptures with patients.
Brief Psychotherapy Research Program
The data from this study is collected through the Brief Psychotherapy Research
Program (BPRP) at Beth Israel Medical Center in New York City, co-directed by Chris
Muran and Jeremy Safran. The research program began in the early 1980s to study
psychotherapy process and outcome, with a particular emphasis on alliance ruptures and
repair. The BPRP provides 30 sessions of low-fee psychotherapy to individuals in the
community. Patients are primarily recruited through advertisements in local news papers.
Patients are first screened by trained research assistants for suitability to the project over
the phone, and must be between the ages of 18 and 65, have been out of previous
psychotherapy for at least three months, demonstrate cognitive coherence, and be able to
report one close relationship. Patients must report no indication of suicidal or homicidal
ideation, impulse disorder or history of mania. If patients meet these criteria they are
69
brought in for two meetings where a trained clinical research assistant conducts the
Structured Clinical Interview for the DSM-IV (SCID) (Spitzer, Williams, & Gibbon,
1987, 1994). Based on this interview, the patient is diagnosed along Axis I and Axis II of
the DSM-IV. Patients are generally accepted into the program if they demonstrate
suitability for time-limited therapy. Many of the patients included in the study meet
criteria for Axis I anxiety and mood disorders, and Axis II cluster C personality disorders
such as avoidant, dependent and obsessive compulsive personality disorder. Patients are
excluded from the program if they meet diagnostic criteria for the following Axis I
disorders: (i) active or recent substance use, or dependence (ii) Bipolar I or II disorder
(iv) any psychotic spectrum disorder, (vi) active or recent eating disorder such as
anorexia nervosa and bulimia nervosa (vii) Post Traumatic Stress Disorder, or any Axis II
Cluster A diagnoses of Paranoid, Schizoid and Schizotypl Personality Disorders, and
Cluster B diagnoses of Antisocial, Narcissistic and Borderline Personality Disorders. In
addition, patients are excluded from the study if they meet a DSM-IV-R Axis III medical
condition, neurological impairment or significant intellectual deficit, or if they are in need
of crisis intervention, have had previous suicidal attempts or psychiatric hospitalizations,
and are currently prescribed psychotropic medications requiring further stabilization, or
that have not been stabilized for at least three months.
Patients participating in the program have at some point during the history of the
program been randomly assigned to one of the following manualized treatment
modalities: Brief Relational Therapy (Safran & Muran, 2000), Cognitive Behavioral
Therapy (Turner & Muran, 1992), an experimental conditioning combining Cognitive
70
Behavioral Therapy with Brief Relational Therapy, Brief Adaptive Therapy or Short-term
Psychodynamic Psychotherapy (Winston & Pollack, 1991). Over the years therapists
have consisted of psychology interns and externs enrolled in a Clinical Psychology
Doctoral program, third and fourth year psychiatry residents, and licensed staff
supervising psychologists at Beth Israel Medical Center. All therapists receive at least
one hour of group supervision per week in their assigned treatment modality and see only
one patient through the program at a time. At intake each therapist is required to fill out a
confidential self-report packet that includes the interpersonal schema questionnaire and
the intrex questionnaire. Therapists and Patients are required to independently fill out a
post-session questionnaire at the end of each session that includes a 12-item working
alliance inventory, a section regarding the occurrence and resolution of ruptures, and a
10-item questionnaire reflecting the degree of smoothness and depth of experience
perceived by patients and therapists during rupture sessions. All self-report measures are
returned to the treatment team and kept strictly confidential.
Participants
Therapists
All therapists included in the study were participants in the Brief Psychotherapy
Research Program at Beth Israel Medical Center, and completed 30 sessions of
psychotherapy. Each therapist completed the interpersonal schema questionnaire and
intrex questionnaire once in the beginning of treatment. Therapists that have successfully
filled out post-session questionnaires after the first five sessions of therapy, and the ISQ
71
and Intrex at intake are selected for the study. There are a total of 96 therapists that meet
this criteria. The pilot study includes 24 (10 men and 14 women) therapists who saw
three or more patients, and ranged in age from 25-50 with a mean age of 38. The current
sample consists of the original 24 therapists plus 72 additional therapists who have filled
out the appropriate questionnaires. This totals 96 (37 men and 59 women) therapists with
an age range of 25-67 with a mean age of 37. Slight variations in age and gender ratios
occur between multi-level models due to missing data and cases excluded from analysis
due to absence of ruptures.
Patients
All patients included in the study were participants at the Brief Psychotherapy
Research Program at Beth Israel Medical Center, and completed 30 sessions of
psychotherapy. Patient selection was based on the availability of their therapists’ data
(patients were included if their therapist filled out an ISQ and Intrex Questionnaire in the
beginning of treatment). In addition, all patients as well as their therapists’ had to have
successfully completed the first five post session questionnaires to be included in the
study. The pilot study totals 72 patients (three patients for each of the 24 therapists)
including 28 men and 43 women (with one gender report missing) ranging in age from 24
to 64 with a mean age of 42, while the current study includes all patients that were seen
by all 96 therapists totaling 186 patients (114 women and 70 men with two missing
gender values) ranging in age from 23-64 and with a mean age of 40 (with two age values
72
missing). Slight variations in age and gender ratios occur between multi-level models
due to missing data and cases excluded from analysis due to absence of ruptures.
Measures of Therapist Internal Process (Independent Variables)
Interpersonal Schema Questionnaire (ISQ)
Therapists’ interpersonal schemas of their mothers and fathers are assessed
independently using the ISQ, and in terms of their expected responses and the expected
degree of desirability of those responses from each parent across 16 different situations
reflecting the sixteen segments of Kiesler’s interpersonal circumplex. For example,
therapists are asked to imagine themselves engaging in an activity or situation such as
acting very competitive to win a tennis match, collaborating on a project and taking the
lead on making decisions, or as being reserved and non-sociable with each of their
parents. They are then asked to select a response reflecting the expected behavior from
the given parent (e.g. I expect my mother would be friendly and warm; I expect my
mother would take charge and try to influence me). Each response that therapists’ can
choose from represents one of the 8 octants of Kiesler’s interpersonal circumplex and has
varying degrees of interpersonal affiliation and control, thus yielding two scores:
response-control and response-affiliation. After selecting a response, therapists are asked
to rate the desirability of the expected response in the given situation on scale from 1-7
(with 7 being the highest.) The current study uses this desirability index to assess
interpersonal schemas. This decision was made due to previous studies suggesting this
index’s high reliability (Soygut and Savasir, 2001). In addition, preliminary factor
73
analysis we conducted also suggested that the control index may be less reliable, and the
affiliation index may be somewhat less reliable, and highly correlate with the desirability
index for both mother (r=.91, p < .001) and father (r=.83, p < .001), thus being redundant
to assess both indices. (See appendix C for further discussion and CFA tables).
Intrex Questionnaire
This study uses a 36-item version of the Intrex Questionnaire and corresponds to
the third surface of the SASB circumplex model, which measures introjects (internalized
self-representations). Therapists complete this questionnaire once at intake and are
instructed to think of a specific time when they were at “their best” and a time when they
were at “their worst”. They then rate themselves on a scale of 0-100 (in intervals of 10)
two separate times, once in response to how they would describe themselves “at best”,
and again how they would describe themselves “at worst.” Example items included “I
tenderly, lovingly cherish myself” and “to make sure I do things right, I tightly control
and watch over myself”. The measure yields two scores reflecting an “introject at best”
and an “introject at worst” which are scored along five dimensions. The first three
include self-attack, self-control and self-conflict and are primarily assessed with
relatively small data sets employing non-parametric statistics. The latter two dimensions
are self-autonomy and self-affiliation, and are easier to analyze with relatively large
samples sizes and multivariate statistics (Pincus and colleagues, 1998). These two
dimensions were solely used in this study due to the large sample size being assessed and
the need for multivariate statistics. In addition, this study only uses the self-autonomy
74
and self-affiliation dimensions calculated from “at worst” scores. The “introject at best”
scores were left out due to the nature of the questions yielding idealized scores that are
restricted in range (Henry et al, 1990).
Measures of Psychotherapy Process (Dependent Variables)
Working Alliance Inventory (WAI)
The WAI (Horvath & Greenberg, 1986) is a 36 item scale used to assess the
quality of the therapeutic alliance. The current study used an abbreviated 12-item scale
developed by Tracey and Kokotovic (1989) through factor analysis. The 12 item scale,
like the original, assesses the three aspects of the working alliance defined by Bordin
(1979): (i) The bond between the therapist and patient, (ii) the level of agreement
between the therapist and patient on the goals of therapy and (iii) the level of agreement
between the therapist and patient on the tasks of therapy. This abbreviated version uses
the four items for each of the three subscales that had the highest factor loadings. In
addition, this version of the WAI yields a total score which is an average across all 12
items. The therapists’ and the patients’ total WAI score for sessions 1-5 are used in this
study to assess psychotherapy process in relation to therapists’ interpersonal schemas and
introjects. The WAI is rated on a likert scale of 1-7 (with seven being the highest rating)
and consists of items such as: “I think my therapist likes me” (Bond), “My therapist and I
agree on important changes” (Goal), and “Therapy gives me a new way of looking at
things” (Task).
75
Post-Session Questionnaire and Rupture Section
The Post-Session Questionnaire described above includes a brief section developed by
Muran, Safran, Samstag & Winston (1999) regarding the occurrence and resolution of
ruptures. This section was designed as a means to identify patterns in ruptures and
rupture resolution over the course of treatment, and asks patients and therapists the
following questions regarding the most recent session:
1) Did you experience any problem or tension in your relationship during the
session? (subject responds yes or no).
2) If so, about where in the session did this problem begin? (subject selects from
beginning, middle or end).
3) Please rate the highest degree of tension you felt during the session as a result of
this problem?
4) To what extent was this problem addressed in this session?
5) To what degree do you feel this problem was resolved by the end of the session?
This study used question number 5 to determine the degree to which both the patient and
therapist perceived ruptures to be resolved by the end of the corresponding session.
Session Evaluation Questionnaire (SEQ)
The SEQ (Stiles Gordon & Lani, 2002) includes 21 items that are rated on a 7
point, bi-polar scale. The questions were distinguished via factor analysis and divided
into two sections. The first section is the “session evaluation” and includes 11 adjective
dyads that assess two core therapeutic experiences; 1) valuable and powerful verses weak
76
and worthless; 2) relaxed and comfortable verses weak and distressing. The second
section includes 10 items that assess two dimensions of post-session mood; 1) positivity
and 2) arousal. Both sections of the SEQ are applicable to therapists’ and patients’
experiences as suggested by factor analysis (Stiles, 1908; Stiles, Reynolds, et al., 1994).
The current study only uses the “session evaluation” section. Sample items include:
Rough
1
2
3
4
5
6
7
Smooth
Shallow
1
2
3
4
5
6
7
Deep
Respondents are asked to circle the appropriate number along this spectrum that “best
describes the session.” The 11 dyads are averaged to yield two variable ratings:
Smoothness and Depth of experience, with higher ratings representing greater
smoothness and greater depth (1 being the lowest and 7 being the highest). Both of these
variables have demonstrated strong internal consistency (i.e., .93 for smoothness and .90
for depth).
Procedures
Pilot Study: Goals and Procedures of Part-I of study
Twenty-four therapists who completed the ISQ at intake and who had seen at least
3 separate patients were selected. All therapists and patients in the program fill out a
required post session questionnaire after each session that includes the Working Alliance
Inventory (Horvath & Greenberg, 1989) and the section regarding ruptures described
above. The first 5 post session questionnaires for both the patient and the therapist were
77
collected and scored. The WAI was used to assess therapists’ ability to establish a
positive working alliance with their patients, and the item reflecting the degree to which
ruptures were resolved was used to assess therapists’ likelihood of resolving ruptures
with patients. Each therapist was measured across the first 5 sessions and for three
separate patient cases in order to account for the patient variable. The patient and
therapist scores were collapsed separately and over 15 sessions from all three therapistpatient dyads to create averages. Thus, in the end each therapist was measured by one
average WAI score and one average Rupture Resolve score representing their 3 patients’
perspectives and the therapist’s own perspectives with each patient in the first 5 sessions
of therapy. Therapists’ interpersonal schemas were assessed using the desirability index
on the ISQ. Desirability ratings for each therapist were broken into the 4 circumplex
quadrants (hostile, friendly, submissive and dominant) in order to see if desirability of
particular kinds of situations predicts in-session processes as well as their ability to form
a positive working alliance. For example, does desirability of expected responses from
the mother in friendly situations predict in-session processes more or less than expected
responses from the mother in hostile situations? Desirability for these quadrants was
assessed for both mother and father independently. Pearsons r correlations were then run
between therapists’ average desirability scores in hostile, friendly, submissive and
dominant situations with both therapist and patient reports of the WAI and resolve item,
and with mother and father separately. The findings suggested that therapists’ who
expected desirable outcomes with their fathers were more likely to resolve ruptures with
their patients (refer to table 1), whereas therapists’ who expected desirable responses
78
from the mothers were more likely to establish a working alliance (refer to table 2).
These findings were consistent across situations, and for the therapist and patient
perspectives.
Table 1: Preliminary Results for Therapist ISQ and Rupture Resolution
Desirability of Social Outcomes with Mother and Rupture Resolution
Patient Resolve (r)
Therapist Resolve (r)
Hostile Situations
(Quad1)
.155
.481
.341
.111
Friendly Situations
(Quad2)
.317
.141
.320
.137
Submissive Situations
(Quad3)
.286
.195
.211
.333
.364
.087
.413*
.050
*
Dominant Situations
(Quad4)
Desirability of Social Outcomes with Father and Rupture Resolution
Patient Resolve (r)
Therapist Resolve (r)
Hostile Situations
(Quad1)
.486*
.019
.353
.098
Friendly Situations
(Quad2)
.437*
.037
.377
.076
Submissive Situations
(Quad3)
.420*
.046
.164
.456
.487*
.019
.401
.058
*
pDominant
(Quad4)
Situations
<
*p < .05
79
Table 2: Preliminary Results for Therapist ISQ and Working Alliance
Desirability of Social Outcomes with Mother and Working Alliance
Quadrant
Patient WAI (r)
Therapist WAI (r)
Hostile Situations
(Quad1)
.282
.181
.154
.472
Friendly Situations
(Quad2)
.492*
.015
.600*
.002
Submissive Situations
(Quad3)
.364
.080
.281
.184
Dominant Situations
(Quad4)
.442*
.031
.508*
.011
Desirability of Social Outcomes with Father and Working Alliance
Quadrant
Patient WAI (r)
Therapist WAI (r)
Hostile Situations
(Quad1)
.217
.308
.129
.549
Friendly Situations
(Quad2)
.318
.229
.299
.155
Submissive Situations
(Quad3)
.180
.400
.180
.400
Dominant Situations
(Quad4)
.341
.102
.341
.102
*p < .05
80
Current Study: Goals and Procedures
The current study expands on the pilot study findings by continuing to look at the
relationship between therapists’ anticipated desirability of social outcomes with their
mothers verses their fathers in relation to psychotherapy process, however, several
limitations are addressed: First, the pilot study consisted of a small sample size, thereby
making it necessary to assess only those therapists who had seen at least three patients.
For example, the pilot study aims to control for any impact the patient’s personality may
have on the therapeutic process by averaging three separate patients for each therapist
(with the idea that no three patients will have the same personality, and therefore any
significant relationship found between therapists’ interpersonal schemas and therapeutic
process will be due to the therapist and not the patient). In contrast, the current study
increases the sample size to look at 96 therapists’ in conjunction with all the patients they
had seen through the BPRP. (Therapists ranged from seeing between 1-8 patients). Such
a large sample size ensures adequate patient variability, making it reasonable to attribute
significant findings to the therapist. This enables therapists’ to be included in the study
even if they had seen only one or two patients. Thus, interpersonal schema data was
collected from intake and added for an additional 72 therapists. Consistent with the MA
thesis, the desirability index of the ISQ was used to represent measures of interpersonal
schemas, thus averages for the level of anticipated desirability of social outcomes with
mothers and fathers were calculated for each quadrant (reflecting hostile, friendly,
submissive, and dominant situations), and corresponding working alliance and rupture
resolution data for the first five sessions from both the therapist and their respective
81
patient(s) was also collected. In order to simplify the complexity of analyzing and
interpreting data in individual sessions for several patients per therapist, we averaged
across the first five sessions for within patient and within therapist data for each
dependent variable.
A second limitation of the pilot study is that the primary rupture resolution
measure reported by therapists and patients is a single item response and may therefore
have limited validity. The current study addresses this limitation by including the SEQ
which measures the degree of perceived smoothness and depth of experience in therapy
sessions. This questionnaire was assessed for sessions where ruptures were reported and
in relation to therapists’ interpersonal schemas of their mothers and their fathers. The
goal of including this measure was to obtain a richer understanding of the relationship
between interpersonal schemas and rupture resolution.
Thirdly, the current study includes the therapist’s introject as an independent
variable effecting therapists’ ability to establish a working alliance, and resolve ruptures
with patients. Therapists’ introjects are measured by the Intrex Questionnaire which is
completed once at intake. In the current study, therapists’ introjects are measured
according to the self considered at worst along a self-autonomy dimension and selfaffiliation dimension These two dimensions are assessed for their predictive value of the
working alliance and rupture resolution ratings across the first five sessions and as
perceived by both the patient and the therapist.
Fourthly, the pilot study used preliminary statistics such as pearson r correlations
to assess the data. However, three patients were matched to every one therapist. Thus,
82
therapists’ independent variables were essentially measured times three thereby inflating
the correlations. The pilot study made some attempt to account for this by averaging
scores across all three patients. However, this process limits the depth and specificity of
the findings. The current study controls for nested data while maintaining individual
ratings and accounting for variance between patients by employing multi-level modeling
that can accurately control for several patients being paired with only one therapist.
CHAPTER V
Analyses
Intrex variables (i.e., therapist affiliation and autonomy at worst) and ISQ
variables (i.e., therapist desirability of anticipated social outcomes with the mother and
the father in hostile, friendly, submissive and dominant situations) were assessed in
relation to therapist and patient ratings of psychotherapy process using multilevel
modeling (Snijders & Bosker, 1992) in the statistical program “R” (R Core Development
Team, 2009). This method allows for the analysis of “nested” data, in this case multiple
patients being seen by the same therapist. In other words, using multilevel modeling
enabled us to account for the nesting in the data created by therapists being rated by their
patients as well as themselves in multiple psychotherapy dyads. This allowed for
analysis at the individual level, appropriately capturing the similarities that may exist
among the psychotherapy process ratings for multiple patients seen by a given therapist.
Multi-level modeling is also referred to as hierarchical modeling, or random coefficient
modeling, and is employed to address “individual-level data that is collected within
83
groups” (Ciarleglio & Makuch, 2007). Ordinary least squares (OLS) regression assumes
independence of observations, and would not account for the similarity (or nonindependence) of ratings of patients seeing the same therapist. In this study, ratings of
patients who are seen by the same therapist are expected to be more similar than ratings
of patients with different therapists as a result of therapist consistencies across patients
and time that impact ratings of psychotherapy process. Multi-level modeling does not
assume “independence” of observations, and takes into account the hierarchical
structuring of the data (patient and therapist ratings are nested within one unique
therapist). In this study, multilevel models with random-intercepts are used where patient
and therapist ratings of psychotherapy process (level-one) are nested within therapists
(level-two). Patient gender and age are controlled in the level-one portion of the model
while therapist gender and age are controlled in the level-two portion of the model. For a
more in depth description of multi-level modeling see Ciarleglio and Makuch (2007).
Before proceeding to multi-level modeling to examine Intrex and ISQ variable
effects, therapist and patient ratings were averaged across the first five sessions creating
one observation per dependent variable for individual therapists and patients. This was
done in order to simplify the multilevel modeling and summarize the earliest sessions. In
other words, while the data were structured for analysis to take into account the nesting of
therapist and patient ratings under unique therapists, they were not structured to take into
account the individual “session” as this would have been unwieldy.
We also calculated Cronbach’s alpha coefficients before proceeding to multi-level
modeling in order to determine the degree of agreement between therapists and patients
84
on dependent variable ratings. Results suggested low agreement on all measures
including rupture resolution ( = .341) working alliance ( = .538) smoothness ( =
.344) and depth ( = .435), indicating the need to separately assess patients’ and
therapists’ ratings in relation to therapist interpersonal schemas and introjects. The
dataset for multi-level model analysis was structured to include a “rater” variable which
had values of either “therapist” or “patient.” This rater variable enabled patient and
therapist ratings to remain separate yet be analyzed in the same multilevel statistical
model. The interaction between an Intrex or ISQ variable and the rater variable was
examined to determine whether the association of the Intrex or ISQ variable with a
psychotherapy process variable was different for therapist and patient ratings. If an
interaction effect with the rater variable was significant (or approaching significance at
the p < .05 level), this suggested that associations were not the same for therapist and
patient ratings of the process variable. When even marginally significant interaction
effects involving the rater variable were observed, the simple main effects of the Intrex or
ISQ variable were estimated (simple main effects were estimated by specifying
appropriate contrasts of the coefficients from the multilevel model with the interaction
term). Thus, when a significant interaction was observed, separate regression coefficients
characterized the association of the Intrex or ISQ variable with 1) the therapist rating of
the process variable and 2) the patient rating of the process variable. When the rater
variable and the Intrex or ISQ variable did not have a significant interaction effect, the
interaction term was dropped but the main effect for the rater variable was retained. In
these cases, the regression coefficient for the Intrex or ISQ variable indicated its
85
association with a combined rating of the process variable by both the therapist and
patient. In other words, when the rater variable was included only as a main effect, the
multilevel model essentially averaged therapist and patient ratings of the process variable,
but adjusted for the mean difference between ratings by therapists and patients.
86
Chapter VI
Results
Descriptives of Ratings
Table 3: Summary of Dependent Variable Ratings
Therapist
Mean
SD
Median Min
Max
n
Alliance
4.68
0.67 4.74
2.12 6.13
(First 5 session Avg)
Rupture Resolution
2.79
1.92 2.77
1.00 5.00
(First 5 session Avg)
Depth
4.79
0.53 4.85
3.60 5.85
(First 5 session Avg)
Smooth
4.20
0.54 4.20
2.65 5.30
(First 5 session Avg)
n = number of observations after averaging first five sessions
186
150
61
61
Patient
Mean
SD
Median Min
Max
n
Alliance
4.95
0.78 5.00
2.33 6.88
(First 5 session Avg)
Rupture Resolution
3.09
1.02 3.00
1.00 5.00
(First 5 session Avg)
Depth
4.86
0.60 4.95
3.35 5.85
(First 5 session Avg)
Smooth
4.13
0.62 4.00
3.00 5.62
(First 5 session Avg)
n = number of observations after averaging first five sessions
177
103
45
45
Note: Slight variation in the number of process ratings exists from model to model due to missing
data.
87
Table 4: Summary of Therapist-ISQ Quadrant Ratings for Desirability
Mother
Mean
SD
Median Min
Max
n
Hostile
3.65
1.52
3.40
1.00
6.80
95
Friendly
5.86
0.99
6.10
1.40
7.00
96
Submissive
4.71
1.33
5.00
1.60
7.00
94
Dominant
4.80
1.32
5.00
1.20
7.00
95
Median Min
Max
n
Father
Mean
SD
Hostile
3.89
1.36
3.80
1.00
7.00
95
Friendly
5.51
1.27
5.80
1.20
7.00
95
Submissive
4.58
1.34
4.60
1.00
7.00
94
Dominant
4.70
1.35
5.00
1.00
7.00
95
Note: Slight variation exists from model to model if a therapist(s) is excluded from the analysis
due to missing data, or there are no reported ruptures associated with their cases.
Multilevel Modeling
Hypothesis I: Therapist ISQ, Working Alliance and Rupture Resolution
a) Working Alliance: Therapists' interpersonal schemas of their mothers and fathers (in
hostile, friendly, submissive, and dominant situations) were assessed in relation to
working alliance as perceived by patients and therapists. There were no significant
findings (p < .05) for any of these relationships (refer to Table 12). However, patients had
significantly higher ratings of working alliance than therapists (p = .0001).
88
b) Rupture Resolution: Therapists' interpersonal schemas of their mothers and fathers (in
hostile, friendly, submissive, and dominant situations) were assessed in relation to rupture
resolution as perceived by patients and therapists. On average, patients tended to report
higher rupture resolution than therapists (p = .0045). As illustrated in tables 5 - 8,
significant relationships were found in friendly and dominant situations for both mother
and fathers:
(see table below)
89
Mother Findings
Table 5: ISQ-Mother in Friendly Situations and Therapist/Patient Rupture Resolution
FIXED EFFECTS
PARAMETER
Intercept
Coefficient
PT
TH
3.09 1.43
SE
PT
0.74
df
TH
0.55
PT
TH
151 151
t
PT
4.12
p
TH
2.60
PT
0.00
TH
0.01
LEVEL 1 (PATIENT)
Gender
-0.003
0.129
151
-0.128
0.977
Age
-0.010
0.006
151
-1.577
0.116
1.660
0.805
151
2.061
*0.041
Gender
0.110
0.156
88
0.704
0.438
Age
0.015
0.009
151
1.529
0.128
-0.232
0.133
151
-1.734
0.084
Rater Effect
LEVEL 2 (THERAPIST)
INTERACTION
ISQ MQuad2
PT
TH PT
-0.01 0.22 0.11
TH PT TH
0.09 151 151
PT
-0.11
TH
2.39
PT
0.910
TH
*0.018
RANDOM EFFECTS
Standard Deviation
INTERCEPT
0.417
RESIDUAL
0.896
ISQ MQuad2 = Therapists anticipated desirability from mothers in friendly situations.
Male = 1; Female = 0. Rater Effect and Interaction statistics in this table reflect coding scheme of Th = 0
and Pt = 1.
*p < .05
This model (table 5) consisted of 90 therapists, with 247 observations of rupture
resolution (combined patient and therapist; each observation represents either a patient or
therapist average rating over the first five sessions). Patients rated rupture resolution
higher than therapists, t(151) = 2.061, p = .041. However, the marginally significant
90
interaction between the rater variable and ratings of mother desirability in friendly
situations, t(151) = -1.734, p = .084, suggests therapists and patients ratings were
discrepantly associated with the predictor variable. Due to this interaction, the patient
and therapist rupture resolution effects were estimated separately. After controlling for
gender and age, the results suggest that therapists' expectations of social outcomes with
their mothers in friendly situations are positively related to therapists' reports of rupture
resolution, t(151) = 2.387, p = .018. No significant effect was found on patient ratings of
rupture resolution, t(151) = -.112, p = .911.
91
Table 6: ISQ-Mother in Dominant Situations and Therapist/Patient Rupture Resolution
FIXED EFFECTS
PARAMETER
Intercept
Coefficient
PT
TH
3.31 1.96
SE
PT
0.69
df
TH
0.35
t
PT TH
150 150
PT
6.68
p
TH
5.59
PT
0.00
TH
0.01
LEVEL 1 (PATIENT)
Gender
-0.013
0.130
150
-0.105
0.916
Age
-0.010
0.006
150
-1.695
0.092
1.174
0.512
150
2.290
*0.023
Gender
0.122
0.156
87
0.781
0.436
Age
0.012
0.009
150
1.32
0.188
0.098
150
-1.810
0.072
Rater Effect
LEVEL 2 (THERAPIST)
INTERACTION
ISQ MQuad4
-0.17
PT
TH PT
0.02 0.16 0.09
TH PT TH
0.07 150 150
PT
-0.25
TH
2.28
PT
0.801
TH
*0.024
RANDOM EFFECTS
Standard Deviation
INTERCEPT
0.405
RESIDUAL
0.904
ISQ MQuad4 = Therapists anticipated desirability from mothers in dominant situations.
Male = 1; Female = 0. Rater Effect and Interaction statistics in this table reflect coding scheme of Th = 0
and Pt = 1.
*p < .05
This model (table 6) consisted of 89 therapists and 245 observations of rupture resolution
(combined patient and therapist; each observation represents either a patient or therapist
average rating over first five sessions). Patients rated rupture resolution higher than
therapists, t(150) = 2.290, p = .023. However, the marginally significant interaction
between the rater variable and ratings of mother desirability in dominant situations,
t(150) = -1.81, p = .072 suggests therapists and patients ratings of rupture resolution were
92
discrepantly associated with the predictor variable. Due to this interaction, the patient
and therapist rupture resolution effects were estimated separately. After controlling for
gender and age, therapists' expectations of social outcomes with their mothers in
dominant situations were positively related to therapists' reports of rupture resolution,
t(150) = 2.279, p = .024. No significant effect was found on patient ratings of rupture
resolution, t(150) = -.246, p = .805.
93
Father Findings
Table 7: ISQ-Father in Friendly Situations with Therapist/Patient Rupture Resolution
FIXED EFFECTS
PARAMETER
Intercept
Coefficient
PT
TH
2.80 1.61
SE
PT
0.48
df
TH
0.43
t
PT TH
151 151
PT
5.86
p
TH
3.80
PT
0.00
TH
0.01
LEVEL 1 (PATIENT)
Gender
-0.027
0.130
151
-0.213
0.831
Age
-0.011
0.006
151
-1.725
0.086
Rater Effect
1.186
0.540
151
2.195
0.091
LEVEL 2 (THERAPIST)
Gender
0.135
0.154
87
0.872
0.385
Age
0.018
0.010
151
1.817
*0.029
-0.161
0.094
151
-1.698
0.066
INTERACTION
ISQ FQuad2
PT TH
0.16 0.09
PT
0.07
TH PT TH
0.07 151 151
PT
1.70
TH
2.70
PT
0.81
TH
**0.007
RANDOM EFFECTS
Standard Deviation
INTERCEPT
0.404
RESIDUAL
0.899
ISQ FQuad2 = Therapists anticipated desirability from fathers in friendly situations.
Male = 1; Female = 0. Rater Effect and Interaction statistics in this table reflect coding scheme of Th = 0
and Pt = 1.
*p < .05; **p < .01
This model (table 7) consisted of 89 therapists and 246 observations of rupture resolution.
Patients rated rupture resolution higher than therapists, t(151) = 2.195, p = .029.
However, the marginally significant interaction between the rater variable and ratings of
father desirability in friendly situations, t(151) = -1.698, p = .091 suggests therapists’ and
94
patients’ ratings of rupture resolution were discrepantly associated with the predictor
variable. Due to this interaction, patient and therapist rupture resolution effects were
estimated separately. After controlling for gender and age, the results suggest that
therapists' expectations of social outcomes with their fathers in friendly situations were
positively related to therapists' reports of rupture resolution, t(151) = 2.696, p = .007. No
significant effect was found on patient rupture resolution ratings, t(151) = 1.698, p =
.805.
95
Table 8: ISQ-Father in Dominant Situations with Therapist/Patient Rupture Resolution
FIXED EFFECTS
PARAMETER
Coefficient
SE
df
2.088
.272
141
Gender
-0.031
0.129
141
-0.245
0.806
Age
-0.011
0.006
141
-1.83
0.069
Rater Effect
0.346
0.122
141
2.823
**0.005
Gender
0.180
0.142
87
0.271
0.206
Age
0.018
0.009
141
1.998
*0.047
ISQ FQuad4
0.119
0.053
141
2.240
*0.026
Intercept
t
p
7.653
0.000
LEVEL 1(PATIENT)
LEVEL 2 (THERAPIST)
RANDOM EFFECTS
INTERCEPT
Standard Deviation
0.296
RESIDUAL
0.905
ISQ FQuad4 = Therapists anticipated desirability from fathers in dominant situations.
Male = 1; Female = 0. Rater Effect statistics table reflect coding scheme of Th = 0 and Pt = 1.
Intercept and ISQ Quad2 statistics reflect effects on combined patient and therapist ratings.
*p < .05
This model (table 8) consisted of 89 therapists and 235 observations of rupture resolution.
Patients rated rupture resolution higher than therapists, t(141) = 2.823, p = .005. This
model also found a significant effect for therapist age, suggesting that as therapists get
older, they are more likely to perceive rupture resolution with their patients, t(141) =
1.99, p < .05. The interaction variable “rater * FQuad4” was tested however dropped
from the statistical model as it was not even marginally significant. Thus, after
controlling for gender and age, combined patient and therapist reports of rupture were
96
assessed using the rater variable. The results suggest that therapists' expectations of
social outcomes with their fathers in dominant situations are positively related to
therapists' and patients’ reports of rupture resolution, t(141) = 2.40, p = .026.
HYPOTHESIS II : Therapist ISQ and Session smoothness and Depth
a) Smoothness: Therapists' interpersonal schemas of their mothers and fathers (in hostile,
friendly, submissive, and dominant situations) were assessed in relation to the degree of
smoothness perceived by therapists and patients in rupture sessions. There were no
significant findings for the mother (p < .05, refer to table 12). As illustrated in table 9, a
significant relationship was found for the father in dominant situations.
(see table on following page)
97
Father Findings
Table 9: ISQ-Father in Dominant Situations and Perceived Session Smoothness
FIXED EFFECTS
PARAMETER
Intercept
Coefficient
PT
4.80
TH
4.04
SE
PT
0.34
df
TH
0.29
PT
46
t
TH PT
46 13.56
p
TH
13.89
PT
0.00
TH
0.00
LEVEL 1 (PATIENT)
Gender
0.040
0.12
46
0.336
0.737
Age
0.003
0.006
46
0.489
0.626
Rater Effect
0.768
0.456
46
1.682
0.099
Gender
-0.085
0.120
45
-0.705
0.484
Age
0.007
0.006
46
1.140
0.260
-0.176
0.094
46
-10.876
0.066
LEVEL 2 (THERAPIST)
INTERACTION
ISQ FQuad4
PT
TH
-0.15 0.03
PT
0.07
TH PT TH
0.06 46 46
PT
-2.03
TH
0.49
PT
*0.048
TH
0.62
RANDOM EFFECTS
Standard Deviation
INTERCEPT
2.503
RESIDUAL
0.572
ISQ FQuad4 = Therapists anticipated desirability from fathers in dominant situations.
Male = 1; Female = 0. Rater Effect and Interaction statistics in this table reflect coding scheme of Th = 0
and Pt = 1.
*p < .05
This model (table 9) consisted of 47 therapists and 99 observations of session
smoothness. There was an approaching marginally significant interaction between the
rater variable and ratings of father desirability in dominant situations, t(46) = -10.88, p =
.066, suggesting that therapist and patient ratings of session smoothness were
98
discrepantly associated with the predictor variable. Due to this interaction, the simple
main effects of patient and therapist session smoothness were estimated separately. After
controlling for gender and age, the results suggest that therapists' expectations of social
outcomes with their fathers in dominant situations are negatively related to patients'
reports of in-session smoothness, t(46) = -2.029, p = .048. No significant effect was
found on therapists’ ratings of session smoothness, t(46) = .494, p = .623.
b) Depth: Therapists' interpersonal schemas of their mothers and fathers (in hostile,
friendly, submissive, and dominant situations) were assessed in relation to the degree of
depth experienced in sessions as perceived by therapists and patients in rupture sessions.
There were no significant findings for the mother (p < .05, refer to table 12). As
illustrated in table 10, a marginally significant relationship was found for the father in
friendly situations:
(See table below)
99
Father Findings
Table 10: ISQ-Father in Friendly Situations and Depth of Experience in Session
FIXED EFFECTS
PARAMETER
Intercept
Coefficient
4.285
SE
df
0.298
50
t
p
14.361
0.000
LEVEL 1(PATIENT)
Gender
-0.010
0.113
50
-0.094
0.925
Age
0.001
0.006
50
0.224
0.823
Rater Effect
0.063
0.107
50
0.583
0.561
Gender
-0.017
0.125
46
-0.139
0.889
Age
-0.011
0.007
50
-1.614
0.112
ISQ FQuad2
0.100
0.051
50
1.959
*0.055
LEVEL 2 (THERAPIST)
RANDOM EFFECTS
INTERCEPT
Standard Deviation
0.296
RESIDUAL
0.905
ISQ FQuad2 = Therapists anticipated desirability from fathers in friendly situations.
Male = 1; Female = 0. Rater Effect statistics in this table reflect coding scheme of Th = 0 and Pt = 1.
Intercept and ISQ Quad2 statistics reflect effects on combined patient and therapist ratings.
*p = .055.
This model (table 10) consisted of 48 therapists and 103 reports of session depth.
Therapist and patient ratings were assessed together because father friendliness did not
interact with rater (the interaction variable “rater * FQuad4” was not even marginally
significant, and thus dropped from the statistical model). After controlling for gender and
age, the results suggest that therapists' expectations of social outcomes with their fathers
100
in friendly situations are related to therapists’ and patients' reports of in-session depth of
experience. This finding was marginally significant; t(50) = 1.959, p = 0.055.
Hypothesis III : Therapists’ Introjects
a) Therapists' introjects' as autonomous-self were assessed in relation to the four
dependent variables (working alliance, rupture resolution, smoothness, and depth) for
therapist and patient perspectives. No significant relationships were found (p < .05, refer
to table 12).
b) Therapists' introjects' as affiliative-self were assessed in relation to the four dependent
variables (working alliance, rupture resolution, smoothness, and depth) for therapist and
patient perspectives. As illustrated in table 11, a significant relationship was found
between therapists' introjects of affiliative-self and therapists’ reports of rupture
resolution.
(see table on following page)
101
Table 11: Therapists’ Affiliative Introjects and Rupture Resolution
FIXED EFFECTS
PARAMETER
Intercept
Coefficient
PT
TH
3.00 2.75
SE
PT
0.15
df
TH
0.13
t
PT TH PT
100 100 19.50
p
TH
13.89
PT
20.80
TH
0.00
LEVEL 1 (PATIENT)
Gender
-0.145
0.157
100
-0.920
0.359
Age
-0.008
0.007
100
-1.069
0.287
0.253
0.145
100
1.744
0.084
Gender
0.205
0.186
73
1.101
0.274
Age
0.003
0.013
100
0.239
0.811
-0.005
0.001
100
2.085
**0.005
Rater Effect
LEVEL 2 (THERAPIST)
INTERACTION
Introject-Aff
PT
TH PT
-0.00 0.00 0.00
TH
0.00
PT TH PT
0.00 0.00 -0.704
TH
3.01
PT
0.48
TH
**0.00
RANDOM EFFECTS
Standard Deviation
INTERCEPT
.424
RESIDUAL
.901
Introject-Aff = Therapists affiliative introjects of self.
Male = 1; Female = 0. Rater Effect and Interaction statistics in this table reflect coding scheme of Th = 0
and Pt = 1.
**p < .01
Only 81 therapists from the total sample had available Intrex data. Due to additional
missing data, this model (table 11) consisted of 74 therapists and 181 observations of
rupture resolution (combined patient and therapist; each observation represents either a
patient or therapist average rating over first five sessions). There was a significant
interaction between the rater variable and therapist affiliative introject ratings, t(100) = 102
2.085, p = .005, suggesting that therapists’ and patients’ ratings of session smoothness
were discrepantly associated with the predictor variable. Due to this interaction, the
simple main effects of patient and therapist rupture resolution were estimated separately.
After controlling for gender and age, therapists’ affiliative beliefs towards themselves
were associated with therapists’ ratings of rupture resolution, t(100) = 3.01, p = .003. No
significant association was found between therapists’ affiliative beliefs and patients’
ratings of session smoothness, t(100) = -.704, p = .483.
Random Effects
The random effects represent the random variation in outcome (randomly varying
intercepts). In other words, the standard deviations reflect the variation in how therapists
and patients rate dependent variables after removing the fixed effects of interpersonal
schemas or introjects. The intercept standard deviation can be interpreted as the degree
to which therapy process is rated consistently across patients treated by the same
therapist, and the residual standard deviation reflects the variability within a single
therapist in ratings of different patients. As illustrated in tables 5-11, the residual
standard deviation is consistently higher than the intercept standard deviation. Thus,
therapists are not responding in the same way to each patient. This suggests that variance
not attributable to therapists’ interpersonal schemas or introjects is primarily accounted
for by individual differences in patients, and how therapists and patients are likely to rate
aspects of rupture resolution in response to those differences. Overall, this finding helps
to confirm that outside the effects of interpersonal schemas and introjects, therapists are
103
responding to the individual differences of their patients rather than rating therapeutic
processes in the same way regardless of who they are treating, and different patients are
rating therapeutic processes differently despite having the same therapist.
Table 12: Summary of Regression Coefficients for all Main Effects of ISQ/Intrex
Mother
ISQ
Hostile
Friendly
Submissive
Dominant
Father
ISQ
Hostile
Friendly
Submissive
Dominant
Alliance
RR
TH
.028
(.424)
-.003
(.948)
.067
(.086)
.016
(.682)
.111
(.076)
.218
*(.018)
.068
(.195)
.156
*(.024)
Alliance
.028
(.458)
.075
(.071)
.033
(.402)
.055
(.155)
-.097
(.178)
-.013
(.910)
-.082
(.316)
-.021
(.805)
RR
TH
Depth
Smooth
-.007
(.870)
.081
(.269)
.044
(.404)
-.006
(.900)
-.002
(.945)
.019
(.777)
0.27
(.569)
-.017
(.735)
PT
Depth
PT
.045
(.417)
.199
.037
**(.007) (.652)
.040
(.473)
.119
*(.026)
RR
Depth
Smooth
TH
PT
Affiliation
.000
.004
-.001
.000
.000
(.556)
**(.003) (.483)
(.624)
(.729)
Autonomy
-.000
.001
-.005
.000
-.000
(.539)
(.574)
(.063)
(.399)
(.668)
Signficance = * p < .05; ** p < .01
Note: cells split with TH/PT represent models with significant interactions and thus patient and
therapist were assessed separately. Cells with one rating reflect models that combined patient and
therapist effects.
Intrex
Alliance
.012
(.825)
.100
*(.055)
.035
(.552)
.046
(.377)
Smooth
TH
PT
-.034
(.521)
-.008
(.869)
-.042
(.447)
.030
-.146
(.623)
*(.048)
104
Chapter VII
Discussion
Rupture Resolution
Hypothesis I was at least partially supported, suggesting in multiple situations that
therapists' relationships with their fathers, and beliefs and expectations surrounding those
relationships are meaningfully related to therapists' rupture resolution in psychotherapy,
regardless of patient or therapist gender. Specifically, the findings suggest that the more
therapists anticipate desirable outcomes in friendly and dominant social interactions with
their fathers (in response to their own friendly and controlling behavior), the more likely
they are to resolve ruptures with their patients. These relationships were also observed
between therapists' anticipated social outcomes with their mothers and rupture resolution;
however, anticipated outcomes with mothers only predicted therapist and not patient
ratings of rupture resolution. The relationship with the father in dominant situations, on
the other hand, predicted both therapists' and patients' perceptions of rupture resolution.
This suggests that the relationship with the father is a more powerful predictor of rupture
resolution than that of the mother, as well as that interpersonal schemas in dominant
situations predict more accurate representations of psychotherapy process. Therapists’
interpersonal expectations of fathers and mothers in friendly situations only predicted
their own ratings of rupture resolution. Perhaps therapists’ friendly tendencies account
for their likelihood of perceiving rupture resolution, whereas these same friendly
tendencies conceal unresolved tension that continues to be experienced by their patients.
105
Hypothesis II was also supported in suggesting that the relationship with the
father is important to not only the likelihood and degree of rupture resolution, but to the
quality of rupture sessions including perceived smoothness and depth, while the
relationship with the mother did not predict these variables. For example, therapists who
anticipated more desirable social outcomes with their fathers in friendly situations were
more likely to have rupture sessions where both patients and therapists experienced
increased levels of emotional depth. Thus, therapists’ friendly interactions with their
fathers may be relevant to effective conflict resolution skills, or at least to the approach
taken by therapists during difficult and tense moments with patients. Perhaps therapists
who imagine positive reactions to their own friendly behaviors with fathers feel more
comfortable with friendliness in general, thus creating a feeling of security with patients
that enables a more in depth exploration of interpersonally challenging moments.
Therapists’ interpersonal schemas of their fathers’ in dominant situations were
negatively related to patients’ perception of smoothness in rupture sessions. This
suggests that therapists who expect desirable outcomes in response to their own
controlling behavior with their fathers have patients who experience more ‘roughness’ in
working through rupture sessions. It is uncertain as to whether or not this “roughness” is
related to positive or negative outcome; however, it is possible that this roughness is an
important characteristic of resolving conflicts, and therapists who expect positive
outcomes in controlling situations may be more comfortable with control, less likely to
avoid moments of tension and more likely to confront uncomfortable interactions with
their patients. On the other hand, therapists’ interpersonal schemas of their fathers in
106
dominant situations only predicted patient ratings of ‘roughness,’ and may be indicative
of a therapists’ controlling tendencies that are overlooked by therapists but are
experienced by patients as tense or uncomfortable moments. Nonetheless, the overall
combined findings from hypotheses I and II suggest that therapists’ interpersonal
schemas with their fathers are meaningful predictors of rupture resolution in
psychotherapy.
There is also limited evidence suggesting that age may affect rupture resolution
(as described in table 8), and that as therapists get older they are more likely to perceive
rupture resolution. Older therapists are more likely to have more experience, and thus
may be more effective at resolving ruptures with patients.
Dominant and friendly situations were consistently the two interpersonal
situations that yielded significant results for both the degree of rupture resolution, and for
the quality of rupture sessions (while hostile and submissive situations were not
significantly related to any outcome variables). Although not all four situations were
meaningful predictors of rupture variables, each of the two interpersonal dimensions
characterized on Kiesler’s interpersonal circumplex model of behavior were represented
as significant predictors: Dominant on the Dominant-Submissive scale and Friendly on
the Friendly-Hostile scale. This suggests that both the control axis, and the affiliative
axis are important, and that experiences with fathers in controlling and affiliative
situations are important in developing beliefs and approaches to conflict situations.
These findings are consistent with studies from the child-development literature
suggesting that internalized experiences with their fathers are important in the
107
development of conflict resolution skills (refer to chapter 2). This relationship may have
to do with an emerging relevance of the father at preschool age when toddlers begin to
negotiate their social world (Steele and Steele, 2005), and potential characteristics
relevant to how fathers may engage in play, and how they approach conflict related
situations (McDowell et al., 2002; Parke et al., 1989; Pakaslahti et al 1996; Roberts,
1999). Perhaps fathers are particularly relevant in discipline situations which involve
interpersonal conflict, and thus the relationship with the father is more deeply or
meaningfully internalized with relation to difficult social situations. Further research is
required to more fully understand this relationship.
This study in particular suggests that this relationship is translated into the therapy
room and becomes important to the therapeutic process and rupture resolution. This
study may more precisely suggest that therapists who anticipate overall desirable
outcomes with their fathers in response to their own friendliness have healthy
perspectives on social relationships, or feel more comfortable with their own friendly
behaviors, and are therefore comfortable taking interpersonal risks with their patients to
resolve breaches in the therapeutic alliance, at least from the therapist’s own perspectives.
Therapists who have had positive outcomes with their fathers in response to their own
controlling behaviors may know how to effectively negotiate more difficult situations,
and ultimately feel more comfortable with asserting their own feelings and perceptions of
breaches in the therapeutic alliance.
Working Alliance
108
Hypothesis I predicted that the working alliance would be more related to
therapists' relationships with their mothers than that of their fathers. The findings did not
suggest any meaningful relationship between alliance and either mother or father
schemas. Nonetheless, it is worth noting that in a couple of situations the results
approached significance. For example, as illustrated in table 12, anticipated responses
with mothers in submissive situations and anticipated responses with fathers in friendly
situations approached significance. Although not quite statistically significant in this
study, further assessment to understand potential relationships between therapists'
interpersonal schemas of their mothers and/or fathers and the working alliance they form
with patients may be worthwhile.
Therapists’ Introjects and Rupture Resolution
Hypothesis III was supported in that there was a positive relationship between
therapists’ affiliative introjects (intrapersonal representations) and therapists’ perception
of rupture resolution. In other words, therapists who are able to maintain friendly beliefs
about themselves even in worst case situations are more likely to experience themselves
as confronting and resolving ruptures with patients. This finding may suggest that
therapists who view and approach themselves in a friendly manner (even when they are
feeling at their worst and there is more potential for self-blame, self-control and inward
directed hostility) have healthy self-concepts and are therefore more comfortable and
perhaps confident in threatening interpersonal situations. This finding provides support
to the overall concept that internalized representations of self, through intra-psychic and
109
interpersonal processes are meaningful in relation to rupture resolution, and that further
research in this domain is a meaningful endeavor. In addition, the Intrex findings in
concurrence with the ISQ findings demonstrate that the relationship between internalized
representations of friendliness and rupture resolution is suggested in two at least partially
separate constructs (interpersonal schemas and introjects). Perhaps friendliness is a more
generalized characteristic that can be more easily captured in similar ways across
measures, whereas beliefs of control are more nuanced in representation and
measurement.
Limitations and Future Directions
A methodological limitation of this study includes the use of a single-item
measure to assess rupture resolution. This was to some extent addressed through adding
additional measures to capture the smoothness and depth of experience in rupture
sessions; however, only the single-item rating was used as a measure of the actual extent
of resolution experienced by patients and therapists. Psychometrists have traditionally
discouraged the use of single-item measures citing concerns as to the ability of one item
to correlate with a construct (Nunnally & Bernstein, 1994). However, single-item
measures of moderately complex constructs have also been argued to have better face
validity and be less burdensome for participants, thus reducing the risk of annoyance and
unreliable responding (Wanous, Reichers, and Hudy, 1997). In addition, studies have
demonstrated reliability, convergent validity and discriminant validity for single-item
measures that assess such variables as symptom severity, psychosocial functioning and
110
quality of life in depressed patients (Robins, Hendin and Trzesniewski; 2001 &
Zimmerman et al., 2006). Nonetheless, future research benefit from additional measures
that can capture the nuances of rupture resolution processes. Examining video-tapes of
sessions reporting high resolution may be one way of identifying more precisely what
processes are occurring, and if any of these processes are more robustly related to
therapists’ interpersonal schemas.
Another methodological limitation in this study is that the independent and
dependent variables are self-report measures. Findings from previous studies have
indicated that reliance on self-report measures may underestimate the actual frequency of
ruptures (Sommerfeld, Orbach, Zim & Mikulincer, 2008; Eubanks-Carter, Muran, Safran,
& Mitchell, 2008). Therapists may be reluctant to respond openly about their
relationships with their parents. Novice therapists in particular may have reservations
regarding reporting a rupture, as they may feel that this could be interpreted as a lack of
therapeutic skill on their part. Patients as well may be reluctant to recognize a problem in
the therapeutic relationship, and may be less attuned than therapists to the therapeutic
process and subtle ruptures. This may explain in part therapists’ tendency to report more
ruptures than patients (150 verses 103 respectively for the overall sample). Samstag and
colleagues (Samstag et al., 1998) conducted a pilot study within the brief psychotherapy
research program and found patient failure to complete post-session questionnaires was a
better predictor of drop-out than working alliance ratings. Assuming patients who dropout often experience ruptures in the alliance, this finding may suggest that ruptures
perceived by patients were not always reported, potentially weakening the overall power
111
of the study. In addition, when patients did report ruptures they tended to report higher
resolution than therapists, perhaps feeling obligated to continue to view their therapist in
a positive light.
This study only used data from the first five sessions of a thirty-session
psychotherapy protocol. This was done in part for manageability of such a large
database, but was also supported theoretically in that the first several sessions are often
considered to be particularly important in predicting the course of therapy (Suh,
O’Malley and Strupp, 1986; Horvath & Symonds, 1991). Nonetheless, limiting the study
to these sessions may miss many ruptures that evolve over time, ebbs and flows in the
therapeutic alliance, and patterns of relationships between interpersonal schemas and
rupture resolution. To address several of these methodological limitations, a follow-up
study may use a smaller sample size but include more sessions, and obtain observerbased rupture ratings through video-taped sessions or transcripts. Although the goals of
this study were to examine therapeutic processes, follow-up studies may assess how
therapists’ interpersonal schemas and rupture resolution affect psychotherapy outcomes.
Other limitations of this study include the lack of cultural and ethnic diversity
represented in the sample, and the fact that all subjects were participants in a research
study in a hospital setting, with a focus on cluster C personality disorders. Variables
related to Cluster C personality disorders, such as avoidant or dependent tendencies, as
well as aspects of the research program, including video-taped sessions, time-limited
therapy and extensive supervision, may limit the generalizability of the findings.
112
This study did not control for factors of father availability and whether or not and
to what extent a father was present throughout a therapist’s childhood. Factors such as
travel, degree of occupational intensity, divorce and death may significantly affect the
relationship between interpersonal schemas of fathers and conflict resolution skills. In
addition, the father as a primary or sole care-taker and the availability or absence of the
mother may also significantly affect this relationship. In addition to considering these
factors related to availability, future directions may include looking more closely at
approaches to fathering. For example, a worthwhile endeavor may include assessing
more qualitatively or elaborately -- through the use of detailed self-report measures,
interviewing, or observer-based ratings -- how and what fathers do when responding to
their children’s friendly and controlling behaviors, perceived outcomes of these
interactions, and how these variables relate to their children’s conflict resolution skills in
social settings.
Follow-up studies may also asses the relationship between introjects and
interpersonal schemas. Our assessment of these two variables provided evidence
suggesting that constructs in relation to interpersonal and intrapersonal expectations of
friendliness are predictive of rupture resolution. Future studies may assess the
relationship between these two variables, including construct validity, potential
interactions, or moderating or mediating effects.
Conclusion
113
This study contributes to child-development literature by contributing supportive
data suggesting that the father, more so than the mother, may play a critical role in the
development of conflict resolution skills. More so, this relationship is translated into the
therapy room, affecting psychotherapeutic process. Thus, this study contributes to the
child-development literature, as well as to psychotherapy process literature suggesting
that therapists’ personalities are meaningful predictors of psychotherapy process,
highlighting the importance for therapists to evaluate their own internal processes and
how they react to and approach breaches in the therapeutic alliance. As suggested in
previous research, rupture resolution is an important component of psychotherapeutic
change, and the failure of therapists to recognize and address impasses with their patients
may preclude opportunity for core schematic change to occur. In addition, the ability of
therapists to recognize and resolve ruptures with their patients may decrease missed
sessions, and prevent patient drop-out (Muran, J.C., et al., in press). The findings from
this study may be considered relevant to child-development literature and potentially as
information for approaches to parenting. For example, fathers may benefit from an
increased awareness, and understanding that the way they respond to their children’s
behaviors (e.g., friendliness and controlling behaviors) are important determinants of
their children’s future beliefs surrounding conflicts, and conflict resolution skills. These
findings may also have important implications for training psychotherapists. For
example, these findings may be applied to therapist supervision, helping therapists to
understand their own beliefs and approaches to conflict, how these beliefs may be
inhibiting or even contributing to maladaptive patterns in the alliance, and ultimately
114
helping them to become comfortable addressing difficult interpersonal moments with
patients.
115
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Appendix A: Interpersonal Circumplex
Figure A1:
The 1982 Interpersonal Circumplex: Depicting 16 Categories of
Interpersonal Behavior
Figure A2:
The 1982 Interpersonal Circumplex: Depicting 2 Levels of Interpersonal
Behavior
133
Figure A1
The 1982 interpersonal circumplex circle: Depicting 16 categories of interpersonal
behavior. Used with permission from D. Kiesler, retrieved August 8, 2008 from
http://www.vcu.edu/sitar/1982basiccircle.jpg
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Figure A2
Figure A2. The 1982 interpersonal circumplex circle: Depicting 2 levels of interpersonal
behavior. Used with permission from D. Kiesler, retrieved August 8, 2008 from
http://www.vcu.edu/sitar/1982circ.jpg
135
Appendix B: Contents of ISQ
SITUATIONS (1982 Interpersonal Circle letters in parentheses)
1 (A) Imagine that you and your _______ are collaborating on something. You have
more knowledge and expertise in this area than your _______, so you take the
lead in making decisions.
2 (E) Imagine yourself feeling angry and argumentative towards your _______.
3 (I) Imagine yourself feeling weak or passive and wanting your _______ to take the
lead.
4 (M) Imagine yourself being friendly and helpful with your _______.
5 (B) Imagine yourself in a game (tennis, scrabble, etc.) with your _______. You act
very competitive and work hard to win the game.
6 (F) Imagine yourself being preoccupied with your own thoughts and detached with
your _______.
7 (J) Imagine yourself in an unmotivated or lazy mood where you feel like just going
along with whatever your _______ is doing.
8 (N) Imagine yourself expressing genuine interest and concern for your _______.
9 (C) Imagine a situation where you feel that your _______ has disappointed you.
10 (G) Imagine yourself in a serious mood where you are reserved and not sociable with
your _______.
11 (K) Imagine yourself confiding in your _______ something that is important to you.
12 (O) Imagine feeling uninhibited and spontaneous with your _______.
13 (D) Imagine that you have had a terrible day and are feeling peeved off with the
whole world. You are definitely not feeling affectionate or cordial toward anyone.
14 (H) Imagine feeling not very confident or sure of yourself and feeling dependent on
your _______.
15 (L) Imagine yourself feeling warm and affectionate towards your _______.
16 (P) Imagine yourself acting independently and confidently about something you have
never done before, and not feeling that you need assistance from _______.
RESPONSES (1982 Interpersonal Circle letters in parentheses)
A
B
C
D
E
F
G
H
(PA)
(BC)
(DE)
(FG)
(HI)
(JK)
(LM)
(NO)
Would take charge, or try to influence me.
Would be disappointed, resentful, or critical.
Would be impatient, or quarrelsome.
Would be distant, or unresponsive.
Would go along with me, or act unsure.
Would respect me, or trust me.
Would be warm, or friendly.
Would show interest, or let me know what he/she thinks.
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CODING OF THE ISQ
Responses are recoded to reflect the amount of control and affiliation each represents.
ISQ RESPONSE
OCTANT
A
B
C
D
E
F
G
H
Controlling
Mistrustful
Hostile
Distant
Submissive
Trusting
Friendly
Interested
CONTROL
.875
.625
.125
-.375
-.875
-.625
-.125
.375
137
AFFILIATION
.125
-.375
-.875
-.625
-.125
.375
.875
.625
Appendix C
Table 13:
Goodness of Fit Statistics of Models for Father and Mother ISQ Index
Scores
Table 14:
Factor Loadings for the Correlated Uniqueness Confirmatory Factor
Analysis
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Preliminary Analysis: ISQ factor Analysis
The ISQ consists of 16 situations which are often collapsed into four quadrants, or
types of situations (hostile, friendly, submissive and dominant) and rated along three
dimensions (desirability, affiliation and control) for mother and father, thus yielding 24
independent variables. Preliminary analyses were conducted to address the unwieldy task
of analyzing the effects of this many variables, to determine ways to reasonably reduce
ISQ variables, and better understand psychometric properties of mother and father
factors, the three ISQ indices, and 16 different situations. Two confirmatory factor
analyses were conducted in the statistical program Mplus (Muthén & Muthén, 19982007) to assess goodness of fit of a correlated uniqueness model (Marsh & Bailey, 1991).
In this correlated uniqueness model, ratings of desirability in hostile, friendly, submissive
and dominant situations all loaded on a desirability factor. Similarly, ratings of affiliation
and control across situations loaded of affiliation and control factors, respectively.
Correlations among observed variables pertaining to one situation were freely estimated
(e.g., correlations among desirability, affiliation, and control in hostile situations were
freely estimated). Analyses yielded mixed results for overall goodness of fit for mother
and father, with better results for the father (refer to table 13). The chi square statistic is
significant for both mother (x² = 92.75, p < .01) and father (x² = 71.36, p < .01) indicating
a statistically significant discrepancy between the observed and model-implied
covariance matrices; however, the CFI suggests marginally adequate fit for the mother
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(CFI = 0.928) and adequate fit for the father (CFI = 0.963). The RMSEA statistic for
father is also reasonable (RMSEA = 0.093).
As illustrated in table 14, freely estimated factor loadings for both the mother and
the father were quite high. For example, all four quadrants had strong positive loadings
on their respective factors (desirability, affiliation, control) for both mother and father. In
addition, coefficient alpha was calculated for each dimension across all 16 situations,
confirming that each rating had adequate internal consistency (Table 14). Desirability
and affiliation factors were highly correlated for both mother (r=.91, p < .001) and father
(r=.83, p < .001) regardless of the kind of situation they were being measured in. For
example, therapists who anticipated high degrees of affiliation from their mothers or
fathers in hostile, friendly, submissive or dominant situations were likely to rate the
response as highly desirable. This finding suggests that desirability and affiliation may
be redundant and that it is superfluous to assess both of these dimensions. Given the
overlap of desirability and affiliation and because desirability was more reliable than
control, desirability ratings were the focus of this study.
Although the overall goodness of fit statistics for the correlated uniqueness model
were not strong, given the small sample size, CFI, RMSEA, and coefficient alpha
statistics (Table 13), no attempt was made to undertake a data-driven search for a more
complex model with better fit. On the whole, these findings suggest the reliability of
desirability, affiliation, and control items is adequate for research purposes, but it may be
useful to improve the measurement of interpersonal schemas, particularly with the
mother, in future work.
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Confirmatory Factor Analysis of the ISQ
Table 13: Goodness of Fit Statistics of Models for Father and Mother ISQ Index Scores
(N = 96)
=
Model
2
2(df)
p
CFI
RMSEA
90%CI
Mothers
92.75
39
0.00
.928
.120
.089-.151
Fathers
71.36
39
0.001
.963
.093
.058-.127
Table 14: Factor Loadings for the Correlated Uniqueness Confirmatory Factor Analysis
Model(N = 96)
Mother
Estimate
SE
Est. / SE
p
Hostile
0.825
0.046
17.912
0.00
Friendly
0.720
0.058
12.494
0.00
Submissive
0.870
0.040
21.606
0.00
Dominant
0.813
0.049
16.513
0.00
Hostile
0.750
0.062
12.072
0.00
Friendly
0.550
0.082
6.689
0.00
Submissive
0.677
0.070
9.706
0.00
Dominant
0.755
0.063
12.012
0.00
Hostile
0.664
0.135
4.931
0.00
Friendly
0.419
0.155
2.700
0.00
Submissive
0.683
0.129
5.284
0.00
Desirability ( = .880)
Affiliation ( = .703)
Control ( = .636)
141
Dominant
0.507
0.100
5.088
0.00
Estimate
SE
Est. / SE
p
Hostile
0.856
0.034
25.342
0.00
Friendly
0.713
0.052
13.803
0.00
Submissive
0.869
0.032
27.336
0.00
Dominant
0.883
0.033
26.921
0.00
Hostile
0.799
0.049
16.231
0.00
Friendly
0.586
0.067
8.774
0.00
Submissive
0.717
0.055
13.142
0.00
Dominant
0.834
0.054
16.549
0.00
Hostile
0.658
0.074
8.853
0.00
Friendly
0.468
0.089
5.289
0.00
Submissive
0.668
0.084
7.924
0.00
Dominant
0.734
0.071
10.335
0.00
Father
Desirability ( = .903)
Affiliation ( = .813)
Control ( = .735)
Note: Cronbach’s alpha ( ) represents reliability of 16 ISQ situations/items for the
http://www.theonion.com/content/news_briefs/ahmad_bradshaw_still_hadgiven index.
142