Verbal Response Mode Correlates of Experiencing

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Verbal Response Mode Correlates of Experiencing. William B. Stiles, Susan H. McDaniel, and Kim McGaughey. University of North Carolina at Chapel Hill.
Journal of Consulting and Clinical Psychology 1979, Vol. 47, No. 4, 795-797

Verbal Response Mode Correlates of Experiencing William B. Stiles, Susan H. McDaniel, and Kim McGaughey University of North Carolina at Chapel Hill This study, one in a series seeking indices of good psychotherapy process in the client's verbal behavior, compared specific verbal response mode (VRM) indices with the more global Experiencing (EXP) Scale, a measure reported to correlate with positive psychotherapy outcome. Stiles's VRM taxonomy was used to code the 90 transcribed interview segments published in the EXP manual. As predicted, the strongest VRM correlate of EXP level was the percentage of utterances that were Disclosure in form (first person; "I") and intent (revealing subjective experience). Results suggest that good process may be measurable on an utterance-by-utterance basis. Psychotherapists of different theoretical orientations systematically use different profiles of verbal response modes (VRMs), but clients use approximately the same profile despite therapist differences (Stiles, 1979; Stiles & Sultan, 1979). Thus, if there is a common "active ingredient" that makes verbal interaction psychologically therapeutic, it is more likely to be found in the client's behavior than in the therapist's. The present study compares VRM indices with a more established, global measure of good psychotherapeutic process, the Experiencing (EXP) Scale (Klein, Mathieu, Gendlin, & Kiesler, 1969a), to determine what cues EXP raters use and by implication, to suggest which specific classes of client utterances contribute to therapeutic benefit. A VRM taxonomy fully described elsewhere (Stiles, 1978, 1979) identifies eight basic classes: Disclosure (D), Question (Q), Edification (E), Acknowledgment (K), Advisement (A), Interpretation (I), Confirmation (C), and Reflection (R). Each has a characteristic interpersonal intent and a distinctive

We thank Laurie Arneke, Kim Bullock, Molly Hunter, and George Ploghoft for coding the transcripts and Donald J. Kiesler for his comments on an earlier version of this article. A version of this article has been accepted for presentation at the 1979 Annual Convention of the American Psychological Association in New York. Requests for reprints should be sent to William B. Stiles, who is now at the Department of Psychology, Miami University, Oxford, Ohio 4S056.

grammatical form, both of which are coded. For example, "Pass the salt" is Advisement in form and intent, written A (A), whereas "Would you pass the salt?" is Question in form, but Advisement in intent, written Q ( A ) . Of the 64 possible modes (form-intent combinations) the four exposition modes— D(D), E(D), D(E), and E(E)—account for about 75% of clients' utterances in psychotherapy (Stiles & Sultan, 1979). Disclosure form is declarative and first person ("I"), whereas Edification form is declarative and third person (e.g., "he," "she," "it"). Disclosure intent is to reveal subjective information—thoughts, feelings, perceptions, intentions—whereas Edification intent is to transmit objective information. In terms of the taxonomic principles of classification (Stiles, 1979), Disclosure and Edification differ in frame of reference; Disclosure uses the speaker's internal frame of reference, whereas Edification uses a neutral frame of reference shared with the other. To illustrate, "I'm afraid of him" is D ( D ) ; "It scared me" is E(D) ; "I ran away" is D(E) ; and "He shouted at me" is E(E), Running and shouting are objective matters (Edification intent) ; fear is the speaker's subjective experience (Disclosure intent). The EXP scale is a fully anchored 7-point Likert-type rating scale developed to measure the primary client process variable in the client-centered theory of personality change: At a low level on the continuum of experiencing, discourse is markedly impersonal or superficial. Moving up the scale, there is a progression from simple, limited or externalized self-references to

Copyright 1979 by the American Psychological Association, Inc. 0022-006X/79/4704-0795$00.75

795

BRIEF REPORTS

796 Table 1

Mean Verbal Response Mode Profiles for Each Level of Experiencing and Correlations of Each Mode With Experiencing Scale Experiencing level

Verbal mode

D(D) E(D) D(E) E(E) K(C) Other" Total No. of segments

1

2

3

4

5

6

7

r

19.4 10.0 10.9 27.9 2.3

32.6 11. 7 14.4 22.0 4.6 14.7 100.0

41.4 12.0 6.1 11.0 10.0 19.5 100.0

40.0 20.8 5.5

29.5 100.0

26.4 13.4 12.4 21.2 5.3 21.3 100.0

5.1 18.2 100.0

40.8 24.4 6.2 13.2 0.1 15.3 100.0

81.7 11.1 3.2 0.0 0.0 4.0 100.0

.58** .31* -.29* -.48** .07 -.33*

13

32

12

15

14

3

1

10.4

Note. Mode abbreviations: Disclosure (D), Edification (E), Acknowledgment (K), Confirmation (C). Form is written first, and intent is in parentheses. * Includes modes averaging less than 3% of utterances and unscorable utterances. *p < .01. ** p < .0001. inwardly elaborated descriptions of feelings. At higher experiencing levels, feelings are explored and emergent levels of experiencing serve as basic referents for problem-resolution and self-understanding. (Klein et al., 1969a, p. 1) Studies by the client-centered group (see Klein et al., 1969a) have shown that successful clients start, continue, and end psychotherapy at higher EXP levels than less successful clients. Although neurotics obtain higher EXP ratings than schizophrenics, there is no consistent correlation of EXP with psychological adjustment within these diagnostic groups. Thus, EXP appears to measure the process of psychological growth rather than the state of psychological health. Theoretically and empirically, the most promising VRM index of good process is the client's use of D ( D ) . Theoretically, in making a series of Disclosures, a client explores his or her internal frame of reference. By using the first person (i.e., Disclosure form, "I"), the client forms and strengthens associative bonds between internal experiences and the self. In effect, the client takes responsibility for feelings, intentions, and so forth. Disclosure intents expressed in Edification forms should be less effective because they fail to acknowledge ownership of the internal experience, for example, "She makes me angry," E(D), rather than "I am angry at her," D ( D ) . Edification intents do not symbolize (label) internal experiences ; they dilute therapeutic impact. Empirically, D(D) is the most common

client mode, averaging 38% of client utterances in the earlier study (Stiles & Sultan, 1979). It is thus reasonable to begin by seeking associations between D ( D ) and measures of good processes. Materials for coding consisted of 90 verbatim transcriptions of 2- to 8-minute segments of psychotherapy sessions and other interviews published in the EXP rating manual (Klein et al., 1969b). Each segment's EXP score was the "mode rating," which "characterizes the overall, general, or average level of the segment," as judged by "expert raters" (Klein et al., 1969a, p. 65), Segments were first unitized, and subject utterances were then coded independently by two coders according to the VRM manual (Stiles, 1978). Interviewer utterances were not coded. Coders were not aware of the segments' EXP ratings, the nature of the EXP scale, or the specific hypotheses of the study. Intercoder agreement on all 5,409 utterances was 88% for form and 71% for intent. The final profile for each segment was the mean of the two coders' percentages of utterances in each mode. Closely paralleling the earlier study of client mode use (Stiles & Sultan, 1979), 74.4% (vs. 75.6%) of all utterances were in the four exposition modes and 5.3% (vs. 4.2%) were K(C)—brief utterances such as "mm-hm" or "yeah" or "no" that signal agreement, disagreement, or shared experience. The number of utterances per segment averaged 60.1 and was uncorrelated with EXP level (—.11, ns; n= 90).

BRIEF REPORTS Table 1 shows the mean VRM profiles for segments rated at each EXP level. As predicted, D ( D ) showed the strongest correlation with EXP level (.58, p < .0001). The sum of the percentages of D(D) and E ( D ) was correlated .63 (p < .0001) with the EXP scale. Post hoc exploration of these data using multiple regression techniques revealed no other combination of VRM indices that explained substantially more variance. The results clarify what cues experts use to rate EXP levels. Whereas EXP is an abstract, difficult-to-articulate construct, VRMs are relatively concrete and discriminable, and they provide far more detail about the therapeutic process. The strongest VRM correlate of EXP was percentage of D(D), as predicted; however, EXP raters apparently also react to E(D) as contributing to good process. The substantial (approximately 40%) variance EXP shares with D(D) + E ( D ) looms even larger when it is considered that much of the remaining variance is attributable to unreliability of the EXP and VRM measures. The association of D ( D ) with EXP indirectly supports the hypothesis that D(D) is

797

an index of good therapeutic process. The next step will be to assess whether a client's use of D(D) is directly related to psychotherapeutic impact and positive outcome. References Klein, M. H., Mathieu, P. L., Gendlin, E. T., & Kiesler, D. J. The experiencing scale: Vol. 1. A research and training manual. Madison: Wisconsin Psychiatric Institute, 1969. (a) Klein, M. H., Mathieu, P. L., Gendlin, E. T., & Kiesler, D. J. The experiencing scale. Vol. 2. Transcripts oj tapes for training sessions. Madison: Wisconsin Psychiatric Institute, 1969. (b) Stiles, W. B. Manual for a taxonomy of verbal response modes. Chapel Hill, N.C.: Institute for Research in Social Science, University of North Carolina at Chapel Hill, 1978. Stiles, W. B. Verbal response modes and psychotherapeutic technique. Psychiatry, 1979, 42, 4962. Stiles, W. B., & Sultan, F. E. Verbal response mode use by clients in psychotherapy. Journal of Consulting and Clinical Psychology, 1979, 47, 611-613. Received April 9, 1979 •