A study aimed at cross-validating previous research suggesting that the levels of the therapist's accurate empathy, nonpossessive warmth, and genuineness were causally related to the degree of patient improvement or deterioration. An equal number of "good" or "poor" therapy prospects were randomly assigned to 4 resident psychiatrists (10 patients each) for 4 mo. of psychotherapy. Results tended to confirm the importance of the 3 therapeutic conditions in combination and of empathy and genuineness separately. Negative findings for separate analysis of therapist's warmth were interpreted in terms of its negative correlation with empathy and genuineness in the present sample. On the overall measure for all patients, therapists providing high therapeutic conditions had 90% patient improvement while those providing lower conditions had 50% improvement.Previous research, built upon the Whitehorn and Betz (1954) and Betz (1963aBetz ( , 1963b studies, indicated a positive relationship between levels of therapist-offered accurate empathy, nonpossessive warmth, and genuineness on the one hand and the degree of patient improvement or deterioration on the other. These findings have been obtained in patient populations as diverse as hospitalized schizophrenics, college underachievers, juvenile delinquents, and counseling center cases, and in both individual and group psychotherapy. In a number of these studies, the data also suggest that when these same therapist factors are present to a low degree, then there is concomitant negative change or deterioration in personality functioning for the patient (reviewed by Truax & Carkhuff, 1964, and Truax & Wargo, in press).These studies involved mainly psycholo-
PROBLEMPrior research (3' 5 , 6 ) indicates that the therapist, himself, and not the patient, accounts for the level of accurate empathy and genuineness communicated by him during psychotherapy, while both the therapist and the patient have significant effects upon the level of lion-possessive warmth. van der Veen (12) originally reported findings suggesting that, the levels of accurate empathy and congruence (genuineness) were, i n part, determined by the patient, but a re-analysis(lO) of that data using a more appropriate statistical test, showed no such effects of the patient. Since research is now accumulating which suggests that these three "therapeutic condit,ions", when present to a high degree, tend to lead to positive outcomes, while if present to a low degree lead to negative out,comes in patients(I0), the question of whether it, is the therapist, or the patient that det,ermines the level of these conditions becomes of central importance. That is, if the patient determines the level of accurat)e cnipathy, non-possessive warnith and genuineness communicated by the therapist, then the existing data would merely suggest that good patients elicit high conditions while poor patients elicit low conditions. On the other hand, if it were true that the levels of accurate empathy, non-possessive warmth and genuineness were priinarily a function of t,he therapist, tBen the enhancement of psychotherapy could be accomplished by either training or by selecting therapist's who characteristically offered high levels of these conditions. The present effort is an attempt, t.o extend t,hese prior findings to a different population of therapists arid patieilk, using a different design, and to thus provide converging e\idence indicating whether it is the therapist or t,he patient who primarily deteriiiines the level of accurate empathy, non-possessive warmth and genuineness.
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