By Ana Riley,2014-01-10 19:36
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    Barbara Brodley Fred Zimring Illinois School of Case Western Professional Psychology Reserve University Chicago, Illinois U.S.A.

This article is concerned with a short therapy interview that a beginning student (Claudia) of Barbara

    Brodley's had with a practice client (Suzanna). Both the therapist and the client have given permission

    for this publication. After the transcript of the interview there are comments by Barbara and Fred. A

    short note comparing our comments concludes the article. The following transcript was made by a graduate student as an assignment in empathetic

    following. The student had no previous experience as a therapist and this assignment was turned in the

    third week of class; thus, she had practiced only two weeks and had only two classes in an introductory

    course in client-centered therapy. The client is a practice client chosen by the student from among her

    acquaintances who had agreed to participate in the student's practice for the course; The "client" was a

    client in a regular therapy relationship. The topic of the practice interview was the client's reactions to

    an incident with her regular therapist. The transcript is verbatim of the entire interview, with the names mentioned by the client changed to preserve anonymity.

    Client-Centered Session: Peggy with Therapist Claudia Pl --I feel, uhm, I'm gonna see Laura tonight. We haven't spoken since Saturday night about what

    happened between us.

    Tl --And Laura is your therapist?

    P2--My therapist, and fairly semi-undecided I have some ideas about where I want this to go..

    T2--uh uh

    P3--But I guess I just want to talk about, I guess I just want to clarify how I feel about it cuz I'm


    T3--So you can get it straight in your mind for when you talk to her? P4--Right, right, cuz when I sit down with her I think I would feel better going in having a clear



    P5--Than just possibly being swayed or talked into something or, I don't know I am really afraid that

    she will try to control me, and make me do something I don't want to do as much as it's me that I have

    to decide this and I don't know how objective she can be to help me make the decision because the

    conflict involves her.


    P6-- So I think I should feel better going in to it knowing my mind. T6--So you think you're gonna encounter some emotionality from her, because she's involved?

    P7--Yes, I do. I think that, I'm not looking at tonight as a therapy session. I don't plan to talk about

    anything other than this issue so I can resolve it with her, T7--Yeah

    P8--In whatever way we resolve it. I feel like I have thought about the input that I've gotten from the

    past couple days from Leo and from my husband about stretching myself to accept her as a flawed

    person who still can help me even though she's flawed. T8--Yeah

    P9--And the fact that most likely she didn't personally try to hurt me personally by being late.

    T9--Uh huh

    P10 --It's her issue rather than something that was directed at me.. Tl0--Uh huh

    P11--And I happened to be on the receiving end of it. Tl1--Uh huh. So you don't feel it was really directed at you, it might have been something else she was

    involved in?

    P12Right. I don't feel that it was on purpose, nor do I feel that she had any intention of making me

    feel bad.


P13But the end result is still that I'm the recipient of her action, and for every action there's a

    reaction, and I don’t feel honest with myself if I can just gloss over it and say "Well it's her problem, it

    wasn't personal, therefore I'm just gonna go on as before." T13--Because it was personal.


    Tl4--You felt it was personal.

    Pl5--Even if it wasn't intentional,


    P16--It still was me, so I still feel like I need to do something about it. Even if she wants to just forget it

    and go on.

    Tl6--Uh huh

    Pl7--l don't feel comfortable just forgetting it. Tl7--Uh huh, so you want to talk about it, you want to get it out in the open.

    P18--Yes, definitely

    Tl 8--Yeah

    Pl9--And I want to let her know that again, this is the second time it's happened, that I feel realty not

    good when it happens.

    Tl9--Uh huh

    P20--And if I continue to see her, that we need to find some kind of way to prevent it from happening.

    T20--So you are going to try to discuss some kind of program to maybe if it’s gonna happen again,

    some way to circumvent it.

    P21 --Right, like if she's in the office and I'm not there, and it's 45 minutes late, come out and look for


    T21 --Yes

    P22--Or pick up the phone.


    P23--Because I'm never late and I'm never not there. T23--Yeah, and she doesn't do that now.

    P24--She waited till the next hour, till her next client came and then said, "Oh, whatever happened to


    T24--Did that make you feel like you were forgotten? P25--Yeah, not only did I get there and first feel that she forgot me, but then it was kind of reinforced,

    because she didn't even think of picking up the phone for an hour later.


    P26--Knowing that she's aware of what I just went through with this whole doctor business where I felt

    abused and taken advantage of and manipulated and it took a lot of courage for me after a week, to

    speak up and not only not see this doctor again but call her on the phone and tell her why.

    T26--Uh huh

    P27--And it was hard to do but I felt great that I did it. Even though it didn't fix what she had done to

    me, I felt great that I had the courage to do that, cuz I didn't used to have that, I would have just,

    number one I would have thought it was me. T27--Uh huh

    P28--I'm too sensitive.

    T28--Uh huh

    P29--Number two I would have just not ever seen her again, so it was a big step for me and Laura

    knew what it took for me to not, to stand up. And expect to be treated well.

    T29--To stand up for yourself .

    P30--Right and expect to get um, what I deserve. T30--Uh huh

    P31--What I'm entitled to, we talk alot about entitlement, T31--Uh huh

    P32--So in my therapeutic relationship with her, I feel entitled to certain contractual behavior, like

    we're both there when we say we're gonna be, so that we can get something accomplished in therapy.

    T32--You have an unspoken contract with her that you feel that she's violated.

    P33--Right, and even a spoken contract.

    T33--Spoken contract

     P34--And then when she, if I were late consistently, no matter what excuses I had, rationally I would

    know that she had a right to be annoyed with me. T34--Uh huh

P35--And to not feel as maybe accepting of me. Now maybe if she was client-centered she, she'd

    always accept me no matter what! But she's not. T35--So, so you feel the fact that she, does she not, does she say to you that she feels you should not be


    P36--No, she said that there must be some logical explanation for it her office was painted and maybe

    the bell stuck. When I still don’t just give in and say, “OK, I'll see you Monday,” she pushed it further

    and this bothered me, she said that maybe I was on the verge of reaching a certain point in my therapy

    and facing something that would be upsetting and maybe I was being resistant and I didn't press the

    bell. And there I feel totally manipulated and angry. T36--So she kind of pushed it off of herself and on to P37--Yes


    P38--She feels in a way innocent, she says she feels very frustrated cuz she honestly didn't do anything



    P39--And I understand that feeling. But neither did I, and I feel like it's not fair in her position for her

    to use that psychology knowledge on me trying to convince me that there is something I'm afraid of. I

    don't think that's fair.

    T39--Instead of, instead of saying that maybe it was a little bit me and maybe a little bit you?


    T40--Can we work it out?

    P41 --We can't think of an explanation for this. T41 --Yeah

    P42--So let's just, let's just say here's what we'll do to never let it happen again, instead of saying

    maybe you sat there and you never pressed the bell, that makes me feel stupid.


    P43--It makes me feel childish,


    P44--And not open to wanting to be in the relationship. T44--Sure

    P 45--l feel angry and resentful

    T45--Uh huh

    P46--Because all my work with her, because it's been so good it's involved dealing with painful stuff.


    P47—I’ve aways been there and felt pain or anger or something uncomfortable and it’s been big things,

    so I resent the implication that I'm avoiding something not. It doesn't even make sense with what I've

    done so far.

    T-47--This seems so minimal.

    P48--It's like she's not giving me credit for what I have accomplished ,

    So far to suppose that maybe I’m afraid to face something now. It's kind of belittling what I've done so

    far, I think.

    T48--So you feel almost as if she has discounted your previous work.

    P49--l think she thinks I've done well, very well, but now she's using this incident and trying to get me

    back by saying you know maybe there still is something that you are repressing, that you are

    resisting. She used the word “you have resistance, maybe you're resisting.” And it bothers me that

    she's not, by saying that she's not taking any responsibility for what happened. And I guess what I'm

    hearing myself say is, I have to tell her that, T49--Uh huh

    P50--Real clear

    T50--Uh huh

    P51—So that I don’t know what happened. I know my side of it was I was there and she wasn’t.

    T51Uh huh

    P52--Her side of it is she was in the room and I didn't some. But she knows, I left her a note, she found

    my note. So she thinks I was there and I didn't ring the bell. We both totally think different things. If

    I'm gonna work with her I need to know I have, she has enough respect for my integrity that I am

    telling the truth, and that maybe we can move on from there to make rules.

    T52--So it’s really an issue of respect here. P53--Right, mutual respect


    P54--And maybe I need to overlook the lateness thing if she gives me time on the end, if I can do that.


    P55--If I know I can structure my day that whenever I have her I might be 15 minutes late coming out,

    T55--Uh huh

    P56--And not care that she's being late with every other client for the rest of the day, that's really not

    my problem.

    T56--Uh huh

    P57--Maybe I could just give her her flaw, allow her her, flaw, get what I can out of it, but before we

    do that I need to feel that she believes that I rang the bell. And if she thinks I didn't then I don’t think I feel comfortable being with her but I don't know how to find that out, she may just say she believes me

    just to keep it going. I don't know how to tell whether she really believes me. T57--So if, so it's an issue of being believed for what you have said. That you are telling the truth.

    P58Whatever it is that I say with her, that I have revealed so much of myself so deep deep layers,

    that this is nothing compared to that I don't have a reason to not tell the truth. And I'm insulted and

    hurt to think that maybe she thinks I'm not.

    T58--It bothers you when somebody, when you know you are telling the truth and someone doesn't.

    P59--Right, and on the other hand maybe she's thinking the same thing “I know I was in there” but then we need to meet in the middle. I can't do all of the coming, all of the meeting her.


    P60--Coming to her. I have a thing in my life and I'm aware of this, of balance in relationships, and

    I've alot been on the giving end, and a few years ago I realized what I was doing and I reached a certain

    point where when people don't, not even Steven, tit for tat, but generally, give a little bit, you give a

    little then you get a little, you give a little and if it’s very unbalanced for a long period of time, I don't realty want it if it’s I mean if there were extenuating circumstances a sick person or a child, but when

    it's an adult relationship I want to get something out of it too. And I finally feel like I have the right to

    expect that.

    T60--Uh huh

    P61 --And it's foreign to me but it's good. I know it's a good thing.

     T61 --So you learn that you're important enough to expect to get.

Comments: Barbara Brodley

    Having the benefit of hearing the tape while reading the transcript, I felt Claudia was very present

    and responsive to Suzanna and that she consistently conveyed an attitude of acceptance towards

    Suzanna and to whatever Suzanna expressed. Claudia's tone of voice was caring and respectful and her

    manner of expression was lively and real. Suzanna's reactions to Claudia, conveyed both by her

    intonations and the things she said, seemed to indicate that she felt understood, supported and

    respected. Claudia's good client-centered general qualfties, and her apparent effectiveness in

    facilitating Suzanna's expression of her issue and her feelings suggest that a breakdown and analysis of

    her verbal behavior might be instructive to students and others.

In the transcribed segment Claudia makes thirty-seven responses which I term "verbal gestures or

    acknowledgements of following." Of the total thirty-seven acknowledgements, nineteen are in the

    explicitly supportive or agreement form of "yeah", "OK". "yes", "sure", or "right", and the remaining

    eighteen of the total are in the more neutral form of acknowledgement -- "un hum."

    Claudia's high frequency of support/agreement forms of acknowledgement does bias the interview

    away from the evaluative neutrality that was asked of her in the instructions. Claudia may have

    interpreted the instruction to avoid evaluative responses as pertaining only to articulate responses, or it

    may be that her supportiveness towards her friend and her relatively high level of energy spilled into

    and affected the form of those acknowledgements. Although acknowledgements of following

    expressed as "yeah" or "OK", etc., are natural variations on the familiar "un hum", I have observed that

    their meaning changes from the evaluatively neutral meaning - "I am following and understanding" to

    an evaluative meaning in the sense of "you are doing (or saying) the right thing" when they are

    expressed frequently in an interview. Student therapists admit this latter meaning when they have

    frequently used the "yeah", etc., forms.

    In addition to Claudia’s acknowledgement responses, she made twenty-three distinct articulate

    responses. Only two of these responses seem to be ones made from Claudia's frame of reference

    (instead of being empathic following responses representing her client's frame of reference). Claudia's

    response T35 probes for information and the question is not attuned to the client's immediate frame of

    reference. Response T58 is a generalization that Claudia formulates out of Suzanna's specific

    experiences. An empathic response that would be more attuned to Suzanna at that point might be "It's

    deeply insulting and it hurts that she doesn't believe you, especially she who knows what you've faced,"

    The twenty-one remaining responses I classify as some form of empathic following response. Five of these responses (Tl, 3, 6, the latter part of 11 and 24) are questions for clarification. The other

    sixteen responses (Tl1 - first part, 13, 14, 17, 20, 23, 29, 32, 33, 36, 37, 39-40, 47, 48, 52, 57, and 61)

    are empathic understanding responses in declarative forms.

    Some of Claudia's empathic responses are not the most accurate statements of understanding that are possible given her client, Suzanna's clarity of communication. For example, Claudia's T23 is

    somewhat elliptical because it expresses the fact of Suzanna's therapist's behavioral deficiency rather

    than Suzanna's strong desire for her therapist to take the action of checking on her presence in the

    waiting room if she doesn't hear Suzanna's ringing. Response T23 is, nevertheless, obviously intended

    to be an expression of empathic following and is closely, although indirectly, related to Suzanna's


    Claudia's empathic following response T36-37 seems not to be emotionally attuned to the intensity of feeling expressed by Suzanna in her C36 statement. It is, however, a following response,

    and it is in part descriptive of the aspect of the interaction that Suzanna was upset about. An alternative

    response at that point which might have felt more fully responsive to Suzanna's feelings is (instead of

    T37-38) “It makes you pretty angry at her to be told you've distorted and misrepresented what happened.”

    Another of Claudia's empathic following responses, T47, is in the most empathic element having to do with Suzanna's resentment of the apparent disregard of her past therapy work. A response that

    might feel more fully empathic to Suzanna (instead of T47) might be “You resent her implication that

    you would avoid some responsibility or some blame if you deserved it, when she should know very

    well that you've faced so many painful things.” In fact,Suzanna restates and elaborates her point expressed in C47 after Claudia's T47. This is often-observed client behavior -- that the client will

    restate something that is important to them if the therapist has mis-stated it or overlooked it.

    Claudia's T52 is a following response, but it focuses on Suzanna's communication in terms of an issue, rather than the lived experience. A more immediate form of response (instead of T52) might be

    “To feel able to keep on working with her you need to trust that she respects you and really believes

    you are telling the truth.” Claudia's T57 is, also, less immediate because of its reference to the "issue."

    An alternative might be "You want to feel sure that she believes you, but at this point you don't entirely

    trust her to be honest with you."

    Regardless of the instances of relatively weak or imprecise empathic following responses, Claudia was effective in, communicating acceptance, an empathic attitude, and relatively, accurate empathic

    responses. She tended toward agreements in her acknowledge-of-following vocalizations and in that

    way brought into the relationship an evaluative quality. But those responses also contributed to the

    supportiveness of her presence which was most strongly, and non-evaluativety, communicated through

    her non-evaluative empathic understandings. She did not make the mistake, in a single response, of

    volunteering her opinion, or making interpretations or explanations. In only one instance was she

    probing and in one instance she made a response that had the character of a comment, when she

    expressed the client's experience in terms of a generality. Claudia came across to me, and, I think, to

    Suzanna, as very consistently and as sincerely trying to follow and understand Suzanna's feelings and

    reactions as well as she could. The mistakes and imprecisions in her responses are slight enough that it

    seems clear that Claudia is trying to empathically understand and is not trying to produce some effect,

    or have some specific influence, under the cover of understanding.

    A significant factor in the constructive flow and effectiveness of the interview is Claudia's practice client. Suzanna is strong in her ability to pursue and persist in expressing what she is getting at even

    when Claudia's responses are inaccurate or imprecise. As she states in the course of the interview,

    Suzanna has been a client in therapy for a while, and she has worked on identifying her feelings,

    asserting herself and clarifying herself to others in interpersonal situations. These abilities help

    Suzanna to keep on her own track when Claudia's responses might deflect some clients from their own


    When I first read and listened to the interview segment I felt it likely that the clarifications that Suzanna expressed with Claudia's help would help her to talk over her problem directly with her

    therapist. Indeed, Claudia later told me that the discussion had taken place and that it had gone well,

    according to Suzanna.

    Claudia's work in her session with Suzanna, I think, was very good considering the short time she had been exposed to client-centered ideas and the very short time she had practiced before this

    interview. Study of her successes and mistakes or shortcomings in the approach are interesting to see. I

    appreciate Claudia's and Suzanna's permission to present this analysis of their interaction.

Comments: Fred Zimring

    Suzanna, the client, starts, in C2 and in C3, to talk about being undecided and wanting to clarify how she feels about the situation with her therapist (Laura). This, the present therapist, Claudia,

    mentions in T3. The client, in C5, then talks about not wanting to be controlled. "I'm really afraid that

    she will try to control me". In T6 the therapist talks about the client thinking that she will encounter

    emotionality from Laura but does not pick up the fear of the client about control.

    In C7 and in various places through C17, the client talks about her intention of talking to Laura about the issue. After the client repeats herself, in C16 saying that she "needs to do something about it"

    and then in Cl7 says that she would not "feel comfortable just forgetting it", the therapist finally

    mentions this in Tl7. The client then moves, in C19, to say that this is the second time this has

    happened with Laura and that the client does not feel good about this. The therapist in T23 talks about

    what Laura does but does not talk about the client not feeling good about what Laura does. The

    therapist asks a question in T24 about how the client felt: "Did this make you feel that you were

    forgotten?". In answer, the client goes on to explain, in the group of responses through C31, that

    entitlement is involved in how she feels about what Laura did. The therapist picks this up in T32 in

    commenting that "you have an unspoken contract with her that you feel she violated." This talk of

    entitlement leads to mention of what would be right in the situation and then leads to talk about feeling

    totally manipulated and angry (C36). The therapist (T36) ignores these feelings and instead focuses on

    what Laura did. This focus on Laura leads the client to consider what Laura feels and then the client

    comes back (C39) to her feeling that Laura is unfairly using her position. Rather than following the

    client's feelings of unfairness the therapist describes what it might have been fair for Laura to do.

    The client then goes on to talk about her feelings. In C42 she says she feels stupid, in C43 she says she feels childish and in C45 that she feels angry and resentful. The therapist ignores all of these

    feelings. The client goes on to talk about her feelings of resentment about the implication that she is

    avoiding something and, in C48, that she feels belittled by what Laura did.

    The client, in C49, becomes clear about what she wants to tell Laura and then, in C52, says that she needs to know about Laura's attitudes, if she is to continue to work with her. In T52 the therapist

    correctly picks up the "issue of respect". This allows the client to realize that her minimal condition for

    continuing in therapy is that Laura believes her. The therapist's understanding of this leads the client to

    realize that she is willing to give something but that Laura is going to have to give also, that she

    "finally feel like I have the right to expect that" (C60), something much like the previous respect

    issue. The therapist communicates her understanding of this in T61, concluding the interview.

    The therapist allowed the client her own world, allowed the client to go wherever the client wanted and did not try to convince the client of whatever truths the therapist might have seen. The

    therapist was not accurate in following one type of feeling but was in following another. The

    therapist's understanding of the "hotter, feelings, of feelings of pain, anger, childishness, and

    resentment were not communicated to the client. The therapist seemed to have much less trouble

    understanding the client's "cooler" feelings about entitlement and respect.

    In general, Barbara's and Fred's analysis were quite similar, paying close attention to the client and therapist interchanges. In future analyses of therapy in the Journal it might be better to have

    comments from people who were not quite so similar in their approach to therapy. There were some

    differences, however. Correctly, I think, Barbara gave more attention than Fred did to the

    therapist’s attitudes. Also, Barbara, having access to the tape of the interview as well as to the

    transcript, was more sensitive to the client’s feelings of being understood as conveyed by voice


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