epistemología y psicoterapia.pdf

The Relationship Between TherapistEpistemology Therapy Style Working

Alliance and Interventions Use

JOCELYN A LEE PhDGREG J NEIMEYER PhDKENNETH G RICE PhD

The current study examines the relationship of therapist epistemic style andtherapeutic method emphasis on working alliance and use of specificinterventions The studyrsquos aim was to discover if epistemological approachcould predict therapist report of therapy practice The most robust finding ofthis study provides provisional support for the notion that there are specificdifferences in therapistrsquos personal styles related to epistemic assumptions(rationalist vs constructivist) Additionally we found that therapistsrsquo epis-temological viewpoints were a significant predictor of their emphasis on theworking alliance (bond subscale) as well as their use of specific interventions(cognitive behavioral vs constructivist) The current study extends thedeveloping literature investigating the translation of epistemology in topractice specifically looking at therapistsrsquo self-reports Further work is neededto see if client reports corroborate therapistsrsquo self-report and to investigatewhether or not therapistsrsquo epistemology affects the outcome of therapy work

KEYWORDS epistemology therapy style working alliance therapyinterventions epistemic style

INTRODUCTION

A growing area of interest in counseling psychology research exploresthe philosophical underpinnings of different approaches to counseling andpsychotherapy (DisGiuseppe amp Linscott 1993 Lyddon 1990 Mahoney1991) More specifically recent literature has investigated the translationof ldquoepistemology into practicerdquo exploring the relationship between phil-osophical commitments and theories and concepts related to changeprocesses (Arthur 2000 Botella amp Gallifa 1995) One expression of this

Private Practice Gainsville FL Department of Psychology University of Florida Gainesville FLMailing address 2653 SW 87th Drive Suite A Gainesville FL 32608 e-mail josses78yahoocom

AMERICAN JOURNAL OF PSYCHOTHERAPY Vol 67 No 4 2013

323

work looks at the epistemic assumptions that underpin the theory andpractice of cognitive therapy (Lyddon 1991a) In particular a developingliterature addresses the distinct differences between contemporary cogni-tive therapies according to their epistemic assumptions rationalist empir-icist and constructivist (Hollon amp Beck 1986 Lyddon 1991a)

The notion that counselors maintain different perspectives regardingthe processes and methods of human change because of differing philo-sophical commitments has been considered in the epistemic style literature(Lyddon 1989) Personal epistemological commitments have been linkedto a variety of different features in psychotherapy such as preferences forparticular types of therapy (Lyddon 1989 G Neimeyer amp Morton 1997)and specific therapeutic interventions (Winter amp Watson 1999)

The link between personal epistemologies and particular therapistbehaviors is just beginning to receive attention In fact there has beenrelatively little empirical research addressing the translation of therapistepistemological leanings into corresponding therapeutic practices Thepurpose of such exploration would be to gain a better understanding oftherapist epistemic style and how it relates to the methods and processesof therapy There is reason to believe that specific epistemic commitmentswould be related to and may potentially direct a) particular psychothera-peutic styles b) the structuring of particular types of therapeutic relation-ships and c) the selection of particular forms of psychotherapy interven-tions

LITERATURE REVIEWEPISTEMIC STYLE

Royce has developed a long-standing line of research investigatingpeoplersquos ldquoways of knowingrdquo (1964 Diamond amp Royce 1980 Royce ampPowell 1983) Throughout this extensive program of research Royce andhis colleagues developed a conceptual model that specifies three funda-mental classes of knowing These three primary approaches to knowing arereferred to as the three epistemic styles rationalism empiricism andmetaphorism

Rationalism maintains the dominant assertion that thought has superi-ority over the senses with regards to obtaining knowledge Those with arational epistemic style are devoted to testing their views of reality in termsof logical consistency Rationalism is the epistemological worldview thatunderlies cognitive-rational therapy (Lyddon 1989 Mahoney 1991)

Empiricism is primarily concerned with sensory experience as the mainway of knowing in this style people know to the extent that they are able

AMERICAN JOURNAL OF PSYCHOTHERAPY

324

to perceive accurately The empirical view of knowledge is primarilyinductive and determined mostly by the reliability and validity of obser-vations (Diamond amp Royce 1980 Vincent amp LeBow 1995) Empiricismis the epistemological worldview that underlies behavioral therapy(Mahoney 1991 Schacht amp Black 1985)

The metaphorist perspective sees knowledge neither as firm nor rigidbut as more flexible and as embedded within individually and sociallyconstructed symbolic processes Metaphorism thus takes the stance thatreality is personal and mutable rather than fixed and that individualsconstruct their bases of knowledge from their personal learning historiesexternal experience and their own personally constructive processes(Vincent amp LeBow 1995) Metaphorism is the epistemological worldviewthat underlies constructivist therapy (Neimeyer Prichard Lyddon ampSherrard 1993)

Roycersquos conceptual framework holds that the processes of conceptual-izing perceiving and symbolizing are interdependent processes where themeaningful convergence of these three processes makes up a personrsquos viewof reality or worldview Although the processes are interdependent peopletend to show a leaning towards a dominant epistemic style (Royce amp Mos1980 Royce amp Powell 1983)

EPISTEMOLOGY AND RATIONALIST-CONSTRUCTIVIST THERAPIES

Mahoney (1991) distinguishes and extends epistemic-style research bysuggesting that current cognitive therapies are distinguished by theirdiffering epistemological commitments (rationalism and constructivism)Rationalism argues there is a single stable external reality and thoughtsare held superior to senses when determining the accuracy of knowledge(Mahoney 1991 Mahoney amp Gabriel 1987 Mahoney amp Lyddon 1988)Winter and Watson (1999) further depict rationalists as believing thetherapistrsquos role is to instruct the client to think more rationally thusincreasing the correspondence between an individualrsquos perceptions andthe reality of the events confronted Thus rationalist therapies are morepersuasive analytical and technically instructive than the constructivisttherapies (Neimeyer 1993b) Successful rationalist therapy occurs whenclients are able to control their negative emotions through rational think-ing (Mahoney amp Lyddon 1988) Lyddon (1989) goes on to note thatrationalist cognitive theories due to their epistemological commitment toreason and logical-analytic processes depict a rational epistemic style

Constructivism however argues that individuals are proactive in theirpersonal constructions of their realities From this point of view knowl-

THERAPIST EPISTEMOLOGY AND PRACTICE

325

edge is comprised of meaning-making processes in which the individual isin charge of organizing his or her experiences Constructivists believe thatreality is not single stable or external and instead assert that individualsrsquofeelings and actions cannot be meaningfully separated from humanthought (Lyddon 1988 Mahoney 1991 Mahoney amp Gabriel 1987Mahoney amp Lyddon 1988) Thus constructivist therapies are more per-sonal reflective and elaborative than the rationalist therapies (Neimeyer1993b)

Lyddon (1990) notes the different role that emotions play in psycho-therapy for rational and constructivist therapists Rationalists view negativeemotions as representing problems that need to be controlled or elimi-nated whereas constructivist therapists see emotion as playing a functionalrole in the change process and ldquoencourage emotional experience expres-sion and explorationrdquo (p 124) Lyddon (1989) further notes that con-structivist cognitive theories due to the primacy placed on the construc-tion and alteration of personal meaning is most representative of aconstructivist epistemic style

EPISTEMIC STYLE AND PREFERENCES

The influence of epistemic style on preference for rational and con-structivist therapies have been noted in recent research (Arthur 2000)The primary implications of this research reveal an existing match betweenthe rational epistemic style and rational therapies as well between theconstructivist epistemic style and constructivist therapies Lyddon (1989)noted that for example people with a dominant rational epistemic styletend to prefer rationalist therapy because rational therapy facilitates clientsapproaching emotional and personal troubles in a rational and logical waythat is congruent with their ways of dealing with difficulties in otheraspects of their lives Thus when considering the findings of Royce andMos (1980)mdash people tend to have a leaning towards a dominant epistemicstylemdashit naturally follows that a match would exist between therapistsrsquoepistemology and their theoretical orientation reflected in the underlyingepistemology of that therapy orientation (Lyddon 1989)

In the broader literature the impact of additional therapist variables ontherapistrsquos selection of different therapeutic approaches has also beenconsidered (Scaturo 2005) Selection of theoretical orientations by thera-pists has been conceptualized by looking at primitive (grounded in onersquospersonal experience) versus higher order belief systems (received fromformal education) or worldviews Scaturo (2005) supports the influence oftherapist worldview on treatment approach and further discusses how the


326

therapist variable of repression versus sensitization (component of world-view looking at how one defends against threat to onersquos domain) impactstherapy orientation This author proposes that therapists who identify morewith repression from their worldview may align with behavioral approacheswhereas those that identify more with sensitization may align with insight-oriented approaches This highlights how certain therapist variables mayunderlie therapist development of different epistemological leanings

In considering the epistemology literature a much broader range oftheoretical strategic and technical distinctions have been conceptualizedin relation to differing epistemological positions than have actually beendocumented in research literatures (Mahoney amp Lyddon 1988 RNeimeyer 1993b) These conceptual differences include expected differ-ences in the characteristic style of therapy differences in the nature andenactment of the therapeutic relationship (R Neimeyer 1995) and differ-ences in the actual interventions associated with different therapy orien-tations (Lyddon 1990) Despite the many different conceptual differencesthat have been noted relatively few of these have received careful empir-ical documentation (Neimeyer Saferstein amp Arnold 2005)

Working on the basis of current conceptual distinctions in the litera-ture it is possible to identify and test expected differences betweenrational and constructivist therapists in relation to

(1) therapy style(2) the therapeutic relationship and(3) the selection of specific therapeutic interventions

Therapy StyleThere has been some literature investigating conceptual differences in

the relationship between therapist epistemic assumptions and therapystyle Granvold (1996) for example suggests that traditional cognitivebehavioral therapists tend to target irrational beliefs for modificationeducate and guide the client and take an active and directive position withthe client On the other hand a constructivist therapy style is characterizedby the therapist who is less directive and who engages in more exploratoryinteraction in their behavior with clients

In addition empirical work has begun exploring differences in therapystyle and epistemic assumptions For example Winter amp Watson (1999)found that rationalist therapists showed a more negative attitude towardstheir clients while the personal construct therapists showed greater regardfor them Additionally clients involved in personal construct therapyshowed greater overall involvement in therapy These differences are in


327

line with the collaborative nature of the personal construct therapist asoriginally depicted by Kelly (1955)

In another study Neimeyer and Morton (1997) compared the commit-ments to epistemological assumptions they found personal constructtherapists demonstrated a significantly higher commitment to a construc-tivist epistemology (and a lower commitment to a rationalist perspective)compared to rational-emotive therapists who supported the translation ofepistemic commitments into therapeutic practice

Further efforts to build upon these findings can be developed inrelation to the conceptualization by Fernandez-Alvaraez Garcia Biancoamp Santoma (2003) of therapistsrsquo personal style These authors describetherapistsrsquo personal style as the ldquo imprint left by each professional in hisworkrdquo and note that it ldquohas a relevant impact on the outcomes of thetreatmentrdquo (p 117) This can be considered in relation to how therapystyle manifests differently in various theoretical approaches For exampleGranvold (1996) notes the marked differences between cognitive behav-ioral (eg more directive) and constructivist therapy styles (eg moreexploratory and experiential) regarding how these different orientationsview treatment goals

Fernandez-Alvaraez et al (2003) created the Personal Style of theTherapist Questionnaire to measure therapistsrsquo personal style It assessesfive specific dimensions of therapist style

Instructional (flexibility-rigidity)Expressive (distance-closeness)Engagement (lesser degree-greater degreeAttentional (broad focused-narrow focusedOperative (spontaneous-planned)Thus the first hypothesis makes predictions regarding the influence of

therapist epistemology on therapistsrsquo particular therapy style According tothese authorsrsquo definitions our first hypothesis is that therapist epistemol-ogy will be a significant predictor of their therapy style More specificallywhen compared to therapists with a constructivist epistemology therapistswith rational epistemologies would have a therapy style depicting greaterrigidity on the Instructional subscale greater distance on the Expressivesubscale a lesser degree of Engagement a narrower focus on the Atten-tional subscale and more planned on the Operative subscale

Working AllianceThese differences in therapy style reflect broader differences regarding

the nature and role of the therapeutic relationship In addition to therapy


328

style cognitive behavioral and constructivist therapies maintain notabledifferences in the nature of the working alliances they form with theirclients The working alliance is defined by Bordin (1979) as the combina-tion of (a) client and therapist agreement on goals (Task) (b) client andtherapist agreement on how to achieve the goals (Goal) and (c) thedevelopment of a personal bond between the client and therapist(Bond)

While rationalist and constructivist therapies both value the workingalliance the empirical literature suggests that rationalist and constructivisttherapies value different qualities within the working alliance A concep-tual depiction of the differences between cognitive behavioral and con-structivist therapists in the therapeutic relationship comes from BeckRush Shaw and Emery (1979) who state that the therapist is a ldquoguidewho helps the client understand how beliefs and attitudes influence affectand behaviourrdquo (p 301) This assertion highlights the differences betweencognition affect and behavior in Beckrsquos approach compared to the holisticperspective maintained in the constructivist approach

Further empirical studies have addressed key distinctions betweencognitive behavioral and constructivist therapies with regard to emphasison working alliance For example a study by Winter and Watson (1999)found that constructivist therapists were ldquoless negatively confrontativeintimidating authoritarian lecturing defensive and judgmentalrdquo (p 17)In addition constructivist therapists had greater use of exploration si-lence open questions and paraphrasing along with decreased use ofapproval information and direct guidance compared to cognitive behav-ioral therapists

Additionally the working alliance has been noted to have an importantrole in cognitive behavioral therapy (Raue Goldfried amp Barkham 1997)The CBT therapists value working toward a common goal more importantthan the bond of the relationship itself Consensus on the tasks and goalsof therapy is inherent in Beckrsquos (1975) basic notion of collaborativeempiricism which highlights the collaboration between client and thera-pist in achieving therapeutic gains Consensus which is highly valuedwithin the rationalist therapies falls in line with Bordinrsquos (1979) definitionof the Task and Goal components in the working alliance

Constructivists tend to have less narrowly defined tasks or goalscompared to cognitive behavioral therapists (Granvold 1996) Mahoney ampLyddon (1988) depict constructivist therapists as viewing the humanconnection within the therapeutic relationship as a crucial component oftherapeutic change a connection that ldquofunctions as a safe and supportive


329

home base from which the client can explore and develop relationshipwith self and worldrdquo (p 222) This is directly in line with Bordinrsquos (1979)depiction of the Bond component of the working alliance as comprisingthe key elements of rapport trust acceptance and confidence

Thus the second hypothesis is that therapist epistemology will be asignificant predictor of working alliance (Task Bond and Goal) and thatrationalist therapists will have higher scores on the Task and Goal sub-scales and lower on the Bond subscale than therapists with constructivistepistemologies

Therapeutic InterventionsBoth rationalist and constructivist therapies view psychotherapy as

occurring within a therapeutic relationship however the nature of thisrelationship is somewhat different (eg instruction vs exploration correc-tion vs creation etc) Thus the specific techniques used by rationalist andconstructivist therapists might be expected to fit within these broadrelationship differences

For example Mahoney and Lyddon (1988) point out that rationalistinterventions tend to focus on the ldquocontrol of the current problems andtheir symptomatologyrdquo (p 217) In contrast constructivist interventionstend to focus on ldquodevelopmental history and current developmentalchallengesrdquo (p 217) They highlight the key differences between these twotherapy interventions as reflecting a ldquoproblem-versus-processrdquo distinctionthat itself is reflected in the implicit and explicit goals of these two typesof therapy

Additionally Granvold (1996) notes that traditional cognitive behav-ioral interventions are geared at controlling altering or terminating nega-tive emotions (eg anxiety depression anger worry etc) In contrastconstructivist interventions use more creative than corrective interventions(eg exploration examination and experience)

Winter and Watson (1999) noted empirical evidence for these concep-tual distinctions between cognitive behavioral and constructivist therapytechniques Findings indicated that cognitive behavioral therapists usedinterventions that seemed to be ldquomore challenging directive and to beoffering interpretations that do not always lead directly from what theclient has saidrdquo (p 17) whereas constructivist therapists asked morequestions than made statements and used interpretation more as a meansof facilitating the clientrsquos elaboration

Consequently psychotherapy research investigations have found atheoretical allegiance according to which techniques therapists use in their


330

practice Personal construct therapists were found to use techniques withgreater relying on exploration open questions and paraphrase (Winter ampWatson 1999) The current study plans to extend this line of researchaccording to therapist epistemology

Thus for the third hypothesis epistemology will be a significantpredictor of therapy techniques used by the therapists in the sample Morespecifically therapists with rationalist epistemologies are expected toreport using techniques associated with cognitive behavioral therapy (egadvice giving) more than constructivist epistemologies and therapists withconstructivist epistemologies will report using techniques associated withconstructivist therapy (eg emotional processing) more than therapistsrsquowith rationalist epistemologies

In the present study we investigate the potential influence of epistemicstyle (rational vs constructivist) on therapist therapy style nature of theworking alliance and use of specific interventions These therapist vari-ables were included according to noted importance in translating episte-mology into practice (Neimeyer et al 2005)

METHODPARTICIPANTS

Most participants were professional psychologists recruited onlinethrough membership in different professional organizations the AmericanPsychological Association (APA)mdashPractice Organization online practitio-ner directory (wwwapapracticeorg of approximately 15057 members)

In addition to a number of APA-approved counseling centers partic-ipant solicitation e-mails were also sent to APA Division 17 (CounselingPsychology 355 members) APA Division 29 (Psychotherapy approxi-mately 224 members) APA Division 32 (Humanistic Psychology approx-imately 130 members) The North American Personal Construct Network(NAPCN) list serve (approximately 95 members) the Albert Ellis Institutee-mail list (approximately 57 members) The solicitation e-mail also en-couraged participants to forward the e-mail survey on to other eligiblepractitioners therefore the response rate of approximately 135 has tobe considered with reservations (approximately 15918 surveys were so-licited and 2149 returned) Because we encouraged recipients to forwardthe email on to others it is an approximation

Therapist participation was voluntary it took therapists approximately30 minutes to complete the instruments and the study was conducted inaccordance with APA ethical guidelines


331

DEMOGRAPHICS

The sample consisted of 1151 therapists (733 women 418 men) with aMage of 4509 (SD 1254) The sample was primarily European Ameri-can 888 (N 1030) followed by Multiracial 29 (N 34)Hispanic 27 (N 31) African American 24 (N 28) AsianAmerican 21 (N 24) and Other 11 (N 13)

Participants were asked to indicate the level of their highest degreeheld which consisted of PhD 601 (N 700) followed by MAMS186 (N 216) PsyD 110 (N 128) BABS 43 (N 50)EdD 17 (N 20) MSW 14 (N 16) and Other 29 (N 34) Additionally the average year participants obtained their highestdegree was 199255 (SD 111) along with the average total number ofyears spent in clinical practice being 1401 (SD 1103) The majority ofparticipants were no longer in school 935 (N 1105) 65 (N 77)were graduate students

In addition participants were asked their dominant theoretical orien-tation and most participants indicated that their dominant theoreticalorientation was cognitive behavioral 359 (N 414) followed byintegrative 181 (N 209) psychodynamic 152 (N 175) inter-personal 76 (N 88) humanistic 72 (N 83) constructivist 32(N 37) existential 22 (N 25) rational emotive 17 (N 20)gestalt 07 (N 8) and other 82 (N 95)

MEASURES

Members from the aforementioned organizations were sent an onlinesurvey containing an informed consent form a brief demographics infor-mation sheet and the five measures Therapist attitudes questionnaire-short form (TAQ-SF) Constructivist assumptions scale (CAS) Personalstyle of the therapist questionnaire (PST-Q) Working alliance inventory-short form (WAI-S) and the Techniques list (TL) Participants weredebriefed at the end of the study and were provided with the contactinformation for further inquiries

Therapist Attitudes Questionnaire-Short Form (TAQ-SF)The TAQ-SF developed by Neimeyer and Morton (1997) is a revision

of the Therapist Attitudes Questionnaire (TAQ) developed by Dis-Giuseppe and Linscott (1993) The TAQ-SF measures philosophicaltheoretical and technical dimensions of rationalist and constructivisttherapies The instrument contains 16 items rated on a 5-point Likert scaleranging from 1 (strongly disagree) to 5 (strongly agree) and requiresapproximately five minutes to complete The TAQ-SF replicates the basic


332

factor structure of the original TAQ and has shown its predictive validityby predicting the therapeutic identifications and descriptions of a group ofpracticing professionals (Neimeyer amp Morton 1997) TAQ-SF scores inthe present study yielded a Chronbachrsquos alpha of 72 for rationalist scaleand a Chronbachrsquos alpha of 63 for the constructivist scale (see Table 1)

Constructivist Assumptions Scale (CAS)The Constructivist Assumptions Scale (CAS) was developed by Ber-

zonsky (1994) and was designed to assess constructivist epistemologicalassumptions This is a 12-item self-report measure with each item beingrated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5(strongly agree) The CAS has internal reliability estimated to be 61 anda 2-month test-retest reliability (N 78) of 68 CAS scores in the presentstudy yielded a Chronbachrsquos alpha of 72 (see Table 1)

Personal Style of the Therapist Questionnaire (PST-Q)The Personal Style of the Therapist Questionnaire (PST-Q) was devel-

oped by Fernandez-Alvarez et al (2003) and was created to assess ldquothe setof characteristics that each therapist applies in every psychotherapeuticsituation thus shaping the main attributes of the therapeutic actrdquo (p 117)The questionnaire assesses five different dimensions flexibility-rigidity(Instructional subscale) distance-closeness (Expressive subscale) lesserengagement-greater engagement (Engagement subscale) broad focused-narrow focused (Attentional subscale) and spontaneous-planned (Opera-tive subscale) This is a 36-item self-report measure filled out by therapistswith answers rated on a scale ranging from 1 (total disagreement) to 7 (totalagreement) The measure has shown a test-retest reliability of 79 withChronbachrsquos reliability coefficients for each subscale as follows instruc-tional 69 expressive 75 engagement 78 attentional 80 operative 78Factor Analysis revealed a KMO 756 (See Table 1 for alphas in thecurrent study)

Working Alliance Inventory-Short Form (WAI-S)The Working Alliance Inventory (WAI) developed by Horvath amp

Greenberg (1986) is a 36 item questionnaire that can be administered toboth clients and therapists and is rated on a 7-point Likert type scale from1(never) to 7 (always) Tracey and Kokotovic (1989) proposed a client andtherapist Working Alliance Inventory-Short Form (WAI-S) which con-tains four items per subscale (Task Goal and Bond) and overall WAI-Sscores demonstrating high reliability with alpha levels similar to and evenbetter than the WAI for the therapist subscales and overall average scores


333

(Task alpha 83 Bond alpha 91 Goal alpha 88 and GeneralAlliance alpha 95) See Table 1 for alphas in the current study

Techniques List (TL)The Techniques List measure was adapted from Hollis (1995) who

catalogued an extensive list of counseling and psychotherapy techniquesrepresenting a broad spectrum of philosophical bases In order to refinethis extensive list according to techniques used specifically by cognitivebehavioral and constructivist therapy orientations we recruited counselingpsychology graduate students to read through the total list of 108 therapytechniques and rate the extent to which each technique is used by eachtherapeutic approach (cognitive behavioral and constructivist) using a5-point Likert type scale from 1 (Never or Almost Never) to 5 (Always orAlmost Always)

PROCEDURES

Sixteen counseling psychology graduate students participated in theseratings (six men 10 women) with the Mage 2844 (SD 267) Resultsof a paired differences analysis for all 108 items indicated that there were77 techniques rated as being used with significantly differential frequencyby cognitive behavioral and constructivist therapies We then divided thisdistribution of 77 techniques into quartiles and retained the top andbottom quartiles This resulted in 20 cognitive behavioral techniques (eg

Table 1 INTERNAL CONSISTENCIES FOR THE CAS TAQ-SF WAI-S PST-QAND TECHNIQUES LIST

Scale N Alpha P-value

CAS 1113 070 001TAQ-Rational 1130 072 001TAQ-Constructivist 1138 063 001WAI-S-Total 1107 075 001WAI-S-Task 1146 080 001WAI-S-Bond 1145 071 001WAI-Goals 1149 061 001PST-Q-Instructional 1114 065 001PST-Q-Expressive 1135 065 001PST-Q-Engagement 1148 068 001PST-Q-Attentional 1148 047 001PST-Q-Operative 1146 075 001CBT Techniques 1033 091 001CON Techniques 1054 084 001


334

advice giving rational restructuring) and 20 constructivist techniques (egemotional processing reflection) that were rated most significantly differ-ent (cognitive behavioral vs constructivist) This final list of 40 items oftherapy techniques (20 cognitive behavioral techniques 20 constructivisttechniques) was used in the current study

These 40 items were listed alphabetically and participants were askedto rate the extent to which they use each technique in their practice oftherapy along a 5-point scale from 1 (Never or Almost Never) to 5 (Alwaysor Almost Always) The ratings of the 20 rationalist items were summedand a mean was calculated to reflect the average frequency of usingrationalist interventions (possible range 1-5) and the same procedurewas applied in relation to the 20 constructivist interventions

The raw data was used to conduct a confirmatory factor analysis on theTechniques List measure The current analysis was examined for multi-variate normalcy and the assumptions were met All kurtosis estimates forthe variables fell between 1 and ndash1 variables except constructivist items 1213 16 and 20 and cognitive behavioral item 3 which had a kurtosis valuesbetween 2 and 2 Consequently these five items were removed from themeasure prior to running the confirmatory factor analysis

A confirmatory factor analysis was utilized to fit a model of two typesof therapy technique factors (constructivist and cognitive behavioral ther-apy techniques) Thirty-five indicators were included in the model (16constructivist techniques and 19 cognitive behavioral techniques) Afterrunning the analysis with the 35 items and two factors (constructivisttechniques and cognitive behavioral techniques) factor loadings revealedeight items (six constructivist items and two cognitive behavioral items)loading at less than 40 These eight items were removed and the confir-matory factor analysis was then re-run with the remaining 27 items (10constructivist and 17 cognitive behavioral items) No further model mod-ifications were made because there was no other compelling theoreticalrationale for additional changes and these 27 items were used in allsubsequent analyses using this measure Items were constrained to loadonly on to their respective factors (constructivist techniques and cognitivebehavioral techniques) and the two factors were allowed to correlate

The measurement model was examined utilizing LISREL (87) and wasevaluated based on multiple goodness of fit indices with the maximumlikelihood as the estimation method Examination of the results revealedthat the fit of the model was a fairly good fit although not necessarily asuperior fit for the data 2 (323 N 914) 224937 p 001 SRMR 066 RMSEA 08 NFI 91 and CFI 93 suggesting overall a good


335

fit The final standardized solution factor loadings were all significant (p 05) and ranged from 40 to 81 for the constructivist techniques and from47 to 71 for the cognitive behavioral techniques The correlation betweenthe two factors was 30 p 03 See Table 1 for alphas in the currentstudy

RESULTS AND DISCUSSIONCORRELATIONAL ANALYSES

Person Product Moment correlations using a criterion level of 05(1-tailed) were computed between the two epistemology subscales (Ra-tionalist and Constructivist) and each of the criterion variables in anattempt to confirm that the relationships were in the predicted directionsResults were in the predicted directions revealing a significant positivecorrelation between the TAQ-SF constructivist subscale and the CAS r 030 P 0001 and a significant negative correlation between the TAQ-SFrationalist subscale and the CAS r 036 P 001 Additionally aPearson Product Moment correlation was conducted on the TAQ-SFrationalist and constructivist subscales to justify their use as two separatecontinuous subscale scores r 09 P 001

For therapist style the rationalist and constructivist subscales weresignificantly correlated with the subscales of the PST-Q all in the pre-dicted directions For the WAI-S rationalist epistemologies were notsignificantly correlated with any of the WAI-S subscales (eg Task Bondand Goal) however the constructivist epistemology was significantlypositively correlated with all three subscales of the WAI-S and in thepredicted direction When looking at types of techniques therapists use intreatment the rationalist epistemology was significantly negatively corre-lated with the use of constructivist techniques (r 32 P 001) andsignificantly positively correlated with the use of cognitive behavioraltechniques (r 043 P 001) which was in the predicted directionsWhile constructivist epistemologies were significantly positively correlatedwith the use of constructivist techniques (r 022 P 001) which wasin the predicted direction however constructivist epistemology was notsignificantly correlated with cognitive behavioral techniques (See Table 2for a complete listing of correlations)

REGRESSION ANALYSES

In order to assess the capacity of the data to be in line with thenormality assumptions of multiple regressions the data was subjected totests of skewness and kurtosis Results of these analyses indicate that the


336

assumptions for multivariate normalcy were met In addition Bonferronicorrections were utilized

Hypothesis 1mdashTherapist Epistemology as a Predictor of Therapy StyleThe first hypothesis concerned therapist epistemology as a predictor of

therapy style We hypothesized that therapists with rational epistemologieswould have a therapy style depicting more rigidity on the Instructionalsubscale greater distance on the Expressive subscale a lesser degree ofEngagement a narrower focus on the Attentional subscale and be moreplanned on the Operative subscale compared to therapists with a con-structivist epistemology Separate regression analyses were conducted foreach of the five PST-Q scores measuring therapy style

The Instructional Subscale The epistemology scores accounted forsignificant variation in Instructional scores F(2 1061) 706 p 001 (R2

013) The standardized beta coefficient for the rationalist epistemology( 053) was in the positive direction but was not significantmdasht(1061) 173 p 084 The standardized beta coefficient for theconstructivist epistemology ( 0097) was significant and in thenegative direction for the Instructional subscalemdash t(1061) 315 p 002 The direction of the effect indicated that the more a therapistendorsed constructivist epistemology the less likely that therapist was touse an instructional approach to therapy This supported the hypothesisthat a constructivist epistemology tends toward the direction of flexibility

Table 2 PEARSON CORRELATIONS FOR THERAPY STYLE WORKINGALLIANCE TECHNIQUES AND YEARS OF EXPERIENCE

Epistemology Instructional Expressive Engagement Attention Operative

Rationalist Correlation 007 021 026 041 048Sig (2-tailed) 003 0 0 0 0N 1074 1093 1109 1109 1105

Constructivist Correlation 01 034 014 015 022Sig (2-tailed) 0001 0001 0001 0001 0001N 1085 1104 1120 1118 1117

Task Bond GoalsCBT

TechniquesConstructivist

Techniques




337

on the Instructional subscale however the small effect size of approxi-mately 1 of the variance needs to be considered

The Expressive Subscale Epistemology was also a significant predictorof the therapy style along the Expressive subscale F(2 1080) 9427 p 001 (R2 15) The standardized beta coefficient ( 0177) wassignificant for the rationalist epistemology t(1080) 628 p 0001 andin the negative direction whereas the significant standardized beta coef-ficient for the constructivist epistemology ( 0326) was significantt(1080) 1156 p 0001 and in the positive direction along theExpressive subscale This supported the hypothesis that the rationalistepistemology tends towards distance on the Expressive subscale whereasthe constructivist epistemology tends towards greater closeness on theExpressive subscale

The Engagement Subscale Epistemology was also significant predictorof the therapy style along the Engagement subscale F(2 1096) 4726p 001 (R2 08) The significant standardized beta coefficient ( 0245) for the rationalist epistemology t(1096) 842 p 001 wasin the opposite direction compared to the significant standardized betacoefficient ( 0119) for the constructivist epistemology t(1096) 408p 001 along the Engagement subscale This supported the hypothesisthat the rationalist epistemology tends towards a lesser degree of engage-ment on the Engagement subscale and the constructivist epistemologytends towards a greater degree of engagement on the Engagement sub-scale

The Attentional Subscale Epistemology was also significant predictorof the therapy style along the Attentional subscale F(2 1096) 11833p 001 (R2 18) The significant standardized beta coefficient ( 0396) for the rationalist epistemology t(1096) 1441 p 001 was inthe positive direction whereas the significant standardized beta coefficient( 0129) for the constructivist epistemology t(1096) 412 p 001 which was in the negative direction along the Attentional subscaleThis supported the hypothesis that the rationalist epistemology has moreof a leaning towards a narrow focus on the Attentional subscale and theconstructivist epistemology leans more towards a broad focus on theAttentional subscale

The Operative Subscale Lastly epistemology was a significant predic-tor of the therapy style along the Operative subscale F(2 1093) 18786p 001 (R2 256) The standardized beta coefficient ( 0461) for therationalist epistemology was significant t(1093) 1761 p 0001 andin the positive direction compared to the significant standardized beta


338

coefficient ( 0170) for the constructivist epistemology t(1093) 650 p 0001 which was in the negative direction along the Operativesubscale This supported the hypothesis that the rationalist epistemologytends towards more planning on the Operative subscale and the construc-tivist epistemology tends towards more spontaneity on the Operativesubscale

Thus epistemology (rationalist vs constructivist) was found to be asignificant predictor of therapy style In particular the most robustfindings provide provisional support for the notion that there are specificdifferences in the personal style of the therapist according to the therapistsrsquoepistemic assumptions More specifically the current study found thattherapists with rationalist epistemologies tended towards more distance alesser degree of engagement a narrower focus and a greater degree ofplanning in their sessions with clients whereas the constructivist episte-mology tended towards having a greater degree of closeness a greaterdegree of engagement a broader focus and more spontaneity in theirtherapy sessions Additionally there was some support for the notion thattherapists with constructivist epistemologies tend toward the direction offlexibility rather than rigidity in their therapy style however this was nota particularly strong finding in the current study

These findings are helpful when considering the potentially inherentdifferences maintained by rationalist versus constructivist epistemologiesaccording to therapy style More specifically current findings support thenotion that cognitive-behavioral therapies which represent the best de-piction of the rationalist epistemology maintain an ldquoactive-directiverdquo andsystematic approach to therapy (Granvold 1988) with specific goals usedto plan the course of the session (Mahoney amp Lyddon 1988)

Hypothesis 2mdashEpistemology Influences the Therapeutic RelationshipAccording to the second hypothesismdashtherapists with rationalist epis-

temologies will score higher on the Task and Goal subscales and lower onthe Bond subscale than the constructivist epistemologiesmdashanother multi-ple linear regression model was conducted to determine if the samepredictor variable (therapist epistemology) would influence therapistsrsquoratings of the criterion variables (working alliance) based on therapistsrsquoscores of three subscalesmdashTask Goal and Bond

The Task Subscale Epistemology was a significant predictor of thera-pist emphasis on the working alliance along the Task subscale (eg clientand therapist agreement on goals) F(2 1080) 834 p 001 (R2 015) The standardized beta coefficient for the rationalist epistemology (


339

0042) was in the positive direction but was not significant t(1080) 139 p 164 The significant standardized beta coefficient ( 0120)for the constructivist epistemology t(1080) 396 p 0001 was also inthe positive direction along the Task subscale This was inconsistent withthe hypothesis that the rationalist epistemology would place a greateremphasis on the Task subscale in the working alliance than therapists witha constructivist epistemology However the small effect size of approxi-mately 2 of the variance needs to be considered when interpreting thesefindings

The Goal Subscale Epistemology was also a significant predictor oftherapist emphasis on the working alliance along the Goal subscale (egclient and therapist agreement on how to achieve the goals) F(2 1093) 492 p 007 (R2 009) The significant standardized beta coefficient ( 0065) for the rationalist epistemology t(1093) 216 p 031 was inthe positive direction The significant standardized beta coefficient ( 0075) for the constructivist epistemology t(1093) 247 p 014 wasalso in the positive direction along the Goal subscale This was againinconsistent with the proposed hypothesis that the rationalist epistemologywould have stronger leanings towards the Goal subscale in the therapistemphasis on working alliance compared to therapists with a constructivistepistemology

The Bond Subscale Lastly epistemology was also a significant predic-tor of the therapist emphasis on the working alliance along the Bondsubscale (the development of a personal bond between the client andtherapist) F(2 1089) 1949 p 001 (R2 035) The standardizedbeta coefficient for the rationalist epistemology ( 0034) was in thenegative direction but was not significant t(1089) 115 p 249 Forthe constructivist epistemology the standardized beta coefficient ( 0179) was significant t(1089) 599 p 0001 and in the positivedirection along the Bond subscale This supported the hypothesis that therationalist epistemology is less inclined towards therapist emphasis onworking alliance on the Bond subscale than the constructivist epistemol-ogy

The current study indicated that therapist epistemology was a signifi-cant predictor of at least some aspects of the working alliance Thestrongest finding was in relation to the development of a personal bondbetween the client and therapist (Bond subscale) Therapists with aconstructivist epistemology tended to place more emphasis on the personalbond in the therapeutic relationship compared to therapists with a ratio-nalist epistemology This supports the notion in the literature that con-


340

structivist therapists place a greater emphasis on building a quality thera-peutic relationship characterized by ldquoacceptance understanding trustand caring

Hypothesis 3mdashthe Selection of Specific Therapeutic InterventionsThe third and final analysis is designed to address the prediction that

epistemology will be a predictor of therapist use of specific therapytechniques More specifically that the rationalist epistemology will reportusing techniques associated with cognitive behavioral therapy (eg advicegiving) more than constructivist epistemologies and therapists with con-structivist epistemologies will report using techniques associated withconstructivist therapy (eg emotional processing) more than therapistswith rationalist epistemologies) A multiple linear regression analysis wasconducted to determine if the predictor variable (therapist epistemology)will influence therapist ratings of the criterion variables (therapy tech-niques)

Epistemology was a significant predictor of cognitive behavioral ther-apy techniques F(2 993) 11234 p 001 (R2 185) The standard-ized beta coefficient for the rationalist epistemology ( 0430) wassignificant t(993) 1496 p 001 and in the positive direction Thestandardized beta coefficient for the constructivist epistemology ( 0057) was significant and in the positive direction t(993) 198 p 05This supported the hypothesis that the rationalist epistemology would havestronger leanings of therapist use of cognitive behavioral techniques whenconducting therapy than constructivist epistemologies

Finally epistemology was a significant predictor of constructivist ther-apy techniques F(2 1012) 8082 p 001 (R2 138) The standard-ized beta coefficient for the rationalist epistemology ( 0297) wassignificant t(1012) 1009 p 0001 and in the negative direction Thestandardized beta coefficient for the constructivist epistemology ( 0195) was significant t(1012) 663 p 0001 and in the positivedirection This supported the hypothesis that the constructivist epistemol-ogy would place a stronger emphasis on therapist use of constructivisttechniques when conducting therapy than rationalist epistemologies

Findings in the current study regarding therapistsrsquo epistemology andtheir use of specific techniques revealed that therapistsrsquo with rationalistepistemologies tended to favor the use of cognitive behavioral techniquesand also tended to reject the use of constructivist techniques Similarlytherapistsrsquo with constructivist epistemologies tended to favor the use ofconstructivist techniques in their practice of therapy however they did not


341

as strongly reject the use of cognitive behavioral techniques This notion issupported by literature that suggests that constructivist therapists valuehaving ldquoa rich set of possibilities that can be engaged at any momentdepending on the clientrsquos needrdquo (R Neimeyer 2005 p 83) Thus findingsfrom the current study may suggest that while the constructivist therapistis more likely to use constructivist therapy techniques they are also moreopen to using other techniques depending on the individual client com-pared to rationalist therapists

LIMITATIONS AND FUTURE RESEARCH

This study is not without limitations For example this study wasconducted on a voluntary basis and those who volunteered to participatemay have been a biased sample and compromised the external validityRosenthal and Rosnow (1975) suggest that volunteers tend to differ fromnon-volunteers in behavioral research regarding their level of educationintelligence and desire of social approval Additionally the externalvalidity may have been compromised by the data collection which wasconducted via the Internet and may further distinguish the characteristicsof the participants who volunteered to participate in the study fromnon-volunteers Another limitation regarding the generalizability of thefindings in the current study is the self-report nature of the studyRosenthal and Rosnow (1991) indicate that self-reports are subject todistortion and social desirability effects In addition self-reports may notcorrelate well with participantsrsquo actual behavior

However in light of these limitations having an overall sample size ofmore than one thousand practicing psychologists representing all of the 50United States may have improved the representativeness of the sample andsubsequently the generalizability of the findings

In addition greater confidence in the representativeness of the samplein the current study is found by using the closest approximation to whatwould be a comparison with the bulk of our sample (eg psychologists) tomembers of the American Psychological Association along demographicdimensions (eg gender ethnicity and age) For example in the currentstudy women were 64 of the sample and men 36 of the samplewhich is roughly comparable to APA members (approximately 53women and 47 men) The mean age of participants in the current studywas 4509 (SD 1254) which again is roughly comparable to APAmembers (mean age 5330 SD 136) The ethnicities in the currentstudy were Caucasian 888 Multiracial 29 Hispanic 27 AfricanAmerican 24 and Asian American 21 Again this is roughly


342

comparable the APA members reported ethnicities as Caucasian 676Multiracial 03 Hispanic 21 African American 17 and AsianAmerican 19 (httpresearchapaorgprofile2005t1pdf 2005)

It is also important to highlight the fact that the findings in the currentstudy are associations between the variables of interest and do not implycausal relationships Therefore current results can only suggest potentialrelationships and cannot imply causality

Further research could aim to investigate clientrsquos perceptions of cog-nitive-behavioral and constructivist therapistsrsquo therapy style emphasis onthe working alliance and use of particular therapeutic interventions to seeif clients corroborate therapistsrsquo self-reported styles with their experienceof the therapistsrsquo style

Finally while the fit of the two factors (constructivist techniques andcognitive behavioral techniques) to the Techniques List was relativelygood future work on the Techniques List measure might also benefit fromsome revision of the current instrument and the addition of more psycho-metrics

Nonetheless the findings of this study contribute to the literatureaddressing the translation of epistemology into practice The current studysupports the notion that therapists with rationalist epistemologies areconsistently different in their approach to therapy including the emphasison the therapeutic relationship and use of particular interventions fromtherapists with a constructivist epistemology in ways consistent with theirepistemological underpinnings

The current findings are important because they (1) demonstrate thetranslation of epistemology into practice (2) provide information thatcould be useful to clients in selecting a therapist whose orientation mayenable them to anticipate stylistic features and (3) provide the opportunityto further study the translation of these perceptions into actual behaviorsand behaviors into different impacts or outcomes

CONCLUSION

The current study extended the developing literature on therapistsrsquoepistemology as a factor relating to psychotherapistsrsquo practice of therapyFurther more outcome-related research is required to understand howtherapistsrsquo epistemological beliefs impact the successfulness of work withclients The current study was the first empirical investigation of therapistsrsquoepistemological values and the specific translation of epistemology into thepractice of therapy in relation to therapistsrsquo style working alliance and useof specific techniques While some of the results failed to support the


343

expected directions for the specified subscales most results were in theexpected directions supporting the overall coherence of the epistemolog-ical commitment with therapeutic enactments Further work may benefitfrom focusing on how therapist epistemological viewpoints might affectthe effectiveness of practicing psychotherapy in accordance with thera-pistsrsquo epistemic commitments

REFERENCES

American Psychological Association Website (2005) Retrieved April 11 2005 from httpresearchapaorgprofile2005t1pdf

Arthur A R (2000) The personality and cognitive-epistemological traits of cognitive behavioral andpsychoanalytic psychotherapists British Journal of Medical Psychology 73 243-257 doi101348000711200160453

Beck A T Rush A J Shaw B F amp Emery G (1979) Cognitive therapy of depression New YorkGuilford

Beck A T (1995) Cognitive therapy Basics and beyond New York GuilfordBordin E S (1979) The generalizability of the psychoanalytic concept of the working alliance

Psychotherapy Theory Research and Practice 16 252-260 doi 101037h0085885Botella L amp Gallifa J (1995) A constructivist approach to the development of personal epistemic

assumptions and world views Journal of Constructivist Psychology 8 1-18 doi10108010720539508405238

Diamond S R amp Royce JR (1980) Cognitive abilities as expressions of three ldquoways of knowingrdquoMultivariate Behavioral Research 15(1) 31-56 doi 101207s15327906mbr1501_3

DisGiuseppe R amp Linscott J (1993) Philosophical differences among cognitive behavioral thera-pists Rationalism constructivism or both Journal of Cognitive Psychotherapy 7(2) 117-130

Fernandez-Alvarez H Garcia F Bianco J L Santoma S C (2003) Assessment questionnaire onthe personal style of the therapist PST-Q Clinical Psychology and Psychotherapy 10 116-125doi 101002cpp358

Granvold D K (1996) Constructivist psychotherapy Families in Society The Journal of Contempo-rary Human Services 77(6) 345-359 doi 1016061044-3894932

Hollis J W (1995) Techniques used in counseling and psychotherapy In J C Boylan P B Malleyamp J Scott (Eds) Practicum and internship Textbook for counseling and psychotherapy (pp 182-189) Washington DC Taylor amp Francis

Hollon S D amp Beck AT (1986) Research on cognitive therapies In S L Garfield amp A E Bergin(Eds) Handbook of psychotherapy and behavior change (3rd ed pp 443-482) New YorkWiley

Horvath A O amp Greenberg L S (1986) The development of the working alliance inventory InL S Greenberg amp W M Pinsof (Eds) The psychotherapeutic process A research handbook(pp 529-556) New York Guilford

Kelly G (1955) The psychology of personal constructs New York NortonLyddon W J (1988) Information-processing and constructivist models of cognitive therapy A

philosophical divergence The Journal of Mind and Behavior 9 137-166Lyddon W J (1989) Personal epistemology and preference for counseling Journal of Counseling

Psychology 36 423-429 doi 1010370022-0167364423Lyddon W J (1990) First- and second-order change Implications for rationalist and constructivist

cognitive therapies Journal of Counseling amp Development 69 122-127 doi101002j1556-66761990tb01472x

Lyddon W J (1991a) Epistemic style implications for cognitive psychotherapy Psychotherapy 28588-597 doi 1010370033-3204284588

Mahoney M J (1991) Human change processes New York Basic Books IncMahoney M J amp Gabriel T J (1987) Psychotherapy and the cognitive sciences An evolving

alliance Journal of Cognitive Therapy An International Quarterly 1 39-59


344

Mahoney M J amp Lyddon W J (1988) Recent developments in cognitive approaches to counselingand psychotherapy The Counseling Psychologist 16 190-234 doi 1011770011000088162001

Neimeyer G J Saferstein J and Arnold W (2005) Personal construct psychotherapy Epistemologyand practice In D Winter and L Viney (Eds) Advances in personal construct psychotherapyLondon Whurr Publishers

Neimeyer G J amp Morton R J (1997) Personal epistemologies and preferences for rationalist versusconstructivist psychotherapies Journal of Constructivist Psychology 10 109-123 doi 10108010720539708404616

Neimeyer G J Prichard S Lyddon W J amp Sherrard P A D (1993) The role of epistemic stylein counseling preference and orientation Journal of Counseling and Development 71 515-523doi 101002j1556-66761993tb02234x

Neimeyer R A (2005) The construction of change Personal reflections on the therapeutic processConstructivism in the Human Sciences 10 77-98

Neimeyer R A (1995) Constructivist psychotherapies Features foundations and future directionsIn R A Neimeyer amp M J Mahoney (Eds) Constructivism in psychotherapy (pp 11-38)Washington DC American Psychological Association

Neimeyer R A (1993b) Constructivism and the cognitive psychotherapies Some conceptual andstrategic contrasts Journal of Cognitive Psychotherapy 7 159-171

Raue PJ Goldfried MR amp Barkham M (1997) The therapeutic alliance in psychodynamicinterpersonal and cognitive-behavioral therapy Journal of Consulting and Clinical Psychology65(4) 582-587 doi 1010370022-006X654582

Rosenthal R amp Rosnow RL (1991) Essentials of behavioral research Methods and data analyse (2ndEdition) Boston McGraw-Hill

Rosenthal R amp Rosnow RL (1975) The volunteer subject New York John WileyRoyce J R (1964) The encapsulated man An interdisciplinary search for meaning Princeton NJ Van

NostrandRoyce J R amp Mos L P (1980) Psycho-epistemological profile manual Edmonton Canada University

of Alberta PressRoyce J R amp Powell A (1983) Theory of personality and personal differences Factors systems

processes Englewood Cliffs NJ Prentice HallScaturo D J (2005) Clinical Dilemmas in Psychotherapy A Transtheoretical Approach to Psycho-

therapy Integration Washington DC American Psychological AssociationSchacht T E amp Black D A (1985) Epistemological commitments of behavioral and psychoanalytic

therapists Professional Psychology Research and Practice 16(2) 316-323 doi 1010370735-7028162316

Tracey T J amp Kokotovic A M (1989) Factor structure of the Working Alliance InventoryPsychological Assessment 1(3) 207-210 doi 1010371040-359013207

Vincent N amp LeBow M (1995) Treatment preference and acceptability Epistemology and locus ofcontrol Journal of Constructivist Psychology 8(2) 81-96 doi10108010720539508405244

Winter D A amp Watson S (1999) Personal construct psychotherapy and the cognitive therapiesDifferent in theory but can they be differentiated in practice Journal of ConstructivistPsychology 12(1) 1-22 doi 10108010720539508405238


345

Copyright of American Journal of Psychotherapy is the property of Association for theAdvancement of Psychotherapy and its content may not be copied or emailed to multiple sitesor posted to a listserv without the copyright holders express written permission Howeverusers may print download or email articles for individual use

work looks at the epistemic assumptions that underpin the theory andpractice of cognitive therapy (Lyddon 1991a) In particular a developingliterature addresses the distinct differences between contemporary cogni-tive therapies according to their epistemic assumptions rationalist empir-icist and constructivist (Hollon amp Beck 1986 Lyddon 1991a)

The notion that counselors maintain different perspectives regardingthe processes and methods of human change because of differing philo-sophical commitments has been considered in the epistemic style literature(Lyddon 1989) Personal epistemological commitments have been linkedto a variety of different features in psychotherapy such as preferences forparticular types of therapy (Lyddon 1989 G Neimeyer amp Morton 1997)and specific therapeutic interventions (Winter amp Watson 1999)

The link between personal epistemologies and particular therapistbehaviors is just beginning to receive attention In fact there has beenrelatively little empirical research addressing the translation of therapistepistemological leanings into corresponding therapeutic practices Thepurpose of such exploration would be to gain a better understanding oftherapist epistemic style and how it relates to the methods and processesof therapy There is reason to believe that specific epistemic commitmentswould be related to and may potentially direct a) particular psychothera-peutic styles b) the structuring of particular types of therapeutic relation-ships and c) the selection of particular forms of psychotherapy interven-tions

LITERATURE REVIEWEPISTEMIC STYLE

Royce has developed a long-standing line of research investigatingpeoplersquos ldquoways of knowingrdquo (1964 Diamond amp Royce 1980 Royce ampPowell 1983) Throughout this extensive program of research Royce andhis colleagues developed a conceptual model that specifies three funda-mental classes of knowing These three primary approaches to knowing arereferred to as the three epistemic styles rationalism empiricism andmetaphorism

Rationalism maintains the dominant assertion that thought has superi-ority over the senses with regards to obtaining knowledge Those with arational epistemic style are devoted to testing their views of reality in termsof logical consistency Rationalism is the epistemological worldview thatunderlies cognitive-rational therapy (Lyddon 1989 Mahoney 1991)

Empiricism is primarily concerned with sensory experience as the mainway of knowing in this style people know to the extent that they are able


324








325







326









327










328







329










330




METHODPARTICIPANTS





331

DEMOGRAPHICS




MEASURES





332









333




PROCEDURES






334







335





REGRESSION ANALYSES



336










Task Bond GoalsCBT


Techniques




337







338








339






340








341







342







CONCLUSION



343


REFERENCES






















344




















345









325







326









327










328







329










330




METHODPARTICIPANTS





331

DEMOGRAPHICS




MEASURES





332









333




PROCEDURES






334







335





REGRESSION ANALYSES



336










Task Bond GoalsCBT


Techniques




337







338








339






340








341







342







CONCLUSION



343


REFERENCES






















344




















345








326









327










328







329










330




METHODPARTICIPANTS





331

DEMOGRAPHICS




MEASURES





332









333




PROCEDURES






334







335





REGRESSION ANALYSES



336










Task Bond GoalsCBT


Techniques




337







338








339






340








341







342







CONCLUSION



343


REFERENCES






















344




















345










327










328







329










330




METHODPARTICIPANTS





331

DEMOGRAPHICS




MEASURES





332









333




PROCEDURES






334







335





REGRESSION ANALYSES



336










Task Bond GoalsCBT


Techniques




337







338








339






340








341







342







CONCLUSION



343


REFERENCES






















344




















345











328







329










330




METHODPARTICIPANTS





331

DEMOGRAPHICS




MEASURES





332









333




PROCEDURES






334







335





REGRESSION ANALYSES



336










Task Bond GoalsCBT


Techniques




337







338








339






340








341







342







CONCLUSION



343


REFERENCES






















344




















345








329










330




METHODPARTICIPANTS





331

DEMOGRAPHICS




MEASURES





332









333




PROCEDURES






334







335





REGRESSION ANALYSES



336










Task Bond GoalsCBT


Techniques




337







338








339






340








341







342







CONCLUSION



343


REFERENCES






















344




















345











330




METHODPARTICIPANTS





331

DEMOGRAPHICS




MEASURES





332









333




PROCEDURES






334







335





REGRESSION ANALYSES



336










Task Bond GoalsCBT


Techniques




337







338








339






340








341







342







CONCLUSION



343


REFERENCES






















344




















345





METHODPARTICIPANTS





331

DEMOGRAPHICS




MEASURES





332









333




PROCEDURES






334







335





REGRESSION ANALYSES



336










Task Bond GoalsCBT


Techniques




337







338








339






340








341







342







CONCLUSION



343


REFERENCES






















344




















345


DEMOGRAPHICS




MEASURES





332









333




PROCEDURES






334







335





REGRESSION ANALYSES



336










Task Bond GoalsCBT


Techniques




337







338








339






340








341







342







CONCLUSION



343


REFERENCES






















344




















345










333




PROCEDURES






334







335





REGRESSION ANALYSES



336










Task Bond GoalsCBT


Techniques




337







338








339






340








341







342







CONCLUSION



343


REFERENCES






















344




















345





PROCEDURES






334







335





REGRESSION ANALYSES



336










Task Bond GoalsCBT


Techniques




337







338








339






340








341







342







CONCLUSION



343


REFERENCES






















344




















345








335





REGRESSION ANALYSES



336










Task Bond GoalsCBT


Techniques




337







338








339






340








341







342







CONCLUSION



343


REFERENCES






















344




















345






REGRESSION ANALYSES



336










Task Bond GoalsCBT


Techniques




337







338








339






340








341







342







CONCLUSION



343


REFERENCES






















344




















345











Task Bond GoalsCBT


Techniques




337







338








339






340








341







342







CONCLUSION



343


REFERENCES






















344




















345








338








339






340








341







342







CONCLUSION



343


REFERENCES






















344




















345









339






340








341







342







CONCLUSION



343


REFERENCES






















344




















345







340








341







342







CONCLUSION



343


REFERENCES






















344




















345









341







342







CONCLUSION



343


REFERENCES






















344




















345








342







CONCLUSION



343


REFERENCES






















344




















345








CONCLUSION



343


REFERENCES






















344




















345



REFERENCES






















344




















345





















345



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epistemología y psicoterapia.pdf