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THE EFFECTS OF YOUNG SCHEMA DOMAINS, YOUNG MALADAPTIVE COPING STYLES, AND YOUNG PARENTING STYLES ON WORKING
ALLIANCE AMONG SUPERVISORS, THERAPISTS, AND THE CLIENTS
A DISSERTATION SUBMITTED TO THE GRADUATE SCHOOL OF SOCIAL SCIENCES
OF MIDDLE EAST TECHNICAL UNIVERSITY
BY
BAHAR KÖSE KARACA
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR
THE DEGREE OF DOCTOR OF PHILOSOPHY IN
THE DEPARTMENT OF PSYCHOLOGY
JUNE 2014
Approval of the Graduate School of Social Sciences
Prof. Dr. Meliha Altunışık
Director
I certify that this thesis satisfies all the requirements as a thesis for the degree of Doctor of Philosophy. Prof. Dr. Tülin Gençöz
Head of Department
This is to certify that we have read this thesis and that in our opinion it is fully adequate, in scope and quality, as a thesis for the degree of Doctor of Philosophy. _____________________
Prof. Dr. Tülin Gençöz Supervisor
Examining Committee Members
Prof. Dr. Tülin Gençöz (METU, PSY)
Prof. Dr. Gonca Soygüt Pekak(Hacettepe Uni.,PSY)
Asst. Dr. Özlem Bozo (METU, PSY)
Prof. Dr. Faruk Gençöz (METU, PSY)
Prof. Dr. Gülsen Erden (Ankara Uni., PSY)
iii
PLAGIARISM
I hereby declare that all information in this document has been obtained and
presented in accordance with academic rules and ethical conduct. I also
declare that, as required by these rules and conduct, I have fully cited and
referenced all material and results that are not original to this work.
Name, Last name: Bahar Köse Karaca
Signature:
iv
ABSTRACT
THE EFFECTS OF YOUNG SCHEMA DOMAINS, YOUNG MALADAPTIVE
COPING STYLES, AND YOUNG PARENTING STYLES ON WORKING ALLIANCE AMONG SUPERVISORS, THERAPISTS, AND THE CLIENTS
Köse Karaca, Bahar
Ph. D., Department of Psychology
Supervisor: Prof. Dr. Tülin Gençöz
June 2014, 169 pages
In the current study, the aim was to measure the effects of Young schema domains,
Young maladaptive coping styles, and Young parenting styles on working alliance
among supervisors, therapists, and the clients. Participants were eight supervisors
(clinical psychology doctorate students), twelve therapists (clinical psychology
master students), and four clients (applicants to AYNA Psychotherapy Unit). In
order to measure working alliance, two types of measurement based on qualitative
(open ended questions and relational circles (developed by the researcher) and
quantitative (Working alliance inventory/supervisor-therapist and therapist-client
forms) methods were used. According to results, a relationship between Young
schemas, parent styles, and coping styles and working alliance was found among
supervisors, therapists, and clients. Associations were discussed in line with
Schema Theory.
Keywords: Schema Theory, Working Alliance, Supervision, Psychotherapy
v
ÖZ
YOUNG ŞEMA ALANLARI, UYUMSUZ BAŞ ETME BİÇİMLERİ VE YOUNG EBEVEYNLİK BİÇİMLERİNİN SÜPERVİZÖRLER, TERAPİSTLER
VE HASTALARIN TERAPÖTİK İLİŞKİSİ ÜZERİNDEKİ ETKİSİ
Köse Karaca, Bahar
Doktora, Psikoloji Bölümü
Tez Danışmanı: Prof. Dr. Tülin Gençöz
Haziran 2014, 169 sayfa
Yapılan çalışmanın hedefi Young şema alanlarının, Young uyumsuz baş etme
biçimlerinin, Young ebeveynlik biçimlerinin süpervizörler, terapistler ve hastalar
arasındaki terapötik ittifakını ölçmekti. Katılımcılar sekiz süpervizör (klinik
psikoloji doktora öğrencileri), on iki terapist (klinik psikoloji yüksek lisans
öğrencileri) ve dört hastadan (AYNA klinik psikoloji ünitesine başv uranlar)
oluşmaktaydı. Araştırmada, terapötik ittifakı ölçmek için niteliksek (araştırmacı
tarafından geliştirilen açık uçlu soru formu ve ilişkisel halkalar) ve niceliksel
(terapötik ittifak ölçekleri/süpervizör-terapist formları ve terapist-hasta formları)
olmak üzere iki farklı ölçüm biçimi kullanıldı. Sonuçlara göre, Young erken yaş
dönemi uyumsuz şemaları, Young baş etme biçimleri, Young ebeveynlik biçimleri
ile süpervizörler, terapistler ve hastaların terapötik ittifakları arasında bir ilişki
olduğu tespit edildi. Çıkan sonuçlar Şema Teori çerçevesinde tartışıldı.
Anahtar Kelimeler: Şema Teori, Terapötik İttifak, Süpervizyon, Psikoterapi
vi
DEDICATION
To my husband, to my new life…
vii
ACKNOWLEDGMENTS
I would like to express my very great appreciation to Prof. Dr. Tülin Gençöz... My
doctorate education came across a crisis period in my family life; it was dark,
uncontrollable, and frustrating. I was withdrawn from life. However, she did not
allow me to lose my way; did not give up my hands... If I reached to today in my
academic career and private life, her contribution have had remarkable effect. She
shared my sadness and happiness. She provided “limited reparenting” in real life.
Thank you, thank you very much my teacher, my educator, my advisor…
I would like to offer my special thanks to Prof. Dr. Gonca Soygüt Pekak… She
accepted being in my jury and she unconditionally shared all her materials related
to my dissertation with me and spent much time to discuss on my dissertation. Her
supportive, accepting, and warm relationship style with me made me feel relaxed,
safe, and motivated for my dissertation. Besides, she exemplified how a schema
therapist should be with her attitudes and behaviors in real life. Thank you very
much for everything…
I would like to express gratitude to Doç. Dr. Özlem Bozo İrkin. She accepted to be
in my jury and followed my developing process. She directed me easy and quick
solutions for complicated parts of my dissertation. She approached positive and
understanding to me in this period…
I would like to express my deep gratitude to Prof. Dr. Faruk Gençöz. He became
the pioneer of my dissertation. He suggested the topic of my dissertation and
facilitated the conditions to reach the aims of it. More important than all these
things, he made me learn question my life, formulate my clients, and give
supervision as the therapist. He made the greatest contribution to be a
psychotherapist and to deal with my own life. If I did not know all these things, I
viii
could not interpret associations in my dissertation, but the most importantly; I
could not become who I am now. By decreasing, we increased by the help of him.
I would like to thank Prof. Dr. Gülsen Erden. She accepted to be in my jury
unconditionally and she supported me in this process. Her questions and feedbacks
were important for me at this period. Thank you very much…
I would also like to thank Nurten Özüorçun since she was another pioneer to
develop my dissertation topic and her supportive attitude; to Öznur Öncül since
she facilitated complicated method of dissertation and her friendly attitude, to
Gözde İkizer since she became near me whenever I was lost in questions, to
Nilüfer Ercan since she supported me by finding technical support or by sharing
my emotions; to Murat Sayın since he recovered my computer; to dear Fazilet
Canbolat since she shared me all the process caressively and warm friendship; to
Dilek Sarıtaş Atalar for her psychological support; to Yağmur Ar since she was
ready to help any time; Bülent Aykutoğlu and Mehmet Gültaş for their technical
support; to Yeşim Üzümcüoğlu for her collaborative room friendship…
My special thanks to Dilek Demirtepe, İncila Gürol, Filiz Özekin Üncüer, Pınar
Özbağrıaçık Çağlayan, Canan Büyükaşık Çolak, Başak Safrancı, Gaye Zeynep
Çenesiz, Gizem Ateş, İlknur Dilekler, Yankı Süsen, Sedef Tulum, Pelin Deniz
Begüm Babuşçu, Kerim Selvi, Seda Meşeli Allard, Tuğba Yılmaz, Beyza Ünal,
Ezgi Tuna, Zulal Törenli, and Ali Can Gök since if they were not there, this
dissertation could not be real. You became understanding, helpful, and patient,
thank you all…
I would like to thank my mother, sister, and brother since they shared this
adventure with me, they loved me; tried to understand, support, and protect me; to
my father since I learnt more things from his absence than his existence and I still
feel his love and can go to my way with confidence; to Murat Karaca, my husband
since he always forced me to be what I am and since he opened a sunny window to
my life…
ix
TABLE OF CONTENTS
PLAGIARISM ........................................................................................................ iii
ABSTRACT ............................................................................................................ iv
ÖZ............................................................................................................................. v
DEDICATION ........................................................................................................ vi
ACKNOWLEDGMENTS ...................................................................................... vii
TABLE OF CONTENTS ........................................................................................ ix
LIST OF TABLES ................................................................................................ xiv
LIST OF FIGURES .............................................................................................. xvii
CHAPTER ................................................................................................................ 1
1. INTRODUCTION ............................................................................................ 1
1.1. Therapeutic Relationship............................................................................... 1
1.1.1. Historical Context of Therapeutic Relationship and Conceptualizations .. 2
1.1.2. Measurement of Therapeutic Relationship ................................................ 4
1.2. The Place of Therapeutic Relationship in Different Psychotherapy
Approaches and the Factors Affecting Therapeutic Relationship in
Psychotherapy Process…………………………………………………….10
1.2.1. Schema Theory ........................................................................................ 13
1.2.1.1. Early Maladaptive Schemas, Schema Domains and Family Origins .. 13
1.2.1.2. Coping with Early Maladaptive Schemas ............................................ 16
1.2.1.3. Schema Theory and Therapeutic Alliance ........................................... 18
1.3. Specific Aims of the Study.......................................................................... 20
2. METHOD ....................................................................................................... 21
x
2.1. Participants .................................................................................................. 21
2.2. Measures ...................................................................................................... 22
2.2.1. Demographic Information Form .............................................................. 22
2.2.2. The Young Schema Questionnaire (YSQ) .............................................. 22
2.2.3. Young Parenting Inventory (YPI) ........................................................... 23
2.2.4. Young-Rygh Avoidance Inventory (YRAI) ............................................ 24
2.2.5. Young Compensation Inventory (YCI) ................................................... 24
2.2.6. Working Alliance Inventory—Therapist and Client Forms .......................
(WAI-T and WAI-C) ............................................................................... 24
2.2.7. Working Alliance Inventory—Supervisor and Therapist Forms ................
(WAI-S and WAI-T) ................................................................................ 25
2.2.8. Open-ended Question Form ..................................................................... 25
2.2.9. Projective Measurement-Relational Circles ............................................ 25
3. Procedure ........................................................................................................ 26
4. Statistical Analysis .......................................................................................... 28
3. RESULTS & DISCUSSION ........................................................................... 29
3.1. General Results for the Study ...................................................................... 29
3.2. Differences of Demographic Variables ....................................................... 29
3.3. Descriptive Information for the Measures of the Study .............................. 29
3.3.1. Descriptive Measures for Young Schema Inventories for the ....................
Supervisors .............................................................................................. 30
3.3.2. Descriptive Measures for Young Schema Inventories for the ....................
Therapists ................................................................................................. 35
3.3.3. Descriptive Measures of Young Schema Inventories for the Clients ...... 39
3.3.4. Descriptive Measures for Therapeutic Alliance ...................................... 42
3.4. Correlation Coefficients between Groups of Variables .............................. 42
xi
3.4.1. Correlation Coefficients between Groups of Variables for Supervisors ....
in Supervision Settings ............................................................................ 43
3.4.2. Correlation Coefficients between Groups of Variables for Therapists ......
in Supervision Settings ............................................................................ 47
3.4.3. Correlation Coefficients between Groups of Variables for Therapists ......
in Therapy Settings .................................................................................. 49
3.4.4. Correlation Coefficients between Groups of Variables for Clients in
Therapy Settings ..................................................................................................... 51
3.5. Case Examples to Illustrate the Relationship of Young Schemas, Young
Coping Mechanisms, Young Parenting Styles with Therapeutic Alliance ............ 54
3.5.1. Case of SupervisorA-TherapistB-ClientC ............................................... 54
3.5.1.1. Characteristics of Supervisor A ........................................................... 54
3.5.1.2. Characteristics of Therapist B .......................................................... 58
3.5.1.3. Characteristics of Client C ................................................................... 61
3.5.1.4. Therapeutic Alliance between Supervisor A and Therapist B with ........
the Associations of Schema Theory ..................................................... 64
3.5.1.5. Therapeutic Alliance between Supervisor A and Therapist B ................
depending on Quantitative Measurement and Its Associations with
Schema Theory .................................................................................... 64
3.5.1.6. Therapeutic Alliance between Supervisor A and Therapist B ................
depending on Qualitative Measurement and Its Associations with
Schema Theory .................................................................................... 68
3.5.1.7. Therapeutic alliance between Therapist B and Client C and Its
Associations with Schema Theory ....................................................... 73
3.5.1.8. Therapeutic Alliance between Therapist B and Client C depending ......
on Qualitative Measurement and Its Associations with Schema ............
Theory ................................................ ………………………………..74
xii
3.5.1.9. Therapeutic Alliance between Therapist B and Client C depending ......
on Qualitative Measurement and Its Associations with Schema ............
Theory .................................................................................................. 77
3.5.2. Case of Supervisor M and Therapist K ........................................................ 80
3.5.2.1. Characteristics of Supervisor M ................................................................ 80
3.5.2.2. Characteristics of Therapist K ................................................................... 83
3.5.2.3. Therapeutic Alliance between Supervisor M and Therapist K with .......
the Associations of Schema Theory ..................................................... 86
3.5.2.4. Therapeutic Alliance between Supervisor M and Therapist K ................
depending on Quantitative Measurement and Its Associations with
Schema Theory ..................................................................................... 87
3.5.2.5. Therapeutic Alliance between Therapist B and Client C depending ......
on Qualitative Measurement and Its Associations with Schema ............
Theory .................................................................................................. 92
3.6. General Discussions .................................................................................... 97
3.6.1. Contributions of the Study ....................................................................... 97
3.6.2. General Discussion for the Results .......................................................... 98
3.6.2.1. Rationale of Using YSQ with its 18 Schemas ................................... 100
3.6.3. Limitations of the Study and Future Directions .................................... 102
REFERENCES ..................................................................................................... 103
APPENDICES ...................................................................................................... 118
Appendix A: Informed Consent ........................................................................... 118
Appendix B: Demographic Information Form ..................................................... 119
Appendix C: Young Schema Questionnaire ........................................................ 119
Appendix D: Young Parenting Inventory ............................................................ 126
Appendix E: Young Rygh Avoidance Inventory ................................................. 130
Appendix F: Young Compensation Inventory ..................................................... 133
xiii
Appendix G: Working Alliance Inventory-Therapist and Client Forms ...................
(Therapist Form)………………………………………………………………...136
Appendix H: Working Alliance Inventory-Therapist and Client Forms.............. 139
(Client Form) ........................................................................................................ 139
Appendix I: Working Alliance Inventory-Supervisor and Therapist Forms........ 142
(Supervisor Form) ................................................................................................ 142
Appendix J: Working Alliance Inventory-Supervisor and Therapist Forms ....... 144
(Therapist Form) .................................................................................................. 144
Appendix K: Open-Ended Question Form ........................................................... 145
Appendix L: Relational Circles ............................................................................ 146
Appendix M: Tez Fotokopisi İzin Formu ............................................................ 149
CURRICULUM VITAE ...................................................................................... 151
TURKISH SUMMARY ....................................................................................... 153
xiv
LIST OF TABLES
TABLES
Table 1.Descriptive Information of the Measures for Supervisors ........................ 34
Table 2.Descriptive Information of the Measures for Therapists .......................... 38
Table 3.Descriptive Information of the Measures for Clients ................................ 41
Table 4.General Therapeutic Alliance Scores of Supervisors, Therapists, and
Clients ............................................................................................................. 42
Table 5.Pearson correlations between young schemas, young coping ......................
mechanisms, young parenting styles, and therapeutic alliance variables .. ……
of supervisors with therapis……………………………………………….....46
Table 6.Pearson correlations between young schemas, young coping ......................
mechanisms, young parenting styles, and therapeutic alliance of .....................
. therapists with their supervisors.....................................................................49
Table 7.Pearson correlations between young schemas, young coping ......................
mechanisms, young parenting styles, and therapeutic alliance variables ..........
of therapists with their clients..........................................................................51
Table 8.Pearson correlations between young schemas, young coping ......................
mechanisms, young parenting styles, and therapeutic alliance variables for
clients’ perception of therapeutic alliance with their therapists ...................... 53
Table 9.Early Maladaptive Schemas for Supervisor A .......................................... 55
Table 10.Types of Overcompensation of Schemas for Supervisor A .................... 56
Table 11. Types of Avoidance for Supervisor A .................................................... 56
Table 12.Characteristics of Mother of Supervisor A ............................................. 57
Table 13.Young Fatherhood Styles for Supervisor A ............................................ 57
Table 14.Early Maladaptive Schemas for Therapist B ........................................... 58
Table 15.Types of Overcompensation of Schemas for Therapist B ....................... 59
Table 16.Types of Avoidance for Therapist B ....................................................... 59
Table 17.Characteristics of Mother of Therapist B ................................................ 60
Table 18.Characteristics of Father of Therapist B ................................................. 60
xv
Table 19. Early Maladaptive Schemas for Client C ............................................... 61
Table 20.Types of Overcompensation of Schemas for Client C ............................ 62
Table 21.Types of Avoidance for Client C ............................................................ 62
Table 22.Characteristics of Mother of Client C ..................................................... 63
Table 23.Characteristics of Father of Client C ....................................................... 63
Table 24.General Therapeutic Alliance between Supervisor A and Therapist B .. 66
Table 25.Goal Oriented Therapeutic Alliance between Supervisor A and ...............
Therapist B…………………………………………………………………...67
Table 26.Task Oriented Therapeutic Alliance between Supervisor A and ...............
Therapist B…………………………………………………………………...67
Table 27.Emotional-Bond Oriented Therapeutic Alliance between Supervisor A
and Therapist B ............................................................................................... 68
Table 28. General Therapeutic Alliance between Therapist B and Client C ......... 75
Table 29. Goal Oriented Therapeutic Alliance between Therapist B and ................
Client C………………………………………………………………………76
Table 30. Task Oriented Therapeutic Alliance between Therapist B and ................
Client C………………………………………………………………………76
Table 31. Emotional-bond Oriented Therapeutic Alliance between Therapist B .....
and Client C……………………………………………………………….....77
Table 32. Early Maladaptive Schemas for Supervisor M ...................................... 81
Table 33. Types of Overcompensation of Schemas for Supervisor M .................. 81
Table 34.Types of Avoidance for Supervisor M .................................................... 82
Table 35.Characteristics of Mother of Supervisor M ............................................. 82
Table 36. Characteristics of Father of Supervisor M ............................................. 83
Table 37.Early Maladaptive Schemas of Therapist K............................................ 84
Table 38.Types of Overcompensation of Schemas for Therapist K ...................... 84
Table 39.Types of Avoidance for Therapist K ....................................................... 85
Table 40. Characteristics of Mother of Therapist K............................................... 85
Table 41.Characteristics of Father of Therapist K ................................................. 86
Table 42.General Therapeutic Alliance between Supervisor M and Therapist K . 90
Table 43.Goal Oriented Therapeutic Alliance between Supervisor M and ..............
Therapist K…………………………………………………………………..91
xvi
Table 44.Task Oriented Therapeutic Alliance between Supervisor M and ..............
Therapist K…………………………………………………………………..91
Table 45.Emotional Bond Oriented Therapeutic Alliance between ..........................
Supervisor M and Therapist K………………………………………………92
xvii
LIST OF FIGURES
FIGURES
Figure 1. Early Maladaptive Schemas and Schema Domains…………………….14
Figure 2. Projective measurement of therapeutic alliance for Supervisor A
and Therapist B…………………………………………………………………72
Figure 3. Open-ended questions and answers for Supervisor A………………….73
Figure 4. Open-ended questions and answers for Therapist B…………...………73
Figure 5. Projective measurements of therapeutic alliance for Therapist B
andClient C ………………………………………………………………79
Figure 6. Projective measurement of therapeutic alliance for Supervisor M…….96
Figure 7. Open-ended Questions and Answers for Supervisor M………………..96
Figure 8. Open-ended Questions and Answers for Therapist K……………….....96
1
CHAPTER
1. INTRODUCTION
1.1. Therapeutic Relationship
Although psychological approaches, methods, and psychological
symptoms were kept constant during psychotherapy researches, the outcome of
psychotherapy did not indicate similarity perpetually. In the literature, there were
different explanations for this situation. Different approaches used in
psychotherapy, training experiences of therapists, type of psychopathology of the
clients, frequency of sessions, and client’s level of motivation were some of the
factors affecting the outcomes (Crits-Christoph et al., 1991; McCarthy & Frieze,
1999; McCoy Lynch, 2012). Besides, one remarkable factor affecting outcomes,
mostly emphasized by researchers, was undoubtedly therapeutic relationship. In
the literature, in spite of the debate on whether it had direct or indirect effect, there
was a striking agreement that client-therapist relationship had an important healing
effect on treatment (Elvins & Green, 2008; Gelso & Carter, 1985; Gelso & Carter,
1994; Horvath, Del Re, Flückiger, & Symonds, 2011; Huppert et al., 2014; Priebe
& McCabe, 2006). Especially, being aware of experienced difficulties between
therapist and client and trying to overcome these difficulties in order to maintain a
good therapeutic alliance made vital contribution to change of the client in
psychotherapy process (Safran, 1993). However, although many researchers
accepted the importance of therapeutic alliance for outcome of psychotherapy,
operational definition of this concept and measurement method of it was still
controversial. Additionally, in order to analyze, measure, and control therapeutic
alliance, researchers from different approaches go on to debate on factors affecting
therapeutic alliance.
Thus, in this dissertation, firstly, therapeutic relationship as a concept and
assessment of therapeutic relationship will be explained. Secondly, the factors
2
affecting therapeutic relationship will be explained in the relation with schema
theory.
1.1.1. Historical Context of Therapeutic Relationship and
Conceptualizations
As historical context, first theoretical studies belonged to psychodynamic
approach. Freud (1912/1966) had initial attempts to draw attention to importance
of relationship. Freud (1913), in his writings, focused on patient’s affections and
attachment to his/her doctor and put forward the concepts of transference and
countertransference. He associated client’s affections for the therapist with parent
relationship. After attempts of Freud, some psychoanalysts pointed therapeutic
alliance in order to solve inner difficulties experienced in psychotherapy. In 1934,
Sterba first used the concept of ego alliance in order to define split in the ego in
terms of observing and experiencing. This splitting in ego was related with both
mature ego of client and working style of therapist. Moreover, following Freud,
Zetzel (1956) put forward the concept of “therapeutic alliance” and explained this
concept as attachment of client with the therapist. She associated therapeutic
alliance with reemerging mother-child relationship. Furthermore, inspired by
Sterba (1934) and Zetzel (1956), Greenson (1965) started to use the concept of
working alliance as the same meaning of therapeutic alliance. He interpreted
alliance as patient’s ability to work according to the purposes of intervention
during therapy process. According to Greenson (1965), alliance included both
affections of client towards therapist and capacity of client to work in therapy
process.
In addition to client’s contribution to therapeutic alliance, Freud
(1912/1913) also pointed that therapist also had a major contribution to therapeutic
alliance in his writings. However, Rogers (1957) just focused on client-centered
alliance. Rogers (1957) and Barrett-Lennard (1962, 1978, 1986) claimed that
empathy and unconditional positive regard of therapist had crucial healing effect
on clients; nevertheless, therapist did not have a major contribution by himself.
Besides, Anderson and Anderson in 1962 put forward an operational definition in
3
order to express empathy and rapport in a one concept; namely, therapeutic bond.
With this conceptualization, Orlinsky and Howard (1975) started to test this
concept in their empirical studies. They found that credibility of therapists in
treatment process was associated with therapeutic outcome. They suggested three
dimensions of alliance “working alliance (investment of both client and therapist
in the process of therapy), empathic resonance, and mutual affirmation
(conceptually close to the Rogerian concept of unconditional positive regard) (as
cited in Elvins and Green in 2008)”. Additionally, inspired by this tripartite model,
Bordin (1979) started to test goal, task, and bond oriented therapeutic relationship
for different therapeutic approaches. Despite researches claiming positive affect of
therapeutic relationship on therapeutic outcome, Brenner (1979) claimed that
alliance was unnecessary and unreliable. According to Brenner, the relationship
between client and therapist was related to transference and transference was
something that must be resolved by dealing with resistance. Similarly, Curtis
(1979) also considered the concept of alliance as something dangerous since
alliance distracted focus of psychoanalysis from unconscious world of client.
After all these debates in literature, many researches were conducted in
order to find empirical evidence for healing effect of therapeutic alliance
(Luborsky, Singer & Luborsky, 1975; Smith & Gloss, 1977) and variability in
definitions started to emerge (Luborsky, 1976; Bordin, 1976, 1980, 1994).
Luborsky (1976) and Zetzel (1956) described the alliance as the patient’s bond
with the therapist and the therapist’s helpfulness as perceived by the patient.
However, Frieswyk et al. (1986) defined the alliance as the patient’s “active
collaboration in treatment tasks” (as cited in Baillargeon, Cote, & Douville, 2012).
Moreover, Frank and Frank (1991) handled the concept of working alliance as
therapeutic alliance, which included “active common factors” such as accurate
empathy, and task understanding. On the other hand, in the study of Hougaard
(1994), therapeutic alliance was divided into two as “personal alliance” meaning
interpersonal relationship between client and therapist and the “task related
alliance” meaning aspects of treatment plan and goal orientation. Hayes (1998)
stated that there were many concepts to describe alliance such as therapeutic
alliance, working relationship, and helping alliance. In the literature, many
4
operational definitions were created for therapeutic relationship. Whereas some of
had similar meaning, some had different meaning. Nevertheless, in order to seek
therapeutic relationship, the concept of working alliance, put forward by Bordin
(1979), became the mostly used one by the researchers in the literature (Gelso &
Carter, 1985; Greenson, 1967; Horvath & Greenberg, 1989; Patton, 1984).
According to Bordin (1979), “the relationship between client and therapist based
on here and now which was common to all forms of psychotherapeutic treatment
regardless of treatment orientation or approach”. Moreover, therapeutic alliance
depended on shared participation of both client and therapist included three
dimensions in terms of task, goal, and bond. Task oriented alliance consisted of
agreed upon tasks between therapist and client in order to reach aims of the
therapy process. On the other hand, goals represented agreed upon purposes in
therapy between therapist and client so that client could gain expected outcomes
from the therapy. Furthermore, bond included a positive relationship consisting of
intimacy and trust between therapy and client, which was facilitative for doing
tasks and reaching aims in therapy process. In the present study, working alliance
concept of Bordin (1979) will be used in order to measure and analyze therapeutic
relationship.
1.1.2. Measurement of Therapeutic Relationship
Considering all these concepts, different measurement instruments were
developed in the literature and their validity were tested by different studies.
Nevertheless, since there was no consensus on definition of therapeutic alliance,
there were many scales in the literature (Elvins & Green, 2008). Elvins and Green
(2008) gathered all these concepts and different measures in their empirical review
as mentioned below. As an initial attempt, Barrett-Lennard (1962) developed
Barrett-Lennard’s Relationship Inventory in order to measure level of empathic
understanding and regard of therapist (Rogerian dimension) from the view of
patients and it was originally developed for a doctorate program and Wisconsin
Psychotherapy Project with schizophrenic patients. On the other hand, Linden,
Stone and Shertzer (1965) developed Counseling Evaluation Inventory (CEI) for
5
adults in order to measure bond oriented therapeutic alliance (based on Anderson
and Anderson’s (1962) therapeutic alliance concept). Moreover, Orlinsky and
Howard (1966) to evaluate working alliance (contribution of both client and
therapist), empathic resonance, and mutual affirmation (depending on Rogerian
concept of unconditional positive regard) developed Therapy Session Report
Scales. Adding to these scales, The Counselor Rating Form (1975), originated
from Strong’s conceptualization of counseling relationship and Bordin’s concept
of bond implicitly, was designed by Bachelor (1975) and used for clients with
anxiety and interpersonal problems. The Penn Alliance Scale (developed by
Luborsky in 1976) was another scale created to test helping alliance from the view
of client. Furthermore, Gomes-Schwartz (1978) developed Vanderbilt Scales by
combining dynamic and integrative conceptualizations of alliance. Toronto Scales,
which were developed by Marziali, Marmar, and Krupnick in 1981 was used to
measure affective sides of alliance. On the other hand, Menninger Alliance Rating
Scale/Collaboration Scale was designed by Allen, Newsom, Gabbard, and Coyne
(1984) to measure collaboration of patients. Furthermore, Psychotherapy Status
Report (Svensson & Hansson, 1985) was used especially for schizophrenic
patients. Moreover, California Scales (Marmar et al., 1989) and Therapeutic Bond
Scales (Saunders et al., 1989) were used to test alliance from psychodynamic point
of view in adult group. Besides, Working Alliance Inventory (WAI) was
developed to analyze Bordin’s alliance dimensions (i.e., goal, task, and bond) in
adult group. A couple version for this scale was designed by Symonds and
Horvath in 2004. Moreover, Child Psychotherapy Process Measures (Smith-
Acuna, Durlak, & Kaspar, 1991) were devised by adapting Orlinsky and Howard’s
(1975) adult self-report measures. Child’s Perception of Therapeutic Relationship
was developed by Kendall (1991) by inspiring from bond-oriented alliance of
Bordin. Similarly, Shirk and Saiz (1992) developed Therapeutic Alliance Scales
for Children by focusing on Bordin’s bond concept. Sarlin (1992) also designed
Treatment Alliance Scales in order to measure alliance between families of
children with asthma and their physician. Adapted Psychotherapy Process
Inventory (developed by Gorin in 1993) was used to measure therapy process for
children rather than alliance. Additionally, Adolescent Working Alliance
6
Inventory was devised by Di Giuseppe et al. in 1993 (improved by Florsheim et
al., in 2000) in order to obtain patient report for adolescents between 11 to 18
years. Helping Alliance Scale (Priebe & Gruyters, 1993) was another self-report
scale that was used for evaluating patient’s view of case manager’s understanding,
involvement, and patients’ feeling after session. Empathy and Understanding
Questionnaire (Green et al., 1996) and Family Engagement Questionnaire (Kroll &
Green, 1997) were inspired from concepts of Frank, Bordin, and Hougaard. The
former was used for outpatient treatment process while the latter was devised for
child psychiatry inpatients. On the other hand, Barriers to Treatment Participation
Scale (Kazdin et al., 1997) had six item subscale which analysed parent’s alliance
and bonding with therapist although the scale was not a strict alliance measure.
Therapist Alliance Focus Scale was designed by Molinaro (1997) to determine
time (for discussing alliance) spent by therapist. Furthermore, Johnson et al.
(1998) developed Adolescent Therapeutic Alliance Scale to examine working
relationship between therapist and adolescent. Agnew Relationship Measure was
designed by Agnew, Davies, Stiles, Hardy, Barkam, and Shapiro (1998) in order to
use for Sheffield psychotherapy project for comparing CBT and psychodynamic
therapy for depression. Moreover, Child Psychotherapy Process Scales were
devised by Estrada and Russell (1999) for examining task and goal oriented
alliance in child psychodynamic therapies. Besides, Family Therapy Alliance
Scale was developed by Pinsof (1999) in order to determine client’s perception in
family therapy process. Johnson (2000) designed Early Adolescent Therapeutic
Alliance Scale for early adolescent clients with drug misuse. Kim Alliance Scale
(Kim et al., 2001) was developed in order to analyze quality of therapeutic
relationship since Kim et al. believed that patients should have responsibility for
their own benefits. On the other hand, System for Observing Family Therapy
Alliance (Friedlander et al., 2001) was developed to conceptualize Bordin’s
alliance model with qualitative research in family therapy. McLeod and Weisz
(2005), to assess child-therapist and parent-therapist alliance as defined by Shirk
and Saiz in 1992, developed the Therapy Process Observational Coding System-
Alliance Scale. Additionally, McGuire-Snieckus, McCabe, Catty, Hanson, and
Priebe (2007) developed Scale to Assess Therapeutic Relationship in order to
7
examine task and goal oriented alliance from the viewpoints of patient and
clinician.
According to review of Elvins and Green (2008), the most common used
raters of alliance measures were the patients. Patients were the best predictor for
the outcome of alliance for adult group whereas therapists were the best predictor
for child psychotherapy (Horvath & Symonds, 1991). All of the scales mentioned
above were used in some studies; however, most of them did not have enough
sample size to be able to reach robust outcome. From these scales, Working
Alliance Inventory, Vanderbilt Therapeutic Alliance Scales, and California
Psychotherapy Alliance Scales indicated most empirical support for adult
literature. On the other hand, modified Vanderbilt Therapeutic Alliance Scales,
Working Alliance Inventory, and Penn Scales became the mostly used ones for
younger people. Due to its psychometric properties, in the present study, Working
Alliance Inventory will be used as a quantitative measure.
After the process of conceptualization of alliance concept, follower of these
researchers developed different scales in order to measure these concepts as listed
above. Nevertheless, to measure an abstract concept in a relational setting was not
an easy task. Therefore, these scales had some limitations and shortcomings to be
able to measure working alliance exactly. Firstly, since there was not agreement on
operational definition of therapeutic alliance, too many scales were designed by
researchers (Elvins & Green, 2008). Thus, there was not a representative scale for
alliance literature and this caused scale focused research results. Secondly,
according to Green et al. (2001), the inventories were inadequate to measure the
alliance when the patient was too young. The younger the patient was, the more
difficult to comprehend of therapeutic experiences. Creed and Kendall (2005) also
expressed that these scales could have limitations to measure perception of alliance
for adolescents and children due to their developmental constraints. In their
studies, they noticed that the alliance measuring of young patients indicated their
relationship with their parents rather than therapeutic relationship. Thirdly,
according to Braswell, Kendall, Braith, Carey, and Vye (1985), measurement of
therapeutic alliance after different sessions caused session based evaluations.
Moreover, in the study of Elvins and Green (2008), it was claimed that therapeutic
8
relationship originated from early attachment style of the patient by considering
Bowlby’s attachment theory (1988). Therefore, they expressed that an inventory
performing accurate measurement should have the competency to measure
complex structure of working alliance associated with attachment pattern.
Furthermore, Kazdin and Nock (2003) expressed that there were common method
confounds for measurement of therapeutic alliance. As Eugster and Wampold
(1996) asserted, four variables (i.e., patient involvement, patient comfort, patient
progress, and patient real relationship) were found associated with patient’s
alliance evaluation in the literature. Therefore, these scales could not have
measured real alliance in therapeutic relationship. Additionally, pre-treatment
factors (such as social functioning of patient) or early alliance (before session five)
could predict measurement of alliance (Elvins & Green, 2008). Besides, a
difficulty in measurement of alliance arised from difficulty in discrimination of
therapist effect from patient effect (Castonguay, Constantino, & Grosse Holforth,
2006). In order to solve this difficulty, observer was used in alliance studies.
However, observer evaluation could be misleading since observers could not
perceive directly motivational and attitude related therapeutic alliance (Elvins &
Green, 2008). Apart from these limitations, one other limitation was that outcome
of the working alliance measurements could change with regard to at what stage
the measurement was made since alliance had unstable and developing structure
(Elvins & Green, 2008). Furthermore, since prior expectations of the sessions
(Constantine, Arnow, Blosey, & Agras, 2005) and how the patient perceived real
relationship (Eugster & Wampold, 1996) could affect perception of the alliance, so
these inventories could not measure the real alliance. Finally, Migone (1996)
claimed that since therapists, clients, and observers could interpret each case
differently, the results of the researches of therapeutic alliance could be specific to
the case, and generalization could not be possible. Based on these limitations,
qualitative, experimental measurement, and analytic techniques were suggested by
Elvins and Green (2003) for future directions.
Thus, considering all these limitations, a new measurement method was
suggested in the present study. This measurement was based on qualitative and
intrinsic method. Instead of using self-report questionnaire, a projective test, which
9
depended on Object Relations Theory, was suggested since there were many
advantages of using object relations in the assessment. Firstly, according to Kelly
(1997), object representation information could provide more interpersonal
knowledge related to attachment and family bonds. Moreover, object relations
could facilitate to understand the client’s contribution to the working alliance as
well as attachment theory. According to Klein (1932), it was assumed that early
relationships were internalized and became intra-psychic schemas, which provided
to feel connectedness to others. The term object representation referred to this
inner domain of schemas that provided to increase awareness and to serve as a
map to define self and others (Kelly, 1997). Based on this knowledge, in the
present research, it was assumed that supervisors, therapists, and clients had
representations of each other in their minds. It was proposed that if working
alliance was measured based on symbols and representations, therapeutic alliance
of which roots originated from early family bonds could be measured more
accurately. Moreover, early relationship cycle with parents and transferences could
be obtained from the implicit memory by symbols. However, there were also some
studies (Bell, Billington, & Becker, 1986; Stricker & Healy, 1990) drawing
attention to complex evaluation format of the measure of object relations.
Considering advantages of object relations, in order to indicate object
representations of the participants, three different circles representing supervisor,
therapist, and the client will be used in the current study. In order to deal with this
complex evaluation format (asserted by Bell, Billington, & Becker, 1986; Stricker
& Healy, 1990), single case measurement and evaluation will be conducted.
Similar representing symbols were also used in the book of Supervising
Psychotherapy (Driver, Martin, Banks, Mander, & Stewart, 2002). Driver et al.
(2002) used three triangles in order to exemplify the concept of psychic
apparatuses of Freud (i.e., id, ego, and superego) for supervisor, therapist, and the
client, and in order to indicate how these three psychic apparatuses could overlap
during the supervision period. Based on these symbols, three circles will be
proposed in order to represent supervisor, therapist, and the client in this study (as
shown in Appendix L).
10
1.2. The Place of Therapeutic Relationship in Different Psychotherapy
Approaches and the Factors Affecting Therapeutic Relationship in
Psychotherapy Process
According to classical psychoanalytic theory, as mentioned before,
therapeutic relationship was vital component of treatment (Freud, 1913). In order
to indicate relationship between therapist and patient, Freud (1913) used the
concepts of transference and countertransference. While transference was defined
as unconscious redirection of feelings of the client to the therapist,
countertransference was defined as the reflection of unconscious feelings of
therapist towards the client. With the appearance of countertransference, a client
represented an object, which was projected by therapist’s own feelings and wishes.
This projection created an inhibitory affect for clear perception of the therapist;
thus, the therapist probably could start to maintain his/her past relationship cycle
with the client unintentionally. Therefore, countertransference was accepted as a
threat in the therapeutic process in early formulations (Freud, 1912; Jung, 1976;
Berne, 1975). Similarly, transference was also accepted as an obstacle for
treatment by Freud (1912) since transference of the client caused different
emotions such as anger, mistrust, rage, love, and extreme dependency. On the
other hand, according to Greenson (1967), psychoanalysis deliberately triggered
transference in order to create a relationship cycle with therapist, which the client
usually used with others in real life. Therefore, transference was a necessary
psychotherapy technique in treatment process.
As for object relations theory, Melanie Klein (Hinshelwood, Robinson &
Zarate, 2006) and Hanna Segal (Bell, 1997) highlighted that countertransference of
the therapist did not belong only to therapeutic relationship but also it was an
extension and production of the client. Considering these approaches,
countertransference was accepted as a vital part of therapeutic tool (Bell, 1997;
Hishelwood, Robinson, & Zarate, 2006). Object relations theory considered
therapy relationship as the reflection of client’s mother-child relationship.
Accordingly, therapist’s projected emotions were considered as important tool in
11
psychotherapy and they were used to understand the relationship cycle of the client
in real life experiences.
Furthermore, the effects of transference and countertransference on
therapeutic relationship were examined by recent psychodynamic oriented studies.
Mayers and Hayes (2006) who handled countertransference as self-disclosure in
their research claimed that the client evaluated self-disclosure of the therapist as
something requiring expertise when working alliance was accepted as positive
between therapist and the client. Moreover, in the study of Rosenberger and Hayes
(2002), it was claimed that if therapist was aware of countertransference and used
countertransference as an effective tool in therapy, this strengthened working
alliance. Similarly, according to Gelso and Carter (1994), positive transference
fostered the working alliance while negative one could weaken the alliance.
Additionally, working alliance also affected from transference since therapeutic
alliance was facilitative to increase awareness of the client for probable
transference. On the other hand, positive working alliance facilitated self-
disclosure of the client for negative transference. Besides, countertransference of
the therapist could strengthen working alliance if therapist observed his/her
attitudes towards the client (Gelso & Carter, 1994). One another study (Marmarosh
et al., 2009) asserted that the when the more real relationship elements were
ignored by the therapist, s/he rated the more negative transference.
According to interpersonal theory formulated by Sullivan (1953) and his
followers (Carson, 1969; Kiesler, 1988/1996; Leary, 1957), therapist should
behave surrender with affections and attitudes of client. Then, s/he should notice
the pattern by behaving out of expectants of client. Thus, therapist has
demonstrated alternative reactions in relational cycle of the client in corrective
emotional experience.
Additionally, in relational theory (Aron, 1996; Levenson, 1995; Mitchell,
1988, 1993; Safran & Muran, 2000; Wachtel, 2008 as cited in Hill & Knox, 2009)
therapy process endured a dual relationship. According to this theory, this dual
relationship could change due to different relationship pattern between therapist
and client. Treatment and improvement depended on dealing with problems in
therapeutic relationship. Safran and Muran (2000) expressed that treatment was
12
related to discuss on what was going on between therapist and client and analyzing
here-and-now oriented relationship.
On the other hand, according to humanistic/experiential theory (Elliott,
Watson, Goldman, & Greenberg, 2004; Greenberg, Rice, & Elliott, 1993),
therapeutic relationship was an important component of treatment process.
According to Elliott et al. (2004), there were six signals indicating problem in
therapeutic alliance. The first one was client’s rejecting activities suggested by
therapist. The second one was disruption in trust and collaboration in
psychotherapy process due to the attitudes in order not to lose control and power.
Thirdly, when client thought that s/he was not taken care or liked by therapist.
Fourthly, when the client withdrew from therapy latently and started to question
intentions of therapist. Fifthly, when client did not want to get responsibility of
therapeutic process since s/he thought that this process had an end. The sixth one
was therapist’s incompetency to control his/her own negative reactions resulted
from withdrawal of the client and behaving without acceptance.
Moreover, in cognitive theory (Beck, Rush, Shaw, & Emery, 1979), it was
expressed that if there were a problem in therapy relationship, this would be
handled directly by making associations with cognitive distortions of the client.
Apart from all these theories, Schema Theory (Young, 1996) originated
from psychodynamic approach, Bowlby’s attachment theory, Ryle’s cognitive-
analytic therapy, Horowitz’s person schemas therapy, and emotionally-focused
therapy emphasized the therapy relationship as a vital component of schema
assessment and change. Schema Theory (Young, Klosko, & Weishaar, 2003)
considered the therapist’s own schemas and coping styles as negative for treatment
process if therapist was not aware of them. For example, a therapist who was
unaware of his/her maladaptive schemas could trigger dysfunctional parent mode
of the client. Thus, this triggering effect could strengthen maladaptive pattern
instead of breaking it. Besides, if therapist was aware of his/her schemas triggered
in therapy process, therapy relationship could be used as therapy tool in an
adaptive way in the process of empathic confrontation and limited parenting.
Therefore, in the current study, schema theory will be examined in order to make
13
associations with working alliance and determining factors affecting working
alliance.
1.2.1. Schema Theory
1.2.1.1. Early Maladaptive Schemas, Schema Domains and Family
Origins
In Schema Theory, in order to define thoughts, beliefs and rules arising
from childhood, the concept of early maladaptive schemas (EMS) was used. It was
defined as “stable and enduring themes that develop during childhood are
elaborated throughout an individual’s lifetime” (Young, 1999, p.9). EMS
originated from traumatic childhood experiences and began to emerge in early
stage of life (Young, 1999). According to Young (1999), family represented whole
world of a child. Therefore, with early experiences of children, children started to
develop rules in order to deal with problems in life. They developed a pattern of
behavior by monitoring reactions of their parents. Nevertheless, when they became
adult, they continued childhood pattern of behaviors especially in relationship
which activating their early maladaptive schemas. The dramatic situation was that
this pattern of behavior could have emerged in order to cope with unhealthy
parenthood in their family. With the effect of this, they evaluated world as if it was
same as early experiences. Unintentionally, they maintained to keep alive their
maladaptive schemas. Based on these characteristics of EMS, Young (1999)
pointed out that these schemas had deep roots embedded in the past; identifying
them were often difficult since they were blocked, and they were mostly related to
personality disorders including difficulty in interpersonal relationships.
According to Young et al. (2003), there were eighteen schemas under five
schema domains (as shown in Figure 1). First domain (Young et al., 2003, p.14-
17) was “disconnection & rejection” including expectation of one’s needs for
security, safety, stability, nurturance, empathy, sharing of feelings, acceptance, and
respect. However, these needs were not met in a predictable manner. A typical
family triggering this domain had “detached, cold, rejecting, withholding, lonely,
14
explosive, unpredictable, or abusive” characteristics. This domain included
schemas of abandonment/instability based on “perceived instability or unreliability
of those available for support and connection”; mistrust/abuse depending on
“expectation that others would hurt, abuse, humiliate, cheat, lie, manipulate, or
take advantage”; emotional deprivation related to “expectation that one's desire for
a normal degree of emotional support would not be adequately met by others”;
defectiveness /shame based on “the feeling that one is defective, bad, unwanted,
inferior, or invalid in important respects; or that one would be unlovable to
significant others if exposed”; and social isolation /alienation related to “the
feeling that one was isolated from the rest of the world, different from other
people, and/or not part of any group or community”.
Figure 1. Early Maladaptive Schemas and Schema Domains (Young et al., 2003)
The second domain was “impaired autonomy and performance” (Young et
al., 2003, p.14-17). This domain included “expectations about oneself and the
DISCONNECTION
& REJECTION
1. Abandonment/ Instability 2. Mistrust/ Abuse 3. Emotional Deprivation 4. Defectiveness/ Shame 5. Social Isolation/ Alienation
OVERVILIGANCE
&
INHIBITION
15. Negativity/ Pessimism 16. Emotional Inhibition 17. Unrelenting Standards / Hypercriticalness 18. Punitiveness
OTHER -
DIRECTEDNESS
12. Subjugation 13. Self- Sacrifice 14. Approval- Seeking / Recognition- Seeking
IMPAIRED
LIMITS
10. Entitlement/ Grandiosity 11. Insufficient Self Control/ Self Discipline
IMPAIRED
AUTONOMY &
PERFORMANCE
6. Dependence/ Incompetence 7. Vulnerability to Harm or Illness 8. Enmeshment/ Undeveloped Self 9. Failure
Early
Maladaptive
Schemas
)
15
environment that interfere with one's perceived ability to separate, survive,
function independently, or perform successfully”. This domain originated from a
family that was “enmeshed, undermining of child's confidence, overprotective, or
failing to reinforce child for performing competently outside the family”. Impaired
autonomy and performance domain involved the schemas of
dependence/incompetence based on “the belief that one was unable to handle one's
everyday responsibilities in a competent manner, without considerable help from
others”; vulnerability to harm or illness including “exaggerated fear that imminent
catastrophe would strike at any time and that one would be unable to prevent it”;
enmeshment/undeveloped self depending on “excessive emotional involvement and
closeness with one or more significant others (often parents), at the expense of full
individuation or normal social development”; failure based on the belief that “one
had failed, would inevitably fail, or was fundamentally inadequate relative to one's
peers, in areas of achievement”.
“Impaired limits” was the third domain of Young (Young et al., 2003,
p.14-17). It was depended on “deficiency in internal limits, responsibility to others,
or long-term goal-orientation”. It was originated from a family having
characteristics of “permissiveness, overindulgence, lack of direction, or a sense of
superiority -- rather than appropriate confrontation, discipline and limits in relation
to taking responsibility, cooperating in a reciprocal manner, and setting goals”.
Schemas of entitlement/grandiosity were based upon “the belief that one was
superior to other people; entitled to special rights and privileges; or not bounded
by the rules of reciprocity that guided normal social interaction”; and insufficient
self-control /self-discipline indicating “pervasive difficulty or refusal to exercise
sufficient self-control and frustration tolerance to achieve one's personal goals, or
to restrain the excessive expression of one's emotions and impulses” took part
under the domain of impaired limits.
Other-directedness was the fourth domain of Young (Young et al., 2003,
p.14-17). This domain was based on “an excessive focus on the desires, feelings,
and responses of others, at the expense of one's own needs -- in order to gain love
and approval, maintain one's sense of connection, or avoid retaliation”. Roots of
this domain arised from “conditional acceptance: children must suppress important
16
aspects of themselves in order to gain love, attention, and approval. In many such
families, the parents' emotional needs and desires -- or social acceptance and status
-- were valued more than the unique needs and feelings of each child”. Domain of
other-directedness involved the schemas of subjugation based on “excessive
surrendering of control to others because one felt coerced - - usually to avoid
anger, retaliation, or abandonment”; self-sacrifice related to “excessive focus on
voluntarily meeting the needs of others in daily situations, at the expense of one's
own gratification”; and approval-seeking/recognition-seeking based on “excessive
emphasis on gaining approval, recognition or attention from other people or fitting
in, at the expense of developing a secure and true sense of self”.
The final domain is “overvigilance and inhibition” (Young et al., 2003,
p.14-17). It was based on “excessive emphasis on suppressing one's spontaneous
feelings, impulses, and choices or on meeting rigid, internalized rules and
expectations about performance and ethical behavior -- often at the expense of
happiness, self-expression, relaxation, close relationships, or health”. This domain
mainly was originated from the family that was “grim, demanding, and sometimes
punitive: performance, duty, perfectionism, following rules, hiding emotions, and
avoiding mistakes predominates over pleasure, joy, and relaxation”. Overvigilance
and inhibition domain consisted of the schemas of negativity /pessimism
depending on “a pervasive, lifelong focus on the negative aspects of life while
minimizing or neglecting the positive or optimistic aspects”; emotional inhibition
including “excessive inhibition of spontaneous action, feeling, or communication -
- usually to avoid disapproval by others, feelings of shame, or losing control of
one's impulses”; unrelenting standards/hypercriticalness based on “the underlying
belief that one must strive to meet very highly internalized standards of behavior
and performance, usually to avoid criticism”; and punitiveness including “the
belief that people should be harshly punished for making mistakes”.
1.2.1.2. Coping with Early Maladaptive Schemas
In order to deal with the problems and negative life events, a child
developed some rules/schemas (EMS) in order to fight and survive. However,
17
although EMS could be functional in early life, maintenance of these schemas in
later life became dysfunctional because the perception of the world was not the
same as the one during childhood period (Young et al, 2003). While all these
schemas arised during childhood and seemed to be dominant in this period
(Stallard, 2007), prevalence of such schemas later in life brought about tackling
the problems in a maladaptive way. According to Young et al. (2003), there were
three maladaptive ways that people utilized to cope with their schemas. “Schema
surrender” was the first style in which people accepted their schemas as an
accurate rule in their life. They did not avoid or fight with it. Without being
unaware of what they did, they behaved according to their schemas based on
childhood experiences. For example, if a person had the abandonment/instability
schema (“The world is not stable, I can be abandoned”), s/he tended to choose a
partner who could not maintain a stable relationship. Thus, s/he maintained his/her
maladaptive schema. “Schema avoidance” was the second style of coping. In this
situation, people tended to avoid from their schemas, the life events, and thoughts
triggering their schemas. They suppressed their feelings and avoided facing with
their schemas. For example, a person with abandonment/instability schema did not
have tendency to build relationship in order not be abandoned (“There was no need
to be in relationship with someone since I was sure that I would certainly be
abandoned”). These people might tend to have drug abuse in order to suppress
painful feelings. Moreover, these people might try to avoid from their schemas by
psychosomatic symptoms, emotional control, numbness/suppressing emotions,
withdrawal from people, distraction through activity, and ignoring sadness or
disturbance. Finally, “schema overcompensation”, which was the third style of
coping, indicated that people fight with their schemas and tried to oppose them. In
practice, this style seemed more beneficial for the well-being of the individual than
other coping styles. However, during contemplating to fight against schemas, they
tended to pay a lot of attention to the existence of the schemas, which resulted in
prevalence. Therefore, overcompensation unintentionally made schemas
permanent in their life. For example, a person with abandonment/instability
schema tried not to miss any clues related to abandonment when s/he was in a
relationship with somebody. Whenever s/he felt that there was something negative
18
or blurry in this relationship, s/he thought that s/he could be abandoned. In order
not to be abandoned, s/he abandoned his/her partner. This overcompensation
seemed to help vulnerable child not to feel helplessness by trying to control the
events. Nevertheless, a person with too much focus on his/her schemas could miss
to see positive things around and exaggerate negative things. People
overcompensated their maladaptive schemas with status-seeking, controlling,
rebellion, counterdependency, manipulation, intolerance to criticism, and
egocentrism.
1.2.1.3. Schema Theory and Therapeutic Alliance
According to Young, therapeutic relationship was affected from schema
related patterns since a therapist could represent or symbolize a patient’s early
experiences or parent attitude. Therefore, a patient built a relationship with his/her
therapist in different formats depending on his/her schema patterns and coping
mechanisms. Firstly, a person yielding his/her maladaptive schemas might put
himself/herself into the child mode (under the effect of maladaptive schemas) and
perceive his/her therapist as undesirable parent mode (activating his/her
maladaptive schemas). This perception could cause prevalence of maladaptive
schemas in therapy settings. Secondly, a person utilizing schema avoidance in
order to cope with his/her schemas could avoid situation activating his/her
schemas, such as affiliation and challenges (Young, 1996). This kind of people
could forget to do homework, suppress their emotions, not deepen issues, delay the
sessions, or maybe drop out quickly in therapy settings. Finally, a person with
overcompensating his/her schemas could not take responsibilities for their
mistakes since they thought that they do whatever was required in order to fight
with his/her maladaptive schemas. When they experienced regression in their fight
against maladaptive schemas, they could experience big hopelessness and become
depressed. This pattern could be obstructive to reach goals of therapy.
Apart from clients’ schema patterns and coping mechanisms, therapists’
own schema patterns and coping mechanisms could affect therapeutic relationship
in different formats as well (Young et al., 2003). Firstly, the patient’s schemas
19
could collide with schemas of therapists. This meant that they maintained each
other’s schemas, this could be risky for therapy of which aim was to break schema
pattern of the client. Secondly, therapists’ schemas and coping mechanisms could
be incompatible with the needs of the therapists. This meant that therapist could
not provide reparenting for the client. Therapist could behave similar to client’s
parents triggering his/her schemas. Thirdly, therapists could have the same
schemas and coping mechanisms with the ones of clients. Thus, therapists might
evaluate therapeutic process subjectively. Fourthly, patients’ emotions could
induce avoidance mechanism of the therapists. In order not to exposure emotions
of the clients, therapists might withdraw themselves to behave what was required
or beneficial for the clients. The more therapists withdrew, the more clients
expressed emotions. This pattern maintained like that. Fifthly, the patients could
induce schemas of the therapists and therapists could cope with their schemas via
overcompensation. This meant that when the clients experienced emotions
depending on their schemas, therapists could try to eradicate these emotions by
overcompensation. However, the emotions experienced by clients were not real.
They were product of schema-oriented perception of the world. The treatment
should be focused on dysfunctional structure of the schemas rather than clearing
away schema-related emotions. Overcompensation of therapists could not
eradicate schemas; instead of this, this could perpetuate the schemas. Sixthly, the
behaviors of the clients could induce dysfunctional parent mode. This meant that
as Young stated (2003), “The patient behaved like a “bad child”, triggering a
disapproving parent mode in therapist. The therapist reprimanded the parent like a
scolding parent.” Furthermore, the clients could meet the unsatisfied schema-
oriented needs of the therapists. The therapists who were not aware their own
schemas could exploit their clients unintentionally in order to satisfy their
childhood needs. This could be risky for treatment of the client. Eighthly, the
clients with inadequate improvement in therapy process could induce schemas of
the therapists. Therapists especially having defectiveness, failure or
dependence/incompetence schemas could get angry with their clients when they
did not perceive a satisfied improvement in therapy process. Ninthly, crises of
clients could induce the schemas of the therapists. Therapists could lose ability to
20
deal with the problems in functional and positive ways. Finally, if therapists had
narcissistic tendencies, they could be jealous of their clients. In this situation,
therapist could not be empathetically and candidly. This client could drop out the
therapy. This kind of therapist needed to get supervision.
Since therapy relationship was utilized as one of the main treatment
strategies, understanding therapeutic relationship and the factors affecting
therapeutic relationship was vital for Schema Therapy. Establishing rapport,
formulating the case conceptualization, and assessing the client’s reparenting
needs were all associated with therapy relationship in ongoing therapy process.
Additionally, as an important part of this relationship, Schema Therapy (Young,
1996) emphasized that a schema therapist should have characteristics, which could
meet the clients’ needs of “secure attachment, autonomy, and competence, genuine
self-expression of needs and emotions, spontaneity and play, and realistic limits”.
These characteristics were important for client in order to learn internalization of
Healthy Adult Mode by modeling therapist.
1.3. Specific Aims of the Study
Although Clinical Psychology Literature expressed the importance of
therapeutic relationship for treatment process, there were limited studies in the
literature to indicate factors affecting this pattern. Therefore, based on all these
assumptions, this study has the following specific aims:
1) To examine whether Young schema domains, coping styles and parenting
styles of supervisors, therapists and clients affect therapeutic alliance
2) To make comparison among the descriptions of the therapeutic alliance
given by supervisor, therapist, and the client
3) To develop an intrinsic measurement method to assess therapeutic alliance
4) To study Turkish premodification of Working Alliance Supervisory
Inventory-Supervisor Version and Supervisory Working Alliance
Inventory-Trainee Version
5) To compare limitations and difference between qualitative and quantitative
measures of therapeutic alliance
21
2. METHOD
2.1. Participants
The participants were consisted of three groups. First group was composed
of eight supervisors who were studying in clinical psychology doctorate program
of Middle East Technical University. Senior instructors chose these supervisors
among the students who had provided at least 200 psychotherapy sessions under
supervision and had taken psychotherapy supervision class. The supervisors
supervised a group of therapist for the first time in their education process.
Therefore, their supervision process was also supervised by the senior instructors
once a month in the department. Moreover, they also joined peer supervision once
a month. Second group was composed of twelve therapists studying in clinical
psychology master program at Middle East Technical University. These students
were continuing second year of master’s program and had taken psychotherapy
courses in the first year of this program. Furthermore, therapists also took part in
psychotherapy process for the first time. They took supervision once a week from
their supervisors and they presented their cases in front of graduate students and
instructors of clinical psychology program once a month. Both supervisors and
therapists were evaluated by the senior instructors via these case presentations. All
these supervision and psychotherapy processes were provided in Ayna Clinical
Psychology Unit. “Ayna” is a clinical support unit, which was instituted for
internship of the students studying in clinical psychology in the Psychology
Department of Middle East Technical University. In this unit, students continuing
their master or doctorate education can provide psychotherapy under supervision.
Finally, the third group consisted of eight clients applied to Ayna with complaints
of depression, anxiety, close relationship problems, or personality disorders. These
clients were mostly students who were studying in different departments of Middle
East Technical University.
22
2.2. Measures
In the present study, two types of questionnaires were used. Firstly,
quantitative, structured inventories were used in order to examine demographic
information (Demographic Information Form), early maladaptive schemas (Young
Schema Questionnaire), parental origins of early maladaptive schemas (Young
Parenting Inventory), schema avoidance (Young-Rygh Avoidance Inventory),
schema compensation (Young Compensation Inventory), and therapeutic alliance
(Working Alliance Inventory-Therapist and Client Forms and Working Alliance
Inventory- Supervisor and Therapist Forms).
As the second set of measurement, qualitative, projective, and open-ended
measurements were used in order to examine implicit perception of participants for
therapeutic alliance (Relational Circles) and psychotherapy/supervision period
(Open-ended Question Form).
2.2.1. Demographic Information Form
Demographic information form included questions regarding nicknames of
the participants, number of sessions for therapy or supervision, and psychological
approaches used in therapy or supervision sessions. Since this participant group
was a small group and the researcher was working as a research assistant in this
department, any questions related to socio-demographic characteristics of the
sample were not added to the form in order to keep confidentiality (See Appendix
B for demographic information form).
2.2.2. The Young Schema Questionnaire (YSQ)
It was developed by Young and Brown (1990). The 90-item scale measures
18 early maladaptive schemas (EMS). Adding to this, there is another YSQ
measuring 15 EMS which was developed (1990) and revised (1991) by Young and
Brown. In the present study, 90-item short form of the original YSQ was used. The
23
90-item YSQ was developed from the 205-item original YSQ. The original
questionnaire is 6-point Likert type scale (from 1 = never or almost never, to 6 =
all of the time). The Turkish adaptation of YSQ was done by Soygüt,
Karaosmanoğlu, and Çakır (2009). According to this study done with university
students, internal consistency coefficients for the EMS were found to be between
the range of .53 (unrelenting standards) and .81 (impaired autonomy) (See
Appendix C for YSQ). Number of factors were different in Turkish version. There
were fourteen schemas (namely, emotional deprivation, failure, pessimism, social
isolation/mistrust, emotional inhibition, approval seeking,
enmeshment/dependency, entitlement/insufficient self-control, self-sacrifice,
abandonment, punitiveness, defectiveness, vulnerability to harm, and unrelenting
standards). However, in this study, the original form was used and the reasons
were discussed in Chapter 3.2.1.2.
2.2.3. Young Parenting Inventory (YPI)
It was developed by Young (1994). The 72-item scale measures the origins
of the early maladaptive schemas based on parenting behavior. The questionnaire
contains 17 subscales, which identifies the most likely origin for each schema. It is
a 6-point Likert type scale (from 1 = never or almost never, to 6 = all of the time).
For each item, participants must rate the statement two times based upon how the
item describes their mothers and their fathers. The Turkish adaptation of YPI was
done by Soygüt and Çakır (2009). In Turkish adaptation, ten subscales were
determined, namely; emotionally depriving, overprotective/anxious,
belittling/criticizing, pessimistic/worried, normative, restricted/emotionally
inhibited, punitive, conditional/ achievement focused, over permissive/boundless,
and exploitative/abusive parenting. The study will be conducted based on these ten
subscales (See Appendix D for YPI). According to this study, internal consistency
coefficients for the items of mother style changed between .53 and -.86 and .61
and -.88 for the items of father style.
24
2.2.4. Young-Rygh Avoidance Inventory (YRAI)
It was developed by Young and Rygh (1991) in order to measure the
degree to which a patient utilizes various forms of schema avoidance. This
inventory, a type of 6 Likert Scale (from 1 = never or almost never, to 6 = all of
the time), consists of 40 items to evaluate the avoidance coping style of patients. It
was adapted into Turkish by Soygüt and her colleagues (in press). In this study, six
subscales were determined, namely, psychosomatic symptoms, ignoring sadness or
disturbance, emotional control, withdrawal from people, distraction through
activity, and numbness/suppressing emotions (See Appendix E for YRAI).
2.2.5. Young Compensation Inventory (YCI)
It was developed by Young (1995) in order to measure the most common
ways that a patient overcompensates for his or her schemas. It contains 48 items. It
is a 6-point Likert type scale (from 1 = never or almost never, to 6 = all of the
time). The Turkish adaptation of YPI was done by Karaosmanoğlu, Soygüt, and
Kabul (2009). In Turkish adaptation, eight subscales for the compensation method
were determined, namely; status seeking, control, rebellion, frostiness,
counterdependency, manipulation, intolerance to criticism, and egocentrism.
According to this study, internal consistency coefficients for the compensation
styles were found to be between the range of .60 and .81 (See Appendix F for
YCI).
2.2.6. Working Alliance Inventory—Therapist and Client Forms (WAI-T
and WAI-C)
These scales were developed by Horvath and Greenberg (1989). They
measure participants’ level of agreement with the goals, tasks, and emotional
bonds of therapy by depending on the concept of working alliance propounded by
25
Bordin (1979). They have 36-items including three subscales of task, goal, and
emotional bond related working alliance. They are rated on a 7-point Likert scale
ranging from 1 _ never to 7 _ always. Soygüt and Işıklı (2008) did Turkish
adaptation of the scale. According to this study, internal consistency coefficients
for the therapist form were found to be .96 while it was .90 for the client form (See
Appendix G for WAI-T and See Appendix H for WAI-C). In the present study,
working alliance was expressed with the concept of therapeutic alliance.
2.2.7. Working Alliance Inventory—Supervisor and Therapist Forms (WAI-
S and WAI-T)
Based on the items of working alliance scales (WAI-T and WAI-C) for
therapist and client developed by Horvath and Greenberg (1989), an instrument
was developed to measure working alliance for supervisor and therapist in the
present study (See Appendix I for WAI-S and See Appendix J for WAI-T). In
parallel with WAI-T and WAI-C, subscales were also consisted of goal, task, and
emotional bond oriented working alliance in the present study. In this study,
working alliance was represented by the concept of therapeutic alliance.
2.2.8. Open-ended Question Form
In the present study, in order to examine the supervisors’ and therapists’
viewpoint for difficulties met in psychotherapy or supervision processes and
coping styles with these difficulties, two open-ended questions were given at the
end of the semester (See Appendix K for Open-ended Question Form).
2.2.9. Projective Measurement-Relational Circles
In order to measure unconscious/subconscious and implicit perception of
participants for the working alliance during supervision and therapy processes that
can be missed by structured and quantitative inventories, a different qualitative
26
inventory (i.e., relational circles) was developed by the researcher inspiring from
Driver and his colleagues’ representations of supervision process. As shown in
Appendix L, three circles were used in the study. Each of three circles represented
supervisor, therapist, and the client. Location of these circles represented the
position of supervisor, therapist, and client toward each other in the psychotherapy
process. Overlapping areas of these circles indicated how much portion had been
shared by the circles representing supervisor, therapist, or the client. In order to
examine different areas of working alliance, these relational circles were used for
subscales of goals, tasks, and bond (Bordin, 1979). Participants were expected to
choose one among the given groups of the circles or to draw a new group of
circles, which had not been drawn into the form by the researcher. Then,
participants were expected to write an explanation into the form to remark why
they had chosen this group of circles. The results were associated and compared
with working alliance scales (WAI-S & WAI-T and WAI-T & WAI-C). Moreover,
results were discussed in line with participants’ schemas, family origins, and
schema coping mechanisms (See Appendix L).
3. Procedure
Before starting the present study, permission was taken both from the
Director of Ayna Clinical Psychology Unit and from Middle East Technical
University Ethical Committee. Additionally, at the beginning of the study,
participants signed the informed consent forms in order to express their volunteer
participation for this study (See Appendix A). In order to provide confidentiality,
firstly, names of the participants were hidden and nicknames were given to
participants by a person who was not involved in research. The researcher did not
know which nicknames belonged to which person. Nevertheless, participants were
informed about their own nicknames so that they could fill the inventories
according to these nicknames. Supervisors were coded by the nickname “Süper”
and a number was assigned to this nickname (e.g., Süper1). Furthermore,
therapists were coded by the nickname “Freud” and a number was assigned to this
nickname (e.g., Freud1). Moreover, clients were given the nickname “Kaşif”
27
preceded by the number of the supervisor providing supervision to his/her therapist
and followed by the number of his/her therapist (e.g., 1Kaşif5). However, the
researcher changed these nicknames while writing this dissertation in order not to
disclose what they said about each other. In the present study, three groups of
inventories were given to the participants. The first group was given only once as
the take-home format at the beginning of the research. This group was consisted of
Young Schema Questionnaire, Young Parenting Inventory, Young-Rygh
Avoidance Inventory, and Young Compensation Inventory. The second group,
which was related to therapeutic alliance, was started to be given after at least
three sessions of supervision and therapy processes since according to the
literature, therapeutic alliance started to appear after three sessions. These
inventories were applied to the participants as soon as session of supervision or
therapy was completed. For this aim, a box and envelopes were placed in the
therapy and supervision rooms. Reminding notes were placed into these rooms.
After the end of each session, participants were expected to fill these inventories;
put them into the envelope; close the envelope and put it into the box. As the third
group of assessment, non-structured inventories (e.g., relational circles and open-
ended question form) were given to the participants by the researcher at the end of
each supervision and therapy process. Participants were expected to fulfill the
relational circles for three subscales of goals, tasks, and emotional bond.
Instructions for the definitions of goal, task, and emotional bond were given to
participants by the researcher before starting to fulfill relational circles. Based on
conceptualizations of Bordin (1979), goals were defined as things/skills the
participant hoped to gain from therapy or supervision, based on his/her presenting
concerns. Tasks were defined as how the supervisor and therapist or therapist and
client agreed with the needs to be done to reach the client's goals and agreed
responsibilities. Emotional bond was described as affiliation and confidence
between either supervisor and therapist or therapist and client while trying to reach
goals.
28
4. Statistical Analysis
In this study, in order to obtain descriptive information of Young Schema
Questionnaire, Young Parenting Inventory, Young-Rygh Avoidance Inventory,
Young Compensation Inventory, Working Alliance Inventory-S/T, and Working
Alliance Inventory T/C, quantitative analyses were conducted via SPSS. On the
other hand, in order to examine relational circles and open-ended questions,
qualitative analyses were utilized. The researcher explained therapeutic alliance by
using participants’ scores on schemas, parenting style, and schema coping
mechanisms, and by their relational cycles.
29
3. RESULTS & DISCUSSION
3.1. General Results for the Study
The aim of this study was to examine whether early maladaptive schemas,
family origins of schemas, avoidance, and compensation schema coping
mechanisms of supervisors, therapists, and clients were associated with therapeutic
alliance. In order to reach this aim, qualitative and quantitative (as mentioned in
the method section) measures were given to the participants. However, only four
of the clients filled out all of the inventories, while all supervisors and therapists
completed the inventories. In the study, two types of relationship were determined
to examine therapeutic alliance. These were between either supervisor and
therapist or therapist and client. In total, 52 separate relationships were obtained.
Nevertheless, due to the limitation of space, only two of them could be illustrated
in the present study.
3.2. Differences of Demographic Variables
According to the demographic form, it was found that supervisors and
therapists used mostly Cognitive Behavioral Therapy approach (10 people).
However, it was combined either with the approaches of Psychodynamic
Approach (6 people), Schema Therapy (4 people), Relational Psychotherapy (2
people), Emotion-Focused Therapy (1 person), Attachment Oriented Therapy (1
person), Gestalt Therapy (1 person), or Psychoeducation (1 person) during
supervision and therapy sessions.
3.3. Descriptive Information for the Measures of the Study
In order to analyze descriptive characteristics of the measures, standard
deviations, and minimum-maximum ranges were examined for Early Maladaptive
Schemas; namely, emotional deprivation, abandonment/instability, mistrust/abuse,
30
social isolation/alienation, defectiveness/shame, failure,
dependence/incompetence, vulnerability to harm or illness,
enmeshment/undeveloped self, subjugation, self-sacrifice, emotional inhibition,
unrelenting standards/hypercriticalness, entitlement/grandiosity, insufficient self-
control/self-discipline, approval-seeking/recognition-seeking, pessimism, and
punitiveness; Young Parenting Inventory; namely, emotionally depriving,
overprotective/anxious, belittling/criticizing, pessimistic/worried, normative,
restricted/emotionally inhibited, punitive, conditional/achievement focused,
overpermissive/boundless, and exploitative/abusive parenting; Young-Rygh
Avoidance Inventory; namely, psychosomatic symptoms, ignoring sadness or
disturbance, emotional control, withdrawal from people, distraction through
activity, and numbness/suppressing emotions; Young Compensation Inventory;
namely, status-seeking, control, rebellion, counterdependency, manipulation,
intolerance to criticism, and egocentrism. For each participant group (i.e.,
supervisors, therapists, and clients) descriptive information for these inventories
was given in three tables (See Table1, Table2, and Table3). Furthermore,
descriptive information for Working Alliance Inventories in terms of task, goal,
and bond was given in one table for all participant groups.
3.3.1. Descriptive Measures for Young Schema Inventories for the
Supervisors
As shown in Table 1, it was found that schemas of self-sacrifice (M =
2.95), approval-seeking/recognition-seeking (M = 2.88), unrelenting
standards/hypercriticalness (M = 2.75), abandonment/instability (M = 2.63),
entitlement/grandiosity (M = 2.40), punitiveness (M = 2.28), pessimism (M =
2.03), and social isolation/alienation (M = 2.00) were mostly used ones among
supervisors. On the other hand, the results indicated that supervisors were more
likely to have emotionally depriving mother (M = 4.56) and father (M = 3.69),
pessimistic/worried mother (M = 3.21) and father (M = 2.79),
restricted/emotionally inhibited mother (M = 2.67) and father (M = 3.21),
normative mother (M = 2.53) and father (2.47), and conditional/achievement-
31
focused mother (M = 2.40) and father (2.85) as the characteristics of parents.
Furthermore, while withdrawal from people (M = 4.08) and emotional control (M
= 3.00) were mostly used as avoidance methods, frostiness (M = 3.55), control (M
= 3.50), counterdependency (M = 2.83), and status-seeking (M = 2.41) were
mostly used compensation methods in this group. Actually, the scores of Young
schema questionnaires were not in the border of psychopathology for supervisors.
However, these scores were discussed as the tendencies of supervisors in the
present study. Thus, these results did not indicate a psychopathology among
supervisors.
According to the results of supervisors’ schema characteristics, it was
noticed that these supervisors more likely came from family environment in which
they felt disconnected and rejected, other-directedness was encouraged and
emotions were inhibited (According to Young’s classification of schema domains
in 1996). These results indicated that for the supervisors, achievement, unrelenting
standards, status-seeking, and self-sacrifice were mostly used strategies in order to
cope with the extreme need of approval and acceptance from others. Maybe, since
these coping mechanisms were exaggerated and unhealthy, a pessimistic/negative
perception of the world seemed inevitable in the life of them. On the other hand,
withdrawal from people, emotional control, frostiness, control, and
counterdependency were other coping mechanisms of the supervisors against their
excessive needs. It was apparently seen that while they had tendencies to feel
threat for their acceptance or approval, they more likely chose to be withdrawn
from the environment or tried to control this environment. Besides, in order not to
be in such a position, it seemed that they had tendencies to inhibit their emotions
and did not attach to others. Based on these comments for this supervisor group, it
could be predicted that the features written below could be disruptive:
Other Directedness Domain: If supervisors extremely focused how they
were perceived by therapists, they could have missed therapeutic
relationship during the session. Moreover, if their schema of self-sacrifice
was triggered during supervision, they could not have distributed
responsibility in realistic boundaries. This could have inhibited the
development of therapists and created an artificial supervision
32
environment, in which feedback could not be given related to the skills of
the therapists.
Emotional Inhibition: If supervisors did not use open communication
methods and hided their feelings, this could have paralyzed the opportunity
of solving experienced problems. Thus, therapists could have missed the
opportunity to learn how to cope with conflicts in a real relationship.
Moreover, inhibited emotions could have caused exaggerated emotional
expressions and this could also have damaged the relationship.
Control: Supervision or therapy environment could be imponderable
sometimes. Tendencies in excessive need of control of supervisors could
have prevented behaving spontaneously during crises. Moreover, it could
have caused increment in anxiety of therapists who tried not to make
mistakes in order to be accepted from supervisors. However, a good
supervisor should have tolerance to their own anxiety and should sooth the
anxiety of the therapists. Thus, therapist could learn from their supervisors
that making mistakes was normal and acceptable. They should be accepted
from their supervisors without considering their mistakes. Thus, they could
be relaxed, open to learn from their mistakes, and educate their clients
about accepting themselves.
Driver, Martin, Banks, Mander, and Stewart (2002) also supported
the comments above. They claimed that supervision had a therapeutic
environment comprised from inner worlds of supervisor, therapist, and
client naturally. Therefore, supervisor should focus on dynamics of
supervision and withdrawal of therapist. In order to develop reciprocal
understanding in supervision period, supervisors should be active and open
to explain the issues or problems arising from intra and interpersonal
relationship. Thus, if supervisors had tendencies for other directedness
(blindness to inner world), and emotional inhibition, they could have
interrupted flow of supervision consisting of teaching, learning from intra
and interpersonal dynamics. Moreover, they (2002) expressed that
controlling and colluding were easy ways used by some supervisors in
order to prevent disapproval from therapists and feel hierarchically
33
powerful. Nevertheless, as mentioned above, these attitudes could cause
too much focus on dual relationship and ignorance of the third one. This
meant that while trying to control how s/he was perceived by therapists,
supervisors could have miss to set an example (to tolerate anxiety and to
accept making mistakes) for therapists. Thus, supervisors could not deal
with the problems related to client since they may get too much focused on
the relationship with therapist.
34
Table 1.Descriptive Information of the Measures for Supervisors Measures N Mean SD Range
(Min/
Max)
Early Maladaptive Schemas Self-sacrifice Approval-seeking/Recognition-seeking Unrelenting standards/Hypercriticalness Abandonment/Instability Entitlement/Grandiosity Punitiveness Emotional Inhibition Pessimism Social isolation/Alienation Insufficient self-control/Self-discipline Failure Vulnerability to harm or illness Subjugation Enmeshment/Undeveloped self Mistrust/Abuse Defectiveness/Shame Emotional Deprivation Dependence/Incompetence
8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
2.95 2.88 2.75 2.63 2.40 2.28 2.03 2.03 2.00 1.98 1.95 1.95 1.80 1.68 1.68 1.53 1.22 1.08
0.99 0.76 1.10 0.83 0.71 0.75 1.32 0.73 0.42 0.65 0.97 0.54 0.60 0.63 0.93 0.55 0.42 0.15
1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6
Young-Rygh Avoidance Inventory Withdrawal from people Emotional control Psychosomatic symptoms Distraction through activity Numbness/suppressing emotions Ignoring sadness or disturbance
8 8 8 8 8 8
4.08 3.00 2.23 2.08 1.63 1.60
1.06 1.01 1.01 1.02 0.74 0.51
1-6 1-6 1-6 1-6 1-6 1-6
Young Compensation Inventory Frostiness Control Counterdependency Status seeking Egocentrism Rebellion Manipulation Intolerance to criticism
8 8 8 8 8 8 8 8
3.55 3.50 2.83 2.41 2.16 1.93 1.85 1.75
0.83 0.86 0.89 0.98 0.62 0.97 0.67 0.61
1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6
Young Parenting Inventory Mother Father Mother Father Emotionally depriving Pessimistic/worried Restricted/emotionally inhibited Normative Overprotective/anxious Conditional/ achievement focused Punitive Belittling/criticizing Over permissive/boundless Exploitative/abusive
8 8 8 8 8 8 8 8 8 8
4.56 3.21 2.67 2.53 2.46 2.40 2.22 1.66 1.56 1.14
3.69 2.79 3.21 2.47 2.13 2.85 1.97 1.67 2.13 1.60
0.51 1.42 0.91 1.43 0.92 1.00 0.89 0.86 1.13 0.25
1.25 1.73 1.47 0.91 0.56 1.25 0.47 0.59 1.83 0.74
1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6
35
3.3.2. Descriptive Measures for Young Schema Inventories for the
Therapists
Considering the results for the therapists as shown in Table 2, it was
identified that schemas of unrelenting standards/hypercriticalness (M = 3.80),
approval-seeking/recognition-seeking (M = 3.60), entitlement/grandiosity (M =
3.35), self-sacrifice (M = 2.93), social isolation/alienation (M = 2.81),
abandonment/instability (M = 2.67), insufficient self-control (M = 2.62), and
punitiveness (M = 2.40) were among the strongest schemas among therapists.
Adding to this, the results indicated that the therapists mostly had emotionally
depriving mother (M = 4.18) and father (M = 3.53), conditional/achievement-
focused mother (M = 3.42) and father (3.40), pessimistic/worried mother (M =
3.19) and father (M = 3.00), restricted/emotionally inhibited mother (M = 3.08)
and father (M = 4.25), normative mother (M = 2.94) and father (3.11), and
overprotective/anxious mother (M = 2.92). Moreover, avoidance methods from
these schemas were withdrawal from people (M = 4.00), distraction through
activity (M = 3.17) and emotional control (M = 2.79) whereas mostly used
compensation methods were frostiness (M = 3.82), status-seeking (M = 3.32),
control (M = 3.32), counterdependency (M = 3.08), egocentrism (M = 2.78), and
intolerance to criticism (M = 2.69) in this group.
The mean scores for the therapists indicated that they were more likely to
have similar family origins, schemas, and coping mechanisms with supervisors in
some sense. However, they had higher degrees of these characteristics compared to
supervisors. Therapists mostly had family origin in which disconnection-rejection
existed, other-directedness was encouraged, emotions were inhibited, and impaired
limits were set (According to Young’s classification of schema domains in 1996).
According to Young’s Schema Theory (1999), it was determined that emotional
control, withdrawal from people, and distraction through activity were developed
in order to avoid the extreme need of approval and acceptance from others, while
status-seeking, control, frostiness, counterdependency, egocentrism, and
intolerance to criticism existed in order to compensate these schemas. Considering
all the information, it could be inferred that these therapists due to their family
36
origins may have learned that they could get approval and acceptance
conditionally, through the help of achievement. Therefore, they were more likely
not to satisfy with the things they have had, they may have wanted more and more.
Therefore, they could not have dealt with any critics or feedbacks coming from
environment; they may have kept themselves away from them. Maybe, their
grandiose self was fed by this egocentric structure. Thus, actual self may not be
allowed to develop since negative feedback was not accepted and processed in
their mind. This psychological structure could have affected supervision and
therapy processes differently:
Other Directedness Domain: If therapists focused how clients perceived
them, they could have missed real needs of the clients and therapeutic
relationship in the sessions (Driver et al., 2002). Moreover, if they focused
how supervisors perceived them they could have missed to focus on real
development of themselves since they could not express their mistakes or
doubts during supervision period (Driver et al., 2002).
Emotional Inhibition: If therapists inhibited emotions, a fake or masked
self could have become in touch with supervisor and the client, this could
have paralyzed the opportunity of solving existing problems (Eckler-Hart,
1987; Winnicott, 1965). Therefore, therapists could have missed the
opportunity to notice their deficiency in psychotherapy skills and thus
could not get to overcome their lacking features (Nissen-Lie & Havik,
2013). Subsequently, the clients could have missed the opportunity to learn
how to cope with conflicts in a real relationship. Moreover, inhibited
emotions could have caused exaggerated expressions and this could also
have damaged the relationship.
Entitlement/Grandiosity: A critical point was that being efficient in
psychotherapy was not only related to theoretical background of the
therapists. It was mostly related to self-knowledge, self-enhancement, and
experience (Driver, et al, 2002). Supervision period was the most important
process in order to increase the awareness about the self, enhance it, and
experience it. However, if therapists behaved in egocentric manner during
supervision and therapy sessions, actual self could not have developed
37
(Glickauf-Hughes & Mehlman, 1995). Accordingly, therapists could have
filtered the feedback of their supervisors and could not have heart what the
client told them. This could have blocked the development of the
therapists. A level of entitlement could have increased self-confidence and
become beneficial to a certain degree; nevertheless higher levels could be
detrimental to see reality.
Insufficient Self-Control/Self-Discipline: According to Young (1999),
people having insufficient self-control were associated with avoidance. If
therapists had difficulty to set self-discipline, they could have thought that
they did not need to take responsibility for the things that other people have
taken for. This could have disrupted therapeutic alliance in terms of goals
and tasks in supervision. Moreover, insufficient self-control could have
disrupted therapeutic relationship with the client as well and could have
created difficulty to set limits to the clients who also have difficulty in
setting limits.
38
Table 2.Descriptive Information of the Measures for Therapists Measures N Mean SD Range
(Min-Max)
Early Maladaptive Schemas Unrelenting standards/Hypercriticalness Approval-seeking/Recognition-seeking Entitlement/Grandiosity Self-sacrifice Social isolation/Alienation Abandonment/Instability Insufficient self-control/Self-discipline Subjugation Punitiveness Emotional Inhibition Pessimism Mistrust/Abuse Defectiveness/Shame Failure Enmeshment/Undeveloped self Emotional Deprivation Dependence/Incompetence Vulnerability to harm or illness
12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12
3.80 3.60 3.35 2.93 2.81 2.67 2.62 2.52 2.40 2.35 2.28 2.15 2.11 2.10 2.02 1.80 1.77 1.62
1.33 1.01 1.23 0.92 1.12 0.55 1.24 0.74 0.80 1.13 0.60 0.93 1.11 1.08 0.97 1.04 0.87 0.57
1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6
Young-Rygh Avoidance Inventory Withdrawal from people Distraction through activity Emotional control Ignoring sadness or disturbance Numbness/suppressing emotions Psychosomatic symptoms
12 12 12 12 12 12
4.00 3.17 2.79 2.67 2.06 1.98
0.87 1.20 0.89 0.82 0.72 0.53
1-6 1-6 1-6 1-6 1-6 1-6
Young Compensation Inventory Frostiness Status seeking Counterdependency Control Egocentrism Intolerance to criticism Rebellion Manipulation
12 12 12 12 12 12 12 12
3.82 3.32 3.08 3.32 2.78 2.69 2.43 2.13
0.71 0.92 0.82 1.09 1.10 0.76 1.32 0.75
1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6
Young Parenting Inventory Mother Father Mother Father Emotionally depriving Conditional/ achievement focused Pessimistic/worried Restricted/emotionally inhibited Normative Overprotective/anxious Punitive Belittling/criticizing Over permissive/boundless Exploitative/abusive
12 12 12 12 12 12 12 12 12 12
4.18 3.42 3.19 3.08 2.94 2.92 2.73 2.08 1.50 1.32
3.53 3.40 3.00 4.25 3.11 1.99 2.67 2.31 1.68 1.54
1.13 1.47 1.59 1.35 1.32 1.39 1.44 1.37 0.46 0.61
1.18 1.66 1.49 1.50 1.18 0.99 1.16 1.00 0.66 0.66
1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6
39
3.3.3. Descriptive Measures of Young Schema Inventories for the Clients
The results for the clients as shown in Table 3 posed that schemas of
unrelenting standards/hypercriticalness (M = 4.70), entitlement/grandiosity (M =
4.00), self-sacrifice (M = 3.98), insufficient self-control (M = 3.60), approval-
seeking/recognition-seeking (M = 3.55), punitiveness (M = 3.55), pessimism (M =
3.53), abandonment/instability (M = 3.30), social isolation/alienation (M = 3.30),
and emotional inhibition (M = 3.00) were higher among the clients. Besides, these
schemas originated from parenthood of emotionally depriving mother (M = 4.88)
and father (M = 3.63), overprotective/anxious mother (M = 4.29),
conditional/achievement-focused mother (M = 3.75) and father (3.35), normative
mother (M = 3.66) and father (3.00), pessimistic/worried mother (M = 3.58) and
father (M = 2.79), and restricted/emotionally inhibited mother (M = 2.96). On the
other hand, schema avoidance strategies mostly utilized by the clients were
detected as withdrawal from people (M = 4.54), distraction through activity (M =
4.00), emotional control (M = 3.88), and psychosomatic symptoms (M = 2.77). As
for schema compensation, many remarkable strategies were found; namely,
frostiness (M = 4.85), control (M = 4.41), egocentrism (M = 3.79),
counterdependency (M = 3.63), status-seeking (M = 3.61), rebellion (M = 3.58),
manipulation (M = 3.35), and intolerance to criticism (M = 3.21).
The mean scores for the clients showed that they mostly had family origins
in which disconnection-rejection existed, other-directedness was encouraged,
impaired limits were set, and emotions were inhibited. Based on the information
taken from the clients, it was found that many types of schemas were active and
they were maintained by many unhealthy coping mechanisms. In therapy
environment, different schema characteristics of the clients could make treatment
difficult in different ways depending on the case. However, two critical points
could be pointed out at that point. Firstly, therapists’ having the same schema
characteristics with the client could be a challenge for the therapy (Lesser, 1961
cited in Luborsky, et al., 1971; Young, 1996). For example, if therapist had faced
with difficulty in his/her life that s/he could not cope with, and faced with the same
problem with his/her client, it would be very difficult for him/her to deal with this
40
situation. Secondly, basic aims of Schema Therapy (as asserted by Young in 1996)
in treatment process were nurturing and protecting vulnerable child mode, setting
limits for the angry and impulsive child mode, challenge with critical parent mode,
fight with detached protector mode, and encourage healthy adult mode for
reparenting. If the therapist could not practice all these things and thus did not
know how healthy adult could be, it would be unrealistic to expect him/her to treat
the patient. Undoubtedly, these two problems indicated that being therapist needed
supervision and receiving psychotherapy as well (Fleischer & Wissler, 1985;
Geller, Orlinsky, & Norcross, 2005; Macran, Stiles, & Smith, 1999; Sidney, 2013).
41
Table 3.Descriptive Information of the Measures for Clients Measures N Mean SD Range
(Min/Max)
Early Maladaptive Schemas Unrelenting standards/Hypercriticalness Entitlement/Grandiosity Self-sacrifice Insufficient self-control/Self-discipline Punitiveness Approval-seeking/Recognition-seeking Pessimism Abandonment/Instability Social isolation/Alienation Emotional Inhibition Mistrust/Abuse Failure Vulnerability to harm or illness Subjugation Enmeshment/Undeveloped self Defectiveness/Shame Emotional Deprivation Dependence/Incompetence
8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
4.70 4.00 3.98 3.60 3.55 3.55 3.53 3.30 3.30 3.00 2.95 2.88 2.80 2.75 2.60 2.56 2.45 2.18
0.96 0.63 0.84 0.45 0.98 0.93 0.79 0.76 0.92 1.08 1.16 1.17 1.34 0.74 0.95 1.27 1.01 1.01
1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6
Young-Rygh Avoidance Inventory Withdrawal from people Distraction through activity Emotional control Psychosomatic symptoms Ignoring sadness or disturbance Numbness/suppressing emotions
8 8 8 8 8 8
4.54 4.00 3.88 2.77 2.66 1.96
1.22 1.23 1.47 0.84 0.77 0.77
1-6 1-6 1-6 1-6 1-6 1-6
Young Compensation Inventory Frostiness Control Egocentrism Counterdependency Status seeking Rebellion Manipulation Intolerance to criticism
8 8 8 8 8 8 8 8
4.85 4.41 3.79 3.63 3.61 3.58 3.35 3.21
0.94 1.08 1.11 1.23 1.20 1.08 2.60 1.34
1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6
Young Parenting Inventory Mother Father Mother Father Emotionally depriving Overprotective/anxious Conditional/ achievement focused Normative Pessimistic/worried Restricted/emotionally inhibited Punitive Over permissive/boundless Belittling/criticizing Exploitative/abusive
8 8 8 8 8 8 8 8 8 8
4.88 4.29 3.75 3.66 3.58 2.96 2.81 1.96 1.88 1.23
3.63 2.79 3.35 3.00 2.79 3.79 2.66 2.17 2.10 1.46
0.76 1.05 1.10 0.81 1.58 0.65 1.16 0.44 0.81 0.35
1.27 1.04 1.37 1.14 1.46 1.32 0.64 0.67 1.15 0.53
1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6
42
3.3.4. Descriptive Measures for Therapeutic Alliance
As indicated in Table 4, therapists (Task: M = 6, Goal: M = 6, Bond: M =
5.72) evaluated their task, goal, and bond oriented therapeutic alliance with
supervisors by giving higher scores compared to supervisors (Task: M = 5.80,
Goal: M = 5.77, Bond: M = 5.59). Furthermore, clients (Task: M = 5.06, Goal: M
= 5.77, Bond: M = 5.85) also gave higher scores during the evaluation of
therapeutic alliance with their therapists compared to the therapists (Task: M =
4.64, Goal: M = 5.18, Bond: M = 5.80). These differences were not notable;
however, one outstanding factor was that the group who took part in a lower
hierarchic position evaluated the process as being better than the group taking part
in the higher hierarchic position. It could be resulted from the need of idealization
(Luborsky, Chandler, Auerbach, Cohen, & Bachrach, 1971). Moreover, it could
show that there were things that were not talked openly between groups since
perception of two groups were somehow different from each other.
Table 4.General Therapeutic Alliance Scores of Supervisors, Therapists, and Clients Task Goal Emotional Bond
Participants Mean SD Mean SD Mean SD
Supervisors (340sessions) 5.77 0.67 5.80 0.67 5.59 0.83 Therapists-S (338 sessions) 6 0.56 6 0.47 5.72 0.62 Clients (83 sessions) 5.06 0.40 5.77 0.42 5.85 0.55 Therapists-C (85 sessions) 4.64 0.32 5.18 0.34 5.80 0.22
3.4. Correlation Coefficients between Groups of Variables
In order to determine the relationship between Early Maladaptive Schemas
[i.e., emotional deprivation, abandonment/instability, mistrust/abuse, social
isolation/alienation, defectiveness/shame, failure, dependence/incompetence,
vulnerability to harm or illness, enmeshment/undeveloped self, subjugation, self-
sacrifice, emotional inhibition, unrelenting standards/hypercriticalness,
entitlement/grandiosity, insufficient self-control/self-discipline, approval-
seeking/recognition-seeking, pessimism, and punitiveness], Young Parenting
Inventory measures [i.e., emotionally depriving, overprotective/anxious,
43
belittling/criticizing, pessimistic/worried, normative, restricted/emotionally
inhibited, punitive, conditional/achievement focused, overpermissive/boundless,
and exploitative/abusive parenting], Young-Rygh Avoidance Inventory measures
[i.e., psychosomatic symptoms, ignoring sadness or disturbance, emotional
control, withdrawal from people, distraction through activity, and
numbness/suppressing emotions], Young Compensation Inventory measures [i.e.,
status seeking, control, rebellion, counterdependency, manipulation, intolerance to
criticism, and egocentrism] with Working Alliance Inventory measures [i.e., goal
oriented therapeutic alliance, task oriented therapeutic alliance, and emotional
bond oriented therapeutic alliance] Pearson’s correlation analyses were performed.
Four analyses were conducted in order to determine the therapeutic alliance
between either supervisor and therapist or therapist and the client.
3.4.1. Correlation Coefficients between Groups of Variables for Supervisors
in Supervision Settings
According to the results for supervisors’ evaluation of therapeutic alliance
with therapists (See Table 5), goal oriented therapeutic alliance revealed
significant negative correlation with avoidance strategy of intentionally not
thinking about upsetting things (r = -.85, p < .01) and positive correlation with task
oriented therapeutic alliance (r = .97, p < .001). On the other hand, there were also
significant correlations between task oriented therapeutic alliance and schema
avoidance method of intentionally not thinking about upsetting things (r = -.80, p <
.05). Furthermore, emotional bond oriented therapeutic alliance indicated
significant positive correlation with schema of subjugation (r = .74, p < .05),
having pessimistic/worried mother (r = .81, p < .05), and having
exploitative/abusive father (r = .77, p < .05), while there were significant negative
correlations between emotional bond oriented therapeutic alliance and having
restricted emotionally inhibited father (r = -.85, p < .01) and intentionally not
thinking about upsetting things (r = -.82, p < .05). Thus, using intentionally not
thinking about upsetting things as schema avoidance strategy was correlated lower
levels of goal, task, and emotional bond oriented therapeutic alliance. This could
44
be because supervisors, who did not want to see problems and did not voice the
problems, were not satisfied with collaboration of the therapists. Nevertheless,
they did not explain it. Since they did not notice it, accept it, and voice it, they
could not solve the problems. Therefore, it can be inferred that there could be
many things that were not talked and handled during supervision. Supervisors
behaved as if everything was okay. Nevertheless, according to Prochaska and
Norcross (2006), in order to change, firstly, existence of a problem should be
accepted and voiced. This attitude of supervisors could be resulted from the need
of love, approval, and acceptance of the supervisors as it was mentioned in the
descriptive measures of Young Schema Inventories. On the other hand, if
supervising was associated with the role of parenthood (with the inner voice of
“You know psychotherapy, now teach how to make psychotherapy!”) and if being
psychotherapist was related with the role of childhood, maybe supervisors in this
parenthood role tried to give unlimited approval and acceptance to their children
(the therapists) and ignored their own sadness, since they did not obtain expected
approval and acceptance from their parents during their childhood (Driver et al.,
2002). Therefore, maybe in order to try to be better parents for these therapists,
they chose a wrong way by trying to compensate their own childhood needs
(Young, 1996). Trying to develop better alliance, they did not open their actual
self. They created masked, fake, and misleading supervision environment
(Winnicott, 1965). Therefore, while ignoring own sadness/disturbance, therapeutic
alliance got worse.
Furthermore, having higher levels of subjugation was correlated with
higher emotional bond oriented therapeutic alliance. According to Young (1999),
subjugation took part under the domain of other-directedness and was associated
with excessive compliance to others by suppressing own emotions, thoughts, and
decisions against being rejected and exposure to anger from others. From this point
of view, it could be inferred that if supervisors suppressed their own needs,
emotions, and desires, they could have thought that they had better emotional
bond. It meant that subjugation schema was activated in supervisors’ relationship
with therapists since they knew to use suppressing themselves in order to make
good relationship. Nevertheless, as mentioned above, ignorance
45
sadness/disturbance and suppressing real needs was associated with worse
interpersonal functioning (Gross & John, 2003) and caused decrements in the
perception of what was going on in supervision room (therapeutic alliance). Young
(1999) especially stated that people having higher levels of subjugation had
tendency for passive aggressive behavior, extreme expression of emotions.
Therefore, emotional bond’s being dependent on subjugation was not something
healthy. It could result in outbursts of emotions.
As for family origins, having pessimistic/worried mother and having
exploitative/abusive father were correlated higher levels of emotional bond. It
could be a kind of compensation method of supervisors’ own needs and childhood
(Young, Klosko, & Weishaar, 2003). It meant that if a supervisor grew up with
pessimistic mother and exploitative father, maybe s/he did not live an expected
emotional bond with these parents. While father was exploitative and mother was
pessimistic, there was no hope at this home. Maybe the supervisors chose to study
psychology in order to exist out from this dark and hopeless picture since they
wanted to change their life unconsciously. Maybe, s/he tried to maintain a good
relationship by compensating for his/her own childhood (i.e., behaving in a way
opposite of his/her parents). Thus, s/he perceived (thought it would be better if I
did not behave like my parents) a higher emotional bond with therapist. On the
other hand, a family environment with the characteristics of worried/pessimistic
and exploitative/abusive parents could provoke to develop depression easily.
According to Scott et al. (2000), if a person had depression with the symptoms of
hopelessness, low self-esteem, and guilt, s/he could have tendency to develop
dependent relationship with others. Therefore, maybe, with the effect of dependent
relationship needs, supervisors could have evaluated emotional bond better.
Additionally, having restricted/emotionally inhibited father was correlated with
lower levels of emotional bond. This finding could be resulted from the father’s
position and functionality during child development at home as explained before.
According to Cabrera and his colleagues (2000), fathers emboldened their children
to take risks, be independent, and compete with others. Additionally, Tessman (as
cited in Russell and Saebel, 1997) argued that fathers were important for their
daughters especially for learning loving and working. Accordingly, fathers
46
represented the outer world of their children and a strong predictor in interpersonal
relationship (Lamb, 1975; Lamb, Pleck, & Levine, 1985). Thus, fathers
represented how children would contact with outer world and reality and how they
would open their inner world to outer world. Therefore, a restrictive/emotionally
inhibited father could have interrupted learning partnership, sharing, and
collaboration. Thus, therapists with this kind of father could have difficulty in
setting common goals with their clients.
Finally, higher levels of goal oriented therapeutic alliance were correlated
with higher levels of task oriented therapeutic alliance. It could derive from that
goal and task subscales of the working alliance inventories could not be
differentiated from each other. On the other hand, it could arise from another
perception that having agreed aims meant agreed distribution of responsibility to
reach these aims. However, sometimes, people knew that there was a problem and
what should be done (goals), but they did not want to take responsibility to solve
these problems (task). Therefore, in order to understand the reasons behind the
perception of similarity between goal and task, more application to more
participants could be conducted in the future.
Table 5.Pearson correlations between young schemas, young coping mechanisms, young parenting
styles, and therapeutic alliance variables of supervisors with therapists
Goal Task Bond
Subjugation .24 .32 .74*
Having pessimistic/worried
mother .51 .46 .81*
Having exploitative/abusive
father .43 .52 .77*
Having restricted
emotionally inhibited father -.36 -.42 -.85**
Intentionally not thinking
about upsetting things -.85** -.80* -.82*
Goal - .97*** .56
Task .97*** - .53
Bond .56 .53 -
Note. * p < .05, ** p < .01, *** p < .001.
47
3.4.2. Correlation Coefficients between Groups of Variables for Therapists
in Supervision Settings
According to the results for therapeutic alliance of therapists with the
supervisors as shown in Table 6, goal oriented therapeutic alliance indicated
significant positive correlation with having emotionally depriving mother (r = .62,
p < .05), task oriented therapeutic alliance (r = .89, p < .001), and emotional bond
oriented therapeutic alliance (r = .77, p < .001). On the other hand, task oriented
therapeutic alliance had significant negative correlation with having punitive
mother (r = -.63, p < .05), while there was a significant positive correlation with
emotional bond oriented therapeutic alliance (r = .89, p < .001). Moreover,
emotional bond oriented therapeutic alliance indicated significant negative
correlations with schema of punitiveness (r = -.65, p < .05), schema avoidance
strategies of control (r = -.63, p < .05) and manipulation (r = -.60, p < .05), and
having punitive mother (r = -.68, p < .05).
As for the position of therapists during supervision, having higher levels of
punitiveness schema, control, and manipulation were correlated with lower levels
of emotional bond oriented therapeutic alliance. According to Young (1999),
punitiveness schema depends on the belief that “people should be harshly punished
for their mistakes” and this schema includes “tendency to be angry, intolerant,
punitive, and impatient with those people (including oneself) who do not meet
one’s expectations and standards”. From this definition of the schema, it can be
inferred that therapists with this schema could be afraid of making emotional
bonds with supervisors in order to protect themselves since if they made emotional
bond with the supervisor and made any mistake during supervision period,
breaking of this emotional bond could be a big disappointment. On the other hand,
it seems that from the side of these therapists, supervisors could have been
perceived just as an instructor or parent. If so, therapists could focus on not
making mistake, instead of learning from mistakes. In this anxious situation, not
making mistake seems impossible. Thus, they could have needed a strategy to
direct this supervision process. Most probably, in order to compensate their
48
mistakes they used strategies of control and manipulation. They were devoid of
making emotional bonds with their supervisors.
Furthermore, having emotionally depriving mother was correlated with
higher levels of goal and emotional bond oriented therapeutic alliance. It could be
due to starvation of building partnership and affiliation that these therapists had
not obtained from their mothers. On the other hand, having punitive mother was
correlated lower levels of task oriented and emotional bond oriented therapeutic
alliances (Durlak, 1998). Actually, having punitive parent was a trigger factor to
build a schema of punitiveness (Young, 1996). Correspondingly, as explained
above, therapists with fear of making mistake could not have taken responsibility
and felt affiliation with the supervisors.
Apart from these, goal oriented therapeutic alliance was correlated with
higher levels of task oriented and emotional bond oriented therapeutic alliances.
From this result, it seemed that if these therapists perceived higher therapeutic
alliance for any one in goal, task, and bond orientations, they also perceived a
higher therapeutic alliance for the rest. As mentioned in the part of descriptive
characteristics of schemas for therapists, other directedness was one of the
remarkable schema domains for these therapists. Maybe, since these therapists
knew to get acceptance, approval, and attraction conditionally especially with
achievement (as Young stated in 1996), they perceived goals, tasks of supervision
together with emotional bond. It seemed that if these therapists were given
negative feedback from their performance related to task, they could have had
tendency to perceive it personally and generalize it to goals of supervision and
emotional bonds with supervisors.
49
Table 6.Pearson correlations between young schemas, young coping mechanisms, young parenting
styles, and therapeutic alliance of therapists with their supervisors
Goal Task Bond
Punitiveness -.17 -.46 -.65*
Control -.30 -.53 -.63*
Manipulation -.36 -.57 -.60*
Having emotionally
depriving mother .62* .47 .61*
Having punitive mother -.41 - .63* -.68*
Goal - .89*** .77***
Task .89*** - .89***
Bond .77*** .89*** -
Note. * p < .05, ** p < .01, *** p < .001.
3.4.3. Correlation Coefficients between Groups of Variables for Therapists
in Therapy Settings
In the results for therapeutic alliance of therapists with clients as shown in
Table 7, goal oriented therapeutic alliance showed significant negative correlation
with having restricted/emotionally inhibited father (r = -.81, p < .05) and positive
correlations with numbness/suppressing emotions (r = .86, p < .05) and task
oriented therapeutic alliance (r = .87, p < .05). Furthermore, task oriented
therapeutic alliance had significant negative correlations with schema of social
isolation (r = -.82, p < .05) and frostiness (r = -.88, p < .05). Moreover, emotional
bond oriented therapeutic alliance revealed significant negative correlation with
schema of pessimism (r = -.86, p < .05).
According to the results, higher levels of task oriented therapeutic alliance
were correlated with lower levels of social isolation and lower levels of frostiness.
According to Young (1999) social isolation schema imposed the feeling of “being
isolated from the world, different from others and not part of any group”.
Additionally, this schema took part under disconnection and rejection schema
domain. All these meant that therapists with social isolation schema could not have
felt belonging to their clients; thus, they could not have wanted to take
responsibilities for therapeutic relationship. As Young asserted (1999), this schema
originated from detached, cold, and rejecting family. With activation of this
schema in therapeutic relationship, maybe, therapists could not have allowed the
50
clients affiliate and they could have maintained their maladaptive schemas by that
way. Moreover, they could have used the compensation strategy of frostiness in
that relationship, have felt free, and did not take required responsibilities for
therapy process.
Moreover, higher pessimism was correlated lower levels of emotional
oriented bond. Actually, this arised from the structure of this schema. Activation of
pessimism schema (as Young asserted, 1996) brought exaggerated feeling of
“something bad will happen”. Therefore, these people with this schema always
could have looked around to find something bad, disruptive, or negative and
neglect positive sides of the situations. Therefore, it was possible that therapists
with this schema could have missed the positive things in the relation with their
clients (Seligman, Reivich, Jaycox, & Gillham, 1995).
According to one another result, there was correlation between higher
levels of numbness/suppressing emotions and higher levels of goal oriented
therapeutic alliance. Actually, numbness/suppressing emotions were an avoidance
strategy to cope with negative feelings coming from maladaptive schemas and
undesirable things happening around (Richards & Gross, 1999). If therapists had
schemas being active in the therapeutic relationship with their clients, maybe they
could not have concentrated on their work due to their own negative emotions
(Ludwig, 1983). Therefore, they tried to focus on the work by dissociating
themselves. Although it was not real, therapists could have thought that their goal
oriented therapeutic alliance was high by the effect of numbness/suppressing
emotions. Thus, they could have deprived their clients from experiencing real
relationship.
On the other hand, having restricted/emotionally inhibited father was
correlated lower levels of goal oriented therapeutic alliance. This finding can be
resulted from the father’s position and functionality during child development at
home as explained before. According to Cabrera et al. (2000), fathers emboldened
their children to take risks, being independent and compete with others.
Additionally, Tessman argued that fathers were important for their daughters
especially for learning loving and working (as cited in Russell and Saebel, 1997).
Accordingly, fathers represented the outer world of their children and a strong
51
predictor in interpersonal relationship (Lamb, 1975; Lamb, Pleck, & Levine,
1985). Thus, fathers represented how children contacted with outer world and
reality. Therefore, a restrictive/emotionally inhibited father could interrupt
learning partnership, sharing, and collaboration. Thus, a restrictive/emotionally
inhibited father could interrupt learning partnership, sharing, and collaboration.
Therefore, therapists with this kind of father could have had difficulty in setting
common goals with their clients.
Finally, there was a correlation between higher levels of goal oriented
therapeutic alliance and task oriented therapeutic alliance. It can be resulted from
the reasons explained before in the part of 3.4.2.
Table 7.Pearson correlations between young schemas, young coping mechanisms, young parenting
styles, and therapeutic alliance variables of therapists with their clients
Goal Task Bond
Social Isolation -.71 -.82* -.51
Pessimism -.09 -.39 -.86*
Frostiness -.68 -.88* -.05
Numbness/suppressing
emotions .86* .67 -.10
Having restricted/
emotionally inhibited father -.81* -.71 .07
Goal - .87* .15
Task .87* - .40
Bond .15 .40 -
Note. * p < .05, ** p < .01.
3.4.4. Correlation Coefficients between Groups of Variables for Clients in
Therapy Settings
According to the results from the side of the clients as shown in Table 8,
goal oriented therapeutic alliance indicated a significant positive correlations with
schema of entitlement/grandiosity (r = .95, p < .05), frostiness (r = .92, p < .05),
and task oriented therapeutic alliance (r = .90, p < .05), whereas it showed a
significant negative correlation with having pessimistic father (r = -.89, p < .05).
Besides, task oriented therapeutic alliance had significant positive correlations
with the schema of entitlement/grandiosity (r = .95, p < .05). Moreover, emotional
bond oriented therapeutic alliance revealed significant positive correlation with the
52
schema of entitlement/grandiosity (r = .93, p < .05) and significant negative
correlation with having pessimistic father (r = -.93, p < .05).
According to the results, higher levels of entitlement/grandiosity schema
were correlated with higher levels of goal, task, and emotional bond oriented
therapeutic alliance. According to Schema Theory (Young, 1996),
entitlement/grandiosity schema originated from impaired realistic limits and arised
from the belief of being superior to others, need of owning power, and control.
Clients with this schema evaluated higher levels of therapeutic alliance with their
therapists. It could be explained with two viewpoints. Firstly, maybe these clients
applied to psychotherapy since they did not tolerate inferiority. They noticed a
problem in their lives, felt the self-confidence to change it, cooperated with their
therapists for goals and tasks of psychotherapy, and affiliated with their therapists.
It meant that these people were in the stage of action of Prochaska and DiClemente
(1986) (aware of the problem, gathered information related to his problem from
environment and now ready/motivated to change). Secondly, if these clients had
grandiose self, they could think that there was a functional, beneficial, and
emotional therapeutic alliance with their therapists since they chose this therapist.
They could not go to a therapist who was not good at his/her work. However, this
perception could not be real. The trouble was that if there was something
disrupting therapeutic alliance, which was arisen from the client, s/he could not
want to notice and accept it due to its grandiose self (self-aggrandizer mod as
Young asserted in 1996). Nevertheless, even if it was like that, idealization of the
therapy in the eyes of the client could increase motivation of this client for the
psychotherapy to a certain degree. Thus, this client could develop himself/herself
by the help of this motivation. On the other hand, maybe these clients were not
applied limited reparenting by their therapists as it was explained in Schema
Therapy. Thus, the clients could have maintanained their maladaptive structure
also in therapy settings and self-aggrendizor mode could be dominant in therapy.
In such a position, no development could be seen.
Furthermore, higher level of frostiness as schema compensation strategy
was correlated with higher levels of goal oriented therapeutic alliance. The result
could be arised from the structure of frostiness. According to Young (1999), this
53
coping mechanism was used to compensate dependency and other-directedness.
The person using this mechanism could be aware of tendency for dependency and
other-directedness and could want to get rid of them. Since s/he did not know to
act freely in a healthy way and drew boundaries to others, s/he rigidly could
exclude necessary and beneficial bonds. The clients who used this strategy in their
relationships could not be fed from deep relationships and could not make bonds
with others Derlega & Chaikin, 2010). Therefore, they could feel isolated from the
society and lack of social support (Solano, Batten, & Parish, 1982). Maybe,
therefore they decided to receive psychotherapy and noticed that there was
something wrong in their life. Thus, when they received psychotherapy, they
collaborated with their therapists in terms of the goals in order to change their
problems.
On the other hand, having pessimistic father was correlated with higher
levels of goal and task oriented therapeutic alliance. This can be explained by
fathers’ important role for child development in terms of interpersonal relationship
as explained before in Chapter 3.4.3.
Moreover, higher levels of goal oriented therapeutic alliance were
correlated with higher levels of task oriented therapeutic alliance. This could be
resulted from the structure of inventories or perception of the participants as
mentioned above.
Table 8.Pearson correlations between young schemas, young coping mechanisms, young parenting
styles, and therapeutic alliance variables for clients’ perception of therapeutic alliance with their
therapists
Goal Task Bond
Entitlement/Grandiosity .95* .95* .93*
Frostiness .92* .74 .85
Having pessimistic father -.89* -.79 -.93*
Goal - .90* .84
Task .90* - .80
Bond .84 .80 -
Note. * p < .05, ** p < .01.
54
3.5. Case Examples to Illustrate the Relationship of Young Schemas,
Young Coping Mechanisms, Young Parenting Styles with Therapeutic
Alliance
In order to exemplify the relationship of Early Maladaptive Schemas,
Young Parenting Inventory measures, Young-Rygh Avoidance Inventory
measures, Young Compensation Inventory measures with Working Alliance
Inventory measures, the two case examples were written below. The first one
included a triangular relationship among Supervisor A, Therapist B, and Client C
while the second one consisted of a dual relationship between Supervisor M and
Therapist K.
3.5.1. Case of SupervisorA-TherapistB-ClientC
In this case, Supervisor A carried on supervision with an eclectic approach
including CBT, attachment, and dynamic orientations with Therapist B. On the
other hand, Therapist B used CBT approach combined with relationship oriented
psychotherapy methods for Client C who indicated dependent personality
characteristics and difficulty in building relationship. For this group, at the
beginning, schema scales were applied and the remarkable schema characteristics
were represented as written below.
3.5.1.1. Characteristics of Supervisor A
According to the results, Supervisor A had the remarkable schemas of
abandonment, approval-seeking, insufficient self-control, defectiveness, and self-
sacrifice (See Table 9). In order to compensate these schemas, the mostly used
coping mechanisms by Supervisor A were control, status seeking, frostiness, and
counterdependency as shown in Table 10. On the other hand, withdrawal from
people, emotional control, and psychosomatic symptoms were the most
noteworthy schema avoidance strategies that were used by Supervisor A (See
Table 11). Besides, it was identified that Supervisor A had a mother who had been
55
pessimistic/worried, emotional depriving, overpermissive/boundless,
conditional/achievement focused and a father who had been pessimistic/worried,
overpermissive/boundless, emotional depriving, exploitative/abusive, and
conditional/achievement focused respectively (See Table 12 and 13).
Table 9.Early Maladaptive Schemas for Supervisor A
1
2
3
4
5
6
56
Table 10.Types of Overcompensation of Schemas for Supervisor A
Table 11. Types of Avoidance for Supervisor A
0,00
1,00
2,00
3,00
4,00
5,00
6,00
0
1
2
3
4
5
6
Withdrawal from people Emotional control Psychosomatic symptoms
57
Table 12.Characteristics of Mother of Supervisor A
Table 13.Young Fatherhood Styles for Supervisor A
0
1
2
3
4
5
6
0
1
2
3
4
5
6
58
3.5.1.2. Characteristics of Therapist B
As for the Therapist B, the noteworthy schemas were self-sacrifice,
unrelenting standards, approval-seeking, entitlement/grandiosity, and insufficient
self-control (See Table 14). The most outstanding coping strategies used by
Therapist B were frostiness, status-seeking, control, intolerance to criticism,
counterdependency, and manipulation in order to avoid from schemas (See Table
15). Distraction through activity, emotional control, intentionally not thinking
about upsetting things, and withdrawal from people were the mostly used
compensation methods by Therapist B (See Table 16). According to parenthood
styles, Therapist B reported an emotional depriving, conditional/achievement
focused, punitive, overprotective/anxious, restricted/emotionally inhibited, and
normative mother remarkably (See Table 17) and normative,
conditional/achievement focused, restricted/emotionally inhibited,
belittling/criticizing, and overpermissive/boundless father characteristics (See
Table 18).
Table 14.Early Maladaptive Schemas for Therapist B
0
1
2
3
4
5
6
59
Table 15.Types of Overcompensation of Schemas for Therapist B
Table 16.Types of Avoidance for Therapist B
0
1
2
3
4
5
6
0
1
2
3
4
5
6
Distraction throughactivity
Emotional control Intentionally notthinking about
upsetting things
Withdrawal frompeople
60
Table 17.Characteristics of Mother of Therapist B
Table 18.Characteristics of Father of Therapist B
0
1
2
3
4
5
6
0
1
2
3
4
5
6
61
3.5.1.3. Characteristics of Client C
According to the results for Client C, the most outstanding schemas were
entitlement/grandiosity, self-sacrifice, unrelenting standards, abandonment,
pessimism, punitiveness, and insufficient self-control (See Table 19). All
compensation methods (i.e., frostiness, intolerance to criticism, control,
counterdependency, egocentrism, status-seeking, rebellion, and manipulation)
were frequently used by Client C; however from these, frostiness was
exaggeratedly used by Client C (See Table 20). Furthermore, distraction through
activity, withdrawal from people, emotional control, intentionally not thinking
about upsetting things, and psychosomatic symptoms were the most noteworthy
avoidance methods (See Table 21). On the other hand, the results indicated that
emotional depriving, overprotective/anxious, normative, and
conditional/achievement focused mother features and restricted/emotionally
inhibited and belittling/criticizing father characteristics (See Table 22 and Table
23).
Table 19. Early Maladaptive Schemas for Client C
0
1
2
3
4
5
6
62
Table 20.Types of Overcompensation of Schemas for Client C
Table 21.Types of Avoidance for Client C
0123456
0
1
2
3
4
5
6
Distractionthrough activity
Withdrawal frompeople
Emotional control Intentionally notthinking about
upsetting things
Psychosomaticsymptoms
63
Table 22.Characteristics of Mother of Client C
Table 23.Characteristics of Father of Client C
0
1
2
3
4
5
6
0
1
2
3
4
5
6
64
3.5.1.4. Therapeutic Alliance between Supervisor A and Therapist B
with the Associations of Schema Theory
In order to examine therapeutic alliance between Supervisor A and
Therapist B, seven measurements could be obtained. From these measurements,
general, goal, task, and emotional bond oriented therapeutic alliance means were
acquired. Obtained scores were evaluated by making comparisons between
Supervisor A and Therapist B by making associations with Early Maladaptive
Schemas [i.e., emotional deprivation, abandonment/instability, mistrust/abuse,
social isolation/alienation, defectiveness/shame, failure,
dependence/incompetence, vulnerability to harm or illness,
enmeshment/undeveloped self, subjugation, self-sacrifice, emotional inhibition,
unrelenting standards/hypercriticalness, entitlement/grandiosity, insufficient self-
control/self-discipline, approval-seeking/recognition-seeking, pessimism, and
punitiveness], Young Parenting Inventory measures [i.e., emotionally depriving,
overprotective/anxious, belittling/criticizing, pessimistic/worried, normative,
restricted/emotionally inhibited, punitive, conditional/achievement focused, over
permissive/boundless, and exploitative/abusive parenting], Young-Rygh
Avoidance Inventory measures [i.e., psychosomatic symptoms, ignoring sadness
or disturbance, emotional control, withdrawal from people, distraction through
activity, and numbness/suppressing emotions], Young Compensation Inventory
measures [i.e., status-seeking, control, rebellion, counterdependency,
manipulation, intolerance to criticism, and egocentrism].
3.5.1.5. Therapeutic Alliance between Supervisor A and Therapist B
depending on Quantitative Measurement and Its Associations with
Schema Theory
According to the general results for therapeutic alliance between
Supervisor A and Therapist B, it was determined that Supervisor A perceived more
therapeutic alliance in their supervision period compared to Therapist B (See Table
65
24). At the beginning of the measurement, Supervisor A reported the highest
therapeutic alliance score for Therapist B. Then, there happened a fluctuation
when the time went on. On the other hand, Therapist B started with the lowest
score. Then, the evaluations of Therapist B for this supervision period increased
progressively. Nevertheless, at the session when Supervisor A gave the lowest
score for therapeutic alliance for Therapist B (9th supervision), interestingly
Therapist B gave the highest score for Supervisor A. Additionally, the highest
score given by Supervisor A came up to the time when the Therapist B gave the
lowest score. According to this result, it seems that there were issues, which were
not handled or talked openly between Supervisor A, and Therapist B. Moreover, it
seemed that the things perceived as good or bad from Supervisor A or Therapist B
were perceived as opposite for the other one. There was a difference between their
perceptions of building relationships.
Furthermore, in the evaluation of goal, task, and emotional-bond oriented
therapeutic alliance, there was a distinctive decline of the score given by
Supervisor A (7th supervision) (See Table 25, Table 26, and Table 27). However, it
seemed that Therapist C was not aware of this situation. Maybe, Supervisor A
ignored this or handled it during supervision. Similarly, at the 12th supervision
session, there was prominent decline of the score given by Therapist B for
emotional bond oriented therapeutic alliance and it was not noticed by Supervisor
A (See Table 27). It seemed that there could be lack of clear and open
communication between Supervisor A and Therapist B during supervision.
Depending on all these results, firstly, Therapist B’s tendency to give lower
score for alliance could be explained by his/her maintenances of unrelenting
standards and entitlement schemas. As Young stated (1999), people with these
schemas had tendencies to undervalue and devalue while evaluating others and
achievement. Moreover, Supervisor A’s starting with higher scores could derive
from fight with his/her pessimistic and achievement focused parents. Maybe s/he
did not want to be like them in the “role of parent”. According to Klein (1952),
parents with unhealthy attitude used projective identification in order to load their
unmet wishes and needs to their children. Additionally, Cashdan (1988) claimed
that projective identification meant forcing a person to behave according to your
66
own psychological structure. However, if the person, who was forced, had
different characteristics from the other one or if s/he had therapeutic awareness,
s/he could reject this unhealthy cycle (Cashdan, 1988) as similar as attitude of
Supervisor A in the present study. On the other hand, emotional control
mechanism could be affective on the sudden decrease in Supervisor A’s
evaluation. Since s/he did not express his/her emotions promptly and maybe
suppressed, emotion’s effect (decrease) was high (Gross, 2002). Additionally,
emotional control used by Therapist B and Supervisor A as maladaptive coping
mechanism could be effective on lack of clear and open communication between
Supervisor A and Therapist B during supervision.
Table 24.General Therapeutic Alliance between Supervisor A and Therapist B
0
1
2
3
4
5
6
7
Supervisor A
Therapist B
67
Table 25.Goal Oriented Therapeutic Alliance between Supervisor A and Therapist B
Table 26.Task Oriented Therapeutic Alliance between Supervisor A and Therapist B
0
1
2
3
4
5
6
7
Supervisor A
Therapist B
0
1
2
3
4
5
6
7
Supervisor A
Therapist B
68
Table 27.Emotional-Bond Oriented Therapeutic Alliance between Supervisor A and Therapist B
3.5.1.6. Therapeutic Alliance between Supervisor A and Therapist B
depending on Qualitative Measurement and Its Associations with
Schema Theory
Depending on relational circles for Supervisor A (as shown in Figure 2),
Supervisor A thought that supervisor and therapist had shared goals; however, the
client was not involved in this shared goals according to the perception of
Supervisor A. Therapist B perceived balanced shared or independent goals among
supervisor, therapist, and client (See Figure 2). From the results, it was understood
that there was not a parallel perception for goal oriented therapeutic alliance
between Supervisor A and Therapist B. In terms of Supervisor A, it was realized
that Supervisor A focused on the relationship of therapist and supervisor in terms
of goals. S/he ignored shared goals with clients. This could be because the
supervisor worked as supervisor for the first time; s/he did not balance his/her
focus for shared goals of therapist and client. Additionally, due to the schemas and
origins of the schemas of Supervisor A, Supervisor A was maybe afraid of being
abandoned and getting no approval from Therapist B based on his/her emotionally
0
1
2
3
4
5
6
7
Supervisor A
Therapist B
69
depriving and achievement focused parents. According to Ladany, Constantine,
Miller, and Erickson (2000), supervisors’ unresolved past issues affected
supervision environment. In order to cope with his/her unhealthy childhood
experiences’ effect, Supervisor A could have used control as maladaptive coping
style; maybe s/he concentrated too much on keeping a stable relationship with the
therapist and forgot the goals of the client. On the contrary, Ladany, Constantine,
Miller, and Erickson (2000) asserted that supervisors’ talking his/her difficulties
during supervision with therapist could be consolidating therapeutic relationship
instead of controlling. On the other hand, Therapist B evaluated this supervision
process in realistic limits.
As for task (See Figure 2), Supervisor A perceived shared or independent
tasks among the supervisor, the therapist, and the client in a balanced manner. On
the other hand, Therapist B considered equal, overlapped, and biggest share of
tasks for therapist and the client; however, the smallest and completely dependent
(all tasks which Supervisor A had were related to Therapist B and Client C) task
for supervisor. According to this result, it was inferred that Supervisor A thought
that everybody in this process had equal responsibility ideally. On the other hand,
Therapist B considered that Supervisor A did not have any other responsibility in
this process independent from Therapist B and Client C. Additionally; Supervisor
A had the smallest responsibility in this group. It was understood that Therapist B
could have undervalued the contribution of Supervisor A. It could be resulted from
a hidden anger of Therapist B to Supervisor A (suppressed emotion, Gross, 2002).
Maybe since Therapist B had the schemas of unrelenting standards, defectiveness
and entitlement/grandiosity, s/he needed to exaggerate own responsibilities to cope
with high expectations from oneself and maintained the belief of own competency
by transferring emotional depriving, achievement focused, and belittling/criticizing
parents to his/her supervisor (the effect of unresolved issues from childhood as
expressed from Young (1999)). On the other hand, it was maybe related to being
caught by projective identification of the client. As Klein (1952) stated as
projective identification, maybe Therapist B positioned himself/herself in a
dependent relationship with his/her client and was not aware of the supervisor (as
answer to client’s desire of integration with mother). Besides, Therapist B
70
described an equal responsibility with Client C. It could be related to self-sacrifice
or grandiosity of Therapist B. Firstly, since Therapist B had schemas under other-
directedness schema domain, Therapist could have overvalued responsibility of
Client C (Young, Klosko, & Weishaar, 2003). Secondly, both Therapist B and
Client C had grandiosity and intolerance to criticism as for schema compensation
mechanism. Therefore, Therapist B could have compensated this schema and
could have overvalued responsibility of Client C (Young, 1996).
For emotional bond (See Figure 2), Supervisor A figured an enmeshed
alliance between the therapist and the client and a small portion of relatedness of
himself/herself. Nevertheless, Therapist B perceived a nonfunctional enmeshed
alliance among the supervisor, therapist, and client. There was a similar perception
between supervisor and therapist. It was understood that both Supervisor A and
Therapist B perceived an enmeshed nonfunctional bond between Therapist B and
Client C. However, Supervisor A thought that s/he had a small relatedness with
them while Therapist B perceived that Supervisor A was also completely
enmeshed. From these perceptions, it was inferred that dependent characteristics of
the Client C expanded to therapeutic relationship (projective identification/forcing
others to behave according to own psychological needs as Cashdan stated in 1988).
Maybe, Supervisor A felt that this strong dependent structure between therapist
and client made him/her not interfere with them. Maybe, this could have made
him/her feel isolated due to the schema of abandonment. Maybe, as s/he could not
cope with this situation since s/he used the withdrawal from people as maladaptive
coping. On the other hand, although Therapist B was aware of nonfunctional
enmeshed circle, s/he continued to behave accordingly since s/he had the schemas
of unrelenting standards, self-sacrifice, and extreme urge for approval and
acceptance (affect of therapist’s own schemas/ Young, Klosko, & Weishaar,
2003). S/he looked for status and this dependent relationship made Therapist B
feel good by meeting childhood needs of Therapist B. Nevertheless, enmeshed
relationship for Client C was not something healing since this relationship style
made his/her schemas of undeveloped self, abandonment, and insufficient self-
control maintain (client’s schemas’ clashing with the ones of therapist/ Young,
Klosko, & Weishaar, 2003).
71
According to the open-ended question form (as represented in Figure 3),
Supervisor A got angry with a therapist, s/he did not show his/her anger, then s/he
talked about his/her anger during supervision. It caused to negative and positive
results. On the other hand, Therapist B (as represented as Figure 4), also got angry
with one of the supervisors. Therapist B mentioned a reciprocal anger with his/her
supervisor. The style of dealing with this anger of Supervisor A forced Therapist
B. However, both Supervisor A and Therapist B shared this issue with their
academic group and looked for support. All these answers given to open-ended
questions indicated that both Supervisor A and Therapist B had difficulty in
talking their emotions and anger management. Both of them had the tendency to
use emotional control as maladaptive coping style. Nevertheless, they tried to
break emotional control mechanism by expressing their emotions. However, since
it was the first time, it was not functional enough and good enough for therapist.
72
Supervisor A Therapist B
G
O
A
L
O
R
I
E
N
T
E
D
Explanation: No explanation. Explanation: In some sessions supervisor, therapist, client share goals equally; while they think that they have mutual goals, client has different goals from therapist; therapist has different goals from supervisor in some other sessions.
T
A
S
K
O
R
I
E
N
T
E
D
Explanation: No explanation. Explanation: I think that while therapist and client take part in big circles, supervisor has small portion in this circle.
E
M
O
T
I
O
N
A
L
Explanation: The client and therapist enmeshed; the supervisor is related with them.
Explanation: As supervisor, therapist, and client, I think that there are nonfunctional enmeshed emotional bonds.
Figure 2. Projective measurement of therapeutic alliance for Supervisor A and Therapist B Note: S = Supervisor A, T = Therapist B, C = Client C
S T
C
S
C T
S
C T
S C
T
T C
S
S C
T
73
3.5.1.7.Therapeutic alliance between Therapist B and Client C and Its
Associations with Schema Theory
In order to examine therapeutic alliance between Therapist B and Client C,
fourteen measurements could be obtained. From these measurements, general,
goal, task, and emotional bond oriented therapeutic alliance means were acquired.
Obtained scores were evaluated by making comparisons between Therapist B and
Client C by making associations with Early Maladaptive Schemas [i.e., emotional
deprivation, abandonment/instability, mistrust/abuse, social isolation/alienation,
defectiveness/shame, failure, dependence/incompetence, vulnerability to harm or
illness, enmeshment/undeveloped self, subjugation, self-sacrifice, emotional
inhibition, unrelenting standards/hypercriticalness, entitlement/grandiosity,
insufficient self-control/self-discipline, approval-seeking/recognition-seeking,
pessimism, and punitiveness], Young Parenting Inventory measures [i.e.,
emotionally depriving, overprotective/anxious, belittling/criticizing,
pessimistic/worried, normative, restricted/emotionally inhibited, punitive,
What was the most difficult situation during supervision period?
I got angry with one of the therapists. I did not show my anger. Actually, I was affected from this
situation very much. Next week, I attempted to open this situation during supervision since I
thought I could deal with it. However, very emotional environment emerged (with its positive and
negative sides).
How did you cope with it?
With peer supervision and supervision of supervision.
What was the most difficult situation during supervision period?
Emotional process between my supervisor and me; reciprocal existence of anger, the style of my
supervisor to deal with this anger and following processes were the most difficult times for me.
How did you cope with it?
By being aware of my emotions, by trying to understand the supervisor, by talking with other
therapists who took part in the same supervision group when I felt difficulty, I tried to cope with.
Figure 3. Open-ended questions and answers for Supervisor A
Figure 4. Open-ended questions and answers for Therapist B
74
conditional/achievement focused, over permissive/boundless, and
exploitative/abusive parenting], Young-Rygh Avoidance Inventory measures [i.e.,
psychosomatic symptoms, ignoring sadness or disturbance, emotional control,
withdrawal from people, distraction through activity, and numbness/suppressing
emotions], Young Compensation Inventory measures [i.e., status seeking, control,
rebellion, counterdependency, manipulation, intolerance to criticism, and
egocentrism].
3.5.1.8. Therapeutic Alliance between Therapist B and Client C depending
on Qualitative Measurement and Its Associations with Schema
Theory
As for general therapeutic alliance (as shown in Table 28) between
Therapist B and Client C, Therapist B indicated more fluctuated and lower level of
therapeutic alliance compared to Client C. It could derive from unrelenting
standards schema of Therapist B. Moreover, this schema could have activated
more at this supervision period because Therapist B started to provide
psychotherapy at first time and could be trying to cope with performance anxiety.
On the other hand, since Therapist B had the schema of entitlement/grandiosity,
s/he could have overvalued of himself/herself to cope with challenges as a young
therapist as belonging to conditional/achievement focused parents (related to
overlapping or clashing of schemas of client and therapist as Young underlined in
1996 as risks for therapy). Moreover, Client C perceived more stable therapeutic
alliance compared to Therapist B in all types of therapeutic alliance (as shown in
Table 28, Table 29, Table 30, and Table 31). It could be resulted from idealization
of therapist by client due to having emotional depriving mother (desire for
integrating with mother/ Klein, 1952). Maybe s/he needed to share his/her feelings
and being listened; maybe therapist could have met all these needs even by
existing there for the client. Additionally, when there was decrement in general
therapeutic alliance for Therapist B, Client C reported an increment in therapeutic
alliance and vice versa (i.e., 13. and 16. sessions). It could be due to maladaptive
coping mechanisms (i.e., emotional control, intentionally not thinking about
75
upsetting things, and withdrawal from people). Depending on coping strategies,
maybe if there was a problem, it could not be handled in details, and maybe even
they did not talk about it (due to overidentification when the client’s and
therapist’s schemas overlapped as Young expressed in 1996). Additionally,
Therapist B indicated the highest similarity with Client for emotional bond
oriented alliance (See Table 31). Maybe, s/he was not sure whether there were
shared goals and tasks during therapy process with client. However, s/he seemed
sure that there was emotional bond oriented therapeutic alliance between them.
Maybe, Therapist B did not evaluate goal and task oriented therapeutic alliance
without the schemas of unrelenting standards and entitlement/grandiosity and
without eyes of emotional depriving, conditional/achievement focused, punitive
mother and normative, conditional/achievement focused, belittling/criticizing
father. Nevertheless, s/he could evaluate emotions more positive. Maybe, it was
because Therapist B was emotionally deprived child, s/he was sensitive emotional
bond focused alliance. Maybe she wanted to take and give the thing that s/he did
not take during his/her childhood (clashing schemas of therapist and client/ client’s
satisfaction the therapist’s schema driven needs, Young, Klosko, & Weishaar,
2003).
Table 28. General Therapeutic Alliance between Therapist B and Client C
3,8
4,3
4,8
5,3
5,8
6,3
6,8
Therapist B
Client C
76
Table 29. Goal Oriented Therapeutic Alliance between Therapist B and Client C
Table 30. Task Oriented Therapeutic Alliance between Therapist B and Client C
0
1
2
3
4
5
6
7
Therapist B
Client C
0
1
2
3
4
5
6
7
Therapist B
Client C
77
Table 31. Emotional-bond Oriented Therapeutic Alliance between Therapist B and Client C
3.5.1.9. Therapeutic Alliance between Therapist B and Client C depending
on Qualitative Measurement and Its Associations with Schema
Theory
According to projective measurement (See Figure 5), while
Therapist B expressed equally shared or independent goals among supervisor,
therapist, and client. Client C defined a relationship all goals were determined
according to the need of herself/himself. Moreover, Client C defined a relationship
in which goals of Therapist B included goals of Supervisor A. Moreover, goals of
Client C consisted of goals of Therapist B and Supervisor A. It could be due to
Client C’s compensation of neglected childhood needs. This meant that Client C
maybe thought that everything should be done for just herself/himself. Up to a
point, this expectation could be considered as realistic since psychotherapy could
go on in the existence of client. Nevertheless, maybe, in his/her relational cycle,
Client C could have explained what s/he dreamt for under the effect of emotional
depriving, belittling/criticizing, conditional/achievement focused parents. Thus,
this expectation could be an overcompensation method for unmet childhood needs
0
1
2
3
4
5
6
7
Therapist B
Client C
78
(Young, 1996). On the other hand, there was a similarity between evaluation of
Therapist B and Client C in terms of task and emotional bond oriented therapeutic
alliance. Both of them thought that there was an enmeshed relationship for tasks
and emotional bond. However, while therapist considered that this emotional
structure was nonfunctional, the client did not think so. Arntz (2012) claimed that
client with dependent personality disorder could have compliant surrender mode.
Thus, client could not have opposed their therapist, not got angry with him/her or
not perceived any problem in therapeutic process. Moreover, Therapist B thought
that Supervisor A also had enmeshed relationship with Therapist B and Client C
even it was small for task oriented therapeutic alliance. On the other hand,
Therapist B indicated completely enmeshed emotional bonds among Supervisor A,
Therapist B, and Client C. It could be resulted from Therapist B’s need of
dependence and avoiding from abandonment. The risky position in this result was
that since Therapist B and Client C had similar schemas and parent characteristics,
they could have supported their maladaptive circles and psychotherapy could not
have reached its aims (overlapping schemas as Young stated in 1996). On the
other hand, Client C defined the position of Supervisor A independent from
himself/herself since s/he did not know him/her. However, s/he accepted an effect
coming from supervisor transferred by Therapist B. This could be explained with
the need of frostiness of Client C to avoid from his/her abandonment and rejection
rooted schemas. S/he accepted existence of supervisor. However, since s/he did
not meet to him/her, maybe she did not know whether s/he was trustful. Therefore,
s/he separated Supervisor A from their task and emotional bond oriented
therapeutic relationship. Accordingly, in Schema Theory, Young (1999) expressed
that people positioned themselves distant from interpersonal relationship
(frostiness/ avoidance coping mechanism) in order prevent triggering of schemas
(being abandoned, rejected, and disapproved).
79
Therapist B Client C
G
O
A
L
O
R
I
E
N
T
E
D
Explanation: In some sessions, supervisor, therapist, client share goals equally; while they think that they have mutual goals, client has different goals from therapist; therapist has different goals from supervisor in some other sessions.
Explanation: In order to determine the goals, I think that I have the most proportion. Because due to my problems, with the bigger affect of my therapist (but small effect of supervisor but effective) our goals are determined.
T
A
S
K
O
R
I
E
N
T
E
D
Explanation: I think that while therapist and client take part in big circles, supervisor has small portion in this circle.
Explanation: I think that my therapist and I in an enmeshed manner determine tasks according to the situation that I am in and my emotions. After we direct what the tasks are, I think that therapist and supervisor give a mutual decision.
E
M
O
T
I
O
N
A
L
Explanation: As supervisor, therapist, and client, I think that there are nonfunctional enmeshed emotional bonds.
Explanation: The emotional bond that I made with my therapist is enmeshed since we share lots of things for a long time. However, since I did not have the opportunity to meet the supervisor, his/her effect on emotional bond is transferred only by my therapist to me.
Figure 5. Projective measurements of therapeutic alliance for Therapist B and Client C Note: S = Supervisor A, T = Therapist B, C = Client C
S
C T
C
T
S
S C
T
T C S
T
S C
T T C S
T
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3.5.2. Case of Supervisor M and Therapist K
3.5.2.1. Characteristics of Supervisor M
According to schema inventories, Supervisor M had the schemas of
unrelenting standards, approval-seeking, failure, self-sacrifice,
entitlement/grandiosity, pessimism, and punitiveness remarkably (See Table 32).
Furthermore, Supervisor M had strong tendencies to overcompensate these
schemas by utilizing frostiness, control, status-seeking, counterdependency,
manipulation, egocentrism, and intolerance to criticism (See Table 33). On the
other hand, Supervisor M utilized schema avoidance in terms of distraction
through activity, psychosomatic symptoms, emotional control, and withdrawal
from people (See Table 34). As for origins of family (as indicated in Table 35 and
Table 36), Supervisor M had normative, pessimistic/worried, emotional depriving,
punitive, conditional/achievement focused, and belittling/criticizing mother and
pessimistic/worried, emotional depriving, restricted/emotionally inhibited, and
normative father.
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Table 32. Early Maladaptive Schemas for Supervisor M
Table 33. Types of Overcompensation of Schemas for Supervisor M
0
1
2
3
4
5
6
0
1
2
3
4
5
6
82
Table 34.Types of Avoidance for Supervisor M
Table 35.Characteristics of Mother of Supervisor M
0
1
2
3
4
5
6
Distraction throughactivity
Psychosomaticsymptoms
Emotional Control Withdrawal frompeople
0
1
2
3
4
5
6
83
Table 36. Characteristics of Father of Supervisor M
3.5.2.2. Characteristics of Therapist K
The noteworthy schemas of Therapist K were insufficient self-control,
social isolation, defectiveness, entitlement/grandiosity, abandonment,
mistrust/abuse, approval-seeking, and pessimism (See Table 37). Besides,
Therapist K mostly overcompensated these schemas with frostiness, intolerance to
criticism, counterdependency, and rebellion (See Table 38). Moreover, Therapist
K utilized types of avoidance in terms of withdrawal from people, distraction
through activity, and psychosomatic symptoms (See Table 39). On the other hand,
Therapist K had pessimistic/worried, restricted/emotional inhibited,
overprotective/anxious, and emotional depriving mother (See Table 40) and
conditional/achievement focused, normative, emotional depriving,
belittling/criticizing, and exploitative/abusive father remarkably (See Table 41).
0
1
2
3
4
5
6
84
Table 37.Early Maladaptive Schemas of Therapist K
Table 38.Types of Overcompensation of Schemas for Therapist K
0
1
2
3
4
5
6
0
1
2
3
4
5
6
Frostiness Intolerance tocriticism
Counterdependency Rebellion
85
Table 39.Types of Avoidance for Therapist K
Table 40. Characteristics of Mother of Therapist K
0
1
2
3
4
5
6
Withdrawal from people Distraction through activity Psychosomatic symptoms
0
1
2
3
4
5
6
86
Table 41.Characteristics of Father of Therapist K
3.5.2.3. Therapeutic Alliance between Supervisor M and Therapist K
with the Associations of Schema Theory
With the purpose of finding out therapeutic alliance between Supervisor M
and Therapist K, eleven measurements could be acquired with qualitative
inventories. At the beginning of this measurement, an instruction was given to
Supervisor M and Therapist K in order to highlight that they should start to fill
inventories after at least three sessions passed. They even did so, however, they
represented their starting session as first session as shown in Table 42, Table 43,
Table 44, and Table 45. Apart from quantitative ones, projective measurement and
open-ended question form were applied to Supervisor M and Therapist K once in
research process as qualitative measures. Obtained scores and implicit
0
1
2
3
4
5
6
87
measurements were appraised by making associations with Early Maladaptive
Schemas [i.e., emotional deprivation, abandonment/instability, mistrust/abuse,
social isolation/alienation, defectiveness/shame, failure,
dependence/incompetence, vulnerability to harm or illness,
enmeshment/undeveloped self, subjugation, self-sacrifice, emotional inhibition,
unrelenting standards/hypercriticalness, entitlement/grandiosity, insufficient self-
control/self-discipline, approval-seeking/recognition-seeking, pessimism, and
punitiveness], Young Parenting Inventory measures [i.e., emotionally depriving,
overprotective/anxious, belittling/criticizing, pessimistic/worried, normative,
restricted/emotionally inhibited, punitive, conditional/achievement focused, over
permissive/boundless, and exploitative/abusive parenting], Young-Rygh
Avoidance Inventory measures [i.e., psychosomatic symptoms, ignoring sadness
or disturbance, emotional control, withdrawal from people, distraction through
activity, and numbness/suppressing emotions], Young Compensation Inventory
measures [i.e., status seeking, control, rebellion, counterdependency, manipulation,
intolerance to criticism, and egocentrism] of Supervisor M and Therapist K.
3.5.2.4. Therapeutic Alliance between Supervisor M and Therapist K
depending on Quantitative Measurement and Its Associations with Schema
Theory
In accordance with the results for quantitative measurements, Therapist K
indicated more positive and stable attitude for therapeutic relationship with
Supervisor M (See Table 42). As for Supervisor M, a sudden decrease in the 3th
session was experienced. This decrement maintained for two sessions, then, a
sudden increase was experienced. After this sudden increment, Supervisor M
started to indicate better perception for therapeutic alliance progressively. It was
inferred that there was a difference between perception of Supervisor M and
Therapist K although these differences were not notable. The reason for this
difference could be related to the schemas of Supervisor M (i.e., unrelenting
standards and failure) and normative, pessimistic family origins of Supervisor M.
This meant that maybe although therapeutic alliance between Supervisor M and
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Therapist K was satisfied, it could not be perceived as good enough by Supervisor
M due to his/her unrelenting standards and failure schemas (as Young explained in
Schema Theory, 1996). Moreover, maybe Supervisor M had tendency to evaluate
situations in a normative and pessimistic manner as his/her parents had done
before (Young, Klosko, & Weishaar, 2003). Besides, Therapist K was also aware
that there was something wrong in therapeutic alliance with Supervisor M during
3th and 4th sessions. It was thought that Therapist K generally was aware of reality
in the relationship with Supervisor M.
Nevertheless, for goal-oriented therapeutic alliance, Therapist K perceived
a stable therapeutic alliance with Supervisor M, while Supervisor M indicated
perception of decrement three times in therapeutic alliance with Therapist K. It
could be resulted from schemas of unrelenting standards, failure, and approval-
seeking of Supervisor M. Depending on these schemas’ structure (Young, 1996),
maybe, Supervisor M could not have considered positive things in supervision
environment, felt unsuccessful, and tried to get approval in order to feel satisfied.
It was thought that Supervisor M did not express his/her feelings and thoughts with
compensation mechanism of frostiness and avoidance mechanisms of emotional
control and social isolation. In this pattern, Supervisor M could have missed one of
the ideal therapist qualities (i.e., “therapist’s genuine self-expression of needs and
emotions”) which Young highlightened in Schema Theory (1999). On the other
hand, Therapist K having schemas from disconnection-rejection domain did not
notice what Supervisor M lived and s/he missed the reality with his/her
disconnected pattern. This could be arised from “mismatch between the client’s
needs and therapist’s schemas or coping styles” (as Young, Klosko, and Weishaar
asserted in the book of Schema Theory in 2003).
Moreover, Supervisor M experienced the fastest decrease in task oriented
therapeutic alliance with Therapist K. After 4th session, Supervisor M reported a
distinctive increment in task oriented relationship and a slight decrement in
following sessions. Then a slight increment appeared. Therapist K perceived a
slight decrease just one time in supervision period. It could be inferred that
Supervisor M perceived that there was a problem in getting responsibility and
fulfilling tasks between himself/herself and Therapist K. Maybe, Supervisor M
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expected too much from Therapist K with activation of unrelenting standards and
entitlement (Young, 1996). On the other hand, it could be a problem totally related
to Therapist K. If so, it could be resulted from insufficient self-control of Therapist
K (“Pervasive difficulty or refusal to exercise sufficient self-control and frustration
tolerance to achieve one's personal goals” Young, 1996). With this schema,
Therapist K could not have fulfilled the responsibilities during supervision period.
Additionally, Therapist K who was unaware of this problem could have tried to
compensate defectiveness, abandonment, approval-seeking, and pessimism
schemas. If s/he had realized this problem, s/he could have felt defective; this
could have been a threat for being abandoned and not being approved by others,
and this could have caused pessimism. Therefore, Therapist K could have tried not
to perceive the problem unconsciously in order not to feel sadness, guilt, and pain
(avoidance from schemas; Young, 1996).
Furthermore, Supervisor M perceived a fluctuation for emotional bond
focused therapeutic alliance with Therapist K. At the end of the supervision
period, evaluation of Supervisor M, which started with perception of lower
emotional bond oriented therapeutic alliance, indicated increment. Supervisor M
even perceived better emotional bond compared to Therapist K at the end of
supervision period. On the contrary, Therapist K perceived a better emotional bond
oriented therapeutic alliance with Supervisor M at the beginning of the
supervision. After this perception reached to the top, a descending emotional bond
oriented therapeutic alliance was perceived from Therapist K. At the end of
supervision process, Therapist K perceived a worse emotional bond than
Supervisor M. It could be resulted from schemas of Supervisor M (i.e., pessimism,
approval-seeking) and unhealthy schema coping mechanism of frostiness (Young,
Klosko, & Weishaar, 2003). Furthermore, maybe, growing in an emotional
depriving family had caused a problem in order to attach, affiliate, giving and
taking love for Supervisor M (Typical family origin of other-directedness domain
in Schema Theory, Young, Klosko, & Weishaar, 2003). On the other hand, at 7th
session (as shown in Table 45), there happened something and Supervisor M
experienced a decrement in emotional bond with Therapist K. After this session,
Therapist K also started to perceive a lower level of emotional bond with
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Supervisor M. It could be resulted from schemas of Therapist K, which took part
under domain of disconnection rejection. As Young asserted in Schema Theory
(1999) people having schemas from this domain were sensitive to read emotional
cues of others in order to check their availability. Since Therapist K had the
schemas of abandonment, mistrust/abuse, and social isolation, after s/he noticed
change in the evaluation of Supervisor M for emotional bond, s/he did not perceive
their therapeutic emotional bond better any more. Maybe, Therapist K, with
mistrust/abuse schema and utilizing coping mechanisms of frostiness and
counterdependency, realized the perception of Supervisor M and believed that it
was not something situational (general attitude) even if it changed in time for
Supervisor M.
Table 42.General Therapeutic Alliance between Supervisor M and Therapist K
0
1
2
3
4
5
6
7
Supervisor M
Therapist K
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Table 43.Goal Oriented Therapeutic Alliance between Supervisor M and Therapist K
Table 44.Task Oriented Therapeutic Alliance between Supervisor M and Therapist K
0
1
2
3
4
5
6
7
Supervisor M
Therapist K
0
1
2
3
4
5
6
7
Supervisor M
Therapist K
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Table 45.Emotional Bond Oriented Therapeutic Alliance between Supervisor M and Therapist K
3.5.2.5. Therapeutic Alliance between Therapist B and Client C
depending on Qualitative Measurement and Its Associations with Schema
Theory
In accordance with the results of projective measurement (See Figure 6),
Supervisor M thought that the client took part out of the goals of Therapist K,
whereas Therapist K asserted that the client had overlapping goals with Supervisor
M and Therapist K even if they were not in big amount. On the other hand,
Therapist K expressed that s/he agreed upon all goals with Supervisor M.
However, Supervisor M reported overlapping goals with Therapist K in relational
cycles, but they were not completely overlapped. At that point, there was a
difference between perception of Supervisor M and Therapist K. It could be
resulted from Therapist K’s schema of entitlement/grandiosity and coping
mechanism of intolerance to criticism. Accordingly, maybe, Therapist K could not
have wanted to accept his/her lack of goal oriented therapeutic alliance with
Supervisor M (overcompensation for entitlement/grandiosity; Young, 1996). From
another viewpoint, maybe Supervisor M could have achieved to give trust to
Therapist K. Although Therapist K had schemas related to disconnection-rejection,
s/he perceived an agreed upon relationship in terms of goals (one of the ideal
0
1
2
3
4
5
6
7
Supervisor M
Therapist K
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therapist qualities (i.e., secure attachment) expressed in Schema Theory, Young,
Klosko, & Weishaar, 2003).
For task-oriented therapeutic alliance (See Figure 6), unlike quantitative
measurements, Therapist K in projective measures indicated that s/he had
awareness for that s/he could not have fulfilled responsibilities/tasks given by
Supervisor M as well as his/her client. Maybe, quantitative methods activated a
coping mechanism to decrease negative emotions based on maladaptive schemas
in order to suppress pain related to schemas. They were superficial and inadequate
to show reality. However, projective measures could have made participants open
his/her implicit mind and indicated reality. According to Kelly (1932), implicit
measurement was a kind of map revealing latent part of the human psychology and
increasing insight. Therefore, relational cycles could have revealed awareness of
lack of responsibility of Therapist K even if this was a difficult topic to tackle for
Therapist K with insufficient self-control and defectiveness schemas. On the other
hand, Supervisor M, in projective evaluations, explained that s/he had perceived an
equal task distribution among supervisor, therapist, and the client. Although
Therapist K had difficulty taking responsibility, Supervisor M draw attention
his/her trials to achieve. Maybe, since Supervisor M grow up in a family
environment in which normative, pessimistic, emotional depriving, and
conditional/achievement focused parent took part, s/he tried to compensate this
parenthood pattern by drawing attention positive behaviors of Therapist K
(reparenting of therapist with awareness of his/her own schemas, Young, Klosko,
& Weishaar, 2004).
In terms of emotional bond oriented therapeutic alliance (See Figure 6),
Supervisor M reported no emotional bond oriented alliance between Therapist K
and the client. According his/her relational cycle explaining this pattern,
Supervisor M tried to be a bridge between them. It could be related to self-sacrifice
schema of Supervisor (“client’s triggering the schemas of therapist and therapist’s
overcompensation” as explained by Young, Klosko, & Weishaar, 1996).
Conversely, Therapist K defined overlapping/shared areas among supervisor,
therapist, and the client even if it was not remarkable. Although Therapist K
mentioned s/he had benefited from directions for goals and tasks of Supervisor M,
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Therapist K indicated a small amount of overlapping area with Supervisor M for
emotional bond oriented therapeutic alliance. It could be resulted from Therapist
K’s schemas of mistrust/abuse, abandonment, and social isolation. With these
schemas, Therapist K could have had difficulty make bonds, trust, and attach to
others especially for the people in the role of parent (Young, 1996).
According to open-ended question form, it was understood that Supervisor
M (See Figure 7) had high awareness and insight. S/he sometimes had difficulties
in transferring his/her observations to words, felt anxiety, but s/he did not give up
fighting against challenges. Maybe, this could be related to his/her schemas of
unrelenting standards and failure (maintenance of schemas and focusing success
oriented approval, Young, 1996) or maybe s/he was aware of his/her relational
patterns and learned to behave in a healthy way. On the other hand, Therapist K
(See Figure 8) was aware of his/her schema of unrelenting standards. Accordingly,
excessive need of acceptance and connection maybe was compensated with
unrelenting standards (Young, 1996). However, this schema could have created a
dependent pattern. Therapist K, who behaved out of rules during supervision,
maybe unintentionally tried to break this dependent pattern. Moreover, Therapist
K had defectiveness schema and maybe this brought intolerance to criticism.
Therefore, although open communication was perceived something positive,
Therapist K could not benefit from it completely. Maybe, s/he needed further
support to learn how to tackle with his/her schemas.
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Supervisor M Therapist K
G
O
A
L
O
R
I
E
N
T
E
D
Explanation: The goals of client making his/her to apply to therapy and the goals handled in supervision process changed in time. It was thought that the most important reason why the patient took part in outside of supervision process was his/her trying to make therapy a part of his/her cycle of relationship. The client had difficulty to come to the same point with therapist’s transference.
Explanation: My supervisor approved what I aimed for the client and tried to make me handle other aims which I had not been aware of and was important for the client. We handled the goals which the client mentioned in the therapy; however, we noticed that the client unconsciously perceived psychotherapy process as a place which s/he could exhibit his/her being victim rather than seeking for help. Accordingly, we noticed that the aim of the client which brought him/her to therapy was out of our aims.
T
A
S
K
O
R
I
E
N
T
E
D
Explanation: Despite having difficulty with working this client, the therapist tried to fulfill his/her responsibilities with supervisor and tried to keep in touch with the client. Counting both the therapist and the client in this process, the supervisor determined tasks which would develop self-improvements of the therapist and the client and paid attention feedbacks coming from both of them in this process.
Explanation: As the therapist did not fulfill the tasks given by supervisor, there were some parts which the client also did not fulfill the tasks given by the therapist and responsibilities in therapy process.
E
M
O
T
I
O
N
A
L
Explanation: Due to his/her personal processes, the therapist had difficulty to make emotional bonds with the client. The supervisor tried to balance in between. Handling personal process of the therapist; the supervisor tried the client not to keep outside of this process.
Explanation: There were emotional processes and empathy consisting from interconnected bonds of everybody. Nevertheless, these interconnected emotional bonds included small portions in individual processes.
Figure 6. Projective measurement of therapeutic alliance for Supervisor M Note: S = Supervisor A, T = Therapist B, C = Client C
S
C
T S
C
T
S
C T
S
T
C
T C S
S
C T
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Figure 7. Projective measurement of therapeutic alliance for Supervisor M Note: S = Supervisor A, T = Therapist B, C = Client C
What was the most difficult situation during supervision period?
I had difficulty to deal with passive reactions indicated from a therapist when personal processes
of other therapist were being handled. I was noticing that other therapists were also affected from
his/her passive resistance, but I was not dealing with his/her style efficiently. This was damaging
the dynamic of the group, making me angry and anxious.
How did you cope with it?
I noticed that one of the therapists was drawing on a paper during his/her supervision. However, I
waited until process with others had been terminated. Then, I started with asking what s/he had
drawn. After understanding his/her shame due to his/her being noticed, we mentioned his/her
general attitudes when s/he did something shameful and his/her aggression which s/he exhibited
until now. After handling the experiences under the roots of this attitude and adding personal
experiences of other therapists, both my anger and anxiety dissolved distinctively. Feeling of
relaxed for understanding him/her caused change not only for me but also for him/her (in a
positive direction).
What was the most difficult situation during supervision period?
This semester, I had difficulty in doing report homework in a given time (despite I obeyed the
rules more compared to the past semester) and especially its effect on one of my supervisors.
Since I have had a trouble in fulfilling the things that I did not want through my life, this
reverberated to the supervision, which was a course.
How did you cope with it?
When my supervisor questioned the reasons of my behavior, whether I gave importance to the
supervisions or not, s/he understood that this problem was not just related to this process, I had
also passive aggressive attitudes towards the tasks given by figures of authority and we talked
why I had revealed this pattern. This conversation provided an open communication, but I did not
get over my problem yet.
Figure 8. Open-ended Questions and Answers for Supervisor M
Figure 9. Open-ended Questions and Answers for Therapist K
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3.6.General Discussions
3.6.1. Contributions of the Study
The present study was unique and important for applied psychology
literature depending on many factors. Firstly, any study examining the relationship
between early maladaptive schemas, avoidance schema coping, schema
compensation, and parenting styles expressed in Schema Theory and therapeutic
alliance among supervisors, therapists, and clients was not conducted before.
Secondly, this study indicated that supervisors’ and therapists’ own personal
history were important to examine how they built relationship during supervision
and therapy process as well as clients’ personal history. Thirdly, the study revealed
that therapeutic alliance could not be measured by quantitative inventories good
enough since quantitative measurement was not explaining how participants
perceived this process. Accordingly, a new projective measure was developed for
this study. This measurement method indicated that supervisors, therapists, and
clients had different processes in their minds. Quantitative methods were not
competent to determine what participants really thought about relationship with
their partners since it could be filled quickly. However, projective measurement
made participants to think about therapeutic alliance in detail. Therefore, it could
reach to implicit knowledge. Furthermore, in order to analyze the relationship
between supervisors and therapists, therapeutic alliance inventory developed via
adaptation of items of therapeutic alliance therapist and client forms. Moreover,
this study became an example for how a clinician could associate schema therapy
concepts and interpersonal relations. Finally, this study was important since it was
the pioneer to give information on how supervision and therapy processes could be
developed and organized.
98
3.6.2. General Discussion for the Results
According to the results, it was found that therapeutic alliance was affected
from schemas, schema origins, and schema coping mechanisms of supervisors,
therapists, and the clients. The schemas, origins of schemas, schema coping among
supervisors, therapists, and the clients created risky situation in therapy or
supervision period when they were similar or complementary. Firstly, if there was
a similarity, it created sympathy or repulsion among participants. If this was
sympathy, the participant under the effect of this similarity (supervisor or
therapist) tried to behave contrary to them. This viewpoint depended on the
thought that “I was affected negatively from my parents’ maladaptive attitudes
during my childhood, therefore I should behave contrary to my parents’ attitude.”
This behavior could be beneficial if it was limited in empathy. Holland (1997) also
expressed that similarity between therapist and client could cause a positive
interpersonal relationship. According to Taber, Leibert, Agaskar (2011),
congruence between therapist and client was especially associated with bon
oriented therapeutic alliance whereas task and goal oriented ones were related to
therapeutic outcome. However, if the supervisors or the therapists overvalued this
similarity (trying to make changes which s/he could not make before), s/he could
miss differences of therapist or client (working on his/her childhood problems
unconsciously). According to Duan and Hill (1996), there were two types of
empathy (i.e., intellectual empathy and emotional empaty). Firstly, intellectual
empathy consisted of therapist’s understanding viewpoint, needs, and emotions of
the client. Secondly, emotional empathy included therapist’s giving response to
emotion of the client with the same emotion. This was caused by overemphasis of
similarity and could cause losing objectivity (Duan & Kivlighan, 2002; Ladany,
Miller, Erickson, & Muse-Burke, 2000). On the other hand, if this was repulsion,
this could be related to that supervisors or therapists could see their unwanted sides
(that they could not achieve to change and accept) in the lives of therapists and
clients. It could seem ugly. If these supervisors and therapists were lack of insight,
they could behave as their parents behaved those years ago since they were not
aware of the reasons of their problematic sides (maintenance of the schemas,
99
Young, 1996). This could feed maladaptive structure. Secondly, if there were
complementary schemas, schema origins, and schema coping among supervisors,
therapists, and the clients, this could be risky since it could be facilitative for
continuation maladaptive patterns (Chapter of The Therapy Relationship in
Schema Therapy Book, Young, Klosko, & Weishaar, 2003). Depending on this
commend, it can be inferred that supervisors or therapists should have insight and
awareness for their own schemas, schema origins, and schema coping in order to
differentiate whether the problems faced in supervision or therapy are related to
themselves or others. This reveals the importance of receiving psychotherapy as
supervisor or therapist or receiving supervision focusing on personal backgrounds
of supervisors and therapists (Geller, Orlinsky, & Norcross, 2005; Macran, Stiles,
& Smith, 1999; Safran & Segal, 1996; Sidney, 2013). Moreover, despite receiving
psychotherapy, supervisors, and therapists sometimes can face with difficulty in
therapeutic relationship and they cannot determine the reasons. This could be
related to blind spots of them (i.e., they even do not know how to deal with some
problems in their life). In order to solve these problems, a position of another
person (i.e., supervisor) evaluating this process objectively is necessary in order to
mirror blind spot and teach how to tackle these problems. According to Rosenfeld
(2010), the effect of supervision period is depending on some factors. Firstly, it is
related to therapist’s personal problems pointed in supervision. Secondly,
characteristics of supervisors contribute to development of therapists. Thirdly,
feeling understood and being respected by supervisors are important for therapists
for an open supervision relationship. Fourthly, a trustful supervision environment
is important for working alliance. Moreover, setting boundaries between
supervisors and therapist cause either fostering student relationship or hierarchical
supervision relationship. Finally, supervisors lead therapist to make connections
between past and future experiences.
100
3.6.2.1. Rationale of Using YSQ with its 18 Schemas
Considering early maladaptive schemas derived from YSQ (Young, 1999),
though the original form offers 18 schemas (1999), Turkish adaptation conducted
by Soygüt, Karaosmanoğlu, and Çakır (2009) revealed 14 schemas. However,
many studies conducted with YSQ use their own factor structure, and the numbers
of utilized schemas tend to vary between 13 and 21. Thus in the literature there is
no consistency over the number of schemas involved in the studies (e.g., Baranoff,
Oei, Ho, Cho, & Kwan, 2006; Hawke & Provencher, 2012; Hoffort et al., 2005;
Lee, Taylor, & Dunn, 1999; Saariaho, Saariaho, Karila, & Joukama, 2009).
In Turkey, many studies were conducted by using the original factor
structure of YSQ (i.e., 18). According to study of Sarıtaş (2007), in order to
examine mediator role of early maladaptive schemas between the relationship of
perceived maternal rejection and psychological distress of adolescents, eighteen
schemas and three schema domains created from factor analyses were utilized.
Moreover, Köse (2009) utilized original schema structure of Young (1999) to
examine the possible influences of demographic variables (i.e., age, gender,
marital status, sibling number, mother’s education, father’s education) on the
various measures of schema domains, self-orientations, and well-being measures
(i.e. depression, positive affect, negative affect, and reassurance-seeking); the
differences of schema domains on self-orientations of Balanced Integration
Differentiation Model and also on well-being, and the differences of four self-
construals of Balanced Integration Differentiation Model on schema domains and
well-being measures. Besides, Gök (2012) conducted a study to investigate
associated factors (i.e., early maladaptive schemas, schema coping processes, and
parenting styles) of psychological well-being, by using the YSQ with its 18
schemas. Furthermore, Ünal (2012) analyzed early maladaptive schemas and well-
being in relation with importance of parenting styles and other psychological
resources by using the schema domains derived from 18 original factor structure of
YSQ. Additionally, Özbaş, Sayın, and Coşar (2012) examined the relationship
between early maladaptive schemas and anxiety of examination for the students
preparing for university entrance exam by using the original factors of schemas
101
and schema domains. Besides, Aslan, Taymur and Türkçapar (2012), investigated
the cognitive profiles of coronary artery disease patients with or without comorbid
anxiety disorder by using original schema domains constituted from eighteen
schemas.
Soygüt, Karaosmanoğlu, and Çakır (2009) adapted YSQ to Turkish and
found a different factor structure than original form. According to this study,
fourteen schemas (namely, emotional deprivation, failure, pessimism, social
isolation/mistrust, emotional inhibition, approval-seeking,
enmeshment/dependency, entitlement/insufficient self-control, self-sacrifice,
abandonment, punitiveness, defectiveness, vulnerability to harm, and unrelenting
standards) and five schema domains (i.e., impaired autonomy, disconnection,
unrelenting standards, other-directedness, and impaired limits) were determined.
Considering the qualitative nature of the present study, the original factor
structure (Young, 1999) was preferred instead of the adapted 14 schemas (Soygüt,
Karaosmanoğlu, & Çakır, 2012). Since the present study was not a quantitative
one, it did not aim to compare the obtained results with the available quantitative
outcome. Instead, qualitative studies aim at obtaining detailed information and its
comprehension. Thus, in order to enrich the study and discussions, since detailed
information was needed for the qualitative studies, 18 factors of YSQ -the original
schema domains of Young (1999) were preferred over 14 factors. Furthermore,
using original domains suggested by Young, provided opportunity to simplify
results and increase comprehension.
Thus, for the clarification and explanation of the obtained results the
maladaptive schemas were discussed by referring to the schema domains
suggested by Young (1999). Likewise, Sarıtaş and Gençöz (2011) studied schema
domains in a Turkish adolescent sample by using the original 18 schemas, and
they revealed 3 schema domains (namely; “impaired limits-exaggerated
standards”, “disconnection-rejection”; “impaired autonomy-other directedness”)
that are similar to the original ones, where two of the original domains merged into
the others.
Considering that other schema related questionnaires (i.e., Young Parenting
Inventory, Young-Rygh Avoidance Inventory, and Young Compensation
102
Inventory) did not have domain-oriented subscales, Turkish adapted forms of these
scales were used in the current study.
3.6.3. Limitations of the Study and Future Directions
Although this study was unique and important for the literature, it had
some limitations due to the nature of research structure and settings. Firstly,
although more clients were willing to participate to this study at the beginning of
the study, some of them quitted filling inventories during research process.
Therefore, therapeutic alliance could be examined by analyzing the relationship
between supervisor and therapist mostly in the study. Secondly, therapeutic
alliance between pairs of supervisor-therapist and therapist-client could not
measure concurrently. Correspondingly, it was not known how therapeutic alliance
between supervisor and therapist reflected to therapeutic alliance session by
session, instead a general effect between these pairs was examined. Thirdly,
although therapeutic alliance was measured session by session, it was not known
why therapeutic alliance increased and decreased in some sessions. The issues,
which were handled at these sessions, were not known. Fourthly, although this
research included many case studies, only two of them could be mentioned in this
dissertation due to the limitations of space. Moreover, as statistical methods,
correlation, and descriptive statistics were used. However, this research setting
could be utilized for hierarchical linear modeling. Furthermore, although the levels
of education were same and participants were mostly females, demographic
characteristics could not be mentioned due to confidentiality reasons.
103
REFERENCES
Agnew Davies, R., Stiles, W. B., Hardy, G. E., Barkam, M., & Shapiro, D. A.
(1998). Alliance structure assessed by the Agnew Relationship
Measure (ARM). British Journal of Clinical Psychology, 37, 155−172.
Allen, J. G., Newsom, G. E., Gabbard, G. O., & Coyne, L. (1984). Scales to assess
the therapeutic alliance from a psychoanalytic perspective. Bulletin of
the Menninger Clinic, 48, 383−400.
Anderson, R., & Anderson, G. (1962). Development of an instrument for
measuring rapport. Personal Guidance Journal, 41, 18-24.
Aslan, H., Taymur, İ., & Türkçapar, M. H. (2012). Evaluation of cognitive
schemas based on the presence of anxiety disorder among coronary artery
disease patients. Journal of Cognitive-Behavioral Psychotherapy and
Research, 1(3), 171-177.
Arntz, A. (2012). Schema Therapy for Cluster C Personality Disorders, in The
Wiley- Blackwell Handbook of Schema Therapy: Theory, Research, and
Practice (eds. M. van Vreeswijk, J. Broersen and M. Nadort), John Wiley
& Sons, Ltd, Chichester, UK.
Aron, L. (1996). A meeting of minds: Mutuality in psychoanalysis. Hillsdale, NJ:
Analytic Press.
Bachelor, A. (1987). The counseling evaluation inventory and the counselor rating
form: Their relationship to perceived improvement and to each other.
PsychologicalReports, 61(2), 567−575.
Baillargeon, P., Cote, R., & Douville, L. (2012). Resolution process of therapeutic
alliance ruptures: A review of the literature. Psychology, 3(12), 1049-1058.
Baranoff, J., Oei, T. P. S., Ho Cho, S., & Kwon, S.-M. (2006).Factor structure and
internal consistency of the Young Schema Questionnaire (Short Form) in
Korean and Australian samples. Journal of Affective Disorders, 93, 133–
140.
Barrett-Lennard, G. T. (1962). Dimensions of therapist response as casual factors
in therapeutic change. Psychological Monographs, 76, 562.
104
Barrett-Lennard, G. T. (1986). The relationship inventory now: Issues and
advances in theory, method and use. In L. S. Greenberg & W.M. Pinsof
(Eds.), The psychotherapeutic process: A research handbook (pp.
439−467). New York and London: Guilford Press.
Beck, A. T., Rush, J. A., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of
depression. New York: Guilford Press.
Bell, D. (1997). Reason and Passion. London
Bell, M., Billington, R., & Becker, B. (1986). A scale for the assessment of object
relations: Reliability, validity, and factorial invariance. Journal of Clinincal
Psychology, 42, 733-741.
Berne, E. (1975). What do you say after you say hello? London.
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the
working alliance. Psychotherapy: Theory, Research, and Practice, 16, 252-
260.
Bordin, E. S. (1980). Of human bonds that bind or free. Presidential Address to
Tenth Annual Convention of Society for Research on Psychotherapy,
Pacific Grove, California.
Bordin, E. (1983). Supervision in counseling: II Contemporary models of
supervision: A working alliance based model of supervision.
CounselingPsychologist, 11, 35–42.
Bordin, E. S. (1994). Theory and research on the therapeutic working alliance:
New directions. In A. O. Horvath & L. S. Greenberg (Eds.), The working
alliance: Theory, research and practice (pp. 13-37). New York: Wiley.
Bowlby, J. (1988). A Secure Base. New York: Basic Books.
Braswell, L., Kendall, P. C., Braith, J., Carey, M. P., & Vye, C. S. (1985).
Involvement in cognitive-behavioral therapy with children: process and its
relationship to outcome. Cognitive Therapy and Research, 9, 611−630.
Brenner, C. (1979). Working alliance, therapeutic alliance, and transference.
Journal of the American Psychoanalytic Association, 27, 136-158.
Cabrera, N. J., Tamis-LeMonda, C. S., Bradley, R. H., Hofferth, S., & Lamb, M.
E. (2000). Fatherhood in the twenty-first century. Child Development, 71,
127-136.
105
Carson, R. C. (1969). Interaction concepts of personality. Oxford, England:
Aldine.
Castonguay, L. G., Constantino, M. J., & Grosse Holtforth, M. (2006). The
working alliance: Where are we and where should we go? Psychotherapy:
Theory, Research, Practice, Training, 43(3), 271−279.
Derlega, V. J., & Chaikin, A. L. (2010). Privacy and self-disclosure in social
relationships. Journal of Social Issues, 33(3), 102-115.
Cashdan, S. (1988). Object Relations Therapy. New York: Norton & Company, s.
53-78.
Constantino, M. J., Arnow, B., Blasey, C., & Agras,W. S. (2005). The association
between patient characteristics and the therapeutic alliance in cognitive-
behavioral and interpersonal therapy for bulimia nervosa. Journal of
Consulting and Clinical Psychology, 73, 203−211.
Creed, T. A., & Kendall, P. C. (2005). Therapist alliance – building behavior
within a cognitive – behavioral treatment for anxiety in youth. Journal of
Consulting and Clinical Psychology, 73(3), 498−505.
Crits-Christoph, P., Baranackie, K., Kurcias, J. S., Beck, A. T., Carroll, K., Perry,
K.,Luborsky, L., McLellan, A. T., Woody, G. E., Larry, T., Gallagher, D.,
& Zitrin, C. (1991). Meta-analysis of therapist effects in psychotherapy
outcome studies. Psychotherapy Research, 1(2), 81-91.
Curtis, H. C. (1979). The concept of the therapeutic alliance: Implications for the
“widening scope”. Journal of the American Psychoanalytic Association,
27, 159-192.
Di Giuseppe, R., Linscott, J., & Jilton, R. (1996). Developing the therapeutic
alliance in child-adolescent psychotherapy. Applied and Preventive
Psychology, 5, 85−100.
Driver, C., Martin, E., Banks, M., Mander, G., & Stewart, J. (2002). Supervising
Psychotherapy. London: Sage Publications.
Duan, C., & Hill, C. E. (1996). The current state of empathy research. Journal of
Counseling Psychology, 43, 267-274.
106
Duan, C., & Kivlighan, D. M. (2002). Relationships among therapist presession
mood, therapist empathy, and session evaluation. Psychotherapy Research,
12(1), 23-37.
Durlak, J. A. (1998). Common risk and protective factors in successful prevention
programs. American Journal of Orthopsychiatry, 68(4), 512-520.
Eckler-Hart, A. H. (1987). True and false self in the development of
psychotherapist. Psychotherapy: Theory, Research, Practice, Training,
24(4), 683-692.
Efstation, J. F., Patton, M. J., & Kardash, C. M. (1990). Measuring the working
alliance in counselor supervision. Journal of Counseling
Psychology, 37,322–329.
Elliott, R., Watson, J. C., Goldman, R. H., & Greenberg, L. S. (2004). Learning
emotion-focused therapy: The process-experiential approach to change.
Washington, DC: American Psychological Association.
Ellis, M. V. (1991). Critical incidents in clinical supervision and in supervisor
supervision: Assessing supervisory issues. Journal of Counseling
Psychology,38, 342-349.
Elvins, R., & Green, J. (2008). The conceptualization and measurement of
therapeutic alliance: An empirical review. Clinical Psychology Review, 28,
1167–1187.
Estrada, A., & Russell, R. (1999). The development of the child psychotherapy
process scales (CPPS). Psychotherapy Research, 9, 154−166.
Eugster, S. L., &Wampold, B. E. (1996). Systematic effects of participant role on
evaluation of the psychotherapy session. Journal of Consulting and
Clinical Psychology, 64(5), 1020−1028.
Fleischer, J. A., & Wissler, A. (1985). The therapist as patient: Special problems
and considerations. Psychotherapy, 22(3), 587-594.
Florsheim, P., Shotorbani, S., Guest-Warnick, G., Barrett, T., & Hwang, W. C.
(2000). Role of the working alliance in the treatment of delinquent boys in
community based programs. Journal of Clinical Child Psychology, 29,
94−107.
107
Frank, A. F., & Gunderson, J. G. (1990). The role of the therapeutic alliance in the
treatment of schizophrenia. Relationship to course and outcome. Archives
of General Psychiatry, 47, 228−236.
Frank, J. D., & Frank, J. B. (1991). Persuasion and Healing: A comparative study
of psychotherapy, (3rd Ed) Baltimore: Johns Hopkins University Press.
Freud, S. (1912). Standard Ed. The dynamics of transference. In Complete
Psychological Works, vol. 12. (pp. 97−108)London: Hogarth Press.
Freud, S. (1913). On beginning the treatment: Further recommendations on the
technique of psychoanalysis. Standard edition of the completeworks of
Sigmund Freud (pp. 97-108). London: Hogarth Press.
Freud, S. (1966). On the beginning the treatment. In J. Strachey (Ed. and Trans.),
The standard edition of the complete psychological works of Sigmund
Freud (Vol. 12, pp. 112-144). London: Hogarth Press. (Original wok
published in 1913
Frieswyk, S. H., Allen, J. G., Colson, D. B., Coyne, L., Gabbard, G. O., Horwitz,
L., & Newsom, G. (1986). Therapeutic alliance: Its place as a process and
outcome variable in dynamic psychotherapy
research. Journal of Consulting and Clinical Psychology, 54, 32-38.
Friedlander, M. L., Horvath, A. O., Cabero, A., Escudero, V., Heatherington, L., &
Martens, M. P. (2006). System for observing family therapy alliances: a
tool for research and practice. Journal of Counseling Psychology, 53(2),
214−224.
Frieswyk, S. H., Allen, J. G., Colson, D. B., Coyne, L., Gabbard, G. O., Horwitz,
L., & Newsom, G. (1986). Therapeutic alliance: Its place as a process and
outcome variable in dynamic psychotherapy research. Journal of
Consulting and Clinical Psychology, 54, 32-38.
Geller, J., Orlinsky, D., & Norcross, J. (2005). The psychotherapist’s own
psychotherapy: Client and clinician perspectives. New York, NY: Oxford
University Press.
Gelso, C. J., & Carter, J. A. (1985). The relationship in counseling and
psychotherapy: Components, consequences, and theoretical antecedents.
The Counseling Psychologist, 13, 155-244.
108
Gelso, C. J., & Carter, J. A. (1994). Components of the psychotherapy
relationship: Their interaction and unfolding during treatment. Journal of
Counseling Psychology, 41(3), 296-306.
Gelso, C. J., & Hayes, J. A. (1998). The psychotherapy relationship: Theory,
research, and practice. New York: John Wiley.
Glickauf-Hughes, C., & Mehlman, E. (1995). Narcissistic issues in therapists:
Diagnostic and treatment considerations. Psychotherapy: Theory,
Research, Practice, Training, 32(2), 213-221.
Gomes-Schwartz, B. (1978). Effective ingredients in psychotherapy: prediction of
outcome from process variables. Journal of Consulting and Clinical
Psychology, 46, 1023−1035.
Gorin, S. (1993). The prediction of child psychotherapy outcome: Factors specific
to treatment. Psychotherapy, 30(1), 152−158.
Gök, A. C. (2012). Associated factors of psychological well-being: Early
maladaptive schemas, schema coping processes, and parenting styles.
Unpublished master’s thesis, Middle East Technical University, Ankara,
Turkey.
Green, J., Kroll, L., Imre, D., Frances, F. M., Begum, K., & Gannon, L. (2001).
Health gain and predictors of outcome in inpatient and day patient child
psychiatry treatment. Journal of the American Academy of Child and
Adolescent Psychiatry, 40, 325−332.
Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). Facilitating emotional change.
New York: Guilford Press.
Greenson, R. R. (1965). The working alliance and the transference neuroses.
Psychoanalysis Quarterly, 34, 155-181.
Greenson, R. R. (1967). The technique and practice of psychoanalysis. New York:
International Universities Press, Inc.
Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social
consequences. Psychophysiology, 39(3), 281-291. Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation
processes: Implications for affect, relationships, and well-being. Journal of
Personality and Social Psychology, 85(2), 348-362.
109
Hawke, L. D., & Provencher, M. D. (2012). The Canadian French young schema
questionnaire: Confirmatory factor analysis and validation in clinical and
nonclinical samples. Canadian Journal of Behavioural Science, 44(1), 40-
49.
Hinshelwood, R., Robinson, S. & Zarate, O. (2006). Introducing Melanie Klein.
Cambridge.
Hoffart, A., Sexton, H., Hedley, L. M., Wang, C. E., Holthe, H., Haugum, J. A.,
Nordahl, H. M., Hovland, O. J., & Holte, A. (2005). The structure of
maladaptive schemas: A confirmatory factor analysis and a psychometric
evaluation of factor-derived scales. Cognitive Therapy and Research,
29(6), 627–644.
Holland, J. L. (1997). Making vocational choices (3rd ed.). Odessa, FL:
Psychological Assessment Resources
Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in
individual psychotherapy. Psychotherapy, 48(1), 9-16.
Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the
Working Alliance Inventory. Journal of Counseling Psychology, 36, 223-
233.
Horvath, A. O., & Symonds, D. B. (1991). Relation between working alliance and
outcome in psychotherapy; A meta analysis. Journal of Counseling
Psychology, 38(2),139−149.
Hougaard, E. (1994). The therapeutic alliance: A conceptual analysis.
Scandinavian Journal of Psychology, 35, 67−85.
Huppert, J. D., Kivity, Y., Barlow, D. H., Gorman, J. M., Shear, K., & Woods, S.
W. (2014). Therapist effects and the outcome-alliance correlation in
cognitive behavioral therapy for panic disorder with agoraphobia. Behavior
Research and Therapy, 52, 26-34.
Jacobs, C. (1991). Violations of the supervisory relationship: An ethical and
educational blind spot. Social Work, 36, 130-135.
Johnson, S. (2001). The therapeutic alliance with early adolescents: Introduction of
an instrument. Dissertation Abstracts International, 61(10), 5567B.
Johnson, S., Hogue, A., Diamond, G., Leckrone, J., & Liddle, H. A. (1998).
110
Scoring manual for the Adolescent Therapeutic Alliance Scale (ATAS).
Philadelphia: Temple University Unpublished manuscript.
Jung, C. G. (1976). Analytical psychology: Its theory and practice. London.
Karaosmanoğlu, A., Soygüt, G., & Kabul, A. (2011). Psychometric properties of
the Turkish Young Compensation Inventory. Clinical Psychology and
Psychotherapy. Published online in Wiley Online Library
(wileyonlinelibrary.com). DOI: 10.1002/cpp.78.
Kazdin, A. E., Holland, L., Crowley, M., & Breton, S. (1997). Barriers to
treatment participation scale: Evaluation and validation in the context of
child outpatient treatment. Journal of Child Psychology and Psychiatry,
38(8), 1051−1062.
Kazdin, A. E., & Nock, M. K. (2003). Delineating mechanisms of change in child
and adolescent therapy: Methodological issues and research
recommendations. Journal of Child Psychology and Psychiatry, 44,
1116−1129.
Kelly, F. D. (1997). The psychological assessment of abused and traumatized
children. Mahwah, NJ: Erlbaum.
Kendall, P. C. (1994). Treating anxiety disorders in children: results of a
randomised controlled trial. Journal of Consulting and Clinical
Psychology, 62, 100−110.
Kiesler, D. J. (1988). Therapeutic metacommunication: Therapist impact
disclosure as feedback in psychotherapy. Palo Alto, CA: Consulting
Psychologist Press.
Kiesler, D. J. (1996). Contemporary interpersonal theory and research:
Personality, psychopathology, and psychotherapy. New York: Wiley.
Kim, S. C., Boren, D. M., & Solem, S. L. (2001). The Kim alliance scale:
Development and preliminary testing. Clinical Nursing Research, 10,
314−331.
Klein, M. (1932). The psychoanalysis of children. London: Hogarth Press.
Klein, M. (1952). “Some Theoretical Conclusions Regarding the
111
Emotional Life of the Infant” in Developments in Psychoanalysis, London:
Hogarth Press.
Köse, B. (2009). Associations of psychological well-being with early maladaptive
schemas and self-construals. Unpublished master’s thesis. Middle East
Technical University, Ankara, Turkey.
Kroll, L., & Green, J. M. (1997). Therapeutic alliance in inpatient child psychiatry.
Development and initial validation of the family engagement questionnaire.
Clinical Child Psychology and Psychiatry, 2(3), 431−447.
Ladany, N., Constantine, M. G., Miller, K., Erickson, C. D., & Muse-Burke, J. L.
(2000). Supervisor countertransference: A qualitative investigation into its
identification and description, Journal of Counseling Psychology, 47(1),
102-115.
Lamb, M. E. (1975). Fathers: Forgotten contributors to child development. Human
Development, 18(4), 245-266.
Lamb, M. E., Pleck, J. H., & Levine, J. A. (1985). The role of the father in child
development. Advances in Clinical Child Psychology, 8, 229-266.
Leary, T. (1957). Interpersonal diagnosis of personality. New York: Ronald Press.
Lee, C. W., Taylor, G., & Dunn, J. (1999). Factor structure of the schema
questionnaire in a large clinical sample. Cognitive Therapy and Research,
23(4), 441-451.
Levenson, H. (1995). Time-limited dynamic psychotherapy: A guide to clinical
practice. New York: Basic Books.
Linden, J., Stone, J., & Shertzer, B. (1965). Development and evaluation of an
inventory for rating counseling. Personnel and Guidance Journal, 44,
267−276.
Luborsky, L. (1976). Helping alliances in psychotherapy. In J. L. Claghorn (Ed.),
Successful psychotherapy (pp. 92-116). New York: Brunner/Mazel.
Luborsky, L. (1984). Principles of Psychodynamic Psychotherapy. New York:
Basic Books.
Luborsky, L., Chandler, M. Auerbach, A. H., Cohen, J., & Bachrach, H. M.
(1971). Factors influencing the outcome of psychotherapy: A review of
quantitative research. Psychological Bulletin, 75(3), 145-185.
112
Luborsky, L., Singer, B., & Luborsky, L. (1975). Comparative studies of
psychotherapies: Is it true that "Everyone has won and all must have
prizes?” Archives of General Psychiatry, 32, 995-1008.
Ludwig, A. M. (1983). The psychobiological functions of dissociation. American
Journal of Clinical Hypnosis, 26(2), 93-99.
Macran, S., Stiles, W. B., & Smith, J. A. (1999). How does personal therapy affect
therapist’s practice. Journal of Counseling Psychology, 46, 419-431.
Marmar, C. R., Horowitz, M. J.,Weiss, D. S., & Marziali, E. (1986). The
development of the therapeutic alliance rating system. In L. S. Greenberg
&W.M. Pinsof (Eds.), The psychotherapeutic process: A research
handbook (pp. 367−390). New York and London: Guilford Press.
Marmarosh, C. L., Gelso, C. J., Markin, R. D., Majors, R., Mallery, C., & Choi, J.
(2009). The real relationship in psychotherapy: Relationships to adult
attachments, working alliance, transference, and therapy outcome. Journal
of Counseling Psychology, 56(3), 337-350.
Marziali, E., Marmar, C., & Krupnick, J. (1981). Therapeutic alliance scales:
development and relationship to psychotherapy outcome. Journal of
Nervous and Mental Disease, 172, 417−423.
Mayers, D., & Hayes, J. A. (2006). Effects of therapist general self-disclosure and
countertransference disclosure on ratings of the therapist and session.
Psychotherapy: Theory, Research, Practice, Training, 43(2), 173-185.
McCarthy, W.C., & Frieze, I.H. (1999). Negative aspects of therapy: Client
perceptions of therapists’ social influence, burnout, and quality of care.
Journal of Social Issues, 55(1), 33-50.
McCoy Lynch, M. (2012). Factors influencing successful psychotherapy
outcomes. Master of Social Work Clinical Research Papers, 57.
McGuire-Snieckus, R., McCabe, R., Catty, J., Hanson, L., & Priebe, S. (2007). A
new scale to assess the therapeutic relationship in community mental
health: STAR. Psychological Medicine, 37, 85−95.
113
McLeod, B. D., & Weisz, J. R. (2005). The therapy process observational coding
system-alliance scale: Measure characteristics and prediction of outcome in
usual clinical practice. Journal of Consulting and Clinical Psychology,
73(2), 323−333.
Mitchell, S. A. (1988). Relational concepts in psychoanalysis. Cambridge, MA:
Harvard University Press.
Mitchell, S. A. (1993). Hope and dread in psychoanalysis. New York: Basic
Books.
Molinaro (1998). Development and validation of a new measure of therapist focus
on alliance related content. Dissertation Abstracts International, 58(10),
5651B.
Nissen-Lie, H. A., & Havik, O. E. (2013). The contribution of the quality of
therapists’s personal lives to the development of the working alliance.
Journal of Counseling Psychology, 60(4), 483-495.
Orlinsky, D. E., & Howard, K. I. (1966). Therapy Session Report (Form T and
Form P). Chicago: Institute of Juvenile Research.
Orlinsky, D. E., & Howard, K. I. (1975). Varieties of Psychotherapeutic
Experience: Multivariate Analysis of Patients' and Therapists' Reports.
New York: Teachers College Press.
Özbaş, A. A., Sayın, A., & Coşar, B. (2012). Üniversite sinavina hazirlanan
öğrencilerde sinav öncesi anksiyete düzeyi ile erken dönem uyumsuz şema
ilişkilerinin incelenmesi. Bilişsel Davranışçı Psikoterapi ve Araştırmalar
Dergisi, 1, 81-89.
Patton, M. J. (1984). Managing social interaction in counseling: A contribution
from the philosophy of science. Journal of Counseling Psychology, 31,
442-456.
Pinsof, W.M. (1999). Family Therapy Alliance Scale-Revised. Unpublished
Manuscript. The Family Institute, Evanston IL.
Priebe, S., & Gruyters, T. (1993). Role of the helping alliance in psychiatric
community care: A prospective study. Journal of Nervous and Mental
Disease, 181(9), 553−557.
114
Priebe, S., & McCabe, R. (2006). The therapeutic relationship in psychiatric
settings. Acta Psychiatrica Scandinavica, 113(429), 69−72.
Prochaska, J. O., & Norcross, J. C. (2006). Systems of psychotherapy: A
transtheoretical analysis (Sixth Edition). Pacific Grove, CA: Brooks-Cole.
Prochaska, J. O., & DiClemente C. C. (1986). Toward a comprehensive model of
change. Addictive Behaviors: Processes of Change. W. R. Miller and N.
Heather. New York; Plenum Press: 3-27.
Richards, J. M., & Gross, J. J. (1999). Composure at any cost? The cognitive
consequences of emotion suppression. Personality and Social Psychology
Bulletin, 25(8), 1033-1044.
Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic
personality change. Journal of Consulting Psychology, 21, 95-103.
Rogers, C. R. (1965). Client-centered therapy: its current practice, implications,
and theory. Boston: Houghton Mifflin.
Rosenberger, E. W., & Hayes, J. A. (2002). Origins, consequences, and
management of countertransference: A case study. Journal of Counseling
Psychology, 49(2), 221-232.
Rosenfeld, H. W. (2010). Addressing personal issues in supervision: Positive and
negative experiences of supervisees. Dissertation Abstracts International:
Section B: The Sciences and Engineering, 71(4-B), 2699.
Russell, A. & Saebel, J. (1997). Mother–son, mother–daughter, father–son, and
father–daughter: Are they distinct relationships? Developmental Review,
17, 111-147.
Saariaho, T., Saariaho, A., Karila, I., & Joukama, M. (2009). The psychometric
properties of the Finnish Young Schema Questionnaire in chronic pain
patients and a non-clinical sample. Journal of Behavior Therapy and
Experimental Psychiatry, 40, 158-168.
Safran, J. D. (1993). Breaches in the therapeutic alliance: An arena for negotiating
authentic relatedness. Psychotherapy, 30(1), 11-24.
Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: A
relational treatment guide. New York: Guilford Press.
115
Safran, J. D., & Segal, Z. (1996). Interpersonal process in cognitive therapy.
Northvale, New Jersey: Jason Aronson Inc.
Sarıtaş, D. (2007). The effects of maternal acceptance-rejection on
psychological distress of adolescents: The mediator roles of early
maladaptive schemas. Unpublished mater’s thesis, Middle East Technical
University, Ankara, Turkey.
Sarıtaş, D., & Gençöz, T. (2011). Psychometric properties of “Young Schema
Questionnaire-Short Form 3” in a Turkish adolescent sample. Journal of
Cognitive Behavioral Psychotherapies, 11(1), 83-96.
Sarlin, N.S. (1992). Working relationships in the treatment of adolescent
inpatients: Early treatment predictors and associations with outcome.
Dissertation Abstracts International.
Saunders, S. M., Howard, K. I., & Orlinsky, D. E. (1989). The therapeutic bond
scales: Psychometric characteristics and relationship to treatment
effectiveness. Psychological assessment: A Journal of Consulting and
Clinical Psychology, 1, 323−330.
Scott, J., Teasdale, J. D., Paykel, E. S., Johnson, A. L., Abbott, R., Hayhurst, H,.
Moore, R., & Garland, A. (2000). Effects of cognitive therapy on
psychological symptoms and social functioning in residual depression. The
British Journal of Psychiatry, 177, 440-446.
Seligman, M. E. P., Reivich, K., Jaycox, L., & Gillham, J. (1995). The optimistic
child. US: Houghton, Mifflin and Company.
Shirk, S. R., & Saiz, C. C. (1992). Clinical, empirical and developmental
Perspectives on the therapeutic relationship in child psychotherapy.
Development and Psychopathology, 4, 713−728.
Sidney, J. B. (2013). The patient’s contribution to the therapeutic process: A
Rogerian-psychodynamic perspective. Psychoanalytic Psychology, 30(2),
139-166.
Smith, M. L., & Glass, G. V. (1977). Meta-analysis of psychotherapy outcome
studies. American Psychologist, 32, 752-760.
116
Smith-Acuna, S., Durlak, J., & Kaspar, C. (1991). Development of child
psychotherapy measures. Journal of Clinical Child Psychology, 20,
126−131.
Solano, C. H. Batten, P. G., & Parish, E. A. (1982). Loneliness and patterns of
self-disclosure. Journal of Personality and Social Psychology, 43(3), 524-
531.
Soygüt, G., Karaosmanoğlu, H.A., & Çakır, Z. (2008a). Early stage maladaptic
schemas: An examination of the psychometric properties of the Young
Parenting Inventory. Turkish Psychological Articles, 11(22), 34–36.
Soygüt, G., Karaosmanoğlu, A. ve Çakır, Z. (2009). Erken Dönem Uyumsuz
Şemaların Değerlendirilmesi: Young Şema Ölçeği Kısa Form-3'ün
Psikometrik Özelliklerine İlişkin Bir İnceleme. Türk Psikiyatri Dergisi,
20(1), 75-84.
Stallard, P. (2007). Early maladaptive schemas in children: Stability and
differences between a community and a clinic referred sample. Clinical
Psychology and Psychotherapy, 14, 10-18.
Sterba, R. (1934). The fate of the ego in analytic therapy. International Journal of
Psychoanalysis, 15, 117-126.
Stricker, G. & Healey, B. J. (1990). Projective assessment of object relations: A
review of the empirical literature. Psychological Assessment, 2, 219-230.
Strong, S. R. (1968). Counseling: An interpersonal influence process. Journal of
Counseling Psychology, 15, 215−224.
Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New
York: Norton.
Svensson, B., & Hansson, L. (1999). Relationships among patient and therapist
ratings of therapeutic alliance and patient assessment of therapeutic
process: A study of cognitive therapy with long term mentally ill patients.
Journal of Nervous and Mental Disease, 87(9), 579−585.
Symonds, D., & Horvath, A. O. (2004). Optimising the alliance in couple therapy.
Family Process, 43(4), 443−455.
Taber, B. J., Leibert, T. W., & Agaskar, V. R. (2011). Relationships among client–
therapist personality congruence, working alliance, and therapeutic
117
outcome. Psychotherapy, 48(4), 376-380.
Teitelbaum, S. H. (1990). Supertransference: The role of the supervisor's blind
spots. Psychoanalytic Psychology, 7, 243-258.
Tracey, T. J., & Kokotovic, A. M. (1989). Factor structure of the Working
Alliance Inventory. Psychological Assessment, 1, 207–210.
Ünal, B. (2012). Early maladaptıve schemas and well-beıng: Importance of
parenting styles and other psychological resources. Unpublished master’s
thesis, Middle East Technical University, Ankara, Turkey.
Wampold, B. E., & Brown, G. S. (2005). Estimating variability in outcomes
attributable to therapists: a naturalistic study of outcomes in managed care.
Journal of Consulting and Clinical Psychology, 73(5), 914−923.
Wachtel, P. L. (2008). Relational theory and the practice of psychotherapy. New
York: Guilford Press.
Winnicott, D. W. (1965). The Family and Individual Development. London:
Tavistock.
Young, J. (1994). Young Parenting Inventory. Unpublisehed report.
Young, J. (1995). Young Compensation Inventory. New York: Cognitive Therapy
Center of New York.
Young, J. E. (1999). Cognitive therapy for personality disorders: A schema-
focused approach. (3rd ed.) Sarasota FL: Professional Resource Press.
Young, J. E., & Brown, G. (1990). Young Schema Questionnaire: Special Edition.
New York: Schema Therapy Institute.
Young J. E., Klosko J. S., & Weishaar, M. E. (2003). Schema therapy: A
practitioner’s guide. New York. The Guilford Pres.
Young, J., & Rygh, J. (1994). Young-Rygh Avoidance Inventory. New York:
Cognitive Therapy Center of New York.
Zetzel, E. (1956). Current concepts of transference. International Journal of
Psychoanalysis, 37, 369-375.
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APPENDICES
Appendix A: Informed Consent
Gönülü Katılım Formu
Bu çalışma, Prof. Dr. Tülin Gençöz danışmanlığında doktora öğrencisi Bahar Köse’nin
tezi kapsamında yürütülen bir çalışmadır. Çalışmanın amacı, katılımcıların erken yaş dönemindeki
şemaları ve bunların terapötik ilişkiye etkisi ilgili bilgi toplamaktır. Çalışmaya katılım tamimiyle
gönüllülük temelinde olmalıdır. Ankette, sizden kimlik belirleyici hiçbir bilgi istenmemektedir.
Cevaplarınız tamimiyle gizli tutulacak ve sadece araştırmacılar tarafından değerlendirilecektir; elde
edilecek bilgiler bilimsel yayımlarda kullanılacaktır.
Anket, genel olarak kişisel rahatsızlık verecek soruları içermemektedir. Ancak, katılım
sırasında sorulardan ya da herhangi başka bir nedenden ötürü kendinizi rahatsız hissederseniz
cevaplama işini yarıda bırakıp çıkmak da serbestsiniz. Böyle bir durumda anketi uygulayan kişiye,
anketi tamamlamadığınızı söylemek yeterli olacaktır. Anket sonunda, bu çalışmayla ilgili
sorularınız cevaplanacaktır. Bu çalışmaya katıldığınız için şimdiden teşekkür ederiz. Çalışma
hakkında daha fazla bilgi almak için Psikoloji Bölümü öğretim üyelerinden Prof. Dr. Tülin Gençöz
(Oda: B239; Tel: 210 3131; E-posta: [email protected]) ya da araştırma görevlisi Bahar Köse
(Oda: B203; Tel: 210 5962; E-posta: [email protected]) ile iletişim kurabilirsiniz.
Bu çalışmaya tamamen gönüllü olarak katılıyorum ve istediğim zaman yarıda kesip
çıkabileceğimi biliyorum. Verdiğim bilgilerin bilimsel amaçlı yayımlarda kullanılmasını kabul
ediyorum. (Formu doldurup imzaladıktan sonra uygulayıcıya geri veriniz).
İsim Soyad Tarih İmza
----/----/-----
119
Appendix B: Demographic Information Form
Genel Bilgi Formu
Lütfen doldurmaya başlamadan önce, eşleştirmenin doğru yapılabilmesi için her seferinde kendi rumuzunuzu ve kimin için dolduruyorsanız (hasta, terapist ya da süpervizör) onun rumuzunu yazınız ve bu formu kaçıncı süpervizyon görüşmesi için doldurduğunuzu bildiriniz.
1) Benim rumuzum:……………………………………………………………………
2) Doldurduğum hastanın/terapistin/süpervizörün
rumuzu:.................................................
3) Kaçıncı terapi/süpervizyon görüşmesi için
doldurdunuz?..................................................
120
Appendix C: Young Schema Questionnaire
Rumuzunuz:.................................
Yönerge: Aşağıda, kişilerin kendilerini tanımlarken kullandıkları ifadeler sıralanmıştır.
Lütfen her bir ifadeyi okuyun ve sizi ne kadar iyi tanımladığına karar verin. Emin
olamadığınız sorularda neyin doğru olabileceğinden çok, sizin duygusal olarak ne
hissettiğinize dayanarak cevap verin.
Bir kaç soru, anne babanızla ilişkiniz hakkındadır. Eğer biri veya her ikisi şu anda
yaşamıyorlarsa, bu soruları o veya onlar hayatta iken ilişkinizi göz önüne alarak
cevaplandırın.
1 den 6’ya kadar olan seçeneklerden sizi tanımlayan en yüksek şıkkı seçerek her sorudan önce yer alan boşluğa yazın.
Derecelendirme:
1- Benim için tamamıyla yanlış
2- Benim için büyük ölçüde yanlış
3- Bana uyan tarafı uymayan tarafından biraz fazla
4- Benim için orta derecede doğru
5- Benim için çoğunlukla doğru
6- Beni mükemmel şekilde tanımlıyor
121
1. _____ Bana bakan, benimle zaman geçiren, başıma gelen olaylarla gerçekten ilgilenen kimsem olmadı. 2. _____ Beni terkedeceklerinden korktuğum için yakın olduğum insanların peşini bırakmam. 3. _____ İnsanların beni kullandıklarını hissediyorum 4. _____ Uyumsuzum. 5. _____ Beğendiğim hiçbir erkek/kadın, kusurlarımı görürse beni sevmez. 6. _____ İş (veya okul) hayatımda neredeyse hiçbir şeyi diğer insanlar kadar iyi yapamıyorum 7. _____ Günlük yaşamımı tek başıma idare edebilme becerisine sahip olduğumu hissetmiyorum. 8. _____ Kötü bir şey olacağı duygusundan kurtulamıyorum. 9. _____ Anne babamdan ayrılmayı, bağımsız hareket edebilmeyi, yaşıtlarım kadar, başaramadım. 10. _____ Eğer istediğimi yaparsam, başımı derde sokarım diye düşünürüm. 11. _____ Genellikle yakınlarıma ilgi gösteren ve bakan ben olurum. 12. _____ Olumlu duygularımı diğerlerine göstermekten utanırım (sevdiğimi, önemsediğimi göstermek gibi). 13. _____ Yaptığım çoğu şeyde en iyi olmalıyım; ikinci olmayı kabullenemem. 14. _____ Diğer insanlardan bir şeyler istediğimde bana “hayır” denilmesini çok zor
kabullenirim. 15. _____ Kendimi sıradan ve sıkıcı işleri yapmaya zorlayamam. 16. _____ Paramın olması ve önemli insanlar tanıyor olmak beni değerli yapar. 17. _____ Her şey yolunda gidiyor görünse bile, bunun bozulacağını hissederim. 18. _____ Eğer bir yanlış yaparsam, cezalandırılmayı hakkederim. 19. _____ Çevremde bana sıcaklık, koruma ve duygusal yakınlık gösteren kimsem yok. 20. _____ Diğer insanlara o kadar muhtacım ki onları kaybedeceğim diye çok endişeleniyorum. 21. _____ İnsanlara karşı tedbiri elden bırakamam yoksa bana kasıtlı olarak zarar vereceklerini hissederim. 22. _____ Temel olarak diğer insanlardan farklıyım.
122
23. _____ Gerçek beni tanırlarsa beğendiğim hiç kimse bana yakın olmak istemez. 24. _____ İşleri halletmede son derece yetersizim. 25. _____ Gündelik işlerde kendimi başkalarına bağımlı biri olarak görüyorum. 26. _____ Her an bir felaket (doğal, adli, mali veya tıbbi) olabilir diye hissediyorum. 27. _____ Annem, babam ve ben birbirimizin hayatı ve sorunlarıyla aşırı ilgili olmaya eğilimliyiz. 28. _____ Diğer insanların isteklerine uymaktan başka yolum yokmuş gibi hissediyorum;
eğer böyle yapmazsam bir şekilde beni reddederler veya intikam alırlar. 29. _____ Başkalarını kendimden daha fazla düşündüğüm için ben iyi bir insanım. 30. _____ Duygularımı diğerlerine açmayı utanç verici bulurum. 31. _____ En iyisini yapmalıyım, “yeterince iyi” ile yetinemem. 32. _____ Ben özel biriyim ve diğer insanlar için konulmuş olan kısıtlamaları veya
sınırları kabul etmek zorunda değilim. 33. _____ Eğer hedefime ulaşamazsam kolaylıkla yılgınlığa düşer ve vazgeçerim. 34. _____ Başkalarının da farkında olduğu başarılar benim için en değerlisidir. 35. _____ İyi bir şey olursa, bunu kötü bir şeyin izleyeceğinden endişe ederim. 36. _____ Eğer yanlış yaparsam, bunun özürü yoktur. 37. _____ Birisi için özel olduğumu hiç hissetmedim. 38. _____ Yakınlarımın beni terk edeceği ya da ayrılacağından endişe duyarım 39. _____ Herhangi bir anda birileri beni aldatmaya kalkışabilir. 40. _____ Bir yere ait değilim, yalnızım. 41. _____ Başkalarının sevgisine, ilgisine ve saygısına değer bir insan değilim. 42. _____ İş ve başarı alanlarında birçok insan benden daha yeterli. 43. _____ Doğru ile yanlışı birbirinden ayırmakta zorlanırım. 44. _____ Fiziksel bir saldırıya uğramaktan endişe duyarım. 45. _____ Annem, babam ve ben özel hayatımız birbirimizden saklarsak, birbirimizi
aldatmış hisseder veya suçluluk duyarız 46. _____ İlişkilerimde, diğer kişinin yönlendirici olmasına izin veririm.
123
47. _____ Yakınlarımla o kadar meşgulüm ki kendime çok az zaman kalıyor. 48. _____ İnsanlarla beraberken içten ve cana yakın olmak benim için zordur. 49. _____ Tüm sorumluluklarımı yerine getirmek zorundayım. 50. _____ İstediğimi yapmaktan alıkonulmaktan veya kısıtlanmaktan nefret ederim. 51. _____ Uzun vadeli amaçlara ulaşabilmek için şu andaki zevklerimden fedakarlık etmekte zorlanırım 52. _____ Başkalarından yoğun bir ilgi görmezsem kendimi daha az önemli hissederim. 53. _____ Yeterince dikkatli olmazsanız, neredeyse her zaman bir şeyler ters gider. 54. _____ Eğer işimi doğru yapmazsam sonuçlara katlanmam gerekir. 55. _____ Beni gerçekten dinleyen, anlayan veya benim gerçek ihtiyaçlarım ve
duygularımı önemseyen kimsem olmadı. 56. _____ Önem verdiğim birisinin benden uzaklaştığını sezersem çok kötü hissederim. 57. _____ Diğer insanların niyetleriyle ilgili oldukça şüpheciyimdir. 58. _____ Kendimi diğer insanlara uzak veya kopmuş hissediyorum. 59. _____ Kendimi sevilebilecek biri gibi hissetmiyorum. 60. _____ İş (okul) hayatımda diğer insanlar kadar yetenekli değilim. 61. _____ Gündelik işler için benim kararlarıma güvenilemez. 62. _____ Tüm paramı kaybedip çok fakir veya zavallı duruma düşmekten endişe duyarım. 63. _____ Çoğunlukla annem ve babamın benimle iç içe yaşadığını hissediyorum-Benim
kendime ait bir hayatım yok. 64. _____ Kendim için ne istediğimi bilmediğim için daima benim adıma diğer insanların
karar vermesine izin veririm. 65. _____ Ben hep başkalarının sorunlarını dinleyen kişi oldum. 66. _____ Kendimi o kadar kontrol ederim ki insanlar beni duygusuz veya hissiz bulurlar. 67. _____ Başarmak ve bir şeyler yapmak için sürekli bir baskı altındayım. 68. _____ Diğer insanların uyduğu kurallara ve geleneklere uymak zorunda olmadığımı hissediyorum.
124
69. _____ Benim yararıma olduğunu bilsem bile hoşuma gitmeyen şeyleri yapmaya kendimi zorlayamam.
70. _____ Bir toplantıda fikrimi söylediğimde veya bir topluluğa tanıtıldığımda onaylanılmayı ve takdir görmeyi isterim. 71. _____ Ne kadar çok çalışırsam çalışayım, maddi olarak iflas edeceğimden ve neredeyse her şeyimi kaybedeceğimden endişe ederim. 72. _____ Neden yanlış yaptığımın önemi yoktur; eğer hata yaptıysam sonucuna da katlanmam gerekir. 73. _____ Hayatımda ne yapacağımı bilmediğim zamanlarda uygun bir öneride
bulunacak veya beni yönlendirecek kimsem olmadı. 74. _____ İnsanların beni terk edeceği endişesiyle bazen onları kendimden uzaklaştırırım. 75. _____ Genellikle insanların asıl veya art niyetlerini araştırırım. 76. _____ Kendimi hep grupların dışında hissederim. 77. _____ Kabul edilemeyecek pek çok özelliğim yüzünden insanlara kendimi
açamıyorum veya beni tam olarak tanımalarına izin vermiyorum. 78. _____ İş (okul) hayatımda diğer insanlar kadar zeki değilim. 79. _____ Günlük yaşamımı tek başıma idare edebilme becerisine sahip olduğumu hissetmiyorum. 80. _____ Bir doktor tarafından herhangi bir ciddi hastalık bulunmamasına rağmen bende
ciddi bir hastalığın gelişmekte olduğu endişesine kapılıyorum. 81. _____ Sık sık annemden babamdan ya da eşimden ayrı bir kimliğimin olmadığını hissediyorum. 82. _____ Haklarıma saygı duyulmasını ve duygularımın hesaba katılmasını istemekte çok zorlanıyorum. 83. _____ Başkaları beni, diğerleri için çok, kendim için az şey yapan biri olarak görüyorlar. 84. _____ Diğerleri beni duygusal olarak soğuk bulurlar. 85. _____ Kendimi sorumluluktan kolayca sıyıramıyorum veya hatalarım için gerekçe bulamıyorum. 86. _____ Benim yaptıklarımın, diğer insanların katkılarından daha önemli olduğunu hissediyorum. 87. _____ Kararlarıma nadiren sadık kalabilirim. 88. _____ Bir dolu övgü ve iltifat almam kendimi değerli birisi olarak hissetmemi sağlar.
125
89. _____ Yanlış bir kararın bir felakete yol açabileceğinden endişe ederim. 90. _____ Ben cezalandırılmayı hakeden kötü bir insanım.
126
Appendix D: Young Parenting Inventory
Rumuzunuz:.......................................
Aşağıda anne ve babanızı tarif etmekte kullanabileceğiniz tanımlamalar verilmiştir. Lütfen her tanımlamayı dikkatle okuyun ve ebeveynlerinize ne kadar uyduğuna karar verin. 1 ile 6 arasında, çocukluğunuz sırasında annenizi ve babanızı tanımlayan en yüksek dereceyi seçin. Eğer sizi anne veya babanız yerine başka insanlar büyüttü ise onları da aynı şekilde derecelendirin. Eğer anne veya babanızdan biri hiç olmadı ise o sütunu boş bırakın.
1 - Tamamı ile yanlış
2 - Çoğunlukla yanlış
3 - Uyan tarafı daha fazla
4 - Orta derecede doğru
5 - Çoğunlukla doğru
6 - Ona tamamı ile uyuyor.
127
Anne Baba
1. ____ ____ Beni sevdi ve bana özel birisi gibi davrandı.
2. ____ ____ Bana vaktini ayırdı ve özen gösterdi.
3. ____ ____ Bana yol gösterdi ve olumlu yönlendirdi.
4. ____ ____ Beni dinledi, anladı ve duygularımızı karşılıklı paylaştık.
5. ____ ____ Bana karşı sıcaktı ve fiziksel olarak şefkatliydi.
6. ____ ____ Ben çocukken öldü veya evi terk etti.
7. ____ ____ Dengesizdi, ne yapacağı belli olmazdı veya alkolikti.
8. ____ ____ Kardeş(ler)imi bana tercih etti.
9. ____ ____ Uzun süreler boyunca beni terk etti veya yalnız bıraktı.
10. ____ ____ Bana yalan söyledi, beni kandırdı veya bana ihanet etti.
11. ____ ____ Beni dövdü, duygusal veya cinsel olarak taciz etti.
12. ____ ____ Beni kendi amaçları için kullandı.
13. ____ ____ İnsanların canını yakmaktan hoşlanırdı.
14. ____ ____ Bir yerimi inciteceğim diye çok endişelenirdi.
15. ____ ____ Hasta olacağım diye çok endişelenirdi.
16. ____ ____ Evhamlı veya fobik/korkak bir insandı.
17. ____ ____ Beni aşırı korurdu.
18. ____ ____ Kendi kararlarıma veya yargılarıma güvenememe neden oldu
19. ____ ____ İşleri kendi başıma yapmama fırsat vermeden çoğu işimi o yaptı.
20. ____ ____ Bana hep daha çocukmuşum gibi davrandı.
21. ____ ____ Beni çok eleştirirdi.
22. ____ ____ Bana kendimi sevilmeye layık olmayan veya dışlanmış bir gibi
hissettirdi.
23. ____ ____ Bana hep bende yanlış bir şey varmış gibi davrandı.
24. ____ ____ Önemli konularda kendimden utanmama neden oldu.
25. ____ ____ Okulda başarılı olmam için gereken disiplini bana kazandırmadı.
26. ____ ____ Bana bir salakmışım veya beceriksizmişim gibi davrandı.
27. ____ ____ Başarılı olmamı gerçekten istemedi.
28. ____ ____ Hayatta başarısız olacağıma inandı.
29. ____ ____ Benim fikrim veya isteklerim önemsizmiş gibi davrandı.
30. ____ ____ Benim ihtiyaçlarımı gözetmeden kendisi ne isterse onu yaptı.
128
31. ____ ____ Hayatımı o kadar çok kontrol altında tuttu ki çok az seçme
özgürlüğüm oldu.
32. ____ ____ Her şey onun kurallarına uymalıydı.
33. ____ ____ Aile için kendi isteklerini feda etti.
34. ___ ____ Günlük sorumluluklarının pek çoğunu yerine getiremiyordu ve ben
her zaman kendime düşenden fazlasını yapmak zorunda kaldım.
35. ____ ____ Hep mutsuzdu ; destek ve anlayış için hep bana dayandı.
36. ____ ____ Benim güçlü olduğumu ve diğer insanlara yardım etmem gerektiğini
hissettirdi.
37. ____ ____ Kendisinden beklentisi hep çok yüksekti ve bunlar için kendini çok
zorlardı.
38. ____ ____ Benden her zaman en iyisini yapmamı bekledi.
39. ____ ____ Pek çok alanda mükemmeliyetçiydi; ona göre her şey olması gerektiği
gibi olmalıydı.
40. ____ ____ Yaptığım hiçbir şeyin yeterli olmadığını hissetmemi sağladı.
41. ____ ____ Neyin doğru neyin yanlış olduğu hakkında kesin ve katı kuralları
vardı.
42. ____ ____ Eğer işler düzgün ve yeterince hızlı yapılmazsa sabırsızlanırdı.
43. ____ ____ İşlerin tam ve iyi olarak yapılmasına, eğlenme veya dinlenmekten
daha fazla önem verdi.
44. ____ ____ Beni pek çok konuda şımarttı veya aşırı hoşgörülü davrandı.
45. ____ ____ Diğer insanlardan daha önemli ve daha iyi olduğumu hissettirdi.
46. ____ ____ Çok talepkardı; Her şeyin onun istediği gibi olmasını isterdi.
47. ____ ____ Diğer insanlara karşı sorumluklarımın olduğunu bana öğretmedi.
48. ____ ____ Bana çok az disiplin veya terbiye verdi.
49. ____ ____ Benim için çok az kural koydu veya sorumluluk verdi.
50. ____ ____ Aşırı sinirlenmeme veya kontrolümü kaybetmeme izin verirdi.
51. ____ ____ Disiplinsiz bir insandı.
52. ____ ____ Birbirimizi çok iyi anlayacak kadar yakındık.
53. ____ ____ Ondan tam olarak ayrı bir birey olduğumu hissedemedim veya
bireyselliğimi yeterince yaşamadım.
54. ____ ____ Onun çok güçlü bir insan olmasından dolayı büyürken kendi yönümü
belirleyemiyordum.
55. ____ ____ İçimizden birinin uzağa gitmesi durumunda, birbirimizi
üzebileceğimizi hissederdim.
129
56. _____ ____ Ailemizin ekonomik sorunları ile ilgili çok endişeli idi.
57. ____ ____ Küçük bir hata bile yapsam kötü sonuçların ortaya çıkacağını
hissettirirdi.
58. ____ ____ Kötümser bir bakışı açısı vardı, hep en kötüsünü beklerdi.
59. ____ ____ Hayatın kötü yanları veya kötü giden şeyler üzerine odaklanırdı.
60. ____ ____ Her şey onun kontrolü altında olmalıydı.
61. ____ ____ Duygularını ifade etmekten rahatsız olurdu.
62. ____ ____ Hep düzenli ve tertipliydi; değişiklik yerine bilineni tercih ederdi.
63. ____ ____ Kızgınlığını çok nadir belli ederdi.
64. ____ ____ Kapalı birisiydi; duygularını çok nadir açardı.
65. ____ ____ Yanlış bir şey yaptığımda kızar veya sert bir şekilde eleştirdiği
olurdu.
66. ____ ____ Yanlış bir şey yaptığımda beni cezalandırdığı olurdu.
67. ____ ____ Yanlış yaptığımda bana aptal veya salak gibi kelimelerle hitap ettiği
olurdu.
68. ____ ____ İşler kötü gittiğinde başkalarını suçlardı.
69. ____ ____ Sosyal statü ve görünüme önem verirdi.
70. ____ ____ Başarı ve rekabete çok önem verirdi.
71. ____ ____ Başkalarının gözünde benim davranışlarımın onu ne duruma
düşüreceği ile çok ilgiliydi.
72. ____ ____ Başarılı olduğum zaman beni daha çok sever veya bana daha çok özen
gösterirdi.
130
Appendix E: Young Rygh Avoidance Inventory
Rumuzunuz:……………………………………..
Aşağıda kişilerin kendilerini tanımlarken kullandıkları ifadeler sıralanmıştır. Lütfen her bir ifadeyi okuyun ve sizi ne kadar iyi tanımladığına karar verin. Daha sonra 1 den 6 ya kadar olan seçeneklerden sizi tanımlayan en yüksek dereceyi seçerek her sorudan önce yer alan boşluğa yazın.
1- Benim için tamamıyla yanlış
2- Benim için büyük ölçüde yanlış 3- Bana uyan tarafı uymayan tarafından biraz fazla 4- Benim için orta derecede doğru 5- Benim için çoğunlukla doğru 6- Beni mükemmel şekilde tanımlıyor
131
1. ___ Beni üzen konular hakkında düşünmemeye çalışırım.
2. ___ Sakinleşmek için alkollü içecekler içerim.
3. ___ Çoğu zaman mutluyumdur.
4. ___ Çok nadiren üzgün veya hüzünlü hissederim.
5. ___ Aklı duygulara üstün tutarım.
6. ___ Hoşlanmadığım insanlara bile kızmamam gerektiğine inanırım.
7. ___ İyi hissetmek için uyuşturucu kullanırım.
8. ___ Çocukluğumu hatırladığımda pek bir şey hissetmem.
9. ___ Sıkıldığımda sigara içerim.
10. ___ Sindirim sistemim ile ilgili şikayetlerim var (Örn: hazımsızlık, ülser, bağırsak
bozulması).
11. ___ Kendimi uyumuş hissederim.
12. ___ Sık sık baş başım ağrır.
13. ___ Kızgınsam insanlardan uzak dururum.
14. ___ Yaşıtlarım kadar enerjim yok.
15. ___ Kas ağrısı şikayetlerim var.
16. ___ Yalnızken oldukça fazla TV seyrederim.
17. ___ İnsanın duygularını kontrol altında tutmak için aklını kullanması gerektiğine inanırım.
18. ___ Hiç kimseden aşırı nefret edemem.
19. ___ Bir şeyler ters gittiğindeki felsefem, olanları bir an önce geride bırakıp yola devam
etmektir.
20. ___ Kırıldığım zaman insanların yanından uzaklaşırım.
21. ___ Çocukluk yıllarımı pek hatırlamam.
22. ___ Gün içinde sık sık şekerleme yaparım veya uyurum.
23. ___ Dolaşırken veya yolculuk yaparken çok mutlu olurum.
24. ___ Kendimi önümdeki işe vererek sıkıntı hissetmekten kurtulurum.
25. ___ Zamanımın çoğunu hayal kurarak geçiririm.
26. ___ Sıkıntılı olduğumda iyi hissetmek için bir şeyler yerim.
27. ___ Geçmişimle ilgili sıkıntılı anıları düşünmemeye çalışırım.
28. ___ Kendimi sürekli bir şeylerle meşgul edip düşünmeye zaman ayırmazsam daha iyi
hissederim.
29. ___ Çok mutlu bir çocukluğum oldu.
30. ___ Üzgünken insanlardan uzak dururum.
31. ___ İnsanlar kafamı sürekli kuma gömdüğümü söylerler, başka bir deyişle, hoş olmayan
düşünceleri görmezden gelirim.
32. ___ Hayal kırıklıkları ve kayıplar üzerine fazla düşünmemeye eğilimliyim.
132
33. ___ Çoğu zaman, içinde bulunduğum durum güçlü duygular hissetmemi gerektirse de
bir şey hissetmem.
34. ___ Böylesine iyi ana-babam olduğu için çok şanslıyım.
35. ___ Çoğu zaman duygusal olarak tarafsız kalmaya çalışırım.
36. ___ İyi hissetmek için, kendimi ihtiyacım olmayan şeyler alırken bulurum.
37. ___ Beni zorlayacak veya rahatımı kaçıracak durumlara girmemeye çalışırım.
38. ___ İşler benim için iyi gitmiyorsa hastalanırım.
39. ___ İnsanlar beni terk ederse veya ölürse çok fazla üzülmem.
40. ___ Başkalarının benim hakkımda ne düşündükleri beni ilgilendirmez.
133
Appendix F: Young Compensation Inventory
Rumuzunuz:.......................................
Aşağıda kişilerin kendilerini tanımlarken kullandıkları ifadeler sıralanmıştır. Lütfen her bir ifadeyi okuyun ve sizi ne kadar iyi tanımladığına karar verin. Eğer isterseniz ifadeyi
size en yakın gelecek şekilde yeniden yazıp derecelendirebilirsiniz. Daha sonra 1 den 6 ya kadar olan seçeneklerden sizi tanımlayan en yüksek dereceyi seçerek her sorudan önce yer alan boşluğa yazın
1- Benim için tamamıyla yanlış
2- Benim için büyük ölçüde yanlış 3- Bana uyan tarafı uymayan tarafından biraz fazla 4- Benim için orta derecede doğru 5- Benim için çoğunlukla doğru 6- Beni mükemmel şekilde tanımlıyor
134
beni gözetmeyeceklerinden A: Örnek: ---4---İnsanların benden hoşlanmayacaklarından endişe duyarım
1. ___ Kırıldığımı çevremdeki insanlara belli ederim.
2. ___ İşler kötü gittiğinde sıklıkla başkalarını suçlarım.
3. ___ İnsanlar beni hayal kırıklığına uğrattığında veya ihanet ettiğinde çok fazla
öfkelenir ve bunu gösteririm.
4. ___ İntikam almadan öfkem dinmez.
5. ___ Eleştirildiğimde savunmaya geçerim.
6. ___ Başarılarımı veya galibiyetimi başkalarının taktir etmesi önemlidir.
7. ___ Pahalı araba, elbiseler, ev gibi başarının görünür ifadeleri benim için
önemlidir.
8. ___ En iyi ve en başarılı olmak için çok çalışırım.
9. ___ Tanınmış olmak benim için önemlidir.
10. ___ Başarı, ün, zenginlik, güç veya popülarite kazanma ile ilgili hayaller kurarım.
11. ___ İlgi odağı olmak hoşuma gider.
12. ___ Diğer insanlardan daha cilveli / baştan çıkarıcı bir insanımdır.
13. ___ Hayatımda düzen olmasına çok önem veririm (Organizasyon, düzenlilik,
planlama, gündelik işler).
14. ___ İşler kötü gitmesin diye çok çaba harcarım.
15. ___ Hata yapmamak için karar verirken kılı kırk yararım.
16. ___ Çevremdeki insanların yaptıklarını fazlasıyla kontrol ederim.
17. ___ Çevremdeki insanlar üzerinde denetim veya otorite sahibi olabildiğim
ortamlardan hoşlanırım.
18. ___ Hayatımla ilgili bir şey söyleyen, bana karışan insanlardan hoşlanmam.
19. ___ Uzlaşmakta veya kabullenmekte çok zorlanırım.
20. ___ Kimseye bağımlı olmak istemem.
21. ___ Kendi kararlarımı almak ve kendime yeterli olmak benim için hayati önem
taşır.
22. ___ Bir insana bağlı kalmakta veya yerleşik bir düzen kurmakta güçlük çekerim.
23. ___ İstediğimi yapma özgürlüğüm olması için “bağımsız biri” olmayı tercih
ederim.
24. ___ Kendimi sadece bir iş veya kariyerle sınırlamakta zorlanırım, hep başka
seçeneklerim olmalıdır.
25. ___ Genellikle kendi ihtiyaçlarımı başkalarınınkinden önde tutarım.
135
26. ___İnsanlara sık sık ne yapmaları gerektiğini söylerim. Her şeyin doğru bir
şekilde yapılmasını isterim.
27. ___ Diğer insanlar gibi önce kendimi düşünürüm.
28. ___ Bulunduğum ortamın rahat olması benim için çok önemlidir ( örn: ısı, ışık,
mobilya).
29. ___ Kendimi asi biri olarak görürüm; ve genellikle otoriteye karşı koyarım.
30. ___ Kurallardan hoşlanmam ve onları çiğnemekten mutlu olurum.
31. ___ Hoş karşılanmasa veya bana uymasa da alışılmışın dışında olmayı severim.
32. ___ Toplumun standartlarında başarılı olmak için uğraşmam.
33. ___ Çevremdekilerden hep farklı oldum.
34. ___ Kendimden bahsetmeyi sevmem ve insanların özel yaşamımı veya hislerimi
bilmelerinden hoşlanmam.
35. ___ Kendimden emin olmasam da veya kendimi kırılmış hissetsem de
başkalarına hep güçlü görünmeye çalışırım.
36. ___ Değer verdiğim insana yakın dururum ve sahiplenirim.
37. ___ Hedeflerime ulaşmak için sık sık çıkarlarım doğrultusunda yönlendirici
davranışlarda bulunurum.
38. ___ İstediğimi elde etmek için açıkça söylemektense dolaylı yollara başvururum
39. ___ İnsanlarla aramda mesafe bırakırım bu sayede benim izin verdiğim kadar beni
tanırlar.
40. ___ Çok eleştiririm.
41. ___ Standartlarımı korumak ve sorumluluklarımı yerine getirmek için kendimi
yoğun bir baskı altında hissederim.
42. ___ Kendimi ifade ederken sıklıkla patavatsız veya duyarsızımdır.
43. ___ Hep iyimser olmaya çalışırım; olumsuzluklara odaklanmama izin vermem.
44. ___ Ne hissettiğime aldırmadan çevremdekilere güler yüz göstermem gerektiğine
inanırım.
45. ___ Başkaları benden daha başarılı veya daha fazla ilgi odağı olduğunda
kıskanırım veya kötü hissederim.
46. ___ Hakkım olanı aldığımdan ve aldatılmadığımdan emin olmak için çok ileri
gidebilirim.
47. ___ İnsanları gerektiğinde şaşırtıp alt edebilmek için yollar ararım, dolayısı ile
benden faydalanamazlar veya bana kötülük yapamazlar.
48. ___ İnsanların benden hoşlanması için nasıl davranacağımı veya ne söyleyeceğimi
bilirim.
136
Appendix G: Working Alliance Inventory-Therapist and Client Forms
(Therapist Form)
GÖRÜŞME DEĞERLENDİRME ÖLÇEĞİ (TERAPİST FORMU)
Aşağıdaki her bir cümleyi okuduktan sonra, ifadelerle ilgili değerlendirmenizi sağdaki yedi kutucuktan birinin içine (x) işareti koyarak yapınız.
Hiç
bir z
aman
Çok
Seyr
ek
Seyr
ek
Baz
en
Sık
sık
Çok
sık
Her
zam
an
1. Hastamla kendimi rahat hissetmiyorum.
2. Hastam ve ben, sorunlarının düzelmesi için terapide neler yapması gerektiği konusunda aynı şekilde düşünüyoruz.
3. Bu görüşmelerin sonucunda ne olacağı konusunda endişelerim var.
4. Hastam ve ben, terapide yaptıklarımızın işe yaradığına inanıyoruz.
5. Hastamı anladığımı düşünüyorum.
6. Hastam ve ben, onun terapiden neler beklediği konusunda hemfikiriz.
7. Hastam terapide yaptıklarımızı kafa karıştırıcı buluyor.
8. Hastamın bana yakın hissettiğine inanıyorum.
9. Hastam için görüşmelerimizin amacını netleştirmeye ihtiyacım var.
10. Terapiden ne elde etmesi gerektiği konusunda hastamla aynı fikirde değiliz.
11. Hastamla zamanı etkin kullanmadığımıza inanıyorum.
12. Terapide neye ulaşmak istediğimiz konusunda şüphelerim var.
13. Hastamın terapide üzerine düşenlerin ne olduğunu bildiğine eminim.
137
14. Bu görüşmelerin amaçları hastam için önemli.
15. Terapide yaptıklarımızın, hastamın sorunlarıyla ilişkili olmadığını düşünüyorum.
16. Terapide yaptıklarımızın, hastamın istediği değişikliklere ulaşmada ona yardımcı olacağını hissediyorum.
17. Hastamın iyiliğini gerçekten düşünüyorum.
18. Görüşmelerde hastamdan ne beklediğimi biliyorum.
19. Hastam ve ben birbirimize saygı duyuyoruz.
20. Hastama gösterdiğim duygularımda tam olarak dürüst olmadığımı hissediyorum.
21. Hastama yardım edebileceğime inanıyorum.
22. Hastam ve ben, ortak hedeflerimize doğru ilerliyoruz.
23. Hastamı takdir ediyorum.
24. Hastam için neyin üzerinde durmamızın daha önemli olacağı konusunda hemfikiriz.
25. Hastam bu görüşmelerin sonunda neler yaparak değişebileceğini daha iyi anladı.
26. Hastam ve ben birbirimize güveniyoruz.
27. Hastam ve ben sorunlarının neler olduğu konusunda farklı düşünüyoruz.
28. İlişkimiz hastam için çok önemli.
29. Hastamın, eğer yanlış şeyler söyler ya da yaparsa, benim terapiye devam etmeyeceğime dair korkuları var.
30. Görüşmelerin amaçlarını belirleme konusunda hastam ve ben işbirliği içindeyiz.
31. Hastam terapide yapmasını istediğim şeylerden dolayı yerinde saydığını hissediyor.
32. Ne tür değişikliklerin onun yararına olacağı konusunda anlaşmaya vardık.
33. Terapide yaptıklarımız hastama anlamlı gelmiyor.
138
34. Hastam terapinin sonucunda neye ulaşacağını bilmiyor.
35. Hastam sorununu ele alma yollarımızın doğru olduğuna inanıyor.
36.Onaylamadığım şeyler yapsa da hastama olan saygım devam eder.
Yukarıdaki değerlendirmeyi yaptığınız danışanınızla (hastanızla) çalışmanızda sıklıkla hangi kuramın tekniklerinden yararlanıyorsunuz?
…………………………………………………………………………………………………………………………………………………………………………………………………………………………
139
Appendix H: Working Alliance Inventory-Therapist and Client Forms
(Client Form)
GÖRÜŞME DEĞERLENDİRME ÖLÇEĞİ (HASTA FORMU)
Aşağıdaki herbir cümleyi okuduktan sonra, ifadelerle ilgili değerlendirmenizi sağdaki yedi kutucuktan birinin içine (x) işareti koyarak yapınız.
Hiç
bir z
aman
Çok
Seyr
ek
Seyr
ek
Baz
en
Sık
sık
Çok
sık
Her
zam
an
1 Terapistimin yanında kendimi rahat hissetmiyorum.
2. Terapistim ve ben sorunlarımın düzelmesi için terapide neler yapmam gerektiği konusunda aynı şekilde düşünüyoruz.
3. Bu görüşmelerin sonucunda ne olacağı konusunda endişelerim var.
4. Terapide yaptıklarım, bana sorunumla ilgili yeni bir bakış açısı kazandırıyor.
5. Terapistim ve ben birbirimizi anlıyoruz.
6. Terapistim, terapiden neler beklediğimi doğru anlıyor.
7. Terapide yaptıklarımı kafa karıştırıcı buluyorum.
8. Terapistimin bana yakın hissettiğine inanıyorum.
9. Terapistimle görüşmelerimizin amaçlarını belirleyebilmiş olmayı isterdim.
10. Terapiden ne elde etmem gerektiği konusunda terapistime katılmıyorum.
11. Terapistimle zamanı etkin kullanmadığımıza inanıyorum.
140
12. Terapistim terapide neye ulaşmak istediğimi anlamıyor.
13. Terapide üzerime düşenlerin ne olduğunu biliyorum.
14. Bu görüşmelerin amaçları benim için önemli.
15. Terapide yaptıklarımızın, sorunlarımla ilişkili olmadığını düşünüyorum.
16. Terapide yaptıklarımın, istediğim değişikliklere ulaşmamda bana yardımcı olacağını hissediyorum.
17. Terapistimin iyiliğimi gerçekten düşündüğüne inanıyorum.
18. Görüşmelerde terapistimin benden ne beklediğini biliyorum.
19. Terapistim ve ben birbirimize saygı duyuyoruz.
20. Terapistimin bana gösterdiği duygularında tam olarak dürüst olmadığını hissediyorum.
21. Terapistimin bana yardım edebileceğine inanıyorum.
22. Terapistim ve ben, ortak hedeflerimize doğru ilerliyoruz.
23. Terapistimin beni takdir ettiğini hissediyorum.
24. Benim için neyin üzerinde durmamızın daha önemli olacağı konusunda hemfikiriz.
25. Bu görüşmelerin sonunda neler yaparak değişebileceğimi daha iyi anladım.
26. Terapistim ve ben birbirimize güveniyoruz.
27. Terapistim ve ben sorunlarımın neler olduğu konusunda farklı düşünüyoruz.
28. Terapistimle olan ilişkim benim için çok önemli.
29. Eğer yanlış şeyler söyler ya da yaparsam, terapistim terapiye devam etmeyecekmiş gibi geliyor.
141
30. Terapistim ve ben terapiden neler kazanmam gerektiği konusunda hemfikiriz.
31. Terapide yaptığım şeyler bana yerimde saydığımı hissettiriyor.
32. Ne tür değişikliklerin benim yararıma olacağı konusunda anlaşmaya vardık.
33. Terapistimin yapmamı istediği şeyler bana anlamlı gelmiyor.
34. Terapimin sonucunda neye ulaşacağımı bilemiyorum.
35. Sorunumu ele alma yollarımızın doğru olduğuna inanıyorum.
36. Onun onaylamadığı şeyler yaptığımda da terapistimin beni önemsediğini hissediyorum.
142
Appendix I: Working Alliance Inventory-Supervisor and Therapist Forms
(Supervisor Form)
SÜPERVİZYON DEĞERLENDİRME ÖLÇEĞİ (SÜPERVİZÖR FORMU)
Aşağıdaki her bir cümleyi okuduktan sonra, ifadelerle ilgili değerlendirmenizi sağdaki yedi kutucuktan birinin içine (x) işareti koyarak yapınız.
Hiç
bir
zam
an
Çok
Seyr
ek
Seyr
ek
Baz
en
Sık
sık
Çok
sık
Her
zam
an
1. Terapist ve ben, hastanın durumunun iyileştirilmesine yönelik terapide atılan adımlar konusunda hemfikiriz.
2. Terapist ve ben, terapide yapılmakta olanların yararı
konusunda hemfikiriz.
3. Terapistle aramızda yakınlık olduğunu hissediyorum.
4. Süpervizyonda neye ulaşmak istediğimiz konusunda kendimi kaybolmuş hissediyorum.
5. Terapiste yardımcı olabileceğim konusunda becerilerime güveniyorum .
6. Terapist ve ben, süpervizyondaki amaçlarımız konusunda hemfikiriz.
7. Terapisti insan olarak takdir ediyorum.
8. Terapisle ben terapistin gelişimi için, neyin üzerinde durmamızın daha önemli olacağı konusunda hemfikiriz.
9. Terapist ve ben birbirimize güveniyoruz.
10. Terapist ve ben terapistin yaşadığı asıl güçlüklerin neler olduğu konusunda farklı düşünüyoruz.
11. Terapist ve ben, ne tür değişikliklerin benim yararıma olacağı konusunda hemfikiriz.
12. Terapist, süpervizyonda terapi süreci için bulduğumuz/uyguladığımız çözüm yollarını doğru buluyor.
143
Yukarıdaki değerlendirmeyi yaptığınız terapistle çalışmanızda sıklıkla hangi kuramın tekniklerinden yararlanıyorsunuz?
Adleryen Psikoterapi
Analitik (Jungian) Psikoterapi
Bilişsel-Davranışçı Terapiler
Danışanı Merkez Alan Psikoterapiler
Davranışçı Terapiler
Destekleyici Terapiler
Gerçeklik Terapisi
Gestalt Terapisi
Pozitif Psikoterapi
Psikanalitik Psikoterapiler
Psikanaliz
Rasyonel-Duygusal Terapi
Transaksiyonel Analiz
Varoluşçu Psikoterapiler
Eklektik Yaklaşım (hangi kuramlardan oluştuğunu lütfen belirtiniz):....................................................
..............................................................................................................................................
.......Entegratif Yaklaşım (hangi kuramlardan oluştuğunu lütfen belirtiniz):..................................................
......................................................................................................... .....................................
.......Diğer (lütfen belirtiniz):.............................................................
144
Appendix J: Working Alliance Inventory-Supervisor and Therapist Forms
(Therapist Form)
SÜPERVİZYON DEĞERLENDİRME ÖLÇEĞİ (TERAPİST FORMU)
Aşağıdaki her bir cümleyi okuduktan sonra, ifadelerle ilgili değerlendirmenizi sağdaki yedi kutucuktan birinin içine (x) işareti koyarak yapınız.
Hiç
bir
zam
an
Çok
Seyr
ek
Seyr
ek
Baz
en
Sık
sık
Çok
sık
Her
za
man
1. Süpervizörüm ve ben, becerilerimin gelişmesine yönelik terapide atılan adımlar konusunda hemfikiriz.
2. Süpervizörüm ve ben, terapide yapılmakta olanların yararı konusunda hemfikiriz.
3. Süpervizörümle aramızda yakınlık olduğunu hissediyorum.
4. Süpervizyonda neye ulaşmak istediğimiz konusunda kaybolmuş hissediyorum.
5. Bana yardımcı olabileceği konusunda süpervizörümün becerilerine güveniyorum .
6. Süpervizörüm ve ben, süpervizyondaki amaçlarımız konusunda hemfikiriz.
7. Süpervizörümün beni insan olarak takdir ettiğini hissediyorum.
8. Süpervizörümle, süpervizyonda benim için neyin üzerinde durmamızın daha önemli olacağı konusunda hemfikiriz.
9. Süpervizörüm ve ben birbirimize güveniyoruz.
10. Süpervizörüm ve ben, yaşadığım asıl güçlüklerin neler olduğu konusunda farklı düşünüyoruz.
11. Süpervizörüm ve ben, ne tür değişikliklerin benim yararıma olacağı konusunda hemfikiriz.
12. Süpervizyonda, yaşadığım güçlüklerle baş edebilmek için uyguladığımız yolları doğru buluyorum.
145
Appendix K: Open-Ended Question Form
Rumuzunuz:……………………………….
1) Süpervizyon sürecinde yaşadığınız en büyük güçlük ne oldu?
…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
2) Bununla nasıl başa çıktınız? ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
146
Appendix L: Relational Circles
Katılımcı Rumuzu……………......
Yönerge:
ODTÜ Psikoloji Bölümü’ne ait UYAREM Klinik Psikoloji Ünitesi’nde bir süredir psikoterapi hizmetleri içerisinde yer alıyorsunuz. Süpervizör, terapist ya da hasta olarak bu süreci üçlü bir eğitim süreci içerisinde devam etmektesiniz. Tüm bu süreçleri düşündüğünüzde, süpervizör, terapist ve hasta ilişkisi açısından, bu üçlü eğitim sürecinde aşağıdaki başlıklar açısından bu süreci sizin bakış açınıza göre en iyi tanımlayan semboller hangileridir?
1. Süpervizyon ve psikoterapi sürecinde görevler açısından, süpervizörün, terapistin ve hastanın sizce konumu ve etkileşimi aşağıdaki hangi şekille en iyi anlatılmaktadır? (halkaların kesişimlerini görevlerin ortak paylaşımı olarak değerlendirebilirsiniz)
2. Süpervizyon ve psikoterapi sürecinde amaçlar açısından, süpervizörün, terapistin ve hastanın sizce konumu ve etkileşimi aşağıdaki hangi şekille en iyi anlatılmaktadır? (halkaların kesişimlerini amaçların ortak paylaşımı olarak değerlendirebilirsiniz)
3. Süpervizyon ve psikoterapi sürecinde duygusal bağ açısından, süpervizörün, terapistin ve hastanın sizce konumu ve etkileşimi aşağıdaki hangi şekille en iyi anlatılmaktadır? (halkaların kesişimlerini duygusal bağın ortak paylaşımı olarak değerlendirebilirsiniz)
147
D)
E)
F)
Terapist
Süpervizör
Hasta
Hasta
Süpervizör
Terapist
Hasta
Terapist
Süpervizör
A)
B)
C)
Süpervizör
Terapist
Hasta
Terapist
Hasta
Süpervizör
Süpervizör
Hasta
Terapist
148
G)
H)
I)
J)
Süpervizör
Hasta Terapist
Süpervizör Hasta Terapist
Terapist Hasta
Süpervizör
Süpervizör Terapist Hasta
K)
L)
M)
Süpervizör Hasta
Terapist
Süpervizör Terapist
Hasta
Terapist Hasta
Süpervizör
149
N)
O)
Süpervizör
Hasta
Terapist
Süpervizör
Hasta
Terapist
P) Diğer….
Eğer bu üç halka ve kesişimleri dışında
aklınıza gelen başka bir üçlü varsa lütfen
aşağıdaki boş alana çizerek neden böyle
çizilmesi gerektiğine dair birkaç cümle ile
açıklama yapınız.
Açıklama…………………………………………………
………………………………………………………………
………………………………………………………………
………………………………………………………………
………………………………………………………………
………………………………………………………………
………………………………………………………………
………………………………………………………………
………………………………………………………………
………………………………………………………………
………………………………………………………………
………………………………………………………………
………………………………………………………………
………………………………………………………………
………………………………………………………………
………………………………………………………………
………………………………………………………………
………………………………………………………………
………………………………………………………………
……………………
150
Appendix M: Tez Fotokopisi İzin Formu
ENSTİTÜ
Fen Bilimleri Enstitüsü
Sosyal Bilimler Enstitüsü
Uygulamalı Matematik Enstitüsü
Enformatik Enstitüsü
Deniz Bilimleri Enstitüsü
YAZARIN
Soyadı :
Adı :
Bölümü :
TEZİN ADI (İngilizce):
TEZİN TÜRÜ : Yüksek Lisans Doktora
1. Tezimin tamamından kaynak gösterilmek şartıyla fotokopi alınabilir.
2. Tezimin içindekiler sayfası, özet, indeks sayfalarından ve/veya bir bölümünden kaynak gösterilmek şartıyla fotokopi alınabilir.
3. Tezimden bir bir (1) yıl süreyle fotokopi alınamaz.
TEZİN KÜTÜPHANEYE TESLİM TARİHİ:
151
CURRICULUM VITAE
PERSONAL INFORMATION
Surname, Name: Köse Karaca, Bahar Nationality: Turkish (TC) Date and Place of Birth: 5 March 1984 , Ankara Marital Status: Married Phone: +90 312 210 5110 Fax: +90 312 210 7975 email: [email protected] EDUCATION
Degree Institution Year of Graduation
MS METU Clinical Psychology 2014 BS METU Psychology 2007 High School Binnaz Rıdvan Ege High
School, Ankara 2002
WORK EXPERIENCE
Year Place Enrollment
2007-still METU Department of
Psychology Research Assistant
INTERNATIONAL PRESENTATIONS
Köse, B., & Gençöz, T. (2013, July). Associations between
schema domains and personality traits: A study conducted with turkish
adults. 7 th World Congress of Behavioural and Cognitive Therapies,
Lima, Peru.
Köse, B., & Gençöz, T. (2013, July). Associates of
well-being measures with young schema domains and personality
traits: A study conducted with Turkish adults.13th European Congress
of Psychology, Stockholm, Sweden. 4
152
Köse, B., & Gençöz, T. (2012, July). Associations between schema
domains and personality traits: A study conducted with Turkish adults.
30th International congress of psychology, Cape Town, South Africa.
Köse, B. & Gençöz, T. (June, 2011). Tendencies towards Young Schema
Domains among Turkish Adults regarding Gender, and Different Levels
of Parental Education. 12th European Congress of Psychology, İstanbul,
Turkey.
Köse, B. & Gençöz, T. (June, 2011). The association between young schema
domains and well-being measures.Poster presented at 7th International
Congress of Cognitive Psychotherapy, İstanbul, Turkey.
Köse, B. (May, 2009). The relationship between attachment style and
interpersonal intelligence of Howard Gardner’s multiple intelligence
concept. Poster presented at 1st International Conference of Living
Theorists-Howard Gardner, Burdur, Turkey.
ASSISTED COURSES
PSY 543/544 Cognitive Behavioral Therapies
Duties: Organizing and instructoring CBT laboratory courses every week
targeting improvement psychotherapy skills and self-awareness of the
students and evaluation of papers of the students.
PSY 512 Developmental Psychopathology
Duties: Evaluating of student reaction papers, term papers, and exams.
PSY 610 Research Methods in Clinical Psychology
Duties: Organizing and evaluation of student reaction papers, term papers,
and exams.
PSY 374 Physiological Psychology
Duties: Organizing and evaluation of student reaction papers, term papers,
and exams.
PSY 531 Clinical Assesment
Duties: Assisted to the instructor for the application of education tools.
153
TURKISH SUMMARY
Araştırmalarda, kullanılan terapi yaklaşımları, yöntemler ve psikolojik
semptomlar sabit tutulsa bile, psikoterapilerin sonuçlarının her zaman aynı
çıkmadığı tespit edilmiştir. Literatürde, bu durum için farklı açıklamalar
mevcuttur. Psiokoterapide kullanılan terapi yaklaşımı, terapistin eğitimi ve
deneyimi, hastanın psikopatolojisi, seansların sıklığı ve hastaların tedavi için ne
derecede motive olduğu bunlardan bazıları (Crits-Christoph ve ark., 1991;
McCarthy ve Frieze, 1999; McCoy Lynch, 2012). Bunların yanı sıra, dikkat çeken
bir diğer faktör şüphesiz ki terapötik ilişkidir. Literatürde, terapötik etkinin
doğrudan mı yoksa dolaylı mı etkisi olduğu hala tartışma konusuyken, hasta ve
terapist arasındaki ilişkinin iyileştirici etkisi olduğu ciddi kabul görmektedir
(Elvins ve Green, 2008; Gelso ve Carter, 1985; Gelso ve Carter, 1994; Horvath,
Del Re, Flückiger, ve Symonds, 2011; Huppert ve ark., 2014; Priebe ve McCabe,
2006). Özellikle, terapi ilişkisinde yaşanan sıkıntıların farkında olunması ve bu
sıkıntıları aşarak kaliteli bir terapötik ittifak yaratmak hastanın psikoterapi
sürecinde değişim yaşamasına önemli derecede katkı sağlamaktadır (Safran,
1993). Ancak, birçok araştırmacının psikoterapi sürecinde terapötik ittifakın
önemini kabul etmesine karşın, terapötik ittifakın kavramsal tanımı ve terapötik
ittifakın nasıl ölçülebileceği henüz tartışma konusudur. Bununla birlikte, terapötik
ittifakı analiz etmek, ölçmek ve control etmek için, farklı yaklaşımlardan
araştırmacılar hangi faktörlerin terapötik ittifakı etkilediği üzerine tartışma
yürütmeye devam etmektedir.
Tarihsel bağlamda, terapötik ittifak kavramıyla ilgili ilk çalışmalar
psikodinamik kurama aittir. Terapi içerisindeki ilişkinin önemine ilk kez Freud
(1912/1913) dikkatleri çekmiştir. Freud (1913) yazılarında hastalarının
duygularına ve doktorlarına olan bağlanmasına odaklanmış ve buna bağlı olarak
aktarım ve karşıaktarım kavramlarını ortaya atmıştır. Freud’dan sonra daha birçok
araştırmacı kendi kavramları ile terapötik ilişkinin önemine dikkat çekmiştir
(Anderson ve Anderson, 1962; Baillargeon, Cote ve Douville, 2012; Barrett-
Lennard, 1962/1978/1986; Curtis, 1979; Frank ve Frank, 1991; Frieswyk ve
ark.,1986; Greenson, 1965; Hayes, 1998; Hougaard, 1994; Luborsky, 1976;
154
Luborsky, Singer ve Luborsky, 1975; Orlinsky ve Howard, 1975; Rogers, 1957;
Smith ve Gloss, 1977; Sterba, 1934; Zetzel, 1956). Ancak literatürde, bu
kavramlar arasında en çok kabul gören ve kullanılan Bordin’in terapötik ittifak
kavramı olmuştur (Gelso ve Carter, 1985; Greenson, 1967; Horvath ve Greenberg,
1989; Patton, 1984). Bordin’e göre (1979), terapötik ilişki hangi yaklaşımın
kullanıldığına bağlı olmaksızın şimdi ve burada terapist ve hasta arasında terapötik
tedavinin bütün biçimlerini kapsayan ilişkidir. Ayrıca terapötik ilişki hem
terapistin hem de hastanın ortak katılımından oluşan amaç, hedef ve duygusal bağ
boyutlarından oluşmaktadır. Bu çalışmada da Bordin’in kavramı kullanılmıştır.
Terapötik ilişkinin öneminin anlaşılması ve kavramsallaştırma
çalışmalarından sonra bu kavramların nasıl ölçüleceği literatür için diğer bir
tartışma konusu olmuştur. Birçok araştırmacı çeşitli ölçekler geliştirmiştir (örn.
Anderson ve Anderson, 1962; Barrett-Lennard, 1962; Stone ve Shertzer; 1965;
Orlinsky ve Howard; 1966). Bu ölçeklerden ampirik olarak güçlü olması nedeniyle
en çok kullanılanlardan biri Horvath ve Greenberg’in (1989) Bordin’in (1979)
amaç, hedef ve duygusal bağ odaklı terapötik ilişki kavramını ölçmek için
oluşturulmuş olduğu Terapötik İttifak Ölçeği olmuştur. Bu çalışmada da nicel
yöntem olarak bu ölçek kullanılmıştır. Ancak, terapötik ilişkinin ölçümü ile ilgili
tartışmalar devam etmekte ve üretilen ölçüm araçları birtakım kısıtlılıklar
içermektedir. İlk olarak, terapötik ilişkinin ne olduğu konusunda kavramsal olarak
ortak bir kabulun olmaması birçok ölçek üretilmesine neden olmuştur (Elvins ve
Green, 2008). Buna bağlı olarak terapötik ilişki literatürü için temsili bir ölçek
oluşmamış böylece ölçek odaklı birçok çalışma yapılmıştır. İkinci olarak, Green ve
ark.’na göre (2001), bu ölçekler genç yaş grubunu değerlendirmek için yetersiz
kalmaktadır. Creed ve Kendall (2005) da özellikle gelişimsel kısıtlılıkları
nedeniyle ergenlerin ve çocukların terapötik ilişki algısını ölçmekte bu ölçeklerin
yetersiz kaldığını vugulamışlardır. Çalışmalarında (2005) gençlerin ittifak olarak
algıladıklarının kendi ebeveynleri ile olan ilişkiyi yansıttığını fark etmişlerdir.
Üçüncü olarak, Braswell, Kendall, Braith, Carey ve Vye (1985), farklı seanslar
sonrası yapılan terapötik ittifak ölçümlerinin sadece o seansa ait ölçümler
olduğunu vurgulamıştır. Elvins ve Green (2008) çalışmalarında, terapötik ilişkinin
erken yaş dönemindeki bağlanma biçimi ile ilgili olduğunu keşfetmişler ve yapılan
155
ölçeklerin bağlamayı da esas alarak terapötik ittifakın karmaşık yapısını
ölçebilecek şekilde olması gerektiğini vurgulamışlardır. Ayrıca Eugster ve
Wampold (1996) dört değişkenin (hastanın katılımı, hastanın rahatlığı, hastanın
gelişimi ve hastanın gerçek ilişkisi) hastanın ittifakı değerlendirmedeki algısını
etkilediğini vurgulamıştır. Bundan dolayı, literatüdeki ölçeklerin gerçek ittifakı
ölçemeyeceğini savunmuşlardır. Bunlarla birlikte literaütdeki ölçeklerle ilgili daha
birçok eleştiri mevcuttur (örn. Castonguay, Constantino ve Grosse Holforth, 2006;
Constantine, Arnow, Blosey ve Agras, 2005; Eugster ve Wampold, 1996; Migone,
1996). Tüm bu eleştirilere çözüm üretmek amacıyla Kelly (1997) obje nesne
ilişkilerine dikkatleri çekerek obje ilişkilerinin hastanın terapötik ilişkiye
katkısının bağlanma kuramı çerçevesinde de ele alınabileceğini savunmuştur.
Kelly (1997) sembollere ve temsillere dayalı ölçülürse kökenini çocukluk ve aile
bağlarından alan terapötik ittifakın çok daha doğru ölçülebileceğini iddia etmiştir.
Buradan çıkarak, bu çalışmada terapötik ittifak için nitel ve projektif bir ölçek
geliştirilmiştir.
Literatürdeki kavramsallaştırma ve ölçme çalışmalarından sonra, bir diğer
tartışma konusu terapötik ittfakı nelerin etkiliyor olduğudur. Bununla ilgili terapi
yaklaşımlarından farklı açıklamalar yapılmıştır (Beck, Rush, Shaw ve Emery,
1979; Elliott, Watson, Goldman ve Greenberg, 2004; Freud, 1912; Hinshelwood,
Robinson ve Zarate, 2006; Mayers ve Hayes, 2006; Sullivan, 1953; Safran ve
Muran, 2000). Bu yaklaşımlardan en çok göze çarpan ise Şema Teori’nin
açıklamaları olmuştur (Young, 1999). Şema terapiye göre hem terapistin hem de
hastanın çocukluktan getirdiği erken yaş dönemi uyumsuz şemaları, ebeveyn
kökeni, kaçınma ve telafi baş etme süreçleri terapötik ilişkiyi etkilemektedir. Şema
Teori’ye göre (Young, 1999), beş şema alanı altında (ayrılma ve
dışlanma/reddedilme, zedelenmiş özerklik ve performans, zedelenmiş sınırlar,
başkalarına yönelimlilik, aşırı tetikte olma ve baskılama) toplam on sekiz tane
erken yaş dönemi uyumsuz şema vardır (terk edilme, güvensizlik/istismar edilme,
duygusal yoksunluk, kusurluluk/utanç, sosyal izolasyon, bağımlılık/yetersizlik,
hastalıklar ve zarar görme karşısında dayanıksızlık, yapışıklık, başarısızlık, boyun
eğicilik, kendini feda, onay arayıcılık, karamsarlık, duygusal bastırma, yüksek
standartlar, cezalandırıcılık).
156
Klinik Psikoloji Literatüründe terapötik ilişkinin tedavi sürecindeki
önemine daikkat çekilmesine rağmen, literatüde ilişki döngüsünü neyin etkilediği
üzerine kısıtlı sayıda araştırma vardır. Bundan dolayı, bu çalışmada şu amaçlara
ulaşmak hedeflenmektedir: Young şema alanlarının, baş etme biçimlerinin ve
ebeveyn biçimlerinin süpervizörler, terapistler ve hastalar arasındaki terapötik
ilişkiye etki edip etmek; süpervizörlerin, terapistlerin ve hastaların terapötik ilişki
tanımlarını karşılaştırmak; terapötik ittifakı ölçmek için örtük bir ölçüm aracı
geliştirmek; Terapötik İttifak Ölçeği’nin süpervizör ve terapist formlarının Türkçe
modifikasyonunun yapılması; terapötik ittifakın nitel ve nicel ölçümlerini
kısıtlılıkları ve farklılıkları açısından kıyaslamak
Bu araştırmada hedeflere ulaşabilmek için methot olarak şöyle bir yöntem
ve prosedürler uygulanmıştır. Araştırmada katılımcılar üç grubtan oluşmuştur.
Birinci grup, Orta Doğu Teknik Üniversitesi klinik psikoloji doktora programında
öğrenim gören sekiz süpervizörden oluşmuştur. Bu öğrenciler bölümdeki kıdemli
öğretim görevlileri tarafından, süpervizyon altında en az iki yüz seans hasta gören
ve psikoterapi dersi almış olan grup içierisinden seçilmiştir. Süpervizörler kendi
eğitim sürecinde ilk kez süpervizyon vermiştir. Bu nedenle, onların süpervizyon
süreci de bölümdeki öğretim görevlileri tarafından ayda bir kez denetlenmiştir.
Ayrıca, süpervizörler ayda bir kez da akran süpervizyonuna katılmışlardır. İkinci
grup, Orta Doğu Teknik Üniversitesi klinik psikoloji yüksek lisans programına
devam eden on iki terapistten oluşmuştur. Bu öğrenciler lisans programının ikinci
yılına devam etmektedir ve bu programın ilk yılında psikoterapi dersi almıştır.
Ayrıca, terapistler de ilk kez psikoterapi sürecinde yer almıştır. Terapistler haftada
bir kez süpervizyon almış ve ayda bir kez de lisansüstü öğrencileri ve klinik
psikoloji programının öğretim üyeleri önünde kendi vakalarını sunmuşlardır.
Süpervizörler ve terapistler vaka sunumları aracılığıyla da öğretim görevlileri
tarafından değerlendirilmiştir. Tüm bu süpervizyon ve psikoterapi süreçleri Ayna
Klinik Psikoloji Birimi tarafından sağlanmıştır. "Ayna", Orta Doğu Teknik
Üniversitesi Psikoloji Bölümü'nde klinik psikoloji programına devam eden
öğrencilerin stajı için tesis edilmiş bir klinik destek ünitesidir. Bu ünitede, yüksek
lisans veya doktora eğitimine devam eden öğrenciler süpervizyon altında
psikoterapi hizmeti vermektedir. Üçüncü grupsa, depresyon, anksiyete, yakın ilişki
157
sorunları, veya kişilik bozukluğu şikayetleri ile Ayna’ya başvurmuş sekiz hastadan
oluşmaktadır. Bu hastalar çoğunlukla Orta Doğu Teknik Üniversitesi'nin farklı
bölümlerinde öğrenim gören öğrenciler olmuştur.
Bu çalışmada, iki tip ölçüm yöntemi kullanılmıştır. Birincisi, nicel ölçme
yöntemidir. Nicel ölçüm için Demografik Bilgi Formu, Young Şema Ölçeği,
Young Ebeveynlik Ölçeği, Young-Rygh Kaçınma Envanteri, Young Telafi
Envanteri ile Terapötik İttifak Ölçekleri’nin süpervizör-terapist ve terapist-hasta
formları kullanılmıştır (Detaylı bilgi için tezin orjinaline bakınız). İkinci olarak
nitel ölçüm yöntemi kullanılmıştır. İlk olarak, süpervizörlerin ve terapistlerin
süpervizyon sürecinde yaşadığı zorlukları ve bunlarla nasıl baş ettiklerini
belirlemek için araştırmacı tarafından geliştirilen Açık Uçlu Soru Formu
uygulanmıştır. Buna ek olarak, tüm katılımcıların örtük olarak süpervizyon ve
psikoterapi süreçlerini nasıl algıladıklarını belirleyebilmek için İlişkisel Halkalar
adında bir projektif ölçek geliştirilmiştir. Mevcut çalışma başlamadan önce, Ayna
Klinik Psikoloji Birimi Direktörü ve Orta Doğu Teknik Üniversitesi Etik
Komitesi’nden izin alınmıştır. Ayrıca, çalışmanın başında, katılımcıların bu
çalışmaya gönüllü katılımını ifade ettikleri bilgilendirilmiş onam formu
imzalatılmıştır. Gizliliği sağlamak için, öncelikle, katılımcılara araştırmaya dahil
olmayan bir kişi tarafından takma isim verilmiştir.Araştırmacı takma isimlerin
hangi kişiye ait olduğunu bilmemektedir. Ancak katılımcılara birbirleri için
değerlendirme yapacaklarından takma isimlerin kime ait olduğu bilgisi verilmiştir.
Süpervizörler "Süper" takma adı ile kodlanmış ve bu takma adın arkasına bir sayı
(örneğin, SUPER1) atanmıştır. Ayrıca, terapistler "Freud" takma adı ile kodlanmış
ve bir sayı bu takma adın arkasına (örneğin, Freud1) atanmıştır. Benzer şekilde,
hastalar da “Kaşif” takma adıyla kodlanmış, bu kodun önüne bir sayı sonuna bir
sayı eklenmiş; önüne eklenen sayı hastanın süpervizörünü, arkasına eklenen
sayıysa terapistini temsil etmiştir (örneğin, 1Kaşif5). Ancak araştırmacı bu kodları
tezde yazarken gizliliği sağlayabilmek için tekrar değiştirmiştir. Mevcut çalışmada
üç grup ölçek verilmiştir. Birinci grup araştırmanın başında bir defaya mahsus
olarak evde doldurulacak biçimde uygulanmıştır. Bu grubu Young Şema Ölçeği,
Young Ebeveynlik Ölçeği, Young-Rygh Kaçınma Envanteri ve Young Telafi
Envanteri oluşturmuştur. Terapötik ittifakı ölçen ikinci grupsa, terapi seansı veya
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süpervizyon seansı en az üç seans geçtikten sonra verilmiştir, literatüre göre
terapötik ilişki en erken üç seanstan sonra başladığı için. Bu ölçekler her seans
veya süpervizyon oturumu biter bitmez katılımcılara uygulanmıştır. Bu amaçla,
süpervizyon ve terapi odalarına, bir kutu ve zarf yerleştirilmiştir. Ayrıca hatırlatma
notları da bu odaların içine yerleştirilmiştir. Her oturumun sonunda, katılımcıların
ölçekleri doldurmsı, zarfın içine koymas, zarfı kapatması ve zarfı kutuya atması
beklenmiştir. Üçüncü grup olarak, her süpervizyon ve terapi sürecinin sonunda
doldurulmak üzere, katılımcılara yapılandırılmamış ölçekler (örn. ilişkisel halkalar
ve açık uçlu soru formu) verilmiştir. Katılımcılardan ilişkisel halkaları hedef,
görev ve duygusal bağ açısından doldurmaları beklenmiştir. Hedef, görev ve
duygusal bağ tanımlarına yönelik talimatlar ilişkisel halkaları doldurma işlemi
başlamadan önce araştırmacı tarafından katılımcılara anlatılmıştır. Bordin’in
(1979) kavramsallaştırılmasına dayanarak, amaçlar katılımcın yaşadıkları durumlar
çerçevesinde terapiden ve süpervizyondan kazanmayı umut ettikleri şeyler/bceriler
olarak tanımlanmıştır. Görevler süpervizör ve terapist ya da terapist ve hastanın
birlikte ulaşmak istedikleri amaçlar doğrultusunda hemfikir oldukları görev ve
sorumlulukları içermiştir. Duygusal bağ ise süpervizör-terapist veya terapist-hasta
arasındaki amaçlara ulaşmaya çabalarken oluşan yakınlık ve güven duygusu olarak
tarif edilmiştir.
Bu çalışmada, nicel ölçüm yöntemlerinde diskriptif ve korelasyon amaçlı
sonuçlara ulaşmak için SPSS kullnılmıştır. Nitel ölçümler ise nicel ölçümlerden
çıkan sonuçlarla ilişkilendirilerek açıklanmaya çalışılmıştır.
Yapılan çalışmada sekiz hasta ile başlayan hasta katılımı dört tanesi ile
devam etmiştir. Süpervizör ve terapist sayısında bir kayıp yaşanmamıştır.
Araştırmanın tamamında 52 ilişki biçimi saptanmıştır. Ancak tezde yer
kısıtlılığından dolayı bunların genel bilgisi ile sadece iki vaka anlatılabilmiştir.
Genel bilgi formuna göre, süpervizörler ve terapistler tarafından çoğunlukla
Bilişsel Davranışçı Yaklaşım (10 kişi) kullanılmış bununla kombine olaraksa
Psikodinamik Yaklaşım (6 kişi), Şema Teori (4 kişi), İlişkisel Yaklaşım (2 kişi),
Duygu Odaklı Yaklaşım (1 kişi), Bağlanma Odaklı Yaklaşım (1 kişi), Geştalt
Yaklaşımı (1 kişi), veya Psikoeğitim (1 kişi).
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Ölçeklerin deskriptif özelliklerini analiz edebilmek için, Young Şema
Ölçeği (örn. terk edilme, güvensizlik/istismar edilme, duygusal yoksunluk,
kusurluluk/utanç, sosyal izolasyon, bağımlılık/yetersizlik, hastalıklar ve zarar
görme karşısında dayanıksızlık, yapışıklık, başarısızlık, boyun eğicilik, kendini
feda, onay arayıcılık, karamsarlık, duygusal bastırma, yüksek standartlar,
cezalandırıcılık); Young Ebeveynlik Ölçeği (kuralcı/kalıplayıcı,
küçümseyici/kusur bulucu, duygusal bakımdan yoksun bırakıcı, sömürücü/istismar
edici, aşırı koruyucu/evhamlı, koşullu/başarı odaklı, aşırı izin verici/sınırsız,
kötümser/endişeli, cezalandırıcı, değişime kapalı/duygularını bastıran); Young-
Rygh Kaçınma Ölçeği (örn. psikosomatizm, sıkıntıyı yok saymak, duygu kontrolü,
sosyal çekilme, aktiviteyle zihinden uzaklaştırma, hissizlik, duyguları bastırma);
Young Telafi Ölçeği’nin (örn. statü düşkünlüğü, kontrol, asilik, aşırı bağımsızlık,
manipülatif olma, eleştiriye tahammülsüzlük, kendi yönelimlilik, mesafelilik)
ortalamaları, standart sapmaları ve minimum-maksimum aralıkları
değerlendirilmiştir. Bu analiz süpervizörler, terapistler ve hastalar için ayrı ayrı
tekrarlanmıştır.
Çıkan sonuçlara göre, süpervizörler çoğunlukla kendini feda ( şemalarını
kullanma eğilimindedirler sacrifice (M = 2.95), onay arayıcılık (M = 2.88), yüksek
standartlar (M = 2.75), terk edilme (M = 2.63), büyüklenmecilik (M = 2.40),
cezalandırma (M = 2.28), karamsarlık (M = 2.03) ve sosyal izolasyon (M = 2.00)
şemalarını kullanmaktadırlar. Diğer bir taraftan, sonuçlar gösteriyor ki
süpervizörler çoğunlukla duygusal bakımdan yoksun bırakıcı anne (M = 4.56) ve
baba (M = 3.69), karamsar/kaygılı anne (M = 3.21) ve baba (M = 2.79), değişime
kapalı/duygularını bastıran anne (M = 2.67) ve baba (M = 3.21), kuralcı/kalıplayıcı
anne (M = 2.53) ve baba (M = 2.47) ve koşullu/başarı odaklı anne (M = 2.40) ve
baba (M = 2.85) kökenine sahip ailelerden gelmektedir. Bununla beraber, sosyal
çekilme ve (M = 4.08) ve duygu kontrolü (M = 3.00) süpervizörlerin çoğunlukla
kullandıkları kaçınma baş etme yöntemiyken, mesafelilik (M = 3.55), kontrol (M =
3.50), aşırı bağımsızlık (M = 2.83) ve statü düşkünlüğü (M = 2.41) süpervizörler
tarafından telafi baş etme biçimi olarak saptanmıştır. Sonuçlara gore,
süpervizörlerin Young şema ölçeklerindeki dereceleri psikopatoloji seviyesinde
bulunmamıştır. Ancak, bu araştırmada elde edilen puanlar süpervizörlerin bir
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yatkınlığı olarak ele alınmış ve tartışılmıştır. Terapistlerle ilgili sonuçlar
değerlendirildiğinde, terapistlerin yüksek standartlar (M = 3.80), onay arayıcılık(M
= 3.60), büyüklenmecilik(M = 3.35), kendini feda (M = 2.93), sosyal izolasyon(M
= 2.81), terk edilme(M = 2.67), yetersiz özdenetim (M = 2.62), ve cezalandırıcılık
(M = 2.40) şemalarını çoğunlukla kullanma eğiliminde olduğu saptanmıştır.
Bununla beraber, terapistlerin çoğunlukla duygusal bakımdan yoksun bırakıcı anne
(M = 4.18) ve baba (M = 3.53), koşullu/başarı odaklı anne (M = 3.42) ve baba
(3.40), kötümser/endişeli anne (M = 3.19) ve baba (M = 3.00), değişime
kapalı/duygularını bastıran anne (M = 3.08) ve baba (M = 4.25), kuralcı/kalıplayıcı
anne (M = 2.94) ve baba (3.11) ve aşırı koruyucu/evhamlı anne (M = 2.92)
özellikleri barındıran aile kökenine sahip olduğu dikkati çekmiştir. Ayrıca,
şemalardan kaçınma yöntemi olarak sosyal çekilme (M = 4.00), aktiviteyle
zihinden uzaklaştırma (M = 3.17) ve duygu kontrolü (M = 2.79) çoğunlukla
kullanılıyorken, terapistler arasında sıklıkla kullanılan telafi yöntemleri mesafelilik
(M = 3.82), statü düşkünlüğü (M = 3.32), kontrol (M = 3.32), aşırı bağımsızlık (M
= 3.08), kendi yönelimlilik (M = 2.78), ve eleştiriye tahammülsüzlük(M = 2.69)
olarak belirlenmiştir.
Hastaların sonuçları değerlendirildiğindeyse, hastaların sıklıkla
kullandıkları şemaların yüksek standartlar (M = 4.70), büyüklenmecilik (M =
4.00), kendini feda (M = 3.98), yetersiz özdenetim (M = 3.60), onay arayıcılık(M
= 3.55), cezalandırıcılık (M = 3.55), karamsarlık (M = 3.53), terk edilme (M =
3.30), sosyal izolasyon (M = 3.30) ve duyguları bastırma (M = 3.00) olduğu göze
çarpmıştır. Hastalar için bu şemaların aile kökeni ise, duygusal bakımdan yoksun
bırakıcı anne (M = 4.88) ve baba (M = 3.63), aşırı koruyucu/evhamlı anne (M =
4.29), koşullu/başarı odaklı anne (M = 3.75) ve baba (3.35), kuralcı/kalıplayıcı
anne (M = 3.66) ve baba (3.00), kötümser/endişeli anne (M = 3.58) ve baba (M =
2.79) ve değişime kapalı/duygularını bastıran anne (M = 2.96) özelliklerinden
kaynağını almıştır. Bu şemalarla kaçınma baş etme biçimi olarak hastalar
çoğunlukla sosyal çekilme(M = 4.54), aktiviteyle zihinden uzaklaştırma (M =
4.00), duygu kontrolü (M = 3.88) ve psikosomatizm (M = 2.77) yöntemlerini
kullanmışlardır. Telafi baş etme biçimi olaraksa, mesafelilik (M = 4.85), kontrol
(M = 4.41), kendi yönelimlilik(M = 3.79), aşırı bağımsızlık (M = 3.63), statü
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düşkünlüğü (M = 3.61), asilik (M = 3.58), manipülatif olma (M = 3.35) ve
eleştiriye tahammülsüzlük(M = 3.21) dikkati çekmiştir.
Süpervizörler, terapistler ve hastaların şema ölçeklerinde çıkan yönelim ve
sonuçlarının süpervizyon ve terapi sürecindeki olası etkileri tezin orijinal halinde
tartışılmıştır. Katılımcıların şemaya özellikleri belirlendikten sonra bu özelliklerin
terapötik ilişki ile nasıl ilişkili olduğuna ise korelasyon analizi ile bakılmıştır.
Korelasyon analizinin genel sonuçları değerlendirildiğinde, terapistler
(Görev: M = 6, Amaç: M = 6, Duygusal bağ: M = 5.72) süpervizörleri ile olan
görev, amaç ve duygusal baş odaklı terapötik ilişkilerini süpervizörlerin
puanlamalarına(Görev: M = 5.80, Amaç: M = 5.77, Duygusal bağ: M = 5.59)
kıyasla daha yüksek puanlar ile değerlendirmişlerdir . Ayrıca, hastalar da (Görev:
M = 5.06, Amaç: M = 5.77, Duygusal bağ: M = 5.85) terapi sürecindeki terapötik
ilişkiyi terapistlere (Görev: M = 4.64, Amaç: M = 5.18, Duygusal bağ: M = 5.80)
oranla daha yüksek puanlamalarla değerlendirmişlerdir. Gruplar arası farklılıklar
rakam bazında çok yüksek olmasa da düşük hiyerarşik konumdaki kişilerin yüksek
hiyerarşik konumdaki kişileri daha pozitif değerlendirdiği dikkati çekmiştir. Bu
durum içinde bulunulan süreci idealize etmek ihtiyacı ile ilişkilendirilebilir
(Luborsky, Chveler, Auerbach, Cohen, & Bachrach, 1971). Ayrıca, gruplar arası
fark gruplar içinde açık iletişimle halledilmeyen problem olabileceğini de
düşündürmüştür.
Süpervizörlerin süpervizyon sürecinde terapötik ilişki algısı
değerlendirildiğinde, amaç odaklı terapötik ilişkinin sıkıntıyı yok saymak (r = -
.85, p < .01) ile negatif korelasyon gösterdiği ve görev odaklı terapötik ilişki (r =
.97, p < .001) ile de pozitif korelasyon içinde olduğu saptanmıştır. Bunun yanı sıra,
görev odaklı terapötik ilişki ve bir kaçınma baş etme yöntemi olan sıkıntıyı yok
saymak (r = -.80, p < .05) arasında önemli bir korelasyon saptanmıştır. Ayrıca,
duygusal bağ odaklı terapötik ilişki boyun eğicilik şeması (r = .74, p < .05),
kötümser/endişeli anneye sahip olmak (r = .81, p < .05) ve sömürücü/istismar edici
babaya sahip olmak (r = .77, p < .05) ile önemli pozitif korelasyon gösterirken,
duygusal bağ odaklı terapötik ilişki ile değişime kapalı/duygularını bastıran babaya
sahip olmak (r = -.85, p < .01) ve sıkıntıyı yok saymak(r = -.82, p < .05) arasında
önemli bir negatif korelasyon bulunmuştur. Bu sonuçlara dayanarak, sıkıntıyı yok
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saymak kaçınma yöntemini kullanmak düşük derecede amaç, görev ve duygusal
bağ odaklı terapötik ilişkile korelasyon göstermiştir. Bunun sebebinin problemleri
görmek ve ifade etmek istemeyen süpervizörlerin terapistlerle olan işbirliğinden
hoşnut olmaması olduğu düşünülmüştür. Ancak onlar bunu dile getirmemiştir.
Onlar problemleri fark etmediği, kabul etmediği ve ifade etmediği için de
problemler çözülememiş olabileceği düşünülmüştür. Bu sebeple süpervizyon
esnasında birçok şeyin konuşulmamış olabileceği çıkarımı yapılabilir. Belki de
süpervizörler her şeyin younda olduğuna dair bir tablo çizmiştir. Halbuki
Prochaska ve Norcross’a göre (2006), değişimi başlatabilmek için öncelikle
problemi fark edip, kabul edip dile getirmek gerekir. Süpervizörlerin bu tutumu
belki de onların şema ölçeklerinde de dikkati çeken sevgi, onay ve kabul
ihtiyacından ileri gelmiş olabilir. Diğer taraftan, süpervizyon vermeyi ebeveynlik
süreci ile ilişkilendirirsek (“Psikoterapiyi öğrendin, şimdi nasıl yapılır onu öğret!”
iç sesiyle) ve terapist olabilme süreci çocuk rolü ile ilişkilendirilirse belki de
süpervizörler ebeveyn rolündeyken çocuklarına (terapistlere) sınırsız onay ve
kabul sunmuş ve kendi yaşadıkları üzüntüleri göz ardı etmiştir çünkü kendileri
ailelerinden onay ve kabul alamadıkları için bunu bu şekilde telafi etmeye
çalışmaktadırlar (Driver et al., 2002). Bu yüzden, belki, bu terapistler için iyi bir
ebeveyn olmaya çalışırken yanlış yöntem kullanmışlardır, aslında telafi etmeye
çalıştıkları kendi çocukluk ihtiyaçları olmuştur (Young, 1996). Daha iyi ittifak
sağlayayım derken, gerçek benliklerini ortaya koymamışlarıdır. Belki de maskeli
bir benlikle yanlış yönlendiren bir süpervizyon atmosferi yaratmışlardır
(Winnicott, 1965). Böylece, kendi rahatsız oldukları şeyleri ve üzünleri göz ardı
ettikçe terapötik ilişki daha kötüye gitmiş olabilir. Bununla birlikte, yüksek
seviyede boyun eğicilik şemasına sahip olmakla yüksek seviyede duygusal bağ
odaklı terapötik ilişki arasında bir korelasyon bulunmuştur. Young’a göre (1999),
boyun eğicilik başkaları yönlimlilik şema alanı altında yer almaktadır ve kişinin
kendi duygu, düşünce ve kararlarını reddedilmemek ve başkalarının öfkesine
maruz kalmamak için bastırarak başkalarına aşırı derecede uyum sağlaması ile
ilişkilendirilmektedir. Buradan yola çıkarak, süpervizörler kendi ihtiyaç, duygu ve
isteklerini bastırarak daha yoğun bir duygusal bağa kurmuş olmayı beklemiş
olabilir. Bu da süpervizörlerde terapistle ilişkide boyun eğicilik şemasının aktive
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olduğunu çünkü süpervizörlerin iyi ilişkiler kurabilmek için duyguları bastırmayı
biliyor oldukları düşünülmüştür. Ancak daha önce de bahsedildiği gibi sıkıntıyı
yok saymanın ve gerçek ihtiyacı bastırmanın kişiler arası ilişkilerde daha kötü bir
tablo ile sonuçlandığı belirtilmiştir (Gross & John, 2003) ve bu yapı süpervizyon
odasında gerçekten ne yaşandığının algılanmasını engellemiş olabilirca (terapötik
ilişki). Young (1999) aşırı derece boyun eğicilik şeması olan kişilerde pasif agresif
tutumların ve duygu patlamalarının olabileceğini vurgulamıştır. Aile kökenleri
açısından, kötümser/endişeli anneye ve sömürücü/istismar edici babaya sahip
olmak yüksek seviyede duygusal bağ odaklı terapötik ittifak ilişki ile ilişkili
bulunmuştur. Bunun spervizörlerin kendi çocukluk ihtiyaçlarının bir telafisi
olabileceği düşünülmüştür (Young, Klosko, & Weishaar, 2003). Eğer süpervizör
kötümser bir anne ve sömürücü bir baba ile büyümüşse, belki de ebeveynleriyle
umduğu ve hayalini kurduğu duygusal bağı kuramamıştır. Annenin kötümser ve
babanın sömürücü olduğu bir ortamda belki de umut duygusu var olamamıştır.
Belki de süpervizörler biliçdışından psikoloji bölümünü seçerek bu kötümser ve
umutsuz döngüyü kırmayı hedeflemiştir. Belki de kendi çocukluk ihtiyaçlarını
telafi etmeye çalışarak iyi bir ilişki örüntüsü götürmeye çalışmışlardır (kendi
ebeveynlerinin olamadığı gibi davrnamya çalışarak). Böylece, belki de olduğundan
daha fazla bir duygusal bağ algılmış olabilirler terapistlerle (çünkü kendi ebeynleri
gibi davranmayınca her şeyin yolunda gideceğini düşünmüş olabilirler). Diğer
taraftan, kötümser/endişeli ve sömürücü/istismar edici ebeveynlerin olduğu bir aile
atmosferinde büyümek depresyonun gelişimin provoke eden bir zemin yaratmış
olabilir. Scott ve ark.’na göre (2000), eğer bir kişi umutsuzluk, düşük özgüven ve
suçluluk semptomları ile bir depresyon yaşıyorsa, bu kişinin başkaları ile olan
ilişkilerde bağımlı bir yapı geliştirmeye eğilimi olabilir. Bu yüzden, belki de,
bağımlı ilişki ihtiyacı içerisinde, süpervizörler duygusal bağı gerçekte olduğundan
daha iyi algılamış olabilir. Buna ek olarak, değişime kapalı/duygularını bastıran
babaya sahip olmak düşük seviyedeki duygusal bağ odaklı terapötik ittifak ile
korelasyon göstermiştir. Çıkan bu sonuç aile ortamında çocuğun gelişimi
sürecinde babanın işlevi ve rolü açısından açıklanabilir. Cabrera ve arkadaşlarına
göre (2000), babalar çocuklarını risk alabilmek, bağımsız olabilmek ve başkaları
ile rekabete girebilmek için cesaretlendirmektedir. Ek olarak, Tessman (as cited in
164
Russell ve Saebel, 1997) babaların özellikle kız çocukların sevmeyi ve çalışmayı
öğrenmesinde önemli bir rolü olduğunu savunur. Buna göre, babalar çocuklarının
dış dünya ile bağını temsil eder ve kişiler arası ilişkilerinde güçlü bir yordayıcıdır
(Lamb, 1975; Lamb, Pleck, & Levine, 1985). Tüm bu sebeplerden ötürü, babalar
çocuklarının dış dünya ve gerçeklik ile nasıl ilişki kuracağını ve iç dünyalarını dış
dünyaya nasıl açacaklarını temsil ederler. Bu yüzden, değişime kapalı/duygularını
bastıran baba çocuğunun işbirliği kurmayı, paylaşmayı ve ortaklık edebilmeyi
öğrenmesini engellemiş olabilir. Böylece, bu tarz babalara sahip olan süpervizörler
terapistler ile temel amaçlar koymakta zorluk çekiyor olabilir. Son olaraksa,
yüksek seviyedeki amaç odaklı terapötik ilişki ile yüksek seviyelerdeki görev
odaklı terapötik ilişki arasında bir korelasyon bulunmuştur. Bu belki de amaç
odaklı ve görev odaklı terapötik ilişki maddelerinin birbirlerinden yeterince ayırt
edilememesinden kaynaklanmış olabilir. Diğer taraftan, belki de amaçlar açısından
hemfikir olmak aynı zamanda görevler ve sorumlulukların dağılımı açısından da
hem fikir olunduğu anlamına geliyor olabilir. Ancak bazen insanlar aşılması
gereken bir sorun olduğunu bilir (amaç) ama bunun için yapılması gerekenleri
yapmak istemezler (görev). Bu sebeplerler, amaç ve görevin benzer anlaşılmasının
arkasındaki nedenleri algılamak için dahaz fazla uygulama yapılması gerektiği
düşünülmüştür.
Terapistlerin süpervizyon sürecinde süpervizörlerle olan ilişkilerini nasıl
algıladıklarına gelince, amaç odaklı terapötik ilişki duygusal bakımdan yoksun
bırakıcı anneye sahip olmak (r = .62, p < .05), görev odaklı terapötik ilişki (r = .89,
p < .001) ve duygusal bağ odaklı terapötik ilişki (r = .77, p < .001) ile öenmli
pozitif korelasyon göstermiştir. Ayrıca, görev odaklı terapötik ilişki cezalandırıcı
anneye sahip olmak (r = -.63, p < .05) ile önemli negatif korelasyon gösterirken,
duygusal bağ odaklı terapötik ilişki (r = .89, p < .001) ile önemli pozitif korelasyon
göstermiştir. Ayrıca, duygusal bağ odaklı terapötik ilişki cezalandırıcılık şeması (r
= -.65, p < .05), kontrol kaçınma biçimi (r = -.63, p < .05), manipülatif olma (r = -
.60, p < .05) ve cezalandırcı anneye sahip olmak (r = -.68, p < .05) ile önemli bir
negatif korelasyon göstermiştir.
Terapistlerin süpervizyon sürecindeki pozisyonu açısındansa, yüksek
derecede cezalandırıcılık şemasına sahip olmak, kontrol ve manipülatif olma
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düşük seviyede duygusal bağ odaklı terapötik ilişki ile korelasyon göstermiştir.
Young’a göre (1999), cezalandırıcılık şeması insanın yaptığı hatalar için
cezalandırılması gerektiği inancına dayanır ve bu şema kişinin beklentilerini ve
standartlarını sağlamayan kişiler karşısında asabi, töleranssız, cezalandırıcı ve
sabırsız olma eğilimlerini arttırır (kişinin kendisi için de aynısı söz konusudur).
Şemanın bu tanımından yola çıkarak, bu şemaya sahip terapistler süpervizörleri ile
duygu odaklı terapötik ittifak kurmaya çekinmiş olabilirler. Çünkü eğer ki
süpervizyonda bir hata yaparlarsa bu onlar için duygusal bağ kurulan bir ortamda
daha fazla hayalkırıklığına sebep olacaktır. Bu sayede terapistler kendilerini
cezalandırıcı yapılarından korumuş olabilirler. Bunun yanı sıra, terapistler
açısından bakınca, belki de süpervizörler bir öğretmen ya da ebeveyn gibi
algılanmış olabilir. Eğer böyleyse terapistler hatalarından ders çıkarmak yerine bu
süreçte hata yapmamaya fazlaca odaklanmış olabilirler. Bu kaygılı durum
içerisindeyse, hata yapmak imkansız gibi görünmektedir. Böyle bir süpervizyon
atmosferini yönetebilmek içinse bir strateji gerekmektedir. Büyük olasılıkla,
yaptıkları hataları telafi edebilmek amacıyla kontrol ve manipülatif olma
stratejilerini kullanmış olabilirler. Böylece süpervizörle duygusal bağ kurmaktan
kendilerini yoksun bırakmışlardır. Ayrıca, duygusal bakımdan yoksun bırakıcı
anneye sahip olmak yüksek derecede amaç ve duygusal bağ odaklı terapötik ilişki
ile korelasyon göstermiştir. Bu belki de terapistlerin annelerinden alamadıkları ve
açlığını çektikleri yakınlaşma ve ilişki kurma ihtiyacı ile ilişkilidir. Öte yandan,
cezalandırıcı anneye sahip olmak düşük seviyede görev odaklı ve duygusal bağ
odaklı terapötik ilişki ile korelasyon göstermiştir (Durlak, 1998). Özellikle,
cezalandırıcı ebeveyne sahip olmak cezalandrıcılık şemasının oluşmasını
tetikleyen faktörler arasındadır (Young, 1996). Buna bağlı olarak, yukarda
açıklandığı üzere, terapistler hata yapma korkusuyla sorumluluk almayıp duygusal
bağ kuramadılar. Bunların dışındaysa, amaç odaklı terapötik ilişki yüksek derecede
görev odaklı ve duygusal bağ odaklı terapötik ilişki ile ilişki göstermiştir. Bu
sonuca dayanarak, terapistler amaç, görev ve duygusal bağ odaklı terapötik
ittifakın herhangi birini yüksek değerlendirmişlerse kalan diğerlerine de yüksek
puan vermişlerdir. Yukarıda bahsedildiği gibi, bu terapistlerin şemaları ile
açıklanabilir. Başkaları yönelimlilik şema alanı terapistler için dikkat çekicidir.
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Belki de terapistler onay, kabul ve ilgi almayı koşullu ve başarı vasıtasıyla almayı
öğrendikleri için (Young’ın belirttiği gibi, 1999), belki de amaçta ve görevde
ittifak algılıyorlarsa bunun duygusal bağı da etkilemiş olacağını düşünmüş
olabilirler. Ancak tam tersi düşünülürse, eğer bu terapistlere ortak görev ve
amaçlarladaki performanslarıyla ilgili negatif geribildirim verilirse, onların bunu
genelleyip kişiselleştirip duygusal bağı da olumusuz algılama ve sürdürme eğilimi
olabilir.
Terapistlerin hastlar ile olan sürecindeki terapötik ilişki algılarına
bakıldığındaysa, amaç odaklı terapötik ilişki değişime kapalı/duygularını bastıran
babaya sahip olmak (r = -.81, p < .05) ile negatif korelasyon gösterirken
hissizlik/duygularını bastırma (r = .86, p < .05) ve görev odaklı terapötik ilişki (r =
.87, p < .05) ile pozitif korelasyon göstermiştir. Ayrıca, görev odaklı terapötik
ilişki, sosyal izolasyon (r = -.82, p < .05) ve mesafelilik (r = -.88, p < .05) ile
önemli bir negatif korrelasyon göstermiştir. Diğer taraftan, duygusal bağ odaklı
terapötik ilişki karamsarlık şemasıyla önemli bir negatif korelasyon göstermiştir (r
= -.86, p < .05). Sonuçlara göre, According yüksek seviyedeki görev odaklı
terapötik ilişki düşük seviyelerdeki sosyal izolasyon ve mesafelilik ile ilişkili
bulunmuştur. Young’a göre (1999) sosyal izolasyon şeması dünyadan,
başkalarından ve herhangi bir gruptan izole hissetmekle ilgilidir. Bu şema ayrılma
ve dışlanma şema alanı altında yer almaktadır. Sosyal izolasyon şeması olan
terapistler, tüm bunlardan dolayı, hastalarına aitlik hissetmemiş olabilirler, böylece
terapötik ilişkideki sorumlulukları almamış olabilirler. Young’ın vurguladığı gibi
(1999), bu şema bağımsız, soğuk ve dışlayan bir aileden kökenini alıyor olabilir.
Bu şemanın terapötik ilişki içerisindeki aktivasyonu ile belki de terapistler
hastalarının kendileri ile yakınlaşmasına izin vermemiş ve böylece kendi şema
döngülerini devam ettirmiş olabilirer. Ayrıca, mesafelilik baş etme biçimini
kullarak ilişki içerisinde bağsız hissedip terapi sürecindeki sorumlulukları
üstlenmemiş olabilirler. Ayrıca, yüksek seviyedeki karamsarlık düşük
seviyelerdeki duygusal bağ odaklı terapötik ittifak ile ilişkili bulunmuştur. Bu
şemanın yapısından kaynaklanıyor olabilir. Karamsarlık şemasının aktivasyonu
(Young’ın vurguladığı gibi, 1999) kötü bir şey olacak duygusunu yoğun bir
şekilde yaşatmaktadır. Bu yüzden, bu şema kökeninden insanlar etraflarına kötü
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bir şeyler bulmak için bakarlar ve olan pozitif şeyleri göz ardı ederler. Bundan
dolayı bu şema ile terapistler hastaları ile yaşadıkları ilişki içerisindeki pozitif
şeyleri kaçırmış olabilirlert (Seligman, Reivich, Jaycox ve Gillham, 1995). Diğer
bir sonuca göreyse, yüksek seviyelerdeki hissizlik/duygularını bastırma baş etme
şekli yüksek seviyelerdeki amaç odaklı terapötik ilişki ile ilişkili bulunmuştur.
Aslında, hissizlik/duygularını bastırma etrafta olan negatif şeylerden ve şemaların
yarattığı olumsuz duygulardan kaçınmak için kullanılan bir baş etme şeklidir
(Richards ve Gross, 1999). Eğer terapistlerin şemaları hasta ile ilişkileri esnasında
aktive oluyorsa belki de onlar şemaların yarattığı negatif duygulanımdan dolayı
yaptıkları işe konsantre olamamış olabilirler (Ludwig, 1983). Bundan dolayı, bu
durumda olan terapistler duygularından koparak (disosiasyon) işlerine
odaklanmaya çalışıyor olabilirler. Gerçek olmamasına rağmen, terapistler amaç
odaklı terapötik ilişkinin hissizlik/duyguları bastırma ile arttığını düşünüyor
olabilirler. Bu yüzden, hastalarını gerçek bir ilişki yaşamaktan mahrum bırakıyor
olabilirler. Diğer bir taraftan, değişime kapalı/duygularını bastıran babaya sahip
olmanın düşük derecedeki amaç odaklı terapötik ilişki ile ilişkili olduğu
saptanmıştır. Çıkan bu sonuç yukarıda açıklandığı gibi babanın evdeki fonksiyonu
ile ilişkili olabilir. Son olarak, Finally, yüksek seviyelerdeki amaç odaklı terapötik
ilişki ile görev odaklı terapötik ilişki arasında ilişki olduğu saptanmıştır. Bunun da
nedenleri yukarıda açıklandığı gibi olabilir.
Hastaların terapi sürecindeki terapötik ilişkiyi nasıl değerlendirdiklerine
bakıldığındaysa, amaç odaklı terapötik ilişki büyüklenmecilik(r = .95, p < .05),
mesafelilik (r = .92, p < .05), ve görev odaklı terapötik ilişki (r = .90, p < .05) ile
önemli pozitif korelasyon gösterirken, kötümser/endişeli babaya sahip olmakla (r =
-.89, p < .05) negatif bir korelasyon göstermiştir. Bunun yanı sıra, görev odaklı
terapötik ilişki büyüklenmecilik (r = .95, p < .05) şeması ile önemli pozitif
korelasyona sahiptir. Ayrıca, duygusal bağ odaklı terapötik ilişki büyüklenmecilik
(r = .93, p < .05) şeması ile önemli pozitif korelasyon ve kötümser/endişeli babaya
sahip olmakla (r = -.93, p < .05) önemli negatif korelasyon göstermiştir. Sonuçlara
göre, yüksek seviyelerdeki büyüklenmecilik şeması yüksek seviyelerdeki amaç,
görev ve duygusal bağ odaklı terapötik ilişki ile ilişkilidir. Şema Teori’ye göre
(Young, 1996), büyüklenmecilik şeması kökenini zedelenmiş sınırlar ve kişinin
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kendisinin diğerlerinden üstün olduğu, güce ve kontrole ihtiyaç duyduğu
inancından alır. Bu şema eğiliminde olan hastalar terapistleri ile olan terapötik
ilişkiyi yüksek değerlendirilmiştir. Bu durum birkaç şekilde açıklanabilir.
Öncelikle, belki de bu hastalar psikoterapiye aşağılık duygusu ile baş edemedikleri
için başvurmuş olabilir. Hayatlarında bir problem olduğunu belirleyip bunu
değiştirebilecekleri konusunda kendilerine güvenerek terapist ile amaç, görev ve
duygusal bağ açısından işbirliği yapmış olabilirler. Bu hastaların değişim için
aksiyon fazında olduğunu göstermektedir (Prochaska ve DiClemente , 1986).
İkinci olarak, bu hastaların büyüklenmeci şeması baskınsa, terapistlerini kendileri
seçtikleri için terapistin elbette iyi olduğunu düşünüyor olabilirler. Zaten kötü olan
bir terapiste gitmeyeceklerdir. Ancak bu durum gerçekçi değildir. İşin kötü yanı
terapötik ilişkiyi bozan bir şey varsa, bu hastalar bunu fark etmek ve kabul etmek
istemeyebilir (büyüklenmeci mod /Young, 1999). Ancak, durum böyleyse bile,
terapisti idealize etme durumu terapinin kendisi için bir motivasyon kaynağı
olabilir. Böylece, bu motivasyonla hasta değişebilir. Diğer bir bakış açısıyla ise,
belki de bu hastalara terapistleri tarafından sınırlı yeniden ebeveynlik Şema
Terapi’nin önerdiği şekilde uygulanamamıştır. Hastalar kendi büyüklenmeci
yapısını terapide de devam ettirmektedir. Böyle bir durumdaysa gelişim beklemek
çok gerçekçi olmaz. Ayrıca yüksek seviylerdeki mesafelilik abş etme biçimi
yüksek seviyelerdeki amaç odaklı terapötik ilişki ile ilişkili bulunmuştur. Bu
sonuç mesafeliliğin yapısından kaynaklı olabilir. Young’a göre (1999), bu baş
etme biçimi bağımlılığı ve başkaları yönelimlilik ile baş etme amacıyla kullanılır
.Bu baş etme biçimini kullanan kişiler kendi bağımlılık ve başkaları
yönelimliliklerinin farkında olup bundan kurtulmak isterler. Sağlıklı ve gerçekçi
sınırlar çizerek insanlarla ilişki kurmayı bilmedikleri için kendileri için gerekli ve
faydalı olan duygusal bağdan yoksun kalırlar. Bu stratejiyi kullanan hastalar
ilişkilerini derin yaşayamayıp, beslenemiyor olabilirler (Derlega ve Chaikin,
2010). Bundan dolayı, kendilerin toplumdan izole olmuş hissedebilirler ve sosyal
destekten yoksun kalabilirler (Solano, Batten ve Parish, 1982). Belki de, tam da bu
yüzden, bir problem olduğunu fark edip terapiye başvurmuş olabilirler. Değişmek
istedikleri için de terapistleri ile amaç odaklı terapötik ittifak içinde
olabilirler.Diğer bir taraftan, kötümser/endişeli babaya sahip olmak ile düşük
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seviyelerdeki amaç ve görev odaklı terapötik ilişki arasında ilişki bulunmuştur. Bu
da yukarıda belirtilen babanın işlevi kısmı ile açıklanabilir.
Genel sonuçların yanı sıra, bu doktora tezinde iki tane de vaka örneği
üzerinden şema ölçekleri ve terapötik ilişki arasındaki bağ açıklanmaya
çalışılmıştır. Ayrıca, tartışma ve kısıtlılıklar kısımlarında tezle ilgili önerilere de
yer verilmiştir (Detaylı bilgi için tezin orjinaline bakınız).