Psychological Bulletin

1978, Vol. 85, No. 3, 467-489

Therapist Interpersonal Skills: Process, Outcome, Methodological

Considerations, and Recommendations for Future Research
Michael J. Lambert Steven S. DeJulio
Brigham Young University North Texas State University
David M. Stein
Brigham Young University

This article reviews psychotherapeutic outcomes as they are related to such

therapist interpersonal skills as empathy, regard, and genuineness. Professional
and paraprofessional training programs that have grown out of the client-
centered framework are also discussed. In addition, empirical research concern-
x
-_ ing confounding variables and the methodological shortcomings of this research
domain are reviewed. Conclusions include the idea that Rogerian hypotheses
have been only modestly supported, that the lack of support is due both to the
difficulties encountered in sampling and rating therapy sessions and to the
failure of client-centered theory to specify more precisely the times when spe-
cific conditions (such as empathy) might be most facilitative. It is noted that
judges ratings of audiotape recordings of counseling have not provided better
predictions of positive therapeutic outcome than have client perception mea-
sures of the counseling process. Also, it is concluded that the efficacy of popplar
'interpersonal skills training models has not been demonstrated. It is recom-
mended that in addition to multiple criterion measures, researchers apply mul-
tiple process measures to assess the nature of the therapeutic relationship in
outcome studies.

The impact of the theoretical formulations In an attempt to substantiate these proposed

and clinical practice of Carl Rogers and his therapist variables, Rogers and his colleagues
associates has been profound. Many of the have been deeply involved in a great deal of
constructs and techniques developed by Rog- empirical research on the process and out-
ers have been adopted by a wide variety of come of psychotherapy,
therapy modalities (Jakubowski-Spector, If one surveys the current literature gen-
1973; Weiner, 197S; Yalom, 1975). Rogers erated by hypotheses derived from client-
has stated what he feels are the necessary and centered theory, several trends are apparent:
sufficient therapist variables and client char- First, there has been a general shift away
acteristics for positive outcome in therapy in from examining therapist attitudes and be-
much the same way as a mathematician might liefs, and movement toward demonstrating
state theorems or postulates (Rogers, 1959). the importance of the relationship between
therapist skills, for example, empathy,
warmth, and genuineness, with outcome.
Preparation of this article was supparted in-part by Secon(j there hag been a marked trend
a faculty research grant from Brighajn Young Urn- l , ' , . . ., ., • 4. i MI •
versity to Michael J. Lambert. Portions of this ar- °ward emphasizing these therapist skills in
tide were presented by Steven S. De Julio at the systematic training programs for professional
Seventh Annual Meeting of the Society for Psycho- therapists and paraprofessional counselors,
therapy Research, San Diego, June 1976. Carkhuff (1969. 1971, 1972) and his associ-
Requests for reprints should be sent to Michael J. F d f fa { develoPed what they
Lambert, Institute for Studies in Values and Human , , f . m. ji
Behavior, Lindley House, Brigham Young University, denote as a technology of helping. The model
Provo, Utah 84602. proposed by Carkhuff (systematic human

Copyright 1978 by the American Psychological Association, Inc. 0033-2909/78/8503-0467$00.75

467
468 M. LAMBERT, S. DEjULIO, AND D. STEIN
relations training) has been received by some
with great enthusiasm (e.g., Aspy, 1975;
Gazda, 1973; Sprintall, 1972). Gazda (1973)
stated, "The research by Carkhuff and his
colleagues on the development and effective-
ness of this model is unequalled by any other
human relations model employed today" (p.
22). Aspy (1975) has argued that the model
is both effective and efficient.
However, a discussion of the possible impact
and implications of this particular model has
been ignored by very reputable reviews of
psychotherapy outcome (Bergin, 1971; Ber-
gin & Suinn, 1975; Luborsky, Chandler, Auer-
bach, Cohen, & Bachrach, 1971; Meltzoff &
Kornreich, 1970).
Third, a number of reviewers (Bergin &
Suinn, 1975; Mitchell, Note 1) who were once
convinced of the primary importance of the
therapist interpersonal skills proposed by
Rogers now seem less enthusiastic and more
tentative in their appraisal. Perhaps the
variables of therapist empathy, respect, and
congruence are not as important as was once
thought or at least do not generalize to all
modalities of therapy, as has been suggested
by Rogers and his colleagues.
The present article is an effort to sum-
marize and evaluate the empirical literature
associated with client-centered psychother-
apy. We also discuss many of the important
methodological issues and confounding varia-
bles that have made hypothesis testing in this
area difficult. Finally, we suggest some direc-
tions for future research efforts.
How Strong is the Relationship Between the
Faqilitative Conditions of Therapy and
Positive Client Change?
The earliest studies of psychotherapy out-
come in this area concerned changes in psy-
chotherapy patients as a function of a global
variable, that is, client-centered therapy.
Cartwright's (1957) bibliography summarized
these early crude studies, which generally did
not involve the specification of therapist be-
havior and its differential relation to outcome.
Even the volume edited by Rogers and Dy-
mond (1954) did not look at therapist inter-
personal skills but concentrated on the over-
all effects of treatment. Since Rogers' (1957)
specification of the "necessary and sufficient
conditions" for personality change, research
efforts have been marked by improved meth-
odology and increasing precision in isolating
and measuring presumably crucial therapist
variables.
Definitions of the therapist skills or facili-
tative conditions can be stated briefly at this
point. The reader should be aware that mea-
suring high versus low levels of these condi-
tions has generally been accomplished by the
use of interval rating scales with theorem-
like definitions for each scale point. Several
sets of scales have been developed, the most
notable being those of Truax and Carkhuff
(1967) and Carkhuff (1969). These scales
are very similar in both construction and
content. Generally, they attempt to measure
the degree to which the following conditions
are provided by the therapist in the helping
relationship (for a more in-depth discussion
of these constructs, see Truax & Carkhuff,
1967:
Accurate empathy (empathic understand-
ing) is the degree to which the therapist is
successful in communicating his awareness
and understanding of the client's current
feelings in language that is attuned to that
client.
Nonpossessive warmth (unconditional posi-
tive regard) is the extent to which the thera-
pist communicates nonevaluative caring and
positive regard for the client, respecting the
client as a person.
Genuineness (congruence) is the extent to
which the therapist is nondefensive, real, and
"nonphony" in his interactions with the client.
Soon after Rogers' original specification of
these conditions, a study was undertaken to
test the emerging hypotheses about the im-
portance of therapist attitudes or facilitative
conditions. Halkides (1958) has often been
quoted as providing evidence that the facili-
tative conditions offered by therapists are
related to positive changes in clients. Halkides
sampled interviews from 20 client-therapist
pairs and had three judges rate them for de-
gree of therapist unconditional positive re-
gard, congruence, and empathic understand-
ing. On the basis of criteria derived from
several change measures, the client sample
was divided into most and least successful
 THERAPIST INTERPERSONAL SKILLS 469

cases. Highly significant associations between In a somewhat less comprehensive review

the criterion of success and the relationship of studies examining client-centered psycho-
variables were found. It has been reported by therapy, Rachman (1973) questioned much
Truax (1963), however, that an attempt to of the research methodology and stated, "Un-
replicate this study was not successful. fortunately, however, most of these lack ade-
Rogers and his associates were sufficiently quate control groups. The control studies are
enthusiastic about the possibilities suggested few in number but they do, in general, en-
by this study so that the last IS years have courage the view that satisfactory thera-
brought forth a proliferation of studies on peutic conditions do facilitate therapeutic
these so-called interpersonal skills or facili- movement."
tative conditions. Studies involving facili- Luborsky et al. (1971), in a conscientious
tative conditions and client outcome have review of 166 controlled outcome studies
been reviewed by numerous authors with covering the 24-year period from 1946 to
varying degrees of optimism. Summaries by 1969, presented yet another point of view.
Truax and Carkhuff (1967) and Truax and These authors tried to identify certain thera-
Mitchell (1971) represent the most complete pist skills that showed up across studies and
and thorough reviews by those involved in therefore proved to be most reliable. Of the
the studies themselves. These authors con- studies reviewed, only the therapist variables
cluded that the accumulation of evidence of empathy and experience showed a reliable
clearly demonstrates the importance of ther- relationship with outcome.
apist interpersonal skills in the improvement Mitchell (Note 1), updating and summariz-
of patients. Also, Truax (1971) concluded ing his and Truax's review (Truax & Mitchell,
that the warm, empathic, and genuine thera- 1971), noted that of the 14 studies considered
pist need have no particular theoretical ori- most important, the success rate was as fol-
entation in order to be effective. In addition, lows: Of 109 possible relationships between
he believed that the research has adequately empathy and outcome, 24 were significantly
shown these variables to be effectively opera- positive; of 108 posible correlations of out-
tive with a wide variety of clients and therapy come and warmth, 34 were significant; and
modalities. of 88 involving genuineness, 20 showed a
Researchers from more general theoretical significant positive relationship, whereas 6
perspectives have not been equally impressed showed a significant but negative relationship
by the data after reviewing these psycho- with outcome. This summary indicates a
therapy outcomes. Bergin (1971; Bergin & clear lack of consistency between these
Jasper, 1969) suggested that the results of "facilitative conditions" and outcome. It also
client-centered researchers may not generalize raises some important questions. For exam-
to other modes of therapy. Meltzoff and ple, if it is assumed that the constructs mea-
Kornreich (1970), in a most comprehensive sured by the Carkhuff-like scales are valid
survey of outcome research, wrote, and reliable and if a cause-effect relationship
between therapist-offered facilitative condi-
The facilitative conditions proposed by Rogers and tions and outcome truly exists, then in some
the experimental means created to demonstrate their therapy settings, increasing levels of both em-
existence and meaning from the process of psycho-
therapy are interesting. However, too much is de- pathy and nongenuineness (phoniness) serve
pendent on the assumption that self-exploration leads to increase the likelihood of positive outcome.
to change and facilitative conditions lead to self-ex- This possibility is certainly difficult to recon-
ploration, (p. 401)
cile with client-centered theory!
The authors concluded, Blackwood (Note 2) reanalyzed the data
summarized by Truax and Mitchell (1971)
It would be a mistake to freeze therapeutic research with an interest in individual psychotherapy
in process into the current versions of these facilita- studies, thus eliminating group therapy out-
tive conditions when the results are ambiguous and
much remains to be explored. Rogerian conditions
comes. His careful analysis of these data led
have not been proven, (p. 402) him to conclude,
Table 1
Relationship of Facilitative Conditions to Improvement in Psychotherapy Patients in Selected Outcome Studies

Type and source of ratings

Therapist of therapist facilitative
b 0
Study orientation (N)* Client population (N) Source of outcome criteria conditions'"
§
Barrett-Lennard (1962) Client centered (21) College counseling center Client and therapist BRI,* T r
clients (42) g
Bergin & Jasper (1969) Unspecified (36) Outpatients (36) Clinician AE w
Beutler, Johnson, Neville, & £0
Workman (1972) Unspecified (8) Inpatients (54) Therapist and other AE H
Beutler, Johnson, Neville, in
Workman, & Elkins (1973) Unspecified (8) Inpatients (49) Therapist AE, NPW, G L
Dickenson & Truax (1966) Client centered (1) Counseling center clients (24) Other AE,* UPR,* G* B
Garfield & Bergin (1971) Mixed (21) Outpatients (38) Client, therapist, and clinician AE, NPW, G el
Kurtz & Grummon (1972) Mixed (31) Counseling center clients (31) Client, clinician, and therapist Other, BRI,* AE* t—t
Mitchell (Note 1) Mixed (1) Outpatients (120) Client, therapist, clinician, and AE, NPW, G* P
significant others >
Mullen & Abeles (1971) Mixed (36) Counseling center clients (36) Client AE,* NPW H
Rogers, Gendlin, Kiesler, &
Truax (1967) Client centered (8) Inpatients (16) Therapist, client, clinician, and AE, NPW, G,* BRI t)
other vi
Sloane, Staples, Cristol, York- B
ston, & Whipple (1975) Other (6) Outpatients (30) Therapist, client, clinician, and AE, NPW, G
significant other
Truax (1963) Unspecified (—) Inpatients (14) Client and clinician AE, UPR, G, Composite*
Truax (1966) Unspecified (8) Delinquent inpatients (69) Client and other AE, NPW,* G,* TRQ
Truax, Altman, Wright, &
Mitchell (1973) Other (16) Outpatients (16) Client, therapist, significant AE,* NPW,* G*
others, and clinician
Table 1 (continued)

Type and source of ratings

Therapist of therapist facilitative
Study orientation (N)* Client population (N)b Source of outcome criteria0 conditions'*

Truax, Carkhuff, & Rodman

(1965) Mixed (4) Inpatients (40) Client AE,* UPR,* G*
Truax, Wargo, & Silber (1966) Unspecified (2) Delinquents (40) Client and other AE,* UPR,* G*
Truax, Wargo, Frank, Imber,
Battle, Hoehn-Saric, Nash,
5
^
HH

& Stone (1966) Unspecified (4) Outpatients (40) Client, therapist, and clinician AE,* NPW,* G* H
Truax, Wittmer, & Wargo
(1971) Mixed (15) Inpatients (160) Client and other AE,* NPW, G, Composite* g
B
• The therapist's theoretical orientation was classified as client centered, mixed (when some of the therapists in a study were client centered), other (which
usually meant the therapists were eclectic or analytically oriented), or unspecified.
b
Patients classified as outpatients were for the most part adult neurotics, whereas those classified as inpatients were hospitalized schizophrenics.
c
Outcome measures were for the most part diverse but common standardized assessment devices. Those that were self-report devices filled out by the client
included the Minnesota Multiphasic Personality Inventory, Q-Sort, and Tennessee Self Concept Scale. Therapist measures included gross ratings of improve-
ment and Target Symptom Complaints. Clinician ratings came from measures such as the Structured and Scaled Interview to Assess Maladjustment and the I
Psychiatric Status Schedule. Reports of change from significant others included ratings by parents and the Vineland Social Maturity Scale. The "other" c/i
category included criteria from diverse sources and involved diverse indices of change such as grade point average and time out of hospital. P
d
The process measures of facilitative conditions consisted of the rating scales devised by Truax or Carkhuff. Trained judges rated samples of therapy process,
usually from audiotapes. These ratings are abbreviated as follows: AE = accurate empathy, NPW = nonpossessive warmth, and G = genuineness or con-
gruence. The second most frequently used measures were filled out by the clients themselves and involved either the Truax Relationship Questionnaire
(TRQ) or the Barrett-Lennard Relationship Inventory (BRI). Ratings of the quality of the relationship were occasionally made by the therapist (T) or by
some other measurement method (Other) such as the Affective Sensitivity Scale.
* Indicates a statistically significant relationship between ratings of facilitative conditions and measures of therapy outcome. It should be noted that there
were many nonsignificant correlations. Also, the statistically significant relationships that were found seldom accounted for much of the variance in client
improvement.
472 M. LAMBERT, S. DEjULIO, AND D. STEIN
Thus, the seemingly impressive listing of studies put
forward by Truax and Mitchell (1971) as evidence of
the therapeutic effectiveness of AE [accurate em-
pathy], actually reduces to one published individual
psychotherapy outcome study (the data from which
has been reanalyzed five times), which offers little
support for the AE hypothesis, (p. 4)
Gladstein (1977) reviewed client outcomes
and their relationship to empathy in counsel-
ing studies and psychotherapy outcome stud-
ies. Among his conclusions was the idea that
empathy is more strongly related to patient
improvement in psychotherapy than to client
improvement in counseling (help in decision
making, etc.). In either case his review did
not suggest the often stated belief that there
is a clear relationship between empathy and
positive change.
It is not infrequent for outcome and pro-
cess studies in this area to begin with a
phrase such as, "The relationship between
therapist-offered conditions and positive cli-
ent outcomes has been clearly documented."
However, the relationship is not as predicta-
ble as might be imagined. The studies in
Table 1 represent the best this area has to
offer in answer to the question of the rela-
tionship between conditions and outcome. The
studies included were drawn from the pub-
lished literature, from the first studies on
therapist conditions to those published in
early 1977. They were drawn from the re-
views of Truax and Mitchell (1971) and Lu-
borsky et al. (1971) or have appeared since
the publication of these reviews.
The generally well designed and executed
studies in Table 1 present only modest evi-
dence in favor of the hypothesis that such
factors as accurate empathy, warmth, and gen-
uineness relate to measures of outcome.
These studies do make it clear that there are
other unaccounted-for variables contributing
to changes occurring in clients. In addition,
the nature of this evidence does not show a
cause-effect relationship between facilitative
conditions and outcome. Also summarized in
Table 1 are variables that we felt might add
to our understanding of the relationship be-
tween facilitative conditions and outcome.
Some authors had suggested that differential
effects would result when therapy was of-
fered by therapists who had orientations other
than client centered. Others suggested that
client perception measures of conditions
would be better predictors of outcome with
less disturbed clients. The variables sum-
marized, therefore, include the theoretical
orientation and experience of the therapist,
the degree of disturbance noted in clients, the
nature and source of outcome data, and the
type and source of process ratings. There were
some missing data, especially with regard to
an accurate description of the experience
level and theoretical orientation of the thera-
pists.
We were unable to see any trends in the
data that support the idea that the relation-
ship between therapist interpersonal skills
and therapy outcome interact with theoreti-
cal orientation, type of process measure, type
of outcome measure, or patient diagnosis. It
did appear that significant positive relation-
ships were prevalent in the research con-
ducted by Truax.
Below, we discuss some of the methodo-
logical problems that may have reduced the
relationships reported between facilitative
conditions and therapy outcome. It is im-
portant to reiterate the major conclusion of
our review to this point: Proponents of the
"necessary and sufficient conditions" have
emphasized the positive evidence and mini-
mized conflicting and negative evidence. A
more objective appraisal indicates far less
optimism and more guarded conclusions.
Implications o] Relationships Reported in
Recent Studies
Two recent studies that have failed to find
a relationship between facilitative conditions
and psychotherapy outcome illustrate prob-
lems of measurement in this area.
Mitchell (Note 1) has conducted the most
large-scale outcome study of experienced
practicing psychotherapists to date. The au-
thor randomly chose therapists from across
the country and rated segments of their taped
interviews using the Carkhuff (1969) scales.
Significant correlations between the outcome
measures and facilitative conditions were ex-
pected but not found. However, two weak-
nesses should be mentioned that could ac-
count for the failure to find any significant
relationship between warmth or empathy, and
 THERAPIST INTERPERSONAL SKILLS
outcome (genuineness was modestly related
to outcome). The most serious problem was
one of inadequate sampling. Facilitative con-
ditions were not measured throughout ther-
apy and therefore may not accurately repre-
sent a therapist's level of responding during
the therapy relationship. In fact, although
therapy lasted from 6 months to more than
2 years, only five 3-min. samples were drawn
for each therapist-patient dyad. This limita-
tion is being studied by Mitchell, but at
present the failure of this project to get sig-
nificant results could well be due to this
sampling problem. Furthermore, the ratings
themselves were lower than in other studies
employing the same scales and were more
restricted in range. This may well be a con-
sequence of the sample of therapists studied:
Only seven percent of the therapists sampled
considered themselves Rogerian. This sug-
gests that empathy and warmth may really
not be basic techniques or skills of many
eclectic, psychoanalytic, and behavioral
therapists. Other variables must account for
their effectiveness. Certainly, this raises ques-
tions about possible problems with the rat-
ings themselves.
Sloane, Staples, Cristol, Yorkston, and
Whipple (1975), in a generally well designed
study with experienced therapists, compared
behavioral therapists with psychoanalytically
oriented psychotherapists in the treatment of
a sample of neurotic patients. Among nu-
merous significant and important findings,
these authors examined but found no sig-
nificant relationship between outcome and
facilitative conditions. Again, this could be
a function of the previously suggested inap-
propriateness of the scales for schools of
therapy other than client centered. It is in-
teresting to note, however, that the behav-
ioral therapists were, on the average, rated
higher on Truax-Carkhuff facilitative condi-
tions than were the psychoanalytically ori-
ented psychotherapists.
Other explanations can be suggested for
the failure to find significant relationships
between the facilitative conditions and ther-
apy outcome. Ratings of the conditions were
noticeably restricted in range. This would not
only limit the size of the correlations but
also raises questions about the rating pro-
473
cedure. As with the Mitchell study, samples
were taken from only a single interview, not
from across all therapy sessions. Further, the
sampling procedure was a peculiar one where-
in behavior therapists' ratings were not ran-
domly selected from within the hour but
were chosen from times when they were act-
ing like psychotherapists, as opposed to
times when they were using behavioral tech-
niques. Thus the samples rated were not
necessarily representative of the level of fa-
cilitative conditions offered through the en-
tire hour. This obviously poses a dilemma for
researchers interested in studying diverse
therapies.
Although the overall methodology and de-
sign of these more recent studies is commend-
able, it would be a shame to see researchers
discontinue the examination of the facilitative
conditions because of these recent negative
results. The most promising research on ther-
apist interpersonal skills has been obtained
only as a result of very careful attention to
important methodological issues such as ade-
quate therapy-sampling techniques and thor-
ough training of raters. On the basis of the
evidence that has thus far accumulated, it ap-
pears to us that much is yet to be discovered
about the process of psychotherapy and the
outcomes that result.
Some New Directions
An interesting offshoot of client-centered
therapy has been the systematic training of
professional therapists and paraprofessional
counselors in the use of facilitative condi-
tions. Teaching these facilitative interpersonal
skills to those seeking therapy has even been
considered a viable and even preferable
treatment method. This approach is typified
by the work of Robert Carkhuff and his asso-
ciates.
Carkhuff (1972) argued that training in
relationship skills has a powerful effect on
the adequacy of all trainees. In addition, he
suggested that his model for training has
clearly demonstrated positive effects on psy-
chological adjustment and the total function-
ing of the personality. In fact, he emphasized
that trainee benefits (which supposedly gen-
eralize to many life tasks, e.g., school per-
474 M. LAMBERT, S. DEJULIO, AND D. STEIN
formance, work stability) are the only really
significant outcomes of training. To support
this contention he listed 30 studies purported
to provide evidence of the strength and effi-
cacy of his helping model. The studies re-
ported by Carkhuff to support this position
can be severely criticized on a number of
points (Lambert & Dejulio, 1977). These
can be summarized as follows:
1. There has been a failure to specify the
nature of the treatment (training) in most of
Carkhuffs studies. The duration of training
as well as its components seems to have
varied considerably from one study to the
next. Variations in training procedure in-
crease the likelihood that different studies are
not comparing the same treatment. There
have been virtually no studies that tease
apart the treatment components and try to
specify crucial variables (within the training
package) that make a therapist more or less
effective. This also makes replication of a
study impossible.
2. Carkhuff has generally failed to provide
data about the reliability of the ratings in
studies he has conducted (Hefele & Hurst,
1972).
3. Control groups have been omitted or
incorrectly used in most studies.
4. Process measures have been inade-
quately related to outcome.
5. Outcome criterion deficiencies have been
numerous, more so than in most psychother-
apy outcome studies.
Although the training programs that teach
the interpersonal skills derived from Rogers
are very popular (Aspy, 1972, 1975; Sprint-
hall, 1972), their impact on therapy outcome
is very much open to question (Lambert &
Dejulio, 1977). It is no wonder that they
have been ignored by major reviews of psy-
chotherapy outcome (Bergin & Suinn, 1975;
Luborsky, Singer, & Luborsky, 1975).
Not only is there a growing number of
programs that are training people in these
interpersonal skills but Carkhuff (1969) has
suggested that there is an increasing number
of human relations skills that are important
in help-intended communication. Carkhuff
(1969), for example, has added several to the
three already discussed: therapist self-dis-
closure, concreteness, confrontation, and im-
mediacy. As new interpersonal skills are be-
ing specified and taught, there is an ever-
widening gap between what is claimed in
terms of training program effectiveness and
what has been demonstrated empirically
about the efficacy of the facilitative condi-
tions.
The skills training programs mentioned
above represent a significant departure from
the theory and practice of client-centered
psychotherapy as expressed by Rogers.
Though Rogers (1975) believed that in the
proper environment individuals may become
more empathic and genuine, the focus for
training has shifted from a somewhat philo-
sophical, existential emphasis on therapist
attitudes and beliefs to a technology for
teaching effective and concrete therapist re-
sponses. This trend appears to be an out-
growth of research efforts that have at-
tempted to specify and measure the three
original facilitative conditions proposed by
Rogers. Once it was considered possible to
discriminate between high and low levels of
these therapist attitudes, it was a natural
step to begin training counselors to give spe-
cific responses that would be rated high on
the research scales.
It seems possible, even likely, that coun-
selors are now being trained to use technically
sound responses. This, however, seems to be
something quite different from the "effective
moments" of change alluded to in the fol-
lowing quote from Rogers:
I feel that when I'm being effective as a therapist, I
enter the relationship as a subjective person, not as a
scmtinizer, not as a scientist. I feel, too, that when I
am most effective, then somehow I am relatively
whole in that relationship, or the word that has
meaning to me is "transparent." Then I think, too,
that in such a relationship I feel a real willingness
for this other person to be what he is. I call this "ac-
ceptance." And then another aspect of it which is
important to tne is that I think in those moments I
am able to sense with a good deal of clarity, the way
his experience seems to him. . . . Then in addition to
those things on my part, my client or the person with
whom I'm working is able to sense something of
those attitudes in me, then it seems to me that there
is a real, experiential meeting of persons, in which
each of us is changed. (Buber & Friedman, 196S, pp.
169-170.
 THERAPIST INTERPERSONAL SKILLS
Methodological Issues
To attempt to draw valid conclusions from
experiments on the phenomenon of psycho-
therapy with its inherent complexity, sub-
tlety, and disputed criteria is an extremely
difficult task. Since the relationships between
outcome and any conditions that facilitate
therapy are critically important to clinical
training and practice, it becomes crucial to
attain maximum methodological sophistica-
tion in our experiments. A number of ques-
tions can be raised in regard to the method-
ology in this research domain. Some ques-
tions that are important for our interpreta-
tion of past research as well as for careful
planning of future experimental endeavors are
examined below.
From Whose Point oj View Shall the Process
oj Therapy Be Assessed?
As mentioned previously, the Rogerian
conception of empathic understanding
stressed an empathic attitude on the part of
the therapist. This is well illustrated in a
recent article, "Empathic: An unappreciated
way of being" (Rogers, 1975). In addition to
therapist attitude, Rogers has repeatedly
emphasized the need for the client to experi-
ence being understood. This is central to
client-centered therapy and, from Rogers'
point of view, central to the therapeutic re-
lationship. Rogers (1975) still contends that
clients are better able to judge levels of em-
pathy in therapy than are therapists.
Despite the Rogerian emphasis on client-
perceived empathy, Rogers and his co-work-
ers (Rogers, Gendlin, Kiesler, & Truax,
1967) employed ratings by objective judges
as well as client perception measures of fa-
cilitative conditions. These researchers felt
that judges naive to the purposes and design
of the study could rate the process unob-
trusively. On the other hand, some have felt
that the client or even the therapist, since
they are participants, would be best able to
judge the level of conditions present in their
psychotherapy sessions. The question of who
should evaluate therapist warmth, empathy,
and genuineness is a central issue in the study
of therapy.
475
Carkhuff (Carkhuff & Burstein, 1970) has
tried to refute Rogers' position that the cli-
ent must perceive the conditions and has
asserted that "high-level" judges who are not
part of the process are the only ones who can
be relied on to understand and rate client-
therapist interactions. This issue continues to
be of concern and is of practical as well as
theoretical significance. Ideally, both clients
and judges would assess the therapist's em-
pathy with equal accuracy. This would cer-
tainly make tests of the relationships of these
qualities with outcome much more meaning-
ful and conclusive. As we point out below,
this ideal is rarely attained.
Several related issues are also important:
What is the relationship between diverse
psychotherapy process measures such as
Truax-type rating scales and the Barrett-
Lennard Relationship Inventory? What is
the relationship between these diverse pro-
cess measures and different therapeutic out-
comes? Is there a tendency for a specific type
of process measure to relate to a particular
kind of outcome measure? Do these measure-
ment issues interact with variables related to
the client (e.g., type or severity of problem),
therapist, or treatment modality?
Table 2 summarizes some data from studies
that are relevant to these issues. These stud-
ies are briefly discussed below.
The earliest data on this subject were gen-
erated by the Wisconsin Project. Kiesler,
Mathieu, and Klein (cited in Rogers et al.,
1967, chap. 11) reported that objective
judges' ratings and patients' perceptions of
the level of facilitative conditions were mod-
estly correlated. Therapists' perceptions were
virtually unrelated to either, except when
only successful cases were considered, in
which case clients and therapists agreed at
high levels.
Truax (1966) compared client perception
of process, as measured by the Barrett-Len-
nard Relationship Inventory (BRI), with
judges' ratings of therapy from time sam-
ples with varying amounts of information on
therapist behavior. Although all three of the
objective raters' judgments agreed with one
another and correlated with outcome criter-
ion, they showed little relationship to the
client perception measure.
 *>•
^J
Ov

Table 2
Summary of Relationships Between Different Methods of Measuring Facilitative Conditions and Facilitative Conditions and Therapy Outcome

Apparent relationship Presence of a statistically

Method with which between methods of significant correlation
facilitative conditions measuring facilitative between facilitative
Study Subjects" were measured11 conditions conditions and outcome g
Bozarth & Grace (1970) College counseling Client perception Moderate Not tested
center clients Tape- judged ratings
Caracena & Vicory (1969) Normal college Client perception None Not tested
volunteers Tape- judged ratings 8
Carkhuff & Burstein (1970) Interview with a Client perception None Not tested
single normal Tape- judged ratings
subject Therapist perception
Fish (1970) Outpatients Client perception None Not tested f
i—i
Tape-judged ratings O

Hansen, Moore, & Carkhuff (1968) Secondary school Client perception None No
students with Tape-judged ratings Yes
behavior problems
Hill (1974) College counseling Client perception None Not tested C/3
H
center clients Taped-judged ratings Positive relationship between M
Frequency counts" frequency counts and
judges' ratings
Kurtz & Grummon (1972) College counseling Client perception"1 None Yes on 4/6
center clients Tape-judged ratings Yes on 1/6
Therapist trait measure No
Therapist perception No
Therapist prediction No
Table 2 (continued)

Apparent relationship Presence of a statistically

Method with which between methods of significant correlation
facilitative conditions measuring facilitative between facilitative
Study Subjects' were measured1" conditions conditions and outcome

McWhirter (1973) Coached clients Ch'ent perception None Not tested

Tape-judged ratings
Rogers, Gendlin, Kiesler, & Truax
(1967) Hospitalized Tape-judged ratings Positive but moderate be- Yes
schizophrenics Client perception tween judges and client ; No
Therapist perception neither related to therapist No
judgment H
Truax (1966) Schizophrenics and Client perception None No
delinquents Tape-judged ratings w

I
Yes »
Van Der Veen (1970) Schizophrenics Client perception None Yes
Tape-judged ratings Yes/more significant
r
• A number of subjects in these studies were not from clinical populations but participated as clients in an analogue study. This is indicated by such terms as
coached client and college volunteer. Since differential results did not arise from considering these client populations separately, we have included both ana-
logue and clinical studies.
b
The methods of measuring therapist interpersonal skills employed by trained judges were usually the Truax or Carkhuff rating scales of accurate empathy,
nonpossessive warmth, therapist congruence, and unconditional positive regard. When client perception was the method of process analysis, either the Truax
Relationship Questionnaire or the Barrett-Lennard Relationship Inventory was used.
° Hill used the Psychotherapy Session Report, Carkhuff Empathy Scale, and frequency counts of objectively defined behavior such as additive empathy
(therapist statements that involved interpretations of client feeling and behavior), number of topic changes, and advice.
d
Kurtz and Grummon used the Carkhuff modification of the Truax Accurate Empathy Scale, the Barrett-Lennard Relationship Inventory, the Affective
Sensititivy Scale, Interpersonal Checklist, and the Kelly Role Concept Repertory Test.
478 M. LAMBERT, S. DEjULIO, AND D. STEIN
Hansen, Moore, and Carkhuff (1968) re-
ported a similar conclusion after contrasting
BRI ratings with judges' ratings of facilitative
conditions. Again, though none of the ratings
of tape-recorded sessions were significantly
correlated with the BRI ratings, they were
related to outcome. However, it must be
noted that clients filled out the BRI only
once—at the end of the counseling, but
judges rated therapy at various intervals
during counseling. Can we safely say that a
posttreatment assessment by the clients mea-
sured anything similar to what the judges
were evaluating as a process?
Caracena and Vicory (1969) compared
judges' ratings of accurate empathy, the BRI,
and some measures of therapist activity
(mainly, frequency counts of various thera-
pist behaviors). Again, they reported negli-
gible correlations among these measures. This
study also investigated the hypothesis that
lack of correspondence among different mea-
sures of empathy was due to client distortion.
Actually, the clients studied were not in need
of therapy but were college students recruited
for the study. These researchers concluded
that since the clients were normals, it did not
make sense to attribute the discrepancy in
results to the client-distortion hypothesis.
Carkhuff and Burstein (1970), reporting
an analogue study, found no significant posi-
tive relationship between ratings of facilita-
tive conditions by objective judges, clients,
and therapists. Initially, there was a tendency
for the experienced therapists in this study to
be rated lower on facilitative conditions than
were inexperienced therapists. This was a
rather poorly designed study with only one
client who was interviewed by all counselors.
Fish (1970) found no correlation between
judged empathy ratings and the BRI, which
he interpreted as cross-validating an unpub-
lished study by Feitel (1968). This study
was methodologically sound and provided
some other interesting data, including the
fact that therapist's level of experience had a
relatively high correlation with tape-judged
ratings of empathy, whereas age of the thera-
pist (maturity?) correlated with client ratings
of empathy. Tape-judged empathy also
seemed to relate to the verbal style of the
therapist. This seems to lend weight to the
interpretation that judges may be responding
to something other than their perception of
the therapist's ability to communicate to his
client that he understands him.
Bozarth and Grace (1970) reported a study
with counseling center clients (in their fifth
interview). The data collected showed that
tape-judged ratings of the facilitative condi-
tions correlated, in some cases, with client
perception of conditions in that interview.
McWhirter (1973) reported a similar result
from an analogue study that employed coun-
seling trainees working with a coached client.
No significant relationship could be identi-
fied with regard to the BRI and an audiotape
of the same data.
Hill (1974) has reported the most thorough
and exhaustive study of this phenomenon to
date. She compared the perceptions of a
single therapy session by clients, therapists,
objective judges using rating scales, and
judges who made frequency tabulations.
Twenty-four therapists saw 48 clients and
made audiotapes of the second session. Two
judges rated samples (N — 144) from these
tapes on empathy and self-exploration. Cli-
ents filled out a report on satisfaction and
progress, including information on what they
perceived as happening during the session.
The therapist did likewise. Many interrela-
tionships were reported among the various
measurements and points of view. Empathy,
as measured by the Carkhuff (1969) scale
and rated by obective judges, was found to
correlate with the frequency count of em-
pathic responding but was unrelated to items
assessing satisfaction and progress, as judged
by both clients and therapists.
In summary, it appears that the four meth-
ods of evaluating what went on in therapy
sessions produced somewhat conflicting and
confusing results. Hill (1974) has attempted
to deal with this confusion. She noted that
each point of view of the therapy process
takes into account different information and
needs. For example, the client, who is not
trained to look at the process of therapy bit
by bit, probably saw it in totality at the end
of treatment as either good or bad. On the
other hand, therapists were able to recall
more accurately than clients what went on in
each session but were generally less satisfied
 THERAPIST INTERPERSONAL SKILLS
with the results. Perhaps this discrepancy is a
function of therapist and client expectation.
Tape-judged empathy ratings and observer-
judged frequency counts of behavior were in
close agreement; however, they did not relate
to perceptions of therapy from other points
of view. Objective judges, whose expecta-
tions may differ from both clients and thera-
pists, evaluate the process from yet another
point of view—usually from audiotapes. This
third point of view excludes the therapist's
nonverbal cues (which certainly affect the
client's perception).
Kurtz and Grummon (1972) used six di-
verse measures of empathy and correlated
them with each other and with psychotherapy
outcome. This was a well-designed and im-
portant study with several implications.
First, none of the measures of empathy,
which included the Carkhuff modification of
the Truax scale, a trait measure of empathy,
the BRI, and three additional empathy mea-
sures correlated with each other! Second,
tape-judged empathy correlated significantly
with the experiencing scale but not with out-
come. Third, the Truax Relationship Inven-
tory was correlated with some outcome mea-
sures but not with client depth of self-explor-
ation. The remaining measures were unre-
lated to outcome.
Conclusions based on this group of studies
are tenuous because no series of studies has
systematically varied the many possible com-
binations of process and outcome measures.
However, some conclusions appear warranted,
though they may be modified after further
research is reported.
1. There is little relationship among mea-
sures drawn from therapist, clients, and
judges in regard to the level of facilitative
conditions offered during psychotherapy.
2. Tape-judged therapist interpersonal
skills (despite assertions by Truax & Cark-
huff, 1967, and Carkhuff, 1969, to the con-
trary), do not show a stronger overall rela-
tion to outcome than do client-perception
measures. This trend has been reinforced by
the review of Luborsky et al. (1971). They
reported that of six studies using tape-rated
empathy, three showed a significant relation-
ship to outcome and three showed no rela-
tionship. Of six studies in which empathy
479
was judged by client-perception methods
(mainly the BRI), four showed a significant
relationship with psychotherapy outcome.
Gurman (1977), in a very comprehensive
review of the relationship between client-
perceived facilitative conditions and outcome,
drew about the same conclusion, although he
felt that client perception is a better predic-
tor of outcome than we believe has been
demonstrated.
3. Both client-perceived and tape-judged
empathy seem to fare better than other
methods (e.g., trait measures of empathy) at
predicting outcome. We clearly favor the
assessment of actual in-therapy interactions.
Process measures have been sparsely applied
and related to outcome in the work of Cark-
huff (1972). Most studies in this area have
not examined the process of counseling but
have used trait measures such as the Dis-
crimination Index, Communication Index,
and "standard client interviews" to judge the
level of conditions offered clients or achieved
by training. As Gormally and Hill (1974)
and Lambert and DeJulio (1977) have
pointed out, these measures have a question-
able relationship to actual behavior and to
tape ratings of conditions offered in actual
interviews. Although it has been assumed by
Carkhuff and his associates that facilitative
conditions remain constant and can be in-
ferred from past experience or in ways other
than from studying the actual process, there
is little evidence to support this contention.
Lambert and Beier (1974), for example,
found that levels of therapist-offered condi-
tions varied considerably in supervision and
counseling situations despite assumptions
(e.g., Pierce & Schauble, 1970) to the con-
trary. There is a definite need for more
studies that actually examine process con-
currently with outcome .
4. It does not seem to make a difference
whether clients are severely disturbed or
mildly disturbed. In either case, neither ob-
jective judges nor the clients themselves
seem better predictors of successful outcomes.
5. So far, a relationship between point of
view from which the process is assessed and
the type or source of outcome criteria most
closely related has not emerged. We suspect
that some complex relationships exist and in-
480 M. LAMBERT, S. DfiJULIO, AND D. STEIN
teract with the time at which process and out-
come data are collected. It seems likely that
client-judged empathy will be more highly re-
lated to self-report measures of change, since
both measure satisfaction to some degree. This
is especially likely when both are collected at
the end of therapy. In order to be most con-
vincing, client self-reports would need to cor-
relate with outcome measures taken from a
source other than the client.
Reading the studies in this area, one is
struck by the interest researchers develop in
their own method of assessment. For some, it
becomes important to identify one and only
one point of view or device as the ultimate and
single accurate way of measuring the therapy
process. It is apparent that measurements from
various points of view are necessary; dis-
crepancies between these points of view and
their relationship to outcome criteria need not
be viewed as contradictory and problematic
but as fact. Tape-judged empathy, rather than
presenting an objective and therefore best
method for understanding which therapeutic
factors are prepotent, only provides one means
of looking at the process. It seems to us that
research would provide more answers if con-
current diverse measures of process that in-
cluded perceptions of therapists, clients, and
judges were employed. Further, it is apparent
that client perception of the therapy process
must be evaluated by devices other than the
BRI. The data obtained from clients who fill
out the BRI need to be compared with data
from such measures as the videotape tech-
niques employed by Kagan and Krathwohl
(Note 3) and similar techniques. These re-
searchers provided the client with a foot
pedal that when depressed would indicate on
the videotape monitor that the client was
feeling understood. Certainly, our understand-
ing of the relationships between therapist
attitudes and client growth would be greatly
enhanced by innovation and diversification in
measurement methods.
Is the Medium of Audiotape a Representative
and Suitable One for Judging
Facilitative Conditions?
It is our desire here to focus more spe-
cifically on the procedure of using rating
scales, judges, and the medium of audiotape
to assess the therapeutic process. We do not
discuss the controversy surrounding the reli-
ability and meaning of the rating scales per
se, which has been amply reviewed elsewhere
(i.e., Bozarth & Krauft, 1972; Chinsky &
Rappaport, 1970; Lambert & Dejulio, 1977;
Rappaport & Chinsky, 1972; Truax & Cark-
huff, 1967; Truax & Mitchell, 1971).
In past studies in which researchers have
studied the relationship between therapist in-
terpersonal skills (empathy, warmth, etc.) and
outcome, taped therapy sessions were usually
rated in order to determine the level of the
therapist-offered facilitative conditions. Rat-
ings of audiotaped sessions are obviously in-
sensitive to nonverbal, behavioral messages
that may occur in conjunction with the thera-
pist's spoken responses. Thus, the conclusions
of many research reports are limited by the
sensitivity of this particular medium to repre-
rent accurately the process of therapy as a
whole. Those who have studied the therapy
process using videotaped sessions have em-
phasized the importance of nonverbal cues and
expressive behaviors in the communication of
facilitative attitudes and have questioned the
adequacy of audiotape procedures.
Mehrabian and Ferris (1967) have empha-
sized the importance of bodily cues in interper-
sonal communication. Fretz (1966) has shown
that nonverbal counselor behaviors can be re-
lated to clients' perceptions of empathic re-
sponding. Also, Shapiro, Foster, and Powell
(1968) have demonstrated that the facilitative
conditions can be judged with a modicum of
reliability from bodily and facial clues with-
out the aid of speech. A few researchers have
tried to study systematically the relationship
between ratings of facilitative conditions from
audiotapes and those from videotapes of ther-
apy. Examining the importance of nonverbal
cues contrasted with verbal cues, J. G. Shapiro
(1968b) compared audio-only, video-only, and
audio-video ratings of the facilitative condi-
tions. His results suggest that both single-di-
mension ratings have a similar relationship
with the audio-video ratings, although they
fail to correlate highly with each other. Pre-
sumably, raters who are trained on a single
dimension (e.g., audio) might obtain higher
 THERAPIST INTERPERSONAL SKILLS
reliability and accuracy when trained on au-
diovisual material.
Haase and Tepper (1972), in an analogue
study, attempted to assess the relative con-
tribution of selected verbal and nonverbal
components in the communication of empathy.
They asked the following question: "If there
are different contributions by the separate
(verbal and noverbal) components of em-
pathic communication, what is their relative
weight?" A factorial design was employed
that varied level of eye contact, trunk lean,
body orientation, distance, and verbal em-
pathy. Forty-eight stimulus situations and 26
counselors of various levels of experience were
studied. The significance of four main effects,
namely, close versus far distance, backward
versus forward trunk lean, constant versus no
eye contact, and medium-to-high versus low
levels of verbal empathy, suggests that each of
these factors can independently increase or de-
crease the empathy rating of a videotaped
therapist's response. More importantly, there
were a number of important interaction ef-
fects: A combination of constant eye contact,
forward body lean, more distance and a verbal
response rated as containing a medium level
of empathy, or a combination of close dis-
tance, eye contact, forward trunk lean and
high-empathy verbal message seemed to pro-
duce the highest Carkhuff scale ratings of
overall empathy by judges. When eye contact
was not maintained, the overall level of em-
pathy (regardless of the level of empathy in
the verbal message alone) was likely to be
rated as very low. In short, the authors con-
cluded that the use of Carkhuff scales with
audio-only ratings of therapy sessions may re-
duce the accuracy of judged empathy by 66%,
since critical nonverbal behaviors cannot be
evaluated.
In yet another study, D'Augelli (1974)
found low but significant correlations between
high frequencies of head nodding by nonpro-
fessional helpers and the ratings of the help-
ers' responses on empathic understanding
(Truax & Carkhuff, 1967, scales). However, if
should be noted that the author and another
observer did the rating, which probably in-
troduced some unwitting experimenter bias.
The results of these studies, taken together,
481
would suggest that the sole use of audiotape
recordings in outcome studies may cause us
to estimate inaccurately the actual relation-
ship between therapist interpersonal skills and
psychotherapeutic outcome. If therapist non-
verbal behaviors that communicate warmth,
empathy, detachment, hostility, and so forth
are not assessed along with the verbal message,
judges are denied important information
about what is truly being communicated. Un-
less videotape recording of live observations is
used, the client is the only one with informa-
tion about the therapist's nonverbal behaviors.
Perhaps ratings by objective judges (who
have generally rated audio recordings) and
ratings by clients will correlate more highly if
audio-video recordings are used by judges.
Judges rating therapy samples should there-
fore use videotape recordings when possible.
Should Raters Be Experienced Therapists or
Naive Persons Trained Specifically
(or the Purpose?
An assumption made in the original de-
velopment of the Truax-type scales was that
they needed to be used by experienced, sensi-
tive therapists. Yet therapists did not pro-
duce high interrater reliabilities. Even at-
tempts to define points along scales more
clearly did not invariably lead to greater re-
liability. Gendlin and Tomlinson (cited in
Rogers et al., 1967) have pointed out (p. 128)
that judges trained together could obtain high
interrater agreement on globally denned scales,
though this was probably due to informal
group consensus rather than the reliability of
the scale. Although a study that depends on
the scales may be replicated, studies that rely
on ratings based on informal consensus can-
not be replicated. Thus, it is important to use
scales that are specific enough for naive raters
to utilize.
Naive raters (college undergraduates in lib-
eral arts) have served as raters in most studies
reported because it was assumed that they
would be freer to adopt the set necessary for
rating conditions from the recipient's point of
view. Research supporting the use of naive
raters (Arnhoff, 1954; Cronbach, 1960) sug-
gests that they attend to the scaled dimensions
as taught, rather than their clinical intuition.
482 M. LAMBERT, S. DEjULIO, AND D. STEIN
In summary, these studies were far from ex-
haustive, and in terms of actual correlation
with outcome, no evidence is available to per-
suade us to suggest that one or the other cate-
gory of raters is superior. In general, the type
of scales actually employed in the research
studies reviewed in the present article seems to
call for some intellectual sophistication on the
part of the raters.
The training procedure employed to attain
the high interrater reliability with the scales
reported in many studies has frequently gone
undescribed. It appears that the rating scales,
at present, are not clearly denned and are
therefore much more subjective than a fre-
quency count of therapist's behavior or a con-
tent analysis would be. Since the scales require
many inferences and interpretations of client
response and therapist attitude, it seems more
justifiable to employ experienced therapists as
raters. On one hand, intuition would suggest
that experienced clinicians should be employed
if rating scales of the sort proposed by Truax
and Carkhuff are used. On the other hand, if
more content oriented or behavior rating scales
(e.g., frequency counts) were to be employed,
the use of naive raters would, on logical and
economic grounds, be more justifiable. The use
of naive raters on rather ambiguous scales,
which require considerable inferential ability
(and presumably clinical knowledge) leads
one to ask: Even when high reliability is
reached, what is being rated, and does it make
sense to call it empathy?
Is It Even Necessary to Train Judges?
Several reports have considered the issue of
whether the training of judges is necessary. J.
G. Shapiro (1968a), Gurman (1971), and D.
A. Shapiro (1973) examined this question.
The data indicate that some conditions, nota-
bly genuineness, are difficult to rate using
typescripts, but overall, naive (untrained
judges) do show high correlations with trained
judges and with experts' ratings of empathy,
warmth, and to a lesser degree, genuineness.
However, it appears from these studies that
these dimensions are highly interrelated and
that even training does not increase their inde-
pendence. Comparison of these studies is made
difficult by the fact that untrained judges in
some studies did not use the same method for
rating excerpts; perhaps more important is
the fact that the training of raters was ac-
complished on material as varied as audio
recordings and typescripts. None of these
studies employed actual therapy samples;
hence the results cannot be generalized to
studies of psychotherapy outcome.
Does the Sex of Raters Confound the Rating
Process?
Olesker and Baiter (1972) studied differ-
ences between men and women in their ability
to identify the feelings and moods of same-sex
and opposite-sex subjects. Videotaped stimuli
were presented and rated in a multiple-choice
format on the Affective Sensitivity Scale. No
difference was found between the sexes in their
ability to determine when an empathic re-
sponse occurred. However, subjects were sig-
nificantly more accurate in judging same-sex
clients. No dicussion of the practical value of
this statistically significant finding for ratings
of therapy process was included in their re-
port. A weakness of the study was that the
criterion for empathy was one of deviance
from expert ratings. No mention was made as
to the sex of these experts. The predominance
of male researchers in the area would lead one
to suppose they were mostly males.
In a study that measured differential sensi-
sivity to nonverbal cues, Sweeney and Cottle
(1976) compared counselors with noncoun-
selors and examined possible sex differences
within and between these groups. The results
showed that as a group, females were able to
identify the nonverbal emotional states de-
picted in black-and-white pictures significantly
more accurately than were men. In fact, grad-
uate noncounselor females did better than
graduate male counselors, though not signifi-
cantly so. Strahan and Zytowski (1976) sug-
gested that sex differences may exist in the
ratings of many of the visual and nonvisual
components of a therapy session.
Abramowitz, Abramowitz, and Weitz (Note
4) presented a paper that found sex differ-
ences in ability to judge clients' feelings. Fe-
males appeared to be more empathic. This re-
sult was replicated in a later study by these
same authors. This study employed the
 THERAPIST INTERPERSONAL SKILLS
method of rating empathy most commonly
used by Carkhuff. However, no mention was
made with regard to the sex of judges.
Hoffman (1977) recently reviewed the re-
search concerning sex differences in empathy
and other related behaviors. He proffered
much evidence to suggest that although fe-
males are more empathically responsive (af-
fectively aroused), it does not necessarily
follow that they are better judges of another
individual's affective state, for example, em-
pathy. Hoffman found that although there was
a minor trend that showed females to be better
judges of empathy than were males, the sex
differences were not significant. He believed
that such differences probably do not exist.
However, Hoffman's review did not include
the aforementioned studies that relate to sex
differences. These, in particular, seem quite
pertinent to this issue as it relates to psycho-
therapy process research. The problem of pos-
sible sex differences in ability to judge and
provide facilitative conditions is a potentially
serious problem, not only as it relates to the
selection and training of judges, but also with
regard to the training of therapists. It is recog-
nized that differential empathic responses in
males and females may be found in early
childhood (Feshbach, 197S; Hoffman, 1977).
Most studies of psychotherapy have not men-
tioned the sex of the raters. As yet, it has been
assumed to be a variable that does not affect
ratings. If women are more empathic thera-
pists, then the question must be raised: Are
they also more sensitive raters? Though high
interrater reliability might be obtained within
a given study, a homogeneous group of all
male raters may be measuring the facilitative
conditions much differently from an all-female
group of raters would. Also, it is possible that
some interaction among sex of judge, sex of
client, and sex of therapist exists in ratings of
psychotherapy. At this point, relatively little
is known about the variable of gender and its
implications for psychotherapy process re-
search.
How Should Samples Be Collected: What Are
the Effects of Segment Location?
The most usual way of discovering the re-
lationship between facilitative conditions and
483
therapy outcome has been to sample therapist-
client interactions and rate the therapist's re-
sponse to his or her client along such dimen-
sions as empathy and warmth, comparing this
with outcome. Ordinarily, 3-S-min. samples
have been drawn from each psychotherapy
hour. Does the practice of sampling thera-
pist's interaction affect the relationship be-
tween outcome and facilitative conditions as
they are currently being measured? Is the
specific location within the hour from which a
segment is selected a possible source of error
in studies in this area?
Kiesler, Klein, and Mathieu (1965) dem-
onstrated with the Experiencing Scale that
segment location does make a difference. In
addition, this difference interacted with pa-
tient diagnosis. For example, neurotics, in con-
trast with both schizophrenics and normals,
functioned at a higher level of Experiencing
at different points in time. It may be unwise
to generalize this result to all patient popula-
tions, which are not as clearly differentiated,
or to other rating scales, which look at dif-
ferent variables and possibly show their own
distinct trend over time. But this study should
make us wary of generalizing when a proce-
dure is used that samples only a very small
number of the interactions of a therapy ses-
sion.
Karl and Abeles (1969), in a content analy-
sis of individual psychotherapy tapes, at-
tempted to study the possible biasing of sam-
pling from sessions. They determined the rela-
tive frequencies of certain response measures
during the first, second, third, fourth, and
fifth 10-min. therapy segments. Some variables
were found to occur more freqently during
certain segments of the hour. This finding
corresponds with other similar observations
that there are important differences early and
late in the interview as well as in the therapy
relationship across sessions.
Gurman (1973) compared six therapists
using measures of facilitative conditions taken
over 10 min. across five sessions with the
same patient. The most significant finding was
that therapists varied significantly in the rat-
ings they received, both within and between
hours. This finding held up whether therapists
were rated high or low on the therapist skills.
484 M. LAMBERT, S. DcJULIO, AND D. STEIN
Even so, therapists' ratings stayed within the
expected ranges of high and low performance.
Both groups reached peak levels of function-
ing at middle-late and late points during the
hour, though it appeared that low-functioning
therapists peaked earlier.
These results raise questions about inter-
preting studies that measure empathy only
once per session and suggest that sample loca-
tion is a very important methodological issue.
It would appear that sampling one segment
per session is too insensitive a procedure with
which to generalize to the entire therapy hour.
In addition, it suggests that sampling from
only one session is not sufficiently reliable to
represent the nature and quality of a long-
term therapeutic relationship. The results of
studies that inadequately sample the therapy
relationship contribute little to our knowledge
of the functional relationship between thera-
pist interpersonal skills and outcome.
A final issue that is related to sampling the
therapy interaction is also of major methodo-
logical and theoretical importance. This im-
portant topic, to our knowledge, has not yet
been researched. Are certain therapist atti-
tudes of particular importance at specific
times in therapy? For example, is it possible
that warmth at one time and empathy at a
different moment will most effectively produce
positive client outcome? It may be that the
level of empathy offered during these critical
periods, or more accurately, the level offered
in response to certain client behaviors would
best predict the amount of positive client
change.
Perhaps one refinement that client-centered
theory must undergo is the elaboration of the
critical moments when empathy, warmth, and/
or genuineness are most appropriate and
helpful. This would enable researchers to ex-
amine more closely the nature of client be-
havior and to refine their judgments about
the process of effective therapy beyond the
level of merely assigning a numeral to a com-
plex interaction that surely deserves more re-
fined assessment. In this regard the random
sampling of therapy sessions might become a
thing of the past, one of those interesting but
crude first steps toward a more complete un-
derstanding of human behavior.
Do the Process Scales Measure Separate
Unidimensional Traits or a Single
Dimension?
Several researchers have investigated this
topic, but due to varied designs and methodo-
logical dissimilarities their studies are difficult
to integrate. Muehlberg, Pierce, and Drasgow
(1969) performed the most frequently quoted
study examining the interrelationship of
scales. Using experienced counselors in a single
analogue interview, they had "highly experi-
enced researchers" rate counselors on the
Carkhuff (1969) scales on respect, empathy,
concreteness, genuineness, and self-disclosure.
Unfortunately, each of the judges rated all the
dimensions considered, rather than having
separate trained judges rate a single dimen-
sion. Almost no data were given about pro-
cedure (e.g., reliability, rating method, train-
ing of raters), making it difficult to assess
other possible weaknesses in methodology.
They reported that a single factor ac-
counted for 89% of the variance. They ap-
peared to agree with F. C. Thome who, in a
personal communication with them (cited in
Muehlberg et al., 1969) labeled this underly-
ing factor a "good guy" factor, that is, a fac-
tor indicating someone who is likable, friendly,
and helpful. They analyzed the differential
behavior of the highest- and lowest-function-
ing therapists and concluded that the factor
was present whether high- or low-facilitative
therapists were considered. The authors as-
serted that "therapists high on one facilita-
tive dimension are high on all facilitative
dimensions and vice versa" (p. 95). This as-
seration of course, runs counter to even some
of the most optimistic research (reviewed
above). The "good guy" factor could be a
result of the ambiguity of the scales on which
the raters were trained; that is, the description
or definition of each scale, and the differences
between scale points are neither clear nor op-
erationally elegant.
Following this study, Collingwood, Hefele,
Muehlberg, and Drasgow (1970) discussed
the results again, although their presentation
was difficult to follow. For example, they dis-
cussed four facilitative conditions, although
the study to which they referred reported re-
sults on five facilitative conditions. In dis-
 THERAPIST INTERPERSONAL SKILLS
cussing the single factor that emerged, they
decided to label it a "good guy" factor be-
cause "it seems so descriptive of the success-
ful therapists we know" (p. 119).
In yet another report, by Hefele, Colling-
wood, and Drasgow (1970), the responses of
27 graduate students to the Counseling Simu-
lation Inventory (CSI) were factor analyzed.
The authors were trying to discover if coun-
selors could respond to different topic areas
and emotional content with equal facility. The
authors found that a single factor emerged
(accounting for 19% of the variance) and
suggested that this was a cross-validation of
the earlier study by Muehlberg et al. (1969).
This is quite an ambiguous conclusion, since
(a) they misquoted the figure reported in
1969 as 81%, (b) they were reporting on a
study that did not even involve counseling but
used a pencil-and-paper device, and (c) they
didn't report data from responses that were
rated on scales of empathy, genuineness, and
so on but on a scale of global performance
that sought to measure all conditions simul-
taneously. Again the method of rating re-
sponses was so lacking in detail as to make im-
possible a critical review of procedure.
Friel, Berenson, and Mitchell (1971) also
reported a factor analytic study that differed
in methodology from the studies just reported.
They examined 45 counselors, heterogeneous
in professional experience, during their first
interview with real clients. Factor loadings
from high- and 32 low-functioning therapists
rated on eight interpersonal process dimen-
sions were compared. The first factor ac-
counted for 47%-53% of the variance; the
second accounted for lQ%-22%. The authors
concluded that factor patterns suggest a struc-
tural difference in interrelationships among
facilitative conditions offered by therapists
functioning at various levels. Again, little is
known about the judges, how they proceeded
to do ratings, how many there were, whether
ratings were independent or averaged, and so
forth. Also, it is difficult to compare this with
other studies because it included facilitative
conditions (confrontation, client self-explora-
tion, relationship to significant others) not
frequently researched.
In perhaps the most well defined factorial
study to date, Zimmer and Anderson (1968)
485
attempted to "discover whether positive re-
gard and empathy can be described as a con-
struct on a single dimension or in terms of
orthogonally related factors" (p. 417). The
question of how empathy and positive regard
are alike or different was also asked.
Zimmer and Anderson examined ratings
done by students trained to rate positive re-
gard (N = 149) and empathy (N = 123) on
the Carkhuff scales. Each student rated sam-
ples from one actual counseling session. It
should be noted that in this study, the train-
ing procedure was described, and videotapes
of the sessions were used. Also, a group of
judges were allowed to rate only one of the
facilitative conditions (thus increasing the
likelihood that knowledge of or involvement
in the ratings of one scale would not bias rat-
ings on another). Examining these interactions
by rating 100 of 153 therapist statements on
both conditions, they concluded that (a) posi-
tive regard and empathy, although defined as
single constructs on a continuum from more
to less, are really composed of orthogonally re-
lated factors, (b) the factors found to be
unique to each dimension probably do not
represent the central defining characteristics
of their respective scales, (c) these factors
are not unique to the constructs they are pur-
portedly denning and (d) there is little to be
gained from continuing to hold sacred the
constructs of empathy and positive regard.
Among other suggestions, Zimmer and And-
erson proposed that new operational defini-
tions be created to replace those that make up
the Truax-derived scales. For example, Level
2 of positive regard might be redefined as,
"The counselor responds using personal pro-
nouns and intransitive verbs and in this way
makes himself the locus of evaluation" (p.
425).
In another factor analytic study, Wenegrat
(1974) compared 60 random samples from
early and late in the therapy of 12 therapists
with 21 clients on the Truax Accurate Em-
pathy Scale. Factor analyzing these ratings
with syntactic and semantic measures, she
concluded that what judges seemed to be re-
sponding to was a general assertiveness on the
part of the therapist in regard to approach-
ing client feelings. This is reminiscent of sug-
gestions by others who are critical of the
486 M. LAMBERT, S. DsJULIO, AND D. STEIN
scales and the assertion that what is in fact
being measured is something like verbosity, a
general style of communicating, or confidence.
Summary and Conclusions
The best conclusions that can be drawn
based on the existing data are as follows: (a)
Despite more than 20 years of research and
some improvements in methodology, only a
modest relationship between the so-called fa-
cilitative conditions and therapy outcome has
been found. Contrary to frequent claims for
the potency of these therapist-offered relation-
ship variables, experimental evidence suggests
that neither a clear test nor unequivocal sup-
port for the Rogerian hypothesis has ap-
peared. Also, the efficacy of Carkhuff's popu-
lar training model has not been established.
(b) This low relationship is probably a func-
tion of the complexity of the task, especially
when audiotape recordings form the basis of
process judgments. Such factors as sex of
rater, therapist nonverbal behavior, and in-
adequate sampling of therapy sessions are
emerging as important confounding variables
that must be taken into account when carry-
ing out research in this area, (c) More con-
cern should be given to reporting the method
of training of raters, (d) Consideration should
be given to relying more heavily on measures
of client-perceived empathy, (e) Also, not one
study has, to our knowledge, undertaken the
task of comparing ratings made by one group
of researchers with those of a distinct and in-
dependent group of researchers. It would be
reassuring to know that in studies in which
therapists interpersonal skills are assessed, the
raters were actually trained in a similar man-
ner and had high intergroup reliability, (f)
When Truax-Carkhuff type scales are used, a
given judge should be trained to rate only one
scale, since knowledge of ratings on one scale
may interfere with objective assessment on
another. Also, videotaped (as opposed to au-
diotaped) sessions provide additional impor-
tant information about the therapy process.
(g) Consideration needs to be given to im-
provements and diversification in measure-
ment techniques. Too many conclusions are
based on the Truax and Carkhuff rating scales
and the Barrett-Lennard Relationship Inven-
tory alone. More sophisticated measurement
methods are needed, (h) More hypothesis
testing regarding the times in therapy when
warmth, empathy, and so forth are and are not
efficacious needs to be carried out. This should
also involve more specification of particular
kinds of client changes that are expected, (i)
Improvements in methodology may yet lead to
a significant revision of the client-centered
hypothesis and an increase in its ability to
specify conditions leading to therapeutic
change.
Reference Notes
1. Mitchell, K. M. Effective therapist interpersonal
skills: The search goes on. Invited address at
Michigan State University, 1973.
2. Blackwood, G. L. Accurate empathy: Critique of
a construct. Unpublished manuscript, Vanderbilt
University, 1975.
3. Kagan, N., & Krathwohl, D. R. Studies in human
interaction—Interpersonal process recall stimulated
by video tapes. Washington, D.C.: U.S. Govern-
ment Printing Office, December 1967.
4. Abramowitz, C. V., Abramowitz, S. I., & Weitz, L.
J. Are men therapists soft on empathy? Two stud-
ies in feminine understanding. Paper presented at
the meeting of 'the Society for Psychotherapy Re-
search, Denver, 1974.
References
Arnhoff, F. N. Some factors influencing the unreliabil-
ity of clinical judgments. Journal of Clinical Psy-
chology, 1954, 10, 272-275.
Aspy, D. N. Reaction to Cairkhuff's articles. Counsel-
ing Psychologist, 1972, 3, 35^1.
Aspy, D. N. Empathy: Let's get the hell on with it.
Counseling Psychologist, 1975,5, 10-14.
Barrett-Lennard, G. T. Dimensions of therapist re-
sponse as causal factors in therapeutic change.
Psychological Monographs, 1962, 7(5(43, Whole No.
562).
Bergin, A. E. The evaluation of therapeutic outcomes.
In A. E. Bergin & S. L. Garfleld (Eds.), Hand-
book of psychotherapy and behavior change: An
empirical evaluation. New York: Wiley, 1971.
Bergin, A. E., & Jasjter, L. G. Correlates of empathy
in psychotherapy: A replication. Journal of Ab-
normal Psychology, 1969, 74, 477-481.
Bergin, A. E., & Suinn, R. M. Individual psycho-
therapy and behavior therapy. Annual Review of
Psychology, 1975, 26, 509-556.
Beutler, L. E., Johnson, D. T., Neville, C. W., Jr., &
Workman, S. N. "Accurate empathy" and the A-B
dichotomy. Journal of Consulting and Clinical Psy-
chology, 1972, 38, 372-375.
 THERAPIST INTERPERSONAL SKILLS
Beutler, L. E., Johnson, D. T., Neville, C. W., Jr.,
Workman, S. N., & Elkins, D. The A-B therapy-
type distinction, accurate empathy, nonpossessive
warmth, and therapist genuineness in psychother-
apy. Journal of Abnormal Psychology, 1973, 82,
273-277.
Bozarth, J. D., & Grace, D. P. Objective ratings and
client perception of therapeutic conditions with uni-
versity counseling center clients. Journal of Clinical
Psychology, 1970, 26, 117-118.
Bozarth, J. D., & Krauft, C. C. Accurate empathy
ratings: Some methodological considerations. Jour-
nal of Clinical Psychology, 1972, 28, 408-410.
Buber, M., & Friedman, M. The knowledge of man.
New York: Harper & Row, 196S.
Caracena, P. F., & Vicory, J. R. Correlates of phe-
nomenological and judged empathy. Journal of
Counseling Psychology, 1969,16, S10-515.
Carkhuff, R. R. Helping and human relations: A
primer for lay and professional helpers (2 vols.).
New York: Holt, Rinehart & Winston, 1969.
Carkhuff, R. R. The development of human resources.
New York: Holt, Rinehart & Winston, 1971.
Carkhuff, R. R. The development of systematic hu-
man resource development models. Counseling Psy-
chologist, 1972, 3, 4-16.
Carkhuff, R. R., & Burstein, J. Objective therapist
and client ratings of therapist-offered facilitative
conditions of moderate to low functioning thera-
pists. Journal of Clinical Psychology, 1970, 26, 394-
395.
Cartwright, D. S. Annotated bibliography of re-
search and theory construction in client-centered
therapy. Journal of Counseling Psychology, 1957, 4,
82-100.
Chinsky, J. M., & Rappaport, J. Brief critique of the
meaning and reliability of "accurate empathy" rat-
ings. Psychological Bulletin, 1970, 73, 379-382.
Collingwood, T., Hefele, T., Muehlberg, N., & Dras-
gow, J. Toward identification of the therapeutically
facilitative factor. Journal of Clinical Psychology,
1970, 26, 119-120.
Cronbach, L. J. Essentials of psychological testing.
New York: Harper & Row, 1960.
D'Augelli, A. R. Nonverbal behavior of helpers in
initial helping interactions. Journal of Consulting
and Clinical Psychology, 1974, 21, 360-363.
Dickenson, W. A., & Truax, C. B. Group counseling
with college underachievers: Comparisons with a
control group and relationship to empathy, warmth,
and genuineness. Personnel and Guidance Journal,
1966, 45, 243-247.
Feitel, B. S. Feeling understood as a function of a
variety of therapist activities. Unpublished doctoral
dissertation, Teachers College, Columbia University,
1968.
Feshbach, N. D. Empathy in children: Some theoreti-
cal and empirical considerations. The Counseling
Psychologist, 1975, S, 25-30.
Fish, J. M. Empathy and the reported emotional ex-
periences of beginning psychotherapists. Journal
of Consulting and Clinical Psychology, 1970, 35,
64-69.
487
Fretz, B. R. Postural movements in a counseling
dyad. Journal of Counseling Psychology, 1966, 13,
335-343.
Friel, T. W., Berenson, B. G., & Mitchell, K. M.
Factor analysis of therapeutic conditions for high
and low functioning therapists. Journal of Clinical
Psychology, 1971, 27, 291-293.
Friel, T., Kratochvil, D., & Carkhuff, R. R. The ef-
fects of the manipulation of client depth of self-
exploration 'upon helpers of different training and
experience. Journal of Clinical Psychology, 1968, 24,
247-249.
Garfield, S. L., & Bergin, A. E. Therapeutic conditions
and outcome. Journal of Abnormal Psychology,
1971,77, 108-114.
Gazda, G. M. Human relations development. Boston,
Mass.: Allyn & Bacon, 1973.
Gladstein, G. A. Empathy and counseling outcome:
An empirical and conceptual review. Counseling
Psychologist, 1977, 6, 70-79.
Gormally, J., & Hill, C. E. Guidelines for research on
Carkh'Uff's training model. Journal of Counseling
Psychology, 1974, 21, 539-547.
Gurman, A. S. Rating of therapeutic warmth and
genuineness by untrained judges. Psychological Re-
ports, 1971, 28, 711-714.
Gurman, A. S. Effects of therapist and patient mood
on the therapeutic functioning of high- and low-
facilitative therapists. Journal of Consulting and
Clinical Psychology, 1973, 40, 48-58.
Gurman, A. S. The patient's perception of the thera-
peutic relationship. In A. S. Gurman & A. M. Razin
(Eds.), The therapist's contributions to effective
psychotherapy: An empirical assessment. New
York: Pergamon Press, 1977.
Haase, R. F., & Tepper, D. T., Jr. Nonverbal com-
ponents of empathic communication. Journal o.f
Counseling Psychology, 1972, 19, 417-424.
Halkides, G. An investigation of therapeutic success
as a function of four variables. Unpublished doc-
toral dissertation, University of Chicago, 1958.
Hansen, J. C., Moore, G. D., & Carkhuff, R. R. The
differential relationships of objective and client per-
ceptions of counseling. Journal of Clinical Psychol-
ogy, 1968, 24, 244-246.
Hefele, T. J., Collingwood, T., & Drasgow, J. Thera-
peutic facilitativeness as a dimension of effective
living: A factor analytic study. Journal of Clinical
Psychology, 1970,2(5, 121-123.
Hefele, T., & Hurst, M. W. Interpersonal skill mea-
surements: Perception, validity and utility. Coun-
seling Psychologyist, 1972, 3, 62-69.
Hill, C. E. A comparison of the percetions of a ther-
apy session by clients, therapists, and objective
judges. JSAS Catalog of Selected Documents in
Psychology, 1974, 4, 16. (Ms. No. 564)
Hoffman, M. L. Sex differences in empathy and re-
lated behaviors. Psychological Bulletin, 1977, 48,
712-722.
Jakubowski-Spector, P. Facilitating the growth of
women through assertive training. Counseling Psy-
chologist, 1973, 4, 75-86.
Karl, N. J., & Abeles, N. Psychotherapy process as a
488 M. LAMBERT, S. DEjULIO, AND D. STEIN
function of 'the time segment sampled. Journal of
Consulting and Clinical Psychology, 1969, 33, 207-
212.
Kiesler, D. J., Klein, M. H., & Mathieu, P. L. Sam-
pling from .the recorded therapy interview: The
problem of segment location. Journal of Consult-
ing Psychology, 1965, 29, 337-344.
Kurtz, R. R., & Grummon, D. L. Different approaches
to the measurement of therapist empathy and their
.relationship to therapy outcomes. Journal of Con-
sulting and Clinical Psychology, 1972, 39, 106-115.
Lambert, M. J., & Beier, E. G. Supervisory and coun-
seling process: A comparative study. Counselor
Education and Supervision, 1974, 54-60.
Lambert, M. J., & Dejulio, S. S. Outcomes in Cark-
huff's human resource development: Where's the
donut? Counseling Psychologist, 1977, 6, 79-86.
Luborsky, L. B., Chandler, M., Aueirbach, A. H.,
Cohen, J., & Bachrach, H. M. Factors influencing
the outcome of psychotherapy: A review of quan-
titative research. Psychological Bulletin, 1971, 75,
145-185.
Luborsky, L., Singer, B., & Luborsky, L. A compara-
tive study of psychotherapies: Is it true that
"everyone has won and all deserve prizes"? Ar-
chives of General Psychiatry, 1975, 32, 995-1008.
McWhirter, J. J. Two measures of the facilitative
conditions: A correlation study. Journal of Coun-
seling Psychology, 1973, 20, 317-320.
Mehrabian, A., & Ferris, S. R. Inference of attitudes
from nonverbal communication in two channels.
Journal of of Consulting Psychology, 1967, 31,
248-252.
Meltzoff, J., & Kornreich, M. Research in psychother-
apy. New York: Atherton Press, 1970.
Muehlberg, N., Pierce, R., & Drasgow, J. A factor
analysis of therapeutically facilitative conditions.
Journal of Clinical Psychology, 1969, 25, 93-95.
Mullen, J., & Abeles, N. Relationship of liking, em-
pathy, and therapist's experience to outcome of
therapy. Journal of Counseling Psychology, 1971,
18, 39-43.
Olesker, W., & Baiter, L. Sex and empathy. Journal
of Counseling Psychology, 1972,19, 559-562.
Pierce, R. M., & Schauble, R. G. Graduate training of
facilitative counselors: The effects of individual
supervision. Journal of Counseling Psychology,
1970,77,210-215.
Rappaport, J., & Chinsky, J. M. Accurate empathy:
Confusion of a construct. Psychological Bulletin,
1972, 77, 400-404.
Rachman, S. J. The effects of psychological treat-
ment. In H. J. Eysenck (Ed.), Handbook of ab-
normal psychology. New York: Basic Books, 1973.
Rogers, C. R. The necessary and sufficient conditions
of therapeutic personality change. Journal of Con-
sulting Psychology, 1957, 22, 95-103.
Rogers, C. R. A Theory of therapy, personality, and
interpersonal relationships, as developed in the
client-entered framework. In S. Koch (Ed.), Psy-
chology: A study of a science. Vol. 3. Formulations
of the person and the social context. New York:
McGraw-Hill, 1959.
Rogers, C. R. Empathic: An unappreciated way of
being. Counseling Psychologist, 1975, 5, 2-10.
Rogers, C. R., & Dymond, R. F. Psychotherapy and
personality change. Chicago: University of Chicago
Press, 1954.
Rogers, C. R., Gendlin, G. T., Kiesler, D. V., &
Truax, C. B. The therapeutic relationship and its
impact: A study of psychotherapy with schizo-
phrenics. Madison: University of Wisconsin Press,
1967.
Shapiro, D. A. Naive British judgments of thera-
peutic conditions. British Journal of Social and
Clinical Psychology, 1973, 12, 289-294.
Shapiro, J. G. Relationships between expert and
neophyte ratings of therapeutic conditions. Journal
of Consulting and Clinical Psychology, 1968, 32,
87-89. (a)
Shapiro, J. G. Relationships between visual and
auditory cues of therapeutic effectiveness. Journal
of Clinical Psychology, 1968, 34, 236-239. (b)
Shapiro, J. G., Foster, C. P., & Powell, T. Facial and
bodily cues of genuineness, empathy and warmth.
Journal of Clinical Psychology, 1968, 24, 233-236.
Sloane, R. B., Staples, F. R., Cristol, A. H., Yorkston,
N. J., & Whipple, K. Psychotherapy versus be-
havior therapy. Cambridge, Mass.: Harvard Uni-
versity Press, 1975.
Sprinthall, N. Human resource training: A response.
Counseling Psychologist, 1972, 3, 57-61.
Strahan, C., & Zytowski, D. G. Impact of visual,
vocal, and lexical cues on judgments of counselor
qualities. Journal of Counseling Psychology, 1976,
23, 387-393.
Sweeney, M. A., & Cottle, W. C. Nonverbal acuity:
A comparison of counselors and nonoounselors.
Journal of Counseling Psychology, 1976, 23, 394-
397.
Truax, C. B. Effective ingredients in psychotherapy:
An approach to unraveling the patienHherapist in-
teraction. Journal of Counseling Psychology, 1963,
10, 256-263.
Truax, C. B. Therapist empathy, warmth, and genu-
ineness and patient personality change in group
psychotherapy: A comparison .between interaction
unit measures, time sample measures, and patient
perception measures. Journal of Clinical Psychol-
ogy, 1966, 22, 225-229.
Truax, C. B. Effectiveness of counselor and counselor
aides: A rejoinder. Journal of Counseling Psychol-
ogy, \<)n,18, 365-367.
Truax, C. B., Altmann, H., Wright, L., & Mitchell, K.
M. Effects of therapeutic conditions in child ther-
apy. Journal of Community Psychology, 1973, 1,
313-318.
Truax, C. B., & Carkhuff, R. R. Toward effective
counseling and psychotherapy: Training and prac-
tice. Chicago: Aldine, 1967.
Truax, C. B., Carkhuff, R. R., & Kodman, F., Jr.
Relationships between therapist-offered conditions
and patient change in group psychotherapy. Journal
of Clinical Psychology, 1965, 21, 327-329.
Truax, C. B., & Mitchell, K. M. Research on certain
therapist interpersonal skills in relation to process
 THERAPIST INTERPERSONAL SKILLS 489

and outcome. In A. E. Bergin & S. L. Garfield
(Eds.)i Handbook o.f psychotherapy and behavior
change: An empirical evaluation. New York:
Wiley, 1971.
Truax, C. B., Wargo, D. G., Frank, J. D., Imber, S.
D., Battle, C. C., Hoehn-Saric, R., Nash, E. H., &
Stone, A. R. Therapist empathy, genuineness, and
warmth and patient therapeutic outcome. Journal
of Consulting Psychology, 1966, 30, 395-401.
Truax, C. B., Wargo, D. G., & Silber, L. D. Effects
of group psychotherapy with high accurate em-
pathy and nonpossessive warmth upon female in-
stitutionalized delinquents. Journal of Abnormal
Psychology, 1966, 71, 267-274.
Truax, C. B., Wittmer, J., & Wargo, D. G. Effects of
the therapeutic conditions of accurate empathy,
non-possessive warmth, and genuineness on hos-
pitalized mental patients during group therapy.
Journal of Clinical Psychology, 1971, 27, 137-142.
Van Der Veen, F. Client perception of therapist con-
ditions as a factor in psychotherapy. In J. T. Hart
& T. M. Tomlinson (Eds.), New directions in
client-centered therapy. Boston: Houghton Mifflin,
1970.
Weiner, I. B. Principles of psychotherapy. New York:
Wiley, 197S.
Wenegrat, A. A factor analytic study of the Truax
Accurate Empathy Scale. Psychotherapy: Theory,
Research and Practice, 1974,11, 48-51.
Yalom, I. D. The theory and practice of group Psy-
chotherapy (2nd ed.). New York: Basic Books,
1975.
Zimmer, J. M., & Anderson, S. Dimensions of posi-
tive regard and empathy. Journal of Counseling
Psychology, 1968, IS, 417-426.
Received March 1, 1977 •

Errata to Larzelere and Mulaik

The article, "Single-Sample Tests for Many Correlations," by Robert E.
Larzelere and Stanley A. Mulaik (Psychological Bulletin, 1977, Vol. 84, No. 3,
pp. 557-569) contains the following errors:
On page 558, the sentence that includes Equation 1 should read: "Assuming
that the X and Y variables have a joint multivariate normal distribution, one
then regards the multiple correlation as significantly different from zero if

is greater than Fa, the corresponding critical value of the F distribution with p
and N — p — 1 degrees of freedom at the 100(1 — «) percentile level, with .W
the sample size."
On page 559, the sentence that includes Equation 2 should read: "The popu-
lation correlation p(W, Y) between W and Y is then regarded as significantly
different from zero if
P= -p- (2)
is greater than the critical value of Fa of the F distribution with p and N — p
— 1 degrees of freedom at the 100(1 — a) percentile level."
On page 559, the sentence that reads, "If p(W, Y) is regarded as equal to
zero, then any variable Xt with a nonzero weight wi in the linear combination W
is also considered to have a zero correlation with Y," should be deleted.
Thanks are due to Paul A. Games.