THE EFFECTS OF YOUNG SCHEMA DOMAINS, YOUNG …etd.lib.metu.edu.tr/upload/12617444/index.pdf · the...

THE EFFECTS OF YOUNG SCHEMA DOMAINS, YOUNG MALADAPTIVE COPING STYLES, AND YOUNG PARENTING STYLES ON WORKING

ALLIANCE AMONG SUPERVISORS, THERAPISTS, AND THE CLIENTS

A DISSERTATION SUBMITTED TO THE GRADUATE SCHOOL OF SOCIAL SCIENCES

OF MIDDLE EAST TECHNICAL UNIVERSITY

BY

BAHAR KÖSE KARACA

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR

THE DEGREE OF DOCTOR OF PHILOSOPHY IN

THE DEPARTMENT OF PSYCHOLOGY

JUNE 2014

Approval of the Graduate School of Social Sciences

Prof. Dr. Meliha Altunışık

Director

I certify that this thesis satisfies all the requirements as a thesis for the degree of Doctor of Philosophy. Prof. Dr. Tülin Gençöz

Head of Department

This is to certify that we have read this thesis and that in our opinion it is fully adequate, in scope and quality, as a thesis for the degree of Doctor of Philosophy. _____________________

Prof. Dr. Tülin Gençöz Supervisor

Examining Committee Members

Prof. Dr. Tülin Gençöz (METU, PSY)

Prof. Dr. Gonca Soygüt Pekak(Hacettepe Uni.,PSY)

Asst. Dr. Özlem Bozo (METU, PSY)

Prof. Dr. Faruk Gençöz (METU, PSY)

Prof. Dr. Gülsen Erden (Ankara Uni., PSY)

iii

PLAGIARISM

I hereby declare that all information in this document has been obtained and

presented in accordance with academic rules and ethical conduct. I also

declare that, as required by these rules and conduct, I have fully cited and

referenced all material and results that are not original to this work.

Name, Last name: Bahar Köse Karaca

Signature:

iv

ABSTRACT

THE EFFECTS OF YOUNG SCHEMA DOMAINS, YOUNG MALADAPTIVE

COPING STYLES, AND YOUNG PARENTING STYLES ON WORKING ALLIANCE AMONG SUPERVISORS, THERAPISTS, AND THE CLIENTS

Köse Karaca, Bahar

Ph. D., Department of Psychology

Supervisor: Prof. Dr. Tülin Gençöz

June 2014, 169 pages

In the current study, the aim was to measure the effects of Young schema domains,

Young maladaptive coping styles, and Young parenting styles on working alliance

among supervisors, therapists, and the clients. Participants were eight supervisors

(clinical psychology doctorate students), twelve therapists (clinical psychology

master students), and four clients (applicants to AYNA Psychotherapy Unit). In

order to measure working alliance, two types of measurement based on qualitative

(open ended questions and relational circles (developed by the researcher) and

quantitative (Working alliance inventory/supervisor-therapist and therapist-client

forms) methods were used. According to results, a relationship between Young

schemas, parent styles, and coping styles and working alliance was found among

supervisors, therapists, and clients. Associations were discussed in line with

Schema Theory.

Keywords: Schema Theory, Working Alliance, Supervision, Psychotherapy

v

ÖZ

YOUNG ŞEMA ALANLARI, UYUMSUZ BAŞ ETME BİÇİMLERİ VE YOUNG EBEVEYNLİK BİÇİMLERİNİN SÜPERVİZÖRLER, TERAPİSTLER

VE HASTALARIN TERAPÖTİK İLİŞKİSİ ÜZERİNDEKİ ETKİSİ

Köse Karaca, Bahar

Doktora, Psikoloji Bölümü

Tez Danışmanı: Prof. Dr. Tülin Gençöz

Haziran 2014, 169 sayfa

Yapılan çalışmanın hedefi Young şema alanlarının, Young uyumsuz baş etme

biçimlerinin, Young ebeveynlik biçimlerinin süpervizörler, terapistler ve hastalar

arasındaki terapötik ittifakını ölçmekti. Katılımcılar sekiz süpervizör (klinik

psikoloji doktora öğrencileri), on iki terapist (klinik psikoloji yüksek lisans

öğrencileri) ve dört hastadan (AYNA klinik psikoloji ünitesine başv uranlar)

oluşmaktaydı. Araştırmada, terapötik ittifakı ölçmek için niteliksek (araştırmacı

tarafından geliştirilen açık uçlu soru formu ve ilişkisel halkalar) ve niceliksel

(terapötik ittifak ölçekleri/süpervizör-terapist formları ve terapist-hasta formları)

olmak üzere iki farklı ölçüm biçimi kullanıldı. Sonuçlara göre, Young erken yaş

dönemi uyumsuz şemaları, Young baş etme biçimleri, Young ebeveynlik biçimleri

ile süpervizörler, terapistler ve hastaların terapötik ittifakları arasında bir ilişki

olduğu tespit edildi. Çıkan sonuçlar Şema Teori çerçevesinde tartışıldı.

Anahtar Kelimeler: Şema Teori, Terapötik İttifak, Süpervizyon, Psikoterapi

vi

DEDICATION

To my husband, to my new life…

vii

ACKNOWLEDGMENTS

I would like to express my very great appreciation to Prof. Dr. Tülin Gençöz... My

doctorate education came across a crisis period in my family life; it was dark,

uncontrollable, and frustrating. I was withdrawn from life. However, she did not

allow me to lose my way; did not give up my hands... If I reached to today in my

academic career and private life, her contribution have had remarkable effect. She

shared my sadness and happiness. She provided “limited reparenting” in real life.

Thank you, thank you very much my teacher, my educator, my advisor…

I would like to offer my special thanks to Prof. Dr. Gonca Soygüt Pekak… She

accepted being in my jury and she unconditionally shared all her materials related

to my dissertation with me and spent much time to discuss on my dissertation. Her

supportive, accepting, and warm relationship style with me made me feel relaxed,

safe, and motivated for my dissertation. Besides, she exemplified how a schema

therapist should be with her attitudes and behaviors in real life. Thank you very

much for everything…

I would like to express gratitude to Doç. Dr. Özlem Bozo İrkin. She accepted to be

in my jury and followed my developing process. She directed me easy and quick

solutions for complicated parts of my dissertation. She approached positive and

understanding to me in this period…

I would like to express my deep gratitude to Prof. Dr. Faruk Gençöz. He became

the pioneer of my dissertation. He suggested the topic of my dissertation and

facilitated the conditions to reach the aims of it. More important than all these

things, he made me learn question my life, formulate my clients, and give

supervision as the therapist. He made the greatest contribution to be a

psychotherapist and to deal with my own life. If I did not know all these things, I

viii

could not interpret associations in my dissertation, but the most importantly; I

could not become who I am now. By decreasing, we increased by the help of him.

I would like to thank Prof. Dr. Gülsen Erden. She accepted to be in my jury

unconditionally and she supported me in this process. Her questions and feedbacks

were important for me at this period. Thank you very much…

I would also like to thank Nurten Özüorçun since she was another pioneer to

develop my dissertation topic and her supportive attitude; to Öznur Öncül since

she facilitated complicated method of dissertation and her friendly attitude, to

Gözde İkizer since she became near me whenever I was lost in questions, to

Nilüfer Ercan since she supported me by finding technical support or by sharing

my emotions; to Murat Sayın since he recovered my computer; to dear Fazilet

Canbolat since she shared me all the process caressively and warm friendship; to

Dilek Sarıtaş Atalar for her psychological support; to Yağmur Ar since she was

ready to help any time; Bülent Aykutoğlu and Mehmet Gültaş for their technical

support; to Yeşim Üzümcüoğlu for her collaborative room friendship…

My special thanks to Dilek Demirtepe, İncila Gürol, Filiz Özekin Üncüer, Pınar

Özbağrıaçık Çağlayan, Canan Büyükaşık Çolak, Başak Safrancı, Gaye Zeynep

Çenesiz, Gizem Ateş, İlknur Dilekler, Yankı Süsen, Sedef Tulum, Pelin Deniz

Begüm Babuşçu, Kerim Selvi, Seda Meşeli Allard, Tuğba Yılmaz, Beyza Ünal,

Ezgi Tuna, Zulal Törenli, and Ali Can Gök since if they were not there, this

dissertation could not be real. You became understanding, helpful, and patient,

thank you all…

I would like to thank my mother, sister, and brother since they shared this

adventure with me, they loved me; tried to understand, support, and protect me; to

my father since I learnt more things from his absence than his existence and I still

feel his love and can go to my way with confidence; to Murat Karaca, my husband

since he always forced me to be what I am and since he opened a sunny window to

my life…

ix

TABLE OF CONTENTS

PLAGIARISM ........................................................................................................ iii

ABSTRACT ............................................................................................................ iv

ÖZ............................................................................................................................. v

DEDICATION ........................................................................................................ vi

ACKNOWLEDGMENTS ...................................................................................... vii

TABLE OF CONTENTS ........................................................................................ ix

LIST OF TABLES ................................................................................................ xiv

LIST OF FIGURES .............................................................................................. xvii

CHAPTER ................................................................................................................ 1

1. INTRODUCTION ............................................................................................ 1

1.1. Therapeutic Relationship............................................................................... 1

1.1.1. Historical Context of Therapeutic Relationship and Conceptualizations .. 2

1.1.2. Measurement of Therapeutic Relationship ................................................ 4

1.2. The Place of Therapeutic Relationship in Different Psychotherapy

Approaches and the Factors Affecting Therapeutic Relationship in

Psychotherapy Process…………………………………………………….10

1.2.1. Schema Theory ........................................................................................ 13

1.2.1.1. Early Maladaptive Schemas, Schema Domains and Family Origins .. 13

1.2.1.2. Coping with Early Maladaptive Schemas ............................................ 16

1.2.1.3. Schema Theory and Therapeutic Alliance ........................................... 18

1.3. Specific Aims of the Study.......................................................................... 20

2. METHOD ....................................................................................................... 21

x

2.1. Participants .................................................................................................. 21

2.2. Measures ...................................................................................................... 22

2.2.1. Demographic Information Form .............................................................. 22

2.2.2. The Young Schema Questionnaire (YSQ) .............................................. 22

2.2.3. Young Parenting Inventory (YPI) ........................................................... 23

2.2.4. Young-Rygh Avoidance Inventory (YRAI) ............................................ 24

2.2.5. Young Compensation Inventory (YCI) ................................................... 24

2.2.6. Working Alliance Inventory—Therapist and Client Forms .......................

(WAI-T and WAI-C) ............................................................................... 24

2.2.7. Working Alliance Inventory—Supervisor and Therapist Forms ................

(WAI-S and WAI-T) ................................................................................ 25

2.2.8. Open-ended Question Form ..................................................................... 25

2.2.9. Projective Measurement-Relational Circles ............................................ 25

3. Procedure ........................................................................................................ 26

4. Statistical Analysis .......................................................................................... 28

3. RESULTS & DISCUSSION ........................................................................... 29

3.1. General Results for the Study ...................................................................... 29

3.2. Differences of Demographic Variables ....................................................... 29

3.3. Descriptive Information for the Measures of the Study .............................. 29

3.3.1. Descriptive Measures for Young Schema Inventories for the ....................

Supervisors .............................................................................................. 30

3.3.2. Descriptive Measures for Young Schema Inventories for the ....................

Therapists ................................................................................................. 35

3.3.3. Descriptive Measures of Young Schema Inventories for the Clients ...... 39

3.3.4. Descriptive Measures for Therapeutic Alliance ...................................... 42

3.4. Correlation Coefficients between Groups of Variables .............................. 42

xi

3.4.1. Correlation Coefficients between Groups of Variables for Supervisors ....

in Supervision Settings ............................................................................ 43

3.4.2. Correlation Coefficients between Groups of Variables for Therapists ......

in Supervision Settings ............................................................................ 47

3.4.3. Correlation Coefficients between Groups of Variables for Therapists ......

in Therapy Settings .................................................................................. 49

3.4.4. Correlation Coefficients between Groups of Variables for Clients in

Therapy Settings ..................................................................................................... 51

3.5. Case Examples to Illustrate the Relationship of Young Schemas, Young

Coping Mechanisms, Young Parenting Styles with Therapeutic Alliance ............ 54

3.5.1. Case of SupervisorA-TherapistB-ClientC ............................................... 54

3.5.1.1. Characteristics of Supervisor A ........................................................... 54

3.5.1.2. Characteristics of Therapist B .......................................................... 58

3.5.1.3. Characteristics of Client C ................................................................... 61

3.5.1.4. Therapeutic Alliance between Supervisor A and Therapist B with ........

the Associations of Schema Theory ..................................................... 64

3.5.1.5. Therapeutic Alliance between Supervisor A and Therapist B ................

depending on Quantitative Measurement and Its Associations with

Schema Theory .................................................................................... 64

3.5.1.6. Therapeutic Alliance between Supervisor A and Therapist B ................

depending on Qualitative Measurement and Its Associations with

Schema Theory .................................................................................... 68

3.5.1.7. Therapeutic alliance between Therapist B and Client C and Its

Associations with Schema Theory ....................................................... 73

3.5.1.8. Therapeutic Alliance between Therapist B and Client C depending ......

on Qualitative Measurement and Its Associations with Schema ............

Theory ................................................ ………………………………..74

xii



Theory .................................................................................................. 77

3.5.2. Case of Supervisor M and Therapist K ........................................................ 80

3.5.2.1. Characteristics of Supervisor M ................................................................ 80

3.5.2.2. Characteristics of Therapist K ................................................................... 83

3.5.2.3. Therapeutic Alliance between Supervisor M and Therapist K with .......

the Associations of Schema Theory ..................................................... 86

3.5.2.4. Therapeutic Alliance between Supervisor M and Therapist K ................


Schema Theory ..................................................................................... 87



Theory .................................................................................................. 92

3.6. General Discussions .................................................................................... 97

3.6.1. Contributions of the Study ....................................................................... 97

3.6.2. General Discussion for the Results .......................................................... 98

3.6.2.1. Rationale of Using YSQ with its 18 Schemas ................................... 100

3.6.3. Limitations of the Study and Future Directions .................................... 102

REFERENCES ..................................................................................................... 103

APPENDICES ...................................................................................................... 118

Appendix A: Informed Consent ........................................................................... 118

Appendix B: Demographic Information Form ..................................................... 119

Appendix C: Young Schema Questionnaire ........................................................ 119

Appendix D: Young Parenting Inventory ............................................................ 126

Appendix E: Young Rygh Avoidance Inventory ................................................. 130

Appendix F: Young Compensation Inventory ..................................................... 133

xiii

Appendix G: Working Alliance Inventory-Therapist and Client Forms ...................

(Therapist Form)………………………………………………………………...136

Appendix H: Working Alliance Inventory-Therapist and Client Forms.............. 139

(Client Form) ........................................................................................................ 139

Appendix I: Working Alliance Inventory-Supervisor and Therapist Forms........ 142

(Supervisor Form) ................................................................................................ 142

Appendix J: Working Alliance Inventory-Supervisor and Therapist Forms ....... 144

(Therapist Form) .................................................................................................. 144

Appendix K: Open-Ended Question Form ........................................................... 145

Appendix L: Relational Circles ............................................................................ 146

Appendix M: Tez Fotokopisi İzin Formu ............................................................ 149

CURRICULUM VITAE ...................................................................................... 151

TURKISH SUMMARY ....................................................................................... 153

xiv

LIST OF TABLES

TABLES

Table 1.Descriptive Information of the Measures for Supervisors ........................ 34

Table 2.Descriptive Information of the Measures for Therapists .......................... 38

Table 3.Descriptive Information of the Measures for Clients ................................ 41

Table 4.General Therapeutic Alliance Scores of Supervisors, Therapists, and

Clients ............................................................................................................. 42

Table 5.Pearson correlations between young schemas, young coping ......................

mechanisms, young parenting styles, and therapeutic alliance variables .. ……

of supervisors with therapis……………………………………………….....46


mechanisms, young parenting styles, and therapeutic alliance of .....................

. therapists with their supervisors.....................................................................49


mechanisms, young parenting styles, and therapeutic alliance variables ..........

of therapists with their clients..........................................................................51


mechanisms, young parenting styles, and therapeutic alliance variables for

clients’ perception of therapeutic alliance with their therapists ...................... 53

Table 9.Early Maladaptive Schemas for Supervisor A .......................................... 55

Table 10.Types of Overcompensation of Schemas for Supervisor A .................... 56

Table 11. Types of Avoidance for Supervisor A .................................................... 56

Table 12.Characteristics of Mother of Supervisor A ............................................. 57

Table 13.Young Fatherhood Styles for Supervisor A ............................................ 57

Table 14.Early Maladaptive Schemas for Therapist B ........................................... 58

Table 15.Types of Overcompensation of Schemas for Therapist B ....................... 59

Table 16.Types of Avoidance for Therapist B ....................................................... 59

Table 17.Characteristics of Mother of Therapist B ................................................ 60

Table 18.Characteristics of Father of Therapist B ................................................. 60

xv

Table 19. Early Maladaptive Schemas for Client C ............................................... 61

Table 20.Types of Overcompensation of Schemas for Client C ............................ 62

Table 21.Types of Avoidance for Client C ............................................................ 62

Table 22.Characteristics of Mother of Client C ..................................................... 63

Table 23.Characteristics of Father of Client C ....................................................... 63

Table 24.General Therapeutic Alliance between Supervisor A and Therapist B .. 66

Table 25.Goal Oriented Therapeutic Alliance between Supervisor A and ...............

Therapist B…………………………………………………………………...67

Table 26.Task Oriented Therapeutic Alliance between Supervisor A and ...............

Therapist B…………………………………………………………………...67

Table 27.Emotional-Bond Oriented Therapeutic Alliance between Supervisor A

and Therapist B ............................................................................................... 68

Table 28. General Therapeutic Alliance between Therapist B and Client C ......... 75

Table 29. Goal Oriented Therapeutic Alliance between Therapist B and ................

Client C………………………………………………………………………76

Table 30. Task Oriented Therapeutic Alliance between Therapist B and ................

Client C………………………………………………………………………76

Table 31. Emotional-bond Oriented Therapeutic Alliance between Therapist B .....

and Client C……………………………………………………………….....77

Table 32. Early Maladaptive Schemas for Supervisor M ...................................... 81

Table 33. Types of Overcompensation of Schemas for Supervisor M .................. 81

Table 34.Types of Avoidance for Supervisor M .................................................... 82

Table 35.Characteristics of Mother of Supervisor M ............................................. 82

Table 36. Characteristics of Father of Supervisor M ............................................. 83

Table 37.Early Maladaptive Schemas of Therapist K............................................ 84

Table 38.Types of Overcompensation of Schemas for Therapist K ...................... 84

Table 39.Types of Avoidance for Therapist K ....................................................... 85

Table 40. Characteristics of Mother of Therapist K............................................... 85

Table 41.Characteristics of Father of Therapist K ................................................. 86

Table 42.General Therapeutic Alliance between Supervisor M and Therapist K . 90

Table 43.Goal Oriented Therapeutic Alliance between Supervisor M and ..............

Therapist K…………………………………………………………………..91

xvi

Table 44.Task Oriented Therapeutic Alliance between Supervisor M and ..............

Therapist K…………………………………………………………………..91

Table 45.Emotional Bond Oriented Therapeutic Alliance between ..........................

Supervisor M and Therapist K………………………………………………92

xvii

LIST OF FIGURES

FIGURES

Figure 1. Early Maladaptive Schemas and Schema Domains…………………….14

Figure 2. Projective measurement of therapeutic alliance for Supervisor A

and Therapist B…………………………………………………………………72

Figure 3. Open-ended questions and answers for Supervisor A………………….73

Figure 4. Open-ended questions and answers for Therapist B…………...………73

Figure 5. Projective measurements of therapeutic alliance for Therapist B

andClient C ………………………………………………………………79

Figure 6. Projective measurement of therapeutic alliance for Supervisor M…….96

Figure 7. Open-ended Questions and Answers for Supervisor M………………..96

Figure 8. Open-ended Questions and Answers for Therapist K……………….....96

1

CHAPTER

1. INTRODUCTION

1.1. Therapeutic Relationship

Although psychological approaches, methods, and psychological

symptoms were kept constant during psychotherapy researches, the outcome of

psychotherapy did not indicate similarity perpetually. In the literature, there were

different explanations for this situation. Different approaches used in

psychotherapy, training experiences of therapists, type of psychopathology of the

clients, frequency of sessions, and client’s level of motivation were some of the

factors affecting the outcomes (Crits-Christoph et al., 1991; McCarthy & Frieze,

1999; McCoy Lynch, 2012). Besides, one remarkable factor affecting outcomes,

mostly emphasized by researchers, was undoubtedly therapeutic relationship. In

the literature, in spite of the debate on whether it had direct or indirect effect, there

was a striking agreement that client-therapist relationship had an important healing

effect on treatment (Elvins & Green, 2008; Gelso & Carter, 1985; Gelso & Carter,

1994; Horvath, Del Re, Flückiger, & Symonds, 2011; Huppert et al., 2014; Priebe

& McCabe, 2006). Especially, being aware of experienced difficulties between

therapist and client and trying to overcome these difficulties in order to maintain a

good therapeutic alliance made vital contribution to change of the client in

psychotherapy process (Safran, 1993). However, although many researchers

accepted the importance of therapeutic alliance for outcome of psychotherapy,

operational definition of this concept and measurement method of it was still

controversial. Additionally, in order to analyze, measure, and control therapeutic

alliance, researchers from different approaches go on to debate on factors affecting

therapeutic alliance.

Thus, in this dissertation, firstly, therapeutic relationship as a concept and

assessment of therapeutic relationship will be explained. Secondly, the factors

2

affecting therapeutic relationship will be explained in the relation with schema

theory.

1.1.1. Historical Context of Therapeutic Relationship and

Conceptualizations

As historical context, first theoretical studies belonged to psychodynamic

approach. Freud (1912/1966) had initial attempts to draw attention to importance

of relationship. Freud (1913), in his writings, focused on patient’s affections and

attachment to his/her doctor and put forward the concepts of transference and

countertransference. He associated client’s affections for the therapist with parent

relationship. After attempts of Freud, some psychoanalysts pointed therapeutic

alliance in order to solve inner difficulties experienced in psychotherapy. In 1934,

Sterba first used the concept of ego alliance in order to define split in the ego in

terms of observing and experiencing. This splitting in ego was related with both

mature ego of client and working style of therapist. Moreover, following Freud,

Zetzel (1956) put forward the concept of “therapeutic alliance” and explained this

concept as attachment of client with the therapist. She associated therapeutic

alliance with reemerging mother-child relationship. Furthermore, inspired by

Sterba (1934) and Zetzel (1956), Greenson (1965) started to use the concept of

working alliance as the same meaning of therapeutic alliance. He interpreted

alliance as patient’s ability to work according to the purposes of intervention

during therapy process. According to Greenson (1965), alliance included both

affections of client towards therapist and capacity of client to work in therapy

process.

In addition to client’s contribution to therapeutic alliance, Freud

(1912/1913) also pointed that therapist also had a major contribution to therapeutic

alliance in his writings. However, Rogers (1957) just focused on client-centered

alliance. Rogers (1957) and Barrett-Lennard (1962, 1978, 1986) claimed that

empathy and unconditional positive regard of therapist had crucial healing effect

on clients; nevertheless, therapist did not have a major contribution by himself.

Besides, Anderson and Anderson in 1962 put forward an operational definition in

3

order to express empathy and rapport in a one concept; namely, therapeutic bond.

With this conceptualization, Orlinsky and Howard (1975) started to test this

concept in their empirical studies. They found that credibility of therapists in

treatment process was associated with therapeutic outcome. They suggested three

dimensions of alliance “working alliance (investment of both client and therapist

in the process of therapy), empathic resonance, and mutual affirmation

(conceptually close to the Rogerian concept of unconditional positive regard) (as

cited in Elvins and Green in 2008)”. Additionally, inspired by this tripartite model,

Bordin (1979) started to test goal, task, and bond oriented therapeutic relationship

for different therapeutic approaches. Despite researches claiming positive affect of

therapeutic relationship on therapeutic outcome, Brenner (1979) claimed that

alliance was unnecessary and unreliable. According to Brenner, the relationship

between client and therapist was related to transference and transference was

something that must be resolved by dealing with resistance. Similarly, Curtis

(1979) also considered the concept of alliance as something dangerous since

alliance distracted focus of psychoanalysis from unconscious world of client.

After all these debates in literature, many researches were conducted in

order to find empirical evidence for healing effect of therapeutic alliance

(Luborsky, Singer & Luborsky, 1975; Smith & Gloss, 1977) and variability in

definitions started to emerge (Luborsky, 1976; Bordin, 1976, 1980, 1994).

Luborsky (1976) and Zetzel (1956) described the alliance as the patient’s bond

with the therapist and the therapist’s helpfulness as perceived by the patient.

However, Frieswyk et al. (1986) defined the alliance as the patient’s “active

collaboration in treatment tasks” (as cited in Baillargeon, Cote, & Douville, 2012).

Moreover, Frank and Frank (1991) handled the concept of working alliance as

therapeutic alliance, which included “active common factors” such as accurate

empathy, and task understanding. On the other hand, in the study of Hougaard

(1994), therapeutic alliance was divided into two as “personal alliance” meaning

interpersonal relationship between client and therapist and the “task related

alliance” meaning aspects of treatment plan and goal orientation. Hayes (1998)

stated that there were many concepts to describe alliance such as therapeutic

alliance, working relationship, and helping alliance. In the literature, many

4

operational definitions were created for therapeutic relationship. Whereas some of

had similar meaning, some had different meaning. Nevertheless, in order to seek

therapeutic relationship, the concept of working alliance, put forward by Bordin

(1979), became the mostly used one by the researchers in the literature (Gelso &

Carter, 1985; Greenson, 1967; Horvath & Greenberg, 1989; Patton, 1984).

According to Bordin (1979), “the relationship between client and therapist based

on here and now which was common to all forms of psychotherapeutic treatment

regardless of treatment orientation or approach”. Moreover, therapeutic alliance

depended on shared participation of both client and therapist included three

dimensions in terms of task, goal, and bond. Task oriented alliance consisted of

agreed upon tasks between therapist and client in order to reach aims of the

therapy process. On the other hand, goals represented agreed upon purposes in

therapy between therapist and client so that client could gain expected outcomes

from the therapy. Furthermore, bond included a positive relationship consisting of

intimacy and trust between therapy and client, which was facilitative for doing

tasks and reaching aims in therapy process. In the present study, working alliance

concept of Bordin (1979) will be used in order to measure and analyze therapeutic

relationship.

1.1.2. Measurement of Therapeutic Relationship

Considering all these concepts, different measurement instruments were

developed in the literature and their validity were tested by different studies.

Nevertheless, since there was no consensus on definition of therapeutic alliance,

there were many scales in the literature (Elvins & Green, 2008). Elvins and Green

(2008) gathered all these concepts and different measures in their empirical review

as mentioned below. As an initial attempt, Barrett-Lennard (1962) developed

Barrett-Lennard’s Relationship Inventory in order to measure level of empathic

understanding and regard of therapist (Rogerian dimension) from the view of

patients and it was originally developed for a doctorate program and Wisconsin

Psychotherapy Project with schizophrenic patients. On the other hand, Linden,

Stone and Shertzer (1965) developed Counseling Evaluation Inventory (CEI) for

5

adults in order to measure bond oriented therapeutic alliance (based on Anderson

and Anderson’s (1962) therapeutic alliance concept). Moreover, Orlinsky and

Howard (1966) to evaluate working alliance (contribution of both client and

therapist), empathic resonance, and mutual affirmation (depending on Rogerian

concept of unconditional positive regard) developed Therapy Session Report

Scales. Adding to these scales, The Counselor Rating Form (1975), originated

from Strong’s conceptualization of counseling relationship and Bordin’s concept

of bond implicitly, was designed by Bachelor (1975) and used for clients with

anxiety and interpersonal problems. The Penn Alliance Scale (developed by

Luborsky in 1976) was another scale created to test helping alliance from the view

of client. Furthermore, Gomes-Schwartz (1978) developed Vanderbilt Scales by

combining dynamic and integrative conceptualizations of alliance. Toronto Scales,

which were developed by Marziali, Marmar, and Krupnick in 1981 was used to

measure affective sides of alliance. On the other hand, Menninger Alliance Rating

Scale/Collaboration Scale was designed by Allen, Newsom, Gabbard, and Coyne

(1984) to measure collaboration of patients. Furthermore, Psychotherapy Status

Report (Svensson & Hansson, 1985) was used especially for schizophrenic

patients. Moreover, California Scales (Marmar et al., 1989) and Therapeutic Bond

Scales (Saunders et al., 1989) were used to test alliance from psychodynamic point

of view in adult group. Besides, Working Alliance Inventory (WAI) was

developed to analyze Bordin’s alliance dimensions (i.e., goal, task, and bond) in

adult group. A couple version for this scale was designed by Symonds and

Horvath in 2004. Moreover, Child Psychotherapy Process Measures (Smith-

Acuna, Durlak, & Kaspar, 1991) were devised by adapting Orlinsky and Howard’s

(1975) adult self-report measures. Child’s Perception of Therapeutic Relationship

was developed by Kendall (1991) by inspiring from bond-oriented alliance of

Bordin. Similarly, Shirk and Saiz (1992) developed Therapeutic Alliance Scales

for Children by focusing on Bordin’s bond concept. Sarlin (1992) also designed

Treatment Alliance Scales in order to measure alliance between families of

children with asthma and their physician. Adapted Psychotherapy Process

Inventory (developed by Gorin in 1993) was used to measure therapy process for

children rather than alliance. Additionally, Adolescent Working Alliance

6

Inventory was devised by Di Giuseppe et al. in 1993 (improved by Florsheim et

al., in 2000) in order to obtain patient report for adolescents between 11 to 18

years. Helping Alliance Scale (Priebe & Gruyters, 1993) was another self-report

scale that was used for evaluating patient’s view of case manager’s understanding,

involvement, and patients’ feeling after session. Empathy and Understanding

Questionnaire (Green et al., 1996) and Family Engagement Questionnaire (Kroll &

Green, 1997) were inspired from concepts of Frank, Bordin, and Hougaard. The

former was used for outpatient treatment process while the latter was devised for

child psychiatry inpatients. On the other hand, Barriers to Treatment Participation

Scale (Kazdin et al., 1997) had six item subscale which analysed parent’s alliance

and bonding with therapist although the scale was not a strict alliance measure.

Therapist Alliance Focus Scale was designed by Molinaro (1997) to determine

time (for discussing alliance) spent by therapist. Furthermore, Johnson et al.

(1998) developed Adolescent Therapeutic Alliance Scale to examine working

relationship between therapist and adolescent. Agnew Relationship Measure was

designed by Agnew, Davies, Stiles, Hardy, Barkam, and Shapiro (1998) in order to

use for Sheffield psychotherapy project for comparing CBT and psychodynamic

therapy for depression. Moreover, Child Psychotherapy Process Scales were

devised by Estrada and Russell (1999) for examining task and goal oriented

alliance in child psychodynamic therapies. Besides, Family Therapy Alliance

Scale was developed by Pinsof (1999) in order to determine client’s perception in

family therapy process. Johnson (2000) designed Early Adolescent Therapeutic

Alliance Scale for early adolescent clients with drug misuse. Kim Alliance Scale

(Kim et al., 2001) was developed in order to analyze quality of therapeutic

relationship since Kim et al. believed that patients should have responsibility for

their own benefits. On the other hand, System for Observing Family Therapy

Alliance (Friedlander et al., 2001) was developed to conceptualize Bordin’s

alliance model with qualitative research in family therapy. McLeod and Weisz

(2005), to assess child-therapist and parent-therapist alliance as defined by Shirk

and Saiz in 1992, developed the Therapy Process Observational Coding System-

Alliance Scale. Additionally, McGuire-Snieckus, McCabe, Catty, Hanson, and

Priebe (2007) developed Scale to Assess Therapeutic Relationship in order to

7

examine task and goal oriented alliance from the viewpoints of patient and

clinician.

According to review of Elvins and Green (2008), the most common used

raters of alliance measures were the patients. Patients were the best predictor for

the outcome of alliance for adult group whereas therapists were the best predictor

for child psychotherapy (Horvath & Symonds, 1991). All of the scales mentioned

above were used in some studies; however, most of them did not have enough

sample size to be able to reach robust outcome. From these scales, Working

Alliance Inventory, Vanderbilt Therapeutic Alliance Scales, and California

Psychotherapy Alliance Scales indicated most empirical support for adult

literature. On the other hand, modified Vanderbilt Therapeutic Alliance Scales,

Working Alliance Inventory, and Penn Scales became the mostly used ones for

younger people. Due to its psychometric properties, in the present study, Working

Alliance Inventory will be used as a quantitative measure.

After the process of conceptualization of alliance concept, follower of these

researchers developed different scales in order to measure these concepts as listed

above. Nevertheless, to measure an abstract concept in a relational setting was not

an easy task. Therefore, these scales had some limitations and shortcomings to be

able to measure working alliance exactly. Firstly, since there was not agreement on

operational definition of therapeutic alliance, too many scales were designed by

researchers (Elvins & Green, 2008). Thus, there was not a representative scale for

alliance literature and this caused scale focused research results. Secondly,

according to Green et al. (2001), the inventories were inadequate to measure the

alliance when the patient was too young. The younger the patient was, the more

difficult to comprehend of therapeutic experiences. Creed and Kendall (2005) also

expressed that these scales could have limitations to measure perception of alliance

for adolescents and children due to their developmental constraints. In their

studies, they noticed that the alliance measuring of young patients indicated their

relationship with their parents rather than therapeutic relationship. Thirdly,

according to Braswell, Kendall, Braith, Carey, and Vye (1985), measurement of

therapeutic alliance after different sessions caused session based evaluations.

Moreover, in the study of Elvins and Green (2008), it was claimed that therapeutic

8

relationship originated from early attachment style of the patient by considering

Bowlby’s attachment theory (1988). Therefore, they expressed that an inventory

performing accurate measurement should have the competency to measure

complex structure of working alliance associated with attachment pattern.

Furthermore, Kazdin and Nock (2003) expressed that there were common method

confounds for measurement of therapeutic alliance. As Eugster and Wampold

(1996) asserted, four variables (i.e., patient involvement, patient comfort, patient

progress, and patient real relationship) were found associated with patient’s

alliance evaluation in the literature. Therefore, these scales could not have

measured real alliance in therapeutic relationship. Additionally, pre-treatment

factors (such as social functioning of patient) or early alliance (before session five)

could predict measurement of alliance (Elvins & Green, 2008). Besides, a

difficulty in measurement of alliance arised from difficulty in discrimination of

therapist effect from patient effect (Castonguay, Constantino, & Grosse Holforth,

2006). In order to solve this difficulty, observer was used in alliance studies.

However, observer evaluation could be misleading since observers could not

perceive directly motivational and attitude related therapeutic alliance (Elvins &

Green, 2008). Apart from these limitations, one other limitation was that outcome

of the working alliance measurements could change with regard to at what stage

the measurement was made since alliance had unstable and developing structure

(Elvins & Green, 2008). Furthermore, since prior expectations of the sessions

(Constantine, Arnow, Blosey, & Agras, 2005) and how the patient perceived real

relationship (Eugster & Wampold, 1996) could affect perception of the alliance, so

these inventories could not measure the real alliance. Finally, Migone (1996)

claimed that since therapists, clients, and observers could interpret each case

differently, the results of the researches of therapeutic alliance could be specific to

the case, and generalization could not be possible. Based on these limitations,

qualitative, experimental measurement, and analytic techniques were suggested by

Elvins and Green (2003) for future directions.

Thus, considering all these limitations, a new measurement method was

suggested in the present study. This measurement was based on qualitative and

intrinsic method. Instead of using self-report questionnaire, a projective test, which

9

depended on Object Relations Theory, was suggested since there were many

advantages of using object relations in the assessment. Firstly, according to Kelly

(1997), object representation information could provide more interpersonal

knowledge related to attachment and family bonds. Moreover, object relations

could facilitate to understand the client’s contribution to the working alliance as

well as attachment theory. According to Klein (1932), it was assumed that early

relationships were internalized and became intra-psychic schemas, which provided

to feel connectedness to others. The term object representation referred to this

inner domain of schemas that provided to increase awareness and to serve as a

map to define self and others (Kelly, 1997). Based on this knowledge, in the

present research, it was assumed that supervisors, therapists, and clients had

representations of each other in their minds. It was proposed that if working

alliance was measured based on symbols and representations, therapeutic alliance

of which roots originated from early family bonds could be measured more

accurately. Moreover, early relationship cycle with parents and transferences could

be obtained from the implicit memory by symbols. However, there were also some

studies (Bell, Billington, & Becker, 1986; Stricker & Healy, 1990) drawing

attention to complex evaluation format of the measure of object relations.

Considering advantages of object relations, in order to indicate object

representations of the participants, three different circles representing supervisor,

therapist, and the client will be used in the current study. In order to deal with this

complex evaluation format (asserted by Bell, Billington, & Becker, 1986; Stricker

& Healy, 1990), single case measurement and evaluation will be conducted.

Similar representing symbols were also used in the book of Supervising

Psychotherapy (Driver, Martin, Banks, Mander, & Stewart, 2002). Driver et al.

(2002) used three triangles in order to exemplify the concept of psychic

apparatuses of Freud (i.e., id, ego, and superego) for supervisor, therapist, and the

client, and in order to indicate how these three psychic apparatuses could overlap

during the supervision period. Based on these symbols, three circles will be

proposed in order to represent supervisor, therapist, and the client in this study (as

shown in Appendix L).

10

1.2. The Place of Therapeutic Relationship in Different Psychotherapy

Approaches and the Factors Affecting Therapeutic Relationship in

Psychotherapy Process

According to classical psychoanalytic theory, as mentioned before,

therapeutic relationship was vital component of treatment (Freud, 1913). In order

to indicate relationship between therapist and patient, Freud (1913) used the

concepts of transference and countertransference. While transference was defined

as unconscious redirection of feelings of the client to the therapist,

countertransference was defined as the reflection of unconscious feelings of

therapist towards the client. With the appearance of countertransference, a client

represented an object, which was projected by therapist’s own feelings and wishes.

This projection created an inhibitory affect for clear perception of the therapist;

thus, the therapist probably could start to maintain his/her past relationship cycle

with the client unintentionally. Therefore, countertransference was accepted as a

threat in the therapeutic process in early formulations (Freud, 1912; Jung, 1976;

Berne, 1975). Similarly, transference was also accepted as an obstacle for

treatment by Freud (1912) since transference of the client caused different

emotions such as anger, mistrust, rage, love, and extreme dependency. On the

other hand, according to Greenson (1967), psychoanalysis deliberately triggered

transference in order to create a relationship cycle with therapist, which the client

usually used with others in real life. Therefore, transference was a necessary

psychotherapy technique in treatment process.

As for object relations theory, Melanie Klein (Hinshelwood, Robinson &

Zarate, 2006) and Hanna Segal (Bell, 1997) highlighted that countertransference of

the therapist did not belong only to therapeutic relationship but also it was an

extension and production of the client. Considering these approaches,

countertransference was accepted as a vital part of therapeutic tool (Bell, 1997;

Hishelwood, Robinson, & Zarate, 2006). Object relations theory considered

therapy relationship as the reflection of client’s mother-child relationship.

Accordingly, therapist’s projected emotions were considered as important tool in

11

psychotherapy and they were used to understand the relationship cycle of the client

in real life experiences.

Furthermore, the effects of transference and countertransference on

therapeutic relationship were examined by recent psychodynamic oriented studies.

Mayers and Hayes (2006) who handled countertransference as self-disclosure in

their research claimed that the client evaluated self-disclosure of the therapist as

something requiring expertise when working alliance was accepted as positive

between therapist and the client. Moreover, in the study of Rosenberger and Hayes

(2002), it was claimed that if therapist was aware of countertransference and used

countertransference as an effective tool in therapy, this strengthened working

alliance. Similarly, according to Gelso and Carter (1994), positive transference

fostered the working alliance while negative one could weaken the alliance.

Additionally, working alliance also affected from transference since therapeutic

alliance was facilitative to increase awareness of the client for probable

transference. On the other hand, positive working alliance facilitated self-

disclosure of the client for negative transference. Besides, countertransference of

the therapist could strengthen working alliance if therapist observed his/her

attitudes towards the client (Gelso & Carter, 1994). One another study (Marmarosh

et al., 2009) asserted that the when the more real relationship elements were

ignored by the therapist, s/he rated the more negative transference.

According to interpersonal theory formulated by Sullivan (1953) and his

followers (Carson, 1969; Kiesler, 1988/1996; Leary, 1957), therapist should

behave surrender with affections and attitudes of client. Then, s/he should notice

the pattern by behaving out of expectants of client. Thus, therapist has

demonstrated alternative reactions in relational cycle of the client in corrective

emotional experience.

Additionally, in relational theory (Aron, 1996; Levenson, 1995; Mitchell,

1988, 1993; Safran & Muran, 2000; Wachtel, 2008 as cited in Hill & Knox, 2009)

therapy process endured a dual relationship. According to this theory, this dual

relationship could change due to different relationship pattern between therapist

and client. Treatment and improvement depended on dealing with problems in

therapeutic relationship. Safran and Muran (2000) expressed that treatment was

12

related to discuss on what was going on between therapist and client and analyzing

here-and-now oriented relationship.

On the other hand, according to humanistic/experiential theory (Elliott,

Watson, Goldman, & Greenberg, 2004; Greenberg, Rice, & Elliott, 1993),

therapeutic relationship was an important component of treatment process.

According to Elliott et al. (2004), there were six signals indicating problem in

therapeutic alliance. The first one was client’s rejecting activities suggested by

therapist. The second one was disruption in trust and collaboration in

psychotherapy process due to the attitudes in order not to lose control and power.

Thirdly, when client thought that s/he was not taken care or liked by therapist.

Fourthly, when the client withdrew from therapy latently and started to question

intentions of therapist. Fifthly, when client did not want to get responsibility of

therapeutic process since s/he thought that this process had an end. The sixth one

was therapist’s incompetency to control his/her own negative reactions resulted

from withdrawal of the client and behaving without acceptance.

Moreover, in cognitive theory (Beck, Rush, Shaw, & Emery, 1979), it was

expressed that if there were a problem in therapy relationship, this would be

handled directly by making associations with cognitive distortions of the client.

Apart from all these theories, Schema Theory (Young, 1996) originated

from psychodynamic approach, Bowlby’s attachment theory, Ryle’s cognitive-

analytic therapy, Horowitz’s person schemas therapy, and emotionally-focused

therapy emphasized the therapy relationship as a vital component of schema

assessment and change. Schema Theory (Young, Klosko, & Weishaar, 2003)

considered the therapist’s own schemas and coping styles as negative for treatment

process if therapist was not aware of them. For example, a therapist who was

unaware of his/her maladaptive schemas could trigger dysfunctional parent mode

of the client. Thus, this triggering effect could strengthen maladaptive pattern

instead of breaking it. Besides, if therapist was aware of his/her schemas triggered

in therapy process, therapy relationship could be used as therapy tool in an

adaptive way in the process of empathic confrontation and limited parenting.

Therefore, in the current study, schema theory will be examined in order to make

13

associations with working alliance and determining factors affecting working

alliance.

1.2.1. Schema Theory

1.2.1.1. Early Maladaptive Schemas, Schema Domains and Family

Origins

In Schema Theory, in order to define thoughts, beliefs and rules arising

from childhood, the concept of early maladaptive schemas (EMS) was used. It was

defined as “stable and enduring themes that develop during childhood are

elaborated throughout an individual’s lifetime” (Young, 1999, p.9). EMS

originated from traumatic childhood experiences and began to emerge in early

stage of life (Young, 1999). According to Young (1999), family represented whole

world of a child. Therefore, with early experiences of children, children started to

develop rules in order to deal with problems in life. They developed a pattern of

behavior by monitoring reactions of their parents. Nevertheless, when they became

adult, they continued childhood pattern of behaviors especially in relationship

which activating their early maladaptive schemas. The dramatic situation was that

this pattern of behavior could have emerged in order to cope with unhealthy

parenthood in their family. With the effect of this, they evaluated world as if it was

same as early experiences. Unintentionally, they maintained to keep alive their

maladaptive schemas. Based on these characteristics of EMS, Young (1999)

pointed out that these schemas had deep roots embedded in the past; identifying

them were often difficult since they were blocked, and they were mostly related to

personality disorders including difficulty in interpersonal relationships.

According to Young et al. (2003), there were eighteen schemas under five

schema domains (as shown in Figure 1). First domain (Young et al., 2003, p.14-

17) was “disconnection & rejection” including expectation of one’s needs for

security, safety, stability, nurturance, empathy, sharing of feelings, acceptance, and

respect. However, these needs were not met in a predictable manner. A typical

family triggering this domain had “detached, cold, rejecting, withholding, lonely,

14

explosive, unpredictable, or abusive” characteristics. This domain included

schemas of abandonment/instability based on “perceived instability or unreliability

of those available for support and connection”; mistrust/abuse depending on

“expectation that others would hurt, abuse, humiliate, cheat, lie, manipulate, or

take advantage”; emotional deprivation related to “expectation that one's desire for

a normal degree of emotional support would not be adequately met by others”;

defectiveness /shame based on “the feeling that one is defective, bad, unwanted,

inferior, or invalid in important respects; or that one would be unlovable to

significant others if exposed”; and social isolation /alienation related to “the

feeling that one was isolated from the rest of the world, different from other

people, and/or not part of any group or community”.

Figure 1. Early Maladaptive Schemas and Schema Domains (Young et al., 2003)

The second domain was “impaired autonomy and performance” (Young et

al., 2003, p.14-17). This domain included “expectations about oneself and the

DISCONNECTION

& REJECTION

1. Abandonment/ Instability 2. Mistrust/ Abuse 3. Emotional Deprivation 4. Defectiveness/ Shame 5. Social Isolation/ Alienation

OVERVILIGANCE

&

INHIBITION

15. Negativity/ Pessimism 16. Emotional Inhibition 17. Unrelenting Standards / Hypercriticalness 18. Punitiveness

OTHER -

DIRECTEDNESS

12. Subjugation 13. Self- Sacrifice 14. Approval- Seeking / Recognition- Seeking

IMPAIRED

LIMITS

10. Entitlement/ Grandiosity 11. Insufficient Self Control/ Self Discipline

IMPAIRED

AUTONOMY &

PERFORMANCE

6. Dependence/ Incompetence 7. Vulnerability to Harm or Illness 8. Enmeshment/ Undeveloped Self 9. Failure

Early

Maladaptive

Schemas

)

15

environment that interfere with one's perceived ability to separate, survive,

function independently, or perform successfully”. This domain originated from a

family that was “enmeshed, undermining of child's confidence, overprotective, or

failing to reinforce child for performing competently outside the family”. Impaired

autonomy and performance domain involved the schemas of

dependence/incompetence based on “the belief that one was unable to handle one's

everyday responsibilities in a competent manner, without considerable help from

others”; vulnerability to harm or illness including “exaggerated fear that imminent

catastrophe would strike at any time and that one would be unable to prevent it”;

enmeshment/undeveloped self depending on “excessive emotional involvement and

closeness with one or more significant others (often parents), at the expense of full

individuation or normal social development”; failure based on the belief that “one

had failed, would inevitably fail, or was fundamentally inadequate relative to one's

peers, in areas of achievement”.

“Impaired limits” was the third domain of Young (Young et al., 2003,

p.14-17). It was depended on “deficiency in internal limits, responsibility to others,

or long-term goal-orientation”. It was originated from a family having

characteristics of “permissiveness, overindulgence, lack of direction, or a sense of

superiority -- rather than appropriate confrontation, discipline and limits in relation

to taking responsibility, cooperating in a reciprocal manner, and setting goals”.

Schemas of entitlement/grandiosity were based upon “the belief that one was

superior to other people; entitled to special rights and privileges; or not bounded

by the rules of reciprocity that guided normal social interaction”; and insufficient

self-control /self-discipline indicating “pervasive difficulty or refusal to exercise

sufficient self-control and frustration tolerance to achieve one's personal goals, or

to restrain the excessive expression of one's emotions and impulses” took part

under the domain of impaired limits.

Other-directedness was the fourth domain of Young (Young et al., 2003,

p.14-17). This domain was based on “an excessive focus on the desires, feelings,

and responses of others, at the expense of one's own needs -- in order to gain love

and approval, maintain one's sense of connection, or avoid retaliation”. Roots of

this domain arised from “conditional acceptance: children must suppress important

16

aspects of themselves in order to gain love, attention, and approval. In many such

families, the parents' emotional needs and desires -- or social acceptance and status

-- were valued more than the unique needs and feelings of each child”. Domain of

other-directedness involved the schemas of subjugation based on “excessive

surrendering of control to others because one felt coerced - - usually to avoid

anger, retaliation, or abandonment”; self-sacrifice related to “excessive focus on

voluntarily meeting the needs of others in daily situations, at the expense of one's

own gratification”; and approval-seeking/recognition-seeking based on “excessive

emphasis on gaining approval, recognition or attention from other people or fitting

in, at the expense of developing a secure and true sense of self”.

The final domain is “overvigilance and inhibition” (Young et al., 2003,

p.14-17). It was based on “excessive emphasis on suppressing one's spontaneous

feelings, impulses, and choices or on meeting rigid, internalized rules and

expectations about performance and ethical behavior -- often at the expense of

happiness, self-expression, relaxation, close relationships, or health”. This domain

mainly was originated from the family that was “grim, demanding, and sometimes

punitive: performance, duty, perfectionism, following rules, hiding emotions, and

avoiding mistakes predominates over pleasure, joy, and relaxation”. Overvigilance

and inhibition domain consisted of the schemas of negativity /pessimism

depending on “a pervasive, lifelong focus on the negative aspects of life while

minimizing or neglecting the positive or optimistic aspects”; emotional inhibition

including “excessive inhibition of spontaneous action, feeling, or communication -

- usually to avoid disapproval by others, feelings of shame, or losing control of

one's impulses”; unrelenting standards/hypercriticalness based on “the underlying

belief that one must strive to meet very highly internalized standards of behavior

and performance, usually to avoid criticism”; and punitiveness including “the

belief that people should be harshly punished for making mistakes”.

1.2.1.2. Coping with Early Maladaptive Schemas

In order to deal with the problems and negative life events, a child

developed some rules/schemas (EMS) in order to fight and survive. However,

17

although EMS could be functional in early life, maintenance of these schemas in

later life became dysfunctional because the perception of the world was not the

same as the one during childhood period (Young et al, 2003). While all these

schemas arised during childhood and seemed to be dominant in this period

(Stallard, 2007), prevalence of such schemas later in life brought about tackling

the problems in a maladaptive way. According to Young et al. (2003), there were

three maladaptive ways that people utilized to cope with their schemas. “Schema

surrender” was the first style in which people accepted their schemas as an

accurate rule in their life. They did not avoid or fight with it. Without being

unaware of what they did, they behaved according to their schemas based on

childhood experiences. For example, if a person had the abandonment/instability

schema (“The world is not stable, I can be abandoned”), s/he tended to choose a

partner who could not maintain a stable relationship. Thus, s/he maintained his/her

maladaptive schema. “Schema avoidance” was the second style of coping. In this

situation, people tended to avoid from their schemas, the life events, and thoughts

triggering their schemas. They suppressed their feelings and avoided facing with

their schemas. For example, a person with abandonment/instability schema did not

have tendency to build relationship in order not be abandoned (“There was no need

to be in relationship with someone since I was sure that I would certainly be

abandoned”). These people might tend to have drug abuse in order to suppress

painful feelings. Moreover, these people might try to avoid from their schemas by

psychosomatic symptoms, emotional control, numbness/suppressing emotions,

withdrawal from people, distraction through activity, and ignoring sadness or

disturbance. Finally, “schema overcompensation”, which was the third style of

coping, indicated that people fight with their schemas and tried to oppose them. In

practice, this style seemed more beneficial for the well-being of the individual than

other coping styles. However, during contemplating to fight against schemas, they

tended to pay a lot of attention to the existence of the schemas, which resulted in

prevalence. Therefore, overcompensation unintentionally made schemas

permanent in their life. For example, a person with abandonment/instability

schema tried not to miss any clues related to abandonment when s/he was in a

relationship with somebody. Whenever s/he felt that there was something negative

18

or blurry in this relationship, s/he thought that s/he could be abandoned. In order

not to be abandoned, s/he abandoned his/her partner. This overcompensation

seemed to help vulnerable child not to feel helplessness by trying to control the

events. Nevertheless, a person with too much focus on his/her schemas could miss

to see positive things around and exaggerate negative things. People

overcompensated their maladaptive schemas with status-seeking, controlling,

rebellion, counterdependency, manipulation, intolerance to criticism, and

egocentrism.

1.2.1.3. Schema Theory and Therapeutic Alliance

According to Young, therapeutic relationship was affected from schema

related patterns since a therapist could represent or symbolize a patient’s early

experiences or parent attitude. Therefore, a patient built a relationship with his/her

therapist in different formats depending on his/her schema patterns and coping

mechanisms. Firstly, a person yielding his/her maladaptive schemas might put

himself/herself into the child mode (under the effect of maladaptive schemas) and

perceive his/her therapist as undesirable parent mode (activating his/her

maladaptive schemas). This perception could cause prevalence of maladaptive

schemas in therapy settings. Secondly, a person utilizing schema avoidance in

order to cope with his/her schemas could avoid situation activating his/her

schemas, such as affiliation and challenges (Young, 1996). This kind of people

could forget to do homework, suppress their emotions, not deepen issues, delay the

sessions, or maybe drop out quickly in therapy settings. Finally, a person with

overcompensating his/her schemas could not take responsibilities for their

mistakes since they thought that they do whatever was required in order to fight

with his/her maladaptive schemas. When they experienced regression in their fight

against maladaptive schemas, they could experience big hopelessness and become

depressed. This pattern could be obstructive to reach goals of therapy.

Apart from clients’ schema patterns and coping mechanisms, therapists’

own schema patterns and coping mechanisms could affect therapeutic relationship

in different formats as well (Young et al., 2003). Firstly, the patient’s schemas

19

could collide with schemas of therapists. This meant that they maintained each

other’s schemas, this could be risky for therapy of which aim was to break schema

pattern of the client. Secondly, therapists’ schemas and coping mechanisms could

be incompatible with the needs of the therapists. This meant that therapist could

not provide reparenting for the client. Therapist could behave similar to client’s

parents triggering his/her schemas. Thirdly, therapists could have the same

schemas and coping mechanisms with the ones of clients. Thus, therapists might

evaluate therapeutic process subjectively. Fourthly, patients’ emotions could

induce avoidance mechanism of the therapists. In order not to exposure emotions

of the clients, therapists might withdraw themselves to behave what was required

or beneficial for the clients. The more therapists withdrew, the more clients

expressed emotions. This pattern maintained like that. Fifthly, the patients could

induce schemas of the therapists and therapists could cope with their schemas via

overcompensation. This meant that when the clients experienced emotions

depending on their schemas, therapists could try to eradicate these emotions by

overcompensation. However, the emotions experienced by clients were not real.

They were product of schema-oriented perception of the world. The treatment

should be focused on dysfunctional structure of the schemas rather than clearing

away schema-related emotions. Overcompensation of therapists could not

eradicate schemas; instead of this, this could perpetuate the schemas. Sixthly, the

behaviors of the clients could induce dysfunctional parent mode. This meant that

as Young stated (2003), “The patient behaved like a “bad child”, triggering a

disapproving parent mode in therapist. The therapist reprimanded the parent like a

scolding parent.” Furthermore, the clients could meet the unsatisfied schema-

oriented needs of the therapists. The therapists who were not aware their own

schemas could exploit their clients unintentionally in order to satisfy their

childhood needs. This could be risky for treatment of the client. Eighthly, the

clients with inadequate improvement in therapy process could induce schemas of

the therapists. Therapists especially having defectiveness, failure or

dependence/incompetence schemas could get angry with their clients when they

did not perceive a satisfied improvement in therapy process. Ninthly, crises of

clients could induce the schemas of the therapists. Therapists could lose ability to

20

deal with the problems in functional and positive ways. Finally, if therapists had

narcissistic tendencies, they could be jealous of their clients. In this situation,

therapist could not be empathetically and candidly. This client could drop out the

therapy. This kind of therapist needed to get supervision.

Since therapy relationship was utilized as one of the main treatment

strategies, understanding therapeutic relationship and the factors affecting

therapeutic relationship was vital for Schema Therapy. Establishing rapport,

formulating the case conceptualization, and assessing the client’s reparenting

needs were all associated with therapy relationship in ongoing therapy process.

Additionally, as an important part of this relationship, Schema Therapy (Young,

1996) emphasized that a schema therapist should have characteristics, which could

meet the clients’ needs of “secure attachment, autonomy, and competence, genuine

self-expression of needs and emotions, spontaneity and play, and realistic limits”.

These characteristics were important for client in order to learn internalization of

Healthy Adult Mode by modeling therapist.

1.3. Specific Aims of the Study

Although Clinical Psychology Literature expressed the importance of

therapeutic relationship for treatment process, there were limited studies in the

literature to indicate factors affecting this pattern. Therefore, based on all these

assumptions, this study has the following specific aims:

1) To examine whether Young schema domains, coping styles and parenting

styles of supervisors, therapists and clients affect therapeutic alliance

2) To make comparison among the descriptions of the therapeutic alliance

given by supervisor, therapist, and the client

3) To develop an intrinsic measurement method to assess therapeutic alliance

4) To study Turkish premodification of Working Alliance Supervisory

Inventory-Supervisor Version and Supervisory Working Alliance

Inventory-Trainee Version

5) To compare limitations and difference between qualitative and quantitative

measures of therapeutic alliance

21

2. METHOD

2.1. Participants

The participants were consisted of three groups. First group was composed

of eight supervisors who were studying in clinical psychology doctorate program

of Middle East Technical University. Senior instructors chose these supervisors

among the students who had provided at least 200 psychotherapy sessions under

supervision and had taken psychotherapy supervision class. The supervisors

supervised a group of therapist for the first time in their education process.

Therefore, their supervision process was also supervised by the senior instructors

once a month in the department. Moreover, they also joined peer supervision once

a month. Second group was composed of twelve therapists studying in clinical

psychology master program at Middle East Technical University. These students

were continuing second year of master’s program and had taken psychotherapy

courses in the first year of this program. Furthermore, therapists also took part in

psychotherapy process for the first time. They took supervision once a week from

their supervisors and they presented their cases in front of graduate students and

instructors of clinical psychology program once a month. Both supervisors and

therapists were evaluated by the senior instructors via these case presentations. All

these supervision and psychotherapy processes were provided in Ayna Clinical

Psychology Unit. “Ayna” is a clinical support unit, which was instituted for

internship of the students studying in clinical psychology in the Psychology

Department of Middle East Technical University. In this unit, students continuing

their master or doctorate education can provide psychotherapy under supervision.

Finally, the third group consisted of eight clients applied to Ayna with complaints

of depression, anxiety, close relationship problems, or personality disorders. These

clients were mostly students who were studying in different departments of Middle

East Technical University.

22

2.2. Measures

In the present study, two types of questionnaires were used. Firstly,

quantitative, structured inventories were used in order to examine demographic

information (Demographic Information Form), early maladaptive schemas (Young

Schema Questionnaire), parental origins of early maladaptive schemas (Young

Parenting Inventory), schema avoidance (Young-Rygh Avoidance Inventory),

schema compensation (Young Compensation Inventory), and therapeutic alliance

(Working Alliance Inventory-Therapist and Client Forms and Working Alliance

Inventory- Supervisor and Therapist Forms).

As the second set of measurement, qualitative, projective, and open-ended

measurements were used in order to examine implicit perception of participants for

therapeutic alliance (Relational Circles) and psychotherapy/supervision period

(Open-ended Question Form).

2.2.1. Demographic Information Form

Demographic information form included questions regarding nicknames of

the participants, number of sessions for therapy or supervision, and psychological

approaches used in therapy or supervision sessions. Since this participant group

was a small group and the researcher was working as a research assistant in this

department, any questions related to socio-demographic characteristics of the

sample were not added to the form in order to keep confidentiality (See Appendix

B for demographic information form).

2.2.2. The Young Schema Questionnaire (YSQ)

It was developed by Young and Brown (1990). The 90-item scale measures

18 early maladaptive schemas (EMS). Adding to this, there is another YSQ

measuring 15 EMS which was developed (1990) and revised (1991) by Young and

Brown. In the present study, 90-item short form of the original YSQ was used. The

23

90-item YSQ was developed from the 205-item original YSQ. The original

questionnaire is 6-point Likert type scale (from 1 = never or almost never, to 6 =

all of the time). The Turkish adaptation of YSQ was done by Soygüt,

Karaosmanoğlu, and Çakır (2009). According to this study done with university

students, internal consistency coefficients for the EMS were found to be between

the range of .53 (unrelenting standards) and .81 (impaired autonomy) (See

Appendix C for YSQ). Number of factors were different in Turkish version. There

were fourteen schemas (namely, emotional deprivation, failure, pessimism, social

isolation/mistrust, emotional inhibition, approval seeking,

enmeshment/dependency, entitlement/insufficient self-control, self-sacrifice,

abandonment, punitiveness, defectiveness, vulnerability to harm, and unrelenting

standards). However, in this study, the original form was used and the reasons

were discussed in Chapter 3.2.1.2.

2.2.3. Young Parenting Inventory (YPI)

It was developed by Young (1994). The 72-item scale measures the origins

of the early maladaptive schemas based on parenting behavior. The questionnaire

contains 17 subscales, which identifies the most likely origin for each schema. It is

a 6-point Likert type scale (from 1 = never or almost never, to 6 = all of the time).

For each item, participants must rate the statement two times based upon how the

item describes their mothers and their fathers. The Turkish adaptation of YPI was

done by Soygüt and Çakır (2009). In Turkish adaptation, ten subscales were

determined, namely; emotionally depriving, overprotective/anxious,

belittling/criticizing, pessimistic/worried, normative, restricted/emotionally

inhibited, punitive, conditional/ achievement focused, over permissive/boundless,

and exploitative/abusive parenting. The study will be conducted based on these ten

subscales (See Appendix D for YPI). According to this study, internal consistency

coefficients for the items of mother style changed between .53 and -.86 and .61

and -.88 for the items of father style.

24

2.2.4. Young-Rygh Avoidance Inventory (YRAI)

It was developed by Young and Rygh (1991) in order to measure the

degree to which a patient utilizes various forms of schema avoidance. This

inventory, a type of 6 Likert Scale (from 1 = never or almost never, to 6 = all of

the time), consists of 40 items to evaluate the avoidance coping style of patients. It

was adapted into Turkish by Soygüt and her colleagues (in press). In this study, six

subscales were determined, namely, psychosomatic symptoms, ignoring sadness or

disturbance, emotional control, withdrawal from people, distraction through

activity, and numbness/suppressing emotions (See Appendix E for YRAI).

2.2.5. Young Compensation Inventory (YCI)

It was developed by Young (1995) in order to measure the most common

ways that a patient overcompensates for his or her schemas. It contains 48 items. It

is a 6-point Likert type scale (from 1 = never or almost never, to 6 = all of the

time). The Turkish adaptation of YPI was done by Karaosmanoğlu, Soygüt, and

Kabul (2009). In Turkish adaptation, eight subscales for the compensation method

were determined, namely; status seeking, control, rebellion, frostiness,

counterdependency, manipulation, intolerance to criticism, and egocentrism.

According to this study, internal consistency coefficients for the compensation

styles were found to be between the range of .60 and .81 (See Appendix F for

YCI).

2.2.6. Working Alliance Inventory—Therapist and Client Forms (WAI-T

and WAI-C)

These scales were developed by Horvath and Greenberg (1989). They

measure participants’ level of agreement with the goals, tasks, and emotional

bonds of therapy by depending on the concept of working alliance propounded by

25

Bordin (1979). They have 36-items including three subscales of task, goal, and

emotional bond related working alliance. They are rated on a 7-point Likert scale

ranging from 1 _ never to 7 _ always. Soygüt and Işıklı (2008) did Turkish

adaptation of the scale. According to this study, internal consistency coefficients

for the therapist form were found to be .96 while it was .90 for the client form (See

Appendix G for WAI-T and See Appendix H for WAI-C). In the present study,

working alliance was expressed with the concept of therapeutic alliance.

2.2.7. Working Alliance Inventory—Supervisor and Therapist Forms (WAI-

S and WAI-T)

Based on the items of working alliance scales (WAI-T and WAI-C) for

therapist and client developed by Horvath and Greenberg (1989), an instrument

was developed to measure working alliance for supervisor and therapist in the

present study (See Appendix I for WAI-S and See Appendix J for WAI-T). In

parallel with WAI-T and WAI-C, subscales were also consisted of goal, task, and

emotional bond oriented working alliance in the present study. In this study,

working alliance was represented by the concept of therapeutic alliance.

2.2.8. Open-ended Question Form

In the present study, in order to examine the supervisors’ and therapists’

viewpoint for difficulties met in psychotherapy or supervision processes and

coping styles with these difficulties, two open-ended questions were given at the

end of the semester (See Appendix K for Open-ended Question Form).

2.2.9. Projective Measurement-Relational Circles

In order to measure unconscious/subconscious and implicit perception of

participants for the working alliance during supervision and therapy processes that

can be missed by structured and quantitative inventories, a different qualitative

26

inventory (i.e., relational circles) was developed by the researcher inspiring from

Driver and his colleagues’ representations of supervision process. As shown in

Appendix L, three circles were used in the study. Each of three circles represented

supervisor, therapist, and the client. Location of these circles represented the

position of supervisor, therapist, and client toward each other in the psychotherapy

process. Overlapping areas of these circles indicated how much portion had been

shared by the circles representing supervisor, therapist, or the client. In order to

examine different areas of working alliance, these relational circles were used for

subscales of goals, tasks, and bond (Bordin, 1979). Participants were expected to

choose one among the given groups of the circles or to draw a new group of

circles, which had not been drawn into the form by the researcher. Then,

participants were expected to write an explanation into the form to remark why

they had chosen this group of circles. The results were associated and compared

with working alliance scales (WAI-S & WAI-T and WAI-T & WAI-C). Moreover,

results were discussed in line with participants’ schemas, family origins, and

schema coping mechanisms (See Appendix L).

3. Procedure

Before starting the present study, permission was taken both from the

Director of Ayna Clinical Psychology Unit and from Middle East Technical

University Ethical Committee. Additionally, at the beginning of the study,

participants signed the informed consent forms in order to express their volunteer

participation for this study (See Appendix A). In order to provide confidentiality,

firstly, names of the participants were hidden and nicknames were given to

participants by a person who was not involved in research. The researcher did not

know which nicknames belonged to which person. Nevertheless, participants were

informed about their own nicknames so that they could fill the inventories

according to these nicknames. Supervisors were coded by the nickname “Süper”

and a number was assigned to this nickname (e.g., Süper1). Furthermore,

therapists were coded by the nickname “Freud” and a number was assigned to this

nickname (e.g., Freud1). Moreover, clients were given the nickname “Kaşif”

27

preceded by the number of the supervisor providing supervision to his/her therapist

and followed by the number of his/her therapist (e.g., 1Kaşif5). However, the

researcher changed these nicknames while writing this dissertation in order not to

disclose what they said about each other. In the present study, three groups of

inventories were given to the participants. The first group was given only once as

the take-home format at the beginning of the research. This group was consisted of

Young Schema Questionnaire, Young Parenting Inventory, Young-Rygh

Avoidance Inventory, and Young Compensation Inventory. The second group,

which was related to therapeutic alliance, was started to be given after at least

three sessions of supervision and therapy processes since according to the

literature, therapeutic alliance started to appear after three sessions. These

inventories were applied to the participants as soon as session of supervision or

therapy was completed. For this aim, a box and envelopes were placed in the

therapy and supervision rooms. Reminding notes were placed into these rooms.

After the end of each session, participants were expected to fill these inventories;

put them into the envelope; close the envelope and put it into the box. As the third

group of assessment, non-structured inventories (e.g., relational circles and open-

ended question form) were given to the participants by the researcher at the end of

each supervision and therapy process. Participants were expected to fulfill the

relational circles for three subscales of goals, tasks, and emotional bond.

Instructions for the definitions of goal, task, and emotional bond were given to

participants by the researcher before starting to fulfill relational circles. Based on

conceptualizations of Bordin (1979), goals were defined as things/skills the

participant hoped to gain from therapy or supervision, based on his/her presenting

concerns. Tasks were defined as how the supervisor and therapist or therapist and

client agreed with the needs to be done to reach the client's goals and agreed

responsibilities. Emotional bond was described as affiliation and confidence

between either supervisor and therapist or therapist and client while trying to reach

goals.

28

4. Statistical Analysis

In this study, in order to obtain descriptive information of Young Schema

Questionnaire, Young Parenting Inventory, Young-Rygh Avoidance Inventory,

Young Compensation Inventory, Working Alliance Inventory-S/T, and Working

Alliance Inventory T/C, quantitative analyses were conducted via SPSS. On the

other hand, in order to examine relational circles and open-ended questions,

qualitative analyses were utilized. The researcher explained therapeutic alliance by

using participants’ scores on schemas, parenting style, and schema coping

mechanisms, and by their relational cycles.

29

3. RESULTS & DISCUSSION

3.1. General Results for the Study

The aim of this study was to examine whether early maladaptive schemas,

family origins of schemas, avoidance, and compensation schema coping

mechanisms of supervisors, therapists, and clients were associated with therapeutic

alliance. In order to reach this aim, qualitative and quantitative (as mentioned in

the method section) measures were given to the participants. However, only four

of the clients filled out all of the inventories, while all supervisors and therapists

completed the inventories. In the study, two types of relationship were determined

to examine therapeutic alliance. These were between either supervisor and

therapist or therapist and client. In total, 52 separate relationships were obtained.

Nevertheless, due to the limitation of space, only two of them could be illustrated

in the present study.

3.2. Differences of Demographic Variables

According to the demographic form, it was found that supervisors and

therapists used mostly Cognitive Behavioral Therapy approach (10 people).

However, it was combined either with the approaches of Psychodynamic

Approach (6 people), Schema Therapy (4 people), Relational Psychotherapy (2

people), Emotion-Focused Therapy (1 person), Attachment Oriented Therapy (1

person), Gestalt Therapy (1 person), or Psychoeducation (1 person) during

supervision and therapy sessions.

3.3. Descriptive Information for the Measures of the Study

In order to analyze descriptive characteristics of the measures, standard

deviations, and minimum-maximum ranges were examined for Early Maladaptive

Schemas; namely, emotional deprivation, abandonment/instability, mistrust/abuse,

30

social isolation/alienation, defectiveness/shame, failure,

dependence/incompetence, vulnerability to harm or illness,

enmeshment/undeveloped self, subjugation, self-sacrifice, emotional inhibition,

unrelenting standards/hypercriticalness, entitlement/grandiosity, insufficient self-

control/self-discipline, approval-seeking/recognition-seeking, pessimism, and

punitiveness; Young Parenting Inventory; namely, emotionally depriving,

overprotective/anxious, belittling/criticizing, pessimistic/worried, normative,

restricted/emotionally inhibited, punitive, conditional/achievement focused,

overpermissive/boundless, and exploitative/abusive parenting; Young-Rygh

Avoidance Inventory; namely, psychosomatic symptoms, ignoring sadness or

disturbance, emotional control, withdrawal from people, distraction through

activity, and numbness/suppressing emotions; Young Compensation Inventory;

namely, status-seeking, control, rebellion, counterdependency, manipulation,

intolerance to criticism, and egocentrism. For each participant group (i.e.,

supervisors, therapists, and clients) descriptive information for these inventories

was given in three tables (See Table1, Table2, and Table3). Furthermore,

descriptive information for Working Alliance Inventories in terms of task, goal,

and bond was given in one table for all participant groups.

3.3.1. Descriptive Measures for Young Schema Inventories for the

Supervisors

As shown in Table 1, it was found that schemas of self-sacrifice (M =

2.95), approval-seeking/recognition-seeking (M = 2.88), unrelenting

standards/hypercriticalness (M = 2.75), abandonment/instability (M = 2.63),

entitlement/grandiosity (M = 2.40), punitiveness (M = 2.28), pessimism (M =

2.03), and social isolation/alienation (M = 2.00) were mostly used ones among

supervisors. On the other hand, the results indicated that supervisors were more

likely to have emotionally depriving mother (M = 4.56) and father (M = 3.69),

pessimistic/worried mother (M = 3.21) and father (M = 2.79),

restricted/emotionally inhibited mother (M = 2.67) and father (M = 3.21),

normative mother (M = 2.53) and father (2.47), and conditional/achievement-

31

focused mother (M = 2.40) and father (2.85) as the characteristics of parents.

Furthermore, while withdrawal from people (M = 4.08) and emotional control (M

= 3.00) were mostly used as avoidance methods, frostiness (M = 3.55), control (M

= 3.50), counterdependency (M = 2.83), and status-seeking (M = 2.41) were

mostly used compensation methods in this group. Actually, the scores of Young

schema questionnaires were not in the border of psychopathology for supervisors.

However, these scores were discussed as the tendencies of supervisors in the

present study. Thus, these results did not indicate a psychopathology among

supervisors.

According to the results of supervisors’ schema characteristics, it was

noticed that these supervisors more likely came from family environment in which

they felt disconnected and rejected, other-directedness was encouraged and

emotions were inhibited (According to Young’s classification of schema domains

in 1996). These results indicated that for the supervisors, achievement, unrelenting

standards, status-seeking, and self-sacrifice were mostly used strategies in order to

cope with the extreme need of approval and acceptance from others. Maybe, since

these coping mechanisms were exaggerated and unhealthy, a pessimistic/negative

perception of the world seemed inevitable in the life of them. On the other hand,

withdrawal from people, emotional control, frostiness, control, and

counterdependency were other coping mechanisms of the supervisors against their

excessive needs. It was apparently seen that while they had tendencies to feel

threat for their acceptance or approval, they more likely chose to be withdrawn

from the environment or tried to control this environment. Besides, in order not to

be in such a position, it seemed that they had tendencies to inhibit their emotions

and did not attach to others. Based on these comments for this supervisor group, it

could be predicted that the features written below could be disruptive:

Other Directedness Domain: If supervisors extremely focused how they

were perceived by therapists, they could have missed therapeutic

relationship during the session. Moreover, if their schema of self-sacrifice

was triggered during supervision, they could not have distributed

responsibility in realistic boundaries. This could have inhibited the

development of therapists and created an artificial supervision

32

environment, in which feedback could not be given related to the skills of

the therapists.

Emotional Inhibition: If supervisors did not use open communication

methods and hided their feelings, this could have paralyzed the opportunity

of solving experienced problems. Thus, therapists could have missed the

opportunity to learn how to cope with conflicts in a real relationship.

Moreover, inhibited emotions could have caused exaggerated emotional

expressions and this could also have damaged the relationship.

Control: Supervision or therapy environment could be imponderable

sometimes. Tendencies in excessive need of control of supervisors could

have prevented behaving spontaneously during crises. Moreover, it could

have caused increment in anxiety of therapists who tried not to make

mistakes in order to be accepted from supervisors. However, a good

supervisor should have tolerance to their own anxiety and should sooth the

anxiety of the therapists. Thus, therapist could learn from their supervisors

that making mistakes was normal and acceptable. They should be accepted

from their supervisors without considering their mistakes. Thus, they could

be relaxed, open to learn from their mistakes, and educate their clients

about accepting themselves.

Driver, Martin, Banks, Mander, and Stewart (2002) also supported

the comments above. They claimed that supervision had a therapeutic

environment comprised from inner worlds of supervisor, therapist, and

client naturally. Therefore, supervisor should focus on dynamics of

supervision and withdrawal of therapist. In order to develop reciprocal

understanding in supervision period, supervisors should be active and open

to explain the issues or problems arising from intra and interpersonal

relationship. Thus, if supervisors had tendencies for other directedness

(blindness to inner world), and emotional inhibition, they could have

interrupted flow of supervision consisting of teaching, learning from intra

and interpersonal dynamics. Moreover, they (2002) expressed that

controlling and colluding were easy ways used by some supervisors in

order to prevent disapproval from therapists and feel hierarchically

33

powerful. Nevertheless, as mentioned above, these attitudes could cause

too much focus on dual relationship and ignorance of the third one. This

meant that while trying to control how s/he was perceived by therapists,

supervisors could have miss to set an example (to tolerate anxiety and to

accept making mistakes) for therapists. Thus, supervisors could not deal

with the problems related to client since they may get too much focused on

the relationship with therapist.

34

Table 1.Descriptive Information of the Measures for Supervisors Measures N Mean SD Range

(Min/

Max)

Early Maladaptive Schemas Self-sacrifice Approval-seeking/Recognition-seeking Unrelenting standards/Hypercriticalness Abandonment/Instability Entitlement/Grandiosity Punitiveness Emotional Inhibition Pessimism Social isolation/Alienation Insufficient self-control/Self-discipline Failure Vulnerability to harm or illness Subjugation Enmeshment/Undeveloped self Mistrust/Abuse Defectiveness/Shame Emotional Deprivation Dependence/Incompetence

8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8

2.95 2.88 2.75 2.63 2.40 2.28 2.03 2.03 2.00 1.98 1.95 1.95 1.80 1.68 1.68 1.53 1.22 1.08

0.99 0.76 1.10 0.83 0.71 0.75 1.32 0.73 0.42 0.65 0.97 0.54 0.60 0.63 0.93 0.55 0.42 0.15

1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6

Young-Rygh Avoidance Inventory Withdrawal from people Emotional control Psychosomatic symptoms Distraction through activity Numbness/suppressing emotions Ignoring sadness or disturbance

8 8 8 8 8 8

4.08 3.00 2.23 2.08 1.63 1.60

1.06 1.01 1.01 1.02 0.74 0.51

1-6 1-6 1-6 1-6 1-6 1-6

Young Compensation Inventory Frostiness Control Counterdependency Status seeking Egocentrism Rebellion Manipulation Intolerance to criticism

8 8 8 8 8 8 8 8

3.55 3.50 2.83 2.41 2.16 1.93 1.85 1.75

0.83 0.86 0.89 0.98 0.62 0.97 0.67 0.61

1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6

Young Parenting Inventory Mother Father Mother Father Emotionally depriving Pessimistic/worried Restricted/emotionally inhibited Normative Overprotective/anxious Conditional/ achievement focused Punitive Belittling/criticizing Over permissive/boundless Exploitative/abusive

8 8 8 8 8 8 8 8 8 8

4.56 3.21 2.67 2.53 2.46 2.40 2.22 1.66 1.56 1.14

3.69 2.79 3.21 2.47 2.13 2.85 1.97 1.67 2.13 1.60

0.51 1.42 0.91 1.43 0.92 1.00 0.89 0.86 1.13 0.25

1.25 1.73 1.47 0.91 0.56 1.25 0.47 0.59 1.83 0.74

1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6

35

3.3.2. Descriptive Measures for Young Schema Inventories for the

Therapists

Considering the results for the therapists as shown in Table 2, it was

identified that schemas of unrelenting standards/hypercriticalness (M = 3.80),

approval-seeking/recognition-seeking (M = 3.60), entitlement/grandiosity (M =

3.35), self-sacrifice (M = 2.93), social isolation/alienation (M = 2.81),

abandonment/instability (M = 2.67), insufficient self-control (M = 2.62), and

punitiveness (M = 2.40) were among the strongest schemas among therapists.

Adding to this, the results indicated that the therapists mostly had emotionally

depriving mother (M = 4.18) and father (M = 3.53), conditional/achievement-

focused mother (M = 3.42) and father (3.40), pessimistic/worried mother (M =

3.19) and father (M = 3.00), restricted/emotionally inhibited mother (M = 3.08)

and father (M = 4.25), normative mother (M = 2.94) and father (3.11), and

overprotective/anxious mother (M = 2.92). Moreover, avoidance methods from

these schemas were withdrawal from people (M = 4.00), distraction through

activity (M = 3.17) and emotional control (M = 2.79) whereas mostly used

compensation methods were frostiness (M = 3.82), status-seeking (M = 3.32),

control (M = 3.32), counterdependency (M = 3.08), egocentrism (M = 2.78), and

intolerance to criticism (M = 2.69) in this group.

The mean scores for the therapists indicated that they were more likely to

have similar family origins, schemas, and coping mechanisms with supervisors in

some sense. However, they had higher degrees of these characteristics compared to

supervisors. Therapists mostly had family origin in which disconnection-rejection

existed, other-directedness was encouraged, emotions were inhibited, and impaired

limits were set (According to Young’s classification of schema domains in 1996).

According to Young’s Schema Theory (1999), it was determined that emotional

control, withdrawal from people, and distraction through activity were developed

in order to avoid the extreme need of approval and acceptance from others, while

status-seeking, control, frostiness, counterdependency, egocentrism, and

intolerance to criticism existed in order to compensate these schemas. Considering

all the information, it could be inferred that these therapists due to their family

36

origins may have learned that they could get approval and acceptance

conditionally, through the help of achievement. Therefore, they were more likely

not to satisfy with the things they have had, they may have wanted more and more.

Therefore, they could not have dealt with any critics or feedbacks coming from

environment; they may have kept themselves away from them. Maybe, their

grandiose self was fed by this egocentric structure. Thus, actual self may not be

allowed to develop since negative feedback was not accepted and processed in

their mind. This psychological structure could have affected supervision and

therapy processes differently:

Other Directedness Domain: If therapists focused how clients perceived

them, they could have missed real needs of the clients and therapeutic

relationship in the sessions (Driver et al., 2002). Moreover, if they focused

how supervisors perceived them they could have missed to focus on real

development of themselves since they could not express their mistakes or

doubts during supervision period (Driver et al., 2002).

Emotional Inhibition: If therapists inhibited emotions, a fake or masked

self could have become in touch with supervisor and the client, this could

have paralyzed the opportunity of solving existing problems (Eckler-Hart,

1987; Winnicott, 1965). Therefore, therapists could have missed the

opportunity to notice their deficiency in psychotherapy skills and thus

could not get to overcome their lacking features (Nissen-Lie & Havik,

2013). Subsequently, the clients could have missed the opportunity to learn

how to cope with conflicts in a real relationship. Moreover, inhibited

emotions could have caused exaggerated expressions and this could also

have damaged the relationship.

Entitlement/Grandiosity: A critical point was that being efficient in

psychotherapy was not only related to theoretical background of the

therapists. It was mostly related to self-knowledge, self-enhancement, and

experience (Driver, et al, 2002). Supervision period was the most important

process in order to increase the awareness about the self, enhance it, and

experience it. However, if therapists behaved in egocentric manner during

supervision and therapy sessions, actual self could not have developed

37

(Glickauf-Hughes & Mehlman, 1995). Accordingly, therapists could have

filtered the feedback of their supervisors and could not have heart what the

client told them. This could have blocked the development of the

therapists. A level of entitlement could have increased self-confidence and

become beneficial to a certain degree; nevertheless higher levels could be

detrimental to see reality.

Insufficient Self-Control/Self-Discipline: According to Young (1999),

people having insufficient self-control were associated with avoidance. If

therapists had difficulty to set self-discipline, they could have thought that

they did not need to take responsibility for the things that other people have

taken for. This could have disrupted therapeutic alliance in terms of goals

and tasks in supervision. Moreover, insufficient self-control could have

disrupted therapeutic relationship with the client as well and could have

created difficulty to set limits to the clients who also have difficulty in

setting limits.

38

Table 2.Descriptive Information of the Measures for Therapists Measures N Mean SD Range

(Min-Max)

Early Maladaptive Schemas Unrelenting standards/Hypercriticalness Approval-seeking/Recognition-seeking Entitlement/Grandiosity Self-sacrifice Social isolation/Alienation Abandonment/Instability Insufficient self-control/Self-discipline Subjugation Punitiveness Emotional Inhibition Pessimism Mistrust/Abuse Defectiveness/Shame Failure Enmeshment/Undeveloped self Emotional Deprivation Dependence/Incompetence Vulnerability to harm or illness

12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12

3.80 3.60 3.35 2.93 2.81 2.67 2.62 2.52 2.40 2.35 2.28 2.15 2.11 2.10 2.02 1.80 1.77 1.62

1.33 1.01 1.23 0.92 1.12 0.55 1.24 0.74 0.80 1.13 0.60 0.93 1.11 1.08 0.97 1.04 0.87 0.57

1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6

Young-Rygh Avoidance Inventory Withdrawal from people Distraction through activity Emotional control Ignoring sadness or disturbance Numbness/suppressing emotions Psychosomatic symptoms

12 12 12 12 12 12

4.00 3.17 2.79 2.67 2.06 1.98

0.87 1.20 0.89 0.82 0.72 0.53

1-6 1-6 1-6 1-6 1-6 1-6

Young Compensation Inventory Frostiness Status seeking Counterdependency Control Egocentrism Intolerance to criticism Rebellion Manipulation

12 12 12 12 12 12 12 12

3.82 3.32 3.08 3.32 2.78 2.69 2.43 2.13

0.71 0.92 0.82 1.09 1.10 0.76 1.32 0.75

1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6

Young Parenting Inventory Mother Father Mother Father Emotionally depriving Conditional/ achievement focused Pessimistic/worried Restricted/emotionally inhibited Normative Overprotective/anxious Punitive Belittling/criticizing Over permissive/boundless Exploitative/abusive

12 12 12 12 12 12 12 12 12 12

4.18 3.42 3.19 3.08 2.94 2.92 2.73 2.08 1.50 1.32

3.53 3.40 3.00 4.25 3.11 1.99 2.67 2.31 1.68 1.54

1.13 1.47 1.59 1.35 1.32 1.39 1.44 1.37 0.46 0.61

1.18 1.66 1.49 1.50 1.18 0.99 1.16 1.00 0.66 0.66

1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6

39

3.3.3. Descriptive Measures of Young Schema Inventories for the Clients

The results for the clients as shown in Table 3 posed that schemas of

unrelenting standards/hypercriticalness (M = 4.70), entitlement/grandiosity (M =

4.00), self-sacrifice (M = 3.98), insufficient self-control (M = 3.60), approval-

seeking/recognition-seeking (M = 3.55), punitiveness (M = 3.55), pessimism (M =

3.53), abandonment/instability (M = 3.30), social isolation/alienation (M = 3.30),

and emotional inhibition (M = 3.00) were higher among the clients. Besides, these

schemas originated from parenthood of emotionally depriving mother (M = 4.88)

and father (M = 3.63), overprotective/anxious mother (M = 4.29),

conditional/achievement-focused mother (M = 3.75) and father (3.35), normative

mother (M = 3.66) and father (3.00), pessimistic/worried mother (M = 3.58) and

father (M = 2.79), and restricted/emotionally inhibited mother (M = 2.96). On the

other hand, schema avoidance strategies mostly utilized by the clients were

detected as withdrawal from people (M = 4.54), distraction through activity (M =

4.00), emotional control (M = 3.88), and psychosomatic symptoms (M = 2.77). As

for schema compensation, many remarkable strategies were found; namely,

frostiness (M = 4.85), control (M = 4.41), egocentrism (M = 3.79),

counterdependency (M = 3.63), status-seeking (M = 3.61), rebellion (M = 3.58),

manipulation (M = 3.35), and intolerance to criticism (M = 3.21).

The mean scores for the clients showed that they mostly had family origins

in which disconnection-rejection existed, other-directedness was encouraged,

impaired limits were set, and emotions were inhibited. Based on the information

taken from the clients, it was found that many types of schemas were active and

they were maintained by many unhealthy coping mechanisms. In therapy

environment, different schema characteristics of the clients could make treatment

difficult in different ways depending on the case. However, two critical points

could be pointed out at that point. Firstly, therapists’ having the same schema

characteristics with the client could be a challenge for the therapy (Lesser, 1961

cited in Luborsky, et al., 1971; Young, 1996). For example, if therapist had faced

with difficulty in his/her life that s/he could not cope with, and faced with the same

problem with his/her client, it would be very difficult for him/her to deal with this

40

situation. Secondly, basic aims of Schema Therapy (as asserted by Young in 1996)

in treatment process were nurturing and protecting vulnerable child mode, setting

limits for the angry and impulsive child mode, challenge with critical parent mode,

fight with detached protector mode, and encourage healthy adult mode for

reparenting. If the therapist could not practice all these things and thus did not

know how healthy adult could be, it would be unrealistic to expect him/her to treat

the patient. Undoubtedly, these two problems indicated that being therapist needed

supervision and receiving psychotherapy as well (Fleischer & Wissler, 1985;

Geller, Orlinsky, & Norcross, 2005; Macran, Stiles, & Smith, 1999; Sidney, 2013).

41

Table 3.Descriptive Information of the Measures for Clients Measures N Mean SD Range

(Min/Max)

Early Maladaptive Schemas Unrelenting standards/Hypercriticalness Entitlement/Grandiosity Self-sacrifice Insufficient self-control/Self-discipline Punitiveness Approval-seeking/Recognition-seeking Pessimism Abandonment/Instability Social isolation/Alienation Emotional Inhibition Mistrust/Abuse Failure Vulnerability to harm or illness Subjugation Enmeshment/Undeveloped self Defectiveness/Shame Emotional Deprivation Dependence/Incompetence

8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8

4.70 4.00 3.98 3.60 3.55 3.55 3.53 3.30 3.30 3.00 2.95 2.88 2.80 2.75 2.60 2.56 2.45 2.18

0.96 0.63 0.84 0.45 0.98 0.93 0.79 0.76 0.92 1.08 1.16 1.17 1.34 0.74 0.95 1.27 1.01 1.01

1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6

Young-Rygh Avoidance Inventory Withdrawal from people Distraction through activity Emotional control Psychosomatic symptoms Ignoring sadness or disturbance Numbness/suppressing emotions

8 8 8 8 8 8

4.54 4.00 3.88 2.77 2.66 1.96

1.22 1.23 1.47 0.84 0.77 0.77

1-6 1-6 1-6 1-6 1-6 1-6

Young Compensation Inventory Frostiness Control Egocentrism Counterdependency Status seeking Rebellion Manipulation Intolerance to criticism

8 8 8 8 8 8 8 8

4.85 4.41 3.79 3.63 3.61 3.58 3.35 3.21

0.94 1.08 1.11 1.23 1.20 1.08 2.60 1.34

1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6

Young Parenting Inventory Mother Father Mother Father Emotionally depriving Overprotective/anxious Conditional/ achievement focused Normative Pessimistic/worried Restricted/emotionally inhibited Punitive Over permissive/boundless Belittling/criticizing Exploitative/abusive

8 8 8 8 8 8 8 8 8 8

4.88 4.29 3.75 3.66 3.58 2.96 2.81 1.96 1.88 1.23

3.63 2.79 3.35 3.00 2.79 3.79 2.66 2.17 2.10 1.46

0.76 1.05 1.10 0.81 1.58 0.65 1.16 0.44 0.81 0.35

1.27 1.04 1.37 1.14 1.46 1.32 0.64 0.67 1.15 0.53

1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6 1-6

42

3.3.4. Descriptive Measures for Therapeutic Alliance

As indicated in Table 4, therapists (Task: M = 6, Goal: M = 6, Bond: M =

5.72) evaluated their task, goal, and bond oriented therapeutic alliance with

supervisors by giving higher scores compared to supervisors (Task: M = 5.80,

Goal: M = 5.77, Bond: M = 5.59). Furthermore, clients (Task: M = 5.06, Goal: M

= 5.77, Bond: M = 5.85) also gave higher scores during the evaluation of

therapeutic alliance with their therapists compared to the therapists (Task: M =

4.64, Goal: M = 5.18, Bond: M = 5.80). These differences were not notable;

however, one outstanding factor was that the group who took part in a lower

hierarchic position evaluated the process as being better than the group taking part

in the higher hierarchic position. It could be resulted from the need of idealization

(Luborsky, Chandler, Auerbach, Cohen, & Bachrach, 1971). Moreover, it could

show that there were things that were not talked openly between groups since

perception of two groups were somehow different from each other.

Table 4.General Therapeutic Alliance Scores of Supervisors, Therapists, and Clients Task Goal Emotional Bond

Participants Mean SD Mean SD Mean SD

Supervisors (340sessions) 5.77 0.67 5.80 0.67 5.59 0.83 Therapists-S (338 sessions) 6 0.56 6 0.47 5.72 0.62 Clients (83 sessions) 5.06 0.40 5.77 0.42 5.85 0.55 Therapists-C (85 sessions) 4.64 0.32 5.18 0.34 5.80 0.22

3.4. Correlation Coefficients between Groups of Variables

In order to determine the relationship between Early Maladaptive Schemas

[i.e., emotional deprivation, abandonment/instability, mistrust/abuse, social

isolation/alienation, defectiveness/shame, failure, dependence/incompetence,

vulnerability to harm or illness, enmeshment/undeveloped self, subjugation, self-

sacrifice, emotional inhibition, unrelenting standards/hypercriticalness,

entitlement/grandiosity, insufficient self-control/self-discipline, approval-

seeking/recognition-seeking, pessimism, and punitiveness], Young Parenting

Inventory measures [i.e., emotionally depriving, overprotective/anxious,

43

belittling/criticizing, pessimistic/worried, normative, restricted/emotionally

inhibited, punitive, conditional/achievement focused, overpermissive/boundless,

and exploitative/abusive parenting], Young-Rygh Avoidance Inventory measures

[i.e., psychosomatic symptoms, ignoring sadness or disturbance, emotional

control, withdrawal from people, distraction through activity, and

numbness/suppressing emotions], Young Compensation Inventory measures [i.e.,

status seeking, control, rebellion, counterdependency, manipulation, intolerance to

criticism, and egocentrism] with Working Alliance Inventory measures [i.e., goal

oriented therapeutic alliance, task oriented therapeutic alliance, and emotional

bond oriented therapeutic alliance] Pearson’s correlation analyses were performed.

Four analyses were conducted in order to determine the therapeutic alliance

between either supervisor and therapist or therapist and the client.

3.4.1. Correlation Coefficients between Groups of Variables for Supervisors

in Supervision Settings

According to the results for supervisors’ evaluation of therapeutic alliance

with therapists (See Table 5), goal oriented therapeutic alliance revealed

significant negative correlation with avoidance strategy of intentionally not

thinking about upsetting things (r = -.85, p < .01) and positive correlation with task

oriented therapeutic alliance (r = .97, p < .001). On the other hand, there were also

significant correlations between task oriented therapeutic alliance and schema

avoidance method of intentionally not thinking about upsetting things (r = -.80, p <

.05). Furthermore, emotional bond oriented therapeutic alliance indicated

significant positive correlation with schema of subjugation (r = .74, p < .05),

having pessimistic/worried mother (r = .81, p < .05), and having

exploitative/abusive father (r = .77, p < .05), while there were significant negative

correlations between emotional bond oriented therapeutic alliance and having

restricted emotionally inhibited father (r = -.85, p < .01) and intentionally not

thinking about upsetting things (r = -.82, p < .05). Thus, using intentionally not

thinking about upsetting things as schema avoidance strategy was correlated lower

levels of goal, task, and emotional bond oriented therapeutic alliance. This could

44

be because supervisors, who did not want to see problems and did not voice the

problems, were not satisfied with collaboration of the therapists. Nevertheless,

they did not explain it. Since they did not notice it, accept it, and voice it, they

could not solve the problems. Therefore, it can be inferred that there could be

many things that were not talked and handled during supervision. Supervisors

behaved as if everything was okay. Nevertheless, according to Prochaska and

Norcross (2006), in order to change, firstly, existence of a problem should be

accepted and voiced. This attitude of supervisors could be resulted from the need

of love, approval, and acceptance of the supervisors as it was mentioned in the

descriptive measures of Young Schema Inventories. On the other hand, if

supervising was associated with the role of parenthood (with the inner voice of

“You know psychotherapy, now teach how to make psychotherapy!”) and if being

psychotherapist was related with the role of childhood, maybe supervisors in this

parenthood role tried to give unlimited approval and acceptance to their children

(the therapists) and ignored their own sadness, since they did not obtain expected

approval and acceptance from their parents during their childhood (Driver et al.,

2002). Therefore, maybe in order to try to be better parents for these therapists,

they chose a wrong way by trying to compensate their own childhood needs

(Young, 1996). Trying to develop better alliance, they did not open their actual

self. They created masked, fake, and misleading supervision environment

(Winnicott, 1965). Therefore, while ignoring own sadness/disturbance, therapeutic

alliance got worse.

Furthermore, having higher levels of subjugation was correlated with

higher emotional bond oriented therapeutic alliance. According to Young (1999),

subjugation took part under the domain of other-directedness and was associated

with excessive compliance to others by suppressing own emotions, thoughts, and

decisions against being rejected and exposure to anger from others. From this point

of view, it could be inferred that if supervisors suppressed their own needs,

emotions, and desires, they could have thought that they had better emotional

bond. It meant that subjugation schema was activated in supervisors’ relationship

with therapists since they knew to use suppressing themselves in order to make

good relationship. Nevertheless, as mentioned above, ignorance

45

sadness/disturbance and suppressing real needs was associated with worse

interpersonal functioning (Gross & John, 2003) and caused decrements in the

perception of what was going on in supervision room (therapeutic alliance). Young

(1999) especially stated that people having higher levels of subjugation had

tendency for passive aggressive behavior, extreme expression of emotions.

Therefore, emotional bond’s being dependent on subjugation was not something

healthy. It could result in outbursts of emotions.

As for family origins, having pessimistic/worried mother and having

exploitative/abusive father were correlated higher levels of emotional bond. It

could be a kind of compensation method of supervisors’ own needs and childhood

(Young, Klosko, & Weishaar, 2003). It meant that if a supervisor grew up with

pessimistic mother and exploitative father, maybe s/he did not live an expected

emotional bond with these parents. While father was exploitative and mother was

pessimistic, there was no hope at this home. Maybe the supervisors chose to study

psychology in order to exist out from this dark and hopeless picture since they

wanted to change their life unconsciously. Maybe, s/he tried to maintain a good

relationship by compensating for his/her own childhood (i.e., behaving in a way

opposite of his/her parents). Thus, s/he perceived (thought it would be better if I

did not behave like my parents) a higher emotional bond with therapist. On the

other hand, a family environment with the characteristics of worried/pessimistic

and exploitative/abusive parents could provoke to develop depression easily.

According to Scott et al. (2000), if a person had depression with the symptoms of

hopelessness, low self-esteem, and guilt, s/he could have tendency to develop

dependent relationship with others. Therefore, maybe, with the effect of dependent

relationship needs, supervisors could have evaluated emotional bond better.

Additionally, having restricted/emotionally inhibited father was correlated with

lower levels of emotional bond. This finding could be resulted from the father’s

position and functionality during child development at home as explained before.

According to Cabrera and his colleagues (2000), fathers emboldened their children

to take risks, be independent, and compete with others. Additionally, Tessman (as

cited in Russell and Saebel, 1997) argued that fathers were important for their

daughters especially for learning loving and working. Accordingly, fathers

46

represented the outer world of their children and a strong predictor in interpersonal

relationship (Lamb, 1975; Lamb, Pleck, & Levine, 1985). Thus, fathers

represented how children would contact with outer world and reality and how they

would open their inner world to outer world. Therefore, a restrictive/emotionally

inhibited father could have interrupted learning partnership, sharing, and

collaboration. Thus, therapists with this kind of father could have difficulty in

setting common goals with their clients.

Finally, higher levels of goal oriented therapeutic alliance were correlated

with higher levels of task oriented therapeutic alliance. It could derive from that

goal and task subscales of the working alliance inventories could not be

differentiated from each other. On the other hand, it could arise from another

perception that having agreed aims meant agreed distribution of responsibility to

reach these aims. However, sometimes, people knew that there was a problem and

what should be done (goals), but they did not want to take responsibility to solve

these problems (task). Therefore, in order to understand the reasons behind the

perception of similarity between goal and task, more application to more

participants could be conducted in the future.

Table 5.Pearson correlations between young schemas, young coping mechanisms, young parenting

styles, and therapeutic alliance variables of supervisors with therapists

Goal Task Bond

Subjugation .24 .32 .74*

Having pessimistic/worried

mother .51 .46 .81*

Having exploitative/abusive

father .43 .52 .77*

Having restricted

emotionally inhibited father -.36 -.42 -.85**

Intentionally not thinking

about upsetting things -.85** -.80* -.82*

Goal - .97*** .56

Task .97*** - .53

Bond .56 .53 -

Note. * p < .05, ** p < .01, *** p < .001.

47

3.4.2. Correlation Coefficients between Groups of Variables for Therapists

in Supervision Settings

According to the results for therapeutic alliance of therapists with the

supervisors as shown in Table 6, goal oriented therapeutic alliance indicated

significant positive correlation with having emotionally depriving mother (r = .62,

p < .05), task oriented therapeutic alliance (r = .89, p < .001), and emotional bond

oriented therapeutic alliance (r = .77, p < .001). On the other hand, task oriented

therapeutic alliance had significant negative correlation with having punitive

mother (r = -.63, p < .05), while there was a significant positive correlation with

emotional bond oriented therapeutic alliance (r = .89, p < .001). Moreover,

emotional bond oriented therapeutic alliance indicated significant negative

correlations with schema of punitiveness (r = -.65, p < .05), schema avoidance

strategies of control (r = -.63, p < .05) and manipulation (r = -.60, p < .05), and

having punitive mother (r = -.68, p < .05).

As for the position of therapists during supervision, having higher levels of

punitiveness schema, control, and manipulation were correlated with lower levels

of emotional bond oriented therapeutic alliance. According to Young (1999),

punitiveness schema depends on the belief that “people should be harshly punished

for their mistakes” and this schema includes “tendency to be angry, intolerant,

punitive, and impatient with those people (including oneself) who do not meet

one’s expectations and standards”. From this definition of the schema, it can be

inferred that therapists with this schema could be afraid of making emotional

bonds with supervisors in order to protect themselves since if they made emotional

bond with the supervisor and made any mistake during supervision period,

breaking of this emotional bond could be a big disappointment. On the other hand,

it seems that from the side of these therapists, supervisors could have been

perceived just as an instructor or parent. If so, therapists could focus on not

making mistake, instead of learning from mistakes. In this anxious situation, not

making mistake seems impossible. Thus, they could have needed a strategy to

direct this supervision process. Most probably, in order to compensate their

48

mistakes they used strategies of control and manipulation. They were devoid of

making emotional bonds with their supervisors.

Furthermore, having emotionally depriving mother was correlated with

higher levels of goal and emotional bond oriented therapeutic alliance. It could be

due to starvation of building partnership and affiliation that these therapists had

not obtained from their mothers. On the other hand, having punitive mother was

correlated lower levels of task oriented and emotional bond oriented therapeutic

alliances (Durlak, 1998). Actually, having punitive parent was a trigger factor to

build a schema of punitiveness (Young, 1996). Correspondingly, as explained

above, therapists with fear of making mistake could not have taken responsibility

and felt affiliation with the supervisors.

Apart from these, goal oriented therapeutic alliance was correlated with

higher levels of task oriented and emotional bond oriented therapeutic alliances.

From this result, it seemed that if these therapists perceived higher therapeutic

alliance for any one in goal, task, and bond orientations, they also perceived a

higher therapeutic alliance for the rest. As mentioned in the part of descriptive

characteristics of schemas for therapists, other directedness was one of the

remarkable schema domains for these therapists. Maybe, since these therapists

knew to get acceptance, approval, and attraction conditionally especially with

achievement (as Young stated in 1996), they perceived goals, tasks of supervision

together with emotional bond. It seemed that if these therapists were given

negative feedback from their performance related to task, they could have had

tendency to perceive it personally and generalize it to goals of supervision and

emotional bonds with supervisors.

49


styles, and therapeutic alliance of therapists with their supervisors

Goal Task Bond

Punitiveness -.17 -.46 -.65*

Control -.30 -.53 -.63*

Manipulation -.36 -.57 -.60*

Having emotionally

depriving mother .62* .47 .61*

Having punitive mother -.41 - .63* -.68*

Goal - .89*** .77***

Task .89*** - .89***

Bond .77*** .89*** -

Note. * p < .05, ** p < .01, *** p < .001.

3.4.3. Correlation Coefficients between Groups of Variables for Therapists

in Therapy Settings

In the results for therapeutic alliance of therapists with clients as shown in

Table 7, goal oriented therapeutic alliance showed significant negative correlation

with having restricted/emotionally inhibited father (r = -.81, p < .05) and positive

correlations with numbness/suppressing emotions (r = .86, p < .05) and task

oriented therapeutic alliance (r = .87, p < .05). Furthermore, task oriented

therapeutic alliance had significant negative correlations with schema of social

isolation (r = -.82, p < .05) and frostiness (r = -.88, p < .05). Moreover, emotional

bond oriented therapeutic alliance revealed significant negative correlation with

schema of pessimism (r = -.86, p < .05).

According to the results, higher levels of task oriented therapeutic alliance

were correlated with lower levels of social isolation and lower levels of frostiness.

According to Young (1999) social isolation schema imposed the feeling of “being

isolated from the world, different from others and not part of any group”.

Additionally, this schema took part under disconnection and rejection schema

domain. All these meant that therapists with social isolation schema could not have

felt belonging to their clients; thus, they could not have wanted to take

responsibilities for therapeutic relationship. As Young asserted (1999), this schema

originated from detached, cold, and rejecting family. With activation of this

schema in therapeutic relationship, maybe, therapists could not have allowed the

50

clients affiliate and they could have maintained their maladaptive schemas by that

way. Moreover, they could have used the compensation strategy of frostiness in

that relationship, have felt free, and did not take required responsibilities for

therapy process.

Moreover, higher pessimism was correlated lower levels of emotional

oriented bond. Actually, this arised from the structure of this schema. Activation of

pessimism schema (as Young asserted, 1996) brought exaggerated feeling of

“something bad will happen”. Therefore, these people with this schema always

could have looked around to find something bad, disruptive, or negative and

neglect positive sides of the situations. Therefore, it was possible that therapists

with this schema could have missed the positive things in the relation with their

clients (Seligman, Reivich, Jaycox, & Gillham, 1995).

According to one another result, there was correlation between higher

levels of numbness/suppressing emotions and higher levels of goal oriented

therapeutic alliance. Actually, numbness/suppressing emotions were an avoidance

strategy to cope with negative feelings coming from maladaptive schemas and

undesirable things happening around (Richards & Gross, 1999). If therapists had

schemas being active in the therapeutic relationship with their clients, maybe they

could not have concentrated on their work due to their own negative emotions

(Ludwig, 1983). Therefore, they tried to focus on the work by dissociating

themselves. Although it was not real, therapists could have thought that their goal

oriented therapeutic alliance was high by the effect of numbness/suppressing

emotions. Thus, they could have deprived their clients from experiencing real

relationship.

On the other hand, having restricted/emotionally inhibited father was

correlated lower levels of goal oriented therapeutic alliance. This finding can be

resulted from the father’s position and functionality during child development at

home as explained before. According to Cabrera et al. (2000), fathers emboldened

their children to take risks, being independent and compete with others.

Additionally, Tessman argued that fathers were important for their daughters

especially for learning loving and working (as cited in Russell and Saebel, 1997).

Accordingly, fathers represented the outer world of their children and a strong

51

predictor in interpersonal relationship (Lamb, 1975; Lamb, Pleck, & Levine,

1985). Thus, fathers represented how children contacted with outer world and

reality. Therefore, a restrictive/emotionally inhibited father could interrupt

learning partnership, sharing, and collaboration. Thus, a restrictive/emotionally

inhibited father could interrupt learning partnership, sharing, and collaboration.

Therefore, therapists with this kind of father could have had difficulty in setting

common goals with their clients.

Finally, there was a correlation between higher levels of goal oriented

therapeutic alliance and task oriented therapeutic alliance. It can be resulted from

the reasons explained before in the part of 3.4.2.


styles, and therapeutic alliance variables of therapists with their clients

Goal Task Bond

Social Isolation -.71 -.82* -.51

Pessimism -.09 -.39 -.86*

Frostiness -.68 -.88* -.05

Numbness/suppressing

emotions .86* .67 -.10

Having restricted/

emotionally inhibited father -.81* -.71 .07

Goal - .87* .15

Task .87* - .40

Bond .15 .40 -

Note. * p < .05, ** p < .01.

3.4.4. Correlation Coefficients between Groups of Variables for Clients in

Therapy Settings

According to the results from the side of the clients as shown in Table 8,

goal oriented therapeutic alliance indicated a significant positive correlations with

schema of entitlement/grandiosity (r = .95, p < .05), frostiness (r = .92, p < .05),

and task oriented therapeutic alliance (r = .90, p < .05), whereas it showed a

significant negative correlation with having pessimistic father (r = -.89, p < .05).

Besides, task oriented therapeutic alliance had significant positive correlations

with the schema of entitlement/grandiosity (r = .95, p < .05). Moreover, emotional

bond oriented therapeutic alliance revealed significant positive correlation with the

52

schema of entitlement/grandiosity (r = .93, p < .05) and significant negative

correlation with having pessimistic father (r = -.93, p < .05).

According to the results, higher levels of entitlement/grandiosity schema

were correlated with higher levels of goal, task, and emotional bond oriented

therapeutic alliance. According to Schema Theory (Young, 1996),

entitlement/grandiosity schema originated from impaired realistic limits and arised

from the belief of being superior to others, need of owning power, and control.

Clients with this schema evaluated higher levels of therapeutic alliance with their

therapists. It could be explained with two viewpoints. Firstly, maybe these clients

applied to psychotherapy since they did not tolerate inferiority. They noticed a

problem in their lives, felt the self-confidence to change it, cooperated with their

therapists for goals and tasks of psychotherapy, and affiliated with their therapists.

It meant that these people were in the stage of action of Prochaska and DiClemente

(1986) (aware of the problem, gathered information related to his problem from

environment and now ready/motivated to change). Secondly, if these clients had

grandiose self, they could think that there was a functional, beneficial, and

emotional therapeutic alliance with their therapists since they chose this therapist.

They could not go to a therapist who was not good at his/her work. However, this

perception could not be real. The trouble was that if there was something

disrupting therapeutic alliance, which was arisen from the client, s/he could not

want to notice and accept it due to its grandiose self (self-aggrandizer mod as

Young asserted in 1996). Nevertheless, even if it was like that, idealization of the

therapy in the eyes of the client could increase motivation of this client for the

psychotherapy to a certain degree. Thus, this client could develop himself/herself

by the help of this motivation. On the other hand, maybe these clients were not

applied limited reparenting by their therapists as it was explained in Schema

Therapy. Thus, the clients could have maintanained their maladaptive structure

also in therapy settings and self-aggrendizor mode could be dominant in therapy.

In such a position, no development could be seen.

Furthermore, higher level of frostiness as schema compensation strategy

was correlated with higher levels of goal oriented therapeutic alliance. The result

could be arised from the structure of frostiness. According to Young (1999), this

53

coping mechanism was used to compensate dependency and other-directedness.

The person using this mechanism could be aware of tendency for dependency and

other-directedness and could want to get rid of them. Since s/he did not know to

act freely in a healthy way and drew boundaries to others, s/he rigidly could

exclude necessary and beneficial bonds. The clients who used this strategy in their

relationships could not be fed from deep relationships and could not make bonds

with others Derlega & Chaikin, 2010). Therefore, they could feel isolated from the

society and lack of social support (Solano, Batten, & Parish, 1982). Maybe,

therefore they decided to receive psychotherapy and noticed that there was

something wrong in their life. Thus, when they received psychotherapy, they

collaborated with their therapists in terms of the goals in order to change their

problems.

On the other hand, having pessimistic father was correlated with higher

levels of goal and task oriented therapeutic alliance. This can be explained by

fathers’ important role for child development in terms of interpersonal relationship

as explained before in Chapter 3.4.3.

Moreover, higher levels of goal oriented therapeutic alliance were

correlated with higher levels of task oriented therapeutic alliance. This could be

resulted from the structure of inventories or perception of the participants as

mentioned above.


styles, and therapeutic alliance variables for clients’ perception of therapeutic alliance with their

therapists

Goal Task Bond

Entitlement/Grandiosity .95* .95* .93*

Frostiness .92* .74 .85

Having pessimistic father -.89* -.79 -.93*

Goal - .90* .84

Task .90* - .80

Bond .84 .80 -

Note. * p < .05, ** p < .01.

54

3.5. Case Examples to Illustrate the Relationship of Young Schemas,

Young Coping Mechanisms, Young Parenting Styles with Therapeutic

Alliance

In order to exemplify the relationship of Early Maladaptive Schemas,

Young Parenting Inventory measures, Young-Rygh Avoidance Inventory

measures, Young Compensation Inventory measures with Working Alliance

Inventory measures, the two case examples were written below. The first one

included a triangular relationship among Supervisor A, Therapist B, and Client C

while the second one consisted of a dual relationship between Supervisor M and

Therapist K.

3.5.1. Case of SupervisorA-TherapistB-ClientC

In this case, Supervisor A carried on supervision with an eclectic approach

including CBT, attachment, and dynamic orientations with Therapist B. On the

other hand, Therapist B used CBT approach combined with relationship oriented

psychotherapy methods for Client C who indicated dependent personality

characteristics and difficulty in building relationship. For this group, at the

beginning, schema scales were applied and the remarkable schema characteristics

were represented as written below.

3.5.1.1. Characteristics of Supervisor A

According to the results, Supervisor A had the remarkable schemas of

abandonment, approval-seeking, insufficient self-control, defectiveness, and self-

sacrifice (See Table 9). In order to compensate these schemas, the mostly used

coping mechanisms by Supervisor A were control, status seeking, frostiness, and

counterdependency as shown in Table 10. On the other hand, withdrawal from

people, emotional control, and psychosomatic symptoms were the most

noteworthy schema avoidance strategies that were used by Supervisor A (See

Table 11). Besides, it was identified that Supervisor A had a mother who had been

55

pessimistic/worried, emotional depriving, overpermissive/boundless,

conditional/achievement focused and a father who had been pessimistic/worried,

overpermissive/boundless, emotional depriving, exploitative/abusive, and

conditional/achievement focused respectively (See Table 12 and 13).

Table 9.Early Maladaptive Schemas for Supervisor A

1

2

3

4

5

6

56

Table 10.Types of Overcompensation of Schemas for Supervisor A

Table 11. Types of Avoidance for Supervisor A

0,00

1,00

2,00

3,00

4,00

5,00

6,00

0

1

2

3

4

5

6

Withdrawal from people Emotional control Psychosomatic symptoms

57

Table 12.Characteristics of Mother of Supervisor A

Table 13.Young Fatherhood Styles for Supervisor A

0

1

2

3

4

5

6

0

1

2

3

4

5

6

58

3.5.1.2. Characteristics of Therapist B

As for the Therapist B, the noteworthy schemas were self-sacrifice,

unrelenting standards, approval-seeking, entitlement/grandiosity, and insufficient

self-control (See Table 14). The most outstanding coping strategies used by

Therapist B were frostiness, status-seeking, control, intolerance to criticism,

counterdependency, and manipulation in order to avoid from schemas (See Table

15). Distraction through activity, emotional control, intentionally not thinking

about upsetting things, and withdrawal from people were the mostly used

compensation methods by Therapist B (See Table 16). According to parenthood

styles, Therapist B reported an emotional depriving, conditional/achievement

focused, punitive, overprotective/anxious, restricted/emotionally inhibited, and

normative mother remarkably (See Table 17) and normative,

conditional/achievement focused, restricted/emotionally inhibited,

belittling/criticizing, and overpermissive/boundless father characteristics (See

Table 18).

Table 14.Early Maladaptive Schemas for Therapist B

0

1

2

3

4

5

6

59

Table 15.Types of Overcompensation of Schemas for Therapist B

Table 16.Types of Avoidance for Therapist B

0

1

2

3

4

5

6

0

1

2

3

4

5

6

Distraction throughactivity

Emotional control Intentionally notthinking about

upsetting things

Withdrawal frompeople

60

Table 17.Characteristics of Mother of Therapist B

Table 18.Characteristics of Father of Therapist B

0

1

2

3

4

5

6

0

1

2

3

4

5

6

61

3.5.1.3. Characteristics of Client C

According to the results for Client C, the most outstanding schemas were

entitlement/grandiosity, self-sacrifice, unrelenting standards, abandonment,

pessimism, punitiveness, and insufficient self-control (See Table 19). All

compensation methods (i.e., frostiness, intolerance to criticism, control,

counterdependency, egocentrism, status-seeking, rebellion, and manipulation)

were frequently used by Client C; however from these, frostiness was

exaggeratedly used by Client C (See Table 20). Furthermore, distraction through

activity, withdrawal from people, emotional control, intentionally not thinking

about upsetting things, and psychosomatic symptoms were the most noteworthy

avoidance methods (See Table 21). On the other hand, the results indicated that

emotional depriving, overprotective/anxious, normative, and

conditional/achievement focused mother features and restricted/emotionally

inhibited and belittling/criticizing father characteristics (See Table 22 and Table

23).

Table 19. Early Maladaptive Schemas for Client C

0

1

2

3

4

5

6

62

Table 20.Types of Overcompensation of Schemas for Client C

Table 21.Types of Avoidance for Client C

0123456

0

1

2

3

4

5

6

Distractionthrough activity

Withdrawal frompeople

Emotional control Intentionally notthinking about

upsetting things

Psychosomaticsymptoms

63

Table 22.Characteristics of Mother of Client C

Table 23.Characteristics of Father of Client C

0

1

2

3

4

5

6

0

1

2

3

4

5

6

64

3.5.1.4. Therapeutic Alliance between Supervisor A and Therapist B

with the Associations of Schema Theory

In order to examine therapeutic alliance between Supervisor A and

Therapist B, seven measurements could be obtained. From these measurements,

general, goal, task, and emotional bond oriented therapeutic alliance means were

acquired. Obtained scores were evaluated by making comparisons between

Supervisor A and Therapist B by making associations with Early Maladaptive

Schemas [i.e., emotional deprivation, abandonment/instability, mistrust/abuse,






punitiveness], Young Parenting Inventory measures [i.e., emotionally depriving,


restricted/emotionally inhibited, punitive, conditional/achievement focused, over

permissive/boundless, and exploitative/abusive parenting], Young-Rygh

Avoidance Inventory measures [i.e., psychosomatic symptoms, ignoring sadness

or disturbance, emotional control, withdrawal from people, distraction through

activity, and numbness/suppressing emotions], Young Compensation Inventory

measures [i.e., status-seeking, control, rebellion, counterdependency,

manipulation, intolerance to criticism, and egocentrism].



Schema Theory

According to the general results for therapeutic alliance between

Supervisor A and Therapist B, it was determined that Supervisor A perceived more

therapeutic alliance in their supervision period compared to Therapist B (See Table

65

24). At the beginning of the measurement, Supervisor A reported the highest

therapeutic alliance score for Therapist B. Then, there happened a fluctuation

when the time went on. On the other hand, Therapist B started with the lowest

score. Then, the evaluations of Therapist B for this supervision period increased

progressively. Nevertheless, at the session when Supervisor A gave the lowest

score for therapeutic alliance for Therapist B (9th supervision), interestingly

Therapist B gave the highest score for Supervisor A. Additionally, the highest

score given by Supervisor A came up to the time when the Therapist B gave the

lowest score. According to this result, it seems that there were issues, which were

not handled or talked openly between Supervisor A, and Therapist B. Moreover, it

seemed that the things perceived as good or bad from Supervisor A or Therapist B

were perceived as opposite for the other one. There was a difference between their

perceptions of building relationships.

Furthermore, in the evaluation of goal, task, and emotional-bond oriented

therapeutic alliance, there was a distinctive decline of the score given by

Supervisor A (7th supervision) (See Table 25, Table 26, and Table 27). However, it

seemed that Therapist C was not aware of this situation. Maybe, Supervisor A

ignored this or handled it during supervision. Similarly, at the 12th supervision

session, there was prominent decline of the score given by Therapist B for

emotional bond oriented therapeutic alliance and it was not noticed by Supervisor

A (See Table 27). It seemed that there could be lack of clear and open

communication between Supervisor A and Therapist B during supervision.

Depending on all these results, firstly, Therapist B’s tendency to give lower

score for alliance could be explained by his/her maintenances of unrelenting

standards and entitlement schemas. As Young stated (1999), people with these

schemas had tendencies to undervalue and devalue while evaluating others and

achievement. Moreover, Supervisor A’s starting with higher scores could derive

from fight with his/her pessimistic and achievement focused parents. Maybe s/he

did not want to be like them in the “role of parent”. According to Klein (1952),

parents with unhealthy attitude used projective identification in order to load their

unmet wishes and needs to their children. Additionally, Cashdan (1988) claimed

that projective identification meant forcing a person to behave according to your

66

own psychological structure. However, if the person, who was forced, had

different characteristics from the other one or if s/he had therapeutic awareness,

s/he could reject this unhealthy cycle (Cashdan, 1988) as similar as attitude of

Supervisor A in the present study. On the other hand, emotional control

mechanism could be affective on the sudden decrease in Supervisor A’s

evaluation. Since s/he did not express his/her emotions promptly and maybe

suppressed, emotion’s effect (decrease) was high (Gross, 2002). Additionally,

emotional control used by Therapist B and Supervisor A as maladaptive coping

mechanism could be effective on lack of clear and open communication between

Supervisor A and Therapist B during supervision.

Table 24.General Therapeutic Alliance between Supervisor A and Therapist B

0

1

2

3

4

5

6

7

Supervisor A

Therapist B

67

Table 25.Goal Oriented Therapeutic Alliance between Supervisor A and Therapist B

Table 26.Task Oriented Therapeutic Alliance between Supervisor A and Therapist B

0

1

2

3

4

5

6

7

Supervisor A

Therapist B

0

1

2

3

4

5

6

7

Supervisor A

Therapist B

68

Table 27.Emotional-Bond Oriented Therapeutic Alliance between Supervisor A and Therapist B


depending on Qualitative Measurement and Its Associations with

Schema Theory

Depending on relational circles for Supervisor A (as shown in Figure 2),

Supervisor A thought that supervisor and therapist had shared goals; however, the

client was not involved in this shared goals according to the perception of

Supervisor A. Therapist B perceived balanced shared or independent goals among

supervisor, therapist, and client (See Figure 2). From the results, it was understood

that there was not a parallel perception for goal oriented therapeutic alliance

between Supervisor A and Therapist B. In terms of Supervisor A, it was realized

that Supervisor A focused on the relationship of therapist and supervisor in terms

of goals. S/he ignored shared goals with clients. This could be because the

supervisor worked as supervisor for the first time; s/he did not balance his/her

focus for shared goals of therapist and client. Additionally, due to the schemas and

origins of the schemas of Supervisor A, Supervisor A was maybe afraid of being

abandoned and getting no approval from Therapist B based on his/her emotionally

0

1

2

3

4

5

6

7

Supervisor A

Therapist B

69

depriving and achievement focused parents. According to Ladany, Constantine,

Miller, and Erickson (2000), supervisors’ unresolved past issues affected

supervision environment. In order to cope with his/her unhealthy childhood

experiences’ effect, Supervisor A could have used control as maladaptive coping

style; maybe s/he concentrated too much on keeping a stable relationship with the

therapist and forgot the goals of the client. On the contrary, Ladany, Constantine,

Miller, and Erickson (2000) asserted that supervisors’ talking his/her difficulties

during supervision with therapist could be consolidating therapeutic relationship

instead of controlling. On the other hand, Therapist B evaluated this supervision

process in realistic limits.

As for task (See Figure 2), Supervisor A perceived shared or independent

tasks among the supervisor, the therapist, and the client in a balanced manner. On

the other hand, Therapist B considered equal, overlapped, and biggest share of

tasks for therapist and the client; however, the smallest and completely dependent

(all tasks which Supervisor A had were related to Therapist B and Client C) task

for supervisor. According to this result, it was inferred that Supervisor A thought

that everybody in this process had equal responsibility ideally. On the other hand,

Therapist B considered that Supervisor A did not have any other responsibility in

this process independent from Therapist B and Client C. Additionally; Supervisor

A had the smallest responsibility in this group. It was understood that Therapist B

could have undervalued the contribution of Supervisor A. It could be resulted from

a hidden anger of Therapist B to Supervisor A (suppressed emotion, Gross, 2002).

Maybe since Therapist B had the schemas of unrelenting standards, defectiveness

and entitlement/grandiosity, s/he needed to exaggerate own responsibilities to cope

with high expectations from oneself and maintained the belief of own competency

by transferring emotional depriving, achievement focused, and belittling/criticizing

parents to his/her supervisor (the effect of unresolved issues from childhood as

expressed from Young (1999)). On the other hand, it was maybe related to being

caught by projective identification of the client. As Klein (1952) stated as

projective identification, maybe Therapist B positioned himself/herself in a

dependent relationship with his/her client and was not aware of the supervisor (as

answer to client’s desire of integration with mother). Besides, Therapist B

70

described an equal responsibility with Client C. It could be related to self-sacrifice

or grandiosity of Therapist B. Firstly, since Therapist B had schemas under other-

directedness schema domain, Therapist could have overvalued responsibility of

Client C (Young, Klosko, & Weishaar, 2003). Secondly, both Therapist B and

Client C had grandiosity and intolerance to criticism as for schema compensation

mechanism. Therefore, Therapist B could have compensated this schema and

could have overvalued responsibility of Client C (Young, 1996).

For emotional bond (See Figure 2), Supervisor A figured an enmeshed

alliance between the therapist and the client and a small portion of relatedness of

himself/herself. Nevertheless, Therapist B perceived a nonfunctional enmeshed

alliance among the supervisor, therapist, and client. There was a similar perception

between supervisor and therapist. It was understood that both Supervisor A and

Therapist B perceived an enmeshed nonfunctional bond between Therapist B and

Client C. However, Supervisor A thought that s/he had a small relatedness with

them while Therapist B perceived that Supervisor A was also completely

enmeshed. From these perceptions, it was inferred that dependent characteristics of

the Client C expanded to therapeutic relationship (projective identification/forcing

others to behave according to own psychological needs as Cashdan stated in 1988).

Maybe, Supervisor A felt that this strong dependent structure between therapist

and client made him/her not interfere with them. Maybe, this could have made

him/her feel isolated due to the schema of abandonment. Maybe, as s/he could not

cope with this situation since s/he used the withdrawal from people as maladaptive

coping. On the other hand, although Therapist B was aware of nonfunctional

enmeshed circle, s/he continued to behave accordingly since s/he had the schemas

of unrelenting standards, self-sacrifice, and extreme urge for approval and

acceptance (affect of therapist’s own schemas/ Young, Klosko, & Weishaar,

2003). S/he looked for status and this dependent relationship made Therapist B

feel good by meeting childhood needs of Therapist B. Nevertheless, enmeshed

relationship for Client C was not something healing since this relationship style

made his/her schemas of undeveloped self, abandonment, and insufficient self-

control maintain (client’s schemas’ clashing with the ones of therapist/ Young,

Klosko, & Weishaar, 2003).

71

According to the open-ended question form (as represented in Figure 3),

Supervisor A got angry with a therapist, s/he did not show his/her anger, then s/he

talked about his/her anger during supervision. It caused to negative and positive

results. On the other hand, Therapist B (as represented as Figure 4), also got angry

with one of the supervisors. Therapist B mentioned a reciprocal anger with his/her

supervisor. The style of dealing with this anger of Supervisor A forced Therapist

B. However, both Supervisor A and Therapist B shared this issue with their

academic group and looked for support. All these answers given to open-ended

questions indicated that both Supervisor A and Therapist B had difficulty in

talking their emotions and anger management. Both of them had the tendency to

use emotional control as maladaptive coping style. Nevertheless, they tried to

break emotional control mechanism by expressing their emotions. However, since

it was the first time, it was not functional enough and good enough for therapist.

72

Supervisor A Therapist B

G

O

A

L

O

R

I

E

N

T

E

D

Explanation: No explanation. Explanation: In some sessions supervisor, therapist, client share goals equally; while they think that they have mutual goals, client has different goals from therapist; therapist has different goals from supervisor in some other sessions.

T

A

S

K

O

R

I

E

N

T

E

D

Explanation: No explanation. Explanation: I think that while therapist and client take part in big circles, supervisor has small portion in this circle.

E

M

O

T

I

O

N

A

L

Explanation: The client and therapist enmeshed; the supervisor is related with them.

Explanation: As supervisor, therapist, and client, I think that there are nonfunctional enmeshed emotional bonds.

Figure 2. Projective measurement of therapeutic alliance for Supervisor A and Therapist B Note: S = Supervisor A, T = Therapist B, C = Client C

S T

C

S

C T

S

C T

S C

T

T C

S

S C

T

73

3.5.1.7.Therapeutic alliance between Therapist B and Client C and Its

Associations with Schema Theory

In order to examine therapeutic alliance between Therapist B and Client C,

fourteen measurements could be obtained. From these measurements, general,

goal, task, and emotional bond oriented therapeutic alliance means were acquired.

Obtained scores were evaluated by making comparisons between Therapist B and

Client C by making associations with Early Maladaptive Schemas [i.e., emotional

deprivation, abandonment/instability, mistrust/abuse, social isolation/alienation,

defectiveness/shame, failure, dependence/incompetence, vulnerability to harm or

illness, enmeshment/undeveloped self, subjugation, self-sacrifice, emotional

inhibition, unrelenting standards/hypercriticalness, entitlement/grandiosity,

insufficient self-control/self-discipline, approval-seeking/recognition-seeking,

pessimism, and punitiveness], Young Parenting Inventory measures [i.e.,

emotionally depriving, overprotective/anxious, belittling/criticizing,

pessimistic/worried, normative, restricted/emotionally inhibited, punitive,

What was the most difficult situation during supervision period?

I got angry with one of the therapists. I did not show my anger. Actually, I was affected from this

situation very much. Next week, I attempted to open this situation during supervision since I

thought I could deal with it. However, very emotional environment emerged (with its positive and

negative sides).

How did you cope with it?

With peer supervision and supervision of supervision.


Emotional process between my supervisor and me; reciprocal existence of anger, the style of my

supervisor to deal with this anger and following processes were the most difficult times for me.


By being aware of my emotions, by trying to understand the supervisor, by talking with other

therapists who took part in the same supervision group when I felt difficulty, I tried to cope with.

Figure 3. Open-ended questions and answers for Supervisor A

Figure 4. Open-ended questions and answers for Therapist B

74

conditional/achievement focused, over permissive/boundless, and

exploitative/abusive parenting], Young-Rygh Avoidance Inventory measures [i.e.,

psychosomatic symptoms, ignoring sadness or disturbance, emotional control,

withdrawal from people, distraction through activity, and numbness/suppressing

emotions], Young Compensation Inventory measures [i.e., status seeking, control,

rebellion, counterdependency, manipulation, intolerance to criticism, and

egocentrism].

3.5.1.8. Therapeutic Alliance between Therapist B and Client C depending

on Qualitative Measurement and Its Associations with Schema

Theory

As for general therapeutic alliance (as shown in Table 28) between

Therapist B and Client C, Therapist B indicated more fluctuated and lower level of

therapeutic alliance compared to Client C. It could derive from unrelenting

standards schema of Therapist B. Moreover, this schema could have activated

more at this supervision period because Therapist B started to provide

psychotherapy at first time and could be trying to cope with performance anxiety.

On the other hand, since Therapist B had the schema of entitlement/grandiosity,

s/he could have overvalued of himself/herself to cope with challenges as a young

therapist as belonging to conditional/achievement focused parents (related to

overlapping or clashing of schemas of client and therapist as Young underlined in

1996 as risks for therapy). Moreover, Client C perceived more stable therapeutic

alliance compared to Therapist B in all types of therapeutic alliance (as shown in

Table 28, Table 29, Table 30, and Table 31). It could be resulted from idealization

of therapist by client due to having emotional depriving mother (desire for

integrating with mother/ Klein, 1952). Maybe s/he needed to share his/her feelings

and being listened; maybe therapist could have met all these needs even by

existing there for the client. Additionally, when there was decrement in general

therapeutic alliance for Therapist B, Client C reported an increment in therapeutic

alliance and vice versa (i.e., 13. and 16. sessions). It could be due to maladaptive

coping mechanisms (i.e., emotional control, intentionally not thinking about

75

upsetting things, and withdrawal from people). Depending on coping strategies,

maybe if there was a problem, it could not be handled in details, and maybe even

they did not talk about it (due to overidentification when the client’s and

therapist’s schemas overlapped as Young expressed in 1996). Additionally,

Therapist B indicated the highest similarity with Client for emotional bond

oriented alliance (See Table 31). Maybe, s/he was not sure whether there were

shared goals and tasks during therapy process with client. However, s/he seemed

sure that there was emotional bond oriented therapeutic alliance between them.

Maybe, Therapist B did not evaluate goal and task oriented therapeutic alliance

without the schemas of unrelenting standards and entitlement/grandiosity and

without eyes of emotional depriving, conditional/achievement focused, punitive

mother and normative, conditional/achievement focused, belittling/criticizing

father. Nevertheless, s/he could evaluate emotions more positive. Maybe, it was

because Therapist B was emotionally deprived child, s/he was sensitive emotional

bond focused alliance. Maybe she wanted to take and give the thing that s/he did

not take during his/her childhood (clashing schemas of therapist and client/ client’s

satisfaction the therapist’s schema driven needs, Young, Klosko, & Weishaar,

2003).

Table 28. General Therapeutic Alliance between Therapist B and Client C

3,8

4,3

4,8

5,3

5,8

6,3

6,8

Therapist B

Client C

76

Table 29. Goal Oriented Therapeutic Alliance between Therapist B and Client C

Table 30. Task Oriented Therapeutic Alliance between Therapist B and Client C

0

1

2

3

4

5

6

7

Therapist B

Client C

0

1

2

3

4

5

6

7

Therapist B

Client C

77

Table 31. Emotional-bond Oriented Therapeutic Alliance between Therapist B and Client C

3.5.1.9. Therapeutic Alliance between Therapist B and Client C depending

on Qualitative Measurement and Its Associations with Schema

Theory

According to projective measurement (See Figure 5), while

Therapist B expressed equally shared or independent goals among supervisor,

therapist, and client. Client C defined a relationship all goals were determined

according to the need of herself/himself. Moreover, Client C defined a relationship

in which goals of Therapist B included goals of Supervisor A. Moreover, goals of

Client C consisted of goals of Therapist B and Supervisor A. It could be due to

Client C’s compensation of neglected childhood needs. This meant that Client C

maybe thought that everything should be done for just herself/himself. Up to a

point, this expectation could be considered as realistic since psychotherapy could

go on in the existence of client. Nevertheless, maybe, in his/her relational cycle,

Client C could have explained what s/he dreamt for under the effect of emotional

depriving, belittling/criticizing, conditional/achievement focused parents. Thus,

this expectation could be an overcompensation method for unmet childhood needs

0

1

2

3

4

5

6

7

Therapist B

Client C

78

(Young, 1996). On the other hand, there was a similarity between evaluation of

Therapist B and Client C in terms of task and emotional bond oriented therapeutic

alliance. Both of them thought that there was an enmeshed relationship for tasks

and emotional bond. However, while therapist considered that this emotional

structure was nonfunctional, the client did not think so. Arntz (2012) claimed that

client with dependent personality disorder could have compliant surrender mode.

Thus, client could not have opposed their therapist, not got angry with him/her or

not perceived any problem in therapeutic process. Moreover, Therapist B thought

that Supervisor A also had enmeshed relationship with Therapist B and Client C

even it was small for task oriented therapeutic alliance. On the other hand,

Therapist B indicated completely enmeshed emotional bonds among Supervisor A,

Therapist B, and Client C. It could be resulted from Therapist B’s need of

dependence and avoiding from abandonment. The risky position in this result was

that since Therapist B and Client C had similar schemas and parent characteristics,

they could have supported their maladaptive circles and psychotherapy could not

have reached its aims (overlapping schemas as Young stated in 1996). On the

other hand, Client C defined the position of Supervisor A independent from

himself/herself since s/he did not know him/her. However, s/he accepted an effect

coming from supervisor transferred by Therapist B. This could be explained with

the need of frostiness of Client C to avoid from his/her abandonment and rejection

rooted schemas. S/he accepted existence of supervisor. However, since s/he did

not meet to him/her, maybe she did not know whether s/he was trustful. Therefore,

s/he separated Supervisor A from their task and emotional bond oriented

therapeutic relationship. Accordingly, in Schema Theory, Young (1999) expressed

that people positioned themselves distant from interpersonal relationship

(frostiness/ avoidance coping mechanism) in order prevent triggering of schemas

(being abandoned, rejected, and disapproved).

79

Therapist B Client C

G

O

A

L

O

R

I

E

N

T

E

D

Explanation: In some sessions, supervisor, therapist, client share goals equally; while they think that they have mutual goals, client has different goals from therapist; therapist has different goals from supervisor in some other sessions.

Explanation: In order to determine the goals, I think that I have the most proportion. Because due to my problems, with the bigger affect of my therapist (but small effect of supervisor but effective) our goals are determined.

T

A

S

K

O

R

I

E

N

T

E

D

Explanation: I think that while therapist and client take part in big circles, supervisor has small portion in this circle.

Explanation: I think that my therapist and I in an enmeshed manner determine tasks according to the situation that I am in and my emotions. After we direct what the tasks are, I think that therapist and supervisor give a mutual decision.

E

M

O

T

I

O

N

A

L

Explanation: As supervisor, therapist, and client, I think that there are nonfunctional enmeshed emotional bonds.

Explanation: The emotional bond that I made with my therapist is enmeshed since we share lots of things for a long time. However, since I did not have the opportunity to meet the supervisor, his/her effect on emotional bond is transferred only by my therapist to me.

Figure 5. Projective measurements of therapeutic alliance for Therapist B and Client C Note: S = Supervisor A, T = Therapist B, C = Client C

S

C T

C

T

S

S C

T

T C S

T

S C

T T C S

T

80

3.5.2. Case of Supervisor M and Therapist K

3.5.2.1. Characteristics of Supervisor M

According to schema inventories, Supervisor M had the schemas of

unrelenting standards, approval-seeking, failure, self-sacrifice,

entitlement/grandiosity, pessimism, and punitiveness remarkably (See Table 32).

Furthermore, Supervisor M had strong tendencies to overcompensate these

schemas by utilizing frostiness, control, status-seeking, counterdependency,

manipulation, egocentrism, and intolerance to criticism (See Table 33). On the

other hand, Supervisor M utilized schema avoidance in terms of distraction

through activity, psychosomatic symptoms, emotional control, and withdrawal

from people (See Table 34). As for origins of family (as indicated in Table 35 and

Table 36), Supervisor M had normative, pessimistic/worried, emotional depriving,

punitive, conditional/achievement focused, and belittling/criticizing mother and

pessimistic/worried, emotional depriving, restricted/emotionally inhibited, and

normative father.

81

Table 32. Early Maladaptive Schemas for Supervisor M

Table 33. Types of Overcompensation of Schemas for Supervisor M

0

1

2

3

4

5

6

0

1

2

3

4

5

6

82

Table 34.Types of Avoidance for Supervisor M

Table 35.Characteristics of Mother of Supervisor M

0

1

2

3

4

5

6

Distraction throughactivity

Psychosomaticsymptoms

Emotional Control Withdrawal frompeople

0

1

2

3

4

5

6

83

Table 36. Characteristics of Father of Supervisor M

3.5.2.2. Characteristics of Therapist K

The noteworthy schemas of Therapist K were insufficient self-control,

social isolation, defectiveness, entitlement/grandiosity, abandonment,

mistrust/abuse, approval-seeking, and pessimism (See Table 37). Besides,

Therapist K mostly overcompensated these schemas with frostiness, intolerance to

criticism, counterdependency, and rebellion (See Table 38). Moreover, Therapist

K utilized types of avoidance in terms of withdrawal from people, distraction

through activity, and psychosomatic symptoms (See Table 39). On the other hand,

Therapist K had pessimistic/worried, restricted/emotional inhibited,

overprotective/anxious, and emotional depriving mother (See Table 40) and

conditional/achievement focused, normative, emotional depriving,

belittling/criticizing, and exploitative/abusive father remarkably (See Table 41).

0

1

2

3

4

5

6

84

Table 37.Early Maladaptive Schemas of Therapist K

Table 38.Types of Overcompensation of Schemas for Therapist K

0

1

2

3

4

5

6

0

1

2

3

4

5

6

Frostiness Intolerance tocriticism

Counterdependency Rebellion

85

Table 39.Types of Avoidance for Therapist K

Table 40. Characteristics of Mother of Therapist K

0

1

2

3

4

5

6

Withdrawal from people Distraction through activity Psychosomatic symptoms

0

1

2

3

4

5

6

86

Table 41.Characteristics of Father of Therapist K

3.5.2.3. Therapeutic Alliance between Supervisor M and Therapist K

with the Associations of Schema Theory

With the purpose of finding out therapeutic alliance between Supervisor M

and Therapist K, eleven measurements could be acquired with qualitative

inventories. At the beginning of this measurement, an instruction was given to

Supervisor M and Therapist K in order to highlight that they should start to fill

inventories after at least three sessions passed. They even did so, however, they

represented their starting session as first session as shown in Table 42, Table 43,

Table 44, and Table 45. Apart from quantitative ones, projective measurement and

open-ended question form were applied to Supervisor M and Therapist K once in

research process as qualitative measures. Obtained scores and implicit

0

1

2

3

4

5

6

87

measurements were appraised by making associations with Early Maladaptive

Schemas [i.e., emotional deprivation, abandonment/instability, mistrust/abuse,






punitiveness], Young Parenting Inventory measures [i.e., emotionally depriving,


restricted/emotionally inhibited, punitive, conditional/achievement focused, over

permissive/boundless, and exploitative/abusive parenting], Young-Rygh

Avoidance Inventory measures [i.e., psychosomatic symptoms, ignoring sadness

or disturbance, emotional control, withdrawal from people, distraction through

activity, and numbness/suppressing emotions], Young Compensation Inventory

measures [i.e., status seeking, control, rebellion, counterdependency, manipulation,

intolerance to criticism, and egocentrism] of Supervisor M and Therapist K.

3.5.2.4. Therapeutic Alliance between Supervisor M and Therapist K

depending on Quantitative Measurement and Its Associations with Schema

Theory

In accordance with the results for quantitative measurements, Therapist K

indicated more positive and stable attitude for therapeutic relationship with

Supervisor M (See Table 42). As for Supervisor M, a sudden decrease in the 3th

session was experienced. This decrement maintained for two sessions, then, a

sudden increase was experienced. After this sudden increment, Supervisor M

started to indicate better perception for therapeutic alliance progressively. It was

inferred that there was a difference between perception of Supervisor M and

Therapist K although these differences were not notable. The reason for this

difference could be related to the schemas of Supervisor M (i.e., unrelenting

standards and failure) and normative, pessimistic family origins of Supervisor M.

This meant that maybe although therapeutic alliance between Supervisor M and

88

Therapist K was satisfied, it could not be perceived as good enough by Supervisor

M due to his/her unrelenting standards and failure schemas (as Young explained in

Schema Theory, 1996). Moreover, maybe Supervisor M had tendency to evaluate

situations in a normative and pessimistic manner as his/her parents had done

before (Young, Klosko, & Weishaar, 2003). Besides, Therapist K was also aware

that there was something wrong in therapeutic alliance with Supervisor M during

3th and 4th sessions. It was thought that Therapist K generally was aware of reality

in the relationship with Supervisor M.

Nevertheless, for goal-oriented therapeutic alliance, Therapist K perceived

a stable therapeutic alliance with Supervisor M, while Supervisor M indicated

perception of decrement three times in therapeutic alliance with Therapist K. It

could be resulted from schemas of unrelenting standards, failure, and approval-

seeking of Supervisor M. Depending on these schemas’ structure (Young, 1996),

maybe, Supervisor M could not have considered positive things in supervision

environment, felt unsuccessful, and tried to get approval in order to feel satisfied.

It was thought that Supervisor M did not express his/her feelings and thoughts with

compensation mechanism of frostiness and avoidance mechanisms of emotional

control and social isolation. In this pattern, Supervisor M could have missed one of

the ideal therapist qualities (i.e., “therapist’s genuine self-expression of needs and

emotions”) which Young highlightened in Schema Theory (1999). On the other

hand, Therapist K having schemas from disconnection-rejection domain did not

notice what Supervisor M lived and s/he missed the reality with his/her

disconnected pattern. This could be arised from “mismatch between the client’s

needs and therapist’s schemas or coping styles” (as Young, Klosko, and Weishaar

asserted in the book of Schema Theory in 2003).

Moreover, Supervisor M experienced the fastest decrease in task oriented

therapeutic alliance with Therapist K. After 4th session, Supervisor M reported a

distinctive increment in task oriented relationship and a slight decrement in

following sessions. Then a slight increment appeared. Therapist K perceived a

slight decrease just one time in supervision period. It could be inferred that

Supervisor M perceived that there was a problem in getting responsibility and

fulfilling tasks between himself/herself and Therapist K. Maybe, Supervisor M

89

expected too much from Therapist K with activation of unrelenting standards and

entitlement (Young, 1996). On the other hand, it could be a problem totally related

to Therapist K. If so, it could be resulted from insufficient self-control of Therapist

K (“Pervasive difficulty or refusal to exercise sufficient self-control and frustration

tolerance to achieve one's personal goals” Young, 1996). With this schema,

Therapist K could not have fulfilled the responsibilities during supervision period.

Additionally, Therapist K who was unaware of this problem could have tried to

compensate defectiveness, abandonment, approval-seeking, and pessimism

schemas. If s/he had realized this problem, s/he could have felt defective; this

could have been a threat for being abandoned and not being approved by others,

and this could have caused pessimism. Therefore, Therapist K could have tried not

to perceive the problem unconsciously in order not to feel sadness, guilt, and pain

(avoidance from schemas; Young, 1996).

Furthermore, Supervisor M perceived a fluctuation for emotional bond

focused therapeutic alliance with Therapist K. At the end of the supervision

period, evaluation of Supervisor M, which started with perception of lower

emotional bond oriented therapeutic alliance, indicated increment. Supervisor M

even perceived better emotional bond compared to Therapist K at the end of

supervision period. On the contrary, Therapist K perceived a better emotional bond

oriented therapeutic alliance with Supervisor M at the beginning of the

supervision. After this perception reached to the top, a descending emotional bond

oriented therapeutic alliance was perceived from Therapist K. At the end of

supervision process, Therapist K perceived a worse emotional bond than

Supervisor M. It could be resulted from schemas of Supervisor M (i.e., pessimism,

approval-seeking) and unhealthy schema coping mechanism of frostiness (Young,

Klosko, & Weishaar, 2003). Furthermore, maybe, growing in an emotional

depriving family had caused a problem in order to attach, affiliate, giving and

taking love for Supervisor M (Typical family origin of other-directedness domain

in Schema Theory, Young, Klosko, & Weishaar, 2003). On the other hand, at 7th

session (as shown in Table 45), there happened something and Supervisor M

experienced a decrement in emotional bond with Therapist K. After this session,

Therapist K also started to perceive a lower level of emotional bond with

90

Supervisor M. It could be resulted from schemas of Therapist K, which took part

under domain of disconnection rejection. As Young asserted in Schema Theory

(1999) people having schemas from this domain were sensitive to read emotional

cues of others in order to check their availability. Since Therapist K had the

schemas of abandonment, mistrust/abuse, and social isolation, after s/he noticed

change in the evaluation of Supervisor M for emotional bond, s/he did not perceive

their therapeutic emotional bond better any more. Maybe, Therapist K, with

mistrust/abuse schema and utilizing coping mechanisms of frostiness and

counterdependency, realized the perception of Supervisor M and believed that it

was not something situational (general attitude) even if it changed in time for

Supervisor M.

Table 42.General Therapeutic Alliance between Supervisor M and Therapist K

0

1

2

3

4

5

6

7

Supervisor M

Therapist K

91

Table 43.Goal Oriented Therapeutic Alliance between Supervisor M and Therapist K

Table 44.Task Oriented Therapeutic Alliance between Supervisor M and Therapist K

0

1

2

3

4

5

6

7

Supervisor M

Therapist K

0

1

2

3

4

5

6

7

Supervisor M

Therapist K

92

Table 45.Emotional Bond Oriented Therapeutic Alliance between Supervisor M and Therapist K

3.5.2.5. Therapeutic Alliance between Therapist B and Client C

depending on Qualitative Measurement and Its Associations with Schema

Theory

In accordance with the results of projective measurement (See Figure 6),

Supervisor M thought that the client took part out of the goals of Therapist K,

whereas Therapist K asserted that the client had overlapping goals with Supervisor

M and Therapist K even if they were not in big amount. On the other hand,

Therapist K expressed that s/he agreed upon all goals with Supervisor M.

However, Supervisor M reported overlapping goals with Therapist K in relational

cycles, but they were not completely overlapped. At that point, there was a

difference between perception of Supervisor M and Therapist K. It could be

resulted from Therapist K’s schema of entitlement/grandiosity and coping

mechanism of intolerance to criticism. Accordingly, maybe, Therapist K could not

have wanted to accept his/her lack of goal oriented therapeutic alliance with

Supervisor M (overcompensation for entitlement/grandiosity; Young, 1996). From

another viewpoint, maybe Supervisor M could have achieved to give trust to

Therapist K. Although Therapist K had schemas related to disconnection-rejection,

s/he perceived an agreed upon relationship in terms of goals (one of the ideal

0

1

2

3

4

5

6

7

Supervisor M

Therapist K

93

therapist qualities (i.e., secure attachment) expressed in Schema Theory, Young,

Klosko, & Weishaar, 2003).

For task-oriented therapeutic alliance (See Figure 6), unlike quantitative

measurements, Therapist K in projective measures indicated that s/he had

awareness for that s/he could not have fulfilled responsibilities/tasks given by

Supervisor M as well as his/her client. Maybe, quantitative methods activated a

coping mechanism to decrease negative emotions based on maladaptive schemas

in order to suppress pain related to schemas. They were superficial and inadequate

to show reality. However, projective measures could have made participants open

his/her implicit mind and indicated reality. According to Kelly (1932), implicit

measurement was a kind of map revealing latent part of the human psychology and

increasing insight. Therefore, relational cycles could have revealed awareness of

lack of responsibility of Therapist K even if this was a difficult topic to tackle for

Therapist K with insufficient self-control and defectiveness schemas. On the other

hand, Supervisor M, in projective evaluations, explained that s/he had perceived an

equal task distribution among supervisor, therapist, and the client. Although

Therapist K had difficulty taking responsibility, Supervisor M draw attention

his/her trials to achieve. Maybe, since Supervisor M grow up in a family

environment in which normative, pessimistic, emotional depriving, and

conditional/achievement focused parent took part, s/he tried to compensate this

parenthood pattern by drawing attention positive behaviors of Therapist K

(reparenting of therapist with awareness of his/her own schemas, Young, Klosko,

& Weishaar, 2004).

In terms of emotional bond oriented therapeutic alliance (See Figure 6),

Supervisor M reported no emotional bond oriented alliance between Therapist K

and the client. According his/her relational cycle explaining this pattern,

Supervisor M tried to be a bridge between them. It could be related to self-sacrifice

schema of Supervisor (“client’s triggering the schemas of therapist and therapist’s

overcompensation” as explained by Young, Klosko, & Weishaar, 1996).

Conversely, Therapist K defined overlapping/shared areas among supervisor,

therapist, and the client even if it was not remarkable. Although Therapist K

mentioned s/he had benefited from directions for goals and tasks of Supervisor M,

94

Therapist K indicated a small amount of overlapping area with Supervisor M for

emotional bond oriented therapeutic alliance. It could be resulted from Therapist

K’s schemas of mistrust/abuse, abandonment, and social isolation. With these

schemas, Therapist K could have had difficulty make bonds, trust, and attach to

others especially for the people in the role of parent (Young, 1996).

According to open-ended question form, it was understood that Supervisor

M (See Figure 7) had high awareness and insight. S/he sometimes had difficulties

in transferring his/her observations to words, felt anxiety, but s/he did not give up

fighting against challenges. Maybe, this could be related to his/her schemas of

unrelenting standards and failure (maintenance of schemas and focusing success

oriented approval, Young, 1996) or maybe s/he was aware of his/her relational

patterns and learned to behave in a healthy way. On the other hand, Therapist K

(See Figure 8) was aware of his/her schema of unrelenting standards. Accordingly,

excessive need of acceptance and connection maybe was compensated with

unrelenting standards (Young, 1996). However, this schema could have created a

dependent pattern. Therapist K, who behaved out of rules during supervision,

maybe unintentionally tried to break this dependent pattern. Moreover, Therapist

K had defectiveness schema and maybe this brought intolerance to criticism.

Therefore, although open communication was perceived something positive,

Therapist K could not benefit from it completely. Maybe, s/he needed further

support to learn how to tackle with his/her schemas.

95

Supervisor M Therapist K

G

O

A

L

O

R

I

E

N

T

E

D

Explanation: The goals of client making his/her to apply to therapy and the goals handled in supervision process changed in time. It was thought that the most important reason why the patient took part in outside of supervision process was his/her trying to make therapy a part of his/her cycle of relationship. The client had difficulty to come to the same point with therapist’s transference.

Explanation: My supervisor approved what I aimed for the client and tried to make me handle other aims which I had not been aware of and was important for the client. We handled the goals which the client mentioned in the therapy; however, we noticed that the client unconsciously perceived psychotherapy process as a place which s/he could exhibit his/her being victim rather than seeking for help. Accordingly, we noticed that the aim of the client which brought him/her to therapy was out of our aims.

T

A

S

K

O

R

I

E

N

T

E

D

Explanation: Despite having difficulty with working this client, the therapist tried to fulfill his/her responsibilities with supervisor and tried to keep in touch with the client. Counting both the therapist and the client in this process, the supervisor determined tasks which would develop self-improvements of the therapist and the client and paid attention feedbacks coming from both of them in this process.

Explanation: As the therapist did not fulfill the tasks given by supervisor, there were some parts which the client also did not fulfill the tasks given by the therapist and responsibilities in therapy process.

E

M

O

T

I

O

N

A

L

Explanation: Due to his/her personal processes, the therapist had difficulty to make emotional bonds with the client. The supervisor tried to balance in between. Handling personal process of the therapist; the supervisor tried the client not to keep outside of this process.

Explanation: There were emotional processes and empathy consisting from interconnected bonds of everybody. Nevertheless, these interconnected emotional bonds included small portions in individual processes.

Figure 6. Projective measurement of therapeutic alliance for Supervisor M Note: S = Supervisor A, T = Therapist B, C = Client C

S

C

T S

C

T

S

C T

S

T

C

T C S

S

C T

96

Figure 7. Projective measurement of therapeutic alliance for Supervisor M Note: S = Supervisor A, T = Therapist B, C = Client C


I had difficulty to deal with passive reactions indicated from a therapist when personal processes

of other therapist were being handled. I was noticing that other therapists were also affected from

his/her passive resistance, but I was not dealing with his/her style efficiently. This was damaging

the dynamic of the group, making me angry and anxious.


I noticed that one of the therapists was drawing on a paper during his/her supervision. However, I

waited until process with others had been terminated. Then, I started with asking what s/he had

drawn. After understanding his/her shame due to his/her being noticed, we mentioned his/her

general attitudes when s/he did something shameful and his/her aggression which s/he exhibited

until now. After handling the experiences under the roots of this attitude and adding personal

experiences of other therapists, both my anger and anxiety dissolved distinctively. Feeling of

relaxed for understanding him/her caused change not only for me but also for him/her (in a

positive direction).


This semester, I had difficulty in doing report homework in a given time (despite I obeyed the

rules more compared to the past semester) and especially its effect on one of my supervisors.

Since I have had a trouble in fulfilling the things that I did not want through my life, this

reverberated to the supervision, which was a course.


When my supervisor questioned the reasons of my behavior, whether I gave importance to the

supervisions or not, s/he understood that this problem was not just related to this process, I had

also passive aggressive attitudes towards the tasks given by figures of authority and we talked

why I had revealed this pattern. This conversation provided an open communication, but I did not

get over my problem yet.

Figure 8. Open-ended Questions and Answers for Supervisor M

Figure 9. Open-ended Questions and Answers for Therapist K

97

3.6.General Discussions

3.6.1. Contributions of the Study

The present study was unique and important for applied psychology

literature depending on many factors. Firstly, any study examining the relationship

between early maladaptive schemas, avoidance schema coping, schema

compensation, and parenting styles expressed in Schema Theory and therapeutic

alliance among supervisors, therapists, and clients was not conducted before.

Secondly, this study indicated that supervisors’ and therapists’ own personal

history were important to examine how they built relationship during supervision

and therapy process as well as clients’ personal history. Thirdly, the study revealed

that therapeutic alliance could not be measured by quantitative inventories good

enough since quantitative measurement was not explaining how participants

perceived this process. Accordingly, a new projective measure was developed for

this study. This measurement method indicated that supervisors, therapists, and

clients had different processes in their minds. Quantitative methods were not

competent to determine what participants really thought about relationship with

their partners since it could be filled quickly. However, projective measurement

made participants to think about therapeutic alliance in detail. Therefore, it could

reach to implicit knowledge. Furthermore, in order to analyze the relationship

between supervisors and therapists, therapeutic alliance inventory developed via

adaptation of items of therapeutic alliance therapist and client forms. Moreover,

this study became an example for how a clinician could associate schema therapy

concepts and interpersonal relations. Finally, this study was important since it was

the pioneer to give information on how supervision and therapy processes could be

developed and organized.

98

3.6.2. General Discussion for the Results

According to the results, it was found that therapeutic alliance was affected

from schemas, schema origins, and schema coping mechanisms of supervisors,

therapists, and the clients. The schemas, origins of schemas, schema coping among

supervisors, therapists, and the clients created risky situation in therapy or

supervision period when they were similar or complementary. Firstly, if there was

a similarity, it created sympathy or repulsion among participants. If this was

sympathy, the participant under the effect of this similarity (supervisor or

therapist) tried to behave contrary to them. This viewpoint depended on the

thought that “I was affected negatively from my parents’ maladaptive attitudes

during my childhood, therefore I should behave contrary to my parents’ attitude.”

This behavior could be beneficial if it was limited in empathy. Holland (1997) also

expressed that similarity between therapist and client could cause a positive

interpersonal relationship. According to Taber, Leibert, Agaskar (2011),

congruence between therapist and client was especially associated with bon

oriented therapeutic alliance whereas task and goal oriented ones were related to

therapeutic outcome. However, if the supervisors or the therapists overvalued this

similarity (trying to make changes which s/he could not make before), s/he could

miss differences of therapist or client (working on his/her childhood problems

unconsciously). According to Duan and Hill (1996), there were two types of

empathy (i.e., intellectual empathy and emotional empaty). Firstly, intellectual

empathy consisted of therapist’s understanding viewpoint, needs, and emotions of

the client. Secondly, emotional empathy included therapist’s giving response to

emotion of the client with the same emotion. This was caused by overemphasis of

similarity and could cause losing objectivity (Duan & Kivlighan, 2002; Ladany,

Miller, Erickson, & Muse-Burke, 2000). On the other hand, if this was repulsion,

this could be related to that supervisors or therapists could see their unwanted sides

(that they could not achieve to change and accept) in the lives of therapists and

clients. It could seem ugly. If these supervisors and therapists were lack of insight,

they could behave as their parents behaved those years ago since they were not

aware of the reasons of their problematic sides (maintenance of the schemas,

99

Young, 1996). This could feed maladaptive structure. Secondly, if there were

complementary schemas, schema origins, and schema coping among supervisors,

therapists, and the clients, this could be risky since it could be facilitative for

continuation maladaptive patterns (Chapter of The Therapy Relationship in

Schema Therapy Book, Young, Klosko, & Weishaar, 2003). Depending on this

commend, it can be inferred that supervisors or therapists should have insight and

awareness for their own schemas, schema origins, and schema coping in order to

differentiate whether the problems faced in supervision or therapy are related to

themselves or others. This reveals the importance of receiving psychotherapy as

supervisor or therapist or receiving supervision focusing on personal backgrounds

of supervisors and therapists (Geller, Orlinsky, & Norcross, 2005; Macran, Stiles,

& Smith, 1999; Safran & Segal, 1996; Sidney, 2013). Moreover, despite receiving

psychotherapy, supervisors, and therapists sometimes can face with difficulty in

therapeutic relationship and they cannot determine the reasons. This could be

related to blind spots of them (i.e., they even do not know how to deal with some

problems in their life). In order to solve these problems, a position of another

person (i.e., supervisor) evaluating this process objectively is necessary in order to

mirror blind spot and teach how to tackle these problems. According to Rosenfeld

(2010), the effect of supervision period is depending on some factors. Firstly, it is

related to therapist’s personal problems pointed in supervision. Secondly,

characteristics of supervisors contribute to development of therapists. Thirdly,

feeling understood and being respected by supervisors are important for therapists

for an open supervision relationship. Fourthly, a trustful supervision environment

is important for working alliance. Moreover, setting boundaries between

supervisors and therapist cause either fostering student relationship or hierarchical

supervision relationship. Finally, supervisors lead therapist to make connections

between past and future experiences.

100

3.6.2.1. Rationale of Using YSQ with its 18 Schemas

Considering early maladaptive schemas derived from YSQ (Young, 1999),

though the original form offers 18 schemas (1999), Turkish adaptation conducted

by Soygüt, Karaosmanoğlu, and Çakır (2009) revealed 14 schemas. However,

many studies conducted with YSQ use their own factor structure, and the numbers

of utilized schemas tend to vary between 13 and 21. Thus in the literature there is

no consistency over the number of schemas involved in the studies (e.g., Baranoff,

Oei, Ho, Cho, & Kwan, 2006; Hawke & Provencher, 2012; Hoffort et al., 2005;

Lee, Taylor, & Dunn, 1999; Saariaho, Saariaho, Karila, & Joukama, 2009).

In Turkey, many studies were conducted by using the original factor

structure of YSQ (i.e., 18). According to study of Sarıtaş (2007), in order to

examine mediator role of early maladaptive schemas between the relationship of

perceived maternal rejection and psychological distress of adolescents, eighteen

schemas and three schema domains created from factor analyses were utilized.

Moreover, Köse (2009) utilized original schema structure of Young (1999) to

examine the possible influences of demographic variables (i.e., age, gender,

marital status, sibling number, mother’s education, father’s education) on the

various measures of schema domains, self-orientations, and well-being measures

(i.e. depression, positive affect, negative affect, and reassurance-seeking); the

differences of schema domains on self-orientations of Balanced Integration

Differentiation Model and also on well-being, and the differences of four self-

construals of Balanced Integration Differentiation Model on schema domains and

well-being measures. Besides, Gök (2012) conducted a study to investigate

associated factors (i.e., early maladaptive schemas, schema coping processes, and

parenting styles) of psychological well-being, by using the YSQ with its 18

schemas. Furthermore, Ünal (2012) analyzed early maladaptive schemas and well-

being in relation with importance of parenting styles and other psychological

resources by using the schema domains derived from 18 original factor structure of

YSQ. Additionally, Özbaş, Sayın, and Coşar (2012) examined the relationship

between early maladaptive schemas and anxiety of examination for the students

preparing for university entrance exam by using the original factors of schemas

101

and schema domains. Besides, Aslan, Taymur and Türkçapar (2012), investigated

the cognitive profiles of coronary artery disease patients with or without comorbid

anxiety disorder by using original schema domains constituted from eighteen

schemas.

Soygüt, Karaosmanoğlu, and Çakır (2009) adapted YSQ to Turkish and

found a different factor structure than original form. According to this study,

fourteen schemas (namely, emotional deprivation, failure, pessimism, social

isolation/mistrust, emotional inhibition, approval-seeking,

enmeshment/dependency, entitlement/insufficient self-control, self-sacrifice,

abandonment, punitiveness, defectiveness, vulnerability to harm, and unrelenting

standards) and five schema domains (i.e., impaired autonomy, disconnection,

unrelenting standards, other-directedness, and impaired limits) were determined.

Considering the qualitative nature of the present study, the original factor

structure (Young, 1999) was preferred instead of the adapted 14 schemas (Soygüt,

Karaosmanoğlu, & Çakır, 2012). Since the present study was not a quantitative

one, it did not aim to compare the obtained results with the available quantitative

outcome. Instead, qualitative studies aim at obtaining detailed information and its

comprehension. Thus, in order to enrich the study and discussions, since detailed

information was needed for the qualitative studies, 18 factors of YSQ -the original

schema domains of Young (1999) were preferred over 14 factors. Furthermore,

using original domains suggested by Young, provided opportunity to simplify

results and increase comprehension.

Thus, for the clarification and explanation of the obtained results the

maladaptive schemas were discussed by referring to the schema domains

suggested by Young (1999). Likewise, Sarıtaş and Gençöz (2011) studied schema

domains in a Turkish adolescent sample by using the original 18 schemas, and

they revealed 3 schema domains (namely; “impaired limits-exaggerated

standards”, “disconnection-rejection”; “impaired autonomy-other directedness”)

that are similar to the original ones, where two of the original domains merged into

the others.

Considering that other schema related questionnaires (i.e., Young Parenting

Inventory, Young-Rygh Avoidance Inventory, and Young Compensation

102

Inventory) did not have domain-oriented subscales, Turkish adapted forms of these

scales were used in the current study.

3.6.3. Limitations of the Study and Future Directions

Although this study was unique and important for the literature, it had

some limitations due to the nature of research structure and settings. Firstly,

although more clients were willing to participate to this study at the beginning of

the study, some of them quitted filling inventories during research process.

Therefore, therapeutic alliance could be examined by analyzing the relationship

between supervisor and therapist mostly in the study. Secondly, therapeutic

alliance between pairs of supervisor-therapist and therapist-client could not

measure concurrently. Correspondingly, it was not known how therapeutic alliance

between supervisor and therapist reflected to therapeutic alliance session by

session, instead a general effect between these pairs was examined. Thirdly,

although therapeutic alliance was measured session by session, it was not known

why therapeutic alliance increased and decreased in some sessions. The issues,

which were handled at these sessions, were not known. Fourthly, although this

research included many case studies, only two of them could be mentioned in this

dissertation due to the limitations of space. Moreover, as statistical methods,

correlation, and descriptive statistics were used. However, this research setting

could be utilized for hierarchical linear modeling. Furthermore, although the levels

of education were same and participants were mostly females, demographic

characteristics could not be mentioned due to confidentiality reasons.

103

REFERENCES

Agnew Davies, R., Stiles, W. B., Hardy, G. E., Barkam, M., & Shapiro, D. A.

(1998). Alliance structure assessed by the Agnew Relationship

Measure (ARM). British Journal of Clinical Psychology, 37, 155−172.

Allen, J. G., Newsom, G. E., Gabbard, G. O., & Coyne, L. (1984). Scales to assess

the therapeutic alliance from a psychoanalytic perspective. Bulletin of

the Menninger Clinic, 48, 383−400.

Anderson, R., & Anderson, G. (1962). Development of an instrument for

measuring rapport. Personal Guidance Journal, 41, 18-24.

Aslan, H., Taymur, İ., & Türkçapar, M. H. (2012). Evaluation of cognitive

schemas based on the presence of anxiety disorder among coronary artery

disease patients. Journal of Cognitive-Behavioral Psychotherapy and

Research, 1(3), 171-177.

Arntz, A. (2012). Schema Therapy for Cluster C Personality Disorders, in The

Wiley- Blackwell Handbook of Schema Therapy: Theory, Research, and

Practice (eds. M. van Vreeswijk, J. Broersen and M. Nadort), John Wiley

& Sons, Ltd, Chichester, UK.

Aron, L. (1996). A meeting of minds: Mutuality in psychoanalysis. Hillsdale, NJ:

Analytic Press.

Bachelor, A. (1987). The counseling evaluation inventory and the counselor rating

form: Their relationship to perceived improvement and to each other.

PsychologicalReports, 61(2), 567−575.

Baillargeon, P., Cote, R., & Douville, L. (2012). Resolution process of therapeutic

alliance ruptures: A review of the literature. Psychology, 3(12), 1049-1058.

Baranoff, J., Oei, T. P. S., Ho Cho, S., & Kwon, S.-M. (2006).Factor structure and

internal consistency of the Young Schema Questionnaire (Short Form) in

Korean and Australian samples. Journal of Affective Disorders, 93, 133–

140.

Barrett-Lennard, G. T. (1962). Dimensions of therapist response as casual factors

in therapeutic change. Psychological Monographs, 76, 562.

104

Barrett-Lennard, G. T. (1986). The relationship inventory now: Issues and

advances in theory, method and use. In L. S. Greenberg & W.M. Pinsof

(Eds.), The psychotherapeutic process: A research handbook (pp.

439−467). New York and London: Guilford Press.

Beck, A. T., Rush, J. A., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of

depression. New York: Guilford Press.

Bell, D. (1997). Reason and Passion. London

Bell, M., Billington, R., & Becker, B. (1986). A scale for the assessment of object

relations: Reliability, validity, and factorial invariance. Journal of Clinincal

Psychology, 42, 733-741.

Berne, E. (1975). What do you say after you say hello? London.

Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the

working alliance. Psychotherapy: Theory, Research, and Practice, 16, 252-

260.

Bordin, E. S. (1980). Of human bonds that bind or free. Presidential Address to

Tenth Annual Convention of Society for Research on Psychotherapy,

Pacific Grove, California.

Bordin, E. (1983). Supervision in counseling: II Contemporary models of

supervision: A working alliance based model of supervision.

CounselingPsychologist, 11, 35–42.

Bordin, E. S. (1994). Theory and research on the therapeutic working alliance:

New directions. In A. O. Horvath & L. S. Greenberg (Eds.), The working

alliance: Theory, research and practice (pp. 13-37). New York: Wiley.

Bowlby, J. (1988). A Secure Base. New York: Basic Books.

Braswell, L., Kendall, P. C., Braith, J., Carey, M. P., & Vye, C. S. (1985).

Involvement in cognitive-behavioral therapy with children: process and its

relationship to outcome. Cognitive Therapy and Research, 9, 611−630.

Brenner, C. (1979). Working alliance, therapeutic alliance, and transference.

Journal of the American Psychoanalytic Association, 27, 136-158.

Cabrera, N. J., Tamis-LeMonda, C. S., Bradley, R. H., Hofferth, S., & Lamb, M.

E. (2000). Fatherhood in the twenty-first century. Child Development, 71,

127-136.

105

Carson, R. C. (1969). Interaction concepts of personality. Oxford, England:

Aldine.

Castonguay, L. G., Constantino, M. J., & Grosse Holtforth, M. (2006). The

working alliance: Where are we and where should we go? Psychotherapy:

Theory, Research, Practice, Training, 43(3), 271−279.

Derlega, V. J., & Chaikin, A. L. (2010). Privacy and self-disclosure in social

relationships. Journal of Social Issues, 33(3), 102-115.

Cashdan, S. (1988). Object Relations Therapy. New York: Norton & Company, s.

53-78.

Constantino, M. J., Arnow, B., Blasey, C., & Agras,W. S. (2005). The association

between patient characteristics and the therapeutic alliance in cognitive-

behavioral and interpersonal therapy for bulimia nervosa. Journal of

Consulting and Clinical Psychology, 73, 203−211.

Creed, T. A., & Kendall, P. C. (2005). Therapist alliance – building behavior

within a cognitive – behavioral treatment for anxiety in youth. Journal of

Consulting and Clinical Psychology, 73(3), 498−505.

Crits-Christoph, P., Baranackie, K., Kurcias, J. S., Beck, A. T., Carroll, K., Perry,

K.,Luborsky, L., McLellan, A. T., Woody, G. E., Larry, T., Gallagher, D.,

& Zitrin, C. (1991). Meta-analysis of therapist effects in psychotherapy

outcome studies. Psychotherapy Research, 1(2), 81-91.

Curtis, H. C. (1979). The concept of the therapeutic alliance: Implications for the

“widening scope”. Journal of the American Psychoanalytic Association,

27, 159-192.

Di Giuseppe, R., Linscott, J., & Jilton, R. (1996). Developing the therapeutic

alliance in child-adolescent psychotherapy. Applied and Preventive

Psychology, 5, 85−100.

Driver, C., Martin, E., Banks, M., Mander, G., & Stewart, J. (2002). Supervising

Psychotherapy. London: Sage Publications.

Duan, C., & Hill, C. E. (1996). The current state of empathy research. Journal of

Counseling Psychology, 43, 267-274.

106

Duan, C., & Kivlighan, D. M. (2002). Relationships among therapist presession

mood, therapist empathy, and session evaluation. Psychotherapy Research,

12(1), 23-37.

Durlak, J. A. (1998). Common risk and protective factors in successful prevention

programs. American Journal of Orthopsychiatry, 68(4), 512-520.

Eckler-Hart, A. H. (1987). True and false self in the development of

psychotherapist. Psychotherapy: Theory, Research, Practice, Training,

24(4), 683-692.

Efstation, J. F., Patton, M. J., & Kardash, C. M. (1990). Measuring the working

alliance in counselor supervision. Journal of Counseling

Psychology, 37,322–329.

Elliott, R., Watson, J. C., Goldman, R. H., & Greenberg, L. S. (2004). Learning

emotion-focused therapy: The process-experiential approach to change.

Washington, DC: American Psychological Association.

Ellis, M. V. (1991). Critical incidents in clinical supervision and in supervisor

supervision: Assessing supervisory issues. Journal of Counseling

Psychology,38, 342-349.

Elvins, R., & Green, J. (2008). The conceptualization and measurement of

therapeutic alliance: An empirical review. Clinical Psychology Review, 28,

1167–1187.

Estrada, A., & Russell, R. (1999). The development of the child psychotherapy

process scales (CPPS). Psychotherapy Research, 9, 154−166.

Eugster, S. L., &Wampold, B. E. (1996). Systematic effects of participant role on

evaluation of the psychotherapy session. Journal of Consulting and

Clinical Psychology, 64(5), 1020−1028.

Fleischer, J. A., & Wissler, A. (1985). The therapist as patient: Special problems

and considerations. Psychotherapy, 22(3), 587-594.

Florsheim, P., Shotorbani, S., Guest-Warnick, G., Barrett, T., & Hwang, W. C.

(2000). Role of the working alliance in the treatment of delinquent boys in

community based programs. Journal of Clinical Child Psychology, 29,

94−107.

107

Frank, A. F., & Gunderson, J. G. (1990). The role of the therapeutic alliance in the

treatment of schizophrenia. Relationship to course and outcome. Archives

of General Psychiatry, 47, 228−236.

Frank, J. D., & Frank, J. B. (1991). Persuasion and Healing: A comparative study

of psychotherapy, (3rd Ed) Baltimore: Johns Hopkins University Press.

Freud, S. (1912). Standard Ed. The dynamics of transference. In Complete

Psychological Works, vol. 12. (pp. 97−108)London: Hogarth Press.

Freud, S. (1913). On beginning the treatment: Further recommendations on the

technique of psychoanalysis. Standard edition of the completeworks of

Sigmund Freud (pp. 97-108). London: Hogarth Press.

Freud, S. (1966). On the beginning the treatment. In J. Strachey (Ed. and Trans.),

The standard edition of the complete psychological works of Sigmund

Freud (Vol. 12, pp. 112-144). London: Hogarth Press. (Original wok

published in 1913

Frieswyk, S. H., Allen, J. G., Colson, D. B., Coyne, L., Gabbard, G. O., Horwitz,

L., & Newsom, G. (1986). Therapeutic alliance: Its place as a process and

outcome variable in dynamic psychotherapy

research. Journal of Consulting and Clinical Psychology, 54, 32-38.

Friedlander, M. L., Horvath, A. O., Cabero, A., Escudero, V., Heatherington, L., &

Martens, M. P. (2006). System for observing family therapy alliances: a

tool for research and practice. Journal of Counseling Psychology, 53(2),

214−224.

Frieswyk, S. H., Allen, J. G., Colson, D. B., Coyne, L., Gabbard, G. O., Horwitz,

L., & Newsom, G. (1986). Therapeutic alliance: Its place as a process and

outcome variable in dynamic psychotherapy research. Journal of

Consulting and Clinical Psychology, 54, 32-38.

Geller, J., Orlinsky, D., & Norcross, J. (2005). The psychotherapist’s own

psychotherapy: Client and clinician perspectives. New York, NY: Oxford

University Press.

Gelso, C. J., & Carter, J. A. (1985). The relationship in counseling and

psychotherapy: Components, consequences, and theoretical antecedents.

The Counseling Psychologist, 13, 155-244.

108

Gelso, C. J., & Carter, J. A. (1994). Components of the psychotherapy

relationship: Their interaction and unfolding during treatment. Journal of

Counseling Psychology, 41(3), 296-306.

Gelso, C. J., & Hayes, J. A. (1998). The psychotherapy relationship: Theory,

research, and practice. New York: John Wiley.

Glickauf-Hughes, C., & Mehlman, E. (1995). Narcissistic issues in therapists:

Diagnostic and treatment considerations. Psychotherapy: Theory,

Research, Practice, Training, 32(2), 213-221.

Gomes-Schwartz, B. (1978). Effective ingredients in psychotherapy: prediction of

outcome from process variables. Journal of Consulting and Clinical

Psychology, 46, 1023−1035.

Gorin, S. (1993). The prediction of child psychotherapy outcome: Factors specific

to treatment. Psychotherapy, 30(1), 152−158.

Gök, A. C. (2012). Associated factors of psychological well-being: Early

maladaptive schemas, schema coping processes, and parenting styles.

Unpublished master’s thesis, Middle East Technical University, Ankara,

Turkey.

Green, J., Kroll, L., Imre, D., Frances, F. M., Begum, K., & Gannon, L. (2001).

Health gain and predictors of outcome in inpatient and day patient child

psychiatry treatment. Journal of the American Academy of Child and

Adolescent Psychiatry, 40, 325−332.

Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). Facilitating emotional change.

New York: Guilford Press.

Greenson, R. R. (1965). The working alliance and the transference neuroses.

Psychoanalysis Quarterly, 34, 155-181.

Greenson, R. R. (1967). The technique and practice of psychoanalysis. New York:

International Universities Press, Inc.

Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social

consequences. Psychophysiology, 39(3), 281-291. Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation

processes: Implications for affect, relationships, and well-being. Journal of

Personality and Social Psychology, 85(2), 348-362.

109

Hawke, L. D., & Provencher, M. D. (2012). The Canadian French young schema

questionnaire: Confirmatory factor analysis and validation in clinical and

nonclinical samples. Canadian Journal of Behavioural Science, 44(1), 40-

49.

Hinshelwood, R., Robinson, S. & Zarate, O. (2006). Introducing Melanie Klein.

Cambridge.

Hoffart, A., Sexton, H., Hedley, L. M., Wang, C. E., Holthe, H., Haugum, J. A.,

Nordahl, H. M., Hovland, O. J., & Holte, A. (2005). The structure of

maladaptive schemas: A confirmatory factor analysis and a psychometric

evaluation of factor-derived scales. Cognitive Therapy and Research,

29(6), 627–644.

Holland, J. L. (1997). Making vocational choices (3rd ed.). Odessa, FL:

Psychological Assessment Resources

Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in

individual psychotherapy. Psychotherapy, 48(1), 9-16.

Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the

Working Alliance Inventory. Journal of Counseling Psychology, 36, 223-

233.

Horvath, A. O., & Symonds, D. B. (1991). Relation between working alliance and

outcome in psychotherapy; A meta analysis. Journal of Counseling

Psychology, 38(2),139−149.

Hougaard, E. (1994). The therapeutic alliance: A conceptual analysis.

Scandinavian Journal of Psychology, 35, 67−85.

Huppert, J. D., Kivity, Y., Barlow, D. H., Gorman, J. M., Shear, K., & Woods, S.

W. (2014). Therapist effects and the outcome-alliance correlation in

cognitive behavioral therapy for panic disorder with agoraphobia. Behavior

Research and Therapy, 52, 26-34.

Jacobs, C. (1991). Violations of the supervisory relationship: An ethical and

educational blind spot. Social Work, 36, 130-135.

Johnson, S. (2001). The therapeutic alliance with early adolescents: Introduction of

an instrument. Dissertation Abstracts International, 61(10), 5567B.

Johnson, S., Hogue, A., Diamond, G., Leckrone, J., & Liddle, H. A. (1998).

110

Scoring manual for the Adolescent Therapeutic Alliance Scale (ATAS).

Philadelphia: Temple University Unpublished manuscript.

Jung, C. G. (1976). Analytical psychology: Its theory and practice. London.

Karaosmanoğlu, A., Soygüt, G., & Kabul, A. (2011). Psychometric properties of

the Turkish Young Compensation Inventory. Clinical Psychology and

Psychotherapy. Published online in Wiley Online Library

(wileyonlinelibrary.com). DOI: 10.1002/cpp.78.

Kazdin, A. E., Holland, L., Crowley, M., & Breton, S. (1997). Barriers to

treatment participation scale: Evaluation and validation in the context of

child outpatient treatment. Journal of Child Psychology and Psychiatry,

38(8), 1051−1062.

Kazdin, A. E., & Nock, M. K. (2003). Delineating mechanisms of change in child

and adolescent therapy: Methodological issues and research

recommendations. Journal of Child Psychology and Psychiatry, 44,

1116−1129.

Kelly, F. D. (1997). The psychological assessment of abused and traumatized

children. Mahwah, NJ: Erlbaum.

Kendall, P. C. (1994). Treating anxiety disorders in children: results of a

randomised controlled trial. Journal of Consulting and Clinical

Psychology, 62, 100−110.

Kiesler, D. J. (1988). Therapeutic metacommunication: Therapist impact

disclosure as feedback in psychotherapy. Palo Alto, CA: Consulting

Psychologist Press.

Kiesler, D. J. (1996). Contemporary interpersonal theory and research:

Personality, psychopathology, and psychotherapy. New York: Wiley.

Kim, S. C., Boren, D. M., & Solem, S. L. (2001). The Kim alliance scale:

Development and preliminary testing. Clinical Nursing Research, 10,

314−331.

Klein, M. (1932). The psychoanalysis of children. London: Hogarth Press.

Klein, M. (1952). “Some Theoretical Conclusions Regarding the

111

Emotional Life of the Infant” in Developments in Psychoanalysis, London:

Hogarth Press.

Köse, B. (2009). Associations of psychological well-being with early maladaptive

schemas and self-construals. Unpublished master’s thesis. Middle East

Technical University, Ankara, Turkey.

Kroll, L., & Green, J. M. (1997). Therapeutic alliance in inpatient child psychiatry.

Development and initial validation of the family engagement questionnaire.

Clinical Child Psychology and Psychiatry, 2(3), 431−447.

Ladany, N., Constantine, M. G., Miller, K., Erickson, C. D., & Muse-Burke, J. L.

(2000). Supervisor countertransference: A qualitative investigation into its

identification and description, Journal of Counseling Psychology, 47(1),

102-115.

Lamb, M. E. (1975). Fathers: Forgotten contributors to child development. Human

Development, 18(4), 245-266.

Lamb, M. E., Pleck, J. H., & Levine, J. A. (1985). The role of the father in child

development. Advances in Clinical Child Psychology, 8, 229-266.

Leary, T. (1957). Interpersonal diagnosis of personality. New York: Ronald Press.

Lee, C. W., Taylor, G., & Dunn, J. (1999). Factor structure of the schema

questionnaire in a large clinical sample. Cognitive Therapy and Research,

23(4), 441-451.

Levenson, H. (1995). Time-limited dynamic psychotherapy: A guide to clinical

practice. New York: Basic Books.

Linden, J., Stone, J., & Shertzer, B. (1965). Development and evaluation of an

inventory for rating counseling. Personnel and Guidance Journal, 44,

267−276.

Luborsky, L. (1976). Helping alliances in psychotherapy. In J. L. Claghorn (Ed.),

Successful psychotherapy (pp. 92-116). New York: Brunner/Mazel.

Luborsky, L. (1984). Principles of Psychodynamic Psychotherapy. New York:

Basic Books.

Luborsky, L., Chandler, M. Auerbach, A. H., Cohen, J., & Bachrach, H. M.

(1971). Factors influencing the outcome of psychotherapy: A review of

quantitative research. Psychological Bulletin, 75(3), 145-185.

112

Luborsky, L., Singer, B., & Luborsky, L. (1975). Comparative studies of

psychotherapies: Is it true that "Everyone has won and all must have

prizes?” Archives of General Psychiatry, 32, 995-1008.

Ludwig, A. M. (1983). The psychobiological functions of dissociation. American

Journal of Clinical Hypnosis, 26(2), 93-99.

Macran, S., Stiles, W. B., & Smith, J. A. (1999). How does personal therapy affect

therapist’s practice. Journal of Counseling Psychology, 46, 419-431.

Marmar, C. R., Horowitz, M. J.,Weiss, D. S., & Marziali, E. (1986). The

development of the therapeutic alliance rating system. In L. S. Greenberg

&W.M. Pinsof (Eds.), The psychotherapeutic process: A research

handbook (pp. 367−390). New York and London: Guilford Press.

Marmarosh, C. L., Gelso, C. J., Markin, R. D., Majors, R., Mallery, C., & Choi, J.

(2009). The real relationship in psychotherapy: Relationships to adult

attachments, working alliance, transference, and therapy outcome. Journal

of Counseling Psychology, 56(3), 337-350.

Marziali, E., Marmar, C., & Krupnick, J. (1981). Therapeutic alliance scales:

development and relationship to psychotherapy outcome. Journal of

Nervous and Mental Disease, 172, 417−423.

Mayers, D., & Hayes, J. A. (2006). Effects of therapist general self-disclosure and

countertransference disclosure on ratings of the therapist and session.

Psychotherapy: Theory, Research, Practice, Training, 43(2), 173-185.

McCarthy, W.C., & Frieze, I.H. (1999). Negative aspects of therapy: Client

perceptions of therapists’ social influence, burnout, and quality of care.

Journal of Social Issues, 55(1), 33-50.

McCoy Lynch, M. (2012). Factors influencing successful psychotherapy

outcomes. Master of Social Work Clinical Research Papers, 57.

McGuire-Snieckus, R., McCabe, R., Catty, J., Hanson, L., & Priebe, S. (2007). A

new scale to assess the therapeutic relationship in community mental

health: STAR. Psychological Medicine, 37, 85−95.

113

McLeod, B. D., & Weisz, J. R. (2005). The therapy process observational coding

system-alliance scale: Measure characteristics and prediction of outcome in

usual clinical practice. Journal of Consulting and Clinical Psychology,

73(2), 323−333.

Mitchell, S. A. (1988). Relational concepts in psychoanalysis. Cambridge, MA:

Harvard University Press.

Mitchell, S. A. (1993). Hope and dread in psychoanalysis. New York: Basic

Books.

Molinaro (1998). Development and validation of a new measure of therapist focus

on alliance related content. Dissertation Abstracts International, 58(10),

5651B.

Nissen-Lie, H. A., & Havik, O. E. (2013). The contribution of the quality of

therapists’s personal lives to the development of the working alliance.

Journal of Counseling Psychology, 60(4), 483-495.

Orlinsky, D. E., & Howard, K. I. (1966). Therapy Session Report (Form T and

Form P). Chicago: Institute of Juvenile Research.

Orlinsky, D. E., & Howard, K. I. (1975). Varieties of Psychotherapeutic

Experience: Multivariate Analysis of Patients' and Therapists' Reports.

New York: Teachers College Press.

Özbaş, A. A., Sayın, A., & Coşar, B. (2012). Üniversite sinavina hazirlanan

öğrencilerde sinav öncesi anksiyete düzeyi ile erken dönem uyumsuz şema

ilişkilerinin incelenmesi. Bilişsel Davranışçı Psikoterapi ve Araştırmalar

Dergisi, 1, 81-89.

Patton, M. J. (1984). Managing social interaction in counseling: A contribution

from the philosophy of science. Journal of Counseling Psychology, 31,

442-456.

Pinsof, W.M. (1999). Family Therapy Alliance Scale-Revised. Unpublished

Manuscript. The Family Institute, Evanston IL.

Priebe, S., & Gruyters, T. (1993). Role of the helping alliance in psychiatric

community care: A prospective study. Journal of Nervous and Mental

Disease, 181(9), 553−557.

114

Priebe, S., & McCabe, R. (2006). The therapeutic relationship in psychiatric

settings. Acta Psychiatrica Scandinavica, 113(429), 69−72.

Prochaska, J. O., & Norcross, J. C. (2006). Systems of psychotherapy: A

transtheoretical analysis (Sixth Edition). Pacific Grove, CA: Brooks-Cole.

Prochaska, J. O., & DiClemente C. C. (1986). Toward a comprehensive model of

change. Addictive Behaviors: Processes of Change. W. R. Miller and N.

Heather. New York; Plenum Press: 3-27.

Richards, J. M., & Gross, J. J. (1999). Composure at any cost? The cognitive

consequences of emotion suppression. Personality and Social Psychology

Bulletin, 25(8), 1033-1044.

Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic

personality change. Journal of Consulting Psychology, 21, 95-103.

Rogers, C. R. (1965). Client-centered therapy: its current practice, implications,

and theory. Boston: Houghton Mifflin.

Rosenberger, E. W., & Hayes, J. A. (2002). Origins, consequences, and

management of countertransference: A case study. Journal of Counseling

Psychology, 49(2), 221-232.

Rosenfeld, H. W. (2010). Addressing personal issues in supervision: Positive and

negative experiences of supervisees. Dissertation Abstracts International:

Section B: The Sciences and Engineering, 71(4-B), 2699.

Russell, A. & Saebel, J. (1997). Mother–son, mother–daughter, father–son, and

father–daughter: Are they distinct relationships? Developmental Review,

17, 111-147.

Saariaho, T., Saariaho, A., Karila, I., & Joukama, M. (2009). The psychometric

properties of the Finnish Young Schema Questionnaire in chronic pain

patients and a non-clinical sample. Journal of Behavior Therapy and

Experimental Psychiatry, 40, 158-168.

Safran, J. D. (1993). Breaches in the therapeutic alliance: An arena for negotiating

authentic relatedness. Psychotherapy, 30(1), 11-24.

Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: A

relational treatment guide. New York: Guilford Press.

115

Safran, J. D., & Segal, Z. (1996). Interpersonal process in cognitive therapy.

Northvale, New Jersey: Jason Aronson Inc.

Sarıtaş, D. (2007). The effects of maternal acceptance-rejection on

psychological distress of adolescents: The mediator roles of early

maladaptive schemas. Unpublished mater’s thesis, Middle East Technical

University, Ankara, Turkey.

Sarıtaş, D., & Gençöz, T. (2011). Psychometric properties of “Young Schema

Questionnaire-Short Form 3” in a Turkish adolescent sample. Journal of

Cognitive Behavioral Psychotherapies, 11(1), 83-96.

Sarlin, N.S. (1992). Working relationships in the treatment of adolescent

inpatients: Early treatment predictors and associations with outcome.

Dissertation Abstracts International.

Saunders, S. M., Howard, K. I., & Orlinsky, D. E. (1989). The therapeutic bond

scales: Psychometric characteristics and relationship to treatment

effectiveness. Psychological assessment: A Journal of Consulting and

Clinical Psychology, 1, 323−330.

Scott, J., Teasdale, J. D., Paykel, E. S., Johnson, A. L., Abbott, R., Hayhurst, H,.

Moore, R., & Garland, A. (2000). Effects of cognitive therapy on

psychological symptoms and social functioning in residual depression. The

British Journal of Psychiatry, 177, 440-446.

Seligman, M. E. P., Reivich, K., Jaycox, L., & Gillham, J. (1995). The optimistic

child. US: Houghton, Mifflin and Company.

Shirk, S. R., & Saiz, C. C. (1992). Clinical, empirical and developmental

Perspectives on the therapeutic relationship in child psychotherapy.

Development and Psychopathology, 4, 713−728.

Sidney, J. B. (2013). The patient’s contribution to the therapeutic process: A

Rogerian-psychodynamic perspective. Psychoanalytic Psychology, 30(2),

139-166.

Smith, M. L., & Glass, G. V. (1977). Meta-analysis of psychotherapy outcome

studies. American Psychologist, 32, 752-760.

116

Smith-Acuna, S., Durlak, J., & Kaspar, C. (1991). Development of child

psychotherapy measures. Journal of Clinical Child Psychology, 20,

126−131.

Solano, C. H. Batten, P. G., & Parish, E. A. (1982). Loneliness and patterns of

self-disclosure. Journal of Personality and Social Psychology, 43(3), 524-

531.

Soygüt, G., Karaosmanoğlu, H.A., & Çakır, Z. (2008a). Early stage maladaptic

schemas: An examination of the psychometric properties of the Young

Parenting Inventory. Turkish Psychological Articles, 11(22), 34–36.

Soygüt, G., Karaosmanoğlu, A. ve Çakır, Z. (2009). Erken Dönem Uyumsuz

Şemaların Değerlendirilmesi: Young Şema Ölçeği Kısa Form-3'ün

Psikometrik Özelliklerine İlişkin Bir İnceleme. Türk Psikiyatri Dergisi,

20(1), 75-84.

Stallard, P. (2007). Early maladaptive schemas in children: Stability and

differences between a community and a clinic referred sample. Clinical

Psychology and Psychotherapy, 14, 10-18.

Sterba, R. (1934). The fate of the ego in analytic therapy. International Journal of

Psychoanalysis, 15, 117-126.

Stricker, G. & Healey, B. J. (1990). Projective assessment of object relations: A

review of the empirical literature. Psychological Assessment, 2, 219-230.

Strong, S. R. (1968). Counseling: An interpersonal influence process. Journal of

Counseling Psychology, 15, 215−224.

Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New

York: Norton.

Svensson, B., & Hansson, L. (1999). Relationships among patient and therapist

ratings of therapeutic alliance and patient assessment of therapeutic

process: A study of cognitive therapy with long term mentally ill patients.

Journal of Nervous and Mental Disease, 87(9), 579−585.

Symonds, D., & Horvath, A. O. (2004). Optimising the alliance in couple therapy.

Family Process, 43(4), 443−455.

Taber, B. J., Leibert, T. W., & Agaskar, V. R. (2011). Relationships among client–

therapist personality congruence, working alliance, and therapeutic

117

outcome. Psychotherapy, 48(4), 376-380.

Teitelbaum, S. H. (1990). Supertransference: The role of the supervisor's blind

spots. Psychoanalytic Psychology, 7, 243-258.

Tracey, T. J., & Kokotovic, A. M. (1989). Factor structure of the Working

Alliance Inventory. Psychological Assessment, 1, 207–210.

Ünal, B. (2012). Early maladaptıve schemas and well-beıng: Importance of

parenting styles and other psychological resources. Unpublished master’s

thesis, Middle East Technical University, Ankara, Turkey.

Wampold, B. E., & Brown, G. S. (2005). Estimating variability in outcomes

attributable to therapists: a naturalistic study of outcomes in managed care.

Journal of Consulting and Clinical Psychology, 73(5), 914−923.

Wachtel, P. L. (2008). Relational theory and the practice of psychotherapy. New

York: Guilford Press.

Winnicott, D. W. (1965). The Family and Individual Development. London:

Tavistock.

Young, J. (1994). Young Parenting Inventory. Unpublisehed report.

Young, J. (1995). Young Compensation Inventory. New York: Cognitive Therapy

Center of New York.

Young, J. E. (1999). Cognitive therapy for personality disorders: A schema-

focused approach. (3rd ed.) Sarasota FL: Professional Resource Press.

Young, J. E., & Brown, G. (1990). Young Schema Questionnaire: Special Edition.

New York: Schema Therapy Institute.

Young J. E., Klosko J. S., & Weishaar, M. E. (2003). Schema therapy: A

practitioner’s guide. New York. The Guilford Pres.

Young, J., & Rygh, J. (1994). Young-Rygh Avoidance Inventory. New York:

Cognitive Therapy Center of New York.

Zetzel, E. (1956). Current concepts of transference. International Journal of

Psychoanalysis, 37, 369-375.

118

APPENDICES

Appendix A: Informed Consent

Gönülü Katılım Formu

Bu çalışma, Prof. Dr. Tülin Gençöz danışmanlığında doktora öğrencisi Bahar Köse’nin

tezi kapsamında yürütülen bir çalışmadır. Çalışmanın amacı, katılımcıların erken yaş dönemindeki

şemaları ve bunların terapötik ilişkiye etkisi ilgili bilgi toplamaktır. Çalışmaya katılım tamimiyle

gönüllülük temelinde olmalıdır. Ankette, sizden kimlik belirleyici hiçbir bilgi istenmemektedir.

Cevaplarınız tamimiyle gizli tutulacak ve sadece araştırmacılar tarafından değerlendirilecektir; elde

edilecek bilgiler bilimsel yayımlarda kullanılacaktır.

Anket, genel olarak kişisel rahatsızlık verecek soruları içermemektedir. Ancak, katılım

sırasında sorulardan ya da herhangi başka bir nedenden ötürü kendinizi rahatsız hissederseniz

cevaplama işini yarıda bırakıp çıkmak da serbestsiniz. Böyle bir durumda anketi uygulayan kişiye,

anketi tamamlamadığınızı söylemek yeterli olacaktır. Anket sonunda, bu çalışmayla ilgili

sorularınız cevaplanacaktır. Bu çalışmaya katıldığınız için şimdiden teşekkür ederiz. Çalışma

hakkında daha fazla bilgi almak için Psikoloji Bölümü öğretim üyelerinden Prof. Dr. Tülin Gençöz

(Oda: B239; Tel: 210 3131; E-posta: [email protected]) ya da araştırma görevlisi Bahar Köse

(Oda: B203; Tel: 210 5962; E-posta: [email protected]) ile iletişim kurabilirsiniz.

Bu çalışmaya tamamen gönüllü olarak katılıyorum ve istediğim zaman yarıda kesip

çıkabileceğimi biliyorum. Verdiğim bilgilerin bilimsel amaçlı yayımlarda kullanılmasını kabul

ediyorum. (Formu doldurup imzaladıktan sonra uygulayıcıya geri veriniz).

İsim Soyad Tarih İmza

----/----/-----

119

Appendix B: Demographic Information Form

Genel Bilgi Formu

Lütfen doldurmaya başlamadan önce, eşleştirmenin doğru yapılabilmesi için her seferinde kendi rumuzunuzu ve kimin için dolduruyorsanız (hasta, terapist ya da süpervizör) onun rumuzunu yazınız ve bu formu kaçıncı süpervizyon görüşmesi için doldurduğunuzu bildiriniz.

1) Benim rumuzum:……………………………………………………………………

2) Doldurduğum hastanın/terapistin/süpervizörün

rumuzu:.................................................

3) Kaçıncı terapi/süpervizyon görüşmesi için

doldurdunuz?..................................................

120

Appendix C: Young Schema Questionnaire

Rumuzunuz:.................................

Yönerge: Aşağıda, kişilerin kendilerini tanımlarken kullandıkları ifadeler sıralanmıştır.

Lütfen her bir ifadeyi okuyun ve sizi ne kadar iyi tanımladığına karar verin. Emin

olamadığınız sorularda neyin doğru olabileceğinden çok, sizin duygusal olarak ne

hissettiğinize dayanarak cevap verin.

Bir kaç soru, anne babanızla ilişkiniz hakkındadır. Eğer biri veya her ikisi şu anda

yaşamıyorlarsa, bu soruları o veya onlar hayatta iken ilişkinizi göz önüne alarak

cevaplandırın.

1 den 6’ya kadar olan seçeneklerden sizi tanımlayan en yüksek şıkkı seçerek her sorudan önce yer alan boşluğa yazın.

Derecelendirme:

1- Benim için tamamıyla yanlış

2- Benim için büyük ölçüde yanlış

3- Bana uyan tarafı uymayan tarafından biraz fazla

4- Benim için orta derecede doğru

5- Benim için çoğunlukla doğru

6- Beni mükemmel şekilde tanımlıyor

121

1. _____ Bana bakan, benimle zaman geçiren, başıma gelen olaylarla gerçekten ilgilenen kimsem olmadı. 2. _____ Beni terkedeceklerinden korktuğum için yakın olduğum insanların peşini bırakmam. 3. _____ İnsanların beni kullandıklarını hissediyorum 4. _____ Uyumsuzum. 5. _____ Beğendiğim hiçbir erkek/kadın, kusurlarımı görürse beni sevmez. 6. _____ İş (veya okul) hayatımda neredeyse hiçbir şeyi diğer insanlar kadar iyi yapamıyorum 7. _____ Günlük yaşamımı tek başıma idare edebilme becerisine sahip olduğumu hissetmiyorum. 8. _____ Kötü bir şey olacağı duygusundan kurtulamıyorum. 9. _____ Anne babamdan ayrılmayı, bağımsız hareket edebilmeyi, yaşıtlarım kadar, başaramadım. 10. _____ Eğer istediğimi yaparsam, başımı derde sokarım diye düşünürüm. 11. _____ Genellikle yakınlarıma ilgi gösteren ve bakan ben olurum. 12. _____ Olumlu duygularımı diğerlerine göstermekten utanırım (sevdiğimi, önemsediğimi göstermek gibi). 13. _____ Yaptığım çoğu şeyde en iyi olmalıyım; ikinci olmayı kabullenemem. 14. _____ Diğer insanlardan bir şeyler istediğimde bana “hayır” denilmesini çok zor

kabullenirim. 15. _____ Kendimi sıradan ve sıkıcı işleri yapmaya zorlayamam. 16. _____ Paramın olması ve önemli insanlar tanıyor olmak beni değerli yapar. 17. _____ Her şey yolunda gidiyor görünse bile, bunun bozulacağını hissederim. 18. _____ Eğer bir yanlış yaparsam, cezalandırılmayı hakkederim. 19. _____ Çevremde bana sıcaklık, koruma ve duygusal yakınlık gösteren kimsem yok. 20. _____ Diğer insanlara o kadar muhtacım ki onları kaybedeceğim diye çok endişeleniyorum. 21. _____ İnsanlara karşı tedbiri elden bırakamam yoksa bana kasıtlı olarak zarar vereceklerini hissederim. 22. _____ Temel olarak diğer insanlardan farklıyım.

122

23. _____ Gerçek beni tanırlarsa beğendiğim hiç kimse bana yakın olmak istemez. 24. _____ İşleri halletmede son derece yetersizim. 25. _____ Gündelik işlerde kendimi başkalarına bağımlı biri olarak görüyorum. 26. _____ Her an bir felaket (doğal, adli, mali veya tıbbi) olabilir diye hissediyorum. 27. _____ Annem, babam ve ben birbirimizin hayatı ve sorunlarıyla aşırı ilgili olmaya eğilimliyiz. 28. _____ Diğer insanların isteklerine uymaktan başka yolum yokmuş gibi hissediyorum;

eğer böyle yapmazsam bir şekilde beni reddederler veya intikam alırlar. 29. _____ Başkalarını kendimden daha fazla düşündüğüm için ben iyi bir insanım. 30. _____ Duygularımı diğerlerine açmayı utanç verici bulurum. 31. _____ En iyisini yapmalıyım, “yeterince iyi” ile yetinemem. 32. _____ Ben özel biriyim ve diğer insanlar için konulmuş olan kısıtlamaları veya

sınırları kabul etmek zorunda değilim. 33. _____ Eğer hedefime ulaşamazsam kolaylıkla yılgınlığa düşer ve vazgeçerim. 34. _____ Başkalarının da farkında olduğu başarılar benim için en değerlisidir. 35. _____ İyi bir şey olursa, bunu kötü bir şeyin izleyeceğinden endişe ederim. 36. _____ Eğer yanlış yaparsam, bunun özürü yoktur. 37. _____ Birisi için özel olduğumu hiç hissetmedim. 38. _____ Yakınlarımın beni terk edeceği ya da ayrılacağından endişe duyarım 39. _____ Herhangi bir anda birileri beni aldatmaya kalkışabilir. 40. _____ Bir yere ait değilim, yalnızım. 41. _____ Başkalarının sevgisine, ilgisine ve saygısına değer bir insan değilim. 42. _____ İş ve başarı alanlarında birçok insan benden daha yeterli. 43. _____ Doğru ile yanlışı birbirinden ayırmakta zorlanırım. 44. _____ Fiziksel bir saldırıya uğramaktan endişe duyarım. 45. _____ Annem, babam ve ben özel hayatımız birbirimizden saklarsak, birbirimizi

aldatmış hisseder veya suçluluk duyarız 46. _____ İlişkilerimde, diğer kişinin yönlendirici olmasına izin veririm.

123

47. _____ Yakınlarımla o kadar meşgulüm ki kendime çok az zaman kalıyor. 48. _____ İnsanlarla beraberken içten ve cana yakın olmak benim için zordur. 49. _____ Tüm sorumluluklarımı yerine getirmek zorundayım. 50. _____ İstediğimi yapmaktan alıkonulmaktan veya kısıtlanmaktan nefret ederim. 51. _____ Uzun vadeli amaçlara ulaşabilmek için şu andaki zevklerimden fedakarlık etmekte zorlanırım 52. _____ Başkalarından yoğun bir ilgi görmezsem kendimi daha az önemli hissederim. 53. _____ Yeterince dikkatli olmazsanız, neredeyse her zaman bir şeyler ters gider. 54. _____ Eğer işimi doğru yapmazsam sonuçlara katlanmam gerekir. 55. _____ Beni gerçekten dinleyen, anlayan veya benim gerçek ihtiyaçlarım ve

duygularımı önemseyen kimsem olmadı. 56. _____ Önem verdiğim birisinin benden uzaklaştığını sezersem çok kötü hissederim. 57. _____ Diğer insanların niyetleriyle ilgili oldukça şüpheciyimdir. 58. _____ Kendimi diğer insanlara uzak veya kopmuş hissediyorum. 59. _____ Kendimi sevilebilecek biri gibi hissetmiyorum. 60. _____ İş (okul) hayatımda diğer insanlar kadar yetenekli değilim. 61. _____ Gündelik işler için benim kararlarıma güvenilemez. 62. _____ Tüm paramı kaybedip çok fakir veya zavallı duruma düşmekten endişe duyarım. 63. _____ Çoğunlukla annem ve babamın benimle iç içe yaşadığını hissediyorum-Benim

kendime ait bir hayatım yok. 64. _____ Kendim için ne istediğimi bilmediğim için daima benim adıma diğer insanların

karar vermesine izin veririm. 65. _____ Ben hep başkalarının sorunlarını dinleyen kişi oldum. 66. _____ Kendimi o kadar kontrol ederim ki insanlar beni duygusuz veya hissiz bulurlar. 67. _____ Başarmak ve bir şeyler yapmak için sürekli bir baskı altındayım. 68. _____ Diğer insanların uyduğu kurallara ve geleneklere uymak zorunda olmadığımı hissediyorum.

124

69. _____ Benim yararıma olduğunu bilsem bile hoşuma gitmeyen şeyleri yapmaya kendimi zorlayamam.

70. _____ Bir toplantıda fikrimi söylediğimde veya bir topluluğa tanıtıldığımda onaylanılmayı ve takdir görmeyi isterim. 71. _____ Ne kadar çok çalışırsam çalışayım, maddi olarak iflas edeceğimden ve neredeyse her şeyimi kaybedeceğimden endişe ederim. 72. _____ Neden yanlış yaptığımın önemi yoktur; eğer hata yaptıysam sonucuna da katlanmam gerekir. 73. _____ Hayatımda ne yapacağımı bilmediğim zamanlarda uygun bir öneride

bulunacak veya beni yönlendirecek kimsem olmadı. 74. _____ İnsanların beni terk edeceği endişesiyle bazen onları kendimden uzaklaştırırım. 75. _____ Genellikle insanların asıl veya art niyetlerini araştırırım. 76. _____ Kendimi hep grupların dışında hissederim. 77. _____ Kabul edilemeyecek pek çok özelliğim yüzünden insanlara kendimi

açamıyorum veya beni tam olarak tanımalarına izin vermiyorum. 78. _____ İş (okul) hayatımda diğer insanlar kadar zeki değilim. 79. _____ Günlük yaşamımı tek başıma idare edebilme becerisine sahip olduğumu hissetmiyorum. 80. _____ Bir doktor tarafından herhangi bir ciddi hastalık bulunmamasına rağmen bende

ciddi bir hastalığın gelişmekte olduğu endişesine kapılıyorum. 81. _____ Sık sık annemden babamdan ya da eşimden ayrı bir kimliğimin olmadığını hissediyorum. 82. _____ Haklarıma saygı duyulmasını ve duygularımın hesaba katılmasını istemekte çok zorlanıyorum. 83. _____ Başkaları beni, diğerleri için çok, kendim için az şey yapan biri olarak görüyorlar. 84. _____ Diğerleri beni duygusal olarak soğuk bulurlar. 85. _____ Kendimi sorumluluktan kolayca sıyıramıyorum veya hatalarım için gerekçe bulamıyorum. 86. _____ Benim yaptıklarımın, diğer insanların katkılarından daha önemli olduğunu hissediyorum. 87. _____ Kararlarıma nadiren sadık kalabilirim. 88. _____ Bir dolu övgü ve iltifat almam kendimi değerli birisi olarak hissetmemi sağlar.

125

89. _____ Yanlış bir kararın bir felakete yol açabileceğinden endişe ederim. 90. _____ Ben cezalandırılmayı hakeden kötü bir insanım.

126

Appendix D: Young Parenting Inventory

Rumuzunuz:.......................................

Aşağıda anne ve babanızı tarif etmekte kullanabileceğiniz tanımlamalar verilmiştir. Lütfen her tanımlamayı dikkatle okuyun ve ebeveynlerinize ne kadar uyduğuna karar verin. 1 ile 6 arasında, çocukluğunuz sırasında annenizi ve babanızı tanımlayan en yüksek dereceyi seçin. Eğer sizi anne veya babanız yerine başka insanlar büyüttü ise onları da aynı şekilde derecelendirin. Eğer anne veya babanızdan biri hiç olmadı ise o sütunu boş bırakın.

1 - Tamamı ile yanlış

2 - Çoğunlukla yanlış

3 - Uyan tarafı daha fazla

4 - Orta derecede doğru

5 - Çoğunlukla doğru

6 - Ona tamamı ile uyuyor.

127

Anne Baba

1. ____ ____ Beni sevdi ve bana özel birisi gibi davrandı.

2. ____ ____ Bana vaktini ayırdı ve özen gösterdi.

3. ____ ____ Bana yol gösterdi ve olumlu yönlendirdi.

4. ____ ____ Beni dinledi, anladı ve duygularımızı karşılıklı paylaştık.

5. ____ ____ Bana karşı sıcaktı ve fiziksel olarak şefkatliydi.

6. ____ ____ Ben çocukken öldü veya evi terk etti.

7. ____ ____ Dengesizdi, ne yapacağı belli olmazdı veya alkolikti.

8. ____ ____ Kardeş(ler)imi bana tercih etti.

9. ____ ____ Uzun süreler boyunca beni terk etti veya yalnız bıraktı.

10. ____ ____ Bana yalan söyledi, beni kandırdı veya bana ihanet etti.

11. ____ ____ Beni dövdü, duygusal veya cinsel olarak taciz etti.

12. ____ ____ Beni kendi amaçları için kullandı.

13. ____ ____ İnsanların canını yakmaktan hoşlanırdı.

14. ____ ____ Bir yerimi inciteceğim diye çok endişelenirdi.

15. ____ ____ Hasta olacağım diye çok endişelenirdi.

16. ____ ____ Evhamlı veya fobik/korkak bir insandı.

17. ____ ____ Beni aşırı korurdu.

18. ____ ____ Kendi kararlarıma veya yargılarıma güvenememe neden oldu

19. ____ ____ İşleri kendi başıma yapmama fırsat vermeden çoğu işimi o yaptı.

20. ____ ____ Bana hep daha çocukmuşum gibi davrandı.

21. ____ ____ Beni çok eleştirirdi.

22. ____ ____ Bana kendimi sevilmeye layık olmayan veya dışlanmış bir gibi

hissettirdi.

23. ____ ____ Bana hep bende yanlış bir şey varmış gibi davrandı.

24. ____ ____ Önemli konularda kendimden utanmama neden oldu.

25. ____ ____ Okulda başarılı olmam için gereken disiplini bana kazandırmadı.

26. ____ ____ Bana bir salakmışım veya beceriksizmişim gibi davrandı.

27. ____ ____ Başarılı olmamı gerçekten istemedi.

28. ____ ____ Hayatta başarısız olacağıma inandı.

29. ____ ____ Benim fikrim veya isteklerim önemsizmiş gibi davrandı.

30. ____ ____ Benim ihtiyaçlarımı gözetmeden kendisi ne isterse onu yaptı.

128

31. ____ ____ Hayatımı o kadar çok kontrol altında tuttu ki çok az seçme

özgürlüğüm oldu.

32. ____ ____ Her şey onun kurallarına uymalıydı.

33. ____ ____ Aile için kendi isteklerini feda etti.

34. ___ ____ Günlük sorumluluklarının pek çoğunu yerine getiremiyordu ve ben

her zaman kendime düşenden fazlasını yapmak zorunda kaldım.

35. ____ ____ Hep mutsuzdu ; destek ve anlayış için hep bana dayandı.

36. ____ ____ Benim güçlü olduğumu ve diğer insanlara yardım etmem gerektiğini

hissettirdi.

37. ____ ____ Kendisinden beklentisi hep çok yüksekti ve bunlar için kendini çok

zorlardı.

38. ____ ____ Benden her zaman en iyisini yapmamı bekledi.

39. ____ ____ Pek çok alanda mükemmeliyetçiydi; ona göre her şey olması gerektiği

gibi olmalıydı.

40. ____ ____ Yaptığım hiçbir şeyin yeterli olmadığını hissetmemi sağladı.

41. ____ ____ Neyin doğru neyin yanlış olduğu hakkında kesin ve katı kuralları

vardı.

42. ____ ____ Eğer işler düzgün ve yeterince hızlı yapılmazsa sabırsızlanırdı.

43. ____ ____ İşlerin tam ve iyi olarak yapılmasına, eğlenme veya dinlenmekten

daha fazla önem verdi.

44. ____ ____ Beni pek çok konuda şımarttı veya aşırı hoşgörülü davrandı.

45. ____ ____ Diğer insanlardan daha önemli ve daha iyi olduğumu hissettirdi.

46. ____ ____ Çok talepkardı; Her şeyin onun istediği gibi olmasını isterdi.

47. ____ ____ Diğer insanlara karşı sorumluklarımın olduğunu bana öğretmedi.

48. ____ ____ Bana çok az disiplin veya terbiye verdi.

49. ____ ____ Benim için çok az kural koydu veya sorumluluk verdi.

50. ____ ____ Aşırı sinirlenmeme veya kontrolümü kaybetmeme izin verirdi.

51. ____ ____ Disiplinsiz bir insandı.

52. ____ ____ Birbirimizi çok iyi anlayacak kadar yakındık.

53. ____ ____ Ondan tam olarak ayrı bir birey olduğumu hissedemedim veya

bireyselliğimi yeterince yaşamadım.

54. ____ ____ Onun çok güçlü bir insan olmasından dolayı büyürken kendi yönümü

belirleyemiyordum.

55. ____ ____ İçimizden birinin uzağa gitmesi durumunda, birbirimizi

üzebileceğimizi hissederdim.

129

56. _____ ____ Ailemizin ekonomik sorunları ile ilgili çok endişeli idi.

57. ____ ____ Küçük bir hata bile yapsam kötü sonuçların ortaya çıkacağını

hissettirirdi.

58. ____ ____ Kötümser bir bakışı açısı vardı, hep en kötüsünü beklerdi.

59. ____ ____ Hayatın kötü yanları veya kötü giden şeyler üzerine odaklanırdı.

60. ____ ____ Her şey onun kontrolü altında olmalıydı.

61. ____ ____ Duygularını ifade etmekten rahatsız olurdu.

62. ____ ____ Hep düzenli ve tertipliydi; değişiklik yerine bilineni tercih ederdi.

63. ____ ____ Kızgınlığını çok nadir belli ederdi.

64. ____ ____ Kapalı birisiydi; duygularını çok nadir açardı.

65. ____ ____ Yanlış bir şey yaptığımda kızar veya sert bir şekilde eleştirdiği

olurdu.

66. ____ ____ Yanlış bir şey yaptığımda beni cezalandırdığı olurdu.

67. ____ ____ Yanlış yaptığımda bana aptal veya salak gibi kelimelerle hitap ettiği

olurdu.

68. ____ ____ İşler kötü gittiğinde başkalarını suçlardı.

69. ____ ____ Sosyal statü ve görünüme önem verirdi.

70. ____ ____ Başarı ve rekabete çok önem verirdi.

71. ____ ____ Başkalarının gözünde benim davranışlarımın onu ne duruma

düşüreceği ile çok ilgiliydi.

72. ____ ____ Başarılı olduğum zaman beni daha çok sever veya bana daha çok özen

gösterirdi.

130

Appendix E: Young Rygh Avoidance Inventory

Rumuzunuz:……………………………………..

Aşağıda kişilerin kendilerini tanımlarken kullandıkları ifadeler sıralanmıştır. Lütfen her bir ifadeyi okuyun ve sizi ne kadar iyi tanımladığına karar verin. Daha sonra 1 den 6 ya kadar olan seçeneklerden sizi tanımlayan en yüksek dereceyi seçerek her sorudan önce yer alan boşluğa yazın.


2- Benim için büyük ölçüde yanlış 3- Bana uyan tarafı uymayan tarafından biraz fazla 4- Benim için orta derecede doğru 5- Benim için çoğunlukla doğru 6- Beni mükemmel şekilde tanımlıyor

131

1. ___ Beni üzen konular hakkında düşünmemeye çalışırım.

2. ___ Sakinleşmek için alkollü içecekler içerim.

3. ___ Çoğu zaman mutluyumdur.

4. ___ Çok nadiren üzgün veya hüzünlü hissederim.

5. ___ Aklı duygulara üstün tutarım.

6. ___ Hoşlanmadığım insanlara bile kızmamam gerektiğine inanırım.

7. ___ İyi hissetmek için uyuşturucu kullanırım.

8. ___ Çocukluğumu hatırladığımda pek bir şey hissetmem.

9. ___ Sıkıldığımda sigara içerim.

10. ___ Sindirim sistemim ile ilgili şikayetlerim var (Örn: hazımsızlık, ülser, bağırsak

bozulması).

11. ___ Kendimi uyumuş hissederim.

12. ___ Sık sık baş başım ağrır.

13. ___ Kızgınsam insanlardan uzak dururum.

14. ___ Yaşıtlarım kadar enerjim yok.

15. ___ Kas ağrısı şikayetlerim var.

16. ___ Yalnızken oldukça fazla TV seyrederim.

17. ___ İnsanın duygularını kontrol altında tutmak için aklını kullanması gerektiğine inanırım.

18. ___ Hiç kimseden aşırı nefret edemem.

19. ___ Bir şeyler ters gittiğindeki felsefem, olanları bir an önce geride bırakıp yola devam

etmektir.

20. ___ Kırıldığım zaman insanların yanından uzaklaşırım.

21. ___ Çocukluk yıllarımı pek hatırlamam.

22. ___ Gün içinde sık sık şekerleme yaparım veya uyurum.

23. ___ Dolaşırken veya yolculuk yaparken çok mutlu olurum.

24. ___ Kendimi önümdeki işe vererek sıkıntı hissetmekten kurtulurum.

25. ___ Zamanımın çoğunu hayal kurarak geçiririm.

26. ___ Sıkıntılı olduğumda iyi hissetmek için bir şeyler yerim.

27. ___ Geçmişimle ilgili sıkıntılı anıları düşünmemeye çalışırım.

28. ___ Kendimi sürekli bir şeylerle meşgul edip düşünmeye zaman ayırmazsam daha iyi

hissederim.

29. ___ Çok mutlu bir çocukluğum oldu.

30. ___ Üzgünken insanlardan uzak dururum.

31. ___ İnsanlar kafamı sürekli kuma gömdüğümü söylerler, başka bir deyişle, hoş olmayan

düşünceleri görmezden gelirim.

32. ___ Hayal kırıklıkları ve kayıplar üzerine fazla düşünmemeye eğilimliyim.

132

33. ___ Çoğu zaman, içinde bulunduğum durum güçlü duygular hissetmemi gerektirse de

bir şey hissetmem.

34. ___ Böylesine iyi ana-babam olduğu için çok şanslıyım.

35. ___ Çoğu zaman duygusal olarak tarafsız kalmaya çalışırım.

36. ___ İyi hissetmek için, kendimi ihtiyacım olmayan şeyler alırken bulurum.

37. ___ Beni zorlayacak veya rahatımı kaçıracak durumlara girmemeye çalışırım.

38. ___ İşler benim için iyi gitmiyorsa hastalanırım.

39. ___ İnsanlar beni terk ederse veya ölürse çok fazla üzülmem.

40. ___ Başkalarının benim hakkımda ne düşündükleri beni ilgilendirmez.

133

Appendix F: Young Compensation Inventory

Rumuzunuz:.......................................

Aşağıda kişilerin kendilerini tanımlarken kullandıkları ifadeler sıralanmıştır. Lütfen her bir ifadeyi okuyun ve sizi ne kadar iyi tanımladığına karar verin. Eğer isterseniz ifadeyi

size en yakın gelecek şekilde yeniden yazıp derecelendirebilirsiniz. Daha sonra 1 den 6 ya kadar olan seçeneklerden sizi tanımlayan en yüksek dereceyi seçerek her sorudan önce yer alan boşluğa yazın


2- Benim için büyük ölçüde yanlış 3- Bana uyan tarafı uymayan tarafından biraz fazla 4- Benim için orta derecede doğru 5- Benim için çoğunlukla doğru 6- Beni mükemmel şekilde tanımlıyor

134

beni gözetmeyeceklerinden A: Örnek: ---4---İnsanların benden hoşlanmayacaklarından endişe duyarım

1. ___ Kırıldığımı çevremdeki insanlara belli ederim.

2. ___ İşler kötü gittiğinde sıklıkla başkalarını suçlarım.

3. ___ İnsanlar beni hayal kırıklığına uğrattığında veya ihanet ettiğinde çok fazla

öfkelenir ve bunu gösteririm.

4. ___ İntikam almadan öfkem dinmez.

5. ___ Eleştirildiğimde savunmaya geçerim.

6. ___ Başarılarımı veya galibiyetimi başkalarının taktir etmesi önemlidir.

7. ___ Pahalı araba, elbiseler, ev gibi başarının görünür ifadeleri benim için

önemlidir.

8. ___ En iyi ve en başarılı olmak için çok çalışırım.

9. ___ Tanınmış olmak benim için önemlidir.

10. ___ Başarı, ün, zenginlik, güç veya popülarite kazanma ile ilgili hayaller kurarım.

11. ___ İlgi odağı olmak hoşuma gider.

12. ___ Diğer insanlardan daha cilveli / baştan çıkarıcı bir insanımdır.

13. ___ Hayatımda düzen olmasına çok önem veririm (Organizasyon, düzenlilik,

planlama, gündelik işler).

14. ___ İşler kötü gitmesin diye çok çaba harcarım.

15. ___ Hata yapmamak için karar verirken kılı kırk yararım.

16. ___ Çevremdeki insanların yaptıklarını fazlasıyla kontrol ederim.

17. ___ Çevremdeki insanlar üzerinde denetim veya otorite sahibi olabildiğim

ortamlardan hoşlanırım.

18. ___ Hayatımla ilgili bir şey söyleyen, bana karışan insanlardan hoşlanmam.

19. ___ Uzlaşmakta veya kabullenmekte çok zorlanırım.

20. ___ Kimseye bağımlı olmak istemem.

21. ___ Kendi kararlarımı almak ve kendime yeterli olmak benim için hayati önem

taşır.

22. ___ Bir insana bağlı kalmakta veya yerleşik bir düzen kurmakta güçlük çekerim.

23. ___ İstediğimi yapma özgürlüğüm olması için “bağımsız biri” olmayı tercih

ederim.

24. ___ Kendimi sadece bir iş veya kariyerle sınırlamakta zorlanırım, hep başka

seçeneklerim olmalıdır.

25. ___ Genellikle kendi ihtiyaçlarımı başkalarınınkinden önde tutarım.

135

26. ___İnsanlara sık sık ne yapmaları gerektiğini söylerim. Her şeyin doğru bir

şekilde yapılmasını isterim.

27. ___ Diğer insanlar gibi önce kendimi düşünürüm.

28. ___ Bulunduğum ortamın rahat olması benim için çok önemlidir ( örn: ısı, ışık,

mobilya).

29. ___ Kendimi asi biri olarak görürüm; ve genellikle otoriteye karşı koyarım.

30. ___ Kurallardan hoşlanmam ve onları çiğnemekten mutlu olurum.

31. ___ Hoş karşılanmasa veya bana uymasa da alışılmışın dışında olmayı severim.

32. ___ Toplumun standartlarında başarılı olmak için uğraşmam.

33. ___ Çevremdekilerden hep farklı oldum.

34. ___ Kendimden bahsetmeyi sevmem ve insanların özel yaşamımı veya hislerimi

bilmelerinden hoşlanmam.

35. ___ Kendimden emin olmasam da veya kendimi kırılmış hissetsem de

başkalarına hep güçlü görünmeye çalışırım.

36. ___ Değer verdiğim insana yakın dururum ve sahiplenirim.

37. ___ Hedeflerime ulaşmak için sık sık çıkarlarım doğrultusunda yönlendirici

davranışlarda bulunurum.

38. ___ İstediğimi elde etmek için açıkça söylemektense dolaylı yollara başvururum

39. ___ İnsanlarla aramda mesafe bırakırım bu sayede benim izin verdiğim kadar beni

tanırlar.

40. ___ Çok eleştiririm.

41. ___ Standartlarımı korumak ve sorumluluklarımı yerine getirmek için kendimi

yoğun bir baskı altında hissederim.

42. ___ Kendimi ifade ederken sıklıkla patavatsız veya duyarsızımdır.

43. ___ Hep iyimser olmaya çalışırım; olumsuzluklara odaklanmama izin vermem.

44. ___ Ne hissettiğime aldırmadan çevremdekilere güler yüz göstermem gerektiğine

inanırım.

45. ___ Başkaları benden daha başarılı veya daha fazla ilgi odağı olduğunda

kıskanırım veya kötü hissederim.

46. ___ Hakkım olanı aldığımdan ve aldatılmadığımdan emin olmak için çok ileri

gidebilirim.

47. ___ İnsanları gerektiğinde şaşırtıp alt edebilmek için yollar ararım, dolayısı ile

benden faydalanamazlar veya bana kötülük yapamazlar.

48. ___ İnsanların benden hoşlanması için nasıl davranacağımı veya ne söyleyeceğimi

bilirim.

136

Appendix G: Working Alliance Inventory-Therapist and Client Forms

(Therapist Form)

GÖRÜŞME DEĞERLENDİRME ÖLÇEĞİ (TERAPİST FORMU)

Aşağıdaki her bir cümleyi okuduktan sonra, ifadelerle ilgili değerlendirmenizi sağdaki yedi kutucuktan birinin içine (x) işareti koyarak yapınız.

Hiç

bir z

aman

Çok

Seyr

ek

Seyr

ek

Baz

en

Sık

sık

Çok

sık

Her

zam

an

1. Hastamla kendimi rahat hissetmiyorum.

2. Hastam ve ben, sorunlarının düzelmesi için terapide neler yapması gerektiği konusunda aynı şekilde düşünüyoruz.

3. Bu görüşmelerin sonucunda ne olacağı konusunda endişelerim var.

4. Hastam ve ben, terapide yaptıklarımızın işe yaradığına inanıyoruz.

5. Hastamı anladığımı düşünüyorum.

6. Hastam ve ben, onun terapiden neler beklediği konusunda hemfikiriz.

7. Hastam terapide yaptıklarımızı kafa karıştırıcı buluyor.

8. Hastamın bana yakın hissettiğine inanıyorum.

9. Hastam için görüşmelerimizin amacını netleştirmeye ihtiyacım var.

10. Terapiden ne elde etmesi gerektiği konusunda hastamla aynı fikirde değiliz.

11. Hastamla zamanı etkin kullanmadığımıza inanıyorum.

12. Terapide neye ulaşmak istediğimiz konusunda şüphelerim var.

13. Hastamın terapide üzerine düşenlerin ne olduğunu bildiğine eminim.

137

14. Bu görüşmelerin amaçları hastam için önemli.

15. Terapide yaptıklarımızın, hastamın sorunlarıyla ilişkili olmadığını düşünüyorum.

16. Terapide yaptıklarımızın, hastamın istediği değişikliklere ulaşmada ona yardımcı olacağını hissediyorum.

17. Hastamın iyiliğini gerçekten düşünüyorum.

18. Görüşmelerde hastamdan ne beklediğimi biliyorum.

19. Hastam ve ben birbirimize saygı duyuyoruz.

20. Hastama gösterdiğim duygularımda tam olarak dürüst olmadığımı hissediyorum.

21. Hastama yardım edebileceğime inanıyorum.

22. Hastam ve ben, ortak hedeflerimize doğru ilerliyoruz.

23. Hastamı takdir ediyorum.

24. Hastam için neyin üzerinde durmamızın daha önemli olacağı konusunda hemfikiriz.

25. Hastam bu görüşmelerin sonunda neler yaparak değişebileceğini daha iyi anladı.

26. Hastam ve ben birbirimize güveniyoruz.

27. Hastam ve ben sorunlarının neler olduğu konusunda farklı düşünüyoruz.

28. İlişkimiz hastam için çok önemli.

29. Hastamın, eğer yanlış şeyler söyler ya da yaparsa, benim terapiye devam etmeyeceğime dair korkuları var.

30. Görüşmelerin amaçlarını belirleme konusunda hastam ve ben işbirliği içindeyiz.

31. Hastam terapide yapmasını istediğim şeylerden dolayı yerinde saydığını hissediyor.

32. Ne tür değişikliklerin onun yararına olacağı konusunda anlaşmaya vardık.

33. Terapide yaptıklarımız hastama anlamlı gelmiyor.

138

34. Hastam terapinin sonucunda neye ulaşacağını bilmiyor.

35. Hastam sorununu ele alma yollarımızın doğru olduğuna inanıyor.

36.Onaylamadığım şeyler yapsa da hastama olan saygım devam eder.

Yukarıdaki değerlendirmeyi yaptığınız danışanınızla (hastanızla) çalışmanızda sıklıkla hangi kuramın tekniklerinden yararlanıyorsunuz?

…………………………………………………………………………………………………………………………………………………………………………………………………………………………

139

Appendix H: Working Alliance Inventory-Therapist and Client Forms

(Client Form)

GÖRÜŞME DEĞERLENDİRME ÖLÇEĞİ (HASTA FORMU)

Aşağıdaki herbir cümleyi okuduktan sonra, ifadelerle ilgili değerlendirmenizi sağdaki yedi kutucuktan birinin içine (x) işareti koyarak yapınız.

Hiç

bir z

aman

Çok

Seyr

ek

Seyr

ek

Baz

en

Sık

sık

Çok

sık

Her

zam

an

1 Terapistimin yanında kendimi rahat hissetmiyorum.

2. Terapistim ve ben sorunlarımın düzelmesi için terapide neler yapmam gerektiği konusunda aynı şekilde düşünüyoruz.

3. Bu görüşmelerin sonucunda ne olacağı konusunda endişelerim var.

4. Terapide yaptıklarım, bana sorunumla ilgili yeni bir bakış açısı kazandırıyor.

5. Terapistim ve ben birbirimizi anlıyoruz.

6. Terapistim, terapiden neler beklediğimi doğru anlıyor.

7. Terapide yaptıklarımı kafa karıştırıcı buluyorum.

8. Terapistimin bana yakın hissettiğine inanıyorum.

9. Terapistimle görüşmelerimizin amaçlarını belirleyebilmiş olmayı isterdim.

10. Terapiden ne elde etmem gerektiği konusunda terapistime katılmıyorum.

11. Terapistimle zamanı etkin kullanmadığımıza inanıyorum.

140

12. Terapistim terapide neye ulaşmak istediğimi anlamıyor.

13. Terapide üzerime düşenlerin ne olduğunu biliyorum.

14. Bu görüşmelerin amaçları benim için önemli.

15. Terapide yaptıklarımızın, sorunlarımla ilişkili olmadığını düşünüyorum.

16. Terapide yaptıklarımın, istediğim değişikliklere ulaşmamda bana yardımcı olacağını hissediyorum.

17. Terapistimin iyiliğimi gerçekten düşündüğüne inanıyorum.

18. Görüşmelerde terapistimin benden ne beklediğini biliyorum.

19. Terapistim ve ben birbirimize saygı duyuyoruz.

20. Terapistimin bana gösterdiği duygularında tam olarak dürüst olmadığını hissediyorum.

21. Terapistimin bana yardım edebileceğine inanıyorum.

22. Terapistim ve ben, ortak hedeflerimize doğru ilerliyoruz.

23. Terapistimin beni takdir ettiğini hissediyorum.

24. Benim için neyin üzerinde durmamızın daha önemli olacağı konusunda hemfikiriz.

25. Bu görüşmelerin sonunda neler yaparak değişebileceğimi daha iyi anladım.

26. Terapistim ve ben birbirimize güveniyoruz.

27. Terapistim ve ben sorunlarımın neler olduğu konusunda farklı düşünüyoruz.

28. Terapistimle olan ilişkim benim için çok önemli.

29. Eğer yanlış şeyler söyler ya da yaparsam, terapistim terapiye devam etmeyecekmiş gibi geliyor.

141

30. Terapistim ve ben terapiden neler kazanmam gerektiği konusunda hemfikiriz.

31. Terapide yaptığım şeyler bana yerimde saydığımı hissettiriyor.

32. Ne tür değişikliklerin benim yararıma olacağı konusunda anlaşmaya vardık.

33. Terapistimin yapmamı istediği şeyler bana anlamlı gelmiyor.

34. Terapimin sonucunda neye ulaşacağımı bilemiyorum.

35. Sorunumu ele alma yollarımızın doğru olduğuna inanıyorum.

36. Onun onaylamadığı şeyler yaptığımda da terapistimin beni önemsediğini hissediyorum.

142

Appendix I: Working Alliance Inventory-Supervisor and Therapist Forms

(Supervisor Form)

SÜPERVİZYON DEĞERLENDİRME ÖLÇEĞİ (SÜPERVİZÖR FORMU)


Hiç

bir

zam

an

Çok

Seyr

ek

Seyr

ek

Baz

en

Sık

sık

Çok

sık

Her

zam

an

1. Terapist ve ben, hastanın durumunun iyileştirilmesine yönelik terapide atılan adımlar konusunda hemfikiriz.

2. Terapist ve ben, terapide yapılmakta olanların yararı

konusunda hemfikiriz.

3. Terapistle aramızda yakınlık olduğunu hissediyorum.

4. Süpervizyonda neye ulaşmak istediğimiz konusunda kendimi kaybolmuş hissediyorum.

5. Terapiste yardımcı olabileceğim konusunda becerilerime güveniyorum .

6. Terapist ve ben, süpervizyondaki amaçlarımız konusunda hemfikiriz.

7. Terapisti insan olarak takdir ediyorum.

8. Terapisle ben terapistin gelişimi için, neyin üzerinde durmamızın daha önemli olacağı konusunda hemfikiriz.

9. Terapist ve ben birbirimize güveniyoruz.

10. Terapist ve ben terapistin yaşadığı asıl güçlüklerin neler olduğu konusunda farklı düşünüyoruz.

11. Terapist ve ben, ne tür değişikliklerin benim yararıma olacağı konusunda hemfikiriz.

12. Terapist, süpervizyonda terapi süreci için bulduğumuz/uyguladığımız çözüm yollarını doğru buluyor.

143

Yukarıdaki değerlendirmeyi yaptığınız terapistle çalışmanızda sıklıkla hangi kuramın tekniklerinden yararlanıyorsunuz?

Adleryen Psikoterapi

Analitik (Jungian) Psikoterapi

Bilişsel-Davranışçı Terapiler

Danışanı Merkez Alan Psikoterapiler

Davranışçı Terapiler

Destekleyici Terapiler

Gerçeklik Terapisi

Gestalt Terapisi

Pozitif Psikoterapi

Psikanalitik Psikoterapiler

Psikanaliz

Rasyonel-Duygusal Terapi

Transaksiyonel Analiz

Varoluşçu Psikoterapiler

Eklektik Yaklaşım (hangi kuramlardan oluştuğunu lütfen belirtiniz):....................................................

..............................................................................................................................................

.......Entegratif Yaklaşım (hangi kuramlardan oluştuğunu lütfen belirtiniz):..................................................

......................................................................................................... .....................................

.......Diğer (lütfen belirtiniz):.............................................................

144

Appendix J: Working Alliance Inventory-Supervisor and Therapist Forms

(Therapist Form)

SÜPERVİZYON DEĞERLENDİRME ÖLÇEĞİ (TERAPİST FORMU)


Hiç

bir

zam

an

Çok

Seyr

ek

Seyr

ek

Baz

en

Sık

sık

Çok

sık

Her

za

man

1. Süpervizörüm ve ben, becerilerimin gelişmesine yönelik terapide atılan adımlar konusunda hemfikiriz.

2. Süpervizörüm ve ben, terapide yapılmakta olanların yararı konusunda hemfikiriz.

3. Süpervizörümle aramızda yakınlık olduğunu hissediyorum.

4. Süpervizyonda neye ulaşmak istediğimiz konusunda kaybolmuş hissediyorum.

5. Bana yardımcı olabileceği konusunda süpervizörümün becerilerine güveniyorum .

6. Süpervizörüm ve ben, süpervizyondaki amaçlarımız konusunda hemfikiriz.

7. Süpervizörümün beni insan olarak takdir ettiğini hissediyorum.

8. Süpervizörümle, süpervizyonda benim için neyin üzerinde durmamızın daha önemli olacağı konusunda hemfikiriz.

9. Süpervizörüm ve ben birbirimize güveniyoruz.

10. Süpervizörüm ve ben, yaşadığım asıl güçlüklerin neler olduğu konusunda farklı düşünüyoruz.

11. Süpervizörüm ve ben, ne tür değişikliklerin benim yararıma olacağı konusunda hemfikiriz.

12. Süpervizyonda, yaşadığım güçlüklerle baş edebilmek için uyguladığımız yolları doğru buluyorum.

145

Appendix K: Open-Ended Question Form

Rumuzunuz:……………………………….

1) Süpervizyon sürecinde yaşadığınız en büyük güçlük ne oldu?

…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

2) Bununla nasıl başa çıktınız? ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

146

Appendix L: Relational Circles

Katılımcı Rumuzu……………......

Yönerge:

ODTÜ Psikoloji Bölümü’ne ait UYAREM Klinik Psikoloji Ünitesi’nde bir süredir psikoterapi hizmetleri içerisinde yer alıyorsunuz. Süpervizör, terapist ya da hasta olarak bu süreci üçlü bir eğitim süreci içerisinde devam etmektesiniz. Tüm bu süreçleri düşündüğünüzde, süpervizör, terapist ve hasta ilişkisi açısından, bu üçlü eğitim sürecinde aşağıdaki başlıklar açısından bu süreci sizin bakış açınıza göre en iyi tanımlayan semboller hangileridir?

1. Süpervizyon ve psikoterapi sürecinde görevler açısından, süpervizörün, terapistin ve hastanın sizce konumu ve etkileşimi aşağıdaki hangi şekille en iyi anlatılmaktadır? (halkaların kesişimlerini görevlerin ortak paylaşımı olarak değerlendirebilirsiniz)

2. Süpervizyon ve psikoterapi sürecinde amaçlar açısından, süpervizörün, terapistin ve hastanın sizce konumu ve etkileşimi aşağıdaki hangi şekille en iyi anlatılmaktadır? (halkaların kesişimlerini amaçların ortak paylaşımı olarak değerlendirebilirsiniz)

3. Süpervizyon ve psikoterapi sürecinde duygusal bağ açısından, süpervizörün, terapistin ve hastanın sizce konumu ve etkileşimi aşağıdaki hangi şekille en iyi anlatılmaktadır? (halkaların kesişimlerini duygusal bağın ortak paylaşımı olarak değerlendirebilirsiniz)

147

D)

E)

F)

Terapist

Süpervizör

Hasta

Hasta

Süpervizör

Terapist

Hasta

Terapist

Süpervizör

A)

B)

C)

Süpervizör

Terapist

Hasta

Terapist

Hasta

Süpervizör

Süpervizör

Hasta

Terapist

148

G)

H)

I)

J)

Süpervizör

Hasta Terapist

Süpervizör Hasta Terapist

Terapist Hasta

Süpervizör

Süpervizör Terapist Hasta

K)

L)

M)

Süpervizör Hasta

Terapist

Süpervizör Terapist

Hasta

Terapist Hasta

Süpervizör

149

N)

O)

Süpervizör

Hasta

Terapist

Süpervizör

Hasta

Terapist

P) Diğer….

Eğer bu üç halka ve kesişimleri dışında

aklınıza gelen başka bir üçlü varsa lütfen

aşağıdaki boş alana çizerek neden böyle

çizilmesi gerektiğine dair birkaç cümle ile

açıklama yapınız.

Açıklama…………………………………………………

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150

Appendix M: Tez Fotokopisi İzin Formu

ENSTİTÜ

Fen Bilimleri Enstitüsü

Sosyal Bilimler Enstitüsü

Uygulamalı Matematik Enstitüsü

Enformatik Enstitüsü

Deniz Bilimleri Enstitüsü

YAZARIN

Soyadı :

Adı :

Bölümü :

TEZİN ADI (İngilizce):

TEZİN TÜRÜ : Yüksek Lisans Doktora

1. Tezimin tamamından kaynak gösterilmek şartıyla fotokopi alınabilir.

2. Tezimin içindekiler sayfası, özet, indeks sayfalarından ve/veya bir bölümünden kaynak gösterilmek şartıyla fotokopi alınabilir.

3. Tezimden bir bir (1) yıl süreyle fotokopi alınamaz.

TEZİN KÜTÜPHANEYE TESLİM TARİHİ:

151

CURRICULUM VITAE

PERSONAL INFORMATION

Surname, Name: Köse Karaca, Bahar Nationality: Turkish (TC) Date and Place of Birth: 5 March 1984 , Ankara Marital Status: Married Phone: +90 312 210 5110 Fax: +90 312 210 7975 email: [email protected] EDUCATION

Degree Institution Year of Graduation

MS METU Clinical Psychology 2014 BS METU Psychology 2007 High School Binnaz Rıdvan Ege High

School, Ankara 2002

WORK EXPERIENCE

Year Place Enrollment

2007-still METU Department of

Psychology Research Assistant

INTERNATIONAL PRESENTATIONS

Köse, B., & Gençöz, T. (2013, July). Associations between

schema domains and personality traits: A study conducted with turkish

adults. 7 th World Congress of Behavioural and Cognitive Therapies,

Lima, Peru.

Köse, B., & Gençöz, T. (2013, July). Associates of

well-being measures with young schema domains and personality

traits: A study conducted with Turkish adults.13th European Congress

of Psychology, Stockholm, Sweden. 4

152

Köse, B., & Gençöz, T. (2012, July). Associations between schema

domains and personality traits: A study conducted with Turkish adults.

30th International congress of psychology, Cape Town, South Africa.

Köse, B. & Gençöz, T. (June, 2011). Tendencies towards Young Schema

Domains among Turkish Adults regarding Gender, and Different Levels

of Parental Education. 12th European Congress of Psychology, İstanbul,

Turkey.

Köse, B. & Gençöz, T. (June, 2011). The association between young schema

domains and well-being measures.Poster presented at 7th International

Congress of Cognitive Psychotherapy, İstanbul, Turkey.

Köse, B. (May, 2009). The relationship between attachment style and

interpersonal intelligence of Howard Gardner’s multiple intelligence

concept. Poster presented at 1st International Conference of Living

Theorists-Howard Gardner, Burdur, Turkey.

ASSISTED COURSES

PSY 543/544 Cognitive Behavioral Therapies

Duties: Organizing and instructoring CBT laboratory courses every week

targeting improvement psychotherapy skills and self-awareness of the

students and evaluation of papers of the students.

PSY 512 Developmental Psychopathology

Duties: Evaluating of student reaction papers, term papers, and exams.

PSY 610 Research Methods in Clinical Psychology

Duties: Organizing and evaluation of student reaction papers, term papers,

and exams.

PSY 374 Physiological Psychology

Duties: Organizing and evaluation of student reaction papers, term papers,

and exams.

PSY 531 Clinical Assesment

Duties: Assisted to the instructor for the application of education tools.

153

TURKISH SUMMARY

Araştırmalarda, kullanılan terapi yaklaşımları, yöntemler ve psikolojik

semptomlar sabit tutulsa bile, psikoterapilerin sonuçlarının her zaman aynı

çıkmadığı tespit edilmiştir. Literatürde, bu durum için farklı açıklamalar

mevcuttur. Psiokoterapide kullanılan terapi yaklaşımı, terapistin eğitimi ve

deneyimi, hastanın psikopatolojisi, seansların sıklığı ve hastaların tedavi için ne

derecede motive olduğu bunlardan bazıları (Crits-Christoph ve ark., 1991;

McCarthy ve Frieze, 1999; McCoy Lynch, 2012). Bunların yanı sıra, dikkat çeken

bir diğer faktör şüphesiz ki terapötik ilişkidir. Literatürde, terapötik etkinin

doğrudan mı yoksa dolaylı mı etkisi olduğu hala tartışma konusuyken, hasta ve

terapist arasındaki ilişkinin iyileştirici etkisi olduğu ciddi kabul görmektedir

(Elvins ve Green, 2008; Gelso ve Carter, 1985; Gelso ve Carter, 1994; Horvath,

Del Re, Flückiger, ve Symonds, 2011; Huppert ve ark., 2014; Priebe ve McCabe,

2006). Özellikle, terapi ilişkisinde yaşanan sıkıntıların farkında olunması ve bu

sıkıntıları aşarak kaliteli bir terapötik ittifak yaratmak hastanın psikoterapi

sürecinde değişim yaşamasına önemli derecede katkı sağlamaktadır (Safran,

1993). Ancak, birçok araştırmacının psikoterapi sürecinde terapötik ittifakın

önemini kabul etmesine karşın, terapötik ittifakın kavramsal tanımı ve terapötik

ittifakın nasıl ölçülebileceği henüz tartışma konusudur. Bununla birlikte, terapötik

ittifakı analiz etmek, ölçmek ve control etmek için, farklı yaklaşımlardan

araştırmacılar hangi faktörlerin terapötik ittifakı etkilediği üzerine tartışma

yürütmeye devam etmektedir.

Tarihsel bağlamda, terapötik ittifak kavramıyla ilgili ilk çalışmalar

psikodinamik kurama aittir. Terapi içerisindeki ilişkinin önemine ilk kez Freud

(1912/1913) dikkatleri çekmiştir. Freud (1913) yazılarında hastalarının

duygularına ve doktorlarına olan bağlanmasına odaklanmış ve buna bağlı olarak

aktarım ve karşıaktarım kavramlarını ortaya atmıştır. Freud’dan sonra daha birçok

araştırmacı kendi kavramları ile terapötik ilişkinin önemine dikkat çekmiştir

(Anderson ve Anderson, 1962; Baillargeon, Cote ve Douville, 2012; Barrett-

Lennard, 1962/1978/1986; Curtis, 1979; Frank ve Frank, 1991; Frieswyk ve

ark.,1986; Greenson, 1965; Hayes, 1998; Hougaard, 1994; Luborsky, 1976;

154

Luborsky, Singer ve Luborsky, 1975; Orlinsky ve Howard, 1975; Rogers, 1957;

Smith ve Gloss, 1977; Sterba, 1934; Zetzel, 1956). Ancak literatürde, bu

kavramlar arasında en çok kabul gören ve kullanılan Bordin’in terapötik ittifak

kavramı olmuştur (Gelso ve Carter, 1985; Greenson, 1967; Horvath ve Greenberg,

1989; Patton, 1984). Bordin’e göre (1979), terapötik ilişki hangi yaklaşımın

kullanıldığına bağlı olmaksızın şimdi ve burada terapist ve hasta arasında terapötik

tedavinin bütün biçimlerini kapsayan ilişkidir. Ayrıca terapötik ilişki hem

terapistin hem de hastanın ortak katılımından oluşan amaç, hedef ve duygusal bağ

boyutlarından oluşmaktadır. Bu çalışmada da Bordin’in kavramı kullanılmıştır.

Terapötik ilişkinin öneminin anlaşılması ve kavramsallaştırma

çalışmalarından sonra bu kavramların nasıl ölçüleceği literatür için diğer bir

tartışma konusu olmuştur. Birçok araştırmacı çeşitli ölçekler geliştirmiştir (örn.

Anderson ve Anderson, 1962; Barrett-Lennard, 1962; Stone ve Shertzer; 1965;

Orlinsky ve Howard; 1966). Bu ölçeklerden ampirik olarak güçlü olması nedeniyle

en çok kullanılanlardan biri Horvath ve Greenberg’in (1989) Bordin’in (1979)

amaç, hedef ve duygusal bağ odaklı terapötik ilişki kavramını ölçmek için

oluşturulmuş olduğu Terapötik İttifak Ölçeği olmuştur. Bu çalışmada da nicel

yöntem olarak bu ölçek kullanılmıştır. Ancak, terapötik ilişkinin ölçümü ile ilgili

tartışmalar devam etmekte ve üretilen ölçüm araçları birtakım kısıtlılıklar

içermektedir. İlk olarak, terapötik ilişkinin ne olduğu konusunda kavramsal olarak

ortak bir kabulun olmaması birçok ölçek üretilmesine neden olmuştur (Elvins ve

Green, 2008). Buna bağlı olarak terapötik ilişki literatürü için temsili bir ölçek

oluşmamış böylece ölçek odaklı birçok çalışma yapılmıştır. İkinci olarak, Green ve

ark.’na göre (2001), bu ölçekler genç yaş grubunu değerlendirmek için yetersiz

kalmaktadır. Creed ve Kendall (2005) da özellikle gelişimsel kısıtlılıkları

nedeniyle ergenlerin ve çocukların terapötik ilişki algısını ölçmekte bu ölçeklerin

yetersiz kaldığını vugulamışlardır. Çalışmalarında (2005) gençlerin ittifak olarak

algıladıklarının kendi ebeveynleri ile olan ilişkiyi yansıttığını fark etmişlerdir.

Üçüncü olarak, Braswell, Kendall, Braith, Carey ve Vye (1985), farklı seanslar

sonrası yapılan terapötik ittifak ölçümlerinin sadece o seansa ait ölçümler

olduğunu vurgulamıştır. Elvins ve Green (2008) çalışmalarında, terapötik ilişkinin

erken yaş dönemindeki bağlanma biçimi ile ilgili olduğunu keşfetmişler ve yapılan

155

ölçeklerin bağlamayı da esas alarak terapötik ittifakın karmaşık yapısını

ölçebilecek şekilde olması gerektiğini vurgulamışlardır. Ayrıca Eugster ve

Wampold (1996) dört değişkenin (hastanın katılımı, hastanın rahatlığı, hastanın

gelişimi ve hastanın gerçek ilişkisi) hastanın ittifakı değerlendirmedeki algısını

etkilediğini vurgulamıştır. Bundan dolayı, literatüdeki ölçeklerin gerçek ittifakı

ölçemeyeceğini savunmuşlardır. Bunlarla birlikte literaütdeki ölçeklerle ilgili daha

birçok eleştiri mevcuttur (örn. Castonguay, Constantino ve Grosse Holforth, 2006;

Constantine, Arnow, Blosey ve Agras, 2005; Eugster ve Wampold, 1996; Migone,

1996). Tüm bu eleştirilere çözüm üretmek amacıyla Kelly (1997) obje nesne

ilişkilerine dikkatleri çekerek obje ilişkilerinin hastanın terapötik ilişkiye

katkısının bağlanma kuramı çerçevesinde de ele alınabileceğini savunmuştur.

Kelly (1997) sembollere ve temsillere dayalı ölçülürse kökenini çocukluk ve aile

bağlarından alan terapötik ittifakın çok daha doğru ölçülebileceğini iddia etmiştir.

Buradan çıkarak, bu çalışmada terapötik ittifak için nitel ve projektif bir ölçek

geliştirilmiştir.

Literatürdeki kavramsallaştırma ve ölçme çalışmalarından sonra, bir diğer

tartışma konusu terapötik ittfakı nelerin etkiliyor olduğudur. Bununla ilgili terapi

yaklaşımlarından farklı açıklamalar yapılmıştır (Beck, Rush, Shaw ve Emery,

1979; Elliott, Watson, Goldman ve Greenberg, 2004; Freud, 1912; Hinshelwood,

Robinson ve Zarate, 2006; Mayers ve Hayes, 2006; Sullivan, 1953; Safran ve

Muran, 2000). Bu yaklaşımlardan en çok göze çarpan ise Şema Teori’nin

açıklamaları olmuştur (Young, 1999). Şema terapiye göre hem terapistin hem de

hastanın çocukluktan getirdiği erken yaş dönemi uyumsuz şemaları, ebeveyn

kökeni, kaçınma ve telafi baş etme süreçleri terapötik ilişkiyi etkilemektedir. Şema

Teori’ye göre (Young, 1999), beş şema alanı altında (ayrılma ve

dışlanma/reddedilme, zedelenmiş özerklik ve performans, zedelenmiş sınırlar,

başkalarına yönelimlilik, aşırı tetikte olma ve baskılama) toplam on sekiz tane

erken yaş dönemi uyumsuz şema vardır (terk edilme, güvensizlik/istismar edilme,

duygusal yoksunluk, kusurluluk/utanç, sosyal izolasyon, bağımlılık/yetersizlik,

hastalıklar ve zarar görme karşısında dayanıksızlık, yapışıklık, başarısızlık, boyun

eğicilik, kendini feda, onay arayıcılık, karamsarlık, duygusal bastırma, yüksek

standartlar, cezalandırıcılık).

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Klinik Psikoloji Literatüründe terapötik ilişkinin tedavi sürecindeki

önemine daikkat çekilmesine rağmen, literatüde ilişki döngüsünü neyin etkilediği

üzerine kısıtlı sayıda araştırma vardır. Bundan dolayı, bu çalışmada şu amaçlara

ulaşmak hedeflenmektedir: Young şema alanlarının, baş etme biçimlerinin ve

ebeveyn biçimlerinin süpervizörler, terapistler ve hastalar arasındaki terapötik

ilişkiye etki edip etmek; süpervizörlerin, terapistlerin ve hastaların terapötik ilişki

tanımlarını karşılaştırmak; terapötik ittifakı ölçmek için örtük bir ölçüm aracı

geliştirmek; Terapötik İttifak Ölçeği’nin süpervizör ve terapist formlarının Türkçe

modifikasyonunun yapılması; terapötik ittifakın nitel ve nicel ölçümlerini

kısıtlılıkları ve farklılıkları açısından kıyaslamak

Bu araştırmada hedeflere ulaşabilmek için methot olarak şöyle bir yöntem

ve prosedürler uygulanmıştır. Araştırmada katılımcılar üç grubtan oluşmuştur.

Birinci grup, Orta Doğu Teknik Üniversitesi klinik psikoloji doktora programında

öğrenim gören sekiz süpervizörden oluşmuştur. Bu öğrenciler bölümdeki kıdemli

öğretim görevlileri tarafından, süpervizyon altında en az iki yüz seans hasta gören

ve psikoterapi dersi almış olan grup içierisinden seçilmiştir. Süpervizörler kendi

eğitim sürecinde ilk kez süpervizyon vermiştir. Bu nedenle, onların süpervizyon

süreci de bölümdeki öğretim görevlileri tarafından ayda bir kez denetlenmiştir.

Ayrıca, süpervizörler ayda bir kez da akran süpervizyonuna katılmışlardır. İkinci

grup, Orta Doğu Teknik Üniversitesi klinik psikoloji yüksek lisans programına

devam eden on iki terapistten oluşmuştur. Bu öğrenciler lisans programının ikinci

yılına devam etmektedir ve bu programın ilk yılında psikoterapi dersi almıştır.

Ayrıca, terapistler de ilk kez psikoterapi sürecinde yer almıştır. Terapistler haftada

bir kez süpervizyon almış ve ayda bir kez de lisansüstü öğrencileri ve klinik

psikoloji programının öğretim üyeleri önünde kendi vakalarını sunmuşlardır.

Süpervizörler ve terapistler vaka sunumları aracılığıyla da öğretim görevlileri

tarafından değerlendirilmiştir. Tüm bu süpervizyon ve psikoterapi süreçleri Ayna

Klinik Psikoloji Birimi tarafından sağlanmıştır. "Ayna", Orta Doğu Teknik

Üniversitesi Psikoloji Bölümü'nde klinik psikoloji programına devam eden

öğrencilerin stajı için tesis edilmiş bir klinik destek ünitesidir. Bu ünitede, yüksek

lisans veya doktora eğitimine devam eden öğrenciler süpervizyon altında

psikoterapi hizmeti vermektedir. Üçüncü grupsa, depresyon, anksiyete, yakın ilişki

157

sorunları, veya kişilik bozukluğu şikayetleri ile Ayna’ya başvurmuş sekiz hastadan

oluşmaktadır. Bu hastalar çoğunlukla Orta Doğu Teknik Üniversitesi'nin farklı

bölümlerinde öğrenim gören öğrenciler olmuştur.

Bu çalışmada, iki tip ölçüm yöntemi kullanılmıştır. Birincisi, nicel ölçme

yöntemidir. Nicel ölçüm için Demografik Bilgi Formu, Young Şema Ölçeği,

Young Ebeveynlik Ölçeği, Young-Rygh Kaçınma Envanteri, Young Telafi

Envanteri ile Terapötik İttifak Ölçekleri’nin süpervizör-terapist ve terapist-hasta

formları kullanılmıştır (Detaylı bilgi için tezin orjinaline bakınız). İkinci olarak

nitel ölçüm yöntemi kullanılmıştır. İlk olarak, süpervizörlerin ve terapistlerin

süpervizyon sürecinde yaşadığı zorlukları ve bunlarla nasıl baş ettiklerini

belirlemek için araştırmacı tarafından geliştirilen Açık Uçlu Soru Formu

uygulanmıştır. Buna ek olarak, tüm katılımcıların örtük olarak süpervizyon ve

psikoterapi süreçlerini nasıl algıladıklarını belirleyebilmek için İlişkisel Halkalar

adında bir projektif ölçek geliştirilmiştir. Mevcut çalışma başlamadan önce, Ayna

Klinik Psikoloji Birimi Direktörü ve Orta Doğu Teknik Üniversitesi Etik

Komitesi’nden izin alınmıştır. Ayrıca, çalışmanın başında, katılımcıların bu

çalışmaya gönüllü katılımını ifade ettikleri bilgilendirilmiş onam formu

imzalatılmıştır. Gizliliği sağlamak için, öncelikle, katılımcılara araştırmaya dahil

olmayan bir kişi tarafından takma isim verilmiştir.Araştırmacı takma isimlerin

hangi kişiye ait olduğunu bilmemektedir. Ancak katılımcılara birbirleri için

değerlendirme yapacaklarından takma isimlerin kime ait olduğu bilgisi verilmiştir.

Süpervizörler "Süper" takma adı ile kodlanmış ve bu takma adın arkasına bir sayı

(örneğin, SUPER1) atanmıştır. Ayrıca, terapistler "Freud" takma adı ile kodlanmış

ve bir sayı bu takma adın arkasına (örneğin, Freud1) atanmıştır. Benzer şekilde,

hastalar da “Kaşif” takma adıyla kodlanmış, bu kodun önüne bir sayı sonuna bir

sayı eklenmiş; önüne eklenen sayı hastanın süpervizörünü, arkasına eklenen

sayıysa terapistini temsil etmiştir (örneğin, 1Kaşif5). Ancak araştırmacı bu kodları

tezde yazarken gizliliği sağlayabilmek için tekrar değiştirmiştir. Mevcut çalışmada

üç grup ölçek verilmiştir. Birinci grup araştırmanın başında bir defaya mahsus

olarak evde doldurulacak biçimde uygulanmıştır. Bu grubu Young Şema Ölçeği,

Young Ebeveynlik Ölçeği, Young-Rygh Kaçınma Envanteri ve Young Telafi

Envanteri oluşturmuştur. Terapötik ittifakı ölçen ikinci grupsa, terapi seansı veya

158

süpervizyon seansı en az üç seans geçtikten sonra verilmiştir, literatüre göre

terapötik ilişki en erken üç seanstan sonra başladığı için. Bu ölçekler her seans

veya süpervizyon oturumu biter bitmez katılımcılara uygulanmıştır. Bu amaçla,

süpervizyon ve terapi odalarına, bir kutu ve zarf yerleştirilmiştir. Ayrıca hatırlatma

notları da bu odaların içine yerleştirilmiştir. Her oturumun sonunda, katılımcıların

ölçekleri doldurmsı, zarfın içine koymas, zarfı kapatması ve zarfı kutuya atması

beklenmiştir. Üçüncü grup olarak, her süpervizyon ve terapi sürecinin sonunda

doldurulmak üzere, katılımcılara yapılandırılmamış ölçekler (örn. ilişkisel halkalar

ve açık uçlu soru formu) verilmiştir. Katılımcılardan ilişkisel halkaları hedef,

görev ve duygusal bağ açısından doldurmaları beklenmiştir. Hedef, görev ve

duygusal bağ tanımlarına yönelik talimatlar ilişkisel halkaları doldurma işlemi

başlamadan önce araştırmacı tarafından katılımcılara anlatılmıştır. Bordin’in

(1979) kavramsallaştırılmasına dayanarak, amaçlar katılımcın yaşadıkları durumlar

çerçevesinde terapiden ve süpervizyondan kazanmayı umut ettikleri şeyler/bceriler

olarak tanımlanmıştır. Görevler süpervizör ve terapist ya da terapist ve hastanın

birlikte ulaşmak istedikleri amaçlar doğrultusunda hemfikir oldukları görev ve

sorumlulukları içermiştir. Duygusal bağ ise süpervizör-terapist veya terapist-hasta

arasındaki amaçlara ulaşmaya çabalarken oluşan yakınlık ve güven duygusu olarak

tarif edilmiştir.

Bu çalışmada, nicel ölçüm yöntemlerinde diskriptif ve korelasyon amaçlı

sonuçlara ulaşmak için SPSS kullnılmıştır. Nitel ölçümler ise nicel ölçümlerden

çıkan sonuçlarla ilişkilendirilerek açıklanmaya çalışılmıştır.

Yapılan çalışmada sekiz hasta ile başlayan hasta katılımı dört tanesi ile

devam etmiştir. Süpervizör ve terapist sayısında bir kayıp yaşanmamıştır.

Araştırmanın tamamında 52 ilişki biçimi saptanmıştır. Ancak tezde yer

kısıtlılığından dolayı bunların genel bilgisi ile sadece iki vaka anlatılabilmiştir.

Genel bilgi formuna göre, süpervizörler ve terapistler tarafından çoğunlukla

Bilişsel Davranışçı Yaklaşım (10 kişi) kullanılmış bununla kombine olaraksa

Psikodinamik Yaklaşım (6 kişi), Şema Teori (4 kişi), İlişkisel Yaklaşım (2 kişi),

Duygu Odaklı Yaklaşım (1 kişi), Bağlanma Odaklı Yaklaşım (1 kişi), Geştalt

Yaklaşımı (1 kişi), veya Psikoeğitim (1 kişi).

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Ölçeklerin deskriptif özelliklerini analiz edebilmek için, Young Şema

Ölçeği (örn. terk edilme, güvensizlik/istismar edilme, duygusal yoksunluk,

kusurluluk/utanç, sosyal izolasyon, bağımlılık/yetersizlik, hastalıklar ve zarar

görme karşısında dayanıksızlık, yapışıklık, başarısızlık, boyun eğicilik, kendini

feda, onay arayıcılık, karamsarlık, duygusal bastırma, yüksek standartlar,

cezalandırıcılık); Young Ebeveynlik Ölçeği (kuralcı/kalıplayıcı,

küçümseyici/kusur bulucu, duygusal bakımdan yoksun bırakıcı, sömürücü/istismar

edici, aşırı koruyucu/evhamlı, koşullu/başarı odaklı, aşırı izin verici/sınırsız,

kötümser/endişeli, cezalandırıcı, değişime kapalı/duygularını bastıran); Young-

Rygh Kaçınma Ölçeği (örn. psikosomatizm, sıkıntıyı yok saymak, duygu kontrolü,

sosyal çekilme, aktiviteyle zihinden uzaklaştırma, hissizlik, duyguları bastırma);

Young Telafi Ölçeği’nin (örn. statü düşkünlüğü, kontrol, asilik, aşırı bağımsızlık,

manipülatif olma, eleştiriye tahammülsüzlük, kendi yönelimlilik, mesafelilik)

ortalamaları, standart sapmaları ve minimum-maksimum aralıkları

değerlendirilmiştir. Bu analiz süpervizörler, terapistler ve hastalar için ayrı ayrı

tekrarlanmıştır.

Çıkan sonuçlara göre, süpervizörler çoğunlukla kendini feda ( şemalarını

kullanma eğilimindedirler sacrifice (M = 2.95), onay arayıcılık (M = 2.88), yüksek

standartlar (M = 2.75), terk edilme (M = 2.63), büyüklenmecilik (M = 2.40),

cezalandırma (M = 2.28), karamsarlık (M = 2.03) ve sosyal izolasyon (M = 2.00)

şemalarını kullanmaktadırlar. Diğer bir taraftan, sonuçlar gösteriyor ki

süpervizörler çoğunlukla duygusal bakımdan yoksun bırakıcı anne (M = 4.56) ve

baba (M = 3.69), karamsar/kaygılı anne (M = 3.21) ve baba (M = 2.79), değişime

kapalı/duygularını bastıran anne (M = 2.67) ve baba (M = 3.21), kuralcı/kalıplayıcı

anne (M = 2.53) ve baba (M = 2.47) ve koşullu/başarı odaklı anne (M = 2.40) ve

baba (M = 2.85) kökenine sahip ailelerden gelmektedir. Bununla beraber, sosyal

çekilme ve (M = 4.08) ve duygu kontrolü (M = 3.00) süpervizörlerin çoğunlukla

kullandıkları kaçınma baş etme yöntemiyken, mesafelilik (M = 3.55), kontrol (M =

3.50), aşırı bağımsızlık (M = 2.83) ve statü düşkünlüğü (M = 2.41) süpervizörler

tarafından telafi baş etme biçimi olarak saptanmıştır. Sonuçlara gore,

süpervizörlerin Young şema ölçeklerindeki dereceleri psikopatoloji seviyesinde

bulunmamıştır. Ancak, bu araştırmada elde edilen puanlar süpervizörlerin bir

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yatkınlığı olarak ele alınmış ve tartışılmıştır. Terapistlerle ilgili sonuçlar

değerlendirildiğinde, terapistlerin yüksek standartlar (M = 3.80), onay arayıcılık(M

= 3.60), büyüklenmecilik(M = 3.35), kendini feda (M = 2.93), sosyal izolasyon(M

= 2.81), terk edilme(M = 2.67), yetersiz özdenetim (M = 2.62), ve cezalandırıcılık

(M = 2.40) şemalarını çoğunlukla kullanma eğiliminde olduğu saptanmıştır.

Bununla beraber, terapistlerin çoğunlukla duygusal bakımdan yoksun bırakıcı anne

(M = 4.18) ve baba (M = 3.53), koşullu/başarı odaklı anne (M = 3.42) ve baba

(3.40), kötümser/endişeli anne (M = 3.19) ve baba (M = 3.00), değişime

kapalı/duygularını bastıran anne (M = 3.08) ve baba (M = 4.25), kuralcı/kalıplayıcı

anne (M = 2.94) ve baba (3.11) ve aşırı koruyucu/evhamlı anne (M = 2.92)

özellikleri barındıran aile kökenine sahip olduğu dikkati çekmiştir. Ayrıca,

şemalardan kaçınma yöntemi olarak sosyal çekilme (M = 4.00), aktiviteyle

zihinden uzaklaştırma (M = 3.17) ve duygu kontrolü (M = 2.79) çoğunlukla

kullanılıyorken, terapistler arasında sıklıkla kullanılan telafi yöntemleri mesafelilik

(M = 3.82), statü düşkünlüğü (M = 3.32), kontrol (M = 3.32), aşırı bağımsızlık (M

= 3.08), kendi yönelimlilik (M = 2.78), ve eleştiriye tahammülsüzlük(M = 2.69)

olarak belirlenmiştir.

Hastaların sonuçları değerlendirildiğindeyse, hastaların sıklıkla

kullandıkları şemaların yüksek standartlar (M = 4.70), büyüklenmecilik (M =

4.00), kendini feda (M = 3.98), yetersiz özdenetim (M = 3.60), onay arayıcılık(M

= 3.55), cezalandırıcılık (M = 3.55), karamsarlık (M = 3.53), terk edilme (M =

3.30), sosyal izolasyon (M = 3.30) ve duyguları bastırma (M = 3.00) olduğu göze

çarpmıştır. Hastalar için bu şemaların aile kökeni ise, duygusal bakımdan yoksun

bırakıcı anne (M = 4.88) ve baba (M = 3.63), aşırı koruyucu/evhamlı anne (M =

4.29), koşullu/başarı odaklı anne (M = 3.75) ve baba (3.35), kuralcı/kalıplayıcı

anne (M = 3.66) ve baba (3.00), kötümser/endişeli anne (M = 3.58) ve baba (M =

2.79) ve değişime kapalı/duygularını bastıran anne (M = 2.96) özelliklerinden

kaynağını almıştır. Bu şemalarla kaçınma baş etme biçimi olarak hastalar

çoğunlukla sosyal çekilme(M = 4.54), aktiviteyle zihinden uzaklaştırma (M =

4.00), duygu kontrolü (M = 3.88) ve psikosomatizm (M = 2.77) yöntemlerini

kullanmışlardır. Telafi baş etme biçimi olaraksa, mesafelilik (M = 4.85), kontrol

(M = 4.41), kendi yönelimlilik(M = 3.79), aşırı bağımsızlık (M = 3.63), statü

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düşkünlüğü (M = 3.61), asilik (M = 3.58), manipülatif olma (M = 3.35) ve

eleştiriye tahammülsüzlük(M = 3.21) dikkati çekmiştir.

Süpervizörler, terapistler ve hastaların şema ölçeklerinde çıkan yönelim ve

sonuçlarının süpervizyon ve terapi sürecindeki olası etkileri tezin orijinal halinde

tartışılmıştır. Katılımcıların şemaya özellikleri belirlendikten sonra bu özelliklerin

terapötik ilişki ile nasıl ilişkili olduğuna ise korelasyon analizi ile bakılmıştır.

Korelasyon analizinin genel sonuçları değerlendirildiğinde, terapistler

(Görev: M = 6, Amaç: M = 6, Duygusal bağ: M = 5.72) süpervizörleri ile olan

görev, amaç ve duygusal baş odaklı terapötik ilişkilerini süpervizörlerin

puanlamalarına(Görev: M = 5.80, Amaç: M = 5.77, Duygusal bağ: M = 5.59)

kıyasla daha yüksek puanlar ile değerlendirmişlerdir . Ayrıca, hastalar da (Görev:

M = 5.06, Amaç: M = 5.77, Duygusal bağ: M = 5.85) terapi sürecindeki terapötik

ilişkiyi terapistlere (Görev: M = 4.64, Amaç: M = 5.18, Duygusal bağ: M = 5.80)

oranla daha yüksek puanlamalarla değerlendirmişlerdir. Gruplar arası farklılıklar

rakam bazında çok yüksek olmasa da düşük hiyerarşik konumdaki kişilerin yüksek

hiyerarşik konumdaki kişileri daha pozitif değerlendirdiği dikkati çekmiştir. Bu

durum içinde bulunulan süreci idealize etmek ihtiyacı ile ilişkilendirilebilir

(Luborsky, Chveler, Auerbach, Cohen, & Bachrach, 1971). Ayrıca, gruplar arası

fark gruplar içinde açık iletişimle halledilmeyen problem olabileceğini de

düşündürmüştür.

Süpervizörlerin süpervizyon sürecinde terapötik ilişki algısı

değerlendirildiğinde, amaç odaklı terapötik ilişkinin sıkıntıyı yok saymak (r = -

.85, p < .01) ile negatif korelasyon gösterdiği ve görev odaklı terapötik ilişki (r =

.97, p < .001) ile de pozitif korelasyon içinde olduğu saptanmıştır. Bunun yanı sıra,

görev odaklı terapötik ilişki ve bir kaçınma baş etme yöntemi olan sıkıntıyı yok

saymak (r = -.80, p < .05) arasında önemli bir korelasyon saptanmıştır. Ayrıca,

duygusal bağ odaklı terapötik ilişki boyun eğicilik şeması (r = .74, p < .05),

kötümser/endişeli anneye sahip olmak (r = .81, p < .05) ve sömürücü/istismar edici

babaya sahip olmak (r = .77, p < .05) ile önemli pozitif korelasyon gösterirken,

duygusal bağ odaklı terapötik ilişki ile değişime kapalı/duygularını bastıran babaya

sahip olmak (r = -.85, p < .01) ve sıkıntıyı yok saymak(r = -.82, p < .05) arasında

önemli bir negatif korelasyon bulunmuştur. Bu sonuçlara dayanarak, sıkıntıyı yok

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saymak kaçınma yöntemini kullanmak düşük derecede amaç, görev ve duygusal

bağ odaklı terapötik ilişkile korelasyon göstermiştir. Bunun sebebinin problemleri

görmek ve ifade etmek istemeyen süpervizörlerin terapistlerle olan işbirliğinden

hoşnut olmaması olduğu düşünülmüştür. Ancak onlar bunu dile getirmemiştir.

Onlar problemleri fark etmediği, kabul etmediği ve ifade etmediği için de

problemler çözülememiş olabileceği düşünülmüştür. Bu sebeple süpervizyon

esnasında birçok şeyin konuşulmamış olabileceği çıkarımı yapılabilir. Belki de

süpervizörler her şeyin younda olduğuna dair bir tablo çizmiştir. Halbuki

Prochaska ve Norcross’a göre (2006), değişimi başlatabilmek için öncelikle

problemi fark edip, kabul edip dile getirmek gerekir. Süpervizörlerin bu tutumu

belki de onların şema ölçeklerinde de dikkati çeken sevgi, onay ve kabul

ihtiyacından ileri gelmiş olabilir. Diğer taraftan, süpervizyon vermeyi ebeveynlik

süreci ile ilişkilendirirsek (“Psikoterapiyi öğrendin, şimdi nasıl yapılır onu öğret!”

iç sesiyle) ve terapist olabilme süreci çocuk rolü ile ilişkilendirilirse belki de

süpervizörler ebeveyn rolündeyken çocuklarına (terapistlere) sınırsız onay ve

kabul sunmuş ve kendi yaşadıkları üzüntüleri göz ardı etmiştir çünkü kendileri

ailelerinden onay ve kabul alamadıkları için bunu bu şekilde telafi etmeye

çalışmaktadırlar (Driver et al., 2002). Bu yüzden, belki, bu terapistler için iyi bir

ebeveyn olmaya çalışırken yanlış yöntem kullanmışlardır, aslında telafi etmeye

çalıştıkları kendi çocukluk ihtiyaçları olmuştur (Young, 1996). Daha iyi ittifak

sağlayayım derken, gerçek benliklerini ortaya koymamışlarıdır. Belki de maskeli

bir benlikle yanlış yönlendiren bir süpervizyon atmosferi yaratmışlardır

(Winnicott, 1965). Böylece, kendi rahatsız oldukları şeyleri ve üzünleri göz ardı

ettikçe terapötik ilişki daha kötüye gitmiş olabilir. Bununla birlikte, yüksek

seviyede boyun eğicilik şemasına sahip olmakla yüksek seviyede duygusal bağ

odaklı terapötik ilişki arasında bir korelasyon bulunmuştur. Young’a göre (1999),

boyun eğicilik başkaları yönlimlilik şema alanı altında yer almaktadır ve kişinin

kendi duygu, düşünce ve kararlarını reddedilmemek ve başkalarının öfkesine

maruz kalmamak için bastırarak başkalarına aşırı derecede uyum sağlaması ile

ilişkilendirilmektedir. Buradan yola çıkarak, süpervizörler kendi ihtiyaç, duygu ve

isteklerini bastırarak daha yoğun bir duygusal bağa kurmuş olmayı beklemiş

olabilir. Bu da süpervizörlerde terapistle ilişkide boyun eğicilik şemasının aktive

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olduğunu çünkü süpervizörlerin iyi ilişkiler kurabilmek için duyguları bastırmayı

biliyor oldukları düşünülmüştür. Ancak daha önce de bahsedildiği gibi sıkıntıyı

yok saymanın ve gerçek ihtiyacı bastırmanın kişiler arası ilişkilerde daha kötü bir

tablo ile sonuçlandığı belirtilmiştir (Gross & John, 2003) ve bu yapı süpervizyon

odasında gerçekten ne yaşandığının algılanmasını engellemiş olabilirca (terapötik

ilişki). Young (1999) aşırı derece boyun eğicilik şeması olan kişilerde pasif agresif

tutumların ve duygu patlamalarının olabileceğini vurgulamıştır. Aile kökenleri

açısından, kötümser/endişeli anneye ve sömürücü/istismar edici babaya sahip

olmak yüksek seviyede duygusal bağ odaklı terapötik ittifak ilişki ile ilişkili

bulunmuştur. Bunun spervizörlerin kendi çocukluk ihtiyaçlarının bir telafisi

olabileceği düşünülmüştür (Young, Klosko, & Weishaar, 2003). Eğer süpervizör

kötümser bir anne ve sömürücü bir baba ile büyümüşse, belki de ebeveynleriyle

umduğu ve hayalini kurduğu duygusal bağı kuramamıştır. Annenin kötümser ve

babanın sömürücü olduğu bir ortamda belki de umut duygusu var olamamıştır.

Belki de süpervizörler biliçdışından psikoloji bölümünü seçerek bu kötümser ve

umutsuz döngüyü kırmayı hedeflemiştir. Belki de kendi çocukluk ihtiyaçlarını

telafi etmeye çalışarak iyi bir ilişki örüntüsü götürmeye çalışmışlardır (kendi

ebeveynlerinin olamadığı gibi davrnamya çalışarak). Böylece, belki de olduğundan

daha fazla bir duygusal bağ algılmış olabilirler terapistlerle (çünkü kendi ebeynleri

gibi davranmayınca her şeyin yolunda gideceğini düşünmüş olabilirler). Diğer

taraftan, kötümser/endişeli ve sömürücü/istismar edici ebeveynlerin olduğu bir aile

atmosferinde büyümek depresyonun gelişimin provoke eden bir zemin yaratmış

olabilir. Scott ve ark.’na göre (2000), eğer bir kişi umutsuzluk, düşük özgüven ve

suçluluk semptomları ile bir depresyon yaşıyorsa, bu kişinin başkaları ile olan

ilişkilerde bağımlı bir yapı geliştirmeye eğilimi olabilir. Bu yüzden, belki de,

bağımlı ilişki ihtiyacı içerisinde, süpervizörler duygusal bağı gerçekte olduğundan

daha iyi algılamış olabilir. Buna ek olarak, değişime kapalı/duygularını bastıran

babaya sahip olmak düşük seviyedeki duygusal bağ odaklı terapötik ittifak ile

korelasyon göstermiştir. Çıkan bu sonuç aile ortamında çocuğun gelişimi

sürecinde babanın işlevi ve rolü açısından açıklanabilir. Cabrera ve arkadaşlarına

göre (2000), babalar çocuklarını risk alabilmek, bağımsız olabilmek ve başkaları

ile rekabete girebilmek için cesaretlendirmektedir. Ek olarak, Tessman (as cited in

164

Russell ve Saebel, 1997) babaların özellikle kız çocukların sevmeyi ve çalışmayı

öğrenmesinde önemli bir rolü olduğunu savunur. Buna göre, babalar çocuklarının

dış dünya ile bağını temsil eder ve kişiler arası ilişkilerinde güçlü bir yordayıcıdır

(Lamb, 1975; Lamb, Pleck, & Levine, 1985). Tüm bu sebeplerden ötürü, babalar

çocuklarının dış dünya ve gerçeklik ile nasıl ilişki kuracağını ve iç dünyalarını dış

dünyaya nasıl açacaklarını temsil ederler. Bu yüzden, değişime kapalı/duygularını

bastıran baba çocuğunun işbirliği kurmayı, paylaşmayı ve ortaklık edebilmeyi

öğrenmesini engellemiş olabilir. Böylece, bu tarz babalara sahip olan süpervizörler

terapistler ile temel amaçlar koymakta zorluk çekiyor olabilir. Son olaraksa,

yüksek seviyedeki amaç odaklı terapötik ilişki ile yüksek seviyelerdeki görev

odaklı terapötik ilişki arasında bir korelasyon bulunmuştur. Bu belki de amaç

odaklı ve görev odaklı terapötik ilişki maddelerinin birbirlerinden yeterince ayırt

edilememesinden kaynaklanmış olabilir. Diğer taraftan, belki de amaçlar açısından

hemfikir olmak aynı zamanda görevler ve sorumlulukların dağılımı açısından da

hem fikir olunduğu anlamına geliyor olabilir. Ancak bazen insanlar aşılması

gereken bir sorun olduğunu bilir (amaç) ama bunun için yapılması gerekenleri

yapmak istemezler (görev). Bu sebeplerler, amaç ve görevin benzer anlaşılmasının

arkasındaki nedenleri algılamak için dahaz fazla uygulama yapılması gerektiği

düşünülmüştür.

Terapistlerin süpervizyon sürecinde süpervizörlerle olan ilişkilerini nasıl

algıladıklarına gelince, amaç odaklı terapötik ilişki duygusal bakımdan yoksun

bırakıcı anneye sahip olmak (r = .62, p < .05), görev odaklı terapötik ilişki (r = .89,

p < .001) ve duygusal bağ odaklı terapötik ilişki (r = .77, p < .001) ile öenmli

pozitif korelasyon göstermiştir. Ayrıca, görev odaklı terapötik ilişki cezalandırıcı

anneye sahip olmak (r = -.63, p < .05) ile önemli negatif korelasyon gösterirken,

duygusal bağ odaklı terapötik ilişki (r = .89, p < .001) ile önemli pozitif korelasyon

göstermiştir. Ayrıca, duygusal bağ odaklı terapötik ilişki cezalandırıcılık şeması (r

= -.65, p < .05), kontrol kaçınma biçimi (r = -.63, p < .05), manipülatif olma (r = -

.60, p < .05) ve cezalandırcı anneye sahip olmak (r = -.68, p < .05) ile önemli bir

negatif korelasyon göstermiştir.

Terapistlerin süpervizyon sürecindeki pozisyonu açısındansa, yüksek

derecede cezalandırıcılık şemasına sahip olmak, kontrol ve manipülatif olma

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düşük seviyede duygusal bağ odaklı terapötik ilişki ile korelasyon göstermiştir.

Young’a göre (1999), cezalandırıcılık şeması insanın yaptığı hatalar için

cezalandırılması gerektiği inancına dayanır ve bu şema kişinin beklentilerini ve

standartlarını sağlamayan kişiler karşısında asabi, töleranssız, cezalandırıcı ve

sabırsız olma eğilimlerini arttırır (kişinin kendisi için de aynısı söz konusudur).

Şemanın bu tanımından yola çıkarak, bu şemaya sahip terapistler süpervizörleri ile

duygu odaklı terapötik ittifak kurmaya çekinmiş olabilirler. Çünkü eğer ki

süpervizyonda bir hata yaparlarsa bu onlar için duygusal bağ kurulan bir ortamda

daha fazla hayalkırıklığına sebep olacaktır. Bu sayede terapistler kendilerini

cezalandırıcı yapılarından korumuş olabilirler. Bunun yanı sıra, terapistler

açısından bakınca, belki de süpervizörler bir öğretmen ya da ebeveyn gibi

algılanmış olabilir. Eğer böyleyse terapistler hatalarından ders çıkarmak yerine bu

süreçte hata yapmamaya fazlaca odaklanmış olabilirler. Bu kaygılı durum

içerisindeyse, hata yapmak imkansız gibi görünmektedir. Böyle bir süpervizyon

atmosferini yönetebilmek içinse bir strateji gerekmektedir. Büyük olasılıkla,

yaptıkları hataları telafi edebilmek amacıyla kontrol ve manipülatif olma

stratejilerini kullanmış olabilirler. Böylece süpervizörle duygusal bağ kurmaktan

kendilerini yoksun bırakmışlardır. Ayrıca, duygusal bakımdan yoksun bırakıcı

anneye sahip olmak yüksek derecede amaç ve duygusal bağ odaklı terapötik ilişki

ile korelasyon göstermiştir. Bu belki de terapistlerin annelerinden alamadıkları ve

açlığını çektikleri yakınlaşma ve ilişki kurma ihtiyacı ile ilişkilidir. Öte yandan,

cezalandırıcı anneye sahip olmak düşük seviyede görev odaklı ve duygusal bağ

odaklı terapötik ilişki ile korelasyon göstermiştir (Durlak, 1998). Özellikle,

cezalandırıcı ebeveyne sahip olmak cezalandrıcılık şemasının oluşmasını

tetikleyen faktörler arasındadır (Young, 1996). Buna bağlı olarak, yukarda

açıklandığı üzere, terapistler hata yapma korkusuyla sorumluluk almayıp duygusal

bağ kuramadılar. Bunların dışındaysa, amaç odaklı terapötik ilişki yüksek derecede

görev odaklı ve duygusal bağ odaklı terapötik ilişki ile ilişki göstermiştir. Bu

sonuca dayanarak, terapistler amaç, görev ve duygusal bağ odaklı terapötik

ittifakın herhangi birini yüksek değerlendirmişlerse kalan diğerlerine de yüksek

puan vermişlerdir. Yukarıda bahsedildiği gibi, bu terapistlerin şemaları ile

açıklanabilir. Başkaları yönelimlilik şema alanı terapistler için dikkat çekicidir.

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Belki de terapistler onay, kabul ve ilgi almayı koşullu ve başarı vasıtasıyla almayı

öğrendikleri için (Young’ın belirttiği gibi, 1999), belki de amaçta ve görevde

ittifak algılıyorlarsa bunun duygusal bağı da etkilemiş olacağını düşünmüş

olabilirler. Ancak tam tersi düşünülürse, eğer bu terapistlere ortak görev ve

amaçlarladaki performanslarıyla ilgili negatif geribildirim verilirse, onların bunu

genelleyip kişiselleştirip duygusal bağı da olumusuz algılama ve sürdürme eğilimi

olabilir.

Terapistlerin hastlar ile olan sürecindeki terapötik ilişki algılarına

bakıldığındaysa, amaç odaklı terapötik ilişki değişime kapalı/duygularını bastıran

babaya sahip olmak (r = -.81, p < .05) ile negatif korelasyon gösterirken

hissizlik/duygularını bastırma (r = .86, p < .05) ve görev odaklı terapötik ilişki (r =

.87, p < .05) ile pozitif korelasyon göstermiştir. Ayrıca, görev odaklı terapötik

ilişki, sosyal izolasyon (r = -.82, p < .05) ve mesafelilik (r = -.88, p < .05) ile

önemli bir negatif korrelasyon göstermiştir. Diğer taraftan, duygusal bağ odaklı

terapötik ilişki karamsarlık şemasıyla önemli bir negatif korelasyon göstermiştir (r

= -.86, p < .05). Sonuçlara göre, According yüksek seviyedeki görev odaklı

terapötik ilişki düşük seviyelerdeki sosyal izolasyon ve mesafelilik ile ilişkili

bulunmuştur. Young’a göre (1999) sosyal izolasyon şeması dünyadan,

başkalarından ve herhangi bir gruptan izole hissetmekle ilgilidir. Bu şema ayrılma

ve dışlanma şema alanı altında yer almaktadır. Sosyal izolasyon şeması olan

terapistler, tüm bunlardan dolayı, hastalarına aitlik hissetmemiş olabilirler, böylece

terapötik ilişkideki sorumlulukları almamış olabilirler. Young’ın vurguladığı gibi

(1999), bu şema bağımsız, soğuk ve dışlayan bir aileden kökenini alıyor olabilir.

Bu şemanın terapötik ilişki içerisindeki aktivasyonu ile belki de terapistler

hastalarının kendileri ile yakınlaşmasına izin vermemiş ve böylece kendi şema

döngülerini devam ettirmiş olabilirer. Ayrıca, mesafelilik baş etme biçimini

kullarak ilişki içerisinde bağsız hissedip terapi sürecindeki sorumlulukları

üstlenmemiş olabilirler. Ayrıca, yüksek seviyedeki karamsarlık düşük

seviyelerdeki duygusal bağ odaklı terapötik ittifak ile ilişkili bulunmuştur. Bu

şemanın yapısından kaynaklanıyor olabilir. Karamsarlık şemasının aktivasyonu

(Young’ın vurguladığı gibi, 1999) kötü bir şey olacak duygusunu yoğun bir

şekilde yaşatmaktadır. Bu yüzden, bu şema kökeninden insanlar etraflarına kötü

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bir şeyler bulmak için bakarlar ve olan pozitif şeyleri göz ardı ederler. Bundan

dolayı bu şema ile terapistler hastaları ile yaşadıkları ilişki içerisindeki pozitif

şeyleri kaçırmış olabilirlert (Seligman, Reivich, Jaycox ve Gillham, 1995). Diğer

bir sonuca göreyse, yüksek seviyelerdeki hissizlik/duygularını bastırma baş etme

şekli yüksek seviyelerdeki amaç odaklı terapötik ilişki ile ilişkili bulunmuştur.

Aslında, hissizlik/duygularını bastırma etrafta olan negatif şeylerden ve şemaların

yarattığı olumsuz duygulardan kaçınmak için kullanılan bir baş etme şeklidir

(Richards ve Gross, 1999). Eğer terapistlerin şemaları hasta ile ilişkileri esnasında

aktive oluyorsa belki de onlar şemaların yarattığı negatif duygulanımdan dolayı

yaptıkları işe konsantre olamamış olabilirler (Ludwig, 1983). Bundan dolayı, bu

durumda olan terapistler duygularından koparak (disosiasyon) işlerine

odaklanmaya çalışıyor olabilirler. Gerçek olmamasına rağmen, terapistler amaç

odaklı terapötik ilişkinin hissizlik/duyguları bastırma ile arttığını düşünüyor

olabilirler. Bu yüzden, hastalarını gerçek bir ilişki yaşamaktan mahrum bırakıyor

olabilirler. Diğer bir taraftan, değişime kapalı/duygularını bastıran babaya sahip

olmanın düşük derecedeki amaç odaklı terapötik ilişki ile ilişkili olduğu

saptanmıştır. Çıkan bu sonuç yukarıda açıklandığı gibi babanın evdeki fonksiyonu

ile ilişkili olabilir. Son olarak, Finally, yüksek seviyelerdeki amaç odaklı terapötik

ilişki ile görev odaklı terapötik ilişki arasında ilişki olduğu saptanmıştır. Bunun da

nedenleri yukarıda açıklandığı gibi olabilir.

Hastaların terapi sürecindeki terapötik ilişkiyi nasıl değerlendirdiklerine

bakıldığındaysa, amaç odaklı terapötik ilişki büyüklenmecilik(r = .95, p < .05),

mesafelilik (r = .92, p < .05), ve görev odaklı terapötik ilişki (r = .90, p < .05) ile

önemli pozitif korelasyon gösterirken, kötümser/endişeli babaya sahip olmakla (r =

-.89, p < .05) negatif bir korelasyon göstermiştir. Bunun yanı sıra, görev odaklı

terapötik ilişki büyüklenmecilik (r = .95, p < .05) şeması ile önemli pozitif

korelasyona sahiptir. Ayrıca, duygusal bağ odaklı terapötik ilişki büyüklenmecilik

(r = .93, p < .05) şeması ile önemli pozitif korelasyon ve kötümser/endişeli babaya

sahip olmakla (r = -.93, p < .05) önemli negatif korelasyon göstermiştir. Sonuçlara

göre, yüksek seviyelerdeki büyüklenmecilik şeması yüksek seviyelerdeki amaç,

görev ve duygusal bağ odaklı terapötik ilişki ile ilişkilidir. Şema Teori’ye göre

(Young, 1996), büyüklenmecilik şeması kökenini zedelenmiş sınırlar ve kişinin

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kendisinin diğerlerinden üstün olduğu, güce ve kontrole ihtiyaç duyduğu

inancından alır. Bu şema eğiliminde olan hastalar terapistleri ile olan terapötik

ilişkiyi yüksek değerlendirilmiştir. Bu durum birkaç şekilde açıklanabilir.

Öncelikle, belki de bu hastalar psikoterapiye aşağılık duygusu ile baş edemedikleri

için başvurmuş olabilir. Hayatlarında bir problem olduğunu belirleyip bunu

değiştirebilecekleri konusunda kendilerine güvenerek terapist ile amaç, görev ve

duygusal bağ açısından işbirliği yapmış olabilirler. Bu hastaların değişim için

aksiyon fazında olduğunu göstermektedir (Prochaska ve DiClemente , 1986).

İkinci olarak, bu hastaların büyüklenmeci şeması baskınsa, terapistlerini kendileri

seçtikleri için terapistin elbette iyi olduğunu düşünüyor olabilirler. Zaten kötü olan

bir terapiste gitmeyeceklerdir. Ancak bu durum gerçekçi değildir. İşin kötü yanı

terapötik ilişkiyi bozan bir şey varsa, bu hastalar bunu fark etmek ve kabul etmek

istemeyebilir (büyüklenmeci mod /Young, 1999). Ancak, durum böyleyse bile,

terapisti idealize etme durumu terapinin kendisi için bir motivasyon kaynağı

olabilir. Böylece, bu motivasyonla hasta değişebilir. Diğer bir bakış açısıyla ise,

belki de bu hastalara terapistleri tarafından sınırlı yeniden ebeveynlik Şema

Terapi’nin önerdiği şekilde uygulanamamıştır. Hastalar kendi büyüklenmeci

yapısını terapide de devam ettirmektedir. Böyle bir durumdaysa gelişim beklemek

çok gerçekçi olmaz. Ayrıca yüksek seviylerdeki mesafelilik abş etme biçimi

yüksek seviyelerdeki amaç odaklı terapötik ilişki ile ilişkili bulunmuştur. Bu

sonuç mesafeliliğin yapısından kaynaklı olabilir. Young’a göre (1999), bu baş

etme biçimi bağımlılığı ve başkaları yönelimlilik ile baş etme amacıyla kullanılır

.Bu baş etme biçimini kullanan kişiler kendi bağımlılık ve başkaları

yönelimliliklerinin farkında olup bundan kurtulmak isterler. Sağlıklı ve gerçekçi

sınırlar çizerek insanlarla ilişki kurmayı bilmedikleri için kendileri için gerekli ve

faydalı olan duygusal bağdan yoksun kalırlar. Bu stratejiyi kullanan hastalar

ilişkilerini derin yaşayamayıp, beslenemiyor olabilirler (Derlega ve Chaikin,

2010). Bundan dolayı, kendilerin toplumdan izole olmuş hissedebilirler ve sosyal

destekten yoksun kalabilirler (Solano, Batten ve Parish, 1982). Belki de, tam da bu

yüzden, bir problem olduğunu fark edip terapiye başvurmuş olabilirler. Değişmek

istedikleri için de terapistleri ile amaç odaklı terapötik ittifak içinde

olabilirler.Diğer bir taraftan, kötümser/endişeli babaya sahip olmak ile düşük

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seviyelerdeki amaç ve görev odaklı terapötik ilişki arasında ilişki bulunmuştur. Bu

da yukarıda belirtilen babanın işlevi kısmı ile açıklanabilir.

Genel sonuçların yanı sıra, bu doktora tezinde iki tane de vaka örneği

üzerinden şema ölçekleri ve terapötik ilişki arasındaki bağ açıklanmaya

çalışılmıştır. Ayrıca, tartışma ve kısıtlılıklar kısımlarında tezle ilgili önerilere de

yer verilmiştir (Detaylı bilgi için tezin orjinaline bakınız).

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