PSYCHOTHERAPY ENGAGERS VERSUS NON-ENGAGERS

and that contextual variables (e.g., stage in therapy, client state) were not considered.
Results also showed large individual differences in the frequency of use and effectiveness
of the response modes for different clients. Limitations of the study include its limited
sample size of 8 female clients in brief therapy, which means the results may not apply to
female clients in general, male clients, or clients in long-term therapy.
Hess, Knox, and Hill (2006) studied the effects of three types of training
(supervisor-facilitated training, self-training, and biblio-training) on graduate student
therapists’ use of reflections and immediacy with videotaped vignettes of angry clients.
62 (40 female, 22 male; age range 22-57 years old) master’s and doctoral graduate
student therapists from counseling-related programs in three universities served as
participants. Three female European American faculty members (the authors of the
study) served as supervisors. The supervisors were primarily humanistic in their
theoretical orientation. Judges consisted of three female master’s degree students in
counselor education with prior helping skills training. The average kappa between pairs
of judges was .91. The Hill and O’Brien (1999) version of the HSS was used; this study
focused only on the proportions of reflection of feelings and immediacy because these
were the focus of the supervision. The therapists were randomly assigned to one of six
different sequences for types of training. After each type of training, therapists watched a
randomly assigned vignette and wrote interventions at each of the five pauses in the
vignette. Results showed that for reflections, supervisor-facilitated training led to more
reflections than self-training (there were no statistically significant differences found for
the other two comparisons). For immediacy, no statistically significant differences
between the three types of training were found. Limitations include that the training only
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