ANALYSIS OF A TRANSCRIPT:
CLAUDIA’S SESSION WITH SUZANNA
Barbara Brodley Fred Zimring
Illinois School of Case Western
Professional Psychology Reserve University
Chicago, Illinois U.S.A.
This article is concerned with a short therapy interview that a beginning student (Claudia) of Barbara Brodley's had with a practice client (Suzanna). Both the therapist and the client have given permission for this publication. After the transcript of the interview there are comments by Barbara and Fred. A short note comparing our comments concludes the article.
The following transcript was made by a graduate student as an assignment in empathetic following. The student had no previous experience as a therapist and this assignment was turned in the third week of class; thus, she had practiced only two weeks and had only two classes in an introductory course in client-centered therapy. The client is a practice client chosen by the student from among her acquaintances who had agreed to participate in the student's practice for the course; The "client" was a client in a regular therapy relationship. The topic of the practice interview was the client's reactions to an incident with her regular therapist. The transcript is verbatim of the entire interview, with the names mentioned by the client changed to preserve anonymity.
Client-Centered Session: Peggy with Therapist Claudia
Pl --I feel, uhm, I'm gonna see Laura tonight. We haven't spoken since Saturday night about what happened between us.
Tl --And Laura is your therapist?
P2--My therapist, and fairly semi-undecided I have some ideas about where I want this to go..
T2--uh uh
P3--But I guess I just want to talk about, I guess I just want to clarify how I feel about it cuz I'm confused.
T3--So you can get it straight in your mind for when you talk to her?
P4--Right, right, cuz when I sit down with her I think I would feel better going in having a clear direction.
T4--Yeah
P5--Than just possibly being swayed or talked into something or, I don't know I am really afraid that she will try to control me, and make me do something I don't want to do as much as it's me that I have to decide this and I don't know how objective she can be to help me make the decision because the conflict involves her.
T5--OK
P6-- So I think I should feel better going in to it knowing my mind.
T6--So you think you're gonna encounter some emotionality from
her, because she's involved?
P7--Yes, I do. I think that, I'm not looking at tonight as a therapy session. I don't plan to talk about anything other than this issue so I can resolve it with her,
T7--Yeah
P8--In whatever way we resolve it. I feel like I have thought about the input that I've gotten from the past couple days from Leo and from my husband about stretching myself to accept her as a flawed person who still can help me even though she's flawed.
T8--Yeah
P9--And the fact that most likely she didn't personally try to hurt me personally by being late.
T9--Uh huh
P10 --It's her issue rather than something that was directed at me..
Tl0--Uh huh
P11--And I happened to be on the receiving end of it.
Tl1--Uh huh. So you don't feel it was really directed at you, it might have been something else she was involved in?
P12—Right. I don't feel that it was on purpose, nor do I feel that she had any intention of making me feel bad.
T12--OK
P13—But the end result is still that I'm the recipient of her action, and for every action there's a reaction, and I don’t feel honest with myself if I can just gloss over it and say "Well it's her problem, it wasn't personal, therefore I'm just gonna go on as before."
T13--Because it was personal.
P14--Right.
Tl4--You felt it was personal.
Pl5--Even if it wasn't intentional,
Tl5--Yeah
P16--It still was me, so I still feel like I need to do something about it. Even if she wants to just forget it and go on.
Tl6--Uh huh
Pl7--l don't feel comfortable just forgetting it.
Tl7--Uh huh, so you want to talk about it, you want to get it out in the open.
P18--Yes, definitely
Tl 8--Yeah
Pl9--And I want to let her know that again, this is the second time it's happened, that I feel realty not good when it happens.
Tl9--Uh huh
P20--And if I continue to see her, that we need to find some kind of way to prevent it from happening.
T20--So you are going to try to discuss some kind of program to maybe if it’s gonna happen again, some way to circumvent it.
P21 --Right, like if she's in the office and I'm not there, and it's 45 minutes late, come out and look for me.
T21 --Yes
P22--Or pick up the phone.
T22--Yes
P23--Because I'm never late and I'm never not there.
T23--Yeah, and she doesn't do that now.
P24--She waited till the next hour,
till her next client came and then said, "Oh, whatever happened to Suzy?"
T24--Did that make you feel like you were forgotten?
P25--Yeah, not only did I get there and first feel that she forgot me, but then it was kind of reinforced, because she didn't even think of picking up the phone for an hour later.
T25--Yeah
P26--Knowing that she's aware of what I just went through with this whole doctor business where I felt abused and taken advantage of and manipulated and it took a lot of courage for me after a week, to speak up and not only not see this doctor again but call her on the phone and tell her why.
T26--Uh huh
P27--And it was hard to do but I felt great that I did it. Even though it didn't fix what she had done to me, I felt great that I had the courage to do that, cuz I didn't used to have that, I would have just, number one I would have thought it was me.
T27--Uh huh
P28--I'm too sensitive.
T28--Uh huh
P29--Number two I would have just not ever seen her again, so it was a big step for me and Laura knew what it took for me to not, to stand up. And expect to be treated well.
T29--To stand up for yourself .
P30--Right and expect to get um, what I deserve.
T30--Uh huh
P31--What I'm entitled to, we talk alot about entitlement,
T31--Uh huh
P32--So in my therapeutic relationship with her, I feel entitled to certain contractual behavior, like we're both there when we say we're gonna be, so that we can get something accomplished in therapy.
T32--You have an unspoken contract with her that you feel that she's violated.
P33--Right, and even a spoken contract.
T33--Spoken contract
P34--And then when she, if I were late consistently, no matter what excuses I had, rationally I would know that she had a right to be annoyed with me.
T34--Uh huh
P35--And to not feel as maybe accepting of me. Now maybe if she was client-centered she, she'd always accept me no matter what! But she's not.
T35--So, so you feel the fact that she, does she not, does she say to you that she feels you should not be annoyed?
P36--No, she said that there must be some logical explanation for it her office was painted and maybe the bell stuck. When I still don’t just give in and say, “OK, I'll see you Monday,” she pushed it further and this bothered me, she said that maybe I was on the verge of reaching a certain point in my therapy and facing something that would be upsetting and maybe I was being resistant and I didn't press the bell. And there I feel totally manipulated and angry.
T36--So she kind of pushed it off of herself and on to
P37--Yes
T37--You
P38--She feels in a way innocent, she says she feels very frustrated cuz she honestly didn't do anything wrong.
T38--Yeah
P39--And I understand that feeling. But neither did I, and I feel like it's not fair in her position for her to use that psychology knowledge on me trying to convince me that there is something I'm afraid of. I don't think that's fair.
T39--Instead of, instead of saying that maybe it was a little bit me and maybe a little bit you?
P40--Right
T40--Can we work it out?
P41 --We can't think of an explanation for this.
T41 --Yeah
P42--So let's just, let's just say here's what we'll do to never let it happen
again, instead of saying maybe you sat there and you never pressed the bell,
that makes me feel stupid.
T42--Yeah
P43--It makes me feel childish,
T43--Sure
P44--And not open to wanting to be in the relationship.
T44--Sure
P 45--l feel angry and resentful
T45--Uh huh
P46--Because all my work with her, because it's been so good it's involved dealing with painful stuff.
T46--OD
P47—I’ve aways been there and felt pain or anger or something uncomfortable and it’s been big things, so I resent the implication that I'm avoiding something not. It doesn't even make sense with what I've done so far.
T-47--This seems so minimal.
P48--It's like she's not giving me credit for what I have accomplished ,
So far to suppose that maybe I’m afraid to face something now. It's kind of belittling what I've done so far, I think.
T48--So you feel almost as if she has discounted your previous work.
P49--l think she thinks I've done well, very well, but now she's using this incident and trying to get me back by saying you know maybe there still is something that you are repressing, that you are resisting. She used the word “you have resistance, maybe you're resisting.” And it bothers me that she's not, by saying that she's not taking any responsibility for what happened. And I guess what I'm hearing myself say is, I have to tell her that,
T49--Uh huh
P50--Real clear
T50--Uh huh
P51—So that I don’t know what happened. I know my side of it was I was there and she wasn’t.
T51—Uh huh
P52--Her side of it is she was in the room and I didn't some. But she knows, I left her a note, she found my note. So she thinks I was there and I didn't ring the bell. We both totally think different things. If I'm gonna work with her I need to know I have, she has enough respect for my integrity that I am telling the truth, and that maybe we can move on from there to make rules.
T52--So it’s really an issue of respect here.
P53--Right, mutual respect
T53--Yeah
P54--And maybe I need to overlook the lateness thing if she gives me time on the end, if I can do that.
T54--Yeah
P55--If I know I can structure my day that whenever I have her I might be 15 minutes late coming out,
T55--Uh huh
P56--And not care that she's being late with every other client for the rest of the day, that's really not my problem.
T56--Uh huh
P57--Maybe I could just give her her flaw, allow her her, flaw, get what I can out of it, but before we do that I need to feel that she believes that I rang the bell. And if she thinks I didn't then I don’t think I feel comfortable being with her but I don't know how to find that out, she may just say she believes me just to keep it going. I don't know how to tell whether she really believes me.
T57--So if, so it's an issue of being believed for what you have said. That you are telling the truth.
P58—Whatever it is that I say with her, that I have revealed so much of myself so deep deep layers, that this is nothing compared to that I don't have a reason to not tell the truth. And I'm insulted and hurt to think that maybe she thinks I'm not.
T58--It bothers you when somebody, when you know you are telling the truth and someone doesn't.
P59--Right, and on the other hand maybe she's thinking the same thing “I know I was in there” but then we need to meet in the middle. I can't do all of the coming, all of the meeting her.
T59--Right
P60--Coming to her. I have a thing in my life and I'm aware of this, of balance in relationships, and I've alot been on the giving end, and a few years ago I realized what I was doing and I reached a certain point where when people don't, not even Steven, tit for tat, but generally, give a little bit, you give a little then you get a little, you give a little and if it’s very unbalanced for a long period of time, I don't realty want it if it’s I mean if there were extenuating circumstances a sick person or a child, but when it's an adult relationship I want to get something out of it too. And I finally feel like I have the right to expect that.
T60--Uh huh
P61 --And it's foreign to me but it's good. I know it's a good thing.
T61 --So you learn that you're important enough to expect to get.
Comments: Barbara Brodley
Having the benefit of hearing the tape while reading the transcript, I felt Claudia was very present and responsive to Suzanna and that she consistently conveyed an attitude of acceptance towards Suzanna and to whatever Suzanna expressed. Claudia's tone of voice was caring and respectful and her manner of expression was lively and real. Suzanna's reactions to Claudia, conveyed both by her intonations and the things she said, seemed to indicate that she felt understood, supported and respected. Claudia's good client-centered general qualfties, and her apparent effectiveness in facilitating Suzanna's expression of her issue and her feelings suggest that a breakdown and analysis of her verbal behavior might be instructive to students and others.
In the transcribed segment Claudia makes thirty-seven responses which I term "verbal gestures or acknowledgements of following." Of the total thirty-seven acknowledgements, nineteen are in the explicitly supportive or agreement form of "yeah", "OK". "yes", "sure", or "right", and the remaining eighteen of the total are in the more neutral form of acknowledgement -- "un hum."
Claudia's high frequency of support/agreement forms of acknowledgement does bias the interview away from the evaluative neutrality that was asked of her in the instructions. Claudia may have interpreted the instruction to avoid evaluative responses as pertaining only to articulate responses, or it may be that her supportiveness towards her friend and her relatively high level of energy spilled into and affected the form of those acknowledgements. Although acknowledgements of following expressed as "yeah" or "OK", etc., are natural variations on the familiar "un hum", I have observed that their meaning changes from the evaluatively neutral meaning - "I am following and understanding" to an evaluative meaning in the sense of "you are doing (or saying) the right thing" when they are expressed frequently in an interview. Student therapists admit this latter meaning when they have frequently used the "yeah", etc., forms.
In addition to Claudia’s acknowledgement responses, she made twenty-three distinct articulate responses. Only two of these responses seem to be ones made from Claudia's frame of reference (instead of being empathic following responses representing her client's frame of reference). Claudia's response T35 probes for information and the question is not attuned to the client's immediate frame of reference. Response T58 is a generalization that Claudia formulates out of Suzanna's specific experiences. An empathic response that would be more attuned to Suzanna at that point might be "It's deeply insulting and it hurts that she doesn't believe you, especially she who knows what you've faced,"
The twenty-one remaining responses I classify as some form of empathic following response. Five of these responses (Tl, 3, 6, the latter part of 11 and 24) are questions for clarification. The other sixteen responses (Tl1 - first part, 13, 14, 17, 20, 23, 29, 32, 33, 36, 37, 39-40, 47, 48, 52, 57, and 61) are empathic understanding responses in declarative forms.
Some of Claudia's empathic responses are not the most accurate statements of understanding that are possible given her client, Suzanna's clarity of communication. For example, Claudia's T23 is somewhat elliptical because it expresses the fact of Suzanna's therapist's behavioral deficiency rather than Suzanna's strong desire for her therapist to take the action of checking on her presence in the waiting room if she doesn't hear Suzanna's ringing. Response T23 is, nevertheless, obviously intended to be an expression of empathic following and is closely, although indirectly, related to Suzanna's explanation,
Claudia's empathic following response T36-37 seems not to be emotionally attuned to the intensity of feeling expressed by Suzanna in her C36 statement. It is, however, a following response, and it is in part descriptive of the aspect of the interaction that Suzanna was upset about. An alternative response at that point which might have felt more fully responsive to Suzanna's feelings is (instead of T37-38) “It makes you pretty angry at her to be told you've distorted and misrepresented what happened.”
Another of Claudia's empathic following responses, T47, is in the most empathic element having to do with Suzanna's resentment of the apparent disregard of her past therapy work. A response that might feel more fully empathic to Suzanna (instead of T47) might be “You resent her implication that you would avoid some responsibility or some blame if you deserved it, when she should know very well that you've faced so many painful things.” In fact,Suzanna restates and elaborates her point expressed in C47 after Claudia's T47. This is often-observed client behavior -- that the client will restate something that is important to them if the therapist has mis-stated it or overlooked it.
Claudia's T52 is a following response, but it focuses on Suzanna's communication in terms of an issue, rather than the lived experience. A more immediate form of response (instead of T52) might be “To feel able to keep on working with her you need to trust that she respects you and really believes you are telling the truth.” Claudia's T57 is, also, less immediate because of its reference to the "issue." An alternative might be "You want to feel sure that she believes you, but at this point you don't entirely trust her to be honest with you."
Regardless of the instances of relatively weak or imprecise empathic following responses, Claudia was effective in, communicating acceptance, an empathic attitude, and relatively, accurate empathic responses. She tended toward agreements in her acknowledge-of-following vocalizations and in that way brought into the relationship an evaluative quality. But those responses also contributed to the supportiveness of her presence which was most strongly, and non-evaluativety, communicated through her non-evaluative empathic understandings. She did not make the mistake, in a single response, of volunteering her opinion, or making interpretations or explanations. In only one instance was she probing and in one instance she made a response that had the character of a comment, when she expressed the client's experience in terms of a generality. Claudia came across to me, and, I think, to Suzanna, as very consistently and as sincerely trying to follow and understand Suzanna's feelings and reactions as well as she could. The mistakes and imprecisions in her responses are slight enough that it seems clear that Claudia is trying to empathically understand and is not trying to produce some effect, or have some specific influence, under the cover of understanding.
A significant factor in the constructive flow and effectiveness of the interview is Claudia's practice client. Suzanna is strong in her ability to pursue and persist in expressing what she is getting at even when Claudia's responses are inaccurate or imprecise. As she states in the course of the interview, Suzanna has been a client in therapy for a while, and she has worked on identifying her feelings, asserting herself and clarifying herself to others in interpersonal situations. These abilities help Suzanna to keep on her own track when Claudia's responses might deflect some clients from their own direction.
When I first read and listened to the interview segment I felt it likely that the clarifications that Suzanna expressed with Claudia's help would help her to talk over her problem directly with her therapist. Indeed, Claudia later told me that the discussion had taken place and that it had gone well, according to Suzanna.
Claudia's work in her session with Suzanna, I think, was very good considering the short time she had been exposed to client-centered ideas and the very short time she had practiced before this interview. Study of her successes and mistakes or shortcomings in the approach are interesting to see. I appreciate Claudia's and Suzanna's permission to present this analysis of their interaction.
Comments: Fred Zimring
Suzanna, the client, starts, in C2 and in C3, to talk about being undecided and wanting to clarify how she feels about the situation with her therapist (Laura). This, the present therapist, Claudia, mentions in T3. The client, in C5, then talks about not wanting to be controlled. "I'm really afraid that she will try to control me". In T6 the therapist talks about the client thinking that she will encounter emotionality from Laura but does not pick up the fear of the client about control.
In C7 and in various places through C17, the client talks about her intention of talking to Laura about the issue. After the client repeats herself, in C16 saying that she "needs to do something about it" and then in Cl7 says that she would not "feel comfortable just forgetting it", the therapist finally mentions this in Tl7. The client then moves, in C19, to say that this is the second time this has happened with Laura and that the client does not feel good about this. The therapist in T23 talks about what Laura does but does not talk about the client not feeling good about what Laura does. The therapist asks a question in T24 about how the client felt: "Did this make you feel that you were forgotten?". In answer, the client goes on to explain, in the group of responses through C31, that entitlement is involved in how she feels about what Laura did. The therapist picks this up in T32 in commenting that "you have an unspoken contract with her that you feel she violated." This talk of entitlement leads to mention of what would be right in the situation and then leads to talk about feeling totally manipulated and angry (C36). The therapist (T36) ignores these feelings and instead focuses on what Laura did. This focus on Laura leads the client to consider what Laura feels and then the client comes back (C39) to her feeling that Laura is unfairly using her position. Rather than following the client's feelings of unfairness the therapist describes what it might have been fair for Laura to do.
The client then goes on to talk about her feelings. In C42 she says she feels stupid, in C43 she says she feels childish and in C45 that she feels angry and resentful. The therapist ignores all of these feelings. The client goes on to talk about her feelings of resentment about the implication that she is avoiding something and, in C48, that she feels belittled by what Laura did.
The client, in C49, becomes clear about what she wants to tell Laura and then, in C52, says that she needs to know about Laura's attitudes, if she is to continue to work with her. In T52 the therapist correctly picks up the "issue of respect". This allows the client to realize that her minimal condition for continuing in therapy is that Laura believes her. The therapist's understanding of this leads the client to realize that she is willing to give something but that Laura is going to have to give also, that she "finally feel like I have the right to expect that" (C60), something much like the previous respect issue. The therapist communicates her understanding of this in T61, concluding the interview.
The therapist allowed the client her own world, allowed the client to go wherever the client wanted and did not try to convince the client of whatever truths the therapist might have seen. The therapist was not accurate in following one type of feeling but was in following another. The therapist's understanding of the "hotter, feelings, of feelings of pain, anger, childishness, and resentment were not communicated to the client. The therapist seemed to have much less trouble understanding the client's "cooler" feelings about entitlement and respect.
In general, Barbara's and Fred's analysis were quite similar, paying close attention to the client and therapist interchanges. In future analyses of therapy in the Journal it might be better to have comments from people who were not quite so similar in their approach to therapy. There were some differences, however. Correctly, I think, Barbara gave more attention than Fred did to the therapist’s attitudes. Also, Barbara, having access to the tape of the interview as well as to the transcript, was more sensitive to the client’s feelings of being understood as conveyed by voice quality.