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The Role of Nonverbal Immediacy Behaviors and the Therapeutic Relationship

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The Role of Nonverbal Immediacy Behaviors and the Therapeutic Relationship ADAMSON, NICOLE A., Ph. D. Outcome Effectiveness in Counseling: The Role of Nonverbal Immediacy Behaviors and the Therapeutic Relationship. (2014) Directed by Dr. Kelly L. Wester. 174pp. The achievement in counseling of client outcome goals has typically been referred to as outcome effectiveness (Miller & Duncan, 2004; Lambert & Hill, 1994). Two theoretical frameworks have been highly supported as viable explanations for the way in which counselors achieve outcome effectiveness (i.e., Empirically-Validated Treatment and Common Factors Theory), but neither framework has gained full support as a comprehensive explanation of outcome effectiveness. One component of outcome effectiveness that is common between both frameworks is the therapeutic relationship; nonverbal immediacy behaviors are theoretically supported as potential contributors to the therapeutic relationship. In this study, it was found that therapeutic relationship increased from session one to session three, but nonverbal immediacy behaviors did not change across sessions. Nonverbal immediacy behaviors did not predict therapeutic relationship, but therapeutic relationship was found to be a significant predictor of outcome effectiveness. Implications of these results and areas for future research are discussed. OUTCOME EFFECTIVENESS IN COUNSELING: THE ROLE OF NONVERBAL IMMEDIACY BEHAVIORS AND THE THERAPEUTIC RELATIONSHIP by Nicole A. Adamson A Dissertation Submitted to the Faculty of The Graduate School at The University of North Carolina at Greensboro in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy Greensboro 2014 Approved by ______________________________ Committee Chair APPROVAL PAGE This dissertation written by NICOLE A. ADAMSON has been approved by the following committee of the Faculty of The Graduate School at the University of North Carolina at Greensboro. Committee Chair__________________________________ Dr. Kelly L. Wester Committee Members__________________________________ Dr. James M. Benshoff __________________________________ Dr. Richard M. Luecht __________________________________ Dr. Loreen N. Olson ____________________________ Date of Acceptance by Committee __________________________ Date of Final Oral Examination ii ACKNOWLEDGEMENTS A very special “thank you” is extended to Dr. Kelly L. Wester; this dissertation would not have been possible without your support and guidance. I also thank Dr. James M. Benshoff, Dr. Richard M. Luecht, and Dr. Loreen N. Olson for the time, energy, and support you have contributed as members of this dissertation committee. Dr. A. Keith Mobley graciously provided resources and support for this dissertation project, and E. Nikki Hillman worked many long hours in lieu of other personal and professional obligations in order to make this dream a reality. Finally, Keith J. Stargell, my family, and The Cohort Bango provided support at the times I needed it most. Thank you. iii TABLE OF CONTENTS Page LIST OF TABLES ............................................................................................................ vii LIST OF FIGURES ......................................................................................................... viii CHAPTER I. INTRODUCTION .................................................................................................1 Rationale for the Study ................................................................................1 Therapeutic Relationship: The Common Component ....................4 Nonverbal Immediacy Behaviors, Therapeutic Relationship, and Outcome Effectiveness .................................7 Purpose of the Study ....................................................................................9 Need for the Study .....................................................................................10 Research Questions ....................................................................................13 Definition of Terms....................................................................................14 Brief Overview...........................................................................................16 II. REVIEW OF THE LITERATURE .....................................................................17 Outcome Effectiveness ..............................................................................17 The History of Outcome Effectiveness .........................................19 Measuring Outcome Effectiveness ...............................................22 Outcome Effectiveness and the Therapeutic Relationship .............................................................................26 Theoretical Frameworks of Outcome Effectiveness .................................29 Empirically-Validated Treatments ................................................30 Common Factors Theory ..............................................................40 Nonverbal Immediacy Behaviors and the Therapeutic Relationship ..........................................................................................55 Nonverbal Immediacy Behaviors .................................................58 Quantity and Correspondence of Nonverbal Immediacy Behaviors ..................................................................................61 Importance of Nonverbal Immediacy Behaviors in the Therapeutic Relationship .........................................................64 Demographic Information about Nonverbal Immediacy Behaviors .................................................................................67 Summary ...................................................................................................68 iv III. METHODOLOGY ..............................................................................................70 Research Questions and Hypotheses .........................................................70 Research Question 1 .....................................................................71 Research Question 2 .....................................................................71 Research Question 3 .....................................................................71 Participants ................................................................................................72 Instrumentation .........................................................................................76 Nonverbal Immediacy Scale (NIS) ................................................77 Outcome Rating Scale (ORS) ........................................................81 Session Rating Scale (SRS) ...........................................................85 Client Demographics .....................................................................87 Counselor Demographics ...............................................................88 Procedures ..................................................................................................88 Inter-rater Reliability for NIS Scores .........................................................91 Training ..........................................................................................91 Bracketing ......................................................................................94 Inter-Rater Reliability ....................................................................95 Data Analysis .............................................................................................96 IV. RESULTS ............................................................................................................98 Resulting Sample Characteristics ..............................................................98 Preliminary Analyses ...............................................................................100 Data Analyses and Results ......................................................................101 Research Question 1 ...................................................................102 Research Question 2 ...................................................................106 Research Question 3 ...................................................................109 V. DISCUSSION ....................................................................................................111 Summary of Findings ...............................................................................111 Research Question 1 ...................................................................113 Research Question 2 ...................................................................119 Research Question 3 ...................................................................124 Implications for Counselors and Educators ............................................126 Congruence and NIB ...................................................................126 Therapeutic Relationship across Time .........................................127 Teaching and Practice Standards .................................................129 Legislation....................................................................................130 Limitations of the Study...........................................................................131 Suggestions for Future Research .............................................................134 v REFERENCES ................................................................................................................137 APPENDIX A. IRB APPROVAL ...................................................................................158 APPENDIX B. INSTRUMENTATION ..........................................................................162
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