In order to assess the capacity of the data to be in line with the normality assumptions of multiple regressions, the data was subjected to tests of skewness and kurtosis. Results of these analyses indicate that the assumptions for multivariate normalcy were met. In addition, Bonferroni corrections were utilized.
Hypothesis 1—Therapist Epistemology as a Predictor of Therapy Style
The first hypothesis concerned therapist epistemology as a predictor of therapy style. We hypothesized that therapists with rational epistemologies would have a therapy style depicting more rigidity on the Instructional subscale, greater distance on the Expressive subscale, a lesser degree of Engagement, a narrower focus on the Attentional subscale, and be more planned on the Operative subscale compared to therapists with a constructivist epistemology. Separate regression analyses were conducted for each of the five PST-Q scores measuring therapy style.
The Instructional Subscale The epistemology scores accounted for significant variation in Instructional scores, F(2, 1061) = 7.06, p < .001 (R2= .013). The standardized beta coefficient for the rationalist epistemology (β = .053) was in the positive direction, but was not significant— t(1061) = 1.73, p < .084. The standardized beta coefficient for the constructivist epistemology (β = – 0.097) was significant and in the negative direction for the Instructional subscale— t(1061) = –3.15, p < .002. The direction of the effect indicated that the more a therapist endorsed constructivist epistemology, the less likely that therapist was to use an instructional approach to therapy. This supported the hypothesis that a constructivist epistemology tends toward the direction of flexibility on the Instructional subscale; however, the small effect size of approximately 1% of the variance needs to be considered.
The Expressive Subscale Epistemology was also a significant predictor of the therapy style along the Expressive subscale F(2, 1080) = 94.27, p < .001 (R2 = .15). The standardized beta coefficient (β = –0.177) was significant for the rationalist epistemology t(1080) = – 6.28, p <.0001 and in the negative direction, whereas the significant standardized beta coefficient for the constructivist epistemology (β = 0.326), was significant t(1080) = 11.56, p < .0001 and in the positive direction along the Expressive subscale. This supported the hypothesis that the rationalist epistemology tends towards distance on the Expressive subscale, whereas, the constructivist epistemology tends towards greater closeness on the Expressive subscale.
The Engagement Subscale Epistemology was also significant predictor of the therapy style along the Engagement subscale, F(2, 1096) = 47.26, p < .001 (R2 = .08). The significant standardized beta coefficient (β = –0.245) for the rationalist epistemology, t(1096) = – 8.42, p < .001, was in the opposite direction compared to the significant standardized beta coefficient (β = 0.119) for the constructivist epistemology, t(1096) = 4.08, p < .001, along the Engagement subscale. This supported the hypothesis that the rationalist epistemology tends towards a lesser degree of engagement on the Engagement subscale and the constructivist epistemology tends towards a greater degree of engagement on the Engagement subscale.
The Attentional Subscale Epistemology was also significant predictor of the therapy style along the Attentional subscale, F(2, 1096) = 118.33, p < .001 (R2 = .18). The significant standardized beta coefficient (β = 0.396) for the rationalist epistemology t(1096) = 14.41, p < .001, was in the positive direction; whereas the significant standardized beta coefficient (β = –0.129) for the constructivist epistemology t(1096) = –4.12, p < .001, which was in the negative direction along the Attentional subscale. This supported the hypothesis that the rationalist epistemology has more of a leaning towards a narrow focus on the Attentional subscale, and the constructivist epistemology leans more towards a broad focus on the Attentional subscale.
The Operative Subscale Lastly, epistemology was a significant predictor of the therapy style along the Operative subscale, F(2, 1093) = 187.86, p < .001 (R2 = .256). The standardized beta coefficient (β = 0.461) for the rationalist epistemology was significant, t(1093) = 17.61, p < .0001 and in the positive direction, compared to the significant standardized beta coefficient (β = –0.170), for the constructivist epistemology, t(1093) = –6.50, p < .0001, which was in the negative direction along the Operative subscale. This supported the hypothesis that the rationalist epistemology tends towards more planning on the Operative subscale and the constructivist epistemology tends towards more spontaneity on the Operative subscale.
Thus, epistemology (rationalist vs. constructivist) was found to be a significant predictor of therapy style. In particular, the most robust findings provide provisional support for the notion that there are specific differences in the personal style of the therapist according to the therapists’ epistemic assumptions. More specifically, the current study found that therapists with rationalist epistemologies tended towards more distance, a lesser degree of engagement, a narrower focus, and a greater degree of planning in their sessions with clients, whereas, the constructivist epistemology tended towards having a greater degree of closeness, a greater degree of engagement, a broader focus, and more spontaneity in their therapy sessions. Additionally, there was some support for the notion that therapists with constructivist epistemologies tend toward the direction of flexibility rather than rigidity in their therapy style; however this was not a particularly strong finding in the current study.
These findings are helpful when considering the potentially inherent differences maintained by rationalist versus constructivist epistemologies according to therapy style. More specifically, current findings support the notion that cognitive-behavioral therapies, which represent the best depiction of the rationalist epistemology, maintain an “active-directive” and systematic approach to therapy (Granvold, 1988) with specific goals used to plan the course of the session (
Mahoney & Lyddon, 1988).
Hypothesis 2—Epistemology Influences the Therapeutic Relationship
According to the second hypothesis—therapists with rationalist epistemologies will score higher on the Task and Goal subscales and lower on the Bond subscale than the constructivist epistemologies—another multiple linear regression model was conducted to determine if the same predictor variable (therapist epistemology) would influence therapists’ ratings of the criterion variables (working alliance) based on therapists’ scores of three subscales—Task, Goal, and Bond.
The Task Subscale Epistemology was a significant predictor of therapist emphasis on the working alliance along the Task subscale (e.g. client and therapist agreement on goals), F(2, 1080) = 8.34, p < .001 (R2 = .015). The standardized beta coefficient for the rationalist epistemology (β = 0.042) was in the positive direction, but was not significant t(1080) = 1.39, p < .164. The significant standardized beta coefficient (β = 0.120) for the constructivist epistemology, t(1080) = 3.96, p < .0001, was also in the positive direction along the Task subscale. This was inconsistent with the hypothesis that the rationalist epistemology would place a greater emphasis on the Task subscale in the working alliance than therapists with a constructivist epistemology. However, the small effect size of approximately 2% of the variance needs to be considered when interpreting these findings.
The Goal Subscale Epistemology was also a significant predictor of therapist emphasis on the working alliance along the Goal subscale (e.g. client and therapist agreement on how to achieve the goals), F(2, 1093) = 4.92, p < .007 (R2 = .009). The significant standardized beta coefficient (β = 0.065) for the rationalist epistemology t(1093) = 2.16, p < .031, was in the positive direction. The significant standardized beta coefficient (β = 0.075) for the constructivist epistemology t(1093) = 2.47, p < .014, was also in the positive direction along the Goal subscale. This was again inconsistent with the proposed hypothesis that the rationalist epistemology would have stronger leanings towards the Goal subscale in the therapist emphasis on working alliance compared to therapists with a constructivist epistemology.
The Bond Subscale Lastly, epistemology was also a significant predictor of the therapist emphasis on the working alliance along the Bond subscale (the development of a personal bond between the client and therapist), F(2, 1089) = 19.49, p < .001 (R2 = .035). The standardized beta coefficient for the rationalist epistemology (β = – 0.034) was in the negative direction, but was not significant, t(1089) = –1.15, p < .249. For the constructivist epistemology, the standardized beta coefficient (β = 0.179) was significant t(1089) = 5.99, p < .0001, and in the positive direction along the Bond subscale. This supported the hypothesis that the rationalist epistemology is less inclined towards therapist emphasis on working alliance on the Bond subscale than the constructivist epistemology.
The current study indicated that therapist epistemology was a significant predictor of at least some aspects of the working alliance. The strongest finding was in relation to the development of a personal bond between the client and therapist (Bond subscale). Therapists with a constructivist epistemology tended to place more emphasis on the personal bond in the therapeutic relationship compared to therapists with a rationalist epistemology. This supports the notion in the literature that constructivist therapists place a greater emphasis on building a quality therapeutic relationship characterized by, “acceptance, understanding, trust, and caring.
Hypothesis 3—the Selection of Specific Therapeutic Interventions
The third and final analysis is designed to address the prediction that epistemology will be a predictor of therapist use of specific therapy techniques. More specifically, that the rationalist epistemology will report using techniques associated with cognitive behavioral therapy (e.g. advice giving) more than constructivist epistemologies, and therapists with constructivist epistemologies will report using techniques associated with constructivist therapy (e.g. emotional processing) more than therapists with rationalist epistemologies). A multiple linear regression analysis was conducted to determine if the predictor variable (therapist epistemology) will influence therapist ratings of the criterion variables (therapy techniques).
Epistemology was a significant predictor of cognitive behavioral therapy techniques F(2, 993) = 112.34, p < .001 (R2 = .185). The standardized beta coefficient for the rationalist epistemology (β = 0.430) was significant, t(993) = 14.96, p < .001 and in the positive direction. The standardized beta coefficient for the constructivist epistemology (β = 0.057) was significant and in the positive direction t(993) = 1.98, p < .05. This supported the hypothesis that the rationalist epistemology would have stronger leanings of therapist use of cognitive behavioral techniques when conducting therapy than constructivist epistemologies.
Finally, epistemology was a significant predictor of constructivist therapy techniques F(2, 1012) = 80.82, p < .001 (R2 = .138). The standardized beta coefficient for the rationalist epistemology (β = – 0.297) was significant t(1012) = –10.09, p < .0001 and in the negative direction. The standardized beta coefficient for the constructivist epistemology (β = 0.195) was significant t(1012) = 6.63, p < .0001, and in the positive direction. This supported the hypothesis that the constructivist epistemology would place a stronger emphasis on therapist use of constructivist techniques when conducting therapy than rationalist epistemologies.
Findings in the current study regarding therapists’ epistemology and their use of specific techniques revealed that therapists’ with rationalist epistemologies tended to favor the use of cognitive behavioral techniques and also tended to reject the use of constructivist techniques. Similarly, therapists’ with constructivist epistemologies tended to favor the use of constructivist techniques in their practice of therapy; however they did not as strongly reject the use of cognitive behavioral techniques. This notion is supported by literature that suggests that constructivist therapists value having “a rich set of possibilities that can be engaged at any moment depending on the client’s need.” (R.
Neimeyer, 2005, p. 83). Thus, findings from the current study may suggest that while the constructivist therapist is more likely to use constructivist therapy techniques, they are also more open to using other techniques depending on the individual client compared to rationalist therapists.