The Therapeutic Relationship and its Links to Emotional Intelligence

The Therapeutic Relationship and its Links to Emotional Intelligence

CHAPTER ONE
1. Introduction
1.1. Prologue to the problem under investigation
1.2. Statement of the problem
1.3. Significance of the research
1.4. Reflexive Statement (Epistemological Standpoint)
1.5. Aims and Objectives

CHAPTER TWO
2. Literature Review
2.1. What is emotional intelligence
2.2. Conception of intelligence
2.2.1. Multiple intelligences
2.2.2. Post-Cognitivism
2.3. Emotions and Intelligence Traits
2.3.1. Structure of Emotional Experience
2.3.2. Emotions and consciousness.
2.3.3. Conceptions of emotion and EI
2.3.4. Cognitions and Emotions
CHAPTER THREE
3. Emotional Intelligence
3.1. Early perspectives and theories of Emotional Intelligence
3.1.1. The Salovey and Mayer EI Model (1990)
3.1.2. Goleman’s Emotional Intelligence Model and Contribution
3.1.3. Bar –On (1997) EI Model
3.1.4. The Mayer and Salovey Ability EI model (1997)
3.2. Modern theories and approaches of Emotional Intelligence
3.2.1. Ability Models of Emotional Intelligence
3.2.2. Mixed Models of Emotional Intelligence
3.2.3. Trait Emotional Intelligence Model
3.3. Emotional intelligence measurement
3.4. Emotional Intelligence and Clinical Evidence
3.5. Summary of Emotional Intelligence Models 9
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CHAPTER FOUR
4. The Therapeutic Relationship
4.1. The therapeutic relationship and its links to EI
4.1.1. The Role of Emotional Intelligence within Therapy
4.1.1.1. Empathy
4.1.1.2. The role of Implicit Memory
4.1.1.3. Transference
4.1.1.4. Implicit Procedural Knowledge
4.1.1.5. Change
4.1.1.6. The Lived-Body Paradigm
4.2. The Characteristics of the therapist
4.3. Therapeutic relationship and emotional experience
4.3.1. Metacognition and reflective functioning
4.4. The Transpersonal relationship
4.5. Professional development training, and supervision in therapy
4.6. Summary

CHAPTER FIVE
5. Methodology
5.1. An overview to the grounded theory methodology
5.1.1. Two Grounded Theory Schools
5.2. Rationale for adopting a grounded theory method
5.3. Research Design
5.3.1. Sample
5.3.2. Data Collection
5.4. Data Analysis
5.5. Analytical strategy
5.5.1 Open Coding
5.5.2 Axial Coding
5.5.3 Selecting Coding
5.5.4 Trustworthiness
Limitations and Ethical Considerations

CHAPTER SIX
6. Finding and Homework help – Discussion
6.1.Overview of Themes
6.1.1. Theme A- Empathetic Balance
6.1.1.1. Empathy
6.1.1.2. Empathetic Balance
6.2. Theme B- Benevolent Connection
6.2.1. Connecting
6.2.2. Transpersonal / Spirituality
6.2.3. Difficulties in forming an Emotional Connection
6.2.4. Subtle competencies of an emotional connection
6.2.5. Presence
6.2.6. Role of the Therapist
6.3. Theme C-Mindfulness
6.3.1. Emotions
6.3.2. Difference between Feelings and Emotion
6.3.3. Emotions and Cognition
6.3.4. Physical, Emotional and Cognitive awareness
6.4. Extraneous Involvement
6.4.1. Supervision and personal therapy
6.4.2. Emotional Intelligence

CHAPTER SEVEN: Conclusion

References
Appendices:
Appendix A: Invitation posted British Psychological Society Magazine
Appendix B: Information for prospective participants
Appendix C: Participant Consent Form
Appendix D: Interview Schedule
Appendix E: Debrief for Participants
Appendix F: Example of a TEIQue score and interpretation
Appendix G: Categories gained from the open coding stage
Appendix H: Example from an interviewee transcript.
Appendix I: The TEIQUE and the Facets of TEIQUE
Appendix J: Facets of TEIQUE The Adult Sampling Domain of Trait Emotional Intelligence
Appendix K: Senate Research Ethics Committee Application
Appendix L: Memos and Mapping draft

Figures
Figure 1: Mayer and Salovey (1997) Four Branch Model of EI
Figure 2: Stages in the Grounded Theory analysis of qualitative data
Figure 3: Concept-Indicator of the concept
(Subtle competencies of an emotional connection)
Figure 4: Concept-Indicator of the concept (Containment)
Figure 5: Mapping of the Core Emergent Themes

Tables
Table 1: EI Models
Table 2: Comparisons of the two schools of Grounded Theory
Table 3: Worked example of transcript
Table 4: Strategies of trustworthiness of the thesis
Table 5: Emerging themes and the frequency of the sub-themes

Section C: Professional practice: Advanced case study
Part A – Introduction to the client study
1. Summary of Theoretical Framework
2. Introduction to the Client and Background plus Context of the Work
2.1. Convening the first session Presenting problem
2.2. Presenting problem
2.3. Background and family history
2.4. Initial assessment / formulation of the problem
2.5. Choosing an appropriate treatment approach
2.6. Negotiating a contract and therapeutic aims

Part B – The Development of the Therapy
3. Therapeutic plan and main techniques used
3.1. The therapeutic process and intervention
3.2. Difficulties during therapeutic work
3.3. Making use of supervision
3.4. Changes in the therapeutic process
3.5. Changes in the therapeutic plan
3.6. The therapeutic ending

Part C- Reflection and Learning & the Therapeutic dialogue
4. A critique about the chosen framework
5. Conclusion

References
Appendices:
Appendix 1: CAT Model and terminology
Appendix 2: The sequential diagrammatic reformulation (SDR)
Appendix 3: Reformulation letter
Appendix 4: States Description Procedure (SDP)
Appendix 5: Therapeutic Plan Notes
Appendix 6: Reflective notes on critical moments
Figure 1: Paulina’s state grid
Figure 2: Dominant Reciprocal Role Procedure
Section D: Critical literature review: The Importance of Positive Emotions to Mental and Physical Well-Being
Abstract
1. Introduction
2. Literature review
2.1. The Broaden-and- build theory and Positive Emotions
2.2. The neglect of positive emotions in prior research
2.3. Positive Psychology and Positive Emotions
2.3.1. Happiness, Joy and Pride
2.3.2. Hope and Optimism
3. Empirical support of positive emotions
4. Emotion Regulation
4.1. The development and origins of positive emotions
4.2. Measurement of Positive Emotions
4.3. Cognition and positive emotions

Positive psychology in mental health practising
Summary and conclusion
References
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Acknowledgements
In would like to express my gratitude to all the participants in this study and my supervisors who assisted me in completing this thesis.

University Declaration
I grant powers to discretion to the University Librarian to allow this thesis to be copied in whole or in part without further reference to me. This permission covers only single copies made for study purposes, subject to normal conditions of acknowledgement.
Section A: PREFACE
The primary purpose of this thesis was to assess whether emotional intelligence (EI) is distinctive and useful in understanding the therapeutic relationship. I investigated how qualified therapists view the concept of EI, focusing on the optimisation of EI skills and knowledge, with the aim of improving the therapeutic relationship. The primary focus was whether therapists who are skilful at regulating their own and others’ emotions would be able to protect clients and themselves from the adverse effects of a range of emotional reactions and assist the processes and solutions for therapeutic intervention. The topic of EI and its links to the therapeutic relationship were inspired via my own academic and professional journey as a chartered counselling psychologist and my aspirations to examine the positive relevance of emotional intelligence as a part of training programmes in counselling psychology.
My primary interest in the area of counselling psychology is rooted in my personal experiences as a four-year-old refugee boy. During those years of my life, I experienced the chaos of a war and the feelings of loss and hopelessness. Growing up in a refugee camp and having several times witnessed how people kept ‘hope’ as a way to manage their suffering prompted my curiosity about the importance of ‘positive psychology’. I observed how the crucial determinant of suffering or stress response was not the war environment itself but rather the meaning that individuals attached to their experiences.
Throughout my undergraduate and postgraduate years and my clinical placement experiences, I was particularly inquisitive about the role of emotional perception in the stress-mental health relationship. During my counselling psychology chartered training, I found my early master’s thesis on EI reminding me of a process in the therapeutic relationship. From my childhood memories and the journey in academic, clinical, and professional experiences, I became more interested in investigating the links between EI and therapy. A review of the literature on the construct of emotional intelligence, positive psychology, and the therapeutic relationship did not provide extensive evidence supporting the nature of the relationship of these elements. This research revealed an ideal opportunity for me to explore my own interest in this notion and contribute to the research on such a possible relationship.
This was a qualitative study with the data analysed using grounded theory (Strauss & Corbin 1990) approach. Semi-structured face- to- face interviews were used with questions loosely guided by prominent themes taken from my previous experience and literature. Due to my previous experience in EI and quantitative research (Sanchez-Ruiz, Mavroveli & Poullis under review) I became familiar with the concept of EI via a quantitative approach and felt that I was positioning myself within a particular discipline or research tradition. To improve understanding from my previous quantitative research, I felt that a qualitative study is important in order to keep an open direction and awareness of EI and therapy. This systematic approach supports triangulation and the convergence of data by sifting out what is accurate and valid to study (McLeod 2003). This approach enabled me to position myself as other than an objective observer, as in quantitative research, to broaden the concepts and methods of modern science.
Introduction to the thesis
This thesis has three sections. Each section explores a different area that, in some way, is associated with the central theme of the therapeutic relationship. First is the phenomenological approach and investigation to study the perceptions and experiences of therapist, and gain their perspectives on the therapeutic encounter and its links to EI. The second part of the thesis focuses on the challenges of therapeutic work with a female client who suffered from childhood sexual abuse (CSA). The case is related to the practical applications of the therapeutic relationship and certain therapist characteristics and behaviours that are positively associated with quality alliances and the EI concept. The third part presents prior research related to the field of positive psychology and the relationships found among positive emotional /mental states, well being wellbeing and survival.

Section B: Research
The principle aims of this study were to investigate the role that emotional intelligence plays in therapy, the therapist‘s perspective of trait emotional intelligence in therapy, and the meaning of the therapeutic relationship from therapists’ perspectives. This research was conducted because of a lack of research in this area. The literature review revealed some considerable gaps concerning the emotional experience of the therapeutic relationship and its link to emotional intelligence theory. Some contributions provided only a superficial assessment and analysis of this link, indicating the need to conduct research to analyze analyse and determine the existence and importance of this relationship. Finally, a review of the literature on the therapeutic relationship, emotions, and intelligence traits, reinforced the significance of this research to the body of knowledge concerning EI and its possible relationship with the process of therapeutic relationship.
The study explored the therapeutic experience and offered me the chance to participate and immerse in the research. That approach was very rewarding because it included the study of EI and consciousness completely free of preconceptions, especially those stemming from a natural science orientation. As a practicing counseling psychologist, I believe that qualitative research is appropriate to answer certain kinds of questions in certain conditions while quantitative is appropriate for others. In this particular thesis, I chose a qualitative approach and incorporated elements of grounded theory to ensure using the most effective ways to explore the links between EI and the therapeutic relationship.
The grounded methodology chosen reminded me of a ‘bottom up’ inductive process, and the similarities in my own therapeutic practice. I reflected how grounded theory shares a common approach with Cognitive Analytic Therapy and its reformulation process. I believe grounded theory is the most appropriate method to use in explaining the phenomenon under investigation and generate a new theory. Theories provide maps for organizing practice experiences and structure for ongoing personal and professional development. I remained open-minded concerning whether a new theory would emerge from the data and offer a connection between EI in the therapeutic relationship, a link that could become palpable upon further investigation. A further discussion and the implications of the findings were analysed based on the most dominant themes that emerged.
Section C: Professional Practice Section
The purpose of this section is to depict the use of Cognitive Analytic Therapy (CAT) as a theoretical basis and treatment framework for clients who suffer from childhood sexual abuse (CSA). I chose to present this particular client because I encountered key therapeutic challenges that contributed to both my professional and personal learning. The case focuses on the open and collaborative relationship, the use of shared written material, and how the client and therapist worked toward a process of developing an understanding of unhelpful procedures and then exploring alternatives. This relationship was achieved by paying careful attention to the client’s story, particularly the history of relationship patterns, using information provided from relevant psychometric measures and the psychotherapy file, and most importantly, using the space of the therapeutic relationship to identify dysfunctional procedures as revealed in the therapy itself. The dysfunctional procedures were identified by pointing out examples of repeated relationship patterns that occurred in sessions and exploring their origins and consequences openly with the patient. The analysis of the case study also attempts to critically evaluate the limitations of CAT with constructive reflections on the therapeutic process and the particular case study in focus. I also found this section extremely challenging because it was very difficult to know how to write about clients: Is it a novel Is it an allegory Is it a true descriptive account What is it It’s very difficult.

Section D: Critical Literature Review
The aim of this part of work is to present a link between positive mental states and mental/physical well-being. This present work also investigated the determining mechanisms, causes, and outcomes of positive emotional states and their individual implications as regards cognitive functions encompassing social thought process and social behaviour. The results of the review showed that there is indeed a link between positive mental states and mental/physical well-being. The topic of positive psychology emanated from my personal experience as a counselling psychologist and its importance in therapy (e.g., mood monitoring, relaxation training, mindfulness). I believe that positive emotions such as hope, joy, happiness and optimism all share a pleasant subjective feel’ and are the building blocks of unconditional love, congruence and authenticity. The awareness of how these positive emotions can provide a more complete understanding of the human experience and plays a major role in establishing a therapeutic alliance. It has been shown that such cognitive modification reduce negatively biased and distorted perspectives on events. The findings presented in this section also strongly relate to the section on EI and show that EI is indeed an integral part of positive psychology. I was surprised to observe how EI and positive psychology overlap and share a positive and significant impact on performance, happiness, well-being, and the quest for a more meaningful life. It would be beneficial to consider the evidence in positive psychology and to develop programs to or to develop EI training programs for enhancing competencies and skills in counselling psychology. The review concludes and recommends the need of more studies to establish the application of positive emotional states in therapy to promote physical and mental well-being.
Personal reflections
The experience of researching and writing this thesis was a big learning curve itself. This project was largely a process of reflection, intuition, and research that provided a type of consciousness-raising by enhancing a process of self-knowledge and self-awareness. I reflect this process currently in my professional development and my therapeutic work. The journey through this thesis was, at times, enormously challenging and emotionally exhausting. At other times, I felt extremely helpless and powerless to complete the thesis and felt extremely vulnerable. Thinking and supervision during these dark times provided an enormous relief and encouragement. I reflected a great deal on my own experience of positive psychology, positive thinking, and optimism, as well as on the reverse psychology of negative thinking, pessimism, and negative support. I questioned the applications of my experience in my clinical work and practice.
Moreover, during the writing stage of the thesis, I became aware from the interviews how words fail to capture and describe events such as the “now moments” described by Stern (1998) or intuition and emotional connection. However, perhaps the problem is that we cannot grasp ‘now moments’, intuition and emotional connection. It is having a feeling, a felt sense of what is going on in terms of a process. It is like two streams coming down and running together or like weaving in which the warp and the woof have been woven together. That is, if the therapist is not alive, he or she will not be able to help other people be alive. This awareness concerning trusting intuition and connectivity as part of a human energy that gives rise to patterns of meaning has broadened my clinical and professional perspective.

Section B: The Research

The Therapeutic Relationship and its Links to Emotional Intelligence

Abstract
The importance of emotional intelligence (EI) as a theoretical construct to understand human emotions has become quite prominent over the last two decades. However, the concept of EI has not been frequently applied to the therapeutic setting. This study investigated the role that EI plays in therapy, the therapist‘s perspective of trait EI in his or her work, and the meaning of the therapeutic relationship from therapists’ perspectives. From interviewing 12 counselling psychologists and therapists, and analyzing analysing their responses using a grounded theory approach, a number of findings emerged. The main themes that emerged from the data collected were empathetic balance, benevolent connection and mindfulness. Most EI traits appear to be present within the therapy setting, albeit not in an overtly conscious way. Their relation to the concept of emotional intelligence was discussed. There was also a sense that emotional intelligence cannot adequately explain or describe the subtle yet very real emotional connection and empathy that the therapist and the client share and experience. From these findings, various recommendations for future research exploring the relevance of EI in the therapeutic setting were made. Such as therapists’ perception and experience of ability versus trait EI measurements and their effectiveness on therapists training and instruments used in the 21st century. Furthermore, it would be useful to cross-reference results gained from therapists’ studies on EI with that of individuals or therapists’ who are affected by conditions on the Autistic spectrum.

Chapter One
1. Introduction
According to therapists Picard, Vyzas, and Healey (2001), emotional intelligence (EI) is a fairly new construct in the psychiatric and social literatures. It was not until the early 1990s that researchers, including Salovey and Mayer (1990), Goleman (1995a), Bar-On (1997), and Cooper and Sawaf (1997), de-emphasized the traditional, narrow conceptualisation of intelligence – which focused on performance, verbal intelligence and other traditional academic skills, and began to emphasize EI in later publications. For example, Salovey and Mayer (1990) argued that a person’s measure of intelligence should include the ability to perceive, understand, and manage one‘s emotions. EI has generally been explored and investigated as a distinct entity from cognitive intelligence, but Goleman (1995b) proposes that it can help to predict many practical outcomes, such as degrees of happiness and success.
Interestingly Petrides and Furnham (2001) reported that trait EI seems to influence affective responding beyond common personality traits (i.e., the Big Five) and thus, indicating its conceptualization as a distinct personality trait. These researchers also found that individuals with a high degree of trait EI were fast at identifying emotional expressions and experience healthy socio-psychological functioning; however, the results also suggested that high trait EI can interfere with a broad range of evaluative estimations and cognitions because of sensitivity to emotion-laden stimuli in general.

In an important paper Petrides et al., (2007), made the convincing argument that “Trait EI is a constellation of behavioural dispositions and self-perceptions relating to an individual‘s ability to recognize, process, and utilize emotion-laden information” (p.23). Trait EI is a collection of emotional self-perceptions found to be situated at the lower degrees of personality (Petrides, Pita, & Kokkinaki 2007). In a previous study, Petrides and Furnham (2003) demonstrated that EI individuals with high trait EI are more sensitive to the mood induction procedures than EI individuals with low trait EI scores. In another important study, Sanchez-Ruiz, Mavroveli, and Poullis (under review) found differences across university majors in trait EI scores. In particular, psychology students scored higher on trait EI than computer science, electrical engineering, and business and management students.
Given its status as an intrinsic element of human functioning and success, as Ciarrochi, Chan and Caputi (2000) so eloquently pointed out in their works, it is understandable that therapists have placed much emphasis on emotionally connecting with their clients in therapeutic relationships. According to Picard, Vyzas, and Healey (2001), the ability to recognize and respond to emotion is one of the hallmarks of emotional intelligence, and is arguably more important than verbal and mathematical intelligence in psychotherapy. However, little empirical research has been conducted into the role that emotional intelligence plays within the therapeutic relationship.
1.1. Prologue to the Problem under investigation
This study aims to explore the role that EI plays within the therapeutic relationship. In particular, this study explores how certain emotional competencies (e.g., preceding, implicit memories, social developmental determinants, intrapersonal competencies, attributes, and skills) can help the therapist accurately perceive, understand, monitor, and manage affective information in self and the client; and can assist how the therapist determines the processes and solutions for therapeutic intervention.

1.2. Statement of the problem
The results of the study may provide support for exploring how emotional intelligence informs the therapy process and relates to the documented evidence of competencies and skills in the therapeutic relationship process. Given that little empirical research have explored this research aim, this study addresses a gap in the literature, and may provide a foundation from which further research can be conducted, as well as build a framework for future, clear sighted therapeutic practice. The study may also show the validity and precision of the Trait Emotional Intelligence Questionnaire (TEIQue) – an instrument for the measurement of emotional intelligence – with the therapist population, which could have clear implications for current counselling programs and therapy processes.

1.3. Significance of the Research
There is a meagre amount of research on the concept of emotional intelligence and its connection to the therapeutic relationship. This study addresses this gap and focuses on the therapists’ perspectives of the role of intelligence in therapy, and the role of emotions as a vital information process in therapist-client responses and relationship. This researcher assumes that when these aspects are considered, the role of EI will take primary emphasis in the therapeutic process.

1.4. Reflexive Statement (Epistemological Standpoint)
As a Chartered Counselling Psychologist with experience in the NHS and private clinical settings, I have encountered the process of therapy and Emotional intelligence in practice. My personal experience and previous research of the Emotional intelligence would not be possible to postpone as Glaser and Strauss (1967) advocate; they formed part of an intersubjective research experience. My epistemological stance rests on inter-subjective phenomenological principles, emphasising the value of researcher and participant subjectivity that can provide a meaningful investigation of human phenomena to this research (Luca 2009). I am also adopting Husserl’s (1931b) ‘bracketing’ as a method to discourage the possibility of imposing meaning onto the results gained, and therefore promote validity.
This project aims to explore whether there is a link between emotional intelligence and the therapeutic relationship, and how therapists perceive, envision, use, and theorize emotional intelligence, including the role that they believe it to play in the therapy process (if any). The inquiry of how the quality of the therapist-client relationship directly contributes to therapy outcomes is of prime importance for both graduate training programs and therapy results. This is because the client therapist relationship is central to the process of therapy and provides some knowledge concerning the therapeutic process. The reflexive process also includes taking into account dimensions of power, control and inequality. The researcher is mindful of issues of gender, class, race, ethnicity, age, sexuality that may be impacting the process and relationship with participants. As Hoffmann (2007) noted the researcher’s negotiations with their participants can involve considerable emotional labour (Hoffmann, 2007).
The objective of this research was to provide rich, deep data that placed an emphasis on the therapists experiences, with an attempt at “letting the therapist speak’’, this placed a large focus on language, meaning and description. In order to be critically reflexive a combination of analysis and descriptions were quotes from therapists were included as an essential element of the analysis and description (Simon et al., 1996). Therefore by adopting this approach and mixing direct quotations into the analysis and description, the therapists’ are allowed to “speak’’ and the full meaning and richness of the opinions and attitudes can be allowed to come across. This allows the therapists to have a greater input and hence to be critically reflexive. The interviews, being open-ended in nature ensure that the participant felt as though they were in control of the direction that the interview took – they were made aware prior to the interview that they were able to discuss anything concerning the subject of emotional intelligence and the therapeutic relationship. This ensured that the researcher was not placing their own ideas of the outcomes of the interviews onto the participant – rather, the researcher enabled the conversation to unfold naturally.

In order to examine this subject, and the various issues that it concerns, this researcher decided to take a phenomenological (or interpretivist) stance when conducting this research. A phenomenological research approach does not primarily concern itself with researcher objectivity or absolutes, which can be difficult to manage under the best of circumstances. Instead, this researcher adopted the approach of Miles and Huberman (1998), whereby phenomenologists perceive that there can be more than one interpretation gleaned from the data collected. This logical stance recognizes that the interpretations gained may be influenced by researcher preconceptions or aims of the research, and further recognizes the influence of the specific cultural and historical period in which the research is collated. The phenomenologist takes all of this this into account when assessing collected data. This approach does enable flexibility in interpretation, however, and as Madill et al. (2000) claimed, the “reflexivity of the researcher, the attempt to approach the topic from differing perspectives, and the richness of the description produced” make up necessary elements of the research investigation in its entirety (p. 74). This study adopts a grounded theory approach in order to investigate the association among EI and the therapeutic relationship and processes. With the advent of this new associated tendency, it is envisioned that a new perspective will emerge that might be used in generating a new theory of development to inform therapist and counselling practising. Grounded theory is one of the qualitative research approaches suited to the purpose of theory development. Successfully described and used by Strauss and Corbin (1990, 1994), Glaser (1995), and Charmaz (2000), grounded theory is a systematic qualitative research methodology that focuses on generating theory from data in the process of carrying out a research.
1.5. Aims and Objectives
The principle aims of this study are to explore the role of EI in therapy, and investigate some of the overarching issues presented by Cadman and Brewer (2001), Simpson and Keegan (2002). Their results imply that the emotional and cognitive dimensions have to be taken into account in future training programs for nursing and health care professionals. Emotional intelligence, therefore, seems a relevant concept in health care, when it is considered important for practitioners to understand patients’ perspectives and for therapists to engage in relationships that will facilitate positive therapeutic outcomes. It can also provide an outlook on the effect of the training programme on EI and its consistency with previous research (Zijlmans et al., 2011).
Thus, the central research question for this study is as follows: How does the therapist‘s experience of the therapeutic relationship relate to emotional intelligence theory In order to address and answer this research question, various objectives must be addressed. These objectives include:
 Analyze what is meant by the term “emotional intelligence” and how it is measured, theorized and conceived.
 Explore the therapeutic relationship competences as documented in previous research and their associations with emotional intelligence concept.
 Understand if and how therapists’ degree of emotional intelligence is used in the therapeutic setting.
 Evaluate the (TEIQue) and consider its relevance in the therapeutic process.
 Investigate the meaning of the therapeutic relationship as described by therapists and its links to existing therapeutic relationship competences as reported in the literature.
 And consider the relevance of the findings for developing a new theory and enhancing counseling and therapy programs.

In addressing these aims and objectives, it is hoped that a sound conclusion can be reached as to the role that emotional intelligence plays, if any, in the therapy process and the therapeutic relationship.
Chapter Two
2. Literature Review
In order to better understand emotional intelligence and its role in the therapeutic process and relationship, an investigation of the current research and theories surrounding emotional intelligence and its relation to psychotherapy literature in the twenty-first century is needed. This chapter is comprised of a literature review of various sources, such as scholarly books, and journal articles, in order to gain a greater understanding of the published works and comments surrounding emotional intelligence today.
Herbert and Choen (1993) heightened the awareness of how emotional reactions and experiences affect both physical as well as mental health. For example, it has been noticeable that negative emotional states are associated with unhealthy patterns of physiological functioning, whereas positive emotional states are associated with healthier patterns of respond in both cardiovascular activity and immune system (Booth-Kewley & Friedman, 1987).
Neuro-developmental research indicates how human’s initial experiences can transform neural pathways and structures to develop patterns of reacting to everyday events. According to Damasio (1999) and Stern (1985) these patterns are basically emotional (i.e., evaluations concerning harms or benefits) and serve to regulate behaviour at a subconscious level, referring to an individual‘s primary or core self that develops during early stages of human life. Stern emphasized that a majority of the transformation that takes place in a therapeutic relationship originates from the implicit knowledge evolving inside the therapeutic relationship between the clients and the therapists, respectively. The author claimed that the patient‘s awareness of implicit memories is inter-subjectively shared within the process of the therapeutic relationship and that is an effective apparatus for therapeutic transformation. In the company of an emotionally available therapist, these memories can be re-experienced and understood. In fact, Bar-On (1997) and Martinez-Pons (1997) reported that substantiating implicit memories (e.g., instinctual capacities drawn from subconscious experience) requires a specific type of context similar to one in which the memory was acquired. Within the therapeutic relationship, the memory occurs spontaneously when the relationship between the subject and context is reconstituted.
Martinez-Pons (1997) noted how mental health difficulties are understood as implicit memories that manifest as symptoms under stress, and it is difficult to make them explicit because they lack an interpersonal context that could foster inculcation into the autobiography of the self. These implicit memories remain split off or dissociated from the conscious self. It is the therapeutic relationship that enables the re-enactment of the memories inter-subjectively and then facilitates their introduction into the autobiographical self. In opposition to traditional psychological theories which are based on the often implicit “Myth of the Isolated Mind” (Stolorow and Atwood 2002, p. 7), the Intersubjective Systems Theory (Stolorow & Atwood 2002) seeks to overcome the subject-object dichotomy and aims to describe the essentially affective and pre-reflective nature of the therapeutic situation (Atwood & Stolorow 1984, p. 64).
The patient experiences the therapist as someone who reacts to his true self, his true feelings and hitherto forbidden thoughts differently from the pathogenic parent. The researchers also pointed out that “intellectual insight alone is not sufficient” (Atwood & Stolorow 1984, p.68). As Stein and Lambert (1995) confirmed at a later date, the significance of researching the therapeutic relationship and its processes, and examining how the research can enhance the therapist‘s training skills, and attributes, are of critical importance. An impressive group of researchers agree that the therapeutic relationship is one of the key factors influencing therapeutic outcomes (Cooper, 2004; Horvath & Bedi, 2002; Luborsky, Singer & Luborsky, 1975; Martin et al., 2000; Norcoss, 2002; Shapiro, 1985; Smith & Glass, 1977). It would be simplistic to reduce EI to Salovey and Mayer’s work in the 1990’s since this orientation has a long tradition of thinkers. The construct of EI is akin to the Intersubjective Systems Theory (Stolorow & Atwood 2002), but also is anchoring to a long-standing philosophical position on the phenomenology of intersubjectivity (Husserl 1931). Husserl intersubjectivity is more than shared or mutual understanding and is closer to the notion of the possibility of being in the place where the Other is (walking in the moccasins of another).
Husserl’s long-standing philosophical position on intersubjectivity and his advocacy of the connecting of consciousness and body into a natural unity or “mutual understanding” led to the eventual emergence of a new set of postulates such as the concept of EI. EI also arise from non-cognitive aspects of intelligence as described by Spearman (1927), Thorndike‘s (1920) work on social intelligence, and Gardner‘s (1983) development of the constructs of interpersonal and intrapersonal intelligence.
The paper ‘Emotional intelligence’, published in the Imagination, Cognition, and Personality (Salovey and Mayer 1990), dropped like a bomb and its reverberations have been felt ever since. Today the idea of EI inspires new approaches to research factors other than cognition in helping people to succeed in both life and the workplace. Notwithstanding previous work, it was Salovey and Mayer (1990) who initiated a research program that was intended to develop an EI model and a valid instrument of measurement.
In their pioneering essay on EI, Salovey and Mayer‘s (1990) define EI as “a subset of social intelligence that involves the ability to monitor one‘s own and others’ feelings and emotions, to discriminate among them, and to use this information to guide one‘s thinking and actions” (p. 5). Although Salovey and Mayer were by no means the first to make social intelligence a crucial construct in the field of psychology, it was their advocacy of the idea that EI was a fundamental ability for greater problem-solving in an individual‘s emotional life.

2.1. What is Emotional Intelligence
Definitions are being revised and updated continuously as more research is completed in the field of EI. It is helpful for the purposes of this study however, to gain a greater understanding of the terms emotion and intelligence, in order to explore the varying perspectives of the theories dealing with EI. Many authors claimed and reported that there existed a significant relationship of emotional intelligence with mental health (Goleman, 1995; Salovey & Mayer, 1990; Bar-On, 2005). EI has been present in the literature for a relatively long time although it was not until later that the construct was introduced under the concept of EI (Salovey & Mayer, 1990). The distal roots of emotional intelligence (EI) can be traced back to the philosophy of “inter-subjectivity”, which pertains to the social and psychological cohesion between individuals, such as relationship understanding (Gallagher, Jaeger, and Paulo, 2010). Emotional intelligence identifies a previously overlooked area of ability that is critical to certain important areas of human functioning. This will be discussed in detail later with reference to studies examining the consequences of impaired emotion on decision making. To return to the mental ability conception of emotional intelligence, there are two further questions often asked about EI. Firstly, first is emotional intelligence (as an ability) an intelligence, or a talent, or an acquired skill Whether EI is accepted as an intelligence dimension, it is partly contingent on one’s subjective definition of is, to some extent, a matter of one’s definition of “intelligence,” “talent,” and “skill.”

Emotional intelligence (EI) has been described by researchers Mayer, Salovey, and Caruso (2000) to be “an ability to appraise oneself and others’ emotions, an ability to regulate one‘s own emotions, and an ability to use emotions to solve problems” (p.396). In addition to the ability model of EI developed by Mayer and Salovely (1997) and Mayer, Salovey, & Caruso (2000) there are models labelled “mixed models of EI” that include many non-intelligence qualities and personality traits such as Goleman (1995), and Bar-0n (1997). Goleman define EI as “the abilities which include self-control, zeal and persistence, and the ability to motivate oneself” (Goleman, 1995, p. xii). Bar-On’s (1997) model describe EI as “an array of noncognitive capabilities, competencies, and skills that influence one’s ability to succeed in coping with environmental demands and pressures” (Bar-On, 1997, p. 14). A more recent model by Petrides and Furnham (2001, 2003) seems to cover much the same ground as they define EI as “a constellation of emotion-related self-perceptions and dispositions, assessed through self-report” (Petrides & Furnham, 2003, p. 40).

2.2. Conceptions of intelligence
By the 1950s, the area of intelligence was divided into two distinct traditions – the intelligence tradition and the social psychological tradition. The intelligence tradition was interested in the abilities of person perception and the social psychological tradition was focused on the social determinants of person perception (Roberts et al., 2001). There seems to be two main perspectives on what is intelligence. On the one hand, we have an academic movement, supporting that the realm of human cognitive abilities has been fully defined using major psychometric tools. For example, Jensen (1998) and Caroll (1993) employed scholarly computational, genetic, and neuroscientific models to support that general intelligence is the most important predictor of educational, occupational, and even life success. On the other hand, many other researchers like Mayer, Salovey, and Caruso (2000); Stankov (2000); and Robert, Pallier, and Goff (1999) reported that there is still much work to carry out in understanding individual differences in human cognitive abilities and in charting the so called cognitive sphere.
One of the determining factors for individual differences in cognitive competencies is the unique variability of how a person is positioned in their cognitive development, which according to Jean Piaget (1980), is a continuous process of perceptual growth and assimilation of knowledge, coined by the term equilibration (Traill, 2000). The relationship cognition has with emotional intelligence may be found in how individuals acquire different stages of social and cognitive awareness with the objects and people around them. This may have implications on how the function of emotional intelligence has been appraised by researchers in terms of certain traits, such as acknowledging the dispositions and viewpoints of other people, are differentiated from oneself, as noted in Petrides and Furnham’s trait model of emotional intelligence, which will be discussed in more detail later with reference to empathetic awareness. With this in mind, it addresses the need to investigate how individual abilities in emotional intelligence, with specific reference to external sensitivity such as empathy and egocentrism, are expressed progressively in terms of their contingency on personal development and life experiences that concern emotional challenges. Therefore, the degree to which an individual expresses a trait of emotional intelligence is, in part, dependent on the stage in their own personal life such as the relationship experiences they have endured and learnt from. This idea is reminiscent of Freud’s (1925) theory of early psychosexual stages of development, which if breakthroughs in gender specific lessons and relationship with parents are not accomplished properly, this would result in certain inadequacies in emotional stability throughout adult life (Seagall and Marshall, 1999). This is also evident psychodynamic counselling case studies reported by Fromm-Reichmann (1940) who found that individuals who had been raised by cold and domineering parents had the tendency to contract interpersonal issues and problems with expressing emotions (Mcglashan, Thomas, Fenton and Wayne, 1998).
It is acknowledged in this qualitative study that certain traits in emotional intelligence will be expressed based on participants’ current life experiences. It is also acknowledged that the degree to which participants display an empathetic understanding and inquisition about the clients involved in their therapeutic sessions may be confounded by practitioner experience. It is therefore important to note the changeability of the behaviours that will be reported in this study, particularly the fact that empathetic awareness is also dependent on the patient’s own abilities to express their dispositions through somatic and verbal communication. New discussions around the constructs of emotional intelligence, implicit knowledge, and meta-cognitive processes have been advanced (Gardner, 1983).

2.2.1. Multiple Intelligences.
Gardner (1983) played a major role in resurrecting EI theory in psychology. The author‘s influential theory of multiple intelligences includes personal intelligences. Gardner (1983) described two kinds of personal intelligence – intrapersonal intelligence and interpersonal intelligence. Intrapersonal intelligence is defined as a capacity for, “…access to one‘s own feelings and one‘s range of affects or emotions: the capacity instantly to effect discrimination among these feelings and to label them, to enmesh them in symbolic codes, to draw upon them as a means of understanding and guiding one‘s behaviour” Gardner, p. 239). Interpersonal intelligence is defined as, “…the ability to notice and make distinctions among other individuals and, in particular, among their moods, temperaments, motivations, and intentions” (Gardner 1983, p. 239). This intelligence includes the, “…capacity to place one‘s self into the skin of specific other individuals” (Gardner 1983, p. 250).
2.2.2. Post-Cognitivism
Alternative approaches in the field of cognitive sciences and intelligence have opened the field of investigation to new approaches that challenged the dominant classical paradigm, known as computationalism (Fodor 2000). Perception understood in computational terms became passive, and in clear contradiction to the natural interaction with action and environment. As disappointment with cognitivism grew a new era of post-cognitivism and intersubjectivity emerged. The new approaches claimed back the lost meaning from the mechanistic explanations of the mind as, Stolorow, Atwood & Orange (2002) captured this essence of expanding our knowledge by noting: “Human beings are by nature relational. This paradigm, according to which the mind is embedded into the body, till now has been mainly a subject of speculation by many scholars; but now new results in neuroscience grounds it on a safer basis. For example, Damasio (1994, 1999) assumes a position against classic cognitivism (that sustains a Cartesian disembodiment of mind), in favour of the new paradigm. With supporting discussion, he argues for the connection between the body, individual structures in the brain and aspects of the mind such as consciousness, emotion, self-awareness and will. Similarly, the embodied cognition approach, drawn from the work of Merleau-Ponty (1962), focuses attention on the sensory and motor systems rather than thinking, reasoning or memory per se. Carlos Cornejo (2008) advocated the idea that meaning is defined as a phenomenologically experienced construal. Consequently, Cornejo postulated, intersubjectivity is the space when we are being-in the- world-with-others. An open ended, evolving presentational construction, deeply rooted into our bodies and our tacit knowledge and far from a theoretical representation (Cornejo 2008).

To sum up it is clear that intelligence meaning lost its leading role in the mechanistic explanation on the structure of psychometric intelligence (Carroll, 1993). The study of human cognitive abilities lies at something of a crossroads; this divergence may be due to the fact that intelligence is a complex and multi-faceted phenomenon that admits a wide variety of approaches. Alternative approaches in cognition have drawn out a clear necessity in the field of cognitive sciences. There is a need for a reconceptualization focused on action and intentionality as a principle of ordering between sensing subjects and objects. Moreover, we need to encompass the intersubjective nature of complex cognitive phenomena with its implication in all individual and social behaviours.

2.3. Emotions and Intelligence Traits
An analysis of the literature by Griffin & Mascolo (1998), reported the lack of expert consensus on the question of what is an emotion, and the difficulty of trying to pin down emotions. However, the authors categorize emotion theories into biological, cognitive, structural-developmental, functionalist, and socio-cultural perspectives. They assert that biological theories describe emotions as “innate, neuromuscular processes and for cognitivists, emotions are the coming together of thoughts, external incentives and feeling tones” (pp. 6-11). The structural-developmental theory is based on the idea of emotions as subjective reactions to an important event, characterized by physiological, experiential and overt behavioural change.
The work of Antonio Damasio (1994, 2000, 2003, 2010) provides scientific evidence which can influence an understanding of inter-subjective and intra-subjective experiences. Damasio (1994) provides insight into the phenomena of neural connections between the cognitive and emotional parts of the human brain. This pioneer work revealed how brain neural imaging and research on the development of consciousness have illustrated the interconnectedness of thought and emotion in the brain (Damasio 1994, 2000, 2003). Damasio made it clear that emotions are imperative to the elevated levels of characteristic human intelligence, diverging from the notions of Descarte’s (the dualist separation of mind and body, rationality and emotion). Damasio (1994), made the convincing argument that emotions do not obstruct or impair rational thinking, but are rather vital to rationality, anchoring it to a long-standing philosophical position of intersubjectivity and arguably much of the literature on empathy and theory of mind.
Damasio (1994, 1999) researched the process of reasoning in people possessing neurological damage to their emotional systems, such as damage to the ventro-medial segment of the pre-frontal cortex. He discovered that such people may be capable of performing to a high degree on most intelligence tests, but they express or reveal gross deficiencies in their abilities in planning, judgement, and social suitability. These defects are a direct result of their inability to react emotionally to the content of their respective thoughts. For example, these individuals were not able to feel the emotion of fear when thinking about a violent person.
Another significant contribution of Damasio was the notion of a ‘somatic marker’ mechanism, which is fundamental to the structure of human consciousness. This mechanism is the system through which cognitive representations of the external environment interact with cognitive conceptions of the internal environment, and perceptions are in a constant interaction with emotions. Damasio (1999) argued that consciousness is dependent on or founded upon an awareness of the somatic environment. This awareness of inner states enables humans to use somatic states (i.e., emotions) to mark and therefore, evaluate external perceptual data. This communication of cognitive conceptualizations also takes place in working memory, according to Damasio, for instance, in registering the image of a violent man, the reactionary emotion of fear is also registered. Therefore, the brain creates a cognitive image that holds both the external perceptual data (representation of the violent man) and the internal emotional data (fear in response to the violent man). This is possible in working memory based on the basic mechanism of an evolved capacity to project images where humans can be aware of them.
In referring to emotions as intelligence, Lazarus (1994) followed the same line as Damasio (1994) who suggested that emotions and intelligence go hand in hand. The scholar asserted that emotions are elicited according to an individual’s subjective interpretation or evaluation of important events or situations. In particular, an emotion is a subjective mental state with complex reactions that engages both our mind and body. It is aroused by an appraisal of the personal significance or meaning of what is happening in that encounter. The meaning that a person attributes to a stimulus is an important factor in determining his or her reaction. Lazarus (1994) theorized that attributions are influenced by learning and previous experience; as a result, emotions are influenced by hereditary temperament, early experiences (e.g., attachment), and cognitive appraisal.
In his work The Nature of Sympathy (1954), Scheler argued that emotions have been understood by philosophers as merely “subjective” and therefore, promoted a “cognitive” view that emotions could be construed as a source of knowledge. Scheler rejected the Cartesian analysis of emotion in terms of sensation (humans are not considered to be both minds and bodies but minds alone). They are, in the words of Descartes (1993/1641 cited in Scheler 1954), thinking things (res cogitans). Instead Scheler transcend the traditional distinction between emotion and reason by asserting that rationality includes, and does not stand in opposition to, our emotional judgment of the world.
The work of Scheler (1954) also influenced another scholar, Heidegger. Heidegger‘s role in the history of existential phenomenology of emotions is important but also complicated and problematic. There is a very interesting discussion of moods in Being and Time (1962). Heidegger never acknowledged or coined the term emotions and did not properly distinguish moods from emotions but instead wrote about moods such as angst as a fundamental mood that attunes us i.e. opens us up, to Being. This “mood” is not a mere psychological feeling but a mode of being-in-the-world. He opposed the Cartesian framework and emphasised the concept that existing-in-the-world is a unitary occurrence. A human being is not a Cartesian subject that is distinct from the world, but is an entity whose being is characterized by its very involvement in the world. Human beings and the world are revealed together, as a unitary phenomenon. Heidegger‘s idea of ‘unitary phenomenon’ is an important breakthrough in understanding emotional experience. Heidegger in his book Being and Time (1962) further explained that moods neither come from the outside nor the inside; rather moods arise out of being-in-the-world. The acknowledgements that moods are not just subjective feelings, as Scheler (1954) postulated, but are a direct apprehension of the world.
Radford (2002) discussed emotions as inner and subjective phenomena that can be discovered via a process of self-awareness or introspection. Comprehending and explaining emotions consists of a process of self-exploration carried out via a mixture of dialogue; a process appearing quite similar to therapy. The concept of intersubjectivity as the core element of consciousness has several consequences for cognitive theories. Flores-Gonzales (2008) expanded the dynamic and relational property of being-in-the-world. The embodied, temporal and intentional aspects of consciousness are immersed with others in the world.

2.3.1. Structure of Emotional Experience
Solomon (2003) made the convincing argument that emotions are rational and purposive and have a structure, and that the most important structure is like intentionality. Emotions are unitary phenomena that cannot be adequately analysed in terms of subject/object, internal/external, or any other dualistic distinction. Solomon proposed that emotions are not feelings but rather are judgments. In fact, he theorized emotions consist of a web of constitutive judgments through which things appear in a certain way. These judgments are not intentional states. Thus, an emotion is not an internal, psychological state that reaches out to hook up with an external and distinct intentional object. Instead emotions are structures through which the world is experienced. They do not connect with but rather constitute their objects.
Solomon’s definition of emotions as a system of judgement, prevents the concept from evolving into an explanation for everything- and thereby, nothing. In this way, Solomon turned to phenomenology, noting, “An emotion, as a system of judgments, is not merely a set of beliefs about the world, but rather an active way of structuring our experience, a way of experiencing something” (Solomon, 1984, p. 54). Solomon regularly appeals to the likes of Heidegger, and Sartre, all of whom drew attention to the practical and/or embodied nature of world experience. Emotional experience, Solomon (2003) claimed, deals with our ways of engaging the world and generates the questions for a phenomenology of emotions describing how we are doing rather than knowing what we are emotional about.
In referring to emotions as a value judgement, Clore (1994) followed the same line as Peikoff (1991), who noted that emotions are the form in which one experiences automised value judgments. Peikoff asserted that emotions entail an automatic process of unconsciously held knowledge and values. Mayer, Salovey and Caruso (2000) also infer that the interaction between emotion and cognition should then also lead to emotional intelligence.

2.3.2. Emotions and consciousness.
The importance of a synchronous response to emotions as a state of mind was made by Ekman and Davidson (1994). Ekman and Davidson suggested that it is possible to have an emotion without conscious awareness, and that emotions can be considered as states of mind that take up a larger portion of consciousness and other psychological processes. Emotions reflect implicit memories; stored beliefs about relations with objects, people or situations; and one‘s unconscious appraisal of them based on one‘s values. Every emotion represents a particular kind of value judgment. For example, joy is the outcome of achievement, while fear is the instinctual reaction to a threat. Damasio (1994) similarly recognizes and offer deep reassurance to those who believe in the complementarity in intellectual development of emotion and cognition. Damasio noted that emotion and feeling, “provide the bridge between rational and non-rational processes, between cortical and subcortical structures” (1994, p.128).
It was apparent to Damasio (2006) that when emotion was left out of the picture when it comes to intellectual reasoning, that the outcome fared far worse than if emotions had skewed logical calculated reasoning. An example of this is when Damasio reviewed a case of a patient that had impaired emotion. The patient was walking on very thin ice and was incapable of coming to a firm conclusion, such as deciding on what date to make his next appointment to. Furthermore, the patient would walk him through a long winded and boring cost-benefit analysis whose outcome became an endless and fruitless comparison of options and possible consequences. It is interesting to note that neurotypicals would view this as a huge waste of time and would have thus marked this as a negative; meaning they would view in their subjective interpersonal imagination the minds of others looking at them and therefore marked it as embarrassing. However, there is good reason to assume that the patient had some of these internal pictures assimilated but the obviation of a marker prevented these pictures from being correctly processed.
There are a wide range of various emotional responses that emerge due to the varied dimensionality of consciousness. While emotion-regulatory actions involve only a moderate part of the personality function as a whole, they form a rather broad topic to examine altogether. There are subcategories of emotional regulation according to the levels of awareness or consciousness they involve. (Mayer & Gaschke, 1988). We will expand on the triad frame of reference including non-, low-, and high-conscious levels of regulation:
• Unconscious emotions occur at a neurological level that is unreachable to the conscious (Kihlstrom, 1987; 1990). Some forms of non-conscious emotion regulation could well reflect emotional intelligence.
• Low-level consciousness usually incorporates temporary conscious awareness that is only shows up peripherally, not reenacted, and unlikely to be recollected. In addition to constructing various emotions at a lower level of awareness, people may divert their focus towards or away from emotional experience.
• Higher consciousness operates at a contemplative, going above or beyond in an awareness that extends self-observation through purposeful extent, involving attention, not to mention having thoughts of self. Regulation of emotion becomes more interesting at a higher, more reflective level.
It is therefore necessary to examine the makeup and self-regulation at each of these three levels of aspects.
In terms of the unconscious, physiological dispositions and early education history affect the emotion system. Emotions are commonly considered to be constructed at their lowest level by biologically programmed combinations of cognitive reactions and physiological experience (Buck, 1985; LeDoux, 1989; Plutchik, 1994; Thayer, 1989).
In regards to Low-level Consciousness, there is no doubt that with the growing of age guarantees the array of emotions that builds with complexity. People’s emotions seem to develop in complexity over time as many systems are evolving by influencing social and cultural learning. People learn rules as to when emotions are pertinent to feel. In addition to establishing particular emotions at the low level of awareness, people may aim their focus towards or away from emotional experience. For example, while pending on important medical news, people can change their attention towards or away from their fears (Miller, Brody, & Summerton, 1987).
There has been a clinical phenomenon in pointing to the importance of attention versus inattention in relation to mood. Negative mood plus mood inattention correlates even more that a primary indicator of depression is the active endeavor to avoid emotional pain (Mayer et al., 1991).
In terms of the High Level of Consciousness, a higher level of conscious emotional makeup is accompanied by intentional, well extended attempts to comprehend, define, and possibly enhance emotion. Much of this sort of activity takes place within political, ethical, and religious scholarship.
While at lower levels of consciousness, emotional regulation is not more than deciding on attending or not attending to a feeling. Regulation becomes more interesting at a higher, more contemplative level. At this level, people regulate emotions by evaluating them, attending to them, and reflectively monitoring them. This is described by Mayer and Gaschke (1988) about this level of reflective, or meta, experience of emotion. Clarity and attention are two common factors of meta-experience. It is in the clarity of mood that predicts more positive judgments (Mayer et al. (1992).
The utilization of emotional intelligence theory to the area of meta-experience raises the thought-provoking question of which meta-experiences are paramount. As it may be those experiences that are the most flexible involve better reported understanding of emotion. Either clarity or a more complex profile may be linked to emotional intelligence.
Therefore, good judgment can best be carried out if the person has access to pertinent information could well reduce emotional intelligence. Defensiveness such as denial, projection, and intellectualization may impede judgment because they lessen both the material about the world that relates to it as well reduced pain. Increased denial may lead to a reduced sensitivity to others, less social understanding, and poorer health (Weinberger, 1990, pp. 359-360).

2.3.3. Conceptions of emotion and EI.
With emotions, Mayer, Salovey and Caruso (2000) believe these mental operations have evolved in order to signal and respond to the relationship between the individual and the environment, including the place one imagines oneself to inhabit within the environment. For example, fear rises as a response to danger. There is no specific course of time or duration that emotions follow, like there is for motivational components (such as thirst, which rises until it is quenched). Rather, emotions respond to the environment, and can instigate behavioural responses, such as fighting or fleeing (in response to fear). They are therefore much more flexible than motivations.
Motives interact with emotion when frustrated needs result in increased aggression or anger, whereas emotion interacts with cognition when positive emotions result in an individual thinking positively. In continuing this review, it is important to consider the role of emotions and cognitions and the contributions of Salovey and Mayer (1990) with regards to the concept of EI, which arose from non-cognitive aspects of intelligence proposed by Spearman (1927) and Gardner‘s (1983).

2.3.4. Emotions and Cognitions
There is growing evidence that the interplay between emotion and cognition may be fundamental to the ability to adaptively regulate emotions (Dennis 2006). Emotion and cognition are acknowledged to be closely integrated in emotion regulation (Gross, 1998) but many studies continue to examine emotion as the antithesis of cognition (e.g., Zajonc, 1980), rather than an integral part of thought processes (Bower 1981; Gray 2004; Lewis, 2005). LeDoux (1996) examine the low route to emotion and proposal that the amygdala can elicit emotion before information reaches the cortex. However, Storbeck and Clore (2006) argued that the amygdala, and emotion in general, does not function independently of perceptual and cognitive processes. Neuroimaging research by Gray (2004) found that specific emotional states or different cognitive control functions, can influence each other in selective ways, such as working memory (Braver, Cohen, & Barch, 2002; Gray 2004).
Research on the affective regulation of perception (Bruner, 1957) maintained that rather than being a passive registration of reality, perception reflected internal expectations and motivations as part of an adaptive process. Witt, Proffitt, and Epstein (2004) suggests that perception of the physical world is influenced by emotion and other internal factors.
Cognition and emotion are coming to be viewed as complementary rather than antagonistic processes. Evidence in support of such a view comes from research on decision making and memory by Damasio, Tranel and Damasio (1991) who found that patients with lesions to neural networks have an inability to use affective feedback and that has profoundly negative consequences for judgement and decision making. In another pioneer study Phelps and Sharot (2008) found that emotions support both memory accuracy and a subjective sense of recollection.

Chapter Three

3. Emotional Intelligence
3.1. Early Perspectives and Competing Theories of Emotional Intelligence
Since the introduction of the concept, however, a division has developed in which some researchers have focused on EI as a distinct group of mental abilities. A number of authors in the field of EI have termed this set of mental abilities as emotional intelligence (Mayer & Salovey, 1997; Mayer, Salovey, & Caruso, 2000; Mayer, DiPaolo, & Salovey, 1990). Mayer, Salovey and Caruso (2008) asserted that EI is how people differ in their ability and capacity to carry out sophisticated information processing about emotions and emotion-relevant stimuli and use this information as a guide to thinking and behaviour. While others view it as an eclectic mix of positive traits, such as empathy, relationship skills, self motivation, social competence, adaptability, assertiveness, happiness, self-esteem, and optimism (Petrides & Furnham, 2001; Bar-On, 1997; Schutte et al., 2002).
Goleman (1995a) was the most influential in launching research on EI. Goleman’s (1995) concept avail researchers to expand EI from a specific psychological entity – a mental capacity for processing emotion – to a broader collection of personal qualities. The development of an alternative notion of EI by Goleman (1995a) led Bar-On (1997) to define EI as a mixture of emotion-related competencies, personality traits and dispositions (mixed model). This early model was followed by several alternative conceptions, which translated quickly into standardised instruments to measure individual differences in this construct (e.g. Mayer & Salovey, 1997; Shutte et al., 1998; Bar-On, 1997; Mayer, Salovey and Caruso, 2000; Goleman 2000; Tapia, 2001; Petrides and Furnham, 2001). As such, Mayer, Salovey and Caruso (2008) noted that there are various models that have been proposed to explain or conceptualize EI. Three broad perspectives on EI can be distinguished in the literature. The ability model is provided by Mayer, Salovey, & Caruso (2000) which focuses exclusively on mental abilities. The second theoretical perspective concerns the mixed models, which mix emotional abilities with a variety of personality traits and dispositions (e.g. Bar-On, 1997). The third perspective is the trait approach whereas Petrides and Furnham (2000) claim that EI should be examined within the framework of personality, that is, Trait EI, and not that of intelligence. Table 1 below shows the major EI models and their main facets, however, this table does not claim to include all the elements and relevant information in the various models.
Ability EI Trait EI Model
(self assessment test) Mixed Model of EI
(self assessment test)
Mayer & Salovey (1997) Petrides & Furnham (2001) Goleman (1995a)

Overall Definition: Emotional intelligence is the set of abilities that account for how people’s emotional perception and understanding vary in their accuracy. More formally, we define emotional intelligence as the ability to perceive and express emotion, assimilate emotion in thought, understand and reason with emotion, and regulate emotion in the self and others (after Mayer & Salovey, 1997) Overall Definition:“trait EI is “a constellation of emotion-related self-perceptions and dispositions, assessed through self-report. The precise composition of these self-perceptions and dispositions varies across different conceptualizations, with some. . . being broader than others” (Petrides & Furnham, 2003, p. 40). Overall Definition The abilities called here emotional intelligence, which include self-control, zeal and persistence, and the ability to motivate oneself (Goleman, 1995a: xii). […and…] There is an old-fashioned word for the body of skills that emotional intelligence represents characters (Goleman, 1995a: 28)
Major Areas of Skills and Specific Examples
Major Areas of Skills and Specific Examples
Major Areas of Skills and Specific Examples

Perception and Expression of Emotion
 Identifying and expressing emotions in one’s physical states, feelings, and thoughts
 identifying and expressing emotions in other people, artwork, language etc.

Assimilating Emotion in Thought

 Emotions prioritize thinking in productive
 Emotions generated as aids to judgment and memory

Understanding and Analyzing Emotion

 Ability to label emotions, including complex emotions and simultaneous feelings
 Ability to understand relationships associated with shifts of emotion

Reflective Regulation of Emotion
 Ability to stay open to feelings
 Ability to reflectively monitor and regulate emotions to promote emotional and intellectual growth
• Adaptability

• Assertiveness

• Emotional appraisal (self and others)

• Emotion expression

• Emotion Management (others)

• Emotional regulation

• Impulsiveness (low)

• Relationship skills

• Self Esteem

• Self motivation

• Social competence

• Stress management

• Trait Empathy

• Trait Happiness

• Trait Optimism
Knowing One’s Emotions
 Recognizing a feeling as it happens
 Monitoring feelings from moment to moment

Managing Emotions
 handling feelings so they are appropriate
 Ability to soothe oneself
 Ability to shake off rampant anxiety, gloom, or irritability

Motivating Oneself

 Marshaling emotions in the service of a goal
 Delaying gratifications and stifling impulsiveness
 Being able to get into the flow state

Recognizing Emotions in Others

 Empathic Awareness
 Attunement to what others need or want

Handling Relationships

 skill in managing emotions in others
 interacting smoothly with others.
3.1.1. The Salovey and Mayer EI model.
Despite Gardner’s previous work on non-cognitive aspects of intelligence, it was Salovey and Mayer (1990) who initiated a research program intended to develop an EI model and EI scale of measurement. These researchers identified three components of EI: an ability to appraise oneself and others’ emotions, an ability to regulate one’s own emotions, and an ability to use emotions to solve problems. Since Salovey and Mayer‘s (1990) conceptualisation of EI, the construct has received considerable attention in the scientific literature. A number of competing EI models have also been developed, providing several theoretical frameworks for conceptualising and measuring the construct (e.g., Bar-On, 1997; Goleman, 1995, 1998, 2001; Mayer and Salovey, 1997). Besides the original Salovey and Mayer (1990) conceptualisation of EI, there are two main mixed models that have been particularly important and influential: Goleman (1995) and Bar-On‘s (1997). All these EI models, however, share a common core of basic concepts. EI, at the most general level, refers to the ability to recognize and regulate emotions in ourselves and in others.

3.1.2. Goleman’s EI Model
Goleman (1995a) proposed a theory of EI that is performance based. According to this scholar, emotional intelligence consists of five factors: knowing one’s emotions, managing emotions, motivating oneself, recognizing emotions in others, and handling relationships. The author also presented an emotional competence framework in which each broad area consists of a number of specific competencies. As a result, EI can be distilled into a framework that embraces only five competencies: self-awareness, self-regulation, self-motivation, empathy, and social skills. The first three components are intrapersonal, that is, within the individual, and the second two are interpersonal, between people. Goleman‘s model is developmental, because each succeeding factor builds upon the skills learned in the preceding factor. For example, one must have good intrapersonal skills to develop good interpersonal skills.

3.1.3. Bar-On’s EI Model
The theoretical EI model established by Bar-On (1997) includes factors significantly related to personality rather than cognitive abilities and does not address the cognitive characteristics that are typical of the traditional definition of the intelligence construct. As a result, Bar-On‘s conceptualization of EI is not far removed from Goleman‘s, in that both authors advocate EI as a complex interaction of cognition, meta-cognition, emotions, mood, and personality that are applied to both interpersonal and intrapersonal situations. Bar-On appears to cite clusters of established personality traits, and extends the construct to encompass many aspects of well-being. Bar-On characterizes EI as “…an array of non-cognitive capabilities, competencies, and skills that influence one‘s ability to succeed in coping with environmental demands and pressures” (1997, p.14).

3.1.4. The Mayer and Salovey Ability EI model.
Mayer and Salovey (1997) reported that their earlier (1990) model was inadequate because it did not consider mechanisms related to thinking about feelings. Their later model (1997) proposes four dimensions of EI: (1) perception, appraisal and expression of emotion, (2) emotional facilitation of thinking, (3) understanding, analysing, and employing emotional knowledge, (4) and finally, reflective regulation of emotions so as to promote further intellectual and emotional growth (see Figure 3).

Figure 1: Mayer and Salovey (1997) Four Branch Model of Emotional Intelligence

3.2. Modern Theories and approaches of Emotional Intelligence
At present, there are three main models of emotional intelligence: ability models, mixed models, and trait EI models. Mayer, Salovey and Caruso (2000; 2007) and Salovey and Grewal (2005) support the ability model or emotional intelligence. Bar-On (1997) and Goleman (1995) advanced the second theoretical perspective, mixed models, which combine emotional abilities with various personality traits and dispositions. The third perspective is the trait approach, developed by Petrides and Furnham (2000), which suggests that emotional intelligence should be explored within the framework of personality (trait emotional intelligence), not cognitive intelligence. These models will be discussed in greater detail below.

3.2.1. Ability models of emotional intelligence.
In 2005, Salovey and Grewal created a more complex ability model of emotional intelligence. These researchers perceived emotions as useful sources of information that can help individuals to make sense of and navigate the social environment. The model posits that people vary in their ability to process information pertaining to emotions and in their ability to relate this processing to a wider cognition. Thus, emotional intelligence refers to a variety of subtle emotional abilities divided into four classes (or branches). These include: 1) appraising and expressing emotions, 2) assimilating basic emotional skills into cognitive life, 3) understanding and reasoning with emotions, and 4) managing and regulating emotions in oneself and others.

3.2.2. Mixed models of emotional intelligence.
Mixed models of emotional intelligence are very different from the mental ability models. Some of the earliest studies by Mayer, DiPaolo and Salovey (1990) and Salovey and Mayer (1990) on emotional intelligence proposed both the ability and mixed models. These articles, as well as suggesting that there is a mental ability conception of emotional intelligence, also discussed the notion that personality characteristics might complement this intelligence. Another mixed model was put forward by Goleman (1995a) and was named the emotional competencies model. Goleman put forward five broad areas, including: 1) knowing one‘s emotions, 2) managing emotion 3) motivating oneself, 4) recognizing emotions in others, and 5) handling relationships.

3.2.3. Trait EI model.
The third EI model is the trait EI approach and is an important theoretical distinction, which has not been included in previous research. Petrides and Furnham (2000) argued that EI should be examined within the framework of personality, that is, trait EI, and not that of intelligence. The researchers posited that there is a conceptual difference between the capacity or competence based model and a trait dependent model of EI. According to Petrides and Furnham “trait EI is “a constellation of emotion-related self-perceptions and dispositions, assessed through self-report. The precise composition of these self-perceptions and dispositions varies across different conceptualizations, with some. . . being broader than others” (Petrides & Furnham, 2003, p. 40). Trait EI also relates to the self-perceptions of the emotional dispositions of an individual. This description of EI includes behavioural orientations and self-perceived capacities, and is quantified by self report, in contrast to the ability based model which relates to competences and have shown to be very resistant to empirical measurement. Furthermore, the development of EI as a personality trait results in a framework or model that is found to be exclusive of the classification of human cognitive ability (Day & Carroll, 2008). Petrides, Pita and Kokkinaki (2007), reported that this cognitive exclusion directly impacts the operationalization of this model, and its hypotheses and theoretical propositions.

It is now necessary to explore how the constructs of emotional intelligence approaches are measured objectively, particularly due to the conceptual framework being underpinned by such abstract psychosocial dynamics.

3.3. Emotional Intelligence measurements

There have been many different measures in order to hypothesize, conceptualize, and test emotional intelligence (Mayer, Roberts & Barsade, 2008). Continually evaluating the effectiveness of EI measurements, Salovey and Grewel (2005) assert that the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) is the most commonly used instrument for the ability model. This test is based on a variety of emotion-based, problem-solving items. Given that this model of EI claims that emotional intelligence is a type of intelligence, the MSCEIT is modelled on ability-based IQ tests, assessing an individual‘s personal abilities on each one of the four branches of emotional intelligence competencies. In this way, it calculates a score for each of the branches, as well as a total score.
The first branch to the MSCEIT measurement scale is the construct of ‘perceiving emotions’, which is examined along the dimensions that determine a participant’s ability to interpret facial expressions, as visual social cues, correlated with emotions (Ekman, 2003). The perception of emotions is also measured by the extent to which participants correlate picture imagery and colours with moods and feelings, particularly from the conveyed viewpoint of the designer (Arnheim, 1974). However, this facet of perceiving emotion can be criticised for being confounded by subjectivity considering the use of colour and pattern in art embodies qualitative differences such as cultural values (Davies, 1998). The second branch to the MSCEIT is measuring the extent to which individuals utilise emotions to supplement thoughts. One of the ways this is assessed is by collecting data on the individual’s ability to distinguish between emotions and other tactile/sensory information (Cisamolo, 1990). This is evident where a particular stimulus may elicit a sensory perceived response which could have emotional values, or simply stimulate thought in absence of any associated feelings. However, the measurement of emotional facilitation is the extent to which an individual accesses certain emotions to help implement thoughts and mental representations about a particular subject, such as dealing with the loss of a significant person in their life (Isen, 2001). Branch three of the MSCEIT measurement for emotional intelligence focuses on the ability to understand emotions, which is assessed in two ways. Firstly, an individual’s awareness of emotional change is evaluated based on their ability to identify social situations where the intensity of feelings moderate or decline. This also measures egocentrism to some extent, because the approximation of emotional states of other people in certain circumstances should not be based on the individual’s own subjective appraisal, but rather other peoples’. One way this has been investigated is a participant’s ability to identify a person’s emotional transition from one state to another, for example; from frustration into aggression (Roseman, 1984). The final fourth branch of MSCEIT is the measurement of the individual’s ability to manage emotions during different hypothetical situations. This is operationalised by presenting participants with scenarios that elicit certain feelings, and asking how they would cope and moderate them under emotional intensity (Gross, 1998). Another important measurement for the fourth branch to MSCEIT is the assessment of managing emotions in relationships. This is tested by asking participants how they would try to influence someone else’s emotionally affective states in order to implement a desired outcome (Ford and Tisak, 1983).
After outlining the four branches to the MSCEIT measurement of EI, it is important to have some critical understanding of how these test items have proven resilience under research scrutiny, before exploring remits for using other EI measures.
The constructs of EI have been criticised as being incompletely valid and confounded by a scholar’s own research data in the conceptualisation of EI, which has taken several different concepts for such an abstractly diverse topic (Matthews, 2002). Taking into account some of the operationalised items of the MSCEIT are designed to elicit emotional states in participants, it raises a question on how ecologically valid the conditions are during the test to ensure the responses are natural and representative of real life scenarios. The questions that pertain to a participant’s ability to decipher another individual’s feelings across different situations may have ecological validity through written and visual imagery. This is because certain emotions are conveyed through verbal and visual content in real life, which may result in valid responses. A study was conducted to investigate whether people who had a tendency to accurately decipher emotional content through EI measures could demonstrate this in a situation involving real people experiencing dispositional states. Geher, Warner, and Brown (2001) used a sample comprising of 40 undergraduate student participants, half of which were selected based on the lowest EI scores, and half based on the highest EI scores from the MSCEIT measurement. The students then observed video recordings of other undergraduates who were filmed describing their thoughts about certain issues. It was found that those participants who previously scored the highest on EI demonstrated the most accurate estimations about the emotional states of the individuals video recorded, compared to the 20 students who scored the lowest on EI (Geher, Warner, and Brown, 2001). These results suggest that the MSCEIT items measure EI in a way that can be generalised to competency based situations that require the responses to be more qualitatively engaged. On the other hand, there has been controversy regarding the reliability of the MSCEIT, which has proceeded from the scrutiny faced by early measures of EI. This controversy is grounded in the fundamental issue that it is rather difficult to ensure a scientifically objective measure for such an abstract and changeable trait of human behaviour, even though its manifestations can be seen with varied consistency. This is evident in recent discussions noting that the reliability of the MSCEIT scale items are not consistent between different samples of data results, and the performance based scoring of EI does not consistently provide valid conclusions from an entirely empirically driven approach (Matthews, 2002). It was also pointed out by Roberts (2001) that the reliability of the items that are operationalised in the first few prominent branches of the MSCEIT model are the most inconsistent in response data, however, internal consistency was quite acceptable. Even though many scholars, including the ones mentioned thus far, have concurred to the MSCEIT model of EI being a good comprehensive measure, there still needs to be further investigation of other measures.
Mixed models of emotional intelligence have four main assessment tools as discussed by Bradberry and Greaves (2009): 1) the Emotional Competency Inventory (ECI), 2) the Emotional and Social Competency Inventory (ESCI), 3) the Emotional Intelligence Appraisal, and 4) the Emotional Quotient Inventory EQ-I. In order to conclude a methodological verdict for the proposed study, it is important to explore the remits of using each of the EI assessment tools in terms of reliability and validity.
The ECI assessment model of EI emerged from the emotional competencies identified by Goleman (1998), also competencies investigated by Hay and McBer’s (1996) in their published ‘Generic Competency Dictionary’, as well as from Boyatzis (1991) Self-Assessment Questionnaire (SAQ). The SAQ was originally employed for testing MBA and executive students’ competencies in the Generic Model of Management, utilised by at the Weatherhead School of Management, Case Western Reserve University (Boyatzis and Kolb, 1993). Both Boyatzis and Goleman conceived the inventory from the items used in the SAQ, in part, in order to address the diverse spectrum of competency based emotional behaviours and expressive traits. However, according to Daus and Ashkanasy (2005), the ECI measurement has done more harm than good in terms of establishing emotional intelligence as a legitimate, empirical construct. This criticism is largely attributed to the methodology of the ECI measurement collecting respondent data as a self-report tool, which opens the door to confounding variables such as biased responses; the most objective way of deciphering EI traits is to assess how they are expressed through stimulus driven situations in order to maximise ecological credibility. Therefore, self-reporting in the ECI assessment may not be representative of how emotional traits are expressed in real life, which supports Daus and Ashkanasy’s (2004) criticism of the model lacking objectivity. The ECI assessment has been subject to multiple studies of criterion and construct validity. Research has also found that ECI scores can be correlated with associated behaviour in real life ecology, for example, outcomes in individual life success (Sevinc, 2001), subjective appraisal of leadership (Humphrey, Sleeth and Kellet, 2001), and fire fighter performance (Stagg and Gunter, 2002). Construct validity has also been evident in research scrutinising the ECI scale of EI, particularly in terms of the similar relationship the scale has with other measures such as the MBTI; social intuition and sense, and affective cognition (Burckle, 2000). It should be noted that even though these measured dispositional behaviours have proven to have similarities with the ECI model, other behavioural relationships have been rejected, as expected, such as links to personality dimensions – introversion/extroversion – thus, providing positive appraisal of the construct validity. The scores generated by the ECI measurement have also been correlated with coaching style behaviours exercised in leadership contexts such as the management of team oriented sports, however, the EI scores have an insignificant correlation with coercive authoritative behaviours (Carulli and Com, 2003). This may provide credence to Goleman’s (1998) notion of emotional competencies being expressed through empathetic awareness and the responsiveness to other individuals’ dispositions and motivations. Byrne (2003) also conducted an investigation into the overall validity rating of the ECI measurement by using a self-assessment version of the model test. It was found that the ECI assessment demonstrated strong criterion, discriminant, and construct validity (Byrne, 2003).

Anand (2010) reported that the EQ-I, as developed by Bar-On 2006), is the most commonly used instrument in assessing mixed models of emotional intelligence. The EQ-I is a self-report measure of EI that measures emotional and social competent behaviour. This measure, however, has been criticized for claiming to measure an ability through self-report items (Roberts, Zeidner, & Matthews, 2001), and according to Day and Carroll (2008) and Grubb and McDaniel (2007), it has also been highly susceptible to participant bias. This criticism coincides with the evaluative point of respondent bias mentioned earlier on the ECI self-assessment measurement. To test trait EI, a multitude of self-report EI measures, including the Trait Emotional Intelligence Questionnaire (TEIQue) are neccessary. The TEIQue test is organized and comprised of 15 subscales under four headings: well-being, self-control, emotionality, and sociability. Various studies conducted by Mikolajczak, Luminet, Leroy and Roy (2007) have shown the results of this test to be normally distributed and reliable.

Thus, the TEIQue is considered to be a useful, reliable test to use in order to discern an individual‘s emotional intelligence.

3.4. Emotional Intelligence and Clinical Evidence
There are various theories and models of emotional intelligence that have arisen since the 1990s, as evidenced in the publications of Fox and Spector (2000), Mostow et al. (2002), Petrides and Furnham (2003), and Van der Zee et al. (2002). These researchers and others have shown an increasing interest in the theoretical development of the emotional intelligence concept, with the need to explore its status as and beyond, intelligence and personality, within the realm of human social transactions. EI examined in all three models (trait, mixed and ability measurements) has been both theoretically and empirically linked to many psychological constructs that play a large role in the therapeutic relationship and setting. More researchers have examined trait EI under the general label of emotional intelligence.

Trait EI has been especially related to various emotion-related variables, including alexithymia, optimism, and mood (Petrides, Pérez-González, & Furnham, 2007). It has also been related to adaptive coping to depressive affect, and effective decision-making (Sevdalis, Petrides, & Harvey, 2007). In demanding and challenging environments, emotional intelligence influences the selection and control of coping strategies for use within the immediate situation (Matthews & Zeidner 2000). There is evidence to suggest that some forms of EI can moderate the relationship between stress and mental health and lead to better adaptation (Ciarrochi et al., 2002).
There are a variety of cross-over subjects that emotional intelligence has been related to, including life satisfaction and success, social network size, loneliness (Saklofske, Austin, & Minski 2003), psychological distress, (Slaski & Cartwright 2002), depression and mental health, (Dawda & Hart 2000; Taylor 2001), psychopathology (Malterer, Glass, & Newman 2008). Various studies like those of Bar-On (1997) and Martinez-Pons (1997) have been specifically focused on the role that EI plays in the prediction of life satisfaction, and found that those people with a higher emotional intelligence were more likely to have greater outcomes. Bar-On (1997) demonstrated the EQ-I total scores are positively related to measures of emotional health, and negatively related to measures of psychopathology and neuroticism.
David (2005) demonstrated that the higher a person‘s EI, the lower their psychiatrist distress including, fewer headaches and less trouble concentrating. Other reports, like those of Lizeretti, Oberst, Chamarro, and Farriols (2006) indicated that those diagnosed with dysthymia have lower EI scores than other psychiatric groups. Subsequently, there has been considerable evidence reported by Schneider, Lyons, and Williams (2005) that a higher degree EI does appear to promote better attention to physical and mental processes relevant to clinical outcomes. For example, people higher in some EI skills are more accurate in detecting variations in their own heartbeat—an emotion-related physiological response. Malterer et al., (2008) found the association between psychopathy and EI. This study of trait EI found that individuals with primary psychopathy are both less likely to attend to emotion cues and less able to revise their mood states once emotions are experienced.
There is also preliminary evidence that depressed youth may also have difficulty regulating negative affect (Shabani et al., 2010). In particular, it appears that they may have a more limited repertoire of strategies for regulating affect, use less effective strategies, or fail to use strategies within their repertoire. Trait EI scores positively correlated with emotional stability and negatively correlated with neuroticism and psychopathology (Dawda & Hart, 2000). Trait EI negatively correlated with depression in studies by Dawda and Hart (2000) and Schutte et al. (1998), and psychological distress (Slaski & Cartwright, 2002).
Sanchez-Ruiz, Mavroveli and Poullis (under review) in their recent study aimed at investigating the relationships between academic performance (AP) and general ability (Gf), personality traits, and trait emotional intelligence. The study also explored differences across university majors (i.e., computer sciences, business and management, electrical engineering, tourism and marketing, law and accounting, and psychology) in trait EI profiles. Trait EI predicted AP over and above cognitive ability and established personality traits, whereby Openness to experience remained significant. There were differences across university majors in trait EI scores. In particular, psychology students scored higher on trait EI than computer science, electrical engineering, and business and management students.

Little is known about the relationship between personality disorders and emotional intelligence. Leible and Snell (2004) revealed that personality disorders have a similar pattern with the measures of emotional intelligence. Thus, all of these personality disorders directly related to private emotional preoccupation and public emotional concern, but indirectly related to emotional clarity and emotional repair. In a recent study by Salami (2011) trait EI had significant correlations with psychological well-being in adolescents. The study points out the moderate relationship between EI with neuroticism, extraversion, and psychological well-being. The study implies that EI limits the negative effects of high Neuroticism and boosts the positive effects of Extraversion to produce greater well being.

3.5. Summary of EI Models
To conclude, there are mental ability models, mixed models, and the trait EI model of emotional intelligence. The mental ability models of Salovey and Mayer (1990) Mayer and Salovey (1997), Mayer, Salovey, and Caruso (2000), emphasized the role of emotions themselves, and the interactions that they have with thought. On the other hand, the mixed models of Bar-On (1997) and Goleman (1995a) imply that both mental abilities and a multitude of other individual characteristics, such as motivation, states of consciousness (and flow), and social activity, come together as a single entity to create emotional intelligence. The trait EI model, however, as developed by Petrides et al., (2007), focuses on the self-perceptions of individuals with respect to their emotional self-efficacy and self-perceived ability to determine their emotional intelligence. All these models have their benefits and limitations, as well as measured in different ways.
Chapter Four
4. The Therapeutic Relationship
Freud (1940) coined the notion of therapeutic alliance by emphasizing the importance of the “pact” between the analyst and the patient who “band” together with a common goal based on the demands of external reality. Since Freud made his claims in 1940’s, researchers had been floating around the idea that the relationship between the client and the therapist as the major influence on the effectiveness and outcomes of therapy (Ackerman & Hilsenroth, 2003; Burns & Nolen-Hoeksema, 1992; Cooper, 2004; Luborsky, McLellan, Woody, O’Brien, & Auerbach, 1986; Norcross, 2002). Clearly there is a piece of the puzzle missing in terms of explaining the successful client-therapist relationship. It is only logical that researcher Lambert (1983) would state that the consistent failure to find differences in the efficacy of different forms of psychotherapy and the therapy nonspecific factors, along with a significant unexplained proportion of variance, promotes the attention of research to be placed on the therapeutic relationship.
Saul Rosenzweig (1936) was the first to coin the notion of common factors in counselling. The author noted that common factors across schools of psychotherapy are responsible for facilitating change. Almost three decades later, Frank (1971) proposed six therapeutic factors: an intense, emotionally charged relationship; a rationale that explains the nature of the client‘s distress; provision of new information about the sources of the client’s problems; strengthening of the client’s expectation of help through the therapist’s personal qualities; provision of the experience of success; and facilitation of emotional arousal.
The concept of therapeutic alliance by Zetzel (1956) introduced the term therapeutic alliance as a conscious, collaborative, rational agreement between therapist and client. Greenberg and Safran (1987) advocate that the positive working alliance between therapist and client foster the necessary conditions for a client to express and explore any inner feelings and facilitates a safe space to experiment with new behaviours. Empirical research on the therapeutic relationship in general and the therapeutic alliance in particular has been advancing (Horvath (2005). A number of studies have shown that the therapeutic alliance is significant in just about any form of therapy, regardless of the particular approach employed (Horvath & Bedi 2002; Luborsky, Singer, & Luborsky 1975; Martin et al. 2000; Shapiro 1985; Smith and Glass 1977). Knox (2001) describes how the therapeutic relationship generates change via the recovery of autobiographical memories. Evidence also suggests that the alliance is particularly predictive of outcome when measured early in treatment.
The question concerning whether the alliance is essentially an intrapersonal process or an interpersonal phenomenon also needs to be considered. In Horvath’s (2005) view the evidence appears to support both perspectives. Hendry and Strupp (1994) expanded on the inter- and intrapersonal concepts by documenting that components of therapists’ and clients’ internalized self (introject) interact unconsciously, and affect the quality of the therapeutic alliance. Thus, both processes, inter- and intrapersonal contribute to the quality of a positive alliance.
Suggestions on other possible methods of examining the therapeutic relationship presented by Horvath and Bedi (2002) include considering the micro-level rather than the macro-level identification of intrapersonal variables and qualities of therapists, which could affect their interpersonal relationships in therapy and its outcomes. Suggesting that without these inter and intrapersonal skills or abilities, therapist will not be as successful. A number of studies on therapist characteristics pertinent to the development of a good alliance are supporting the importance of these characteristics to the therapeutic relationship. Research conducted in an important study by Perraud, Delaney, Carlson-Sabelli, Johnson, Shephard, and Paun (2006) has focused on particular psychotherapy skills necessary on therapeutic alliance. Drawing on this review, they suggested that these skills could be understood as involving four basic domains of competence: “Therapist Contributions to the Therapeutic Alliance,” “Skills and Techniques to Increase Positive Reception of Empathic Overtures,” “Goal Consensus and Collaboration Skills,” and “Skills Related to Development of Self-awareness and Management of Countertransference” (Perraud et al., 2006, pp., 221–223).

4.1. The therapeutic relationship and its links to EI

There have been studies investigating the possible positive correlations between EI and the therapeutic relationship, however, only a limited handful of EI constructs have been used to decipher this link. Poullis (2007) conducted a phenomenological investigation into the extent to which EI competencies mediate and have an influence on the therapeutic relationship, and found five themes emerged from qualitative thematic analysis; Therapist’s subtle competencies, substantial attributes and skills, experience, extraneous variables, and the process of interaction. The therapeutic relationship and the studied constructs of EI models share similarities, however, the issue still remains with attempting to formulate measures for EI that capture the inter-subjectivity of a therapeutic experience, as well as the variability of relationship contexts in psychotherapy (Clarkson 1990; 1995).

Clearly the notion that the complex relationship between the therapist and the client has a profound effect on the therapeutic journey has been the subject of much research and debate for quite some time, as has the ways in which the quality of the therapy-client relationship affect client outcomes. The ways in which emotions may impact the therapeutic relationship, and the significance of emotional intelligence within therapy could also be critical areas for current and future therapists. Thus, these are issues that are areas of acute importance for practitioners and trainee therapists in the twenty-first century. A growing volume of research on the therapeutic alliance focuses on exploring the relation between the alliance and therapy outcomes across various helping contexts, such as different types of treatments, diverse populations, gender effects, therapist training and experience. It also should be noted whether the alliance is in itself a curative component of therapy or whether the quality and process of the relationship creates the interpersonal context for other therapeutic elements.
In referring to self-management and coping to emotional stress, Salovey (2001) states that the introduction of these EI skills may have a positive impact in dealing with the perception, expression, and regulation of moods and emotions. This is particularly evident with the issue faced by newly qualified social workers, as there is an ever increasing disparity between the taught theoretical models of solving mental health problems and the emotional stress the comes with the cross-cultural diversity among poly-ethnic communities – a qualitative variable that seems to underpin the extent of patient compliance to interventions (Bidgood, Holosko, and Taylor, 2003). Therefore, in order to further explore the link which EI has with the therapeutic relationship, it is important to identify how certain expressive traits of EI play an integral role of professional competence in the applied psychodynamic setting.
The social work profession has been the subject of much research concerning the extent to which empathetic awareness – a trait of EI – and intuition plays a role in the interaction with clients who are socially/psychologically vulnerable, oppressed and living in low economically developed communities (NASW, 1999). The approach to social work has become increasingly more focused on global and cross-cultural sensitivity, as traditional theoretical models of solving social issues – taught through accredited curriculums – are now faced with a steep demand for real world adaptation (Bidgood, Holosko, and Taylor, 2003). While governmental agencies have recognised the need for interventions to accommodate the culturally diverse systems that underpin behaviour to ensure responsiveness and compliance, it is evident that new academically qualified social workers lack the emotionally intuitive preparedness of this variable that is so disruptive to the standard protocol of theoretical execution.
The social work profession may be a promising starting ground for exploring the correlative link between EI and the clinical Therapeutic relationship, primarily because it incorporates similar psychosocial and interpersonal dynamics evident in a traditional counselling context (Eborall and Garmeston, 2001). The self-management and coping of emotional stress mentioned earlier in reference to Salovey (2001), is prominent in the emotional demands and stress that accompany the client assignments of social work. Stress in recent qualified social workers is considerably high, which is evident in the high rates of psychosocial distress found in participants sampled by a study conducted by Kinman and Grant (2011), which found 43% generated scores that are reflective of those that remit a patient’s intervention. Even though recent studies have indicated that emotional awareness of oneself and of others in a therapeutic setting help to improve the efficacy of therapist to patient relationship and intervention outcome (Gant, 2007), it has been found that students generally have the notion that it is not professional to express or share their personal emotional reactions to client cases, even to their own supervisors in the practicing field (Rajan-Rankin, 2013). This is also shown in social workers’ perception of empathy and empathetic awareness; it is viewed of as a positive trait, however, can be used to skew the accuracy of trained judgement and consequently lead to empathetic distress (Grant, 2013). Contemporary researchers debating the remits of using emotions in counselling and therapeutic settings with a more functional purpose, have concurred with Salovey’s (2001) self-management idea of coping with emotional stress in order to meet the demands of the dispositions of a patient/client. Laming (2009) argued that social workers need to develop emotional resilience in order to persevere through the challenges faced between the patient. It has also been suggested that in order for the social worker’s or therapist’s internal emotional management to yield a more effective intervention for the client, it is important to also exercise accurate empathetic awareness (Morrison, 2007). After all, inadequacies and irreversible situations transpire when performance difficulties occur in the context of social workers and therapists who lack self-awareness and consideration of patient subjective feelings (Morrison, 2007). The Social Work Task Force also agreed that the need for developing and exercising empathetic awareness, emotional resilience, and intuitive skills, are integral for the success of social workers to deliver effective interventions for their patients (SWTF, 2009). It has been suggested through research that a therapist’s and social workers’ emotional resilience of their personal feelings and stress management plays a significant role in determining the efficacy of the therapeutic relationship with the patient. Grant and Kinman (2013) conducted a qualitative study investigating which inter- and intra-personal values predict emotional resilience in student social workers; testing variables such as EI, multi-dimensional measures of empathy and reflection, social competence, and coping mechanisms. Their study found that emotional resilience is a complex multi-faceted construct that encapsulates many values, and should be viewed as a generalised conceptual term within the therapy/intervention context. Grant and Kinman also found that student social workers need to develop competencies that coincide with Salovey and Grewel’s (2005) MSCEIT measurement of EI, particularly when self-regulation and awareness of emotional states underpins resilience in order to improve their wellbeing and practice. It was also found in the study that students in social work education learning therapeutic interventions and how to deal with patients, need to be supported to develop emotional literacy, and they also need to undergo training to foster reflective ability and to better understand the multifaceted characteristic of empathy. Grant and Kinman (2013) made several inferences from the qualitative data they analysed from their study, and one of the prominent findings was that self-reflection and increase focus on empathetic awareness, is correlated with higher scores on emotional resilience and more effective professional competence in the social intervention practice. This provides credence to the notion that stronger resilience in the face of patient conflict and reception of emotional turmoil, paired with heightened accurate empathetic awareness, both provide vital performance metrics for therapeutic relationships with successful outcomes (Wilks and Spivey, 2010). Grant, Kinman, and Baker (2013) conducted another study to explore the remits for using EI as an application for improving social work education curriculums, particularly to address the reviewed research findings pointing to enhanced therapist resilience and patient intervention success outcomes. Quantitative survey data was collected online from thirty five university student respondents, followed by a follow-up qualitative telephone interview which was used for thematic content analysis. It was found that 92% of respondents perceived emotional resilience and EI to be of high necessity for social workers managing projects for patients complying with therapeutic interventions, and 95% of respondents believe that hiring social workers should include emotional resilience as a key competence criteria for practicing in the field. Respondents were asked whether they view reflective writing as an important part of the curriculum for enhancing their empathetic awareness and intuition from acquired knowledge, which turned to be a majority supported verdict. However, coping strategies and mentoring have the least contribution to the design and execution of education curriculums, which supports the rationale of Grant, Kinman, and Baker’s (2013) study to encourage a revision that scaffolds the development of EI competencies through mentoring applications that help prepare newly qualified students on how to cope with emotional stresses during patient interaction in the field. Another qualitative finding is that students who were studying social work education and psychodynamic counselling practice perceived emotional resilience as a collection of coping mechanisms during a given challenge with a patient interaction, which also was frequently referenced to the idea of what EI subjectively means. Emotional awareness, control, realism, support networks and social capital, are all indicators of what constitutes for an effective link between EI and effective social work patient intervention through developed resilience Grant, Kinman, and Baker’s (2013).
As suggested from prior studies, an emotional component in psychodynamic therapy and social work education is important for fostering resilience and empathetic awareness. The methods used by schools to help students enhance their professional identity and transferable EI competencies in the patient interaction context, may be a strategy to counter the disparity between theoretical limitations and real work scenarios. Taking into account the cognitive assimilation of social work concepts operates on a unidimensional plane of hypothetical cases, it creates an unexplored gap in practical competence when the newly qualified social worker is presented with a problematic situation that has mild similarities with the ways in which intervention models have been studied. This has been a long standing issue challenging the reliability and validity of the generalisation of theoretical applications, which is understandable considering how complex human social behaviour is, particularly with abstract traits such as emotional states and culture influencing the variance in behaviour across therapeutic practice fields, namely, substance abuse, mental health, and child welfare. With such changeable dynamics in human behaviour expressed in these various domains, it raises a question of how significant the role of EI is when solving social and psychological issues, particularly in growing poly-ethnic societies where social aid needs more tailoring to different belief systems for what constitutes favourable interventions. To answer this question, recent research has explored the benefits of self-assessment and personal development methods used in social work education programs, examining how the enhancement of self-management and empathetic awareness has implications to the therapeutic relationship. This also coincides with studies analysing the link between increased intuition and empathetic awareness, and how this strengthens a newly qualified worker’s ability to apply theory in solving untrained situations during stressful patient interaction scenarios (Curtis, Moriarty, and Netten, 2009).
The conception of the ‘reflective practitioner’ was coined by Schon (1983), a practitioner who adopts the use of self-reflection as a way of reviewing prior experiences and acquired knowledge in order to learn from it, and for its relationship to socially complex problems in professional practice that require emotional resilience. Self-reflection is therefore a means to enhancing EI and professional intuition by knowing when certain components of acquired knowledge serve as useful solutions to circumstances that carry a need for empathetic awareness amidst suspense, which would otherwise cloud the quality of judgement in the mind of a newly qualified therapist or social worker (Mann, Gordon, and MacLeod, 2009).
The emergence and use of self-reflection for tracking personal development and empathetic awareness in social work is an increasingly used application in the contemporary curriculum environment and therapist practices (Anghel, Hicks, and Amas, 2010). The need for this is to respond to individual differences in EI and the appraisal of theory by promoting self-reflection of knowledge and feelings with social awareness, particularly the extent to which students are intellectually prepared to transfer their knowledge in real world scenarios. The application of self-reflection for personal development has, in part, been drawn from organisational contexts in industry. Early organisational leadership was defined by an outcome-based standard which adopted performance benchmarking and forecasting to implement strategic solutions (Aitken and Higgs, 2010). This was also reflected in certain facets of educational leadership which were being studied during the late 1980s to recognise the need to address skewed academic scores of students within the same classes and curriculums (Grift and Houtveen, 1999). Talent acquisition requirements for recruiting social workers are also placing more emphasis on their ability to pass competency based interview questions that need more than just theoretical knowledge, but more of a transferable social and empathetic awareness. The justification for using self-reflection and assessment may therefore be its purpose for addressing students’ unique mile stones in progress, that are reflective of an individual rather than the entire group’s EI competence in transferring knowledge into the real world of social and psychological problems. The direct positive outcomes of using self-reflection, particularly in terms of increasing intuition and professional EI competence, are growing. Prior research, as mentioned earlier, has found self-reflection to increase empathetic awareness and intuition in newly qualified therapists and social workers’ ability to apply theory in solving untrained situations. Evidence supporting the benefits of self-assessment and reflection for enhancing empathetic awareness and intuition needs to be clarified.
Personal reflection is addressed frequently in literature discussing psychodynamic therapy outcomes, and it is now concurred among researchers that enhancing self-awareness mutually raises a therapist’s empathetic awareness among clinical settings as well as social work fields (Boud et al. 1985; Epstein and Hundert 2002; Moon 1999). Although students qualifying for social work do not have as much demand counselling psychologists do in providing empirical grounds of reflective practice for licensure, it is becoming an increasing remit for maturing the awareness of patients’ emotional states in order for therapeutic relationships to be more responsive and successful (Negi, Bender, Furman, Fowler, Prickett, 2010), and also part of the academic development (Catto 2005). However, in order to ensure the efficacy of experiential knowledge that has emotional content, it is important to keep engaging with situations that coincide with what has been previously learned through adversity to avoid egocentrism and allowing for a more receptive awareness of a patient’s feelings, especially when certain dispositions are difficult to articulate or express. Self-reflection provides an explicit way of integrating emotional awareness and theoretical knowledge into real world therapeutic relationship situations (Epstein, 1999). The early onset of this metacognitive process takes place during psychodynamic therapy and social intervention education, which may perhaps underpin the student’s advancement into professional and EI competencies through the degree of self-awareness, thus engaging with out-of classroom situations in a more intuitive manner through self-regulation (Bandura, 1986).
The reason why self- reflective methods are becoming a prominent part of training students to become qualified therapists and social workers is because schools acknowledge the need for students to be more mindful of empathetic awareness and stress coping mechanisms, in addition to learning theories (Boud, 1999). This is to reverse the traditional pattern in therapist recruitment; where students tended to learn theory before they exposed themselves to emotionally demanding situations with direct patient contact. Laming (2009) argued that social work education should help students in growing their emotional perseverance, as well as the ability to reflect on what they have learned and experienced to ensure professional competence under real stressful work situations, this is in agreement with Epstein’s (1999) argument. In order to endure stress and emotional challenges during social work practice, students need to be more self-aware and develop coping mechanisms for professional etiquette (Howe, 2008; Laming, 2009). This would allow new restructured curriculums to support students in attaining a better grasp of tolerance and working with uncertainty (Stevens & Cox, 2008), as well as adequate coping mechanisms (Collins, 2008; Ferguson, 2005). A qualitative study on self-reflection in social work practice, conducted by Ruch (2000), found that it enhances empathetic awareness and increases insight into how a student’s personal background and affects academic development and future employment. The emotional values evident between the social worker and client is an interpersonal dynamic which requires regulation, which may be aided by the increased empathetic awareness and intuition through self-assessment and reflection exercises. The utilisation of self-reflection also refines the concept of ‘self’ during a professional case, which grants the newly qualified social worker the EI competencies to moderate personal anxieties (Anghel, Deborah, and Hicks, 2010).
Prior research findings have suggested that emotional intelligence skills can be taught may provide a positive impact by infusing interventions in various areas of human functioning (Bar-On 2006). Perhaps one route to better understand EI and its links to therapeutic relationship, so as to examine its potency in therapy, is to study the views of experienced therapists to determine the alliance development, maintenance, and negotiation. In this way, for example, therapist can share their experiences of how they first establish an effective alliance; the flow that the alliance tends to take during the process of therapy with both engaging and less responsive clients; and how they manage or fail to manage the alliance and to balance these complex issues with different types of clients.

Emotional intelligence, as a construct and identifier of personal and social maturity, often helps therapists discern whether a certain individual may be suitable for psychotherapy. For this reason, Ciarrochi, Forgas and Mayer (2001) noted the importance of the EI assessment as a tool that enables the therapist to identify the patient‘s ability to understand and express emotions. An important part of research remains as to the benefits and implications of EI concept on therapist mental and emotional health, skills in therapeutic relationship and professional development. Moreover, whether the quality of a positive alliance with both inter- and intrapersonal skills can be taught via the concept of EI.
4.1.1. The Role of Emotional Intelligence within Therapy
As aforementioned, emotional intelligence appears to play a key role in the therapeutic process. Matthews, Zeidner, and Roberts (2004) reported:
“Psychologists have proposed that understanding the emotions of oneself and others is the key to a satisfying life. Those people who are self-aware and sensitive to others manage their affairs with wisdom and grace, even in adverse circumstances. On other hand, those who are ‘emotionally illiterate’ blunder their way through lives marked by misunderstandings, frustrations, and failed relationships. A scientific understanding of this EI can allow us to train our emotional skills so that we can live more fulfilling and productive lives”. (p. 3).

Levels and ability of emotional intelligence, then, differs for each individual. The personal importance given to emotion management in today‘s society has grown over the past few decades. Thus, Matthews, Zeidner, and Roberts (2004) suggested that it has become clinically important to nurture people‘s personal emotional intelligence so that they may have a greater awareness and control of their own emotions and of others, leading them to have happier, more fulfilled lives.
The knowledge and importance attached to emotional intelligence over recent years has led to various new types or methods of therapy, for instance Maree and Fernande’s (2003) solution-focused therapy, and Greenberg’s (2004) emotion-focused therapy. Clinical psychology offers a multitude of therapeutic techniques for improving the management of emotions, including cognitive-behavioural therapies, occupational psychology, and even educational and school psychology. Not only does this indicate the importance of emotional intelligence, but also suggests that many therapists, counsellors, and psychotherapy practitioners may have been improving their client‘s EI without realizing – especially given the rate of “emotional dysregulation” that clients of therapy harbour (Matthews, Zeidner & Roberts, 2004).
However, Matthews, Zeidner and Roberts (2004, p. 74) are compelled to point out that, despite its importance and its place among academic literature and theory, there is actually a paucity of studies that measure the practical utility of EI in various applied settings, such as clinical psychotherapy. EI is viewed as a prerequisite to therapy, and according to Salovey (2001), those with a high emotional intelligence should be more likely to be amenable to treatment, and more successful in attaining their therapeutic goals, as well as experience greater coping. Yet the therapist‘s perception of EI, its components, and its place within the therapeutic relationship, has not yet been fully explored, and thus provides an issue that is central to the concerns of this study.
Empathy, as a construct of EI, has been argued among researchers as the fundamental component of virtually all successful therapeutic relationships, also noticeably in the primary care practice field (Mercer and Reynolds, 2002). The credibility of empathy playing a key role in therapeutic relationships as an expression of EI, comes mostly from Patient satisfaction feedback data indicating the common perception of quality of care is attributed to therapists’ display of empathetic awareness (Mercer and Reynolds, 2002). Research has found a significant positive correlation between empathy and improved diagnostic accuracy. Empathy has been argued to be imperative to the growth of a successful therapeutic relationship. This is evident across several studies proving a positive correlation between empathy and the therapeutic relationship in the psychiatric field; findings demonstrating enhanced patient outcomes in terms of psychological and pharmacological interventions (Krupnick, Sotsky, and Elkin, 1996). Contrary to the theoretical models and training students undergo to become qualified psychotherapists, it has been emerging from recent studies that the reciprocation and transferability of an empathetic relationship is more vital to the clinical outcome than the therapy itself (Orlinski, Grawe, and Parks, 1994). This is particularly evident several examined cases of cognitive behavioural therapy, where the therapist’s empathetic awareness and other EI competencies such as self-regulation of feelings, play a pivotal role in aiding trust and comfort in order for a patient’s adequate recovery from issues, such as depression (Burns, Auerbach, 1996).
Taking into account the correlations between a therapist’s empathy and the intervention success of the therapeutic relationship has been quite prevalent in recent literature, it is important to explore this link further.

4.1.1.1. Empathy
As Mercer and Reynolds (2002) argued, one of the most important elements of emotional intelligence that therapists must use is that of empathy. Empathy is a complex multi-dimensional concept that has moral, cognitive, emotive and behavioural components; as Mercer and Reynolds (2002) stated: Clinical empathy involves an ability to:
(a) Understand the patient’s situation, perspective, and feelings (and their attached meanings)

(b) Communicate that understanding and check its accuracy; and

(c) Act on that understanding with the patient in a helpful (therapeutic) way.
Thus, the concept of EI becomes not only relevant, but integral, to the therapeutic relationship, as it contains within it all the components necessary to identify not only the feelings in others, but also in oneself, which is essential for the therapist and the client if they are to have successful emotional and personal lives. Furthermore, emotional intelligence enables the therapist to aid the management of those aspects of the client that carry the potential for pre-reflective complicity with destructive tendencies (on the part of the client) within the therapeutic setting. This self-awareness enables the therapists to identify and apprehend those emotions or feelings that the client experiences, which may be transferred to the client, enabling them to deal with these emotions, and transfer them back to the client in a therapeutically appropriate manner (Salovey 2001).

4.1.1.2. The role of implicit memory
Earlier in the discussion it was noted that various researchers have traced the development of EI to a child‘s early years, given that neural pathways are altered by everyday events in order to help create ways of responding to everyday events (Damasio, 1999). Stein et al., (1993) expanded on this topic by noting that these patterns and ways of responding are primarily emotional, serving to (unconsciously) regulate behaviour and forming one‘s ‘primary‘ or ‘core‘ self that starts in early infancy. The importance of the implicit memory system in human functioning is of paramount importance. Tulving (1983) distinguished two memory systems in humans: explicit memory and implicit memory. Explicit memory recalls events and “…is concerned with unique, concrete personal experiences dated in the rememberer’s past” (Tulving, 1983, p. 1). Implicit memory, on the other hand, is self-relevant, context specific, and concrete. Explicit and implicit memory, therefore, may differentiate between the two types of cognitive systems – rational and experiential. Epstein (1991) noted that the rational system is analytical, involving conscious appraisal processes that function via conscious control. The researcher also stated that the experiential system, however, is much more concrete and emotional, as well as being experienced passively, and is based on feelings from past experiences, as opposed to present judgements and appraisals.
Siegel (2001) found that the brains of infants are attuned to social information and that interpersonal relationships begin to develop due to repeated social interactions and experiences. The multiple, repeated social experiences are believed by researchers Beebe (1998), Lyons-Ruth (1999), and Siegel (2001) to become part of the natural makeup embodied in neuromotor pathways, which lead to relational knowing, implicit memories of how to behave with others. For example, Siegel (2001) claimed, “although we may never recall ‘explicitly’ what happened to us as infants, the experiences we had with our caregivers have a powerful and lasting impact on our implicit processes” (p. 74). Alan Schore (2000) dovetail with others authors such as Bowlby (1988), Damasio (1999), and Siegel (2001), to describe how these experiences involve our emotions, our behaviours, our perceptions, and our mental models of the work of others and of ourselves. Implicit memories encode our earliest forms of learning about the world. Implicit memories directly shape our here-and-now experiences without clues to their origins from past events (Siegel 2001).
Interestingly Schore (2000) advocated in his theory that an essential component of the regulatory implicit memory is the child‘s experiences and history of the contact and emotion that they have had with significant others. Communication with others is important in helping the scheme of a regulatory implicit relational memory to be developed. This is acquired by experiencing many of the common facets involved in relationships and forming an attachment, such as separation, reunion, and mutual availability issues. Of key relevance here, Panksepp (2001) concluded that the development of an infant‘s brain depends on their social experiences, as they learn to view their social environment as fundamentally threatening of fundamentally friendly. In this way, the regulatory implicit memory processes mature, and the brain creates an unconscious, intuitive sense of one‘s ability to regulate emotional flow in relationship to others or alone. If an infant has a sense of security, they are more likely to be able to regulate their experiences of a range of positive and negative emotions, as their social relational experience of these emotions has been, in the past, effectively resolved.
Daniel Stern (1985) similarly recognizes the profound impact of empathic attunement in early learning, emotional development and socialisation. Stern describes the process by which the mother’s empathic responsiveness ensures that her underlying affective response is encoded in the baby’s brain. According to Stern (1985) this empathic attunent evokes, stimulates, validates and maybe names the infant’s emotional and physical state. Stern work outline the development of ‘intersubjective relatedness’, that ability to experience one’s self as a separate being from others, but as a dependent being too. Regulatory implicit memories, rather than simply being accurate records of single events, are the result of a group of early experiences according to Stern (1985) and Epstein (1991). Generalisations such as these result in an unconscious predisposition to behave in certain ways, or feel certain emotions, dependent on the situation. The role of the subconscious is revealed in the works of Siegel (2001), when he stated that one’s emotional intelligence is formed by monitoring and regulating the links between the self and others, and then altering the possibility for an emotional response prior to the emotion actually being experienced. This is a subconscious occurrence, and is generally unable to be explicitly accessed. Psychotherapy, as a process, among other goals, attempts to free and unpack these unconscious or implicit memories of emotionally heavy experiences.

4.1.1.3. Transference.
Implicit memory forms the basis of the unconscious patterns of attitude, behaviour, and expectations that clients often re-enact in therapeutic sessions. A whole set of models of the world are constructed in implicit memory and these models program the patterns that an individual relates to any new experience. Implicit memory helps us to see how multiple real-life events become aggregated and that the fears or hopes a person has at the time can also become incorporated into memory events (Knox, 2001). The end result of this process of internalization of multiple experiences was captured by Bowlby (1988, p. 129) as an “internal working model” or as internal maps organizing our perception of the world. An insecurely attached child will have internal working models of other people as unreliable, dangerous, rejecting, or unpredictable and will bring this generalized expectation into transference. Internal working models are the most obvious clinical examples of implicit memory and have profound implications for our understanding of the therapeutic relationship and its process. Thus, it is easy to accept Knox’s (2001) theory that implicit memory is the basis for the transference.
Transference describes the process within the therapeutic relationship wherein the client projects onto the therapist the feelings or ideas that are deriving from introjected figures, objects, and implicit memories in the client‘s past. When the transference is analysed, with the help of the therapist, the unconscious patterns or suppressions may become conscious. If the therapist themselves projects back their own previous “wounds” or suppressions, this is known as countertransference (Martin et al., 2000). Jung (1958) posited that the processes of transference and countertransference is “…the crux, or at any rate the crucial experience, in any thoroughgoing analysis” (p. vii). Psychotherapy then, as described by Knox (2001), through the process of the quality of the therapeutic relationship, brings about a positive change by the recovery of autobiographical memories.
Sedgwick (1994) so vividly ‘coloured’ in his book the wounded healer how the central unconscious connection between the therapist and the client (labelled as ‘transference‘) enables a mutual attraction, understanding, respect, and the possibility for healing. Given that emotional intelligence describes an individual‘s ability to appraise the emotions of the self and of others, and to regulate emotions in oneself, and to use emotions to solve problems (Salovey & Mayer, 1997), it is easy to see how the therapist within the therapeutic relationship is placed in a situation that requires these skills. The therapist recognizes unhelpful or negative emotions in the client, and understands if and how they may be transferred to the therapist themselves. The therapist must then react accordingly in order to help the client to become more self-aware about the feelings they are emitting, and to explore their cause.

4.1.1.4. Implicit procedural knowledge.
Stern et al., (1998) suggested that one of the most important tools for use within the therapeutic setting is implicit procedural knowledge. This researcher asserted that much of the change that occurs with the client in the therapeutic relationship is due to the implicit knowledge that occurs and changes between the therapist and the client. The patient‘s awareness of implicit memories, Stern argues is intersubjectively shared within the therapy process, providing a potent mechanism for therapeutic change. An emotionally intelligent therapist can help these memories become re-experienced and understood.
As has already been noted by Siegel (2001), implicit memories cannot easily be accessed, but they have helped to shape the foundations of adult mental and emotional functioning. Psychological difficulties are therefore, implicit memories which can manifest as symptoms under stressful circumstances or situations. It is difficult to make them explicit as they lack an interpersonal context that could help the client to integrate the memory as a conscious part of oneself. However, as Stern et al., (1998) asserted, the therapeutic context enables these implicit memories to be re-enacted, as the therapeutic context is reconstituted to the context wherein the memory was acquired, and this enables the memories to be dealt with and explored, and then integrated into the autobiographical self.

4.1.1.5. Change
Continuing with Stern’s et al., (1998) train of thought, an appropriate environment and an emotionally intelligent therapist can provide the best aid for clients that are experiencing negative emotional and/or psychological symptoms, and desire change. Throughout the therapeutic process, there are various moments of change, including an improvisational (Beebe & Stern, 1977; Gianino & Tronick, 1988; Stern, 1985; Stern et al., 1980), self-finding, and self-correcting process (Tronick, 2007), which work towards a specified goal. Daniel Stern refers to talks about the significance of “now moments” (2004). These are flashes of interactions between the therapist and the client, that are rich in potential for change and growth in the client, but also in the therapist and the relationship as well. Stern (2004) describes the process of therapy as moving along in a somewhat spontaneous and sometimes random manner until these moments occur. When this happens, Stern et al, (1998) referred to this as a “moment of meeting,” which facilitates change in the client. This is also akin to transference, as described above. The “open space” which Stern et al., (1998) insisted proceeds immediately after a moment of meeting describes the brief pause for reflection from both the therapist and the client. The dynamic of the therapeutic relationship has changed, as has the status quo within the client and thus, a moment is required wherein the client (and the therapist) need time to reflect and adjust to this change.

4.1.1.6. The Lived-Body Paradigm
The views of Merleau-Ponty (1962) are important for the phenomenology of emotions, mainly for advancing the theory from intentionality to motility, and creating a unique bodily perspective. Husserl’s notion of intentionality ignores the significance of the embodied experience of emotions and focuses on the object of emotion and its relevance to the subject, and is only secondary to the “act” of intending (Solomon, 2003). The perspective of embodiment relevant to the therapeutic relationship is taken from the phenomenological movement and particularly from the phenomenology of perception and the work of Merleau-Ponty (1962). Merleau-Ponty (1962) asserts that the way therapists experience their bodies in relation to their clients can have an important role in interpreting and making sense in the therapeutic relationship.

Merleau-Ponty’s (1962) work provides a new perspective for viewing the process of therapeutic relationship this process as an intrinsically embodied experience. Shaw (2004) suggests that the therapist’s body is a way of monitoring the psychotherapeutic process. Field (1989) examined a number of somatic phenomena in his therapeutic practice, which he termed embodied countertransference. Samuel (1993) used the same term, embodied countertransference, and noted that the body is an organ of information, which echoes Merleau-Ponty’s view in that an understanding of our life world begins as an embodied experience. Rowan (1998) took Samuel’s notion of the term embodied countertransference and introduced the idea of linking as a term to describe a special type of empathy and an embodied nature of the connection between therapist and client. Thus, the idea of linking offers the opportunity to view the therapeutic relationship as an embodied encounter.
The lived-body paradigm emphasizes the notion that it is our perception of the world that is crucial in acquiring knowledge, and that our understanding emanates from our bodily sensations. The notion is that the body is the means by which we engage with the world. As Merleau-Ponty (1962) stated, “The world is not an object such that I have in my possession the law of its making, it is a natural setting of, and field for, all my thoughts and my explicit perceptions” (Merleau-Ponty 1962 p.x1). The importance of his work is summed up in the following quotation from Merleau-Ponty (1962, p.186): “It is through my body that I understand other people.” Merleau-Ponty noted that an understanding of our life world starts as an embodied experience. Thus, he maintains that emotions are essentially bodily, but without ignoring the phenomenology of emotion and by encompassing a phenomenology of the body and bodily movement.
4.2. The Characteristics of the Therapist
A number of reliable studies have concluded that certain commonalities and qualities of therapists are important in the therapeutic relationship. Norcross (2002), listed 11 elements and eight processes within the framework of therapeutic relationships; the alliance, cohesion, empathy, goal consensus and collaboration, positive regard, congruence, feedback, repair of alliance ruptures, self-disclosure, countertransference (management of) and relational interpretation. Although there is evidence that many of these measures overlap (Bachelor & Horvath, 1999), there are also important differences among them (Horvath & Bedi, 2002). This ecumenical status of the alliance makes it much more complicated to distill clinically useful guidance and training for the therapist (Horvath, 2004).
Luborsky et al., (1986) cited findings from the data of four major outcome studies and showed how the personal competencies of the therapist contribute more significantly to therapeutic outcomes than the treatment modality. From his findings, Strupp (1980) argued that a major factor distinguishing poor outcome cases from effective ones was the therapist‘s difficulty in establishing a good therapeutic relationship with the client. Strupp (1980) inferred that such difficulties for the therapist might emanate from a negative interaction cycle in which the therapist responds to the client‘s hostility with counter hostility. Grencavage and Norcross (1990) carried out a review of 50 articles and books for an investigation on common reasons that lead to therapeutic change. The authors cited the attributes of the therapist as one of four causal factors leading to therapeutic change.
Ackerman and Hilsenroth (2003) found that the therapist‘s personal attributes, such as benevolence, dependability, responsiveness, and experience assists patients with holistically trusting their therapist to both empathize with and help them manage the issues that are behind needing therapy. The researchers noted that a kind relationship between the patient and therapist assists in creating a cordial, accommodating, and supportive therapeutic environment that could add to therapeutic change. Saunders (1999) reported that clients rated sessions highly when they had a feeling of being understood by their therapist, when their therapist expressed her/himself effectively, and when their therapist was truthfully dedicated to the therapy. Saunders concluded that a therapeutic relationship encompasses both commitment of personal energy and attendant variables. Orlinsky and Howard (1986) had first introduced this theme by describing three dimensions in the therapeutic relationship: commitment, empathy and acceptance.

4.3. Therapeutic Relationship and Emotional Experience
The question of what factors determine our emotional experience is vital in understanding the role of the therapeutic relationship. The concept of cognitive factors (especially appraisals) as of fundamental importance in determining emotional experience, is emphasized in appraisal theory. Thus, whether emotion is generated in response to perceived, remembered, imagined events, and by automatic or controlled processing. In his theoretical advances on what constitutes an emotional experience, Parkinson (1994) revealed how emotional experience depends on four separate factors, e.g., appraisal of some external situation, reaction of the body, facial expression, and action tendencies. More specifically, cognitive appraisal of the situation affects bodily reactions, facial expression, and action tendencies, but equally having a direct effect on emotional experience.

Winnicott’s (1963) concept of holding is the notion that at the beginning of life, the infant is in a state of absolute dependency on mother or the caregiver. The word ‘holding’ for Winnicott, is “relocating the arena of psychic life from the internal world of the individual into the environment” (Winnicott, 1960: 43). The holding process is provide an as near-perfect adaptation to the infant’s needs as is possible in order to foster a continuity of being in its world that aids in the process of integration. This represents a “psychosomatic existence that is lived out and bestowed with meaning in inter-human relationships, be it from the viewpoint of the self or that of the individual’s relationship to the environment” (Fulgencio, 2007, p. 450). For example, Bowlby‘s (1969) notion of attachment, as well as Stern’s (1985), description that attachment develops out of the interplay in the optimal infant-mother relationship in the first year of life.
Daniel Stern (1985) work outlined the importance of parents’ representations and the relational constellations of attachment, and offers a closer examination of conscious and unconscious factors in their interaction with infants, and the way in which early experiences of attachment form templates or blueprints for ways-of-being-in-relationship-with. Leiper and Casares (2000) took this concept further by describing these memories of past attachment experience (secure and insecure), as instrumental in fostering behaviour in interpersonal encounters through life.
The essence of appraisal theory by Lazarus (1982), which led to the development of several appraisal theories (Barrett in press), inspired the bold notion that “appraisals start the emotion process, initiating the physiological, expressive, behavioural and other changes that comprise the resultant emotional state’’ (Roseman & Smith, 2001, p.7). Another important theoretical approach in appraisal theory is Smith and Kirby (2001) emphasising the processes involved and underlying mechanisms in producing appraisals. According to their theory, various appraisals processes occur in parallel and first there is associative processing that entails activation of memories. This process takes place instantly and automatically and lacks flexibility. Second, there is a process of thinking and reasoning which is slower and more flexible, and thirdly there is a continuous appraisal and monitoring of information coming from the associative and thinking processing. Thus emotional states and experiences is determined by a total process of information registered by the appraisal detector (Smith and Kirby 2001). Beck and Clark (1988) assumed that appraisal processes and in particular cognitive biases (e.g., attentional, interpretive, explicit memory, and implicit memory) enhances the vulnerability in developing depressive or anxiety disorders. Let us now consider another theoretical approach as to what constitutes an emotional experience within the therapeutic relationship. Alexander and French (1946) first proposed the classical understanding of the “corrective emotional experience” and asserted the importance of the emotional experience as therapeutic action. In an almost ‘throwaway’ line on in this paper, Alexander has this to say:
“If the therapist knows what kind of problem is emerging into consciousness he will find it simple to elicit such reactions deliberately. He may, for example praise a patient for therapeutic progress in order to bring out a latent guilt feeling about receiving the father’s approval. Or he may express approval of a friend of the patients in order to bring out latent jealousy. (p. 83)

Corrective in this aspect relates to providing patients with a positive experience that is in contrast to what patients have come to expect. In other words, therapists provide their clients with deliberate provocations, selected on the basis of this “principle of contrast”, and consciously choose to respond in ways that contrast with the previous patterns by which clients have been emotionally treated in the past. Alexander and French argued that insight, interpretation in therapy was not enough, and that therapists should provide clients with an experience rather than an explanation. Problems in therapy, according to researcher Knight (2005), are understood as a result of the therapist and client using the professional relationship for re-enacting, rather than resolving, the same conflict that the client has been struggling with in other personal relationships despite the fact that neither is aware of the re-enactment.

4.3.1. Meta-cognition and reflective functioning
Research conducted by Main (1991) has suggested that an important aspect of children’s development is the ability to develop meta-cognitions. The author defines meta-cognitions ‘the thoughts about thoughts’ (p. 68) and a way of how the child interacts with his parents and resolves contradictions and incongruity. Bowlby (1998) proposed that a particularly damaging process for children was a communicational context in which the different parenting styles shaped attachment and the child’s affective communicational styles. The type of attachment that a child forms has long-term repercussions for many aspects of the child’s development and adult life (Bowlby, 1969). In relation to chaotic or inconsistent care-taking, or if the child experiences the parent as inconsistent, Main (1991) suggests that older children are less vulnerable to difficult attachment experiences because they are able to form meta-cognitions. For instance, with a parent saying, ‘You are a bad child’, an older child can use reason to digest it, saying, ‘I may be a bad person because Mum seems to think so, but she might be wrong, as many times I saw that’. Conversely, a younger child finds it harder to resist the parent’s perception.
Fonagy, Leigh, and Steele (1996) supported the concept in which a child’s internal working model encompasses an ability to engage in meta-cognition. In addition, Fonagy et al., (1996) noted that the ability to think about others’ internal thoughts and feelings is the fundamental ingredient of attachment processes; therefore, there is a close link between reflective functioning and attachment patterns. Main (1991) also noted that the mother’s ability to reflect on the child’s internal state is vital. Consistent with this notion is Bion’s (1962) influential concept of ‘containment’—the idea that, in understanding the child, the mother is understanding both what has caused the child anxiety and also what the anxiety feels like. Furthermore, the mother is seen as communicating that she does not feel overwhelmed by it herself.
Bion (1962) has suggested a link between container and contained that was beneficial and growth promoting to both the mother and the infant. In particular, Bion (1970) emphasized the types of links further as “symbiotic” and “parasitic” and says, “By ‘symbiotic’ I understand a relationship in which one depends on another to mutual advantage. By ‘parasitic’ I mean to represent a relationship in which one depends on another to produce a third, which is destructive to all three” (Bion, 1970 p. 95). The integrated nature of coping and understanding of what the child is feeling connects with the work on theory of mind (Baron-Cohen, Tager-Flusberg, & Cohen 1993), which argues that mindblindness is the inability to understand others as having thoughts, intentions, and perceptions, and to recognize that these can be different than our own. Children with autism have much more difficulty in making this judgment (Baron-Cohen and Goodhart, 1994).
In summary, reflective functioning and meta-cognition abilities are vital our ability to change. The conceptual approach in reflective functioning of Fonagy et al., (1991) has important implications how we understand mental activities. These activities includes being able to reflect on our own thought, see contradictions in our perspectives, contemplate alternative views, identify the origins of our memories and beliefs, hold the view that there are multiple ways to interpret events, be mindful when we may have become stuck, and recognise how others can impact the way we perceive things.

4.4. The Transpersonal relationship
In a pivotal book, The Transpersonal Relationship in Psychotherapy, Clarkson (2002) instigated a new perspective in the field of therapeutic relationship. This perspective accords with the idea that spiritual meaning to one’s existence comes through self-actualization (Maslow 1993), ‘transcendent actualization’ (Hamel, Leclerc, and Lefrancois 2003), ‘ecological actualization’ (Reason 2002). Transcendence is a spiritual human reality that has been primarily studied through states of consciousness, that is, the perceptive content of reality (Grof, 2000), and through motivational aspects, that is, the experiential process (Assagioli, 1991b; Maslow, 1993).
The importance of transpersonal experiences is that they can initiate deep questioning and engagement in life (Redfield, Murphy, and Timbers 2002), which can also contribute to a fuller expression of human potential. Transpersonal experiences not only evoke existential questions, they can confront a person with an expanded view of self, other, and world (Vaughan 2002). It is through a process of transpersonal development that human beings can gain a different conception of the self—beyond ego/identity (Rothberg 2003)—which is connected to an ecological “field-like sense of self” (Fox 1990, p. 69). However, the profound nature of transpersonal experiences—beyond the personal boundaries of ego/identity— reveals that there are “many possible meanings, living within us in potentia, moving through us, awaiting enactment” (Tarnas 2006, p. 491).
These transpersonal experiences can provide a foundation for human beings to evolve what Loretta do Rozario (1997, p. 116) has described as a transcendent ecology of living. This is a viewpoint echoed by Clarkson (2002), who observed that there is a growing acknowledgement of the influences of healing qualities in therapeutic relationship that transcends the limits of our understanding. Clarkson (2002) posed the question ‘what is the transpersonal’ and grounds it in the human search for meaning and the existential task of ‘how to live in the face of death’ (p. 3). Levin, cited in Zahi (2009), argues that the major characteristics of the transpersonal discipline comprise the search for goals and the meaning of life, the strengthening of inner personal resources, and the belief in transcendental abilities for self-growth.
Jung’s work ‘On the nature of the psyche’ (cited in Hull, 1960/2001) underpinned the appreciation of spiritual or transpersonal dimension as the most profound in human life. This implies much more than a traditional understanding of healing primarily in the sense of symptom reduction (although this may occur as a secondary benefit) in the therapy relationship. It opens the way to the acknowledgement of the fundamental meaning of the experience of otherness at all levels, which implies taking an I-Thou stance (Buber, 1958) toward the world. In other terms, it represents Buber’s (1958) I-Thou relationship, which honours the simultaneous interconnectedness and separateness of the persons involved.
Palmer (1998) identified that knowing can occur through an “intuitive intelligence” (p. 173), which is then reflected through being via the different “qualities of consciousness” that are experienced. Vaughan (2002) characterizes spiritual intelligence as “a capacity for a deep understanding of existential questions and insight into multiple levels of consciousness” (p. 19). Mayer (2000) enquired about the mental transformations necessary to think and tune in the spiritual sphere of human experiences. The difficulty with Mayer’s (2000) question is that spiritual/transpersonal experiences are not only about mental transformations, they are also profound multisensory experiences that connect body, mind, and soul (Sommer 2003). Orr (2001) argues that growth in EI contributes to spiritual development and in similar way Hartsfield (2003) found a link between EI and spirituality.
Conversely, EI may be developed though mindfulness meditation, a practice aimed at the spiritual development of consciousness (Cherniss & Goleman, 2001). Tischler, Biberman, and McKeage (2002) asserted that qualities such as self-awareness manifests in high EI and spiritually developed people. Among those qualities is the possibility that EI and spiritual intelligence (SI) share common factors (e.g., self-awareness). The authors also suggested a few models linking EI, spirituality and argued that links between EI and SI make it inappropriate to exclude either EI or SI from a review of newer forms of intelligence.

4.5. Professional development training, and supervision in therapy.
Haynes, Corey, & Moulton, (2003) defined clinical supervision as a process whereby consistent observation and evaluation of the therapy process is provided by a trained and experienced professional who recognizes and is competent in the unique body of knowledge and skill required for professional development. Brown & Miller (2002) highlights the importance of intersubjective matrix through examination in the supervisory process.
The experiences of the supervisor support the therapist to observe parallel processes in the therapy and supervisory dyads. In intersubjective analysis inspection of parallel processes in client-therapist and therapist-supervisor dyads is core to therapy supervision (Auerbach & Blatt, 2001). Client disclosures provide information about the therapist’s functioning and reveals the transference issues of the client and the countertransference reactions of the clinician (Brown and Miller 2002). Exploration of parallel processes identifies recurrent patterns of behaviour, which may reflect re-enactments of unfinished business or themes that interfere with the growth process (Brown & Miller, 2002). The work of Wheeler (1996) proposed a number of major criteria for supervision, such as written work, theoretical essays, case studies, reports of personal experience, observation of practice via live recording or role-play, and experience of trainees as they relate to supervisors and others as part of the training experience.
Bernard & Goodyear (2004) have considered clinical supervision as a primary way that therapists in training learn to become effective clinicians. Bambling, King, Rauer, Schweitzer, and Lambert (2006) stated that therapists who received one supervision session before beginning treatment showed a significant effect on both supervision conditions on the working alliance from the first session, but also a significant effect on symptoms of reduction, treatment retention, and evaluation. Similarly Lyons and Woods (1991) found a significant correlation between therapist experience and training with treatment effects, also confirmed the importance of training and experience with an extensive rational-emotive therapy meta-analysis of 70 studies. To sum up there seems to be a consensus in these studies that supports the importance of supervision in facilitating and hindering therapists’ work with clients (Lyons and Woods 1991).
4.6. Summary
This literature review succeeded in reviewing literature relevant to the therapeutic relationship and emotional intelligence (EI). After reviewing the various contributions from seminal researchers and theorists, such as Goleman (1995), Bar-On (1997), Petrides and Furnham (2001), Petrides, et al. (2007), Ciarocchi et al. (2000) and the numerous other theoretical models developed in association with this research topic, the researcher discovered that there are some considerable gaps and deficiency in the available literature concerning the emotional experience of the therapeutic relationship and its link to emotional intelligence theory. Some contributions, such as Ciarocchi et al. (2000), provided only a superficial assessment and analysis of this link and its attendant impact in the individual. This link then underscores the significance of carrying out a research aimed at analyzing and determining the existence and importance of this relationship. Finally, the review covered reviews of literature on the therapeutic relationship, emotions, and intelligence traits. These reinforced the significance of this research to the pool of knowledge concerning the therapeutic relationship on the basis of a deficiency of studies in this area.
Chapter Five
5. Methodology
This chapter introduces the research methodology used for this study and how it has guided data collection, analysis and development of theory. Different methods of data collection are discussed with a background in different approaches to grounded theory methodology (GTM).Given the aims and nature of the research it explores and discusses the reasons for choosing particular methods over others. Following, the details of the research method will be provided, and the limitations and ethical considerations regarding this project will be outlined. This research has been undertaken in order to understand the role that emotional intelligence plays in the therapeutic relationship. The chapter concludes by explicating the analysis approach for the empirical data.

5.1. An overview to grounded theory methodology
Grounded theory is a methodology that instead of using data to test theory, they used it to develop theory about issues of importance in peoples’ lives (Glaser & Strauss, 1967; Strauss & Corbin, 1998). Through developing theory by ‘grounding’ it in data, Glaser and Strauss were able to bridge the void between theoretically ‘uninformed’ empirical research and empirically ‘uninformed’ theory (Charmaz, 1983). Strauss and Corbin (1990) provided a useful definition:
“A grounded theory is one that is inductively derived from the
study of the phenomenon it represents. That is, it is discovered,
developed, and provisionally verified through systematic data
collection and analysis of data pertaining to that phenomenon.
Therefore, data collection, analysis, and theory stand in
reciprocal relationship with each other” (p. 23).

The theory develops during the research process itself and is a “product of continuous inter-play between analysis and data collection” (Goulding 2002 p. 42). It does this through a process of data collection that is often described as inductive in nature (Morse, 2001), in that the researcher has no preconceived ideas to prove or disprove. The data’s usefulness earns its way by constant comparison, initially of data with data, progressing to into the emergent theory because of its relevance “through the comparisons between their interpretations translated into codes and categories to generate concepts, categories, and their variations” (Strauss and Corbin, 1998, p. 52).
5.1.1. Anticipated methodological challenges

The consistencies of patterns evident in the data may result in subjective inferences drawn from them to formulate theories. This means, although the researcher commences data collection without biases and expectations, there is an element of pattern recognition that may be used to construct certain themes which are confounded by a degree of cognitive attribution (McLeod, 2010).

Due to the process by which theories are formulated through the grounded theory method, particularly in a qualitative setting, it is logical to suspect that the social perception of data patterns takes the judgement of information to construct causal relationships between certain themes and events. It is therefore an important acknowledgement in this study of EI and therapeutic relationships to scrutinise what data patterns are identified and how this information is used in an appraisal to develop logical equations and concepts. However, attribution theory is focused on the comfortable generalisations and explanations ordinary individuals give to relationships with other people and events (Fiske & Taylor, 1991), which does not take into account objective reasoning which one would apply through empirical research. With the multifaceted social environment that surrounds people’s lifestyles across different domains in relationships such as culture, it is understandable for why people have a tendency to attribute explanations to make sense of such a mosaic of complex data in everyday life. Heider (1958) addressed this tendency through an analogy by saying people are much like ignorant psychologists attempting to decode this world of multiple relationships with varying emotional and transactional implications. The notion held by attribution theory that provokes a degree of strict scrutiny during the grounded methodological process is the perception of cause and effect in the relationships between data patterns, which in some situations, there are none. There are two forms of attribution tendencies which will be countered by the rigorous objective process of data collection through grounded methodology. Firstly, the behaviours expressed by other individuals across different social situations are categorised by the observer into one explanation, which is usually underpinned by an intrinsic trait such as personality being the causal variable. However, the second attribution tendency is to direct the cause of the individual’s own behaviour onto extraneous variables that are outside the degree of intrinsic control, such as blaming failed relationships on bad luck. The disparity between the two forms of attribution are an important factor worth noting during data analysis between the therapy practitioner and the patient. This is because the therapists observations of the patient may be expressed in the qualitative data as focused more on intrinsic variables explaining the emotionally driven behaviours of the patient, which would otherwise be attributed to extraneous causes, according to Heider (1958).

One of the most pioneered theoretical approaches to attribution has been developed by Kelley’s (1967) covariation model. Kelley formulated a conceptual framework for logical judgement based on the information accessible to individuals, which takes into consideration of specific actions that may have either internal (personal) or external (environmental) causes. Hence, the inception of the term ‘covariation’ pertains to the many different pieces of social and interpersonal information available across different angles to any given situation at multiple times, which are ultimately used to construct a verdict. Kelley (1967) also argued that there are a further three sources of information which individuals examine for patterns in explaining behaviour; much like the manner in which a detective pursues clues in support of evidence for a developing theory. Consensus is the first type of causal information which influences attribution judgement, and is the degree in which a sample of other individuals express similar behavioural characteristics in a comparable situation. This is a form of pattern validation and consistency, much in the same way grounded methodology collects data to find consistent themes and qualitative correlations that may construct new theories. The second type of causal information is distinctiveness, which is the extent to which an individual expresses the same observable characteristics across similar circumstances and social scenarios with other people. The third causal information used to create theoretical judgement is consistency, which is the likelihood of the individual behaving precisely the same way every single time the situation occurs. It can be argued this third piece of information is rather difficult to attain given the complex and changeable nature of human behaviour, particularly when dispositions in emotion are a strong mediator of expressive actions, even when certain behaviours are natural to the individuals’ personality traits.

Identifying causality based on the correlation of consistent behaviours and their relationship with personality and dispositional traits, is therefore the logical process of creating theory from information sources. However, in some cases, as might be anticipated in qualitative studies of therapeutic relationships, insufficient data may detriment empirically based judgement and the formulation of theories from grounded methodology. It is therefore imperative to the design of this study that sufficient sample sizes and data collection variables are used, in order to address cross-situational consistencies and validations of emerging themes and behavioural patterns. The consistency of data in this study must also have, to some extent, consideration of the passage of time and how it may skew certain behavioural information in terms of the participants’ history and future experiences. In accordance with Kelley’s (1967) argument, changeable behavioural expressions are standardised in their susceptibility to past experiences, which play a significant role in mediating an individual’s coping mechanisms and key moments of social reactions. To counter the possible confounding influence of researcher attribution during the process of data collection and analysis, this qualitative study diligently applied the methodological principles of the social constructionist and objectivist stances in grounded theory, which will be outlined in more detail in the following section.

5.1.1. Two Grounded Theory Schools
The writings of Glaser (1978), Strauss and Corbin (1990, 1998) and Charmaz (e.g. 2000, 2006) are seen as influential for the development of GTM. Grounded Theory was initially developed by two researchers Barney Glaser and Anselm Strauss (1967). However, early in its development the two researchers continued to use grounded theory but developed it in different ways. This resulted in some controversy (Charmaz 2000) and we now have two fundamental schools for Grounded Theory the ‘Glaserian’ and ‘Straussian’ approaches (Onion 2006). These differences are detailed in Table 2 (borrowed from Onions 2006).

‘Glaserian’ ‘Straussian’
Beginning with the general wonderment (an empty mind) Having a general idea of where to begin
Emerging theory, with neutral questions. Forcing the theory, with structure questions
Development of a conceptual theory Conceptual description (description of situations)
Theoretical sensitivity (the ability to perceive
variables and relationships) comes from immersion in the data Theoretical sensitivity comes from methods and tools
The theory is grounded in the data The theory is interpreted by an observer
The credibility of the theory, or verification is derived from its grounding in the data The credibility of the theory comes from the rigour of the method
A basic social process should be identified Basic social processes need to be indentified
The researcher is passive, exhibiting disciplined restraint The researcher is active
Data reveals the theory Data is structured to reveal the theory
Coding is less rigorous, a constant comparison of incident to incident, with neutral questions and categories and properties evolving. Take care not to ‘over-conceptualise’, identify key points Coding is more rigorous and defined by technique. The nature of making comparisons varies with the coding technique. Labels are carefully crafted at the time. Codes are derived from ‘micro-analysis which consists of analysis data word-by-word’
Two coding phases or types, simple (fracture
the data then conceptually group it) and substantive (open or selective, to produce categories and properties) Three types of coding, open (identifying, naming, categorising and describing phenomena), axial (the process of relating codes to each other) and selective (choosing a core category and relating other categories to that)
Regarded by some as the only ‘true’ GTM Regarded by some as a form of qualitative data analysis (QDA)

Table 2: Comparisons of the two schools of Grounded Theory (adapted from Onion 2006)

More recently, the grounded theory method had been further developed by Kathy Charmaz (Charmaz, 1990, 2000). Charmaz (2007) claims that it is important to distinguish between a social constructionist and objectivist approach to grounded theory, as it provides a heuristic means by which grounded theory can be understood and enables the social constructionist view of grounded theory to be further clarified. Charmaz (2000) argues that both Glaser’s and Strauss and Corbin’s approaches to GTM assume an objective external reality and hence take a positivist and objectivist stance.
Gaining an understanding of both constructionist and objectivist ideas of grounded theory enables researchers to clarify and discern their own assumptions and knowledge prior to the research. Constructionism therefore relates to: the reflexivity of the researcher; the relativity of the researcher’s ideas, practice and research circumstances; and the way social constructions are viewed. Charmaz (2007) perceives action to be a primary focus of social construction as it cannot be separated from, and arises from, the context, and from socially embedded and created situations and structures. Constructionists therefore ask the what and the how questions, and do so through studying ‘abstract understanding of empirical phenomena and contend that this understanding must be located in the studied specific circumstances of the research process’ (Charmaz, 2007, p. 398).
On the other hand, objectivist grounded theory (as discussed and expounded by Glaser, 1998) has origins in mid-20th century positivism, and caters for the ‘why’ questions of research. Generalised explanations, predictions and recommendations are explored as answers to specific research phenomena and circumstances. Glaser (2002) strongly objects to the Constructivist tradition, claiming that the approach risks ‘descriptive capture’ (which seeks accurate descriptions of the data rather than transcending abstractions), and fails to remove ‘researcher bias’ in its privileging of the active interpretive role of the researcher.
Grounded theory is a method that, Charmaz (2007) argues, is fitting for a social constructionist research approach, as it not only asks the ‘what’ and ‘how’ of social constructions, but also asks the ‘why’ questions which characterize more positivistic research enquiries. It is an inductive methodology in which theory is grounded in the qualitative data but does not mean as a proof that the theory is correct; rather the theory is a set of integrated hypotheses. It is not the final word on the subject but a step on the pathway of development of fuller understanding. Grounded theory is therefore both a research method, and a means by which data can be analyzed. It starts by utilizing various strategies and methods by which qualitative data can be both collected and analyzed in order to produce theories, enabling the complex ‘why’ questions to be brought in and answered using this method (Charmaz, 2007).
Objectivist grounded theory and social constructionist grounded theory are not paradigms that are mutually exclusive; rather, social constructionists can gain abstract understandings and views of specific phenomena and can then (in the vein of objectivist grounded theory) move towards a more general, conceptual understanding and application. In fact, Charmaz (2007, p. 400) argues that, ‘the close attention that social constructionist grounded theorists give their research problems builds the foundations for generic statements that they qualify according to particular temporal, social and situational conditions.’ Thus, grounded theory within the social constructionist paradigm can be influenced by objectivist ideas so as to ensure that all bases are covered, and the who, what, how and why questions can all be answered, so as to provide a much rounder, deeper analysis of a phenomenon (Morse 2001; Stern & Corbin, 2008). Charmaz (2006 p. 402) however claims that grounded theory strategies are just that, ‘strategies for creating and interrogating our data, not routes to knowing an objective external reality’.
Grounded theory from the objectivist viewpoint assumes that a single reality can be discovered by a ‘passive, neutral observer…through value-free enquiry’ (Charmaz, 2007, p. 402). Thus, if one makes assumptions about objectivity and neutrality in order to make the data collection, selection and analysis processes unproblematic and straightforward, they become givens, as opposed to constructions that take place and form during the research process itself. They also therefore shape its outcomes, and a ‘naive empiricism results’ (Charmaz, 2007, p. 402). Clarke (2006) concurs with this argument, stating that objectivists claim that data is self-explicit and evident, and the possibility that the data is duplicated, limited, partial or missing is overlooked.
Glaser (2001) maintains that objectivists attempt to generalize via abstractions which distinguish and separate grounded theory from the conditions of the data collection and analysis processes. Yet, the more abstraction there is, the more the research is decontextualized (Charmaz, 2007, p. 402). Glaser (1978) maintains that objectivists desire to ascertain generalizations which give explanations and predictions, and that the whole and completed grounded theory aims for fit, work, relevance and modifiability. Glaser (2002) rightly depicted that ground theory is about a conceptualisation of latent pattern rather than explicit patterns. By contrast, Charmaz (2006, p. 403) states that, from her perspective: “Reality is multiple, processual, and constructed – but constructed under particular conditions; The research process emerges from interaction, It takes into account the researcher’s positionality as well as that of the research participants”.
Whilst both practices are used in the implementation of grounded theory method, objectivist grounded theory strategies urge researchers to actively analyze their data. Constructionist approaches to grounded theory urge reflexivity and relativity when analyzing data, to better understand the researcher’s position and impact on the data gathered, and to assess how the participants of the research construct their lives (Charmaz, 2006; 2007). The researcher disagrees with the notion that reality is objective and neutral and adopts Strauss and Corbin’s (1998) and Charmaz’s (2006) ideas and interpretation of grounded theory.

5.2. Rationale for adopting a grounded theory method
The methodology used in this thesis was most closely aligned to Grounded theory as first outlined by Glaser and Strauss (1967) and further elaborated by Strauss and Cobin (1998). This research is an interpretation of the situation of therapists’ experiences of a particular trait EI inventory (TEIQue) and its links to therapeutic relationship and training programs. A qualitative approach was deemed appropriate for this study for a number of reasons.
First the research questions explores subjective experiences and is more suited to be the most appropriate choice of methodology (Strauss and Corbin, 1998, Luca 2009). The researcher also believes that many of the familiar therapeutic encounter competencies (assessments, exploring, bottom-up processing, empathy, reflexive or intuitive interpretations and analysis thinking) are similar to grounded theory and directly transferable to the research domain (Luca 2009). Grounded theory may create a best practice for psychotherapy and counselling, dependent on the results gained, and helps to explain the phenomenon under scrutiny (Charmaz, 2006).The research aim was not being limited to predetermine hypotheses or quantifiable variables but was seeking to explore qualified therapist’s beliefs, experiences and perceptions in great depth. Thus also akin to the researcher’s therapeutic work of broadening the understanding of clients ’ worlds as well as challenging assumptions and beliefs about therapy (Cooper, 2004).The participants were therapists and this method allowed themes to emerge from the data rather than have them imposed on the participants by the researcher (Layder 1993). This appears to be an appropriate method for exploring therapists’ subjective experience, meanings and processes pertinent to therapy and EI.
Secondly, there was no clear hypothesis arising from current knowledge which could be tested and provide answers to the research questions. Therefore, this was considered to be the most appropriate methodology for this research as it is particularly appropriate for discovery- oriented research in areas which are under-theorized (Charmaz 1995).
Thirdly, the types of research questions that grounded theory methodology address are often open-ended and exploratory, aiming to generate hypotheses rather than to test them. This approach was selected because it is flexible and enables the researcher to respond to findings as they emerge. Moreover, this approach is similar with the researchers practising as a Counselling psychologist.

5.3. Research Design
The purpose of this study is to understand, analyze and interpret experiences, feelings, and emotions. The types of research questions which qualitative research methodologies address are often open-ended and exploratory, aiming to generate hypotheses rather than to test them (Burck 2005). As a result, a qualitative research design was chosen for this study. Del Barrio (1999) indicated that qualitative research usually consists of non-structural procedures from observations to interviews, from self-reports to written narratives, and focuses the study within the situation or the individual. In this design, the gathering of information and data are open-ended, and the emphasis on interpreting the results is on understanding as opposed to judging.
The type of qualitative research design most appropriate for this study was a phenomenological approach. This methodology is a research approach that encourages the researcher to suspend his/her own objectivity, on the basis that a researcher has his/her own personal experiences and inner reactions to the phenomenon that is being investigated. The researcher also acknowledges that different re-searchers with their different backgrounds, using the same data, are likely to unfold different meanings (Luca 2009). In addition the researchers is a joint product with participants (and readers), and the relationships they build, and subsequently that research is dynamic and co – created. Despite the fact that researcher bias should be kept to a minimum, this approach is based on the idea that conclusions to the research topic and questions will be gleaned not only through the data collected but by the ways in which the data has been collected, analysed, and interpreted by the researcher, and the fact what is in the field – including wider social relationships and our historical and cultural ‘being’ in the world. Thus, “reflexivity of the researcher, the attempt to approach the topic from differing perspectives, and the richness of the description produced” are facets that many phenomenological researchers claim are central to any research investigation (Madill et al., 2000, p. 74). In qualitative research, the world is understood as too chaotic to be represented in unambiguous, straightforward cause – and – effect terms. The flexibility in methodology and creativity is of paramount importance to keep ourselves open to unfolding encounters during the process of data collection. As Braud and Anderson (1998, p. 24) playfully suggest, ‘We need an imaginative, even outlandish, science to envision the potential of human experience … not just tidy reports. ’
This study opted to conduct open-ended interviews with 12 registered therapists practicing in the United Kingdom, in order to gain their perspectives on the use and importance of emotional intelligence theory and practice in their therapeutic processes and relationships. The researcher aims to understand therapists’ experiences instead of predicting or controlling behaviour. Open-ended interviews facilitate depth, detail, and meaning at a very personal level of experience for the research participant. The focus is on the ‘hows’ and ‘whats’ rather than the ‘whys’ and ‘whethers’. Rather than asking participants to answer a questionnaire whose responses are quantifiable, the researcher poses open – ended questions such as: ‘How do you understand … What do you mean by …
Prior to the interview, this research sent each participant a Trait Emotional Intelligence Questionnaire (TEIQue) to complete (see Appendix I). I asked each participant to return the completed questionnaires before the interview to discuss results. This is a topic that also naturally leads onto the participants’ ideas of emotional intelligence, and any links it has to the therapeutic setting.
This researcher invited various therapists in UK to participate in the study. Once participants provided email confirmation, I sent the TEIQue to participants and scheduled an interview time once the questionnaire was returned. Once the interviews were complete, I transcribed the interviews and analyzed participants’ responses via a grounded theory method.

5.3.1. Sample
The participants chosen for this study are all registered therapists practicing in the United Kingdom. The 12 participants were selected through purposive (or theoretical) sampling, wherein individuals and settings were identified that were deemed as being most likely to offer valid material for analysis. Glaser and Strauss (1967) explained:
“Theoretical sampling is the process of data collection for generating theory whereby the analyst jointly collects, codes and analyses his data and decides what to collect next and where to find them, in order to develop his theory as it emerges” (p. 45).

Thus, various therapists were selected via the British Psychology Society, and invited to participate in this study. An advertisement for participants for this study was also placed in the British Psychological Magazine. The therapists were offered the hourly rate at which they would usually charge clients for their time, as an added incentive to participate in the study. The invitation to participate in this study can be found in appendix A. The criteria for participant inclusion for this study was that the participant must be over 18, must be a trained therapist, must be willing and able to discuss their therapeutic experiences, and must be aware of the theories and concept of emotional intelligence. Of the total sample, 7 males and 5 female therapists were chosen to participate in this study, with varying age ranges. This study was guided by the ethical principles on research with human participants as outlines by the British Psychological Society and City University. The participants were assured that their details and identities would be kept confidential at all times.
5.3.2. Data Collection
The research interview is a form of human interaction in which knowledge and understanding evolves through a conversation (Kvale 1996). The interviews were conducted at the participants’ convenience, usually in a quiet place of their choice (e.g., their therapy rooms provided a useful setting as it enabled the participant to reflect about their practice much more authentically and automatically). Figure 2 shows the different layers in processing qualitative data showing how raw data is analysed to produce themes, categories, substantive theory and formal theory. Data collection ceased when categories became saturated, new sources provided redundant data, and clear patterns regularly emerged (Guba, 1978). Descriptions of the major categories and related content are presented in this analysis. The interviews were recorded into a discrete dictaphone, and generally lasted between 40 and 60 minutes in length. The researcher asked various open-ended questions relating to the subject of the therapeutic relationship and experience and emotional intelligence, and also enabled the participant to discuss issues and ideas of their own relating to these subjects. Therefore, the participant was given control over the direction that the interview took, enabling the participant to relax and focus on the subject areas in hand. In keeping with grounded theory, the nature of the interview changed as new data suggested new areas to explore. The early interviews were kept very open structured. The therapists’ responses would lead to further topics for discussion.The data collected was professionally transcribed, and the transcripts were analyzed using grounded theory. This method was chosen because it was felt that it was the most appropriate method for a qualitative study. Grounded theory as a data analysis method is designed to enable and facilitate the process of discovery, and it is set apart from most research data analysis methods in psychological and social sciences in that it does not start with the design or implementation of an experimental hypothesis (Charmaz, 2006).
Quality in qualitative research demands credibility and more than mere adherence to correct procedures and attention to relevant criteria. Bearing this important qualification in mind, the credibility of the interview process was assessed according to quality criteria devised by Kvale (1996). Kvale (1996) emphasised that qualitative research does not have to look objectively, since objectivity in itself is a rather subjective notion and that the interview is neither an objective nor a subjective method since its essence is intersubjective interaction. I propose that the data presented below will demonstrate that I have met the quality criteria as proposed by Kvale (1996). As a succinct summary of the essential qualities of sound qualitative research, (Kvale1996, p. 145) criteria include:
 The extent of spontaneous, rich, specific, and relevant answers from the interviewee.
 The shorter the interviewer’s questions and the longer the interviewer’s answers, the better.
 The degree to which the interviewer follows up and clarifies the meanings of the relevant aspects of the answers.
 The ideal interview is to a large extent interpreted throughout the interview.
 The interviewer attempts to verify his or her interpretations of the subject’s answers in the course of the interview.
 The interview is ‘self-communicating’ – it is a story contained in it self that hardly requires much extra descriptions and explanations.

Moreover, the clinical experience and the experience relevant to the research question added to the ability and credibility of the researcher over a four year period. Thus, the insights of researcher from different perspectives added to the richness of the understanding of phenomenon under investigation and credibility, this could be checked at subsequent interviews. Credibility was also attained by using a female postgraduate student who have acted for the purposes of auditing, and clarification. Whilst I am wary of the danger of a‘naive empiricism results’ (Charmaz, 2007, p. 402) the researcher is framed within an approach that, whilst accepting that there cannot be a single category of ‘EI and therapeutic experience’ applicable to every therapist in the world, nevertheless generalisations are possible within broad categories.
In order to minimize any bias interpretation and artificiality as a researcher, I remained cognizant of the subtle nature of categorization and Husserl’s epochs. Husserl broadened the concepts and methods of modern science to include the study of consciousness completely free of preconceptions, especially those stemming from a natural science orientation. Husserl (1913/1962) used two procedures, called epochs, which are abstentions from influences that could bias description. The first is the “epoché of the natural sciences” (Huserl, 1954, p.135) and suggests that the researchers abstain from incorporating (“brackets”) natural scientific theories, explanations, hypotheses, and conceptualizations of the subject matter. Thus a return to phenomena as they lived, in contrast to beginning with scientific preconceptions.
Moreover, the quality of research, though, lies not just in the variety of methods and sources, but in the practical skills of the researcher. Kvale (1996) rightly stated a poor interviewer can collect just as many interviews as a skilled one, but the quality of the data will be thinner, because responses are not probed, they will remain superficial. Interviewing, as Kvale observes, is a craft resting on the researcher’s judgement rather than ‘content and context free rules of method’ (1996, p.105).
5.4. Data Analysis
The 12 interviews were analysed, based on the principles of grounded theory (Strauss and Corbin, 1990). Grounded theory equips the researcher with guidelines on how categories and themes can be identified, how links can be made between categories, and how relationships can be established between them, to ultimately develop a theory for the subject area in question. The process entailed a repeated immersion into the data, and repeated sorting and coding of the data. Figure 2 shows the different layers in processing qualitative data showing how raw data is analysed to produce themes, categories, substantive theory and formal theory.
A concept is a labelled phenomenon and an abstract representation of what the researcher identified between the different codes as being significant. These concepts were then sorted into categories based on similarities in meaning (Straus and Corbin 1998). In conceptualising we are abstracting and this was a process where the transcripts are read and sentences and phrases relating to therapeutic relationship and EI were highlighted and then organized into open codes. Concepts are described by Glaser as being the “underlying meaning, uniformity and/or pattern within a set of incidents” (Glaser 1992 p. 38).
These concepts are then grouped into descriptive categories and closely examined for their interrelationships, differences and similarities through a series of analytical steps. This allows for a fine discrimination and differention among categories which are gradually evolving into higher order categories, or one underlying core category which suggests an emergent theory (Glaser 1998). In grounded theory, data collection and analysis are not separate stages. As more data are collected, further codes are created and existing codes added to and amended (Pidgeon and Henwood, 1996). The themes that emerged and the inter-relationships between categories were then considered in terms of existing theories. In order to further check the veracity of the categories the final account was discussed with colleagues and one of the participants.

Figure 2: Steps in developing a grounded theory (after Harwood 2002 p.69)
5.5. Analytical strategy
In analyzing data using grounded theory, there are various rules concerning coding and concept formulation that must be followed. However, applying grounded theory to data sets is a subjective concept. For the purposes of this study, however, a lengthy process of coding, categorization, and concept formulation was conducted, which was broadly akin to the general principles of grounded theory (refer to appendix G and H). Glaser and Strauss (1967) suggested that there are four stages that must be fulfilled to analyze data using this approach: 1) generating, 2) integrating categories and their properties, 3) delimiting, and 4) writing the emerging theory.
The data for this study was collected and analysed in a standard grounded theory format. Strauss and Corbin (1998) indicated that there are three sorts of coding processes that must be carried out during these stages:
1) Open coding (identifying, naming, describing, and categorizing phenomena found in texts)
2) Axial coding (to interconnect the categories- the process of relating codes to each other through a process of inductive and deductive reasoning)
3) Selective coding (choosing one category to be the core category and relating all others to the chosen category).

The data was broken down, conceptualised and put back together in new ways. The lines between these forms of coding are artificial, as is the divide between data collection and analysis. The three major coding stages – open, axial and selective – in the analysis procedure is an analytic distinction. It must be acknowledged, however, that in practice all of these elements of grounded theory analysis intersect as the interpretation proceeds.

5.5.1. Open coding.
Open coding is defined by Strauss and Corbin (1990) as “the process of breaking down, examining, comparing, conceptualising, and categorising of phenomena through close examination of data” (p. 62). Open coding involves exploring the data and identifying units of analysis to code for meanings, feelings, actions, and events. Open coding is essentially interpreting rather than summarizing (Robson 1993). As a result, the interviews were transcribed verbatim, leaving large margins on both the left and right hand side of the page. The content of each interview was examined to determine themes, patterns, ideas stimulated by the data, and isolated instances that provoked thought. Reading the written transcriptions provided insight into participant reports and a good starting point to identify phenomena and produce themes.
The analytical process involved opening up the interview transcriptions and expose the thoughts, ideas, and meaning contained therein and forming open coding strategies of which are labelled to generate concepts. During this process, theory memos were written to record the development of concepts, categories and dimension (Refer to appendix L). The first read of the interviews was just to become well acquainted with the material. During a second reading of the data, the transcriptions were analysed line-by-line, and initial responses to the data were written in the transcripts (refer appendix G), which are effectively unfocused thoughts and associations. The text analysis began line by line, with a full transcription of an interview, in an attempt to identify key expression, words, phrases and episodes which connected the interviewees to the experience under investigation. Line-by-line coding, assist the researcher to make decisions about what kinds of data you need to collect next. Line-by-line and a more focused coding is essential in order to move away from the process of summarizing data into interpreting. Thus, you begin to distil the data and frame your inquiry from very early in the data collection (Charmaz 2007). The following questions occupied the initial stages of the coding process:
1. What actually happens in the text
2. What category does the textual passage suggest
3. What is going on
4. What is the person saying
5. What do these statements take for granted

Strauss and Corbin (1998) advocate the use of questions such as ‘What are the actors’ definitions and meaning of these phenomena or situations:’ (Stauss and Corbin, 1998, p.77). Line-by-line coding protects the researcher from ‘going narrative’, or from becoming so immersed in participant’s world view which could endanger the analytical and critical focus. As the data collection and line-by-line coding transformed the process to a more focused coding the initial line-by-line-coding became less open-ended and more directed (refer to appendix H). Charmaz, (1983) suggests that the initial line-by-line coding to take a step forward in analysis and focus your codes by collapsing them into new categories (process, causation, degree, dimension, type, or structure, time or generality. This forces you to develop categories rather than simply label topics. An example from one of the participants is provided on Table 3 bellow, depicting how the data was focused coded and labelled as I asked ‘what is this data a study of’, ‘What category does this incident indicate’, ‘What is actually happening in the data’, ‘What accounts for the continual resolving of this concern’ Glaser advised asking these questions to identify a central phenomenon or core category around which sub-core categories revolved (1998, p. 140). The researcher codes up the data, creating new codes and categories and subcategories where necessary, and integrating codes where appropriate. The process of analysis requires that the researcher can simplify the data and form categories that reflect the subject of study in a reliable manner (Robson 1993). Subsequently content analysis generated more accurate inferences and a collection of valid and reliable data (Weber 1990). The transcripts were read a third time, and themes and categories began to emerge, capturing participant meaning.
Creating categories is both an empirical and a conceptual challenge, as categories must be conceptually and empirically grounded (Dey 1993). Categories can vary in how abstract they are, however, as initial responses and categories were compared, more abstract categories and ideas emerged, given that, “different categories and their properties tend to become integrated through constant comparisons that force the analyst to make some related theoretical sense of each comparison” (Glaser & Straus, 1967, p. 109). This process is integrative, and helps to show repeating patterns of integration within the data, enabling significant similarities (or differences) between the categories (and within them). After the categories and concepts were gleaned from the data, the data were then discounted since: “Once a category or property is conceived, a change in the evidence that indicated it will not necessarily alter, clarify, or destroy it…conceptual categories and properties have a life apart from the evidence that gave rise to them” (Glaser & Strauss, 1967, p. 36). It was of paramount importance that categories were exhausted in order to address content validity.

CATEGORY TRANSCRIPT

FEAR
ADMIRATION
COURAGE
IDENTIFICATION
SHAME
TALK
ENGAGEMENT
DEFENSE
REJECTION
REASSURANCE
CONSTANCY
NON-JUDGMENTAL
OPENNESS
RELAXATION
TRUST
OPENNESS
DEFENCE
ENGAGEMENT
HONESTY / AUTHENTICITY
PRESENCE
AVOIDING DISCLOSURE OF FEELINGS/BALANCE
EMOTIONAL REGULATION
CONNECTION
SAFE
ROLE CHANGE
EMBODIED COMMUNICATION
ENGAGEMENT
TRUST
SAFE
COURAGE
TRANSPERSONAL

Okay. Well, the woman who just left is a good example. Because she was utterly terrified of the process and of me when she came. And, um, what I admire about her is that she has the courage to keep coming even though she’s terrified. And at the beginning I simply identified her terror. “It’s okay to be terrified. It’s alright, you know. It’s not shameful to be terrified, it’s fine. Do you want to talk about how that works for you”
Yeah. Or what … and then later on as she tried to engage, and her terror was in the way, so then we talk about, “Okay, well, there’s this terror in the way, you keep defending yourself, you keep fighting me. I’m on your side, you don’t need to fight me.” Now when she saw that, that it wasn’t me, you know, that she could come toward me and I wasn’t going to change, I wasn’t going to judge her, I wasn’t going to defend myself, I wasn’t going to do any of these things, then she started to relax. And now she can bring her worst here, and so the trust developed. But I think that in the first three minutes, I didn’t lie to her, and I think that that’s a big deal. I started out working with children, and children have lie detectors and creep detectors that are absolutely finely attuned. If you lie to a child, it simply stops listening. That’s all. It will very rarely talk back to you or tell you, or even acknowledge inside the child that it’s stopped listening, but it has, and the wall has gone up. And the only way you can engage with a child is to be really honest with a child. To be really authentic. Not to talk down to that little child, not to put on any kind of a face, just to be there in the room, in that moment.

You know, if you … with a little child that if the kid knows that you’re not going to change, you’re not going to suddenly get angry or suddenly get afraid, you’re not going to deliver your own anxieties to this child or try and control him in some way, then gradually he’ll relax and the whole arousal thing just goes down. Yeah. Everything gets slower. And then (exhales sharply) you … I could feel it, after the first 10 minutes, somebody just goes (exhales sharply) and the relief is there. So how that works, I’m not entirely sure. But for me, the key route is attunement.
To tune in. To pick up all the little clues about somebody’s voice, their body language, to ask questions, to keep eye contact. To modulate your voice so that it’s safe in the room. And then to just listen with your whole body to what’s happening. And then you know, I’m different with every patient, because I’m attuned to that patient, I’m not the same with everybody.

But, and very often when I think that, and I think, “Ah”, you know, “this attunement is not working”, they do come back. So something worked. There was a safety there, something …

I know, the things I’m saying sound really flaky, don’t they, but it’s true. (Pause). A relationship has a life of its own. I think we need courage not to control things (pause) you know. We have all these books, I mean, I went to the same therapy school you’re going to, and the same therapy school that Dawn Rosen went to. And, um, I mean, we went to school together, and now after this, I think all the things that I learned about the therapeutic relationship, what a load of fucking codswallop that was.
Table 3: Worked example of a transcript open coding

5.5.2. Axial coding
A subsequent phase of coding is axial coding, defined by Strauss and Corbin as “the act of relating categories to subcategories along the lines of their properties and dimensions” (Stauss and Corbin, 1998, p123). The essence of axial coding is the interconnectedness of categories. After open coding, it is normally not yet clear whether a particular concept has to do with a condition, a strategy or a consequence. This refers to the procedures of creating new relationships between categories, for example, specifying a category (phenomena) in terms of the conditions that give rise to it; the context (its specific set of properties) in which it is embedded; the action/interaction strategies by which it is handled, managed, carried out; and the consequences of those strategies (Strauss & Corbin, 1990, p. 97). Hence codes are explored, their interrelationships are examined, and codes and categories are compared to existing theory.
In axial coding the properties of a category are first elaborated which means that the category is dimensionalized either implicitly or explicitly. Then assumptions about the condition, interactions, strategies and consequences are specified and tested which increases the relationship to other categories. The links between the categories should be recorded in representation of networks and the investigator should capture in the form of coding notes and theory memos as many as possible of the thoughts, which have occurred during the process. Open coding split the data into categories, and thus axial coding listed these categories and concepts, and sought relationships and links between them. Thus, a large number of categories were ‘pulled together’ to form a smaller number of more meaningful categories, which can be reverified against the original transcripts for authenticity and coherence within the participant’s meaning.
The content of the categories is described through subcategories (Marshall & Rossman 1995). Tables were then produced showing the categories that had emerged (refer to appendix H but also table 3 above). The tables of categories were then reduced to those categories for which only a small amount of evidence exists in the transcripts. Credibility of research findings also deals with how well the categories cover the data (Graneheim & Lundman 2004). For cross validation the researcher adopted the concept-indicator model. The rudiments of open coding are captured in what Glaser (1978, p. 62-67) called the concept-indicator model ( see also Strauss 1987, p. 25-26). The concept-indicator model is predicated on the constant comparison of indicators. An indicator refers to a word, phrase, or sentence, or a series of words, phrases or sentences, in the data analyzed. A concept is a label or name associated with an indicator or indicators; stated another way a concept is theoretically saturated in GTM terms. Besides developing concepts, open coding also is said to involve the formulation of categories. Strauss and Corbin (1998) said that “a category is a concept that stands for phenomena” (p. 101) and “category is a type of concept that is usually used for higher level of abstraction” (Strauss and Corbin 1990, p.38).
In this study Figure 3 and 4 illustrates how indicators and categories are integrated in open coding. There researcher followed the warning of Charmaz (2006), who advised of the danger in axial of a very rigid and formal frame to the data analysis. Therefore, a less formalised approach was taken by the researcher on reflecting on categories and sub-categories and attempting to make links grounded mainly on the interview data.

Figure 3: Example of concept-indicator concept subtle competencies of an emotional connection

Cross-comparison analysis is a process of interrelating findings from several contexts to generate themes which may be used to develop new theory (Miles & Huberman, 1998). Indicators refer to events, acts or facts that constitute the data and which are constantly compared with one another in order to understand differences and similarities in meaning. Such constant comparison is achieved by a line-by-line or word-by-word comparison, and is based on asking questions such as; What is this fragment of data about What does it represent How does it differ from the previous fragment of data How is it similar to the previous segment of data For instance in the figure 3 above the researcher used the concept of subtle competencies of an emotional connection to summarize the meaning of a series of statements that therapists (the participants) in this study made. These verbalizations included “Oh okay, and erm…that’s really hard to say. You know, I mean I tend to adopt a rather warm and open stance, emotionally. Erm, psychoanalysts would be much more neutral, much cooler, more opaque. Erm, you know I tend to be warm, open, active, positive and let’s connect, let’s understand let’s do some work, let’s invent some experiments, let’s figure out what the problem is”. (Source participant 2). The second statement from another participant (indicator 2) also noted “Okay well again that would be very different with different people so I’d say that my own sort of inclination is to be um quite sort of open and reassuring um in contract may be to a sort of blank slate to … you know to somebody that … I’m, I’m probably a bit more animated may be than some therapists or some psychologists”. This statement triggered the openness concept (indicator 1). Similarly a number of other participants described another indicator that was similar to the previous segment of data but was different. For example the indicator 2 verbalizations, “I guess that it means to me that some sort, some form of trust that is created you know between two people erm and one person who is more, in a more vulnerable position is able to trust me as a person”. This prompted the researcher to think what the meaning around trust was. This ensured a higher degree of conceptualisation and abstraction. Examples of questions that were asked included: How are the concepts, trust and openness similar What do both these concepts entail Do they belong to a more abstract category How do these concepts relate to the therapeutic relationship The two indicators openness and trust would be grouped together, the last statement would be compared with the first two. The result of this comparison seemed to belong together and the statements would be classified as indicators for the concept of subtle competencies of an emotional connection. Several categories were developed from a comparison of the concepts. These categories included: ‘openness’ ‘trust’ ‘honesty’ ‘acceptance’ ‘genuine’ ‘authentic’ ‘non-judgmental’. In that way the researcher was condensing information from several contexts to the most significant meanings (Miles & Huberman 1994, p. 429) and at the same time was looking for other ways of organizing the data that might lead to different findings. One may ask, how do these statements lead to the concept of subtle competencies of an emotional connection How are the lines drawn between one and the other According to Strauss (1987) the main element in concept formation is to pose generative questions. This was done by scrutinising the data very carefully and asking questions, such as: Who How When Why What conditions Which context What consequences (Strauss, 1987). For example, the following questions were asked about the relationship between the participants experience when in the role as a therapist and the subtle competencies of an emotional connection in therapeutic relationship. How are they related Are they examples of a higher-order category of ‘benevolent connection’ Why are they related Mostly, this questioning involved understanding the context and conditions of the phenomenon under study. During this stage of the analysis, the categories were further compared with each other in order to understand whether some categories were actually properties of some higher-order categories. This process was a matter of considering the weight of data emerging evidence and looking for the best fit between data and analysis The process lends considerable credibility to the final set of findings offered by the researcher’s interpretations. Table 5 shows the higher order categories that were formed, their properties and dimensions.

Figure 4: Example of concept-indicator concept (Containment)
5.5.3. Selective coding.
In this final stage of coding, the researcher searched for one core category that enables the material world to make sense. Strauss and Corbin (1990) claimed that, “the process of selecting the core category, systematically relating to other categories, validating those relationships, and filling in categories in that need further refinement and development” (p. 16).
Thus, from these categories a central integrating focus pertaining to the participants of the study was discerned, which was a phenomena that integrated the categories as established in the axial coding stage. This central focus hopefully will enable much basis for discussion. High quality qualitative data and research methods are discerned by the transparency of their analysis. To increase the reliability of the study, it is necessary to demonstrate a link between the results and the data (Polit & Beck 2004).
As a result, an example of how grounded theory coding was applied to the data gathered for this research investigation can be found in table 3 above and figure 3 bellow as well in appendices H. As coding proceeds the researcher develops concepts and makes connections between them. The application of open, axial and selective coding adopts the method of constant comparison. Glaser and Strauss (1967, p. 102) noted that ‘the purpose of the constant comparative method of joint coding and analysis is to generate theory…by using explicit coding and analytic procedures’. Constant comparison is the process by which the properties and categories across the data are compared continuously until no more variations occur, for example saturation of data is reached and not consideration of all available data.
Glaser and Strauss (1967) write that the constant comparison method involves four stages: comparing incidents and data that are applicable to each category, for example this entails coding of incidents and comparing them with previous incidents in the same and different groups and with other data that are in the same category. The second stage involves integrating these categories and their properties, thus, ‘the constant comparative units change from comparison of incident with incident to comparison of incident with properties of the category that resulted from initial comparisons of incidents’ (Glaser and Strauss 1967, p. 108). The third stage of bounding the theory occurs at the levels of the theory and the categories and in which theoretical saturation takes place. The final stage of setting out the theory happens when the researcher has gathered and generated coded data, memos, and a theory, and this is then the writing theory in full.

5.5.4. Trustworthiness
The criteria for measuring reliability and validity of quantitative research instruments are not appropriate in qualitative approaches (Agar cited in Krefting 1991). The trustworthiness of this study adopted the value position that a quality research was based on the substance, depth and innovation of the product that is generated (Corbin and Strauss 1990). Another important condition for the quality of this study is the researchers experience and training in psychotherapy, whereas clarity and accessibility are certainly two important criteria. In qualitative research, certain strategies can be adopted to achieve trustworthiness and to increase the study’s validity. Lincoln and Guba (1990) frame trustworthiness through the triangulation of data and name four types: a) methods triangulation, b) data triangulation, c), triangulation through multiple analysts, and d) theory triangulation (Lincoln & Guba, 1985). This study adopts Lincoln and Guba’s (1985) achievement of trustworthiness and attainment of four key constructs that relate to:

1. Credibility The adequacy of data from the field, which should involve drawing on different data types, gathered in different ways from different participants.
2. Dependability: Dependability is defined as the stability of data over time and over conditions.
3. Transferability: refers to the extent to which findings can be transferred to other groups or contexts and is dependent upon the researchers’ thick description of the phenomenon under study and the richness of description and interpretation offered.
4. Confirmability: The neutrality of the data that the researcher illustrates as clearly as possible the evidence and thought processes that have let to the findings.

The strategies carried out in the thesis to ensure trustworthiness are depicted in Table 4 and conform to Guba’s model of trustworthiness as described in Krefting (1991).
Criterion Qualitative approach Action taken by researcher
Truth value Credibility • Interview techniques based on quality criteria for an interview as proposed by (Kvale 1996)
• Continuous discussion with peers and the panel of experts, contributing to deeper reflexive analysis.
• Structural coherence and analysis of inconsistencies between interviews and interpretation.
• Peer discussion of the research findings with impartial colleagues experiences in qualitative methods.
• questioning, the flip-flop technique.
• Reflexivity (assessing my own biases as a researcher and bracketed them)
Applicability Transferability • Description of the research methodology, literature control and verbatim quotations taken from interviews.
Consistency Dependability • Maintaining an audit trail for review by the panel of experts.
• Peer discussion of the research findings with impartial colleagues experiences in qualitative methods.
• keeping a research diary and memo writing. (refer appendix L)
• Reflexivity (assessing my own biases as a researcher and bracketed them)
• questioning, the flip-flop technique.
Neutrality Confirmability • Maintaining an audit trail for review by the panel of experts. The audit trail consisted of the researchers’ memos throughout the research process, including raw data, evidence of the analysis and data reduction, reconstruction, and synthesis (Wolf, 2003)
• The discussions with the expert panel regarding coding and categories helped to ensure the confirmability of the findings.
• Reflexivity (assessing my own biases as a researcher and bracketed them)
• Reflexive analysis to assess the influence on my background and perception as these will influence neutrality.
• keeping a research diary and memo writing (Appendix L)
• questioning, the flip-flop technique.

Table 4: Strategies of Trustworthiness of the Thesis.
In accordance with grounded theory methodology, using participants’ own language at all levels of coding can further ground theory construction and add to the credibility of findings (Strauss & Corbin 1990). In this study, this issue was addressed by supported interpretations and meaning to codes and categories relationship and action with excerpts from interview data. Furthermore, the quality of the study encompassed Bochner’s (2001) set of criteria, which blends scientific rigour with ethical integrity and artistry. The researcher in this study values Bochner’s criteria as important based on his experience in psychotherapy and research. Additionally, the emerging theory of this study adopted the qualitative evaluation criteria of ‘rigour, relevance, resonance and reflexivity’ (Finlay and Evans 2009, p. 60). In their pioneer work Finlay and Evans (2009) noted that qualitative research should be evaluated in terms of its rigour, for example, have quotations taken out from an interview been illustrated a theme Have the knowledge claims been tested, validated and argued in dialogue with co-researchers, supervisors or colleagues. Another major criteria adopted in this study was reflexivity. The researcher’s own self-awareness of his subjective positioning was noted, and openness about the research process with an appropriate level of humility in acknowledging any limitations of the findings was established. The analysis of the data also involved engagement, constant abstraction and a dynamic process of identifying codes, and categories grounded in the data. The researcher used words that best represented the meaning of codes and categories. The descriptive categories underwent a separate audit to check validity. A female postgraduate research students evaluated the coding and categorizing and that led to the re-coding and re-arrangement adjustments. Triangulation provided yet another framework for ensuring quality control in involving multiple sources and perspectives to reduce the chance of systematic bias.

5.6. Limitations and Ethical Considerations
As this project involves human respondents, there were various ethical considerations that required attention. First of all, it was necessary to apply for permission to conduct this research from the Senate Research Ethics Committee to ensure the subject matter and methodology were sound. Also, correct consent forms were signed by each of the participants prior to the interviews commencing. The main concern was ensuring that the participants’ details and identities were kept confidential; not only to ensure that the study complies with standard ethical procedure, but also to aid the participants’ relaxation and honesty in the interview sessions. This was maintained by keeping passwords on the computer where the transcript and questionnaire data were stored. The researcher’s safety was assured by conducting the interviews in the certified treatment rooms of the therapist, and by ensuring that a University supervisor also was aware of the interview location.
Given that this project was qualitative in nature, issues of reliability are not as complex as they may be for quantitative research. The sample of participants are entitled (in fact, encouraged) to express their own views, so as to enable an analysis of various themes and ideas arising from the experiences and perspectives of others. The participants are not assumed to be a general representative of the population, or of those within their field (such as therapists in general). On the other hand, Kippax et al. (1988) argued that, “a given experience, once we have identified it through qualitative research…is valuable within a culture or society” (p. 25).
All research methods used in a study must be defensible to ensure the quality of that study. A criticism in the field of grounded theory has been the claim that it is affected by internal misalignment (Bryant, 2002) because interpretivist and constructionist tools are used in this method that is based on positivism and objectivism. Cognizant of this fact, Charmaz, (1983) argued that Glaser and Strauss were able to bridge the void between theoretically “uninformed” empirical research and empirically uninformed theory. They achieved this through developing theory by grounding it in data.
The selection of grounded theory among participants who are experienced therapists resulted in some advantages. As Finlay and Evans (2009) contemplated, many of the familiar clinical skills and interests of psychotherapists (such as interviewing skills, empathy, reflexive or intuitive interpretations, and inferential thinking) are directly transferable to the qualitative research domain. Subsequently, the research relationship is perceived between researcher and participants to emerge out of a dialogical process to which both parties contribute. In this study, I was involved in considerable reflective evaluation of my own position with regard to the therapeutic relationship and my own working model of cognitive analytic therapy. This resulted in more work that I had first thought. The process of gathering data is primarily a co-creation of researcher and participant; therefore, the topic under investigation is more of an art or craft than science. The essence of therapy research and life is a reciprocally interacting world of experience, interconnection, and interdependence. This “intersubjective horizon of experiences needs an approach such as grounded theory to allow access to the experiences of others” (Wertz, 2005, p. 168). At the same time, those experiences must be credibly and reliably studied and reported while avoiding polarization or dichotomy in the study of complicated entanglements. Although most methods are designed to test theory, only a few actually result in the building theory (Glaser & Strauss, 1967). Through grounded theory, this topic of research resulted in a much more substantial end product.
Another argument put forward by Morgan (1996) was that the grounded approach was not repeatable and that the findings were just specific to the particular study. On the other hand, by definition, the nature of qualitative research is not to seek to be consistent or to gain consistent results; rather it is to elicit the responses of a participant or researcher at a specific time and place and in a specific interpersonal context. The position of qualitative research is that we can never exactly replicate situations. Qualitative research is a joint product of researchers and participants (and readers) and the relationships they build. However, as Strauss and Corbin (1990) argued, as long the data used are comprehensive and the interpretations made are conceptually broad, the theory developed can result in an adequate summary and variations to enable its application to many other related contexts. Because the theory developed from this work contained sufficient variation for EI and its links to therapeutic relationship, EI research in therapy within one context could reveal something of relevance about EI and anxiety of therapists in another related context.
As with any other qualitative methods, the subjective elements of grounded theory in this study could be criticized. However, as a qualitative researcher in this current study, I recognized that research is dynamic and co-created and that, by definition, it involves subjective interpretations. Because interpretation is inexplicably linked in the research process, any analysis must be seen as a “tentative statement opening upon a limitless field of possible interpretations” (Churchill, 2000, p.164). These subjective interpretations are part of the process in this research through which vicarious experiences are enabled (Polkinghorne, 1983). However, grounded theory also resulted in broadening my understanding of participants’ meanings and in challenging my assumptions about the phenomenon (Cooper, 2004). Therefore, as a researcher, I remained open to such claims rather than denying them and accepted that the researcher is a central figure who influences (and actively constructs) the collection, selection, and interpretation of data.
The researcher acknowledges his personal experience and reading of the literature on EI and therapeutic relationship could negatively influence the interpretation of the research. Thus, the researcher imposes meaning onto the results gained. Subsequently it would not be possible to postpone as Glaser and Strauss (1967) advocate that those experiences form part of an intersubjective research experience. Embracing researcher and participant subjectivity can have the advantage to enrich and provide a meaningful and embodied understanding of human phenomena (Luca 2009) and therefore promotes validity. The interviews, being open-ended in nature ensure that the participant felt as though they were in control of the direction that the interview took – they were made aware prior to the interview that they were able to discuss anything concerning the subject of emotional intelligence and the therapeutic relationship that they felt comfortable with. This ensured that the researcher was not placing their own ideas of the outcomes of the interviews onto the participant – rather, the researcher enabled the conversation to unfold naturally. Another limitation and paradox is the fact that grounded theory cannot claim to be objective as any experience is subjective. However, does objectivity means credibility According to Beck (1993), credibility is a term that relates to ‘how vivid and faithful the description of the phenomenon is’ (p. 264). In qualitative research, credibility is demonstrated when ‘informants, and also readers who have had the human experience…recognize the researcher’s described experiences as their own’ (p. 264).

Chapter Six
6. Findings and Homework help – Discussion
This chapter highlights the main findings from the interviews, using grounded theory as a method of analysis. A worked example of how the interview transcripts were used in order to discern emergent themes, as well as a variety of categories discerned through open coding, can be found in Appendix C. A chart of the most prominent themes that resulted from the study is also shown, and a more detailed analysis of each of these themes follows.
Themes Sub-Themes P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11 P12
Empathetic Balance
Empathy √ √ √ √ √ √ √ √ √ √

Spirituality √ √ √ √ √ √ √

Emotional Exhaustion and Maintaining Balance √ √ √ √ √ √ √ √ √ √
√
Containment and Manage feelings in self and others √ √ √ √ √ √ √ √ √ √ √ √

Benevolent Connection Connection √ √ √ √ √ √ √ √ √ √ √ √
Difficulties in forming an emotional connection √ √ √ √
Been present √ √ √ √ √
Transpersonal and spiritual connection √ √ √ √ √ √ √ √
Subtle attributes and competencies of an emotional connection √ √ √ √ √ √ √ √ √ √ √ √
Role of the Therapist √ √ √ √ √

Mindfulness
Physical, Emotional and cognitive awareness √ √ √ √ √ √ √ √ √ √

Differences between feelings and Emotions √ √ √

Emotions and Cognitions √ √ √ √ √ √ √

Extraneous Involvement Personal therapy √ √ √

Supervision √ √ √ √ √

Trait EI inadequate √ √ √ √ √ √ √ √ √

Trait EI as a mean for training programmes √ √ √

Trait EI inventory captured therapist being √

Table 5: The emerging themes and the frequency of the sub-themes of each participant
6.1. Overview of Themes
The central and most prominent themes found in this study are shown in the diagram below. The main themes that arose from selective coding were: empathetic balance, benevolent connection, mindfulness and extraneous involvement. The sub-categories that emerged through axial coding can be found in figure 3 and discussion below.
Figure 5: Mapping of the Core Emergent Themes
6.1.1. Theme A – Empathetic Balance
One of the most prominent themes to emerge from the data was empathetic balance. Whilst each participant talked extensively about empathy as a main attribute of a successful therapeutic relationship, the idea that balance was necessary in order to ensure that the therapist does not become overwhelmed with emotion was prevalent throughout most, if not, all interviews.

6.1.1.1. Empathy
Various participants discussed empathy in the interviews. Participant 1, for example, claimed that the most important element of the therapeutic relationship from his perspective, was, “being able to be empathetic, being able to meet the client where they are”. This was a colloquial way of expressing a portion of the Mercer and Reynolds (2002) definition of empathy: “…understand the patient’s situation, perspective, and feelings…[and]…communicate that understanding…” (p. 9). The therapist had experienced times when he himself had felt the same emotions as his client: “[I was] sort of recognizing that I’d felt like that myself at times. Similarly, it just enabled me to connect with her…I just suddenly thought God you know I really, I really know how you’re feeling.”
Participant 5 commented that in a particularly poor therapy session she found she wasn’t being empathetic, which added to the sense of disconnectedness with and lack of care for the client. Participant 7 reported, “Therapists without empathy I think are ineffective.” Stern (1998) reported that empathy is a necessary component of emotional intelligence, as it leads to a connection with the client’s subconscious emotional state to help them understand what is happening and why. Furthermore, the idea that empathy is a complex, multidimensional concept, which has moral, cognitive, emotive and behavioural components (Mercer and Reynolds, 2002), suggests that it is integral to the therapeutic relationship, as was found in the literature review. Participant 2 added that empathy seeks to understand human behaviour, not to judge it: “what the client is experiencing…and the ability to afterwards make sense of it and you know let the client know what is happening. Interpreting or facilitating you know asking certain questions that might eventually help the client to make sense of it by himself but not judge him”. This reflects the third component of the Mercer and Reynolds (2002) definition of empathy, which is to “act on that understanding with the patient in a helpful (therapeutic) way.” (p. 9) Thus, emotions are shared between the client and the therapist within a positive therapeutic relationship. Participant 2 explained, “To a certain degree it’s his emotions not mine but now it’s mine because I’m experiencing it.”
The therapist expresses an important point concerning empathy. He must convert empathy into an act that assists the client in some way, such as helping the client make sense of feelings and thoughts. Participant 3 also used empathy to get to the root of the client’s problems: [I]t’s not like in counselling where you might just say the same thing back again…you have to be aware of what people are feeling but you can’t sort of lose it, you can’t sort of just sit there being sympathetic. I see my job as helping them come to terms with that thing so in a way you have to be a bit stronger about it than whatever it is, you have to contain it somehow in yourself.” The above comments address all of the components of empathy, which include understanding, communicating, and acting on that understanding. Participant 3 also raised an interesting point in terms of feedback. The acting on the clinical empathy does not mean simple mirroring feedback of what the client said, which is typical in some types of counselling. Participant 3 attempted to assimilate the same feelings and then use feedback as an act of therapeutic counselling. As participant 3 suggested, the therapist must be able to control the feelings once assimilated so they don’t overwhelm the therapist, which can then result in biased feedback.
Similar to participants 1, 2 and 3, viewing the situation from someone else’s perspective, as opposed to simply seeing things through one’s own eyes, is also an important aspect of therapy for Participant 4, who claimed that the most important element of therapy for her is the, “empathetic approach, I guess…maybe through the empathy, being able to, sort of, see it through someone else’s eyes, maybe. You know, not always from my own.”
Therapists are subject to the same subjective interpretation of feelings that the client is subjected to, which can actually lead to a distortion of the empathetic feelings. In other words, the therapist has an emotional intelligence made up of the eclectic mix of positive traits that include relationship skills, self-motivation, happiness, and self-esteem, among others. Participant 5 pointed out that some attempts to empathise fail and those times are surprising to the therapist: “I can get quite surprised when I, you know when I get it wrong and I can get it oh get it really wrong really I’m really way off here.” It’s possible the therapist’s own emotional intelligence has blocked attempts to develop the empathy needed to provide the appropriate feedback to the client. Participant 12 alluded to the same issue, describing the entire therapeutic relationship as “an exercise in attunement” and cautioning, “Our job as therapists is to feel where the person is when they come. And to see if we can attune to that place, and keep our own observer, without judgment and free, to see what’s going on.”

Maintaining clinical empathy requires the therapist to process client’s feelings without judgment, and that can be difficult if the therapist’s own self-awareness and introspection distort the therapist’s empathy. However, if we follow Solomon (2003) in defining emotions as judgements, it would appear that a clinician could not attune to emotions without judgement because they are one and the same. In the Salovey and Mayer (1990, 1997) EI Model, a component of emotional intelligence includes “an ability to regulate one’s own emotions, and an ability to use emotions to solve problems” (p.189). Empathy then, as one component of EI, requires therapists to manage their own emotions to better counsel a client.
Most participants claimed that they generally do “feel a great deal of empathy [or] a great deal of pain depending on what’s going on and [of the client’s] concern’ (Participant 6). Participant 1 agreed with reporting, “I have…a lot of feelings for her…because I know it’s really hard for what she’s going through.” Attunement or attuning to someone else’s emotions is often used in place of the word empathy. Participant 2 commented, ‘”that can also be a certain aspect of empathy when you attune to someone else’s feelings.” Participant 6 on the other hand called this ‘”being emotionally available,” and claimed that, “it’s important as a human being to be emotionally available,” so as not to “become to as it were clinical about it” – the therapy.
Often, the times when a participant has had a difficult experience of therapy was when it was hard to empathise with the client, or when there were inhibitors to the development of an emotional connection. Participant 2 commented:
“I found it really difficult to kind of empathise with her. I really felt even a sense of hate towards her and I had a really lot of negative feelings which I found it really difficult…there are times when I could really probably empathise with people and see things from their perspective but there are probably other times when I’m really you know, I don’t know, I might not be open to listen to anyone else because I’m, for example, I’m in an emotional turmoil myself and I’m not open to kind of see other people’s pain or how they feel you know because I’m really kind of closed off in my own [world]”.

This account reflects the difficulty therapists may encounter in managing their own feelings so as to not interfere with the empathetic process. This reflects the emotional facilitation of thinking as a component of EI in the expanded Mayer and Salovey (1997) EI model. The words “I might not be open to listen to anyone” and “I’m really kind of closed off in my own [world]” indicate the therapist is involved in a personal cognitive process that prevents empathy.

6.1.1.2. Empathetic balance
In Goleman’s theory (1995), this balance would fall within the five factors of EI (knowing, managing, motivating, recognizing, and handling), but particularly in the factors of knowing one’s own emotions and managing emotions. Maintaining balance would be a form of self-regulation (intrapersonal) competency, which influences the therapist-patient relationship (interpersonal). The Bar-On (1997) EI also encompasses the competencies influencing the internal attunement to the patient’s feelings and emotions and the external expression of that attunement. Participant 9 similarly recognized the importance of knowing the feelings in self and others, an important part of Mayer and Salovey EI definition:
“ This is mine, this is my stuff. This is … doesn’t belong to me, just wait one second, what I’m feeling, what I’m thinking it’s not my normal way of thinking or feeling.” …which in it means something, oh, between my relationship, it means something about all relationship than anybody else would experience, which is important to help the client to gain awareness about the impact that she has on me. Or it could be also a window in her inner world, which then is really how she feels”.

Thus, participant 9 attempted to portray the complexity of the interplay between contradictions, incongruity, and awareness as the therapist is accumulating knowledge about the relationship with the client. This interplay is also advocated by Fonagy et al. (1991) and Main (1991), who emphasizes the ability to engage in meta-cognition and also connects with the work on theory of mind (Baron-Cohen et al. 1993). In the same line of synthesis, Salovey & Mayer (1997) employ this structure of coherence to label this set of mental abilities as emotional intelligence (Mayer, DiPaolo, & Salovey, 1990; Mayer & Salovey, 1997; Mayer, Salovey, & Caruso, 2000). This is also consistent with previous discussions in literature review on the concept of transference (Samuels 2006) as the process of a person recreating her or his patterns of emotional experience in the context of the present therapeutic relationship. Similarly, Knox’s (2001) theory maintains that implicit memory is the basis for the transference.
Participant 6 noted that one of the most important aspects as an empathetic therapist is to find “balance between being emotionally close and available and emotionally separate so as to preserve the independence…That balance between emotional distance and emotional closeness … those seem to me to be the key features.” This participant also reported, “I need to maintain a stability of my own so as to be helpful.” This idea is also supports the work of Winnicott (1971), who says that clients need to “use the therapist” (Winnicott, 1971 p.121) for working through feelings and beliefs about early experiences. The therapist is not the provider of experience for clients, but rather clients find their own experience within the therapeutic relationship.
The idea that a therapist cannot be helpful if they are ‘lost’ in the emotions was expounded by participant 7:
“You’ve got to position yourself somewhere in the middle…where you can…understand what people are feeling, feel it yourself to some extent too, to be able to help them deal with it, but yet not be swamped by it, to the extent that you cannot actually be therapeutic . . . I’m here to experience and try and be helpful to deal with this problem, because they’re not dealing with it… You know that experiencing, um, some awful trauma is helpful to people. Re-experiencing it in a therapeutic relationship is helpful, that’s the evidence of it. But it needs to be directed. It can’t be swamped…you need to have some balance…It’s being moved but not swamped”
The need for balance is expressed in this participant’s words of “middle”, “deal with,” and “directed.” The word “contain” was also used by a number of participants to denote the same meaning as balance. For instance, participant 11 stressed that it is important “to feel these emotions, contain these emotions so that at the end of the session she could leave in one piece”. This is also linked to Bion’s (1962, 1970) concept of ‘containment’ and developmental theory of the ‘good-enough mother’ which is translated into the ‘good-enough therapist’. In understanding the child, the mother is seen as both understanding the cause of the child’s distress and also feeling what the distress is like (e.g., empathy). In the same manner, all containment done in therapy is loving, encouraging, understanding, and accepting. However, the vital issue is that the mother does not feel overwhelmed by these negative feelings herself, and in a similar position, the therapist must ‘contain’ the experience of the client’s emotional pain but regain a balance and not be swamped. Participant 1 commented: “if a session is sort of really emotionally difficult . . . I’ll sort of recruit my internal supervisor if you like and so I’ll sort of clock into an awareness of me feeling like it’s really difficult. . . . I maybe slow down ”. The words ‘internal supervisor’, ‘awareness’ and ‘slow down’ shows how the participant is engaging in a process of managing the difficult feelings and maintaining equilibrium or balance. The balance is necessary if emotions are to be “used in functional ways,” as George (2000) purported is necessary for EI. Maintaining balance requires that therapists appraise not only the emotions of others, but also their own, and more importantly regulate them, which are important facets of emotional intelligence theory (Mayer & Salovey, 1997). As participant 7 reported, “we all have experienced anxiety and low mood…. And that helps, I think, to consider one’s own experience.” Therapists, like any other human being, are feeling creatures, and thus they must appraise and regulate their own emotion, as participant 3 reported:
“I see myself if you like, as the sort of … it’s like having a barometer, it’s like being a little instrument, you have to sort of keep that working properly (laughs), so if you don’t pay attention to the build up of feelings in yourself it can sort of go over the top sometimes”

Thus, balance is described as a ‘barometer’ that prevents therapists from being so involved with clients’ emotions that they cannot be helpful. In addition, balance helps the therapist to journey toward a more empathetic place. The therapist plays an attachment role in the therapeutic relationship, and this is akin to Winnicott’s (1963) child development ideas, discussed in the literature review. As participant 2 contemplated:
“let’s say anger was not really allowed in relationship with the mother that was not strong enough to contain or so all of sudden if it becomes er a possibility in the room or in the relationship between myself and the clients then it can become it might initially be really and being a very passive, aggressive way he would not be able to own his anger you know erm but I will not retaliate or suggest that it’s not allowed erm you know”.

The need for emotional balance is expressed in the words “contain”, “not retaliate,” and “suggest that it’s not allowed”. In other words, the therapeutic relationship provides a developmental trajectory in which the client begins in a state of great dependence, and from there progresses to a state of relative dependence, and then later “towards independence”, with the facilitating therapeutic relationship space (environment) providing the arena for the maturational processes to drive this trajectory. Balance is necessary for this therapeutic maturation to occur. Balance also helps the therapist deal with the challenge of sexual attraction. Regarding sexual attraction, containment, and boundaries, participant 8 said about a client, “I’m very fond of er she’s er I think she’s very attractive, she makes a lot of money you know er but part of it is I think oh gee if I wasn’t her therapist you know I, I would, I would be interested in her, you try to keep that out of it”. The participant links boundaries and containment and the importance of maintaining emotional balance.
The question of whether empathy can be learnt is something that emerged in the interviews, with participant 7 reporting:
“Empathy is quite interesting, because a question came out about a trainee who was lacking in empathy. ‘Can it be trained’ . . . I’m not sure that the evidence is very clear cut about whether you can increase something which isn’t there, or at least is very lacking. But certainly it’s important”.
The idea that empathy cannot be trained is perhaps one that does not sit very well with those who advocate emotional intelligence, simply because if emotional intelligence is measured and effected like cognitive intelligence, which can be learnt, then emotional intelligence can be learnt also. Emotional intelligence is, however, mainly learnt during childhood, and therefore is something that is subconsciously – and often quickly – learnt by those children that have emotionally intelligent parents (Siegel, 2001). Thus, given that empathy is a major facet of emotional intelligence, it stands to reason that empathy can be taught and learnt. This is similar to Ciarrochi, Forgas, and Mayer’s (2001) conceptualisation of self-actualisation, wherein they claim that individuals must continually work towards being the best that they can be. Thus, it stands to reason, that people should, and can, continually work towards being the most empathetic that they can be (Ciarrochi, Forgas, & Mayer, 2001). The theme of empathetic balance emerged out of the results because the terms ‘empathy’, ‘containment’, and ‘balance in empathy’ (and variations of these terms) were mentioned in almost all participant interviews. Of course, the theme of empathetic balance is interlinked with the next theme, emotional connection and attachment, which has subtle but important differences (as well as similarities) with empathetic balance.
The idea that there should be an empathetic balance in the therapeutic setting could refer to the discussion of transference in the literature, which suggests that feelings especially are ‘transferred’ from the client to the therapist (Samuels, 2006), who must identify these emotional projections and utilize, unpack, and make sense of them in an effective manner before passing or reflecting them back to the client in what is termed ‘counter transference’ (Sedgwick, 1994). This process enables a subconscious undercurrent to be present between the therapist and the client, and allows the therapist to react to – but not become too involved in – the client’s emotional projections and experiences. This process ensures that the therapist always remains a calming, constant presence. These ideas are all intrinsically interlinked with the idea of the therapist achieving an empathetic balance within the therapeutic relationship.

6.2. Theme B – Benevolent Connection
The idea of an emotional connection and attachment was prevalent throughout most of the interviews, and underscored most participants’ ideas of what constituted a successful therapeutic relationship. For this reason, it was the theme that the participants talked most about, and its links with emotional intelligence are subtle but nevertheless present. The role of the therapist was also a sub-theme of this category because of its links with attachment, as was presence, which relates to the idea of an intrinsic, alive, ‘present’ emotional connection.

6.2.1. Connecting
Participant 8 commented that one of the most important facets of a healthy therapeutic relationship is connecting, claiming that, with one troubled client, “it felt like we were able to make that connection and I was feeling really hopeful.” Thus, connecting is related to hope that the client can benefit from the therapeutic relationship. Participant 11 commented that a connection is vital, claiming that, “You have to make a connection. And that connection is subtle. It’s not just an intellectual connection…meeting on some kind of emotional level.” However, participant 11 does not view hope as a necessary component of connecting – rather, truthfulness is key: “telling [the client] what I felt truthfully…actually about unlocking people to enable them to find their own capacities including emotional capacity so that may or may not include hope.” Yet a connection is of course more than simply one person reaching out to another, as participant 11 described it, but rather it requires the input of two people. This harkens to the central unconscious connection between the client and the therapist described by Sedgwick (1994) that can lead to mutual attraction, mutual understanding, mutual respect, and thus a possibility of healing. Participant 8 commented that one client:
“Wanted to connect as well. Maybe that’s something actually I mean you know it’s not just me that’s staring that you know there’s two people in the relationship so er I guess it’s about what the other person’s coming with and how much they are able to connect or not”.

Other participants described this mutuality in a variety of ways. Interestingly, participant 9 viewed the emotional connection between the therapist and client as “like a bridge. It’s a meeting between two persons …I’m a specialist in social science, he’s a specialist of his own experience. If we don’t create a relationship between both of us, well, nothing is possible.” Participant 9 reported that someone lacking emotional connection with another as being “cut out of the world.” In a similar vein to empathy, where often transference and countertransference underscore the therapeutic relationship, participant 3 asserted the emotional connection between the therapist and the client as “like a mirror I suppose, it’s so that they can see themselves.” In this way, participant 3 does not attempt to colour the connection with her own views, rather she claimed that:
“I try to see what that person is needing and I try to be completely blank about it. It doesn’t matter. They should be able to say anything they want to say and then by reflecting back to them, responding to them, they get a picture and then they can correct me if I’m not quite there or whatever, so that they see the picture clearly, so they can actually see what they’re doing . . . once people see what’s going on they start to be able to recognise in themselves how it feels when that happens and make those connections, and that’s when the emotional awareness part comes in, connects with the behaviours, but obviously it’s a very gradual process, which sometimes takes a long time”.
In order to create an appropriate emotional connection with a client, it is important to know one’s own limitations as a therapist. Participant 3 described this as being “completely blank,” which decidedly could be difficult. Therapists would have to self-regulate their feelings, moods, and emotions to create such a blank person. Without the blankness, it will be more difficult to establish a connection. Participant 12 described attunement as the most valuable thing. Participant 4 viewed it as most important to “have a good knowledge of yourself, I suppose, and your…weak points maybe,” to be “quite solid in yourself” – something that is often aided by personal therapy for therapists, and the willingness of therapists to enter therapy. Interestingly, participant 7 defined emotional connection as “being present. So, unless one has some degree of understanding of phenomenology and the developed capacity to bracket off the intrusion of agendas, habits, assumptions, dogmas, it would be very difficult.”
Another description of connecting was from participant 10, who saw the therapeutic relationship between client and therapist as a form of teaming up. The participant reported:
“Therapy only works if the client and the therapist are teamed up in some way, you know if they’re performing some kind of team to solve one person’s problems. And if that doesn’t happen, then the outcomes are usually very bad. So, the therapist has to be able to have a set of social skills and atonement abilities to deal with the range of people that come with problems”.

The introduction of the concept of ‘team’ is not surprising. Any relationship requires a mutual exchange, but successful relationships lead to mutually beneficial exchanges. The therapist is able to connect emotionally with the client only if the client is willing to share, and that leads to a possibility of positive outcomes as the therapist provides counselling feedback. The focus must be on the client, of course, but if there is too much focus, participant 10 claimed that the therapeutic relationship can become “lopsided.” Yet the ability to maintain the relationship, emotional connection, and focus on the client is not always easy, especially in the first few years of being a therapist, which is something that participant 10 admitted:
“When I started off being very self conscious, you know trying to do interventions very mechanically, trying to follow a model, do everything right, to the point where you often neglect the warmth of the relationship, you know one is too busy trying to do the job properly and of course when all that stuff becomes second nature then it is much easier to concentrate on the relationship . . . I think that it took 10 years for the tools to become almost unconscious so that they appear in your mind rather than having to reach for them. So the conversation is flying along and something will just pop out of there”.

The idea that more forces are at work within the therapeutic relationship than what meets the eye is something that a variety of participants commented on, and this is also supported by the idea, discussed in the literature review, of implicit procedural knowledge. According to Siegel (2001), implicit procedural knowledge is where many memories are hardwired into the unconscious self, and that these all work to influence how we think, and interact, with others – including in the therapeutic setting. It is these implicit memories that the therapist must seek to draw out for the client, in order for them to be acknowledged and dealt with. In some cases, this led to the next sub-theme found within participants’ interviews, spirituality.
6.2.2. Transpersonal / Spirituality.
The connection between client and therapist was often described in terms of something outside of the two people in the room. Participant 12 included a spiritual or transpersonal perspective in defining the meaning of the therapeutic relationship by suggesting “the therapeutic relationship, in my experience of 15 or 20 years of doing this, happens within the first three minutes. And if doesn’t happen, it isn’t going to”.
Participant 9 referred to the emotional connection as “a taste of spirituality which means me, the client, and something bigger than us,” and added, ‘spirituality is being connected with myself and what’s going on for me, and being able to connect with someone else.” Thus, for participant 9, connecting with another person is almost transcending reality and the notion of a higher power outside of the two of them, yet embedded within the relationship. This perspective identifies how the whole person is capable of being transformed through multisensory engagement, which can lead to different ways of knowing, being, and doing (Braud 1998). Participant 5 echoed the sentiment that the emotional connection in the therapeutic relationship transcends the everyday relationships that are available to the client, and Participant 7 describes the mystery of the emotional connection by noting, ‘Ontology is a mystery that shifts further and further away from us, we can’t grasp it’.
Furthermore, the relationship between the therapist and the client is described by other participants as being subconscious rather than unconscious. For example, participant 12 reported, “[I]f we’re used to being attuned to people, then we know things. Sometimes without knowing them consciously.” This is a point echoed by Palmer (1998) who identified that knowing can occur through an “intuitive intelligence.” (p. 173). Whilst it is not always possible to describe the exchange that occurs between therapist and client, it appears that most participants believe that there are greater forces at work, whether spiritual, from a higher power, or from a subconscious activity in the brain and body. That idea of spiritual circulation is akin to Jung who noted “There is no linear evolution; there is only circumambulation of the self” (Jung, 1965, p.196).
This appears to focus on the powerful effect that spiritual experiences and deep transpersonal encounters can have between client and therapist. The idea that more forces are at work within the therapeutic relationship than what meets the eye is something that a variety of participants commented on, and this is also supported by the idea, discussed in the literature review, on transpersonal relationship and spiritual intelligence. “The transpersonal relationship is the timeless facet of the psychotherapeutic relationship, which is impossible to describe, but refers to the spiritual dimension of the healing relationship” (Clarkson, 2003, p. 187). Grof (2000) has stated that spiritual intelligence reflects our capacity to engage in life, adding a depth of philosophical or metaphysical inquiry about what it means to be a human being, which can open people up to questions about humanity’s relationship to reality and the nature of existence. Moreover, transpersonal relationship is also linked to implicit procedural knowledge (Siegel 2001).

6.2.3. Difficulties in forming an emotional connection
What happens when therapists are not able to create that blank person discussed earlier and personal emotions intrude What if therapists cannot marshal their emotions As was the case with empathy, the inability to develop an emotional connection can create worry and unsettledness. Participant 8 reported:
“[One client was] the first person that I’ve actually felt that I don’t like and that I can’t find something to connect with… and that just feels really…well, different and worrying [sic] and just something that I’ve not experienced before….I’m normally able to find something, there’ll be something somewhere and it’s normal . . . it doesn’t take that long actually to find a connection.”

This passage offers a sound example of reflexivity, and the participant reflects at different levels on connection while showing awareness of the potential impact of not connecting. Similarly, participant 6 had had negative experiences of therapy, which were more often than not the result of not being able to find an emotional connection with a client:
“At the other end of the scale is someone I’ve worked with who I found very difficult to build…an emotional um relationship with…with this particular woman um it was possible to go through the mechanics of the process but without the essential emotional engagement which I think resulted in it being a much less rich experience for her well and for me”.

Thus, it appears that the inability or the resistance by client or therapists towards an emotional connection, bond, or engagement can lead to difficulties, and therefore therapists should recognise such limits and bring the therapy to a close, as was noted by participant 6: “I’ve learned that it’s not very helpful to continue to pursue a therapeutic process when clearly there is no therapeutic engagement and the resistance is such that it’s not making any progress and therefore it’s better simply to confront that and if necessary draw the therapy to a close”. Participate 8 reported words like “don’t like” and “can’t find.” Participant 6 actually called the client “very hostile and very um challenging.” The hesitation in the description would seem to indicate that the therapist did not like calling a patient challenging but does admit that the client was defensive.

6.2.4. Subtle attributes and competencies of an emotional connection
All participants have substantial attributes and competencies of a good therapist (refer to table 5), for enabling an emotional connection under the following data emerging categories: openness, acceptance, clarity, honesty, flexibility, alive, courage, safety, care, trust, and patience. The findings also support Norcross (2002), framework of therapeutic relationships as discussed in literature review, such as; the alliance, cohesion, empathy, goal consensus and collaboration, positive regard, congruence, feedback, repair of alliance ruptures, self-disclosure, countertransference (management of) and relational interpretation. Participant 8 claimed that the most valuable assets of a sound emotional connection are “comfort, encouragement, and clarification…time for me to get to know the person and time for them to get to know me… and relating to people.” For participant 2, a good emotional connection within the therapeutic relationship is constituted of trust, listening, the ability not to be judgmental, and a personal compatibility: “a therapeutic relationship usually works the best when there’s some sort of compatibility between the personality of myself as a human being, regardless of my you know interpreting approach and knowledge and the personality of the client.” Gaining a client’s trust leads to an “understanding . . . to feel safe enough to start gradually settle more and more into therapy and bring more painful issues to deal with,” as participant 2 indicated. Thus, trust and openness may lead to progress. The notion of trust and openness to facilitate the connection process is also related to implicit memories as explained by Epstein (1991). The implicit memory is context specific and is composed of both rational and experiential cognitive systems. The experiential system is the more emotional one and is based on things like feelings and vibes that are actually a response to past experiences. Some participants’ responses seemed to indicate that a therapist must overcome the clients and therapists implicit memories to gain a client’s trust. For example, participant 8 commented on the need for the client to “feel safe” and to bring openness to the session. Without the implicit (and explicit) memories there were be no learned feelings to overcome.
This phenomenon is echoed by participant 9, who reported that the healing factor of any therapeutic relationship is prevalent in the connection that the two people in the therapy setting have. Participant 9 suggested that it is easier to emotionally connect with another if a relationship is formed that is “more on a dialogical relationship, which means more human to human, on a more equal level.” Furthermore, participant 3 reported that it is about being “reliable” and being “consistent,” yet at the same time being “flexible to what they need me to be… my relationship has to vary depending on them to some extent.”
Safety and security are also two very prominent ideals for a good therapeutic relationship, and are two elements that are related closely to trust. Participant 8 spoke of safety and trust as components of a successful therapist-client relationship. Participant 5 echoed this comment:
‘[The] best I can generally hope for is a good relationship where I feel pretty confident, eighty five, ninety percent, at least eighty five percent confident that my client feels eighty five, ninety five percent safe with me erm but that’s the very best. There’s no more to it, there’s no substance to it.’

Of course, the subtle balance that should be maintained between challenging clients and ensuring that they feel safe and cared for is difficult, but important, and must change and adapt to certain clients, depending on their needs. Participant 10, for instance, claimed that whilst he tends “to adopt a rather warm and open stance, emotionally… active, positive and let’s connect, let’s understand let’s do some work, let’s invent some experiments, let’s figure out what the problem is,” at the same time, he can also be “quite challenging, quite confronting, you know I don’t pussy foot around,” depending on the client’s needs, and how the participant feels the client is most likely to have a positive motivation and experience. Altering the therapeutic connection to adapt to the client as an individual was also explored by participant 6, who reported:
“For me, it differs with each person I’m working with. It manifests itself in different ways, it develops at a different pace, it can be ruptured by different things, it can be easier or more difficult to maintain depending on the nature of the process and the transaction.”

The honesty that clients require provides the crux of participant 12’s therapy practice. Participant 12 claimed:
“I think that the therapeutic relationship has to engage someone with real honesty right from the first second… the only way you can engage with a child is to be really honest with a child. To be really authentic. Not to talk down to that little child, not to put on any kind of a face, just to be there in the room, in that moment…. And that’s exactly the way I am with adults”.

The need for hope and optimism was also discussed by participant 3 and was added as a valuable asset in therapeutic relationship. Participant 3 noted:
“Optimism yes, I believe in the value of hope, I don’t believe there’s any such thing as false hope, it doesn’t mean anything at all because hope stimulates you in your system, it’s very important.”
Participant 4 noted honesty and genuineness within an empathetic approach as vital for the therapist and stated: “honesty and empathetic approach, I guess, um, openness, a willingness, um, honesty, um, genuineness”. The genuineness or authenticity of the therapist’s responses to the client can create those “now moments” during which something important happens. Stern and colleagues (1998) described an important moment as a “moment of meeting” during which the relationship changes. The authentic moment does not even have to be verbally explicit, and that is reflected in Participant 12’s comment to “not to put on any kind of face, just be there in the room, in that moment.” One major element of the emotional connection between both the client and the therapist that participant 12 reported as essential to the therapeutic relationship is courage, claiming that the therapeutic relationship is “two very brave people trying to be honest with each other…trying to trust a complete stranger is a big deal for any two human beings.” Therefore, participant 12 claimed, “courage…That’s the primary quality. I think courage to get out of the way of the processes between you and another person. To leave yourself out of the room. And to let what is happening happen.” The ability to have the aforementioned competencies’ will create the context of trust and connection. As also suggested by Stupp (1986) the therapist’s skills consist of an ability to create a particular interpersonal context, and within that context to facilitate certain kinds of learning.
6.2.5. Presence
Being present is a predominant theme in the literature concerning the therapeutic relationship. In these interviews, being present also emerged and described in terms of the emotional connection that the participants felt with their clients. A solid, safe, ‘alive’ emotional connection was very much rooted in the present day, when the therapist engaged fully with the client on a cognitive and emotional level. Participant 1 stated that the therapeutic practice should be focused on:
“Being present with the client and attending to their needs, you know, finding out what they need, where, where they want to go um assessing what are their skills, what are their abilities to, to get where they want to be and what are they going to have to do to get there, what’s the reparative work that they’re going to have to do in terms of erroneous beliefs or irrational beliefs to use the Rational emotive behavior therapy lingo and what are the skills that they’re going to have to learn that they didn’t get growing up, what are the traumas, the losses. I think a lot of clients have to have a lot of grieving that they have to do”.

Furthermore, being present was related to the therapist consistency and time reliability, a key variable of the therapeutic relationship. According to participant 2, being there involves being “physically present… week after week at a particular time, consistent.” In being present, the therapist is letting the client know that “during the fifty minutes time that you are with him you are fully present and you are there for him…And you are communicating somehow with you know you do care about what goes on.”
When dealing with difficult emotions, participant 2 claimed that he “will kind of sit with it, try to make sense of it, understand it” and that it is important to be “very still and very, very much present.” Participant 1 viewed that the crux of the therapeutic relationship with clients as “going with [the client], being with her through those emotions helping her to deal with them effectively er to give her reassurance.” Participant 12 concurred, reporting:
“You have to just be with what they’re feeling…[Other therapists] want to fix stuff just because whatever the patient is feeling is scary. So you have to be willing to be with that level of pain, just be with it, without trying to fix it or change it, run away from it, minimise it, identify it, label it or anything else, just be with it. …You have to be right there. So you can’t avoid feeling the things yourself….And if I feel moved or tearful, I tell my patient that is what I’m feeling”.

Participant 1, however, claimed that being available in the present also has its implications for the past and the future, reporting that it is important to “engage with what’s going on and in the here and now but relate it to the past, use it to predict the future or create in the future what the client wants.” Again, this is in keeping with the idea of displacement of memories and feelings that individuals may have had when they were growing up, which can manifest as negative tendencies or anxieties in the present. The idea of presence in the therapeutic relationship also relates to the notion of ‘now moments’, as just mentioned and as discussed in the literature review, which are charged moments of truth, explored by Stern (1998). These moments are important, and the therapist’s being present, Stern (1998) noted, is the only way that these moments can be tapped into.
6.2.6. Role of the therapist.
Most of the participants discussed the role that they play as a therapist within the emotional connection that they experience within the therapeutic relationship. Interestingly, different participants saw the role that the therapist played slightly differently. For example, participant 8 described the relationship with the client as being “[l]ike a parent and a child and a parent being there to explain to the child kind of how the world is and why things are as they are; and when things go wrong, helping the child to sort of make sense of them”. This parental figure is also reflected in participant 2’s notion of the therapeutic relationship:
“There’s something also to a certain degree quite paternal in that relationship because you’re, you know, me, myself as a therapist I’m in a kind of more powerful position. I’m working with someone who is vulnerable and if you think about…all sorts of processes that happens in therapy so er I might be perceived as the parent, the client might experience me as a parent”.

Whilst this is a fairly common experience and interpretation of the therapist-client relationship, it is not always a beneficial one or one that works, as participant 4 reported about one client:
“I represent her, um, abusive father sometimes, you know, someone who is quite controlling of her, as a child, and so sometimes she will see me as controlling of her, er, particularly when I’m trying to … I guess, trying to get to help her to look at changing some of her behaviours, because she has a lot around the emotion dysregulation so when she gets angry, for instance, she finds it very difficult, once it, sort of, takes off, she finds it very difficult to control it”.

Participant 1 viewed the paternal element of the therapeutic relation as being a form of attachment that is made between the client and the therapist, an attachment that did not happen correctly during the client’s childhood, which is why “the clients are having problems today”.The idea of the therapist being a substitute figure and a surrogate mother that the client can ‘attach’ themselves to is prevalent in many therapy theories, and is one that resonates quite strongly with participant 1’s view of herself within the relationship. Attachment functions, and specifically attachment to the therapist, could mirror and emanate clues for the therapist of the early attachment pattern of the child to the mother. This is also linked to the idea of meta-cognition and reflective functioning (Main 1991, Fonagy et al., 1996) as does Bion’s (1962) concept of ‘containment’. Participant 1 claimed that the lack of emotional connection that a client has with others in their lives often leads the therapist to play the role of the figure that the client can attach themselves onto, which comes with responsibilities:
“Part of it I think is being sensitive to the client’s needs as mum or the good attachment figure ought to be to the child’s needs. That’s how I see it today in rather simplistic terms…[I am] a substitute for emotional connection with her partner of twenty two years er that’s where the issue that brought her to therapy”.

This verbatim is asserting the vital role of a good attachment and this means that the therapist must be able to tolerate clients relating in ways that belong to early stages of development. This connects with the work of Freud (1924) in his paper ‘Neurosis and Psychosis’ and the idea that “in the psychoses the…ego in the service of the id, withdraws itself from a part of reality” (Freud, 1924). The “corrective emotional experience” relates to this participant’s descriptions as discussed in our literature review. Emotions are influenced by early experiences, such as attachment, and are influenced by cognitive appraisal (Lazarus, 1994). This is also linked to Mayer and Salovey’s (1997) ideas about our abilities to recognize and regulate emotions in ourselves and in others (Mayer and Salovey, 1990; Goleman, 1985; Bar-On, 1997).
Playing the role of an attachment figure means accommodating and accepting the client’s needs. The therapist takes the role of the mother during the developmental stages of the child (but now an adult) and offers now a new experience of resolving contradictions and incongruity. The patient now in the relationship with the therapist needs to experience the child within and resolve it by recognising that he or she has mixed feelings and that these result from the contradictory way the parents behave. Main (1991) suggests that it is the mother’s ability to reflect on the child’s internal state. Participant 3, for instance, reported:
“I changed myself in this role, and I think when you start off, often the feeling is you’re trying to help people but actually I’ve learnt that if you allow people to just be and accept them they find their own way of accommodating what’s happened to them.”

The theme of the parenting role is consistent with the notion of reflective functioning of Fonagy et al. (1991). The therapeutic relationship re-enacts the parental role which is like the mother’s ability to reflect on the child’s internal state. Similarly, the client in a secure relationship with the therapist (e.g., parental role) can make an assumption that his or her mental state will be appropriately reflected on and responded to accurately (Fonagy et al., 1991). Adapting to the client’s needs resonates with most of the participants, especially in terms of the roles that they play. Most participants concurred that they are different as therapists than they are in their own social and personal lives, and that the therapeutic relationship is, above all, a professional relationship, where the therapist is ‘playing a role,’ as participant 6 indicated:
“If I put my therapist hat, I’m quiet by nature, I’ve a high positive regard about my client, because when I’m working with very, very disturbed clients, if I don’t succeed when there is a chance for them, well, I would have gave up this job”.

Participant 4 concurred:
“[T]he professional relationship is different to a personal relationship. Although there are aspects, maybe, of you that you bring in, but you don’t do it in the same way as you do on an outside, er, personal relationship.”

Forming attachments to therapists or viewing them as parental figures is common in successful therapeutic relationships. This finding may also relate to the idea that when an individual is growing up, their subconscious or early relationships with their parents may not have been wholly satisfying, or the guidance that they perhaps should have received in order to view the world as ‘fundamentally friendly’ as opposed to ‘fundamentally threatening’ was wanting.

6.3. Theme C – Mindfulness
The term mindfulness was thoughtfully used by some participants; others did not so much use this term but described its meaning when discussing the roles of emotion and cognition within the therapeutic relationship. Mindfulness suggests that being aware of one’s own emotions and those of others, and working to unpack these emotions and cognitively make sense of them, is an important tool in a successful therapeutic alliance. In order to understand how emotions and cognitive considerations go hand in hand, emotions will be discussed first, and all the issues that arose during the interviews concerning emotions, and then the place of cognition in emotion as viewed by the participants will be presented and discussed.

6.3.1. Emotions
Therapists deal with emotions as a component of EI, and therefore it was important to learn what ideas practicing therapists possess about emotions. Most participants had a similar idea of what emotions were, and why they existed. Participants seemed to support previous concepts of emotions as discussed in the literature review. Popular concepts of emotions are those, for instance, of Lazarus (1994) and Solomon (2003), who both view emotions as elicited according to an individual’s interpretation or evaluation of important events or situations. In particular, Solomon (2003) suggested that emotions are not feelings but judgments, a web of constitutive judgments through which things appear in a certain way. As does participant’s 4 statement “for me, emotion, it’s a sign who give information”. Whilst participant 10 also noted “…human beings have an ability to use words with meanings, you know because we have a symbolic system called language but other than that we communicate with emotion, which is a subliminal communication through the body, tone of the voice, through the eyes, physical posture, hands waving about, you know, all of that stuff is mostly communicating emotion.”
Moreover, Damasio (1999) argued that consciousness is dependent on or founded upon an awareness of the somatic environment, which supports Rowan’s (1998) concept of linking as a term to describe a special type of empathy and an embodied nature of the connection between therapist and client. Participant 10 describes emotion as a complex reaction that engages both our mind and body and summarized:
‘I think the mind body system is one system, so I don’t think one can really separate it out. I mean the cognitive bit of me was in a panic trying to think of something to say, you know, the fight flight stuff was going on in the body, and also there’s a certain amount of “fucking bitch, Jesus I hate you”.

The description of participant’s notion of emotions encapsulates the primitive mammal’s function of flight-or-fight system, as well as a subliminal communication through body language. That was further supported by participant 7, saying “emotions are powerful they’re often primitive stuff to avoid you getting into trouble”. Whereas, the relationship of emotions to needs was noted by participant 3:
“[Emotions] tell us what to do physically as an animal, emotions are instructions in a way about our situation and they lead to behaviours which are about survival basically, so I think they’re in your body and that’s how to read them and that’s how I read them in other people, because my body will react to what they’re saying, although my mind is thinking ‘I need to follow that up.’

These comments support the view of researchers such as Mayer, Salovey, and Caruso (2000), who suggest emotions convey information about relationships. As was discussed in the literature review, these researchers indicated that “emotions reflect relationships between a person and a friend, a family, the situation, a society, or more internally, between a person and a reflection or memory” (p. 26).
The idea that emotions are a symbolic language is an important one, and is an idea that is prevalent in most of the participant interviews. Emotions teach humans important elements pertinent to their survival, such as their needs, whether danger is near, and so on. They can be communicated also, as participant 10 noted, “through an unconscious, habitual activity, and reflects the whole idea of what transference and counter transference is often about.” Along a similar vein, Participant 11 reported that emotions are “the neglected side of our psyches…it’s when we react to something not with our heads, but in our body, our hearts … in ways that we usually don’t understand.” This statement supports the idea that the body is an organ of information, which echoes Merleau-Ponty’s view that an understanding of our life world begins as an embodied experience. Thus, emotions appear to be whole-body experiences, which take over our senses. Participant 1 reported that even negative emotions “provide energy, emotional energy, you know, the word emotion is the same route word as motion, movement so they’re what get us going.” This is important to keep in mind, especially given that the literature has found that some emotions, even the negative ones, have useful properties, and that being able to access and utilize a whole spectrum of emotions has many benefits (Mayer, Salovey, & Caruso, 2008).

6.3.2. Difference between feelings and emotion
Prior research seems to indicate there is a difference between feeling and emotions, but at the same time, their interrelatedness is also documented. For example, Mayer and Solovey (1997) labelled a skill set in their EI model as the perception and expression of emotion that requires indentifying and expressing emotions in one’s physical states, feelings, and thoughts.
Participant 4 distinguished between feelings and emotion:
“Emotions for me are, um, things that we have, er, I guess, are linked very much in to past experiences. Um, so whereas the feeling can be what you’re experiencing in the moment, I guess it’s what links in to past experiences and, er, my past experiences, I guess, in my … which is what my emotion will come from, I guess, my experience. Um, and what links into the feeling that I’m experiencing in the present.’

Distinguished so, emotions relate to the past experiences that individuals had, and feelings relate to the way that they are experiencing the present. Given the complexity of this description, participant 3 admitted, “I think emotions and feelings can become merged, but I suppose it’s important, yeah, to separate out what is, um, where the emotion is coming from, maybe.” In contrast to participant 4, participant 11 did not define feelings and emotions in terms of their place in the past or present, but rather reported that they are regulated differently:
“I like a distinction…between feelings and emotions. Feelings are something we have so I’m feeling angry, I know that I’m angry, I know why that I’m angry and I’m not out of control. And an emotion is something that has us, completely lost control, emotion wells up from somewhere and we can’t regulate it or not easily…. I think that’s a very important distinction that’s actually quite neglected.”

Thus, the difference between emotions and feelings, according to these participants, is one wherein feelings can be easily regulated, and emotions are more difficult to regulate, as they are beyond reason. Participant 11 further explained that whilst it is “very important to have feelings in any human interaction…a lot of the time emotions take over and we don’t know what we’re doing.” Thus, from participant 11’s perspective, emotions are much more primitive than feelings, and “they’re certainly more unconscious.”

6.3.3. Emotions and Cognition
As noted previously in our literature review, emotion and cognitive control are integrated, at times working in harmony (Gross 1998). Brain neural imaging and research on the development of consciousness have illustrated the interconnectedness of thought and emotion in the brain (Damasio1994, 2000, 2003). Davidson (2003) claimed that one of the seven deadly sins of cognitive neuroscience is to assume that emotions is independent from cognition. Mayer et al. (1997) defined cognition as including memory, learning, and problem-solving, in addition to information processing. Though trait EI theories (e.g., Bar-On 1997, Petrides & Furnham 2001) are non-cognitive, most of the participants reported a place for cognition in emotion. For example, participant 1 reported, “the…triple F as I like to call it, you know, fight, flight or freeze, you know, that’s very primitive, I mean, it’s wired into our whole brain so it’s going to operate there.” Participant 8 claimed that emotions are “sort of bodily, it’s a sort of feeling … at that level but also a sort of cognitive level that it goes hand in hand really.” To explain further, participant 8 stated:
“I may be feeling something along the lines of, of what they’re talking about and what they’re feeling so there’s something at that very sort of primal level but then there’s also what, what feels like the sort of cognitive … processing of that and just er I guess I would go away from a session and I’ll be really there in my head and … and I’ll be sort of I’ll maybe carry on thinking about that and making sense of it”.

Most of the participants reported a place for cognition in emotion. Some participants did not believe that emotion and cognition were separable, in the way that other participants noted. Participant 1 reported that “we do have emotions, sensations, call them what you will, that arise from certain situations that also influence our thinking.” Participant 3 suggested that she uses emotions to understand the client:
“I’ve learned that boredom is a really interesting thing to monitor in myself. I very rarely become bored and it usually means that someone has a very passive, aggressive defense system problems… I am feeling what I am feeling and then a kind of, a cognitive commentator, who’s watching the feeling, watching what’s going on in my body”

Furthermore , participant 3 suggested that:
“the behaviour that follows the emotion, the emotion leads you to think what you must do about it, I think that’s what the emotion part of an animal is, so if I’m feeling fear then that’s because it’s not safe”.

The idea that cognition follows emotion is explicitly discussed by participant 7, who stated:
“I think probably one feels it first, cos part of the thing about therapy is that you think about your own reactions during the … whatever model of therapy you do…and then think about it. “Why did I feel so much about that” So it’s the thinking bit comes, I think, second to the emotional response. That comes first. Some people will argue that in fact what’s happened is a very fast, um, cognitive processing which goes to the, um, emotional response, but I’m not sure that that’s the case. But anyway, it feels like the emotional response comes first and then you think about what you’re having. It’s rather like when you’re thinking about transference and countertransference”.

The separation of cognitive and emotional experiences, despite the fact that they may be occurring simultaneously, or one almost immediately after another, can be identified in the idea of the ‘internal supervisor’ or cognitive ‘observer’ that practically all the participants mention, as a tactic with which to regulate and monitor the situation, to make sense of the emotions that they are feeling or that others are feeling. This is similar to the theory of Solomon, who noted, “An emotion, as a system of judgments, is not merely a set of beliefs about the world, but rather an active way of structuring our experience, a way of experiencing something” (Solomon, 1984, p.54). Participant 8 finds the internal supervisor useful for therapy:
“I’ve sort of recruited my internal supervisor then I might be thinking oh you know I wonder what’s going on here and I wonder how he’s feeling and I wonder how this is repeating a pattern for this guy from other situations in his life so I suppose in many respects I make a kind of, I use the sort of psychodynamic theory to make most sense of how emotion’s important in, in therapeutic work”.

Participant 9 also mentioned this internal phenomenon:
“There is…what we call an internal supervisor in my head…there is…a voice in my head who are telling me, “… there is something going on here.” Which…is a bit like if I internalise my supervisor, which then I am able to just think, “Okay… there is …”, when I can feel my body raising and feeling a bit more agitated, there is a voice who tells me, “Okay, calm down, breathe, stay with the client, it’s okay.”

Participant 12 also referred to a commentator:
“I’m feeling what I’m feeling and then there’s a, kind of, a cognitive commentator who’s watching the feelings, watching what’s going on in my body, watching what’s going on in my emotional centre, in my heart, and saying, I don’t know what it’s saying actually, it’s just, kind of, describing it so that, oh, I don’t know it’s an observer, really”.

Participant 3 also described this observer as though, in a room with “two or three people . . . you’re watching what’s going on between the two people.” Participant 11 claimed that, in the actual therapy setting:
“The therapist has to be able to think very fast and very widely and very deeply… it seems to require fast thought in order for the conversation to keep going, deep thought in order to understand. Then it has to be expressed in a way that isn’t just cognitive but actually touches the heart”.

The thinking that occurs in the therapeutic relationship, then, is based upon present emotions that need to be addressed. Other participants, such as participant 2, however, thought that cognitively assessing a situation when you are experiencing emotion to be unlikely. For example, this participant claimed:
“When you are able to reflect and understand your emotions then you can afterwards talk about it and discuss it with people and make sense of it. Its usually when this actually happens it might be too difficult to kind of have some sort of cognitive understanding you just kind of, especially when its very powerful you know when you’re angry yeah you might be a while that you’re angry but you’re not thinking about it because now you are busy being angry you know”.

Emotions are powerful and should be given due respect and attention for their own sake, as participant 8 indicated:
“Cognitive processes have been given far too much um sort of dominance and attention at the expense of actually…you know attending much more to emotions…when the level of somebody’s emotion is so great that just tinkering around with cognition is not really a very good well it’s not really an answer”.

The notion that emotions are real and powerful, and that parts of the brain are required in order to make sense of these emotions, were in some cases described as awareness, which summed up the idea of the cognitive brain and emotions working together to help the therapist be of use to the client in the therapy setting. As does Mayer and Salovey’s (1997) EI concept and the perception, appraisal, and expression of emotions. However, many of the participants felt that others within social sciences desire to intellectualise emotions and other experiences, in order to rationalise and make sense of them. Some of the participants criticized such rationalization, especially when discussing emotional intelligence itself, and the power of emotions. Also, many participants reported that there is an almost indescribable, subconscious spirituality that occurs within the therapeutic relationship – something that transcends reality, cognitive rationalism, and theory. These ideas all impacted on the ways in which these participants viewed emotional intelligence, and the subtle interplay between emotions and cognitive processes.

6.3.4. Physical, Emotional and cognitive awareness
Participants, when describing the process and interaction of the therapeutic relationship, identified bodily, emotional, and cognitive awareness as pivotal in this encounter. These perceptual phenomena are important in order to understand the therapeutic process. Participant 5 claimed to experience emotions cognitively:
“An emotion is something that I feel. I experience it at a vistral level. I feel it in my body. I also experience it cognitively…But it’s got far, far more impact at the visceral level (long pause). And the meaning it’s got for me…is so important”.

The cognitive almost seems to be an afterthought, however, the embodied part of cognition and emotions were noted by several participants, reflecting the influence of the embodied cognition approach (Damasio et al., 1991) and the notion that the body continuously affects and influences the mind in a substantial manner that cannot be reduced to neural activity (Damasio 2000).
According to the embodied approach, not only our body plays a special role in cognition at multiple levels, but also other bodies constitute a special object for perception. Related is the idea of intersubjectivity and the term ‘co-phenomenology’ postulated by Cornejo (2008), which says that comprehension is possible only when people are sharing similar experiencing as result of their being-in-the-world. When analyzed in this way, meaning deploys at the same time in social, phenomenological, and biological dimensions. This idea supports Damasio, who noted that emotion, feeling, and biological regulation all play a role in human reason. The lowly orders of our organism are in the loop of high reason (Damasio, 1994, p. xiii). In the same way participant 10, appears to not believe that there is a distinction between body, emotion, and cognition, reporting that emotions are both:
“I think the mind body system is one system, so I don’t think one can really separate it out. I mean the cognitive bit of me was in a panic trying to think of something to say, you know, the fight flight stuff was going on in the body”.

Most of the participants asserted a number of feelings before thinking during the therapeutic encounter, and some others noted that the therapeutic encounter is experienced as a physical and cognitive practice. For example, participant 6 noted, ‘I think it’s the physiological feeling is followed by the cognitive explanation’. The importance of body language as a communication was expressed by participant 12 by saying: ‘To pick up all the little clues about somebody’s voice, their body language, to ask questions, to keep eye contact. To modulate your voice so that it’s safe in the room. And then to just listen with your whole body to what’s happening’. The body language can communicate a level of connection and engagement.

Body language can also act as a way of animated communication and connection to the client’s experience. For instance participant 1 noted:
“[I]f somebody tells me something that’s quite um surprising or horrible or shocking I would be very likely to, to react to that so rather than just sit here and say that sounds like that was really awful or um I’d think I’d probably, there would be more animation in my voice and in my face really so I would say gosh that’s, that’s really awful, really did that happen, what did you do or how you know so be that … I think there would be more emotion there.”

The body language and ‘animation’ in the therapist’s voice and face communicates empathy and attunement with the client’s feelings. Constructing a therapeutic relationship is in itself a process of an embodiment experience Merleau-Ponty’s (1962). The aforementioned descriptions by participants describe the therapist’s body as a subject of perception and can provide invaluable information relating to the intersubjective space between therapist and client (Shaw, 2004).

6.4. Extraneous involvement
Extraneous involvement emerged as a theme, suggesting the importance of supervision and therapists’ own personal therapy in facilitating their subtle competencies within the process of the therapeutic relationship. The therapeutic relationship and EI share commonalities on theoretical conceptualization, according to the participants in this study. However, problems arise when trying to develop measures to assist therapist competencies in the clinical encounter and engage the practical use of any EI instrument in the multiplicity of relationships within psychotherapy (Clarkson 1990; 1995).

6.4.1. Supervision and personal therapy
Most participants noted the themes and importance of supervision and personal therapy supporting them and helping them in their professional development. Six participants reported supervision to be more useful than trait EI. The majority of participants noted that personal supervision was important for building up their competence. Subsequently, it is also documented in the literature review that therapist competence, along with therapeutic alliance, is related to outcome and may well be one of the key common factors across the psychotherapies (Trepka, Rees, Shapiro, Hardy 2004). The importance of personal supervision was reflected by participant 9—‘I remember needed to call my supervisor to be able to express how I felt’—and by participant 2:
“My ability to work as a psychologist, I think the best way is if an external observer…either monitor my work and gets to know me in different situations…my clinical work…as sample from my clinical work and engage with me in supervision on one to one level”.

The words, ‘ability,’ ‘external observer,’ and ‘supervision’ emphasize the idea that supervision engages a dialogical approach and creates the space and trust allowing an open relationship for monitoring therapeutic work and reflexivity. Monitoring provides information otherwise difficult to obtain: participant 7 noted ‘the other subtle bits about whether you’re really accurate about seeing someone, is very difficult to measure, partially that’s why one uses live supervision’. Monitoring also provides support, according to participant 6:
“So er and I think er supervision is quite important in that respect so that when I have my supervision which is a … not group but er one to one supervision um it’s, it’s of great value to me to be able to express my own feelings and to receive some reassurance about what’s going on and particularly when we’ve got to a point where she’s got very close to the edge to be reassured about um the level of risk and the way in which that’s being properly managed”.

The importance of supervision is cited in the literature review and supports the notion that supervision broadens therapists’ competencies and enables to explore new ways of being (Bambling, King, Rauer, Schweitzer, & Lambert 2006; Orlinsky & Rønnestad, 2005).

6.4.2. Emotional intelligence
When participants responded the possible links of EI in therapeutic relationships based on their personal experience with clients, an interesting array of perspectives emerged. For instance participants 4 seemed to accept that the theory of EI concept was relevant in therapeutic relationship: “I think EI is probably, er, very true about what goes on, and probably not as overtly, sort of, aware of the description that you have there”. Participant 12 used the words “oh absolutely, yeah” responding to the question of the link between EI and what the therapist in doing in therapeutic relationship. Whereas, some participants accepted the relevance of EI in therapy, at the same time questioned its applicability in training or therapist selection process. For instance participant 5 suggested: “there is a great difference between therapists own perceptions of their own various emotions and emotion traits. And using it not as a tool of selection but using it as a tool for education”. Thus, the participant debates the trustworthiness of TEIQue (as a self-reported method) in selection or training and suggests its use as an educational instrument.
Many of the participants reported using various facets of emotional intelligence in their therapy practice, yet there was also a sense that the self-reported TEIQue inventory cannot adequately explain or describe the subtle yet very real emotional connection, mindfulness, presence, and empathy that the therapist and the client share and experience. The TEIQue was generally perceived by participants as not significantly relevant or appropriate instrument for professional development or training, for instance, participant 1 argued:
“…that was quite a surprise really… I really struggle with that so you know… it’s just that it didn’t um feel so much like this was a particularly good or true representation of me… I’m just thinking like about that hope one seeing as I’ve … so I got 10% for optimism er organ…What so I need to be the pessimistic in, in an optimistic team. …It’s funny that because I’m in a group, a psychology group where I’ve got this reputation for being the one that’s too optimistic in myself”.

The participant expressed the great surprise at the scoring and interpretation but also her disapproval in its use or application for therapist training. Participant 10 had the same reservations and stated: “I think EI is a sort of overarching label for a whole bunch of staff,” Furthermore, participant 10 noted that therapy is a subversive activity as it is always trying to get people to think for themselves and not dictate what to think or feel:
“I had a patient who came to see me the other day she had been to her doctor with anxiety and depression and the doctor had given her a CD-rom and said she had to come into surgery one a week and work on the computer and that’s your therapy…I mean how you define EI may be this questionnaire… okay …or read Golman’s book…maybe go supervision or personal therapy and work it through organically otherwise you have no integrity with it.”

This participant encapsulated the enormous challenges of applying EI theory into actual training and practice. One aspect of such challenge between EI concept and practice of measurement in EI test, was questioned by participant 9, who stated: “how can we quantify if it’s not true behavioural attitude in the room and I think it would take some of them, then we will cluster as, well, this is the concept, or, it’s a representation of spirituality.” The meaning of words used in the TEIQue was also debated by participant 3 as arbitrary and ambiguous, and noted:
“[S]ee on this scale what the difference is between empathy and emotional perception, I would imagine empathy is more of a mental thing than a … I used to … I don’t know, um, that … I don’t know whether it matters whether … if I feel what someone’s feeling I don’t know whether the empathy bit is relevant then, according to this it doesn’t really matter does it I’ve got 96% on emotional perception and 61% on empathy and I don’t understand what would be the difference and what’s that actually distinguishing between on this questionnaire, what’s it saying. I mean do you know”

Participant 3 was confused over the TEIQue wording, whereas participant 8 expressed discomfort about the question of using the TEIQue in training: “I don’t know the answer to that Joseph because um it, it does in a way it brings up the question of how invasive or how intrusive is the training process going to be er to or on the individual involved.” However, participant 3 admitted that with some changes it can be used as part of training and continued by saying:

“So yeah, there are probably about ten things on there. How many, one, two, three, four, five, yeah ten things on there that you could pull out and say these could be turned into things, I don’t know, CPD or whatever (laughs), but probably you wouldn’t need all of them”

In a similar frame of mind, participant 9 asserted the intrusive issues of such any test and noted:
“all this kind of test can be used if it’s explained properly and not used, I suppose, to shame or to give a, er, a view of the, er, to a trainee, because keeping in mind I did this test and I have 18 years of therapy and 10 years of experience, I just wonder if someone who just in this three first months of therapy or training or the first two years or three years with less than 400 hours of one to one, and you get emotional management sixteen percent, you just think, “Well, how can I help a client manage his emotion”

Some of the participants, however, did report some of the TEIQue facets to be relevant but needed changes in order to adapt to therapeutic relationship or for playing a role in continuing professional development. For instance participant 4 referring to the TEIQue usefulness as a training tool asserted:
“No, I think this would be really, really useful, actually, er, to have. Um, because, I mean, I think half and half, I’d probably say three quarters of it is probably right, and I guess, er, you know, if you’re thinking about, um, trying to improve or trying to, um, think about what … how you are as a therapist, I guess this is really important, you know, to have some, sort of, score or some, sort of, um, judge I guess of how you are, which I guess could be invaluable..”

In a similar frame of mind, participant 6 suggested the test as a means-to–an-end but not to become clinical about it and noted:
“…enter discussion even if it’s internal discussion to get the thinking going and the engagement of the cognitive functions…[E]xperiential techniques er the use of instruments of this sort to provide an agenda for debate er and an, an, an awareness and understanding of how one interacts with other people, how one interacts with different situations, how one deals with um different challenges whether that’s um managing aggression or managing indifference or managing er transferences of various.”

The participant proposes the use of TEIQue test as part of educational and cognitive engagement. Supervision and patient feedback rather than any use of instrument for professional development or training, was suggested by participant 7, and stated:
“…would I rely on that versus live supervision No. I’d rely on live supervision and patient feedback, cos what it does, it doesn’t claim to do any more than have a snapshot of what you, the respondent, feels about answering those things”.

Supervision was described by participant 7 as an important process of engaging with therapist’s own perception and their clients by using supervision. In general, participants favoured supervision and not the notion psychometrics for professional training development. While there may be substantial differences of opinion between participants about EI and its practical application in training and professional development, it seems better to at least begin to think about its use and practical adaptability. Despite the diversification of responses among participants with regards to the EI concept and its links to the therapeutic relationship, it is in many ways a positive association. For instance, Mayer and Salovey’s (1997) perception, appraisal, and expression of emotions and level-two emotional facilitation of thoughts could be associated with the participants descriptions of containment, emotional balance, mindfulness, connection, or emotional stability. The second stage of Mayer and Salovey’s (1997) emotional facilitation of thoughts could be associated with participants’ notions of acceptance, presence, connection, openness, courage, empathy, and congruence.
6.5 Distinct contributions to the theory of emotional intelligence and therapeutic relationships from grounded methodology

Through the diligent process of open, axial, and selective coding, empathy and its balance was one of the prominent themes that emerged from the standard grounded theory approach (Strauss and Corbin, 1998) to qualitative data collection and analysis. This finding coincides with Petrides and Furnham’s (2001) trait EI model identified through self-assessment, with trait empathy being an integral ability component of emotional intelligence. This is also mirrored in Goleman’s (1995a) mixed model of EI through self-assessment, which identifies empathetic awareness as the ability to recognise emotions in other individuals. This function of empathetic awareness also takes a more expressive form when an individual’s dispositions are verbally appraised, and personally identified with by another person. This was evident with ‘participant 1’ noticing how important it is to articulate their own experiences meeting the same emotionally driven event(s) reported by patients during a therapeutic session; providing credence to the notion of empathy held by Mercer and Reynolds (2002) that communicating an understanding of a person’s feelings is a strong sign of empathy.
A key contribution of the empathy component in EI theory is its interrelatedness with therapeutic relationships, which is apparent in the interview script with participant 5, who claimed an unsuccessful therapy session was, in part, influenced by a lack of empathetic awareness in terms of the recognition of common experiences between the therapist and patient. This finding supports the idea proposed by Mercer and Reynolds (2002) that empathy helps to fill the void in personal connection between what the patient’s intrinsic state of dispositions are, and the similar experiences shared by the therapist to elicit deeper understanding. Several studies have been conducted to explore the potential relationship benefits in therapy sessions, particularly in accounts of patients seeking help for eating disorders. Costin and Johnson (2002) found that patients that had therapists who did not share their own similar experiences of overcoming eating disorders, expressed less successful therapy outcomes than those patients that had more open therapists who displayed a more active empathetic awareness by revealing their personal history.

However, even in the absence of experiential connection between the therapist and patient, the empathetic awareness may be a vital component of EI that, when actively recognised through verbal communication, could fortify the patient’s willingness to share more personal details and generally engage in a more positive manner.
Application: incorporating a sense of ‘empathy and connectedness’ with the client in a therapeutic relationship.
Chapter Seven
7. Conclusion
This study was an investigation of the role of EI in therapy, the therapist‘s perspective of trait EI in therapy, and the meaning of the therapeutic relationship from therapists’ perspectives. Based on interviews with 12 counselling psychologists and therapists and an analysis of their responses using a grounded theory approach, a number of findings resulted. The most prominent themes identified through the data were empathetic balance, emotional connection, mindfulness, and extraneous involvement, all of which are related to EI theory. As a result, these four core themes were central in answering the following research question: How does the therapist‘s experience of the therapeutic relationship relate to emotional intelligence theory
From the discussion in the previous chapter we can see that there are profound differences in the way that EI concept and measurements can appear in the therapeutic setting. The participants’ descriptions of the therapeutic relationship and the emerging themes of empathetic balance, mindfulness, extraneous involvement and emotional connection could be interestingly related and linked to any of the EI models (Mayer & Salovey, 1997; Goleman, 1995; Bar-On, 1997).
The most prominent themes presented highlighted the necessity of the concept of EI for a successful therapeutic relationship. Participants’ concepts of the container/contained, empathetic balance, connection, and mindfulness all had profound similarities with EI theory, denoting essentially the same process in therapeutic relationships. EI was used in subtle, notably subconscious ways. Therapists, in their relationship with clients, must use this intelligence to balance and contain emotions properly; however, therapists must be able to regulate this skill to create balance between their empathy and their ability to look at situations objectively. In addition, therapists must be able to create emotional connections with their clients (either consciously or unconsciously) by communicating properly, being present, and meeting their clients’ therapy needs of warmth and openness. Furthermore, therapists, according to the sample in this study, must be mindful to judge situations accurately, adapt to their clients’ needs, and work objectively. These four main themes (and the subthemes derived from them) were important elements of empathetic balance and needed subtle attributes and emotional competencies for therapists. Thus, the next question for future research should be how and under what conditions emotional intelligence can be used to enhance training and therapists’ skills.
However, the TEIQue test was not regarded as an important training tool or a valid recruitment measure for applicants in counselling and psychotherapy programs. Instead, supervision was noted as the way to develop mindfulness and competencies. This was akin to the previous notion that supervisors set the limits in the supervisory process through examination of the intersubjective matrix (Auerbach & Blatt, 2001; Brown & Miller, 2002). In addition to this, our discussion in the finding section of Chapter 6 showed that there are substantial differences in the understanding and meaning of words on the TEIQue measurement among participants.
A number of caveats must be noted regarding the present study. Most qualitative approaches, not just grounded theory, have frequently been criticised for being subjective. By the same token, we could also argue that all quantitative and qualitative methods, if executed poorly, could result in biased research outcomes. It was, therefore, of paramount importance to consider the concept of reflexivity and the researcher’s reflections upon the possible bias (e.g., how research design decisions related to the analysis methods used in the study) and its effect on this research. Concerning the researcher’s personal reflexivity, a number of limitations must be considered.
Despite the limited sample size, the findings of this study indicated some critical directions for the use of EI in therapy as a means for training and career development. Although I have spent many years researching the concept of EI in education and clinical practice, I needed to think through my responses to EI as it related to participants in their therapy role. This involved reflecting on questions for improving future studies, perhaps by considering the gender, ethnicity, age, spirituality, and sexuality of participants. Those factors might affect the therapeutic relationship and, subsequently, the depth and findings of this study. Due to the sample size and purpose of this thesis, the effectiveness of the TEIQue questionnaire as a reliable and valid instrument in therapy could have resulted in further limitations for the outcome of this study. The geography, inter-rater reliability, and self- report date in general could also have negatively affected the findings.
The second limitation was that the methodology could have been resulted in greater reliability had the interview questions been more focused. Although it was important that the researcher maintain control over the direction of the interviews, a number of questions were not wholly relevant, or focused, towards the research purpose. A pilot study might have been useful in separating the relevant items from the irrelevant ones.
A third and perhaps related limitation was the many categories that arose from the data analysis approach. Although interesting, some of these categories were not wholly relevant to the subject of EI in the therapeutic relationship, such as the process or models that the therapists use in their practice. The scope of this paper was not sufficient to discuss all these categories; however, they could be included in a more extensive paper to discuss their role in the way participants make sense of their role as therapist in the therapeutic relationship. A list of these emerging categories has been given in Appendix G.
The axial-coding process resulted in the identification of many subcategories and themes; the selective-coding process was used to identify core themes or categories from the findings of this study. Four core themes drawn from the data were prevalent and salient to the subject matter at hand and to most of the interview transcripts. Thus, these were chosen as the most important core themes from which subthemes were discussed. However, it might have been helpful to ensure that the themes drawn from the data could not be reduced further into a core theme from which the research question could be addressed. Doing so would have required more time and resource, and a third opinion on the themes produced through grounded theory for this study.
To understand fully the role of EI in therapy, additional research must be conducted. Questions to research could include these: Is EI something that therapists naturally employ, whether consciously or subconsciously Is it transpersonal Can it be taught to therapists Considerably more work must be done to determine the effects of different types of EI measurements. Given the negative reactions toward the TEIQue questionnaire gleaned from the participants in this study, one focus of future research could be an exploration of therapists’ reactions to a variety of empathy measurement scores and comparison of therapists’ results and reactions. Designing an EI test specifically for therapists might also be useful. Given the lack of relevance, many of the meanings of questions and results from the instrument used in this study seemed to be confusing and ambiguous. For instance, some skills that are desirable in a social setting might not be desirable in a therapeutic setting.
Future research on EI in therapy and training should embrace a mixed design, incorporating EI inventories and supervision methods. Ideally, objective tests, such as the TEIQue or Bar-On (1997), can be adapted to measure mindfulness, emotional balance or transference / countertransference mindfulness and impacts on the therapeutic relationship. The model of EI in therapy needs to acknowledge the necessity for therapists themselves to observe, feel, intuit, think, introspect, imagine and test their own data gathering. Thus, attitude itself will influence the phenomena of engagement. However, it will remain essential to explore the complex issue of transpersonal relationship and intersubjectivity, which does not readily submit to objective measurement. The best means for learning about the transpersonal relationships and intersubjectivity may be supervision since the intersubjective matrix, including supervisor countertransference, is accessible to all participants. Intersubjective engagement is to recognise that therapeutic alliance is best achieved in a climate of care and mutual respect. The therapeutic relationship needs to offer such care, with openness and acceptance and not imposed it in an intellectual engagement. The therapeutic process must accept humans’ need for autonomy, self-determination, and provide security and safety in making mistakes. In this therapeutic relationship model, EI needs to acknowledge the fluidity of human engagements, as a dynamic and autonomous process engaging the past and the present, the felt and the unknown, the transpersonal and the visible. An understanding of this process and the ability to put it into effect generally mark an empathically intelligent person.
Any future study should also have more resources available to encompass a larger sample based on a judgment sample (purposeful sample). In this process, the researcher actively selects the most productive sample to answer the research question and enhances reflexivity and the framework of the variables that may affect an individual’s contribution. It could also be advantageous to study a broad range of participants, recruiting both male and female interviewers and a special expertise sample. Important variables to consider in sample selection should include gender, ethnicity, spirituality, sexuality, experience, and therapeutic practice model orientation. Useful potential candidates for the study could also be recommended by participants (a snowball sample of subjects). During interpretation of the data, researchers must consider therapists who support emerging explanations and, perhaps more importantly, participants who disagree (confirming and disconfirming samples). The experiences of such a diversified sample could be vital in considering the narratives of therapists and comparing and contrasting the emerging themes among groups with common attributes.
The issue of objectivity is critical for any construct being conceptualized, and the method and type of EI measurement are of paramount importance. Through the participants’ narratives of the therapeutic process, the theme of mindfulness became evident. The process of mindfulness entails an embodiment experience, emotions, and cognitive aptitudes for processing those experiences. Therefore, any measurement adopted should include cognitive aspects as well in contradiction to Bar-On’s (1997) and Petrides and Furnmans’ (2001) views that the EI is a noncognitive ability. Other important themes were also found interacting in the therapeutic relationship for the therapists’ interventions, such as the themes of connection and empathetic balance, which were both supported by extraneous involvement. Training on EI is part of the extraneous involvement.
Objectivity is also critical for any construct being conceptualized as a trustworthy and valid measure. Considering that the EI measure was divided between two conceptualizations of EI, a self-report test of trait EI (or trait emotional self-efficacy) and a tested ability EI (or cognitive-emotional ability), biases and correct responses must be considered. A number of participants in this study noted this type of self-report can be unconsciously or consciously manipulated to reflect a nice self-image. Perhaps having significant others who know the participants score the participants could result in limiting the self-distortion bias. Although trait EI can be adapted to changes over the cognitive issues, another core challenge has remained as to how and in what way the inventory should be administered to avoid self-bias responses. Perhaps future research could be conducted to investigate the use of such measurement by encompassing cognitive aspects to reason and understand emotions as well as facets of balancing emotions and relevant competencies for emotional connection.
Another important theme that cannot be accounted for through the use of any change in the EI measurement is transpersonal and spiritual relationship. Determining whether EI is a measurable quality is a core issue within the transpersonal theme in this study that has not been countable in any conceptualisation of EI. In search for a correct response to measure EI, both self-reported measures, such as trait EI, and consensual scoring have been utilized in studies. In the consensual scoring method, more and less correct answers to items are endorsed according to normative averages. Thus, if the group agrees that a face (or case study, verbatim, etc.) conveys an emotion of loss or rage, then that becomes the correct response. Target scoring based on the patient’s case study could also be part of such a test whereby a supervisor becomes the judge and assesses what the patient is portraying at the time the target individual is experiencing some emotional activity.
Another possible improvement to the study could be the use of ability EI, trait EI, and reports of the experiences of therapists or expertise in formulating another version of EI. The further exploration of these measurements could result in adding to a new theory on the practical adaptation of EI (ability vs. trait) in training and professional development counselling programs. These ideas relating to the validity and usefulness of EI in therapists’ training and professional development should be studied and explored further if the true meaning and use of EI is ever to be discovered. Furthermore, results gained from therapists’ studies on EI with that of individuals or therapists who are affected by conditions on the autistic spectrum, such as Asperger’s syndrome, should be cross referenced for comparison. The following questions could be addressed: Are those therapists with a low EI always affected by autistic spectrum disorders Can those with Asperger’s syndrome ever gain high EI scores
Limitations and discussion
This thesis argues that EI models and therapeutic relationship overlap and EI training can lead to sustainable improvements of emotional functioning. In particular participants in the study, characterize as important part of their therapeutic intervention the ability to correctly perceive process, understand and respond under the right therapeutic involvement and dynamics. The current research offers two main contributions. First it describes new ideas of how emotional intelligence can be applied in the therapeutic relationship process. How the therapeutic competences –for example; resilence, empathy, intuitive interpretations, inferential thinking, reflexivity, psychological control, autonomy and ability to relate to others are similar to EI concept. Second, it report with a qualitative study how a self-reported trait measurement of Emotional Intelligence (TEIQue) is perceived and experienced by qualified therapist with their professional competencies and emotional literacy. In particular is trait EI measurement relevant to those therapeutic competences and transformative to clinicians training programs. If so can it be used as a training tool to familiarise trainees with discriminating features in therapeutic interventions.
This present study is among the first to investigate EI among psychotherapist. Over the last 30 years, evidence pointing the crucial role of emotional abilities and dispositions for life success and psychological well being. Most if not all of the research in EI is quantitative and is focusing on correlation of EI and mental health, leadership or life satisfaction. At a psychological level, Bar-On (1997) demonstrated the EQ-I total scores are positively related to measures of emotional health, and negatively related to measures of psychopathology and neuroticism).Higher trait Ei is associated with greater well-being and higher self-esteem (Schutte, Malouff, Simunek, McKenley, & Hollander, 2002). As well as a lower risk to develop psychological disorders for example Trait EI negatively correlated with depression in studies by Dawda and Hart (2000) and Schutte et al. (1998), and psychological distress (Slaski & Cartwright, 2002, Mikolajczak, Luminet, &, Menil 2006).
Socially, higher ability-trait EC is related to better social and marital relationships (Lopes et al., 2004; Lopes, Salovey, Côté, & Beers, 2005; Schutte et al., 2001) There are a variety of cross-over subjects that emotional intelligence has been related to, including life satisfaction and success, social network size, loneliness (Saklofske, Austin, & Minski 2003),
In academic and work success, higher trait Ei is associated with greater academic achievement (Petrides, Frederickson, & Furnham, 2004). Various studies like those of Bar-On (1997) and Martinez-Pons (1997) have been specifically focused on the role that EI plays in the prediction of life satisfaction, and found that those people with a higher emotional intelligence were more likely to have greater outcomes.

Let us now summarise the key findings:
1. The overlap between EI and the therapist themes of relational competencies. For example Mayers and Salovey’s (1997) perception, appraisal and expression of emotions and emotional facilitation of thought is linked with the participants themes and categories of Benevolent connection (containment, presence, subtle competencies, role, spirituality). The second stage of Mayer and Salovey (1997) namely Emotional facilitation of thinking could be linked to the participants theme of Mindfulness and categories of feelings V emotions, Emotions and cognition, Physical, emotional and cognitive awareness. Whist the higher stage of Mayer and Salovely understanding and analysing emotions and the reflective regulation of emotion to promote emotional and intellectual growth, resonates a link with the participants theme on Empathetic Balance.
2. The most prominent themes presented highlighted the potential value of EI in counselling and psychotherapy programmes. This denotes the usefulness of developing EI training competencies which could lead to improvement of emotional functioning and contribute to an effective therapeutic relationship.
3. The concept of EI as part of an integrated training programme in counselling and psychotherapy training.

As a first study into this area replication is strongly needed. Use a different design – Triangulation is a powerful technique that facilitates validation of data through cross verification from two or more sources. In particular, it refers to the application and combination of several research methodologies in the study of the same phenomenon.

A number of important outcomes emanated from this research experience. First, using EI as part of developing emotional learning and build on therapeutic competencies, appear to lack a clear theoretical rationale and techniques of which EI training programs can emerge from their current dubious bases.
Second we need to address and investigate how the themes emerged as important in the therapeutic relationship and the existing EI re-integration of a research measure is appropriate for implementation in training. While measures of therapist process or therapeutic relationship intervention (e.g., Trait EI) could help trainees to have knowledge and understanding, ‘what to do as a therapist’, client process measures on the other hand would help trainees to perceive what is happening in the session. This research was focused on the process of therapy and therapist subjective experience of therapy and trait EI. Further studies need to encompass more information on the outcome and process.
Thirdly we need to develop appropriate EI teaching module for psychotherapy training purposes, using a series of group training session, including group discussion, role plays, lectures and homework focused on perception, appraisal and expression of emotion, emotional facilitation of thinking, understanding and analysing emotions and reflective regulation to promote emotional and intellectual growth. Supervision and perhaps an expect consensus panel can limit the limitations of trait EI or ability EI pitfalls. Psychotherapy and counselling training teams offer an ideal environment in which such modules can prosper. Training would be implemented early in the doctoral program and discussion on EI facets would be offered under supervision.
In this study, I did not seek to present myself as an all-knowing expert but rather as an honest individual conveying my doubts and the limitations of the existing status quo in therapeutic relationship and EI research. Throughout this encounter, I remained reflective to avoid a closed judgement on the issue under investigation. However, I am also mindful of exuding a sense of “knowing it all.”
References:

Ackerman, S. J., & Hilsenroth, M. J. (2001). A review of therapist characteristics and techniques negatively impacting on the therapeutic alliance. Psychotherapy: Theory, Research, Practice, Training, 38, 171–185.

Auerbach, J. S., & Blatt, S. J. (2001). Self-reflexivity, intersubjectivity, and therapeutic change. Psychoanalytic Psychology, 18, 427–450.

Ackerman, S. J., & Hilsenroth, M. J. (2003). A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review, 23, 1-33.

Adams, S. (1997). Journey to Cubeville. Kansas City, MO: Andrews McMeel Publishing.

Alexander, F., French, T. M. (1946). Psychoanalytic therapy: Principles and application. New York: Ronald Press.

Anand, R. (2010). Emotional intelligence and its relationship with leadership practices. International Journal of Business and Management, 5(2), 65-76.

Anderson, M. (2003). Embodied cognition: A field guide. Artificial Intelligence, 149, 91–130.

Andrews, F. M., & Robinson, J. P. (1991). Measures of subjective well-being. In J. P. Robinson (Ed.), Measures of personality and social psychological attitudes (pp. xx-xx). Place of publication: Gulf Professional Publishing.

Anghel, Deborah, and Hicks (2010). Self-Awareness and Personal Development in Social Work Education – A Pilot Programme of Experiential Workshops. Social Work and Social Policy Department, Faculty of Health and Social Care. Networks Issue 13, February 2010.

Assagioli, R. (1991b). Transpersonal development. The dimension beyond psychosynthesis. San Francisco: The Aquarian Press.

Atwood, G. E., & Stolorow, R. D. (1984). Structures of subjectivity: Explorations in psychoanalytic phenomenology. Hillsdale, NJ: The Analytic Press.

Bachelor, A., & Horvath, A. O. (1999). The therapeutic relationship. In M. A. Hubble, B. L Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 133-178). Washington, DC: American Psychological Association.

Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.

Barbour (1984). Social Work Education: Tackling The Theory—Practice Dilemma. Br J Soc Work (1984) 14 (1): 557-578.
Bidgood, Holosko, and Taylor (2003). The history of the working definition of practice. Research on Social Work Practice, 13(3), May 2003, pp.271-283. Publisher: Sage.

Boud, D. (1999). Avoiding the traps: Seeking good practice in the use of self assessment and reflection in professional courses. Social Work Education, 18, 121–132.

Boud, D., Keogh, R., & Walker, D. (1985). Reflection: Turning experience into learning. London: Kogan Page.

Bambling, M., King, R., Raue, P., Schweitzer, R., & Lambert, W.(2006). Clinical supervision: Its influence on client rated working alliance and client symptom reduction in the brief treatment of major depression. Psychotherapy Research, 16, 317-331.

Barrett, L. F. (in press). On the automaticity of emotion. In J. Bargh (Ed.), Automatic processes in social thinking and behaviour. New York: Psychology Press.

Baron-Cohen, S., & Goodhart, F. (1994). The “seeing leads to knowing” deficit in autism: the Pratt and Bryant probe. British Journal of Developmental Psychology, 12,397-402.

Baron-Cohen, S., Tager-Flusberg, H., & Cohen, D. (Eds.). (1993). Understanding
other minds: perspectives from autism: Oxford University Press.

Bar-On, R. (1996). The emotional intelligence inventory (EQ-I): A test of emotional intelligence. Toronto, Write my essay for me – CA Essay writer Canada: Multi-Health systems.

Bar-On, R. (1997). The Emotional Quotient Inventory (EQ-i): Technical manual. Toronto Write my essay for me – CA Essay writer Canada: Multi-Health Systems.

Bar-On, R. (2000). Emotional and social intelligence: Insights from the Emotional Quotient Inventory. The handbook of emotional intelligence. SanFransico: Jossey-Bass.

Bar-On, R. (2005). The impact of emotional intelligence on subjective well-being. Perspectives in Education, 23(2), 41-61.

Bar-On, R. (2006). The Bar-On model of emotional-social intelligence (ESI). Psicothema, 18, 13-25.

Bar-On, R., Brown, J. M., Kirkcaldy, B. D., & Thome, E. P. (2000). Emotional expression and implications for occupational stress: An application of the Emotional Quotient Inventory (EQ-i). Personality and Individual Differences 28, 1107-1118.

Bein, E., Anderson, T., Strupp, H.H., Henry, W.P., Schacht, T.E., Binder, J.L., & Butler, S.F. (2000). The effects of training in time-limited dynamic psychotherapy: Change in therapeutic outcome. Psychotherapy Research, 10, 119-132.

Beebe, B., & Stern, D. N. (1977). Engagement-disengagement and early object experiences. In M. Freedman & S. Grand (Eds.), Communicative structures and psychic structures. New York: Plenum Press.

Beebe, J. (1988). Primary ambivalence toward the self: Its nature and treatment. In N. Schwartz-Salant & M. Stein (Eds.), The borderline personality in analysis (pp. 97-127). Wilmette, IL: Chiron.

Bennett-Levy, J. (2006) Therapist skills: their acquisition and refinement. Behavioural and Cognitive Psychotherapy, 34 (1): 57–78.

Beck, A. T., & Clark, D. A. (1997). An information processing model of anxiety: Automatic and strategic processes. Behaviour Research and Therapy, 35, 49-58.

Beck C.T. (1993) Qualitative research: the evaluation of its credibility, fittingness, and auditability. Western Journal of Nursing Research 15, 263–266.

Bergin, A.E. (1971). The evaluation of therapeutic outcomes. In AE Bergin & S.l Garfield, Handbook of psychotherapy and behavior change. New York; Wiley.

Berman, J.S, & Norton, N.C. (1985) Does professional training make a therapist more effective Psychological Bullettin, 98, 40-407.

Bernard, J.M., & Goodyear, R.K. (2004). Fundamentals of clinical supervision (3rd ed) Boston: Allyn & Bacon.

Bion, W.R. (1962). Learning from Experience. London: William Heinemann.

Bion, W.R. (1970). Attention and Interpretation. London: Tavistock.

Bion, W.R. (2005). The Tavistock Seminars. London: Karnac.

Booth-Kewley, S., & Friedman, H. S. (1987). Psychological predictors of heart disease: A quantitative review. Psychological Bulletin, 101, 343-362.

Bochner, A.P. (1984). The function of communication in interpersonal bonding. In C.Arnold and J.Bowers (Eds), The Handbook OF Rhetoric and Communication (pp.544-621). Thousand Oaks, CA: Sage.

Bochner, A.P. (2001). Narative’s virtues, Qualitative Inquiry, 7, 131-156.

Boyatzis, R. E., & Kolb, D. A. (1991). Learning Skills Profile. TRG.

Bower, G. H. (1981). Mood and memory. American Psychologist, 36, 129-48.

Bowlby, J. (1958). The nature of the child’s tie to his mother. International Journal of Psychoanalysis, 39, 350-373.
Bowlby, J. (1969). Attachment and loss. Vol. 1. Attachment. New York: Basic Books.
Bowlby, J. (1988). A secure base: Clinical applications of attachment theory. London: Routledge.

Bradberry, T., & Greaves, J. (2009). Emotional intelligence. San Francisco: Publishers Group West.

Braud, W. (1998). Can research be transpersonal Transpersonal Psychology Review 2(2): 9–17.

Braver, T. S., Cohen, J. D., & Barch, D. M. (2002). The role of the prefrontal cortex in normal and disordered cognitive control: A cognitive neuroscience perspective. In D. T. Stuss & R. T. Knight (Eds.), Principles of frontal lobe function (pp. 428–448). Oxford: Oxford University Press.

Braud, W., & Anderson, R. (1998). Transpersonal research methods for the social sciences. Thousand Oaks, CA: Sage.

Bryant, A. (2002). Re-grounding grounded theory. JITTA: Journal of Information Technology Theory and Application, 4(1), 25.

Brown, L. J., & Miller, M. (2002). The triadic intersubjective matrix in supervision: The use of disclosure to work through painful affects. International Journal of Psychoanalysis, 83, 811–823.

Brushweiler-Stern, N., & Tronick, E. Z. (1997, March). Mechanisms of change in psychoanalytic therapy: Implicit relational knowing, the “something more” than interpretation. Symposium conducted at the meeting of…Boston.
Bruner, J. S. (1957). Going beyond the information given. In J. S. Bruner et al. (Eds.), Contemporary approaches to cognition, pp. 41-69, Cambridge, MA: Harvard University Press.

Buber, M. (1958). I and thou. New York: Scribner

Buck, R. (1984). The communication of emotion. New York: The Guilford Press.

Burck, C. (2005). Comparing qualitative research methodologies for systemic research: The use of grounded theory, discourse analysis and narrative analysis. Journal of Family Therapy, 27(3), 237-263

Burns, D. D., & Nolen-Hoeksema, S. (1992). Therapeutic empathy and recovery from depression in cognitive-behavioral therapy: A structural equation model. Journal of Consulting and Clinical Psychology, 60, 441-449.

Burns DD, Auerbach A (1996). Therapeutic empathy in cognitive-behavioural therapy: Does it really make a difference In: Paul M Salkovskis (ed). Frontiers of cognitive therapy. New York/London: Guilford Press, 1996: 135-164.

Cadman, C., & Brewer, J. ( 2001). Emotional Intelligence: a vital prerequisite for recruitment in nursing. Journal of Nursing Management, 9, 321-324.

Carroll, J. B. (1993). Human cognitive abilities: A survey of factor analytic studies. Cambridge, England: Cambridge University Press.

Catto, G. (2005). GMC and the future of revalidation: Building on the GMC’s achievements. British Medical Journal, 330, 1205–1207.

Chapin, F. S. (1967). The social insight test. Palo Alto, CA: Consulting Psychologists Press.

Charmaz, K. (1983). The grounded theory method: An explication and interpretation. In R. Emerson (Ed.), Contemporary field research: A collection of readings (pp. 109-126). Boston, MA: Little Brown Company.

Charmaz, K. (1990). ‘Discovering’ chronic illness: Using grounded theory. Social Science and Medicine, 30(11), 1161-1172.
Charmaz, K. (2000). Grounded theory: Objectivist and constructivist methods. In N. Denzin & Y. Lincoln (Eds.), Handbook of qualitative research (2nd ed., pp. 509-535). Thousand Oaks, CA: SAGE.

Charmaz, K. (2003). Grounded theory – Objectivist and constructivist methods. In N. K. Denzin & Y. S. Lincoln (Eds.), Strategies of qualitative inquiry (pp. 249-291). London: SAGE.

Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London: SAGE.

Charmaz, K. (2007). Constructionism and the grounded theory method. In J.A. Holstein & J. F. Gubrium (Eds.), Handbook of constructionist research. Place of publication: Guilford Press.

Charmaz, K., & Bryant, A. (2007). The SAGE handbook of grounded theory. Place of publication: SAGE.

Cherniss, C. (2001). Emotional intelligence & organizational effectiveness. In. C. Cherniss & D. Goleman (Eds.), The emotionally intelligent workplace (pp. 1-12). San Francisco: Jossey-Bass.

Cherniss, C, & Goleman, D. (2001). Training for emotional intelligence. In C. Cherniss & D. Goleman (Eds.), The emotionally intelligent workplace: how to select for, measure, and improve emotional intelligence in Individuals, Groups, and Organizations (pp. 209-233). San Francisco, CA: Jossey-Bass.

Churchill, S D (2000) Phenomenological psychology. In A D Kazdin (ed) Encyclopedia of psychology. Oxford: Oxford University Press.

Ciarrochi, J. V., Chan, A. Y. C., & Caputi, P. (2000). A critical evaluation of the emotional intelligence construct. Personality and Individual Differences, 28, 539-561.
Ciarrochi, J., Forgas, J. P., & Mayer, J. D. (2001). Emotional intelligence in everyday life: a scientific enquiry. Place of publication: Psychological Press.

Ciarrochi, J., Deane, P. F., & Anderson, S. (2002).Emotional intelligence moderates the relationship between stress and mental health. Personality and Individual Differences, 32, 197-209.

Clarke, A. E. (2006). Feminisms, grounded theory, and situational analysis. In S. Hens-Biber & D. Leckenby (Eds.), Handbook of feminist research methods (pp. 315-376). Thousand Oaks, CA: SAGE.

Clarkson, P. (1990). “A Multiplicity of Psychotherapeutic Relationships”.
British Journal of Pschotherapy, 7 (2) : 148 – 163.

Clarkson, P. (1995). The therapeutic relationship in psychoanalysis, counselling psychology and psychotherapy. London, England: Publisher.

Clarkson. P. (2002). The Transpersonal Relationship in Psychotherapy: The Hidden Curriculum of Spirituality, London: Whurr Publishers.

Clore, G. (1994). Why emotions are never unconscious. In P. Ekman & R. Davidson (Eds.), The nature of emotions. Fundamental questions (pp 285-290). New York: Oxford University Press.

Corbin, J., & Strauss, A. (1990). Grounded theory research: Procedures, canons, and evaluative criteria. Qualitative Sociology, 13, 3-21.

Cooper, M. (2004). Towards a relational-orientated approach to therapy: Empirical support and analysis. British Journal of Guidance and Counselling, 32, 4.

Cooper. M. (2005) Cooper M. Therapists’ experiences of relational depth: a qualitative interview study. Counselling and Psychotherapy Research. 5(2):87-95.

Cooper, R. K., & Sawaf, A. (1997). Executive EQ: Emotional intelligence in leadership and organizations. New York: Grosset/Putnum.

Cornejo, C. (2008). Intersubjectivity as Co-phenomenology: From the Holism of Meaning to the Being-in-the-world-with-others. Integrative Psychological and Behavioral Science 42:171–178

Curtis, L., Moriarty, J. & Netten, A. (2009) ‘The expected working life of a social worker’, British Journal of Social Work, vol. 40, no. 5, pp. 1628–1643.

Dallos, R. (2006). Attachment Narrative Therapy. Maidenhead, UK: Open University Press.

Damasio, A. (1994). Descartes error! Emotion, relation, and the human brain. New York: Penguin Books.

Damasio, A. (1999). The feeling of what happens: Body, emotion and the making of consciousness. London: Heinemann.

Damasio, A. (2000). The feeling of what happens: Body and emotion in the making of consciousness. London, England: Vintage.

Damasio, A. (2003). Looking for Spinoza: Joy, sorrow and the feeling brain. New York: Harcourt.

Damasio, A. (2010). Self comes to mind. New York: Pantheon.

Damasio, A. R., Tranel, D., & Damasio, H. (1991). Somatic markers and the guidance of behavior: Theory and preliminary testing. In H. S. Levin, H. M. Eisenberg & A. L. Benton (Eds.), Frontal Lobe Function and Dysfunction (pp. 217–229). New York: Oxford University Press.

David, S. A. (2005). Emotional intelligence: Conceptual and methodological issues, and its role in coping and well-being. (Unpublished doctoral dissertation). University of Melbourne, Melbourne: Australia.

Davies, M., Stankov, L., & Roberts, R. D. (1998). Emotional intelligence: In search of an elusive construct. Journal of Personality and Social Psychology, 75, 989-1015.

Dawda, D., & Hart, S. D. (2000). Assessing emotional intelligence: Reliability and validity of the Bar-On Emotional Quotient Inventory (EQ-i) in university students. Personality and Individual Differences, 28, 797-812.

Daus and Ashkanasy (2005). The Case for the Ability Based Model of Emotional Intelligence In Organizational Behavior. Later published as Journal of Organizational Behavior 2005 26 (4) : 453-466. doi: 10.1002/job.321.

Day, A. L., & Carroll, S. (2008). Faking emotional intelligence (EI): Comparing response distortion on ability and trait-based EI measures. Journal of Organizational Behaviour, 29, 761-784.

Del Barrio, C. (1999). The use of semi-structured interviews and qualitative methods for the study of peer bullying. Retrieved from http://old.gold.ac.uk/tmr/reports/aim2_madrid1.html. Accessed on 13/07/10.

Dennis, T. A. (2006). Emotional self regulation in preschoolers: The interplay of temperamental approach reactivity and control processes. Developmental Psychology, 42, 84–97.

Dey I. (1993). Qualitative Data Analysis. A User-Friendly Guide for Social Scientists. Routledge, London.

do Rozario, L. (1997). Shifting paradigms: The transpersonal dimensions of ecology and
occupation. Journal of Occupational Science 4(3): 112–118.

Doehrman, M. (1976). Parallel process in supervision and psychotherapy. Bulletin of the Menninger Clinic, 40, 3-104.

Eborall, C. & Garmeson, K. (2001) Desk Research on Recruitment and Retention in Social
Care and Social Work, Business and Industrial Market Research, London.
Ekman. P., & Davidson. R. (1994). Epilogue. In P. Ekman & R Davidson (Eds.), The nature of emotions. Fundamental questions (pp 409-430). New York: Oxford University Press.

Ekman (2003). Emotions Revealed: Recognizing Faces and Feelings to Improve Communication and Emotional Life. Publisher: Owl Books (NY); Rep edition (Mar 2004). ISBN-13: 978-0805075168.

Ellis, M.V., & Ladany, N. (1997). Inferences concerning supervisees and clients in clinial supervision: An integrative review. In C.E. Watkins, Jr. Handbook of Psychotherapy supervision, 567-607. New York: Wiley.

Emmons, R. (2000a). Is spirituality and intelligence Motivation, cognition and the psychology of the ultimate concern. International Journal for the Psychology of Religion, 10(1), 3-26.

Epstein, S., & Meier, P. (1989). Constructive thinking: A broad coping variable with specific components. Journal of Personality and Social Psychology, 57(2), 332-350.

Epstein, S. (1991). Cognitive-experiential self-theory: Implications for developmental psychology. In M. Gunnar & L.A. Sroufe (Eds.), Self-processes and development: Vol. 23. Minnesota Symposia on Child Psychology (pp. 79-123). Hillsdale, NJ: Erlbaum.

Epstein, R. (1999). Mindful practice. JAMA, 282, 833–839.

Eysenck, M. W., Payne, S., & Santos, R. (2006). Anxiety and depression: Past, present, and future events. Cognition and Emotion, 20, 274–294.

Fiedler, F. E., & House, R. J. (1994). Leadership theory and research: A report of progress. In C .L. Cooper & I. T. Robertson (Eds.), Key reviews in managerial psychology (pp. 97-116). New York: John Wiley & Sons.

Finley, L., & Evans. K. ( 2009). Relational-centred research for psychotherapists. Exploring meaning and experience. Willey Blackwell.

Fiske, S.T., & Taylor, S.E. (1991). Social cognition (2nd ed.). New York: McGraw-Hill

Flores-González, M. L., (2008). Phenomenological views on intersubjectivity: Towards a reinterpretation of consciousness. Integrative Psychological and Behavioral Science, 42(2), 187-193. DOI: 10.1007/s12124-007-9044-5

Fonagy, P., Leigh, T., Steele, H., G.S., Steele, M. & Higgit, A. (1991). The capacity for understanding mental states: the reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal, 13, 200-17.

Fonagy, P., Leigh, T., Steele, M., et al (1996) The relation of attachment status, psychiatric classification, and response to psychotherapy. Journal of Consulting and Clinical Psychology, 64 , 22–31

Ford, M.E., & Tisak, M.S. (1983). A further search for social intelligence. Journal of Educational Psychology, 75, 196-206.

Forgas, J. P., Bower, G. H., & Krantz, S. E. (1984). The influence of mood on perceptions of social interactions. Journal of Experimental Social Psychology, 20, 497-513

Fox, S., & Spector, P. E. (2000). Relations of emotional intelligence, practical intelligence, general intelligence and trait affectivity with interview outcomes: It’s not all just ‘G.’ Journal of Organizational Behavior, 21, 203-220.

Fox,W. (1990). Transpersonal ecology: “Psychologising” ecophilosophy. Journal of Tanspersonal Psychology 22(1): 59–96.

Frank, J. D. (1971). Therapeutic factors in psychotherapy. American Journal of Psychotherapy, 25, 350-361.

Friedman, M. (1985). The healing dialogue in psychotherapy. New York: Jason Aronson.

Freud, S. (1913). On beginning the treatment. In The standard edition of the complete psychological works of Sigmund Freud, Volume XII (1911-1913): The case of Schreber, papers on technique and other works (pp. 121-144). Place of publication: publisher.

Freud, S. (1913). Claims of psychoanalysis to scientific interest. Standard Edition, 13. No place of publication or publisher.

Freud, S. (1915). Instincts and their vicissitudes. (Standard edition). London: Hogarth Press.

Freud, S. (1924). Neurosis and Psychosis. SE XIX, 149-153.

Freud, S. (1940). An Outline of psychoanalysis. In The standard edition of the complete psychological works of Sigmund Freud, Volume XXIII. (page numbers). Place of publication: Publisher.

Furnham, A., & Petrides, K. V. (2003). Trait emotional intelligence and happiness. Social Behavior and Personality, 31, 815-824.

Fulgencio, L. (2007). Winnicott’s rejection of the basic concepts of Freud’s metapsychology. International Journal of Psychoanalysis, 88, 443-461.

Gallagher, S, De Jaeger, H & Di Paulo, E. (2010) Can social interaction constitute social cognition Trends in Cognitive Science. Vol. 14, No. 10. Pg 441.

Garber, J., Braafladt, N., & Weiss, B. (1995). Affect regulation in depressed and nondepressed children and young adolescents [Special Issue]. Development and Psychopathology, 7(1), 93-115.

Gardner, H. (1983). Frames of mind. New York: Basic Books.

Geher, G., Warner, R.M., & Brown, A. (2001). Predictive validity of the Emotional Accuracy Research Scale. Intelligence, 29, 373-388.

George, J. M. (2000). Emotions and leadership: The role of emotional intelligence. Human Relations, 53(8), 1027-1055.

Gianino, A., & Tronick, E. (1988). The mutual regulation model: The infant’s self and interactive regulation. Coping and defense capacities. In T. Field, P. McCabe, & N. Schneiderman (Eds.), Stress and coping (pp. 47–68). Hillsdale, NJ: Erlbaum.

Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory. Chicago: Aldine.

Glaser, B. G. (1978). Theoretical sensitivity: Advances in the methodology of grounded theory. Mill Valley, CA: Sociology Press.

Glaser B.G. (1992). Basics of grounded theory analysis. Emergence vs. forcing
California: Sociology Press.

Glaser, B. G. (1995). Grounded theory: 1984-1994. Mill Valley, CA: Sociology Press.

Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. New York: Aldine Publishing Company.

Glaser, B. (1998). Doing grounded theory. Mill Valley, CA: Sociology Press.

Glaser, B. (2001). The grounded theory perspective: conceptualization contrasted with description. Mill Valley, CA: Sociology Press.

Glaser, B. (2002). The grounded theory perspective: Conceptualization contrasted with description. Mill Valley, CA: Sociology Press.

Goleman, D. (1995a). Emotional intelligence. New York: Bantam Books.

Goleman, D. (1995b). What’s your EQ. The Utne lens. Utne Reader. Retrieved from www.utne.com/lens/bms/eq.htm. Accessed on 09/07/10.

Goleman, D. (1998). Working with emotional intelligence. New York: Bantam Books.

Goleman, D. (2001). Emotional intelligence: Issues in paradigm building. In C. Cherniss & D. Goleman (Eds.), The emotionally intelligent workplace (pp. 13-26). San Francisco: Jossey-Bass.

Goulding. C. (2002) Grounded Theory: A practical guide for Management Business and Market Researchers. London: SAGE.

Graneheim U.H. & Lundman B. (2004). Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today 24, 105–112.

Grant L (2013 in press) Hearts and minds: aspects of empathy and wellbeing in social work
students. Social Work Education The International Journal

Gray, J. R. (2004). Integration of emotion and cognitive control. Current Directions in Psychological Science, 13, 46–48.

Greenberg, L. (2002). Emotion-focused therapy: Coaching clients to work through their feelings. Washington, DC: American Psychological Association.

Greenberg, L. S. (2004). Emotion-focused therapy. Clinical Psychology & Psychotherapy, 11(1), 3-16.

Greenberg, L., & Safran, J. (1987). Emotion in psychotherapy: Affect, cognition and the process of change. New York: Guilford Press.

Greenspan, M., & Kulish, N.(1985). Factors in premature termination in long-term psychotherapy. Psychotherapy, 22, 75-82.

Grencavage, L. M., & Norcross, J. C. (1990). Where are the commonalities among the therapeutic common factors Professional Psychology: Research and Practice, 21, 372-378.

Griffin. S., & Mascolo M. (1998). On the nature, development, and function of emotion. In M. Mascolo & S.Griffin (Eds), What develops in emotional development. New York: Plenum.

Grof, S. (2000). Psychology of the future: Lessons from modern consciousness research.
Albany: State University of New York.

Gross, J. J. (1998). Antecedent- and response-focused emotion regulation: Divergent consequences for experience, expression, and physiology. Journal of Personality and Social Psychology, 74, 224–237.

Grubb, W. L., III, & McDaniel, M. A. (2007).‘The fakability of Bar-On’s Emotional Quotient Inventory Short Form: Catch me if you can. Human Performance, 20, 43-55.

Guba, E. (1978). Toward a methodology of naturalistic inquiry in educational evaluation (Monograph No. 8). Los Angeles: UCLA Center for the Study of Evaluation.

Guildford, J. P. (1967). The nature of human intelligence. New York: McGraw-Hill.

Hatcher, R. L. (1999). Therapists’ view of treatment alliance and collaboration in therapy. Psychotherapy Research, 9, 405-423.

Hamel, S., Leclerc, G., and Lefrancois, R. (2003). A psychological outlook on the concept of transcendent actualisation. International Journal for the Psychology of Religion 13(1): 3–15.

Hartsfield, M. (2003). The Spirit of Transformational Leadership: Emotions or Cognition Paper presented at the annual (2003) conference of Christian Business Faculty Association.

Henry, W.P., & Strupp, H. H. (1994). The therapeutic alliance as interpersonal process. In A. O. Horvath & L. Greenberg (Eds). The working alliance: Theory, research, and practice (pp. 51-84). New York: Wiley.

Hersoug, A. G., Hoglend, P., Monen, J. T., & Havik, O. E. (2001). Quality of working alliance in psychotherapy; therapist variables and patient/therapist similarity as predictors. Journal of Psychotherapy Research, 10(4), 205-216.

Hertel, J., Schutz, A., & Lammers, N. K. A., (2009). Emotional intelligence and mental disorder. Journal of Clinical Psychology, 65, 942-954.

Herbert, T. B., & Choen, S. (1993). Depression and immunity: A meta-analytic review. Psychological Bulletin, 113, 472-486.

Haynes, R., Corey, R., & Moulton, P. (2003). Clinical supervision in the helping profession: A practical guide. Pacific Grove, CA: Brooks/Cole.

Heidegger, M. (1962). Being and time. New York: Harper & Row.

Hoffman, E. (2007) ‘Open-Ended Interviews, Power, and Emotional Labour’, Journal of Contemporary Ethnography 36(3): 318–46.

Horvath, A. O. (2004). Training and supervision for the ‘common factors.’ Paper presented at the 112th Annual Convention of the American Psychological Association, Honolulu.

Horvath, A. O. (2005). The Therapeutic Relationship: Research and Theory. Psychotherapy Research, 15, 3-7.

Horvath, A.O., & Bedi, R. (2002). The alliance. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 37-70). New York: Oxford University Press.

Horvath, A. O., Gaston L., & Luborsky L. (1993). The therapeutic alliance and its measures. In L. Miller, L.Luborsky, Barber J., & J. P. Docherty (Eds.), Psychodynamic treatment research (pp. 247-273). New York: Basic Books.

Horvath, A. O., & Symonds, B. D. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Consulting Psychology, 38, 139-149.

Husserl, E. (1931b). Ideas: General Introduction to Pure Phenomenology. (W. R. Boyce Gibson, Trans.). New York: Collier.

Jensen, A. R. (1998). The g factor: The science of mental ability. Westport, State: Praeger.

Journal of Transpersonal Psychology website (2009) https://monkessays.com/write-my-essay/atpweb.org/journal.asp (accessed 11 August 2009).

Jung, C. (1921/1971). Psychological types. Princeton, NJ: Princeton University Press.

Jung, C. (1958). The Psychology of the Transference. In R.F.C. Hull (Trans.), The collected works of C.G. Jung (Vol. 16). Princeton NJ: Princeton University Press.

Jung, C. G. (1965). Memories, dreams, reflections. New York: Vintage.

Jung, C. (1960/2001). On the nature of the psyche. (R.Hull, Trans.). London: Routledge.

Kelley, H. H. (1967). Attribution theory in social psychology. In D. Levine (ed.), Nebraska Symposium on Motivation (Volume 15, pp. 192-238). Lincoln: University of Nebraska Press.

Kippax, S., Connell, R. W., Crawford, J., Dowsett, G. W., Baxter, D., Watson, L., & Berg, R. (1988). Facing the epidemic: Changes in the sexual lives of gay and bisexual men in Australia and their implications for AIDS prevention strategies. Social Problems, 36(4), 384-402.

Knightg, G. Z. (2005). The use of the ‘corrective Emotional Experience’ and the search for the bad object in psychotherapy. American Journal of Psychotherapy, 59(1), 30-41.

Knox, M. J. (2001). Memories, fantasies, archetypes: an exploration of some connections between cognitive science and analytical psychology. Journal of Analytical Psychology, 46(4), 613–635.

Kvale, S. (1996). Interviews: An introduction to qualitative research interviewing. New York: SAGE.

Krefting, L. (1991). Rigor in qualitative research: The assessment of trustworthiness. The American Journal of Occupational Therapy, 45(3), 214-222.

Krupnick JL, Sotsky SM, Elkin I, et al. The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National Institute Of Mental Health Treatment Of Depression Collaborative Research Programme. J Consult Clin Psychol 1996; 64 (3): 532-539

Lajoie D.H, Shapiro S.I. (1992). Definitions of transpersonal psychology: the first twenty-three years. Journal of Transpersonal Psychology 24(1): 79–94.

Lambert, M. J. (1983). Psychotherapy and patient relationships. Homewood, IL: Dorsey.

Lambert, M. J. & Ogles, B. M. (2004) ‘The efficacy and effectiveness of psychotherapy. In M. J. Lambert (ed.). Bergin & Garfield’s Handbook of Psychotherapy and Behavior Change, 5th edition. New York: Wiley.

Lazarus, R. S. (1982). Thoughts on the relations between emotion and cognition. American Psychologist, 37, 1019–1024.

Lazarus, R. S. (1991). Emotion and adaptation. Oxford, UK: Oxford University Press.

Lazarus, R. S. (1994). The stable and the unstable in the motions. In P. Ekman & R Davidson.(Eds.), The nature of emotions. Fundamental questions (pp 306-310). New York: Oxford University Press.

LeDoux, J. (1996). The emotional brain: The mysterious underpinnings of emotional life. New
York: Simon & Schuster.

Leible T. L., & Snell, W. E., Jr. (2004). Borderline personality disorders and aspects of emotional intelligence. Personality and Individual Differences, 37:393–404.

Laming, W. H. (2009) The Protection of Children in England: A Progress Report,
availableonline at http://publications.everychildmatters.gov.uk/eOrderingDownload/HC-
330.pdf

Layder D. (1993). New Strategies in Social Research. Cambridge: Polity Press.

Leiper, R., & Casares. P. (2000). An investigation of the attachment organisation of clinical psychologists and its relation to clinical practice. British Journal of Medical Psychology, 73, 449-464.

Lewis, M. D. (2005). Bridging emotion theory and neurobiology through dynamic systems modeling. Behavioral and Brain Sciences, 28, 169–245.

Lizeretti, N. P., Oberst, U., Chamarro, A., & Farriols, N. (2006). Assessment of emotional intelligence in patients with psychopathology: Preliminary results using TMSS-24 and the MSCEIT. Ansiedad y Estre´s, 12, 355–364.

Lincoln, Y., & Guba, E. (1985). Naturalistic Inquiry. Beverly Hills, CA: SAGE.

Loren, L.A.. & Dietrich, E. (1997). Merleau-Ponty, embodied cognition, and the problem of intentionality. Cybernetics and Systems, 28, 345–358.

Luborsky, L., Mclellan, A. T., Woody, G. E., O’Brien, C. P., & Auerbach, A. (1986). Therapist success and its determinants. Archives of General Psychiatry, 42, 602-611.

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.

Luca, M. (2009). A therapist’s portrait of a clinical encounter with a somatizer. In L. Finlay & K.Evans (Eds), Relational-centred research for psychotherapists: Exploring meaning and experience. London: John Wiley and Sons.

Lyons-Ruth, K. (1999). The two-person unconscious: Intersubjective dialogue, enactive relational representation, and the emergence of new forms of relational organization. Psychoanalytic Inquiry, 19(4), 576-617

Lyons, L.C & Woods, P.J. (1991). The efficacy of rational-emotive therapy; A quantitative review of the outcome research. Clinical Psychology Review, 11, 357-369.

MacLeod, C., Campbell, L., Rutherford, E., & Wilson, E. (2004). The causal status of anxiety-linked attentional and interpretive bias. In J. Yiend (Ed.), Cognition, emotion and psychopathology: Theoretical, empirical and clinical directions. Cambridge, England: Cambridge University Press.

McLeod, J. (2003). Doing counselling research. London: Sage

Main, M. (1991). Metacognitive knowledge, metacognitive monitoring, and singular (coherent) vs. multiple (incoherent) models of attachment: Some findings and some directions for future research. In P. Marris, J. Stevenson-Hinde and C. Parkes, (eds), Attachment Across the Life Cycle, pp. 127-159. New York: Routledge.

Madill, A., Jordan, A., & Shirley, C. (2000). Objectivity and reliability in qualitative analysis: Realist, contextualist and radical constructivist epistemologies. British Journal of Psychology, 91(1), 1-20.

Mann, Gordon, and MacLeod (2009). Reflection and reflective practice in health professions education: a systematic review. Adv in Health Sci Educ (2009) 14:595–621. DOI 10.1007/s10459-007-9090-2.

Maslow, A. H. (1993). The farther reaches of human nature. New York: Penguin Arkana. (Original work published in 1971)

Malterer, M. B., Glass, S. J., & Newman, J. P. (2008). Psychopathy and trait emotional intelligence. Personality and Individual Differences, 44, 733-743.

Maree, J. G., & Fernandes, M. P. J. (2003). The impact of emotional intelligence on solution-focused therapy with an adolescent. Early Child Development and Care, 173(5), 499-508.

Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68(3), 438–450.

Martinez-Pons, M. (1997). ‘The relation of emotional intelligence with selected areas of personal functioning. Imagination, Cognition and Personality, 17, 3-13.

Marshall C. & Rossman G.B. (1995). Designing Qualitative Research. Sage Publications, London.

Maslow, A.H. (1993). The Farther Reaches of Human Nature, Penguin Books, N.Y.
Matthews, G., Zeidner, M., & Roberts, R. (2004). Emotional Intelligence: science and myth. Place of publication: MIT Press.

Mavroveli, S. Petrides. K. V., Rieffe, C., & Bakker, F. (2007). Trait emotional intelligence, psychological well-being, and peer-rated social competence in adolescence. British Journal of Developmental Psychology, 25, 263-275

Mayer, J. (2000). Spiritual intelligence or spiritual consciousness The International Journal for the Psychology of Religion 10(1): 47–56.

Mayer, J. D., & Salovey, P. (1997). What is emotional intelligence. In P. Salovey & D. Sluyter (Eds.), Emotional development and emotional intelligence: Implications for educators (pp. 3-31). New York: Basic Books.

Matthews G., & Zeidner M. (2000) Emotional intelligence, adaptation to stressful encounters, and health outcome. In R. Bar-on & J. D. A. Parker (Eds.), The handbook of emotional intelligence: Theory, development, assessment, and application at home, school, and in the workplace (pp. 459–89). San Fransisco, CA : Jossey-Bass..

Mayer, J. D., DiPaolo, M. T., & Salovey, P. (1990). Perceiving affective content in ambiguous visual stimuli: A component of emotional intelligence. Journal of Personality Assessment, 54, 772-781.

Mayer, J. D., Salovey, P., & Caruso, D. (2000). Models of emotional intelligence. In R. J. Sternberg (Ed.), The Handbook of Intelligence (pp. 396-420). Place of publication: Cambridge University Press.

Mayer, J. D., Salovey, P., & Caruso, D. (2007). Emotional IQ test. Needham, MA: Virtual Knowledge.
Mayer, J., Roberts, R. D., & Barsade, S. G. (2008). Human Abilities: Emotional Intelligence. Annual Review of Psychology, 59, 507-536.

Mayer, J. D., Salovey, P., & Caruso, D. R. (2000). Selecting a measure of emotional intelligence. The handbook of emotional intelligence. Place of publication: UNH.

Mayer, J. D., Salovey, P., & Caruso, D. R. (2008). Emotional intelligence: New ability or eclectic traits. American Psychologist, 63(6), 503-517.

Mcglashan, Thomas H. and Fenton, Wayne S. (1998) Frieda Fromm-Reichmann, 1889–1957, Journal of Psychiatry, 155, p123

Mercer, S., & Reynolds, W. J. (2002). Empathy and quality of care. Journal of General Practice, 54, 9-12.

Merleau-Ponty, M. (1962). Phenomenology of perception. London: Routledge.

Mikolajczak, M., Luminet, O., & Menil, C. (2006). Predicting resistance to stress: Incremental validity of trait emotional intelligence over alexithymia and optimism. Psicothema, 8, 79-88.

Miles, M.B., and Huberman, A.M. (1984). Qualitative Data Analysis, 16. Newbury Park, CA: Sage.

Miles, M.B, and Huberman, A.M. (1994). Qualitative Data Analysis, 2nd Ed., p. 10-12. Newbury Park, CA: Sage.

Miles, M. B., & Huberman, A. M. (1998). Qualitative data analysis: an expanded sourcebook. Place of publication; SAGE.

Morgan, M. (1996). Qualitative research: a package deal The Psychologist, 9, (1), 31-32.

Morse, J. M. (2000). Determining sample size. Qualitative Health Research, 10(1), 3-5.

Morrison, T. (2007). Emotional intelligence, emotion and social work: context, characteristics, complications and contribution. British Journal Of Social Work, 37(2), 245-263.
Morse, J. (2001). Situating grounded theory within qualitative inquiry. In R. Schreiber & P. N. Stern (Eds.), Using grounded theory in nursing (pp. 1-16). New York: Springer.

Mostow, A., Izard, C., Fine, S., & Trentacosta, C. (2002). Modeling emotional, cognitive and behavioural predictors of peer acceptance. Child Development, 73(6), 1775-1787.

Negi, Bender, Furman, Fowler, Prickett (2010). Enhancing Self-Awareness: A Practical Strategy to Train Culturally Responsive Social Work Students. Copyright © 2010 Advances in Social Work Vol. 11 No. 2 (Fall 2010), 223-234.

Norcross, J. C. (2002). Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. New York: Oxford University Press.

Onions, P. E. W. (2006). Grounded theory application in reviewing knowledge management literature. Retrieved from
https://monkessays.com/write-my-essay/lmu.ac.uk/research/postgradconf/papers/Patrick_Onions_paper.pdf

Orlinsky, D. E., Botermans, J. F., & Ronnestad, M. H. (2001). Towards and empirically grounded model of psychotherapy training : Four thousand therapists rate influences on their development. Australian Psychologist, 36, 139-148.

Orlinsky, D. E., & Howard, K. I. (1986). The psychological interior of psychotherapy; explorations with the therapy session reports. In L. S. Greenberg & W. M. Pinsof (Eds.), The psychotherapeutic process; a research handbook. New York: Guildford.

Orlinsky, D. E., & Howard, R I. (1986). The relation of process to outcome in psychotherapy. In S.L. Garfield & A.E. Bergin (Eds.), Handbook of psychotherapy and behaviour change. New York: John Wiley.

Orlinsky, D. E., Norcross, J. C., & Ronnestad, M. H. & Wiseman, H. (2005). Outcomes and impacts of the psychotherapists own psychotherapy: A research review (pp. 214-230). New York: Oxford University Press.

Orlinsky, D. E., & Ronestad, M. H. (2005). How psychotherapists develop: A study of therapeutic work and professional growth. Washington, DC: American Psychological Association.

Orr, L. G. (2001). How emotional intelligence facilitates spiritual formation. Write my thesis – Dissertation Abstracts International, Azusa Pacific University, CA.

Palmer, B., Donaldson, C., & Stough, C. (2002). Emotional intelligence and life satisfaction. Personality and Individual Differences, 33, 1091-1100.

Palmer, H. (1998). Inner knowing: Consciousness, creativity, insight, intuition. New York:
Jeremy P. Tarcher/Putnam.

Panksepp, J. (2001). The long-term psychobiological consequences of infant emotions: Prescriptions for the twenty-first century. Infant Mental Health Journal, 22(1-2), 132-173.

Peikoff, L. (1991). Objectivism: The philosophy of Ayn Rand. New York: Dutton.

Petrides, K. V. (2004). Estimates of emotional and psychometric intelligence: Evidence for gender–based. The Journal of Social Psychology, 144, 149-163.

Petrides, K. V., Frederickson, N., & Furnham, A. (2004). The role of trait emotional intelligence in academic performance and deviant behaviour at school. Personality and Individual Differences, 36, 277–293.

Petrides, K. V., & Furnham, A. (2000). On the dimensional structure of emotional intelligence. Personality and Individual Differences, 29, 313-320.

Petrides, K. V., & Furnham, A. (2001). Trait emotional intelligence: Psychometric investigation with reference to established trait taxonomies. European Journal of Personality, 15, 425-448

Petrides, K. V., & Furnham, A. (2003). Trait emotional intelligence: Behavioral validation in two studies of emotion recognition and reactivity to mood induction. European Journal of Personality, 17, 39–75.

Petrides, K. V., Furnham, A., & Mavroveli, S. (2007). Trait emotional intelligence. Retrieved from https://monkessays.com/write-my-essay/psychometriclab.com/admins/files/OUP%20chapter%20(2007)%20-%20T_EI.pdf.

Petrides, K. V., Pérez-González, J. C., & Furnham, A. (2007). On the criterion and incremental validity of trait emotional intelligence. Cognition and Emotion, 21, 26-55

Petrides, K. V., Pita, R., & Kokkinaki, F. (2007). The location of trait emotional intelligence in personality factor space. British Journal of Psychology, 98(2), 273-289.

Petrides, K. V., Sangareau, Y., Furnham, A., & Frederickson, N. (2006). Trait emotional intelligence and children’s peer relations at school. Social Development, 15, 537-547

Picard, R. W., Vyzas, E., & Healey, J. (2001). Towards machine emotional intelligence: analysis of effective physiological state, IEEE transactions on pattern analysis and machine. Intelligence, 23(10), 1175- 1191.

Perraud, S., Delaney, K., Carlson-Sabelli, L., Johnson, M. E., Shephard, R., & Paun, O. (2006). Advanced practice psychiatric mental health nursing, finding our core: The therapeutic relationship in 21st century. Perspectives in Psychiatric Care, 42, 215–226.

Parkinson, B. (1994). Emotion. In A.M. Coleman (Ed.), Companion encyclopaedia of psychology (Vol. 2, pp. xx-xx). London: Routledge.

Phelps, E. A., & Sharot, T. (2008). How (and why) emotion enhances the subjective sense of recollection. Current Directions in Psychological Science, 17, 147–152.

Pidgeon, N., & Henwood, K. (1997). Using grounded theory in psychological research, In N, Hayes (Ed.), Doing qualitative analysis in psychology (pp.xx-xx). Hove: Psychology Press.

Plutchik, R. (1984). Emotions and Imagery. Journal of Mental Imagery, 8, 105-112.

Polit, D. F., & Hungler, B. P. (2004). Nursing research: Principles and methods (6th ed.). Philadelphia: Lippincott, Williams & Wilkins.

Polit D.F. & Beck C.T. (2004). Nursing Research. Principles and Methods. Lippincott Williams & Wilkins, Philadelphia, PA.

Polkinghorne, D (1983). Methodology for the human sciences. Albany: Suny Press.

Ponsi, M. (2000). Therapeutic alliance and collaborative interactions. International Journal of Psycho-Analysis, 81, 687-704.

Poullis (2007). The therapist emotional experience of the therapeutic relationship and Its links to emotional intelligence theory A Write my thesis – Dissertation Submitted in Partial Fulfilment of the MA in Counselling. Retrieved from: https://monkessays.com/write-my-essay/researchgate.net/publication/258517545_The_therapist_emotional_experience_of_the_therapeutic_relationship_and_Its_links_to_emotional_intelligence_theory_A_Write my thesis – Dissertation_Submitted_in_Partial_Fulfilment_of_the_MA_in_Counselling.
Radfor, M. (2002). Educating the emotions. Interior and exterior realities. Pastoral Care in Education, 20(2), 24-29.

Rajan-Rankin, S. (2013) Self-Identity, Embodiment and the Development of Emotional
Resilience British Journal of Social Work. Advance Access doi: 10.1093/bjsw/bct083

Redfield, J., Murphy, M., and Timbers, S. 2002. God and the evolving universe: The next
step in personal evolution. London: Bantam Books.
Reason, P. (2002). Justice, sustainability, and participation. Concepts and Transformation
7(1): 7–29.

Roberts, R. D., Pallier, G., & Nelson-Goff, G. (1999). Sensory processes within the structure of human cognitive abilities. In P. L. Ackerman, P. C. Kyllonen, & R. D. Roberts (Eds.), Learning and Individual Differences (Vol. 15, pp. 339-368). Washington, DC: American Psychological Association.

Robson C. (1993) Real World Research. A Resource for Social Scientists and Practitioner–Researchers. Blackwell Publishers, Oxford.

Roberts, R. D., Zeidner, M., & Matthews, G. (2001). Does emotional intelligence meet traditional standards for an intelligence Some new data and conclusion. Emotion, 1, 196–231.

Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting and Clinical Psychology, 22, 95-103.

Rothberg, D. (2003). Contribution in: M. Caplan, G. Hartelius, and M. A. Rardin. Contemporary viewpoints on transpersonal psychology. Journal of Transpersonal Psychology 35(2): 143–162.

Rosenzweig, S. (1936). Some implicit common factors in diverse methods of psychotherapy. American Journal of Orthopsychiatry, 6, 412-415.

Roseman, I. J., & Smith, C. A. (2001). Appraisal theory: Overview, assumptions, varieties, controversies. In K.R. Scherer, A. Schorr, & T. Johnstone (Eds.), Appraisal processes in emotion: Theory, methods, research. Oxford, UK: Oxford University Press.

Rowan, J. (2004). Three levels of therapy. Counselling and Psychotherapy Journal, 15(9), 21.

Rowan, J. (1998) Linking its place in therapy. International Journal of Psychotherapy, 3, 245-254.

Saklofske, D. H., Austin, E. J., & Minski, P. S. (2003). Factor structure and validity of a trait emotional intelligence measure. Personality and Individual Differences, 34, 1091-1100.

Salami, O. S. (2011). Personality and psychological well-being of adolescents: the moderating role of emotional intelligence. Social Behavior and Personality, 39(6), 785-794.

Salovey, P., & Grewal, D. (2005). The science of emotional intelligence. Current Directions. Psychological Science, 14(6), 281-285.

Salovey, P., & Mayer, J. D. (1990). Emotional intelligence. Imagination, Cognition, and Personality, 9, 185-211.

Salovey, P. (2001). Applied emotional intelligence: Regulating emotions to become healthy, wealthy, and wise. In J. Ciarrochi, J. Forgas, & J.D. Mayer (Eds.), Emotional intelligence in everyday life: A scientific inquiry (pp. 168-184). Philadelphia, PA: Psychology Press.

Samuels, A. (2006). Transference/Countertransference. In R. Papadopoulos (Ed.), Handbook of Jungian psychology. New York: Routledge.

Samuel, A. (1993). The political psyche. London; Routledge.

Sanchez-Ruiz, M, Mavroveli, S. & Poullis, J. (under review). Trait Emotional Intelligence In Higher Education. Personality and Individual Differences Journal.

Saunders, S.M. (1999). Client’s assessment of the affective environment of the psychotherapy session; relationship to session quality and treatment effectiveness. Journal of clinical Psychology, 55(5) 597-605.

Segall, Marshall H. (2 March 1999). Human behavior in global perspective: an introduction to cross-cultural psychology. Allyn and Bacon. p. 399. ISBN 978-0-205-18861-1. Retrieved 19 October 2013.

Shawn, R. (2004) The embodied psychotherapist: An exploration of the therapist’s somatic phenomena within the therapeutic encounter. Psychotherapy research. 14, 3, 271-288.

Scheier, M. F., & Carver, C. S. (1985). Optimism, coping, and health: Assessment and implications ofgeneralized outcome expectancies. Health Psychology, 4, 219-247.

Scheler, M.. (1954). The Nature of Sympathy. (P. Heath, Trans.). London: Routledge & Kegan Paul.

Schneider, T. R., Lyons, J. B., & Williams, M. (2005). Emotional intelligence and autonomic self-perception: Emotional abilities are related to visceral acuity. Personality and Individual Differences, 39, 853–861.

Schore, A. (2000). Minds in the making: attachment, the self-organizing brain and developmentally-orientated psychoanalytic psychotherapy. British Journal of Psychotherapy, 17(3): 299-327.

Schulte, M. J., Ree, M. J., & Carreta, T. R. (2004) Emotional intelligence: not much more than g and personality. Personality and Individual Differences, 37, 1059-1068.

Schutte, N. S., Malouff, J. M., Bobik, C., Coston, T. D., Greeson, C., Jedlicka, C., (2001). Emotional intelligence and interpersonal relations. Journal of Social Psychology, 141, 523–536.

Schutte, N. S., Malouff, J. M., Hall, L. E., Haggerty, D. J., Cooper, J. T., Golden, C. J., & Dornheim, L. (1998). Development and validation of a measure of emotional intelligence. Personality and Individual Differences, 25, 167-177.

Schutte, N. S., Malouff, J. M., Simunek, M., McKenlye, J., & Hollander, S. (2002). Characteristic emotional intelligence and emotional well-being. Cognition & Emotion, 16, 769-785.

Scho¨n, D. (1983). The reflective practitioner. San Francisco: Jossey-Bass.

Sedgwick, D. (1994).The wounded healer. London: Routledge

Sevdalls, N., Petrides, K. V., & Harvey, N. (2007). Trait emotional intelligence and decision-related emotions. Personality and Individual Differences, 2(7), 1347-1358.

Shapiro, D. A. (1985). Recent applications of met-analysis in clinical research. Clinical Psychology Review, 5(1) 13-34.

Shabani, J., Hassan, A. S., Ahmad, A., & Baba. M. (2010). Exploring the relationship of emotional intelligence with mental health among early adolescents. International Journal of Psychology Studies, 2(2), page numbers.

Siegel, D. J. (2001). Toward an interpersonal neurobiology of the developing mind: Attachment relationships, ‘mindsight’ and neural integration. Infant Mental Health Journal, 22(1-2), 67-94.

Simon, H. A. (1982). Comments. In M.S. Clark, & S.T. Fiske (Eds.), Affect and cognition (pp. 333-342). Hillsdale, NJ: Erlbaum.

Simon, A., Sohal, A., & Brown, A. (1996). Generative and case study research in quality management. Part I: Theoretical considerations. International Journal of Quality & Reliability Management, 13(1), 32-42.

Simpson, R., & Keegan, A. (2002). How connected are you Employing emotional intelligence in a high-tech world. Nursing Administration Quarterly, 26(2), 80-86.

Slaski, M., & Cartwright, S. (2002). Health, performance and emotional intelligence: an exploratory study of retail managers. Stress and Health, 18, 63-68

Smith, J. A. (2003). Qualitative psychology: a practical guide to research methods. Place of publication: SAGE.

Smith, C. A., & Kirby, L. D. (2001). Toward delivering on the promise of appraisal theory. In K.R. Scherer, A. Schoor, & T. Johnstone (Eds.), Appraisal processes in emotion: Theory, methods, research. Oxford, UK: Oxford University Press.

Smith, M.L. and Glass, G.V. (1977). Meta-analysis of psychotherapy outcome studies, American Psychologist, 32: 752-760

Solomon, R. (1984). The Passions: The Myth and Nature of Human Emotions. New York: Doubleday.

Solomon, R. (2003). What is an emotion Classic and contemporary readings. Austin: TX: Publisher.

Solomon, R. C. (2003). Not passion’s slave: Emotions and choice. Oxford: Oxford University Press.

Sommer, F. S. (2003). Contribution in: M. Caplan, G. Hartelius, and M. A. Rardin. Contemporary viewpoints on transpersonal psychology. Journal of Transpersonal Psychology 35(2): 143–162.

Spearman, C. (1927). The abilities of man. New York: Macmillan.

Stankov, L. (2000). Structural extensions of a hierarchical view on human cognitive abilities. Learning and Individual Differences, 12(1), 35-51.

Stein, M. (1989). Gratitude and attitude: A note on emotional welfare. Social Psychology Quarterly, 52(3), 242-248.

Stein, D. M., & Lambert, M. J. (1984). 0n the relationship between therapist experience and psychotherapy outcome. Clinical Psychology Review, 4, 127-142.

Stein, D. M., & Lambert, M. J. (1995). Graduate training in psychotherapy; Are therapy outcomes enhanced. Journal of Consulting and Clinical Psychology, 63, 182-196.

Stein, N. L., Trabasso, T., & Liwag, M. (1993). The representation and organization of emotional experience: Unfolding the emotion episode. In M. Lewis & J. M. Haviland (Eds.), Handbook of emotions (pp.279-300). New York: Guilford Press.

Stern, D. N. (1977). The first relationship: Infant and mother. Cambridge: Harvard University Press.

Stern, D. N. (1985). The international world of the infant. New York: Basic Books.

Stern, D. N., Morgan, A. C., Nahum, J.P., Sander, L., & Tronick, E.Z. (1998). The Process of Therapeutic Change, Involving Implicit Knowledge: Some Implications of Developmental Observations for Adult Psychotherapy. Infant Mental Health Journal, 19, 300-308

Stern, D. N. (1985). The interpersonal world of the infant. New York: Basic Books.

Stern, D. N. (2003). The Interpersonal World of the Infant: A View from Psychoanalysis and Developmental Theory. London: Karnac

Stern, Daniel (2004). The Present Moment in Psychotherapy and Everyday Life. New York: W.W. Norton & Company

Sternberg, R. J. (1985). Beyond IQ: A triarchic theory of human intelligence. New York: Cambridge University Press

Sternberg, R. J., & Caruso, D. R. (1985). Practical models of knowing’ in Learning and teaching the ways of knowing. Place of publication: Routledge.

Sternberg, R. J., & Ruzgis, P. (1994). Personality and intelligence. New York: Cambridge University Press.

Stolorow, R. D., & Atwood, G. E, (2002). Contexts of Being–The Intersubjective Foundations of Psychological Life. Hillsdale, NJ: Analytic Press.

Stolorow, R. D., Atwood, G. E., & Brandchaft, B. (Eds.). (1994). The intersubjective perspective. Northvale NJ: Jason Aronson.

Stolorow, R. D., Atwood,G. E., & Orange, D. M. (2002). Worlds of Experience: interweaving philosophical and clinical dimensions in psychoanalysis.,New York: Basic Books.

Storbeck, J., & Clore, G. L. (2005). With sadness come accuracy, with happiness, false memory:
Mood and the false memory effect. Psychological Science, 16, 785-791.

Storbeck, J., & Clore, G. L. (2006). Turning on and off affective and categorical priming with
mood. Manuscript submitted for publication.

Stolk, Y. and Perlesz, A. J. (1990). Do better trainees make worse family therapists A follow-up study of client families. Family Process, 29, 45–58.

Strauss, A. (1987). Qualitative analysis for social scientists. Cambridge, UK: Cambridge University Press.

Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: SAGE.

Strauss, A., & Corbin, J. (1994). Grounded theory methodology: An overview. In N. Denzin & Y. Lincoln (Eds.), Handbook of qualitative research (pp. 273-285). Thousand Oaks, CA: SAGE.

Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory (2nd ed.). Thousand Oaks, CA: SAGE.

Strupp, H. H. (1980). Hummanism and psychotherapy. A general statement of psychotherapist essential value. Psychotherapy theory, Research and practice, 17, 396-400.

Strupp, H. H. (1986). Psychotherapy; Research, practice, and public policy: How to avoid dead-ends. American Psychologist, 41, 120-130.

Strupp, H.H., & Hadley, S.W. (1979). Specific versus non-specific factors in psychotherapy. A controlled study of outcome. Archieves of General Psychiatry, 36, 1125-1136.

Taibbi, R. (1993). The way of the supervisor: Facing fear, rigidity, power, and death.
Family Therapy Networker, 17(3), 50–55.

Tapia, M. (2001). Measuring emotional intelligence. Psychological Reports, 88, 353-364.

Taylor, G. J. (2001). Low emotional intelligence and mental health. In J. Ciarrochi, J. Forgas, & J. Mayer (Eds.), Emotional Intelligence in everyday life: A scientific inquiry (pp. 67-81). Philadelphia: Psychology Press.

Tarnas, R. (2006). Cosmos and psyche: Intimations of a new world view. New York: Viking.

Thorndike, E. L., & Stein, S. (1937). An evaluation of the attempts to measure social intelligence. Psychological Bulletin, 34, 275-284.

Thorndike, R. K. (1920). Intelligence and its uses. Harper’s Magazine 140, 227-335.

Tischler, L., & Biberman, J., & McKeage, R. (2002). Linking emotional intelligence, spirituality and workplace performance: Definitions, models and ideas for research. Journal of Managerial Psychology, 17(3), 203-218.

Thurstone, L. L. (1938). Primary mental abilities. Chicago: University of Chicago Press.

Tomkins, S. S. (1962). Affect, imagery, consciousness (Vol. 1): The positive affects. New York: Springer.

Traill, R.R. (2000) Physics and Philosophy of the Mind. Melbourne: Ondwelle. ISBN 0-9577737-1-4

Trepka, C., Rees, A., Shapiro, D.A. & Hardy, G.E. (2004). Therapist competence and outcome of cognitive therapy of depression. Cognitive Therapy and Research, 28: 143–57.

Tronick, E. Z. (1989). Emotions and emotional communication in infants. American Psychologist, 44, 112–119.

Tronick, E. Z. (2007). The neurobehavioural and social-emotional development of infants and children. Place of Publication: Norton & Co.

Tulving, E. (1983). Elements of episodic memory. Oxford University Press.

Vaughan, F. (2002). What is spiritual intelligence Journal of Humanistic Psychology 42(2): 16–33.

Van der Zee, K., Thijs, M., & Schakei, L. (2002). The relationship of emotional intelligence with academic intelligence and the Big Five. European Journal of Personality, 16(2), 103-125.

Weber R.P. (1990) Basic Content Analysis. Sage Publications, Newburry Park, CA.

Wechsler, D. (1940). Nonintellective factors in general intelligence. Psychological Bulletin, 37, 444- 445.

Wechsler, D. (1943). Non-intellective factors in general intelligence. Journal of Abnormal Social Psychology, 38, 100-104

Wertz, F. (2005). Phenomenological research methods for counselling psychology. Journal of Counseling Psychology, 52, 167-177.

Wechsler, D. (1940). Nonintellective factors in general intelligence. Psychological Bulletin, 37, 444–445.

Wechsler, D. (1943). Non-intellective factors in general intelligence. Journal of Abnormal Social Psychology, 38, 100–104.

Wechsler, D. (1958). The measurement and appraisal of adult intelligence. (4th ed.). Baltimore, MD: The Williams & Wilkins Company.

Wessman, A. E., & Ricks, D. F. (1966). Mood and personality. New York: Holt, Rinehart and Winston.

Weinstein, M., & Broda, M. (2009b). Dialectics, dialogics and other ways of reading us.
Cultural Studies of Science Education, 4, 799-801.

Wheeler, S., (1996). Training Counsellors: The assessment of Competence. Cassell: London.

Wilks, S., & Spivey, C. (201 Rajan-Rankin, S. (2013) Self-Identity, Embodiment and the
Development of Emotional Resilience British Journal of Social Work. Advance Access doi:
10.1093/bjsw/bct083

Witt, J. K., Proffitt, D. R., & Epstein, W. (2004). Perceiving distance: A role of effort and intent.
Perception, 33, 577-590.

Winnicott, D. W. (1960). The maturational processes and the facilitating environment. London: Hogarth Press.

Winnicott, D.W. (1963). From Dependence towards Independence in the development of the Individual. In The maturational process and the facilitating environment (Ch 7). London & New York: Karnac.

Winnicott, D. W. (1971). Playing and reality. London: Tavistock Publications.

Wiseman, H., & Egozi, S. (2006). Personal therapy for Israeli school counselors: prevalence, parameters and professional difficulties and burnout. Psychotherapy Research, 16, 332-347.

Wong, C. T., Day, J. D., Maxwell, S. E., & Meara, N. M. (1995). A multitrait-multimethod study of academic and social intelligence in college students. Journal of Educational Psychology, 87, 117-133.

Wolf, Z. R. (2003). Exploring the audit trail for qualitative investigations. Nurse Educator, 28 (4), 175–178.

Zajonc, R. (1980). Feeling and thinking: Preferences need no inferences. American Psychologist,
35, 151_175.

Zajonc, R. (2000). Feeling and thinking: Closing the debate over the independence of affect. In
J. P. Forgas (Ed.), Feeling and thinking: The role of affect in social cognition. Studies in emotion and social interaction (Vol. 2., pp. 31_58). New York: Cambridge University Press.

Zahi, A. (2009 ). Spiritual Transpersonal Hypnosis. Contemp. Hypnosis 26(4): 263–268

Zetzel, E. R. (1956). Current concepts of transference. International Journal of Psychoanalysis, 37, 369-376.

Zijlmans, .L. J. M, Embregts P. J. C. M., Gerits. L., Bosman A. M. T., & Derksen, J. J. L. (2011). Training emotional intelligence related to treatment skills of staff working with clients with intellectual disabilities and challenging behaviour. Journal of Intellectual Disability, 55, 219-230.

Zohar, D., & Marshall, I. (2000). Spiritual intelligence: The ultimate intelligence. London: Bloomsbury.

Zohar, D., & Marshall, I. (2003). The mystery of consciousness: Spiritual intelligence. In The Bloomsbury book of the mind, ed. S. Wilson, 288–291. London: Bloomsbury Publishing Plc.

APPENDIX A
Invitation posted at British Psychological Society Magazine

Research study: THE ROLE OF EMOTIONAL INTELLIGENCE IN THERAPY.

Dear colleagues I am interested to interview qualified therapist on the topic of
therapeutic relationship and the links to emotions and the theory of emotional
intelligence concept which I will provide some information. The project is part
of my Post Chartered DPsych in Counselling Psychology at City University. I will
need an hour of your time and I am willing to pay for your rate of the session.
If interested please email me on poullis@yahoo.com or call me on 07500016004.
Thank you in advance for your consideration. Joseph poullis

APPENDIX B
Information for prospective participants
Invitation to Take Part in Counselling Research

Dear Colleague,

Thank you for taking the time to read this information sheet. My name is Joseph Poullis and I am Chartered Counseling Psychologist doing research on the Post-Chartered (“Top-up”) DPsych at City University in Counselling Psychology.

I am pursuing to investigate the role of trait emotional intelligence and the concept of it within the therapeutic process and outcomes and I would like to invite your participation in the study. I am willing pay for your one hour of participation at your provided session rate. Topic: The Therapist’s Emotional Experience of the Therapeutic Relationship and its Links to Emotional Intelligence Theory.

Definitions In this research –
Emotional Intelligence has been described as an ability to appraise oneself and others’ emotions, an ability to regulate one’s own emotions, and an ability to use emotions to solve problems (Salovey & Mayer, 1997). The therapist’s awareness of the entire gamut of his feelings and thoughts is crucial for sensitive and subtle management of the therapist’s reaction. This self-awareness enables the therapist to take responsibility for a pre-reflective contribution to the feelings transferred from the client, and for passing it back to the client as therapeutically appropriate. The therapist has to remain open and receptive about his own emotions and should be able to empathise the affect, cognition and behaviour or other reactions responses of the clients.

What is this about
EI has been described an ability to appraise oneself and others’ emotions, an ability to regulate one’s own emotions, and an ability to use emotions to solve problems (Salovey & Mayer, 1997). The therapist is being placed in a similar psychological dilemma within the therapeutic relationship. What is of interest is the process in which the therapist recognizes the psychological act of transferring unbearable feelings in another, as akin to the process where the therapist needs to be aware of what evoked the feeling, and how our self- awareness or lack of it ultimately shapes the therapeutic project. In other words it is a process of identifying the feelings in ourselves and the client, and managing those aspects of ourselves that carry the potential for pre-reflective complicity with the client’s destructive tendencies in the therapeutic encounter. The therapist’s awareness of the entire gamut of his feelings and thoughts is crucial for sensitive and subtle management of the therapist’s reaction. This self-awareness enables the therapist to take responsibility for a pre-reflective contribution to the feelings transferred from the client, and for passing it back to the client as therapeutically appropriate. The purpose of this study is to investigate what therapist themselves experience as being part of the therapeutic relationship and how they will perceive the facets explained in the emotional intelligence theory and if it is relevant to the therapeutic relationship.

Who can participate

Qualified therapist. The term therapy refers to counselling and/or psychotherapy

Confidentiality
In order to respect privacy and meet ethical requirements for confidentiality personally identifying details such as name and/or email address are not being collected in this survey.

How to take part

Taking part is voluntary and you have the right to withdraw at any point during the survey, or to choose not to submit on completion. If you would like any more information or have any concerns with regard to taking part in this study, please
feel free to contact me via my E-mail: info@thepsychotherapy.co.uk phone 07500016004

Ethical approval

This research has been approved by City University Ethics committee.

What is expected from you

If you are willing to participate I will email you the trait emotional intelligence inventory (Teique). The TEIQue is underpinned by an academic research program based at University College London (UCL) and you will need about 15 minutes to complete it. Once you completed it please forward it back in order to enteryour scores on a UCL computerised system with a private code to protect your anonymity. The scoring and
report will be provided by the Psychometric Laboratory at University College London (UCL) and I will be the only one who will know the name of each report. I will then forward the report to you three days before the day of our interview in order to discuss its relevance to yourself and your therapeutic work.

More about TEIQue

For more information about the inventory please visit the web site www.teique.com.
What if you have worries about the study

Should you have any concerns about the conduct of this study you can contact my academic supervisor Dr Don Rawson or the Chair of Social Sciences Research Committee through the course administration office on the number below:

City University London
SocialSciences Building,
Northampton Square
London EC1V 0HB Tel: +44 (0)20 7040 5060

If you have any further questions and/or concerns with regards to this study please do not hesitate to contact myself Joseph Poullis (Researcher) by using the following contact details: poullis@yahoo.com

Thank you in advance for your time.
Joseph Poullis

APPENDIX C
Participants Consent Form
Project Title: The Therapist’s Emotional Experience of the Therapeutic Relationship and its Links to Emotional Intelligence Theory I agree to take part in the above University research project. I have had the project explained to me, and I have read the Explanatory Statement, which I may keep for my records. I understand that agreeing to take part means that I am willing to:
1) be interviewed by the researcher
2) allow the interview to be audiotaped
3) complete questionnaires asking me about emotional intelligence
4) make myself available for a further interview should that be required
5) use a computer to transcribe the interview and analyse it
Data Protection
This information will be held and processed for the following purpose(s): To analyse the data and compare the themes with the literature review in the area of therapeutic relationship and Emotional intelligence.
• I understand that any information I provide is confidential, and that no information that could lead to the identification of any individual will be disclosed in any reports on the project, or to any other party.
• No identifiable personal data will be published. The identifiable data will not be shared with any other organisation.
• I understand that I will be given a transcript of data concerning me for my approval before it is included in the write up of the research.
• I consent to the audiotapes to be heard by the researcher supervisor
• I consent to the use of sections of the audiotapes in publications.
• I agree to City University recording and processing this information about me. I understand that this information will be used only for the purpose(s) set out in this statement and my consent is conditional on the University complying with its duties and obligations under the Data Protection Act 1998. Withdrawal from study (this clause must be included in all consent forms)
• I understand that my participation is voluntary, that I can choose not to participate in part or all of the project, and that I can withdraw at any stage of the project without being penalised or disadvantaged in any way.

Name: ………………………………………………………………………………………..(please print)
Signature………………………………………………………………………. Date:…………………………………
Address:…………………………………………………………………………………………………..
APPENDIX D
Interview Schedule

Introduction to the interview: Thank you for accepting the invitation for this research. As you have read from the emails and attached handouts I am interested to know your views about the therapeutic relationships and the concept of Emotional intelligence. In particular I am interested in your emotional experience within the therapeutic relationship and in your experience in responding to the Traits EI report.

Explaratory questions on therapeutic relationship

1. As a therapist what is the meaning of the therapeutic relationship based on your role and experiences with clients
2. Please describe an actual experience you have had with a client in therapy that will help me to understand what the therapeutic relationship means to you
3. What did you think or feel about the experience
4. What was the meaning of the experience for you

Characteristics of Therapists
5. Could you please describe based on your own experience as a therapist, the qualities that you perceive as important in a therapeutic relationship

Therapeutic relationship experience

6. Can you recall any experiences with clients who brought into the session a very emotionally (heavy) session and how was that experience

• How do you understand emotions
• Are you describing it as physiological, behavioural or cognitively Could you tell me more

7. Can you reflect any important themes that emerged for yourself in terms of relating and responding to this emotional experience in therapy
• How did you experience that
• How did you feel
• Did you physically feel anything
• Did you think at the same time or latter
• Was it physically, cognitive, affect or behavioural
• Was it difficult or easy to hold the session
• How where you able to cope with the thinking and feelings at the same time
• Can you tell me more, and how it was easy or how it was hard and difficult

Therapist’s understanding and perception of Emotional intelligence perception

8. Emotional Intelligence has been described as an ability to appraise oneself and others’ emotions, an ability to regulate one’s own emotions, and an ability to use emotions to solve problems (Salovey & Mayer, 1997).
9. As a therapist do you have are you familiar with the psychological concept of emotional intelligence.
10. Based on your experience as a therapist when encountering clients in sessions do you perceive any similarities with the definition of Emotional intelligence Therapist’s personal experience of Trait Emotional Intellligence test and their scores
11. Reflecting back on the interview and your scores in the trait EI can you please describe your experience
12. Can you comment on your own experience as a therapist and compare them with the facets of EI that you personally scored in the test Therapist’s personal experience of the therapeutic relationship and how they perceive its links to emotional intelligence
13. Based on your experience as a therapist when encountering clients in therapy sessions do you identify any similarities with the definition of Emotional intelligence
14. Can you comment on your own experience of the therapeutic relationship and compare them with the facets of EI that you know
15. Can you please identify any personal perceptions concerning the importance of emotional intelligence to your work as a therapist

Summarising Questions

16. In your opinion, will emotional intelligence theory be of any use in understanding the therapeutic relationship by combined- or integrated training programs
17. Finally based on your experience as a therapist, do you think there is any relationship or link between the therapeutic relationship and Emotional Intelligence.

Ending the interview

18. What haven’t I asked that you think we should have Thank you for participating in this research. Could I ask you if you have any questions that you would like to ask me
APPENDIX E
Debrief for Participants
Thank you for taking part in this research project, your participation is extremely valuable. The purpose of this research is to gain a more in-depth understanding of the process in the therapeutic relationship and the possible links with the concept and measurements of trait emotional intelligence.

Should you have any questions or concerns about this study or should you wish to withdraw your consent or participation at any time, you can contact me directly on 07500016004 or poullis@yahoo.com. If you decide to withdraw from the research, the recording of your interview and any reports and transcripts will be destroyed.

If you have any diffuculties or concerns about this research or the conduct of the interview and you do not wish to share with me, you may contact my supervisor: Dr Don Rawson or the Chair of Social Sciences Research Committee through the course administration office on the number below:

CityUniversity London
SocialSciences Building,
Northampton Square
London EC1V 0HB Tel: +44 (0)20 7040 5060
In addition, if you would like to receive a copy of the findings of the study, please email me with your postal
address and I will forward a copy of the results when the study is completed.
I would like to thank you again for your input and time in this research.

Joseph Poullis
APPENDIX F
Example of TEIQUE Score and interpretation
(For full printout version please refer ON CD‐ROM)

This report has been developed by: K. V. Petrides (University College London) https://monkessays.com/write-my-essay/psychometriclab.com and Adrian Furnham (University College London) https://monkessays.com/write-my-essay/psychol.ucl.ac.uk/people/profiles/furnham_adrian.htm

The Trait Emotional Intelligence Questionnaire (TEIQue) is a scientific measurement instrument. The TEIQue inventories are underpinned by an academic research program based at University College London.

Below you will find your scores on the 15 subscales and four factors that make up the TEIQue, along with other information that will help you interpret and understand them. These scores are entirely based on your responses and, as such, they reflect your personal view of your own self, behaviour, and preferences weighted against the views of the wider population.

Your self-perceptions will likely remain relatively stable over your life (particularly between 30-65 years). However, they can change considerably after serious life changes or in response to systematic efforts on your part. It is also important to recognize that the way in which you see yourself may be different to how other people see you. Although the reliability of the TEIQue is very high, it is recommended that you take the questionnaire at least once more within the next year in order to determine the stability of your scores.

NB: This is a generic report and, consequently, some of the comments and examples may not apply to your particular circumstances or organization. The in-depth interpretation of this report requires an understanding of the principles of psychological measurement and of trait emotional intelligence theory (Petrides, Furnham, & Mavroveli, 2006). This report should not be used as the sole basis for important decisions about an individual. Rather, it should be used in conjunction with other information, including objective performance indicators and an assessment by an experienced consultant. This report has been automatically produced by the research program`s on-line report engine. For further interpretation of profiles, bespoke feedback, or statistical and psychometric analyses, email admin@teique.com.

Global trait EI
Your Score: 5.53
Your Score: 85%
Your Score(z):1.067
Global trait EI
The global trait EI score provides a snapshot of your general emotional functioning.
understand, process, and utilize emotion-related information in your everyday life.
may mask considerable discrepancies between some of the more narrow aspects of the construct. Overall, your score indicates that you are emotionally well-adjusted. For specific details, please refer to the entries for the TEIQue subscale and factor scores

APPENDIX G
Categories gained from the open coding stage:
 Empathy
 Emotional awareness
 Training
 Motivation
 Healing
 Spirituality / Transpersonal/Intuition
 Coping
 Self –Esteem
 Self-awareness
 Self reflection
 Context Perspective
 Connection
 Accepting
 Non judgemental
 Being present
 Honesty / Integrity
 Anger
 Fear
 Patience
 Role of Therapist
 Containment
 Parenting
 Acknowledgement
 Physiology / Emdodied
 Structure
 Past-present-future
 Risk
 Trait EI discredited
 Willingness and Listening attentively
 Flexibility and independence of therapist in the process in therapy.
 Boundaries
 Supervision
 Bodily, emotional and cognitive experience
 Embodied relationship
 Perseverance

APPENDIX H
Example 1: from a participant’s transcript including the open code
and themes from the analytical process
(For full printout version please refer ON CD‐ROM)
Worked example of transcript:

Transcripts were analysed separately for salient themes, which were then noted on the transcript itself, with the reference highlighted. These were placed into a table (see below). The themes from each transcript were cross-referenced in order to allow common themes to emerge. Each individual transcript was then re-examined with these themes in mind in order to assess their relevance. The most relevant themes (empathetic balance, emotional connection and mindfulness) were applicable in various ways to all transcripts, and provided the focal point of the results for this study.

 
Example 1: from a participant’s transcript including the open coding, axial coding
and themes from the analytical process

Table Showing Line Numbers for participant 6 Interview.
Key to transcript

INT: = Interviewer
RES: = Participant Co-researcher
… : = break in sentence
(laughing) = participant laughted whilst talking.

Line Category Dialogue
1 INT: One two yeah we’re on.
2 RES: Okay good.
3 INT: Okay so thank you for coming.
4 RES: That’s alright.
5 INT: Thanks for accepting the invitation.
6 RES: It’s a pleasure.
7 INT: Er well as you probably know it’s about the therapeutic relationship …
8 RES: Yeah, yeah.
9 INT: … and the …
10 RES: I ought to say from the start I, I know very little of the theory of EI[ph] …
11 INT: Right.
12 RES: … so that may er shorten things a little. (laughs)
13 INT: That’s okay. Um yeah I mean basically I’m just trying to see you know based on the experience you had …
14 RES: Yeah.
15 INT: … with this test …
16 RES: Yeah.
17
18 INT: … um if there is something there which it informs the therapeutic relationship based on what you have scored …
19 RES: Mm.
20 INT: … and what is the interpretation of those results …
21 RES: Mm.
22
23 INT: … er but before I’m going to get into that I’d just like a few, plus a few questions about er your experience as a therapist …
24 RES: Sure.
25
26 INT: … um and what is the meaning in your own words of the therapeutic relationship having taken that role with clients …
27 RES: I hear you…
28 INT: … for some years
29
30
31 RES: Previous
Experience

Training Yeah. Well I’ve occupied that role in a, in, in, in different ways um originally I, I don’t know how much I told you er er about the background with … I worked with um an organisation called Samaritans for slightly more than thirty years …
32 INT: Mhm.
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47 RES:
EXPERIENCE
BALANCE “Reflectively monitor and manage emotions in self and others”
RUPTURES
PROCESS
AVAILABLE
BALANCE
EMPATHY
/DETACHMENT
… as a volunteer, I also worked on the staff as Chief Executive of Samaritans for fifteen years um so I had a lot of experience of working with suicidal people in that capacity which was technically not a therapeutic capacity because Samaritans always maintain that they didn’t do therapy but they did befriending but actually when all’s said and done it really is a Rogerian approach, person centred approach er so in the broader context I reckon it is therapeutic. Anyway having done all, all of that at, at … I trained oh ten years ago I suppose in cognitive analytic therapy and during that time I’ve um obviously worked in that discipline and in a rather more formalised and structured way and um I guess for me that the, the relationship within the therapeutic context is about um the balance between being emotionally close and available and emotionally separate so as to preserve the independence and um I think for, for me it, it differs with each person I’m working with. It manifests itself in different ways, it develops at a different pace, it can be ruptured by different things, it can be easier or more difficult to maintain depending on the nature of the process and the transaction so I don’t think there’s a short answer to your succinct question.
48
49 INT: Mhm. You said something about balance between being emotionally available but at the same time not fully emerging to that …
50 RES: Yes.
51 INT: … would you like to tell me a bit more about that
52
53
54
55
56
57
58
59
60 RES: ENGAGEMENT
SYMPATHY vs
EMPATHY
OPENNESS
BALANCE
CONNECTION
RELAXATION
BOUNDARIES
SAFETY & SECURITY
CONTEXT PERSPECTIVE
EMPATHY
/DETACHMENT Sure what I really mean is that um in my experience in order to build a therapeutic alliance and to maintain that there has to be a degree of emotional closeness, emotional availability to what the patient, the client is um is bringing into the therapeutic process. It has to be possible to engage with that not only intellectually, cognitively but also emotionally er but at the same time in order to preserve boundaries and in order to preserve one’s sense of being as a therapist it’s necessary to have a distance er that er er ensures that you don’t get so enmeshed with what’s going on, that you cease to be of relevance of use, of value, of, of objectivity so it’s that sort of difference, that balance that seems to me to be important
61
62 INT: Right okay. Um well just going to be even more down into these experiences that you had with clients in therapy …
63 RES: Mm.
64
65
66 INT: … and in order for you to help me to understand what did you mean by that therapeutic relationship er I will ask you if it’s possible just to bring me some of those experiences you had with clients and perhaps you know what was that …
67 RES: Mm.
68 INT: … in terms of what you’ve just explained
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100 RES:
CONTAINMENT ability to recognize and manage feelings in self and others
/COURAGE
ENGAGEMENT
/ PRESENCE

PATIENCY

TRUST/SAFETY

BALANCE

MANAGE FEELINGS IN SELF
Yeah. Well let me give you two examples. Um the first is someone I’ve been working with which really er er is, is, is not in any way a typical cognitive analytical therapy which as you’ll know is time limited and very problem focused but I’ve been working with a person now for three and a half years um who and this patient is somebody who has um had experience in her childhood and early adolescence of satanic rituals, satanic er abuse and she has been reliving that um in the process of dealing with it so as to be able to put it away and that has been um both cathartic but also extremely um emotional challenging to her so much so that um quite a lot of the time er quite a lot … in, in quite a lot of the sessions she experiences flashbacks and has great difficulty and it’s, in a way it’s been one of the most challenging therapies I’ve undertaken but also albeit in a rather slow way one of the most rewarding both in terms of progress that’s being made and it is being made but also in terms of the accessibility to the issues that she is dealing with and the way in which she wants to um bring them er bring them into the er therapeutic space. Um and you know there have been times during what she’s been describing where it’s been very harrowing er obviously for her and also for me um so there’s been quite a lot of um er need to carry and to hold the pain that she is suffering and to help to relieve her of that by er taking it from her to some extent. So in that way the emotional engagement has been very important, it would be very difficult in my view to have been anything like as successful with that process and it’s by no means finished yet um were it not for the fact that there has been built up over that time a considerable emotional closeness but taking account of the nature of what’s being dealt with a) I haven’t experienced it obviously and b) um I need to maintain a stability of my own so as to be helpful um and thus I need to avoid getting so engrossed with what she’s bringing into the process that it becomes disabling so I think that’s a good example of how that balance is struck and, and maintained er sometimes you know with more or less ease. Another example at the other end of the scale is someone I’ve worked with who I found very difficult to build er an emotional um relationship with. Er she was very hostile and very um challenging which I think probably brought out of me a defensiveness that was not helpful um and I don’t think that at the end of the process she had really gained a great deal. I mean we’d been through the mechanics um and you can approach CAT in a very mechanical way …
101 INT: Mhm.
102
103
104
105
106
107
108
109
110 RES: Flexibility in interventions and understanding
INDIVIDUAL NEEDS … but sh… I personally don’t do er it is as you will know quite a prescribed process um and I think like a lot of CAT therapists I’m inclined to adapt it to the needs of the, of the client, of the patient um so I’m less rigorous in terms of maintaining the er theoretical milestones within the model as some other people might be but I think in doing that it’s possible to get a greater richness from er what’s involved. Anyway with this particular woman um it was possible to go through the mechanics of the process but without the essential emotional engagement which I think resulted in it being a much less rich experience for her well and for me but that’s not really the point …
111 INT: Mhm.
112
113
114
115
116 RES: DEFENSE BARRIERS
BOUNDARIES … um and I don’t think she really benefitted from it and part of that was to, to do with very well developed defence mechanisms that she was displaying which was, which were very very difficult to um to work with and to help her to overcome which meant that really she didn’t get to the depth that she needed to in order to address the issues she really needed to address which were to do again with childhood abuse …
117 INT: Mhm.
118 RES: … but not satanic abuse in this case but abuse within the family.
119 INT: Mhm.
120
121 RES: So two examples of one where it’s worked I think very well and continues to and one where it really didn’t work terribly well.
122 INT: And what did you think or feel in these two examples that you gave me
123
124
125
126
127
128
129
130 RES: EMPATHY
BALANCE/
FELEXIBLE
Flexibility in
interventions
and understanding Er well as … in the first one I feel a great deal of empathy um a great deal of pain depending on what’s going on and concern because this particular person has been and is from time to time still very very close to the edge, a very high suicide risk. I’m not unused to er working with suicidal people as I’ve said but it always is a great um generator of anxiety um and you will know that from your own experience I’d expect. As far as the second one was concerned it generated within me feelings of frustration and um boredom um irritation um and a sense of wondering whether it was worth her while and my while to continue the process. So again quite a contrast.
131 INT: Mhm, mhm. Thank you. What about the meaning after these two cases how did these two cases in a way inform your practice or the relationship with the clients and yourself
132
133
134
135
136
137
138
139
140 RES: FLEXIBLE
COURAGE
THEORY v
PRACTICE RISK
Okay well I think I, I continue to learn er you know as we all do um through the experience that we have as therapists and the privilege that we’re um allowed to have in working with people and their distress and the difficulties that they face and I think that um because it’s a learning process you know one’s learnt the theory but in terms of practice and it’s application then it, it is a constant learning process and um with these two particular cases I’ve described the, the, the first I think um I’ve learned the value of um taking risks um and measured risks and it … of, of course it’s always difficult to be absolutely confident that you’ve taken the right amount of risk and not too much.
141 INT: What do you mean by the risk
142
143
144
145
146
147
148
149
150
151 RES:

COURAGE/TRUST
RISK Um allowing the therapy to progress to a point where there is a distinct possibility that it will precipitate a suicide. Now it’s not only the therapist’s responsibility of course um but I think in holding the process and in holding the trust that the patient puts in one’s therapist there is a responsibility to ensure that um care is taken but equally unless some risk is taken carefully measured as it is then there is less likely to be the progress that needs to be made particularly with this particular person who needs to deal with the experience that she’s had by er recounting it for the first time in thirty years and being able then to understand it and to let go of it. Um so I think that’s, that’s a learning and I think as far as the other case is concerned and these are only two plucked out of …
152 INT: Mhm.
153
154
155
156
157 RES: ENGAGEMENT
DEFENSE
/DETACHMENT
LIMITS OF THERAPY … well I suppose now hundreds of people I’ve seen um then I think I’ve learned that it’s not very helpful to continue to pursue a therapeutic process when clearly there is no therapeutic engagement and the resistance is such that it’s not making any progress and therefore it’s better simply to confront that and if necessary draw the therapy to a close.
158
159
160
161
162 INT: Mhm. I guess on the first occasion where the session was quite emotionally charged um I wonder you know how was … based on that experience how, how was that for you to hold that session, how, how … was it difficult to hold the session, was it easy to hold the session, was it easy just to separate
163 RES: Um I wouldn’t say it was easy …
164 INT: Mhm.
165
166
167
168 RES: ROLE PLAY
RELIABLE/TRUST
PRESENCE
ALIVE
… but as that particular therapy progresses I’m playing a role of being immoveable, unshockable, wholly reliable and always there … I don’t mean always there but always present in, in the process and ready to work with what, what
169 INT: Yeah.
170 RES:
171 INT: HMM
172
173 RES: CONTAINMENT Oh okay. Um so yeah just, just being able to be, to be present and to hold what is, what is um brought into the process.
174
175
176
177 INT: Okay so to hold the session you said um and I guess what I’m trying to you know explore a bit more from that experience is if the session was more er felt physiologically or cognitively or emotionally or how was that session felt by you What was the experience from that session
178
179
180
181
182
183 RES: BODY EXPERIENCE
COGNITIVE BODILY
REALIZATION
CONTAINMENT
EMPATHY
/ DETACHMENT
Well I can’t really draw to mind a specific session um let me try. Um yeah I think physiologically there have been occasions where I’ve felt sick er because of what I’ve been hearing and um it’s then been necessary to try to rationalise that cognitively er and yet a lot of what is being disclosed is um so abhorrent that it is very difficult to rationalise so there’s a sense of having to hold onto something that is um so unacceptable as to be very very difficult to, to keep hold of.
184 INT: Mhm.
185
186
187
188
189
190 RES: SUPERVISION
So er and I think er supervision is quite important in that respect so that when I have my supervision which is a … not group but er one to one supervision um it’s, it’s of great value to me to be able to express my own feelings and to receive some reassurance about what’s going on and particularly when we’ve got to a point where she’s got very close to the edge to be reassured about um the level of risk and the way in which that’s being properly managed.
191
192 INT: Mhm. Do, do I hear you that in that process it was thinking and feeling the same time or was it …
193 RES: EMBODIED
COMMUNICATION Bodily, emotional and cognitive experience
No I think it’s the physiological feeling is followed by the cognitive explanation.
194 INT: Okay. What about the feelings afterwards
195
196 RES: MAGAGING
FEELINGS Um I think once having rationalised them um the, the feelings um are able to be er er no longer there. I mean one can deal with, dispose of them …
197 INT: Mhm.
198
199 RES: COGNITION … um and I think if, if one wasn’t able to rationalise them and then it would be very difficult to continue to hold them.
200 INT: Okay. And how were you able to cope with the thinking and feeling at the same time
201
202
203 RES: FEELINGS SUPERCEDE
THOUGHTS
Um okay I think it was I think that in the session itself it’s sometimes the, the feeling is so intense that it’s difficult to engage in a thinking process um because it … at the same time er and, and therefore there’s a need for one to process the feeling …
204 INT: Mhm.
205
206 RES: QUICK PROCESS
FEELINGS/
COGNTION
… in order then to be able to engage with the thinking but mostly that happens very quickly so as to be able to maintain the pace …
207 INT: Mhm.
208 RES: … and not to get, to run the risk of becoming disabled by what’s going on.
209 INT: Right because so I hear you saying that it was felt, it was physically first …
210 RES: Yeah.
211 INT: … then cognitively …
212 RES: Yes.
213 INT: … then the effect.
214 RES: Yes.
215 INT: Okay thanks. Um I think I’m just going to move into the topic of emotional intelligence.
216 RES: Okay. You tell me about it.
217
218 INT: Okay but before I’m going to get into that topic um I’d just like to ask this question about emotions. I know it’s a very large concept …
219 RES: Mm.
220 INT: … but I want your understanding of what is an emotion
221
222
223
224
225
226 RES: EMOTIONS
DISTINGUISHED
FROM
INTELLIGENCE (laughs) Um well I’m not going to give you a scientific explanation of that but for me an emotion is um a feeling that one has that is not necessarily always capable of rational explanation um at least at the time that it’s being experienced. It’s something that is, that takes over one’s being and sometimes in a broader sense one can become lost with, in an emotion er before the thinking can be put in place so as to be able to understand it, rationalise it and contain it.
227 INT: Mhm. Still hear you saying something about being primitive
228 RES: PRIMITIVE
FREUD ID Yes, yes primitive in freudian terms we’re talking about the ID.
229 INT: Right. Okay. Right just moving on to this concept of emotional intelligence …
230 RES: Yeah.
231
232 INT: … um you’ve already mentioned that you’re not familiar but you don’t have a great knowledge about …
233 RES: No.
234 INT: … the er emotional intelligence …
235 RES: I think I’ve read a bit of Daniel Goleman[ph] but for long… not for a long time so …
236 INT: It’s okay. Oh just to tell you a bit about this definition of Salovey[ph] and Mayer in 1997 …
237 RES: Mhm.
238
239
240
241
242
243 INT: … they talk about the ability to appraise one’s self and other’s emotions, an ability to regulate one’s own emotions and an ability to use emotions to …solve issues or problems whatever you might be wrestling with and I just wonder if based on your experience er of narrating to me in this interview the two cases there … and on the trait[ph] the high score … which um you had the experience of scoring …
244 RES: Mm.
245 INT: … and getting the interpretation and the results …
246 RES: Mm.
247 INT: … if you can comment about this concept
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
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267
268 RES:
BALANCE Reflectively monitor and manage emotions in self and others
CONNECTION
PRESENCE
ROLE PLAY
CONSISTENT
Mm. Yeah well I mean it, it … the, the definition you’ve read out which of course is one of a number is, makes a lot of sense. It, in, in fact I think it encapsulates um fortunately more or less what I’ve been saying um so in that sense it’s reassuring. Um I found that the interpretation of the questionnaire and the results of that quite interesting. Um I showed them also to my wife who recognised most of what was there but said that there was some interesting variances with what she perceived um in me um but er I, I suppose I was gratified to, to, to discover on the basis of this um instrument that um I was sort of more or less emotionally stable but nevertheless emotionally available and I think that’s, that’s important. I think it’s important as a human being to be emotionally available and with a completely different hat on I spend quite a lot of time working at er Broadmoor Hospital er which is one of the high secure hospitals er where there are a lot of patients who um are there with um personality disorders of one sort or another and certainly the um antisocial personality disorders which tend to be associated with a lack of emotional um um availability er one’s sees a lot of people who are devoid of emotion and er as far as I’m concerned emotion er good and bad play a very important part in being a functioning human being and certainly play an important part in being a functioning therapist because without being able to be in touch with one’s own emotions it’s in my view very difficult to be engaged with the emotions that other people have and to be able to understand them, to relate to them but also to be able to keep the space between one’s own emotions and the emotions of the people that one’s working with.
269 INT: Mhm and do you think this test actually did capture your subjective experience of …
270
271
272
273
274
275
276
277
278
279 RES: INTERPRETATIONS
VALIDATION OF EI Yeah I think it did more or less. I think there … I think it was um er without wanting to confuse it with, with other instruments um I think it probably ascribed to me a greater degree of extraversion than actually is the case. I know it wasn’t men… measuring introversion, extraversion but I think interpreting some of what the results were it, it, it made … it made it appear as though I was a more extraverted person than I believe I really am in terms of social engage… I’d, if one’s looking for example in MBTI[ph] terms or um um FIRO B[ph] for example um then I would be coming out much more of the introverted side than my interpretation of the results of this suggest but having put that to one side um the rest I think I’ve found very convincing and certainly felt very much in tune with what I believe I am, who I believe I am.
280 INT: Mhm. Are there any of those facets which you felt apart from be… the extrovert
281 RES: Not really no.
282 INT: Mhm.
283
284 RES: No not really. I think that um I mean it’s, it’s, it’s matters of degree I suppose but by and large it seemed to me to be um a fair representation.
285 INT: Mhm.
286 RES: Which was, which was interesting and um and somewhat gratifying, reassuring.
287
288 INT: Mhm. And do you think again er based on your experience um and looking at the qualities of the therapeutic relationship …
289 RES: Mm.
290
291 INT: … I guess um what do you perceive as important in therapy relationship to have as a therapist
292
293
294
295 RES: CONNECTING
EMPATHY
ENGAGEMENT
BALANCE
Well I think an emotional availability and um a resilience and a um a well developed sense of empathy um and the ability as I’ve said already to maintain an appropriate emotional distance. That balance between emotional distance and emotional closeness um those seem to me to be the key features …
296 INT: Mhm.
297
298 RES: THEORY vPRACTICE … um that er make the difference between the purely mechanical application of a model and the practical work of being an effective therapist working with people.
299
300
301 INT: Mhm. And looking on those er facets of the [unclear-00:28:57] here do you think there is something there which we can integrate in the training programmes or the informs perhaps of the therapeutic relationship
302
303
304
305
306
307
308
309
310
311
312
313 RES: TRAINING
UNDERSTADING SELF
AUTHENTICITY MINDFULNESS
ASSET
OF THERAPIST
-COGNITION Er will I think it’s really important and I don’t think this features enough in, in the training that I’m familiar with anyway but I think it’s really important for people er to have the opportunity to, perhaps to experience er an instrument of this sort er and, and other means by which they can understand themselves rather better. Anyone going er training as a therapist obviously goes through person therapy which is one thing but actually to, to deconstruct um in personality terms and to understand one’s self in those terms I think is very interesting and very useful because after all what the, the tools of the trade of a therapist principally is the therapist’s mind and if the therapist isn’t aware of the content and application of their mind they’re not going to be very effective as a therapist. They may have the knowledge but unless they have the ability to interpret, to understand and to put that into the context of their own being then I think it’s going to be a rather sterile process.
314 INT: Mhm.
315
316
317
318
319
320 RES: THEORYv PRACTICE So I think that as far as training is concerned there is clearly a lot to be said for learning the theory um getting all that understood but I think there needs still should be greater emphasis on understanding one’s self within the context of what becomes a therapeutic relationship and there are different ways of doing that, part of which is by this process of looking at an objective measure or an instrument that’s going to give you some feedback and allow that then to become the agenda for discussion.
321 INT: Mhm. And do you think we can teach people to be empathic or emotionally available or …
322
323
324
325
326
327
328
329
330
331 GUIDANCE TECHNIQUES
OPENNNESS
MINDFULNESS I don’t know that it’s a matter of teaching in terms of, of um instruction I think there is for the very very large er proportion of the population the ability to engage one’s own emotions in a constructive way but I think that needs to be enabled and I don’t think it’s something that necessarily taught but I think it’s enabled through process of discussion, experiential techniques er the use of instruments of this sort to provide an agenda for debate er and an, an, an awareness and understanding of how one interacts with other people, how one interacts with different situations, how one deals with um different challenges whether that’s um managing aggression or managing indifference or managing er transferences of various sorts um it, those are the things that I think need to have perhaps greater emphasis that purely the um the imparting of knowledge.
332
333 INT: So what I hear you saying is more the experiential side of things just this instrument to be the vehicle for …
334 RES: Yeah.
335 INT: … self reflection and debating and challenging
336
337
338
339
340 RES: Yeah, yeah. This instrument er provides the agenda, this is sort of many, one of many, many that provides an agenda for discussion and for understanding. Of course that will only be possible if it can be done within a context that safe where the person concerned feels able to self disclose and to be um available to um challenge and, and, and indeed interpretation and support.
341
342
343
344
345
346 INT: Mhm and based on those um traits as this test is measuring adaptability, motivation, emotionality, emotional expression, emotional perception, empathy, relationships, self control, emotional regulation, low passivity, stress management, social ability, assertiveness, emotion management, social awareness, wellbeing, happiness, optimism, self esteem these do you think are important in the therapeutic relationship
347
348
349
350
351
352 RES: MINDFULL
AUTHENTICITY
Um I think they can be important both in … what, what, what is really important is to um be comfortable with who you are er by way of being aware of your own er personality um and of course you know personality’s a big subject and this is only one way of looking at it but I think it’s quite a useful way and I think the way in which it, it, it um divides the um the, the overall um er context of personality into those different constituent parts is, is very helpful.
353 INT: Mhm.
354
355
356
357
358
359 RES: THOUGHT PROCESS Um but I think it’s important not to become to as it were clinical about it, it’s it’s important to see it as a means to an end rather than an end in itself and by that I mean it’s a means to enter a discussion even if it’s an internal discussion to get the thinking going and the engagement of the cognitive functions um rather than simply to say well that’s it, that’s what it says, that’s the answer it, it sparks um an internal discussion about who one really is …
360 INT: Mhm.
361 RES: … and what one’s particular strengths or indeed weaknesses might be.
362
363
364 INT: Mhm and do you think just by responding to those questions there and looking on the interpretation of scores was there something that you felt if was missing from this test as part of the therapeutic relationship
365
366
367
368
369
370
371 RES: MANAGE FEELINGS IN SELF AND OTHERS COURAGE
CONTAINMENT I think probably one thing I don’t know how you’d do it because I’m not um I’m not a psychologist er but I think one thing that would be very interesting to try to er measure or to reveal is resilience um because a lot of as you know the therapeutic process is about being resilient, whether it’s resilience to um being able to manage other people’s distress or to be able to hold a process or to be able to um deal with um er strong counter transferences that may be of a very negative nature er and I think that would be quite useful.
372 INT: Mhm.
373 RES: But I, I don’t know how you do it.
374 INT: COURAGE
CONTAINMENT Mm so resilience in terms … we’re using different language obviously in this test they’re talking about emotion management …
375 RES: Yes.
376 INT: … or about regulation …
377 RES: Yes.
378 INT: … so I guess is that what …
379 RES: Yeah may be that, may be yeah may be there needs to be a bit more emphasis on that …
380 INT: Right.
381 RES: TRAINING … and a bit more understanding or interpretation of it.
382
383 INT: Okay. And I guess I’m just going to ask you the last few questions here what haven’t I asked that you think I should be asking here
384 RES: (laughs) It depends what you want I know. (laughter)
385 INT: This is the topic area.
386
387388
389 RES: Well I, I, I think you’ve probably covered the ground fairly well. Um I mean we could have a um well we couldn’t but you might want to have a er strenuous academic discussion about um emotional intelligence viewed from difference perspectives. Um if you want that then you’d better go and talk to somebody else about it.
390
391
392 INT: Okay and to [unclear-00:37:59] if I’m going um er ask the question if emotional intelligence the wording of emotional intelligence it feels to you that it should be changed to something else or based on your experience is there a …
393
394
395
396
397 RES: THEORY EI
v
PRACTISE Um not really um I mean it’s a … because it’s a subject that has been um um considered from a, a number of different academic perspectives it tends to I think become a little bit um er rarefied whereas for the practical hands on purposes of being a therapist then it’s all to do with what’s going on in the room um er rather than you know what er various learned texts might say.
398
399
400
401 INT: Mhm. Thank you. I’m just going to move to the final question. Based on your experience as a therapist do you think there is any relationship between the therapeutic relationship and emotional intelligence based on this psychometric that you’ve just er [unclear-00:39:26](speaking together)
402
403
404
405
406
407 RES: EMOTIONAL
INTELLIGENCE
ENHANCES
UNDERSTDANDING
OF SELF Yeah, yeah, yeah I do I think the, the way in which emotional intelligence is er considered within this instrument and it’s um analysis is very relevant to the work of a therapist and it will certainly enhance my own understanding of myself er as represented in these, by these measures and offers um a, an opportunity to um consider where one might want to put more emphasis or increase one’s experience or learning or understanding so yeah I think it’s, it’s, it’s useful.
408 INT: Mhm. Thank you so much for your time.
409 RES: That’s okay.
Example 1: Table of themes for this participant’s transcript

Theme Sub-theme Reference Notes
Subtle Competencies in therapy Interrelating, openness and connecting
Present and real

37-47, 52-60,
43-45, 84-93,124, 154-157, 183,326
167-169, 292-295,367

Accessibilty to the issues emotional engagement. There has to be a degree of emotional closeness, emotional availability to what the patient, the client is um is bringing into the therapeutic process.

Substantial attributes Aliveness, genuine, integrity

41-43, 52-60, 78-95, 115-116, 123-125, 172-173, 179-183, 255-257, 260-268, 292-295, 323-324, 367-371 Judging the environment – being perceptive. Emotional engagement has been very important,

Balance Manage feelings in self and others.
84-85,60, 37-38, 47,100, 126, 115, 126,173,196,251,370,374. Balance between being emotionally close and available and emotionally separate so as to preserve the independence. Stability of my own so as to be helpful.
Risk Emotional experience 137-140, 142-150, 165-167, 189-190 Taking risks, allowing others to take risks. Approaching other therapists.
Risk of patient suicide.
Extraneous involvement Experience , Supervision,
Validation of training tools . 29-31, 33-36, 132,298 186,303,316
272,381, 394, 402-407 Worked as a Samaritan for 10 years. Experience of suicide cases.
Training and theory.Theory versus practise

APPENDIX I
TEIQUE Inventory

APPENDIX J
Facets of TEIQUE
The Adult Sampling Domain of Trait Emotional Intelligence

Facets High scorers perceive themselves as…
Adaptability …flexible and willing to adapt to new conditions.
Assertiveness …forthright, frank, and willing to stand up for their rights.
Emotion perception (self and others) …clear about their own and other people’s feelings.
Emotion expression …capable of communicating their feelings to others.
Emotion management (others) …capable of influencing other people’s feelings.
Emotion regulation …capable of controlling their emotions.
Impulsiveness (low) …reflective and less likely to give in to their urges.
Relationships …capable of having fulfilling personal relationships.
Self-esteem …successful and self-confident.
Self-motivation …driven and unlikely to give up in the face of adversity.
Social awareness …accomplished networkers with excellent social skills.
Stress management …capable of withstanding pressure and regulating stress.
Trait empathy …capable of taking someone else’s perspective.
Trait happiness …cheerful and satisfied with their lives.
Trait optimism …confident and likely to “look on the bright side” of life.

APPENDIX K

APPENDIX L
MEMOS
(For full printout version please refer ON CD‐ROM)
Memo : 19.06.10
Questions to focus in Line by Line coding and then in focus coding
Who is she/ he
What does she/he do in her therapeutic appproach
What do you think she meant by that
What are they supposed to do
Why did she/he said that
Why is that said
What happens after ________
What would happen if ________
What do you think about ________

Memo: – 13.08.2010 Emotional intelligence and therapists experiences

Re-reading participants response to their experience of the trait EI test … I feel some of those quotes have a different meaning hard to capture in words. Or perhaps the possibility of multiple understandings and interpretations. However do I allow more time to reflect the other participants contribution as this quote from the participant 12 really through my assumptions from literature review out of the window.
P12: Yeah, I think that, um (laughs) you’re probably not going to like this, but I think that it would be a really good instrument to take apart, er, in terms of the research component of the programme, to … so that students could understand the precise ways in which those questions are loaded. “Have you stopped beating your wife, Joseph”

Challenging my assumption of a link between the EI and therapeutic relationship is part of the healthy development of theory and I should be open to such critics not to allow the subjectivity and interpretation from developing to bias and cherry picking process. I thought that such a response excludes EI from the therapy context in any possible way for training. However I must be honest here and take a ‘subtle realist’ position. Ensure the ‘truth’ and trustworthiness of the account by following other participants’ experiences. A will treat the above response as a beginning of an audit trail, maybe allow my thinking to emerge from different participants descriptions around the theme of emotional balance and perhaps the link to the EI

Memo : 02/11/2010

I need to modify any emerging theory, exploring cases that do not fit as well as those which might generate new knowledge. The number of participants seems to have crash down the idea of trait EI as part of an important measurement in training and therapy. I wonder if I am Sensitivity to negotiated realities – While participant validation may be necessary I must be aware as a researcher of the power differentials and participant reactions to the research. It is particularly important to explain any differences between the researcher’s interpretations and those of the participant(s).

Memo : 01.01.2011
I need to continuously develop and modify the link of EI to what participants desribe as important themes in therapeutic relationship. Empathy, Spirituality / Transpersonal, Connection, Accepting, Non judgemental, Being presence, Patience Containment, Physiology / Embodied and Emotional intelligence

Memo : 01.02.2011
But most importantly theoretical memos are written about codes and their (potential) relationships with other codes. How and why was the core category of emotional balance selected On what grounds There are lots of participants that talk about containment and presence and openness and acceptance and the ability to stay with the client in their role as therapist. I think Emotional balance is a concept to capture their descriptions and my interpretation of their meaning. Do the theoretical findings of emotional balance seem significant All participants seem to share a common description of some level of containment and balance of feelings. The feelings that are described as physical, emotional and cognitive and share the purpose of regulating emotions and accept the client unconditionally. That seems to relate to the concept of EI but the test used and the participants experiences are so varied and most therapist do not agree with the way the test captures their self. Some of them found the facet of controlling others very traumatised as they do not attempt in therapy to control their clients. As participant 8 noted:
Maps making connections:

Section C: Professional Practice
Advanced Client Study

Cognitive Analytic Therapy Applied to a Child Sexual Abuse Survivor
Part A – Introduction to the client study
The present case study demonstrates the use of Cognitive Analytic Therapy (CAT) (Ryle, 1990) as a theoretical basis and treatment framework for clients who suffer from childhood sexual abuse (CSA) and borderline personality disorder. In this paper, I will critically reflect upon my work and professional development as a counselling psychologist from engendered by my clinical engagement working with such a patient, who I will refer to as Paulina. I will also discuss the feedback I received from supervision.

1. Summary of Theoretical Framework
In the present paper no attempt is made to offer a comprehensive account of CAT approach. A full description is available in Ryle (1997) and in numerous papers and in appendix 1. The aim is rather to focus on the use of CAT as a theoretical basis and treatment framework for clients who suffer from childhood sexual abuse (CSA). Nevertheless it is important to introduce briefly the key components of CAT and demonstrate its use by a case example. CAT is a time-limited, structured psychotherapy that combines psychoanalytic cognitive, and behavioural (Marzillier & Butler, 1995) elements into a “common language” (Ryle, 1997). CAT was developed by Antony Ryle, a British psychodynamic psychiatrist, in the late 1970s. His aim was to create a brief, focussed and effective integrative approach (Ryle and Kerr 2002). A number of papers have been published demonstrating the clinical effectiveness of CAT (Pollock 2001; Clarke and Llewelyn 2001; Duignan and Mitzman 1994).
The psychotherapy is based on a radically social model of self, which is seen as fundamentally constituted by internalised, socially-meaningful, interpersonal experience and described in terms of a repertoire of reciprocal roles and their procedural enactments (Ryle, 1997). From this perspective, it can be argued that there can be no such thing as individual psychopathology but only socio-psychopathology. For a more descriptive explanation of CAT used in this case study please refer to appendix 1.

2. Introduction to the Client and Background plus Context of the Work
Paulina was referred to the psychological services department of a private clinic via a psychiatrist assessment letter. The letter stated that Paulina was suffering from unwavering shock of grief, emotional intensity, ambivalence, confusion and depressive moods. The incident leading to up to the referral was her husband’s (“Adam’s”) infidelity. The emotional turmoil she was experiencing was staggering, particularly because she could not circumvent such shame and betrayal. The referrer noted that the client would benefit from CAT, because of its structure which permits the client and therapist to make sense of what is going on.

2.1. Convening the first session
I first met Paulina in the waiting area of the private clinic. Paulina is a 32-years-old, white woman, married to a very successful physician with two children – aged 2 and 1 years-old. She works part-time in the banking sector. Upon our first session, Paulina appeared to be very polite and with exceptionally good mannerism; however, she was clearly emotionally distressed and labile, with clear indications of depressed mood. She arrived punctually for her appointment and was positive and cooperative throughout the assessment. It was evident that Paulina experienced difficulty focusing on and addressing demands and responsibilities despite being able to recognise them. Depressed mood and lack of motivation appeared to interfere with her functioning and ability to cope. She reported using drugs in order to avoid demanding and conflicting situations, which leaves her immobilised in the face of expectations and responsibilities for change. As therapist I sensed that Paulina experiences her environment as punitive and generally lonely. The client’s suitability for CAT is discussed below.

2.2. Presenting problem
As the therapist, I began the session by asking Paulina why she decided to come to therapy at this time and to describe what she expects to achieve from treatment. Paulina spoke clearly and in a very articulate manner, asserting that she requested these sessions due to her shocking discovery of Adam’s affairs. She was in tears with her voice breaking at times. Paulina described how her husband’s infidelity provoked her with a sense of humiliation, inadequacy, rejection, and abandonment. She had no motivation to return back to work, felt depressed, and was binging on alcohol and drugs to change her moods. She further stated that Adam had always been a work alcoholic and that she had taken the role of looking after him as a good wife. When asked why she remained in such an empty relationship long before Adam’s numerous affairs, Paulina said that it was her moral duty as a wife to deal with the situation and save her marriage. Responding to my question of whether she had any suicidal thoughts, Paulina disclosed that she had thought about ending her life but she will never do it because of her two children. Paulina continued to live with Adam, and was anxious not to reveal her secret of drug addiction in case the marriage would dissolve and could endanger her custody of the children. Paulina acknowledged that her drug habit does negatively affect her parenting.

2.3. Background and family history
Paulina described both of her parents as promiscuous and emotionally unavailable. She also reported that as a child, she felt powerless numerous times when watching her parents drink and abusively argue. Paulina then wept while she described her father’s sexual abuse, occurring from the ages of 11 to 15 years. At the age of 15, she managed to find the strength and disclosed her abuse to a neighbour, who in turn, reported it to social services. The abuse has left Paulina with a repulsive memory of her father. Paulina’s mother, although accepting her father’s wrongs in the abuse, managed to convince Paulina to drop any allegation to social services.
Despite her childhood adversities, Paulina graduated with excellent grades and was accepted into one of the most prestigious universities. She graduated with honours from university and then travel for two years. Those two years, Paulina described, were a period of promiscuousness with many sexual adventures. Paulina reported how she met Adam in a local coffee shop, and how his obsessive pursuit was initially stalking and scary. Despite Paulina’s ambiguous feelings and early hesitations about Adam, within three months, the couple were married.
2.4. Initial Assessment / Formulation of the Problem
From the initial assessment, I recommended therapeutic assistance for Paulina to deal with her current issues with and from Adam, but more important, her unresolved issues related to her parents, such as the feelings of rejection and abandonment, which could be viewed as a theme reoccurring throughout her life. Both parents were emotionally unavailable, alcohol-dependent, unresponsive, and neglectful. Between the ages of 11 to 15 years-old, sexual abuse from her father only exacerbated matters. As a child, Paulina felt desperately lonely, lost, and unprotected. Paulina received developmentally inappropriate, unreliable, and inconsistent parenting ambivalent needs, and had witnessed extreme parental aggravation domestic violence.
Paulina was neglected and abandoned and that negatively impacted upon her developmental dependency needs. Neglected and abandoned by her alcoholic primary care givers and without someone to reflect her emotions Paulina had no way of knowing who she was. Abandonment includes the loss of mirroring and Children cannot know who they are without reflective mirrors (Bradshaw 2005). The core wound of abandonment is Paulina’s primary driving force. She does not know how to attach in healthy inter-dependent emotional adult way. Her relationship with Adam is co-dependant wherein Adam covertly or overtly demands that her choices should please him. In that process Paulina ends up compromising her authenticity and emotional health.
Not being able to count on her partner to meet her needs could be viewed as a key factor for Paulina’s current drug addiction. Trust and dependency are two issues that can determine personal strength and confidence to enslaving one’s addiction or dependency. In addition, these chaotic circumstances in childhood and current life (Ryle 1990) generated low self-esteem for Paulina, and a combination of a corrupting/exploiting and isolating/abandonment childhood experience. As noted by Bandura (1994), self-efficacy can have an impact on everything from psychological states to behaviour. Assessment data from the Beck Depression Inventory (Becks 1996), Becks Anxiety Inventory (Becks and Steer 1993), and Beck Hopelessness Scale (Becks 1988) confirmed that Paulina was currently suffering from severe depression, anxiety, and a pervasive sense of hopelessness, which were corroborated by her high scores on all three psychometric instruments.

2.5. Choosing an appropriate treatment approach
Having reflected on the assessment session as therapist a decision was made to use CAT for the following reasons. First, and as aforementioned, CAT is specifically helpful for clients suffering from CSA (Pollock, 2001) and neglect, as well as from borderline personality disorders (Ryle & Kerr, 2002). CAT, as a time-limited therapy, has even proven to resolve threats to the therapeutic alliance with cases of clients suffering from both CSA and borderline personality disorder (Bennet, Parry & Ryle 2006). The use of CAT tools, such as the reformulation letter or a diagram representing the main dysfunctional and problem procedures, provides a language and structure that permits the client and therapist to make sense of the chaotic inner life of CSA survivors and resolves threats to the therapeutic alliance (Bennet, Parry & Ryle 2006). Second, the collaborative nature of CAT challenges the victimization and powerlessness often experienced by CSA survivors and promotes a sense of control for clients (Bennet, Parry & Ryle 2006). Moreover, the therapeutic relationship between therapist and client is from the start collaborative and mindful of imbalances of power. CAT insists on conceptualizing ‘the patient in non-static, systemic terms whereby actions and relationships are understood as both causal and caused by each other’ (Llewelyn, 2003, p. 503). All this gives CAT a theoretical flexibility and relational dynamism that more Cognitive forms of therapy have forsaken over the therapeutic model of their co-option.

2.6. Negotiating a contract and therapeutic aims
Paulina was eager to start therapy immediately. She wanted to put an end to this experience of confusion and pervading sense of powerlessness. Paulina hoped that therapy would assist her to achieve the following goals:
 Resolve the confusing thoughts regarding her identity and marriage;
 Stop her addiction (drugs); and
 Reduce the pervading sense of low self-worth and self-defeated thinking.
Following the identification of Paulina’s goals, I described the nature of CAT and determined a course of treatment. I did explain that I am under supervision and I might share information from time-to-time with my supervisor. I informed her that in case of suicidal ideation, self-harm, or harm to others, I would be required to disclose this information to her General Practitioner.

Part B – The Development of the Therapy
Paulina’s treatment consisted of 21, one-hour sessions of individual CAT, occurring on weekly intervals. Paulina attended 21 sessions and then an arranged follow-up session three weeks after the last session.

3. Therapeutic Plan and Main Techniques Used
In CAT, treatment is divided into three overlapping phases, namely, reformulation, active therapy, and termination. The initial phase of therapy with Paulina focused on developing a therapeutic frame, while establishing clear boundaries through a working alliance. Over the first 8 sessions, the aim of therapy was to establish a collaborative therapeutic relationship and a narrative reconstruction of Paulina’s problem procedures. The psychotherapy file is used as the immediate tools to learn to identify patterns of behaviours. I also linked RRPs to the diagram and referred to or refined them accordingly throughout treatment. Paulina’s dominant RRPs are concerned with care-dependency, control-submission, and abuse-victimization. The diagrams SDR and repertory grid described Paulina’s different states and traced switches between them. The majority of the RRPs described in the SSD diagram was also emphasised as manifestations on Paulina’s ongoing life and in the therapy relationship.
The second phase of treatment was the creation of a descriptive reformulation letter (appendix 3), offering the outline of Paulina’s meaningful life story and addressing her interpersonal difficulties. I also used an imagery rescripting technique to enhance the reformulation process. Reformulation provided the framework of therapy but did not limit the therapeutic methods employed.
The next stage involved a more active therapy as the issue of change begun during the reformulation stage and work within the ZPD to describe maladaptive reciprocal role procedures and address multiple ‘self states’. These, tested out against further experiences, serve to understand ongoing relationships and to anticipate how dysfunctional RRPs are likely to affect the therapy relationship. Further notes on therapeutic plan were drafted as shown in appendix 5, and a reflective analysis during the process of therapy and supervision was established.
Key content issues. Paulina’s key psychological issues are:
 Disturbance of self-identity, such as low self-worth, vulnerable, unlovable, defective, alone, rejected, abandoned.
 Affect dysregulation, such as toxic shame, depression, humiliation, trauma symptoms, hopelessness, self-hatred, powerlessness, betrayal, rage, denial, and rejection.
 Interpersonal problems, such as victimization, alcohol/substance abuse, occupational underachievement.

3.1. The therapeutic process and interventions
The therapeutic relationship was facilitating a process of a collaborative non-colluding working relationship, sustained by adequate secure emotional attention and support whereas Paulina could encounter me and the world in a fresh way (e.g., breaking out of her powerless notion that she was imprisoned, acknowledging the possibility of choices). I experienced discomfort and fear of abandonment when I was exploring Paulina’s understanding and expectations of my role as her therapist. I thought it was indicative of what she was experiencing and it was useful in my therapeutic intervention and process to bring in that space my self and our relationship.
Paulina was able to explore how such expectations can influence our therapeutic relationship. For example we discussed how previous dilemmas (e.g., “I want to be independent but also approved of”, might repeated with her therapist. The aim was to create an awareness of how imbued internalised co-dependant patterns wherein her husband (or primary caregivers) covertly or overtly demands that her choices should please them, which in turn ends up compromising her authenticity and emotional health. That intervention provided an experience of a different attachment in a healthy inter-dependent emotional adult way and paved the way for our working alliance. Such a strong working alliance was necessary as Paulina disentangled a combination of shameful, low self-worth, and painful feelings. The emotional pain created by childhood abuse, neglect, and parents’ domestic violence were pivotal starting points to assess when constructing the SSD diagram.

Phase one: Reformulation process.
Paulina was open but also distressed about talking of her childhood adversity. At the end of the first session, I requested Paulina to complete the psychotherapy file and attempt to recognise familiar patterns of understanding and acting with her self and others. At the next session, Paulina returned the completed file and was eager to discuss it in therapy. One of the first findings discussed was her contradictory beliefs. For example, three ambivalent statements Paulina endorsed were a dilemma: “I am a brute or a martyr” and “either I feel I spoil myself and feel greedy or I deny myself things and punish myself feeling miserable.” Also the dilemma “I want to be independent but also approved of”. Paulina identified her relation to drug abuse as a trap (Negative assumptions generate actions which produce consequences seemingly reinforcing the assumptions), and a snag, whereby positive events were forbidden due to her feelings of low self-worth. Another interesting finding in the psychotherapy file Paulina wanted to discuss was her frequent unstable states of mind (e.g., vulnerable, needy, passively helpless, waiting to be rescued, wanting to hurt herself, humiliated, hurt, zombie, paranoid, agitated, confused, and anxious).
By the eighth therapy session, I felt the longing that Paulina needed to be understood and to connect. In that moment I reflected on an important book in Stolorow’s and Atwood’s (2002) term ‘the myth of isolated mind, a theory that intrigued me. The book defined the term as ‘a state in which one feels neither known nor understood at the level of one’s deepest affects; it is, moreover, one in which the longing for such sustaining connection to others has succumbed to resignation and hopelessness’(Stolorow and Atwood 2002, p.9). From this I inferred how our self-consciousness can only exist if it is recognised and acknowledged by another. Just been present, accepting, and understanding Paulina with empathy was in my opinion a pivotal element to build the relationship and made Paulina to feel very important.
Paulina’s involvement in the therapeutic process was important in order to foster a feeling of control and self-confidence. This active participation in the therapeutic process also creates a perception of belonging and increases self-confidence in the self as being able to solve the problem (e.g., experience the ability of not been helpless with overwhelming feelings). The principal focus was to work collaboratively with Paulina, provide an interpersonal safety, and involve her in all or most of the activities (e.g., psychotherapy file, SSD, SDR, mindfulness, a diary of moods, and repeated dominant RRP). This introduced her to active participation in the process and initiated a task of self-reflection, awareness, control, and interpersonal safety rather than helplessness and powerlessness.
The first 8 sessions were focused on the joint creation of written and diagrammatic descriptive reformulations of Paulina’s perception and experiences in her life story and perception of self-state and self-others. The reformulation letter (see Appendix 1), was a joined attempt to try and understand how Paulina came to the present set of difficulties, and to understand how coping strategies, devised by the child in distress, may be causing additional problems now as an adult. The reformulation letter and preliminary diagram was presented to Paulina, and upon her reflective input, we collaboratively revised and adapted it accordingly.

Understanding the reciprocal role procedures, and self states which maintain their dysfunction and distress.
Following, we jointly produced a list of dominant RRPs. I requested Paulina to rate the extent to which she was able to recognise the influence of those RRPs in her behaviour and relationships. Paulina noted how hearing the reformulation letter being read aloud during the session seemed to instil feelings of being heard, listened to, and understood. From this narrative, we jointly constructed a The sequential diagrammatic reformulation (refer appendix 2). Paulina’s story was of early neglect and abuse, but the cycle of expecting perfect care and always being disappointed shows that she did not copy exact role patterns. Instead, it seems she created her own responses to the position that her parents brought her into. Paulina’s search for an ideal parent to offer perfect care, but always being disappointed, shows early, attachment experiences. These experiences can cause unintegrated mental processes via the RRPs. For example, Paulina is repeating parent-to-child relationships by being at one pole of a ‘neglecting parent-neglected child’ or ‘dependable adult-dependent child’ relationship. As a result, my therapeutic job was to provide adequate scaffolding via interpersonal safety, and a specific form of non-reciprocation.
The first step in this process was the formulation of sequentiality of Paulina’s reciprocal patterns and multiple self-states. A self-state appears as a repeated dominant RRP that permeates experiences. The process was to explore and understand how Paulina related to herself and other people (i.e., a self-state). Paulina’s repertoire of relating to herself and others included the following dominant RRPs:
A1 Idealised, rescued to A2 Saved, dependent (Self state 1)
B1 Abandoned, neglected to B2 Unlovable, untrusting (Self state 2)
C1 Contemptible, betrayed to C2 Depleted, deflated (Self state 3)
D1 Exploited, violated to D2 Martyr, unworthy (Self state 4)
E1 Admired/ Admiring to E2 Compliant /Controlling (Self state 5)

Paulina was invited to participate in the interpretation and analysis of these dominant RRPs and reflect on possible connections with her dysfunctioning symptomatic procedures (dilemmas, traps, and snags). In order to explore how the relationship between each of these self-states were depicted; I created a two-dimensional plot, based on Paulina’s completion of the States Description Procedure (SDP) as illustrated in appendix 4 (Ryle, 2007). It should be emphasized that the SDP is a procedure and not a psychometric test. The purpose of the SDP is to assist Paulina to identify, understand, and generate her own subjective self-states. Stories from outside the therapy room were then linked to the sequential diagrammatic reformulation (SDR), and RRP enactments were held in focus throughout Paulina’s therapy, particularly within supervision. The availability of the diagram also reminded me as a therapist to recognise these self-states and RRP enactments within the therapeutic relationship and to support Paulina’s self development via the ZPD. This is also akin to the main theme findings of section B (The therapeutic relationship and its links to Emotional intelligence). Paulina was encouraged to identify and track switches between these self-states within the SDR sequential patterns (refer to appendix 3 for a description of self states and switching).
Paulina showed a great interest in reviewing the diagram in appendix 4 and reflecting on the patterns (see Figure 1). We also discussed how to be alert in the process of therapy of possible destructive patterns that can emerge in the relationship with her therapist. For example, if due to Paulina’s childhood-derived patterns of the general form contemptible, betrayed in relation to depleted, deflated, would generate both abusive and abused states.

I am striving performing I control others

Feel crashed, anger, abandoned

Can’t be the real ‘me’/ sadness Others care for me
I feel betrayed / used I feel safe
Abandoned
Others control me Pleasing / no joy
Attack me
I hate myself
I feel unreal
I feel guilty I feel powerless
I am anxious
Feel helpless
Contemptuous of others I am ‘fearful of a mess’
I feel like hurting myself I feel rejected, I feel angry (hide it)
Figure 1: Paulina’s States Grid.
I encouraged Paulina to reflect, respond, and adjust the dominant RRPs accordingly. In addition, I prompted her to consider any links or relevance within the SSD sequential patterns and reformulation letter. Paulina agreed on formal homework assignments devoted to the recognition of powerlessness and hopelessness procedures. The greater safety provided by the therapeutic relationship and the new understanding of her RRPs permitted Paulina to access and assimilate previously avoided or dissociated memories and feelings via the use of imagery rescriptive and reprocessing techniques. Paulina’s was also challenged on specific procedures that reformulation identified, e.g. abusive to abused/rejected, as likely to be manifested in the therapy relationship.

3.2. Difficulties during therapeutic work
During the 17th session, Paulina received a call five minutes before entering the therapy room. Adam managed to hack into her email accounts and found a handful of sexually explicit messages. Paulina was in a full-blown panic attack and exploded emotionally, as well as physically (e.g., hyperventilating and trembling). I found myself in a state of confusion at first as to what should I do to calm her down. After five minutes of immense hyperventilation and trembling, I used a progressive muscle relaxation technique in which you systematically tense and relax different muscle groups in the body, as a way to bring one’s nervous system back into balance. Paulina managed to take control of the anxiety but stated she did not want to go home. With tears in her eyes, she stated her wish to stay in the therapy room as a refuge. Then, Paulina asked me if she could call me at any time if things perpetuate further. I responded by asserting that I believe she can manage the situation without the need to call or see me until our next session. As a therapist, I was mindful of the need to offer Paulina adequate holding, meaning to provide a specific form of non-reciprocation, this is elaborated further in my reflection notes appendix 6 and figure 1.
Furthermore and more importantly I had to trust my intuition by trusting and motivating Paulina that she had the capacity to go through this experience. Being able to support Paulina and offer trust, motivation and interpersonal integrity during these challenges was vitally important to establish an empowering connection and strengthen her confidence. I experienced emotional discomfort and anxiety as my interventions was counting in her ability to maintain a healthy psychological balance of autonomy as she was encountering the danger of foregrounding ability of freedom, choice and independency. However I was aware that being filled with Paulina’s emotions, or being over attentive to the emotions that are called up by that space, is not very helpful. The classic image of this is from the Odyssey, when Odysseus is sailing past the rock with the Sirens on it. The therapist must be both ‘stupid’, and keep going, and must be present, if you cannot contain your emotions they will overwhelm everything. You have to keep rowing but, you also have to feel, it’s not one or the other. I indicated my supportive presence but I fear that this would have been withholding and may have re-created her childhood experience of abandonment and sense of emotional neglect. Nevertheless I trusted my connection with Paulina and I felt a strength in her will for autonomy in meeting her own needs.

3.3. Making Use of Supervision
At times, Paulina appeared disengaged from therapy and at other times, appeared to be idealising and admiring her therapist. This represented a splitting between perceiving her therapist as saviour (idealised and rescued) and a frustrating, neglectful carer (rejecting, abusing). As a therapist, I sensed the therapy process could have demeaned, belittled, and rejected Paulina, which tested both my empathic capacity and resilience. At fortnight CAT supervision, we discussed how Paulina appeared to adopt the RRP “powerful, rejecting, and contemptuous” roles. Her early abuse and neglect had taught Paulina to reverse these roles in order to survive emotionally. She seemed to continue to do this in her relationships and now with her therapist.
At fortnight CAT supervision, an explicit reference was made to how the procedures identified may affect the therapeutic relationship. Paulina’s adverse developmental history, and inadequate and abusive parental environment were negatively internalised and impacted the nature and content of her repertoire of RRPs. Multiple episodes of frequent abuse experiences become an automatic generic script and colour the survivor’s self-perception of self-self and self-other interactions. The RRP of fearful attachment of Paulina could be conceptualized as a betraying-to-exploited RRP, resulting in a confusing dilemma. On one side of the dilemma, seeking care risks being disappointed or abandoned. On the other end, seeking care can cause loneliness and depression. This dominant RRP could be generalised as exploiting abusing in relation to exploited violated.
Figure 2: Dominant Reciprocal Role Procedure

In supervision we discussed how these RRPs must be understood, reorganised, tracked, transformed, and managed through therapeutic discourse and techniques. Supervision also helped me to address subtle violence and confusion in regards to setting boundaries, but also to reflect on my empathic capacity and resilience as Paulina is re-experiencing the ambivalent relational bond with her parents. In supervision, the theme of control often resurfaced and how as a therapist I should stay out of Paulina’s SSD and RRPs. Child abuse is all about the abuse of power, and it is imperative that this is no way reflected in the therapeutic process. The supervisor noted how control is a pillar of the therapeutic process and it was important that Paulina could control the use, progress, and content of the time available to her. In this manner, Paulina was given the assurance that she can proceed at a comfortable pace, without any pressure to disclose anything. More notes on supervision is available in appendix 6.

3.4. Changes in the Therapeutic Process
In the sixteenth session, and weeks that followed, Paulina managed to control her addiction on drugs and alcohol but a new addiction resurfaced. Paulina kept describing in the sessions numerous sexual affairs with various random men and couples. She stated how those new encounters offered a new comfort and security. Paulina expressed how embarrassing is for her to reveal that side of herself and felt shameful but less reluctant to talk about them. I attempted to explore with Paulina the meaning of those intimate encounters by first accepting and allowing Paulina perhaps to be more accepting of herself. Feeling accepted was a theme that links closely with other themes, such as feeling heard or having space to talk. Paulina’s sexual encounters were described as sexually gratifying with no strings attached. The supervisor described the ‘dilemma’ for Paulina who was being sexually abused as a child by the primary care-giver and how as a child she relied upon the abuser for ‘protection’ and closeness. A possible scenario is that Paulina through internalised maladaptive learning and as a child internalised that sexually toned behaviour can lead to warm responses from others (e.g., behave seductively as a way of maintaining interpersonal relatedness). Another possible scenario is that Paulina might perceive relationships as a price to pay (e.g., to be close will mean to lose reality or integrity, and therefore, intimacy is avoided). Paulina was challenged why she was avoiding intimacy or other feelings. Paulina responded that the fear of feeling unworthy or rejected made her behave that way.
In fortnight CAT supervision, we discussed whether Paulina was seeking degrading or humiliating sexual experiences simply as a way of extending internal feelings of shame and unworthiness. Perhaps Paulina concluded that meaningful relationships with rules and boundaries are for people who are lovable, and those who are unlovable have to survive in other ways. The danger was that Paulina could confuse nurturing with sex and thus, support, care, affirmation and love are all distorted into a sexualized manner. The question posed during a mutual reflection with my supervisor was whether Paulina avoided an ending in her marriage and a new beginning because she had no confidence that ‘others’ could love her. The supervisor suggested exploring the meaning of sexual obsession and shame.

3.5. Changes in the Therapeutic Plan
Between sessions 19 and 20, I was off sick (the therapist) for two weeks, which Paulina found distressing. The distress of such an experience then caused her to role enactment abandoned and hurt client reciprocating an abandoning and powerful therapist. Paulina then cancelled the next session and I felt that this was possibly due to letting her down and disappointment. It was possible a wish to leave therapy and not come back. During the first half of the 21st session Paulina withdraw into silence and short responses. I focused the rest of the session by discussing the meaning of her silence. Paulina’s was able to tell me how she felt both guilty and angry and how this changed to hurt and withdrawal. Having acknowledge my role in the incident and my understanding on how she experienced that absence, we then discussed Paulina’s habitual response to hurt and how that had been replayed in therapy and ways of dealing more appropriately with incidents (such as the therapist’s illness) .
During the next session Paulina began the session with her work progress as a volunteer. She described that there is a voluntary organisation she is supporting and is about helping soldiers who had experienced traumas. She went on to explain how those soldiers that are following order to keep a curfew to disturbing cantons in the Middle East, are experiencing odd behaviour as normal. How people in these cantons are not allowed to walk on the street (after specific hours in one day) and how the behaviour of transporting food via the roofs of their houses became a ‘normal’ way of living. I then took the chance to explore with Paulina the parallel of that story and the current session with me as therapist. Paulina burst to tears and noted how she was exceedingly careful to discuss at length the end of therapy and to explore feelings of disappointment because of my absence. This gave me the chance to discuss the forthcoming termination of therapy and my permanent absence. I felt the need to assist this process by positively encouraging change.
The procedural understanding of Paulina’s difficulties suggests a change on therapeutic plan to terminate therapy and help Paulina to accept ‘exits’ in general terms. This was also a chance to appraise the gains and failures of therapy and the chance to explore feelings of disappointment via the termination of therapy. Moreover this could assist Paulina to face the challenges with more confidence and develop into particular lived out solutions. Paulina also improved her ability to recognise the operation of her maladaptive reciprocal roles. She was more willing to begin to try out new ways of behaving by becoming more mindful how the multiple sexual affairs and co-habituating with Adam as two strangers became normal.

3.6. The Therapeutic Ending
One of the most important issues of CAT approach is termination of therapy. The final 5 sessions were aiming in fostering Paulina’s increased sense of self –esteem, mindfulness and termination of therapy. With regards to termination of therapy a constant attention was paid to the salient aspects of Paulina’s abuse by significant others and the sense of loss and trust in her childhood. The experience of losing the therapeutic bond could bring back painful feelings of betrayal and loss for Paulina and that needed time and space to discuss. The last two sessions was based towards the termination of therapy. This was a painful time for Paulina and a process of dealing with loss, trust and self-esteem. Through therapy she had completed a diary and a weekly rating sheet focusing on loss, trust and self-esteem and exploring her unhelpful procedures as detailed in the SSD and reformulation. The last stage in the CAT is the termination of therapy, where Paulina is made more aware of the RRPs’ and her behaviour to change them.
To support this process, a goodbye letter was written to Paulina at the last session through which she is helped to avoid denial or idealization, and to monitor and reflect on what has and has not been achieved. The goodbye letter is a technique to review the themes of the reformulation letter, the challenges within the therapeutic relationship, and the successes achieved with an indication of where vigilance or further work is needed. Although Paulina was also invited to review her therapy and write a letter at the same time, she decided not to do so as things had been busy at work and home. I accepted this as a healthy sign of Paulina’s diminishing urge to please but also as a form of rejection given the termination of therapy. I experienced CAT as containing the pressure as a time limited therapy and as such restraining Paulina to reflect and connect with her experience. This deeper understanding was necessary to explore how Paulina’s expectations impact on and influence our therapeutic relationship.

Part C- Reflection and Learning & the Therapeutic dialogue
I feel a brief self reflective confessional would be appropriate place to start in this part of the case study. “Dialogue or Diatribe” is the article that Simon Du Plock (1997) wrote and it is the heart of what I call dialogical psychotherapy – a therapy that focuses on the meeting between therapist and client. In this psychotherapy, what is essential is not what goes on within the minds of the partners in a relationship but what happens between them. Du Plock has ably used Buber’s notion ‘‘Healing through Meeting’’ (Buber, 1990, p. 91, See pp. 91–97). Du Plock noted, “what might be the outcome of therapy, in terms of a genuine dialogue, if the patient does not have an urgent well-defined goal on entering the consultation room” (p. 96). To become aware of a person recognizable sign of uniqueness, Martin Buber points out, what is crucial is not the skill of the therapist but, rather, what takes place between the therapist and the client as a partner in dialogue and between the client and other people (Buber, 1990). Winnicott (1971) once noted, if the patient cannot play, you have to teach him to play. Only then can psychotherapy begin. If you cannot play, you cannot do therapy, because neurosis is too serious. That is what people are persecuted by, seriousness. As in with Paulina’s story ‘My father sexually abused me’, that is very serious, so the whole of her life becomes serious because she is betrayed and that provokes a series of issues. She has low self esteem, she is feelings that trusting others is an issue, it is all very serious. As a therapist what are we going to do with the seriousness If we go right back to Socrates, his main tool was irony. Irony means not taking people too seriously. However, does that imply not be respectful towards our clients’, they are suffering. But maybe they are suffering because they have chosen to suffer, a little bit of irony would be like a wedge, it would open up a gap in which maybe they could feel “uh oh, the past is gone” that acceptance can be perhaps liberating.
4. A critic about the chosen framework (CAT)
There are a number of advantages in adopting the CAT framework, briefly presented above, as the basic unit of analyzing dialogical relationships in life and the dialogical structure of self and self-states. CAT will have the greatest affinity if it avoids a narrow-minded system of therapy by transforming the monologic discourse of therapy about the client to a dialogic (collaboration with client). It was important in my experience with CAT to ensure that both narrative (e.g., reformulation letter) and paradigmatic discourses (RRPs, SDP) where therapist and client via the ZPD create conceptual tools for enhancing self knowledge (Ryle 1997) remain dialogic and flexible. The recognition of self as a multiplicity of positions and outstanding contribution by Hermans and Kempen (1993) adds a new dimension to the collaborative dialogue at the heart of CAT. An essential question remains around CAT’s notion of self-states as reified entities. Indeed, CAT has to deal with uncomfortable questions, such as what do self-states represent without been wrapped in solipsism. Can self-states conceive the multiplicity of the self in a way that dissolves the apparent contradiction between our sense of unity and our sense of being multiple CAT practitioners would agree that therapist and client should negotiate the meaning and sense of words in the course of therapy and interpret events jointly. Paré and Lysack (2004) in a compelling way emphasized the struggle of how to balance client knowledge with therapist knowledge without feeling overwhelmed and hemmed in by therapeutic discourse. CAT approach implements certain ways of making an autobiographical meaning around problems, however it could limit therapy and its process into a “problem-oriented” approach.
5. Conclusion
There is currently no one comprehensive model for treating adult survivors of childhood abuse which is able to account for the whole spectrum of problems that adult survivors experience. However, I learned that using the CAT model I was able to account for some of the more common problems that Paulina presented, such as low self esteem, interpersonal and revictimisation. I worked collaborative with Paulina aiming to understand and support her in developing awareness of procedures and replacing dysfunctional procedures with healthier ones, including those which occurred in the therapeutic relationship.
I have learned enormously from working with Paulina that early attachment, interpersonal experiences, unique idiosyncratic ways in which cognitive representations of those experiences are created, constitute deep emotional structural changes and a complicated ‘sense of self’. The experience with Paulina was a significant contribution to my perception of understanding interpersonal relationships, and a unique set of meaning surrounding our client’s experience. At the same time, I learned that accepting that there are no definite answers to clients’ problems is an important aspect of therapy. Departing from this premises I will argue that therapy is based on not knowing. I do not have space to rehearse the arguments from research about what works in therapy but my deep belief is that we don’t know the answer. I am not suggesting clinical incompetence or irresponsibility but rather an attitude that once the skills and training have become a part of our implicit memory, then the most important skill is to be present in the here and now. However, the worrisome is that as therapist we try to prove that what we do it works most other skills tend to work against the creation of a space without goals. The danger is that CAT is transformed into a medicalised way of defining psychological experience.
References
Bachelor, A. (1995). Clients’ perception of the therapeutic alliance: A qualitative analysis. Journal of Counselling Psychology, 42(3), 323-337.

Bakhtin, M. M. (1981). The dialogic imagination (M. Holquist & C. Emerson, Trans.). Austin: University of Texas Press.

Bakhtin, M. M. (1984). Problems of Dostoevsky’s poetics (C. Emerson, Trans.). Minneapolis: University of Minnesota Press. (Original work published 1929).

Beck, A. (1993). Cognitive therapy and the emotional disorders. New York: Penguin.

Bennett, D., Parry, G., & Ryle, A. (2006) Resolving threats to the therapeutic alliance in cognitive analytic therapy of borderline personality disorder: a task analysis. Psychology and Psychotherapy: Theory, Research and Practice. 79, 395-418

Beck (1996) Beck Depression Inventory. Place of publication: Harcourt Brace.

Beck A. T. (1988). Beck Hopelessness Scale. Place of publication: The Psychological Corporation.

Beck, A., & Steer R. A. (1993). Inventory Manual. San Antonio, TX: Harcourt Brace.

Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice, 16, 252–260.

Bowlby, J. (1969). Attachment and loss (Vol. 1). New York: Basic Books.

Bradshaw, J. (2005). Healing the shame that blinds you. Place of publication: Health Communications.

Buber, M. (1951). Healing through Meeting. In Pointing the way: Collected essays. City: NJ: Humanities Press International.

Buber, M. (1958). For the Sake of Heaven (L. Lewisohn, Trans.). New York: Meridian Books.

Bugental, J. F. (1965). The search for authenticity. New York: Holt, Rinehart and Winston.

Bugental, J. F. (1978). Psychotherapy and process: The fundamentals of an existential-humanistic approach. New York: McGraw-Hill.

Carpendale, J. I. M., & Lewis, C. (2004). Constructing an understanding of mind: The development of children’s social understanding within social interaction. Behavioral and Brain Sciences, 27, 79-151.

Clark C. C. (1997). Combining therapeutic approaches. Journal of Psychiatric Nursing and Mental Health Services, 15(10), 18-22.

Clarke, S., & Llewelyn, S. (2001). A case of borderline personality disorder. In P. Pollock (Ed), Cognitive analytic therapy and adult survivors of childhood abuse. Chichester, England: Wiley.

Deurzen-Smith, E. van (1988). Existential counselling in practice. London: SAGE.

Deurzen-Smith, E. van (1992). Dialogue as therapy. Journal of the Society for Existential Analysis, 3, 15-23.

Duignan, I., & Mitzman, S. (1994). Measuring individual change in patients receiving time limited cognitive analytic therapy. International Journal of Time-Limited Psychotherapy, 9, 151-60.

Du Plock, S. (1997). Dialogue or diatribe: A brief comparison of the implications for the client therapist interaction of existential and cognitive-analytic approaches. Journal of the Society for Existential Analysis, 4, 91-107.

Guterman, J. T. (1996). Doing mental health counselling: A social constructionist re-vision. Journal of Mental Health Counselling, 18, 228-252.

Hanna, F. J. (1991). Suicide and hope: The common ground. Journal of Mental Health Counselling, 13, 459-472.

Heidegger, M. (1927) Being and time. J Macquarrie & E. S. Robinson, Trans.). London: Harper and Row. 1962. Zeit (J. Stambaugh, Trans.). Albany, NY: SUNY Press.

Heidegger, M. (1962). Being and time. (J. Macquarrie, & E. Robinson, Trans.). Oxford: Blackwell.

Hermans, H. J. M., & Kempens, H. (1993). The dialogical self: Meaning as movement.
New York: Academic Press.

Holmes, J., & Lindley, R. (1989). The values of psychotherapy. London: Oxford University Press.

Isen (2001). An Influence of Positive Affect on Decision Making in Complex Situations: Theoretical Issues With Practical Implications. Johnson Graduate School of Management and Department of Psychology. Cornell University. JOURNAL OF CONSUMER PSYCHOLOGY, 11(2), 75–85. Copyright © 2001, Lawrence Erlbaum Associates, Inc.

Josselson, R. (1992). The space between us: Exploring the dimension of human relationships. San Franscisco: Jossey-Bass.

Llewlyn, S. (2003). Cognitive analytic therapy: time and process. Psychodynamic Practice, 9(4): 501–20.

Marcuse, H. (1972). Sartre’s existentialism. In J. D. Bres (Trans..), Studies in critical philosophy (pp. 161-). London: NLB.

Marzillier, J., & Butler, G. (1995) CAT in relation to cognitive therapy. In A. Ryle (Ed.), Cognitive Analytic Therapy: Developments in Theory and Practice (pp. 121–138). Chichester, England: John Wiley & Sons.

May, R. (1958). Contributions of existential psychotherapy. In R. May, E. Angels, & H. F. Ellenberger (Eds.), Existence: A new dimension in psychiatry and psychology (pp. 37-91). New York: Simon & Schuster.

McCullough, J. P. (2003). Treatment for chronic depression: Cognitive Behavioral Analysis System of Psychotherapy (CBASP). Place of publication: Guilford Press.

Nietzsche, F. (1969). Thus Spoke Zarathustra. (R. J. Hollongdale, Trans.). London: Penguin.

Paré, D., & Lysack, M. (2004). The willow and the oak: from monologue to dialogue in the scaffolding of therapeutic conversations. Journal of Systemic Therapies, 23(1): 6–20.

Pollock, P. (2001). Cognitive analytic therapy for adult survivors of childhood abuse: Approaches to treatment and case management. Chichester, England: Wiley.

Ryle, A. (1990). Cognitive analytic therapy. In Handbook of integrative therapies (pp. 84-193). Place of publication: OUP.

Ryle, A. (1997). The structure and development of borderline personality disorder: a proposed model. British Journal of Psychiatry, 170, 82 -87

Ryle, A., & Kerr, I. B. (2002). Introducing cognitive analytic therapy: Principles and practice. Chichester: John Wiley & Sons.

Sartre, J. P. (2003). Being and nothingness (H. E. Barnes, Trans.). London, England: Routledge Classics.

Spinelli, E. (1997). Tales of unknowing. Therapeutic encounters from an existential perspective. London, England: Duckworth.

Spinelli, E. (2000). The interpreted world. An introduction to phenomenological psychology. London, England: SAGE.

Stolorow, R. D., & Atwood, G. E. (2002). Contexts of Being–The Intersubjective Foundations of Psychological Life. Hillsdale, NJ: Analytic Press.

Tillich, P. (2000). The courage to be. London: Yale University Press.

Trevarthen, C. (2001). Intrinsic motives for companionship in understanding: Their origin, development and significance for infant mental health. Infant Mental Health Journal, 22, 95-131.

Vandenberg, B. (1991) Is epistemology enough An existential consideration of development. American Psychologist, 46, 1278-1286.

Verrier, N. (1989). The primal wound: Understanding the adopted child. Paper presented at the fourth International Congress on Pre- and Perinatal Psychology, Amherst, MA.

Vygotsky, L. S. (1978). Mind in Society. Cambridge, MA: Harvard University Press.

Walter, K. (1956). Existentialism: From Dostoevsky to Sartre. Cleveland, OH: World Publishing Company.

Winnicott, D. W. (1971). Therapeutic Consultations in Child Psychiatry. London, England: Hogarth Press and the Institute of Psycho-Analysis.

Yalom, I. (1980). Existential psychotherapy. New York: Basic Books

Appendix 1
CAT Model description and terminology
CAT originated in part from objects relations theories in which a child’s experience is perceived as more crucial than unconscious conflicts. Psychological development is influenced by early post-natal experiences; the personal, temperamental characteristics of the child; and the caretaker personality and social context (Trevarthen 2001). The child then begins to internalize relationship patterns, involving a joint activity of mutual imitation, rhythmic activity, expressive communications between the child and significant others and conveying of meaning by signs and language (Carpendale & Lewis 2004). These evolving repertoires of relationship patterns are described in CAT as reciprocal role procedures (RRPs) (Ryle, 1997). The key concept in CAT is the reciprocal role procedure (RRP) which refers to the internalization process of early interpersonal experience procedures for organising relationships (including the relationship with the self). Role procedures have, as their aim, the responses of others; in addition, these same patterns are internalized, determine self-management, and influence an internal self-dialogue as an instrument of thought. For example, the internalization of harsh patterns of a neglectful abuser in relation to a deprived victim can play either role of a RRP at different times, both in relation to others and in self-management. The chaotic inner lives of CSA survivors, particularly their anxiety and destructive patterns of behaviour, can influence a later inability or helplessness to escape subsequent abusive relationships, as well as abusive behaviour to others or to themselves.
CAT is influenced by Vygotsky (1978) work and ideas, particularly the Zone of Proximal Development (ZPD). ZPD is the space between one’s current ability and the potential ability this person could reach with the assistance from another (Ryle 1997). This is accomplished with the therapist and client collaboration, an empathic relationship, and appropriate mediating tools e.g., the use of a psychotherapy file and reformulation letter. The non-collusive therapeutic stance is equally important as the therapist is refraining from enacting a damaging pattern. The psychotherapy file is a psychometric measure to identify relationship patterns as self reported by the client. From the psychotherapy file, clients begin to critically review their lives. The first crucial stage of CAT therapy is for the therapist to pay careful attention to the client’s story, particularly the history of relationship patterns, and most centrally to elaborate repeated relationship patterns as they occur in sessions. CAT may provide a solution for such individuals with a haunting past. For therapists, the aim of CAT is first to observe and then to formulate dysfunctional patterns or procedures so that the client is able to make changes by developing other more functional procedures. The therapist’s role is to assist the client to understand how that issue develops in everyday interactions, what triggers it, what follows it, what the consequences are, and how it is maintained. Hence, what is presented as a problem in CAT is perceived as a problem procedure. Target Problem Procedures (TPPs) describe how the client maintains the problem procedure. Ryle (1997) introduced three main types of TPP dysfunctional procedures: the traps, the dilemma, and the snag . Therapists and clients then jointly construct a written reformulation letter which entails mediating tools (e.g., Therapeutic file, RPP’s). The therapeutic process provides the opportunity for the client to reflect with clarity and try to understand what has happened and why.
The reformulation letter helps to understand the client’s core beliefs by exploring the individual’s past history and early-life experiences (refer appendix 3). For example, a client and therapist work together during the early sessions to link together a number of fragmentary and confusing memories, and to establish a coherent story. For many people, a number of core beliefs have become scripted from many negative and early-life experiences. The reformulation describes how early meanings generated from these experiences have generated a number of current, dysfunctional procedures and are exceedingly resistant to change.
CAT does not seek to create major, characterological changes, but rather aims to un-stick a stuck system by generating mindfulness, self-awareness, and supporting self-confidence. The client is guided into understanding the importance of past relationships/experience, how meanings are imported onto events, how patterns of relating are formed, and how these patterns can become current, maladaptive coping strategies.
Following reformulation, therapist and client collaborative attempt to elaborate their understanding of how and when these dysfunctional patterns of thinking, feeling and behaving operate. Self-reflection is finite and the aim is to engage the client in a diagrammatic reformulation on the principle that a picture is worth more than a thousand words. The state description procedures (SDR) as depicted in appendix 2, is a rough core ‘subjective’ self in diagrammatic sketch of relationships and procedures as a visual image. The SDR can quickly and simply map out the client’s patterns of thinking, feeling, acting and relating.

In addition the States Description Procedure (SDS) provide a feedback loop to the client regarding her/his problem procedures and life difficulties. In CAT an attempt is made to alter how a person experiences manages and understands themselves. The use of the time limit, the open and collaborative relationship, the use of shared written material (e.g., SDR, SDS, reformulation letter) and the overt discussion of RRPs are all aimed to reduce dependency, and facilitate change in as brief a period of time as possible. In cognitive analytic therapy, threats to the alliance are seen as re-enactments of dysfunctional interpersonal patterns in which the therapist is as active as the client (i.e., the difficulty is not located within the client but is understood as fully relational). Therapists drawn into playing collusive roles are opening the way to alliance rapture (Ryle, 2006). Ryle also suggests that much of the work of therapy will actually be done after therapy ends, as the client puts his or her new procedures and reciprocal roles into practice. To facilitate this, client and therapist, towards the end of therapy, are encouraged to exchange a ‘Goodbye letter’ in which both are able to reflect and which sets out the principles to be remembered for the future

Appendix 2
The sequential diagrammatic reformulation (SDR)

Appendix 3
Reformulation letter

Dear Paulina,

Here is the letter I promised you; This letter is my attempt to develop an understanding of what you have said, please do alter anything that I may have got wrong or misunderstood and does not reflect your experience of events.
During our sessions we have covered lots of ground, and I have been moved by your willingness, honesty and courage to face what has been painful. Over the last few weeks you have told me about yourself and how you feel. You were overwhelmed by painful emotions and you described your sense of shock, betrayal and powerlessness over Adma’s affairs. Powerlessness in the face of injustice and abuse is a familiar theme in your life. Your story of care from your parents shows how much you have suffered in silence because of their incapacity for empathy and care. Because of that you remembered both your parents as remote and ‘vampire’ figures; you felt that they were caught up in their own alcoholic and interpersonal issues and had no capacity to accommodate your feelings. You also remembered how your older sister was envious of you and how you felt guilty because of her feelings.
These events triggered a very desolate early life with your family. You tried to remain cheerful and helped your parents, at the expense of losing out from your childhood. Then when you were about 11 you tell me that your father started to want you to touch him sexually, which you hated and felt shame, guilty and powerless. It seemed to you that this was again your own responsibility, and that you could not tell your ‘vulnerable’ mother who was more in need of your protection than you were in need of hers. Instead feeling bad, you confined that to your neighbour and secret diary. The events were then forgotten and your parents moved on forgetting what you had experienced in those horrific moments in your life. Disappointments in relationships have been common for you and you describe a ‘constant hope’ that someone will not fail you.
School was a successful task in your life and you managed to accomplish a good educational background and to graduate from one of the best universities in the country. At 18 you set off alone and ended up making a success in exploring the world through travelling and other experiences.
Your first powerful attachment pertain the themes of control, power, rescuer and a man who is a perpetrator and can provoke excitement. Two of the most important men in your life follow this pattern, however, when they abuse their power you are deeply humiliated, saddened, betrayed, punished, rejected, powerless and helpless. I wondered how that dependency nourishes infantilism rather than growth I also wonder if that are the same feelings as you experienced in early childhood.
I feel that since your early childhood you learned to expect little from others; it was safer to manage on your own. But, as you indicated when completing the psychotherapy file, you either become a brute, or a martyr and that positive events and success were forbidden due to your feelings of worthless, and “badness”. I wonder how far you may have felt you deserved the difficulties of your childhood, and if you felt as a child you were too sexy for your own good and was therefore your responsibility for what took place. I also wonder. Could this may be the source of your worthless.
Your husband was the first person with who you experienced the depth of your need for affection. Maybe what you hoped for was never there, or maybe he was just not ready for all the roles of family commitment. Whatever the reason, his affairs were a terrible blow, and since then you have experienced the abandonment and uncared feelings which, I feel, you had learned to put aside in your early life.
After our few meeting and the imaginary rescripting session, you told me about your memories of abuse and parents arguments and violence. These disturbing memories seemed to me to stand for the feelings of the forlorn child you have always carried within you, despite your achievements and strengths. I also wonder if your fearful pattern of insecurity relies upon denial and substance abuse to protect that “little child” inside you. In therapy we will be trying to go through and beyond your hopelessness and the negative feelings you have about yourself (the target problem). To do this we will need to work on the patterns of thinking and behaving which continue to make you vulnerable and behave in a placatory way.
From how you describe being with people, and from the psychotherapy file, it appears that when people do fail you, you feel neglected and a desire for substance abuse. The dilemma you are challenged is Approval vs independence (refer to figure bellow). Relationships and your marriage take without giving and you feel drained and emotionally empty. Your parents in a similar way appeared to care very little for you and failed to show any interest or concern for your welfare. These experiences have coloured how you feel in relationships as an adult. In therapy I hope we can work on recognising and controlling these negative patterns as they recur in daily life. We can look at these patterns of relationships and see if there are other ways for you to be able to develop relationships with others which are not so costly for you. We will also need to be alert to how they may arise in your relationship with me.

No therapy and no relationship can make up for the lacks you experienced but I believe that working together it can give you a new understanding and a manageable loss. The aim of therapy is by building on your own strengths so you can feel free to find the good that is available in others and in yourself. I suggest our target problem to be:
Target problem 1: feeling inferior depressed and overwhelmed, you take alcohol and other substances to ‘blog out your thoughts’ which only works temporarily. Differently you drink to achieve an illusory sense of ‘bliss’ and feelings of anxiety than does not last. This makes you more depressed and powerless.

Aim: to deal with the source of the emotions that produce substances misuse and to learn to cope differently.

Target problem 2: coping with suffering

Your world of relationships is dominated by the emotional suffering of yourself or others- you feel that no other possibilities can occur. You feel that hurting others ‘gets on first’ and protecting others from suffering will stop that little ‘lost child’ inside you from hurting.

Aim: to recognise these pattern and how it stops you from maximizing your potentials.

I look forward to work with you during our therapy sessions

Joseph
Appendix 4
Self-States Description procedure (SDS)

Firstly, the childhood interpersonal social process, whereas Paulina’s victim rage and unmet qualities of those early parenting experiences (unintegrated) were internalised and re-enacted later in her marriage (e.g., the search for the ideal parent), represents a state switch from idealised/rescued–saved/dependent (SS1; A1/A2), and also a state switch of admired/admiring–compliant/controlling (SS1; A1.1/A1.2). Both these state switches provoke a transition state of abandoning/neglecting- unlovable/untrusting (a switch state of SS2; B1/B2) toexploited/violated- martyr and unworthy (SS4; D1/D2 /D3). A splitting within Paulina’s contradictory nature of self states is revealed between her changeable presentations within the SSD sequential patters self-state 1 to self-state 4.
Paulina’s response from submission to defiance in response to control is called a response shift (e.g., an alteration in the reciprocal response made to the same role of an RRP). The response shifts, as in from compliant to defiant in relation to abuser. Paulina’s reactions to being victimised, and feeling psychological paralyzed and powerless led to a strong desire for help from others (SS1; A2, A1.1). Alternatively the role reversal type as in from self as victim to abuser to self as abuser to victim, thus. Paulina, noted feeling exploited and violated, resulting in her need to gain control via exploiting /abusing role of SS4, D1 (trap). Thereafter, the reciprocal role of D1 compensated for the core pain of shame, worthless, and unlovable fear (D2, D3, D4) and self-state shifts, as in from a state defined by the RRP as ideal carer to ideally cared for to one defined by victim to abuser. Paulina was able to insightfully comment that her multiple sexual encounters after Adam’s infidelity was inducing suffering to him. The early trauma of sexual abuse from Paulina’s father, combined with the envy of her sister, had taught Paulina that being admired evoked rejection and abuse from others. Paulina pictured her parent’s care and quality of the relationship as abandoning, abusive, and neglecting (SS2; B1 to B2). Paulina’s relationship with Adam was characterised by emotional neglect and felt contemptible, betrayed and affected her low self-esteem (SS3; C1, C2). Paulina felt that her love, commitment, loyalty and time invested in her relationship were taken without respect and reciprocation. She described Adam and previous serious relationships and partners to be perpetrators (C1) and she felt depleted / deflated (C2). This resulted in feeling depressed, and provoked a compulsive state to find comfort via drugs and by binging on alcohol to change her moods. Paulina categorized Self-State 1 (SS1) as the “Rescuing Prince” in relation to ‘”Cloud Cuckoo Land.” In Self-State 2 (SS2), she matched “Tyrannical Parenting” to Forlorn Child.” In Self-State 3 (SS3), Paulina linked “Perpetrators” to “Zombie.” And Self-State 4 (SS4) was described as “Demons” in relation to three differing roles: “martyr,” “unworthy,” and “victim rage.” We then traced the switches between these self states. For example, how the state switch between, ‘cloud cuckoo land’ (A2) to ‘forlorn child’ (B2) and to ‘demon’ (D1). This process provided the ground for jointly constructing the Self States Sequential Diagram (SSD) as shown on appendix 2. The joint construction aided to identify, understand, and track changes in Paulina’s experiences within and between self-states. Moreover, Paulina was advised to observe how these Self-States could manifest in ongoing life and in the relationship with her own therapist.

APPENDIX 5
Therapeutic Plan Notes
Adam’s betrayal triggered an overwhelming sense of debasement, worthlessness, powerlessness, and self-fragmentation within Paulina that perhaps, was there along from her childhood. In order to find comfort, Paulina found resolution in drug addiction. Paulina’s story illustrates feelings of inadequacy and common antecedents to addiction. First, there is alcoholism from her parents. Second, Paulina’s emotional abuse was accompanied by her sexual abuse. Third, consensual, sexual experience for her is both humiliating and comforting. Subsequently, Paulina’s emotional and physical survival depends upon her acquiescence to her perpetrator. And fourth, the reality of what happened to Paulina as an abused child was denied and her feelings were not taken seriously. She experiences her basic interpersonal and emotional needs as being unmet in relationships and consequently, she feels rejected and abandoned. All of these are potent contributors to her drug addiction. By far the most important factor, however, is Paulina’s sexual abuse and a sense of having been abandoned.
Along with a violation of Paulina’s body, her trust and love were also violated, which influences her current relationships and perhaps, feeds her fear of abandonment. For example, her relationship with male authority and father figures is characterised by lack of trust and abuse. Paulina also reported no meaningful or secure attachment experiences with a mother figure. Moreover, Paulina reported her marriage has become another painful abandonment.
Abandonment generally means unwanted; therefore, as a child, Paulina searched for an explanation and possibly interpreted that she was abandoned or unwanted because she is unworthy or bad. This hypothesis is exemplified when Paulina reported her first core belief: “I am basically a bad, unworthy person.” One could also imagine that Adam’s numerous affairs revived or supported Paulina’s belief of being unlovable. Paulina revisits that child within her who was unloved and unlovable. Paulina’s discovery of Adam’s affairs was a turning point and another realization that she is unlovable, resulting in rage, depression and powerlessness. Adam became a ‘rescuing prince’ and then transformed into another ‘perpetrator’. Subsequently alcohol and drugs was the answer to find comfort and alleviate the pain of abandonment. Thus, Paulina internalised the first core belief as: ‘I am flawed and defective as a human being’. Due to her childhood adversities, Paulina also reported shame for being a failure, viewed this defective or flawed self-image as unchangeable, and therefore, expressed a sense of hopelessness. Kaufman (1980) described extreme shame as creating a binding and paralyzing effect upon the self. This paralysis may manifest as a split self.
During treatment, Paulina was experiencing a pervasive sense of not belonging and an inner alienation from chronic depression. However, she also reported interest for increasing her status and identity. It is possible that driven by the feelings of inadequacy and failure, she sought out to meet her needs by depending, idealising, and perhaps admiring another (i.e., being the wife of a famous physician). The defensive self-structure so strongly attached to Paulina’s identity via her marriage, was in response to her low self-worth and interpersonal safety (e.g., the search for the ideal parent bit). The fortress she created for self-worth and interpersonal safety was a deluded state that consumed all her energy and created a self-prison. This self-prison generated a huge emotional cost from experiencing the world, her possibilities, and her freedom. There is a deep grief that lay unacknowledged behind the enjoyments of her status dependency. Paulina was encountering the world only within the tyrannical walls of an empty self as “the wife of a famous physician” and yet, the real liberation was out of such inaction and self-structure into a new relationship with life. The therapeutic relationship was important in order to provide interpersonal safety for Paulina, and letting her “step out of her comfort zone” and allow a new perspective of choices to resurface.
Paulina feels abused in relationships and lacks meaningful emotional involvement; this leaves her feeling emotionally unfulfilled. The main purpose of the CAT was to explore the idea of how she becomes emotionally unfulfilled, before she closes off all avenues of vulnerability. The process was to assist Paulina in interacting and engaging meaningfully via the ZPD and scaffolding. For example, I tolerated her anxiety about vulnerability, self-worth, and rejection. To explore her subjective notion for identity change, we explored ambivalent attachment feelings in a stuck relationship and her possibilities and choices.
APPENDIX 6
Reflective notes on critical moments
Paulina needed to independently erect boundaries and not allow Adam to become a perpetrator (SS3) or a demon (SS4) and thus, strengthening her experience of self-worth and control rather than the self-state of powerlessness and self-defeat. I felt as a therapist to resist the pull or pressure to adopt any expected role’ e.g., ‘soldiering on state’ (A1.1.) or the state switch ‘cloud cuckoo land’ (A2) to ‘forlorn child’ (B2) to ‘demon’ (D1). This offered Paulina the possibility of being more than the ‘a bit part’ allocated to her in the past roles of interpersonal conflict. Subsequently, I became alert to how Paulina responded to my intervention and to this lack of certainty and resultant anxiety. In response to this non-reciprocation, Paulina commended, “I feel I am abandoned and not wanted,” in a submissive response shift of a self-state of a martyr or unworthy (D2). Following, she then became angry and withdrew in silence by taking a defiant response shift and a self-state of a victim rage (D4). Then, Paulina showed despair, while asserting in a plaintive voice, “You men are all the same,” which is a role reversal of a self-state victim rage (D4) to demon exploiting/abusing (D1).

Section D: Critical literature review:
The importance of Positive emotions to mental and physical well being

Abstract
This section presents prior research related to the field of positive psychology. Specifically, the paper presents a review of research efforts and studies relevant to the relationships found among positive emotional/mental states, well-being, and survival. In this paper, the researcher also explored the causes and outcomes of positive emotional states and their implications to cognitive functioning, such as social thought processes and social behaviour. The results of the review show that there is indeed a link between positive mental states and mental/physical well being.

1. Introduction
This section presents prior studies and experimental research efforts relevant to the field of positive psychology. It assesses or reviews results on the causes and outcomes of positive emotional states. The determining mechanisms of and relationships found among positive emotional/mental states, well-being, and survival are also presented. The paper concludes with a summary and recommendations for future research.

2. Literature Review
Psychological research has often ignored the normal healthy functioning of human behaviour and the conditions that foster well-being (Seligman, 2002). Throughout human history, the theme of positive change following adversity is found in countless religions and philosophies. Most notable is Nietzsche’s (1889) famous saying, “What doesn’t kill me makes me stronger.” (as cited in Kaufmann 1968 p.35). This notion is also portrayed by Kierkegaard (1855) and Viktor Frankl (1963), who both advocated the innate human potential for growth through meaning (as cited in Wong, 2007). Kierkegaard (as cited in Halling & Nill, 1995, pp. 3-4) introduced despair as a deep level of anxiety that if properly recognized, can be used as a guide through the process of self-actualization. In other words, he argued that despair is a judgement about choices, behaviours, and experiences that can promote growth, or lead to stasis and withdrawal.
Frankl proposed a concept of tragic optimism (TO), which, he argued, acts to guide us from grief to hope and courage. According to Wong (2007), TO is an essential factor in enabling us to endure extreme adversity through meaning by transcending pain and suffering. Frankl (1992) wrote about “the will to meaning” following his experiences in Auschwitz and noted “suffering became an option through which to find meaning and experience values in life” (p. 118). These philosophers – Nietzsche, Kierkegaard, and Frankl – juxtapose the premise of resilience with positive living or a meaningful life. This philosophical landmark provided the foundations for exploring adversity, trauma, fulfilment and resilience in mental health.
Another cornerstone of the “human potential” movement in positive psychology was Maslow’s (1968) optimistic description of human nature as intrinsically good. Maslow (1962) started out with defining humanness as being with a natural tendency to growth. May, Angel, and Ellenberger (1958) in their book “Existence” agree with Nietzsche and Kierkegaard and noted “man is an organism who makes certain values-prestige, power, tenderness, love-more important than pleasure and even more important than survival itself” (p.22). Thus a philosophical presupposition represents, we might argue the one cornerstone of positive psychology.
The positive psychology movement reflects a shift of emphasis away from pathology towards resilience and offers a solution to the common deficit-based model used in current mental health practices. Positive psychology seeks to provide a complete understanding of the human experience by integrating prior knowledge about mental illness with knowledge from positive mental health. As a result, it can create opportunities for an individual to search out his potentials and choices. Seligman and Csikszentmihalyi (2000) indicated that the field of positive psychology focuses at the “subjective level on well-being, contentment, satisfaction with the past, hope and optimism for the future, and flow and happiness in the present . . . on an individual level it focuses on positive traits [such as] the capacity for love and vocation, courage, interpersonal skill, aesthetic sensibility, perseverance, forgiveness, originality, future mindedness, spirituality, high talent and wisdom” (p. 5). Seligman and colleagues found many benefits from such positive emotions, including the protection from depression (Seligman, Park, Peterson, 2005) and greater life satisfaction (Peterson, Park, & Seligman, 2005).

2.1. The Broaden-and-Build Theory and Positive Emotions
The broaden-and-build theory developed by Barbara Fredrickson (1998) is a well-known theory, attempting to coherently outline the effect of positive emotions. According to this theory, the form and function of positive and negative emotions are distinct and complementary. Positive emotions yield non-specific action tendencies and are characterised by relatively broad thought-action tendencies. Fredrickson (1998) advocates that previous emotion models assumed that an emotion results in physical action, which she calls specific action tendencies.
As opposed to specific action tendencies, Fredrickson (1998, 2000) noted that positive emotions can be understood as thought-action tendencies. Fredrickson proposed that positive emotions do not narrow one’s thought-action response but instead, broaden it. Furthermore, she argued that the experience of positive emotions has the ability to broaden one’s scope of attention. For example, while positive emotions may not always elicit a specific response, as is in the case with negative emotions (i.e., anger = attack), they have the ability to generate more vague and creative reactions. For example, the experience of joy has been shown to evoke directionless activation, satisfaction with inactivity, and focused interest (Frijda, 1986).
Fredrickson’s (1998, 2001) broaden-and-build theory also posits that negative emotions (e.g., fear, anger, and sadness) narrow an individual’s momentary thought–action repertoire toward specific actions that serve the ancestral function of promoting survival. Fear, for example, is linked with the urge to escape, anger with the urge to attack, disgust with the urge to expel, and so on. By contrast, positive emotions (e.g., joy, interest, and contentment) build larger reserves of intellectual, emotional, and social resources, which enable individuals to manage challenges and threats.
One implication of the broaden–and–build model is that positive emotions have an undoing effect on negative emotions. The process iterates, leading to increased psychological resilience and enhanced emotional well-being over time. Within the array of emotion regulatory behaviours, people could engage in strategies that increase their positive emotional experiences. To demonstrate this argument, Ekman (1989) found that people may smile when feeling sad or upset in order to balance their low mood after receiving disappointing news. To validate this model and underlying factors, Fredrickson and Branigan (2005) found that positive emotions induced by video clips influenced participants to broaden their thoughts and actions in comparison to participants within a control condition. Nevertheless, it is important to note that most of the supporting evidence for the broaden hypothesis lack ecological validity and stems from a laboratory context.
An interesting theory akin to the broaden hypothesis is emotional intelligence (EI), which suggests that making use of both positive and negative emotions, and understanding their different impact on thought processes, is a form of intelligence (Mayer, Salovey, & Caruso, 2004). Let us now consider some of the reasons for the luck of interest in positive emotions.

2.2. The Neglect of Positive Emotions in Prior Research
Freud’s momentous work and its derivatives dominated both psychiatry and psychology until the late nineteenth century (Barone, Maddux, & Snyder, 1997; Korchin, 1976). Psychoanalytic theory, with its emphasis on hidden intrapsychic processes and attention to psychopathology, strengthened the illness ideology within the psychological field. Today, the discipline is still steeped in psychopathology, as evident by the fact that the language of medicine remains the language of the medical model (Madux, 2008).
Critics have argued that this psychopathological, medical language disempowers people by robbing them of the control over their own lives and the power to change, which can also become a self-fulfilling prophecy (Salleby 1977). For example, Salleby (1977) noted how a person’s life meaning is evaporated with the adoptions of medical labels that suggest “the person is the problem or pathology named” (p. 5). Once a person has been given such a label (e.g., having schizophrenia), the person can become defined by that label and consequently, the entire person’s experiences, feelings, and desires become bound within that label.
The chief architect of the Diagnostic and Statistical Manual of Mental Disorders, Robert Spitzer (Zimmerman & Spitzer, 2005), candidly admitted that a diagnosis of a primary mental disorder must be arbitrary because the distress or social impairment under consideration could well be a normal-range reaction to sociological events. Research also reveals that among humans even fundamental physiological responses to threat are determined to a large extent on the social awareness that individuals bring to a particular event (Blascovich & Mendes, 2000) or on the quality of our social relationships (Cohen, Doyle, Turrner, Alper, and Skoner 2003). Jacobs (2010) noted that “it is an illusion to hope that research in evolutionary psychology will reveal how people are supposed to react to stressful events and thereby rescue psychiatric diagnosis from the false positive problem” (p. 1).
In terms of research, the current medical model has affected a great part of psychological research in the Western world. This approach is prominent in neuropsychology, where mental dysfunctions or diseases can be understood via brain functioning. Thus, health has been merely studied as the absence of physical or mental dysfunction rather than the increase of positive emotions or well-being.
In her review of research on positive emotions, Fredrickson (1998) argued that the focus of specific action tendencies is the reason for the lack of attention and limited body of research on positive emotions. Fredrickson (1998) outlined various reasons for that lack of research in this area of positive psychology and noted: Positive emotions lack specific facial configurations (Ekman et al., 1987). By contrast to negative emotions positive emotions have no unique signal value, thus, lack specific facial configurations (Ekman, 1992). Many positive emotions they lack autonomic activation and distinguishable autonomic responses (Levenson, Ekman, & Friesen 1990). People’s self-reports of subjective experience show a great degree of blending in how they are experienced (Ellsworth & Smith, 1988b). Finally Fredrickson emphasized the impact of Darwinian natural selection influence. The fact that numerous theorists focused on emotions that increase the odds of ancestors’ survival, thus, shapes emotions only for situations that encompass threats than opportunities (Nesse, 1990).

2.3. Positive Psychology and Positive Emotions
Although research on positive psychology is becoming more apparent, the field is still unfamiliar to many. Plenty of people are familiar with human negative emotions (e.g., fear, disgust, anger), why such emotions exist (e.g., to secure our personal safety or survival), and their potential effects (e.g., increased stress levels, narrowed responses for action). However, fewer know about the types, explanations, and effects of positive emotions, such as hope happiness, pride, contentment, and love. Fredrickson (2001) suggested that resilient individuals are believed to experience positive emotions in the face of difficult events, thus allowing them to thrive and benefit from positive outcomes. Let us now consider some of these emotions and how they are presented in prior research.

2.3.1. Happiness, joy and pride.
Lazarus and Lazarus (1994) described happiness as an emotion or as an estimate of well-being. More specifically, these researchers noted that “when we ask people how happy they are, the answer does not really refer to the acute emotion of feeling happy, but about their general well-being” (p. 89). Joy, which is often used interchangeably with happiness (Lazarus, 1991), is often derived from contexts deemed as secure and familiar (Izard, 1977), and in some situations, by events perceived as achievements or progress towards the objectives or aims of an individual (Izard; Lazarus). King and Pennebaker (1998) suggest that “meaning in life” and happiness are interwoven constructs. They indicate that not only is “meaning in life” a characteristic of a good life, but the act of finding meaning is also correlated with happiness as well.
Lazarus and Lazarus (1994) in their book Passion and Reason noted the following:
[T]he plot of happiness, its provocation, is a bit of good news about our lives, which we interpret as indicating that we are making progress towards attaining immediate and long term goals. This progress is the fundamental personal meaning that underlies feeling happy.” (p. 96)

Feeling happy is often conjoined with feeling proud but the two emotions are different. Hume (1957) suggested that pride confirms or enhances our sense of self-efficacy rather that just happiness. Thus, the personal meaning of pride fosters social status and the identity as an individual. Therefore, this emotion makes us, as well as others, think of ourselves as special.
Seligman, Steen, Park, and Peterson (2005) cited the efficacy of several positive psychology interventions aimed at increasing individual happiness. These researchers first point out the need to better define happiness, which they later define as an emotion consisting of at least the following three distinct aspects or dimensions (Seligman, 2005): “(a) positive emotion and pleasure (the pleasant life); (b) engagement (the engaged life); and (c) meaning (the meaningful life)” (p. 413). In addition, Peterson, Park, and Seligman (2005) found that the most satisfied people are those who pursue all three distinct aspects, with engagement and meaning carrying the most weight.

2.3.2. Hope and optimism.
In their theory of optimism, Scheier and Carver (1985, 1987) emphasized people’s generalized outcome expectancies. Their theory suggests that optimism involves a goal-based approach, as well as considerable value being attached to a perceived outcome. Scheier and Carver (1985) eloquently defined optimism as a stable predisposition to “believe that good rather than bad things will happen” (p. 219). Optimism presents a positive reinterpretation as a style of coping, or, as reported by Scheier, Carver, and Bridges (1994), is about “putting problems in the best possible light and searching for hidden benefits and meaning when difficulties arise” (p. 1072).
According to Seligman (1989), optimism promotes better health outcomes. In particular, a) optimism prevents helplessness explanatory styles, b) optimism allows one to engage and maintain in healthy behaviours since it is thought that we have the power to make a difference in our lives, c) optimists have a reduced number of negative life events, and d) optimists have more social support as they engage in more social interactions instead of retreating and isolating themselves.
Related to the notion of optimism, and sharing some of the same conceptual features (see Snyder, Sympson, Michael, & Cheavens, 2001), is the concept of hope. Hope is characterized by imagined outcomes that have sufficient importance to demand mental attention. Snyder, Irving, & Anderson (1991) defined hope as ‘‘a positive motivational state that is based on an interactively derived sense of successful (a) agency (goal-directed energy), and (b) pathways (planning to meet goals)’’ (p. 287). Harvey and Miller (1998) defined hope as the ability to look forward to something with confidence and conceptualized as a belief system or thought process through which positive emotions can be generated through future attributions. In addition, Harvey and Miller (1998) postulated that finding meaning is instrumental to finding hope, and without meaning, hope may not exist. It has further been suggested by Morgante (2000) that hope is essential as it provides humans with a vision of the future, an opinion of self and others, and gives us with a sense of control over our lives.

3. Empirical Support of Positive Emotions
Research is showing that positive emotions facilitate coping with distress and adversity (Fredrickson, 2004). Fredrickson, Tugade, Waugh, and Larkin (2003) maintained that in a context of negative emotions, positive emotions provide a psychological break, restore physiological resources that have been depleted by distress, and result in cognitive broadening. As such, positive emotions may help with psychological resilience.
Psychological resilience is the ability to bounce back from negative emotional experiences during stressful situations (Block & Kremen, 1996; Lazarus, 1993; Tugade & Fredrickson, 2004). Thus, resilience is an effective adaptation and coping mechanism when faced with adversity (Tugade & Fredrickson, 2004). Lazarus (1993) found that resilient individuals are characterized by positive emotionality and can appraise a stressful situation as less threatening and more effectively. This suggests the possibility that the repeated broadening of attention and thinking that comes about through the momentary experience of positive emotions enables us to discover and build enduring, personal resources at a physical, psychological, intellectual and social level (Fredrickson, 2003), which can then lead to improved resilience. Research is beginning to show that positive emotions lead to resilience and broaden the scopes of cognition and action and, as a consequence, trigger an upward spiral toward emotional well-being (Fredrickson, 1998, 2001).
Recent literature is beginning to show that stress and trauma can actually be good for people (Haidt, 2006). A handful of studies in the late 1980s and early 1990s reported positive changes in, for example, rape survivors (Burt & Katz, 1987), male cardiac patients (Affleck, Tennen, Croog, & Levine, 1987), bereaved adults (Edmonds & Hooker, 1992), and combat veterans (Elder & Clipp, 1989). An interesting perspective for those positive changes is provided by Charmaz (1993) who observed the changing of meaning and its impact on self identity. Thus, identity renegotiation occurs when patients begin to see themselves in new roles that have meaning (Charmaz, 1993); in other words, when they find new strength “because of” or “in spite of” the traumatic event or illness. There is also a growing section of research indicating that positive moods may predispose people to feel that life is meaningful and increase their sensitivity to the meaning relevance of a situation engagement (King, Hicks, Krull, & Del Gaiso, 2006). For example, King et al. (2006) noted that ‘‘positive affect is related to biological responses in the laboratory and everyday life that may be health protective’’ (p. 56). Subsequently, a positive correlation between biological responses and positive affect was found, including diurnal cortisol patterns and systolic pressure (Steptoe, Gibson, Hamer, & Wardle, 2007).
A number of studies are increasingly unfolding the positive impacts on health and the importance of a sense of coherence (Antonovsky, 1987), optimism (Scheier & Carver, 1985; Scheier, Matthews, & Owens, 1985), and posttraumatic growth (Tedeschi & Calhoun, 1985). The term “sense of coherence” describes internal congruence with regard to an individual’s global view of the world and the environment as comprehensible, manageable, and meaningful (Antonovsky, 1987). Therefore, the magnitude of the relations among sense of coherence, resilience, and posttraumatic growth all lead to the “light at the end of the tunnel” (Almedom, 2005, p. 253).
Tedeschi and Calhoun’s (2004) concept of posttraumatic growth (PTG) is defined as “positive psychological change experienced as the result of the struggle with highly challenging life circumstances” (p. 1). PTG is more than mere survival or a traumatic experience; it is transformational change beyond pre-trauma levels, often representing a change in perception of self, change in the experience of relationships with others, and/or change in one’s general philosophy of life (Tedeschi & Calhoun, 1996). Neimeyer (2006) reported that PTG is a function of narrative reconstruction. Ultimately, there is a new sense of self that integrates the experiences and develops a more vulnerable, less naïve sense of self (Calhoun & Tedeschi, 2006). Despite these broad and important consequences, little is known about how people regulate their emotions in their daily lives.

4. Emotion Regulation
In the past two decades, psychological research has begun to focus explicitly on emotion regulation. Emotion regulation is not a new concept, although the literature is replete with inconsistent definitions. Any discussion of emotion regulation presupposes an understanding of what emotion is. In this section, emotions are considered flexible response sequences (Buck, 1994) that are called forth whenever an individual evaluates a situation as offering important challenges or opportunities (Tooby & Cosmides, 1990). Moreover, as Lang (1995) noted, these emotional response tendencies are short lived and encompass changes in the behavioural, experiential, autonomic, and neuroendocrine systems. Emotions help us respond adaptively to environmental challenges and opportunities (Frijda, 1988). Emotion regulation refers to individuals using a wide range of strategies to exert considerable control over, and to influence, their emotions, and determine when they have them (Gross & John, 1998, p. 170). Among the core capacities that characterize emotion regulation, is the ability to reduce negative emotional responses; this particular capacity may be a key mechanism in the development of mood disruptions (Cole, Martin, & Dennis, 2004).
Based on this view of emotional regulation, Gross (1999) proposed five regulation strategies: situation selection, situation modification, attentional deployment, cognitive change, and response modulation. He asserted that reappraisal and suppression as two basic strategies to regulate negative emotions. Reappraisal consists of changing the way a situation is construed so as to decrease its emotional impact. Suppression consists of inhibiting the outward signs of inner feelings. Gross (2002) noted these two strategies have different outcomes and that only reappraisal decreases emotional experience. Furthermore, greater use of reappraisal was found to improve interpersonal functioning and psychological adjustment (Gross 2002).
Contrary, greater use of suppression was found to be negatively related to such outcomes (Gross & John, 2003). Nezlek and Kuppens (2008) adopted the model of emotional regulation as proposed by Gross (1998) and found that regulation through reappraisal was beneficial, whereas regulation by suppression was not. In addition, reappraisal of positive emotions was associated with increases in positive affect, self-esteem, and psychological adjustment. On the contrary suppressing positive emotions was associated with decreased positive emotion, self-esteem, and psychological adjustment, and increased negative emotions.
Importantly is the notion that these emotional response tendencies can be regulated and may shape an individual’s emotional response (Gross, 1998). In their research on individual differences in expressivity, Gross and John (1995), emphasized positive expressivity, negative expressivity, and impulse strength as major emotional tendencies. In addition, they noted: “Unmistakable individual differences in expressivity suggest that people differ in the emotional tendencies they have. These differences are important to understand because they influence a wide range of intra- and interpersonal processes” (p. 555).
Emotion regulation theorists posit that both positive and negative emotional expression and experience may be regulated (Gross, 1998). Wang, Zhang, Li, and Liu, (2007) found that individuals who effectively regulate emotion, via cognitive reappraisal strategies, benefit in their social adaptation and psychological health. Furthermore, they found that the use of cognitive reappraisal strategies was related with to higher levels of self-approval and subjective well-being. Campbell-Sills and Barlow (2007) found a correlation between inappropriate emotion regulation strategies and negative effects in mental health. In addition, these researchers noted that using inhibition as a regulation strategy may increase the risk of cancer and accelerate cancer progression.
Research on emotion regulation originated in developmental psychology (Gaensbauer, 1982) and now is flourishing in the child and adult literatures alike (Campos, Campos, & Barrett, 1989; Gross, 1998). Yet, Gross (1998) acknowledged the huge challenge in regulating emotions and noted, “our theoretical and empirical grasp of emotion regulation is still quite uncertain, and the details of how such an integration of reason and emotion might be achieved remain obscure” (p. 18).

4.1. The Development and Origins of Positive Emotions
The elongated period of the development of the human brain, which is perceived as being quite extraordinary, is imperative to understanding why some people express such identifiable variations in their individual level of emotional health.. Distinct from the other important organs of the human body, most of the brain develops after birth and reacts to one’s environmental settings. A sensitive period in human brain development seems to exist up to about two years of age (Dawson et al., 2000), but marked transformations and reorganisation persist until the attainment of the age of puberty (Huttenlocher, 1990). Nevertheless, the development of the human frontal lobes, which handle such advanced processes like planning and emotional control, continues until early adulthood (Keverne, 2004).
All species of mammal orientations show that later emotional health and cognitive capability seems to be markedly determined by the premature social setting (Huppert, 2005). More important is the close association of the connection between mother and infant. Pioneer research on mother-infant bonding has indicated that the dyadic experiences of attachment lead to a representational internal working model of relationships that provide a mechanism for a translation of a dyadic feature into a personal quality (Bowlby, 1969, 1973, 1980). Other studies have revealed that babies in a secure attachment, as compared to babies with an insecure emotional attachment, show more confidence in exploring their immediate external environment and in reacting to people that they do not know (Ainsworth & Bell, 1970). The studies of Ainsworth and Elicker (1970), and Englund, and Sroufe (1992) provide some of the evidence that even in the infant stages of human development, positive emotions are linked to positive cognition and social behaviour, which have the tendency of giving a basis for resilience for the remaining period of human life.
Elicker, Englund and Sroufe (1992) postulated that through taking part in a relationship with an empathic and responsive caregiver, a child also learns about reciprocity and the nature of empathic relating. Moreover, according to these researchers, the history of responsive care can generate a sense of self-worth in a child.
Studies have also reported a strong relationship between early attachment and the social competence of children of all ages. For example, Matas et al. (1978) found that securely attached toddlers exhibited more symbolic play, were more enthusiastic, more compliant, and showed more positive affect than insecurely attached children. Elicker, Englund, and Sroufe (1992) found that attachment at 12 and 18 months of age predicted their social competence levels at age 10 years.

4.2. Measurement of Positive Emotion
Dimberg et al. (2000) stated that the quantification of emotion, especially positive affect, is carried out in a variety of ways. Positive emotion in people can be validly quantified using facial movement, especially smiles. The smile is the fastest and simplest facial motion to identify. This is particularly imperative when the motion is short and inherent in an ongoing activity. Self-reports of emotional states are also dependable when longer emotional states are measured. Dimberg et al. found that the real smile is progressively associated with positive emotion in humans and is a dependable marker of happiness, irrespective of whether or not the joy can be self-reported. For instance, according to Messinger et al. (2001), the Duchenne smile is linked to reciprocating positive mood and as a result, is often elicited by babies when their maternal parents smile. Williams et al. (2001) argued that a real smile reveals a connected reciprocal reaction in observers. The Duchenne smile performs both as joint communication, as well as functions as an individual reaction to positive stimuli. It is a dependable marker of the capability of a stimulus to express immediate positive mood. Schultz, Izard, and Bear (2004), in an important study on children’s emotional processing patterns and social adjustment, noted that happiness can be a significant factor to the prediction of aggression beyond that which was accounted for by anger.

4.3. Cognition and positive emotions
A considerable array of data derived from cross-sectional survey reveals that individuals who are happy have the apparent tendency of functioning more optimally in life in comparison to individuals who are less happy (Diener, 2000). Social psychology on an experimental basis has a lot of instances expressing the fact that positive emotional encounters are beneficial to the perception and interpretation of social behaviours and the initiation of social interactions (Forgas, 2001; Isen, 1987). Results show that individuals encountering positive affect perceive themselves and other people more positively, show higher levels of lenient attributions, and act with higher expressions of confidence, optimistic and generous modes in interpersonal scenarios (Forgas, 2002; Sedikides, 1995).
As such it is obvious that from the experimental studies concerning induced emotional states, that happiness or other positive moods have the tendency of a direct impact on cognitive functions, cognitive appraisal and social interactions. These results reinforce the ‘broaden-and-build’ theory of Fredrickson concerning positive moods and puts up the position that the frequent encounters of positive affect widens cognitive functions and develops enduring coping tools leading to future survival (Fredrickson, 2001; Fredrickson, 2004; In press). Put in the same place, the results imply that positive emotions result in positive cognitions, positive attitudes and elevated cognitive capability, and that positive cognitions, attitudes and abilities consequentially enhance positive emotions (Fredrickson & Joiner, 2002). The identification of this rising tide (and its opposite) accounts for the basis of cognitive therapy (Beck, 1979).

5. Positive Psychology and Mental Health Practicing
Saleeby (2002) noted that children and adolescents continue to receive mental health services that are more inclined to stigmatize than cure, instill doubt rather than hope, and generate avoidance over motivation. If we are to change our paradigm, psychologists need to acknowledge that “much of the best work that [we] already do in the counseling room is to amplify strengths rather than repair the weaknesses of their clients” (Seligman & Csikszentmihalyi, 2000, p. 23). Rogers’ experience of person-centered therapy (1957) corroborates the fact that attitudes of unconditional positive regard, accurate empathy and genuineness, perceived by participants in their helpers, are necessary for therapeutic progress.
Therapeutic interventions drawn from solution-focused therapies can be effective when the aim is to increase participants’ insight into their coping ability (de Shazer, 1991; Watkins, 2001). Thus, these approaches support, supply and emphasize the interpretation and operationalization of the theory of salutogenesis, which represents tension and strain as potentially health-promoting rather than illness-creating (Antonovsky, 1987). The theory emphasizes a person as an open system in active interaction with the environment. The implication for therapists is to view clients as moving towards a healthy end of the continuum by supporting clients’ sense of coherence.
From the field of social work, Saleebey (1997, 2002) advocated a strength-based approach by encouraging clients to cultivate strategies of resilience from resources within in order to cope with life’s issues. This scholar suggested that “the stimulation of a strengths discourse involves a vocabulary of strengths (in the language of the client), mirroring – providing a positive reflection of the client’s abilities and accomplishments, and helping the client to find other positive mirrors in the environment “ (p. 55). Thus, acknowledging that clients possess strengths, attributes and resources can facilitate resilience and growth. For instance, a depressed, socially withdrawn girl who has a talent for poetry might be encouraged to write and read poems dealing with loss in sessions with her therapist. This clinical intervention would motivate and support the client in locating a creative writing class or group wherein she would be encouraged to practice specific social skills and accept appreciation for her evolving ability and talent as an aspiring poet. This is akin to the core philosophy of positive psychology as it assumes that the girl already has within her ‘self’ resources to develop and help her flourish.
Summary and Conclusion
This chapter reviewed relevant literature concerning the impact of positive emotional states on mental and physical health or well-being. A comprehensive investigation of related prior research indicates that positive moods can promote mental and physical well-being. Fredrickson (2000); Schultz, Izard, and Bear (2004); and Lazarus (2001) also proved that joy in humans may yield sustainable survival benefits. Prior research also indicated that positive affect can make people look more attractive, even sexually attractive, as well as socially approachable (Otta et al., 1996). These findings indicate that in building a positive clinical psychology field, we must adopt not only a new approach and value set, but also a new language for talking about human behaviour. In this new language, ineffective patterns of behaviours, cognitions, and emotions are construed as problems in living, not as disorders or diseases. From this conclusion, more studies need to be carried out on the application of positive emotional states in therapy to promote physical and mental well-being. Throughout my clinical experience working with children, adolescents and adults, I have been privileged to witness the growth of some people, and come to understand the stagnation in others. I have deeply reflected upon and appreciated many theoretical approaches and the based evidence value in practice. Based on my observations, our clients struggle for change and seek our assistance to place their often chaotic mental states into an organized and meaningful understanding. This occurs on a different level of emotional processing. This level refers to the regulation of emotions and strategies aimed to maintain and increase experiences of positive emotions. Thus, cultivating positive emotions is particularly vital for building resilience to stressful events (Tugade and Fredrickson, 2006).

References

Ainsworth M. D., & Bell S. M. (1970). Attachment, exploration, and separation: Illustrated by the behaviour of one-year-olds in a strange situation. Child Development, 41, 49-67.

Argyle, M. (1987). The Psychology of Happiness. London: Methuen.

Arnheim (1974). Art and Visual Perception: A Psychology of the Creative Eye. University of California Press, 1974 – Psychology.

Arsenio, W. F., Cooperman, S., & Lover, A. (2000). Affective predictors of preschoolers’ aggression and peer acceptance: Direct and indirect effects. Developmental psychology 36, 438-448.

Barkow, L. Cosmides, & J. Tooby (Eds.), The adapted mind: Evolutionary psychology and the generation of culture (pp. 429 4n4). New York: Oxford University Press.

Barone, D.F., Maddux, J.E., & Snyder, C.R. (1997). Social cognitive psychology: History and current domains. New York: Plenum.

Blascovich, J. & Mendes, W. B. (2000). Challenge and threat appraisals: The role of affective cues. In Forgas, J. (Ed.). Feeling and Thinking: The Role of Affect in Social Cognition. Cambridge University Press, Paris, 59-82

Bless, H., Bohner, G., Schwarz, N., & Strack, F. (1990). Mood and persuasion: a cognitive response analysis. Personality and Social Psychology Bulletin, 16, 331–345.

Boulton, M. J. & Smith, P. K. 1992 The social nature of play fighting and play chasing: mechanisms and strategies underlying cooperation and compromise. In The adapted mind: evolutionary psychology and the generation of culture (ed. J. H. Barkow, L. Cosmides & J. Tooby), pp. 429–444. New York: Oxford University Press.

Bowlby, J. (1969). Attachment and loss, Vol 1. Attachment (2nd edn). New York: Basic Books.

Bowlby, J. (1973). Attachment and loss, Vol 2. Separation, anxiety and anger. London: Hogarth Press.

Bowlby, J. (1980). Attachment and loss, Vol 3. Loss sadness and depression. London: Hogarth Press.

Bradburn, N. M. (1969). The Structure of Psychological Well-being. Chicago,IL: Alding Publishing Co.

Brake, W.G., Zhang, T.Y., Diorio, J., Meaney, M.J. and Gratton, A. (2004). Influence of early postnatal rearing conditions on mesocorticolimbic dopamine and behavioural responses to psychostimulants and stressors in adult rats. European Journal of Neuroscience, 19(7), 1863-1874.

Bredy, T.W., Zhang, T.Y., Grant, R.J., Diorio, J. and Meaney, M.J. (2004). Peripubertal environmental enrichment reverses the effects of maternal care on hippocampal development and glutamate receptor subunit expression. European Journal of Neuroscience, 20(5), 1355-1362.

Brunstein, J.C., Schultheiss, O.C. and Grassman, R. (1998). Personal goals and emotional well-being: The moderating role of motive dispositions. Journal of Personality and Social Psychology, 75, 494-508.

Buck, R. (1985). Prime theory: An integrated view of motivation and emotion. Psychological Review, 92, 389-413.

Clore, G. L., Schwarz, N., & Conway, M. (1994). Affective causes and consequences of social information processing. In R. S.Wyer & T. K. Srull (Eds.) The handbook of social cognition (2nd Ed). Hillsdale, NJ: Lawrence Erlbaum Associates.

Cisamolo (1990). Social schemata of peripheral changes in emotion. J Pers Soc Psychol. 1990 Jul;59(1):38-49.

Cohen, S., Doyle, W.J., Turrner, R., Alper, C.M. & Skoner, D.P. (2003). Sociability and susceptibility to the common cold. Psychological Science, 14(5), 389-395.

Crane, T.(2005). The problem of perception, The Stanford Encyclopedia of Philosophy. Zalta.

Csikszentmihalyi, M. (1990). Flow: The psychology of optimal experience. New York: HarperPerennial.

Damasio, A.R. (1994). Descartes’ error: Emotion, reason and the human brain. New York: Avon.

Danner, D., Snowdon, D. and Friesen, W. (2001). Positive emotions in early life and longevity: Findings from the Nun Study. Journal of Personality and Social Psychology, 80 (5), 814-813.

Davidson, R.J, Kabat-Zinn, J, Schumacher, J, Rosenkrantz, M, Muller, D, Santorelli SF. et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564-570.

Davidson, R.J. (1992) Emotion and affective style: Hemispheric substrates. Psychological Science, 3, 39-43.

Davidson, R.J. (In press). Well-being and affective style: neural substrates and biobehavioral correlates. In FA Huppert, N Baylis & B Keverne (Eds). The Science of Well-being. Oxford: Oxford University Press.

Davidson, R.J., Chapman, J.P., Chapman, L.P. and Henriques, J.B. (1990). Asymmetrical brain electrical activity discriminates between psychometrically-matched verbal and spatial cognitive tasks. Psychophysiology, 27, 238-543.

Davidson, R.J., Coe, C.C., Dolski, I and Donzella, B. (1999) Individual differences in prefrontal activation asymmetry predict natural killer cell activity at rest and in response to challenge. Brain, Behaviour and Immunity,13, 93-108.

Dawson, G., Ashman, S. B., & Carver, L. J. (2000). The role of early experience in shaping behavioural and brain development and its implications for social policy. Development and Psychopathology, 12, 695-712.

De Rivera, J., Possel, L., Verette, J. A., & Weiner, B. (1989). Distinguishing elation, gladness, and joy. Journal of Personality and Social Psychology, 57, 1015-1023.

Deci, E. L., & Ryan, R. M. (1985). Intrinsic motivation and self-determination in human behavior. New York: Plenum.

Descartes, R (1986). Meditations on first philosophy: With Selections from the Objections and Replies. J. Cottingham (Ed. & Trans.). Cambridge Development and Psychopathology, 14, 761-787.

Diener, E. (1984). Subjective well-being. Psychological Bulletin, 95, 542-575.

Diener, E. (2000). Write my Essay Online Writing Service with Professional Essay Writers – Explaining differences in societal levels of happiness: Relative standards, need fulfilment, culture, and evaluation theory. Journal of Happiness Studies, 1(1), 41-78.

Diener, E., Suh, E. M., Lucas, R. E., & Smith, H. L. (1999). Subjective well-being: Three decades of progress. Psychological Bulletin, 125, 276-302.

Dimberg, U., & Thell, S. (1988). Facial electromyography, fear relevance and the experience of stimuli. Journal of Psychophysiology, 2, 213-219.

Dimberg, U., Thunberg, M., & Elmehed, K. (2000). Unconscious facial reactions to emotional facial expressions. Psychological Science, 11(1), 86-89.

Dolhinow, P. J., & Bishop, N. (1970). The development of motor skills and social relationships among primates through play. In J. E Hill (Ed.), Minnesota symposia on child psychology (Vol. 4, pp. 141-198). Minneapolis: University of Minnesota Press.

Donovan, N., & Halpern, D. (2002). Life satisfaction: The state of knowledge and implications for Government. Prime Minister’s Strategy Unit. (https://monkessays.com/write-my-essay/strategy.gov.uk/2001/futures/attachments/ls/paper.pdf)

Ehrenreich B. (2009). Bright-sided: How the relentless promotion of positive thinking has undermined America. New York: Henry Holt & Company

Ekman, P. (1992). An argument for basic emotions. Cognition and Emotion, 6, 169-200.

Ekman, P. (1994). Are these basic emotions In P. Ekman & R. J. Davidson (Eds.), The nature of emotions: Fundamental questions (pp. xx-xx). Oxford, England: Oxford University Press.

Ekman, P., Friesen, W. V., O’Sullivan, M., Chan, A., Diacoyanni-Tarlatzis, I., Heider, K., Sroufe, L.A. (1992). Predicting peer competence and peer relationships in childhood from early parent-child relationships. In R. D. Parke & G. W. Ladd (Eds.), Family-peer relationships: Modes of linkage (pp. 77-106). New Jersey: Erlbaum.

Elicker, J., Englund, M., & Sroufe, L.A. (1992). Predicting peer competence and peer relationships in childhood from early parent-child relationships. In R.D. Parke & G.W. Ladd (Eds.), Family-Peer Relationships: Modes of Linkage (pp. 77-106). New Jersey: Lawrence Erlbaum.

Elliot, A.J., Sheldon, K.M. and Church, M.A. (1997). Avoidance personal goals and subjective well-being. Personality and Social Psychology Bulletin, 23, 915-927.

Ellsworth, P. C., & Smith, C. A. (1988a). From appraisal to emotion: Differences among unpleasant feelings. Motivation and Emotion, 2, 271-302.

Ellsworth, P. C., & Smith, C. A. (1988b). Shades of joy: Patterns of appraisal differentiating pleasant emotions. Cognition and Emotion, 2, 301-331.

Izard, C. E., King, K. A., Trentacosta, C. J., Morgan, J. K., Laurenceau, J., Krauthamer-Ewing, E. S., & Finlon, K. (2008). Accelerating the development of emotion competence in Head Start children: Effects on adaptive and maladaptive behavior. Development and Psychopathology, 20, 369-397

Fiedler, K., Asbeck, J., & Nickel, S. (1991). Mood and constructive memory effects on social judgment. Cognition and Emotion, 5, 363-378.

Folkman, S., & Moskowitz, J. T. (2000). Stress, positive emotion, and coping. Current Directions in Psychological Science, 9, 115-118.

Forgas, J. P. (1999). On feeling good and being rude: Affective influences on language use and request formulations. Journal of Personality and Social Psychology, 76, 928-939.

Forgas, J. P. (2001). The handbook of affect and social cognition. Mahwah, NJ: Erlbaum.

Forgas, J. P. (2002). Feeling and doing: Affective influences on interpersonal behavior. Psychological Inquiry, 13 (1), 1-28.20

Forgas, J. P. (In press). Mood effects on eyewitness memory: Affective influences on susceptibility to misinformation.

Francis, D. D., Diorio, J., Plotsky, P. M., & Meaney, M. J. (2002). Environmental enrichment reverses the effects of maternal separation on stress reactivity. Journal of Neuroscience, 22(18), 7840-7843.

Fredrickson, B. L., Tugade, M. M., Waugh, C. E., & Larkin, G. (2003). What good are positive emotions in crises: A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th, 2001. Journal of Personality and Social Psychology, 84, 365-376.

Fredrickson, B. L., & Branigan, C. (2005). Positive emotions broaden the scope of attention and thought-action repertoires. Cognition and Emotion, 19(3), 313-332.

Fredrickson, B. L. & Joiner, T. (2002) Positive emotions trigger upward spirals toward emotional well-being. Psychological Science, 13(2), 172-5.

Fredrickson, B. L. (1998). What good are positive emotions Review of General Psychology, 2, 300–319.

Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. American Psychologist, 56, 218-226.

Fredrickson, B. L. (2002a). Cultivating positive emotions to optimize health and well being. Prevention & Treatment, 3, Article 0001a. Retrieved from https://monkessays.com/write-my-essay/journals.apa.org/prevention/volume3/pre0030001a.html.

Fredrickson, B. L. (2004). Gratitude, like other positive emotions, broadens and builds. In R. A. Emmons & M. E. McCullough (Eds.), The psychology of gratitude (pp.145-166). New York: Oxford University Press.

Frijda, N. H. (1986). The emotions. Cambridge, England: Cambridge University Press.

Frijda, N. H., Kuipers, P., & Schure, E. (1989). Relations among emotion, appraisal, and emotional action readiness. Journal of Personality and Social Psychology, 57, 212-228.

Gallie, R. (1989). Thomas Reid and ‘The Way of Ideas.’ Dordrecht, Country: Kluwer.

Gasper, K., & Clore, G. L. (2000). Do you have to pay attention to your feelings to be influenced by them Personality and Social Psychology Bulletin, 26, 698-711.

Gasper, K., & Clore, G. L. (2002). Attending to the big picture: Mood and global versus local processing of visual information. Psychological Science, 13, 34-40.

Gibson, James J. (1987). The ecological approach to visual perception. Erlbaum.

Glasersfeld, E. von. (1995). Radical constructivism: A way of knowing and learning. London: Routledge Falmer

Grant, V., & Grant, K. (1983). Behavior of hawk moths on flowers of Datura meteloides. Botanical Gazette, 144, 280–284.

Grinde, B. (2002). Darwinian Happiness: Evolution as a guide for living and understanding human behavior. Princeton: Darwin Press.

Hatfield, E., & Rapson, R. (1993). Love and attachment processes. In M. Lewis & J. M. Haviland (Eds.), Handbook of emotion (pp. 595-604). New York: Guilford Press

Helliwell, J. F. (2003). How’s life Combining individual and national variations to explain subjective well-being. Economic Modelling, 20, 331-360.

Helliwell, J., & Putnam, R. D. (2004). The social context of well-being. Philosophical Transactions of the Royal Society series B, 359, 1435-1446.

Helliwell, J., & Putnam, R. D. (In press). The social context of well-being. In F. A. Huppert, N. Baylis, & B. Keverne (Eds). The science of well-being. Oxford: Oxford University Press.

Hockly, D., Cordery, P. M., Woodman, B., Mahal, A., van Dellen, A., Blakemore, C. Bates, G. P. (2002). Environmental enrichment slows disease progression in R6/2 Huntington’s Disease. Annals of Neurology, 51: 235-242.

Huppert, F. A. (In press) Positive mental health in individuals and populations. In F. A. Huppert, N. Baylis, & B. Keverne (Eds). The science of well-being. Oxford: Oxford University Press.

Huppert, F., Baylis, N., & Keverne, B. (2005). The science of well-being. Oxford: Oxford University Press.

Huppert, F. A., & Whittington, J. E. (2003) Evidence for the independence of positive and negative well-being: implications for quality of life assessment. British Journal of Health Psychology, 8, 107-122.

Huttenlocher, P. R. (1990) Morphometric study of human cerebral cortex development. Neuropsychologia, 28, 517-527.

Isen, A. M. (1987). Positive affect, cognitive processes and social behaviour. In L Berkowitz (Ed.), Advances in experimental social psychology (Vol.20, pp.203-253). New York: Academic Press.

Izard, C. E. (1977). Human emotions. New York: Plenum Press.

Izard, C. E. (2001). Emotional intelligence or adaptive emotions Emotion, 1(3), 249-257.

Izard, C. E., Fine, S. E., Mostow, A., Trentacosta, C., & Campbell, J. (2002). Emotion processes in normal and abnormal development and preventive intervention. Development and Psychopathology, 14, 761-787.

Izard, C. E., Huebner, R. R., Risser, D., McGinnes, G. C., & Dougherty, L. M. (1980). The young infant’s ability to produce discrete emotion expressions. Developmental Psychology, 16, 132-140.

Izard, C. E., King, K. A., Trentacosta, C. J., Morgan, J. K., Laurenceau, J., Krauthamer-
Jackson, D. C.,…Davidson, R. J. (2000). Resting frontal and anterior temporal EEG asymmetry predicts ability to regulate negative emotion. Psychophysiology, 37, S50.

Jackson, D. C., Mueller, C. J., Dolski, I., Dalton, K. M., Nitschke, J. B., Urry, H.L.,…Davidson, R. J. (2003). Now you feel it, now you don’t: Frontal brain electrical asymmetry and individual differences in emotion regulation. Psychological Science, 14, 612–617.

Jahoda, M. (1958). Current concepts of positive mental health. New York: Basic Books.

Judge, T.A., Thoresen, C. J., Bono, J. E., & Patton, G. K. (2001). The job satisfaction-job performance relationship: a qualitative and quantitative review. Psychological Bulletin, 127(3), 376-407.

Kaplan, S. (1992). Environmental preference in a knowledge-seeking, knowledge-using organism. In J. H. Barkow, L. Cosmides, & J. Tooby (Eds.), The adapted mind: Evolutionary psychology and the generation of culture (pp. 581-598). New York: Oxford University Press.

Kasser, T.,& Ryan, R. M. (1996). Further examining the American dream: Differential correlates of intrinsic and extrinsic goals. Personality and Social Psychology Bulletin, 22, 280-287.

Keverne, E. B. (2004) Understanding well-being in the evolutionary context of brain development. Philosophical Transactions of the Royal Society series B, 359, 1349-1358.

Keverne, E.B. (2004) Understanding well-being in the evolutionary context of brain
development. Philosophical Transactions of the Royal Society series B, 359, 1349-1358,
London.

Keyes, C. L. M., & Haidt, J. (2003). Flourishing: Positive psychology and the life well-lived. Washington, DC: American Psychological Association.

Kierkegaard, S. (1954). Fear and trembling and the sickness unto death. Garden City, NY: Doubleday.

Kihlstrom, J.F. (1987). The cognitive unconscious, Science, 237, 1445-1452.

Kihlstrom, J.F. (1990). The psychological unconscious. In L.A. Pervin (Ed.), Handbook of personality: Theory & Research (pp. 445-464), New York: Guiford Press.

Korchin, S. J. (1976). Modern clinical psychology. New York: Basic Books.

Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.

Lazarus, R. S. (1991). Emotion and adaptation. New York: Oxford University Press.

Lazarus, R. S. (1993). From psychological stress to the emotions: A history of changing outlooks. In M. R. Rosenzweig & L. W. Porter (Eds.), Annual review of psychology (pp. 1–21). Palo Alto: Annual Reviews.

Lazarus, R. S. (2003). Does the positive psychology movement have legs Psychological Inquiry, 14, 93–109.

Lazarus, R. S., & Smith, C. (1988). Knowledge and appraisal in the cognition-emotion relationships.Cognition and Emotion, 2, 281–300.

Lazarus, R. S., Kanner, A. D., & Folkman, S. (1980). Emotions: A cognitive phenomenological analysis. In R. Plutchik & H. Kellerman (Eds.), Emotion: Theory, research and experience: Vol. 1. Theories of emotion (pp. 189-217). New York: Academic Press.

LeDoux, J.E. (1989). Cognitive-emotional interactions in the brain. Cognition and Emotion, 3, 267-389

Leverich, G. S., Perez, S., Luckenbaugh, D. A., & Post, R. M. (2002) Early psychosocial stressors: relationship to suicidality and course of bipolar illness. Clinical Neuroscience Research 2, 161-170.

Levine, L. J., & Burgess, S. L. (1997). Beyond general arousal: Effects of specific emotions on memory. Social Cognition, 15(3), 157-181.

Levy, B. R., Hausdorff, J. M., Hencke, R.,& Wei, J. Y. (2000). Reducing cardiovascular stress with positive self-stereotypes of aging. Journals of Gerontology B Psychological Science and Social Science, 55(4), 205-213.

Lewis, M.,& Haviland-Jones, J. M. (Eds.). (2000). The Handbook of emotions (2nd ed.). New York: The Guilford Press.

Liu, D., Diorio, J., Day, J. C., Francis, D. D., & Meaney, M. J. (2000). Maternal care, hippocampal synaptogenesis and cognitive development in rats. Nature and Neuroscience, 3(8), 799-806.

Loftus, E. F. (1979). Eyewitness testimony. Cambridge: Harvard University Press.

Lykken, D. (2000). Happiness: The nature and nurture of joy and contentment. New York: St Martin’s Press.

Lykken, D., & Tellegen, A. (1996). Happiness is a stochastic phenomenon. Psychological Science, 7(3), 186-189.

Lyubomirsky, S., & Ross, L. (1999). Changes in attractiveness of elected, rejected and precluded alternatives: a comparison of happy and unhappy individuals. Journal of Personality and Social Psychology, 76, 988-1007.

Lyubomirsky, S., & Tucker, K. L. (1998). Implications of individual differences in subjective happiness for perceiving, interpreting and thinking about life events. Motivation and Emotion, 22, 155-186.

Maccoby, E. E., & Martin, J. A. (1983). Socialization in the context of the family: parent child interaction. In P. H. Mussen & E. M. Hetherington (Eds.). Handbook of child psychology: Vol. 4. Socialization, personality, and social development (4th ed., pp.1-101). New York: Wiley.

Maddux, J. E. (2008). Positive psychology and the illness ideology: Toward a positive clinical psychology. Applied Psychology: An International Review, 57, 54-70.

May, R., E. Angel, H.F. Ellenberger. (1958). Existence. A new dimension in psychiatry and psychology. New York. Basic Books.

May, R. (1953). Man’s search for himself. New York: Norton.

May, R. (1961). Existential psychology. New York: Random House.

Mayer, J.D., & Gaschke, Y.N. (1988). The experience and meta-experience of mood. Journal of personality and Social Psychology, 55, 1-2-111.

Mayer, J.D., & Gaschke, Y.N., Braverman, D.L., & Evans, T.W. (1992). Mood-congruent judgment is a general effect. Journal of Personality and Social Psychology, 63, 119-132.

Mayer, J.D., Salovey, P. Gomberg-Kaufman, S., & Blainey, K. (1991). A broader conception of mood experience, Journal of Personality and Social Psychology,

Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50, 370–396.

Maslow, A. (1968). Toward a Psychology of Being. New York: D. Van Norstrand Co.

Maslow, A. H. (1978). Motivation and personality. New York: Harper & Row.
Miller, S.M., Brody, D.S., & Summerton, J. (1987). Styles of coping with threat: Implications for health. Journal of Personality and Social Psychology, 54, 142-148.

Plutchik, R. (1994). The psychobiology of emotions, New York: Harper Collins.

Siegel, S., & Castellan, N. J. (1988). Nonparametric statistics for the behavioral

Maddi, S. (2006). Hardiness: The courage to grow from stresses. Journal of Positive Psychology, 1, 160–168.

Mastekaasa, A. (1992). Marriage and psychological well-being: Some evidence on selection into marriage. Journal of Marriage and the Family, 54(4), 901-911.

Matas, L., Arend, R.A., & Sroufe, L.A. (1978). Continuity of adaptation in the second year: the relationship between quality of attachment and later competence. Child Development, 49, 547-556.

McGuire, T. R. (1993). Emotion and behavior genetics in vertebrates and invertebrates. In M. Lewis and J. M. Haviland (Eds.), The Handbook of Emotion (pp. 155-166). New York: Guilford Press.

Meaney, M. J. (2001). Maternal care, gene expression, and the transmission of individual differences in stress reactivity across generations. Annual Reviews of Neuroscience, 21, 1161-1192.

Messinger, D. S., Fogel, A., & Dickson, K. L. (2001). All smiles are positive, but some smiles are more positive than others. Developmental Psychology, 37(5), 642-653.

Murray, N., Sujan, H., Hirt, E. R., & Sujan, M. (1990). The influence of mood on categorization: A cognitive flexibility interpretation. Journal of Personality and Social Psychology, 59, 411-425.

Nesse, R. (2004). Natural selection and the elusiveness of well-being. Philosophical Transactions of the Royal Society series B, 359, 1333-1348.

Nesse, R. (In press). Natural selection and the elusiveness of happiness. In FA Huppert, N. Baylis & B Kevernes (Eds.). The Science of well-being. Oxford: Oxford University Press.

Kaufmann, W. (1968). Twilight of the Idols. trans. The Portable Nietzsche. New York: Viking Press.

Oatley, K. & Jenkins, J. M. (1996). Understanding emotions. Cambridge, MA: Blackwell.of emotion. In R. S. Wyer & T. K. Srull (Eds.), Handbook of social cognition (pp. 323–418). Hillsdale, NJ: Erlbaum.
Ostir, G.V., Markides, K.S., Peek, M.K. & Goodwin, J.S. (2001) The association between emotional well-being and the incidence of stroke in older adults. Psychosomatic Medicine, 63(2), 210-215.

Ostir, G. V., Markides, K. S., Peek, M. K. & Goodwin, J. S. (2001) The association between emotional well-being and the incidence of stroke in older adults. Psychosomatic Medicine, 63(2), 210-215.

Otta, E., Abrosio, F. F. E., & Hoshino, R. L. (1996). Reading a smiling face: Messages conveyed by various forms of smiling. Perceptual and Motor Skills, 82(3), 1111-1121.

Ozelle, Ron (2005). Write great fiction: description & setting. Cincinnati, OH: Writer’s Digest Books

Panksepp, J. (2000a). Emotions as natural kinds within the mammalian brain. In M. Lewis & J. Haviland-Jones (Eds.), Handbook of emotions (2nd ed., pp. 137-156). New York: Guilford Press.

Panksepp, J. (2000b). The riddle of laughter: Neural and psychoevolutionary underpinnings of joy. Current Directions in Psychological Science, 9(6), 183-186.

Poerksen, B. (2004). The certainty of uncertainty: dialogues introducing constructivism, Exeter: Imprint Academic.

Poole. T. B. (1997). Happy animals make good science. Laboratory Animals 31, 116–124.

Putnam, R.D. (2000). Bowling alone. New York: Simon & Schuster Beck, A.T. (1979) Cognitive therapy and the emotional disorders. New York: Penguin.

Pressman, S. D., & Cohen, S. (In press). Does positive affect influence health
Processes in normal and abnormal development and preventive intervention.
Psychology, 36(4), 438-448.

Reverberi, C., Lavaroni, A., Gigli, G. L., Skrap, M., & Shallice, T. (2005). Specific impairments of rule induction in different frontal lobe subgroups. Neuropsychologia, 43, 460-472.

Rosenkranz, M. A., Jackson, D. C., Dalton, K. M., Dolski, I., Ryff, C. D., Singer, B. H.,… Davidson, R. J. (2003) Affective style and in vivo immune response: neurobehavioral mechanisms. Proceedings of the National Academy of Science, 100(19), 11148-11152.

Rossi, S., Cappa, S. F., Babiloni, C., Pasualetti, P., Miniussi, C., Carducci, F., Babiloni, F. & Rossini, P. M. (2001). Prefrontal cortex in long-term memory: an ‘interference’ approach using magnetic stimulation. Nature Neuroscience, 9, 948-952.

Ruch, W. (1993). Exhilaration and humor. In M. Lewis & J. M. Haviland (Eds.), Handbook of emotions (pp. 605–616). New York: Guilford Press.

Ryan, R.M., & Deci, E. L. (2001). On happiness and human potentials: A review of research on hedonic and eudaimonic well-being. Annual Reviews of Psychology, 52, 141-166.

Ryle, G (2002). The concept of mind. Chicago: University of Chicago Press.

Schultz, D., Izard, C. E., & Bear, G. (2004). Children’s emotion processing: Relations to emotionality and aggression. Development and Psychopathology, 16, 371-387.

Scheie,r M. F, Carver C.S. (1985). Optimism, coping, and health: Assessment and implications of generalized outcome expectancies. Health Psychology, 4, 219–247.

Scheier M.F., Matthews K.A., Owens J.F. (1989). Dispositional optimism and recovery from coronary artery bypass surgery: The beneficial effects on physical and psychological well-being. Journal Personality Social Psychology, 57, 1024–1040.

Sedikides, C. (1995). Central and peripheral self-conceptions are differentially influenced by mood: Tests of the differential sensitivity hypothesis. Journal of Personality and Social Psychology, 69(4), 759-777.

Seligman, M. E. P. (2002). Authentic happiness: Using the new positive psychology to realize your potential for lasting fulfilment. NY: Free Press.

Seligman, M. E. P., Steen, T A., Park, N., & Peterson, C. (2005). Positive psychology progress: American Psychologist, 55, 5-4.

Seligman, M.E.P., & Csikszentmihalyi, M. (2000). Positive psychology: An introduction. American Psychologist.55: 5–14.

Shallice, T. (2004). The fractionation of supervisory control. In M. S. Gazzaniga (Ed.). The cognitive neurosciences III, 943-956. Cambridge, MA: MIT Press.

Sheldon, K. M., & Kasser, T. (1998). Pursuing personal goals: Skills enable progress but not all progress is beneficial. Personality and Social Psychology Bulletin, 24, 1319-1331.

Sheldon, K.M. and Elliot, A.J. (1999). Goal striving, need satisfaction, and longitudinal well-being: The self-concordance model. Journal of Personality and Social Psychology, 76, 482-497.

Stroop, J. R. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18, 643–662.

Szasz, S. T. (1978). The myth of psychotherapy. Syracuse, NY: Syracuse University Press.

Szasz. T. S. (1987). Insanity the idea and its consequences. New York Willey.

Tedeschi, R.G., & Calhoun L.G. (1985). Trauma and Transformation: Growing in the Aftermath of Suffering. Thousand Oaks: Sage.

Thayer, R.E. (1989). The biopsycology of mood and emotion. New York: Oxford University Press.

Tugade, M. M., & Fredrickson, B. L. (2004). Resilient individuals use positive emotions to bounce back from negative emotional experiences. Journal of Personality and Social Psychology, 86, 320_333.

Tugade, M. M., & Fredrickson, B. L. (2006). Regulation of positive emotions: Emotion regulation strategies that promote resilience. Journal of Happiness Studies, 8, 311_333.

Werner, E..E., & Smith R.S. (1982). Vulnerable but Invincible: A Longitudinal Study of Resilient Children and Youth. New York. McGraw-Hill.

Weinberger, D.A. (1990). The construct validity of the repressive coping style. In J.L. Singer (Ed.), Repression and Dissociation: Implications for personality theory, psychopathology, and health (pp. 337-386). Chicago: University of Chicago Press.