Copyright is owned by the Author of the thesis. Permission is given for a copy to be downloaded by an individual for the purpose of research and private study only. The thesis may not be reproduced elsewhere without the permission of the Author. AWARENESS: EVALUATING TSQ PSYCHOMETRIC PROPERTIES i Awareness: Facilitating the Therapeutic Dance along the Path of Growth and Change; Evaluating the Psychometric Properties of a Therapist Schema Questionnaire A thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Albany, New Zealand Rebekah Jenny Phin 2013 AWARENESS: EVALUATING TSQ PSYCHOMETRIC PROPERTIES ii Abstract The importance of the therapeutic relationship and the therapist?s contribution to the interpersonal processes, have been increasingly recognized as important factors in Cognitive Behavioural Therapy change and outcome. More specifically, the therapists? understanding and awareness of their own beliefs, assumptions and schema, and the potential effect that they can have on therapy, has been increasingly emphasized. Leahy?s (2001) Therapist Schema Questi onnaire (TSQ) is a potentially useful screening measure designed to identify Therapist Schema. No research has evaluated the psychometric properties of the TSQ. This study investigated the underlying factor structure and reliability of the TSQ in a therapist sample ( N = 269). An exploratory factor analysis suggested a 7 factor structure and a 37 item scale that included 4 of the original 15 schema factors, as well as 3 additional factors, each containing a theoretically meaningful combination of original schema factors. The 3 most commonly identified Therapist Schemas reveal ed in the study were ?self-sacrifice?, ?demanding standards?, and ?sen sitive/rejection?. The identi fied factors and the 37 item scale were found to have adequate to good inte rnal consistency. Implications of these findings are discussed and recommendations are made for further research. Keywords: Cognitive behavioural therapy, therapeutic relationship, schema, therapist schema, therapist se lf-awareness, self-p ractice, self-refl ection, questionnaire validation. AWARENESS: EVALUATING TSQ PSYCHOMETRIC PROPERTIES iii Acknowledgments This experience has been enriched by ma ny people, all of whom have generously given of their time, expertise, support, and encouragement. First and foremost I would like to expre ss my appreciation to my supervisors, Beverly Haarhoff and Mei Williams. This thesis could not have reached successful conclusion without your assistance and support. Bev, your generous and patient direction, expertise, input, and overall guida nce to the thesis, have made this often daunting and challenging process a far smoother experience. Mei, thanks for contributing your knowledge to this study in areas where mine was so limited. I have learned a lot and I am very grateful. Thanks to God for giving me the passion and love for people, that flows almost effortlessly, and for giving me the desire, motivation, and strength to persevere with study and develop myself in knowledge and wisdom. I am forever connected to you, and your beautiful sea- the view that has so often been my solace and inspiration when writing. I would also like to thank my family fo r your encouragement in this journey. I love you all so much! Mum and Dad, you have taught me to have faith and to never give up, and to use my life and mind to its fullest potential. My brother Tim, you believed in me and encouraged me to always ?improve? and to expand myself. My sister Miriam, you are such an inspirer, en couraging me to visualise and ?see? my dreams fulfilled; my angel. My little si ster Lois, you have been gently supportive in your own sweet and quiet way. Not to forget, my darling niece Jasmine, thanks for your precious cards and letters to keep me going and smiling. On a final note, thanks to my close girl friends, Salina-Pearl, Fleur, Ana, Monica, Faaiza, Naoko, and Janar. Especially, th anks to Alejandra and Jessica for your constant care and every week asking ?how?s the thesis going?? Thank you all for being there. I am so blessed and grateful. Muchas gracias! AWARENESS: EVALUATING TSQ PSYCHOMETRIC PROPERTIES iv Table of Contents Abstract??????????????????????????????..ii Acknowledgments??????????????????????????.iii Table of Contents..........................................................................................................iv List of Tables...............................................................................................................viii List of Figures................................................................................................................ix Overview.........................................................................................................................1 Chapter One: Cognitive Behavioural Therapy and Concept of Schema.................4 The Cognitive Behavioural Therapy Model.....................................................................4 Schema in Cognitive Behavioural Therapy.....................................................................6 Conditional versus unconditional Schema...........................................................7 Schema Theory.................................................................................................................8 Disorder specific schema.....................................................................................8 Interpersonal schema and emotional Schema....................................................14 Therapist Schema...............................................................................................14 Importance of schema........................................................................................18 Chapter Two: The Evolution of the Therapeutic Relationship in Cognitive Behavioural Therapy...................................................................................................20 Early Conceptualizations................................................................................................20 Changes over the Past Four Decades.............................................................................23 Bonds, tasks, and goals......................................................................................24 Constructivist/social le arning perspectives........................................................25 Cognitive-interpersonal perspectives.................................................................26 Empirical findings..............................................................................................28 AWARENESS: EVALUATING TSQ PSYCHOMETRIC PROPERTIES v Distinguished as the Background, and as an Intervention.............................................28 Chapter Three: Understanding the Therapeutic Relationship in CBT.................35 Influencing Models........................................................................................................36 Transference and counter transference...............................................................36 The role of social interaction..............................................................................40 The role of emotional processing.......................................................................41 Attachment theory..............................................................................................44 The role of compassion and mindfulness...........................................................46 The Importance of Therapist Schema Awareness..........................................................49 Chapter Four: Identifying Schema............................................................................54 Using Standard Cognitive Beha vioural Therapy Techniques........................................54 Useful Self Report Questionnaires.................................................................................56 Personality Belief Questionnaire (PBQ)............................................................56 Young?s Schema Questionnaire (SQ)................................................................57 Dysfunctional Attitude Scale (DAS).................................................................58 Personal Therapy............................................................................................................59 Self-Practice/Se lf-Reflection..........................................................................................61 Declarative-Procedural-Reflec tive (DPR) conceptual model........................................62 Therapist Belief system (TBS) conceptual model..........................................................64 Therapist Schema Questionnaire (TSQ)........................................................................65 Present Study.................................................................................................................. 68 Chapter Five: Method.................................................................................................71 Research Design.............................................................................................................71 AWARENESS: EVALUATING TSQ PSYCHOMETRIC PROPERTIES vi Participants.....................................................................................................................72 Recruitment process.......................................................................................................75 Measure........................................................................................................................ ..77 Procedure........................................................................................................................77 Analysis..........................................................................................................................78 Chapter Six: Results....................................................................................................79 Preliminary Data Analysis.............................................................................................79 Missing Data......................................................................................................79 Normality and Outliers.......................................................................................80 Factor Analysis ..............................................................................................................8 1 Choice of factor extrac tion and rotation method................................................81 Suitability of the Data Set for Factor Analysis..................................................82 Initial Factor Extraction.....................................................................................84 Factor Rotation and Interpretation.................................................................................87 Refining of the Factors.......................................................................................91 Internal Consistency of the Identified Factors...................................................94 Final 37 Item Scale.............................................................................................96 The Final Seven Factors/schemas....................................................................100 The Most Commonly Identified Therapist Schemas............................................................................................................106 Chapter Seven: Discussion.......................................................................................108 Summary of Aims and of the Findings............................................................108 Underlying Factor Structure.............................................................................108 AWARENESS: EVALUATING TSQ PSYCHOMETRIC PROPERTIES vii Comparison of Findings with Pr evious Research Observations......................111 Reliability.........................................................................................................115 Factor Correlations...........................................................................................115 Most Commonly Identified Therapist Schemas...............................................116 Implications......................................................................................................118 Limitations.......................................................................................................119 Future Directions..............................................................................................121 Conclusions......................................................................................................122 References...................................................................................................................124 Appendix A: Information sheet for participants....................................................136 Appendix B: Demographic information page.........................................................137 Appendix C: Advertisement requesting research participants.............................138 Appendix D: Email requesting research participants...........................................139 Appendix E: Therapist?s Schema Questionnaire: Leahy?s (2001) 46-Item........140 Appendix F: Therapist?s Schema Questionnaire: Leahy?s (2001) Guide...........142 Appendix G: Early maladaptive schemas with associated schema domains (Young, Klosko, & Weishaar, 2003).............................................................................................................................143 Appendix H: Correlation Matrix: 46-Item Therapist SchemaQuestionnaire.....145 Appendix I: Pattern Matrix for PCA with Oblimin Rotation of Seven Factor Solution of TSQ Items................................................................................................157 Appendix J: Therapist?s Schema Questionnaire: 37-Item (TSQ-37)..................159 AWARENESS: EVALUATING TSQ PSYCHOMETRIC PROPERTIES viii Lists of Tables Table 1. Summary of Demographic Characteristics of the Sample.....................74 Table 2. Mean Total Subscale Scores , Skew, and Kurtosis for the TSQ Subscales................................................................................................81 Table 3. EFA Results from Principal Co mponent Analysis, with No Specified Number of Factors, Extracted from Total Variance E xplained Matrix..85 Table 4. Structure Matrix for PCA w ith Oblimin Rotation of Seven Factor Solution of TSQ Items............................................................................89 Table 5. Structure Matrix for PCA w ith Oblimin Rotation of Seven Factor Solution of 42 TSQ Items, Displaying Results where Factor Loading is Greater than 0.4......................................................................................93 Table 6. Factor Correlations and Fact or Alpha Coefficients for the Seven Identified Factors of the 37 Item TSQ scale..........................................96 Table 7. Structure Matrix for PCA w ith Oblimin Rotation of Seven Factor Solution of 37 TSQ Items, Displaying Results where Factor Loading is Greater than 0.4......................................................................................97 Table 8. Identified Factor Structur e with Corresponding Items, and Item Loadings...............................................................................................102 Table 9. Total Variance Explained by th e Seven Extracted Factors, with an Oblimin Rotation Method....................................................................102 Table 10. Mean and Standard Deviati on Total Factor Scores for the Seven Identified Factors/Schemas..................................................................107 AWARENESS: EVALUATING TSQ PSYCHOMETRIC PROPERTIES ix List of Figures Figure 1. Screeplot results from PCA EFA with no specific number of factors...86