Check List for Clinical Observations

Reference

Forer, B. R., Farberow, N. L., Feifel, H., Meyer, M. M., Sommers, V. S., & Tolman, R. S. (1961). Clinical perception of the therapeutic transaction. Journal of Consulting Psychology, 25(2), 93–101. https://doi.org/10.1037/h0044887

Check List for Clinical Observations

• 1. Therapist was primarily active. (Active: verbal activity)a
• 2. Therapist was primarily comfortable. (Comfortable: has sense of ease with the patient. Frame of
  reference should be our concept of comfort for all therapists.)

Therapist’s major method was:

• 3. Reflective
• 4. Interpretive
• 5. Supportive
• 6. The session seemed to be focused on a problem.
  • (6a. Therapist attempted to focus on a particular problem, either content or dynamic.)
  • (6b. Patient tended to ramble from topic to topic.)
• 7. There were silences. (Silence: period when no one is talking, 30 seconds or more)
• 8. If there were silences, they were usually broken by:
• a. the patient
• b. the therapist
• 9. The hour was characterized by resistance.
  • (9a. Patient expressed verbal disagreement with therapist’s interpretations, regardless of
    unconscious factors.)
  • (9b. Patient interrupted therapist more than once.)
  • (9c. Patient was halting in his speech: made pauses before words, incomplete sentences, more
    than once.)
  • (9d. Patient spoke mostly in generalities.)
  • (9e. Patient used technical psychological terms, more than once.)
• 10. Patient spoke in a monotone.
• 11. Patient was fidgety or restless.

Problem areas worked on were:

• 12. Authority
• 13. Sex
• 14. Dependency
• 15. Work
• 16. Hostility
• 17. Emotional control
• 18. Symptoms
• 19. Relationships with peopleb
• 20. Patient used gestures. (More than once)
• 21. Patient brought up a lot of material. (Material: variety or elaboration of content)
• 22. The material brought up was deep. (Deep: (a) patient meaningfully relates something that is happening in present to what has happened in past [content], or (b) produces something with great affect)
• 23. Patient was experiencing affect.

If experiencing affect, it was:

• 24. Anger
• 25. Fear
• 26. Sadness
• 27. Anxiety
• 28. Warmth
• 29. Patient seems to be rigid. (This applies to fluidity and spontaneity during the hour, whether material is censored or uncensored, etc. Not a judgment of character structure.)
• 30. Patient seems to show ability to form close relationships.
• 31. Patient seems capable of insight.
• 32. Patient seems self-critical.b
• 33. (Patient’s relationship to the therapist during the hour seemed to be one of positive feelings or rapport. This refers to conscious feelings.)
• 34a. The nature of the transference is predominantly positive.
• 34b. The nature of the transference is predominantly negative.
• 35. Projection (Attribution to other person of motives unacceptable to oneself).
• 36. Repression (Rationalization: logical excuse or justification of feelings or behavior).
• 37. Avoidance (Denial: avowed nonperception of reality situation, internal or external).
• 38. Intellectualization (Explanation of one’s feelings or behavior in terms of general or theoretical principles or abstract concepts).
• 39. Isolation (Separation of feeling and idea).
• 40. Reaction formation (Turning into the opposite, internal).
• 41. Conversion (Displacement: shift of feeling from one object or person to another).
• 42. Patient will complete therapy.
• 43. Patient will need long-term therapy, 1 ½ years or more.
• 44. Diagnostic impression.

a Items in parentheses are clarifications or substitute items created during the revision period before the
three observations of the last patient.
b Items 19 and 32 added after first period of observation.