Date of Award

Winter 2010

Document Type


Degree Name

Doctor of Psychology (PsyD)



Committee Director

Michael P. Nichols

Committee Member

J. D. Ball

Committee Member

W. Larry Ventis

Committee Member

Glenn D. Shean

Committee Member

Richard W. Handel


Although contemporary practitioners have rejected the confrontational style and perceived aggressiveness of earlier family therapists in favor of a more "collaborative" stance, confrontation, as a technique, is still widely used in almost all forms of psychotherapy, including family therapy. The present process study explored what makes confrontation more or less effective in motivating clients to recognize and reevaluate counterproductive ways of interacting. Using videotaped family therapy sessions, confrontation clarity, emotional reactivity, and the use of suggestion were examined in relation to client levels of acceptance of confrontation immediately following the confrontation, as well as in relation to overall client change within the session. Findings indicate a significant positive relationship between clarity and understanding of confrontation suggesting that direct and focused confrontations are more likely to be understood and accepted than indirect and unfocused confrontations. Findings also indicate that client confrontation response is positively and significantly correlated with within-session change.


A Dissertation Submitted to the Faculties of The College of William and Mary, Eastern Virginia Medical School, Norfolk State University, and Old Dominion University in Partial Fulfillment of the Requirements for the Degree of Doctor of Psychology in Clinical Psychology through the Virginia Consortium Program in Clinical Psychology.