[Mandala by Clare Goodwin]
[Psychosynthesis]





An exploration of the perception of practitioners of the strengths and limitations of psychosynthesis psychotherapy in application
by Zen Kyle





CHAPTER THREE
Findings of the investigation


Introduction

This chapter presents the findings of this investigation. The phenomenological approach was used to identify twenty seven categories that emerged from the data analysis. These were grouped to form four major themes. The first three reflect the strengths of psychosynthesis in practice, and are presented as: benefits for clients, the conduciveness of psychosynthesis's theoretical perspective for practitioners, and the practitioner's role. The final theme is presented as psychosynthesis's limitations.

The referencing system adopted by the researcher in the analysis of the data is used throughout this chapter, with upper case letters referring to individual research participants, and numbers identifying sections of meaning in the original transcriptions of the taped interviews.

The four themes are addressed separately. Each one is presented with the outcomes of the data analysis, points of discussion relating it to psychosynthesis literature, and a conclusion. A final conclusion brings this chapter to an end and links it with the discussion in chapter four.

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How psychosynthesis benefits clients

The first major theme that emerged from the data and addressed the strengths of psychosynthesis was the participants' perceptions of how they had experienced psychosynthesis to be beneficial for clients.

Five participants outlined the ways in which psychosynthesis psychotherapy presented clients with a non-threatening experience (L10, 11, C12, G14, I10, 12, H9, 21). L10 stated that any psychotherapeutic encounter was seen to be challenging, daunting often frightening for people but "they don't find [the] psychosynthesis model threatening." It offered a safe person-centred experience where, as participant I10 said, "people benefit from having somebody paying undivided attention…in a non-judgemental fashion". In this environment, a person felt reassured that the approach was respectful of the beliefs, values, structures and practices they lived by, and benefited by becoming progressively more comfortable in themselves (B1, L10, 11). Clients were more likely to explore what they were defending against if the practitioner was accepting of their resistances (C13, E26). They were able to address pains and difficulties, and in some cases acknowledge and change unhelpful conditioning, to evoke an attitude to themselves and life which was adventuresome and open, rather than being unwittingly driven (C12, H21).

These findings were consistent with those of Young Brown (2000 p.87) who emphasised the fundamental need to accept resistances but went on to say that they could also be proactively worked with in the therapeutic encounter, "treating [them] with respect," in order to be utilised as a means of growth.

Ten participants discussed the consequences of the practitioner's way of being in, and the importance for clients of, the therapeutic relationship. These offered clients a refuge when they were confused or uncertain, or had experiences of a spiritual nature (C5, G7b). Also, the practitioner's holding of the person's potential, and that there was an emerging purpose at those times when they could only think of the pain and difficulties, was seen to benefit the client (D40). Participant E37 argued that the value of the therapeutic relationship was underlined by clients benefiting from a sense of not being alone, and there being a meeting at the superconscious level of their being. Two participants stated that remaining alongside the client irrespective of what they had done, encouraged trust to be developed and an openness to ensue. Clients began to learn to give themselves permission and the process of becoming who they really were, was enhanced (I10, F13, 35, 43). They were more likely to attend to their moment to moment feelings, thoughts and sensations, than to focus on the problem (K4, A5, D4). As a result clients learnt to choose, to take steps forwards, and to be more in touch with their potential (L24, K4, B18). They began to see that they need not be identified with any of the changing phenomena such as anxiety, fear or pain, which they had previously struggled with at the experiential level (K4).

These findings were supported by Assagioli (1993 p.230-231) who reflected on his work with clients as having "yielded very gratifying results" because the relationship was infused with "trust and appreciation". Crampton (1977 p.29) referred to the healing effects of "close attunement to the client", whilst Whitmore (1998) cited the beneficial effects of the therapeutic relationship in psychosynthesis, including a development of trust within the client.

However, other literature highlighted the limitations of these findings. Firman and Gila (1997) using a case study, illustrated how the therapeutic relationship in psychosynthesis, was also the arena in which the client's wounds in his personality surfaced, where the repair of broken empathic connections could give rise to trust and further growth for the client. And describing other benefits, Haronian (1975 p.34-35) said that the "synthesis of therapist and client into a collaborative relationship" resulted in a "community of interest" enhancing the client's progress.

Three participants stated that psychosynthesis facilitated clients in making creative use of pain, crisis and failure. They learnt to acknowledge the traumas and consequential wounding, and avoided a collusion with a tendency to deny the hurt (D35). In this respect A12 said, "people can walk away from [therapy] and they can say 'maybe the pain hasn't changed, but I feel as though I have more choice'". Psychosynthesis enabled people to emerge from a crisis where there had not seemed to be any meaning or purpose; when they were depressed, unable to see their way forwards in life (D42). Participant J29 reported that it had also been effective with people who had reached an impasse in their careers or personal life, where they did not want to loose what they had, but neither was it enough. In these cases, psychosynthesis assisted people to discover their deeper qualities and values, and thus they re-embarked upon their life journey.

Growing in awareness, having an enhanced consciousness and its benefits for clients was discussed by seven participants. Clients were enabled to explore repressed and difficult feelings (C10). Parts of themselves which they had previously disowned re-emerged, and a healthier acceptance developed (C11). Accessing what had been unconscious to the person through visualisation techniques lead to new insights (E16). Clients became clearer about how they had been blocking their creative energies and desires (L14, D26). They learnt that they were responsible for their own journey, realised the self defeating and dis-empowering patterns of attitudes and behaviours, and gradually changed these (B7, I11, A16, 17). Clients were also inspired by what they yearned for, what offered them a sense of wholeness, of joy, peace and contentment (D25).

The sub-personality model and the processes of dis-identification and re-identification, also facilitated progress towards greater awareness and an enhanced consciousness. Two participants stated that the model was easily understood and F7 said, "it's also a fun way of working, so it doesn't have to be all terribly serious" (also E3). Clients appreciated and benefited from an enhanced sense of who they were and understanding of themselves (D7, 8, 20, 21, G8, 11, C10, 11, 32, K38, F9, A45). Three participants reported that dis-identification assisted clients to stand apart from their experiences, to objectify them (J36, G18, K40). They realised their destructive negative self images, and came to understand that they were more than those parts, roles, identifications, that they would have previously, unwittingly identified with (K38, F9). Clients became familiar with their sub-personalities, their origin and purpose, and dis-identification helped them to see that these previous identifications were not all they were. They were opened up to the possibility of learning from those parts they had previously been unaware of in themselves (G18, C32), and resolving inherent resistances and conflicts (L18, C20, J37, K39).

The opportunities for re-identifying more authentically and holistically with their true personality and essential Self arose out of dis-identification (I18, K5, F10). In effect it meant that they saw themselves as different people in different situations, and thus were always more than one identification with a particularly familiar sub-personality (I15, F18). They chose to adopt more roles, and being generally freer to choose, it "frees them to change" (C32). Clients broadened the range of responses they made to themselves and what life presented (F20, A11, D9). They were able to express their genuine will, and be more in charge of their life (F22, C22). They had moved from dis-empowerment to conscious self-empowerment (A16).

Having recognised themselves as so much more than their persona, clients had a greater sense of their potential (D3, F9, 12). Experiencing a greater integration, being more aligned with themselves and their true values, clients lived a more authentic, self-fulfilling life, in which changes were possible (G8, K5, F10). Participant D39 also argued that clients were encouraged that they had a superconscious dimension to their being. They were reassured by the growing sense that they were connected to a greater whole, a greater universal good.

A case study presented by Firman and Gila (1997 p.64) supported this study's findings regarding the effects of the sub-personality model. They referred to working with a client's "strong driver sub-personality" which he had developed to cope with his childhood experience of emotional neglect and abuse. They explained that "he gradually learned to dis-identify from the driver…and become open to alternative ways of being…in short, an expansion of consciousness and will, of I-amness, was evident."

In the light of the findings in this theme, psychosynthesis was thought to benefit clients when practitioners facilitated them to make creative use of pain, crisis and failure. It was also seen to be efficacious when practitioners used the sub-personality model. Otherwise there did not appear to be any other perceived benefit peculiar to psychosynthesis that could not be attributed to other psychotherapeutic approaches.

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The conduciveness of psychosynthesis's theoretical perspective for practitioners

The second theme referred to what practitioners appreciated about psychosynthesis's theoretical perspective, which enabled them to work effectively with clients.

Three participants argued that psychosynthesis's view of the unconscious mind incorporated but also contrasted with psychoanalytic models. It included the superconscious, a positive dimension of the hidden mind (E14) as well as addressing the shadow with its concept of the lower unconscious (F33); enabling people to understand and work with both dimensions (G7). Consequently, psychosynthesis was intrinsically more optimistic, and it facilitated a greater emphasis on the future and the release of the person's potential (E10, 11). Correspondingly, a core perception amongst six participants was that psychosynthesis offered a broader and deeper perspective than many of the other counselling and psychotherapy approaches. This was because it offered a transpersonal view of the individual, as well as seeing them in the contexts of their history and current circumstances (I5b, E5, B25). A1 argued that, "the context is completely different" because the transpersonal was understood to imbue and transform the personal dimensions of the individual (H12, K9), and thus the human person was seen as, "a spiritual being having a human experience, as opposed to human beings having occasional spiritual experiences" (also A2, K32, 52). The human experience was a journey towards the realisation of wholeness. This journey involved movement from often unconscious dis-empowerment to broader consciousness which made conscious self-empowerment possible (A16, H3, 14).

This study's findings that psychosynthesis offered a broader and deeper perspective than many other counselling and psychotherapy approaches, received some support from Friedman (1984) whose critique of psychoanalysis in relation to psychosynthesis concluded that the latter was more comprehensive because it accommodated the transpersonal levels of human development. Firman and Gila (2002 p.2) took a similar position explaining that psychosynthesis "extends beyond psychoanalysis". However, the participants' claim encompassed many other psychotherapies, and as such remained insubstantial without further support from additional literature.

Five participants argued that psychosynthesis had a broad and in some respects, unique way of understanding psychological disturbance. Painful experiences and discomfort could be considered to be symptoms of either a disruption between the person's Higher Self and their personality, or as disarrangement within their personality, and thus could indicate the nature of the healing or integration that needed to take place (J13). The practitioner looked beyond the pathology or neurosis to a related emerging purpose. People's traumas, pains and difficulties were opportunities for new developments because psychosynthesis held the perspective that there was a spiritual guidance - the Higher Self seeking expression through the personality (I6, D1). All painful experiences were seen as being in the service of the person's journey to wholeness, which was a process of becoming more human (A3, K2).

Assagioli (1993) contended that psychosynthesis offered additional insights and techniques to those of psychoanalysis, for addressing psychological disturbances. Ferrucci (1982) explained psychological pain in terms of blockages and frustrations in the person's naturally occurring process of synthesis; "its lack causes serious difficulties" p.22. And Firman and Gila (2002 p.1) used the notion of "primal wounding" to describe the source of psychological disturbance. Thus these authors offered some support for the findings of this study in this respect.

Two participants argued that psychosynthesis would interpret some clients' experiences that would otherwise be diagnosed psychotic, as being symptomatic of a spiritual crisis. Few if any other psychotherapeutic perspectives could enable the practitioner to re-conceptualise clients' experiences in this way (J32, G6, G7b, 10). In these cases, psychosynthesis empowered the practitioner to offer the holding essential for the client's progress, and gave a sense of purpose to their work (G26, 27).

Three participants argued that there were distinctive aspects of the therapeutic relationship in psychosynthesis which were inspired by its theoretical perspective. C21 said that it allowed for a level of connection which was a "soul to soul communication" (A32, C21, 22, E35). The therapeutic alliance was also described at the deepest level as consisting of the practitioner and client respectively, being "love" (A32). Participant A32 stated that the essential nature of human beings was seen to be love, and in the therapeutic relationship the participants had, at this level, no other need than to connect with their essential nature.

The reference in this section of the study to love, was corroborated by Assagioli (1993 p.5) where he referred to "inter-individual psychosynthesis" and it being synonymous with "the reality and function of love", otherwise known as "communion" and "altruism". Thus defined, Assagioli saw that love was intrinsic to the psychotherapeutic processes of psychosynthesis.

Three participants stated that the relationship in psychosynthesis was, as in psychoanalytic methods, a means for a corrective experience for the client; as for example, when there had been a deficiency in parenting. But the focus was upon the client's need rather than being drawn into pathologising the client's symptoms or their causes (A 20-22, 28, 37, H 13, K13-17).

Three participants reported how psychosynthesis involved an invitation to use the personal functions of loving and willing, which were equally important as the means by which people made effective choices to bring about changes, and Self realisation (H17, B23). In this respect, facilitating the effective use of will, which one participant stated was unique amongst therapeutic approaches (E32), corresponded with the client being enabled to express their spiritual values, and to progress with their journey more effectively (B23).

Young Brown's (2000) discourse regarding psychosynthesis's notions of love and will, argued for a balanced perspective, in which both were treated with equal importance. This vindicated the corresponding data in this theme. In addition, where the data explicated the correspondence between values and the will, it was also validated by Haronian (1975 p.31) who stressed the functional process of the will, and that it, "demands we hold values", including those of a higher, spiritual quality.

Two participants contended that the psychosynthesis perspective did not support a problem solving approach. It was important to respect the scope of the possible ways individuals' processes could evolve. Thus, clients were seen to be involved in a movement to find ways of learning to be more accepting and to treat themselves as more than an object, which was contrary to problem solving and quick fixes (H15, B19).

Five of the participants considered psychosynthesis to be "inclusive" (L1, C3, G14, H24). It was reported to be inclusive of all cultures, and social aspects of people's lives (C3, 28), and easily transposed for use with people "who are on a spiritual path, but don't subscribe to any religious belief or practice" (D38). Psychosynthesis's utilisation of techniques and models from other psychotherapeutic approaches was also indicative of its inclusivity (G13, H24). In refraining from assuming the aspect of a "meta theory" (H34), psychosynthesis was argued to be open to developments, which was considered to be a corresponding strength.

These findings regarding inclusivity in this theme were particularly contentious because the participants contributed opinions with insufficient evidence from their experience in practice. That having been said, psychosynthesis's theoretical perspective was found to be conducive to practitioners especially because compared with psychoanalysis, it offered a more comprehensive and optimistic framework for understanding the human person. Practitioners also benefited from the distinctive perspective psychosynthesis had regarding psychological disturbance, which made it possible for them to attend to the transpersonal aspects of the person in these experiences, and thus facilitate healing and growth more holistically.

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The psychosynthesis practitioner's role in the service of clients' needs

The third theme summarised strengths in psychosynthesis with regard to the nature and basis of interventions in the course of the therapeutic encounter. The theme demonstrated how the practitioners operated, how they discharged their functions; what constituted the service they offered in the course of the coenselling process and relationship.

Four participants stated that psychosynthesis's theoretical perspective, helped practitioners to refrain from pathologising any of their client's experiences, to avoid thinking that they had the answers, and to see the client's enormous potential (A5, I7, 8, L5, 23, C27). Suspending the tendency to pathologise, making use of "bi-focal vision" (J4), and trusting that the person's deeper Self knew what needed to happen (I5a, J15), were all considered to be important, as were self awareness and an avoidance of assumptions. These skills and attitudes of practitioners, helped them to see that what the person presented may be woundedness and pain, but also, as J19 described it, "a cry of the soul", a deeper part of the person trying to get things right, trying to bring about a wholeness. Practitioners also facilitated an integration for the individual between their personal and transpersonal dimensions. This assisted clients not only to be more authentic, but also to come to their own unique path in life (J6, 7, 17, 18, D33 L13, A11).

Three participants referred to an instructional role as when people learnt to relax and find themselves for ten minutes every day and when exercises and techniques were used to help facilitate clients (G17, 19, L7, J36). It was stated that the practitioner also used their imagination and meditative abilities, to for example, seek insights into the client's needs and potential (E6, L12, I1). One participant described the role as that of being a guide, which meant that they worked collaboratively with the client, being alongside them on their journey. It included a form of companionship, and making available their experiences of their own journey (E24, F15, 16).

Assagioli's (1993 p.231) position, where he said "the role of the active counsellor is a normal constructive role", supported the data which indicated that the psychosynthesis practitioner offered a greater availability, involvement, and direction than psychoanalytic or Rogerian practitioners, for example. In exposing the meaning of guide, Assagioli (1993 p.231) described the use of "example", and Haronian (1975 p.34) referred to "total responsiveness" in his psychosynthesis practice. Crampton (1977) viewed the guide as a collaborator and Young Brown's (2000) position was that guiding was an art requiring the creative involvement of the practitioner's whole personality. Alberti (1975 p.3) was more specific and explicit, referring to guiding as being "short-lived and transitory…steering and directing" until the client learnt to utilise his own will. Thus, in the matter of practitioner as guide, the findings were supported but also shown to be restricted.

Eight participants discussed the use of techniques in psychosynthesis. Participant G17, 18 outlined how relaxation, together with dis-identification and identification were used in order to help clients to objectify their experience and discover their authentic identity. The same participant said that the practitioner had a "tool box" (G19), which consisted of exercises to facilitate clients' developmental processes (G18). Techniques were used to help people to come to terms with threatening intra psychic forces and to a greater self realisation (K39, A40). Using visualisation exercises people unhooked themselves when their process was stuck (L22, K12). They could tap into their intuition and unconscious, gain insights and understanding, and conversely, learn about and utilise their repressed desires and pains, and thus came to a closer correspondence with their spiritual path (E13, 15, 16, D26, C12). The practitioners also used exercises to help a person ground their spiritual experiences (B21).

Assagioli (1993) offered substantial guidance regarding the application and contra-indications for the use of techniques in psychosynthesis psychotherapy. Petrie's (1983) discourse on psychosynthesis, included valuable discussions about how techniques were to be applied. Parfitt (2003), Charles (2000) and Young Brown (2000) all illustrated techniques as a means of furthering a client's own psychosynthesis. Thus, the literature overwhelmingly supported this data, on this matter.

In the light of the findings in this theme, psychosynthesis was thought to benefit practitioners by encouraging them to adopt a particular attitude in their role, which consisted of refraining from pathologising any of their client's experiences. In addition it inspired them to avoid thinking that they had the answers, and to attend to the client's enormous potential. The nature of the practitioner's role was otherwise insufficiently explained by the findings, and the reference to 'guide' required further substantiation in additional research.

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The limitations of psychosynthesis

The theme entitled 'the limitations of psychosynthesis' reflected the experiences of all twelve participants who outlined restrictions in the application and effectiveness of psychosynthesis psychotherapy.

According to five participants, there were contra-indications for the use of psychosynthesis with particular groups of people. Two of these argued that it was inappropriate for use with people who had psychotic episodes, and bi-polar disorder (D32, G12). Those people who were considered to be seriously damaged psychologically, to have fragmented psyches, to be psychologically unstable, and had a history of serious depression, were also considered as unlikely to be helped with the use of psychosynthesis (I9, B28, D29, J38).

Tuyn (1988) partially supported the findings at this point, by contending that these clients could learn about their personality, but cautioned against progressing to further phases of psychosynthesis psychotherapy, with clients diagnosed as having moderate to severe borderline personality disorder. On the other hand, the majority of the available literature contradicted these findings. Assagioli (1993), discussed the care required when applying techniques, to avoid exacerbating the symptoms of clients disposed to psychotic episodes, but nowhere suggested that psychosynthesis is inapplicable with people who experience serious mental ill-health. More recent literature indicated that psychosynthesis had been successfully used with people who were mentally unwell and seriously damaged psychologically. Gelbond (2003) discussed the rehabilitating work with people psychiatrically diagnosed with chronic and acute schizophrenia. Brown's (2003 p.1) case study of a woman who had "major recurrent severe depression", illustrated how psychosynthesis facilitated positive changes in his client's condition. Dummer & Greene (1988) discussed the successes achieved when using the sub-personality model with clients diagnosed as having Multiple Personality Disorder. And Firman & Gila (2002) argued that psychosynthesis is applicable when working with people with the most severe psychological disturbances.

Three of the participants reported that psychosynthesis could attract people who did not want to deal with what was painful and difficult in their lives. They stated that there was a general danger in psychosynthesis that the negative got repressed, the shadow side of the person was overlooked, and all the parts a person considered unacceptable, they continued to disown and project onto others. In these cases, clients were relying upon denial and a disservice to clients would ensue, because the ego level of their personality had not been developed (H27, 35, C16, D37). One participant highlighted a related aspect of psychosynthesis which she considered to be a limitation, by stating that there was nothing explicit in the approach, in terms of a methodology for conducting an assessment of clients' suitability for psychosynthesis psychotherapy (E27). There was if anything an "underlying assumption that psychosynthesis can be good for everybody" (E29).

There was some support in the literature for the finding that psychosynthesis could be limited when it attracted people who did not want to deal with what was painful and difficult in their lives. Tuyn (1988 p. 263) asserted that an exploration of the lower unconscious, learning about the personality in which pains and difficulties were likely to be encountered, "must be emphasised because some people are drawn to psychosynthesis as an easy, new-age path to enlightenment and peace."

The literature from Assagioli (1993), Petri (1983), Crampton (1977) and Haronian (1975), included discussions about assessment in psychosynthesis psychotherapy. It was understood as a means of establishing the strengths and weaknesses of a person's psychological functioning, and internal dynamics. Assagioli (1993) discussed assessment as a process in which the client was an equal participant. No literature was found by this author that suggested the therapist conducted an assessment unilaterally, to establish a diagnosis of the client's condition, or their suitability for psychosynthesis psychotherapy. Thus, the literature highlighted the need for assessment, which the data had ignored, and contradicted the one reference to the subject.

Three of the participants reported limitations in the use of the sub-personality model. The model required a lengthy process and it was sometimes utilised improperly in a truncated form (L18, 19, 20, F19). Participant B2.6.1 stated that care had to be taken when using the sub-personality model with an addicted person, to avoid the danger of the addicted part of the person continuing to justify their destructive behaviour. She also argued that it was insufficient for people requiring a deeper perspective for working with attachment issues, which might be better facilitated by Object Relations theories (B26).

Seven participants reported limitations in the use of techniques in psychosynthesis. Practitioners could misuse them by attempting to provide quick fixes or good feelings for their clients (B20, 21), and clients also, by utilising them as a means for avoidance, to feel better rather than gaining insights and doing serious work on themselves (E18). Techniques were used inappropriately if there was too little reference to the person's current circumstances, and level of psychological maturation (I21). They were also misused if applied instead of developing the therapeutic relationship (A43, I22, J2, 22). Using techniques with people who were not able to work at the personal as well as the transpersonal levels, was likely to be unhelpful (C17, D34 J27). Participant B29 stated that the technique of visualisation would be inappropriate for use with people experiencing difficulties with addiction, because as a consciousness altering facility, it reinforced what they had been doing with drugs, and took them further away from the truth and themselves.

Assagioli's discourse (1993) supported these findings when he indicated the contra-indications for the use of techniques. Whitmore (1998 p.43) was corroborative, suggesting a critical approach to the use of techniques, because of the danger "of the counsellor becoming merely a technician." Crampton (1977 p.29) reflected in a similar manner when she said, "the quality of the helping relationship…is the indispensable context, without which techniques are mere mechanical gimmicks which lack true healing power".

Five participants discussed the limitations of psychosynthesis which arose from the training and level of personal development of practitioners. The extent to which the therapist had explored and experienced their own processes and journey was a significant influence on the likely effects of psychosynthesis in practice (A14, 46, K48). The therapist's own sense of being himself and not retreating behind an identity of the professional expert was also crucial in this respect (H13). The inexperienced or less well integrated practitioner could tend to provide answers, and they could be unaware of their own prejudices and assumptions about class and cultures, thus being exclusive (C27). Practitioners' training was also limited in its non-acknowledgement of the body (K50) and F27 posited that the training emphasised the use of techniques at the expense of working with the client's lower unconscious and shadow, resulting in practitioners colluding with clients and avoiding more difficult work (F28, 29, 30, 31).

There was some limited corroborative literature regarding the findings about restrictions in psychosynthesis due to insufficient integration of practitioners. Crampton (1977 p.29) posited that "the level of the guide's personal integration is a crucial element which determines the amount of clarity and love he/she is able to bring to the traveller on the path."

The finding in this theme, that psychosynthesis was not appropriate for use with certain groups of people, consisted of conclusions without explanations. The literature offered a contradictory perspective on the issue, and there was thus a need for further research to be conducted, into whether or not psychosynthesis could make a contribution to specifically diagnosed mental illnesses. Similarly, in all but one case, the participants offered opinions without demonstrating a rationale for techniques being avoided in certain cases. Additional investigations into the effects of psychosynthesis techniques would offer further guidance for their use. It could also be concluded from this section of the findings that there was a need for practitioners to be trained more comprehensively in the skills of assessment in psychosynthesis psychotherapy. It could avoid the unhelpful assumption that it was effective for everybody. The literature, in particular Assagioli's (1993) text, was illustrative of the assessment process in psychosynthesis, and its absence in this study could have been indicative of a restricted service to clients.

This concludes the presentation of the findings of this study, and their implications will be discussed more extensively in the final chapter.



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