The Individual Therapy Process Questionnaire: Development and Validation of a Revised Measure to Evaluate General Change Mechanisms in Psychotherapy

Abstract

There is a dearth of measures specifically designed to assess empirically validated mechanisms of therapeutic change. To fill in this research gap, the aim of the current study was to develop a measure that covers a large variety of empirically validated mechanisms of change with corresponding versions for the patient and therapist. To develop an instrument that is based on several important change process frameworks, we combined two established change mechanisms instruments: the Scale for the Multiperspective Assessment of General Change Mechanisms in Psychotherapy (SACiP) and the Scale of the Therapeutic Alliance-Revised (STA-R). In our study, 457 psychosomatic inpatients completed the SACiP and the STA-R and diverse outcome measures in early, middle and late stages of psychotherapy. Data analyses were conducted using factor analyses and multilevel modelling. The psychometric properties of the resulting Individual Therapy Process Questionnaire were generally good to excellent, as demonstrated by (a) exploratory factor analyses on both patient and therapist ratings, (b) CFA on later measuring times, (c) high internal consistencies and (d) significant outcome predictive effects. The parallel forms of the ITPQ deliver opportunities to compare the patient and therapist perspectives for a broader range of facets of change mechanisms than was hitherto possible. Consequently, the measure can be applied in future research to more specifically analyse different change mechanism profiles in session-to-session development and outcome prediction. Key Practitioner Message This article describes the development of an instrument that measures general mechanisms of change in psychotherapy from both the patient and therapist perspectives. Post-session item ratings from both the patient and therapist can be used as feedback to optimize therapeutic processes. We provide a detailed discussion of measures developed to evaluate therapeutic change mechanisms.

The working alliance: Where have we been, where are we going?

“…Of specific concern is the lack of negative items on short versions of the WAI, including the WAI-S and WAI-SR. As research has not directly examined what is lost in their elimination, the effects of their absence remain unclear. Of note, recently developed measures that expand beyond the construct of the alliance and incorporate more general mechanisms of change do assess more negatively valenced processes (Mander et al, 2013(Mander et al, , 2014. Taken together, the above critiques suggest that both the construct of the working alliance and the way in which it is measured are in need of revision.…”

“…The measure consists of seven subscales that reflect different components of psychotherapy process, including general change mechanisms (Gomes-Schwartz, 1978). Two newly developed instruments, the Scale for the Multiperspective Assessment of General Change Mechanisms in Psychotherapy (SACiP; Mander et al, 2013) and the Individual Therapy Process Questionnaire (ITPQ; Mander et al, 2014), integrate existing alliance measures with specific common factors change mechanisms. The SACiP integrated items from the Bernese Post Session Report (BPSR; Fluckiger, Regli, Zwahlen, Hostettler, & Caspar, 2010), a measure of Grawe's (2004) mechanisms of change, and the German WAI-SR (Munder, Wilmers, Leonhart, Linster, & Barth, 2010).…”

The therapeutic alliance in different mental disorders: A comparison of patients with depression, somatoform, and eating disorders

“…The instrument captures Bordin's () concept of the therapeutic alliance with the three dimensions Bond , Task, and Goal . In several studies, a two factor model with a Bond factor and a Goal & Task factor showed the best psychometric fit (e.g., Falkenström, Hatcher, & Holmqvist, ; Mander et al ., ; Webb et al ., ). The items of the WAI‐SR were rated on a five‐step scale ranging from 1 (does not apply) to 5 (applies fully).…”

“…In several studies, a two factor model with a Bond factor and a Goal & Task factor showed the best psychometric fit (e.g., Falkenstr€ om, Hatcher, & Holmqvist, 2015;Mander et al, 2015;Webb et al, 2011). The items of the WAI-SR were rated on a five-step scale ranging from 1 (does not apply) to 5 (applies fully).…”

Theorie-Praxis-Netzwerke in verhaltenstherapeutischer Ausbildung: Schulung, Selbsterfahrung und Einsatz in der Therapie am Beispiel von Achtsamkeit

“…Während aktuell Tausende von randomisierten kontrollierten Psychotherapiestudien (RCTs) vorliegen, die in Hunderten von Meta-Analysen zusammengefasst wurden [Hofmann et al, 2012], sind die spezifischen Mechanismen für therapeutische Verände-rungen kaum bekannt [Flückiger et al, 2015;Mander et al, 2015b;McMain et al, 2015]. Dies mag unter anderem daran liegen, dass die RCTs typischerweise komplexe Therapiemanuale evaluieren, die aus einer Vielzahl einzelner therapeutischer Bausteine zusammengesetzt sind.…”