Clients’ Critical Experiences in Psychotherapy: Initial Measure Development

Symptom-focused measures are the most common means of assessing therapeutic outcome, although not all therapy approaches view symptom resolution as the central marker of therapeutic success. The present study sought to inform the development of an instrument to assess in-session experiences that clients, across therapy orientations, have reported as valuable to their progress. The measure is based upon a large-scale meta-synthesis of the qualitative research on what clients value in psychotherapy, across therapy orientations (Levitt, Pomerville, & Surace, 2016). The findings from this meta-synthesis were converted into a preliminary set of items for a measure of critical experiences in therapy that can be applied across therapeutic orientations. Thus, the purpose of this measure is to facilitate feedback to therapists throughout the course of treatment regarding in-session processes that clients themselves report are essential to their ultimate outcome from therapy. To develop this measure, I conducted a principal components analysis to identify primary components from a list of experiences that psychotherapy clients have reported are valuable to their therapy. Additionally, I examined whether the measure was reliable across clients from a variety of backgrounds, as well as how well the measure correlated with existing standard measures of therapy outcome and alliance. The results of this principal components analysis ultimately informed the development of a measure that has a reduced number of items, which will be further evaluated through a confirmatory factor analysis. Implications for training, prevention of client deterioration in therapy, and customization of treatment to clients’ unique needs are discussed