Initial Development and Psychometric Properties of the Therapist Quality Scale

• Published in: Rehabilitation psychology Vol. 69; no. 4; pp. 326 - 334
• Main Authors: Day, Melissa A., Ward, L. Charles, Ehde, Dawn M., Mendoza, M. Elena, Phillips Reindel, Kala M., Thorn, Beverly E., Bindicsova, Ingrid, Jensen, Mark P.
• Format: Journal Article
• Language: English
• Published: United States American Psychological Association 01-11-2024
• Subjects: Behavioral Activation System; Chronic Pain; Human; Pain Management; Psychometrics; Test Construction; Test Reliability; Test Validity; chronic pain; fidelity; clinical trials; Therapist Quality Scale; psychosocial treatment
• ISSN: 0090-5550; 1939-1544; 1939-1544
• DOI: 10.1037/rep0000550

Purpose/Objective. This study sought to develop and evaluate the psychometric properties of a brief measure of the quality of therapist treatment delivery that would be applicable for use across different types of psychosocial chronic pain treatments: the Therapist Quality Scale (TQS). Research Method/Design. An initial pool of 14 items was adapted from existing measures, with items selected that are relevant across interventions tested in a parent trial comparing an 8-week, group, Zoom-delivered mindfulness meditation, cognitive therapy, and behavioral activation for chronic back pain from which data for this study were obtained. A random selection of 25% of video-recorded sessions from each cohort was coded for therapist quality (two randomly selected sessions per group), with 66 sessions included in the final analyses (n = 33 completed pairs). Items were coded on a 7-point Likert-type scale. Exploratory factor analysis (EFA) and reliability estimates were generated. Results. EFA showed a single-factor solution that provided a parsimonious explanation of the correlational structure for both sessions. Eight items with factor loadings of ≥.60 in both sessions were selected to form the TQS. Reliability analyses demonstrated all items contributed to scale reliability, and internal consistency reliabilities were good (αs ≥ .86). Scores for the eight-item TQS from the two sessions were significantly correlated (r = .59, p < .001). Conclusions/Implications. The TQS provides a brief measure with preliminary psychometric support that is applicable for use across different types of treatments to rate the quality of the therapist's delivery. The items assess quality in delivering specific techniques, maintaining session structure, and in developing and maintaining therapeutic rapport.
Impact and ImplicationsThe quality in which various psychosocial treatments are delivered has been shown to predict outcome improvement in the broader psychotherapy literature; however, therapist quality is rarely assessed in clinical trials. The Therapist Quality Scale (TQS) is the first validated measure with demonstrated reliability that can be used to assess therapist quality in the delivery of different types of psychosocial chronic pain treatments, thereby providing a tool to assess the role of quality in accounting for outcome change in comparative trials and naturalistic settings. The TQS could also be used for therapist training and supervision purposes, to advance therapist skills in delivering specific psychotherapy techniques for chronic pain management, in maintaining session structure, and in developing and maintaining therapeutic rapport.