Construct validity of the Experiences of Therapy Questionnaire (ETQ)

BMC Psychiatry, Dec 2014

Background The Experiences of Therapy Questionnaire (ETQ) is a reliable measure of adverse effects associated with psychotherapy. The measure has not been subject to validity analyses. This study sought to examine the validity of the ETQ by comparison against a measure of therapist satisfaction. Methods Participants were recruited from the Black Dog Institute’s website and completed all measures online, at two time points (two weeks apart). Correlational analyses compared scale scores on the ETQ with related constructs of the Therapist Satisfaction Scale (TSS). To exclude any impact of current depression on ratings, we examined correlations between salient ETQ and TSS scales after controlling for depression severity. Results Forty-six participants completed all the measures at both time points. Hypothesised associations between the ETQ and TSS scales were supported, irrespective of current depression severity. Conclusions The validity of the ETQ is supported; however limitations of the study are noted, including generalizability due to sample characteristics.

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Construct validity of the Experiences of Therapy Questionnaire (ETQ)

Gordon Parker 0 1 Amelia Paterson 0 1 Kathryn Fletcher 0 1 Georgia McClure 0 1 Michael Berk 2 3 4 0 Black Dog Institute , Sydney , Australia 1 School of Psychiatry, University of New South Wales , Sydney , Australia 2 Department of Clinical and Biomedical Sciences, University of Melbourne , Victoria , Australia 3 Mental Health Research Institute , Melbourne, VIC , Australia 4 Orygen Research Centre , Melbourne, VIC , Australia Background: The Experiences of Therapy Questionnaire (ETQ) is a reliable measure of adverse effects associated with psychotherapy. The measure has not been subject to validity analyses. This study sought to examine the validity of the ETQ by comparison against a measure of therapist satisfaction. Methods: Participants were recruited from the Black Dog Institute's website and completed all measures online, at two time points (two weeks apart). Correlational analyses compared scale scores on the ETQ with related constructs of the Therapist Satisfaction Scale (TSS). To exclude any impact of current depression on ratings, we examined correlations between salient ETQ and TSS scales after controlling for depression severity. Results: Forty-six participants completed all the measures at both time points. Hypothesised associations between the ETQ and TSS scales were supported, irrespective of current depression severity. Conclusions: The validity of the ETQ is supported; however limitations of the study are noted, including generalizability due to sample characteristics. - Background We previously proposed [1] that psychotherapy can, as for any other active therapy, risk possible side-effects. Such a proposition risks being viewed as incongruous for a talking therapy and elicited some engagement with correspondents when we originally published our proposition [2-4]. Some were positive comments, in stating that all clinicians need to acknowledge that any treatment that has the capacity to greatly help the patient can also in equal measure have the potential to cause harm [3] or in basically agreeing with the premise [4]. However, correspondents also urged prudence when distinguishing between negative effects of therapy and negative effects of the therapist [3], and cautioned about framing an event such as sexual exploitation of a patient as a side-effect instead of a gross violation of conduct [2,3]. Such views encourage consideration of what is really meant by the term side-effect. For drug therapies, the term is normally used for any adverse event that is considered to be a negative consequence of the medication. In psychotherapy, side-effects have previously been described to include adverse treatment reactions that are defined as unwanted events caused by treatment which has been applied according to the rules [5] thereby distinguishing these side-effects from therapist misconduct. We suggest, in accordance with the above definition, that reasons for terminating drug therapy or psychotherapy due to negative experiences (e.g. feeling judged by a therapist) can both equally be termed sideeffects. We understand that this may be considered a controversial definition but note that the term side-effect has been used to describe a range of negative outcomes of psychotherapy from deterioration in functioning [6], lowered expectations of therapeutic benefit [6] to harmful therapy techniques [7]. Indeed, it has been argued that training therapists to evaluate side-effects of their therapy is crucial and standardized instruments to evaluate such effects are recommended [5,6]. In addition to this, it has been suggested that the best avenue of obtaining information on both the positive and negative effects of psychotherapy is via client feedback [7,8]. Thus, we define a psychotherapeutic side-effect broadly - reflecting an adverse outcome as a consequence of therapy. Feedback from our initial paper was taken into consideration when we developed (Parker et al., 2013) a self-report measure to assess negative outcomes in psychotherapy - the Experiences of Therapy Questionnaire (ETQ) and where we also established the reliability of the ETQ [9]. Content validity was established during the development of the ETQ. First, studies assessing psychotherapeutic ingredients that impact on psychotherapy were reviewed. Items derived from this review process largely captured eight domains including client efficacy, the therapeutic relationship, impact of therapy, rational/ treatment fit, treatment as restorative, therapist factors and the therapeutic setting. The items were reviewed by three clinicians (two psychiatrists and a psychologist) to ensure key aspects were represented. This process yielded 103 items that were then refined to the 63 contained in the final version of the ETQ [9]. The reliability of the ETQ has been reported elsewhere [9]. A factorial analysis favoured a five-factor solution. Factor one (Negative Therapist), captures a construct where the therapist lacks empathy or respect, is intrus (...truncated)


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Gordon Parker, Amelia Paterson, Kathryn Fletcher, Georgia McClure, Michael Berk. Construct validity of the Experiences of Therapy Questionnaire (ETQ), BMC Psychiatry, 2014, pp. 369, 14, DOI: 10.1186/s12888-014-0369-6