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.
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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)