Validation of the Cooper-Norcross Inventory of Preferences (C-NIP) in Chinese lay clients and mental health professionals: Factor structure, measurement invariance, and scale differences.

The Cooper-Norcross Inventory of Preferences (C-NIP) is one of the most widely used measures of psychotherapy preferences. However, its psychometric properties have not been examined in non-Western samples. Research on disparities between the preferences of mental health professionals and their clients is also limited. We evaluated the C-NIP's psychometric properties and measurement invariance in Chinese lay clients and mental health professionals and evaluated the latent mean differences between clients' and professionals' scores on the C-NIP's four scales (preference for therapist vs. client directiveness, emotional intensity vs. emotional reserve, past vs. present orientation, and warm support vs. focused challenge). This cross-sectional investigation involved 301 lay clients and 856 mental health professionals who completed the Chinese version of the C-NIP. Confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used to examine the factor structure of the C-NIP. ESEM provided stronger evidence than CFA for the four-factor model in both samples. The four scales had adequate internal consistency in both the lay clients (αs = .68-.89) and the mental health professionals (αs = .70-.80). Partial scalar invariance was established across these two populations. Chinese mental health professionals preferred less therapist directiveness, past orientation, and warm support-but more emotional intensity-than Chinese lay clients (ds = 0.25-0.90). Culture-specific cutoff values (norms) to identify strong therapy preferences were established. This study supports the application of the C-NIP to non-Western populations and suggests that discrepancies between the preferences of lay clients and mental health professionals are a cross-cultural phenomenon. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Cancer patients' experiences of moments of relational depth during psychological therapy: a qualitative study.

OBJECTIVE: Research into psychological interventions for cancer patients has focused on the effectiveness of different treatment methods. Investigating common factors across treatments, such as qualities within the therapeutic relationship, has been neglected. This study explores cancer patients' experiences of moments of profound contact and engagement with their therapist, including any perceived impact. METHODS: Semi-structured interviews were conducted with ten cancer patients. Eight participants reported having experienced moments of relational depth. Their transcripts were analyzed using thematic analysis. FINDINGS: Five themes were identified: "Being physically and psychically vulnerable," "Being rescued from the waves," "Experiencing the calm after the storm," "More than a feeling," and "The therapist as 'a stranger and not a stranger'." CONCLUSION: Both novice and experienced practitioners should be aware of the potential power of moments of relational depth for cancer patients: to normalize patients' increased vulnerability and emotionality, and to manage breaks and endings with relational sensitivity.

Goals Form: Reliability, validity, and clinical utility of an idiographic goal-focused measure for routine outcome monitoring in psychotherapy.

OBJECTIVE: This study aimed to assess the reliability, validity, and clinical utility of an idiographic, goal-focused patient-reported outcome measure: The Goals Form. METHODS: Data were analyzed from 88 participants, across three samples, who had participated in collaborative-integrative psychotherapy at university-based clinics in the UK. The samples were approximately 70% female with mean age of 30 years old. RESULTS: The psychometric properties of the Goals Form were generally good. Noncompletion of individual items was low, temporal stability tended to be at target levels, and mean change scores showed moderate to good convergent validity against measures of psychological distress. The measure appeared sensitive to change in psychotherapy and was experienced by most patients as helpful. CONCLUSIONS: The Goals Form shows acceptable psychometric and clinical properties for routine outcome monitoring in psychotherapy.

Test-retest stability, convergent validity, and sensitivity to change for the Goal-Based Outcome tool for adolescents: Analysis of data from a randomized controlled trial.

OBJECTIVE(S): To examine the psychometric properties of the idiographic Goal-Based Outcome (GBO) tool for young people: test-retest stability, convergent validity, and sensitivity to an intervention. METHODS: This measure validation study used data from a randomized controlled trial of school-based humanistic counseling. We used multilevel analyses to assess test-retest stability, convergent validity of the GBO tool against nomothetic measures of mental wellbeing, and sensitivity to an intervention. RESULTS: The GBO tool showed acceptable stability over a 6-24 week period; moderate convergent validity with nomothetic measures of mental well-being, self-esteem, and depression; and greater sensitivity to an intervention than a measure of psychological distress. CONCLUSIONS: The GBO tool shows evidence of having acceptable psychometric properties and is suitable for monitoring change on individual goals. It may also have the capacity to function as a population-level indicator of outcomes in conjunction with the use of other measures of mental health and wellbeing.

Extended validation of the Relational Depth Frequency Scale: Retest reliability, divergent validity, criterion validity with psychotherapy satisfaction, and measurement invariance in UK- and US-stratified samples.

BACKGROUND: The Relational Depth Frequency Scale (RDFS) assesses moments of profound connection in psychotherapy, associated with therapeutic benefit. To date, the RDFS has not been tested for its retest reliability, divergent and criterion validity, and measurement invariance, nor has it been tested in stratified samples of psychotherapy patients. METHODS: Two stratified online samples of United Kingdom (n = 514) and United States (n = 402) psychotherapy patients filled out the RDFS, the Brief Social Desirability Scale (BSDS); and the Satisfaction with Therapy and Therapist Scale-revised (STTS-R). Two subsamples of patients (United Kingdom: n = 50 and United States: n = 203) filled out the RDFS again after 1 month. RESULTS: Reliability for the six-item RDFS were excellent in United Kingdom and United States samples (Cronbach's α = 0.91 and 0.92; retest r = 0.73 and r = 0.76). Divergent (r = 0.10 and r = 0.12) and criterion validity (r = 0.69; and r = 0.70) were good. Full scalar invariance was established across countries, genders, and time. CONCLUSION: This contributes important evidence to the validity of the RDFS. Future research should assess predictive validity against psychotherapy outcomes and replicate these analyses in diverse samples.

Idiographic patient reported outcome measures (I-PROMs) for routine outcome monitoring in psychological therapies: Position paper.

Idiographic patient-reported outcome measures (I-PROMs) are a growing set of individualized tools for use in routine outcome monitoring (ROM) in psychological therapies. This paper presents a position statement on their conceptualization, use, and analysis, based on contemporary evidence and clinical practice. Four problem-based, and seven goal-based, I-PROMs, with some evidence of psychometric evaluation and use in psychotherapy, were identified. I-PROMs may be particularly valuable to the evaluation of psychological therapies because of their clinical utility and their alignment with a patient-centered approach. However, there are several challenges for I-PROMs: how to generate items in a robust manner, their measurement model, methods for establishing their reliability and validity, and the meaning of an aggregated I-PROM score. Based on the current state of the literature, we recommend that I-PROMs are used to complement nomothetic measures. Research recommendations are also made regarding the most appropriate methods for analyzing I-PROM data.

Patient perspectives on working with preferences in psychotherapy: A consensual qualitative research study.

OBJECTIVE: Assessing and accommodating patient preferences is integral to evidence-based practice. This qualitative study sought to explore patient perspectives and experiences of preference work in psychotherapy. METHODS: Participants were 13 UK-based patients who had completed up to 24 sessions of a collaborative-integrative psychotherapy. Ten participants identified as female and three as male. Interviews were conducted at endpoint and analyzed using a team-based, consensual qualitative research approach. RESULTS: Three superordinate domains were developed: Preferences Themselves, Process of Working with Preferences in Psychotherapy, and Effect of Preference Work (or its Absence). Patients typically wanted leadership, challenge, and input from their psychotherapist, and an affirming style. Patients attributed the origin of their preferences to personal history, characteristics, or circumstances; the present psychotherapy; or past episodes of psychotherapy. Some preferences changed over time. Preference work was described as having positive effects on the therapeutic relationship and patients' intrapersonal worlds; however, variantly, non-accommodation of preferences was also experienced as beneficial. CONCLUSION: Our findings provide in-depth answers to a range of novel questions on preference work-potential mechanisms by which preference work impacts outcomes, factors that may facilitate preference work, and origins of preferences-as well as nuancing previously-established quantitative findings. Implications for clinical training and practice are discussed.

Effects and experiences of idiographic patient-reported outcome measures for feedback in psychotherapy: A systematic review and secondary analysis of the empirical literature.

Objective: There is a growing interest in idiographic patient-reported outcome measures (I-PROMs) for routine outcome monitoring (ROM) and clinical feedback (CF) in psychotherapy, but to our knowledge, no systematic reviews of the empirical literature. Method: We conducted a systematic literature search for empirical papers investigating effects and experiences of I-PROMs for ROM/CF and found a total of 13 papers. There was only one experimental controlled effectiveness study. Results: We formulated a narrative summary of the data set as a whole. We conducted a secondary analysis of nine papers containing qualitative data on stakeholder experiences with I-PROMs and found three superordinate themes and eight subthemes, summarized as "I-PROMs can facilitate self-reflection for patients, assist in identifying and tracking therapeutic topics, and make patients more committed to therapy by giving them a greater sense of responsibility and empowerment. Formulating goals and problems can be difficult, and lack of progress can be demotivating. Time in therapy is precious and must be spent wisely. Effective use of I-PROMs is facilitated by flexibility and therapists' use of clinical skills." Conclusion: We discuss the limitations of the study and provide recommendations for future research and clinical practice.

The Cooper-Norcross Inventory of Preferences: Measurement invariance across & international datasets and languages.

OBJECTIVE: The Cooper-Norcross Inventory of Preferences (C-NIP) is a brief, multidimensional measure of clients' therapy preferences. This study aimed to examine the factor structure and measurement invariance of the C-NIP. METHOD: Fifteen datasets (N = 10,088 observations) representing the C-NIP in nine language versions were obtained from authors of psychometric studies. Confirmatory factor analysis and exploratory structural equation modeling were used to analyze the data. RESULTS: None of the proposed models adequately fit the data. Therefore, a new model was developed that sufficiently fit most of the C-NIP version 1.1 datasets. The new model was invariant up to the strict and means levels across genders, ages, and psychotherapy experience but only up to the metric level across translations. CONCLUSIONS: The C-NIP can be used to compare men and women, people of diverse ages, and people with some vs. no experience with psychotherapy. Lower reliabilities of the C-NIP scales are a limitation.

Relational depth from the perspective of the psychotherapy dyad: Psychometric properties of the Relational Depth Frequency Scale.

Objective: The Relational Depth Frequency Scale (RDFS) is a 6-item measure to assess the impact of relational depth experiences on psychotherapeutic outcomes. To date, the RDFS has only been validated in online samples of clinical and non-clinical individuals. This study aimed to examine the psychometric properties of the RDFS in clinical dyads of clients and psychotherapists.Method: A total of 86 psychotherapy dyads-86 psychotherapists (18 male, 68 female, mean age = 44.34) and 86 clients (17 male, 69 female, mean age = 34.22)-completed the RDFS, and the Scale to Assess the Psychotherapeutic Relationship (STAR), mid-psychotherapy.Results: CFA showed acceptable fit statistics for a one-factor model. The partial measurement invariance across both partners of the psychotherapeutic dyad was positively verified. The RDFS had good internal consistency for psychotherapists and clients (α = .90 and .81, respectively). Actor-partner interdependence model confirmed moderate to high levels of convergent validity against the STAR. Relational depth in both partners was predicted by their own perceptions of the quality of the psychotherapeutic relationship. Psychotherapist frequency of relational depth was also related to client perceptions of the psychotherapeutic relationship.Conclusion: The RDFS is a promising tool measuring relational depth both from psychotherapist and client perspectives.

The impact of a needs-based model of care on accessibility and quality of care within children's mental health services: A qualitative investigation of the UK i-THRIVE Programme.

BACKGROUND: The i-THRIVE Programme is a needs-based model of care, based on the THRIVE Framework, that is being implemented across the United Kingdom with the aim of improving outcomes for children and young people's mental health and wellbeing. This study aimed to investigate the impact that this programme has on accessibility and quality of care, as viewed by key stakeholders. METHODS: Interviews with professionals and service users were conducted during the implementation of the THRIVE Framework in four sites of one mental health and community service provider. RESULTS: Three themes are identified: 'impact of needs-based groupings on referral', 'impact of collaborative and interagency approach' and 'impact of i-THRIVE on clinical practice'. Findings suggest that accessibility was seen to be promoted through the integration of a needs-based approach, flexible re-referral, signposting and information sharing, the use of goal-orientated interventions and collaboration over risk and treatment endings. Shared decision making was perceived to improve the experience of care for young people, as was interagency working. Goal-focused interventions and upfront discussion of treatment endings were seen to help clinicians manage expectations and discharge but could also compromise effectiveness and engagement. Obstacles to impact were resistance to interagency working and a shortage of resources across the system. CONCLUSIONS: i-THRIVE is a promising approach with the potential to facilitate the accessibility and quality of mental health care. However, a tension exists between enhancing accessibility and quality of care, which points towards the importance of outcome and satisfaction monitoring. Obstacles to impact point to the importance of a whole-system approach supported by sufficient resources across the locality.

Development and validation of the relational depth frequency scale.

Objective: The Relational Depth Frequency Scale (RDFS) was developed to measure the frequency of specific moments of profound contact and engagement in psychotherapy. Method: Following an initial process of item generation and rating, Three-Step Test Interviews were conducted with eight therapists and clients to further refine potential items. Sixteen relational depth items were then taken forward for psychometric assessment in an online sample of 336 therapists and 220 clients, each divided into separate "shortening" and "checking" subsamples. Results: Following psychometric scale shortening involving confirmatory factor analysis (CFA) and Rasch analysis, we formed a six item RDFS that could be used with both therapists and clients. The parameters of the shortened form replicated well in the independent checking subsamples with good internal consistency (Cronbach's α = .85 and .93 in therapist and clients respectively), acceptable fit statistics in CFA and Rasch analysis, and moderate to high levels of convergent validity against the Working Alliance Inventory (Short Form, Revised) and Relational Depth Inventory (RDI-R2). Conclusion: As a brief self-report measure, the RDFS can be used to further assess the relationship between relational depth and therapeutic outcomes. Further research is needed to examine the validity of the RDFS in clinical settings.

From intention to action: A mixed methods study of clients' experiences of goal-oriented practices.

OBJECTIVES: Goal-oriented practices are central to many contemporary psychotherapies. The aim of this study was to explore clients' experiences of this work. DESIGN: Mixed methods, with a main qualitative part and a smaller quantitative component. Participants were 22 clients in integrative psychotherapy (15 females, 6 males, 1 "other"). Semistructured interviews after session 4 and at endpoint were analyzed thematically. On the basis of the identified themes, "goal attitude" scores were developed and their correlations with outcomes investigated. RESULTS: Goal-oriented practices could help clients move from intention to action through increased awareness and focus, setting manageable tasks, and progress monitoring. However, they had the potential to hinder clients' awareness of their intentions, feel irrelevant, disorientating, or demotivating. Effectiveness hinged on client's management of their expectations, flexible working, and time. Positive attitudes toward goal-oriented practices were associated with improvement. CONCLUSIONS: Goal-oriented practices can enhance psychotherapeutic work but need to be individually tailored and implemented collaboratively.

The impact of accommodating client preference in psychotherapy: A meta-analysis.

Client preferences in psychotherapy reflect specific conditions and activities that clients desire in their treatment, with increasing evidence pointing to preference accommodation as facilitating psychotherapy outcomes. This updated meta-analysis establishes the magnitude of the effect of client preference accommodation in psychotherapy. Based on data from 53 studies and over 16,000 clients, preference accommodation was associated with fewer treatment dropouts (OR = 1.79) and more positive treatment outcomes (d = 0.28) than providing client with a nonpreferred treatment or psychotherapy condition. The preference effect was moderated by study design, timing and type of outcome measurement, and client diagnosis. It was not moderated by year of publication, treatment duration, preference type, treatment options, client age, client gender, client ethnicity, or client years of education. The authors provide a case example of preference accommodation and practice recommendations for working with client preferences.

Sulfonylative and Azidosulfonylative Cyclizations by Visible-Light-Photosensitization of Sulfonyl Azides in THF.

The generation of sulfonyl radicals from sulfonyl azides using visible light and a photoactive iridium complex in THF is described. This process was used to promote sulfonylative and azidosulfonylative cyclizations of enynes to give several classes of highly functionalized heterocycles. The use of THF as the solvent is critical for successful reactions. The proposed mechanism of radical initiation involves the photosensitized formation of a triplet sulfonyl nitrene, which abstracts a hydrogen atom from THF to give a tetrahydrofuran-2-yl radical, which then reacts with the sulfonyl azide to generate the sulfonyl radical.

Acceptability, reliability, referential distributions and sensitivity to change in the Young Person's Clinical Outcomes in Routine Evaluation (YP-CORE) outcome measure: replication and refinement.

BACKGROUND: Many outcome measures for young people exist, but the choices for services are limited when seeking measures that (a) are free to use in both paper and electronic format, and (b) have evidence of good psychometric properties. METHOD: Data on the Young Person's Clinical Outcomes in Routine Evaluation (YP-CORE), completed by young people aged 11-16, are reported for a clinical sample (N = 1269) drawn from seven services and a nonclinical sample (N = 380). Analyses report item omission, reliability, referential distributions and sensitivity to change. RESULTS: The YP-CORE had a very low rate of missing items, with 95.6% of forms at preintervention fully completed. The overall alpha was .80, with the values for all four subsamples (11-13 and 14-16 by gender) exceeding .70. There were significant differences in mean YP-CORE scores by gender and age band, as well as distinct reliable change indices and clinically significant change cut-off points. CONCLUSIONS: These findings suggest that the YP-CORE satisfies standard psychometric requirements for use as a routine outcome measure for young people. Its status as a free to use measure and the availability of an increasing number of translations makes the YP-CORE a candidate outcome measure to be considered for routine services.

Counselling versus low-intensity cognitive behavioural therapy for persistent sub-threshold and mild depression (CLICD): a pilot/feasibility randomised controlled trial.

BACKGROUND: Persistent depressive symptoms below the threshold criteria for major depression represent a chronic condition with high risk of progression to a diagnosis of major depression. The evidence base for psychological treatments such as Person-Centred Counselling and Low-Intensity Cognitive Behavioural Therapy for sub-threshold depressive symptoms and mild depression is limited, particularly for longer-term outcomes. METHODS: This study aimed to test the feasibility of delivering a randomised controlled trial into the clinical and cost effectiveness of Low-Intensity Cognitive Behavioural Therapy versus Person-Centred Counselling for patients with persistent sub-threshold depressive symptoms and mild depression. The primary outcome measures for this pilot/feasibility trial were recruitment, adherence and retention rates at six months from baseline. An important secondary outcome measure was recovery from, or prevention of, depression at six months assessed via a structured clinical interview by an independent assessor blind to the participant's treatment condition. Thirty-six patients were recruited in five general practices and were randomised to either eight weekly sessions of person-centred counselling each lasting up to an hour, or up to eight weeks of cognitive-behavioural self-help resources with guided telephone support sessions lasting 20-30 minutes each. RESULTS: Recruitment rate in relation to the number of patients approached at the general practices was 1.8 %. Patients attended an average of 5.5 sessions in both interventions. Retention rate for the 6-month follow-up assessments was 72.2 %. Of participants assessed at six months, 71.4 % of participants with a diagnosis of mild depression at baseline had recovered, while 66.7 % with a diagnosis of persistent subthreshold depression at baseline had not developed major depression. There were no significant differences between treatment groups for both recovery and prevention of depression at six months or on any of the outcome measures. CONCLUSIONS: It is feasible to recruit participants and successfully deliver both interventions in a primary care setting to patients with subthreshold and mild depression; however recruiting requires significant input at the general practices. The evidence from this study suggests that short-term Person-Centred Counselling and Low-Intensity Cognitive Behaviour Therapy are potentially effective and their effectiveness should be evaluated in a larger randomised controlled study which includes a health economic evaluation. TRIAL REGISTRATION: Current Controlled Trials ISRCTN60972025 .

Depth of emotional experiencing and outcome in therapy with young people.

OBJECTIVES: To analyse the relationship between depth of emotional experiencing and outcomes in young people. We also wanted to understand whether 'early' or 'working' depth of emotional experiencing was most predictive of outcomes, and how these compared against alliance effects. DESIGN: Hierarchical linear regression analysis of data from a study of school-based humanistic counselling (SBHC). METHODS: Data from 60 young people were used for the study across 15 schools: mean age 13.7 years old (range: 13-16); 67% female; 52% from Black, mixed or non-white ethnicities. Depth of emotional experiencing was rated using the Client Experiencing Scale at session 1 (early EXP) and session 6 (working EXP). The dependent variable was changes in psychological distress from baseline to 12-week follow-up, as assessed by the Young Person's CORE. RESULTS: In our final model, working EXP accounted for 11.6% of the variance in YP-CORE change scores after baseline YP-CORE scores were taken into account. Early EXP and working alliance were not predictive of benefit. Sensitivity analyses indicated that working EXP was associated with benefits across a range of indicators. CONCLUSIONS: Our findings show, for the first time, that depth of emotional experiencing has a significant and sizeable association with outcomes in therapy for young people. This is consistent with emerging evidence from the adult field. It suggests that practitioners working with young people should monitor the depth of emotional experiencing and foster methods for supporting its development.

How do we know whether treatment has failed? Paradoxical outcomes in counseling with young people.

Background: In both routine practice contexts and research studies, evidence from standardized self-report symptom measures, administered pre- and post-treatment, is predominantly used to determine whether psychotherapy has been successful. Understanding the nature of unsuccessful psychotherapy requires an ability to evaluate the credibility of outcome data generated by such techniques. An important body of research has identified discrepancies between outcomes assessed through symptom measures and those obtained from other sources. However, not enough is known about the extent to which such paradoxical outcomes exist. Objective: This study analyzes the relationship between outcomes, as assessed by a standardized self-report measure, and as assessed by ratings of young people's descriptions of change at post-counseling interviews. Methods: Participants were 50 young people (13-16 years old) who had taken part in a trial of up to 10 weeks of school-based humanistic counseling. Our primary standardized measure was the Young Person's CORE (YP-CORE). To assess young people's experiences of counseling change, three independent raters scrutinized transcripts of post-counseling interviews, and scored levels of helpfulness on a 1 (Not at all helpful) to 10 (Extremely helpful) scale. Inter-rater reliabilities were 0.94 (Cronbach's Alpha) and 0.96 (McDonald's Omega). Sensitivity analyses were conducted to explore relationships between helpfulness ratings and other outcome measures, i.e., satisfaction with counseling (ESQ) and the Goal-Based-Outcome Tool (GBO), and process measures, i.e., the Working Alliance Inventory (WAI-S) and the Barret Lennard Relationship Inventory (BLRI). Results: Multilevel analysis indicated that helpfulness ratings were not significantly associated with changes in YP-CORE scores. Analyzed categorically, 38% of those showing reliable improvement on the standardized measure were below the median for self-described helpfulness, and 47% of those not showing reliable change were at or above the median for self-described helpfulness. Sensitivity analyses demonstrated closer correlations between helpfulness ratings and other outcome measures (ESQ and GBO), and between helpfulness ratings and process measures (WAI-S and BLRI). Discussion: Our results raise questions about reliance on symptom change outcome measures for defining treatment success and failure, given their disparity with clients' own descriptions of the helpfulness of therapy. Implications for practice and research are discussed.