A Scale for Measuring Positive and Negative Experiences of Psychotherapy (PNEP): First Psychometric Findings of a New Instrument for Monitoring Clients' Experiences

Abstract

BackgroundClients' adverse experiences during psychotherapy are rarely monitored in clinical practice or research trials. One obstacle here is the lack of a measure to gauge both positive and negative experiences during psychotherapy. We developed and evaluated a new instrument for measuring such experiences.MethodThe Positive and Negative Experiences of Psychotherapy (PNEP) questionnaire was developed based on pilot data, a literature review, and two existing scales for measuring primarily adverse experiences during psychotherapy. Mental healthcare clients (N = 200) anonymously completed and evaluated the PNEP. Subsequently, a sample of professionals (N = 34) who underwent psychotherapy in the context of their training filled in the PNEP twice, with a 2‐week interval in between.ResultsThe positive and negative experiences subscales of the PNEP were found to possess excellent internal consistencies (αs ≥ 0.90). The PNEP test–retest reliability was 0.93 for the positive experiences subscale and 0.78 for the negative experiences subscale. For the positive subscale, four factors were extracted: symptom reduction and positive well‐being, high quality of therapy and therapeutic relation, personal growth and acceptance and interpersonal functioning. For the negative subscale, exploratory factor analysis suggested a three‐factor solution: escalation of symptoms and emotional distress, low quality of therapy and therapeutic relation and (self‐)stigmatization and dependency. Participants related a median of 13 positive and six negative therapy experiences to their most recent treatment. The most frequently endorsed negative experiences were having more negative thoughts and memories, feeling emotionally overwhelmed and an increase in stress due to the therapy. A minority of participants (10.5%) reported no negative treatment experiences.ConclusionsIn the field of psychotherapy, the evaluation of risks and benefits is crucial for assessing safety and effectiveness. The PNEP could be a promising instrument for achieving this objective, although further research is needed to replicate and expand upon the current findings.

No pain, no gain revisited: the impact of positive and negative psychotherapy experiences on treatment outcome

“…Although no association was found between negative experiences reported at mid-treatment and treatment outcome in terms of symptom reduction on the OQ-45, we did find that reporting more negative experiences was associated with reporting fewer positive experiences, and with a less positive overall evaluation of the treatment. These results are consistent with another recent study ( Dandachi-Fitz Gerald et al, 2024 ) and suggest that negative experiences, while having no effect on symptomatic improvement, may be related to the way in which patients evaluate their treatment. These findings are similar to those reported for adverse side effects of pharmacological treatments, which also do not appear to have a direct impact on their mechanisms of action, but can negatively affect patients’ quality of life, treatment adherence ( Dibonaventura et al, 2012 ; Franzoi et al, 2021 ; Fleming et al, 2022 ), and treatment satisfaction ( Hughes et al, 2017 ).…”

“…The Positive and Negative Experiences of Psychotherapy Questionnaire (PNEP; Dandachi-Fitz Gerald et al, 2024 ) was used to measure the occurrence of positive and negative psychotherapy experiences at mid-and end-treatment assessments.…”

“…At the end of the PNEP, participants are asked to rate the extent to which they have benefited from their treatment (7-point Likert scale, strongly deteriorated, deteriorated, slightly deteriorated, unchanged, slightly improved, improved and strongly improved ). First psychometric findings indicate that the PNEP is a sound instrument with adequate internal reliabilities (positive subscale: α = 0.94; negative subscale: α = 0.90) and quite good test–retest stability (positive subscale: r = 0.93; negative subscale r = 0.78) ( Dandachi-Fitz Gerald et al, 2024 ). In the current study, Cronbach’s alpha values were 0.90 for the positive subscale and 0.81 for the negative subscale.…”

“…An instrument with only items about negative experiences could potentially contribute to a nocebo effect due to negative expectations about the occurrence of side effects ( Herzog et al, 2019 ; Moritz et al, 2019 ; but see Muschalla et al, 2023 ). Taking into account these findings on negative priming and the lack of a golden standard instrument for measuring negative reactions to psychotherapy, Dandachi-Fitz Gerald et al (2024) developed a new instrument incorporating several points of improvement: the Positive and Negative Experiences of Psychotherapy Questionnaire (PNEP). This self-report questionnaire is based on the PANEPS ( Peth et al, 2018 ; Moritz et al, 2019 ), the NEQ ( Rozental et al, 2016 ), a literature review, and an evaluation of both the PANEPS and the NEQ by a panel of experiential experts.…”

“…The term psychotherapy experience was chosen rather than psychotherapy effect , because the latter implies a causal relationship that is difficult to establish. In a sample of 200 participants, Dandachi-Fitz Gerald et al (2024) found that 89.5% reported at least one negative treatment experience as measured by the PNEP. This percentage is close to the upper bound of the 22 to 93% range of negative treatment experiences found in various studies (e.g., Schneibel et al, 2017 ; Moritz et al, 2019 ; Rozental et al, 2019 ; Gerke et al, 2020 ).…”