Facilitative interpersonal skills are relevant in child therapy too, so why don’t we measure them?

Abstract

One of the consistent findings from psychotherapy process research has been the impact of therapist effects on patient change and the therapeutic alliance. The Facilitative Interpersonal Skills (FIS) paradigm is a task in which participants respond to standardized videos of actors playing patients in interpersonally challenging moments as if they were the therapist, which was designed to assess therapist effects. Participants’ video recorded responses are coded for eight skills: verbal fluency, emotional expressiveness, warmth/acceptance/ understanding, empathy, persuasiveness, hope/positive expectations, alliance-bond capacity, and rupture-repair responsiveness. Performance-based procedures like the FIS minimize self-report bias and systematically control for client-related variability while maintaining strong clinical relevance. Research has shown that therapist FIS predicts the quality of the therapeutic alliance and outcome in adult psychotherapy. This paper describes the development and first adaptation of the FIS task using child and adolescent patients as the stimuli, and reports findings from a pilot study testing the reliability. The FIS-Child (FIS-C) task was administered to 10 therapists with a range of clinical backgrounds. Participants also completed the original FIS task and self-report measures of their empathy, social skills, and playfulness. Adequate interrater reliability was achieved on the FIS-C. There were no significant differences between participants’ ratings on the FIS-C compared to the original FIS, although there were minor differences in the correlations between the FISC and self-report measures compared to the original FIS. Findings support moving forward with utilizing the FIS-C to empirically study therapist effects that may be common factors across treatment models.

A review of the facilitative interpersonal skills performance task and rating method.

“…Using LEGEND to determine the quality of the literature, our 24 studies were categorized into five forms: psychometric ( n = 9), longitudinal ( n = 9), RCT ( n = 4), cohort ( n = 1), and cross-sectional ( n = 1). Nineteen of 24 studies were assessed as “good.” Of the five studies not rated as good quality, three were given a “lesser” quality assessment due to small sample sizes (Bate & Tsakas, 2022; Camp, 2012; Ryum et al, 2021) similarly, some of the main findings in Crowley (2000) were only identified in the small high FIS therapist sample size resulting in a “lesser” quality level. The final study of the five was assessed as “lesser” because there were missing participants not accounted for and the groups were not treated equally (Perlman et al, 2023).…”

“…Research is currently being conducted on the use of alternate forms of the FIS performance task. These alternate forms include different languages such as Norwegian, German, Dutch, Danish, Portuguese, and Chinese (Anderson, Finkelstein, & Horvath, 2020; van Thiel et al, 2021) and different populations, such as child therapy (Bate & Tsakas, 2022). Similarly, the success of the rating based method in response to brief challenging situations has led to the development of an FIS-self-report measure (Anderson, Finkelstein, & Horvath, 2020), and FIS-IS in-session method (for rating extracts of actual therapy situations; Uhlin, 2011), FIS-text for evaluating text responses and adds the prospect of using machine learning for evaluation (Anderson, Finkelstein, & Horvath, 2020; Schwartzman, 2022; Zech et al, 2022), an FIS client rated measure (Santos et al, 2023), and FIS for multiple responses that is used to rate therapists as they respond to changing therapeutic situations (Finkelstein, 2022) or high risk situations such as suicidal clients (Duffy, 2022).…”

Determining differences between therapists using an extended version of the facilitative interpersonal skills performance test

“…The power, impact, and originality of the FIS instrument has inspired many researchers, proven by the many replications and follow‐up studies that have been established in the past decade (Bate & Tsakas, 2022; Goldberg et al, 2020; Munder et al, 2019; Santos et al, 2022; Steggles & de Jong, 2018; van Thiel et al, 2021; Zech et al, 2022). The FIS was translated into eight different non‐English languages, and additional versions of the FIS clips are released focusing on different difficult therapy situations, such as cultural differences and suicidal situations (Anderson et al, 2019).…”

“…Research also examined therapists' physiological reactions during the presentation of provocative and benign FIS clips (Steggles & de Jong, 2018). Bate and Tsakas (2022) developed a FIS task using child and adolescent patients as stimuli. Other research has focused on evaluating whether machine learning tools can automatically assess therapist interpersonal skills (Goldberg et al, 2020).…”

Special issue: <em>Research in child and adolescent psychotherapy</em>

“…Giving a voice to the child’s experience and the perception of his/her own well-being, as a verification of the effectiveness of the treatment, can be of great use especially in understanding how much parent and child are able to cooperate in achieving therapeutic goals starting from the understanding of suffering (Abraham, Edginton, Cottrell, & Tubeuf, 2022 ). At the same time it is important to have new models of intervention for children with emotional disorders that can reduce their suffering (Qanbari et al ., 2022) as well as using new methodologies in the training of child psychotherapists (Bate & Tsakas, 2022 ).…”