The Psychometric Properties of the Outcome Rating Scale Used in Practice: A Narrative Review

Harris, Rachel; Murphy, Melissa G.; Rakes, Sarah

doi:10.1080/26408066.2019.1645071

Cited by 9 publications

(9 citation statements)

References 48 publications

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“…The initial review produced 369 articles, which were then evaluated by three criteria for retention: (a) reports of reliability and validity estimates based on clinical samples, (b) published between 2003 and 2018, and (c) published in English. Harris et al (2019) found data supporting the internal consistency and convergent validity estimates of ORS scores.…”

Section: Study 2: Alliance Progress Monitoring Studiesmentioning

confidence: 53%

“…Thirty-three studies from the Flückiger et al (2020) review and four studies from the Harris et al (2019) review contained sufficient information to calculate a total of 92 CEEs based on 6,439 participants. Study 1 employed 11 different WAMs but Study 2 examined scores only on the SRS.…”

Section: Discussionmentioning

confidence: 99%

“…Both the SRS and ORS are repeatedly administered across psychotherapy sessions to provide feedback to the therapist relevant to client progress; both employ 4 items marked on a 40 mm Visual Analogue (VAS) line. Although no systematic reviews of SRS psychometric properties have been published, Harris et al (2019) conducted a narrative review of the ORS’s psychometric properties based on a search of three databases (PsycINFO, Web of Science, and PubMed) using three keywords ( outcome rating scale, ORS, and feedback informed treatment ). The initial review produced 369 articles, which were then evaluated by three criteria for retention: (a) reports of reliability and validity estimates based on clinical samples, (b) published between 2003 and 2018, and (c) published in English.…”

Section: Methodsmentioning

confidence: 99%

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Ceiling effects indicate a possible threshold structure for working alliance.

Meier¹,

Feeley²

2022

Journal of Counseling Psychology

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This review investigated whether ceiling effects on client-reported working alliance measures represent measurement artifacts or valid information related to the formation of the working alliance. Using data from two previously published meta-analyses, a total of 92 estimates of ceiling effects were calculated based on 37 studies with 6,439 participants. Analyses examined the size of ceiling effects, relation with demographic variables, type of alliance measure, and ceiling effect stability across sessions. Moderate to large ceiling effects appeared across score distributions of multiple measures of client-rated alliance, across time administered, and across different sample characteristics such as gender, age, and ethnicity. When examined with the Session Rating Scale (SRS), analyses indicated ceiling effects had a moderate correlation with session number. When SRS ceiling effects were examined in a single study with a large sample of complete cases (N = 2,990) across seven sessions, large initial ceiling effects continued to increase slightly in size across sessions. Higher ceiling effects were also observed with the Working Alliance Inventory. Given the prevalence and relative stability of ceiling effects on score distributions, working alliance scores do not exhibit the characteristics of a normally distributed continuous variable. While the working alliance has typically been defined in terms of theoretical content such as tasks, goals, and bond, study findings suggest another key element may be a threshold structure where clients shift to an experience of the therapeutic relationship as established. Discussion focuses on directions for alliance research and clinical practice as well as study limitations. Public Significance StatementThis review found evidence of widespread ceiling effects on measures of the working alliance, suggesting that the alliance typically develops early in psychotherapy. Findings can inform the development of new theory about the early therapy environment as well as new methods to assess the alliance.

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Section: Study 2: Alliance Progress Monitoring Studiesmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Ceiling effects indicate a possible threshold structure for working alliance.

Meier¹,

Feeley²

2022

Journal of Counseling Psychology

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“…The ORS represents a balanced trade-off between the reliability and validity of longer measures [ 79 ]. Moreover, the ORS has a moderately high to high internal consistency and can be used as a screening measure and monitoring tool for subjective symptoms of psychological distress [ 80 ].…”

Section: Methodsmentioning

confidence: 99%

The effectiveness and cost-effectiveness of Acceptance and Commitment Therapy as a transdiagnostic intervention for transitional-age youth: study protocol of a randomized controlled trial

et al. 2023

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Background Although the prevalence of psychological problems in transitional-age youth (i.e., youth aged 15 to 25; TAY) is high, TAY are much less likely to receive age-appropriate treatments for their psychological problems compared to younger adolescents or older adults. Hence, effective interventions for TAY seem warranted. ACT your way is a transdiagnostic treatment, specifically developed for TAY, based on the principles of Acceptance and Commitment Therapy (ACT). ACT your way is not directed primarily at symptom reduction, but mainly aims to change the underlying mechanism of psychopathology, namely increasing TAY’s psychological flexibility. Meta-analyses show that ACT is an effective treatment for adults with diverse types of psychopathology. Less is known about the effectiveness of ACT for TAY. Therefore, the goal of this study is to examine the effectiveness and cost-effectiveness of ACT your way. In addition, we will investigate for whom and under what circumstances (i.e., moderators) and how (i.e., mediators) the intervention is (most) effective. Method The study is designed as a multi-centre, randomized controlled trial. In total, 140 TAY diagnosed with any psychological disorder will be randomly assigned to either the ACT your way or treatment as usual (TAU) condition. In total, six assessments will be conducted: at baseline, after 3, 6 and 9 sessions, at post-intervention and at 6-month follow-up, using multiple informants (TAY, parents/caregivers, therapists). Assessments will include diagnostic interviews and questionnaires. The primary outcomes are psychological flexibility and number of DSM-5 diagnoses; the secondary outcomes are the presence of the primary DSM-5 diagnosis, psychopathology, personality problems, global, individual and societal functioning, quality of life, stress, treatment satisfaction, treatment drop-out and therapeutic alliance. We will also assess costs and various moderators (i.e., demographic characteristics, type and severity of problems, psychopathology of parents/caregivers, treatment expectancy and previous treatments) and mediators (i.e., psychological flexibility, emotion regulation, self-compassion, autonomy, perfectionism, self-esteem and group cohesion). Discussion To our knowledge, this is the first study investigating the (cost-)effectiveness of ACT compared to TAU in clinically referred TAY with various types of psychopathology, using a rigorous design. Trial registration The research project is registered in the Dutch Trial Register (Trial NL9642).

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“…Miller et al (2003) indicated that the ORS total score should be considered a “global measure of distress” (p. 95). Based on a narrative review of 24 studies evaluating the psychometric properties of the ORS with clinical populations, Harris et al (2019) found that the ORS total score correlated above .70 with measures of depression and distress. Meier’s (2020) extension of Harris et al’s (2019) review found that ORS scores evidenced a large response to depression interventions as well as high correlations with measures of depression.…”

Section: Clinical Research Implications Of the Ete Modelmentioning

confidence: 99%

A model of the early therapeutic environment: Predicting client attrition.

Meier¹

2023

Journal of Psychotherapy Integration

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How can clinicians predict who is more likely to drop out of therapy during initial sessions? Studies indicate that many clients in early sessions (a) quickly reach a threshold where they establish an alliance with their therapists, (b) report large decreases in distress after completing only one session of therapy, and (c) attend only one to three sessions before prematurely terminating. Based on these findings, this article describes a model of an early therapeutic environment that predicts that clients are likely to terminate prematurely if (a) clients fail to establish what they experience as a holistic connection with the therapist, (b) client distress remains too high or too low, and (c) clients lack efficacy and outcome expectations appropriate for initiating therapy. With suitable levels of alliance, distress, and expectations, however, clients are more likely to remain in therapy. Recommendations for future research include examination of the interactive effects of alliance, distress, and expectations on attrition; development of new measures of the working alliance and self-efficacy for therapy-related behaviors; and further evaluation of the construct validity of distress-related measures.

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The Psychometric Properties of the Outcome Rating Scale Used in Practice: A Narrative Review

Cited by 9 publications

References 48 publications

Ceiling effects indicate a possible threshold structure for working alliance.

Ceiling effects indicate a possible threshold structure for working alliance.

The effectiveness and cost-effectiveness of Acceptance and Commitment Therapy as a transdiagnostic intervention for transitional-age youth: study protocol of a randomized controlled trial

A model of the early therapeutic environment: Predicting client attrition.

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