Assessing the patient's affective perception of their psychotherapist: validation of the in-Session Patient Affective Reactions Questionnaire

Alberto Stefana; Paolo Fusar-Poli; Eduard Vieta; Eric A Youngstrom

doi:10.3389/fpsyt.2024.1346760

Assessing the patient's affective perception of their psychotherapist: validation of the in-Session Patient Affective Reactions Questionnaire

Front Psychiatry. 2024 Apr 24:15:1346760. doi: 10.3389/fpsyt.2024.1346760. eCollection 2024.

Authors

Alberto Stefana^{1

2}, Paolo Fusar-Poli^{1

3

4}, Eduard Vieta⁵, Eric A Youngstrom^{2

6

7}

Affiliations

¹ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
² Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
³ OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom.
⁴ Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
⁵ Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Biomedical Research Agusti Pi i Sunyer (IDIBAPS), Centro de Investigacio Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona, Barcelona, Spain.
⁶ Institute for Mental and Behavioral Health Research, Nationwide Children's Hospital, Division of Child and Family Psychiatry, The Ohio State University, Columbus, OH, United States.
⁷ Helping Give Away Psychological Science, Chapel Hill, NC, United States.

Abstract

Background: Psychotherapists need effective tools to monitor changes in the patient's affective perception of the therapist and the therapeutic relationship during sessions to tailor therapeutic interventions and improve treatment outcomes. This study aims to evaluate the factor structure, reliability, and validity of the in-Session Patient Affective Reactions Questionnaire (SPARQ), a concise self-report measure designed for practical application in real-world psychotherapy settings.

Methods: Validation data was gathered from (N = 700) adult patients in individual psychotherapy. These patients completed the SPARQ in conjunction with additional measures capturing sociodemographic details, characteristics of therapeutic interventions, individual personality traits, mental health symptom severity, elements of the therapeutic relationship, and session outcomes. This comprehensive approach was employed to assess the construct and criterion-related validity of the SPARQ.

Results: The SPARQ has a two-factor structure: Positive Affect (k = 4, ω total = .87) and Negative Affect (k = 4, ω total = .75). Bifactor confirmatory factor analysis (CFA) yielded the following fit indices: X²[df] = 2.53, CFI = .99; TLI = .98; RMSEA = .05; and SRMR = .02. Multi-group CFAs demonstrated measurement invariance (i) across patients who attended psychotherapy sessions in person versus in remote mode, and (ii) across patients with and without psychiatric diagnoses confirmed metric invariance. Furthermore, the SPARQ showed meaningful correlations with concurrently administered measures.

Discussion: The SPARQ proves to be a valuable instrument in clinical, training, and research contexts, adept at capturing patients' session-level affective responses towards their therapist and perceptions of the therapeutic alliance. Comprehensive descriptive statistics and a range of score precision indices have been reported, intended to serve as benchmarks for future research.

Keywords: affective reaction; emotional reaction; evidence-based assessment; in-session process; psychological assessment; psychotherapy; self-report measure; therapeutic relationship.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The study has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 101030608.