An examination of clients' in-session changes and their relationship to the working alliance and outcome

Abstract

The objective of the current study was to investigate the psychometric properties of the Client Task Specific Change Measure–Revised (CTSC-R), a measure of clients' in-session changes, and to determine whether the CTSC-R predicted outcome over and above the therapeutic alliance in a study of 66 clients treated with process-experiential psychotherapy or cognitive–behavioural therapy for depression. The measure showed high internal consistency and item–total correlations. Principal-axis factoring, followed by oblique rotation, showed that the measure comprised two factors: (a) behaviour change and (b) awareness and understanding. Clients' CTSC-R scores changed over the course of psychotherapy and predicted change in depression at the end of therapy over and above the therapeutic alliance, explaining an additional 13% of the variance in outcome on the Beck Depression Inventory. Limitations of the study and future directions for research are discussed.