Hostname: page-component-7dd5485656-j7khd Total loading time: 0 Render date: 2025-10-30T17:08:43.942Z Has data issue: false hasContentIssue false
  • English
  • Français

Development of the Therapist Empathy Scale

Published online by Cambridge University Press:  12 March 2013

Suzanne E. Decker ,
Charla Nich ,
Kathleen M. Carroll  and
Steve Martino
Suzanne E. Decker
Affiliation:
New England Mental Illness Research Education and Clinical Centers, VA Connecticut Healthcare System, and Yale School of Medicine, USA
Charla Nich
Affiliation:
Yale School of Medicine, USA
Kathleen M. Carroll
Affiliation:
Yale School of Medicine, USA
Steve Martino*
Affiliation:
Yale School of Medicine and VA Connecticut Healthcare System, USA
*
Reprint requests to Steve Martino, VA Connecticut Healthcare System, 950 Campbell Avenue (151D), West Haven, Connecticut 06516, USA. E-mail: steve.martino@yale.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Few measures exist to examine therapist empathy as it occurs in session. Aims: A 9-item observer rating scale, called the Therapist Empathy Scale (TES), was developed based on Watson's (1999) work to assess affective, cognitive, attitudinal, and attunement aspects of therapist empathy. The aim of this study was to evaluate the inter-rater reliability, internal consistency, and construct and criterion validity of the TES. Method: Raters evaluated therapist empathy in 315 client sessions conducted by 91 therapists, using data from a multi-site therapist training trial (Martino et al., 2010) in Motivational Interviewing (MI). Results: Inter-rater reliability (ICC = .87 to .91) and internal consistency (Cronbach's alpha = .94) were high. Confirmatory factor analyses indicated some support for single-factor fit. Convergent validity was supported by correlations between TES scores and MI fundamental adherence (r range .50 to .67) and competence scores (r range .56 to .69). Discriminant validity was indicated by negative or nonsignificant correlations between TES and MI-inconsistent behavior (r range .05 to −.33). Conclusions: The TES demonstrates excellent inter-rater reliability and internal consistency. Results indicate some support for a single-factor solution and convergent and discriminant validity. Future studies should examine the use of the TES to evaluate therapist empathy in different psychotherapy approaches and to determine the impact of therapist empathy on client outcome.

Keywords

Empathytherapist empathypsychotherapypsychotherapy processadherencetherapist adherence and competence

Information

Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 42 , Issue 3 , May 2014 , pp. 339 - 354
Creative Commons
This is a work of the U.S. Government and is not subject to copyright protection in the United States.
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Ackerman, S. J. and Hilsenroth, M. J. (2002). A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review, 23, 1–33.CrossRefGoogle Scholar
Arbuckle, J. (2005). AMOS (Version 6.0). Chicago, IL: SPSS.Google Scholar
Bachelor, A. (1988). How clients perceive therapist empathy: a content analysis of “received” empathy. Psychotherapy, 25, 227–240.CrossRefGoogle Scholar
Ball, S., Martino, S., Corvino, J., Morgenstern, J. and Carroll, K. (2002). Independent Tape Rater Guide. Unpublished psychotherapy tape rating manual.Google Scholar
Ball, S. A., Martino, S., Nich, C., Frankforter, T. L., Van Horn, D., Crits-Christoph, P., et al. (2007). Site matters: motivational enhancement therapy in community drug abuse clinics. Journal of Consulting and Clinical Psychology, 75, 556–567.CrossRefGoogle ScholarPubMed
Barber, J. P., Liese, B. S. and Abrams, M. J. (2003). Development of the Cognitive Therapy Adherence and Competence Scale. Psychotherapy Research, 13, 205–221.CrossRefGoogle Scholar
Barrett-Lennard, G. T. (1962). Dimensions of therapist response as causal factors in therapeutic change. Psychological Monographs: General and Applied, 76, Whole Number 562.CrossRefGoogle Scholar
Barrett-Lennard, G. T. (1981). The empathy cycle: refinement of a nuclear concept. Journal of Counseling Psychology, 28, 91–100.CrossRefGoogle Scholar
Bohart, A., Elliott, R., Greenberg, L. S. and Watson, J. C. (2002). Empathy. In Norcross, J. C. (Ed.), Psychotherapy Relationships that Work: therapist contributions and responsiveness to patients (pp. 89–108). New York: Oxford University Press.Google Scholar
Bohart, A. C. and Greenberg, L. S. (1997). Empathy: where are we and where do we go from here? In Bohart, A. C. and Greenberg, L. S. (Eds.), Empathy Reconsidered: new directions in psychotherapy (pp. 419–450). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research, and Practice, 16, 252–260.CrossRefGoogle Scholar
Burns, D. D. and Nolen-Hoeksema, S. (1992). Therapeutic empathy and recovery from depression in cognitive-behavioral therapy: a structural equation model. Journal of Consulting and Clinical Psychology, 60, 441–449.CrossRefGoogle ScholarPubMed
Carroll, K. M., Ball, S. A., Nich, C., Martino, S., Frankforter, T. L., Farentinos, C., et al. (2006). Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: a multisite effectiveness study. Drug and Alcohol Dependence, 81, 301–312.CrossRefGoogle ScholarPubMed
Carroll, K. M., Martino, S., Suarez-Morales, L., Ball, S. A., Miller, W. R., Añez, L., et al. (2009). Multisite randomized controlled effectiveness trial of Motivational Enhancement for Spanish-speaking substance users. Journal of Consulting and Clinical Psychology, 77, 993–999.CrossRefGoogle ScholarPubMed
Carroll, K. M., Nich, C., Sifry, R., Frankforter, T., Nuro, K. F., Ball, S. A., et al. (2000). A general system for evaluating therapist adherence and competence in psychotherapy research in the addictions. Drug and Alcohol Dependence, 57, 225–238.CrossRefGoogle ScholarPubMed
Cicchetti, D. (1994). Guidelines, criteria, and rules of thumb for evaluating normed and standardized instruments in psychology. Psychological Assessment, 6, 284–290.CrossRefGoogle Scholar
Duan, C. and Hill, C. (1996). The current state of empathy research. Journal of Counseling Psychology, 43, 261–274.CrossRefGoogle Scholar
Elliott, R., Bohart, A., Watson, J. and Greenberg, L. (2011). Empathy. Psychotherapy, 48, 43–49.CrossRefGoogle ScholarPubMed
Elliott, R., Filipovich, H., Harrigan, L., Gaynor, J., Reimschuessel, C. and Zapadka, J. (1982). Measuring response empathy: the development of a multicomponent rating scale. Journal of Counseling Psychology, 29, 379–387.CrossRefGoogle Scholar
Gagne, P. and Hancock, G. R. (2006). Measurement model quality, sample size, and solution propriety in confirmatory factor models. Multivariate Behavioral Research, 41, 65–83.CrossRefGoogle ScholarPubMed
Gibbons, C. J., Carroll, K. M., Ball, S. A., Nich, C., Frankforter, T. L. and Martino, S. (2010). Community program therapist adherence and competence in a motivational interviewing assessment intake session. The American Journal of Drug and Alcohol Abuse, 36, 342–349.CrossRefGoogle Scholar
Gladstein, G. A. (1983). Understanding empathy: integrating counseling, developmental, and social psychology perspectives. Journal of Counseling Psychology, 30, 467–482.CrossRefGoogle Scholar
Gordon, T. (1970). Parent Effectiveness Training. New York: Wyden.Google Scholar
Greenberg, L. and Rushanski-Rosenberg, R. (2002). Therapists’ experiences of empathy. In Watson, J., Goldman, R. and Warner, M. (Eds.), Client-Centered and Experiential Psychotherapy in the Twenty-First Century: advances in theory, research, and practice (pp. 204–220). Ross on Wye: PCCS Books.Google Scholar
Gurman, A. (1977). Therapist and patient factors influencing patients perception of facilitative therapeutic conditions. Psychiatry, 40, 218–231.CrossRefGoogle ScholarPubMed
Horvath, A. O. and Bedi, R. P. (2002). The alliance. In Norcross, J. C. (Ed.), Psychotherapy relationships that work: therapist contributions and reponsiveness to patients (pp. 37–70). New York: Oxford University Press.Google Scholar
Kelloway, E. K. (1998). Using LISREL for Structural Equation Modeling: a researcher's guide. Thousand Oaks, CA: Sage.Google Scholar
King, S. and Holosko, M. (2011). The development and initial validation of the Empathy Scale for social workers. Research on Social Work Practice, 22, 174–185.CrossRefGoogle Scholar
Kurtz, R. and Grummon, D. (1972). Different approaches to the measurement of therapist empathy and their relationship to therapy outcomes. Journal of Consulting and Clinical Psychology, 39, 106–115.CrossRefGoogle Scholar
Luborsky, L., Singer, B. and Luborsky, L. (1975). Comparative studies of psychotherapies: is it true that “everyone has won and all must have prizes”? Archives of General Psychiatry, 32, 995–1007.CrossRefGoogle Scholar
Lundahl, B., Kunz, C., Brownell, C., Tollefson, D. and Burke, B. (2010). A meta-analysis of motivational interviewing: twenty-five years of empirical studies. Research on Social Work Practice, 20, 137–160.CrossRefGoogle Scholar
Marsh, H., Balla, J. and McDonald, R. (1988). Goodness-of-fit indexes in confirmatory factor analysis: the effect of sample size. Psychological Bulletin, 103, 391–410.CrossRefGoogle Scholar
Martin, D. J., Garske, J. P. and Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. Journal of Consulting and Clinical Psychology, 46, 1526–1530.Google Scholar
Martino, S., Ball, S. A., Nich, C., Canning-Ball, M., Rounsaville, B. J. and Carroll, K. M. (2010). Teaching community program clinicians motivational interviewing using expert and train-the-trainer strategies. Addiction, 106, 428–441.CrossRefGoogle ScholarPubMed
Martino, S., Ball, S. A., Nich, C., Frankforter, T. L. and Carroll, K. M. (2008). Community program therapist adherence and competence in motivational enhancement therapy. Drug and Alcohol Dependence, 96 (1–2), 37–48.CrossRefGoogle ScholarPubMed
Mercer, S., Maxwell, M., Heaney, D. C. and Watt, G. (2004). The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. Family Practice, 21, 699–705.CrossRefGoogle ScholarPubMed
Miller, W., Hedrick, K. E. and Orlofsky, D. R. (1991). The helpful responses questionnaire: a procedure for measuring therapeutic empathy. Journal of Clinical Psychology, 47, 444–448.3.0.CO;2-U>CrossRefGoogle ScholarPubMed
Miller, W. R., Moyers, T. B., Arciniega, L., Ernst, D. and Forcehimes, A. (2005). Training, supervision, and quality monitoring of the COMBINE study behavioral interventions. Journal of Studies on Alcohol, Supplement 15, 188–195.Google Scholar
Miller, W. R. and Mount, K. A. (2001). A small study of training in Motivational Interviewing: does one workshop change clinician and client behavior? Behavioural and Cognitive Psychotherapy, 29, 457–471.CrossRefGoogle Scholar
Miller, W. R. and Rollnick, S. R. (2012). Motivational Interviewing: helping people change (3rd ed.). New York: The Guilford Press.Google Scholar
Miller, W. R. and Rose, G. S. (2009). Toward a theory of motivational interviewing. American Psychologist, 64, 527–537.CrossRefGoogle Scholar
Moyers, T., Martin, T., Manuel, J., Hendrickson, S. and Miller, W. (2005). Assessing competence in the use of motivational interviewing. Journal of Substance Abuse Treatment, 28, 19–26.CrossRefGoogle ScholarPubMed
Moyers, T. B. and Miller, W. R. (2012). Is low therapist empathy toxic? Psychology of Addictive Behaviors. Advance online publication. doi: 10.1037/a0030274 Google ScholarPubMed
Moyers, T. B., Miller, W. R. and Hendrickson, S. M. (2005). How does motivational interviewing work? Therapist interpersonal skill predicts client involvement within motivational interviewing sessions. Journal of Consulting and Clinical Psychology, 73, 590–598.CrossRefGoogle ScholarPubMed
Nerdrum, P. and Hoglend, P. (2002). Short and long-term effects of training in empathic communication: trainee personality makes a difference. The Clinical Supervisor, 21, 1–19.CrossRefGoogle Scholar
Persons, J. and Burns, D. (1985). Mechanisms of action of cognitive therapy: the relative contributions of technical and interpersonal interventions. Cognitive Therapy and Research, 9, 539–551.CrossRefGoogle Scholar
Rogers, C. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Counseling Psychology, 21, 95–103.Google ScholarPubMed
Rogers, C. (1975). Empathic: an unappreciated way of being. The Counseling Psychologist, 5, 2–10.CrossRefGoogle Scholar
Santa Ana, E. J., Carroll, K. M., Añez, L., Paris, M., Ball, S. A., Nich, C., et al. (2009). Evaluating motivational enhancement therapy adherence and competence among Spanish-speaking therapists. Drug and Alcohol Dependence, 103, 44–51.CrossRefGoogle ScholarPubMed
Shrout, P. and Fleiss, J. (1979). Intraclass correlations: uses in assessing rater reliability. Psychological Bulletin, 2, 420–428.CrossRefGoogle Scholar
Smedslund, G., Berg, R. C., Hammerstrom, K. T., Steiro, A., Leiknes, K. A., Dahl, H. M., et al. (2011). Motivational interviewing for substance abuse. Cochrane Database of Systematic Reviews, Issue 5. Art. No.: CD008603.Google Scholar
Tabachnick, B. and Fidell, L. (2007). Using Multivariate Statistics (5 ed.). Boston: Pearson Education.Google Scholar
Thwaites, R. and Bennett-Levy, J. (2007). Conceptualizing empathy in cognitive behaviour therapy: making the implicit explicit. Behavioural and Cognitive Psychotherapy, 35, 591–612.CrossRefGoogle Scholar
Truax, C. B. and Carkhuff, R. R. (1967). Toward Effective Counseling and Psychotherapy. Chicago: Aldine.Google Scholar
Truax, C. B., Wargo, D. G., Frank, J. D., Imber, S. D., Battle, C. C., Hoehn-Saric, R., et al. (1966). The therapist's contribution to accurate empathy, non-possessive warmth, and genuineness in psychotherapy. Journal of Consulting Psychology, 27, 297–299.Google Scholar
Watson, J. C. (1999). Measure of Expressed Empathy. Toronto: Department of Adult Education, Community Development, and Counseling Psychology, OISE, University of Toronto.Google Scholar
Watson, J. C. (2002). Re-visioning empathy. In Cain, D. (Ed.), Humanistic Psychotherapies: handbook of research and practice. Washington, DC: American Psychological Association.Google Scholar
Watson, J. C. and Geller, S. M. (2005). The relation among the relationship conditions, working alliance, and outcome in both process-experiential and cognitive-behavioral psychotherapy. Psychotherapy Research, 15, 25–33.CrossRefGoogle Scholar
Watson, J. C. and Prosser, M. (2002). Development of an observer-rated measure of therapist empathy. In Watson, J., Goldman, R. and Warner, M. (Eds.), Client-Centered and Experiential Psychotherapy in the 21st Century: advances in theory, research, and practice (pp. 303–314). Ross on Wye: PCCS Books.Google Scholar
Yadama, G. N. and Pandey, S. (1995). Effect of sample size on goodness-of-fit indices in structural equation modeling. Journal of Social Service Research, 20, 49–70.CrossRefGoogle Scholar
Zuroff, D. C. and Blatt, S. J. (2006). The therapeutic relationship in the brief treatment of depression: contributions to clinical improvement and enhanced adaptive capacities. Journal of Consulting and Clinical Psychology, 74, 130–140.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.