Date of Award


Document Type


Degree Name

Doctor of Psychology (PsyD)


Graduate Department of Clinical Psychology


In the study of treatment outcomes, a subset of effectiveness research, the client-focused approach is ideal, as it examines individual responses to therapy over time. The Life Status Questionnaire (LSQ) is designed to track therapy outcomes over time. Despite the emphasis on client outcomes, the process between a therapist and client may have the greatest impact on therapy outcomes and should be an inherent part of a client-focused approach. This study investigated the effects of simultaneous use of an outcome (LSQ) and two Empathy Scale-Revised process subscales, Positive (ES-P) and Negative (ES-N), to determine how these separately and collectively affect therapy process and outcomes. Procedures included administering the LSQ before the 15 \ 3rd, and 5th therapy sessions and both the ES-P and ES-Nat the end of sessions 2 and 4. Dependent variables of interest included (a) LSQ, (b) ES-P, and (c) ES-N. The primary independent variable in this study was the impact that feedback derived from these instruments, although several ancillary independent variables were considered. Feedback effects were measured by randomly assigning clients to one of four treatment conditions: (a) No Feedback, (b) LSQ Feedback, (c) ES Feedback (combined ES-P and ES-N), and (d) Both Feedback (feedback provided for all three instruments). Results found no evidence that feedback conditions impacted therapy outcomes. However, insufficient sample size may be responsible. The LSQ showed significant improvement from sessions 1 to 5. The ES-P showed positive changes in therapeutic relationship from sessions 2 to 4 despite a significant ceiling effect. An even more profound ES-N floor effect may explain why four sessions were necessary to show significant reduction in the negative therapeutic relationship. Findings suggest that clients' overall mental health and in their positive and negative feelings toward their therapist improved over time, and that clients who terminated therapy generally had more improved LSQ scores compared to those who did not. These findings replicate that shown by, among others, Lambert et al., (2001).

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