Confirming, Validating, and Norming the Factor Structure of Systemic Therapy Inventory of Change Initial and Intersession

• Author: Anthony L. Chambers,Jacob Z. Goldsmith,Tara A. Latta,Lynne M. Knobloch‐Fedders,Jay L. Lebow,Kenichi Shimokawa,Richard E. Zinbarg,William M. Pinsof
• Date: 01 September 2015
• Published date: 01 September 2015
• DOI: http://doi.org/10.1111/famp.12159

Confirming, Validating, and Norming the Factor

Structure of Systemic Therapy Inventory of Change

Initial and Intersession

WILLIAM M. PINSOF*

RICHARD E. ZINBARG*

,†

KENICHI SHIMOKAWA*

TARA A. LATTA*

JACOB Z. GOLDSMITH*

LYNNE M. KNOBLOCH-FEDDERS*

ANTHONY L. CHAMBERS*

JAY L. LEBOW*

Progress or feedback research tracks and feeds back client progress data throughout the

course of psychotherapy. In the effort to empirically ground psychotherapeutic practice, feed-

back research is both a complement and alternative to empirically supported manualized

treatments. Evidence suggests that tracking and feeding back progress data with individual

or nonsystemic feedback systems improves outcomes in individual and couple therapy. The

research reported in this article pertains to the STIC

â

(Systemic Therapy Inventory of

Change)—the first client-report feedback system designed to empirically assess and track

change within client systems from multisystemic and multidimensional perspectives in indi-

vidual, couple, and family therapy. Clients complete the STIC Initial before the first session

and the shorter STIC Intersession before every subsequent session. This study tested and its

results supported the hypothesized factor structure of the six scales that comprise both STIC

forms in a clinical outpatient sample and in a normal, random representative sample of the

U.S. population. This study also tested the STIC’s concurrent validity and found that its 6

scales and 40 of its 41 subscales differentiated the clinical and normal samples. Lastly, the

study derived clinical cut-offs for each scale and subscale to determine whether and how

much a client’s score falls in the normal or clinical range. Beyond supporting the factorial

and concurrent validity of both STIC forms, this research supported the reliabilities of the

six scales (Omega

hierarchical

) as well as the reliabilities of most subscales (alpha and rate–rer-

ate). This article delineates clinicalimplications and directions for future research.

Keywords: Progress Research; Feedback Research; Multi-Systemic

Fam Proc 54:464–484, 2015

The study and tracking of how people change in psychotherapy along with the feeding

back of these client change data, client-focused progress, or feedback research (How-

ard, Moras, Brill, Martinovich, & Lutz, 1996; Kazdin, 2007), have emerg ed in the last

20 years as an important component of empirically informed psychotherapy. Randomized

*The Family Institute at Northwestern University, Evanston, IL.

†

Department of Psychology, Northwestern University, Evanston, IL.

Correspondence concerning this article should be addressed to William M. Pinsof, The Family Institute

at Northwestern University, 618 Library Place, Evanston, IL 60201. E-mail: w-pinsof@northwestern.edu

The research received support from the Dan J. Epstein Family Foundation, the Harris Family Founda-

tion, and the Arthur C. Nielsen Family Charitable Trusts.

464

Family Process, Vol. 54, No. 3, 2015 ©2015 Family Process Institute

doi: 10.1111/famp.12159

clinical trials (RCTs), another component, delineate empirically supported treatments

that guide the selection as well as the initial stages of treatment for specific disorders.

However, a sizeable minority (approximately one-third in most studies) of clients in empir-

ically supported treatment research (RCTs) do not improve and there is evidence that of

those clients that do improve, many subsequently deteriorate (Lambert & Ogles, 2004;

Pinsof & Wynne, 1995; Wampold et al., 2011). Empirically supported treatments do not

necessarily or generally collect client change data and feed them back to therapists over

the course of therapy. Without tracking and feeding back client change data, empirically

supported treatments are unable to course correct based on empirical feedback once treat-

ment has begun. A growing body of empirical evidence suggests that tracking and feeding

back client change data improves outcomes and has potential to increase efficacy beyond

the historically asymptotic two-thirds (Bickman, Kelley, Breda, Vides de Andrade, & Ri-

emer, 2011; Lambert & Shimokawa, 2011; Shimokawa, Lambert, & Smart, 2010).

THE PROBLEMS WITH CLIENT-FOCUSED PROGRESS RESEARCH

Although progress research has begun to illuminate how clients change in therapy and

has good potential to improve outcomes, the research to date has three major limitations

(Pinsof, Tilden, & Goldsmith, in press). First, with few exceptions (Sexton & Fisher, in

press; Weisz et al., 2011), it has not been anchored in clien t assessment. The majority of

extant measurement systems primarily target progress in broad domains (e.g., individual

functioning, social functioning, etc.) and fail to provide detailed assessment at the onset of

therapy to specify specific treatment targets (outcomes) that are subsequently tracked

and fed back. In other words, progress assessments are not linked to any kind of initial

problem assessment.

A related problem is that progress research has, with few exceptions (Bickman et al.,

2011; Sexton & Fisher, in press; Weisz et al., 2011), been unidimensional or focused on a

very small number of key dimensions of clients’ lives. That limited focus is too global and

minimally useful to clinicians in that it does not address the specific aspects of clients’

lives. In most therapies, specific aspects of clients’ lives become the intervention targets

and extant progress research systems, for the most part, do not penetrate to that level of

specificity. A more molecular multidimensional system provides the methodological foun-

dation for multidimensional assessment and tracking of change targets derived from that

assessment, both of which we hypothesize improve therapist utilization of progress

research systems and therapeutic efficacy.

Third, progress research has focused almost exclusively on individual psychotherapy

(Lambert, Hansen, & Finch, 2001; Lambert & Ogles, 2004). Two couple therapy studies

found that a global, individually based progress rating and feedback package improved

outcomes (Anker, Duncan, & Sparks, 2009; Reese, Toland, Sloan, & Norsworthy, 2010).

Bickman et al. (2011) found that randomly selected clinics that utilized their Vanderbilt-

Peabody scales and feedback system, which assesses adolescents and one of their caregiv-

ers, had better outcomes than clinics that did not use their system. None of the extant pro-

gress research packages, including those in the couple and adolescent treatment studies,

are multisystemic—they focus on individuals (and their caregivers) and do not specifically

address the couple, family, and child systems that comprise most adult (and adolescent)

clients’ intimate lives.

Pinsof and colleagues have strongly argued for the added value of a multisystemic per-

spective in treatment and research (Breunlin, Pinsof, Russell, & Lebow, 2011; Pinsof,

Breunlin, Russell, & Lebow, 2011; Pinsof & Lebow, 2005). They address the “client sys-

tem”—“all of the people who are or may be involved in the maintenance or resolution of

the presenting problem” (Pinsof, 1995, p. 3)—and differentiate client systems into direct

Fam. Proc., Vol. 54, September, 2015

PINSOF ET AL.

/

465