SRSSocDesDemandChar

Social Desirability and Validity of Clients’ Rating
of the Session Rating Scale
Kevin L. Flora Linda E. Cunningham Kim A. Waldheim
Jennie L. Pahl, Robert J. ReeseArthur Gillaspy, Jr. Troy M. Marsden Danielle Archie Benjamin J. Yoder
University of Kentucky University of Central Arkansas Asbury Theological Seminary
Abstract
Monitoring treatment outcome and the therapeutic alliance has become a recommended practice. However, concern has been expressed that most client rate the alliance high. Clients (N = 173) at three sites were randomly assigned to three alliance feedback conditions to evaluate if social desirability and other demand characteristics influenced scores. Clients completed the Session Rating Scale (SRS; Miller, Duncan, & Johnson, 2000) the first three sessions of treatment in one of three feedback conditions: (1) Immediate Feedback (I) – SRS completed in presence of therapist and the results discussed immediately afterward; (2) Next Session Feedback (NS) – SRS completed alone and results discussed next session; or (3) No Feedback (NF) – SRS completed alone and results not available to therapist. No statistically significant differences in SRS scores across the feedback conditions were found, indicating that alliance scores are not inflated due to the presence of a therapist or knowing that the scores will be observed by the therapist. Additionally, the analysis showed that SRS scores were not correlated with a measure of social desirability but demonstrated evidence of concurrent validity with an established alliance measure.
Method
Participants and Procedure
Participants (N = 173) were clients from three sites: a counseling center at a small, private university (CC1; n = 22); a counseling center at a medium-to-large public university (CC2; n = 80); and undergraduate volunteer clients at a large, state university for a pre-practicum course (TC; n = 71). The sample was comprised of students who were primarily female (80.9%) and White (79.8%; 6.9% Hispanic/Latino; 6.4% African American; 1.7% American Indian/Alaskan Native; 0.6% Asian American, 1.2% indicated “Other,” and 3.5% did not indicate ethnicity/race). Mean age was 21.84 (SD = 5.17). Counseling services were provided by 39 therapists (CC1 = 5; CC2 = 11; TC = 23) who were either practicum students (n = 7), professional staff (n = 9), or pre-practicum students (n = 23).
After random assignment to one of the three feedback conditions, the SRS was administered at the end of each of the first three treatment sessions. When feedback about the alliance was provided to the therapist, the scores were graphed and discussed with the client.
Table 1
Summary of Fixed Effects for the Multilevel Model Predicting SRS Intercept Score
Introduction
Monitoring treatment outcome and the therapeutic alliance, a process termed client feedback, has consistently been found to improve client retention and treatment outcomes (e.g., Anker, Duncan, & Sparks, 2009; Reese, Norsworthy, & Rowlands, 2009; Shimokawa, Lambert & Smart, 2010). The research evidence has been substantial enough that client feedback is a recommended practice for clinicians (American Psychological Association, 2006). If client feedback is to become part of routine clinical care, however, it is imperative that the measures used to monitor treatment generate reliable and valid scores.
One concern voiced by researchers regarding therapeutic alliance measures is that most clients rate the alliance high (Tryon, Blackwell, & Hammel, 2008). Hatcher and Gillaspy (2006) found, for example, that clients generally endorsed only the upper two points of the 7-point scale on the Working Alliance Inventory (WAI; Horvath, & Greenberg, 1989). Some of the reasons posited for this include: scale development problems, measures being given later in treatment after an alliance has been established, or simply a failure of respondents to be candid in their appraisal given the potential influence of social desirability and/or other demand characteristics.
The purpose of this study was to investigate if clients who completed a therapeutic alliance measure in treatment were influenced by social desirability and other demand characteristics. We used the SRS (Miller, Duncan, & Johnson, 2000), a brief four-item measure of the therapeutic alliance from the Partners for Change Outcome Management System (PCOMS), a commonly used client feedback system. The PCOMS was chosen because the protocol calls for the SRS to be completed in the presence of the therapist and discussed immediately afterward, potentially maximizing the possibility of inducing social desirable or agreeable behavior.
Research Questions:
Does altering the feedback process result in differences in SRS scores?
Does the SRS demonstrate evidence of concurrent validity?
Results
To evaluate the primary research question we applied a three-level multilevel model (MLM) to account for the interdependencies in the data.
Clients’ SRS scores did not significantly vary as a function of their feedback condition assignment. Additionally, the SDS was not a statistically significant predictor (see Table 1).
The slope for SRS scores was statistically significant, suggesting that clients increased their SRS scores 0.69 points per session. There were no differences in changes in SRS scores across conditions.
The SRS demonstrated evidence of discriminant evidence (low correlation with the SDS-SF) and convergent validity (statistically significant correlations with the WAI-SRS) as can be seen in Table 2.
Notes. Immediate -Fdbck = Immediate Feedback Condition, No Fdbck = No Feedback Condition, Next Sess -Fdbck = Next Session Feedback Condition. Client-Type was coded 1 = pre-practicum clients, 0 = actual clients. SDS-SF = Marlowe-Crowne Social Desirability Scale – Short Form. SE = Standard Error. SRS = Session Rating Scale.
Table 2
BivariateCorrelations for the SDS-SF, WAI-SR, and SRS
Conclusions
The SRS yielded reliable scores and demonstrated solid evidence of concurrent validity.
Our results indicate that clients do not inflate alliance scores due to the presence of their therapist or knowing that the results would be discussed with their therapist.
The analysis showed that SRS scores were not correlated with a measure of social desirability. So, high scores on therapeutic alliance measures are perhaps not best explained by social desirability or demand characteristics.
The findings suggest that future research is needed to investigate other proposed factors that may lead to potentially inflated alliance scores.
Note.SDS-SF = Social Desirability Scale,-Short Form, WAI-SR1 to WAI-SR3 = Working Alliance Inventory – Short Revised (Sessions 1-3), SRS1 to SRS3 = Session Rating Scale (Sessions 1-3).
***p < .001

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