1PAGE 21. What is the question the authors are asking .docx
Treatment Goals Checklist Poster
1. Treatment Goals Checklist:
Development, factor analysis, reliability, and validity
Erin Stotts, MA, Erica Christianson, MA, Evan T. Stanforth, Ruth Chao, Ph.D., & Andi Pusavat, Ph.D.
University of Denver, Counseling Psychology Program, Morgridge College of Education
Abstract Method Results
ReferencesIntroduction
Discussion
Byrne, B.M. (2001). Structural equation modeling with AMOS: Basic
concepts, applications, and programming. Mahwah, NJ: Lawrence
Erlbaum Associates Inc.
Corey, G.C. (2009). Theory and practice of counseling and
psychotherapy, (8th ed.). Belmont, CA: Thomson Higher
Education.
Hackney, H.L., & Cormier, S. (2009). The professional counselor: A
process guide to helping, (6th ed.). Upper Saddle River, NJ:
Pearson Education Inc.
Hudspeth, E.F. (2010). Relationships between substance abuse related
factors, counseling, and harm reduction in emerging adult college
students. Dissertation abstracts international section A:
Humanities and social sciences, 70(11-A), 4192.
Joreskog, K. G., & Sorbom, D. (1989). LISREL 8.72: User's reference
guide. Mooresville, IN: Scientific Software.
Marlatt, G.A., Larimer, M.E., & Witkiewitz, K. (Eds.). (2011) Harm
reduction: Pragmatic strategies for managing high-risk behaviors.
New York, NY: Guilford Press.
Quintana, S. M., & Maxwell, S. E. (1999). Implications of recent
developments in structural equation modeling for counseling
psychology. The Counseling Psychologist, 27, 485–527.
Schumacker, R. E., & Lomax, R. G. (1996). A beginner’s guide to
structural equation modeling (2nd ed.). Mahwah, NJ: Lawrence
Erlbaum.
Szymanski, L. S. (2000). Happiness as a treatment goal. American
Journal on Mental Retardation, 105, 352-362.
Table 1: Demographic Characteristics
Study 1 Gender
(N = 131)
57 men (43.5%), 71 women (54.1%), 3
transgender (2.2%)
Age 18-79, M = 39.3 ± 14 years
Racial Status 100 Caucasian (76.3%) 31 racial minorities
(23.6%)
Study 2 Gender
(N = 124)
60 men (48.4%), 64 women (51.6%)
Age 17-58, M = 35.94 ± 12.39 years
• Effectively and efficiently assessing clients' goals in treatment
has been a foundation to quality treatment (Corey, 2009;
Hackney & Cormier, 2009)
• Szymanski (2000) conducted a qualitative content analysis of
counseling theories in regard to themes of clients' needs in
counseling
• (need-fulfillment, effective interpersonal relations,
minimization of anxiety and conflict, intentional action,
personal growth and development, pursuit of meaningful
work or activity, & holistic health)
• Marlatt, Larimer, and Witkiewitz (2011) reported the
significant role of harm reduction in counseling
• Hudspeth (2010) indicated increasing requests of clients on
alcohol and drug issues, and the misunderstanding of these
goals have a negative impact on treatment outcome
• We developed a tool to better understand clients' treatment
goals: the Treatment Goals Checklist (TGC)
• The study reports results of two studies detailing the TGC’s
psychometric properties
• Study 2 was to investigate the structural stability of the Study
1 factor solution and to provide additional validity evidence
• Participants recruited from Western university counseling
center
• Approval was obtained from university human subjects review
committee
Instruments
• Demographic questionnaire (see Table 1)
• TGC - Initial
Procedure
• Participants briefed on study and informed of rights
• Completed instruments at intake
Setting treatment goals is essential for quality assurance and has been a
long tradition in order to direct the therapy process itself and evaluate the
outcome. The present studies report the development of a scale that
includes a checklist of treatment goals by reporting results detailing the
TGC’s psychometric properties. Study 1 administered the items to adult
clients and conducted an exploratory factor analysis (EFA) of responses,
computed subscale correlations, and assessed initial internal consistency.
Items originated from the literature review and psychologists' expertise
regarding treatment goals. Participants were recruited from a Western
university counseling center. The five resultant factors were Positive
Enhancement, Harming, Change, Use of drug, and Alcohol use. Study 2
was to investigate the structural stability the Study 1 factor solution and to
provide additional validity evidence. Comparisons were made among an
identified five-component oblique model found in the exploratory factor
analysis in Study 1, two simpler models, and a five-factor model. The
hypothesized model represented an acceptable fit to the data and
stronger fit than competing models. The results of exploratory and
confirmatory factor analyses of the TGC revealed that the relationships
among the original TGC items were explained by the five hypothesized
subscales. The findings of this study support the TGC as a measure of
the multidimensional aspects of treatment goals of clients.
Study 1: Exploratory Factor Analysis
• Necessary assumptions met (Kaiser-Meyer-Olkin measure of
sampling adequacy .92, Bartlett’s Test of Sphericity converted
to a chi-square statistic significant at .001 level, five factors
had eigenvalues higher than 1.00 and were ranging from 2.07
to 9.98, screen test indicated a five-factor solution)
• The researchers forced a one-, four-, and five six-factor
solution using both orthogonal and oblique rotation.
• Five-factor oblique-rotation solution with components together
accounted for 39.49% of the variance
• Positive Enhancement (Factor 1, 21 items) that measures
clients' goals in enhancing their attitudes and moods
• Harming (Factor 2, 2 items) to measure their thoughts of
harming themselves or others
• Change (Factor 3, 3 items) which measures their goal in
making changes
• Use of drug (Factor 4, 1 item) to measure their goal in
control their use of drugs
• Alcohol use (Factor 5, 1 item) which measures their
willingness to control their use of alcohol.
• The coefficient alphas for the TGC subscales were .92 for
Positive Enhancement; .88 for Harming; .84 for Change; .82
for Use of drug; and .82 for Alcohol use (Table 2)
Study 2: Confirmatory Factor Analysis
• 28 items of the TGC using LISREL 8.72 (Joreskog & Sorbom,
2005)
• Comparisons made among hypothesized model – (Study 1),
two simpler models--a global component model (Competing
Model A), a four-component model (Competing Model B)--
and a five-factor model (Competing Model C).
• Acceptable fit to the data, all of the fit indices “good” (Byrne,
2001; Quintana & Maxwell, 1999; Schumacker & Lomax,
1996)
• Comparative fit index [CFI] = .97
• Normed fit index [NFI] = .94
• Non-normed fit index [NNFI] = .96
• Incremental fix index [IFI] = .97
• Root-mean-square error of approximation [RMSEA] = .041
[.034-.048])
• With suggested tests (Byrne, 2001) the hypothesized model:
• Had the lowest χ2 value (925.23)
• Highest goodness-of-fit index (GFI; .92) and adjusted
goodness-of-fit index (AGFI; .90)
• The lowest χ2/df value (1.75)
• The lowest root mean square residual (RMSR; .06)
• The highest relative noncentrality index (RNI; .94),
Effect session limits has in two analyses
• The TGC is a measure of treatment goals that has been
developed with adult clients
• There is evidence of initial reliability for the TGC
• Consistent with research, positive aspects play a substantial
role in mental health
• Harm-related behaviors and thoughts were important goals
• Changing habits, drug use, and alcohol use are all important
components
• Counselors can use the TGC during an intake or when
constructing a treatment plan
Table 2: Items, Factor Loadings, Standard Deviations,
Communalities, Cronbach’s Alpha, and Eigenvalues for the
Treatment Goals Checklist (TGC)
Factor Loadings
Item 1 2 3 4 5 h2
1. Reducing my fears .45 .07 .13 .22 -.24 .73
3. Expressing myself more assertively .49 -.12 -.17 .23 .20 .73
4. Learning how to relax .64 -.26 .14 -.17 -.12 .68
6. Better tolerating my mistakes .60 -.21 -.18 .16 -.28 .69
9. Feeling less depressed .63 -.16 .16 .15 -.01 .75
13. Not taking disappoints so hard .62 -.23 -.26 .00 -.21 .78
14. Doubting myself less .70 -.03 .07 .15 -.17 .71
15. Thinking more positively .71 -.10 .06 -.10 -.19 .75
21. Better managing my physical health .41 .20 -.05 -.06 -.01 .76
22. Learning how to improve relationships .54 .21 -.19 .23 .14 .67
23. Reducing uncomfortable thoughts .50 -.24 -.09 -.05 -.06 .78
27. Reducing my sensitivity to criticism .59 -.29 -.16 .10 .13 .72
29. Learning problem-solving skills .58 -.04 -.15 -.15 -.34 .69
35. Decreasing procrastination .47 .04 .20 .05 .09 .72
36. Better managing time .51 .10 .18 -.18 .11 .73
37. Decreasing trying to be perfect .45 -.09 .22 -.29 .16 .70
40. Feeling more self-confident .71 -.04 -.08 .01 -.30 .74
45. Becoming more confident .65 .01 .06 -.27 .02 .71
46. Improving my self-awareness .44 .16 -.05 -.32 .11 .69
47. Adopting more healthy attitudes .46 .31 .35 -.18 .29 .71
48. Worrying less .47 -.01 .29 -.00 -.10 .73
41. Discussing/reducing my thoughts of
harming myself
.21 -.45 .19 .20 .12 .74
42. Discussing/reducing my thoughts of
harming others
.13 -.57 .10 -.23 .31 .72
2. Improving communications with my
spouse/significant other
.29 .03 -.45 .27 -.01 .71
19. Changing my habits of _________ .13 .05 .49 -.05 -.26 .70
34. Receiving medical help .20 .08 .45 -.07 -.31 .72
20. Controlling my use of drugs -.04 -.17 .04 .64 .29 .71
18. Controlling my alcohol use .29 -.08 .13 .26 .56 .72
Eigenvalue 9.82 2.55 2.44 2.32 2.12
Percent of Variance 19.6 5.12 4.84 4.72 4.21
Cronbach’s Alpha for Subscale .92 .88 .84 .82 .82
Note. Loadings <| .20| are omitted. Factor loadings > .40 are in bold.
![Treatment Goals Checklist:
Development, factor analysis, reliability, and validity
Erin Stotts, MA, Erica Christianson, MA, Evan T. Stanforth, Ruth Chao, Ph.D., & Andi Pusavat, Ph.D.
University of Denver, Counseling Psychology Program, Morgridge College of Education
Abstract Method Results
ReferencesIntroduction
Discussion
Byrne, B.M. (2001). Structural equation modeling with AMOS: Basic
concepts, applications, and programming. Mahwah, NJ: Lawrence
Erlbaum Associates Inc.
Corey, G.C. (2009). Theory and practice of counseling and
psychotherapy, (8th ed.). Belmont, CA: Thomson Higher
Education.
Hackney, H.L., & Cormier, S. (2009). The professional counselor: A
process guide to helping, (6th ed.). Upper Saddle River, NJ:
Pearson Education Inc.
Hudspeth, E.F. (2010). Relationships between substance abuse related
factors, counseling, and harm reduction in emerging adult college
students. Dissertation abstracts international section A:
Humanities and social sciences, 70(11-A), 4192.
Joreskog, K. G., & Sorbom, D. (1989). LISREL 8.72: User's reference
guide. Mooresville, IN: Scientific Software.
Marlatt, G.A., Larimer, M.E., & Witkiewitz, K. (Eds.). (2011) Harm
reduction: Pragmatic strategies for managing high-risk behaviors.
New York, NY: Guilford Press.
Quintana, S. M., & Maxwell, S. E. (1999). Implications of recent
developments in structural equation modeling for counseling
psychology. The Counseling Psychologist, 27, 485–527.
Schumacker, R. E., & Lomax, R. G. (1996). A beginner’s guide to
structural equation modeling (2nd ed.). Mahwah, NJ: Lawrence
Erlbaum.
Szymanski, L. S. (2000). Happiness as a treatment goal. American
Journal on Mental Retardation, 105, 352-362.
Table 1: Demographic Characteristics
Study 1 Gender
(N = 131)
57 men (43.5%), 71 women (54.1%), 3
transgender (2.2%)
Age 18-79, M = 39.3 ± 14 years
Racial Status 100 Caucasian (76.3%) 31 racial minorities
(23.6%)
Study 2 Gender
(N = 124)
60 men (48.4%), 64 women (51.6%)
Age 17-58, M = 35.94 ± 12.39 years
• Effectively and efficiently assessing clients' goals in treatment
has been a foundation to quality treatment (Corey, 2009;
Hackney & Cormier, 2009)
• Szymanski (2000) conducted a qualitative content analysis of
counseling theories in regard to themes of clients' needs in
counseling
• (need-fulfillment, effective interpersonal relations,
minimization of anxiety and conflict, intentional action,
personal growth and development, pursuit of meaningful
work or activity, & holistic health)
• Marlatt, Larimer, and Witkiewitz (2011) reported the
significant role of harm reduction in counseling
• Hudspeth (2010) indicated increasing requests of clients on
alcohol and drug issues, and the misunderstanding of these
goals have a negative impact on treatment outcome
• We developed a tool to better understand clients' treatment
goals: the Treatment Goals Checklist (TGC)
• The study reports results of two studies detailing the TGC’s
psychometric properties
• Study 2 was to investigate the structural stability of the Study
1 factor solution and to provide additional validity evidence
• Participants recruited from Western university counseling
center
• Approval was obtained from university human subjects review
committee
Instruments
• Demographic questionnaire (see Table 1)
• TGC - Initial
Procedure
• Participants briefed on study and informed of rights
• Completed instruments at intake
Setting treatment goals is essential for quality assurance and has been a
long tradition in order to direct the therapy process itself and evaluate the
outcome. The present studies report the development of a scale that
includes a checklist of treatment goals by reporting results detailing the
TGC’s psychometric properties. Study 1 administered the items to adult
clients and conducted an exploratory factor analysis (EFA) of responses,
computed subscale correlations, and assessed initial internal consistency.
Items originated from the literature review and psychologists' expertise
regarding treatment goals. Participants were recruited from a Western
university counseling center. The five resultant factors were Positive
Enhancement, Harming, Change, Use of drug, and Alcohol use. Study 2
was to investigate the structural stability the Study 1 factor solution and to
provide additional validity evidence. Comparisons were made among an
identified five-component oblique model found in the exploratory factor
analysis in Study 1, two simpler models, and a five-factor model. The
hypothesized model represented an acceptable fit to the data and
stronger fit than competing models. The results of exploratory and
confirmatory factor analyses of the TGC revealed that the relationships
among the original TGC items were explained by the five hypothesized
subscales. The findings of this study support the TGC as a measure of
the multidimensional aspects of treatment goals of clients.
Study 1: Exploratory Factor Analysis
• Necessary assumptions met (Kaiser-Meyer-Olkin measure of
sampling adequacy .92, Bartlett’s Test of Sphericity converted
to a chi-square statistic significant at .001 level, five factors
had eigenvalues higher than 1.00 and were ranging from 2.07
to 9.98, screen test indicated a five-factor solution)
• The researchers forced a one-, four-, and five six-factor
solution using both orthogonal and oblique rotation.
• Five-factor oblique-rotation solution with components together
accounted for 39.49% of the variance
• Positive Enhancement (Factor 1, 21 items) that measures
clients' goals in enhancing their attitudes and moods
• Harming (Factor 2, 2 items) to measure their thoughts of
harming themselves or others
• Change (Factor 3, 3 items) which measures their goal in
making changes
• Use of drug (Factor 4, 1 item) to measure their goal in
control their use of drugs
• Alcohol use (Factor 5, 1 item) which measures their
willingness to control their use of alcohol.
• The coefficient alphas for the TGC subscales were .92 for
Positive Enhancement; .88 for Harming; .84 for Change; .82
for Use of drug; and .82 for Alcohol use (Table 2)
Study 2: Confirmatory Factor Analysis
• 28 items of the TGC using LISREL 8.72 (Joreskog & Sorbom,
2005)
• Comparisons made among hypothesized model – (Study 1),
two simpler models--a global component model (Competing
Model A), a four-component model (Competing Model B)--
and a five-factor model (Competing Model C).
• Acceptable fit to the data, all of the fit indices “good” (Byrne,
2001; Quintana & Maxwell, 1999; Schumacker & Lomax,
1996)
• Comparative fit index [CFI] = .97
• Normed fit index [NFI] = .94
• Non-normed fit index [NNFI] = .96
• Incremental fix index [IFI] = .97
• Root-mean-square error of approximation [RMSEA] = .041
[.034-.048])
• With suggested tests (Byrne, 2001) the hypothesized model:
• Had the lowest χ2 value (925.23)
• Highest goodness-of-fit index (GFI; .92) and adjusted
goodness-of-fit index (AGFI; .90)
• The lowest χ2/df value (1.75)
• The lowest root mean square residual (RMSR; .06)
• The highest relative noncentrality index (RNI; .94),
Effect session limits has in two analyses
• The TGC is a measure of treatment goals that has been
developed with adult clients
• There is evidence of initial reliability for the TGC
• Consistent with research, positive aspects play a substantial
role in mental health
• Harm-related behaviors and thoughts were important goals
• Changing habits, drug use, and alcohol use are all important
components
• Counselors can use the TGC during an intake or when
constructing a treatment plan
Table 2: Items, Factor Loadings, Standard Deviations,
Communalities, Cronbach’s Alpha, and Eigenvalues for the
Treatment Goals Checklist (TGC)
Factor Loadings
Item 1 2 3 4 5 h2
1. Reducing my fears .45 .07 .13 .22 -.24 .73
3. Expressing myself more assertively .49 -.12 -.17 .23 .20 .73
4. Learning how to relax .64 -.26 .14 -.17 -.12 .68
6. Better tolerating my mistakes .60 -.21 -.18 .16 -.28 .69
9. Feeling less depressed .63 -.16 .16 .15 -.01 .75
13. Not taking disappoints so hard .62 -.23 -.26 .00 -.21 .78
14. Doubting myself less .70 -.03 .07 .15 -.17 .71
15. Thinking more positively .71 -.10 .06 -.10 -.19 .75
21. Better managing my physical health .41 .20 -.05 -.06 -.01 .76
22. Learning how to improve relationships .54 .21 -.19 .23 .14 .67
23. Reducing uncomfortable thoughts .50 -.24 -.09 -.05 -.06 .78
27. Reducing my sensitivity to criticism .59 -.29 -.16 .10 .13 .72
29. Learning problem-solving skills .58 -.04 -.15 -.15 -.34 .69
35. Decreasing procrastination .47 .04 .20 .05 .09 .72
36. Better managing time .51 .10 .18 -.18 .11 .73
37. Decreasing trying to be perfect .45 -.09 .22 -.29 .16 .70
40. Feeling more self-confident .71 -.04 -.08 .01 -.30 .74
45. Becoming more confident .65 .01 .06 -.27 .02 .71
46. Improving my self-awareness .44 .16 -.05 -.32 .11 .69
47. Adopting more healthy attitudes .46 .31 .35 -.18 .29 .71
48. Worrying less .47 -.01 .29 -.00 -.10 .73
41. Discussing/reducing my thoughts of
harming myself
.21 -.45 .19 .20 .12 .74
42. Discussing/reducing my thoughts of
harming others
.13 -.57 .10 -.23 .31 .72
2. Improving communications with my
spouse/significant other
.29 .03 -.45 .27 -.01 .71
19. Changing my habits of _________ .13 .05 .49 -.05 -.26 .70
34. Receiving medical help .20 .08 .45 -.07 -.31 .72
20. Controlling my use of drugs -.04 -.17 .04 .64 .29 .71
18. Controlling my alcohol use .29 -.08 .13 .26 .56 .72
Eigenvalue 9.82 2.55 2.44 2.32 2.12
Percent of Variance 19.6 5.12 4.84 4.72 4.21
Cronbach’s Alpha for Subscale .92 .88 .84 .82 .82
Note. Loadings <| .20| are omitted. Factor loadings > .40 are in bold.](https://image.slidesharecdn.com/edd7793c-92e9-4417-8ec9-2237e9e2fb4a-151231191149/85/Treatment-Goals-Checklist-Poster-1-320.jpg)
