PSYCHOTHERAPY SKILLS INVENTORY – Rater Version

ã 2000 Philadelphia College of Osteopathic Medicine

Directions: Choose the rating for each of the items below which best describes the therapist’s session and circle that number.
Make sure you circle ONLY ONE number.

ITEMS 1-4, 25: Y N Is there a specific agenda set? If No, score items 1-4 items “0” and score item 25 “0”

1. RATIONALE FOR AGENDA SETTING: The extent to which the reasoning/rationale underlying the agenda setting
is explained to the patient

0 Therapist fails to discuss rationale for agenda

1 Therapist alludes to need for agenda
2 Therapist states the necessity for an agenda, but includes no rationale
3 Therapist states the necessity for an agenda and presents a rationale

2. MUTUALITY OF AGENDA SETTING: The extent to which the patient and therapist jointly contribute to the
process of agenda setting

0 Therapist completely ignores, discounts, or overrides input from the patient

1 Therapist unilaterally sets the agenda
2 Patient unilaterally sets the agenda
3 Therapist and patient negotiate an agenda

3. QUALITY OF THE AGENDA PROPER: The extent to which the agenda is specified, relevant, and attainable

0 The agenda has little relevance (e.g. to an initial evaluation)

1 The agenda is relevant but items are ambiguous and not specified
2 The agenda items are relevant and specified but unattainable in the session
3 The agenda items are relevant, specified, and attainable in the session

4. COMPONENTS OF THE AGENDA PROPER: The extent to which the agenda includes 4 key components:

Reason for referral

Presenting problem
Background information
Plans for future sessions

0 None of the items

1 One of the items
2 Two of the items
3 Three or more of the items

5. USES EMPATHIC RESPONSES: The extent to which the therapist verbally acknowledges his/her understanding of
the patient’s predicament

0 Therapist devotes no effort to communicate understanding of the patient’s feelings about the
predicament throughout the encounter
1 Therapist devotes little effort to verbally communicate understanding of the patient’s feelings about the
predicament throughout the encounter
2 Therapist devotes some effort to verbally communicate understanding of the patient’s feelings about the
predicament throughout the encounter
3 Therapist devotes a great deal of effort to verbally communicate understanding of the patient’s feelings
about the predicament throughout the encounter
 6. EXUDES A SENSE OF WARMTH: The extent to which the therapist bonds with the patient in a warm manner

0 Therapist is hostile, demeaning, sarcastic, or cold OR there is a boundary violation (therapist is

suggestive or flirtatious, or pushes patient to divulge inappropriate personal information).
1 Therapist exhibits warmth at times
2 Therapist behaves such that the session is generally warm
3 Therapist exudes a sense of warmth that pervades the interaction

7. EXHIBITS CONCERN FOR THE PATIENT: The extent to which the therapist expresses genuine concern for the
patient’s issue(s)

0 Therapist generally misses or ignores the patient’s issue(s).

1 Therapist generally acknowledges the patient’s issue(s) and/or discounts the importance
2 Therapist generally expresses concern about the patient’s issue(s) but fails to explore it
3 Therapist generally expresses concern about the patient’s issue(s) and encourages exploration or
offers assistance

8. PRESENTS SELF IN A CONGRUENT MANNER: The extent to which the therapist presents him/her-self in a
congruent manner (i.e., as a real person without a façade)

0 Therapist shows virtually no consistency between verbal and non-verbal communication, e.g., facial
expressions, gestures, or voice tone
1 Therapist shows little consistency between verbal and non-verbal communication, e.g., facial
expressions, gestures, or voice tone
2 Therapist shows some consistency between verbal and non-verbal communication, e.g., facial
expressions, gestures, or voice tone
3 Therapist shows a good deal of consistency between verbal and non-verbal communication, e.g.,
facial expressions, gestures, or voice tone

9. COMMUNICATES CONFIDENCE IN OWN ABILITY: The extent to which the therapist communicates a realistic
sense of confidence in his/her ability to help and work with the patient

0 Therapist communicates no confidence in his/her ability to realistically help and work with the patient
1 Therapist appears tentative or overly confident in dealing with the patient’s problem(s)
2 Therapist appears confident in demeanor
3 Therapist appears confident in demeanor and supports the patient by appropriate behavior, e.g.,
asking appropriate questions, giving relevant information, discussing prior experiences

10. CREATING A COMFORTABLE, SAFE ATMOSPHERE IN WHICH PATIENT CAN SHARE CONCERN(S):
The extent to which the therapist creates a therapeutic atmosphere

0 Therapist creates an unsafe atmosphere

1 Therapist mentions the issue of safety but does nothing to promote it or does nothing to prevent
the patient from divulging too much
2 Therapist engages in an intellectual discussion of what would promote safety for the patient
3 Therapist uses techniques that assure the patient of safety, e.g., normalizing, matching the
pace of the session to the patient, giving the patient control over how much he/she explores, all
designed to promote safety

11. ASKING EFFECTIVE QUESTIONS: The extent to which the therapist employs questioning which
leads the patient to discover important information about him/her-self

0 Therapist appears to be cross-examining the patient throughout

1 Therapist asks mostly closed-ended questions without moving toward a goal
2 Therapist mixes open-ended questions and closed-ended questions with a vague, unclear,
or indeterminate goal
3 Therapist asks specific, targeted questions designed to move toward a clearer diagnosis or in the
Socratic method to lead the patient to a conclusion

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12. ELICITING FEEDBACK ABOUT THE THERAPY PROCESS: The extent to which the therapist elicits
necessary feedback about in-session activity

0 Therapist does not invite feedback when needed or invites so much it interferes with the process
1 Therapist invites feedback when needed; patient becomes confused and therapist fails to clarify
2 Therapist invites feedback when needed; patient is confused and therapist clarifies
3 Therapist asks for feedback when needed in a clear, non-confusing way and the patient is
not confused

13. FACILITATING COLLABORATION: The extent to which the therapist promotes a sense of
collaboration with the patient

0 Therapist makes no or a poor attempt to encourage collaboration with the patient

1 Therapist is minimally effective in encouraging collaboration when appropriate during the session
2 Therapist makes good attempts at encouraging collaboration when appropriate during the session
3 Therapist makes excellent attempts at encouraging collaboration when appropriate during the session

14. PROVIDING FOCUS ON THE WORK AT HAND: The extent to which the therapist actively directs and redirects the
patient’s attention to important content

0 There is no focus to the session

1 Therapist maintains little focus to the session; allows frequent shifts in topic
2 Therapist maintains generally focused session; topic shifts are logical and necessary to the task
with too little or too much exploration
3 Therapist maintains generally focused session; topic shifts are logical and necessary to the task
with appropriate level of exploration

15. REFLECTING CONTENT: The extent to which the therapist accurately paraphrases the content of
what the patient is saying throughout

0 Therapist does not reflect content or uses too much reflection so it impedes the therapeutic process
1 Therapist inaccurately reflects content; conveys little understanding of the content when reflecting
2 Therapist accurately reflects content; fails to ascertain accuracy
3 Therapist accurately reflects content; conveys almost totally accurate understanding of content
when reflecting; checks to ascertain that patient acknowledges the accuracy

16. ELICITING, ACKNOWLEDGING, AND/OR FACILITATING MOTIVATION IN THE PATIENT:

The extent to which the therapist actively attempts to motivate the patient to work on his/her problem

Stages of Change
Precontemplation
Contemplation
Preparation
Action
Maintenance

0 Therapist fails to gather information to determine the patient’s stage of change or level of motivation
1 Therapist identifies the patient’s stage of change, but makes no attempt to enhance patient’s
motivation or fails to support patient’s existing motivation
2 Therapist appropriately identifies the patient’s stage of change and makes some attempt to help
patient become more motivated
3 Therapist appropriately identifies the patient’s stage of change and skillfully uses motivational
interviewing techniques to help the patient move to the next stage of change

17. ELICITATION OF BELIEFS, ASSUMPTIONS, AUTOMATIC THOUGHTS, OR WORLDVIEW:

The extent to which the therapist attempts to elicit the beliefs, assumptions, worldview, or automatic
thoughts of the patient

0 Therapist fails to address the automatic thoughts, assumptions, beliefs, or worldview of the patient
1 Therapist mentions the importance of automatic thoughts, assumptions, beliefs, or worldview
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 2 Therapist directs attention to the automatic thoughts, assumptions, beliefs, or worldview but
uses no strategies to help patient gain access
3 Therapist directs attention to the automatic thoughts, assumptions, beliefs, or worldview and uses
standard strategies to assist patient in gaining access to them

18. PROMOTES AWARENESS OF FEELING: The extent to which the therapist assists the patient in becoming aware of
feelings

0 Therapist makes no effort to help patient become aware of feelings

1 Therapist mentions importance of feelings but makes no effort to help patient become aware
(e.g., seems to use “What are you feeling?” as a way to fill time during the session)
2 Therapist directs attention to feelings as a means to identify them; labels feelings for the patient;
uses “What are you feeling?” as an outgrowth of the context
3 Therapist directs patient’s awareness to feelings and demonstrates or employs strategies to
arouse awareness of feelings or modulate feelings so they can be worked with therapeutically

19. IDENTIFYING TROUBLESOME BEHAVIORS: The extent to which the therapist helps the patient to
identify maladaptive behaviors

0 Therapist fails to help patient identify troublesome behaviors

1 Therapist emphasizes the importance of the patient becoming aware of his/her own behaviors
but makes no effort to help the patient do so
2 Therapist encourages the patient to attend to his/her specific behaviors
3 Therapist encourages the patient to attend to his/her specific behaviors and to understand the
meaning of these behaviors

20. IDENTIFYING CONNECTIONS FROM PAST TO PRESENT (non-familial issues): The extent to which
the therapist helps the patient to identify connections between past events and current events unrelated to
family concerns

0 Therapist fails to help the patient make a connection between past experience and the present
1 Therapist alludes to a connection but does not pursue it
2 Therapist encourages the patient to reflect on the connections of past to present
3 Therapist encourages the patient to reflect on the connections and helps the patient to enrich
his/her understanding of how these experiences in the past are reflected in the present

21. IDENTIFYING CONNECTIONS BETWEEN FAMILY RELATIONSHIPS AND THE PRESENT:

The extent to which the therapist helps the patient to identify the relationship between family relations
and current problems

0 Therapist fails to help the patient make a connection between family relationships and
present problems
1 Therapist alludes to a connection but does not pursue it
2 Therapist encourages the patient to reflect on the connections between family relationships
and present problems
3 Therapist encourages the patient to reflect on the connections and helps the patient to enrich
his/her understanding of how these experiences in the past are related to the present problems

22. EFFECTIVE MONITORING OF THE ALLIANCE DURING THE SESSION PROCESS:

The extent to which the therapist actively monitors the alliance between the therapist and the patient

0 Therapist fails to actively monitor the process of the session as evidenced by inattention
to the therapeutic bond or agreement on goals or tasks
1 Therapist responds defensively to evidences of patient discomfort or challenge(s) during the session;
therapist attempts to justify his/her behavior
2 Therapist recognizes the patient’s positive connection and/or responds by acknowledging patient
discomfort or challenge(s) during the session
3 Therapist recognizes the patient’s positive connection and/or responds by acknowledging and
exploring patient discomfort or challenge during the session

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23. SUMMARIZING: The extent to which the main points of the session are delineated in summary fashion.

0 Therapist fails to summarize, or summary is poor, e.g., incorrect, vague, global, useless
or time-filling
1 Summarizes only at the end
2 Periodic, clear summary of content
3 Periodic, clear summary of content and the therapist checks with the patient for accuracy.

24. PSYCHOEDUCATIONAL ACTIVITIES: The extent to which the therapist engages in appropriate
psychoeducational activities designed to provide information to the patient. For example:

Examples:

Fight-Flight-Freeze reaction
Explanation for treatment processes
Explanation for symptoms
Explanation for diagnosis
Interpersonal patterns

0 Therapist fails to use psychoeducational activities when needed or uses when not appropriate
1 Therapist provides a vague explanation for the patient’s predicament or the intervention is
not geared to the patient’s culture or level of education and experience
2 Therapist provides a clear explanation for the patient’s predicament that is geared to the
patient’s culture, level of education and experience; therapist may use analogies or metaphors
3 Therapist provides a clear explanation for the patient’s predicament that is geared to the patient’s
culture, level of education and experience; therapist may use analogies or metaphors; therapist
checks to determine that the patient understands.

25. ADHERENCE TO THE AGENDA: The extent to which the therapist adheres to the agenda

Reason for referral

Presenting problem
Background information
Plans for future sessions

0 Therapist did not adhere at all to the agenda items

1 Therapist adhered to one (1) of the four (4) agenda items
2 Therapist adhered to two (2) of the four (4) agenda items
3 Therapist adhered to at least three (3) of the four (4) agenda items

26. SEEKS EVALUATION AT THE END OF THE SESSION: The extent to which the therapist appropriately
seeks evaluation at the end of the session

0 Therapist seeks no evaluation from the patient about the session

1 Therapist alludes to the need for a session evaluation but never pursues it with the patient
2 Therapist seeks an evaluation of the session but it is too general
3 Therapist seeks specific, focused feedback related to the session

27. USE OF HOMEWORK: The extent to which the therapist appropriately develops and incorporates
homework into the therapy

0 Therapist fails to incorporate homework; no mention of it

1 Therapist fails to discuss homework in sufficient detail or assigns inappropriate homework
2 Therapist unilaterally assigns appropriate homework and connects homework to therapy
3 Therapist carefully, collaboratively, and mutually develops appropriate homework with the patient from
session material to allow the patient to test ideas, try new experiences, or experiment with new ways of
responding

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28. TREATMENT PLANNING: The extent to which the therapist appropriately plans for future sessions

0 Therapist makes no mention of the need to plan the next step in treatment
1 Therapist mentions the need to plan treatment but pursues it no further
2 Therapist addresses a concrete, measurable, plan for the next step
3 Therapist negotiates a concrete, measurable plan for the next step and the patient agrees
to participate in it and the therapist encourages the patient to explore potential barriers to completing it

29. PROVIDING APPROPRIATE CLOSURE TO THE SESSION: The extent to which the therapist structures
the session to include an adequate closure

0 Therapist opens up another essential issue for discussion at the end of the session
1 Therapist runs out of time and ends the session with no discussion; “Time’s up”
2 Therapist is rushed at the close and ends the session with a summary, an evaluation,
or a plan for future sessions
3 Therapist ends the session with an adequate amount of time to complete the closing tasks of the
session; including an adequate summary, an evaluation of the session, and making a plan for future
session(s)

30. SATISFACTION WITH THE THERAPIST: The patient would say: “I would go to _______________ for therapy.”

0 No, definitely not

1 Maybe, but only if there were no other options or therapists
2 Yes, he/she is a good therapist
3 Yes, definitely, he/she is a great therapist