An examination of clients' in-session changes and their relationship to the working alliance and outcome

The objective of the current study was to investigate the psychometric properties of the Client Task Specific Change Measure-Revised (CTSC-R), a measure of clients' in-session changes, and to determine whether the CTSC-R predicted outcome over and above the therapeutic alliance in a study of 66 clients treated with process-experiential psychotherapy or cognitive-behavioural therapy for depression. The measure showed high internal consistency and item-total correlations. Principal-axis factoring, followed by oblique rotation, showed that the measure comprised two factors: (a) behaviour change and (b) awareness and understanding. Clients' CTSC-R scores changed over the course of psychotherapy and predicted change in depression at the end of therapy over and above the therapeutic alliance, explaining an additional 13% of the variance in outcome on the Beck Depression Inventory. Limitations of the study and future directions for research are discussed.