End of Treatment Rating Scale

Abstract

The End of Treatment Rating Scale (EOTRS), developed by Nichols and Beck in 1960, is a specialized instrument designed to measure the perceived therapeutic outcome at the conclusion of psychotherapy. This instrument is unique because it captures the subjective experience of change from two critical perspectives: the client (patient) and the treating therapist. The client version is a brief, four-item self-report measure, while the therapist completes a more extensive version that incorporates the core items present in the patient’s scale. The primary aim is to quantify the amount of change achieved during the therapeutic process across key areas such as symptom reduction and enhanced self-understanding.

Keywords

End of Treatment Rating Scale, EOTRS, Psychotherapy Outcome, Therapy Change Assessment, Patient-Reported Outcome, Rating Scale, Clinical Assessment.

Authors

Nichols, Robert C., Beck, Karl W.

Purpose

The primary purpose of the End of Treatment Rating Scale is to systematically assess the perceived magnitude of change observed at the termination of a course of psychotherapy. It is specifically structured to gather parallel data from both the consumer (the client or patient) and the provider (the therapist), offering a dual perspective on treatment efficacy.

By utilizing separate but corresponding versions for clients and therapists, the scale allows researchers and clinicians to compare the congruence, or divergence, between professional assessment and patient self-perception regarding the success of the intervention. This comparative assessment is crucial for evaluating treatment effectiveness and informing future clinical practice.

Construct

The central psychological construct measured by the EOTRS is Change after Therapy, often categorized within broader domains of treatment outcome or therapeutic effectiveness. This construct encompasses several dimensions of improvement, including symptomatic relief, enhanced self-understanding, and general psychological well-being.

The scale operationalizes this construct through specific items that require respondents to quantify change relative to their baseline state prior to treatment. This focus on perceived change, rather than absolute status, distinguishes it as a measure of therapeutic process and outcome.

Validity

Specific empirical data regarding the formal establishment of validity—such as construct validity, criterion validity, or predictive validity—were not explicitly documented in the original scale entry materials (Nichols & Beck, 1960). As an early instrument in the field of psychological assessment, its initial utility was likely established through face validity and clinical consensus regarding the relevance of the items.

Subsequent research utilizing the EOTRS would be required to rigorously confirm its psychometric properties and ensure that it accurately measures the intended construct of change following treatment.

Reliability

Information concerning the reliability of the End of Treatment Rating Scale, including measures such as internal consistency (e.g., Cronbach’s alpha) or test-retest reliability, was not indicated in the foundational documents. The absence of reported reliability data suggests that users should exercise caution or seek out later studies that may have established these essential psychometric characteristics.

Given the scale’s structure, particularly the brief, four-item patient version, the internal consistency might be limited, underscoring the necessity for further psychometric evaluation.

Factor Analysis

Formal reports detailing the results of a factor analysis on the End of Treatment Rating Scale were not present in the primary source documentation. Factor analysis is typically employed to determine the underlying dimensions or factors that contribute to the overall construct of change being measured.

Based on the four distinct item categories (symptoms, self-understanding, outlook, and overall change), the scale potentially measures a single, overarching factor of global improvement, though empirical confirmation via exploratory or confirmatory factor analysis is necessary.

Instrument

Test Type: Rating Scale (Self-report and Clinician-report)

Format: The patient version consists of four core items, utilizing either a 4-point or 5-point Likert-style scale for response selection. The therapist version is corresponding but longer, allowing for a more detailed professional assessment.

Language Available: English (Original)

Population Group: Clinical samples undergoing psychotherapy.

Age Group: Adulthood (18 years and older).

Population Details: The scale was initially developed and utilized within a U.S. clinical setting, involving a sample composed of both clients and their treating therapists.

Test Methodology: Respondents indicate their perceived change by marking the appropriate numerical rating corresponding to descriptive anchors (e.g., "Worse than when I came" to "No longer bothered by symptoms") at the conclusion of the treatment phase.

Keywords

Treatment Outcome Measurement, Clinical Psychology, Therapeutic Efficacy, Patient-Therapist Agreement, 1960 Scale, Mental Health Assessment.

Authors

Author ORCID Identifier: Not provided in source.

Affiliation Email addresses: Not provided in source.

Correspondence Address: Not provided in source.

Permissions & Fee and Test Year

The scale was developed and published in 1960. Information regarding current usage permissions or associated licensing fees is not specified in the primary academic source. The scale’s foundational DOI, identifying its entry in psychological databases, is https://doi.org/10.1037/t31490-000.

Reference’s

The primary academic reference detailing the development and initial application of the scale is:

• Nichols, R. C., & Beck, K. W. (1960). Factors in psychotherapy change. Journal of Consulting Psychology, 24(5), 388–399. DOI: https://doi.org/10.1037/h0044678

Items of the End of Treatment Rating Scale

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The patient scale consists of four core items, each utilizing a descriptive rating scale:

1. Change in Symptoms or Complaints

   Rate the amount of change in the symptoms or complaints that brought you to the clinic. Consider all changes, regardless of their cause.

   • 1. Worse than when I came
   • 2. No change
   • 3. Some improvement
   • 4. Considerable improvement
   • 5. No longer bothered by symptoms

2. Understanding of Self and Behavior

   Rate the amount of change in your understanding of yourself and your behavior.

   • 1. More confused about myself
   • 2. No change
   • 3. Somewhat better understanding
   • 4. Much better understanding now

3. General Outlook and Well-Being

   Rate the amount of change in your feelings and general outlook on life (e.g., happiness, sense of well-being).

   • 1. Feel worse
   • 2. No change
   • 3. Feel somewhat better
   • 4. Feel considerably better
   • 5. Feel a great deal better

4. Overall Change

   Rate the overall change considering all factors that are important to you.

   • 1. Change for the worse
   • 2. No change
   • 3. Some change for the better
   • 4. Considerable change for the better
   • 5. A great deal of change for the better