The problematic impressions of therapy scale: a transtheoretical measure of negative patient experience in psychotherapy

OBJECTIVE: Although negative experiences in psychotherapy are commonly reported by patients, these phenomena are understudied. The present study introduces the Problematic Impressions of Therapy Scale (PITS), a new measure designed to assess distressing in-session experiences. METHODS: = 545), we conducted exploratory factor analysis followed by exploratory structural equation modeling to determine the underlying factor structure and psychometric properties of the PITS. RESULTS: Results supported a 21-item, two-factor model reflecting therapist "errors of commission" (e.g., pressuring disclosure, expressing judgment) and "errors of omission" (e.g., failing to provide support or direction). Both subscales demonstrated acceptable internal consistency and good model fit across U.K.- and U.S.-based samples. In tests of concurrent validity, higher PITS scores showed moderate-to-strong negative associations with measures of the working alliance (Working Alliance Inventory) and perceived therapist responsiveness (Patient's Experience of Attunement and Responsiveness), suggesting that more frequent or distressing negative experiences correlate with weaker alliances. Further, errors of omission uniquely predicted poorer ratings of both bond and task dimensions of the alliance. CONCLUSION: These findings support the reliability and construct validity of the PITS as a tool for identifying and quantifying negative or hindering experiences in psychotherapy.