Description

The Questionnaire for the Identification of the Treated with the Therapist (QITT-20) is a specialized observational instrument developed by R. Kosmidou, A. Kalaitzaki, and I. Nestoros to examine identification between the client and therapist during the psychotherapeutic process.

Unlike a conventional self-report questionnaire, the assessment is conducted by external trained observers-raters, who evaluate aspects of the interaction between the therapist and the client.

The QITT-20 consists of 20 items which, according to the factor analysis reported in the source material, are organized into three main categories: Imitation, Identification, and Non-Verbal Behavior.

Objective

The primary objective of the QITT-20 is to assess processes of identification and interaction between the client and therapist through systematic observation.

The instrument evaluates aspects of mutual recognition between therapist and client, including consistency between them and the enactment of therapeutic roles within their interaction.

More specifically, it seeks to capture the extent to which the client demonstrates verbal, attitudinal, and non-verbal behaviors associated with the therapist.

Assessment of these processes may contribute to a better understanding of the dynamics that develop within the therapeutic relationship and their role in the psychotherapeutic process.

Dimensions

Based on the factor analysis reported in the source document, the QITT-20 comprises three main dimensions:

Imitation: Refers to the ways in which the client copies the therapist’s verbal responses or behaviors. Examples provided in the source include the use of similar words and imitative forms of responding.

Identification: Refers to the client’s acceptance and adoption of the therapist’s values and views. Examples include adopting values or accepting aspects of the therapist’s worldview.

Non-Verbal Behavior: Refers to the client’s motor and non-verbal manifestations considered to result from interaction with the therapist. Examples include imitating movements or mirroring the therapist’s body posture.

Together, these dimensions allow identification to be examined through verbal, attitudinal, behavioral, and non-verbal manifestations within the therapeutic interaction.

Development and Evaluation Sample

According to the source document, the original study was based on 18 psychotherapy sessions from a single case receiving psychotherapy using a synthetic model.

The sessions were evaluated by trained raters who were second-year clinical psychology trainees in the Organized Postgraduate Program in Clinical Psychology at the Department of Psychology of the University of Crete.

Their training included both theoretical and practical components. The theoretical component covered definitions and examples related to identification and the concepts represented by the scales.

Practical training involved identifying relevant phenomena in videotaped psychotherapy sessions using another individual client, different from the case included in the study, as a training example.

Scoring

Each of the 20 items is evaluated on a 5-point scale, ranging from:

1 = Minimal
to
5 = Absolute.

Of the 20 items, three serve as control items and are reverse-scored.

The items are distributed across the three subcategories identified through factor analysis:

Imitation
Identification
Non-Verbal Behavior

The score for each subcategory is calculated by summing the scores of its corresponding items.

In addition, an overall QITT-20 score is calculated, allowing both dimension-specific and overall assessment.

Validity

According to the available source, face validity was evaluated through comments provided by the raters regarding the logical relevance of the questionnaire items to the intended purpose of the instrument.

Criterion-related validity was not examined, because comparable questionnaires in the Greek language were not available at the time to serve as an appropriate external criterion.

Consequently, the validity evidence presented in the source should be interpreted within the limitations of the original evaluation.

Reliability

Reliability was primarily examined in terms of inter-rater reliability.

Across the 18 psychotherapy sessions, statistically significant correlations were observed between the scores assigned by the three raters:

Rater 1 – Rater 2: r = 0.72, p < 0.01

Rater 1 – Rater 3: r = 0.76, p < 0.01

Rater 2 – Rater 3: r = 0.77, p < 0.01

These findings indicate satisfactory agreement between the trained raters within the psychotherapy sessions evaluated in the original study.

Data Analysis and Use

QITT-20 data can be analyzed at both the individual subscale level and the overall questionnaire level.

Scores for Imitation, Identification, and Non-Verbal Behavior can be examined separately to describe different manifestations of identification within the therapist-client interaction.

The overall score provides an additional summary measure based on the complete set of questionnaire items.

Because the QITT-20 is an observer-rated instrument, standardized training of raters and examination of inter-rater agreement are particularly important when it is used in research.

Psychometric Considerations

The available source provides initial information regarding the factor structure, face validity, and inter-rater reliability of the QITT-20.

However, the original evaluation was based on a limited dataset consisting of 18 psychotherapy sessions from a single case. This characteristic of the original study should be considered when interpreting the reported psychometric findings.

The source does not provide evidence regarding criterion-related validity because an appropriate comparable Greek-language questionnaire was unavailable.

Therefore, conclusions regarding the broader psychometric properties or generalizability of the instrument should not extend beyond the evidence reported in the available material.

Applications

The QITT-20 can primarily be used in research examining the psychotherapeutic process, particularly when the focus is on identification and interaction between the therapist and client.

Its observer-based approach enables researchers to examine aspects of therapeutic interaction without relying exclusively on self-reports from either the therapist or the client.

The separate assessment of Imitation, Identification, and Non-Verbal Behavior may provide a structured framework for studying different manifestations of client-therapist identification during psychotherapy sessions.

Reference

Kosmidou RV, Kalaitzaki AE, Nestoros IN. Identification of the client with the therapist in the psychotherapeutic process. Presented at the 9th Panhellenic Conference of Psychological Research; May 2003; Rhodes, Greece.