Assessing the psychotherapist's affective reactions toward their patient: validation of the Clinician Affective REsponse (CARE) scales

Background: This study aims to evaluate the factor structure, reliability, and validity of the Clinician Affective REsponse (CARE) scales, a 15-item self-report measure designed for practical use in psychotherapy settings. Methods: Validation data were gathered from 151 mental health clinicians. These clinicians completed the CARE scales alongside measures capturing sociodemographic and professional details, patient demographics and clinical details, therapeutic intervention characteristics, therapeutic relationship elements, and session outcomes. Results: The CARE scales had a three-factor structure: positive engagement (k = 5, ω =.78), enmeshed (k = 5, ω =.72), and stuck (k = 5, ω =.71). Confirmatory factor analysis (CFA) yielded the following fit indices for the three-factor model: χ2(87)= 120.41, CFI =.94; TLI =.93, RMSEA =.05, and SRMR =.08. Multigroup CFA (which pooled two samples for a total of 607 subjects) showed that the CARE scales were invariant across remote and in-person session formats. The scales showed meaningful correlations with concurrent measures of working alliance, real relationship, countertransference, patient's experience of the therapeutic relationship, and session outcome. Discussion: The CARE scales are a valuable instrument in clinical, training, and research contexts, adept at capturing clinicians’ session-level affective responses and perceptions of the therapeutic relationship. Quantifying these reactions facilitates statistical analysis and empirical research, while their monitoring can guide therapeutic interventions and inform clinical supervision.