Group Dynamics: Theory, Research, and Practice © 2011 American Psychological Association

2011, Vol. 15, No. 3, 201–219 1089-2699/11/$12.00 DOI: 10.1037/a0024677

Factor Structure and Validity of the Therapeutic Factors

Inventory–Short Form

Anthony S. Joyce Rebecca MacNair-Semands

University of Alberta The University of North Carolina at Charlotte

Giorgio A. Tasca John S. Ogrodniczuk

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

The Ottawa Hospital, Ottawa, Ontario, Canada; University of British Columbia

This document is copyrighted by the American Psychological Association or one of its allied publishers.

The University of Ottawa

Clinical group practice is commonly guided by the assumption that 11 distinct therapeutic
factors operate in psychotherapy groups. This assumption should be closely examined due
to the emerging evidence of fewer, more global therapeutic factors. The present study was
conducted to continue the development of the Therapeutic Factors Inventory–Short Form
(TFI–S) and focused on confirming its factor structure and evaluating aspects of its
concurrent, discriminant, and predictive validity. A sample comprising a total of 435
clients from 52 distinct therapy groups at eight different clinical sites in the U.S. and
Canada was obtained. Structural equation modeling analyses indicated that a four-
factor model had a reasonably good fit to the TFI–S rating data, and it provided
indications for further refinement of the constituent items. The analyses resulted in a
revised, 19-item measure, the Therapeutic Factors Inventory–19 (TFI–19). Three-level
HLM analyses demonstrated that the four factors were sensitive to change in member
perceptions over time. Significant and meaningful relationships between the TFI–19
factors and subscales of the Group Climate Questionnaire-Short Form provided support
for the concurrent validity of the TFI–19. Two-level HLM analyses identified signif-
icant relationships between the TFI–19 factors and posttreatment status on symptomatic
and interpersonal distress, thereby supporting the predictive validity of the TFI–19. The
findings suggest that the TFI–19 may be a useful instrument to assess group members’
perceptions of more global therapeutic factors.

Keywords: therapeutic factors, group psychotherapy, assessment

Group therapy is a powerful therapeutic agent
for helping people with a wide range of health
and mental health problems (Burlingame,
MacKenzie, & Strauss, 2004; McRoberts, Bur-
lingame, & Hoag, 1998). However, the mecha-
nisms through which group therapy achieves its
effects are less understood. Clinical observation
and previous research have suggested several
promising areas for understanding how group
therapy works. One such area concerns the ther-
apeutic factors (Yalom, 1995) that are operative
in clinical therapy groups.
Therapeutic factors (TFs) have a rich history
in the group literature and have been described

This article was published Online First August 8, 2011.
Anthony S. Joyce, Department of Psychiatry, University of
Alberta, Edmonton, Alberta, Canada; Rebecca MacNair-
Semands, Counseling Center, The University of North Caro-
lina at Charlotte; Giorgio A. Tasca, Department of Psychology,
The Ottawa Hospital, and Department of Psychiatry, The Uni-
versity of Ottawa, Ottawa, Ontario, Canada; John S. Ogrod-
niczuk, the Department of Psychiatry, University of British
Columbia, Vancouver, British Columbia, Canada.
This research was supported by a grant awarded by the
Group Psychotherapy Foundation of the American Group
Psychotherapy Association. Some of the data for this study
were also collected as part of a grant awarded by the
Canadian Institutes for Health Research, Institute of Gender
and Health. Special appreciation to Kristi Vera, Linda God-
dard, Theo DeGagne, Ward Nicholson, and Amanda Shep-
tycki for their contributions to this article.
Correspondence concerning this article should be ad-
dressed to Rebecca MacNair-Semands, Counseling Center,
158 Atkins, The University of North Carolina at Charlotte,
9201 University City Blvd., Charlotte, NC 28223-0001.
E-mail: RRMACNAI@uncc.edu

201
 202 JOYCE, MACNAIR-SEMANDS, TASCA, AND OGRODNICZUK
as the crucial mechanisms that promote change
in group therapy. Yalom (1995) delineates 11
TFs: instillation of hope, universality, imparting
information, altruism, corrective recapitulation
of the primary family group, development of so-
cializing techniques, imitative behavior, interper-
sonal learning, group cohesiveness, catharsis, and
existential learning. Taken together, these factors
comprise a theoretical constellation of curative
aspects and are believed to operate in all types of
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groups (Corsini & Rosenberg, 1955; Yalom,
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1995). However, there has been continuous debate
in the literature about the number and precise
nature of TFs that operate in group treatments
(Bednar & Kaul, 1994; Crouch, Bloch, & Wan-
lass, 1994; Johnson, Burlingame, Olsen, Dav-
ies, & Gleave, 2005; Kivlighan & Mullison,
1988; Lese & MacNair-Semands, 2000; Mac-
Nair-Semands, Ogrodniczuk, & Joyce, 2010).
Emerging evidence suggests that the TFs
may be organized within a few more global
factors. Although Yalom discusses the TFs in-
dependently, he acknowledges that the factors
do not function separately (Yalom & Leszcz,
2005). Several other authors have also argued
that there is much overlap among the TFs
(Fuhriman, Drescher, Hanson, Henrie, & Ry-
bicki, 1986; MacNair-Semands & Lese, 2000;
Tschuschke & Dies, 1994). If the proposed con-
cepts actually represent facets of more global
TFs, then studying the interrelated nature of
factors rather than TFs in isolation may yield
more meaningful results (Kivlighan & Lilly,
1997; McGrath, 1997).
Researchers have attempted to identify the
“essential” therapeutic factors that operate in
group therapy. Single factors have been high-
lighted by some authors, such as expressed
emotion (Castonguay, Pincus, Agras, & Hines,
1998) or cohesion (Budman, Soldz, Demby,
Davis, & Merry, 1993; Burlingame, Fuhriman,
& Johnson, 2002). Others have identified mul-
tiple factors. Kivlighan, Multon, and Brossart
(1996) examined the components of the Group
Counseling Helpful Impacts Scale and identified
four global factors: (1) emotional awareness-
insight, (2) relationship climate, (3) other-focus
versus self-focus, and (4) problem definition-
change. Dierick and Lietaer (2008) determined
that the underlying structure of TFs involves
two higher order dimensions: relational climate
and psychological work. Finally, Johnson and
colleagues (Johnson et al. 2005) examined four
key group therapeutic relationship constructs—
group climate, cohesion, alliance, and empa-
thy—across member–member, member– group,
and member–leader relationships. A model rep-
resenting bonding, working, and negative rela-
tionship factors provided the best fit to the data,
and this factor structure was independently rep-
licated by several investigative teams (Bakali,
Baldwin, & Lorentzen, 2009; Bormann &
Strauss, 2007; Krogel, 2009). Our work with the
Therapeutic Factors Inventory (TFI) also of-
fered evidence for fewer, more global TFs in
group treatments.
Preliminary Scale Development: The
Therapeutic Factors Inventory–Short Form
The original 99-item Therapeutic Factors In-
ventory (Lese & MacNair-Semands, 2000;
MacNair-Semands & Lese, 2000) was concep-
tually derived to obtain ratings of the perceived
presence or absence of Yalom’s (1995) 11 TFs.
While the original TFI was comprehensive, and
the subscales demonstrated good internal con-
sistency, its length was a significant limitation
to widespread use (Roy, Turcotte, Montminy, &
Lindsay, 2005). More recently, the Therapeutic
Factors Inventory–Short Form (TFI–S) was de-
veloped to assess more global dimensions of the
group process (MacNair-Semands et al., 2010)
in a more efficient manner. The TFI–S was
based on selecting 44 items with the highest
loadings per TF (4 items per TF) from a data set
involving three different types of groups at
counseling centers at three major universities.
The TFI–S was then examined, using a sample
of patients with complex clinical diagnoses who
were engaged in an intensive, 18-week group
therapy program (the Psychiatric Day Treat-
ment Program, Department of Psychiatry, Uni-
versity of Alberta Hospital). Seventy-one per-
cent of the patients received at least one Axis II
diagnosis, and 94% of the sample was diag-
nosed with an Axis I disorder. At the time of
their entry into the Day Treatment Program
(DTP) and again at termination, participants
completed four outcome measures. The TFI–S
and the Group Climate Questionnaire-Short
Form were completed after the 4th week of the
participants’ 18-week stay in the program to
determine how early perceptions of the thera-
peutic factors related to outcome. Factor analy-
ses guided further item refinement, distilling the
 THERAPEUTIC FACTORS INVENTORY–SHORT FORM
TFI–S to 23 items. Four broad therapeutic fac-
tors were identified: Instillation of Hope, Secure
Emotional Expression, Awareness of Relational
Impact, and Social Learning. Items loading on
each factor of the TFI–S were simply averaged
for each factor subscale, making the scale short
and user-friendly for scoring (see Appendix A).
Preliminary testing of the TFI–S revealed
good internal consistencies of the four factors,
with ␣ ranging from 0.71 to 0.91. Concurrent
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validity was demonstrated by meaningful rela-
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tionships between the TFI–S factors and the
Group Climate Questionnaire (MacKenzie,
1983). Predictive validity was demonstrated by
significant relationships between the TFI–S fac-
tors and improvement in symptoms, quality of
life, and interpersonal distress among patients
who had completed the group therapy program.
Given the preliminary nature of our findings and
possible limitations to generalization imposed
by the use of a specialized program and patient
population, further work on the TFI–S was re-
quired.
The present study aimed at further examina-
tion of the factor structure of the TFI–S and
evaluations of the measure’s concurrent and
predictive validity. In addition, an evaluation of
the measure’s sensitivity to change over time in
group treatment was included. Past research has
suggested that the TFs mature with time in
group therapy. Evidence suggests that ratings of
not only the presence of TFs (MacNair-
Semands & Lese, 2000), but also ratings of the
importance of the TFs, increase over time in
group (Butler & Fuhriman, 1983; Kivlighan &
Goldfine, 1991). MacKenzie (1990) proposed
that both hope and universality, two concepts
that are blended in the first TFI–S factor, la-
beled Instillation of Hope, promote a sense of
belongingness and acceptance early in the
group. This factor would be expected to emerge
more strongly over time, as the recognition of
universality among the members promotes hope
and stimulates further participation as sessions
progress. The second TFI–S factor, Secure
Emotional Expression, appears to reflect an in-
dication of safety and comfort in group, and
thus may be associated with the members com-
municating openly and honestly (MacNair-
Semands et al., 2010). It has been noted that
greater disclosure of personal information and
emotions becomes possible only after some
time has been spent in the group (Toseland &
203
Rivas, 1998). This disclosure reflects elements
of transparency that emerge more prominently
as the group evolves. The third TFI–S factor,
Awareness of Relational Impact, refers to a
connection between interpersonal experiences
and cognitive-affective factors associated with
gaining insight (Kivlighan et al., 1996); this
factor would be expected to increase over time
as members receive feedback from others in the
group. The fourth TFI–S factor, Social Learn-
ing, emphasizes skills acquired through behav-
ioral processes, such as actively communicating
about immediate thoughts and feelings. The
transition from insight to action is considered
the most difficult to accomplish in therapy, but
over time, members experience an enhancement
of these skills as the leaders encourage interac-
tional opportunities that lead to learning greater
interpersonal flexibility (MacKenzie, 1990). In
sum, clinical experience and group theory
would suggest that the four TFs assessed by the
TFI–S would demonstrate a sensitivity to
change over time in group treatment.
Purpose of Study
The present study had four objectives that
were addressed using a larger and more diverse
sample than that which was used for the initial
construction and preliminary validation of the
TFI–S. The first objective was to verify the
factor structure of the TFI–S by using confir-
matory factor analysis. The second objective
was to examine the sensitivity of the resulting
TFI–S factors to change over time in group. The
third objective was to test the discriminant and
concurrent validity of the TFI–S by examining
its relationships with measures of social desir-
ability, initial disturbance, and group climate.
The fourth objective was to test the predictive
validity of the TFI–S by examining its associa-
tion with posttreatment status on measures of
symptomatic and interpersonal distress.
Method
Participants
Data collection involved eight sites in North
America, including two urban university coun-
seling centers in the Southeastern U.S. (one
involving six groups and 43 participants; one
involving eight groups and 84 participants);
 204 JOYCE, MACNAIR-SEMANDS, TASCA, AND OGRODNICZUK
outpatient services at three local hospitals in
Vancouver, Canada (one involving four groups
and 53 participants; two with two groups and 15
participants); an urban outpatient mental health
clinic system in Calgary, Canada (four clinics
comprising 12 groups and 102 participants); an
evening partial hospitalization program in Ed-
monton, Canada (six cohorts involving 35 par-
ticipants); and an outpatient Eating Disorder
Program in a general hospital in Ottawa, Can-
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ada (12 groups with 103 participants).
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Twenty-eight individuals dropped out of group
therapy prior to session four; early dropouts
ranged in number from 1–9 across individual sites
and were excluded from further analyses. Four
therapy groups provided only a single rating or no
data on the TFI–S at week 4; these data were also
excluded. After exclusions, data from a total of 51
different groups and 380 group members were
available for analyses.
The final sample included 267 women and 93
men (missing data on gender for 20 members),
with a mean age of 36.28 years (SD ⫽ 13.6). Of
the available sample, 85.5% were Cauca-
sian, 5.0% were African American, 2.8% were
Asian/Asian American, 1.7% were multira-
cial, 1.1% were Persian/Arabic, 1.4% were La-
tino/Hispanic, 1.1% were East Indian, and 1.4%
reported “other” ethnicity. Of the available sam-
ple, 52.1% had some postsecondary education,
high school education, or less, and 47.9% had at
least a university/college degree or technical/
trade diploma. Regarding employment sta-
tus, 53.5% were employed, 22.6% were stu-
dents, 16.5% were unemployed or on disabil-
ity, 3.8% were in job training, homemakers, or
volunteers, and 3.8% were retired.
Measures
Therapeutic Factors Inventory–Short
Form (TFI–S). The TFI–S is a self-report
measure designed to assess individual group
members’ perceptions of the presence of four
broad therapeutic factors: Instillation of Hope,
Secure Emotional Expression, Awareness of
Relational Impact, and Social Learning (Mac-
Nair-Semands et al., 2010). The scale is com-
prised of 23 items; to derive scores for the
derived factors, items loading on a particular
factor can be simply averaged (see Appendix
A). Group members are asked to indicate the
extent of their agreement with each item using a
Likert-type scale that ranges from 1 (strongly
disagree) to 7 (strongly agree).” In previous
work, the factor scores of the TFI–S were in-
ternally consistent, ␣ between 0.71 – 0.91.
Based on independent data collected via admin-
istrations of the 44-item TFI in early group
sessions one week apart, N ⫽ 39, Pearson cor-
relation coefficients representing test–retest re-
liability of the four factors were calculated:
Instillation of Hope, .72; Secure Emotional Ex-
pression, .73; Awareness of Relational Impact,
.66; and Social Learning, .53. The coefficients
suggest that, for a given individual group mem-
ber across two early sessions, the factors dem-
onstrate fair to moderate stability. The early
status of the groups’ development likely ac-
counts for the weaker coefficients shown for the
two factors reflective of group learning.
Group Climate Questionnaire–Short
Form (GCQ–S). The GCQ–S (MacKenzie,
1983) is a self-report measure designed to as-
sess individual members’ perceptions of a
group’s therapeutic environment. The GCQ–S
has 12 items rated on a 7-point Likert scale
indicating extent of agreement ranging from 0
(not at all) to 6 (extremely). The items provide
for the scoring of three subscales: Engagement
(5 items), Avoidance (3 items), and Conflict (4
items). The Engagement scale consists of items
that call for ratings on the degree of self-
disclosure, cognitive understanding, and confron-
tation occurring in the group. The Avoidance
scale measures how much the group members
avoid responsibility for their change process.
The Conflict scale assesses the level of inter-
personal conflict and distrust (MacKenzie,
1983). For the present sample, and based on
administration of the measure at Week 4 in all
groups, the Engaged scale had a ␣ of .74 (mean
interitem r ⫽ .41); the Avoiding scale had a ␣
of .40 (mean interitem r ⫽ .18); and the Conflict
scale had a ␣ of .74 (mean interitem r ⫽ .49).
Although the coefficient alpha for the Avoiding
scale is low, this may partly be a function of the
small number of constituent items. The mean
interitem correlation indicates adequate internal
consistency for the Avoiding scale (Clarke &
Watson, 1995).
Brief Symptom Inventory. The Brief
Symptom Inventory–18 (BSI–18) is an 18-item
instrument that measures psychological distress
(Derogatis, 2000). The BSI–18 is composed of
six items each for the dimensions of Somatiza-
 THERAPEUTIC FACTORS INVENTORY–SHORT FORM
tion, Depression, and Anxiety, scored on a Lik-
ert scale of 0 to 4 to reflect the degree of distress
experienced during the preceding two weeks.
An overall score representing general level of
symptom distress (Global Severity Index) was
calculated. For the present sample at pretreat-
ment, the Somatization scale had a ␣ of .84
(mean interitem correlation ⫽ .47); the Depres-
sion scale had a ␣ of .88 (mean interitem r ⫽
.56); the Anxiety scale had a ␣ of .87 (mean
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interitem r ⫽ .52); and the Global Severity
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Index had a ␣ of .93 (mean interitem r ⫽ .43).
Inventory of Interpersonal Problems.
The Inventory of Interpersonal Problems–28
(IIP–28) is a 28-item self-report measure that
assesses three aspects of interpersonal function-
ing: Interpersonal Sensitivity, Interpersonal
Ambivalence, and Aggression (Pilkonis, Kim,
Proietti, & Barkham, 1996). At pretreatment,
the Interpersonal Sensitivity scale had a ␣ of .85
(mean interitem r ⫽ .34); the Interpersonal Am-
bivalence scale also had a ␣ of .85 (mean in-
teritem r ⫽ .36); and the Aggression scale had
a ␣ of .89 (mean interitem r ⫽ .55). The IIP–28
Total Score, a global measure of interpersonal
distress, had a ␣ of .93 (mean interitem r ⫽ .31).
Social desirability. We assessed social de-
sirability using the Desirability scale of the Per-
sonality Research Form (Jackson, 1984). The
Desirability scale is a 16-item, true–false, self-
report measure. Higher scores reflect a greater
tendency to provide socially desirable re-
sponses. At pretreatment, ␣ was .73 and the
mean interitem r was .14.
Procedure
The project and data collection were ap-
proved by the affiliated research ethics board at
each site. After the research coordinator at each
site provided the potential recruits with a de-
scription of the study, written informed consent
to participate was obtained. Prior to the start of
group therapy, participants completed a demo-
graphics questionnaire, the social desirability
scale, and the two outcome measures (BSI–18
and IIP–28). As the predominant majority of the
groups made use of a short-term format, a time
frame for obtaining assessments was chosen to
reflect early, middle, and termination phases of
the group experience. Following the fourth ses-
sion of their group treatment, the TFI–S and
GCQ–S were completed by each participant.
205
Most participants then completed the TFI–S and
GCQ–S at Sessions 8 and 12, but individuals at
sites with rolling membership (i.e., day treat-
ment programs) only completed the measures at
Weeks 4 and 12. Participants at all sites com-
pleted the BSI–18 and IIP–28 outcome mea-
sures at Session 12.
Data Analyses
The SPSS AMOS 18.0 structural equation
modeling program was used for the confirma-
tory factor analysis (CFA). Forty-eight distinct
groups were represented in the analysis, N ⫽
301 individuals. The TFI–S item ratings from
Week 4 were used for the CFA. The CFA model
that we tested was based on the exploratory
factor analysis (principal axis factoring with
promax rotation) conducted previously on an
independent sample (MacNair-Semands et al.,
2010). The hypothesized model reflected four
correlated, first-order latent factors: Instillation
of Hope (6 items), Secure Emotional Expres-
sion (7 items), Awareness of Relational Impact
(6 items), and Social Learning (4 items); see
Figure 1. Five goodness-of-fit indices were ex-
amined to determine the validity of the hypoth-
esized model (Byrne, 2001): a ␹2 test of mini-
mum discrepancy (CMIN) between the model
and the data (with a smaller ␹2 value and higher
probability reflecting better fit); the root-mean-
square residual (RMR) with smaller values re-
flecting better fit; the goodness-of-fit index
(GFI), ideally ⬎ .90; the normed fit index
(NFI), ideally ⬎ .95; and the root mean square
error of approximation (RMSEA), ideally ⬍
.08.
To assess sensitivity to change and predictive
validity of the TFI scales, we used the hierar-
chical linear modeling (HLM 6.08) program
(Raudenbush, Bryk, Cheong, Congdon, & du
Toit, 2004). Grouped data is nested by design
(i.e., individuals nested within groups), and this
nesting may result in dependence in the grouped
data which violates an important assumption of
parametric statistics. If data is at least moder-
ately dependent, as indicated by an intraclass
correlation coefficient of ␳ ⬎ .05, then Type I
error rates are drastically increased, possibly
resulting in spuriously significant results
(Kenny, Kashy, & Bolger, 1998). As expected,
there was clear evidence for within-group de-
pendency in the dataset. Intraclass correlation
 206 JOYCE, MACNAIR-SEMANDS, TASCA, AND OGRODNICZUK
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Figure 1. Hypothesized Model of Therapeutic Factor Inventory–Short Form Factor Structure.

coefficient values indicate the percent variance GCQ subscales, intraclass coefficients ranged
accounted for in each variable by the group between .12 to .40, at Weeks 4, 8, or 12. For the
effect. For the TFI–S items, intraclass coeffi- outcome variables, intraclass coefficients
cients ranged between .00 and .31, and for the ranged between .08 to .28 at posttreatment.
 THERAPEUTIC FACTORS INVENTORY–SHORT FORM 207

Given that most intraclass correlation values Results

were above .05, we elected to use HLM to
account for the dependence in the data, thus
focusing our analyses on the upper (group) level
outcomes. One advantage of HLM is that all the
data are used; that is, cases were not deleted if
ratings from an assessment were missing.
For the sensitivity analysis, the degree of
change of TFI–S scores across assessment times
was assessed with three-level longitudinal hier-
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Data Screening
Prior to conducting the primary analyses, the
dataset was examined according to the recom-
mendations of Tabachnik and Fidell (2007).
Univariate outliers were identified, and single
extreme scores for these cases were adjusted
such that their values fell within 3.3 standard
deviation units of the variable grand mean.

archical linear modeling (HLM; Tasca, Illing,

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Cases representing multivariate outliers were

Joyce, & Ogrodniczuk, 2009). Level 1 of the
model represented the repeated measurement of
the TFI–S factors across the three time points,
nested within each individual group member.
Level 2 represented estimated initial scores (in-
tercepts) and rates of change (slopes) of indi-
viduals nested within the distinct therapy
groups in the sample. Level 3 represented inter-
cepts and slopes for the distinct groups them-
selves. Appendix B indicates the full three-level
HLM for the longitudinal data analysis. For the
predictive validity analysis, in which pre- and
posttreatment outcome data were available, we
used a hierarchically nested two-level HLM
(Tasca et al., 2009). In these equations, Level 1
models the individual posttreatment outcome
while controlling for pretreatment values, and
individual TFI–S factor scores were entered as
predictors. At Level 2, the group level effect of
the TFI–S factor on outcome was evaluated.
Appendix B also provides the full two-level
hierarchically nested HLM for the predictive
validity analyses.
excluded from analyses involving the respective
set of variables. Item ratings on the TFI–S
tended to demonstrate a moderate negative
skew as sessions progressed, and outcome vari-
ables demonstrated positive skew, reflecting the
clinical status of the sample. Consequently, no
transformations of any variable distributions
were implemented.
Confirmatory Factor Analysis
Table 1 summarizes the goodness-of-fit indi-
ces for the hypothesized model in Figure 1. The
CFA of the TFI–S item ratings demonstrated
“mediocre” fit (Byrne, 2001) of the hypothe-
sized model to the data. Consequently, we un-
dertook modifications of the CFA model
through additional exploratory analyses within
AMOS. First, those items demonstrating multi-
ple nonmodeled covariances with other items,
cross-factor item loadings, and/or content re-
dundancy with other items were considered for
deletion. As a result, four items (5, 6, 12, and
14) were excluded from the hypothesized

Table 1
Structural Equation Modeling of TFI–S Factor Structure, N ⫽ 301
Goodness-of-fit indices
Model tested CMIN Df p RMR GFI NFI RMSEA
Hypothesized model 887.21 224 .0001 .16 .78 .79 .099 (.093–.106)
Final model 394.29 143 .0001 .11 .88 .88 .077 (.068–.086)
Note. For the final model, items were deleted on the basis of multiple non-modeled covariances with other items,
cross-factor loadings, and/or content redundancy with other items; see text. Three covariances between item pairs were also
incorporated into the final model; see text. TFI–S ⫽ Therapeutic Factors Inventory–Short Form; CMIN ⫽ ␹2 test of
minimum discrepancy between the model and the data (a smaller ␹2 value and a higher probability reflects better fit);
RMR ⫽ root mean square residual, or average residual value after fitting the model; GFI ⫽ goodness-of-fit index, or relative
amount of variance and covariance in the data explained by the model (ideally ⬎ .90); NFI ⫽ normed fit index, or a
reflection of fit relative to a complete independence model (ideally ⬎ .95); RMSEA ⫽ root mean square error of
approximation, an estimate of model fit to the population covariance matrix (ideally ⬍ .08); the 90% confidence interval
for the RMSEA is presented in parentheses.
 208 JOYCE, MACNAIR-SEMANDS, TASCA, AND OGRODNICZUK

model. Second, we considered modeling interi-
tem covariances that had not been addressed
through item deletion. Standardized covariances
greater than 2.58 (Byrne, 2001) are considered
problematic. Three item pairings demonstrated
residual covariances that exceeded this value.
Thus, an alternative exploratory model was
tested, involving 19 items and including the
modeling of the covariances of three pairs of
items (see Figure 2). Relative to the hypothe-
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This document is copyrighted by the American Psychological Association or one of its allied publishers.
sized model, a significant improvement in fit
was realized, ⌬␹2 ⫽ 492.92, df ⫽ 81, p ⬍ .001,
and goodness-of-fit statistics approached ac-
ceptable values (see Table 1). Figure 2 presents
this final model as tested, with the standardized
estimates of free parameters. The resulting 19-
item version of the measure will be referred to
henceforth as the TFI–19.
The factor score coefficient matrix provided
by the analysis of the final model was used to

Figure 2. Final Model of Therapeutic Factor Inventory–Short Form Factor Structure.

 THERAPEUTIC FACTORS INVENTORY–SHORT FORM
calculate factor scores for each case in the sam-
ple at each time point (see Appendix A). This
matrix of coefficients takes into account the
correlated error associated with particular item
pairs but requires that weighted composite
scores based on all items be calculated for each
factor.
The values for two indicators of internal con-
sistency for the four TFI–19 factors at Week 4
were as follows: Instillation of Hope, ␣ ⫽ .90
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and mean interitem r ⫽ .70; Secure Emotional
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Expression, ␣ ⫽ .85 and mean interitem r ⫽
.45; Awareness of Relational Impact, ␣ ⫽ .79
and mean interitem r ⫽ .43; and Social Learn-
ing, ␣ ⫽ .66 and mean interitem r ⫽ .39. Thus,
the factors demonstrated good internal consis-
tency.
Validity Analyses
Sensitivity to change. Table 2 presents the
means and standard deviations for the TFI–19
factor scores at Weeks 4, 8, and 12. Due to
differences in data collection across sites (e.g.,
certain groups collected TFI–S ratings only at
Week 4 and at Week 12, while other groups
collected ratings at each of the three assess-
ments), the N available at each assessment var-
ied. Table 3 presents the findings from the
three-level HLM longitudinal data analyses.
The results of the analyses were consistent
for each of the TFI–19 factors: the group level
effect for time (i.e., the slope) was significant
and positive ( p ⬍ .001), indicating a progres-
sive linear increase in the TFI–19 factor scores
across time, as expected. The slope parameter
accounted for 28% – 34% of the variance in
TFI–19 factor scores, indicating large effects.
Thus, the four TFI–19 factors at the group level
Table 2
Means and Standard Deviations For TFI–19 Factor Scores at Successive Group Process Assessments
Week 4
(N ⫽ 272)
TFI–19 Factor Mean
Instillation of Hope 4.34
Secure Emotional Expression 2.93
Awareness of Relational Impact 3.20
Social Learning 3.35
Note. TFI–19 ⫽ Therapeutic Factors Inventory–19.
209
demonstrated good sensitivity to change across
time.
Discriminant validity. Statistically signif-
icant correlations were evident between social
desirability and three of the four TFI–19 factors
at week 4: Secure Emotional Expression,
r(248) ⫽ .26, p ⬍ .001; Awareness of Rela-
tional Impact, r(247) ⫽ .17, p ⬍ .007; and
Social Learning, r(247) ⫽ .16, p ⬍ .01; in each
instance, the coefficient represented a small ef-
fect (r ⬍ .30). Pretreatment scores on the IIP–28
Interpersonal Ambivalence subscale were in-
versely associated with the Secure Emotional
Expression factor based on Week 4 ratings,
r(261) ⫽ ⫺.14, p ⬍ .03, but, again, the effect
was small. The coefficients suggested that per-
ceptions of Secure Emotional Expression in the
group were slightly influenced by a tendency
toward social desirability; in the main, the
TFI–19 factors were largely independent of so-
cial desirability and initial disturbance, indicat-
ing good discriminant validity.
Convergent validity. Table 4 presents the
correlations between the TFI–19 factors and the
GCQ–S subscales for the process assessment at
Week 4; the pattern of correlations was similar
when data were drawn from assessments at
Weeks 8 and 12. All four TFI–19 factors were
significantly associated ( p ⬍ .001) with ratings
of the GCQ–S Engaged subscale, reflecting me-
dium to large effects. All other associations
were small in effect size. Relationships between
the TFI–19 factors and the GCQ–S Engaged
subscale provide evidence of convergent valid-
ity.
Predictive validity. The four TFI–19 fac-
tors at Week 4 were evaluated individually as
predictors of posttreatment status on the out-
come variables. For five outcome variables (So-
Week 8 Week 12
(N ⫽ 174) (N ⫽ 197)
SD Mean SD Mean SD
1.14 4.70 1.05 4.83 1.21
0.66 3.17 0.58 3.18 0.71
0.77 3.50 0.70 3.59 0.81
0.80 3.66 0.74 3.75 0.85
 210 JOYCE, MACNAIR-SEMANDS, TASCA, AND OGRODNICZUK

Table 3
TFI–19 Factors Over Time: Base and Linear Three-Level Hierarchical Linear Models (N ⫽ 47 Groups,
N ⫽ 266 Individuals)
Unconditional base Unconditional linear model
TFI–19 Factor model (⌺2) (⌺2, ⬃R2, ␲1ij)
Instillation of Hope .46 .31, .33, .24ⴱⴱⴱ
Secure Emotional Expression .13 .09, .28, .11ⴱⴱⴱ
Awareness of Relational Impact .19 .13, .32, .19ⴱⴱⴱ
Social Learning .21 .14, .34, .19ⴱⴱⴱ
Note. The linear model tested the effect of time (i.e., successive process assessments), with the intercept defined as Week 4
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(first assessment). TFI–19 ⫽ Therapeutic Factors Inventory–19; ⌺2 ⫽ ␴2, an index of the variation in the dependent
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variable; ⬃R2 ⫽ Pseudo-R2, an index of the effect size of the predictor-dependent variable relationship (in this case, the
effect of time on the TFI–19 factor score), based on the change in variance accounted for from the base model. ⬃R2 is
calculated as follows: (⌺2 base ⫺ ⌺2 linear)/⌺2 base. ␲1ij ⫽ slope coefficient, reflecting the effect of time or the rate of
growth for the individual group member.
ⴱⴱⴱ
p ⬍ .0001.

matization, Depression, Anxiety, Interpersonal
Sensitivity, and the IIP Total Score), group-
level variation in the baseline–posttreatment
slope parameter was not significant. This pa-
rameter was, therefore, constrained for the anal-
yses involving the TFI–19 factors as predictors
of posttreatment status on these variables. For
the remaining outcome variables (Global Sever-
ity, Interpersonal Ambivalence, Interpersonal
Aggression), this slope parameter was allowed
to vary in the analyses. Table 5 presents the
significant findings of the predictor analyses.
Instillation of Hope at Week 4 accounted for
a small but significant proportion of the varia-
tion (1.0%) in posttreatment Depression scale
scores. Three of the four TFI–19 factors (Instil-
lation of Hope, Secure Emotional Expression,
and Awareness of Relational Impact) accounted
for significant variation in the BSI–18 Anxiety
scale at posttreatment. All four TFI–19 factors
demonstrated significant relationships with the
posttreatment scores for the BSI–18 Global Se-
verity Index. The significant predictor relation-
ships involving the TFI–19 factors from Week 4
accounted for 1.0% to 5.3% of the variation in
symptom severity at posttreatment.
The Instillation of Hope factor at Week 4 was
significantly associated with the IIP–28 Total
Score at posttreatment, and it accounted
for 7.0% of the variation. However, no signifi-
cant predictor relationships were identified for
the IIP–28 Interpersonal Sensitivity, Interper-
sonal Ambivalence, or Aggression subscales. In
sum, results suggested that the TFI–19 factors
were significantly predictive of posttreatment
levels of depression, anxiety, and general symp-
tomatic distress, as well as general interpersonal
distress.
Discussion
The present study drew data from a variety of
groups in diverse settings across North America
and examined the structure, sensitivity to

Table 4
Correlations Among TFI-19 Factors and GCQ–S Subscale Scores at the Week 4 Process Assessment
GCQ–S Subscale
TFI-19 Factor Engaged Avoiding Conflict
Instillation of Hope .51ⴱⴱⴱ ⫺.03 ⫺.14ⴱ
Secure Emotional Expression .68ⴱⴱⴱ ⫺.16ⴱ ⫺.23ⴱⴱⴱ
Awareness of Relational Impact .61ⴱⴱⴱ ⫺.09 ⫺.15ⴱ
Social Learning .60ⴱⴱⴱ ⫺.07 ⫺.16ⴱ
Note. Week 4 ratings (N ⫽ 260). TFI–19 ⫽ Therapeutic Factors Index–19; GCQ–S ⫽ Group Climate Questionnaire–Short
Form.
ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .01. ⴱⴱⴱ p ⬍ .001.
 THERAPEUTIC FACTORS INVENTORY–SHORT FORM 211

Table 5
TFI–9 Factors as Predictors of Outcome: Significant Findings of the Two-Level HLM Model
Outcome Initial Predictor Level 2
variable ⌺2 TFI Factor⫺19 ⌺2 ⬃R2 ␥ t variance ␹2
Depression .39 Instillation of Hope .38 .01 ⫺.08 ⫺1.98ⴱ .000 31.95
Secure Emotional Expression .38 .00 ⫺.12 ⫺1.30 .003 24.92
Awareness of Relational Impact .38 .01 ⫺.12 ⫺1.82 .000 28.84
Social Learning .38 .01 ⫺.09 ⫺1.37 .002 32.56
Anxiety .32 Instillation of Hope .30 .05 ⫺.11 3.29ⴱⴱ .000 29.56
Secure Emotional Expression .31 .03 ⫺.16 ⫺2.17ⴱ .005 31.09
Awareness of Relational Impact .31 .03 ⫺.13 ⫺2.25ⴱ .000 35.93
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⫺.10 ⫺1.85
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Social Learning .31 .02 .001 35.76

Global Severity .17 Instillation of Hope .17 .02 ⫺.06 ⫺2.68ⴱ .000 16.21
Secure Emotional Expression .17 .01 ⫺.11 ⫺2.31ⴱ .000 13.37
Awareness of Relational Impact .17 .01 ⫺.08 ⫺2.34ⴱ .000 16.51
Social Learning .17 .02 ⫺.07 ⫺2.00ⴱ .001 14.26
IIP Total .17 Instillation of Hope .16 .07 ⫺.08 ⫺2.06ⴱ .023 50.62ⴱ
Secure Emotional Expression .16 .05 ⫺.14 ⫺1.94 .019 41.49
Awareness of Relational Impact .17 .04 ⫺.10 ⫺1.74 .021 43.05
Social Learning .17 .01 ⫺.07 ⫺1.31 .012 43.27
Note. Degrees of freedom for the group-level t-tests of the ␥ coefficients ⫽ 35. Degrees of freedom for the ␹2 tests of the
level-2 variance components ⫽ 32. TFI–19 ⫽ Therapeutic Factors Inventory–19; ⌺2 ⫽ ␴2, an index of the variation in the
dependent variable; ⬃R2 ⫽ Pseudo-R2, an index of the effect size of the predictor-dependent variable relationship; ␥ ⫽
coefficient for the TFI–19 factor-outcome relationship; Level-2 Variance ⫽ estimate of variation in the IV-outcome
relationship at the group level, tested for significance with the chi-square statistic; IIP ⫽ Inventory of Interpersonal
Problems.
ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .01. ⴱⴱⴱ p ⬍ .001.

change, construct validity, and predictive valid-
ity of a measure of group therapeutic factors,
the TFI–S. The current study represented a
more extensive validation of the original mea-
sure, and resulted in a revised, 19-item version,
the TFI–19. The findings generally offer strong
support for the use of the TFI–19 as a measure
of global group therapeutic factors.
Factor Structure
The confirmatory factor analysis of the
TFI–S factor structure that was identified in an
exploratory analysis (MacNair-Semands et al.,
2010) provided “mediocre” fit (Byrne, 2001) to
the data. In effect, this indicated that the model
had some correspondence to the pattern of re-
lationships represented in the data but did not
capture all features of the group members’ rat-
ings. After modification, four items were de-
leted from the scale, and covariances involving
three item pairings were modeled. As a result,
the TFI–S was pared down to 19 items repre-
senting the four hypothesized factors. Hence,
we would recommend using the TFI–19 to as-
sess members’ perceptions of four global ther-
apeutic factors operating in their group: Instil-
lation of Hope, Secure Emotional Expression,
Awareness of Relational Impact, and Social
Learning.
The goodness-of-fit statistics for the final
model were adequate although some (e.g., GFI,
NFI) remained somewhat below commonly ac-
cepted values. This would suggest that further
refinement of the TFI–19 items may be benefi-
cial. Of note in the estimates provided for the
final model of the structure of the TFI–19 (see
Figure 2) were the high correlations among the
four latent factors (r values between .74 and
.93). On the one hand, then, the TFI–19 taps
into dimensions of the group members’ experi-
ence that are distinct and representative of dif-
ferent change mechanisms. On the other hand,
these four global therapeutic factors appear to
be strongly interdependent and likely function
in a mutually facilitative manner at any one time
or over the course of the group’s development.
Other exploratory models incorporating a sec-
ond-order latent factor, overarching the four
identified TFI–19 factors, were tested but not
found to improve fit relative to the hypothesized
model. This is in line with the findings of John-
 212 JOYCE, MACNAIR-SEMANDS, TASCA, AND OGRODNICZUK
son et al. (2005), who found that most subscales
of group climate, cohesion, alliance, and empa-
thy questionnaires were significantly intercorre-
lated, reflecting aspects of a common higher-
order construct, but they did not load on a
common factor. Our results and those of John-
son and colleagues suggest that, while such
constructs may be related, they do not necessar-
ily reflect a single latent dimension. The current
findings also suggest the value of examining
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how the factors of the TFI–19 might relate in
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terms of a sequential order, from early sessions
when establishing hope and encouraging emo-
tional expression is paramount, to later sessions
when aspects of interpersonal learning begin to
emerge more clearly.
Validity
Sensitivity to change. Scores on the four
TFI–19 factors demonstrated a significant linear
growth over time, and this effect of time ac-
counted for substantial variance in the scores.
The assessments of the therapeutic factors were
conducted over a relatively brief time period
(every four weeks for 12 weeks), suggesting
that the TFI–19 was quite sensitive to changes
in members’ perceptions of the presence of the
four factors in their group. The finding also
makes good clinical sense: as the groups pass
through initial developmental stages and mature
into an effective working pattern, the members’
experiences of the global therapeutic factors
would also reflect this maturation. The linear
development demonstrated by the four TFI–19
factors would not necessarily correspond to the
nonlinear, phasic changes—forming, norming,
storming, and performing— described by Tuck-
man (1963), but the progressive movement to-
ward a maturely functioning group is captured
in a similar manner by both perspectives. This
correspondence might be expected to be greater
if the TFI–19 was administered on a session-
by-session basis. In summary, then, the TFI
factors demonstrate reasonable stability within
individuals over brief periods in the group (test–
retest reliability), and they show sensitivity to
change in members’ perceptions over longer
intervals of intervention and group experience.
Discriminant validity. The tendency to
provide socially desirable responses was
weakly associated with perceptions of Secure
Emotional Expression in early sessions of the
group. This might indicate that initial attempts
at risk-taking in the group, such as disclosure or
feedback, are in part prompted by perceived
social pressures to perform. Across the board,
however, ratings of the four TFI–19 factors
based on Week 4 ratings demonstrated only
minor associations with social desirability or
initial disturbance, representing small effects.
Members’ perceptions of the therapeutic factors
were not influenced to any appreciable degree
by concerns about social desirability or the se-
verity of their symptoms or interpersonal dis-
tress at the start of treatment.
Convergent validity. Relationships be-
tween the TFI–19 factors and the subscales of
the GCQ–S at all time points were consistent
with findings previously reported (MacNair-
Semands et al., 2010). The strongest correla-
tions indicated that the four TFI–19 factors were
closely associated—though not overlapping—
with the GCQ–S Engaged subscale, and are,
thus, indicative of groups characterized by high
cohesion, collaboration, and a working culture.
Other relations indicated that scores on the
TFI–19 factors, especially Secure Emotional
Expression, were lower in groups characterized
by a high degree of conflict. Thus, the percep-
tion of the group as an emotionally safe envi-
ronment is reduced when the level of group
conflict is high.
The four TFI–19 factors can be considered in
terms of the model developed and validated by
Johnson et al. (2005) that highlighted positive
relationship factors, positive working factors,
and negative factors as broad dimensions of the
group therapy process. Instillation of Hope
would represent a positive relationship factor:
The members are encouraged by joining with
those having similar issues, and they are able to
envision achieving problem resolution through
the collaboration and support of others in the
group. Secure Emotional Expression may also
represent a positive relationship factor, in that
engagement in meaningful disclosure serves to
enlist other members as therapeutic agents and
increase group cohesion. The factor may also
function as a positive working factor: It is fre-
quently the case that a significant piece of ther-
apeutic work by a member is initiated by the
expression of problematic feelings to the group.
Awareness of Relational Impact and Social
Learning are also likely representative of posi-
tive working factors in the group, the former
 THERAPEUTIC FACTORS INVENTORY–SHORT FORM
reflecting insight into how one’s own behavior
affects other people and the latter reflecting the
transfer of learning between the group micro-
cosm and interpersonal relationships in the
wider world. Members frequently follow up on
insights that emerge in the group process, or
they report back on the value of lessons imple-
mented in the real world, and these feedback
loops can facilitate further work by the individ-
ual, other members, and the group as a whole.
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Predictive validity. The analyses of the
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ability of the TFI–19 factors to predict posttreat-
ment status offered evidence that the factors
accounted for variation in function over and
above that accounted by initial status on the
outcome indices. Members’ perceptions of the
therapeutic factors had been gathered early in
the life of the groups (at Week 4) and demon-
strated significant relationships with posttreat-
ment status assessed two months later. This
implies that the TFI–19 has good potential to
assess dimensions of the early group process
that have a bearing on the outcome of treatment.
Instillation of Hope emerged most frequently
as a significant predictor of posttreatment status
on depression, anxiety, and overall symptom-
atic distress, as well as overall interpersonal
distress. As these process– outcome relation-
ships are correlational in nature, it is possible
that early benefit in the group prompted the
development of hope, which in turn was asso-
ciated with later improvement. It would, thus,
be important in future research with the TFI–19
to examine the prediction of outcome afforded
by the Instillation of Hope factor after account-
ing for early in-treatment improvement on the
outcome measures. Notwithstanding this issue
with process– outcome relationships, Instillation
of Hope is likely one of the first therapeutic
factors experienced by the members of a begin-
ning group, and it is based on a sense that
problems are shared and resolution can be
achieved by working together. This might be in-
dicative of the power of “remoralizing” the patient
(Frank, 1974) early in the life of the group and
facilitating initiation of the process of psycholog-
ical change. The finding certainly underscores the
value of facilitating the members’ hopefulness for
the success of the treatment at the beginning stage
of the group experience.
The remaining TFI–19 factors emerged as
predictors of posttreatment status for anxiety
(excepting Social Learning) and global severity
213
of symptoms. A number of the relationships
between the TFI–19 factors and posttreatment
status on the subscales of the IIP–28 were in the
expected direction but did not reach statistical
significance. This might suggest a differential
effect for the therapeutic factors on symptom
change relative to change in interpersonal do-
mains. It is also possible that perceptions of the
therapeutic factors later in the group might
prove to be associated with change in domains
such as interpersonal sensitivity or aggression,
which generally demonstrate a slower course to
resolution than symptoms of distress.
Limitations of the Study
The sample for the current study was repre-
sentative of group interventions offered in out-
patient settings, community agencies, and col-
lege counseling centers. The diversity of groups
in the sample was regarded as a strength of the
study, but it was not representative of the entire
range of group treatments. Groups are common
in many other settings, including inpatient units
and independent practice clinics. Consequently,
the actual representativeness of the sample to
the population of groups may be somewhat re-
stricted. Examining the emergence and devel-
opment of the therapeutic factors in groups of
longer duration (i.e., ⬎ 12 sessions) also would
be of interest. Further, the sample was predom-
inantly Caucasian, which may have resulted in
the presence of certain biases in the ratings.
Replication with a more ethnically diverse sam-
ple would demonstrate the generalizability of
the findings.
We were cognizant of the issue of within-group
dependency in data with a nested structure such as
this. Initial analyses indeed demonstrated mild to
substantial systematic group-level variation for the
indices associated with assessment of outcome or
group therapeutic factors and climate. Our analy-
ses of the factor structure of the TFI–S did not
involve use of multilevel structural equation mod-
eling to address relationships at both the individ-
ual and group levels, however. Given that Johnson
et al.’s (2005) multilevel CFA did not converge
even though they had a much larger sample of
groups and members, we did not expect that a
multilevel model of our data would converge. Our
results of the analysis of the factor structure of
the TFI–S could, thus, be evaluated critically on
these grounds, but the omission of a multilevel
 214 JOYCE, MACNAIR-SEMANDS, TASCA, AND OGRODNICZUK
perspective was, essentially, unavoidable. A
larger sample of participants and groups, or the
amalgamation of datasets to achieve such a
sample, would allow for these questions to
eventually be answered using a multilevel struc-
tural equation modeling approach. Analyses fo-
cusing on the measure’s sensitivity to change
and capacity to predict therapy outcome, how-
ever, did encompass the examination of individ-
ual- and group-level effects. For example, up to
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31% of the change in the TFI–19 scale scores
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from Session 4 to 12 was accounted for by the
group effect. This indicated that the particular
group that a participant belonged to could exert
a large effect on the amount of change in the
participant’s experience of a therapeutic factor.
The findings of the exploratory analysis of
the measure’s factor structure, using individual-
level structural equation modeling, were reason-
ably strong. However, further efforts to refine
the item content of the TFI–19 might offer a
means to improve model fit. Consideration
should likely be given to replacing items that
were excluded, especially in order to provide
for better representation of certain factors (e.g.,
Instillation of Hope, Social Learning). It is pos-
sible that revising certain items could provide
better differentiation of the associated latent
factors. This work would require the collection
of an independent sample of rating data, but in
the end, it may provide for a model with better
fit and factors which more accurately represent
the TFs operative in therapy groups. Having
acknowledged these limitations of the confir-
matory factor analyses, we would nonetheless
argue that the TFI–19 represents an efficient and
useful means of evaluating members’ percep-
tions of more global therapeutic factors operat-
ing in a therapy group.
Finally, our evaluation of group outcome was
limited in scope, a necessity in order to recruit
busy clinical settings as providers of rating data.
The findings suggested that the TFI–19 factors
might indeed demonstrate differential relation-
ships with outcome domains, varying as a func-
tion of the time in group when they are assessed
or the particular orientation of the group inter-
vention. Further research on the predictive
strengths of the TFI–19 would make a compre-
hensive evaluation of outcome domains an im-
portant objective. We believe the measure has
promise for illuminating the change mecha-
nisms in group treatment, and we look forward
to further research on its capabilities.
Almost 20 years ago, Crouch et al. (1994)
argued that conceptualizations of the therapeu-
tic factors were unbalanced in breadth and over-
lapping in their content. Perhaps as we have
moved toward identifying fewer, more global
and interdependent therapeutic factors, we are
approaching more clarity about the underlying
mechanisms of therapeutic changes in the group
modality. On a practical level, group leaders can
benefit from understanding how members per-
ceive the Instillation of Hope, Secure Emotional
Expression, Awareness of Relational Impact,
and Social Learning available to them at differ-
ent stages of their group’s life. Particularly if
the scoring method based on a simple averaging
of the items for each factor is used (see Appen-
dix A), leaders can gain an immediate picture of
members’ perceptions of the therapeutic factors
operating in their group. Like the CORE Bat-
tery–Revised offered by the American Group
Psychotherapy Association (Burlingame et al.,
2006), which provides measures for leaders to
“take the pulse” of the members of their groups,
the TFI–19 may facilitate intervening with spe-
cific knowledge of how members perceive the
therapeutic factors operative in the group at
different stages of development.
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 THERAPEUTIC FACTORS INVENTORY–SHORT FORM 217

Appendix A
The Therapeutic Factors Inventory–Short Form
Name __________________________________

© R. MacNair-Semands, J. Ogrodniczuk, A. Joyce, Tasca, G., & K. Lese-Fowler (2007)

Please rate the following statements as they apply to your experience in your group by circling the
corresponding number, using the following scale:

1= Strongly Disagree to 7= Strongly Agree

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

1. Because I’ve got a lot in common with other group members, I’m 1 2 3 4 5 6 7
This document is copyrighted by the American Psychological Association or one of its allied publishers.

starting to think that I may have something in common with people

outside group too.

2. Things seem more hopeful since joining group. 1 2 3 4 5 6 7

3. I feel a sense of belonging in this group. 1 2 3 4 5 6 7

4. I find myself thinking about my family a surprising amount in group. 1 2 3 4 5 6 7

5.* Sometimes I notice that in group I have the same reactions or feelings 1 2 3 4 5 6 7
as I did with my sister, brother, or a parent in my family.

6.* In group I’ve learned that I have more similarities with others than I 1 2 3 4 5 6 7
would have guessed.

7. It’s okay for me to be angry in group. 1 2 3 4 5 6 7

8. In group I’ve really seen the social impact my family has had on my 1 2 3 4 5 6 7
life.

9. My group is kind of like a little piece of the larger world I live in: I see 1 2 3 4 5 6 7
the same patterns, and working them out in group helps me work them
out in my outside life.

10. Group helps me feel more positive about my future. 1 2 3 4 5 6 7

11. It touches me that people in group are caring toward each other. 1 2 3 4 5 6 7

12.* I pay attention to how others handle difficult situations in my group so I 1 2 3 4 5 6 7

can apply these strategies in my own life.

13. In group sometimes I learn by watching and later imitating what 1 2 3 4 5 6 7

happens.

14.* This group helps me recognize how much I have in common with other 1 2 3 4 5 6 7
people.

15. In group, the members are more alike than different from each other. 1 2 3 4 5 6 7

16. It’s surprising, but despite needing support from my group, I’ve also 1 2 3 4 5 6 7
learned to be more self-sufficient.

(Appendices continue)
 218 JOYCE, MACNAIR-SEMANDS, TASCA, AND OGRODNICZUK

17. This group inspires me about the future. 1 2 3 4 5 6 7

18. Even though we have differences, our group feels secure to me. 1 2 3 4 5 6 7

19. By getting honest feedback from members and facilitators, I’ve learned 1 2 3 4 5 6 7
a lot about my impact on other people.

20. This group helps empower me to make a difference in my own life. 1 2 3 4 5 6 7

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

21. I get to vent my feelings in group. 1 2 3 4 5 6 7

This document is copyrighted by the American Psychological Association or one of its allied publishers.

22. Group has shown me the importance of other people in my life. 1 2 3 4 5 6 7

23. I can “let it all out” in my group. 1 2 3 4 5 6 7

Scoring Key

The factor scores from the TFI-S were based on a simple averaging of the associated items: Instillation of
Hope (items 2, 6, 10, 14, 17, and 20); Secure Emotional Expression (items 3, 7, 11, 15, 18, 21, and 23);
Awareness of Relational Impact (items 4, 8, 12, 16, 19, and 22); and Social Learning (items 1, 5, 9, and
13).

*Items 5, 6, 12, and 14 were excluded from the TFI-S to create the TFI-19. The same parsimonious scoring
method outlined above can be used, i.e., to take the mean of the items associated with each of the four
factors. These scores would be regarded as course estimates of the factor scores derived from the weighted
summation method portrayed below.

Each TFI-19 factor is based on a sum of the item ratings each multiplied by a factor score weight. This
scoring method is based on the factor score coefficient matrix provided by the AMOS structural equation
modeling following identification of the final model, and takes into account the correlated error between
specific item pairs (see text).

Instillation of Hope = (Item01 * .016) + (Item02 * .119) + (Item03 * .009) + (Item04 * .005) + (Item07 *
.000) + (Item08 * .008) + (Item09 * .031) + (Item10 * .274) + (Item11 * .008) + (Item13 * .014) +
(Item15 * .004) + (Item16 * .021) + (Item17 * .206) + (Item18 * .013) + (Item19 * .037) +
(Item20 * .135) + (Item21 * .004) + (Item22 * .029) + (Item23 * .003)

Secure Emotional Expression = (Item01 * .011) + (Item02 * .006) + (Item03 * .094) + (Item04 * .006) +
(Item07 * .019) + (Item08 * .000) + (Item09 * .021) + (Item10 * .014) + (Item11 * .086) +
(Item13 * .009) + (Item15 * .040) + (Item16 * .016) + (Item17 * .010) + (Item18 * .138) +
(Item19 * .029) + (Item20 * .007) + (Item21 * .045) + (Item22 * .022) + (Item23 * .029)

Awareness of Relational Impact = (Item01 * .028) + (Item02 * .026) + (Item03 * .030) + (Item04 * .016) +
(Item07 * .001) + (Item08 * .023) + (Item09 * .055) + (Item10 * .059) + (Item11 * .028) +
(Item13 * .025) + (Item15 * .013) + (Item16 * .062) + (Item17 * .044) + (Item18 * .044) +
(Item19 * .108) + (Item20 * .029) + (Item21 * .014) + (Item22 * .083) + (Item23 * .009)

Social Learning = (Item01 * .070) + (Item02 * .026) + (Item03 * .027) + (Item04 * .010) + (Item07 * .002)
+ (Item08 * .014) + (Item09 * .137) + (Item10 * .059) + (Item11 * .025) + (Item13 * .062) +
(Item15 * .011) + (Item16 * .039) + (Item17 * .044) + (Item18 * .039) + (Item19 * .068) +
(Item20 * .029) + (Item21 * .013) + (Item22 * .052) + (Item23 * .008)

(Appendices continue)
 THERAPEUTIC FACTORS INVENTORY–SHORT FORM 219

Appendix B
Hierarchical Linear Models
Three-Level Longitudinal Model (for sensitivity to change)

Level 1: Y tij ⫽ ␲ 0ij ⫹ ␲ 1ij ⴱ (log time) ⫹ e tij

Level 2: ␲ 0ij ⫽ ␤ 00j ⫹ ␤ 01j ⴱ (individual pre-scores) ⫹ r 0ij

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

␲ 1ij ⫽ ␤ 10j ⫹ ␤ 11j ⴱ (individual pre-score) ⫹ r 1ij

This document is copyrighted by the American Psychological Association or one of its allied publishers.

Level 3: ␤ 00j ⫽ ␥ 000 ⫹ ␥ 001 (group pre-score) ⫹ u 00j

␤ 01j ⫽ ␥ 010 ⫹ u 01j

␤ 10j ⫽ ␥ 100 ⫹ ␥ 101 (group pre-score) ⫹ u 10j

␤ 11j ⫽ ␥ 110 ⫹ u 11j

The dependent variables (Ytij) in this model are one of the TFI–19 subscales. The growth models
shown here used a log transformation for “time” to model a more pronounced change from
session 4 to 8, and less pronounced change from sessions 8 to 12. Individual pre-scores were group
mean centered and group pre-scores were grand mean centered.

Two Level Hierarchically Nested Models (For Predictive Validity)

Level 1: Y ij ⫽ ␤ 0j ⫹ ␤ 1j(pre-score) ⫹ ␤ 2j (TFI scale) ⫹ r ij.

Level 2: ␤ 0j ⫽ ␥ 00 ⫹ u 0j.

␤ 1j ⫽ ␥ 10 ⫹ u 1j

␤ 2j ⫽ ␥ 20 ⫹ u 2j

The dependent variables (Yij) in this model are one of the individual outcome scale scores at
session 12. Individual pre-scores and TFI scale scores were grand mean centered.

Received October 21, 2010

Revision received April 13, 2011
Accepted May 11, 2011 䡲