INTRODUCTION AND OVERVIEW Introduction Many of the advances in clinical psychology stem from applications of experimental psychology to the clinical enterprise. For example, much of cognitive behavior therapy is predicated on ap- plications from the learning, cognitive, social, and developmental branches of experimen- tal psychology (Craighead, Craighead, Kazdin, & Mahoney, 1994). Surprisingly, clinical psy- chologists have largely ignored the voluminous ‘empirical literature on quality of life, life satisfac- tion, and subjective well-being and its potential clinical applications (Diener, 1984; Inglehart, 1990; Schuessler & Fisher, 1985; Strack, Argyle, & Schwartz, 1991). This abundant literature, in- cluding the work of sociologists and social and personality psychologists, has obvious impli- cations for assessing health care outcomes, for psychotherapy, for treatment planning, for defin- ing mental health and positive adjustment, and for understanding numerous psychological disor- ders, including depression (Frisch, 1989, 1992b). ‘The development of the QOLI® (Quality of Life Inventory) represents one effort to apply the literature on quality of life and subjective well- being to the fields of clinical psychology, health psychology, psychiatry, and other branches of medicine. ‘The remainder of this chapter discusses the defin tion of quality of life, the rationale for developing, a measure of quality of life, Quality of Life Thei and an overview of the QOL itself and how it can be used. Chapter 2 details the standardization study conducted to examine the psychometric properties of the QOLI. Information about the administration and scoring of the QOLI is presented in Chapter 3, and the interpretation of QOLI results is discussed in Chapter 4. Chapter 5 discusses the use of the QOLI in psychotherapy treatment planning, including a detailed case study and general treatment strategies aimed at all areas of life assessed by the QOLL Defining Quality of Life ‘The terms quality of life, perceived quality of life, subjective well-being, happiness, and life sat- isfaction have been used interchangeably, and inconsistently, in the literature, although each term has unique theoretical nuances (Campbell, Converse, & Rogers, 1976; Diener, 1984; Evans, in press; Frisch, Cornell, Villanueva, & Retzlaff, 1992; Strack et al., 1991; Veenhoven, 1984). The global constructs of subjective well-being and happiness have, for the most part, been defined in terms of affect or cognition or a combination thereof (Andrews & Robinson, 1991; Diener, 1984) Affective definitions view subjective well-being as cither positive affect alone or as a preponder- ance of positive affect (such as joy, contentment, ure) over negative affect (such as sadness, ion, anxiety, or anger) in an individual ¢ (Andrews & Robinson, 1991; Braeburn, , 1980), experiei 1969; Cognitive definitions (or the life satisfaction ap- ‘ach to subjective well-being) view happiness in terms of cognitive judgments as to whether one's needs, goals, and wishes have been fulfilled (Campbell et al., 1976, Cantril, 1965; Evans, in ; Freedman, 1978; French, Rodgers, & Cobb, 1974; Michalos, 1985). Thus, life satisfaction is de- edas a “cognitive judgmental proce dependentype a comparison of one’s creumstanees with shat i thonght to be an appropriate standard (enter, Emmons, Larsen, & ¢ 1985, p. 71) The smaller the perceived discrepancy between and achievements, the greater the one’s aspirations approach level af satisfaction, according to this Some define subjective well-being in both cogni tive and alfective terms (Diener, 1984). Andrews and Withey (1976) suggest that measures of hap- piness consist of three ingredients: positive affect, negative affect, and cognitive evaluation, Similarly, Veenhoven (1984) defines happiness in terms of the degree to which a person experiences posi- tive affect and perceives that his or her aspirations have been met (that is, life satisfaction). The Quality of Life Theory of life satisfaction, which underlies the QOLT and Quality of Life Therapy”, takes the combined cognition-and- affect approach to defining subjective well-being. (Frisch, 1989, 1992b; Frisch et al., 1992). Life satisfaction and negative and positive affect are viewed as components of the broader construct, of subjective well-being or happiness. It is as- sumed that the affective correlates of subjective well-being largely stem from cognitively based life satisfaction judgments (Lazarus, 1991). Life satisfaction is equated with quality of life and refers to a person's subjective evaluation of the degree to which his or her most important needs, goals, and wishes have been fulfilled. Thus, the perceived gap between what a person has and what he or she wants to have in valued areas of life determines his or her satisfaction or dissat- isfaction, For purposes of clarity and continuity, quality of life, life satisfaction, subjective well-be- ing, and happiness will be used as defined here through the remainder of this manual Rationale for Developing a Measure of Quality of Life Quality of life: A new criterion for mental health and adjustment. Prominent leaders from opposing theoretical camps in clinical psychol- ogy, psychiatry, health psychology, and general medicine are clamoring for the development of nonpathology-oriented measures of subjective well-being, quality of life, and positive mental health to augment those that focus on negative affect and symptoms (Bigelow, Brodsky, Stewart, & Olson, 1982; Cowen, 1991; Fallowfield, 1990; M. R. Goldfried; personal communication, July 21, Isworth, 1987, 1988; Howard, Luege 1993;Jenkins, 1992; Kazdit 1991; Lehman, Ward, & Linn, 1982; Lewinsohn, Redner, & Seeley, 1991 Matarazzo, 1992; Rogers, 1951; Spilker, 1990ky Stewart & Ware, 1992; H. I. Strupp, personal com- munication, October 14, 1989; Strupp & Hadley 1977; Wolf, 1978). For example, some behavioral and psychodynamic theorists agree that a client happiness or satisfaction with life is an esseng ‘criterion for mental health and for a positive outcome in psychotherapy. Happiness or satis faction with life should be routinely assessed bj researchers and clinicians alike (Hollandsworth 1987, 1988; Howard et al., 1993; Kazdin, 1993 Strupp & Hadley, 1977). These theorists and oth. ers (Beiser, 1971; Bigelow et al., 1982; Coan, 1977s Diamond, 1985; Jahoda, 1958; Seaman, 198%@ Taylor & Brown, 1988) wish to broaden the cri- teria for mental health and adjustment to includ. personal happiness and life satisfaction as well as the mere absence of disease or psychiatric symp toms. If personal happiness is a central part of ‘mental health, it should be assessed and moni- tored on a routine basis by health care provider (Fallowfield, 1990). a 1992; Holland Maling, & Martinovich, 1993a, 1993b; Lazarus tial Howard et al. (1993) reported evidence thaj@ | improvement in subjective well-being is a neces- sary first step for all psychotherapeutic change@® Specifically, they demonstrated that symptom | reduction and improved functioning in every> > day life do not occur in psychotherapy unles<>! a client’s quality of life is first enhanced. These authors argue that, because improved quality o% life is an essential prerequisite for any change, as a result of psychotherapy, quality of life as*y sessment is a necessary part of all mental healtlg® - treatment and evaluation. ’ © ‘Another reason for the importance of routine | quality of life measurement is the fact that re“ duced quality of life is considered a key ampere of many, if not most, psychological and physical disturbances (see Spilker, 1990b), including des pression (American Psychiatric Association, 1994; Beck, 1976; Frisch, 1992a, 1992b; Lewinsohn et al., 1991; Newman & Beck, 1990), anxiety disp, orders (American Psychiatric Association, 1994 Craske, Barlow, & O'Leary, 1992), alcohol and drug abuse (Frisch 1989; Metzger & O'Brieng 1990; Peele & Brodsky, 1991), somatoform dis- orders (Dworkin et al., 1992; Frisch, 1989; Lee & Rowlingson, 1990), psychophysiological disorder, ¢ 7UFrisch, 1989; Gatchel & Blanchard, 1993) schizo: phrenia (Lehman et al., 1982), and marital discord (Gottman, 1994), Addressing quality of life issues in areas of life such as love, work, and recreation, whether they are part of a client’s. presenting problem or not, is often crucial to the success of treatment (Beck, Rush, Shaw, & Emery, 1979; Craske et al., 1992; Frisch, 1989, 1992b; Lehm: et al., 1982; Metzger & O'Brien, 1990; Pee Brodsky, 1991) q & A more complete view of mental statu: Commonly used measures of psychiatric symp toms and negative affect do not provide a complete picture of a client’s mental status or progress in treatment, Life satisfaction and posi- tive affect are somewhat independent of negative affect and symptoms such as depression (Andrews & Robinson, 1991; Argyle, 1987; Bradburn, 1969; Bryant & Veroff, 1982; Chamberlain, 1988; Costa & McCrae, 1980; Diener & Emmons, 1984; Headey, Kelley, & Wearing, 1993; Keeler, Wells, & Manning, 1986; Lewinsohn et al, 1991; Moriwaki, 1974; Stewart, Ware, Sherbourne, & Wells, 1992; Ware, Manning, & Duan, 1984; Watson, Clark, & Carey, 1988; Wood, Rhodes, & Whelan, 1989; Zevon & Tellegen, 1982). This means that positive feelings and life satisfaction cannot be inferred from the absence of negative feelings; we cannot assume that clients feel good just because they don’t feel bad. This may explain why some psychotherapy clients are discontent even though their symptoms andl negative affect have remitted with treatment For example, R. B, Jarrett (personal communica- tion, October 28, 1988) has reported instances of patients treated in mood disorder clinics who complain of feeling vaguely unhappy, discontent, ‘or *blal” long after their major symptoms have re- mitted and their Beck Depression Inventory (BDI; “fleck & Steer, 1987) scores have fallen within the ‘normal range. Researchers in medicine and health psychology have noted a similar phenomenon; at times, physical disease, its treatment, and other stressful life events take the joy out of life without a discernable increase in negative affect or psychi atric symptoms (Stewart et al., 1992; Ware, 1986), ‘One review of both mental and physical health studies concludes that measures of psychological distress or symptoms must be supplemented by quality of life measures to fully capture the im- pact of a disease or disorder and its treatment. At times, key outcomes such as reduced pleasure and. satisfaction with and enjoyment of life are only captured by quality of life measures (Ware, 1986). A more complete view of physical health sta- tus. The Workd Health Organization defines health asa state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (World Health Organization, 1948). In keeping with this definition, the goal of health care today is to improve the client's quality of life in addition to effecting a biological cure for physical illness or disability (Hollandsworth, 1988; Seaman, 1989; Spilker, 1990b; Stewart & Ware, 1992), Leaders in the fields of general medicine and health psychology are saying that biological measures of health must be supplemented with quality of life measures to adequately represent the health of an individual ora group (Fallowfield, 1990; Jenkins, 1992; Kaplan & Anderson, 1990; Matarazzo, 1992; Spilker, 1990b; Stewart & Ware, 1992), A clinically important dimension that predicts future health problems. Changes in quality of life are no less important than changes in nega- Live affect or psychiatric symptoms in evaluating adjustment (Stewart et al., 1992). Quality of life re- flects an important part of human experience that makes life worthwhile (Lazarus, 1991), and assess- ing quality of life can identify those who are at risk for health problems in the future. Specifically, life satisfaction has been identified as a predic~ tor of clinical depression (Gonzales, Lewinsohn, & Clarke, 1985; Lewinsohn et al, 1991), chronic pain syndrome (Dworkin et al., 1992), and vari- ous physical illnesses (Anderson, Kiecolt-Glaser, satisfaction may allow clini address a whole new realm of psychological expe- rience and functioning. Quality of life and medical outcome assess- ‘ments, Jenkins (1992) persuasively argues that we must assess patients’ quality of life subsequent to any medical treatment in order to judge the treat- ment’ effectiveness because “the ultimate purpose of all health interventions is to enhance patients? quality of life” (p. 367). The view that quality of lifeis an essential health care outcome is reflected in the fact that quality of life assessments are becoming a required part of any treatment outcome evaluation in the fields of general medicine and health psy- chology (American College of Physicians, 1988; Cox & Gonder-Frederick, 1992; Fallowfield, 19 Henderson-James & Spilker, 1990; Hyland, 199; Jenkins, 1992; Kaplan & Anderson, 1990; Levine, 1990; Seaman, 1989; Spilker, 1990b; Stewart &Ware, 1992). Quality of life measures can be used to assess the impact of a medical treatment on how a client feels and functions in everyday life Patients are often the only experts on the various impacts of their diseases or injuries, and so the ultimate judge of what treatment has achieved (Sullivan, 1992, p. 79) Assessing the quality of life of clients being treat ed for physical maladies can help to improve the effectiveness of treatment (Spilker, 1990a, 1990b). On a nationwide level, quality of life assessments can help to establish the comparative efficacy of different treatments or service delivery systems (e.g., managed care). Adverse reactions to a medi cal or behavioral medicine intervention should reduce clients’ quality of life, and beneficial reac- tions to treatment should improve their quality of fe. Managed care systems, hospitals, insurance ‘companies, government agencies, and health care buying groups are more likely to approve of, pay for, or use a particular intervention or service delivery system if its ability to improve clients’ quality of life (by itself and relative to competing treatments) has been established (Babigian, Cole, Reed, Brown, & Lehman, 1991; Henderson-James & Spilker, 1990; Howard et al., 1993). Quality of life as an aid to developing new treatments. There may be an ethical (and often a legal or regulatory) obligation to conduct quality of life assessments during the development of any new medical or psychological therapy. Just as it is unethical to introduce new treatments without first establishing their safety and efficacy through research, it may also be unethical to introduce new treatments without first assessing their im- pact on clients’ quality of life (Awad, 1992; Faclen & Leplege, 1992; Levine, 1990; Ogihara, Ozawa, & Kuramoto, 1991; Shoemaker, Burke, Dors, Temple, & Freidman, 1990). In fact, a Food and Drug ‘Administration committee recommended quality of life and survival as the key outcome variables to consider in deciding whether or not to approve the use of new anticancer medications (Johnson & ‘Temple, 1985). nstruct for understanding ‘An integrative co ‘The constructs of ‘and treating mental disorders. Gqualty of life and subjective welHbeing may have AUisiderable heuristic value in helping t0 explain snd treat a variety of psychological disorders. Por example, Frisch (1989, 1992b; Frisch et aly 1992) has used these constructs to integrate various “ 6 theories of depression. According to Frisch (1987 isch ct al,, 1992), dissatisfaction depression, <8 cliologically distinct subtype of clinical depre " sion, is immediately caused by a combination ol negative selfevaluation and hopelessness, whic | in turn, are based on repeated failures to iT aspirations and meet personal standards in high(e thu eas of life Disatisiaction depresion or lile dissatisfaction, may also influence the dA | velopment of other disorders such as drug an alcohol abuse, anxiety disorders, psychophyst ological disorders, and somatoform disorders (ser Frisch, 1989; Frisch et al, 1992). Quality of Lif Therapy, an integrative psychotherapy approaclh is proposed as a way to increase clients’ subjecti¢_ wellbeing and ameliorate these disorders (see Frisch, 1989). If the construct of life satisfaction = useful in explaining and treating depression ang related disorders, valid measures of this construct would be invaluable in planning and evaluating. treatments for these disorders. = Quality of Life Theory e The QOLI is based on an empirically validated model of life satisfaction and subjective well-be ing, which is then incorporated into a model & depression and related disorders. Thus, Quality Life Theory attempts to integrate existing theories of depression with each other and with the sul@ jective well-being literature (Frisch, 1989, 1992b, Frisch et al., 1992; Lewinsohn et al., 1991). ThE integration is achieved through the unifying co struct of life satisfaction or quality of life, whicl the QOLI attempts to measure ¢ ‘The Quality of Life model of life satisfaction ar subjective well-being is depicted in Figure 1 this model, life satisfaction is equated with qualit of life and refers to a person's subjective evaluaticg® of the degree to which his or her most important needs, goals, and wishes have been fulfilled. Thue life satisfaction is the perceived gap between why 4 person wants and what he or she has. The small” er the perceived discrepancy between a persone aspirations and achievements, the greater his of her life satisfaction will be. ‘he model of life satisfuction is tinear and addiiv® it assumes that a person's overall life satisfaction consists largely of the suim of satisfactions in par ticular areas of life that are valued or deeme important. A person's satisfaction in a particuly area of life is made up of four components: (a) the ¢ ¢ &Figure 1. Quaity of uit ~ Qualit Of Life mode! of life satistaction and subjective well-being ve i alued Area of Lite #1 Objective Percei Evaluation Based | Characters or Charcaca Persona ‘cumstances ——\ Standards and oF Attitudes Overall . Satisfaction Valued Area of Life #n | Evaluation Based Objective Perceived | on Personal Characteristics or |__, Characteristics ___| Standards and |_. Circumstances | or Attitudes: ‘Overall Satisfaction | | objective characteristics or circumstances of an area, (b) how the person perceives and interprets an area, (©) the person's evaluation of fulfillment in an area, based on the application of standards, of fulfillment or achievement, and (d) the value or importance the person places on an area regard- ing his or her overall happiness or well-being. ‘The objective characteristics of an area of life con- tribute to satisfaction judgments, such as when a person's satisfaction with work is based on the work itself, pay, relationships with co-workers and bosses, the work environment, and job security. ‘A person's subjective perception and interpreta‘ tion of an area's characteristics will also influence his or her satisfaction with the area, such as when he or she distorts the objective reality of a situ- ation in either a positive or a negative way. In addition to reality testing, this attitude component of satisfaction judgments includes how a person interprets reality or a set of circumstances. This in- terpretation includes deciding on the implications Satisfaction Weighted by Importance or Value Subjective Well-Being | | Satisfaction Weighted by Importance or | | "\vaue | that a given set of circumstances has for one’s self- esteem and future well-being. The perceived characteristics of an area of life are evaluated through the application of standards of fulfillment that reflect a person’s goals and aspi- rations for that particular area of life. That is, a person will decide whether his or her needs and aspirations have been met in a valued area of life. People will feel more satisfied when they perceive that their standards of fulfillment have been met and less satisfied when they have not, Quality of Life Theory proposes that a person's satisfaction with a particular area of life is weight- ed according to its importance or value before the level of satisfaction with that area enters into the equation of overall life satisfaction. Thus, satisfac- tion in highly valued areas of life is assumed to have a greater influence on evaluations of over- all life satisfaction than areas of equal satisfaction that are judged to be of less importance.The theory assumes that lite most important cause its aff istaction is the aspect of subjective well-being be frome aglleetive elements are assumed to stem rom satisfaction judgments (Campbell et al., 1976; Cella & Tulsky, 1990; Diener, 1984; Evans, in press Trans & Powers, 1992; George & Bearon, 1980; Lewinsohn et al., 1991). Once life satisfaction judgments have been made and associated affects, both positive and negative, have been generated, it is further assumed that these emotions will, in turn, affect cognitive evaluations of satisfaction, Suggesting some measure of “bidirectional cau- sality” of thoughts and emotions (Lazarus, 1991; Lazarus & Folkman, 1984). Finally, overall life sat- isfaction and positive and negative affect combine to form the higher-level construct of subjective well-being, The Quality of Life model of depression and related disorders assumes that dissatisfaction de- pression is immediately caused by a combination of a negative self-evaluation and hopelessness that, in turn, is based on repeated failures to fulfill aspirations and meet personal standards in highly valued areas of life (see Figure 1). Moving from the most distant to the most immediate sequence of events leading to dissatisfaction depression, it is hypothesized that low life satisfaction may elicit dysphoria, which serves to motivate individuals to initiate coping efforts to increase their life satis- faction. Most individuals succeed in their efforts, thereby increasing life satisfaction, reducing the frequency and intensity of negative affect, and in- creasing the frequency and intensity of positive affective experiences. In contrast, those who de- velop dissatisfaction depression are not successful in their attempts to boost satisfaction in valued areas and therefore fail to increase life satisfaction as a whole. Furthermore, they become hopeless and blame themselves for their failure to achieve satisfaction as part of a general negative self-eval- uation (Frisch, 1989). This negative self-evaluation consists of five cognitive processes and struc- tures: increased self-focused attention, self-blame, self-criticism for repeated failures to increase life satisfaction, low self-efficacy with respect to val ued areas of life, and low self-esteem. It is further assumed that most depressions are dissatisfaction depressions and that other related disorders may also develop as a result of repeated failures to gain satisfaction in valued areas of life ‘These disorders include drug and alcohol abuse, anxiety, and psychophysiological and somatoform 6 e apy is proposed a disorders, Quality of Life Thera f client's life satislaction ance ameliorate these disorders (see Chapter 5). el 2 Cy The QOLI was developed to provide a measure t of positive mental health that could supplement measures of negative affect and psychiatric symp toms in both outcome assessment and treatment planning. In addition, the QOLI was developed t focus the attention of health providers on a cli ent’s sources of fulfillment, including the real-life concerns of work, money, and physical surround» ings. Finally, the QOLI was developed to provicie, ‘a measure of life satisfaction based on an articul lated theory—Quality of Life Theory—because mE] 1 way to increase the Development of the QOLI E E construct has such great integrative, heuristic, an I practical appeal to the fields of psychology an® medicine, among others. IE Quality of Life Theory assumes that a finite numbeg. i i of areas of human aspiration and fulfilment car T p be identified that are applicable to both clinica and nonclinical populations. Based on an exhaus- | tive review of the literature, especially cognitive mapping studies of human concerns tandewes| z & Inglehart, 1979; Andrews & Withey, 1976) and” | studies identifying particular areas of life that ar® associated with overall life satisfaction and hapyy | piness (Andrews & Withey, 1976; Campbell gE al., 1976; Cantril, 1965; Diener, 1984; Flanagar. 1978; Veenhoven, 1984), a comprehensive list o! 16 human concerns, or areas of life, was deve * oped for inclusion in the QOLI. An effort wax. made to be comprehensive but to limit the area¥ | of life to those that are empirically associated wit overall satisfaction and happiness. The 16 areag of life form the centerpiece for the QOLI. Th&S are Health, Self-Esteem, Goals-and-Values, Mone; Work, Play, Learning, Creativity, Helping, Love, Friends, Children, Relatives, Home, Neighborhoos> and Community. . Bach area of life assessed by the QOLI relate to the client's everyday functioning, making areas of life more closely related to change Ou side of the therapy consulting room than other measures, In addition, QOLI items related to lationships, surroundings, and finances especial reflect “external” as opposed to “internal” com cerns, helping clinicians avoid the “psychologist. error" (Abranison, Metalsky, & Alloy, 1989; Dolla: & Miller, 1950) in which internal (e.g., ognitie c Cc666668 é oode je umic) factors psychody © emphasized to the ing and exclusion of external factors in explais treating psychological disturbance. Overview of the QOLI The QOL is a brief but comprehensive measure of life satisfaction. It can assess outcome (with an overall score) and facilitate treatment planning by revealing arcas of satisfaction and dissatisfaction in 16 areas of life, such as love, work, and health. Each of these 16 areas of life is rated by respon- dents in terms of its importance to their overall happiness and in terms of their satisfaction with the area, Thus, the QOLI's content and scoring scheme directly reflect Quality of Life Theory in (a) the way in which life satisfaction is defined, (b) the way in which overall life satisfaction consists of the sum of satisfactions in particular areas of life, (€) the way in which Satisfaction ratings are weighted by importance, and (d) the 16 areas of life assessed by the instrument. With 32 items, the QOLI takes only about five minutes to complete. An additional five minutes is needed to score the hand-scored version of the test. The hand-scored version allows respondents to further explain their Satisfaction ratings by listing specific problems that interfere with their satisfaction in all 16 areas of life assessed by the QOLI. (This option is not available with the com- puterized version.) ‘The QOL! is readily understandable to clients be- cause it is written at a sixth-grade reading level and because its theoretical basis is commonsensi- cal, clear, and intuitively appealing. For example, the QOLI instructions state that “satisfied means how well your needs, goals, and wishes are being ‘met in this area of life.” Clients can readily see how ‘a gap between what they want and what they have ina particular area of life will determine their hap- piness or satisfaction. They can also see how areas of dissatisfaction contribute to their unhappiness, depression, alcohol abuse, etc. Finally, they can readily sce that areas of dissatisfaction are logical targets for treatment because their overall QOLI score will go up if their happiness with specific, valued parts of life goes up. An examination of a QOLI profile will suggest areas on which clients may want to focus attention. ‘The QOLI improves upon existing measures of life satisfaction and subjective well-being because it is based on an explicit theoretical framework (Hollandsworth, 1988; Ryll, 1989), it weights person's satisfaction by the importance he or she attaches to format that bas es overa of life that are explicitly defined for the first time in the literature and it has extensive validation relative to related! measures (Frisch ct al., 1992; Frisch, Villanueva Cornell, & Retzlaff, 1990; Lambert, Masters, & Ogles, in press; McMahon, 1994), The QOL has xl by several leaders in the coming eat of Tile, i isi satisfaction on 16 area been favorably eval field. Lambert et al, (in press), in their up* book, Practical Outcome Assessment, reter to He QOL instru ment available.” K: tuse of quality of life measures in general and the QOLI in particular as a measure of clinically sig nificant change and as a treatment planning tool “the most promising quality of life azdin (1993a) has endorsed the Uses of the QOLI “The QOL! is well suited for planning and evaluating medical and psychological treatment. This appli cation typically involves administering the QOL! before, during, and at the conclusion of treatment in order to chart a client’s progress and to detect specific areas of life that may require intervention Grisch, 1992b; Kazdin, 1993a). Many therapists administer the QOLI on a monthly or weekly basis in order to closely monitor their clients’ progress ‘The QOLI has been used successfully by research- ers and program administrators as a measure of quality assurance or outcome for both medical and psychological treatment based on various theoretical perspectives for a wide array of physi- cal and psychological disorders. In addition, the QOL has been successfully applied in non-health- related settings such as college counseling centers and businesses with organizational development programs. ‘The QOLI as a measure of treatment outcome. Because the QOLI is not a disorder or disea specific measure (Spilker, 1990b) and because all health care interventions aim to improve a patient's quality of life, regardless of their theoretical dif ferences (Vallowfield, 1990; Jenkins, 1992; Kazdin, 1993a, 1993b; Matarazzo, 1992; Seaman, 1989; Stewart & Ware, 1992; Strupp & Hadley, 1977), the QOL has potential as a universal outcome mea- sure. That is, the QOLI may be used to evaluate the effectiveness of psychological and medical treatments for virtually any mental or physical dis- based on any theoretical perspective. orde