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Brigham Young University, 2University of Wurzburg, and 3Center for Change, Orem, Utah
Abstract
The authors developed the Theistic Spiritual Outcome Survey (TSOS) to measure the spiritual outcomes of psychotherapy
from a theistic spiritual perspective. A 17-item version of the TSOS was found to have adequate reliability and validity in a
sample of college students. Three factors emerged from the analyses that corresponded to the Love of God, Love of Others,
and Love of Self subscales. Correlations with measures of psychological outcomes were statistically significant. In
subsequent analyses, the TSOS was administered over an 8-week period to a sample of inpatient women with eating
disorders and to two samples from inpatient psychological clinics in Germany. The analyses resulting from these studies
were also supportive of the psychometric properties and clinical sensitivity of the TSOS.
Correspondence: P. Scott Richards, 340 MCKB, Department of Counseling Psychology, Brigham Young University, Provo, UT 84602.
E-mail: scott_richards@byu.edu
ISSN 1050-3307 print/ISSN 1468-4381 online # 2005 Society for Psychotherapy Research
DOI: 10.1080/10503300500091405
458
459
460
Table I. Study 1: Item commonalities and rotated pattern matrix for Theistic Spiritual Outcome Survey items in the college student sample.
Rotated pattern matrix
Item
1. I had feelings of love toward others. (LO)
2. I felt there is a spiritual purpose for my life. (LG)
3. I felt good about my moral behavior. (LS)
4. I wanted to make the world a better place. (LO)
5. I felt peaceful. (LS)
6. I felt appreciation for the beauty of nature. (LO)
7. I felt like praying. (LG)
8. I felt spiritually alive. (LG)
9. I felt worthy. (LS)
10. My behavior was congruent with my values. (LS)
11. I felt love for all of humanity. (LO)
12. I had faith in Gods will. (LG)
13. I felt like helping others. (LO)
14. I felt Gods love. (LG)
15. I praised and worshipped God. (LG)
16. I felt forgiveness toward others. (LO)
17. I loved myself. (LS)
Communality
.33
.64
.55
.45
.47
.38
.68
.68
.55
.41
.50
.67
.51
.78
.73
.35
.37
.09
.73
.01
/.01
.01
/.12
.87
.62
.01
.08
.09
.84
.01
.93
.85
.07
/.07
.42
.06
.05
.75
.21
.62
.03
.02
/.13
.10
.66
/.10
.71
/.04
.08
.46
.01
.11
.05
.71
/.12
.53
.10
/.11
.26
.82
.51
/.19
.07
/.11
/.04
/.08
.11
.65
Note. Factor 1 was labeled love of God (LG), Factor 2 love of others (LO), and Factor 3 love of self (LS).
Scale
TSOS
Love of God
Love of Others
Love of Self
Outcome Questionnaire
OQ-45 total
Symptom Distress
Relationship Conflict
Social Role Conflict
TSOS
total
Love of
God
Love of
Others
.91
.81
.81
.58
.58
.59
/.33
/.38
/.55
/.38
/.25
/.28
/.45
/.31
/.20
/.23
/.39
/.26
Love of
Self
/.48
/.54
/.61
/.45
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462
Results
Correlations with measures of religiousness and
spiritual well-being. The Pearson correlations of the
TSOS with the Religious Orientation Scale (ROS)
Table III. Study 2: Correlations of Theistic Spiritual Outcome Survey total score and subscales with religious and psychological measures in
eating-disordered patient sample.
Scale
TSOS total
Love of God
ROS
Intrinsic
Extrinsic
.37***
.15
.53***
.18
SWBS
Religious Well-Being
Existential Well-Being
.57***
.49***
.71***
.43***
Outcome Questionnaire
OQ-45 total
Symptom Distress
Relationship Conflict
Social Role Conflict
/.35***
/.31***
/.37***
/.23*
EAT
BSQ
Global Self-Esteem (MSEI)
/.01
/.27**
.33***
Love of Others
.05
/.04
Love of Self
.17
.13
.19*
.33***
.29**
.45***
/.18
/.15
/.27**
/.10
/.31***
/.28**
/.31***
/.23*
/.44***
/.43***
/.35***
/.29**
.04
/.21*
.26**
.08
/.07
.23*
/.18
/.38***
.37***
Note. TSOS/Theistic Spiritual Outcome Survey; ROS/Religious Orientation Scale; SWBS/Spiritual Well-Being Scale; EAT /Eating
Attitudes Test; BSQ/Body Shape Questionnaire; MSEI/Multidimensional Self-Esteem Inventory.
*p B/.05. **p B/.01. ***p B/.001.
da
TSOS total
Spiritual
.58
M
45.3 46.4 48.9 49.9 49.3 51.4 52.9 51.9
SD
11.9 11.3 10.3 9.2 10.3 10.3 8.3 10.8
Cognitive
.23
M
41.0 43.7 42.7 40.7 40.3 41.6 41.6 43.2
SD
9.4 11.1 8.8 10.4 8.5 10.2 13.3 9.8
Support
M
SD
Week
Measure/
group
463
.32
39.1 40.9 40.9 41.8 45.6 42.5 45.2 43.1
11.8 11.1 12.0 14.8 14.8 16.9 14.5 13.0
TSOS translation. A native German doctorallevel psychologist translated the 17-item English
version of the TSOS into German. A native English
speaker then verified the accuracy of the translation
by retranslating the German version of the
TSOS back into English. Once the accuracy of the
German translation of the TSOS was verified, the
TSOS- German translation (TSOS-GT) was then
used in a comparative inpatient treatment outcome
study.
Treatment clinics and participants. Two inpatient
psychiatric clinics in Germany participated in the
treatment outcome study. Psychotherapists in both
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465
Table V. Correlations of Theistic Spiritual Outcome Survey total score and subscales with religious and psychological measures in
german psychiatric clinics (Study 3).
Scale
Importance of Personal Belief
Beliefs a Source of Consolation
SCL-90-R Global Severity Index
FPI Satisfaction With Life
TSOS total
NA
NA
/.24**
.32**
Love of God
Love of Others
.64***
.73***
/.08
.16**
Love of Self
/.01
.25**
/.49***
.47**
.10*
.27**
/.14**
.35**
Note. TSOS/Theistic Spiritual Outcome Survey; NA /not applicable; SCL-90-R/Symptom Checklist-90-Revised; FRI/Freiburg
Personality Inventory.
*p B/ .05. **p B/.01. ***p B/.001.
Pre
Post
37.4
12.0
44.9*
11.7
14.5
5.3
17.3*
5.0
13.1
4.2
14.8*
4.0
9.8
4.5
12.8*
4.2
Secular clinic
Pre
Post
39.8
11.8
40.3
10.7
12.7
5.7
12.1
5.5
15.7
4.2
15.3
3.6
11.1
4.3
12.7*
3.9
.63
d
.04
/.11
.49
/.10
.41
.69
.39
466
References
Bergin, A. E. (1980). Psychotherapy and religious values. Journal
of Consulting and Clinical Psychology, 48 , 75 /105.
Bryk, A. S., & Raudenbush, S. W. (1992). Hierarchical linear
models: Applications and data analysis methods . Newbury Park,
CA: Sage.
Cooper, P. J., Taylor, M., Cooper, Z., & Fairburn, C. G. (1987).
The development and validation of the Body Shape Questionnaire. International Journal of Eating Disorders , 6 , 48 /494.
Derogatis, L. R. (1983). SCL-90: Administration, scoring, and
procedures manual for the revised version . Baltimore: Clinical
Psychometric Research.
Ellison, C. W. (1983). Spiritual well-being: Conceptualization and
measurement. Journal of Psychology and Theology, 11 , 330 /340.
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Zusammenfassung
Entwicklung und Validierung des theistisch
spirituellen Ergebnisbogens
Die Autoren entwickelten den theistisch spirituellen Ergebnisbogen (Theistic Spiritual Outcome Survey
[TSOS]), um die spirituellen Ergebnisse von Psychotherapie aus einer theistisch spirituellen Sichtweise zu messen.
Eine 17-Itemversion des TSOS zeigte angemessene Werte
fur Zuverlassigkeit und Gultigkeit bei einer Stichprobe von
Collegestudenten. Drei Faktoren wurden extrahiert und
als Gottesliebe, Liebe zu anderen und Selbstliebe benannt.
Es gab signifikante Korrelationen mit den Maen anderer
psychologischer Tests. In den nachfolgenden Analysen
wurde TSOS uber einen Zeitraum von acht Wochen einer
Stichproben essgestorter Patientinnen gegeben und an
zwei Stichproben stationarer Patienten in psychotherapeutischer Behandlung in Deutschland. Die Ergebnisse dieser
Untersuchungen weisen ebenfalls auf gute psychometrische Eigenschaften und eine klinische Sensibilitat von
TSOS hin.
Resume
Developpement et validation du Theistic Spiritual
Outcome Survey
Les auteurs ont developpe le Theistic Spiritual Outcome
Survey (TSOS) pour mesurer les issues spirituelles de la
psychotherapie dun point de vue theiste et spirituel. Une
version en 17 items du TSOS a montre une fidelite et une
validite adequates dans un echantillon detudiants universitaires. Trois facteurs emergeant des analyses correspondaient aux sous-echelles de lAmour de Dieu,
lAmour des autres et lAmour de soi. Des correlations
avec des mesures du resultat psychologique etaient statistiquement significatives. Dans des analyses consecutives, le
TSOS a ete administre pendant 8 semaines a` un echantillon de femmes hospitalisees souffrant de troubles de
lalimentation ainsi qua` 2 echantillons issus de cliniques
psychologiques en Allemagne. Les analyses resultant de
ces etudes soutenaient egalement les proprietes psychometriques et la sensibilite clinique du TSOS.
Resumen
Desarrollo y validacion del relevamiento testico
espiritual
Los autores desarrollaron el Relevamiento del Resultado
Teista Espiritual (TSOS) para medir los resultados espirituales de la psicoterapia desde una perspectiva espiritual
testa. Se considero que la version de 17-tems de la TSOS
tena una confiabilidad y validez adecuadas para una
muestra de estudiantes univesitarios. De los analisis
emergieron tres factores que correspondieron a las subescalas de Amor a Dios, Amor a Otros y Amor a s mismos.
Las correlaciones con las mediciones de los resultados
psicologicos fueron estadsticamente significativs. En analisis subsiguientes, se administro el TSOS por un perodo
de ocho semanas a una muestra de pacientes femeninas
internadas por desordenes alimentarios y a dos muestras
de internadas en clnicas psicologicas de Alemania. Los
analisis resultantes de estos estudios tambien confirmaron
las propiedades psicometricas y la sensibilidad clnica del
TSOS.
Resumo
Desenvolvimento e Validacao do Inventario de
Resultado Testa-Espiritual
Os autores desenvolveram o Inventario de Resultado
Testa-Espiritual (IRTE) para avaliar os resultados espirituais da psicoterapia a partir de uma perspective testaespiritual. A versao de 17itens do IRTE foi considerada
adequada em termos de fidelidade e validade numa
amostra de estudantes universitarios. A partir das analises
emergiram tres factores que correspondem a`s subescalas
de Amor de Deus, Amor de Outros e Amor-proprio. As
correlacoes com as medidas psicopatologicas foram estatisticamente significativas. Em analises subsequentes, o
IRTE foi administrado durante um perodo de 8 semanas a
uma amostra de mulheres internadas com perturbacao
alimentar e a duas amostras de pacientes internados em
Sommario
Sviluppo e convalida dei risultati dei sondaggi
teistico spirituali
Gli autori hanno sviluppato la TSOS per misurare i
risultati spirituali di una psicoterapia da una prospettiva
spirituale teistica. Una versione di 17 item del TSOS e`
stata trovata per avere laffidabilita` e validita` sufficiente in
un campione di studenti delluniversita`. Tre fattori sono
emersi dalle analisi che corrispondevano alle sottoscale :
lamore di Dio, lamore di altri, lamore di se`. Le
correlazioni con le misure dei risultati psicologici erano
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