The Reliability of the Achievement of Therapeutic Objectives Scale (atos): a Research and Teaching Tool for Psychotherapy

This study reports on the development and reliability of the Achievement of Therapeutic Objectives Scale (ATOS), a scale designed to assess patients attainment of specific treatment objectives identified as important change mechanisms, both theoretically and clinically in Short-Term Dynamic Psychotherapy (STDP). These items, which also represent common factors across therapies include: patients’ recognition of defensive behavior (insight); desire to change the maladaptive responses (motivation); visceral experience of the conflicted feeling (exposure); and adaptive expression of those feelings (new learning). In addition, there is a need to regulate the anxiety or inhibition in the session, and improve the sense of self and others. The ATOS Scale was used to assess patient responses in videotaped STDP in five reliability studies. Three studies were conducted by the originators of the scale at the Psychotherapy Research Program at Harvard Medical School. Two additional studies were conducted at the Psychiatric Clinic-Affori, Università Statale, in Milano, Italy, and at the Norwegian University of Science and Technology (NTNU) in Trondheim, Norway. Patients in all five studies had received an Axis II diagnosis and were participating in individual outpatient psychotherapy on a weekly basis. These studies demonstrate that the ATOS is a reliable instrument, and show a clear “dose-response” relationship between training on the scales and reliability. At NTNU, there is ongoing work on training, reliability and validity of the ATOS scale.