Scale To Assess Therapeutic Relationships STAR-P
Scale To Assess Therapeutic Relationships STAR-P overview
Creator and Context
The Scale To Assess Therapeutic Relationships, Patient version (STAR-P) is a 12 item measure of the therapeutic relationship in community mental health care.
It was developed by Rebecca McGuire-Snieckus, Rosemarie McCabe, Jocelyn Catty, Lars Hansson and Stefan Priebe, and published in Psychological Medicine in 2007. A parallel clinician version, the STAR-C, allows both sides of the relationship to be measured.
Presenting Conditions
The STAR-P produces three subscales:
Positive collaboration (6 items)
Positive clinician input (3 items)
Non supportive clinician input (3 items, reverse scored)
Administration
Self completed by the patient in five minutes or less. No training is required. Each item is rated Never (0), Rarely (1), Sometimes (2), Often (3) or Always (4). Items describe the ongoing relationship rather than a fixed recall period.
Desired Audience
Adults with severe mental illness under the care of a community mental health team with a named care coordinator or key worker. It was developed in that setting and is not a general psychotherapy alliance measure.
In community mental health, the relationship with the care coordinator often is the intervention. The STAR is one of very few instruments that measures it from both sides, and the gap between the patient's view and the clinician's is frequently the most useful thing in the file.
Considerations
There is no published clinical cut off. The developers publish reference means from the development sample only. Any threshold quoted elsewhere is invented.
Responsiveness to change was not established in the development study.
Patient and clinician ratings correlate only weakly. They are not interchangeable.
It was developed in a UK inner city and a Swedish sample, and the authors note it remains to be tested outside Western and Northern European health systems.
It is designed for severe mental illness in community psychiatry. Positioning it as a generic therapy alliance measure would be a misuse.
How to score the Scale To Assess Therapeutic Relationships STAR-P
Conducting the assessment
The patient rates 12 items from 0 to 4. The three non supportive clinician input items are reverse scored before summing.
Interpretation
After reverse scoring, items are summed to give a total from 0 to 48. Higher scores indicate a better relationship.
There are no clinical cut offs. Reference means from the development sample: total 38.4 with a standard deviation of 12.0; positive collaboration 19.9; positive clinician input 9.3; non supportive clinician input 9.3.
Test retest reliability over two weeks was 0.76 for the total score.
Clinical Considerations
Collect both the patient and the clinician version. The divergence is the finding.
Do not apply a threshold. Compare to the reference means or to the person's own earlier rating.
Read the non supportive subscale carefully. It captures something the positive items cannot.
Scale To Assess Therapeutic Relationships STAR-P use cases
Measuring the therapeutic relationship in community mental health care
Comparing the patient and clinician view of the same relationship
Service level quality monitoring
Research in community psychiatry
Category
Feedback
Research Summary
McGuire-Snieckus, R., McCabe, R., Catty, J., Hansson, L., & Priebe, S. (2007). A new scale to assess the therapeutic relationship in community mental health care: STAR. Psychological Medicine, 37(1), 85 to 95.
McCabe, R., & Priebe, S. (2004). The therapeutic relationship in the treatment of severe mental illness: A review of methods and findings. International Journal of Social Psychiatry, 50(2), 115 to 128.
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