Impact Factor 3.161 | CiteScore 3.13
More on impact ›

Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2019.00575

Psychometric properties of Scale To Assess therapeutic Relationship - Japanese version (STAR-J)

 Asami Matsunaga1, 2*,  Sosei Yamaguchi1, Utako Sawada1, 3, Takuma Shiozawa4 and Chiyo Fujii1
  • 1National Institute of Mental Health (NIMH), Japan
  • 2Kitamura Institute of Mental Health Tokyo, Japan
  • 3Department of Psychiatric Nursing, Graduate school of Medicine, The University of Tokyo, Japan
  • 4National Institute of Mental Health (NIMH), United States

Background: A good therapeutic relationship between patient and psychiatrist is vital for effective mental health care. However, no instruments to assess this relationship are available in Japan. This study aimed to develop a Japanese version of a Scale To Assess Therapeutic Relationship (STAR-J), which measures such relationships from the viewpoints of both the patient (STAR-J-P) and clinician (STAR-J-C). We examined the tool’s psychometric properties, including factor structure, internal consistency, convergent validity, and test-retest reliability among psychiatric outpatients and psychiatrists.
Methods: Study participants comprised 139 outpatients and 10 psychiatrists. Exploratory factor analysis was conducted to investigate factor structure; to confirm cross-validity, the analysis was conducted using a different sample constituting 195 participants in an assertive community treatment program and their 91 case managers. Cronbach’s alpha was used to assess internal consistency. For STAR-J-P only, the intra-class correlation coefficient (ICC) was computed for 17 patients to determine test-retest reliability. Spearman’s correlation coefficients were calculated to examine convergent validity with service satisfaction, empowerment, and medication adherence.
Results: We identified a two-factor structure for STAR-J-P and a one-factor structure for STAR-J-C. Cronbach’s alphas for the two STAR-J-P factors were 0.897 and 0.645, and that for the STAR-J-C factor was 0.949. The ICCs for STAR-J-P factors 1 and 2 were 0.765 and 0.630, respectively. STAR-J-P and STAR-J-C were not significantly correlated. STAR-J-P factors 1 and 2 showed significant correlations with service satisfaction (factor 1: ρ=0.648, p<0.001; factor 2: ρ=0.238, p=0.005) and medication adherence (factor 1: ρ=0.508, p<0.001; factor 2: ρ=0.347, p<0.001), but only factor 1 showed a significant relationship with empowerment (ρ=0.283, p=0.001). STAR-J-C was significantly correlated only with empowerment (ρ=0.207, p=0.017).
Conclusions: STAR-J appears to be a useful instrument for assessing therapeutic relationships in the Japanese psychiatric outpatient setting. Further studies should test its validity and applicability in different mental health service settings.

Keywords: therapeutic relationship, validity, community mental health, scale, Reliability, factor structure

Received: 20 Nov 2018; Accepted: 22 Jul 2019.

Copyright: © 2019 Matsunaga, Yamaguchi, Sawada, Shiozawa and Fujii. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Ms. Asami Matsunaga, National Institute of Mental Health (NIMH), Tokyo, Japan,