Therapist Rating Scale-2 (TRS-2)

The Therapist Rating Scale-2 (TRS-2) is presented below along with information on scoring. For a more comprehensive overview of the TRS-2 including examples of scoring and reporting, contact us at admin@rockwoodpsyc.com.

2020 Version

 THE THERAPIST-RATING SCALE-2 (TRS-2)

 

 Liam E. Marshall, PhD, RP, ATSAF, &

 

W. L. Marshall, O.C, F.R.S.C., Ph.D. (C.PSYCH)

TRS-2 - RATING FORM

RATINGS

 

NOTE: “Average” is compared to non-offenders; “normal, average, non-offending, everyday” people on the street of a comparable socio-economic status.

 

• Level 4 = Optimal Functioning
• Significantly better than average
• Most group participants will not achieve this level on any topic or category
• Level 3 = Normative (IS THE TARGET OF TREATMENT)
• Average functioning
• Mostly achieves target of treatment
• Might still have a little work to do, but no worse than non-offenders
• Level 2 = Approaching Normative
• Approaching average functioning
• Starting to understand and see value in topic/category
• May achieve level 3 post-treatment
• Level 1 = Unsatisfactory
• Needs to redo treatment component

 

Information on Ratings

 

• Levels should vary across topics (Sense of Agency, Empathy, Prosocial Attitudes, etc.)
• Levels should vary between categories (Intellectual Understanding, Acceptance/Demonstration)
• Avoid “halo” and opposite (“pitchfork”) effect
• When learning to use, have therapists complete separately and independently, and then discuss differences – aiming for inter-rater agreement 8-9 times out of 10 (i.e., does not have to be perfect agreement on all items)

 

HOW TO DO IT:

• Using the descriptors (e.g., “Believes in own ability to control life”) below each topic HEADING (e.g., “SENSE OF AGENCY”), rate your impressions of where the client/patient is at this moment in terms of his “Intellectual Understanding” of the issue and how much they have taken it on board (i.e., Acceptance/Demonstration) using the described 4-point rating scale.
• Intellectual Understanding is often reflected by the client/patient being able to say the right things in therapy but not necessarily doing so outside of the therapy setting. Intellectual understanding usually, but not always, occurs prior to actually doing the right things as a habit. For example, a client/patient may espouse appropriate attitudes in treatment, but may not totally behave in a way reflective of these better attitudes.
• Acceptance/Demonstration is when an client/patient is not just saying the right things, but also putting them into practice. For example, being empathic toward others, espousing appropriate attitudes to people outside therapy, contacting supports in the community, establishing relationships with pro-social peers.
• As an example of QUALITY OF FUTURE PLANS, a client/patient might report seeing the importance of establishing good community supports and thus receive a 3 on intellectual understanding of the topic, but not have actually contacted, or established, any good community supports yet and therefore receive a 1 or 2 on acceptance/demonstration of the issue.
• When struggling with a particular topic, it may be useful, until comfortable with that topic, to rate the client/patient on each of the descriptors of the topic and average them out.

 

WHEN TO DO IT

• It is suggested to use the TRS-2 approximately halfway through a client/patient’s time in treatment and then again at the end of treatment. Using the TRS-2 halfway through treatment helps therapists to have a sense of where the client/patient is well before the end of the program in order to direct the remaining time in treatment to the most pressing issues. Using the TRS-2 at the end of treatment will give a sense of how close the client/patient is to “normal functioning” and inform report writing. Reports based on the TRS-2 can inform on whether subsequent treatment is necessary and what the focus of subsequent treatment should be. We recommend using the Topics of the TRS-2 as headings in treatment reports and including the ratings both within the body of reports, and attaching a copy of the complete TRS-2 to the report; parole boards and supervisors report this to be helpful. Redacted examples of reports are given below.

INTERPRETATION

• Although the TRS-2 has not yet received extensive empirical validation, it is based on the original TRS (17-item version), which has received some examination (e.g., good inter-rater reliability), and what is known about dynamic risk in offenders. At the current moment the TRS-2 is intended as a guide for therapists and others making post-treatment decisions about offenders.
• Clients/patients are considered to have reached the target of treatment when they achieve a score of 3 on an item. Ideally, clients/patients will achieve a 3 on both Intellectual Understanding and Acceptance/Demonstration for each of the 10 topics. However, this is unlikely to occur and consequently therapists will have to use good judgement about the overall impact of treatment. In a recent study, the total score of recidivists (M= 44.57, SD= 6.85) was statistically significantly lower than non-recidivist offenders (M= 51.07, SD= 5.07; possible range of the TRS-2 total score is 20-80), t = 4.78, p < .001, suggesting total scores above 50 may be indicative of treatment success. Total scores less than 45 likely indicate a need for further treatment. This pattern, of higher scores indicating lower risk for recidivism, was found for both the Intellectual Understanding and Acceptance/Demonstration categories, both p < .001. However, more research is needed to better define cutoffs for treatment success and this example is provided as a possible guideline.
• The TRS-2 can be a helpful guide to writing treatment reports and redacted exemplars are included at the end of this package. We include the TRS-2 at the beginning of the report, and then subsequent paragraphs explain and give rationale for the scoring, finally, a “Conclusions and Recommendations” section can comment on treatment induced risk reduction, if appropriate. Parole boards and supervisors also report the information from the TRS-2 to be helpful.

TO WHOM CAN I APPLY THE TRS-2?

• The original TRS was developed for use with sexual offenders. However, the issues in the TRS-2 apply to many forms of offending behaviour and the TRS-2 has been used with anger management, domestically violent, and mentally disordered clients/patients. The TRS-2 reflects all of those dynamic risk factors for offending in general, commonly referred to as the “Big Eight”, such as antisocial attitudes, antisocial associates, general self-regulation problems, and relationship issues.

WHO CAN USE THE TRS-2

• The TRS-2 is a license free measure; that is, there is no cost associated with its use. However, please use the reference below to cite the measure in any publications or presentations.
• Using the TRS-2 does not require any particular educational level (e.g., Bachelor, Masters, PhD degrees) in any particular discipline (e.g., Psychology, Psychiatry, Social Work). However, knowledge of dynamic risk factors in offenders is recommended and training programs designed to enhance knowledge of these issues in offenders are available (e.g., rockwoodpsyc.com).

 

REFERENCE FOR THE SCALE

 

Marshall, L. E., & Marshall, W. L. (2020). The Therapist Rating Scale-2. Unpublished Manuscript available from the first author: liam@rockwoodpsyc.com.

 

RESULTS OF RESEARCH USING THE TRS-2

 

Psychometrics

 

• The internal consistency of the TRS-2 has been found to be high with alphas of .97 for the total score, .96 for Intellectual Understanding, and .95 for Acceptance/Demonstration.

 

REFERENCE: Marshall, L. E., Marshall, W. L., Humphries, S., Serran, G. A., O’Brien, M. D. (September, 2010). A Therapist Rating Scale for Determining Treatment-Induced Change. Paper presented at the 11th annual conference of the International Association for the Treatment of Sexual Offenders (IATSO). Oslo, Norway.

 

• Inter-rater reliability of the scale has been demonstrated to be excellent with intraclass correlation coefficients of .90 for Intellectual Understanding, .96 for Acceptance/Demonstration, and .95 for the total scale score.

 

REFERENCE: Marshall, L. E., Marshall, W. L., Gates, M., Alguire, T., & Humphries, S. (October, 2010). A Therapist Rating Scale for Determining Treatment-Induced Change. Paper presented at the 29th annual conference of the Association for the Treatment of Sexual Abusers (ATSA). Phoenix, AZ.

 

• In a preliminary retrospective study the TRS-2 demonstrated encouraging predictive ability for sexual recidivism (see Table below). A sample of ninety-six of the offenders in our most recent outcome study were scored on the TRS-2 from therapist reports on those offenders by a rater blind to the results of the outcome study. Under these less than ideal conditions, scores on the TRS-2 Intellectual Understanding and Acceptance/Demonstration categories, and the total scores demonstrated a statistically significant ability to predict sexual reoffending (AUC = .75, 78, & .77, respectively, all p < .001) – see table below.

 

REFERENCE: Marshall, L. E., Marshall, W. L., Humphries, S. (February, 2012). A Therapist Rating Scale for Determining Treatment-Induced Change. Paper presented at the annual conference of the Partner Assault Response program of Eastern Ontario (P.A.R.E.O.). Gananoque, Canada.