Session Evaluation Questionnaire- Client Form (SEQ-C)

1. Abstract

The Session Evaluation Questionnaire – Client Form (SEQ-C) is one of the most widely utilized, psychometrically robust self-report instruments in psychotherapy process-outcome research. Developed principally by William B. Stiles and validated across multiple iterations (Stiles, 1980; Stiles & Snow, 1984a, 1984b; Stiles et al., 1994), the SEQ-C captures clients' immediate, post-session subjective appraisals of an individual therapy hour and their accompanying affective states. The instrument comprises 21 bipolar adjective items framed within a 7-point semantic differential format. Factor analytic investigations across diverse clinical populations and theoretical orientations consistently confirm a four-dimensional latent architecture partitioned into two primary evaluative domains: Session Evaluation, which incorporates the subscales of Depth (measuring the perceived power, value, and emotional or cognitive weight of the session) and Smoothness (indexing the degree of comfort, ease, pleasantness, and lack of friction in the session); and Post-Session Mood, which encompasses Positivity (evaluating affective valence, confidence, and happiness) and Arousal (capturing physiological and subjective activation, energy, and alertness).

Empirical evaluations demonstrate that the SEQ-C exhibits high internal consistency, with Cronbach's alpha coefficients regularly exceeding .85 to .92 for Depth, Smoothness, and Positivity, and .75 to .82 for Arousal. The scale exhibits robust construct, convergent, and predictive validity, correlating systematically with therapeutic alliance indices (e.g., the Working Alliance Inventory), the Session Impacts Scale, and subsequent treatment outcomes. Because it requires less than three minutes to administer immediately following a consultation, the SEQ-C serves as a vital clinical feedback and routine outcome monitoring (ROM) instrument. It allows clinicians and researchers to track micro-level session trajectories, differentiate between comfortable yet unproductive sessions versus difficult yet clinically transformative encounters, detect covert ruptures in the therapeutic alliance, and unpack the nuanced mechanisms that facilitate psychotherapeutic change.

2. Keywords

Session Evaluation Questionnaire, SEQ-C, William B. Stiles, psychotherapy process research, Session Depth, Session Smoothness, Post-Session Mood, semantic differential, measurement-based care, routine outcome monitoring, therapeutic alliance, psychometrics

3. Authors

The primary architect of the Session Evaluation Questionnaire is William B. Stiles, Ph.D., Professor Emeritus of Psychology at Miami University in Oxford, Ohio, and Adjunct Professor of Psychology at Appalachian State University. Over four decades, Dr. Stiles has served as a preeminent scholar in psychotherapy research, renowned for establishing the assimilation model of problematic experiences, verbal response modes, and the methodological foundations of session-level assessment.

Substantial refinements, structural validations, and comparative psychometric advancements of the instrument (specifically the Form 4 and Form 5 versions, including parallel client and therapist formats) were conducted in collaboration with prominent clinical psychologists and researchers based at the Mental Health Research Council (MRC) / Economic and Social Research Council (ESRC) Social and Applied Psychology Unit at the University of Sheffield and the University of Leeds, United Kingdom. Key co-investigators include:

• Shirley Reynolds, Ph.D. – Professor of Clinical Psychology, University of Reading / University of East Anglia, specializing in evidence-based psychological treatments for affective disorders.
• Gillian E. Hardy, Ph.D. – Professor of Clinical Psychology, Department of Psychology, University of Sheffield, recognized for extensive empirical work on the therapeutic relationship, alliance ruptures, and process-outcome dynamics.
• Anne Rees, Ph.D. – Clinical researcher and psychologist, University of Sheffield, focusing on the comparative evaluation of cognitive-behavioral and psychodynamic-interpersonal therapies.
• Michael Barkham, Ph.D. – Professor of Clinical Psychology, University of Sheffield, pioneer of the CORE (Clinical Outcomes in Routine Evaluation) system and leading expert in routine outcome monitoring and psychological service benchmarking.
• David A. Shapiro, Ph.D. – Emeritus Professor, University of Sheffield, renowned for landmark clinical trials investigating the efficacy and process mechanisms of brief psychotherapies (e.g., the Sheffield Psychotherapy Projects).

Primary Inquiries & Academic Contact: William B. Stiles, Ph.D., Department of Psychology, Miami University, Oxford, OH 45056, USA. Email: [email protected].

4. Purpose

Psychotherapy is an inherently dynamic, non-linear, and micro-developmental enterprise. While traditional macro-outcome instruments (e.g., the Beck Depression Inventory, SCL-90-R, or CORE-OM) quantify broad clinical changes across weeks, months, or years, they remain methodologically blind to the immediate, intra-session phenomena that drive these distal shifts. The Session Evaluation Questionnaire – Client Form was engineered to resolve this empirical blind spot by providing an efficient, reliable, and standardized operationalization of the “session impact”—the psychological imprint left upon the client directly at the conclusion of a therapeutic hour.

The primary clinical and empirical purposes of the SEQ-C encompass:

• Capturing Micro-Process Dimensions: The SEQ-C isolates how clients experience the therapeutic work itself. Rather than evaluating therapist technique or global symptomatic distress, it captures whether a session was experienced as impactful, evocative, and substantive (Depth) versus easy, flowing, and comfortable (Smoothness).
• Distinguishing Productive Strain from Superficial Ease: A critical contribution of the SEQ-C is its empirical demonstration that Depth and Smoothness are distinct, often orthogonal constructs. A psychotherapy session can be intensely valuable and deep precisely because it was painful, taxing, and difficult (high Depth, low Smoothness). Conversely, a session marked by jovial conversation, high rapport, and pleasant dialogue may feel remarkably smooth but yield minimal structural or emotional transformation (high Smoothness, low Depth). The SEQ-C prevents clinicians from conflating immediate client comfort with therapeutic efficacy.
• Monitoring Post-Session Emotional State: Through the Positivity and Arousal dimensions, the SEQ-C serves as a vital post-session affective barometer. Monitoring a client's immediate feeling state enables practitioners to evaluate whether the client is leaving the consulting room emotionally dysregulated, agitated, deeply depressed, or, conversely, empowered, relieved, and grounded. This immediate data point is essential for risk management, therapeutic titration, and closing phases of trauma-focused interventions.
• Facilitating Measurement-Based Care (MBC) and Routine Outcome Monitoring (ROM): Because the instrument comprises only 21 brief items and can be completed in approximately 2 to 3 minutes, it imposes minimal administrative burden. In contemporary clinical settings utilizing MBC paradigms, longitudinal SEQ-C data can be graphed session-by-session to identify alliance ruptures, plateaus in engagement, or sudden gains.
• Interpersonal Perception and Dyadic Concordance: Administered alongside the Session Evaluation Questionnaire – Therapist Form (SEQ-T), the SEQ-C allows researchers and supervisors to calculate dyadic divergence scores. Discrepancies between therapist and client appraisals—such as when a therapist views a session as deeply transformative while the client perceives it as hostile and shallow—serve as potent markers of interpersonal misalignment, unaddressed resistance, or impending premature termination.

5. Psychological Construct

The construct measured by the SEQ-C is multidimensional, tapping into both evaluative cognitive appraisals of the interactional process and immediate affective states. Based on extensive factor analyses spanning decades of psychotherapy research (Stiles, 1980; Stiles et al., 1994; Stiles, Gordon, & Lani, 2002), the instrument maps onto two overriding psychological domains, each bifurcated into two distinct factors:

Domain 1: Session Evaluation

Session Evaluation assesses the participant's cognitive-affective appraisal of the quality, atmosphere, and substantive value of the therapeutic encounter. This domain does not evaluate technical compliance or theoretical fidelity; rather, it measures phenomenological impact along two primary axes:

• Depth: Defined as the perceived power, value, meaningfulness, and emotional weight of the session. A session scoring high in Depth is experienced by the client as profound, penetrating, intensely focused, and substantial. Items anchoring this dimension include valuable–worthless, shallow–deep, full–empty, weak–powerful, and special–ordinary. High Depth reflects sessions where significant cognitive restructuring, emotional catharsis, painful insight, or deep relational processing occurred. In contrast, low Depth characterizes sessions perceived as trivial, uninspired, superficial, or disjointed.
• Smoothness: Defined as the degree to which the session was experienced as comfortable, harmonious, safe, and free from interpersonal conflict or emotional distress. Anchored by bipolar pairs such as difficult–easy, relaxed–tense, unpleasant–pleasant, rough–smooth, and comfortable–uncomfortable, Smoothness captures the absence of friction. High Smoothness denotes a soothing, reassuring, and tranquil hour where the therapeutic dialogue progressed without tension or anxiety. Low Smoothness reflects a rough, taxing, highly stressful, or conflictual session, which may signify an alliance rupture, an overwhelming affective Abreaction, or intense confrontation of avoided trauma.

Domain 2: Post-Session Mood

Post-Session Mood assesses the immediate feeling state of the client at the exact moment of leaving the therapeutic setting (“Right now I feel…”). Unlike enduring mood states measured by instruments like the PANAS or trait inventories, this domain captures the immediate emotional residue of the therapeutic dialogue along two orthogonal axes of affect:

• Positivity: Taps into the hedonic valence and sense of psychological security experienced by the respondent. It is characterized by feelings of happiness, confidence, safety, and benevolence versus sadness, fear, and hostility. Key adjective pairs loading onto this dimension include happy–sad, angry–friendly, confident–afraid, uncertain–definite, and pleased–displeased. High Positivity indicates that the client departs the session feeling uplifted, resolved, efficacious, and interpersonally warm. Low Positivity reflects enduring despair, apprehension, agitation, or demoralization.
• Arousal: Measures the level of physiological, energetic, and somatic activation versus quiescence. Anchored by items such as calm–excited, moving–still, slow–fast, energetic–peaceful, and quiet–aroused, Arousal is independent of affective valence. A client may be in a high-arousal positive state (exuberant, energized, mobilized for action) or a high-arousal negative state (agitated, anxious, panicked). Conversely, low arousal can reflect peaceful serenity or depressive lethargy. In psychotherapy process research, tracking Arousal allows researchers to evaluate whether emotional processing adhered to optimal zones of arousal (neither emotionally numb nor flooded).

6. Theoretical Framework

The conceptual architecture of the Session Evaluation Questionnaire is anchored in a synthesis of Osgood's Semantic Differential Theory of Meaning, Humanistic/Experiential Process Theories, and the Generic Model of Psychotherapy.

Osgood's Dimensional Theory of Affect and Meaning

In developing the SEQ, Stiles (1980) drew heavily upon the structural psycholinguistic research of Charles E. Osgood, George Suci, and Percy Tannenbaum (1957). Osgood demonstrated that human affective appraisal across diverse cultures and languages can be universally mapped onto three fundamental, orthogonal semantic dimensions: Evaluation (good-bad), Potency (strong-weak), and Activity (active-passive). Stiles adapted this framework to clinical interactions:

• The Depth index represents a clinical fusion of Osgood's Evaluation and Potency dimensions. A deep session is one that is both potent (powerful, full) and valuable.
• The Smoothness index reflects a specialized clinical manifestation of Evaluation combined with low tension or low conflict (pleasant, relaxed, smooth).
• The Post-Session Mood dimensions directly parallel the circumplex models of affect (e.g., Russell, 1980; Watson & Tellegen, 1985), where affective states are parsed along axes of Valence (Positivity) and Physiological Activation (Arousal).

The Generic Model of Psychotherapy and Interactional Dynamics

The SEQ operates under the theoretical assumptions of the Generic Model of Psychotherapy articulated by Orlinsky and Howard (1986). In this model, the therapeutic enterprise comprises multiple concentric levels: input variables (patient/therapist pre-existing traits), the therapeutic contract, process operations (technical interventions), the therapeutic bond, in-session therapeutic impacts, and distal treatment outcomes.

The SEQ-C specifically operationalizes the in-session impacts and the immediate micro-outcomes. According to Stiles, Reynolds, et al. (1994), these immediate impacts represent the bridge linking technical interventions (e.g., interpretation, two-chair work, exposure) to long-term symptomatic remission. Therapeutic change does not occur in an abstract vacuum; it is mediated through the subjective phenomenological reality of specific hours. If a therapist delivers an evidence-based intervention, but the client experiences the hour as low in Depth and highly uncomfortable without resolution, the intended technical mechanism is likely compromised.

The Assimilation of Problematic Experiences Model

Stiles' later theoretical work on the Assimilation Model (Stiles et al., 1990; Stiles, 2002) provides an explanatory framework for why Depth and Smoothness diverge. The Assimilation Model posits that psychological difficulties consist of non-assimilated “voices” or problematic cognitive-affective schema that have been warded off from the dominant self-narrative. When therapy approaches unassimilated, highly threatening material (stages of “unwanted thoughts” or “clarification”), the client experiences intense psychological discomfort, anxiety, and turbulence. Consequently, sessions characterized by active, transformative assimilation work are routinely rated as High Depth but Low Smoothness. As the problematic experience becomes integrated and understood (stages of “insight” and “working through”), subsequent sessions shift toward High Depth and High Smoothness. The SEQ-C thus serves as a sensitive seismograph tracking the client's passage through these developmental stages of change.

7. Validity

The psychometric validity of the SEQ-C has been established across hundreds of clinical studies encompassing individual, couple, and group therapies, spanning outpatient clinics, university counseling centers, and controlled clinical trials (e.g., Sheffield Psychotherapy Projects).

Construct and Factorial Validity

Construct validity is substantiated by the replication of the four-factor model across highly disparate theoretical orientations, including Cognitive Behavioral Therapy (CBT), Psychodynamic-Interpersonal Therapy (PIT), Person-Centered Therapy, and Emotion-Focused Therapy (EFT). Confirmatory factor analytic investigations by Stiles et al. (1994), Reynolds et al. (1996), and Stiles, Gordon, and Lani (2002) demonstrate that items load cleanly onto their designated constructs without problematic cross-loadings. The distinct separation between Depth and Smoothness confirms that clients differentiate between how “substantive” an hour was versus how “pleasant” it felt.

Convergent and Concurrent Validity

The SEQ-C demonstrates strong, theoretically coherent correlations with several established psychotherapy process measures:

• Working Alliance Inventory (WAI): SEQ-C Smoothness and Positivity correlate moderately to strongly with the WAI Goal, Task, and Bond subscales ($r = .45$ to $.68, p < .001$), confirming that collaborative, secure relationships foster comfortable, low-friction sessions. SEQ-C Depth correlates robustly with the WAI Task subscale ($r = .50$ to $.62$), indicating that sessions perceived as deep are those in which clients actively engage in meaningful therapeutic tasks.
• Session Impacts Scale (SIS): In the landmark validation by Stiles et al. (1994), SEQ Depth exhibited high convergent validity with the SIS Task Impacts subscale ($r = .65$ to $.74$), which indexes insight, cognitive restructuring, and therapeutic problem-solving. SEQ Smoothness correlated strongly with the SIS Relationship Impacts subscale ($r = .58$), confirming its sensitivity to the supportive, comforting qualities of the therapeutic presence.
• Agnew Relationship Measure (ARM): Studies within the National Health Service (NHS) in the UK have demonstrated that SEQ Positivity and Smoothness correlate significantly with the ARM dimensions of Core Bond and Client Empowerment.

Predictive and Outcome Validity

The SEQ-C displays predictive utility regarding both intermediate session-to-session gains and final clinical outcomes. Multilevel growth curve modeling (e.g., Stiles et al., 2002; Mallinckrodt, 1993) has shown that:

• Mean levels of Depth across treatment significantly predict post-treatment symptom reduction (assessed via instruments such as the BDI and CORE-OM), even after controlling for baseline severity. Clients who consistently experience their sessions as deep demonstrate greater structural psychological change.
• Acute drops in Smoothness often predict therapeutic ruptures. When a drop in Smoothness is accompanied by a sharp decline in Positivity, it frequently heralds premature dropout if left unaddressed. However, when a transient drop in Smoothness is followed by an elevation in Depth in subsequent sessions, it reflects a successful “rupture-resolution sequence,” which correlates with superior overall outcomes.

Discriminant Validity

The empirical independence of Depth and Smoothness underscores the discriminant validity of the instrument. Across large samples, the intercorrelation between Depth and Smoothness typically hovers between $r = .10$ and $r = .35$, demonstrating that they share less than 12% common variance. Furthermore, the Post-Session Mood dimensions (Positivity and Arousal) show low mutual intercorrelations ($r < .20$), validating the theoretical premise that affective valence operates independently of somatic and psychological activation.

8. Reliability

The Session Evaluation Questionnaire demonstrates exemplary reliability across internal consistency, inter-item homogeneity, and generalizability metrics across both clinical and analog samples.

Internal Consistency

Internal consistency estimates for the SEQ-C dimensions are consistently high across empirical studies. Representative Cronbach's alpha ($lpha$) coefficients reported in foundational validation literature (Stiles et al., 1994; Stiles & Snow, 1984a; Stiles et al., 2002) include:

• Depth: $lpha = .87 ext{ to } .91$ (typically reported at .90 in core clinical cohorts). The items valuable–worthless and shallow–deep demonstrate the highest item-total correlations ($r > .75$).
• Smoothness: $lpha = .89 ext{ to } .93$ (frequently averaging .92). The items rough–smooth and unpleasant–pleasant consistently yield corrected item-total correlations exceeding .78.
• Positivity: $lpha = .88 ext{ to } .92$ (standard benchmark at .90). Adjective pairs such as happy–sad and pleased–displeased drive the exceptional internal consistency of this affective scale.
• Arousal: $lpha = .75 ext{ to } .82$ (standard benchmark at .80). While slightly lower than the other three dimensions—partially reflecting the biological complexity of activation states—it safely exceeds the psychometric threshold of .70 for research and screening applications.

Test-Retest Reliability and Generalizability Theory

Because the SEQ-C is fundamentally a state measure designed to capture immediate, transient session dynamics, conventional test-retest reliability across weekly intervals is conceptually inappropriate; session impacts are expected to fluctuate depending on the technical and relational tasks of a given hour. Psychometricians therefore evaluate the SEQ using Generalizability Theory (G-Theory) to decompose variance components across sessions, clients, and therapists (Stiles & Snow, 1984b; Crits-Christoph et al., 1991):

• Variance decomposition indicates that approximately 40% to 50% of the variance in Depth and Smoothness is accounted for by systemic differences across sessions within the same client, establishing that the scale is acutely sensitive to genuine, session-specific micro-processes rather than merely capturing static client response sets.
• Between-client variance accounts for roughly 30% to 40% of the variance, reflecting stable individual tendencies in how clients appraise relationships.
• Therapist variance accounts for 10% to 15%, demonstrating that certain therapists systematically foster deeper or smoother sessions across their caseloads.

9. Factor Analysis

The factorial structure of the SEQ has undergone rigorous structural testing using both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) across five distinct developmental phases (from the original 1980 exploratory studies to the standardized Form 4 and Form 5 iterations).

Exploratory Factor Analysis (EFA)

In early development, Stiles (1980) submitted large matrices of bipolar adjective ratings collected across hundreds of university counseling and community clinic sessions to principal components analysis (PCA) followed by Varimax and Oblimin rotations. The analysis consistently extracted four distinct eigenvalues exceeding 1.0, accounting for over 65% of the total variance:

• Factor 1 (Session Depth): Items reflecting substance, potency, and value loaded heavily (.65 to .85) on this factor (valuable, deep, full, powerful, special).
• Factor 2 (Session Smoothness): Items indexing comfort, tranquility, and ease loaded between .68 and .88 (easy, relaxed, pleasant, smooth, comfortable).
• Factor 3 (Post-Session Positivity): Affective items denoting positive valence and security loaded cleanly (.70 to .86) (happy, pleased, definite, confident, friendly).
• Factor 4 (Post-Session Arousal): Items denoting physiological activation and speed loaded between .60 and .81 (excited, fast, aroused, moving, energetic).

The Anomalous Behavior of “Bad – Good”

A notable factor-analytic finding across multiple validation trials involves Item 1 (bad – good). While theoretically an evaluative item, empirical factor analyses demonstrated that bad – good exhibits complex cross-loadings across Depth, Smoothness, and Positivity. Crucially, Stiles et al. (1994) revealed that clients and therapists utilize this item differently: clients tend to treat “good” as synonymous with “smooth and comfortable,” whereas therapists treat “good” as synonymous with “deep, challenging, and productive.” Consequently, in the standardized scoring algorithm, Item 1 (bad – good) is retained on the test form for clinical inspection but is excluded from the calculation of the four formal subscale indexes to preserve dimensional purity.

Confirmatory Factor Analysis (CFA) and Model Fit

Confirmatory factor analyses testing the hypothesized four-factor oblique model (Stiles et al., 1994; Reynolds et al., 1996) against alternative one-factor, two-factor (Session vs. Mood), and orthogonal models have uniformly demonstrated superior fit for the four-factor structure. Typical structural equation modeling (SEM) fit indices reported in contemporary literature demonstrate excellent parameters:

• Comparative Fit Index (CFI): $ge .94 ext{ to } .96$
• Tucker-Lewis Index (TLI): $ge .93 ext{ to } .95$
• Root Mean Square Error of Approximation (RMSEA): $le .048 ext{ to } .058$ ($90% \text{ CI } [.040, .065]$)
• Standardized Root Mean Square Residual (SRMR): $le .052$

Multilevel CFA (MCFA) separating within-client from between-client variance confirms that this four-factor architecture remains invariant at both the within-person (session-to-session changes) and between-person (inter-individual differences) levels.

10. Instrument / Measurement Tool

• Instrument Name: Session Evaluation Questionnaire – Client Form (SEQ-C)
• Alternative / Related Versions: Session Evaluation Questionnaire – Therapist Form (SEQ-T); SEQ Form 4; SEQ Form 5.
• Primary Developer: William B. Stiles, Ph.D. (in collaboration with S. Reynolds, G. E. Hardy, A. Rees, M. Barkham, and D. A. Shapiro).
• Constructs Measured: Session Depth, Session Smoothness, Post-Session Positivity, and Post-Session Arousal.
• Target Population: Adult and adolescent psychotherapy clients across outpatient, inpatient, residential, and private practice settings.
• Administration Format: Self-report paper-and-pencil questionnaire, digital survey interface, or integrated Electronic Health Record (EHR) clinical tablet.
• Completion Time: Approximately 2 to 3 minutes.
• Administration Timing: Immediately following the conclusion of the psychotherapy session (within 5–15 minutes post-session, prior to leaving the clinic or closing the telehealth portal).
• Number of Items: 21 bipolar adjective pairs (plus optional single-item global impact / help ratings).
• Response Scale: 7-point semantic differential scale (1 to 7 between bipolar adjective anchors).
• Scale Structure & Item Allocations:
  • Part 1: Session Evaluation (11 items): Evaluates the session itself (“This session was:”).
    • Depth Index (5 items scored): valuable–worthless, shallow–deep, full–empty, weak–powerful, special–ordinary.
    • Smoothness Index (5 items scored): difficult–easy, relaxed–tense, unpleasant–pleasant, rough–smooth, comfortable–uncomfortable.
    • Unscored / Qualitative Item: bad–good (Item 1; omitted from index scoring due to client-therapist perceptual divergence).
  • Part 2: Post-Session Mood (10 items): Evaluates immediate affective state (“Right now I feel:”).
    • Positivity Index (5 items scored): happy–sad, angry–friendly, confident–afraid, uncertain–definite, pleased–displeased.
    • Arousal Index (5 items scored): moving–still, calm–excited, energetic–peaceful, quiet–aroused, wakeful–sleepy (or slow–fast depending on version variant).
• Scoring and Computational Rules:
  • Each item is scored on a continuum from 1 to 7 based on the physical position selected between the left and right adjective poles.
  • Prior to calculating index means, items must be reverse-coded as necessary so that higher scores uniformly correspond to greater Depth, greater Smoothness, greater Positivity, and higher Arousal. For a 7-point scale, reverse scoring is executed via the standard linear transformation: $\text{Reversed Score} = 8 – \text{Raw Score}$.
  • Standard Computational Formulas:
    • Depth = $[(8 – \text{worthless}) + \text{deep} + (8 – \text{empty}) + \text{powerful} + (8 – \text{ordinary})] / 5$
    • Smoothness = $[\text{easy} + (8 – \text{tense}) + \text{pleasant} + \text{smooth} + (8 – \text{uncomfortable})] / 5$
    • Positivity = $[(8 – \text{sad}) + \text{pleased} + \text{definite} + (8 – \text{afraid}) + (8 – \text{unfriendly})] / 5$
    • Arousal = $[(8 – \text{still}) + \text{excited} + \text{fast} + (8 – \text{peaceful}) + \text{aroused}] / 5$
  • Scale Score Range: Each subscale yields a continuous mean score ranging from 1.00 to 7.00.
• Interpretation Guidelines:
  • High Depth (> 5.0) / High Smoothness (> 5.0): Optimal collaborative work; highly effective, comfortable integration.
  • High Depth (> 5.0) / Low Smoothness (< 3.5): Intense, challenging, emotionally taxing work; significant therapeutic confrontation or emotional processing. Clinically productive but requires monitoring.
  • Low Depth (< 3.5) / High Smoothness (> 5.0): Pleasant, polite, but superficial encounter; potential avoidance of core conflicts or therapeutic plateau.
  • Low Depth (< 3.5) / Low Smoothness (< 3.5): Problematic session; indicative of severe alliance rupture, misunderstanding, or disengagement.

11. Permissions & Fee and Test Year

The original Session Evaluation Questionnaire was first introduced in 1980 by Dr. William B. Stiles, with major revisions, standardized indices, and joint UK-US normative validation published in 1994 (Form 4 and Form 5). In accordance with the ethos of public-domain academic psychotherapy research, Dr. William B. Stiles and his co-authors placed the Session Evaluation Questionnaire in the open-access domain for educational, clinical, and non-commercial scientific research purposes.

Licensing and Usage Conditions:

• Fee: There is no licensing fee, purchase cost, or royalty required to administer the SEQ-C in clinical practice, training clinics, or academic investigations.
• Permission: Explicit written permission is generally not required for non-commercial clinical or empirical research, provided that formal academic attribution is given to Dr. William B. Stiles and the primary validation studies in all resultant presentations and publications.
• Modifications: Users are strictly advised not to alter the bipolar adjective wordings, polar orientations, or the 7-point formatting, as psychometric factor stability and normative benchmarking depend directly upon standardized presentation.
• Commercial Digital Applications: Integration of the SEQ into commercial, proprietary software platforms or fee-for-service EHR systems should be cleared via professional courtesy contact with the primary copyright holder: Dr. William B. Stiles ([email protected]).

12. References

• Crits-Christoph, P., Mellon, J., Lysaker, P., & Minegar, D. (1991). The generalizability of the Session Evaluation Questionnaire. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 3(4), 629–636. https://doi.org/10.1037/1040-3590.3.4.629
• Mallinckrodt, B. (1993). Session evaluation and the working alliance: Divergent client and counselor perspectives. Journal of Counseling Psychology, 40(1), 25–32. https://doi.org/10.1037/0022-0167.40.1.25
• Orlinsky, D. E., & Howard, K. I. (1986). Process and outcome in psychotherapy. In S. L. Garfield & A. E. Bergin (Eds.), Handbook of psychotherapy and behavior change (3rd ed., pp. 311–381). John Wiley & Sons.
• Osgood, C. E., Suci, G. J., & Tannenbaum, P. H. (1957). The measurement of meaning. University of Illinois Press.
• Reynolds, S., Stiles, W. B., Barkham, M., Shapiro, D. A., Hardy, G. E., & Rees, A. (1996). Acceleration of changes in session evaluation during cognitive-behavioral and psychodynamic-interpersonal psychotherapy. Journal of Consulting and Clinical Psychology, 64(3), 577–586. https://doi.org/10.1037/0022-006X.64.3.577
• Russell, J. A. (1980). A circumplex model of affect. Journal of Personality and Social Psychology, 39(6), 1161–1178. https://doi.org/10.1037/h0077714
• Stiles, W. B. (1980). Measurement of the impact of psychotherapy sessions. Journal of Consulting and Clinical Psychology, 48(2), 176–185. https://doi.org/10.1037/0022-006X.48.2.176
• Stiles, W. B. (2002). Assimilation of problematic experiences. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 357–365). Oxford University Press.
• Stiles, W. B., & Snow, J. S. (1984a). Counseling session impact as viewed by novice counselors and their clients. Journal of Counseling Psychology, 31(1), 3–12. https://doi.org/10.1037/0022-0167.31.1.3
• Stiles, W. B., & Snow, J. S. (1984b). Dimensions of psychotherapy session impact across sessions and across clients. British Journal of Clinical Psychology, 23(1), 59–63. https://doi.org/10.1111/j.2044-8260.1984.tb00627.x
• Stiles, W. B., Tupler, L. A., & Carpenter, J. C. (1982). Participants' perceptions of self-analytic group sessions. Small Group Behavior, 13(2), 237–254. https://doi.org/10.1177/104649648201300208
• Stiles, W. B., Reynolds, S., Hardy, G. E., Rees, A., Barkham, M., & Shapiro, D. A. (1994). Evaluation and description of psychotherapy sessions by clients using the Session Evaluation Questionnaire and the Session Impacts Scale. Journal of Counseling Psychology, 41(2), 175–185. https://doi.org/10.1037/0022-0167.41.2.175
• Stiles, W. B., Gordon, L. E., & Lani, J. A. (2002). Session evaluation and the Session Evaluation Questionnaire. In G. S. Tryon (Ed.), Counseling based on process research: Applying what we know (pp. 325–343). Allyn & Bacon.
• Watson, D., & Tellegen, A. (1985). Toward a consensual structure of mood. Psychological Bulletin, 98(2), 219–235. https://doi.org/10.1037/0033-2909.98.2.219

13. Items of the Scale (Questionnaire)