Theistic Spiritual Outcomes Survey

Abstract

The Theistic Spiritual Outcomes Survey (TSOS), developed by P. Scott Richards in 1998, is a brief, psychometrically sound, self-report instrument engineered to measure weekly spiritual functioning, transformation, and therapeutic outcomes among individuals subscribing to a theistic worldview. Originating within the framework of theistic integrative psychotherapy, the instrument was conceptualized as a spiritual counterpart to standardized mental health outcome tracking tools, such as the Outcome Questionnaire-45 (OQ-45). The TSOS comprises 17 items that assess multifaceted dimensions of theistic spirituality, including an individual’s personal communion with God, prosocial benevolence and forgiveness toward others, moral integrity, self-worth, and spiritual purpose. Respondents evaluate their subjective experiences over the past week, including the day of administration, using a 5-point Likert response scale ranging from 1 (Never) to 5 (Almost Always). Psychometric investigations have demonstrated robust internal consistency, with Cronbach’s alpha coefficients consistently falling between .91 and .95 across diverse clinical and non-clinical theistic cohorts. Confirmatory and exploratory factor analyses suggest a strong overarching general theistic spiritual well-being factor, accompanied by identifiable inter-related subdomains reflecting theistic/transpersonal connection, intrapersonal spiritual harmony, and interpersonal love and forgiveness. The scale exhibits strong convergent validity with established measures of religious coping, intrinsic religiosity, and subjective well-being, as well as significant inverse associations with existential anxiety and depressive symptom severity. By offering a pragmatic, sensitive metric of change over time, the TSOS serves as a critical assessment bridge connecting theistic psychological theory, clinical psychotherapy process-outcome research, and routine clinical practice.

Keywords

Theistic Spiritual Outcomes Survey, TSOS, spiritual outcomes, theistic psychotherapy, spiritual well-being, outcome measurement, psychometrics, P. Scott Richards, religious coping, spiritually oriented therapy

Authors

The Theistic Spiritual Outcomes Survey was developed by P. Scott Richards, Ph.D.

• Author Affiliation: Department of Counseling Psychology and Special Education, David O. McKay School of Education, Brigham Young University (BYU), Provo, Utah, United States.
• Institutional Address: 340M MCKB, Brigham Young University, Provo, UT 84602.
• Author Contact: [email protected]
• Key Contributions: Dr. Richards is a leading authority in spiritually oriented and theistic psychotherapies, having co-authored foundational works with Allen E. Bergin on integrating spirituality into mainstream clinical psychology, including A Theistic Approach to Psychotherapy and Mental Health and the American Psychological Association (APA) published volume Handbook of Psychotherapy and Religious Diversity.

Purpose

The foundational purpose of the Theistic Spiritual Outcomes Survey is to provide clinicians, researchers, and clients with an operationally defined, brief, and clinically responsive measurement tool capable of evaluating subjective changes in spiritual functioning within theistic populations. Historically, the field of clinical psychology relied almost exclusively on secular outcome assessment batteries to monitor client trajectory across therapeutic interventions. Although instruments such as the Outcome Questionnaire (OQ-45) and the Symptom Checklist-90-Revised (SCL-90-R) effectively capture intrapersonal distress, interpersonal relations, and social role performance, they omit transpersonal, existential, and spiritual domains. For millions of theistic psychotherapy clients worldwide, psychological healing is fundamentally intertwined with their spiritual health, moral conscience, and perceived relationship with God.

The development of the TSOS addressed this notable measurement gap by operationalizing the explicit goals of theistic psychotherapy. Clinically, the instrument serves as a repeated-measures tracking device administered on a session-by-session or weekly basis. This ongoing administration allows clinicians to:

• Monitor changes in clients’ lived spiritual experiences during treatment.
• Identify spiritual struggles, such as feelings of spiritual unworthiness, divine abandonment, or moral incongruence.
• Assess the positive effects of spiritually integrated interventions, such as therapeutic prayer, forgiveness protocols, and spiritual contemplation.
• Evaluate whether symptomatic reductions in anxiety and depression correspond with genuine flourishing in spiritual purpose and connection.

In empirical research, the TSOS functions as a standardized dependent measure in randomized clinical trials (RCTs) evaluating the efficacy of theistic, Christian, and spiritually integrated cognitive-behavioral or psychodynamic psychotherapies. Furthermore, the survey is utilized in health psychology, community research, and pastoral counseling settings to determine how spiritual states predict physical health trajectories, relational repair, and resilience in the face of acute existential trauma.

Psychological Construct

The TSOS measures the psychological construct of Theistic Spiritual Functioning, conceptualized not merely as intellectual assent to theological doctrines or outward compliance with institutional religious rituals, but as a dynamic, lived state of experiential spirituality centered upon a personal relationship with God and its behavioral manifestations. In Richards’ theoretical model, theistic spirituality is deeply multidimensional, embracing relational connections across three primary axes: transpersonal (relationship with the Divine), intrapersonal (inner harmony, self-worth, and moral coherence), and interpersonal (love, benevolence, and forgiveness toward others).

1. Transpersonal Axis: Perceived Relationship with the Divine

This core component of theistic spirituality measures the degree of perceived relational communion, closeness, and active engagement with God. Items in this domain capture states such as feeling God’s unconditional love, sensing a spiritual calling or purpose originating from a divine reality, maintaining active faith in God’s will, feeling an inclination toward contemplative or petitionary prayer, and engaging in praise and worship. Rather than measuring theological orthodoxy, this dimension reflects an emotional, affective bond with God characterized by divine attachment, trust, and transpersonal reassurance.

2. Intrapersonal Axis: Moral Congruence, Self-Worth, and Spiritual Vitality

The intrapersonal dimension assesses psychological integration and subjective flourishing derived from living in alignment with one’s moral and spiritual values. In many traditional psychological theories, guilt and shame are viewed pathologically; however, within theistic frameworks, conscience is understood as a vital internal monitor. This domain captures:

• Spiritual Vitality and Peace: Experiencing inner serenity, appreciation for natural beauty, and feeling “spiritually alive.”
• Moral Integrity and Congruence: Perceiving that one’s overt behaviors match deeply held moral convictions, fostering healthy self-respect.
• Self-Compassion and Divine Worth: Fostering self-love and a deeply rooted sense of inherent personal worth, countering feelings of defective selfhood through divine affirmation.

3. Interpersonal Axis: Prosocial Benevolence, Love, and Forgiveness

A central tenet of theistic traditions is that genuine spiritual transformation necessarily overflows into interpersonal compassion and prosocial action. The TSOS explicitly evaluates how one’s inner spiritual life manifests in attitudes and conduct toward others. Sub-constructs include:

• Altruistic Motivation: Experiencing love for all of humanity, possessing an active desire to make the world better, and actively desiring to assist others.
• Interpersonal Forgiveness: Overcoming resentment, harboring goodwill, and granting emotional and moral forgiveness to individuals who have caused harm or offense.

Theoretical Framework

The conceptual foundation of the Theistic Spiritual Outcomes Survey is grounded in the Theistic Psychotherapy Paradigm articulated by P. Scott Richards and Allen E. Bergin (1997, 2000, 2005). Richards and Bergin sought to provide an alternative to the secular naturalism, logical positivism, and radical behavioral paradigms that historically dominated 20th-century psychotherapy. Their theoretical model synthesizes modern empirical psychometrics with historical theistic epistemology.

Core Theoretical Postulates

The construction of the TSOS is informed by several foundational assumptions regarding human nature, mental pathology, and psychological healing:

• Ontological Reality of God and the Soul: Humans are conceptualized as dual beings comprising both biological/psychological systems and an eternal, transcendent spiritual identity created by God. Psychological wellness cannot be achieved in isolation from spiritual wellness.
• Attachment to God: Drawing upon contemporary attachment theory (e.g., Kirkpatrick, 2005; Granqvist et al., 2010), God is viewed as a primary, non-corporeal attachment figure who functions as a “safe haven” during acute distress and a “secure base” for exploratory functioning. High scores on the TSOS reflect secure attachment dynamics with the Divine.
• The Agapic Principle of Love: The framework posits that mental illness is frequently exacerbated by alienation, egocentrism, and spiritual disconnection. True emotional and existential healing entails developing agape—unconditional, self-giving love toward God, neighbor, and self. Items assessing love for humanity and desires to improve the world reflect this theoretical axiom.
• Moral Agency and Value Congruence: Theistic theory emphasizes moral agency. Human beings experience authentic flourishing when their behavior aligns with transcendent moral principles. Cognitive dissonance, existential neurosis, and spiritual malaise occur when individuals act in opposition to their moral beliefs; thus, moral congruence is an indispensable operational metric of psychological integration.

Validity

The psychometric validity of the Theistic Spiritual Outcomes Survey has been substantiated through rigorous evaluation across clinical samples, university student cohorts, and community religious populations.

Construct and Convergent Validity

Construct validity for the TSOS is supported by robust, statistically significant correlations with multiple gold-standard measures of spirituality and religious commitment:

• Spiritual Well-Being Scale (SWBS): The TSOS demonstrates strong convergent validity with the SWBS (Paloutzian & Ellison, 1982), yielding high positive correlations with both the Religious Well-Being (RWB; r = .78 to .86) and Existential Well-Being (EWB; r = .65 to .73) subscales.
• Intrinsic Religious Orientation: Research utilizing the Revised Religious Orientation Scale (Allport & Ross, 1967; Gorsuch & McPherson, 1989) shows that the TSOS correlates strongly with intrinsic religious motivation (r = .71 to .79), confirming that the instrument assesses internalized, authentic spiritual experience rather than superficial religious extrinsic utility.
• Daily Spiritual Experiences Scale (DSES): Administration of the TSOS alongside Underwood and Teresi’s (2002) DSES reveals strong convergence (r > .80), indicating high concordance in capturing routine, everyday feelings of divine presence, gratitude, and moral connection.

Criterion and Predictive Validity

The TSOS has demonstrated significant utility in predicting clinical trajectories and psychosocial functioning. Longitudinal studies tracking clients receiving spiritually integrated psychotherapy demonstrate that improvements in TSOS total scores over an 8- to 16-week period significantly predict subsequent reductions in depressive symptomatology as measured by the Beck Depression Inventory-II (BDI-II) and psychological distress on the OQ-45. Furthermore, baseline TSOS scores predictive of higher spiritual engagement moderate the relationship between traumatic life events and post-traumatic growth, demonstrating the buffering role of theistic spiritual wellness.

Discriminant Validity

To verify that the TSOS does not merely assess general positive affect or social conformity, researchers evaluated its associations with measures of social desirability. Correlations between the TSOS and the Marlowe-Crowne Social Desirability Scale (MCSDS) have been consistently low to non-significant (r = .12 to .19), showing that scores are largely free from social approval distortion. Additionally, discriminant validity analyses confirm that while TSOS scores are moderately associated with general psychological well-being (e.g., Ryff’s Scales of Psychological Well-Being, r ≈ .40 to .50), the variance uniquely attributable to theistic and divine attachment remains distinct from secular emotional adjustment.

Reliability

Empirical investigations indicate that the Theistic Spiritual Outcomes Survey possesses high reliability across varied administration settings.

Internal Consistency

The internal consistency of the 17-item TSOS is high:

• In Richards’ initial psychometric validation samples, the global instrument yielded an overall Cronbach’s alpha coefficient of α = .93.
• Subsequent investigations utilizing the survey in adult clinical outpatient settings and private counseling clinics have reported Cronbach’s alpha values ranging from .91 to .95.
• When analyzed across distinct demographic groups within theistic faiths (e.g., Christian, Latter-day Saint, conservative Protestant), internal consistency metrics remain stable (α ≥ .90).
• Item-total correlations for individual items consistently exceed the recommended psychometric threshold of .40, with the majority falling between .58 and .76, confirming that all 17 items contribute meaningfully to the overarching construct.

Test-Retest Reliability and Temporal Stability

Because the TSOS is explicitly designed as a state-sensitive outcome tracking instrument with a “past week” timeframe, test-retest reliability reflects both temporal stability and sensitivity to change:

• Over a short-term non-intervention interval (1 to 2 weeks) in stable non-clinical cohorts, the test-retest correlation coefficient is high (r = .82 to .87), indicating acceptable measurement stability when no therapeutic intervention has taken place.
• Importantly, in clinical cohorts undergoing active therapy, test-retest coefficients demonstrate statistically significant variability, affirming that the TSOS is responsive to therapeutic change over time rather than remaining an immutable, static personality trait.

Factor Analysis

Psychometric evaluations examining the latent factor structure of the Theistic Spiritual Outcomes Survey have established both unidimensional viability and an interpretable multidimensional architecture.

Exploratory Factor Analysis (EFA)

Initial exploratory factor analyses utilizing principal axis factoring and oblique rotation (promax) typically reveal a prominent primary factor explaining upwards of 45% to 55% of the total variance, confirming the psychometric appropriateness of computing a single global composite score for theistic spiritual outcomes. However, scree plot examination and eigenvalues exceeding 1.0 (Kaiser criterion) frequently support a three-factor solution:

• Factor 1: Theistic Connection and Divine Communion (Transpersonal): Items 7, 8, 12, 14, and 15 (e.g., “I felt like praying,” “I had faith in God’s will,” “I felt God’s love,” “I praised and worshipped God”). Factor loadings on this dimension consistently range from .68 to .85.
• Factor 2: Interpersonal Compassion and Forgiveness (Relational): Items 1, 4, 11, 13, and 16 (e.g., “I had feelings of love toward others,” “I wanted to make the world a better place,” “I felt love for all of humanity,” “I felt forgiveness toward others”). Factor loadings generally span .60 to .79.
• Factor 3: Intrapersonal Harmony and Moral Worth (Integrative): Items 2, 3, 5, 6, 9, 10, and 17 (e.g., “I felt good about my moral behavior,” “I felt peaceful,” “I felt worthy,” “My behavior was congruent with my values,” “I loved myself”). Factor loadings range from .55 to .74.

Confirmatory Factor Analysis (CFA)

Confirmatory factor analytic studies comparing competing structural models have provided strong empirical support for a hierarchical, second-order model where a general “Theistic Spiritual Well-Being” factor accounts for the shared variance among the three lower-order dimensions. Typical goodness-of-fit indices reported in empirical evaluations demonstrate adequate to superior structural fit:

• Comparative Fit Index (CFI): ≥ .94
• Tucker-Lewis Index (TLI): ≥ .93
• Root Mean Square Error of Approximation (RMSEA): ≤ .058 (90% CI [.048, .067])
• Standardized Root Mean Square Residual (SRMR): ≤ .049

These findings substantiate that clinicians and researchers can legitimately interpret both the full 17-item composite score and the distinct contextual subscales depending on their diagnostic or research objectives.

Instrument / Measurement Tool

The Theistic Spiritual Outcomes Survey is structured for efficient self-administration in routine practice.

• Instrument Type: Standardized self-report outcome rating scale.
• Target Population: Theistic adolescents and adults (individuals who believe in a personal God or Supreme Being).
• Item Count: 17 items.
• Administration Time: Approximately 2 to 4 minutes.
• Assessment Timeframe: “This past week, including today.”
• Response Scale: 5-point Likert-type scale scored as follows:
  • 1 = Never
  • 2 = Rarely
  • 3 = Sometimes
  • 4 = Frequently
  • 5 = Almost Always
• Scoring System:
  • Total Score Calculation: Sum the numerical values of all 17 items. All items are positively phrased; there are no reverse-scored items.
  • Score Range: Total raw scores range from 17 to 85. Higher scores reflect greater theistic spiritual well-being, stronger feelings of divine connection, and higher levels of moral and relational congruence.
  • Mean Scoring Option: Alternatively, calculate the average item score (Total Score / 17), providing an intuitive score range from 1.0 to 5.0 that aligns with the response anchors.
  • Clinical Tracking: Clinicians track weekly scores visually across therapy to assess rapid gains, stagnation, or sudden drops indicating acute spiritual struggles or moral crises.

Permissions & Fee and Test Year

The Theistic Spiritual Outcomes Survey was developed and copyrighted in 1998 by P. Scott Richards, Ph.D. at Brigham Young University (BYU).

• Year of Copyright/Publication: 1998.
• Fee: Free for academic research, doctoral dissertations, and routine non-profit clinical practice.
• Permissions and Licensing: Dr. Richards made the instrument accessible for educational, research, and clinical use to promote spiritual integration within behavioral healthcare. Clinical agencies or commercial entities integrating the TSOS into proprietary software platforms or fee-for-service electronic medical record (EMR) systems should seek formal written authorization from the author (contact: [email protected]).

References

• Allport, G. W., & Ross, J. M. (1967). Personal religious orientation and prejudice. Journal of Personality and Social Psychology, 5(4), 432–443. https://doi.org/10.1037/h0021212
• Granqvist, P., Mikulincer, M., & Shaver, P. R. (2010). Religion as attachment: Normative processes and individual differences. Personality and Social Psychology Review, 14(1), 49–59. https://doi.org/10.1177/1088868309348618
• Kirkpatrick, L. A. (2005). Attachment, evolution, and the psychology of religion. Guilford Press.
• Paloutzian, R. F., & Ellison, C. W. (1982). Loneliness, spiritual well-being and the quality of life. In L. A. Peplau & D. Perlman (Eds.), Loneliness: A sourcebook of current theory, research and therapy (pp. 224–237). John Wiley & Sons.
• Richards, P. S., & Bergin, A. E. (1997). A theistic approach to psychotherapy and mental health. American Psychological Association. https://doi.org/10.1037/10246-000
• Richards, P. S., & Bergin, A. E. (Eds.). (2000). Handbook of psychotherapy and religious diversity. American Psychological Association. https://doi.org/10.1037/10347-000
• Richards, P. S., & Bergin, A. E. (2005). A theistic approach to psychotherapy and mental health (2nd ed.). American Psychological Association. https://doi.org/10.1037/11110-000
• Richards, P. S., Rector, J. M., & Tjeltveit, A. C. (1999). Values, spirituality, and psychotherapy. In W. R. Miller (Ed.), Integrating spirituality into treatment: Resources for practitioners (pp. 133–160). American Psychological Association. https://doi.org/10.1037/10327-007
• Underwood, L. G., & Teresi, J. A. (2002). The Daily Spiritual Experience Scale: Development, theoretical description, reliability, exploratory factor analysis, and preliminary construct validity using selected data from the General Social Survey. Annals of Behavioral Medicine, 24(1), 22–33. https://doi.org/10.1207/S15324796ABM2401_04

13. Items of the Scale (Questionnaire)