Development of the Therapist Empathy Assessment Scale (TEAS) and comparison of therapists' empathy levels across specializations

Development of the Therapist Empathy Assessment Scale (TEAS) and comparison of therapists' empathy levels across specializations | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development of the Therapist Empathy Assessment Scale (TEAS) and comparison of therapists' empathy levels across specializations Zeynep Tekkuş Set, Muzaffer Şahin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8669903/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background As one of the strongest predictors of therapeutic outcome, the assessment of empathy from the client's perspective within a multidimensional framework is of critical importance. The aim of this study was to develop the "Therapist Empathy Assessment Scale" (TEAS), based on Richard Erskine's Integrative Psychotherapy approach, and to compare the empathy levels of therapists from different psychotherapeutic orientations in terms of both client perception and self-report. Methods The study was conducted with two independent samples: 315 clients (M age = 35.9 years, 82.5% female) currently in therapy and 100 therapists (M age = 41.0 years, 82.0% female) with at least one year of clinical experience. Clients completed the TEAS to assess their therapists' empathy, while therapists completed the Toronto Empathy Questionnaire (TEQ) for self-reported empathy. The construct validity of the TEAS was examined using Exploratory Factor Analysis and Confirmatory Factor Analysis. Convergent and discriminant validity were assessed using Average Variance Extracted and the Fornell-Larcker criterion. Reliability was evaluated through Cronbach's alpha, Composite Reliability, and test-retest correlations. Independent samples t-tests were used to compare empathy levels across eight therapeutic orientations. Results The analyses demonstrated that the TEAS is a valid and reliable 19-item instrument consisting of four subscales: Cognitive Empathy, Affective Empathy, Empathic Concern, and Behavioral Empathy (Cronbach's α = .82-.93). Comparisons across therapeutic orientations revealed that clients of therapists practicing Integrative Psychotherapy and Transactional Analysis reported significantly higher perceived empathy scores on all TEAS subscales and the total score compared to other orientations. In contrast, EMDR and Schema Therapy showed significantly higher scores only in the Behavioral Empathy dimension. However, therapists' self-reported empathy levels (measured by TEQ) did not differ significantly across orientations. Conclusions These results confirm that the TEAS is a psychometrically robust tool for psychotherapy research. Furthermore, the findings suggest that therapeutic orientation determines not the therapist's "internal empathy capacity," but rather how this capacity is expressed in the session and perceived by the client. Empathy Psychotherapy schools Integrative psychotherapy Scale development Figures Figure 1 Figure 2 Introduction Empathy as a common factor in psychotherapy Psychotherapy is inherently an interpersonal interaction; therefore, the therapist’s way of relating is not merely a "setting" but often the direct carrier of change. In this context, the concept of empathy holds a central place in a vast literature ranging from social and personality psychology to neuroscience, and from clinical practice to health domains [ 1 ]. In psychotherapy, empathy is conceptualized as the capacity to approach the client’s internal frame of reference "as if" one were the other person but without losing the "as if" condition, to comprehend the client’s experience in both cognitive and affective dimensions, and to communicate this understanding to the client [ 2 – 4 ]. In Rogers’ approach, empathy, along with unconditional positive regard and congruence, was counted among the core conditions of therapeutic change; the therapist’s empathic understanding was seen as a key element in creating a safe relational ground for the client to explore themselves and construct new meanings [ 2 , 5 , 6 ]. This emphasis largely aligns with subsequent process-outcome research: Meta-analytic findings indicate that therapist empathy is consistently and moderately associated with treatment outcomes across different therapeutic orientations, explaining approximately 7–10% of the variance in outcomes, and in many studies, serving as a predictor comparable to (or in some contexts, higher than) specific technical effects [ 7 – 11 ]. The American Psychological Association’s framework for evidence-based therapy relationships has also registered empathy as an effective relationship factor [ 3 ]. It is suggested that the impact of empathy is not limited to increasing the feeling of being "understood"; it operates through a series of mechanisms such as helping the client feel safer, approach difficult content, support emotion regulation, and make a corrective emotional experience possible [ 3 , 12 , 13 ]. Clients feeling understood and accepted by their therapists can reduce the experience of loneliness and alienation, creating a more relational "state of being" [ 4 ]. The contextual model perspective also emphasizes that an empathic and caring therapeutic relationship strengthens the "healing setting," and that warm, involved, and reassuring interaction (e.g., active listening and supportive communication) can create meaningful differences in client experiences [ 14 ]. The problem of assessing empathy: What, from whom, and how is it measured? Despite the importance of empathy in psychotherapy, the lack of a single, agreed-upon definition in the field creates significant difficulties in measurement [ 15 , 16 ]. In the literature, empathy can be addressed as a trait, a capacity/competence, an interpersonal process, an attitudinal orientation, or a behavioral style of communication [ 1 , 7 ]. This conceptual diversity leads measurement tools to capture vastly different "parts of empathy," resulting in often weak correlations between different empathy measures [ 8 , 17 ]. Another critical issue in empathy measurement is the source of the report. Barrett-Lennard [ 18 ] proposed addressing empathy in the context of psychotherapy from the perspectives of the therapist, the client, and the observer; subsequent meta-analytic studies have shown that the empathy measures that best predict therapy outcomes are mostly those perceived by the client [ 8 , 11 , 19 ]. This finding requires thinking of empathy not merely as the therapist’s "internal capacity," but as a relationship phenomenon communicated within the session and experienced by the client. Indeed, Rogers specifically emphasized the importance of empathic understanding not just being "offered" by the therapist, but being perceived/experienced by the client [ 4 ]. Although self-report tools provide ease of administration, they carry limitations due to social desirability and self-assessment bias; it is debated how "accurately" individuals can report on their empathic accuracy or in-session empathic communication [ 20 – 23 ]. Indeed, in both health communication and psychotherapy, it is noted that first-person measures (self-report) may show weaker relationships with patient/client evaluations and clinical outcomes [ 10 , 24 ]. While observer ratings and behavioral coding systems may offer a more "outside" window, they can harbor problems such as time costs, reliability challenges, and the limitation of the assumption that the "expert truly knows the client’s internal world" [ 25 , 26 ]. Therefore, one of the fundamental needs in the measurement field is the development of current and comprehensive tools that evaluate empathy specifically within the therapeutic context and based on the client’s experience, without reducing empathy to a single dimension [ 16 , 22 ]. Theoretical framework: Integrative psychotherapy and multidimensional empathy The most common distinction in empathy literature is made between cognitive and affective components: Cognitive empathy is associated with perspective-taking and meaning-making processes, while affective empathy is associated with affect sharing, emotional resonance, and emotional recognition processes [ 1 , 15 , 27 ]. However, defining empathy in the therapeutic context solely at the level of "understanding" and "feeling" may overshadow certain elements that make empathy functional within the session (such as concern for the client’s well-being, safety climate, non-verbal/verbal communication behaviors, rhythm, and attunement) [ 7 , 28 , 29 ]. At this point, the Integrative Psychotherapy approach offers a significant contribution by expanding empathy within a relationship-centered framework. In Erskine’s approach, relationship and contact are at the center of human motivation; a significant portion of psychological distress can be seen as linked to the repeated failure to meet essential relational needs (e.g., security, valuing, acceptance, validation, mutuality, self-definition, making an impact, the other’s initiative, and expressing love) [ 30 – 33 ]. In this perspective, the therapeutic relationship is not merely the "ground" for interventions, but a curative factor in itself that enables the client to integrate dissociated parts and develop more flexible choices [ 34 – 37 ]. Erskine’s emphasis on "beyond empathy" suggests that empathy is completed not only by feeling the client’s emotion but by the capacity to produce a therapeutic response sensitive to the client’s relational needs [ 31 , 38 ]. In this approach, the therapeutic process requires the continuous operation of methods such as phenomenological inquiry, attunement, and involvement/presence within the relationship [ 30 , 35 , 39 ]. Attunement involves a sensitive adjustment not only to the client’s content but also to their rhythm, affect intensity, developmental level, and relational needs [ 31 , 40 ]. Thus, therapeutic empathy becomes visible not merely as a cognitive-affective "state," but as a dynamic and multidimensional interaction process shaped by cues (verbal and non-verbal) received from the client [ 21 , 29 ]. The Therapist Empathy Assessment Scale (TEAS) developed in this study aims to transport this theoretical background into a measurable framework. The scale addresses therapeutic empathy in four components through the client’s experience: Cognitive Empathy (comprehending the client’s beliefs and world of meaning), Affective Empathy (accompanying affect and appropriate emotional response), Empathic Concern (valuing, acceptance, safety climate, and commitment to the client’s well-being), and Behavioral Empathy (the transformation of the empathic process into visible communication behaviors; e.g., listening attentively, respecting silence, in-session tracking) [ 7 , 24 , 28 , 30 , 38 ]. Empathy in the context of therapeutic orientations Although empathy is accepted as a central relationship element in different psychotherapy orientations, the function attributed to empathy and the forms of "showing/conveying" empathy may differ according to theoretical emphasis and technical ecology [ 4 , 11 ]. For instance, in the psychoanalytic tradition, the ideal of neutrality and maintaining boundaries has been discussed as a balance to be operated within an empathic atmosphere [ 41 ]. In the cognitive-behavioral tradition, empathy is often positioned as a supportive relationship condition that enables collaboration and working with challenging tasks; it is noted that empathic communication can be intertwined with formulation and intervention strategies [ 7 , 10 ]. In approaches like Motivational Interviewing, empathy is operationalized as a core component of the therapeutic language and the stance that facilitates change talk [ 26 ]. Nevertheless, the literature shows that the empathy-outcome relationship is observed at generally similar levels across different orientations; that is, empathy largely operates as a common factor across schools [ 8 , 11 ]. At this point, a more refined question arises: Do schools create different effects on how the therapist expresses empathy and how the client perceives it, rather than changing the therapist’s empathy capacity? Perceived empathy by the client can be influenced by micro-behaviors such as non-verbal behaviors (eye contact, body lean), tone of voice/rhythm matching, and the adjustment of in-session responses, as much as by verbal content [ 28 , 29 , 42 ]. Therefore, to understand potential differences between therapeutic orientations, "who evaluates empathy" and "which dimensions of empathy we capture" become decisive [ 8 , 25 , 43 ]. The present study The first aim of this study is to develop a multidimensional measurement tool evaluating therapist empathy from the client's perspective and to examine its psychometric properties, based on the Integrative Psychotherapy approach and Erskine’s conceptualizations that expand empathy within the framework of relational needs, attunement, and "beyond empathy." Although there are numerous tools to measure empathy in the literature, the lack of a "gold standard" and the often limited validity evidence keep the need for scale development specific to the therapeutic context alive [ 20 , 22 , 23 ]. Furthermore, a significant portion of the tools used, particularly in the context of Turkey, are adaptations of older self-report scales and remain limited in evaluating the multidimensional and relational nature of therapeutic empathy from the client's eyes [ 44 – 52 ]. Therefore, the development of an evaluation tool that is both culturally sensitive and theoretically integrative is a critical need for advancing psychotherapy research in this region. The second aim of the study is to present a comparative framework in the context of therapeutic orientations by addressing empathy from two different sources: (a) therapist empathy perceived by the client (TEAS) and (b) the therapist’s self-reported empathy level. This dual approach aims to provide a design sensitive to the difference in evaluation source (client–therapist–observer) frequently emphasized in the field and to examine empathy not merely as a "personality trait" but as a relationship phenomenon communicated and experienced within the session [ 11 , 18 , 29 ]. Methods Participants This research was conducted on two independent sample groups, "Clients" and "Therapists," created to serve different purposes of the study. Clients group The first study group of the research was formed for (1) conducting validity and reliability analyses of the "Therapist Empathy Assessment Scale" and (2) examining whether the therapist empathy level perceived by clients differs according to the school adopted by the therapist. In determining the participants, convenience sampling, one of the non-probability sampling methods, was preferred. The inclusion criteria for the research were: being 18 years of age or older, being in an active therapy process, and voluntarily agreeing to participate in the research. Initially, data were obtained from a total of 352 participants. One participant was excluded from the study due to missing data. To detect the presence of multivariate outliers in the remaining dataset of 351 individuals, Mahalanobis distance values were calculated, and 36 participants were identified as outliers at the p < .001 significance level [ 53 ]. After removing these participants from the dataset, the final study group consisting of 315 participants was formed. According to Comrey and Lee, a sample of 300 people is considered good for factor analysis [ 54 ], while Bryman and Cramer state that the sample size should be at least five times the number of items in scale development studies [ 55 ]. This obtained sample size has the recommended adequacy for factor analysis, considering the number of participants per item (approximately 13:1). Table 1 Demographic characteristics of the clients group Variable Category n % Gender Female 260 82.5 Male 55 17.5 Education High school and below 39 12.4 Associate degree 34 10.8 Bachelor's degree 128 40.6 Graduate degree 114 36.2 Marital status Single 123 39.0 Married 148 47.0 Divorced 34 10.8 Living with partner 10 3.2 Employment status Yes 230 73.0 No 85 27.0 Number of sessions with therapist 2–4 13 4.1 5–9 60 19.0 10–19 74 23.5 20–39 63 20.0 40–79 50 15.9 80–159 26 8.3 More than 160 29 9.2 Therapist's school* Cognitive behavioral therapy 159 30.3 Integrative psychotherapy 94 17.9 EMDR 47 9.0 Transactional analysis 44 8.4 Schema therapy 40 7.6 Behavioral 29 5.5 Positive therapy 26 5.0 Psychodynamic 26 5.0 Other 60 11.4 * Participants were given the opportunity to select multiple options for this question. Percentage values indicate the proportion within total responses. Consequently, this study group consists of a total of 315 volunteer clients aged 18–66 years (M = 35.9; SD = 9.9) residing in various provinces of Turkey and currently receiving therapy services from a mental health professional. The demographic statistics of the participants are presented in Table 1 . The vast majority of participants are female (n = 260, 82.5%); their education levels are predominantly concentrated at undergraduate (n = 128, 40.6%) and graduate (n = 114, 36.2%) levels. In terms of marital status, married (n = 148, 47.0%) and single (n = 123, 39.0%) participants constitute the majority of the sample, while in terms of employment status, the majority of the group (n = 230, 73.0%) is actively working. When data regarding the therapy process are evaluated, it was found that a significant portion of clients received services in the range of 10–19 sessions (n = 74, 23.5%) and 20–39 sessions (n = 63, 20.0%); they most frequently indicated Cognitive Behavioral Therapy (n = 159, 30.3%) and Integrative Psychotherapy (n = 94, 17.9%) as the approaches adopted by their therapists. Therapists group The second study group of the research was formed to examine whether therapists' self-reported empathy levels measured by the "Toronto Empathy Questionnaire" differ according to the therapy school they adopt. Convenience sampling, one of the non-probability sampling methods, was used in determining the participants. The inclusion criteria for the research were: actively providing therapy services for at least one year and voluntarily agreeing to participate in the research. The sample size was calculated to be at least 96 people based on Yazıcıoğlu and Erdoğan's [ 56 ] assumptions of p = 0.50, q = 0.50, and 0.10 sampling error. Within the scope of the research, 100 therapists were reached, thus achieving the required sample size. Consequently, this study group consists of a total of 100 volunteer therapists aged 26–76 years (M = 41.0; SD = 10.9) residing in various provinces of Turkey and actively providing therapy services for at least one year. The demographic statistics of the therapists are presented in Table 2 . The majority of participating therapists are female (n = 82, 82.0%), and their education levels are concentrated at the graduate level, predominantly master's degree (n = 67, 67.0%) and doctorate (n = 21, 21.0%). In terms of professional experience, the majority of the sample consists of experts with experience between 5–9 years (n = 30, 30.0%) and 10–19 years (n = 32, 32.0%). Among the titles declared by participants, Clinical Psychologist (n = 61, 49.2%) ranks first; it was determined that the schools most frequently used by therapists in their practice are Cognitive Behavioral Therapy (n = 55, 20.0%), EMDR (n = 36, 13.1%), and Integrative Psychotherapy (n = 33, 12.0%), respectively. Table 2 Demographic characteristics of the therapist group Variable Category n % Gender Female 82 82.0 Male 18 18.0 Marital status Single 34 34.0 Married 66 66.0 Education Bachelor's degree 6 6.0 Master's degree 67 67.0 Doctorate 21 21.0 Medical specialist 6 6.0 Experience in therapy services 1–2 years 7 7.0 3–4 years 16 16.0 5–9 years 30 30.0 10–19 years 32 32.0 20–39 years 14 14.0 More than 40 years 1 1.0 Title* Clinical psychologist 61 49.2 Expert psychologist 23 18.5 Licensed psychotherapist 18 14.5 Psychological counselor 16 12.9 Psychiatrist 6 4.8 School* Cognitive behavioral therapy 55 20.0 EMDR 36 13.1 Integrative psychotherapy 33 12.0 Psychodynamic 27 9.8 Family therapy 25 9.1 Transactional 24 8.7 Eclectic 21 7.6 Schema therapy 20 7.3 Other 34 12.4 * Participants were given the opportunity to select multiple options for these questions. Percentage values indicate the proportion within total responses. Measures Therapist Empathy Assessment Scale (TEAS) In the research, the "Therapist Empathy Assessment Scale" (TEAS), developed by the researchers, was used to measure how clients perceive their therapists' empathy levels. While creating the item pool for the scale, the International Integrative Psychotherapy approach was taken as the basis; particularly, Erskine's concepts of "empathy" and "beyond empathy," which refers to focusing on the client's relational needs, were determined as reference points [ 57 – 59 ]. The scale consists of a total of 23 items and four sub-dimensions: Cognitive Empathy (items 1–5): Contains items measuring the therapist's ability to understand the client's beliefs, values, and perspective on events (e.g., "My therapist understands my beliefs and values"). Affective Empathy (items 6–11): Evaluates the therapist's capacity to attune to the client's emotions, feel these emotions, and provide appropriate emotional responses (e.g., "My therapist understands my emotions and gives appropriate responses to my emotions"). Empathic Concern (items 12–17): Encompasses the therapist's care for the client's well-being, provision of a safe environment, and supportive attitude (e.g., "My therapist provides me with a safe environment in the therapy process"). Behavioral Empathy (items 18–23): Represents the concrete behavioral manifestation of the empathic process (careful listening, respect for silence, etc.) (e.g., "My therapist listens to me carefully"). The scale is rated on a 5-point Likert scale (1 = Strongly Disagree, 5 = Strongly Agree). Higher scores on the scale indicate a high level of empathy perceived by the client from the therapist. During the content validity process of the scale, the items were reviewed by five different accredited psychotherapists, and necessary adjustments were made. The final version of the scale was submitted for evaluation by Richard Erskine, the founder of Integrative Psychotherapy theory; Erskine confirmed the comprehensiveness and appropriateness of the items, and the final form was created (Erskine's feedback dated February 19, 2025: " I have carefully read through the scale; it seems that no changes are necessary "). Toronto Empathy Questionnaire (TEQ) In the research, the Toronto Empathy Questionnaire (TEQ), developed by Spreng et al. [ 60 ] and adapted into Turkish by Totan et al. [ 46 ], was used to determine therapists' self-reported empathy levels. The unidimensional scale contains a total of 13 items. Sample items are "It upsets me to see someone being treated disrespectfully" and "I enjoy making other people feel better." The scale is prepared on a 4-point Likert scale (1 = Not at all appropriate, 4 = Completely appropriate) and contains a total of eight reverse-coded items (items 1, 3, 5, 7, 8, 9, 11, 12). An increase in the total score obtained from the scale indicates that the individual's empathy level is high. In the Turkish adaptation study, the Cronbach's alpha reliability coefficient of the scale was reported as α = .79 [ 46 ]. In the current study, the Cronbach's alpha reliability coefficient of the scale was determined as α = .85. Procedure The data collection process lasted approximately eight months (April-November 2025) online through Google Forms. For the clients group, clients were reached through mental health professionals actively providing therapy services in various provinces of Turkey; participants completed the demographic information form and the "Therapist Empathy Assessment Scale." For test-retest reliability, a second measurement was taken from 33 participants after a two-week interval. For the therapists group, mental health professionals with at least one year of experience were reached and asked to complete the demographic information form and the Toronto Empathy Questionnaire. In both groups, completing the scales took approximately 8–10 minutes. The obtained data were analyzed using SPSS 26.0 and AMOS 22.0 programs. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were applied for the construct validity of the scale. In CFA, the Maximum Likelihood estimation method was used, and χ²/df ratio, Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and Root Mean Square Error of Approximation (RMSEA) criteria were used to evaluate model fit. For good fit, χ²/df ≤ 3, CFI and TLI ≥ .95, RMSEA ≤ .06; for acceptable fit, χ²/df ≤ 5, CFI and TLI ≥ .90, RMSEA ≤ .08 criteria were adopted [ 61 , 62 ]. Average Variance Extracted (AVE) values were used for convergent validity, and the Fornell-Larcker criterion was used for discriminant validity [ 63 ]. In reliability analyses, Cronbach's Alpha internal consistency coefficient, Composite Reliability (CR), and test-retest correlations were calculated. Normality assumptions were evaluated with skewness and kurtosis values (± 3), and all variables were determined to be suitable for parametric analyses [ 64 ]. Independent samples t-test was used to compare therapists' empathy levels according to their schools. In all analyses, the significance level was accepted as p < .05. Results Exploratory factor analysis EFA was first applied to test the construct validity of the Therapist Empathy Assessment Scale. In the initial analysis, factor analysis was performed with all 23 items, but it was found that four items (6, 10, 20, and 21) created problems in the factor structure. It was observed that items 6 and 10 did not load sufficiently on any factor (factor loading below .40), and items 20 and 21 loaded highly on multiple factors (cross-loading). These items were removed separately by trying all possible combinations, and analyses were repeated. However, these items maintained their problematic structures under all conditions. Therefore, to preserve the theoretical structure and strengthen the psychometric properties of the scale, these four items were removed from the scale, and analyses were conducted on the remaining 19 items. Before proceeding to factor analysis, the Kaiser-Meyer-Olkin (KMO) sampling adequacy coefficient and Bartlett's Test of Sphericity were examined to evaluate the suitability of the data for factor analysis. According to the analysis results, the KMO value was found to be .90, indicating an "excellent" level of sampling adequacy [ 53 ]. The Bartlett's Test of Sphericity result was found to be statistically significant (χ² = 4915.77, df = 171, p < .001). These findings show that the data are suitable for factor analysis. All diagonal values in the anti-image correlation matrix were found to be above .75, supporting the suitability of each item for factor analysis. Eigenvalue statistics and scree plot were considered in determining the number of factors. As a result of EFA performed by applying Principal Components Analysis and Oblimin rotation, four factors with eigenvalues greater than 1 were obtained. The reason for preferring Oblimin rotation is that correlations between factors are theoretically expected. When the scree plot was examined, it was observed that the curve flattened after the fourth factor (Fig. 1 ). As a result of the analysis, it was found that the four-factor structure explained 73.98% of the total variance. The first factor (Empathic Concern) explained 49.91% of the total variance, the second factor (Affective Empathy) 10.09%, the third factor (Cognitive Empathy) 8.33%, and the fourth factor (Behavioral Empathy) 5.64%. All items had factor loadings above .40, and items loaded on theoretically predicted factors. Factor loadings are presented in Table 3 . Table 3 Therapist Empathy Assessment Scale EFA results Factor Item Factor Loadings Variance (%) (1) (2) (3) (4) Cognitive Empathy Item 01 .878 8.33 Item 02 .793 Item 03 .846 Item 04 .537 Item 05 .991 Affective Empathy Item 07 .916 10.09 Item 08 .878 Item 09 .539 Item 11 .824 Empathic Concern Item 12 .817 49.91 Item 13 .700 Item 14 .833 Item 15 .734 Item 16 .780 Item 17 .975 Behavioral Empathy Item 18 .695 5.64 Item 19 .742 Item 22 .787 Item 23 .686 Note . Extraction method: Principal Component Analysis. Factor loadings are taken from the Pattern Matrix after Oblimin rotation. Factor loadings below .40 are not shown in the table. KMO=.90, Bartlett χ²=4915.77 (p<.001). When the Pattern Matrix was examined, the first factor contains six items (12, 13, 14, 15, 16, 17). These items include the therapist's interest, valuing, and follow-up behaviors toward the client and were named "Empathic Concern." The second factor contains four items (7, 8, 9, 11). These items reflect the therapist's emotional responses and emotional attunement and were named "Affective Empathy." The third factor consists of five items (1, 2, 3, 4, 5) and contains items reflecting the therapist's cognitive understanding; this factor was defined as "Cognitive Empathy." The fourth factor contains four items (18, 19, 22, 23), includes the therapist's concrete behavioral responses, and was named "Behavioral Empathy". Confirmatory factor analysis CFA was performed using AMOS 22.0 to test the accuracy of the 19-item, four-subdimension structure revealed by EFA. First, a first-order measurement model was established in which the four subdimensions were related to each other but no hierarchical superstructure was tested (Fig. 2 a). Although the initial analysis results were close to acceptable fit values, modification indices were examined. Following modification recommendations, error covariances were defined between two pairs of items that were theoretically meaningful and within the same factor (Items: 7↔9 and 15↔16). The fit indices achieved after modifications revealed that the model showed acceptable fit (χ² = 512.78, df = 144, p < .001, χ²/df = 3.56, CFI = .925, TLI = .910, RMSEA = .060 [90% CI: .052 − .079]). When the factor loadings (Standardized Regression Weights) in the model were examined, it was seen that all items loaded on the relevant factor at a statistically significant level (p < .001). Standardized factor loadings ranged from .65 to .97 for the Cognitive Empathy dimension, .69 to .97 for the Affective Empathy dimension, .72 to .96 for the Empathic Concern dimension, and .70 to .80 for the Behavioral Empathy dimension. These values prove that the items have high power to represent the relevant constructs. Additionally, when inter-factor correlations were examined, it was observed that there were positive, moderate to high-level significant relationships among the four subdimensions. Correlation coefficients ranged from .47 to .74. These high correlations indicate that the subdimensions share a common superstructure (general therapeutic empathy) and provide empirical support for second-order factor analysis. Considering the high correlations among first-order factors and theoretical foundations, Second-Order CFA was applied to test whether the four subdimensions of the scale constitute a higher latent structure called "Therapist Empathy" (Fig. 2 b). The fit values obtained as a result of the analysis are almost the same as the first-order model and within acceptable limits (χ² = 515.12, df = 146, χ²/df = 3.53, p < .001, CFI = .924, TLI = .911, RMSEA = .060 [90% CI: .051 − .078]). All second-order factor loadings are above .63 and statistically significant (p < .001). In the second-order analysis, the relationship of the four subdimensions with the upper factor was also examined. It was determined that all subdimensions loaded on the general factor at high and significant levels (p < .001). Standardized loading values are respectively: Behavioral Empathy (.86), Empathic Concern (.86), Cognitive Empathy (.69), and Affective Empathy (.63). Table 4 Comparison of first-order and second-order CFA models Model χ² df χ²/df CFI TLI RMSEA (90% GA) Δχ² Δdf p First-Order 512.78 144 3.56 .925 .910 .060 (.052-.079) - - - Second-Order 515.12 146 3.53 .924 .911 .060 (.051-.078) 2.34 2 > .05 Note . df = Degrees of Freedom, CFI = Comparative Fit Index; TLI = Tucker-Lewis Index; RMSEA = Root Mean Square Error of Approximation; CI = Confidence Interval Chi-square difference test and fit indices were examined to compare first-order and second-order models (Table 4 ). According to the chi-square difference test result, no statistically significant difference was found between the two models (Δχ² = 2.34, Δdf = 2, p>.05). When fit indices were compared, it was seen that both models had similar values. The high second-order factor loadings (ranging from .63 to .86) show that the four subdimensions strongly represent the general empathy structure. Consequently, it was concluded that the Therapist Empathy Assessment Scale can be used both with four subdimension scores (Cognitive Empathy, Affective Empathy, Empathic Concern, and Behavioral Empathy) and with a total score. Convergent and discriminant validity AVE values were calculated for convergent validity. An AVE value above .50 indicates that the factor explains at least half of the variance in its own items and that convergent validity is achieved [ 65 ]. According to the analysis results, the AVE values of the four factors ranged from .56 to .70 (Table 5 ). Since all AVE values are above the .50 threshold, it was concluded that the convergent validity of the scale was achieved. Table 5 Convergent and discriminant validity results Variables AVE Correlations (1) (2) (3) (4) (1) Cognitive Empathy .694 (.883) (2) Affective Empathy .666 .465 ** (.816) (3) Empathic Concern .696 .598 ** .519 ** (.834) (4) Behavioral Empathy .559 .571 ** .553 ** .739 ** (.748) Note . Values in parentheses are square root of AVE values. AVE = Average Variance Extracted. ** p < .01. The Fornell-Larcker criterion was used for discriminant validity [ 63 ]. According to this criterion, the square root of each factor's AVE value should be higher than that factor's correlations with other factors. As seen in Table 5 , diagonal values (in parentheses) show the square root of AVE for each factor, while off-diagonal values show inter-factor correlations. Analysis findings revealed that the AVE square root values calculated for each dimension were higher than the correlation coefficients of the relevant dimension with other dimensions. These findings show that the four factors are sufficiently differentiated from each other and that discriminant validity is achieved. Reliability analysis Internal consistency coefficients (Cronbach's Alpha and Composite Reliability) and test-retest reliability analyses were performed to evaluate the reliability of the scale. Cronbach's Alpha coefficients ranged from .82 to .93, and Composite Reliability (CR) coefficients ranged from .84 to .97 (Table 6 ). All values are above .80, showing high internal consistency [ 65 ]. Table 6 Reliability analysis results Variable Cronbach Alpha CR Test-Retest Cognitive Empathy .91 .92 .77*** Affective Empathy .83 .89 .95*** Empathic Concern .93 .93 .75*** Behavioral Empathy .82 .84 .72*** Empathy (Total) .92 .97 .90*** Note. CR = Composite Reliability. ***p < .001. For test-retest reliability, two measurements were taken from a total of 33 participants aged 27–59 years (M = 37.7, SD = 8.7) at two-week intervals, and Pearson correlation coefficients were calculated. Test-retest correlations ranged from .72 to .95, and all values are above the acceptable level (.70) [ 62 ]. For the total score of the scale, Cronbach's Alpha was .92, CR was .97, and test-retest correlation was .90. These findings show that the scale has adequate reliability in terms of both internal consistency and stability over time. Empathy levels perceived by clients according to therapists' schools Whether the therapist empathy levels perceived by clients (cognitive, affective, empathic concern, behavioral, and total score) differ according to the therapy school adopted by their therapists was examined with an independent samples t-test. In the analyses, "therapist working with this school" and "therapist not working with this school" groups were compared for each therapeutic school. Analyses were conducted for eight different therapeutic schools, and the results are presented in Table 7 . Table 7 Empathy levels perceived by clients according to therapists' schools School Cognitive Empathy Affective Empathy Empathic Concern Behavioral Empathy Empathy (Total) Cognitive Behavioral Therapy No (n = 156) 4.82 ± 0.34 4.57 ± 0.58 4.76 ± 0.38 4.79 ± 0.34 4.74 ± 0.34 Yes (n = 159) 4.81 ± 0.34 4.53 ± 0.73 4.76 ± 0.39 4.80 ± 0.35 4.70 ± 0.35 t-test t = 0.402 p = .688 t = 0.821 p = .412 t = -0.006 p = .995 t = -0.100 p = .920 t = 1.251 p = .212 Integrative Psychotherapy No (n = 221) 4.78 ± 0.36 4.39 ± 0.68 4.73 ± 0.40 4.77 ± 0.36 4.68 ± 0.35 Yes (n = 94) 4.89 ± 0.27 4.63 ± 0.61 4.83 ± 0.33 4.85 ± 0.30 4.81 ± 0.31 t-test t = -3.043 p = .003 t = -3.133 p = .002 t = -2.272 p = .024 t = -1.972 p = .049 t = -3.257 p = .001 EMDR No (n = 268) 4.80 ± 0.34 4.48 ± 0.66 4.76 ± 0.38 4.78 ± 0.35 4.72 ± 0.34 Yes (n = 47) 4.86 ± 0.33 4.34 ± 0.70 4.77 ± 0.40 4.90 ± 0.25 4.73 ± 0.33 t-test t = -1.022 p = .308 t = 1.362 p = .174 t = -0.174 p = .862 t = -2.956 p = .004 t = -0.262 p = .794 Transactional Analysis No (n = 271) 4.79 ± 0.35 4.43 ± 0.68 4.75 ± 0.40 4.78 ± 0.35 4.70 ± 0.35 Yes (n = 44) 4.92 ± 0.24 4.68 ± 0.52 4.87 ± 0.28 4.89 ± 0.24 4.85 ± 0.22 t-test t = -3.000 p = .004 t = -2.779 p = .007 t = -2.544 p = .013 t = -2.603 p = .011 t = -3.767 p < .001 Schema Therapy No (n = 275) 4.82 ± 0.34 4.46 ± 0.66 4.76 ± 0.38 4.78 ± 0.35 4.72 ± 0.34 Yes (n = 40) 4.80 ± 0.36 4.46 ± 0.75 4.76 ± 0.40 4.89 ± 0.29 4.73 ± 0.36 t-test t = 0.351 p = .726 t = 0.002 p = .998 t = 0.027 p = .979 t = -2.038 p = .046 t = -0.275 p = .783 Behavioral No (n = 286) 4.82 ± 0.34 4.48 ± 0.67 4.77 ± 0.38 4.80 ± 0.34 4.73 ± 0.34 Yes (n = 29) 4.72 ± 0.39 4.34 ± 0.66 4.75 ± 0.42 4.75 ± 0.38 4.66 ± 0.38 t-test t = 1.471 p = .142 t = 1.070 p = .285 t = 0.163 p = .871 t = 0.073 p = .440 t = 1.047 p = .296 Positive Therapy No (n = 289) 4.82 ± 0.34 4.45 ± 0.68 4.76 ± 0.39 4.80 ± 0.34 4.72 ± 0.34 Yes (n = 26) 4.78 ± 0.37 4.59 ± 0.50 4.84 ± 0.34 4.77 ± 0.36 4.76 ± 0.35 t-test t = 0.558 p = .577 t = -0.986 p = .325 t = -1.046 p = .297 t = 0.429 p = .668 t = -0.541 p = .589 Psychodynamic No (n = 289) 4.81 ± 0.34 4.47 ± 0.68 4.78 ± 0.37 4.80 ± 0.34 4.73 ± 0.34 Yes (n = 26) 4.81 ± 0.33 4.42 ± 0.59 4.64 ± 0.52 4.76 ± 0.36 4.66 ± 0.36 t-test t = 0.078 p = .938 t = 0.315 p = .753 t = 1.296 p = .206 t = 0.578 p = .563 t = 0.877 p = .381 Note . Values are presented as mean ± standard deviation. When Table 7 is examined, it is seen that clients who indicated that their therapists adopted the Integrative Psychotherapy school had statistically significantly higher scores in Cognitive Empathy (t = -3.043; p < .01), Affective Empathy (t = -3.133; p < .01), Empathic Concern (t = -2.272; p < .05), Behavioral Empathy (t = -1.972; p < .05) subdimensions and Total Empathy (t = -3.257; p < .01) compared to those who did not adopt this school. Similarly, it is seen that clients who indicated that their therapists applied the Transactional Analysis school had statistically significantly higher scores in Cognitive Empathy (t = -3.000; p < .01), Affective Empathy (t = -2.779; p < .01), Empathic Concern (t = -2.544; p < .05), and Behavioral Empathy (t = -2.603; p < .05) subdimensions and Total Empathy (t = -3.767; p < .001) compared to those who did not apply this school. When EMDR and Schema Therapy schools are examined, it is seen that differentiation occurs in only one dimension. Clients whose therapists apply EMDR (t = -2.956; p < .01) and clients whose therapists apply Schema Therapy (t = -2.038; p < .05) have significantly higher Behavioral Empathy subdimension scores compared to clients of therapists who do not apply these schools. No significant difference was found in other subdimensions and total score. On the other hand, in comparisons made in terms of Cognitive Behavioral Therapy, Behavioral Therapy, Positive Therapy, and Psychodynamic approaches, no statistically significant differentiation was found between "Yes" and "No" groups in either subdimensions or total empathy scores (p > .05). In conclusion, therapists using Integrative Psychotherapy and Transactional Analysis among therapeutic schools are perceived as significantly more empathic by their clients. Therapists using EMDR and Schema Therapy score higher especially in the behavioral empathy dimension. No significant differences in empathy perception were observed for CBT, Behavioral Therapy, Positive Therapy, and Psychodynamic Therapy. These findings suggest that some therapeutic schools may emphasize empathy expression more due to their nature. Toronto Empathy Questionnaire scores according to therapists' schools Independent samples t-test was applied to determine whether therapists' empathy levels based on self-reports (Toronto Empathy Questionnaire) differ according to the therapy school they adopt. Analyses were conducted for eight different therapeutic schools, and the results are presented in Table 8 . Table 8 Toronto Empathy Questionnaire scores according to therapists' schools School No Yes t p Cognitive Behavioral Therapy 3,54 ± 0,31 3,47 ± 0,34 1,099 ,274 EMDR 3,51 ± 0,31 3,49 ± 0,36 0,214 ,831 Integrative Psychotherapy 3,52 ± 0,34 3,47 ± 0,29 0,746 ,458 Psychodynamic 3,48 ± 0,32 3,56 ± 0,33 -1,081 ,282 Family Therapy 3,49 ± 0,33 3,54 ± 0,31 -0,669 ,505 Transactional Analysis 3,50 ± 0,34 3,49 ± 0,26 0,179 ,858 Eclectic 3,52 ± 0,33 3,42 ± 0,28 1,326 ,188 Schema Therapy 3,49 ± 0,31 3,55 ± 0,37 -0,757 ,451 Note . Values are presented as mean ± standard deviation. According to the analysis results, no statistically significant difference was found in terms of therapists' own empathy levels for any therapeutic school (p>.05). Toronto Empathy Questionnaire scores of therapists in all therapeutic schools are at medium-high levels (in the range of M = 3.42–3.56) and at similar levels to each other. These findings show that therapists' own empathy levels are independent of the therapeutic school they choose. In other words, therapists using different therapeutic schools have similar empathy capacity. When this result is evaluated together with the findings obtained in the previous section (Table 7 ), an interesting picture emerges: While therapists' own empathy levels (Toronto Empathy Questionnaire) do not differ according to schools, empathy levels perceived by clients (Therapist Empathy Assessment Scale) are significantly higher in some schools (especially Integrative Psychotherapy and Transactional Analysis). This finding suggests that rather than the empathy capacity therapists possess, the ways different therapeutic schools express and communicate empathy may be effective on client perception. Discussion This study was conducted to develop the Therapist Empathy Assessment Scale (TEAS), which enables the evaluation of empathy—one of the most critical common factors of the psychotherapy process—from the client's perspective and within a multidimensional structure, and to compare the empathy levels of therapists adopting different schools from both client and therapist viewpoints. The research findings generally point to two main conclusions. First, the TEAS, developed to evaluate therapist empathy multidimensionally from the client's perspective, possesses strong psychometric properties. Second, while therapists' self-reported empathy levels did not differ based on their adopted school, the empathy levels perceived by clients were significantly higher in certain orientations (Integrative and TA). These results are consistent with the extensive literature regarding the curative function of empathy as a common factor in psychotherapy [ 3 , 11 ] and confirm the importance of addressing empathy not merely as the "therapist's internal capacity" but as a "quality of relationship experienced by the client" [ 4 , 18 ]. Findings regarding the construct validity of the scale demonstrated that the TEAS is organized in a four-factor structure and that these factors constitute a meaningful whole both theoretically and empirically. In the exploratory factor analysis, after removing four items (6, 10, 20, 21) that disrupted the factor structure or cross-loaded, the scale achieved a stable structure with 19 items. Confirmatory factor analysis findings revealed that the first-order model yielded acceptable fit and that each item loaded significantly on the relevant factor. The moderate-to-high correlations between factors suggested that the subscales share a common higher-order structure; indeed, the tested second-order model was also confirmed with similar fit values. This finding overlaps with theoretical views that empathy is a multidimensional phenomenon consisting of separable components yet organized by a common higher structure [ 1 , 15 ]. Considering that empathy definitions in the context of psychotherapy include empathic concern/compassion and behavioral/communicative components alongside cognitive and affective components [ 3 , 24 ], it can be stated that the four-dimensional structure of the TEAS rests on a theoretically solid ground. The convergent and discriminant validity findings of the TEAS supported that the scale consistently captures the measured construct. The AVE values being above the threshold indicated that each factor explained a significant portion of the variance in its items. The differentiation of factors from each other according to the Fornell–Larcker criterion is particularly important when a construct like empathy, which is conceptually prone to overlap with other constructs (alliance, acceptance, genuineness, etc.), is in question [ 10 , 66 ]. Reliability analyses also confirmed that the TEAS is a robust measurement tool. High internal consistency coefficients indicated that the scale works consistently within itself, while high test-retest correlations showed that the measurement is resistant to time. In a process that can fluctuate within the session like empathy [ 29 ], high stability values obtained with a two-week interval suggest that the TEAS is able to capture the client's continuous empathy experience in the therapeutic relationship rather than an instantaneous session impression. When examining perceived empathy levels according to therapeutic orientations, it was observed that clients of therapists practicing Integrative Psychotherapy and Transactional Analysis (TA) reported significantly higher scores on all subscales and the total score of the TEAS. For EMDR and Schema Therapy, differentiation emerged only in the Behavioral Empathy dimension, while no significant difference was detected in CBT, Behavioral Therapy, Positive Therapy, and Psychodynamic approaches. This pattern is noteworthy in two respects. First, consistent with meta-analytic evidence that the empathy-outcome relationship is a "common factor" across orientations [ 8 , 11 ], clients in all approaches generally reported high empathy perception. Second, the association of certain orientations (Integrative and TA) with higher scores demonstrates the importance of addressing empathy not merely as a capacity, but as an active process related to how it is embodied within the session and communicated to the client [ 4 , 12 ]. For Integrative Psychotherapy, these findings overlap with the theoretical framework. In this approach, psychological healing becomes possible within a relationship that is sensitive, attuned, and in contact with the client's relational needs [ 30 , 31 ]. The methods of "inquiry, attunement, and involvement" emphasized by Erskine [ 34 ] and the conceptualization of "beyond empathy" require the therapist not only to accompany the client's emotion but to actively support the experience of safety and being valued by producing an appropriate response [ 38 ]. The association of the Integrative approach with higher perception, especially in the Empathic Concern and Behavioral Empathy dimensions, can be explained by this school positioning the relationship not merely as a tool but as a curative factor in itself [ 35 , 36 ]. Similarly, high scores observed for Transactional Analysis are consistent with the central role of the empathic bond in relational TA schools within the context of "contact messages" and safety needs [ 4 , 67 ]. The finding of significant differentiation only in the Behavioral Empathy dimension in EMDR and Schema Therapy suggests that empathy perception can be shaped by technical and action-oriented cues. The client's empathy perception is influenced by the therapist's non-verbal cues such as eye contact and body lean, as well as structuring and active intervention forms within the session [ 28 , 42 ]. In schools with distinct technical and procedural structures like EMDR and Schema Therapy, active techniques applied by the therapist (eye movements, chair work, reparenting, etc.) might be coded by the client as a concrete effort for their benefit, i.e., an indicator of "behavioral empathy." Regarding therapists' self-reported empathy levels (TEQ), no significant difference was detected in any orientation. This result confirms the "evaluator paradox" in empathy literature. Meta-analyses report that measures based on client perception best predict therapy outcome, whereas therapist self-report shows weaker relationships with the outcome [ 8 , 19 ]. Therapists, due to their "helping professional" identities, may fall into social desirability bias when evaluating themselves through their intentions; however, this internal capacity may not always reflect as accurate "attunement" to the client [ 20 , 29 ]. The picture emerging in this study shows that therapeutic orientation does not change the therapist's "empathy capacity," but creates a difference in client perception by changing "how this capacity is communicatively embodied." From a clinical and educational perspective, the most important contribution of the TEAS is its ability to present therapist empathy as a detailed profile in cognitive, affective, empathic concern, and behavioral dimensions, rather than just a general score. This study supports integrative approaches emphasizing that therapeutic change is related not only to "understanding" but to the continuous construction of the client's experience of safety and being valued (concern) [ 30 , 40 ]. Therefore, the TEAS offers a practical assessment framework for therapists to recognize their strengths and areas open to development in supervision processes. The findings of the study should be evaluated within the framework of certain limitations. First, the use of convenience sampling limits generalizability. Second, the fact that therapists may draw from multiple schools (eclectic/integrative) can make it difficult to distinguish orientations as pure categories. Third, the risk of mono-method bias exists in measures based on client perception [ 43 ]. Future studies addressing TEAS scores together with observer ratings (e.g., TES [ 21 ]) and psychophysiological measures [ 17 ] would strengthen the evidence regarding criterion validity. Conclusion In conclusion, this study has proven that the TEAS, which evaluates therapist empathy multidimensionally from the client's perspective, is a valid and reliable measurement tool in Turkish culture. While there was no difference in therapists' self-reports, the fact that Integrative and TA-oriented therapists were perceived as more empathic by their clients reveals that empathy is not a static trait in psychotherapy, but a dynamic relationship process actively established, communicated, and experienced within the session. Abbreviations AVE Average Variance Extracted CFA Confirmatory Factor Analysis CFI Comparative Fit Index CI Confidence Interval CR Composite Reliability EFA Exploratory Factor Analysis EMDR Eye Movement Desensitization and Reprocessing KMO Kaiser-Meyer-Olkin RMSEA Root Mean Square Error of Approximation TA Transactional Analysis TEAS Therapist Empathy Assessment Scale TEQ Toronto Empathy Questionnaire TLI Tucker-Lewis Index Declarations Ethics approval and consent to participate Approval was obtained from Istanbul Arel University Ethics Committee dated 18/04/2025 with number 2025/10 for the research, and the study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent based on voluntary participation was obtained from all participants, and assurance was given that the data would be evaluated anonymously and used only for scientific purposes. Consent for publication Not applicable. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution ZTS designed the study, performed statistical analyses, and wrote the manuscript. MŞ collected the data. All authors read and approved the final manuscript. Acknowledgement The authors would like to thank Richard G. Erskine for his valuable feedback on the scale items, and all the therapists and clients who participated in this study. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Hall J, Schwartz R. Empathy present and future. J Soc Psychol. 2018;159(3):225–43. 10.1080/00224545.2018.1477442 . Rogers CR, Empathic. An unappreciated way of being. Couns Psychol. 1975;5:2–10. 10.1177/001100007500500202 . Schnur JB, Montgomery GH. 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In this context, the concept of empathy holds a central place in a vast literature ranging from social and personality psychology to neuroscience, and from clinical practice to health domains [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In psychotherapy, empathy is conceptualized as the capacity to approach the client\u0026rsquo;s internal frame of reference \"as if\" one were the other person but without losing the \"as if\" condition, to comprehend the client\u0026rsquo;s experience in both cognitive and affective dimensions, and to communicate this understanding to the client [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Rogers\u0026rsquo; approach, empathy, along with unconditional positive regard and congruence, was counted among the core conditions of therapeutic change; the therapist\u0026rsquo;s empathic understanding was seen as a key element in creating a safe relational ground for the client to explore themselves and construct new meanings [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This emphasis largely aligns with subsequent process-outcome research: Meta-analytic findings indicate that therapist empathy is consistently and moderately associated with treatment outcomes across different therapeutic orientations, explaining approximately 7\u0026ndash;10% of the variance in outcomes, and in many studies, serving as a predictor comparable to (or in some contexts, higher than) specific technical effects [\u003cspan additionalcitationids=\"CR8 CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The American Psychological Association\u0026rsquo;s framework for evidence-based therapy relationships has also registered empathy as an effective relationship factor [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is suggested that the impact of empathy is not limited to increasing the feeling of being \"understood\"; it operates through a series of mechanisms such as helping the client feel safer, approach difficult content, support emotion regulation, and make a corrective emotional experience possible [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Clients feeling understood and accepted by their therapists can reduce the experience of loneliness and alienation, creating a more relational \"state of being\" [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The contextual model perspective also emphasizes that an empathic and caring therapeutic relationship strengthens the \"healing setting,\" and that warm, involved, and reassuring interaction (e.g., active listening and supportive communication) can create meaningful differences in client experiences [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe problem of assessing empathy: What, from whom, and how is it measured?\u003c/p\u003e \u003cp\u003eDespite the importance of empathy in psychotherapy, the lack of a single, agreed-upon definition in the field creates significant difficulties in measurement [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In the literature, empathy can be addressed as a trait, a capacity/competence, an interpersonal process, an attitudinal orientation, or a behavioral style of communication [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This conceptual diversity leads measurement tools to capture vastly different \"parts of empathy,\" resulting in often weak correlations between different empathy measures [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother critical issue in empathy measurement is the source of the report. Barrett-Lennard [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] proposed addressing empathy in the context of psychotherapy from the perspectives of the therapist, the client, and the observer; subsequent meta-analytic studies have shown that the empathy measures that best predict therapy outcomes are mostly those perceived by the client [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This finding requires thinking of empathy not merely as the therapist\u0026rsquo;s \"internal capacity,\" but as a relationship phenomenon communicated within the session and experienced by the client. Indeed, Rogers specifically emphasized the importance of empathic understanding not just being \"offered\" by the therapist, but being perceived/experienced by the client [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough self-report tools provide ease of administration, they carry limitations due to social desirability and self-assessment bias; it is debated how \"accurately\" individuals can report on their empathic accuracy or in-session empathic communication [\u003cspan additionalcitationids=\"CR21 CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Indeed, in both health communication and psychotherapy, it is noted that first-person measures (self-report) may show weaker relationships with patient/client evaluations and clinical outcomes [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. While observer ratings and behavioral coding systems may offer a more \"outside\" window, they can harbor problems such as time costs, reliability challenges, and the limitation of the assumption that the \"expert truly knows the client\u0026rsquo;s internal world\" [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Therefore, one of the fundamental needs in the measurement field is the development of current and comprehensive tools that evaluate empathy specifically within the therapeutic context and based on the client\u0026rsquo;s experience, without reducing empathy to a single dimension [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTheoretical framework: Integrative psychotherapy and multidimensional empathy\u003c/p\u003e \u003cp\u003eThe most common distinction in empathy literature is made between cognitive and affective components: Cognitive empathy is associated with perspective-taking and meaning-making processes, while affective empathy is associated with affect sharing, emotional resonance, and emotional recognition processes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, defining empathy in the therapeutic context solely at the level of \"understanding\" and \"feeling\" may overshadow certain elements that make empathy functional within the session (such as concern for the client\u0026rsquo;s well-being, safety climate, non-verbal/verbal communication behaviors, rhythm, and attunement) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAt this point, the Integrative Psychotherapy approach offers a significant contribution by expanding empathy within a relationship-centered framework. In Erskine\u0026rsquo;s approach, relationship and contact are at the center of human motivation; a significant portion of psychological distress can be seen as linked to the repeated failure to meet essential relational needs (e.g., security, valuing, acceptance, validation, mutuality, self-definition, making an impact, the other\u0026rsquo;s initiative, and expressing love) [\u003cspan additionalcitationids=\"CR31 CR32\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In this perspective, the therapeutic relationship is not merely the \"ground\" for interventions, but a curative factor in itself that enables the client to integrate dissociated parts and develop more flexible choices [\u003cspan additionalcitationids=\"CR35 CR36\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eErskine\u0026rsquo;s emphasis on \"beyond empathy\" suggests that empathy is completed not only by feeling the client\u0026rsquo;s emotion but by the capacity to produce a therapeutic response sensitive to the client\u0026rsquo;s relational needs [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In this approach, the therapeutic process requires the continuous operation of methods such as phenomenological inquiry, attunement, and involvement/presence within the relationship [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Attunement involves a sensitive adjustment not only to the client\u0026rsquo;s content but also to their rhythm, affect intensity, developmental level, and relational needs [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Thus, therapeutic empathy becomes visible not merely as a cognitive-affective \"state,\" but as a dynamic and multidimensional interaction process shaped by cues (verbal and non-verbal) received from the client [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Therapist Empathy Assessment Scale (TEAS) developed in this study aims to transport this theoretical background into a measurable framework. The scale addresses therapeutic empathy in four components through the client\u0026rsquo;s experience: Cognitive Empathy (comprehending the client\u0026rsquo;s beliefs and world of meaning), Affective Empathy (accompanying affect and appropriate emotional response), Empathic Concern (valuing, acceptance, safety climate, and commitment to the client\u0026rsquo;s well-being), and Behavioral Empathy (the transformation of the empathic process into visible communication behaviors; e.g., listening attentively, respecting silence, in-session tracking) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEmpathy in the context of therapeutic orientations\u003c/p\u003e \u003cp\u003eAlthough empathy is accepted as a central relationship element in different psychotherapy orientations, the function attributed to empathy and the forms of \"showing/conveying\" empathy may differ according to theoretical emphasis and technical ecology [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. For instance, in the psychoanalytic tradition, the ideal of neutrality and maintaining boundaries has been discussed as a balance to be operated within an empathic atmosphere [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. In the cognitive-behavioral tradition, empathy is often positioned as a supportive relationship condition that enables collaboration and working with challenging tasks; it is noted that empathic communication can be intertwined with formulation and intervention strategies [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In approaches like Motivational Interviewing, empathy is operationalized as a core component of the therapeutic language and the stance that facilitates change talk [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNevertheless, the literature shows that the empathy-outcome relationship is observed at generally similar levels across different orientations; that is, empathy largely operates as a common factor across schools [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. At this point, a more refined question arises: Do schools create different effects on how the therapist expresses empathy and how the client perceives it, rather than changing the therapist\u0026rsquo;s empathy capacity? Perceived empathy by the client can be influenced by micro-behaviors such as non-verbal behaviors (eye contact, body lean), tone of voice/rhythm matching, and the adjustment of in-session responses, as much as by verbal content [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Therefore, to understand potential differences between therapeutic orientations, \"who evaluates empathy\" and \"which dimensions of empathy we capture\" become decisive [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe present study\u003c/p\u003e \u003cp\u003eThe first aim of this study is to develop a multidimensional measurement tool evaluating therapist empathy from the client's perspective and to examine its psychometric properties, based on the Integrative Psychotherapy approach and Erskine\u0026rsquo;s conceptualizations that expand empathy within the framework of relational needs, attunement, and \"beyond empathy.\" Although there are numerous tools to measure empathy in the literature, the lack of a \"gold standard\" and the often limited validity evidence keep the need for scale development specific to the therapeutic context alive [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Furthermore, a significant portion of the tools used, particularly in the context of Turkey, are adaptations of older self-report scales and remain limited in evaluating the multidimensional and relational nature of therapeutic empathy from the client's eyes [\u003cspan additionalcitationids=\"CR45 CR46 CR47 CR48 CR49 CR50 CR51\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Therefore, the development of an evaluation tool that is both culturally sensitive and theoretically integrative is a critical need for advancing psychotherapy research in this region.\u003c/p\u003e \u003cp\u003eThe second aim of the study is to present a comparative framework in the context of therapeutic orientations by addressing empathy from two different sources: (a) therapist empathy perceived by the client (TEAS) and (b) the therapist\u0026rsquo;s self-reported empathy level. This dual approach aims to provide a design sensitive to the difference in evaluation source (client\u0026ndash;therapist\u0026ndash;observer) frequently emphasized in the field and to examine empathy not merely as a \"personality trait\" but as a relationship phenomenon communicated and experienced within the session [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eParticipants\u003c/p\u003e \u003cp\u003eThis research was conducted on two independent sample groups, \"Clients\" and \"Therapists,\" created to serve different purposes of the study.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eClients group\u003c/h2\u003e \u003cp\u003eThe first study group of the research was formed for (1) conducting validity and reliability analyses of the \"Therapist Empathy Assessment Scale\" and (2) examining whether the therapist empathy level perceived by clients differs according to the school adopted by the therapist. In determining the participants, convenience sampling, one of the non-probability sampling methods, was preferred. The inclusion criteria for the research were: being 18 years of age or older, being in an active therapy process, and voluntarily agreeing to participate in the research.\u003c/p\u003e \u003cp\u003eInitially, data were obtained from a total of 352 participants. One participant was excluded from the study due to missing data. To detect the presence of multivariate outliers in the remaining dataset of 351 individuals, Mahalanobis distance values were calculated, and 36 participants were identified as outliers at the p \u0026lt; .001 significance level [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. After removing these participants from the dataset, the final study group consisting of 315 participants was formed. According to Comrey and Lee, a sample of 300 people is considered good for factor analysis [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e], while Bryman and Cramer state that the sample size should be at least five times the number of items in scale development studies [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. This obtained sample size has the recommended adequacy for factor analysis, considering the number of participants per item (approximately 13:1).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the clients group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssociate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiving with partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e73.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eNumber of sessions with therapist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80\u0026ndash;159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than 160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eTherapist's school*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive behavioral therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntegrative psychotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEMDR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTransactional analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchema therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBehavioral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychodynamic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e* Participants were given the opportunity to select multiple options for this question. Percentage values indicate the proportion within total responses.\u003c/p\u003e \u003cp\u003eConsequently, this study group consists of a total of 315 volunteer clients aged 18\u0026ndash;66 years (M\u0026thinsp;=\u0026thinsp;35.9; SD\u0026thinsp;=\u0026thinsp;9.9) residing in various provinces of Turkey and currently receiving therapy services from a mental health professional. The demographic statistics of the participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The vast majority of participants are female (n\u0026thinsp;=\u0026thinsp;260, 82.5%); their education levels are predominantly concentrated at undergraduate (n\u0026thinsp;=\u0026thinsp;128, 40.6%) and graduate (n\u0026thinsp;=\u0026thinsp;114, 36.2%) levels. In terms of marital status, married (n\u0026thinsp;=\u0026thinsp;148, 47.0%) and single (n\u0026thinsp;=\u0026thinsp;123, 39.0%) participants constitute the majority of the sample, while in terms of employment status, the majority of the group (n\u0026thinsp;=\u0026thinsp;230, 73.0%) is actively working. When data regarding the therapy process are evaluated, it was found that a significant portion of clients received services in the range of 10\u0026ndash;19 sessions (n\u0026thinsp;=\u0026thinsp;74, 23.5%) and 20\u0026ndash;39 sessions (n\u0026thinsp;=\u0026thinsp;63, 20.0%); they most frequently indicated Cognitive Behavioral Therapy (n\u0026thinsp;=\u0026thinsp;159, 30.3%) and Integrative Psychotherapy (n\u0026thinsp;=\u0026thinsp;94, 17.9%) as the approaches adopted by their therapists.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTherapists group\u003c/h3\u003e\n\u003cp\u003eThe second study group of the research was formed to examine whether therapists' self-reported empathy levels measured by the \"Toronto Empathy Questionnaire\" differ according to the therapy school they adopt. Convenience sampling, one of the non-probability sampling methods, was used in determining the participants. The inclusion criteria for the research were: actively providing therapy services for at least one year and voluntarily agreeing to participate in the research. The sample size was calculated to be at least 96 people based on Yazıcıoğlu and Erdoğan's [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e] assumptions of p\u0026thinsp;=\u0026thinsp;0.50, q\u0026thinsp;=\u0026thinsp;0.50, and 0.10 sampling error. Within the scope of the research, 100 therapists were reached, thus achieving the required sample size.\u003c/p\u003e \u003cp\u003eConsequently, this study group consists of a total of 100 volunteer therapists aged 26\u0026ndash;76 years (M\u0026thinsp;=\u0026thinsp;41.0; SD\u0026thinsp;=\u0026thinsp;10.9) residing in various provinces of Turkey and actively providing therapy services for at least one year. The demographic statistics of the therapists are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The majority of participating therapists are female (n\u0026thinsp;=\u0026thinsp;82, 82.0%), and their education levels are concentrated at the graduate level, predominantly master's degree (n\u0026thinsp;=\u0026thinsp;67, 67.0%) and doctorate (n\u0026thinsp;=\u0026thinsp;21, 21.0%). In terms of professional experience, the majority of the sample consists of experts with experience between 5\u0026ndash;9 years (n\u0026thinsp;=\u0026thinsp;30, 30.0%) and 10\u0026ndash;19 years (n\u0026thinsp;=\u0026thinsp;32, 32.0%). Among the titles declared by participants, Clinical Psychologist (n\u0026thinsp;=\u0026thinsp;61, 49.2%) ranks first; it was determined that the schools most frequently used by therapists in their practice are Cognitive Behavioral Therapy (n\u0026thinsp;=\u0026thinsp;55, 20.0%), EMDR (n\u0026thinsp;=\u0026thinsp;36, 13.1%), and Integrative Psychotherapy (n\u0026thinsp;=\u0026thinsp;33, 12.0%), respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the therapist group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoctorate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical specialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eExperience in therapy services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;4 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;9 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;19 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;39 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than 40 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eTitle*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical psychologist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExpert psychologist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLicensed psychotherapist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychological counselor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychiatrist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eSchool*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive behavioral therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEMDR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntegrative psychotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychodynamic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTransactional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEclectic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchema therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e* Participants were given the opportunity to select multiple options for these questions. Percentage values indicate the proportion within total responses.\u003c/p\u003e \u003cp\u003eMeasures\u003c/p\u003e\n\u003ch3\u003eTherapist Empathy Assessment Scale (TEAS)\u003c/h3\u003e\n\u003cp\u003eIn the research, the \"Therapist Empathy Assessment Scale\" (TEAS), developed by the researchers, was used to measure how clients perceive their therapists' empathy levels. While creating the item pool for the scale, the International Integrative Psychotherapy approach was taken as the basis; particularly, Erskine's concepts of \"empathy\" and \"beyond empathy,\" which refers to focusing on the client's relational needs, were determined as reference points [\u003cspan additionalcitationids=\"CR58\" citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. The scale consists of a total of 23 items and four sub-dimensions:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCognitive Empathy (items 1\u0026ndash;5): Contains items measuring the therapist's ability to understand the client's beliefs, values, and perspective on events (e.g., \"My therapist understands my beliefs and values\").\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAffective Empathy (items 6\u0026ndash;11): Evaluates the therapist's capacity to attune to the client's emotions, feel these emotions, and provide appropriate emotional responses (e.g., \"My therapist understands my emotions and gives appropriate responses to my emotions\").\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eEmpathic Concern (items 12\u0026ndash;17): Encompasses the therapist's care for the client's well-being, provision of a safe environment, and supportive attitude (e.g., \"My therapist provides me with a safe environment in the therapy process\").\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eBehavioral Empathy (items 18\u0026ndash;23): Represents the concrete behavioral manifestation of the empathic process (careful listening, respect for silence, etc.) (e.g., \"My therapist listens to me carefully\").\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe scale is rated on a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;Strongly Disagree, 5\u0026thinsp;=\u0026thinsp;Strongly Agree). Higher scores on the scale indicate a high level of empathy perceived by the client from the therapist.\u003c/p\u003e \u003cp\u003eDuring the content validity process of the scale, the items were reviewed by five different accredited psychotherapists, and necessary adjustments were made. The final version of the scale was submitted for evaluation by Richard Erskine, the founder of Integrative Psychotherapy theory; Erskine confirmed the comprehensiveness and appropriateness of the items, and the final form was created (Erskine's feedback dated February 19, 2025: \"\u003cem\u003eI have carefully read through the scale; it seems that no changes are necessary\u003c/em\u003e\").\u003c/p\u003e\n\u003ch3\u003eToronto Empathy Questionnaire (TEQ)\u003c/h3\u003e\n\u003cp\u003eIn the research, the Toronto Empathy Questionnaire (TEQ), developed by Spreng et al. [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e] and adapted into Turkish by Totan et al. [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], was used to determine therapists' self-reported empathy levels. The unidimensional scale contains a total of 13 items. Sample items are \"It upsets me to see someone being treated disrespectfully\" and \"I enjoy making other people feel better.\" The scale is prepared on a 4-point Likert scale (1\u0026thinsp;=\u0026thinsp;Not at all appropriate, 4\u0026thinsp;=\u0026thinsp;Completely appropriate) and contains a total of eight reverse-coded items (items 1, 3, 5, 7, 8, 9, 11, 12). An increase in the total score obtained from the scale indicates that the individual's empathy level is high. In the Turkish adaptation study, the Cronbach's alpha reliability coefficient of the scale was reported as α\u0026thinsp;=\u0026thinsp;.79 [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. In the current study, the Cronbach's alpha reliability coefficient of the scale was determined as α\u0026thinsp;=\u0026thinsp;.85.\u003c/p\u003e \u003cp\u003eProcedure\u003c/p\u003e \u003cp\u003eThe data collection process lasted approximately eight months (April-November 2025) online through Google Forms. For the clients group, clients were reached through mental health professionals actively providing therapy services in various provinces of Turkey; participants completed the demographic information form and the \"Therapist Empathy Assessment Scale.\" For test-retest reliability, a second measurement was taken from 33 participants after a two-week interval. For the therapists group, mental health professionals with at least one year of experience were reached and asked to complete the demographic information form and the Toronto Empathy Questionnaire. In both groups, completing the scales took approximately 8\u0026ndash;10 minutes.\u003c/p\u003e \u003cp\u003eThe obtained data were analyzed using SPSS 26.0 and AMOS 22.0 programs. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were applied for the construct validity of the scale. In CFA, the Maximum Likelihood estimation method was used, and χ\u0026sup2;/df ratio, Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and Root Mean Square Error of Approximation (RMSEA) criteria were used to evaluate model fit. For good fit, χ\u0026sup2;/df\u0026thinsp;\u0026le;\u0026thinsp;3, CFI and TLI \u0026ge; .95, RMSEA \u0026le; .06; for acceptable fit, χ\u0026sup2;/df\u0026thinsp;\u0026le;\u0026thinsp;5, CFI and TLI \u0026ge; .90, RMSEA \u0026le; .08 criteria were adopted [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. Average Variance Extracted (AVE) values were used for convergent validity, and the Fornell-Larcker criterion was used for discriminant validity [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. In reliability analyses, Cronbach's Alpha internal consistency coefficient, Composite Reliability (CR), and test-retest correlations were calculated. Normality assumptions were evaluated with skewness and kurtosis values (\u0026plusmn;\u0026thinsp;3), and all variables were determined to be suitable for parametric analyses [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. Independent samples t-test was used to compare therapists' empathy levels according to their schools. In all analyses, the significance level was accepted as p \u0026lt; .05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eExploratory factor analysis\u003c/p\u003e \u003cp\u003eEFA was first applied to test the construct validity of the Therapist Empathy Assessment Scale. In the initial analysis, factor analysis was performed with all 23 items, but it was found that four items (6, 10, 20, and 21) created problems in the factor structure. It was observed that items 6 and 10 did not load sufficiently on any factor (factor loading below .40), and items 20 and 21 loaded highly on multiple factors (cross-loading). These items were removed separately by trying all possible combinations, and analyses were repeated. However, these items maintained their problematic structures under all conditions. Therefore, to preserve the theoretical structure and strengthen the psychometric properties of the scale, these four items were removed from the scale, and analyses were conducted on the remaining 19 items.\u003c/p\u003e \u003cp\u003eBefore proceeding to factor analysis, the Kaiser-Meyer-Olkin (KMO) sampling adequacy coefficient and Bartlett's Test of Sphericity were examined to evaluate the suitability of the data for factor analysis. According to the analysis results, the KMO value was found to be .90, indicating an \"excellent\" level of sampling adequacy [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. The Bartlett's Test of Sphericity result was found to be statistically significant (χ\u0026sup2; = 4915.77, df\u0026thinsp;=\u0026thinsp;171, p \u0026lt; .001). These findings show that the data are suitable for factor analysis. All diagonal values in the anti-image correlation matrix were found to be above .75, supporting the suitability of each item for factor analysis.\u003c/p\u003e \u003cp\u003eEigenvalue statistics and scree plot were considered in determining the number of factors. As a result of EFA performed by applying Principal Components Analysis and Oblimin rotation, four factors with eigenvalues greater than 1 were obtained. The reason for preferring Oblimin rotation is that correlations between factors are theoretically expected. When the scree plot was examined, it was observed that the curve flattened after the fourth factor (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAs a result of the analysis, it was found that the four-factor structure explained 73.98% of the total variance. The first factor (Empathic Concern) explained 49.91% of the total variance, the second factor (Affective Empathy) 10.09%, the third factor (Cognitive Empathy) 8.33%, and the fourth factor (Behavioral Empathy) 5.64%. All items had factor loadings above .40, and items loaded on theoretically predicted factors. Factor loadings are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTherapist Empathy Assessment Scale EFA results\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eFactor Loadings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariance (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eCognitive Empathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.878\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e8.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAffective Empathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.916\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e10.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.878\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.539\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.824\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eEmpathic Concern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.817\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e49.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.734\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.975\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBehavioral Empathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e5.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.742\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.787\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.686\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eNote\u003c/em\u003e. Extraction method: Principal Component Analysis. Factor loadings are taken from the Pattern Matrix after Oblimin rotation. Factor loadings below .40 are not shown in the table. KMO=.90, Bartlett χ\u0026sup2;=4915.77 (p\u0026lt;.001).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen the Pattern Matrix was examined, the first factor contains six items (12, 13, 14, 15, 16, 17). These items include the therapist's interest, valuing, and follow-up behaviors toward the client and were named \"Empathic Concern.\" The second factor contains four items (7, 8, 9, 11). These items reflect the therapist's emotional responses and emotional attunement and were named \"Affective Empathy.\" The third factor consists of five items (1, 2, 3, 4, 5) and contains items reflecting the therapist's cognitive understanding; this factor was defined as \"Cognitive Empathy.\" The fourth factor contains four items (18, 19, 22, 23), includes the therapist's concrete behavioral responses, and was named \"Behavioral Empathy\".\u003c/p\u003e \u003cp\u003eConfirmatory factor analysis\u003c/p\u003e \u003cp\u003eCFA was performed using AMOS 22.0 to test the accuracy of the 19-item, four-subdimension structure revealed by EFA. First, a first-order measurement model was established in which the four subdimensions were related to each other but no hierarchical superstructure was tested (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ea). Although the initial analysis results were close to acceptable fit values, modification indices were examined. Following modification recommendations, error covariances were defined between two pairs of items that were theoretically meaningful and within the same factor (Items: 7\u0026harr;9 and 15\u0026harr;16). The fit indices achieved after modifications revealed that the model showed acceptable fit (χ\u0026sup2; = 512.78, df\u0026thinsp;=\u0026thinsp;144, p \u0026lt; .001, χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;3.56, CFI = .925, TLI = .910, RMSEA = .060 [90% CI: .052 \u0026minus;\u0026thinsp;.079]).\u003c/p\u003e \u003cp\u003eWhen the factor loadings (Standardized Regression Weights) in the model were examined, it was seen that all items loaded on the relevant factor at a statistically significant level (p \u0026lt; .001). Standardized factor loadings ranged from .65 to .97 for the Cognitive Empathy dimension, .69 to .97 for the Affective Empathy dimension, .72 to .96 for the Empathic Concern dimension, and .70 to .80 for the Behavioral Empathy dimension. These values prove that the items have high power to represent the relevant constructs. Additionally, when inter-factor correlations were examined, it was observed that there were positive, moderate to high-level significant relationships among the four subdimensions. Correlation coefficients ranged from .47 to .74. These high correlations indicate that the subdimensions share a common superstructure (general therapeutic empathy) and provide empirical support for second-order factor analysis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eConsidering the high correlations among first-order factors and theoretical foundations, Second-Order CFA was applied to test whether the four subdimensions of the scale constitute a higher latent structure called \"Therapist Empathy\" (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eb). The fit values obtained as a result of the analysis are almost the same as the first-order model and within acceptable limits (χ\u0026sup2; = 515.12, df\u0026thinsp;=\u0026thinsp;146, χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;3.53, p \u0026lt; .001, CFI = .924, TLI = .911, RMSEA = .060 [90% CI: .051 \u0026minus;\u0026thinsp;.078]).\u003c/p\u003e \u003cp\u003eAll second-order factor loadings are above .63 and statistically significant (p \u0026lt; .001). In the second-order analysis, the relationship of the four subdimensions with the upper factor was also examined. It was determined that all subdimensions loaded on the general factor at high and significant levels (p \u0026lt; .001). Standardized loading values are respectively: Behavioral Empathy (.86), Empathic Concern (.86), Cognitive Empathy (.69), and Affective Empathy (.63).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of first-order and second-order CFA models\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eχ\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2;/df\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCFI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTLI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRMSEA (90% GA)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eΔχ\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eΔdf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst-Order\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e512.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.925\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.910\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c7\"\u003e \u003cp\u003e.060 (.052-.079)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond-Order\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e515.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.924\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.911\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c7\"\u003e \u003cp\u003e.060 (.051-.078)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003cem\u003eNote\u003c/em\u003e. df\u0026thinsp;=\u0026thinsp;Degrees of Freedom, CFI\u0026thinsp;=\u0026thinsp;Comparative Fit Index; TLI\u0026thinsp;=\u0026thinsp;Tucker-Lewis Index; RMSEA\u0026thinsp;=\u0026thinsp;Root Mean Square Error of Approximation; CI\u0026thinsp;=\u0026thinsp;Confidence Interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eChi-square difference test and fit indices were examined to compare first-order and second-order models (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). According to the chi-square difference test result, no statistically significant difference was found between the two models (Δχ\u0026sup2; = 2.34, Δdf\u0026thinsp;=\u0026thinsp;2, p\u0026gt;.05). When fit indices were compared, it was seen that both models had similar values. The high second-order factor loadings (ranging from .63 to .86) show that the four subdimensions strongly represent the general empathy structure. Consequently, it was concluded that the Therapist Empathy Assessment Scale can be used both with four subdimension scores (Cognitive Empathy, Affective Empathy, Empathic Concern, and Behavioral Empathy) and with a total score.\u003c/p\u003e \u003cp\u003eConvergent and discriminant validity\u003c/p\u003e \u003cp\u003eAVE values were calculated for convergent validity. An AVE value above .50 indicates that the factor explains at least half of the variance in its own items and that convergent validity is achieved [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. According to the analysis results, the AVE values of the four factors ranged from .56 to .70 (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Since all AVE values are above the .50 threshold, it was concluded that the convergent validity of the scale was achieved.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConvergent and discriminant validity results\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAVE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eCorrelations\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(4)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(1) Cognitive Empathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.694\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(.883)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(2) Affective Empathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.465\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(.816)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(3) Empathic Concern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.696\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.598\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.519\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(.834)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(4) Behavioral Empathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.559\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.571\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.553\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.739\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(.748)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eNote\u003c/em\u003e. Values in parentheses are square root of AVE values. AVE\u0026thinsp;=\u0026thinsp;Average Variance Extracted. **\u003cem\u003ep\u003c/em\u003e \u0026lt; .01.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe Fornell-Larcker criterion was used for discriminant validity [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. According to this criterion, the square root of each factor's AVE value should be higher than that factor's correlations with other factors. As seen in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, diagonal values (in parentheses) show the square root of AVE for each factor, while off-diagonal values show inter-factor correlations. Analysis findings revealed that the AVE square root values calculated for each dimension were higher than the correlation coefficients of the relevant dimension with other dimensions. These findings show that the four factors are sufficiently differentiated from each other and that discriminant validity is achieved.\u003c/p\u003e \u003cp\u003eReliability analysis\u003c/p\u003e \u003cp\u003eInternal consistency coefficients (Cronbach's Alpha and Composite Reliability) and test-retest reliability analyses were performed to evaluate the reliability of the scale. Cronbach's Alpha coefficients ranged from .82 to .93, and Composite Reliability (CR) coefficients ranged from .84 to .97 (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). All values are above .80, showing high internal consistency [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReliability analysis results\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCronbach Alpha\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTest-Retest\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognitive Empathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.77***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAffective Empathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.95***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmpathic Concern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.75***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBehavioral Empathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.72***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmpathy (Total)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.90***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eNote.\u003c/em\u003e CR\u0026thinsp;=\u0026thinsp;Composite Reliability. ***p \u0026lt; .001.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFor test-retest reliability, two measurements were taken from a total of 33 participants aged 27\u0026ndash;59 years (M\u0026thinsp;=\u0026thinsp;37.7, SD\u0026thinsp;=\u0026thinsp;8.7) at two-week intervals, and Pearson correlation coefficients were calculated. Test-retest correlations ranged from .72 to .95, and all values are above the acceptable level (.70) [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. For the total score of the scale, Cronbach's Alpha was .92, CR was .97, and test-retest correlation was .90. These findings show that the scale has adequate reliability in terms of both internal consistency and stability over time.\u003c/p\u003e \u003cp\u003eEmpathy levels perceived by clients according to therapists' schools\u003c/p\u003e \u003cp\u003eWhether the therapist empathy levels perceived by clients (cognitive, affective, empathic concern, behavioral, and total score) differ according to the therapy school adopted by their therapists was examined with an independent samples t-test. In the analyses, \"therapist working with this school\" and \"therapist not working with this school\" groups were compared for each therapeutic school. Analyses were conducted for eight different therapeutic schools, and the results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEmpathy levels perceived by clients according to therapists' schools\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCognitive Empathy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAffective Empathy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEmpathic Concern\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBehavioral Empathy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEmpathy (Total)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCognitive Behavioral Therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;156)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;159)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.402\u003c/p\u003e \u003cp\u003ep = .688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.821\u003c/p\u003e \u003cp\u003ep = .412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et = -0.006\u003c/p\u003e \u003cp\u003ep = .995\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et = -0.100\u003c/p\u003e \u003cp\u003ep = .920\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.251\u003c/p\u003e \u003cp\u003ep = .212\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIntegrative Psychotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;221)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003et = -3.043\u003c/p\u003e \u003cp\u003e\u003cb\u003ep = .003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et = -3.133\u003c/p\u003e \u003cp\u003e\u003cb\u003ep = .002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et = -2.272\u003c/p\u003e \u003cp\u003e\u003cb\u003ep = .024\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et = -1.972\u003c/p\u003e \u003cp\u003e\u003cb\u003ep = .049\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003et = -3.257\u003c/p\u003e \u003cp\u003e\u003cb\u003ep = .001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEMDR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;268)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003et = -1.022\u003c/p\u003e \u003cp\u003ep = .308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.362\u003c/p\u003e \u003cp\u003ep = .174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et = -0.174\u003c/p\u003e \u003cp\u003ep = .862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et = -2.956\u003c/p\u003e \u003cp\u003e\u003cb\u003ep = .004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003et = -0.262\u003c/p\u003e \u003cp\u003ep = .794\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTransactional Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;271)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003et = -3.000\u003c/p\u003e \u003cp\u003e\u003cb\u003ep = .004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et = -2.779\u003c/p\u003e \u003cp\u003e\u003cb\u003ep = .007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et = -2.544\u003c/p\u003e \u003cp\u003e\u003cb\u003ep = .013\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et = -2.603\u003c/p\u003e \u003cp\u003e\u003cb\u003ep = .011\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003et = -3.767\u003c/p\u003e \u003cp\u003e\u003cb\u003ep \u0026lt; .001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSchema Therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;275)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.351\u003c/p\u003e \u003cp\u003ep = .726\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.002\u003c/p\u003e \u003cp\u003ep = .998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.027\u003c/p\u003e \u003cp\u003ep = .979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et = -2.038\u003c/p\u003e \u003cp\u003e\u003cb\u003ep = .046\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003et = -0.275\u003c/p\u003e \u003cp\u003ep = .783\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBehavioral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;286)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.471\u003c/p\u003e \u003cp\u003ep = .142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.070\u003c/p\u003e \u003cp\u003ep = .285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.163\u003c/p\u003e \u003cp\u003ep = .871\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.073\u003c/p\u003e \u003cp\u003ep = .440\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.047\u003c/p\u003e \u003cp\u003ep = .296\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePositive Therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;289)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.558\u003c/p\u003e \u003cp\u003ep = .577\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et = -0.986\u003c/p\u003e \u003cp\u003ep = .325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et = -1.046\u003c/p\u003e \u003cp\u003ep = .297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.429\u003c/p\u003e \u003cp\u003ep = .668\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003et = -0.541\u003c/p\u003e \u003cp\u003ep = .589\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePsychodynamic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;289)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.078\u003c/p\u003e \u003cp\u003ep = .938\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.315\u003c/p\u003e \u003cp\u003ep = .753\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.296\u003c/p\u003e \u003cp\u003ep = .206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.578\u003c/p\u003e \u003cp\u003ep = .563\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.877\u003c/p\u003e \u003cp\u003ep = .381\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eNote\u003c/em\u003e. Values are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e is examined, it is seen that clients who indicated that their therapists adopted the Integrative Psychotherapy school had statistically significantly higher scores in Cognitive Empathy (t = -3.043; p \u0026lt; .01), Affective Empathy (t = -3.133; p \u0026lt; .01), Empathic Concern (t = -2.272; p \u0026lt; .05), Behavioral Empathy (t = -1.972; p \u0026lt; .05) subdimensions and Total Empathy (t = -3.257; p \u0026lt; .01) compared to those who did not adopt this school.\u003c/p\u003e \u003cp\u003eSimilarly, it is seen that clients who indicated that their therapists applied the Transactional Analysis school had statistically significantly higher scores in Cognitive Empathy (t = -3.000; p \u0026lt; .01), Affective Empathy (t = -2.779; p \u0026lt; .01), Empathic Concern (t = -2.544; p \u0026lt; .05), and Behavioral Empathy (t = -2.603; p \u0026lt; .05) subdimensions and Total Empathy (t = -3.767; p \u0026lt; .001) compared to those who did not apply this school.\u003c/p\u003e \u003cp\u003eWhen EMDR and Schema Therapy schools are examined, it is seen that differentiation occurs in only one dimension. Clients whose therapists apply EMDR (t = -2.956; p \u0026lt; .01) and clients whose therapists apply Schema Therapy (t = -2.038; p \u0026lt; .05) have significantly higher Behavioral Empathy subdimension scores compared to clients of therapists who do not apply these schools. No significant difference was found in other subdimensions and total score.\u003c/p\u003e \u003cp\u003eOn the other hand, in comparisons made in terms of Cognitive Behavioral Therapy, Behavioral Therapy, Positive Therapy, and Psychodynamic approaches, no statistically significant differentiation was found between \"Yes\" and \"No\" groups in either subdimensions or total empathy scores (p \u0026gt; .05).\u003c/p\u003e \u003cp\u003eIn conclusion, therapists using Integrative Psychotherapy and Transactional Analysis among therapeutic schools are perceived as significantly more empathic by their clients. Therapists using EMDR and Schema Therapy score higher especially in the behavioral empathy dimension. No significant differences in empathy perception were observed for CBT, Behavioral Therapy, Positive Therapy, and Psychodynamic Therapy. These findings suggest that some therapeutic schools may emphasize empathy expression more due to their nature.\u003c/p\u003e \u003cp\u003eToronto Empathy Questionnaire scores according to therapists' schools\u003c/p\u003e \u003cp\u003eIndependent samples t-test was applied to determine whether therapists' empathy levels based on self-reports (Toronto Empathy Questionnaire) differ according to the therapy school they adopt. Analyses were conducted for eight different therapeutic schools, and the results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eToronto Empathy Questionnaire scores according to therapists' schools\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognitive Behavioral Therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3,54\u0026thinsp;\u0026plusmn;\u0026thinsp;0,31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3,47\u0026thinsp;\u0026plusmn;\u0026thinsp;0,34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,274\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEMDR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3,51\u0026thinsp;\u0026plusmn;\u0026thinsp;0,31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3,49\u0026thinsp;\u0026plusmn;\u0026thinsp;0,36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,831\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntegrative Psychotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3,52\u0026thinsp;\u0026plusmn;\u0026thinsp;0,34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3,47\u0026thinsp;\u0026plusmn;\u0026thinsp;0,29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,746\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,458\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychodynamic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3,48\u0026thinsp;\u0026plusmn;\u0026thinsp;0,32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3,56\u0026thinsp;\u0026plusmn;\u0026thinsp;0,33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1,081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,282\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3,49\u0026thinsp;\u0026plusmn;\u0026thinsp;0,33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3,54\u0026thinsp;\u0026plusmn;\u0026thinsp;0,31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,669\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,505\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransactional Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3,50\u0026thinsp;\u0026plusmn;\u0026thinsp;0,34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3,49\u0026thinsp;\u0026plusmn;\u0026thinsp;0,26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,858\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEclectic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3,52\u0026thinsp;\u0026plusmn;\u0026thinsp;0,33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3,42\u0026thinsp;\u0026plusmn;\u0026thinsp;0,28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,188\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchema Therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3,49\u0026thinsp;\u0026plusmn;\u0026thinsp;0,31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3,55\u0026thinsp;\u0026plusmn;\u0026thinsp;0,37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,757\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,451\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eNote\u003c/em\u003e. Values are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the analysis results, no statistically significant difference was found in terms of therapists' own empathy levels for any therapeutic school (p\u0026gt;.05). Toronto Empathy Questionnaire scores of therapists in all therapeutic schools are at medium-high levels (in the range of M\u0026thinsp;=\u0026thinsp;3.42\u0026ndash;3.56) and at similar levels to each other. These findings show that therapists' own empathy levels are independent of the therapeutic school they choose. In other words, therapists using different therapeutic schools have similar empathy capacity.\u003c/p\u003e \u003cp\u003eWhen this result is evaluated together with the findings obtained in the previous section (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e), an interesting picture emerges: While therapists' own empathy levels (Toronto Empathy Questionnaire) do not differ according to schools, empathy levels perceived by clients (Therapist Empathy Assessment Scale) are significantly higher in some schools (especially Integrative Psychotherapy and Transactional Analysis). This finding suggests that rather than the empathy capacity therapists possess, the ways different therapeutic schools express and communicate empathy may be effective on client perception.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study was conducted to develop the Therapist Empathy Assessment Scale (TEAS), which enables the evaluation of empathy\u0026mdash;one of the most critical common factors of the psychotherapy process\u0026mdash;from the client's perspective and within a multidimensional structure, and to compare the empathy levels of therapists adopting different schools from both client and therapist viewpoints. The research findings generally point to two main conclusions. First, the TEAS, developed to evaluate therapist empathy multidimensionally from the client's perspective, possesses strong psychometric properties. Second, while therapists' self-reported empathy levels did not differ based on their adopted school, the empathy levels perceived by clients were significantly higher in certain orientations (Integrative and TA). These results are consistent with the extensive literature regarding the curative function of empathy as a common factor in psychotherapy [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and confirm the importance of addressing empathy not merely as the \"therapist's internal capacity\" but as a \"quality of relationship experienced by the client\" [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFindings regarding the construct validity of the scale demonstrated that the TEAS is organized in a four-factor structure and that these factors constitute a meaningful whole both theoretically and empirically. In the exploratory factor analysis, after removing four items (6, 10, 20, 21) that disrupted the factor structure or cross-loaded, the scale achieved a stable structure with 19 items. Confirmatory factor analysis findings revealed that the first-order model yielded acceptable fit and that each item loaded significantly on the relevant factor. The moderate-to-high correlations between factors suggested that the subscales share a common higher-order structure; indeed, the tested second-order model was also confirmed with similar fit values. This finding overlaps with theoretical views that empathy is a multidimensional phenomenon consisting of separable components yet organized by a common higher structure [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Considering that empathy definitions in the context of psychotherapy include empathic concern/compassion and behavioral/communicative components alongside cognitive and affective components [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], it can be stated that the four-dimensional structure of the TEAS rests on a theoretically solid ground.\u003c/p\u003e \u003cp\u003eThe convergent and discriminant validity findings of the TEAS supported that the scale consistently captures the measured construct. The AVE values being above the threshold indicated that each factor explained a significant portion of the variance in its items. The differentiation of factors from each other according to the Fornell\u0026ndash;Larcker criterion is particularly important when a construct like empathy, which is conceptually prone to overlap with other constructs (alliance, acceptance, genuineness, etc.), is in question [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. Reliability analyses also confirmed that the TEAS is a robust measurement tool. High internal consistency coefficients indicated that the scale works consistently within itself, while high test-retest correlations showed that the measurement is resistant to time. In a process that can fluctuate within the session like empathy [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], high stability values obtained with a two-week interval suggest that the TEAS is able to capture the client's continuous empathy experience in the therapeutic relationship rather than an instantaneous session impression.\u003c/p\u003e \u003cp\u003eWhen examining perceived empathy levels according to therapeutic orientations, it was observed that clients of therapists practicing Integrative Psychotherapy and Transactional Analysis (TA) reported significantly higher scores on all subscales and the total score of the TEAS. For EMDR and Schema Therapy, differentiation emerged only in the Behavioral Empathy dimension, while no significant difference was detected in CBT, Behavioral Therapy, Positive Therapy, and Psychodynamic approaches. This pattern is noteworthy in two respects. First, consistent with meta-analytic evidence that the empathy-outcome relationship is a \"common factor\" across orientations [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], clients in all approaches generally reported high empathy perception. Second, the association of certain orientations (Integrative and TA) with higher scores demonstrates the importance of addressing empathy not merely as a capacity, but as an active process related to how it is embodied within the session and communicated to the client [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor Integrative Psychotherapy, these findings overlap with the theoretical framework. In this approach, psychological healing becomes possible within a relationship that is sensitive, attuned, and in contact with the client's relational needs [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The methods of \"inquiry, attunement, and involvement\" emphasized by Erskine [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] and the conceptualization of \"beyond empathy\" require the therapist not only to accompany the client's emotion but to actively support the experience of safety and being valued by producing an appropriate response [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The association of the Integrative approach with higher perception, especially in the Empathic Concern and Behavioral Empathy dimensions, can be explained by this school positioning the relationship not merely as a tool but as a curative factor in itself [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Similarly, high scores observed for Transactional Analysis are consistent with the central role of the empathic bond in relational TA schools within the context of \"contact messages\" and safety needs [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe finding of significant differentiation only in the Behavioral Empathy dimension in EMDR and Schema Therapy suggests that empathy perception can be shaped by technical and action-oriented cues. The client's empathy perception is influenced by the therapist's non-verbal cues such as eye contact and body lean, as well as structuring and active intervention forms within the session [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. In schools with distinct technical and procedural structures like EMDR and Schema Therapy, active techniques applied by the therapist (eye movements, chair work, reparenting, etc.) might be coded by the client as a concrete effort for their benefit, i.e., an indicator of \"behavioral empathy.\"\u003c/p\u003e \u003cp\u003eRegarding therapists' self-reported empathy levels (TEQ), no significant difference was detected in any orientation. This result confirms the \"evaluator paradox\" in empathy literature. Meta-analyses report that measures based on client perception best predict therapy outcome, whereas therapist self-report shows weaker relationships with the outcome [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Therapists, due to their \"helping professional\" identities, may fall into social desirability bias when evaluating themselves through their intentions; however, this internal capacity may not always reflect as accurate \"attunement\" to the client [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The picture emerging in this study shows that therapeutic orientation does not change the therapist's \"empathy capacity,\" but creates a difference in client perception by changing \"how this capacity is communicatively embodied.\"\u003c/p\u003e \u003cp\u003eFrom a clinical and educational perspective, the most important contribution of the TEAS is its ability to present therapist empathy as a detailed profile in cognitive, affective, empathic concern, and behavioral dimensions, rather than just a general score. This study supports integrative approaches emphasizing that therapeutic change is related not only to \"understanding\" but to the continuous construction of the client's experience of safety and being valued (concern) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Therefore, the TEAS offers a practical assessment framework for therapists to recognize their strengths and areas open to development in supervision processes.\u003c/p\u003e \u003cp\u003eThe findings of the study should be evaluated within the framework of certain limitations. First, the use of convenience sampling limits generalizability. Second, the fact that therapists may draw from multiple schools (eclectic/integrative) can make it difficult to distinguish orientations as pure categories. Third, the risk of mono-method bias exists in measures based on client perception [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Future studies addressing TEAS scores together with observer ratings (e.g., TES [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]) and psychophysiological measures [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] would strengthen the evidence regarding criterion validity.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study has proven that the TEAS, which evaluates therapist empathy multidimensionally from the client's perspective, is a valid and reliable measurement tool in Turkish culture. While there was no difference in therapists' self-reports, the fact that Integrative and TA-oriented therapists were perceived as more empathic by their clients reveals that empathy is not a static trait in psychotherapy, but a dynamic relationship process actively established, communicated, and experienced within the session.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAVE Average Variance Extracted\u003c/p\u003e\u003cp\u003eCFA Confirmatory Factor Analysis\u003c/p\u003e\u003cp\u003eCFI Comparative Fit Index\u003c/p\u003e\u003cp\u003eCI Confidence Interval\u003c/p\u003e\u003cp\u003eCR Composite Reliability\u003c/p\u003e\u003cp\u003eEFA Exploratory Factor Analysis\u003c/p\u003e\u003cp\u003eEMDR Eye Movement Desensitization and Reprocessing\u003c/p\u003e\u003cp\u003eKMO Kaiser-Meyer-Olkin\u003c/p\u003e\u003cp\u003eRMSEA Root Mean Square Error of Approximation\u003c/p\u003e\u003cp\u003eTA Transactional Analysis\u003c/p\u003e\u003cp\u003eTEAS Therapist Empathy Assessment Scale\u003c/p\u003e\u003cp\u003eTEQ Toronto Empathy Questionnaire\u003c/p\u003e\u003cp\u003eTLI Tucker-Lewis Index\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e Approval was obtained from Istanbul Arel University Ethics Committee dated 18/04/2025 with number 2025/10 for the research, and the study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent based on voluntary participation was obtained from all participants, and assurance was given that the data would be evaluated anonymously and used only for scientific purposes.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eNot applicable.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eZTS designed the study, performed statistical analyses, and wrote the manuscript. MŞ collected the data. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank Richard G. Erskine for his valuable feedback on the scale items, and all the therapists and clients who participated in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHall J, Schwartz R. Empathy present and future. J Soc Psychol. 2018;159(3):225\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/00224545.2018.1477442\u003c/span\u003e\u003cspan address=\"10.1080/00224545.2018.1477442\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRogers CR, Empathic. An unappreciated way of being. 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The aim of this study was to develop the \"Therapist Empathy Assessment Scale\" (TEAS), based on Richard Erskine's Integrative Psychotherapy approach, and to compare the empathy levels of therapists from different psychotherapeutic orientations in terms of both client perception and self-report.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study was conducted with two independent samples: 315 clients (M age\u0026thinsp;=\u0026thinsp;35.9 years, 82.5% female) currently in therapy and 100 therapists (M age\u0026thinsp;=\u0026thinsp;41.0 years, 82.0% female) with at least one year of clinical experience. Clients completed the TEAS to assess their therapists' empathy, while therapists completed the Toronto Empathy Questionnaire (TEQ) for self-reported empathy. The construct validity of the TEAS was examined using Exploratory Factor Analysis and Confirmatory Factor Analysis. Convergent and discriminant validity were assessed using Average Variance Extracted and the Fornell-Larcker criterion. Reliability was evaluated through Cronbach's alpha, Composite Reliability, and test-retest correlations. Independent samples t-tests were used to compare empathy levels across eight therapeutic orientations.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe analyses demonstrated that the TEAS is a valid and reliable 19-item instrument consisting of four subscales: Cognitive Empathy, Affective Empathy, Empathic Concern, and Behavioral Empathy (Cronbach's α\u0026thinsp;=\u0026thinsp;.82-.93). Comparisons across therapeutic orientations revealed that clients of therapists practicing Integrative Psychotherapy and Transactional Analysis reported significantly higher perceived empathy scores on all TEAS subscales and the total score compared to other orientations. In contrast, EMDR and Schema Therapy showed significantly higher scores only in the Behavioral Empathy dimension. However, therapists' self-reported empathy levels (measured by TEQ) did not differ significantly across orientations.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThese results confirm that the TEAS is a psychometrically robust tool for psychotherapy research. Furthermore, the findings suggest that therapeutic orientation determines not the therapist's \"internal empathy capacity,\" but rather how this capacity is expressed in the session and perceived by the client.\u003c/p\u003e","manuscriptTitle":"Development of the Therapist Empathy Assessment Scale (TEAS) and comparison of therapists' empathy levels across specializations","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-20 12:16:35","doi":"10.21203/rs.3.rs-8669903/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9e73c1f8-8f8c-46d8-9715-7a9b3a325f12","owner":[],"postedDate":"February 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-17T06:57:29+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-20 12:16:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8669903","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8669903","identity":"rs-8669903","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}