Patient Activation in Psychotherapy Interactions: Developing and Validating the Consultation Interactions Coding Scheme

Objective. We describe the development of an instrument aiming to offer interaction-level feedback based on “patient activation”: Client confidence and perceived ability to manage their health. Method. Twenty-two session-transcripts from cognitive behavioral therapy with high-users of healthcare were analyzed thematically, producing themes describing in-session interactions. Themes were sub-categorized using patient activation theory into high and low activation presentations. Two coders new to the process were trained to use this Consultation Interactions Coding Scheme. Inter-rater reliability, convergent validity and clinical utility were assessed and illustrated with extreme cases. Results. Good-to-excellent inter-rater reliability was achieved. The Consultation Interactions Coding Scheme, therapeutic alliance and therapist competence were correlated. Client engagement in session structuring interactions correlated with outcome. The highest Consultation Interactions Coding Scheme scorer showed multiple outcome-improvements, the lowest scorer reported deteriorations. Conclusions. This study presents the Consultation Interactions Coding Scheme’s psychometric properties and indicates the value of client engagement in session structuring.