How Patients Guide Therapy: A Pilot Study on the Development and Reliability of the Patient Coaching Rating System

Patient coaching refers to patient-initiated communication that helps therapists understand therapy goals, maladaptive beliefs, personal challenges, and preferred therapeutic approaches. Despite its theoretical significance, empirical research remains limited, with a few recent studies relying on labor-intensive methods involving extensive training of raters and detailed case analysis. To support broader empirical research, this study introduces the Patient Coaching Rating System (PCRS) to assess two dimensions of patient coaching: information coaching (what and why) and direction coaching (how).

Seven raters used the PCRS to rate 22 segments from an early psychotherapy session. Each segment was rated on two dimensions-information coaching and direction coaching-with a 0-4 scale.

The raters achieved interrater reliability scores of 0.86 for information coaching and 0.68 for direction coaching. Whereas information coaching demonstrated excellent reliability, direction coaching showed moderate to good reliability, highlighting the need for further refinement of the coding manual.

This pilot study provides a structured method for assessing patient coaching and represents an initial step toward facilitating empirical investigation within therapy sessions.