Barriers to Using Immediacy Scale (BUIS)

Abstract

The Barriers to Using Immediacy Scale (BUIS; Hillman et al., 2023) is a self-report measure designed for therapists to assess their perceived barriers to utilizing immediacy in therapy. Immediacy, as defined by Hill (2020), involves therapists inquiring about a client’s feelings regarding the therapeutic relationship or disclosing their own feelings about the client, themselves in relation to the client, or the therapeutic relationship. This skill is crucial for fostering open communication and processing the therapeutic relationship.

The development of the BUIS began with an initial pool of 50 items, created based on four theorized factors of barriers therapists might encounter: Concerns About Client Reactions, Concerns About Therapist Reactions, Negative Beliefs About Immediacy, and Lack of Skills for Using Immediacy. This initial pool was refined to 45 items after soliciting feedback from faculty members and advanced doctoral students with expertise in therapist skills. The resulting measure underwent evaluation across three studies. Factor analysis supported a final 16-item scale with a four-factor structure. Although higher-order and bifactor models also demonstrated adequate fit, the 4-factor structure was chosen. The development and validation process included reporting on the reliability and validity of the measure. The BUIS aims to provide insights into why therapists might struggle with the use of immediacy in their practice.

Keywords

Concerns About Client Reactions, Concerns About Therapist Reactions, Incremental Validity, Lack of Skills for Using Immediacy, Metacommunication, Negative Beliefs About Immediacy, Psychotherapy Process, Therapist Skills

Authors

Hillman, Justin W.; Gerstenblith, Judith A.; Jankauskaite, Greta; Mohr, Jonathan J.; Hill, Clara E.

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Purpose

The BUIS assesses therapists’ perceived barriers to using immediacy, encompassing concerns about client reactions, concerns about therapist reactions, negative beliefs about immediacy, and a lack of skills for using immediacy.

Validity

Criterion-Related and Incremental Validity: The Barriers to Using Immediacy Scale (BUIS) demonstrated several significant correlations indicative of its validity. Self-efficacy for immediacy (SEIm) was negatively associated with all BUIS scales, suggesting that higher self-efficacy in immediacy correlates with fewer perceived barriers.

Regarding therapeutic orientations, a cognitive behavioral orientation was positively associated with the BUIS-Total score, BUIS-Negative Beliefs, and BUIS-Lack of Skills, implying that therapists with this orientation might perceive more barriers in these areas. Conversely, a psychodynamic orientation showed significant negative correlations with the BUIS-Negative Beliefs and BUIS-Lack of Skills subscales, suggesting fewer perceived barriers related to negative beliefs or skill deficits in this group. No significant correlations were observed with a humanistic orientation.

Years of clinical practice were negatively correlated with all BUIS scales except BUIS-Negative Beliefs, indicating that more experienced therapists generally perceive fewer barriers to immediacy.

Anxiety (measured by ECR-Anxiety) was positively correlated with the BUIS-Total score (r = .28, p = .02) and BUIS-Therapist Reactions (r = .39, p = .001). However, no significant correlations were found between anxiety and BUIS-Client Reactions (r = .23, p = .07), BUIS-Negative Beliefs (r = −.10, p = .41), or BUIS-Lack of Skills (r = .23, p = .07). Critically, even after controlling for SEIm, ECR-Anxiety remained positively correlated with BUIS-Total (r = .26, p = .03) and BUIS-Therapist Reactions (r = .37, p = .002), further supporting the relationship between anxiety and perceived barriers, particularly those related to therapist reactions.

Reliability

Internal Consistency: The internal consistency of the BUIS was high, with Cronbach’s alpha ranging from .87 to .89 across different samples for the total score.

Test-Retest Reliability: The test-retest reliability of the BUIS was assessed over a 2–4 week period and demonstrated strong, significant correlations (p < .001) between initial and follow-up administrations. The correlation coefficients were as follows: BUIS-Total, r = .80; BUIS-Client Reactions, r = .74; BUIS-Therapist Reactions, r = .70; BUIS-Negative Beliefs, r = .68; and BUIS-Lack of Skills, r = .86. These results indicate good stability of the measure over time for both the total score and its individual subscales.

Factor Analysis

Exploratory Factor Analysis (EFA): An initial pool of items was subjected to rigorous refinement. Items that did not load at least .50 in absolute magnitude on a factor, did not load at least .20 higher than on another factor (to ensure subscale distinctiveness), had multiple cross-loadings, were redundant with better-fitting items, or contained complex or confusing language compared to other items in the factor were systematically removed. This process resulted in a refined 16-item BUIS. An EFA conducted on these 16 items yielded a clear four-factor structure.

Confirmatory Factor Analysis (CFA): CFA was performed to further validate the proposed four-factor structure. The results demonstrated adequate fit to the data based on established fit indices (Kline, 2016): Comparative Fit Index (CFI) = .96, Root Mean Square Error of Approximation (RMSEA) = .05 (with a 90% Confidence Interval of [.041, .063]), and Standardized Root Mean Square Residual (SRMR) = .05. While the chi-square test of model fit was statistically significant (χ²(98) = 190.96, p < .001), which is common in larger samples, the other fit indices support the model’s appropriateness.

Furthermore, both higher-order and bifactor CFAs provided support for a general barriers factor. This suggests that while there are distinct barriers, there is also a general tendency for therapists to experience variations across all barrier domains represented in the scale. The results from the Incremental Explained Variance (I-ECV) indicated that the BUIS is a multidimensional scale with a strong general factor, alongside distinct specific factors, affirming its complex structure.

Instrument

Test Type: Original Inventory/Questionnaire

Format: The BUIS consists of 16 items. Each item is rated on a 5-point Likert scale, where 1 indicates “strongly disagree,” 3 indicates “neutral,” and 5 indicates “strongly agree.” Higher scores on the scale indicate a greater number of perceived barriers to using immediacy.

Language Available: English

Population Group: Human; Male; Female; Transgender

Age Group: Adulthood (18 years & older)

Population Details: The study participants were located in the United States and included individuals who identify as nonbinary, as well as trainee therapists.

Test Methodology: The development and validation of the BUIS involved a comprehensive methodology, including Test Validity (Criterion Validity, Incremental Validity), Test Reliability (Internal Consistency, Test-Retest Reliability), and Factor Analysis (Confirmatory Factor Analysis, Exploratory Factor Analysis).

Keywords

Communication Skills; Professional Competence; Psychotherapeutic Processes; Therapist Characteristics; Incremental Validity; Mental Health Care Personnel Measures

Authors

Author OCRID Identifier:

• Hillman, Justin W.: orcid.org/0000-0002-7457-0570

• Gerstenblith, Judith A.: orcid.org/0000-0003-3763-8932

• Jankauskaite, Greta: orcid.org/0000-0003-1120-7536

• Mohr, Jonathan J.: orcid.org/0000-0002-3350-5860

• Hill, Clara E.: orcid.org/0000-0003-4334-0825

Affiliation:

• Hillman, Justin W.: University of Maryland, College Park Department of Counseling, Higher Education, and Special Education

• Gerstenblith, Judith A.: University of Maryland Department of Psychology

• Jankauskaite, Greta: University of Maryland Department of Psychology

• Mohr, Jonathan J.: University of Maryland Department of Psychology

• Hill, Clara E.: University of Maryland Department of Psychology

Email addresses:

• Hillman, Justin W.: [email protected]

Correspondence Address:

• Hillman, Justin W.: University of Maryland, College Park, Department of Counseling, Higher Education, and Special Education, 3115 Benjamin Building, 3942 Campus Drive, College Park, Maryland, United States, 20742, [email protected]

Permissions & Fee and Test Year

Permissions: May use for Research/Teaching

Commercial: No

Fee: No

Test Year: 2023

References

Hillman, J. W., Gerstenblith, J. A., Jankauskaite, G., Mohr, J. J., & Hill, C. E. (2023). Development and validation of the Barriers to Using Immediacy Scale (BUIS). Journal of Counseling Psychology, 70(5), 571–583. doi.org/10.1037/cou0000685

Items of the Barriers to Using Immediacy Scale (BUIS)

The Barriers to Using Immediacy Scale (BUIS) is composed of 16 items, each rated on a 5-point Likert scale (1 = strongly disagree, 3 = neutral, 5 = strongly agree). The items are structured around four distinct factors, as supported by factor analysis:

Factors and Subscales:

• Concerns About Client Reactions: No data is Available

• Concerns About Therapist Reactions: No data is Available

• Negative Beliefs About Immediacy: No data is Available

• Lack of Skills for Using Immediacy: No data is Available

The specific text for each of the 16 items is not provided in the supplied information, but it is indicated that they are available in the Appendix, Page 13 of the source reference: Hillman, J. W., Gerstenblith, J. A., Jankauskaite, G., Mohr, J. J., & Hill, C. E. (2023). Development and validation of the Barriers to Using Immediacy Scale (BUIS). Journal of Counseling Psychology, 70(5), 571–583.

 

Barriers to Using Immediacy Scale (BUIS)

Introduction to Immediacy

Immediacy is a therapeutic skill utilized by therapists to foster dialogue concerning the client’s and therapist’s thoughts and emotions regarding the therapeutic relationship. Illustrative examples include: “I’ve been feeling disconnected from you today,” “How did you feel just now when I praised you?” and “How do you think things are going between us?”

Other terminologies associated with immediacy include metacommunication, here-and-now communication, self-involving self-disclosure, and I-thou communication.

Scale Instructions

The subsequent statements outline reasons therapists might opt against using immediacy in their interactions with clients. Please evaluate your level of agreement with each statement as it pertains to your practice with the majority of clients in psychotherapy/counseling, using a 5-point Likert scale where 1 signifies strongly disagree and 5 signifies strongly agree.

Immediacy Scale Items

1. My clients might perceive my use of immediacy as inappropriate.

2. There is no sound justification for employing immediacy.

3. Should I use immediacy, I might experience excessive nervousness.

4. My clients might not continue therapy if I implement immediacy.

5. I might feel excessively vulnerable if I use immediacy.

6. I lack adequate training to effectively utilize immediacy.

7. The application of immediacy does not align with my theoretical orientation.

8. My personal issues might impede my capacity to use immediacy effectively.

9. If I use immediacy, my clients might develop a dislike for me.

10. I would not know how to proceed with the discussion after initiating immediacy.

11. Immediacy does not conform to my beliefs regarding what is beneficial in therapy.

12. My clients might become distressed if I use immediacy.

13. Generally, immediacy is not beneficial for clients.

14. I am unfamiliar with the techniques for using immediacy.

15. I might encounter difficulty managing my anxiety if I use immediacy.

16. I currently lack the requisite skills to use immediacy in a manner that aids my clients.

Note on Scale Usage

For the purpose of comparability with norms established in this study, the aforementioned instructions should be incorporated. To promote further research, other researchers are permitted to utilize this scale without prior communication with us. Subscale scores are derived by averaging the item ratings within each subscale. The composition of the subscales is as follows:

• Concerns About Client Reactions: Items 1, 4, 9, 12.

• Concerns About Therapist Reactions: Items 3, 5, 8, 15.

• Negative Beliefs: Items 2, 7, 11, 13.

• Lack of Skills: Items 6, 10, 14, 16.