Common Factors Questionnaire
Common Factors Questionnaire (CFQ) · Also known as: CFQ, Therapeutic Factors Scale
The Common Factors Questionnaire (CFQ) is a structured client-report measure that quantifies the client's perception of therapeutic factors deemed common to effective psychotherapy across all modalities—including alliance, therapist empathy, client agency, goal clarity, and emotional expression. Based on Lambert's contextual model and Wampold's therapeutic relationship framework, the CFQ operationalizes the empirical finding that 70% or more of therapy outcome variance is attributable to common factors (relationship, expectancy, therapeutic environment) rather than specific technique. It is used in research to examine mechanisms of change and to compare common factors across therapy types.
Read the full method
Sign in with a free account to read this section.
Method map
The neighbourhood of related methods — select a node to explore.
When to use it
The CFQ is used in: (1) research testing the common factors hypothesis—examining whether common factors mediate outcome more than specific technique; (2) comparative effectiveness studies across therapy modalities; (3) therapist training to assess whether trainees establish foundational common factors before deploying technique; (4) program evaluation to measure the relational climate and therapeutic conditions within an organization; (5) process research examining how common factors develop over the course of therapy (early strong alliance predicts late outcome?); (6) studies of non-traditional therapy formats (online, group, self-help) to determine whether common factors are replicated. Suitable for adolescents (age ≥14) and adults. Not recommended for very young children or those unable to complete self-report scales.
Strengths & limitations
- Operationalizes evidence-based common factors (Lambert, Wampold): relationship, hope, emotional processing, clarity, new perspective—all empirically linked to outcome.
- Transdiagnostic and modality-agnostic; captures universal therapeutic conditions applicable to any therapy type or presenting problem.
- Multi-dimensional subscale structure reveals which factors clients experience most strongly; enables targeted feedback for therapists.
- Efficient; 15–30 items can be administered mid-treatment or post-treatment without excessive burden.
- Explicit measurement of mechanism: rather than assuming technique works, CFQ measures whether the relational conditions are in place.
- Useful for training; supervisors can review CFQ scores to discuss with trainees: 'Your client rates you high on empathy but low on clarity. How might you improve goal-setting conversations?'
- Client response bias: socially desirable responding (giving high ratings to please therapist) is common; order effects may occur if CFQ is embedded in satisfaction surveys.
- Limited specificity to technique; high CFQ does not guarantee technique is appropriate, only that relational foundation is solid.
- No consensus on optimal CFQ items or subscales; different researchers use different versions, limiting comparison across studies.
- Ordinal scale issues: if subscales are summed and means calculated, assumptions of interval data are violated; median/quartile analyses are more appropriate.
- Therapist skill variance not measured; CFQ reveals client perception of common factors but does not assess whether the therapist is using empirically-supported techniques correctly.
- Cross-cultural validation is limited; most evidence is from English-speaking Western samples; meaning of 'empathy' or 'respect' varies culturally.
- Retrospective bias: post-treatment CFQ may reflect current outcome state rather than true in-session experience.
Frequently asked
Is a high CFQ score enough to ensure good therapy outcome?
No. High CFQ indicates strong common factors (relationship, clarity, hope) are in place, which is necessary for outcome but not sufficient. A client might report strong alliance and clarity but receive ineffective or incorrect technique. Combine CFQ (process) with outcome measures (ORS, PHQ-9) and assess technical competence (skill in delivering the chosen therapy modality). Strong common factors + competent technique + appropriate case formulation = good outcome.
Which CFQ subscales are most predictive of outcome?
Research suggests Relationship/Alliance is the strongest predictor across modalities. Hope/Agency and Clarity/Goals are also important. The relative importance varies by population: in depression treatment, Hope may be most critical; in OCD exposure therapy, Clarity of rationale may matter more. Don't assume all subscales contribute equally; examine correlation between each subscale and your outcome measure in your sample.
Can I compare CFQ scores across different therapy modalities?
Yes, with caution. Two modalities might produce equal outcomes but via different common factor profiles: CBT clients rate Clarity high (structured agenda, homework), while psychodynamic clients rate Empathy high (deep listening, transference work). Both reach outcome. Use CFQ to reveal these profiles, not to rank modalities. Conclude: 'Both modalities leverage common factors, but emphasize different dimensions.'
What if a client's CFQ subscale scores are all very high—does that mean they're giving inflated ratings?
Possibly, but not necessarily. Some clients genuinely experience all aspects of therapy positively (strong alliance, clear goals, hopeful outlook). However, check: if CFQ is uniformly high across all clients and all therapists in your program, social desirability bias is likely. Ask clients to rate therapist on a separate form, or use an external observer (supervisor) to cross-validate. Triangulate CFQ with client engagement (homework compliance, session attendance) and outcome.
Can I administer CFQ every session or is it better to use post-treatment?
Both are valid. Session-by-session CFQ reveals trajectory of common factors (Does alliance strengthen over time? Does clarity increase after goal-setting session?). Post-treatment CFQ allows reflection on the full course. For practice, session-by-session at mid-point (session 3–5) and end is a practical compromise. For research, every-session CFQ is more rigorous but burdensome.
How do I act on CFQ results?
Use CFQ for supervision and feedback loops: (1) Review CFQ with therapist: 'Your client rated Relationship high but Clarity low. What might you do next session to clarify goals?'; (2) Aggregate CFQ across your caseload or team to identify training needs (if all therapists score low on Hope, provide training on motivational techniques); (3) Track CFQ over time in an individual client to monitor alliance trajectory (if Relationship drops, address rupture).
Sources
- Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38(4), 357–361. DOI: 10.1037/0033-3204.38.4.357 ↗
- Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings. Mahwah, NJ: Lawrence Erlbaum. link ↗
How to cite this page
ScholarGate. (2026, June 3). Common Factors Questionnaire (CFQ). ScholarGate. https://scholargate.app/en/psychotherapy-research/common-factors-questionnaire
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
- Helpful Aspects of Therapy FormPsychotherapy Research↔ compare
- Session Rating ScalePsychotherapy Research↔ compare
- Therapeutic Alliance ScalePsychotherapy Research↔ compare
- Working Alliance InventoryPsychotherapy Research↔ compare