The researchers employed a confirmatory tetrad analysis (CTA) using partial least squares--structural equation modeling (PLS-SEM) with Outcome Questionnaire--45.2 (OQ-45) data, examining the measurement model of the OQ-45 scores with a sample of male adult clients (N = 1,558) receiving individual therapy at a university-based community counseling and research center (UBCCRC). Using CTA-PLS, this study examined the reflective and formative nature of each of the OQ-45 items and dimensions. These results identified the innovative second-order formative-formative three-factor model as a best alternative measurement model to represent and calculate the scores of OQ-45 scale.