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This study reports on the relationship of therapist competence to the outcome of cognitive-behavioral treatment in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Outpatients suffering from major depressive disorder were treated by cognitive-behavioral therapists at each of 3 U.S. sites using a format of 20 sessions in 16 weeks. Findings provide some support for the relationship of therapist competence (as measured by the Cognitive Therapy Scale) to reduction of depressive symptomatology when controlling for therapist adherence and facilitative conditions. The results are, however, not as strong or consistent as expected. The component of competence that was most highly related to outcome is a factor that reflects the therapist's ability to structure the treatment.

The Cognitive Therapy Scale (CTS;Young & Beck, 1980) was developed to evaluate therapist competence in cognitive therapy for depression. Preliminary data on the psychometric properties of the scale have been encouraging but not without problems. In this article, we present data on the interrater reliability, internal consistency, factor structure, and discriminant validity of the scale. To overcome methodological problems with previous work, expert raters were used, all sessions evaluated were cognitive therapy sessions, and a more adequate statistical design was used. Results indicate that the CTS can be used with only moderate interrater reliability but that aggregation can be used to increase reliability. The CTS is highly homogeneous and provides a relatively undifferentiated assessment of therapist performance, at least when used with therapists following the cognitive therapy protocol. The scale is, however, sensitive to variations in the quality of therapy.As psychotherapy research continues, more and more attention is being given to therapist in-session behavior (Elkin, 1984;Schaffer, 1983). DeRubeis, Hollon, Evans, and Bemis (1982) and Luborsky, Woody, McLellan, O'Brien, and Rosenzweig (1982) have developed rating scales to assess therapy-specific therapist behavior, and these scales have been shown to clearly differentiate therapy types (e.g., cognitive therapy and interpersonal therapy). Ensuring that different therapies are unique is an important contribution, but this work does not address how competently a The National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program is a multisite program initiated and sponsored by the Psychosocial Treatment Research Branch, Division of Extramural Research Programs, NIMH, and is funded by cooperative agreements to six participating sites. The principal NIMH collaborators are Irene Elkin, coordinator; John P. Docherty, acting branch chief; and Morris B. Parloff, former branch chief. Tracie Shea, of George Washington University, is associate coordinator. The principal investigators and project coordinators at the three participating research sites are Stuart M

Sixty-two adults who underwent orthotopic liver transplantations between February 1981 and June 1983 were followed for a mean of 170 days after the operation. Twenty-six patients developed 30 episodes of significant fungal infection. Candida species and Torulopsis glabrata were responsible for 22 episodes and Aspergillus species for 6. Most fungal infections occurred in the first month after transplantation. In the first 8 weeks after transplantation, death occurred in 69% (18/26) of patients with fungal infection but in only 8% (3/36) of patients without fungal infection (P less than 0.0005). The cause of death, however, was usually multifactorial, and not solely due to the fungal infection. Fungal infections were associated with the following clinical factors: administration of preoperative steroids (P less than 0.05) and antibiotics (P less than 0.05), longer transplant operative time (P less than 0.02), longer posttransplant operative time (P less than 0.01), duration of antibiotic use after transplant surgery (P less than 0.001), and the number of steroid boluses administered to control rejection in the first 2 posttransplant months (P less than 0.01). Patients with primary biliary cirrhosis had fewer fungal infections than patients with other underlying liver diseases (P less than 0.05). A total of 41% (9/22) of Candida infections resolved, but all Aspergillus infections ended in death.