The role of therapists' treatment adherence, professional experience, therapeutic alliance, and clients' severity of psychological problems: Prediction of treatment outcome in eight different psychotherapy approaches. Preliminary results of a naturalistic study

Abstract

In this naturalistic study, 262 audiotaped psychotherapy sessions--randomly drawn from 81 individual therapies from eight different psychotherapy approaches--were rated completely on treatment adherence using a newly developed rating manual. In the therapy sessions, a relatively low percentage of treatment specific interventions (ranging from 4.2% to 27.8%) was found for all eight approaches, 50% to 73% of the interventions were nonspecific or common, and approximately 18% to 27% were intervention techniques from other approaches. Different types of psychotherapy differed highly significantly in levels of treatment adherence. There was no statistically significant association between the type of psychotherapy and its outcome, or between the degree of therapists' treatment fidelity and the treatment outcome. However, there were significant associations between therapists' degree of professional experience, clients' initial psychological burden, and treatment response. Clients' severity of psychological problems prior to treatment predicted quality of therapeutic alliance while therapists' treatment adherence was predicted by therapists' professional experience and by the quality of the therapeutic alliance. We discuss the seemingly indirect importance of treatment adherence for psychotherapy outcome that we found in this study in relation to findings from other studies and in the context of the role of schools within psychotherapy.

Alliance and adherence in a systemic therapy

“…Building a good working relationship and setting common goals may facilitate adherence to the treatment protocol. These findings are similar to findings from previous studies on individual adult psychotherapy showing that alliance predicted adherence (Tschuschke et al., ; Weck et al., ). Moreover, the results are in accordance with the MST treatment manual, according to which an MST therapist should start by creating engagement and a positive working relationship, and formulating common treatment goals.…”

“…Studies investigating the conjoint role of alliance and adherence have usually tested specific hypotheses regarding the mediating or moderating role of alliance on outcome, assessing alliance and adherence at a single point in time (e.g. Castonguay, Goldfried, Wiser, Raue, & Hayes, ; The Multisite Violence Prevention Project, ; Tschuschke et al., ; Webb et al., ). Yet, theoretical models argue that alliance and therapist adherence are essential in each phase of therapy and are interrelated all along (Goldfried & Davila, ; Hill, ).…”

“…This may have led to contradictory findings in the past. Some studies did not find any association between alliance and adherence (The Multisite Violence Prevention Project, ), whereas others showed alliance to predict adherence (Tschuschke et al., ), or to mediate the association between adherence and outcome (Weck, Grikscheit, Jakob, Höfling, & Stangier, ). In the absence of a strong alliance, a rigid focus on adherence may either lead to further deterioration of the alliance and interfere with therapeutic change (Barber et al., ; Castonguay et al., ), or may ‘save’ a treatment with low alliance, leading to positive treatment outcomes (Webb et al., ).…”

Explaining variability in therapist adherence and patient depressive symptom improvement: The role of therapist interpersonal skills and patient engagement

“…In a study on process variables in CBT for patients with binge-eating disorder (Brauhardt et al, 2014), patient and therapist characteristics did not predict therapist adherence to CBT. Other studies showed that a more positive working alliance as perceived by patients is associated with higher therapist adherence (Owen & Hilsenroth, 2011;Tschuschke et al, 2015;Weck, Grikscheit, Jakob, Höfling, & Stangier, 2015), whereas the direction of the interaction between adherence and the therapeutic alliance in predicting treatment outcomes seems to be inconsistent (Barber et al, 2006;Weck et al, 2015).…”

Sensitivity analysis in multiple imputation in effectiveness studies of psychotherapy

“…The data were collected as part of a project promoted by the Swiss Charta for Psychotherapy, with the aim of investigating various process-outcome aspects of outpatient treatments (Tschuschke et al, 2015). In this non-randomized field study, therapies were carried out with different experiential and psychodynamic therapy methods.…”