Therapist adherence/competence and treatment outcome: A meta-analytic review.

Abstract

Objective The authors conducted a meta-analytic review of adherence–outcome and competence– outcome findings, and examined plausible moderators of these relations. Method A computerized search of the PsycINFO database was conducted. In addition, the reference sections of all obtained studies were examined for any additional relevant articles or review chapters. The literature search identified 36 studies that met the inclusion criteria. Results R-type effect size estimates were derived from 32 adherence–outcome and 17 competence–outcome findings. Neither the mean weighted adherence– outcome (r = .02) nor competence–outcome (r = .07) effect size estimates were found to be significantly different from zero. Significant heterogeneity was observed across both the adherence–outcome and competence–outcome effect size estimates, suggesting that the individual studies were not all drawn from the same population. Moderator analyses revealed that larger competence–outcome effect size estimates were associated with studies that either targeted depression or did not control for the influence of the therapeutic alliance. Conclusions One explanation for these results is that, among the treatment modalities represented in this review, therapist adherence and competence play little role in determining symptom change. However, given the significant heterogeneity observed across findings, mean effect sizes must be interpreted with caution. Factors that may account for the nonsignificant adherence– outcome and competence–outcome findings reported within many of the studies reviewed are addressed. Finally, the implication of these results and directions for future process research are discussed.

The Relationship Between Provider Competence, Content Exposure, and Consumer Outcomes in Illness Management and Recovery Programs

“…While most of the prior research has been mixed (Webb et al, 2010), our findings are in line with studies of depression in which provider competence has been associated with better consumer outcomes (Mowrer & Jones, 1945;Trepka, Rees, Shapiro, Hardy, & Barkham, 2004). Moreover, to our knowledge, this is the first study to examine the relationship between provider competence and outcomes for people with severe mental illness.…”

“…Although provider competence is considered important, the relationship between competence and clinical outcome is not always direct. In a recent meta-analysis, Webb, DeRubeis, and Barber (2010) found no overall association between clinical competence and client outcomes, but did find a positive relationship in studies focused on depression. Moreover, there was substantial variation in effect sizes across studies, suggesting potential moderators of the relationship between competence and outcome.…”

“…First, competence research is often conducted in university training clinics or controlled clinical trials; in both cases, providers are highly trained, often included because of demonstrated skill, and generally receive supports such as supervision and session feedback (Webb et al, 2010). This restricts the range of competence, thus limiting the examination of its effects on outcomes.…”

Cognitive Restructuring

“…The specific type of automatic thought targeted during group CBT for social anxiety also appears to influence treatment outcome (Hope, Burns, Hayes, Herbert, & Warner, 2010). Finally, patients' competence in acquiring CR skills in CT predicted lower 1-year relapse in one study (Strunk, DeRubeis, Chiu, & Alvarez, 2007), although the evidence is mixed on whether therapist adherence to or competence in the CT protocol is significantly related to outcome (Strunk, Brotman, DeRubeis, & Hollon, 2010;Webb, DeRubeis, & Barber, 2010). Overall, then, considerable progress has been made in understanding the mechanisms of change in CBT.…”

Treatment Fidelity Over the Last Decade in Psychosocial Clinical Trials Outcome Studies: A Systematic Review

“…The value of measuring adherence and competence to determine the quality of Treatment Fidelity is a fundamental consideration [19][20][21]. Adherence is expressed as the delivery of a key component or technique of the treatment [9].…”