Treatment Integrity and Therapeutic Change: Issues and Research Recommendations

Abstract

One of the most important aspects of treatment outcome research is establishing treatment integrity. Integrity of the treatment refers to the degree to which treatment is implemented as intended. Research examining the relationship between treatment integrity and therapeutic change has produced conflicting results. However, assessment, design strategies, and the possible confound of integrity with other variables may explain the inconsistency in findings. This paper elaborates the limitations of existing strategies for evaluating the relationship between treatment integrity and outcome. Recommendations for future research include controlling possible confounding variables, experimentally manipulating treatment integrity, and using novel assessment and evaluation strategies.

Therapeutic collaboration and the assimilation of problematic experiences in emotion-focused therapy for depression: Comparison of two cases

“…Specific EFT tasks (such as two-chair dialogue, empty-chair work or evocative unfolding) appeared in 59.5% of the sample of sessions analyzed. Given these results, the authors concluded that these therapists exhibited a majority of essential and unique EFT behaviors, showing adequate therapist adherence and adequate treatment integrity according to the guidelines proposed by Perepletchikova (2011) andPerepletchikova andKazdin (2005). …”

Evaluating the efficacy of a self-guided Web-based CBT intervention for reducing cancer-distress: a randomised controlled trial

“…1,2 Assessing therapist adherence also provides an indication whether treatments under investigation can be differentiated. 2,3 Therapist adherence is commonly measured by reviewing recordings of therapy sessions, and rating whether core treatment components are observed using a suitable rating scale. These rating scales also tend to include items that measure nonspecific factors, such as therapist empathy.…”

“…14 The aims were to (1) develop and test a measure of therapist adherence for use in the SWAN study, (2) assess therapist adherence to the treatments under investigation, and (3) examine inter-site differences in therapist adherence.…”

Psychometric assessment of the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ)

“…Attention to fidelity, or the degree to which providers implement programs as intended [12], is vital in ensuring that interventions are delivered in an optimal manner. Although system resource constraints and local contextual factors can be highly influential, protocol adherence, or a provider's utilization of specific procedures and engagement in specific tasks and activities [13], is a crucial measure of implementation fidelity. A major challenge to assessing CCC fidelity, however, is that a psychometrically sound and provider-friendly measure of protocol adherence has not been available.…”