Effects of competence feedback on therapist competence and patient outcome: A randomized controlled trial.

OBJECTIVE: Therapist competence is considered essential for the success of psychotherapy. Feedback is an intervention which has the potential to improve therapist competence. The present study investigated whether competence feedback leads to an improvement of therapist competence and patient outcome. METHOD: Sixty-seven master-level clinical trainees were randomly assigned to either a competence feedback group (CFG) or a control group (CG). Patients with a diagnosis of major depression (N = 114) were randomly assigned to CFG or CG. Treatment included 20 individual sessions of cognitive behavioral therapy (CBT). In CFG, therapists received, parallel to the treatment, five competence feedbacks, based on videotaped therapy sessions. Independent raters assessed therapist competence with the Cognitive Therapy Scale (CTS) and provided the competence feedback. Patient outcome was evaluated with the Beck Depression Inventory-II (BDI-II) and therapeutic alliance (Helping Alliance Questionnaire [HAQ]) from both therapist's (HAQ-T) and patient's (HAQ-P) perspective were evaluated after each of the 20 sessions. RESULTS: (a) Therapist competence (CTS) increased significantly more for CFG than CG. (b) Depression (BDI-II) decreased significantly across sessions for both groups, but without evidence for a group-differential benefit for the CFG. (c) Therapeutic alliance (HAQ-T/P) increased significantly across sessions for both groups from both perspectives, but without group differences. (d) There is a positive effect of BDI-II on CTS at the beginning and a negative effect of CTS on BDI-II at the end of therapy. CONCLUSION: Competence feedback improves therapists' independently rated competence, but there is no evidence that competence feedback in CBT leads to better outcome. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Assessing therapist development: Reliability and validity of the Supervisee Levels Questionnaire (SLQ-R).

BACKGROUND: Therapist development is a crucial target for clinical training in order to ensure high-quality psychotherapy. A major challenge in examining therapeutic development is the assessment of developmental processes. The Supervisee Levels Questionnaire (SLQ-R) was analyzed in this study to examine its validity, reliability, and underlying dimensional structure. METHOD: Seven hundred and sixty therapists participated in an online survey concerning their current psychotherapy training. The factor structure as well as the validity of the SLQ-R were investigated using exploratory and confirmatory factor analysis. RESULTS: In line with the results of the exploratory factor analyses, a Bifactor ESEM (exploratory structural equation modeling) model with two factors and one global factor provided the best fit to the data. The two factors were labeled professional self-confidence and professional insecurity. CONCLUSION: Empirical support for reliability and validity of the new factor structure of the SLQ-R was found. The instrument is useful for assessing the therapist's developmental level.

The role of therapist and patient in-session behavior for treatment outcome in exposure-based cognitive behavioral therapy for panic disorder with agoraphobia.

OBJECTIVE: There is a very limited amount of research on the relationship between therapist and patient in-session behavior and treatment outcome in cognitive behavioral therapy (CBT) for panic disorder with agoraphobia (PD/AG). Additionally, the findings tend to be inconclusive. This study investigates the association between therapist competence, adherence, patient interpersonal behavior, and therapeutic alliance and outcome in a low-control CBT setting by using comprehensive measures. METHODS: Twenty-six patients with PD/AG received 12 sessions of exposure-based CBT. With regard to the outcome, treatments were classified either as problematic or nonproblematic by means of distinct criteria. Two raters evaluated the in-session behavior. RESULTS: Patient interpersonal behavior was significantly associated with outcome at follow-up (r = 0.49). At posttreatment, the correlation did not reach significance ( r = 0.34). Competence, adherence, and alliance were not outcome associated. CONCLUSION: The findings emphasize the need for therapists to pay particular attention to patients' interpersonal behavior during treatment.