Academic journal article Journal of Cognitive Psychotherapy

The Relationship between Therapist Competency in Cognitive Therapy and General Therapy Skill

Academic journal article Journal of Cognitive Psychotherapy

The Relationship between Therapist Competency in Cognitive Therapy and General Therapy Skill

Article excerpt

One recent trend in psychotherapy research involves the increased specification of the treatment variable through the use of therapy manuals and therapists who are trained to criteria. This study is an investigation of the relationship between ratings of therapist competence in one system of psychotherapy (cognitive therapy, CT) and ratings of therapist performance less dependent on modality-specific interventions (i.e., general therapy skills). Experts in cognitive therapy judged the quality with which a group of therapists implemented the CT protocol. The Matarazzo Checklist of Therapist Behaviour (MCTB), a scale less dependent on modality-specific interventions, was used by other, independent judges to rate the same therapy sessions. Results of correlational analyses indicated that subcategories of errors on the MCTB were differentially related to competence in cognitive therapy as measured by the Cognitive Therapy Scale. Highly competent performance was negatively related to errors in therapeutic focus, but was positively related to errors in communication. These data were interpreted to reflect the importance of tying judgments of therapy skill to the specific theoretical and technical model of the therapy system being examined.

Psychotherapy researchers have long been interested in identifying the effective mechanisms of change in psychotherapy. Therapist characteristics and interventions, as well as client processes, have all been examined to determine their contribution to the change process (Bergin & Lambert, 1978; Garfield, 1978). A necessary first step, in any attempt to identify mechanisms of change, is the clear description and measurement of the variables of interest. Recently, there has been an emphasis on the specification and assessment of therapist interventions (see Shaw, 1984; Elkin, 1984). It is no longer being assumed, without independent validating evidence, that therapists actually adhere to the techniques under evaluation. For example, within the National Institute of Mental Health's Treatment of Depression Collaborative Research Program (TDCRP), a rating scale, the Collaborative Study Psychotherapy Rating Scale (CSPRS), has been developed to assess therapist adherence to three specific therapeutic approaches (Cognitive Therapy, Interpersonal Therapy, and Pharmacotherapy). The scale has been used to demonstrate that the therapists in the TDCRP adhere to the therapeutic interventions specified in the treatment manuals (Evans, Piasecki, Kriss, & Hollon, 1984).

The demonstration that therapists adhere to the techniques specified within the system of therapy being examined is an important methodological contribution to psychotherapy research. However, scales assessing adherence provide only a manipulation check; that is, such scales can only tell us that therapists are doing what they are supposed to be doing. They do not provide information on how well therapists employ the relevant techniques (i.e., the issue of skill or competence). Schaffer (1983) has stressed the importance of assessing the skillfulness of therapeutic interventions. He maintains that by measuring multiple dimensions of therapist behavior, skillfulness being one such dimension, researchers will obtain better predictions of therapy outcome.

Young and Beck (1980), drawing upon the work on cognitive therapy for depression, have developed a competency rating scale, the Cognitive Therapy Scale (CTS). The CTS is an 11 item rating scale, designed to assess both general, modality nonspecific skills (such as understanding or interpersonal effectiveness), as well as specific cognitive therapy skills (empiricism, focus on key cognitions or behavior, homework). Scale validation studies (Dobson, Shaw, & Vallis, 1985; Hollon, Mandell, Bemis, DeRubeis, Emerson, Evans, & Kriss, 1981; Vallis et al., 1986) have shown the CTS to be reliable, both in terms of internal consistency and inter-rater reliability. Data also validate that the scale does in fact reflect therapist competency (Hollon et al. …

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