Therapist Adherence and Competence in Psychotherapy Research

Therapist adherence refers to the extent to which a therapist uses the specific techniques of a particular therapy approach; competence is the degree of skillfulness in their delivery. Both are essential to ensure treatment integrity, which is especially important when conducting studies on the efficacy of a specific form of psychotherapy. Although adherence and competence measures have been developed to assess treatment integrity, they are also used to test whether high levels of adherence and competence are associated with good therapeutic outcome. Across studies, however, the reported associations of both adherence and competence with therapeutic outcome are heterogeneous, which points to a complex relationship between therapeutic techniques and patient improvement. Future directions include a refinement of existing measures and research designs as well as an examination of the interdependence of technical and relationship variables in psychotherapy research.