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Cognitive Therapy and Research

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29.03.2018 | Original Article

Revisiting How We Assess Therapist Competence in Cognitive Therapy

verfasst von: Iony D. Schmidt, Daniel R. Strunk, Robert J. DeRubeis, Laren R. Conklin, Justin D. Braun

Erschienen in: Cognitive Therapy and Research | Ausgabe 4/2018

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Abstract

We report on two approaches to addressing the problem of low reliability in the assessment of therapist competence in cognitive therapy (CT). In Study 1, we utilized ratings of a session from each of six therapists and investigated how CT experts evaluate specific therapist behaviors in making ratings on the Cognitive Therapy Scale (CTS). Departures from the consensus on judgments of these therapist behaviors were associated with more discrepant competence ratings. We take these results to suggest that, at least among experts, providing greater clarity about which therapist behaviors are relevant to each CTS item may enhance reliability. In Study 2, we utilize a sample of 14 therapists and pilot test a standardized assessment of therapist competence. The standardized assessment exhibited an intra-class correlation coefficient of 0.89 for a single rater. Standardized assessments of competence were related to four measures of therapist experience and qualifications, whereas the CTS was only related to two of these measures. With these promising initial results, we encourage future research to examine the predictive validity of standardized competence assessments in CT.

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One of the 15 therapists did not have a consenting patient and therefore did not participate in the CTS portion of the study.

Because the SCARS-CT was conducted over the phone, it did not include non-verbal information, which can be considered in competence assessments made on the basis of video recordings.

One might be interested in comparing the mean CTS scores across Study 1 and Study 2. While Study 1 included more expert therapists, the mean was numerically lower than that observed in Study 2. This difference should be interpreted with caution as raters across studies differed, meaning that any differences in CTS scores might be attributed to either true differences in competence or differences in raters’ tendencies to make higher or lower competence ratings.

The low correlation might be attributable to the different contexts in which therapist evaluations occurred, but it might also be due to differences in the items to assess competence. To address this issue, we examined a single CTS item assessing overall competence that was highly correlated with (r = .86), but not included in the total score. This item was nearly identical to the item used in the SCARS-CT and yet the correlation of the overall competence item from the CTS and the SCARS-CT was similarly small (r = .10, p = .7). We take this to suggest that the difference in scores from the CTS and SCARS-CT may reflect either differences in the evaluative context (standardized assessment vs. regular session) or the extent to which these measures assess discrete skills vs. interwoven skills.

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Titel: Revisiting How We Assess Therapist Competence in Cognitive Therapy
verfasst von: Iony D. Schmidt
Daniel R. Strunk
Robert J. DeRubeis
Laren R. Conklin
Justin D. Braun
Publikationsdatum: 29.03.2018
Verlag: Springer US
Erschienen in: Cognitive Therapy and Research / Ausgabe 4/2018
Print ISSN: 0147-5916
Elektronische ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-018-9908-7

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