Therapist predictors of treatment delivery fidelity in a community-based trial of 12-step facilitation.

Therapist characteristics may be associated with variation in consistency, quality and effectiveness of treatment delivery. This ancillary investigation of National Drug Abuse Treatment Clinical Trials Network protocol CTN-0031 (Stimulant Abuser Groups to Engage in 12-Step (STAGE-12)) examined associations between treatment fidelity and therapist education, experience, treatment orientation, and perceived skills. Raters scored audio-recorded TSF sessions (n=966; 97% of TSF sessions) from 32 community-based, trained therapists for adherence, competence, empathy, and global session performance. Therapists with graduate degrees had significantly higher adherence and global performance fidelity ratings. Therapists reporting more positive attitudes toward 12-Step groups had lower adherence ratings. Being in recovery was associated with lower fidelity in univariate tests, but higher adherence in multivariate analysis. Fidelity was higher for therapists reporting self-efficacy in basic counseling skills and lower for self-efficacy in addiction-specific counseling skills. Fidelity was also superior in group relative to individual TSF sessions.

Conclusions: Results from this study have implications for therapist selection, training, and supervision in community-based, effectiveness trials and community implementation of evidence-based treatments. To obtain high fidelity and improve outcomes, it may be preferable to choose masters level therapists who are open to learning new treatments and have good, general counseling skills.

Related protocols: CTN-0031, CTN-0031-A-3