Treatment adherence, competence, and outcome in individual and family therapy for adolescent behavior problems
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This study examined the impact of treatment adherence and therapist competence on treatment outcome in a controlled trial of individual cognitive-behavioral therapy (CBT) and multidimensional family therapy (MDFT) for adolescent substance use and related behavior problems. Participants included 136 adolescents (62 CBT, 74 MDFT) assessed at intake, discharge, and 6-month follow-up. Observational ratings of adherence and competence were collected on early and later phases of treatment (192 CBT sessions, 245 MDFT sessions) by using a contextual measure of treatment fidelity. Adherence and competence effects were tested after controlling for therapeutic alliance. In CBT only, stronger adherence predicted greater declines in drug use (linear effect). In CBT and MDFT, (a) stronger adherence predicted greater reductions in externalizing behaviors (linear effect) and (b) intermediate levels of adherence predicted the largest declines in internalizing behaviors, with high and low adherence predicting smaller improvements (curvilinear effect). Therapist competence did not predict outcome and did not moderate adherence-outcome relations; however, competence findings are tentative due to relatively low interrater reliability for the competence ratings. Clinical and research implications for attending to both linear and curvilinear adherence effects in manualized treatments for behavior disorders are discussed.
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For fidelity coding, 1 session will be randomly selected from the early phase (sessions 1-3) and 2 from the later phase (sessions from session 5) of each client.
“As per the study team’s numerous observational fidelity studies [126-130], 1 session will be randomly selected from the early phase of treatment (sessions 1 to 3) and 2 from the later phase (sessions from session 5) of each client for coding with an observational version of the Fam-AID Fidelity Checklist (described in the Study Measures section).”
From Family Support Protocol for Adolescent Internalizing Disorders: Protocol for a Pre-Post Quantitative Treatment Development Study (2024) · cites this paper as [130]
The Method’s Sampling Procedures describe selecting sessions from early and later treatment phases for observational coding, with a randomly selected later-phase set. But this paper selected the first two available sessions between sessions 1 and 5, plus up to three consecutive sessions starting at session 6—not one randomly selected session from sessions 1–3 and two from session 5 onward. Page numbers are not provided in the supplied passages. (LLM, conf=0.88)
Experimental — accuracy not yet measuredTherapist adherence level is a better predictor of positive therapy outcomes than competence per se.
“Therapist adherence level is a better predictor of positive therapy outcomes than competence per se (e.g., Hogue et al., 2008).”
From Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track (2016) · cites this paper as Hogue et al., 2008
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- Authors
- Hogue, A., Henderson, C. E., Dauber, S., Barajas, P. C., Fried, A., & Liddle, H. A.
- Affiliations
- National Center on Addiction and Substance Abuse at Columbia University (US)
- Sam Houston State University (US)
- University of Miami (US)
- Corresponding author
- Hogue, Aaron
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2008-08
- Volume
- 76
- Issue
- 4
- Pages
- 544-555
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC2843085
- OpenAlex
- W2155455205
- Cited by
- 284
- References
- 69
- Citations by year
- 2026: 3 · 2025: 17 · 2024: 13 · 2023: 7 · 2022: 12 · 2021: 24 · 2020: 8 · 2019: 18 · 2018: 18 · 2017: 16 · 2016: 13 · 2015: 20 · 2014: 25 · 2013: 29 · 2012: 30
- FWCI
- 11.53
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (R01 DA14571; P50 DA07697)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Keywords
- medication adherence, therapist competence, treatment outcomes, adolescent substance use, adolescent behavior problems, cognitive behavioral therapy, multidimensional family therapy, intervention fidelity, therapeutic relationship, externalizing problems, internalizing problems
- MeSH terms
- Adolescent, Child Behavior Disorders, Family Therapy, Female, Follow-Up Studies, Humans, Internal-External Control, Male, Patient Compliance, Professional Competence, Professional-Patient Relations, Comorbidity, Cognitive Behavioral Therapy, Substance-Related Disorders
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