Therapist adherence/competence and treatment outcome: A meta-analytic review.
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OBJECTIVE: The authors conducted a meta-analytic review of adherence-outcome and competence-outcome findings, and examined plausible moderators of these relations. METHOD: A computerized search of the PsycINFO database was conducted. In addition, the reference sections of all obtained studies were examined for any additional relevant articles or review chapters. The literature search identified 36 studies that met the inclusion criteria. RESULTS: R-type effect size estimates were derived from 32 adherence-outcome and 17 competence-outcome findings. Neither the mean weighted adherence-outcome (r = .02) nor competence-outcome (r = .07) effect size estimates were found to be significantly different from zero. Significant heterogeneity was observed across both the adherence-outcome and competence-outcome effect size estimates, suggesting that the individual studies were not all drawn from the same population. Moderator analyses revealed that larger competence-outcome effect size estimates were associated with studies that either targeted depression or did not control for the influence of the therapeutic alliance. CONCLUSIONS: One explanation for these results is that, among the treatment modalities represented in this review, therapist adherence and competence play little role in determining symptom change. However, given the significant heterogeneity observed across findings, mean effect sizes must be interpreted with caution. Factors that may account for the nonsignificant adherence-outcome and competence-outcome findings reported within many of the studies reviewed are addressed. Finally, the implication of these results and directions for future process research are discussed.
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In a meta-analysis of adherence and competence, the effect for adherence was small (d=0.04, n=28).
“In a meta-analysis of adherence and competence (55), effects were small (d50.04,n528 for adherence; d50.14, n518 for competence; see Figure 1).”
From How important are the common factors in psychotherapy? An update (2015) · cites this paper as [55]
The Results (Distribution of Effect Sizes; page unavailable) report a very small mean weighted adherence–outcome effect of .02, expressed in the paper as an r-type effect size; this is approximately d = .04 after conversion. But the Results (Moderator Analyses) identify 26 adherence studies, and the Method (Literature Search Procedures) reports 32 extracted adherence effect-size estimates, so the claimed n = 28 is not supported by our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn a meta-analysis of adherence and competence, the effect for competence was small (d=0.14, n=18).
“In a meta-analysis of adherence and competence (55), effects were small (d50.04,n528 for adherence; d50.14, n518 for competence; see Figure 1).”
From How important are the common factors in psychotherapy? An update (2015) · cites this paper as [55]
The Results (Distribution of Effect Sizes; page unavailable) report a small mean competence–outcome effect of r = .07, approximately equivalent to d = .14. But the Method (Literature Search Procedures; page unavailable) reports 17 competence–outcome effect-size estimates, not the claimed n = 18. (LLM, conf=0.90)
Experimental — accuracy not yet measuredExisting literatures on measuring fidelity, learning, and homework compliance provide a foundation, but greater integration and precision (e.g., regarding timing, specific active elements) is needed.
“Existing literatures on measuring fidelity, learning, and homework compliance provide a foundation, but greater integration and precision (e.g., regarding timing, specific active elements, etc.) is needed (Stir man, 2020; Webb, DeRubeis, & Barber, 2010).”
From Measuring the active elements of cognitive-behavioral therapies (2023) · cites this paper as Webb, DeRubeis, & Barber, 2010
The Discussion (page unavailable) calls for studying adherence and competence alongside other process variables across several time points, and the paper discusses identifying active treatment ingredients. It addresses measuring treatment fidelity, but does not support the sentence’s references to literatures on measuring learning or homework compliance. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe average effect of the alliance is larger than the effects of therapist adherence to treatment manual or therapist competence.
“the average effect of the alliance is larger than the effects of other treatment variables such as therapist adherence to treatment manual or therapist competence (Webb et al., 2010).”
From Synchrony in Psychotherapy: A Review and an Integrative Framework for the Therapeutic Alliance (2016) · cites this paper as Webb et al., 2010
Meta-analyses of adherence-outcome and competence-outcome links show non-significant associations in adults (rs = .02 and .07) and a small significant adherence-outcome effect (r = .10) but not competence-outcome (r = .02) in youth.
“Results from meta-analyses of adherence-outcome and competence-outcome associations are mixed, with non-significant associations in adult samples (rs = .02 and .07, for adherence-outcome and competence-outcome, respectively64) and a small but significant effect for adherence-outcome (r = .10) but not competence-outcome (r = .02) in youth samples65.”
From A common factors perspective on mindfulness-based interventions (2022) · cites this paper as [64]
Possible explanations for the lack of association include unreliable adherence and competence measures and range restriction.
“Potential explanations offered for this lack of association include unreliability in adherence and competence measures and range restriction (owing to selecting highly adherent and/or competent therapists to deliver treatments in research studies)64.”
From A common factors perspective on mindfulness-based interventions (2022) · cites this paper as [64]
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- Authors
- Webb, C. A., DeRubeis, R. J., & Barber, J. P.
- Affiliations
- University of Pennsylvania (US)
- Philadelphia VA Medical Center (US)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2010
- Volume
- 78
- Issue
- 2
- Pages
- 200-211
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC4246504
- OpenAlex
- W2081283342
- Cited by
- 657
- References
- 66
- Citations by year
- 2026: 21 · 2025: 21 · 2024: 31 · 2023: 37 · 2022: 27 · 2021: 68 · 2020: 40 · 2019: 54 · 2018: 64 · 2017: 47 · 2016: 38 · 2015: 52 · 2014: 44 · 2013: 49 · 2012: 30
- FWCI
- 39.60
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (MH60998 (R01), MH061410 (R01))
- Social Sciences and Humanities Research Council of Canada
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Social Psychology › Counseling Practices and Supervision
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Keywords
- therapist adherence, therapist competence, treatment outcomes, therapeutic relationship, depression treatment, process research, symptom change, moderators of treatment outcome
- MeSH terms
- Mental Disorders, Clinical Competence, Humans, Guideline Adherence
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