Anthony D. Roth

Patient Attachment Orientation and the Early Working Alliance-A Study of Patient and Therapist Reports of Alliance Quality and Ruptures

This study investigated the relationship between attachment orientation in adult patients and the early therapeutic alliance. Attachment was measured by self-report following the first session of therapy. The alliance was studied using patient and therapist ratings of its quality and reports of ruptures following early sessions. The sample comprised 30 clinical psychology outpatients treated by 11 experienced therapists. Correlation and multiple regression statistics provided partial support for the hypothesized relationships between attachment orientation and reports of alliance quality and ruptures. In line with predictions, fearful attachment was associated with lower alliance ratings (significantly with patient ratings at sessions 3 and 5 and therapist ratings at session 2) and secure attachment was associated with higher alliance ratings (significantly with therapist ratings at session 5). Preoccupied attachment and dismissing attachment were associated with improvement in alliance ratings over time, although there was some question about the reliability of these findings. Additionally, the frequency of rupture reporting varied with attachment orientation. Preoccupied attachment was associated with more frequent reports of ruptures and dismissing attachment was associated with fewer reports of ruptures. Implications for clinical understanding and future research are discussed.

Using an Evidence-Based Methodology to Identify the Competences Required to Deliver Effective Cognitive and Behavioural Therapy for Depression and Anxiety Disorders

A number of developments make the formal specification of competences in CBT both timely and relevant, in particular the Improving Access to Psychological Therapies (IAPT) programme, the increasing focus on process and therapist variables in determining outcome, and the increasing diversity of CBT. This paper outlines the development of an evidence-based methodology for determining both a model and a framework for CBT competences, and considers issues related to the implementation of the framework.

Therapist Training and Supervision in Clinical Trials: Implications for Clinical Practice

BACKGROUND Researchers in clinical trials usually pay close attention to therapist selection, training, supervision and monitoring, but the extent of this input has not been systematically documented. AIMS To describe the extent of training and supervision activity within clinical trials, and to consider any implications for transporting therapies from research to routine clinical contexts. METHOD Twenty-seven randomized studies examining the efficacy of CBT interventions for people with depression or anxiety disorders were selected on the basis of their quality and impact on the field. Published and unpublished sources were used to gather information about therapist selection, training and supervision within these trials. RESULTS The review identified the extent of investment by researchers in assuring therapist expertise, adherence and competence. It also indicated inconsistencies in the clarity with which this input was reported. CONCLUSIONS The ubiquity of intervention-specific training in research contexts risks being overlooked when commissioning evidence-based therapies in routine practice. This has clear implications for the likely effectiveness of interventions. Greater consistency in the reporting of training in clinical trials may help to draw attention to the role of training and supervision in maximizing clinical outcomes.

The outcome of psychodynamic psychotherapy for psychological disorders

Notwithstanding a history of over 100 years, psychoanalytically informed psychological therapies have a poor evidence base. This paper provides a selective review of trials of brief psychodynamic psychotherapies and an overview of mostly follow-up or follow-along studies of long-term more intensive psychoanalytic therapy. In relation to the treatment of mood disorders, particularly depression, anorexia nervosa and some personality disorders, there is evidence to suggest that brief psychodynamic psychotherapy is comparable in effectiveness to empirically supported treatments. No trial has shown it to be superior to alternative treatment. Notwithstanding the small number of studies, independent replications of the same version of short-term therapy are totally lacking. This survey of the literature underscores the urgent need for innovative therapeutic interventions based on psychoanalytic models of mental functioning which are specific to the clinical problems they aim to address. q 2005 Association for Research in Nervous and Mental Disease. Published by Elsevier B.V. All rights reserved.

Are competence frameworks fit for practice? Examining the validity of competence frameworks for CBT, psychodynamic, and humanistic therapies

Abstract Practitioners transporting psychological therapies from a research context to clinical settings need to know what competences they should demonstrate to maintain congruence with the evidence base. This study explores the validity of a suite of competence frameworks for cognitive behavior therapy (CBT), humanistic, and psychodynamic therapies developed to aid the transportation process. Experienced psychological therapists (N = 111) undertook a Q-sort of 100 items, drawn from frameworks representing each of the modalities and including a set of pantheoretical generic competences, rating items as characteristic or uncharacteristic of their orientation. There were significant differences in the way competences were assigned, with practitioners strongly favoring items from their own modality framework and eschewing items from the others. These results confirm the validity of the items within the frameworks; their utility and application is discussed.

A New Scale for the Assessment of Competences in Cognitive and Behavioural Therapy

BACKGROUND Scales for assessing competence in CBT make an important contribution to research and practice. AIMS To develop a novel scale. METHOD A new structured assessment tool is described, which draws on a widely-used CBT competence framework to identify relevant areas of clinical practice. RESULTS Scale content was clarified through piloting and review by a range of stakeholders. CONCLUSION Pending formal testing of the psychometric properties, the scale is ready for use to assess competences in cognitive and behavioural therapy.