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

Abstract

Background and aims: Therapist characteristics may be associated with variation in consistency, quality and effectiveness of treatment delivery. We examined associations between treatment fidelity and therapist education, experience, treatment orientation and perceived skills in a randomized, multi-site trial of Twelve Step Facilitation (TSF). Methods: 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. Results: 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 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.

• Therapist characteristics
• treatment fidelity
• twelve-step facilitation

Acknowledgements

Awards from the National Institute on Drug Abuse (R01 DA025600, U10 DA015815 and P50 DA009253) supported this investigation. We appreciate the generous assistance of Dennis Donovan, Dennis Daley and the STAGE-12 study team in providing access to STAGE-12 adherence scales, digital recordings of treatment sessions and other study data. We thank Kevin Delucchi, University of California, San Francisco, for consultation regarding statistical analysis and Barbara Tajima and Emma Passalacqua for their formatting assistance. Special thanks to our raters and the staff at all the participating treatment sites.