Therapist competence, homework engagement, and client characteristics in CBT for youth depression: A study of mediation and moderation in a community-based trial

ABSTRACT

Objective

Prior studies of Cognitive Behavioral Therapy (CBT) have focused on the quantity and quality of clients’ homework completion and only rarely have considered the role of therapist competence.

Methods

The present study examined (a) therapist competence across the entire process of integrating homework into CBT, including the review, design, and planning of tasks; (b) homework engagement, including client appraisals of the difficulty and obstacles encountered in task completion using the Homework Rating Scale – Revised (HRS-II); (c) pre–post symptom reduction as the index of outcome; and (d) considered client factors such as suicide risk in a community-based trial for adolescent depression. Trained independent observers assessed therapist competence and engagement with homework at two consecutive sessions of CBT for N = 80 young people (M_age = 19.61, SD = 2.60).

Results

Significant complementary mediation effects were obtained; there was an indirect mediation effect of HRS-II Beliefs (b = 1.03, SE B = 0.42, 95% BCa CI [0.35, 2.03]) and HRS-II Perceived Consequences on the Competence-Engagement relationship (b = 0.85, SE B = 0.31, 95% BCa CI [0.39, 1.61]). High levels of suicidal ideation were also shown to moderate this relationship.

Conclusions

The present findings contribute to the growing body of CBT process research designed to examine the complex interrelationships of client and therapist variables, in a manner that reflects the actual process of therapy, and advances beyond studies of isolated predictors of symptom change.

Keywords:

• homework
• therapist competence

Disclosure Statement

Kazantzis disclosed his royalties from Guilford Press (Therapeutic Relationship in Cognitive Behavior Therapy; Cognitive and Behavior Theories in Clinical Practice), Routledge (Using Homework Assignments in Cognitive Behavior Therapy); SpringerNature publishers (CBT: Science into Practice Book Series; Handbook of Homework Assignments in Psychotherapy: Research, Practice, & Prevention). The other authors have no conflict of interest to disclose.