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Cross your T's & dot your I's: An explorative study for therapist treatment fidelity in an asynchronous web-based treatment

Roskam, R.V. (2013) Cross your T's & dot your I's: An explorative study for therapist treatment fidelity in an asynchronous web-based treatment.

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Abstract:INTRODUCTION: This research is the first research assessing therapist treatment fidelity in a web-based treatment for participants coping with alcohol abuse- or addiction. The therapist treatment fidelity consists of an assessment of therapist treatment adherence and therapist competence, mostly measured by means of a rating scale. Encompassing an exploration of concepts of cognitive behavioral therapy (CBT) and motivational interviewing (MI) this research lays an extensive fundament for the ‘Look At Your Drinking – Adherence Competence Scale (LAYD-ACS)’. The main research question is: ‘How can therapist treatment adherence and competence be assessed in the web-based treatment’ METHODS: A combination of directive and summative content analysis is used to explore three asynchronous online treatments. The treatments were initiated within the period of January 2009 until December 2011. The LAYD-ACS is created based on literature about therapeutic skills and has a dichotomous way of assessing therapist treatment fidelity by giving either a plus (+, good) or minus (-, not so good/room for improvement). An expert interview is held to assess the validity of the LAYD-ACS. The messages are analyzed independently by two raters (RVR and TZ). An inter-rater agreement has been achieved a priori by testing a pilot and a posteriori by discussions between the raters. RESULTS: 24 categories were taken into account, 23 were recognized as applied in the treatments used. A total amount of 2154 codes were found. Almost 84% of all codes were given a plus value, and more than 16% are graded minus. The most dominant therapeutic skills were ‘Support & Endorsement’ and ‘Consent & Non-Committal. Every category is described and underpinned with quotes from the web-based treatment. CONCLUSION: The therapist treatment fidelity and the therapist competence are very good. Quantitative data showed very high rates. Concepts like ‘Empathy’ and ‘Motivation’ are not seen very often, but are the main concepts of MI, and thus, could be used more. The LAYD-ACS has shown to be an useful and promising rating scale to assess therapist treatment fidelity. Improvement can be made in validating the LAYD-ACS, by increasing reliability by using a more critical tool and make the LAYD-ACS more manageable. Although the LAYD-ACS shows a lot of room for improvement, this research has led to an extensive fundament of therapeutic techniques in a web-based treatment. SEACH TERMS: Therapist treatment fidelity, integrity, adherence, competence, web-based treatment, rating scale, qualitative research.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:77 psychology
Programme:Psychology MSc (66604)
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