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dimensions, coders were instructed to consider a third factor—the item's categorization in terms of the following three subcategories: (1) "global" items, which represent a defining aspect of the treatment and tend to occur frequently and pervasively, (2) "moderately occurring" items, which can occur not-at-all to frequently, and (3) "infrequent" items, which may occur infrequently, but are nevertheless substantive in nature. Coders were instructed to code the items according to their category of frequency. An infrequently occurring item of a treatment is a hallmark of the treatment and is not as routinely observed as global items of the treatment. For example, in CBT, the technique of assigning "homework" is considered an infrequent item and would be noted as such, thereby rendering a greater score. The coding process proceeded in the following step-by-step manner: Coders listened to a segment and noted the presence of a specific item following each therapist intervention. Coders used a Likert-type scale that primarily assessed degree of occurrence: 1 = not at all; 2 = slightly; 3 = somewhat; 4 = moderately; 5 = considerably; 6 = extensively. A notation of a check (V) representing the presence of an item, combined with either a minus sign (V-) for less than average clarity, or a plus sign (V+) for more than average clarity, was made in the margin for each item. Upon completion of a segment, the coder added the number of checks for each item, factoring in the clarity "markers" for each item, as well as the "weight" of the items. The Beth Israel Adherence Scale provides raw scores for each treatment subscale (i.e., BRT, CBT, and BAP). These scores represent the degree of overall adherence to the 41
prescribed treatment. In this study, a greater frequency count—or the peak subscale of the specific treatment techniques—determines the specific treatment to which the therapist is considered adherent. Coders performed adherence checks on a total of 56 sessions (28 sessions in both treatment groups). Recall two sessions were selected across treatment to assess early (sessions 3-15) and late (sessions 16-30) therapist adherence on the Beth Israel Adherence Scale. These scores were averaged across the early and late sessions, resulting in one adherence score per treatment subscale. The decision to average the two adherence scores was made after analysis of sessions indicated that there were no significant differences attributable to the sessions being rated. Outcome Measures Outcome was defined by two outcome measures: The Symptom Checklist-90- Revised, which assesses the severity of psychiatric symptoms, and the Inventory of Interpersonal Problems-64, which measures individuals' degree of interpersonal distress. Symptom Checklist-90-Revised (SCL-90-R; Derogatis, 1975a, 1975b). The SCL- 90-R is a self-report, paper-and-pencil inventory designed to identify and measure overall psychiatric symptoms. It is comprised of 90 items presented in Likert-type format and designed to assess degree of severity. Adequate psychometric properties have been demonstrated (e.g., Derogatis, Rickels, & Rock, 1976). The SCL-90-Rhas 12 sub-scales: Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, Psychoticism, Positive Symptom Distress Index, Positive Symptom Total, and 42
Page 1 and 2: Therapists' Adherence To Manualized
Page 3 and 4: Abstract The overall goal of this s
Page 5 and 6: Table of Contents List of Tables v
Page 7 and 8: List of Tables Table 1. ICC Means,
Page 9 and 10: APPENDIX A. APPENDIX B. APPENDIX C.
Page 11 and 12: For example, research in contempora
Page 13 and 14: This study will investigate therapi
Page 15 and 16: Greenson (1967) extended the ego ps
Page 17 and 18: The conceptualization of the allian
Page 19 and 20: Rhodes, Hill, Thompson, and Elliott
Page 21 and 22: Researchers have demonstrated that
Page 23 and 24: characteristic of stages that commo
Page 25 and 26: treatment manuals; methodological a
Page 27 and 28: set of propositions that therapists
Page 29 and 30: most therapists do not administer t
Page 31 and 32: Research on the Effects of Therapis
Page 33 and 34: higher 'toxic-dose' of disaffiliate
Page 35 and 36: interpretations may not be helpful.
Page 37 and 38: during ruptures, and to assess the
Page 39 and 40: For the purposes of this study, dat
Page 41 and 42: immediacy achieved by using phenome
Page 43 and 44: In the CBT treatment condition, fou
Page 45 and 46: Selection Procedure of Ruptures In
Page 47 and 48: adequate internal consistency, inte
Page 49: BAP techniques. The BAP (BAP; Polla
Page 53 and 54: Interrater Reliability Reliability
Page 55 and 56: BAP). The between-treatment factor
Page 57 and 58: Table 3 Analysis of Variance for Tr
Page 59 and 60: Table 4 Differences Between Adheren
Page 61 and 62: Figure 1 Means for Adherence Scores
Page 63 and 64: Table 5 Intercorrelations Between M
Page 65 and 66: Table 6 Intercorrelations Between M
Page 67 and 68: Discussion The overall goal of this
Page 69 and 70: predictive abilities of the therape
Page 71 and 72: Another limitation is that this stu
Page 73 and 74: References Addis, M. E. (1997). Eva
Page 75 and 76: Derogatis, L. R., Rickels, K., & Ro
Page 77 and 78: Greenson, R. R. (1971). The 'real'
Page 79 and 80: Kivlighan, M. D., Jr., & Schmitz, J
Page 81 and 82: Najavits, M. L., Weiss, D. R., Shaw
Page 83 and 84: Safran, D. J. (1984a). Assessing th
Page 85 and 86: Shaw, B. F. (1984). Specification o
Page 87 and 88: Waltz, J., Addis E. M, Koerner K.,
Page 89 and 90: Appendix A SCL—90—R® HOW MUCH
Page 91 and 92: 14. socialize with other people. 15
Page 93 and 94: Appendix C BRIEF PSYCHOTHERAPY RESE
Page 95 and 96: PART D The following items reflect
Page 97 and 98: PART E Please rate how well each of
Page 99 and 100: Appendix D BETH ISRAEL ADHERENCE SC
Page 101 and 102:
15. Therapist involvement. How invo
Page 103 and 104:
31. Engages in didactic persuasion.
Page 105 and 106:
Appendix E Definitions of the Treat
Page 107 and 108:
BRIEF ADAPTIVE PSYCHOTHERAPY 13. In
Page 109 and 110:
COGNITIVE-BEHAVIORAL THERAPY 25. Pr
Page 111 and 112:
NON-SPECIFICS 37. Therapist's commu
Page 113 and 114:
Global Items Frequent & Pervasive (
Page 115 and 116:
BETH ISRAEL MEDICAL CENTER FIRST AV
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