Therapist treatment fidelity in prescriptive vs. exploratory psychotherapy

Therapist fidelity to the manuals for prescriptive and exploratory psychotherapies was assessed via the Sheffield Psychotherapy Rating Scale. Ratings on 220 sessions drawn from the Second Sheffield Psychotherapy Project showed adequate inter-rater reliabilities within and between treatments. Discriminant analysis showed that the treatments could be differentiated almost perfectly even though the same five therapists delivered both of them. Relationship enhancing skills, measured by a facilitative conditions scale, were held constant across treatments and contributed nothing to the discriminant function. There was no evidence that adherence varied with the severity of the clients' symptoms and only very limited evidence that it varied with the duration of treatment, despite there being adequate statistical power to detect small effects. Small variations in adherence with the stage of treatment were found but only for sessions of prescriptive therapy.