title: The effects of treatment adherence and treatment-specific therapeutic competencies on outcome and goal attainment in telephone-based therapy with caregivers of people with dementia.
abstract: OBJECTIVE
  Contradictory results have been found for the impact of therapist's adherence and competence on intervention outcomes. Most studies focus on generic aspects of competence and adherence, rather than taking into account treatment-specific aspects or specific challenges of the clientele. Appropriate analyses are lacking for cognitive behavioral therapy (CBT) with caregivers of people with dementia.
  
  
  METHODS
  In a sample of 43 caregivers, we examined adherence and different competence ratings of 80 complete sessions, as predictors of symptom change and goal attainment. Therapist's competence was evaluated by four raters, using an adapted version of the cognitive therapy scale (CTS) on three subscales of competence: General therapeutic (GT), session-structuring (SS), and treatment-specific CBT technique (CT). Therapist's adherence to the manual was also assessed.
  
  
  RESULTS
  The results show that GT competencies were associated with lower post-test depression scores and that CT competencies predicted a decrease in caregiver burden and higher goal attainment, while SS competencies predicted higher post-test burden. Therapist's adherence had no relationship to outcome, but the higher application of modifying dysfunctional thoughts was associated with higher goal attainment.
  
  
  CONCLUSIONS
  The results suggest the importance of treatment-specific competencies for outcome. Future research should identify empirically what kind of therapeutic behavior is appropriate to the challenges of a specific clientele such as caregivers of people with dementia.
authors.affiliation: a Department of Clinical Intervention, Institute of Psychology , University of Jena , Jena , Germany.
authors.forename: Denise
authors.initials: D
authors.lastname: Schinköthe
authors.forename: Uwe
authors.initials: U
authors.lastname: Altmann
authors.forename: Gabriele
authors.initials: G
authors.lastname: Wilz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D002983:Clinical Competence; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003704:Dementia / Q000451:nursing*; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D013689:Telephone; D016896:Treatment Outcome
keywords: CBT; adherence; competence; dementia caregivers; treatment integrity