Fonagy, P;
Luyten, P;
(2019)
Fidelity versus flexibility in the implementation of psychotherapies: Time to move on.
World Psychiatry : official journal of the World Psychiatric Association (WPA)
, 18
(3)
pp. 270-271.
10.1002/wps.20657.
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Abstract
In psychotherapy, treatment fidelity refers to the extent to which treatments are delivered as intended, and is considered to encompass adherence (the extent to which pre-specified interventions are used) and competence (the skill with which they are implemented). Treatment fidelity is typically assumed to be positively related to outcome. This assumption rests on the drug metaphor – that there is a positive relationship between the “dose” of the “active ingredients” in any given treatment and the outcome. For instance, the extent to which therapists use specific theory-derived techniques and interventions, such as challenging automatic thoughts in cognitive-behavioural therapy or working with the transference in psychodynamic psychotherapy, should be directly related to better outcomes.
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