The importance of competence-feedback for therapy outcome: a randomized controlled trial

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Psychotherapeutic competencies are considered to be an important factor for therapy success. However, empirical studies which have investigated the competence-outcome relationship were only based on correlational analyses. Therefore, these studies are inappropriate for the investigation of causal relationships. In previous studies, feedback on therapists' competencies was found to be suitable for enhancing such competencies. Therefore, in the current research project, competence-feedback should be used to enhance therapeutic competencies systematically, in order to investigate the impact of these competencies on therapy outcome. Using a randomized controlled study design, n = 58 treatments of patients with depression were to be conducted under a feedback-condition, in which the therapist would receive feedback five times within 20 treatment sessions. The competence-feedback includes detailed feedback about 14 different aspects of therapist behavior. The control group includes n = 58 further treatments within which therapists do not receive any competence-feedback (treatment as usual; TAU). We hypothesize that the feedback-group is superior to the TAU-group and that their treatments lead to significantly better therapy outcome. Moreover, we use mediator analysis to analyze whether the group-outcome relationship is mediated by therapeutic competencies or by the quality of the therapeutic alliance. By means of a naturalistic 6-month follow-up, the aim was also to investigate how the symptoms and need for treatment of a particular patient develop in terms of competence feedback and of the TAU condition. It is expected that the competence feedback condition would be significantly superior to the TAU condition, even at the point in time of a 6-month follow-up. In addition, the acceptance of the competence feedback and its benefits for the participating therapists for the participating therapists is investigated by means of both quantitative and qualitative methods. The results are highly relevant for clinical process research, psychotherapy training and for the dissemination of treatment approaches in routine care.