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

心理治疗能力被认为是治疗成功的重要因素。然而，实证研究已经调查的能力和结果的关系只基于相关分析。因此，这些研究不适合调查因果关系。在以往的研究中，治疗师的能力反馈被认为是适合提高这种能力。因此，在本研究项目中，应使用能力反馈系统地提高治疗能力，以探讨这些能力对治疗结果的影响。采用随机对照研究设计，在反馈条件下对抑郁症患者进行n = 58次治疗，治疗师在20次治疗中接受5次反馈。能力反馈包括关于治疗师行为的14个不同方面的详细反馈。对照组包括n = 58个进一步治疗，其中治疗师不接受任何能力反馈（照常治疗; TAU）。我们假设反馈组比TAU组有上级优势，并且他们的治疗导致显著更好的治疗结果。此外，我们使用中介分析，以分析是否组的结果关系是由治疗能力或治疗联盟的质量介导。通过自然的6个月随访，目的还在于调查特定患者的症状和治疗需求如何在能力反馈和TAU条件方面发展。预计能力反馈条件将显著上级TAU条件，即使在6个月随访时也是如此。此外，通过定量和定性的方法，调查了参与治疗师对能力反馈的接受程度及其对参与治疗师的益处。结果是高度相关的临床过程研究，心理治疗培训和传播的治疗方法在常规护理。

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.