D.Litt. et Phil. / The aim of this study was to evaluate a feasible rating scale to measure the adherence of therapists carrying out Dialectical Behavior Therapy (DBT) with Borderline Personality Disorder (BPD) clients. Adherence referred to therapists carrying out DBT and how frequently and thoroughly they executed the specific targets and strategies of the therapy, which included taking the context into account. DBT is very specific in its treatment targets and in their hierarchical order of importance. The 97 item adherence scale was rated on a 7 point (0-6) scale. Some 86 items, that corresponded with the therapist ethological scale, were selected and then compared to the therapist and client ethological scales from an earlier study. These ethogram scales were process coding instruments which rated minute-by-minute, the frequency of specific categories of client and therapist verbal behaviors. The adherence scale was further compared to client self-report diary card measures. The diary card measures were also compared to the therapist and client ethological scales. Randomly selected client-therapist dyads (N = 10) were used, meeting criteria for BPD. All clients were women and between the ages of 18-45. The clients were seen by a total of 7 DBT trained therapists. Random sessions (N = 6) were selected from the first 16 sessions for each clienttherapist dyad. Some 60 sessions were chosen. 57 tapes were coded as 3 were too inaudible to code. Results indicated that the adherence rating of the respective therapist increased as the negative behaviors of the client increased (p < 0.05). Conversely, the greater the client's positive behavior on the ethological scale, the lower the DBT adherence rating of the therapist (p < 0.05). The problem solving category on both the adherence and therapist ethological scale covaried significantly (p < 0.02). Other therapist strategies (i.e., reciprocal, irreverence, primary targets 1-4, contingencies and validation) between the two scales were not significantly correlated. A test of the validity of the adherence scale to measure DBT fidelity draws its strongest support from two findings: 1) that when a client portrayed positive behaviors the therapist needed not to follow the primary targets so closely, resulting in a decrease in the adherence rating; and 2) the greater the negative behaviors of the client, the more stringently the therapist focused upon the primary targets and a wider array of strategies, which led to an overall increase in the adherence rating. The results of this study confirmed that a rating scale of therapist adherence is possible even with a flexible therapy such as DBT. Further, that minute-by-minute ethological ratings may serve to validate a more holistic adherence scale as tested here. Finally, recommendations are discussed for the further improvement and enhancement of the DBT adherence scale when used as a tool for rating DBT's treatment fidelity.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uj/uj:8944 |
| Date | 08 August 2012 |
| Creators | Prisman, Desiree |
| Source Sets | South African National ETD Portal |
| Detected Language | English |
| Type | Thesis |
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