Treatment Integrity

This website is dedicated to raising awareness about treatment integrity, communicating its importance for psychotherapy research and practice, providing recommendations on implementing integrity procedures, and examining relevant issues. Treatment integrity (also known as treatment fidelity) refers to the degree to which intervention is implemented as intended. Interpretations of the obtained results require some assurance that treatment was carried our as it was designed or, in other words, that treatment was implemented with high levels of integrity. Compromised integrity has serious implications for inferences drawn about the relationship between treatment and outcome. Indeed, the obtained results are related not to the intended intervention (i.e., treatment as designed) but to the implemented intervention (i.e., treatment as delivered by treatment agents). Therapists may implement all of the procedures specified in the treatment protocol, some of them or none of them, or may supplement prescribed tasks with procedures from other interventions (i.e., not specified in a manual). The data on treatment integrity allow judgments on how closely the implemented intervention approximates the intended intervention.

 

Treatment integrity is not an esoteric subject but is fundamental to empirical testing. Lack of concern about integrity presupposes ideal delivery of interventions, a notion that belongs to science fiction rather than science.  Yet, reviews on treatment integrity suggest that psychotherapy research continues to treat integrity as if its implementation is a matter of choice. Insufficient attention to treatment integrity greatly limits our confidence in psychotherapy research because it renders questionable the validity of the inferences drawn from published studies. It appears that at this time psychosocial interventions are identified as empirically supported primarily on the basis of whether changes on the dependent measures are empirically demonstrated. Thus, the psychotherapeutic ingredients are validated without showing what those ingredients are.

 

The call for accountability in mental health care necessitates establishing scientific basis of psychological treatments. However, a threshold for clearing what is considered ‘evidence-based’ is very low. The bar has to be raised by imposing stringent criteria for empirical validation of interventions. Ethical and professional responsibilities of the psychotherapy field demand amendments to the continually demonstrated methodological neglect of independent variables in testing treatment efficacy.

 

To improve how treatment integrity is addressed, the understanding and appreciation of the issues should be increased. The purpose of this website is to introduce the readers to some of the research on treatment integrity. Issues that are examined include importance of treatment integrity to empirical testing of intervention efficacy; recommendations on treatment integrity implementation; specific strategies to increase integrity and demonstrate manipulation checks on treatment delivery; relationship between treatment integrity and treatment outcome; and barriers to implementing treatment integrity procedures. The list of topics will continue to expand as materials are added to this website.

 

 


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