Text

theses

Therapist adherence is a necessary prerequisite to delivering evidence-based treatments competently. While therapist adherence has been identified as an important construct to assess in research trials, little has been written about the methods used to train therapists to adherence or how therapists' ability to self-assess adherence compares to actual adherence to a treatment model. Within dialectical behavior therapy (DBT), therapist adherence is especially important because of the complex treatment being delivered and the high-risk population being treated. Live supervision strategies have been developed to address problems that occur with regular, between-session supervision. The implementation of "Bug-in-the-Eye" (BITE) supervision, a live supervision strategy providing visual feedback to the therapist through the use of video-conferencing technology, was utilized in a DBT training clinic to determine the effects of live supervision on student therapist adherence to DBT. In this dissertation, an in-depth examination of one therapist-patient dyad that participated in a pilot study of BITE is presented. Differences between expert adherence scores and therapist self-assessment adherence scores to both global DBT adherence and adherence to the subcategory of dialectical strategies were examined. Additionally, feasibility and acceptability of BITE supervision to the student therapist were measured. Expert coder adherence scores indicate that the student therapist began the protocol already adherent to DBT, and the therapist remained adherent throughout the trial. Self-assessed adherence scores did not significantly differ from expert-coded adherence scores. The therapist found the use of BITE supervision both acceptable and feasible within the DBT training clinic. Session transcripts and copies of BITE feedback are provided in a narrative form to provide an in-depth look at how BITE supervision was implemented. This study adds to the existing literature that finds BITE supervision feasible and acceptable to therapists. The therapist's adherence to DBT throughout this study suggests that BITE supervision might have a greater effect on therapist adherence among more novice therapists. Future research should focus on implementing BITE supervision in DBT training clinics with a larger and more diverse therapist sample.

ETD_7497

Psy.D.

Includes bibliographical references

by Sara Geisser

doi:10.7282/T39W0HSC

ETD doctoral

The author owns the copyright to this work.