a Viersprong Institute for Studies on Personality Disorders.
b Department of Psychiatry, Section of Medical Psychology & Psychotherapy , Erasmus Medical Center.
J Clin Child Adolesc Psychol. 2019;48(sup1):S337-S346. doi: 10.1080/15374416.2018.1477049. Epub 2018 Jun 18.
Therapist adherence to the treatment manual is assumed to be crucial for adequate implementation and subsequent achievement of the intended, positive treatment outcomes. Although adherence has been mostly studied as a static factor, recent studies suggest that adherence might be dynamic and changes over time. We investigated how parent-perceived adherence to the multisystemic therapy (MST) model develops during treatment and how this development is related to treatment outcomes up to 18 months posttreatment, controlling for the effect of alliance. We used routinely collected data from 848 adolescents (66% male and 76% Western, M age = 15.25 years) and their caregivers participating in MST, a family- and community-based intervention for antisocial adolescents. Adherence and alliance were measured monthly through phone interviews with the caregivers using the Therapist Adherence Measure-Revised. Outcomes were assessed at the end of the treatment and at 18 months posttreatment using the scale Rule-Breaking Behavior of the Child Behavior Checklist and two MST Ultimate Outcomes (i.e., police contact and out-of-home placement). On average, adherence showed an increasing and then flattening slope. The initial level of adherence predicted treatment outcomes at the end of treatment but not at 18 months posttreatment. Change in adherence did not predict treatment outcomes after controlling for alliance. We advocate the need to consider the dynamic nature of adherence in research as well as clinical practice. Change in adherence during treatment, as well as its association with outcome, is likely to be dependent on the adherence measure being used.
治疗师对治疗手册的遵循被认为是充分实施治疗以及随后达到预期积极治疗结果的关键。尽管依从性大多被研究为一个静态因素，但最近的研究表明，依从性可能是动态的，并随时间而变化。我们调查了家长感知到的多系统治疗（MST）模型的依从性在治疗期间是如何发展的，以及这种发展与治疗结果的关系，直到治疗后 18 个月，同时控制了联盟的影响。我们使用了来自 848 名青少年（66%为男性，76%为西方，平均年龄为 15.25 岁）及其看护者的常规收集数据，他们参与了 MST，这是一种针对反社会青少年的家庭和社区干预。通过每月与看护者进行电话访谈，使用治疗师依从性量表修订版来测量依从性和联盟。使用儿童行为检查表的违规行为量表和 MST 最终结果（即警察联系和离家安置）在治疗结束时和治疗后 18 个月进行评估。平均而言，依从性呈上升然后趋于平稳的斜率。依从性的初始水平预测了治疗结束时的治疗结果，但不能预测治疗后 18 个月的结果。在控制了联盟之后，依从性的变化并不能预测治疗结果。我们主张需要在研究和临床实践中考虑依从性的动态性质。治疗期间依从性的变化及其与结果的关系可能取决于所使用的依从性测量。
