From Implementation to Alliance : the role of therapist adherence within Multisystemic Therapy

This dissertation studies therapist adherence (the degree to which a clinician delivers the specified components of a treatment) from different perspectives. For this purpose, the Dutch Therapist Adherence Measure Revised (TAM-R) was used, which was developed to asses therapist adherence to the treatment model of Multisystemic Therapy (MST). MST is an evidence-based family- and community-based intervention for adolescents with antisocial and/or delinquent behavioural problems aged 12 to 18 years. The TAM-R is routinely collected in clinical practice as part of the quality-assurance system of MST and is used to monitor and improve adherent delivery of MST worldwide.
The first aim of this dissertation was to evaluate what factors affect therapist adherence scores when disseminating evidence-based interventions, as it has proven challenging to implement evidence-based interventions with high levels of adherence into clinical practice. This dissertation assesses the equivalence of the Dutch TAM-R to the American original, and studies the effect of experience on adherence and treatment outcome.
The second aim was to study how adherence and the client-therapist working alliance interact and uniquely and jointly contribute to treatment outcomes. A focus on adherence presupposes that the specific techniques of the intervention are important for achieving good outcomes. Some scholars, however, have stated that common factors (factors common to all psychotherapy) play a much larger role. The second aim addresses how adherence and alliance interact and uniquely and jointly contribute to treatment outcome.