The Question: Cognitive processing therapy has been shown to be effective in the treatment of posttraumatic stress disorder. It is one of only a few techniques that has been adapted for use in adolescent populations, where it shows similar effectiveness. However, it is unclear whether the treatment itself is what is contributing to success, or one or more therapist or client factors. This study sought to test the contribution of integrity of treatment, defined as a combination of therapist adherence and competence with cognitive processing therapy, in comparison to the treatment alliance in bringing about positive outcomes when developmentally adapted CPT is applied to adolescents with PTSD.
The Method: Regina Steil and her colleagues recruited 88 adolescents with a primary diagnosis of PTSD following childhood physical and/or sexual abuse. 44 of these young adults were placed in a wait list/treatment as usual group, whereas 38 received active treatment with CPT. The 14 therapists in the study all had their master’s degree in psychology and at least two years of clinical training. All therapists received a workshop on CPT and treated a pilot case before starting the trial. Video recordings of sessions were rated for treatment adherence and competence by two experienced psychologists. A measure of therapeutic alliance was also completed after each session. Treatment improvement was measured using the clinician administered PTSD scale for children, along with self-reported symptoms.
Key Results: Adherence to the principles of CPT was not a significant predictor of outcomes, nor was therapist competence in using this method. The only significant finding was an interaction between time in therapy and treatment alliance, with high alliance therapist/client dyads showing improvement over the course of therapy.
Why Does This Matter? The results suggest that when the effects of Cognitive Processing Therapy are looked at more closely, treatment alliance proves to be more important to outcomes than the integrity of the treatment itself. This adds further evidence to the claim that clinicians need to pay at least as much attention to common factors in therapy such as the alliance as they do to mastering the technical aspects of the treatment itself.
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