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J Consult Clin Psychol. 1993 Aug;61(4):620-30.

Testing the integrity of a psychotherapy protocol: assessment of adherence and competence.

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  • 1Department of Psychology, University of Washington, Seattle 98195.


Manipulation checks should be used in psychotherapy trials to confirm that therapists followed the treatment manuals and performed the therapy competently. This article is a review of some strategies that have been used to document treatment integrity; also, their limitations are discussed here. Recommendations for improving these checks are presented. Specific guidelines are offered regarding when and how to assess both therapist adherence to treatment protocols and competence.

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