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Fortschr Neurol Psychiatr 2014; 82(09): 502-510
DOI: 10.1055/s-0034-1366798
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Der Zusammenhang der Therapeutenkompetenz und Adhärenz zum Therapieerfolg in der Kognitiven Verhaltenstherapie – metaanalytische Ergebnisse

The Relationship between Therapist’s Competence and Adherence to Outcome in Cognitive-Behavioural Therapy – Results of a Metaanalysis
S. Zarafonitis-Müller
1   Klinik für Psychiatrie und Psychotherapie, Uniklinik Köln
,
K. Kuhr
2   Institut für medizinische Statistik, Informatik und Epidemiologie, Universität Köln
,
A. Bechdolf
1   Klinik für Psychiatrie und Psychotherapie, Uniklinik Köln
› Author Affiliations
Further Information

Publication History

Publication Date:
01 September 2014 (online)

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Zusammenfassung

Mittlerweile stellt die Psychotherapieforschung genügend Evidenzen zugunsten der Wirksamkeit von Psychotherapie, insbesondere der Kognitiven Verhaltenstherapie (KVT), bereit. Daher kann angenommen werden, dass Psychotherapie „hilft“. Dennoch ist die Frage nach den Ursachen ihrer Wirksamkeit noch weitgehend unbeantwortet. Diese Unklarheit gilt es in der vorliegenden Übersicht so gut wie möglich aufzulösen, indem der Fokus auf die aktiven Bestandteile der KVT gelegt wird. Im Einzelnen untersuchten wir, ob die Kompetenz des Therapeuten oder seine Adhärenz gegenüber dem kognitiv-behavioralen Manual einen entscheidenden Einfluss auf die Besserung des Patienten nach Abschluss der Therapie zeigt. Mithilfe einer breit angelegten Literaturrecherche konnten insgesamt n = 13 Primärstudien identifiziert werden. Darunter bezogen sich n = 7 auf den Beitrag der Therapeutenkompetenz und n = 7 auf den Beitrag der Adhärenz zum Therapieergebnis, wobei sich eine auf beides bezog. Unsere metaanalytischen Berechnungen ergaben schließlich einen signifikanten kleinen Gesamteffekt (r = 0,24) für den Einfluss der Kompetenz auf die Besserung der Patienten mit variablen Störungsbildern. Beim Betrachten der Patienten mit Depressiven Störungen konnte sogar ein moderater Gesamteffekt (r = 0,38) identifiziert werden. Zur Rolle der Adhärenz beim Therapieerfolg konnten hingegen keine signifikanten Gesamteffekte ermittelt werden. Vor diesem Hintergrund scheint die kompetente Durchführung von kognitiv-behavioralen Techniken durchaus einen Beitrag zur Symptomreduktion der Patienten nach Abschluss der Psychotherapie zu leisten. Hingegen scheint eine allein manualkonforme Durchführung der KVT auf die Besserung des Patienten keinen signifikanten Einfluss zu haben. Dennoch zeigen die Ergebnisse auch, dass es sich um einen komplexen Prozess bei der therapeutischen Veränderung handelt, den es in der zukünftigen Prozess-Ergebnis-Forschung besser zu verstehen gilt. Implikationen der genannten Ergebnisse sowie Möglichkeiten für zukünftige Forschung werden zum Abschluss diskutiert.

Abstract

By now psychotherapy research has provided sufficient evidence in favour of the efficacy of psychotherapy, especially of the cognitive behaviour therapy (CBT). Hence one can argue that psychotherapy truly “works”. Nevertheless, the rationale for the efficacy and the underlying mechanisms have not yet been explored. Resolving this ambiguity by focusing on the active ingredients in CBT is the aim of our review. More precisely we have explored whether the therapist’s competence or his/her adherence to the CBT protocol is responsible for the therapeutic improvement that many patients sustain subsequent to psychotherapy. By means of a broad literature search we identified a total of n = 13 studies, whereby n = 7 referred to the impact of therapist’s competence and n = 7 to the impact of adherence on post-treatment outcome, respectively, and one of these studies referred to both. The meta-analytical evaluation yielded a small significant total effect (r = 0.24) for the therapist’s competence on therapeutic improvement of patients with diverse disorders and a moderate total effect (r = 0.38) regarding patients with major depression. In contrast, for the case of an influence of adherence to protocol on post-treatment outcome we did not achieve significant results. Therefore a competent performance of cognitive-behaviour techniques on the part of the therapist seems to contribute thoroughly to the therapeutic improvement subsequent to treatment. However, solely a manual-guided implementation of CBT seems not to have a significant impact on patients impromvement. Furthermore, our results indicate that the therapeutic change constitutes an extensive process that has consequently to be understood in future process-outcome research. Finally the implications of our results as well as potentials for future research are discussed.

Schlüsselwörter

Kompetenz - Adhärenz - Psychotherapie - Kognitive Verhaltenstherapie - Therapieerfolg

Key words

competence - adherence - psychotherapy - cognitive behaviour therapy - outcome
 

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