Therapist competence in case conceptualization and outcome in CBT for depression.

OBJECTIVE: This study aimed to investigate the relationship between therapist competence in case conceptualization and outcome in psychotherapy.

METHOD: Twenty-eight adults received Cognitive Behavioral Therapy (CBT) for depression. The Conceptualization Rating Scale (CRS) was used to systematically evaluate therapist competence in case conceptualization using ratings from 225 DVD recordings of live therapy in real time across the first ten sessions of treatment.

RESULTS: Multilevel modelling (MLM) analysis revealed that after controlling for time and other pertinent therapy influencing variables, therapist competence in case conceptualization explained 40% of within patient variance and 19% of between patient variance associated with significant and positive change on the BDI-II.

CONCLUSIONS: This study provided evidence that increased therapist competence in using case conceptualization in CBT is associated with greater reductions in depressive symptomology. The implications for supervision, training, and practice are discussed.