Therapist predictors of treatment delivery fidelity in a community-based trial of 12-step facilitation

Barbara K. Campbell, Allison Buti, Holly E. Fussell, Priya Srikanth, Dennis Mccarty, Joseph R. Guydish

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Background and aims: Therapist characteristics may be associated with variation in consistency, quality and effectiveness of treatment delivery. We examined associations between treatment fidelity and therapist education, experience, treatment orientation and perceived skills in a randomized, multi-site trial of Twelve Step Facilitation (TSF). Methods: Raters scored audio-recorded, TSF sessions (n = 966; 97% of TSF sessions) from 32 community-based, trained therapists for adherence, competence, empathy and global session performance. Results: Therapists with graduate degrees had significantly higher adherence and global performance fidelity ratings. Therapists reporting more positive attitudes toward 12-Step groups had lower adherence ratings. Being in recovery was associated with lower fidelity in univariate tests, but higher adherence in multivariate analysis. Fidelity was higher for therapists reporting self-efficacy in basic counseling skills and lower for self-efficacy in addiction-specific counseling skills. Fidelity was also superior in group relative to individual TSF sessions. Conclusions: Results have implications for therapist selection, training and supervision in community-based, effectiveness trials and community implementation of evidence-based treatments. To obtain high fidelity and improve outcomes, it may be preferable to choose masters level therapists who are open to learning new treatments and have good, general counseling skills.

Original languageEnglish (US)
Pages (from-to)304-311
Number of pages8
JournalAmerican Journal of Drug and Alcohol Abuse
Issue number5
StatePublished - Sep 2013


  • Therapist characteristics
  • Treatment fidelity
  • Twelve-step facilitation

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Clinical Psychology
  • Psychiatry and Mental health


Dive into the research topics of 'Therapist predictors of treatment delivery fidelity in a community-based trial of 12-step facilitation'. Together they form a unique fingerprint.

Cite this