The development of the Compassion Focused Therapy Therapist Rating Scale (CFT-TRS)

The literature review aimed to systematically review whether higher ratings of therapist competence predicted better treatment outcomes in cognitive behavioural therapy (CBT). A systematic search was completed of four electronic databases. A total of 16 relevant articles met inclusion criteria. Findings provided variable support for therapist competence predicting better treatment outcomes in CBT. However, the findings indicated a stronger link between competency and outcome in anxiety treatments. There was evidence that therapeutic alliance and therapist adherence may have influenced the link between therapist competence and outcome, and competencies such as 'structuring' and 'homework setting' were shown to be strongly related to outcome. Limitations of the included papers included small sample sizes, biases in the sampling of therapists and insufficient ratings of tapes to establish a reliable measure of therapist competence. Further research and ongoing review is needed that uses more robust methodologies. The aims of the research were to develop a useful measure of therapist competence in compassion focused-therapy (CFT) that could be used to assess therapist competence in research trials, clinical practice and training. Eleven experts were involved in the development of the CFT therapist competence scale (CFT-TRS). The Delphi method was used to develop and operationalise the competencies over five rounds. The CFT-TRS included 23 competencies and these were separated into fourteen CFT unique therapist competencies and nine microskills. There was high agreement about the included unique and generic competencies, however there were differences in opinion between experts about the content of items and item overlap. The scale can be used as a learning guide for delivering CFT, to assess therapist competence for CFT training courses or clinical practice, and to assess fidelity in research trials. Future research is required to understand and evaluate the psychometric properties of this scale.