Definition, operationalization and quality assurance of psychotherapy. An investigation with the behavior...

Quality assurance is an important issue in psychotherapy research and practice, which is methodologically still in development. Apart from unstructured supervision, reliable assessment instruments are needed.

A theoretical concept is outlined that allows to define the main techniques which constitute behavior therapy. An assessment instrument is introduced, which allows to measure whether a therapist applies these standards in therapy and to evaluate their quality.

The development of the "Behavior Therapy-Competence-Checklist (BTCC)" is described. 182 tape-recorded therapy sessions of 14 behavioral therapists who were working full time in routine care were evaluated.

The most often used behavior therapy techniques were preparation of homework assignments (71.4%) and modification of cognitions (41.6%). Most rare were macro-behavioral-analysis (19.5%) and problem solving (19.5%). The mean-total score of the BTCC was 3.4 on a scale that ranges from 1 (bad) to 7 (very good). The lowest scores were found for "problem solving" (2.7). The highest scores were found for "establishment of a therapeutic relationship" (5.2).

Therapeutic competency can be operationalized and measured with the BTCC. The quality of behavior therapists under conditions of routine is moderate. They show the tendency to prefer certain therapeutic options and do not use the full spectrum of therapeutic options. Such findings point to areas in need of training.