When less is enough : Streamlining assessment methods for treatment integrity in emotion-focused therapy

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Monteiro, Marina Lopes and Elliott, Robert and Nogueira, Daniela Alves and Mesquita, Edgar and Cunha, Carla Alexandra Castro (2026) When less is enough : Streamlining assessment methods for treatment integrity in emotion-focused therapy. Counselling Psychology Quarterly. pp. 1-23. ISSN 1469-3674 (https://doi.org/10.1080/09515070.2026.2627868)

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Abstract

Research in psychotherapy often highlights the value of observing and evaluating therapist performance, as differences in treatment delivery can occur, and assessing treatment integrity may provide useful insights. Practical challenges, including time constraints, high costs, and limited resources, can make such evaluation difficult. This study investigated if 10-minute segments could be generalized to whole-session ratings of treatment integrity and whether the results differed according to the observation format (video vs. audio). Twenty-two sessions (66 segments) of emotion-focused therapy (EFT) from 11 cases were coded, including 13 (59.1%) videos and 9 (40.9%) audio recordings. A mixed-design analysis of variance examined differences across three within-session segments and between observation formats (video or audio) and session timings (session 5 or session 10). Overall interrater reliability was good (ICC=.90). Mid-session and late-session segments demonstrated higher shared variance with global ratings than early-session segments. Video segments received significantly higher ratings than audio segments did. These preliminary findings suggest that one or two 10-minute segments may provide a reasonable approximation of whole-session treatment integrity ratings in EFT. Video recordings, which capture both verbal and nonverbal cues, may offer greater value than audio alone, but their use should be weighed against practical considerations.

ORCID iDs

Monteiro, Marina Lopes, Elliott, Robert ORCID logoORCID: https://orcid.org/0000-0002-3527-3397, Nogueira, Daniela Alves, Mesquita, Edgar and Cunha, Carla Alexandra Castro;
CORE (COnnecting REpositories)