C.A. Webb, R.J. DeRubeis, & J.P. Barber. (2010). Therapist adherence-competence and treatment outcome: A meta-analytic review.  Journal of Consulting & Clinical Psychology  78: 200-211.

Any type of psychotherapy, psychoanalysis included, consists of a number of interventions that clinicians expect will help patients improve. Greater use of these techniques is considered “adherence” to a theory or manual of treatment. Selective and timely application of these techniques is considered “competence” at delivering the treatment. It is reasonable to assume that when clinicians are more adherent to the techniques put forth in a treatment and are more competent at delivering the techniques, patients should improve more than when these conditions are not met. This principle strongly guides psychoanalytic education, which emphasizes adherence to core techniques of psychoanalysis in order to provide maximum clinical benefit and to demarcate psychoanalysis from related treatment modalities. However, a recent study of adherence-competence measures and their relation to psychotherapy outcome performed by suggests that this assumption may not be correct.

Webb and colleagues reviewed electronic databases and reference sections of papers dealing with adherence-competence to find empirical investigations (published and unpublished) of individual psychotherapy that included at least five clinical patients and used an observer-rated measure of adherence-competence. Of the 5,868 articles returned by this search, 36 met all the criteria. For each of these studies, the investigators extracted