Fidelity measurement in psychotherapy: Current status and improvements

doi:10.3724/SP.J.1042.2026.1843

Abstract

Abstract:

Fidelity in psychotherapy refers to the extent to which treatment is delivered as intended, serving as a key indicator of clinical quality and the reliability of therapeutic outcomes. Given the limited domestic research on fidelity in the evaluation of psychotherapy processes, this article reviews its conceptual structure and the rationale for its assessment, compares common assessment methods, and discusses current strategies for improvement. Existing studies indicate that observational coding, written surveys, and behavioral rehearsals each have distinct features and limitations. Across current approaches, major challenges include substantial demands on time and labor, limited applicability, and low scoring consistency. Recent efforts to develop assessment frameworks, specify intervention procedures, and introduce computer-assisted assessment have improved standardization and efficiency to some extent. However, the persistent issues of high costs and inconsistent assessment remain unresolved. Future research may further refine the assessment framework, establish a more systematic knowledge base, and continue exploring and validating automated tools such as large language models in psychotherapy settings, thereby advancing the quality assessment of psychotherapy processes from theoretical advocacy to standardized practice.

Key words: fidelity, psychotherapy, psychological counseling, measurement methods, evaluation framework

CLC Number:

R395

YANG Haoran, SUN Huanxiang, LIU Xiaoming. Fidelity measurement in psychotherapy: Current status and improvements[J]. Advances in Psychological Science, 2026, 34(10): 1843-1861.

Figures/Tables 3

References 124

[1]	艾小青, 曹玉萍, 张亚林. (2012). 内容分析方法在心理治疗研究中的应用. 中国心理卫生杂志, 26(5), 373-376.
[2]	陈祉妍, 刘正奎, 祝卓宏, 史占彪. (2016). 我国心理咨询与心理治疗发展现状、问题与对策. 中国科学院院刊, 31(11), 1198-1207.
[3]	程万军, 贾晓明, 钱铭怡, 江光荣, 王建平, 肖旭, ... 林秀彬. (2024). 心理咨询行业管理办法. 中国临床心理学杂志, 32(5), 1191-1194.
[4]	国家市场监督管理总局, 中国国家标准化管理委员会. (2018). 心理咨询服务第1部分: 基本术语 (GB/T 30446.1-2018) [国家标准]. 全国标准信息公共服务平台.
[5]	黄峰, 丁慧敏, 李思嘉, 韩诺, 狄雅政, 刘晓倩, … 朱廷劭. (2025). 基于大语言模型的自助式AI心理咨询系统构建及其效果评估. 心理学报, 57(11), 2022-2042.
[6]	李孛, 万巧琴, 于放. (2019). 干预性研究中干预忠实度的提出与发展. 中华护理教育, 16(12), 945-949.
[7]	李牧阳, 雷霆, 谢燮, 国泽宇, 刘可欣, 陈雯青, … 臧寅垠. (2025). 心理咨询中来访者负面体验的质性探索. 心理学报, 57(7), 1216-1230.
[8]	李晓苗, 李占江. (2014). 心理治疗疗效研究的方法学述评. 中国心理卫生杂志, 28(3), 163-167.
[9]	上海市市场监督管理局. (2024). 心理咨询机构服务规范 (DB31/T 1530-2024) [地方标准]. 地方标准信息服务平台.
[10]	杨文登. (2012). 循证心理治疗. 北京: 商务印书馆.
[11]	杨文登, 李晓苗, 张小远. (2017). 心理治疗循证实践中“证据”的四个基本问题. 心理学报, 49(6), 841-852.
[12]	张静, 陶红霞, 阮海慧, 牛晓丹, 迟俊婷, 王艳红. (2020). 动机式访谈法培训师的培养和实施保真度评估现状. 中华护理教育, 17(12), 1134-1137.
[13]	中国心理学会. (2018). 中国心理学会临床与咨询心理学工作伦理守则(第二版). 心理学报, 50(11), 1314-1322.
[14]	中国心理学会学校心理专业委员会. (2026). 中国心理学会学校心理工作伦理守则. 心理学报, 58(1), 180-184.
[15]	朱廷劭. (2023). 试析通用人工智能在心理学领域的应用. 人民论坛·学术前沿, (14), 86-91.
[16]	Abdou, M., Sahi, R. S., Hull, T. D., Nook, E. C., & Daw, N. D. (2025). Leveraging large language models to estimate clinically relevant psychological constructs in psychotherapy transcripts. Computational Psychiatry, 9(1), 187-209.
[17]	Ahmadi, A., Noetel, M., Schellekens, M., Parker, P., Antczak, D., Beauchamp, M., ... Lonsdale, C. (2021). A systematic review of machine learning for assessment and feedback of treatment fidelity. Psychosocial Intervention, 30(3), 139-153.
[18]	Alonso-Coello, P., Schünemann, H. J., Moberg, J., Brignardello- Petersen, R., Akl, E. A., Davoli, M., ... GRADE Working, Group. (2016). GRADE evidence to decision (EtD) frameworks: A systematic and transparent approach to making well informed healthcare choices. 1: Introduction. BMJ, 353, i2016.
[19]	American Psychological Association. (2021). Professional practice guidelines for evidence-based psychological practice in health care. https://www.apa.org/about/policy/psychological-practice-health-care.pdf
[20]	American Psychological Association, Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271-285.
[21]	Anis, L., Benzies, K. M., Ewashen, C., Hart, M. J., & Letourneau, N. (2021). Fidelity assessment checklist development for community nursing research in early childhood. Frontiers in Public Health, 9, 582950.
[22]	Atil, B., Aykent, S., Chittams, A., Fu, L., Passonneau, R. J., Radcliffe, E., ... Baldwin, B. (2024). Non-determinism of "deterministic" LLM settings. arXiv. https://doi.org/10.48550/arXiv.2408.04667
[23]	Beck, A. K., Baker, A. L., Britton, B., Lum, A., Pohlman, S., Forbes, E., ... Carter, G. (2023). Adapted motivational interviewing for brief healthcare consultations: A systematic review and meta-analysis of treatment fidelity in real- world evaluations of behaviour change counselling. British Journal of Health Psychology, 28(4), 972-999.
[24]	Becker-Haimes, E. M., Marcus, S. C., Klein, M. R., Schoenwald, S. K., Fugo, P. B., McLeod, B. D., ... Beidas, R. S. (2022). A randomized trial to identify accurate measurement methods for adherence to cognitive- behavioral therapy. Behavior Therapy, 53(6), 1191-1204.
[25]	Begg, C. (1996). Improving the quality of reporting of randomized controlled trials: The CONSORT statement. Journal of the American Medical Association, 276(8), 637-639.
[26]	Behn, N., Harrison, M., Brady, M. C., Breitenstein, C., Carragher, M., Fridriksson, J., ... Hilari, K. (2023). Developing, monitoring, and reporting of fidelity in aphasia trials: Core recommendations from the collaboration of aphasia trialists (CATs) trials for aphasia panel. Aphasiology, 37(11), 1733-1755.
[27]	Beidas, R. S., Maclean, J. C., Fishman, J., Dorsey, S., Schoenwald, S. K., Mandell, D. S., ... Marcus, S. C. (2016). A randomized trial to identify accurate and cost- effective fidelity measurement methods for cognitive- behavioral therapy: Project FACTS study protocol. BMC Psychiatry, 16(1), 323.
[28]	Bellg, A. J., Borrelli, B., Resnick, B., Hecht, J., Minicucci, D. S., Ory, M., ... Treatment Fidelity Workgroup of the NIH Behavior Change Consortium. (2004). Enhancing treatment fidelity in health behavior change studies: Best practices and recommendations from the NIH Behavior Change Consortium. Health Psychology, 23(5), 443-451.
[29]	Blackburn, I. M., James, I. A., Milne, D. L., Baker, C., Standart, S., Garland, A., & Reichelt, F. K. (2001). The revised cognitive therapy scale-revised (CTS-R). Behavioural and Cognitive Psychotherapy, 29(4), 431-446.
[30]	Blanck, P., Perleth, S., Heidenreich, T., Kröger, P., Ditzen, B., Bents, H., & Mander, J. (2018). Effects of mindfulness exercises as stand-alone intervention on symptoms of anxiety and depression: Systematic review and meta- analysis. Behaviour Research and Therapy, 102, 25-35.
[31]	Bond, G. R., & Drake, R. E. (2020). Assessing the fidelity of evidence-based practices: History and current status of a standardized measurement methodology. Administration and Policy in Mental Health and Mental Health Services Research, 47(6), 874-884.
[32]	Borrelli, B. (2011). The assessment, monitoring, and enhancement of treatment fidelity in public health clinical trials. Journal of Public Health Dentistry, 71(s1), S52- S63.
[33]	Borrelli, B., Sepinwall, D., Ernst, D., Bellg, A. J., Czajkowski, S., Breger, R., ... Orwig, D. (2005). A new tool to assess treatment fidelity and evaluation of treatment fidelity across 10 years of health behavior research. Journal of Consulting and Clinical Psychology, 73(5), 852-860.
[34]	Brickman, J., Gupta, M., & Oltmanns, J. R. (2025). Large language models for psychological assessment: A comprehensive overview. Advances in Methods and Practices in Psychological Science, 8(3), 1-26.
[35]	Brown, R., Iqbal, Z., Reynolds, L., Press, D. A., Shaker-Naeeni, H., Scrivener, L., ... Murphy, S. (2015). Inter-rater reliability of treatment fidelity and therapeutic alliance measures for psychological therapies for anxiety in young people with autism spectrum disorders. International Journal of Developmental Disabilities, 61(4), 190-199.
[36]	Brown, R. C., Southam-Gerow, M. A., McLeod, B. D., Wheat, E. B., Tully, C. B., Reise, S. P., ... Weisz, J. R. (2018). The global therapist competence scale for youth psychosocial treatment: Development and initial validation. Journal of Clinical Psychology, 74(4), 649-664.
[37]	Brown, T. B., Mann, B., Ryder, N., Subbiah, M., Kaplan, J., Dhariwal, ... Amodei, D. (2020). Language models are few-shot learners. Advances in Neural Information Processing Systems, 33, 1877-1901.
[38]	Brueck, R. K., Frick, K., Loessl, B., Kriston, L., Schondelmaier, S., Go, C., ... Berner, M. (2009). Psychometric properties of the German version of the Motivational Interviewing Treatment Integrity Code. Journal of Substance Abuse Treatment, 36(1), 44-48.
[39]	Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007). A conceptual framework for implementation fidelity. Implementation Science, 2(1), 40.
[40]	Cecilione, J. L., McLeod, B. D., Southam-Gerow, M. A., Weisz, J. R., & Chorpita, B. F. (2021). Examining the relation between technical and global competence in two treatments for youth anxiety. Behavior Therapy, 52(6), 1395-1407.
[41]	Chen, Z., Flemotomos, N., Singla, K., Creed, T. A., Atkins, D. C., & Narayanan, S. (2022). An automated quality evaluation framework of psychotherapy conversations with local quality estimates. Computer Speech & Language, 75, 101380.
[42]	Cook, S. C., Schwartz, A. C., & Kaslow, N. J. (2017). Evidence-based psychotherapy: Advantages and challenges. Neurotherapeutics, 14(3), 537-545.
[43]	Crane, R. S., & Kuyken, W. (2019). The mindfulness-based interventions: Teaching assessment criteria (MBI: TAC): reflections on implementation and development. Current Opinion in Psychology, 28, 6-10.
[44]	Demszky, D., Yang, D., Yeager, D. S., Bryan, C. J., Clapper, M., Chandhok, S., ... Pennebaker, J. W. (2023). Using large language models in psychology. Nature Reviews Psychology, 2(11), 688-701.
[45]	Des Jarlais, D. C., Lyles, C., Crepaz, N., & TREND, Group. (2004). Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: The TREND statement. American Journal of Public Health, 94(3), 361-366.
[46]	Devane, N., Mazzoleni, S., Behn, N., Marshall, J., Wilson, S., & Hilari, K. (2025). Treatment fidelity in a feasibility trial of the aphasia intervention, virtual elaborated semantic feature analysis. International Journal of Language & Communication Disorders, 60(3), e70054.
[47]	Dimitropoulos, G., Lock, J. D., Agras, W. S., Brandt, H., Halmi, K. A., Jo, B., ... Woodside, D. B. (2020). Therapist adherence to family based treatment for adolescents with anorexia nervosa: A multi-site exploratory study. European Eating Disorders Review, 28(1), 55-65.
[48]	Dobson, K. S., & Singer, A. R. (2005). Definitional and practical issues in the assessment of treatment integrity. Clinical Psychology: Science and Practice, 12(4), 384-387.
[49]	Dreyfus, S. E., & Dreyfus, H. L. (1980). A five-stage model of the mental activities involved in directed skill acquisition (Report No. ORC-80-2). University of California, Berkeley, Operations Research Center.
[50]	Esposito, G., Di Maro, A., & Passeggia, R. (2024). The relationship between treatment integrity and outcome in group psychotherapy: A systematic review. Clinical Psychology & Psychotherapy, 31(1), e2952.
[51]	Freire, E., Elliott, R., & Westwell, G. (2014). Person-centred and experiential psychotherapy scale: Development and reliability of an adherence/competence measure for person-centred and experiential psychotherapies. Counselling and Psychotherapy Research: Linking Research with Practice, 14(3), 220-226.
[52]	Gearing, R. E., El-Bassel, N., Ghesquiere, A., Baldwin, S., Gillies, J., & Ngeow, E. (2011). Major ingredients of fidelity: A review and scientific guide to improving quality of intervention research implementation. Clinical Psychology Review, 31(1), 79-88.
[53]	Goldberg, S. B., Baldwin, S. A., Merced, K., Caperton, D. D., Imel, Z. E., Atkins, D. C., & Creed, T. (2020). The structure of competence: Evaluating the factor structure of the Cognitive Therapy Rating Scale. Behavior Therapy, 51(1), 113-122.
[54]	Goldman, H. H., Ganju, V., Drake, R. E., Gorman, P., Hogan, M., Hyde, P. S., & Morgan, O. (2001). Policy implications for implementing evidence-based practices. Psychiatric Services, 52(12), 1591-1597.
[55]	Greenhalgh, T., & Papoutsi, C. (2018). Studying complexity in health services research: Desperately seeking an overdue paradigm shift. BMC Medicine, 16(1), 95.
[56]	Griffith, G. M., Crane, R. S., Baer, R., Fernandez, E., Giommi, F., Herbette, G., & Koerbel, L. (2021). Implementing the mindfulness-based interventions; teaching assessment criteria (MBI: TAC) in mindfulness- based teacher training. Global Advances in Health and Medicine, 10, 1-6.
[57]	Gu, J., Jiang, X., Shi, Z., Tan, H., Zhai, X., Xu, C., … Guo, J. (2026). A survey on LLM-as-a-Judge. The Innovation, 7, 101253.
[58]	Gumz, A., Treese, B., Marx, C., Strauss, B., & Wendt, H. (2015). Measuring verbal psychotherapeutic techniques: A systematic review of intervention characteristics and measures. Frontiers in Psychology, 6, 1705.
[59]	Harned, M. S., Korslund, K. E., Schmidt, S. C., & Gallop, R. J. (2021). The dialectical behavior therapy adherence coding scale (DBT ACS): Psychometric properties. Psychological Assessment, 33(6), 552-561.
[60]	Harned, M. S., Schmidt, S. C., Korslund, K. E., & Gallop, R. J. (2023). Development and evaluation of a pragmatic measure of adherence to dialectical behavior therapy: The DBT adherence checklist for individual therapy. Administration and Policy in Mental Health and Mental Health Services Research, 50(5), 734-749.
[61]	Harstad, S., Bjaastad, J. F., Hjemdal, O., Compton, S., Waaktaar, T., & Aalberg, M. (2021). Competence and Adherence Scale for Cognitive Behavioural Therapy (CAS-CBT) for anxiety disorders in youth: Reliability and factor structure. Behavioural and Cognitive Psychotherapy, 49(6), 745-757.
[62]	Heilemann, C., Best, W., Johnson, F., Beckley, F., Edwards, S., Maxim, J., & Beeke, S. (2014). Investigating treatment fidelity in a conversation-based aphasia therapy. Aphasie und verwandte Gebiete/Aphasie et domaines associés, 37(2). 14-26.
[63]	Hill, C. E., O'Grady, K. E., & Elkin, I. (1992). Applying the Collaborative Study Psychotherapy Rating Scale to rate therapist adherence in cognitive-behavior therapy, interpersonal therapy, and clinical management. Journal of Consulting and Clinical Psychology, 60(1), 73-79.
[64]	Hoffmann, T. C., Glasziou, P. P., Boutron, I., Milne, R., Perera, R., Moher, D., ... Michie, S. (2014). Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide. BMJ, 348, g1687.
[65]	Hogue, A. (2022). Behavioral intervention fidelity in routine practice: Pragmatism moves to head of the class. School Mental Health, 14(1), 103-109.
[66]	Hopewell, S., Chan, A. -W., Collins, G. S., Hróbjartsson, A., Moher, D., Schulz, K. F., … Boutron, I. (2025). CONSORT 2025 statement: Updated guideline for reporting randomised trials. BMJ, 389, e081123.
[67]	Husabo, E., Haugland, B. S. M., McLeod, B. D., Baste, V., Haaland, A. T., Bjaastad, J. F., ... Wergeland, G. J. (2022). Treatment fidelity in brief versus standard-length school- based interventions for youth with anxiety. School Mental Health, 14(1), 49-62.
[68]	Imel, Z. E., Pace, B. T., Soma, C. S., Tanana, M., Hirsch, T., Gibson, J., ... Atkins, D. C. (2019). Design feasibility of an automated, machine-learning based feedback system for motivational interviewing. Psychotherapy, 56(2), 318-328.
[69]	Jelsma, J. G. M., Mertens, V. -C., Forsberg, L., & Forsberg, L. (2015). How to measure motivational interviewing fidelity in randomized controlled trials: Practical recommendations. Contemporary Clinical Trials, 43, 93-99.
[70]	Kaplan, J., McCandlish, S., Henighan, T., Brown, T. B., Chess, B., Child, R., ... Amodei, D. (2020). Scaling laws for neural language models. arXiv.
[71]	Kalyan, K. S. (2024). A survey of GPT-3 family large language models including ChatGPT and GPT-4. Natural Language Processing Journal, 6, 100048.
[72]	Karterud, S., Pedersen, G., Engen, M., Johansen, M. S., Johansson, P. N., Schlüter, C., ... Bateman, A. W. (2013). The MBT adherence and competence scale (MBT-ACS): Development, structure and reliability. Psychotherapy Research, 23(6), 705-717.
[73]	Kazdin, A. E. (2017). Addressing the treatment gap: A key challenge for extending evidence-based psychosocial interventions. Behaviour Research and Therapy, 88, 7-18.
[74]	Kendall, P. C., & Frank, H. E. (2018). Implementing evidence-based treatment protocols: Flexibility within fidelity. Clinical Psychology: Science and Practice, 25(4). e12271.
[75]	Kok, G., Gottlieb, N. H., Peters, G. -J. Y., Mullen, P. D., Parcel, G. S., Ruiter, R. A. C., ... Bartholomew, L. K. (2016). A taxonomy of behaviour change methods: An Intervention Mapping approach. Health Psychology Review, 10(3), 297-312.
[76]	Leijten, P., Weisz, J. R., & Gardner, F. (2021). Research strategies to discern active psychological therapy components: A scoping review. Clinical Psychological Science, 9(3), 307-322.
[77]	Leventhal, H., & Friedman, M. A. (2004). Does establishing fidelity of treatment help in understanding treatment efficacy? Comment on Bellg et al. (2004). Health Psychology, 23(5), 452-456.
[78]	Lichstein, K. L., Riedel, B. W., & Grieve, R. (1994). Fair tests of clinical trials: A treatment implementation model. Advances in Behaviour Research and Therapy, 16(1), 1-29.
[79]	Lim, K., Jung, Y. C., & Kim, B. H. (2025). Evaluating motivational interview quality using large language models and hidden Markov models. BMC Psychiatry, 25(1), 908.
[80]	Lopez-Alcalde, J., Yakoub, N., Wolf, M., Munder, T., Von Elm, E., Flückiger, C., ... Barth, J. (2022). The RIPI-f (Reporting Integrity of Psychological Interventions delivered face-to-face) checklist was developed to guide reporting of treatment integrity in face-to-face psychological interventions. Journal of Clinical Epidemiology, 151, 65-74.
[81]	Marriott, B. R., Meyer, A. E., Feagans, A., Batch, B. L., & Adams, Z. W. (2026). Characterizing fidelity monitoring practices in community behavioral health care. The Journal of Behavioral Health Services & Research, 53(1), 45-64.
[82]	McHugh, R. K., Murray, H. W., & Barlow, D. H. (2009). Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: The promise of transdiagnostic interventions. Behaviour Research and Therapy, 47(11), 946-953.
[83]	McLeod, B. D., Porter, N., Hogue, A., Becker-Haimes, E. M., & Jensen-Doss, A. (2023). What is the status of multi- informant treatment fidelity research? Journal of Clinical Child & Adolescent Psychology, 52(1), 74-94.
[84]	McLeod, B. D., Southam-Gerow, M. A., Tully, C. B., Rodríguez, A., & Smith, M. M. (2013). Making a case for treatment integrity as a psychosocial treatment quality indicator for youth mental health care. Clinical Psychology: Science and Practice, 20(1), 14-32.
[85]	McLeod, B. D., Wood, J. J., Cecilione Herbst, J., Dunn, D., Kendall, P. C., Storch, E. A., Cho, A. C., & Rosenau, K. A. (2025). Treatment fidelity and outcome in CBT for youth with autism: The MEYA Fidelity Scale. Journal of Clinical Child & Adolescent Psychology, 54(1), 136-151.
[86]	Melchert, T. P., Halfond, R. W., Hamdi, N. R., Bufka, L. F., Hollon, S. D., & Cuttler, M. J. (2024). Evidence-based practice in psychology: Context, guidelines, and action. American Psychologist, 79(6), 824-837.
[87]	Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., ... Wood, C. E. (2013). The Behavior Change Technique Taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine, 46(1), 81-95.
[88]	Miller, W. R., & Rollnick, S. (2014). The effectiveness and ineffectiveness of complex behavioral interventions: Impact of treatment fidelity. Contemporary Clinical Trials, 37(2), 234-241.
[89]	Moher, D., Schulz, K. F., & Altman, D. G. (2001). The CONSORT statement: Revised recommendations for improving the quality of reports of parallel-group randomised trials. The Lancet, 357(9263), 1191-1194.
[90]	Moncher, F. J., & Prinz, R. J. (1991). Treatment fidelity in outcome studies. Clinical Psychology Review, 11(3), 247-266.
[91]	Montgomery, P., Grant, S., Mayo-Wilson, E., Macdonald, G., Michie, S., Hopewell, S., & Moher, D. (2018). Reporting randomised trials of social and psychological interventions: The CONSORT-SPI 2018 Extension. Trials, 19(1), 407.
[92]	Moyers, T. B., Rowell, L. N., Manuel, J. K., Ernst, D., & Houck, J. M. (2016). The motivational interviewing treatment integrity code (MITI 4): Rationale, Preliminary reliability and validity. Journal of Substance Abuse Treatment, 65, 36-42.
[93]	Nielsen, A., Dyer, N. L., Lechuga, C., McKee, M. D., & Dusek, J. A. (2024). Fidelity to the acupuncture intervention protocol in the ACUpuncture in the emergency department for pain management (ACUITY) trial: Expanding the gold standard of STRICTA and CONSORT guidelines. Integrative Medicine Research, 13(2), 101048.
[94]	Ogrodniczuk, J. S., & Piper, W. E. (1999). Measuring therapist technique in psychodynamic psychotherapies: Development and use of a new scale. The Journal of Psychotherapy Practice and Research, 8(2), 142-154.
[95]	O’Shea, O., McCormick, R., Bradley, J. M., & O’Neill, B. (2016). Fidelity review: A scoping review of the methods used to evaluate treatment fidelity in behavioural change interventions. Physical Therapy Reviews, 21(3-6), 207-214.
[96]	Öst, L. G., & Ollendick, T. H. (2017). Brief, intensive and concentrated cognitive behavioral treatments for anxiety disorders in children: A systematic review and meta- analysis. Behaviour Research and Therapy, 97, 134-145.
[97]	Ottman, K. E., Kohrt, B. A., Pedersen, G. A., & Schafer, A. (2020). Use of role plays to assess therapist competency and its association with client outcomes in psychological interventions: A scoping review and competency research agenda. Behaviour Research and Therapy, 130, 103531.
[98]	Pennebaker, J. W., Francis, M. E., & Booth, R. J. (2001). Linguistic inquiry and word count: LIWC2001 [Computer software manual]. Mahwah, NJ: Lawrence Erlbaum Associates.
[99]	Perepletchikova, F. (2011). On the topic of treatment integrity. Clinical Psychology: Science and Practice, 18(2), 148-153.
[100]	Perepletchikova, F., Hilt, L. M., Chereji, E., & Kazdin, A. E. (2009). Barriers to implementing treatment integrity procedures: Survey of treatment outcome researchers. Journal of Consulting and Clinical Psychology, 77(2), 212-218.
[101]	Perepletchikova, F., Treat, T. A., & Kazdin, A. E. (2007). Treatment integrity in psychotherapy research: Analysis of the studies and examination of the associated factors. Journal of Consulting and Clinical Psychology, 75(6), 829-841.
[102]	Peterson, L., Homer, A. L., & Wonderlich, S. A. (1982). The integrity of independent variables in behavior analysis. Journal of Applied Behavior Analysis, 15(4), 477-492.
[103]	Peyser, D., Sysko, R., Webb, L., & Hildebrandt, T. (2021). Treatment fidelity in eating disorders and psychological research: Current status and future directions. International Journal of Eating Disorders, 54(12), 2121-2131.
[104]	Power, N., Noble, L. A., Simmonds-Buckley, M., Kellett, S., Stockton, C., Firth, N., & Delgadillo, J. (2022). Associations between treatment adherence-competence- integrity (ACI) and adult psychotherapy outcomes: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 90(5), 427-445.
[105]	Quay, H. C. (1977). Measuring dimensions of deviant behavior: The behavior problem checklist. Journal of Abnormal Child Psychology, 5(3), 277-287.
[106]	Ravitz, P., Heeney, N., Lawson, A., McAnanama, E., Pain, C., Kiss, A., ... Singla, D. R. (2025). Scaling up interpersonal psychotherapy training: A pilot randomized controlled trial of digital asynchronous self-directed vs. synchronous group workshop training. Journal of Affective Disorders Reports, 19, 100863.
[107]	Robbins, M. S., Feaster, D. J., Horigian, V. E., Puccinelli, M. J., Henderson, C., & Szapocznik, J. (2011). Therapist adherence in brief strategic family therapy for adolescent drug abusers. Journal of Consulting and Clinical Psychology, 79(1), 43-53.
[108]	Rodriguez-Quintana, N., & Lewis, C. C. (2018). Observational coding training methods for CBT treatment fidelity: A systematic review. Cognitive Therapy and Research, 42(4), 358-368.
[109]	Sansom, S., A., & Crane, R. S. (2025). Mindfulness-based interventions: Teaching assessment criteria (MBI:TAC). In O. N. Medvedev, C. U. Krägeloh, R. J. Siegert, & N. N. Singh (Eds.), Handbook of assessment in mindfulness research. Springer.
[110]	Schmidt, L. K., Andersen, K., Nielsen, A. S., & Moyers, T. B. (2019). Lessons learned from measuring fidelity with the Motivational Interviewing Treatment Integrity code (MITI 4). Journal of Substance Abuse Treatment, 97, 59-67.
[111]	Schoenwald, S. K., & Garland, A. F. (2013). A review of treatment adherence measurement methods. Psychological Assessment, 25(1), 146-156.
[112]	Schoenwald, S. K., Garland, A. F., Chapman, J. E., Frazier, S. L., Sheidow, A. J., & Southam-Gerow, M. A. (2011). Toward the effective and efficient measurement of implementation fidelity. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 32-43.
[113]	Schulz, K. F., Altman, D. G., & Moher, D. (2010). CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. BMJ, 340, c332.
[114]	Smith, J. E., Gianini, L. M., Garner, B. R., Malek, K. L., & Godley, S. H. (2014). A behaviorally-anchored rating system to monitor treatment integrity for community clinicians using the adolescent community reinforcement approach. Journal of Child & Adolescent Substance Abuse, 23(3), 185-199.
[115]	Stirman, S. W., Gutner, C. A., Gamarra, J., Suvak, M. K., Vogt, D., Johnson, C., ... Resick, P. A. (2021). A novel approach to the assessment of fidelity to a cognitive behavioral therapy for PTSD using clinical worksheets: A proof of concept with cognitive processing therapy. Behavior Therapy, 52(3), 656-672.
[116]	The Project SAFER Intervention Team, Seng, E. K., & Lovejoy, T. I. (2013). Reliability and validity of a treatment fidelity assessment for motivational interviewing targeting sexual risk behaviors in people living with HIV/AIDS. Journal of Clinical Psychology in Medical Settings, 20(4), 440-448.
[117]	Toomey, E., Hardeman, W., Hankonen, N., Byrne, M., McSharry, J., Matvienko-Sikar, K., & Lorencatto, F. (2020). Focusing on fidelity: Narrative review and recommendations for improving intervention fidelity within trials of health behaviour change interventions. Health Psychology and Behavioral Medicine, 8(1), 132-151.
[118]	Violante, S., McLeod, B. D., Southam-Gerow, M. A., Chorpita, B. F., & Weisz, J. R. (2024). Using adherence and competence measures based on practice elements to evaluate treatment fidelity for two CBT programs for youth anxiety. Behavior Therapy, 55(3), 605-620.
[119]	Walton, H., Spector, A., Williamson, M., Tombor, I., & Michie, S. (2020). Developing quality fidelity and engagement measures for complex health interventions. British Journal of Health Psychology, 25(1), 39-60.
[120]	Waltz, J., Addis, M. E., Koerner, K., & Jacobson, N. S. (1993). Testing the integrity of a psychotherapy protocol: Assessment of adherence and competence. Journal of Consulting and Clinical Psychology, 61(4), 620-630.
[121]	Wiltsey Stirman, S., La Bash, H., Nelson, D., Orazem, R., Klein, A., & Sayer, N. A. (2022). Assessment of modifications to evidence-based psychotherapies using administrative and chart note data from the US department of veterans affairs health care system. Frontiers in Public Health, 10, 984505.
[122]	Wynia, Z., Delity, M., Morris, L., Costello, K., & Ashar, Y. (2025). Interrater agreement between a large language model and human raters for pain psychotherapy fidelity assessments. The Journal of Pain, 29, 105081.
[123]	Zainal, N. H., Eckhardt, R., Rackoff, G. N., Fitzsimmons- Craft, E. E., Rojas-Ashe, E., Barr Taylor, C., ... Newman, M. G. (2025). Capitalizing on natural language processing (NLP) to automate the evaluation of coach implementation fidelity in guided digital cognitive-behavioral therapy (GdCBT). Psychological Medicine, 55, e106.
[124]	Zhao, Z., Wallace, E., Feng, S., Klein, D., & Singh, S. (2021). Calibrate before use: Improving few-shot performance of language models. In Proceedings of the 38th International Conference on Machine Learning (Vol. 139, pp. 12697- 12706). PMLR.

测量阶段	测量过程
Ⅰ. 数据取样阶段	从所有待检查会谈中随机选取10%~20%的样本作为测量对象。
Ⅱ. 培训阶段	1. 确保评分者理解忠实度概念, 熟悉评分表所有项目, 明确评分标准。 2. 评分者对会谈进行试评, 这些样本取自研究, 但不用于最终统计。之后集体讨论以澄清分歧, 直至对评分标准和项目理解达成共识。 3. 研究者根据讨论结果, 进一步修订和完善评分标准。 4. 重复上述过程数次, 每次均使用新的会谈材料, 直至在各项目上达到令人满意的评分者间一致性(即评分者信度, inter-rater reliability)。
Ⅲ. 忠实度评估阶段	不同评分者独立对正式样本进行评估。定期(如每周)组织培训和独立的编码练习, 以维持评分者之间的编码一致性。
Ⅳ. 结果可靠性评估阶段	评估评分者间一致性。通常要求Intraclass Correlation Coefficient (ICC)系数达到0.75以上, 或Cohen's Kappa系数达到0.70以上。评估评分者内一致性(intra-rater reliability, 即重测信度)。

测量阶段	测量过程
Ⅰ. 数据取样阶段	从所有待检查会谈中随机选取10%~20%的样本作为测量对象。
Ⅱ. 培训阶段	1. 确保评分者理解忠实度概念, 熟悉评分表所有项目, 明确评分标准。 2. 评分者对会谈进行试评, 这些样本取自研究, 但不用于最终统计。之后集体讨论以澄清分歧, 直至对评分标准和项目理解达成共识。 3. 研究者根据讨论结果, 进一步修订和完善评分标准。 4. 重复上述过程数次, 每次均使用新的会谈材料, 直至在各项目上达到令人满意的评分者间一致性(即评分者信度, inter-rater reliability)。
Ⅲ. 忠实度评估阶段	不同评分者独立对正式样本进行评估。定期(如每周)组织培训和独立的编码练习, 以维持评分者之间的编码一致性。
Ⅳ. 结果可靠性评估阶段	评估评分者间一致性。通常要求Intraclass Correlation Coefficient (ICC)系数达到0.75以上, 或Cohen's Kappa系数达到0.70以上。评估评分者内一致性(intra-rater reliability, 即重测信度)。

测量方法	优势	局限
观察性编码 (观察法)	1. 评估依据直接、清晰、明确。 2. 公认的评估“金标准”。	1. 依赖人工评估, 成本高昂。 2. 缺乏统一标准, 评估一致性难以保证。 3. 成本与不一致问题相互加剧, 形成恶性循环。
书面调查法	1. 评估成本低。 2. 可提供多方视角。	1. 间接评估, 易受自我表征扭曲、记忆偏差、社会赞许效应等主观因素影响。 2. 可靠性低, 仅适合作为补充依据。
行为排练法	1. 可严格控制评估情境。 2. 采用直接观察。	1. 无法评估真实治疗的忠实度。 2. 同样存在成本高和评估不一致问题。

测量方法	优势	局限
观察性编码 (观察法)	1. 评估依据直接、清晰、明确。 2. 公认的评估“金标准”。	1. 依赖人工评估, 成本高昂。 2. 缺乏统一标准, 评估一致性难以保证。 3. 成本与不一致问题相互加剧, 形成恶性循环。
书面调查法	1. 评估成本低。 2. 可提供多方视角。	1. 间接评估, 易受自我表征扭曲、记忆偏差、社会赞许效应等主观因素影响。 2. 可靠性低, 仅适合作为补充依据。
行为排练法	1. 可严格控制评估情境。 2. 采用直接观察。	1. 无法评估真实治疗的忠实度。 2. 同样存在成本高和评估不一致问题。

改进措施	改进成本问题	改进不一致问题
忠实度评估框架	——	优势: 明确忠实度的测量内容以改善不一致问题。局限: 未提供可操作的测量指南。
干预措施分类法	——	优势: 为描述心理治疗干预措施提供分类和描述方法, 以改善不一致问题。局限: 仅涉及干预措施(依从性), 未涉及胜任力(包括技术胜任力和基础胜任力)。
计算机辅助评估	优势: 摆脱人工评估的局限性, 拥有巨大的成本优势。局限: 传统模型训练仍需耗费大量人力物力, 且泛化能力差。	优势: 通过模型自身的稳定特性改善人工评估的不一致问题。局限: 如果模型质量不佳, 输出结果仍不可用。