Using latent profile analysis of clinical microskills to predict alliance and outcome of cognitive behavioral therapy.

Objective: Research on clinical skills and therapy outcomes is inconsistent. This study identifies skills profiles in patient-therapist dyads and their links to outcomes.

Method: Clinical microskills were assessed using the Inventory of Therapeutic Interventions and Skills (ITIS) in video-recorded therapy sessions of 194 patients treated by 32 therapists at a CBT outpatient clinic. Outcome and process measures - including distress, anxiety, depression, and alliance - were assessed at session 15. Latent profile analysis identified distinct skills profiles, and multilevel regression models examined their ability to predict outcomes.

Results: Three latent skills profiles emerged: one high, one medium, and one low. Therapists shifted between profiles depending on the patient, averaging 2.4 profiles each. Higher skills profiles correlated with better alliance ratings and lower distress in session 15. Skills profiles were not linked to depressive symptoms, anxiety, or patient rated outcome.

Conclusion: Therapeutic skills show state-like variability and influence the therapeutic alliance. These findings highlight the importance of examining dyadic processes to enhance therapy effectiveness.