Therapist self-report reliability and accuracy in individual vs. conjoint systemic family therapy sessions: implications for clinical monitoring.

Purpose: This study investigated how session composition (individual vs. conjoint) influenced the reliability and accuracy of therapist self-report on the use of Systemic Family Therapy (SFT) techniques in a community-based mental health clinic (CMHC). Accurate self-reporting is essential for monitoring and improving clinical practice, ensuring treatment fidelity, and evaluating evidence-based models. Method: Eighteen therapists from a CMHC in New York City submitted 165 session recordings with corresponding self-report scores on use of SFT interventions. Therapist reliability with observational scores was analyzed using intraclass correlation coefficients (ICCs), and accuracy was evaluated through comparisons with observer ratings using linear mixed models. The effect of session composition on extensiveness of SFT technique delivery was tested with a linear mixed model. Results: Therapists demonstrated strong reliability in reporting SFT techniques overall (ICC = 0.76) and in both individual (ICC = 0.71) and conjoint sessions (ICC = 0.67). However, accuracy varied by session type; therapists tended to overestimate their use of SFT techniques in individual sessions and were more accurate in conjoint sessions. Conjoint sessions also tended to feature a more extensive application of SFT techniques. Conclusion: These findings suggest that session composition influences the accuracy of therapist self-report and the extensiveness of SFT delivery. The overestimation in individual sessions highlights the need for enhanced training and supervision to improve ability to accurately report on use of SFT techniques. Further research is needed to explore the factors influencing differences in reporting accuracy between types of sessions and to refine methods for assessing SFT implementation.