Fidelity with Flexibility

Research has linked the use of evidence-supported treatments to effective, efficient therapeutic outcomes. Questions related to the best way to disseminate and implement evidence-supported treatments in the field has led to discussions about transportability of treatments from controlled to applied settings. Specifically, scholars have focused on issues related to treatment fidelity, acceptability, and adoption versus adaptation of evidence-based treatments in practice. Treatment fidelity, a multidimensional construct, pertains to how extensively a treatment is delivered to a client, and it may be affected by several variables. Although the relationship is complex, treatment fidelity is considered an important moderator of client outcomes. Furthermore, the acceptability of a treatment appears to be of importance. Simply, if a treatment is perceived to be acceptable, it is more likely to be implemented with high levels of fidelity, increasing the chances that successful therapeutic outcomes will result. Nevertheless data indicate that some clinicians are wary of using evidence-supported treatments; their chief concern is feasibility of implementation, which could affect treatment fidelity and acceptability. Thus, there is a debate about whether evidence-supported treatments should be adopted strictly as developed or whether they might be adapted to improve implementation and acceptability. In adaptation of a treatment, relevant clinician variables (e.g., training received, availability of resources) and client factors (e.g., cultural fit) might be considered to promote therapeutic outcomes. This chapter describes how the key to treatment success may be to strike a balance between fidelity and adaptation of evidence-based treatments and fidelity with flexibility.