Table 2.
Adaptation codes, frequency, and sample therapist write-in response
| % of adapted sessions (N=429) | % of total sessions (N=731) | Sample therapist write-in response | |
|---|---|---|---|
| Augmenting adaptations | 63.40% | 37.21% | |
| Modifying presentation | 35.20% | 20.66% | “Client presents with language problems and I apply the use of visuals for client to identify and place meaning to topic discussed.” |
| Integrating supplemental content/strategies | 17.72% | 10.40% | “Therapist added mindfulness reading into session due to previous statements by [client] that she is trying to think positive and push away her ‘bad thoughts’ and emotions.” |
| Repeating components | 8.62% | 5.06% | “Client is very young, had difficulty focusing on tasks, staying on topic and comprehending the practice skills discussed. Clinician had to go over skills several times, practice, model and work on focusing and client still appeared confused at times and disinterested.” |
| Providing psychoeducation | 4.66% | 2.74% | “Added psychoeducation on trauma.” |
| Lengthening pacing of practice | 3.50% | 2.05% | “I am doing the trauma narrative more slowly to help client feel comfortable.” |
| Translating materials | 1.86% | 1.09% | “Translating into Spanish and facilitating collateral with clients [biological mother] and maternal grandmother who, is another caregiver for client.” |
| Combining with other services | 1.17% | .68% | “This week, I and the therapist of my client’s sibling met jointly with caregivers in order to do very simple, concrete safety planning regarding physical aggression and sexual behaviors in the home.” |
| Reducing adaptations | 19.58% | 11.49% | |
| Pausing EBP delivery | 8.86% | 5.20% | “Allowing client to talk about bio father due to her father not visiting client this week, which heavily impacted client. Therapist also used this session to work on grief and loss to deal with client’s bereavement, which was not focus of MAP.” |
| Removing components | 6.29% | 3.69% | “Caregiver has previously received parenting classes so she is somewhat familiar with interventions and tools. I did not start at the basics of these interventions because of this. I felt it was more effective to start in the middle and build off caregiver skills she currently has.” |
| Adjusting order of practice/components | 3.03% | 1.78% | “I used some of the PRAC components out of order, picking and choosing the activities related to feelings, as that is what we had been working on prior to this session.” |
| Shortening pacing of practice | 2.56% | 1.50% | “Therapist had to conduct the session in a shorter time due to father’s hesitation in the past to participate in collateral sessions.” |
| Generalizing adaptations | 13.05% | 7.66% | |
| Applying to alternate setting or individuals | 10.72% | 6.29% | “There were several adaptations that had to be made during this session mainly that we were meeting outside since the client is on spring break and cannot meet at school as we do normally. The parent was not at home so the session was conducted only with the client.” |
| Applying to novel problem focus | 2.33% | 1.37% | “Seeking Safety [was] adapted to target mood disruption and anxiety, as this has previously resulted in self-harm behavior, rather than targeting substance use.” |
| Non-classifiable | 13.29% | 7.80% | |
| Not enough information to code | 11.89% | 6.98% | “I addressed client’s needs while in treatment regarding his irritability. He refused to talk for a period of time.” |
| No text write-in | 1.40% | .82% |