Symposium
Interventions and Care Delivery Models in the Context of Resource Limitations
Katy Dondanville, PsyD, ABPP
Associate Professor
The University of Texas Health Science Center at San Antonio
San Antonio, TX, United States
Amber Calloway, Ph.D. (she/her/hers)
Assistant Professor
University of Pennsylvania
Philadelphia, PA, United States
Stefanie LoSavio, ABPP, Ph.D.
Assistant Professor
The University of Texas Health Science Center at San Antonio
San Antonio, TX, United States
Bailee Schuhmann, PhD (she/her/hers)
Postdoctoral fellow
University of Texas Health Sciences Center for San Antonio
San Antonio, TX, United States
Brittany Hall Clark, PhD (she/her/hers)
Assistant Professor
University of Texas Health Sciences Center for San Antonio
San Antonio, Texas, United States
.jpeg.jpg "Christine Bird, Ph.D. photo")
Christine Bird, Ph.D.
Postdoctoral Fellow
Stanford University
Moutain View, California, United States
Shannon L. Wiltsey Stirman, Ph.D. (she/her/hers)
Associate Professor/Acting Deputy Director
National Center for PTSD and Stanford University
Menlo Park, California, United States
Text-based psychotherapy is growing quickly and reaching large populations. This growth creates an important opportunity to better understand therapist training, fidelity, and treatment content in asynchronous care. This presentation provides one of the first in-depth examinations of therapist training, fidelity, and therapy content in text-based delivery of Cognitive Processing Therapy (CPT-Text) compared to a culturally informed treatment-as-usual condition (CI-TAU).
Participants included 62 licensed therapists across five training cohorts, practicing in 19 U.S. states, with nearly half providing care in multiple states. Therapists were primarily licensed in counseling or social work and treated between 1 and 18 participants (M = 5.10). Over half of responding therapists reported prior experience delivering therapy via text.
Therapists in the CPT-Text condition had prior foundational CPT training and completed two virtual workshops focused on adapting CPT for asynchronous messaging, use of digital tools and scripts, rapport-building via text, and addressing race-based stress within CPT. Training materials included a CPT-Text manual, sample transcripts, and educational videos. Therapists also completed standardized patient simulations and received ongoing asynchronous consultation. CI-TAU therapists, who had no formal CPT training, completed live workshops emphasizing culturally responsive trauma care and race-based stress, supplemented by consultation calls throughout participation.
Fidelity was assessed by adapting the Cognitive Processing Therapy Fidelity Rating Form for CPT-Text and the MULTI for CI-TAU. This presentation highlights how therapeutic structure, collaboration, and core intervention elements are operationalized in text-based care, raising critical questions about training models, fidelity expectations, and the evolving nature of psychotherapy delivered via text.