Fidelity and clinical competence in providing IMR 161 and home assignments, are critical for implementing these elements. Therefore, IMR trainers who lack skills across these eight elements may need supplementary training following the initial training in IMR to teach cognitive-behavioral skills (e.g., a one- or two-day workshop). Skills would also be effectively reinforced by the routine incorporation of training in supervision sessions. Furthermore, the need for training in specific cognitive-behavioral skills could be determined by systematically providing feedback on clinician fidelity ratings obtained during the course of their providing the program, such as with the IT-IS based on audio recordings of IMR sessions.
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