Category: Dissemination / Implementation
Internalizing disorders are the most common group of mental illnesses in the United States. To increase treatment of people with internalizing disorders, movements to implement evidence-based practices have gained speed over the past 20 years by providing training, ongoing consultation, and organizational and system support across the country. Although these efforts are important to ensure that clients receive appropriate treatment, many clients with internalizing disorders do not receive any treatment at all. Many factors are associated with limited receipt of services for clients with internalizing disorders, including living in areas with low number of providers available to treat these clients. One possibility for the provider shortage is the long training period for qualified mental health providers, due to a basic assumption that the more experience and training a provider has, the better their client’s outcomes will be. However, for clients with internalizing disorders, there is limited evidence that more therapist experience leads to better client outcomes.
To synthesize the research in this area, we conducted a meta-analysis on 16 studies representing 31 distinct comparison groups. All analyses were run as random-effects models using the metafor package in R. Most studies in our sample used multiple measurements of outcome, so we aggregated outcomes within studies using the Borenstein, Hedges, Higgins, and Rothstein procedure. Overall, higher levels of therapist experience were associated with better client outcomes (Hedge’s g=.08, p=.02). Due to significant heterogeneity in the model, we conducted several moderator analyses. Client diagnostic category moderated the relationship between therapist experience and client outcome, such that studies treating clients with depression showed a significant positive relationship between therapist experience and outcome. However, in studies treating clients with anxiety disorders, the relationship between therapist experience and outcome was attenuated. In addition, the rater of client outcome moderated the relationship between therapist experience and client outcome. When independent evaluators and multiple reporters were used to determine outcome, a significant positive relationship between therapist experience and client outcome was found. However, when clients rated their own outcomes, the relationship was attenuated. Results of this meta-analysis have implications for policies aiming to address mental health disparities in the United States, the use of lay-people in treating clients with internalizing disorders, as well as understanding many of the long standing methodological concerns in this research area.
Lucia Walsh– Graduate Student, University of Miami, Miami, Florida
McKenzie Roddy– Graduate Student, University of Miami, Coral Gables, Florida
Kelli Scott– Graduate Student, Indiana University Bloomington
Cara Lewis– Associate Scientific Investigator, Kaiser Permanente Washington Health Research Institute, Seattle, Washington
Amanda Jensen-Doss– Associate Professor, University of Miami, Coral Gables, Florida
Associate Scientific Investigator
Kaiser Permanente Washington Health Research Institute