Category: Health Care System / Public Policy

Symposium

Therapist Effects Can Support Personalized Treatments: Outcome, Dropout, and Treatment Length

Friday, November 17
8:30 AM - 10:00 AM
Location: Cobalt 502, Level 5, Cobalt Level

Keywords: Psychotherapy Outcome
Presentation Type: Symposium

Aim: To consider the concept of therapist effects in relation to effective therapists and the natural phenomenon of variability in outcome, dropout and treatment length.


Method:   We briefly reviewed landmark as well as current studies using large Ns of therapists and argued for research studies to design in the investigation of therapist effects. We tested one factor that appeared to determine the extent of therapist effects: patient severity. We constructed a large dataset from the US, UK, and Germany comprising different outcome measures (N= 48,648: e.g. the BSI, the CORE-OM, and OQ-45. Furthermore, we investigated therapist effects on dropout and treatment length.


Results: Although there was a range in the size of therapist effect, when considered as a function of initial patient severity, the outcomes from different outcome measures showed a similar pattern: hence, the higher the initial client severity level, the greater the therapist effect. Additional analysis revealed therapist effects on dropout and treatment length in a comparable size to therapist effects on outcome. Interestingly, the three different forms of outcome were not correlated.


Conclusions:  In conclusion, therapist effects appear to have a substantial impact not only on treatment effects, but also on treatment length and drop out. The middle two-thirds of therapists cannot be confidently and reliably distinguished from each other regarding their effectiveness; and approximately 15-20% of therapists have distinguishably better outcomes and the same percentage distinguishably poorer outcomes. We discuss the application of therapist-focused research into practice settings by developing and implementing prediction and clinical adaptation tools to support personalized treatments.

Anne-Katharina Deisenhofer

University of Trier, Germany

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