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De Jong K, Wilkens J, Anderson T, Steggles K. Facilitative interpersonal skills in benign versus challenging therapy situations in trainee therapists: a pilot study. RESEARCH IN PSYCHOTHERAPY (MILANO) 2024; 27:804. [PMID: 39221904 PMCID: PMC11417669 DOI: 10.4081/ripppo.2024.804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
Therapists' responses to challenging therapy situations on the Facilitative Interpersonal Skills (FIS) performance task are a significant predictor of therapists' differences in treatment outcomes. The aim of this study was to assess whether the complexity of the therapy situation influenced the facilitative interpersonal skills of trainees. Trainee therapists (n=46) participated in an experiment in which they responded to a set of challenging and benign (i.e., non-challenging) video vignettes of therapy situations of the FIS performance task. Their responses were video recorded and coded by four independent raters. Results showed that trainees scored significantly higher on the FIS performance task responding to benign therapy situations than responding to challenging situations. This is the first study to investigate difficulty of therapy situations as a potential predictor or trainees interpersonal skills. Further research is needed to replicate these results in a larger sample.
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Affiliation(s)
- Kim De Jong
- Clinical Psychology Unit, Institute of Psychology, Leiden University.
| | - Johanna Wilkens
- Clinical Psychology Unit, Institute of Psychology, Leiden University.
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2
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Deisenhofer AK, Hehlmann MI, Rubel JA, Lutz W, Schwartz B, Bräscher AK, Christiansen H, Fehm L, Glombiewski JA, Heider J, Helbig-Lang S, Hermann A, Hoyer J, In-Albon T, Lincoln T, Margraf J, Risch AK, Schöttke H, Schulze L, Stark R, Teismann T, Velten J, Willutzki U, Wilz G, Witthöft M, Odyniec P. Love yourself as a therapist, doubt yourself as an institution? Therapist and institution effects on outcome, treatment length, and dropout. Psychother Res 2024:1-14. [PMID: 38831579 DOI: 10.1080/10503307.2024.2352749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 05/02/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE Research suggests that some therapists achieve better outcomes than others. However, an overlooked area of study is how institution differences impact patient outcomes independent of therapist variance. This study aimed to examine the role of institution and therapist differences in adult outpatient psychotherapy. METHOD The study included 1428 patients who were treated by 196 therapists at 10 clinics. Two- and three-level hierarchical linear regression models were employed to investigate the effects of therapists and institutions on three dependent patient variables: (1) symptom change, (2) treatment duration, and (3) dropout. Level three explanatory variables were tested. RESULTS The results showed that therapist effects (TE) were significant for all three types of treatment outcome (7.8%-18.2%). When a third level (institution) was added to the model, the differences between therapists decreased, and significant institution effects (IE) were found: 6.3% for symptom change, 10.6% for treatment duration, and 6.5% for dropout. The exploratory analyses found no predictors able to explain the systematic variation at the institution level. DISCUSSION TE on psychotherapy outcomes remain a relevant factor but may have been overestimated in previous studies due to not properly distinguishing them from differences at the institution level.
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Affiliation(s)
| | - Miriam I Hehlmann
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Osnabrück, Osnabrück, Germany
| | - Julian A Rubel
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Osnabrück, Osnabrück, Germany
| | - Wolfgang Lutz
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, Trier, Germany
| | - Brian Schwartz
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, Trier, Germany
| | - Anne-Kathrin Bräscher
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Hanna Christiansen
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
- Child and Adolescent Psychotherapy Clinic (KJ-PAM), Marburg, Germany
- German Center for Mental Health (DZPG), Bochum-Marburg, Germany
| | - Lydia Fehm
- Center for Psychotherapy at the Insitute of Psychology (ZPHU), Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julia A Glombiewski
- Clinical Psychology and Psychotherapy of Adulthood, University of Kaiserslautern-Landau, Kaiserslautern, Germany
| | - Jens Heider
- Clinical Psychology and Psychotherapy of Adulthood, University of Kaiserslautern-Landau, Kaiserslautern, Germany
| | - Sylvia Helbig-Lang
- Psychotherapy Training Program (PTA Hamburg) at Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Science, Universität Hamburg, Hamburg, Germany
| | - Andrea Hermann
- Psychotherapy and Systems Neuroscience, Department of Psychology, Justus Liebig University of Giessen, Giessen, Germany
| | - Jürgen Hoyer
- Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology and Psychotherapy, University of Kaiserslautern-Landau, Kaiserslautern, Germany
| | - Tania Lincoln
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Science, Universität Hamburg, Hamburg, Germany
| | - Jürgen Margraf
- Child and Adolescent Psychotherapy Clinic (KJ-PAM), Marburg, Germany
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Anne Katrin Risch
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Henning Schöttke
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Osnabrück, Osnabrück, Germany
| | - Lars Schulze
- Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Rudolf Stark
- Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
| | - Tobias Teismann
- Mental Health Treatment and Research Center, Ruhr-University Bochum, Bochum, Germany
| | - Julia Velten
- Faculty of Psychology, Mental Health Research and Treatment Center, Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany
| | - Ulrike Willutzki
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - Gabriele Wilz
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Michael Witthöft
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Patrizia Odyniec
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
- Department of Psychology, University of Kassel, Kassel, Germany
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Schaffrath J, Bommer J, Schwartz B, Lutz W, Deisenhofer AK. Where it all begins: Predicting initial therapeutic skills before clinical training in cognitive behavior therapy. PLoS One 2024; 19:e0294183. [PMID: 38386643 PMCID: PMC10883575 DOI: 10.1371/journal.pone.0294183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/27/2023] [Indexed: 02/24/2024] Open
Abstract
To train novice students adequately, it is crucial to understand where they start and how they develop their skills. This study examined the impact of novice students' characteristics on their initial clinical micro-skills when treating simulated patients with cognitive behavior therapy. The sample consisted of 44 graduate psychology students treating seven simulated patients. Clinical micro-skills were measured both using video-based ratings in reaction to short video clips of simulated patients (via the Facilitative Interpersonal Skills (FIS) performance task) and by using video-based ratings within a session with a simulated patient (using the Inventory of Therapeutic Interventions and Skills; ITIS). Two separate LASSO regressions were performed using machine learning to select potential predictors for both skills assessments. Subsequently, a bootstrapping algorithm with 10,000 iterations was used to examine the variability of regression coefficients. Using LASSO regression, we identified two predictors for clinical micro-skills in standardized scenarios: extraversion (b = 0.10) and resilience (b = 0.09), both were not significantly associated with clinical micro-skills. Together, they explained 15% of the skill variation. Bootstrapping confirmed the stability of these predictors. For clinical micro-skills in sessions, only competitiveness was excluded by LASSO regression, and all predictors showed significant instability. The results provide initial evidence that trainees' resilience and extraversion should be promoted in the clinical training of cognitive behavior therapy. More studies on clinical micro-skills and training with larger sample sizes are needed to fully understand clinical development.
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Affiliation(s)
- Jana Schaffrath
- Department of Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
| | - Jana Bommer
- Department of Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
| | - Brian Schwartz
- Department of Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
| | - Wolfgang Lutz
- Department of Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
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Bowker H, Saxon D, Delgadillo J. First impressions matter: The influence of initial assessments on psychological treatment initiation and subsequent dropout. Psychother Res 2024:1-11. [PMID: 38289694 DOI: 10.1080/10503307.2024.2308164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE This study investigated if patients' experience of an initial assessment may be associated with outcome expectations, and with subsequent treatment attendance. METHOD The sample comprised n = 6051 patients with depression/anxiety disorders, nested within k = 148 assessing therapists. Multilevel modelling (MLM) was used to examine therapist effects on treatment initiation and subsequent dropout, adjusting for patient-level characteristics. We tested associations between early outcome expectancy measured at an initial assessment with attendance at a first therapy session, and with dropout after initiation. Variability in mean expectancy ratings in the caseloads of assessing therapists was examined using the intracluster correlation coefficient (ICC). RESULTS Therapist effects partly explained the variance in treatment initiation and dropout. Pre-treatment outcome expectations significantly predicted treatment initiation but not dropout for the subgroup of patients who started treatment. Approximately 16% of variability in mean expectancy ratings was explained by therapist effects (ICC = 0.159) after controlling for patient-level covariates. CONCLUSIONS Patients assessed by some therapists are more likely to have higher outcome expectations, which influences their decision to initiate treatment thereafter. Once patients start therapy, early expectancy measured at assessment no longer influences their attendance, but the "first impression" from an initial assessment does influence their subsequent likelihood of dropout.
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Affiliation(s)
- Hannah Bowker
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - David Saxon
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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Clements-Hickman AL, Reese RJ. The person of the therapist: therapists' personal characteristics as predictors of alliance and treatment outcomes. Psychother Res 2023; 33:173-184. [PMID: 35634653 DOI: 10.1080/10503307.2022.2080610] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objective Studies examining the unique contribution that the therapist has on outcomes (i.e., "therapist effects") have increased in recent years. Therapist effects are believed to occur via how the therapist's interpersonal and intrapersonal qualities influence the therapeutic relationship, which in turn influences outcomes. The current study focused on the extent to which professional self-doubt, counseling self-efficacy, and humility are therapist qualities that influence treatment outcomes. Methods: Data were collected from 46 therapists at a multi-site community behavioral health organization. Therapists completed measures of therapist characteristics. Therapists' responses were matched with de-identified archival client data (N = 1, 817) that contained an outcome and alliance measure administered every session. Multilevel modeling was used to determine the extent to which therapists' personal characteristics predicted client outcomes. Results: Results of the unconditional model for the alliance measure indicated a lack of growth in alliance scores across treatment. Approximately 5% of the variance in rate of growth for treatment outcome was between therapists. When controlling for the effects of counseling self-efficacy, professional self-doubt was marginally significant. When counseling-self-efficacy was removed from the model, professional self-doubt was no longer marginally significant. Conclusion: The findings highlight the complexity of therapist effects and the need for future research on this topic.
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Affiliation(s)
| | - Robert J Reese
- Department of Special Education, Rehabilitation, and Counseling, Auburn University, Auburn, AL, USA
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Xiao H, Castonguay LG, Hayes JA, Janis RA, Locke BD. Reconstructing dropout: Building from multiple definitions, therapist effects, and center effects. Psychother Res 2023; 33:146-157. [PMID: 35737892 DOI: 10.1080/10503307.2022.2082897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Objective: The literature regarding dropout from psychotherapy has suffered from issues of diverse operationalization of the construct. Some have called for a more uniform definition to aid in generalization across research; this study aimed to assess the viability of such a definition by examining the rate of occurrence for three distinct definitions simultaneously. In addition, therapist and center level variances are explored to further understand the differences between definitions. Method: We compared the prevalence rates and overlap of three distinct operationalizations of dropout (based on last session attendance, therapist judgment, and symptom change) using data gathered from a national practice research network (N = 2977). Higher-order therapist and center-level effects were assessed for each definition. Results: There was very little overlap among definitions, with less than one percent of clients simultaneously meeting criteria for all three definitions. Additionally, therapist and center effects were found for each definition, especially notable for therapist-rated and last-session attendance definitions of dropout. Conclusion: Rather than a singular definition of dropout, these results instead suggest that multiple, specific, and unique definitions more accurately depict clinical reality, and future research might benefit from uncovering predictors of different "classes" of dropouts and examining the different practices of therapists and centers.
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Affiliation(s)
- Henry Xiao
- Center for Counseling and Psychological Services, Pennsylvania State University, University Park, PA, USA
| | - Louis G Castonguay
- Department of Psychology, Pennsylvania State University, University Park, PA, USA
| | - Jeffrey A Hayes
- Department of Educational Psychology, Counseling, and Special Education, Pennsylvania State University, University Park, PA, USA
| | - Rebecca A Janis
- Center for Counseling and Psychological Services, Pennsylvania State University, University Park, PA, USA
| | - Benjamin D Locke
- Center for Counseling and Psychological Services, Pennsylvania State University, University Park, PA, USA
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7
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Lin T, Anderson T, Austin M, Mischkowski D. Early trajectories of symptom change and working alliance as predictors of treatment outcome. Psychother Res 2023; 33:185-197. [PMID: 35659497 DOI: 10.1080/10503307.2022.2080028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE We aim to examine how different trajectories of symptom change and working alliance in early psychotherapy predict treatment outcomes. METHOD We performed a growth mixture model (GMM) to examine trajectories of symptom change and working alliance in the first five therapy sessions in a sample of 272 outpatients and tested the association of early symptom trajectories and alliance patterns with treatment outcome. RESULTS We identified two symptom trajectories: high symptom/steady change (63.2%) and early improving (36.8%), and four alliance development patterns: undeveloped alliance (40.1%), strengthening moderate alliance (31.6%), optimal alliance (17.3%), and improved alliance (11%) in early psychotherapy. The symptom trajectories and alliance patterns both independently and interactively predicted treatment outcomes. The optimal alliance was generally associated with the best outcome. The effect of improved alliance on treatment outcome was moderated by symptom trajectories: for high symptom/steady change subgroup, the improved alliance was related to better treatment outcome, whereas for early improving subgroup, the improved alliance was associated with poorer outcome. CONCLUSIONS Patients fell into different trajectories regarding symptom reduction and alliance development in early psychotherapy that affected final treatment outcome. Combining early symptom trajectories and alliance trajectories simultaneously can facilitate routine outcome monitoring and contribute to the prediction of treatment outcome.
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Affiliation(s)
- Tao Lin
- Department of Psychology, Ohio University, Athens, OH, USA
| | | | - Megan Austin
- Department of Psychology, Ohio University, Athens, OH, USA
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8
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Moggia D, Schwartz B, Rubel JA, Zimmermann D, Kästel B, Lutz W. Is it me, is it you or is it both of US? Applying the social relations model to disentangle the components of the therapeutic bond. Psychother Res 2023; 33:30-44. [PMID: 36215730 DOI: 10.1080/10503307.2022.2126334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE The study investigated the contribution of therapists and patients to the therapeutic bond and their associations (at the within and between levels) to treatment outcome. On this aim, the social relations model (SRM, aimed to analyze dyadic interpersonal data) was implemented. METHOD A novel design for individual psychotherapy studies was adopted, a many-with-many asymmetrical block dyadic design, in which several patients interact with several therapists. Hierarchical linear models were computed to study through variance partitioning the different components of the SRM and their association to treatment outcome. RESULTS All SRM components (with significant effects at therapist- and patient- within and between levels) resulted in significant contributions to the bond. However, only components at the within- and between-therapist, and within-patient levels resulted in significant associations with outcome. CONCLUSION Given the dyadic nature of the bond, our results support not only studying and offering clinical training on interpersonal therapeutic skills but also on constant monitoring and feedback of the relationship at the more idiosyncratic level.
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9
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Gómez Penedo JM, Flückiger C. Therapists' perceptions of interpersonally challenging patients in generalized anxiety disorder. Psychother Res 2023; 33:45-56. [PMID: 35446230 DOI: 10.1080/10503307.2022.2062268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE This study explores in cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD) to what degree therapists' perceptions of their patients as interpersonally challenging (IC) is explained by the therapist or patient effects, if baseline patients' characteristics predict IC, and if IC is related to outcome. METHOD Eighty patients diagnosed with GAD and treated by 20 therapists with 16 sessions of CBT were randomized to two different implementation conditions. Patients completed baseline measures of depression, anxiety, interpersonal problems, and interpersonal strengths. The therapists completed a single-item assessing IC session-by-session. As an outcome, patients completed a worry measure at baseline, session 5, session 10, and posttreatment. RESULTS Multilevel models showed meaningful therapist effects, explaining 18% of IC variance. Interpersonal strengths were the only baseline predictor significantly and negatively associated with IC during treatment. Structural equation models showed significant negative IC effects on subsequent patient worry during therapy. CONCLUSIONS IC might represent a risk factor for psychotherapy outcome. Patient interpersonal strengths at baseline may buffer therapists perceiving their patients as ICs. The therapist effects on IC suggest that CBT clinicians treating GAD might benefit from identifying cases that are interpersonally challenging for them and reflecting about what might trigger that perception.
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Affiliation(s)
- Juan Martín Gómez Penedo
- Department of Psychology, University of Zürich & Facultad de Psicología, Universidad de Buenos Aires (CONICET), Buenos Aires, Argentina
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Cloutier-Bergeron A, Samson A, Provencher V, Mongeau L, Paquette MC, Turcotte M, Bégin C. Health At Every Size intervention® under real-world conditions: the rights and wrongs of program implementation. Health Psychol Behav Med 2022; 10:935-955. [PMID: 36210868 PMCID: PMC9543046 DOI: 10.1080/21642850.2022.2128357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Implementation integrity is known to be critical to the success of interventions. The Health At Every Size® (HAES®) approach is deemed to be a sustainable intervention on weight-related issues. However, no study in the field has yet investigated the effects of implementation on outcomes in a real-world setting.
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Affiliation(s)
| | - Amélie Samson
- Centre de recherche Nutrition, santé et société (NUTRISS), INAF, Université Laval, Québec, Canada
- Ministère de la santé et des services sociaux, Québec, Canada
| | - Véronique Provencher
- Centre de recherche Nutrition, santé et société (NUTRISS), INAF, Université Laval, Québec, Canada
- School of Nutrition, Université Laval, Québec, Canada
| | - Lyne Mongeau
- School of Public Health, Université de Montréal, Montréal, Canada
| | - Marie-Claude Paquette
- Institut national de santé publique du Québec, Québec, Canada
- Department of Nutrition, Université de Montréal, Montréal, Canada
| | - Mylène Turcotte
- Centre de recherche Nutrition, santé et société (NUTRISS), INAF, Université Laval, Québec, Canada
| | - Catherine Bégin
- School of Psychology, Université Laval, Québec, Canada
- Centre de recherche Nutrition, santé et société (NUTRISS), INAF, Université Laval, Québec, Canada
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Alfi-Yogev T, Kivity Y, Hasson-Ohayon I, Ziv-Beiman S, Yehezkel I, Atzil-Slonim D. Client-therapist temporal congruence in perceiving immediate therapist self-disclosure and its association with treatment outcome. Psychother Res 2022:1-15. [DOI: 10.1080/10503307.2022.2151947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Tal Alfi-Yogev
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Yogev Kivity
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | | | - Sharon Ziv-Beiman
- Faculty School of Behavioral Sciences, The Academic College Tel-Aviv Yaffo, Tel Aviv-Yaffo, Israel
| | - Ido Yehezkel
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
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12
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Schürmann-Vengels J, Appelbaum S, Apel MK, Trimpop L, Muermans MM, Ostermann T, Teismann T, Willutzki U. Association of patients’ pre-therapy strengths and alliance in outpatient psychotherapy: A multilevel growth curve analysis. Psychother Res 2022; 33:551-565. [DOI: 10.1080/10503307.2022.2146543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jan Schürmann-Vengels
- Department of Psychology and Psychotherapy, Universität Witten/Herdecke, Witten, Germany
| | - Sebastian Appelbaum
- Department of Psychology and Psychotherapy, Universität Witten/Herdecke, Witten, Germany
- Trimberg Research Academy, University of Bamberg, Bamberg, Germany
| | - Marie-Kristin Apel
- Department of Psychology and Psychotherapy, Universität Witten/Herdecke, Witten, Germany
| | - Leonie Trimpop
- Department of Psychology and Psychotherapy, Universität Witten/Herdecke, Witten, Germany
| | | | - Thomas Ostermann
- Department of Psychology and Psychotherapy, Universität Witten/Herdecke, Witten, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Ulrike Willutzki
- Department of Psychology and Psychotherapy, Universität Witten/Herdecke, Witten, Germany
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Increasing the effectiveness of psychotherapy in routine care through blended therapy with transdiagnostic online modules (PsyTOM): study protocol for a randomized controlled trial. Trials 2022; 23:830. [PMID: 36180962 PMCID: PMC9524091 DOI: 10.1186/s13063-022-06757-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In blended therapy, face-to-face psychotherapy and Internet-based interventions are combined. Blended therapy may be advantageous for patients and psychotherapists. However, most blended interventions focus on cognitive behavioral therapy or single disorders, making them less suitable for routine care settings. METHODS In a randomized controlled trial, we will compare blended therapy and face-to-face therapy in routine care. We intend to randomize 1152 patients nested in 231 psychotherapists in a 1:1 ratio. Patients in the blended therapy group will receive access to a therapeutic online intervention (TONI). TONI contains 12 transdiagnostic online modules suited for psychodynamic, cognitive behavioral, and systemic therapy. Psychotherapists decide which modules to assign and how to integrate TONI components into the psychotherapeutic process to tailor treatment to their patients' specific needs. We will assess patients at baseline, 6 weeks, 12 weeks, and 6 months. Patients enrolled early in the trial will also complete assessments at 12 months. The primary outcomes are depression and anxiety at 6-month post-randomization, as measured by PHQ-8 and GAD-7. The secondary outcomes include satisfaction with life, level of functioning, personality traits and functioning, eating pathology, sexual problems, alcohol/drug use, satisfaction with treatment, negative effects, and mental health care utilization. In addition, we will collect several potential moderators and mediators, including therapeutic alliance, agency, and self-efficacy. Psychotherapists will also report on changes in symptom severity and therapeutic alliance. Qualitative interviews with psychotherapists and patients will shed light on the barriers and benefits of the blended intervention. Furthermore, we will assess significant others of enrolled patients in a sub-study. DISCUSSION The integration of online modules which use a common therapeutic language and address therapeutic principles shared across therapeutic approaches into regular psychotherapy has the potential to improve the effectiveness of psychotherapy and transfer it into everyday life as well help save therapists' resources and close treatment gaps. A modular and transdiagnostic setup of the blended intervention also enables psychotherapists to tailor their treatment optimally to the needs of their patients. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00028536. Registered on 07.06.2022.
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14
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Schürmann-Vengels J, Victor PP, Odyniec P, Flückiger C, Teismann T, Willutzki U. A Mental Imagery Micro-Intervention to Increase Positive Affect in Outpatient CBT Sessions (PACIfIC): Study Protocol of a Randomized Controlled Implementation Trial. CLINICAL PSYCHOLOGY IN EUROPE 2022; 4:e7043. [PMID: 36397941 PMCID: PMC9667424 DOI: 10.32872/cpe.7043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 03/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background Recent findings indicated that mental disorders are associated with both an up-regulation of negative affect and a down-regulation of positive affect (PA) as distinct processes. Established treatment approaches focus on the modification of problems and negative affect only. Experimental paradigms in healthy samples and research on strengths-based approaches showed that fostering PA may improve psychotherapy process and outcome. Specific and easily implementable interventions targeting PA in treatment sessions are scarce. Mental imagery was shown to be a promising strategy for boosting positive emotional experiences. Method The PACIfIC-study is planned as a longitudinal randomized-controlled trial in the context of cognitive behavioral therapy, implemented at a German outpatient training and research center. In the process analysis, trajectories of PA over the first twelve treatment sessions will be examined with weekly questionnaires. In the intervention analysis, a six-minute positive mental imagery intervention to enhance PA will be developed and tested. The intervention is implemented with loudspeakers at the beginning of each session for a standardized induction of PA. The experimental group will be compared to an active control group (neutral mental imagery) and treatment as usual. Procedures in all treatment arms are parallelized. Main outcomes after twelve sessions of psychotherapy will be psychosocial resources, resilience and self-esteem (theory-driven), as well as psychopathology and working alliance (secondary outcome). Multilevel modeling will be conducted to address the nested data structure. Conclusion Study results may have implications on the consideration of positive constructs in mental disorders and the implementation of strengths-based interventions in psychotherapy.
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Affiliation(s)
- Jan Schürmann-Vengels
- Department of
Psychology and Psychotherapy, Universität
Witten/Herdecke, Witten,
Germany
| | - Philipp Pascal Victor
- Department of
Psychology and Psychotherapy, Universität
Witten/Herdecke, Witten,
Germany
| | - Patrizia Odyniec
- Department of
Psychology and Psychotherapy, Universität
Witten/Herdecke, Witten,
Germany
| | - Christoph Flückiger
- Department of
Clinical Psychology and Psychotherapy, University
of Zurich, Zurich,
Switzerland
| | - Tobias Teismann
- Mental Health
Research and Treatment Center, Ruhr-Universität
Bochum, Bochum, Germany
| | - Ulrike Willutzki
- Department of
Psychology and Psychotherapy, Universität
Witten/Herdecke, Witten,
Germany
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15
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Sayer NA, Wiltsey-Stirman S, Rosen CS, Bernardy NC, Spoont MR, Kehle-Forbes SM, Eftekhari A, Chard KM, Nelson DB. Investigation of Therapist Effects on Patient Engagement in Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in the Veterans Health Administration. J Trauma Stress 2022; 35:66-77. [PMID: 34048602 DOI: 10.1002/jts.22679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 12/11/2022]
Abstract
The present study examined whether certain Veterans Health Administration (VHA) therapists have more success than others in keeping patients engaged in evidence-based psychotherapies for posttraumatic stress disorder (PTSD). Our objective was to use multilevel modeling to quantify the variability between therapists in two indicators of patient engagement: early dropout (i.e., < 3 sessions) and adequate dose (i.e., ≥ 8 sessions). The phenomenon of systematic variability between therapists in patients' treatment experience and outcomes is referred to as "therapist effects." The sample included the 2,709 therapists who provided individual cognitive processing therapy (CPT) or prolonged exposure (PE) to 18,461 veterans with PTSD across 140 facilities in 2017. Data were extracted from administrative databases. For CPT, therapist effects accounted for 10.9% of the variance in early dropout and 8.9% of the variance in adequate dose. For PE, therapist effects accounted for 6.0% and 8.8% of the variance in early dropout and adequate dose, respectively. Facility only accounted for an additional 1.1%-3.1% of the variance in early dropout and adequate dose. For CPT, patients' odds of receiving an adequate dose almost doubled, OR = 1.41/0.72 = 1.96, if they were seen by a therapist in the highest compared with the lowest retention decile. For PE, the odds of a patient receiving an adequate dose were 84% higher, OR = 1.38/0.75 = 1.84, when treated by a therapist in the highest compared with the lowest retention decile. Therapist skills and work environment may contribute to variability across therapists in early dropout and adequate dose.
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Affiliation(s)
- Nina A Sayer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shannon Wiltsey-Stirman
- Dissemination & Training Division, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Craig S Rosen
- Dissemination & Training Division, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Nancy C Bernardy
- Executive Division, National Center for PTSD, White River Junction, Vermont, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Michele R Spoont
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shannon M Kehle-Forbes
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Afsoon Eftekhari
- Dissemination & Training Division, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Kathleen M Chard
- Cincinnati Department of Veterans Affairs (VA) Medical Center, Cincinnati, Ohio, USA.,University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David B Nelson
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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16
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Carney DM, Castonguay LG, Janis RA, Scofield BE, Hayes JA, Locke BD. Center Effects: Counseling Center Variables as Predictors of Psychotherapy Outcomes. COUNSELING PSYCHOLOGIST 2021. [DOI: 10.1177/00110000211029271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Treatment context may have a unique impact on psychotherapy outcomes, above and beyond client, therapist, and therapy process variables. University counseling centers represent one such treatment context facing increasing treatment demands. This study examined the role of counseling centers and center variables in explaining differences in psychotherapy outcomes. The Center for Collegiate Mental Health, a large practice–research network, contained data from 116 counseling centers, 2,362 therapists, and 58,423 clients. Multilevel modeling tested if some counseling centers systematically achieved better outcomes than others (a “center effect”). Outcome was operationalized as clients’ magnitude and rate of change in distress across treatment. Results showed a relatively small “center effect” for both outcomes. Analyses sought to explain that center effect through administrative policies and characteristics. As a group, these variables partially explained the center effect. None explained a large portion of total outcome variance. Potential future implications for policy and advocacy efforts are discussed.
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17
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Zhou S, Hou Y, Liu D, Xu D, Zhang X. Psychotherapy Style Scale: Development and Validation. Front Psychol 2021; 12:543989. [PMID: 34108900 PMCID: PMC8182688 DOI: 10.3389/fpsyg.2021.543989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
Psychotherapy style is conceptualized as the therapeutic method that a therapist employs while working with clients during treatment. It influences both the therapeutic process and results of therapeutic actions. The present study developed and validated the Psychotherapy Style Scale (PSS). By following a systematic psychometric development process, a three-factor structure of the PSS was identified. Exploratory factor analysis and confirmatory factor analysis provided evidence of multidimensional structure and validity of the PSS. Cronbach's α suggested that the resulting scale was highly reliable. Criterion validity was also satisfactory, demonstrated by correlations between the scale and criterion validity measures. The PSS has the potential to help better understand therapists' behavioral characteristics and select the most appropriate therapists for clients who undergo psychotherapy.
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Affiliation(s)
- Shegang Zhou
- Department of Psychology, Institute of Education, Henan Normal University, Xinxiang, China.,Mental Health Center, Henan Normal University, Xinxiang, China
| | - Yanfei Hou
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Ding Liu
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Duo Xu
- Department of Psychology, Institute of Education, Henan Normal University, Xinxiang, China
| | - Xiaoyuan Zhang
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
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18
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Deisenhofer AK, Rubel JA, Bennemann B, Aderka IM, Lutz W. Are some therapists better at facilitating and consolidating sudden gains than others? Psychother Res 2021; 32:343-357. [PMID: 33938406 DOI: 10.1080/10503307.2021.1921302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Changes during psychotherapy often include sudden symptom improvements, called sudden gains (SGs), which have been identified as being superior to gradual symptom change with regard to treatment success. This study investigates the role of therapists in initiating and/or consolidating SGs. METHODS The analyses are based on a sample of patients (N = 1937) who were seen by 155 therapists and received individual psychotherapy at a university outpatient clinic. First, the therapist effect (TE) on SG was investigated using multilevel modeling (MLM). Second, MLM was used to explore the relative importance of patient and therapist variability in SGs as they relate to outcome. RESULTS The TE on SGs accounted for 1.8% of variance, meaning that therapists are accountable for inter-individual differences in their patients' likelihood to experience SGs. Furthermore, results revealed a significant effect of SGs on outcome for both levels, while therapist differences regarding the consolidation of SGs were not significant. CONCLUSIONS The analyses indicated that some therapists are better in facilitating and initiating SGs. The process of triggering SGs seems to be a therapist skill or competence, which opens up an additional pathway to positive outcomes that could be used to improve clinical training.
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Affiliation(s)
| | | | - Björn Bennemann
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
| | | | - Wolfgang Lutz
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
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19
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Abstract
ZusammenfassungDer Beitrag gibt einen Überblick über verschiedene Ansätze, wie die Wirkungsweise von Psychotherapie erklärt werden kann. Basierend auf dem biopsychosozialen Rahmenmodell postuliert die evidenzbasierte Praxis einen Rahmen des professionellen psychotherapeutischen Handelns. Grundsätzlich haben alle an der Therapie beteiligten Personen aktive Mitwirkung. Allgemeine Wirkfaktoren wie beispielsweise die Bereitschaft der Patient*innen zur Veränderung, die Qualität der gemeinsamen Arbeitsallianz oder die Auseinandersetzung der Therapeut*innen mit systematischem Feedback werden dabei als übergeordnete störungs- und therapieschulenübergreifende Wirkkomponenten verstanden.
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20
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Willis KL, Miller RB, Anderson SR, Bradford AB, Johnson LN, Yorgason JB. Therapist effects on dropout in couple therapy. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:104-119. [PMID: 33507576 DOI: 10.1111/jmft.12473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/04/2020] [Accepted: 11/08/2020] [Indexed: 06/12/2023]
Abstract
Marriage and family therapy scholars have argued that therapists play a crucial role in successful couple therapy, yet little research has empirically documented that the therapist in couple therapy has a significant impact on outcomes. Known as the study of therapist effects, this study sought to assess the amount of variance attributed to the therapist in couple therapy outcomes. Using dropout as the outcome variable, this study analyzed data from 1,192 couples treated by 90 masters and doctoral student therapists at a university-based training clinic. Results from multilevel analysis indicated that therapists in the sample accounted for 9.4% of the variance in couple dropout while controlling for initial couple impairment. Therapist gender and therapist experience did not significantly predict variability in therapist effects. These findings give promise to future research on therapist effects in couple therapy and encourage exploration into which therapist characteristics and behaviors contribute to successful clinical outcome.
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21
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Abstract
Zusammenfassung
Hintergrund
Die Studie untersuchte Therapeuteneffekte bei der Psychotherapie der sozialen Angststörung unter Verwendung von 3 methodischen Ansätzen: 1. Varianzen zufälliger Effekte, 2. Effekte soziodemografischer Variablen und 3. eine Disaggregation von therapeutischer Beziehung und nonverbaler Synchronisation in einen „Between“- und einen „Within“-Anteil der Therapeutenvarianz sowie deren Vorhersage des Outcome.
Material und Methoden
Die Patienten wurden mit manualisierter supportiver-expressiver Therapie (n = 54), manualisierter kognitiver Verhaltenstherapie (n = 102) oder naturalistischer kognitiver Verhaltenstherapie (n = 111) behandelt (insgesamt n = 267). Es wurden Patientenbeurteilungen interpersonaler Probleme (Inventar zur Erfassung interpersonaler Probleme, IIP-32), von Depressionssymptomen (Beck-Depressions-Inventar, BDI) und der therapeutischen Beziehung (Helping Alliance Questionnaire, HAQ) erfasst. Die nonverbale Synchronisation wurde mithilfe der Motion Energy Analysis und zeitreihenanalytischer Verfahren quantifiziert. Die Zusammenhangsanalysen erfolgten mit Mehrebenenmodellen.
Ergebnisse
Alter und Geschlecht des Therapeuten waren nicht prädiktiv für die zum Therapieende gemessenen IIP-32- und BDI-Werte. Therapeuteneffekte in Form zufälliger Effekte (Intra-Klassen-Korrelation [ICC] = 23,4 % bzw. 30,1 %) erklärten ein Vielfaches mehr an Outcome-Varianz als das Therapieverfahren (ICC = 6 % bzw. ICC = 1,6 %). Bei der nonverbalen Synchronisation waren Between-therapist- und Within-therapist-Anteil mit der Reduktion des IIP-32 assoziiert. Der Between-therapist-Anteil des HAQ sagte eine Reduktion des BDI vorher.
Schlussfolgerung
Bei der Behandlung sozialer Ängste sind Therapeuteneffekte bedeutsamer als das Therapieverfahren. Desgleichen waren die Therapeutenanteile bei den prozessrelevanten Variablen therapeutische Beziehung und nonverbale Synchronisation bedeutsamer als die patienten- bzw. dyadenspezifischen Anteile.
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22
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Sale R, Bearman SK, Woo R, Baker N. Introducing a Measurement Feedback System for Youth Mental Health: Predictors and Impact of Implementation in a Community Agency. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:327-342. [PMID: 32809082 DOI: 10.1007/s10488-020-01076-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Measurement feedback systems (MFSs) that routinely collect and report client progress to mental health therapists have demonstrated beneficial impact on outcomes in numerous studies, with evidence that there is a dose-response relationship related to the implementation of the MFS. The current study examined the impact of MFS implementation (Implementation Index) on youth symptom outcomes separately by caregiver and youth self-report. Additionally, we tested the extent to which Implementation Index rates varied by individual therapists and clients, and whether therapist and client characteristics predicted MFS implementation. Methods: Administrative data (client charts, youth- and caregiver-reported Youth Outcome Questionnaires) for 229 youth (52.83% Latinx, 42.79% girls, M age = 10.33) treated during a 1-year period at a community mental health organization in Central Texas were analyzed using multi-level modeling. Caregiver-reported symptoms decreased faster for those with a higher MFS Implementation Index. Between-group differences among therapists accounted for a significant proportion of variance in the Implementation Index for caregiver report, whereas client differences accounted for most of the variance in the Implementation Index for youth self-report. Therapist trainee status predicted a significant increase in the Implementation Index for caregiver-report data. Youth symptom improvement as reported by caregivers varied with the extent of MFS implementation fidelity, and MFS implementation fidelity was higher for clients treated by trainees relative to staff therapists for caregiver report of symptoms.
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Affiliation(s)
- Rafaella Sale
- Department of Educational Psychology, The University of Texas At Austin, 504 SZB, 1 University Station, D5800, Austin, TX, 78712-0383, USA.
| | - Sarah Kate Bearman
- Department of Educational Psychology, The University of Texas At Austin, 504 SZB, 1 University Station, D5800, Austin, TX, 78712-0383, USA
| | - Rebecca Woo
- Department of Educational Psychology, The University of Texas At Austin, 504 SZB, 1 University Station, D5800, Austin, TX, 78712-0383, USA
| | - Nichole Baker
- Department of Educational Psychology, The University of Texas At Austin, 504 SZB, 1 University Station, D5800, Austin, TX, 78712-0383, USA
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23
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Pfeiffer E, Ormhaug SM, Tutus D, Holt T, Rosner R, Wentzel Larsen T, Jensen TK. Does the therapist matter? Therapist characteristics and their relation to outcome in trauma-focused cognitive behavioral therapy for children and adolescents. Eur J Psychotraumatol 2020; 11:1776048. [PMID: 33029318 PMCID: PMC7473296 DOI: 10.1080/20008198.2020.1776048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND There is a broad evidence-base for the effectiveness of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) in treating children and adolescents with posttraumatic stress disorder (PTSD). The effect of therapist characteristics on patient symptoms has been neglected in psychotraumatology research and necessitates further investigation. OBJECTIVE This study aims to investigate the impact of therapist characteristics (gender, clinical experience and theoretical background) on posttraumatic stress symptoms (PTSS) in a heterogeneous and international sample of traumatized children and adolescents. METHOD Data from two RCTs on the effectiveness of TF-CBT in Norway and Germany were included, comprising N = 52 therapists (78.8% female) and N = 153 patients (72.3% female). All therapists underwent thorough training and continuous supervision in TF-CBT. The Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA) assessed pre- and post-treatment served as the outcome variable in a linear mixed-effects model with therapists' theoretical background, prior clinical experience and gender as independent variables, adjusted for patient gender, measurement time and country. The possibility of an interaction between therapist and patient gender was investigated subsequently. RESULTS None of the therapist characteristics were significantly related to PTSS. There was no indication of an interaction between patient and therapist gender (p =.878). CONCLUSION The lack of evidence for a relationship of therapists' theoretical orientation and clinical experience with outcome suggests that a wider dissemination of TF-CBT may be warranted. More studies with larger therapist and patient sample sizes and including only community practice are needed.
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Affiliation(s)
- Elisa Pfeiffer
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University Ulm, Ulm, Germany
| | - Silje Mørup Ormhaug
- Norwegian Center for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Dunja Tutus
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University Ulm, Ulm, Germany
| | - Tonje Holt
- Division of Mental & Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Rita Rosner
- Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Tore Wentzel Larsen
- Norwegian Center for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway.,Centre for Child and Adolescent Mental Health, Oslo, Norway
| | - Tine K Jensen
- Norwegian Center for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway.,Department of Psychology, University Oslo, Oslo, Norway
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24
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Firth N, Saxon D, Stiles WB, Barkham M. Therapist effects vary significantly across psychological treatment care sectors. Clin Psychol Psychother 2020; 27:770-778. [PMID: 32307805 DOI: 10.1002/cpp.2461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/25/2020] [Accepted: 04/16/2020] [Indexed: 11/08/2022]
Abstract
Psychological intervention outcomes depend in part on the therapist who provides the intervention (a therapist effect). However, recent reviews suggest that therapist effects may vary as a function of the context in which care is provided and therefore should not be generalized beyond that context. This study statistically analysed therapist effect differences between care sectors delivering psychological interventions. The sample comprised routine clinical data from 26,814 patients (69% female; mean age 38) and 466 therapists in five care sectors: primary care, secondary care, university, voluntary, and workplace. Therapist effects were analysed using multilevel models and Markov chain Monte Carlo credible intervals. The therapist effect was significantly larger in primary care (8.4%) than in any other sector (1.1%-2.3%) except secondary care (4.1%), after controlling for explanatory baseline and process variables as well as accounting for differences between clinics. There were no other significant differences detected between care sectors. These findings support the hypothesis that differences in effectiveness between therapists vary depending on the context in which psychological treatment is provided. Differences in relative therapist impact can vary by a factor of 4-8 across treatment sectors. This should be considered in the application of research evidence, treatment planning, and the design and delivery of psychological care provision.
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Affiliation(s)
- Nick Firth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - David Saxon
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - William B Stiles
- Department of Psychology, Miami University, Oxford, OH, USA.,Department of Psychology, Appalachian State University, Boone, NC, USA
| | - Michael Barkham
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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25
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Delgadillo J, Branson A, Kellett S, Myles-Hooton P, Hardy GE, Shafran R. Therapist personality traits as predictors of psychological treatment outcomes. Psychother Res 2020; 30:857-870. [PMID: 32089100 DOI: 10.1080/10503307.2020.1731927] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Aim: To investigate if therapists' personality influences their patients' treatment outcomes. Methods: N = 4,052 patients were treated by 69 therapists, including 36 Psychological Wellbeing Practitioners (PWPs) and 33 Cognitive Behavioural Therapists (CBTs). Therapists completed the NEO-PI-R personality inventory, they reported years of clinical experience, and expert assessors rated their clinical competence and reflective abilities. Their patients completed pre and post-treatment measures of depression (PHQ-9) and anxiety (GAD-7). Associations between therapist personality traits and patient treatment outcomes were examined using multilevel modelling, controlling for therapist demographics, clinical experience, technical competence and reflective ability. Results: Relative to other sources of variability, therapists accounted for 1% to 3% of overall variability in treatment outcomes. However, the magnitude of systematic heterogeneity in performance between therapists was around 6%, such that the best-performing therapists outperformed average therapists by a margin of moderate to large effects (g = .57-1.10). Clinical experience, technical competence and reflective ability were unrelated to treatment outcomes. Patients treated by PWPs with above-average agreeableness scores and CBTs with above-average openness to experience scores had poorer treatment outcomes. Conclusions: Therapist effects may be partly explained by the influence of their personality on their work with anxious and depressed patients.
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Affiliation(s)
- Jaime Delgadillo
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Amanda Branson
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Stephen Kellett
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Pamela Myles-Hooton
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Gillian E Hardy
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, London, UK
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26
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Yonatan-Leus R, Tishby O, Abargil M, Wiseman H. Therapist effects in yearlong psychodynamic therapy: An exploratory study. Clin Psychol Psychother 2019; 26:751-760. [PMID: 31614043 DOI: 10.1002/cpp.2400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 11/12/2022]
Abstract
A large body of research indicates that therapists can have a strong impact on treatment outcome, but little is known about the relationship between therapist effects and treatment phase. Our objective was to examine the interactive effect of therapist effectiveness and treatment phase on the outcome of 1 year of dynamic therapy. Therapists' effectiveness scores were defined as the extent of change for each therapist on the OQ-45 scores across their clients at five time points. The sample included 24 therapists who conducted psychodynamic therapy with 65 clients in a naturalistic setting. A three-level hierarchical linear model was applied. In accordance with the hypotheses, a significant main effect was found for effectiveness (estimate = 1.69, p < .05), for the two-way interactions between effectiveness and time (estimate = 1.36, p < .01), and for effectiveness and initial severity of symptoms (estimate = -0.02, p < .05). Simple slope analysis was conducted showing that among the less effective therapists, no significant change in outcome was found as time progressed; among the more effective therapists, outcome improved as time progressed. In addition, therapists were more influential in the treatments of clients with low initial severity. Our findings lend some support to the notion that therapist effects become increasingly influential as therapy progresses. The findings highlight the need for further research into changes in the magnitude of therapists' effect in various phases of therapy. Furthermore, the severity level of the initial symptoms of the client should be taken into account.
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Affiliation(s)
- Refael Yonatan-Leus
- Department of Psychology, Hebrew University of Jerusalem, Mount Scopus, Israel
| | - Orya Tishby
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel
| | - Maayan Abargil
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel
| | - Hadas Wiseman
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel
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27
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Galili-Weinstock L, Chen R, Atzil-Slonim D, Rafaeli E, Peri T. Enhancement of self compassion in psychotherapy: The role of therapists' interventions. Psychother Res 2019; 30:815-828. [PMID: 31380731 DOI: 10.1080/10503307.2019.1650979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Aim: Self Compassion (SC) has been consistently linked to decreased emotional distress and is offered as a mechanism of change in several therapeutic approaches. The current study aimed to identify therapists' interventions that enhance clients' SC within individual psychodynamic psychotherapy. We examined a diverse set of interventions as predictors of clients' SC, on treatment and session levels. We hypothesized that improvement in SC will be associated with greater use of directive or common factor interventions. Method: Client/therapist (N = 89) dyads from a university-based community clinic participated in the study. Therapists' interventions and changes in clients' SC level were monitored at each psychotherapy session. Results: Clients' SC in a given session was not predicted by therapist use of interventions from any of the three clusters in the previous session. However, positive change in SC across treatment was predicted by greater use of directive interventions. Furthermore, among clients with low pretreatment SC, a positive change in SC across treatment was predicted by lesser use of common factor interventions. Discussion: The results highlight the importance of understanding clients' pretreatment characteristics when selecting therapeutic interventions and suggest that the integration of directive interventions into the psychodynamic therapeutic practice may be beneficial in enhancing clients' SC.
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Affiliation(s)
| | - Roei Chen
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | | | - Eshkol Rafaeli
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Tuvia Peri
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
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28
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Casari LM, Ison MS, Gómez BMM. Personal style of the therapist and personality dimensions in a sample of Argentinian therapists. ACTA ACUST UNITED AC 2019; 22:362. [PMID: 32913799 PMCID: PMC7451301 DOI: 10.4081/ripppo.2019.362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/26/2019] [Indexed: 11/23/2022]
Abstract
The Personal Style of the Therapist (PST) is an important aspect to assess in the therapeutic process. Previous research has explored therapist’s profiles and their differences according to a variety of theoretical orientations, as well as the association between these profiles and personality traits. This study aims to put together these lines of research through a cluster analysis. The specific goals were to describe the profiles of therapists with respect to the functions of the PST and personality traits; and to analyze whether the professionals’ profiles and their theoretical orientations were related. The sample was comprised of 546 Argentinian therapists. The Personal Style of the Therapist Questionnaire (PST-Q) and the Big Five Inventory (BFI) were used as measuring instruments. Using the methodology of hierarchical analysis based on a cluster analysis integrating the five factors of the PST, a four-cluster solution was confirmed to be the most satisfactory. Subsequently, a cluster analysis of k-means based on the five factors of each test (PST-Q and BFI) was performed. Finally, the relationship between the clusters and theoretical orientation and years of clinical practice was assessed, rendering positive outcomes. The results are discussed based on previous research studies and the significance of studying the therapist’s personal variables and their connection with psychotherapy efficacy.
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Affiliation(s)
- Leandro Martín Casari
- National Scientific and Technical Research Council, City of Mendoza, Mendoza.,Pontifical Catholic University of Argentina, City of Mendoza, Mendoza
| | - Mirta Susana Ison
- National Scientific and Technical Research Council, City of Mendoza, Mendoza
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Ziem M, Hoyer J. Modest, yet progressive: Effective therapists tend to rate therapeutic change less positively than their patients. Psychother Res 2019; 30:433-446. [PMID: 31223074 DOI: 10.1080/10503307.2019.1631502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective: Empirical findings on self-serving biases amongst psychotherapists are inconsistent. We tested in a large naturalistic data set, if therapists are prone to illusory superiority when estimating their patients' outcome and whether this effect is buffered by therapists' effectiveness. Method: A post-hoc analysis with N = 69 therapists, who treated N = 1080 patients, was conducted. Therapists' and patients' mean ratings for therapeutic improvement in the Clinical Global Impression Scale (CGI) were compared. Using a multilevel modelling approach, we further investigated the relation between the patient-therapist divergence in the CGI and actual therapeutic change in the Global Severity Index (GSI) of the Brief Symptom Inventory and in the Satisfaction With Life Scale (SWLS). Results: Ratings in the CGI did not show significant differences between patients' and therapists' assessment of therapeutic change. Lower estimations by therapists, compared to patients' self-report, were associated with greater therapeutic change in GSI and SWLS. Conclusions: Therapists, on a whole, did not seem to be prone to illusory superiority when assessing therapeutic outcome. Contrary, the more modest the therapists' estimation of therapeutic outcome was, the greater the actual therapeutic change.
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Affiliation(s)
- Max Ziem
- Institute for Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Saxonia, Germany
| | - Juergen Hoyer
- Institute for Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Saxonia, Germany
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Delgadillo J, Saxon D, Barkham M. Associations between therapists' occupational burnout and their patients' depression and anxiety treatment outcomes. Depress Anxiety 2018; 35:844-850. [PMID: 29719089 DOI: 10.1002/da.22766] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/17/2018] [Accepted: 03/31/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Occupational burnout is common in mental health professionals, but its impact on patient outcomes is as yet uncertain. This study aimed to investigate associations between therapist-level burnout and patient-level treatment outcomes after psychological therapy. METHODS We used multilevel modeling using depression (PHQ-9) and anxiety (GAD-7) outcomes data from 2,223 patients nested within 49 therapists. Therapists completed a survey including the Oldenburg Burnout Inventory (OLBI) and a job satisfaction scale (JDSS). RESULTS After controlling for case-mix, around 5% of variability in treatment outcomes was explained by therapist effects (TE). Higher therapist OLBI-disengagement and lower JDSS scores were significantly associated with poorer treatment outcomes, explaining between 31 and 39% of the TE estimate. Higher OLBI scores were also correlated with lower job satisfaction ratings. CONCLUSIONS Therapist burnout has a negative impact on treatment outcomes and could be the target of future preventive and remedial action.
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Affiliation(s)
- Jaime Delgadillo
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, United Kingdom.,Centre for Psychological Services Research, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - David Saxon
- Centre for Psychological Services Research, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Michael Barkham
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, United Kingdom.,Centre for Psychological Services Research, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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Uckelstam CJ, Holmqvist R, Philips B, Falkenström F. A relational perspective on the association between working alliance and treatment outcome. Psychother Res 2018; 30:13-22. [PMID: 30165801 DOI: 10.1080/10503307.2018.1516306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective: Evidence is inconclusive on whether variability in alliance ratings within or between therapists is a better predictor of treatment outcome. The objective of the present study was to explore between and within patient and therapist variability in alliance ratings, reciprocity among them, and their significance for treatment outcome. Method: A large primary care psychotherapy sample was used. Patient and therapist ratings of the working alliance at session three and patient ratings of psychological distress pre-post were used for analyses. A one-with-many analytical design was used in order to address problems associated with nonindependence. Results: Within-therapist variation in alliance ratings accounted for larger shares of the total variance than between-therapist variation in both therapist and patient ratings. Associations between averaged patient and therapist ratings of the alliance for the individual therapists and their average treatment outcome were weak but the associations between specific alliance ratings and treatment outcome within therapies were strong. Conclusions: The results indicated a substantial dyadic reciprocity in alliance ratings. Within-therapist variation in alliance was a better predictor of treatment outcome than between-therapist variation in alliance ratings.
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Affiliation(s)
- Carl-Johan Uckelstam
- Department of Behavioral Science and Learning, Linköping University, Linköping, Sweden
| | - Rolf Holmqvist
- Department of Behavioral Science and Learning, Linköping University, Linköping, Sweden
| | - Björn Philips
- Department of Behavioral Science and Learning, Linköping University, Linköping, Sweden.,Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Fredrik Falkenström
- Department of Behavioral Science and Learning, Linköping University, Linköping, Sweden
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Johns RG, Barkham M, Kellett S, Saxon D. A systematic review of therapist effects: A critical narrative update and refinement to review. Clin Psychol Rev 2018; 67:78-93. [PMID: 30442478 DOI: 10.1016/j.cpr.2018.08.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review the therapist effects literature since Baldwin and Imel's (2013) review. METHOD Systematic literature review of three databases (PsycINFO, PubMed and Web of Science) replicating Baldwin and Imel (2013) search terms. Weighted averages of therapist effects (TEs) were calculated, and a critical narrative review of included studies conducted. RESULTS Twenty studies met inclusion criteria (3 RCTs; 17 practice-based) with 19 studies using multilevel modeling. TEs were found in 19 studies. The TE range for all studies was 0.2% to 29% (weighted average = 5%). For RCTs, 1%-29% (weighted average = 8.2%). For practice-based studies, 0.2-21% (weighted average = 5%). The university counseling subsample yielded a lower TE (2.4%) than in other groupings (i.e., primary care, mixed clinical settings, and specialist/focused settings). Therapist sample sizes remained lower than recommended, and few studies appeared to be designed specifically as TE studies, with too few examples of maximising the research potential of large routine patient datasets. CONCLUSIONS Therapist effects are a robust phenomenon although considerable heterogeneity exists across studies. Patient severity appeared related to TE size. TEs from RCTs were highly variable. Using an overall therapist effects statistic may lack precision, and TEs might be better reported separately for specific clinical settings.
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Affiliation(s)
- Robert G Johns
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield S10 2TN, UK
| | - Michael Barkham
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield S10 2TN, UK.
| | - Stephen Kellett
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield S10 2TN, UK
| | - David Saxon
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield S10 2TN, UK
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Delgadillo J, de Jong K, Lucock M, Lutz W, Rubel J, Gilbody S, Ali S, Aguirre E, Appleton M, Nevin J, O'Hayon H, Patel U, Sainty A, Spencer P, McMillan D. Feedback-informed treatment versus usual psychological treatment for depression and anxiety: a multisite, open-label, cluster randomised controlled trial. Lancet Psychiatry 2018; 5:564-572. [PMID: 29937396 DOI: 10.1016/s2215-0366(18)30162-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/09/2018] [Accepted: 04/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Previous research suggests that the use of outcome feedback technology can enable psychological therapists to identify and resolve obstacles to clinical improvement. We aimed to assess the effectiveness of an outcome feedback quality assurance system applied in stepped care psychological services. METHODS This multisite, open-label, cluster randomised controlled trial was done at eight National Health Service (NHS) Trusts in England, involving therapists who were qualified to deliver evidence-based low-intensity or high-intensity psychological interventions. Adult patients (18 years or older) who accessed individual therapy with participating therapists were eligible for inclusion, except patients who accessed group therapies and those who attended less than two individual therapy sessions. Therapists were randomly assigned (1:1) to an outcome feedback intervention group or a treatment-as-usual control group by use of a computer-generated randomisation algorithm. The allocation of patients to therapists was quasi-random, whereby patients on waiting lists were allocated sequentially on the basis of therapist availability. All patients received low-intensity (less than eight sessions) or high-intensity (up to 20 sessions) psychological therapies for the duration of the 1-year study period. An automated computer algorithm alerted therapists in the outcome feedback group to patients who were not on track, and primed them to review these patients in clinical supervision. The primary outcome was symptom severity on validated depression (Patient Health Questionnaire-9 [PHQ-9]) and anxiety (Generalised Anxiety Disorder-7 [GAD-7]) measures after treatment of varying durations, which were compared between groups with multilevel modelling, controlling for cluster (therapist) effects. We used an intention-to-treat approach. This trial was prospectively registered with ISRCTN, number ISRCTN12459454. FINDINGS In total, 79 therapists were recruited to the study between Jan 8, 2016, and July 15, 2016, but two did not participate. Of these participants, 39 (51%) were randomly assigned to the outcome feedback group and 38 (49%) to the control group. Overall, 2233 patients were included in the trial (1176 [53%] were treated by therapists in the outcome feedback group, and 1057 [47%] by therapists in the control group). Patients classified as not on track had less severe symptoms after treatment if they were allocated to the outcome feedback group than those in the control group (PHQ-9 d=0·23, B=-1·03 [95% CI -1·84 to -0·23], p=0·012; GAD-7 d=0·19, B=-0·85 [-1·56 to -0·14], p=0·019). INTERPRETATION Supplementing psychological therapy with low-cost feedback technology can reduce symptom severity in patients at risk of poor response to treatment. This evidence supports the implementation of outcome feedback in stepped care psychological services. FUNDING English NHS and Department of Health Sciences, University of York, York, UK.
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Affiliation(s)
- Jaime Delgadillo
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK.
| | - Kim de Jong
- Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Mike Lucock
- Centre for Applied Research in Health, University of Huddersfield, Huddersfield, UK; South West Yorkshire Partnership NHS Foundation Trust, Barnsley, UK
| | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
| | - Julian Rubel
- Department of Psychology, University of Trier, Trier, Germany
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Shehzad Ali
- Department of Health Sciences, University of York, York, UK
| | - Elisa Aguirre
- North East London National Health Service (NHS) Foundation Trust, London, UK
| | | | - Jacqueline Nevin
- Cheshire and Wirral Partnership NHS Foundation Trust, Winsford, UK
| | | | - Ushma Patel
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Peter Spencer
- South West Yorkshire Partnership NHS Foundation Trust, Barnsley, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
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Pereira JA, Barkham M, Kellett S, Saxon D. The Role of Practitioner Resilience and Mindfulness in Effective Practice: A Practice-Based Feasibility Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:691-704. [PMID: 27424107 PMCID: PMC5550533 DOI: 10.1007/s10488-016-0747-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A growing body of literature attests to the existence of therapist effects with little explanation of this phenomenon. This study therefore investigated the role of resilience and mindfulness as factors related to practitioner wellbeing and associated effective practice. Data comprised practitioners (n = 37) and their patient outcome data (n = 4980) conducted within a stepped care model of service delivery. Analyses employed benchmarking and multilevel modeling to identify more and less effective practitioners via yoking of therapist factors and nested patient outcomes. A therapist effect of 6.7 % was identified based on patient depression (PHQ-9) outcome scores. More effective practitioners compared to less effective practitioners displayed significantly higher levels of mindfulness as well as resilience and mindfulness combined. Implications for policy, research and practice are discussed.
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Affiliation(s)
- Jo-Ann Pereira
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Michael Barkham
- Centre for Psychological Services Research, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Stephen Kellett
- Centre for Psychological Services Research, Department of Psychology, University of Sheffield; Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - David Saxon
- Centre for Psychological Services Research, School of Health and Related Research, University of Sheffield, Sheffield, UK
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35
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Paulick J, Rubel JA, Deisenhofer AK, Schwartz B, Thielemann D, Altmann U, Boyle K, Strauß B, Lutz W. Diagnostic Features of Nonverbal Synchrony in Psychotherapy: Comparing Depression and Anxiety. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9914-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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36
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Abstract
Psychotherapy meta-analyses sometimes generate heterogeneous results, partially due to key methodological characteristics which vary between studies (e.g., psychotherapy conditions are contrasted with structurally different control conditions). Examining these potential moderator variables can help explain heterogeneous results within and between psychotherapy meta-analyses. The present manuscript provides an overview of moderators that are highly relevant to test the generalizability of effects across psychotherapy trials. These moderators mainly fall into one of the following groups: (a) structural equivalence of interventions, (b) preferences/allegiances, (c) therapist effects, and (d) sample representativeness. Individual moderators include: Bona fide psychotherapy, proximity to psychological interventions, psychotherapy orientation, pre-training of therapists, supervision, caseload of therapists, dosage, homework, patient preferences, researcher and therapist allegiance, therapist effects in nested designs, aspects of sample representativeness, multiple outcomes, and time of assessment. Our analysis of 15 psychotherapy meta-analyses published in 2016 suggests that the structural equivalence of psychotherapeutic conditions, patient and therapist preferences/allegiances, therapist effects and nested data structures as well as sample representativeness were often neglected and little-discussed as potential moderators. The manuscript describes further conceptual and methodological challenges when conducting moderator analyses such as the categorization of psychological treatments and the importance of interrater coding. We encourage meta-analysts to consider moderators which have previously shown utility in explaining heterogeneous results in the psychotherapy literature. Clinical or methodological significance of this article: Relevant moderator variables help explain heterogeneous results in psychotherapy meta-analyses. Though these variables are often overlooked, they should be regularly incorporated in meta-analyses.
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Affiliation(s)
- Glen I Spielmans
- a Department of Psychology , Metropolitan State University , Saint Paul , MN , USA.,b Department of Counseling Psychology , University of Wisconsin , Madison , WI , USA
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37
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Galili-Weinstock L, Chen R, Atzil-Slonim D, Bar-Kalifa E, Peri T, Rafaeli E. The association between self-compassion and treatment outcomes: Session-level and treatment-level effects. J Clin Psychol 2017; 74:849-866. [PMID: 29251782 DOI: 10.1002/jclp.22569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 09/18/2017] [Accepted: 10/25/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Self-compassion (SC) has been consistently linked to less psychopathology; however, the link between changes in client's SC levels and psychotherapy outcomes has yet to be explored. METHOD Clients at a university-based community clinic completed SC and outcome measures session by session (N = 112) as well as pre- to posttreatment (N = 70). RESULTS Increases in clients' SC levels across the entire therapeutic process were associated with improvement in all posttreatment outcomes. Additionally, session-to-session increases in SC levels predicted improved symptoms and functioning at the session level; these effects were significant above and beyond the effects of the therapeutic alliance. CONCLUSION The results of the current study highlight SC as a possible process variable in psychotherapy.
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Miller SD, Hubble MA, Wampold BE. Growing Better Therapists: A New Opportunity for Mental Health Administrators. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 44:732-734. [PMID: 28466369 DOI: 10.1007/s10488-017-0805-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Scott D Miller
- International Center for Clinical Excellence, Chicago, IL, USA.
| | - Mark A Hubble
- International Center for Clinical Excellence, Chicago, IL, USA
| | - Bruce E Wampold
- Modum Bad Psychiatric Center and University of Wisconsin, Madison, WI, USA
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Odyniec P, Probst T, Margraf J, Willutzki U. Psychotherapist trainees’ professional self-doubt and negative personal reaction: Changes during cognitive behavioral therapy and association with patient progress. Psychother Res 2017; 29:123-138. [DOI: 10.1080/10503307.2017.1315464] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Patrizia Odyniec
- School of Psychology, University Witten/Herdecke, Witten, Germany
| | - Thomas Probst
- Georg-Elias-Müller Institute for Psychology, Georg-August-University Göttingen, Göttingen, Germany
| | - Jürgen Margraf
- Department of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Ulrike Willutzki
- School of Psychology, University Witten/Herdecke, Witten, Germany
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40
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Yonatan-Leus R, Tishby O, Shefler G, Wiseman H. Therapists' honesty, humor styles, playfulness, and creativity as outcome predictors: A retrospective study of the therapist effect. Psychother Res 2017; 28:793-802. [PMID: 28277039 DOI: 10.1080/10503307.2017.1292067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE This study examined whether therapists' honesty, humor style, playfulness, and creativity would retrospectively predict the outcomes of therapies ended five years earlier. METHOD In the Jerusalem-Haifa study, 29 therapists treated 70 clients in dynamic psychotherapy for 1 year. The Outcome Questionnaire 45 scores were collected at five time points. Five years later, the therapists were contacted via email and asked to fill out honesty, humor styles, playfulness, and creativity self-report questionnaires. Five were excluded since they had only one client in the study each. The remaining 24 therapists treated 65 clients out of whom 20 therapists with 54 clients completed the questionnaires. RESULTS Therapists' Aggressive Humor Style (AHS) was a significant negative predictor of clients' symptom change over time. The therapists' honesty scores were positively correlated with symptom change. That is, higher AHS therapists were more effective, while higher honesty therapists were less effective. CONCLUSIONS Therapists' inferred traits of Honesty-Humility and AHS may influence the effectiveness of their treatments.
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Affiliation(s)
- Refael Yonatan-Leus
- a Department of Psychology , Hebrew University of Jerusalem , Mount Scopus , Israel
| | - Orya Tishby
- a Department of Psychology , Hebrew University of Jerusalem , Mount Scopus , Israel
| | - Gaby Shefler
- a Department of Psychology , Hebrew University of Jerusalem , Mount Scopus , Israel
| | - Hadas Wiseman
- b Department of Counseling and Human Development, Faculty of Education , University of Haifa , Haifa , Israel
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Flückiger C, Held J, Wolfer C, Allemand M, Visla A. Ressourcenorientierung als Interventionsleitbild. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0168-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Goldberg SB, Hoyt WT, Nissen-Lie HA, Nielsen SL, Wampold BE. Unpacking the therapist effect: Impact of treatment length differs for high- and low-performing therapists. Psychother Res 2016; 28:532-544. [PMID: 27616739 DOI: 10.1080/10503307.2016.1216625] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Differences between therapists in their average outcomes (i.e., therapist effects) have become a topic of increasing interest in psychotherapy research in the past decade. Relatively little work, however, has moved beyond identifying the presence of significant between-therapist variability in patient outcomes. The current study sought to examine the ways in which therapist effects emerge over the course of time in psychotherapy. METHOD We used a large psychotherapy data set (n = 5828 patients seen by n = 158 therapists for 50,048 sessions of psychotherapy) and examined whether outcomes diverge for high-performing (HP) and low-performing (LP) therapists as treatment duration increases. RESULTS Therapists accounted for a small but significant proportion of variance in patient outcomes that was not explained by differences between therapists' caseload characteristics. The discrepancy in outcomes between HP and LP therapists increased as treatment duration increased (interaction coefficient = 0.071, p < .001). In addition, patients' trajectories of change were a function of their therapist's average outcome as well as the patient's duration of treatment (interaction coefficient = 0.060, p = .040). CONCLUSIONS Indeed, patterns of change previously described ignoring between-therapist differences (e.g., dose-effect, good-enough level model) may vary systematically when disaggregated by therapist effect.
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Affiliation(s)
- Simon B Goldberg
- a Department of Counseling Psychology , University of Wisconsin-Madison , Madison , WI , USA
| | - William T Hoyt
- a Department of Counseling Psychology , University of Wisconsin-Madison , Madison , WI , USA
| | | | - Stevan Lars Nielsen
- c Counseling and Psychological Services , Brigham Young University , Provo , UT , USA
| | - Bruce E Wampold
- a Department of Counseling Psychology , University of Wisconsin-Madison , Madison , WI , USA.,d Modum Bad Psychiatric Center , Vikersund , Norway
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