Exploring therapist effectiveness across multiple domains over time.

Despite the common assumption that increased therapist experience correlates with improved client outcomes, studies reveal inconsistent relationships between therapist experience and therapy effectiveness. Some studies have demonstrated a slight worsening of client outcomes as therapists gain more experience. Yet, there are few studies that have examined how therapists change in their client outcomes over time, especially across different outcomes (e.g., depression, life functioning, anxiety). The present study used the Behavioral Health Measure-17 to investigate therapist effectiveness over time on multiple treatment outcomes (e.g., general distress, life functioning, anxiety, alcohol/drug use) using a large naturalistic sample of 613 professional therapists and 42,690 clients over approximately 12 years of psychotherapy data. Our results show a significant decrease in client outcomes over time in three domains: general distress, life functioning, and anxiety, albeit small-sized effects. Our findings also indicate that therapist caseload and baseline severity were not associated with predicting client outcomes and that, unexpectedly, the severity of therapist caseloads decreased over time. These findings underscore the importance of a nuanced understanding of therapist effectiveness, challenging the assumption of universal improvement with experience. Furthermore, we believe that these findings may offer preliminary support for matching therapists with clients based on domain-specific strengths. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sudden gains and deteriorations: Modeling the impact across outcomes with university counseling center clients.

OBJECTIVE: This study examines the longitudinal impact of sudden gains/deteriorations across the outcomes associated with the phase model. METHOD: In a sample of 16,657 clients who completed the Behavioral Health Measure-20, we identified sudden gains/deteriorations and employed multilevel piecewise analyses to assess their impact on subsequent treatment phases. RESULTS: We found that: (1) Following a sudden gain in the well-being outcome, the mean-level for the symptom outcome increased (meaning symptoms improved), and the rate of change decreased, (2) Following a sudden gain in the symptom outcome, the mean-level for the life functioning outcome increased, (3) Following a sudden deterioration in the well-being outcome, the mean-level and rate of change for the symptom outcome decreased, and (4) Following a sudden deterioration in the symptom outcome, the mean-level for the life functioning outcome decreased. CONCLUSIONS: These findings reveal that sudden gains/deteriorations function and occur at different rates across phases of change in psychotherapy.

Differences among trainees in client outcomes associated with the phase model of change.

This study investigated psychotherapy trainees' ability to facilitate change in outcomes (e.g., well-being, symptom reduction, and life functioning) specifically related to the phase model. Four different psychotherapist experience levels (beginning practicum, advanced practicum, intern/postdoc, and psychologist) were compared to determine whether there are training differences related to significant change for psychotherapy outcomes according to the phase model. A total of 1,318 clients from a university counseling center, treated by 64 psychotherapists, were included in the analysis for this study. Results indicate that interns/postdocs' clients achieve more significant change than psychologists' and advanced practicum students' clients related to life functioning. In addition, interns/postdocs' clients achieve more significant change related to symptom reduction, when compared with the clients of psychologists. Implications for these results, given the hypotheses of both the phase model and competency models, are discussed.

The dose-effect relationship in psychotherapy: a defining achievement for Dr. Kenneth Howard.

This article summarizes the Howard, Kopta, Krause, and Orlinsky (1986) study and notes its contributions to the field of psychotherapy. These contributions include (a) being the flagship study to estimate how psychotherapy is enough, (b) establishing number of sessions or dose as the common treatment unit of psychotherapy, (c) providing the first dosage standard for determining treatment groups, (d) inspiring the recent wave of effectiveness research, and (e) presenting the first methodology that assesses the efficiency of psychotherapy.