Objective: Patient-reported outcomes data reveal differences both in therapists' global effectiveness across their average patient (between-therapist effect) and in treating different problems within ...their caseload (within-therapist effects). Yet, it is unclear how accurately therapists perceive their own measurement-based, problem-specific effectiveness and whether such self-perceptions predict global between-therapist performance differences. We explored these questions in naturalistic psychotherapy. Method: For 50 therapists, we drew on data from a mean of 27 past patients (total N = 1,363) who completed a multidimensional outcome measure-Treatment Outcome Package (TOP)-at pre- and posttreatment. For each of 12 outcome domains (e.g., depression, anxiety), TOP data classified therapists as historically "effective," "neutral," or "ineffective." Unaware of their data-driven classifications, therapists rated their perceived effectiveness for each domain. We conducted chi-square analyses to determine whether therapists predicted their own measurement-based effectiveness classifications to a level greater than chance. We then used multilevel modeling to test whether therapists' problem-specific perceptions predicted global between-therapist performance differences. Results: For all but one outcome domain, therapists were no better than chance at predicting their measurement-based effectiveness classification. Additionally, controlling for patient baseline impairment, therapists who consistently overestimated their problem-specific effectiveness had patients who reported worse global outcomes than patients whose therapist more accurately estimated their effectiveness. Conversely, therapists who underestimated their problem-specific effectiveness had patients who reported better outcomes than patients whose therapist over- or accurately estimated their effectiveness. Conclusions: Therapist humility may differentiate the most from least globally effective therapists, and this virtue should be cultivated in clinical trainings.
What is the public health significance of this article?
Psychotherapy patients often choose a therapist based on the therapist's self-assessed areas of expertise. Yet, this study indicated that therapists can be inaccurate judges of their own measurement-based, problem-specific effectiveness, which underscores a significant public health issue. Moreover, the direction of such inaccuracies may be clinically meaningful; whereas therapist underestimation of their measurement-based effectiveness classifications (humility) predicted better between-therapist (patient-reported) global outcomes in naturalistic treatment, therapist overestimation (overconfidence bias) predicted worse between-therapist global outcomes. These results reinforce the importance of using an outcome measure to determine, and transparently report to the public, therapists' problem-specific effectiveness.
Nonverbal behavior is a central factor influencing the therapeutic relationship. Despite broad agreement on its importance, empirical studies assessing nonverbal behavior in counseling and ...psychotherapy are relatively scarce and often limited to few cases. One restraining factor may be the resources needed when assessing nonverbal behavior. Movement dynamics are an exemplary aspect of nonverbal behavior that can be captured with computer vision-a discipline concerned with the automated analysis of footage captured on video. One of the simplest methods requiring no special detectors, devices, or markers on patients or therapists is based on the assessment of differences in sequences of pictures (frames) found in video recordings. Algorithms of so-called frame-differencing methods may be implemented on commonly available computers, and they provide a good, straightforward assessment of, for example, patients' and therapists' movement dynamics in counseling and therapy sessions. Frame-differencing methods in psychology date back 36 years, but their use in counseling and psychotherapy research is only recently gaining momentum. In this introductory article, the use of one specific application suitable for the assessment of human motion from archival video material is presented. Motion energy analysis (MEA) is a procedure particularly appropriate for clinicians and researchers who have access to recordings of sessions or who wish to record their own video material. Focusing on the phenomenon of nonverbal synchrony-the coordination of movement between patient and therapist-a step-by-step demonstration of the stages involved in a successful application of MEA in psychotherapy research is provided.
Public Significance Statement
An objective, computer-based tool for the assessment of nonverbal behavior shown by dyads in counseling and psychotherapy is presented. Motion energy analysis (MEA) automatically quantifies movement dynamics shown by patients and therapists during their verbal interaction. This aspect of nonverbal behavior provides valuable information on specific characteristics of the therapeutic relationship and other facets of the therapy process. The practical use of MEA is illustrated in a sample of psychotherapy intake interviews.
This study examined the relationships between patient-therapist similarity and therapy outcome. We aimed to explore whether patient-therapist match in personality and attachment styles leads to a ...better therapy outcome.
We collected data from 77 patient-therapist dyads in short-term dynamic therapy. Patients' and therapists' personality traits (Big-5 Inventory) and attachment styles (ECR) were assessed prior to beginning therapy. Outcome was measured on the OQ-45.
When patients and therapists scored either high or low on neuroticism and conscientiousness we found a decrease in symptoms from beginning to end of therapy. When patients' and therapists' combined scores were either high or low on attachment anxiety, we found an increase in symptoms.
Match or mismatch on personality and attachment style in therapy dyads contributes to therapy outcome.
The Dependability of Alliance Assessments Crits-Christoph, Paul; Gibbons, Mary Beth Connolly; Hamilton, Jessica ...
Journal of consulting and clinical psychology,
06/2011, Letnik:
79, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Objective:
To examine the dependability of alliance scores at the patient and therapist level, to evaluate the potential causal direction of session-to-session changes in alliance and depressive ...symptoms, and to investigate the impact of aggregating the alliance over progressively more sessions on the size of the alliance-outcome relationship.
Method:
We used data from a study (
N
= 45 patients;
N
= 9 therapists) of psychotherapy for major depressive disorder in which the alliance was measured at every treatment session to calculate generalizability coefficients and to predict change in depressive symptoms from alliance scores. Two replication samples were also used.
Results:
At the therapist level, a large number of patients (about 60) per therapist is needed to provide a dependable therapist-level alliance score. At the patient level, generalizability coefficients revealed that a single assessment of the alliance is only marginally acceptable. Very good (>.90) dependability at the patient level is only achieved through aggregating 4 or more assessments of the alliance. Session-to-session change in the alliance predicted subsequent session-to-session changes in symptoms. Evidence for reverse causation was found in later-in-treatment sessions, suggesting that only aggregates of early treatment alliance scores should be used to predict outcome. Session 3 alliance scores explained 4.7% of outcome variance, but the average of Sessions 3-9 explained 14.7% of outcome variance.
Conclusion:
Adequate assessment of the alliance using multiple patients per therapist and at least 4 treatment sessions is crucial for fully understanding the size of the alliance-outcome relationship.
Objective: Psychotherapy researchers have long questioned whether increased therapist experience is linked to improved outcomes. Despite numerous cross-sectional studies examining this question, no ...large-scale longitudinal study has assessed within-therapist changes in outcomes over time. Method: The present study examined changes in psychotherapists' outcomes over time using a large, longitudinal, naturalistic psychotherapy data set. The sample included 6,591 patients seen in individual psychotherapy by 170 therapists who had on average 4.73 years of data in the data set (range = 0.44 to 17.93 years). Patient-level outcomes were examined using the Outcome Questionnaire-45 and a standardized metric of change (prepost d). Two-level multilevel models (patients nested within therapist) were used to examine the relationship between therapist experience and patient prepost d and early termination. Experience was examined both as chronological time and cumulative patients seen. Results: Therapists achieved outcomes comparable with benchmarks from clinical trials. However, a very small but statistically significant change in outcome was detected indicating that on the whole, therapists' patient prepost d tended to diminish as experience (time or cases) increases. This small reduction remained when controlling for several patient-level, caseload-level, and therapist-level characteristics, as well as when excluding several types of outliers. Further, therapists were shown to vary significantly across time, with some therapists showing improvement despite the overall tendency for outcomes to decline. In contrast, therapists showed lower rates of early termination as experience increased. Conclusions: Implications of these findings for the development of expertise in psychotherapy are explored.
Previous studies show that therapist mood is associated with psychotherapy processes, but the observational nature of these studies does not allow for causal inference. It is also unclear if other ...therapist characteristics, such as therapist trait empathy, moderate the relation between therapist mood and process variables. Thirty-four therapists and volunteer client dyads participated in three weekly counseling sessions. Before each session, therapists were induced to experience one of three moods, elation, depression, or neutral, in a counterbalanced order, using a combination of music and the Velten method. After each session, clients rated therapist empathy and session quality, therapists rated session quality, and observers rated therapist empathy using videotapes. Electrocardiogram was collected from therapists and clients during the session to assess heart rate synchrony as an indicator of therapist empathy. Therapist trait empathy moderated the effect of mood induction on observer-rated therapist empathy, such that when induced to experience elation, therapists with high trait empathy were observed to be more empathic, whereas therapists with low trait empathy were observed to be less empathic. Therapists of different trait empathy levels did not differ on observer-rated empathy when induced to experience depression or neutral mood. No significant effect of mood induction was found for client-rated empathy, client- and therapist-rated session quality, or heart rate synchrony. The experimental design offers preliminary evidence that therapist presession mood may influence the psychotherapy process. The findings are explained in light of empathy amplification and empathy attenuation hypotheses in relation to positive emotion. Practice and research implications are discussed.
Public Significance Statement
This study shows that therapists' mood may interact with therapists' trait characteristics to influence therapists' ability to convey empathy in counseling sessions. The demonstration of empathy is thus influenced by both personality and state factors, suggesting that therapists should pay attention to how their self and presession mood may affect their work with clients.
The primary aim of this study was to investigate the effects of the 2016 United States presidential election and ensuing political climate on patients’ experiences in psychotherapy. A sample of 604 ...self‐described Democrat and Republican patients from 50 states participated in the study. Results showed that most therapists disclosed their political stance (explicitly or implicitly) and most patients discussed politics with their therapists. 64% of Clinton supporters and 38% of Trump supporters assumed political similarity with their therapist. Stronger patient‐reported alliance levels were found for patients who (a) perceived political similarity; (b) reported implicit therapist political disclosure; and (c) found in‐session political discussions helpful. Additionally, Clinton (but not Trump) supporters reported significant pre‐post‐election decreases in expression of positive emotions and increases in both expression of negative emotions and engagement in discussions about socio‐political topics. Our findings suggest that the current political climate infiltrates the therapeutic space and affects therapeutic process and content.
Objective: The relationship between the therapeutic alliance and outcome has been supported consistently over time. More recently, studies have examined therapist effects in the alliance-outcome ...relationship and came up with somewhat mixed findings. The purpose of this study was to replicate and extend previous meta-analytic work using a much larger data set, permitting not only the verification of the overall impact of the therapists' contribution but, at the same time, controlling for several potential covariates effecting this relationship. Method: We conducted two- and three-level mixed-effects meta-analyses (k = 152; 827 total effect sizes) to examine the significance of several potential moderators of the alliance-outcome correlation. These moderators included (a) Patient-Therapist Ratio (PTR; Patient N divided by therapist N to test therapist effects), (b) Alliance and Outcome Rater's contribution (patient, therapist, observer, and other), (c) Alliance Measures, (d) Research Design (RCT, Other) and (e) Personality Disorder. Results: The PTR, an index of the therapist's contribution to the alliance, was a significant moderator of the alliance-outcome correlation in both the two- and three-level models. When several potential confounds were simultaneously tested in a three-level multipredictor metaregression, including rater of alliance and outcome, research design, alliance measure, and personality disorder, PTR remained a significant moderator of the alliance-outcome correlation. Conclusion: Replicating and extending previous research, this study supported the significance of therapists' impact in the alliance-outcome relationship. These results remained significant even when, using three-level metaregressions, several potential covariates were simultaneously controlled.
What is the public health significance of this article?
Previous research has established that the therapeutic alliance between the
therapist and the patient is robustly related to the success of psychotherapy. This meta-analysis
strongly suggests that more effective therapists are better able to form a strong alliance with
their patients than less effective therapists. Regardless of treatment provided to patients,
therapists need to be able to form an alliance with a variety of patients.
Facilitative interpersonal skills (FIS) are a promising variable to explain the so-called therapist effect. We aimed to investigate associations between observer-rated interpersonal skills and ...self-reported personal characteristics of future therapists.
In this cross-sectional observational study, psychology students and trainee therapists completed self-report personality and sociodemographic questionnaires as well as the FIS Performance Task (German version, observer-rated). Mixed multilevel model analysis was conducted with FIS total mean score (mean value of 312 individual ratings 13 video-clips, 8 FIS-items, 3 raters) as dependent variable, therapist ID and FIS clip ID as random effects and 15 therapist variables as fixed effects.
In the present sample consisting of 177 participants (age: M = 29.8 years (SD = 7.3), 18,59; 79.1% female, 20.9% male) greater therapists' experience level, male gender and lower levels of alexithymia were predictive for higher FIS score when statistically controlling for other therapist variables in the model. Age, self-reported childhood maltreatment, attachment style, emotion regulation and self-concept variables turned out to be unrelated.
The results can inform psychotherapy training programs. They specifically support the importance of addressing therapists' potential difficulties in recognizing and verbalizing emotions. This is in line with theoretical literature on alliance ruptures and premises of the Alliance-focused training.
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