Experience is often regarded as a prerequisite of high performance. In the field of psychotherapy, research has yielded inconsistent results regarding the association between experience and therapy outcome. However, this research was mostly conducted cross-sectionally. A longitudinal study from the U.S. recently indicated that psychotherapists' experience was not associated with therapy outcomes. The present study aimed at replicating study in the German healthcare system. Using routine evaluation data of a large German university psychotherapy outpatient clinic, the effect of N = 241 therapists' experience on the outcomes of their patients (N = 3,432) was assessed longitudinally using linear and logistic multilevel modeling. Experience was operationalized using the number of days since the first patient of a therapist as well as using the number of patients treated beforehand. Outcome criteria were defined as change in general psychopathology as well as response, remission, and early termination. Several covariates (number of sessions per case, licensure, and main diagnosis) were also examined. Across all operationalizations of experience (time since first patient and number of cases treated) and therapy outcome (change in psychopathology, response, remission, and early termination), results largely suggest no association between therapists' experience and therapy outcome. Preliminary evidence suggests that therapists need fewer sessions to achieve the same outcomes when they gain more experience. Therapeutic experience seems to be unrelated to patients' change in psychopathology. This lack of findings is of importance for improving postgraduate training and the quality of psychotherapy in general.
Public Significance StatementThis study suggests that psychotherapists' experience is largely not associated with the amount of improvement their patients achieve throughout therapy. These results call for further investigations into the mechanisms of psychotherapy and what makes psychotherapy effective.
Background: Outcome predictions allow to improve psychotherapy and to increase economic benefit. The efficient translation into practice requires simple prediction methods. The present study evaluates the prediction of treatment outcome based on initial distress level. Methods: Routine data of a university psychotherapy outpatient clinic were used (N = 3,145, Mage = 35.8, 67% female). Low versus high distress patients (classified by overall psychological distress, symptomatology, and previous treatment) were compared on total reduction in psychopathology, (early) response, remission, and premature treatment discontinuation using t tests and logistic regressions. Response and remission were assessed via relative (percentage improvement) and absolute measures (Reliable Change Index; RCI). Results: Distress level was inversely related to percentage improvement (OR = 0.62) and remission (OR = 0.34). It was positively related to total reduction in psychopathology (d = 0.63), RCI response (OR = 2.37), and treatment discontinuation (OR = 2.15). Early response and treatment discontinuation partially mediated the relationship between distress level and treatment outcome. Conclusions: Treatment success tends to be lower when initial distress is high, but this finding appears contingent on the operationalization of treatment outcome. The presented classification approach is easy to implement in practice and may be useful in order to counter an excessive workload in psychotherapy trainees.
<b><i>Hintergrund:</i></b> Erfolgsprognosen ermöglichen eine stetige Weiterentwicklung und ökonomische Anwendung von Psychotherapie. Deren effizienter Einsatz in der Praxis bedarf einer einfach umzusetzenden Prognosestellung. Die vorliegende Studie prüft die Vorhersage von Therapieerfolg aufgrund des anfänglichen Belastungsniveaus. <b><i>Methoden:</i></b> Verwendet wurden Daten aus der Routineevaluation einer psychotherapeutischen Hochschulambulanz von 3’145 PatientInnen (M<sub>Alter</sub> = 35,8, 67% weiblich). Anhand vor Therapiebeginn vorliegender Kriterien (allgemeine psychische Belastung, Symptomatik, Vorbehandlung) wurden niedrig versus hoch belastete PatientInnen differenziert und bezüglich der Erfolgsmaße absolute Belastungsreduktion, (Early) Response, Remission und Therapieabbruch mithilfe von <i>t</i>-Tests und logistischen Regressionsanalysen verglichen. Response und Remission wurden über ein relatives (prozentuale Verbesserung) und ein absolutes Maß (Reliable Change Index, RCI) operationalisiert. <b><i>Ergebnisse:</i></b> Hohe psychische Belastung stand in negativem Zusammenhang mit Response gemäß prozentualer Verbesserung (OR = 0,62) und Remission (OR = 0,34) sowie in positivem Zusammenhang mit absoluter Belastungsreduktion (<i>d</i> = 0,63), RCI-Response (OR = 2,37) und Therapieabbruch (OR = 2,15). Early Response und Therapieabbruch nahmen im Zusammenhang von anfänglichem Belastungsniveau und Behandlungserfolg eine partiell vermittelnde Rolle ein. <b><i>Schlussfolgerungen:</i></b> Behandlungserfolge fallen bei hoher anfänglicher psychischer Belastung vergleichsweise geringer aus, wobei die Operationalisierung von Erfolg eine entscheidende Rolle spielt. Die vorgestellte Klassifizierung ist leicht umzusetzen und kann im Ausbildungssetting helfen, einer therapeutischen Überlastung entgegenzuwirken.
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