Patterns of therapist variability: Therapist effects and the contribution of patient severity and risk.

Saxon, David; Barkham, Michael

doi:10.1037/a0028898

Cited by 152 publications

(171 citation statements)

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“…This extended range held even when a standardization procedure based on the average impairment of a clinical reference sample was implemented to control for the impact of initial impairment. Initial patient severity was found to be a significant predictor in all naturalistic datasets as well as in the integrated total dataset, which replicates former research (Saxon & Barkham, 2012). Additionally, in all eight datasets we consistently found the random slope model to be significantly superior as compared to the fixed slope model.…”

Section: Discussionsupporting

confidence: 72%

“…In sum, the size of the TE in the three-level MLM was comparable to the findings in the most recent meta-analysis in this field, which suggested that approximately 7% of the variance in outcome was associated with therapists in naturalistic study designs (Baldwin & Imel, 2013). In addition, the distribution of therapist effectiveness was akin to that reported by Saxon and Barkham (2012), although our data revealed approximately 10% more therapists to be average. Although variations in sample sizes across datasets may partially explain the range of TEs in the current study sample, it is unlikely to be the only source of variability across datasets.…”

Section: Discussionmentioning

confidence: 59%

“…The analyses were conducted for pre-post models, which were corrected for initial impairment. This model has emerged to be the most applied model in TE research (Baldwin & Imel, 2013;Saxon & Barkham, 2012). However, there is a broad range of more complex models in the field of multilevel modeling.…”

Section: Discussionmentioning

confidence: 99%

“…So far, very few research studies have been able to realize these sample size demands (e.g. Saxon & Barkham, 2012). Nonetheless, several studies have at least approximately reached tolerable sample sizes (e.g.…”

mentioning

confidence: 99%

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Reliability of Therapist Effects in Practice-Based Psychotherapy Research: A Guide for the Planning of Future Studies

Schiefele

Lutz

Barkham

et al. 2016

Adm Policy Ment Health

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Reliability of Therapist Effects in Practice-Based Psychotherapy Research: A Guide for the Planning of Future Studies

Schiefele

Lutz

Barkham

et al. 2016

Adm Policy Ment Health

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“…The residual for each therapist represents the degree to which a therapist's outcomes depart from those of the average therapist while controlling for patient characteristics (case-mix) and can be seen as the additional, unexplained impact of the therapist on & Spiegelhalter, 1996;Rasbash et al, 2009;Saxon & Barkham, 2012).…”

Section: Discussionmentioning

confidence: 99%

The Contribution of Therapist Effects to Patient Dropout and Deterioration in the Psychological Therapies

Saxon

Barkham

Foster

et al. 2016

Clin Psychology and Psychoth

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Background In the psychological therapies, patient outcomes are not always positive. Some patients leave therapy prematurely (dropout), while others experience deterioration in their psychological well‐being. Methods The sample for dropout comprised patients (n = 10 521) seen by 85 therapists, who attended at least the initial session of one‐to‐one therapy and completed a Clinical Outcomes in Routine Evaluation‐Outcome Measure (CORE‐OM) at pre‐treatment. The subsample for patient deterioration comprised patients (n = 6405) seen by the same 85 therapists but who attended two or more sessions, completed therapy and returned a CORE‐OM at pre‐treatment and post‐treatment. Multilevel modelling was used to estimate the extent of therapist effects for both outcomes after controlling for patient characteristics. Results Therapist effects accounted for 12.6% of dropout variance and 10.1% of deterioration variance. Dropout rates for therapists ranged from 1.2% to 73.2%, while rates of deterioration ranged from 0% to 15.4%. There was no significant correlation between therapist dropout rate and deterioration rate (Spearman's rho = 0.07, p = 0.52). Conclusions The methods provide a reliable means for identifying therapists who return consistently poorer rates of patient dropout and deterioration compared with their peers. The variability between therapists and the identification of patient risk factors as significant predictors has implications for the delivery of safe psychological therapy services. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Therapists play an important role in contributing to patient dropout and deterioration, irrespective of case mix. Therapist effects on patient dropout and deterioration appear to act independently. Being unemployed as a patient was the strongest predictor of both dropout and deterioration. Patient risk to self or others was also an important predictor.

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Effect of Matching Therapists to Patients vs Assignment as Usual on Adult Psychotherapy Outcomes

et al. 2021

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IMPORTANCE Psychotherapists possess strengths and weaknesses in treating different mental health problems, yet performance information is rarely harnessed in mental health care (MHC). To our knowledge, no prior studies have tested the causal efficacy of prospectively matching patients to therapists with empirically derived strengths in treating patients' specific concerns.OBJECTIVE To test the effect of measurement-based matching vs case assignment as usual (CAU) on psychotherapy outcomes. DESIGN, SETTING, AND PARTICIPANTSIn this randomized clinical trial, adult outpatients were recruited between November 2017 and April 2019. Assessments occurred at baseline and repeatedly during treatment at 6 community MHC clinics in Cleveland, Ohio. To be eligible, patients had to make their own MHC decisions. Of 1329 individuals screened, 288 were randomized. Excluding those who withdrew or provided no assessments beyond baseline, 218 patients treated by 48 therapists were included in the primary modified intent-to-treat analyses.INTERVENTIONS Therapist performance was assessed pretrial across 15 or more historical cases based on patients' pre-post reporting across 12 problem domains of the routinely administered Treatment Outcome Package (TOP). Therapists were classified in each domain as effective (on average, patients' symptoms reliably improved), neutral (on average, patients' symptoms neither reliably improved nor deteriorated), or ineffective (on average, patients' symptoms reliably deteriorated). Trial patients were randomly assigned to good-fitting therapists (matched group) or were assigned to therapists pragmatically (CAU group). There were multiple match levels, ranging from therapists being effective on the 3 most elevated domains reported by patients and not ineffective on any others (highest) to not effective on the most elevated domains reported by patients but also not ineffective on any domain (lowest). Therapists treated patients in the matched and CAU groups, and treatment was unmanipulated.MAIN OUTCOMES AND MEASURES General symptomatic and functional impairment across all TOP domains (average z scores relative to the general population mean; higher scores indicate greater impairment), global distress (Symptom Checklist-10; higher scores indicate greater distress), and domain-specific impairment on each individual's most elevated TOP-assessed problem. RESULTSOf 218 patients, 147 (67.4%) were female, and 193 (88.5%) were White. The mean (SD) age was 33.9 (11.2) years. Multilevel modeling indicated a match effect on reductions in weekly general symptomatic and functional impairment (γ 110 = −0.03; 95% CI, −0.05 to −0.01; d = 0.75), global distress (γ 110 = −0.16; 95% CI, −0.30 to −0.02; d = 0.50), and domain-specific impairment (γ 110 = −0.01; 95% CI −0.01 to −0.006; d = 0.60), with no adverse events. CONCLUSIONS AND RELEVANCEMatching patients with therapists based on therapists' performance strengths can improve MHC outcomes.

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Patterns of therapist variability: Therapist effects and the contribution of patient severity and risk.

Cited by 152 publications

References 62 publications

Reliability of Therapist Effects in Practice-Based Psychotherapy Research: A Guide for the Planning of Future Studies

Reliability of Therapist Effects in Practice-Based Psychotherapy Research: A Guide for the Planning of Future Studies

The Contribution of Therapist Effects to Patient Dropout and Deterioration in the Psychological Therapies

Effect of Matching Therapists to Patients vs Assignment as Usual on Adult Psychotherapy Outcomes

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