Psychotherapy Research

Castonguay, Louis G.; Norberg, Samuel S.; Schut, Alexander J.; Constantino, Michael J.

doi:10.1002/9780470479216.corpsy0754

Cited by 2 publications

(1 citation statement)

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“…Given that processes that occur during a course of psychotherapy can come in many guises, we are adopting a broad definition of a during-therapy process variable as any variable that might help explain how treatment works, whether measured in a moment during a session, following a session, or at some other time after treatment starts but before it ends (Castonguay, Nordberg, Schut, & Constantino, 2010). With this broad definition in mind, duringtherapy process characteristics that might explain therapist effects could be explicit dyadic processes such as client-therapist bond, goal agreement, or collaboration.…”

Section: Characteristics Of During-therapy Processmentioning

confidence: 99%

Who works for whom and why? Integrating therapist effects analysis into psychotherapy outcome and process research.

Constantino

Boswell

Coyne

et al. 2017

How and Why Are Some Therapists Better Than Others?: Understanding Therapist Effects.

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multiple specific client outcome domains (e.g., depression, anxiety, substance use, sleep, quality of life, sexual functioning) with a measure like the Treatment Outcome Package (Kraus, Seligman, & Jordan, 2005), two main findings have emerged.First, in large naturalistic samples, therapist effects are evident on specific outcomes; the individual psychotherapist can have a notable effect on clients' depression, substance use, and so forth (Kraus et al., 2016;Kraus, Castonguay, Boswell, Nordberg, & Hayes, 2011). Practically, when assessing a specific outcome domain such as depression, some therapists' clients (on average) achieve consistently better depression reduction than other therapists' clients (on average), with this same notion holding for other specific outcome domains. Although, which therapists are more effective could, and likely would, differ depending on the domain. Interestingly, the degree to which variability in a specific outcome is explained by therapists varies by domain. For example, in the Kraus et al. ( 2016) study, when accounting for initial severity and other risk factors (e.g., unemployment, divorce), the therapist had a more pronounced effect on outcome domains, like substance abuse (18.28% variance explained) and quality of life (18.72%) than other domains, like psychosis (3.71%) and mania (1.56%). Practically, it appears that the person of the therapist may have a greater influence when treating clients with substance abuse problems than when treating clients with psychosis (for the latter, other factors will explain a greater portion of the outcome variance pie). Others have replicated this finding of differential therapist effects across quality of life, functional, and symptom domains (e.g., Owen, Adelson, Budge, Kopta, & Reese, 2016).The second finding that has emerged from multidimensional outcome studies focused on the therapists is a pattern of relative strengths and weaknesses within therapists' own practice. In the Kraus et al. ( 2011) study, results demonstrated a differential pattern of individual therapist performance depending on their clients' problem domain; for example, some therapists demonstrated substantial effectiveness in depression reduction but ineffective ness or even harm in other domains. Many therapists demonstrated effectiveness over multiple domains, yet no therapists demonstrated reliable effectiveness across all domains. A small but notable 4% of therapists failed to demonstrate positive outcomes on any domain. These findings were replicated in the Kraus et al. ( 2016) study; even after controlling for significant variance at the client level, therapists demonstrated differential patterns of relative strengths and weaknesses within their caseload. Additionally, hierarchical linear modeling-based correlations demonstrated stability in therapists' domain-specific performance across subsequent clients. As one concrete example, therapists who were particularly effective in facilitating depression reduction in one wave of 30 clients within their caseload rema...

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Section: Characteristics Of During-therapy Processmentioning

confidence: 99%