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

Abstract

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.

Do therapists' subjective variables impact on psychodynamic psychotherapy outcomes? A systematic literature review

“…Despite most practice guidelines depict therapists who perform procedures on Diagnostic and Statistical Manual of Mental Disorders ( DSM ) categories of psychiatric disorders without considering the contribution of their individual and subjective characteristics (Norcross, ), growing evidence demonstrates that therapists significantly differ in their effectiveness (Crits‐Christoph & Mintz, ; Del Re, Flückiger, Horvath, Symonds, & Wampold, ; Goldberg, Hoyt, Nissen‐Lie, Nielsen, & Wampold, ; Luborsky, McLellan, Diguer, Woody, & Seligman, ; Okiishi, Lambert, Nielsen, & Ogles, ; Saxon, Barkham, Foster, & Parry, ; Zimmermann, Rubel, Page, & Lutz, ), and therapist factors account for 5% to 9% of outcome variance in psychotherapy (Baldwin & Imel, ; Crits‐Christoph et al, ). Although this effect seems small in magnitude, a careful comparison with other therapeutic factors in psychotherapy shows that the person of the therapist represents one of the most influential factors in patient outcome, along with other key therapy ingredients, including—most notably—the well‐studied therapeutic alliance (Horvath, Del Re, Flückiger, & Symonds, ).…”

Evaluating the effectiveness and cost-effectiveness of British Sign Language Improving Access to Psychological Therapies: an exploratory study

“…161,162 Again, these effects are not directly included in the model, which may overestimate the benefits of treatment and underestimate the costs. However, whether either the long-lasting or shorter-term bad effects differ between the BSL and standard IAPT services is unknown.…”

“…Furthermore, in the comparative analyses it should be noted that BSL-IAPT is a single-service provider with the same personnel (regardless of delivery location), whereas standard IAPT is made up of a number of different services with variable degrees of experience of Deaf people ranging from 1 client to 24 clients. This, combined with growing evidence about therapist effects on participant engagement and negative outcomes, 162,168 increases uncertainty about the robustness and transferability of our comparisons of outcomes. To reduce uncertainty in the comparative analyses of clinical outcomes, a far greater number of Deaf clients would be required per standard IAPT service, whether a single service or a combined standard IAPT service.…”

“…Data limitations meant that the costs and consequences of adverse events (worsening of existing symptoms and emergence of new symptoms) and of service users stopping or dropping out of therapy 161,162 were not explicitly included in the decision tree part of the model. In the longer term, the costs and consequences of these events are modelled indirectly through the probability that service users do not experience partial or full recovery and the subsequent costs and QALYs associated with relapse/recurrence.…”

Contradicciones de la psiquiatría médica

“…Se han identificado distintos moderadores de la deserción como las expectativas (Aubuchon-Endsley y Callahan, 2009; Greenberg, Constantino y Bruce, 2006) y el efecto del terapeuta (Saxon, Barkham, Foster y Parry, 2017;Zimmermann, Rubel, Page y Lutz, 2017) entre otros. La deserción ocurre comúnmente en la psicoterapia afectando a todas las modalidades, métodos y modelos de administración de tratamientos, incluidas las psicoterapias más sólidas basadas en la evidencia como lo son para el estado de ánimo, la ansiedad y otros trastornos psicológicos (Nathan y Gorman, 2015).…”