Therapist effects, effective therapists, and the law of variability.

Abstract

which refers to the finding that some therapists are more effective than others, and the second is variability, which refers to the natural phenomenon that pervades almost all human endeavors, such that achieving similar levels of skills within a profession is nigh on impossible. In this chapter, we first set out more fully the central definitions and concepts relating to therapist effects, effective therapists, and variability. We then provide a brief history of research in this field, focus on how research studies are moving toward placing therapists at the center of research-what we term therapist-focused research-and identify one situation where therapist effects appear most apparent. We draw together six substantive conclusions concerning our current view of therapist effects and flag key directions for improving research before concluding with a section on applying research in this field to key areas of practice.Our aim is to introduce readers to the conceptual issues that underpin implications for practitioners, policymakers, and researchers. However, this chapter focuses primarily on therapist effects and is, therefore, only a starting point. For specific perspectives, we direct interested readers to more detailed accounts within this volume (e.g., Chapters 2 and 3 address characteristics and behaviors of effective therapists, as well as statistical and methodological strategies to identify these therapist factors; Chapter 16 discusses what to do with data related to therapist effects in terms of practice, training, and policymaking). DEFINITIONS AND CONCEPTSThe term therapist effects encompasses conceptual, clinical, and statistical phenomena that refer to "the contribution that can be attributed to therapists when evaluating the efficacy of a psychological intervention" (Lutz & Barkham, 2015, p. 1). In this sense, therapist effects can be distinguished from reporting on the effectiveness of therapists. Therapist effects refer to the contribution made to the outcome variance that can be apportioned to therapists rather than to other variables, primarily the client. For example, an article might report that 8% of outcome variance was attributable to therapists. This would be sufficient for a clinic to take note and appreciate that it is not just the treatment or therapy that is important for client outcomes. It is predominantly a term used in research but which has widespread implications for clinical practice and policy. The term therapist effects captures the variability that is attributable to therapists. If there was no therapist effect, all therapists would yield identical client outcomes (i.e., there would be no variability). In this scenario, it would not matter which therapist clients see, as outcomes would not vary between therapists.

Therapeutische Fertigkeiten – Relevanz für Ausbildung, Praxis und Forschung

“…Sie erklären circa 5 % der Varianz am Therapieerfolg. Dieser Effekt wiegt bei schwerer gestörten Patien-tInnen mehr [4] [5]. Verglichen mit anderen Wirkfaktoren beeinflussen sie das Ergebnis einer Psychotherapie nur begrenzt.…”

Pericia, Efectos Del Terapeuta Y Práctica Deliberada: El Ciclo De La Excelencia

“…Convertirse en experto en psicología clínica y en psicoterapia son objetivos que todo residente y especialista deberían plantearse seriamente. Sin embargo, alcanzar un rendimiento superior a la media no es una tarea ni sencilla ni frecuente (Baldwin y Imel, 2013;Barkham, Lutz, Lambert y Saxon, 2017). Probablemente porque el camino hacia la excelencia clínica es largo, desafiante, esforzado, sacrificado, solitario, muchas veces frustrante y exige perseverar.…”

“…Precisamente un resultado de este tipo es lo que se conoce en investigación en psicoterapia como efectos del terapeuta. La variable efectos del terapeuta es un constructo transteórico que puede conceptualizarse como un factor común presente en las diferentes formas de psicoterapia y que se define habitualmente como el porcentaje de la varianza de los resultados de la psicoterapia que se explica por la persona del profesional, con independencia del efecto de otros aspectos como el tipo de tratamiento, las técnicas empleadas o JAVIER PRADO-ABRIL, ALBERTO GIMENO-PEÓN, FÉLIX INCHAUSTI Y SERGIO SÁNCHEZ-REALES el diagnóstico del paciente (Baldwin y Imel, 2013;Barkham et al, 2017;Castonguay y Hill, 2017).…”

“…Saxon y Barkham (2012) reportan un 6,6% de la varianza del resultado de la psicoterapia. Y, recientemente, Barkham et al (2017), tras revisar exhaustivamente toda la literatura disponible, concluyen que el porcentaje se encuentra entre el 5% y el 8%, matizando que el tamaño del efecto está en función de la gravedad inicial del paciente. Es decir, cuanto más grave es el caso mayor importancia cobran los efectos del terapeuta (Inchausti, Prado-Abril, Sánchez-Reales, Vilagrà-Ruiz y Fonseca-Pedrero, 2018).…”

An evaluation of the effectiveness and acceptability of a new technology system to support psychotherapy helping skills training

“…There is now a trend in the psychotherapy research literature towards understanding the effects of individual therapists rather than the therapy approach and its association with outcomes (Castonguay & Hill, ). Large‐scale studies using practice‐based research designs have considered individual therapist effects by clustering groups of clients nested within therapist caseloads (Barkham, Lutz, Lambert, & Saxon, ). Such designs allow for the effects of individual therapists to be modelled within large data sets, such as that derived from the UK’s IAPT programme (Saxon & Barkham, ).…”