Therapist effects on outcome and alliance in inpatient psychotherapy

Abstract

As an addition to the ongoing discussion concerning the magnitude of therapist effects on outcome in psychotherapy, we investigated therapist variability in a large inpatient psychotherapy sample. We included global symptomatic outcome (Global Severity Index of the Symptom Checklist-90 Revised [SCL-90-R]; German version, Franke, 1995) and alliance (Helping Alliance Questionnaire; German version, Bassler, Potratz & Krauthauser, 1995) ratings of 2554 inpatients who were treated by 50 psychotherapists. Multilevel regression analyses (HLM; Raudenbush, Bryk, Cheong, & Congdon, 2004) were used for analyses. Overall, therapists accounted for a much greater variability on alliance (33%) than on outcome (3%). Therapists were differentially effective with regard to their patients' symptom severity at the beginning of treatment, and therapists differed in the degree that a positive alliance was associated with therapeutic outcome. The relatively small therapist effect on outcome is attributed to compensatory mechanisms in the specific context of inpatient therapy.

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

“…Nonetheless, several studies have at least approximately reached tolerable sample sizes (e.g. Dinger, Strack, Leichsenring, Wilmers, & Schauenburg, 2008;Lutz, Leon, Martinovich, Lyons, & Stiles, 2007;Okiishi, Lambert, Nielsen, & Ogles, 2003) with an average of 55 therapists per dataset, who treated at least 10 patients each, resulting in samples ranging from N = 1,779 to N = 2,554 cases. However, in Baldwin and Imel's (2013) review, 43 out of 46 studies can be classified as having serious sample size problems.…”

Therapist variation within randomised trials of psychotherapy: implications for precision, internal and external validity

“…Luborsky 8 ). Since then associations between therapist characteristics and patient outcomes have been studied (see reviews by Parloff et al 9 and Beutler et al 10 ) and comparisons made of patient outcomes between individual therapists (see Ricks,11 Howard et al, 12 Orlinsky and Howard, 13 Brooker and Wiggins, 14 Luborsky et al, 15,16 McLellan et al 17 and Shapiro et al 18 for early examples; Okiishi et al, 19,20 Wampold and Brown, 21 McKay et al, 22 Lutz et al, 23 Baldwin et al 24 and Dinger et al 25 Despite awareness of therapist variability, the statistical and wider conceptual implications of therapist variation for psychotherapy trials have not been widely recognised. Research on the relationship between individual therapists and patient outcomes has also been separated from randomised trials.…”

Positions Constructed for a Female Therapist in Male Batterers' Treatment Group

“…Psychotherapy research has consistently demonstrated that the strength of the clienttherapist alliance is significantly related to positive outcomes in therapy (Blow, Sprenkle, & Davis, 2007;Dinger, Strack, Leichsenring, Wilmers, & Schauenburg, 2008). The gender of the therapist, like other demographic characteristics, has only a minor if any effect on the alliance (Dinger et al 2008).…”