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Therapist effects on early change in psychotherapy in a naturalistic setting.
OBJECTIVE: Client trajectories of change in psychotherapy differ. Early change is a trajectory that has been shown to be associated with better outcomes over time. Little is known about the mechanisms of this type of change, however. The current study examined the therapist effect in early change, and explored differences between therapists in the likelihood that early change would occur and how early in a course of therapy the change would occur.
METHODS: Using 20 years of archival data from a university counseling center, we identified 16,825 clients who had been seen by 273 therapists. We examined therapist differences using chi-square analyses, multilevel logistic regression, and survival analyses.
RESULTS: We found significant variance between therapists in both their likelihood to predict early change, and how early that change was predicted to occur. Therapist effects, however, accounted for a small portion of the overall variance; despite this small effect, differences between the best performing therapists and the worst performing therapists were substantial.
CONCLUSIONS: Therapists were differentially effective in helping clients achieve early change. Future research examining mechanisms associated with these effects will be important in informing psychotherapy process and therapist training. Clinical or methodological significance of this article: Psychotherapy clients who experience early reduction of symptoms have been shown to be more likely to recover and to maintain recovery over time; it remains unclear, however, what factors contribute to this type of change. Our study showed that therapists have some effect on this change, and that a client is significantly more likely to experience it if they are being treated by one of the few exceptional therapists. We discuss the potential importance of exploring this finding further in order to strengthen therapist training and increase the overall effectiveness of psychotherapy.
METHODS: Using 20 years of archival data from a university counseling center, we identified 16,825 clients who had been seen by 273 therapists. We examined therapist differences using chi-square analyses, multilevel logistic regression, and survival analyses.
RESULTS: We found significant variance between therapists in both their likelihood to predict early change, and how early that change was predicted to occur. Therapist effects, however, accounted for a small portion of the overall variance; despite this small effect, differences between the best performing therapists and the worst performing therapists were substantial.
CONCLUSIONS: Therapists were differentially effective in helping clients achieve early change. Future research examining mechanisms associated with these effects will be important in informing psychotherapy process and therapist training. Clinical or methodological significance of this article: Psychotherapy clients who experience early reduction of symptoms have been shown to be more likely to recover and to maintain recovery over time; it remains unclear, however, what factors contribute to this type of change. Our study showed that therapists have some effect on this change, and that a client is significantly more likely to experience it if they are being treated by one of the few exceptional therapists. We discuss the potential importance of exploring this finding further in order to strengthen therapist training and increase the overall effectiveness of psychotherapy.
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