Unpacking the therapist effect: Impact of treatment length differs for high- and low-performing therapists
Abstract
OBJECTIVE: Differences between therapists in their average outcomes (i.e., therapist effects) have become a topic of increasing interest in psychotherapy research in the past decade. Relatively little work, however, has moved beyond identifying the presence of significant between-therapist variability in patient outcomes. The current study sought to examine the ways in which therapist effects emerge over the course of time in psychotherapy. METHOD: We used a large psychotherapy data set (n = 5828 patients seen by n = 158 therapists for 50,048 sessions of psychotherapy) and examined whether outcomes diverge for high-performing (HP) and low-performing (LP) therapists as treatment duration increases. RESULTS: Therapists accounted for a small but significant proportion of variance in patient outcomes that was not explained by differences between therapists' caseload characteristics. The discrepancy in outcomes between HP and LP therapists increased as treatment duration increased (interaction coefficient = 0.071, p < .001). In addition, patients' trajectories of change were a function of their therapist's average outcome as well as the patient's duration of treatment (interaction coefficient = 0.060, p = .040). CONCLUSIONS: Indeed, patterns of change previously described ignoring between-therapist differences (e.g., dose-effect, good-enough level model) may vary systematically when disaggregated by therapist effect.
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Approximately 87% (29,012/33,492) of clients achieved clinical improvement over a median of 6 live synchronous sessions, compared with 22%-67% improvement rates over 8-15 sessions (or even longer) in traditional mental health care settings.
“Approximately 87% (29,012/33,492) of clients achieved clinical improvement (ie, reliable improvement or recovery) over a median of 6 live synchronous sessions, compared with 22%-67% improvement rates over 8-15 sessions (or even longer) in traditional mental health care settings [19,39-41].”
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- Authors
- Goldberg, S. B., Hoyt, W. T., Nissen-Lie, H. A., Nielsen, S. L., & Wampold, B. E.
- Affiliations
- University of Wisconsin–Madison (US)
- Department of Psychology, University of Oslo, Oslo, Norway
- Brigham Young University (US)
- Corresponding author
- Goldberg, Simon B.
- Venue
- Psychotherapy Research
- Publisher
- Informa UK Limited
- Published
- 2016-09-12
- Volume
- 28
- Issue
- 4
- Pages
- 532-544
- ISSN
- 1050-3307 (ISSN-L)
- 1468-4381
- OpenAlex
- W2520727566
- Cited by
- 35
- References
- 44
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 5 · 2021: 2 · 2020: 4 · 2019: 5 · 2018: 5 · 2017: 5
- FWCI
- 6.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychotherapy Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Society for Psychotherapy Research
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Social Psychology › Counseling Practices and Supervision
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- therapist effects, treatment duration, patient outcomes, dosage effect, change trajectories, psychotherapy outcome
- MeSH terms
- Work Performance, Adult, Mental Disorders, Health Personnel, Humans, Psychotherapy, Time Factors, Models, Statistical, Outcome Assessment, Health Care, Multilevel Analysis
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