Understanding the Therapist Contribution to Psychotherapy Outcome: A Meta-Analytic Approach
- 1.5k Downloads
Understanding the role that therapists play in psychotherapy outcome, and the contribution to outcome made by individual therapist differences has implications for service delivery and training of therapists. In this study we used a novel approach to estimate the magnitude of the therapist contribution overall and the effect of individual therapist differences. We conducted a meta-analysis of studies in which participants were randomised to receive the same treatment either through self-help or through a therapist. We identified a total of 15 studies (commencement N = 910; completion N = 723) meeting inclusion criteria. We found no difference in treatment completion rate and broad equivalence of treatment outcomes for participants treated through self-help and participants treated through a therapist. Also, contrary to our expectations, we found that the variability of outcomes was broadly equivalent, suggesting that differences in efficacy of individual therapists were not sufficient to make therapy outcomes more variable when a therapist was involved. Overall, the findings suggest that self-help, with minimal therapist input, has considerable potential as a first-line intervention. The findings did not suggest that individual differences between therapists play a major role in psychotherapy outcome.
KeywordsTherapist effects Self-help psychotherapy Cognitive behavior therapy Meta-analysis
This study was financed by Queensland University of Technology. No external funding was involved.
Compliance with Ethical Standards
Conflict of interest
The authors listed above declare that they have no conflict of interest.
Research Involving Human Rights
This article relies entirely on analysis of secondary data. It does not contain any studies with human participants performed by any of the authors. References marked with an asterisk indicate studies included in the meta-analysis.
- American Psychological Association. (2012). Recognition of psychotherapy effectiveness. Retrieved from http://www.apa.org/about/policy/resolution-psychotherapy.aspx.
- Andrews, G., Cuijpers, P., Craske, M. G., McEvoy, P., & Titov, N. (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: A meta-analysis. PLoS One, 5(10), e13196. doi: 10.1371/journal.pone.0013196.CrossRefPubMedPubMedCentralGoogle Scholar
- Baldwin, S., & Imel, Z. (2013). Therapist effects: Findings and methods. In M. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behaviour change (6th edn.). Hoboken, NJ: Wiley.Google Scholar
- Borenstein, M., Hedges, L., Higgins, J., & Rothstein, H. (2005). Comprehensive meta-analysis: Version 2 (Version 2.2.021). Englewood, NJ: Biostat.Google Scholar
- Botella, C., Gallego, M. J., Garcia-Palacios, A., Guillen, V., Baños, R. M., Quero, S., & Alcañiz, M. (2010). An Internet-based self-help treatment for fear of public speaking: A controlled trial. Cyberpsychology, Behavior and Social Networking, 13, 407–421. doi: 10.1089/cyber.2009.0224.CrossRefPubMedGoogle Scholar
- Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., Fennell, M., Herbert, C., & Mayou, R. (2003). A randomized controlled trial of Cognitive Therapy, a self-help booklet, and repeated assessments as early interventions for Posttraumatic Stress Disorder. Archives of General Psychiatry, 60, 1024–1032. doi: 10.1001/archpsyc.60.10.1024.CrossRefPubMedGoogle Scholar
- Greist, J. H., Marks, I. M., Baer, L., Kobak, K. A., Wenzel, K. W., Hirsch, M. J., … Clary, C. M. (2002). Behavior therapy for obsessive–compulsive disorder guided by a computer or by a clinician compared with relaxation as a control. Journal of Clinical Psychiatry, 63, 138–145. doi: 10.4088/JCP.v63n0209.CrossRefPubMedGoogle Scholar
- Higgins, J. P. T., & Green, S. (2009). Cochrane handbook for systematic reviews of interventions version 5.0.2. Chichester: Wiley.Google Scholar
- Kay-Lambkin, F. J., Baker, A. L., Lewin, T. J., & Carr, V. J. (2009). Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: A randomized controlled trial of clinical efficacy. Addiction (Abingdon, England), 104, 378–388. doi: 10.1111/j.1360-0443.2008.02444.x.CrossRefGoogle Scholar
- Kilfedder, C., Power, K., Karatzias, T., McCafferty, A., Niven, K., Chouliara, Z., … Sharp, S. (2010). A randomized trial of face-to-face counselling versus telephone counselling versus bibliotherapy for occupational stress. Psychology and Psychotherapy, 83, 223–242. doi: 10.1348/147608309X476348.CrossRefPubMedGoogle Scholar
- Kiropoulos, L. A., Klein, B., Austin, D. W., Gilson, K., Pier, C., Mitchell, J., & Ciechomski, L. (2008). Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT? Journal of Anxiety Disorders, 22, 1273–1284. doi: 10.1016/j.janxdis.2008.01.008.CrossRefPubMedGoogle Scholar
- Leong, J., Cobham, V. E., de Groot, J., & McDermott, B. (2009). Comparing different modes of delivery: A pilot evaluation of a family-focused, cognitive-behavioral intervention for anxiety-disordered children. European Child & Adolescent Psychiatry, 18, 231–239. doi: 10.1007/s00787-008-0723-7.CrossRefGoogle Scholar
- Lipsey, M., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks, CA: Sage.Google Scholar
- Marks, I. M., Kenwright, M., McDonough, M., Whittaker, M., & Mataix-Cols, D. (2004). Saving clinicians’ time by delegating routine aspects of therapy to a computer: A randomized controlled trial in phobia/panic disorder. Psychological Medicine, 34, 9–17. doi: 10.1017/S003329170300878X.CrossRefPubMedGoogle Scholar
- Newman, M. G., Kenardy, J., Herman, S., & Taylor, C. B. (1997). Comparison of palmtop-computer-assisted brief cognitive-behavioral treatment to cognitive-behavioral treatment for Panic Disorder. Journal of Consulting and Clinical Psychology, 65, 178–183. doi: 10.1037/0022-006X.65.1.178.CrossRefPubMedGoogle Scholar
- Okishi, J., Lambert, M., Eggett, D., Nielsen, L., Dayton, D., & Vermeerch, D. (2006). An analysis of therapist treatment effects: Toward providing feedback to individual therapists on their clients’ psychotherapy outcome. Journal of Clinical Psychology, 62, 1157–1172. doi: 10.1002/jclp.20272.CrossRefGoogle Scholar
- Orwin, R. G., & Vevea, J. L. (2009). Evaluating coding decisions. In H. M. Cooper, L. V. Hedges & J. C. Valentine (Eds.), The handbook of research synthesis and meta-analysis (2nd edn., pp. 177–203). New York, NY: Russell Sage Foundation.Google Scholar
- Spence, S. H., Donovan, C. L., March, S., Gamble, A., Anderson, R. E., Prosser, S., & Kenardy, J. (2011). A randomized controlled trial of online versus clinic-based CBT for adolescent anxiety. Journal of Consulting and Clinical Psychology, 79, 629–642. doi: 10.1037/a0024512.CrossRefPubMedGoogle Scholar
- Tolin, D. F., Hannan, S., Maltby, N., Diefenbach, G. J., Worhunsky, P., & Brady, R. E. (2007). A randomized controlled trial of self-directed versus therapist-directed Cognitive-Behavioral Therapy for Obsessive–Compulsive Disorder patients with prior medication trials. Behavior Therapy, 38, 179–191. doi: 10.1016/j.beth.2006.07.001.CrossRefPubMedGoogle Scholar