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Therapist Effects

The investigation of therapist effects is one the most exciting and important areas of research. I hope that others will add to this discussion and help flesh out our understanding of this important phenomena. Before I write anything else though, I'd like to suggest to anyone who is serious about understanding the science behind therapist effects to read Bruce Wampold's The Great Psychotherapy Debate.

Here's my stab at a definition....

Therapist (or clinician) effects refer to the phenomena that practitioners of healing practices (including psychotherapy) differ in their outcomes even when delivering ostensibly identical treatments. In stark statistical terms, often more of the variance in outcomes is due to who does the treatment than to what the treatment is. This is certainly true for psychotherapy, and recent evidence suggests it may be true for pharmacotherapy also. See Wampold BE & Brown GS, 2005; McKay KM, Imel ZE & Wampold BE, 2006

Analysis of therapist effects depends upon multilevel modeling, also call hierarchical linear modeling (HLM). Use of HLM permits correct modeling of the variance at the clinician level and treatment level. Use of traditional analysis of variance which does not treat the therapist as a variable tends to result in an over estimate of the treatment effect. Unfortunately, many clinical trails for psychotherapy and almost all pharmacy trials fail to correctly model for therapist effects.

Therapist effects are good news (mostly) for therapists. It means that we are not simply technician delivering well specified and empirically validated treatments. The outcome of mental health treatment depends largely on the effectiveness of the therapist; the treatment requires all of our knowledge, skill, experience, creativity and personal human qualities to be maximally effective.

Value in behavioral health care can be defined as the magnitude of improvement divided by the cost of services. By this metric, the services of some therapists have more value than others. See PayForPerformance and HonorsForOutcomes.

It seems to me that those of us who believe in the value of psychotherapy owe it to ourselves to measure our outcomes so that we can make the case to health plans, employers and other payers to the value of our services.

For more discussion of the implication of therapist effects see the OutcomesInformedCare topic.

-- JebBrown - 04 Nov 2006

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