Predicting Therapist Effectiveness From Their Own Practice-Based Evidence

• Published in: Journal of consulting and clinical psychology Vol. 84; no. 6; pp. 473 - 483
• Main Authors: Kraus, David R., Bentley, Jordan H., Alexander, Pamela C., Boswell, James F., Constantino, Michael J., Baxter, Elizabeth E., Castonguay, Louis G.
• Format: Journal Article
• Language: English
• Published: United States American Psychological Association 01-06-2016
• Subjects: Adult; Client relationships; Clinical outcomes; Decision Tree Algorithms; Effectiveness studies; Evidence Based Practice; Female; Health Personnel; Human; Humans; Male; Middle Aged; Parks & recreation areas; Past performance; Professional-Patient Relations; Psychological distress; Psychotherapy; Referrals; Risk adjustment; Risk Factors; Therapist Characteristics; Therapist patient relationships; Therapists; Treatment Effectiveness Evaluation; Treatment Outcome; Treatment Outcomes; Jordan (country); therapist effectiveness, Treatment Outcome Package, risk adjustment, multilevel modeling, random forest
• ISSN: 0022-006X; 1939-2117
• DOI: 10.1037/ccp0000083

Objective: Differences between therapists (therapist effect) are often larger than differences between treatments (treatment effect) in explaining client outcomes, and thus should be considered relevant to providing optimal treatment to clients. However, research on therapist effectiveness has focused largely on global measures of distress as opposed to a multidimensional assessment, and has failed to risk-adjust for client characteristics. The purpose of this study was to examine the stability and predictive validity of therapist effectiveness across multiple outcome domains using risk-adjusted outcomes. Method: Initial and follow-up outcome data on the Treatment Outcome Package (Kraus, Seligman, & Jordan, 2005) were collected on 3,540 clients who were treated in naturalistic settings by a sample of 59 therapists. After risk-adjusting outcomes based on case-mix variables using random forest models, outcome data from the first 30 clients of each therapist were used to classify each therapist's effectiveness on 12 outcome domains. These results were then compared with outcome data from the therapist's next 30 clients. Results: Results demonstrated that therapist effectiveness was relatively stable, although somewhat domain specific. Therapists classified as "exceptional" were significantly more likely to remain above average with future cases, suggesting that a therapist's past performance is an important predictor of their future performance. Conclusions: Clients are likely to experience differential benefit depending on the particular therapist and his or her strengths. Clinical outcomes may be improved by developing the best possible prediction model for each new client and then providing that client with referrals to therapists with well-matched strengths.
What is the public health significance of this article?
Therapist effectiveness in treating different domains of client functioning can be predicted from past performance, and using this actuarial information in clinical decision making holds promise for improving the percentage of clients who experience a positive treatment effect.