Therapist Factors

Therapist Factors (Mick Cooper)Therapists vary in effectiveness Luborsky and Colleagues (1985) - clients of best therapist had a greater effect size compared to other therapists pg 81 Okiishi et.al (2003) clients had an average rate of change ten times greater than average pg 81 Crits Christoph (91) meta-analysis from 15 studies shows around nine percent of variance in outcome is due to individual therapist factors. Wampold 2001 - effect size related to therapists is 0.6 compared to 0.2 for therapy Stiles-Shields, Colleen; Touyz, Stephen; Hay, Phillipa; Lacey, Hubert; Crosby, Ross D; et al. The International journal of eating disorders46.8 (December 2013): 783-789. therapeutic alliance important in treating anorexia nervosa Miller, 1993, Ricks 1974 - some therapists achieve consistently positive results ( cited in Kraus, 2011). Deterioration in therapy Kraus et. al 2011 - Therapists who are skilled in one domain may be harmful in another, and therapists showed large effect sizes for worsening of symptoms Kraus - low correlations in rankings across domains, i.e - just because someone is good at treating substance use does not infer they will be good at treating psychosis. (Okiishi, Lambert, Nielsen & Ogles, 2003) - some therapists leave their patients worse off than when they started - ethics(cited in Kraus) AGAINSTElkin and colleagues - due to outliersCrits Cristoph - effects are reduced among therapists of experience.Relationshipfewer negative symptoms in schizophrenics creates a stronger therapeutic alliance Jung, Esther; Wiesjahn, Martin; Lincoln, Tania M.. Psychotherapy Research24.2 (Mar 2014): 171-183. Roth and Fongay (1996)Hubble et. al (1999)Cooper, 2008 (all cited in strawbridge and woolfe chapter one page - 5).Psychological FunctioningEvidence for but no evidence for effect of personal therapyTraining (pg 91) Evidence show that training increases therapeutic skills (Lambert and Ogles, 1997) Stein and Lambert 95 - most comprehensive meta-analysis, clients of more training experienced more positive outcomes(lower drop-out rates) more satisfied with therapy and stayed in it for longer but relatively small effect size - 0.3 Orlinsky et al 2004 - skillfulness generally associated with more positive outcomes. para professionals more effective than professionals (Durlak, 1979; Hattie et.al 1984) - relationship Project Match Research Group - 1997 - same outcomes from AA etc as from a professional Bermand and Norton (1985) meta-analysis challeged it but strikingly close to zero  Some studies show psychologists or psychiatrists are better than para professionals (Balastrieri et.al 1988)  Kraus et. al (2001) providing regular outcome feedback may be helpful in training because therapists vary in effectiveness across domains - i.e - argument for reflective practitioner.                                                                                                                                 Supervision Bambling et.al 2006 found that 67 percent of clients achieved clinical remission from depression in supervised conditions compared with 47 percent from non supervised. Wheeler and Richards (2007) found that supervision can help therapists improve self awareness, apply skills effectively and and experience self-efficacy Vallance 2005 - trainees found supervision to help their freedom, focus, confidence and safety. Orlinsky and Ronnestad (2005) clients feeling of healing involvement correlated strongly with years of supervision Professional Practice (years of experience) Beutler et,al 2004 suggest that what is important is years of clinical contact rather developing apptitude in a particular therapy Huppert and colleagues (2001) found a large effect size between years of experience and clients levels of anxiety post therapy. Christenses and Jacobson, 1994 found that experienced therapists were no better at reading clients reactions than non experienced ones. How clients relate to therapists seems to be key pg 96 - class system, orthodox jew, strong values - all about how they relate to each other as all prefer people of similar views or class or religion so they dont feel judged (may be their own perception) professional development through training, supervision and experience have some relationship but very small effect sizes and para professionals tend to do as well therapists traits in general seems to be less important than how they relate to their clients.

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