Therapists, therapist variables, and cognitive-behavioral therapy outcome in a multicenter trial for panic disorder.

The relationship between therapists and treatment outcome was examined in 14 highly trained therapists who participated in the Multicenter Collaborative Study for the Treatment of Panic Disorder. Overall, therapists yielded positive outcomes in their caseloads; yet, therapists significantly differed in the magnitude of change among caseloads. Effect sizes for therapist impact on outcome measures varied from 0% to 18%. Overall experience in conducting psychotherapy was related to outcome on some measures, whereas age, gender, gender match, and experience with cognitive-behavioral therapy (CBT) were not. Therapists with above- and below-average outcomes were rated similarly on measures of adherence and competency. The results suggest that therapists make a contribution to outcome in CBT for panic disorder, even when patients are relatively uniform, treatment is structured, and outcome is positive. Implications for future clinical outcome studies and for training clinicians are discussed.

[1]  K. Dobson,et al.  Cognitive therapy of depression: pretreatment patient predictors of outcome. , 2002, Clinical psychology review.

[2]  M K Shear,et al.  Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. , 2000, JAMA.

[3]  C. Schaap,et al.  The Impact of Interpersonal Patient and Therapist Behavior on Outcome in Cognitive-Behavior Therapy , 2000, Behavior modification.

[4]  N. Schmidt,et al.  The effects of treatment compliance on outcome in cognitive-behavioral therapy for panic disorder: quality versus quantity. , 2000, Journal of consulting and clinical psychology.

[5]  K. Dobson,et al.  Therapist competence ratings in relation to clinical outcome in cognitive therapy of depression. , 1999, Journal of consulting and clinical psychology.

[6]  P. Kendall,et al.  Normative comparisons for the evaluation of clinical significance. , 1999, Journal of consulting and clinical psychology.

[7]  I. Elkin,et al.  A Major Dilemma in Psychotherapy Outcome Research: Disentangling Therapists From Therapies , 1999 .

[8]  C. Zlotnick,et al.  Does the gender of a patient or the gender of a therapist affect the treatment of patients with major depression? , 1998, Journal of consulting and clinical psychology.

[9]  S. Hollon,et al.  Defining empirically supported therapies. , 1998, Journal of consulting and clinical psychology.

[10]  P. Kendall.  Empirically supported psychological therapies. , 1998, Journal of consulting and clinical psychology.

[11]  M K Shear,et al.  Multicenter collaborative panic disorder severity scale. , 1997, The American journal of psychiatry.

[12]  L. Beutler.  The Psychotherapist as a Neglected Variable in Psychotherapy: An Illustration by Reference to the Role of Therapist Experience and Training , 1997 .

[13]  G. Woody,et al.  The Psychotherapist Matters: Comparison of Outcomes Across Twenty-Two Therapists and Seven Patient Samples , 1997 .

[14]  H. Strupp,et al.  On the Limitations of Therapy Manuals , 1997 .

[15]  S. Garfield.  The Therapist as a Neglected Variable in Psychotherapy Research , 1997 .

[16]  D. Zuroff,et al.  Characteristics of effective therapists: further analyses of data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. , 1996, Journal of consulting and clinical psychology.

[17]  D. Barlow,et al.  Health care policy, psychotherapy research, and the future of psychotherapy. , 1996, The American psychologist.

[18]  J. Weisz,et al.  Effects of psychotherapy with children and adolescents revisited: a meta-analysis of treatment outcome studies. , 1995, Psychological bulletin.

[19]  D. M. Stein,et al.  Graduate Training in Psychotherapy: Are Therapy Outcomes Enhanced?. , 1995 .

[20]  D. Barlow.  Psychological Interventions in the Era of Managed Competition , 1994 .

[21]  A. Beck,et al.  Meta‐Analysis of Therapist Effects in Psychotherapy Outcome Studies , 1991 .

[22]  S. Whiston,et al.  A Review of the Empirical Basis for Counseling: Implications for Practice and Training , 1991 .

[23]  N. Jacobson,et al.  Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. , 1991, Journal of consulting and clinical psychology.

[24]  J. Mintz,et al.  Implications of therapist effects for the design and analysis of comparative studies of psychotherapies. , 1991, Journal of consulting and clinical psychology.

[25]  L. Beutler,et al.  Differences between more and less effective psychotherapists: a study of select therapist variables. , 1989, Journal of consulting and clinical psychology.

[26]  D. F. Beck.  Counselor Characteristics: How They Affect Outcomes , 1988 .

[27]  L. Thompson,et al.  Comparative effectiveness of psychotherapies for depressed elders. , 1987, Journal of consulting and clinical psychology.

[28]  Windy Dryden,et al.  Handbook of Psychotherapy and Behavior Change , 1987, Journal of Cognitive Psychotherapy.

[29]  P. Pilkonis,et al.  Do therapists vary much in their success? Findings from four outcome studies. , 1986, The American journal of orthopsychiatry.

[30]  Donald R. Atkinson,et al.  Similarity in Counseling , 1986 .

[31]  A T McLellan,et al.  Therapist success and its determinants. , 1985, Archives of general psychiatry.

[32]  I. Elkin,et al.  NIMH Treatment of Depression Collaborative Research Program. Background and research plan. , 1985, Archives of general psychiatry.

[33]  C. Martindale,et al.  The therapist-as-fixed-effect fallacy in psychotherapy research. , 1978, Journal of consulting and clinical psychology.

[34]  T. Cooper.  Department of Health, Education, and Welfare. , 1976, Military medicine.

[35]  I. Marks,et al.  Exposure in vivo of agoraphobics: contributions of diazepam, group exposure, and anxiety evocation , 1976, Psychological Medicine.

[36]  M. Chandler,et al.  Factors influencing the outcome of psychotherap: a review of quantitative research. , 1971, Psychological bulletin.

[37]  M. Hamilton.  A RATING SCALE FOR DEPRESSION , 1960, Journal of neurology, neurosurgery, and psychiatry.

[38]  M. Hamilton.  The assessment of anxiety states by rating. , 1959, The British journal of medical psychology.

[39]  E. Slater,et al.  The psychopathology of a correspondence column. , 1947, The British journal of medical psychology.

[40]  A. Bergin,et al.  Handbook of psychotherapy and behavior change, 4th ed. , 1994 .

[41]  D. Bowman.  Effects of therapist sex on the outcome of therapy. , 1993 .

[42]  Elizabeth Fisher.  Gender bias in therapy? An analysis of patient and therapist causal explanations. , 1989 .

[43]  N. Kulish,et al.  Factors in premature termination in long-term psychotherapy. , 1985 .

[44]  D. Ikle,et al.  The influence of client–clinician demographic match on client treatment outcomes. , 1983 .

[45]  R. Persons,et al.  Perceived helpful therapists' characteristics, client improvements, and sex of therapist and client. , 1974 .

[46]  D. Ricks.  Supershrink: Methods of a therapist judged successful on the basis of adult outcomes of adolescent patients. , 1974 .

[47]  G. Winokur,et al.  Life history research in psychopathology , 1970 .