Therapist effects on early change in psychotherapy in a naturalistic setting

Abstract

Objective: Client trajectories of change in psychotherapy differ. Early change is a trajectory that has been shown to be associated with better outcomes over time. Little is known about the mechanisms of this type of change, however. The current study examined the therapist effect in early change, and explored differences between therapists in the likelihood that early change would occur and how early in a course of therapy the change would occur.

Methods: Using 20 years of archival data from a university counseling center, we identified 16,825 clients who had been seen by 273 therapists. We examined therapist differences using chi-square analyses, multilevel logistic regression, and survival analyses.

Results: We found significant variance between therapists in both their likelihood to predict early change, and how early that change was predicted to occur. Therapist effects, however, accounted for a small portion of the overall variance; despite this small effect, differences between the best performing therapists and the worst performing therapists were substantial.

Conclusions: Therapists were differentially effective in helping clients achieve early change. Future research examining mechanisms associated with these effects will be important in informing psychotherapy process and therapist training.

Keywords:

• early change
• rapid response
• psychotherapy outcome
• therapist effects

ORCID

DAVID M. EREKSON http://orcid.org/0000-0001-6214-485X