Therapist effects on outcome and alliance in inpatient psychotherapy

J Clin Psychol. 2008 Mar;64(3):344-54. doi: 10.1002/jclp.20443.

Abstract

As an addition to the ongoing discussion concerning the magnitude of therapist effects on outcome in psychotherapy, we investigated therapist variability in a large inpatient psychotherapy sample. We included global symptomatic outcome (Global Severity Index of the Symptom Checklist-90 Revised [SCL-90-R]; German version, Franke, 1995) and alliance (Helping Alliance Questionnaire; German version, Bassler, Potratz & Krauthauser, 1995) ratings of 2554 inpatients who were treated by 50 psychotherapists. Multilevel regression analyses (HLM; Raudenbush, Bryk, Cheong, & Congdon, 2004) were used for analyses. Overall, therapists accounted for a much greater variability on alliance (33%) than on outcome (3%). Therapists were differentially effective with regard to their patients' symptom severity at the beginning of treatment, and therapists differed in the degree that a positive alliance was associated with therapeutic outcome. The relatively small therapist effect on outcome is attributed to compensatory mechanisms in the specific context of inpatient therapy.

MeSH terms

  • Adult
  • Comorbidity
  • Female
  • Germany
  • Humans
  • Male
  • Middle Aged
  • Mood Disorders / diagnosis
  • Mood Disorders / psychology
  • Mood Disorders / therapy
  • Neurotic Disorders / diagnosis
  • Neurotic Disorders / psychology
  • Neurotic Disorders / therapy*
  • Patient Admission*
  • Personality Disorders / diagnosis
  • Personality Disorders / psychology
  • Personality Disorders / therapy*
  • Personality Inventory
  • Professional-Patient Relations*
  • Psychoanalytic Therapy*
  • Treatment Outcome