Exploring therapist characteristics as potential moderators of the effects of client feedback on treatment outcome

Clin Psychol Psychother. 2023 May-Jun;30(3):690-701. doi: 10.1002/cpp.2828. Epub 2023 Jan 31.


Although studies have shown that client feedback can improve treatment outcome, little is known about which factors might possibly moderate the effects of such feedback. The present study investigated potential therapist variables that might influence whether frequent client feedback is effective, including the Big Five personality traits, internal/external feedback propensity and self-efficacy. Data from two previous studies, a quasi-experimental study and a randomized controlled trial, were combined. The sample consisted of 38 therapists and 843 clients (55.4% females, mean age = 42.05 years, SD = 11.75) from an outpatient mental health institution. The control condition consisted of cognitive-behavioural therapies combined with low frequency monitoring of clients' symptoms. In the experimental condition, high-intensity (i.e., frequent) client feedback as an add-on to treatment as usual was provided. Outcomes were measured as adjusted post-treatment symptom severity on the Symptom Checklist-90 and drop out from treatment. The final model of the multilevel analyses showed that therapists with higher levels of self-efficacy had poorer treatment outcomes, but when high-intensity client feedback was provided, their effectiveness improved. Furthermore, higher self-efficacy was associated with a higher estimation of therapists' own effectiveness, but therapists' self-assessment of effectiveness was not correlated with their actual effectiveness. The results of this study might indicate that therapists with high levels of self-efficacy benefit from client feedback because it can correct their biases. However, for therapists with low self-efficacy, client feedback might be less beneficial, possibly because it can make them more insecure. These hypotheses need to be investigated in future research.

Keywords: client feedback; feedback-informed treatment; routine outcome monitoring (ROM); therapist characteristics.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Cognitive Behavioral Therapy*
  • Feedback
  • Female
  • Humans
  • Male
  • Mental Health
  • Professional-Patient Relations
  • Psychotherapy* / methods
  • Treatment Outcome