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Are therapists uniformly effective across patient outcome domains? A study on therapist effectiveness in two different treatment contexts.

https://arctichealth.org/en/permalink/ahliterature280038
Source
J Couns Psychol. 2016 Jul;63(4):367-78
Publication Type
Article
Date
Jul-2016
Author
Helene A Nissen-Lie
Simon B Goldberg
William T Hoyt
Fredrik Falkenström
Rolf Holmqvist
Stevan Lars Nielsen
Bruce E Wampold
Source
J Couns Psychol. 2016 Jul;63(4):367-78
Date
Jul-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Counseling - methods
Female
Health Personnel
Humans
Male
Mental Disorders - psychology - therapy
Mental health
Middle Aged
Psychotherapy - methods
Surveys and Questionnaires
Sweden
Treatment Outcome
United States
Young Adult
Abstract
As established in several studies, therapists differ in effectiveness. A vital research task now is to understand what characterizes more or less effective therapists, and investigate whether this differential effectiveness systematically depends on client factors, such as the type of mental health problem. The purpose of the current study was to examine whether therapists are universally effective across patient outcome domains reflecting different areas of mental health functioning. Data were obtained from 2 sites: the Research Consortium of Counseling and Psychological Services in Higher Education (N = 5,828) in the United States and from primary and secondary care units (N = 616) in Sweden. Outcome domains were assessed via the Outcome Questionnaire-45 (Lambert et al., 2004) and the CORE-OM (Evans et al., 2002). Multilevel models with observations nested within patients were used to derive a reliable estimate for each patient's change (which we call a multilevel growth d) based on all reported assessment points. Next, 2 multilevel confirmatory factor analytic models were fit in which these effect sizes (multilevel ds) for the 3 subscales of the OQ-45 (Study 1) and 6 subscales of CORE-OM (Study 2) were indicators of 1 common latent factor at the therapist level. In both data sets, such a model, reflecting a global therapist effectiveness factor, yielded large factor loadings and excellent model fit. Results suggest that therapists effective (or ineffective) within one outcome domain are also effective within another outcome domain. Tentatively, therapist effectiveness can thus be conceived of as a global construct. (PsycINFO Database Record
PubMed ID
27124549 View in PubMed
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Patient and therapist perspectives on alliance development: therapists' practice experiences as predictors.

https://arctichealth.org/en/permalink/ahliterature272154
Source
Clin Psychol Psychother. 2015 Jul-Aug;22(4):317-27
Publication Type
Article
Author
Helene A Nissen-Lie
Odd E Havik
Per A Høglend
Michael Helge Rønnestad
Jon T Monsen
Source
Clin Psychol Psychother. 2015 Jul-Aug;22(4):317-27
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Attitude of Health Personnel
Cooperative Behavior
Female
Humans
Male
Mental Disorders - therapy
Middle Aged
Norway
Patient Satisfaction - statistics & numerical data
Professional-Patient Relations
Psychotherapy
Surveys and Questionnaires
Young Adult
Abstract
Research has shown that the therapist's contribution to the alliance is more important for the outcome than the patient's contribution (e.g., Baldwin, Wampold, & Imel, 2007); however, knowledge is lacking about which therapist characteristics are relevant for alliance building and development. The objective of this study was to explore the development of the working alliance (using the Working Alliance Inventory), rated by both patients and therapists as a function of therapist in-session experiences. The therapist experiences were gathered by means of the Development of Psychotherapists Common Core Questionnaire (Orlinsky & Rønnestad, 2005). Data from the Norwegian Multisite Study of the Process and Outcome of Psychotherapy (Havik et al., 1995) were used. Multilevel growth curve analyses of alliance scores from Sessions 3, 12, 20 and 40 showed that the therapist factors predicted working alliance levels or growths differently, depending on whether the alliance was rated by patients or by therapists. For example, it emerged that therapists' negative reactions to patients and their in-session anxiety affected patient-rated alliance but not therapist-rated alliance, whereas therapist experiences of flow (Csikszentmihalyi, 1990) during sessions impacted only the therapist-rated alliance. The patterns observed in this study imply that therapists should be particularly aware that their negative experiences of therapy are noticed by, and seem to influence, their clients when they evaluate the working alliance through the course of treatment.
The findings of this study suggest that the working alliance is influenced by therapists' self-reported practice experiences, which presumably are communicated through the therapists' in-session behaviours. The study found a notable divergence between practice experiences that influenced the therapists and those that influenced the patients when evaluating the working alliance. Specifically, practitioners' self-reported difficulties in practice, such as their negative reactions to patients and their in-session anxiety, affected patient-rated alliance but not therapist-rated alliance, whereas therapist experiences of 'flow' during sessions impacted only the therapist-rated alliance. Practitioners should note that patient alliance ratings were more likely to be influenced by therapists' negative practice experiences than by positive ones. The divergence in the patient and therapist viewpoints has potential implications for therapist training and supervision and everyday self-reflection.
PubMed ID
24574034 View in PubMed
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Love Yourself as a Person, Doubt Yourself as a Therapist?

https://arctichealth.org/en/permalink/ahliterature282706
Source
Clin Psychol Psychother. 2017 Jan;24(1):48-60
Publication Type
Article
Date
Jan-2017
Author
Helene A Nissen-Lie
Michael Helge Rønnestad
Per A Høglend
Odd E Havik
Ole Andrè Solbakken
Tore C Stiles
Jon T Monsen
Source
Clin Psychol Psychother. 2017 Jan;24(1):48-60
Date
Jan-2017
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
Clinical Competence
Female
Humans
Job Satisfaction
Male
Middle Aged
Norway
Outcome and Process Assessment (Health Care)
Personality Disorders - diagnosis - psychology - therapy
Problem Solving
Professional Role
Professional-Patient Relations
Psychotherapy
Self Concept
Abstract
There are reasons to suggest that the therapist effect lies at the intersection between psychotherapists' professional and personal functioning. The current study investigated if and how the interplay between therapists' (n?=?70) professional self-reports (e.g., of their difficulties in practice in the form of 'professional self-doubt' and coping strategies when faced with difficulties) and presumably more global, personal self-concepts, not restricted to the professional treatment setting (i.e., the level of self-affiliation measured by the Structural Analysis of Social Behaviour (SASB) Intrex, Benjamin, ), relate to patient (n?=?255) outcome in public outpatient care.
Multilevel growth curve analyses were performed on patient interpersonal and symptomatic distress rated at pre-, post- and three times during follow-up to examine whether change in patient outcome was influenced by the interaction between their therapists' level of 'professional self-doubt' and self-affiliation as well as between their therapists' use of coping when faced with difficulties, and the interaction between type of coping strategies and self-affiliation.
A significant interaction between therapist 'professional self-doubt' (PSD) and self-affiliation on change in interpersonal distress was observed. Therapists who reported higher PSD seemed to evoke more change if they also had a self-affiliative introject. Therapists' use of coping strategies also affected therapeutic outcome, but therapists' self-affiliation was not a moderator in the interplay between therapist coping and patient outcome.
A tentative take-home message from this study could be: 'Love yourself as a person, doubt yourself as a therapist'. Copyright © 2015 John Wiley & Sons, Ltd.
The findings of this study suggest that the nature of therapists' self-concepts as a person and as a therapist influences their patients' change in psychotherapy. These self-concept states are presumably communicated through the therapists' in-session behaviour. The study noted that a combination of self-doubt as a therapist with a high degree of self-affiliation as a person is particularly fruitful, while the combination of little professional self-doubt and much positive self-affiliation is not. This finding, reflected in the study title, 'Love yourself as a person, doubt yourself as a therapist', indicates that exaggerated self-confidence does not create a healthy therapeutic attitude. Therapist way of coping with difficulties in practice seems to influence patient outcome. Constructive coping characterized by dealing actively with a clinical problem, in terms of exercising reflexive control, seeking consultation and problem-solving together with the patient seems to help patients while coping by avoiding the problem, withdrawing from therapeutic engagement or acting out one's frustrations in the therapeutic relationship is associated with less patient change.
PubMed ID
26450342 View in PubMed
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The contribution of the quality of therapists' personal lives to the development of the working alliance.

https://arctichealth.org/en/permalink/ahliterature107957
Source
J Couns Psychol. 2013 Oct;60(4):483-95
Publication Type
Article
Date
Oct-2013
Author
Helene A Nissen-Lie
Odd E Havik
Per A Høglend
Jon T Monsen
Michael Helge Rønnestad
Author Affiliation
Department of Psychology, University of Oslo.
Source
J Couns Psychol. 2013 Oct;60(4):483-95
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Attitude of Health Personnel
Female
Health Personnel - psychology
Humans
Male
Mental Disorders - psychology - therapy
Middle Aged
Norway
Patient Satisfaction - statistics & numerical data
Personal Satisfaction
Professional-Patient Relations
Psychotherapy - methods
Quality of Health Care - statistics & numerical data
Quality of Life - psychology
Questionnaires
Young Adult
Abstract
Research suggests that the person of the psychotherapist is important for the process and outcome of psychotherapy, but little is known about the relationship between therapists' personal experiences and the quality of their therapeutic work. This study investigates 2 factors (Personal Satisfactions and Personal Burdens) reflecting therapists' quality of life that emerged from the self-reports of a large international sample of psychotherapists (N = 4,828) (Orlinsky & Rønnestad, 2004, 2005) using the Quality of Personal Life scales of the Development of Psychotherapists Common Core Questionnaire (Orlinsky et al., 1999). These factors were investigated as predictors of alliance levels and growth (using the Working Alliance Inventory) rated by both patients and therapists in a large (227 patients and 70 therapists) naturalistic outpatient psychotherapy study (Havik et al., 1995). The Personal Burdens scale was strongly and inversely related to the growth of the alliance as rated by the patients, but was unrelated to therapist-rated alliance. Conversely, the factor scale of therapists' Personal Satisfactions was clearly and positively associated with therapist-rated alliance growth, but was unrelated to the patients' ratings of the alliance. The findings suggest that the working alliance is influenced by therapists' quality of life, but in divergent ways when rated by patients or by therapists. It seems that patients are particularly sensitive to their therapists' private life experience of distress, which presumably is communicated through the therapists' in-session behaviors, whereas the therapists' judgments of alliance quality were positively biased by their own sense of personal well-being.
PubMed ID
23957765 View in PubMed
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