Therapist perceptions of their own measurement-based, problem-specific effectiveness

• Published in: Journal of consulting and clinical psychology Vol. 91; no. 8; p. 474
• Main Authors: Constantino, Michael J, Boswell, James F, Coyne, Alice E, Muir, Heather J, Gaines, Averi N, Kraus, David R
• Format: Journal Article
• Language: English
• Published: United States 01.08.2023
• Subjects: Anxiety; Humans; Outcome Assessment, Health Care; Professional-Patient Relations; Psychotherapy - methods; Treatment Outcome
• ISSN: 1939-2117
• DOI: 10.1037/ccp0000813

Patient-reported outcomes data reveal differences both in therapists' global effectiveness across their average patient (between-therapist effect) and in treating different problems within their caseload (within-therapist effects). Yet, it is unclear how accurately therapists perceive their own measurement-based, problem-specific effectiveness and whether such self-perceptions predict global between-therapist performance differences. We explored these questions in naturalistic psychotherapy. For 50 therapists, we drew on data from a mean of 27 past patients (total = 1,363) who completed a multidimensional outcome measure-Treatment Outcome Package (TOP)-at pre- and posttreatment. For each of 12 outcome domains (e.g., depression, anxiety), TOP data classified therapists as historically "effective," "neutral," or "ineffective." Unaware of their data-driven classifications, therapists rated their perceived effectiveness for each domain. We conducted chi-square analyses to determine whether therapists predicted their own measurement-based effectiveness classifications to a level greater than chance. We then used multilevel modeling to test whether therapists' problem-specific perceptions predicted global between-therapist performance differences. For all but one outcome domain, therapists were no better than chance at predicting their measurement-based effectiveness classification. Additionally, controlling for patient baseline impairment, therapists who consistently overestimated their problem-specific effectiveness had patients who reported worse global outcomes than patients whose therapist more accurately estimated their effectiveness. Conversely, therapists who underestimated their problem-specific effectiveness had patients who reported better outcomes than patients whose therapist over- or accurately estimated their effectiveness. Therapist humility may differentiate the most from least globally effective therapists, and this virtue should be cultivated in clinical trainings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).