Estimating variability in outcomes attributable to therapists: a naturalistic study of outcomes in managed care.
To estimate the variability in outcomes attributable to therapists in clinical practice, the authors analyzed the outcomes of 6,146 patients seen by approximately 581 therapists in the context of managed care. For this analysis, the authors used multilevel statistical procedures, in which therapists were treated as a random factor. When the initial level of severity was taken into account, about 5% of the variation in outcomes was due to therapists. Patient age, gender, and diagnosis as well as therapist age, gender, experience, and professional degree accounted for little of the variability in outcomes among therapists. Whether or not patients were receiving psychotropic medication concurrently with psychotherapy did affect therapist variability. However, the patients of the more effective therapists received more benefit from medication than did the patients of less effective therapists.
Wampold
Bruce E
BE
Department of Counseling Psychology, University of Wisconsin, Madison, WI 53562, USA. wampold@education.wisc.edu
Brown
George S Jeb
GS
D000328:Adult; D000704:Analysis of Variance; D001524:Behavioral Medicine / Q000193:education / Q000379:methods / Q000592:standards*; D017050:Episode of Care; D006801:Humans; D007398:Interpersonal Relations; D008329:Managed Care Programs / Q000592:standards*; D001523:Mental Disorders / Q000145:classification / Q000188:drug therapy / Q000628:therapy*; D008875:Middle Aged; D008960:Models, Psychological; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011331:Private Practice; D011613:Psychotherapy / Q000193:education / Q000592:standards*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome