title: Therapist effects and IAPT Psychological Wellbeing Practitioners (PWPs): a multilevel modelling and mixed methods analysis.
abstract: The aim of this research was (a) to determine the extent of therapist effects in Psychological Wellbeing Practitioners (PWPs) delivering guided self-help in IAPT services and (b) to identify factors that defined effective PWP clinical practice. Using patient (N = 1122) anxiety and depression outcomes (PHQ-9 and GAD-7), the effectiveness of N = 21 PWPs across 6 service sites was examined using multi-level modelling. PWPs and their clinical supervisors were also interviewed and completed measures of ego strength, intuition and resilience. Therapist effects accounted for around 9 per cent of the variance in patient outcomes. One PWP had significantly better than average outcomes on both PHQ-9 and GAD-7 while 3 PWPs were significantly below average on the PHQ-9 and 2 were below average on the GAD-7. Computed PWP ranks identified quartile clusters of the most (N = 5) and least (N = 5) effective PWPs. More effective PWPs generated higher rates of reliable and clinically significant change and displayed greater resilience, organisational abilities, knowledge and confidence. Study weaknesses are identified and methodological considerations for future studies examining therapist effects in low intensity cognitive behaviour therapy are provided.
authors.affiliation: Clinical Psychology Unit, Department of Psychology, University of Sheffield, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Green
authors.affiliation: Clinical Psychology Unit, Department of Psychology, University of Sheffield, UK; Centre for Psychological Services Research, Department of Psychology, University of Sheffield, UK. Electronic address: m.barkham@sheffield.ac.uk.
authors.forename: Michael
authors.initials: M
authors.lastname: Barkham
authors.affiliation: Clinical Psychology Unit, Department of Psychology, University of Sheffield, UK; Centre for Psychological Services Research, Department of Psychology, University of Sheffield, UK; Sheffield Health and Social Care NHS Foundation Trust, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kellett
authors.affiliation: Centre for Psychological Services Research, School of Health and Related Research, University of Sheffield, UK.
authors.forename: David
authors.initials: D
authors.lastname: Saxon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011369:Professional-Patient Relations; D055815:Young Adult
keywords: IAPT; Psychological Wellbeing Practitioners; Resilience; Therapist effects