title: Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting.
abstract: OBJECTIVE
  Psychotherapy researchers have long questioned whether increased therapist experience is linked to improved outcomes. Despite numerous cross-sectional studies examining this question, no large-scale longitudinal study has assessed within-therapist changes in outcomes over time.
  
  
  METHODS
  The present study examined changes in psychotherapists' outcomes over time using a large, longitudinal, naturalistic psychotherapy data set. The sample included 6,591 patients seen in individual psychotherapy by 170 therapists who had on average 4.73 years of data in the data set (range = 0.44 to 17.93 years). Patient-level outcomes were examined using the Outcome Questionnaire-45 and a standardized metric of change (prepost d). Two-level multilevel models (patients nested within therapist) were used to examine the relationship between therapist experience and patient prepost d and early termination. Experience was examined both as chronological time and cumulative patients seen.
  
  
  RESULTS
  Therapists achieved outcomes comparable with benchmarks from clinical trials. However, a very small but statistically significant change in outcome was detected indicating that on the whole, therapists' patient prepost d tended to diminish as experience (time or cases) increases. This small reduction remained when controlling for several patient-level, caseload-level, and therapist-level characteristics, as well as when excluding several types of outliers. Further, therapists were shown to vary significantly across time, with some therapists showing improvement despite the overall tendency for outcomes to decline. In contrast, therapists showed lower rates of early termination as experience increased.
  
  
  CONCLUSIONS
  Implications of these findings for the development of expertise in psychotherapy are explored. (PsycINFO Database Record
authors.affiliation: Department of Counseling Psychology, University of Wisconsin-Madison.
authors.forename: Simon B
authors.initials: SB
authors.lastname: Goldberg
authors.affiliation: Student Health and Counseling, University of Alaska-Fairbanks.
authors.forename: Tony
authors.initials: T
authors.lastname: Rousmaniere
authors.affiliation: International Center for Clinical Excellence.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Miller
authors.affiliation: Department of Psychology, University of Alaska-Fairbanks.
authors.forename: Jason
authors.initials: J
authors.lastname: Whipple
authors.affiliation: Department of Psychology, Brigham Young University.
authors.forename: Stevan Lars
authors.initials: SL
authors.lastname: Nielsen
authors.affiliation: Department of Counseling Psychology, University of Wisconsin- Madison.
authors.forename: William T
authors.initials: WT
authors.lastname: Hoyt
authors.affiliation: Department of Counseling Psychology, University of Wisconsin- Madison.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Wampold
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel / Q000592:standards* / Q000639:trends*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011369:Professional-Patient Relations; D011613:Psychotherapy / Q000592:standards* / Q000639:trends*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult