title: The Contribution of Therapist Effects to Patient Dropout and Deterioration in the Psychological Therapies.
abstract: BACKGROUND
  In the psychological therapies, patient outcomes are not always positive. Some patients leave therapy prematurely (dropout), while others experience deterioration in their psychological well-being.
  
  
  METHODS
  The sample for dropout comprised patients (n = 10 521) seen by 85 therapists, who attended at least the initial session of one-to-one therapy and completed a Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at pre-treatment. The subsample for patient deterioration comprised patients (n = 6405) seen by the same 85 therapists but who attended two or more sessions, completed therapy and returned a CORE-OM at pre-treatment and post-treatment. Multilevel modelling was used to estimate the extent of therapist effects for both outcomes after controlling for patient characteristics.
  
  
  RESULTS
  Therapist effects accounted for 12.6% of dropout variance and 10.1% of deterioration variance. Dropout rates for therapists ranged from 1.2% to 73.2%, while rates of deterioration ranged from 0% to 15.4%. There was no significant correlation between therapist dropout rate and deterioration rate (Spearman's rho = 0.07, p = 0.52).
  
  
  CONCLUSIONS
  The methods provide a reliable means for identifying therapists who return consistently poorer rates of patient dropout and deterioration compared with their peers. The variability between therapists and the identification of patient risk factors as significant predictors has implications for the delivery of safe psychological therapy services. Copyright © 2016 John Wiley & Sons, Ltd.
  
  
  CONCLUSIONS
  Therapists play an important role in contributing to patient dropout and deterioration, irrespective of case mix. Therapist effects on patient dropout and deterioration appear to act independently. Being unemployed as a patient was the strongest predictor of both dropout and deterioration. Patient risk to self or others was also an important predictor.
authors.affiliation: Centre for Psychological Services Research, University of Sheffield, Sheffield, UK.
authors.forename: David
authors.initials: D
authors.lastname: Saxon
authors.affiliation: Centre for Psychological Services Research, University of Sheffield, Sheffield, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Barkham
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Alexis
authors.initials: A
authors.lastname: Foster
authors.affiliation: Centre for Psychological Services Research, University of Sheffield, Sheffield, UK.
authors.forename: Glenys
authors.initials: G
authors.lastname: Parry
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D011613:Psychotherapy; D011795:Surveys and Questionnaires
keywords: CORE-OM; Deterioration; Dropout; Outcomes; Therapist effects; Variability