title: The Relationship Between Therapist Effects and Therapy Delivery Factors: Therapy Modality, Dosage, and Non-completion.
abstract: To consider the relationships between, therapist variability, therapy modality, therapeutic dose and therapy ending type and assess their effects on the variability of patient outcomes. Multilevel modeling was used to analyse a large sample of routinely collected data. Model residuals identified more and less effective therapists, controlling for case-mix. After controlling for case mix, 5.8 % of the variance in outcome was due to therapists. More sessions generally improved outcomes, by about half a point on the PHQ-9 for each additional session, while non-completion of therapy reduced the amount of pre-post change by six points. Therapy modality had little effect on outcome. Patient and service outcomes may be improved by greater focus on the variability between therapists and in keeping patients in therapy to completion.
authors.affiliation: Centre for Psychological Services Research, University of Sheffield, ScHARR, Regent Court, Regent St., Sheffield, S1 4DA, UK. d.saxon@sheffield.ac.uk.
authors.forename: David
authors.identifier: http://orcid.org/0000-0002-9753-8477
authors.initials: D
authors.lastname: Saxon
authors.affiliation: School of Health and Related Research, University of Sheffield, ScHARR, Regent Court, Regent St., Sheffield, S1 4DA, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Firth
authors.affiliation: Centre for Psychological Services Research, University of Sheffield, ScHARR, Regent Court, Regent St., Sheffield, S1 4DA, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Barkham
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D011369:Professional-Patient Relations; D011613:Psychotherapy / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D013222:State Medicine / Q000458:organization & administration* / Q000592:standards; D013997:Time Factors; D006113:United Kingdom
keywords: Depression; Dose effect; Drop-out; Therapist effect; Variability