A major dilemma in psychotherapy outcome research: Disentangling therapists from therapies.

Abstract

In interpreting results of psychotherapy outcome studies, particularly those of comparative studies, it is often difficult to disentangle the effects due to the treatments per se from those that may be due to differential competence and other characteristics of the therapists carrying out the treatments. This article attempts to address this general dilemma in psychotherapy outcome research, drawing on the experience and findings of the NIMH Treatment of Depression Collaborative Research Program. Issues discussed include the nature of the overall therapist sample, variability in therapist efficacy, therapist characteristics, training and supervision of therapists, and adherence and competence in carrying out a treatment. Implications discussed include the need to provide, both in presentations of the results of individual outcome studies and in dissemination of information regarding “empirically validated treatments,” critical information about the therapists carrying out the treatment.

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