There is a lot of evidence that some therapists are more effective than others, and this difference among therapists accounts for between 5% and 10% of patient outcomes. Although 10% seems small, it represents many patients in the population. One of the factors that researchers have examined among more or less effective therapists is their experience level. There is a common assumption that the more experience a psychotherapist has, the more likely their patients will have a positive outcome from therapy. However, the research to date has not supported this notion. Several studies have failed to show that there is an association between therapist experience and patient outcomes. Some studies show that the effectiveness of supervised trainees tends to be superior or on par with that of licensed professionals. Longitudinal studies that looked at the same therapists across years of practice also found that therapists’ effectiveness either stayed the same or declined over time. That is, therapists do not improve with age and experience. Other research suggests that while therapists may be less effective for some problems (e.g., drug dependence), they may be more effective for other issues (e.g., depression). Possibly complicating these findings may be that more experienced therapists have a larger caseload with more severe clients, and so their poorer outcomes may be due to the caseload mix. In this study, Coleman and colleagues were interested in examining if the effectiveness of therapists at different experience levels varied depending on the patient problem, and they controlled for caseload size and patient symptom severity. This extensive study aggregated data from several university counselling centres in the U.S. that included 613 therapists treating 42,690 patients. They assessed pre- to post-treatment outcomes in four domains (general distress, anxiety, life functioning, and drug/alcohol use). On average, patients improved at post-treatment with moderate effects. In particular, the therapy helped the average patient reduce general distress and improve life functioning. Nevertheless, as therapist experience levels increased, their patient outcomes for general distress, anxiety, and life functioning declined. The effects were small but statistically significant. Even after controlling for caseload size and patient symptom severity for each therapist, the results showed a negative association between experience level and patient improvement in most domains. On the positive side, only a tiny fraction of therapists (2.1%) declined in effectiveness across all four outcome domains. However, only 34% of therapists did not show a decline in effectiveness for any outcome domain, whereas most therapists (52%) declined in effectiveness in one or two outcome domains.
Practice Implications
If you thought, like me, that you might improve as a therapist as you accumulate more experience, you might want to reconsider. Therapists, in general, tend to overestimate how effective they are, and this may be particularly true for more senior therapists. Senior therapists may be more complacent, spend less time thinking about their work, and may be less inclined to seek out peer consultation. More junior therapists likely spend more time discussing their cases in supervision, reading about psychotherapy, and attending workshops to hone their craft. Routine outcome monitoring may help therapists see if their outcomes for different patient problems vary and if their outcomes decline or improve over time. Systematic tracking of patient outcomes with validated measures may point therapists to specific continuing education from which they and their patients might benefit.
Coleman, J. J., Freetly Porter, E., Musliu, S., Kopta, S. M., & Owen, J. (2024). Exploring therapist effectiveness across multiple domains over time. Journal of Counseling Psychology. Advance online publication. https://doi.org/10.1037/cou0000763
To learn more about the Psychotherapy Practice Research Network, visit www.pprnet.ca.
-COLOUR.svg "Collabzium")
