PPRNet Clinical summary: Progress Feedback Narrows the Gap Between More and Less Effective Therapists

Some psychotherapists are more effective than others, which means that patients’ treatment outcomes are, in part, a result of “therapist effects.” Meta-analyses estimate that therapist effects account for between 5% and 8% of the variance in patients’ mental health outcomes. In other words, the therapist’s abilities and skills matter. Therapist effects are more prominent in everyday clinical practice than in controlled research trials, and also more significant for longer-term treatments. Therapists’ interpersonal skills are one of the few known predictors of therapist effects. Therapists who have an attitude of humility, who can repair therapeutic alliance ruptures, and who experience lower levels of burnout tend to be more effective. Theoretical orientation, therapist gender, and caseload are unrelated to treatment outcomes. In this meta-analysis, Delgadillo and colleagues were interested in seeing if providing therapists with ongoing feedback on their patients’ progress could reduce the therapist effect. Progress monitoring involves regularly measuring and tracking patients’ progress with standardized self-report scales throughout treatment and providing the clinician with this information during therapy. The authors looked closely at six controlled trials of short-term therapies in which 131 therapists treated 4,549 patients. Therapists were randomly assigned to receive or not receive feedback about their patients’ progress throughout treatment. The therapist effect explained a small but statistically significant proportion (1.1%) of variability in patient symptom reduction. Progress monitoring and feedback to therapists were associated with reducing the therapist effect by 18.2%. Feedback was associated with better treatment outcomes and fewer differences between therapists. Progress monitoring and feedback increased the positive outcomes of patients treated by the least effective therapists.

Practice Implications

Progress monitoring and feedback narrowed the gap between the most and least effective therapists by improving patient outcomes of the least effective therapists. A single ineffective therapist could attain relatively poor outcomes with dozens or even hundreds of patients over time. This and previous research suggest that “who the therapist is” matters, especially in regular clinical care and for longer-term therapies. Progress monitoring and feedback improve mental health outcomes for patients' treated by a less effective therapist.

Delgadillo, J., Deisenhofer, A.-K., Probst, T., Shimokawa, K., Lambert, M. J., & Kleinstäuber, M. (2022). Progress feedback narrows the gap between more and less effective therapists: A therapist effects meta-analysis of clinical trials. Journal of Consulting and Clinical Psychology, 90(7), 559–567. https://doi.org/10.1037/ccp0000747