PPRNet Clinical summary: Are Therapists More Effective When Delivering One Type of Therapy vs Another?

When we think about personalizing therapy, we often consider what type of psychotherapy would be best for which patient. Few studies have yielded practically useful findings. Nevertheless, there is some evidence, for example, that matching patients to therapists on race or ethnicity or sexual orientation improves patient outcomes. Another approach to this might be to examine whether a given therapist is more effective depending on how they treat their patients – that is, whether they deliver one type of therapy versus another. This would represent personalizing treatment for the therapist, so they could choose the therapy most likely to lead to the best outcome for their patients. Therapists might choose to specialize in their treatment strengths or obtain further training in treatments they use less effectively, potentially allowing them to treat a wider range of patients. One way to research this is to have the same therapist provide two different therapies and see whether patients’ outcomes differ depending on the type of treatment delivered. In this individual participant-level data meta-analysis, Coyne and colleagues did just that. They were able to aggregate patient-level data from five independent trials that compared cognitive behavioural therapy (CBT) and psychodynamic therapy (PDT) for depression delivered by the same therapist. The studies included in Coyne and colleagues’ meta-analysis extensively trained and supervised therapists to deliver both CBT and PDT. Their meta-analysis included 30 experienced therapists treating 492 patients with depression. The results indicated that 4.8% of the variance in patient outcomes was attributable to differences between therapists (p < .001), indicating that some therapists were more effective than others. Unsurprisingly, there was no significant difference between CBT and PDT on patient outcomes (p = .622). But the association between treatment type and outcome varied significantly among therapists (p < .001), indicating that some therapists were more effective depending on what type of therapy they provided. 47% of therapists’ patients had a small to moderate difference in their outcomes depending on whether the same therapist provided CBT or PDT.

This study demonstrated that slightly more than half of therapists (53%) could flexibly switch between CBT and PDT without compromising their effectiveness. Nevertheless, a sizeable proportion of therapists (47%) can be significantly more effective when using CBT or PDT than when using the other, despite similar training in both. That is, a meaningful number of therapists had a treatment-specific effectiveness edge. For some therapists, understanding their potential strengths and weaknesses when using distinct therapies may be important for providing the best treatment for their patients. Therapists who are versatile in multiple treatments may be able to deliver effective therapy based on patients’ preferences. The study also suggests that therapists should measure their patients’ outcomes to identify their personal strengths and weaknesses within their own caseload.

Coyne, A. E., Constantino, M. J., Gaines, A. N., Wienicke, F. J., Mehta, A. H. P., Barkham, M., …, Cohen, Z. D., & Driessen, E. (2026). Are some therapists more effective when they deliver one type of therapy versus another? Psychotherapy, 63(1), 70–78. https://doi.org/10.1037/pst0000614