Therapist perceptions of their own measurement-based, problem-specific effectiveness.

IF 4.5 1区心理学 Q1 PSYCHOLOGY, CLINICAL Journal of consulting and clinical psychology Pub Date : 2023-08-01 DOI:10.1037/ccp0000813

Michael J Constantino, James F Boswell, Alice E Coyne, Heather J Muir, Averi N Gaines, David R Kraus

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引用次数: 3

Abstract

Objective: Patient-reported outcomes data reveal differences both in therapists' global effectiveness across their average patient (between-therapist effect) and in treating different problems within their caseload (within-therapist effects). Yet, it is unclear how accurately therapists perceive their own measurement-based, problem-specific effectiveness and whether such self-perceptions predict global between-therapist performance differences. We explored these questions in naturalistic psychotherapy.

Method: For 50 therapists, we drew on data from a mean of 27 past patients (total N = 1,363) who completed a multidimensional outcome measure-Treatment Outcome Package (TOP)-at pre- and posttreatment. For each of 12 outcome domains (e.g., depression, anxiety), TOP data classified therapists as historically "effective," "neutral," or "ineffective." Unaware of their data-driven classifications, therapists rated their perceived effectiveness for each domain. We conducted chi-square analyses to determine whether therapists predicted their own measurement-based effectiveness classifications to a level greater than chance. We then used multilevel modeling to test whether therapists' problem-specific perceptions predicted global between-therapist performance differences.

Results: For all but one outcome domain, therapists were no better than chance at predicting their measurement-based effectiveness classification. Additionally, controlling for patient baseline impairment, therapists who consistently overestimated their problem-specific effectiveness had patients who reported worse global outcomes than patients whose therapist more accurately estimated their effectiveness. Conversely, therapists who underestimated their problem-specific effectiveness had patients who reported better outcomes than patients whose therapist over- or accurately estimated their effectiveness.

Conclusions: Therapist humility may differentiate the most from least globally effective therapists, and this virtue should be cultivated in clinical trainings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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治疗师对自己基于测量的、针对特定问题的有效性的认知。

目的:患者报告的结果数据揭示了治疗师在其平均患者中的整体有效性(治疗师间效应)和在其病例量内治疗不同问题(治疗师内效应)的差异。然而，目前尚不清楚治疗师如何准确地感知他们自己基于测量的、特定问题的有效性，以及这种自我感知是否预测了治疗师之间的整体表现差异。我们在自然主义心理治疗中探讨了这些问题。方法:对于50名治疗师，我们从27名过去的患者(总N = 1363)中提取数据，这些患者在治疗前后完成了多维结果测量-治疗结果包(TOP)。对于12个结果域(如抑郁、焦虑)中的每一个，TOP数据将治疗师分为历史上“有效”、“中性”或“无效”。治疗师不知道他们的数据驱动分类，他们对每个领域的感知有效性进行了评估。我们进行了卡方分析，以确定治疗师是否预测他们自己的基于测量的有效性分类到一个高于偶然的水平。然后，我们使用多层模型来检验治疗师的特定问题感知是否预测了治疗师之间的整体绩效差异。结果:除了一个结果领域外，治疗师在预测基于测量的有效性分类方面并不比机会好。此外，在控制患者基线损伤的情况下，一贯高估其特定问题有效性的治疗师报告的患者总体结果比治疗师更准确地估计其有效性的患者更差。相反，那些低估了他们针对特定问题的有效性的治疗师，其患者报告的结果比那些高估或准确估计其有效性的治疗师的患者报告的结果更好。结论:治疗师的谦逊可以区分最有效和最无效的全球治疗师，这种美德应该在临床培训中培养。(PsycInfo数据库记录(c) 2023 APA，版权所有)。

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来源期刊

Journal of consulting and clinical psychology PSYCHOLOGY, CLINICAL-

CiteScore

9.00

自引率

3.40%

发文量

期刊介绍： The Journal of Consulting and Clinical Psychology® (JCCP) publishes original contributions on the following topics: the development, validity, and use of techniques of diagnosis and treatment of disordered behaviorstudies of a variety of populations that have clinical interest, including but not limited to medical patients, ethnic minorities, persons with serious mental illness, and community samplesstudies that have a cross-cultural or demographic focus and are of interest for treating behavior disordersstudies of personality and of its assessment and development where these have a clear bearing on problems of clinical dysfunction and treatmentstudies of gender, ethnicity, or sexual orientation that have a clear bearing on diagnosis, assessment, and treatmentstudies of psychosocial aspects of health behaviors. Studies that focus on populations that fall anywhere within the lifespan are considered. JCCP welcomes submissions on treatment and prevention in all areas of clinical and clinical–health psychology and especially on topics that appeal to a broad clinical–scientist and practitioner audience. JCCP encourages the submission of theory–based interventions, studies that investigate mechanisms of change, and studies of the effectiveness of treatments in real-world settings. JCCP recommends that authors of clinical trials pre-register their studies with an appropriate clinical trial registry (e.g., ClinicalTrials.gov, ClinicalTrialsRegister.eu) though both registered and unregistered trials will continue to be considered at this time.