Supershrinks: What is the secret of their success?

Clients of the best therapists improve at a rate at least 50 per cent higher and drop out at a rate at least 50 per cent lower than those of average clinicians. What is the key to superior performance? Are 'supershrinks' made or born? Is it a matter of temperament or training? Have they discovered a secret unknown to other clinicians or are their superior results simply a fluke, more measurement error than reality? We know that who provides the therapy is a much more important determinant of success than what treatment approach is provided. The age, gender and diagnosis of the client has no impact on the treatment success rate, nor does the experience, training, and theoretical orientation of the therapist. In attempting to answer these questions, Miller, Hubble and Duncan have found that the best of the best simply work harder at improving their performance than others and attentiveness to feedback is crucial. When a measure of the alliance is used with a standardised outcome scale, available evidence shows clients are less likely to deteriorate, more likely to stay longer and twice as likely to achieve a change of clinical significance. (editor abstract)