Patterns of therapist variability: therapist effects and the contribution of patient severity and risk

摘要: Objective To investigate the size of therapist effects using multilevel modeling (MLM), to compare outcomes therapists identified as above and below average, consider how key variables--in particular patient severity risk caseload--contribute variability outcomes. Method We used a large practice-based data set comprising patients referred U.K.'s National Health Service primary care counseling psychological therapy services between 2000 2008. Patients were included if they had received ≥2 sessions 1-to-1 (including an assessment), planned ending treatment, completed Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM; Barkham et al., 2001; Barkham, Mellor-Clark, Connell, & Cahill, 2006; Evans 2002) at pre- post-treatment. The study sample comprised 119 10,786 patients, whose mean age was 42.1 years (71.5% female). MLM, including Markov chain Monte Carlo procedures, derive estimates produce analyze variability. Results model yielded effect 6.6% for average severity, but it ranged from 1% 10% non-risk scores increased. Recovery rates individual 23.5% 95.6%, greater levels aggregated therapist's caseload associated with poorer Conclusions similar those found elsewhere, more severe patients. Differences or large, caseload, rather than