Science Monday: Therapist characteristics that may lead to greater treatment success

Today in Psychopathology class we will be studying the anxiety disorders. In preparing for the class, I happened on an 2001 article by Huppert, Bufka, Barlow, Gorman, Shear, & Woods in the Journal of Consulting and Clinical Psychology (v. 69, pp747-755). FYI, David Barlow is a well-known anxiety researcher in the Boston area.

These authors researched how various therapist characteristics influence outcome in CBT for anxiety disorders.  While CBT has been found to be effective in treating anxiety, does it matter much what therapist you get?

What therapist characteristics were not found to be all that meaningful to outcome? Gender, age, and theoretical orientation did not seem to make any difference. The fact that theoretical orientation didn’t make much difference is quite interesting. This suggests that expertise in CBT may not matter as much as one might think. Anybody with a manual and a willingness to follow it can do it well enough–maybe.  

So what counselor characteristics do increase successful outcome for anxiety treatment? Experience. The more experienced therapists had clients who had less anxiety after treatment. Experience (number of years as a therapist) matters quite a bit. The authors did not find that experienced therapists were more apt to follow the treatment protocol as there were no differences between experienced and inexperienced therapists as far how they did in following the protocol.

So, what does experience mean? We’re not really sure but it probably has something to do with therapist flexibility while continuing to adhere to the treatment protocol. Those who followed the protocol but were more rigid may have communicated that rigidity to their patients and missed key interpersonal processes. This study didn’t explore this issue but I surmise that is part of the issue.

One funny finding was that more experienced therapists suffered the same drop-out rate as did the more inexperienced therapists. And yet, those who stayed in treatment had much lower anxiety when they were seen by the experienced therapists. So, just because you go to an experienced therapist, don’t assume that everything will go well. No, you have to want to be there and be willing to do the hard work. Also, you just may not click with the counselor.

Most of us counselors want to be skilled and have cool techniques. But once again we find that relationships matter more than technique.

1 Comment

Filed under Anxiety, counseling, counseling science

One response to “Science Monday: Therapist characteristics that may lead to greater treatment success

  1. eclexia

    relationships matter more than technique.

    So very true. I have been in counseling that turned out terrible. I have been in some extremely helpful counseling relationships. I think I have often been a source of frustration to my counselors, mainly because. Well, no mainly. I guess I found that systems and theories kept missing my heart. And if you use the wrong system in the wrong place (like anger management or marriage counseling with an abuser, who is so smart even the counselors can’t figure out he’s playing mind games with them, and the wife is all the time shriveling up and dying, and looking for all the world like the root of the problem….), well, things can get a lot worse.

    After all of that (yes, that is a glimpse into my story), it is only the grace of God that I ever walked into another counselor’s office (and eventually, two–one who helped me personally and one who helped me navigate my way out of the abuse). And it is only the grace of God that the two counselors did not give up on me when it looked like I was so uncooperative, when really, I was hypersensitive to all the counseling techniques that felt way too close to what had gone on in the counseling that missed the abuse.

    I remember the first time my current counselor believed me when I disagreed with his clinical insight. I about fell over, because he trusted me and the Holy Spirit in me more than he trusted his own professional “insight” and opinions. That was hugely healing. He connected to me as a person, and let me see him as a real person. And, out of that relationship, healing began. They made space for me to be me in a context which was very uncomfortable for me. It made the shape of our counseling look very different, but together, a counseling relationship has happened that has made a huge difference in my life.

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