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Therapist Characteristics that Impact Outcome

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Slavin-Mulford, J. (2016, February). Therapist characteristics that impact outcome. [Web Article]. Retrieved from:

Dr. Jenelle Slavin-Mulford

Dr. Jenelle Slavin-Mulford

Ample research suggests that therapists differ in their level of effectiveness (Baldwin & Imel, 2012; Blow et al., 2007; Wampold, 2001). Even more striking is that therapist effects appear to be larger than treatment effects (e.g., Lindgren et al., 2010). Moreover, therapist training, experience, and theoretical orientation do not appear to explain the majority of therapist effects (e.g., Beutler et al., 2004; Okiishi et al., 2003; Stirman & Crits-Cristoph, 2011).

Therefore, it has been hypothesized that therapists’ personal characteristics may impact treatment (e.g., Black et al., 2005; Heinonen et al., 2012; Hersoug et al., 2009). If this is true, it would seem wise for clinical graduate programs to accept students who possess these important traits and to provide focused training in areas that may lead to personal growth in related areas.

In a recently published study, Anderson, McClintock, Himawan, Song, and Patterson (2016) explored whether clinical graduate students’ level of therapeutic effectiveness could be predicted based on an assessment conducted prior to training.

Due to issues inherent in measuring therapist characteristics by therapist self-report (e.g., social desirability, lack of insight into oneself etc.), they utilized the Facilitative Interpersonal Skills task (FIS), a performance based measure of therapist interpersonal skills in which students were asked to respond to a standardized video clip of a challenging clinical encounter. The students’ responses were then rated by expert coders on 8 dimensions including: verbal fluency, emotional expression, persuasiveness, warmth/positive regard, hopefulness, empathy, alliance bond capacity, and alliance-rupture repair responsiveness.

Anderson and colleagues found that in their sample of 44 graduate students who saw a total of 117 clients, the FIS strongly predicted patient self-reported symptom change in short-term therapies (e.g., < 8 sessions). Given that this was a prospective study, this suggests that students’ interpersonal skills when they arrived at graduate school (prior to receiving any training) later predicted their ability to help patients. These findings are in line with previous work by Anderson and colleagues (2009; 2015) which has also found that FIS predicts alliance and outcome both at termination and three month follow-up.

Swift - February 2016

Interestingly, in their 2015 work, Anderson and colleagues found that while FIS was an important predictor, training was not.

Taken together, these studies provide compelling evidence that:

  • who the therapist is matters
  • some therapist characteristics appear unrelated to training (i.e., are innate or acquired through experiences unrelated to schooling)
  • graduate schools may want to give important consideration to students’ interpersonal abilities during the application process
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Anderson, T., Crowley, M.E., Himawan, L., Holmberg, J.K., & Uhlin, B.D. (2015). Therapist     facilitative interpersonal skills and training status: A randomized clinical trial on alliance    and outcome. Psychotherapy Research, Advance online publication. DOI:   10.1080/10503307.2015.1049671

Anderson, T., McClintock, A. S., Himawan, L., Song, X., & Patterson, C. L. (2015). A prospective study of therapist facilitative interpersonal skills as a predictor of treatment outcome. Journal of Consulting and Clinical Psychology.

Anderson, T., Ogles, B.M., Patterson, C.L., Lambert, M.J., & Vermeersch, D.A., Therapist effects: Facilitative interpersonal skills as a predictor of therapist success. Journal of Clinical Psychology, 65, 755-768. doi: 10.1002/jclp.20583.

Baldwin, S. A., & Imel, Z. E. (2012). Therapist effects, findings and methods. In M. J. Lambert (Ed.), Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (6th ed., pp. 258–297). Hoboken, NJ: Wiley.

Beutler, L. E., Malik, M. L., Alimohamed, S., Harwood, T. M., Talebi, H., & Noble, S. (2004). Therapist variables. In M. J. Lambert (Ed.), Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (6th ed., pp. 227–257). Hoboken, NJ: Wiley.

Black, S., Hardy, G., Turpin, G., & Parry, G. (2005). Self-reported attachment styles and therapeutic orientation of therapists and their relationship with reported general alliance quality and problems in therapy. Psychology and Psychotherapy: Theory, Research and Practice, 78(3), 363–377.

Blow, A. J., Sprenkle, D. H., & Davis, S. D. (2007). Is who delivers the treatment more important than the treatment itself? The role of the therapist in common factors. Journal Of Marital And Family Therapy, 33(3), 298–317.

Heinonen, E., Lindfors, O., Laaksonen, M. A., & Knekt, P. (2012). Therapists’ professional and personal characteristics as predictors of outcome in short- and long-term psychotherapy. Journal of Affective Disorders, 138(3), 301–312.

Hersoug, A. G., Høglend, P., Havik, O., von der Lippe, A., & Monsen, J. (2009). Therapist characteristics influencing the quality of alliance in long-term psychotherapy. Clinical Psychology & Psychotherapy, 16(2), 100–110.

Lindgren, O., Folkesson, P., & Almqvist, K. (2010). On the importance of the therapist in psychotherapy: A summary of current research. International Forum of Psychoanalysis, 19(4), 224–229.

Okiishi, J., Lambert, M. J., Nielsen, S. L., & Ogles, B. M. (2003). Waiting for supershrink: An empirical analysis of therapist effects. Clinical Psychology & Psychotherapy, 10(6), 361–373.

Stirman, S. W., & Crits-Christoph, P. (2011). Psychotherapy research: Implications for optimal therapist personality, training, and development. In R. H. Klein, H. S. Bernard, V. L. Schermer, R. H. (Ed) Klein, H. S. (Ed) Bernard, & V. L. (Ed) Schermer (Eds.), On becoming a psychotherapist: The personal and professional journey. (pp. 245–268). New York, NY, US: Oxford University Press.

Wampold, B. E. (2001). Therapist effects: An ignored but critical factor. In The great psychotherapy debate: Models, methods, and findings (pp. 184–202). Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers.


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