Therapists' professional and personal characteristics as predictors of working alliance and outcome in psychotherapy
Year: 2014
Type: article
Abstract: Although psychotherapies of different forms and lengths have been found effective for treating depressive and anxiety disorders, some therapists have been shown to be more effective than others in producing positive treatment outcomes. Yet little is known about the characteristics of the more effective therapists. Just as importantly, it is not known whether different therapist qualities are needed in therapies of differing forms and lengths. In contrast, a good working alliance between therapist and patient has been identified as one of the strongest and most consistent predictors of outcome across various therapy forms. The present study investigated therapists professional and personal characteristics as determinants of the therapists effectiveness by studying their ability to predict working alliances and therapy outcomes in two short-term and two long-term therapy forms. Additionally, the study explored correspondences between the professional and personal characteristics of therapists endorsing different therapy forms. In the Helsinki Psychotherapy Study, a total of 367 patients, aged 20-46 years and suffering from depressive or anxiety disorders, were randomly assigned to solution-focused therapy (n = 97), short-term psychodynamic psychotherapy (n = 101), and long-term psychodynamic psychotherapy (n = 128), with 41 patients self-selected to psychoanalysis. Treatments were provided by 71 volunteering psychotherapists who had an average of 17 years of therapy work experience. Working alliance was rated by both patient and therapist at the third therapy session and the 7 months follow-up point. Treatment outcome was assessed via patients self-reports of psychiatric symptoms at baseline and 9 times during a 5-year follow-up. The correspondences between therapists professional and personal characteristics were explored using an international database of over 10 000 therapists representing varied theoretical orientations, career levels, background professions, and nationalities. The therapists endorsed therapy models and their characteristics in both professional and personal life were assessed similarly via self-report. The Helsinki Psychotherapy Study results showed therapists professional and personal characteristics to predict working alliances and treatment outcomes differently in psychotherapies of different forms and lengths. Various experiences of unskillfulness and lack of enjoyment seemed potentially detrimental especially in the two short-term therapies, where a professionally confident, interpersonally active, and engaging manner seemed particularly needed. In comparison, a deliberate, non-intrusive, and considerate relational stance was found more beneficial in long-term psychodynamic therapy. A further consideration emerged in the comparison of long-term psychodynamic therapy to psychoanalysis, in which the benefits of a professionally restrained but personally highly 'present' relational stance in psychoanalysis was suggested. That such a dynamic between the professional and personal may not be uncommon was suggested by findings from the international therapist database: these findings showed that therapists adjust their professional manner from their personal manner in private life according to the expectations of their treatment models. Future studies aiming to replicate the present findings might assess therapist characteristics from additional perspectives, such as those of external observers and patients. Insofar as confirmed, results should have implications for improving the quality and flexibility of therapist training programs and supervision, and help in accommodating clinicians personal qualities with therapy models for optimizing effective training, learning, and therapy practice. Keywords: psychotherapy, psychotherapists, prediction of effectiveness, working alliance, depressive disorder, anxiety disorder
Author: Erkki Heinonen
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W1787232034