Navigation Links
Therapist competence matters -- and more for some patients than others

COLUMBUS, Ohio While studies have shown that cognitive therapy is an effective treatment for depression, it has still not been clear the role therapists' training and expertise plays in making treatment successful.

A new study finds that depressed patients show more symptom improvement when their therapists more competently follow the guidelines for delivering cognitive therapy.

The study also suggests therapist competence may be a particularly important determinant of outcome for some patients. Researchers found that therapist competence was more strongly related to symptom improvement in patients who suffered from anxiety as well as depression, and for those who first experienced depression at an early age.

"People with depression who don't have complicating issues like anxiety are fairly likely to show benefit even if they don't see the most highly rated therapists," said Daniel Strunk, co-author of the study and assistant professor of psychology at Ohio State University.

"But people who have substantial anxiety or a history of depression that began at an early age really do best if they have the most highly rated treatment."

While the need for competent therapists might seem obvious, Strunk said there have been very few studies looking at whether the competence with which the therapy is delivered predicts subsequent outcomes. Studies that have examined the issue have tended to examine the relation of ratings of therapists and the overall outcomes of their patients. But that ignores the possibility that the competence of the therapists may not have been responsible for their patients' improvement.

"Once patients have improved, they might help to make their therapists look more competent. If so, this could explain the competence-outcome relation. So, we wanted to see if we could rule out that possibility by examining whether competence predicted subsequent outcomes," Strunk said.

The research appears in a recent issue of the Journal of Consulting and Clinical Psychology.

In this study, two researchers examined videotapes of therapy sessions involving 60 adults with moderate to severe depression and their six therapists. The researchers rated competence using the Cognitive Therapy Scale, which is also used by the accrediting organization for cognitive therapists (The Academy of Cognitive Therapy). The scale rates therapists on a variety of skills, including their interpersonal relations and their use of specific techniques thought to help patients facing depression.

The researchers rated the therapists' competence during the first four sessions with each of the 60 patients.

In addition, patients completed a questionnaire at each session that measured their depression levels.

Strunk and his colleagues then compared how competence scores given to the therapists for each session related to change in patients' depression levels from session to session.

The researchers rated competence levels without knowing how the patients were progressing and whether their symptoms were improving, Strunk said. This way, the researchers could later tell whether there was an association between competence and subsequent patient improvement.

Strunk said the strongest results came when they looked at how therapist competence was related to improvement in patients with specific characteristics. That is where they found that patients with high anxiety and early onset depression benefitted most from the highly rated therapy sessions.

In addition to looking at how therapist competence interacted with patient characteristics, the researchers also examined how competence, measured for each individual session, was related to patient improvement from one session to the next. Results showed that higher levels of therapist competence were related to more symptom improvement during the first four sessions.

The researchers also tested patients again after 16 weeks of treatment to see if competence predicted longer-term improvement. Here, competence was significantly related to patient improvement on just one of two measures of depression severity.

"When you look at how patients do after four full months of treatment, the importance of therapist competence was still there, but not as strong," he said.

Strunk said the results suggest that therapists may show higher levels of competence in some sessions compared to others, even with the same patient.

"From our results, you should expect that there will be a range of competence from session to session even among good therapists," Strunk said.

"That may mean that the way we define competence is still not good enough, because we're finding that even highly trained therapists get below-average scores a fair number of times."

The results should encourage more study about the best way to measure competence in therapists.

"The field is still struggling to figure out how to measure competence, and that's one of the things this study is about," he said.

Strunk also said that, if replicated, these results would suggest that clinic directors should look at patient characteristics when deciding which therapists should treat individual patients with depression. Those patients with anxiety issues or early onset depression should be placed with the highest-rated therapists to get the most benefit.


Contact: Daniel Strunk
Ohio State University

Related medicine news :

1. New Online Physical Therapy Marketing Academy Helps Physical Therapists Conquer The Web
2. "Revised Yoga for Dummies" Author and Co-Founder of International Association for Yoga Therapists Celebrates 30th Anniversary in Los Angeles
3. Psychotherapist and Media Personality Stacy Kaiser Joins ToughLOVE
4. Physical therapist-led exercise in patients in ICU improves function and decreases hospital stay
5. Self-Psychology Allows You to Carry A Cognitive Behavioral Therapist On Your iPhone
6. Respiratory Therapist School, Pima Medical Institute, Donates Time, Money to American Lung Association
7. Physical Therapist Wins Nautica South Beach Triathlon
8. HealthLinkRx Announces Classes in Spanish for Occupational and Physical Therapists
9. and Partner to Help Therapy Seekers Find a Therapist
10. Offers A Free Therapist Listing For Credentialed Counselors and Psychologists
11. Pioneering Hormone Therapist to Host Free Health Seminar
Post Your Comments:
(Date:11/29/2015)... , ... November 29, 2015 , ... ... and unique analog distortion effect tool designed specially for Final Cut Pro X. ... create limiltess looks with the easy-to-use modification controls. Destoying and creating chaotic distortion ...
(Date:11/28/2015)... ... November 28, 2015 , ... Safe storage for contraceptive devices may ... one from Lakewood, New Jersey and the other from Bradley Beach, New Jersey, there ... save the expense of having to replace NuvaRings more often than necessary. As such, ...
(Date:11/27/2015)... ... , ... There is only one major question facing all law firms in ... question has not been an easy question to answer. Especially when the senior partners ... workforce don’t share the same discipline around working long hours. , In addition ...
(Date:11/27/2015)... ... 27, 2015 , ... The rapid speed at which Americans ... more care is needed, especially with Alzheimer’s, dementia and other cognitive conditions becoming ... The forgotten part of this equation: 80 percent of medical care occurs in ...
(Date:11/27/2015)... ... November 27, 2015 , ... Lizzie’s Lice Pickers just announced ... offering customers 10% off of their purchase of lice treatment product. In addition, customers ... According to a company spokesperson. “Finding lice is a sure way to ruin the ...
Breaking Medicine News(10 mins):
(Date:11/29/2015)... 2015   National Decision Support Company (NDSC) continues ... including notable statewide implementations. As a result, ordering ... Select, more than 1 million times per month—all ... Select provides real-time feedback on the most appropriate ... been implemented at over 100 healthcare systems nationally, ...
(Date:11/27/2015)... 2015  Lannett Company, Inc. (NYSE: LCI ... acquisition of Kremers Urban Pharmaceuticals Inc. (KU), the ... company UCB S.A. (Euronext: UCB). ... KU from UCB for total consideration of approximately ... customary working capital adjustment, a deduction of certain ...
(Date:11/26/2015)... , Países Bajos, November 26, 2015 ... la terapia fotodinámica de Bremachlorin para el cáncer avanzado. ... la inmunoterapia con la terapia fotodinámica de Bremachlorin para ... Un nuevo enfoque combina la inmunoterapia con la terapia ... Clinical Cancer Research . --> ...
Breaking Medicine Technology: