Dear Colleague: For this month, the NEARI Press newsletter article examined whether the experience of the therapist has any effect on the client’s ou

   
NEARI Press Masthead with Photos

Dear Colleague:
For this month, the NEARI Press newsletter article examined whether the experience of the therapist has any effect on the client’s outcomes. In other words, does it matter if you are seeing someone with years of experience or someone who has recently completed their training program. To date, there has not been any large-scale longitudinal study about whether the professional experience of the therapist would improve outcomes over time. Surprisingly, the study overall showed that therapists did not improve with more experience, as measured by either time or the number of people with whom they had worked. It is worthwhile reading the rest of the newsletter to see what can make a difference in the lives of our clients.

As always, if you have any other questions or suggestions for future newsletter topics, please don't hesitate to contact us.

Sincerely,
Craig Latham, Executive Director, NEARI
and
Joan Tabachnick, Director, NEARI Press

Check out our NEW 2016-2017 NEARI Press Catalog!

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Exploring the Impact of Time and Experience on Client Outcomes

by David S. Prescott and Joan Tabachnick

Authors
Simon B. Goldberg, Scott D. Miller, Stevan Lars Nielsen, Tony Rousmaniere, Jason Whipple, and William T. Hoyt

The Question
Do Psychotherapists Improve with Time and Experience?

The Research
This study explored whether increased therapist experience is linked to improved outcomes for the client. Simon B. Goldberg, Scott D. Miller, Stevan Lars Nielsen, Tony Rousmaniere, Jason Whipple, and William T. Hoyt studied 6,591 patients seen in individual psychotherapy by 170 therapists over nearly five years. Previous studies have found that more therapist experience is modestly linked with lower rates of dropout and better outcomes in psychotherapy. However, to date, no large-scale longitudinal study has assessed whether the professional experience of the therapist would improve outcomes over time.

The sample overall showed that the therapy used was effective with a significant drop in psychological systems over the course of treatment. The analyses also showed that therapists did not improve with more experience, as measured by either time or the number of people with whom they had worked. Surprisingly, the results suggest that therapists become slightly less effective over time (although the authors note that the magnitude of the decrease in effectiveness was extremely small). The authors also note that these results contrast with clinician self-reported experiences with clients. The majority of practitioners experience themselves as developing professionally over their careers and that those with 15 or more years in practice were significantly more likely to perceive that their work with patients was more effective.

While this is first study of this magnitude, there were also some limitations that were noted. For example, as time progressed therapists may have received less training, increased workload and more difficult patients resulting in poorer outcomes even as their skills were improving. No single standardized treatment intervention was provided to patients so there was no clear path to how therapist skills could be operationalized. They also noted that the quality of experience may be a better indicator than the quantity of experience since nearly 40% improved their outcomes over time.

Bottom Line: Overall, therapists did not significantly improve with more experience, measured as either time or number of cases.

Implications for Professionals
Effective treatment of people who sexually abuse is a matter of public safety as well as a means to help individual clients manage their lives. These findings suggest that practitioners can easily be lulled into a sense of complacency about their effectiveness; confidence can improve across one’s career, but it may not improve one’s effectiveness.

Fortunately, the authors provide many ideas for professional development culled from the training literature in psychology and medicine. They include:

Setting small process and outcome goals based on client-specific information
Creating social experiments in naturalistic settings to test, recalibrate, and improve (for example, generating possible responses to client interactions, selecting one, testing it, and then exploring how well it worked)
Enhance professional environments for targeted learning (e.g., set goals related to increasing effectiveness and not just preventing mistakes)
Using case vignettes to improve interactions with clients (e.g., practicing responses to typical and/or specific client statements)

Implications for the Field
It is easy to talk about professional development in our field; accomplishing professional development that can improve our client’s outcomes is much more difficult. These findings point to the importance of always maintaining a personal and professional goal of being more effective tomorrow than we are today. While there are many resources outside of our field for becoming more effective at a given endeavor (e.g., Cal Newport’s book Deep Work), this study shows that part of professional self-care can be to move beyond efforts aimed at professional longevity to an active focus on specific competencies.

Abstract
Objective: Psychotherapy researchers have long questioned whether increased therapist experience is linked to improved outcomes. Despite numerous cross-sectional studies examining this question, no large-scale longitudinal study has assessed within-therapist changes in outcomes over time.
Method: The present study examined changes in psychotherapists’ outcomes over time using a large, longitudinal, naturalistic psychotherapy data set. The sample included 6,591 patients seen in individual psychotherapy by 170 therapists who had on average 4.73 years of data in the data set (range _ 0.44 to 17.93 years). Patient-level outcomes were examined using the Outcome Questionnaire-45 and a standardized metric of change (prepost d). Two-level multi-level models (patients nested within therapist) were used to examine the relationship between therapist experience and patient prepost d and early termination. Experience was examined both as chronological time and cumulative patients seen.
Results: Therapists achieved outcomes comparable with benchmarks from clinical trials. However, a very small but statistically significant change in outcome was detected indicating that on the whole, therapists’ patient prepost d tended to diminish as experience (time or cases) increases. This small reduction remained when controlling for several patient-level, caseload-level, and therapist-level characteristics, as well as when excluding several types of outliers. Further, therapists were shown to vary significantly across time, with some therapists showing improvement despite the overall tendency for outcomes to decline. In contrast, therapists showed lower rates of early termination as experience increased.
Conclusions: Implications of these findings for the development of expertise in psychotherapy are explored.

Citation
Goldbert, S.B., Miller, S.D., Nielsen, S.L., Rousmaniere, T., Whipple, J., & Hoyt, W.T. (2016). Do Psychotherapists Improve with Time and Experience? Journal of Counseling Psychology, 63, 1-11.

To print a pdf of this article, click NEARI NEWS.

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FEATURED NEARI RESOURCES

Book Beyond Manuals and Workbooks

Beyond Manuals and Workbooks: Improving Clinical Outcomes with Adolescents who have Sexually Abused

by David S. Prescott

This booklet focuses on the essential elements that every clinician can integrate into their current treatment to make it more effective. While many treatment programs organize themselves around specific curricula, this booklet makes recommendations for specific skills for improving outcomes and therapeutic alliances, early identification of at-risk cases, motivational goal setting, and considerations for successfully moving clients into a healthier environment. Based upon the current research, this booklet outlines the core values and concrete steps towards developing a truly evidence-based practice.

ISBN: 978-1-929657-61-2
Catalog Number: 9706
Price: $3.75 plus shipping and handling

nearicover2016

NEW 2016-2017 NEARI Press Catalog Now Available!

We would like to share our brand-new 2016-2017 NEARI Press catalog with you. The link to download the online version of the catalog is [here], or you can copy and paste the following URL into your browser. https://drive.google.com/file/d/0B2pSEohGdn5faGhkVk9NS0ZMYlk/view?usp=sharing

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NEW!! A Training Opportunity with Phil Rich, Ed.D., LICSW

Assessment of Juvenile Sexual Risk: Three-Day Certification

October 17-19, 2016

This three-day training course will provide instruction and practice experience in administration of sexual risk assessment for juveniles who have previously engaged in sexually abusive behavior. The course will cover the process of risk assessment, from theory, method, and instrumentation to case study and applied practice, including case formulation.

This training program is not a webinar, but will be occurring at the LaSalle School in Albany, NY.

For more information, please click here.

You can download the registration form for this training course here.

BECOME A WEBINAR SERIES SPONSOR

Please consider becoming a sponsor of our exciting 2016-2017 NEARI Press Webinar series. We will have a great lineup of nationally recognized authors including Phil Rich, Tim Kahn, David Prescott, Geral Blanchard, Anna Hanson, Steven Brown, among many others.

For $98 as an individual or $250 as an organization, we will guarantee your seat in the webinar AND you have access to CE credits. We do all of the work to sign you up each month, and, as a thank you for your essential support, we offer you two free NEARI Press books Current Perspectives and Current Applications, both edited by David Prescott and Robert Longo. We think that this is really a win-win situation for all of us.

For more information or to sign up, visit our website at info@nearipress.org or contact Diane Langelier at 413.540.0712 x14 or email her at info@nearipress.org.

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Volume 9, Issue 9: September 2016

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