Do time and experience make a better therapist?

Despite widespread consensus on the importance of providing ongoing training and continuing education throughout the career trajectories of mental health professionals, the impact of such efforts on therapist effectiveness remains an area of great interest for both clinicians and researchers in the field of psychology.

A recent study published in the Journal of Counseling Psychology sheds light on the subject of therapist professional development by conducting the first large-scale longitudinal assessment of changes in therapist effectiveness over the course of their careers. As therapists work to improve treatment outcomes, this study contributes valuable - and perhaps surprising - information about the relationship between clinical experience and outcome effectiveness.

Researchers examined whether therapists became more effective as they gained experience, using at a sample of 170 therapists and 6,591 patients at a large university counseling center from a period spanning over 18 years. The study tested the basic conjecture that therapists’ outcomes would improve over time or with a greater number of cases treated and that seasoned therapists would have fewer dropouts. Therapist experience was measured in two ways: as chronological time and cumulative patients seen. Therapist effectiveness was measured as the average ability of the therapist to improve patient outcomes over time. The Outcome Questionnaire-45 was administered to all patients at intake and prior to each therapy visit, and was used to quantify patient progress across time.

While patients significantly benefitted from treatment, the study found no evidence that therapists improved in their effectiveness as they gained experience through time in the profession or cumulative number of patients seen. In fact, therapists on average became slightly less effective over time, although this down-trend in effectiveness was minimal. These results are particularly interesting given practitioners’ self-reported experience. Using self-report methodology, the majority of therapist rated themselves as becoming more effective over time. This disparity between actual and perceived effectiveness is curious but understandable. Self-assessment is a challenge for anybody and as therapists gain experience, the need for feedback only increases.

Considering these important research findings, should you simply throw in the towel on bettering your clinical skills and accept the fact that you are as effective as you will ever be?

Of course not!

When it comes to experience, more is not necessarily better. Importantly, the researchers identified a noteworthy subset (39%) of therapists who actually got more effective at improving patient outcomes over time and noted that “it may be that the quality of experience is a better predictor of outcomes that the mere quantity of experience measured in the present study.” More specifically, results from the study reinforce the need for clinicians - and clinics - to use effective tools that can be applied to everyday clinical encounters in order to promote ecologically-valid ongoing professional development.

A particularly important piece of this process is the routine use of feedback, whereby therapists can use quantitative information to evaluate their actions and behaviors in session in order to identify strategies and approaches that are most effective among their patient population. In this way, measurement-based care (MBC) - the practice of collecting, sharing, and responding to data throughout the course of care - is a widely supported approach that has been shown to increase therapist effectiveness and lead to improved patient outcomes. Implementation of strategies like MBC provide benefits at all levels of care and can help you rise above the average and ensure that you are progressing in your professional development.

Goldberg, S., Rousmaniere, T., Miller, S., Whipple, J., Nielsen, S., Hoyt, W., & Wampold, B. (2016). Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting. Journal of Counseling Psychology, 63(1), 1-11.