Just as clients vary widely in their presenting problems, therapists also vary in their effectiveness at treating those problems. And, that’s a good thing! Imagine you were assembling a baseball team filled only with pitchers. You’d be in big trouble for about 50% of the game. Successful teams are comprised of individuals who, together, offer a diverse array of abilities. After all, you want to make sure all your bases are covered, clinically speaking of course…
But while it’s true that each therapist on your team offers a unique area of skills and expertise, you may not be using this information to your advantage. If you’re like most practices, you’re probably relying on therapists’ self-report of their own effectiveness. It turns out, though, that therapists may not be so accurate in judging their strengths and weaknesses accurately. One notable study of therapist perceived effectiveness showed that 92% of therapists rated themselves as being in the top quartile of overall effectiveness, and 0% rated themselves as being in the bottom 50% (Walfish et al., 2012).
This isn’t the therapist’s fault. Mental healthcare does not afford practitioners the ability to watch their colleagues in action. So, most of the time, competence is self-reported based on therapist past experience. Moreover, effectiveness is often self-identified as a yes-or-no binary variable. On widely used therapist search engines like Psychology Today, therapists are asked to report checklist-style on populations and presenting problems that they are competent to treat.
As a practice manager, you can help your therapists see their strengths more objectively.
Let’s go back to your baseball team. When it comes to evaluating skills, would you simply take each player at their word? Of course not! Not only would you hold tryouts, you’d test all the players on a range of abilities, like how fast they run and how far they hit the ball. You don’t need each player to be the best at every skill, but you do need players to understand their strengths and weaknesses. You’d likely do this by measuring the seconds it took to run from base to base or distance in feet that the ball was hit from home plate.
In other words, you’d use a measurement-based approach to evaluating strengths and weaknesses. The same can be done in the clinic.
A new study recently showed that using objective data of therapist effectiveness to inform clinical decisions, like case assignments, could be a big boost to your practice’s outcomes. The authors of the study sought to compare therapists’ own perceptions of their strengths and weaknesses with objective, patient-reported outcome measures. They studied 50 masters- and doctoral-level clinicians with an average of 17 years of post-license clinical experience. Clinicians in this study were treating patients in outpatient community centers using a variety of therapeutic modalities.
The authors measured effectiveness two ways: 1) therapist rating their own perceived strengths and 2) using a patient-reported outcome measure called the Treatment Outcome Package, which assesses outcomes across 12 domains: depression, quality of life (QOL), mania, panic/anxiety, psychosis, substance misuse, social conflict, sexual functioning, sleep, suicidality, violence, and work functioning. Clinical benchmarks for the Treatment Outcome Package were generated from a reference group of over 28,000 patients.
Here’s what they found:
-The objective data was far superior to therapists’ subjective data at identifying these strengths and weaknesses
-And, patients of therapists who over-estimated their effectiveness tended to do worse than patients of therapists who accurately or under-estimated their effectiveness.
Moreover, when treating psychosis, mania, substance use, sexual functioning, and sleep, therapist perception of their own skills generally matched the objective data report. But, therapists most often overestimated their perceived effectiveness with treating domains like anxiety, depression, and suicidality. In fact, therapists were no better than chance at predicting their effectiveness in 11 out of the 12 domains (with the exception of psychosis).
So, what does this mean for your practice? Measurement-based patient-reported outcomes give the most accurate picture of therapist abilities, compared to more subjective self-evaluations. However, measurement-based care is not a therapist report card, and unlike your baseball team, the purpose of measuring therapist relative effectiveness is not to foster a competitive atmosphere. On the contrary, this information can be used to make sure that your therapists and clients are well-matched. In fact, the authors of this study cited data showing that making case assignments based on therapist strengths led to significantly greater symptom reduction and functional improvement compared to case assignments made based on chance (Constantino et al., 2021). When therapists feel competent, patients get better, and therapist burnout risk is low. Everybody wins.
Constantino, M. J., Boswell, J. F., Coyne, A. E., Muir, H. J., Gaines, A. N., & Kraus, D. R. (2023). Therapist perceptions of their own measurement-based, problem-specific effectiveness. Journal of Consulting and Clinical Psychology. Advance online publication.
Constantino, M. J., Boswell, J. F., Coyne, A. E., Swales, T. P., & Kraus, D. R. (2021). Enhancing mental health care by matching patients to providers' empirically derived strengths: A randomized clinical trial. JAMA Psychiatry. https://doi. org/10.1001/jamapsychiatry
Walfish, S., McAlister, B., O’Donnell, P., & Lambert, M. J. (2012). An investigation of self-assessment bias in mental health providers. Psycho-ogical Reports, 110 (2), 639–644.