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Therapist Success and Its Determinants

Lester Luborsky, PhD; A. Thomas McLellan, PhD; George E. Woody, MD; Charles P. O'Brien, MD, PhD; Arthur Auerbach, MD
Arch Gen Psychiatry. 1985;42(6):602-611. doi:10.1001/archpsyc.1985.01790290084010.
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• This study examined the relatively unexplored contribution of the therapist's performance in determining outcomes of treatment. Nine therapists were studied: three performed supportive-expressive psychotherapy; three, cognitive-behavioral psychotherapy; and three, drug counseling. Profound differences were discovered in the therapists' success with the patients in their case loads. Four potential determinants of these differences were explored: (1) patient factors; (2) therapist factors; (3) patient-therapist relationship factors; and (4) therapy factors. Results showed that (1) patient characteristics within each case load (after random assignments) were similar and disclosed no differences that would have explained the differences in success; (2) therapist's personal qualities were correlated with outcomes but not significantly (mean r=.32); (3) an early-in-treatment measure of the patienttherapist relationship, the Helping Alliance Questionnaire, yielded significant correlations with outcomes (mean r=.65); (4) among the therapy techniques, "purity" provided significant correlations with outcomes (mean r=.44), both across therapists and within each therapist's case load. The three therapist-related factors were moderately associated with each other.

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