Preliminary validation of the Rating of Outcome Scale and equivalence of ultra-brief measures of well-being.

Three brief psychotherapy outcome measures were assessed for equivalence. The Rating of Outcome Scale (ROS), a 3-item patient-reported outcome measure, was evaluated for interitem consistency, test-retest reliability, discriminant validity, repeatability, sensitivity to change, and agreement with the Outcome Rating Scale (ORS) and Outcome Questionnaire (OQ) in 1 clinical sample and 3 community samples. Clinical cutoffs, reliable change indices, and Bland-Altman repeatability coefficients were calculated. Week-to-week change on each instrument was compared via repeated-measures-corrected effect size. Community-normed T scores and Bland-Altman plots were generated to aid comparisons between instruments. The ROS showed good psychometric properties, sensitivity to change in treatment, and discrimination between outpatients and nonpatients. Agreement between the ROS and ORS was good, but neither the agreement between these nor that between ultrabrief instruments and the OQ were as good as correlations might suggest. The ROS showed incremental advantages over the ORS: improvements in concordance with the OQ, better absolute reliability, and less oversensitivity to change. The ROS had high patient acceptance and usability, and scores showed good reliability, cross-instrument validity, and responsiveness to change for the routine monitoring of clinical outcomes. (PsycINFO Database Record

The role of deliberate practice in the development of highly effective psychotherapists.

Little empirical research exists about highly effective psychotherapists, and none about the factors that mediate the acquisition and maintenance of superior performance skills (e.g., Ericsson, 1996, 2006; Ericsson, Krampe, & Tesch-Romer, 1993). In the full sample, a 3-level multilevel modeling (Level 1: clients; Level 2: therapists; Level 3: organization types) of practitioner outcomes was used to examine the contribution of the therapist to treatment effectiveness. Consistent with prior research, in the full sample (n = 69 therapists; n = 4,580 clients) it was found that therapist effects explained 5.1% of the variance in outcome, after adjusting for initial severity. Therapist gender, caseload, and age were not found to be significant predictors. In a subsample of therapists, the relationship between outcome and therapist demographic variables, professional development activities, and work practices was analyzed (n = 17 therapists, n = 1,632 clients). Therapist characteristics (e.g., years of experience, gender, age, profession, highest qualification, caseload, degree of theoretical integration) did not significantly predict client-reported outcomes. Consistent with the literature on expertise and expert performance, the amount of time spent targeted at improving therapeutic skills was a significant predictor of client outcomes. Further, highly effective therapists indicated requiring more effort in reviewing therapy recordings alone than did the rest of the cohort. Caveats and implications for clinical practice, continuing professional development, and training are discussed.

Effect size calculations for the clinician: methods and comparability.

OBJECTIVE: The measurement of clinical change via single-group pre-post effect size has become increasingly common in psychotherapy settings that collect practice-based evidence and engage in feedback-informed treatment. Different methods of calculating effect size for the same sample of clients and the same measure can lead to wide-ranging results, reducing interpretability. METHOD: Effect sizes from therapists-including those drawn from a large web-based database of practicing clinicians-were calculated using nine different methods. RESULTS: The resulting effect sizes varied significantly depending on the method employed. Differences between measurement methods routinely exceeded 0.40 for individual therapists. CONCLUSIONS: Three methods for calculating effect sizes are recommended for moderating these differences, including two equations that show promise as valid and practical methods for use by clinicians in professional practice.

The outcome of psychotherapy: yesterday, today, and tomorrow.

In 1963, the first issue of the journal Psychotherapy appeared. Responding to findings reported in a previous publication by Eysenck (1952), Strupp wrote of the "staggering research problems" (p. 2) confronting the field and the necessity of conducting "properly planned an executed experimental studies" to resolve questions about the process and outcome of psychotherapy. Today, both the efficacy and effectiveness of psychotherapy has been well established. Despite the consistent findings substantiating the field's worth, a significant question remains the subject of debate: how does psychotherapy work? On this subject, debate continues to divide the profession. In this paper, a "way out" is proposed informed by research on the therapist's contribution to treatment outcome and findings from studies on the acquisition of expertise.

Experience is a biochemical intervention: reconceptualizing the "biologically based mental illness".

Empirical evidence challenges the discriminant validity of the "biologically based mental illness" (BBMI) construct. Data indicate that interventions such as psychotherapy, placebo, and medication yield similar changes in brain function when effective. Drug and brain imaging studies show that psychological and biochemical phenomena can be manipulated reciprocally. Data suggest that mental disorders are biologically expressed, not epiphenomenal to a biological process. Suggestions are given for further research and alternative conceptualizations that may lead to changes in healthcare policy.