Nissen-Lie Helene A, Goldberg Simon B, Hoyt William T, Falkenström Fredrik, Holmqvist Rolf, Nielsen Stevan Lars, Wampold Bruce E
Department of Psychology, University of Oslo.
Department of Counseling Psychology, University of Wisconsin-Madison.
J Couns Psychol. 2016 Jul;63(4):367-78. doi: 10.1037/cou0000151. Epub 2016 Apr 28.
As established in several studies, therapists differ in effectiveness. A vital research task now is to understand what characterizes more or less effective therapists, and investigate whether this differential effectiveness systematically depends on client factors, such as the type of mental health problem. The purpose of the current study was to examine whether therapists are universally effective across patient outcome domains reflecting different areas of mental health functioning. Data were obtained from 2 sites: the Research Consortium of Counseling and Psychological Services in Higher Education (N = 5,828) in the United States and from primary and secondary care units (N = 616) in Sweden. Outcome domains were assessed via the Outcome Questionnaire-45 (Lambert et al., 2004) and the CORE-OM (Evans et al., 2002). Multilevel models with observations nested within patients were used to derive a reliable estimate for each patient's change (which we call a multilevel growth d) based on all reported assessment points. Next, 2 multilevel confirmatory factor analytic models were fit in which these effect sizes (multilevel ds) for the 3 subscales of the OQ-45 (Study 1) and 6 subscales of CORE-OM (Study 2) were indicators of 1 common latent factor at the therapist level. In both data sets, such a model, reflecting a global therapist effectiveness factor, yielded large factor loadings and excellent model fit. Results suggest that therapists effective (or ineffective) within one outcome domain are also effective within another outcome domain. Tentatively, therapist effectiveness can thus be conceived of as a global construct. (PsycINFO Database Record
多项研究表明,治疗师的治疗效果存在差异。目前一项至关重要的研究任务是了解更有效或较无效的治疗师有何特点,并调查这种差异效果是否系统地取决于客户因素,如心理健康问题的类型。本研究的目的是检验治疗师在反映心理健康功能不同领域的患者结果领域中是否普遍有效。数据来自两个地点:美国高等教育咨询与心理服务研究联盟(N = 5828)以及瑞典的初级和二级护理单位(N = 616)。通过结果问卷-45(兰伯特等人,2004年)和CORE-OM(埃文斯等人,2002年)对结果领域进行评估。使用将观察值嵌套在患者内的多层次模型,根据所有报告的评估点得出每个患者变化的可靠估计值(我们称之为多层次增长d)。接下来,拟合了两个多层次验证性因素分析模型,其中OQ-45的3个分量表(研究1)和CORE-OM的6个分量表(研究2)的这些效应大小(多层次d)是治疗师层面一个共同潜在因素的指标。在这两个数据集中,这样一个反映全球治疗师有效性因素的模型产生了较大的因素负荷和出色的模型拟合。结果表明,在一个结果领域有效(或无效)的治疗师在另一个结果领域也有效。因此,初步认为治疗师的有效性可以被视为一个全局结构。(PsycINFO数据库记录