School of Health and Related Research, University of Sheffield, Sheffield, UK.
Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK.
Clin Psychol Psychother. 2020 Sep;27(5):770-778. doi: 10.1002/cpp.2461. Epub 2020 Apr 28.
Psychological intervention outcomes depend in part on the therapist who provides the intervention (a therapist effect). However, recent reviews suggest that therapist effects may vary as a function of the context in which care is provided and therefore should not be generalized beyond that context. This study statistically analysed therapist effect differences between care sectors delivering psychological interventions. The sample comprised routine clinical data from 26,814 patients (69% female; mean age 38) and 466 therapists in five care sectors: primary care, secondary care, university, voluntary, and workplace. Therapist effects were analysed using multilevel models and Markov chain Monte Carlo credible intervals. The therapist effect was significantly larger in primary care (8.4%) than in any other sector (1.1%-2.3%) except secondary care (4.1%), after controlling for explanatory baseline and process variables as well as accounting for differences between clinics. There were no other significant differences detected between care sectors. These findings support the hypothesis that differences in effectiveness between therapists vary depending on the context in which psychological treatment is provided. Differences in relative therapist impact can vary by a factor of 4-8 across treatment sectors. This should be considered in the application of research evidence, treatment planning, and the design and delivery of psychological care provision.
心理干预的结果在一定程度上取决于提供干预的治疗师（治疗师效应）。然而，最近的综述表明，治疗师效应可能会随着护理提供的环境的变化而变化，因此不应将其推广到该环境之外。本研究从统计学上分析了提供心理干预的不同护理领域之间治疗师效应的差异。样本包括来自五个护理领域（初级保健、二级保健、大学、志愿和工作场所）的 26814 名患者（69%为女性；平均年龄 38 岁）和 466 名治疗师的常规临床数据。使用多层次模型和马尔可夫链蒙特卡罗可信区间分析治疗师效应。在控制了解释性基线和过程变量并考虑到诊所之间的差异后，初级保健（8.4%）的治疗师效应明显大于其他任何领域（1.1%-2.3%），除了二级保健（4.1%）。在护理领域之间没有发现其他显著差异。这些发现支持了这样一种假设，即治疗师之间有效性的差异取决于心理治疗提供的环境。治疗师相对影响的差异在治疗领域之间可能相差 4-8 倍。在应用研究证据、治疗计划以及心理保健提供的设计和交付时，应考虑到这一点。
