Schwartz Brian, Hehlmann Miriam I, Deisenhofer Anne-Katharina, Rubel Julian A, Fischer Lea, Lutz Wolfgang, Schöttke Henning
Department of Psychology, Trier University, Germany.
Department of Psychology, Osnabrück University, Germany.
Behav Res Ther. 2025 Mar;186:104689. doi: 10.1016/j.brat.2025.104689. Epub 2025 Jan 22.
Therapists differ in their average treatment outcomes. However, it remains unclear which characteristics differentiate more from less effective therapists. This study examined the association between therapist interpersonal skills and treatment outcome as well as the moderating effect of initial impairment.
Interpersonal skills were assessed with the Therapy-Related Interpersonal Behaviors (TRIB) scale, a group-discussion based rating system, in 99 incoming therapy trainees. The trainees treated n = 1031 outpatients with psychological therapies, whose treatment outcomes were assessed with the Symptom-Checklist 90 Revised (SCL-90-R). Linear mixed models were conducted to predict outcome by therapists' interpersonal skills beyond initial impairment, number of sessions, therapist age, gender, and theoretical orientation. The moderating effect of initial impairment was calculated as cross-level interaction.
The therapist effect (TE) in this sample was 5.6%. Interpersonal skills were a significant predictor of outcome (b = -0.124, p < .001) and explained 1.3% of variance beyond all control variables. The TE in the final model was VPC = .036 indicating that 26.79% of the TE were attributable to interpersonal skills. The impairment-skills interaction was significant (b = -0.172, p < .001). The effect of interpersonal skills on outcome increased with more severe initial impairment. Results were replicated in a second outcome measure (Outcome Questionnaire 30).
Interpersonal skills were found to be important characteristics to differentiate between more and less effective therapists, especially when treating severely distressed patients. Considering them in therapist selection and matching, outcome prediction, and clinical training could improve the effectiveness of psychological therapies.
治疗师的平均治疗效果存在差异。然而，尚不清楚哪些特征能区分治疗效果较好和较差的治疗师。本研究考察了治疗师人际技能与治疗效果之间的关联以及初始损伤的调节作用。
采用基于小组讨论的评分系统“治疗相关人际行为（TRIB）量表”对99名即将接受治疗的实习生的人际技能进行评估。这些实习生对n = 1031名门诊患者进行心理治疗，其治疗效果通过症状自评量表90修订版（SCL - 90 - R）进行评估。采用线性混合模型，在控制初始损伤、治疗次数、治疗师年龄、性别和理论取向的基础上，预测治疗师人际技能对治疗效果的影响。初始损伤的调节作用通过跨层次交互作用进行计算。
本样本中的治疗师效应（TE）为5.6%。人际技能是治疗效果的显著预测因素（b = -0.124，p <.001），在控制所有变量后解释了1.3%的方差。最终模型中的TE为VPC =.036，表明26.79%的TE可归因于人际技能。损伤 - 技能交互作用显著（b = -0.172，p <.001）。人际技能对治疗效果的影响随着初始损伤程度的加重而增加。结果在第二项疗效测量指标（结果问卷30）中得到了重复验证。
人际技能是区分治疗效果较好和较差的治疗师的重要特征，尤其是在治疗严重困扰的患者时。在治疗师的选拔与匹配、疗效预测和临床培训中考虑这些因素，可能会提高心理治疗的效果。
