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Objective : Psychotherapists differ notably in the outcomes their patients achieve, and the characteristics that may explain these differences have attracted increasing interest. We systematically review studies on therapist pre-treatment characteristics predicting patient outcomes. Method: Systematic searches on databases for psychotherapy research, clinical psychology, and medical science for the years 2000-2018 identified published research examining therapist characteristics and psychotherapy outcomes. Of 2041 studies, 31 met inclusion criteria. Results : Findings show a few direct effects of therapist intrapersonal variables (e.g., self-relatedness, attachment) and several interaction effects with other constructs (e.g., patient pathology) on outcome. There is little support for the relevance of self-rated social skills. However, more consistent evidence has recently emerged for performance-based measurements of professional interpersonal skills, especially when elicited in challenging situations. Patient outcomes were also predicted by therapists' self-rated professional characteristics, such as their experienced difficulties in practice, coping mechanisms, and attitudes towards therapeutic work, indicating that therapist self-perception also matters, although not always in the direction expected. Conclusions : More effective therapists seem characterized by professionally cultivated interpersonal capacities, which are likely rooted in their personal lives and attachment history. Research guidelines are proposed for moving this field forward (including larger samples, multilevel modeling, and in-depth qualitative work).

Objective: Psychotherapists' experiences of emotional burdens and distress in their personal lives can compromise their professional functioning, as well as undermine their own wellbeing. To identify preventative measures, we need more knowledge about the personal and situational risk factors that contribute to therapists' emotional burdens. Method: From a large-scale international study of psychotherapists (N = 12,036), we analyzed a scale of Personal Burdens (PB) as a criterion variable with different sets of predictors: (a) age and gender; (b) childhood family functioning (e.g., trauma/abuse; early care quality); (c) dimensions of self (as experienced in close personal relationships); (d) current work satisfaction; and (e) current life stressors (financial and health worries), examining the relative importance of these predictors. Scores on attachment avoidance and anxiety were also included (as Step 6) for a subsample (N = 1,243) which had responded to a standard measure of those dimensions. Finally, we investigated whether the association of personal self (in the full sample) and attachment dimensions (in the subsample) depended on therapist gender and age cohort (Steps 7 & 8). Results: The most salient predictors of therapists' PB were current worries; early trauma; experiences of self in close relationships (e.g., being demanding and/or reclusive); low work satisfaction; an anxious attachment style (especially for male therapists) and younger age. The model with all predictors explained almost 30% of the variance in PB. Conclusions: Both personality-related and past and current life circumstances contributed to therapists' emotional burdens. Implications for prevention and selfcare are suggested. [ABSTRACT FROM AUTHOR]

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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. [ABSTRACT FROM AUTHOR]

Research has shown that the therapist's contribution to the alliance is more important for the outcome than the patient's contribution (e.g., Baldwin, Wampold, & Imel, 2007); however, knowledge is lacking about which therapist characteristics are relevant for alliance building and development. The objective of this study was to explore the development of the working alliance (using the Working Alliance Inventory), rated by both patients and therapists as a function of therapist in-session experiences. The therapist experiences were gathered by means of the Development of Psychotherapists Common Core Questionnaire (Orlinsky & Rønnestad, 2005). Data from the Norwegian Multisite Study of the Process and Outcome of Psychotherapy (Havik et al., 1995) were used. Multilevel growth curve analyses of alliance scores from Sessions 3, 12, 20 and 40 showed that the therapist factors predicted working alliance levels or growths differently, depending on whether the alliance was rated by patients or by therapists. For example, it emerged that therapists' negative reactions to patients and their in-session anxiety affected patient-rated alliance but not therapist-rated alliance, whereas therapist experiences of flow (Csikszentmihalyi, 1990) during sessions impacted only the therapist-rated alliance. The patterns observed in this study imply that therapists should be particularly aware that their negative experiences of therapy are noticed by, and seem to influence, their clients when they evaluate the working alliance through the course of treatment. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message The findings of this study suggest that the working alliance is influenced by therapists' self-reported practice experiences, which presumably are communicated through the therapists' in-session behaviours., The study found a notable divergence between practice experiences that influenced the therapists and those that influenced the patients when evaluating the working alliance., Specifically, practitioners' self-reported difficulties in practice, such as their negative reactions to patients and their in-session anxiety, affected patient-rated alliance but not therapist-rated alliance, whereas therapist experiences of 'flow' during sessions impacted only the therapist-rated alliance., Practitioners should note that patient alliance ratings were more likely to be influenced by therapists' negative practice experiences than by positive ones., The divergence in the patient and therapist viewpoints has potential implications for therapist training and supervision and everyday self-reflection. [ABSTRACT FROM AUTHOR]

Research suggests that the person of the psychotherapist is important for the process and outcome of psychotherapy, but little is known about the relationship between therapists' personal experiences and the quality of their therapeutic work. This study investigates 2 factors (Personal Satisfactions and Personal Burdens) reflecting therapists' quality of life that emerged from the self-reports of a large international sample of psychotherapists (N = 4,828) (Orlinsky & Ronnestad, 2004, 2005) using the Quality of Personal Life scales of the Development of Psychotherapists Common Core Questionnaire (Orlinsky et al., 1999). These factors were investigated as predictors of alliance levels and growth (using the Working Alliance Inventory) rated by both patients and therapists in a large (227 patients and 70 therapists) naturalistic outpatient psychotherapy study (Havik et al., 1995). The Personal Burdens scale was strongly and inversely related to the growth of the alliance as rated by the patients, but was unrelated to therapist-rated alliance. Conversely, the factor scale of therapists' Personal Satisfactions was clearly and positively associated with therapist-rated alliance growth, but was unrelated to the patients' ratings of the alliance. The findings suggest that the working alliance is influenced by therapists' quality of life, but in divergent ways when rated by patients or by therapists. It seems that patients are particularly sensitive to their therapists' private life experience of distress, which presumably is communicated through the therapists' in-session behaviors, whereas the therapists' judgments of alliance quality were positively biased by their own sense of personal well-being. [ABSTRACT FROM AUTHOR]