It is essential that outcome research permit clear conclusions to be drawn about the efficacy of interventions. The common practice of nesting therapists within conditions can pose important methodological challenges that affect interpretation, particularly if the study is not powered to account for the nested design. An obstacle to the optimal design of these studies is lack of data about the intraclass correlation coefficient (ICC), which measures the statistical dependencies introduced by nesting. To begin the development of a public database of ICC estimates, the authors report ICCs for a variety outcomes reported in 20 psychotherapy outcome studies. The magnitude of the N = 495 ICC estimates varied widely across measures and studies. The authors provide recommendations regarding how to select and aggregate ICC estimates for power calculations and show how researchers can use ICC estimates to choose the number of patients and therapists that will optimize power. Attention to these recommendations will strengthen the validity of inferences drawn from psychotherapy studies that nest therapists within conditions.

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Patient-focused research has been empirically established to reduce drop-out (Lambert, Hansen, & Finch, 2001) and improve outcomes (Reese, Norsworthy, & Rowlands, 2009), particularly for those at risk for treatment failure (Shimokawa, Lambert, & Smart, 2010). An additional benefit associated with the use of patient-focused research systems is the facilitating the integration of clinical and research endeavors. In an archival study, the current work utilized patient-focused research data (N = 132) to explore outcomes. Analyses focused on the number of sessions required for clients to experience reliable improvement or clinically significant change, while controlling for relevant pretreatment characteristics. Results demonstrated that while a significant proportion of clients experienced positive effect from treatment (41.2%), an even larger proportion of the sample (48.9%) did not experience any reliable improvement. In addition, results demonstrated that the number of presenting problems significantly influenced the median treatment length for improvement, with more than 1 problem generally predicting faster improvement. Finally, the results also highlighted potential problems with treatment length, with a number of clients staying in treatment significantly longer than what would be predicted to generate reliable or clinically significant change. Overall, the results support conducting psychotherapy research in a training clinic environment, with the potential for research to inform clinical care as well as clinical care informing future research projects.

This is one of the first studies to examine attitudes toward psychotherapy as contributing to help-seeking intentions of veterans and service members and results provide strong support for inclusion of this variable in future studies in addition to social support and stigma. Limitations of the study are discussed as well as suggestions for future research. It is our hope that findings from this study may inform administrators and providers regarding assessment, outreach, and program development for our country's veterans and service members.