One explanation for differences in treatment effectiveness for targeted symptoms is that more-effective treatments are more focused on patients' problems than are less-effective treatments. This conjecture was examined meta-analytically. Comparisons of two treatments of adults with anxiety disorders were included. Effect sizes for targeted symptoms, nontargeted symptoms, and global outcomes (e.g., quality of life and well-being) as well as the relative focus on patients' problems and researcher allegiance were coded. Metaregressions were conducted to predict effect sizes from (a) variables related to the focus on patients' problems and (b) researcher allegiance. For symptom measures, the relative focus on patients' problems predicted the relative effectiveness of the treatments, with the expectations created by explanation appearing more predictive than specific therapeutic actions focused on patients' problems, although conclusions about relative importance were difficult to determine given collinearity of predictors. Researcher allegiance also predicted the effects of the comparisons. For global outcomes, both the focus on patients' problems and researcher allegiance seemed to have smaller roles. A focus on patients' problems appears to be important for the reductions of symptoms. Clinical trials comparing treatments need to balance the focus on patients' problems and reduce researcher allegiance. (PsycINFO Database Record

Health service psychology (HSP) graduate programs are shifting from knowledge-to competency-based assessments of trainees' psychotherapy skills. This study used Generalizability Theory to test the dependability of psychotherapy competence assessments based on video observation of trainees. A 10-item rating form was developed from a collection of forms used by graduate programs (n = 102) in counseling and clinical psychology, and a review of the common factors research literature. This form was then used by 11 licensed psychologists to rate eight graduate trainees while viewing 129, approximately 5-min video clips from their psychotherapy sessions with clients (n = 22) at a graduate program's training clinic. Generalizability analyses were used to forecast how the number of raters and clients, and length of observation time impact the dependability of ratings in various rating designs. Raters were the primary source of error variance in ratings, with rater main effects (leniency bias) and dyadic effects (rater-target interactions) contributing 24% and 7% of variance, respectively. Variance due to segments (video clips) was also substantial, suggesting that therapist performance varies within the same counseling session. Generalizability coefficients (G) were highest for crossed rating designs and reached maximum levels (G > .50) after four raters watched each therapist working with three clients and observed 15 min per dyad. These findings suggest that expert raters show consensus in ratings even without rater training and only limited direct observation. Future research should investigate the validity of competence ratings as predictors of outcome. Public Significance StatementRatings of clinical competence are used to determine adequate progress for trainees in HSP and to document competence for accreditation and licensure bodies. This study examined sources of error in these ratings to provide guidance on improving assessment procedures. For competence assessments based on direct observation, we recommend evaluation by multiple raters for each trainee, and observation times of at least 60 min per trainee.

There is negligible research exploring mental health clinicians' perceptions of clients based upon client social class and sexual orientation (McGarrity, 2014;Whitcomb & Walinsky, 2013). The purpose of this study was to examine how licensed mental health clinicians' perceptions of clients were influenced by a hypothetical client's social class and sexual orientation using a 2 (lower social class vs. higher social class) ϫ 2 (lesbian vs. straight) quasi-experimental vignette-based design. Results from 257 practitioners demonstrated that the hypothetical client portrayed in the video was rated differently on levels of depression, anxiety, and flourishing, as well as job satisfaction and meaningful work. Participants who viewed the client portrayed as having a lower social class rated her as having more symptoms of depression and anxiety, as being less satisfied at work, as having lower levels of meaningful work, and as having lower levels of flourishing as compared with the participants who viewed the client portrayed as having a higher social class. Participants did not rate the hypothetical clients differently on symptoms of depression, anxiety, meaningful work, or job satisfaction based upon client sexual orientation. The lesbian client was rated as being significantly more attractive to work with and as having significantly higher levels of flourishing as compared to the straight clients. No interaction effects were demonstrated. Implications of these findings and directions for future research are discussed. Clinical Impact StatementQuestion: Do mental health practitioners' perceptions of a hypothetical client presented in one of four versions of a video vignette vary based upon social class and sexual orientation cues? Findings: Results from a 2 (lower social class vs. higher social class) ϫ 2 (lesbian vs. straight) quasiexperimental design demonstrated that sexual orientation and social class cues influenced mental health practitioners' views of straight and lesbian clients who present as being from higher and lower social classes. Meaning: Client characteristics may affect mental health practitioners' perceptions of clients. Next Steps: Future research is needed to understand the implications of such perceptions on treatment for clients from diverse identities and who hold various social group memberships.

The move toward a culture of competence in health service psychology has increased interest in methods for assessing competence. Generalizability studies (G studies) can assist psychologists to develop reliable and valid measurement procedures. We review findings from G studies of performance ratings used in various contexts, including an initial G study of expert evaluations of therapist competence, to illustrate the value of generalizability theory for development of competence assessments. We describe possible roles for competence assessment based on direct observation of trainee clinical work and discuss implications and future research directions to provide an evidentiary basis for refining such assessment methods.

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