Does the therapist matter? Therapist characteristics and their relation to outcome in trauma-focused cognitive behavioral therapy for children and adolescents

Abstract

Background: There is a broad evidence-base for the effectiveness of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) in treating children and adolescents with posttraumatic stress disorder (PTSD). The effect of therapist characteristics on patient symptoms has been neglected in psychotraumatology research and necessitates further investigation. Objective: This study aims to investigate the impact of therapist characteristics (gender, clinical experience and theoretical background) on posttraumatic stress symptoms (PTSS) in a heterogeneous and international sample of traumatized children and adolescents. Method: Data from two RCTs on the effectiveness of TF-CBT in Norway and Germany were included, comprising N = 52 therapists (78.8% female) and N = 153 patients (72.3% female). All therapists underwent thorough training and continuous supervision in TF-CBT. The Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA) assessed preand post-treatment served as the outcome variable in a linear mixed-effects model with therapists' theoretical background, prior clinical experience and gender as independent variables, adjusted for patient gender, measurement time and country. The possibility of an interaction between therapist and patient gender was investigated subsequently. Results: None of the therapist characteristics were significantly related to PTSS. There was no indication of an interaction between patient and therapist gender (p =.878). Conclusion:The lack of evidence for a relationship of therapists' theoretical orientation and clinical experience with outcome suggests that a wider dissemination of TF-CBT may be warranted. More studies with larger therapist and patient sample sizes and including only community practice are needed.

Predictors of nonresponse and drop-out among children and adolescents receiving TF-CBT: investigation of client-, therapist-, and implementation factors

“…The therapists' educational background was not related to the risk of nonresponse or drop-out among the patients, signifying that TF-CBT is a treatment method suitable for clinical therapists with various academic backgrounds. This is in line with findings from Pfeiffer and colleagues [45], who found no association between the educational background of the therapist (n = 52) and posttraumatic stress outcomes in the patients (n = 153). This is promising, as there is a lack of specialized professionals in many parts of the world.…”

Trauma-focused cognitive–behavioral therapy (TF-CBT) for interpersonal trauma in transitional-aged youth.

“…An RCT of D-CPT also found large effects for PTSD, depression, borderline symptoms, behavioral problems, and dissociation (Rosner et al, 2019). Additionally, D-CPT included 14 therapists compared with the single therapist involved in TF-CBT, and although therapists' prior experience and gender do not necessarily make a difference in the implementation of TF-CBT, this difference is worth noting (Pfeiffer et al, 2020). Differences in the duration and intensity of treatment in D-CPT and TF-CBT are noteworthy.…”

Associations between therapist factors and treatment efficacy in randomized controlled trials of trauma‐focused cognitive behavioral therapy for children and youth: A systematic review and meta‐analysis

“…Despite this, few reviews have focused on TF‐CBT therapists, with fewer still in child populations (Baldwin & Imel, 2013 ; Johns et al., 2019 ; Fjermestad et al., 2016 ). In their review, Pfeiffer and colleagues ( 2020 ) collated therapist data from two randomized controlled trials (RCTs) examining the effectiveness of TF‐CBT for children and youth and found no evidence of an association between therapists’ theoretical background or clinical experience and patient outcomes. Although there is a significant evidence base for trauma‐focused therapies for children and youth, particularly for TF‐CBT, Pfeiffer and colleagues’ ( 2020 ) review is, to our knowledge, the only study to date that has examined the impact of therapist factors in TF‐CBT for this population.…”

“…In their review, Pfeiffer and colleagues ( 2020 ) collated therapist data from two randomized controlled trials (RCTs) examining the effectiveness of TF‐CBT for children and youth and found no evidence of an association between therapists’ theoretical background or clinical experience and patient outcomes. Although there is a significant evidence base for trauma‐focused therapies for children and youth, particularly for TF‐CBT, Pfeiffer and colleagues’ ( 2020 ) review is, to our knowledge, the only study to date that has examined the impact of therapist factors in TF‐CBT for this population. However, no reviews have yet provided a summary of the providers delivering TF‐CBT in the research trials or the clinical guidelines on which the trials are based, therefore making it difficult to understand the effect of therapist factors on trial outcomes more widely.…”