What do we know about highly effective therapists? A systematic review

Abstract

Highly effective therapists are clinicians who systematically achieve excellent therapeutic outcomes. However, variables that could explain this performance still unknown. To identify these variables (i.e., definition, objective measurements; and the degree to which the independent variables measure what it claims) could help to know more about highly effective therapists’ performance. Therefore, a systematic review was conducted. Publications between 2000 and 2020 -from Scopus, MEDLINE/PubMed, Web of Science, PsycInfo, Google Scholar and ProQuest Research Library databases- were included. After analyzing 2784 empirical works, 31 studies have met the inclusion criteria. This systematic review allowed to identify, summarize, and define almost 50 variables that could predict therapists’ effects. The need to increase construct validity, to improve empirical designs, and to measure therapist-client interaction is discussed. Los terapeutas altamente eficaces son aquellos que logran sistemáticamente elevados niveles de éxito terapéutico. Sin embargo, aunque se contraste empíricamente dicha eficacia inter-terapeuta, todavía no se conocen cuáles son las conductas que explican este desempeño diferenciado. El objetivo de este trabajo es identificar las variables asociadas a estos terapeutas altamente eficaces, sus definiciones, los parámetros de medida de éxito y la precisión con la que se miden los constructos de interés. Para ello, se realizó una revisión sistemática (RS) con publicaciones entre los años 2000 y 2020 de las bases de datos Scopus, MEDLINE/PubMed, Web of Science, PsycInfo, Google Académico y ProQuest Research Library. Se seleccionaron 2784 artículos empíricos, de los cuales 31 cumplieron los criterios de inclusión. Los principales resultados muestran que hay casi 50 variables predictoras del efecto del terapeuta. Se resume y se define cada una de estas variables psicológicas, y se concluye que para lograr explicar el alto nivel de éxito inter-terapeuta es necesario incrementar la validez de constructo de las variables predictivas, adecuar el diseño de las investigaciones e incluir datos con respecto a la interacción entre el terapeuta y su cliente.

Understanding the role of emotion and expertise in psychotherapy: An application of dynamical systems mathematical modeling to an entire course of therapy

“…These differences in ability to form these relationships have been shown to impact clinical effectiveness (2). "Master" or expert therapists differ from novices, and even professional therapists, in several important ways (8,(25)(26)(27). A hallmark of these experts is the clinician's technical skill, as well as her response to larger contextual issues (7,8).…”

“…However, approximately 15–20% of clinicians could be identified with consistently good outcomes, and approximately the same level for clinicians with consistently poorer outcomes ( 11 ). More recently, Pereira et al ( 25 ) conducted a systemic review of highly effective therapists and found that emotional expression was a significant predictor of therapist effectiveness. It stands to reason that clinicians who consistently have better outcomes, must construct their therapeutic relationships differently than other professional clinicians.…”

“…In fact, their analysis lead Peluso and Freund to speculate that “there might be an element of mediation between how experience and mastery affect the expression of affect and its impact on clinical outcomes” (2019, p. 448). Unfortunately, there is a lack of definitive research on how expert therapists accomplish this, let alone utilize an effective relationship to effect change in their clients ( 7 , 8 , 25 – 27 , 29 ).…”