Beyond Best Practice: How Mental Health Services Can Be Better by Birgit Valla & David S Prescott

Author:Birgit Valla & David S Prescott [Valla, Birgit & Prescott, David S]
Language: eng
Format: epub
ISBN: 9780367175108
Google: YaOAvQEACAAJ
Goodreads: 42583828
Publisher: Routledge
Published: 2019-01-15T06:42:12+00:00

Large differences in the outcomes of respective therapists

Outcomes achieved by different therapists tend to vary dramatically. It seems the best therapists are successful with approximately 70% of their clients, the worst with only about 20%. The therapist effect explains most of the differences in therapy outcomes, far more than the therapeutic approach. In clinics, some therapists are more effective than others, regardless of which method they use. As a person seeking help, in other words, the particular therapist plays a more important part than the method employed in working towards a positive therapeutic outcome.

Further, findings show that, regardless of whether or not they achieve good outcomes, therapists are not particularly adept at identifying the clients who do not experience change. In one study by Hannan and his colleagues (2005), researchers wanted to determine how proficient therapists were at evaluating whether the clients experienced a worsening of their condition. The therapists’ assessments were compared with assessments made using a statistical method. The therapists were familiar with the purpose of the study, familiar with the outcome scale that was used, and informed that it was likely that 8% would experience worsening. Nonetheless, the therapists were able to identify worsening in only one out of 550 clients. In other words, the therapists failed to notice the deterioration in 39 of 40 clients, which was the actual number of clients whose condition worsened. By comparison, the statistical method was able to identify 36 out of 40. The therapists’ evaluation also determined that the condition of 91% was improved by the treatment, even though the actual number was less than half (40%).

It appears that many of us suffer from what has been called the “Lake Wobegon effect”. In his weekly radio programme A Prairie Home Companion, Garrison Keillor reported from the fictional city of Lake Wobegon, Minnesota, “where all the women are strong, all the men are good-looking, and all the children are above average.” Named for this town, the Lake Wobegon effect describes a natural human tendency to overestimate one’s own proficiency.

Walfish, McAlister, O’Donnell, and Lambert (2012) asked 129 therapists to assess their own abilities in a study originally submitted with the title “Are all psychotherapists from Lake Wobegon? An investigation of self-assessment bias in mental health providers”. One-quarter of the therapists claimed that they were at the top level and performed better than 90% of their colleagues. On average, the therapists assessed themselves as being 80% better than their colleagues, while only 8.4% believed their ranking to be less than 75%. Nobody assessed themselves as below average. It can perhaps be viewed as positive that we have such healthy self-confidence, but in principle such an understanding of own abilities makes improvement unlikely. It is difficult to know where you’re going when you don’t know where you are.

In Chapter 4 we addressed K.A. Ericsson’s research, which showed that, when learning a new skill, one achieves an acceptable level quickly, but often remains at that plateau. Therapists are no different. Repeated studies examining the differences in therapy outcomes do not show that experience as a determining factor.

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