As a professor of clinical psychology in the Department of Psychological and Brain Sciences at UMass Amherst, Michael Constantino is passionate about “bridging the longstanding chasm between science and practice" to improve the effectiveness of psychotherapy.
“I’m really interested in applying science to something that is sometimes viewed as more of an art—the work that psychotherapists do to try to help their patients,” he said. For Constantino, that means identifying evidence-based ways to personalize therapy for the benefit of patients, including finding a good fit between therapist and patient.
Constantino remembers as a child being drawn to the idea of helping people with mental health concerns when he learned about the job of a friend’s father, a psychiatrist. He studied psychology as an undergraduate at the University of Buffalo, and went on to graduate studies at The Pennsylvania State University focused on psychotherapy research and practice. Throughout his graduate training, as a postdoctoral fellow at Stanford University Medical Center, and for a few years after joining the UMass Amherst faculty in 2004, he practiced therapy in a clinical setting. Today, he focuses primarily on research, teaching, and clinical supervision.
In his Psychotherapy Research Lab at UMass Amherst, Constantino conducts research in close collaboration with community-based clinicians, patient stakeholders, mental healthcare consortiums, and industry partners. He also works with a vibrant group of graduate and undergraduate students in his lab, many who go on to practice, teach, or conduct research on psychotherapy.
Over the past decade, Constantino’s research has focused on improving the “match” between patients and therapists. Typically, patients are matched with therapists through pragmatic means, such as provider availability, geography, and insurance considerations. “We’re interested in making that more of an evidence-based process,” he explained.
Through a randomized clinical trial published in the premier journal, JAMA Psychiatry, and follow-up analyses published in the Journal of Consulting and Clinical Psychology, Constantino and colleagues demonstrated that patients had better outcomes when they were matched with providers shown to have historical strengths in treating other patients with the same primary concern(s). The match relied on a tool to assess a therapist’s effectiveness at treating patients across 12 symptomatic or functional domains, including depression, mania, substance misuse, and others. Using data from a critical mass of patients, a “report card” was established showing the therapist’s strengths and weaknesses.
“While previous research has focused on the effectiveness of different treatment methods used in therapy, we showed the importance of who the therapist is in contributing to patient outcomes,” Constantino said.
Constantino’s research has found that the majority of therapists are effective in between three and seven domains, while about 4 percent are ineffective or even harmful across all domains. This information can be helpful not only for patients in choosing a therapist, but for clinicians themselves, as they consider areas of strength in which to specialize or weaker areas to seek out more training, Constantino said.
“One thing we’ve learned for sure is that therapists do not get better just because they have more experience,” he said. Rather, deliberate practices, like participating in continuing education and consulting with peers, seem to be more predictive of therapists’ effectiveness. Other important factors include therapists’ interpersonal skills and humility in assessing their own abilities.
Constantino noted that in their study, the “match effect” was found to be stronger for patients who initially presented with more severe symptoms, and was twice as pronounced for patients who identified as racial or ethnic minorities. Interestingly, therapists and patients were not necessarily best matched if they shared a racial or ethnic identity; rather, it is possible that therapists who convey cultural humility and a willingness to talk about cultural issues are the ones most effective at treating patients with any underrepresented racial or ethnic identities (though this notion requires testing).
"I’m really interested in applying science to something that is sometimes viewed as more of an art—the work that psychotherapists do to try to help their patients."
Building on this research, since 2022, Constantino has been principal investigator on a $4.6 million contract from the Patient-Centered Outcomes Research Institute (PCORI) for large-scale implementation of a program that uses therapists’ “report cards” to match them with new patients. Starting in partnership with nine clinics in the Philadelphia area, if all goes well, the second phase will see the program expanded to about 50 additional clinics around the country.
“We’re hoping to reach many, many patients, and help therapists learn more about themselves,” said Constantino.
Constantino has published 134 peer-reviewed journal articles, including in many of his field’s highest-impact outlets. He is co-editor of the book, Principles of Change, and co-author of the book, Deliberate Practice in Cognitive Behavioral Therapy, as well as co-editor of the in-press American Psychological Association (APA) Handbook of Psychotherapy. Additionally, he has published 64 book chapters and invited articles. In 2020, he received the Mid-Career Award for Distinguished Contributions to the Advancement of Psychotherapy from APA Division 29. He is also an APA Fellow and has received multiple early career research excellence awards.
Ultimately, Constantino hopes his research will improve the quality, and perhaps even the availability, of mental healthcare. He recently was awarded, as a co-principal investigator, a Small Business Innovation Research Grant from the National Institutes of Health to develop and test an app that would allow patients to simultaneously get on waitlists for multiple providers, and make treatment decisions that balance a provider’s geographic location, wait time, and report card scores.
“Wherever the data take us, we hope to keep innovating and addressing big challenges like the mental health crisis in this country,” said Constantino.