Alice Coyne, a fourth-year student in the Clinical Psychology Program working with Dr. Michael Constantino, was awarded the second annual Keith Rayner Memorial Graduate Student Research Award. Awards from the endowment support graduate research expenses including equipment purchases, data collection, professional travel, or summer stipends. Data from Alice's project, Explaining the “Therapist Effect:” Determinants of Between-Therapist Differences in Alliance Quality and the Alliance-Outcome Association, will be used to develop an empirically-supported therapist training manual. Such work is likely to reflect an improvement on current training practices, as there is currently no evidence that therapist effectiveness improves with experience or following traditional “top-down” theoretical trainings.
Specific Aims: The first aim will be to (a) prospectively test and replicate the between-therapist alliance-outcome association in a large naturalistic dataset; (b) determine, for the first time, if the between-therapist alliance-outcome correlation varies across therapists; and (c) determine if “static” therapist characteristics (e.g., theoretical orientation, training/experience, perceived strengths/weaknesses, preferences) predict between-therapist alliance quality and/or between-therapist variability in the alliance-outcome correlation (i.e., moderate this association). The second aim will be to (a) divide the large naturalistic sample into the therapists whose alliances translate into the most positive and least positive (or even negative) overall outcomes, and (b) invite these good/poor alliance therapists to participate in a brief exercise to assess their observer-coded facilitative interpersonal skill (FIS) while responding to a challenging clinical scenario. This will allow examination of whether therapist FIS differences account for differences between therapists in their ability to foster positive alliances, which in turn would relate to better patient outcomes. Importantly, this will enable a test of one of the first true therapist-level mediational models examining whether between-therapist alliance quality mediates the association between therapist FIS and outcome.
Implications: Once determinants of reliably “good alliance” therapists, or those for whom the alliance relates most strongly and positively to patient improvement, are identified, this information will be used to develop the therapist training manual. Such trainings are likely to reflect an improvement on current training practices, as there is currently no evidence that therapist effectiveness improves with experience or following traditional “top-down” theoretical trainings. Additionally, current training practices are generally based on clinicians’ experience (which does not predict patient outcome), rather than on empirical data that identifies specific therapist skills/behaviors that relate to more positive alliances and outcomes.
Fund Usage: Participant recruitment/compensation, travel