Individual therapists in inpatient psychotherapy - A pilot study on their importance for therapeutic outcome

Objective: How much does the individual psychotherapist influence therapy outcome in a multimodal inpatient setting with several therapeutic relationships and the additional influence of group processes. Methods: We studied the outcome of n = 293 psychotherapy inpatients (mean treatment duration: 11 weeks) who were treated in an integrated inpatient concept by 9 mostly psychodynamically oriented psychotherapists (professional experience 0.5 to 7 yrs, 13 to 56 patients per therapist). Patients had an extensive evaluation of process and outcome variables (e.g. SCL 90R, IIP, Global outcome rating, Helping Alliance Questionnaire - HAQ). Differences in outcome between patients of different therapists were calculated. Results: Patients assigned to the participating therapists did not differ in their basic clinical characteristics, except in the clinical severity rating carried out by therapists themselves. Outcome in the SCL90R - GSI residual score and global rating differed significantly between the therapists (d(SCL-pooled) (SD) = 0.43 to 1.10, explained variance: 10%). The same holds true for the therapeutic alliance (HAQ, explained variance: 45%). Assessment of therapeutic relationship shows good correlation between patients and therapists, outcome assessment does not. Therapists differed in the degree of matching between their own and their patients' evaluations. Conclusions: We found significant therapist differences in outcome and alliance. Despite the multifaceted inpatient setting the individual therapist is an important determinant of therapeutic success.