As a clinician providing behavioral health services to clients, your personal behaviors and attitudes can influence the outcomes that your clients receive. Not only does implementing your service as it is designed, such as using applied behavior analysis accurately, make a difference; Your actions, thoughts, beliefs, and values can also impact the treatment process and experience for your clients.
In 1974, a study was published that looked at the differences in treatment outcomes for two behavior therapists who had very similar caseloads. These therapist were working with adolescents with challenging behaviors who were also at high risk for developing schizophrenia. The results of the study showed that 27% of the clients of the first therapist met the diagnostic criteria for schizophrenia while 84% of the second therapist’s clients met the schizophrenia diagnostic criteria. The first therapist experienced much better outcomes even though both therapists shared a similar caseload in terms of difficulty and client characteristics. This shows that two therapists providing the same service can have drastically different outcomes (Rick, 1974 as cited in
The term “therapist effects” refers to the factors of the therapist that influence treatment outcomes for clients. Outside of the actual treatment model being used, a therapist influences their client’s progress and outcomes anywhere from 5 to 17%.
A therapist’s worldview, their personal philosophy, can influence treatment outcomes. This refers to the therapist’s overall experiences and way of thinking which is influenced by things like “ethnicity, race, gender, education, environment, family history, genetics, physiology, religion/spirituality, sexual orientation, community, politics, economics, disability, and social relationships.”
A therapist’s worldview can affect the client’s outcomes in treatment by affecting the way the therapist approaches working with that client and the choices the therapist makes in that client’s treatment services.
One aspect of a person’s worldview could be how strengths-based they are or how much they live and act with a growth mindset. When a therapist approaches their work with clients from a strengths-based perspective and with a growth mindset, they are more likely to believe that the client can make progress. They are less likely to give up on a client. And they are able to come up with more creative ideas to help their clients accomplish their goals. This approach also helps the therapist to enjoy their job more, be less stressed about their work, and to reduce chances of burnout.
Another therapist effect that influences client outcomes is how reflective the therapist is about their own behaviors and the way they provide services. A reflective therapist engages in a 3-step process including 1. Think, 2. Act, and 3. Reflect. This is known as the TAR process.
The TAR process includes thinking about one’s behaviors and services, setting goals related to providing quality services, making plans to reach those goals, measuring progress on those goals of personal performance, and being very detail-oriented in assessing and reviewing one’s performance.
Self-reflection is one of the key characteristics that a therapist or human service provider should have to provide quality and exceptional services.
A client receiving human service interventions such as behavioral health therapy or applied behavior analysis will likely experience changes from receiving that service, hopefully those changes are in the direction of their goals. A therapist plays a role in the outcomes the client experiences. It has more to do with just the treatment model itself and also has to do with factors related to the therapist themselves, as well.
Bertolino, B. (2018). Chapter 1: The influence of the therapist. Effective counseling and psychotherapy. (pp 1-22). Springer Publishing Company. DOI: 10.1891/9780826141132.0001. Retrieved from: https://connect.springerpub.com/content/book/978-0-8261-4113-2/chapter/ch01
Ricks, D. (1974). Supershrink: Methods of a therapist judged successful on the basis of adult outcomes of adolescent patients. In D. Ricks,, A. Thomas, & M. Roff (Eds.), Life history research in psychopathology (Vol. 3. pp. 275–297). Minneapolis: University of Minnesota.