Abstract
Background: Variability in human performance is a naturally occurring phenomenon and applies to practitioners. Mainstream psychotherapy research has focused on treatments rather than practitioners and has viewed variability as error within the dominant paradigm of the randomised controlled trial.
Aims: To investigate variability via the role of practitioner personal qualities and their association with differential patient outcomes, their contribution to effective practice, and the extent these qualities vary with patient severity.
Method: A practice-based paradigm was adopted and sampled practitioners and data within a single Improving Access to Psychological Therapies (IAPT) service. The full sample comprised 42 practitioners – psychological wellbeing practitioners, counsellors, and cognitive-behaviour therapists – who completed measures of resilience, empathy, and mindfulness as well as provided qualitative accounts of their practice. A series of seven sequential studies utilised subsamples of the responses from these 42 practitioners, which were analysed prior to yoking with their patient outcome data to determine associations with more and less effective practice. Studies comprised mixed and integrated quantitative and qualitative analyses comparing benchmarking and multilevel modelling research methods (N=37) and thematic analysis (N=6).
Results: Significant variability in practitioner effectiveness was found. Practitioners’ personal aspects were associated with patient outcomes and were influenced by their professional roles, level of treatment intensity provided, and their theoretical orientation. Practitioners’ mindfulness and combined resilience and mindfulness were associated with better patient outcomes and this role increased as patient severity increased. In contrast, empathy did not differ between more and less effective practitioners, with more effective practitioners showing marginally lower levels of empathy.
Conclusion: Findings suggest that more effective practitioners do differ from less effective practitioners in the personal aspects they bring to their professional practice. Findings have implications for practitioner training and routine practice. The findings are limited in their generalisability and may only apply to IAPT services
