Therapist Effects in Three Treatments for Alcohol Problems

Prior research indicates that therapist effects can be sizeable in substanceabusetreatment. Therapist differences were examined within a multisite(N = 1726) randomized trial of three psychosocial treatments for alcoholproblems: twelve-step facilitation (TSF), cognitive-behavioral skillstraining (CBT), and motivational enhancement therapy (MET). Therapists(N = 80) were nested within treatments, selected and trained forexpertise in a specific approach. This report describes: (1) differencesin therapist characteristics across the three treatments; (2) the magnitudeof therapist effects within each treatment; and (3) exploratory analysesof therapist attributes associated with successful outcomes. Therapistcharacteristics differed between TSF and the other two conditions.Significant therapist effects were found in client satisfaction and outcomes,even after covarying for effects of treatment sites and clientbaseline characteristics. Specific therapist attributes were predictive ofclient outcomes. Outlier therapists whose caseloads showed unusuallypoor outcomes accounted for most of the observed effects.