Therapist Credibility Research Articles

Therapist and treatment credibility in treatment outcomes: A systematic review and meta-analysis of clients’ perceptions in individual and face-to-face psychotherapies

ABSTRACT Objective No systematic review was identified investigating the influence of perceived therapist credibility on treatment outcomes. Extant treatment credibility reviews have focused on early perceptions without considering influence of various therapy phases. This study aimed to examine the relationship between perceived treatment and therapist credibility and treatment outcomes, while considering the timing of the credibility assessment as a potential moderator. Method Articles published in English peer-reviewed journals containing at least one quantitative measure of credibility and treatment outcome regarding face-to-face therapist-delivered interventions were eligible. PsycINFO, MEDLINE and Embase online databases were last searched on April 5th, 2023, and the Effective Public Health Practice Project tool was used to assess the study quality. Correlations between treatment credibility and outcomes, and therapist credibility were calculated separately. Results Analysis of 27 studies revealed a positive association between perceived treatment credibility and treatment outcome (r = 0.15,95%CI = 0.09,0.21,p < 0.001,n = 2061). Nine studies showed a strong association between perceived therapist credibility and outcome (r = 0.35,95%CI = 0.18,0.51;p < .001,n = 1161). No significant moderator found in both meta-analyses. Conclusion Findings suggest that clients’ perceptions of higher credibility – whether concerning the treatment or the therapist – are associated with better therapeutic outcomes. Constraints in inclusion criteria and the small sample size in eligible studies were notable limitations.

4065 Preferences, Expectancies, and Stigma among Treatment Seeking Combat PTSD Patients

OBJECTIVES/GOALS: Cognitive Processing Therapy (CPT) is a cognitive behavioral treatment for posttraumatic stress disorder (PTSD). CPT is effective in treating combat-related PTSD among Veterans and active duty service members. It is unknown whether improvement in PTSD is related to accommodation of patient preference of the modality of therapy, such as in-office, telehealth, and in-home settings. An equipoise-stratified randomization design allows for complete randomization of participants who are interested and eligible for all three treatment arms. It also allows participants to reject one treatment arm if they are not interested or eligible. Participants who elect to opt out of one arm are randomized to one of the two remaining treatment arms. The primary aim of this study was to evaluate differences in patient satisfaction, treatment stigma beliefs, and credibility beliefs based on patient treatment modality preference. The second aim of this study was to examine if baseline satisfaction, stigma beliefs, and credibility beliefs predicted PTSD treatment outcomes. METHODS/STUDY POPULATION: Active duty service members and veterans with PTSD (N = 123) were randomized to one of three arms using an equipoise stratified randomization. Participants underwent diagnostic interviews for PTSD at baseline and post-treatment and completed self-report measures of satisfaction, stigma, credibility and expectancies of therapy. RESULTS/ANTICIPATED RESULTS: A series of ANOVAs indicated that there were group differences on patient stigma beliefs regarding mental health, F = 5.61, p = .001, and therapist credibility, F = 5.11, p = .002. Post hoc analyses revealed that participants who did not opt of any treatment arm demonstrated lower levels of stigma beliefs compared to participants who opted-out of in-office, p = .001. Participants who opted out of in-home viewed the therapist as less credible compared to participants who did not opt of any arm, p = .004. Multiple regression analysis found that baseline patient satisfaction, stigma beliefs, and credibility beliefs were not predictive of PTSD treatment outcomes, p &gt; .05. DISCUSSION/SIGNIFICANCE OF IMPACT: Combat PTSD patients may opt out of in-office therapy due to mental health stigma beliefs, and visibility in mental health clinics may be a concern. For patients who opted out of in-home therapy, lack of credibility may have decreased participants’ desire for therapists to enter their home. Despite concerns of mental health stigma and the credibility of the therapy in certain treatment arms, patients in each treatment arm significantly improved in PTSD symptomotology. Moreover, patient characteristics, including satisfaction, stigma, and credibility of the therapy, did not significantly predict treatment outcomes, which demonstrates the robustness of Cognitive Processing Therapy.

Cultural Adaptations of Psychotherapy: Therapists' Applications of Conceptual Models with Asians and Asian Americans.

Although conceptual models of cultural adaptations of psychotherapy have been developed, little is known about how therapists apply these models in clinical practice. The purpose of the current study was to examine, using a directed content analysis, how therapists culturally adapt cognitive-behavioral therapy (CBT), one of the most widely used evidence-based approaches, for application with clients of Asian ancestry. The study also examined if there were major differences in adaptation strategies between therapists who practice in the United States (N = 9), a predominantly individualistic society as opposed to those who practice in Japan (N = 6), a predominantly collectivistic society. Semi-structured, open-ended interviews revealed that interdependent conceptualizations of the self and indirect communication were addressed by therapists in both countries, and therapist credibility issues were addressed only by therapists in the United States. These results imply that when culturally adapting psychotherapy, therapists incorporate elements of conceptual models that are relevant to their clients' cultures.

Patients’ views on a new treatment for Bulimia nervosa and binge eating disorder combining physical exercise and dietary therapy (the PED-t). A qualitative study

ABSTRACTA new group based treatment for patients with bulimia nervosa (BN) and binge eating disorder (BED), combining guided Physical Exercise and Dietary therapy (PED-t), has shown the capacity to alleviate BN and BED symptoms. The PED-t is run by therapists with a professional background in sport sciences and nutrition, which in many clinical settings is an uncommon group of professionals. The symptom reduction effects using the PED-t need validation from patients who have been given this kind of treatment, as negative experiences may impinge further clinical implementation. To explore such experiences, semistructural interviews were conducted with 15 participants. The interviews were transcribed and analyzed using a systematic text condensation approach. Overall, patients experienced the format and content of the PED-t as beneficial and as providing tools to manage BN- and BED symptoms. The patients’ experiences of therapist credibility was enhanced by their appreciation of the therapists’ professional background. Finally, some treatment modifications were suggested. Overall, the PED-t may thus be offered to patients with BN and BED, by a new set of professionals, and in uncommon settings. This possibility calls for future effectiveness studies integrating both parametric and experiential data.

Metacognitive therapy versus disorder-specific CBT for comorbid anxiety disorders: A randomized controlled trial

Few studies have compared the effects of Metacognitive therapy (MCT) and Cognitive behavioral therapy (CBT) for comorbid anxiety disorders. In the current study we compared CBT and MCT for heterogeneous anxiety disorders in a residential setting. Ninety patients with a primary diagnosis of Post Traumatic Stress Disorder, Social Phobia or Panic disorder, with and without Agoraphobia, were randomized to either CBT or MCT. Patients were assessed at pre-treatment, post-treatment and one-year follow-up. Primary outcome measures were Beck Anxiety Inventory and ADIS IV and secondary outcome measures were SCID II, Beck Depression Inventory, Penn State Worry Questionnaire, The Symptom Checklist-90 and the Inventory of Interpersonal Problems–64. Treatment fidelity was satisfactory and therapist credibility was equal in both treatments. There was a significant difference in the level of anxiety favouring MCT at post-treatment (d=0.7), but there were no differences at one-year follow-up, mainly due to a further improvement in the CBT group during the follow-up period. Both treatments were efficacious. No differences in effect on comorbid diagnoses and symptoms were found, but MCT produced larger change in personality problems. MCT seems to have a more rapid effect on anxiety symptoms, but there were no significant differences in the long term for patients with comorbid anxiety disorders.

The influence of an Alaska Native accent and reputation on perceived therapist credibility.

In this study, we examined the influence of an Alaska Native (AN) accent and reputation on perceived therapist credibility after controlling for universal-diverse orientation. Participants listened to and rated therapist audio recordings that differed in AN accent (strong, minimal) and reputational cues (expert, recent graduate, student). While credibility ratings of the accent conditions did not differ in the expert and recent graduate scenarios, the graduate student therapist was seen as less attractive and useful when she spoke with a strong accent.

Understanding the psychological processes of the racial match effect in Asian Americans.

Some studies on mental health outcomes research have found that when clients and therapists are ethnically or racially matched, this tends to be related to greater satisfaction and better outcomes. However, the precise underlying mechanism for the match effect has not been extensively examined. In this experimental study, we tested the effect of racial match on critical counseling processes (i.e., therapist credibility and the working alliance) using a sample of 171 Asian American respondents. We also examined Asian ethnic identification as a potential moderator of the racial match effect. Structural equation modeling analyses indicated that racially matched individuals perceived greater experiential similarity with the therapist than nonmatched individuals, and experiential similarity was positively associated with therapist credibility. Although racial match did not predict attitudinal similarity, attitudinal similarity was strongly related to the working alliance and therapist credibility. Counseling implications are discussed.

Therapist Variables: Predictors of Process in the Treatment of Alcohol and Other Drug Problems

Research indicates that alcohol and other drug problem (AOD) therapists who are in recovery yield comparable outcomes to therapists who are not in recovery. Might these generally equivalent outcomes be produced via different therapeutic processes? What factors other than, or in interaction with, therapist recovery status predict effective treatment process? This study sought to answer these questions. Therapists' well-being, emotional reactions toward clients, and recovery status were measured to determine if these variables predict specific therapy process variables, namely client perceptions of therapist empathy, the working alliance, session depth, and therapist credibility. A national survey found that therapists' emotional reactions to clients predicted client ratings of the working alliance and therapist empathy. Therapist well-being was not related significantly to any of the criterion variables, nor was recovery status or the interaction of the two. Implications for theory, research, clinical work, and training are discussed.

Process and outcome of therapy in ethnically similar and dissimilar therapeutic dyads

This study examined the effects of ethnic matching on two process variables —working alliance and perceived therapist credibility—and therapy outcome in 100 ethnic minority clients evenly split between matched and nonmatched therapeutic dyads. All clients and therapists belonged to ethnic minorities in London (South Asian, Black African, Black Caribbean, and Middle Eastern). Clients in the matched dyads had expressed a preference for matching. Outcome and process variables were all significantly better in matched than in nonmatched dyads, and the process variables mediated the relationship between ethnic matching and outcome. Age, gender, and length of therapy did not predict outcome or process. The validity of these results is discussed, and implications for further research, practice, and training are briefly considered.

Good grief and not‐so‐good grief: Countertransference in bereavement therapy

This study examined the relationship between therapists' grief related to the death of a loved one and clients' perceptions of the process of bereavement therapy. Mail survey data were obtained from 69 client-therapist dyads. Results indicated that the extent to which therapists missed deceased loved ones was inversely related to client perceptions of therapist empathy, but not to client ratings of the alliance, session depth, or therapist credibility. Therapist acceptance of the death of a loved one was unrelated to any of the dependent measures. Results are discussed in terms of countertransference and its management.

EMDR as a Treatment for Test Anxiety

We assigned sixty-two test-anxious undergraduates to eye movement desensitization and reprocessing (EMDR), rational emotive therapy (RET), and information only, which were administered in a single session by trained, “blind” therapists. At posttest, EMDR was most effective in reducing distress whereas RET decreased global test anxiety more than information only. These results may reflect the differential impact of EMDR and RET on verbalized distress and on combined affective and cognitive dimensions of test anxiety, respectively. Perceptions of therapist credibility and helpfulness of treatment moderated the results. We discuss the clinical and research implications of these findings.

Antecedents and effects of perceived therapist credibility: A meta-analysis.

Published studies examining antecedents or effects (or both) of perceived therapist credibility were subjected to a meta-analytic review to test S. R. Strong's (1968) 2-phase model of interpersonal influence in counseling. Results conformed to the predictions of the model, with therapist credibility cues moderately related to credibility, and credibility strongly related to therapist influence. Cue type was a significant moderator of the relation between cues and credibility. Cue types were also differentially related to influence, but this relation was mediated by cue strength, or the relation of cues to credibility. Tests of differential reactivity among influence measures yielded equivocal results, as did tests of participant involvement as a moderator of the relation between cues and influence. It is suggested that a simple mediational model cannot fully account for the relations among cues, credibility, and influence.

Antecedents and effects of perceived therapist credibility: A meta-analysis.

Antecedents and effects of perceived therapist credibility: A meta-analysis.

Lay theories of psychotherapy and perceptions of therapists: A replication and extension of furnham and wardley

This study examined laypersons' perceptions of psychotherapy, the experience of psychotherapy clients, and therapist credibility. Most of Furnham and Wardley's recent findings of positive and realistic lay views on psychotherapy and therapists were replicated. Age, sex, and psychological experience mediated some beliefs about therapy and clients' experience. Although positive views were associated with higher ratings on some aspects of therapist credibility, only the modality of the therapy (behavior vs. client-centered vs. rational-emotive individual therapy) influenced perceptions of overall credibility. Neither the fee charged nor the participant's sex had any effect on perceptions of therapist credibility.

Cognitive elaboration: Basic research and clinical application

This article reviews two lines of research in social-clinical psychology demonstrating that a person's own elaborative thinking mediates cognitive, affective, and behavioral change. Research on attitude change has found that what kind of arguments a person generates in response to a message predicts whether subsequent attitudes and behavior will be more resistant or changed. When an unmotivated person generates no arguments, belief is based on cues such as therapist credibility. Analogue research supports the importance of argument strength over source credibility in promoting attitude and behavior change in therapy. Research on simulation has found that when a person imagines a scenario of how he or she might behave and why, expectancies about such behavior and its actual performance are increased. Analogue research supports the role of constructing scenarios in changing the behavior of persons with low self-esteem and of clients in counseling. A research agenda is provided for assessing cognitive elaboration as a mediator of long-term change in therapy, for evaluating various interventions which should promote it, and for matching interventions to the cognitive style of clients.

Perceptions of therapists as a function of professional fees and treatment modalities

Consumers, therapists, and researchers share an interest in the topic of service fees. The issue of fees can affect clients' evaluation of the provider as well as the likelihood of using the service being offered. In a between-subjects design, adult males (n = 84) and females (n = 78) read a brief description of a psychologist who provided individual or group therapy for a fee of $50, $80, or $110. While fees had no effect, treatment mode and participant sex did relate to perceptions of therapist credibility. A triple interaction emerged with respect to participants' willingness to consult the psychologist. Implications for service providers are discussed.

Effects of Professional Title and Degree Upon the Perceived Credibility of A Sex Therapist

Ninety undergraduate students (38 males and 52 females) were given brief written job descriptions of therapists who specialize in treating individuals with sexual dysfunction. A different level of each of two independent variables (professional title: licensed clinical psychologist, licensed clinical social worker, certified sex therapist and degree: Ph.D. or no Ph.D.) were administered to each of six groups of participants. After reading the job description, participants were asked to rate the therapist by completing a questionnaire designed to measure therapist credibility. Results showed that professional title, but not degree, had a significant effect upon four of five dependent variables. Psychologists were perceived as significantly more credible than either of the other two professions. In addition, the data revealed a consistently predictable interaction between the two independent variables.

Reputation, training, fee, and androgyny: their comparative effects on impressions of therapist credibility.

Two hundred and forty-eight college students viewed a vignette from a therapy-analogue session. Before Ss viewed the vignette they all read a summary that described the vignette plus an additional description that stressed different aspects of the therapist. One-fifth of the Ss were told of the therapist's excellent reputation, one-fifth were told of the therapist's excellent training and credentials, one-fifth were told of the therapist's high fee, and one-fifth were told of the therapists' androgenous personality. The remaining one-fifth of the Ss, who served as controls, were told nothing further; they only received the standard description of the vignette. After the vignette, Ss completed measures designed to assess their perception of therapist credibility and attractiveness. The results indicate that the androgenous therapist was rated as most credible and attractive (whereas the high-fee-charging therapist was least credible and attractive.) Explanation for these results and implications are discussed.

Therapeugenic factors in psychotherapy: The effect of attitude similarity on therapist credibility and attraction

Investigated the effect of attitude similarity upon perceived therapist credibility and attraction. Intially, Ss (N = 128) were given an attitude survey on topics of current interest. The second phase of the study had Ss supply an evaluation of a hypothetical therapist based upon a brief description of the therapist and a sample of the therapist's attitudes. The descriptions differed only in terms of the sex of the therapist, while the attitudes were constructed to be either 80% or 20% similar to the survey each S had completed. Results indicate that the therapist with similar attitudes was seen as more qualified, higher in interpersonal attraction, more likeable, and that Ss were more willing to recommend the therapist to a friend as well as seek therapy from the therapist. A significant interaction indicated that male Ss were more affected by the degree of attitude similarity than were female Ss. Implications of the results are discussed.

Attraction to therapy and therapist credibility as a function of therapy orientation.

Exposed male and female Ss (N = 96) to psychoanalytic, behavioral, client-centered, or gestalt therapy, in the form of a brief written description and a 5-minute videotaped simulation. Attraction to therapy and various dimensions of therapist credibility were measured. The psychoanalytic presentation generated the greatest attraction and the greatest perceived total credibility. The gestalt presentation was next highest on these variables, followed by the behavioral and client-centered presentation. No significant effects for sex of S or sex by therapy approach interaction were reported. Explanations for and implications of these findings are discussed.