How experienced is your therapist and does that even matter?

by Michael D. Anestis, M.S.

In most of our articles, we look at the different characteristics of clients that predict therapy outcomes.  Today, however, I would like to turn that question around and instead look at a characteristic of therapists that many believe is critical to therapeutic outcomes: experience.  I suspect that most everyone, given the option, would prefer to work with a therapist who has decades of experience rather than one who is a novice, perhaps still in the midst of his or her graduate training.  After all, it seems reasonable to assume that, as a therapist spends more time working in the profession, he or she will develop more skill and become better equipped to help their clients battle mental illness.  As it turns out, this is an empirical question, one that we can answer by comparing the outcomes of therapists with varying levels of experience, so we do not need to rely upon our intuition on this matter.

Over the past several decades, a number of researchers have attempted to address the question of how important a therapist's experience is with respect to producing good outcomes.  What may come as a surprise to many of you is that, more often than not, studies indicate that a greater level of experience is not related to better outcomes (e.g., Beutler, Machado, & Neufeldt, 1994; Christensen & Jacobson, 1994).  This finding is not universal or without controversy and some researchers have pointed out that most studies examining experience only consider number of years practicing therapy (or years since graduate school) rather than specific components of experience (e.g., number of clients treated, level of training in that particular treatment) that might be more telling (e.g., Beutler, 1997).  Today, I would like to provide you with a quick summary of some of the research on this topic and then open up a discussion about what we can take away from these findings.

In one widely cited study conducted by Paul Crits-Christoph and a number of his colleagues (1991), the authors found that, while therapists with a greater amount of experience did produce better results overall, this was only true when they failed to use treatment manuals.  In other words, if therapists follow protocols based upon scientific studies that have shown that specific procedural plan to produce quality results, level of experience does not matter; however, when therapists simply improvise and use their intuition to guide treatment, experience matters quite a bit.  Given that empirically supported treatments - those that have been repeatedly shown to produce the best results - utilize manuals, this finding highlights the possibility that experience becomes less important when the type of treatment being used is of a higher quality.   

In a study conducted by John Dunkle and Myrna Friedlander (1996), the authors were surprised to find that therapist experience was unrelated to therapeutic alliance as rated by the client.  The authors had anticipated that therapists with more experience would have an easier time connecting with their clients and making them feel as though the working relationship was strong and conducive to treatment, but as it turns out, newer therapists were just as capable in this regard. 

In a naturalistic study conducted in an outpatient clinic by Franklin, Abramowitz, Furr, Kalsy, and Riggs (2003), the authors found that therapists with little experience in conducting exposure and ritual prevention (EX/RP) for obsessive-compulsive disorder (OCD) produced results just as strong as those produced by therapists with substantial experience in that treatment approach.  Importantly, because it was a naturalistic study, clients were not randomly assigned to therapists and, in fact, the more experienced therapists treated the most severe clients.  To address this, the authors examined whether the two groups differed in their outcomes when statistically controlling for initial OCD severity and found that they did not.  In other words, while the study had some important limitations, the results were consistent with the idea that experience does not impact outcome in a "real world" setting in EX/RP for OCD.

In one final study I want to note (although there are certainly others and I welcome your thoughts on other studies not included in this article), Jonathan Huppert and colleagues (2001) examined the impact of therapist experience in cognitive behavioral therapy (CBT) for panic disorder (PD).  They found that experience had no impact on the number of panic attacks clients were having following treatment (the primary outcome measure); however, therapists with greater experience were more successful in helping their clients reduce several secondary symptoms, including anxiety sensitivity and overall panic severity.

What does it all mean?

Given that the vast majority of the evidence indicates that having a lot of experience does not make a therapist more likely to help their clients get better, what should people consider when making a decision on which therapist to see?  There is no single right answer to that question, but our thoughts are that people seeking help for mental illness should most heavily consider the following variables rather than therapist experience:

1. Does the therapist utilize empirically supported treatments?  Ask your therapist how he or she arrives at diagnoses and makes treatment decisions and ask your therapist what evidence he or she has to support the idea that the treatment being recommended, on average, produces better results than would another form of therapy (pharmacological or psychosocial) for your particular set of symptoms.  This type of information should not be withheld from you and personal experience does not overrule scientific studies, even when it sounds remarkably compelling.
2. Does the office feel like a place that you will be comfortable going for help?  Ultimately, therapy only works if you stick with it, go through the protocol, and work on your assignments between sessions.  If you are not comfortable, you are less likely to do this.  That being said, while we consider this variable important, we think it is significantly less pivotal than the degree to which the therapist provides therapy based upon empirical evidence.

The studies cited in this study do not conclusively rule out the possibility that, at least in some circumstances, therapist experience is important.  That being said, they do make it difficult to justify considering experience to be one of if not the most important consideration in determining whether a therapist is likely to produce optimal results.  Just because somebody has been doing something for a long time does not mean that they are doing it well and, even if they are, it does not mean that they are outperforming their less experienced peers.

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Mike Anestis is a doctoral candidate in the clinical psychology department at Florida State University