Psychotherapy effectiveness and the expert performance framework

Although no differential effectiveness of treatment approach in relation to client outcomes has been found, differential effectiveness of therapists, in both controlled and naturalistic studies, is evident. Despite such findings, therapist factors have largely been ignored. Counter-intuitively, increased experience does not automatically lead to increased therapist effectiveness. Explanations for this finding, either conceptual or empirical, are not apparent within the psychotherapy literature. In contrast, the expert performance framework provides a unified set of empirically supported constructs that can explain the differential effectiveness of novice, experienced, highly skilled performers. The expert performance framework is supported by an impressive body of empirical evidence from diverse domains, including chess, medicine, sports, and music. Recent application of the principles in complex professional domains, including nursing and medicine, have resulted in improved practitioner performance. The aim of this theoretical paper is to add to the as yet embryonic exploration of the expert performance framework and psychotherapy. Given the promising findings in related domains, and the impact of therapist performance on client outcomes, such exploration is warranted. First, the expert performance framework is outlined, and the ways in which it might be used to inform understanding about therapist effectiveness are discussed. Implications for therapist selection and training are also discussed, including the need for an integrated model of therapeutic change in order to facilitate more effective training. Finally, suggestions for future research about therapist factors are presented.