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How much difference does the therapist make?

In 2004 Scott Miller studied the effect of therapists working in an American College and found quite a large variation between the effectiveness of different therapists. Some did considerably better than average for their clients but some did considerably worse. You can see it from this chart of their outcome:

The verticle lines represent the range of scores that clients achieved with each therapist and the blocks mark the mean scores. At the bottom, you can see the number of clients each therapist had worked with. 

You can see there is quite a sizable difference in outcomes.

Okiishi et al (2006) found even more of an effect. In their study, the clients of the top 10% of practitioners were *twice* as likely to recover and 50% less likely to deteriorate than clients seen by the least effective therapists!  

In case you thought this was simply a matter of how much experience each therapist has, this study in 2015 showed that the top 1/4 of therapists were always significantly better than the remaining 3/4. In fact, as time went on, this difference got even greater.

So, what does all this mean for clinicians and clinics? It means we should be routinely monitoring our personal work and our individual outcomes as clinicians. How can we know we need to improve something if we don’t know it could be better? From feedback, we can improve our own individual practice. As clinics, we can use this monitoring to ensure that only the highest performing therapists are working with our clients. 

We use many measures of progress at PROMIS. Amongst them are the CORE-OM (Evans et al, 2000) and another is the ORS / SRS (FIT) system developed by Scott-Miller. 

There are also many other possible outcome measures you can use, the BACP has a review of outcome measuring here:


The Royal Society of Psychiatrists has also given advice for Psychotherapists here:


Whichever method is used to measure the outcome, we owe it to our clients to be measuring so we can offer the best service possible.

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