Therapist facilitative interpersonal skills and the relation to psychotherapy outcome

Lay Summary The interpersonal characteristics of a therapist, such as their ability to show warmth, empathy, and hope, have been found to influence how beneficial therapy is for a client. A measure called the facilitative interpersonal skills task was developed to rate how much therapists use interpersonal skills in simulated therapy sessions with clients. One important interpersonal skill is called the therapeutic alliance, which measures agreement between a client and therapist on the “what” and “how” of therapy, as well as a feeling of closeness between them. Part One is a meta-analytic review aiming to look at whether clients with a weak therapeutic alliance with their therapist are more likely to drop out of therapy early. The review brought together the findings of 25 studies and confirmed that there is a relationship of medium strength between the therapeutic alliance and a client dropping out of psychotherapy. Other factors such as the client’s diagnosis or educational history, the type and length of therapy, and the way studies measured alliance and dropout, did not make an important difference to the strength of this relationship. However, the strength of the relationship was weaker in studies that had not published their findings in journals, compared to those that had. Part Two is a research study aiming to look at whether a therapist’s facilitative interpersonal skills are linked to therapy being more successful for clients. To do this, the measure had to be adapted to rate therapists’ skills in actual client therapy sessions that were not going well. Overall, the interpersonal skills a therapist used in the session did not link to more successful treatment for clients. Furthermore, the relationship between a therapist’s skills and the success of treatment did not differ based on the type of therapy clients received. The study did find that there were different patterns in how therapist’s skills impact on treatment success based on how severe the client’s depression was when they started therapy. For clients with moderate depression, treatment was more successful when the therapist used more interpersonal skills. For clients with severe depression, treatment was more successful when the therapist used less interpersonal skills. Overall, the findings suggest that the interpersonal skills of a therapist can make a difference to how successful psychotherapy is for a client and whether they might drop out early. The findings suggest the need for therapists to pay close attention to their use of interpersonal skills and the therapeutic alliance with a client to maximise the benefit of psychotherapy.