Research Article: The Role of Practitioner Resilience and Mindfulness in Effective Practice: A Practice-Based Feasibility Study

Date Published: July 16, 2016

Publisher: Springer US

Author(s): Jo-Ann Pereira, Michael Barkham, Stephen Kellett, David Saxon.


A growing body of literature attests to the existence of therapist effects with little explanation of this phenomenon. This study therefore investigated the role of resilience and mindfulness as factors related to practitioner wellbeing and associated effective practice. Data comprised practitioners (n = 37) and their patient outcome data (n = 4980) conducted within a stepped care model of service delivery. Analyses employed benchmarking and multilevel modeling to identify more and less effective practitioners via yoking of therapist factors and nested patient outcomes. A therapist effect of 6.7 % was identified based on patient depression (PHQ-9) outcome scores. More effective practitioners compared to less effective practitioners displayed significantly higher levels of mindfulness as well as resilience and mindfulness combined. Implications for policy, research and practice are discussed.

Partial Text

There is a growing body of evidence that variability exists between psychological therapists in relation to patient outcomes (Baldwin and Imel 2013), a phenomenon termed therapist effects (Lutz and Barkham 2015). In general, research studies have reported therapist effects in the region of 5–8 % (e.g., Crits-Christoph et al. 1991; Crits-Christoph and Mintz 1991; Wampold 2001). However, other research has found that therapist effects are minimal, with researchers arguing that the evidence base is actually a methodological artefact (Ehlers et al. 2013; Erickson et al. 2012; Huppert et al. 2014). The most parsimonious explanation for these apparent discrepant views is that therapist effects are manifest only under certain conditions or in specific situations. Factors that could influence the detection of therapist effects include the research paradigm adopted, the sample size of therapists, and patients’ presenting conditions.

The current study aimed to identify personal aspects that differentiated between more effective and less effective practice. Controlling for case-mix, a therapist effect of 6.7 % was found, which was partly explained by more effective practitioners having significantly higher levels of mindfulness alone as well as resilience and mindfulness combined when compared with less effective practitioners.




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