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It is more effective in preventing relapse and it produces fewer side effects. It is striking that large, sophisticated, recent research programs suggest that antidepressants are even less effective in "real life" than they are in controlled trials.

"These concerns are bolstered by research findings showing that many of the claims made to mental health practitioners, medical professionals, and the public through journal advertisements and the media are not empirically confirmed or carefully examined by government oversight (Donohue, Cevasco, & Rosenthal, 2007; Spielmans et al., 2008).

Therapist variables

Therapist effects on outcome and alliance in inpatient psychotherapy.

Dinger, U., Strack, M., Leichsenring, F., Wilmers, F. & Schauenburg, H. (2008). Journal of Clinical Psychology, 64(3), 344-354

As an addition to the ongoing discussion concerning the magnitude of therapist effects on outcome in psychotherapy, we investigated therapist variability in a large inpatient psychotherapy sample. We included global symptomatic outcome (Global Severity Index of the Symptom Checklist-90 Revised [SCL-90-R]; German version, Franke, 1995) and alliance (Helping Alliance Questionnaire; German version, Bassler, Potratz & Krauthauser, 1995) ratings of 2554 inpatients who were treated by 50 psychotherapists. Multilevel regression analyses (HLM; Raudenbush, Bryk, Cheong, & Congdon, 2004) were used for analyses. Overall, therapists accounted for a much greater variability on alliance (33%) than on outcome (3%). Therapists were differentially effective with regard to their patients' symptom severity at the beginning of treatment, and therapists differed in the degree that a positive alliance was associated with therapeutic outcome. The relatively small therapist effect on outcome is attributed to compensatory mechanisms in the specific context of inpatient therapy.  

Therapist competence in cognitive therapy for depression: Predicting subsequent symptom change.

 Strunk, D. R., Brotman, M., A., DeRubeis, R. J. & Hollon, S. D. (2010). Journal of Consulting and Clinical Psychology, 78(3), 429-437.

Objective: The efficacy of cognitive therapy (CT) for depression has been well established. Measures of the adequacy of therapists' delivery of treatment are critical to facilitating therapist training and treatment dissemination. While some studies have shown an association between CT competence and outcome, researchers have yet to address whether competence ratings predict subsequent outcomes. Method: In a sample of 60 moderately to severely depressed outpatients from a clinical trial, we examined competence ratings (using the Cognitive Therapy Scale) as a predictor of subsequent symptom change. Results: Competence ratings predicted session-to-session symptom change early in treatment. In analyses focused on prediction of symptom change following 4 early sessions through the end of 16 weeks of treatment, competence was shown to be a significant predictor of evaluator-rated end-of-treatment depressive symptom severity and was predictive of self-reported symptom severity at the level of a nonsignificant trend. To investigate whether competence is more important to clients with specific complicating features, we examined 4 patient characteristics as potential moderators of the competence-outcome relation. Competence was more highly related to subsequent outcome for patients with higher anxiety, an earlier age of onset, and (at a trend level) patients with a chronic form of depression (chronic depression or dysthymia) than for those patients without these characteristics. Competence ratings were not more predictive of subsequent outcomes among patients who met (vs. those who did not meet) criteria for a personality disorder (i.e., among personality disorders

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