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Author ORCID Identifier

https://orcid.org/0000-0002-3106-1207

AccessType

Open Access Dissertation

Document Type

dissertation

Degree Name

Doctor of Philosophy (PhD)

Degree Program

Psychology

Year Degree Awarded

2023

Month Degree Awarded

September

First Advisor

Michael Constantino, PhD

Subject Categories

Clinical Psychology | Counseling Psychology

Abstract

Objective: Research demonstrates that mental health clinicians vary in their general effectiveness—the “between-therapist effect.” Thus, it is important to identify determinants of such differences in order to understand and cultivate the therapist characteristics or actions that reliably foster better patient outcomes. To date, several of such variables have emerged empirically. For example, therapists who exhibit higher versus lower levels of professional self-doubt (PSD; a critical questioning of one’s skills as a clinician) have been shown to achieve better interpersonal outcomes with their average patient. Although arguably counterintuitive, the beneficial influence of PSD may make sense if, instead of simply reflecting a negative self-perception, it taps into the broader construct of professional humility; that is, the adaptive ability to maintain a balanced and accurate view of one’s strengths and weaknesses in their clinical practice. However, no research exists that directly tests (vs. infers from PSD) this professional humility hypothesis. Additionally, drawing on the broader positive psychology literature, it is possible that therapists who possess more versus less trait-like personal humility, or one’s balanced view of their general virtues and shortcomings coupled with an other- versus self-focused attitude, would also be generally more effective in their practice. To date, though, little research has examined personal humility as a determinant of therapist effectiveness differences. Addressing these gaps, I respectively examined across two studies the professional and personal humility constructs in relation to therapist performance in naturalistic practice. In the first study, I drew on archival therapist and patient data to test therapists’ professional humility (viz. the degree of under versus overestimation of one’s measurement-based and problem-specific effectiveness, as assessed with a patient-reported multidimensional routine outcomes measure) as a predictor of between-therapist differences in their average patient’s global treatment outcome. In the second study, I prospectively collected therapist data and drew on archival patient data to test therapists’ self-reported personal humility as a predictor of their global effectiveness differences. I hypothesized that each humility type would be positively associated with therapist-level patient improvement. Method: Study 1 included 50 community therapists who delivered treatment as usual (TAU) to 1,363 patients. Without any awareness of their measurement-derived effectiveness, therapists completed a survey of their self-perceived effectiveness in treating 12 presenting-problem domains (e.g., depression, substance misuse). I then derived the professional humility index by comparing these perceptions with a patient-reported, data-driven index of their effectiveness in each domain—this allowed me to determine the degree which therapists over-, under-, and accurately estimated their measurement-based clinical performance (both within specific domains and across them). The patient-reported outcomes data also provided a measure of global outcome measure at pre and posttreatment. Study 2 included a distinct sample of 43 therapists and 289 of their patients who again received TAU in 1 of 3 community mental health care centers. Therapists completed a measure of personal relational humility, and patients had completed a global outcome measure at pre and posttreatment. Results: In Study 1, as hypothesized, greater therapist underestimation of their problem-specific effectiveness was associated with greater global improvement across their patients. In Study 2, counter to my prediction, therapist personal humility was unrelated to their patients’ outcomes. Conclusions: Humility specific to one’s clinical effectiveness may represent a key determinant of the therapist effect; therefore, cultivating this professional form of humility could become a focus of clinical training. However, the influence of personal humility on therapist performance may be less relevant, or it may require measuring this virtue with a method other than therapist self-report.

DOI

https://doi.org/10.7275/35915277

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