Skip to main content
Top
Published in: Administration and Policy in Mental Health and Mental Health Services Research 5/2017

Open Access 01-09-2017 | Original Paper

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

Authors: Jo-Ann Pereira, Michael Barkham, Stephen Kellett, David Saxon

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 5/2017

Login to get access

Abstract

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.
Appendix
Available only for authorised users
Literature
go back to reference Bajaj, B., & Pande, N. (2015). Mediating role of resilience in the impact of mindfulness on life satisfaction and affect as indices of subjective well-being. Personality and Individual Differences. Available online 12 September 2015. Bajaj, B., & Pande, N. (2015). Mediating role of resilience in the impact of mindfulness on life satisfaction and affect as indices of subjective well-being. Personality and Individual Differences. Available online 12 September 2015.
go back to reference Baldwin, S. A., & Imel, Z. E. (2013). Therapist effects: Findings and methods. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed.). Hoboken, NJ: Wiley. Baldwin, S. A., & Imel, Z. E. (2013). Therapist effects: Findings and methods. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed.). Hoboken, NJ: Wiley.
go back to reference Barrick, M. R., Mount, M. K., & Judge, T. A. (2001). Personality and performance at the beginning of the new millennium: What do we know and where do we go next? Personality and Performance, 9, 9–30. Barrick, M. R., Mount, M. K., & Judge, T. A. (2001). Personality and performance at the beginning of the new millennium: What do we know and where do we go next? Personality and Performance, 9, 9–30.
go back to reference Beutler, L. E., Malik, M., Alimohamed, S., Harwood, T. M., Talebi, H., Noble, S., et al. (2004). Therapist variables. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed., pp. 227–306). United States: Wiley. Beutler, L. E., Malik, M., Alimohamed, S., Harwood, T. M., Talebi, H., Noble, S., et al. (2004). Therapist variables. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed., pp. 227–306). United States: Wiley.
go back to reference Bower, P., & Gilbody, S. (2005). Stepped care in psychological therapies: Access, effectiveness and efficiency. Narrative literature review. British Journal of Psychiatry, 186, 11–17.CrossRefPubMed Bower, P., & Gilbody, S. (2005). Stepped care in psychological therapies: Access, effectiveness and efficiency. Narrative literature review. British Journal of Psychiatry, 186, 11–17.CrossRefPubMed
go back to reference Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822–848.CrossRefPubMed Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822–848.CrossRefPubMed
go back to reference Brown, K. W., & Ryan, R. M. (2004). Perils and promise in defining and measuring mindfulness: Observations from experience. Clinical Psychology: Science and Practice, 11, 242–248. Brown, K. W., & Ryan, R. M. (2004). Perils and promise in defining and measuring mindfulness: Observations from experience. Clinical Psychology: Science and Practice, 11, 242–248.
go back to reference Castonguay, L., Barkham, M., Lutz, W., & McAleavey, A. (2013). Practice-oriented research: Approaches and applications. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed., pp. 85–133). Hoboken, NJ: Wiley. Castonguay, L., Barkham, M., Lutz, W., & McAleavey, A. (2013). Practice-oriented research: Approaches and applications. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed., pp. 85–133). Hoboken, NJ: Wiley.
go back to reference Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience. International Review of Psychiatry, 23, 318–327.CrossRefPubMed Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience. International Review of Psychiatry, 23, 318–327.CrossRefPubMed
go back to reference Clark, D. M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., Grey, N., et al. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 568–578.CrossRefPubMed Clark, D. M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., Grey, N., et al. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 568–578.CrossRefPubMed
go back to reference Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: The Connor–Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18, 76–82.CrossRefPubMed Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: The Connor–Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18, 76–82.CrossRefPubMed
go back to reference Crits-Christoph, P., Baranackie, K., Kurcias, J. S., Beck, A. T., Carroll, K., Perry, K., et al. (1991). Meta-analysis of therapist effects in psychotherapy outcome studies. Psychotherapy Research, 1, 81–91.CrossRef Crits-Christoph, P., Baranackie, K., Kurcias, J. S., Beck, A. T., Carroll, K., Perry, K., et al. (1991). Meta-analysis of therapist effects in psychotherapy outcome studies. Psychotherapy Research, 1, 81–91.CrossRef
go back to reference Crits-Christoph, P., & Mintz, J. (1991). Implications of therapist effects for the design and analysis of comparative studies of psychotherapies. Journal of Consulting and Clinical Psychology, 59, 20–26.CrossRefPubMed Crits-Christoph, P., & Mintz, J. (1991). Implications of therapist effects for the design and analysis of comparative studies of psychotherapies. Journal of Consulting and Clinical Psychology, 59, 20–26.CrossRefPubMed
go back to reference Department of Health, National Institute for Mental Health in England. (2008a). Improving access to psychological therapies implementation plan: Curriculum for low-intensity therapies workers (Gateway Ref: 9427). Department of Health, National Institute for Mental Health in England. (2008a). Improving access to psychological therapies implementation plan: Curriculum for low-intensity therapies workers (Gateway Ref: 9427).
go back to reference Department of Health, National Institute for Mental Health in England. (2008b). Improving access to psychological therapies implementation plan: Curriculum for high-intensity therapies workers (Gateway Ref: 9427). Department of Health, National Institute for Mental Health in England. (2008b). Improving access to psychological therapies implementation plan: Curriculum for high-intensity therapies workers (Gateway Ref: 9427).
go back to reference Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., Fennell, M., Herbert, C., & Mayou, R. (2003). A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessments as early interventions for posttraumatic stress disorder. Archives of General Psychiatry, 60, 1024–1032.CrossRefPubMed Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., Fennell, M., Herbert, C., & Mayou, R. (2003). A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessments as early interventions for posttraumatic stress disorder. Archives of General Psychiatry, 60, 1024–1032.CrossRefPubMed
go back to reference Ehlers, A., Grey, N., Wild, J., Stott, R., Liness, S., Deale, A., et al. (2013). Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample. Behaviour Research and Therapy, 51, 742–752.CrossRefPubMedPubMedCentral Ehlers, A., Grey, N., Wild, J., Stott, R., Liness, S., Deale, A., et al. (2013). Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample. Behaviour Research and Therapy, 51, 742–752.CrossRefPubMedPubMedCentral
go back to reference Erickson, S. J., Tonigan, J., & Winhusen, T. (2012). Therapist effects in a NIDA CTN intervention trial with pregnant substance abusing women: Findings from a RCT with MET and TAU conditions. Alcoholism Treatment Quarterly, 30, 224–237.CrossRef Erickson, S. J., Tonigan, J., & Winhusen, T. (2012). Therapist effects in a NIDA CTN intervention trial with pregnant substance abusing women: Findings from a RCT with MET and TAU conditions. Alcoholism Treatment Quarterly, 30, 224–237.CrossRef
go back to reference Ericsson, K. A., Krampe, R. T., & Tesch-Römer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 3, 363–406.CrossRef Ericsson, K. A., Krampe, R. T., & Tesch-Römer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 3, 363–406.CrossRef
go back to reference Firth, N., Barkham, M., & Kellett, S. (2015). The clinical effectiveness of stepped care systems for depression in working age adults: A systematic review. Journal of Affective Disorders, 170, 119–130.CrossRefPubMed Firth, N., Barkham, M., & Kellett, S. (2015). The clinical effectiveness of stepped care systems for depression in working age adults: A systematic review. Journal of Affective Disorders, 170, 119–130.CrossRefPubMed
go back to reference Giluk, T. L. (2009). Mindfulness, big five personality, and affect: A meta-analysis. Personality and Individual Differences, 47, 805–811.CrossRef Giluk, T. L. (2009). Mindfulness, big five personality, and affect: A meta-analysis. Personality and Individual Differences, 47, 805–811.CrossRef
go back to reference Green, H., Barkham, M., Kellett, S., & Saxon, D. (2014). Therapist effects and IAPT Psychological Wellbeing Practitioners (PWPs): A multilevel modeling and mixed methods analysis. Behaviour Research and Therapy, 63, 43–54.CrossRefPubMed Green, H., Barkham, M., Kellett, S., & Saxon, D. (2014). Therapist effects and IAPT Psychological Wellbeing Practitioners (PWPs): A multilevel modeling and mixed methods analysis. Behaviour Research and Therapy, 63, 43–54.CrossRefPubMed
go back to reference Grepmair, L., Mitterlehner, F., Loew, T., Bachler, E., Rother, W., & Nickel, M. (2007). Promoting mindfulness in psychotherapists in training influences the treatment results of their patients: A randomized, double-blind, controlled study. Psychotherapy and Psychosomatics, 76, 332–338.CrossRefPubMed Grepmair, L., Mitterlehner, F., Loew, T., Bachler, E., Rother, W., & Nickel, M. (2007). Promoting mindfulness in psychotherapists in training influences the treatment results of their patients: A randomized, double-blind, controlled study. Psychotherapy and Psychosomatics, 76, 332–338.CrossRefPubMed
go back to reference Gyani, A., Shafran, R., Layard, R., & Clark, D. M. (2013). Enhancing recovery rates: Lessons from year one of IAPT. Behaviour Research and Therapy, 51, 597–606.CrossRefPubMedPubMedCentral Gyani, A., Shafran, R., Layard, R., & Clark, D. M. (2013). Enhancing recovery rates: Lessons from year one of IAPT. Behaviour Research and Therapy, 51, 597–606.CrossRefPubMedPubMedCentral
go back to reference Huppert, J. D., Kivity, Y., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2014). Therapist effects and the outcome-alliance correlation in cognitive behavioral therapy for panic disorder with agoraphobia. Behaviour Research and Therapy, 52, 26–34.CrossRefPubMed Huppert, J. D., Kivity, Y., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2014). Therapist effects and the outcome-alliance correlation in cognitive behavioral therapy for panic disorder with agoraphobia. Behaviour Research and Therapy, 52, 26–34.CrossRefPubMed
go back to reference Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.CrossRefPubMed Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.CrossRefPubMed
go back to reference Kobasa, S. C. (1979). Stressful life events, personality, and health: An inquiry into hardiness. Journal of Personality and Social Psychology, 37, 1–11.CrossRefPubMed Kobasa, S. C. (1979). Stressful life events, personality, and health: An inquiry into hardiness. Journal of Personality and Social Psychology, 37, 1–11.CrossRefPubMed
go back to reference Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32, 1–7.CrossRef Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32, 1–7.CrossRef
go back to reference Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9—Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefPubMedPubMedCentral Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9—Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefPubMedPubMedCentral
go back to reference Lafferty, P., Beutler, L. E., & Crago, M. (1989). Differences between more and less effective psychotherapists—A study of select therapist variables. Journal of Consulting and Clinical Psychology, 57, 76–80.CrossRefPubMed Lafferty, P., Beutler, L. E., & Crago, M. (1989). Differences between more and less effective psychotherapists—A study of select therapist variables. Journal of Consulting and Clinical Psychology, 57, 76–80.CrossRefPubMed
go back to reference Laska, K. M., Smith, T. L., Wislocki, A. P., Minami, T., & Wampold, B. E. (2013). Uniformity of evidence-based treatments in practice? Therapist effects in the delivery of cognitive processing therapy for PTSD. Journal of Counseling Psychology, 60, 31–41.CrossRefPubMed Laska, K. M., Smith, T. L., Wislocki, A. P., Minami, T., & Wampold, B. E. (2013). Uniformity of evidence-based treatments in practice? Therapist effects in the delivery of cognitive processing therapy for PTSD. Journal of Counseling Psychology, 60, 31–41.CrossRefPubMed
go back to reference Marks, I. (1986). Behavioural psychotherapy: Maudsley book of clinical management. Bristol: Wright. Marks, I. (1986). Behavioural psychotherapy: Maudsley book of clinical management. Bristol: Wright.
go back to reference Martin, J. R. (1997). Mindfulness: A proposed common factor. Journal of Psychotherapy Integration, 7, 291–312.CrossRef Martin, J. R. (1997). Mindfulness: A proposed common factor. Journal of Psychotherapy Integration, 7, 291–312.CrossRef
go back to reference McCarthy, W. C., & Frieze, I. H. (1999). Negative aspects of therapy: Client perceptions of therapists’ social influence, burnout, and quality of care. Journal of Social Issues, 55, 33–50.CrossRef McCarthy, W. C., & Frieze, I. H. (1999). Negative aspects of therapy: Client perceptions of therapists’ social influence, burnout, and quality of care. Journal of Social Issues, 55, 33–50.CrossRef
go back to reference Mundt, J. C., Marks, I. M., Shear, M., & Greist, J. M. (2002). The Work and Social Adjustment Scale: A simple measure of impairment in functioning. The British Journal of Psychiatry, 180, 461–464.CrossRefPubMed Mundt, J. C., Marks, I. M., Shear, M., & Greist, J. M. (2002). The Work and Social Adjustment Scale: A simple measure of impairment in functioning. The British Journal of Psychiatry, 180, 461–464.CrossRefPubMed
go back to reference National IAPT Programme Team. (2011). The IAPT data handbook: Guidance on recording and monitoring outcomes to support local evidence-based practice. National IAPT Programme Team. (2011). The IAPT data handbook: Guidance on recording and monitoring outcomes to support local evidence-based practice.
go back to reference National Institute for Health and Clinical Excellence. (2009). Depression: Management of depression in primary and secondary healthcare. London: NICE. National Institute for Health and Clinical Excellence. (2009). Depression: Management of depression in primary and secondary healthcare. London: NICE.
go back to reference National Institute for Health and Clinical Excellence. (2011). Generalised anxiety disorder and panic (with or without agoraphobia) in adults. London: NICE. National Institute for Health and Clinical Excellence. (2011). Generalised anxiety disorder and panic (with or without agoraphobia) in adults. London: NICE.
go back to reference Nissen-Lie, H. A., Monsen, J. T., Ulleberg, P., & Rønnestad, M. H. (2013a). Psychotherapists’ self-reports of their interpersonal functioning and difficulties in practice as predictors of patient outcome. Psychotherapy Research, 23, 86–104.CrossRefPubMed Nissen-Lie, H. A., Monsen, J. T., Ulleberg, P., & Rønnestad, M. H. (2013a). Psychotherapists’ self-reports of their interpersonal functioning and difficulties in practice as predictors of patient outcome. Psychotherapy Research, 23, 86–104.CrossRefPubMed
go back to reference Nissen-Lie, H. A., Havik, O. E., Høglend, P. A., Monsen, J. T., & Rønnestad, M. H. (2013b). The contribution of the quality of therapists’ personal lives to the development of the working alliance. Journal of Counseling Psychology, 60, 483–495.CrossRefPubMed Nissen-Lie, H. A., Havik, O. E., Høglend, P. A., Monsen, J. T., & Rønnestad, M. H. (2013b). The contribution of the quality of therapists’ personal lives to the development of the working alliance. Journal of Counseling Psychology, 60, 483–495.CrossRefPubMed
go back to reference Rasbash, J., Charlton, C., Browne, W. J., Healy, M., & Cameron, B. (2009). MLwiN version 2.30. Bristol: Centre for Multilevel Modelling, University of Bristol. Rasbash, J., Charlton, C., Browne, W. J., Healy, M., & Cameron, B. (2009). MLwiN version 2.30. Bristol: Centre for Multilevel Modelling, University of Bristol.
go back to reference Ryan, A., Safran, J. D., Doran, J. M., & Moran, J. (2012). Therapist mindfulness, alliance and treatment outcome. Psychotherapy Research, 22, 289–297.CrossRefPubMed Ryan, A., Safran, J. D., Doran, J. M., & Moran, J. (2012). Therapist mindfulness, alliance and treatment outcome. Psychotherapy Research, 22, 289–297.CrossRefPubMed
go back to reference Saxon, D., & Barkham, M. (2012). Patterns of therapist variability: Therapist effects and the contribution of patient severity and risk. Journal of Consulting and Clinical Psychology, 80, 535–546.CrossRefPubMed Saxon, D., & Barkham, M. (2012). Patterns of therapist variability: Therapist effects and the contribution of patient severity and risk. Journal of Consulting and Clinical Psychology, 80, 535–546.CrossRefPubMed
go back to reference Schiefele, A.-K., Lutz, W., Barkham, M., Rubel, J., Bøhnke, J., Delgadillo, J., et al. (2016). Reliability of therapist effects in practice-based psychotherapy research: A guide for the planning of future studies. Administration and Policy in Mental Health and Mental Health Services Research. Advance online publication. Schiefele, A.-K., Lutz, W., Barkham, M., Rubel, J., Bøhnke, J., Delgadillo, J., et al. (2016). Reliability of therapist effects in practice-based psychotherapy research: A guide for the planning of future studies. Administration and Policy in Mental Health and Mental Health Services Research. Advance online publication.
go back to reference Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Løwe, B. (2006). A brief measure for assessing generalized anxiety disorder—The GAD-7. Archives of Internal Medicine, 166, 1092–1097.CrossRefPubMed Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Løwe, B. (2006). A brief measure for assessing generalized anxiety disorder—The GAD-7. Archives of Internal Medicine, 166, 1092–1097.CrossRefPubMed
go back to reference Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Patient Health Questionnaire Study Group. (1999). Validation and utility of a self-report version of PRIME-MD—The PHQ primary care study. Journal of the American Medical Association, 282, 1737–1744.CrossRefPubMed Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Patient Health Questionnaire Study Group. (1999). Validation and utility of a self-report version of PRIME-MD—The PHQ primary care study. Journal of the American Medical Association, 282, 1737–1744.CrossRefPubMed
go back to reference Stanley, S., Reitzel, L. R., Wingate, L. R., Cukrowicz, K. C., Lima, E. N., & Joiner, T. E. (2006). Mindfulness: A primrose path for therapists using manualized treatments? Journal of Cognitive Psychotherapy: An International Quarterly, 20, 327–335.CrossRef Stanley, S., Reitzel, L. R., Wingate, L. R., Cukrowicz, K. C., Lima, E. N., & Joiner, T. E. (2006). Mindfulness: A primrose path for therapists using manualized treatments? Journal of Cognitive Psychotherapy: An International Quarterly, 20, 327–335.CrossRef
go back to reference Wampold, B. E. (2001). The great psychotherapy debate: Models, methods and findings. Mahwah, NJ: Erlbaum. Wampold, B. E. (2001). The great psychotherapy debate: Models, methods and findings. Mahwah, NJ: Erlbaum.
go back to reference Zahra, D., Qureshi, A., Henley, W., Taylor, R., Quinn, C., Pooler, J., et al. (2014). The Work and Social Adjustment Scale: Reliability, sensitivity and value. International Journal of Psychiatry in Clinical Practice, 18, 131–138.CrossRefPubMed Zahra, D., Qureshi, A., Henley, W., Taylor, R., Quinn, C., Pooler, J., et al. (2014). The Work and Social Adjustment Scale: Reliability, sensitivity and value. International Journal of Psychiatry in Clinical Practice, 18, 131–138.CrossRefPubMed
Metadata
Title
The Role of Practitioner Resilience and Mindfulness in Effective Practice: A Practice-Based Feasibility Study
Authors
Jo-Ann Pereira
Michael Barkham
Stephen Kellett
David Saxon
Publication date
01-09-2017
Publisher
Springer US
Published in
Administration and Policy in Mental Health and Mental Health Services Research / Issue 5/2017
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI
https://doi.org/10.1007/s10488-016-0747-0

Other articles of this Issue 5/2017

Administration and Policy in Mental Health and Mental Health Services Research 5/2017 Go to the issue