OBJECTIVE Although higher quality patient-therapist alliance and more positive patient outcome expectation (OE) consistently predict symptomatic/functional improvement in psychotherapy, most research has failed to capture the nuance in these process-outcome relations by parsing them into within-therapist (i.e., differences between patients treated by the same therapist) and between-therapist (i.e., differences between therapists' average process/outcome ratings across all patients in their caseloads) components. Moreover, the few studies that have done so have produced mixed results, suggesting the possibility of systematic variability in these associations (i.e., moderators). One potential source of such variability could be providers themselves; that is, different therapists could use these processes to differing therapeutic benefit. This study tested the alliance- and OE-outcome associations at both the within- and between-therapist levels and explored therapist-level moderators of them. METHOD Data derived from 212 adult outpatients treated naturalistically by 42 psychotherapists as part of a randomized trial that compared different case-assignment methods. Patients completed measures of alliance, OE, and outcome repeatedly throughout treatment. Therapist characteristics were assessed at baseline. RESULTS Multilevel structural equation models revealed that, at the between-therapist level, only higher alliance quality, but not more optimistic OE, was associated with greater caseload-level improvement. At the within-therapist level, only more optimistic OE, but not higher alliance quality, was associated with patient improvement. Finally, therapists' self-perceived alliance-fostering effectiveness and cognitive-behavioral orientation moderated the within- and between-therapist alliance-outcome associations, respectively. CONCLUSION Results indicate that different therapists use common treatment processes to differing therapeutic benefit, which can inform more personalized clinical practices and trainings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

中文翻译：

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治疗师内部和治疗师之间过程结果关联的治疗师水平调节。

目标 尽管更高质量的患者-治疗师联盟和更积极的患者结果期望 (OE) 始终可以预测心理治疗中的症状/功能改善，但大多数研究未能通过将这些过程-结果关系解析为治疗师内部（即，由同一治疗师治疗的患者之间的差异）和治疗师之间的差异（即治疗师对所有患者的平均过程/结果评级之间的差异）组成部分。此外，已经这样做的少数研究产生了不同的结果，表明这些关联（即调节因子）存在系统变异的可能性。这种可变性的一个潜在来源可能是提供者本身；也就是说，不同的治疗师可以使用这些过程来获得不同的治疗效果。本研究在治疗师内部和治疗师之间测试了联盟和 OE 结果关联，并探索了治疗师水平的调节因素。方法 数据来自 42 名心理治疗师自然治疗的 212 名成人门诊患者，作为比较不同病例分配方法的随机试验的一部分。患者在整个治疗过程中反复完成了联盟、OE 和结果的测量。在基线评估治疗师特征。结果 多层次结构方程模型显示，在治疗师之间水平，只有更高的联盟质量，而不是更乐观的 OE，与更大的病例量水平改善相关。在治疗师内部水平上，只有更乐观的 OE 而不是更高的联盟质量与患者改善相关。最后，治疗师 自我感知的联盟培养效果和认知行为取向分别调节了治疗师内部和治疗师之间的联盟结果关联。结论 结果表明，不同的治疗师使用共同的治疗过程来获得不同的治疗效果，这可以为更个性化的临床实践和培训提供信息。（PsycInfo 数据库记录 (c) 2022 APA，保留所有权利）。