Psychological Medicine

Therapist competence and clinical outcome in the Prevention of Parasuicide by Manual Assisted Cognitive Behaviour Therapy Trial: the POPMACT study

K. DAVIDSON a1c1, J. SCOTT a1, U. SCHMIDT a1, P. TATA a1, S. THORNTON a1 and P. TYRER a1
a1 Psychological Medicine, Gartnavel Royal, Glasgow, Imperial College, King's College and Maudsley Hospitals, London, UK

Article author query
davidson k   [PubMed][Google Scholar] 
scott j   [PubMed][Google Scholar] 
schmidt u   [PubMed][Google Scholar] 
tata p   [PubMed][Google Scholar] 
thornton s   [PubMed][Google Scholar] 
tyrer p   [PubMed][Google Scholar] 


Background. Therapist competence may be an important factor in determining clinical outcome in psychological therapies. However, there are few published studies of therapist competence v. patient outcome from randomized controlled trials. We tested the hypothesis that higher levels of therapist competence would lead to better clinical outcomes in both patient- and observer-rated measures at 6- and 12-month follow-up.

Method. A random sample of 49 audiotapes of manual assisted cognitive therapy sessions delivered by 21 therapists involved in the Prevention of Parasuicide by Manual Assisted Cognitive Behaviour Therapy trial was rated to assess the level of therapist competence. Patient outcome was assessed using self and observer ratings of depressive and anxiety symptoms, social functioning, global functioning and number of episodes of deliberate self-harm.

Results. At 6-month follow-up, there was a statistically significant association between therapist level of competence and observer-rated depression only. At 12-month follow-up, significant associations were noted between therapist competence and all observer-rated clinical outcomes but not for self-rated outcome measures. However, there was no association between therapist competence and the number of self-harm episodes during follow-up.

Conclusions. When treated by therapists rated as more competent than other therapists who received equivalent brief training, patients with recurrent self-harm show significant clinical improvements. However, this benefit is not identified across all outcome measures and is not fully apparent until 12-month follow-up.

c1 Professor Kate M. Davidson, Psychological Medicine, Division of Community Based Sciences, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK. (Email: