Rating Therapists Based on Evaluations: Is There a Better Way?

The therapeutic alliance is often characterized as the heart and soul of therapy. A strong and trusting relationship between the therapist and client is essential for disclosure, adherence, and ultimate treatment success. In fact, therapist-level alliance, which is a client’s evaluation of the therapeutic alliance, is seen as a robust indicator of treatment efficacy. But does this type of measurement accurately assess a therapist’s performance? To answer this question, Zac E. Imel of the University of Utah’s Department of Educational Psychology recently conducted an analysis to determine if client ratings provided the best view into therapists’ effectiveness.

Imel reviewed data from two samples clients, including over 3,000 ratings of 72 Health Maintenance Organization (HMO) therapists, and over 1,600 ratings of 93 independent practice (IP) therapists. In general, Imel found that there were few differences in the alliance ratings. However, the results did raise some concerns. For instance, therapists with less than 10 ratings had their results scaled to fit the larger model. This generalization of data could suggest that some therapists need additional training when in fact, if their ratings were examined independently, it would be revealed that they are well within satisfactory levels.

Also, Imel noticed a slight difference between HMO therapists and IP therapists, with client evaluations being more varied among IP therapists. Although factors such as type of treatment, training, and client base were not evaluated fully in this study, these are all conditions which can dramatically skew client evaluations. Future studies should look at the diversity of therapists in HMO settings compared to IP settings. Perhaps the HMO therapists, who are more stringently monitored than IP therapists, aim to work within specific HMO-mandated guidelines and offer a narrower range of treatment methods than private practice therapists. “Outstanding performance may be sacrificed in order to homogenize patient experience,” said Imel. However, one common finding was that therapists who were highly rated by the first half of their cases tended to have high ratings throughout the remainder of their cases, regardless of practice environment. Imel believes that although therapists with few client evaluations may benefit from a more focused alliance review, the majority of client evaluations do provide a relatively accurate picture of therapist performance.

Imel, Z. E., Hubbard, R. A., Rutter, C. M., and Simon, G. (2012). Patient-rated alliance as a measure of therapist performance in two clinical settings. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0030903

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  • D.O


    January 7th, 2013 at 12:45 PM

    While client evaluation may or may not be the right indicator for the effectiveness of the therapist,it can surely have an effect on the treatment outcome.that is because client evaluation determines the perception of the client on the quality of the therapist and that could in turn have an effect on the treatment outcome,because the client’s mind is already made up about the quality of treatment he/she receives.

  • Sal


    January 7th, 2013 at 3:56 PM

    What other kind of evaluation could there be that would hold more water than that of what a client thinks of a therapist?
    What are you gonna do? Have outsiders come in and listen to sessions and give them grades? You know you can’t do that because of confidentiality concerns.
    I think that the best indicator of whether or not a therapist is a good one is to look at his client list, his success rate with those clients, and simply talking to the patients and gaging from them just how much they have gained from the therapeutic ecxperience. If then you continue to receive positive feedback, then you know that you have a pretty good therapist on your hands.



    January 7th, 2013 at 11:25 PM

    Ratings-Something that works well for machines but never for humans.There is just too many factors and the evaluator’s prejudices hat come in the way.Two clients with exactly the same problem and response from the therapist will probably rate the therapist differently.

    There really is no such thig as a good therapist or a bad therapist.If you are comfortable with your therapist then that us all that matters.If you are not then it is time to look for another.Ratings don’t mean a thing to me.

  • martin o

    martin o

    January 8th, 2013 at 3:55 AM

    I don’t think that too many clients would get anything inbreturn for lying about their therapist, so why not just take their word for it when they say whether they think that this is a professional doing their job well.

  • Jackson


    January 8th, 2013 at 9:49 PM

    So now we are depending on the assessments provided by those that are in treatment for mental health problems? Seriously?

    Do we not have better ways of determining any of this? Because as far as I can see, clients with certain disorders are going to rate their alliance with the therapist as poor regardless of what it actually is. Some people are just not open to an alliance, to feel connected to others. How can we rate therapists according to the views of such individuals!

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