Author ORCID Identifier

Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation




Educational, School, and Counseling Psychology

First Advisor

Dr. Joseph Hammer

Second Advisor

Dr. Robert. J. Reese


Recent years has seen an increase in studies examining the unique contribution that the therapist has on treatment outcomes, which is commonly referred to as “therapist effects” (Barkham et al., 2017). Therapist effects on outcomes are believed to occur primarily via how the therapist’s interpersonal and intrapersonal qualities influence the therapeutic relationship, which in turn influences outcomes (Wampold et al., 2017). The current study focused on professional self-doubt, counseling self-efficacy, and humility because of previous writings about their potential to influence therapists’ interpersonal behaviors. Data was collected from Southwest Behavioral and Health Services (SBHS), a non-profit, comprehensive community behavioral health organization. A total of 46 therapists participated in the study. Therapists who agreed to participate completed demographic items, a measure of professional-self-doubt, counseling self-efficacy, and humility. Two client-rated outcome measures were used as dependent variables. The Session Rating Scale (SRS; Miller et al., 2002) and the Outcome Rating Scale (ORS; Miller & Duncan, 2000) were collected from clients at each session. Therapists’ responses to these measures were matched with their de-identified archival client outcome data (N = 1, 817) using therapists’ employee identification numbers. Multilevel modelingwas used to determine how therapist personal characteristics predict client outcomes. Interestingly, there was a strong negative correlation between professional self-doubt and counseling self-efficacy (r = -.65). Results of the unconditional model for SRS indicated a lack of overall growth in SRS scores across treatment. Thus, no client or therapist level variables were modeled for this outcome measure. Approximately 5% of the variance in rate of growth for the ORS was between therapists. The most noteworthy finding was that when controlling for the effects of counseling self-efficacy, professional self-doubt was marginally significant, (ß= 0.06, p= .063). Relative to the null model, this model explained approximately 50% of the variance in rate of growth in ORS scores at the therapist-level. However, when counseling-self-efficacy was removed from the model, professional self-doubt was no longer marginally significant (ß = 0.04, p = .162). Overall, the findings indicate that the relationship between professional self-doubt and client outcomes is likely complex and warrants further research. The findings from the current study further efforts to more precisely describe therapist effects and gain insight into the mechanisms by which psychotherapy works.

Digital Object Identifier (DOI)

Funding Information

This study was supported by the University of Kentucky College of Education Turner-Thacker Dissertation Grant in 2019.