Matching patients to therapists based on clinical compatibility improved mental health

1. In this randomized control trial, prospective assignment of patients to matched therapists was superior in improving mental health compared to random assignment.

2. Participants in the matched therapist group had significant reductions in symptoms, distress, and functional impairment.

Evidence Rating Level: 1 (Excellent)

Patients are typically assigned to mental health practitioners based on availability when seeking care. Psychotherapists may have variability in their specific intervention strategies as well as the way that they implement care practices. Accordingly, individual patients may benefit differentially from the same psychological intervention if matched to psychotherapists based on clinical compatibility.

The present double-blind randomized control trial compared measurement-based assignment of patients to therapists with randomized matching. Therapists with 15 or more historical cases with outcome data to establish pretrial performance were included. Patients aged 18-70 years old who presented during the trial period and made their own mental health care decisions were included. Adult outpatients were recruited from mental health centers in Ohio and were excluded if they were unable to consent without a delegated decision maker. The primary outcomes were improvement across Treatment Outpatient Package (TOP) domains and distress (measured by the Symptom Checklist-10). Therapists were matched to patients using TOP domains.

A total of 218 participants were included in analysis after being randomly allocated to either the matched group (n=99) or randomized group (n=119). Participants in the matched group had significant reductions in functional impairment related to symptoms, global distress, domain-specific impairment, and reported no adverse events. Study limitations included selection bias and limited generalizability as most patients were Caucasian and heterosexual. Nonetheless, the present study suggested that therapist-patient clinical compatibility impacts mental health outcomes.

Click to read the study in JAMA Psychiatry

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