Graduate training in psychotherapy: are therapy outcomes enhanced?

Several sources of indirect evidence supporting the value of graduate training in psychotherapy are reviewed here. Training protocols that are known to enhance trainees' skills are briefly discussed, as are conclusions of meta-analytic reviews examining relationships between therapist experience and training, and therapy outcome. An updated meta-analysis of therapy outcome studies involving within-study comparisons of psychotherapists of different levels of training and experience is summarized. It is concluded that a variety of outcome sources are associated with modest effect sizes favoring more trained therapists. In many outpatient settings, therapists with more training tend to suffer fewer therapy dropouts than less trained therapists. Shortcomings of available research and speculations about possible variables influencing outcomes are discussed.