Abstract

Objective This study applied a machine-learning-based skill assessment system to investigate the association between supportive counseling skills (empathy, open questions, and reflections) and treatment outcomes. We hypothesized that higher empathy and higher use of open questions and reflections would be associated with greater symptom reduction. Method We used a dataset with 2974 sessions, 610 clients, and 48 therapists collected from a university counseling center, which included 845,953 rated therapist statements. Client outcome was routinely monitored by the Counseling Center Assessment of Psychological Symptoms Instruments. Therapists’ skills were measured via computer by a bidirectional-long-short-term-memory-based system that rated use of supportive counseling skills. We used multilevel modeling to separate the betweentherapist and the within-therapist associations of the skills and outcome. Results Use of open questions and reflections was associated with client symptom reduction between therapists but not within therapists. We did not find significant associations between therapist empathy and client symptom reduction, but found that empathy was negatively associated with clients’ baseline symptom level within therapists. Conclusions Therapist exploration of clients’ experience and expression of understanding may be important skills that are associated with clients’ better outcomes. This study highlights the importance of support counseling skills, as well as the potential of machine-learning-based measures in psychotherapy research. We discuss the limitations of the study, including the limitations related to …
Objective

Method

Results

Conclusions

Date

February 1, 2025

Authors

Xinyao Zhang, Simon B Goldberg, Scott A Baldwin, Michael J Tanana, Lauren M Weitzman, Shrikanth S Narayanan, David C Atkins, Zac E Imel

Journal

Journal of Consulting and Clinical Psychology

Volume

93

Issue

2