A-B therapist variable and psychotherapeutic outcome

What is referred to as the “A-B” therapist variable has been extensively studied as a possible predictor of therapist effectiveness in psychotherapy. We reviewed the clinical studies of Whitehorn and Betz and other authors and found several factors which cast doubt on the validity of the hypothesis that type A therapists are more effective with schizophrenic patients. Methodological weaknesses, such as the use of many different noncongruent scales for categorization of therapists and impressionistic global ratings as measures of outcome, accounted for some of the confusion in data inter-pretation. Several studies not only did not confirm the hypothesis but also yielded contradictory results. There seemed to be a tendency of some investigators to interpret their findings so as to amend, rather than refute, the A-B hypothesis. We studied three measures of the A-B variable for a group of psychiatric residents and psychology interns who treated psychiatric in patients with psychotherapy. These and several other therapist variables were correlated with independent measures of improvement scored on four-factor, analytically based summary symptom scales. For all the items studied, there were no more statistically significant correlations than would have been expected by chance alone. There were no significant correlations between the three A-B measures of improvement either for the schizophrenic patients only or for the total group of patients. Only two A-B variables had correlations of any magnitude with improvement measures and both were in the opposite direction from the expected. This study adds weight to the other evidence presented that the A-B scale is not useful in attempting to account for therapists’ effectiveness in the treatment of schizophrenic patients.