The effect of counseling center characteristics and policies on psychotherapy outcomes

Restricted (Penn State Only)
Carney, Dever Marie
Graduate Program:
Master of Science
Document Type:
Master Thesis
Date of Defense:
November 29, 2017
Committee Members:
  • Louis G. Castonguay, Thesis Advisor
  • Michael Hallquist, Committee Member
  • Jeffrey A. Hayes, Committee Member
  • multilevel modeling
  • center effects
  • psychotherapy outcomes
  • college counseling
  • Center for Collegiate Mental Health
Researchers agree that psychotherapy works, but not for everyone. Above and beyond contributions from the client, therapist, and therapy process, contextual factors may have a unique impact on the outcomes a person achieves in psychotherapy. At a contextual level, college counseling centers often make key administrative decisions that have the potential to systematically affect their clients’ outcomes in psychotherapy. The current project used data collected through the Center for Collegiate Mental Health, a practice-research network with over 500 participating college and university counseling centers. Clients’ symptoms were measured on the Counseling Center Assessment of Psychological Symptoms (CCAPS), a multidimensional instrument designed for repeated assessment in collegiate mental health settings. The final sample contained 105 centers, 1,601 therapists, and 29,028 clients, and outcome was operationalized as the latent difference score between CCAPS subscale scores at the beginning and end of treatment. Multilevel modeling was used to estimate the percent of the variance in outcome accounted for by the specific counseling center, and further sought to explain that “center effect” by examining the role of a number of specific administrative policies and characteristics like specific services, session limits, student to staff ratios, etc. (after controlling for key client variables). Results found a relatively small center effect, ranging from 1.50% (social anxiety subscale) to 3.32% (hostility subscale). Significant predictors of these center effects were treatment length, initial symptom severity, and the average initial symptom severity at a center, while the majority of other center variables examined were non-significant. This has potentially wide-ranging implications for counseling center policies and resource allocation.