What do therapists with prior experience treating trichotillomania do differently?

Greater therapist experience is not necessarily associated with superior treatment outcomes, but some data suggest that experience with a specific disorder or treatment protocol is helpful. This study conducted a secondary analysis of one such finding, in which therapists with previous experience treating trichotillomania (TTM) achieved better outcomes than did TTM-novice therapists in a randomized controlled trial of the Comprehensive Behavioral (ComB) model. Sixty session recordings from this trial were randomly selected for coding on rationally-selected dimensions of therapist competence, of which seven proved sufficiently reliable for between-groups analysis. Sessions conducted by experienced therapists were superior in management of session time and most indicators tapping complex ComB-specific skills, whereas they were inferior to novice therapists on addressing patient nonadherence. Discussion focused on possible explanations for these results and proposed testing a sequence in which TTM therapists could begin with less complex interventions and implement ComB only after developing improved expertise.