Signs of a Good Therapist: Research on the Effectiveness of Psychotherapy

There is a lot of complex and often contradictory information out there on what makes a great therapist and how to choose a counselor or a therapist. Often such advice is based on the writer’s personal opinion or anecdotal evidence, which is far from being reliable information. In this article I make a short review of the current research regarding therapist characteristics that predict (and don’t predict) good outcomes for their clients — some of the information here may surprise you! Please note that most of the studies I cite below are meta-analyses, which means that they use results of not just one particular study, but of hundreds and hundreds of studies — this means that the conclusions, if not set in stone at this point, are extremely well-established. Use this information when you find yourself wondering, “What kind of therapist do I need?”
 
What not to Worry About
Perhaps somewhat surprisingly, research on the effectiveness of psychotherapy suggests that none of the following factors are correlated with the effectiveness of a therapist:

  • Age (1)
  • Gender (1)
  • Degree level (master’s versus doctorate) (1)
  • Years of experience: even doctorate-level therapists with decades of experience overall tend to perform similarly to graduate students just starting their training (1)
  • Theoretical orientation: despite the academic hype about “empirically supported treatments,” numerous meta-analyses have failed to find significant differences in effectiveness between different theories of psychotherapy (e.g., 2, 3). The therapist’s preferred theory contributes a mere 1% towards the outcome of the therapy (2).
  • How well the therapist adheres to the protocol or treatment plan of a particular therapy modality (10).

Signs of a Good Therapist
A lot of the characteristics of an effective counselor have to do with the so called “common factors” of psychotherapy, which include:

  • The therapist’s ability to build “therapeutic alliance” with the client, which is the degree to which the client and therapist feel a bond between themselves and agree on goals and tasks of therapy. The therapeutic alliance contributes to about 7.5% (4) of the outcome of therapy. It is important to note, too, that it is the therapist’s relational influence on the alliance that predicts therapy outcome, rather than the client’s influence on the alliance (5).
  • The therapist’s empathy, i.e., her ability to put herself into the client’s shoes and not be overwhelmed by the experience. The therapist’s empathic ability contributes to about 9% of the outcome.
  • Goal consensus between the therapist and the client, which is their agreement regarding what they are trying to achieve in therapy. This factor contributes to about 11.5% of the outcome (7).
  • Therapist-client collaboration, i.e., the degree to which they are able to work as a team to achieve common goals. Collaboration is responsible for about 10.8% of the outcome (7).
  • Positive regard — the therapist’s warm acceptance of all parts of the client’s experience. This factor contributes to about 7.3% of the therapy results (8).
  • The therapist’s congruence/genuineness, which is his ability and willingness to “be real,” without hiding behind the professional, clinical facade. Congruence is responsible for about 5.7% of the outcome (9).

In Conclusion
Research on the effectiveness of psychotherapy strongly suggests that it is therapists’ personal characteristics that are the actual signs of a good therapist — as opposed to the formal, superficial facts, which are unfortunately often presented as characteristics of an effective counselor.

References

  1. Chow, D. (2014). The Study of Supershrinks: Development and Deliberate Practices of Highly Effective Psychotherapists (Unpublished doctoral dissertation). Curtin University.
  2. Wampold, B. E., Mondin, G. W., Moody, M., Stich, F., Benson, K., & Ahn, H. (1997). A meta-analysis of outcome studies comparing bona fide psychotherapies: Empirically, “All must have prizes”. Psychological Bulletin, 122, 203–215.
  3. Baardseth, T., Goldberg, S., Pace, B., Wislocki, A. P., Frost, N. D., Siddiqui, J. R., . . . Wampold, B. W. (2013). Cognitive-behavioral therapy versus other therapies: Redux. Clinical Psychology Review, 33, 395–405.
  4. Horvath, A. O., Re, A. D., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. In J. C. Norcross, J. C. Norcross (Eds.) , Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.) (pp. 25–69). New York, NY, US: Oxford University Press.
  5. Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75, 842–852.
  6. Elliott, Robert; Bohart, Arthur C.; Watson, Jeanne C.; Greenberg, Leslie S.; In: Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.) (pp. 132–152). Norcross, John C. (Ed); Publisher: Oxford University Press; 2011.
  7. Tryon, G. S., & Winograd, G. (2011). Goal consensus and collaboration. In J. C. Norcross, J. C. Norcross (Eds.). Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.) (pp. 153–167). New York, NY, US: Oxford University Press.
  8. Farber, B. A., & Doolin, E. M. (2011). Positive regard and affirmation. In J. C. Norcross, J. C. Norcross (Eds.), Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.) (pp. 168–186). New York, NY, US: Oxford University Press.
  9. Kolden, G. G., Klein, M. H., Wang, C., & Austin, S. B. (2011). Congruence/genuineness. In J. C. Norcross, J. C. Norcross (Eds.), Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.) (pp. 187–202). New York, NY, US: Oxford University Press.
  10. Webb, C. A., DeRubeis, R. J., & Barber, J. P. (2010). Therapist adherence/competence and treatment outcome: A meta-analytic review. Journal Of Consulting And Clinical Psychology, 78(2), 200–211.