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Part 1: What Makes a Therapist Effective?

For many years, researchers looked at kinds of counseling or therapy, what are called schools of therapy, to see which approaches worked better or worse than others. Would it be cognitive-behavioral therapy, narrative therapy, emotion-focused therapy, psychodynamic therapy, or some other therapy? What research found, repeatedly, was that therapies all tended to be equally effective overall. (Research then turned to exploring if some types of therapy worked better or worse with particular issues, an approach which has found differences and led to recommended types of therapies for different issues). But if kinds of therapies are equally effective overall (as opposed to looking at specific issues), then is there anything which can explain why some therapists consistently get better results than others?

As it turns out, research has found that effective therapists tend to be characterized by particular qualities and actions. I will share an overview of these with you to help you as you search for the right therapist to help you. To read in greater detail, see this paper here.

Research finds that effective therapists have the ability to focus on the you, the client, in a warm and accepting manner and show empathy and understanding. While you may still feel awkward or uncomfortable at your first or second visit (after all, it’s hard to be relaxed when you know you are going to share personal information with a stranger, however nice that stranger is), unless the therapist comes across to you as uncaring or disinterested, give that person a few sessions. This study found that the client’s perception at the 3rd visit was the strongest predictor of the effectiveness of therapy. If by the end of the third session you are not feeling understood or cared for, it could be time to try a different therapist to see if you have a more comfortable feeling with that one. These qualities are vital to the success of your therapy; don’t try to force a fit that isn’t there. Just how vital? The quality of the relationship you have with your therapist, accounts for about 25% of your outcome, according to research. The better the quality of the relationship with your therapist, the more you boost the odds of getting the progress you want from therapy.

Research also shows that an important characteristic of effective therapists is the ability to form a collaborative relationship with you. That is, it’s not a one-way street running from the therapist to you. Instead, you and the therapist make decisions on how to proceed together. This goes back to the issue of you feeling heard and understood, as well.

Does the therapist explain to you how a particular theory views your issue? Does the therapist’s explanation make sense to you? If so, does the proposed treatment plan appear to be in line with the theory? And, finally, is this explanation compatible with your own beliefs? Effective therapists can tell you how their theoretical approach explains your issue and what it also believes is the best way to approach resolving it. For example, as a therapist who practices TEAM CBT (cognitive-behavioral therapy), I believe that our thoughts are keys to many of our issues. If we can identify the thoughts which lead to the painful emotions or problem behaviors, we can change them, leading to more positive feelings and behaviors. So when I sit down to talk with you about your issue, I am likely to explain how I believe your thoughts are playing a role in your issue and what we can do to make a difference. If this doesn’t ring “true” to you, then I need to be able to offer you another perspective. For example, I could switch to a theory which holds emotions as the key and discuss with you how this theory would explain things or perhaps talk about a theory which believes hurts and unfinished business in our childhoods continues to affect us as adults. (It is important to note that therapists may favor one particular theory but have training to work with multiple theories effectively. What is most important in this situation is that the therapist believes in the theory being used. This has been found to be another key component in your outcome).

In addition to making sense with your beliefs, the explanation must make sense with your own cultural worldview. One big area of potential incompatibility comes from the difference between cultures which prize individual freedoms and those which value families and groups above all else. If you come from a background in which the family is the central consideration, it would not be helpful to you to have a therapist who is treating your concerns as arising from a need to put yourself first. In fact, that’s going to be incredibly stressful and unhelpful for you. If you perceive a misalignment in world views, you may need to emphasize to the counselor that your view is important to you. If the therapist cannot work with that viewpoint, then you would want to look for a therapist who can. If you continued to work with the first therapist in this example, you would be sacrificing your values to fit the therapist’s values and that is not a recipe for good therapy. Therapy should always be based on your values.

In Part Two, I will address four other characteristics of effective therapists. Looking for these characteristics as you begin working with a therapist can help you to maximize the likelihood of a successful result from your therapy.

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