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Part 2: What Makes a Therapist Effective?

In Part One, I discussed the importance of what is called the therapeutic alliance. This is the quality or the relationship between you and the therapist. I also discussed the role of the theory being used in therapy. Effective therapists explain how the theory fits your issue and how it prescribes treatment. This explanation needs to make sense to you.

Once therapy is underway there’s a big component which may go overlooked: the your progress and your perception of therapy. Does your therapist regularly check in with you to ask how you feel it is going? If so, does your therapist appear genuinely interested in knowing or do you feel that it’s only a formality when they ask? Research shows effective therapists check in with clients regularly and discuss client feedback. (Note: do you feel comfortable giving honest feedback to your therapist, particularly if you want to say something that isn’t comfortable, like “I don’t feel like you really understood me”? It’s one thing if it is hard for you to feel like you might say something that hurts your therapist’s feelings but it’s a warning flag if you are hesitating because you have real reasons to think the therapist will not react well.) Most importantly, effective therapists are on alert for evidence that the client is losing ground rather than improving. As I explain on my website, this kind of measurement is foundational in my therapy.

I ask clients to measure anger, depression, anxiety and a couple other things at the beginning and end of each session. We can tell before the client leaves if what we did helped, hurt, or had no obvious effect. This allows us to double-down on the efforts which lead to improvement and to avoid wasting time on treatments that don’t seem to do much of anything. And, most importantly, it allows us to know when a particular treatment might actually do harm so it can be addressed immediately. But my measurement goes one step further: at the end of the session I ask my clients to evaluate how I did for them. Did they feel heard? What did I do well? What could I have improved upon? Remember how I mentioned in Part One that the quality of the therapist-client relationship accounts for 25% of the results? By asking the client to evaluate the session, I am making sure that I am doing all that I can to protect and enhance that relationship for the client’s benefit. In effect, I am allowing you to tell me how to be the best therapist for your needs. Research calls this “feedback informed treatment” and finds that clients have better results when it is used.

Effective therapists, the research shows, are flexible. If, for instance, after many weeks of therapy no progress is occurring, effective therapists are willing to make adjustments, try a different therapeutic approach, or even refer to another therapist or service provider (such as for medication or additional medical treatments). Your therapist may want to give an approach more time before changing treatment, but your therapist should not be wedded to only that one treatment approach overall.

Effective therapists don’t let clients avoid the tough spots, research shows. It’s completely understandable that clients want to avoid difficult topics and materials. Hurts can go so deep and it sounds sensible to let sleeping dogs lie. But therapists understand that until those hurts are dealt with, they won’t heal. Effective therapists will help clients, in a kind and supportive way, to do the work that leads to healing. This often involves raw emotion, the kind clients have told me they know aren’t polite and don’t feel they should expose me to. Anger is a potent example. And swearing. And crying. Effective therapists understand that your emotions need to be heard and addressed in a constructive way. If your therapist cannot tolerate your anger or your tears, you need to find a therapist who is capable of supporting you rather than being uncomfortable with it. I tell my clients who apologize for crying, “If you can’t cry here, where can you cry?” And I mean it. And please don’t worry about your language. I’ve heard it all before and, quite honestly, I’ve been known to use a fair amount of it in my personal life, too. It might sound odd, but your swearing, tears, or anger honors me because it shows that we have created a safe environment of trust where you can show yourself authentically without worrying that I am judging you or worrying about superficial things like politeness. It means that we’re focused on the important stuff in those moments. Whatever therapist you work with, you deserve this.

Finally, still other important characteristics of effective therapists relate to the issue of hope, particularly in keeping real hope (as opposed to some kind of groundless Polyanna-like optimism) of progress when dealing with chronic and long-term or severe issues. And along with this hope, effective therapists help the client to recognize and use his or her own resources and help the client to see that it is his or her own efforts rather than the efforts of the therapist, which lead to therapeutic progress. This is important because effective therapists want to help clients become healthy and independent people who are not dependent upon their therapists for the rest of their lives. As I see it, one of my responsibilities is to work myself out of a job, helping you reach the point where you no longer need me.

Did you notice one characteristic that wasn’t on this list? Experience! Research is not supporting the idea that more experience leads to more effective therapists. I will address this topic in detail in a future blog post.

Hopefully this will help you in your search to find a therapist who will be effective in helping you with your issues. Note your initial reactions and, as therapy proceeds, notice if your therapist checks in with you, if you feel heard, and if you feel hopeful about making progress. If progress isn’t happening, being aware of the factors such as not feeling heard or not talking about progress, can help you determine if you need to request for a referral to a different therapist. Know that your therapist should not be offended if you ask for referrals to other therapists and they should be willing to give you several names.

In short, the most effective therapist for you is likely to be one you feel comfortable with and who you believe listens to you and supports you.

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