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The Good Therapist

November 7, 2014

How effective are therapists?

The average therapist is twice as effective as antidepressants in the treatment of depression and is successful in about 70% of all cases no matter what the diagnosis. This is roughly equivalent to the success rate of most common medical treatments. Some therapists are better than average. In one large scale study, clients of better therapists had twice the improvement rate and half the deterioration rate compared to clients of less effective therapists. (Yes, unfortunately some clients, about 5%, leave therapists worse off than when they came.) Even the best therapists aren’t at their best with all clients. Their worst cases fare about as well as the best cases among the worst therapists. The point is therapists are not all alike and there is wide variability among the outcomes of all therapists.

What makes some therapists better than others?

Therapist empathy is one of the strongest and most reliable predictors of therapeutic outcome. Research indicates that therapist empathy (not sympathy) influences client improvement in a variety of ways. Empathy fosters client self-acceptance and helps client’s develop more effective self-regulation of their emotions. Being understood helps clients’ understand themselves. Empathy also helps the therapist detect and correct misunderstandings in the client-therapist relationship. Additionally, therapist empathy involves attunement to factors that influence client improvement: religion and spirituality, cultural beliefs and values, expectations about therapy, and readiness or motivation to change.

Good therapists have other qualities that contribute to their effectiveness. They are warm, genuine, “real” individuals who can engage clients in the collaborative tasks of therapy. Therapists do not become better by learning new techniques. Some researchers have advanced the idea that some techniques, types of treatment or schools of therapy are more effective than others. The best available research indicates that this is a myth that is largely the product of researcher bias.

How do therapists become more effective?

All therapists have issues that sometimes interfere with their being at their best with clients. They can have emotional reactions that cause them to be rigid, distant or critical. But, the best therapists are aware of these issues and do their own personal and professional work to turn their emotional vulnerabilities into sensitivities that can be of service to therapeutic work. However the average therapist has some biases that can interfere with this sort of ongoing professional development. Ninety percent of therapists rate themselves as better than average. They can’t all be right. Surprisingly, therapists generally do not improve with experience. While more experienced therapists are not more effective, they are more confident in their professional ability. This unfounded confidence can interfere with therapist’s motivation to participate in ongoing professional development. The best therapists are humble about their ability, seek feedback from clients and colleagues about their effectiveness and view professional development as a lifelong process.

This blog post is a brief summary of conclusions drawn from the author’s chapter entitled: “The Good Therapist: Evidence for the Essential Qualities of the Effective Therapist” in the new edition of Humanistic Psychotherapies: Handbook of Research and Practice by D. Cain, K. Keenan, and S. Rubin, soon to be published by the American Psychological Association.

Kevin Keenan, PhD - psychology associates

By Dr. Kevin Keenan, PhD, Core Faculty
Dr. Keenan has special interests in recovery, ethics, spirituality, lifespan development, counseling and psychotherapy, psychological testing, and in mixed models of qualitative and quantitative research. Currently he teaches course in statistics, psychometrics, quantitative research, supervision and a dissertation preparation course that leads students through the process of conducting a pilot study.