What Works in Therapy  |  Douglas Behan, DSW, LCSW

Therapist Factors

Good Therapists Make a Bigger Difference Than Good Models

“In fact, it appears to be at least, or  more, important who clients see rather than what specific therapy is offered”

 

Barkham, Lutz, Lambert, & Saxon, 2017, p. 26

What the Research Says...

Some therapists consistently have outcomes superior to their peers. Evidence shows it is how they conduct therapy and not because of superior expertise in a model (Wampold, Baldwin, Holtforth, & Imel, 2017). 

The person of the therapist and the qualities they bring to the treatment encounter have received relatively little attention in psychotherapy research compared to the study of specific treatment models. However, there is strong evidence that certain therapist qualities are correlated with better outcomes:

Flexibility in Approach

Therapists who are willing and able to shift their treatment approach and techniques to match the client’s characteristics and problems have better outcomes (Norcross & Wampold, 2018; Owen & Hilsenroth, 2014; Stiles, 2009). Evidence suggest that adherence to a single treatment approach does not improve outcomes (Lambert, 2013). In short, "start where the client is."

Facilitative Interpersonal Skills Count

The degree to which a therapist can understand, relate to, and persuade clients has been correlated with effectiveness. Facilitative Interpersonal Skills include:

  • The ability to perceive, understand, and send a wide range of interpersonal messages.

  • The ability to persuade others who have personal problems to apply proposed solutions and abandon maladaptive patterns.

Certain Therapist Behaviors Help  - a Lot

Research says these behaviors improve outcomes: Projecting warmth, instilling trust and hope, conveying empathy, staying present and focused on the client, being genuine, conveying competence, and using the therapist’s own inner experience  (Ackerman& Hilsenroth, 2003; Hill & Castonguay, 2017; Wampold, Baldwin, Holtforth, & Imel, 2017).

Ability to Connect with a Wide Range of Clients

The most effective therapists are capable of forming a treatment alliance with a broad range of clients presenting with varied clinical, cultural, and personal characteristics (Wampold, Baldwin, Holtforth, & Imel, 2017).

What Therapist Factors Don’t  Impact Outcomes?

Research has repeatedly shown that age, gender, ethnicity/culture, profession/training, theoretical orientation, and experience are not related to therapist effectiveness (Beutler et al, 2004; Wampold & Brown, 2005).

What Therapist Behaviors Hurt Outcomes?

Research has shown that certain therapist behaviors are ineffective and hurt outcomes, including:

  • Confrontation

  • Criticizing the client

  • Causing the client to feel attacked

  • Blaming the client

  • Projecting  cultural arrogance & insensitivity

  • Acting on negative emotions (e.g. anger, frustration)

  • Assuming client perceptions vs. inquiring about them

  • Rigidity

  • Creating a poor therapeutic alliance

  • Privileging the therapist’s perspective over the client’s

(Norcross & Lambert, 2018; Norcross & Wampold, 2011)

What it Means for Therapists

The person of the therapist is a significant curative factor in psychotherapy. Therapists should intentionally focus on the personal qualities they bring to therapy and how well they are building therapeutic relationships with clients.

 

These elements should be considered a major part of the treatment and not simply a precursor to treatment. Therapists should also vary the use of evidence supported treatment approaches to match the unique needs of each client vs. sticking rigidly to a single treatment approach.