The Surprising Reason Some Therapists Get Better Results 

Why is it so difficult to find a therapist? It is true that therapists are in demand. But the bigger challenge is how to find the right match. 

Approximately 20% of patients drop out of therapy (Leichsenring et al., 2019). Some people stay and realize later that another therapist would have been a better choice. Common complaints include therapists being” just okay,” distant or passive, and not giving enough feedback, leading to a lack of progress. 

How would the average person know what to look for and what really matters when choosing a therapist? Is it where they did their training, their experience treating a particular issue or diagnosis, or is it the type of therapy they practice, referred to as orientation or modality? What about the therapist’s personal qualities and “chemistry”? 

Sorting through the maze of therapists and therapies is complicated by the number of therapy approaches, the ambiguity in how therapists apply them, and the personal qualities of the therapist that are all part of the picture. 

Many people choose a therapist randomly, based on practical considerations, or look for a type of therapy that they heard was effective. For instance, cognitive behavioral therapy, referred to as CBT, is a popular treatment promoted by insurance companies, marketed as “evidence-based,” though there is no evidence that one therapy type is superior to another (Wampold & Imel, 2017). 

How is it possible to make an informed and wise decision when choosing a therapist based on their orientation anyway when, without an excerpt or direct experience with them, no one knows how a therapist comes across in sessions, let alone whether the labels they use to describe their orientation have a shared meaning and practical translation. Consistently, there is a lack of consensus between the approaches therapists say they are using and how trained observers classify them (Hill & Knox, 2019).

Part of the confusion is that, in practice, different orientations overlap. More importantly, therapy unfolds within the landscape of an interpersonal relationship. Although two therapists may use the same modality, the way they apply it, and approach therapy is filtered through the lens, personality, and voice of the therapist. 

Co-Mingling of Orientation With a Therapist’s Personal Attributes

Since a therapist’s personality, mind, and psychology are all interwoven with their ”approach,” it is no surprise that these factors, rather than the therapy modality or credentials, alone, explain why some therapists get better results.

Nevertheless, type of therapy matters in that a therapist’s orientation should be a good fit for the patient’s personality, and work for their specific problem. 

Effective therapists are experienced in a variety of approaches and flexible in how they operate. Their knowledge and expertise inform their perspective but does not override their ability to be uniquely responsive to the person in front of them. They are able to be present in the here and now, adapting their approach to best address a patients’ needs, preferences, symptoms, and personality – as well as the climate of a particular interaction (Castonguay & Hill, 2017). 

Still, some therapists stick to just one approach. However, rote application of any protocol or framework can be a problem because it limits what therapists notice and leads to interventions that patients may experience as artificial, forced, or not relatable. Further, an approach that works with one patient or at a particular point in time may not be suited to another. 

Interestingly, a therapist’s training, intellect, cognitive style, defenses, and personality not only play a role in how they conduct therapy generally but may also influence the modality they are drawn to and find personally compatible, particularly if they adhere to one approach (Ogunfowora et al., 2008; Topolinski et al., 2007). 

For example, certain orientations lend themselves to a more formulaic, structured, and less interpersonally dynamic climate, potentially attracting therapists who are more standardized or linear, rather than creative thinkers. Other orientations may be conducive to a passive style, potentially attracting therapists inclined to sit back and stay more distant interpersonally. 

Passive or Distant Therapists 

Staying emotionally distant in interactions with patients, may not be an issue when it comes to certain more one-dimensional, circumscribed problems (for example, some phobias), or for certain types of patients. But even then, it’s hard to inspire from an aloof position. 

Further, people generally find emotionally distant therapists, passive therapists, or those using manualized approaches to be unhelpful or off-putting (Delboy & Michaels, 2021). No one wants to feel like they are being treated as a generic “patient,” specimen, or diagnosis, rather than cared about as a person in their full humanity. 

It is reasonable to expect active participation, warmth and help from your therapist. Therapy is not just talking about your problems. Most people prefer an engaged and responsive therapist who provides feedback (Delboy & Michaels, 2021). Effective therapists use a multidimensional approach in which the therapeutic relationship itself is healing, but also functions as a secure base for learning and moving forward in their lives. Helpful therapists genuinely connect with, get involved, and believe in their patients. They roll up their sleeves to be fully with each person and co-create positive solutions.

Why Do a Therapists’ Personal Qualities Matter? 

A therapist’s character, capacities, and style directly and indirectly affect the quality of the therapy relationship, which is the foundation of treatment, the medium through which the therapy is delivered, and a direct agent of change. Further, the interpersonal dynamics that develop and how they are managed shape the therapeutic relationship, and either facilitate, disrupt, or impede the therapeutic process. 

Qualities of Effective Therapists 

Therapists who are warm, attuned, self-aware, able to manage their own feelings, emotionally intelligent, and have good interpersonal skills get better results (Castonguay & Hill, 2017; Norcross et al., 2019; Nyklíček et al., 2015; Schottke et al., 2017). Since therapy is about healing the heart and mind, it makes sense that therapists be skilled at tuning into their patient’s inner and interpersonal world, as well as their own. A therapist’s capacity to notice and interpret their own and others’ internal experiences, referred to as “mentalizing” or reflection, is associated with successful therapy outcomes. (Abargil & Tishby, 2021; Allen et al., 2008). 

Mentalizing involves knowing how to interpret both heart and mind – understanding the complex interplay of thoughts, feelings, intention, and behavior (Allen et. al., 2008). This capacity facilitates a deeper empathic connection, better grasp of the underlying issues contributing to the patient’s problem, and a stronger therapeutic alliance. Also, therapists who can mentalize are more likely to have other qualities associated with successful outcomes such as being able regulate their own emotions, accurately perceive, interpret, and adapt to cues from the patient, as well hold the patient’s perspective in mind alongside their own (Cologon et al., 2017; Schweitzer et al., 2017). 

Further, when therapists have this ability, their patients are more likely to develop it and heal problematic attachment styles. This is an important advantage since mentalizing is not only associated with developing healthier attachment styles but when parents have this skill, their children are buffered from the negative effects of their own problematic attachment styles (Cologon et al., 2017; Allen et al., 2008). In general, being able to interpret oneself and other people accurately helps people in life because they get along better in relationships, and are better able to manage conflict, have perspective, and solve problems. 

How to Tell Whether a Therapist is a Good Match for You

Since it takes two to make a relationship, the match between therapist and patient matters. First, has the therapist had training, experience, and positive results treating your type of issues? After that, a good match involves “chemistry.” Chemistry refers to subtleties such as intuitive “feel” and gut impression. Does this person strike you as someone you like? Would you want to talk to and confide in them?

Listening to a therapist’s outgoing message – the melody of their voice, tone, and use of language – can provide a quick initial sense of whether they seem warm and relatable to you. This can be an efficient way to screen out therapists who are clearly not the right fit. 

The bottom line is that patients have significantly different experiences and outcomes with different therapists. Therefore, if you are new to therapy, or have not had a productive experience, consult with more than one therapist and have a conversation. 

Abargil, M., & Tishby, O. (2021). How therapists’ emotion recognition relates to therapy process and outcome. Clinical Psychology & Psychotherapy, 29(3), 1001-1019. https://doi.org/10.1002/cpp.2680 

Allen, J. G., Fonagy, P., & Bateman, A. W. (2008). Mentalizing in clinical practice. American Psychiatric Publishing, Inc. 

Castonguay, L. G., & Hill, C. E. (Eds.). (2017). How and why are some therapists better than others?: Understanding therapist effects. American Psychological Association. https://doi.org/10.1037/0000034-000 

Cologon, J., Schweitzer, R. D., King, R., & Nolte, T. (2017). Therapist reflective functioning, therapist attachment style, and therapist effectiveness. Administration and Policy in Mental Health and Mental Health Services Research, 44(5), 614-625. https://doi.org/10.1007/s10488-017-0790-5 

Hill, C. E., & Knox, S. (2019). Therapist technique and orientation: Are they distinguishable in practice? Journal of Counseling Psychology, 66(2), 217-228. https://doi.org/10.1037/cou0000321 

Leichsenring, F., Sarrar, L., & Steinert, C. (2019). Drop-outs in psychotherapy: A change of perspective. World Psychiatry, 18(1), 32-33. https://doi.org/10.1002/wps.20588 

Norcross, J. C., & Lambert, M. J. (2019). Evidence-Based Psychotherapy Relationship: The Third Task Force. Psychotherapy Relationships That Work, 1–23. https://doi.org/10.1093/med-psych/9780190843953.003.0001

Nyklíček, I., Schalken, P., & Meertens, S. (2015). The role of emotional intelligence in symptom reduction after psychotherapy in a heterogeneous psychiatric sample. Comprehensive Psychiatry, 57, 65-72. https://doi.org/10.1016/j.comppsych.2014.11.022 

Ogunfowora, B., & Drapeau, M. (2008). A study of the relationship between personality traits and theoretical orientation preferences. Counseling and Psychotherapy Research, 8, 151-159. https://doi.org/10.1080/14733140802193218 

Topolinski, S., & Hertel, G. (2007). The role of personality in psychotherapists’ careers: Relationships between personality traits, therapeutic schools, and job satisfaction. Psychotherapy Research, 17, 365-375. https://doi.org/10.1080/10503300600830736 

Wampold, B. E., & Imel, Z. E. (2017). The efficacy of different psychotherapeutic approaches: A meta-analysis of comparative outcome studies. Clinical Psychology Review, 52, 1-11. https://doi.org/10.1016/j.cpr.2017.11.001