This blog post is dedicated to letting you know what research says is most helpful in psychotherapy. I hope that after reading this you feel more informed about what characteristics to look for as you try to find a therapist.
More than sixty years of research has determined that therapy works. People who undergo some form of psychotherapy are better off than about 80% than those who go untreated. So, it’s not just that time heals all wounds, but that psychotherapy offers a significant and incremental benefit to clients.
Psychotherapy researchers have doggedly set out to figure out why it works.
What happens in sessions that helps clients make lasting improvements in their lives?
The answers to this question are robust and pass the common-sense test:
- Experiencing your therapist as trustworthy, empathic, and competent is the best predictor of improvement
- It doesn’t matter too much what kind of therapy you receive
- Some therapists are good at creating therapeutic alliances and others are not
- What matters most is how you perceive the thereapeutic relationship…not how your therapist perceives it.
Feeling comfortable talking to your therapist means psychotherapy is more likely to work
This is another case of science backing up common sense. How many times have you or a friend gone to see a therapist only to leave saying something like:
“He/she didn’t really get me…”, or
“I didn’t feel like I could trust him/her…”, or
“I ended up feeling judged…”
These gut reactions to avoid situations where you don’t feel “gotten” is a good one! Research shows that clients’ ratings of how comfortable they feel with their therapist after a few sessions predicts their outcomes at the end of therapy. Clients who rate the relationship negatively suffered worse outcomes (e.g. more depression/anxiety) than those who felt comfortable, safe and understood. In fact, the quality of the relationship with the therapist mattered 7x’s more than what type of therapy the client received! So, it is in your best interest to feel like there’s a fit between you and your therapist.
Therapists differ in their ability to create good relationships with their clients
OK, so this may be another common-sense finding but it has important implications. Studies show that clients who improve the most also rate their relationship with their therapist positively. Certain therapists’ received generally positive ratings while other therapists’ were generally rated as average or below-average. This was true even when controlling for how anxious or depressed the clients felt at the start of treatment. This means that some therapists who are good at creating effective therapeutic relationships and others are not. As a potential client, if you don’t feel the fit with one therapist, this research would encourage you to keep looking until you do find a therapist with whom you can create an effective helping relationship.
All therapies are created equal
It’s very intuitive to think that different kinds of therapy are better than others. It stands to reason that randomly assigning people to either cbt or psychodynamic therapy – for example – should prove that one is better than the other. Study after study has pitted cbt against psychodynamic approaches and the typical result is that both work but neither is superior. There are more than 250 identified forms of therapy yet none have “won” to date.
What’s more important are the factors that are common to all therapies: a trusting relationship, the expectation of improvement, and therapeutic competence.
Trust your perspective on your therapist – that’s what predicts improvement!
Ratings of the therapeutic relationship can come from the client or therapist. No source of the relationship ratings predict improvement as effectively as the client’s. Further evidence that trusting your experience with your therapist is so important. Your expectations to feel understood, validated, and helped by your therapist should generally be met. A good relationship with your therapist is necessary achieve the kind of improvement in your quality of life that you are seeking.
Jay Reid is a Licensed Professional Clinical Counselor (LPCC). My focus in therapy is to build a strong relationship with my clients where they feel safe, understood, and empowered. Research suggests that this approach to therapy is especially effective. If you are considering psychotherapy, feel free to contact me for a free 15-minute phone consultation to see if we might be a good fit.