What Are the Essential Qualities of Effective Therapists?
Intriguing findings can ease the search for a skilled helper.
Posted Mar 05, 2017
What makes someone a helpful listener? Do professionally psychological helpers have special training that makes them more helpful than people who are just "good listeners"? If you're looking for a psychotherapist, a fascinating set of research findings can demystify the process.
One of the first choices you’ll face is what sort of theoretical orientation you’re interested in. Popular approaches include psychoanalytic, cognitive behavioral (CBT), client-centered, and mindfulness-based (e.g., Acceptance and Commitment Therapy or ACT), but there are dozens of others in an ever-expanding list of therapies. Each model has its own assumptions about why people become distressed, and what techniques are likely to be helpful. It can be overwhelming for anyone unfamiliar with the various approaches to know how to proceed.
As it turns out, however, it may not matter all that much which orientation a therapist adheres to. One of the more interesting findings from the world of psychotherapy research is the so-called Dodo Bird Verdict. The term comes from Alice in Wonderland, when the Dodo, judging a footrace around a lake, declares that “Everybody has won and all must have prizes.” Applied to psychotherapy, the Dodo Bird Verdict refers to the finding that all major forms of psychotherapy are about equally effective in reducing distress and improving mental health. Despite the importance placed by therapists (and graduate schools) on specific models of therapy, it seems that good therapists are helpful regardless of their theoretical approach.
There are some clear exceptions to the Dodo Bird Verdict: Phobias, for example, are best treated with cognitive behavioral interventions that combine relaxation with graduated exposure to the feared object or situation. And there's good evidence that trauma or PTSD can be effectively treated by helping people learn to tolerate rather than avoid trauma-related memories and feelings (there is also a growing body evidence for somatic approaches to healing trauma). For most common mental health problems, however, dozens of studies (including several meta-analyses) have come to the same conclusion: Therapy can be effective regardless of the model that guides it, and no one model seems to be consistently more effective than any other. Although CBT often shows superiority to other approaches in comparative studies, that difference tends to disappear when the theoretical orientation of the researcher is accounted for (i.e., researchers who favor CBT tend to find that CBT is superior). How this bias slips into the studies is an intriguing question.
One clue to the understanding Dodo Bird Verdict lies in a fascinating body of research on something known as “common factors." Common factors are variables that are common among effective helpers and that are consistently related to good therapy outcomes. Therapists (and other helpers) who are high in empathy, low in defensiveness, and are able to tolerate strong emotions in their clients and encourage the development of new coping skills, are generally more effective than their peers who are lacking in these qualities. Other common factors include the ability to maintain healthy interpersonal boundaries and the capacity to gently confront clients with problematic or contradictory behaviors and attitudes. It turns out that common factors such as these are much better at predicting success in therapy than the particular concepts and techniques associated with specific therapy models (e.g., interpretations in psychoanalysis, challenging irrational thoughts in CBT). The latter are not unimportant; they are simply less powerful predictors of therapeutic change.
Common factors are variables that are common among effective helpers and that are consistently related to good outcomes.
Understanding the Dodo Bird Verdict and the research on common factors should be comforting to anyone looking for a psychotherapist. Rather than getting lost in the vast array of theoretical models currently available, a helpful strategy is to focus on those therapist qualities—common factors—that are most strongly related to therapeutic success. You’ll likely fare well if you find someone who is empathic, attentive, non-defensive, comfortable with strong emotions, able to help you develop new coping skills, and can gently confront you with problematic behavior when it seems helpful to do so. Of course, that may mean giving someone a couple of sessions to see how they work, and what it feels like to sit with them.
Now comes the next conundrum: how to choose among the myriad academic credentials a professional helper may have? Should you choose a social worker (MSW, LCSW), a counselor (MA), a Marriage and Family Therapist (MFT), a psychologist (Ph.D., Psy.D.), or a psychiatrist (MD)? Once again, the research suggests that it may not matter all that much. In fact, just as with theoretical orientation, the particular degree a therapist possesses appears to have little relationship to his or her competence. This might seem counterintuitive. Shouldn’t more years of education equate to better training? The answer, quite simply, is no. Or to be more precise, the data don’t support this intuitively sound supposition.
To understand why not, we need to consider a finding that is just as robust as the Dodo Bird Verdict, but far more puzzling. In dozens of studies comparing the effectiveness of (1) professional psychotherapists, (2) graduate students in a mental health field, and (3) non-professional “good listeners”, all three groups have consistently been found to be equally effective. Stringent meta-analyses, in which the findings of many studies are aggregated to yield greater statistical power, have all come to the same rather startling conclusion: graduate training in mental health does not appear to make people more effective as psychological helpers.
Graduate training does not appear to make people more effective as psychological helpers.
Good therapists, like all helpful listeners, seem to possess a particular set of attributes, the same set of common factors that explain why most forms of therapy are about equally effective. It’s simply not clear whether graduate schools, which focus so heavily on specific theoretical models and their related techniques, are actually training students in the qualities that seem most critical to effective therapy. And that raises an even more fundamental question: Can these common factors actually be taught? To what extent are they personality attributes rather than teachable skills? Can graduate school really make students more empathic, enhance their interpersonal skills, or increase their tolerance for intense emotions? Are good therapists already effective helpers before they get to graduate school?
Good therapists, like all helpful listeners, seem to possess a common set of attributes.
In any case, if you’re looking for a therapist, the good news is that therapy is effective for most people and that a clear set of attributes seems to characterize effective therapists. Shop around, interview a few prospective candidates, and see who feels like a good fit. If they seem to be high on the common factors, you’re probably in good hands, regardless of the particular orientation they espouse or the letters that follow their name. And if it’s disheartening that graduate training doesn’t seem to predict greater helpfulness, it’s also true that good therapists offer something that informal helpers generally do not: a private space in which you are the sole focus of supportive and helpful attention, every time, with no expectation of reciprocity. Perhaps that’s the unique gift of therapy: a skilled listener whose sole aim is to help you find an easier and more satisfying life.
* If you're wondering why a post on the characteristics of effective helpers is appearing in a blog called "The Refugee Experience," in a forthcoming post I'll be writing about the tremendous impact that research in this area has had on delivering mental health services to refugees and other war-affected communities in areas where mental health professionals are extremely scarce. It involves something called "task-shifting," which means training non-professionals to deliver psychological interventions. The good news? It works! More on task-shifting soon...
Ken Miller, PhD, is a psychologist and writer currently based in Amsterdam. He is the author of War Torn: Stories of Courage, Love, and Resilience, from Larson Publications.
Christensen, A., & Jacobson, N. (1994). Who (or what) can do psychotherapy? The status and challenge of nonprofessional therapies. Psychological Science, 5, 8-14.
Duncan, B., Miller, S., Wampold, B., & Hubble, M. (2009).The heart and soul of changeL Delivering what works in therapy (2nd ed.). Washington, DC: American Psychological Association.