As a clinical psychologist and educator, I am often asked to recommend a psychotherapist for people in need. These requests come with a sense of urgency to find the best possible therapist. Many people are at a loss over what to look for.

Here I offer an answer, not just to the question of what makes for a great therapist, but what else helps make therapy work. Decades of research on what improves psychotherapy outcomes yields surprising answers.

Curiously, some things that could matter a lot don’t. These include the therapist’s experience, gender, profession or graduate degree, and even the school of therapy practised. In fact, differences among therapists account for only five per cent of the variability in treatment outcomes.

Of course, five per cent is not nothing and I’ll come back to what makes up these therapist differences. However, it is clear we need to look elsewhere to discover what else makes therapy work.

Be willing to endure discomfort

First, it’s important to know that, in general, psychotherapy is highly effective. Across a wide range of psychological problems and many different types of people, therapy simply works.

For some, the benefits of therapy can be obtained in as few as seven sessions, while others need more to improve. Considering that many untreated problems last for years, or even a lifetime, psychotherapy can be life-changing.

If the particular therapist and type of therapy received are not as important as we thought, who or what does influence outcome?

To a large extent it’s the client. The quality of a patient’s participation in therapy is a key determinant of the outcome.

Understanding how clients make therapy work requires a drastic overhaul of the assumption that they passively respond to the ministrations of guru-like therapists. On the contrary, it is clients’ active participation in therapy through their involvement, learning and application of what they learn that leads to improvement.

For this to occur, it helps if clients are open to exploring their emotions and internal experiences and are willing to endure discomfort and make efforts to achieve change. This requires motivation; enhancing motivation prior to therapy improves outcomes.

Perhaps this is why clients who are in greater distress at the outset of treatment tend to show greater benefit.

Therapist as dance partner

Clients undergoing in-person therapy don’t do this work on their own but in collaboration with their therapist. The quality of this collaborative relationship is in itself an enormously important contributor to good therapy outcomes.

In a good collaboration, both therapist and client work at maintaining a positive relationship and need to continuously respond and adjust to the other, much like dance partners working in synchrony do.

As it turns out, good therapists (I said I’d come back to this) are attentive to building just such a positive alliance and repairing it as needed. They are good at being responsive to clients’ evolving needs and wishes in treatment.

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