I’ll admit, this is a pretty good time in history to be a therapist.
The profession has always been interesting and rewarding, but it was also one that was met with some discomfort when you mentioned it in social settings. You’d typically get the guy at the party leaning back with his arms outstretched in a protective stance, laughing, “Oh, no! Look out, everybody. She’s going to psychoanalyze me…”
I’d worked on perfecting my comeback over the years. Sometimes the snarky, “Don’t worry, I wouldn’t have enough time,” said with a coy smile. Sometimes the, “I’m off the clock, dude,” willing my eyes not to roll.
But recently my comebacks have gone unused, withering without practice. Recently, being a therapist is kind of… cool?
Okay, so maybe cool is a bridge too far. But we therapists seem to be in our heyday, thanks largely to the proliferation of us on social media. We’re all over your feeds, explaining why that ex isn’t actually worth your time and how to finally conquer your fear of public speaking with our six-step method.
Therapists are being treated as experts on the internet these days, which is certainly a step up from the random guy in his Idaho bedroom telling people to drink pickle juice for anxiety. But we also know that all therapists aren’t created equal.
So who do we trust?
Who will be a good therapist for us?
And what’s a good therapist anyway?
With the prevalence and severity of mental health challenges impacting us all these days, figuring out what makes therapy work is a pretty worthy endeavor. Therapy researchers have been at this for decades, trying to understand the most important factors for producing good outcomes in therapy.
You might be wondering if therapy works, as a baseline. The short answer is yes, and this has – fortunately – been well established for a while. We know that therapy works well for all kinds of mental health challenges, helps people be less impacted by their disorders, keeps people healthy, and improves relationships. What we are a lot less certain of is why.
One reason it’s hard to know why therapy is so effective is because there are so many different purposes and so many different styles of therapy. It becomes challenging to compare and to know what aspects of specific approaches actually matter.
It has become abundantly, clear, however, that a certain factor does tend to matter. It matters a lot, actually. That’s who your therapist is.
In fact, the actual style and intervention of treatment matters much less than other factors of who your therapist is. It’s a bit of a gut punch for therapists who have spent thousands of dollars and hours learning certain interventions, but it’s a vital fact –
Lots of different kinds of therapy work. What kind matters less than who is providing it.
A pretty significant meta-analysis was just published that attempted to understand more clearly what makes a highly effective therapist. It looked at almost 3,000 studies of therapist effectiveness and drilled down into the 31 most relevant to try to answer this question.
What the researchers discovered was that there were about 50 different aspects of therapists that they could examine. Some of these factors mattered a lot in what made a good therapist. Some mattered not at all.
Let’s start with what didn’t seem to matter. And you might want to take a deep breath before reading on.
Things that didn’t necessarily contribute to being a highly effective therapist:
- How many years of experience the therapist had
- The gender of therapist
- Which therapeutic model or types of interventions the therapist used
- The age of the therapist
- Their number of years of training
If you’re a therapist, especially one that has poured yourself into gaining experience, training, and specialized skills, you might be thinking… well, shit.
Interpret this cautiously though, because this isn’t saying that those things aren’t helpful in therapy and don’t benefit the outcomes. It’s simply saying that it’s not what separates effective from ineffective therapists.
Think of it this way. Just because I practice soccer for 20 years doesn’t make me a great soccer player if I don’t have the fundamental skills I need. I just have had more time to make the same mistakes over and over.
So what are those skills or factors that do matter? The researchers in this meta-analysis found that the following is what was significant:
- Therapist’s interpersonal skills and ability to form an emotional bond
- How verbally fluent the therapist is
- How well the therapist can repair ruptures that happen in therapy (e.g. apologizing, acknowledging errors)
- Empathy and resilience
- Therapist’s persuasiveness
- How committed the therapist is to their work
My own therapist often references Carl Rogers’ insistence that good therapists are born and not made. While we can’t discount the importance of training and knowledge, there seems to be truth to that assessment.
What might be more accurate to say is that good therapists are not made by their professors or fancy techniques, but rather by the work they have done to cultivate their own interpersonal and emotional skills. I might even venture to say that good therapists are made by being good people.
What this means for people looking for a good, effective therapist is that it might not be possible to base your search off of credentials or particularly modality. Sitting with your therapist and detecting whether you can feel safe, validated, understood, reflected, and guided is your best clue to know this is the right person for you.