Some psychotherapists are more effective than others – their patients achieve better outcomes. Research suggests that differences between therapists can account for between 5% and 15% of patient outcomes. These so-called therapist effects are not explained by the characteristics of patients (symptom severity, age, diagnosis), nor are they related to therapist characteristics like education, profession, therapeutic orientation, and experience level. Therapists who are effective or ineffective in treating one type of patient problem are also effective or ineffective in treating a different kind of problem. In this study, Heinone and Nissen-Lie systematically reviewed the research literature on what makes some therapists more effective. They identified 31 studies that evaluated therapist characteristics at pre-treatment and their association with patient symptom reduction at post-treatment. They found several therapist characteristics that reliably predicted patient outcomes. Therapists’ professional attitudes of valuing insight and kindness were associated with better patient outcomes, whereas psychotherapists who viewed therapy as a set of learnable skills were associated with poorer patient outcomes. Several therapists’ relational skills were also associated with better outcomes, such as empathy, the ability to develop a therapeutic alliance with various patients, and communicating concern to patients. Research on facilitative interpersonal skills suggests that therapists’ verbal fluency, responsiveness, emotional expression, warmth, positive regard, empathy, and capacity to form and repair therapeutic alliances are all related to better patient outcomes. Finally, therapists’ intrapersonal characteristics like secure attachment (as opposed to a preoccupied, dismissing, or disorganized attachment) and a more positive self-concept were related to better patient outcomes.
Research points to the importance of therapists with a warm professional attitude, intrapersonal and relational capacities for empathy, verbal and non-verbal communication skills, and the capacity to form and repair therapeutic alliances. These skills can be observed in trainees and non-therapists and may represent the “talent” clinicians bring to their professional work. Whether these characteristics can be cultivated through training remains to be seen. However, ongoing reflection and personal therapy may be necessary to develop and maintain these characteristics of effective therapists.
Heinonen, E. & Nissen-Lie, H.A. (2020) The professional and personal characteristics of effective psychotherapists: a systematic review. Psychotherapy Research, 30, 417-432.
https://doi.org/10.1080/10503307.2019.1620366.