Evidence from decades of psychotherapy research indicates that patient outcomes across different therapeutic orientations are comparable. There is no compelling research showing that one form of psychotherapy, based on established psychological principles and delivered by a qualified professional, is more effective than another. Further, even in the best studies, time-limited treatment yields modest outcomes, with well over 50% of patients not experiencing lasting, meaningful effects. These are not fluke findings, but consistent results across many decades, studies, and patient problems. Some have suggested a possible solution: providing a sequence of evidence-based treatments until a patient responds. That would mean offering a new treatment after a previous one fails. The subsequent treatment presumably would target an aspect of the patient that the previous treatment left unaddressed. Although intriguing, Wampold and Miller note in this review that a sequential approach leads to several problems. First, treatment failure of the first therapy will likely result in patients becoming demoralized and dropping out of further treatments. Second, it is not feasible for therapists to learn and expertly deliver multiple therapeutic modalities. Third, this sequential approach ignores the fact that there are multiple nontreatment-centric means of improving the quality and outcomes of psychotherapy. Wampold and Imel ask: what if there is an alternative to focusing on treatment methods (CBT, psychodynamic, EFT, DBT…) and specific interventions (exposure and response prevention, cognitive restructuring, interpretations, two-chair technique…)? What if we were to focus on other factors, like the therapeutic relationship, therapeutic alliance, hope, and therapists’ interpersonal skills? In other words, psychotherapy models grounded in healing through interpersonal and social processes. Wampold and Miller suggest that the research does not support a treatment-centric perspective, which rests on the assumption that some treatments are more effective than others. Instead, a key therapeutic factor is the therapist’s person, which research indicates is more important than the specific interventions of a therapy orientation. Factors that improve a therapist’s effectiveness include the capacity to form a strong alliance with a wide range of clients, strong interpersonal skills, the ability to experience and express emotions verbally, and the ability to demonstrate and communicate empathy. These are strategies and capacities with a strong evidence base, yet are often treated as “soft skills” secondary to learning specific interventions.
Practice Implications
It is likely that the key mechanisms of change in psychotherapy lie outside of specific interventions described by psychotherapy orientations. The therapist's interpersonal skills during challenging therapeutic moments, adjusting treatment to patient preferences, culturally adapting interventions, and flexibility rather than strictly adhering to a protocol are likely more important for clients to achieve good outcomes. Therapists and training programs should focus continuing education on the deliberate practice of these relational skills and on routine process and outcome monitoring that provide therapists with real-time information about the state of the therapeutic alliance and the client’s response to the interventions on offer.
Wampold, B. E., & Miller, S. D. (2026). Suppose all psychotherapies are equally effective: What then? Psychotherapy. Advance online publication. https://doi.org/10.1037/pst0000637
The director of the Psychotherapy Practice Research Network (PPRNet) is Dr. Giorgio Tasca. Dr. Tasca is an Associate Professor with the School of Psychology, in the Faculty of Social Sciences at the University of Ottawa. His research is centered around psychotherapy process, mechanisms of change, and outcomes, as well as eating disorders.
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PPRNet Clinical summary: Suppose All Psychotherapies are Equally Effecive: What Then?
Evidence from decades of psychotherapy research indicates that patient outcomes across different therapeutic orientations are comparable. There is no compelling research showing that one form of psychotherapy, based on established psychological principles and delivered by a qualified professional, is more effective than another. Further, even in the best studies, time-limited treatment yields modest outcomes, with well over 50% of patients not experiencing lasting, meaningful effects. These are not fluke findings, but consistent results across many decades, studies, and patient problems. Some have suggested a possible solution: providing a sequence of evidence-based treatments until a patient responds. That would mean offering a new treatment after a previous one fails. The subsequent treatment presumably would target an aspect of the patient that the previous treatment left unaddressed. Although intriguing, Wampold and Miller note in this review that a sequential approach leads to several problems. First, treatment failure of the first therapy will likely result in patients becoming demoralized and dropping out of further treatments. Second, it is not feasible for therapists to learn and expertly deliver multiple therapeutic modalities. Third, this sequential approach ignores the fact that there are multiple nontreatment-centric means of improving the quality and outcomes of psychotherapy. Wampold and Imel ask: what if there is an alternative to focusing on treatment methods (CBT, psychodynamic, EFT, DBT…) and specific interventions (exposure and response prevention, cognitive restructuring, interpretations, two-chair technique…)? What if we were to focus on other factors, like the therapeutic relationship, therapeutic alliance, hope, and therapists’ interpersonal skills? In other words, psychotherapy models grounded in healing through interpersonal and social processes. Wampold and Miller suggest that the research does not support a treatment-centric perspective, which rests on the assumption that some treatments are more effective than others. Instead, a key therapeutic factor is the therapist’s person, which research indicates is more important than the specific interventions of a therapy orientation. Factors that improve a therapist’s effectiveness include the capacity to form a strong alliance with a wide range of clients, strong interpersonal skills, the ability to experience and express emotions verbally, and the ability to demonstrate and communicate empathy. These are strategies and capacities with a strong evidence base, yet are often treated as “soft skills” secondary to learning specific interventions.
Practice Implications
It is likely that the key mechanisms of change in psychotherapy lie outside of specific interventions described by psychotherapy orientations. The therapist's interpersonal skills during challenging therapeutic moments, adjusting treatment to patient preferences, culturally adapting interventions, and flexibility rather than strictly adhering to a protocol are likely more important for clients to achieve good outcomes. Therapists and training programs should focus continuing education on the deliberate practice of these relational skills and on routine process and outcome monitoring that provide therapists with real-time information about the state of the therapeutic alliance and the client’s response to the interventions on offer.
By Dr. Giorgio Tasca
The director of the Psychotherapy Practice Research Network (PPRNet) is Dr. Giorgio Tasca. Dr. Tasca is an Associate Professor with the School of Psychology, in the Faculty of Social Sciences at the University of Ottawa. His research is centered around psychotherapy process, mechanisms of change, and outcomes, as well as eating disorders.Also Read