Friday, February 18, 2011


A couple of weeks ago one of my blog readers suggested that I check out the website  I got a message stating that the website is no longer being maintained but there were links to other websites being managed by the same people.  I followed the links and read some of the articles on the sites.  Their emphasis was on how measuring outcomes and asking for patient feedback about sessions facilitate therapists' professional development.  All this talk about outcomes got me thinking: what are the factors that influence whether or not therapy is helpful?

I did some investigation.  A lot of research has been done in an effort to identify what distinguishes helpful psychotherapy from unhelpful psychotherapy.  Here are some things that have relatively little impact on effectiveness: level of therapist training (Master's vs. PhD vs. MD), years of therapist experience, the discipline of the therapist (psychologist, clinical social worker, licensed professional counselor, psychiatrist, etc.), and therapeutic modality used.  I was a little surprised by this but I also felt relieved.  If none of these things have much influence on whether or not I'm a good therapist then I can stop worrying so much about needing to know more. 

In talking with some of my peers I've discovered that I'm not the only one who, a week or two into her first "real" job, came to the realization that, "I have no idea what I'm doing!"  What a scary feeling!  I'd fooled myself into thinking my education had prepared me well for the real world.  When reality hit, my first instinct was to run the other way.  (I mentioned before that I started thinking about going back to school to learn to do something else).  I've come a long way since then but I still have fears that I don't know enough and that my patients will suffer because of my lack of knowledge.  (This is particularly true when I encounter a patient with severe difficulties).  So  what a relief to learn that how much I know doesn't make very much difference.  (It does, however, make some difference; maybe about 15% of therapeutic outcome is accounted for by therapeutic techniques used). 

So what does make a difference?  The two most important factors that determine whether or not psychotherapy is effective are patient factors (e.g., motivation, social support, etc.) and therapeutic relationship factors (e.g., empathy, acceptance, genuineness, etc.).  The relationship between the patient and therapist accounts for about 30% of outcome variance.  That's DOUBLE the effect of therapeutic technique/skills.

What do I make of this?  Well, I guess it is who I am more than what I know that has the biggest impact on therapy.  (That doesn't mean I'm going to stop learning.  Actually, I love to learn and I often pursue knowledge just because I'm curious).  I actually feel pretty good about this conclusion.  I am much more confident with who I am than I am about my ability to apply theory and techniques to helping someone get better.  It also gives me a good reason to keep working on myself; the better I understand me the more helpful I am to other people.


  1. Thank you so much for this post! I am currently an MSW student who is planning on being a therapist, so your insights are very helpful and reassuring to me.

    I've been a quiet reader for a while now, and your reflections have been very influential for me. Thanks for taking the time to share your thoughts and wisdom, and I look forward to more!

  2. The Talking Cure link that you posted leads to the wrong site. The correct link is The reason I led you to that link is because there was a bit of a split between Miller and Duncan and they both have some good information and tools.

    I'm glad you enjoyed some of the information. It can be powerful, but it's also important to be skeptical of some of it. :)


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