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Key points
- There are specific personal and interpersonal qualities that are strongly linked to good therapy outcomes.
- You needn’t have all your issues resolved to be effective, but getting easily triggered can impede therapy.
- There is no evidence that different graduate degrees are linked to different levels of effectiveness.
- Most models of therapy are about equally effective in treating most mental health problems.
There is abundant evidence that psychotherapy and counseling are helpful in reducing distress and treating a wide range of psychological disorders. They are also effective in helping people create more satisfying and meaningful lives. (For the sake of ease, I’ll refer to psychotherapy and counseling simply as therapy or psychotherapy in this post.)
The work of a psychotherapist can be enormously rewarding. There is something deeply moving about being part of someone’s journey toward becoming unstuck from painful situations and patterns, overcoming a legacy of trauma, and finding greater meaning and happiness in their life.
If you’re considering a career in one of the mental health professions, however, it’s worth taking the time to consider an essential question: What makes someone an effective therapist? It’s a question that’s been getting a lot of attention from researchers in recent years. Some of what we’ve learned may surprise you. My hope is that a greater familiarity with what we know about effective therapists will help guide your decision about whether this is the right path for you, and assist you in considering which type of degree and which program may best meet your professional aspirations.
1. There are specific personal qualities that are strongly linked to good therapy outcomes.
Effective therapists tend to score high on a number of personal and interpersonal attributes: They are empathic, comfortable with emotional intimacy, possess healthy personal boundaries, are able to tolerate strong emotions in others and themselves, and can hear and consider criticism without becoming defensive. This list isn’t exhaustive, but these are some of the most essential attributes shared by effective therapists.
Before filling out any graduate school applications, it’s worth doing an honest self-assessment to see how you rate on these sorts of qualities. It can also be helpful—and a bit scary—to ask a few people who know you well to evaluate you on these attributes. Graduate school may help you grow as a person and may even help you strengthen these important qualities, but if your baseline isn’t reasonably high, it may be worth asking whether this is the right line of work for you, or whether this is the right time in your life to pursue it.
2. You needn’t have resolved all your psychological issues to be an effective therapist.
Research has found that the great majority of psychotherapists have been in therapy themselves after their graduate training. Personal growth can be a lifelong journey, and the idea that one should have all their issues resolved before embarking on a therapy career has no empirical support. It’s also not realistic.
There is an important caveat, however.
Unresolved trauma and other psychological issues can leave us vulnerable to being triggered by the experiences clients bring into therapy. That’s a problem, especially when it leads to empathic failures, emotional distancing, a retreat into advice-giving, or dissociation during the therapy session.
I once had a student tell me that I shouldn’t teach about trauma three weeks in a row in my graduate counseling course because she found it too upsetting. The problem, of course, wasn’t the course content; it was her experience of being triggered by it due to her own unresolved trauma. If you find yourself getting powerfully triggered (upset) by class material or by situations in your everyday life, that’s an important warning sign that you have some important personal work to do before you're ready to sit with clients.
3. There is no evidence that different graduate degrees are linked to different levels of effectiveness.
More years of graduate training have simply not been found to predict greater helpfulness. The type of degree you pursue—MA, MS, MFT, M.Ed, Ph.D., Psy.D., MSW, M.D.—may influence your career options, and will certainly have an impact on your professional status and earning power. It just won’t make you a more effective therapist. That’s counter-intuitive, and not likely something you’ll find in the brochures of expensive, multi-year graduate programs. But it’s a robust finding, replicated in dozens of studies.
This doesn’t mean that all graduate degree programs offer the same learning experience or lead to the same outcomes. A Ph.D. program will train you in how to conduct research and can open up academic opportunities. A Psy.D. will offer extensive supervision and classroom learning, and will likely lead to higher income and more leadership opportunities than a master’s degree. And a social work degree may offer a broader community or systems-level way of viewing and addressing mental health difficulties.
But—at least according to the research—the additional years of training that go into a doctoral degree will not make you a more effective therapist than the training afforded by a briefer degree program.
4. Most models of therapy are about equally effective in treating most mental health problems.
There's a well-established finding that most models of psychotherapy are equally effective for most types of problems: the so-called "dodo bird effect." That doesn't mean models are unimportant, or that it doesn't matter what model (or models) you adopt to guide your work.
Pick a graduate program that offers one or more models of therapy (theoretical approaches) that resonate with you. If you feel comfortable with a particular theoretical model, you’ll convey greater confidence and have greater clarity in explaining to your clients how you work. Confidence and a clear therapeutic model are in turn linked to better therapy outcomes, even though different models are comparably effective.
My own practice is based in an integration of mindfulness, internal family systems (“parts therapy”), and attachment theory, with a grounding in neuroscience and trauma theory. It’s what works for me, and the clients who seek me out generally do so because my approach resonates with their own values, beliefs, and general worldview—or they discover that how I work feels helpful, even if it’s based on an approach they were previously unfamiliar with.
Having suggested the value of finding a particular model that resonates for you, I would offer a caveat: We want to avoid becoming like the carpenter whose only tool is a hammer, and who therefore sees everything as a nail in need of hammering. It’s good to become familiar with a variety of approaches, yet also to know when to refer prospective clients elsewhere because we lack the expertise in an approach they are looking for or are in need of.
I once had a psychoanalysis professor who disparaged all other approaches to therapy. When a businesswoman came to him for help with overcoming her fear of flying (frequent air travel was a requirement of her new job), rather than referring her to a specialized treatment program for aerophobia—such programs are brief and highly effective—he treated her four times a week for two years in classical psychoanalysis. That was a deeply inefficient and costly treatment approach for a problem that could likely have been successfully treated far more quickly and for much less money with a different clinical approach.
5. Experience alone doesn’t make therapists more effective.
To become a more effective therapist, it’s important to routinely seek feedback from clients about the work you are doing together, and to learn and adjust your work based on this feedback. In their excellent article "The Secrets of Supershrinks," researchers Scott Miller, Mark Hubble, and Barry Duncan offer compelling evidence that the single most distinctive feature of highly effective psychotherapists is their practice of routinely soliciting feedback from their clients regarding their work together, and then modifying what they are doing based on that feedback.
Asking clients for feedback can be unsettling and even a bit scary at first. But if we can let go of our egos and allow ourselves to be a bit vulnerable, we may discover that client feedback is an invaluable source of information about what’s feeling helpful and what might indicate the need for some course correction. Indeed, as Miller et al. suggest, the willingness to solicit and learn from client feedback is one of the few hallmarks of truly effective psychotherapists.
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