This One Thing Can Make or Break Your Therapy

A therapist’s personality, mind, and psychology are all interwoven with their approach and the therapy relationship that ensues. Therefore, it is no surprise that these personal variables can help explain why some therapists get better results, rather than their credentials alone or the type of therapy they use, referred to as orientation or modality.

Approximately 20 percent of patients drop out of therapy (Leichsenring, Sarrar, & Steinert, 2019), and some people stay and realize later that another therapist would have been a better choice.

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Common complaints include therapists being “just OK,” distant or passive, not providing enough feedback or guidance, and, ultimately, a lack of progress.

Sorting through the maze of therapists and therapies is complicated by the number of therapy approaches, the ambiguity in how therapists practice them, and the personal qualities of the therapist that are all part of the picture.

Some people choose a therapist randomly, based on practical considerations, but many seek a particular therapy modality that they have heard is effective or is popular in the public eye. Cognitive behavioral therapy (CBT), for example, is promoted by insurance companies and marketed as uniquely “evidence-based.” Interestingly, however, there is no evidence that one therapy modality is superior to another (Wampold & Imel, 2017).

Another problem with selecting a therapist based on therapy modality alone is that without an excerpt or direct experience, no one knows how a therapist comes across in sessions, let alone whether the label they use to describe their orientation has shared meaning and practical translation. In fact, there is a lack of consensus between the approaches therapists say they are using and how trained observers classify them (Hill & Knox).

Part of the confusion is that different therapy approaches overlap in practice. More importantly, therapy unfolds within the landscape of an interpersonal relationship. Although two therapists may use the same modality, the way they apply it and the approach to therapy are filtered through the lens, personality, and voice of the therapist.

Co-Mingling of Orientation and Personality

The type of therapy a patient receives matters in that it should be a good fit for their personality and preferences and, of course, lend itself to treating their issues.

Effective therapists are experienced in a variety of approaches and flexible in how they practice. Their knowledge and expertise inform their perspective but do not override their ability to be uniquely responsive to the person in front of them. They are able to be present in the here and now, adapting their approach to best address a particular patient’s needs, preferences, symptoms, and personality—as well as the climate of a particular interaction (Castonguay & Hill, 2017).

Still, some therapists stick to just one approach. However, the rote application of a protocol or framework can be problematic because it limits what therapists notice and can lead to interventions that patients experience as artificial, forced, or not relatable. Further, an approach that works with one patient, or at a particular point in time, may not be suited to another.

Interestingly, a therapist’s training, intellect, cognitive style, defenses, and personality not only play a role in how they conduct therapy generally but may also influence the modality they are drawn to and find personally compatible, particularly if they adhere to one approach (Ogunfowora et al., 2008; Topolinski et al., 2007).

For example, certain orientations lend themselves to a more formulaic and structured and less interpersonally dynamic climate, potentially attracting some therapists who are more linear versus creative thinkers. Other orientations may be conducive to a passive style, potentially attracting some therapists who are comfortable being more distant interpersonally.

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Passive or Distant Therapists

Staying emotionally distant in therapy interactions may not be an issue when it comes to certain more one-dimensional, circumscribed problems (for example, some phobias) or for certain types of patients. But even then, it’s hard for a therapist to be inspiring from an aloof position.

In general, people find emotionally distant therapists, passive therapists, or those using manualized approaches to be unhelpful (Delboy & Michaels, 2021). No one wants to feel like they are being treated as a generic “patient,” specimen, or diagnosis rather than cared about as a person in their full humanity. It’s reasonable to expect active participation, warmth, and help from your therapist.

Therapy isn’t just talking about your problems and having a sounding board. Most people prefer an engaged and responsive therapist who provides feedback (Delboy & Michaels, 2021). Effective therapists use a multidimensional approach in which the therapeutic relationship itself is healing but also functions as a secure base for learning and moving forward in their lives. Helpful therapists genuinely connect with their patients and get involved. They roll up their sleeves to be fully with each person and co-create positive solutions.

Why Do Personal Qualities Matter?

A therapist’s character, capacities, and style directly and indirectly affect the quality of the therapy relationship, which is the foundation of treatment, the medium through which the therapy is delivered, and a direct agent of change. Further, the interpersonal dynamics that develop and how they are managed shape the therapeutic relationship and either facilitate, disrupt, or impede the therapeutic process.

Qualities of Effective Therapists

Successful outcomes in therapy are associated with the therapist’s warmth, attunement, ability to manage their own emotions, interpersonal skills, emotional intelligence, self-awareness, and the capacity to notice and interpret their own and others’ internal experience, referred to as “mentalizing” or reflection (Abargil & Tishby, 2021; Allen et al., 2008; Castonguay & Hill, 2017; Nyklíček et al., 2015; Norcross & Lambert, 2019).

Mentalizing involves knowing how to interpret both heart and mind and understanding the complex interplay of thoughts, feelings, intentions, and behavior (Allen et al., 2008). Since therapy is about healing the heart and mind, it makes sense that therapists be skilled at tuning in to and understanding their patient’s inner and interpersonal worlds, as well as their own.

This capacity allows therapists to create stronger therapeutic alliances by facilitating a deeper empathic connection and a better grasp of the underlying issues contributing to the patient’s problem. In addition, therapists who can reflect and mentalize are more likely to have other qualities associated with successful outcomes, such as the ability to regulate their emotions, accurately perceive, interpret, and adapt to cues from the patient, as well as hold the patient’s perspective in mind alongside their own (Cologon et al., 2017)

Further, when therapists have this ability, their patients are more likely to develop it and heal their problematic attachment styles. This is an important advantage since mentalizing is not only associated with developing healthier attachment styles, but when parents have this skill, they are able to protect their children from the negative effects of their own problematic attachment styles (Cologon et al., 2017; Allen et al.,2008). In general, being able to interpret oneself and others accurately helps people get along better in relationships, manage conflict, have perspective, and solve problems.

How to Tell if It’s a Good Match

First, a therapist must have training, experience, and success in treating your primary issues.

Second, since it takes two to make a relationship, a good match also involves “chemistry.” Chemistry involves subtleties such as intuitive “feel” and gut impression. Does this person strike you as someone you like? Would you want to talk to and confide in them?

Listening to a therapist’s outgoing voicemail message—the melody of their voice, tone, and use of language—can provide a quick initial sense of whether a therapist feels warm and relatable to you. This can be an efficient means to screen out therapists who are not the right fit.

The bottom line is that patients have very different experiences and outcomes with different therapists. Therefore, if you’re new to therapy or have not had a productive experience, consult with more than one therapist and have a conversation.