7 Qualities of a Great Therapist

Done right, therapy is tough work. Clients confront their deepest feelings, face what in their life and in their self isn’t working, and adopt a plan for and endure the discomfort of change. They probe the past, dismantle often long-standing defenses, and discard decades of habits so entrenched they may have become part of personal identity, clearing the path to change. The process requires tremendous courage.

What exactly are the talents and skills needed to help others transform pain into possibility? Appropriate training and licensure are givens. So is a code of ethics. Trustworthiness, the ability to communicate, and holding the client’s needs foremost represent the baseline for therapists. At its best, therapy leads to freedom. By releasing themselves from the accommodations they have made to survive the past, people can reach for a satisfying future. They progress, achieve, connect, love, and transform.

What successful therapy entails is important for both therapist and patient to know. Psychology Today spoke to several therapists and conducted a survey of readers to understand what they value in a therapist. We identified seven essential traits.

1. Trust-Building

Therapy asks people to expose their secrets, reveal their fears, and craft new ways of seeing and being. Those feats can happen only if patients feel completely safe and unjudged.

Research shows that the effectiveness of therapy hinges on the therapeutic alliance—the relationship between therapist and patient. The pair need to develop a strong sense of rapport, trust, and safety. Trust is the foundation of a sense of security and safety. “Without rapport, therapy cannot proceed,” says Noam Shpancer, a clinical psychologist and professor of psychology at Otterbein University. “That’s the essential ingredient.”

How is that created? Curiosity is often the seed. Great therapists are fascinated by the variety of human experience and are eager to discover more about the individual sitting before them. People respond to genuine curiosity; they begin to feel comfortable, to share, and to trust.

A second element of rapport is listening attentively. Establishing therapy as an enterprise in which the patient feels completely heard forges a special connection between the two. A third facet of rapport is nonjudgmentalism, which frees the patient to open up and allows the therapist to take in who the person is. Those three elements are the core of rapport, Shpancer says.

Once established, rapport is continually nurtured, through a variety of techniques, to deepen the patient’s sense of safety and security. A creative line of questioning can lead the patient to self-discovery. Periodically discussing, and amending as needed, a patient’s concrete goals for therapy assures the patient that their aims are aligned. Rapport may be strengthened by a dash of self-disclosure by the therapist in response to a pertinent question. It may be sustained by voicing optimism about the patient’s ability to change.

Shpancer once worked with a young woman who struggled with loneliness and social anxiety. Yet she was reluctant to open up, and therapy was stalled. One day, she walked into the room visibly shaken. When Shpancer asked why, she responded that she couldn’t tell him because it involved him and his staff. Shpancer didn’t push her; he filed the comment away for later. They had talked about her childhood and her relationship with her parents. Her father had been hostile and abusive; when she expressed an opinion or need, he would bully, criticize, or silence her. Shpancer developed a hunch. Later that session, he ventured:

“I’m not your father. Do you know what I mean when I say that?”

“You mean you’re not going to hurt me if I tell you how I actually feel?”

“That’s right. I’m going to take what you tell me and use it only to understand you better and help you better your life.”

The woman confided her suspicion that members of Shpancer’s staff were making fun of her. He thanked her for her courage and honesty. Not only was Shpancer’s response a demonstration that he wasn’t her father—he accepted and respected her input—it opened a door for both therapist and patient. Shpancer then asked if she often felt that others were scheming against her behind her back. She did.

The two explored her suspicion of others, which was a protective mechanism. Perhaps, Shpancer ventured, it once was but now was harming her ability to engage with the world in a healthy way. Shpancer kept his word: He didn’t react the way her father would have, and he used the information only to help her. “As long as rapport is there, you can recover from setbacks or mistakes,” Shpancer says. “If not, no amount of skill or education is going to work.”

2. Open-Minded

Perhaps paradoxically, “a therapist’s real benefit to the patient is they have no skin in the game,” says Pennsylvania psychologist Daniel Marston.

Great therapists don’t begin with a fixed point of view about what the outcome should be, however subtle. They are guided by the patient and the patient’s view of a meaningful life. Each patient brings a unique history and often remarkable creativity to setting up the life they want—although sometimes they need help resolving some inner conflict before they can enjoy it. The therapist can help them clear the path to whatever they chose. “The goal is to make the patient the best they can be—not the person the therapist thinks they should be,” Marston says.

The challenge to open-mindedness is especially acute in couples therapy. Many couples therapists (and people in general) have internalized myths of what a healthy romantic relationship looks like, says Alexandra Solomon, a clinical psychologist at The Family Institute and a clinical assistant professor at Northwestern University. Maybe the therapist tends to think a couple shouldn’t get married before dating for a year or have a baby before living together. Great family therapists explore their own beliefs and biases about relationships before centering therapy around a couple’s vision.

Solomon once worked with a young couple struggling over whether to get engaged. The man was a bit older and couldn’t wait to get married and settle down with the love of his life. But his young partner had an adventurous nature and first wanted to take up residence in a different part of the country before settling down. “A couples therapist might think, Uh oh, that’ll put the relationship at risk. A couple shouldn’t live apart. Or if you want to live apart, it must mean he’s not the one for you,” Solomon observes. But a great therapist explores unconventional paths that could create room for both partners’ dreams.

Solomon worked with the couple to unearth their concerns. The woman felt torn by a choice she perceived as binary: Do I choose adventure or do I choose love? The man feared that her moving meant that the relationship wasn’t a priority for her and that marriage would be pushed years down the time line.

Therapy focused on the falsity of the binary choice and the couple’s time concerns. Most important, the woman learned how to assure her boyfriend of her love and commitment to him—a skill she hadn’t acquired growing up in a nonexpressive household. Articulating how much she loved him allayed his fear. In the end, the woman moved, and they worked to maintain their long-distance relationship. The man became proud of himself for supporting her. Their mantra became: “We’re slowing down to speed up.”

3. Inquiring

Inquiry is the heart of psychotherapy. It’s the process of peeling back the layers of identity and examining the forces shaping the way people think and act. Probing questions help the therapist understand patients and patients understand themselves. Inquiry doesn’t impose insights on people; it affords them the opportunity of self-discovery, provided the therapist deploys creativity and wisdom in the questioning.

There’s no perfect formula for inquiry. Yet one through line is that successful inquiry must be infused with compassion and kindness from both therapist and patient. Most behaviors are, at their core, self-protective. Kindness of process acknowledges that even the most painful patterns develop for good reason, that acknowledging one’s defenses is an act of bravery. Courage deserves compassion.

One core question that is seemingly obvious but is sometimes overlooked is Why now? says New York City therapist Susan Birne-Stone. A patient may have been depressed for months or years, but last week they picked up the phone and made an appointment. What changed? What prompted them to make the call? Perhaps their spouse threatened to leave. Or a low performance rating at work put their career in jeopardy.

Another core question is Why does this make sense? It gets at the root of all the accommodations and adaptations people make to survive in one environment that may not work in others—the source of so much human suffering. Perhaps, like Shpancer’s suspicious patient, a client developed a harmful pattern of behavior out of self-protection. Perhaps a new obstacle emerged that derailed the progress they were making. Exploring the answers to these questions can lead to discovery that opens the way to progress.

Beyond such basic but critical questions, good therapists get considerably creative. For example, Birne-Stone says, let’s say a client is having an affair and wants to stop—but hasn’t for months. To learn what the situation really means for them, why they are holding on to it, the therapist might ask the provocative question: What’s wrong with having an affair? It takes another angle, Birne-Stone says. “You’re getting them to think about it differently.”

Many psychological problems result from a habit of avoidance, Shpancer says. The client faced a difficult problem, so they took action—they suppressed their emotions, let’s say, or used drugs—to avoid the pain. “People develop a habit of avoidance because it worked in the short term, but that habit can became the problem in the long term,” Shpancer says. In such a case, wise questions to ask are: What are you avoiding by continuing the current pattern of behavior? If you stop the problematic pattern, what will you be losing?

Shpancer has a client whose dream is to be a novelist. Yet day in and day out, he didn’t write. He procrastinated. A classic example of avoidance, Shpancer questioned if he procrastinated because he was scared of failure—of being found to be a terrible writer, a judgment more devastating to him than the act of procrastinating.

A line of inquiry led the patient beyond the impasse: Let’s assume you’ll be found to be a lousy writer. What will happen? Will that be the end of the world? Could being a lousy writer at first help you become a better writer? “Avoiding doesn’t teach you anything but more avoiding,” Shpancer says. “You end up in a prison of avoidance.” Probing questions help patients understand their avoidance and take action to break free. Incisive questions can be revelatory.

4. Demands Accountability

Listening carefully and empathizing with patients’ feelings about their life experiences is a minimum requirement of all therapists. But great therapists move beyond empathy into the realm of accountability and change. They hold their patients’ feet to the fire, even if it’s uncomfortable at times.

“Holding patients accountable is one of the tasks of therapy. But ultimately you want to guide clients to keep themselves accountable,” Shpancer says, and therapy itself becomes the model for accountability.

For example, Shpancer often teaches patients the cognitive behavioral therapy (CBT) technique of cognitive reappraisal—the ability to examine the validity of their thoughts. If a client makes a statement such as “No one likes me” or “I’ll be alone forever,” Shpancer will introduce them to relevant reappraisal questions: Is there evidence to back up that idea? If not, what would be a more accurate statement? Eventually patients learn to challenge their thoughts themselves. With practice, they’ll come into a session and say something like, “I had this encounter, and I got upset. But then I stopped and asked myself: ‘What am I telling myself here?’”

Another way to hold patients accountable is through rehearsal of challenging but necessary tasks. If a woman is nervous about breaking up with her boyfriend, the therapist could have her role-play the conversation and record it. Together they could listen to the “conversation” and revise it until she says what she really wants to say.

An introverted high-school student afraid of meeting new people in college can be asked to rehearse standing up, making eye contact, shaking the therapist’s hand, and introducing himself. And then practice it five more times.

Shpancer often treats anxiety and obsessive-compulsive disorder, in which exposure is a key technique, greatly abetted by the confidence of an experienced therapist. He once worked with a woman who was afraid of driving after having been in a bad accident. Several months into treatment Shpancer announced, “Well, let’s go for a ride.”

First they drove slowly around her apartment complex. Then they ventured onto the road. Periodically, Shpancer sampled her level of discomfort. Her fear level started at 100, then descended to 95, then dropped to 70, and eventually to 50.

She burst into tears and exclaimed, “I can’t believe I’m driving!” It was a cry of relief and a triumph of courage, Shpancer says. “If you can keep people in the discomfort long enough, habituation will occur and they won’t feel scared. That moment is like a miracle.

5. Versatile

Great therapists adapt their approach for each individual patient. They are comfortable working in different modalities and don’t hesitate to try something new.

“I’d like to count on the therapist to not be a one-trick-pony,” says psychiatrist Mark Rego, a clinical assistant professor at the Yale School of Medicine. “People are usually trained in one school, but I’d want a therapist who could say, ‘This isn’t working, but I have another way we could look at it.’”

How do clinicians know when to shift? When the patient isn’t making progress. The time frame depends on the condition.

A clinician may expect signs of improvement in weeks when treating a patient for a phobia, months for a personality disorder—not necessarily vast improvement but signs of change, such as a reduction in symptoms, a new sense of hope, or a deepening of rapport. If therapy is stalled, good clinicians may change modalities, alter their communication style, or dig deeper.

Early in his career, Rego worked with a young woman who was suffering a psychotic depression. She had severe social anxiety, to which Rego took a cognitive approach. He explained how to reframe her experiences of catastrophizing and generalizing using CBT techniques. “She wouldn’t say anything. She would just look at me, and tears would come down her face,” Rego says. “It was getting us absolutely nowhere.”

Rego took a few steps back. He needed to understand her reality. He asked her to describe it. She explained how difficult it was to leave the house, run errands, or complete the simplest of tasks. Life was so much harder than the situational doubts of social anxiety. Her husband, a religious man, thought her problems were due to lack of motivation and felt she could heal herself through spiritual means.

Her illness was so severe that she simply wasn’t ready for CBT skills. Rego decided to bring the husband in to serve as a part of the treatment approach. With this, the woman began to improve.

6. Unifying

Therapy is tough enough with one patient. Two, and the dynamics become infinitely more complicated. Great couples therapists take on a leadership role to unify a couple’s goals. They don’t just empathize with partner A, then partner B; they prioritize the relationship above the individuals. “What makes great couples therapists stand apart is the ability to hold the relational system and see it as the client,” Solomon says.

For example, a couple may come to therapy with the woman wanting to feel more emotionally supported and the man wanting to have more sex. The wise therapist identifies the relational value underlying each partner’s need, then leads the couple in conversation to help them discover it for themselves by asking questions, reflecting back what is heard, synthesizing the two perspectives, and checking whether the insight is aligned with both partners.

The support the woman craves may signal that she values a relationship in which she feels seen, heard, and understood, while the man’s desire for sex may indicate that he values being chosen and prioritized. “In therapy, we would weave those together and create an atmosphere in the relationship where both feel understood and prioritized,” Solomon says.

7. Self-Aware

“If you don’t know yourself, you don’t know what’s happening in the room,” Birne-Stone says. That’s why a therapist’s level of self-awareness is instrumental to effective therapy. Great therapists explore their own background, biases, and blind spots, and the self-exploration is ongoing, whether it takes the form of their own therapy, group work, peer supervision, or continuing education.

Having a deep understanding of who they are can prevent their beliefs from consciously or unconsciously influencing the work. “I wouldn’t trust a therapist who hasn’t done their own therapy,” Solomon agrees.

Whether it’s awareness of their own beliefs about the world, discomfort around certain topics, or even subtle aspects of their own self-perception, great therapists know when to monitor their own reactivity. “It’s important that therapists are comfortable in their own skin, that they are not needy in terms of their ego or desire for validation,” Shpancer says. “If you’re needy, clients are sensitive and will pick up on that and try to give you what you need.”

An important aspect of self-awareness is sensitivity to one’s own assumptions, especially about cultural differences, gender, and race, says Los Angeles psychologist Jennice Vilhauer. Great therapists acknowledge the vast diversity of human experience and do not lock themselves into a single perspective. They also freely ask patients to educate them about their unique perspective.

For example, a patient may be grappling with unreasonable demands from a parent that are contributing to their mental health difficulties and stalling therapeutic progress. Yet saying no to the parent or elders creates a conflict.

A good therapist might ask the patient, What are your thoughts about why your parent wants you to do that?—which may unearth cultural norms that can then be openly discussed in light of what the patient believes is a healthy dynamic. Such an approach helps the therapist identify how to move forward and reduces resistance from the patient, who might have otherwise dismissed their guidance.

Perhaps the last component of self-awareness is recognizing when a patient may be best served by another clinician. As versatile as great therapists can be, they also recognize when they are pushed too far outside their skill set, in which case a referral elsewhere is warranted.

“You have to know your own limits,” Birne-Stone says. A great therapist may not be a great therapist for every patient—but every patient can, with time, find a great therapist.

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Pearls of Wisdom

• Has a statement from a therapist stuck with you over the years? Here are a few nuggets that resonated with PT readers.
• “Feelings are data.”
• “Live in the now, not the past or the future.”
• “Be a door, not a rug.”
• “One step at a time.”
• “You are having a normal reaction to abnormal circumstances.”
• “Do you like the person you have to be in order to stay in this relationship?”
• “You need to move out of your comfort zone.”
• “My choices, my consequences.”
• “You matter, and I’m here for you.”
• “You are not a failure.”

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Patient Perspective

Which factors are most important to patients? Here’s how PT readers ranked them.

• Experience level
• Advanced training
• Type of therapy practiced
• Cost
• Age
• Gender
• Sexual orientation
• Race and ethnicity

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