You can listen to the audio version of this article.
I’m a therapist who is passionate about creating the best experience of therapy for every client. I know that with the right therapist, the experience can be life changing. But how do you find that person?
I’ve spent a couple of decades looking at what works in therapy. I want to share a little of what I’ve learned with you here. If you’re looking for a therapist, I hope it may help shorten your journey in finding the therapist that’s right for you.
If you’ve ever searched online for a therapist, you’ll have some idea of how bewildering the process can be. If you haven’t, try typing ‘find a therapist near me’ into your browser and you’ll see what I mean.
It’s likely you will be shown, on the first and many subsequent pages, a mix of paid ads, therapist directories, and the occasional individual therapist. On the first page you may also see a panel titled ‘People also ask’. One of the questions you may see is this:
I’m hoping that I can help to level up what feels to me a very un-level playing field.
Here’s the short version, in 32 words: Have confidence that therapy works. Don’t get hung up on the model. Choose a therapist that offers the most persuasive road map out of your current difficulty. Think like a consumer. Shop around.
Who am I to say?
Along with other hats I wear, I’m a therapist. I have been for rather more than 30 years. I’m also a former therapy service manager, and it was in that role that I first became interested in the evidence for the effectiveness of therapy. I had to be, as the future of my service depended on our being able to demonstrate our impact.
What I discovered was that while overall, therapy is extremely effective, its effectiveness is far from uniform. It varies across sectors, across services, and across therapists. And so, I became ever more curious about this question: What works in therapy?
The answer to this question is not what you might immediately think. You may think, for example, that more experience would make for more effective therapists. There is no evidence for this, however, and there’s one study in 2016 in which therapists’ outcomes actually deteriorated over a number of years.
Finding answers to this question has been my passion for a couple of decades. I’ve made discoveries over that time that have I’ve incorporated into my own practice, and that I also share with a professional audience in my blog Therapy Meets Numbers. For more than 15 years I’ve also worked as a consultant, helping practitioners and services evaluate their impact.
Therapy works
Therapy is effective. Remarkably effective. So much so that if we compare a group of people who’ve had therapy with a group that haven’t, those that have had therapy tend to be better off (psychologically) than 80% of those who haven’t.
Therapy absolutely does work. How do we know? Very simply, using scientifically validated measures, we’re able to gauge the severity of peoples’ problems, symptoms, or general distress. If therapy works, then we should see reliable reductions in severity between the start of therapy and its end. For sure, improvements aren’t always down to the therapy, but we have enough solid evidence that the gains that people make can be attributed to it.
What about different therapies? If therapy is effective overall, are there therapies that are more effective than others? A simple question with a simple answer. There is no compelling evidence that one model of therapy is ‘better’ than another.
Therapy is an ever-evolving field
New (or ‘new and improved’) therapies seem to emerge all the time. Yet, for most of the common mental health difficulties and challenges that we face, the most robust studies show that, in outcome terms, the differences between therapies are negligible. If there’s a therapy you feel more drawn towards, that’s fine, but don’t get too hung up on the distinctions.
What’s more important are the factors that are common to what I would call all ‘bona fide’ therapies:
- The mechanisms by which individuals develop problematic levels of distress or dysfunction, and how that distress or dysfunction is maintained or perpetuated
- The focus and specific techniques or strategies involved in the therapeutic process
- The supposed ‘therapeutic mechanisms of change’ as they are known – in other words how the techniques or strategies serve to bring about change
Some therapists are remarkable. Your challenge is to find one.
In contrast with therapy models, which research suggests are broadly equivalent in their outcomes, therapists make a significantly greater contribution to the outcomes of therapy. Estimates vary, but some studies suggest the contribution to outcomes made by the therapist is between three and seven times greater than the therapy model.
I have a simple definition of effective therapy. For me, it’s the extent to which therapists can keep clients engaged in therapy to the point where it is possible to see a measurable impact on their difficulties and concerns. As therapists, we vary in our ability to do this. Some therapists are remarkably effective, others less so.
The building blocks of therapy
A vast amount of research effort has gone into identifying the effective elements of the therapy process. These include, on the part of clients, motivation, readiness for change, coping styles and resilience, expectations of therapy and hope.
On the part of the therapist, they include empathy, congruence (or being real), positive regard (or liking for the client), accommodating client preferences, and ability to foster what is known as the working alliance.
The working alliance is something that client and therapist create together. Decades of research has consistently shown, that of all the elements I’ve mentioned, its impact on what is achieved in therapy is among the most significant.
Rather than being one thing, however, the alliance is made up of three elements:
- Goals. In other words, where are we trying to get to? What is it that you, as client, want to achieve from this process?
- Methods. What’s going to be the most effective and efficient way to help you achieve those goals? Where do we start, even if we adjust our course along the way?
- Bond. This is the degree of ‘fit’ between us. Do we like and respect each other enough to make this journey together?
Finding a remarkable therapist
I can’t promise that this guidance will find you a remarkable therapist, but I can promise it will help you know what to look for.
In engaging a therapist you will want to find someone who is warm, accepting, and empathic. But this may not be sufficient in itself. Recall that I mentioned earlier the factors that characterise bona fide therapies, including therapeutic focus, techniques and strategies, and how these serve to bring about change.
As well as having a warm, empathic therapist, then, you also want one who is prepared to work collaboratively with you. They should be interested in your thoughts about your current difficulties, as well as being able to offer some insights of their own.
Together with you, they should be able to offer a compelling proposal about how you work together towards a resolution. This should provide you with a clear sense that your investment in the process will be worth it. It you’re not getting that feeling from a therapist, it might be advisable to move on.
Think like a consumer
I imagine the last time you bought a pair of shoes: you didn’t walk into the shop and buy the first pair you tried on? Chances are you tried a few before making a choice. I would encourage you to approach searching for a therapist in the same way. You need to find the best fit, and you have choices.
Here are some questions that I suggest you ask every therapist you consider working with, as well as a couple that any prospective therapist really should be asking you (They are also included in a more comprehensive guide I’ve produced as a free e-Book. It’s titled 5 Things You Need to Know About Choosing A Therapist, and you can download it from my website):
Questions you should ask a prospective therapist
- What’s your experience of working with people with the kind of issues I’m describing?
- What do you realistically think I can expect from therapy, given what I’ve outlined to you?
- How would you propose that we go about starting this work?
- How long would you expect it to take before I can realistically expect to see some sort of improvement?
- What happens if I’m not seeing improvement?
Questions a prospective therapist should be asking you
- What do you hope to achieve from this process? Ideally, what would you like to go away with by the end of our work together?
- I may have some ideas or insights that may help to explain your current difficulties, but I’m wondering what thoughts you may have that we should explore?
Takeaway
Therapy is highly effective, and, in general, there’s no compelling evidence that one model of therapy is more effective than another. Some therapists, however, consistently achieve better outcomes than others.
Bear in mind the three elements of the therapy relationship that make up the working alliance (goals, methods, and bond) as you ‘shop’ for a therapist. Finally, remember that while warmth and empathy are ‘must have’s’ in a therapist, they should also be able to work with you to create a purposeful direction for the work that is more than simply travelling hopefully.
You can download the free e-book 5 Things You Need to Know About Choosing a Therapist.
Barry McInnes is a therapist, coach and consultant, and co-founder of Therapy Meets Numbers, which aims to bridge the gap between therapy research and practice.
