Doing “Good” Therapy vs. Being a “Good” Therapist

What separates good therapists from great therapists? If you’re seeking a treatment provider, you’re likely to start by looking for a therapist with the right traits (such as compassion, empathy, and good listening skills). If you find those, it seems likely that the rest will follow. Right?

While the qualities listed above contribute to good therapy, great therapy requires hard work on the therapist’s part. Though therapy may – at times – feel like a healing conversation, successful therapy actually involves discreetly hard work by therapists to “do” therapy well (rather than “be” good therapists). In other words, skilled therapists behave in specific ways that foster healthy, therapeutic relationships with patients (this relationship is often called the working alliance or therapeutic alliance). This is done in a few ways:

Successful therapists meet patients as they come to therapy

Unlike people in your daily life, a good therapist comes into your life without expectations or any sort of agenda. They use therapy to determine who you are and what life is like for you, and they craft treatment goals based on your wants and needs as they are when you begin therapy. In other words, the therapist meets you as you are. They may want and encourage healthy behaviors for you, and they may cheer you on when you succeed, but they are not personally invested in the choices that you make.

Successful therapists collaborate and partner with patients

Therapy is a two-sided process, which means that the relationship between therapist and patient is an act of collaboration and partnership. Late psychologist Dr. Jeremy Safran described the relationship between therapist and patient as a constant interaction (American Psychological Association, 2009). Therapy sessions are not static situations in which a patient talks and a therapist listens. Rather, therapy is a dynamic process in which therapist and patient interactions are an essential part of the equation.

Successful therapists level the playing field

Patients come to therapy with expectations of a power differential (the therapist is the “expert,” and the patient is at the mercy of their expertise). Successful therapists attempt to minimize this power differential by working together as equals. In other words, interactions between the therapist and patient convey that both therapist and patient contributions carry equal weight during sessions.

Successful therapists foster successful interpersonal interactions

Therapy tends to work best when therapists can provide examples of positive social interactions. That is, when therapists respond to patients in ways that promote safety, patients tend to remain more engaged in therapy and make greater interpersonal gains outside of therapy. Psychiatrists John C. Markowitz and Myrna M. Weissman (2004) describe a successful therapeutic relationship (also known as a therapeutic alliance or working alliance) as one that “yields success experiences.” In other words, an effective therapist fosters positive experiences during therapy. This may look like responding positively when confronted about something (rather than reenacting unhealthy behaviors that patients may see in other people in their lives).

Successful therapists acknowledge the relationship

Therapy is most successful when therapists and patients address the fact that therapy is taking place. Essentially, the patient and therapist acknowledge that the therapist is an observer, and they openly discuss the dynamics of the therapeutic relationship. This may look like discussing how the therapist and patient will work together and providing examples of the therapist’s role.

In short

In their textbook Interpersonal Process in Therapy: An Integrative Model, Seventh Edition (2017), psychologists Edward Teyber and Faith Holmes Teyber note that therapists who do the above provide the promise of “a safe haven.” In other words, collaboration and purposeful therapist behaviors show patients that safety is possible (in any type of relationship). This improves a patient’s engagement in therapy and comfort with the therapeutic process, which can help patients feel better in the long run.

References

American Psychological Association (Producer). (2009). Session 1 [Video segment]. In Psychoanalytic Therapy Over Time (DVD). Series VIII – Psychotherapy in Six Sessions.

Markowitz, J. C., & Weissman, M. M. (2004). Interpersonal psychotherapy: principles and applications. World Psychiatry, 3(3), 136–139.

Teyber, E., & Teyber, F. H. (2017). Interpersonal process in therapy: An integrative model (7th ed.). Belmont, CA: Brooks/Cole.