Why does therapy sometimes feel life-changing, and other times not so much? It’s a question clients and psychologists have asked for years.
Researchers have studied it closely. In 2017, psychologists Louis Castonguay and Clara Hill brought much of this work together in the book How and Why Are Some Therapists Better Than Others?[1] Here’s what the research tells us, and how you can use it to find a therapist who’s right for you.
At a glance
- Some therapists do consistently get better results than others. This is called the “therapist effect”.
- It’s less about which technique they use, and more about how they relate to you, adapt, keep learning and ask for feedback.
- You’re allowed to look for a good fit, ask questions, and say if something isn’t working.
Do some therapists really get better results?
Yes. Across many studies, some therapists’ clients consistently improve more than others’. A 2019 review found that, on average, about 5% of the difference in client outcomes comes down to the therapist, and in some studies much more.[2]
That might sound small. But it means the same person, with the same concerns, could have a noticeably different experience depending on who they see. It’s also worth knowing what matters most of all: you. Your strengths, support, circumstances and readiness play the biggest part in how therapy goes. A good therapist works with all of that.
6 things effective therapists tend to do
Strong people skills
Effective therapists tend to have strong “facilitative interpersonal skills”. These include warmth, empathy, clear communication and the ability to offer hope. In one study, therapists who showed these skills with challenging simulated clients went on to get better results with real clients.[3]
They build, and repair, the relationship
The working relationship between you and your therapist, often called the therapeutic alliance, is one of the strongest predictors of good outcomes.[4] Good therapists notice when something feels off, and talk about it with you rather than ignoring it.
They use techniques flexibly
Approaches like CBT, ACT and EMDR are useful frameworks. But a meta-analysis found that how closely therapists stuck to a treatment manual wasn’t linked to how well clients did.[5] Skilled therapists adapt the approach to you, rather than following a script.
Healthy self-doubt, with self-kindness
It sounds surprising, but therapists who sometimes questioned their own professional skills had clients who improved more. The best results came from therapists who combined that humility with kindness towards themselves.[6] It’s curiosity, not a lack of confidence.
They keep practising
Like musicians or athletes, some therapists set aside time to deliberately practise difficult skills. In one early study, the most effective therapists spent much more time on this than their peers. Years of experience alone didn’t predict results.[7]
They ask for your feedback
Effective therapists don’t assume therapy is working. They check in with you about progress and about the relationship, then adjust. A meta-analysis found that regularly tracking progress and feedback improved outcomes, especially for people who weren’t doing well.[8]
What this means for neurodivergent clients
For ADHD, autistic and AuDHD people, feeling understood can make all the difference. Many have had therapy before that tried to make them seem less different, rather than helping them thrive. A good fit might look like a therapist who:
- Asks how you communicate best, and adjusts, whether that’s direct language, written notes or time to think.
- Welcomes breaks, fidgets, movement, or having your camera off on telehealth.
- Sees your neurotype as part of who you are, not something to fix.
- Understands masking, burnout and rejection sensitivity.
Read more about our neuro-affirming therapy.
How to tell if a therapist is a good fit
After the first few sessions, ask yourself:
- Do I feel listened to?
- Do I feel respected, not judged?
- Do we agree on what we’re working on?
- Does the approach make sense to me?
- Do they check how it’s going?
- Could I tell them if something felt off?
And some questions you can ask a therapist at the start:
- “What’s your experience with what I’m going through?” Experience in your area matters more than a title.
- “How do you usually work?” A good therapist can explain their approach in plain language.
- “How will we know if therapy is helping?” Look for someone who’s open to reviewing progress with you.
- “What if I’m not happy with how it’s going?” The answer should be “Tell me”, without any defensiveness.
It’s okay to say it’s not working
Good therapists want to know. Telling them often makes therapy better. And if it’s still not the right fit, it’s okay to find someone else. That’s not failure. It’s looking after yourself.
How we approach therapy at Psychcare
- The relationship comes first. We take time to understand you, your goals and how you like to work.
- Approaches that fit you. We draw on CBT, ACT, DBT skills, EMDR and other evidence-based approaches, adapted to how you think.
- Your feedback matters. We’ll check in regularly about how therapy is going, and you’re always welcome to tell us what is and isn’t working.
- Ongoing learning. MJ is a Psychology Board Approved Supervisor and takes part in regular professional development and supervision.
Not sure if we’re the right fit? A free 15-minute call is a low-pressure way to find out. See therapy and support for more.
Common questions
How long before I know if a therapist is right for me?
Many people get a sense of fit within the first few sessions. If you’re unsure, talk about it with your therapist. That conversation itself often helps.
Is it rude to change therapists?
Not at all. Therapists understand that fit matters. You can say so directly, or simply book with someone else.
Does a more experienced therapist always get better results?
Not necessarily. Experience helps, but in one study years of experience on their own didn’t predict outcomes. Ongoing learning and openness to feedback seemed to matter more.
Should I see a registered or clinical psychologist?
Both are fully qualified. What matters most is experience with what you’re going through, and how comfortable you feel together. See our FAQ for more on the difference.
Keep reading
Looking for a psychologist in Wahroonga?
We offer warm, neuro-affirming and trauma-informed therapy for children, teens and adults, in our Wahroonga clinic or by telehealth anywhere in Australia. Book online, call us, or start with a free 15-minute chat.
(02) 9037 3509Suite 4 & 5, 5 Redleaf Avenue, Wahroonga NSW 2076. Psychcare is not an emergency service. If you or someone you know is in immediate danger, call 000 or contact Lifeline on 13 11 14.
Sources
- Castonguay, L. G., & Hill, C. E. (Eds.). (2017). How and why are some therapists better than others? Understanding therapist effects. American Psychological Association.
- Johns, R. G., Barkham, M., Kellett, S., & Saxon, D. (2019). A systematic review of therapist effects: A critical narrative update and refinement to review. Clinical Psychology Review, 67, 78–93.
- Anderson, T., Ogles, B. M., Patterson, C. L., Lambert, M. J., & Vermeersch, D. A. (2009). Therapist effects: Facilitative interpersonal skills as a predictor of therapist success. Journal of Clinical Psychology, 65(7), 755–768.
- Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340.
- Webb, C. A., DeRubeis, R. J., & Barber, J. P. (2010). Therapist adherence/competence and treatment outcome: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 200–211.
- Nissen-Lie, H. A., Rønnestad, M. H., Høglend, P. A., Havik, O. E., Solbakken, O. A., Stiles, T. C., & Monsen, J. T. (2017). Love yourself as a person, doubt yourself as a therapist? Clinical Psychology & Psychotherapy, 24(1), 48–60.
- Chow, D. L., Miller, S. D., Seidel, J. A., Kane, R. T., Thornton, J. A., & Andrews, W. P. (2015). The role of deliberate practice in the development of highly effective psychotherapists. Psychotherapy, 52(3), 337–345.
- Lambert, M. J., Whipple, J. L., & Kleinstäuber, M. (2018). Collecting and delivering progress feedback: A meta-analysis of routine outcome monitoring. Psychotherapy, 55(4), 520–537.
This article is general information, not personal clinical advice.