What Makes Effective Psychotherapy? YOU!

Janae B. Weinhold, PhD LPC

Are you an effective therapist? How can you become more effective in your work with clients? Psychologist George Rosenfeld’s book, Beyond Evidence-Based Psychotherapy,[1] looked at these questions, and he identified four factors:

  • Therapist’s understanding of client symptoms & ability to treat client’s core issues – 40%.
  • The therapist’s ability to form a warm, compassionate relationship – 30%.
  • Specific treatment approach – 15%.
  • Placebo effects – 15%.

Seventy percent of what makes therapy successful is the therapist, while their treatment approach and techniques only contribute fifteen percent! This is in direct contrast to the beliefs of most mental health practitioners, who spend countless hours taking treatment and technique focused trainings.

Rosenfeld also believes that evidence-based psychotherapy approaches aren’t effective because they often lack empathy, positive regard, respect, and genuineness. The also don’t recognize that the therapist, a human, is also a trauma trigger. This is particularly true for clients with developmental or relational trauma in their histories. The probability of creating transference/countertransference issues in the client-therapist relationship is very high—and something that techniques and treatment protocols can’t address.

Rosenfeld says that therapists need advanced interpersonal skills in order to work effectively with clients who have developmental trauma. They include the capacity to encounter and accept any extremely painful material that clients share, the personal grounding necessary for remaining fully present during the trust-building process, and the capacity for creating and sustaining an open-hearted connection during the transference and countertransference process.

This important research disputes behavioral healthcare’s over emphasis on evidence-based therapy approaches such as Cognitive Behavior Therapy. Rosenfeld says that mental health trainees need to spend more time learning how to build warm, compassionate relationships and how to put client’s presenting symptoms into a more relational context. I can say the same thing about psychotherapy that is not trauma-informed. It affects the safety in the therapist-client relationship and determines the degree to which clients can risk attaching to their therapists.

Beliefs also influence the ultimate outcome of therapy. Arthur Combs, a pioneer of humanistic counseling, identified five qualities of helpers that significantly distinguish between effective & ineffective psychotherapy:[2]

  • Their sensitivity, empathy and ability to understand the beliefs of their client.
  • Their beliefs about clients’ ability to solve their problems.
  • Their feelings about themselves.
  • Their purpose in life.
  • Their authenticity and methods.

Other Suggestions for Effective Therapy:

  • Heal your own family-of-origin traumas to avoid creating countertransference with your clients.
  • Use therapy contracts that identify the goals and outcomes of psychotherapy. This creates the boundaries that are so necessary for safety and trust in the client-therapist relationship.
  • Include time-limits in these renewable contracts, which creates points for evaluating progress in reaching the therapeutic goals. Most clients need periodic windows to integrate their learning, which also encourages autonomy and individuation in the therapeutic relationship.
  • Strive to be authentic and interact from your True Self rather than hiding behind an impersonal mask. This is different than trying to be perfect. Allow yourself to be human and to make amends when you trip up. These moments are transformative for clients!
  • Avoid oversharing personal information and problems in an effort to build rapport with clients. They are looking for a role model who has walked their path and mastered it.
  • Be alert for signs of countertransference issues, such as working too hard to help a client. When you are working harder than your client, you’re in countertransference!

Several theorists have proposed that people who hold deeply ingrained beliefs that the world is a benevolent, predictable, and meaningful place, and that the self is worthy experience a sense of security and invulnerability experience more coherence into their lives. Traumas and other kinds of adverse experiences can profoundly challenge these beliefs, an important component of effective therapy.

Become a more effective therapist—take CPDC’s trauma-Informed, attachment-informed, and developmental trauma-informed training for healthcare practitioners. We offer Practitioner and Trainer Certificate Trainings in a 5-day intensive retreat model and a 4-days over two months model. Visit CPDC’s website for more information and to register.


[1] Rosenfeld, G. (2009.) Beyond evidence-based psychotherapy. New York: Routledge, pp. 13-46.
[2] Combs, A. & Gonzalez, D. (1994). Helping Relationships: Basic concepts for the helping professions, 4th Edition. Allyn and Bacon Publishers.



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