Uncovering Traits of Effective Therapists

Kevin McCready, Ph.D.

Psychotherapy consists of a welter of competing techniques, each touted as a means of achieving better mental health. Yet clinicians and researchers have long noted that some therapists are more helpful than others, regardless of what techniques they employ.

A new analysis of data from an eight year old federal study of depression treatments underscores that observation and promises to shed some light on the personal approaches to treatment that make for outstanding psychotherapists.

"Significant differences exist in therapeutic efficacy among therapies, even the experienced and well-trained therapists in (this study)," write psychologist Sidney J. Blatt of Yale University School of Medicine and his co-workers.

The therapists who facilitated the greatest improvement in depressed clients said that they focused on psychological factors, such as distorted thinking and feelings of helplessness, rather than biological disturbances. Blatt's group reports in the December 1996 Journal of Consulting and Clinical Psychology. In addition, superior therapists generally used psychotherapy alone, rather than in combination with psychoactive drugs, in their practices. They also expected treatment for depression to take longer than less effective therapists did.

Clinicians who created a strong therapeutic alliance, a measure of the collaborative bond between therapist and client, were most successful, the scientists argue. One therapist was especially effective even when she simply offered support and advice in brief weekly sessions to clients who received placebo pills, suggesting that a talented clinician needs no formal techniques to exploit the therapeutic alliance.

Moreover, clients who perceived their therapists as empathic and caring responded best to antidepressants drugs. The new report derives from a study funded by the National Institute of Mental Health (NIMH) in Bethesda, MD., that uncovered few differences in the effectiveness of four treatments --two forms of psychotherapy, an antidepressant drug, and placebo pills --given over 16 weeks to 250 depressed people (SN: 12/2/89, p. 365). Drug and placebo clients received support and advice but no formal therapy.

Nine of the 28 therapists in the NIMH study elicited marked improvement from clients, regardless of the treatment to which they were assigned. Blatt's group notes. Another 9 therapists fostered moderate improvement, and 10 fell within a lower range of effectiveness.

"The NIMH study indicates that therapeutic alliance is more critical than the techniques a therapist employees or the drugs that may be prescribed," says psychologist Hans H. Strupp of Vanderbilt University in Nashville. "This is currently not a popular view among many researchers, and it isn't what health care insurers want to hear either."

Elements of the therapeutic alliance are poorly understood. Strupp states. As in any profession, he adds, psychotherapy has small cadres of excellent practitioners and of poor ones. --B.Bower.