The Secrets of Effective Therapists
by Marc G. Schramm, Psy.D., C.G.P.
A recent study by Blatt et al. (1996) suggests that effective psychotherapy has more to do with the therapist than with the techniques he or she employs. The study analyzes the data of the National Institute of Mental Health-sponsored Treatment of Depression Collaborative Research Program, with attention to evaluating the contributions of the therapist.
Blatt and his colleagues were able to divide the participating psychotherapists into three groups with regard to their degree of effectiveness. The clients of the most effective therapists showed marked improvement, regardless of the treatment method used.
Rather, those therapists who were most effective were those that paid more attention to psychological factors (for instance, feelings of helplessness, distorted thinking) as opposed to biological factors. These therapists tended to use psychotherapy by itself rather than in combination with psychotropic medication.
The most effective therapists were able to create a strong therapeutic alliance with their patients, and in fact those patients who saw their therapists as empathic and caring showed the best response to antidepressant medication. Highly effective therapists also expected treatment to take longer than did moderately effective and less effective psychotherapists.
Perhaps some of this research will come as a surprise to many, but the notion that personal qualities are in general more important than technical ones is hardly news (see, for instance, Frank, 1973). While this research is fully in line with my expectations, it unfortunately does not address group psychotherapy.
On reflection, I am unsure whether the same outcome would obtain for group therapists. After all, in individual therapy the therapeutic relationship is the context for treatment, so the personality of the therapist is intuitively a crucial therapeutic factor. In group psychotherapy, the corresponding therapeutic role is played by the group itself. This would suggest a higher degree of importance to technical skill, with the effective therapist being one who is able to mobilize the therapeutic potential inherent in the group (sometimes this means that the therapist has to know to stay out of the way!). Mastery of technique wouldn't be theory specific (recall Fiedler's 1950 study about the similarity between effective therapists of different orientations), but could still be more teachable than are personality traits.
Of course it could be that the therapist's personality itself can mobilize the therapeutic factors in group psychotherapy, but I'm not sure that the impact would be as significant as in individual psychotherapy. Then again, it could just be that nontechnical, personal qualities are equally important for the group and individual psychotherapist, but that the most effective personality types for each are somewhat different from each other. I'm thinking here of Beck et al.'s (1983) research into social roles in groups, such as the emotional and task leaders ("leader" here does not necessarily refer to the therapist's role).
Still, I know many therapists who are outstanding as both group and individual therapists, bringing the same personal qualities to both. But I also know therapists whose personal qualities do not impress me, but whose groups I know to be quite successful. Thus my guess remains that technical abilities are relatively more important for group as compared to individual psychotherapy, but that issues of style and personality can be an enhancement for both. What do the rest of you think?
Beck, A., Dugo, J., Eng, A., Lewis, C., & Peters, L. (1983). The participation of leaders in the structural development of therapy groups. Advances in Group Psychotherapy, ed. R. Dies and K. Roy MacKenzie. New York:IUP.
Blatt S. J., Sanislow, C. A., Zuroff, D. C., & Pilkonis, P. A. (1996). Characteristics of effective therapists: Further analyses of data from the national institute of mental health treatment of depression collaborative research program. Journal of Consulting and Clinical Psychology, 64:6, 1276-1284.
Frank, J. D. (1973). Persuasion and Healing (rev. ed.). Baltimore: Johns Hopkins University Press.
Fiedler, F. (1950). A comparison of therapeutic relationships in psychoanalytic, non-directive and Adlerian therapy, Journal of Consulting Psychology, 14:436-45.
Marc G. Schramm, Psy.D., is a Founding Certificant of the National Registry of Certified Group Psychotherapists, a clinical member of the American Group Psychotherapy Association, and President of the Tri-State Group Psychotherapy Society. He is currently Cincinnati-Dayton Regional Director for Counseling Consultants, Inc. Call Dr. Schramm at 513-984-9222
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