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Some courses of psychotherapy are more successful than others, despite the clinician's theoretical approach.

Studies indicate that the psychotherapist's efficacy may diminish over time.

There is more to choosing the right psychotherapist than considering their particular theoretical approach.

What are a few of the key characteristics of truly effective therapy? This question goes beyond the typical “evidence-based” argument commonly employed by researchers and clinicians to tout the superiority of one therapeutic approach over another, and is often considered by clients or patients when choosing a psychotherapist.

The reality is that the kind of efficacy I am referring to here transcends any particular type of therapy, be it CBT, DBT, REBT, ACT, Adlerian, positive psychology, person-centered, psychodynamic, psychoanalytic, Jungian, humanistic, existential, gestalt therapy, coherence therapy, narrative therapy, solution-focused therapy, etc., because there is variance of efficacy even within these various orientations to therapy. For instance, some courses of psychoanalytic or cognitive-behavioral therapy are more or less successful than others, and the same may be said of all the other therapy types.

How can we account for these significant differences in efficacy within these specific therapeutic approaches? And, more generally, what makes some courses of psychotherapy successful from the patient’s perspective and others not so successful? (See, for example, my previous PT posting about author Daphne Merkin’s deeply frustrating experience with therapy here.)

For some time now, researchers (2024) have been telling us that seasoned psychotherapists not only do not generally attain better outcomes in treatment, but, on average, they actually become somewhat less effective the more experience they accrue. How can that be?

Certainly, this is deeply discouraging news for the senior practitioner, who likes to think of him or herself as improving with age like a fine wine or cheese. If—and this is something difficult for some of us to do—we are to accept this counterintuitive phenomenon noted in scientific studies, including earlier ones that found no difference in therapeutic outcomes between........

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