What Makes Therapy Successful? Eight Evidence-Based Keys (Plus One Bonus)

When I was in therapy myself, I was always curious about what techniques were behind my therapist’s work. I read a lot about different psychotherapeutic approaches and wondered: Does my therapist know what’s best for me? Or should I try something else?

Those same questions stayed with me when I began studying psychotherapy. Which therapies actually work best? There are so many techniques out there. Which approach would be best for my clients? How could I know that what I was studying was truly the best I could offer?

Clients asked these questions too.

I had these questions in mind when I began to study psychotherapy. Which therapies work best as there are alot of techniques out there! Which therapy approach would work best for my clients? How could I know what I studied was the best I could offer to my clients? My clients asked me to differentiate between the therapies as well.

Research has consistently shown that certain common factors — such as therapeutic alliance and collaboration — are central to successful therapy. I explore those in more depth in What Makes Therapy Successful?

The Alphabet Soup of Therapy

CBT, EMDR, DBT, EFT, CBT-I - These are just a few of the many therapy approaches in use today. Every year, new techniques are developed, named, and copyrighted, along with new continuing education courses to match.

Early in my training, I held a mistaken belief: that if I could just learn the right techniques, I would become a successful therapist - and my clients would be “fixed.”

However, as I studied in graduate school, I found that forty years of empirical research proves otherwise.

What the Research Actually Shows

The evidence shows that common factors, not specific techniques, are the strongest contributors to successful therapy outcomes.

Research consistently finds that:

• 40% of change is related to client factors (such as ego strength, resilience, and social support)

• 30% is related to the client’s experience of the therapeutic relationship

• 15% comes from expectancy and placebo effects

• Only 15% is attributable to the specific technique used

  
  

This means the client plays a powerful role in the change process — and that a well-trained therapist can safely and effectively use an integrative approach rather than relying on one “magic” method.

What This Looks Like in Real Practice

As a new therapist, I focused on learning as many techniques as possible. I trained in humanistic therapy, expressive arts, guided imagery, cognitive behavioral methods, and more. All of it was helpful. It gave me a strong foundation.

But as I gained experience, I began to notice something deeper.

I met all sorts of different people, people with all sorts of stories, all wanting to feel better. Each person with his or her own unique story. Each person seeking help for feeling angry, anxious, depressed, grieving, controlling, dependent. Or coming in for therapy because the person s/he married turned out to be physically, financially or emotionally abusive. Or maybe s/he was raped when young, raped as an adult, beaten when young, or grew up in an alcoholic home.

Over time, a pattern emerged.

So I noticed some people come in and stick with the therapy and over time, make profound and lasting changes in their lives and in how they function and feel. And others struggle to sustain the process.

Eight Keys to Successful Therapy

The people who benefited most from therapy either already had — or gradually developed — the following qualities:

1. Realism

Being realistic about how therapy works, and understand it’s not a magic wand, but a process

2. Contribution

Be realistic about yourself, and be willing to explore what you may be contributing to the situation

3. Take Responsibility

Take responsibility for yourself, instead of blaming others

4. Emotional Intelligence

Be neither afraid of nor cut-off from your emotions, or be at least willing to expand your understanding about your emotions and then be willing to express (or learn to express) your emotions

5. Develop Healthy Thought Patterns

Be willing to re-evaluate your thinking patterns and work to create new thinking patterns

6. Learn Productive Coping Skills

Be willing to learn coping skills

7. Practice Coping Skills in Real Life

Learn to actively apply coping skills in real time, in real situations, and not just talk about them in session

8. Become an Active Creator of Your Life

Identifying meaningful goals and taking realistic steps toward building the life you want.

The Bonus Key: The Therapeutic Relationship

Make sure you feel comfortable and safe with your therapist, and that you can trust them consistently behave in a professional manner.

The strength of the therapeutic relationship, that is, the client’s ability to feel accepted by and comfortable with, the therapist, creates a safe container for your process of growth.

And your process is not a straight line. Usually your trust and the bond builds over time. Makes sure your therapist earns your trust by being consistent, caring, professional and knowledgeable.

Growth is rarely a straight line. The relationship is what allows the work to continue when things feel hard.

A Hopeful Closing

Year after year, both research and lived experience show that meaningful change is supported by client engagement and a strong therapeutic relationship — not by perfect techniques alone.

May this year be one in which you develop — and pursue — new dreams.

Many of the qualities that support successful therapy can be actively developed. DBT is one approach that focuses on building these skills step by step, in ways that can be practiced both in and out of therapy.