Green Flags: What a Great Therapist Does Differently

Finding the right therapist can sometimes feel like a guessing game. When you’re scrolling through websites, everyone seems nice. But how do you actually know who is going to help you feel better?

Here’s what the research actually says about what makes therapy work. It turns out that highly effective therapists have specific traits and habits that set them apart!

Let's look over some "green flags" you should look for, and some things to look out for that aren’t so helpful to your goals.

The Green Flags: Traits of Highly Effective Therapists

Great therapists aren’t just passive listeners; they have strong skills that help you make real changes. Here is what a highly-effective therapist incorporates into their work:

A strong therapeutic alliance: In a nutshell, this is their capacity to bond with you. It means you both agree on what your goals are, and you both understand the tasks at hand… which are the actual steps that need to happen to get you to those goals.
Adaptability and flexibility: They are responsive. They can make adjustments as new emotions, stories, and information arise.
Professional self-doubt: This sounds funny, but confidence and effectiveness in therapists are actually inversely related! A good therapist has professional self-doubt, which allows them to see nuance and difficulty. Because they don't assume they know it all, they are willing to adjust, change their minds, and adapt to you.
Honing their craft: The best therapists spend time in solitary practice (Miller & Chow, 2018). Interestingly enough, if a therapist has a laundry list of training certificates, that is not an indicator of how effective they will be. What makes the biggest difference is how much time they spend practicing their skills outside of your appointments. Think of it like learning to play an instrument versus actually making music with it.
Strong interpersonal skills: Surprise! Good therapists are "people people." Research shows they have strong facilitative interpersonal skills, including verbal fluency, empathy, warmth, positive regard, and attunement (Anderson et al., 2009). They can pick up on what isn’t being said, and they have the ability to handle confrontation or ruptures in the relationship without getting defensive.

Red Flags: Traits That Can Be Damaging

There are some traits that are associated with therapists who can actually be damaging to the therapy process (Wolberg, as cited in Castonguay & Hill, 2017). You’ll want be mindful of the impact on your care if a therapists show a tendency toward:

Being domineering, pompous, authoritarian, detached, passive, or over-submissive.
Having an excessive need to be liked or admired.
Perfectionism and creative inhibition.
A poor sense of humor.
An inability to receive criticism, tolerate blows to their self-esteem, or accept their own self-limitations.
Low levels of personal integrity, or not compensating for a basic lack of satisfaction in their own living.

Why the Journey Takes Time (and Why Lower Drop-Out Rates Matter)

Research shows that 8 sessions is widely considered the minimally adequate treatment, meaning it’s the baseline to begin seeing real and longstanding change. That’s not to say you cannot benefit from doing less than 8 sessions, but research continues to show that longer-term therapy always beats out shorter-term therapy in outcomes.

Because of this, an important skill of a therapist is to engage their clients to have them want to stick around for the journey.

Highly effective therapists have a much lower drop-out rate because they are great at engaging with their clients and building that therapeutic alliance. It just makes sense! If a minimum of 8 sessions is needed to make significant and meaningful progress, a therapist has to build a solid bond. If they don't, the client drops out early and likely won't meet their treatment goals.

Don’t know if you are making progress in therapy? Here’s our blog on how to figure that out or what to do if you feel you have reached a stuckpoint.

Inside a Great Session: Goals, Plans, and Structure

This is what makes therapy different from just talking to a friend. It’s the structure, goals, and tasks of the alliance. When you are working with a great therapist, your care will look like this:

1. Collaborative Goal Setting

A good therapist will help you understand your goals and work on the goals YOU want to achieve… not what they think you should work on. They will know exactly why you are coming to therapy, and you will leave sessions feeling heard, understood, hopeful, and a bit more in control.

2. A Living Treatment Plan

Good therapists have a plan for your care and work collaboratively with you on it. You should be taken along on the journey! You deserve a treatment plan that you like, believe in, and understand. Overall, the plan should just make sense to you.

A treatment plan is a living document, and a good therapist will update it as your work updates together. They make sure you know how the treatment plan is translated into therapy, so you always know, "What the heck are we doing here?"

3. Constant Feedback (Feeding it Forward)

The truth is therapists are actually not very good at determining how well therapy is going on their own. This is why feedback and measurements are so important.

One way therapists are more effective is by getting feedback from YOU! This is why some of our therapists at Cultivate Mental Health use a super short pre-session survey called the Outcome Rating Scale to check in with where you are at. At the end of sessions, we use another short survey called the Session Rating Scale.

These allow us to make our therapeutic alliance really strong, ensure we are on the same page as you, and feed that feedback forward to adapt and pivot our work and treatment plans as needed. I know measurements can sometimes get a bad wrap, but when used well measurements act as conversation starters and help us catch blind spots!

How to Pick Your Therapist

When you are ready to choose a therapist, here is how I recommend you go about it:

Make sure they are licensed! In Ontario, there are 6 regulatory colleges whose members are legally allowed to provide psychotherapy as a treatment:

College of Registered Psychotherapists of Ontario (CRPO)
College of Psychologists of Ontario (CPO)
Ontario College of Social Workers and Social Service Workers (OCSWSSW)
College of Physicians and Surgeons of Ontario (CPSO)
College of Nurses of Ontario (CNO)
College of Occupational Therapists of Ontario (COTO)

Look for evidence-based modalities. A therapist should be clear about the modalities they use. The specific modalities don't matter as much as two things: 1) are they evidence-based, and 2) do they click with you? Do you feel they will help you?
Look for feedback-informed care. Look for a therapist who uses outcome monitoring and integrates your feedback into an adaptive treatment plan or alternatively they ask for specific feedback and you feel comfortable giving honest feedback.
Check for warmth. Do you get a sense this person likes you? Do you feel respected, and do you feel like your goals are respected?

Therapy is a collaborative journey, so make sure you're choosing a partner who takes pride in their craft, seeks feedback and pivots to fit your needs!

References & Resources

Anderson, T., Ogles, B. M., Patterson, C. L., Lambert, M. J., & Vermeersch, D. A. (2009). Therapist effects: Evaluated by interviews and a simulated therapist task. Journal of Clinical Psychology, 65(7), 755-768.
Castonguay, L. G., & Hill, C. E. (Eds.). (2017). How and why some therapists are better than others: Understanding therapist effects. American Psychological Association. (Citing Wolberg's historical data on negative therapist traits).
Miller, S. D., & Chow, D. (2018). The better therapist: How to improve your clinical effectiveness through deliberate practice. Psychotherapy Networker.
Government of Ontario. Regulated Health Professions Act, 1991. (Defining the 6 professional colleges authorized to perform the controlled act of psychotherapy).