The ability to perceive the positive sides of a person and to be self-critical about their own skills separates the wheat from the chaff among therapists. (Photo: Colourbox)
The ability to perceive the positive sides of a person and to be self-critical about their own skills separates the wheat from the chaff among therapists. (Photo: Colourbox)

Humble therapists get better results

A therapist's personal traits have a strong effect on the treatment. A humble therapist will be more sensitive to the patient.

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In conversational therapy patients are commonly urged to broach deeply personal and burdensome topics. This can be uncomfortable, and obviously it can be all the more difficult if the patient lacks a good relationship with the therapist.

A new study indicates that a therapist’s personal traits have a strong effect on the amount of benefit patients get from therapy.

A therapist who bristles with professional self-confidence doesn’t necessarily provide good treatment. This is a discovery that surprised psychologist and researcher Helene Amundsen Nissen-Lie:

“We found that therapists with self-doubts about their own competence had patients who gained more from their therapy.”

Researcher Helene Amundsen Nissen-Lie thinks better therapists are self-aware. (Photo: Svein Harald Milde, UiO)
Researcher Helene Amundsen Nissen-Lie thinks better therapists are self-aware. (Photo: Svein Harald Milde, UiO)

She thinks research of psychotherapy for some time has neglected this issue of individual differences among therapists – the therapist effect – perhaps because the responses can be unpleasant.

Eating humble pie

The study indicating that a little self-deprecation can be a positive attribute for a therapist is part of Nissen-Lie’s doctoral dissertation at the Department of Psychology at the University of Oslo (UiO).

“We think the connection here is that therapists who confess to having self-doubts are also more apt to reflect on their contributions to the therapy. This indicates they are humbler, and thus more sensitive and attentive to the patient,” she says.

The researcher says it’s been seen that those who readily admit to shortcomings as a therapist get better results than those who are more reluctant or consider themselves less likely to err.

Nissen-Lie stresses that in this context the issue doesn’t concern severe self-doubt. If the therapist is truly lacking in self-confidence this could readily have a negative impact on a patient’s trust. 

One of ten achieve poor results

The point of departure for the study was stemmed partly from previous research that indicates one out of ten therapists will experience poor results with their patients.

Poor results in this context means the patients do not improve or in some cases even get worse because of the therapy.

“The chemistry one achieves with individual patients has been discussed within the profession, but based on these findings from the study I think there are also individual variations among therapists that shine through and affect the patients,” says Nissen-Lie.

Irritatation leads to poor treatment

Therapists’ considerations of their own competence were not the only factors impacting treatment.

Nissen-Lie’s study shows their attitude toward individual patients also affected the outcome.

Psychotherapists who say they often get angry or irritated with patients and strive to cope with patients’ emotional needs achieve weaker alliances – or positions of trust – with these patients.

Certain patients have problems with interpersonal relationships. For instance they might be prone to say provocative things. Nissen-Lie thinks it’s essential for therapists to find qualities in their patients that they can like or respect.

“We know from earlier studies that there’s a clear connection between alliances and patients’ improvements,” she says.

The researcher compares the findings with the way a good teacher affects pupils’ learning achievements.

“Educational research has shown that the teacher has more effect on pupils’ results than, for instance, educational reforms or the size of classes,” she says.

Working on the relationship helps

Nissen-Lie asserts that changing therapists isn’t necessarily the right solution for patients who are dissatisfied with the treatment they’re getting. In fact, treatment can benefit if therapist and patient can use a poor situation constructively.

“Working out the difficulties in relationship to the therapist has been proved to enhance change in a patient,” she says.

This is because many patients have negative life experiences that cast a pall on their image of the therapist. Working through the negativity toward a goal of a positive relationship can help in similar relationship situations the patient will encounter later in life.

The problematic relationship between the therapist and the patient can also provide both parties with insight into the mechanisms that cause problems in the patient’s daily life.

Therapists need to work on themselves

The main focus of psychotherapy research has been on diverse methods and techniques as well as distinctions between patient groups, rather than the study of the therapist effect, according to Nissen-Lie.

She suggests two likely reasons:

“The notion that personal traits can have a greater impact on the outcome of treatment than choice of methods, or their education, can make some therapists uncomfortable, particularly since they have invested so much time on the latter two.”

She stresses that choice of methods is important too, but methods lose efficacy if therapists neglect to work on themselves and their communication style.

“The idea that certain therapists fail to do a good job because of their personal traits can also be unsettling,” thinks Nissen-Lie.

The patient is still key

A patient’s motivation and the gravity and complexity of his or her problems will still affect the outcome of treatment more than differences between individual therapists.

“But we can’t do anything about the differences among patients – we have to meet them as sensitively and flexibly as we can,” says Nissen-Lie.

Her study is a part of a larger research prosject on the process and outcome of psychotherapy, which involved a large selection of adults in out-patient treatment and their therapists in the public mental health service.

Approximately 250 patients and 70 therapists are comprised by Nissen-Lie’s study, which is based on individual therapy.


Read the article in Norwegian at

Translated by: Glenn Ostling

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