Getting the Most Out of Therapy: Understanding What Works

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Working with a counsellor or therapist is not like calling in a plumber to fix your pipes or a roofer to stop the rain dripping in. The relationship between client and therapist is much more complex than that, and the relationship itself — as well as the specific factors the client brings to the encounter — have a much greater impact on the eventual outcome.

How to Choose an Effective Counsellor or Therapist, and Understanding the Research Evidence

Delving into the details of how to choose a counsellor or therapist is well beyond the scope of this site, and likewise we can’t do more than skim through a few major conclusions from the mountain of research evidence available on therapeutic effectiveness and efficacy. For a guide on choosing a therapist, we recommend this article on Selecting a Counsellor or Therapist, which includes a long list of questions which may be important to you when making your decision. The questions cover confidentiality and security, ethics and supervision, qualifications, fees and contracts, effectiveness, and experience. Additional resources on some of the available research evidence on counselling effectiveness are included in the summary below.

Counselling Works, But Some Counsellors Work Better than Others

Empirical evidence about the effectiveness of counselling and psychotherapy overall — both in the short term and over longer periods — is relatively unambiguous: counselling does work. Less clear, however, is the evidence on the effectiveness of specific types of counselling or psychotherapy: overall, no one therapeutic approach stands out as offering better results than any other. (Evidence from efficacy studies is gradually accumulating to indicate that some specific kinds of distress are particularly well addressed by certain approaches, however: clients with panic disorders, for instance, often respond particularly well to cognitive behavioural therapy.)

While no one type of therapy stands out in terms of overall effectiveness, however, individual counsellors clearly do. Within given approaches, research shows very significant variation between individual counsellors. Indeed, the evidence suggests that the abilities of individual therapists may be a more significant factor in determining outcome than therapeutic orientation! There certainly are better and worse therapists, but the research evidence does not yet offer much insight into exactly why one therapist might be better or worse for a given client than any other.

For an overview of some of those factors which are associated with clinical effectiveness, see this lengthy review of the 1999 Hubble et al. volume called The Heart & Soul of Change. An entertaining article called Therapy Effectiveness? It’s the Relationship, Stupid focuses especially on the relationship factors which stand out as among the most important determinants of therapeutic outcome, while Evaluating Therapeutic Effectiveness in Counselling And Psychotherapy has more to say on comparative studies and the role of research in effective practice more generally.

What About Accreditation and Effectiveness?

For someone trying to figure out who might offer an effective service, there is no evidence that any of the various counsellor accreditation schemes serve to pick out better therapists, and neither years of counsellor experience nor years of training have any strong bearing on therapeutic outcome. Indeed, some research has even suggested that counsellors in training and newly-qualified counsellors are more effective than their more experienced peers! (Lambert and Bergin’s 1994 article includes useful results on individual counsellor effectiveness, while Beutler et al. in that same volume cover cross-study correlational data indicating that levels of experience and therapist training are almost irrelevant to therapeutic outcome.)

What accreditation schemes do guarantee is that a practitioner has completed a particular level of training and/or has acquired a particular volume of experience as specified by the relevant accrediting body. However, accreditation provides no guarantee of service quality. As indicated above, empirical studies have repeatedly shown no positive correlation between the types of educational achievement required by licensing or accrediting bodies and actual clinical effectiveness. (For a provocative argument that licensing and regulation schemes actually have much more to do with some practitioners’ desire for status and prestige than with serving the public good, see Mowbray’s 1995 book.)

Ethical Frameworks

At, we believe that a counsellor’s commitment to adhere to a recognised ethical framework is far more important than the specific details of their educational background. See our page on safety for more on this.

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