What Makes “Good Therapy”?

Good Therapy Relationships are like Kintsugi

Introduction

Choosing to enter therapy is a significant decision, and it's common for new clients to ask “What is good therapy?” There’s even an entire site… goodtherapy.com… that tries to explain this!  As we are a group of professional therapists, although typically for folks seeking an NC therapist or a Durham NC therapist, we can simplify this for most folks seeking to answer this question on the internet. Therapy is much more than just talking about your problems; it's about creating a qualitatively unique collaborative relationship with your therapist that fosters growth, healing, and change for the better.

The Importance of the Therapeutic Relationship

At the core of any successful therapy is the therapeutic relationship. The “therapeutic relationship” is built on trust, understanding, and mutual respect, and not simply a friendship or a business relationship.  It is a qualitatively unique connection that serves as a catalyst for change.

Therapists skilled in establishing these kinds of connections, do so in part by maintaining a central focus on this relationship. This focus is not just about understanding the client's presenting concerns (although that is crucial), but also about exploring the interpersonal dynamics that unfold within the therapy sessions themselves between the therapist and the client (or each partner or family member in multi-person formats). It's about creating a safe space where clients can express their core emotions, needs and hopes without judgment.

Maintaining this focus allows the therapist to truly understand their client's experience of their inner and outer worlds and respond effectively to their in-session emotional needs. It's this focus that can help clients overcome challenges, heal from their wounds, and acheive a more fulfilling life.

Working Alliance: The Therapist and Client as a Team

The working alliance refers to the collaboration between the therapist and client in the therapeutic process. It's about establishing shared goals, agreeing on tasks or strategies to achieve these goals, and building and maintaining the bond that encourages and reinforces intimacy and trust.

Whether a client engages with an in-person therapist or opts for online counseling, a good working alliance is built by actively engaging with a client, empathizing with their experiences, and tailoring therapeutic strategies to each client’s unique needs and circumstances. Therapists who do this invest in understanding a client’s perspective and collaborate with them in setting and working towards their therapy goals.

When a strong working alliance is forged, it facilitates and enhances positive therapy outcomes. Clients feel understood, validated, and motivated to actively participate in their journey towards healing and growth, and ruptures are detected and repaired along the way. A robust working alliance helps clients navigate the challenging terrain of self-exploration, developing insight and making meaningful changes.

Managing Countertransference

Countertransference is a concept in therapy that refers to therapists’ emotional responses/reactions towards a client, often influenced by therapists’ own personal relational experiences and unconscious feelings. These reactions can be both positive (such as warmth and caring) and negative (like irritation or boredom).

For the therapeutic relationship, managing this adaptively is essential. It's not about eliminating countertransference… we can’t; all humans have this. Instead, it involves recognizing one’s own countertransference, understanding how it may be affecting (positively and/or negatively) the therapeutic relationship, and adjusting their responses appropriately in service to the client and their goals.

By effectively managing countertransference, therapists can better maintain their professional role, attend to the working alliance (see above) and the real relationship (see below). This allows them to maintain an intersubjective perspective, ensuring that their responses and strategies remain focused on their client's needs rather than their own. In this way, therapists can support the therapeutic process by way of their part in the relationship, enhancing its effectiveness.

Privileging the Real Relationship

The Real Relationship in therapy refers to the genuine, human connection between the therapist and the client, and is evidenced to be an important mechanism in how therapy works. It means recognizing, always in service to the client, the emotional reactions based in the here-now experiences between the therapist and the client throughout their work.

When a personal therapist privileges the real relationship, they create an environment of genuine warmth, respect, and understanding. They present themselves not as distant professionals, but as empathetic human beings who genuinely care about their clients' wellbeing. This usually enhances the sense of honesty and trust in the therapeutic relationship, and is often healing to clients who receive this: The therapist being authentic allows the client to be more authentic too. Clients can feel more comfortable revealing their true selves, sharing deeper core emotions: fear, sadness, anger, joy, delight, vitality and so on. The honest exchanges and the processing of these experiences can lead to transformative experiences and profound insights which pave the way for accessing a truer core self and meaningful change. In essence, privileging the real relationship makes therapy a truly transformative experience.

Alliance Ruptures and Repairs

Alliance ruptures are disruptions or strains in the therapeutic relationship. They can occur for a variety of reasons, such as misunderstandings, disagreements, or unmet expectations. These can hinder the therapeutic process if not detected and addressed properly by the therapist. A skilled therapist remains attuned to subtle changes in the dynamics of the therapeutic relationship and can recognize when a rupture has occurred. This might involve the client seeming less engaged (withdrawal rupture) or expressing dissatisfaction with the therapy process (hostility rupture).

Once a rupture is detected and acknowledged, the therapist can take steps to facilitate repairs. This involves acknowledging the rupture, privileging the client to express their feelings and thoughts about it, the therapist then expressing their own feelings and thoughts about the rupture and the impact it has had on the client, and the collaborating with the client to find a way forward. By managing these ruptures effectively within the relationship, the therapist ensures integrity and progress in the process. Despite any temporary setbacks ruptures may seem to indicate, the process of these repairs strengthen the working alliance, deepen trust, and privilege the real relationship.

Therapy Effectiveness is more than Credentials and Experience

When seeking therapy, it's common to consider a therapist's model of therapy (i.e. EFT vs CBT vs IFS vs Gottman vs ACT etc), professional affiliation (Psychologist vs Clinical Social Worker vs Marriage and Family Therapist), years of experience, and post-graduate certifications. While these factors are important to acknowledge, none determine or guarantee effective therapy on their own. The factors above about a strong therapeutic relationship with a robust working alliance, adaptively managed countertransference, strong emphasis on the real relationship, and skillfully navigating alliance ruptures and repairs, are more reliable predictors of success in nearly every research or clinical study on psychotherapy effectiveness.

The therapist's personal traits and interpersonal skills are what we believe make the most difference in any therapy's success. Empathy, authenticity, responsiveness, and client-centered adaptability can be more impactful than professional attributes. A therapist with exceptional listening skills, demonstrated emotional intelligence, and genuine regard for their clients’ well-being and healing can facilitate meaningful change regardless of their theoretical orientation,  professional credentials, certification status, or years of experience.

Effective Therapy Across All Age Groups and Formats

The importance of these relational factors extends to therapy with all demographics and in all formats. Whether therapy involves children, adolescents, adults, couples, families, or groups, the foundational elements of a strong therapeutic relationship, effective working alliance, and adept management of the therapy process remain the same.

Moreover, these principles apply regardless of whether you're doing therapy in-person or virtually. Both formats can be highly effective when the therapist prioritizes the factors mentioned in this post. In the end, it's not where therapy takes place or the client's age or circumstances that matter most, but the quality of the therapeutic relationship and the facilitative interpersonal skills of the therapist.

Conclusion

In conclusion, effective therapy goes beyond a therapist's credentials or model of therapy. It's anchored in the emotional depth and responsiveness of the therapeutic relationship, the quality of the working alliance, the attention to a healthy real relationship, and the ability to detect and repair alliance ruptures. These are, we believe, the heart of “good therapy”, forming the bedrock on which transformation, healing and growth can occur.

If you're seeking therapy, it's crucial to find a therapist who understands and prioritizes these aspects. Whether you're looking for an online therapist or an in-person therapist in North Carolina, remember these factors when making your choice.  Whether you're in the heart of Durham near our home offices, in one of the metropolitan hubs (i.e. Charlotte, Asheville, Wilmington, Raleigh, Fayetteville, Greensboro, New Berne, Winston-Salem, etc.) nestled in a micro metropolitan area (i.e. Greenville, Rocky Mount, High Point, Hickory), or anywhere in between in North Carolina, remember that the effectiveness of therapy hinges on these critical factors. In your search for a therapist, prioritize those who recognize this and are committed to providing the highest standard of care with this in mind.

The journey of recovery and change can appear daunting, but with the right therapist, you'll have the support and guidance you need every step of the way. Start your journey today with one of our highly trained and supported therapists.  We Heal North Carolina.