The Seven Habits of Highly Effective Therapists

What qualities make for an effective therapist? Good listening skills? Yes. Ability to connect and empathize with patients? Sure. A nice person who genuinely cares about you? Absolutely. These qualities may enhance the therapeutic relationship, which is important for healing, but the therapeutic relationship itself does not always translate into recovery, especially for persons with serious mental illnesses. A doctoral degree in psychology, a license to practice, and years of experience in the field indicate that a therapist is qualified, but these things do not guarantee effectiveness.

To put it succinctly, a highly effective therapist is one whose patients get better. Here are the qualities, in my opinion, that highly effective therapists possess.

1. A highly effective therapist conducts a thorough assessment at the start of treatment, including, but not limited to: diagnostic interviews with the patient and her parents (if she is <18), psychosocial / developmental history, family history, medical and psychiatric history, and consultations with the patient’s other treating professionals (e.g., primary care physician, psychiatrist). She synthesizes this information to arrive at an accurate diagnosis. She is cognizant of the multifaceted etiology of mental disorders, and takes into account genetics, biology, temperament, psychosocial issues, environmental factors, lifestyle and behaviors (e.g., stress, sleep, nutrition, exercise) when determining the cause(s) of the patient’s problems. 2. At the end of the initial assessment, a highly effective therapist has an in-depth discussion with the patient, and the parents of minor patients, in which diagnostic impressions are shared. The therapist provides the patient and her family with a scientifically-grounded explanation of her disorder(s) and explains the full range of treatment options available.

3. In collaboration with the patient, and parents of minor patients, the highly effective therapist develops a treatment plan. This treatment plan may consist of services delivered by other professionals (e.g., psychiatrist, pediatrician, dietician) and may consist of one or more modalities of treatment (e.g., individual therapy, family therapy, group therapy). Parental involvement is an integral part of the treatment plan for children and adolescents, except in rare cases when parental involvement may be contraindicated. For adult patients, family members are often included in the treatment plan to participate in family therapy or to play a support role. The highly effective therapist coordinates the patient’s treatment with the other professionals on her treatment team and maintains regular contact with all team members throughout the patient’s course of treatment.

4. A highly effective therapist has training and experience in empirically-supported treatments, such as CBT, DBT, ACT, Maudsley FBT, and IPT. She stays abreast of recent developments in the etiology and treatment of the disorders she treats so that she may better serve her patients. She uses empirically-supported treatments with her patients unless contraindicated.

5. A highly effective therapist is well-prepared and fully present, in body and in mind, with her patients. Therefore, the highly effective therapist is not over-scheduled or over-stressed. She has enough time in her schedule to meet with every patient as often as necessary, including last-minute emergency appointments when needed. She has adequate time to devote to preparing treatment interventions, adequate record keeping, maintaining regular contact with other professionals, and returning patients’ calls and emails in a timely fashion. The highly effective therapist demonstrates respect for her patients’ time by starting and ending appointments promptly and refraining from canceling or rescheduling sessions in the absence of a true emergency. She has sufficient flexibility in her schedule so that, if a patient must cancel a session, she can reschedule the patient within the week. The highly effective therapist devotes her full attention to her patient during sessions by turning off her phone, not responding to emails, and not allowing visitors to knock on the door.

6. A highly effective therapist knows when, and when not, to refer her patients to psychiatrists. She knows which symptoms and disorders usually require medication and which symptoms and disorders can be treated solely with behavioral or psychological interventions. She is conservative in her approach to psychotropic medication and views it as an adjunct to effective psychotherapy. She prefers for her patients to be on medication only when necessary, and on as little medication as necessary for optimal functioning. A psychiatric referral almost always results in medication prescribed. Thus, a highly effective therapist refers patients to psychiatrists only if there is evidence that psychological interventions alone will not be sufficient for recovery. When a psychiatric referral is indicated, a highly effective therapist obtains a signed release of information from the patient to communicate with the psychiatrist. Thereafter, the highly effective therapist maintains communication with the psychiatrist for the duration of the patient’s treatment and is closely involved with decisions to start, stop, and change dosage of the patient’s medications.

7. A highly effective therapist terminates treatment at the appropriate time and in the appropriate manner. Typically, therapy is over when the patient has reached maximum benefit. Sometimes treatment must be terminated because a patient is not progressing. At this point, the therapist assists the patient in formulating a plan for future care. When it is clear that a patient requires a higher level of care than the therapist can provide (e.g., residential or inpatient treatment), she makes the appropriate referrals and supports the patient in following through with these referrals. She does not allow the patient to settle for a lower level of care than she requires. Regardless of the reason treatment ends, the therapist provides the patient with the opportunity to create meaning out of her therapeutic experience. At the end of treatment, the therapist allows at least two sessions for the patient to reflect on her experience in therapy, the progress that she has made, and the therapeutic relationship.