What makes a good therapist ?

Could it be that there are no good or bad therapies or “therapeutic techniques”, but that there are only good or bad therapists? As Sigmund Freud already remarked in 1905: “it is not medicine that heals an ailment, but the doctor, which indeed means the personality of the doctor; by his personality he is able to influence the patient, for better or for worse”

When I started practicing as a zealous young counsellor years ago, I worked for a public institution which used almost exclusively a therapy called EMDR, and I placed an incredible amount of hope in this method. (Some of you may know EMDR, it is a therapy which uses either eye movements or acupressure like “tapping” to heal trauma…) As time went on, I remarked something bizarre: what seemed to bring patients relief and put an end to their symptoms wasn’t so much the type of therapy used, but the personality of the counsellor. So, someone with a history of abuse and emotional deprivation swore by EMDR therapy, another person with a quasi-identical experience was very against EMDR and idealised traditional psychoanalysis, the third person claimed that psychoanalysis was useless and that she tried all existing therapies until she found salvation through hypnosis, or Gestalt therapy, etcetera. This made me very curious, and I tried to get my head around this phenomenon. The conclusion I came to was that, as said in the first line: there are no good or bad therapies- there are only good or bad therapists. So what qualities make a therapist good? This is extremely difficult to pinpoint, however here are some traits I believe are essential.
Number one is empathy. A good therapist communicates to the patient a desire to understand and share in their experience. He or she communicates that the patient is not alone- when someone feels understood and really “seen” they can gather the strength to explore themselves courageously. Another quality of a good therapist is respect. This means acknowledging that the patient has a right to choose, to make mistakes, to suffer, or to heal. It also means teaching the patient the principles of how the mind and psyche work, and how to be their own therapist, so that there is no unhealthy dependence. A good therapist is genuine: openly authentic with no phoniness, and also absolutely sincere- this means no game playing. He develops an appropriate relationship with the patient, and knows what limits to put on any personal sharing. Warmth is another quality. The good therapist shows care, concern and affection for the patient, verbally and non-verbally. An effective therapist is concrete: he must not use any fancy language or technical jargon in order to avoid the core of the problem, and must dive into the issue as soon as possible.

Next comes confrontation. Warmth and kindness are all very nice, but a good counsellor must be able to explore any inconsistencies, distortions, or avoidance patterns in the patient’s story. For example, being a “victim” of migraines might mean I don’t have to go to work, or have sex with my husband. The good therapist acknowledges that confrontation may bring up anger, frustration, or defensiveness, whilst at the same time remaining warm and empathetic to the patient’s issue. Another quality is self-disclosure. The good therapist shares something of himself that relates to and inspires the patient to heal. This is done at the right time during the session, and communicates to the patient that “we are in this together.”

Next; the effective therapist makes it okay for the patient to openly express emotions, most importantly, negative emotions towards the therapist. The remark I hear most often is “You don’t really care about me- you’re just doing your job!” This courageously addresses the therapist-patient relationship, and teaches the patient, through the therapist’s example of honesty, to work out his own interpersonal relationships. Next, it is absolutely essential that the therapist communicates personal power, both verbally and non-verbally, through his actions. I call this quality “potency” or “emphatic authority”. The good therapist shows self-confident commitment to the patient, and thus communicates that it is safe for the patient to be authentic in the therapist’s presence. Sooner or later this confidence will rub off on the patient, and self-esteem will soar.

But perhaps the most important quality of a good therapist is self-actualization. This means that they must actively be doing his or her own personal growth work. The therapist must act as a role model for their patient; dependable, trustworthy, kind, and optimistic. The good therapist must have developed their own personal philosophy which allows them to have peace of mind. He or she must be able to share openly and honestly with family and friends, and their personal life should be a calm haven of love, trust, and acceptance. The good therapist should be able to “walk the talk”. If this is not the case, I believe that all our degrees, training and experience are actually quite useless. If we can’t assume this, then it’s just another case of “do as I say, but not as I do.”

For a list of English speaking therapists in the Languedoc region, visit AngloInfo LanguedocRoussillon.