Why do some therapists get better outcomes than others?
It’s an uncomfortable and important question.
Therapy is not only delivered by methods.
It’s delivered by people: us therapists.
As therapists we vary.
After I completed my initial postgraduate therapist training, a peer told me they had just completed a manualised therapy qualification. They told me:
“It’s great. I just deliver the material. If they get better, good. If they don’t, it’s not on me. I did what I was supposed to do.”
I understood their relief.
Therapy can feel exposing of us as practitioners.
It’s comforting to believe that if we deliver the model correctly, we have discharged our responsibility.
But that’s not how I ever understood therapy.
For me, effective therapy is not passive delivery.
It’s active clinical curiosity.
Not:
“Which material do I deliver?”
But:
“What’s happening here?”
“What does this client need in order to change?”
“What’s working?”
“What isn’t working?”
“What am I missing?”
“What needs to be adapted?”
“What capacity is trying to develop?”
That is why I have always thought of my work with clients like a single-case efficacy study.
Not coldly or mechanically.
But carefully, collaboratively, curiously.
The work is not simply:
I apply technique
You receive technique
Outcome follows.
The work is:
we build a therapy experience that actually helps this person, with this history, this nervous system, this shame, this motivation, this intelligence, this fear, this hope, this life.
That requires more than technique.
It requires engagement.
Attention
Warmth
Flexibility
Repair
Course-correction
And real interest in the person in front of us.
Some clients arrive in therapy difficult to like.
Defensive
Shut down
Controlling
Pleasing
Hostile
Ashamed
Performing
Lost
If therapy goes well, something often changes.
The client becomes more contactable.
More real
More able to feel
More able to repair
More able to choose
More able to be in relationship.
Sometimes, frankly, more likeable.
Not because I have performed approval.
But because the client has become less defended and more themselves.
That’s why outcome cannot be separated from the therapist’s capacity to notice and respond.
Some therapists get better outcomes because they don’t simply deliver a model harder when the work is stuck:
They become curious
They seek feedback
They track change
They repair ruptures
They adapt without becoming random
They’re engaged without becoming unboundaried
They keep asking:
“What does this person need to become more able to do?”
And:
“What do I need to notice, feel, tolerate, repair or change, to help that happen?”
Method matters
Training matters
The therapist is not a delivery system, we are an active participant in a living process of change.
In an AI age, this is one way we as humans add value.
Perhaps some therapists get better outcomes not because they’re perfect.
But because they stay curious, engaged, responsive and willing to learn.