What matters most in therapy? | by Asma Suedan

Oftentimes, clients starting psychotherapy wonder if their investment of money, time, and effort will be worthwhile. This is especially the case for individuals who are new to this human endeavour. To try and ensure that psychotherapy works for them, clients may have a lot of questions initially. Psychotherapy can be a powerful process. Effective psychotherapy can lead to clients improving their relationship with themselves and other people. It can provide the insight needed to overcome significant psychological difficulties. Given how enticing these treatment goals sound, it is critical to highlight the factors that facilitate change in psychotherapy. With this blogpost, I hope to do just that.

Achieving positive outcomes in treatment depends on several factors. For example, the specifics of the client’s problem, the client’s belief of whether therapy works, and the therapist’s level of skills (Horvath, 2001). However, most importantly, the effectiveness of treatment depends on the relationship between the client and the therapist (Horvath, 2001).  This relationship is often referred to as the therapeutic alliance. Through interactions with the therapist, clients are able to address ways of managing and coping with symptoms. More importantly, clients are able to uncover what is beyond their awareness. As such, the therapeutic alliance serves as a catalyst in transforming the lives of clients.

Since the quality of the therapeutic relationship is of great significance to treatment outcome, experts have examined and defined what is considered a strong relationship (Bachelor, 2013, Knobloch-Fedders, 2008). Listed below are a few of the essential ingredients for a quality therapist-client relationship. Firstly, sharing a bond of trust, respect, and caring. Secondly, agreeing on goals for therapy. Thirdly, sharing the decision-making process. Fourthly, committing to the work of treatment. Fifthly, discussing here and now aspects of the relationship together when needed. Sixthly, sharing negative emotional responses. Lastly, solving problems that may arise.  Clients are not passive but are active in the development of the therapeutic relationship. In addition, these essential ingredients help facilitate the therapy process.

It is important to note that as Hovarth (2001) demonstrates, the ability to establish a strong therapeutic relationship is not always dependent on the therapist’s level of experience or specific therapeutic approach.  Clients can rest assured knowing that many therapists early in their professional journey are just as skilled as the more experienced therapist in forming strong therapeutic bonds. Still, the level of therapist expertise matters more when forming a relationship with clients who have struggled repeatedly in past relationships.

To ensure that a strong therapeutic alliance exists, the therapist needs to make specific contributions. Of these contributions is conveying empathy and understanding. Also, the therapist's ability to adapt and tailor treatment to the client's needs is essential. In doing so, the therapist conveys openness and willingness to work collaboratively with the client. As such, a skilled therapist consistently asks the client for their input about treatment goals and methods of treatment. These contributions further emphasize Carl Rogers’ three key attributes of a therapist in creating a climate of growth for clients.

  • The first attribute is congruence; this means that the therapist is genuine and authentic with clients. The therapist’s inner experience and outward expression align. This trait conveys to the client trustworthiness and serves as an indication of how they can express themselves, freely.
  • The second attribute is unconditional positive regard, this attribute entails accepting and valuing the client. The therapist neither judges nor evaluates the client’s experiences.
  • The last attribute is accurate empathic understanding. Treatment success is made possible when the client is fully understood in a compassionate manner; this happens when the therapist conveys an understanding of the client’s perspective.

These fundamental attributes are further built upon in the foundation of the distinct quality of presence. The therapeutic presence is experienced when therapists bring their whole selves into their encounter with each client. The therapist is completely in the moment on a physical, emotional, cognitive, spiritual, and relational level. Prescence also consists of therapists being grounded in themselves as they actively take in the expressions (verbal and nonverbal) of the client in the moment.

Clients also contribute to the effectiveness of the therapeutic relationship. When clients communicate effectively, then they are actively developing and maintaining a therapeutic alliance. It is important that clients are open and honest about their needs because it plays a key role in resolving any difficulties. To answer the question proposed in the title of this post, for change to happen in therapy, the most important tool is the quality of the relationship between the therapist and the client, in other words, the therapeutic alliance.

Throughout my training and experience, I have come to have a strong interest in the therapeutic alliance. I enjoy doing my best to establish strong working alliances with the clients I work with.

Asma Suedan, M. A. is a former clinical associate at Karey Wilson Therapy.



Bachelor, A. (2013). Clients' and therapists' views of the therapeutic alliance: Similarities, differences and relationship to therapy outcome. Clinical psychology & psychotherapy20(2), 118-135.

Geller, S. M. (2013). Therapeutic Presence: An Essential Way of Being. In Cooper, M.,Schmid, P. F., O'Hara, M., & Bohart, A. C. (Eds.). The Handbook of Person-Centred Psychotherapy and Counselling (2nd ed.), pp. 209-222. Basingstoke: Palgrave.

Horvath, A.O. (2001). The alliancePsychotherapy, 38(4), 365-372.

Knobloch-Fedders. (2008, January 31). The Importance of the Relationship with the Therapist. Family Institute. https://www.family-institute.org/behavioral-health-resources/importance-relationship-therapist

Rogers, C. R. (2007). The necessary and sufficient conditions of therapeutic personality change. Psychotherapy: Theory, Research, Practice, Training, 44(3), 240–248. https://doi.org/10.1037/0033-3204.44.3.240





Finding the right psychotherapist | by Karey Wilson

Finding the right psychotherapist: What are the top things to consider?



Psychotherapy in Ontario is legally defined in the Psychotherapy Act, 2007:

“The practice of psychotherapy is the assessment and treatment of cognitive, emotional or behavioural disturbances by psychotherapeutic means, delivered through a therapeutic relationship based primarily on verbal or non-verbal communication.  2007, c. 10, Sched. R, s. 3.”

Maybe you are wondering how to find a good therapist for yourself or a loved one. Looking for a therapist can be overwhelming. Here are a few things to consider as you search.

PROFESSION. Currently in Ontario, Psychotherapy is legally regulated. This means that in order to practice psychotherapy here, one must be a member of a professional college that grants the license to practice psychotherapy. There are several professions that can practice psychotherapy: Registered Psychotherapists (RPs), Social Workers, Psychologists and Psychological Associates, Physicians, Occupational Therapists, and Nurses.  If you are seeking psychotherapy, you will look for one of these kinds of professionals.

EXPERTISE. Expertise is about knowledge and skills. You should consider what a psychotherapist's training has been to practice psychotherapy, and also whether they have expertise to help your specific case. Psychotherapy expertise is developed through a combination of training and experience. Training often involves graduate-level coursework in psychotherapy theory and technique, a significant amount of supervision and supervised clinical practice, and a degree of specialization. Psychotherapists will advertise themselves based on their training and experience, and should be open to explaining their expertise to you.

For example, in my case I have a graduate degree in clinical psychology, specializing in adults, and a considerable number of  supervision hours and supervised client contact hours as part of my professional requirements.  Based on my expertise, I practice clinical psychology with adults from an Integrative psychotherapy orientation.  Further, psychotherapists will often list more specific areas of specialization based on specific issues that people seek therapy for (e.g., 'anxiety,' 'trauma,' 'building more satisfying relationships,' etc.). It is always a good idea to ask a psychotherapist to clarify how their expertise can apply to your specific situation, and whether your specific issues fall within their scope of practice. The psychotherapist should be willing to fully explain this to you as part of their referral intake process. 

THERAPIST DIRECTORIES. Therapist directories such as Psychology Today can be good starting points. You can look up psychotherapists in your geographical area or by name, and then read through their profiles to get a sense of expertise, psychotherapy approach, and profession. If interested, you can contact the therapist directly through the directory to ask more questions or book a first appointment.

REPUTATION. Perhaps a friend or colleague has recommended a psychotherapist for you. Or perhaps a therapist has a PhD, has won multiple awards, lectures at a university or college, or has written a research article or book. Although there is no sure way to determine that a good reputation will translate into a good therapy experience for you, a good reputation suggests credibility.

COST AND COVERAGE. One of the first things to find out in order to plan your treatment is the hourly rate a psychotherapist has. These rates can vary between individual psychotherapists and also between professions. Often highly experienced psychotherapists cost more per session than less experienced ones. Consider how much expertise you are willing to pay for.

Some psychotherapists are open to discussing a sliding scale, for example if you are a student or currently unemployed. There is no harm in asking if the therapist offers a sliding scale. An important consideration in calculating cost is to know your extended health benefits plan, if you have one. What is your plan? What is your co-pay and annual limit for psychotherapy? What professionals are covered for psychotherapy with your plan? Knowing these things can help you coordinate your treatment with your therapist and help you know what to expect financially.

YOUR PREVIOUS EXPERIENCE. Your previous experiences with psychotherapy matter. Have you been in psychotherapy in the past? What was it like? This is very valuable information as you move forward to your next experience. Would you like a therapist who is similar or different from your previous one(s), and in what ways? Was your previous therapy a positive or negative experience overall, and what do you see as the reasons?

YOUR IMPRESSION OF THE PSYCHOTHERAPIST. There is no substitute for your personal experience in determining whether a therapist is right for you. Although there is financial investment, meeting several times with a therapist and beginning psychotherapy is the most definitive way of knowing if the therapist is the right fit. Are you comfortable with this therapist, even though what you talk about can be difficult? Do you feel hopeful that this therapist has the expertise and knowledge to help you? Do you feel like the therapist is making an effort to understand you and your therapy goals? Psychotherapy is a complex human experience, but by engaging in a few sessions, you will have your own impression of a psychotherapist and can use this to make a decision about a more regular commitment.

Finding a good psychotherapist can be a life-changing experience. It is my hope that this article can help you get closer to what, and who, you are searching for.