Many authors have been tasked with determining what are the characteristics and skills that a good psychologist should possess applied to therapy.
As we will see, not everything is based on a theoretical knowledge of intervention techniques; other more interpersonal aspects have a considerable influence on the success of the therapy.
The effectiveness of the patient-therapist relationship
The practice of the profession of clinical psychologist involves the mastery of two very different types of knowledge. On the one hand, considerable theoretical learning of the various therapeutic intervention techniques corresponding to the psychological current applied by the professional (cognitive-behavioral, psychoanalyst, phenomenological-existentialist, contextual, etc.) is required.
The second type of competence focuses on the internalization of a certain number of personal competences which have been decisive in the type of therapeutic link established between the patient and the psychologist. Thus, the latter will mark to a large extent the effectiveness of the treatment carried out. In Lambert’s (1986) recognized research on the factors involved in therapeutic success, the following proportion was found among the different factors involved:
1. The extra-therapeutic change (40%)
It refers to the aspects of the patient and the context in which he develops; the personal and social circumstances surrounding him.
2. Common factors (30%)
They include elements that share all types of therapy, regardless of the psychological current applied. This proportion reflects the quality of the therapeutic relationship between the two parties. In this sense, Goldstein and Myers (1986) defend the three main elements on which a positive therapeutic relationship should be based: feelings of gratitude, respect and mutual trust between the two parties.
3. Techniques (15%)
They relate to the specific components that make up a particular type of therapy. This percentage reflects the interaction between the patient and the theoretical-practical components used by the professional, ie how the patient internalizes the methods and content of the intervention.
4. The placebo effect (15%)
It is linked to the patient’s expectations and to the credibility generated by the psychological intervention.
Attributes of the professional therapist
As can be seen in a high percentage of the causes that motivate psychological change are involved variables that depend on the skills derived from the professional. As their studies by Cormier and Cormier (1994) point out, the effectiveness of this figure is based on a balance between their own interpersonal skills and those of a more technical nature.
According to the authors mentioned, the characteristics that an effective therapist must possess are:
- Have an adequate level of intellectual competence.
- Have a dynamic, persistent and energetic attitude in professional practice.
- Show flexibility in the management of theories, techniques and methods, As well as the acceptance of different equally valid lifestyles.
- Act on the basis of a balance between patient support and protection.
- be guided by constructive and positive motivations, Showing genuine concern for the patient.
- Have a sufficient level of self-knowledge of their own limits and strengths (theoretical and interpersonal).
- Self-perception of sufficient professional competence.
- Internal psychological needs resolved and the capacity for self-regulation which prevents the interference of personal aspects of the figure of the psychologist in the development of therapy. This phenomenon is known as countertransference.
- Comply strictly with ethical and moral principles contained in the code of professional ethics (confidentiality, referral to another professional, follow-up of the file and avoid the establishment of non-professional relations between the two parties).
Factors that promote the therapeutic relationship
In addition to the capacities indicated above, Bados (2011) mentions another series of aspects related to the therapist which facilitate the establishment of an appropriate bond between him and the patient:
A moderate expression of interest, encouragement, approval and esteem is linked to establishing a more favorable work climate. At this point, a balance must also be found in the manifestation of the physical contact emitted, because these gestures can be easily misinterpreted by the patient.
In this field, the degree of professional experience of the psychologist and the mastery of the administration and application of the contents included in the specific therapy are decisive. Howard’s research results (1999) seem to indicate that mastery of the latter aspect compared to the first is more associated with a good outcome of the intervention.
Cormier and Cormier (1994) present the following examples of non-verbal behavior as a reflection of professional competence: eye contact, frontal body disposition, fluency in speech, Relevant and stimulating questions and verbal indicators of attention.
It seems that this factor it depends on the perception that the patient generates the combination of phenomena such as: competition, sincerity, motives and intentions, acceptance without value judgment, cordiality, confidentiality, dynamism and security and, finally, the issuance of non-defensive responses (Cormier and Cormier, 1994).
A certain level of perception of the therapist as an attractant correlates positively with the outcome of the treatment, as demonstrated by Beutler, Machado and Neufeldt (1994). This attraction is based on the degree of kindness and cordiality evoked by the professional, As well as in the perception of similar aspects between him and the patient (Cormier and Cormier, 1994).
Actions such as eye contact, frontal body disposition, smile, nod of the head, soft, modulated voice, signs of understanding, some degree of self-disclosure and consensus on the structure of therapy they increase the patient’s interest in his psychologist.
6. Degree of directivity
An intermediate degree of directivity or structuring of therapy is recommended where a balance can be found in aspects such as facilitating instructions to be followed, exposing the content of tasks and topics covered in sessions, resolving issues. doubts or the confrontation of certain ideas of the patient. It all seems ensure a certain level of autonomy for the patient, As well as the feeling of feeling guided and supported in the treatment process.
Professional attitudes that help you progress
In the 1960s, Carl Rogers proposed the fundamental pillars on which the therapist’s attitude to the patient should be based: empathy, unconditional acceptance and authenticity. Subsequently, the ability to actively listen was also considered very relevant.
It is defined as the ability to understand the patient from the patient’s point of view and, above all, the ability to communicate. Therefore, the therapist must first be competent to understand the cognitions, emotions and behaviors as the patient would treat them, do not interfere with the professional’s point of view. The second point is what will really make the patient feel better understood.
2. Unconditional acceptance
It refers to accepting the patient as he is, without judgment, and valuing him as a person worthy of his dignity. Truax and Carkhuff (1967, cited in Goldstein and Myers, 1986). Several elements make up this type of attitude, such as: a strong commitment to the patient, the desire to understand manifest a non-evaluative attitude.
This attitude consists in showing oneself as one is, in expressing one’s own feelings and inner experiences without falsification. Acts like a spontaneous smile, making meaningless comments or the expression of a sincere personal aspect indicate authenticity. However, too much spontaneity is not recommended; it seems relevant that the therapist’s personal revelations are aimed exclusively at the benefit of the patient and the therapy.
4. Active listening
It consists of the ability to receive the message from the interlocutor (dealing with verbal and non-verbal language), its appropriate processing and the issuance of a response indicating that the psychologist pays his full attention to the patient.
Attitudes that hinder the flow of sessions
Finally, a series of actions have been implemented which can produce the opposite effect and hinder the favorable development of psychological therapy. This list reflects the main behaviors that the psychologist should avoid showing the patient:
- Shows insecurity about the interpretation of the problem consulted
- Keep a cool or distant attitude, be critical or bossy.
- Asking too many questions.
- Hastily stop the patient.
- Tolerate and improperly manage the emotional expressions of the patient’s crying.
- Desire to be appreciated by the patient and get their approval.
- Trying to eliminate the patient’s psychological distress too quickly
- The imbalance of approach enters into the simpler and more complex aspects of the therapy.
- Avoid dealing with conflicting issues for fear that the patient will emit an intense emotional reaction.
Bados, A. and Grau, E. (2011). Therapeutic skills. University of Barcelona. Barcelona.
Cormier, W. and Cormier, L. (1994). Interview Strategies for Therapists: Basic Skills and Cognitive Behavioral Interventions. Bilbao: Desclée de Brouwer. (Original 1991).
Lambert, MJ (1986). Implications for psychotherapy outcome research for eclectic psychotherapy. In JC Norcross (Ed.), Handbook of Eclectic Psychotherapy. New York: Brunner-Mazel.