Some therapists are more effective than others, that much is clear; why they are more effective is less clear.

Louis G. Castonguay and Clara E. Hill have gathered a panel of experts from diverse theoretical backgrounds to answer this complicated question. Synthesizing the rich literature on therapist effects, they explore how various effects can help or hinder clients in therapy. They then propose practical strategies that mental health practitioners can use to improve their own effectiveness.

The authors first lay the empirical foundations for understanding therapist effects and why they are important. They also acknowledge the massive variability among therapists and the complexities of studying therapist effects.

Drawing from this fundamental knowledge, they carefully examine specific therapist characteristics, attitudes, and skills that are relevant in any therapeutic setting.

Exciting new studies about therapist effects in the treatment of specific disorders, including depression and generalized anxiety, are also presented.

The closing chapters translate the book's general themes and takeaways into broader applications for research, intervention, training, and policy.

Table of Contents



Louis G. Castonguay and Clara E. Hill

I. Empirical Foundations

  1. Therapist Effects, Effective Therapists, and the Law of Variability
    Michael Barkham, Wolfgang Lutz, Michael J. Lambert, and David Saxon
  2. What Characterizes Effective Therapists?
    Bruce E. Wampold, Scott A. Baldwin, Martin grosse Holtforth, and Zac E. Imel
  3. Who Works for Whom and Why? Integrating Therapist Effects Analysis Into Psychotherapy Outcome and Process Research
    Michael J. Constantino, James F. Boswell, Alice E. Coyne, David R. Kraus, and Louis G. Castonguay

II. Conceptual Contributions

  1. Appropriate Responsiveness as a Contribution to Therapist Effects
    William B. Stiles and Adam O. Horvath
  2. Therapist Presence, Absence, and Extraordinary Presence
    Jeffrey A. Hayes and Maria Vinca
  3. Inner Experience and the Good Therapist
    Charles J. Gelso and Andres E. Perez-Rojas
  4. The Role of the Therapist's Attachment in the Process and Outcome of Psychotherapy
    Bernhard M. Strauss and Katja Petrowski
  5. The Role of Therapist Skills in Therapist Effectiveness
    Timothy Anderson and Clara E. Hill
  6. The Contributions of Client Culture to Differential Therapist Effectiveness
    Jeffrey A. Hayes, Jesse Owen, and Helene A. Nissen-Lie
  7. Therapist Negative Reactions: How to Transform Toxic Experiences
    Abraham W. Wolf, Marvin R. Goldfried, and J. Christopher Muran
  8. Professional Expertise in Psychotherapy
    Franz Caspar
  9. Gaining Therapeutic Wisdom and Skills From Creative Others (Writers, Actors, Musicians, and Dancers)
    Barry A. Farber

III. Empirical Contributions

  1. Effective Therapists in Psychodynamic Therapy for Depression: What Interventions Are Used and How?
    Nadia Kuprian, Harold Chui, and Jacques P. Barber
  2. Effective and Less Effective Therapists for Generalized Anxiety Disorder: Are They Conducting Therapy the Same Way?
    Soo Jeong Youn, Henry Xiao, Hanjoo Kim, Louis G. Castonguay, Andrew A. McAleavey, Michelle G. Newman, and Jeremy D. Safran
  3. Something to Laugh About: Humor as a Characteristic of Effective Therapists
    Sarah Knox, Meghan C. Butler, Dakota J. Kaiser, Graham Knowlton, and Clara E. Hill

IV. Implications and Conclusions

  1. The Implications of Therapist Effects for Routine Practice, Policy, and Training
    James F. Boswell, David R. Kraus, Michael J. Constantino, Matteo Bugatti, and Louis G. Castonguay
  2. Therapist Effects: Integration and Conclusions
    Clara E. Hill and Louis G. Castonguay


About the Editors

Editor Bios

Louis G. Castonguay, PhD, completed his doctorate in clinical psychology at the State University of New York, Stony Brook. He completed a clinical internship at the University of California, Berkeley, and he completed his postdoctorate at Stanford University. He is currently a professor in the Department of Psychology at Penn State University.

With more than 180 publications (including eight coedited books), his scholarly work and research has focused on different aspects of the process of change and training, especially within the context of psychotherapy integration of psychotherapy.

He is also involved in the investigation of the efficacy of new integrative treatments for generalized anxiety disorder and depression, and the development of Practice Research Networks aimed at facilitating collaboration between clinicians and researchers.

Dr. Castonguay has received several awards, including the Early Career Contribution Award from the Society of Psychotherapy Research, and the David Shakow Award from APA Division 12 (Society of Clinical Psychology). He has also received four recognitions from APA Division 29 (Society for the Advancement of Psychotherapy): the Jack D. Krasner Memorial Award, Distinguished Contributions to Teaching and Mentoring, the Distinguished Research Publications Award, and the Distinguished Psychologist Award for his lifetime contributions to the field of psychotherapy.

He also served as president of the North American Society for Psychotherapy Research, as well as the International Society for Psychotherapy Research.

Clara E. Hill, PhD, completed her doctorate in counseling psychology at Southern Illinois University and a clinical internship at University of Florida. She is currently a professor in the Department of Psychology at the University of Maryland.

With 12 books, 74 book chapters, and 215 journal articles, her scholarly work and research has focused on psychotherapy process, therapist interventions, therapist training, dream work, meaning in life, and qualitative research methods.

She has received several awards, including the Leona Tyler Award from APA Division 17 (Society of Counseling Psychology), the Distinguished Psychologist Award from APA Division 29 (Society for the Advancement of Psychotherapy), the Outstanding Lifetime Achievement Award from the Section of Counseling and Psychotherapy Process and Outcome Research of the Society for Counseling Psychology, and the Distinguished Research Career Award from Society for Psychotherapy Research.

She served as the editor of the Journal of Counseling Psychology and Psychotherapy Research, and she also served as the president of the North American Society for Psychotherapy Research, as well as the International Society for Psychotherapy Research.

Reviews & Awards

Ambitious in its scope, this book brings an innovative perspective to the improvement of psychotherapy practice. Chapter references and an index help to make the volume an invaluable resource for program directors, policy makers, and researchers, as well as practitioners themselves.

Provides current researchers excellent reviews and critiques of existing research on various aspects of therapist effects.

This book does a good job of exploring what factors impact therapist effects.
—Doody's Review Service

Mix a bunch of expert research practitioners together to discuss what makes a therapist effective and you get this wonderful book filled with wisdom and research on what characteristics make some therapists better than others. Many of these characteristics can be acquired, and this is unquestionably the best current training guide for therapists.
—Leslie S. Greenberg, PhD
Distinguished Research Professor Emeritus, Department of Psychology, York University, Toronto, Ontario, Canada

Paraphrasing Lake Wobegon's Garrison Keillor, we would like to think that all therapists are way above average. But in fact, some therapists are better than others, and that has implications for how we practice, how we train and supervise, and how we shape health care policy. Refreshingly, this book focuses on therapists rather than treatments. It is a must-read for all of us wanting to do the best by our clients.
—Hanna Levenson, PhD
Wright Institute, Berkeley, CA

Program directors, policymakers, psychotherapists, and psychotherapy researchers will all find this book useful. The authors review important findings on therapist effectiveness and the factors involved in differences. One chapter considers the policy implications of the troubling finding that there is a group of 15% to 20% of therapists who are consistently at the bottom of the heap in effectiveness.
—Dianne L. Chambless, PhD
Professor of Psychology and Director of Clinical Training, University of Pennsylvania, Philadelphia