It’s not all about treatment methods such as cognitive-behavioral therapy: the qualities of therapists themselves strongly influence outcomes in work with individuals who have significant disturbances of personality or character.
Cognitive-behavioral therapy is an effective treatment approach for a wide variety of behavioral disturbances. And, as most of the readers of this blog likely already know, it’s the framework within which I and others have worked for years to help those who have disturbances and disorders of character become better, healthier people. But for years there’s been ample evidence that the personal attributes of a therapist play just as important a role as the treatment methods they employ when it comes to achieving a successful outcome in therapy. So it’s worth asking just what qualities a therapist needs to bring to the therapeutic process to enhance the probability of success in treatment. One answer comes in the form of a “WERD” — an acronym used by some researchers (for example, in Impact of Therapist Qualities on Cognitive-Behavioral Therapy) to describe the key characteristics of the effective cognitive-behavioral therapist: warmth, empathy, rewardingness and directiveness.
Working with folks who have significant disturbances of personality and character is very challenging. Generally speaking, character-disturbed individuals are not optimally motivated to change in the first place. They tend to be happy with the way they see things and do things, even if others are not. But even if they’ve come to that point in their lives where they realize things aren’t working as well as they once thought and they’re acquiring some motivation to change, breaking longstanding and deeply ingrained habits can be difficult. So it’s particularly important to provide just the right atmosphere for change — an atmosphere that both encourages and rewards change that is inherently difficult. Providing this atmosphere is a genuine art and requires the therapist to have certain characteristics.
The first characteristic of an effective cognitive-behavioral therapist is warmth. Because their motivation is usually not optimal, it’s important for the character-impaired person to feel both “invited” into the process and comfortable with the process. So despite how easy it is to become unnerved in the presence of someone whose character features can be quite abrasive, the therapist has to be received as both warm and easily approachable. The therapist’s warmth helps make an inherently difficult endeavor much more endurable.
The effective cognitive behavioral therapist is more than just warm. She or he has to truly care about the client’s welfare, and the empathy behind that care and concern must be clearly evident. Therapeutic encounters with disturbed characters are inherently confrontational in nature. Character impaired folks have certain ways of thinking about things and ways of doing things that cause big problems in relationships and therefore need to be confronted head-on. But how these things are confronted is key to the whole process. Confrontations have to be completely benign — that is, free of any malice or ill intent and rooted solely in a sincere and clearly apparent desire to help make things better.
Perhaps nothing is as important to the success of therapy as is a positive expectation. And perhaps nothing helps fuel positive expectation as much as a therapist who’s willing to reward and reinforce a client’s positive efforts — even the smallest ones. So, in line with the acronym, the effective therapist is also rewarding. He or she rewards any positive movement on the client’s part — any step in the right direction, no matter how small or seemingly insignificant. It’s a central axiom of behavior therapy that no behavior persists unless it’s reinforced. The rewarding therapist does more than just encourage new and more adaptive behavior. He or she recognizes its value and attaches appropriate merit to it, thus helping the client acquire the necessary motivation to replace troublesome old habits with newer, better ones.
The last important quality of the effective cognitive-behavioral therapist has to do with leadership. And to provide that leadership, you have to have a good sense of the direction in which a client needs to head both to see and to do things in more adaptive ways. So, the effective therapist is clearly directive in his or her general approach. It’s not just about showing the way forward but also about outlining the small steps necessary to move forward. And it’s not just about showing a client the healthier path but helping them to stay on that path or to redirect themselves and return to that path when they inevitably stray.
Warmth, empathy, directive leadership, and a rewarding nature — these are the characteristics of an effective cognitive-behavioral therapist. Many think these characteristics are desirable for a therapist working within any therapeutic framework. But they’re particularly important characteristics when doing the challenging work of helping character disturbed individuals change. Despite their natural tendency to resist, if they feel “invited” into the process, believe that their guide truly cares, knows the way, and is willing to reinforce their efforts to follow a better path, there’s a much better chance they’ll be successful in their efforts to change for the better.
For more on therapeutic effectiveness and therapist qualities, see our review of the original The Heart & Soul of Change, our followup on that book’s second edition, and of course the ‘Bible’ of the field, Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change [Amazon-US | Amazon-UK](?), now in its sixth edition. Our article on Evaluating Therapeutic Effectiveness in Counselling And Psychotherapy includes several additional references.
All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. This specific article was originally published by Dr Greg Mulhauser, Managing Editor on .on and was last reviewed or updated by