3 Strong Predictors of Positive Therapy

nicely laid out therapy office for positive therapy

Chances are this question has crossed your mind if you've attended therapy before. Therapy is a private and vulnerable endeavour; of course it's important that people know their mental health and wellbeing is in good hands. So, what is considered to be 'good therapy'?

What does the research say?

According the 16 meta-analyses conducted by the American Psychological Association (APA) Task Force, positive therapy outcomes can generally be predicted by three main factors (DeAngelis, 2019; Misic, Birkenbach, & Attia, 2023). Moreover, the experience level of the therapist did not correlate with therapy outcomes. In other words, therapists who have been practicing for many years were not necessarily more effective than therapists at the beginning of their career.

Three Main Factors that Predict Positive Therapy Outcomes

  1. Therapeutic alliance
    • The therapeutic alliance is the relationship between the client and therapist. A mutual level of engagement is part of a strong therapeutic alliance. This means that both therapist and client are active and equal participants in the process.
  2. Goal consensus
    • Your therapy goals are more likely to be met if they are known to your therapist. It's worth spending time clarifying and defining your therapy goals. This may be done before entering therapy, or alongside your therapist in a collaborative way. Goals may shift and adapt throughout therapy. It's also helpful if the therapist communicates realistic expectations for the process of therapy and mutual participation.
  3. Empathy
    • Empathy refers to the ability to understand another person's perspective and emotions. It's absolutely important that you do not feel judged by your therapist. Your therapist should treat you with unconditional positive regard, understanding, and affirmation. Keep in mind, depending on your therapy goals, a therapist may communicate perspectives you don't agree with and offer challenges to your thinking. Typically, these practices are intended for growth, impact, and positive change. If you ever feel put off by something that your therapist has said or done, then it is encouraged that you tell them.

Five Questions to Ask Yourself About Your Therapy

  1. Do I feel emotionally 'safe' to speak openly with my therapist?
    • Indicators of an emotionally safe therapist:
      • They listen to feedback without becoming highly defensive or reactive.
      • They're reliable. They follow through with their commitments most of the time, they communicate clearly, they have boundaries and respect yours, and they are mostly on time.
      • They show efforts to validate and understand my perspective with unconditional positive regard.
  2. Does my therapist seem competent in dealing with the issues I bring to therapy?
  3. Is my therapist's agenda aligned with my expressed goals for therapy?
  4. Do I feel like I am making progress of some kind?
  5. Do I generally feel positively impacted by therapy or my therapist?

Seven Tips for Getting the Most Out of Your Therapy

Unfortunately, making progress in therapy is not as simple as just showing up. Therapy being another item on the 'to-do list' has the same effect as attending a workout class and laying on the mat the entire time. If you're not working the muscles, you're not building them. Below are things that you can do to help get the most out of your therapy sessions.

  1. Show up on time, be consistent, and create an environment free from distractions. 
    We're more able to access our emotions and be reflective when we're present. Do what you can to minimize outside noise and turn off notifications before a session.
  2. Identify goals or think about what you want to get out of therapy. 
    A therapist is there to help you clarify what's important to you and set realistic, meaningful goals. Don't be afraid to consult with them or explicitly tell them, "This is what I want."
  3. Be willing and open to receiving new information and reflective.
    A sense of curiosity, willingness, patience, and openness go a long way in creating meaningful change.
  4. Be honest with your therapist. 
    Any good therapist welcomes feedback and questions about the work that you do together. If you're concerned about something, or frustrated with progress, you can talk about it with your therapist. Contrary to popular belief, therapists are not mind readers; they cannot help you with something that you have not told them.
  5. Put in the practice. 
    Real change happens between sessions. It's when you take what you experienced or got from a therapy session and contemplate it or apply it in your life. Trial and error is common and a normal part of learning.
  6. Be willing to feel your feelings. 
    A therapist can help you develop safe ways to feel your feelings and contain them. Processing painful events oftentimes requires you to make room to feel - and thinking about your feelings is not feeling your feelings!
  7. Acknowledge the reality that there is no magic wand "fix" for feelings. Therapy and learning how to think differently, responding differently, and feel is a process. Change is most often non-linear and subtle before it becomes significant.

"The principle aim of psychotherapy is not to transport one to an impossible state of happiness, but to help acquire steadfastness and patience in the face of suffering."

- Carl Jung


  1. DeAngelis, T. (2019, November 1). Better relationships with patients lead to better outcomes. American Psychological Association. Retrieved from: https://www.apa.org/monitor/2019/11/ce-corner-relationships
  2. Misic, A., Birkenbach, K., & Attia, P. (2023, March 18). Finding the right fit in a psychotherapist. Peter Attia MD. Retrieved from: https://peterattiamd.com/finding-the-right-fit-in-a-psychotherapist/
  3. Stubbe, D. E. (2018). The therapeutic alliance: The fundamental element of psychotherapy. Focus: The Journal of Lifelong Learning in Psychiatry. https://doi.org/10.1176/appi.focus.20180022