Counseling theory Doesn't work... Or does it?

What Really Works in Counseling?

When people come to counseling, they often ask: “What makes therapy effective?” The answer isn’t just about the type of therapy used. Research shows that while different therapeutic approaches—such as CBT, psychodynamic, existential, and EMDR, may appear very different on the surface, they often produce similar positive results. Furthermore, studies indicate that theory contributes to only 8 to 15% of treatment outcomes. So, what’s really at work?

In this article, I will discuss the most recent literature on what makes counseling effective, i.e., common factors, as well as the characteristics of both the client and the clinician. 

The Evidence Behind Common Factors

Decades ago, Saul Rosenzweig (1936) noted that every form of therapy seemed to produce positive outcomes—a finding known as the “Dodo bird verdict” (after the bird in Alice in Wonderland who declares, “Everybody has won, and all must have prizes”). Modern research supports this idea.

Meta-analyses show that:

• 40% of outcome differences are explained by client contributions, such as motivation, readiness for change, and personal circumstances.

• 30% come from the therapeutic relationship itself, the bond, the agreement on goals, and the collaboration on tasks.

• 15% are expectancy effects, clients’ belief that therapy will help.

• 15% or less are tied to specific techniques or models

Later, Norcross and Lambert updated these findings: 

• 40% – Unexplained Factors: Something happened that helped, but we can’t fully identify what.

• 30% – Client Contributions: Motivation, readiness for change, personal circumstances, and the client’s own efforts.

• 12% – The Therapeutic Relationship: The bond between client and therapist, including trust, empathy, and collaboration.

• 8% – Treatment Methods: The specific techniques or models used in therapy.

• 7% – The Individual Therapist: The counselor’s personal style, skill, and ability to connect.

• 3% – Other Factors

What Makes a Successful Client?

We no longer have to wonder what makes someone a successful participant in counseling. Studies consistently show that successful clients are those who exhibit the following characteristics: 

• Readiness for change and willingness to work hard

• Motivation and commitment to therapy

• Humility—the openness to learn and grow

• Maturity and introspection—the capacity to reflect on one’s own thoughts and feelings

• Interpersonal boundaries—balancing closeness with independence

• Tolerance for frustration—the ability to stay engaged even when therapy feels uncomfortable

Put simply: therapy works best when clients are ACTIVE participants, not passive recipients. The client is the person seeking change; nothing the therapist can do outside of providing a corrective emotional experience can make the client change. 

What Makes a Successful Counselor?

Interestingly, research has shown that some therapists consistently achieve better outcomes than others, regardless of the technique they use. According to Dr. Tian, the greatest therapists are those capable of connecting to and building alliances with anyone. 

• Strong interpersonal skills—empathy, warmth, and the ability to connect

• Authenticity—being genuine and congruent in words and actions

• Emotional stability and maturity

• Cultural awareness and ethical integrity

• Insight and clear communication

A good therapist is one who prioritizes their relationship with you; without that, counseling is unlikely to be effective. 

Where Theory Fits In

If common factors are so important, you might wonder: Why do therapists use theory at all?

The answer: theories give structure. It helps therapists conceptualize problems, set goals, and choose interventions that resonate with clients. Theories aren’t rigid boxes—they’re roadmaps. They guide the therapist in maximizing client strengths, building relationships, and fostering hope. 

That is also not to say that there isn’t merit in choosing counseling theory. There does seem to be differences between counseling theory, some stand above the rest with regard to their treatment outcomes. These counseling theories, called Empirically Supported Treatments, have been studied for their effectiveness and can be found here: https://div12.org/treatments/. 

This is to suggest that clinicians are likely to have the best results when they consider the factors above and use Empirically Supported Treatments (EST). 

Evidence-based therapy

The best farmwork for counseling appears to be Evidence-Based Practice. Evidence-based practice is the integration of research evidence like EST’s, clinical experience (counselor factors), and patient preference (client factors). This framework appears to increase the likelihood that clients experience meaningful improvements. Evidence-based practice is the gold standard in mental health care. 

Final Thoughts

Therapy works, and there is still more to learn about what counseling works. With the information, we can do our part as clients or therapists to get the most out of counseling.