regarded more as trainable and learnable skills.
According to Bergin and Suinn (1975),“It is clearer
now that these variables are not as prepotent as
once believed; but their presence and influence
are ubiquitous, even showing up strongly in behav-
ior therapies”(p. 52). In the case of empathy, how-
ever, some have found that less effective therapists
tend to score lower on empathy than do their more
effective peers (Lafferty, Beutler, & Crago, 1989).
It has also been argued (Beutler et al., 1994)
that these three features reflect not only qualities
of the therapist but also qualities of the therapeutic
relationship. Viewed this way, these features can be
considered indicators of the quality of the therapeu-
tic alliance. Studies have consistently demonstrated
that the nature and strength of the working rela-
tionship between therapist and patient are signifi-
cant, although modest, contributors to positive
outcome (Beutler et al., 1994, 2004).
Emotional Well-Being. Although therapists need
not be paragons of adjustment, it is unlikely that a
therapist beset with emotional problems can be as
effective as one would like. It is important that thera-
pists recognize areas in their own lives that are tender.
The tendency to become angry or anxious when
certain topics arise or the inability to handle a client’s
questions without becoming defensive is a signal that
something is amiss. In short, self-awareness is an
important quality in the therapist (Weiner, 1975).
Therapists must be able to look at their patients
with objectivity and not become entangled in their
personal dynamics. Nor is the therapy room a place
for the gratification of one’s own emotional needs
(Bugental, 1964; Singer, 1965).
In some instances, the therapist may find it nec-
essary to undergo personal therapy to resolve emo-
tional problems. However, whether undergoing
personal therapy makes the therapist more effective
has long been argued. Unfortunately, the research
evidence (Beutler et al., 1994, 2004) is less than
definitive. This is not surprising when one considers
the complexity of the therapy process. Neverthe-
less, it would not seem necessary for all therapists to
undergo treatment as a qualification for conducting
therapy.
Experience and Professional Identification.
Conventional wisdom suggests that the more expe-
rienced a psychotherapist, the more effective she or
he will be with patients. Although this is intuitively
appealing, the bulk of research evidence has not
supported this position (Beutler et al., 1994, 2004;
Smith et al., 1980). Not only does there appear to
be no consistent relationship between therapist
experience and positive outcome but several studies
suggest thatparaprofessionals trained specifically to
conduct psychotherapy produce outcomes equiva-
lent to, or sometimes even exceeding, those pro-
duced by trained psychotherapists (Berman &
Norton, 1985; Durlak, 1981; Hattie, Sharpley, &
Rogers, 1984; Weisz, Weiss, Alicke, & Klotz,
1987). Lambert and Ogles (2004) argue that the
jury is still out on this issue because many of the
studies that have been conducted to date have
major limitations. However, Lambert himself
recently confirmed this lack of relationship between
training level and client outcome in a sample
of over 5,000 clients (Okiishi, Lambert, Egget,
Nielsen, Dayton, & Vermeersch, 2006). Like all of
us, Lambert and Ogles (2004) wonder why more
studies supporting the superiority of experience and
professional training have not appeared.
Does one profession turn out better therapists
than others? Over the years, there have been many
running feuds over which profession is best
equipped to carry out proper therapy. For a long
time, psychiatrists actively sought to prevent clinical
psychologists from conducting therapy in the
absence of psychiatric supervision. Their main argu-
ment was often reducible to one of medical omni-
science and was never based on solid research, and
clinical psychologists gradually freed themselves
from this psychiatric domination. But old animosi-
ties and fights over territorial prerogatives fade
slowly. Indeed, with the availability of federal
funds to pay for health costs and with insurance
coverage being broadened to include psychother-
apy, economic competition has once again kindled
these territorial fights between psychiatry and clini-
cal psychology.
In fact, no real evidence supports the argument
that one profession boasts superior therapists (be328 CHAPTER 11