Does a Therapist’s Effectiveness Determine Anxiety Treatment Outcome?

Henny A. Westra, of the Department of Psychology at York University in Toronto, recently conducted a study to determine if the skill level and effectiveness of a therapist directly influences the outcome of treatment for a client with generalized anxiety disorder (GAD). Westra said until now, there has been no research demonstrating if the outcome of cognitive behavioral psychotherapy (CBT) is influenced by the effectiveness of the therapist, or if differences between therapists’ education level, clinical experience and personalities, would benefit or impair the overall process for the client.

For their study, the researchers enlisted 32 clients and randomly assigned them to one of four therapists of varying degrees of experience who were rated in order of highest to lowest based on observer-rated CBT competence, client expectations of outcome, client rated treatment and client ratings of the quality of the therapeutic alliance early in treatment. Using the Penn State Worry Questionnaire (PSWQ), the Anxiety Change Expectancy Scale (ACES), Credibility and Expectancy Questionnaire (CEQ), the California Psychotherapy Alliance Scales (CALPAS) and the Cognitive Therapy Scale (CTS), the clients and therapists were rated at several different points throughout eight weeks of treatment for GAD.

The results revealed that overall, the therapist’s competence directly impacted decreases in anxiety for the client. The team found that regardless of what a client expected at the onset of treatment, clients who saw more effective therapists believed they would be able to control their anxiety better than those who saw less effective therapists. Additionally, those same clients reported higher levels of therapeutic alliance. “Clinically, then, it seems important for CBT therapists to attend carefully to the skill with which they structure treatment, their interpersonal effectiveness, and their delivery of specific CBT interventions.” The team added, “Clumsiness, non-responsiveness, or rigidity in these areas might interfere with the promotion of hope and positive expectation, which might in turn disrupt clinically significant change.”

Westra, Henny A., Michael J. Constantino, Hal Arkowitz, and David J.A. Dozois. “Therapist Differences in Cognitive–Behavioral Psychotherapy for Generalized Anxiety Disorder : A Pilot Study.” Psychotherapy 48.3 (2011): 283-92. Print.

© Copyright 2011 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • Madeleine


    September 17th, 2011 at 6:09 AM

    This so obviously correlates that it seems like a no brainer to me. Have a good therapist, obviously your chances for recovery are bound to be much greater.

  • Jeff


    September 17th, 2011 at 9:27 AM

    experience does not always equate to competence



    September 17th, 2011 at 8:02 PM

    This experiment is laughable. It doesn’t take an official study to realize that the more effective therapist well have better outcomes with clients. Same goes for anything, better plastic surgeons do a better job, better personal trainers give clients better results with less injuries. It’s common knowledge that the better the professional is the better the clients results will be. I don’t understand why they needed to go around testing it.

    If this wasn’t the case why would it even be necessary to look up reviews on a therapist? Or for clients to pay more money for a better therapist?

  • AB


    September 17th, 2011 at 11:45 PM

    Although the experience may play a role,I don’t think it is too big of a role to consider exclusively on the basis of. There could be a very experienced therapist who does not adopt the best method and the treatment is not all that great and there could be a newbie who takes extra interest and applies all his knowledge and effort and the treatment would be better. So really, it all comes down to the individual treatment and also how comfortable the patient-therapist relationship is, because this is a very important aspect in therapy and counseling.

  • Lon


    September 18th, 2011 at 8:44 AM

    If the therapist does not feel comfortable then how can they ever make the patient feel at ease?

  • Maria Littlefield

    Maria Littlefield

    September 18th, 2011 at 2:46 PM

    What I would like to know is if what came out of their participation in such studies would be taken into account when these therapists come before the licensing boards for renewal. I’m not caring so much about the effective ones but I do care that the ineffective ones have been deemed so and want somebody to take notice of that.

  • Nate


    September 18th, 2011 at 3:29 PM

    ” Does a Therapist’s Effectiveness Determine Client Outcome?”

    Not always would be my answer to this question. There are far too many factors that need to be weighed in. Therapy is not something that can be ‘measured’ that easily. And we can gauge something only if it is measurable.

  • Amber Bowie

    Amber Bowie

    September 18th, 2011 at 3:53 PM

    Maria Littlefield:That’s right! There needs to be follow-up when such findings are reported for the client’s sake. The board should at least be looking at them closer, surely. When do ineffective therapists get weeded out? Do they ever? Or does it take, as I suspect, a complaint or a court case against them before anything is done to ascertain that they are still up to the job?

    Does anyone do more beyond a quick glance at them come renewal time if the name’s not new to them? I have my doubts.

  • sharmaine vance

    sharmaine vance

    September 18th, 2011 at 5:07 PM

    I feel there are therapists of many years standing that get rubber-stamped each time to continue on with their less than stellar work purely because they have experience under their belt.

    As Jeff observed in his comment, experience does not always equate to competence, and that goes for every profession.

  • Timothy Grisham

    Timothy Grisham

    September 18th, 2011 at 5:47 PM

    In fairness to the therapists, not every client is willing to open up to them and make a connection speedily, if at all. The client’s opinions of the therapist could be distorted by the very GAD that they are there seeking help for. It’s a two-way street.

    There could be a very good therapist paired with a very uncooperative client, and they would show up as bad in the survey undeservedly. I’d take such studies with a pinch of salt and make up my own mind whether I felt the therapist was competent once I’d had a few appointments with them-and only then.

  • Mig


    September 19th, 2011 at 3:48 AM

    It does play a role in my opinion.All of us,irrespective of the profession,pick up newer things and learn at every step and our experience is a big asset to us.

    Its the same for therapists.They learn with time and I would feel a lot moire comfortable going to a more experienced therapist than a beginner!

  • Beth Anne

    Beth Anne

    September 19th, 2011 at 3:40 PM

    I suppose that if you are willing to do a lot of the work and healing on your own then it really does not matter one bit about the effectiveness of the therapist. But this seems kind of silly to me- doesn’t it you? I mean if I am going to pay the kind of money that I know therapy runs then why would I not want someone to be as fully invested in my situation as I am? I would expect that of any other physician, and I expect that from my therapist too. And I can assure you that I am not alone in this expectation.

  • Desmond Paul

    Desmond Paul

    September 19th, 2011 at 11:02 PM

    I would gauge a therapist by how I feel after 2-3 therapy sessions.Its not his perfection in his previous cases that matter to me, what matters is if I feel like I’m making progress and am moving towards feeling better. That is the reason we go to therapy isn’t it?

Leave a Comment

By commenting you acknowledge acceptance of's Terms and Conditions of Use.



* Indicates required field.

Therapist   Treatment Center

Advanced Search

Search Our Blog

Title   Content   Author is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on