Is Therapy More Effective When Your Therapist Likes You?

Clients can be resistant to therapy for a number of different reasons. In cognitive behavioral therapy, clients are encouraged to develop a secure and collaborative bond with their therapists. But how much does the therapist’s attitude influence client compliance or resistance? Researchers Henny A. Westra, Adi Aviram, Laura Connors, Angela Kertes, and Mariyam Ahmed, from York University, wanted to find out. “Strong empirical evidence indicates that higher levels of resistance are consistently linked to poor therapy outcomes, as well as premature termination of treatment,” they said. “Thus, resistance in therapy is important to prevent, identify, and minimize.” The researchers enlisted four trained therapists to provide eight sessions of CBT to 30 clients diagnosed with generalized anxiety disorder (GAD). Using the Ratings of Emotional Attitudes to Clients by Treaters (REACT), the team evaluated the emotional response of the therapists to the clients at various points throughout treatment. After the first and third sessions, the Penn State Worry Questionnaire, the Client Resistance Code and the Cognitive Therapy Rating Scale were also administered.

The findings suggest that the emotional reaction of the therapist is paramount in predicting client compliance or resistance. “In particular, therapist report of greater early positive reactions to clients, especially liking, fondness and affection for the client, enjoyment with the client, a sense of connection or attachment to the client, gratified in working with the client, and optimistic about the client’s future were consistently associated with lower levels of independent-rater observed client resistance at midtreatment,” said the team. “Moreover greater positive early reactions to clients were also associated with significant changes (reductions) in client resistance from early to mid-treatment.” The researchers believe their findings are extremely important, especially since there have been few studies on this dynamic. They said, “Although research on therapist characteristics has not commanded a great deal of attention in the context of CBT which has placed relatively more emphasis on technical proficiency, the present findings suggest that such effects may nonetheless exist and exert important influences on client engagement in the therapy process.”

Westra, H. A., Aviram, A., Connors, L., Kertes, A., & Ahmed, M. (2011, June 20). Therapist Emotional Reactions and Client Resistance in Cognitive Behavioral Therapy. Psychotherapy: Theory, Research, Practice, Training. Advance online publication. doi: 10.1037/a0023200

© Copyright 2011 by By John Smith, therapist in Bellingham, 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.

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  • geena


    August 11th, 2011 at 4:31 PM

    Isn’t that crossing the proverbial professional line when your therapist “likes” you? I mean, I don’t care if they really like me or not as long as we can get some resolution to some of my issues together.

  • Heather Brown

    Heather Brown

    August 11th, 2011 at 5:19 PM

    It must be very challenging to put your personal likes and dislikes aside when you’re a therapist. Much as I’m fascinated by psychology and how we become who we are, I don’t know if I could distance myself like that yet simultaneously make a connection with the client.

    Just one more reason to admire the work therapists do!

  • Shari Rose

    Shari Rose

    August 11th, 2011 at 6:23 PM

    “Moreover greater positive early reactions to clients were also associated with significant changes (reductions) in client resistance from early to mid-treatment.” I think that’s only natural. Each one of us can sense when a person likes us or not, even when it’s not obvious on the surface.

    You’re going to be more amenable to another who gives off a friendly vibe than feels hostile or uncaring, no matter which side of the desk you’re on.

  • Carol Cann, MA, LCPC, CADC

    Carol Cann, MA, LCPC, CADC

    August 11th, 2011 at 7:13 PM

    It was really interesting to me that the researchers used CBT in this study. CBT does supposedly place more emphasis on technical proficiency and the structure of the therapy. However, one thing I learned from teaching CBT to psychology graduate students, is that the relationship between the therapist and the client is the number one curative factor. (True for therapy in general, but definitely stressed by the authors of the CBT texts.) An atmosphere of mutual respect and collaboration is a must for successful Cognitive-Behavioral Therapy.

    And, in my opinion as a long-time therapist, it IS important to getting resolution for a client’s issues if the therapist has positive reactions to that client. No matter how hard a therapist may try to keep things neutral if they have negative feelings about someone, those negative reactions will come out in some unconscious ways — perhaps starting sessions late, forgetting information, scheduling errors, etc.
    This is often known as “countertransference.”

  • Faye Samson

    Faye Samson

    August 11th, 2011 at 9:43 PM

    It must be so frustrating for both the client and the therapist when they don’t hit it off. Of course it can happen eventually and the relationship gradually becomes less adversarial but so much time can be wasted before you get to that point. I guess it’s all in a day’s work for the therapist.

  • Johanna


    August 12th, 2011 at 4:43 AM

    A good therapist should be able to leave likes and dislikes out of the equation. But you know that they are human like the rest of us so those thoughts, even when you do not want or need them to, can always come creeping in. There are some people who we instinctively do not like, but as a therapist that should not have any sort of bearing of what kind of help that you offer to this patient. And if it does then you should at least be professional enough to excuse yourself from the case and ask someone else to step in on this patient’s care.

  • helen n

    helen n

    August 12th, 2011 at 4:44 AM

    when I’m in your office with problems of my life and baring everything to you and telling you things that I wouldn’t to anyone else,I would expect there to be a good rapport between us or it will be very weird and inconvenient for me to open up or go on to tell you things.Its simple.

  • Eric


    August 12th, 2011 at 1:55 PM

    any person you have to deal with,there needs to be understanding with the person for the deal(whatever it may be) too go through easily.this becomes enormously more important when it comes to a therapist due to the nature of interaction involved.without first hitting that comfort zone,there is no way you can have a good consultation session.

  • justine andrews

    justine andrews

    August 12th, 2011 at 10:43 PM

    I don’t think it’s that much different from a boss-worker relationship. If you like and respect your boss and he treats you well, you’ll work that much harder for him and go above and beyond the call of duty if need be.

    If he doesn’t, you will do what you have to to get through the working day and no more. The more connection there is, the less resistance and more openness.

  • Jace


    August 13th, 2011 at 6:58 AM

    If I am in an office and I get the sense that eprson across the desk does not like me then I think that automatically I am going to shut down. How can I get therapy that is going to help me when I am in a situation like that? I need someone who is going to open up to me and allow me the comfort of opening up to them. That is what a therapist is supposed to do. Don’t judge me on my character or whether you would like to be my friend. Help me with the issues that I am dealing with.

  • Cheryl


    August 14th, 2011 at 4:48 AM

    Here is the way it is. When your therapist likes you, you are going to sense that. So not only are you going to be more open minded about what he or she has to say, but they are going to know that and are going to be willing to do more to help you through the problems that you are facing. I do not think that there are many professionals though who are going to allow the fact of whether they like you or not personally harm the good that they can help do for you professinally. I think that a good therapist can get past this and can work with you regardless of what they really think about you. Most of them care about the care that you are receiveing and helping you make progress, not whether or not they would want to go out to dinner with you after a session.

  • Jerry Smith

    Jerry Smith

    August 14th, 2011 at 4:03 PM

    You walk into the therapist’s office and if his face says nothing to you that’s welcoming (even if his words do), you know he just wants you out of his hair as soon as possible.

    I can’t imagine what would make a therapist put you on his bad side however. They are professionals. I feel the client would have to do it on purpose and there’s always the possibility they are seeing something that simply isn’t there in the therapist’s expression.

  • George Rothwell

    George Rothwell

    August 14th, 2011 at 6:12 PM

    @Jerry–Actually, I can think of a good one; being a hypochondriac. My brother is a hypochondriac. I have a friend who’s a doctor and he confided in me that he is completely sick of his type and looking forward to retirement. Hypochondria is a genuine medical problem but there’s not much you can do to help it.

  • Simon Francis

    Simon Francis

    August 14th, 2011 at 7:10 PM

    @George – Maybe your brother can’t do much to help it himself but a professional therapist certainly can help him and others like him. Hypochondriacs need treatment for their condition just the same as anyone else.

    Aside from medication like antidepressants, CBT is considered very effective for them. Perhaps it’s a good thing your friend’s retiring if he’s feeling so jaded.

  • Annabelle Marks

    Annabelle Marks

    August 14th, 2011 at 8:59 PM

    @Geena…If your therapist has a positive attitude toward you and you to them, you’re likely to be more open with them, which lets them get to the root of the problem even faster. If they can at least be friendly and not judge me that’s all I can ask.

    We as clients need to meet them halfway. I believe therapists are professional enough that they wouldn’t treat you differently if they had a personal dislike for you than they would if they did.

  • Fran W

    Fran W

    August 15th, 2011 at 4:41 AM

    Well it probably is more effective when there is a strong patient therapist relationship and the therapist actually likes you. But somehow that makes everything feel like a popularity contest and seeking help for an issues should not leave you feeling that way.

  • Karen Parkin

    Karen Parkin

    August 15th, 2011 at 10:07 PM

    @Heather–it really isn’t that hard at all. If you can’t do that, then you honestly have no business being in any social setting OR working a job whatsoever. It does not take much effort to do it, but it does take a great deal to effort to hate someone.

    I’ve worked in retail for years and have regular customers I dislike. However I treat them in a courteous manner because I’m good at my job and do it right, regardless of my personal feelings.

  • E.M. Forbes

    E.M. Forbes

    August 17th, 2011 at 3:31 PM

    @helen n: That’s exactly it. If I don’t trust my therapist and I think she doesn’t even like me, why the Heck should I tell her all of the secrets which I don’t share with my closest friends and family? You’re already taking up my money and my time and if it’s not going anywhere early on, of course I’m going to be having my eye on you.

  • aidan webster

    aidan webster

    September 25th, 2011 at 4:42 PM

    Forming a bond between therapist and client is essential for the success of the therapy sessions. “helen n” is spot on; how can you trust a therapist if you don’t even like them/ you don’t think they like you? The short answer is you can’t.

    While you shouldn’t have a personal relationship with your therapist outside of their office (for obvious reasons), a bond is necessary in order to get yourself or clients to open up.

    Talking to a therapist that you aren’t comfortable opening up to is about as effective as talking to a stranger to help with your problems. *Hint* talking to a stranger isn’t very effective for solving your problems! ROTFL!

  • Emotional


    March 17th, 2015 at 7:42 PM

    i often wish my therapist could be a friend or family member. But I have to put those wishes aside. I’m emotional thinking about this weeks session coming up. Began to cry but stopped in middle of it last time. Now regretting it. Hope that’s a good sign for me to feel more comfortable opening up to her. Abuse sucks

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