If you’ve ever wondered “Which therapy works best—CBT, psychodynamic or something else?” you’re not alone. Many people believe that success in therapy depends mostly on choosing the “right” method. Yet decades of research show a more complex picture: while the specific approach matters, your motivation, the relationship with your therapist, your preferences, and your consistency often matter just as much—or even more.

This article brings together scientific findings to help you understand what really drives progress in therapy, and how you can choose the best approach for yourself.

What Shapes Therapy Outcomes?

Beyond the Therapy Label

A classic model suggested that therapy outcomes can be roughly divided as follows:

• 40% from client factors (motivation, life situation, resilience)
• 30% from the therapeutic relationship
• 15% from specific techniques
• 15% from expectations and hope
  (Lambert, 1992, summarized in Norcross & Wampold, 2011).

While these numbers are not exact, they remind us that therapy works because of multiple interacting factors—not just the method.

Supporting Evidence for Common Factors & Outcome Variance

• Wampold (2015) in How Important are the Common Factors in Psychotherapy? reviews a lot of data showing that therapeutic alliance, empathy, positive expectations/hope, and client/therapist fit tend to explain more outcome variability than the specific method. For example, alliance alone often shows moderate to strong correlations with outcome, across different therapy types. PMC
• A more recent study, Common Factors, Responsiveness and Outcome in Psychotherapy (CROP) (Lauritzen et al., 2023), is investigating how client and therapist attributes and their interaction (responsiveness) relate to outcomes. Although it doesn’t give exact “percentage breakdowns” like Lambert’s model, it does show common factors are strong predictors. PMC
• An article called The Misleading Dodo Bird Verdict: How Much of … (de Felice, 2019) argues that common factors explain somewhere between 30-70% of outcome variance in many studies, while unique or specific ingredients (techniques) explain less (often < 10–15%) depending on the disorder and method. 

Key Factors That Influence Success

1. Client Motivation and Readiness

People who enter therapy with a strong commitment to change often experience greater symptom improvement. A review of 22 studies found that higher motivational readiness at the start of CBT predicted better outcomes, regardless of the specific issue (Crane, Hotton, Shelemy, & Knowles-Bevis, 2024).

2. Expectations and Hope

Believing that therapy will help is powerful. Hope and expectancy effects can explain a meaningful portion of improvement—sometimes estimated around 15% of variance (Norcross & Wampold, 2011).

3. The Therapeutic Alliance

Research consistently shows that the relationship between client and therapist is one of the strongest predictors of change. A meta-analysis with over 30,000 people found a moderate effect size (r = .278, roughly d = .58) for alliance, regardless of the therapy type (Flückiger, Del Re, Wampold, & Horvath, 2018).

4. Therapist Factors

Therapist skill, empathy, and cultural sensitivity play a role. A systematic review showed that therapist effects explain about 5% of outcome differences—with some therapists reliably achieving better results than others (Johns, Barkham, Kellett, & Saxon, 2019). Empathy and cultural competence further enhance trust and engagement (Elliott et al., 2011; Owen et al., 2011).

5. Therapy Approach and Techniques

Across major evidence-based approaches like CBT, interpersonal therapy, and psychodynamic therapy, outcomes are often similar, especially for depression and anxiety (Cuijpers, 2019; Zhou et al., 2015). However, for certain conditions, specific methods are especially effective:

• OCD: exposure and response prevention (ERP)
• PTSD: trauma-focused CBT
• Panic disorder: CBT with interoceptive exposure

6. Matching Therapy to Preferences

When therapy aligns with client preferences—such as structured vs. open style, in-person vs. online—results improve. A meta-analysis showed that preference matching increased completion rates (odds ratio = 1.79) and improved outcomes (d = .28) (Swift, Callahan, Cooper, & Parkin, 2018).

7. Consistency and Dose

Therapy is a process, not a quick fix. A dose–response study with over 6,000 clients found:

• 30% improved by session 2
• 53% by session 8
• 74% by session 26
• 83% after a year of weekly therapy
  (Hansen, Lambert, & Forman, 2002).

Regular sessions and enough time are essential for lasting change.

8. Life and Contextual Factors

Progress in therapy is also influenced by what happens outside the therapy room. Strong social support predicts better outcomes (Haeffel et al., 2008), while stressful life events like job loss or relationship breakdown can slow improvement (Kessler, 1997). Practical barriers—such as cost, access, or scheduling—also affect whether people stay in treatment (Swift & Greenberg, 2012).

How to Choose the Right Therapy for Yourself

1. Clarify your goals. For depression and anxiety, many approaches work. Focus on what feels most suitable to you.
2. Pay attention to the relationship. If you don’t feel understood by session 3–4, consider switching therapists.
3. Match to your preferences. Ask for what you value—structure, flexibility, cultural sensitivity, or session format.
4. Commit to consistency. Plan for at least 8–12 sessions to see change, and longer for deeper or chronic issues.
5. Use specialized approaches when needed. For OCD, PTSD, or panic disorder, look for therapists trained in the methods with the strongest evidence.

Therapy is not about finding the one “perfect” method—it’s about finding the right fit. The science shows that your progress depends on a mix of factors:

• Your own motivation and expectations
• The relationship with your therapist
• Therapist skill and empathy
• The approach (especially for certain conditions)
• Consistency of sessions
• Life context and support systems

When choosing therapy for yourself, don’t just ask “Which method is best?”. Instead, ask:

• Do I feel connected to this therapist?
• Does this style fit my preferences?
• Am I ready to commit the time it takes?

Answering yes to these questions is often a stronger predictor of success than the therapy label alone.

References

Crane, C., Hotton, M., Shelemy, L., & Knowles-Bevis, R. (2024). The association between individual differences in motivational readiness at entry to treatment and treatment attendance and outcome in cognitive behaviour therapy: A systematic review. Cognitive Therapy and Research.

Cuijpers, P. (2019). Targets and outcomes of psychotherapies for mental disorders: An overview. World Psychiatry, 18(3), 276–285. https://doi.org/10.1002/wps.20661

Elliott, R., Bohart, A. C., Watson, J. C., & Greenberg, L. S. (2011). Empathy. Psychotherapy, 48(1), 43–49.

Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172

Haeffel, G. J., et al. (2008). Cognitive vulnerability to depression and stressful life events. Journal of Abnormal Psychology, 117(1), 143–154.

Hansen, N. B., Lambert, M. J., & Forman, E. M. (2002). The psychotherapy dose–response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice, 9(3), 329–343. https://doi.org/10.1093/clipsy.9.3.329

Johns, R. G., Barkham, M., Kellett, S., & Saxon, D. (2019). A systematic review of therapist effects: A critical narrative update. Clinical Psychology Review, 67, 78–93. https://doi.org/10.1016/j.cpr.2018.08.004

Kessler, R. C. (1997). The effects of stressful life events on depression. Annual Review of Psychology, 48, 191–214.

Norcross, J. C., & Wampold, B. E. (2011). Evidence-based therapy relationships: Research conclusions and clinical practices. Psychotherapy, 48(1), 98–102. https://doi.org/10.1037/a0022161

Owen, J., et al. (2011). Cultural ruptures in the therapy relationship: Working alliance as a mediator. Journal of Counseling Psychology, 58(3), 274–282.

Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 80(4), 547–559.

Swift, J. K., Callahan, J. L., Cooper, M., & Parkin, S. R. (2018). The impact of accommodating client preference in psychotherapy: A meta-analysis. Journal of Clinical Psychology, 74(11), 1924–1937. https://doi.org/10.1002/jclp.22680

Webb, C. A., DeRubeis, R. J., & Barber, J. P. (2010). Therapist adherence/competence and treatment outcome: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 200–211.

Zhou, X., et al. (2015). Comparative efficacy and acceptability of psychotherapies for acute anxiety disorders in adults: A network meta-analysis. Scientific Reports, 5, 17088. https://doi.org/10.1038/srep17088