You Don’t Have to Pick the “Perfect” Kind of Therapy

What research shows really makes counselling work — and why that’s good news for you

Written by Jennifer Hollinshead, Clinical Director and Canadian Certified Counsellor – Supervisor at Peak Resilience.

Feeling unsure about therapy? You’re not alone.

Lots of people feel nervous before their first session. One worry comes up again and again: “What if I pick the wrong kind of therapy?” At Peak Resilience we call different therapy modalities “alphabet soup”  — CBT, EMDR, DBT, ACT, and dozens more. It can feel like you need to become an expert just to choose. Here’s the best news: You don’t.

A quick story about a tower

There’s an old story called the Tower of Babel. People tried to build a tower to the sky. But they all began speaking different languages, so no one could understand each other, and the work fell apart.

In the 1990s, three researchers — Scott Miller, Barry Duncan, and Mark Hubble — said therapy had the same problem. Every “brand” of therapy had its own special words and its own leaders. So they wrote a book called Escape from Babel (Miller, Duncan, & Hubble, 1997). Their main idea was simple: stop arguing about whose method is best, and look instead at what all good therapy has in common.

What makes therapy work?

For more than 50 years, researchers have compared:

1. Different models of therapy (“alphabet soup”) used to address
2. Different diagnoses in the DSM-5 in 
3. Different populations of people struggling under 
4. Different social systems (what’s “normal” in any culture)…

Again and again, research shows the same results: 

No single type of therapy is clearly the winner (Wampold & Imel, 2015). 

Most well-built therapies help about the same amount. Scientists even have a nickname for this — the “Dodo bird verdict,” from a story where a bird says, “Everybody has won, and all must have prizes.”

If the method of therapy isn’t the magic ingredient, what is? Researchers point to a few things that show up in every kind of helpful therapy. These are called common factors. Here are the big ones.

Four biggest predictors of therapy “working” for you

1. You matter most. The biggest ingredient in whether therapy works is you — your strengths, your effort, and the good things in your life outside the room (like friends, family, and small daily wins).
   1. Yes, this is a huge blow to your therapist’s ego (kidding). 
   2. Early researchers thought these “client factors” make up the largest share of change (Lambert, 1992). 
   3. Newer work agrees that therapy helps most when it builds on your own goals and strengths (Baier-Mosch, Weiher, & Kananian, 2025). 
   4. In plain words: counselling doesn’t fix you like a machine. It helps you use what you already have.
2. The therapy relationship is the engine. The “vibe” between you and your counsellor is one of the strongest and most studied parts of therapy. When you trust each other and agree on the goals, therapy works better.
   1. A huge review of 295 studies with more than 30,000 clients found this was true across every type of therapy (Flückiger, Del Re, Wampold, & Horvath, 2018). 
   2. It stays true today, even for sessions held online by video (Aafjes-van Doorn, Spina, Horne, & Békés, 2024; Linardon, Wade, & De La Garza, 2024).
3. Hope helps. Simply believing that things can get better is part of what makes therapy work (Wampold & Imel, 2015).
   1. You don’t need to feel 100% sure. Even a little hope — a sense that change is possible — gives therapy something to build on. 
4. Techniques and methods do matter — but more like tools used to build on the foundation of feeling safe enough in your therapeutic relationship.
   1. A good method gives you and your counsellor a clear plan and something to try. Many different tools can work, as long as they fit you and are used inside a caring relationship (Wampold & Imel, 2015).

Finally – Don’t forget to check in

Here’s a practical idea from the same researchers. Instead of guessing whether therapy is working, we can simply talk about it.

Every so often, you let your counsellor know (and/or rate your sessions in JaneApp) how therapy is working (or not working) for you. Counsellors are trained to creatively co-create therapy with you (not do therapy to you). Together you change course if something isn’t working.

If it doesn’t feel like a good fit, that’s real and important information — not a sign that you failed. You’re allowed to say therapy doesn’t feel right, and we can adjust or find a better counsellor for you.

Does feminist therapy matter in all this?

If you happen to run into Jenny (clinical director and founder of Peak) IRL or online, you’ll probably be subjected to the idea that all good, ethical therapy must be feminist. 

This wasn’t our idea – the entire field of mental health is built on a foundation of hard working, radical feminist therapists and psychiatrists from a variety of backgrounds and lived experiences. 

What this means for you

• You don’t have to find the “perfect” modality of therapy.
• The most powerful ingredient is you.
• A caring, honest relationship matters more than any single method.
• A little hope goes a long way.
• We’ll check in often, so therapy always works for you.

If you’re nervous, that’s okay. You don’t need the right words or the right “brand.” You just need to show up as you are. We’ll figure out the rest together.

Jennifer Hollinshead and their team provide trauma informed, liberatory clinical counselling services in Vancouver, Canada and throughout BC. They teach and lead groups on eventbrite and offer Clinical Supervision for students, counsellors and supervisors.

We will help you find a counsellor that fits. 

This handout is for general education. It is not personal medical or mental-health advice. Research gives us the big picture, but every person is different. Some concerns do respond better to certain approaches — if that’s true for you, we’ll talk it through together.

References

Aafjes-van Doorn, K., Spina, D. S., Horne, S. J., & Békés, V. (2024). The association between quality of therapeutic alliance and treatment outcomes in teletherapy: A systematic review and meta-analysis. Clinical Psychology Review, 110, 102430. https://doi.org/10.1016/j.cpr.2024.102430

Baier-Mosch, F., Weiher, G. M., & Kananian, S. (2025). Determining what is common: A theoretical account of common factors in psychotherapy through the lens of self-determination theory. Journal of Contemporary Psychotherapy, 55, 269–281. https://doi.org/10.1007/s10879-025-09664-y

De Jong, K., Conijn, J. M., Gallagher, R. A. V., Reshetnikova, A. S., Heij, M., & Lutz, M. C. (2021). Using progress feedback to improve outcomes and reduce drop-out, treatment duration, and deterioration: A multilevel meta-analysis. Clinical Psychology Review, 85, 102002. https://doi.org/10.1016/j.cpr.2021.102002

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

Lambert, M. J. (1992). Psychotherapy outcome research: Implications for integrative and eclectic therapists. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94–129). Basic Books.

Lambert, M. J., Whipple, J. L., & Kleinstäuber, M. (2018). Collecting and delivering progress feedback: A meta-analysis of routine outcome monitoring. Psychotherapy, 55(4), 520–537. https://doi.org/10.1037/pst0000167

Linardon, J., Wade, T., & De La Garza, R. (2024). Therapeutic alliance in telehealth and traditional therapy for mood and anxiety disorders: A meta-analysis. Psychotherapy, 61(1), 1–12. https://doi.org/10.1037/pst0000345

Miller, S. D., Duncan, B. L., & Hubble, M. A. (1997). Escape from Babel: Toward a unifying language for psychotherapy practice. W. W. Norton.

Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed.). Routledge.