How Therapists Become More Effective: The Research Behind Clearway’s Approach to Clinical Development

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By Gladys Villa, LCSW, LAC, MBA | Clearway Network

A look at psychotherapy research on therapist effects, clinical performance, responsiveness, feedback, and skill development - and how that research has influenced the way Clearway thinks about ongoing clinical development.

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Becoming a licensed therapist takes years of education, supervision, training, and clinical experience.

But licensure is not the end of our development. Once we are practicing independently, a different question becomes important:

How Do we Continue Developing as Therapists and Improving the Clinical work We Do With Our Clients?

The familiar answers have value: see more clients, attend training courses, earn continuing education credits, learn another therapeutic approach, and accumulate experience.

Psychotherapy research, however, gives us reason to look beyond knowledge and years of experience alone. It asks us to pay attention to the individual therapist, to what happens when knowledge must become performance, and to how feedback and intentional skill development may contribute to continued growth.

There probably is not one answer to how therapists improve. But research on therapist effects, interpersonal skills, responsiveness, and professional development gives us useful places to look.

The Therapist Matters

Much of psychotherapy research has understandably focused on treatment: which approaches work, for whom, and under what circumstances?

Another body of research has examined a different question: how much does the individual therapist matter?

Research on therapist effects has found differences in client outcomes associated with the individual therapist providing treatment. Advances in statistical methods have made it increasingly possible to estimate therapist contributions separately from other sources of variation, although identifying exactly which therapist characteristics account for those differences remains more difficult (Baldwin & Imel, 2013; Anderson et al., 2020; Wampold & Imel, 2015).

That distinction matters. The research does not give us a simple profile of the “effective therapist.” It does give us reason to pay attention to the therapist - not only the model being practiced.

The developmental question therefore becomes more specific: How skillfully and responsively can we use what we know with the client in front of us?

Years of Experience Don’t Predict Clinical Effectiveness.

We naturally associate expertise with experience. Experience has real value: the more clinical work we do, the more situations we encounter and the more opportunities we have to learn.

The more useful question is whether the passage of time, by itself, guarantees continued improvement. There is reason not to assume that it does. In a study of psychotherapists and client outcomes, Chow and colleagues found that therapist characteristics such as years of experience, age, profession, highest qualification, caseload, and degree of theoretical integration did not significantly predict client-reported outcomes in the subsample they examined. Time spent in activities targeted at improving therapeutic skills was a significant predictor of outcomes in that study (Chow et al., 2015).

This does not mean experience is unimportant. It means experience and improvement are not necessarily the same thing.

We can become more experienced while continuing to examine difficult clinical moments, question our assumptions, seek feedback, and refine specific skills. Experience creates opportunities to learn. What we do with those opportunities matters.

Clinical Knowledge and Clinical Performance Are Not the Same

This distinction becomes especially interesting in the work of Timothy Anderson and colleagues on Facilitative Interpersonal Skills (FIS). FIS is a research method designed to examine therapists’ interpersonal performance rather than simply what therapists know. Therapists view standardized video simulations of difficult client moments and respond as though they were in the session. Independent raters evaluate those responses across common relational skills such as empathy, warmth, alliance-building, and responsiveness (Anderson et al., 2020).

The method is pan-theoretical and treatment nonspecific. Its purpose is not to test proficiency in one therapeutic model, but to examine interpersonal abilities that may be relevant across approaches. The distinction is between understanding a clinical concept and being able to use the skill when a difficult clinical moment happens.

A therapist can understand alliance rupture. We can read about it, attend a training course, discuss it in consultation, and know the principles involved. Then a client becomes angry, withdraws, challenges something we say, or tells us therapy is not helping. Now knowledge must become a clinical response.

Across several studies, FIS performance has predicted psychotherapy outcomes, including work examining therapist effects (Anderson et al., 2009; Anderson, McClintock, et al., 2016; Anderson et al., 2020). That does not mean FIS captures everything that contributes to therapist effectiveness. It does offer a useful way to study the difference between knowing about a skill and performing it in a challenging interpersonal moment.

Information alone isn't enough.

Difficult Clinical Moments Test Our Ability to Respond.

Another idea in Anderson’s work is therapist responsiveness: the ability to form a response that fits the client’s needs in a particular moment (Anderson et al., 2020). Clinical work does not always offer a predetermined “correct” response. Clients differ. Context matters. The therapeutic relationship matters. The same intervention can land differently depending on the person and what is happening between therapist and client at that moment.

This is one reason difficult clinical moments are so useful to consider in professional development. Relational skills that feel relatively natural when therapy is proceeding smoothly may be tested differently when a client is angry, disappointed, disengaged, or when an intervention clearly is not working.

In those moments, the therapist must notice what is happening, tolerate uncertainty, consider what the client may need, and respond. That is clinical performance, not simply clinical knowledge.

Practice Has to Be Intentional

In psychotherapy, the word practice often means our work itself: clinical practice, private practice, practicing psychotherapy. That is not necessarily the same as practicing a specific skill.

Chow and colleagues studied deliberate practice, a defined framework involving activities targeted at improving therapeutic skills. Their findings associated more time spent in targeted skill-improvement activities with better client outcomes in the subsample studied, while years of experience and several other professional characteristics did not significantly predict outcomes (Chow et al., 2015).

Clearway does not use deliberate practice as a model label. The research on therapist development is still evolving, and deliberate practice has a specific meaning in the expertise literature.

The distinction it highlights is useful, however: doing clinical work and intentionally working on a specific clinical skill are not the same activity. When we use the word practice at Clearway, we mean creating opportunities outside the therapy room to focus on a skill, learn it, practice, receive feedback, refine, and try again.

The goal is not repetition for repetition’s sake. It is to make skill development more intentional.

Developing Clinical Skills Requires Feedback.

Experience gives us opportunities to learn, but experience by itself does not necessarily give us feedback.

We can reflect on a difficult session and consider what went well, what did not, and what we might do differently next time. That kind of self-reflection matters. But we are still examining the experience from our own perspective.

Other clinicians can notice something we miss, ask a question we have not considered, offer another way of understanding a client’s response, or give us feedback on a skill we are trying to develop.

There are things we can learn from experience on our own. Other things become easier to see when someone else is looking with us.

Meaningful feedback also requires a professional environment where clinicians can be uncertain, ask questions, test ideas, and receive thoughtful input. Development is not only an individual process; some of it happens in relationship with other clinicians.

We can reflect on our own work. We can’t give ourselves an outside perspective.

Independent Practice Changes the Feedback Environment.

Earlier in our careers, feedback may be built into the structure around us through graduate training, supervision, consultation, agency teams, and colleagues working nearby.

Independent practice changes that environment. The clinical responsibility remains, but many of the opportunities for feedback, consultation, and professional exchange are no longer built into our day-to-day work. In independent practice, continued development means being intentional about creating those opportunities.

We must seek out consultation, feedback, skill practice, and professional relationships that may once have been part of the environment around us.

Practice Before the Difficult Moment Happens.

One challenge of developing clinical skills is that the moments we most want to handle well happen with real clients. There is no rewind button in therapy.

Outside the therapy room, however, we can slow a situation down. We can examine what made it difficult, consider possible responses, practice one, receive feedback, and try something different.

Anderson and colleagues suggest that difficult clinical moments may require a different kind of practice from more standard interventions and describe these moments as opportunities for therapist development (Anderson et al., 2020).

What Clearway Takes From Research.

Research on therapist development is still evolving. We do not have a complete formula for what makes one therapist more effective than another or exactly how therapists develop across a career. But the research gives us useful direction, and those ideas shape how we approach clinical development at Clearway.

Practice: Clearway creates opportunities to practice clinical skills outside the therapy room, where there is time to slow down, try something, get feedback, adjust, and try again.

Feedback: We can't see everything from inside our own clinical work. Feedback gives us another perspective on how we are responding and what we might consider doing differently.

Consultation: Complex clinical situations rarely have one obvious answer. Thinking alongside other clinicians can help us consider perspectives, questions, and possible responses we may not have reached on our own.

Professional Relationships: Practice, feedback, and consultation require other people. Developing relationships with clinicians we trust creates a place to ask questions, acknowledge uncertainty, exchange perspectives, and continue learning from one another.

Continuous Development: Experience gives us opportunities to grow, but the passage of time doesn't ensure that growth. Clearway creates a structure for clinicians to stay engaged in developing their skills throughout their careers.

Clearway is also not tied to one therapeutic orientation. The goal is not to replace the clinical approach you’ve developed.

It is to keep developing the therapist using it.

What We Mean by Research-Informed.

Clearway is Research-Informed.

The research described here influences how we think about therapist development and why Clearway includes opportunities for practice, feedback, consultation, professional relationships, and ongoing refinement.

Clearway itself has not been studied as a clinical-development intervention, and we do not claim that joining Clearway has been demonstrated to improve client outcomes.

Clearway is a professional development space where research helps guide how we develop as clinicians, rather than leaving growth to guesswork alone. The goal is to become more intentional about our clinical effectiveness and build practices that support the careers we want.

How Therapists Become More Effective Overtime

One of the things I appreciate most about this research is the invitation to remain curious about our clinical work.

Experience gives us more to draw from, but it also gives us more to examine: the clinical moments that challenge us, the assumptions we carry into the room, the skills we want to refine, and perspectives we may not yet have considered.

Continued development is not something we graduate from as we become more experienced. It remains part of our clinical work throughout our careers.

That is the kind of professional environment we are building at Clearway: a place where independent therapists can practice clinical skills, receive feedback, consult with colleagues, and continue developing alongside one another.

There is always more to learn from our clients, from one another, and from the clinical work itself.

About This Article.

This article reflects Clearway’s interpretation of research on how therapists become more effective and how that research has influenced our approach to clinical development. It is intended to explain that foundation, not to provide a comprehensive review of the psychotherapy-outcomes or therapist-development literature.

Research & References.

Anderson, T., Finkelstein, J. D., & Horvath, S. A. (2020). The facilitative interpersonal skills method:

Difficult psychotherapy moments and appropriate therapist responsiveness. Counselling and Psychotherapy Research, 20(3), 463-469. https://doi.org/10.1002/capr.12302

Anderson, T., McClintock, A. S., Himawan, L., Song, X., & Patterson, C. L. (2016).

A prospective study of therapist facilitative interpersonal skills as a predictor of treatment outcome. Journal of Consulting and Clinical Psychology, 84(1), 57–66. https://doi.org/10.1037/ccp0000060

Anderson, T., Ogles, B. M., Patterson, C. L., Lambert, M. J., & Vermeersch, D. A. (2009).

Therapist effects: Facilitative interpersonal skills as a predictor of therapist success. Journal of Clinical Psychology, 65(7), 755–768. https://doi.org/10.1002/jclp.20583

Baldwin, S. A., & Imel, Z. E. (2013). Therapist effects: Findings and methods. In M. J. Lambert

(Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed., pp. 258–297). John Wiley & Sons.

Chow, D. L., Miller, S. D., Seidel, J. A., Kane, R. T., Thornton, J. A., & Andrews, W. P. (2015).

The role of deliberate practice in the development of highly effective psychotherapists. Psychotherapy, 52(3), 337–345. https://doi.org/10.1037/pst0000015

Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what

makes psychotherapy work (2nd ed.). Routledge.