I Dodo Bird You Not

What matters for good therapy? Therapist's attachment, therapy key moments, client's preferences and more. New friendly facts.

In his book Alice’s Adventures in Wonderland, Lewis Carroll describes the following scene:

After a swim, Dodo bird proposes to Alice and other birds to have a particular kind of race - a race where everyone wins. "Everybody has won, and all must have prizes!" - Dodo bird famously exclaims. It is the Dodo Bird verdict.

The Dodo Bird Verdict has famously been used to describe the idea that all psychotherapeutic approaches are equally effective when delivered by a skilled therapist. When it comes to humanistic or relationally oriented therapy approaches, we typically learn that Dodo Bird verdict it is, and - as this article explains - the evidence for it - although not accepted by all - was there. But fast forward to 2026, and post-COVID years bringing new ways of doing and documenting the therapy processes, aided by new methodological advances to track effects and change in therapy, does Dodo Verdict still hold?

And how about other core questions that we might ask about therapy? How much of the therapy process is really down to the therapeutic relationship (the relationship heals postulate)? How therapist’s personality and attachment affect the process of therapy? Is therapy universal or should be culture-dependent? And so on.

Mick Cooper researches effectiveness and outcomes of psychotherapy process and has written the classic text Essential Research Findings in Counselling and Psychotherapy: The Facts Are Friendly in 2008. But have things changed since 2008? The new edition of this book is about to be released and Mick has written a piece for Therapy Today that sheds the light on some of the most salient differences between the research findings about the process of psychotherapy and associated change between now and then.

Mick is one of my favourite authors writing about therapy research and a go-to when I want a balanced perspective on what is effective in therapy when relational depth and big existential givens of human life are taken into the equation.

I encourage you to read Mick’s original piece, and here I simply recount it (with his permission), adding some of my personal reflection and commentary. The original piece also contains the extensive list of supporting references.

In this piece, I will discuss the new - and some maybe unexpected - findings around:

• what counts as improvement in therapy, from the client’s perspective

• how important is the therapist anyways (this might bruise some therapist egos, including mine)

• how therapist’s attachment style and personality matter and affect therapy process

• is the Dodo Verdict still on?

• should we do what we do regardless, or do client’s preferences count?

Let’s go.

What Counts As Change And Improvement (From Clients’ Perspective)

There is lots of oneupmanship in therapy. What really counts as therapy? Am I, as a therapist, working with this premise somehow better, deeper and more fundamentally therapeutic than you working on your premise of therapy? Am I the real therapist whilst you are a mere supportive figure or a coping-strategy teacher.

Others yet, see therapy as having to work under the premises of the medical model: people come with a condition - a disorder - they are treated with therapeutic treatment and subsequently cured and good to go.

So, which one is really therapy? And what aims and goals should therapists be pursuing?

One clever way to try to answer that question is to turn it upside down and instead of asking therapists to answer what they think therapy should be - answers to which that would typically differ depending on their orientation, we could ask the clients what they felt was the most meaningful and important change or improvement they experienced as a result of the therapy process.

The seven most commonly reported impactful results of therapy, a recent meta-analysis found, in that approximate order, from clients’ perspective, were:

1. gaining a new perspective on the self

   In the time when therapy as an open ended endeavour and existential inquiry is under fire, this being the first on the list of things that people find was impactful and end key in their therapeutic journey then we’ve got to stop ourselves what are we doing? Are we always measuring the right thing when we think about therapy effectiveness?

2. experiencing relief

3. feeling heard, understood and accepted

   This obviously is a big win for core conditions of person centred therapy and generally humanistic denominations.

4. developing new skills/coping strategies

   This, on the other hand, is a win for more directive types of therapy such as CBT, ACT, DBT, solution focused approaches but also mindfulness-based therapies, and body-focussed approaches.

5. becoming more in touch with your emotions

   For therapists who mainly work on emotion regulation it is important to consider the value of emotions, helping clients not only regulate them but also their experiencing and meaning making that can happen as a result.

6. feeling empowered

   Therapy can lead to profound change in meaning of our life and our past experiences - and the resulting life narrative that emerges can lead to feeling empowered instead of initial negative feelings and narratives that might have existed.

7. having a sense of reassurance/feeling supported/having a sense of hope

   This is another point that aligns, although more loosely, with the core conditions and is in the heart of all humanistic psychotherapies.

Consistent with this, another qualitative meta-analysis of clients’ experiences, drawing on data from 100+ studies, was able to articulate the core value of psychotherapy as follows: ‘Being known and cared for supports clients’ ability to agentically recognise obstructive experiential patterns and address unmet vulnerable needs.’

It is worth noting that some therapy critics (or therapy philistines rather - at least how I call them), say that the last features above as reasons for therapy are not justified. Those, they argue, should be the province of friends, family members, priests (or even maybe hairdressers). By the virtue of such argument, the profession that provides “care and support and addresses unmet needs” could be seen as obsolete or worse yet exploitative of the relationship-poor people. As you can probably imagine, I could answer many things to that, but I will leave it to you to make your own case in favour of our profession.

Bruising Therapist’s Ego 😢

How important is the therapist in therapeutic change? It turns out not so much. Therapists characteristics contribute the modest (but significant) 7% to the overall therapeutic change.

That is a little bit of a humble pie for us therapists, but it is OK. Maybe the way to understand this is that client that comes to therapy is ready for the change to happen and will find a way to achieve it, regardless of the therapist? I wonder what your take is on this specific result. Is it a surprise? Would you have expected more? Or less?

Infographics: what factors drive therapeutic change. The biggest factor is the client themselves - client is already on a journey and as therapists we are there to help that process. Used with permission. Created: Mick Cooper and xabierlopez.co.uk

Therapist’s Attachment Style And Personality

Now within those 7%, how much therapist’s personality matters for how therapy unfolds? I personally would say quite a bit - although it is difficult to put my finger onto what would the desirable personality traits exactly be.

Digging into what constitutes these personal characteristics that matter, attachment seems to play a role - and my apologies for adding to the Matthew effect of secure attachment - it seems as though the secure attachment leads to better outcomes (it is worth noting that this conclusion has obtained in case of psychodynamic therapy orientations see here and here).

Now what seems to be important too, and this is so important for all of us to understand and take on board as much as possible, greater therapist’s wellbeing better the outcomes.

There is more, and I can totally ascertain to this from my own experience: the reflective function seems to play an important role. The reflective function is the capacity to generate hypotheses about another person’s behaviours, feelings, mental states and intentions. It helps us make sense and interpret other people’s internal world and predict their attitudes and behaviours. In the brain, the reflective function would be underpinned by one of the large brain networks - the default mode network (DMN) - also referred to as the mentalization network.

As it turns out, and maybe unsurprisingly, that the levels of reflexive function are associated with positive outcomes of therapy. In fact, reflexive function of the therapist seems to offset the drawbacks of anxious attachment and the combination of attachment anxiety and high reflective function might lead to the best therapy outcomes.

Now if I think back to the beginning of this section, where I said that there is something that is difficult to pinpoint but that seems fundamental for the personality of a good therapist, it might be that the reflective function was the trait that I was trying to grasp for. In fact, in choosing the job of a therapist, it is my belief that most of us are pretty good at this. I mean who would choose this job unless you relish and enjoy thinking about how and why other people think, feel and behave and make sense of it all. In a way, out job is the job of reflective function.

And if ever this is something we are lacking, the good news is that it can be developed.

I Dodo Bird You No More

And now, how about the Dodo Bird Verdict between different psychotherapy schools? Is everyone winning still?

And here comes the big news - it appears as though Dodo does not stand, or at least that Dodo is not as compelling as it used to be.

These conclusions are based on large UK study where the person-centred therapy was gauged against the CBT when working with depression - and importantly the experimental design of this trial was foolproof when it comes to allegiance bias - the bias that might exist when experimentators hold an allegiance to a specific therapy approach. The therapy was delivered over 20 weekly sessions - so it is the middle ground between the short and long term therapy.

At 6 months, the outcomes did not significantly differ. At 12 however, those who received CBT were doing better.

Of course, this does not mean that CBT is superior that all of the non-CBT approaches or even all humanistic or relational approaches. Person-centred approaches are typically at the extreme end of non-directiveness (see the infographics in the following section) and there is a number of approaches that sit somewhere in the middle between directional and non-directional, such as Transactional Analysis - I am a TA therapist myself and I feel I really work in that middle ground, gestalt or even existential approaches. So not all is lost for humanistic predilections.

Furthermore, it looks like there is a growing evidence pointing to the direction that directive approaches might provide better outcomes compared to purely non-directive supportive relationship oriented therapies. I must say that for me, this is not a surprise. I wonder what you think?

And it might be that having several proverbial strings in one’s therapist’s bow might the best solution allowing for flexibility and accommodation of client’s preferences - which is our next topic to look at.

Tailoring Therapy to Client’s Preferences

Infographics: Types of therapy along features of when (in time) the work is focussed and how directive it is. Different people might have different preferences, when it comes to these features. Specific combination of features might also be suited for a specific presentation. Used with permission. Created: Mick Cooper and xabierlopez.co.uk

I think that in the past, and still possibly today - certainly this was the undertone of my own training experience- the following narrative was common: if the client did not like the therapy approach and voiced their different preference, it would be seen as a valuable information for the therapy and the therapist, but as a form of resistance. We were not necessarily taught to embrace and try to accomodate client’s preference but rather to work out why this “resistance” was here and with a sort of underlying assumption that the resistance behaviour acts as a sort of an oracle - what the resistance defends against that is where the problem lies and that is where we need to lean into eventually.

It is of course a compelling story, but the one that I kind of stopped embracing when I started practising. It just felt that some people respond better to certain kinds of interventions - and in a trivial sense, of course that there was a deeper reason for ir, deeper reason that we are all different in some ways, but that reason was not necessarily THE reason that we were to pursue in therapy.

Based on this experience of my own growth as a therapist, I am not so surprised that the latest research suggests that, in fact, preferences should be taken into account and accommodated.

People are different and based on their coping strategies and personality traits might respond better to directive approaches or non-directive ones, or somewhere in between. The same is true for insight - some people might gain a lot from insight based on what kind of person they are while others might fare better - and ultimately maybe gain more insight in the process - through learning coping strategies and specific ‘techniques’.

And, another big thing that emerges from the research in the last 20 years or so is the value of culturally-sensitive therapy, the importance of awareness on the part of the therapist of client’s culture and the ability to work in a way that tailors to the specifics of the culture and without assuming the universality of reactions, behaviours, emotions and their meaning. But that is an important story that deserves a whole piece to itself, and better delivered by people who know about this much better than me. However, I do want to stress that this undeniably an important realisation that is gaining the mainstream discourse in psychotherapy and rightly so.

The Bigger Picture (and Possible Limitations)

If I take a step back and think about all that is laid out here, to me it corroborates the idea that there is no superior or inferior therapies as such. Different people might have different preferences. Specific therapies might be more suitable for specific presentations. But claiming the universal superiority of one approach over another, to me, at this point, does not make sense.

One caveat here, I suppose. The studies that the above conclusions are based on have mainly been conducted in the UK and US - is therapy practiced the same everywhere? I doubt it, but I don’t know. Do this new results hold universally. Again, I do not know.

Now, what are the take home messages - at least for me. As I said, I might practice one set of therapies with my clients and might have my habitual go-tos when trying to ‘solve’ a specific therapeutic problem. Those are not superior to some others, they are just my mix. I am also taking on board that me, as I therapist, I might not be so important in the end (only meagre 7%). The client is on a journey and we are there to bear witness and help when and how we can. Working towards a secure attachment might be a good idea, but if that is not available, then by all means work on developing the reflexivity - but I guess that might be even stating the obvious, we all are doing that all of the time, as therapists. I also take on board the need to emphasise the culturally-informed psychotherapy practice. Finally, I will try to be even more flexible with my clients and accommodate their preferences, even if it means that I have to expand my set of skills.

If you spot something that I forgot in all this, please let me know. It is quite a complex subject to get around.

What are your reactions after reading this? Surprise? Confirmation of your views?

What are your take home messages?

As always, thank you for reading 🙏.

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The original article from Therapy Today can be found here.

The lovely infographics were created by xabierlopez.co.uk