Psychotherapy is hard to study. It’s particularly hard to study what it is exactly that helps people in therapy get better. Some schools of thought, like psychoanalysis, are uncomfortable even declaring therapeutic aims to be the primary consideration of the analyst. I argue that outcome is the only thing that should matter to us, as therapists, and that there are few universal principles of technique that we can rely on to judge whether or not something that we’re doing is helpful or not. Therapists have to ruthlessly analyze and judge their patients’ responses to their interventions. If a patient leaves sessions feeling misunderstood and isn’t getting better over time, then the therapist is responsible and needs to change his or her approach.