Personality Assessment for Therapy: How to Use Your Results Before Your First Session

Therapy works better when both the client and therapist understand the personality architecture they're working with. Here's how evidence-based personality data can accelerate that process.

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Why Personality Data Matters in Therapy

The therapeutic relationship is the strongest predictor of therapy outcomes across all modalities (Norcross & Lambert, 2011). But the match between therapy approach and client characteristics is also significant—what works for one person may not work for another.

Personality assessment doesn't replace clinical judgment. It provides a structured starting point for understanding:

• How you're likely to respond to different therapeutic approaches
• Which aspects of your experience are most likely to need attention
• How you're likely to behave in the therapeutic relationship itself

Most therapists form these impressions through the intake process. Having assessed personality data coming in accelerates the process and gives both client and therapist a shared vocabulary.

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How Clinicians Use Personality Assessment

Big Five in Clinical Contexts

The Big Five is the most widely used personality framework in clinical psychology research. Clinicians and researchers use it to understand:

Neuroticism is the trait most directly relevant to clinical presentations. High Neuroticism predicts:

• Depression and anxiety disorders (Clark et al., 1994)
• Greater emotional reactivity to daily stressors
• Amplified experience of negative events
• Slower emotional recovery after setbacks

In clinical settings, Neuroticism shapes the pacing and focus of treatment. Clients high in Neuroticism often need help with emotional regulation skills before they can benefit from insight-oriented work. Jumping to cognitive restructuring or trauma processing without building regulation capacity first is often counterproductive.

Conscientiousness predicts therapy engagement. High-Conscientiousness clients tend to complete homework, show up consistently, and apply techniques between sessions—all of which improve outcomes. Low-Conscientiousness clients may need more structure and accountability built into the therapeutic frame.

Agreeableness affects the therapeutic alliance formation. High-Agreeableness clients tend to engage cooperatively but may struggle to voice disagreement with their therapist—an important dynamic to monitor. Low-Agreeableness clients may initially present as more resistant but are often forthright about what is and isn't working.

Openness influences receptivity to different therapeutic modalities. High-Openness clients tend to engage readily with insight-oriented and meaning-making approaches. Lower-Openness clients often prefer practical, skills-based work.

Attachment Style in Clinical Contexts

Attachment theory is among the most clinically influential frameworks in contemporary psychotherapy. The therapeutic relationship itself activates the attachment system—clients relate to therapists through their attachment template.

Levy et al. (2011) found that pretreatment attachment style predicts therapy outcomes and moderates the efficacy of different approaches. Specifically:

Anxious attachment in therapy: These clients may become preoccupied with the therapist's availability and approval, experience strong emotions around session endings and breaks, and struggle with termination. They often need explicit work on the therapeutic relationship and reassurance about the therapist's continued regard.

Avoidant attachment in therapy: These clients may minimize emotional content, intellectualize, present as more functional than they feel, and struggle to use the therapeutic relationship as a vehicle for change. They often need a therapist who doesn't push for emotional disclosure prematurely.

Disorganized attachment in therapy: The most complex presentations. The therapist may simultaneously represent safety and threat. Slower pacing, greater emphasis on safety and regulation, and trauma-informed approaches are typically indicated.

Secure attachment in therapy: The most facilitative baseline for therapy engagement. Securely attached clients are generally able to use the therapeutic relationship effectively and tolerate the vulnerability therapy requires.

For the full attachment framework, see our Attachment Style Guide.

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Therapy Modalities and Personality Fit

Different therapy modalities were developed with different assumptions about what drives psychological distress and what produces change. Personality and attachment data can help identify which approaches are most likely to fit.

Cognitive-Behavioral Therapy (CBT)

Best fit: High Conscientiousness (responds to structured homework); Moderate-Low Openness (prefers concrete skills over abstract exploration); high motivation for symptom relief.

Mechanism: Identifies and challenges maladaptive thought patterns and behavioral avoidance. Works primarily at the level of thoughts and behaviors, less at the level of emotional experience or relational patterns.

Research: Strongest evidence base for depression, anxiety disorders, and OCD. Meta-analyses consistently show effect sizes of d = 0.8–1.0 for anxiety disorders (Butler et al., 2006).

Caution: May be less effective as a standalone approach for clients with complex trauma histories, disorganized attachment, or high Neuroticism with inadequate emotion regulation skills. Adding an emotion-focused component often improves outcomes for these clients.

Psychodynamic / Insight-Oriented Therapy

Best fit: High Openness (engages with exploration and meaning-making); high reflective capacity; able to tolerate ambiguity; interested in understanding patterns rather than just managing symptoms.

Mechanism: Works through insight, interpretation of unconscious patterns, and the therapeutic relationship itself as a vehicle for change. Particularly suited to recurring relational patterns, identity issues, and complex emotional experiences.

Research: Meta-analyses show effect sizes comparable to CBT for many presentations (Shedler, 2010), with benefits that continue to grow after therapy ends—a finding not consistently observed with CBT.

Caution: Requires significant verbal ability and introspective orientation. Less structured—may feel formless to clients who need direction and homework.

Emotion-Focused Therapy (EFT)

Best fit: Clients whose attachment style is a primary driver of distress (especially anxious and avoidant); couples; clients who intellectualize emotional experience; high Neuroticism with suppressed emotional expression.

Mechanism: Works directly with emotional processing, particularly helping clients access and transform "primary adaptive emotions" (the emotions beneath the defensive emotions). Developed by Leslie Greenberg; attachment theory is central.

Research: Strong evidence for depression and couples distress (Greenberg & Watson, 1998). Particularly effective for resolving unfinished emotional business with significant others.

Caution: Requires willingness to engage emotionally, which avoidant-attachment clients may initially resist.

Acceptance and Commitment Therapy (ACT)

Best fit: Clients who struggle with psychological inflexibility—fusion with unhelpful thoughts, avoidance of difficult emotions; any attachment style; works well with high Neuroticism.

Mechanism: Teaches psychological flexibility through six core processes: acceptance, defusion, present-moment awareness, self-as-context, values clarification, and committed action. Values alignment is central.

Research: Good evidence for depression, anxiety, chronic pain, and substance use (Powers et al., 2009).

Particular personality relevance: The values clarification component makes ACT naturally aligned with understanding your personal values profile. See our Personal Values Guide.

Dialectical Behavior Therapy (DBT)

Best fit: High Neuroticism with significant emotion dysregulation; impulsivity; self-harm; borderline personality features; clients who struggle to tolerate distress.

Mechanism: Skills training in four modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Originally developed by Marsha Linehan for borderline personality disorder; now used for any presentation with significant emotion dysregulation.

Research: Strongest evidence base of any treatment for borderline personality disorder (Linehan et al., 2006). Effective for other presentations with dysregulation.

Caution: Resource-intensive (typically includes individual therapy + skills group + phone coaching). Standard DBT requires significant commitment.

Schema Therapy

Best fit: Clients with longstanding patterns that don't respond to standard CBT; early maladaptive schemas (e.g., abandonment, defectiveness, subjugation) often associated with insecure attachment; complex presentations.

Mechanism: Targets deep-seated cognitive-emotional schemas formed in childhood. Integrates CBT, attachment theory, and Gestalt techniques. The "limited reparenting" relationship is central.

Research: Stronger than CBT for personality disorders and treatment-resistant presentations (Giesen-Bloo et al., 2006).

Personality relevance: Schema therapy explicitly addresses attachment-based relational patterns—anxious and avoidant clients often find their core schemas (abandonment, subjugation, emotional deprivation) directly reflected in their attachment profile.

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Using Your Personality Results Before Therapy

Here's how to translate your assessment data into practical preparation:

If You Have High Neuroticism

Before starting therapy, read about emotional regulation—ideally the DERS framework covered in our Emotional Regulation Assessment guide. Know which aspects of regulation you struggle with most (accepting negative emotions, controlling behavior under stress, finding effective strategies). This gives your therapist a specific starting point rather than a general complaint of "I feel overwhelmed."

Consider DBT or EFT as potential modalities. Bring up your Neuroticism score in an initial consultation and ask how the therapist typically works with high emotional reactivity.

If You Have Anxious Attachment

Read about the pursue-withdraw cycle and hyperactivation of the attachment system before starting therapy. You'll likely bring your attachment patterns into the therapeutic relationship—you may become preoccupied with your therapist's availability, feel anxious between sessions, or struggle with vacations and breaks. Knowing this in advance helps you discuss it explicitly rather than acting it out.

See our Anxious Attachment Guide for the full picture.

If You Have Avoidant Attachment

You may initially underreport distress and present as more functional than you feel. A therapist who waits for you to bring up emotional content may wait a long time. Consider telling your therapist directly: "I tend to minimize and intellectualize. I may need help accessing emotional content." This creates permission for the therapist to gently push.

If You Have High Openness

You'll likely engage well with insight-oriented and meaning-making approaches. Psychodynamic and ACT both suit high-Openness individuals.

If You Have High Conscientiousness

You're well-positioned for structured, homework-based approaches like CBT. You'll tend to engage with exercises between sessions. Be aware that your perfectionism may cause you to judge yourself harshly for "homework failures."

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Bringing Your Results to a First Session

A few practical suggestions:

Share your attachment style. It's the single most directly clinically relevant piece of personality data for most presentations. "I tend toward anxious attachment—I hyperactivate in relationships when I feel insecure" gives your therapist a workable hypothesis in the first session.

Name your Neuroticism level. "I score high in emotional reactivity" or "I tend to have strong emotional responses and take time to return to baseline" is directly actionable clinical information.

Describe your conflict style. If you tend to avoid or accommodate, it will show up in how you engage in therapy—avoiding discomfort or going along with your therapist's framing to keep the peace. If you tend to compete, you may push back on interpretations.

Bring your values profile if you have one. Therapy is ultimately about building a life that works. Knowing what you actually value (vs. what you think you should value) accelerates the work of figuring out what needs to change.

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Frequently Asked Questions

Do therapists use personality tests?

Many therapists use validated assessments as part of intake—the PHQ-9 for depression, GAD-7 for anxiety, PCL-5 for PTSD, and various personality instruments depending on training and context. Big Five instruments, attachment measures (like the ECR-RS), and structured clinical interviews are all used in clinical settings. How formally they use assessment varies widely.

Can I use personality test results to choose a therapist?

You can use them to narrow the search. If you have anxious attachment, look for therapists trained in attachment-based approaches or EFT. If you have high Neuroticism and emotion dysregulation, DBT-trained therapists are worth considering. If you have complex trauma, somatic approaches and EMDR are often more effective than standard CBT.

Will my therapist change my personality?

Some traits do shift with effective therapy, particularly Neuroticism. Meta-analyses show that effective therapy produces measurable changes in Big Five Neuroticism scores—larger than the typical change seen over an equivalent time period without treatment (Tackett et al., 2019). Conscientiousness and Extraversion also show smaller but measurable increases.

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Citations

Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17–31.

Clark, L. A., Watson, D., & Mineka, S. (1994). Temperament, personality, and the mood and anxiety disorders. Journal of Abnormal Psychology, 103(1), 103–116.

Giesen-Bloo, J., van Dyck, R., Spinhoven, P., et al. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy vs transference-focused psychotherapy. Archives of General Psychiatry, 63(6), 649–658.

Greenberg, L. S., & Watson, J. C. (1998). Experiential therapy of depression: Differential effects of client-centered relationship conditions and process experiential interventions. Psychotherapy Research, 8(2), 210–224.

Levy, K. N., Ellison, W. D., Scott, L. N., & Bernecker, S. L. (2011). Attachment style. Journal of Clinical Psychology: In Session, 67(2), 193–203.

Linehan, M. M., Comtois, K. A., Murray, A. M., et al. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy. Archives of General Psychiatry, 63(7), 757–766.

Norcross, J. C., & Lambert, M. J. (2011). Psychotherapy relationships that work II. Psychotherapy, 48(1), 4–8.

Powers, M. B., Zum Vörde Sive Vörding, M. B., & Emmelkamp, P. M. (2009). Acceptance and commitment therapy: A meta-analytic review. Psychotherapy and Psychosomatics, 78(2), 73–80.

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109.

Tackett, J. L., Kushner, S. C., De Fruyt, F., & Mervielde, I. (2019). Personality-related changes following psychotherapy: A meta-analysis. Personality Disorders: Theory, Research, and Treatment, 10(4), 349–359.

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Part of the Understanding Your Personality guide. Related: Attachment Style Guide, Emotional Regulation Assessment, High Neuroticism Guide.

Your True Self is an informational and self-reflection tool. It is not a clinical assessment or substitute for professional mental health services.