When you’re going through something that needs professional support, it can be easy to assume that you simply turn up to sessions and change will follow. As much as we’d all like that to be true, in reality, it doesn’t always work that way.
A big part of how well therapy works for you comes down to the relationship you have with your therapist. It’s a unique relationship that’s very different from anything you’ve experienced before, which is why understanding how it works is so important.
Founded in 2010, A Mission For Michael (AMFM) offers specialized mental health care across California, Minnesota, and Virginia. Our accredited facilities provide residential and outpatient programs, utilizing evidence-based therapies such as CBT, DBT, and EMDR.
Our dedicated team of licensed professionals ensures every client receives the best care possible, supported by accreditation from The Joint Commission. We are committed to safety and personalized treatment plans.
What Is a Therapeutic Alliance?
The therapeutic alliance is a term used to describe the relationship between a therapist and their client. For many people, this is an unfamiliar kind of connection, which can make the first few sessions feel a little strange.
Your instinct might be to treat the relationship like a friendship, especially when your therapist helps you work through something meaningful. But the therapeutic alliance doesn’t really work like that. It’s closer to a reliable partnership where you feel supported enough to tackle problems and open up about parts of your life that are difficult to talk about.
Understanding what makes up a strong therapeutic alliance is a good starting point, but it’s also worth knowing how these elements can directly affect your progress in treatment.
8 Ways the Therapeutic Relationship Impacts Treatment Success
A good therapeutic relationship can strengthen your progress. A poor one can hold you back. Knowing the difference helps you identify when therapy is on the right track, and when it may need changes to maximise the outcomes. Here are 8 ways the therapeutic relationship impacts treatment success:
1. It Affects What You’re Willing to Share
Building trust with your therapist takes time, but it’s one of the most important aspects of the therapeutic relationship. If you’re feeling confident that what you share will be handled with care, you’re much more likely to be open about the things that are happening in your life. That kind of openness also gives your therapist a much clearer picture to work with.
One study that focused on measuring trust specifically found that it predicted whether clients were willing to share private information, even when general measures of the therapeutic alliance did not.1
Another review found that shame is the biggest barrier to honesty in therapy and that the strength of the therapist-client relationship is one of the few things that help people move past the initial feelings.2
2. It Affects How Productive Your Sessions Feel
If you’ve ever left a therapy session feeling like your therapist really understood what you were trying to say, that was probably down to a good emotional connection. Emotional connection in therapy matters tremendously, and it’s one of the things that separates a productive session from one that feels like it’s going through the motions.
A review of over 6000 clients confirmed that therapist empathy is a significant predictor of positive therapy outcomes.3 What stood out the most was that the client’s perception of being understood mattered more than the therapist’s own view of how empathetic they were being. This shows it’s how you experience the sessions that count the most.
3. It Influences Whether You Stay in Treatment
Therapy can only produce results if you keep attending sessions, and the quality of the counseling relationship has a direct influence on whether that happens. If the connection with your therapist feels off, the motivation to even attend the sessions can start to disappear.
Studies back this up, showing that a weaker therapeutic alliance meant patients were much more likely to drop out of treatment altogether.4 This finding was the same even in populations where engagement is notoriously difficult, such as people experiencing psychosis.5 When the relationship feels right, people stay long enough for treatment to do its job.
4. It Drives How Much Work You Put In Between Sessions
What takes place inside therapy sessions is a big part of how well you can reach your goals, but the real progress actually comes from what you do in between sessions. If you’re able to implement any advice learned in sessions and apply it to real-world situations, it becomes a great platform for progress.
But the client-therapist relationship is influential in finding the motivation to practice outside of sessions. For example, one study found that clients who engaged more deeply with between-session tasks had considerably better outcomes.6 Another found that early therapist empathy predicted whether clients followed through on homework later in treatment.7
These findings link the therapeutic relationship directly to how invested you become in your own recovery.
5. It Affects Whether the Real Issues Come to Light
Therapy works best when you are completely open with your therapist. However, a study of 547 therapy clients found that 93% had withheld something at some point. The main reason for this was a fear of being judged.8
That same research group studied clients who had concealed suicidal thoughts and found that 70% did so because they feared involuntary hospitalization.9 These are serious omissions that can change the entire course of treatment.
What this shows is that the rapport between therapist and client can affect whether the real issues ever make it into the room. If you feel as though you can’t share certain aspects of your life with your therapist, it might be because you don’t feel safe enough to do so.
6. It Helps You Face the Uncomfortable Parts of Therapy
As scary as it sounds initially, some of the most effective approaches in therapy require you to face moments that are uncomfortable.
For example, exposure therapy for PTSD asks you to engage directly with traumatic memories. This kind of work is difficult to sustain if you don’t feel supported by the person guiding you through these vulnerable moments.
A review study on PTSD treatment confirms this and showed that the quality of the therapist-client relationship predicted how much symptoms improved.10
7. It Keeps You Going When Progress Stalls
There might be moments within therapy where things feel as though they have stalled. You might have been making good progress, then, over a period of time, it feels as though nothing is happening. These moments are called alliance ruptures, and they’re actually completely normal.
What matters, though, is how those ruptures get repaired.
Studies showed that clients who worked through these difficult moments with their therapists had positive treatment outcomes.11 In fact, some of those clients actually did better than those whose alliances never hit a rough patch at all.11 This suggests that working through conflict with your therapist can itself become part of the healing process.
8. It Shapes How Aligned You and Your Therapist Are on Goals
When you and your therapist are on the same page about what you’re working toward, treatment has better outcomes. That might sound obvious, but it’s something that doesn’t always happen in every client-therapist relationship.
Sometimes, goals can be assumed rather than discussed openly, which impacts counseling effectiveness.
If you feel involved in setting the direction of your treatment, you’re more likely to invest in the process and see real results from it.12
What if It Feels Like the Therapeutic Relationship Isn’t There?
If you’re currently in therapy and something about the therapeutic relationship doesn’t feel right, it’s something worth paying attention to.
It doesn’t mean you need to cut ties with your current therapist and find a new one, but it does mean that you should bring this up with them. Cracks can start to form in the therapeutic alliance, so by bringing the issue to light, you and your therapist are both able to work on the problems.
That said, if you’ve raised your concerns and the connection still doesn’t improve, it could be worth considering different options. Research consistently confirms counseling relationship importance, so settling for a relationship that doesn’t feel right could cause more damage than good. It’s normal to try more than one therapist before finding the right fit, and a professional therapist won’t take it personally.
If you haven’t started therapy yet and you’re thinking about it, these are useful things to keep in mind. Knowing what a strong therapeutic alliance looks like can help you recognize it when you find it and speak up if something feels off.
AMFM: Expert Mental Health Care Providers
If you’ve made the decision that your current therapeutic relationship isn’t working out, or you’re considering starting therapy for the first time, AMFM is here to help.
A Mission For Michael provides expert therapists who are carefully matched to each person who walks through our doors. This means that you can rest assured knowing that the therapist you work with will be someone who genuinely fits what you need.
That starts with being paired with the right therapist.
We offer support from therapists who are experienced with mental health conditions like:
If any of what you’ve read on this page has resonated, a conversation with our team is a good place to start. Contact us today, and a member of our team will be more than happy to assist you.
References
- Crits-Christoph, P., Rieger, A., Gaines, A., & Gibbons, M. B. C. (2019). Trust and respect in the patient–clinician relationship. BMC Psychology, 7(1), 91. https://doi.org/10.1186/s40359-019-0347-3
- Farber, B. A. (2003). Patient self-disclosure: A review of the research. Journal of Clinical Psychology, 59(5), 589–600. https://doi.org/10.1002/jclp.10161
- Elliott, R., Bohart, A. C., Watson, J. C., & Murphy, D. (2018). Therapist empathy and client outcome: An updated meta-analysis. Psychotherapy, 55(4), 399–410. https://doi.org/10.1037/pst0000175
- Sharf, J., Primavera, L. H., & Diener, M. J. (2010). Dropout and therapeutic alliance: A meta-analysis of adult individual psychotherapy. Psychotherapy, 47(4), 637–645. https://doi.org/10.1037/a0021175
- Bourke, E., Barker, C., & Fornells-Ambrojo, M. (2021). Systematic review and meta-analysis of therapeutic alliance, engagement, and outcome in psychological therapies for psychosis. Psychology and Psychotherapy, 94(3), 822–853. https://doi.org/10.1111/papt.12330
- Kazantzis, N., Whittington, C., & Dattilio, F. (2016). Quantity and quality of homework compliance: A meta-analysis. Behavior Therapy, 47(5), 755–772. https://doi.org/10.1016/j.beth.2016.05.002
- Constantino, M. J., Westra, H. A., Antony, M. M., & Coyne, A. E. (2017). Therapist empathy, homework compliance, and outcome in CBT for GAD. Cognitive Behaviour Therapy, 46(1), 20–36. https://doi.org/10.1080/16506073.2016.1237313
- Blanchard, M., & Farber, B. A. (2016). Lying in psychotherapy: Why and what clients don’t tell their therapist. Counselling Psychology Quarterly, 29(1), 90–112. https://doi.org/10.1080/09515070.2015.1085365
- Blanchard, M., & Farber, B. A. (2020). “It is never okay to talk about suicide”: Patients’ reasons for concealing suicidal ideation. Psychotherapy Research, 30(1), 124–136. https://doi.org/10.1080/10503307.2018.1543977
- Howard, R., Berry, K., & Haddock, G. (2022). Therapeutic alliance in psychological therapy for PTSD: A systematic review and meta-analysis. Clinical Psychology & Psychotherapy, 29(2), 373–399. https://doi.org/10.1002/cpp.2642
- Eubanks, C. F., Muran, J. C., & Safran, J. D. (2018). Alliance rupture repair: A meta-analysis. Psychotherapy, 55(4), 508–519. https://doi.org/10.1037/pst0000185
- Tryon, G. S., Birch, S. E., & Verkuilen, J. (2018). Meta-analyses of the relation of goal consensus and collaboration to psychotherapy outcome. Psychotherapy, 55(4), 372–383.https://doi.org/10.1037/pst0000170
