A Positive Therapist Client Relationship: Why It’s Important for Recovery

Published: 02/2/2022 | Author: Mark Harrigan

The therapist client relationship is one of the most important factors in the outcome of your therapy, whether you are attending counseling for a substance addiction like alcohol use disorder or a mental health disorder like depression.¹ This relationship can be defined as the attitudes and feelings that the client and the therapist have towards one another. The relationship also includes the way these feelings and attitudes are expressed.²

What is a Therapist Client Relationship?

The therapist client relationship has been studied for decades, and researchers have various views on the definition and what constitutes an excellent client therapist relationship. Yet, despite this disagreement, it continues to be a core component of psychological research, for both behavioral therapy and psychotherapy.

The therapist client relationship is also sometimes referred to as a therapeutic alliance between yourself and a provider. The client therapist relationship has several components, including:¹

• You, as the client, agree with the therapist on the goals to be accomplished during therapy.
• You, as the client, agree with the therapist on the various tasks that help attain the goals.
• You, as the client, feel an emotional bond to the therapist, including feelings of respect, trust, and a general sense of personal attachment to the therapist.

Furthermore, research has found that a strong client therapist relationship is necessary for change, and some researchers have concluded the therapist client relationship is the actual mechanism of positive change.²

How the Therapist Client Relationship is Used

Moreover, some therapists will utilize the client therapist relationship to create a positive corrective experience.³ This relationship can be used to:³

• Address relationship problems
• Challenge maladaptive patterns
• Model ways to resolve interpersonal issues
• Provide feedback

Focusing on the client therapist relationship can be demonstrated in several different ways, such as:³

• Confronting and challenging you and your thought/behavioral patterns
• Supporting and empowering you

The client-therapist relationship can be used for different purposes like:³

• Processing the relationship and using it as the end goal of therapy
• Utilizing the relationship to promote change

Recognizing how the relationship is used and the purpose of such a relationship can be helpful depending on your various needs.3 When matched with your needs, the client therapist relationship is likely to influence the amount of involvement you give to your therapist and therapy overall.³

Characteristics of a Good Therapist Client Relationship

The characteristics of a good client therapist relationship may differ between client and therapist, as each client may have differing needs or qualities that are important to them. Some differences may include a client focusing on the skill level or expertise of the therapist rather than other qualities, whereas some may focus on the therapist’s ability to understand them instead. However, in general, the core components of a good therapist client relationship include:²

• Mutual feelings of empathy
• Consensus on goals
• Mutual positive regard for the other
• Collaboration
• Congruence (e.g., agreement with each other, general compatibility)

Several tools can be used to measure the client therapist relationship, including:⁴

• Assessment Instruments
• Client Satisfaction Questionnaire (CSQ-8)
• Client/Therapist Treatment Expectancy and Evaluation Form*
• Counselor Rating Form (CRF)
• Program Evaluation Form
• Psychotherapy Questionnaire, both client and therapist forms
• Reid-Gundlach Social Service Satisfaction Scale (R-GSSSS)
• Session Evaluation Questionnaire (SEQ)
• Working Alliance Inventory (WAI)

If you do not have access to any of these measurement tools, there are a few questions that might help you assess your own therapist client relationship. These questions can include:⁴

• Does my therapist listen to me?
• Does my therapist understand me?
• Do I trust my therapist?
• Does therapy make me feel better?
• Do I like my therapist?
• Are we working on things I want to work on?
• Does my therapist care about me?
• Do I feel supported by my therapist?
• Is my therapist qualified to treat my problems?
• Have I benefited from therapy?
• How honest am I in therapy?

Overall, with the assessment tools in mind, a good client therapist relationship will have characteristics of:

• Trust
• Comfortability
• Respect
• Mutual understanding
• Confidence in each other
• Positive feelings about your therapist
• Positive feelings about your therapy
• Feeling accepted and care for

How to Form a Healthy Therapeutic Alliance

When researchers examined the client therapist relationship from the client’s perspective, four themes were identified. These themes include:²

• Assessing client therapist match
• Facilitating openness
• Connecting on a deeper level
• Empowerment through respect

Assessing the Client Therapist Match

Assessing the client therapist match involves you evaluating the therapist and how your therapy began.² You would also evaluate how well you felt therapy would meet your needs. Always examine how well you matched with your therapist on general characteristics. Depending on what you are hoping to accomplish from therapy, this may include how well your therapist emphasized things that were important to you, or specific skills and techniques your therapist presented you. These characteristics likely influence if you believe they can implicitly understand your background.

You may find that you prefer a therapist of similar:²

• Gender
• Socioeconomic status
• Religious beliefs
• Race/ethnicity or cultural background

You may also find that you value having a therapist with a different background than yourself, whereby they can provide an alternative viewpoint.² Regardless, as you assess the client therapist match, you are looking for a “goodness of fit.” Lastly, this also includes using your judgment to decide if you feel the therapist has the ability or specialized knowledge to help with your presenting problems.²

Facilitating Openness

Facilitating openness refers to your ability to form a trusting relationship with your therapist. You want to feel safe and comfortable while discussing sensitive issues with your therapist. To build this trust, therapists must create an environment where you can be open and honest without fear of negative response or judgment. You may find that some therapists have a natural ability to respond to your wishes, creating a sense that they are open and receptive to you.²

Connecting on a Deeper Level

The process of connecting on a deeper level typically begins when you feel your therapist truly understands you. It is also when you feel that your therapist hears you. This is also shown when your therapist does or says something that makes you feel appreciated or cared for.²

Empowerment through Respect

Research shows the concept of empowerment through respect was prevalent in studies of adolescents and of minority ethnic groups.² This theme involves the therapist’s attempt to reduce the inherent power differential that comes with therapy. This can be shown by allowing you to set the pace for the therapeutic process or making sure you understand your rights and responsibilities for therapy.

Research shows the closeness shared between the client and therapist augmented the effects that each has on the another.⁵ This closeness then empowers the therapist’s interventions and can intensify the clinical impact the therapist has on the client. Therefore, tightening the closeness between client and therapist can encourage the client to disclose information and focus on the therapeutic process.⁵

Do Better Therapist Client Relationships Improve Treatment Outcomes?

Research has shown that your perspective of the client therapist relationship is one of the best predictors of your treatment outcome.¹ Although the cause of this association has not been entirely identified, researchers have proposed it is due to:⁶

• Contributions made by you
• Contributions made by your therapist
• How you and your therapist interact with each other
• Early change in your functioning

Additional research has found that it may be that the client has a good attachment and well-developed social skills, which allow clients to form a better client therapist relationship.⁶ Contradicting research has concluded that the client therapist relationship correlation to better treatment outcomes is due to the therapist and their ability to establish an alliance with the client.⁶

Lastly, when a good client therapist relationship is formed, the closeness that is established between the two allows for an increase in the value of what each party does.⁵ It is possible this also positively impacts the outcome.

If you are interested in treatment or think you may need treatment for a substance use disorder, please call us at 888-647-0051 (Who Answers?) to speak with a treatment support specialist. We can help you find the right rehab program for you.

Resources

1. Bucci, S., Seymour-Hyde, A., Harris, A., & Berry, K. (2015). Client and therapist attachment styles and working alliance. Clinical Psychology & Psychotherapy, 23(2), 155-165.
2. Noyce, R., & Simpson, J. (2016). The experience of forming a therapeutic relationship from the client’s perspective: A metasynthesis. Psychotherapy Research, 28(2), 281-296.
3. University at Buffalo. (2022). Assessment instruments.
4. Kuutmann, K., & Hilsenroth, M. J. (2012). Exploring in-session focus on the patient-therapist relationship: Patient characteristics, process and outcome. Clinical Psychology and Psychotherapy, 19(3), 187-202.
5. Vandenberghe, L., Coppede, A. M., & Bittencourt, M. V. (2018). Building and handling therapeutic closeness in the therapist-client relationship in behavioral and cognitive psychotherapy. Journal of Contemporary Psychotherapy, 48(4), 215–223.
6. Del Re, A. C., Flückiger, C., Horvath, A. O., Symond, S. D., Wampold, B. E. (2012). Therapist effects in the therapeutic alliance-outcome relationship: A restricted-maximum likelihood meta-analysis. Clinical Psychology Review, 32(7), 642-649.