Does a Good Therapeutic Relationship Matter in Therapy?

Effective therapists possess empathy, compassion, and trustworthiness that make them seem like superhuman healers. Those who find a good therapist often stay with them for years, which can strengthen their overall healing process and improve their resiliency. 

Building a rapport and sense of trust with your therapist can encourage you to share freely and feel safe doing so. This is crucial—if you’re going to therapy but don’t feel comfortable talking to them, you won’t reap the same benefits.

Many therapists encourage you to stay open-minded to the idea of switching therapists, so you can find your best fit. But how do you know what a ‘good fit’ is? And does it really matter?

Defining The Therapeutic Relationship

Therapeutic relationships¹ build off mutual engagement, collaboration, and the bond patients and therapists form. Much of therapy’s success comes from this relationship, even more so than the type of therapy used and the therapist’s specific training. This positive effect exists in both medical and psychological treatment, and improves outcomes in both².

The therapeutic relationship starts to form at your very first session. It can strengthen with each session² as you and your therapist set goals, collaborate, and form a space you feel safe in. 

Benefits and Examples of a Positive Therapeutic Relationship

Ultimately, positive therapeutic relationships link to treatment success² and healing. You’re more likely to continue with treatment and feel hopeful for change if your therapist makes you feel understood, safe, and an important part of the treatment process. 

Setting goals together and working to achieve them teaches practical skills for navigating future problems and concerns—without relying on advice from a therapist. This grows your agency and sense of self-efficacy, bolstering your hope and overall well-being. 

Here’s how a positive therapeutic relationship could look in practice:

• You reach your first therapy appointment, nervous and unsure of how it’ll go. The therapist notes your discomfort and immediately works to reverse it: smiling, welcoming you, and introducing themselves. They ask questions about yourself and what brought you to therapy, listening attentively and engaging in the conversation with their body language and expressions. You feel cared for and safe, and start opening up more. Based on your first or second session, your therapist outlines a few goals you’ll work on together and asks you how they sound. You feel like a collaborative part of your treatment, which makes you want to engage more. 

Effects and Examples of a Negative Therapeutic Relationship

A negative therapeutic relationship can disrupt treatment and reinforce stigma about therapy and mental illness as a whole. You may feel uncomfortable, shamed, and belittled with a therapist that isn’t the right fit for you. But if that happens, don’t worry; you can always switch therapists. A therapist who isn’t the right fit for you could be perfect for someone else, and vice-versa. 

An example of an unhelpful therapeutic relationship could look something like this:

• You go to your first session with the new therapist. Right away, they don’t exude compassion or much interest in you and your issues. You start to feel uncomfortable, and don’t trust them with your pain. They ask a few questions about yourself and why you’re there, but other than that, you feel pressured to fill the silence. They suggest modifications and changes to your behavior in a way that makes you feel diminished and a little embarrassed. You leave and cancel your next appointment.

How Therapists Can Foster a Good Relationship

Some people come to therapy with past misconceptions, shame, and nervousness. Therapists can alleviate these anxieties through the way they treat their patients and how they treat the act of getting help. 

For example, a kind, empathetic, and patient therapist can soothe initial nerves and validate their patient’s desire for getting help. They can express gratitude for their patient seeking care, and for trusting them with their emotions and struggles. These efforts connect the therapist and patient as humans, which can spark an immediate, positive affect on their relationship.

Aspects like these are key to forming a positive therapeutic relationship: 

1. Listening without interrupting
2. Validating fears and emotions
3. Compassion
4. Identifying and setting goals together
5. Communicating regularly about your sessions and how they’re going

How You Can Contribute

A good therapeutic relationship takes effort on both sides, just like other relationships. Here’s what you can do (if and when you feel comfortable):

1. Recognize your therapist can’t, and shouldn’t, think for you
2. Engage in the goals you work on and any homework they may give you
3. Communicate as openly as you feel comfortable
4. Stay open-minded during your sessions
5. Let your therapist know what is and isn’t working for you (they want to know!)