Written by Dr. Natalie Engelbrecht on .

3 ingredients for a good therapeutic relationship 

How do you know if there is a good relationship between your therapist and yourself?

The therapist – client/patient relationship is known as the therapeutic relationship (TR) or the therapeutic alliance (TA). The relationship’s quality is the prime predictor of positive change and success. Some people and even therapists might think it is simple to create this alliance. The reality is different. About 50% of patients drop out of therapy before getting the help they need,[1]Early withdrawal from mental health treatment: implications for psychotherapy practice (Barrett et al., 2008) with approximately 35% of patients ending therapy after a single session.[2]Studies of “Dropout” patients in psychotherapy: A review of findings (Brandt, 1966)

And research shows that if you have not gotten results in the first seven sessions, you will be unlikely to get better with that therapist. (There are caveats to this in more traumatized patients.)

What makes a good therapeutic relationship

The therapeutic alliance is not only a kind relationship. The vital qualities of such an alliance emphasize acceptance, empathy, and non-judgment. It is a relationship designed to accomplish a task — to help the patient change for the better.

To create the TA, specific ingredients are required, without which change does not happen.

  1. Goal: What is the problem the patient wants to solve?
  2. Defenses: It is important to identify and work with the patient’s defenses. Change can be defended against subconsciously when the patient’s suffering is due to trauma. Sometimes long-term treatments are needed, so as a therapist you have to be able to stay with the patient, and work on incremental change.
  3. Caring: You have to care about your patients. I find that without caring, we don’t do our best.

So you are looking for a relationship that focuses on your goals, with a therapist that is invested and cares about you.


Dr. Natalie Engelbrecht RP ND

I am a Canadian leader in PTSD, and have provided patient-centred care with passion, empathy, and respect for over 25 years.
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