We often hear people talk about “chemistry” in relationships — the reason we feel drawn to one person rather than another, or why we feel closer to certain friends. At its core, this connection comes from feeling understood and supported. The same dynamic applies in therapy.

A strong therapeutic relationship, often called the therapeutic alliance, is one of the most important factors in effective treatment. When clients feel safe, heard, and understood, they are more likely to share openly, engage fully, and make meaningful progress.

How the connection develops: Why three sessions matter

Based on my experience as a therapist working with adult clients, I’ve noticed that three sessions often feel like a “magic number” when it comes to establishing the therapeutic relationship. The first session can sometimes feel structured or focused on completing intake paperwork. By the second session, there is usually more space to begin building a connection and exploring concerns in greater detail. By the third session, clients tend to have a clearer sense of what therapy will look like and whether the therapist feels like the right fit for them.

If something still doesn’t feel right after those first few sessions, it’s important to talk about it. Therapists are trained to handle these conversations and can help you explore whether continuing together is best, or even assist you in finding a therapist who may be a better fit.

When reflecting on your sessions, consider asking yourself:

  • Do I feel heard?
  • Do I feel safe?
  • Do I feel seen?

If the answer is “no,” it’s worth bringing these concerns up with your therapist. Open conversations can clarify expectations and ensure you receive the support you need.

What research tells us about therapy relationships

Decades of research highlight just how important the therapeutic relationship is across different settings and treatment models:

  • Overall effectiveness across thousands of clients: A meta-analysis of 295 studies involving over 30,000 clients found that the strength of the therapeutic alliance consistently predicted treatment outcomes in both face-to-face and online therapy (Flückiger et al., 2018). In other words, it is not just the type of therapy that matters but also how connected you feel with your therapist.
  • Empathy is more than kindness; it’s effective: Elliott and colleagues (2018) found that therapist empathy strongly predicts client improvement. Empathy had a moderate effect size (r = .28), which is comparable to many widely used medical interventions. When therapists demonstrate genuine understanding and compassion, clients are more likely to feel safe, open up, and benefit from treatment. Empathy is not just a “soft skill;” it is a measurable ingredient that drives outcomes.
  • Even structured therapies depend on the relationship: Some people believe that therapies like Cognitive Behavioral Therapy (CBT) are purely technique-driven. Yet Kazantzis and Dobson (2022) demonstrated that the therapeutic relationship is central even in CBT, where structured strategies like cognitive restructuring or behavioral activation are used. Techniques are only effective when delivered in the context of a trusting, collaborative relationship.
  • Telehealth is not a barrier to connection: With the rise of online therapy, many clients wonder if they can truly connect with a therapist through a screen. Research suggests they can. Studies such as Eichenberg et al. (2022) found no significant differences in therapeutic alliance between online and in-person sessions. This means the core elements of trust, empathy, and collaboration translate well to telehealth, offering clients flexibility without sacrificing quality of care.
  • Relationship matters even with severe mental illness: Some might assume that for serious conditions like psychosis, only medication or highly specialized interventions matter. However, Bourke et al. (2021) found a moderate but consistent link between therapeutic alliance and outcomes in psychological therapies for psychosis. The human connection is not just important for “mild” cases; it plays a role in recovery even for individuals managing severe mental health conditions.
  • Ruptures and repairs are part of the process: No therapeutic relationship is perfect, and moments of misunderstanding or tension, called “ruptures,” are normal. Research by Hasson-Ohayon and colleagues (2021) shows that when these ruptures are left unaddressed, outcomes may weaken. However, when therapists and clients acknowledge and repair them, the relationship can grow stronger. Challenges in therapy are not necessarily setbacks; they can be opportunities for healing and growth.

Key takeaways for clients

The therapeutic relationship is more than a “good feeling;” it’s a cornerstone of effective treatment. Whether in-person or online, and whether working with mild concerns or severe symptoms, a strong therapeutic alliance can lay the foundation for growth and healing.

If you are in therapy, reflect on how you feel in the room (or on the screen) with your therapist. Do you feel safe, understood, and that your therapist is on your side? Research suggests that when the answer is yes, you are much more likely to benefit from the work you are doing together. If the answer is no, bringing those concerns into the conversation may be the first step toward finding the right support for you.

A strong therapeutic relationship is an important aspect of effective therapy. Whether in-person or online, feeling heard, seen, and understood can make all the difference in your journey toward growth and healing.