There are hundreds of types of therapy, from CBT to psychodynamic to person-centred and beyond. It’s tempting to think that picking the “right” one is the key to success. But one of the most robust findings in psychotherapy research points somewhere else entirely: the relationship.
What the research says
Psychologists call it the therapeutic alliance: the bond between you and your therapist, plus how much you agree on the goals of therapy and how you’ll work towards them.
In 2018, Christoph Flückiger and colleagues pulled together results from 295 studies involving more than 30,000 clients. They found a consistent link between a stronger alliance and better outcomes, across different types of therapy, different problems and different ways of measuring. It’s one of the most reliable predictors of how well therapy goes.
A related finding concerns preferences. A 2018 meta-analysis by Joshua Swift and colleagues found that when clients’ preferences were taken into account (for example, about the type of therapy or the kind of therapist), they were less likely to drop out and tended to have slightly better outcomes.
For LGBTQIA+ and neurodivergent clients, this matters. If you have to spend sessions explaining your identity, defending your relationships or masking your communication style, it’s much harder to build a strong alliance.
A grain of glitter ✨
Alliance research is correlational. A good relationship may help therapy work, but it’s also possible that therapy going well makes the relationship feel better. Effect sizes are moderate rather than huge, so the alliance isn’t everything. And sharing an identity with your therapist doesn’t guarantee a good fit: a queer or neurodivergent therapist isn’t automatically the right therapist for you, and someone who doesn’t share your identity can still be deeply affirming.
What you can do
- Use the first session as a two-way interview. Notice whether you feel heard and respected.
- Ask about their approach. How do they work? How will you know if it’s helping?
- Name what you need. Good therapists welcome feedback and adapt.
- It’s okay to move on. If it doesn’t feel right after a few sessions, finding someone else is a legitimate choice, not a failure.
For tips on what to ask, see “How to Find a Therapist Who Truly Affirms Your Identity”.
The best stable isn’t the fanciest. It’s the one where you can take your saddle off and breathe.
Further reading
- Flückiger, C., Del Re, A. C., Wampold, B. E. & Horvath, A. O. (2018). The alliance in adult psychotherapy: a meta-analytic synthesis. Psychotherapy
- Swift, J. K. et al. (2018). The impact of accommodating client preference in psychotherapy: a meta-analysis. Journal of Clinical Psychology