There is proof that implies that the client–counselor relationship has more influence on engagement and enhanced outcomes than the methods, tools and instruments we employ (Hubble et al., 1999). Clients coming into treatment facilities for assessment indicate that the warmth and welcoming attitudes of the staff—rather than client perceptions of the staff’s skills—are the most significant feature in making clients want to return to use the service.
In a cross-cultural meta-analysis of therapy outcome literature, Asay and Lambert (1999) report that the single most vital aspect is that of the counselor and what he or she can influence, is the therapeutic relationship; this relationship describes 30 percent of the variance in treatment outcome. Technique and method, which counselors tend to concentrate on in their guidance, was only half as influential, accounting for just 15 percent of the outcome variance in therapy. The other factor that the therapist can influence, expectancy (the belief that things will improve or be sufficiently addressed), accounted for 15 percent of the variance—the same as technique and method. That leaves 40 percent of the variance to extra therapeutic factors relating to the client’s personal strengths and weaknesses, social supports and ecological resources.
Too frequently, clinicians have presumed that clients with severe, persistent substance use and mental health issues are too compromised to benefit from the therapeutic relationship in the way healthier clients are. Where clients face overwhelming challenges, a respectful, continuing, supportive relationship with a health care provider not only helps people to get through hard times, but also to accomplish positive change.

References
Roth, D. (1999). Towards Best Practices: Top Ten Findings from the Longitudinal Consumer Outcomes Study 1999. Columbus, OH: Ohio Department of