Trust in the therapeutic relationship: Building with intention

February 26, 2026
By: Dr. Lisa Linardatos, Clinical Psychologist

Trust is a cornerstone of any healthy, long-lasting relationship; that is, being able to trust that the other person will treat you with kindness and respect, will be honest with you, and is generally predictable and reliable (Camanto & Campbell, 2025). The same goes for the relationship between a client and a therapist. Research has shown time and time again that a strong therapeutic alliance, built on trust, is a key component of good therapy outcomes (e.g., Flückiger, Del Re, Wampold, & Horvath, 2018).

A mistake I’ve made as a psychologist is assuming that a client will fairly easily grow to trust me. Afterall, I feel a lot of compassion towards my clients, and work hard to be present and tuned into their needs. The thing is, each individual comes to therapy with their own experiences with relationships, trust, and betrayal. Clients often struggle with trust and attachment for various understandable reasons – they may have been emotionally neglected by a parent, bullied by a sibling or classmate, or treated poorly or discriminated against by an authority figure. Not to mention the fact that therapists are humans too. We may, for example, miss important emotional cues from a client, unknowingly invalidate our clients’ feelings, forget some important information that a client has shared, or make incorrect interpretations or conceptualizations.

What can we, as clinicians, do to make sure we’re attending to potential trust issues in the therapeutic relationship? Check out my tips below.

1. Don’t assume and check in often. Open the door to discuss how your client is feeling in the relationship. Normalize how hard it can be to trust. You might point out that therapy is a unique relationship, and that the client knows very little about you, the therapist, and is yet expected to be vulnerable and share their personal stories. You might point out how given some of their relationship experiences, it would be understandable if it took some time before they felt comfortable opening up.
2. Notice signs that trust might be an issue. More obvious cues might be a client often questioning or criticizing your approach, expressing anger toward you, or often cancelling sessions. More subtle cues might be a look of apprehension on a client’s face, a client appearing emotionally distant or disengaged, or a client not expressing much emotion, or using humour, when discussing a difficult topic.
3. Notice alliance ruptures and work on repairing them. Repairing alliance ruptures is associated with better treatment outcomes (Eubanks, Muran, & Safran, 2018). Open the door for mutual discussions that address the rupture directly. Check out these tips from the Beck Institute on repairing alliance ruptures.
4. Ground yourself. I think I’ve most often missed signs that a client is having trouble trusting the relationship when I’ve been caught up in sharing with my client the “best” intervention, or feeling like I have to help them manage their distress as quickly as possible. In these cases, I’m not tuned into their emotions and needs, and instead I might be rattling off information about the newest therapy technique or my interpretation.
5. When you feel you’re working hard to validate, empathize, provide constructive interventions, and you genuinely care a lot about your client, it can be unsettling when they react with mistrust or suspicion. It might be hard, in these moments, to regulate your frustration and not get defensive. Noticing your counter-transference and regulating your emotions will increase the chances of you and your client having constructive discussions around these issues.
6. Remember that mistrust serves a self-protective function. Unfortunately, many people have had the experience of being mistreated in significant relationships, so forming close relationships can be a very difficult experience; having to be vulnerable can feel threatening to one’s psychological safety. A client’s mistrust is like a shield that has helped to protect them from hurt and pain, so it makes sense that they might not let their “shield” down easily. Being curious vs. judgemental about this protective mechanism will allow you, as a therapist, to address these issues effectively and with compassion.
7. Teamwork makes the dream work. Build a relationship with your client based on collaboration, and actively elicit feedback from your client about therapy goals and progress. Research shows that when therapists and clients agree on client goals, clients tend to have more positive treatment outcomes (Tryon, Birch, & Verkuilen, 2018).
8. Share with your client your feelings about the relationship. Research has shown that when therapists share their thoughts and feelings about the relationship it can open the door for clients to do the same (Hill, Knox, & Pinto-Coelho, 2018).

As clinicians, we sometimes forget how hard it is to be in the client chair. Being intentional about trust-building, and being curious about our client’s protective mechanisms, is an important starting point in the development of a strong therapeutic alliance, paving the way for a healing therapeutic relationship. As psychiatrist Dr. Irvin Yalom once said, “The therapeutic relationship itself is the vehicle for change.”

resources

When Clients Protect Themselves in Therapy: Repairing Ruptures

https://beckinstitute.org/blog/protecting-self-part-two/

references

Camanto, O. J., & Campbell, L. (2025). Trust in close relationships revisited. Journal of Social and Personal Relationships, 42(9), 2516-2544. https://doi.org/10.1177/02654075251346105

Eubanks, C. F., Muran, J. C., & Safran, J. D. (2018). Alliance rupture repair: A meta-analysis. Psychotherapy, 55(4), 508–519. https://doi.org/10.1037/pst0000185

Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172

Hill, C. E., Knox, S., & Pinto-Coelho, K. G. (2018). Therapist self-disclosure and immediacy: A qualitative meta-analysis. Psychotherapy, 55(4), 445–460. https://doi.org/10.1037/pst0000182

Tryon, G. S., Birch, S. E., & Verkuilen, J. (2018). Meta-analyses of the relation of goal consensus and collaboration to psychotherapy outcome. Psychotherapy, 55(4), 372–383. https://doi.org/10.1037/pst0000170