Reflecting on my practice I have often wondered that when it works for clients, what works and why. Is it the clinical approach? In my practice I work interrogatively so there is the choice of psychodynamic, humanistic or cognitive behavioural strategies. Here it is hard to specifically identify what is working, as a true integrative approach works in a seamless way meeting client needs and presenting issues. Is it the flexibility of the integrative approach that is the key? or it something else?I suspect however, if we talked with therapists who worked solely in any of these specific fields and their practices had generally successful outcomes, it maybe said that the approach that they used would demonstrate that that approach was the one that worked.So all this seems inconclusive, until we consider a dynamic that is present in all of these approaches. That dynamic is the relationship. The relationship between client and therapist. Whatever approach that is used and there are many of them, there has to be a relationship. It is my experience that where there is a positive relationship the therapy works. The opposite of a positive relationship also supports the view that the therapeutic relationship is the key to the therapy…….this in that if the relationship is not strong enough it becomes negative and the therapy does not progress successfully.So we may begin to see that therapy is a collaborative process, client and therapist will work together to identify and clarify issues. These issues will be within the person, in their internal world influenced by their external world. In the case of the external world this is with regard to their own relationships, both past and present.The work in therapy is do understand how some of us come into difficulty? Part of this is to understand that human beings are team animals, we relate to others and them to us. Have difficulties occurred because of our past relationships? This maybe with primary care givers and early relationships of any form. There is a sense that we become who we are because of what we have experienced in the world. So here maybe, the cause of emotional challenges that clients seek help with, has been past interactions...........relationships with the world, negative relationships.What better method to create a more balanced individual than to create a relationship that is positive and therapeutic. This is not to say that only that will create change, but it will create a base for growth and understanding and that can lead to change. Developing from this relationship in the therapy, we can introduce insights and awareness to stimulate a shift in an individuals internal world.