The therapeutic relationship, the working bond between the nurse practitioner and patient, is considered to be a significant factor that affects treatment outcome. Components of the therapeutic relationship viewed from the nurse practitioner's perspective and also from the patient's viewpoint are reviewed. Modes of communication the client uses directly influences the therapeutic relationship or alliance. Two communication modes are used to exemplify two case examples in which the patient's mode of perceiving his or her world is an important consideration in the working alliance.