Literature Review. The systematic review considered clients' perception of the therapeutic alliance. Factors identified by clients as important to the alliance were different to previously identified therapist factors, with clients focusing more on therapist behaviours. Although different clients valued different aspects of the alliance, nearly all valued basic counselling skills such as validation. However, some variables such as self-disclosure, friendliness, and professionalism were more contentious; with some clients valuing these highly whilst others found them less helpful or even harmful. This suggests the need for flexibility and attention to client needs and preferences. The implications for clinical practice, methodological limitations and recommendations for future research are discussed. Empirical Report. The aims of the study were to consider the relationship between therapist ratings of psychological mindedness, motivation, and alliance, and treatment model, outcomes and therapy efficiency. A quantitative analysis of an archival client dataset (n=18,257), collected in routine practice, showed that therapy was more effective when clients were rated as good in psychological mindedness, motivation, and alliance. Pre-treatment severity was the largest predictor of outcomes, followed by motivation and psychological mindedness. Alliance was a significant but smaller predictor and treatment model was not significantly predictive of client outcomes. Therapists were generally most likely to rate clients as good in psychological mindedness, motivation, and alliance; however there was large variability between therapists. The results suggest that psychological mindedness, motivation, and alliance are all important to therapeutic change. The implications for clinical practice are discussed as well as methodological limitations and recommendations for future research.