Although writing about the real relationship has existed from the beginnings of the talking cure,” it is only in recent years that empirical research has focused on this phenomenon. The real relationship is the personal relationship between patient and therapist marked by the extent to which each is genuine with the other and perceives/experiences the other in ways that are realistic. The strength of the real relationship is determined by both the extent to which it exists and the degree to which it is positive or favorable. In this chapter, a meta-analysis is presented on the association between the real relationship and the outcome of psychotherapy. Summed across 16 studies, this meta-analysis revealed a moderate association with outcome (r =.38, 95% confidence interval [.30, .47], p<.001, d = 0.80, N = 1,502 participants). This real relationship–outcome association was independent of the type of outcome studies and of the source of the measure. We also present frequent measures of the real relationship, limitations of the research, and patient contributions. The chapter concludes with diversity considerations and practice recommendations for developing and strengthening the real relationship.