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The effectiveness of psychotherapy as a treatment for mental health disorders has been demonstrated overwhelmingly in extensive psychological studies. With increased demand for mental health resources, it is important to identify factors that facilitate successful treatment and measure a positive outcome. Three of these factors, therapist empathy, heart rhythm coherence and the therapeutic alliance, have been shown to be necessary for effective treatment. The current study examined the biopsychosocial aspects of empathy in the alliance, using coherence as a physiological marker of emotional self-regulation as a condition for empathy. This study considered possible relationships between treatment effectiveness, empathy, heart rhythm coherence, and the therapeutic alliance. Results indicated that the client’s perception of their therapist’s empathy was significantly related to their therapist’s level of coherence. Client depression scores were also significantly related to their perceptions of client empathy. Finally, the study found that client symptoms significantly decreased from pre-treatment to post-treatment.