Client preferences in psychotherapy reflect specific conditions and activities that clients desire in their treatment, with increasing evidence pointing to preference accommodation as facilitating psychotherapy outcomes. This updated meta-analysis establishes the magnitude of the effect of client preference accommodation in psychotherapy. Based on data from 53 studies and over 16,000 clients, preference accommodation was associated with fewer treatment dropouts (odds ratio = 1.79) and more positive treatment outcomes (d = .28). The chapter provides case examples of preference accommodation, limitations of the research, diversity considerations, and practice recommendations for working with client preferences.