As more evidence has accumulated regarding child and adolescent development and school mental health promotion has promulgated, significant variables correlated with mental health promotion have emerged with repetition and replication. One such variable is the importance of teacher student relationships. High quality teacher student relationships are necessary components of school’s mental health promotion and, more broadly, comprehensive school performance. Conversely, such matters as negative attributions toward student ability and behavior and teacher student conflicts both tend to constrain desirable student outcomes and are disposed to be highly recalcitrant to change. This chapter summarizes data on these issues, provides strategies for enhancing teacher student relationships that stimulate mental health and optimizing positive outcomes, discusses influences that hinder positive relationships and remediate negative relationships that may already exist, and concludes with a brief discussion of future investigation that will advance our knowledge of this important area.