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The therapeutic alliance is a vital component of not only the psychoanalytic relation but of all therapeutic encounters between psychotherapist and patient. Despite the universal application and realization of the alliance concept in therapeutic endeavors, it is often ignored as an operative concept in the therapeutic theoretical armamentarium or is formulated in alternative terms. It also comes into play implicitly, even when the concept is formally dismissed as irrelevant. This discussion addresses the meaning and variations of expression of the alliance in the clinical setting and focuses particularly on ways in which the alliance is actually formulated in alternate terms that usually address some partial aspect of the alliance without acknowledging its relevance or importance in the therapeutic relationship and interaction between therapist and patient. I conclude that even when its role in therapy is ignored, minimized, or denied, the alliance continues to play a vital role that requires therapeutic attention and processing in its own right.