The therapeutic relationship is the vehicle for change, as well as the delivery system for the treatment itself. Research findings make it increasingly clear that "therapist variability in the alliance appears to be more important than patient variability for improved outcome". This is particularly true when it comes to the ability to deftly handle challenging interactions with patients. In complex cases, a therapeutic alliance can be precluded or undermined by the patient's resistance and negative transference feelings. In addition to elucidating the characteristics of a successful therapeutic alliance, the notion that there is an unconscious component to the alliance will also be emphasized. The new perspective on unconscious, affective-regulating function of relationships, mediated by right brain, highlights the clinician's role as co-participant in the creation of the therapeutic alliance and as a regulator of the patient's dysregulated affective states. The therapeutic alliance is strengthened when patient and therapist agree about problems to be addressed and the goals to be achieved.