In this one hour lecture, eminent Clinical Psychologist Dr. Nancy McWilliams reviews evidence for the critical importance of the therapeutic alliance to therapy outcome. Enactments are now widely assumed to be inevitable in psychotherapy, and sometimes lead to ruptures of the alliance that need to be repaired. She outlines general principles of therapy process relevant to the rupture-repair cycle in psychotherapy, with examples from her clinical experience of enactments and efforts at repair of the therapeutic alliance.