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For expository purposes only, Paolino conceptualizes the patient-analyst relationship in four dimensions: (1) transference neurosis; (2) therapeutic alliance; (3) narcissistic alliance; and (4) the real relationship. Each of these phenomena is described and illustrated with a clinical example. The transference neurosis is a repetition of the past via a displacement onto the analyst, in which the core neurotic conflict is re-experienced and resolved primarily through interpretation. The term therapeutic alliance revolves around the concept of the analyst and patient working together to enhance the patient's psychic growth. This collaboration is characterized by non-neurotic, desexualized, deaggressivized, rational rapport. The concepts and ontogeny of trust and secondary trust (openness which allows a shift of responsibility to another person) provide the foundation for the therapeutic alliance and are briefly outlined. The narcissistic alliance "can be defined as that aspect of the relationship between the patient and the analyst whereby the bodily presence of the analyst serves as a substitute for some of the patient's previously used major coping and defensive psychic devices." It is conceptualized as serving as intermediary between the transference neurosis and the therapeutic alliance wherein the analyst is incorporated into the patient's psychic structure. The real relationship is the final element and resembles the therapeutic alliance in being non-neurotic, but differs from it in that the real relationship is more than an artifact of treatment and exists outside the patient-analyst relationship.