The therapeutic alliance is not the beginning of a treatment event; rather it is a process, an ongoing process that begins with the first contact between client and therapist and continues through the last contact. Although initial interactions are especially important, as first impressions usually are, the development of the therapeutic alliance is intertwined with all aspects of the treatment process and evolves and changes over time. An  effective therapeutic alliance may develop as quickly as the first session but must be in place by the fifth session if treatment is to be successful (Orlinsky et al., 2004). Needless to say, every client-therapist contact, either positive or negative, influences the development and maintenance of the therapist alliance.