This paper traces the history of the therapeutic alliance concept, examining how it has been used and misused, at times elevated to a central position and at others rejected altogether. The loss of this concept created a vacuum in classical psychoanalysis that has been filled by rival theories. The continuing usefulness of looking at the treatment process through the lens of the therapeutic alliance, particularly in relation to the manifold difficulties of working with sadomasochistic pathology, is suggested. To this end, revisions of the theory of the therapeutic alliance are suggested to address some of the difficulties that have arisen in conceptualizing this aspect of the therapeutic relationship, and to provide an integrated dynamic model for working with patients at each phase of treatment. This revised model acknowledges the complexity of the domain and encompasses the multiple tasks, functions, partners, and treatment phases involved. The utility of the revised theory is illustrated in application to understanding the sadomasochistic, omnipotent resistances of a female patient through the phases of her analysis.
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References
1.
Alexander, F. (1950). Analysis of the therapeutic factors in psychoanalytic treatment. Psychoanalytic Quarterly19:482—500.
2.
——— (1956). Psychoanalysis and Psychotherapy: Developments in Theory, Technique and Training. New York: Norton.
3.
——— & French, T.M. (1946). Psychoanalytic Therapy: Principles and Application . New York: Ronald Press.
4.
Balint, M. (1968). The Basic Fault. London: Tavistock.
5.
Bibring, E. (1937). Symposium on the theory of the therapeutic results of psycho-analysis. International Journal of Psycho-Analysis18:170—189.
6.
Bion, W.R. (1977). Seven Servants: Four Works by Wilfred R. Bion . New York: Aronson.
7.
Blum, H.P. (1981). Some current and recurrent problems of psychoanalytic technique. Journal of the American Psychoanalytic Association29:47—68.
8.
Bollas, C. (1987). The Shadow of the Object: Psychoanalysis of the Unthought Known. London: Free Association Press.
9.
Brenner, C. (1979). Working alliance, therapeutic alliance, and transference . Journal of the American Psychoanalytic Association27:137—157.
10.
Breuer, J., & Freud, S. (1893—1895). Studies on hysteria. Standard Edition2.
11.
Curtis, H. (1979). The concept of the therapeutic alliance: Implications for the “widening scope.” Journal of the American Psychoanalytic Association27:159—192.
12.
Eissler, K.R. (1953). The effect of the structure of the ego on psychoanalytic technique. Journal of the American Psychoanalytic Association1:104—143.
13.
Erikson, E. (1950). Childhood and Society. New York: Norton.
14.
Etchegoyen, R.H. (199 1). The Fundamentals of Psychoanalytic Technique . London: Karnac Books.
15.
Farber, S., & Green, M. (1993). Hollywood on the Couch. New York: William Morrow.
16.
Fenichel, O. (1941). Problems of Psychoanalytic Technique. New York: Psychoanalytic Quarterly.
17.
Ferenczi, S. (1928). The elasticity of psychoanalytic technique. In Final Contributions to the Problems and Methods of Psycho-Analysis . London: Hogarth Press, pp. 87—101.
18.
Fine, R. (1979). A History of Psychoanalysis. New York: Columbia University Press.
19.
Frankl, L., & Hellman, I. (1962). The ego's participation in the therapeutic alliance . International Journal of Psycho-Analysis43:333—337.
20.
Freud, A. (1950). The problem of training analysis. In The Writings of Anna Freud, vol. 4. New York: International Universities Press, 1973, pp. 407—421.
21.
——— (1954). The widening scope of indications for psychoanalysis: Discussion. In The Writings of Anna Freud, vol. 4. New York: International Universities Press, 1973, pp. 356—379.
22.
——— (1962). Assessment of childhood disturbances. Psychoanalytic Study of the Child17:149—158.
23.
——— (1965). Normality and Pathology in Childhood. New York: International Universities Press.
24.
——— (1966). A short history of child analysis. In The Writings of Anna Freud, vol.7. New York: International Universities Press, 1976, pp. 48—58.
25.
Freud, S. (1900). The interpretation of dreams. Standard Edition4/5.
26.
——— (1905). Three essays on the theory of sexuality. Standard Edition7:123—243.
27.
——— (1909). Letter to Jung. In The Freud-Jung Letters, transl. R. Manheim & R.F.C. Hull. Princeton, NJ: Princeton University Press.
28.
——— (1912). The dynamics of transference. Standard Edition12:97—108.
29.
——— (1913). On beginning the treatment. Standard Edition12:123—144.
30.
——— (1928). Letter to Ferenzci. In I. Grubrich-Simitis, Six letters of Sigmund Freud and Sandor Ferenzci on the interrelationship of psychoanalytic theory and technique. International Review of Psycho-Analysis13:259—277, 1986.
31.
——— (1937). Analysis terminable and interminable. Standard Edition22:1—182.
32.
——— (1940). An outline of psycho-analysis. Standard Edition23:139—207.
33.
Friedman, L. (1969). The therapeutic alliance. International Journal of Psycho-Analysis50:139—153.
34.
Frieswyk, S.H., Allen, J.G., Colson, D.B., Doyne, L., Gabbard, G.O., Horowitz, L., & Newson, G. ( 1986). Therapeutic alliance: Its place as a process and outcome variable in dynamic psychotherapy research. Journal of Consulting and Clinical Psychology54:32—38.
35.
Gelso, C.J., & Carter, J. (1985). The relationship in counseling psychotherapy. The Counseling Psychologist13:155—244.
36.
Gill, M. (1991). Indirect suggestion. In Interpretation and Interaction, ed. J.J. Oremland. Hillsdale, NJ:Analytic Press , pp. 137—163.
37.
——— (1995). Classical and relational psychoanalysis. Psychoanalytic Psychology12:89—107.
38.
Gitelson, M. (1967). Analytic aphorisms. Psychoanalytic Quarterly36:250—170.
39.
Glover, E. (1955). The Technique of Psychoanalysis. New York: International Universities Press.
40.
Greenberg, J. (1991). Oedipus and Beyond. Cambridge : Harvard University Press.
41.
——— (1995). Psychoanalytic technique and interactive matrix . Psychoanalytic Quarterly64:1—22.
42.
Greenson, R. (1965a). The problem of working through. In Drives, Affects, Behavior, vol. 2, ed. M. Schur. New York: International Universities Press, pp. 277—314.
43.
——— (1965b). The working alliance and the transference neurosis . In Explorations in Psychoanalysis. New York: International Universities Press, 1978, pp. 199—224.
44.
——— (1970). Discussion of “The nontransference relationship in the psychoanalytic situation.” International Journal of Psycho-Analysis51:143—150.
45.
——— (1971). The “real” relationship between the patient and the psychoanalyst. In Explorations in Psychoanalysis . New York: International Universities Press, 1978, pp. 425—440.
46.
——— & Wexler, M. (1969). The nontransference relationship in the psychoanalytic situation. In Explorations in Psychoanalysis. New York: International Universities Press, 1978, pp. 359—386.
47.
Grotstein, J.S. (1990). Introduction. In M.I. Little, Psychotic Anxieties and Containment: A Personal Record of An Analysis with Winnicott . Northvale, NJ: Aronson, pp. 3—11.
48.
Hamm, M. (1967). Some aspects of a difficult therapeutic (working) alliance. In The Child Analyst at Work, ed. E.R. Geleerd.New York: International Universities Press, pp. 185—205.
49.
Hanly, C. (1994). Reflections on the place of the therapeutic alliance in psychoanalysis. International Journal of Psycho-Analysis75:457—467.
50.
Harley, M. (1967). Transference developments in a five-year-old child . In The Child Analyst at Work, ed. E.R. Geleerd.New York: International Universities Press, pp. 115—141.
51.
Hartmann, H., Kris, E., & Loewenstein, R.M. ( 1964). Papers on Psychoanalytic Psychology. Psychological IssuesMonograph 14. New York : International Universities Press.
52.
Heinssen, R.K., Levendusky, P.G., & Hunter, R.H. (1995). Client as colleague: Therapeutic contracting with the seriously mentally ill. American Psychologist50:522—532.
53.
Horvath, A.O., & Greenberg, L.S. (1994). The Working Alliance: Theory, Research and Practice. New York: Wiley.
54.
Kanzer, M. (1979). Book essay: Developments in psychoanalytic technique . Journal of the American Psychoanalytic Association27:327—374.
55.
Karon, B.P. (1989). The state of the art of psychoanalysis: Science, hope, and kindness in psychoanalytic technique. Psychoanalysis and Psychotherapy7:99—115.
56.
Khan, M.M.R. (1974). The Privacy of the Self. London : Hogarth Press.
57.
Klein, M. (1946). Notes on some schizoid mechanisms. In Envy and Gratitude & Other Works, 1946—1963. New York: Delacorte Press / Seymour Lawrence, 1975, pp. 1—24.
58.
Kohut, H. (1971). The Analysis of the Self. New York: International Universities Press.
59.
——— (1977). The Restoration of the Self. New York: International Universities Press.
60.
Langs, R. (1975). Therapeutic misalliances. In Technique in Transition. New York: Aronson ,1978, pp. 155—188.
61.
Loewald, H.W. (1960). On the therapeutic action of psychoanalysis. International Journal of Psycho-Analysis41:16—33.
62.
Meissner, W.W. (1992). The concept of the therapeutic alliance. Journal of the American Psychoanalytic Association40:1059—1087.
63.
——— (1996). The Therapeutic Alliance. New Haven: Yale University Press.
64.
Meyers, H. (1988). A consideration of treatment techniques in relation to the functions of masochism. In Masochism: Current Psychoanalytic Perspectives, ed. R. Glick & D.I. MeyersHillsdale, NJ: Analytic Press, pp. 175—189.
65.
Moore, B.E., & Fine, B.D. (1990). Psychoanalytic Terms and Concepts. New Haven: Yale University Press.
66.
Novick, J. (1970). The vicissitudes of the working alliance in the analysis of a latency girl. Psychoanalytic Study of the Child25:231—256.
67.
——— (1976). Termination of treatment in adolescence. Psychoanalytic Study of the Child31:389—414.
68.
——— (1980). Negative therapeutic motivation and negative therapeutic alliance. Psychoanalytic Study of the Child35:299—320.
69.
——— (1982a). Termination: Themes and issues. Psychoanalytic Inquiry2:239—365.
70.
——— (1982b). Varieties of transference in the analysis of an adolescent. International Journal of Psycho-Analysis63:139—148.
71.
——— (1988). Timing of termination. International Review of Psycho-Analysis69:307—318.
72.
——— (1990). The significance of adolescent analysis for work with adults. In The Significance of Child and Adolescent Analysis for Work with Adults, ed. S. Dowling.Madison, CT: International Universities Press, pp. 81—94.
73.
——— (1991). The therapeutic alliance: A concept revisited . Paper presented to the American Psychological Association, San Francisco, August.
74.
——— (1992). The therapeutic alliance: A concept revisited. ChildAnalysis3:90—100.
75.
——— (1998). Termination conceivable and inconceivable. Psychoanalytic Psychology14:146—162.
76.
——— (1999). Deferred action and recovered memory: The organization of memory in the reality of adolescence. Child Analysis4, in press.
77.
——— & Novick, K.K. (1991). Some comments on masochism and the delusion of omnipotence from a developmental perspective. Journal of the American Psychoanalytic Association39:307—328.
78.
——— ——— (1992). Deciding on termination: The relevance of child and adolescent analytic experience to work with adults. In Saying Goodbye, ed. A. Schmuckler.Hillsdale, NJ: Analytic Press, pp. 285—304.
79.
——— ——— (1994). Externalization as a pathological form of relating: The dynamic underpinnings of abuse. In Victims of Abuse: The Impact of Child and Adult Trauma, ed. A. Sugarman.Madison, CT: International Universities Press, pp. 45—68.
80.
——— ——— (1996a). A developmental perspective on omnipotence. Journal of Clinical Psychoanalysis5:129—173.
81.
——— ——— (1996b). Fearful Symmetry: The Development and Treatment of Sadomasochism. Northvale, NJ: Aronson.
82.
Novick, K.K. (1991). The therapeutic alliance in work with parents . Paper presented to the American Psychological Association, San Francisco, August.
83.
——— & Novick, J. (1987). The essence of masochism. Psychoanalytic Study of the Child42:353—384.
84.
——— ——— (1994a). Postoedipal transformations: latency, adolescence, and pathogenesis. Journal of the American Psychoanalytic Association42:143—170.
85.
——— ——— (1994b). Sadomasochism and the therapeutic alliance: Implications for clinical technique. New York Freudian Society, Washington, DC, October.
86.
——— ——— (1996). An application of the concept of the therapeutic alliance to sadomasochistic pathology. Paper presented to the Michigan Psychoanalytic Society, February, and the American Psychoanalytic Association, December.
87.
Nunberg, H. (1928). Problems of therapy. In Practice and Theory of Psycho-analysis, vol. 1. New York: International Universities Press, 1948, pp. 105—119.
88.
——— (1932). Principles of Psychoanalysis. New York: International Universities Press, 1955.
89.
Pigman, G.W. (1995). Freud and the history of empathy. International Journal of Psycho-Analysis76:237—256.
90.
Rapaport, D. (1960). On the psychoanalytic theory of motivation. In Nebraska Symposium on Motivation, ed. M.R. Jones, pp. 173—247.
91.
Rawn, M.L. (1991). The working alliance: Current concepts and controversies . Psychoanalytic Review78:379—389.
92.
Renik, O. (1993). Analytic interaction: Conceptualizing technique in light of the analyst's irreducible subjectivity. Psychoanalytic Quarterly62:553—571.
93.
——— (1995). The role of an analyst's expectations in clinical technique: Reflection on the concept of resistance. Journal of the American Psycho-analytic Association43:83—94.
94.
Sandler, A.-M., & Sandler, J. (1994). Therapeutic and countertherapeutic factors in psychoanalytic technique. Psychoanalysis in Europe: Bulletin43:45—56.
95.
Sandler, J., Dare, C., & Holder, A. (1973). The Patient and the Analyst. London: Allen and Unwin.
96.
——— Kennedy, H., & Tyson, R.L. (1980). The Technique of Child Psycho-analysis: Discussions with Anna Freud. Cambridge: Harvard University Press.
97.
Schlessinger, N., & Robbins, F.P. (1983). A Developmental View of the Psychoanalytic Process: Follow-up Studies and Their Consequences. New York: International Universities Press.
98.
Shaughnessy, P. (1995). Empathy and the working alliance: The mistranslation of Freud's Einfühlung. Psychoanalytic Psychology12:221—231.
99.
Shengold, L. (1995). Delusions of Everyday Life. New Haven: Yale University Press.
100.
Spence, D. (1982). Narrative Truth and Historical Truth. New York: Norton.
101.
Sterba, R. (1934). The fate of the ego in analytic therapy. International Journal of Psycho-Analysis15:117—126.
102.
Stone, L. (1954). The widening scope of indications for psychoanalysis . Journal of the American Psychoanalytic Association2:567—594.
103.
——— (1961). The Psychoanalytic Situation: An Examination of Its Development and Essential Nature. New York: International Universities Press.
104.
Tahkka, V. (1993). Mind and Its Treatment: A Psychoanalytic Approach . Madison, CT: International Universities Press.
105.
Viorst, J. (1982). Experiences of loss at the end of analysis: The analyst's response to termination. Psychoanalytic Inquiry2:399—418.
106.
Weinshel, E.M. (1984). Some observations on the psychoanalytic process . Psychoanalytic Quarterly53:63—92.
107.
Winnicott, D.W. (1965). The theory of the parent-infant relationship. In The Maturational Processes and the Facilitating Environment. New York: International Universities Press, pp. 37—55.
108.
Zetzel, E.R. (1956). Current concepts of transference. International Journal of Psycho-Analysis37:369—376.
109.
——— (1965). The theory of therapy in relation to a developmental model of the psychic apparatus. International Journal of Psycho-Analysis46:39—52.
