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Few would dispute that the establishment of a bond between analyst and patient that permits the work of analysis to unfold is a sine qua non of our work. Yet serious differences exist regarding the essential nature of this bond, and the clinical implications of these differences are profound. The problem of resistances has thwarted psychoanalysts in their efforts to bring about more predictable structural change, leading to criteria for analyzability that increasingly exclude large numbers of persons seeking analysis. (Waelder, 1960; Greenson, 1967). Freud's (1937) final work, “Analysis Terminable and Interminable,” reflected his preoccupation with the severe limitations posed by resistances on the therapeutic efficacy of psychoanalysis. In this summary he held a large number of factors, all intrapsychic, to account. If Freud's conclusions were to be accepted as final, psychoanalysts were faced with either an analytic procedure severely restricted in its scope or with the necessity of having to alter significantly the basic principles and techniques of psychoanalysis in the hope of increasing its therapeutic effectiveness. This dilemma provided a powerful stimulus for the reexamination of the nature of the therapeutic bond. And so the concept of a therapeutic alliance, already implicit in much of Freud's writings, became the focus of great interest in the 1950s.
In retrospect, it is clear that in the United States the interest in the therapeutic alliance, a particular object relationship between patient and analyst (Sterba, 1934; Bibring, 1937; Fenichel, 1941; Greenson, 1954; Zetzel, 1956; Stone, 1961), was stimulated by the development of ego psychology and paralleled the burgeoning interest in the more general