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Much has been written about the therapeutic alliance, and the concept has a long history in the psychoanalytic and psychotherapy literature. This paper endeavors to clarify certain aspects of the therapeutic alliance, and to highlight ways in which the concept is particularly important in the psychotherapy of suicidal patients. The realm of implicit relational knowing is emphasized as critical to understanding the therapeutic alliance and also as a major arena for psychotherapeutic change. A clinical example is presented of an intensive psychoanalytically oriented psychotherapy with a suicidal patient. The example demonstrates the importance of implicit relational knowing as essential to the therapeutic alliance as well as to psychotherapeutic change.
MARK SCHECHTER is the Chair of the Department of Psychiatry at North Shore Medical Center and an Instructor in Psychiatry at Harvard Medical School. He is also an Advanced Candidate at the Boston Psychoanalytic Society and Institute and a member of the Boston Suicide Study Group. He has published papers about the importance of validation in psychotherapy and psychoanalysis and in the area of suicide and psychoanalytic treatment, and has given numerous lectures on the assessment and treatment of suicidal patients. Address for correspondence: 24 Oak Hill Road, Needham, MA02492, USA. []
MARK GOLDBLATT is a psychiatrist and psychoanalyst in Cambridge, MA. He is an Associate Clinical Professor of Psychiatry at Harvard Medical School, a Clinical Associate at McLean Hospital, a faculty member of the Boston Psychoanalytic Society and Institute, and a member of the Boston Suicide Study Group. He has a long-standing interest in suicide and psychoanalysis, which is reflected in his publications and teaching commitments.
JOHN T. MALTSBERGER MD is a Clinical Professor of Psychiatry in the Harvard Medical School and a faculty member in the Boston Psychoanalytic Society and Institute. He created and leads the Boston Suicide Study Group; and has published widely on suicidal subjects and is widely known as a teacher.