Significance of Patient's Work in the Therapeutic Process

MY THESIS IS that the patient's activity in the working alliance, just because it is work, is intrinsically antithetical to his neurosis, counterposes it from the beginning and increasingly becomes a source of change.

If the ability to work and to love are the principal aims of psychotherapy, they are also, in the form of the working alliance, the means by which the patient begins to move toward those ends. The changes which a patient has to make in his therapeutic activity, so as to work more and more closely with his therapist, are prototypic of the changes involved in his becoming a less neurotic person. The "alliance" has been extensively examined as a paradigm of human closeness, trust and intimacy. Its bearing upon neurotic and schizoid processes and its part in healing are now widely accepted (Kanzer and Blum; Sechehaye). It is work, as one example of the distinctively human mode of dealing with reality which I propose to examine here.

The aim of the patient's therapeutic work is to bring about some alteration in his personality and his mode of life. His work is rooted in the working alliance, but extends beyond it. His task, in collaboration with the therapist, is to try to find out what is the matter with him and the way he lives his life. He is responsible for revealing himself in the sessions as honestly as he can. As he becomes involved in the therapeutic process, he also becomes increasingly aware of the subtle complexities and consequences of his interactions with other people. He learns how to modify his reactions, interrupting neurotic sequences and finding viable