The Therapeutic Alliance

The concept of the therapeutic alliance finds its birth in Freud's 'Dynamics of the Transference' (1912) as the resolution of a paradox encountered in the theory and practice of therapy. Freud had previously (1910b) described the transference as a helpful bond preventing the patient from again 'taking flight' as he had done in building his neurosis. But elsewhere (1910a) he had noted that the transference often constitutes the major resistance to analysis. In 'Dynamics of the Transference' he characteristically confronts this paradox head-on. How, he asks, can the transference, which largely motivates a patient to struggle against his neurosis, at the same time be the major weapon that the neurosis uses against those efforts? He answers that the transference is composed of different kinds of attachment, some of which interfere with the patient's cooperation by lending themselves to the resistance, while others induce the patient to persevere. The non-cooperative elements are negative feeling and the unconscious erotic component. The helpful part of the transference is the 'conscious' and 'unobjectionable' positive feelings of the patient toward his analyst.

This simple answer has complications. First of all, the focus on conscious and unobjectionable positive feelings comes immediately after the statement that 'all the emotional relations of sympathy, friendship, trust, and the like, which can be turned to good account in our lives are genetically linked with sexuality and have developed from purely sexual desires …' (1912, p. 105). Secondly, Freud has declared that 'every single association, every act … must reckon with the resistance' (1912, p. 103; my italics). Thus the helpful and unhelpful feelings of the patient toward the analyst may be not separate feelings (in the way that love and hate are separate), but different aspects of the same feeling. Freud seems to be saying that, whatever its origins and overtones which unconsciously may work against a