The concept of alliance has been subject to inconsistent and idiosyncratic usages by different authors. We attempt to clarify this fundamental concept by identifying six categories of alliance, three in analysis proper and three in areas of psychiatry adjoining analysis.

The rational alliance is made possible by the therapeutic split in the ego which allows the analyst to work with the healthier elements in the patient against resistance and pathology; the work of Sterba, Zetzel, Kernberg and Greenson falls within this category. The irrational alliance paradoxically invokes elements of transference, even of pathology, to develop the analyst-patient bond, as the work of Nunberg and Rosen illustrates. In a related form, the narcissistic alliance invokes nonrational, narcissistic bonds to achieve the working relationship.