Technique: The Therapeutic Alliance

Helene Deutsch (1884–1982) shared Freud's reluctance to publish on technique. Although technical papers might appear to help beginners, they could also, in the hands of the insecure, contribute to unanticipated rigidities (Deutsch, 1983). Her audience for this hitherto unpublished paper was the Boston Psychoanalytic Society, whose Training Institute she helped organize in 1935; Elizabeth R. Zetzel presented a paper, 'Therapeutic alliance in the analysis of hysteria' (Zetzel, 1970), and Helene Deutsch's 1957 discussion of it—found among her papers—reflects her own convictions about psychoanalytic therapy.

Although both Dr Deutsch and Dr Zetzel (1907–1970) were seasoned psychiatrists, they came from dissimilar national backgrounds, contrasting training experiences, and different generations within the history of analysis: Helene Deutsch was Polish, moved to Vienna in 1907, and was analysed by Freud in 1918–19; Elizabeth Zetzel was an American who emigrated to London in the 1930s, was analysed by Ernest Jones, and returned to the States in 1949. While Helene Deutsch was deeply identified with traditionalism in analysis, she modelled herself on Freud's own 'unorthodox' clinical procedures; Elizabeth Zetzel had been influenced by Melanie Klein's ideas (Roazen, 1975). Both women had immense respect for each other, and by 1957 they each had large analytic practices in Cambridge, Mass. (When Helene Deutsch cited Freud's Collected Papers in her manuscript, the appropriate volume of the Standard Edition was not yet in print; but she never bought James Strachey's version of Freud. She knew Freud's writings by heart, and did not need to underline her German edition of his works.)

Helene Deutsch was trying to argue that the concept of therapeutic alliance was implied by previous analytic thought. She did not really approve of Heinz Hartmann's ego psychology, but old loyalties obliged her hesitantly to fit her thinking into his conceptualization. Her examp