You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
The authors have analyzed the commonly, but inconsistently and idiosyncratically, used concept of therapeutic alliance in several areas of usage, some relating to the psychoanalytic method itself and some to broader domains within psychiatry.
Those areas reflecting the actual practice of psychoanalysis include the rational alliance, the irrational, and the narcissistic. The authors understand, by the term rational alliance, the therapeutic “split” in the patient's self or overall mental apparatus, allowing the analyst to work with the patient's healthier personality aspects in order to reduce and modify the resistances or the pathological aspects of the personality. The irrational alliance concerns transference manifestations, including those that would be considered pathological, which nonetheless serve to establish and strengthen the bond between analyst and patient. The narcissistic alliance may be a special case of the irrational, but relates, in any case, to the nonrational, narcissistic bonds developed by the patient to his analyst. At times these may be fostered by the analyst, who by, for example, “speaking the patient's language,” induces the patient to identify narcissistically with the analyst. This is done to enhance