The Problem of Therapeutic Alliance

I will treat the concept of the alliance as a problematic aspect of the larger and far more elusive question of what makes analytic treatment move forward. It seems to me unarguable that whatever factors enable the treatment to move ahead constitute essential contributors to a fruitful outcome, and therefore they deserve the most careful study. The issue is not simply a theoretical conundrum, but also has technical consequences of considerable practical significance.

Freud laid the cornerstone of the concept of a therapeutic alliance, although he did not speak of it in those terms, in his 1912 paper on “The Dynamics of Transference,” as a feature of his exposition of how he conceptualized neurosogenesis and the analytic method of treatment at that time. Friedman (1969), in an incisive and convincing study of the subject, observes that Freud did so in a not entirely successful effort to resolve a theoretical paradox concerning the patient's motivation, and Friedman goes on to expose the persistence of that paradox in the work of subsequent theorists.

You will recall that Freud had already discerned that the transference, as the vehicle for the expression of the patient's unconscious desires, supplies the underlying emotional force which binds the patient to the doctor, and hence commits him or her to the treatment process. He also saw that it simultaneously powers the patient's resistance to the doctor's influence, and, by extension, to the requirements of the treatment situation. Freud's extraordinary theoretical and technical imagination enabled him to construct a revolutionary proposition for the analytic treatment of neurosis out of this apparent contradiction, but in order to do so, he had to postulate a division of the elements of transference that has left us a troublesome legacy.

His solution was to identify and split off a helpful, conscious, unobjectionable positive component of the transference which, he