Discussion

As Abend clearly indicates, controversies concerning the concept of the therapeutic alliance are part of the larger issue of the factors which contribute to progress in analysis.

In his thoughtful contribution, he addresses two main, interrelated points. The first concerns the issue of the patient's motivation for treatment and for the development and maintenance of a therapeutic alliance. As I understand this point, Abend is saying that the behaviors that comprise what is called the alliance are best subsumed under the concept of transference since even the patient's apparently rational responses contain significant transference elements. The second point deals with the question of whether it is necessary or desirable to cultivate the alliance. Here, I understand Abend to be cautioning us that an emphasis on fostering the alliance is likely to be detrimental since it is apt to offer at least unwitting transference gratification and to interfere with one's alertness to and analysis of the transference. I would like to offer a few comments on some aspects of these difficult and complex questions.

Abend believes that “the therapeutic alliance concept rests on the dubious assumption that the patient is motivated to be rational about his or her irrationality…” (p. 225; emphasis added). Why is it a “dubious” assumption? I gather that it is regarded as dubious because behavior that appears to reflect an alliance contains elements of the erotic, hostile, and “unobjectionable” positive transference, all of which can and do serve as resistances and undermine the alliance.

While much of Freudian theory emphasizes our tendencies toward irrationality, it seems to me that within traditional Freudian