Response

I shall try to further clarify my views on the subject of the therapeutic alliance, in the light of the responses of Drs. Stone and Wolitzky. I do not doubt for a moment that patients who seek analytic help, and who stick to the task despite how their particular difficulties may encumber their participation in the enterprise, have established an alliance with their analysts, one that can be called a therapeutic alliance, a working alliance, a mature transference, or by any other suitably descriptive name one might prefer. Furthermore, I do not doubt that all patients are, in some variable measure, mature, reasonable human beings, who know that they and their analysts are in pursuit of a common end, the amelioration of the patient's suffering, to whatever extent analytic treatment can help in that regard. I fully agree with Dr. Stone that to acknowledge this is only common sense, but I am also aware that if analysis has taught us anything, it has taught us to be mindful of the limitations of common sense, and to be aware of the pitfalls of overestimating its influence.

Friedman's emphasis was to examine the logical consequences of our knowledge of the unconscious and its role in mental life, and to apply this understanding to the problem of the patient's motivation. I have extended his reasoning to cast doubt upon the validity of drawing a functional distinction between patients' conscious, mature, and more or less reasonable attitudes about their treatment, and their unconscious aims. By functional distinction, I mean one which has practical implications, or applications. In other words, a distinction among the admittedly complex admixture of motives driving analysands' behavior in treatment that leads to useful technical modifications. When, if ever, in the analytic situation, is it correct for the analyst to give exclusive priority to the patient's most mature level of understanding of their interactions? My answer to that question is