The Contribution of Attachment Theory and Self-Regulation Theory to the Therapeutic Alliance*

The concept of the therapeutic alliance has existed in the shadow of transference through most of the history of psychoanalysis but, as has been the case with its relative, countertransference, it is now beginning to emerge from the shadows to become enfranchised as a powerful and significant element in treatment. The early analysts, including Freud himself, were aware of the subtle dialectic between the need for an ascetic rigor in the analytic setting, on one hand, and the need for humanism on the other. This latter element, the need for analytic humanism, gradually evolved into the therapeutic alliance—working alliance—real relationship concepts, and finally one aspect branched off to reunite with analytic technique in the form of the empathic approach of Self-Psychology. Needless to say, the issue of parameters always lurked over the shoulder of analytic humanism creating perpetual grounds for suspicion of any technical deviations or aberrations which would contaminate the purity of the ascetic approach.

The development of the concept of the therapeutic alliance slowly emerged, consequently, out of the gradual recognition that, even though transference is the most important and most powerful instrument