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Gutheil begins by reminding us of Freud's interest in the application of neuroscience to the treatment of mental disorders, but he warns us to avoid any notion that such treatment will be so precise that it will obviate the need for a dynamic psychotherapeutic relationship. He proposes instead that we extend our psychoanalytic understanding of the therapeutic alliance to the relationship created by prescribing drugs, and proposes the term "pharmacotherapeutic alliance" to connote a collaborative effort in experiencing and observing the pharmacotherapeutic process. He calls attention to the importance of identifying and utilizing the transference aspects of this relationship to achieve the therapeutic goal, and he reminds us that, as in any other therapy, transference may be positive or negative. Gutheil notes that patients tend to link the prescription of medication to the physician's perceived responsiveness and the seriousness with which he views the patient. Giving, responsive, empathic, and validating attitudes tend to be reflected in a positive transference and a positive attitude toward medication. The patient will, of course, bring a personal attitude to the treatment. Some patients may view a suggestion of drug therapy as degrading or as indicating that they are more seriously ill than they wish to believe. For every patient who perceives the prescription of medication as a validation of his distress, there is another who sees the prescription as a dismissal of himself and his suffering, or as an effort to deprive him of valuable, comforting symptoms. The article contains many specific, clinically pertinent observations.