Discussion of Ian Alger's Article, The Clinical Handling of the Analyst's Responses

Dr. Alger's brief paper is pertinent to so many important psychotherapeutic issues that a brief discussion must be selective and incomplete.

The author's emphasis on the need for self-honesty in the therapist about his own reactions in the therapeutic situation is quite valid. The usefulness of the therapist's monitoring of his emotional and cognitive responses to the patient is generally accepted. Dr. Alger's clinical example demonstrates the value of alertness to the transactions between patient and psychotherapist, even when the transactions are fortuitous and realistically unimportant.

It is with the author's basic point, viz., the therapist should regularly discuss his own reactions to the patient with the patient, that I cannot agree. While the therapist is more important in the field of therapeutic interaction than, say, his receptionist, I still regard the patient as the center of field. It seems to be that Dr. Alger argues for the equivalence of patient and therapist and may, in fact, be removing the patient from the center of the field of action.

Certainly, as Dr. Alger points out, the patient will respond to the therapist's conscious and unconscious reactions and communications, and the patient's discussion of these should be facilitated so he can develop an increasingly accurate awareness of his problem areas in their cross-sectional and longitudinal dimensions. However, does discussion by the therapist of his reactions invariably promote such expression by the patient? I think not.

As a patient develops an intense transference reaction, for example, he can readily find neurotic qualities in the therapist which he can effectively use as rationalizations for the

transference reaction. He can once more, then, avoid the important, unrecognized causative factors. If the therapist readily acknowledges his contribution, he may truncate the transference reaction, reinforce the comforting rationalization and, by relieving immediate tension, actually retard the pr