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THE CURRENT EMPHASIS ON A CLEAR CONCEPTUALIZATION OF THE working relationship between patient and analyst appears to be a useful antidote to an indiscriminate and generalized approach to transference phenomena. Nevertheless, although it is useful as a principle, the stress on awareness of illness and the conscious, rational undertaking of analytic work to overcome illness has some disadvantages.
I think that these can be postulated from the theoretical point of view, for example, in the disproportionate weight given by some authors to what is essentially a surface phenomenon. From the clinical point of view, disadvantages are especially conspicuous in child analysis where reliance on the emergence of a treatment alliance must always take account of developmental considerations. For example, during a seminar at the Hampstead Psychoanalytic Index,1 it was noted that, for the young child, the value he places on a positive tie to the analyst probably forms the main basis on which analytic work proceeds.
Developmentally, we expect the older child to place less of an emphasis on the positive tie to the analyst… With adolescent patients, neither the positive tie to the object nor the wish for help with internal problems is alw