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THE CONCEPTUAL UNDERSTANDING OF THE PSYCHOANALYTIC process in adult patients has undergone a progressive expansion since the earliest formulations proposed by Breuer and Freud (1893). Each successive elaboration of the curative factors has moved us further away from an emphasis upon a single therapeutic element. The earlier cathartic model of therapeutic action was replaced during the era of the topographic theory by the conceptualization that the analyst's interpretations make the unconscious become conscious. The significance of the transference was recognized, but the analyst was to be a passive mirror, reflecting whatever transference distortions the patient chose to project.
The introduction of the structural theory led to significant expansion of ego and superego analysis, but conceptualizations of the analyst's role still involved interpretation and reconstruction, and in the therapeutic interaction the analyst was to remain "neutral, aloof, a spectator, and … never a coactor" (Macalpine, 1950, p. 535). Sterba (1934), (1940) had described the alliance between patient and analyst, a subject