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The opening phase is a crucial time in treatment. Attitudes that patient and analyst develop toward each other in that early period, although colored by initial transference feelings and fantasies, can have an enduring effect on the treatment. While these first impressions can, and often do, undergo change as patient and analyst learn more about each other and transferences deepen, not infrequently, the emotional tone set early on influences all that happens thereafter.
The phrase, therapeutic alliance, has been used to designate a particular attitude on the part of patient and analyst. It is one characterized by a spirit of mutual regard and friendly feelings, together with a commitment on the part of both participants to work together on a joint project; exploring the inner world of one individual, the patient, in an effort to help overcome the emotional problems that have hampered the patient's journey through life.
The so-called therapeutic alliance, however, is far from a single entity. It is, in fact, one highly complex phenomenon, composed of a variety of intersecting and intertwining elements. Primarily for that reason and because transference inevitably plays a major role in its formation, a number of analysts, Abend (chapter 1), Brenner (1979), Hoffer (chapter 3), maintain that it is a term without meaning. For them, the therapeutic alliance is a compromise formation composed primarily of the positive transference, to which other elements of the personality make a contribution. From this perspective, then, no new term is needed to designate this compromise formation. What is needed, rather, is thorough analysis of it; a task that can be overlooked when the therapeutic alliance is simply accepted as a reality-based nonconflictual entity.
For Zetzel (1956), Stone (1961) and Greenson (1965), on the other hand, the therapeutic alliance is more than a compromise formation that requires analyzing. It is a phenomenon that is based, in large measure, on certain acc