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This paper will focus on what makes treatment work and what ideas can be helpful to us in doing treatment. It seems to me that at this point the concept of the therapeutic alliance,
while an accustomed part of our theory, doesn't have any immediate practical value in relation to the matters that most concern us as clinicians. I'm not very interested in the concept of therapeutic alliance, myself; and, after reading the previous papers, I have the impression that none of the authors is very interested in it either!
Nonetheless, it's very worthwhile to get a group of smart, clinically effective analysts to take a bead on such a concept, because it requires them to articulate what they think analysis is, what it isn't, how they see “analysis” in relation to “therapy,” and how they explain successful treatment of any kind.
Abend begins his paper by making a crucial point. He states that controversy concerning the value of the concept of therapeutic alliance is really just an aspect of the larger question of “what moves the treatment forward.” I agree, and I believe it is precisely the question of what makes for an effective psychoanalytic treatment that we need to keep in mind as we review the papers by these five thoughtful and experienced clinicians. Because whatever else we may say about it, the concept of a therapeutic alliance, in all of the many and varied ways it has been defined, always represents an attempt to establish a separate category, into which some elements necessary for a successful clinical analysis are placed, and from which others are excluded. The term therapeutic alliance invariably indicates some kind of division among factors contributing to the desired psychoanalytic outcome; and for that reason, certain questions concerning the concept of therapeutic alliance keep recurring in our field. Those questions are evident in all the presentations: What is being divided? Why is division occurring? Is the division useful to us in our clinical work?
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