Chapter 7: The Therapeutic Alliance

These five excellent papers, each written by an original contributor to the field, take, as we could predict that they would, different positions on the concept of the therapeutic

alliance, posing for me a number of important questions. First, and most important, is the therapeutic alliance a useful construct? Hoffer most definitely, but Abend, too, answers in the negative. Hoffer says, with admirable succinctness, “Neutrality, yes; therapeutic alliance, no!” And Abend asserts that, “to hold firmly that all aspects of the patient's relationship to the analyst are manifestations of transference is to commit the analyst to the endeavor to analyze the transference in all its complexity.” “The analyst is … (most) likely to go wrong taking reasonableness at face value.” On the other hand, Adler, Jacobs, and Chused appear to take the usefulness of the concept for granted. Adler says that, “the therapeutic alliance is significant and clarifying.” He also says that, “once transference is resolved, one can have the capacity for a mature collaboration.” And Jacobs says, “the concept of the therapeutic alliance contains the fundamental idea of a trusting bond between patient and analyst, originating in the patient's accurate perception and appreciation of certain qualities and attitudes of the therapist.” He states, further, that, “whether or not we endorse the concept, inasmuch as it designates the existence of basically positive feelings for, and trust of, the therapist, it is an indispensible element in treatment.” Finally, Chused takes a position which is clearly in favor of utilizing the therapeutic alliance. What's more, she takes the concept as a rationale for working with her child patient's parents for months in order to insure the stability of the parental aspect of the treatment alliance, even though or despite “voicing some misgivings.” Thus, with this diversity of response among the five authors, the first question these papers provoke in me—I believe in all of