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Dickes, R. (1967). Severe Regressive Disruptions of the Therapeutic Alliance. J. Amer. Psychoanal. Assn., 15:508-533.

(1967). Journal of the American Psychoanalytic Association, 15:508-533

Severe Regressive Disruptions of the Therapeutic Alliance

Robert Dickes, M.D.


Two major theses concerning the analyst and his role in analysis have developed. One viewpoint stresses the thesis that the analyst should not present himself as a real object. The other viewpoint stresses the importance of the analyst as a person. Both viewpoints are briefly reviewed. This continuing debate concerning the role of the analyst emphasizes the importance of the interaction between patient and therapist, an interaction related to the therapeutic and working alliances, which are next considered. A distinction is made, in this paper, between both types of alliances. The working alliance is defined as that part of the therapeutic alliance related to the healthy portion of the patient's ego. This involves the reality relationship between patient and doctor.

Three cases are presented illustrating varying types of disruption of the working alliance and of the standard analytic situation. Some methods of managing these disruptions are presented as modifications in analytic technique as distinguished from deviations of technique. What constitutes a modification and what constitutes a deviation has been a subject for discussion in the literature and this has been reviewed. An account of the methods used in the management of the disrupted working alliance in my patients is included.

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