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Harty, M.K. (2003). The Therapeutic Alliance. Edited by Steven T. Levy. Madison, CT: International Universities Press, 2000, 139 pp., $27.50.. J. Amer. Psychoanal. Assn., 51(1):343-345.

(2003). Journal of the American Psychoanalytic Association, 51(1):343-345

The Therapeutic Alliance. Edited by Steven T. Levy. Madison, CT: International Universities Press, 2000, 139 pp., $27.50.

Review by:
Michael K. Harty

Time was, at least in some psychoanalytic institutes, when to maintain that the analyst should foster the therapeutic alliance was about as controversial as maintaining that the office should contain a couch. No more. As this volume demonstrates, there are serious questions about the utility of the alliance concept, both as an element of clinical theory and as an influence on technique. The book is the product of two panel presentations at meetings of the American Psychoanalytic Association, and the ninth in their published “Workshop Series”; it includes five individual papers and two discussions, with introductory comments by the editor.

In the opening paper, Sander Abend traces the historical development of the concept, beginning with Freud's designation of the “unobjectionable positive transference,” which enabled the analyst to secure the patient's cooperation. Subsequent theorists—Sterba, Zetzel, and Greenson, in particular—went well beyond Freud in separating off a mature, rational part of the patient's ego that could enter into a working partnership with the analyst. Abend gives a balanced account of these developments, but he is more in agreement with other writers, especially Friedman and Brenner, who have questioned whether patients' (and analysts') motivations are really so separable into the rational/cooperative and irrational/defensive. Better, say these writers, to maintain a consistent focus on searching for unconscious factors than to engage in “alliance-building” techniques that may limit the depth of exploration and may serve the analyst's needs more than the patient's.

Among the other panelists, Axel Hoffer is closest to Abend in his skepticism toward the therapeutic alliance. He argues that the analyst who ventures beyond the basic task of enhancing free association and elucidating conflict may, in seeking to “build the alliance,” actually interfere with expressions of deeper conflict and impose a form of compliance on the patient.

Gerald Adler is also critical of the alliance concept, but for a particular group of patients: those with borderline and narcissistic personality disorders. For these patients, it is the selfobject transference that carries the treatment for a long time, and that may be mistaken for a true alliance in periods of stability.

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