The Therapeutic and Working Alliances in Psychoanalysis

This dissertation aims to bring into focus the importance of the working relationship and the part it plays in the outcome of therapy. There appears to be a lack of attention in the psychoanalytic literature regarding the working alliance, how it is established and maintained, and the role it plays in the uncovering of unconscious material, including the interpretation of the transference. A rough historical survey outlines the evolution of the concept, and traces its gradual decline in the analytic literature in favour of the transference. Greenson's formulations, as the exception to this trend, are expanded to include the usefulness of the concept in working with borderline patients. In recent years, the concept of the working alliance has been neglected in psychoanalytic theory in favour of the study of the transference. There has been a tendency, in the writings of mainstream psychoanalysts, to treat as inferior, or even dangerous, any emphasis on the non-transferential aspects of the relationship between patient and therapist. There is a gulf between what happens in clinical practice and what is written about; what pushes back the frontiers of psychoanalytic knowledge does not always reflect everyday work. But the result is that any work that does not focus on the transference has tended to be seen as merely incidental, a kind of padding between interpretations, and this has precluded active thinking about the working alliance as an important aspect of treatment.