Technical considerations of the therapeutic and working alliances

A brief survey of the development of the idea of the analytic pact and its relationship to the concepts of the therapeutic and working alliances has been presented. I have suggested that the therapeutic alliance be defined as the full-scale therapeutic rapport which includes all the the elements favorable to the progress of therapy. This includes such factors as the patient's motivation for treatment based on ego-alien symptoms, positive transference, and the rational relationship between patient and therapist. I have considered the working alliance as more limited in scope and suggested that it be considered as referring to the healthier interpersonal interchange between the analyst and patient. In general, the relationship is in part dependent on the maturer portion of the patient's ego and is related to the reality relationship. I have ascribed the working alliance to the appropriate maturation of many of the ego's functions. It should be noted that the working alliance is actually one of the factors contributing to a good therapeutic alliance. Case reports have illustrated these considerations and amplified the discussion of the alliances, with emphasis on their technical management. These points are pertinent to the general conduct of therapy and the timing of interpretations. Care directed to the building of good alliances can be of great importance in creating a milieu conducive to therapeutic progress. Identification and its role in the development of the working alliance, and the special place of affection for the analyst were discussed and the differences between transference affection and the affection based on the realities between patient and therapist were related to the effects of interpretation.