Reflections on the place of the therapeutic alliance in psychoanalysis

The connection between the therapeutic alliance and interpretation is examined by means of two distinctions. One distinction is logical and concerns the relation between necessary and sufficient causes, the other is technical and concerns the nature of interpretation. The logical distinction between necessary and sufficient conditions of change is used to help to define the connection between therapeutic alliance and interpretation. It is argued that the therapeutic alliance is a necessary but not a sufficient condition for therapeutic change, whereas interpretation is both a necessary and a sufficient condition. But a logical distinction about the nature of causes can take us only so far in defining the connection between these two aspects of clinical work. A second technical distinction between the explicit and implicit meaning of interpretations is made to further clarify the relative importance of therapeutic alliance and interpretation. It is argued that our efforts to establish and maintain a working alliance work best when they work silently in the implicit dimension of interpretations. Clinical material is introduced to illustrate and test these conclusions.