Psychoanalytic Psychotherapy: Therapeutic Alliance

Therapeutic Alliance

A great deal of research in the outcome of psychoanalytic psycho-therapy has focused on the importance of the therapeutic alliance (Docherty, 1985). Increasing appreciation for the role of support-ive factors, such as the rapport between the patient and therapist that constitutes the therapeutic relationship, has balanced the earlier and more narrowly defined position that attributed thera-peutic success exclusively to insight resulting from specific inter-pretive activity. The clinical consequences of this appreciation of the helpfulness of nonspecific factors have been the psychoana-lytic psychotherapist’s paying much greater attention to the ini-tial phases of engaging the patient in psychotherapy and a greater respect for those positive and negative factors that the therapist brings to the working relationship. Currently, approaches to psy-choanalytic psychotherapy hold that the psychiatrist’s person-ality and interventional technique have equal influence on the therapeutic process. In essence, the contemporary view is more dyadic, and places greater importance on the contributions of the therapist (both the conscious and the unconscious), as well as of the patient with respect to progress and impasse in the psycho-therapeutic process.

Contemporary psychoanalytic psychotherapists still em-phasize elucidation of the unconscious, especially within the transference, and still use interpretation as a primary clinical intervention, but recognizes more fully the important role of the mutual emotional engagement of therapist and patient and the curative role of this relationship in addition to other supportive factors. They adhere to a much broader perspective on human development and psychiatric disorders. Psychological problems

can result not only from early intrapsychic conflict but also from developmental deficits or failures as well as from psychological trauma (Table 66.6).