The Therapeutic Alliance

One point on which the various helping professions agree is that the crucial factor in the success of therapy is the therapeutic alliance—the collaborative relationship a particular therapist is able to form with a particular patient. W. W. Meissner, a highly regarded teacher and practitioner of psychoanalysis and psychotherapy, examines all the prevailing ideas about the therapeutic alliance in this useful book, which is intended for both clinicians and theoreticians. Dr. Meissner explains that in addition to the more familiar aspects of transference and countertransference, the therapeutic alliance encompasses aspects of the therapeutic relation that make it possible for therapist and patient to work together to accomplish therapeutic goals. Dr. Meissner draws a clear distinction not only between alliance and transference but also between alliance and the real relationship. Aspects of the alliance include arrangements and negotiations governing the therapeutic frame and necessary boundaries, neutrality and abstinence, and also personal qualities and capacities that therapist and patient bring to the analytic situation: empathetic attunement, trust, autonomy, authority, responsibility, freedom, and initiative, among others. To the extent that these qualities become operative in the therapeutic relation, they provide the effective basis for a strong therapeutic alliance, which plays an essential structuring role at every step of the analytic process.