Molnos, A. (1998): A psychotherapist's harvest

(4) WORKING ALLIANCE

The concept has been first formulated by Zetzel (1956) and then elaborated by Greenson (1965) and others. Nowadays it is mostly used as interchangeable with therapeutic alliance, which it tends to replace. I prefer to use both expressions, but with a slightly different meaning. Therapeutic alliance covers the unconscious aspects of the co-operation between the patient and the therapist. On the other hand, working alliance for me is the product of the patient's and the therapist's conscious determination and ability to work together on the troublesome aspects of the patient's internal world, his relationships with others and or other aspects of his life. No successful therapy can take place without a good working alliance, which, outside the therapeutic setting, is equivalent to a good working relationship in any team effort.

A good working alliance requires a degree of ego-strength on the part of the patient. He has to be able to look at himself objectively together with the therapist. To do so, the patient has to have sufficient trust in the therapist. I think "trust" is clearer than to say, as some do, that there must be "positive transference". The working alliance is based on the real relationship between the patient and the therapist and not on a transference relationship. On the other hand, good feelings towards the therapist, trust and belief in her abilities and her genuine motivation to help are a prerequisite for a good working alliance.

See also index: EGO-STRENGTH, RAPPORT, RESISTANCE, THERAPEUTIC ALLIANCE, THERAPEUTIC RELATIONSHIP, TRANSFERENCE, TRUST. The next pathfinder entry is (5) BOUNDARIES