The Therapeutic Alliance

Abstract

WILLIAM W MEISSNER, SJ., M.D.: The Therapeutic Alliance. Yale University Press, 1996, 385 pp., $40.00, ISBN 0-300-06684-8. Dr. Meissner has written a classic monograph on the therapeutic alliance that will stand as a definitive work. The book is organized into four parts. Part I focuses on the nature of the therapeutic alliance; it traverses the history of the concept and its definition. Its unique relationship to transference and countertransference are also introduced. Meissner pays heed to one of his fine mentors, Dr. Elizabeth Zetzel, in her classic initial delineation of the therapeutic alliance. Zetzel relied on the concept of mature ego functions in the patient as the backdrop for a good therapeutic alliance. Meissner notes that Zetzel was less clear on the relationship between transference and alliance. This was a historical point of confusion. Turning his attention to Greenson, Meissner notes that Greenson's working relationship focused on the patient's motivation to overcome the illness and the analyst's humanness mixed with straightforwardness and restraint (p. 13). Part I is also notable for one of the book's crucial contributions-the relationship between the therapeutic alliance and transference. Meissner clearly points out the necessary oscillation between the two during the course of treatment. As alliance is in the foreground, transference is in the background. As transference moves to the foreground, alliance moves to the background and at times may almost seem to disappear. Finding the right balance in this choreography within any given treatment is the key. He also notes how transference interpretations may bolster the alliance and how alliance interpretations may enrich the transference. With respect to countertransference, Meissner borrows from Burke and Tansey and outlines a six-step sequence of how countertransference can work favorably in the therapist's empathic connection to the patient. The author also does a wonderful job of pointing out the potential alliance pitfalls that may result from countertransference. Part II addresses the real relationship between therapist and patient and its connection to the therapeutic alliance. Meissner's main message here is that reality factors, in a fashion similar to transference and countertransference, are not at all the same as therapeutic alliance even though they may impinge on it significantly. Missalliances may be influenced by issues of illness, aging, race, gender, pregnancy, money, malpractice concerns, interruptions, and death. …