The Working Alliance and the Transference Neurosis.

The Working Alliance and the Transference Neurosis Ralph R. Greenson, M.D. The clinical material on which this presentation is based is derived from patients who developed unexpected difficulties in the course of psychoanalytic therapy. Some of these patients had undergone one or more analyses with other analysts; others were patients of mine who returned for further analysis. In this group there were patients who were unable to get beyond the preliminary phases of analysis. Even after several years of analysis they were not really 'in analysis'. Others seemed interminable; there was a marked discrepancy between the copiousness of insight and the paucity of change. The clinical syndromes these cases manifested were heterogeneous in diagnostic category, ego functions, or dynamics of personality. The key to understanding the essential pathology as well as the therapeutic stalemate was in the failure of the patient to develop a reliable working relation with the analyst. In each case the patient was either unable to establish or maintain a durable working alliance with the analyst and the analyst neglected this fact, pursuing instead the analysis of other transference phenomena. This error in technique was observable in psychoanalysts with a wide range of clinical experience and I recognized the same shortcoming in myself when I resumed analysis with patients previously treated. In working with these seemingly unanalyzable or interminable patients I became impressed by the importance of separating the patient's reactions to the analyst into two distinct categories: the transference neurosis and the working alliance. Actually this classification is neither complete nor precise. However, this differentiation