The psychoanalytic concept of the working alliance is reviewed and elaborated. It is argued that various modes of psychotherapy can be meaningfully differentiated in terms of the kinds of working alliances embedded in them. Moreover, the strength, rather than the kind of working alliance, will prove to be the major factor in change achieved through psychotherapy. Strength of alliance will be a function of the goodness of fit of the respective personalities of patient and therapist to the demands of the working alliance. Past research bearing on these propositions and indicated future research are discussed. Extensions to changes sought in teaching and other group processes are briefly touched. Proliferation of psychotherapies has dominated the sixties and seventies. Thirty-six psychotherapies (Harper, 1959) had to be supplemented by an additional compilation (Harper, 1975). Unchecked, this trend would come perilously close to the solipsism, a psychotherapeutic method for each psychotherapist. Not unexpectedly, research in psychotherapy has suffered from an analogous lack of convergence, and with it a disappointing impotence about providing empirical tests of competing claims. As Donald Campbell (1976) suggests, given the wide prevalence of the need for psychotherapy, and the continuing ability of individuals or society to pay for it, the winnowing of this harvest of methods must come from research. Campbell (1976) speaks to the practitioner, exhorting him or her to engage in systematic follow-up. This essay addresses those prac1 An earlier version of this paper was given at the annual meeting of the Society for Psychotherapy, June, 1975. * Requests for reprints should be sent to Edward S. Bordin, Ph.D., University of Michigan Counseling Center, 1007 East Huron Street, Ann Arbor, Michigan 48109. titioners who are also research workers, to call attention to a point of view that can encompass most, if not all, approaches to psychotherapy and can lead toward the needed convergence in research. There has been a promising rate of growth of research and research workers, with encouraging trends toward a coming together on basic issues: I aim to contribute to that movement. Moreover, because of the generalizability of my ideas to all change situations, I hope to stimulate research applications to teaching and to community change processes. 1 propose that the working alliance between the person who seeks change and the one who offers to be a change agent is one of the keys, if not the key, to the change process. The working alliance can be defined and elaborated in terms which make it universally applicable, and can be shown to be valuable for integrating knowledge—particularly for pointing to new research directions. As my initial statement suggests, a working alliance between a person seeking change and a change agent can occur in many places besides the locale of psychotherapy. The concept of the working alliance would seem to be applicable in the relation between student and teacher, between community action group and leader, and, with only slight extension, between child and parent. While I believe such extensions to be fruitful, they are beyond the scope of this paper. I shall confine myself to the therapeutic working alliance, making only brief inferences to extensions to other change enterprises.2 2 One might extend the idea of working alliances to nonchange situations. Although prisons, under reform ideology, have been set up as change situations, most observation suggests that staff and inmates typically arrive at a mutually agreed-upon alliance to get through their relationship with as little upset as possible.

https://psycnet.apa.org/journals/pst/16/3/252.pdf

The generalizability of the psychoanalytic concept of the working alliance.

The analysis of the self

Development and validation of the Working Alliance Inventory.

To identify underlying patterns in the alliance literature, an empirical review of the many existing studies that relate alliance to outcome was conducted. After an exhaustive literature review, the data from 79 studies (58 published, 21 unpublished) were aggregated using meta-analytic procedures. The results of the meta-analysis indicate that the overall relation of therapeutic alliance with outcome is moderate, but consistent, regardless of many of the variables that have been posited to influence this relationship. For patient, therapist, and observer ratings, the various alliance scales have adequate reliability. Across most alliance scales, there seems to be no difference in the ability of raters to predict outcome. Moreover, the relation of alliance and outcome does not appear to be influenced by other moderator variables, such as the type of outcome measure used in the study, the type of outcome rater, the time of alliance assessment, the type of alliance rater, the type of treatment provided, or the publication status of the study.

Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review.

Results of 24 studies (based on 20 distinct data sets) relating the quality of the working alliance (WA) to therapy outcome were synthesized using meta-analytic procedures. A moderate but reliable association between good WA and positive therapy outcome was found. Overall, the quality of the WA was most predictive of treatment outcomes based on clients' assessments, less so of therapists' assessments, and least predictive of observers' report

Relation between Working Alliance and Outcome in Psychotherapy: A Meta-Analysis.

Current concepts of transference.

The so called good hysteric

The so called good hysteric.

1965: additional notes upon a case of obsessional neurosis: Freud 1909.

Although all the contributors to this symposium concentrated on its main topic-technique-the discussion clearly illustrated a point raised by several participants to the effect that it is impossible to separate technique from the underlying theoretical premises on which it is based. In this discussion, moreover, the theoretical premises coming under review covered a very wide range, including the very cornerstone on which all analytic development has been based-namely, our fundamental conception of the nature of neurosis, varioys points of view as to the nature of the therapeutic process in analysis, and illustrating how closely such views correlate with our conception of and attitude toward the transference neurosis. Phyllis Greenacre opened the meeting with a paper described by one of the discussants as containing all the basic facts concerning transference, its utilization, and the value and significance of practical arrangements, which should be imparted to every candidate about to embark on his first control case. This is certainly true. On the other hand, a review of this paper, in the light of the day’s discussion, suggests that it is in fact deceptively simple. In the first section, for example, Greenacre describes the essentials of the transference relationship-showing the inevitable resemblance (and of course significant differences) between the transference situation and the mother-child relationship. In so doing, she makes it abundantly clear that she regards the dependent aspects of the transference (regressive though they may be) as integral and unavoidable-and not as an undesirable development which should be minimized. FoIlowing this line of thought, Greenacre’s second section, which considers the two main therapeutic methods of utilizing the transference, contains in essence the essential premises underlying most

Elizabeth R. Zetzel

Papers

Current concepts of transference.

The so called good hysteric

The so called good hysteric.

1965: additional notes upon a case of obsessional neurosis: Freud 1909.

SCIENTIFIC PROCEEDINGS: Panel Reports—Midwinter Meeting, 1952: I. The Traditional Psychoanalytic Technique and its Variations: