An Application of the Concept of the Therapeutic Alliance To Sadomasochistic Pathology

This paper traces the history of the therapeutic alliance concept, examining how it has been used and misused, at times elevated to a central position and at others rejected altogether. The loss of this concept created a vacuum in classical psychoanalysis that has been filled by rival theories. The continuing usefulness of looking at the treatment process through the lens of the therapeutic alliance, particularly in relation to the manifold difficulties of working with sadomasochistic pathology, is suggested. To this end, revisions of the theory of the therapeutic alliance are suggested to address some of the difficulties that have arisen in conceptualizing this aspect of the therapeutic relationship, and to provide an integrated dynamic model for working with patients at each phase of treatment. This revised model acknowledges the complexity of the domain and encompasses the multiple tasks, functions, partners, and treatment phases involved. The utility of the revised theory is illustrated in application to understanding the sadomasochistic, omnipotent resistances of a female patient through the phases of her analysis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66889/2/10.1177_00030651980460031301.pd

The Talking Cure as Action: Freud's Theory of Ritual Revisited

Freud made creative use of late Victorian theories of ritual as empty modes of behavior, using the idea of seemingly meaningless ritual to offer a compelling comparison with obsessive behavior. However, analytic hours, with their repetitive frame and repetition of unconscious conflicts, have stronger links with rituals than Freud admitted. Recent theories highlight the extensive power of rituals to organize and instantiate models of effective action, especially in terms of the multifunctionality of language. These new theories of ritual offer in turn new tools for understanding the therapeutic action of analytic hours. © 2011 Association for the Advancement of Psychoanalysis