Novick K K, Novick J
Michigan Psychoanalytic Institute, USA.
J Am Psychoanal Assoc. 1998;46(3):813-46. doi: 10.1177/00030651980460031301.
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.
本文追溯了治疗联盟概念的历史，审视了它是如何被使用和滥用的，有时被提升到核心地位，有时又被完全摒弃。这一概念的缺失在经典精神分析中造成了真空，而这一真空已被 rival theories 所填补。有人提出，通过治疗联盟的视角审视治疗过程仍具有持续的效用，尤其是在处理与施虐受虐病理相关的诸多困难时。为此，建议对治疗联盟理论进行修订，以解决在概念化治疗关系这一方面所出现的一些困难，并为治疗各阶段与患者合作提供一个综合的动态模型。这一修订后的模型承认该领域的复杂性，并涵盖了所涉及的多项任务、功能、参与者和治疗阶段。通过将修订后的理论应用于理解一位女性患者在分析各阶段的施虐受虐、全能性抵抗，说明了该修订理论的效用。
