Working alliance (psychoanalysis)
As a working alliance in is psychoanalysis and psychoanalytically oriented therapies with which a frame is negotiated for the joint work to ensure their success means an agreement between patient and therapist. The working alliance is contrasted with that part of the therapeutic relationship that is shaped by transference and countertransference , regression and neurotic mechanisms. To simplify matters, it is also referred to as the rational or adult part of the relationship, which is intended to ensure the continuation of treatment even in times of crisis caused by irrationality, violent emotions and reenactments . The working alliance includes agreements on the framework conditions for treatment such as the frequency and duration of the hours, the setting - such as the question of treatment while sitting or lying down - fee agreements and reliability, but also compliance with the so-called abstinence rule and the agreed treatment-technical methods such as that free association . In depth psychology-oriented therapies beyond psychoanalysis, agreements on other methods such as therapeutic painting ( art therapy ), music-making ( music therapy ) or the willingness to express yourself in a group ( group analysis , group psychotherapy ) can be part of the working alliance.
Concept history
The term was largely coined by the American psychoanalyst Ralph R. Greenson . It replaced earlier terms such as rational transference (Fenichel), therapeutic alliance (Zetzel) or mature transference (Stone). According to Greenson, it is the patient's motivation to want to overcome his illness that forms the reliable core of the working alliance. “The real alliance is basically between the patient's reasonable self and the analyst's analyzing self.” This would result in a “partial identification” of the patient with the analyst as he tries to understand the patient. Greenson always emphasized that the two aspects of the therapeutic relationship (working alliance and transference neurosis ) can never be absolutely separated and describes in his numerous case studies, development, disorders and crises in the interaction of the two relationship aspects . He saw the ability to form (mature) object relationships as a prerequisite for the development of the working alliance and is of the opinion that narcissistically disturbed patients are not capable of this.
Later writers such as Heinrich Deserno and Gottfried Fischer , on the one hand criticize the simplification of distinction and secondly a polarization in quasi desirable or less desirable behaviors of the patient. The statement that the working alliance is the prerequisite for analytical work could also become an inadequate demand on the patient. In this later perspective, the more mature aspects of the relationship described are seen more as the success of analytical work that has already been done. The changing understanding of the transference also influenced the view of the working alliance and led to a view in which, with regard to the working alliance, the jointly produced and dialogical aspects come more into focus. In a study it was possible to show which communicative activities and interactive processes promote cooperative communication in analytical initial discussions.
Importance in different schools and fields of work
From the perspective of self-psychology , the working alliance is also understood as that part of the transference with which the patient knows how to use the analyst as a positive self-object for himself. In the sense of transforming internalization ( Kohut ), the analyst's experience of understanding can become part of the patient's self-substance .
Helmut Thomä and Horst Kächele emphasize the importance of fostering a helpful relationship, especially at the beginning of a treatment in which the development of the working alliance and the transference are mutually reinforcing. They are of the opinion that towards the end of the treatment, the relationship between the transfer and the working alliance would have grown to such an extent that “realistic approaches prevail.” When working with children and adolescents , the aspects of the working alliance are divided up, because partial aspects such as punctual delivery, fee issues, etc. are taken over by the parents and it is the parents or legal guardians with whom the therapy agreements are made. By means of trial interpretations, it is also possible at the beginning of the treatment to find out how far a child or adolescent is able to enter into a sustainable working alliance. In family and couple therapy , it is important to build a good working alliance with everyone involved.
By expanding psychoanalytic or psychoanalytically oriented work, e.g. B. on the treatment of patients with borderline or narcissistic personality disorders , there are changed demands on the analyst to support and promote the working alliance in order to prevent premature discontinuation of treatment and to achieve and maintain a sufficiently stable therapeutic relationship.
The Gestalt therapy has taken the concept of the working alliance and conceptualized in addition to the general a special working relationship that is "- closed again anticipated regressive individual work before each - more or less formalized".
Individual evidence
- ↑ a b c d cf. Heinrich Deserno: Working alliance . In: Wolfgang Mertens, Bruno Waldvogel: Handbook of basic psychoanalytic concepts . 3. revised Ed., Kohlhammer-Verlag, Stuttgart 2008, pp. 75–80
- ↑ a b Greenson, Ralph R .: Technology and practice of psychoanalysis. Klett-Cotta, Stuttgart 1986, 4th edition. American original 1967, p. 204
- ↑ Greenson, Ralph R .: Technique and Practice of Psychoanalysis. Klett-Cotta, Stuttgart 1986, 4th edition. American original 1967, p. 217f
- ↑ Rebecca Saladin, Bernhard Grimmer: The working alliance from a conversational analytical point of view, cooperation in the first psychoanalytic interview in the context of changing topics , Psychotherapy and Social Science 2009, 11 (1), 37-69
- ↑ Helmut Thomä, Horst Kächele: Textbook of psychoanalytic therapy, Volume 2 Praxis, Springer Berlin, Heidelberg, p. 38f
- ↑ Helmut Thomä, Horst Kächele: Textbook of Psychoanalytic Therapy, Volume 2 Praxis, Springer Berlin, Heidelberg, p. 414
- ↑ Guidelines for analytical and depth psychology-based child and adolescent psychotherapy of the VAKJP working group ( Memento from April 12, 2016 in the Internet Archive )
- ^ Günther Reich, Almuth Massing, Manfred Cierpa: Practice of psychoanalytic family and couple therapy. Kohlhammer, Stuttgart 2007
- ↑ cf. Otto Kernberg: Serious personality disorder: theory, diagnosis, treatment strategies. Klett-Cotta, Stuttgart 2015, 9th edition
- ↑ Lotte Hartmann Kottek: Gestalt therapy: textbook, Springer Heidelberg, 2012, p. 112f