The therapeutic alliance is a vital component of not only the psychoanalytic relation but of all therapeutic encounters between psychotherapist and patient. Despite the universal application and realization of the alliance concept in therapeutic endeavors, it is often ignored as an operative concept in the therapeutic theoretical armamentarium or is formulated in alternative terms. It also comes into play implicitly, even when the concept is formally dismissed as irrelevant. This discussion addresses the meaning and variations of expression of the alliance in the clinical setting and focuses particularly on ways in which the alliance is actually formulated in alternate terms that usually address some partial aspect of the alliance without acknowledging its relevance or importance in the therapeutic relationship and interaction between therapist and patient. I conclude that even when its role in therapy is ignored, minimized, or denied, the alliance continues to play a vital role that requires therapeutic attention and processing in its own right. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
This is a review of psychosomatic literature which touches on the relationship between patterns of illness and aspects of family interaction. An attempt is made to reconstruct the links in the chain which lead from family patterns of interaction to the occurrence or intensification of physical illness in family members. The central construct proposed is that of the "family emotional system." The influence of emotional factors and certain types of critical events on the family system is traced in relation to the precipitation of both psychological and physiological patterns of disruption. The nature of the family system and its functioning are discussed and questions are raised in areas requiring further study and elucidation, particularly relating to the piocess of symptom distribution and specificity of illness.
This essay proposes replacing the traditional concept of narcissism as derived from the theory of drives with a concept of narcissism that is concerned with motives and their correlative meanings-specifically, motives connected to self-organization, self-preservation, self-cohesion, self-valuation, and self-esteem. The reasons for and the metapsychological underpinnings of a motivationally based theory are discussed. This revised motivational view proposes that narcissistic dynamics can be preserved and articulated in exclusively motivational terms. Developmental aspects are explored, including formation and functioning of the ego ideal and self-esteem regulation. Implications for psychoanalytic technique are suggested in discussions of case material.
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