Adverse reaction of the apparently healthy partner in response to improvement in the overtly dysfunctional partner.

The increase in the number of couples and individuals seeking sex therapy is yielding an increase in the variety as well as number of therapeutic complications. We wish to discuss briefly one complication: the development of emotional and sexual disability in the seemingly healthy member of a couple in treatment as the dysfunctional partner "gets well." The disruption is serious enough to require separate treatment. Our experience with this phenomenon underscores the importance of flexibility on the part of the therapist since it may be necessary to institute individual therapy to avoid overwhelming the new decompensating partner. Examples are provided, and recommendations for management offered.

Countertransference as a factor in premature termination of apparently successful cases.

In brief sex therapy rapid disappearance of symptoms may appear to signal success. However, superficial indications of success may be utilized by the sex therapist as an opportunity to escape from a therapeutic situation which evokes uncomfortable feelings. The need to terminate treatment abruptly may be conscious or unconscious. This presentation discusses a few of the multiple factors which may lead the therapist to initiate premature termination or to collude with the patient's problems rather than the patients' to alert clinicians to the adverse effects of countertransference.

Technical considerations of the therapeutic and working alliances.

A brief survey of the development of the idea of the analytic pact and its relationship to the concepts of the therapeutic and working alliances has been presented. I have suggested that the therapeutic alliance be defined as the full-scale therapeutic rapport which includes all the the elements favorable to the progress of therapy. This includes such factors as the patient's motivation for treatment based on ego-alien symptoms, positive transference, and the rational relationship between patient and therapist. I have considered the working alliance as more limited in scope and suggested that it be considered as referring to the healthier interpersonal interchange between the analyst and patient. In general, the relationship is in part dependent on the maturer portion of the patient's ego and is related to the reality relationship. I have ascribed the working alliance to the appropriate maturation of many of the ego's functions. It should be noted that the working alliance is actually one of the factors contributing to a good therapeutic alliance. Case reports have illustrated these considerations and amplified the discussion of the alliances, with emphasis on their technical management. These points are pertinent to the general conduct of therapy and the timing of interpretations. Care directed to the building of good alliances can be of great importance in creating a milieu conducive to therapeutic progress. Identification and its role in the development of the working alliance, and the special place of affection for the analyst were discussed and the differences between transference affection and the affection based on the realities between patient and therapist were related to the effects of interpretation.