ABSTRACT
All talking therapies profit from a patient’s deliberate work in treatment, for a number of reasons, each of which deserves separate study and reflection. This is as true for psychoanalysis as for other psychotherapies. But in psychoanalysis the idea of a patient’s deliberate work is paradoxical and problematic, bringing special overt and covert benefits, but also risking countertransference hazards like those associated with the notion of therapeutic alliance. Many analysts today use the implicit idea of a patient’s proper, deliberate work as a contrast in defining an enactment, and the idea of this proper work serves both parties as an image of aspiration when they are trying to climb out of an enactment. As always in these matters, that sort of usefulness carries the hazard of unrealistic and unpsychoanalytic expectations.
