Psychoanalysis has long distinguished between the transference neurosis and that part of the communication between therapist and patient which depends upon a relatively intact part of the patient's ego. It has been proposed that it is this capacity of the patient that sustains the difficult work of dealing with communications which are the consequence of transference, and which often threaten the viability of the treatment. This quality has been referred to variously as the unobjectionable positive transference, rational transference, mature transference, therapeutic alliance and working alliance. The ever broadening scope of Psychoanalysis, along with our greater knowledge of early childhood development, has enhanced our understanding of the many influences affecting the treatment alliances. Newer views of the transference, which stress the significance of the therapists' contributions to the therapeutic dyad, make it clear that the therapeutic alliance can no longer be explained as some simple, reality based, conflict free, motivating force. It involves, rather, a complex interaction of several factors, to each of which one must add the therapists' reciprocal reactions. Psychotherapy outcome research will need to take all of these factors into consideration.

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The psychodynamic pattern of acquiring psychotherapy skills can be viewed as one that exhibits regressive periods which tend towards one of two poles, ‘moving towards’, and ‘distancing’. A major block to learning, especially the learning of individual psychotherapy, is the resident's difficulties in the area of self-awareness. Pointing out psychodynamic patterns to him is essential, both to make him cognizant of the existence of the unconscious in the fullest sense and to allow the learning process to progress, possibly in a more adaptive way. Individual psychotherapy supervision is a major vehicle for such learning. Some guidelines for psychotherapy supervision are presented.

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