The Therapist’s Experience of the Rising Unconscious Therapeutic Alliance in the Patient: The UTA Mental State

Traditionally, the rise of the patient’s unconscious therapeutic alliance (UTA) has been described in observable, objective terms in the Intensive Short-Term Dynamic Psychotherapy (ISTDP) literature. The therapist’s subjective experiences of when the UTA rises in the patient, on the other hand, has received little attention. In this paper, the author introduces a first-person account of a subjective phenomenon she experiences as a therapist when the UTA rises in the patient, which will be referred to as the UTA mental state. By defining and describing this phenomenon, the author aims to: a) invite further reflection and development of the concept in the wider clinician community, and b) suggest how the concept may provide an additional data point in the therapist’s clinical decision making. To this end, an historical consideration of the UTA in the ISTDP literature is first presented. Next, a phenomenological description of the proposed UTA mental state concept is provided. Three clinical vignettes are then presented to illustrate the phenomenon, with potential benefits to clinical decision-making discussed, and consideration given to resistance against the UTA in both the therapist and patient. The paper concludes with a discussion of conceptual and practical strengths and limitations of this concept.