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Therapeutic alliance in the field of perinatal depression constitutes a major prevention problem (Chabrol et coll., 2003). The clinical pilot study of two cases presented here includes a double aim: a) to approach some determinants involved during the first phase of therapeutic alliance: therapeutic adherence or refusal. The authors compare, by the way of a clinical multivariate method (interview, clinical scales, Rorschach test), the psychological outcome of two pregnant depressive women, followed until a two months postnatal period, with two evaluations, one at the beginning (5th-6th month) of pregnancy, and the other at the end of the following (2nd month in postnatal). One of these women has accepted the therapeutic engagement, the other has refused it; b) to demonstrate that to prove a change during the psychotherapic process is possible within a psychoanalytic model. Results show opposite evolutions. Therapeutic adherence’s refusal seems to be related to a masochistic personality’s organization, while therapeutic adherence appears with a woman having a nevrotic personality’s organization.