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Therapy

A New Therapeutic Neutrality

Neutrality has gotten a bad rap.

Key points

  • Traditional neutrality is problematic in therapy.
  • Neutrality needs to be remade to encourage emotional intimacy and exploration.
  • Neutrality is necessary to prevent therapy from becoming corrupt: telling patients how to live and what to do.
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It's en vogue to say that therapists should give up on trying to be neutral. Neutrality is sterile, medical, and antithetical to human relationships.

Critics also say neutrality is hypocritically self-defeating because its advocates themselves take a non-neutral stance that we should be neutral. All they do is live in denial about the non-neutral perspectives they bring.

What Is Neutrality?

The concept of neutrality started with Freud's idea that the therapist should remain neutral concerning a patient's inner conflicts, e.g., between superego and id, so that those conflicts can be fully explored and conscious in the transference, i.e., how the patient projects feelings onto the therapist.

Over time, it came to mean that the therapist shouldn't tell the patient what to do or direct the patient to talk about this or that because the goal of therapy is to create a space for the patient to express things that they might otherwise never say, think, or feel, remaining forever unconscious.

Eventually, it became synonymous, particularly in the minds of critics, with the idea that the therapist should be emotionally blank or even wholly analytical.

There is no doubt that therapists must be authentic and connected and have natural emotional reactions to the patient for a psychotherapy relationship that leads to real change and growth. So, if neutrality means "be cold and aloof," we shouldn't be neutral.

But that doesn't mean we should give up on the principle of neutrality altogether. Instead, it shows that neutrality needs to be remade to encourage emotional intimacy.

Therapeutic Intimacy and Exploration Requires Neutrality

When a patient is intruded upon by what the therapist wants, feels, or says, that makes it more likely that the patient will feel that they need to manage the therapist. This managing activity requires the patient to activate her defense mechanisms and enact old patterns instead of bringing up new thoughts and feelings.

Therefore, these impingements make it harder to create a genuinely different relationship than all the other relationships where the patient has to manage people.

We need a new neutrality that recognizes that emotions, ideas, and suggestions from the therapist tend to impinge on the patient's capacity to think, feel, and explore anything with the patient. That exploration is necessary to create a relationship that breaks old patterns and gives the patient the experience of being fully received instead of pushed and prodded by the gusts of another person's thoughts and feelings.

I think the key to implementing a new neutrality, warm and relational neutrality, is to be as humble as possible and to avoid didactic lessons, techniques, and interventions in which one takes on the role of teacher, coach, or giver of wisdom. If the therapist can get the patient to feel in their bones that the therapist doesn't think they know what's best for the patient or what's going on in them better than they do, ideas and feelings coming from the therapist don't have to be conformed to or rejected.

Instead, they can be possibilities, material that helps the patient reflect further on themselves. In psychoanalytic terms, the new neutrality requires what the psychoanalyst Wifrid Bion, following John Keats, called "negative capability," the ability not to know, to not search after knowing, but to tolerate multiple possible ideas all at once.

The Ethical Need for Neutrality

When we give up on neutrality, we also risk corrupting therapy, making ourselves more like self-help gurus who know how patients should live, didactically teaching them how they should respond, feeling happy for them when they succeed, and frustrated when they fail. I think you see some manifestation of this in therapists becoming online influencers who teach self-help-like lessons in sessions.

Refocusing on the importance of neutrality might help restore therapy to something that helps patients become more themselves instead of what the therapists want them to be.

References

Grotstein, James S.. A Beam of Intense Darkness : Wilfred Bion's Legacy to Psychoanalysis, Taylor & Francis Group, 2007. ProQuest Ebook Central, https://ebookcentral.proquest.com/lib/sfsu/detail.action?docID=689887.

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