Neutrality, interpretation, and therapeutic intent

The Portal: Framing and Neutrality in the Age of Virtual Treatment

The author proposes that the concept of framing activity provides a useful approach to neutrality by synthesizing relational approaches with an extension of José Bleger's (1967, 2012) conceptualization of the frame as containing primitive aspects of the analysand. She argues that the analytic frame also serves as a depository, or bulwark, for the analyst's ideological alignments. Identifying how ongoing framing activity is in tension with this bulwark affords a means of approaching, interrogating, and "doing" neutrality that elaborates the flexibility and self-reflection that contemporary psychoanalytic thinking seeks to bring to an earlier, more rigid idea of "the frame." Clinical vignettes focus on framing and its connection to neutrality in the context of remote treatments.

Neutrality in the field: alpha-function and the dreaming dyad in psychoanalytic process

Analysts have interpreted the concept of neutrality in a variety of ways, beginning with Strachey's use of that word to translate Freud's (1915) term, Indifferenz. In this paper, neutrality is linked to Freud's notions of free association and evenly suspended attention. A history of psychoanalytic attempts to clarify the concept are presented, with special attention to issues of ambiguity and the patient's role in the determination of neutrality. Neutrality is further elaborated in relation to the bipersonal field as described by the Barangers and contemporary field theorists. Understood in terms of the field, neutrality becomes a transpersonal concept, here conceived in terms of alpha-function and a dreaming dyad. Two clinical examples cast in the light of a Bionian perspective are discussed to suggest an alternative understanding of analytic impasses and their relation to alpha-function and neutrality.

What is medical ethics consultation?

What happens when the field of ethics consultation meets the hermeneutics of suspicion.

Suggestion and psychoanalytic technique

The role of the analyst's suggestive influence on the course and outcome of psychoanalytic treatment is explored, and traditional and newer perspectives on analytic technique are contrasted. The intersubjective critique of the neutral, objective analyst in relation to suggestion is examined. The inevitable presence and need for suggestive factors in analysis, and the relationship of suggestion to transference susceptibility, are emphasized. The manner in which the analysis of suggestive factors is subsumed in transference analysis as part of traditional technique is highlighted.

Future and potentiality in the psychoanalytic process

A perspective is delineated on the dimension of the future in the psychoanalytic situation. Clinical manifestations are presented of the tension between actuality and potentiality that characterizes the treatment situation. This tension, an aspect of the intersubjective field that exists between patient and analyst, involves the analyst's hopes, expectations, anticipations, sense of purpose, and therapeutic intent, facets of the analyst's subjectivity that affect the clinical process. The question of the patient's individuality and autonomy is raised in the context of the notion of the "true self." To understand potentiality in the clinical situation, it is argued, the intersubjective emphasis on the inevitable mutual influence between analyst and patient must be complemented by a view of the self as emerging from within and gaining coherence through the unfolding of inherent dispositions and potentialities.

Suggestion and veridicality in the reconstruction of sexual trauma, or can a bait of suggestion catch a carp of falsehood?

Freud used the term suggestion in psychoanalysis in different ways, including suggestion as an integral part of the transference and suggestion in the sense of undue influence or technical error. This distinction can be expressed in terms of the patient's suggestibility (capacity for transference) and the analyst's unwarranted suggestion or persuasion representing countertransference, theoretical bias, or a departure from technical neutrality. Whether suggestion is explicit or implicit, the effects of suggestion and suggestibility may be mutual and reciprocal. To the extent that a psychoanalyst maintains the goal of technical neutrality, undue suggestion is likely to be minimal. To the extent that it occurs for transferential or countertransferential reasons, suggestion may itself be analyzed. Problems of suggestion are more likely to occur and persist when they are part of the analyst's theoretical orientation, influencing the course of the analysis and expressing compromise formations for both patient and analyst. At times, even tentatively stated words or unintended behaviors of the analyst can have a dynamic impact that may not be readily analyzed. The analytic situation itself may have retrospective (nachträglich) action. A previously published case is described in which an apparent enactment led the analyst to urge a reconstruction of sexual abuse even though the patient never actually recalled what was presumed to have been fellatio. The need for technical neutrality and alternative reconstructions in such cases is considered. The degree to which the personality and goals of the analyst influence the course of reconstruction remains a vexing issue for psychoanalysis as a scientific endeavor. There is a need for detailed analytic case studies in which alternative reconstructions can be compared by investigating opportunities for external confirmation or falsification.

Interpretation and expectation: the anxiety of influence

Interpretations go beyond assigning unconscious meaning to analytic material. They inevitably communicate the analyst's assessments of the patient's present and past conflicts, and his expectations for their future resolution. The analyst's estimation of a patient's potential, as well as his personal investment in helping the patient realize that potential, is embedded in the interpretive process. Although careful analysis of unintended interpretive influences on a patient's transference and resistance is required to assure relative neutrality, there remains a residual conditioning effect of interpretations that catalyzes the analytic process and reinforces a patient's efforts to change.