Philosophy and Therapy of Existence. Perspectives in Existential Analysis by Anders Draeby Soerensen - HTML preview

A Problematization of Therapeutic Neutrality

Introduction

The therapeutic relationship between therapist and client is a crucial element in psychotherapy. An investigation conducted by Orlinsky and Howard in 1986 even concluded that the primary factor in successful therapy is the relationship that therapists form with their clients (Orlinsky (1986)). Thus, the constituent process of the clinical situation is a certain kind of interpersonal activity between two human subjects. In this article, I will try to accentuate psychotherapy as a dialectic relation, established between two subjects. I will do this in order to problematize Sigmund Freud’s traditional psychoanalytic conception of the analyst as a neutral field. The main purpose is to discuss how far it actually might be rewarding to take into consideration a conception of analyst subjectivity, how such a conception may work in therapeutic practice, and whether an orientation towards analyst subjectivity has any negative sides. In order to make this discussion, I will draw on insights from relational psychoanalyst Stephen Mitchell and existential psychotherapist Ernesto Spinelli, and see whether their criticisms of the neutral stance have any similarities.

Sigmund Freud: The analyst as a blank screen

Freud invented the most traditional conception of psychotherapy. Fundamentally, he understood the human personality as a biologically drive-based system of psychic energy, shaped by childhood experiences. Freud called attention to the presence of unconscious processes, conflicts and defence-mechanisms beyond individual behaviour. Neurotic disorders in adults were considered to be the effect of repressed and split off sexual conflicts in childhood, and the therapeutic aim of the psychoanalyst was to assist the client in making these unconscious conflicts conscious, reintegrating his or her personality. In the clinical situation, the client approached the therapist according to patterns from his or her childhood, making transferences of past feelings and attitudes. In return, the therapist should act according to a principle of neutrality as a blank screen for the projection of the client’s feelings and attitudes in order to throw light on his or her way of approaching relationships.

The doctor should be opaque to his patients and, like a mirror, should show them nothing but what is shown to them (Freud 2001: 118)

This means, that the practice of psychoanalysis involves an asymmetrical relationship, where the client is supposed to reveal his or her subjectivity as a decentered subject to the therapist, being a transference object or “sterile field” (Rachman (2004)). Freud acknowledged that the therapist might experience emotional reactions towards the client’s transference, accounted for as counter-transference. However, the trained therapist should work on keeping a neutral stance and not reveal any personal information. Thus, the analyst’s emotional state must always be one of objectivity and neutrality. The double question is (1) whether it is actually possible at all for a therapist to eliminate him- or herself as a real person in the clinical situation, and (2) whether such an ambition might not also “preclude an empathic, authentic and warm attitude” towards the client and thereby reduce therapeutic effectiveness (Lemma (2007), 45). I will try to outline two alternative approaches that accept a notion of analytic subjectivity: a relational psychoanalytic approach and an existential psychotherapeutic approach.

Stephen Mitchell: Intersubjectivity in the therapeutic relationship

Mitchell confronts the traditional conception of psychoanalysis by articulating a paradigm shift from drive theory to relational psychoanalysis. According to Mitchell, mental problems are due to disorders in our interpersonal relationships rather than caused by repressed drives. Therefore, he introduces a relational model, integrating of insights from object- relations-theory, attachment theory, interpersonal theory and self-psychology. According to this model, not drives but relationships with other people are basic to our mental life and personal development. Thus, our mind is “fundamentally dyadic and interactive” (Mitchell 1988: 3) and all psychodynamic phenomena are conceived from:

a multifaceted relational matrix which takes into account self-organization, attachment to others (“objects”), interpersonal transactions, and the active role of the analysand in the continual re-creation of his subjective world [and] which encompasses both intrapsychic and interpersonal realms (8-9)

The human self is relational by design. We are connected and constructed as subjective and individual human beings through ongoing inter-subjectivity.

One cannot become a human being in the abstract […] Embeddedness is endemic to human experience – I become the person I am in interaction with others. The way I feel it necessary to be with them is the person I take myself to be (275-6)

We are pursuing and maintaining relatedness. Psychopathology involves a failure to relate and grow, rooted in certain conflictual interactional patterns in our relational world. We internalize such patterns at an early stage in life, re-experiencing them in adulthood (148). Furthermore, we are not just passive victims of experience. We are also active creators and perpetuators of our conflictual relational configurations (172).

Mitchell describes this as a position in between psychoanalytic determinism and radical existentialism. The aim of therapy is to give the client