In order to give insight, many psychoanalysts would say, there needs to be neutrality, abstinence and relative anonymity. Neutrality is the value-neutral way of listening which means, as Freud would say, with an evenly hovering attention towards the id, ego and superego. This means there is not admiration or positive reinforcement for a particular behavior such that the patient feels free to express all the parts of his mental landscape and does not seek to get the analyst’s approval. Abstinence refers to not engaging in a dual, but rather listening and thinking. And relative anonymity refers to the analyst not disclosing personal information, such that the patient does not feel compelled to take care of the therapist. This trio of guideposts were intended to give the patient space to explore his mental life without intrusion. None of these guideposts precludes warmth and concern. “Disciplined flexibility” is what Fred Pine PhD says is necessary with these guideposts. We must understand them and adjust accordingly. With my patient who drives a new motorcycle and sees concern on my face as she tells me this, there is a break in neutrality, which inhibits further discussion about her motorcycle, but at the same time, there is an expansion of warmth and concern, which my patient appreciates greatly. This, so called “supportive” aspect of the work, is by some psychoanalysts, not responsible for therapeutic action, but for other psychoanalysts, this supportive aspect does create Therapeutic action because there is the development of a new, caring relationship, and within deep relationships there is an opportunity for psychic change.
Shirah Vollmer MD 