Shirah Vollmer MD

The Musings of Dr. Vollmer

Neutrality, Abstinence and Anonymity: Analytic Triad

Posted by Dr. Vollmer on November 5, 2014

 

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.

 

 

2 Responses to “Neutrality, Abstinence and Anonymity: Analytic Triad”

  1. Shelly said

    After spending time with the therapist, the patient begins to have a dialogue in his mind, complete with what the therapist would say if the patient began to talk about a certain subject. So there, in effect, is already a break in neutrality as the patient screens what he is going to say from the onset. If the therapist is religious (revealed externally by the clothes he wears), the patient may not disclose certain actions or behaviors that might upset the therapist’s sensitivities. I also think that non-disclosure of any details of the therapist’s life makes for an odd and unfair balance in the therapist-patient dyad. While you claim that it is for the good of the patient so that the patient can focus on his issues and not have to take care of the therapist, it sometimes can make the patient feel uncomfortable and emphasize just how unnatural and unbalanced the relationship is.

    • Yes and yes. The idea is not to maintain neutrality at all times, but to be aware of how a non-neutral experience, such as clothes, can create inhibitions or expansion of ideas. You are right that patients who feel particularly uncomfortable with the asymmetry of the relationship often benefit from thoughtful disclosures on the part of therapist. The goal here is for the disclosures to create comfort, rather to promote more anxiety, and to combat many patient’s tendency to be the caretaker and not allow themselves personal exploration. Thanks.

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