Anne Alonso’s Thoughts on Neutrality

I was recently reading a paper by the psychoanalyst and group therapy teacher, Anne Alonso, about therapeutic neutrality that I think complements some of the ideas I have been playing with in recent posts related to ambiguity and relationality.  Alonso’s paper is from the early ‘90s, a period when I think folks in the analytic community were still trying to make sense of this “relational turn” that had been happening for some time before being formalized by Mitchell and his many acolytes.  As such, it does some interesting things in comparing drive theory to relational theories, evaluating differences in what “neutrality” means depending on one’s theoretical lens, and how neutrality contributes to whatever it is we might mean by “curing” someone through a therapeutic process.  In the interest of playing with some of these ideas, I’d like to take a further look at some of Alonso’s arguments and see if we can weave in how they intersect with the idea of ambiguity as it applies to the clinical encounter.

It almost seems strange some 30 years beyond Alonso’s paper, and a century removed from Freud’s original writing, to even try to tackle some of the concerns related to the move from drive theory to relational-structural theories of psychoanalytic process.  Freud’s writing is still worthy of review given the density of theoretical insights and the kernels of even some of the more complex and contemporary ideas related to the analytic process that can be found scattered throughout his work.  In fact, reviewing his work recently only highlighted for me the important relationship Freud saw between ambivalence, grief, and paradox in the psychoanalytic process, which to me remain some of the central factors we contend with in doing the work of psychotherapy.

But the idea that human behavior ought to be interpreted almost exclusively through a lens of unconscious repressed drives largely reducible to feelings attributable to sex and aggression would seem almost laughable if it hadn’t had such a pronounced theoretical stronghold on analytic thought for the first half-century or so of the practice of psychoanalysis.  (As a sort of footnote, there is something interesting in this about the way in which it took Freud several decades of his own writing to even introduce concepts related to internalized objects and representations of the self and the parallels to the development of competing school of psychoanalytic theory and the several decades it took to challenge the inertia of the collective intelligence of analytic thinking on the macro scale and bring about approaches related to object-relations and self-psychology as viable schools of analytic thought, though I think this is little more than a curiosity and likely not worth much further consideration.)

Alonso looks at the distinction between these two and traces a line between the theoretical basis of how relationship is understood, what an analytic “cure” might look like, and how this impacts a sense of neutrality.  In the drive model, the relationship is often described as a “one-person” psychology, where the therapist/analyst is tasked with the responsibility of being a blank slate who does not consider their participation in the analysis of transference data.  The therapist/analyst, in sitting often out of view of the client and saying little, offers interpretations of the clinical data which seems to signal how the client’s repressed urges are shaping their approach to therapy and the kind of material that arises through the process of free association.

Relational work is more a “two-person” psychology, where the therapist recognizes their participation in the therapeutic process, and interpretations are offered from the position of participant-observer.  In this model, the approach is less about a distant interpretation of the material, but rather strives to give the client new relational experiences which help the client’s “partial object representations”—forged through their understanding of formative relationships from their past—restructure themselves and strive towards more coherence.  This often requires some level of transparency from the therapist about how they are experiencing the client or how they see themselves structuring some aspect of the relational dynamic unfolding.

As such, psychoanalytic cure shifts from something having to do with the frustration of repressed elements that are projected onto the analyst and a unilateral interpretation a about what this may mean regarding the client’s psychological defenses, to an interpretation of transference-countertransference dynamics, with careful consideration given to what the analyst is feeling and what that might mean in terms of what is playing out between client and therapist.  The latter may mean alternately frustrating or satisfying repressed needs depending on certain considerations by the therapist.

We can already start to see how different definitions of neutrality are beginning to take shape.  For the classical analysts, neutrality is about striving for the complete removal of the therapist’s own experience from the therapeutic encounter.  Neutrality is meant to signal attempts at having neutralized any sense of the therapist’s unique character, personality, or how their own relationship to what is going on may be informing what is going on.  It is a take on objectivity that assumes the analyst can be completely objective about their assessment of what is going on within the analysand, so long as appropriate analytic distance is maintained.  The relational paradigm shrinks that analytic distance and sees the kind of distance needed for being completely objective in one’s assessment, without any influence from the analysts own repressed or intrapsychic material, as something of an absurd aspiration.  Neutrality in this instance becomes less about the elimination of interpretations contaminated by the analyst’s own material.  The goal is for the analyst to be thoughtful enough about the material they are bringing in, that they are able to be curious about it and take it up as an object of inquiry within the analysis or therapeutic encounter itself.  The therapist does not try to neutralize through distance.  They try to observe their experience with a certain amount of equanimity and then come to careful consideration of what, how, and when to share about that experience with the client.

Hopefully there is some sense developing of how these different relationships to neutrality serve to cast the idea of ambiguity in a different light.  In the classical model, the analyst’s relationship to ambiguity is “resolved” by encouraging a clinical distance which allows for the neutral analysis of transference data.  Ambiguity is a clinical tool that needs to be amplified for the analysand to generate the optimal frustration that allows for the classical notion of the transference neurosis to emerge.  In this way, ambiguity and ambivalence are somewhat resolved through the process of interpretation of that transference neuorsis.  Taken to the other extreme, ambiguity serves a different function for relational-structural approaches.  In the relational model, the therapist’s experience is part of the ambiguity that emerges in the clinical encounter.  Our active participation in the therapy contributes to the ambiguity of the interaction.  Ambiguity is treated as a different kind of clinical tool, as it is most likely to be spoken to in a manner which asks both therapist and client to contend with their own sense of what that ambiguity is disclosing about various aspects of their interaction.  Relational approaches do not seek to resolve ambiguity, but aim, rather, to highlight the inevitability of ambiguity in the context of genuine contact with another human being.  The goal is not insight in the more classical sense where making the repressed conscious alleviates the symptom.  Insight in this model strives to create a context in which the analysand can learn to better tolerate misattunement, miscommunication, failures in empathic understanding, and so on.  A more sincere and welcoming attitude and relationship with ambiguity is the goal.

In a way, as someone who works largely from the relational frame, I sometimes think the point of therapy, whether we are doing this deliberately or not, is to unwittingly turn our clients into good relational therapists.  All psychopathology is to some extent socially determined.  If there were not some perception on their part that there were relational elements to what has them feeling unable to cope with the misadventures of their daily lives, they would not be seeking a relationship to resolve them.  They are already, the moment they show up and decide to do the work, embracing something about vulnerability before the ambiguity of change required to reestablish agency and authentic engagement as relevant principles by which to organize their life.  By being expressive about ways we can bring transparency about our thoughts and feelings into a relationship, grounded in a neutrality spurred by genuine curiosity about our role as participant in the active process between ourself and another as it is happening, we show them someway of daring to bring that to relationships in their lives outside of the consulting room.  Furthermore, in being cognizant about how and when we choose to share those experiences, we can also perhaps gift them some understanding about timing and the ability to tolerate an ambiguity that does not always need to seek its immediate expression and resolution, and perhaps might not ever need to seek resolution at all.