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Addressing the important issue of analytic neutrality currently being debated in many psychoanalytic forums, Winarick focused his thoughtful presentation on the analyst's expectations as they affect treatment and life goals, and in so doing, examined both the inevitability and necessity of therapeutic aspirations. He stressed overall the importance of both therapeutic receptivity to the frequency of these expectations and caution lest they undermine the intrapsychic thrust of analysis and threaten patient autonomy.
Winarick anchored his thoughts in history and noted that the idea of neutrality was implicit in Freud's admonition to physicians about the perils of therapeutic influence and aims for the patient. Referring to theorists such as Greenson, Kernberg, and Stone, he discussed the many attempts to soften the concept of neutrality, but commented that even these do not focus on some of the inherent problems, and cannot resolve the impasse between neutrality and therapeutic aim on the one hand, and differing goals between patient and analyst on the other. Furthermore, he stated, therapeutic expectations have been historically linked with interpretations based on uncovering future potential, and these, according to theorists such as Horney and Ticho, constitute one of the main goals of psychoanalysis.
How can the therapist proceed in light of the seeming inevitability, even the necessity, of expectations and the difficulty in maintaining an ideal neutrality? How can psychoanalysis be practiced so that the patient's real wishes and judgments can emerge? Winarick posed these questions, noting that psychoanalysis is now in a quandary since Freud's warning about the dangers of therapeutic influence is still valid. Rejecting the idea of replacing intrapsychic models with relational and self-disclosure models, Winarick stressed the importance of focusing on theory and clinical observation to inform treatment goals, with consequent emphasis on multiple determinants of confl