Searching for a Passionate Neutrality

Everything about her announced her reluctance to leave childhood behind. Her thin, insubstantial body, her waiflike stare and stubborn pout made this young woman seem early adolescent. With little emotion she described more than a decade of internal warfare over eating enough to live. The struggle with her eating disorder had already taken her life, in that there was room for little else. I found myself immediately, deeply concerned. Every fiber of me wanted to wrestle with the self-destructive forces in her. I wanted the vibrant young woman I saw as her potential to emerge.

For me this is not an unusual clinical moment, although perhaps more vivid than most. I often feel, even with patients who would be considered more traditionally analytic, that treatment involves me in a life-and-death struggle. Fromm (1973) might describe it as the pitting of biophilic, or life-loving, forces against the necrophilic, death-loving pull. A central challenge for the analyst, I believe, is how to integrate her countertransferential responses to this struggle with an appropriately neutral analytic stance.

What follows is an attempt to delineate some of the difficulties neutrality poses. First, I ask how the analyst can express her concern for the quality of the patient's current life, and still retain the benefits of analytic neutrality. How can I actively encourage growth, but still facilitate the patient's exploration of her self-destructive, regressive, self-limiting urges? Next, I focus on the analyst's use of his passion as a tool in the treatment. Finally, after a note on the difficulties in training analysts to integrate concern and passion into their work, I describe passionate neutrality, and how it may be achieved.

I assume that all analysts hope their patients will develop fuller, richer lives, although they may or may not label this a goal of the treatment. Where