The Problem of Neutrality: Some Reflections on the Psychoanalytic Attitude in the Treatment of Borderline and Psychotic Children

A recent paper by Etchegoyan entitled Fifty Years After the Mutative Interpretation discusses at length James Strachey's famous 1934 essay, The Nature of the Therapeutic Action of Psychoanalysis (1983). Etchegoyan agrees with Strachey that for the neurotic vicious circle to be broken, the patient's distorted inner imaginative world of maternal and paternal objects has eventually to be differentiated from the real world. This “real” world is represented by what Strachey calls “the auxiliary superego” of the analyst. The function of auxiliary superego is exercised by means of the analyst's neutral attitude, which ensures that he neither plays in with the patient's “bad” superego which is being projected on to him, nor with his “good” one.

Etchegoyan says that for the gradual differentiation to take place, two conditions must apply — one necessary, the other sufficient. The necessary condition is the analytical setting, defined as the neutral attitude of the analyst. The sufficient condition is the interpretation. He points out that the neutral setting is necessary for the patient's personality and inner world of objects to unfold, but in order for the next stage to take place — that of differentiation of the unfolding inner world from the external one — the analyst has at his disposal a singular instrument, interpretation. I myself think that when Freud talked about analytic neutrality he meant it to apply also to the interpretive work.

I wish to return to Strachey's description of the two phases of a mutative interpretation later, but for the moment I would suggest that psychoanalytic work with children, especially with psychotic and borderline children, puts most fiercely to the test this notion of analytic neutrality. I do not wish to attack the notion of neutrality but I would like to undertake an examination of its meaning. Although I would hope what I say is relevant also to neurotic children, the excessive demands and needs of borderlines do serve to highlight th