Magazine article Clinical Psychiatry News

The Importance of Neutrality

Magazine article Clinical Psychiatry News

The Importance of Neutrality

Article excerpt

Often patients try to engage their psychotherapists in discussions about politics or other matters that are personal. Is neutrality possible in psychotherapy in the face of hot political issues?

Listen for Underlying Theme

The kind of neutrality that puts the patient first is always possible. When a patient raises a hot political issue, often there is an expression of meaning that parallels a theme within his or her own personal life. The psychiatrist does well to listen, allowing space for content that allows the patient to fully express material that could reveal more than the surface political issue.

Despite "hot" political issues, the underlying intrapsychic theme is the actual "hot" content for the psychiatrist. What the patient expresses about the political issue may reveal conflictual dynamics of significant thrust at this point in the patient's life. By listening attentively, the therapist has a chance to gain an understanding that reaches beyond the immediate issue of conscious expression.

Notably, a free society embraces the well-being of the individual, and expressive psychotherapies are best used within such political settings. When a patient yearns for society to take care of people at the expense of liberty, perhaps we see an expression of hopelessness and dependency that requires tolerance, but not enabling, before self-agency can be achieved.

Carol Lidstrom, M.D.

Littleton, N.H.

What's Relevant to the Patient?

Neutrality is a word that can have several shades of meaning among psychotherapists. I am taking it as related to, but distinct from, the concept of anonymity. If neutrality signifies a particular stance, one that involves the conviction that trying to understand the patient is of primary importance, then it becomes clear that it is possible for a therapist to have strong feelings about a given topic and still be relatively neutral in terms of recognizing that only certain types of judgments about patients' actions and beliefs are relevant to the work being done in therapy.

I have found it distracting, at times, for patients to express opinions that clash with mine. A more subtle challenge comes from patients who voice ideas that strike me as especially astute: I suspect that material deserving of analysis could be embedded in such comments and go unrecognized. In both types of situations, it is important to focus on the wealth of possible messages below the surface. To pursue a line of thought involving agreement or disagreement over political or other hot issues, even if I were to maintain anonymity, would not be helpful to the patient.

Julia Danek, M.D.

Chapel Hill, N.C.

Explore the Patient's Motivation

Absolute neutrality is never a possibility for the psychotherapist since he or she will have opinions and values as a participant in the social and cultural milieu in which we all live. The therapist's values and opinions are part of the inevitable subjectivity of all therapists and may be expressed in a variety of indirect ways that the patient (sensitized and influenced by the current transference relationship) can observe, if only subliminally.

It is important and therapeutically useful to explore the patient's motivation in overtly raising the question of the therapist's opinion on a given topic. Is it part of the presenting problem? Is it the patient avoiding other important issues? Is the patient seeking support for an important decision? Is there an oppositional need in seeking the therapist's opinion? Is there a transference anticipation of rejection should the therapist's values be contrary to the patient's? There are many possibilities in such a clinical situation. The decision of whether or not to answer the question directly will depend on the strategy and kind of treatment being used, the nature of the previous therapy relationship, and the therapist's judgment of the effect on the treatment of whichever course is chosen. …

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