GETTING PERSONAL
The ethics of abstinence, neutrality, and candor
BY ELLEN PINSKYWhen I was in my late thirties or early forties, a few years before I started analytic training, some friends and I used to play a game that goes like this: Imagine you overhear someone talking about you, and they speak a single adjective that describes you. A single adjective. What adjective would give you the greatest pleasure to hear? One friend, I remember, chose “brilliant,” another chose “noble”; a third said “complex,” then switched to “deep,” toyed for a moment with “charming,” settling finally on “mysterious.”
Now let’s play the game again but change the players. You are to imagine you overhear someone—say, a colleague—talking about you as an analyst. They speak a single adjective to describe you. What would you like to hear? Trustworthy? Smart? Wise? Kindhearted? Tough-minded?
Not long ago, a colleague introduced me to an adjective I’d never considered: “personable.” He organized a panel to discuss the phrase “Personableness as a Function of Neutrality.” What does it mean to connect the quality of personableness to analytic neutrality? Something about how the analyst is to behave, or to appear. But the phrase suggests more than behavior and self-presentation: not only how the analyst should be but who the analyst is.
I remember how eager, excited, and sometimes overwhelmed my classmates and I felt as new candidates, now over twenty years ago, setting out to learn the craft. We were in our own analyses, full of wonder, tinged with anxiety (at least I was). The first one of us to have an analytic patient said, not long after the treatment began, that he’d taken his seat behind the couch with no idea of the voltage he’d experience. Voltage. As if there’s a shock, an unexpected force—something momentous, a power carrying danger. Our technical term for that force set in motion is the transference.
In class one evening later that first year, another classmate expressed a need for guidance: “We need more help,” she said, “knowing how to behave,” and she offered the following example: “Say, you’re out in the street, you’re walking the dog, or parking the car, and a patient comes toward you,” she said. “What do you do?” The teacher paused, then quietly replied, “Say hello.”
We laughed, understanding both the absurdity of the question and the underlying anxiety. But what’s the anxiety? What rule, or code of conduct, is the student analyst afraid she might break? My class then collaborated on a fantasy that the Education Committee would provide a booth in the common area where, behind a curtain, our own “Miss Psychoanalytic Manners” would sit. You could bring a coin, and in return for that token Miss Manners would answer any question about behavior appropriate to a psychoanalyst. We’d joke, imagining different answers depending on which of the senior eminences sat hidden there. I look back on that playfulness as one way to manage our anxiety.
Freud attempted early to evoke the analyst’s position and ethical responsibility in Papers on Technique, most incisively in “Observations on Transference-Love” (1915). There he addresses the young doctor, giving us terms that provide the foundation. The essay does not only lay down technical principles and ethical precepts: it teaches us that they are the same thing.
“Observations on Transference-Love” is Freud’s methodical argument, first, for what he calls “the fundamental principle of the treatment being carried out in abstinence”—the analyst says, “No,” tacitly setting up the forbidden: an absolute embedded in the restrictions of the setting. With abstinence comes the second, closely associated though distinct notion of neutrality. “Abstinence” refers to the analyst’s behavior, a judicious holding back that protects but at the same time heats things up: abstinence is alluring, it increases the appeal and force of the transference magnet, the human being who occupies the seat. And the second term, neutrality, refers to attitude—a benevolent receptivity not to be confused with coldness, or not caring. The two terms, a behavior and an attitude, can’t be separated. And together, abstinence and neutrality are forms of presence, not absence: a two-person humanity.
“Abstinence” refers to the analyst’s behavior, a judicious holding back that protects but at the same time heats things up: abstinence is alluring, it increases the appeal and force of the transference magnet, the human being who occupies the seat.
Illustration by Austin Hughes
With these two concepts, abstinence and neutrality, plus an essential third element—the patient’s pledge to candor—Freud gives us psychoanalytic treatment. Everything follows from that spacious, flexible, three-part basis.
There is an institutional pull toward automatic formulation: a tendency to codify basic ideas into doctrine or a rulebook. There is also an equal and opposite tendency to dismantle the constructed doctrine. The slide into codification fosters a slide into equally glib debunking. In contrast, actual understanding of the principles indicated by Freud’s words is more difficult and more important. Understanding does not follow from organizational rules or codes; rather, it is the responsibility of each individual person. To put it another way, character underlies ethics.
Which returns me to that adjective: “personable.” Some more history, this from the Oxford English Dictionary on the word. Well into the twentieth century, we’re told, “personable” referred mostly to the physical, or external. Here I quote an OED source from almost five hundred years ago, 1541: “One woman . . . hath many childern, of them some be fayre and personable, some ylle-favoured and croked.” Or, two hundred years later, in 1731, here’s Jonathan Swift: “My Master is a parsonable Man, and not a spindle-shank’d hoddy doddy.” Two hundred years pass, and in 1953, here’s the word having to do with more than the external or appearance: “Sir George Sitwell . . . emerges, if not the hero of the memoirs, a very personable and likeable figure.” Pleasing now in manner—affable. And a few years ago, from the Boston Globe’s sports pages, broadcaster Joe Castiglione opined about
our world- champion Red Sox: “I think it’s actually the best group we’ve ever had in terms of not just ability, but how personable they are.” With the changing definition, there’s a shift from outside (the surface) to inside (the attitude, or character). By the old definition, “personable” male analysts would have been handsome, carefully groomed, and well-dressed—no spindle-shanked hoddy doddies, but young men in nice suits.
We’ve seen a shift from the cartoonish caricature of the heyday’s silent uninvolved doctor to the deeply involved, sometimes over-involved, analyst of today. Some might suggest that too much focus on the analyst’s internal states may overshadow or even erase the patient’s experience, today’s more engaged analyst the obverse of the coolly detached figure who is unresponsive to the point of disappearing. While the growth of a counter-transference literature appreciates the magnitude of that reciprocal force, we can also get stuck in our own vocabulary, at times become almost formulaic: for an example, “Is it a one-person or a two-person psychology?”
Primary questions remain: What kind of person should or can the therapist be? What is due to the patient as a person? I began by suggesting that my friend’s phrase—“Personableness as a Function of Neutrality”—was asking not only how the analyst is to be but who the analyst is. The answer is inside the adjective itself: The analyst is a “person” and “able”—able to become a person. Also, “able” as a person to enable the other as a person: in a professional setting, someone with the capacity to be a person for the other. The patient too must be person-“able,” that is, must become a person for the analyst—not merely the idealized, or demonized, object of a transference fantasy from either side of the couch. Two individuals, two persons, and what passes between the two: in that movement is the therapeutic action.
I think of Hans Loewald’s 1960 “Therapeutic Action” paper: Not only does the analytic attitude include physical and social posture (“outside” and “inside”), but it requires, he writes, “an objectivity and neutrality the essence of which is love and respect for the individual and individual development.” The analyst has to be able to envision the other as a developing separate person. “In sculpturing,” Loewald writes, “the figure to be created comes into being by taking something away from the material.” And he continues: “In analysis, we bring about the true form by taking away the neurotic distortions. However, as in sculpture, we must have, if only in rudiments, an image of that which needs to be brought into its own.”
The analyst holds in safe-keeping the image of the person’s potential—his or her “person-hood.” The activity is a nonintrusive lifting-away; tact is involved: how much to direct, how much to hold back. The other is a person, and to experience that truth, to become “able” to perceive it, is a process that entails a reciprocal presence as a person, and not as a thing or an ideal or a set of abstract categories. The analyst’s offering is in this view an active mirroring: a human transaction, between persons.
I could spin forever in playing the adjective game. Here’s another way to play. This time, imagine you overhear not a colleague but instead a patient talking about you. What would you most wish to hear the patient say about you? And then turn it around: What would you least like to hear the patient say? Most, and then least.
Enjoy the game. ■
Ellen Pinsky is the author of Death and Fallibility in the Psychoanalytic Encounter: Mortal Gifts (Routledge, 2017). She came to psychoanalysis as a second profession following twenty-five years as a middle school English teacher. She is on the faculty at the Boston Psychoanalytic Society and Institute.
Published in issue 57.3, Fall/Winter 2023