Loewald's "Positive neutrality" and the affirmative potential of psychoanalytic interventions

Patients who suffer from severe vulnerability in the narcissistic realm but who otherwise enjoy impressively intact ego functioning can sometimes be helped to endure the rigors of psychoanalysis in the early months of treatment by the analyst's emphasis on, or even exaggeration of, the affirmative elements in ordinary psychoanalytic interventions. Loewald's (1960) concept of "positive neutrality" is explored in an effort to determine an acceptable element of affirmation in the initial analytic stance taken toward these patients, and case material is offered to illustrate the application of these principles in the first fifteen months of psychoanalytic work with a high-functioning but narcissistically vulnerable man. It is thought that this stance, used judiciously, does not compromise the full emergence and analysis of the transference but rather enhances the process. To illustrate this progression, a session is presented from the thirtieth month in the treatment of the same analysand, when the affirmative emphasis had receded and more ordinary interpretive activity had begun to dominate the analytic interchange.