Journal of Psychotherapy Integration © 2017 American Psychological Association

2017, Vol. 27, No. 3, 359 –364 1053-0479/17/$12.00 http://dx.doi.org/10.1037/int0000098

REPLY

Understandings and Misunderstandings About Neutrality in an

Empathic Context: Reply to Wachtel (2017) and Goldman (2017)

Charles J. Gelso Katri M. Kanninen

University of Maryland University of Åbo Akademi
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
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Paul Wachtel (2017) and Rhonda Goldman (2017) have provided thoughtful critiques of
our concept of the importance of therapist neutrality within an empathic context. Although
there are many points of agreement, our reply highlights our disagreements with these
reactions. When accompanied by flexible guidelines, not conflated with uncaring indiffer-
ence, and offered in a context of what we term an empathic atmosphere, neutrality is a
highly effective therapeutic stance. In contrast to Wachtel, we conclude that the therapist
can indeed get far in neutral, so long as it is a benevolent neutrality that is marked by
therapist empathy, caring, and affirmation.

Keywords: neutrality, empathic atmosphere, neutrality guidelines

When it was decided that our paper on neu-
trality (Gelso & Kanninen, 2017) would be a
good choice for reactions, Jennifer Callahan, as
editors often do, invited us to provide names of
possible reactors. Our top choices were Paul
Wachtel and Rhonda Goldman. For one, each is
an extraordinary clinical theoretician who has
written extensively about the therapeutic rela-
tionship. Second, we knew that these scholar/
clinicians would have some very different views
on neutrality than we did, which would give the
reader a good picture of the range of views on
this subject matter. We were not disappointed.
The views of Wachtel (2017) and Goldman
(2017) are thoughtful, clinically rich, and finely
textured. For the most part, they are even-
handed, while also taking us to task on many
points. Their views deserve to be read carefully
and thoughtfully.
Charles J. Gelso, Department of Psychology, University
of Maryland; Katri M. Kanninen, Department of Psychol-
ogy, University of Åbo Akademi.
We thank Ms. Kathryn Kline for her comments on an
earlier version of this reply.
Correspondence concerning this article should be ad-
dressed to Charles J. Gelso, Department of Psychology,
University of Maryland, North Campus Drive, College Park
MD 20742-4411. E-mail: gelso@umd.edu
359
There are many points on which Wachtel and
Goldman are in agreement with us. However,
because we think it is a good idea that reaction
papers be briefer than the papers to which they
react, and replies be briefer than those reaction
papers, we shall focus our reply on points of
disagreement. As we do this, we ask the reader
to hold in mind our overall appreciation of the
ideas offered by Wachtel and Goldman.
General Considerations
One general consideration that we believe
deserves attention is that, in our view, both
reactions at certain points seemed to place us
into boxes more appropriate for the very posi-
tions on neutrality with which we argued
against. Goldman (2017), for example, believes
that we advocate abstaining from warmth. At
several points, Wachtel (2017) chides us for
positions that we have not taken. He asks why
we have committed to retaining a concept (neu-
trality) that has developed so much unfavorable
baggage over the years. His answer (p. 343) is
that we believe “the pendulum has swung too
far, that contemporary practice has become an
‘anything goes’ (p. 343) mélange of self-
indulgence, manipulation, ‘manufactured’ af-
fect, and at times even seduction (p. 343) of the
patient.” This is indeed a colorful portrayal of
 360 GELSO AND KANNINEN
our views. The problem is that it is not an
accurate one. In general, Wachtel has a ten-
dency to portray our views in a much more
inflexible way than we intended. We do indeed
have guidelines, and we do view our conception
of neutrality as the baseline for effective psy-
chotherapy (that is psychodynamic, experien-
tial, or integrative) when the goal is patient
self-understanding, awareness, and insight, but
throughout we have emphasized that our guide-
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lines should be applied flexibly, with a deep
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attention to the individual patient’s needs and
the patient’s level of development.
Although Goldman (2017) is much less prone
to overstate our positions or attribute to us
views that we do not hold, she does puzzle us
with her conclusion that “empathy is a much
more relational process that is allowed by gen-
uineness, presence, and unconditional positive
regard. The relational conditions together, allow
empathy to be conveyed. Neutrality as de-
scribed by Gelso and Kanninen (2017) though,
seems to run counter to imaginatively entering
the world of the other and becoming thoroughly
at home in it” (p. 356). To begin with, when
Goldman (2017) says that empathy is a more
relational process, it is not clear what it is more
than. Is it more relational than our view of
neutrality? Or is it more relational than our view
of the empathic atmosphere we describe as es-
sential to effective therapy? More important, we
cannot see how neutrality as we describe it runs
counter to “imaginatively entering the world of
the other and becoming thoroughly at home in
it.” Indeed, the empathic atmosphere that we
have advocated, marked by deep empathy, car-
ing, and affirmation, fosters the very process
Goldman seeks. And there is nothing about our
conception of neutrality that suggests therapeu-
tic distance.
It seems to us that the reactors had a tendency
to focus more on our five guidelines regarding
effective neutrality than on the empathic atmo-
sphere, and we even wondered if rearranging
our presentation would have helped to highlight
just how deeply important we believe the em-
pathic atmosphere to be. As relationally ori-
ented therapists, empathy, caring, and affirming
are, in our view, the foundation of any thera-
peutic relationship. Empathy indeed involves
being deeply attuned to the inner workings of
the patient, including some feelings that are not
in the patient’s awareness. To use Goldman’s
(2017) words, it does entail the therapist being
“thoroughly at home” in this inner world, and,
like Goldman, we add that this world cannot
always be a comfortable place and at times can
be upsetting, frightening, and painful. Some pa-
tients’ inner worlds are downright scary places,
and yet we must have the courage to dwell in
them. Caring, similar to Rogers’s unconditional
positive regard, is equally foundational, as we
have said, at times involving certain kinds of
love. The point is that it is not enough to be
empathically attuned to the patient. One must
also care about the patient, often deeply, in the
most effective therapies.
Affirmation is a trickier concept, as it at times
involves a certain kind of taking sides with the
patient, and in this sense might seem to run coun-
ter to one of our guidelines (not taking sides in the
patient’s outer struggles). Affirmation does not
mean that the therapist agrees with the patient
against others or agrees with one side or another
of the patient’s intrapsychic struggles. Instead,
affirmation says “I understand how you feel,”
“your feelings makes sense given what you have
been describing,” and “you have a right to feel
what you do, even if it is painful or unkind.”
Still, there are situations in which affirmation
bespeaks a certain kind of agreement, where the
patient’s report of wrongdoing to him or her is
substantiated by the therapist. This agreement
may serve to justify the patient’s feelings, to
confirm the appropriateness of those feelings.
Such justification makes particular sense in the
case of trauma experienced by the patient, es-
pecially when the patient was not complicit in
that trauma. We have found, for example, that
affirming that traumatized patients were in fact
deeply wronged, were dealt a bad hand, or had
injustices perpetrated against them can make
them feel less crazy and can confirm the pa-
tients’ sense of self and self-cohesion. As an
example, Killingmo (1995) uses one of Ingmar
Bergman’s TV plays, Face to Face (1976). As
described by Killingmo,
The main character, a woman, Jenny, is lying in a bed
in hospital. She is about to recover after taking an
overdose. Tomas, her friend, sitting at her bedside,
speaks calmly to her while she desperately discloses
her deeply ambivalent emotions about her parents and
grandparents, oscillating between hatred, love, and
ruthless self-accusations and culminating in a state of
mute, paralyzed gestures. After a while, she suddenly
breaks the silence and says in a clear voice: “Can you
imagine shutting up a child who is afraid of the dark,
 NEUTRALITY REPLY
in a wardrobe? Isn’t it astonishing?” (p. 95). Tomas,
sitting expectantly on his chair, answers in a low-
voiced and definitive way: “Yes, it is astonishing.”
With Tomas’s answer, Jenny’s state of mind alters.
The agony is over. Something has been brought to a
close. (pp. 506 –507)
Here Tomas affirms Jenny’s feelings in the
sense of agreeing with her. What was done to
her was indeed astonishing. Similarly, when we
communicate to our patients who experienced
traumata throughout their childhoods that in-
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deed they were mistreated and indeed it was not
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fair, this serves to remove doubt from their
minds and fortifies their sense of self and self-
worth. Although we believe that this sort of
affirmation is important, we also believe that
therapists must be careful not to simply support
what might be a patient’s defensive externaliz-
ing, that is, blaming others and absolving his or
her own responsibility. Here the therapist must
have a good sense of the extent to which the
patient was indeed wronged, in contrast to when
the patient might have a tendency to blame
defensively the outside world for his or her
pain. The kind of affirmation that sustains a
feeling of justification must only be used when
the therapist is sure that, in fact, the patient was
traumatized, wrongly treated, and/or dealt a bad
hand. Such situations usually occur in child-
hood, generally at the hands of caretakers, but
they can also happen in adulthood, for example,
horrific losses, accidents, instances of rape or
abuse, racial discrimination, and so forth.
We have been elaborating the relational con-
ditions or context under which neutrality, as we
have defined it, is most effective. We have done
so in order to counter a sense that both Wachtel
and Goldman have placed us in a position in
which we may be seen as less relational, more
conservative, more rule bound, and less flexible
than we believe to be true.
Our description so far really does not address
the question of just what the therapist does while
implementing this relational context and maintain-
ing neutrality as we have described it. Simply
creating an empathic atmosphere and maintaining
neutrality is not nearly enough in our view. While
maintaining an empathic neutrality, the therapist
seeks to foster the patient’s self-exploration, ex-
periencing, self-awareness, and self-understand-
ing. This is done usually through both relational
and technical (i.e., technique) operations that are
consonant with the therapist’s theoretical inclina-
361
tions, for example, interpretation, reflection, self-
disclosure and immediacy, and open questions
(see Hill, 2014). The point is that the therapist
actively seeks experiencing, awareness, and
understanding within an empathic relational
context, while flexibly maintaining the kind
of neutrality we have described as a baseline.
Departures are certainly acceptable, in our
view, and indeed we implement such depar-
tures often. But, again, we do believe that it is
helpful to maintain a baseline of neutrality, a
benevolent, present, involved neutrality.
Some Particulars
We now turn to particular arguments made by
Wachtel and Goldman, again focusing on points
of disagreement, while appreciating that there is
much about which we agree with these reactors.
Wachtel’s (2017) first point of contention is that
because the concept neutrality has accumulated so
much negative reaction over the decades, often
due to the rigid manner in which it was concep-
tualized and applied, it may be best to just let the
concept/term find a peaceful resting place. Even if
it is redefined in a way that makes it a viable
construct, our brain functions are such that we will
tend to wrap it into the old, dated conception. This
point is worth taking seriously, and we have. Rec-
ognizing these dangers, we believe that, first, con-
structs have been constantly redefined and refined
in psychological science throughout our short his-
tory. Constructs such as transference and counter-
transference, for example, have been reconceptu-
alized in recently years, to shed perhaps
antiquated notions and better capture useful pro-
cesses in psychotherapy. Constructs such as em-
pathy, unconditional positive regard, and congru-
ence (the humanistic big three) have been
reworked and refined over the decades. This is the
way of good science, in our view, assuming there
is merit in a construct, and it is worth salvaging
and refining. Very clearly, we believe there is
something very important about the neutrality
construct if it is clarified and refined in a way that
both (a) bears enough resemblance to the original
construct that it is not just a very different process
with the same name and (b) adds something im-
portant to current treatments. A second reason
why we believe that the construct should not be
simply scrapped is because we believe the minds
of psychotherapy practitioners are perfectly capa-
ble of internalizing and understanding nuanced
 362 GELSO AND KANNINEN
differences, to say nothing of the fact that current
trainees often have not even studied the concept or
perhaps even heard of it beyond cursory defini-
tions.
A big concern for Wachtel is that neutrality
for us is the default position, such that one
needs to justify departures from neutrality but
not justify its maintenance. This concern per-
haps represents our most fundamental differ-
ence with Wachtel. Yes, for us, neutrality is a
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baseline, albeit a flexible one. We strongly
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believe that this is preferable to having no
baseline, or a baseline of “do whatever is
called for at the moment,” which Wachtel
seems to advocate, although we are not sure
that this is his position. Highly expert thera-
pists like Wachtel and Goldman likely do
very well when they follow their perceptions
of what is called for at the moment, for they
have a storehouse of experience, knowledge,
and understanding to draw upon when making
those decisions. For the trainee or young ther-
apist, however, such an approach leaves the
therapist adrift in a sea of possibilities. Flex-
ible guidelines, such as those we have pro-
posed, can help considerably.
At times, Wachtel (2017) seems to be ar-
guing with theories other than ours and theo-
reticians other than us. For example, he takes
issue with our suggesting that patients’ prob-
lems are repetitions of early experiences that
have become internalized, suggesting instead
that these problems “reflect entrenchment in a
set of vicious circles that are either en-
trenched or partially dismantled by each new
experience. Consequently . . . active collabo-
ration and guidance in the patient’s journey
must often be part of the therapeutic journey”
(p. 344). We think this is a great point. We
agree with Wachtel, although not without
cautions. First, carrying early internalized ex-
periences into the present can be seen as
essentially the same as exhibiting entrenched
sets of vicious circles. Second, Wachtel’s im-
plication that we do not believe that active
collaboration and guidance is effective is sim-
ply incorrect. Still, we believe that the con-
cept of direct guidance of the patient must be
carefully considered. From one vantage point,
we are always guiding the patient, for exam-
ple, when we make interpretations, ask ques-
tions, and suggest in-session activities. How-
ever, it is useful to have some guidelines
about when to directly guide the patient in the
sense of advising actions outside the session
in the patient’s life. Sometimes this is needed,
sometimes it is useless, and sometimes it is
harmful in relation to the goal of awareness
and understanding. We have sought to specify
some guidelines as to when it is one or the
other. And of course we do believe in active
collaboration.
One of Wachtel’s (2017) complaints about
our presentation is that he believes we fall
into making ad hominem arguments. There is
no place in good science for ad hominem
arguments, but we do not believe we have
committed this not uncommon error. An ex-
ample of what Wachtel views as ad hominem is
our suggestion that when psychodynamic and hu-
manistic therapists differ in their use of neutrality,
they do so in opposite directions. Some more
analytic types may be inclined to err in the direc-
tion of too much distance and aloofness, while
some humanistic/experiential therapists seem
more likely to pull for even manufacture affect
through empathic evocations. We do believe that
such theoretical differences exist and that each
theory in its extreme has problematic features (too
much aloofness, too much pull for affect). This
does not seem like an ad hominem argument to us,
and we leave it to each reader to decide for himself
or herself!
Wachtel (2017) expresses serious reserva-
tions about our view that patients make con-
scious, and more often unconscious, demands
on their therapists for satisfaction or gratifi-
cation of their needs for affection and depen-
dency (among other needs) in the therapy
itself. Instead, he believes that patients com-
municate “perfectly valid—indeed critical to
welcome—wishes, feelings, hurts, desires for
understanding and affirmation.” Similarly,
both he and Goldman are uneasy with the
therapist making judgments about the maturi-
ty-immaturity of the patient’s conscious or
unconscious demands to be cared for and
taken care of directly by the therapist in the
therapy. And Goldman (2017) goes so far as
to say that for the EFT therapist, needs are
seen as legitimate, and the motives behind
them are not to be questioned. In our view, all
or nearly all human beings who seek therapy
have wishes, often hidden from themselves,
to be taken care of and cared for in the ther-
apy itself, and these wishes, or unconscious
 NEUTRALITY REPLY
demands, do indeed vary in level of maturity-
immaturity. It is the therapist’s job to assess
the level of maturity of what the patient pulls
for from the therapist. Unlike Wachtel, and
perhaps Goldman too, we have often worked
with patients who want what they cannot have
from the therapist (often regarding affection
and dependency), and we therapists have to
face the fact that these “demands” are at times
highly immature. It does not help the patient
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for the therapist to be a “good guy” and look
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away from the at times deeply pathological
wishes the patient has regarding what he or
she wants from the therapist. To our mind,
doing so is naïve and does not result in the
most effective treatment. Again, though, it
has to be remembered that these clinical judg-
ments are carried out in a context of empathy,
caring, and affirmation.
We have far fewer disagreements with
Goldman, as we found her reactions to be
clinically wise and informative about human-
istic/emotion-focused therapy in relation to
neutrality. We were, however, unclear about
her position on the participant-observer role
we advocate as part of effective neutrality.
She seems at once to (a) be positive about this
stance and (b) eschew the observer part of the
stance, feeling that it is antithetical to the key
therapist features of presence and attunement.
We would share Goldman’s concerns if, and
only if, the therapist leans too far toward the
observer side. We hope we have conveyed the
importance of the therapist balancing these
key roles of participant and observer. We
would further add that if the observer role is
too weak, and the therapist is essentially only
a participant, the therapist cannot stand back
and examine his or her countertransference reac-
tions, cannot examine the pulls the patient makes
on the therapist, and cannot examine their com-
plex interaction to get a sense of what is going
right and what is going wrong. It is hard for us to
see such a process as effective.
It would have been helpful if Goldman had
fleshed out more fully just what she means by
being “actively warm toward all parts of the
person” (p. 353). To our minds, this is both
impossible and undesirable. We are reminded of
Winnicott’s (1949) classic paper on hate in the
countertransference, in which he clarifies and
legitimizes such powerful negative feelings in
the therapist when working with certain patients
363
(see Gelso & Perez-Rojas, 2017). In fact, as
human beings in intimate contact with the pain
and suffering of other human beings, we thera-
pists are bound to experience a wide range of
feelings, and feeling warmth toward all aspects
of the patient seems to run counter to the con-
cept of genuineness, which is so central to the
humanistic/experiential approach.
Conclusion
Wachtel (2017) concludes his argument by
stating that he hopes that we continue to write
on the themes of the article he critiques and to
develop our arguments in a more refined way.
We shall not respond to the slight implied in
Wachtel’s conclusion but will add that both his
and Goldman’s views, while at times missing or
misinterpreting some of our key points, have
been indeed helpful to us in refining our argu-
ments. Finally, although Wachtel (2017) is cor-
rect in his assertion that “you can’t go far in
neutral,” if therapy consists of only neutrality,
we believe that neutrality within the kind of
empathic atmosphere we have described will
get us further down the road to patient self-
understanding, experiencing, and insight than
approaches that negate the guidelines we have
described. Finally, although we are not human-
istic/experiential/emotion-focused therapists,
we have been strongly influenced by that per-
suasion, and we do see our approach as deeply
consistent with the best versions of this theoret-
ical position.
References
Gelso, C. J., & Kanninen, K. M. (2017). Neutrality
revisited: On the value of being neutral within an
empathic atmosphere. Journal of Psychotherapy
Integration, 27, 330 –341. http://dx.doi.org/10
.1037/int0000072
Gelso, C. J., & Perez-Rojas, A. (2017). Inner expe-
rience and the good psychotherapist. In L. Caston-
guay & C. E. Hill (Eds.), Therapist effects: Toward
an understanding of why some therapists are bet-
ter than others. Washington, DC: American Psy-
chological Association.
Goldman, R. N. (2017). The emotion-focused thera-
peutic relationship: Genuineness, Warmth, and
Acceptance Are Not Neutral: Comment on Gelso
and Kanninen (2017). Journal of Psychotherapy
Integration, 27, 350 –358. http://dx.doi.org/10
.1037/int0000096
 364 GELSO AND KANNINEN

Hill, C. E. (2014). Helping skills: Facilitating explo-
ration, insight, and action (4th ed.). Washington,
DC: American Psychological Association. http://
dx.doi.org/10.1037/14345-000
Killingmo, B. (1995). Affirmation in psychoanalysis.
The International Journal of Psychoanalysis, 76
(Pt 3), 503–518.
Wachtel, P. L. (2017). The Ambiguities of Neutral-
ity: Comment on Gelso and Kanninen (2017).
Journal of Psychotherapy Integration, 27, 342–
349. http://dx.doi.org/10.1037/int0000091
Winnicott, D. W. (1949). Hate in the counter-
transference. The International Journal of Psycho-
analysis, 30, 69 –74.

Entendimientos y malentendidos sobre la neutralidad en un contexto empático

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Paul Wachtel y Rhonda Goldman han proporcionado criticas pensativas de nuestro concepto de la importancia de la
This document is copyrighted by the American Psychological Association or one of its allied publishers.

neutralidad del terapeuta dentro de un contexto empático. Aunque haiga varios puntos de acuerdo, nuestra respuesta destaca
los desacuerdos con estas reacciones. Cuando está acompañada por directrices flexibles, no confundido con indiferencia
indiferente, y ofrecida en un contexto que nosotros llamamos una atmosfera empática, la neutralidad es una postura
terapéutico muy efectivo. En contrasto a Wachtel, concluimos que el terapeuta puede ir lejos en la neutralidad, con tal que
es una neutralidad benévola que es marcada por la empatía, cuidado, y afirmación de un terapeuta.

Neutralidad, atmosfera empática, directrices de neutralidad

在一个同情的背景下对中立的理解和误解
Paul Wachtel和Rhonda Goldman对我們所倡的概念--在同情的背景下治疗师的中立性的重要性的概念提出了
深思熟虑的批评。 虽然有很多見解相同之處，我们的答覆强调了我们对这些 回应的不同意见。 当伴随着灵
活的指导方针，并不与冷漠的漠不关心所混淆，并在我们称为同情气氛的背景下，中立是一种非常有效的治疗立
场。 与Wachtel相反，我们推斷得出结论，治疗师确实可以在中立状态中走的很远，只要它是以治疗师的同
情心，关爱，和肯定为特征的仁慈中立。

Received July 20, 2017

Accepted July 23, 2017 䡲