When I attempt to upload a csv file from American Express, purchases end up in the received column and payments in the spent column. How do I fix this?

Thanks for sharing the details with us, @jody-schobel.

You'll want to ensure you use the correct mapping in uploading your bank transactions to your QuickBooks Online (QBO) account.

QBO uses the 3-column or 4-column format in importing the CSV file. The 3 columns have the Date, Description, and the Amount of the transaction. While the 4 columns have a Date, Description, and both Credit and Debit column.

I've attached some images for visual reference. 

You can also check this article for more details about importing bank transactions using Excel CSV file: Import bank transactions using Excel CSV files.

I'm also adding this article that you can use for future reference. This link provides detailed information in reconciling your account accurately: Reconcile an account in QuickBooks Online.

Do get back to me if there's anything else you need help with. I'm always here to back you. Have a wonderful day!