Dr. Matthew Paldy
COMPASSIONATE, EFFECTIVE PSYCHOTHERAPY

The Value of Empathy in Effective Psychotherapy

By Dr. Matthew Paldy

There is a common misconception that empathy is the same as sympathy, or that empathy is an affect, however empathy is commonly defined as the “ability to imagine feelings that one does not actually have.” (Merriam Webster). Kohut suggests empathy is a “mode of observation attuned to the inner life of man.” (Kohut, 1981, p542). Empathy is not kindness, compassion, or intuition, but rather it is the ability of the analyst to imagine and conceptualize the inner life of the patient. “Through the act of empathizing, the therapist conveys an acceptance and sense of importance placed on the patient’s lived experience.” (Kohut, 1981, p544). Not only is empathy critical for an effective analyst, it is a foundation of human relationships. A “good enough” (Winnicott, 1974) parent must empathically respond to their child’s needs for the child to feel taken care of and understood, both physically and emotionally. The curative effects of classical psychoanalytic approaches, while not explicitly suggesting empathy, in my opinion do in fact utilize empathic listening to form interpretations and let the patient know that they are being heard, that they have a understanding receiver for their thoughts and emotions.

We all know that empathy can be lacking among NYC residents. It’s important to note, and critical to intersubjective self-psychological approaches, that empathy is not an objective understanding, but rather is based on the analyst’s own unique subjectivity and is impacted by the intersubjective field created between analyst and patient (Hagman, 2019). Self psychology does not propose that its empathy is different from that of classical analysts, but it does claim that it “has supplied analysis with new theories which broaden and deepen the field of empathic perception.” (Kohut, 1981, p175). Even classically oriented therapists in NYC, which is a hotbed for it, who such as Kernberg recognized the importance of empathy. “Thus, the mother's communication includes clarification of what is going on in the infant's mind, her empathy with it, and her different reaction to the infant's experience.” (Kernberg, 2003). The borderline mother is incapable of empathizing sufficiently with her infant and accepting its communications, leaving the infant alone with “alone with what becomes an unbearable, overwhelming psychic experience that cannot be mentalized adequately."

An analyst who fails to empathically understand the patient does not legitimize and validate the patient’s experience and perception of their reality. In fact, Kohut boldly states, “Empathy is the operation that defines the field of psychoanalysis. No psychology of complex mental states is conceivable without the employment of empathy.” (Kohut, 1981, p174). Through this vicarious introspection the patient feels understood, and in the absence of this real understanding by the analyst a patient may feel retraumatized as he/she felt in early life, and this may lead to a reactivation of archaic selfobject transferences that can impede the analysis. Empathy is thus a foundation of both human interrelatedness and critical to the psychoanalytic cure.

Societal unrest, as we see today in the increasingly politicized and divided American culture, can be viewed in terms of a lack of empathy, or more possibly, a refusal to engage in the effort to empathize with another’s views. Unlike the analyst, the threat of perceived loss (e.g., their way of life) generates a fear and anger that precludes the ability to empathize with those holding opposing viewpoints. The “us versus them” mentality steamrolls any sense of shared humanity between both sides and therefore inhibits empathic understanding and the resolution of disagreements. A subtle yet powerful linguistic tool for encouraging the tolerance of different views is the replacement of “yes, but…” with “yes, and…” For example, when one is presented with an opposing view one can say to the person, “Yes, and [present your viewpoint here]” rather than “Yes, but…” However, it takes energy to attempt to see things from others’ perspectives. Neurological research has shown that empathy relies on specific parts of the brain that facilitate emotional connection with others, and this leads to a behavioral response of compassionate action. Programs that teach and encourage empathic thinking can be implemented in educational and professional settings. For example, empathy training in physicians has been shown to improve medical outcomes. Tribalism, viewed as a main factor genocides around world such as those in Rwanda, Germany, and Armenia, is a roadblock to empathy. Historians have suggested that the course of human civilization is one of reduced tribalism and increased ability to interact with those beyond our tribe. This trend seems disturbingly reversed in recent years. Empathic triggers can be strong, as when Last year, the UK had decided not to take Syrian refugees into the country, “and then there was a single photograph of a small boy called Alan Kurdi – the little toddler who was on the beach in 2015. He could’ve been your child; he could’ve been my child. Within 24 hours, Britain had said it was going to accept Syrian refugees. We had burnout for the population as a whole because we couldn’t identify with them.”

I also found parallels between Kohut’s empathic attunement and concepts in Winnicott’s “Fear of Breakdown” and Fink’s article “Against Understanding: Why Understanding Should not Be Viewed as an Essential Aim of Psychoanalytic Treatment.” Fink implicitly supports Winnicott’s view that the analytic process can be curative for a patient even without the patient’s conscious, intellectual understanding of his/her symptoms and early memories. In fact Fink argues, and I agree, that it is not even imperative for the analyst himself to intellectually understand what is happening in the session for a developmental transformation of the self to occur in the patient. I find this to be somewhat relieving because I sometimes put pressure on myself to know the exact theoretical underpinnings of the patient’s symptoms and communications in the session. Fink’s proposal also appeals to me because it implies that interpretations, the bedrock of classical ego psychology, are not absolutely necessary for mutative and curative effects in the patient.

References
Fink, B. 2010. Against Understanding: Why Understanding Should not Be Viewed as an Essential Aim of Psychoanalytic Treatment. Journal of the American Psychoanalytic Association, 58(2):259-285.

Hagman, G., Et Al. 2019. Intersubjective Self Psychology. Routledge; 1st edition.

Kernberg, O. 2003. The Management of Affect Storms in the Psychoanalytic Psychotherapy of Borderline Patients. Journal of the American Psychoanalytic Association, 51(2):517-544.

Kohut, H. 1981. How Does Analysis Cure?

Mitchell, S. & Black, M. 2016. Freud and Beyond: A History of Modern Psychoanalytic Thought. Basic Books. New York, NY.

Winnicott, D.W. 1974. Fear of Breakdown. International Journal of Psycho-Analysis.,1:103-107.