Empathic understanding: a review of the concept and some theoretical considerations

A review of the psychoanalytic literature shows that empathy has always played an important part in the practice of psychoanalysis, but that as a concept it has not been well understood. This confusion and a certain mistrust of empathy that it engenders were traced to an incomplete understanding of the meaning of the term, and to the lack of an affect theory that could explain the communication involved in the empathic process. These problems were examined and suggestions for their resolution were made. A line of affective development that culminated in empathic understanding was proposed. An operational approach to empathy was described and the role of empathy as the basis for and the prelude to psychoanalytic interpretation was discussed.     

Psychoanalytic observation

The recent focus on empathy as the essential activity in psychoanalytic data gathering has underemphasized the complexity of psychoanalytic observation and has failed to identify what truly makes it unique among modes of psychological investigation. It is a process that includes introspection and empathy. However, it also includes the analyst's observation of the patient's behavior, and particularly verbal behavior, in a way that is not necessarily empathic. The psychoanalytic use of introspection and behavioral observation together, as they are modified by the analysand's free association and the analyst's evenly hovering attention, provides a unique method of data gathering. The transient, mutually related regressions of analyst and analysand which partly constitute the analyzing instrument modify the field of observation available to both, providing better access to derivatives of the analysand's unconscious mental functioning. This more complex concept of psychoanalytic observation, as opposed to that in which empathy is predominant, has important implications for psychoanalytic training, clinical work, and theory.     

Slips of the analyst.

Understanding the analyst's work and its vicissitudes has been a major focus of recent psychoanalytic writing. This study on slips of the analyst represents an attempt to advance our understanding of analytic work. The slips described support the view that slips reflect not simply contributions from instinctual life, but active work-related goals of the analyst in carrying out the analytic tasks. Countertransference is discussed as reflected in the disturbance of intentionality betrayed by the occurrence of a slip. The essential role of the analyst's understanding his or her own reactions is emphasized.     

The language of empathy: an analysis of its constitution, development, and role in psychoanalytic listening

Viewed from an epistemological perspective, empathy in psychoanalytic practice is described as that aspect of a specialized attentional stance that opens channels of interaction facilitating the formation of a trusting bond and enabling one to gain access to the emotional qualities of another's experience. A literature overview traces the origins of the concept in Freud and its role in psychoanalytic listening (including its controversial, divisive evolution in our field). Empathy is then examined from a semiotic-developmental framework. Its constitutional origins, differentiated forms, and distinctive purpose in clinical discourse are discussed. A developmental line is proposed, and clear distinctions are drawn between empathy in everyday life and its specialized technical application in clinical work.     

Psychoanalysis and Eastern spiritual healing traditions

An exploration of the theory and practice of healing in the Eastern spiritual traditions reveals the centrality of the idealizing transference in the patient-seeker's interaction with the spiritual teacher or the guru although the aim and development of the idealizing transference in the spiritual traditions are quite different from those of self psychology. In its emphasis on the guru's empathy and in claiming that its meditative practices radically reduce the noise and glare produced by the sensual self which is the chief obstacle to the teacher-healer's empathic understanding of the patient, the Eastern healing discourse goes considerably beyond most traditional psychoanalytic formulations on the nature and communication of empathy in the analytic situation. The Eastern traditions' claim of a significant enhancement of the teacher-healer's empathic capacity through meditative practices, and its communication to the patient/seeker through other channels besides the verbal one, can make an important contribution to the discussion on the role of empathy in psychoanalytic discourse and, if the claim proves true, to a place for meditative practices in psychoanalytic education.     

Analytic neutrality, anonymity, abstinence, and elective self-disclosure

Recent contributions to the psychoanalytic literature propose new ways of understanding analytic neutrality, anonymity, abstinence, and self-disclosure. They advocate elective self-disclosure by the analyst as an antidote to the allegedly game-playing quality of transference and resistance analysis. The analytic relationship, they assert, becomes unreal when attempts are made to observe the principles of neutrality and abstinence. Both are seen as ill-conceived because of the irreducible subjectivity and unwarranted authority of the analyst. These relational and interactional views are criticized because (1) they ignore the fact that transference and resistance analysis have from Freud onward been accepted as minimal criteria qualifying a clinical process as psychoanalytic; (2) elective self-disclosure carries metapsychological implications dismissing not only Freud's theory of motivation but motivation as a basic feature of human personality; (3) they do not recognize interpersonal relations as mental events and so do not consider the ego's ability to create intrapsychic representations of object relations; (4) elective self-disclosures within the empathic parameters of the analytic situation are themselves unreal compared to the reality of the patient's experience with other objects. Abstinence and neutrality as ideals facilitate maintenance of an internal holding environment or container for the analyst's countertransference.     

情境对共情的影响

共情指的是个体在与人交往的过程中共享并理解他人的情绪状态的倾向, 包括认知共情和情绪共情两种成分。现实生活中的共情总是发生在一定的具体情境中, 受到情境因素的影响。其中, 情境的公开性或私密性、意义性等均在不同程度上影响了共情的产生或共情反应的强烈程度。共情对象在特定情境中与共情主体之间的群际关系、人际关系等也是重要的情境因素, 共情主体对于和自己属于同一群体或拥有较亲密人际关系的他人更容易产生共情。情境对共情的影响通过自上而下和自下而上两种方式实现。有关情境对共情的影响研究虽然取得了一定的成果, 但仍然有进一步拓展的空间, 未来的研究需要在情境因素的内涵上进行深入挖掘, 从认知加工的角度对情境影响共情的机制做更为细致、微观地解析, 还可以从共情主体的视角明确个体差异如何调节了情境对共情的影响作用。     

Ideology Springs Eternal: Reply to Commentaries

Empathy has come to occupy a central place in much discourse on psychoanalytic theory and practice. Since empathy is fundamental to how data are obtained and interpreted within psychoanalysis, it is essential to understand its relationship to the assumptions underlying any psychoanalytic epistemology. This paper examines some of the epistemological issues involved in Kohut's view of empathy as a mode of inquiry. The Kohutian view of empathy is contrasted with the understanding of empathy employed by Harry Stack Sullivan and the epistemology of American pragmatism. The epistemology inherent in empathy as a mode of inquiry is then clarified in relation to hermeneutics, phenomenology, structuralism, and deconstruction. The paper concludes with a case example to illustrate the clinical implications of the particular meaning of empathy as a mode of inquiry.     

Empathy is interpretation (and who ever said it wasn't?)

Whenever the subject is explicitly addressed, all analysts agree that empathic perception is an attitude one takes toward making observations, not a privileged means of perception. Furthermore, analysts seem to agree that observations made with an empathic intention are interpretations like any other observations. Empathy is not a conduit to the patient's inner life. But despite these points of consensus, it often seems to be implied in the psychoanalytic literature, usually unintentionally, that empathy is a privileged means of knowing another person. This undercurrent is sometimes present even in the work of theorists who simultaneously state their opposition to this very point of view. In this paper, after presenting an example from the literature of this kind of contradiction, I, basing my argument in hermeneutics, offer the view that all observation, inside and outside psychoanalysis, is interpretation. Then, turning to the three papers of the symposium individually, I take the perspective that in one way or another they all portray empathic perception as a privileged means of observation. These portrayals are examples of the unconscious politics of theory.     

Unconditional giving and unconditional taking: empathy and narcissism among pastors

Empathy is a key factor in successful pastoral contact. This article reports on an investigation among pastors of the relationship between empathy and narcissism, a personality trait which has acquired considerable importance in recent years. The article distinguishes between several dimensions of empathy and narcissism. In the case of empathy these dimensions are perspective-taking, fantasy, empathic concern, and personal distress, and in the case of narcissism they are centripetal narcissism, centrifugal narcissism, isolation, and self-satisfaction. The meaning of the relationship between empathy and narcissism for pastoral performance is discussed.     

神经科学视角下的共情研究热点

共情是指个体对他人情绪和想法的感受及理解。近年来关于共情神经机制的研究日益增多,但多集中在情感共情、认知共情、生理性疼痛共情等方面,而对社会痛共情、积极共情和不对称共情反应的研究相对较少。且由于研究范式及个体差异等原因,研究结果之间也充满着争议。未来研究可以设计更具生态效度的共情研究范式、进一步深化和细化共情的神经机制研究、从神经机制角度探讨不同共情能力个体的特点及共情反应的调节因素。     

动物和人类的利他本性:共情的进化

共情指个体感知或想象其他个体的情感,并部分体验到其他个体感受的心理过程.利他指以增加其他个体的福利为最终目标的动机.共情起源于动物的亲代养育行为,其神经基础来源于古老的情感系统.共情从动物低水平的情绪感染逐渐进化到同情关注以及观点采择共情.另外,共情具有良好的环境适应性.未来可以进一步研究动物与人类的共情和利他行为的异同,加大研究动物的高级共情能力和利他行为以及深入研究共情受社会因素的调节机制.     

Clinical and theoretical aspects of enactment

Enactment as a concept can serve analytic discourse through its established meaning of an act intended strongly to influence, persuade, or force another to react. We might agree to use the term in two complementary ways: Broadly, enactment can designate all behaviors of both parties in the analytic relationship, even verbal, in consequence of the intensification of the action intent of our words created by the constraints and regressive push induced by the analytic rules and frame. Patient and analyst are vulnerable to falling back on behaviors that actualize their intentions, doing so in ways motivated by and reflecting transference hopes, fears, and compromises shaped in their developmental past. Specifically, enactment can then be defined as those regressive (defensive) interactions between the pair experienced by either as a consequence of the behavior of the other. While nominally an interpersonal perspective, this concept of enactment facilitates more balanced attention to the involvement of both parties and to the intrapsychic dynamics in both that specifically shape their interactions. A clinical vignette illustrates the analyst's contributions to enactment, especially those reflecting his reactivated conflicts and their relation to his theoretical and technical preferences.     

How do you think she feels? Vulnerability in empathy and the role of attention in school‐aged children born extremely preterm

The aim of this study was to examine empathic competence in children born extremely preterm (EP, <28 weeks) given vulnerabilities in social relationships. Empathy in typically developing children is mediated by executive functions. Executive functioning is also impaired in preterm children. Of particular interest in this study are the attentional components of executive functioning as mediators of empathic development. Thirty‐two 7‐year‐old EP children and 40 age‐matched term children participated in the Project K.I.D.S program and completed the Kids Empathy Development Scale (KEDS), Wechsler Intelligence Scale for Children (WISC‐IV), and Test of Everyday Attention for Children (TEA‐Ch). Children born extremely preterm exhibited poorer performance on all measures. The mediating role of attention in empathy competence was not supported by mediation modelling when FSIQ was controlled. As predicted, the EP group showed weaker empathic development relative to typically developing children. They also showed poorer attentional abilities. However, the effect of preterm birth on empathy was not mediated by executive‐level attention. The cognitive mechanisms underpinning poor empathy competence in EP children remain unclear. Future research needs to examine the role of inhibition, social–emotional recognition, and regulation.     

Responding to the emotions of others: dissociating forms of empathy through the study of typical and psychiatric populations

Empathy is a lay term that is becoming increasingly viewed as a unitary function within the field of cognitive neuroscience. In this paper, a selective review of the empathy literature is provided. It is argued from this literature that empathy is not a unitary system but rather a loose collection of partially dissociable neurocognitive systems. In particular, three main divisions can be made: cognitive empathy (or Theory of Mind), motor empathy, and emotional empathy. The two main psychiatric disorders associated with empathic dysfunction are considered: autism and psychopathy. It is argued that individuals with autism show difficulties with cognitive and motor empathy but less clear difficulties with respect to emotional empathy. In contrast, individuals with psychopathy show clear difficulties with a specific form of emotional empathy but no indications of impairment with cognitive and motor empathy.     

On the psychoanalytic treatment of a psychotic breakdown

The author discusses the four-session-a-week psychoanalysis of a patient in psychotic breakdown with outbursts of violence. The analyst's first appearance in the transference was as a "rattle" (the noise made by his shifting in his chair), which constituted undeniable evidence of corporality--first the analyst's and then the patient's--leading eventually to the awareness of there being two separate persons in the psychoanalytic relationship. This case highlights the analyst's need to function in a particular way, and to allow him- or herself to be used in a particular way, in working with very disturbed patients, where issues of the body-mind relationship and of separation from the other are often central to the analytic work.     

Overcoming Obstacles to Empathy: The Use of Experiential Learning in Addictions Counseling Courses

Empathy is associated with positive outcomes in addictions counseling. The moral model of addiction and unresolved countertransference issues may hinder counseling students’ development of empathic understanding for clients with substance use disorders. Counselor educators must structure courses in such a way as to help students overcome obstacles to empathy. We provide examples of several experiential activities framed within the context of Kolb’s experiential-learning cycle that are designed to deconstruct obstacles to student empathy development.     

Raiding the inarticulate: The internal analytic setting and listening beyond countertransference

The analytic setting exists not only externally but also internally as a structure in the mind of the analyst. The internal analytic setting constitutes an area of the analyst's mind where reality is defined by unconscious symbolic meaning. Clinical examples illustrate how a secure internal setting allows flexibility in the external setting without sacrifice of its analytic quality. The internal setting can help analysts listen inwardly to themselves in a way that is free-floating with regard to their internal processes. This points beyond usual ideas of countertransference. An analytic encounter may stir up elements that belong to the analyst's psyche which, rather than impeding the analysis, can actively enrich it. Seamus Heaney's writings evoke comparisons between listening to poems and listening to patients, and a week in a patient's analysis is described in relation to these themes.     

Announcement

Abstract

Empathy has consistently been identified as an important quality of psychotherapists. Understanding unique ways that empathy emerges in group therapy may assist group therapists in fostering empathy. Rogerian and selected psychodynamic and interpersonal perspectives on empathy are discussed. Group psychotherapy poses a challenge for empathic responding, but also a rich opportunity for utilizing a more varied embodied approach to empathy.     

A beam of "chimeric" darkness: presence, interconnectedness, and transformation in the psychoanalytic treatment of a patient convicted of sex offenses

The paper puts forward the dimension created by analytic presence and the ensuing patient-analyst interconnectedness in the process of psychoanalytic treatment and change, particularly with more disturbed patients. Working within this dimension, at a fundamental level of contact and impact, opens up new possibilities of extending the reach of psychoanalytic treatment. The analyst's "presencing" and interconnectedness with the patient forge a living therapeutic entity that is not a one-person or two-person psychology, but an emergent two-in-one new entity that goes beyond the confines of the separate subjectivities of patient and analyst and the simple summation of the two. The paper describes the kind of knowledge, experience, and powerful therapeutic potential that comes into being through analytic "presencing" and patient-analyst interconnectedness, and particularly focuses on the chimeric element, or quality, of this interconnectedness. The term "chimera/chimerism"-chosen here for its wealth of mythological, genetic, biological, biomedicinal (chimeric proteins), and psychoanalytical associations-is used in this paper to highlight the complex quality of patient-analyst interconnectedness, especially in difficult, psychotic, psychically foreclosed, dissociative and perverse states. The author offers an extensive clinical account of psychoanalytic treatment of a patient convicted of sex offenses in order to illustrate "presencing," interconnectedness, and the extent and intricate emotional meaning of the extreme chimerism that this kind of (difficult) treatment entailed.