Listening With Empathy

September 14, 2011

The Chicago Empathy Project is Live!

Filed under: Emotions,Empathy,psychotherapy,talk therapy — Lou Agosta @ 12:24 pm
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The commitment of the Chicago Empathy Project (CEP) is to expand the application of empathy in human relatedness. In particular, the commitment is to provide an opening for the exchange of ideas in a context of empathic human relations by delivering motivational presentations, inspirational conversations, training, workshops, and psychotherapy services to the professionals in the mental health, education, and business communities. This post is a call for participation and an invitation to provide leadership in designing and implementing the Chicago Empathy Project (CEP).

The CEP project acknowledges and promotes the value of empathy engaging competing approaches to restoring emotional well being including Talk Therapy, Cognitive Behavior Therapy (CBT), and psychopharmacology. All three benefit from a foundation in empathy. The possibilities for interdisciplinary networking and interdisciplinary research are significant based on a foundation in empathy. Lining up the optimum therapy with a given individual remains an interdisciplinary art requiring experience, skill, and learning. However, the pendulum has swung far-too-far away from the breakthrough results of the work on empathy (initiated by Heinz Kohut and his colleagues including Michael Basch, Arnold Goldberg, Mark Gehrie, and Ernest Wolf). Empathy is alive and well at dedicated centers of excellance such as The Chicago Institute for Psychoanalysis where Kohut made his mark. But few know about this or have access to it, notwithstanding generous out reach programs. Other dedicated mental health professionals are becoming the shoe maker’s children, living off the worried well. Even psychiatrists (MDs) with a psychodynamic interest find it hard to practice talk therapy (psychotherapy) due to market pressures, declining insurance reimbursements, and the mis-education of the public to expect behavior modification and psychotropic pills to be a silver bullet. Personal dissatisfaction, emotional upset, and despair over the future are growth industries.With apologies to Melanie Klein (a famous psychoanalyst), the CEP refuses to endorse the paranoid position. There is nothing wrong. However, there is something missing – empathy. Expanded empathy is the requirement and commitment.

The Chicago Empathy project bears witness to one fundamental approach: absent a warm, generous, empathic listening, psychotherapy is hard to distinguish from dental work. It can be painful. A gracious, generous, empathic listening provides access to the inner, emotional life of the other person and, with conditions and qualifications, can jup start the process of emotional healing and recovery. This extends (once again with conditions and qualifications) to applications of CBT and psychopharmacology, especially given the side effects of the latter. Though empathy is not a silver bullet (even as the search for one continues), empathy makes a profound difference in the quality of the caregiver-patient experience, the quality of the student-teacher relationship, and the quality of the consumer-business engagement. As every mother of a newborn, every parent, and every caretaker knows, empathy is a natural ability with which all human beings are born; no university degree or license is required to be empathic, though training and education can make a substantial difference in developing the competence. The Chicago Empathy project empowers people through conversations, presentations, workshops, and one-on-one psychotherapy to expand the use of empathy in human relatedness. The result is developing zones of human understanding, possibility, relatedness; the unblocking of obstacles to personal growth and the restarting of human potential and growth; and the transformation of suffering and emotional upset into creativity, humor, wisdom, and expanded empathy.  Full disclosure: This project is a work in progress and its creation and implementation are the result of the contributions of the engaged, participating community. Full disclosure: as I write this, I do so as someone who has been on both sides of the therapist/patient interface as well as the therapist/client one. It is going to sound a tad like bragging here at the backend but if not now when? … Additional qualifications for commenting on what to look for in an empathy project is that my works on empathy are footnotes in Goldberg, Wolf, and Basch (see bibliography below).  This project charter is not complete nor is my knowledge and experience; all the usual disclaimers apply; so the reader’s [your] feedback, criticism, experiences, impertinent remarks, and contribution are hereby requested. This project needs – a web site of its own; a high profile leader with name recognition; individual narratives of how empathy makes a difference; brain storming; speaking opportunities; consulting engagements; training assignments; community engagement. Please let me hear from you.

Bibliography

Agosta, Lou. (2010). Empathy in the Context of Philosophy.London: Palgrave/ Macmillan.

__________. (1984). “Empathy and intersubjectivity,” Empathy I, ed. J. Lichtenberg et al.Hillsdale,NJ: Lawrence Erlbaum Press.

__________. (1980). “The recovery of feelings in a folktale,” Journal of Religion and Health, Vol. 19, No. 4, Winter 1980: 287-97.

__________. (1976). “Intersecting language in psychoanalysis and philosophy,” International Journal of Psychoanalytic Psychotherapy, Vol. 5, 1976: 507-34.

Basch, Michael F. (1983). “Empathic understanding: a review of the concept and some theoretical considerations,” Journal of the American Psychoanalytic Association, Vol. 31, No. 1: 101-126. (See p. 114.) .

Gehrie, Mark (2011). “From archaic narcissism to empathy for the self: the evolution of new capacities in psychoanalysis,” Journal of the American Psychoanalytic Association, Vol. 59, No. 2: 313-333.

Goldberg, Arnold. (2011). “The enduring presence of Heinz Kohut: empathy and its vicissitudes,” Journal of the American Psychoanalytic Association, Vol. 59, No. 2: 289-311. (See  pp. 296, 309.) .

Kohut, Heinz. (1984). How Does Analysis Cure? Chicago: University of Chicago Press.

Wolf, Ernest S. (1988). Treating the Self.New York: The Guilford Press. (See pp. 17, 171.)

This post and all contents of this site (c) Lou Agosta, Ph.D. and the Chicago Empathy Project

August 12, 2011

What to Look For in Selecting a Psychotherapist

Filed under: Emotions,Empathy,psychotherapy,talk therapy — Lou Agosta @ 10:10 pm
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Three criteria are front and center in selecting a psychotherapist: cost, schedule, and empathy. These are not the only variables. For example, academic degrees and diplomas, professional certifications or equivalent publications and experience, insurance benefits, location, and Internet reputation (say, on  Facebook or LinkedIn) are also criteria. Okay, I am just kidding about Facebook; but don’t laugh too hard, we are heading in that direction. In addition, it is increasingly common for psychotherapists to call out the therapeutic agreement explicitly, sometimes in writing, managing the expectations and defining the boundaries of the situation. In general, not a bad thing if it is handled with care – and empathy. The challenge faced by most prospective patients or clients, who are searching for a therapist, is that once they are in an emotional emergency, there is no time to interview several prospective psychotherapists to find a good fit. This is a case for having a periodic emotional check up just as one would have a physical check up in order to establish a relationship against a possible future crisis. However, this level of planning rarely occurs. From a negotiating perspective, the individual seeking help is “one down” in terms of leverage. Of course, reputable professionals will bend over backwards to be accommodating. In any case, the patient/client is still responsible for making his or her own best case and being a powerful self-advocate. Once again, no easy answer here if your issue is low self esteem and loss of power. Still, while acknowledging that the variables of negotiating flexibility, schedule, and cost are on the critical path, they are not the focus of this article. That leaves the criteria of empathy. Without empathy, nothing else works.

The short definition of empathy is that it is the capacity to know what an other individual is experiencing because (speaking in the first person for emphasis) I experience it too, not as a merger but as a trace affect or experience that samples the other’s experience. Thus, if one is overwhelmed by the other’s trauma and re-traumatized, one is not using one’s empathy properly. Simply stated, you are doing it wrong. Optimally, I experience a trace, a sample, a virtual vicarious representation of the other’s experience of suffering or joy or indifference so that I “get it” experientially and emotionally as well as cognitively. The boundary between self and other is firmly maintained, but the boundary is permeable in one limited sector, the communicability of affect, sensation, experience. In a larger context, empathy is the capacity that enables the other person to humanize the one by recognizing and acknowledging the possibilities for growth, transformation, and recovery in the one.

Empathy is different than interpersonal chemistry – that certain something = X that just clicks between two people such that they know they can work together. Yet empathy is the basis for this chemistry and fans out into multiple forms of relatedness and possibilities of understanding.

To cut to the chase, look for a psychotherapist that is genuine and authentic in relating, providing a gracious and generous – that is, empathic – listening. If the individual you are talking with does not provide the empathy you require, keep looking. Absent a warm, empathic listening, the process of psychotherapy is indistinguishable from dental work. It can be painful, granted that many individuals seeking a therapist are already suffering from significant emotional pain. Even in the best of situations, it is not that there are zero challenges even with empathy. The process does not work unless one goes up to the edge of one’s comfort zone and goes through the boundary, pressing beyond it. That takes courage – going forward in spite of being afraid (“anxious”).The more the therapist can be authentic in the relationship, the more powerful he (or she) can be in facilitating transformation in the direction of health and well-being on the part of the patient. This is true even when the attitudes that the therapist experiences are not ones that he would endorse if he lived up to all his ideals. A simple example: if I am approached for services by a person with self-esteem issue [low] who is also obese, my attitude towards the perceived extra weight is going to be front and center. Since the person struggling with low self-esteem and an (un)related weigh issue may not endorse such a view himself, it is important to recognize that there is nothing wrong with people coming in all shapes and sizes. Even if I would not endorse such an admittedly edgy slogan as “fat is beautiful”, it is still essential to be in touch with my own ambivalence (given that such exists). It is essential for the therapist to be intimately in touch with his own feelings and attitudes, generally as a result of his own work in psychotherapy or psychoanalysis as a patient. He must be willing to make the call – “the chemistry is just [not] right here and it is me” – otherwise, it just will not work out. The point is that none of this will work without a deep empathy for the experience of the world of the other individual.

What to look for is a therapist who can provide the kind of empathic relatedness that recognizes the humanity of the other, even amidst the effort and struggle of dealing with unattractive, challenging symptoms, not all of which the patient is even willing to share at first due to doubt, shame, or previous unhappy experiences and outcomes. Sometimes it is necessary for a prospective patient to “burn through” several therapists until he finds someone that he can trust. This doesn’t means that the other therapists were “wrong and bad,” though it might mean the mismatch between patient expectations and therapists’ services took awhile to converge on market availability. In short, look for a therapist who can provide the kind of relationship that the patient/client is able to use to overcome obstacles, jump start growth, and facilitate transformation in the direction of positive possibilities.

The key term here is actually “usability,” not in the sense of mis-use but in the proper and powerful sense of a means to guide the person back to naturally occurring development. The differentiator between use and mis-use is – you guessed it – empathy. The more the patient recognizes the therapist’s empathy, the more the patient will naturally restart the process of growth away from rigid, fixed, apathetic, shut down emotional functioning toward a way of being that is alive, vital, dynamic, full of feeling, engaged for better or worse with the issues that promise to provide satisfaction and fulfillment. Full disclosure: as I write this, I do so as someone who has been on both sides of the therapist/patient interface as well as the therapist/client one. It is going to sound a tad like bragging here at the backend but … additional qualifications for commenting on what to look for is that my works on empathy are footnotes in Goldberg, Wolf, and Basch (see bibliography below).  This list of what to look for is not complete nor is my knowledge and experience; all the usual disclaimers apply; so your feedback, criticism, experiences, impertinent remarks, and comments are hereby requested. Please let me hear from you.

Bibliography

Agosta, Lou. (2010). Empathy in the Context of Philosophy.London: Palgrave/ Macmillan.

__________. (1984). “Empathy and intersubjectivity,” Empathy I, ed. J. Lichtenberg et al.Hillsdale,NJ: Lawrence Erlbaum Press.

__________. (1980). “The recovery of feelings in a folktale,” Journal of Religion and Health, Vol. 19, No. 4, Winter 1980: 287-97.

__________. (1976). “Intersecting language in psychoanalysis and philosophy,” International Journal of Psychoanalytic Psychotherapy, Vol. 5, 1976: 507-34.

Basch, Michael F. (1983). “Empathic understanding: a review of the concept and some theoretical considerations,” Journal of the American Psychoanalytic Association, Vol. 31, No. 1: 101-126. (See p. 114.) .

Gehrie, Mark (2011). “From archaic narcissism to empathy for the self: the evolution of new capacities in psychoanalysis,” Journal of the American Psychoanalytic Association, Vol. 59, No. 2: 313-333.

Goldberg, Arnold. (2011). “The enduring presence of Heinz Kohut: empathy and its vicissitudes,” Journal of the American Psychoanalytic Association, Vol. 59, No. 2: 289-311. (See  pp. 296, 309.) .

Kohut, Heinz. (1984). How Does Analysis Cure? Chicago: University of Chicago Press.

Wolf, Ernest S. (1988). Treating the Self.New York: TheGuilford Press. (See pp. 17, 171.)

This post and all contents of this site (c) Lou Agosta, Ph.D. and the Chicago Empathy Project

April 15, 2011

Live from Division 32 (the Humanistic Psychology Conference, Chicago)! Empathy and Existential Psychotherapy

Filed under: Emotions,Empathy,Feeling,psychotherapy,Self,talk therapy — Lou Agosta @ 6:19 am
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And here is the presentation delivered Sunday April 17, 2011:

CHPCases20110306

Empathy is fundamental to an account of the dynamics of emotions in that empathy is responsible for a person’s emotional equilibrium, homeostasis, balance. Speaking in the first person, without another’s empathic regard for me, I cannot get my emotional bearings. We see this most clearly when, for whatever reasons, a person’s emotional equilibrium has been upset or lost. Without the other’s empathic regard for the person, he or she cannot get back the emotional balance that has been lost. The individual may, indeed will, “crash and burn” emotionally until she is able to comfort herself enough to regain her composure. The person being emotional is whip-sawed from one overwhelming affect and instance of emotional behavior to another. It is the other’s intervention, which consists not just in saying “There, there, I understand,” but in really understanding, in being open to the experience as a vicarious experience that hits one palpably, albeit less powerfully than it impacts the other, that makes the difference in recovering emotional composure.

Since this is a blog post, I end on a personal note. As I write this, I do so as someone who has been on both sides of the therapist/patient interface as well as the therapist/client one. It is going to sound a tad like bragging here at the backend but people might really be wondering …  In addition to substantial work on Heidegger, the phenomenologists, and existentialists, qualifications for commenting on what to look for is that my works on empathy are footnotes in the self psychologists Goldberg, Wolf, and Basch (see bibliography below).  This list of what factors are on the critical path is not complete nor is my knowledge and experience; all the usual disclaimers apply; so your feedback, criticism, experiences, impertinent remarks, and comments are hereby requested. Please let me hear from you.

Bibliography

Agosta, Lou. (2010). Empathy in the Context of Philosophy.London: Palgrave/ Macmillan.

__________. (1984). “Empathy and intersubjectivity,” Empathy I, ed. J. Lichtenberg et al.Hillsdale,NJ: Lawrence Erlbaum Press.

__________. (1980). “The recovery of feelings in a folktale,” Journal of Religion and Health, Vol. 19, No. 4, Winter 1980: 287-97.

__________. (1976). “Intersecting language in psychoanalysis and philosophy,” International Journal of Psychoanalytic Psychotherapy, Vol. 5, 1976: 507-34.

Basch, Michael F. (1983). “Empathic understanding: a review of the concept and some theoretical considerations,” Journal of the American Psychoanalytic Association, Vol. 31, No. 1: 101-126. (See p. 114.) .

Gehrie, Mark (2011). “From archaic narcissism to empathy for the self: the evolution of new capacities in psychoanalysis,” Journal of the American Psychoanalytic Association, Vol. 59, No. 2: 313-333.

Goldberg, Arnold. (2011). “The enduring presence of Heinz Kohut: empathy and its vicissitudes,” Journal of the American Psychoanalytic Association, Vol. 59, No. 2: 289-311. (See  pp. 296, 309.) .

Kohut, Heinz. (1984). How Does Analysis Cure? Chicago: University of Chicago Press.

Wolf, Ernest S. (1988). Treating the Self.New York: TheGuilford Press. (See pp. 17, 171.)

This post and all contents of this site (c) Lou Agosta, Ph.D. and the Chicago Empathy Project

April 10, 2011

Empathy is the new love – and what that means!?

Filed under: autism,Empathy,Feeling,psychotherapy,talk therapy — Lou Agosta @ 10:30 am
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You know how in the world of high fashion grey is the new black? Well, empathy is the new love. Okay, enough with the tenuous humor. What does this mean? Culturally? Politically? Psychodynamically? Polemically? Critically?

Culturally, the context is a conversation in the popular press about empathy. Empathy is now a major publishing event. There is a wave of books on empathy – popular, scientific, political, and scholarly. For example, Frans de Waal’s The Age of Empathy (2009) explores empathy between humans and higher animals; J.D. Trout’s The Empathy Gap (2009) considers empathy and social justice from the perspective of Ignatian Humanism; Jeremy Rifkin’s The Empathic Civilization (2009), now reportedly at $11 dollars, an 800 page hardcover (don’t drop it on your foot) channels Teilhard de Chardin’s idea of a global consciousness, now including the politics of empathy; Jean Decety’s Social Neuroscience (2010) establishes correlations between sensations, affects, and emotions using functional magnetic resonance imaging technology; Simon Baron-Cohen’s Zero Degrees of Empathy (2011) considers the role of empathy in cruelty and diseases of empathy such as psychopathy and autism. Thomas Farrow’s Empathy in Mental Illness (2007) drills down scientifically on the latter diseases of empathy. At the risk of bragging – but if not now, when? – my own empathy book is hard but worthwhile and belongs in the extreme scholarly bucket (see side bar on this web site) as does my refereed on-line “Empathy and Sympathy in Ethics” (http://www.iep.utm.edu/emp-symp). Politically, President Obama continues to drop references  to “empathy” into his speeches, calling out “empathy” as a criterion for US Supreme Court nominees as well as “empathy” in the wake of the mass killings that also wounded Representative Giffords.  Obama’s books contain numerous references to empathy, which, for him means roughly “apply the criterion of how your actions make the other feel and do so prior to acting” as he was reportedly taught by his Mom. You cannot buy publicity like it at any price. This is the context for the discussion of empathy as the new love – what people really want (and what that means).

The main assertion? Under one interpretation of contemporary human relations, people reportedly want love more than anything else. Love is a many-splendored thing including: bonding between neighbors as a kind of Christian agape and the foundation of community; never having to say you’re sorry; just another four-lettered word, which is not the same as sublimated sexuality (itself yet another meaning of “love”) since as a four-lettered word there is no sublimation, it’s just hormones all the way down; the target of narratives about completing the human spheroid in Plato’s Symposium; the last, best hope of happiness. Now fast forward from the days of Erich Fromm’s The Art of Loving (1963) through Alex Comfort’s The Joy of Sex (1974) to today. The argument of this post is that what people “really” want more than anything else is to be gotten for who they are – i.e., people want empathy. This is an unexpressed and undeclared commitment; and something of which most adults are only dimly aware until they get some and discover, “Oh, that’s really cool. It seems to work. May I have another?” Of course, it’s not an exclusive either-or choice; and people still want to be loved too. Just not quite as much as they want to be gotten empathically for who they are. People can get love from Hallmark Cards or from the Internet. There is really a glut in the market for love, though many issues remain with quality. Like any mass product, the quality is questionable. Really fine love remains a scarce commodity in the final analysis. Empathy is a relatively even rarer capacity in the market – though, truth be told, it is common to every mother (or care-taker) or a new born child. We will set aside this paradox for a future post to further consider adult empathy.

In the context of psychodynamic psychotherapy, absent empathy, psychotherapy is hard to distinguish from dental work. It is painful. Is it any wonder that people are asking for psychotropic drugs as if they were an anesthetic. Is it any wonder that Talk Therapy has been in decline since Listening to Prozac was discovered by clients and insurance companies alike? Rare the person who says, “I prefer to do it the bloody hard way – let’s meet more times a week.” I hasten to add that if a person is developing a suicide plan, they should be encouraged (required) to take their sedatives and related medications (SSRIs, SNRIs, etc.).

In the psychodynamic context, this immediately inspires additional controversy. From the perspective of psychotherapy – whether self-psychology oriented, existential, or classical – given that empathy is the new love, if a therapist offers empathy does that mean he or she is offering love? It would be a mischievous distortion to say so or do so. Mischievous and wicked. In general, such a thing wouldn’t work, does not work, and is a non-starter. The “cure through love” is “wild” and a boundary violation – and it should be so dismissed. Still, there is a significant sense in which the idealization of the therapist by the client is related to the idealization that also occurs in love. This is a function of the transference. The transference of idealizing and aggrandizing attachments (connections) from the client’s other relations into the therapy and onto the person of the therapist. Simply stated, if love shows up as idealization in the transference, then so be it. The love in question is related to the client’s defense mechanisms, resistances, and historical patterns. It could also be related to the therapist’s counter-transference; but in either case it is independent of the therapist’s empathic methods of data gathering about how the client experiences love, hate, fear, anger, sadness, and happiness. Love, its idealization or aggradization, will get interpreted along with resistance using empathic methods.

Polemically, and with apologies to Melanie Klein, the suggestion that empathy is the new love invites resistance from the point of view of the paranoid position. No one is advocating an inappropriate “cure through love” (certainly not me). Still, an approach through empathy can inspire fear of non-conformity and dissent and “turn off” psychotherapists who think/feel more in terms of resistance. Some people are scared of empathy because it requires them to open up emotionally and contain another’s feelings, granted even if only in terms of vicarious experience (introspection). In other words, it isn’t just that clients haven’t yet found anyone as wonderful as the empathic psychotherapist, providing a gracious and generous listening. It is that psychotherapy training today is targeted at helping clients deal with and overcome their resistances, borne from prior disappointments, conflicts and deficiencies rather than promote empathy, creativity, humor, or wisdom. There are plenty of the former; less of the latter; and it is just plain more hard work to get both together and converged. The paranoid position goes immediately to “there must be something wrong”. If we are not interpreting resistance right away from the start and continuously, there must be something wrong. However, there is nothing wrong. Resistance happens. Tactically, it is useful and more effective to interpret (“undercut”) resistance in an empathic context. Still, while there is nothing wrong, there is something missing. Absent empathy, psychotherapeutic inquiry is indistinguishable from a root canal.

Critically, one of the classic texts on empathy is Heinz Kohut, How Does Analysis Cure? – the short answer is “empathy”; but it is not an easy read for the average, intelligent, upper class undergraduate. An easier choice on sustained empathy in the context of treatment might perhaps be Arnold Goldberg’s Being of Two Minds (1999), Ernest Wolf’s Treating the Self (1988), or even Bruno Bettelheim’s A Home for the Heart (1974) or The Uses of Enchantment (1975). I am unrepentant in my admiration for Bettelheim’s writing (but that is a story for another post). In addition to the above-cited books on empathy, the reader may find additional resources (papers, links, posts) on empathy on this web site. If you don’t read, see the movies Blade Runner, staring a young Harrison Ford, and The Lives of Others, about an apparatnikin the former Communist East Germany. In both, empathy plays a decisive role. The closing recommendation? If you are seeking psychotherapy services, make sure you ask about the capabilities of your prospective provider in the area of empathy. It is crucial to success. If you are a psychotherapist, get that button from the Hitchhiker’s Guide to the Galaxy and “Don’t panic!” Respectfully decline the paranoid position. There is nothing wrong here. There is nothing wrong with a conversation about empathy. There is plenty of resistance to interpret and empathy can provide an empowering context to do so. Finally, all the usual disclaimers apply. Is this popular psychology? Hey, this is a blog post – you bet it is.

Since this is a blog post, I end on a personal note. As I write this, I do so as someone who has been on both sides of the therapist/patient interface as well as the therapist/client one. It is going to sound a tad like bragging here at the backend but people might really be wondering and if not now when? …  In addition to long work on Heidegger, the phenomenologists, and existentialists, qualifications for commenting on issues of empathy is that my works on empathy are footnotes in the self psychologists Goldberg, Wolf, and Basch (see bibliography below).  This list of what factors are on the critical path is not complete nor is my knowledge and experience; all the usual disclaimers apply; so your feedback, criticism, experiences, impertinent remarks, and comments are hereby requested. Please let me hear from you.

Bibliography

Agosta, Lou. (2010). Empathy in the Context of Philosophy.London: Palgrave/ Macmillan.

__________. (1984). “Empathy and intersubjectivity,” Empathy I, ed. J. Lichtenberg et al.Hillsdale,NJ: Lawrence Erlbaum Press.

__________. (1980). “The recovery of feelings in a folktale,” Journal of Religion and Health, Vol. 19, No. 4, Winter 1980: 287-97.

__________. (1976). “Intersecting language in psychoanalysis and philosophy,” International Journal of Psychoanalytic Psychotherapy, Vol. 5, 1976: 507-34.

Basch, Michael F. (1983). “Empathic understanding: a review of the concept and some theoretical considerations,” Journal of the American Psychoanalytic Association, Vol. 31, No. 1: 101-126. (See p. 114.) .

Gehrie, Mark (2011). “From archaic narcissism to empathy for the self: the evolution of new capacities in psychoanalysis,” Journal of the American Psychoanalytic Association, Vol. 59, No. 2: 313-333.

Goldberg, Arnold. (2011). “The enduring presence of Heinz Kohut: empathy and its vicissitudes,” Journal of the American Psychoanalytic Association, Vol. 59, No. 2: 289-311. (See  pp. 296, 309.) .

Kohut, Heinz. (1984). How Does Analysis Cure? Chicago: University of Chicago Press.

Wolf, Ernest S. (1988). Treating the Self.New York: TheGuilford Press. (See pp. 17, 171.)

This post and all contents of this site (c) Lou Agosta, Ph.D. and the Chicago Empathy Project

Please get in touch with further questions or for further ideas. Let me hear from you.

March 1, 2011

Variations on Empathy IN TREATMENT

Filed under: Einfühlung,Emotions,Empathy,Feeling,Introspection,psychotherapy,Self,talk therapy — Lou Agosta @ 12:02 pm
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Your psychotherapy session is now a major HBO Miniseries, In Treatment. Mine too. Two obvious questions occur. One for prospective clients, one for therapists. If I go to see a therapist about some personal issues and problems, is this what I can expect from treatment? If I am a therapist and someone walks into the room, is something like this HBO series what the individual is expecting? In either case, I decided literally to check out a dozen weeks of the series from Blockbuster and watch it all at once in order to perform a reality check and manage the expectation. Full disclosure: I watched about a dozen of the episodes from seasons one and two.  I did not see how the narrative ends. If you require an update or synopsis on the drama (“melodramatic content”) of the series, that is not provided here.

This is what I learned. The writing is top notch. The screen plays are well written, developed, and engaging – from a dramatic point of view. The acting is top notch. The performances are well crafted. In Treatment is different than real world psychotherapy in at least three respects.

First, the amount of work required getting to a psychodynamic insight, transformation, and result is minimized in the screen play. Thus, the show condenses into a twenty minute segment what might reasonably be expected to require ten or more actual psychotherapy sessions. Unfortunately, by its very nature television turns real human suffering into melodrama. That is not necessarily bad – no finger wagging here – since sometimes we all do the same thing – and that includes psychotherapy patients. We tend to turn suffering into melodrama. Now add psychodrama. However, the challenge is to distinguish real human suffering from the melodrama, each of which is a fundamental part of life. Psychotherapists understand that life can be – is -  a veil of tears. Life is also  inherently dramatic – and melodramatic. Some people are very attached to the melodrama. Without in any way dishonoring or minimizing the challenges of being a victim, the melodrama of victimization or specialness or rescue fantasy provides significant secondary gains (“pay off”). Some flaunt the melodrama; others are ashamed of their melodrama. In some cases, the melodrama is out-and-out human tragedy including shocking trauma, deep suffering, and all the negative side effects that go with it. In other cases, there is a noticeable absence of trauma and yet significance emotional upset, possibly related to pathogenic fantasies and ideas. Significant work over a number of session – not necessarily years, but definitely more than twenty minutes – is required to disentangle these distinctions.

Second, from a clinical point of view, the psychotherapist, Paul, displays excellent intuition. However, he does not have enough time to deploy the long term immersion in listening to the other person required for sustained empathy. What is the difference? Intuition uses subtle clues in the other’s speaking and behavior to provide inferences to the other in a kind of educated guess as to what is going on that can even rise to the level of an “Aha!” moment. Empathy is a form of vicarious experience of the other individual in which I know what the other is experiencing because I experience it too, albeit as a trace affect, experience, or sensation. I repeat: just a trace affect, not total immersion and merging. Empathy includes the additional condition and qualification that the self-other distinction is maintained, even if momentarily suspended via a transient, temporary identification. In a psychotherapy context, empathy requires a sustained immersion – listening – to the other individual and the other’s story, experiences, narrative. There is not a lot of time to do that on camera in a half hour show. Intuition is more dramatic and engaging. For example, in the case of the college student in season two who has a life threatening disease that she does not want to acknowledge (or get chemotherapy for), the young lady presents to Paul with a critical account of a former therapist who kept repeating herself and who was dropped. Paul immediately infers – what is likely accurate – that the client will do the same to him as soon as he stumbles into her blind spot. He shares this with her without apparent impact on the client but with significant impact on the listening audience, who are suitably impressed. Empathy would have required Paul to provide additional context and interpretation based on the real fear (at having a dread disease) and defensive “flight (and fight)” reaction by way of background – you are (perhaps) feeling not listened to, appreciated, or understood; and who do you usually respond when that happens? This is not to say that intuition is useless. It is a powerful tool, and given the urgency of the client’s predicament, it has its uses. The point is just that, as a show, In Treatment is limited in its ability to exploit the distinction between intuition and empathy due to the inherent constraints of the media. The really important content – the empathic resonance – is not visible on the DVD. It never is. To “see” it, one would have to be able to introspect the experiences, sensations, and feelings of the listener and speaker. One more thing. The celebrated psychoanalyst, Heinz Kohut, engaged this distinction between intuition and empathy in detail towards the backend of The Analysis of the Self (1971) where he pointed out that the beginner psychotherapist often has a keen appreciation and use of intuition. As the therapist becomes more experienced in the analysis of the self, this intuition is transformed into the capacity for empathy – as well as human creativity, and wisdom. In this respect, Paul is more of a beginner than is acknowledged in the screen play.

Finally, while psychotherapy can indeed call up the ghosts of the past – trauma and unhappiness – the process can be empowering in the areas of self-expression, creating possibilities, and even fun. In Treatment is a dark and difficult melodrama. Granted that individuals are often impelled into therapy by dark, traumatic, and difficult life experiences, once engaged underway therapy can be a source of satisfaction and even joy. Fun is conspicuously absent (granted, it is rarely apparent at the start). Naturally, all the usual disclaimers apply – your mileage may differ. However, one might reasonably expect to see significantly more favorable outcomes than what occurs in the (otherwise excellent) screen writing. According to the screen writers, the amount of advice, guidance, and confrontation that Paul provides is quite simply “over the top” in relation to real world psychotherapy. Once again this is not to say that advice, and so on, is bad. Far from it. It is useful. However, it is not what psychotherapy is about in its fundamental commitment. In its fundamental commitment, psychotherapy is a commitment to provide a gracious and generous listening (empathy) in the interest of client (patient) possibility, transformation, and self-expression. Often one of the more immediate results of empathy is symptom relief. Significant work is required for the transformation of symptoms into creativity, wisdom, and pragmatic results. Amidst interpretations, pattern detection, transference, and explanations, the work of therapy requires a dogged ability to engage and put what is not working (including the past) back in its place in order to open the future to new possibilities. I know of one client who, in a more cynical moment, said to his therapist, “This process is like being the friend of Tom Sawyer. You have to both paint the fence and pay to do it.” Well, after the age of Listening to Prozac, it can seem like a lot of work; and surely talk therapy takes something extra over and above the band-aide of popping a pill (or a long series of them, the side effects of which you do not want even to think about). Nevertheless, it does not have to be a years long process – though that is possible too – and significant results can be gained in ten or twelve sessions of psychotherapy; and the collateral damage is significantly less than ten or twelve sessions of ECT [electro convulsive therapy] and I have seen ECT used up to 40 sessions. Imagine what can be accomplished in 40 sessions of talk therapy. Okay, ECT is not funny; the delivery of the shocks has been improved to provide micro-bursts; and if you are suicidal, all options are on the table against suffering. Extra caution: Both parties have to be clear and explicit about the therapeutic contract up front in to get results such as those envisioned here. However, the point is that In Treatment just might give talk therapy the boost in requires in this post Prozac, pragmatic, results-oriented age, even amidst its melodrama, virtual experience of treatment, and intuitions.

February 19, 2011

Empathy in the Context of Psychotherapy (Talk Therapy)

Filed under: Einfühlung,Emotions,Empathy,Feeling,Introspection,psychotherapy,talk therapy — Lou Agosta @ 1:49 pm
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Absent a gracious and generous listening (empathy), psychotherapy is hard to distinguish from a dental procedure, probing sensitive, tender spots with sharp instruments. Empathy makes all the difference. If a person is going to express difficult and sensitive personal content, then speaking them into an empathic listening is on the critical path to restoring emotional equilibrium and effective action. Empathy is at the top of the list of what is required for creating the possibility of breakthrough results in the areas meaningful to the speaker (the client).

Indeed empathy itself can be transformational. Just having another person really “get” what it is that is challenging, upsetting, or inhibiting an individual can be activating, enabling a person to recover and sustain commitments that produce results. How does “just talking” make a difference? Calling forth experiences and distinctions that already lurk in the background, boldly stating the obvious (and the less obvious), can make a dramatic difference in removing the blinders that prevent a person from seeing what is “obviously hidden in plain view”. This enables the process of growth and development to resume and go forward in an uninhibited way. In other more challenging cases, empathy combined with an inquiry/analysis into the sources of resistance to change – secondary gain – is required to “jump start” the process of getting moving forward emotionally and in action-oriented ways.

A simple rule-of-thumb is that whatever a person’s issue or obstacle is that “whatever” will be brought into the therapeutic situation. So, to take a deceptively simple example, if your issue is procrastination about career, relationships, money, health (well being), then a similar issue will soon arise in relationship to the therapist. You will be unable to make up your mind whether he or she is really right for you; whether you want to meet once a week or more; how firm is the commitment, and so on. The advantage to having the experience in a well defined situation (rather than the messiness of life at large) is that therapy is context that has fewer variables and that can be looked at in detail between just two people. This enables insights and breakthrough is grasping what is the pattern and why it is activated and triggered here-and-now. This enables insights and break throughs to occur that might not be attainable in the more complex, open system of life at large.

The results of talk therapy include enhanced emotional stability, more power to deal with mood fluctuations when those inevitably occur, improved self-expression, power to deal with upsets in a constructive way that gets one moving again, greater capacity for affection and affinity (and its expression), freedom from worry and preoccupations that drain energy, the experience of oneself as having the power to choose and make a contribution, enhanced self-confidence and personal effectiveness. Talk therapy can also enhance personal traits such as empathy, humor, creativity, and even wisdom in the face of life’s challenges. The impact on relations, career, family, finances, self-expression, and the experience of choosing and personal productivity can be dramatic. This list is far from complete.

This is the age of client service. Any therapist of merit is likely to be a pragmatist. After two or three sessions to get to a diagnostic formulation, he (or she) should be prepared to talk frankly about (1) how he proposes to make a difference in dealing with your complaint – a treatment plan (2) the rewards and risks of talk therapy – a therapeutic contract – even if not in writing (3) fee for service (billing) (4) scheduling.

The results of psychotherapy vary from one person to another, so all the usual disclaimers apply (obviously!). Your mileage may vary; and a key variable includes finding someone to talk with candidly and confidentially where the chemistry between the two persons is just right. In this case, “chemistry” means “empathy”.

At the risk of redundancy (and since this IS a blog), I end on a personal note. As I write this, I do so as someone who has been on both sides of the therapist/patient interface as well as the therapist/client one. It is going to sound a tad like bragging here at the backend but if not now when? … Additional qualifications for commenting on empathy in the context of talk therapy is that my works on empathy are footnotes in Goldberg, Wolf, and Basch (see bibliography below).  This list of critical success factors is not complete nor (obviously) is my knowledge and experience; all the usual disclaimers apply; so your feedback, criticism, experiences, impertinent remarks, and contribution are hereby requested. Please let me hear from you.

Bibliography

Agosta, Lou. (2010). Empathy in the Context of Philosophy.London: Palgrave/ Macmillan. [See not link above right.]

__________. (1984). “Empathy and intersubjectivity,” Empathy I, ed. J. Lichtenberg et al.Hillsdale,NJ: Lawrence Erlbaum Press.

__________. (1980). “The recovery of feelings in a folktale,” Journal of Religion and Health, Vol. 19, No. 4, Winter 1980: 287-97.

__________. (1976). “Intersecting language in psychoanalysis and philosophy,” International Journal of Psychoanalytic Psychotherapy, Vol. 5, 1976: 507-34.

Basch, Michael F. (1983). “Empathic understanding: a review of the concept and some theoretical considerations,” Journal of the American Psychoanalytic Association, Vol. 31, No. 1: 101-126. (See p. 114.) .

Gehrie, Mark (2011). “From archaic narcissism to empathy for the self: the evolution of new capacities in psychoanalysis,” Journal of the American Psychoanalytic Association, Vol. 59, No. 2: 313-333.

Goldberg, Arnold. (2011). “The enduring presence of Heinz Kohut: empathy and its vicissitudes,” Journal of the American Psychoanalytic Association, Vol. 59, No. 2: 289-311. (See  pp. 296, 309.) .

Kohut, Heinz. (1984). How Does Analysis Cure? Chicago: University of Chicago Press.

Wolf, Ernest S. (1988). Treating the Self.New York: The Guilford Press. (See pp. 17, 171.)

This post and all contents of this site (c) Lou Agosta, Ph.D. and the Chicago Empathy Project

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