Abstract
Resistance to empathy takes many forms. Resistance to empathy includes those factors coming from the therapist, those from the patient, including those emerging in the interaction, and those from the culture at large. Although “the culture” is distinct from “the system delivering mental health services” and different from Racker’s “countertransference to the psychoanalytic organization,” especially by those in training (Racker 1968), for purposes of this discussion, the three are considered together. They are ideal types and mixed cases are frequent. This article engages the details of resistances to empathy. Clinical cases exemplifying empathic narratives, as one patient expresses it, of the “Freud [sic, fraud] of psychiatric diagnosis” and related are explored.
Empathy and Its Inauthenticities
This is the ultimate inauthenticity. The author of a book on empathy struggles with his empathy.[1] Introducing myself saying, “I am the author of a book on empathy, and you can count on mine” gets a rise out of people. It sounds like “empathy lives over here by the author of this article.” Over there – “over there by you, the reader” is lack of empathy. Of course, that is a misunderstanding. The commitment in engaging empathy and its resistances it to expand the possibility of empathy and the extent of empathy in the world. On a good day, one does get all the way to empathy – all the way to a gracious and generous listening. Then one has to complete the loop, close the circle. One demonstrates to the other person that one relates to the other and acknowledges the other’s humanity, as a possibility, in the struggles and accomplishments the other has expressed. On a less good day, one struggles along with everyone else. One is subject to the inauthenticities of empathy like everyone else – that one is a wonderful listener, that others admire and idealize one, that one’s guidance is golden. If there is self-deception about the extent and depth of one’s empathy, then can resistance be far behind?
Empathy is one of those things like motherhood and apple pie that every person endorses. How could anyone be against them? What’s not to like? Yet when it comes to my mother or your mother or this tasty looking calorie-laden dessert totally at odds with one’s commitment to taking off five pounds, maybe it is not such a good choice. It reminds one of Thomas Ogden’s patient, who, at the start, associates to misadventures and slips suggesting maybe this process of psychoanalysis is not such a great idea after all. Or the therapist who is not afraid that the patient will leave, but rather afraid that he will stay (Ogden 1992: 228). In short, there is a suspicion that there is more ambivalence about empathy than initially meets the eye. In turn, the ambivalence recruits enactments – confrontations, canonical advice, prescribing medications (or referrals for such) when not really required, affixing devaluing diagnostic labels (“borderline,” comes to mind) when the individual is merely “reactive” and “difficult,” or speaking ex cathedra as the authoritative decoder of meaning instead of the empathic inquirer. Once again, I know that I am not the only one struggling but I too struggle with the ultimate inauthenticity of listening. One is not listening to what the other said. One is listening to his own opinion of what the other person has said. One is listening to one’s opinion of whether one agrees, disagrees, values, devalues, or how it reminds one of something else that one then judges and evaluates. These judgments too get in the way, and are recruited by narcissism to form resistance to empathy. The resistance is subtle. It is rarely acknowledged. It is pervasive. One key to overcoming – or at least managing – the ultimate inauthenticity is to take the focus off of oneself. Empathy lives in relatedness – as the foundation of the community of interrelated individuals, even as the dynamic duo of the psychoanalytic and psychotherapeutic conversation. (Note that this article will henceforth simply say “therapy” and its forms instead of “psychoanalysis and psychoanalytically oriented therapy.”)
Nor should we forget that when we speak of “resistance to empathy,” “resistance” has a long history of being a blessing in disguise – being given lemons and making lemonade. Transference resistance emerges in Freud’s most spectacular failed case, Dora, and it starts out looking like a nearly insurmountable obstacle to treatment. However, this obstacle and the accompanying breakdown becomes a method of getting traction through interpretations that advance treatment. Transference resistance becomes “transference neurosis,” which is “an artificial illness which is at every point accessible to our intervention” (Freud 1914: 154). Breakdown becomes a source of breakthrough.
Likewise, the case is analogous with the analyst’s countertransference. At first it seems an obstacle and a source of breakdown. Freud stresses the need to overcome the countertransference, noting that no therapist can get further in his work with patients than allowed by his own complexes and countertransference. All well and good. Thus, the need for the therapist’s own psychoanalysis, training analysis, and on-going self-analysis (Freud 1910: 144). But the obstacle of countertransference and all the counter-measures become the source of progress and insight. Heinrich Racker speaks truth to power, telling it like it is, and in view of his early death, the psychoanalytic profession decides to honor him and follow his guidance. Far from being dispassionate, the neutral, anonymous, abstinent therapist experiences anxiety, aggression, guilt, etc. (Racker 1968: 169). But when made the focus of his own introspective examination, such countertransference reactions are the source of a breakthrough in the therapist’s relatedness to the patient. Distorted and deficient understanding emerges in the countertransference, which, when processed introspectively-empathically, becomes the basis of positive, integrating interpretations from which the treatment benefits (1968: 153). Again, obstacles and breakdowns point the way to breakthroughs in interpretation and treatment. Thus, the pattern. Arguably, this pattern is also active in the case of resistance to empathy. Unless engaged and made the target of analytic inquiry, it will continue to foil treatment and progress in overcoming emotional suffering. Once engaged, it opens the possibility of progress in using empathy to create possibilities for flourishing and satisfaction where they had previously not been envisioned. However, the forms of resistance are diverse. The devil is in the details, to which we now turn.
Types of Resistance to Empathy
Resistance to empathy includes those factors coming from the therapist, those from the patient, including those emerging in the interaction, and those from the background. Although “background” is distinct from “culture,” “mental health services,” and different from Racker’s “countertransference to the psychoanalytic organization,” especially by those in training (Racker 1968), for purposes of this discussion, the three are considered together. [….] It is relatively short step to gather these distinctions together into a definition of empathy is a multidimensional process encompassing a whole with integrated parts: empathic receptivity, empathic understanding, empathic interpretation, and empathic speech (including listening).
Furthermore, the intersection between Racker’s use of countertransference and empathy is substantial:
[…] [I]t is mainly through the countertransference that we feel and can understand what the patient feels and does in relation to the analyst, and what he feels and does in face of his instincts and feelings toward the analyst (Racker 1968: 60).
If this does not describe empathy, then I would not know what does. Yet overlap is not identification. The reason is simple. On any given occasion, the therapist may be empathic without being distracted, guided, or misguided by countertransference. For example, the communicability of affect undistorted by the analyst’s own issues does occur, and may usefully be acknowledged. In a celebrated example, Dr. Ernest S. Wolf empathically picks up on the experience of latent playfulness where the patient’s manifest presentation was a mournful one, and that is of the essence in his interpreting the leading edge of new possibilities for his patient’s completing her relationship with her difficult, difficult mother (e.g., Wolf 1988: 20-21). Empathy is sui generis and not derivative from countertransference, though the latter influences, guides, misguides, and is input to both empathy and misfirings of empathy.
Empathy provides a vicarious experience of what the other is experiencing. Vicarious experience is what one experiences in the theatre, in a film, or in engaging with a novel. Do not under-estimate the capacity of a vicarious experience to shake one to the core of one’s being. Yet “vicarious” provides a representation – a trace, a sample – not the full-blown experience of what the other is experiencing. In that way, empathy is actually a healthy defense, providing a barrier against over-stimulation, against compassion fatigue, burn out, apathy, or fragmentation. If one experiences compassion fatigue or apathy as a result of being empathic, then one needs to tune up or tune down one’s empathy. One is over-identifying, distancing, merging, or over-intellectualizing. Simply stated, one is doing it wrong. As an attitude towards the other, empathy is a filter – a semi-permeable membrane, a quasi-stimulus barrier – that allows a communicability of affect, feeling, and emotion while preserving a disinterested distance between self and other. Empathy provides a trace of the other’s experience, not the over-whelming presence of a totality of a tidal wave of affect, emotion, or negative feeling. As a form of data gathering about the experiences of the other, empathy samples the experience of the other without merger, over-identification, or over-intellectualization and affective remoteness. Yes, the empathizing person is open to the unhappy experience that the other individual is enduring, but as a trace affect, not the whole bottomless pit of suffering. Yes, one suffers; but, unconventional as it may sound, one suffers only a little bit.
The Resistance to Empathy Lurking in the Background
The matter of resistance to empathy on the part of individual therapists and patients is complicated by the psychosocial dimension. Empathy is not the possession of any one individual. Empathy lives in the relatedness between individuals. Empathy belongs to the community, even if only the community of the analytic duo.
There is no such thing as empathy in isolation. Psychodynamic resistance to empathy recruits obstacles to empathy that have little or nothing to do with personal conflict, traumatically nonresponsive selfobjects, or defense transference. Resistance to empathy is a function of psychoanalytic cultural and community standards or lack thereof that exist in the background. It is always the individual, whether patient or therapist, that is engaged in equilibrium or resistance. But the individual opportunistically adopts views expressed or endorsed by professional organizations, including psychotherapeutic ones, cultural icons and artifacts, and ideas abroad in the community at large. Racker’s transference and countertransference to the local psychoanalytic institute in the background looms large here.
Next, we turn to one of the defining documents of calling out resistance to empathy, Kohut’s posthumously delivered “Introspection, Empathy and the Semi-Circle of Mental Health” (1982).
Towards the end of his career, Kohut returns to the topic and title where he started and from which he rarely strayed. Never shy to begin with and in precipitously declining health, Kohut is no longer in the position of having to be cautious in speaking truth to power as he did in his initial article (1959). In his 1982 statement, Kohut names the names of those, who, in his original 1959 presentation, simply did not get the point or, in denial, pretended not to get it while “back channeling” organizationally to ignore and devalue his innovations (e.g., Rudolph Loewenstein, Helen McLean, Maxwell Gitelson, and Franz Alexander are called out by Kohut as being on the panel and “not getting it”).
In this powerful statement (1982), Kohut is fully self-expressed, and he is angry. However, he has not lost his self-depreciating sense of humor – or his empathy. Kohut cites the example from Laurence Stern’s Tristam Shandy where the young protagonist, in the process of urinating out of the window for reasons not to be explored further here, gets his penis badly bruised as the window falls on it due to the counter-weighs having been removed by his Uncle Toby for his military miniature war games behind the manor house. A picture of narcissistic imbalance – not to mention castration anxiety and wincing pain – is evoked. Like the celebrated surrealist artist Marcel Duchamp’s classic urinal – the artwork – that says to the movers and shakers of the art world’s entrenched mediocrity, “Piss on you,” we get a picture of “bad boy Heinz”. We also get a picture of the “war games” between ego psychology, self psychology, and the object approach. Yet, like Kohut himself, the whole person, not the part object, the self remains intact, maintains its integrity, and is ever again available as whole and complete for exhibiting in the marketplace to confirm its wholeness. Thus, Kohut’s own innovations and initiatives have alternatingly struggled and flourished in the market place of ideas. Even as Kohut personally suffers tragic man’s incompleteness and unfinished business, self psychology lives.
Kohut explicitly denies that his paper is going to interpret the resistance to empathy. However, the suspicion is that he does so in spite of himself. A constantly reiterated theme in Kohut’s work is that narcissistic rage is reactive to injuries and slights endured by the self in the face of unempathic others – the technical term for which is selfobjects. In individual case after case, after a suitably long process of analysis, which has yielded many benefits, it turns out that the patient’s rage is seemingly cycling upwards, and the therapist cannot understand why. Negative therapeutic response? Is this due to mutative interpretations having removed the defenses (resistance) holding down primary aggression? Or is it due to the patient’s experiencing the interpretations as being inconsiderate, condescending, arrogant (this list is not complete), and responding with rage at being retraumatized in the area of her or his vulnerability? This is in principle a solvable problem, though the devil is in the details. It is just that prior to The Analysis of the Self (1971), one did not have a systematic way of describing what came to be called “narcissistic rage,” sourced in self-related issues and an artifact of misinterpretation. It is true that there were hints, but mostly complex and debatable ones, such as Ferenczi’s (1949) – and he was a notorious “wild man” – nor was Kohut’s interest in Ferenczi sufficiently appreciated in the self psychology community (see Lunbeck 2011 for an eye opening discussion).