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This work aims to be educational in a brain-storming way about the role of empathy in the community and the market for empathy services. Hanna Holborn Gray has said that “education should not be intended to make people comfortable, it is meant to make them think.” I hereby also add: The intention of education is to expand one’s empathy. Amazingly enough that is not as comfortable as many people might imagine, which brings up to the first trend – resistance to empathy.
10. Resistance to empathy grows and is acknowledged. I may be a tad late with this one, since it is actually front section news in the New York Times, but just in case you have been living in a cave: Empathy is supposed to be like motherhood, apple pie, and puppies. What’s not to like? Yet people can be difficult – very difficult – why should empathizing with them be easy? Yet most of the things that are cited as reasons for criticizing and dismissing empathy – emotional contagion, projection, misinterpretation, gossip and devaluing language – are actually breakdowns of empathy. With practice and training, one’s empathy expands to shift breakdowns in empathy to breakthroughs in understanding and building community.
9. Empathy is not an on-off switch; it is rather a dimmer or rheostat (and the public debate acknowledges this). Engaging with the issues and sufferings with which people are struggling can leave the would-be empathizer (“empath”) vulnerable to burnout and compassion fatigue. The risk of compassion fatigue is a clue that empathy is distinct from compassion, and if one is suffering from compassion fatigue, then one is doing it wrong. The listener may get a vicarious experience of the other’s issue or problem, including their suffering, so the listener suffers vicariously, but, strange as it may sound, not too much. As noted, if one is over-whelmed by suffering, one is doing it wrong, and one needs to increase the granularity of one’s empathic receptivity. Empathy is like a dimmer – tune it up or tune it down. Empathy is like a filter – increase the granularity and get more of the other’s experience or decrease the granularity (i.e., open the pores) and get less. That is the whole point of a vicarious experience – and training one’s vicarious experiences as distinct from merger or over-identification – to get a sample or trace of the other’s experience without being overwhelmed by it. Empathy is not so much an on-off switch as it is a dimmer or rheostat to gradually turn the lights up or down – gradually expand or contract the granularity of one’s empathic receptivity. This point is completely missed in the otherwise engaging and spirited public debate feature in the New York Times where Hamid Zaki identifies empathy with compassion – and – how shall I put it delicately? – it is a conversation of deaf persons about the importance of listening from that point onwards[see http://tinyurl.com/gwmfpxp%5D. The recommendation? Listen, interpret the resistance and apply conflict resolution principles – identify and express grievances, invite self-expression, apply the soothing salve of empathy to the narcissistic injuries, elicit requests/demands, propose compromises / action items, iterate – until resolution.
8. Empathy is too important to be left to the psychologists. For psychologists empathy is by definition a psychological mechanism. For example, identification or transient identification or projection plus introjection (or visa versa) or mirroring or mirroring plus recognition of the other or inner imitation or motor mimicry. (This list goes on and this is not complete.) And while there is nothing wrong with psychological mechanisms or neuropsychological narratives built around their operation in the cerebral neural cortex and basal ganglia, there is something missing – empathy. So what then is empathy? Very short definition: It is being in the presence of another human as a human being with nothing else added. This [big word trigger alert] is the ontology of empathy – being in the presence of the other individual without anything else added. (This is called “ontology” – the study of being and ways of being, and it is definitely not psychology.) For example, Heinz Kohut, a psychiatrist from a time when psychologists were either psychoanalysts (or behaviorists), had a definition of empathy as vicarious introspection. This has an key ontological dimension as Kohut says “the idea of an inner life of man and thus of a psychology of complex mental states, is unthinkable without our ability to know via vicarious introspection – my definition of empathy […] what the inner life of man is, what we ourselves and what others think and feel life of the other individual would be inconceivable without empathy” (Kohut 1977: 304). The point is that empathy is both deeper and broader than a psychological mechanism – it is the basis for relatedness between individuals. Without empathy, no relatedness. Empathy grants being to relatedness. This matter of being with the other individual, in turn, becomes the foundation for community in an expanding circle of inclusion. As soon as one adds diagnostic categories, labels, arguments – which, admittedly, can be required in some contexts – empathy mis-fires, relatedness goes missing, and resistance to empathy expands. Thus, an empathic conversation is frequently challenged to find the equilibrium between using categories and distinctions to access the experience of the other individual while being with the other and being receptive to the vicarious experience of their suffering (or joy) as another human being.
7. Life coaching gets traction as empathy consulting. Empathy and life coaching intersect (again). The reason an Olympic athlete has a coach is not because she is not good at what she does. Positively expressed, people get a coach when they want to take their game – their performance – to the next level. Many people are already good at what they do and are committed to expanding their results in one area or another such as career, relationships, physical well-being, contribution to community, or peace of mind, in which their experience indicates something is missing. People get a therapist when they want a diagnosis or when they are pushed into survival and need to find a way out. Nothing wrong with that – indeed it can be critical path to transforming suffering into productive results. However, there is good news here – many people are not suffering but have an area in their lives that needs work to provide the results to which they are committed. This is where empathy is oxygen for the soul and can facilitate breathing easier in climbing the stairs to self-satisfaction in accomplishment. Yes, performance may usefully be measured “by the numbers” with meaningful data, but you don’t just need data, expanded empathy is required too.
6. “Hug a stranger” becomes an empathy trend. I am not making this up – well, okay, in a way, I am. The human body is the best picture of the human soul. So hugging another person is not just an emotional and physical but also a spiritual gesture. In this case, hugging and the “space of hugging” starts a journey of discovery that gives us access and reveals that there are far fewer strangers in the world – possibly none – then we at first imagined. I learned about this trend from Stone Kraushaar who distinguishes the physical embrace – the hug [with permission] – between two people from the “space of hugging,” which (on a good day) opens up a whole universe of empathy, sharing, transforming, building community, and being with mutual humanity. While acknowledging that hugging is not empathy, in the context of Stone’s work (and pending book), it is – in the deep sense of being in the presence of another human being without anything extraneous being added or subtracted. So if you see people walking down the street stopping for conversation, asking permission, breaking out in spontaneously hugging one another, you will know they have been engaging with Stone’s provocative proposal. You just might see yourself and encounter your own humanity in another in a new way you had not previously imagined. The empathic point is that you start by thinking these other people “out there” are strangers but when you get to know them well enough to be comfortable with a hug, you and they belong to the same community – you are not strangers after all.
5. Health insurers promise empathy, do not deliver, and continue to collect monopoly rents. The empathy gap widens. Health insurers maintain a firm grip on the market for empathy-related “behavioral health” services without actually providing any. This is the only candidate trend from last year that I am repeating, since it is still accurate but a work in progress – and, unfortunately, picking up speed, going in the wrong direction. The Affordable Health Care Act (“Obamacare”) – reportedly to be terminated with extreme prejudice as this piece is about to be posted – promised to equalize benefits for medical benefits such as annual physical health checkup (including $800 worth of blood work) with mental health services such as psychotherapy. At the risk of being cynical, I don’t know if the reader has tried to collect lately or services rendered. The war stories, pretexts for nonpayment, and simple violations of their own rules – e.g., timely response – by insurers continue to mount. One feels a certain dissatisfaction with the lack of solutions. What to do about it? In spite of claims to the contrary, the recommendation from insurers seems to be: “But your majesty, the people have no mental health benefits. Then let them pay cash! And then let them eat cake.”
4. Medical doctors “get it” – empathy is good for your health. Empathy gets traction as an evidence-based intervention. “Evidence-based everything” is the gold standard in medical and so-called “behavioral health” interventions; and that is as it should be (Jeremy Howick, (2011)). The “gold standard” of the “gold standard” is double-blind testing, which works especially well in the cases of drugs in which one can indeed “double-blind” the test so that neither the researcher nor the recipient knows who is getting what pill. While judgments based on clinical practice, tacit knowledge, and deep life experience will continue to have a role, these need to be qualified by the best available evidence. But here is the issue: There are some interventions such as penicillin and using a parachute when jumping out of an airplane that seem to limit or even defy the gold standard. It would be unethical not to give someone penicillin if they were infected with an infection serious enough to require such treatment, since it is a matter of historical accident that penicillin was invented prior to the “evidence based” paradigm shift. And, as regards using a parachute, that case is the reduction to absurdity of not using common sense as a criteria in deciding what counts as evidence. What is going on here? The answer: The effect size is so large that it outweights and overwhelms any hidden confounding factors and so rises to the level of evidence (without quotation marks) [Howick: 5, 11]. The :effect size” is a function of the the fact – the evidence – that there are so many examples and so much experience that penicillin works – that parachutes – work that the risk of one’s over-looking some other confounding variable is vanishingly small. It really was the penicillin, not (say) the effects of the alignmnet of the planets hidden behind the penicillin. Likewise, with empathy. The trend here is that research will emerge that puts the use of empathy in human relations as demonstrably so effective in the medical and behavioral health contexts in question that not to apply empathy would be like not prescribing antibiotics against a bacterial infection. Empathy has been effective in shifting the suffering and transforming the psychic pain throughout history. The criticism of empathy has usually been that it results in burnout, compassion fatigue. But penicillin, too, has to be properly dosed or the results will be unpredictable. Regarding empathy, see the discussion above about empathy not being an on-off switch but a rheostat that requires training to get just right. Examples of peer-reviewed publications exist in which empathy was shown to be effective (in comparison with less empathy) in correlating with favorable outcomes in diabetes, cholesterol, and the common cold (?!) and are cited in the bibliography (see M. Hojat et al, (2011), John M. Kelley, Helen Riess et al, (2014), David P. Rakel et al, (2009)). Expect this work to expand and gain traction in other areas such as psychiatry and cognitive behavioral therapy. In short, not to begin with empathy would be like jumping out of the airplane without a parachute or not providing penicillin when the infection was bacterial. Curiously enough, among medical doctors, psychiatrics are alleged to be “lagging adopters”; among psychologists, those specializing in cognitive behavioral therapy are – note that Arthur Ciaramicoli claims to have it both ways (in a book (2016) that I wish I had written).
3. The culture of empathy taps into the power of empathy. Empathy gets in touch with its own power and becomes self-aware as being powerful. This is (and would be) completely unpredictable. At least initially that looks like the culture of empathy partnering with assertiveness training, fair fighting, and being self-expressed. The culture of empathy gets traction in conflict resolution, building community, setting limits to the anti-empathic methods of bullies; and this trend gets the attention that it so richly deserves. The CultureOfEmpathy [one word] is the web site and brain child of Edwin Rutsch, whose has literally interviewed dozens of empathy scholars and researchers (including myself) and is one of the most inclusive people I have ever met. Here is the issue: in fighting off bullies how does one do so in such a way that one does not become a bully oneself? The recommendation is direct: empathy is about setting boundaries between self and other and crossing boundaries between self and other in a way that enhances mutual understanding and community. No one was ever required by empathy to be a door matt. Since empathy works best and seems to require that people relate as equals in the matter of their humanity, the relation between empathy and power has always been fraught. It requires work. When the power relations as too asymmetrical or when force (violence) is being used to coerce an outcome, then a level playing field has to be reestablished for empathy to get traction. Then the empathic thing to do is fight back – self-defense is its own justification. Simple as that (though, as usual, the devil is in the details). Bullying – and related forms of aggression are the contrary of empathy – crossing boundaries in ways that generate misunderstanding and the dehumanizing aspects of shame and humiliation. Set firm boundaries.
2. Empathy becomes known as reducing inflammation and restoring homeostatic equilibrium to the body according to evidence based research along with mindfulness (a form of meditation), Yoga, Tai Chi, sensory deprivation and certain naturally occurring steroids (Antoni MH, Lutgendorf SK, Blomberg B et al. (2011), David Black, Steve Cole, Michael Irwin et al, (2013), Michael R Irwin and Richard Olmstead, (2012)). Although an over-simplification, when the human body is attacked by bacteria, it mounts an inflammatory defense that sends macrophages to the site of the attack and causes “sick behavior” in the person. The infected person takes to bed, sleeps either too much or too little, has no appetite (or too much appetite), experiences low energy, possibly has a fever, including the “blahs,” body aches, and flu-like symptoms. This response has evolved over millions of years and is basically healthy as the body fights off the infection using its natural immune response. However, fast forward to modern times. This natural response did not imagine the stresses of modern life back when we were short proto-humanoids inhabiting the Serengeti plain and fending off large predators. Basically, the body responds in the same way to the chronic stress of modern life – the boss at work is a bully, the mortgage is over-due, the children are acting out, the spouse is having a midlife crisis – and the result is “sickness behavior” – many of the symptoms of which resemble clinical depression – but there is no infection. The inflammation become chronic and the body loses its sensitivity to naturally occurring anti-inflammatory hormones, which would ordinarily kick in to down regulate the inflammation after a few days. Peer reviewed papers demonstrate that interventions such as those indicated above reduce biological markers of inflammation and restore equilibrium. This is also a metaphor for when an angry [“inflamed”] person is listened to empathically, they [often] calm down and regain their equilibrium. The trend here is that empathy migrates onto the short list. Now for something completely different …
1. A definable market for empathy software and business services emerges. Virtual reality (VR) software meets and expands empathic understanding. A company named Psious [psious.com] has developed a diverse set of applications for virtual reality goggles to simulate situations that psychotherapy clients may find anxiety inspiring such as flying on a commercial jet, public speaking, shots (e.g., with needles) at doctor visits and many more (see my Blog post on Psious (http://tinyurl.com/jyuxedq)). Two other companies that are a software initiative relating to empathy include Affectiva [affective.com], which automates Paul Ekman’s facial action coding scheme (see my blog post (http://tinyurl.com/hymj3mj)), and Empathetics [empathetics.com], not yet reviewed. From admittedly incomplete reports, the engaging thing about Empathetics is that its value proposition is to train medical doctors in empathy using biofeedback under a program licensing intellectual property developed at Massachusetts General Hospital in Boston. In addition, this medical initiative is distinct from but related to two companies (Business Solver and Maru/VCR) which call out “empathy” explicitly as a key differentiator in what they offer their business clients. Business Solver is branding an empathy monitor for business success in a human resources platform and related services. This includes the disturbing data point that some 61% if business leaders see their firms as being empathic whereas only 24% of employees do. What to do about it constitutes the bulk of the engagement. Maru/VCR has a database based on the Vision Critical Research platform that enables its clients to build customer communities and get access to breakthrough innovations and insights in market research.
0. Businesses “get it” – empathy is good for business. Profit is a result of business operations, not “the why” that motivates commercial enterprise. And if profit shows up that way (as the “the why”), then you can be sure that, with the possible exception of commodities hedging, it is a caricature of business and a limiting factor. Business prospers or fails based on its value chain and commitment to delivering value for clients and consumers. However, some of the things that make people good at business make them relatively poor empathizers. Business leaders lose contact with what clients and consumers are experiencing as the leaders get entangled in solving legal issues, reacting to the competition, or implementing the technologies required to sustain operations. Yet empathy is on the critical path for serving customers, segmenting markets, positioning products (and substitutes), psyching out the competition [not exactly empathy but close enough?], building teams and being a leader who actually has followers. When the ontology of empathy exposes it as the foundation of community, then expanding empathy becomes nearly synonymous with expanding business. For example, building customer communities, building stakeholder communities, team building, are the basis for brand loyalty, employee commitment, and sustained or growing market share. Can revenue be far behind? Sometimes leaders don’t need more data, we need expanded empathy, though ultimately both are on the path to satisfied buyers, employees, and stakeholders. Specific firms that have emerged – albeit in the context of an early market – to address these aspects of empathy in business and are called out in trend #2 above.
[These ten top trends in empathy for 2017 should be read in connection with the score for those from last year (2016) [see http://tinyurl.com/gub7pew]. And, yes, I know that there are actually eleven this year – bonus!?]
Antoni MH, Lutgendorf SK, Blomberg B et al. (2011), Cognitive-Behavioral Stress Management Reverses Anxiety-Related Leukocyte Transcriptional Dynamics. Biological Psychiatry, 2011; 15: 366-372.
David Black, Steve Cole, Michael Irwin et al, (2013), Yogic meditation reverses NF-kB and IRF-related transcriptome dynamics in leukocytes of family dementia caregivers in a randomized controlled trail. Psychoneuroendocrinology, 2013 March 38(3): 348 – 355.
Arthur Ciaramicoli, (2016), The Stress Solution. New York: New World Library.
Jodi Halpern, (2013), “What is Clinical Empathy?” J Gen Intern Med 2003 Aug: 18(8): 670 – 674.
Hojat et al, (2011), Physicians empathy and clinical outcomes for diabetic patients, ACAD MED MAR; 86(3): 359 – 64: doi: 10.1097ACM.0b013e3182086fe1
Jeremy Howick, (2011). The Philosophy of Evidence-Based Medicine, Wiley-Blackwell, 2011.
Michael R Irwin and Richard Olmstead, (2012). Mitigating Cellular Inflammation in Older Adults: A Randomized Controlled Trial of Tai Chi Chih. American Journal of Geriatric Psychiatry. 2012 September; 20(9): 764 – 722.
John M. Kelley, Helen Riess et al, (2014), The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, PLOS ONE [Public Library of Science], April 2014, Vol. 9, Issue 4.
Heinz Kohut, (1977). The Restoration of the Self. New York: International Universities Press.
David P. Rakel et al, (2009),”Practitioner Empathy and the Duration of the common Cold, Fam Med 41(7): 494 – 501.
Lou Agosta, (2015). A Rumor of Empathy: Resistance, Narrative, and Recovery. London: Routledge.
_________ (2014). A Rumor of Empathy: Rewriting Empathy in the Context of Philosophy. New York: Palgrave Pivot.
__________ (2010). Empathy in the Context of Philosophy. London: Palgrave Macmillan.
(c) Lou Agosta, PhD, and the Chicago Empathy Project
Here is my short, half day course on Empathy, Stress (Reduction) and Neural Science delivered at the Joe Palombo Center for Neuroscience at the Institute for Clinical Social Work on December 03, 2016. The image depicted below is the punchline to a Richard Feynman joke about the cosmos – “It’s turtles all the way down” – in the case of neuroscience “It is neurons all the way down!” Granted that the joke is not funny if one has to explain it, the video provides all the background you need to laugh (one way or the other!) –
A famous person once said: “Empathy is oxygen for the soul.” So if one is feeling shortness of breath, maybe one needs expanded empathy! This course will connect the dots between empathy and neuroscience (“brain science”). For example, empathic responsiveness releases the compassion hormone oxytocin, which blocks the stress hormone cortisol. [This is an over-simplification, but a compelling one.] Reduced stress correlates to reduced risk of such life style disorders as cardiovascular disease, diabetes, weak immune system, depression, and the common cold.
The session engages each of the following modules in the discussion segment, including suggested readings. Except for the first two topics, we can take them in any order and the participants will get to select:
- This is your mind on neuroscience – mirror neurons: do they exist, and if not, so what?
- Sperry on the split brain: the information is in the system: how to get at it
- The neuroscience of trauma – and how empathy gives us access to it
- MRI research: as when Galileo looked through the telescope, a whole new world opens
Presenter: Lou Agosta, PhD, is the author of three scholarly, academic books on empathy, including A Rumor of Empathy: Resistance, Narrative, Recovery (Routledge 2015). He has taught empathy in history and systems of psychology at the Illinois School of Professional Psychology at Argosy University and offered a course in the Secret Underground Story of Empathy at the University of Chicago Graham School of Continuing Education. He is an empathy consultant in private practice in “on the forward edge in the Edgewater Community” in Chicago.
(c) Lou Agosta, PhD and the Chicago Empathy Project
The image depicts a mirror neuron – the neurological basis for empathy – admiring itself in the mirror. But do mirror neurons even exist? If not, what is the underlying neural implementation mechanism for empathy? At another level of analysis, how is empathy like oxygen for the soul, reducing stress and enabling possibility? Find out more here …
To register or for more info call Elizabeth Oller: 1-312-935-4245 or email: JosephPalomboCenter@icws.edu
Empathy, Stress Reduction, and Brain Science
A famous person once said: “Empathy is oxygen for the soul.” So if one is feeling shortness of breath, maybe one needs expanded empathy! This course will connect the dots between empathy and neuroscience (“brain science”). For example, empathic responsiveness releases the compassion hormone oxytocin, which blocks the stress hormone cortisol. Reduced stress correlates to reduced risk of such life style disorders as cardiovascular disease, diabetes, weak immune system, depression, and the common cold.
We will engage each of the following modules in the discussion segment, including suggested readings. Except for the first two topics, we can take them in any order and the participants will get to select:
- This is your mind on neuroscience – mirror neurons: do they exist, and if not, so what?
- Sperry on the split brain: the information is in the system: how to get at it
- The neuroscience of trauma – and how empathy gives us access to it
- MRI research: as when Galileo looked through the telescope, a whole new world opens
Presenter: Lou Agosta, PhD, is the author of three scholarly, academic books on empathy, including A Rumor of Empathy: Resistance, Narrative, Recovery (Routledge 2015). He has taught empathy in history and systems of psychology at the Illinois School of Professional Psychology at Argosy University and offered a course in the Secret Underground Story of Empathy at the University of Chicago Graham School of Continuing Education. He is a psychotherapist (and empathy consultant) in private practice in “on the forward edge in the Edgewater Community” in Chicago.
Date: Saturday December 03, 2016
Time: 9 AM – noon
Registration Fee: $35
Location: to be provided upon registration: at or near ICSW at 401 S. State St Chicago, IL
Registration: Call Elizabeth Oller: 312 935 4245 or email: JosephPalomboCenter@icsw.edu
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. As the author of three professional books on empathy, I work with behavioral (mental) health professionals on burnout, compassion fatigue, and related dis-orders of empathy in their lives and practices, and my own client interactions benefit from this depth of expertise and experience.
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.
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