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Noted in passing: Anna Ornstein (1927-2025)
Anna Ornstein, MD, psychiatrist, and psychoanalytic Self Psychologist, is remembered and honored as a Holocaust survivor, having been incarcerated in Auschwitz with her mother in 1944 when the Germans invaded Hungary. Her experiences are narrated in her book, My Mother’s Eyes: Holocaust Memories of Young Girl (2004). Both survived. Anna Ornstein passed away at her home in Brookline, MA at the age of 98 on July 3, 2025 after a rich, challenging, and dynamic life.
Trying to say anything about such searing experiences is perhaps foolish, yet Ornstein’s next major contribution provides the tool to do so in so far as it can be attempted at all. Ornstein is remembered and honored for making empathy central in her clinical practice of psychoanalytic psychotherapy and in her writings on the Self Psychology (more on which shortly). One of the things that empathy teaches us humans is to try to bring words to one’s experiences, no matter how challenging the experiences; try to find words to push back the boundaries of the inexpressible, that which is not to be comprehended. Cognitive understanding should never be underestimated; yet at times cognition is illusive and overrated whereas communication is not, empathy is not, family is not, community is not.
Image / photo credit: Dr. Ornstein in 2018, speaking to high school students in Massachusetts. Credit. Matthew J. Lee/The Boston Globe, via Getty Images
Though starting as a collection of anecdotes and narratives of survival, the title, My Mother’s Eyes, takes the account up a level. As a 17-year-old teenager, incarcerated with her mother and allowed to be together, the survival value of being able to change perspectives – the folk definition of empathy – was critical path to surviving the rigors – the horrors – of death camp life. Even under very challenging circumstances, people are able to support one another emotional regulation by literally being there for another as a comforting presence. The relationship in this extreme situation prefigures the notion of self object, making use of the other person mutually to regulate one another’s emotions. It is the other’s presence that, with a nod to D. W. Winnicott, provides a grounding in the radical possibility of going on being.
This essay is in the nature of an intellectual biography and personal anecdote, rather than an obituary proper. For those interested in how Anna née Brünn met Paul Ornstein and become Anna Ornstein, how all three of their children became psychiatrists, the New York Times articles provides the personal details and a happy, though by no means simple, ending to the catastrophe of the Holocaust and World War II.[1]
On a personal note, my path and that of Anna Ornstein intersected with what can best be described as an existential encounter in 2009. Something called “Self Psychology” was disrupting classic psychoanalysis and innovating around the constraints of Freudian ego psychology. The Self Psychology Conference was in Chicago that year (2009, the full title “International Assoc for Psychoanalytic Self Psychology”).[2] In any case, there were many high points to the Conference including Dr. Arnold Goldberg’s presentation and those of other Self Psychology innovators such as Ernest Wolf, Anna and Paul Ornstein, the Kohut Memorial Lecture, the many spirited exchanges.
The highest of the high points of the Conference came for me in having a one-on-one conversation with Anna Ornstein. There she was between presentations, and I introduced myself as working on a book about empathy, which did indeed get her attention. In a naïve, misguided attempt on my part to establish common ground, I mentioned that I had attended the lectures at the UChicago on the life of the mind by the political theorist Hannah Arendt. I also quoted Arendt to the effect that since the consequences of our human actions escape us, Jesus of Nazareth had innovated in the matter of forgiveness. Star struck, what was I thinking? This was clumsy and naïve on my part, and it got a reaction which was perhaps more than I had bargained for. In the course of the conversation, Ornstein took my hand animatedly and held it as she was making her point, basically that Arendt had gotten matters wrong, very wrong. When I say “took my hand,” I mean she grabbed it and shook it back and forth, not exactly like shaking hands, but like she would wrestle me to the ground. To be sure, it was good natured enough, but intense. The take-away? I got to hold hands with Anna Ornstein! Notwithstanding my clumsiness, that was special. I cherish the encounter.
Now in a short piece such as this, doing justice to Anna Ornstein’s innovations in self psychology (the method not the label), especially the treatment of children, is no simple task. People want to read about tips and technique, and many are available. However, context is required.
On background, Heinz Kohut, MD, was the innovator who put self psychology and empathy on the map starting in the early 1970s (though see Kohut 1959). Kohut was cautious about defining the self formally, implicitly characterizing the self as a comparative experience—a near experience psychoanalytic abstraction, that is central to all human experience since it contains the person’s nuclear ambitions and ideals which are amalgamated to the sense of continuity (Winnicott’s “going on being”), the well-being and cohesion of (our) body and mind (Ornstein 1976: 29ftnt).
Thus, the self oscillates dynamically between ideals and coherence, both of which are needed for a sense of aliveness, vitality, and an actual ability to be productive in contributing to community and relationships with others. Kohut’s (1959) definition of empathy as “vicarious introspection” adds significantly to the folk definition of taking a walk in the other person’s shoes, the better to appreciate the other’s struggles and successes as the person experiences them. (For further on Kohut’s innovation see the book (and chapter devoted to Kohut) to which I referred in my conversation with Ornstein in our encounter (Agosta 2010).)
While firmly founded in Freudian dynamics, Self Psychology called out how parenting environments that delivered unreliable empathy – not total lack of empathy, but unreliable, hit-or-miss empathy – resulted in structural deficits in self-esteem, self-confidence, productivity, feelings of emptiness, lack of aliveness and vitality, in children as well as the adults into which they grow. This was a deficit model rather than – or in addition to – a conflict model. Instead of conflicts between the conscience (superego) and sexual and aggressive drives, something was missing that left the person’s personality at a disadvantage in the face of which the person compensated with arrogance, superiority, coldness, withdrawal, empty depression (rather than melancholia), and poor productivity and superficial relations.
When the self experiences narcissistic injuries – did not get the dignity, respect, empathy – to which it was entitled or felt entitled (eventually a key distinction, but not at this point), then aggressive and sexually fragmented behavior was the result. In short, maladaptive sexual behavior and hostility are reactions to a stressed-out self rather than primary instinctual drives. So if you encounter a person who is enraged, ask yourself, who hurt that person’s feelings? Who did not give her or him the dignity, respect, empathy, they feel they deserve? Thus, self psychology does not so much reject Freud’s approach as re-describe and incorporate it.
Thus the New York Times article is accurate enough when it writes “Dr. Kohut disagreed with Freud’s theory that personality disorders were rooted in the unconscious mind, driven by guilt, sex and aggression” (Gabriel 2025), provided that one takes “rooted” and “unconscious” in the proper sense. In that sense, the dynamics of Freudian pathology becomes a special case of a fragmented self that has not received the empathy, which, as Kohut famously said, is oxygen for the soul: “The child that is to survive psychologically is born into an empathic-responsive human milieu [. . .] just as he [or she] is born into an atmosphere that contains an optimal amount of oxygen” (Kohut 1977: 85; see also 253). Just as the body goes into rapid decline and arrest without oxygen, so to the human psyche (the Greek word for soul) struggles and cannot sustain itself outside of a context of empathic relations at least somewhere in its life.
For example, the classic Freudian family drama of the child (son) who wants to “kill” the father and “marry” the mother, is redescribed as aggressive and sexual fragments of a self that has experienced unreliable empathy and been the recipient of seductive behavior on the part of the mother and aggressive (defensive) behavior on the part of the father. (For the inverse scenario of father daughter, which deserves attention, too, see Kulish and Holtzman 2008, which, strictly speaking is not self psychology but inspired thereby). In a healthy family dynamic, the father welcomes the young son’s competitiveness, knowing that he (the father) is not threatened by the youngster’s competitiveness. It is only when the father is himself insecure and narcissistically vulnerable that he retaliates punitively, giving way to a reactive hatred on the part of the offspring that Freud projected back into the primal scene as the death drive. For Kohut and Ornstein, aggression and hatred are not primary drives, as with Freud’s death drive, but aggressive and hatred live as reactions to failure of empathy, dignity, and respect. Likewise, the mother welcomes the young boy’s affection and ineffective childish romancing, knowing that the childish behavior is not a serious sexual advance. It is only when the mother, unsecure in herself and her own sexuality, behaves seductively towards the youngster that over arousal of sexuality, over stimulation, boundary issues, family drama, and emotional dis-equilibrium are risked. In the inverse scenario, the father welcomes the young daughter’s affection and childish romancing, appreciating and delighting in the child’s development and growth. This is not a serious seduction – unless the father has unresolved issues. When the father is insecure in his own sexuality and responds seductively to the pretend seduction that the risk of over arousal and real and imaginary boundary violation can occur. The complicating factor in the daughter-mother relationship is that the daughter needs the mother to take care of her – unlike with the son where the hostility between father and son is a purer example of competition – as well as wanting to replace her, resulting in an ongoing ambivalence and competitiveness that is not mirrored in the son’s simple desire to “cancel” the father.
Now shift this conversation in the direction of adult empathy with children, which happens to be the title of a famous article by Christine Olden (1956). When one is in the presence of a child, whether of tender age or teenager, one is present to, aware of, one’s own fate as a child. And since one’s own fate may have little or nothing to do with that which this particular child in this pace and time is experiencing and struggling, that is precisely the point at which expanding the parents’ empathy is on the critical path.
“The parent’s ability to become therapeutic may not have always been optimally utilized in the treatment of children. This is in large part due to a rather pervasive attitude among mental health professionals in which the parents are usually considered at fault, primarily for lacking sensitivity relative to their children’s developmental needs. Anger and depreciation for having failed their children precludes any effort on the therapist’s part to understand the reasons why the parents may not have been able to develop empathic capacities. The explanation for this can usually be found in the parents’ own backgrounds. In addition to the parent’s original difficulties to be in empathic tune with the child, the child’s current difficulties create guilt, anger, and disappointment in the parent(s) which further interfere with whatever parental empathy may have otherwise been available” (Ornstein 1976: 18).
In an example of what not to do, Ornstein cites the following case, in which the empathy toward both parent and child is conspicuous by its absence:
“A young mother had regularly taken her 6-yr-old son to bed with her after the sudden death of her husband. When the boy became enuretic she visited the clinic and was told that the boy had to get out of her bed-since this was the cause of his problem. The mother followed through on the recommendation which meant nightly tearful battles with the child. However, since her own affective state was not “treated,” she could not remove him from her bed without ambivalence. The enuresis continued, and in addition, mother and son became increasingly more irritable with each other. As the mother’s depression deepened, the child developed further symptoms; he had become provocative and inattentive at school” (Ornstein 1976; 18).
Given we have an example of what not to do, what is the recommendation of what one should do in this case? As Ornstein explains (1976: 18), recognize and acknowledge the mother’s grief for her husband and the longing for closeness with the boy. You do not have to lie back on a coach to talk about it, but one might consider doing so! The ability to tolerate the separation between mother and son may usefully have been expanded by a gradual, phased introduction of the separate sleeping arrangements. Having agreed to letting the boy in, summarily throwing him out is surely asking for trouble; yet the co-sleeping cannot continue. Don’t forget that applying common sense parenting is consistent with advanced training and credentials. Many parents have an in-bed “cuddle time” with children of tender age, including a bedtime story, prior to each retiring to his or her own respective nest. “Story time” – whether read or from life – is one possible empathic moment between parent and child in the context of an empathic relationship as the adventures and stresses of the day are empathic quiesced in a narrative before the passive overcoming of going to sleep.
By the way, in the world of behavioral interventions, wise parents know to set the clock for a 2 am trip to “go number one,” which will reduce the stress on child and parent, enabling them to address the underlying issues of loss and separation in a calmer, even if not stress free, context of relatedness.
Often when a therapist meets a family, the family is not on a slippery slope, they are at the bottom of it. The narcissistic slights, emotional injuries, blind spots, shame, guilt, boundary issues, and grievances present a tangle that represents a challenge even to the most astute and empathic therapist. People are motivated to reduce the suffering and struggle, and empathy includes many ways to de-escalate conflict. Ornstein points out:
“To enhance the parents’ therapeutic potentials does not mean to give recommendations as to how to interrupt or actively discourage the child’s disturbing behavior. Particularly destructive are recommendations which ask for changed parental behavior without an appreciation for the parents’ difficulty to comply; such recommendations are “grafted” onto the parents’ pathology. Finding themselves unable to follow the therapist’s recommendations, they become more guilty and less able to effect changes in themselves in relation to the child” (Ornstein 1976: 18).
In the world of tips and techniques, Ornstein did not say “treat the parent; the child gets better”; make bedtime stories an empathic encounter for children of tender age; get inside the world of the child for whom the tooth fairy and boogeyman are real, setting boundaries and soothing in tandem; but she strongly implied them (nor is that the complete solution since the child, too, requires treatment (1976: 18)). One can try and force an outcome; but it is not going to stick; and framing boundary setting in an empathic milieu of acceptance has a much greater probability of producing a positive outcome. This report is acknowledged to be incomplete and further reading can be found in the References.
One caveat must also be offered. It is the same world of limited empathy and human success and suffering today (Q3 2025) as when Anna Ornstein published her innovative work in 1976. However, ours is also a different world. Empathy is a key ingredient, and indeed the foundation, of individual well-being, mental health, and flourishing communities. Yet ours is a world in which we have gone from a President Obama who considered empathy a criterion for appointment to the US Supreme Court to one whose billionaire friends (or “frenemies”) consider empathy a defect of civilization. Empathy and its power should never be underestimated. Never. However, one has to be empathic in a context of acceptance and toleration. It does not work to make oneself empathically vulnerable in the presence of bullies, concentration camp guards, or wanton aggression. This is obvious, but a reminder is useful that in such predicaments empathy sets boundaries, defines limits, pushes back, and, if politically possible without getting deported, speaks truth to power using rhetorical empathy (which is not much engaged in therapeutic or psychiatric circles). Carrying forward the work of Anna Ornstein? An example of rhetorical empathy? “No human being is illegal.” However, that starts a new thread – an empathic one.
References
Lou Agosta. (2010). Chapter Six: Empathy as vicarious introspection in psychoanalysis. In Empathy in the Context of Philosophy, by Lou Agosta. London: Palgrave Macmillan.
Trip Gabriel (July 4, 2025), Anna Ornstein, Psychoanalyst who survived the Holocaust, dies at 98 New York Times obituary: https://www.nytimes.com/2025/07/04/health/anna-ornstein-dead.html?unlocked_article_code=1.Vk8.dfZz.8YyxtXebGoP1&smid=url-share
Heinz Kohut. (1959). Introspection, empathy, and psychoanalysis: An examination of the relationship between mode of observation and theory. Journal of the American Psychoanalytic Association, 7, 459–483. https://doi.org/10.1177/000306515900700304
Heinz Kohut. (1977). Restoration of the Self. New York: International Universities Press.
Nancy Kulish and Deanna Holtzman. (2008). A Story of Her Own: The Female Oedipus Complex Reexamined and Renamed. Lanham: Jason Aronson.
Olden, C. (1953). On Adult Empathy with Children. The Psychoanalytic Study of the Child, 8(1), 111–126. https://doi.org/10.1080/00797308.1953.11822764
Anna Ornstein. (2004). My Mother’s Eyes: Holocaust Memories of a Young Girl. Cincinnati, OH: Clarisy Press.
Anna Ornstein. (1976). Making contact with the inner world of the child. Toward a theory of psychoanalytic psychotherapy with children. Comprehensive Psychiatry. 1976 Jan-Feb;17(1):3-36. doi: 10.1016/0010-440x(76)90054-7. PMID: 1248241.
Sam Roberts. (Jan 31, 2017). Paul Ornstein, psychoanalyst and Holocaust survivor, dies. New York Times obituary: https://www.nytimes.com/2017/01/31/us/paul-ornstein-dead-self-psychologist.html
[1] Trip Gabriel (July 4, 2025), Anna Ornstein, Psychoanalyst who survived the Holocaust, dies at 98 New York Times obituary: https://www.nytimes.com/2025/07/04/health/anna-ornstein-dead.html?unlocked_article_code=1.Vk8.dfZz.8YyxtXebGoP1&smid=url-share
[2] I have found the “splash page” for the International Association of Psychoanalytic Self Psychology (IAPSP) Conference of 2009 in my archives (though not the complete program) whereas Google’s Artificial Intelligence bot says there was no such conference. In addition, I was there.
Image / photo credit: Dr. Ornstein in 2018, speaking to high school students in Massachusetts. Credit. Matthew J. Lee/The Boston Globe, via Getty Images
(c) Lou Agosta, PhD and the Chicago Empathy Project
Noted in passing: Arnold Goldberg, MD, Innovator in Self Psychology (1929-2020)
The passing of Arnold I. Goldberg, MD, on September 24, 2020 is a “for whom the bell tolls” moment. No doubt his family, students, friends, and colleagues feel the loss most acutely; however, the community is diminished, though in another sense irreversibly enriched by his contributions and innovations in expanding empathy.
Our loss is great, yet we breath easier thanks his lessons in empathy, which is oxygen to our souls.
Arnold I. Goldberg was an innovator in psychoanalysis and self psychology, a prolific author (really prolific!), an inspiring educator, and simply a wonderful human being.
My personal recollections are of Dr Goldberg inspiring my younger, graduate student self to pursue and complete a dissertation on empathy and interpretation at the
Arnold Goldberg, MD, enjoying Labor Day September 09, 2010 at his vacation home at the Indiana Dunes, illustration by artist Alex ZonisUniversity of Chicago Philosophy Department. I fondly recall introducing Arnold to one of my dissertation advisors, Paul Ricoeur, over a wine-enriched dinner at the middle eastern restaurant that used to be on Diversey Avenue (the Kasbah?). I was also lucky enough to take a year long case conference at Rush Medical that he taught to the psychiatric residents as part of the Committee on Research and Special Projects sponsored by the Chicago Institute for Psychoanalysis. Notwithstanding a multiyear gap during which our paths diverged, I have known him and his wife Connie (herself a Self Psychology power) since I was a twenty-something; and I still have in my possession a couple of his hand written letters to me regarding hermeneutics that I used to good purpose when “roasting” him at a retirement event at Rush Medical. What a privilege: I experienced Arnie’s deep listening, incisive and penetrating wit, the humor, the humanity, the remarkable learning and even-handedness in disagreement, and above all – his empathy.
I choose to republish this book review from June 23, 2013 precisely because its provocative title best encapsulates the validity of Goldberg’s contribution to psychoanalysis and self psychology while subtly and humorously “sending up” some of his less flexible colleagues. Arnie, thank you for being you!
Read the complete review in the International Journal of Psychoanalytic Self Psychology: click here: GoldbergAnalyticFailureReview2014
The power of Arnold Goldberg’s approach in The Analysis of Failure: An Analysis of Failed Cases in Psychotherapy and Psychoanalysis (Routledge) is twofold. First, if a practice or method cannot fail, then can it really succeed? If a practice such as psychoanalysis or dynamic therapy can fail and confront and integrate its failures, then it can also succeed and flourish.
Such is the point of Karl Popper’s approach to the philosophy of science in Conjectures and Refutations. For those who have not heard of hermeneutics, narrative, and deconstruction, and who are still suffering from physics envy, the natural science have advanced most dramatically by formulating and disproving hypotheses. Natural science is avowedly finite, fallible, and subject to revision, advancing most spectacularly within the paradigm of hypothesis and refutation by failing and picking itself up and pulling itself forward.
The Analysis of failure is inspired by this lesson without engaging in most of the messy details of the history of science. Second, for a discipline such as psychoanalysis (and psychodynamic therapy) that prides itself on the courageous exploration of self-deceptions, blind spots, self-defeating behavior, and the partially analyzed grandiosity of its practitioners (and patients), the well worn but apt saying “physician heal thyself” comes to mind.
The professional ambivalence about taking a dose of one’s own medicine upfront is a central focus not only in psychoanalysis (in its many forms) but in related area of psychiatry, psychopharmacology, cognitive behavioral therapy (CBT), social work, clinical psychology, and so on. Goldberg’s openness to alternative conceptions and frameworks along with his exceptional knowledge of and commitment to psychoanalysis (and self psychology) is an obvious strong point.
As a former colleague of the late Heinz Kohut, Goldberg studiously avoids (and indeed fights against) adopting the paranoid position with respect to failed analytic and psychotherapy cases – what’s wrong here? When a therapy case fails (the determination of which is a substantial part of the work) a series of blame-oriented questions arise: What’s wrong with the patient? What’s wrong with the therapist? What’s wrong with the treatment method(s)? What’s wrong!? And, yes, these questions must be engaged; but, Goldberg demonstrates, they must be put in perspective and engaged in the context of a broader question What is missing the presence of which would have made a difference? The answer will often, but not exclusively, turn in the direction of a Kohut-inspired interpretation of sustained empathy.
This leads to the part of Goldberg’s argument that is explicitly humorous. Having announced a case conference on failure and invited all levels of colleagues, Goldberg reports the casual laughter of many colleagues as they announced that they had no failed cases and so could not be helpful. “One person agreed to present but the following day he yelled across a long hall that he could not and quickly walked away (p. 41).
The list of excuses goes on and on, producing a humorous narrative that is definitely a defense against just how confronting the whole issue really is. Less humorous and more problematic is what happens when a case comes to grief and the candidate reportedly does exactly what the supervisor recommends. How one would know what is the “exact recommendation” is hard to determine, but relations of power loom large in such a triangular dynamic. Even Isaac Newton acknowledged that the “three body problem” of the (gravitational) relations between any three bodies is theoretically computable but practically intractable. The number of variables changing simultaneously is such that we are dealing with expert judgment rather than algorithmic results.
For my part I cannot help but think of the process for airline pilot reporting of errors in procedures, operations, and maintenance. Yes, pilots are part of a complex system and “pilot error” does occur – pulling back on the stick to get lift rather than pushing down – yet they are usually given more training and rarely blamed or faulted, absent illegal or blatantly unethical conduct (e.g., drinking on the job).
Goldberg calls for an ongoing case conference inquiring into failed cases, and thereby implicitly calls for taking our thinking to a new level of professional rigor, encompassing scientific objectivity that is consistent with talk therapy being a hermeneutic discipline. One might call it looking at the entire system, but not in the sense of family therapy –rather in the sense of the total professional-cultural-scientific milieu.
However, Goldberg’s approach differs decisively from a Check List Manifesto (a distinction not in Goldberg (he does not need it) but abroad in the land and by a celebrity MD, Atul Gawande) in that individual chemistry looms large between the therapist and the patient. In analysis or therapy, the number of unknown variables in fitting a prospective patient to a prospective treatment (whether analysis, therapy, psychoparm, CBT, etc.) is so large as to be nearly intractable. These are areas where we simply lack the super-shrink who has mastered the basics of all these methods and can make an objective, upfront call of what just might have the best odds of a favorable outcome without the usual trial and error. For the foreseeable future, mental health professionals can be expected to continue to “sell what they got.” If a person knows Talk Therapy, then that is most often what is initially recommended. If that does not work, try CBT or medication – and vice versa.
This reviewer does not agree that the crashes in the mental health area are usually not so spectacular – and they do make the papers in the form of suicides and inexplicable violence – though the track record is no where near the five-nines (one error in a million) that characterizes the airline industry. Goldberg’s subtext for mental health professionals is that we are still learning to live with uncertainty even as we organize case conference, postmortems, and the equivalent of crash investigations that strive to look objectively at outcomes without blame and without omniscient rescue fantasies in the service of healing and professional (“scientific”) development.
In some thirty cases that were reviewed by Goldberg, using the method of expert evaluation and feedback by the participants in the local case conference, the definition of failure included cases that never get off the ground; cases that are interrupted and so felt to be unfinished by the therapist or analyst; cases that suddenly go bad, characterized by a negative eruption whereas previously therapy was perceived to be going well; cases that go on-and-on without improvement; cases that disappoint whether due to the initial goal not being attained or being modified and not attained or endless pondering of what might have been.
Since this is not a “soft ball” review, one category of failure that is conceivable but missing from The Analysis of Failure is the example where treatment arguably left the person worse off (other than in terms of wasted time and money, which itself is not trivial). What about someone who did not experience impotence, writer’s block, or (say) hysterical sneezing until they tried psychoanalysis (psychotherapy)? What about compliance and placating behavior, reportedly a significant risk in the case of candidates for analytic training? What about regression in service of treatment that was initiated within the empathic context of the therapeutic alliance, but something happened and the regression got out of control and a breakdown or fragmentation occurred? Work was required to contain the fragmentation that was minimally successful, prior to an untimely termination that was a flight from fragmentation, a flight into health or a statement that in effect said “Let me otta here for my own good!” To his credit, Goldberg identifies “a patient who was getting worse off” (p. 162), but leaves the matter unconnected to regression mishandled or any other psychodynamic explanation. It is possible that such a scenario is already encompassed in the category of “cases that go bad,” at least implicitly, but in an otherwise through review of possibilities, this one was conspicuous by its absence.
The book itself is Goldberg’s answer to the question, given that failure occurs, what do we do about it? We inquire, define our terms, organize the rich clinical data, identify candidate variables, take the risk of making judgments about possible, probable, and nearly certain reasons, causes, and learn from our failures, pulling ourselves up by our boot straps in an operation that seems impossible until it succeeds. The role of lack of sustained empathy, counter-transference, rescue fantasies, disappointments, uncontrolled hopes or fears, partially analyzed grandiosity (on the part of the therapist), lack of knowledge of alternative approaches to therapy, are towards the top of a long (and growing) list of issues to be engaged in the classification of causes for failure.
The turning point of Goldberg’s argument occurs in his chapter on “How Does Analysis Fail”? This is an obvious allusion to Kohut’s celebrated work on How Does Analysis Cure? Once again, failure is a deeply ambiguous term, and the ironic edge is that in contrast to an analysis gone bad where the patient leaves in a huff with symptoms unresolved, a successful self psychology analysis proceeds step-by-step by tactical, nontraumatic failures of empathy that are interpreted and used to promote the development of self structure. The short answer is that analysis cures through stepwise, incremental, nontraumatic breakdowns – i.e. failures – of empathy, which are interpreted in the analytic context and result in the restarting of the building and firming of psychic structure of the self. In turn, these transformations of the self promote integration of the self resulting in enhanced character traits such as creativity, humor, and expanded empathy in the analysand.
The entertaining and even heartwarming reflections on Goldberg’s relationships with his teachers Max Gitelson and Charles Kligerman, betrayed (at least to this reader) a significant critique of the “old guard,” resolutely defended against the possibility of any failure, thanks to a position that avoided any risk – analysis is about improving self-understanding. According to this position, the reduction of suffering and symptoms relief is a “nice to have” but not essential component. Analysis is a rite of passage into an exclusive club, where you are just plain different than the untransformed masses.
Though Goldberg does not emphasize the debunking approach, the reduction to absurdity of the description of the old guard makes psychoanalysis sound a tad like the est training from the late 1970s. You just “get it” or you don’t – in which case here is your money back and now go be miserable and unenlightened (only analysis does not give you your money back). In both cases failure is not an option, though not in the sense initially intended by the slogan, namely, that risk is analyzed and mitigated through interpretation. Failure is not an option because it is excluded by definition from the system of variables at the onset, thus, also excluding many meaningful forms of success. In short, many things are missing including sustained empathy, which, in turn, becomes the target of the analysis of failure in the remainder of the book
The net result of the compelling chapters on Empathy and Failure, Rethinking Empathy, and Self Psychology and Failure, is to challenge the analyst and psychotherapist to deploy sustained empathy in the service of structural transformation. While I personally believe that agreement and disagreement are over-valued in terms of creating authentic understanding, the section on Empathy and Agreement raises a significant distinction between the two terms. It is insufficiently appreciated by many clinicians how agreement becomes a smoke screen – and defense against – basic inquiry and exposure to the other’s affects in all their messiness and ambivalence. It remains unclear how sustained empathy undercuts agreement (or disagreement).For example, Dr. E. wants his analyst to agree with him that it is okay to sleep with his patient(s). For the sake of discussion, the analyst mouths the form of words, “Okay, given your marriage, okay, I agree.” But Dr. E. then asserts that he can tell the analyst does not really mean it (an accurate observation). So why not raise the question what is agreement doing here other than disguising Dr. E.’s own unacknowledged commitment to “being righteous and justified”. There is nothing wrong with being righteous, everyone does it. However, is it workable?
The resistance has to be engaged and interpreted at some point in order to make a difference in treatment. Agreement (or disagreement) remains a conversation with the superego, even in the mode of denying there is amoral issue. It may stop a tad short of moral justification, but it is on the slippery slope to it. There are many cases along a spectrum of engagements but the really tough one is empathizing with behaviors that are ethically and legally suspect such as doctors sleeping with their patients and other relations of power where one individual uses his or her position to dominate the other as a mere means not an end in him- or herself. This is a high bar in the case of empathizing with the child molester or Nazi who have used a form of empathy (arguably a deviant one) to increase his domination of the victim. This remains a challenge to our empathy as well as to our commitment to treating a spectrum of behavior disorders (where Goldberg has made a life-long contribution) that are significantly upsetting to large parts of the mental healthcare market. Keeping in mind the scriptures and the sayings of Jesus(the rabbi), which Goldberg does not mention but arguably is the subtext, we are still challenged to love the sinner but hate the sin.
In a concluding rhetorical flourish, Goldberg claims that the book is a failure. The prospective reader – a very wide audience as I am any judge of the matter – may see the many complimentary remarks that properly disagree with this rhetoric printed on the back cover (which this review endorses and agrees). In a further ironic and richly semantic double reverse in the title of the final chapter, failure has a great future. This is especially so when failure is scaled down from a global narcissistic blind-spot on the psyche of the therapist (where failure remains a valid research commitment) to an expanded tactical approach in the form of “optimal frustration … disappointment being real, tolerable, and structure building” (p. 200).
The concluding message is an admirably nuanced clarion cry for further study rather than condemnation, finger pointing, or blame of some particular therapeutic modality such as Talk Therapy versus CBT. The concluding message is a sustained reflection on de-idealization, the difficult process of taking responsibility for the inevitability of one’s parents’ lack of omnipotence. Failure is part of the development process in analysis and psychotherapy, and, by implication (and taken up a level), the study of failure in broad terms will be part of the development of the profession going forward. The analyst and therapist must give up the rescue fantasy, give up being right and justified, give up misplaced ambition, but also give up guilt, self-blame, disappointment, and embrace an approach that interpretation of the pathogenic situation of early childhood in which traumatic deidealization of the parent occurred, becomes inherently transformative. It reactivates the process of structure-building internalization. Learning to live within one’s limitations invites a process of risk taking that sometimes results in failure, sometimes results in success, and always results in – redefining one’s limitations outwards towards an endless horizon of progress in satisfaction and meaning making. Our thanks to Arnold Goldberg both for the journey and the end result.
Chicago Tribune Obit, Sept 29, 2020: https://www.legacy.com/obituaries/chicagotribune/obituary.aspx?n=arnold-i-goldberg&pid=196869091
(c) Lou Agosta, PhD and the Chicago Empathy Project
Lou Agosta, Ph.D., Listening With Empathy 
