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Transference and Empathy: Where Transference Was Empathy Shall Be!

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While empathy is seemingly in exceedingly short supply in the world, you do not need a philosopher to tell you what empathy is. Every mother, every teacher with students, every business person with customers, every doctor with patients, every attorney with clients, every politician with supporters, every person with next door neighbors, knows about empathy. 

We shall start with the folk definition of empathy – take a walk in the other person’s shoes, and add one additional recommendation. However, first take off your own shoes before putting on the other’s – an action that is routinely overlooked – otherwise one gets projection, not an experience of otherness. 

The title statement echoes Freud’s celebrated slogan “Where id was, ego shall be!” Neither of these statements is an “either or” proposition. The id is not going away. Freud did not propose to abolish the id with the ego. It is not even clear what that could possibly mean. The idea is to expand the influence, control, and power of the second term (ego, empathy) over the first one (id, transference). The ego expands its power, including power over primitive aggressive and sexual inclinations; likewise, with empathy. Empathy expands its power in creating an opening for effectiveness and success in fulfilling and satisfying human relationships.

Let us define our terms. Transference is the carrying across of meaning from one context, model, or paradigm to another one. It is difference than metaphor, which means a “carrying across or beyond,” but perhaps not by much. We humans have a tendency to make things mean other things. We humans are “meaning making machines,” in the sense that we are a source of acts of conscious intentionality that brings meaning to our encounters with nature and our fellow humans in community. There is indeed something mechanistic about the way we automatically go about making things mean things. We can’t seem to stop doing it, which results in innovations but also distortions and misunderstanding. We take behaviors, conversations, and circumstances and try to make sense out of them by bringing meaning to them, which sometimes applies, but sometimes doesn’t. 

This definition of transference extends into the realm of so-called behavioral health and psychoanalysis (where it was initially and innovatively defined) into the contexts of diverse forms of psychotherapy, empathy consulting, professional coaching, or community building. At the risk of oversimplification, transference takes a cognitive, behavioral, or emotional response from one context, such as childhood or circumstances in the past that one had to survive, and uses it to respond to the therapist, coach, or trainer in a similar way. Typically this introduces distortion or extraneous issues into the relationship. 

The relationship between transference and empathy is under theorized. This is the case in spite of all the great psychoanalysts from Freud onwards commenting on both subjects, albeit sometimes in widely separated contexts and conversations. There are many reasons for under development of theory, both scientific and political, but it is largely due to the nature of the phenomena themselves. Transference as a distinction is largely structural, even though its emergence and transformation unfold in time in the process of a therapeutic psychoanalysis. Empathy as a distinction is largely a process unfolding in the therapeutic relationship, even though it has structural invariants. 

Empathy and transference are the opposite of one another. How so? In empathy one takes a walk in the shoes of the other person, the better to understand the other and relate authentically to the individual. There are many definitions of empathy, but they converge on the idea that empathy is an authentic form of relatedness. Get rid of the judgments, assessments, and evaluations, and be with the other person without applying labels, categories, and prejudices. 

Now transference is the exact opposite of authentic relatedness. The narrow definition of transference says take a pattern or relating from one situation – such as childhood or an experience in another context – and apply it to the current relationship or situation. The result is a distortion of the relatedness. The result is an inauthentic way of relating. In order to bring forth an empathic relationship one has to interpret and resolve the transference distortions. 

Let us take a step back. The implications of the relationship between empathy and transference, as noted, have not been much theorized. It is true that dozens of publication address empathy and dozens of publications address transference, and some even contain discussions of both empathy and transference (e.g., Racker 1968). But the specific interactions between being empathic in the transference and getting engaged in transference in being empathic in a clinical setting have not been much engaged. 

The recommendation? Think of the relationship between empathy and transference (or perhaps you say “the transference” as if it were a single unified thing) as a dance. Sometimes the one leads and the other follows and vice versa. The implications of the dance between empathy and transference are profound, but complex and entangled.

Lest one imagine these two phenomena – empathy and transference – are inevitably at loggerheads, consider the following example of convergence:

The patient comes in and says he saw the film, Elephant Man (directed by David Lynch (1980)) and he was deeply moved. The narrative is of an individua, David Merrick, suffering from Proteus Syndrome (often confused with Neurofibromatosis), which results in disfiguring folds of tissue on the head and other pulmonary and renal abnormalities. “Deeply moved,” by what aspect in particular, I asked? After being a freak, physically disfigured, lacking humanity, David Merrick meets the doctor who acknowledges his humanity. The recognition of humanity – “I am a human being – I am a man” is the most dramatic utterance – and the empathic moment. The client reports being moved to tears and having had a satisfying cry. Without further discussion, the client then spontaneously speculates, wondering if there was a parallel with our relationship, my having recognized something in him that others had not seen. Without going into confidential details, I had seen around or though the significant blind spot that kept him insensitive to an aspect of father’s behavior which was running his life and in a destructive way, yet not acknowledged. This enabled the client to shift his relationship to his life partner (as well as his father) and move on. The parallelism – transference – the recognition of humanity – empathy. 

To try to prevent misunderstanding, one must distinguish between transference in a narrow sense and transference in an enlarged sense. At risk of oversimplification, when transference was first discovered by Freud, it seemed like an obstacle to treatment, since the patient related to Freud as an authority figure such as The Father (in the case of a male patient) or as a seductive father figure (in the case of a female patient) whereas Freud regarded himself as a kind, even empathic, listener to the patient’s neurotic suffering. 

Eventually Freud realized that the patient was relating to him (Freud) as to an important figure from the patient’s past. Regardless of how Freud tried to treat the patient, the patient treated him- or herself with transference – but responding with a transference of meaning from one area of the patient’s life to the relationship with Freud. Just as significantly, Freud discovered that the patient was doing this in other areas of his life as well – towards his lady friend, towards his superiors at work, in a hundred and one ways in his life – with problematic results that caused the individual to seek treatment for his suffering and conflicts. 

For example, when the patient was a woman, the transference was not hostile but erotic. This can be motivated. If the reader saw Vigo Morgenstern play the middle-aged Freud in the film A Dangerous Method, then you know what I mean. This guy was hot! Though unlike Carl Jung, Freud was clear about professional boundaries: “[…] [T]he patient has transferred on to the doctor intense feelings of affection which are justified neither by the doctor’s behavior nor by the situation that has developed during the treatment” [1917, Introductory Lectures on Psycho-Analysis: 440 – 441]. It is in interpreting this transference – based on behavior different than that of the original seductive parental objects and suitable verbal feedback – that the cure of the neurosis is affected: “At the end of the analytic treatment the transference must itself be cleared away: and if success is then obtained or continues, it rests, not on suggestion, but on the achievement by its means of an overcoming of internal resistances, on the internal change that has been brought about in the patient” [1917, Introductory Lectures: 453]

Since this post is part of a larger project, I take the liberty of including several definitions of “transference” by leading figures who defined it. Those readers who wish less detail may skip ahead.

Thomas Szasz (1963: 432 – 443), who was otherwise a notorious psychoanalytic “bad boy,” denouncing the “myth of mental illness,” was an classic Freudian when it came to defining transference: “Freud conceived of transference love as an illusion because the situation in treatment cannot account for the origin of such feelings” [. . . .] [I]t [transference] is considered an expression of interest ‘basically’ directed towards childhood objects, deflected to the analyst or to the figures in the patient’s current life.”

Peter Giovacchini (1965: 287) writes that: “[. . . .] [T]ransference reaction refers to a person’s reactions to an object as they are determined by infantile unconscious factors. Viewing the object in terms of archaic imagos in a primary process orientation lead to irrational attitudes and distortions.”

Carl M. Grossman (1965: 249 – 250) defines transference in a broad sense that seems to go beyond the psychoanalytic context in a narrow sense: “[. . .] [Transference is] a universal human psychological characteristic which causes the internalized representation of certain objects – such as parents or parental surrogates from one’s infantile past – to be projected onto a succession of later, ostensibly unrelated persons. The transferring person then reacts to new objects with the anachronistically habitual reaction in adult life that he had had towards the originally cathected object in infancy.”

Ralph Greenson (1967: 151 – 152) asserts: “[. . . ] [Transference is] a special kind of relationship toward a person: it is a distinctive type of object relationship. The main characteristic is the experience of feelings to a person which do not befit that person and which actually apply to another. Essentially, a person in the present is reacted with as though he were a person in the past. Transference is a repetition, a new edition of an old object relationship” (pp. 151 – 152).” {TI: 339]

Leo Stone (1961: 66 – 67) writes “[…] [Transference is limited] to that aspect or fraction of a relationship which is motivated by persistent unmodified wishes (or other attitudes) toward an actual important personage of the past, which tend to invest a current individual in a sort of misidentification [. . . ] with the unconscious image of the past personage. It is essentially in appropriate to the current situation subjectively misunderstood as to genetic origin until analyzed, and tenaciously resistive to this analysis (pp. 66 – 67).” Stone further notes: “that a nuance of the analyst’s attitude can determine the difference between a lonely vacuum and a controlled but warm human situation, which does indeed offer these gratifications, along with its undoubted rigors” (1961: 21 – 22).” 

In short, transference is what happens when human do what they cannot stop doing – trying to make sense of situations by assimilating them to patterns from key patterns and expectations based on experience. What may have been helpful in one context to enable the person to survive or even flourish is less helpful and even harmful in other situations in that distortions and misunderstandings are introduced.

There is a broader sense of “transference” that developed, in which transference becomes the entire relationship which the patient has towards the therapist. And wherever there is transference can countertransference be far away? Under this idiosyncratic and enlarged meaning, “countertransference” becomes the therapist’s way of relating to the patient. For example, according to Paula Heiman, under this idiosyncratic interpretation of the relationship, “counter- transference” covers all the feelings the analyst experiences toward the patient (see Paula Heiman, 1950. On counter-transference. International Journal of Psycho-Analysis 31: 81 – 84). 

Of course, “counter transference” can mean an unprofessional or pathological response on the part of the therapist, as when s/he behaves in a moralizing, aggressive, or seductive manner; but it can also include appropriate and positive responses such as empathic ones. In the extreme, countertransference comes to mean empathy itself. Heimann’s  thesis is “that the analyst’s emotional response to his patient within the analytic situation represents one of the most important tools for his work. The analyst’s countertransference is an instrument of research into the patient’s unconscious” (1950: 81). The transference is not empathy, but the countertransference is essential input to the empathic process, even if not quite reducible to empathy itself.

While Freud innovated decisively in decoding the meaning of dreams in The Interpretation of Dreams (1900) and the exploration of infantile sexuality, from a clinical perspective, the elaboration of transference defined the clinical encounter between patient and therapist in the context of psychoanalysis. Transference becomes co-extensive with the encounter between patient and therapist. If you can’t form a transference, since the therapy consists in interpreting and raising the transference, the therapy is not going to work. 

We now turn from transference to empathy.

Freud explicitly states that unless the physician begins empathy in engaging in psychoanalysis, that physician is headed for trouble. The issue is that nearly no one knows that Freud said that because the Strachey’s mistranslate “empathy [Einfühlung]” as “sympathetic understanding.” I must insist on the point. We are on firm group as far as Freud’s guidance is concerned. “Empathy” and “sympathetic understanding” are not the same, and what is more, in a kind of Nachträglichkeit – or retrospective consideration – we lose the opportunity to connect to Freud’s guidance (see Agosta 2014). Thus, we have the kind of empathy wars that Heinz Kohut had to fight to demonstrate that empathy had a mutative effect on the structure of the self (presumably and especially including the ego). 

When Freud demonstrated by his empathic way of relating to the patient (including by his verbal interpretations) that he was not the authoritarian or seductive parental figure of the patient’s past or trauma, the patient would often resist, deny, or offer other defensive gestures against Freud’s interventions and interpretations. But eventually the evidence would add up. Freud was not the unkind parent or the seductive uncle – the mischief was coming from the patient’s unconscious (and his circumstances), not from Freud. With this realization, the patient was reliably able to shift out of stuckness and enjoy a new beginning in his work and romantic relatedness thanks to Freud’s revolutionary new method of treatment. 

Although there are numerous definitions of empathy, most include a narrow and an enlarged use of the term. In the narrow sense, empathy is a psychological mechanism, which, in folk psychology terms, as noted, consists in taking a walk in the other person’s shoes. It is rarely pointed out that one must take off one’s own shoes before putting on those of the other or one risks the distortion/defense of projection. As a psychological mechanism, Kohut defines empathy as vicarious introspection, though he does not merely define empathy in that way.

In an enlarged sense, empathy means being present with the other person without applying judgments, labels, or moralizing assessments. When I use the expression “empathic presence,” the word “presence” inevitably invokes Nacht (1962) and Nacht and Viderman (1960), who penetrating and insightful contribution should not be underestimated. However, as I use it the word “presence” should not be understood as a source or justification for any deviations in technique or the frame. If anything “presence” means “being with” one another in a Heideggerian sense or “being” in the sense of “going on being” as Winnicott employed the term. Even though not necessarily visible, if seated behind the couch, the analyst’s listening is a strong presence. 

If one understands “transference” in a broad sense of all aspects of relatedness to the patient, then it tends to merge with an understanding of “empathy” as the foundation of relatedness. 

Anything the analyst does to influence the transference is considered an issue – the question of the background to transference – passivity? Neutrality? Empathy? but empathy is the background to transference.

One of the most enlarged uses of the terms is to be found in Kohut. For Kohut empathy defines the entire field of therapeutic interrelations and one can even give a transcendental argument to that effect

Empathy is not just a useful way by which we have access to the inner life of man – the idea itself 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 explanation of empathy . . . what the inner life of man is, what we ourselves and what others think and feel. (1977: 306)

In this statement, empathy is the foundation of our relations to other individuals. This is a restatement and an expansion of Kohut’s celebrated statement in his 1959 article that empathy is the method of data gathering precisely about what other individuals feel and think. In turn, this method defines the scope and limits of psychoanalysis as a therapy and discipline. The field of empathy that of psychoanalytic therapy become co-extensive. 

As noted, one individual does not directly access the mental states of the other person, but rather had a vicarious experience of the other person’s experience. In empathy one is receptive to the micro-expressions of the other person’s experience – one has an “after image” and a “vicarious” experience of what the other is experience. 

The innovations continue. Kohut innovates around transference in 1971 – the establishment of what was first called idealizing transference and transference of the grandiose self and ultimately becomes selfobject transference is a distinct phase in the history of transference and tends to live like a split off bastion – for example, is there any evidence of a selfobject transference in the Wolfman, who had aspects of the depletion and grandiosity of narcissistic personality disorder? 

The selfobject represents the function that other people have for oneself. Kohut: “[. . .] [T]he general meaning of the term selfobject [is] as that dimension of our experience of another person that related to this person’s function in shoring up [supporting the homeostatis / equilibriating] our self [. . .]” (1984: 49)

In a standard relationship people interact in such a way that they mutually regulate one another’s thoughts, feelings, and actions. This is called “friendship.” It is also the give-and-take at the foundation of many forms of interpersonal cooperation, communication, and collaboration. When one’s spouse comes home from a hard day at the office or clinic or the backroom on Zoom and you give them a good listening as they vent the frustrations, double binds and bullying perpetrated by the boss or client, then you are functioning as a selfobject. Presumably such an interaction or function did not begin with Kohut’s coining the term “selfobject,” though it was more clearly delimited out of the undifferentiated background. 

One significant difference that, unfortunately, has resulted in controversy and lack of clarity, is how Kohut’s selfobject (narcissistic) transference is sustaining to the patient during the long process of interpreting, working through, and dissolving the transference and the inevitable transference distortions. Kohut took considerable pains to emphasize (and empathize!) that confrontational and moralizing methods would unleash reactive narcissistic rage on the part of the patient and that the empathic approach was critical path. 

This lines up with and is complementary to one of Freud’s early discoveries was a later version of this phenomenon – that what seemed to be a source of resistance was actually the way forward. However, the way forward means the possibility of relatedness between internal objects (everything from the superego to hostile introjects to good breasts) and the therapist. Key term: relatedness. Thus, when there are disruptions in the relatedness between the patient and therapist that is conceptualized as a breakdown in the transference – the loss of connectedness, even if the connectedness includes distortions, misunderstandings, and conflicts. But that is usually the way it is thought of or described in the context of classical analysis where the breakdown of the transference often results in what seem like moralistic or objective medical judgments that the patient is not analyzable. 

Instead, the relationship between transference and empathy comes into its own where, in the face of a breakdown in transference, empathy is used to restore the transference relationship. 

For example, speaking of a patient with significant narcissistic disequilibrium, Kohut writes:

  • When the narcissistic transference has become disrupted, he has the impression that he is not fully real, or at least that his emotions are dulled; he is doing his work without zest, that he seeks routines to carry him along since he appears to be lacking in initiative … ((1971): 16)

The restoration of the relatedness and the transference is brought forward when the therapist, using empathic understanding, shows the analysand that the therapist “gets” how the analysand is struggling with a setback or challenge in his life that he left him emotionally disequilibriated, anxious, lethargic, depleted. When this occurs repeatedly in the course of treatment, psychic structure is built and reinforced in the areas of emotional and behavioral regulation. A cure comes into view.

Kohut (1984: 66) writes: “[. . .] [The] aim and the result of the cure – is the opening of a path of empathy between self and selfobject, specifically, the establishment of empathic in-tuneness between self and selfobject on mature adult levels. [….] …the gradual acquisition of empathic contact with mature selfobjects is the essence of the psychoanalytic cure [. . .]” Of course, one must hasten to add that “empathic in-tuneness” is unlikely, even impossible, unless the distortions and illusions of the transference have been engaged interpretively (and in an empathic way) in course of making contact with mature selfobjects in empathic relatedness  

A number of issues occur here that clearly require further research and clarification of terminology. Why would selfobject transference be considered transference at all? Here “transference” again gets used in the broadest sense of “empathic relatedness.” It represents healthy relatedness, good listening, and interpersonal well-being. Interpretation of the transference is a key bridge between empathy and transference – when the interpretation is experienced as unempathic then the aggression released is not due to a lowering or elimination of defense against the death instinct but a reactive rage at getting one’s feelings hurt at being misunderstood by one’s therapist, being re-traumatized in the transference by unempathic caretakers or disappointed parental idealizations.

If such relatedness with its significant component of a “good listening” is spontaneously constellated in the psychoanalytic therapeutic encounter, then it may at first glance seem to be pure positive transference (the analyst as “good object”) or positive nontransference reality-based relatedness. Indeed, Winnicott’s transitional object is a special case of a selfobject but shows that the selfobject is a standard part of development in which the imaginary is integrated into the rich system of conventions and symbols known as everyday life. In that sense, the family pictures on one’s writing desk are reminders of why one works, making the absent present in what is literally a picture of health. 

Where transference was empathy shall be!

References

Szasz, Thomas. (1963). The concept of transference. International Journal of Psychoanalysis 44: 432 – 443. 

Stone, Leo. (1961). The Psychoanalytic Situation. New York: International Universities Press. [TI: 239]

Reich, Annie. (1966). Empathy and countertransference. In Annie Reich, Psychoanalytic Contributions. New York: IUP Press, 1973: 344 – 360.

Nacht, S. (1962). Empathy as a psychological mechanism and empathy as presence (of course it is both). Symposium The curative factors in psycho-analysis. II International Journal of Psychoanalysis 43: 206 – 211

Kohut, Heinz. (1984). How Does Analysis Cure? Eds. Paul Sepansky and Arnold Goldberg. Chicago: University of Chicago Press.

Kohut, Heinz. (1977). The Restoration of the Self. New York: International Universities Press.

Kohut, Heinz. (1971). The Analysis of the Self. New York: International Universities Press.

Grossman, Carl M. (1965). Transference, countertransference, and being in love. Psychoanalytic Quarterly 34: 249 – 256. 

Greenson, Ralph R. (1967). The Technique and Practice of Psychoanalysis vol 1. New York: International Universities Press.

Giovacchini, Peter L. (1965). Transference, incorporation and synthesis. International Journal of Psychoanalysis 46: 287 – 296. 

Agosta, Lou. (2014a). Rewriting empathy in Freud. A Rumor of Empathy: Rewriting Empathy in the Context of Philosophy. New York: Palgrave Macmillan: 66 – 82. DOI:10.1057/978113746534.0009.

(c) Lou Agosta, PhD and the Chicago Empathy Project