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Top 10 Empathy Trends for 2021

“The Year 2020 in review: One Star – definitely would not recommend!” Good things to say about 2020? As Dave Barry quipped, nobody got killed by the murder hornets. Many of my empathy trends for 2020, prepared in December 2019, were blown up on the launch pad by February 2020 as the pandemic accelerated. “Empathy interrupted!”  I acknowledge that I did not see it coming.

The year 2020 was not an ordinary year in any sense. Obviously. The really tough thought gradually dawns on us: “Ordinary” will never  mean the same thing again in quite the same way.

The fundamental meta-trend of trends is to process that there is no going back to the way things were in exactly the way they were in December 2019. 

I ask your understanding, dear reader, in that the pandemic features prominently in the first few trends, but since this is in the nature of a top ten list and the pandemic touches almost everything indirectly, significant trends stronger than the immediate pandemic issues get pushed towards the bottom of the list leading up to #1. So feel free to scan and skip ahead. 

(10) It’s gettin’ crowded under the bus – make room for your neighbor. Empathy as a practice and as a distinction is knocked back on its heels by the pandemic, fights back, and recovers – gradually. We confront the paradox of “embracing” our socially distanced neighbor. There is something about humans that makes us want to breathe on one another. Empathy? Don’t try and hold your breath – even though expanding neighborliness is the ultimate empathy trend. 

Any trends, activities, practices that required getting close to another person physically were under stress if not banned in 2020: breaking bread together in person, hugging your grandma or neighbor, hug therapy [there actually was such a thing – before the pandemic], shaking hand(s) with someone you can’t stand [as Tom Lehrer quipped in his satirical song “National Brotherhood Week”], engaging with the kindness of strangers, dating, occupying the middle seat (or any seat?) on an airplane or bus, participating in person in artistic or sporting activities, in short, breathing with people in close quarters, sharing oxygen with them. All these and more were unceremoniously thrown under the bus in 2020 by the requirement for social distancing. The thing is – it’s getting crowded under the bus. 

Any action, behavior, or practice that takes into account the dignity or well-being of the other person or community expands and empowers empathy. A silver lining: empathy is already “action at a distance,” as I know the experience of the other person because I too experience the experience.

Empathy trends for 2021: how long can you hold your breath?

Empathy in the age of Covid-19 really does mean wearing a mask, practicing social distancing, getting the vaccine (subject to availability). To quote Noah Lindquist: “Wear a mask – think of someone other than yourself, it’s all we ask – get your head out of your [bleep] – no, the mandates aren’t malicious; your conspiracies are fictitious; try not to be so grouchy have some faith in Fauci!” – to be sung to the tune of Disney’s “Be my guest” from The Beauty and the Beast. The part about “thinking of someone other than yourself” is the cognitive empathy moment, which is especially challenging in the face of pandemic fatigue. 

The New York Times (https://tinyurl.com/y9tczw8c) points out that, as President Trump’s trade war with China escalated, the administration all but eliminated the public health partnership with Beijing that had begun after the debacle of the SARS epidemic and was intended to help prevent potential pandemics. 

By pulling out, current and former agency officials say, Washington cut itself off from potential intelligence about the virus, and lost an opportunity to work with China against it. President Trump is voted out of office, while Mr Chairman Xi of China is handing out bonuses and deciding which scientists stay under house arrest.

As my friend David Cole astutely observed, “If you live mostly by yourself in the country, you can afford think about yourself a lot; if you live in the big city, you are forced to think about others.” He did not say “presumably because some of the others might be muggers,” but maybe he didn’t have to. Granted that thinking about others is top down, cognitive empathy, not the full package, still it provides useful training in perspective taking of different points of view and walking in the shoes of others, even if the others can be decidedly un-neighborly.

In terms of creating and expanding inclusive communities, the pandemic has been a significant set back. Empathy is all about being inclusive – take your in-group and reach out to outsiders and include them. The pandemic has made doing that problematic. It is hard to distinguish between being inclusive and a super spreader event such as we in the USA saw over the summer of 2020 with the ten day Sturgis motor cycle rally, which reportedly spread contagion across the upper Midwest. The recommendation is review Robert Pirsig’s influential  Zen and the Art of Motorcycle Maintenance prior to the next event.

 (9) Empathy continues to expand its political footprint. Empathy inhabits politics, even when empathy is conspicuous by its absence. Regardless of what one thinks of the individual candidates or economic platforms, the messaging of decency and cooperation reliably gets more votes than bullying and chest thumping. 

The bridge between the political present and a seemingly impossible-to-imagine future is empathy. The empathic moment is an act of imagination. That is the engaging thing about empathy. It may seem like a dream; but the dream lives. It is inclusive. It is consistent with social distancing. Nor does it require agreement. 

Different viewpoints are available with regard to anyone’s action, including that of the one with whom one is least likely to agree. This is not the narrow psychological mechanism of empathy in which one simply reverses perspective with another person. Political engagement is the  attempt to take on the multiplicity of standpoints represented in a given community. Historical empathy is trending, too (see Kohut 2020). 

The greater variety of perspectives that one has present in one’s mind on the present and past while one is engaging a given issue, and the better one can imagine how one would think and feel if one were in their place. This brief note to point to more discussion in the coming year. 

The politics of rage are abroad in the land. When people are spoken to using ethnic or racial insults, they get enraged. When people feel their values and commitments are not respected, they are aggrieved – and they get enraged. Dignity violations are experienced as breakdowns of empathy – and that causes people to get angry; and the anger often escalates into rage. It gets worse – and more ambiguous.

Demagogues tell their constituents that other groups do not respect them, are out to get them. Demagogues take advantage of people’s sometimes legitimate grievances. The result is that the rage is displaced onto those groups. This becomes especially problematic when the dignity violation is imaginary such as a non-existent Pizzagate Conspiracy. 

The emotional contagion that precedes mob action is a demonstrable breakdown of empathic receptivity. The communicability of negative emotions such as fear, anger, and panic are aroused and the humanity of one’s neighbors is denied. The comparison of the intended victims to insects is a distressing symptom of the denial of empathy, followed by dehumanization, followed by violence. 

The first step in eliminating any natural inhibitions on violence is to deny empathy to the intended victims that accompanies their humanity. Wherever one’s opponent is described in devaluing and dehumanizing language, the red flag is out. Get ready for human rights violations. 

Once called forth, rage can be channeled in a number of different directions. If it is channeled into burning down one’s own neighborhood, that is the self-defeating response to breakdowns in empathy. If it is channeled into a lynch mob, it is an appalling human rights violation that must rally people everywhere to the cause of justice. If it is channeled into righteous indignation and civil disobedience, that is an approach with potentially better outcomes. 

The empathy lesson? An empathic response on the part of the authorities will deescalate the rage and interrupt the potential for violence. People in the community use their empathy as a way of data gathering to determine if the authorities initial empathic responsiveness is the real deal or just more propaganda. 

(8) “USPS, yes!” from a song by The Bobs entitled “Drive by Love.” Add logistics and supply chain genius to the list of “unsung heroics” of empathy. It takes something to “get” that on-time delivery is actually a form of empathic responsiveness. 

Neither rain nor sleet nor snow nor dead of night – nor pandemic – stopped the US Post Office from delivering the mail – which included many mail-in ballots. Hats off to the unsung heroes – there are so many of them – in this case, the logistical accomplishments of forwarding the US mail. What happened once the mail got there is – predictably – more politics. 

Yes, of course, the nurses and doctors and first responders are eminently worthy of our recognition. Of course they are heroes – heroes of restoring health and well-being, cheating death, and survival, even as we also acknowledge that the need for so many heroes is a troubling sign that significant social systems are in breakdown. So do not forget to add to the list the unsung heroes of the solution to the pandemic – the supply chain men and women – the logistics guys. I do not just mean the actual delivery folks driving the trucks as in the song “UPS, yes!” I mean the logistics required to distribute two shots of the first approved vaccine at – what? – 90 degrees below Fahrenheit. No trivial accomplishment.

(7) Empathy is distinguished from simulated empathy (again). People will continue to try to listen to one another, and, by practicing listening, will make progress in distinguishing simulated (“fake”) empathy from empathy – gradually. The matter is complex – and troubling.

Social networking platforms (e.g., Facebook in its current form (Q1 2021)) are unmasked as the ultimate training ground for simulated empathy, a synonym for fake empathy and un-listening. 

In the section late in Shoshana Zuboff’s book (The Age of Surveillance Capitalism (Hachette Press)) on “Homing to the Herd,” Zuboff writes: 

“[Facebook’s] operations are designed to exploit the human inclination toward empathy, belonging, and acceptance. The system tunes the pitch of our behavior with the rewards and punishments of social pressure, herding the human heart toward confluence as a means to other’s commercial ends.” 

I would spit hairs and say, “simulated empathy.” However, the basic point is valid. The user ends up “over sharing” personal information in a kind of tranquilized state of semi-hypnotic psychic numbing similar to that induced in gambling casinos by blinking lights and bells. On FB, you are not the customer – you are the product. 

As bad as that may be, it gets worse. The damage to one’s humanity is already done when one’s personal experience is treated as raw material for the surveillance capital’s revenue model. Facebook and Google users – you and me – are not customers; we are the raw material. The customers are the advertisers, corporations with services and goods, whose selling requires a guaranteed outcome. Machine intelligence operating on big data at hyper-scale has within view behavioral modification the results of which B. F. Skinner, wizard of operant conditioning, can only have dreamed. You do not so much search Google as Google searches you. With that in mind, the next up trend is –

(6) Big brother is overtaken by Big Other without, however, decisively expanding empathy. Empathy scores [some] points against Big Other’s fake news, alternative facts, dangerous half truths, total nonsense, and simulated empathy, but the back-and-forth continues. 

The opponent is no longer “Big Brother” (as in Orwell’s dystopian novel 1984) but “Big Other” (first identified by S. Zuboff in her book (The Age of Surveillance Capitalism (Hachette Press)). Millions of Americans and their representatives in the US Congress subscribe to the fake news promoted by Big Other that the 2020 election was “rigged”; but millions more reject alternative acts, dangerous half truths and total nonsense. 

While fake news is perhaps as old as the Trojan horse in Homer’s Iliadand the warning about Greeks bearing gifts, social networking takes the risks and damage to a new level. Fake news aligns in detail with surveillance capitalism (see Zuboff cited above), because fake news maximizes social conflict, controversy, and most importantly – clicks.

Big Other is itself a Trojan horse appearing to be free search and free digital services. However, without advance in listening skills – i.e., the “free-ness” is illusory. It is more like the first settlers handing out blankets that were used to swaddle small pox patients to the indigenous peoples.

Just as the science of physics and engineering enabled industrial capitalism to master nature, a vision of socialphysics (Alex Pentland’s book of the same name features prominently) is being implemented in big data and machine intelligence to implement behavior modification. Thus Zuboff: “Social media is designed to engage and hold people of all ages, but it is principally molded to the psychological structure of adolescence and emerging adulthood, when one is naturally oriented toward the ‘others,’ especially toward the rewards of group recognition, acceptance, belonging, and inclusion.”

Big Other can mimic empathy, all the while capturing and aggregating the responses such that the predictive modeling can suggest targeted advertisements. Freedom of speech and self-expression continue to flourish. No one is listening.

As noted, social media provide the appearance of connectedness and intimacy – a simulated empathy – while actually perpetrating the equivalent of gossip, social climbing, narcissistic self promotion, and out-and-out deception. Ultimately the idea is to get you to engage in a transaction to buy, use, and consume Big Other’s product or service.

The proper function of education is to promote training in perspective taking (empathy), critical thinking, argumentation, distinguishing fact and fiction, assessing the reliability of reportage in the media, assumption questioning, and how to quote facts in context. These get traction in 2021 and play an expanded role in the school curriculum(s), even as in-person learning makes an all-too-slow comeback. 

(6a) True Believers (TB) are moved by empathy, not the facts, to abandon their illusion(s). The illusion/delusion holds the personality together; sp it is impervious to facts or arguments. Try some empathy? The story that one tells to other people is nothing in comparison with the story that one tells oneself. (Here “story” equals “belief system” or even “fiction.”)

You know the TB as the one who Doubles Down on his illusion when things do not go his way. Key term: Double Down. For example, when the space ship does not arrive from Alpha Centauri to take the TBs to the promised land (or your candidate does not win the election), does the TB inquire: Maybe I was mistaken about some of my facts? Maybe I made a wrong assumption? Or perhaps my messaging was a tad off? No! The TB doubles down. “We musta bin cheated!” “We was robbed!” 

No marshaling of facts, no amount of logical argument, whether overwhelming or debatable, makes a difference. It does no good – it makes no difference – to take the belief system away from the True Believer. The True Believer is not engaging any alternative point of view. Why not?

The answer is direct: the story, belief system, or ficiton is what is holding the True Believer’s self, his or her personality, together. Take away the belief system and the personality falls apart. The person experiences emotional fragmentation, anxiety, and stress. This is why the True Believer becomes angry, starts to shout, escalates to rage in the face of countervailing arguments and facts. The TB experiences a narcissistic injury that threatens the coherence of the TB’s personality. 

The secret of empathic relating to the True Believer is not agreeing or disagreeing, undercutting or sidestepping, antidepressants or antipsychotics, the secret is the relationship the empath has to his own inner True Believer. If you can find an area in which you really are a True Believer, then it is likely you can relate to a True Believer in a conversation for possibility in which both individuals are left in integrity, whole and complete. It does sometimes happen that when the True Believer gets the empathy he or she needs to feel whole and complete, the TB is able to “stand down,” “back away from the ledge,” and rejoin the diverse space of acceptance and tolerance of multiple points of view. It happens, but it takes a lot of work. 

(5) Empathy goes online – and stays there. This is one of the few trends from 2020 that were on target – and the trend continues. Here “empathy” refers to the gracious and generous listening that occurs in therapeutic counseling, behavioral health, life coaching, and empathy consulting, to individuals and organizations.

In particular, while nothing can substitute for an in-person conversation for possibility to shift out of emotional stuck-ness, after two people get to know one another, an online conversation is a good option in case of relocation, bad weather, unpredictable scheduling dynamics – or an especially infectious pandemic. The genie of online therapeutic conversations is out of the bottle, and not going back in. 

Psychotherapy invokes a virtual reality all of its own – even without cyber space. This is especially the case with dynamic psychotherapy that activates forms of transference in which one relates to the therapist “as if” in conversation with a past or future person or reality, the latter not physical present. Indeed, with the exception of being careful not to step in front of a bus while crossing the street on the way to therapy, we are usually over-confident that we know the reality of how our relationships work or what people mean by their communications 

Think about it: Those who complain about the lack of reality in a conversation over Zoom may usefully consider the amount of fiction and fantasy in any psychodynamic conversation, full stop. Never was it truer that meaning – and emotions such as fear – are generated in the mind of the beholder.

(Note: This trend is in part an excerpt from: Lou Agosta’s article “Empathy in Cyberspace: The Genie is Out of the Bottle” in Theory and Practice of Online Therapy: Internet-delivered Interventions for Individuals, Groups, Families, and Organizations edited by Haim Weinberg and Arnon Rolnick. London and New York: Routledge: To learn more about the complete book, click here: Theory and Practice of Online Therapy [https://tinyurl.com/yyyp84zc])

(4) Empathy in law enforcement. The police struggle with policing themselves – succeeding in many cases, failing dramatically in others – and, as a result, we all struggle. I acknowledge the dedication, commitment, and hard work of first responders. And yet the police [need to] do a better job of policing themselves. Expanded empathy training gets traction.

The trend to train the police in empathy to deescalate potentially violent situations continues to get traction – and is making a positive difference in many communities – but the list of people of color that end up dead after an encounter with the local constabulary also continues to grow. Disturbing – verrry disturbing. More progress is needed. 

This is definitely a “hot button” issue. A coherent position is hard to find amid the shouting. I am a radical moderate. I am an extreme centrist. If my house is being burglarized or on fire, I am definitely not  going to call a hippie. Heck, a couple already live there [okay, a bad joke].

However, the trend is to promote accountability – and prevent defending – I almost said “defunding” – and in the case(s) of a few “bad apples” by eliminating organizational obstacles. It lacks credibility that a police union would never  expel one of its members for violating the human rights of a citizen according to the union’s own code of police conduct. The union has a code of conduct that aligns with promoting human rights, right? I acknowledge: The problem is that one person’s bad apple is another’s dedicated professional. However, when unarmed civilians end up taking bullets fired by the police, I assert that we can all tell the difference. 

This is not primarily a public relations problem – it is a human rights one. The police struggle to police themselves, and so, absent expanded empathy in the community with the community for the community, we all struggle.

Communities will benefit from expanded empathy on the part of the law enforcement. However, there is another reason that indicates this trend has traction. The public does not always hear about the multi-million dollar financial settlements that municipalities are required to pay for wrongful death or excessive use of force, because these agreements come with rigorous confidentiality clauses. 

Police who lack training turn out to be extraordinarily expensive to the taxpayers. In this context, “lack of training” does not mean insufficient time taking target practice. It means the need for practice in putting oneself in the other person’s shoes and considering possibilities for conflict resolution, de-escalation, and community building. In short, empathy is an important part of the gear deployed by law enforcement as the warrior cop, who will still be needed in extreme situations, gives way to community policing. Really, is there any other kind?

(3) Expanded empathy in the struggle against domestic violence. Men will find their voice and speak out even more loudly and provide leadership against domestic violence to those of their own gender who just do not get it. Victims and survivors of intimate partner violence face expanded risks if they have to “shelter in place” in the pandemic with the perpetrator(s). 

This is grim – beyond grim. Once again, this is not new news but has been just beneath the surface and underreported because it is so confronting. While women have provided the leadership and will continue to do so, powerful men will step up and provide guidance to their fellow about proper boundaries and respect for them in relationships. This is ongoing. What is new: powerful men step up and speak out and provide leadership among men in establishing respect for boundaries in creating communication, affection, and affinity.

For data- and empathy-based innovations that have occurred in the past year in the fight against domestic violence see No Visible Bruises: What We Don’t Know About Domestic Violence Can Kill Us, New York: Bloomsbury Publishing, 2019. Some sixty percent of domestic violence (DV) victims are strangled at some point during an abusive relationship (p. 65): Big red flag that the perpetrator is escalating in the direction of homicide/Femicide. 

Turns out that only some 15% of the victims in one study had injuries visible enough to photograph for the police report (p. 66). Most strangulation injuries are internal – hence, the title. Good news/bad news: The Fatality Review Board is an idea that is getting attention with law enforcement and the local states attorney function. More progress and action is needed in this area. 

(2) A rumor of empathy in Big Pharma. The rumor is validated. After the debunking of the Diagnostic and Statistical Manual (DSM) completed by Chris Lane (2007) and the disappointing DSM 5th edition (2013), Big Pharma has a real opportunity to redeem itself in the eyes of the community. There is probably no other group of organizations on the planet that can do it. A crash project. High risk. Utterly urgent. The Covid-19 vaccine gets into people’s arms. Vaccine deniers say: “Oh, how I wish I were already experiencing the minor side effects of the shot!”

No, not a new psychotropic intervention for shyness, social anxiety, or hording. A vaccine(s) against Covid-19. The stakes are high, and it actually required [procedural] innovations at the FDA, CDC, and the US Congress (a high bar indeed) to enable treatments to be trialed without the usual ten-year plus long protocols (which are usually appropriate but not in this case). Fingers crossed (as of this writing 12/2020). Seems to be working – albeit gradually. Here me say it again (tongue in cheek): Don’t be so grouchy; have faith in Fauci! We are all most beholden’.

(2a) Empathy intersects with the struggle over climate change. It is a common place that empathy is oxygen for soul. If the human psyche does not get empathy, it suffocates in stress and suffering. Climate change makes the metaphor actual. If we do not drown as the Greenland and Antarctic ice fields slide en masse into the oceans, we are surely doomed to suffocate as the levels of carbon dioxide and heat overwhelm temperate habitats. 

The problem is that this eventuality does not live like an actual possibility for most people, who cannot imagine such an outcome – for example, just as in December 2019 no one could envision the 2020 pandemic. The bridge between the gridlocked present and a seemingly impossible-to-imagine future is empathy. The empathic moment is an act of imagination. That is the interesting thing about empathy. It may seem like a dream; but the dream lives. It is inclusive. Lots more work needs to be on this connection. For purposes of this list of tasks, this “shout out” will have to suffice. For specific actionable recommendations, see David Attenborough’s A Life on Our Planet, now streaming on Netflix: https://www.netflix.com/title/80216393

(1) Remove the obstacles to empathy such as cynicism and bullying—and empathy comes forth. Remove the resistances to empathy and empathy naturally and spontaneously expands. Most people are naturally empathic and they an expanding appreciation of empathy suffuses the community. 

The one-minute empathy training is trending: Eliminate the obstacles to empathy and a space of acceptance and toleration spontaneously emerges.

Most people do not sufficiently appreciate this: people are born with a deep and natural capacity for empathy, but they are also born needing to learn manners, respect for boundaries, and toilet training. Put the mess in the designated place or the community suffers from diseases. People also need to learn how to read and do arithmetic and communicate in writing. But there is a genuine sense in which learning to conform and follow all the rules does not  expand our empathy or our community. It does not help the cause of expanded empathy that rule-making and the drumbeat of compliance are growing by leaps and bounds.

The work at hand? Remove the blocks to empathy such as dignity violations, devaluing language, gossip, shame, guilt, egocentrism, over-identification, lack of integrity, inauthenticity, hypocrisy, making excuses, finger pointing, jealousy, envy, put downs, being righteous, stress, burnout, compassion fatigue, cynicism, censorship, denial, manipulation, competing to be the biggest victim, insults, injuries to self-esteem, and narcissistic merger—and empathy spontaneously expands, develops, and blossoms. Now that is going to require some work!

Teaching empathy consists in overcoming the obstacles to empathy that people have acquired. When the barriers are overcome, then empathy spontaneously develops, grows, comes forth, and expands. There is no catch, no “gotcha.” That is the one-minute empathy training, pure-and-simple. 

Selected Bibliography

Shoshana Zuboff, 2019, The Age of Surveillance Capitalism: The Fight For the Human Future at the New Frontier of Power. New York: Public Affairs (Hachette).

Tom Kohut. (2020). Empathy and the Historical Understanding of the Human Past. London: Routledge (T&F). 

Louise Snyder. (2019). No Visible Bruises: What We Don’t Know About Domestic Violence Can Kill Us, New York: Bloomsbury Publishing, 2019.

Lou Agosta. (2012). A Rumor of Empathy at Apna Ghar, the Videohttps://tinyurl.com/y4yolree [on camera interview with Serena Low, former executive director of Apna Ghar about the struggle against DV] 

Lou Agosta. (2015). Chapter Four: Treatment of Domestic Violence in A Rumor of Empathy: Resistance, Narrative and Recovery in Psychoanalysis and Psychotherapy. London: Routledge.

Lou Agosta and Alex Zonis (Illustrator). (2020). Empathy: A Lazy Person’s Guide. Chicago: Two Pairs Press.

Okay – have read enough and want to order the book Empathy Lessons to learn more about expanding my empathy: I want to order the book HERE.

© Lou Agosta, PhD and the Chicago Empathy Project

Narcissism gets a bad rap: On empathy and narcissism

Narcissism has gotten a bad name. “Narcissism” has become a euphemism – a polite description – for a variety of integrity outages and bad behaviors. These extend from antisocial, psychopathic actions through bullying and domestic violence all the way to bipolar spectrum disorders or moral insanity. “Narcissism” has become the label of choice when an individual is behaving like a jerk. 

In the face of narcissism’s bad name, I am not here to give narcissism a good name,  but rather I suggest the matter is more nuanced than that presented in the popular psychology press today. Like Mark Anthony commenting on Julius Caesar in his funeral oration after Caesar’s assassination, I come not to praise narcissism but to bury it – and to differentiate narcissism from more serious forms of bad behavior with which it is confused. This article suggests that if a person behaves in an anti-social, bullying, boundary violating or other problematic way described above, then narcissism is the least of the worries. 

Whip-sawed as the narcissist is between arrogant grandiosity and vulnerable idealization, the authentic narcissist will reliably provide a positive developmental response to empathy. However, if repeatedly providing empathy to the alleged narcissist just gets you more manipulations, bullying, integrity outages, and broken agreements, then you may really be dealing with an anti-social person and personality, moral insanity, psychopathy, or undefined lack of integrity, in which case, empathy will not work. Neither will compassion. Limit setting is the order of the day. Fill out the police report and get the order of protection. 

The truth of narcissism is that people need and use other people to regulate their emotions. When Elvis sang “I wanna be – your teddy bear” (Elvis Presley, that is), he was bearing witness to the truth that we use other people to sooth our distressed selves, provide emotional calming when we are upset, and give us the empathy we need to fell good about ourselves. 

“I wanna be your teddy bear” means “I wanna give you the empathy, recognition, acknowledge that you need to feel good about yourself.” If the other person subsequently does not respond to you as a whole person, then that is surely a disappointment but the shortcoming is not necessarily in anything you did. The other person did not keep their commitment. 

People want people who respond to them as a whole person. People want people who appreciate who they are as a possibility. People need that sort of thing. People are vulnerable to the promise of such satisfaction because it feels good when it actually shows up.  

Of course, the big ifs contained in such a proposal are that the other person is capable of providing such empathy; the other person is reciprocally acknowledged as being someone from whom empathy is worth receiving, and then the other actually behaves in a way that is understanding and receptive. 

If the other person expresses hostility, withholds acknowledgement, does not honor his or her word, perpetrates micro aggressions (“narcissistic slights”), manipulates in subtle and overt ways, or behaves in a controlling or dominating way, behaves like a bully, then is that narcissism? It might be – but it might also be a lack of integrity (dishonesty), anti-social personality behavior, criminality, boundary violations, and abuse. It might or might not be narcissism – but it is definitely behaving like a jerk [just to use a neutral, non vulgar term].

The person who survives such an encounter or relationship with the alleged psychopath in narcissistic sheep’s clothing then has two problems. The first problem is that the individual has been deceived, manipulated, or cheated. The second problem is that he or she blames himself. 

Narcissists are supposed to be excessively self-involved, self-centered, self indulgent. To succeed in life, most people need to have a dose of healthy self confidence. By a show of hands, who reading this article lacks a strong sense of self-interest? Get some help with that. Okay – that’s narcissism, but not pathological narcissism.

When I read the latest denunciation of narcissism in the pop psychology magazine, I wonder where are all of these people who are not self-involved, self-centered, self-interested, looking out for “number one”? 

I go to social media where self-expression is trending. My take-away? Freedom of speech and self expression are flourishing – no one is listening! Is such lack of listening narcissism? Perhaps. But more likely is not lack of listening rather just lack of listening? Lack of commitment of expanding listening skills, inclusiveness, and lack of community?

So suppose the popular press is all mixed up about narcissism. What does the disentangling of this mess look like? 

People who are described as narcissists have [some] people skills. Even if one’s empathy is incomplete and defective at times, most people crave an empathic response and are able to provide one, at least on a good day. The challenge is that the narcissist’s empathy breaks down in emotional contagion, conformity, lack of perspective taking, and messages getting lost in translation. 

Most people want to look good and avoid looking bad, and narcissists are especially prone to doing that. Most people are committed to being right and, while we theoretically acknowledge we might be wrong, few people actually behave that way. Most behave like “know it alls,” especially in areas about which they literally know nothing. Narcissists are especially prone to that too. So we are all narcissists now? 

The differentiator is that the narcissist ends up feeling like a fake, experiencing an empty (not melancholic) depression, even in the face of authentic accomplishments.

Even when the narcissist actually performs and wins the gold ring, he (or she) still feels like a fake. There is a kind of empty depression, lack of energy, lack of vitality. This lack of aliveness may cause the narcissist arrogant, cold, haughty withdrawal or acting out using substances of abuse or sexual misadventures. In spite of actual accomplishments, the narcissist may feel that life is passing him by. A pervasive sense of lack of aliveness, vitality, or apathy dominates the narcissist’s emotional life. 

The one thing that narcissism is not confused with is autism spectrum disorders. The narcissistic has access to empathy, values it, “gets” it, craves it, even if the narcissist’s empathy is distorted and incomplete. I speculate that the psychopath is good at faking empathy, like an empathy parrot, prior to his perpetrations, whereas the narcissist is just not very good at it. He may seem to be faking empathy, but that is his clumsy effort to get it right, which is not working. 

It seems as though the narcissist has an exaggerated self worth and, if in a position of authority, has the power to enforce his or her distorted view on others. The narcissist shares his suffering in a bad way by causing pain and suffering to the people in his environment. When such a person has authority, the result indeed can be dysfunction behavior, which is hard to distinguish from bullying. 

As with most forms of bad behavior, the optimal first response is to set a limit to the bad behavior by pushing back, calling it out, expressing concern, or using humor to deflect: such behavior (bullying, bad language, physical or financial abuse,  etc.) is unacceptable. “That doesn’t work for me.” “Stop it.” Without establishing a context of safety and security, we do not have a set up for success in which empathy can make a difference. Few people are in a position to up and quit their job. No easy answers here. Depending on the seriousness of the situation, then document, call for backup, and escalate to the authorities, including a call to 911 or a police report as applicable. 

At this point, the narcissist may get the idea, “Hey maybe I need someone to talk to – professionally.” 

While every case is different, no one size fits all, and all the usual disclaimers apply, the intervention with the narcissist often consists in a conversation for possibility. Talk to the person. Give him or her a good listening, and she what shows up. The person’s experiences as a child of tender age show deficiencies in the areas of empathic response, opportunities for emotional regulation, or distress tolerance. This is no excuse for bad behavior; never will be; however, it can point to transformation if the person is open and willing. 

The narcissistic encapsulates his true self into a cocoon, hiding behind a fake self, in order to preserve the hope of aliveness and vitality if an empathic environment were ever to show up. If, in a context of safety for all, the narcissist is encouraged to lay back and to take a look at the precursors, triggers, and behaviors that he experiences as narcissistic insults and injuries causing him to break down or act out, then something starts to shift. They did not get enough empathy, did not get feedback on their own empathic responses (or lack thereof), got empathy but the responses were distorted or flat out crazy (causing the above-cited retreat into the emotional cocoon). 

If the intervention gets off to a good start and the narcissist has a therapeutic response – that is, he feels better and stabilizes – then the work consists of trying to provide empathy, restoring understanding when empathy breaks down, restoring communication when communications break down, and restarting the development of positive personality traits such as empathy, humor, creativity that got lost in the narcissist’s deficient environment coming up. 

The bottom line? Like most human beings, those with significant narcissistic tendencies and behaviors are susceptible of improvement. Sometimes there is no way to know for sure except to attempt the intervention in a context of safety and security. Unlike more serious forms of bad behavior exemplified by anti-social personality disorder, significant bullying, or boundary violating behaviors in which people get hurt, many narcissists are sufficiently in touch with their feelings and cravings for empathy that they will respond positively to an intervention in a context of safety and empathy. 

Bibliography

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

Lou Agosta and Alex Zonis (Illustrator), (2020). Empathy: A Lazy Person’s Guide. Chicago: Two Pears Press.

Go to all A Rumor of Empathy podcast(s) by Lou Agosta on Audible by clicking here: [https://www.audible.com/pd/A-Rumor-of-Empathy-Podcast/B08K58LM19]

Okay, I have read enough. I want to get Empathy: A Lazy Person’s Guide, a light-hearted look at empathy, containing some two dozen illustrations by artist Alex Zonis and including the one minute empathy training plus numerous tips and techniques for taking your empathy to the next level: click here (https://tinyurl.com/y8mof57f)

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

Empathy and the True Believer

Empathy is going to do what it always reliably does: listen. So when empathy encounters the True Believer, empathy is going provide a gracious listening. 

As empathic listeners, we start with an extreme case. We are listening to a narrative about how the space ship was supposed to arrive from Alpha Centauri to take the members of the group (or cult) to the Promised Land; but it did not arrive. As empathic listeners, we find ourselves listening to a narrative about how an election was stolen. However, so far, the recounts fail to surface the theft. We are listening to a narrative of how some racial or ethnic minority stabbed the nation of citizens in the back; but the supposed perpetrators are noticeably without power or influence consistent with such an action or result. We are listening to a discourse about how prayer makes us whole and faith fulfills our aspirations; but we experience prayers as unanswered (as if no one was listening) and faith as indistinguishable from the outcome of our own persistent efforts in a probabilistic universe of random events. 

It does no good – it makes no difference – to take the belief system away from the True Believer. No marshaling of facts, no amount of logical argument, whether overwhelming or debatable, makes a difference. The True Believer is not engaging  any alternative point of view. Why not? 

The answer is direct: the belief system is what is holding the True Believer’s self, his or her personality, together. Take away the belief system and the personality falls apart. The person experiences emotional fragmentation, anxiety, and stress. This is why the True Believer becomes angry, starts to shout, escalates to rage in the face of countervailing arguments and facts. He experiences a narcissistic injury that threatens the coherence of his personality. 

The work of empathy in the face of the True Believer consists in standing for an inquiry into one’s belief systems. If empathy is a belief system, then we inquire into that system too. Such a belief system – if we may tentatively call it that – opens out into a space of acceptance and tolerance. It is a belief system which is skeptical about belief systems. It is a belief system committed to inquiry. Key term: inquiry. Never stop questioning. Never stop listening. 

Empathy creates a commitment to acceptance, toleration, and the ability to walk in the other person’s shoes. The True Believer is committed to a belief system, conformity, and marching together in step. 

Since it would require an entire book to define The True Believer, I will just give a definition by example. It is a high probability you are dealing with a True Believer when, in the face of a setback to the Belief System (whether religion, political party, social movement, or spiritual cause) the adherent to the cause Doubles Down. Key term: double down. 

For example, the end of the world does not arrive on the predicted date as predicted by the leader, the prophet, and the belief system. The space ship does not arrive from Alpha Centauri to take the True Believers to the promised land. You know the authentic True Believer when he experiences a set back to the movement, cause, and belief system to which he is devoted. Do the adherents of the belief system say: Oops, we might have overlooked something – some facts or alternative point of view; we might have made a miscalculation; or some of our assumptions require improvement? We might have made a mistake or two or overlooked a crucial detail? No! The True Believers double down. 

What went wrong? Sometimes the fault is internal. The faith of the True Believer was not strong enough. We must confess our sins. Preferably, we must confess our failings in a public show trial and be martyred. However, preferably the fault is external. Outside agitators, the unwashed masses from a foreign land, a racial or ethnic minority stabbed us in the back. 

Alternative facts, dangerous half-truths, and total nonsense are marshaled to account for the setback. “We was robbed!”  “Betrayal!” The vote count shows we lost by five million votes; but those votes were invalid votes, stolen votes, non-existent votes, and, therefore, irrelevant. Anything except the simple fact, we screwed up (but how?) or our game plan did not survive the encounter with the real world situation at a given time and place. Thus, the definition by example of the True Believer.

You, dear reader, can see where this is going. How does empathy or an empathic person engage with the True Believer? If the True Believer takes a position that rules out an inquiry into the advantages and disadvantages, the benefits and draw backs, of one’s own or competing belief systems, then the conversation does not get going. How to get the conversation going?

Rarely is empathy irrelevant but there are some situations in which empathy is less (or more) useful than other situations. For example, if someone is throwing rocks, then understanding the rock throwing person is expressing his sense of grievance in a bad way is less useful than stopping them from throwing rocks. 

Things such as self-defense, security, safety, basic well being are necessary aspects of the situation for empathy to make a difference. The True Believer is different from the bully, the psychopathic, the psychotic, or the fanatic, whether religious or political – but sometimes not that much different. 

The guidance from empathy in the face of bullying, psychopathic manipulations, or rock throwing is to set limits. Likewise, with the True Believer. Key term: limit setting. Empathy is useful in deescalating aggression, hostility, violence, and other forms of acting out; but once the first rock flies through the air, the situation is no longer one about empathy. It is about reestablishing safety, security, and a space of acceptance and tolerance where empathy can actually make a difference. As noted, empathy is going to give the True Believer a good listening.

It is sometimes said that there is a little bit of larceny in all of us. That little bit of larceny is useful in empathizing with the bad boy or girl. That little bit of larceny is useful in figuring out what might have motivated a given individual’s antisocial behavior. 

The same idea applies to empathizing with the True Believer. If you can relate to your own inner True Believer, then you might be able to engage with the True Believer’s in the community to understand what makes them tick. 

The challenge is that in relating to your inner True Believer, you are not really relating to an individual, you are relating to a belief system, some of the principles of which may be useful and sensible, others less so.

The secret of empathic relating to the True Believer is not agreeing or disagreeing, undercutting or side-stepping, antidepressants or antipsychotics, the secret is the relationship the empath has to his own inner True Believer. If you can find an area in which you really are a True Believer, then it is likely you can relate to a True Believer in a conversation for possibility in which both individuals are left in integrity, whole and complete. 

How shall I put it delicately? An authentic patriot can be willing to die for his [or her] country and yet not be a True Believer. But can he be willing to kill for his country without being a true believer? This is hard to finesse. When challenged, True Believers escalate in the direction of a fanaticism of hostility and aggression, even if they stop short of the death penalty. 

I hasten to add that national defense is a valid function of the national armed forces, and I honor service men and women, first responders, and those committed to homeland security. Following orders to shoot the enemy on command of the commanding officer does not make one a True Believer. But it does make one a cog in a mechanism of defense, which in most cases requires a therapeutic recovery process to regain lost aspects of one’s humanity upon discharge from the armed forces. 

Is the True Believer like the bully, the psychopath, or the perpetrator of domestic violence, for whom the more expanded empathy you give the person, the more ways the True Believer has to manipulate and abuse you?  Some of the best parts of empathy – reduced stress, emotional regulation, self soothing – do not get deployed because empathy must put all its energy into setting limits to the boundary issues and violations. 

The fall back position of empathy – which paradoxically ceases to be empathy – is to have compassion or even pity for the misguided soul who needs such a delusional system to feel or maintain a grip on reality. Absent successful boundary setting using empathy, the recommendation is to dial 911 and summon emergency services to restore order and tranquility (a desperate measure indeed, given that the police may arrive with guns out – how is that serving and protecting?).

I anticipate an objection at this point. The devil’s advocate says: But, Lou, are you not a True Believer in empathy? The answer is direct: No. I am committed to undertaking an inquiry into empathy. Empathy has strengths and weaknesses. It can misfire or it can succeed. It is susceptible of improvement in many situations. I hasten to add that I am also committed to using empathy to benefit people and organizations in the community. I am a shameless and unabashed promoter of the value of empathy. I will go to the matt on this one. 

However, even if you do not believe in empathy, are persuaded that empathy is over-rated, or prefer rational compassion, I will still try my best to give you a good listening and to use empathy to make a positive difference in our relationship. No doubt more needs to be written about empathy and the True Believer. The politics of empathy is deep and complicated. There is a lot at stake. Literally.

This may indeed be a “love the sinner but hate the sin” moment. But such a moment is the positive part of empathic spirituality without which fanaticism causes spirituality to go off the rails and burn people at the stake. So if you find yourself or your neighbor gathering kindling for a bonfire, make sure it is to roast one’s own idols, pretensions, and vanities, not your neighbor. 

Bibliography

Eric Hoffer. (1951). The True Believer: Thoughts on the Nature of Mass Movements. New York: Harper Perennial.

(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 Zonis

University 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

A Rumor of Empathy is now a podcast (series)

A rumor of empathy (the podcast) hears of a report of an alleged example of empathy in the work, action, or conversation of a person or organization. I then reach out to the person and talk to them in detail about the work they are doing try to get the facts and confirm or disconfirm the validity of the rumor. Makes sense?

A Rumor of Empathy is committed to providing a gracious and generous listening, empathy, in conversation with its guests and listeners. Join the host in chasing 

down and confirming or debunking an unsubstantiated report of empathy in the community and engaging in an on the air conversation in transforming human struggle and suffering into meaningful relationships, satisfying results and contribution to the community. When one is really listened to empathically and heard in one’s struggle and effort, then something shifts. Possibilities open up that were hidden in plain view. Action that makes a difference occurs so that empathy becomes less of a rumor and an expanded reality in your life and in the community. When all the philosophical arguments and psychological back-and-forth are over and done, in empathy, one is quite simply in the presence of another human being. Join Dr Lou for an empowering conversation in which empathy is made present.

Go to all A Rumor of Empathy podcast(s) on Audible by clicking here: [https://www.audible.com/pd/A-Rumor-of-Empathy-Podcast/B08K58LM19]

Empathy and humor – resistance to empathy?

Humor and empathy are closely related. We start with an example that includes both. Caution: Nothing escapes debunking, including empathy. My apologies in advance about any ads associated with the video. 

Both empathy and humor create and expand community. Both empathy and humor cross the boundary between self and other. Both empathy and humor relieve stress and reduce tension. 

However, empathy crosses the boundary between self and other with respect, recognition, care, finesse, artistry, affinity, delicacy, appreciation, and acknowledgement, whereas humor crosses the boundary between individuals with aggression, sexuality, or a testing of community standards. 

If you have to explain the joke, it is not funny – nevertheless, here goes. 

The community standard made the target of satire in the SNL skit is that people are supposed to be empathic. The husband claims he wants to understand social justice issues but when given a chance to improve his understanding – drinking the empathy drink by pitched by the voice over – he resists. He pushes back. He pretends to drink, but does not even take off the bottle cap. When pressured, he even jumps out the window rather than drink the drink. 

The wife does not do much better. She resists expanding her empathy too, by pretending that, as a woman, she already has all the empathy needed. Perhaps, but perhaps not. People give lip service to empathy – and social justice – but do not want to do the hard word to create a community that is empathic and works for all. 

The satire surfaces our resistance to empathy, our double standard, and our tendency to be fake about doing the tough work – including a fake empathy drink. If only it were so easy!

Therefore, be careful. Caution! The mechanism of humor presents sex or aggression in such a way that it creates tension by violating social standards, morals, or conventions. This occurs to a degree that causes stress in the listener just short of eliciting a counter-aggression against the teller of the story or joke. Then the “punch line” relieves the tension all at once in a laugh. 

Another sample joke? This one is totally non controversial, so enables one to appreciate the structure of the joke. 

A man is driving a truck in the back of which are a group of penguins. The man gets stopped for speeding by a police officer. Upon consideration, the officer says: “I will let you off with a warning this time, but be sure to take those penguins to the zoo.” The next day the same man is driving the same truck with the exact same penguins. Only this time, the penguins are wearing sunglasses. The same police officer pulls the driver over again and says: “I thought I told you to take those penguins to the zoo!” The man replies: “I did. Yesterday we went to the zoo. Today we are going to the beach!” Pause for laugh. 

The point is that humor, among many things, is a way in which one speaks truth to power—and gets away with it. In this case, one disobeys the police officer. One is technically in the wrong, though vindicated. Penguins in sunglasses are funny. More specifically, the mechanism of the joke is the ambiguous meaning of “takes someone to the zoo.” One can go to the zoo as a visitor to look at the animals or one can be incarcerated there, as are the animals on display. 

Instead of a breakdown in relating such as “you are under arrest!” the relationship is enhanced. The driver is following the officer’s guidance after all, granted the interpretation was ambiguous.

You get a good laugh—and a vicarious trip to the beach added to the bargain. Empathy is the foundation of community in a deep way, for without empathy we would be unable to relate to other people. Humor and jokes also create a community between the audience and storyteller as the tension is dispelled in the laughter (see also Ted Cohen on Joking Matters (1999)).

The story creates a kind of verbal optical illusion, a verbal ambiguity that gets expressed in laughter. In empathy perhaps one gets a vicarious hand shake, hug, “high five,” pat on the back, or tissue to dry a tear, expressing itself in recognition of our related  humanity, while affirming and validating the self-other distinction.

Featured image of laughing carrousel horses (c) Alex Zonis

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

Empathy and Architecture: On Foundations

Empathy is about relationships. Architecture is about building things that last. Building lasting relationships? A marriage made in heaven?

When you are building something – whether a bridge, house, or a relationship – the challenge is to get the fundamentals just right. The foundation is what connects the structure to the earth. This is the case especially with bridges that span vast chasms. 

Empathy: a bridge over waters, calm or troubled. Illustration credit: Alex Zonis

The architect building a structure knows that the structure has to go down to bedrock. You have to go down to what is stable and abides or the structure can be magnificent, beautiful, and elegant; but it will crack, lean over like the leaning Tower of Pisa, and then fall over due to design flaws. Or like the Tacoma Narrows bridge, it will start resonating in the wind and tear itself loos from its foundation and collapse. [Granted, the Leaning Tower was “fixed” by those ingenious Japanese engineers who hollowed out a space on the higher side enabling the Tower to “fall up.”]

Therefore, to explore the bedrock for the structure of empathy we have to ask what is bedrock in human relations? But wait. I thought the foundation of human relations was – empathy. The bedrock is empathy. 

But what is the bedrock of the bedrock? On what is empathy itself founded?  How do we get access to the foundation of the foundation? Isn’t the foundation just the foundation? Not exactly. Read on. 

The way to get access to the question of what is the foundation of the foundation is to ask what can go wrong. Imagine empathy was a bicycle – it can get a flat tire, the handle bars can fall off, the chain can break, or the rim can get bent, and so on.  A square wheel won’t roll. In each case, something is missing – wholeness. The bike as a bike is incomplete and, therefore, does not work. 

Likewise with empathy. Empathy can break down. When we engage with the break downs, we get access to the foundation. 

Empathy can break down as emotional contagion, conformity, projection, or get lost in translation. In each case, something is missing – wholeness. 

The foundation of the foundation is integrity. The Roman Stoic politician and philosopher Cicero defined “insanity” (insanitas) as lack of wholeness, incompleteness, or being fragmented (see Cicero’s Tusculan Disputations a Roman “psychiatry”). Here “integrity” is not meant in the narrow ethical sense of right/wrong, but rather “integrity” in the sense of being authentic. In the case of empathy integrity means being present with the other person without anything else added or missing. 

Therefore, the foundation of empathy is working on one’s own integrity and authenticity in being related. Without such a foundation, one is building on a mud pie.

You know how when things go wrong, the tendency is to find someone to blame and point the finger in someone’s direction? The word “responsibility” can hardly be uttered and our listening is “bad and wrong” and “who’s to blame,” you know? You did it! He did it! She did it! Now in the course of this work on empathy that finger has a tendency to change direction – and it points to oneself. 

Clean up your messes. Illustration credit: Alex Zonis

“I say I am committed to keeping my agreements but I am actually committed to not rocking boat” “I say I am committed to freedom of expression but I am in fact actually committed to being liked, being popular.” “I say that I am generous in my relationships but I am actually attached to holding onto grudges and grievances.” “I say that I am committed to being faithful in my relationship but the only reason I am faithful is that in fact I lack opportunity to betray my partner.” “I say I am honest but cut corners and cheat on my business expenses or taxes.” “I say that I am committed to telling the truth but I am actually committed to looking good.” You can provide examples of your own. This list goes on. 

Therefore, clean up your own messes first. I have to work on myself – and you, dear reader, have to work on yourself – and we have to clean up our own acts prior to taking the empathy game to the street and coaching others. 

The foundation is cleaning up one’s own integrity outages. Acknowledging the cost and impact and, where possible, making restitution and repair. The ultimate path to authenticity is cleaning up one’s inauthenticities. 

Because a bridge falls down does not mean that bridge building is a failed science; because a tower leans over does not mean that the physics of building towers is in error. It means human beings on occasion misapply the practices of bridge building and tower making. Likewise with the practice of empathy. It’s the practice that counts.

Without consistent, enduring practice, the results you get will be a roll of the dice; and getting lucky is not a viable plan when anything important is at stake. That is the bad news and also the good news in expanding empathy in the individual and the community. It’s all about the practice. 

Three recommendations: practice, practice, practice – and be sure to get a second opinion – a coach – to provide feedback on your practice (so the bridge doesn’t fall down!),

So, back to the architectural metaphor: a lot of site preparation is needed. The structure is multi-unit and multi-person. The site of empathy includes receptivity of the other’s feelings, understanding of the other as a possibility, talking a walk in the other’s shoes (the folk definition of empathy), and translating the other’s experience into one’s own and vice versa. Heating and cooling include emotional regulation and distress tolerance shows up as weather proofing and lightening rods. 

From another point of view, empathy is not a standalone structure. It is a bridge connecting individuals and communities. It is a bridge over troubled waters on a stormy day and a source of satisfying relatedness on a sunny one. 

Okay, I have read enough I want to get the book, Empathy: A Lazy Person’s Guide, a light-hearted look at empathy, containing some two dozen illustrations by artist Alex Zonis and including the one minute empathy training plus numerous tips and techniques for taking your empathy to the next level: click here (https://tinyurl.com/y8mof57f)

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

Empathy and Vulnerability

One of the misunderstandings of empathy is that “empathy means weakness.”  Not so. Why not?

Empathy means being firm but flexible about boundaries. The most empathic people that I know are also the strongest and most assertive regarding respect for boundaries. Being empathic does not mean being a push over. You wouldn’t want to mess with them. Where such people show up, empathy lives—shame and bullying have no place. (For a working definition of empathy, see the note at the bottom of this post.)

Empathy thus solves the dilemma of how to deal with a bully without becoming a bully oneself. Bullies are notoriously causal about violating the boundaries of other people, because it is easier to cause pain than to feel pain. Bullies are taking their pain and working it out on other people. Bullies do not acknowledge their own vulnerabilities, and they work out their issues – I almost said “shxt” –on other people. Bullies are offloading their distress on other people. But what to do about it from an empathic perspective? 

I am going to answer that question directly, but first take a short step back: Once the stones start flying back-and-forth, there is nothing to do but defend oneself or try to escape if outnumbered – retreat. If it is a school year brawl, hit ‘em back in self-defense if one is able. If the corporate boss is a bully, document and escalate – and update your resume just in case. If the bully is a politician, speak truth to power like Malcolm-X did: “You did not land on Plymouth Rock; Plymouth Rock landed on you” – use humor to bring down arrogance and privilege. 

Once the stones start flying, the conversation is no longer about empathy or vulnerability. It is about who has the biggest cudgel or stone. Empathy did not work – empathy is in breakdown along with common courtesy and decency – call for backup! However, if things are still at the stage of name calling, remember what to my secular ears the ultimate empath of the spirit, Jesus of Nazareth, said and did. He was outnumbered with the woman “taken in adultery” confronting an angry mob of scribes, elders, and Pharisees, armed with large stones: “Let he who is without sin cast the first stone” (John 7:53 – 8:11). Nothing happened. No one dared be the first to assert his perfection. While the originality of this passage may be debated – did John really write it and who the heck is John, anyway –  the pasage’s psychological power is beyond question.

In the face of loss of power, authority escalates to violence. Jesus dared to make himself vulnerable by aligning with the woman who had violated the community’s standards, which were so rigid that a case of infidelity threatened to below up the entire fabric of civilization. Otherwise, why would the authorities need to stone her to death? (And it really was all men who were about to do the stoning – so you can see there were many problems here!) 

Always the astute practitioner of empathy, Jesus got inside their heads. He knew the authorities wanted to look good and claiming to be better than everyone else would make them look bad. Instead of shaming the woman Jesus turned the tables and put the authorities to shame.  To get power over shame one has to allow oneself to be exposed and vulnerable to it. Be proud!

Thus, Brené Brown makes a parallel observation about vulnerability – she does research on vulnerability and shame – and asserts that it is a myth that “vulnerability is weakness.” Thus her project is to expand our appreciation of the power of vulnerability.  

As Brené Brown uses the distinction “vulnerability,” she means living with uncertainty, living with risk, and living with emotional exposure. She understands vulnerability to mean letting go of “looking good” or fear of being ashamed. She means it to go in harm’s way emotionally or even physically and spiritually by having difficult conversations and taking actions about the things that make a difference – relationships, finances, careers, values, fairness, and so on. The inner game of vulnerability is different than the behavioral vulnerability that consists in leaving the password to your bank account on a yellow sticky pasted to your computer. 

Brené Brown’s coaching is to expand vulnerability in the sense that I have my vulnerabilities; not my vulnerabilities have me. Her lesson “no courage without vulnerability” means that the courageous person goes forth into risk and danger in spite of being afraid. The person who imagines he is without fear is precisely the one who behaves in a foolhardy way, for example, Colonel Custer at the Little Bighorn, about to be wiped out, saying “We’ve got them now!” completely unaware of the risks he was taking. He did not have his vulnerability; his vulnerability had him – and did him in along with his regiment. 

I hasten to add that empathy and vulnerability are different phenomena, not to be confused with one another. They are not either/or – the world needs more of each one – expanded empathy as well as the power conferred by expanded vulnerability. 

You cannot do empathy alone. I get my empathy from the other individual. The other individual expands my empathy by giving me his; and I acknowledge the other individual’s humanity by giving him my empathy. The baby brings forth the parent’s empathy and is socialized by it – brought into the human community. The student brings forth the teacher’s empathy and is educated through it – brought into the educated community. The customer arouses the businessperson’s empathy and is served by it – brought into the community of the market. The list goes on. 

Likewise, you cannot do vulnerability alone. The more armored up and defensive a person becomes, the less vulnerably, the less uncertainty, risk, and emotional exposure the person incurs. However, without uncertainty, risk, or exposure, such essential results as innovation, productivity, courage, relatedness, satisfaction, and, yes, empathy, get lost. 

Even though empathy and vulnerability are distinct phenomena, when they occasionally breakdown and fail, the component fragments are remarkably similar.  Empathic receptivity breaks down as emotional contagion; likewise, in vulnerability a person is overwhelmed by the emotions of the moment. 

Empathic understanding breaks down as conformity. Instead of relating to the other person as an authentic possibility, one conforms to the crowd and what “one does.” Likewise with vulnerability, risk is replaced with playing it safe, not rocking the boat, and remaining as invisible as possible. 

Empathic interpretation breaks down as projection. Instead of taking a walk in the other person’s shoes to appreciate where they pinch the other person, one projects one’s own reactions and responses onto the other. Likewise with vulnerability, uncertainty is replaced with being right, making the other person wrong, and shutting down inquiry and innovation in the interest of not rocking the boat. 

Empathic responsiveness breaks down in getting lost in translation. Instead of acknowledging the other person’s struggle as disclosing aspects of one’s shared humanity, one tries to “cap the rap,” get the last word in, and win the argument. Likewise with vulnerability, one talks about the other person instead of talking to them. Free speech is alive and well; but what has gone missing is listening. People are [mostly] speaking freely – no one is listening. It doesn’t work. 

In each of the breakdowns of empathy, I do not have empathy – rather my break down in empathy has me. Instead of asking, what is wrong? Rather ask, what is missing? And, in this case, what is missing, the presence of which would make a difference, is a radical acceptance that empathy requires emotional exposure to the uncertainty and risk taking of related. That is precisely vulnerability. 

When vulnerability is added to empathy the result is community. Since we are on a roll with our secular but empathic interpretation of spiritual readings, in the defining parable of community, empathy is what enables the Good Samaritan (Luke 10: 25–37) to be vulnerable to a vicarious experience of what the survivor of the assault and robbery is experiencing. 

In contrast, the priest and Levi experience empathic distress – are armored up and defensive in the face of vulnerability – and have to cross the road. The Samaritan’s empathy tells him what the survivor is experiencing; and it is the Samaritan’s vulnerability and ethics that tell him what to do about it. The two are distinct. Yet empathy expands the boundary of who is one’s neighbor to be more-and-more inclusive, extending especially to those whose humanity has been put at risk by the vicissitudes of vulnerability. Be inclusive.

Note: the short definition of empathy is that it is a multi-phase way of relating to people individually and in community with receptivity to the other’s affects, understanding of the other as an authentic possibility, an appreciation of the other’s perspective, and responsiveness in acknowledgement of the other’s humanity in the other’s communication.

Bibliography

Brené Brown. (2012). Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead. New York: Avery, a Division of Random House Penguin.

Lou Agosta. (2010). Empathy in the Context of Philosophy. London: PalgraveMacmillan.

_________.  (2014). A Rumor of Empathy: Rewriting Empathy in the Context of Philosophy. New York: Palgrave Pivot. 

________. (2015). A Rumor of Empathy: Resistance, Narrative, and Recovery in Psychoanalysis and Psychotherapy. London: Routledge.

_________. (2018). Top Seven Lessons on Empathy For Leadership (webcast): Chicago: 2018: https://youtu.be/GrgDWDt4uqg

________. (2018). Empathy Lessons. Chicago: Two Pears Press. 

_______. (2018). A Critical Review of a Philosophy of Empathy. Chicago: Two Pears Press. 

Lou Agosta and Alex Zonis (Illustrator). (2020). Empathy: A Lazy Person’s Guide. Chicago: Two Pears Press.

For further details and additional tips and techniques see Lou’s light-hearted look at the topic, Empathy: A Lazy Person’s Guide or one of his peer-reviewed publications see: Lou Agosta’s publications: click here (https://tinyurl.com/y8mof57f)

© Lou Agosta, PhD and The Chicago Empathy Project

The trouble with the trouble with empathy (this is not a typo)

Empathy flourishes in a space of acceptance and tolerance. But acceptance and tolerance have their dark side, too. People can be intolerant and unaccepting. Be accepting of what? Be accepting of intolerance? Be tolerant of intolerance? Yes, be tolerant, but set limits. But how to do that given that we may still have free speech in the USA, but many people have just stopped listening

“The Trouble With Empathy” is an article by Molly Worthen published in The New York Times on September 04, 2020. The author gets many things just right in an impressive engagement with the complexities of empathy, but in other areas, including the citations of certain academics, I have an alternative point of view. Hence, the trouble with the trouble with empathy is not a typo. The reply is summarized in the diagram (note that it is labeled “Figure 2,” but it is the only diagram – page down, please). For those interested in more detail, read on. 

Babies are not born knowing the names of the color spectrum. Children are taught these names and how to use them in (pre)Kindergarten; likewise, with the names of the emotions such as sadness, fear, anger, and high spirits. However, there is a lot more to empathy than naming one’s feelings and getting in touch with our mammalian ability to resonate with one another in empathic receptivity and understanding. 

As an adult, the fact that you failed to be empathic does not mean that your commitment to empathy is any less strong; just that you did not succeed this time; and you need to keep trying. Stay the course. It takes practice. The practice is precisely the empathy training. 

Often understanding emerges out of misunderstanding. My description of the other person’s experience as they lived it is clumsy and creates a misunderstanding. But when the misunderstanding is clarified and cleaned up, then empathy occurs. Thus, break throughs in empathy emerge out of breakdowns. So whenever a breakdown in empathy shows up, do not be discouraged, but rather be glad, for a break through is near.

Empathy breakdowns lead to breakthroughs

Evidence from the past rarely demonstrates what innovations are possible in the future. Just because people are not born with wings does not mean people cannot fly. If the Wright Brothers had accepted the evidence, we would all still be taking the train. I hasten to add there is nothing wrong with taking the train. People can be intolerant, and I too am people. Work on oneself is constantly needed. 

I open my mouth to be empathic and respond empathically—but instead of an empathic response, out jumps a frog: “I feel your pain.” What a fake! If I really felt your pain, then I would say “Ouch!” not “I feel your pain.” I find that I do frequently say “Ouch!” Or just shake my head and provide acknowledgement and recognition: “You’ve really been dealing with some tough stuff.” “Sounds like use could use some empathy.” 

The point is not to devalue the attempted empathic response, clumsy though it may be. The point is to acknowledge that the lazy person expands his empathy in a practice filled with examples of not getting it quite right. If empathy were a sport, it would be filled with strikeouts, fumbles, off sides, failures, and incomplete plays. There would even perhaps be examples of “unsportsman-like conduct.” 

Each of the four phases of empathy has characteristic breakdowns. This is not new news. The news is that if engaged with a rigorous and critical empathy, these breakdowns readily become breakthroughs in empathy. 

Breakthroughs in empathy arise from working through the breakdowns of empathy. The Big Four breakdowns of empathy are noted: emotional contagion, conformity, projection, and getting lost in translation. These are not the only breakdowns of empathy, which are many and diverse, but these are the most frequent ones. 

In the example of emotional contagion, one anxious person is telling the other person about all the reasons in the world that he is feeling out of sorts. Pretty soon, the person who is listening is starting to feel anxious too. The person’s receptivity—openness and availability—to the other individual’s emotions is working overtime and his empathic receptivity misfires, becoming: Emotional contagion. Emotional infection strikes again! 

Often it is not so obvious. Often people are caught up in the emotion of the moment. The emotion itself is so powerful that it just sweeps over everyone present like a tidal wave—an emotional tsunami. The person is flooded—emotionally.

If the listener realizes that listening to anxiety-inspiring stories causes his own anxiety to spike, then that is already going beyond emotional contagion and the start of an empathic processing of the emotion. 

If one stops in the analysis of empathy with the mere communication of feelings, then empathy collapses into emotional contagion. Empathic receptivity breaks down into emotional contagion, suggestibility, being over-stimulated by the inbound flood of the other person’s strong feelings.

Emotional contagion—basically the communication of emotions, feelings, affects, and experiences—can be redescribed as input to further down stream empathic processing. Then emotional contagion (communicability of affect) gets “normalized” and can very well make a contribution to empathic understanding.

Overcoming the breakdown of empathy into emotional contagion results in the breakthrough to vicarious experience. A vicarious experience is what a person has in going to the theatre, the movies, or a single-person player video game. I experience the fears and hopes of the character in the film, but I do so vicariously. Theatre, film, and the novel were “virtual reality” (VR) long before computers, special VR goggles, and social networking were invented.  

Vicarious experience is not empathy. It is input to the process of empathy. Vicarious experience is the grain of truth in the fake-sounding empathy meme, “I feel your pain.” I feel your pain—vicariously. I experience an after-image of your pain—like the visual after-image of the American flag that results from starring at a vivid depiction of the off-color image of the stars and stripes. I repeat: we gat an after-image of another person’s feelings and emotions. 

I am amazed that no one has as yet explicitly pointed out that we get after-images of other people’s feelings when we are exposed to those feelings for a sustained duration. A vicarious experience of emotion differs from emotional contagion in that one explicitly recognizes and knows that the other person is the source of the emotion. 

You feel anxious or sad or high spirits, because you are with another person who is having such an experience. You “pick it up” from him. You can then process the vicarious experience, unpacking it for what is so and what is possible in the relationship. This returns empathy to the positive path of empathic understanding, enabling a breakthrough in “getting” what the other person is experiencing. Then you can contribute to the other person regulating and mastering the experience by being there for him and responding with soothing words and acknowledgement of the situation.

The next breakdown of empathy is settling for conformity instead of striving for possibility. We might also say: settling for agreement instead of striving for possibility. 

People live and flourish in possibilities. Empathic understanding breaks down as “no possibility,” “stuckness,” and the suffering of “no exit” (the definition of Hell in a famous play of the same name by Jean Paul Sartre). You follow the crowd in responding to the other person; you do what “one does”; you validate feelings and attitudes according to what “they say”; you conform and express agreement; and, with apologies to Henry David Thoreau, you live the life of quiet desperation of the “modern mass of men.” 

When someone is stuck, experiencing shame, guilt, rage, upset, emotional disequilibrium, and so on, the person is fooling himself—has a blind spot—about what is possible. This does not mean that it is easy to be in the person’s situation or for the person to see what is missing. Far from it. We live in possibilities that we allow to define our constraints and limitations—for example, see the example of the friend who was married and divorced three times. This expresses a strong commitment to marriage, though empathy and husbanding skills are seemingly limited. 

If you acknowledge that the things that get in the way of your relatedness are the very rules you make up about what is possible in your relationships, then you get the freedom to relate to the rules and possibilities precisely as possibilities, not absolute “shoulds.” You stop “shoulding” on yourself. This brings us to the next break down—the break down in empathic interpretation. 

Taking a walk in the other person’s shoes—the folk definition of empathy—breaks down if you take that walk using an inaccurate shoe size. You then know where your shoe pinches, not hers. This is also called “projection.” The recommendation? 

Take back the projections of your own inner conflicts onto other people. Take back your projections. Own them. You get your power back along with your projections. Stop making up meaning about what is going on with the other person; or, since you probably cannot stop making up meaning, at least distinguish the meaning—split it off, quarantine it, take distance from it, so that its influence is limited. 

Having worked through your vicarious experiences, worked through possibilities for overcoming conformity and stuckness, and taken back your projections, you are ready to engage in communicating to the other person your sense of the other individual’s experience. You are going to try to say to the other what you got from what they told you, describing back to the other your sense of their experience. And what happens? Sometimes it works; sometimes you “get it” and the other “gets” that you “get it”; but other times the description gets “lost in translation.” 

This breakdown of empathic responsiveness occurs within language. You fail to express yourself satisfactorily. I believed that I empathized perfectly with the other person’s struggle, but my description of her experience failed significantly to communicate to the other person what I got from listening to her. 

My empathy remains a tree in the forest that falls without anyone being there. My empathy remains silent, inarticulate, and uncommunicative. I get credit for a nice empathic try; but the relatedness between the persons is not an empathic one. If the other person is willing, then go back to the start and try again. Iterate. Learn from one’s mistakes and incomplete gestures. 

The fact that you failed does not mean that your commitment to empathy is any less strong; just that you did not succeed this time; and you need to keep trying. Stay the course. It takes practice. The practice is precisely the empathy training. 

Often understanding emerges out of misunderstanding. My description of the other person’s experience as they lived it is clumsy and creates a misunderstanding. But when the misunderstanding is clarified and cleaned up, then empathy occurs. As that notorious bad boy of a certain 18th century enlightenment, Voltaire, is supposed to have said: Let not perfection be the enemy of the good. Thus, break throughs in empathy emerge out of breakdowns. So whenever a breakdown in empathy shows up, do not be discouraged, but rather be glad, for a break through is near.

Knowing Professor Worthen’s [the author of the NYT article that provoked this reply] interest in religious studies, I conclude with a reflection on empathy and the Good Samaritan. The Parable of the Good Samaritan speaks volumes (Luke 10: 25–37). The first two people, who passed by the survivor by crossing the road, experienced empathic distress. They were prevented from helping out by a breakdown of their empathic receptivity. They were overwhelmed by the suffering and crossed the road. In contrast, the Good Samaritan had a vicarious experience of the suffering. His empathic receptivity gave him access to the survivor’s pain. His empathy told him what the other person was experiencing and his compassion told him what to do about it. 

To get Lou’s light-hearted look at the topic, Empathy: A Lazy Person’s Guide or one of his peer-reviewed publications see: Lou Agosta’s publications: https://tinyurl.com/y8mof57f

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

Saint Linehan: Marsha Linehan dishes on what she had to survive to innovate her way to DBT

This is the story, the narrative, of a survivor, Marsha Linehan, an innovator in the treatment of borderline personality disorder (BPD) using a method she and her team

Cover Art: Building a Life Worth Living by Marsha M. Linehan

Cover Art: Building a Life Worth Living by Marsha M. Linehan

invented called Dialectical Behavioral Treatment (DBT). Linehan has written a memoir, not a treatment manual (separately available (see references at bottom)). Her memoir contextualizes the diverse interventions used by DBT such as acceptance, distress tolerance, emotional regulation skills, self soothing skills, communication skills, limit setting skills, assertiveness training, and so on. She attempts and largely succeeds in connecting the dots between DBT and its skills and the key events in her life, many of which had not been publicly available.

While courage is needed for someone who has suffered from invalidation all her life to risk further invalidation in some arbitrary book review, dishing on the details of one’s life is definitely trending. Being vulnerable is trending – see Brena Brown who has virtually branded vulnerability – and Linehan succeeds in spades in opening herself up. Linehan’s narrative is by turns spiritually enriching, educational, funny, discouraging, and inspiring.

For those who require an orientation – and at the risk of over-simplification – DBT combines acceptance and tolerance such as one develops in meditation and mindfulness with the specific cognitive behavioral therapy (CBT) skills designed to interrupt the dysfunctional thinking and negative self-talk of anxious and depressed neurotics. I see it as empathic validation plus homework in CBT skills.

More formally, DBT is an evidence-based, team-abed treatment, requiring individual and group work, that is included in clinical practice guidelines for the treatment of BPD, suicidality, and several other “acting out” types of addictive behavior such as substance dependency that have proved resistant to other forms of treatment.

Linehan’s memoir connects the dots between a specific DBT skill back to her experience in life. Often she calls out the instant in which the DBT skill was born, defined, invented, or got “borrowed” from another theory. For example, and once again at the risk of over-simplification, Linehan does a lot work on mindfulness, meditating in the context of Zen Buddhism; the DBT skill of acceptance is born. Another example, in the case of willingness – like, “I am willing to give it a try” –  Linehan first encounters it at the Shalem Institute. Willingness is borrowed from the existential psychotherapists Gerald and Rollo May, but given its own special spin when combined with the Zen distinction of acceptance (p. 196).

In reading Linehan’s compelling and engaging narrative, she talks a lot about religion and love. The spiritual dimension is front and center.

William James’ The Varieties of Religious Experience (1902) has nothing on Dr Linehan – she sees the golden bright light at the Cenacle Retreat Center over on Fullerton – possibly at about the time I was living around the corner on Belden Avenue.  She has the “blue hydrangea” moment, too. Hence, the title of this review, “Saint Linehan” is not an irreverent joke, in the DBT sense, though it is that, too.

Linehan documents at least two mystical experiences that belong in James’ work. As noted, at the Cenacale Retreat House on Fullerton Avenue, Chicago, she experiences the encompassing, enveloping “bright golden light shimmering all over”  (p. 102, p. 200). Then later she has the “blue hydrangea” pantheism experience of God being everywhere at the Shalem Institute of Christina contemplative prayer with a strong admixture of existential therapy from Gerald and Rollo May (p. 196, 201).

Linehan was in psychoanalysis at the time of her “golden light” experience, and, of course, she told her analyst about it. Now one might expect the analysis had read Freud and he would associate to the “oceanic experience” from childhood that Freud so compelling quotes on the first pages of Civilization and Its Discontents. Instead Linehan reports that the analyst said: “Marsha, I’m an atheist, so I have no idea what happened to you. But I can tell you this: you don’t need therapy anymore.” That was that.

Wait a minute! Freud was an avowed atheist, too, which is where this analyst got the idea, though Freud highly valued Jewish culture and Hebrew teachings. It may be deeply cynical, but I wonder that this so-called analyst (Victor Zielinski, MD, who spent a lot of years at Hines – another bad fit (?)) had not been wishing for awhile that this difficult individual would just “go away.” Another breakdown of empathy?

Marsha did not see it that way, she was sooo happy as she left the office. Though I accept the happiness, the accuracy of her insight into the cause of this happiness is what I am a tad skeptical about. She had a narrow escape from yet another invalidating, unempathic environment like her mother’s home growing up. I hasten to add this was prior to Heinz Kohut, MD, and his innovations, which powerfully embrace empathic listening and responsiveness in the psychoanalytically inspired (and based) context of self psychology.

The causes of BPD are still being debated, but the person is vulnerable in three areas. The person must have a biological disposition; the group (society, community, family, and so on) to which she is a part leaves the person feeling they do not fit in; and, most importantly, the person is not given a chance to develop the interpersonal skills needed to relate to others, regulate their emotions, and self sooth. In short, the aetiology requires an invalidating environment. Key term: invalidation.

To me the invalidation environment often looks like one that lacks empathy or one in which the caretakers are significantly “out of tune” empathically with the child. Of course, the environment may also include more obvious adverse or traumatic experiences. I hasten to add that while it is fashionable to dump on the parents, that is inadequate. One can get similar results as extroverted children are born to introverted parents (and vice versa) and so on. See Andrew Solomon’s book, Far From the Tree (2012). The apple never falls far from the tree? Oh yes it does! Marsha fell far from the tree. But that is not all.

In Linehan’s life, the mother is the image of the invalidating environment – Marsha was never quite right – she came within a hair’s breath of inventing self psychology but once she ended up on the inpatient psychiatric unit and had been subjected to the rigors of electro shock “therapy” that game was over – to save herself she had to wok from the outside inwards behaviorally and invent DBT.

So what did Linehan actually have to survive? She was the round peg in the square hole of her family. She was smart, got good grades, was out-spoken, and even popular in her own eccentric way. All the women in the Linehan family are wife line – thin; Marsha is “large-boned” and if she is not caution those bones can acquire adipose tissue. The mother is prim and proper and the model of an executive’s wife. The executive was remote, taking solace in his work, and keeping his distance from the “house wife obsessions” of the mother of his children. He emotionally abandons Marsha. Meanwhile, according to Marsha’s mom, she [Marsha] just couldn’t do anything right.

Marsha needed fixing and no one knew better how to do it than mom. Yet no matter how much Marsha improved, no matter how good she got, Mom consistently found something to criticize. One can only get better for so long; then one has to be good enough.

The sister’s example was always there to be thrown at Marsha. And mom apparently even warned the sister to stay away from Marsha, further isolating her emotionally in the family, as Marsha was apparently a bad example. She was getting good grades and popular – a bad example of what? “Girls were supposed to be demure, sweetly charming, quietly spoken, and not given to expressing strong opinions, especially around men. They should defer to men at all times and in all things” (p, 111). Her mom valued a “girly girl,” who knew her place. This was not going to go well.

Marsha starts living into the devaluing judgments of her close relatives. Marsha gets to adolescence and her “apparent competence,” her skill in maintaining a false self [not Linehan’s term], the good girl, even if a tad eccentric, breaks down. She has some dates, but she never succeeds in getting a steady boy friend in high school. She comes unraveled, beset with acting out in the form of cutting – what would come to be called para suicidal behavior thanks to DBT.

There was an noticeable absence of trauma on Linehan’s life, except those traumas which she eventually inflicts on herself in cutting with a razor and related para suicidal acting out. But invalidation was pervasive. If empathy is like oxygen for the soul (psyche), Linehan was suffocating. She starts flailing about like someone who can’t breathe.

A constant drumbeat occurs of “you are not all right,” of “you are not important,” “you are less than.” Highly destructive to the nuclear self.

Even though Marsha eventually overcomes many of her demons, mom’s behavior never changes in spite of an honest effort. For example, years later, Marsha is getting her doctorate in social psychology, a significant accomplishment under any circumstances. Congratulations? “Mother had made a dress for me for Aline’s [her sister’s] wedding, and on the morning of graduation she was more focused on fitting my dress than she was on my getting a doctorate” (p. 118).

The word “empathy” occurs once in Linehan’s text (p. 94); and, of course, the word itself as a mere word is dispensable in principle. The text and Linehan’s life work is steeped in empathy. Empathy LIVEs in Linehan’s work. But not empathy as emotional contagion or “touchy feely” fragilization. Key word: fragilizing (p. 223). Not you are very fragile and have to be spoken to softly and treated with kid gloves.

There may indeed be moments for a quiet heart-to-heart talk, and such conversations are highly significant, but if a person is carving up their arm with a razor, this person may be a lot of things, but fragile is not exactly one of them. How shall I put it delicately? They are in a lot of pain and suffering and are employing emergency merges to try and survive the moment.

Paradoxically pain and suffering can become a highly uncomfortable “comfort zone” for the client. Personal suffering is ruining the person’s life, but the person is attached to the suffering. This is the case not only with BPD but with most kinds of mental and emotional disorders. This is different than moral masochism, but sometimes not different by that much. The patient has to be motivated to engage the tough work of moving beyond stuckness to have new experiences, which are by no means guaranteed to be immediately rewarding or satisfying. That is where validation comes in.

We have conceptualized invalidation as a cause of the suffering, so Linehan and DBT deliver validation as part of the treatment. But what is validation? A lot of work is done to meet the client where she is. The client says, “My life sucks.” And that is usually the most accurate available description. The person really is miserable and there are good reasons for it. What’s so about life needs to be validated before the individual can consider the possibility of moving forward out of stuckness. The therapist’s validation provides access to the client’s acceptance of their situation. Acceptance of the situation provides an opening for moving beyond the limits of the situation.

The challenge to the treatment is that acceptance and validation provide access to change, but it does not seem that way to the person who is in pain. The challenge is that pain and suffering can be sticky.

“Validation” means you experience your experience. Invalidation is being told – sometimes quire persuasively – you did not experience your experience. How is that even possible? Believe me, it happens a lot. Blaming the victim. Redescribing the experience as caused by the survivor’s own shortcomings. “Don’t you ever talk that way about Uncle John again! He did not pull down your pants” [not an example in Linehan]. Pretty soon the child does not know what he is experiencing.

The client usually likes to be validated. Validation is different than agreement or disagreement. It means the other person “gets who you are.” It means one is responded to as a whole person, not a diagnosis, label, body part, or partial entity. It means one is responded to as the possibility of flourishing and accomplishment, even if, at the moment, one is stuck in emotional misery. For my money, that is an alternative redescription of empathic understanding. For many, validation is itself a new experience and some can’t believe it or be open to it. It takes time, but most people promptly, though not instantaneously, perceive it as authentic, especially when it is authentic.

Then the client can be motivated, leveraged, incented, to practice new skills, take risks interpersonally, and just try stuff out instead of wallowing in a funk of anxiety and depression. The validation is the empathic moment. To get it right requires expanded empathy. Though the word is not much used, as noted, empathy LIVEs in the work Linehan and DBT treatment programs are doing. But then you also have to do the exercises.

 

Before I read Linehan’s memoir, I knew that she was a survivor. I knew she was a survivor of some of the things for which DBT is a successful treatment. I knew about the “physician, health thyself” aspect of her work and the work at Zen Buddhist retreats – as indeed is often the case with innovators who have to overcome personal demons in order to thrive – Kay Redfield Jameson and Elyn Saks, for example. Indeed Freud and Jung belong on this list – especially Jung.

I digress at this point to point out that Henri Ellenberger (Discovery of the Unconscious (1970)) has the distinction of a “creative illness” – which often has major psychosomatic aspects as the body is the best picture of the human soul/psyche – from which the individual emerges with renewed energies to produce his or her magnum opus or masterpiece. Arguably Linehan’s two years on the inpatient unit were her “creative illness,” though I cannot believe it seemed to her that way at the time.

What I did not know prior to reading the memoir was about the electro convulsive therapy (ECT). Linehan reports she once knew how to play the piano. The ability never returned after the ECT. She got into a pre med program at Loyola in college and found that she had forgotten all her biology and much of her science, once again probably as a result of it having it blasted out of her by ECT and significant does of anti-psychotics – you forget what is bothering you and a whole bunch of other stuff too). So Marsha Linehan is also a survivor of ECT, and not in the best sense of the words.

Need I add that Linehan, with some conditions and qualifications, does not endorse the inpatient treatment of psychiatric disorders? One of her many videos on Youtube makes the distinction between a “life worth living program” and a “suicide prevention program.” I paraphrase Linehan in redescribing suicide to a suicidal client: “It’s good that you see feeling suicidal is a problem; but really suicide is a solution to escape from a messy and painful life; and our job in DBT is to give you a better solution through skills such as self-soothing, distress tolerance, mindfulness, emotional equilibrium training,” By the way, “redescribing” is a DBT skill that has many origins, but most properly credited to the modern philosopher Elizabeth Anscombe.

Linehan’s makes a strength out of a weakness in the memoir as she enrolls important people in her life of giving her an account of publication of what was going on at the time, which she then quotes in the memoir. Still, the number of times is significant that she reports, “I just can’t remember” or “I don’t know why I did this” [or words to that effect].Such statements become an important part of the rhetorical stance of this work. They are also, in their own way, examples of a DBT skill. One does not always need to understand in order to get the result. Understanding has its uses, but also its limitations. If one sits around waiting to understand, it could be a long wait. Get in action. Try something. If it does not work, stop doing that, and try something different.

 

What I did not know was about the extent and depth of the self-harm. She gets put in isolation, and she launches herself head first off the chair in a frenzy of disequilibrated self-harm. Yes, people were supposed to be watching her, but somehow this kept happening. Traumatic brain injury?

What I did not know is that Linehan, finally on the road to recovery, considered becoming a monk or nun. She took vows of poverty, chastity, and obedience as a Lay Religious person instead. In the irreverent spirit of DBT, I note that her career total was zero for three, though here I am making an educated guess, I believe she honored the spirit of her vows.

Since this is not a softball review, I have critical observations. Linehan learned more from that unempathic psychoanalysis than she realized – she was working on an early version of self psychology. Thus, I have some “tough love” for one of the inventor’s of tough love in the context of treatment. However, the one thing I am not going to do is invalidate Linehan’s experience. Her report of her own experience is whole and complete and perfect in every way. She gets to say.

This business of “wise mind” – a DBT koan – needs work. My intuition is that human beings cannot intentionally “be wise.” Some people may end up being wise as a result of processing their experiences in profound ways. Wisdom comes forth “out of the mouth of babes” in that some individuals get in touch with a “beginner’s mind” and are able to express hard-to-capture distinctions hidden in plain view, about life, relationships, and everything. In that sense, yes, “wisdom happens.” Kant said, “Only God is wise.” Kohut said that a certain wisdom – along with humor and expanded empathy – can be brought forth as the result of a successful analysis of the self; but that wisdom was mostly acceptance of our limitations, suffering, and finitude. So I have NEVER been comfortable or “on board” with the over-simplifications in DBT about “wise mind.”

Linehan is often on a tear – standard behavioral therapy doesn’t work with the most seriously distressed (suicidal) patients and cognitive behavioral therapy has serious issues, too. You have to get a person whose life and all-available-evidence “prove” that “all the good one’s are taken” or “life sucks” to be reasonable and admit that “some of the good ones are not taken” or “life does not have to suck at all times.”

Emotional mind does not acknowledge cognitive penetrability or cognitive impenetrability. Cognitive mind does not acknowledge the emotions display a “logic” of their own, disclosing important aspects of a situation while also concealing other aspects. Cognitive mind can tell you “what’s so,” but cognition lacks the power to motivate you to do anything about it. Abstractions do not move people, emotions do. There is a dialectical encounter between the two – and that is commitment, which tries to find a emotional motivation for what cognition shows to be an authentically valid path forward.

The thing about the iceberg is that it’s the iceberg “all the way down.” The visible part of the iceberg is not a different iceberg than the less visible part submerged beneath the water. The behavior is visible, but the biology is not visible, what the individual had to survive is not visible, how the community reacts to the individual of is not visible.  But unlike – or perhaps just like – the iceberg, research treats these all as different siloes. It is true that we all – including Linehan – now speak of the bio-psycho-social individual and express authentic commitment to integration. But the effort required to integrate just shows how dis-integrated the entire phenomenon is.

The tip of the iceberg does not regard itself as distinct from the iceberg. The “tip” is our abstraction. Likewise, with behavior. Linehan demonstrates this compelling as she takes the psychoanalytic distinction of “introject,” operationalizes it, and shows collects evidence that DBT improves measures of introject over against a stricter behavioral intervention. Amazing.

How shall I put it delicately? Like every other individual, Linehan has a privileged access to her own first person experience – the golden light moment, the blue hydrangea moment. She also has many advantages in interpreting what that experience means, since, like every other individual, she knows a lot about her own history that others might or might not know. But as to what the experience “really means,” one individual has as good a chance of getting it right as another once the experience has been captured and reported. At first she says “The golden light means God loves me”; but then, since that experience was like [felt like] her love for Ed [a person who she actually loved deeply], she reinterprets the golden light to mean “I love God.” So she has to continue searching for God’s love for her, which brings us to the blue hydrangea by which time the meaning of God and of love have shifted.

But wait. Her Zen experience will eventually have taught her this is just another Zen koan – it is like the ambiguous Gestalt image the duck-rabbit where the rabbit’s ears and the duck’s bill and the figure spontaneously reverses – perhaps she got it right the first time – “God is God” and “love is love.” In short, Linehan is really slinging it here, and there is nothing wrong with that. It works. Her rhetoric is that of the beginner’s mind after long struggle. She is irreverent, assertive, disruptive within limits (and without), and contrary within  limits (and without), innovative, all DBT skills, and we thank you, Marsha, for being Marsha.

References

Marsha M. Linehan. (2020). Building a Life Worth Living: A Memoir. New York: Random House, 384 pp.

Marsha M. Linehan. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press.

Marsha Linehan Interviews Kelly: https://www.youtube.com/watch?v=tgzw50SbokM

© Lou Agosta, PhD and the Chicago Empathy Project