Wednesday, February 17, 2010

Empathy as a human attribute, a sensibility

In her post of February 15th, Lycia Alexander-Guerra gives us a cogent summary of Frank Lachmann’s
formulations of empathy at the Society’s day-long meeting on Saturday February 13th, 2010. I would like to focus here on one particular aspect of Lachmann’s presentation.

Although in the morning session Lachmann said that “[e]mpathy, like any skill, can be acquired and enhanced
by training and learning,” in the afternoon session, I believe he modeled empathy as a quality of the person, a human attribute, a disposition, an inclination, an attitude, a capacity, a sensibility, a way of being-in-the-world.

For, in the course of our dialogue, something quite remarkable emerged very naturally from within Lachmann,
imperceptibly at first - a delicacy, a caring, a respect, almost a reverence for the human condition as he shared
his understanding of the adolescent who had murdered his parents and about the Tramp’s plight in Charlie
Chaplin’s film ‘City Lights. ’ Then, by the inflection in his voice, his stance, and nearly transcendent facial
expression, Lachmann seemed to be saying appreciatively “behold the patient,” that is, the one who suffers.
We were so fortunate, I believe, to witness the emergence of an analyst’s spirit, of his capacity for empathy, an
ability cultivated over time and in many ways, rather than something (a skill) one can simply go out and get. This
was for me an experience full of wonder, and a richly evocative one at that.

It brought to mind the notion of emotional availability, Donna Orange’s (1995) synonym for empathy. She
describes psychoanalysis as conversation, “as patient and analyst making sense together, reaching an emotional
understanding.” Further, she proposes that “the only sort of understanding that can heal emotional wounds is
emotional understanding.” And argues that “each person’s perspective is inevitably partial and that a more
adequate view of anything requires dialogue. In such conversation we attempt to reach, practically speaking, a
good-enough understanding of whatever is under discussion. In psychoanalysis, where the subject matter is a
person’s emotional life, understanding that heals requires a mutually experienced emotional connection between
patient and analyst.”

Orange suggests that among the conditions and attitudes that support good-enough emotional understanding,
“[o]ne requirement is the emotional availability of particular analyst for a healing connection with the particular
person who comes for therapy or analysis. This implies the willingness and the ability of the therapist to p rovide
for that person a developmental second chance at a rich and integrated emotional life.” Orange continues, “Psychoanalytic understanding is knowledge gained from inside the intersubjective field formed by the intersection of two differently organized subjectivities. In dialogue, both participants attempt to expand
their original subjective perspectives to take in, comprehend, and understand more of the other’s experience.
We do this. . .b y placing ourselves, as consistently as we can, in the other’s shoes, both cognitively and
emotionally. We understand by participating in the emotional experience, in the being, of the other.” (emphasis

A relational mode of knowing emotional reality, empathy not only emerges from personal relation but it creates
the other as a subject, since “subjectivity becomes real only when two subjectivities meet in a personal relation.
Only in such a relation can we empathically know - not just know about - one another.” Orange later concludes, “[a]n analyst must be Gadamer’s “person with understanding,” able and willing to enter the patient’s suffering and share the painful history, able and willing to “undergo the situation” with the other. I will call this combination of capacity and willingness “emotional availability.” Only when it is present can patient and analyst make sense of what seems senseless...”

In sum, “[e]mpathy is emotional knowledge gained by participation in a shared reality. It is knowledge arising
from attunement...Empathic response comes from attunement to this shared reality, and must take the form at
a frequency an d in a mode (auditory or visual, for example) that the receiver can comprehend. An empathic
environment one in which each person can feel like a Thou, a respected and admired partner in a
conversation... Thus, empathy, including empathic response, is a necessary condition for understanding.”
Emotional availability thus understood is a general disposition, a readiness to respond. “This readiness to offer
our emotional expressions - verbal, semiverbal, or nonverbal - is a crucial component of the conversation that
creates psychoanalytic understanding. We offer our emotional expressions, not as substitute for those of the
patient, but as pump-priming, or facilitating, responses, our participation in the analytic squiggle game...often our attempts will be inaccurate, but in the atmosphere of emotional safety provided by this very responsiveness,
many patients can use what we offer as a kind of catalyst for their own emotional expression. We show by those
attempts that we are trying to understand, that we can imagine the patient to be having some emotional
response, and that various - and perhaps less-than-elegant - expressions of emotion are more than acceptable
to us. These attempts are trial balloons...and they convey to the patient that guessing is just fine. Together we
are attempting to find an understanding.”

- Orange, D. M. Emotional Understanding. Studies in Psychoanalytic Epistemology. New York, New York,
Guilford, 1995.

Ernesto Vasquez, MD
February 16, 2010

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