Repulsion in the analyst

In the afternoon session of “A Day with Bruce Herzog” on January 14, 2012, Dr. Herzog presented to the Tampa Bay Psychoanalytic Society, Inc.: Repulsion in the Analyst and its Impact on Empathic Capacity, a paper that is remarkable for Herzog's willingness to discuss something many therapists are loathe to admit. His candor about times when he was disgusted or disdainful and how he traversed these therapeutic impasses was compelling.

Herzog believes “For an adequate therapeutic process to occur there must be islands of empathic contact, which requires some matching of relational premises [1] between the analyst and patient.” and that “greatest empathic connection takes place when the relational premises of patient and therapist are best aligned. [I think of how much easier it is to love a friend than an enemy.]

Patients may come to us expecting rejection or disdain while simultaneously hoping for something different. There are other times when revulsion is in accordance with the patient’s point of view [empathy?], and serves to collude with a patient so that neither discusses something they find unacceptable. Herzog encourages us: “As long as there are enough instances where there is a concordance of relational premises and behaviors in the dyad, sufficient areas of contact for a ‘good enough’ empathic connection can be established.” He emboldens us: “The therapist first needs to know that empathizing with the patient will not harm him [him the therapist].”

While this may be so, it is, of course, I think, incumbent upon the analyst to seek, to struggle, assiduously if need be, to find the point of view of the other. Sometimes there seems to be no common ground, sometimes empathy fails us, and we are left then to negotiate explicitly a way to be together without common ground. Sometimes this negotiation can only come to the table through the other side of an enactment.


[1]“ ‘Relational premises’ refer to the many innate relational assumptions that are applied by an individual to interpersonal circumstances. These assumptions amount to belief systems that we hold about the functioning of, and our place within, relationships. We often assume that others share our relational premises; this is not always the case and can be a cause of considerable conflict…”