Empathic Attunement The 'Technique' of Psychoanalytic Self
Psychology
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EMPATHIC
ATTUNEMENT
THE CLTECHNIQUE77
OF PSYCHOANALYTIC
SELF PSYCHOLOGY
CRAYTON E. ROWE, JR.,M.S.W.
DAVID S. MAC ISAAC, P ~ . D .
ROWMAN & LITTLEFIELD PUBLISHERS, INC.
Lankam Boulder New York Toronto Oxjord
THE MASTER WORK SERIES
A JASON ARONSON BOOK
R O W A N & LITTLEFIELD PUBLISHERS, INC.
Published in the United States of America
by Rowman & Littlefield Publishers, lnc.
A wholly owned subsidiary of The Rowman 8: Littlefield Publishing Group, Inc.
4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706
www.rowmanlittlefield.com
P O Box 3 17
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Copyright O 1991, 1989 by Jason Aronson Inc.
First softcover edition 1995
First Rowman & Littlefield edition 2004
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of the publisher.
British Library Cataloguing in Publication Infomiation Available
Library of Congress Cataloging-in-Publication Data
Rowe, Crayton E.
Empathic attunement.
Bibliography: p.
Includes index.
1. Self psychology. 2. Psychotherapist and patient. I. Mac Isaac, David S. 11. Title.
RC489.S43R68 1989 155.2 88-8069
95-46035
ISBN: 978-0-87668-551-8
Printed in the United States of America
e m ~ hpaper
e used in this publication meets the minimum requirements of American
National Standard for lnformation Sciences-Permanence of Paper for Printed Library
Materials, ANSI/NISO 239.48-1992.
T o our children
Clara, Andrew, Sean,
and
David James
Contents
Acknowledgments
Introduction
PART I
Understanding from the Vantage Point
of the Patient's Experience
Chapter 1. Kohut the Man
vi Contents
Chapter 2. Empathy- Its Definition
and Functions
Chapter 3. The Selfobject Concept
and Selfobject Transference
Chapter 4. Stages in the Development of the Self
PART I1
Treatment in Sell Psychology
Chapter 5. Transmuting Internalization
Chapter 6. Mental Health and Illness
Chapter 7. The Place of Drives in Self Psychology
Chapter 8. Defense and Resistance
Chapter 9. Dreams
Chapter 10. The Curative Process
PART I11
Clinical Applications of Self Psychology
Chapter 11. Kohut's Two Analyses of Mr. Z.
Chapter 12. Treatment of a Narcissistic
Personality Disorder:
The Case of Ms. 0.
Contents
Chapter 13. Expanding Attunement to the
Patient's Shifting Experience:
The Case of Ms. 0.
Chapter 14. Development of the
Therapeutic Process:
The Case of Ms. 0.
Chapter 15. More SpecificUnderstanding:
The Case of Ms. 0.
Chapter 16. Treatment of a Borderline
Personality Disorder:
The Case of Mr. V.
Chapter 17. Development of the
Therapeutic Process:
The Case of Mr. V.
Chapter 18. More Specific Understanding:
The Case of Mr. V. 273
Chapter 19. The Empathic-Introspective Approach 30 1
References
Index
ACKNOWLEDGMENTS
There are many to whom we would like to express
thanks For their support and inspiration in the writing of
this book. First, of course, we would like to acknowledge
Heinz Kohut for his lasting legacy that includes not only
his writings but also the courage and integrity he showed
in putting Forth ideas that were oken not popularly
received. His contributions are a notable basis For further
study, and his example is a model For Future psychoana-
lysts in the presentation OF their own innovative and
creative ideas.
We also acknowledge the valuable contributions
x Acknowledgments
provided in workshops, conferences, and personal communica-
tions by a number of Kohut's intimate collaborators. Among
those we would especially like to thank are Paul Ornstein, Anna
Ornstein, Arnold Goldberg, and Michael Franz Basch.
We would like to express our gratitude to the members of
The Society for the Study of Heinz Kohut's Works, a group
formed in 1985. Among those members we would particularly
like to thank are Florence Rowe and Joseph Walsh for their
important input in our many open and frank exchanges over the
years.
We also thank Dr. Jason Aronson for the confidence he
showed in our work and the enthusiasm with which he greeted
our manuscript. His encouragement and suggestions were in-
valuable. As well, we want to express our deeply felt apprecia-
tion to Dorothy Erstling and Adelle Krauser for their many
thoughtful and perceptive comments and questions, which were
essential to our book7sfinal form.
We thank the many individuals of the Foxy Copy Center
for their helpful suggestions and their cooperative assistance in
the typing process that allowed us to put together the manuscript
for this book in a timely and orderly manner.
Finally, it goes without saying that this book could never
have been completed without the patience and loving support of
our families, who were so understanding of the long hours that
we had to spend apart from them in order to put this text into its
final form.
Crayton E. Rowe, Jr., M.S.W.
New York, New York
David S. Mac Isaac, P ~ . D .
Englewood, New Jersey
INTRODUCTION
Perhaps no one since Freud has jogged the collective
sensibility of the psychoanalytic community more than
Heinz Kohut. Since h s celebrated works were intro-
duced, there has been an outpouring of scholarly litera-
ture explaining and elaborating on his theories of self
psychology, applying them to the existing body of
knowledge in the mental health field. Much of this
literature, however, including Kohut's own writings, re-
quires psychoanalytic background and training in order
to grasp the fundamentals of self psychology. It is clearly
time for a clinical text that captures the essence of Kohut's
xii Introduction
works and presents it in a straightforward, accurate, and usable
way. This book was written to meet that need. It introduces
Kohut to the student, and at the same time it offers the experi-
enced clinician a synthesis of Kohut's major concepts. In partic-
ular, this book highlights Kohut7sFundamental contribution, his
emphasis on the empathic mode of data gathering from within
the patient's experience. Empathic attunement to what the pa-
tient is experiencing is a complex human process that involves a
high degree of technical skill when applied to the therapeutic
clinical situation.
We have presented our clinical material in moment-to-
moment detail in an effort to offer a "hands-on7' experience for
the reader. In this way the reader can participate alongside the
analyst as the session unfolds. Of course, we recognize that
understanding self psychology, and especially its clinical applica-
tion, cannot occur simply through the study of theory and case
material. The process of becoming a psychoanaIytic self psychol-
ogist, with its emphasis on the empathic stance, is a complex
one. Yet we believe that our method of presentation has impor-
tant heuristic value for anyone wishing to grasp the Full implica-
tions of Heinz Kohut's contributions.
T o simplify terminology, we have used the word '(analyst7.'
as a generic title to identify the psychoanalytic practitioner. This
should emphasize the fact that all clinicians may be enriched by
the study of self psychology regardless of their level of training.
The vignettes presented to exemplify the theory in Part I
and Part I1 were taken primarily from treatment cases in our own
practices. However, some examples were taken From cases pre-
sented to us by our supewisees. In all examples, identifying data
were disguised to preserve confidentiality. In addition, indepen-
dent readers were used to Further disguise the material while
maintaining its essential meaning.
In Part 111, Ms. 0. and Mr. V. were treated by Crayton
Introduction xiii
Rowe, Jr., and were similarly disguised to preserve confidenti-
ality and anonymity.
Finally, we believe this book serves as a guide For interested
readers outside the mental health field. Kohut's contributions to
empathy and to understanding the inner experiences of others are
valuable to many audiences - educators, parents, social scientists,
and all those whose work demands a deep sensitivity to their
Fellow human beings.
Understanding from the
Vantage Point
of the Patient's
Experience
