Origins, elements, and functions of therapeutic empathy.

Tracing the roots of empathy (within human history) descriptively to aesthetics and psychologically to the earliest mother-infant interactions, it is proposed that the ontogenesis and employment of mature empathy require repeated flexible--and, if necessary, sustained-access to its primitive levels, levels especially important to the analyst in the understanding of severely disturbed patients. Narcissistic disturbance in the analyst, while occasionally accompanied by a beneficial hypertrophy of primitive empathic capacities, tends to be particularly detrimental to the exercise of mature empathy. Countertransference is considered in this regard and in relation to therapeutic empathy evoked or impeded by unconscious fantasy--the latter proposed to be infrequently, if sometimes necessarily, a central element of therapeutic empathy, which more commonly may function inconspicuously at a preconscious level. In the analytic situation, it is suggested, empathy may often be addressed most usefully to focal conflicts (borrowing French's concept but not his precise definition) via the analyst's partial identification with the patient's self-in-depth, an entity which is acknowledged to be ultimately immeasurable and necessarily mysterious. Several aspects of the therapeutic employment of empathy are examined, including failures of empathy attributable to analyst, patient, or both, for worse and--potentially--for better; the role of empathy and empathic failure(real, imagined, and provoked) in the establishment of archaic negative transferences; and the assessment of abstinence as variable inherent in empathic exploration, with the inference that disciplined employment of empathy, rather than frustration per se, is likeliest to abet a therapeutic regression and to promote an enriching unification of the personality.