The Value of Empathy in Effective Psychotherapy

There is a common misconception that empathy is the same as sympathy, or that empathy is an affect. However, empathy is commonly defined as the “ability to imagine feelings that one does not actually have” (Merriam-Webster). Kohut suggests empathy is a “mode of observation attuned to the inner life of man” (Kohut, 1981, p.542).

Empathy is not kindness, compassion, or intuition, but rather the ability of the analyst to imagine and conceptualize the inner life of the patient. “Through the act of empathizing, the therapist conveys an acceptance and sense of importance placed on the patient's lived experience” (Kohut, 1981, p.544). Not only is empathy critical for an effective analyst, it is a foundation of human relationships.

A “good enough” (Winnicott, 1974) parent must empathically respond to their child's needs for the child to feel taken care of and understood, both physically and emotionally. The curative effects of classical psychoanalytic approaches, while not explicitly centered on empathy, nonetheless rely on empathic listening to form interpretations and communicate that the patient is being heard.

We all know that empathy can be lacking among NYC residents. It is important to note, especially from an intersubjective self-psychological perspective, that empathy is not an objective process but is shaped by the analyst’s subjectivity and the intersubjective field (Hagman, 2019). Self psychology does not propose that its empathy differs from classical analysis, but that it “has supplied analysis with new theories which broaden and deepen the field of empathic perception” (Kohut, 1981, p.175).

Even classically oriented therapists in NYC, such as Kernberg, recognized the importance of empathy: “Thus, the mother's communication includes clarification of what is going on in the infant's mind, her empathy with it, and her different reaction to the infant's experience” (Kernberg, 2003). The borderline mother is often described as unable to adequately mentalize the infant’s experience, leaving the child alone with overwhelming psychic states.

An analyst who fails to empathically understand the patient does not validate the patient’s experience. Kohut states: “Empathy is the operation that defines the field of psychoanalysis. No psychology of complex mental states is conceivable without the employment of empathy” (Kohut, 1981, p.174). Through vicarious introspection, the patient feels understood; without it, retraumatization and archaic selfobject transferences may emerge.

Empathy is thus foundational not only to psychoanalytic cure but also to human interrelatedness. Societal unrest, including increasing polarization in American culture, can be understood as a breakdown in empathic capacity. Perceived threats generate fear and anger that block the ability to understand opposing viewpoints.

A simple linguistic intervention is the replacement of “yes, but…” with “yes, and…”. This shift allows coexistence of perspectives rather than defensive negation. However, empathic engagement requires cognitive and emotional effort, supported by neural systems associated with emotional attunement and social cognition.

Research has shown that empathy training in medical education improves clinical outcomes. At a broader level, tribalism has been implicated in historical violence, including genocides in Rwanda, Germany, and Armenia. Some historians argue that civilization progresses through expanding empathic identification beyond in-group boundaries, though this trend appears increasingly strained in contemporary society.

Empathic triggers can be powerful. As an example, the image of Alan Kurdi, the Syrian child who died on a beach in 2015, rapidly shifted public sentiment regarding refugee policy in the UK, illustrating how identification can temporarily override ideological barriers.

I also see parallels between Kohut’s empathic attunement and Winnicott’s “Fear of Breakdown” as well as Fink’s “Against Understanding.” Fink suggests that full intellectual understanding is not required for therapeutic change, a view that aligns with Winnicott’s emphasis on holding environments rather than interpretive mastery.

This perspective is clinically relieving: it reduces the pressure on the analyst to fully “know” what is happening in every moment. Instead, therapeutic change can emerge through sustained attunement and relational presence, even in the absence of complete theoretical clarity.

References
Fink, B. (2010). Against Understanding: Why Understanding Should not Be Viewed as an Essential Aim of Psychoanalytic Treatment. Journal of the American Psychoanalytic Association, 58(2), 259–285.

Hagman, G. et al. (2019). Intersubjective Self Psychology. Routledge.

Kernberg, O. (2003). The Management of Affect Storms in the Psychoanalytic Psychotherapy of Borderline Patients. Journal of the American Psychoanalytic Association, 51(2), 517–544.

Kohut, H. (1981). How Does Analysis Cure?

Mitchell, S. & Black, M. (2016). Freud and Beyond. Basic Books.

Winnicott, D.W. (1974). Fear of Breakdown. International Journal of Psycho-Analysis, 1, 103–107.