In this plenary paper, three broad categories of difference are explored through the lens of a clinical relationship: gender (male patient-female analyst), cultural identity (growing up outside or inside the U.S.), and political identification (conservative-liberal). Dynamics of power and powerlessness reverberated between the clinical couple and contributed to the patient’s need to repeatedly probe the analyst’s subjectivity to determine if he can be safe and to see if she would remain open to his singular points of view and to his unique experience of being oppressed by females. Contributions from Beebe and Lachmann’s (2013) work on the origins of disorganized attachment are discussed – findings that contribute to an understanding of the patient’s need to probe the analyst’s subjectivity. Slavin and Klein’s (2013) concept of adaptive probing is also discussed.

The paper reflects on conference keynote speaker, Philip Cushman’s views about the limits of empathy when categories of difference such as gender are in play and compares these ideas with Kohut’s. Cushman recommends a clinical approach involving “emotional attention, respectful understanding, careful perceptiveness, critical thought, self-reflection, and expressions of human care and compassion” (Cushman, 2009, p.134). I go on to argue that a self psychologically informed empathic listening stance basically includes the very clinical approach Cushman advises. At the same time, I acknowledge finding Cushman’s caution about the limits of one’s ability to empathize with another’s difference very helpful, even relieving. I describe an intersubjective process related to the way opening myself to the patient’s unique sensitivity to bias came to powerfully affect me and broadened my perceptions.

Themes of existential aloneness emerged in analytic interactions and powerfully affected both patient and analyst. The dyad’s growing ability to repair disruptions and build relational intimacy through processes of coming to know and be known are described. Ultimately, the therapeutic couple’s ability to find their way to mutual caring and compassion helped both partners stand protectively in the face of the ultimate abyss.

Bibliography

Beebe, B., Lachmann, F.M. (2013), The Origins of Attachment. New York: Routledge.

Cushman, P. (2009). Empathy – What One Hand Giveth, the Other Taketh Away:

Commentary on Paper by Lynne Layton. Psychoanalytic Dialogue, 19(2):121-137.

Slavin, M., Klein, J. (2014), Probing to Know and Be Known: Existential and Evolutionary

Perspectives on the “Disorganized” Patient’s Relationship to the Analyst, in Beebe, B.,

Lachmann, F.M. (2014), The Origins of Attachment. New York: Routledge.

Elizabeth Carr briefly addresses the larger, psychosocial context that Philip Cushman laid out. She says: “Cushman… finds that the very notion that we will be able to sense into another’s experience and “feel what they feel” regarding a profound difference such as gender or sexual identity will inevitably prove to be a limited and even futile endeavor…”

Yet, in the depth and detail of Elizabeth’s actual story of her work with Al she shows us a process that is quite accurately called “empathy.” But it is an empathy that asks to be understood – to be re-defined differently from the version to which Phil Cushman may be referring.

Elizabeth shows us something crucial about understanding empathy not as an applied “technique” but, rather, as a “relational achievement.” She shows us how a complex human relationship – emerging through conflict and the patient’s “adaptive probing” of their shared needs and grief, becomes empathic: An inevitably conflictual bond emerges as a complex relational and existential achievement.

Elizabeth’s sensitive use of my term, “adaptive probing” refers to her patient Al’s active, intuitive investigation of what he essentially knows is her Otherness – her experience of herself and of him. It reflects Al’s intuitive knowledge of the inevitable multiplicity, the hidden sides in the other– basic realizations, hard won (if painfully inflated) through trauma and environmental failure.

In order to allow his own past to “speak” Al must invite and open up his therapist’s own struggles with annihilation terrors (around loss and mortality) and her own inner tensions around separateness and connection – what Elizabeth calls their “shared existential terrors.” What Elizabeth’s empathy meant to Al was contingent upon what it meant to her. It was a mutually achieved realness – “surviving” (in Winnicott’s sense) all the human challenges to it. It became the basis of an evolving trust.

Perhaps this what Kohut (19xx) really intended in the notion of “twinship: A vital sameness in difference: A sharing, suffering, grieving together so as to attenuate the pain of human isolation at a very profound level.