The PANY Bulletin

Psychoanalytic Association of New York
Volume 43, #1 Spring 2005

Book Review
Psychoanalytic Empathy

by Stefano Bolognini
(translated by Malcolm Garfield) 2004 Free Association Books (London) pp.191.
Reviewed by Janice Lieberman, Ph. D.

Just a small percentage of the many excellent books and journal articles that are published abroad in languages other than English are ever translated for us to read. Therefore I found myself fortunate to be on a list of psychoanalysts who were sent Psychoanalytic Empathy, written by our distinguished Italian colleague Stefano Bolognini, a member of the IPA, an editor of the International Journal of Psychoanalysis and a senior member of the Italian societies in Venice and Bologna. The excellent translation from the Italian was done by Malcolm Garfield and there is an Introduction by Donald Campbell.

Bolognini explores in depth the nature of the psychoanalyst's internal task that informs his listening and his interpretations. He provides us with a comprehensive historical overview of the ideas presented by the early pioneers who talked about the role of empathy and its vicissitudes. The authors he cites and their books are necessary reading for any analyst-to-be. This is a clearly and elegantly-written book that will be of value to candidates and to the seasoned psychoanalyst who would like to reconsider the seminal ideas about empathy in the psychoanalytic situation.

After giving an historical overview of the concept in Part I in which he includes the work of Italian psychoanalysts less familiar to us, due to the lack of translation, e.g. Spacal, Bolognini goes on in Part II to outline a contemporary perspective and to delineate the various facets of empathy.

He believes that true empathy requires: “above all separation and differentiation and an ability to keep theoretical thought in operation ... it requires the ability to put a name to things, even at very close contact”. (p.15) His definition is in sharp contrast to the early idea of “romantic empathy”, a mental style that stressed feeling over thinking, projection, magic, grandiosity and fusion and the manipulation of subject and object.

To my mind, the value of this book lies in the author's extensive research and his choice of quotations to cite that are so valuable in helping the reader to understand what is meant now and what has been meant in the past about empathy. He cites Pigman (1995) who critiqued Strachey's translation of Freud's writings. Bolognini notes that: “the reason why so many English-speaking analysts are unaware of the importance Freud attributed to the concept of 'empathy' lies in the fact that the Standard Edition translates only three of the twelve mentions of Einfuhlung as 'empathy', and never translates the verb einfuhlen —which appears eight times—with 'empathise'. (p.31) Freud himself was ambivalent about empathy and afraid of analysts becoming excessively involved with their patients; therefore he spoke of necessary detachment.

In 1926 Helene Deutsch suggested: “that, in order to attain this responsiveness, the analyst must succumb to a certain amount of regression (in the service of the ego), resulting in a degree of crepuscular pre-confusion between the self and the other.” (p.37) In 1928 Ferenczi (the emotional one) wrote of: “the capacity to put oneself in another's shoes.” (p.37) In 1942 Fliess spoke of “trial identifications”. In 1958 Olden argued that: “the sensibility of one person toward another can only be called empathy when it is not at the service of narcissistic needs, but of mature object relations, which entails awareness of separation and absence of confusion.” (p.42) She emphasized “the sublimation of maternal sexual impulses for the development of empathy.” (p.42)

Schafer (1959) conceptualized “generative empathy”, “the inner experience of sharing in and comprehending the momentary psychological state of another person, sharing and comprehending desires, feelings, defenses, controls, self-representations, etc.” (p.44) That is, Schafer saw empathy as constructing an image of the patient's inner world and by so doing being able to fantasize as the patient does.

Bolognini describes and compares these different conceptualizations, deepening the reader's understanding of each. For example, he contrasts Schafer with Greenson (1960), who saw empathy as emotional knowledge (rather than Schafer's more cognitive perspective that it is based on identifications) and is the sharing and experiencing of the feelings of the other. Finally he takes up the conceptualization of Kohut (1971;1977; 1984) who located “the primary failure of empathy in the parents in the first stage of infancy, which is responsible for an early loss of cohesion in the self.” (p.47) For Kohut, the analyst must be able to understand empathically but also be capable of learning that stance while using secondary process to evaluate the data. As Bolognini puts it: “one must make it possible for the patient's 'inner dinosaurs', derived from the grandiose self, to become unfrozen and to appear on the surface without overpowering us” (p.49) He also cites the work of Pao (1984), who viewed empathy as a network of communications that get established between the analytic pair, more difficult to attain with psychotics, where non-verbal exchange becomes significant.

The Kleinian concept of projective identification contains within it an idea of empathy. The works of Klein, Rosenfeld, Money-Kryle, Bion and Grotstein are cited.
In the second section of the book Bolognini gives a course in technique, both good and bad, in which he presents examples of intellectual and emotional ways of working with patients. Much of what he recommends has to do with the analyst's own contact with his inner world of emotions and fantasies. He humorously paints a picture of a “preserved” analyst, “like an intelligent and observant child whose mother has deprived him of bodily contact and stopped him playing with supposedly 'dangerous' things, making him melancholic and phobic. ... [who] observes his patients from behind a glass screen, frequently offering realistic, accurate interpretations, which nourish the patient's hopes of establishing contact” (p.76) but never do!

To my mind the best part of the book is the one in which the author presents his own fascinating and extensive clinical examples and his own candid critique of his own work. He reports: “I learned that empathy is a complex, many-faceted and undecidable condition ... Time, prolonged therapy and a lot of working-through is required in order to make contact with the patient in his entirety (and not merely with one specific aspect).” (p.85) He salutes the many advances in our field that have created a climate for work that is “more alive, better articulated and more complex.” (p.95) He then covers topics related to empathy: countertransference sharing; the “kind-hearted” vs. the “good” analyst; empathy and hate in the countertransference; the misuse of empathy (which he calls “empathism”); empathy and fusion and other subjects. At the end he cautions us that the proper use of empathy is only one of the myriad skills essential for doing analysis. Empathy is “delicate”; for example, some patients cannot bear empathy at the beginning of treatment.

I am pleased to non-ambivalently recommend that you read this book, filled with wisdom and the light humor only an Italian can be capable of. Perhaps it takes an Italian to teach us the art of connecting with others. You will enjoy and savor it.