The Patient's Empathy

"You're sweet." Her words startled me, and their sympathetic tone came as if from out of nowhere. So I must have sounded a touch surprised when I asked to what she was referring, what she had in mind.

We were near the start of what was our last hour before a vacation break, indeed for me the final hour of a long last day before the summer interruption. She had begun to speak of her apprehensions about the impending separation when she stopped and made her perceptive and caring statement.

Her explanation was soft yet clear, "You don't really want to talk about this, but you keep trying to do what you think you should do. That's sweet."

She was registering something she saw in me that I had not at that moment recognized in myself, but only a moment's reflection convinced me of the accuracy of her observation. The accuracy, of course, does not explain the appreciative tone her words carried. Nor does it explain what she saw that brought forth her words.

Yet what she observed from the private part of my mind was valid. I cannot be certain, but I think that she picked up something in me at that moment that included a shadow cast by my engagement with my preceding patients as well as my own concerns. I had spent my afternoon immersed in the preoccupations and fears of others whose imminent vacation interruptions had brought forth their individual concerns over abandonment, loss, and death; and those evocative anxieties had reawakened my own fears about departures and demise.

Both her observation and her explanation surprised me. I was touched by her sensitive concern for feelings I believed I had kept to myself. I felt troubled that I had unwittingly communicated my own back-of-the-mind disquiet while trying to work to help her sort out her feelings. I know that at times my own blind spots are sufficient as to be more properly called blind blotches or even a blind rash. However, relentless retrospection left me convinced that I had given no explicit indication of my own frightened feelings in those moments. Such is not made into a fact by virtue of being my conviction, but conviction it remains. Yet she had tuned in to what I believe was not manifestly evident and that rare others would have noticed. She had read me between the lines, and she had done so accurately.

In short, after several painful hours with other patients I had begun a session feeling I was once more at ease, conscious primarily of attending to whatever this next patient might bring. What I did not anticipate was the patient's bringing to the forefront her understanding of my unaware back-of-the-mind feelings. This empathic woman understood what was going on inside me at that moment better than I myself knew, indeed better than I then thought—and even now think—she had had reason to understand.

That woman was innately more empathic than are most people, but though her capacity for attuned reading of others was strong, it was not unique. Not only do analytic patients generally read the emotions of their analysts, they do so more regularly, more deeply, and often more accurately than is commonly appreciated.

The admonition, "Be careful how you see the world, because that's the way it is," might be considered a psychoanalytic maxim, one based on a view that the essence of what is neurotic is one's structuring a present world to find what is expected from past experiences, desires, and fantasies.

The analytic situation is structured to bring those expectations into the actuality of the clinical relationship, putting a magnifying lens over them so they may best be exposed and examined. A patient's assets and multiple strengths may be acknowledged, but the work at hand aims at uncovering the difficulties. As a result, one of the most prevalent of analytic occupational hazards ensues: the analyst's tendency to underestimate the patient's ego strengths!

That the analyst's conflicts are awakened by...