Saturday, February 1, 2014

The Parameters of Empathy

This is a reprint of a recent publication that appears in the ADVANCES IN DESCRIPTIVE PSYCHOLOGY  VOL. 10, 2013 Ann Arbor: Descriptive Psychology Press, eds: Davis, Bergner, Lubuguin & Schwartz.  Much of the content was first in this blog.  SSRN download of paper.


The Parameters of Empathy:  Core Considerations for Psychotherapy and Supervision


A theory neutral and pre-empirical formulation of empathy as empathic action is presented as a basic feature of shared social practice, a core social competence, always more or less present if a person is to adequately engage with others. The conceptual tools of Paradigm Case Formulation and Parametric Analysis are employed to clarify the “more or less” quality of empathy and to provide a format to map agreement and disagreement on meanings. The paradigm case is described as the communication of the recognition of the significance of another person’s ongoing intentional actions and emotional states in a manner that the other person can tolerate. The parametric analysis involves the parameters of Wants, Knows, Knows-How, Significance, Performance, Achievement, Identity and Personal Characteristics. 

The Parameters of Empathy:  Core Considerations for Psychotherapy and Supervision

“You don’t know how it feels, no, you don’t know how it feels, to be me."    Tom Petty

     Years ago, I worked with Bobby, a 13-year old boy, an only child, who was having difficulty in school at a time when his family was falling apart. His grades were poor and maybe once a week he would jump from his chair and run from the classroom without explanation.  He would also get into fights during recess with boys who taunted him. The harassment involved typical but relentless comments that he was gay. 
      His mother showed signs of hypomania and would disappear for days at a time. When she returned, she would be flamboyantly dressed and clownishly made up, and declare her plans to leave the family for New York.  This persisted off and on for the first two years of my work with Bobby. Bobby’s father, an attorney rarely at home, appeared in Bobby’s descriptions as loving but clueless.  I urged his parents to enter couples therapy, but they refused, although they were supportive of my work with their son and met with me from time to time.   
     Although earlier testing had shown Bobby to have strong concept formation skills, he had a weak vocabulary, a pronounced stutter, and a reluctance to talk unless he was certain what he wanted to say. As my relationship with him deepened, his stutter became less apparent. Bobby remarked on various occasions that he thought that if I were his father, his life would be easier. I really liked Bobby and frequently found myself examining the paternal feelings that he evoked.
       Once, seemingly out of the blue, he said that I would look better if I used eye shadow.  I think he thought he was joking.  
        One afternoon as Bobby entered my office, he slipped and fell.  Neither of us thought much of it although I checked the rug to see if it was loose.  It wasn’t. Two weeks later this happened again but this time he seemed to be looking at my face as he lost balance.  We talked a bit about this but he seemed fine and was clearly not interested in exploring why he fell down and he claimed he was not falling down elsewhere. Running out of the classroom had also been an issue during these two weeks. A few sessions latter, he slipped again as he walked to his chair and again did not want to talk about it. (I remember thinking at the time that at Bobby’s age I was reading Ian Fleming’s Goldfinger:  “Once is an accident.  Twice is a coincidence.  Three times is enemy action” (1959).) 
        In my own psychoanalysis, some days later, I was talking about my relation to Bobby and wondering what to do about his falling down “symptom”.  The night after Bobby’s last slip, I had a dream in which I was playing high school football in the stadium near my childhood home.  In the dream, I catch a pass:  as my hands grasp the ball, I slowly fall to the ground. As I fall, I look to the stands where my mother is smiling at me. The dream is comforting.  As I associated to this dream, I remembered going on a hayride with my father around the same football field and how I impulsively jumped off the cart.  My father jumped down, picked me up and we resumed the ride. It was a happy memory although I remember my father being angry with me. In that same session I recalled a series of impulsive behaviors, when I was seven or eight, that involved a compelling desire to open the back seat door of my parent’s car as they drove around the city arguing.  I ended the session believing I understood Bobby’s symptom as a message needing a response.
            Conveniently enough, at the start of a session the following week, Bobby again tripped.  This time I offered my hand and said,  “Bobby, I’m not going to pick you up but I will stand beside you for as long as you need me.”  He said OK, and we went on to discuss how I would continue to work with him as long as he wanted. During that session he remembered a time in the first grade when he fell on the playground and how good it felt when his teacher rushed over and picked him up. 
           He never again tripped in my office and his running from the classroom ceased. I will return to Bobby later, but keep in mind that I did not explicitly explain or interpret his apparent accidents since I did not believe he could make use of the insight, nor did I think he would tolerate my saying what I believe he was unknowingly up to. Rather, I acted from my understanding of the significance of his intentions in a way he could manage and I think he felt appreciated and safely understood as a result. Since he had successfully gotten his message across and achieved his desired response, he no longer needed to repeat it. 
      My primary interest here is to explore empathy as a basic feature of shared social practice, always more or less present.   Empathy is a core social competence, an ordinary feature of engagement, necessary for functioning in a world of persons and their ways. Only, however, in situations where one person’s vulnerability is at stake does empathy appear as a pronounced aspect of how the engagement feels and proceeds.  Where hurt and misunderstanding is likely, empathy especially matters, since the vulnerable party may need evidence that it is safe to engage. 
       In what follows, I will provide a Paradigm Case Formulation of empathic action followed by a Parametric Analysis of that paradigm.  These formulations provide a set of tools useful for the practice of psychotherapy and supervision. I believe they may be helpful in other trainings and practices as well, particularly with people whose empathic skills are limited. 
    The formulations are useful when I sense I am not being empathic or attuned to my client, or when supervising another therapist, I want to make sure I understand what they understand about the person we are discussing.  During supervision, the parametric analysis of empathy can structure an informative interview that enables the supervisor to get a clear handle on what the supervisee understands about his or her client. 

Empathy, Paradigm Case Formulation, and Parametric Analysis

           Paradigm Case Formulations may be employed in situations where it is desirable to achieve a common understanding of a subject matter but where definitions prove too limiting, various, ambiguous or impossible. Empathy poses this definitional problem. 
      Finding an inclusive definition is a common conceptual dilemma. Consider how difficult it is to exactly define what is meant by the word “family” or the word “chair” if we wish to achieve agreement on all examples of possible “families” and “chairs”.  Must all families have two parents of different genders plus their children?  Must all chairs have four legs and a backrest?  A Paradigm Case Formulation of a concept should provide all competent users a conceptualization that can serve as a starting point of agreement.  Generally, it should consist of the most complex case, an indubitable case, or a primary or archetypal case (Ossorio, 2013).  It should be a sort of “By God, if there were ever a case of “X”, then that’s it.”  For example, most would agree that a group of people living together, consisting of a married father and mother, and their biological son and daughter would be a family.  But what if there is only a husband, his husband and their dog?  Or three best friends who live under one roof, share expenses and make their significant decisions together?  What elements must be present and what can we add or leave out and still meet what different people would call a family? 
       By starting with a paradigm case that everyone easily identifies as within their understanding of a concept, it becomes possible to delete or change features of the paradigm with the consequence that with each change some people might no longer agree that we are still talking about the same thing.  But because of the shared paradigm, they can show where we disagree. 
      A Parametric Analysis, on the other hand, attempts to clarify how one example of the subject matter can be the same or different from all other examples (Ossorio, 2013). Each parameter should identify a necessary and independent dimension of the concept.  For example, all figures in plane geometry are the same or different depending on their varied location on the parameters of the ordinate and the abscissa. All colors are the same or different depending on how they vary on the parameters of hue, saturation and brightness.  For my purposes, the concept that will be the subject of a Parametric Analysis will be the general case of Intentional Action (Ossorio, 1973; 2013). 
         Empathy is variously understood to involve an appreciation of being in another person’s position, an appreciation that is both accurate and attuned to the other’s current predicament and state of awareness, a sort of “feeling into” the other.  Empathy is often connected to an altruistic or sympathetic stance and is a feature of the “I-Thou” relationship.  It tends to be respectful and kind. 
        An empathic appreciation of the subjectivity of another person is central to the developmental achievement of “mentalization” (Fonagy et al., 2002) and the kindred notion of “Theory of Mind.” Across various theoretical orientations, empathy is seen as a vital aspect of psychotherapeutic, healing, and nurturing relationships.
        Physiological study has identified neural patterns that respond in a mirror-like manner when certain vertebrates observe another animal behaving  (Rizzolatti & Craighero, 2004). This “mirror neuron” response highlights the ordinary and natural manner of certain shared responses that correspond to a common physical embodiment. Having similar bodies with corresponding systems of sensation and perception facilitates a common affective experience, a shared experience of how another’s actions feel.  This works across species, too. When I yawn, my dog it likely to follow suite (Romero, et. al. 2013).

      As a psychotherapist and supervisor of psychotherapy, I believe that empathy is a defining feature of effective treatment (See, for example, Meissner, 1991, and Shedler, 2010).  In my training, the three most influential theorists of empathy were Carl Rogers, Heinz Kohut, and Roy Schafer. These authors offer a similar vision of the therapist’s empathic activity and of the effect empathy has on the client. Schafer further describes empathy as both a psychological state and as an action, a position I find particularly useful in building a tool for empathic inquiry. These authors provide a starting point for my conceptualization.
      Carl Rogers (1975) makes the following points about empathy. It involves “entering the private perceptual world of the other”, “being sensitive, moment to moment, to the changing felt meaning which flow in this other person”, assuming a nonjudgmental stance, and being careful not to uncover meaning that the other would find threatening.   
      Heinz Kohut  (1984) describes empathy as “the capacity to think and feel oneself into the life of the another person”, as “vicarious introspection”.  Kohut also underscores that appropriate and therapeutic empathy is “attenuated empathy”, a diminished response that is not overwhelming to either party and protects both from becoming too defensive or “walled off”.  
       Roy Schafer (1959, 1983) describes empathy as sharing and comprehending the momentary psychological state of another person. For Schafer, empathy is a central feature of the analyst’s attitude from which the analyst constructs a mental model of the analysand, and expresses this understanding with care not to “mortify” the client. Schafer (1983) writes about empathy as “empathic activity”, a form of intentional action. My analysis will correspond in significant ways to Schafer’s “mental model”.  
        All three authors present empathy as an understanding that is accurate, attuned to the present interaction and tolerable to both people. The requirement that empathy is experienced as tolerable is central to my formulation. 

        In ordinary usage, empathy is understanding  the perspective of being in the other’s shoes, of “entering the private perceptual world of the other”.   Seeing from another’s perspective is a useful reminder and a fiction.  I can only walk in my shoes and see from my perspective.  What I have available are my observations and thoughts regarding my interactions with other people.  I observe other people’s actions but I do so from where I stand.  There is no way around this fact.  Since we cannot get inside another’s head, our sense that the other is being empathic will follow, correctly or not, from whether we experience them as understanding the significance of our actions.

A Paradigm Case Formulation of Empathic Action

     In earlier work, I developed a Paradigm Case Formulation of empathy as activity that communicates an accurate understanding of the significance of another person’s intentional actions in a way they can tolerate (Schwartz, 2002). This requires understanding a person’s currently active motivations, knowledge and skills and how they view the significance of their actions in the current circumstance.   As a Paradigm Case Formulation, I take it that what I have described is recognizable as empathy and that the formulation allows for alterations within the ordinary shared meaning of the concept.  For example, although I have described this as a two-person interaction the number of participants can be increased. The accuracy of the understanding can be shared by all or just assumed by one party (“I’m being empathic even if you don’t realize it.”).  The accurate representation of the content of each of the parameters can be more or less available or certain.  Deficits or changes in the content of the parameters may result in the judgment that the act in question is not or no longer empathic, and this may lead to disagreement, but the parameters of the formulation should allow observers to know how they agree and where they differ. 
       What follows is a parametric analysis of empathic action as a particular type of intentional action. The systematic use of the parameters can generate a set questions and reminders that can be used in clinical interviewing and in self-reflection.

      The parametric analysis of intentional action developed by Peter Ossorio provides the dimensions for my conceptualization of empathy (Ossorio, 2013, and see Bergner, 2011).  Ossorio presents intentional action as the most inclusive concept of behavior that includes the behavior of humans and other animals (and non animal persons and intentional beings should we ever create or encounter any (Schwartz, 1982)).   The general case of intentional action allows for various forms of deliberate and non-deliberate intentional action as well as intentional action performed consciously, pre-consciously or unconsciously. 
      In Deliberate Action, the actor attempts to choose among options relevant to reaching a goal whereas in non-deliberate intentional action only the recognition of a goal matters independent of whether the actor sees alternatives. Impulsive and emotional action may be merely intentional, whereas the recognition of choice and alternative typify deliberate action. The guiding notion is that intentional activity involves a purposeful and meaningful attempt to accomplish something.  This is in contrast to “behaviors” that are accidents, matters of reflex, forced or coerced. Most often, when speaking about behavior, we mean some form of intentional action, although the paradigm case of the behavior of persons will be deliberate action.  Persons are sometimes but not always deliberate actors.  The eligibility to be a deliberate actor is a fundamental to the full concept of “Person”. 

         Here’s the parametric analysis of behavior that indentifies the dimensions one behavior can be the same or different from another behavior:

 Behavior = Intentional Action = < I, W, K, KH, P, A, S, PC > 

I: The Identity of the actor.
W:  What the actor Wants to accomplish.
K:  What the actor Knows, distinguishes, or recognizes in the circumstance that is relevant to what the actor Wants. (In Deliberate Action the actor recognizes different options, in Cognizant Action the actor is self-aware of the ongoing behavior).
KH:  What the actor Knows-How to do given what the actor Wants and Knows about the relevant circumstance.
P:  The procedural manner or Performance of the action in real time.
A:  The Achievement of the action.
S:  The Significance of the action for the actor.  What the actor is up to by performing the act in question.
PC:  The Personal Characteristics of the actor expressed by the action.                                                                                       

     These parameters roughly correspond to the content of Schafer’s “mental model” and are implicit in people’s basic understanding of each other.  We implicitly understand each other as having specific motives, knowledge and skills. We also see people’s behavior as a manifestation of their personal characteristics and we expect that people can appraise the significance of their actions and the actions of others.
    To the extent that these parameters cover the full range of purposeful behavior, they should also cover the distinctions relevant to an explication of empathy.  The parameters also serve as a guide or checklist when I am uncertain about my empathy toward another person.  I find the following useful reminders.  I might ask or wonder: 

1. Given their understanding of the overall circumstance, what does this person want and value? (And do we share an understanding of what the overall circumstance call for?) (The "W" parameter)

2.  What exactly do they recognize in their circumstance that is relevant to what they want and value? (And do we share a common appreciation of the situation?) (The "K" parameter)

3. What do they know how to do given what they see as their current opportunity or dilemma? (And do they have the skill or competence that is needed to successfully manage the circumstance?) (The "KH" parameter)

4. What is the significance to them of how they behave in these circumstances? (The "S" parameter)

5. What personal characteristics are they employing and what is the significance of these characteristics to them? (The "PC" and "S" parameters)

6. Can they tolerate the way I express what I understand about them?

    I have the option of directly or indirectly asking these questions. I might wonder if the answers offered are accurate or serviceable, and I might ask myself the same should our appraisals of the situation differ. While this is happening, I try to be aware that I only know so much and should not presume to know more.  Given that a person can only know how it seems to them, I might suspect, should my understanding differ, that they see the situation differently. I keep in mind that people take things as they seem unless they have sufficient reason to think otherwise. If I think the situation is different from how they see it, the burden of evidence is mine.
      Ordinarily, people are not conscious of any of this, and certainly not as a set of parameters or questions. They just “get it”.  People ordinarily make good enough sense to each other.  When things go smoothly, they have little reason to question their understanding.  But therapy is different from ordinary social life.  In therapy, when the relationship turns awkward, when the client suddenly appears anxious, or when the topic of concern is evaded, the therapist has reason to question his or her empathy, and the questions that follow from the parameters might help regain accord.  Since people come to psychotherapy because they feel misunderstood, because they have significant trouble in managing intimacy and may have problems expressing their thoughts and feelings, it is a good for their therapist to have a systematic method to address these issues.
      For most ordinary understandings of empathic action, some parameters are more useful than others. In my clinical work the W, K, KH, and S parameters serve as a basic checklist, but as I will offer, under certain circumstances the other parameters are relevant. What follows is a commentary on the parameters with specific focus on problematic issues attending these conceptual distinctions.  Especially problematic are behaviors that involve values, motives, recognitions, significances, and personal characteristics that the client unconsciously employs or is deeply reluctant or unwilling to acknowledge. There are personal qualities that are too painful or shameful to directly confront.  When vulnerability is central, safety and empathy matters most. 
         Let’s look more closely at the parameters and some associated reminders.  They could serve just as well for any activity that requires an adequate conceptualization of behavior. 

Wants. Perhaps the most general answer to the question of why someone does something is answered by reference to some state of affairs that the person wants to bring about. Wants refer to the motivations or values that are involved in how a person appraises his or her opportunities and dilemmas given what they see as their options in any given circumstance.  
    Although the paradigm case of a human behavior involves a cognizant person knowing their values and being able to deliberate, i.e., choose whether or not to act on the values, it is also clear that a person can act on motives and values that are not consciously recognized (Schwartz, 1984), or involve motives that the person is deeply reluctant to claim as theirs (Kris, 1982).   This is the subject matter of psychological defense and the dynamic unconscious, the traditional domain of psychoanalytic inquiry. 
      Motivations that a person is reluctant or unable to acknowledge requires empathic tact to be explored, and psychotherapeutic techniques that honor the “conditions of safety” (Schafer, 1983) are employed in exploring them.  Given our personal values, we are prone to judgment, and attempts to maintain empathic neutrality is crucial. Since we cannot give up our judgments, this boils down to self-awareness and the exercise of caution in how we show what we value. We learn to bite our tongue. Without the attempt to withhold judgment, the client is likely to hide what they do not want judged. 
      Some reminders: Actors and their observers might be accurate in knowing what “wants” are in play or they might be mistaken.  Even when known, people might not be in a position to articulate what they want.  Clarity and accuracy have a “more or less” quality and this will hold for the content of all the parameters. It is important to keep this in mind since insistence in attributing motivation, especially when there is disagreement or discomfort, tends to disrupt the safety of a relationship and may foreclose on exploring and appreciating the complexity of a situation. 
       What is wanted is often simple and clear and easy to say.  Other times, it is complicated, multiply determined, conflicted, murky, ambiguous or “unspeakable”, especially in the dilemmas that bring people to therapy.  People often sense their complexity even if they aren’t able to speak about it, and this is frequently the case when they feel they are not adequately understood.  Telling someone why they act as they do is commonly met with the rejoinder, “but it’s more than that”, since it often is.  And some people sometimes take offense at being told what they are feeling.
          Ossorio (2006) indicated that there are four classifications of intrinsic or fundamental motivation:  hedonic, prudent, aesthetic, and ethical.  There may be more. To say they are fundamental is to claim that they intrinsically provide reason enough to do something. These reasons for action can conflict, operate in a complementary or independent fashion, and so on.  If you have two reasons to do something, you have more reason than if you only had one, etc.  
        Hedonic refers to pleasure, prudent to self-interest, aesthetic to values of truth, rigor, objectivity, beauty, closure, or fit, and ethical with concerns of right and wrong, fairness and justice.  Hedonic and prudent motivations can operate consciously, pre-consciously, or unconsciously.  Aesthetic and ethical motivations require that the actor is eligible to choose or refrain from an action, to potentially deliberate about a desirable course to follow.   In the service of being able to choose, a person’s aesthetic and ethical motives are often consciously available (Schwartz, 1984).  I can’t help it that it feels good, or that I see it as in my self-interest, but I can consciously attempt to refrain from seeking pleasure or self-interest on aesthetic and/or ethical grounds.  Since choice is a defining feature of Deliberate Action and Deliberate Action part of the paradigm case of the concept of Persons, Aesthetic and Ethical behavior is quintessentially human.
    Another point. Not doing a pleasurable act because of utter coercion, overwhelming guilt, or unconscious taboo may appear to be an ethical performance, but if the actor had no choice, their performance was not one of renouncing pleasure or self-interest but of forced constraint. A person can do “the right thing’ because they really had no choice.  It may be a mistake to point his out. Without enough shared history, it is hard to judge how a critical observation will be tolerated. This is a key feature of therapeutic tact and why careful listening comes first and may take considerable time before problematic motivations and constraints are interpreted.  This is also the reminder that a person’s observable performance and their psychological state are conceptually separate. (And this is also why they involve distinct sets of parameters). 
      What a person wants is often not a simple matter.  An empathic appreciation is respectful of this. It can be the case that what looks intended is instead an accident or coerced, and in these situations the empathic response acknowledges the absence of motive.  Still, while we tend to be skeptical of the claim “the devil made me do it”, it pays to be sensitive to why a person might make such a claim. The empathic therapist waits until it is safe enough to suggest otherwise.

Knows.  Along with the basic question of why a person does something comes the question of why they are doing it now. The answer will always be some version of their recognition, correct or not, that the current circumstance provides an opportunity to do something they now want to do.  Action requires a correspondence between motive and recognized or known opportunity. 
      The Knows parameter refers to the range of concepts, facts and distinctions a person has available and employs in a given situation. Knowledge, a personal characteristic, is acquired through observation and thought.  Knowledge is relevant to the extent that it involves recognitions that can be acted on, differences that make a difference in behavior.  As a rule of thumb, people tend to notice what they value, including what they want to avoid.  People can also act on distinctions and not be cognizant of doing so, just as people might not recognize an opportunity when it stares them in the face
 A person might be wrong about what they know and this will have consequences especially if they believe they are competent or eligible in ways they are not.  Knowledge can be clear or unclear, certain or uncertain, serviceable or unserviceable. Knowledge relevant to behavior is evaluated on how effectively the known distinctions are employed, and this necessarily has a “more or less” quality to it. 
 The Knows parameter includes the potential awareness or cognizance of one’s own actions and potential choices.  Cognizant recognition of choice is a conceptual requirement for an ethical perspective to be employed or considered. The recognition of choice, including the potential to renounce a choice, serves as one of the ordinary standards for accountability.  Negligence occurs in situations where community standards hold that an ethical dilemma ought to be recognized but isn’t. Significant negligence of ethical considerations with attendant action (or inaction) is central to most conceptualizations of criminality and tort (see, e.g., Prosser, 1941). 
 The eligibility for certain recognitions and choices has a learning history.  Given where and how someone has grown up, what can they be expected to know?  What we expect people to know will be influenced by shared cultural expectations and an appreciation for the idiosyncratic.  Even though membership in a culture involves knowing standard choice principles, we should be careful what we presume.  Similarly, understanding that a person might have underdeveloped or diminished capacity is also part of the empathic observer’s knowledge of the other. If a situation would ordinarily call for a person to do something, if they lack the relevant knowledge (or values or competence), they will do something else instead. A person can only act on the values, concepts and skills they have available unless their performance is coerced (or they get lucky).
Knows-How.  An action is always an expression of a particular skill, competence or know-how if it is something a person can expect to perform non-accidently. Competence is acquired through having a prior capacity and the relevant practice and experience.  Not everyone has the needed prior capacity, practice and experience to develop the competencies that a community might take for granted.  And some people are more talented than others in acquiring or exceeding the expected skills. Their performance can look like magic (Putman, 2012). 
   Having the relevant know-how means that a person can perform an action in a variety of ways with the expected outcome that the actor achieves what is intended. Think of driving a car or dancing with a friend or throwing a fastball high inside at ninety-five miles an hour.  Drivers, dancers and professional pitchers have their expected know-how acquired by having a prior capacity and sufficient practice and experiences.  Behavior going wrong calls for an explanation once adequate competence has been achieved; behavior going right requires no explanation.  Bobby’s walking toward the couch and sitting down requires no explanation, but his repeated stumbling does.
       Akin to what some call procedural memory, once competence is acquired, people are rarely self-conscious of each move necessary in the performance of a task. We tend to be more self-conscious when we believe, correctly or not, that we lack the competence to act in a manner that a situation demands. The absence of self-recognized competence may turn what would be opportunity into threat, manageable hazard into feared danger.  It is unsurprising when worry, anxiety or panic are features of a situation where a person believes they lack the relevant competence to handle a problematic or even desired state of affairs.  This is why the Know-How parameter is of special relevance to what a person can tolerate (Schwartz 2002). 
        Defensively, we are only somewhat able to tolerate how we are seen or what we consciously know.  Defensive styles represent personal characteristics, sometimes unconscious, that limit or shelter a person’s awareness to what they can tolerate at any given time. Defensives may be automatically applied even when a person has outgrown their serviceability. The empathic clinician keeps this in mind.  I think many successful “interpretations of defense” are a result of an empathic therapist recognizing that the client can now tolerate what in the past gave them good reason to remain defensively unaware. What was good to avoid in infancy and childhood may no longer be intolerable, even if the person hasn’t recognized this yet.  Empathic confrontation that a person can do more than they claim follows a careful gathering of the evidence.  
     Psychotherapy is often an exercise in acquiring the competence to sit still and experiment with thought and emotional response.  Except when immediacy is actually necessary, people learn to look and think before they leap.  Empathy is a major aspect of making it safe enough to sit still and practice confronting what might otherwise be unthinkable or intolerable.  Patience and practice are required.  This is the love in the work.

Significance.   Significance is what a person is also doing by doing an act in question.  It is, so to speak, what they are up to. Behavior is organized by its significance and implemented by the particular practices a person engages in. 
      Emphatically, I am aware that what a person’s behavior signifies to me may be different from what it means to them.  I also keep in mind that they may not appreciate what I see as the significance of their behavior, regardless of how compelling the evidence.  I don’t have a pipeline to the truth.  I to Thou requires being clear that mystery and uncertainty remain. 
    In appreciating the significance of an action, especially when that acknowledgment involves interpretation, all of the dilemmas of attempting to make the unconscious conscious, all of the problems of attempting to get someone in touch with what they are reluctant to see, come into play. Therapeutically, confronting someone while they are defensive requires tact.  Tact requires empathy; it requires an empathic appreciation that a person at any given time can tolerate knowing only so much. People have to cope with how they are seen and this comes into play during psychotherapy.  Being seen in ways that a person is careful or reluctant to show is akin to the vulnerability that attends welcome and unwelcome intimacy.  One’s lovers, close friends, and therapists may be given permission to test the boundaries of self-understanding, but even when potential insight comes from a person’s closest confidants, it still might be intolerable.

 Here’s a story that I tell my students

    A baseball player, a pitcher, regularly throws a fastball high inside at ninety-five miles an hour. He mixes this up with a nasty curveball and is known for the occasional wild pitch.  He has hit more than one batter in the helmet. Those that know him outside the game have seen him tease his wife and children beyond what makes his audience comfortable.  This teasing clearly upsets his children.  He doesn’t seem to notice their unhappiness. With his wife and kids, he thinks he is just being playful.  You might think he is sadistic and mean and enjoys making people uncomfortable and helpless.  This is why his preferred pitch to a batter he has previously hit is to throw fast, high and very inside. 
     He had a severe and strict moralistic upbringing and now looks at himself from a perspective of moral superiority. Guilt is very hard for him to acknowledge or bear.  It is reasonable to assume that he’d feel guilty and ashamed if he knew how he looks but defensively he is not going to see himself in that light.  
   Instead, he sees himself as a talented pitcher with a clear appreciation of the strike zone and of the pitches hardest for his opponent to hit.  He views himself as a tough-minded sportsman, hypercompetitive but fair, and accepts only that the significance of his pitches is to strike out the batter, end the inning and win the game.  If he was asked if these pitches are also how he’ll get his contract renewed, feel the admiration of the crowd, and live the life of the ball player, he could probably acknowledge all of that.  But beyond what he can acknowledge about the significance of his pitches, he may also use his style of throw to achieve some sort of sadistic pleasure. It could be that the way he felt helpless and punished as a child is being worked out unconsciously in his manner of play both on the field and off.  He cuts that high inside corner on the wrong side more often than his consummate skill should allow.  His satisfaction at making the batter wince is too much for him to resist.  Since he is unaware of his sadism, he doesn’t control it well. An empathic interpretation of his sadism would require considerable tact and care. It would be resisted. 
     Generally, I make use of the parameters of Wants, Knows, Know-How, and Significance in judging the empathic nature of an interaction, so I will only say a little about Identity, Personal Characteristics, Performance and Achievement. 

Identity. Every action is someone’s action and that someone has a name and a title or some sort of status marker. The Identity parameter specifies that.  A person’s name or title used out loud or silently in social interaction is a significant status marker and may frame how one person appreciates the context and meaning of the other’s action. Addressing or responding to someone by their nickname has different implications than responding to them as Professor or Doctor or Ms. or boy or “hey you”. 
      How a person feels understood, and what they will tolerate from another’s representation of them may significantly reflect the names that are used. Empathy involves being held in mind in a fashion that may be reflected in the means of address.  And, of course, people have various responses to their names being forgotten and may experience such a forgetting as a breach in empathy.

Personal Characteristics. Similarly, people’s behaviors are an expression of their personal characteristics as they show their colors, true or otherwise.  People vary in their powers and dispositions.  A person’s behavior in the world follows from their psychological state and status, their values, knowledge and skills, and their traits, attitudes, interests, and styles.  
       People may want their actions judged as “in character” or not. Problematic or laudable behavior labeled as “out of character” does not create the conditions for degradation or accreditation that these same actions do if they are recognized as “in character” (Ossorio, 2005; Schwartz, 1979).  We offer praise or give people breaks in ways that depend on this distinction.  It gives us wiggle room.

Performance and Achievement.   A performance is an episode of behavior in real time with a beginning and an end. It can be interrupted and achieves some difference.
     We do not directly observe what a person wants, knows, and knows how to do in the sense of being inside their head; instead, we observe their performance. We watch and participate in their social practices. But whatever their behavioral performance, if it is an aspect of an Intentional Action, it achieves some difference in the world, be it trivial or profound.  
     We only have access to their observable behavior and our shared social practices.  Of course, we also have access to a person’s verbal behavior, written, spoken, etc., as part of their representation of what they are doing.  As a rule of thumb, what a person says provides only some evidence of what they can tolerate being told.  They may be able to dish it out but not take it.

     It is in through mutual social practice that we take for granted shared intentionality (Tomasello & Carpenter, 2007). When the shared practice feels attuned, harmonious, cooperative and effective, we do not ordinarily question whether an empathic appreciation occurs.  In contrast, when a shared practice feels awkward, broken, ruptured or breached, a deliberate attention to the parameters of intentional action may be helpful. In general, the more similar we assume to be to the other in values, knowledge, skills and other characteristics, the less likely we are to question our empathy, even if we should.  But when differences in culture, gender, age, embodiment, mental state, social class, etc. are a features of interaction, attention to the parameters may be useful.  Given how frequently psychotherapists are a different gender, age, race and social class from their clients, deliberate attention to the parameters provides a useful set of distinctions for self-refection and supervision (Schwartz, 2008).

    Let’s return to Bobby. I came to see Bobby’s stumbling and classroom behavior as having significance, an intentional communication and a compromise formation that involved conflicting motivations (W).  What Bobby wanted (W) was support, to be picked up and held, and he wanted that from me. His problem was that that wish put him in an intolerable position since he felt only women or mothers are proper for that sort of contact.  It would be too “gay” for him to recognize that he wanted to be held by me.  This is why I think he remarked that I’d look better with eye shadow, making me more like his mother.  Bobby was very concrete this way.  

   Consciously, Bobby recognized (K) that I provided an opportunity for support and he knew how (KH) both to stand and to fall. Of course, only the falling required explanation, since Bobby’s competence in standing was not in question.  He also knew (K) that falling results in being picked up and held, but given his fears, he could not directly ask for that support.  Instead, he unconsciously demonstrated his dilemma by his stumbling performance (P).  In the form of a compromise formation, Bobby achieved (A) both my support and the avoidance of his homophobic concerns. The significance (S) of Bobby’s falling and disruptive classroom actions was a tolerable way to represent an intolerable wish given his concerns with appearing gay.  I, too, understood those feelings but am not nearly as homophobic as was my teenage client. By telling Bobby that I would stand beside him as a comrade rather than hold him as a woman, I found a way to provide for Bobby’s request in a way he could tolerate, even though he remained without insight.  


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  1. Excellent and very helpfull...explaination of how important it is to have empathy towards other, I never knew or thought there was so much more to understand...of course.. I am not a trained therapist...but still I will remember this when I'm in a situation where a friend or loved one needs my attention. Claudia Bach