Altruistic love in psychoanalysis opportunities and resistance

BMC Medical Education, 2021

Background Altruism refers to acting in ‘the best interest of patients, not self-interest’. With an observed discordance between the concept and practice of altruism, and increasing attention to ‘pathologic altruism’, the role of altruism is blurred in present day medical care. In this background, the required balance of altruistic attitude which needs to be fostered in medical students needs clarity. This problem may be best addressed by the practicing clinicians. The objectives of this study were to explore clinicians’ understanding of altruism in the clinical context and to identify the key concepts of altruism which they felt, must be included in clinical practice. Methods It was an exploratory qualitative study to identify clinicians’ understanding of altruism and the key practice points for altruism. Online semi-structured interviews were conducted from 18 clinicians through Zoom and transcribed using Otter. Open coding of interview transcripts was done using Atlas ti 8 and gr...

Australian and New Zealand Journal of Family Therapy, 2017

BMC medical education, 2017

Several research areas, including medical education (ME), focus on empathy as an important topic in interpersonal relationships. This focus is central to the use of communication skills related to empathy and even more crucial to provide information in a way that makes patients feel more involved in the treatment process. Psychoanalysis (PA) provides its initial concept of empathy based on affective aspects including findings from neuroscience and brain research. Enhancing cooperation between ME and PA can help to integrate both aspects of empathy into a longitudinal training program. The condition of psychoanalytic empathy definitions is the understanding of unconscious processes. It is important to primarily attend especially the dominant affects towards the patient before interpreting his or her behaviour, since in explaining the emerging affects, the analyst has to empathize with the patient to understand the (unconscious) reasons for its behaviour. A strong consideration of no...

Kinesthetic empathy is a core concept that has long been mentioned in DMT literature and implemented in dance/movement therapy practice. Empathy is the ability of one person to understand another. It is the attempt to experience somebody else's inner life and implies knowing what the other one feels, having information about the other's situation and acting accordingly. It arises out of elements that are common in the experience of both individuals that are involved in the empathy process. Considered one of DMT´s major contributions to psychotherapy (Berger, 1992), this construct synthesizes an approach of the dynamics of the therapeutic relationship that includes non-verbal communication, bodily movement, dancing and verbal expression. Through the use of kinesthetic empathy, the dance therapist facilitates the self-development of a client when the process has been blocked or interrupted. It also demands that each therapist be open to one's inner sensations and feelings and be aware of what is familiar in one's own movement. Understanding, acknowledging and interpreting are functions inherent to therapeutic processes which aim to relieve human suffering. The ways in which these operations are defined determine different practices in psychotherapy. Dance Movement Therapy (DMT) focuses on the experience of movement sensing and how movement makes sense. The dance therapist gets empathically involved in an intersubjective experience that rooted in the body.

International Forum of Psychoanalysis, 2023

Freud has stated that the psychoanalytic cure is effected through the love of the patient for the analyst. This paper claims that the analyst’s love towards the patient is often essential as well. Countertransference love might indeed be associated with therapeutic risks, yet it is often a crucial part of the analytic process, since in order to be able to change, many people need to feel loved. The analyst’s curative love is defined by being both sublimated and passionate, modulated as well as libidinal. In addition, it is conscious, aware, and reflective, and hence any act based on it is directed solely to the patient’s psychic growth. Developing and maintaining such love is not easy. What comes to the aid of the analyst is the special construction of the analytic setting, which brings up a profound, loving interest in patients’ psyche as well as a “second self” that is consistently benevolent and loving and acts at a level of empathy rarely encountered in ordinary life.

Cardiology in the Young

Congenital heart care offers a unique lens to evaluate the importance of the practice of empathy understood as respectful compassion. Beginning in utero, providers can interact with patients across the lifespan and at different stages in the experience of CHD. These multiple opportunities to connect with patients from diagnosis to correction and recovery allow the clinician to build rapport and trust of tremendous therapeutic and interpersonal value. Taking time to get to know the values, preferences, experiences, and stories of the patient and families and continuity of care are essential elements. The movement towards teaching virtue or character ethics in medicine came forward with the medical professionalism movement. There was an acknowledgment that as one entered medical school, one's identity transitioned towards a professional identity. A road one travelled to become a good doctor included the development of characteristics that good doctors have, including patience, compassion, trustworthiness, honour, duty, excellence, perceptiveness, humility, and accountability, for example. Often on the list of virtues is empathy, and indeed, empathy has become the pinnacle of virtues and the virtue that most caring, humanistic clinicians were said to hold. 1 While empathy is often touted as one of the primary virtues that should be instilled in medical professionals, attempts at a standard definition of empathy and how to tell if it is instilled or not bring forward a legion of challenges. Empathy has many definitions, from moral imagination (Aristotle) to emotional intelligence (Goleman). Empathy is commonly described as the ability to understand or share the feelings and experiences of others and a capacity to perceive another's experience. 2-4 Interestingly, neurologic evaluation has found similarity in excitation of brain areas related to observing another's emotions based on facial expression and when the observer experiences the same emotion through what are referred to as "mirror neurons." 4 However, feeling what a patient feels may not necessarily be what is needed to be a virtuous physician. First, there is an ethical issue regardless of the conceptual and empirical issues surrounding the claim that we can experience the same state as another. It seems to be less than humble to assert that one can indeed be in a position, especially over short durations of time, to honestly know what another is going through and what their experiences mean to them. Second, a mirror state is unnecessary for the kind of humanistic engagement that we believe is important for patients, families, and clinicians. That is not to say that emotion or shared understanding is unnecessary to realise or, worse, detrimental to the goals of medicine in the clinical encounter. As Osler reminds us, it is vital for clinicians to be composed for the sake of patients and to manage one's emotional states to be as transparent as possible in one's clinical judgment. 5 Yet the dictum to manage one's outward and inward emotional responses with patients and families is not the same as a moratorium on emotions. If we regard emotions as being a central part of the human experience, in advocating for humanism in medicine, we must acknowledge the emotional life of patients, families, and clinicians. Perhaps the definition we seek is that empathy is respectful compassion. To respect patients fully as human beings is to acknowledge and provide some space for their emotional life. For example, they may well be scared, hopeful, or angry in the face of a diagnosis. The ability of physicians to perceive such states and communicate in some way that they perceive them makes a positive impact on the clinical interaction because it helps build rapport. Through rapport, trust may be developed, and arguably, a necessary condition of any therapeutic relationship is trust. Marshaling one's ability to perceive the emotions of others, and to know how much space in the clinical encounter to give them, is therefore warranted as it is a means to the best possible outcomes. And it is also valuable because it is a way to respect patients as human beings, as having an inherent dignity. Educational interventions meant to develop empathy in medical students have attempted to realize humanism in medicine. But it is unclear what has been effective, not unsurprisingly, because it is difficult to determine what one can measure to see if empathy has waxed or waned, and indeed, what we mean definitionally by empathy is blurry: it is a tricky subject to teach and assess. Do we mean feeling what another feels? If so, what makes this state better for the goals of medicine than understanding that someone has specific emotional responses and that we ought to acknowledge this in some caring way? Interestingly, pediatricians, internists, and family medicine physicians scored among the highest relative to other subspecialties using a validated scale to assess physician empathy,

Journal of the American Academy of Psychoanalysis …, 1990

Psychoanalytic theories can be arranged along a continuum. At one end, enduring structural aspects of the psyche are primarily seen as derivative of the vicissitudes of drives, while at the other end, structure derives from the vicissitudes of relationships (Greenberg and Mitchell, 1983). Ultimately an integration of these two viewpoints appears to be necessary for a psychoanalysis that is consistent with evolutionary biology (Kriegman and Slavin, 1989, 1990; Slavin, 1990; Slavin and Kriegman, 1989). However, this article focuses on the challenges to the classical paradigm that modern evolutionary theory poses. We shall see that the main thrust of self psychology, a relational/structure model is more consistent with what we now know about the evolution of our species.

The Psychoanalytic Review 94 (4) (August 2007): 553-576. Reprinted in Atterton, Peter and Calarco, Matthew (eds), Radicalizing Levinas (Albany: SUNY Press, 2010).

American journal of psychotherapy, 2015

Success in psychotherapy is correlated with the "fit" between patient and therapist, a factor related to attachment. For psychotherapists of any orientation, empathy and building the bond of attachment is our stock-in-trade. When empathy builds the bond of attachment with someone starved for connection, a therapist may inadvertently set him- or herself up to become a victim of a stalker. Because individuals who stalk others suffer from severe attachment disorders, their hunger for attachment motivates them to shadow psychotherapists, which makes being stalked a very real occupational hazard for psychotherapists. This was a painful discovery for me. I was stalked for 11 months, leaving me with post-traumatic stress disorder. After recovering, I deconstructed the experience to understand how and why it happened, and discovered that it was my empathy and compassion that contributed to and maintained the stalking. What I learned from the forensic literature provided the knowle...