Empathy vs Sympathy in Psychodynamic Psychotherapy

In my last post, I discussed the role of empathy in promoting moral behavior; it set me to thinking more about empathy and, in particular, the way people often use that word interchangeably with the word sympathy when they actually describe different experiences.  If you’re already clear on that difference, bear with me.

Here are two dictionary definitions from Merriam-Webster:


“the act or capacity of entering into or sharing the feelings or interests of another”


“the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts and experience of another of either the past of present without having the feelings, thoughts and experience fully communicated in an objectively explicit manner”

In my view, the distinction between empathy vs sympathy involves the difference between entering into and sharing those feelings that another person may have verbally and intentionally expressed vs intuiting something unspoken, of which the other person may sometimes be entirely unaware.  I often find that clients want me to sympathize with what they’re telling me, when in fact, they need me to empathize with and help them become aware of something unconscious they’re afraid to know.

I gave a good example in my prior post.  My tearful client Stephanie related the story of mean children on the playground at school, torturing an injured bird they had found; she wanted me to share in and sympathize with her expressed feelings of horror at their cruelty, thus validating her self-image as a “good person” in contrast to the other “bad” children.   As I said, I found those tears “emotionally unpersuasive”; I did not sympathize.

Instead, what I felt, though I didn’t fully understand it at that point, was an inkling of her unconscious rage.   I felt it in my body and face; I couldn’t articulate it even to myself, but I had a sense that Stephanie unconsciously felt something quite different from the feelings she apparently wanted me to share.  Such intuitions are the bedrock of psychotherapy from a psychodynamic perspective and not terribly scientific.  In my training, teachers and individual supervisors took this for granted, generally validating such emotional perceptions and treating them as “facts” to be considered along with the other material brought by my clients; but you’re often met with polite skepticism if you express this view to lay people, or even to other psychotherapists who practice in different modalities.

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Art and the Dread of Experience

Over the years, I’ve worked with a number of artists — musicians, a choreographer, several writers — and dealt with various types of artistic inhibition such as writer’s block.  In our work together, my clients and I  struggled with issues that might be familiar to you:  perfectionism, grandiosity of the type described in my post on self-criticism, as well as the self-envy that may lie behind fear of success. With several of my clients, I came to understand another such difficulty in making art, where the original inspiration or emotional charge behind the work of art is killed off in the process of creation.

In an earlier post on anxiety attacks and disorders, I introduced the concept of mind as a container for emotional experience; I discussed how people with “insufficient mind” — that is, an inability to contain and manage their emotional experience — often feel terrified that strong feelings will overwhelm and annihilate them.  Several of the artists in my practice fit this description.  One of them was prone to anxiety attacks and states of disintegration; another led a very controlled life, without much human emotional involvement; a third showed symptoms of autism and often tried to shut out a world that stirred up such terrifying emotions.  These difficulties also affected their creative processes.

Over time, we came to think of the work of art — be it a choreographic work, a song or a piece of fiction — as a sort of container for their emotional experience.  It’s how I think about art in general:  great works of art contain and express profound emotional experiences; optimally, the shape of that container (the individual and unique painting, novel, symphony, etc.) bears an organic relationship to what is contained, adapting its shape to the needs of authentic emotional expression.  I hope that doesn’t sound too abstract; as a clinician, I have found it an incredibly helpful way to think about my artist-clients.  The artist works upon his or her “insights” and tries to create a uniquely powerful work of art that will convey powerful emotion (basic human truths) to an audience.

With several of my clients, they started off with a powerful feeling or insight but in the process of creating their work of art, deadened it.  The art they produced (in their own view, not mine) lacked “depth” or “dimension”:  dance works felt “constipated”, their performers trapped in choreography with constricted movement and little emotion; songs seemed simplistic and boring, without true feeling; characters appeared “flat” and “two-dimensional”.  In our culture, we frequently use these exact critical terms:  lack of depth, flat characters, two-dimensional stories, etc.  A vital artistic container has three dimensions and its own sort of life force; it has an interior and a surface or “skin” with which we, as audience, can interact.

Unsuccessful works of art have little dimension.  Rather than containing and conveying powerful emotion, they stifle it.  The artist who is terrified of intense emotion may mis-use his or her art form, employing it to flatten feelings instead of expressing them.  For that reason, the works of art they produce will leave an audience feeling “cold”, indifferent or bored.  In short, rather than conveying profound and intense human truths, such art works seek to deny them.

Recently, one of my clients (an aspiring and frustrated writer) brought in a dream that perfectly illustrated this process.  She was treading water in a pond along with some “cowboys”.  The pond felt like a whirlpool and they were all in danger of being sucked down into it.  The only way to save themselves — that is, to keep from drowning — was to tell one another non-stop stories while treading water.  At the same time, each of them had to hold onto a piece of raw meat that had been vacuum-sealed in plastic.

The cowboys are linked to the Wild West, a frightening way of life without the restraining influence of law and civilization.  Raw meat connects to raw emotion.  The dream shows how my client is terrified of her own raw emotional experience; in order to save herself from being overwhelmed by that experience, she resorts to “art” (telling stories) as a defense.  In the process, she shrink-wraps her experience and makes it safe, no longer raw and vital but hygienically processed, like something you might find in a supermarket meat case.

Finding Your Own Way:

I know that a number of visitors to this site are artists; I’d welcome your input on this subject.  What sort of artistic inhibitions have you struggled with?  Does this description in any way resonate with your own experience?  What about your view of other artists and their work?

As for the rest of us, we might begin with our relation to different art forms and how they affect us.  Think of a movie you found boring and ask yourself why.  Was it because the characters were flat, the story lacking in dimension?  Movies that portray extremely black-and-white characters often leave me cold because they strike me as a denial of a basic truth, that humans are a mixture of good and bad, each of us struggling with unavoidable ambivalence. What about novels you put aside and never finished?  Was it because they failed to engage your emotions?  Did they seem flat and lacking in dimension?

Many of us have artistic urges and never manage to fulfill them.  Maybe it’s because we lack time and self-discipline; maybe it’s because we don’t have the patience to master the needed skill.  Another possible explanation, suggested by this post, is that we grow bored with the process, bored with our own creations, and abandon them.  Sometimes people take up a “hobby”, an artistic endeavor that holds meaning, and in the process somehow render the experience meaningless to them; often it’s because they simply can’t sustain intense emotional involvement with themselves and their art form.

The Toilet Function of Friendship (and Other Relationships)

Do you have any friends who “unload” or “dump” on you, who dominate phone calls or monopolize dinners together by talking about their problems forever and showing no interest in you?  Do you dread these encounters because you always feel “shitty” afterward?  Welcome to the toilet function of friendship.

When Freud first developed the “talking cure,” he recognized that his patients experienced emotional relief after psychoanalytic sessions during which they discussed their difficulties; what he didn’t at first understand was that many of his patients were unconsciously using those sessions as a way to evacuate their pain and unhappiness rather than to gain insight about them.  I’m not sure that he ever truly recognized this phenomenon, though he did grow more pessimistic about the possibility of psychological change over his lifetime.  Many other theorists have since described this problem; many psychotherapists have the experience of very devoted clients who come into the office overflowing with pain, who fill up the session with endless words about what’s bothering them, go away feeling relieved then come back for the next session and do the same thing all over again.

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Autism Symptoms in Other Disorders

[NOTE:  The following article discusses autism symptoms that may appear in other psychological disorders of adolescence and adulthood; for information on how to recognize and distinguish autism from other early childhood disorders, please click here.]

One of my clients, a young woman in her 20s, would come into session and sit for long periods in silence.  She found it almost impossible to make eye contact.  Later, I learned that she was mentally “singing” brief repetitive songs she herself had composed.  Usually they were but a few bars repeated over and over.  Or she might get a famous song “stuck in her head” and keep the loop running.  The Beatles’ “She’s Got a Ticket to Ride” was a favorite.  At those times, I felt as if she were shutting me out, almost as if I didn’t exist.

At other times in our work, she would communicate with me and use words in a normal way, although she was quite troubled and in a great deal of obvious pain.  She had a few stormy friendships; she mostly dated women and developed one intense, merged relationship that lasted more than a year.  In terms of background, she came from a chaotic and emotionally violent family;  she remembers as a small child regularly crouching behind a chair in the living room, intoning a single word over and over in a monotone way.  She had other such repetitive rituals that soothed her.  She also recalled an early childhood fascination with small hard objects and continually pressing them into her hands.  She didn’t like soft toys.

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Insufficient Mind in Anxiety Attacks and Disorders

This discussion may sound a little abstract at first but it’s crucial for understanding many psychological difficulties, especially in the realm of anxiety attacks and disorders.  It concerns the literal inability to tolerate one’s emotions. In an earlier post, I discussed how hatred can function as a kind of glue to hold the psyche together when a person is unconsciously terrified of falling into pieces under the pressure of intense experience; in my most recent post, I described the fear of psychic disintegration lying behind some anxiety symptoms and panic attacks.  If you haven’t done so already, it would help to read both those posts before this one.

In my psychotherapy practice, I find it useful to think of the mind as a sort of container for emotional experience.  Think of emotions and feelings as shapeless liquid and the mind as a vessel that holds and gives them form — that is, it makes sense of them and gives them meaning.  I know this sounds a little abstract; an example might help make it less so.  Say I’m watching a movie and I start to feel a sensation around my eyes and at the back of my throat.  There’s a tightness in my chest, too; my breathing becomes a little quivery.  My mind brings all those sensations together, and from past experience, I understand that I am feeling sad.  This isn’t a conscious process, of course, but I do believe it’s how we assign meaning to inchoate experience.

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