Disclaimer: nothing in this post should be taken or held as clinical instruction, clinical supervision, or advisory concerning patient care.
Technique or empathy: which one should predominate?
And does the topic of “technique vs empathy” apply to the work across our field?
I would say absolutely it does, especially in the current context we all face.
I’ll address this clinical conundrum by exploring 3 schools of thinking within psychoanalysis.
- Kleinian school: My technique is correct. The patient must adapt to it. And the patient needs to learn how to adopt it and be improved by it.
- Winnicott: We must adapt our technique to the patient. Don’t change the patient, change your technique.
- Kohut: Empathize. Neither lead nor follow the patient.
I recently heard a lecture espousing the correctness of each of these 3 positions within the analytic tradition. But the lecture content did not reconcile them in any way, or even provide a coherent starting place to attempt to do so.
Meanwhile, addiction counselors might be taught to give technique primacy over empathy. Or they might be taught to give empathy primacy over technique. Or to always and only defer all decisions to the patient. (As if these 3 notions are always and necessarily at odds).
Yesterday I decided these 3 can all be held at once, as options. And that the clinician could mindfully choose from among them, including the oscillation between and among them in time. Here’s the way I worked it out:
The flexibility this mindfulness provides might help set the occasion for a better-tuned clinical-next-statement than one that comes from a pre-packaged or linear type of communication (e.g. one derived from a manual).
And it might better fit at times than one derived from a notion of the change process that is within a pre-formed theoretical sequence (e.g. hypothesized stages of growth, change, or treatment).
That is to say, the 3 common continuous processes of change (extrication from the past, accommodation of the new, and shedding) that people often work on concurrently, might be more wholistically supported as a total project by this kind of mindful flexibility.
After getting the Venn diagram done and this writing mostly completed, I remembered Bob Lynn’s commonly stated theme: the “intersection of science and compassion” as of prime importance.
For me, in this topic as I’ve laid it out, “technique” seems to align with “science” and “empathy” seems to align with “compassion”.
Suggested Reading
Bion, W. (1967). Notes on Memory and Desire. The Psychoanalytic Forum. 2:272-273, 279-280.
Reik, T. (1948). Listening with the Third Ear: The Inner Experience of a Psychoanalyst. Farrar, Stauss: NY.
Recovery Review 