What's a Good Object to Do? - PsyBC

22 Neil J. Skolnick
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Empathic Attunement to Psychic Organization
Relational analysts routinely hold up empathy or empathic attunement
as a requisite provision of a good object. It is far beyond the scope of
this paper to explore the development, phenomenology, or nuanced
processes of therapeutic empathy. I would like, however, to note an
observation on a specific use of empathy, gleaned from my work, that
holds consequence for both theory and therapy.
The positional psychic organizations identified by Klein (1935) and
more recently expounded on by Ogden (1986) require a particular
form of empathy as they emerge in treatment. To state this use of
empathy in its simplest form: a patient who is, in the here and now,
experiencing the analyst through the psychic organizational lens of
the paranoid/schizoid position requires that the analyst provide a
variant of empathic attunement. Rather than demonstrating an
attunement for the patient’s affective expression at the moment, such
as, say, “You are in a rage,” or, “You are in a rage because . . . ,” the
analyst needs to express empathy for the patient’s experience of his or
her psychic level of organization 7 and a diminution of attention to
interpretation of psychic meaning. Obversely, a patient positioned
more in the depressive organization requires more empathic
attunement to interpretations of the meaning of their experience.
The paranoid/schizoid psychic organization, as elaborated by Ogden
(1986), devolves into a state of “it-ness.” Emotions, thoughts, and
even behaviors do not seem to be arising from a locus within the
patient. Instead, they are experienced as happening to the patient. As
such, the truth of moment-to-moment psychic meaning is, for the
patient, derived from an absolute external truth. The patient has no
sense that he or she is in any way the arbiter of meaning, the master of
his or her own perceptions. The contemptuous patient does not imagine
that you are a hopeless incompetent, he knows that you are a hopeless
incompetent, with no room for degrees of freedom. Similarly, the
adoring, idealizing patient experiences the truth of his feelings in the
same way. Consequently, his rancor or adoration toward you is not
debatable; it is the only reasonable response from a reasonable person
whose reasoning follows from the absolute truth.
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7
This is similar to what James Fosshage refers to as empathy from within as opposed
to empathy from without (2004, personal communication).