The Dance of Empathy: A Hermeneutic Formulation of Countertransference, Empathy, and Understanding i

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The Dance of Empathy A HermeneuticFormulation
of Counter-transference,Empathy, and
Understanding in theTreatment of Individuals Who
HaveExperienced Early Childhood Trauma

• Pastoral Skills Training
• Week 4 Reading

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GROWING AWARENESS OF THE PSYCHOLOGICAL IMPACT OF
EARLY CHILDHOOD TRAUMA

• Researchers have discovered a relationship
  between early childhood trauma and the later
  development of severe personality disorders, such
  as borderline personality disorder
• Converging evidence suggests that such disorders
  of the self (Kohut, 1971) and related
  disturbances in identity, affective regulation,
  and interpersonal relationships may have their
  origins in highly traumatic childhood
  experiences.

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DANCE OF EMPATHY

• Early childhood trauma usually occurs within a
  relational context and is often associated with
  serious boundary violations, intrusions,
  betrayals, and assaults on the sense of self.
• Thus, the dance of empathy - requires the
  utmost skill and delicacy in managing the complex
  transferencecounter-transference issues that
  inevitably emerge.
• Patients who have experienced early childhood
  trauma will often re-experience and reenact their
  role in previous abusive relationships within the
  context of the therapy relationship.
• The dance of empathy between the therapist and
  the patient who experienced early childhood
  trauma is conceived of here as choreographed and
  guided by the quality and accuracy of empathic
  responses, as determined by the
  counter-transference of the therapist.

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TWO TYPES OF COUNTER-TRANSFERENCE REACTIONS
(CTRs)

• Classical formulations, which refer to subjective
  reactions on the part of the therapist
• Contemporary formulations, which refer to
  objective reactions on the part of the therapist

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CLASSICAL CTRs

• Classical formulations of counter-transference
  refer to reactions on the part of the therapist
  that are specific, personal, and subjective, and
  that resonate with his or her prior understanding
  and experience.
• The patients reaction activates unresolved
  unconscious and conscious conflicts within the
  therapist, arising from his or her personal
  history.

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CONTEMPORARY CTRs

• Contemporary formulations of counter-transference
  refer to reactions on the part of the therapist
  that are universal in that anyone exposed to this
  material is likely to have characteristic
  responses.
• Likewise, these reactions are objective, in that
  they are related to specific trauma-embedded
  images and recollections conveyed by the
  traumatized patient.

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CONTEMPORARY CTRs (contd)

• Contemporary formulations of counter-transference
  refer to universal reactions to the patients
  presentation of traumatic imagery and
  recollections, a process described as secondary
  victimization (Figley, 1983) and vicarious
  traumatization (McCann Pearlman, 1990).

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CONJUNCTIVE AND DYSJUNCTIVECOUNTERTRANSFERENCE
PROCESSES

• Conjunctive CTRs The feelings and experiences
  shared by the patient readily resonate with and
  are assimilated into the internal experience of
  the therapist.
• Dysjunctive CTRs - The therapist takes in the
  patients material, but then alters the
  configuration of the patients experience in
  accordance with his or her own prior experience
  and understanding. The therapist may then react
  to or interpret the information from the patient
  in a way that leads to a misunderstanding of the
  patients experience.

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HERMENEUTIC FORMULATION OF CTR, EMPATHY, AND
UNDERSTANDING
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The Completion of the Hermeneutic Spiral The
Dance of Empathy

• Within the hermeneutic spiral, the dance of
  empathy is choreographed through a mediation
  between
• (1) the quality of empathy,
• (2) the depth of the therapists
  understanding of the patient, and
• (3) the therapists awareness of his or her
  CTRs aroused by the patients material.
• It is through this dance that the fluctuations in
  the empathic position remain beneficial for the
  patient.

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Understanding as the Mediation of Part-to-Whole
Configurations

• A therapist is exposed to tiny fragments or
  isolated parts of a persons experience (Like
  tesserae of a marble mosaic). If the therapist
  attempts to understand the whole person from this
  fragmented piece of experience, little, if any,
  overall understanding will be possible.
• Likewise, the whole person is understood only in
  relation to those parts of his or her experience.
  
• This repeated formulation and mediation from
  part-to-whole experience, and then whole-to-part
  experience, is essential for an overall
  understanding of the person.
• Implicit within the spiral of the hermeneutic
  process is the idea that an understanding of the
  patients experience is never complete.

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The Dance of Empathy and Two-Stepping

• The dance of empathy involves a circular,
  reciprocal process of being with or moving
  closer to the patients experience, and moving
  away from the material in order to maintain an
  appropriate boundary, empathic stance, and level
  of understanding.
• The choreography of the dance is determined by
  the therapists awareness of and management of
  the countertransference. When an effective
  empathic stance is maintained over the course of
  therapy or within an individual session, the
  patient is able to freely be with the therapist
  and work through threatening experiences.
• In the dance of effective empathy the
  approachavoidance of the therapist does not
  parallel the defensive processes of the patient.
• Instead the movements of the therapist complement
  the movements of the patient.

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FOUR STEPS FOR MAINTAINING A MAXIMAL STANCE FOR
EMPATHY AND UNDERSTANDING

• Step 1, Listening Words, Feelings, Transference
• Step 2, Awareness of CTRs - Classical,
  Contemporary, Conjunctive, and Dysjunctive
• Step 3, Monitoring of How CTRs Are Affecting
  Effective Empathic Stance Toward the Patient
• Step 4, Completion of One Cycle of the
  Hermeneutic Spiral The Dance

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APPLYING THE DANCE OF EMPATHY

• What do you remember most about a client that you
  went through the hermeneutic spiral of the dance
  of empathy?
• Which type of CTRs do you find the most difficult
  to manage as a pastoral counselor?
• What has been most challenging for you regarding
  the awareness and monitoring of CTRs?