Kohut’s Reluctance to Pathologize: Replacing Objective Authority With Innovative Compassion

Abstract

When self psychologists speak of empathy and vitality, it recalls a shift in the mindset of psychoanalysts that was nothing short of revolutionary. Early in the last century analysts were objective authorities whom patients consulted about something wrong with themselves. The therapist was motivated to pathologize—diagnosing what was unhealthy and uncovering the origins of this “wrongness.” Kohut played a pivotal role in the movement away from that kind of authoritarianism, toward a warmer psychoanalytic approach that resonated with our patients and ourselves. He embraced what was right in the patient, replacing objective authority with an empathic approach that he grounded in theory. His innovative compassion allowed analysts to treat patients who were previously deemed untreatable, leading to the development of new concepts and techniques. Clinical vignettes demonstrate how a reluctance to pathologize can provide novel insights into the genesis of some apparently dysfunctional choices, now seen for their adaptive potential. A previously unpublished letter of Kohut’s is examined to confirm his respectful recognition of resilience in others.