Empathic Stance Research Articles

Person references, change in footing, and agency positioning in psychotherapeutic conversations.

This study contributes to the research on agency positioning in psychotherapy by looking at how clients and therapists, when discussing the client's difficulties, made use of two specific conversational practices, i.e., different grammatical forms of person reference and changes in footing, and what the consequences of this were for how the clients were positioned in relation to their problematic experiences. A data corpus of the first sessions of nine psychotherapies at a university training clinic in Finland was utilized. The uses of person references and changes in footing in therapists' initiative turns, clients' responses, and therapists' third position (recipient) actions were examined. The analysis showed that in initiative turns therapists usually used the second-person singular, as an invitation for the client to respond from his/her personal point of view, thus ascribing active agency to the client. When telling their problematic experiences, clients typically used so-called zero-person constructions, presenting such experiences as common to people in general, thus lessening their agency and inviting the therapist to share their experiential position. In recipient actions, therapists could use a combination of zero and active person reference which served to communicate an empathic stance and an invitation to the client to take an agentic observer position. Almost exclusively, only therapists used changes in footing. This could happen rapidly within single utterances and serve to express affiliation with the client's emotional experience and to invite or challenge the client to take an observer position. The study supplemented the CA change model with the DA and DSA notions of changes in agency positions as core elements in therapy talk and showed how variations in person references and changes in footing had a decisive influence on how different types of turns functioned within the overall conversational structure of the psychotherapy institution.

Young female adults’ experiences of their relationships with older people: The Mmogo-method®

Most of the intergenerational research in South Africa has been undertaken on African cultures. This study aims to cast light on the experiences of Afrikaans-speaking young female adults in relation to older people, using the Mmogo-method®, a visual projective data collection method. Eighteen young female adults (aged 21–30), all students, were purposefully selected and willingly participated. The four phases of the Mmogo-method were applied, for which participants used unstructured materials, and based on an open-ended prompt constructed visual representations of their interactional experiences in relation to significant older people. Visual representations were discussed individually as well as in a group setting, thereby obtaining personal and group experiences simultaneously. Visual data were analyzed using Roos and Redelinghuys’s proposed six steps, and textual data (verbatim transcriptions of personal and group discussions) were thematically analyzed. All participants were related to significant older people as grandparents. The relational interactions between young female adults and their grandparents emerged on a continuum of emotional closeness and distance: extremely and uncomfortably close, comfortably close, reasonably distant and inaccessible, and extremely distant and totally inaccessible. From the young adults’ perspective, relational interactions at the extremes of the continuum (too close or too distant) are experienced as ineffective, while comfortably close, as effective. Empathy as a relational characteristic created reciprocal feelings of closeness. Awarenessmaking of an empathic stance in intergenerational relationships might increase the support and care rendered through intergenerational relationships.

Razlogi za študij medicine in dentalne medicine pri študentih prvega letnika Medicinske fakultete v Ljubljani

Aim: In addition to clinical knowledge, communication skills and sovereign decision making, a good doctor is also expected to posses Aim: In addition to clinical knowledge, communication skills and sovereign decision making, a good doctor is also expected to posses professional values, including the ability to establish empathic relationships with patients.The purpose of the study was to identify the reasons that lead students to choose the study of dental medicine/medicine, and determine the level of emphaty in relation to the choice of study in the first year students of the Faculty of Medicine in Ljubljana.Methods: For the needs of the research we developed a questionnaire, which included basic data on students, their reasons for choosing the study of medicine or dental medicine and the Jefferson scale of empathy–version for students (JSE-S version with a modified scale with 16 arguments). The questionnaire was forwarded to all 227 first-year students in the academic year 2014/15 at the completion of the Communication course.Results: The study involved a total of 216 (response 95.2 %) students; 158 medical students and 58 students of dental medicine. Among the reasons for enrollment to the Medical Faculty, the highest proportion of medical students indicated a desire to help people (85.3 %), a desire to improve human health (78.8 %) and a desire to work with people (64.7 %); 28.8 % of the medical students chose the argument „because employment is guarantee”, while 14.1 % of medical students believed the argument „because it is well paid“ was the reason to choose the study of medicine.The students of dental medicine most often choose the following answers: a desire to help people (87.9 %), a desire to improve human health (74.1 %), followed by a desire to work with people (65.5 %). The argument “because employment is guaranteed” convinced 50 % of the students, and the argument “because the pay is good” convinced 46.6 %.Three claims were significantly associated with self-assessment of empathic stance: the arguments “because I want to help people” (91.08 ± 10.65 vs. 86.61 ± 12.56; p = 0.037) and »because I want to work with people” (91.82 ± 10.18 vs. 87.90 ± 12.11; p = 0.012) were associated with a greater self-assessmentwhile the argument “because the pay is good” (91.36 ± 11.41 vs. 87.29 ± 9.01; p = 0.023) was associated with a lower self-assessment of empathic stance.Conclusion: Students who want to help people have higher level of self-assessment of empathic stance. The task of a medical faculty is to ensure that students whose choice of study is based on their humanist values are encouraged to have those values further developed and put into practice during their study.

Reasons for the study of medicine and dental medicine in the first year students of the Faculty of medicine in Ljubljana

Aim : In addition to clinical knowledge, communication skills and sovereign decision making, a good doctor is also expected to posses Aim: In addition to clinical knowledge, communication skills and sovereign decision making, a good doctor is also expected to posses professional values, including the ability to establish empathic relationships with patients. The purpose of the study was to identify the reasons that lead students to choose the study of dental medicine/medicine, and determine the level of emphaty in relation to the choice of study in the first year students of the Faculty of Medicine in Ljubljana. Methods : For the needs of the research we developed a questionnaire, which included basic data on students, their reasons for choosing the study of medicine or dental medicine and the Jefferson scale of empathy–version for students (JSE-S version with a modified scale with 16 arguments). The questionnaire was forwarded to all 227 first-year students in the academic year 2014/15 at the completion of the Communication course. Results : The study involved a total of 216 (response 95.2 %) students; 158 medical students and 58 students of dental medicine. Among the reasons for enrollment to the Medical Faculty, the highest proportion of medical students indicated a desire to help people (85.3 %), a desire to improve human health (78.8 %) and a desire to work with people (64.7 %); 28.8 % of the medical students chose the argument „because employment is guarantee”, while 14.1 % of medical students believed the argument „because it is well paid“ was the reason to choose the study of medicine. The students of dental medicine most often choose the following answers: a desire to help people (87.9 %), a desire to improve human health (74.1 %), followed by a desire to work with people (65.5 %). The argument “because employment is guaranteed” convinced 50 % of the students, and the argument “because the pay is good” convinced 46.6 %. Three claims were significantly associated with self-assessment of empathic stance: the arguments “because I want to help people” (91.08 ± 10.65 vs. 86.61 ± 12.56; p = 0.037) and »because I want to work with people” (91.82 ± 10.18 vs. 87.90 ± 12.11; p = 0.012) were associated with a greater self-assessmentwhile the argument “because the pay is good” (91.36 ± 11.41 vs. 87.29 ± 9.01; p = 0.023) was associated with a lower self-assessment of empathic stance. Conclusion : Students who want to help people have higher level of self-assessment of empathic stance. The task of a medical faculty is to ensure that students whose choice of study is based on their humanist values are encouraged to have those values further developed and put into practice during their study.

Hysteria and Self Psychology

ABSTRACTThe article uses a self psychological lens to explore the notion of hysterical personality from our earliest understanding of it as the root of all psychogenic disorders, as discovered by Breuer and Freud, to its present elimination in the DSM-V. Can hysteria still be considered an applicable diagnosis or character style in the modern time? Or is it a culturally and historically limited phenomenon that no longer holds validity? Considering the case of Dora from Heinz Kohut’s revolutionary view, which privileges the subjective and empathic stance in treatment, one can infer that Dora’s own hysterical symptoms were not pathological, as Freud thought, but rather healthy attempts to bolster an enfeebled self. Nevertheless, both Kohut and his followers conclude that from a self psychological perspective both object-instinctual understandings, and self-object transferences, are essential for successful analytic treatment.

Empathy by dominant versus minority group members in intergroup interaction: Do dominant group members always come out on top?

What power dynamics are instantiated when a minority group member empathizes with a dominant group member during social interaction? How do these dynamics compare to those instantiated when the dominant group member instead does the empathizing? According to a general power script account, because empathy is generally directed “down” toward disadvantaged targets needing support, the empathizer should come out “on top” with respect to power-relevant outcomes no matter who it is. According to a meta-stereotype account, because adopting an empathic stance in intergroup contexts leads individuals to think about how their own group is viewed (including with respect to power-relevant characteristics), the dominant group member might come out on top no matter which person empathizes. Two studies involving face-to-face intergroup exchanges yielded results that overall were consistent with the meta-stereotype account: Regardless of who does it, empathy in intergroup contexts seems more apt to exacerbate than mitigate group-based status differences.

Why Psychotherapy Exposure is Relevant for Medical Students

Why Psychotherapy Exposure is Relevant for Medical Students

Interweaving the Symbolic and Nonsymbolic in Therapeutic Action: Discussion of Gianni Nebbiosi’s “The Smell of Paper”

Gianni Nebbiosi’s paper speaks to therapeutic action in a new key in the challenges of finding communion with a hard-to-reach patient. He achieves this through the creative interweaving of the nonsymbolic, his mime and music, and the symbolic, which attains greater purchase through painful personal reckoning in concert with his increasing awareness of previously unformulated states within and between each member of this particular analytic dyad. Central to this paper is the move from an empathic stance to greater complexity for each of the dyad. Distinguishing between empathy and recognition is germane. Particularly as we witness the transformation through therapeutic action of empathic presence to recognizing presence that permits the emergence of a more complex empathy—an achieved empathy that incorporates feeling and knowing the multiple, more deeply held, and often paradoxical aspects of our patients and indeed of ourselves as these play out in intersubjective space.

Can I Wash Away My Skin Color? Compulsive Hand-Washing in a Ten-and-a-Half-Year-Old Girl

This is a clinical presentation of two year, twice-a-week therapy sessions with a ten-and-a-half-year-old girl suffering from compulsive hand washing and social isolation. In the background were her father’s business failure and parents’ marital crisis. I suggest that differences in appearance between parent and child, like marked differences in skin color, are experienced as empathic failures, thus interfering with natural experiences of merger, and processes of transmuting internalization and identification. Skin color resemblance or difference may become the source of identification and feelings of belonging or, conversely, of alienation, strangeness, and loneliness. The opportunity to relive these difficulties in therapy enabled the development of an idealizing transference toward the therapist, and thus provided the opportunity for internalizations that softened the girl’s self-attitude. My empathic stance toward her deep need for bodily resemblance, first to her mother and then to me in the transference, proved crucial for meeting her self needs of merger with an idealized parent and of feeling understood and worthy.

A critical perspective on second-order empathy in understanding psychopathology: phenomenology and ethics.

The centenary of Karl Jaspers' General Psychopathology was recognised in 2013 with the publication of a volume of essays dedicated to his work (edited by Stanghellini and Fuchs). Leading phenomenological-psychopathologists and philosophers of psychiatry examined Jaspers notion of empathic understanding and his declaration that certain schizophrenic phenomena are 'un-understandable'. The consensus reached by the authors was that Jaspers operated with a narrow conception of phenomenology and empathy and that schizophrenic phenomena can be understood through what they variously called second-order and radical empathy. This article offers a critical examination of the second-order empathic stance along phenomenological and ethical lines. It asks: (1) Is second-order empathy (phenomenologically) possible? (2) Is the second-order empathic stance an ethically acceptable attitude towards persons diagnosed with schizophrenia? I argue that second-order empathy is an incoherent method that cannot be realised. Further, the attitude promoted by this method is ethically problematic insofar as the emphasis placed on radical otherness disinvests persons diagnosed with schizophrenia from a fair chance to participate in the public construction of their identity and, hence, to redress traditional symbolic injustices.

The clinical effectiveness and cost-effectiveness of brief intervention for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial (SHEAR).

Excessive use of alcohol is associated with poor sexual health, but the clinical effectiveness and cost-effectiveness of brief alcohol intervention in this setting has not been investigated. To examine the effects and cost-effectiveness of brief intervention for excessive alcohol consumption among people who attend sexual health clinics. A two-arm, parallel-group, single-blind, pragmatic, randomised controlled trial. Participants were randomised via an independent and remote telephone randomisation service using permuted blocks, stratified by clinic. Study participants were recruited from three sexual health clinics in central and west London. For inclusion, potential participants had to be aged ≥ 19 years, drink excessive alcohol according to the Modified-Single Alcohol Screening Question, and be willing to provide written informed consent. We excluded those who were unable to communicate in English sufficiently well to complete the baseline assessment and those who could not provide contact details for the follow-up assessment. Brief advice was delivered by the treating clinician and comprised feedback on the possible health consequences of excessive drinking, a discussion of whether the participant's clinic attendance was linked to current alcohol use, written information on alcohol and health and an offer of an appointment with an alcohol health worker (AHW). Appointments with AHWs took place either in person or by telephone, lasted up to 30 minutes, and used the 'FRAMES' (Feedback about the adverse effects of alcohol, an emphasis on personal Responsibility for changing drinking behaviour, Advice about alcohol consumption, a Menu of options for further help and advice, an Empathic stance towards the patient and an emphasis on Self-efficacy) approach. Those in the control arm of the trial were offered a copy of a leaflet providing general information on health and lifestyle. Outcomes were assessed 6 months after randomisation. The primary outcome was mean weekly alcohol consumption during the previous 90 days. The main secondary outcome was unprotected sex during this period. Eight hundred and two people were recruited to the study of whom 592 (74%) were followed up 6 months later. Among 402 participants who were randomised to brief intervention, 397 (99%) received brief advice from the treating clinician and 81 (20%) also received input from an AHW. The adjusted mean difference in alcohol consumption after 6 months was -2.33 units per week [95% confidence interval (CI) -4.69 to 0.03 units per week, p = 0.053] for those in the active arm compared with the control arm. Unprotected sex was reported by 154 (53%) of those who received brief intervention and by 178 (59%) of controls (adjusted odds ratio 0.89, 95% CI 0.63 to 1.25, p = 0.496). Participants randomised to brief intervention reported drinking a mean of 10.4 units of alcohol per drinking day compared with 9.3 units among control participants (difference 1.10, 95% CI 0.29 to 1.96, p = 0.009). We found no statistically significant differences in other outcomes. Brief intervention (brief advice and input from an AHW) cost on average £12.60 per person to deliver and did not appear to provide a cost-effective use of resources. Introduction of universal screening and brief intervention for excessive alcohol use among people who attend sexual health clinics does not result in clinically important reductions in alcohol consumption or provide a cost-effective use of resources. While people attending sexual health clinics may want to achieve better sexual health, attempts to reduce alcohol consumption may not be seen by them as a necessary means of trying to achieve this aim. This trial is registered as ISRCTN 99963322. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 30. See the NIHR Journals Library website for further project information.

Resolution of an impasse at a network meeting: Dialogical sequence analysis of the use of a shared formulation

The study describes the resolution of an impasse at a network meeting during clinical child neurological assessment procedure, analysed by dialogical sequence analysis (DSA) a micro-analytic method for analysing utterances. The two earlier studies of the project describe how a DSA-based case conceptualisation can be used to assess change in the dyadic interaction between neuropsychologist and parent. This study applies the same formulation to analyse group level interaction at the network meeting. The case of a four-year-old girl was selected from a database of videotaped and transcribed child neurological team assessment processes. A repetitive problematic pattern was clearly manifested between parents and the child. At an early stage of the assessment, the neuropsychologist formulated and shared with the parents a clinical formulation of the pattern, summarised as the controlling/coercive parents to the rebellious child. In the earlier studies, microanalysis using DSA confirmed the accuracy of the neuropsychologist’s initial formulation, which she had used in the encounters with the parents. This study traces how she made use of it to address a re-enactment of the problematic pattern, now between the parents and professionals at the network meeting. The analysis of the phases of the conflict resolution by using DSA suggests that the impasse represented a re-enactment of the role positions of coercion and rebelliousness. The use of the original formulation at the meeting helped the conflicting parties to reach an observing stance to the pattern and a more empathic attitude to each other. The micro-analytic methodology by DSA used in this study allows to show the therapeutic potential of the network meeting and also how the development of an empathic stance is manifested in the discourse content.

Interminability as a Legitimate Need

In this article, I propose to accept “interminability” as a legitimate need of the patient, unlike the tendency to treat it as a problem or as a negative phenomenon indicating an unsuccessful therapy. I present clinical vignettes demonstrating how some patients require a therapist for an unlimited time, continuously or at intervals. These patients require the therapeutic secure base and do not aspire—nor should they be encouraged—to terminate therapy. From the empathic stance of self psychology, such prolonged needs may be respected and provided.

Achieving an empathic stance: Dialogical sequence analysis of a change episode

This study examined a client's therapeutic progress within one session of an 18-session child neurological assessment. The analysis focused on a parent-psychologist dialogue in one session of the assessment process. Dialogical sequence analysis (DSA; Leiman, 2004, 2012) was used as a micro-analytic method to examine the developing discourse. The analysis traced the mother's developing of a reflective stance toward herself and her problematic ways of interacting with her daughter, who was the client. During the dialogue, the mother began to recognize her own contribution in maintaining the problematic pattern. Her gradual acknowledgment of the child's perspective and her growing sense of the child's otherness were mediated by an observer position (third-person view) toward the problematic pattern, which allowed a flexible exchange between the perspectives of self and the other. The results demonstrate the parallel development of intrapersonal and interpersonal empathy shown previously to characterize the transition from stage 3 (problem statement/clarification) to stage 4 (understanding/insight) in the assimilation of problematic experiences sequence (Brinegar, Salvi, Stiles, & Greenberg, 2006).

Ghosts to Ancestors: Bearing Witness to “My” Experience of Genocide

This article describes the relationship between an analyst and her patient who are both children of survivors of the Armenian Genocide in Eastern Anatolia, Turkey, 1915–1923, and the impact of their shared cultural/traumatic history. It explores how their life stories came together via memories, fantasies, metaphors, and fragments of trauma. An empathic introspective stance facilitated understanding and working through of the affective, cognitive aspects of interweaving subjectivities and mutual transferences. A process of transformation from repetition to memory to the creation of coherent narratives is described.

Ethical considerations in dermatologic photography

In dermatology, clinical photographs are an essential component of patient care, enabling clinicians to document changes in skin pathology over time. Recent advances in digital technology and the electronic medical record have revolutionized clinical photography; however, these advances bring with them new ethical, legal, and social concerns. Photographs, more than other forms of documentation, have the potential to make patients uncomfortable. The act of photography, especially for those images requiring exposure of the genital area or the entire body, can be an uncomfortable experience for patients, necessitating the clinician and photographer to take an empathic stance in this setting.The Internet has elicited an increasing, and a very real, concern for patients about possible distribution and use of images outside of their individual care. The clinician and staff can allay these fears by professionally and empathetically addressing their concerns. In addition, it is important that patients receive appropriate informed consent about clinical photographs and the potential use of the images in their care, education, and research. Given the multitude of methods for recording clinical photographs, combined with the increasing complexity of image storage, standardization becomes a critical tool in providing consistency among images and achieving more equitable and efficacious care. To achieve this goal and improve the baseline standard of continuity of care for dermatological practices, we review the role of photographs, develop a model for patient consent, and establish standards for photography so as to provide the most ethical care for the patient.

Managing boundaries under pressure: A qualitative study of therapists’ experiences of sexual attraction in therapy

AbstractAim: To identify therapists’ views on sexual boundaries and the strategies they employ to manage them in therapeutic practice. Method: In‐depth qualitative interviews were conducted with a sample of 13 accredited, experienced practitioners of psychotherapy or counselling. A grounded theory approach, informed by principles from Free Association Narrative methodology, was employed, in which team members used debriefing sessions for extending depth of understanding of the interviews. Findings: There is consensus about boundaries at the extremes, but variability about fantasy, flirtation and touch. A core process was generated from accounts of successful management of sexual attraction. We identified four problematic ways of reacting to boundary pressure, each with potential to harm clients and therapy. Discussion: A participant‐observer stance was conceptualised as essential for managing threats to boundaries, consistent with the empathic stance. Minor boundary crossings were viewed by interviewees as both potential precursors of more serious transgressions, and as opportunities for understanding the client's difficulties. Implications for practice: These span training, accrediting organisations, supervision and therapy practice.

Employing multiple theories and evoking new ideas: The use of clinical material

In this paper, I wish to illustrate how working with a patient who had a certain kind of narcissistic difficulty led me to develop particular clinical strategies to facilitate the development of a sturdier sense of self, greater affect tolerance and modulation, the diminution of harshness of her superego, and the ownership of projected parts of herself, and to decrease paranoid ideation. I call upon concepts from various theoretical schools of psychoanalysis to make sense of the dynamic intricacies of the patient’s psychological organization as they revealed themselves in the analytic process. These conceptualizations of the patient’s difficulties and of clinical interventions to address them result in a hybrid theory of both theory and technique. What transpired in the clinical work also led me to propose an additional way to understand this kind of patient’s difficulties with accepting interpretations or any view that differed from the patient’s subjectivity. I am proposing that ‘otherness’ itself, rather than only specific conflictual aspects of the self, is disowned. It is the analyst’s empathic stance toward all that is repudiated – the specific disowned aspects of the self and ‘otherness’ itself – along with empathy for the patient’s conscious state that will enable reinternalization and ultimately healing.

“If You Think in Systems' Terms …”: Reply to Sandra Hershberg's Commentary

This response expresses appreciation for the quality of Dr. Hershberg's discussion as it both affirmed my contribution and offered a supplementary perspective. Discussing my case in intersubjective systems terms, she helped me to better appreciate its interactive complexity and to rethink how the patient and I co-constructed this period of clinical momentum as well as the previous period of clinical stasis. Applying her perspective led me to identify the implicit rules that seemed to govern the mutual regulatory system that David and I evolved and to reconsider the multiple effects of my empathic stance. In turn, this reconsideration prompted me to raise questions about the best treatment approach to addictive problems, particularly how therapists may unwittingly reinforce or enable their patients' addictive tendencies. Esta respuesta expresa mi agradecimiento por la calidad de la discusión de la Dra. Hershberg, que da soporte a mi presentación y al mismo tiempo ofrece una perspectiva adicional. Al discutir mi caso en términos de los sistemas intersubjetivos me ayudó a valorar mejor su complejidad interactiva, y a repensar como el paciente y yo co-construimos el periodo de progreso clínico así como el periodo previo de estancamiento. La perspectiva de la Dra. Hershberg me condujo a identificar las reglas implícitas que parecían gobernar el sistema de regulación mutua que David y yo desarrollamos, y a reconsiderar los múltiples efectos de mi posición empática. Esta reconsideración me condujo a plantear preguntas acerca de cual es el mejor abordaje a los problemas adictivos, más en concreto cómo los terapeutas pueden reforzar o permitir involuntariamente las tendencias adictivas de sus pacientes. Cette réponse exprime l'appréciation pour la qualité de la discussion offerte par le Dr Hershberg en ce qu'elle a à la fois reconnu ma contribution et offert une perspective supplémentaire. En discutant de mon cas dans une vision de systèmes intersubjectifs, elle m'a aidé à mieux apprécier sa complexité interactive et à repenser comment le patient et moi avons co-construit cette période de momentum clinique tout autant que la période préalable de stagnation clinique. En appliquant sa perpective, j'ai pu identifier les règles implicites qui semblaient gouverner le système de régulation mutuelle que David et moi avons développé, et reconsidérer les effets multiples de ma posture empathique. Cette reconsideration à son tour m'a amené à remettre en question la meilleure approche aux problèmes de dépendance, particulièrement comment les thérapeutes peuvent, sans le vouloir, renforcer et/ou favoriser les tendances à la dépendance chez leurs patients. Questa replica esprime apprezzamento per la qualità della discussione della Dottoressa Hersberg che da un lato conferma il mio contributo e dall'altro propone una prospettiva complementare. Discutendo il mio caso in termini intersoggettivi, la collega mi ha aiutato a capire meglio la sua complessità interattiva e a ripensare come il paziente ed io abbiamo co-costruito questo momento cruciale, come pure il precedente periodo di stasi clinica. L'applicazione della sua prospettiva mi ha portato a identificare le regole implicite che sembravano governare il sistema di mutua regolazione che David ed io avevamo sviluppato e a riconsiderare gli effetti multipli della mia posizione empatica. A sua volta, questa riconsiderazione mi ha portato a sollevare interrogativi riguardo al miglior approccio terapeutico ai problemi di dipendenza, in particolare riguardo a come i terapeuti possano involontariamente rinforzare e/o permettere le tendenze compulsive dei pazienti. Diese Darstellung anerkennt die Qualität von Dr. Hershbergs Diskussion, da sie zum einen meinen Beitrag bestätigt und zum anderen eine ergänzende Perspektive anbietet. Da sie meinen Fall mit Begriffen des intersubjektiven Systems diskutierte, trug sie dazu bei, dass ich deren interaktive Komplexizität besser sehen kann - mit der Möglichkeit, noch einmal darüber nachzudenken, wie der Patient und ich diese Phase des klinischen Fortgangs aber auch die vorausgegangenen Phasen der klinischen Stagnation ko-konstruierten. Die Annahme ihrer Perspektive ermöglichte mir die impliziten Regeln zu identifizieren, die das wechselseitige regulatorische System steuerten, das David und ich entwickelt hatten, und diese Annahme verhalf dazu, die multiplen Auswirkungen meiner empathischen Haltung neu zu bedenken. Dieses Überdenken führte zu Fragenstellungen über den geeignetsten Behandlungszugang bei Suchtproblemen, aber auch wie der Therapeut unbeabsichtigt die Suchttendenzen des Patienten verstärkt und/oder herbeiführt.

The Rhetoric of Empathy: Ethical Foundations of Dialogical Communication

In contrast to the doubting game, which involves rational, skeptical, critical analysis, and argumentation to persuade or defeat others, the believing game might seem uncritically naive, as an effort to listen, affirm, and non-judgmentally understand others. However, the believing game cannot be dismissed so easily. Genuinely engaged, the believing game can function as a profoundly ethical strategy within a larger conceptual framework of what I have called for some years “the rhetoric of empathy.” The necessary condition for honestly playing the believing game is an empathic stance, and the goal is to engage in ethical dialogue. Peter Elbow’s continual insistence on the value of the believing game, and the fact that it does not go away‐given the need for empathic understanding and ethical practice in our private and public lives‐calls our attention to the pragmatic and operational usefulness of the dialectical interplay of this constellation of ideas. When we focus on Elbow’s dialectic of belief and doubt, however, we should clarify the role of games. Years ago, I was initially put off by Elbow’s labeling of his strategies for believing and doubting as games because this could imply that they are merely play, recreation, frivolous, as in “child’s play.” Yet game and gaming can be deadly serious, as in war game, or gaming as a strategy, the gaming industries, or the prey in the hunt. And games certainly are taken seriously in regard to sports and on-line gaming, as any player, spectator, fan, or detractor knows. However, Elbow’s games are not in the same league with those based on the cynical or ironic attitudes that call life or politics games. Underlying Elbow’s games there is the sincere, ethical assumption that we play the roles of belief and doubt honestly, openly, and thoroughly. This idea of role-playing in Elbow’s games requires, literally, recreation, in keeping with its meanings of recreating and refreshing mentally as well as physically. Thus, role-playing in the believing game is literally “to create anew” and “entertain” (a term implying play and civility; see Huizinga 1-27) the thoughts, opinions, feelings of others and suspending criticism or judgment for the purpose of better understanding, even mutual understanding among all parties. For role-playing ethically, empathy is primary. While this could be just a game, it’s also more than just a game. So let the games begin.