Barriers to Empathy in the Therapeutic Dyad
At certain times of crisis and transition in a person’s life, he or she feels the need to talk with someone they can trust, and with whom they can share his or her most disturbing psychological problems. During these times, a person may find life unbearable and is likely to seek help from a well-trained and experienced psychotherapist. The process of psychotherapy is usually difficult and upsetting, and the patient often becomes heavily dependent on the psychotherapist while they are trying to make changes in their lives. Empathy is crucial to effective psychotherapy (Agosta, 2010). The ability of the psychotherapist to exercise empathy in the context of the therapeutic dyad is essential to the improved emotional well-being of the patient. However, the capacity to demonstrate empathy is exceptionally challenging when the psychotherapist is African-American or non-White, and the patient is White and expresses White supremacy or racial bias.
In his book, A Rumor of Empathy: Resistance, Narrative and Recovery in Psychoanalysis and Psychotherapy, Lou Agosta purports that although empathy is crucial to therapeutic insight and adaptation, resistance to empathy exists. Agosta provides clear definitions and examples of the resistances to empathy that stem from the psychotherapist, the patient, and the larger social environment, and endeavors to demonstrate how they can be overcome in the therapeutic dyad.
Agosta utilizes ideas from Freud, Kohut and others, and examines the multidimensionality of empathy. His critical analysis of empathy and its resistances informs and invites the reader to consider new ways of understanding empathy in psychotherapy in order to mitigate emotional pain. The ability to demonstrate empathy is fundamental to psychotherapy (Agosta, 2010). Thus, understanding and overcoming the resistances to empathy in the therapeutic dyad, Agosta argues, will help psychotherapists vastly improve their ability to effectively treat patients.
How does a therapist exercise empathy in the context of racial bias? This is an especially challenging question when one considers it in the therapeutic dyad where the patient is an angry White person expressing hatred toward African Americans and the therapist is African American. Historically, the relationship between White people and African Americans has been laden with hate, discrimination, violence, mistreatment, privilege, fear, and power (Allen, 2012; Feagin, 2013, Painter, 2010). Racism/White supremacy has informed the relationship between these two groups and has had a significant impact on each. The impact of racism/White supremacy on Whites has allowed them to live in a world where they appear to have unmitigated power and privilege. The impact of racism/White supremacy on African Americans has rendered their existence quite difficult. This not changed today in many respects.
The notion of White privilege is such an intricate part of American society and White identity development and is thereby "inextricably interwoven with the notion White racism" or racial bias (Christian, 2002, p. 180). Evidence of racial bias exists in all walks of life and certainly in the context of the therapeutic dyad (Carter, 1995; Sue, Capodilupo, Torino, Bucceri, Holder, Nadal, & Esquilin, 2007). Transference expressions of racism, White racial bias, or White supremacy as well as countertransference reactions informed by expressions of racism, White supremacy or White racial bias can cause difficulty in building a therapeutic relationship and thus inhibit the African-American psychotherapist from exercising empathy (Carter, 1995; Griffith, 1977; Sue, et al., 2007). Further complicating the treatment is the impact of White fragility. In order to provide effective treatment in the context of White racial bias, the African American psychotherapist must be able to understand how to demonstrate empathy in the context of transference and countertransference reactions as well as to address/respond to expressions of White fragility.
Transference is a fundamental aspect of psychotherapy. In the therapeutic dyad, transference occurs when the patient illogically ascribes emotions, thoughts, and desires unconsciously onto the therapist. "Transference consists entirely of irrational attitudes toward another person" (Thompson, 2014, p. 273). Thompson (2014) comments on transference and the human psyche:
"As long as human beings have had relationships with each other, there have probably been irrational elements in those relationships. These irrational elements have been especially marked in the attitudes toward those whom a person is dependent. Therefore, one sees it in all situations where one of the two people is in a position of authority in relation to the other" (p. 273).
Transference is essential to all human relationships and informs how people understand each other. It is something humans do all of the time whether they are aware of it or not. In the racialized therapeutic dyad a patient assigns particular feelings or emotions to the therapist. For example transference "reactions of White patients to Black therapists have centered around feelings of superiority, hostility, paranoid fears of the Black therapist's aggressive powers, or contempt and devaluation of the (ethnic) therapist's linguistic, intellectual competence to help the patient" (Yi, 1998, p. 246). Such expressions of negative transference can cause countertransference reactions in the therapist.
Countertransference is an important, challenging, and ever-present aspect of the therapeutic dyad. Countertransference is "the therapist's conflict-based emotional reactions to the client or all the emotional reactions and related behaviors by the therapist" (Dalenberg, 2000, p. 4). The therapist is subject to his or her own personal feelings, thoughts, and beliefs in the therapeutic dyad and, because of his or her position in the relationship, may have a lasting impact on the patient. This lasting impact can be favorable or unfavorable depending on how the therapist uses the material. Hanna (1993) writes about the importance of this fact:
"It is humbling, and even painful for therapists to recognize limitations in their capacity to help when faced with clients who are suffering intensely. This is especially so when therapists become aware that, because of countertransference, they might have contributed to such suffering" (p. 36).
Countertransference reactions in the racialized therapeutic dyad can be informed by White fragility. DiAngelo (2011) defines the concept of White fragility in her article White Fragility:
White people in North America live in a social environment that
protects and insulates them from race-based stress. This insulated
environment of racial protection builds white expectations for racial comfort while at the same time lowering the ability to tolerate racial
stress, leading to what I refer to as White Fragility. White Fragility is a state in which even a minimum amount of racial stress becomes intolerable, triggering a range of defensive moves. These moves
include the outward display of emotions such as anger, fear, and guilt,
and behaviors such as argumentation, silence, and leaving the
stress-inducing situation. These behaviors, in turn, function to
reinstate white racial equilibrium. (p. 54)
The ability to effectively administer empathy in the context of racial bias in the therapeutic dyad is challenging. Resistances to empathy abound and must be examined, understood, and eradicated. When White patients are confronted about their expressions of White racial bias in the therapeutic dyad, White fragility may emerge. As a result, the African American therapist may not be able to effectively manage countertransference reactions and engage in thinking and behavior that may bring harm to the patient. Examples include not listening or invalidating the patient’s thoughts and feelings. Thus, it is important for the African American psychotherapist to understand transference, White fragility, and to supervise countertransference reactions accordingly.
References
Agosta, L. (2015). A Rumor of Empathy: Resistance, Narrative, and
Recovery In Psychoanalysis and Psychotherapy. Routedge. New York.
Explores how to overcome the resistances to empathy in the patient, therapist, and in the society as a whole.
-----(2010). Empathy in the Context of Philosophy. Palgrave Macmillan. New York.
Explores the roots of empathy and discusses its importance in how human beings relate to one another in a number of areas including self psychology and literature.
Allen, T. W. (2012). The Invention of the White Race: Volume I: Racial
Oppression and Social Control. Verso. New York.
-----(2012). The Invention of the White Race: Volume II: The Origin of
Racial Oppression in Anglo-America.
Tells the story of how the "white race" was invented by the ruling classes as a form of social control.
Carter, R. (1995). The Influence of Race and Racial identity in
Psychotherapy: Toward a Racially Inclusive Model. John Wiley & Sons, Inc.
Discusses how the influence race is central to the experience of living in the US and a critical component of psychotherapy.
Christian, M. (2002). An African-Centered Perspective on White Supremacy.
Journal of Black Studies. 33, (2), 179-198.
This article critically analyzes the ideology and function of White supremacy and racism in the US and Europe. The author puts forth the notion that White supremacy can be eradicated by African people through the use of the agency analysis.
Dalenberg, C. (2000). Countertransference and the Treatment of Trauma.
American Psychological Association. Washington, D. C.
This book demonstrates how mental health practitioners can successfully control their countertransference reactions and utilize them to help patients suffering from trauma.
DiAngelo, R. (2011). White Fragility. International Journal of Critical
Pedagogy, 3(3), 54-70.
This article explains the dynamics of White Fragility.
Feagin, J. R. (2013). The White Racial Frame. Centuries of Racial Framing
and Counter-Framing. Second Edition. Routledge. New York.
Explores how the white racial frame was developed and how it evolved over time. The text also discusses the resistance behavior of non-Whites.
Griffith, M. S. (1997). The influences of Race on the Psychotherapeutic
Relationship. Psychiatry, 40(1), 27-40.
This article discusses how the racial differences between the therapist and client influences treatment.
Leary, K. (1995). "Interpreting in the dark": Race and Ethnicity in Psychoanalytic Psychotherapy. Psychoanalytic Psychology, 12(1), 127-140.
This article discusses the effect of race with three patients in treatment with an African-American psychotherapist.
Mcauley, M.J. (2003). Transference, Countertransference and Mentoring: The Ghost in the Process. British Journal of Guidance & Counseling, 31(1), 11-23.
This paper explores the ideas of transference and countertransference in the context of the counselor and counseled relationship. Transference and countertransference reactions are viewed from multiple lenses including power, authority, and control.
Painter, Nell Irvin. (2010). The History of White People. W. W. Norton & Company, Inc. New York.
Discusses over two thousand years of Western Civilization and how the invention of White race was created for scientific, economic, and political gains.
Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A., Nadal, K. L., & Esquilin, M. (2007). Racial Microaggressions in Everyday Life: implications for Clinical Practice. American Psychologist, 62(4), 271-286.
This article explores microaggressions and provides suggestions for eliminating them from daily life.
Thompson, C. (2014). Transference as a Therapeutic Instrument. Psychiatry, 77(1), 273-278.
This article discusses the phenomenon of transference and its presence in all interpersonal relationships.
Yi, K. Y. (1998). Transference and Race: An Intersubjective Conceptualization. Psychoanalytic Psychology, 15 (2), 245-261.
This article discusses race based transference from the lens of contemporary intersubjective theories.