Empathy. Selfobject transferences. The Disruption/Repair Cycle. Guilty Man/Tragic Man. The guilty man lurking beneath tragic man. Insight or relationship.
I just found your lectures and I find them incredibly helpful. They're especially helpful because I'm studying psychotherapy and due to a brain injury I have difficulty reading for long periods of time so this has made the material that much more accessible to me. I also really like how you mention the father in the mother-baby dyad dynamic because it feels like a lot of the writing has left out the fact that sometimes there is another caregiver that a baby can engage in things like mirroring and idealization with in the event that these do not work or work inconsistently with the mother.
Recently started reading Paul Ricoeur's book "On Psychoanalysis". Stumbled upon self-psychology and Kohut and this video is the best introductory video on it. Thank you Professor Carveth! :)
Thanks for uploading this brilliant overview of Kohut's approach, it made me want to go back and reread all my Kohutian books. My only misgiving was the bit near the end regarding guilty man being behind tragic man. I see the development of the harsh superego-ego ideal that the patient cannot shamefully live up to as a result of a lack of transmuting internalization within the overall socialization process, and that this lack has its roots in infancy. Still it's a wonderful presentation for which I'm truly grateful.
Thank you, Stuart. I agree that the horse super ego results from early failures of containment and internalization have a good object. My point is that this horse super ego is as much a factor in tragic man as it is in guilty man, just more deeply buried behind manifest symptoms of fragmentation. I appreciate your thoughtful engagement with my work. Best wishes, Don
Professor Carveth, Thank you very much for what you do with RU-vid, I really appreciate it. I have been an avid listener for several months now. And I have been wanting to ask, do you think you could do a video on schizoid personality disorder? Your experiences in treating it, your perspective on the literature about it? (In particular, Jeffrey Seinfeld's work, if you know it?) This is a topic that is pretty neglected so it would be interesting to hear your take. Thank you!
Cognitive empathy is the ability to understand how a person feels and what they might be thinking. Cognitive empathy makes us better communicators, because it helps us relay information in a way that best reaches the other person. Emotional empathy (also known as affective empathy) is the ability to share the feelings of another person. Some have described it as "your pain in my heart." This type of empathy helps you build emotional connections with others. Compassionate empathy (also known as empathic concern) goes beyond simply understanding others and sharing their feelings: it actually moves us to take action, to help however we can.
I take issue with this understanding of empathy because it delineate affective and cognitive empathy as using two different "radars", so to speak. There's cognitive empathy, which uses logical deduction, and then affective empathy, which uses some other system of knowing. The way I see it (granted, as someone who struggles with affective empathy and is currently working on it), affective empathy is the second step of cognitive empathy. You need to use cognitive empathy first, otherwise you wouldn't know what feeling you're resonating with, right? It's likely that this becomes second nature past a certain point, but there has to be some kind of cognition going on, conscious or unconscious, which allows you to resonate with the correct emotion. I think a crucial point to remember is that what we call affective empathy isn't always perfectly attuned, and in fact, it can't be! If we were talking about some kind of purely non-cognitive signal, an instinctual, built-in system, then it wouldn't be the case that we see plenty of people who are highly sensitive and emotional in interpersonal situations, but who seem to be reacting emotionally to the *wrong thing*. I guess what I'm saying is that the affective experience of empathy has to be guided by the cognitive experience of empathy, and that what we call empathy always involves cognition - affect alone would be a completely internal process.
Even though Kohut is a rather systematic thinker, which makes his books (somewhat) easy to read, it is always rewarding to hear someone else talking about Kohut. Thanks!
Thank you for your excellent videos! Could you make a video for Fairbairn too? especially regarding his theory in the ''a revised psychopathology of the psychoses and psychoneuroses''?
"Reasons for self-attack need to be analyzed after self-fragmentation is dealt with." Seems to contradict your observation of the danger of too much curative or salvific (neat word) emphasis on the analyst. You said "Guilty man was replaced with Tragic man" is not entirely true but then observe that it's roots are socio-economic. Has this shift been proposed as a result of the systematic degradation of the social safety net since the late fourties? I'm curious if you still refer to Freud over Berne and Karpmann...
Thank you for this video, I found it extremely interesting. I do have several questions and remarks. I have found it extemely interesting how you differentiated between classic Freudian "Triebtherorie" and Kohuts emphasis on the relational aspect of the psyche. Those two perspectives on the psyche seem VERY different. Lets look at Otto Kernberg for a moment, who is a classical Freudian. Every time I hear Kernberg speaking, I cant help but think that he is cooperating with the sadistic super ego of self-disordered patients (because they tend to criticize themselves harshly, and then you have an analyst, who joins the super-ego and in fact reassures them, that you they as horrible as you think you are). While this indeed does create insights about maladaptive behaviour, the way he describes his techniques makes it sound quite really cruel. Now, to add to the irony, Otto Kernberg would call such a critic to his technique as "pseudomoralistic qualities of the grandiose self", which gives the patient even more the feeling of being misunderstood, unrecognized and invalidated. After all, if they were not unhappy about their behaviour, they would not go to therapy anyways? What is your opinion on this "feeling" that I have towards Kernberg? Now Kernberg and Kohut knowlingly had differences in their theories, particularly regarding treatments. To me, it seems like Kohut had a much more "tolerant "view on patients and cultures than Kernberg, who always seemed quite "limited" and black-and-white in his thinking to me. Whereas Kohut sees a patient as an amalgam of development, culture, and a general existential problems we all have to deal with, Kernberg much faster goes into the patient's own responsibility of their acting. In self-disordered patients, however, they often come from traumatic and horrible up-comings, which really brings up the question, how responsible they really can be, given their circumstances. Also, there are many instances in which Otto Kernberg refers to patients as "annoying", "arrogant", "uncomfortably demanding", he makes jokes of their irrational behaviours (sort of "speaking from above") and in many instances, it even seems that he ridicules them. It is true that an analyst is not supposed to cheer up a patient who is behaving badly, but on the other hand, the degree to which Kernberg ridicules those behaviours make it seem quite unsympathetic, and in some instances even sadistic to me (again, now he would accuse me of "projecting my own saditic tendeincies onto him". While this certainly might be true, it is also true, that individual "free will" is not as easy of a concept that he thinks it is) Is this a bias in my thinking, or can you relate? Even Kohut himself accused Kernberg of being a narcissist, which really makes it even harder to understand, who is "right". Personally, I feel very drawn to Kernbergs ideas, because they give me a feeling of control, superiority and structure, whereas Kohuts ideas do have a more chaotic and "vague" feeling. On the other hand, I feel that Kohut does a more complete job of recognizing all of the patients aspects, not just the intrapsychic drives, but also the relationships, culture, etc. Whereas Kernberg would be the first to say that someone is behaving "bad" (moralistically), Kohut would look at this from every possible angle and then most likely would decide that "bad" can be quite relative. To sum up, could you maybe comment on your personal view on the Kernberg and Kohut debate and how their views differ? What is your own clinical experience? I appreciate if you could comment, and thank you for your great content.
I think they worked with very different populations and came up with different theories as a result. I am ploy both in my work. Kern Berg is a poor writer and I think it’s easy to misinterpret him. But at least he recognizes and works with the sadistic super ego, well cohort has very little to say about the rule of what bion called the ego destructive Superego in Narcissism. Self psychology recognizes narcissistic rage but more generally plays down the role of aggression in psychopathology. On a personal level I find a Kernberg to be a very nice fellow. I never met Kohut.
@@doncarveth Would you say, self-psychology "plays down the aggression", or much rather, empathizes with the aggression? If one really digs into the story of the patients, one needs to ask oneself, how ELSE they could have reacted to that degree of trauma. Whereas Kernberg has this cruel moralistic stance, self-psychology at least tries to see the aggression as a physiological response against severe emotional and physical trauma. Narcissism is not a "convenient choice" for a patient, but an emergency reaction to severe trauma. I say that with no intention to downplay their behaviour, but just to provide a different persepctive. The way Kernberg ridicules those patients in some instances is unbearable. This critic has nothing to do with a pseudomoralistic reaction from my side, but just as a general critic against Kernberg, who seems more interested in developing a psychological theory, than in understanding his patients. --- But anaother question, Professor Carveth: in one instance, Kernberg refers to Kohuts treatment as "modifying and gratifiyng" the grandiosity, without resolving it. He calls Kohuts treatment a way of "supportive psychotherapy" with no possibility of "resolving" and "healing" the patient. Do you think "healing" from grandiosity is even possible? After all, pathological narcissim is an adaptation via severe trauma, and it is difficult for me to understand, how you can "heal" or "resolve" this. What does Kernberg refer to "healing" or "resolving the grandiosity?". Or is this his own grandiosity speaking?
@@thesavage9549 I do think that since grandiosity is a defense, I kind of reaction formation, against feelings of insignificant send inferiority. In the deep analysis it is sometimes possible to dismantle the defence and work through the feelings of insignificance and their causes, Usually in the oral phase and some problems with the early maternal containment. Working through on this level can resolve grandiosity. But this is in an intensive cycle analysis with frequent sessions in person on the couch. I don’t think it’s possible through psychotherapy. I don’t know why Kirsten Berg and his followers sat patients up three times a week. I think the coach, and if we are in quarantine, the telephone is much better.
Thank you for this informative lecture. I'm thinking about the "optimal responsiveness" people and asking myself if they are perhaps using the analysand as a kind of self-object -- a deficient object that thus affirms the analyst's own sense of fulness and omnipotence. Is this the danger you mention in the lecture?
@@jacoblui My new book, “guilt: a contemporary introduction“ (Routledge, 2023) is now available for pre-order and should be available in the next month or so. It touches on these issues to some degree.
Hello Don, first thank you a lot for your wonderful videos that are highly appreciated by me and my fellow psychiatry residents in Amsterdam Netherlands. I’m not sure if this question fits here but as it’s somehow related to Kohut’s self psychology I choose this vid. I was wondering what your thoughts/experiences, if any, are about your fellow Canadian Dawson’s Relationship Management method and theory in borderline patients? His thinking is still quite dominant in our emergency social psychiatric services but he elicits controversy in the more analytically focused departments. In my opinion he reduces the borderline pathology to identity diffusion and the role of therapists to stimulators of autonomy, but I have personally had quite good results with this approach. Anyway, in case you have time to reply, thanks in advance. Kind regards, Simon
Simon, I have not studied his approach but, like many other analysts, I have found that with what Ron Britain describes as thin, skinned, narcissist, or borderline objective interpretive methods don’t work, and in such cases, one must confine oneself to an empathic approach, resembling coats, self psychology, at least for a considerable time. I think one put Freud and Klein in the closet while building an atmosphere of safety and trust and forbearing from objective observations and interpretations. The trouble with this approach is that many who adopted never come out of the closet, and proceeded to actually analyze the patient, once this becomes possible, which may take a long time.
This is important to me because I'm an empathic genius but in a shell of narcissism. But realistic narcissism in that I really am objectively "large" in ways - my power relative to my peers. I am a benevolent protective Machiavellian. I'd love your insight, signed, a collapsed narc.
Do you think that self psychology can work with psychotic patients? Or is the best way in working with psychotic dealing with their ego deficits and giving them structure with no interpretation at all?
I think both could work when provided by a warm and conscientious and empathic analyst. But I think a wise and empathic analyst informed by the work of Kleinian and Bion would be best.
@@mirejpaunovic722 you are looking for general rules. Sorry, there aren’t any. Sometimes interpretation can be harmful; sometimes it can be very helpful.
Do you have any thoughts on the psychology of racism in the USA, and outcomes of the George Floyd murder? Or are you aware of any references that might apply? Thanks for all that you do. Ryan
Don Carveth - Thank you for the reference, and considering the topic. I have been working my way through all of your videos over the course of the pandemic. It’s been a great way to continue growing as a clinician, despite all of the loss that seems to continue manifesting here in Chicago. With gratitude, Ryan
That’s a very big topic and I feel as a Canadian I am looking rather from the outside, but I’m thinking a lot about it and I may address the issues. Thanks.
He's written at least two very excellent books that I know of: The Still Small Voice (a wonderful book on the conscience) and Psychoanalytic Dialogues.
My understanding is that, the psychopath's behaivor is not empathy.i think empathy is not noly that you image yourself the perspective of others or the shoes of others, but also in the imagination you try to wear the shoes of others and you get some affections or feelings about it. But i think the psychopath only imagines himself into the shoes of others but he doesn't experience all those affections and feeling. the psychopath just sees it but not experiences it.
I guess that is what you're saying in the end.... But I would imagine both of these should always play a factor to an extent throughout psychotherapy... which is why I prefer it to classical "strict" psychoanalysis. All of the realisations and learning helped me a bit but not fully in my own process. Winnicott is my favourite, bridging the gap between the two.
It can. It is. But I find the people who call themselves self psychologists, or relational analysts over, emphasize the relationship and play down the learning, especially learning about the unconscious.
This is interesting. I thought psychopaths don't have empathy. I thought empathy means" I care. So, this actually makes more sense, a psychopath has empathy but doesn't care;-)
