The Interplay Between Empathy and Authenticity in Moments of Clinical Disjunction

Responding to patients in the midst of intense disjunctions and impending shame states is challenging and worthy of struggle. When we are confronted with dramatically discrepant perspectives about relatedness and emotional meaning, our desire to understand our patients can seem at odds with our desire to express our own subjectivity. We strive to be empathic and authentic. The concepts of empathy and authenticity have been well-covered in the psychoanalytic literature, to the extent that theoretically they are no longer considered dichotomous. And yet, in the consulting room, it often feels that there remains a tension between these two responses. What has not been addressed sufficiently in the literature, and what remains an essential and ubiquitous clinical struggle, is how to understand these concepts in the context of clinical disjunction. This article examines what emerges when seemingly facile theory is challenged by the exigencies and immediacy of clinical practice. This is addressed by providing an in-depth exploration of a disjunction in which the therapist is caught by surprise, there is little time for reflection, and both an empathic and authentic response is indicated and hoped for.