Empathy and attunement in the initial treatment encounters with the narcissistically impaired client: A self psychology/adult developmental perspective

William Dale Brilhart (1989)

This dissertation presents a two-step model of empathy from a Self Psychology/Adult Developmental perspective. Empathy is defined, from the psychotherapist's point of view, as a process of understanding and gaining attunement to the developmental needs of the client's self across the life cycle, from infancy through adulthood. In addition, the author attempts to describe: (1) how empathic understanding is formed by the use of four tools of empathy: conceptual, self-experience, imitative imagination and resonant referents; (2) how to identify the presence of narcissistic impairment during initial encounters; (3) how to use these tools of empathy with the narcissistically impaired adult in nine modes of attunement, from infancy/early childhood/latency/adolescence/and through five periods of the adult life cycle; (4) how to use these tools in pursuing two goals during initial encounters with narcissistically impaired clients; (a) to facilitate an atmosphere of safety for the narcissistically impaired infant/child (from a Self Psychology point of view), and (b) to facilitate an atmosphere of respect for the evolving adult (from an Adult Developmental point of view) within the adult client; and finally, (5) how this clinical stance was used by the author to form empathetic understanding and attunement in the first three encounters with a narcissistically impaired adult. The dissertation concludes with a discussion of further questions for future exploration.