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The real work of therapy requires the deliberate effort Kohut calls “empathy.” We “feel our way in” to the life world of the not-yet-self and “mirror” back what we find -- emptiness, grandiosity, rage, longing, etc. -- and frame these elements as intimations of his self-to-be.
Empathy is an active form of love; for love, wherever it may be found, sees and affirms the unique reality of the other, is drawn to it and values it. No gushing pretension, no perfunctory praise, no hollow compliment, no fobbing off, empathy takes the other seriously, sees the implicit but nevertheless lived reality of his not-yet-self and expresses it accurately…
This work of seeing our patient and then finding a way to articulate what we perceive makes considerable claims upon us as persons. To hold a “mirror” up to him so that he can begin to see himself means that we ourselves have to be that mirror. Our affects are reactions to him, as his are responses to us. In the moment we feel all-powerful and selected by fate to cure him with our benevolence, empathy requires us to attain some distance from our inflation and perceive that he is “idealizing” us the same way we are. His impotence is overwhelming both of us. When we fail to grasp the nature of the forces that would sweep us away, we are no less a fragment of driftwood than he is. We could stay forever in this emotional whirlpool, learning nothing of our patient and keeping him in ignorance of himself.
Progress, the “structuring of a self,” occurs only when we can name these forces: label them, first, so that we can find ourselves, and then discern our patient as our partner. He has been the victim of these forces all his life…No one has taken him seriously enough and loved him sufficiently to stay with him when things are going badly. All his life people have dismissed his feelings of rejection and loss with platitudes and hollow consolations…
In How Does Analysis Cure? Kohut makes it unmistakably clear that in his view what “structures a self” is “optimal frustration.” Each time the patient’s need for gratification is frustrated empathically (“optimally”) a large stone has been laid in the foundation of his emerging self. In order to have a self that “coheres” in the fact of desolation, he needs a “mirror” to reflect that hardest-to-hold center, the one that is breaking up in consequence of a fractured connection. For us to be that mirror, we have to stay in this most difficult temenos and hold our own guilt and sense of inadequacy humbly together with his terror, rage, and resentment.
-- John Ryan Haule, The Love Cure
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