The Empathic Healer: An Endangered Species?

The Empathic Healer: An Endangered Species? offers a wide-ranging exploration of the concept of empathy along with a vigorous advocacy of empathy as a possible healing poultice to soothe both the fractures between biologic and psychotherapeutic approaches to mental disorders and the many fissures in the current confusion of health care systems.

This is a rich book, and a short review can only allude to its contents. The author, Michael J. Bennett, traces the history of empathy from its origin in aesthetics as Einfuhlung—or "a feeling into"—to its present broad usage in health care, especially in the area of mental disorders. He traces the philosophic roots of empathy, particularly as exemplified in the struggle to find a monistic solution to the dualistic mind-body split. He finds encouragement in the new brain research, especially the concept of genetic plasticity, which allows for alteration of the brain circuits through many influences, including relational and psychotherapeutic ones.

Bennett's main purpose is to find a pathway to the rescue of a health care system that has lost its heart and, in the case of mental disorders, has less and less room for psychotherapeutic treatment. He believes that the era of long-term dyadic psychotherapy is over and that managed care in some form or another is here to stay. Psychotherapists of the future, even though they will have an essential role if society is not going to descend into a totally biological and nonhumanistic treatment environment, must accept material changes in their methods and goals. The psychotherapist's role will be that of a treater, not a healer; one of a team of influences that will help patients toward healing. This role will be fulfilled by dealing with patients' illness—their suffering—rather than their objective disease. Therapy then becomes focal, rather than general—as in the psychoanalytic model—and is directed toward less ambitious ends. Empathic listening, both as a way of acquiring knowledge about the patient to assist with treatment and as treatment in itself, underlies all therapeutic transactions.

Bennett strongly maintains that regardless of inevitable changes in his or her role, the therapist—now a catalyst rather than an analyst—cannot be dispensed with if the patient is to be put on the path of healing. Probably influenced by his experience as a senior vice-president of a behavioral managed care company, Bennett forecasts a positive future for psychotherapy under the changed and limited condition he describes.

Certainly there will be readers who will see Bennett as Panglossian rather than realistically optimistic, especially the psychoanalytically minded, who will object to his rather dismissive view of their methods and goals. Bennett will not convince those who regard any version of managed care as anathema. In my opinion he uses empathy somewhat loosely, as a kind of philosopher's stone that will solve all our problems. However, he has presented us with a well-reasoned account of where we are and where we should be going in the field of psychotherapy.

The Empathic Healer is well organized and well written, with some apt phrases, such as the statement that a therapist should be "both ingenious and ingenuous." The text is amply documented, offers relevant case vignettes, and is spiced by classical illustrations and literary quotations. I recommend it to all mental health care professionals, especially to those so-called "mindless" psychopharmacologists and "brainless" psychotherapists.

Dr. Chodoff is clinical professor of psychiatry at George Washington University in Washington, D.C.