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Though he saw them twice daily, though he knew and amply discussed every detail of their expenditures, yet for weeks together Babbitt was no more conscious of his children than of his buttons on his coatsleeves.
—Sinclair Lewis, Babbitt
OFTEN THE PATIENT'S RESPONSE to the analyst's intervention can be quite surprising and at odds with the response expected from clinical theory. During one of these "surprises" I began to reevaluate1 my interest in empathy, the underlying clinical assumptions of the empathic approach, and the data obtained by the analyst's personal empathy. The following clinical vignette highlights the important discrepancy between clinical expectation and the patient's response.
A bright, professional woman, age 40, was raised, as she described, by rather nasty, negligent, and sometimes violent parents who relied on her to raise her four younger siblings. This patient complained that no one listened to her, cared about her or showed any concern as to her welfare. In spite of her history, the patient made extensive professional accomplishments. Although emotionally deadened, she was a very "efficient" mother, raising several children, including one with a major handicap, while dealing with two disastrous marriages to abusive men. In her usual detached narrative style, she revealed to me, during a session in the first year of therapy, a memory which she had always kept secret out of a sense of shame and vulnerability: