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In Her Clinically Rich, Comprehensive Book Making a Difference in Patients' Lives, Sandra Buechler begins her chapter on empathy by describing her interaction with two patients, Arlene and Anna. These descriptions illustrate Buechler's particular ideas about therapeutic action, or how she “makes a difference” with patients. Returning to treatment one year after termination, Arlene is sad and weary, tearfully reflecting on the reasons for her unhappiness, trying to pin down its causes objectively. First Buechler resonates with her patient's misery. Quickly, though, she finds herself recovering from this identification and begins to reflect on what is happening. She wonders about Arlene's missing joy and resolves to inquire about it. Anna, vulnerable to narcissistic injury because of a childhood of extreme isolation and depression, comes into session in an agitated state—nerves jangled, words tumbling out at a fast clip in a strained, high-pitched voice. Feeling swept up in this agitation but resisting being swept away by it, Buechler feels her way out of her reaction by being curious within herself about her own response and the patient's agitation. At the same time, she is recovering her internal emotional balance. She remains calm with the patient, sits back in her chair, and speaks slowly in a measured tone.
In Buechler's view, therapeutic change grows out of such moments of affective exchange between patient and analyst. The patient expresses and enacts her problematic affect state with the analyst, and Buechler is affected, resonating with the patient's state and possibly feeling what it is like to be the object of this state as well. Momentarily, Buechler gives herself over to her reaction, allowing her emotional equilibrium to be disrupted. Then, however, moving out of her immersion in her reaction, she enlists her own coping skills and becomes curious about what has just occurred and what the action reveals about the patient, the analyst, and their relationshi