“When Empathy Opens” proposes an integration of self-psychological and -relational models of therapeutic action. The author argues that consistently approaching patients through the practice of Kohut’s empathy evokes “a leading edge” transference that opens up the treatment relationship by orienting it toward facilitating the patient’s pursuit of what is adaptive and developmental for them. This orientation then can guide the overall treatment process. The author also maintains that this practice of Kohutian empathy contributes to the emergence of impasses outlined by Stephen Mitchell, so that they can be constructively addressed in a transformative way that opens the treatment relationship further, beyond a self-object tie, so it becomes more fluid and multi-faceted. Winnicott’s “leading edge” ideas about destruction and survival and breakdown supplement this self-relational integrative model.