Chapter 9 Insight, Empathy, and Projective Identification

The title of this chapter places together empathy, one of the central topics of interest in self psychology, and projective identification, a key concept in Kleinian psychoanalysis. To what degree do they coincide or differ? What is their respective place in analytic therapy and the acquisition of analytic understanding? Before I attempt any survey of the literature, I will begin with a clinical vignette. It comes from my own experience, very early in my psychoanalytic training, so I trust you will forgive its naiveté. It was one of my first experiences of a powerful countertransference response that I was able to understand partially and use to the patient's benefit, and it remains important to me for that reason. Of course, there have been many occasions before and since when there have been countertransference responses I have not been able to understand or use, or even become aware of, and I am obviously in no position to talk about these.

I will call the patient Nicole. She was a young woman in her late teens referred to the government psychiatric hospital in which I worked, from a local hospital psychiatric unit in her home town some 100 km away. She had been in this unit for a month after taking an overdose. She had moved out of her highly conflicted family home to live with a girlfriend. When this girlfriend became preoccupied with a relationship with a young man, Nicole began telling people she had been diagnosed with cancer. This produced a flood of anxious concern from the girlfriend and others, but when Nicole realized she would be inevitably discovered as a fraud, she took the overdose. Just when the