In the 1960’s, psychologists began to notice that there were a group of patients that were not well described by current Freudian, Cognitive Behavioral, or Ego Psychology models. These patients seemed empty and devoid of internal objects, and came to therapy looking for some meaning in their lives. On the surface, they appeared to be doing well; dig a little deeper and there was a nagging sense of needing to be validated and accepted. They had little sense of who they were and what they felt, thought, or valued. They did not seem mental “sick” as it would be traditionally understood, but they experienced very little pleasure and suffered from true emotional emptiness.
Began and championed by psychoanalyst Heinz Kohut, Self-Psychology posits that most psychopathology originates from failures in empathy from a person’s primary caregiver. For some narcissistically oriented people, because of this mis-attunement in early childhood, they do not have the objects of their parents internalized, leading to emptiness and depression. According to Kohut, empathy and mirroring heal the narcissistically oriented patient and over time this creates self-objects that were once not there. Empathic attunement of the therapist to the patient is an absolutely necessary component of successful therapy.