Mirror Neurons, Embodied Simulation, and the Neural Basis of Social Identification

Relating movements in aesthetic spaces: Immersing, distancing, and remembering

According to Aby Warburg, the aesthetic experience is informed by a pendulum-like movement of the observer's mind that allows him to immerse as well as to take distance from the artwork's composing elements. To account for Warburg's definition, we are proposing embodied simulation and associative processing as constitutive mechanisms of this pendulum-like movement within the aesthetic experience that enable the observer to relate to the displayed artistic material within aesthetic spaces. Furthermore, we suggest that associative processing elicits constructive memory processes that permit the development of a knowledge within which the objects of art become part of memory networks, potentially informing future ways of thinking, feeling, and behaving in real-world situations, as an individual or collectively.

From "Einfühlung" to empathy: exploring the relationship between aesthetic and interpersonal experience

Is there a relationship between aesthetic and interpersonal experience? This question is motivated not only by the fact that historically experiences of both kinds have often been accounted for in terms of "empathy", the English translation of the German term "Einfühlung", but also by the fact that some contemporary theories refer to mechanisms underlying both aesthetic and interpersonal experience. In this Editorial introducing the special section titled "From 'Einfühlung' to empathy: exploring the relationship between aesthetic and interpersonal experience", we briefly sketch these two motivations and the relationship between the different mechanisms that have been associated with both aesthetic and interpersonal experience.

REVISITING THE SAFE PLACE:Method and Regulatory Aspects in Psychotherapy when Easing Allostatic Overload in Traumatized Patients

Safe-place inductions are considered important altered states of consciousness (ASC) to be (re)installed during trauma-informed psychotherapy. Coregulation aimed at changing implicit relational knowing and increasing integration and coherence through relational work and hypnotic techniques is crucial, as clients' abilities to self-soothe and regulate have become seriously impaired. Thus, resource-oriented metaphors as inner strength imagery is advocated. Also, methods such as creative-arts therapy and neurofeedback will induce ASCs, as most methods used with complex traumatized clients, due to their high hypnotizability. When positive or soothing imagery or relationally held suggestions for changed attentional focus are added to both psychodynamic psychotherapy and CBT, a hetero-hypnosis will be induced-a prerequisite for phase-specific trauma therapy aimed at changing inner schemas and scripts.

Effects of repetitive transcranial magnetic stimulation (rTMS) on attribution of movement to ambiguous stimuli and EEG mu suppression

Recent research suggests that attributing human movement to ambiguous and static Rorschach stimuli (M responses) is associated with EEG mu suppression, and that disrupting the left inferior gyrus (LIFG; a putative area implicated in mirroring activity) decreases the tendency to see human movement when exposed to the Rorschach ambiguous stimuli. The current study aimed to test whether disrupting the LIFG via repetitive transcranial stimulation (rTMS) would decrease both the number of human movement attributions and EEG mu suppression. Each participant was exposed to the Rorschach stimuli twice, i.e., during a baseline condition (without rTMS but with EEG recording) and soon after rTMS (TMS condition with EEG recording). Experimental group (N = 15) was stimulated over the LIFG, while the control group (N = 13) was stimulated over the Vertex. As expected, disrupting the LIFG but not Vertex, decreased the number of M attributions provided by the participants exposed to the Rorschach stimuli, with a significant interaction effect. Unexpectedly, however, rTMS did not significantly influence EEG mu suppression.

Cinemotion, a Program of Cognitive Remediation to Improve the Recognition and Expression of Facial Emotions in Schizophrenia: A Pilot Study

Objective: Patients with schizophrenia exhibit impaired social cognition, especially in the recognition and expression of facial emotions, aspects of communication profoundly interlinked in an embodied approach of cognition. Nevertheless, many training programs have been developed that focus on either of these deficits but not both. We therefore designed a training program, Cinemotion, intended to remedy the 2 deficits and investigated its feasibility and effects in patients with schizophrenia. Design: Thirty-one patients undergoing treatment for schizophrenia and presenting deficit in emotion recognition were randomized to a group of 16 to undergo Cinemotion training, delivered in weekly group sessions, and to a control treatment group of 15. At the conclusion of training or after 10 weeks in controls, we reassessed and compared original and final results to determine improvement. Methods: Facial emotions recognition (TREF), empathy (Questionnaire of Cognitive and Affective Empathy, QCAE), and attributional style (Ambiguous Intentions Hostility Questionnaire, AIHQ) were assessed before (T0) and after (T1) the program. External evaluators also assessed ability and accuracy of Cinemotion participants to self-generate facial emotion expression in response to verbal instruction. Results: Between T0 and T1, Cinemotion participants significantly improved total TREF, sadness, disgust, and anger scores, compared to findings in control treatment group. They also improved their ability and accuracy to self-generate facial expressions, especially sadness and fear, with no significant improvement in other components of social recognition. Conclusions: Our findings show the apparent efficacy of training using the Cinemotion program to improve the recognition and expression of facial emotions in schizophrenia.

Action simulation and mirroring in children with autism spectrum disorders

Mental imitation, perhaps a precursor to motor imitation, involves visual perspective-taking and motor imagery. Research on mental imitation in autism spectrum disorders (ASD) has been rather limited compared to that on motor imitation. The main objective of this fMRI study is to determine the differences in brain responses underlying mirroring and mentalizing networks during mental imitation in children and adolescents with ASD. Thirteen high-functioning children and adolescents with ASD and 15 age-and- IQ-matched typically developing (TD) control participants took part in this fMRI study. In the MRI scanner, participants were shown cartoon pictures of people performing everyday actions (Transitive actions: e.g., ironing clothes but with the hand missing; and Intransitive actions: e.g., clapping hands with the palms missing) and were asked to identify which hand or palm orientation would best fit the gap. The main findings are: 1) both groups performed equally while processing transitive and intransitive actions; 2) both tasks yielded activation in the bilateral inferior frontal gyrus (IFG) and inferior parietal lobule (IPL) in ASD and TD groups; 3) Increased activation was seen in ASD children, relative to TD, in left ventral premotor and right middle temporal gyrus during intransitive actions; and 4) ASD symptom severity positively correlated with activation in left parietal, right middle temporal, and right premotor regions across all subjects. Overall, our findings suggest that regions mediating mirroring may be recruiting more brain resources in ASD and may have implications for understanding social movement through modeling.

‘You can hear wholly only if you remove the waxes in your ears’: The Hararghe Oromo’s theory for establishing the intersubjective foundation of cognition

The article sets out to examine the way the Hararghe Oromo in Ethiopia use their mirriiysa culture to express and cultivate criticality, mindfulness, interpersonal sensitivity and emotional intelligence. The paper discusses the nature of the performance culture and analyses the social psychological meanings of a set of mirriiysa texts collected from a group of folk performers who participated also in the interpretation and analysis of the cultural, social and psychological meanings of the texts. For theory, the study drew on interpretivism. During data analysis, the horizontal and vertical planes of analysis interacted and reinforced each other. The act of removing earwax symbolizes a cultural dimension of intersubjectivity and interaffectivity. The analyses indicated that mirriiysa is a socio-cultural performance wherein listening, understanding and responding occur in socially meaningful and interactive contexts. To understand the communicative intent of a mirriiysa text, one should take broader perspectives and pay due attention to the non-linguistic elements that offer the performance holistic import. The paper highlights the implication of these and other findings for our understanding of the meanings of mirriiysa and other genre performances.

Mimetic Theory and the evolutionary paradox of schizophrenia: The archetypal scapegoat hypothesis

Schizophrenia poses an evolutionary paradox, being genetically mediated yet associated with reduced fecundity. Numerous hypotheses have attempted to address this, but few describe how the schizophrenic phenotype itself might constitute an evolutionary adaptation. This paper draws on René Girard's theory on human origins, which claims that humans evolved a tendency to mimic both the desires and the behaviours of each other (mimetic theory). This would have promoted social cohesion and co-operation, but at the cost of intra-group rivalry and conflict. The mimetic dynamic would have escalated such conflicts into reciprocal internecine violence, threatening the survival of the entire group. Girard theorised that the "scapegoat mechanism" emerged, by which means such violence was curtailed by the unanimity of "all against one", thus allowing the mimetic impulse to safely evolve further, making language and complex social behaviours possible. Whereas scapegoating may have emerged in the entire population, and any member of a community could be scapegoated if necessary, this paper proposes that the scapegoat mechanism would have worked better in groups containing members who exhibited traits, recognised by all others, which singled them out as victims. Schizophrenia may be a functional adaptation, similar in evolutionary terms to altruism, in that it may have increased inclusive fitness, by providing scapegoat victims, the choice of whom was likely to be agreed upon unanimously, even during internecine conflict, thus restoring order and protecting the group from self-destruction. This evolutionary hypothesis, uses Girardian anthropology to combine the concept of the schizophrenic as religious shaman with that of the schizophrenic as scapegoat. It may help to reconcile divergent philosophical concepts of mental illness, and also help us to better understand, and thus counter, social exclusion and stigmatisation.

Sustained Empathic Focus and the Creation of a "We Space" Revisited in the Light of Recent Findings in Neurobiology

This article is an attempt to expand our understanding of the curative process with an emphasis on the group therapy setting. It presents a self psychological approach that underlines the importance of a "sustained empathic focus" on each patient's subjective experience and the creation of what we have referred to as shared "vulnerable moments" and a "we-space." The relationship of our approach to recent findings in the field of neurobiology is then considered.

Bodily Reactions to Emotional Words Referring to Own versus Other People's Emotions

According to embodiment theories, language and emotion affect each other. In line with this, several previous studies investigated changes in bodily responses including facial expressions, heart rate or skin conductance during affective evaluation of emotional words and sentences. This study investigates the embodiment of emotional word processing from a social perspective by experimentally manipulating the emotional valence of a word and its personal reference. Stimuli consisted of pronoun-noun pairs, i.e., positive, negative, and neutral nouns paired with possessive pronouns of the first or the third person (“my,” “his”) or the non-referential negation term (“no”) as controls. Participants had to quickly evaluate the word pairs by key presses as either positive, negative, or neutral, depending on the subjective feelings they elicit. Hereafter, they elaborated the intensity of the feeling on a non-verbal scale from 1 (very unpleasant) to 9 (very pleasant). Facial expressions (M. Zygomaticus, M. Corrugator), heart rate, and, for exploratory purposes, skin conductance were recorded continuously during the spontaneous and elaborate evaluation tasks. Positive pronoun-noun phrases were responded to the quickest and judged more often as positive when they were self-related, i.e., related to the reader’s self (e.g., “my happiness,” “my joy”) than when related to the self of a virtual other (e.g., “his happiness,” “his joy”), suggesting a self-positivity bias in the emotional evaluation of word stimuli. Physiologically, evaluation of emotional, unlike neutral pronoun-noun pairs initially elicited an increase in mean heart rate irrespective of stimulus reference. Changes in facial muscle activity, M. Zygomaticus in particular, were most pronounced during spontaneous evaluation of positive other-related pronoun-noun phrases in line with theoretical assumptions that facial expressions are socially embedded even in situation where no real communication partner is present. Taken together, the present results confirm and extend the embodiment hypothesis of language by showing that bodily signals can be differently pronounced during emotional evaluation of self- and other-related emotional words.

Mentalization, embodiment, and narrative: Critical comments on the social ontology of mentalization theory

Recently, mentalization theory has risen to fame as a theoretical framework emphasising social cognition as a key issue in its approach to psychopathology and psychotherapy. In this article, I review and criticise the social-ontological assumptions made by mentalization theory, arguing that, in spite of a strong interactive focus, it remains fundamentally rooted in a Cartesian ontology, overlooking embodied, expressive, enactive, and sociocultural dimensions of social cognition. Furthermore, since mentalization theory was originally developed as a framework for understanding Borderline Personality Disorder (BPD), I offer a reinterpretation of the issue of social cognition reported in BPD from a more embodied and interactional perspective. Contrary to the received view, I suggest that issues of social cognition in BPD should not necessarily be seen as a partial or total inability to mentalize, but rather as a hypersensitivity to expressivity resulting in what I suggest we understand as acts of disnarration.

Perception of Peripersonal and Interpersonal Space in Patients with Restrictive-type Anorexia

This study examines whether the perception of peripersonal action-space and interpersonal social-space is modified in patients with restrictive-type anorexia in two experimental conditions using videos. First, participants stopped the video of an approaching stimulus when they felt the distance to be comfortable for interacting with it (first-person perspective). Second, participants stopped the video when an observed individual approaching a stimulus, or being approached by it, was at a comfortable distance (third-person perspective). In the first-person perspective, the results showed an estimation of peripersonal space that did not differ from controls when an object was approaching and an increase in interpersonal space compared with controls when a male or female individual was approaching. In the third-person perspective, both individual-object and individual-individual distances were larger in anorexic patients. These results indicate a specific deficit in adjusting interpersonal distances in both the first-person and third-person perspectives. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Is there any Influence of Variations in Context on Object-Affordance Effects in Schizophrenia? Perception of Property and Goals of Action

The simple perception of an object can potentiate an associated action. This affordance effect depends heavily on the action context in which the object is presented. In recent years, psychologists, psychiatrists, and phenomenologists have agreed that subjects with schizophrenia may not perceive the affordances of people or objects that could lead to a loss of ease in their actions. We examined whether the addition of contextually congruent elements, during the perception of everyday objects, could promote the emergence of object-affordance effects in subjects with schizophrenia and controls. Participants performed two Stimulus–Response-Compatibility tasks in which they were presented with semantic primes related to sense of property (Experiment 1) or goal of action (Experiment 2) prior to viewing each graspable object. Controls responded faster when their response hand and the graspable part of the object were compatibly oriented, but only when the context was congruent with the individual’s needs and goals. When the context operated as a constraint, the affordance-effect was disrupted. These results support the understanding that object-affordance is flexible and not just intrinsic to an object. However, the absence of this object-affordance effect in subjects with schizophrenia suggests the possible impairment of their ability to experience the internal simulation of motor action potentialities. In such case, all activities of daily life would require the involvement of higher cognitive processes rather than lower level sensorimotor processes. The study of schizophrenia requires the consideration of concepts and methods that arise from the theories of embodied and situated cognition.

Influence of oxytocin on emotion recognition from body language: A randomized placebo-controlled trial

The neuropeptide 'oxytocin' (OT) is known to play a pivotal role in a variety of complex social behaviors by promoting a prosocial attitude and interpersonal bonding. One mechanism by which OT is hypothesized to promote prosocial behavior is by enhancing the processing of socially relevant information from the environment. With the present study, we explored to what extent OT can alter the 'reading' of emotional body language as presented by impoverished biological motion point light displays (PLDs). To do so, a double-blind between-subjects randomized placebo-controlled trial was conducted, assessing performance on a bodily emotion recognition task in healthy adult males before and after a single-dose of intranasal OT (24 IU). Overall, a single-dose of OT administration had a significant effect of medium size on emotion recognition from body language. OT-induced improvements in emotion recognition were not differentially modulated by the emotional valence of the presented stimuli (positive versus negative) and also, the overall tendency to label an observed emotional state as 'happy' (positive) or 'angry' (negative) was not modified by the administration of OT. Albeit moderate, the present findings of OT-induced improvements in bodily emotion recognition from whole-body PLD provide further support for a link between OT and the processing of socio-communicative cues originating from the body of others.

Reputation in an economic game modulates premotor cortex activity during action observation

Our interactions with other people - and our processing of their actions - are shaped by their reputation. Research has identified an Action Observation Network (AON) which is engaged when observing other people's actions. Yet, little is known about how the processing of others' actions is influenced by another's reputation. Is the response of the AON modulated by the reputation of the actor? We developed a variant of the ultimatum game in which participants watched either the visible or occluded actions of two 'proposers'. These actions were tied to decisions of how to split a pot of money although the proposers' decisions on each trial were not known to participants when observing the actions. One proposer made fair offers on the majority of trials, establishing a positive reputation, whereas the other made predominantly, unfair offers resulting in a negative reputation. We found significant activations in two regions of the left dorsal premotor cortex (dPMC). The first of these showed a main effect of reputation with greater activation for the negative reputation proposer than the positive reputation proposer. Furthermore individual differences in trust ratings of the two proposers covaried with activation in the right primary motor cortex (M1). The second showed an interaction between visibility and reputation driven by a greater effect of reputation when participants were observing an occluded action. Our findings show that the processing of others' actions in the AON is modulated by an actor's reputation, and suggest a predictive role for the PMC during action observation.

Sources of mu activity and their functional connectivity in perceiving complexities in reciprocal social interactive motion: An exploratory study using the 'Namaste' task

Cognitive processes underlying reciprocal social interactions are understood by the mechanism of embodiment, which is closely related to the mirror neuron system. Electroencephalographic (EEG) mu activity is a neural marker of the mirror neuron system. This study investigated the mu activity, localization of its sources and functional connectivity, which was induced while watching reciprocal social interactive motion across various degrees of complexity. Eighteen healthy participants underwent high-resolution EEG recording using 256-channels while they watched a specifically designed, culture specific, video task that showed two persons interacting socially using body gestures. Task complexity was determined by (1) whether there was an identical gestural response or a non-identical one; (2) whether the participant watched two persons interacting or was virtually involved in the interaction. Source localization and functional connectivity analysis was conducted for mu activity across various tasks. We also correlated mu activity and functional connectivity measures with serum BDNF. We found that spectral densities in various brain sources of mu activity and their increased functional connectivity distinguished identical and non-identical reciprocal expression observations, while mu suppression alone did not discriminate various degrees of complexities. These findings might have important implications in the understanding of mechanisms underlying mirror neuron dysfunction in various psychiatric disorders.

Self-regulation and Beyond: Affect Regulation and the Infant-Caregiver Dyad

In the available psychological literature, affect regulation is fundamentally considered in terms of self-regulation, and according to this standard picture, the contribution of other people in our affect regulation has been viewed in terms of socially assisted self-regulation. The present article challenges this standard picture. By focusing on affect regulation as it unfolds in early infancy, it will be argued that instead of being something original and fundamental, self-regulation developmentally emerges from the basis of a further type of affect regulation. While infants’ capacities in recognizing, understanding, and modifying their own affective states are initially immature and undeveloped, affect regulation is initially managed by the other: it is initially the self, and not the other, that plays the role of an assistant in affect regulation. To capture this phenomenon, the concepts of “auto-matic,” “hetero-matic,” and “altero-matic” affect regulation will be introduced and their interrelations elaborated. By showing how the capacity of affective self-regulation, which is characteristic to maturity, is developmentally achieved by internalizing regulative functions that, at the outset of development, are managed by the caregiver, it will be argued that altero-matic affect regulation is an autonomous type of affect regulation and the developmental basis for self-regulation.

RACE AND RECOGNITION: THE TIME OF OUR SINGING

Literature affords the opportunity to consider the racial fear, hatred and hostility that can flare in moments when the otherness in the human face occludes the common bonds that join us together. Richard Powers' (2003) compelling novel, The Time of Our Singing, highlights ways in which racial tensions continue to haunt us, impeding the efforts of successive generations to heal the wounds and move forward. In the novel, the parents' efforts to move "beyond race" leave their children utterly unprepared for the ways in which race informs and obstruct their experience, as what has been denied returns to haunt them.

Ashes of Remembrance: Reconfiguring the Phoenix

Literature affords the possibility of diverse perspectives, inviting the reader to try a character or experience on for size and to consider ways in which culture affects the narrative. What it means to be a person and then to become an adult within one's own ancestral tradition is inherited directly, through being with others and also through the stories that are passed along from parent to child, through which one finds one's place in the social world. Whatever the conscious intention of the author, traumatic texts are uniquely colored by the heritage that gives rise to them. Traumatic tales offer us bits and fragments from dream and fantasy, present and past, through which the reader can begin to see how meanings coalesce and cohere around signs that become symbols as we gain greater facility in reading them. In this article, I consider three threads of traumatic tales and their similarities and differences, hoping that the reader will be able to recognize both commonalities and differences, ways in which richness and texture might be added to our lives if we can recognize consciously what otherwise might haunt us.

Hypnosis Without Empathy? Perspectives From Autistic Spectrum Disorder and Stage Hypnosis

Despite volumes of published studies supporting the efficacy of hypnosis for ego-strengthening, performance, and physical and psychological disorders, the precise nature of hypnosis, and in particular, the neurobiological underpinnings of trance-phenomenon, remains tenuous at best. With his empathic involvement theory of hypnosis, Wickramasekera II (2015) brings us closer to an understanding of the elusive nature of hypnotic processes by proposing a bridging of two long-standing and seemingly incongruent theories of hypnosis (i.e., neodissociative versus socio-cognitive). Borrowing from neuroscientific studies of empathy, the empathic involvement theory maintains that empathy, beyond any other human dynamic (including emotions, behavior, personality, and imagination), facilitates and enhances hypnotic experiences for both recipient and provider alike. By the same token, one can reasonably infer from the empathic involvement theory that non-empathic individuals are less likely to benefit from hypnosis. With this perspective in mind, the empathic involvement theory's identification of empathy as an apparent "Holy Grail" of the neural underpinnings and precise nature of hypnosis may be challenged on a number of grounds. Individuals with autistic spectrum disorder, especially those suffering from alexithymia, have been identified as empathy deficient, and therefore according to the empathic involvement theory would be classified as "low-hypnotizable," yet empirical studies, albeit limited in number, suggest otherwise. Furthermore, hypnotic inductions of audience volunteers by stage hypnotists challenge the empathic involvement theory's supposition that empathy is a required component of hypnosis. It is this author's contention that empathy is a beneficial, though not essential, element of successful hypnosis.

The "Feeling of Movement": Notes on the Rorschach Human Movement Response

Human movement responses (M) on the Rorschach have been traditionally viewed as lying neither completely in the inkblot (external reality) nor within the subject's mind (inner world). The authors contend that M is not reducible to the "body that I have" but to the "body that I am," which is a higher level organization of bottom-up and top-down brain networks, integrating body implicit awareness, psychological functioning, and social cognition. Two sources of evidence suggest the close relationship among M, psychological functions, and brain mechanisms. One comes from meta-analytical evidence supporting the close association between M and higher level cognitive functioning or empathy. The second comes from some preliminary studies showing that M activates brain circuits included in the mirror neuron system (MNS). Two conclusions can be drawn: (a) M is related to the effective use of the mentalization function; and (b) future neuroscientific investigations could lead to an understanding of the neuropsychological mechanisms underlying Rorschach responses and variables.

Neural mechanisms of hypnosis and meditation

Hypnosis has been an elusive concept for science for a long time. However, the explosive advances in neuroscience in the last few decades have provided a "bridge of understanding" between classical neurophysiological studies and psychophysiological studies. These studies have shed new light on the neural basis of the hypnotic experience. Furthermore, an ambitious new area of research is focusing on mapping the core processes of psychotherapy and the neurobiology/underlying them. Hypnosis research offers powerful techniques to isolate psychological processes in ways that allow their neural bases to be mapped. The Hypnotic Brain can serve as a way to tap neurocognitive questions and our cognitive assays can in turn shed new light on the neural bases of hypnosis. This cross-talk should enhance research and clinical applications. An increasing body of evidence provides insight in the neural mechanisms of the Meditative Brain. Discrete meditative styles are likely to target different neurodynamic patterns. Recent findings emphasize increased attentional resources activating the attentional and salience networks with coherent perception. Cognitive and emotional equanimity gives rise to an eudaimonic state, made of calm, resilience and stability, readiness to express compassion and empathy, a main goal of Buddhist practices. Structural changes in gray matter of key areas of the brain involved in learning processes suggest that these skills can be learned through practice. Hypnosis and Meditation represent two important, historical and influential landmarks of Western and Eastern civilization and culture respectively. Neuroscience has beginning to provide a better understanding of the mechanisms of both Hypnotic and Meditative Brain, outlining similarities but also differences between the two states and processes. It is important not to view either the Eastern or the Western system as superior to the other. Cross-fertilization of the ancient Eastern meditation techniques presented with Western modern clinical hypnosis will hopefully result in each enriching the other.

The relationship between empathy and sympathy in good health care

Whereas empathy is most often looked upon as a virtue and essential skill in contemporary health care, the relationship to sympathy is more complicated. Empathic approaches that lead to emotional arousal on the part of the health care professional and strong feelings for the individual patient run the risk of becoming unprofessional in nature and having the effect of so-called compassion fatigue or burnout. In this paper I want to show that approaches to empathy in health care that attempt to solve these problems by cutting empathy loose from sympathy-from empathic concern-are mistaken. Instead, I argue, a certain kind of sympathy, which I call professional concern, is a necessary ingredient in good health care. Feeling oneself into the experiences and situation of the patient cannot be pursued without caring for the patient in question if the empathy is going to be successful. Sympathy is not only a thing that empathy makes possible and more or less spontaneously provides a way for but is something that we find at work in connection to empathy itself. In the paper I try to show how empathy is a particular form of emotion in which I feel with, about, and for the other person in developing an interpretation of his predicament. The with and for aspects of the empathy process are typically infused by a sympathy for the person one is empathizing with. Sympathy can be modulated into other ways of feeling with and for the person in the empathy process, but these sympathy-replacement feelings nevertheless always display some form of motivating concern for the target. Such an understanding of empathy is of particular importance for health care and other professions dealing with suffering clients.

Varieties of male-sexual-identity development in clinical practice: a neuropsychoanalytic model

Variations of sexual identity development are present in all cultures, as well as in many animal species. Freud – founding father of psychoanalysis – believed that all men have an inherited, bisexual disposition, and that many varieties of love and desire are experienced as alternative pathways to intimacy. In the neuropsychoanalytic model, psychic development starts with the constitutional self. The constitutional self is comprised of the neurobiological factors which contribute to sexual identity development. These neurobiological factors are focused on biphasic sexual organization in the prenatal phase, based on variations in genes, sex hormones, and brain circuits. This psychosocial construction of sexual identity is determined through contingent mirroring by the parents and peers of the constitutional self. The development of the self—or personal identity—is linked with the development of sexual identity, gender-role identity, and procreative identity. Incongruent mirroring of the constitutional self causes alienation in the development of the self. Such alienation can be treated within the psychoanalytic relationship. This article presents a contemporary, neuropsychoanalytic, developmental theory of male-sexual identity relating to varieties in male-sexual-identity development, with implications for psychoanalytic treatment, and is illustrated with three vignettes from clinical practice.

Embodied simulation in exposure-based therapies for posttraumatic stress disorder-a possible integration of cognitive behavioral theories, neuroscience, and psychoanalysis

Exposure to the trauma memory is the common denominator of most evidence-based interventions for posttraumatic stress disorder (PTSD). Although exposure-based therapies aim to change associative learning networks and negative cognitions related to the trauma memory, emotional interactions between patient and therapist have not been thoroughly considered in past evaluations of exposure-based therapy. This work focuses on recent discoveries of the mirror-neuron system and the theory of embodied simulation (ES). These conceptualizations may add a new perspective to our understanding of change processes in exposure-based treatments for PTSD patients. It is proposed that during exposure to trauma memories, emotional responses of the patient are transferred to the therapist through ES and then mirrored back to the patient in a modulated way. This process helps to alleviate the patient's sense of loneliness and enhances his or her ability to exert control over painful, trauma-related emotional responses. ES processes may enhance the integration of clinical insights originating in psychoanalytic theories-such as holding, containment, projective identification, and emotional attunement-with cognitive behavioral theories of learning processes in the alleviation of painful emotional responses aroused by trauma memories. These processes are demonstrated through a clinical vignette from an exposure-based therapy with a trauma survivor. Possible clinical implications for the importance of face-to-face relationships during exposure-based therapy are discussed.

Mysteries of hypnosis and the self are revealed by the psychology and neuroscience of empathy

This article reviews a growing body of research and theory in hypnosis and neuroscience that supports the empathic involvement theory (EIT) of hypnosis (Wickramasekera II, 2001; Wickramasekera II & Szlyk, 2003; Wickramasekera II, 2007c). The EIT is a unified transpersonal theory of hypnosis and the self, which weaves together empathic elements of Dzogchen, neodissociative, neuroscience, psychoanalytic, sociocognitive, and other theories by proposing that hypnotic phenomena are inherently characterized by their deep involvement with processes of empathy and the self. The EIT proposes that the experience of hypnosis is embodied in a system of neural networks in the brain that utilizes empathy-related processes, adaptive resonance between perceptual input and top-down expectancies, and connectionist learning algorithms to (a) empathically enact the affect, cognition, body language, response expectancies, social roles, sensations, etc. that are presented to them during hypnosis in accordance with socio-cognitive theories of hypnosis; (b) engage in a convergent psychophysiological relationship with another person in accordance with psychoanalytic, Ericksonian, and polyvagal/social engagement system theories; (c) alter the empathic self/other (theory of mind) coding of phenomenological experiences during hypnosis in accordance with aspects of the neo-dissociative and socio-cognitive traditions; and (d) develop an experiential understanding of the illusion of self that may lead, in some people, to its transcendence in accordance with Bon-Buddhist, Dzogchen, and transpersonal scholars. A unified definition of hypnosis is proposed based on findings in the empathic neuroscience of hypnosis as well as a working model of the neuromatrix of the self.

Empathy in group therapy: facilitating resonant chords

Empathy has consistently been identified as an important quality of psychotherapists. Understanding unique ways that empathy emerges in group therapy may assist group therapists in fostering empathy. Rogerian and selected psychodynamic and interpersonal perspectives on empathy are discussed. Group psychotherapy poses a challenge for empathic responding, but also a rich opportunity for utilizing a more varied embodied approach to empathy.

Klein and Lacan meet 21st century schizoid man: fairy stories for the modern era

Melanie Klein invited us into the phenomenology of the schizoid dilemma through her depictions of the paranoid-schizoid position. By inserting his recursive arrows, Bion extended this conceptualization, showing us the folly of believing that we can ever entirely move beyond the frightening fantasies and realities of social exclusion and isolation. The 21st century has brought, along with the explosion of technology, an expulsion from the social order of many children who have found refuge from isolation and humiliation in the more accessible and less terrifying world of media and technological invention. What may look like narcissism can mask a terrible underlying schizoid failure to enter into the human race. This is the realm of fantasy run amok, where desire becomes alien and alienated such that one is haunted and hunted down by its very possibility. In this universe, conceptualizations from Klein, Bion, and Lacan help us to locate the individual who has become caught in a massive psychic retreat such that there is no subject because there are no objects. To illustrate, I describe my work with a young man who is living in a terrible "zombie zone" where people are not real and therefore are incomprehensible and terribly dangerous. The poignancy of his dilemma is heartbreaking. Perhaps that is one lesson we can still take from our old fairy tales: when one's heart can be broken by another's plight, then comes the possibility of a healing, an entry through that piercing of what had been impenetrable.

The phenomenology of empathy in medicine: an introduction

This article is an introduction to a thematic section on the phenomenology of empathy in medicine, attempting to provide an expose of the field. It also provides introductions to the individual articles of the thematic section.