Empathy

In recent years, there has been a revival of interest in the constructive impact of therapist empathy (Bohart & Greenberg, 1997). Watson and colleagues (2002) reviewed the research on therapist empathy and found that: (1) research consistently demonstrates that therapist empathy is the most potent predictor of client progress in therapy and is an essential component of successful therapy in every therapeutic modality; (2) no study shows a negative relationship between empathy and outcome; (3) client ratings of therapist empathy are stronger predictors of successful outcome than the ratings of external judges or therapists; (4) strong behavioral correlates of empathy include (a) therapist direct eye contact and concerned expression, (b) a forward trunk lean and head nods, (c) a vocal tone that communicates interest and emotional involvement, (d) clarity of communication, and (e) use of emotional language; (5) conversely, therapist interruptions, advisement and reassurance, and a detached or mechanical vocal tone were negatively correlated with therapist empathy.

In a research review of 47 studies and 190 tests of the relationship between therapist empathy and outcome, Greenberg, Elliott, Watson, and Bohart (2001) reported that therapist empathy has a medium effect size that accounts for about 10% of outcome variance. A sobering piece of evidence is that lack of therapist understanding is consistently associated with negative outcomes (Mohr, 1995).

Sachse and Elliott’s microprocess research (2002) showed that therapist empathic responses might deepen, maintain, or flatten client experiential processing and self-exploration. Further, they showed that clients do little experiential processing on their own and do not deepen their processing unless the therapist provides deepening empathic responses.

A recent qualitative study by Barbara Grote (2005) on the “experience of feeling really understood in psychotherapy” found that this experience involved clients’ feeling (a) safe, (b) accepted, (c) relieved, (d) validated, (e) heard, (f) seen/known, (g) engaged with an active co-participant, (h) a sense of intimacy with the therapist, (i) surprised and experiencing a sense of awe at the discovery of a core truth or new way of looking at a situation, (j) more self-acceptance, and (k) engaged with a compassionate, genuine “other.” In short, multiple attitudes, qualities, skills, and behaviors contribute to the client’s sense of being heard and seen accurately, some of which differ from what most therapists conceive as empathic understanding. Similarly, Bachelor’s research (1988) demonstrated that what clients perceive to be empathic varies from client to client and does not always correspond to what therapists consider an empathic response.

Both personal and therapeutic experience provides compelling evidence that feeling understood and accepted by important others is conducive to our well-being. Further, research on therapist “listening,” a form or component of empathy, shows that it is rated highly by clients as helpful, especially when clients are struggling with suicidal impulses (Cooper, 2008). Conversely, Paulson, Everall, and Janice (2002) found that the therapist’s failure to listen, as perceived by clients, was extremely unhelpful or hindering. Regardless of one’s therapeutic approach, the desire to hear our clients, enter into their experiential worlds, and communicate that understanding is almost inevitably helpful and never harmful, while failure to do so has adverse effects.