Correlates of empathy in psychotherapy: A replication.

Replicated findings regarding the relationship between therapist personal characteristics and therapist empathy levels during psychotherapy. It is concluded that: (1) there is a moderate inverse relationship between therapist MMPI disturbance levels and degree of therapist empathy in interviews, (2) there is no correlation between indexes of therapists' intellectual ability or academic achievement and their empathy scores and (3) there is some reason to doubt that Truax Empathy scores are related to patient outcome in non-client-centered therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working with dreams using the Hill cognitive-experimental model: A comparison of computer-assisted, therapist empathy, and therapist empathy + input conditions.

Ninety-four undergraduates participated in a computer-assisted, therapist empathy, or therapist empathy + input dream session. Although all conditions were rated positively, both therapist conditions were rated higher than the computer condition, and action ideas were better for the therapist empathy condition than for the other 2 conditions at postsession. At follow-up, the therapist empathy + input was rated higher than the empathy condition, which was higher than the computer condition. Participants in all conditions liked gaining awareness/insight, associations, and the approach to working with dreams; participants in both therapist conditions liked their therapist; participants in the empathy condition liked waking life links. Therapist condition participants mentioned fewer disliked things but complained more about research procedures; computer participants complained about the computer program and not working with a person. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Different approaches to the measurement of therapist empathy and their relationship to therapy outcomes.

Correlated measures of therapist empathy (N. Kagan's, et al, Affective Sensitivity Scale, the Interpersonal Checklist, A. Langield's Role Construct Repertory Test, R. Carkhuff's Empathetic Understanding in Interpersonal Process Scale, and the G. Barrett-Lennard Relationship Inventory) with each other, with R. Carkhuff and B. Berenson's Self-Exploration in Interpersonal Process Scale, and with the Tennessee Self-Concept Scale and MMPI measures of outcome. With the possible exception of client-perceived and tape-judged empathy, the empathy measures were unrelated to each other, indicating that previous research has been measuring several different variables employing a common label. Only tape-judged empathy was related to depth of self-exploration. Client-perceived empathy was strongly related to therapy outcome, tape-judged empathy less so, and the remaining empathy measures were unrelated to outcome. Implications for research methodology and for therapeutic theory are discussed. (28 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships among therapist empathy and authoritarianism and a therapist's prognosis.

Administered the Rokeach Dogmatism Scale (Form E), the Hogan Empathy Scale, and a therapy prognosis scale to 25 therapists (PhD psychologists). A positive relationship was found between therapist empathy and the prognosis variables dealing with perception of degree of disturbance and overall prognosis. Multiple regression analysis revealed that (a) empathy, number of years of experience, and age (in that order) are of greatest importance in predicting a therapist's perception of degree of disturbance of an individual; and (b) empathy and number of years of experience (in that order) are most important in predicting a therapist's overall prognosis for an individual. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The current state of empathy research.

The literature on empathy, primarily from counseling and psychotherapy and secondarily from social and developmental psychology, is reviewed. Obstacles that may account for theoretical confusions and empirical difficulties in studying empathy are highlighted. The decrease in empathy research in recent years appears attributable to the lack of clear focus and effective research tools as well as the shift in interest from empathy to other concepts such as the working alliance. It is argued that there is a need to return to studying empathy. Researchers should distinguish between dispositional and experiential empathy and between intellectual empathy and empathic emotions and indicate whether they are examining therapist or client experience of empathy. Suggestions for future research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Some sources of variance in "accurate empathy" ratings.

Recorded the initial therapy interviews of 8 psychotherapists with 54 inpatients. Interviews were rated on the accurate empathy scale by 2 raters. Estimates of the consistency of therapists from 1 segment to another within the same session and from one patient to the next suggest that accurate empathy may not be a stable quality of the therapist, as is usually assumed, but instead may reflect a dyadic or relationship variable. Thus, the usual method of assessing the interrater reliability of the scale using the number of patient-therapist combinations rather than the number of therapists alone may be defensible in spite of recent criticisms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Narrative empathy.

Therapeutic empathy is described as an active narrative process, in which the therapist attempts to construe and express the inner emotional logic of the client's problem patterns. The empathic narrative is contrasted to the external narrative, which describes the client from the outside and the client's behavior as making sense from the point of view of the theory rather than from that of the client's. The criterion of an empathic narrative is that it elicits from the client the response "That's me!" The external narrative, in distinction, fails to elicit this self-recognition. The persistent rejection of the therapist's formulations by the client and the ensuing state of therapeutic impasse is interpreted as being often due to the therapist's assumption that the client should accept an external narrative as if it were an empathic one. When such a situation develops, the therapist may overcome the impasse by acknowledging the externality of the previous therapeutic narrative and proposing a potentially empathic one in its stead. Three case examples of a 49-yr-old married woman, a teenage girl, and 28-yr-old single male are presented to demonstrate narrative empathy within the therapeutic context. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Therapist Multicultural Competency: A Study of Therapy Dyads": Correction.

Reports an error in "Therapist Multicultural Competency: A Study of Therapy Dyads" by Jairo N. Fuertes, Thomas I. Stracuzzi, Jennifer Bennett, Jennifer Scheinholtz, A. Mislowack, Mindy Hersh and David Cheng (Psychotherapy: Theory, Research, Practice, Training, 2006[Win], Vol 43[4], 480-490). The fifth author's name should be spelled as follows: Alexa Mislowack. (The following abstract of the original article appeared in record 2006-23019-010.) This study examined the role of therapist multicultural competence (TMC). Fifty-one therapy dyads completed measures of therapist multicultural competency, working alliance, and their satisfaction with therapy. Clients also completed measures of therapist attractiveness, expertness, trustworthiness, and empathy. Results showed strong associations between clients' ratings of TMC and ratings of the working alliance, therapist empathy, and satisfaction. Clients' combined rating of therapist expertness, attractiveness, and trustworthiness were not associated with their TMC ratings but were significantly associated with therapists' self-appraised TMC ratings. Therapists' ratings of their TMC were associated with their ratings of the working alliance and satisfaction with their work. Results are discussed in the context of the relevant literature, as are implications for training and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Transforming narcissism: Reflections on empathy, humor, and expectations. Vol. 28: Psychoanalytic inquiry book series.

Reviews the book, Transforming narcissism: Reflections on empathy, humor, and expectations. Vol. 28: Psychoanalytic inquiry book series by Frank M. Lachmann (see record 2008-01083-000). This book is a welcome addition to the conversation on working with self-pathology. Lachmann brings a personal, conversational voice to the dialogue; there is much here to benefit students and seasoned clinicians alike. It is not a treatment manual for narcissism, but rather Lachmann’s own transformational dialogue with Heinz Kohut. Using Kohut’s (1966) article “Forms and Transformations of Narcissism” as a starting point, Lachmann elaborates Kohut’s contention that archaic narcissism is transformed through psychotherapy into empathy, humor, creativity, wisdom, and acceptance of our transience. He focuses on the first three elements as a means as much as a product of transformation in therapy, and the latter two elements are discussed as hopeful outcomes of the transformational process therapy engenders. Although there are limitations in terms of this book’s utility as a treatment guide for interventions with patients with narcissistic disorders, as a series of reflections on transformational processes it is often quite compelling. Lachmann the therapist advocates using empathy, humor, and creativity, not to try to impress or demonstrate his cleverness, but rather as bridge to transformational intimacy with his patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between clients' perceptions of therapist–parent similarity with respect to empathy, regard, and unconditionality and therapists' rating of client transference.

The authors studied the similarity between clients' perceptions of their therapists and their perceptions of their parents (or early parental figures) in terms of the relationship qualities of empathy, positive regard, and unconditionality of regard and how those perceptions compared with their therapists' ratings of transference. Participants were 62 actual therapy dyads. The results failed to support a hypothesized positive association between the similarity of the therapist and parents or parental figures on the relationship dimensions of empathy, regard, and unconditionality and therapist ratings of transference. Instead, the clients' relationship ratings of their parents and therapists suggested that therapists' perceptions of transference may more accurately reflect perceptions of their clients' nontransferential (i.e., real relationship) reactions to the therapist. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An exploratory investigation into self-other differentiation: Empirical evidence for a monistic perspective on empathy.

Several theoretical definitions of empathy have noted a component of emotional self–other differentiation (ESOD) between the experiences of the therapist and the client. In the present study, an instrument designed to measure the maintenance of emotional separation (MES) was developed. 131 graduate students in social work completed the MES scale, items from the Marlowe-Crowne Social Desirability Scale, and a measure of empathic tendency. Results show a negative relationship between empathy and MES. Findings question the notion that ESOD is a necessary component of empathy and support the idea that ESOD is lost after a certain degree of empathy. Findings also support the author's (1981) conceptualization of empathy as a monistic therapist–client experience. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist multicultural competency: A study of therapy dyads.

[Correction Notice: An erratum for this article was reported in Vol 44(1) of Psychotherapy: Theory, Research, Practice, Training (see record 2007-04278-014). The fifth author's name should be spelled as follows: Alexa Mislowack.] This study examined the role of therapist multicultural competence (TMC). Fifty-one therapy dyads completed measures of therapist multicultural competency, working alliance, and their satisfaction with therapy. Clients also completed measures of therapist attractiveness, expertness, trustworthiness, and empathy. Results showed strong associations between clients' ratings of TMC and ratings of the working alliance, therapist empathy, and satisfaction. Clients' combined rating of therapist expertness, attractiveness, and trustworthiness were not associated with their TMC ratings but were significantly associated with therapists' self-appraised TMC ratings. Therapists' ratings of their TMC were associated with their ratings of the working alliance and satisfaction with their work. Results are discussed in the context of the relevant literature, as are implications for training and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Accurate empathy: Confusion of a construct.

Presents empirical and logical evidence to refute the C. Truax (see PA, Vol. 48: Issue 5) rejoinder to an earlier critique by the authors. It is argued that the construct accurate empathy is markedly confused. The accurate empathy scale is shown to lack discriminant validity, and its relationship to therapeutic outcome is considered. The meaning of ratings of empathy in the absence of client responses is questioned. Finally, the use of repeated measurement of the same therapist is shown to be faulty on both statistical and design grounds and to yield spuriously inflated reliability coefficients. (17 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training adolescents in self-disclosure and empathy skills.

Conducted a study to develop, implement, and evaluate a communication skills training program for adolescent high school students. 25 students were given 16 hrs of training in the skills of self-disclosure and empathy, and 23 other students served as a contact control group and received no formal skills training. Ss completed both a behavioral and paper-and-pencil assessment prior to and immediately following training. Ss who received training demonstrated significantly higher self-disclosure and empathy skill levels than did the untrained Ss. Results are discussed in terms of the high skill level attained by Ss and the implications for training adolescents or younger populations in communication skills. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of therapist self-disclosure on patients' perceptions of empathy, competence and trust in an analogue psychotherapeutic interaction.

Psychodynamically oriented clinicians uniformly contraindicate the use of therapist self-disclosure, whereas practitioners disposed toward a humanistic-existential perspective often regard this practice as an essential condition of treatment. In the present study, 57 psychotherapy patients (aged 18–55 yrs) read 1 of 3 patient–therapist dialogs in which the degree of therapist self-disclosure was high, low, or nil. Ss completed the Relationship Inventory and Sorenson Relationship Questionnaire to measure perceived therapist empathy, competence, and trust. Findings confirm the prediction that greater therapist self-disclosure would be related to poorer evaluations of the therapist. Results question the use of self-disclosure as a psychotherapeutic technique and suggest that self-disclosure may adversely affect the perceptions on which the therapeutic alliance is based. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic empathy and recovery from depression in cognitive-behavioral therapy: A structural equation model.

Demonstrated that therapeutic empathy has a moderate-to-large causal effect on recovery from depression in a group of 185 patients (aged 18–75 yrs) treated with cognitive-behavioral therapy (CBT). The authors simultaneously estimated the reciprocal effects of depression severity on therapeutic empathy and found that this effect was quite small. In addition, homework compliance had a separate effect on clinical recovery, over and above the effect of therapeutic empathy. The patients of novice therapists improved significantly less than did the patients of more experienced therapists, when controlling for therapeutic empathy and homework compliance. Ss who terminated therapy prematurely were less likely to complete the self-help assignments between sessions, rated their therapists as significantly less empathic, and improved significantly less. Ss with borderline personality disorder improved significantly less, but they rated their therapists as just as empathic and caring as other patients. The significance of these findings for psychotherapy research, treatment, and clinical training is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Verbal and therapeutic styles of experienced therapists who differ in peer-rated therapist effectiveness.

Investigated some relationships between the verbal behavior of 20 experienced therapists and their therapist effectiveness. Forced oral responses to a taped therapy interaction were obtained and analyzed. Each dependent variable (empathy, positive regard, genuineness, functional level, voice quality, freshness of words, change of topic, confrontation style, personal references, and statements) was correlated against a rating of a therapist's effectiveness made by experienced judges using the Truax-Carkhuff scales. Of 10 hypotheses, 5 were supported. The more effective the experienced therapist, the higher the levels of offered empathy, positive regard, and genuineness, and the more likely the therapist was to use "inner focus" and "experiential confrontation." Variables of number of years of experience and level of empathy were investigated further. Findings and their implications are discussed. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of therapist and patient mood on the therapeutic functioning of high- and low-facilitative therapists.

Determined the effects of presession moods of 12 therapists and their patients on level of therapist empathy, warmth, and genuineness. Results of an intensively designed study indicate that high- and low-facilitative therapists were differentially affected by therapist moods. High-facilitative therapists functioned more facilitatively under dysphoric moods than under positive, while the opposite was true of low-facilitative. There were no differences in tape-rated therapist facilitativeness under different patient moods for either group, yet patients of low-facilitative therapists did perceive such a difference. It is concluded that the therapist feelings preceding the facilitative therapy hour were not the same for high- and low-facilitative therapists. The use of the intensive design in psychotherapy process research is discussed. (44 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empathy.

Empathy is defined, and its measurement is discussed. We then present the results of a new meta-analysis of the relation between measures of empathy and psychotherapy outcome from three perspectives (client, therapist, and observer). Variables that mediate this relationship also are discussed. The processes of change that empathy is posited to facilitate, as well as the different roles and forms that empathy may take in therapy are discussed. Results indicate that clients' and observers' perceptions that therapists understand their clients' internal experiences relate to outcome. This suggests it is important that therapists make efforts to understand their clients, and that this understanding be demonstrated through responses that address the needs of the client, as the client perceives them, on an ongoing basis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Linking mechanisms: Emotional contagion, empathy, and imagery.

Deconstructing the emotional relationship between patient and therapist is certainly a formidable task. Using research results from experimental social psychology, psychophysiology, and developmental psychology, this essay focuses on the automatic processes of mimicry, emotional synchrony, and physiological synchrony—all preludes to empathy. For the therapist to achieve an empathic posture, however, she must also imagine the perspective of the patient. Furthermore, to broaden and sharpen her empathic lens, she must tune in to the ubiquitous current of nonverbal communication that is part and parcel of the interactive treatment process. For these reasons, imagery proves to be a crucial element in the transition from simple attunement to empathy. A clinical vignette and a neuroscience perspective on image formation help illustrate the relationship between emotional contagion and imagery. It is suggested that there is a reciprocal relationship between the emotional ambience cocreated by the two participants and image formation. Sensorial images aid in the detection of gross emotional states as well as in the nuancing of their intensity. Affective ambience, on the other hand, seems to affect the selection of one particular image versus another. (PsycINFO Database Record (c) 2011 APA, all rights reserved)