Empathy in Counseling and Psychotherapy

Perspectives and Practices

Arthur J. Clark

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317716808
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

The purpose of this text is to organize the voluminous material on empathy in a coherent and practical manner, filling a gap that exists in the current therapeutic literature. Empathy in Counseling and Psychotherapy: Perspectives and Practices comprehensively examines the function of empathy as it introduces students and practitioners to the potential effectiveness of utilizing empathic understanding in the treatment process.Employing empathy with full recognition of its strengths and limitations promotes sound strategies for enhancing client development. As an integral component of the therapeutic relationship, empathic understanding is indispensable for engaging clients from diverse backgrounds. This cogent work focuses on understanding empathy from a wide range of theoretical perspectives and developing interventions for effectively employing the construct across the course of treatment. The book also presents a new approach for integrating empathy through a Multiple Perspective Model in the therapeutic endeavor. Organized into three sections, the text addresses empathy in the following capacities:
*historical and contemporary perspectives and practices in counseling and psychotherapy;
*theoretical orientations in counseling and psychotherapy; and
*a Multiple Perspective Model in counseling and psychotherapy.This widely appealing volume is designed for use in courses in counseling and therapy techniques, theories of counseling and psychotherapy, and the counseling internship, and is a valuable resource for counselors, psychotherapists, psychologists, psychiatrists, social workers, and other related fields of inquiry in the human services.

PART I

Empathy: Historical and Contemporary Perspectives and Practices in Counseling and Psychotherapy

Chapter 1

The Meaning of Empathy in Counseling and Psychotherapy

Wouldst thou the others know well, look thou within thine own heart.

—Schiller (1795/1985, p. 329)

My search for refinement of the meaning of empathy and an appreciation of its potency in the therapeutic experience has evolved over the past 30 years. As a graduate student in counseling in the early 1970s, I thought that empathy was largely about perceiving a client’s internal frame of reference and striving to convey this understanding back to the individual. It was also my belief that empathy should be expressed in a caring and accurate manner. In practice, this meant that I would listen attentively to a client and attempt to reflect back the essence of what I had heard. I can recall my numerous efforts to achieve the highest level of perceptivity with my client in my role as a “grand empathizer.” Thinking back on my early views of empathy, I realize that, although I may have grasped essential elements of the construct, I also held an oversimplified conception of empathy and a too narrow perspective of its potential role in counseling and psychotherapy.

As the years passed and my experience in working with a diverse range of clients grew, I became aware that my conception of empathy had become increasingly diffuse and ambiguous. I soon realized that it was essential to include a cognitive component or framework in empathic understanding in order to more fully assess the functioning of clients. I also began to clarify the difference between expressing empathy as a mode of communication and experiencing empathy as an attitudinal engagement. This distinction took on added importance as questions arose in the literature about the operational definitions of empathy, and criticism proliferated relating to the adequacy of measuring empathy as a construct in research designs. It also became apparent to me that closely related concepts, including sympathy, projection, and identification, were also subject to semantic confusion in the therapeutic practice of employing empathy. Finally, as my knowledge of the theoretical conceptualizations of empathy increased beyond client-centered therapy, I began to recognize the importance of expanding my views on the meaning and application of empathy in a treatment situation within a broader context.

THE ORIGIN OF THE MEANING OF EMPATHY

The modern usage of empathy has roots in German aesthetics when Robert Vischer, in 1873, coined the term einfühlung (Hunsdahl, 1967; Pigman, 1995). In his discussion of aesthetics and form perception, Vischer made reference to einfühlung as a means of coming to know a particular work of art through the projection of human feelings (Watson, 2002; Wispé, 1987). For example, when a person observes a piece of art, he or she may experience an inclination to merge or fuse with the object on a physically felt level and lose a sense of self-awareness (Katz, 1963). The German word derives from an individual’s psychological aesthetic experience of “feeling oneself into” or to “feel within” (Jenkins, 1997). In 1897, the German psychologist Theodor Lipps began to discuss einfühlung as a means of perceiving and appreciating art forms, but he subsequently developed a theory that extended the construct into the realm of interpersonal functioning (Wispé, 1987). Through his extensive writing on einfühlung, Lipps conceptually broadened its meaning into the area of understanding others from a psychological vantage point. Lipps conceptualized the response of a person by detailing a process of projection and imitation (Deutsch & Madle, 1975), whereby a person “feels into” the experience of another individual as a means of knowing. The systematic work of Lipps led to a broader understanding of the term as a relational experience in common use and in the professional literature.

Interest in the concept of einfühlung continued to increase into the 20th century. In the United States, Edward Titchener translated einfühlung into empathy from the original German (Katz, 1963). In his 1909 rendering of empathy, Titchener emphasized the aesthetic aspects of the term as they related to projection of feelings into perceived objects (Pigman, 1995). In his later writings, Titchener discussed the process of “feeling oneself” into situations that individuals experience as an imaginative aspect of empathy (Post, 1980; Wispé, 1987). With respect to etymology, Titchener’s translation of empathy originates by way of the Greek word empatheia, which means to enter or to be with a person’s suffering or passion (Schmid, 2001; Wispé, 1987).

MODES OF EMPATHY IN COUNSELING AND PSYCHOTHERAPY

Although there is ambiguity and debate relating to the meaning of empathy in the psychotherapeutic literature, it is possible to conceptually organize the construct into three modes in a treatment context. Experiential, communication, and observational modes represent broad categorizations across diverse theoretical orientations. Carl Rogers recognized empathy as a way of being or an attitude that is a critical variable in therapeutic change. Rogers, and others who expanded on his ideas, emphasized an experiential mode of empathy wherein a counselor or therapist assumes a transitory engagement with a client in an attempt to grasp the inner experience and meanings of a person. The practitioner resonates in a bodily felt response to a client’s functioning and conveys aspects of this interaction to the individual.

As a mode of communication, extensive efforts of researchers have focused on developing operational definitions of empathy for use in practice and for training purposes. With an explicit goal of conceptualizing empathy as a communication skill, criticism grew regarding the quality of the research relating to the construct and its subsequently diminished attitudinal role in counseling and psychotherapy. At the same time, it is widely recognized that for empathy to engender therapeutic gain, it must be communicated to an individual. Contemporary research efforts continue to refine models for evaluating the communication of empathy in a therapeutic situation. With respect to an observational mode, a practitioner may utilize empathy as a means of acquiring psychological data relating to a client. It is then possible for a counselor or therapist to transform the knowledge into an interpretation or related interventions. This process of observing and explaining suggests a deeper quality of empathic understanding as a client achieves a broader perspective relating to his or her experience. The interaction requires the practitioner to simultaneously function in a role that is emotionally involved with a client and in a qualitatively different pursuit that is more detached and objective.

Empathy as a Mode of Experiencing

Throughout the lengthy period when Rogers wrote about the topic of empathy, he was insistent that the construct be viewed as an attitude in counseling and psychotherapy. In his early work with client-centered therapy, Rogers (1949) proposed a set of attitudes that become implemented by various methods and techniques that are consistent within the treatment approach. Rogers (1966) ultimately determined that the presence of empathy was one of the definable variables that, in addition to congruence and unconditional positive regard, affect progress and success in counseling and psychotherapy. In this respect, Rogers’s intent was to convey a comprehensive definition of empathy as a posture or a position of a therapist rather than a repertoire of particular interventions and strategies (Bozarth, 1998). As a fundamental aspect of an empathic attitude, Rogers (1951) felt that it was essential for a practitioner to attempt to grasp the internal frame of reference as a client perceives it and then endeavor to communicate key aspects of this experience to the individual. In this subjective and immediate interaction, an experiential condition of empathy occurs between a counselor and a client. It is the nature of this empathic experience in the therapeutic process that subsequently became a major focus for Rogers and other client-or person-centered therapists.

By distinguishing an attitudinal focus of empathy, Rogers wished to convey a steadiness of purpose on the part of a counselor or therapist. Rogers felt that an effective practitioner needed to consistently manifest an empathic stance in the presence of a client. For Rogers, a sustained attitude on the part of a therapist was crucial in attaining emotional growth and healing (Bennett, 2001). In this respect, empathy involves a way of being with a client and a commitment to a treatment approach that engenders a predictable and therapeutic supportive climate. In particular, an empathic attitude requires that a counselor attempt to capture and stay within a client’s perceptual field in an immediate context (Bozarth, 1998). In order to do this, a practitioner typically expresses empathic responses to a client in order to verify or affirm the experience of the individual. This interactive aspect of understanding emphasizes the experiential quality of empathy. Experiential empathy occurs in the immediate moment in response to a client’s verbal and nonverbal disclosures. A client’s tone of voice, gestures, and manner and content of expression reveal aspects of the individual’s experiencing (Gendlin, 1961). In therapeutic interactions with a client, a practitioner attempts to grasp the explicit and implicit meanings of the person (Rogers, 1966).

The work of Rogers was instrumental in establishing a prominent position with respect to empathic experiencing in counseling and psychotherapy. His focus on empathy largely involved trying to understand the inner experience of an individual in terms of what it would be like if one were the other person. Rogers did attend to aspects of his own experiencing, such as intuitive responses, in the immediacy of counseling, and he began to give more attention to this functioning as his theory evolved. Expanding on the ideas of Rogers, other researchers gave increased emphasis to the experience of the therapist within the counseling relationship. Gendlin (1961, 1962) and Vanaerschot (1990, 1997) wrote about the counselor engaging in empathic resonance and bodily felt responses in reaction to what a client is experiencing. In an intentional way, a practitioner attunes his or her subjective reactions to those of the client. This becomes a visceral process as a therapist experiences transitory feelings similar to those of the client (Chismar, 1988; Feiner & Kiersky, 1994). In practice, a therapist momentarily identifies with a client in order to imagine what it might be like to be the person (Bachrach, 1976). This endeavor calls on a counselor to be openly engaged and responsive to one’s own internal reactions and sensibilities in the service of understanding individuals.

In a treatment example relating to experiential empathy, Justin, a 15-year-old adolescent, is referred to a therapist due to acting-out behavior in his school and community. In the initial session, Justin is sullen and withdrawn and largely refuses to participate in the counseling endeavor. From an experiential perspective, the therapist subjectively reacts by briefly identifying with Justin and fleetingly imagines what it is like to be mandated to attend therapy. The practitioner also experiences a visceral response of tightness in her chest when interacting with Justin. As the therapist attempts to understand Justin’s phenomenological or subjective experiencing, she is aware of Justin’s strong feelings of resentment and alienation. In this context, the practitioner intuitively senses that Justin’s negative feelings must be immediately addressed in order to engender any hope for therapeutic movement.

It may be apparent that when a counselor or therapist identifies with a client through an experiential mode of empathy, there is always a potential for confusion of psychological boundaries. A practitioner may become enmeshed in the experiencing process and fail to maintain a sufficient degree of emotional detachment (Mearns, 2003). As a counselor experiences the feelings and perceptions of a client, even on a momentary basis, the vicarious contact may be intense and engrossing. A therapist is particularly vulnerable to an excessive level of identification with another individual when personal issues and conflicts are unresolved and subject to merging with the material of the client. Rogers (1957) was aware of the possibility of enmeshment when he emphasized the importance of a therapist being able to perceive the experience of a person, but to do so without losing the condition as if the counselor were the client. In practice, it is essential for a practitioner to avoid allowing conflictive personal issues to encroach on the counseling relationship (Boy & Pine, 1982). At the same time, if a therapist maintains only an emotionally distant level of engagement with a client, communications and understandings that are forthcoming from an experiential mode of empathy may be diminished or precluded.

Empathy as a Mode of Communication

Although experiential empathy involves an active resonance, it does not necessarily imply that a therapist communicate this experiencing back to a client (Marcia, 1987). Most often, however, in the context of the therapy process, empathy is understood by a client with respect to its verbal and nonverbal components as expressed by the practitioner (Haase & Tepper, 1972). Rogers (1975) wrote about the therapist sensing the client’s inner experiencing and communicating something about this understanding back to the person. In this regard, empathy involves a commitment to grasp the internal state of an individual as accurately as possible (Cochran & Cochran, 2006; Egan, 2002). It is the sustained interpersonal stance of the counselor in perceiving and responding to the private meanings of the client that is central to the healing and change process (Barrett-Lennard, 1976; Bennett, 2001; Rogers, 1975). In order for an empathic response of a therapist to affect a client, it must be expressed or made visible in some form (Barrett-Lennard, 1981). Rogers (1951, 1961, 1980) provided numerous examples of empathic understanding in his written and recorded sessions with clients in order to identify and clarify experiencing and communication endeavors.

As researchers and practitioners increased their interest in empathy as a therapeutic variable, efforts were extended to operationalize the function of the counselor or therapist with respect to empathic understanding. The perception and communication of empathy as an interpersonal skill became a major focus of research in the late 1960s through the 1970s. Evaluating the accurate communication of empathy through observable criteria largely replaced the sensing of a client’s experience from an attitudinal perspective (Hackney, 1978). During this period, scales were developed that measured the ability of an individual to demonstrate empathy in terms of predictive accuracy (Carkhuff & Berenson, 1977; Jacobs & Williams, 1983; Truax & Carkhuff, 1967). Typically, brief segments of counseling interviews were conducted, and scaled ratings of the interviewers’ ability to express empathy were compiled. After a period of time, many of these research findings were criticized due to what were perceived as serious conceptual and methodological flaws (Barkham, 1988; Gladstein, 1977, 1983; Marks & Tolsma, 1986). Participants in the studies were typically undergraduate students with minimal levels of training, and commentary in the interviews was frequently isolated from a broader treatment context. Definitions of empathy were operationalized in terms of behavioral components, and the meanings of empathic understanding often differed among researchers (Duan & Hill, 1996).

From Rogers’s initial conception of empathy as an attitude and a way of being, the construct subsequently began to assume primarily technological qualities as a communication skill or technique. The essence of empathy became transposed from an experiential state involving the client and counselor to an observable interpersonal process. In particular, the technique of reflection came to be equated with empathic understanding (Bohart & Greenberg, 1997). Other modes of expressing empathy beyond reflecting the feelings and perceptions of clients were subject to far less research interest. The conceptual confusion between empathy and reflection particularly affected client-centered therapy, as the orientation was becoming primarily associated with the technique of reflection. It is understandable that Rogers found the focus of empathic understanding as a communication skill disturbing, and he said that it “led to appalling consequences and complete distortion of client-centered therapy” (Rogers, 1980, p. 139).

The focus on explicit communication methods and the equating of reflection with empathy restricted consideration of a broader range of empathic counseling interventions within theoretical orientations and in practitioner training programs (Bozarth, 1984; Feller & Cottone, 2003). In numerous instances, attitudinal and experiential aspects of empathy were relegated to more narrow operational methods. At the same time, attempts to conceptualize empathy with respect to measurable and observable criteria have enabled trainees and practitioners to clarify what can be a vague and abstract conception (Clark, 2004a). Furthermore, research and training efforts are advanced when constructs are explicitly described. In this direction, although definitions of empathy in counseling and psychotherapy remain ambiguous, in recent years empathy research has improved in terms of providing increased participation of counselors and therapists as subjects, while expanding the contextualization of counseling topics (Avenanti, Bueti, Galati, & Aglioti, 2005; Crutchfield, Baltimore, Felfeli, & Worth, 2000; Duan & Hill, 1996). Additionally, the later work of Rogers and recent trends in the writings of other person-centered therapists have formulated broader ways of conceptualizing and communicating empathic understanding.

To continue the earlier treatment example relating to the adolescent Justin, the therapist recognizes that it is essential for her to attempt to communicate an understanding of Justin’s aversive feelings:

Therapist:	It doesn’t make much sense to you to have to be here for counseling.
Justin:	You got that one right. I get sick of people always being on my case.
Therapist:	A lot of times you resent being told what to do by other people.
Justin:	Yeah. It’s either my mother or my teachers who are constantly after me.
Therapist:	It seems to you that adults in your life are always letting you know what’s best for you.
Justin:	They think so and they never let up. The other day I was in school and …

In this brief exchange, the practitioner utilizes the technique of reflection in an effort to initiate communication with Justin. In an early stage of counseling, the therapist emphasizes communication that focuses on Justin’s phenomenological experiencing and internal frame of reference.

Empathy as a Mode of Observation

From a perspective that is fundamentally different from experiential empathy, an observational mode of empathy provides a method for a counselor or therapist to acquire psychological data with respect to a client. This information-gathering activity is subsequently transformed and communicated to the client through an interpretation or related interventions (Poland, 1984). In a two-part conceptualization, the acquisition of knowledge about a client enables a practitioner to provide informed therapeutic interventions that serve to broaden and deepen the individual’s self-insight (Kahn, 1985). Kohut (1991) conceptualized the interrelated process of understanding and explaining as a means of moving from a lower form of empathy to a higher form. As a therapist observes and increases his or her understanding of a client, it also becomes possible for relevant data to be transposed into theoretical formulations. Unlike experiential empathy, which tends to focus on the immediate functioning of a person, observational empathy more often involves a prolonged immersion in a broader perspective of a client’s life (Ornstein, 1979). In this regard, a practitioner is able to build a model of a patient that provides a developmental context as a basis for deeper understanding (Greenson, 1960; Lichtenberg, 1981). This tentative patient or client model evolves over a period of time and serves as a functional gui...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Contents
• Preface
• Part I Empathy: Historical and Contemporary Perspectives and Practices in Counseling and Psychotherapy
• Part II Empathy: Theoretical Orientations in Counseling and Psychotherapy
• Part III Empathy: A Multiple Perspective Approach in Counseling and Psychotherapy
• References
• Author Index
• Subject Index