“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
Maya Angelou
Empathy comes from the Greek word ‘pathos’ meaning emotion, feeling, suffering, pity. In the mid-19th, the concept of empathy was introduced by philosopher Robert Vischer in his PhD dissertation on aesthetics. From the German word ‘Einfühlung’, he used it to describe the human capacity to enter and feel a piece of art from within, an emotional knowing.
Philosopher Martin Buber further developed the concept of empathy by the ‘I and Thou’ (1923) in the context of a relational encounter between two people where we become fully human in the meeting with another. In his paper, ‘The necessary and sufficient conditions of therapeutic personality change’, Carl Rogers’ discussed the role empathy in bringing about positive change for the client:
"To sense the client’s private world as if it were your own, but without ever losing the ‘as if’ quality – this is empathy, and this seems essential to therapy. To sense the client’s anger, fear, or confusion as if it were your own, yet without your own anger, fear, or confusion getting bound up in it, is the condition we are endeavouring to describe" (1957, p. 99).
As therapists, we know that empathy is an ability to understand another by perceiving their emotions, thoughts, and experiences. A necessary quality of the therapeutic relationship empathy also matures as we evolve and develop as clinicians.
It is helpful to consider that empathy has five developmental stages:
1. Self-Awareness: understanding one’s own emotions, thoughts, feelings, biases.
2. Emotional Recognition: recognising and understanding emotions in oneself and the other.
3. Perspective Taking: understanding the perspective of the another.
4. Emotional Regulation: ability to manage one’s emotions to respond appropriately to another.
5. Empathetic Action: behaviours that show support of the other.
Psychologists, Daniel Goleman, and Paul Ekman identified, Cognitive, Emotional and Compassionate empathy suggesting that overall empathy is a necessary component of emotional intelligence.
Cognitive Empathy: Understanding another’s perspective.
Emotional Empathy: Physically sensing the other’s emotions.
Compassion Empathy: Sensing what the other needs from you.
Acknowledging that empathy involves a deeper level of emotional connection and resonance with the client and their inner world, sometimes empathy can impact on ‘how’ we get drawn into our clients’ worlds, potentially keeping them stuck.
We know that an empathetic style is essential when interacting with clients in the here and now. As therapists we need to be mindful of our own emotions as we sense the client’s feelings ‘as if they were our own’. Yet sometimes we can become lost in the feelings of the client which could lead to burnout and/or vicarious trauma.
Why might this be?
For this blog, we refer to ‘empathy fatigue’ but acknowledge other names including ‘empathic strain’, ‘overidentification’ and ‘pathological bonding’.
Empathy fatigue is when the therapist gets lost in the client’s narrative and the ‘as if’. As we attentively listen to and visualise the distress, terror, and horror of what happened to the client, we can lean into their disturbing ‘material’ and become ‘stuck’ in their suffering. This can lead to feelings of helpless and hopeless. Too much empathy has been associated with negative client reactions (Elliot et al., 2011).
On the other hand, as the client tells their story, how we process their information may result in a failure in the therapist offering little or no empathy. This may lead to ruptures in the therapeutic alliance (Angus & Kagan, 2007).
Whether we experience too much or too little empathy, both have elements that are considered problematic and are linked to empathy fatigue.
What can we do?
As therapists we want to communicate empathy and concern without always being a mirror to the client’s suffering. It is not necessary to understand or picture everything about a client’s story, situation, or experience.
Metaphorically, empathy can be seen as a thermostat, an Empathy Dial which can be turned up and turned down. If there is too much empathy the thermostat is high, and the experience is intense. If there is too little, the thermostat is cold, and the experience is detached.
As therapists, we need to have an awareness of our psychological self, body sensations and facial expressions, sometimes taking an emotional and cognitive step back to allow the client to ‘breathe’ into their distress.
Practically, we can shift our position, take a breath, move our facial muscles. Furthermore, we remind ourselves that we are professional observers witnessing the client. That through the lens of mature and calm detachment, we can offer and maintain deep regulated empathy which not only involves mirroring but responses that allow the client to breath and better able to lower their distress. We know that empathy affords connection and compassion to the client as ultimately, “it’s extremely powerful to hear someone say, “I get you. I understand. I see why you feel this way” Daniel J. Siegel.
(Authors: Karen O’Neill & Tara McDonald)
Published and Copyrighted by PIP Solutions: 10th April 2024
References:
Angus, L., & Kagan, F. (2007). Empathic relational bonds and personal agency in psychotherapy: Implications for psychotherapy supervision, practice, and research. Psychotherapy: Theory, Research, Practice, Training, 44, 371-377.
Buber, M. (1996). I and Thou. New York: Touchstone Books
Elliott, R., Bohart, A. C., Watson, J. C., & Greenberg, L. S. (2011). Empathy. Psychotherapy, 48(1), 43-49.
Norcross, J. C., Dryden, W. & DeMichele, J. T. (1992). British clinical psychologists and personal therapy: What’s good for the goose? Clinical Psychology Forum, 44,29-33.
Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95-103.