Pauline Connolly

“To sense the client’s world as if it were your own, but without ever losing the ‘as if’ quality – this is empathy and this seems essential to therapy.”

Empathy is considered as one of the basic conditions for personality development in psychotherapy. And, is according to Rogers (1944, p.332), “an experience equaled by nothing else”.

To be empathic means to try to comprehend, as best as possible, the accurate meaning of what the other is experiencing in the very moment, and communicate this to him.1

It is an attempt to put oneself in the internal world of perception of the other, in his frame of reference and to feel as if one is him. This ‘as if’ quality is crucial, as it distinguishes empathy from interpretation and identification. Interpretation: - implies to judge the client’s experiential world, to form an evaluation of him from an external frame of reference. Identification: to ignore boundaries between self and other (Schmid, 2001) and become enveloped in/overwhelmed by the other’s emotions - which would not be helpful or professional.

Empathy implies a continuing desire to understand from the client’s perspective, regardless of one’s own view, experiences, values, etc. While common experiences can often facilitate communication, understanding and trust in the relationship, recalling ones own personal experience, sympathizing, identifying with the client’s position – termed ‘false empathy’ (Mearns and Thorne, 1988) – is not the same as empathy.2 Despite commonality, our unique ways of experiencing will always, to some extent be different and thus never fully understood. Accordingly, it is crucial to maintain the necessary distance (boundaries) not just as a respect “of listening to the incomparability of the Thou” (Bernhard Welter, 1966, cited by Schmid, p.7), a realization that more than ‘as if’ is not possible, but also as an ethical responsibility – an expression of professional values.3

Empathy involves openness and a challenge, as well as a risk, to enter the relationship (characterized as the ‘I-Thou’ relationship) and not to lose the necessary distance.

As Rogers (1985, p2) informs, “ You don’t get lost in the world of the other. That [getting lost] can happen, it’s most uncomfortable. It’s not helpful to the other person and it’s certainly not helpful to you.”

How a person perceives himself, including denied /unaccepted perceptions is a major determinant of personal experience, behavior and psychological well-being. Accordingly, the manner in which perception is altered/reorganized is important. Adopting the client’s reality-as-perceived, as a basis for genuine understanding (Rogers, 1947), the counsellor engages in active listening, i.e. an attempt to make sense not only of what is said or shown, but what the client wants/is trying to express; including what is on the edge of his awareness. Considered an affective agent for individual personality change and group development (Rogers, 1947), active listening, involves attending to clients verbal and non-verbal (core) messages, within ‘context’ (social culture, etc; Egan, 1994), in order to appreciate the ‘full flavour’ or ‘total meaning’ (Rogers and Farson, 1987); as well as keeping an ear lightly tuned to oneself and the ‘shadow side of listening’ (Egan, 1994).4

Person-centered philosophy is grounded in a positive view of the human being and his capacity to become fully functioning, given ideal conditions. The inherent drive towards actualization – the actualizing tendency, is viewed as the primary motivating force within the client and constitutes the cornerstone of Rogerian therapy.

Respecting the client’s organismic self-directedness and autonomy, the counsellor trusts and facilitates this natural growth process.

“This way of being trusts the constructive directional flow of the human being toward a more complex and complete development. It is this directional flow that we aim to release” (Bozarth, 2001, p3)

In order to ‘release’ this growth force (free and utilize client’s inner strengths), certain conditions/ relationship-orientated environment must exist; wherein the counsellor subscribes to Roger’s (1957) growth principle, theory of the ‘necessary and sufficient conditions of therapeutic personality change’ - the ‘core conditions’, and certain beliefs/values implicit or explicit in Rogers principles (cited by Brodley, 1987; Mearns and Thorne, 1999, pp.15-18). The implementation of these “attitudinal conditions for constructive change” (Brodley, 1986, p.1) is the essence of person-centered practice. However, “…there is no standard or inevitable way in which the therapeutic conditions are lived out or expressed in client-centered therapy” (p.4). Rogers left it up to the counsellor to choose which techniques, activities, etc, to convey these attitudes to the client. The way empathy, congruence, etc, are expressed will depend upon the client’s ‘readiness’ (Mearns and Thorne, 1999), motivation, participation, stage of change, etc.5

While the counsellor’s personality, experience, competence, etc, will shape his empathic grasp of client’s presented experience and specific responses.6

Empathic listening/understanding is a primary means of implementing the attitudinal conditions. An example of this is, ‘Empathic understanding response process’ (EURP) (Brodley, 1986; 1987).7 EURP involves the counsellor consistently maintaining the therapeutic attitudes in his experience and expressing them to the client.8 Communicating empathy to the client, these responses are intended to express and check the counsellor’s understanding of the client’s experience. Examples include: summaries, statements which point toward the client’s felt experience; inferential guesses concerning what the client is attempting to express; metaphors; questions that attempt to express client’s ambiguities; counsellor’s facial expression, eye-contact, posture, hand gestures, etc (Brodley, 1986).

Thus, the counsellor’s articulations,9 as well as, ‘sensory awareness’ – ‘social-emotional presence’ (Egan, 1994) - are included in the wholeness of the empathic dialogue (Schmid, 2001). Empathic responses implicitly ask the client, i.e., ‘Am I understanding you correctly?’ As a ‘perception-checking-tool’ (Egan, 1994,p.117), the client’s opportunity to confirm/reject them aid the counsellor’s understanding of the client’s immediate (‘here and now’) experiencing – interpersonal and intrapersonal. They also convey the counsellor’s intention to understand, encourage and facilitate dialogue and enhance the working alliance. The therapeutic ‘micro-processes’ released by effective empathic responses, are well illustrated by Vanaerschot (1990; 1993, cited by McLeod 2003, p.173). Moreover, sensitive skilled reflection/mirroring go beyond words and previously clear/articulated perception, enabling the client to get in touch with his ‘edge of awareness’ (Barrett-Lennard, 1993,p.3), and thus enrich/expand his comprehension. Egan (1994) also maintains that ‘advanced empathy’ can help clients identify ‘blind spots’ (p.197),10 and may involve counsellor self-disclosure, immediacy, prompts and probes, challenging, exploring problems, goal setting, etc. While, Bohart et al. (1993, cited by McLeod, 2003) suggest it may be helpful to formulate future orientated empathic reflections, linking current concerns with future intentions and directions.11 While mirroring – essentially, reflections of how the client evaluates himself, others and reality - is a crucial ‘carrier ’of empathy, it’s not the only way of conveying experiential understanding of the client (Barrett-Lennard, 1993). Natalie Rogers’ person-centered expressive art therapy is one example (others include play, drama therapy, etc,) offering another means of expression, respectful of the client’s integrity and self-direction (See Merry, 1997).

If empathy is to be instrumental, however, the client’s capacity to ‘take in’ the counsellor’s response and believe it is genuine, is necessary (Barrett-Lennard, 1993). That the client perceives/experiences the counsellor’s attitudes, at least to a minimal degree is crucial because it his experience of the counsellor’s empathy, regard, etc, that influence him directly.12 When communicated and received, empathy is a powerful way to support empathy towards self, encourage and facilitate self-exploration/understanding, insight, etc (Ibid).

The notion of empathy is multi-dimensional. Viewed as a process, ‘a way of being with’ (Rogers, 1975), its interpersonal/ communicational dimension also characterize it as a communication skill. Outlining the communication skills involved in the therapeutic dialogue, Egan (1994) emphasizes the importance of counsellor’s ability or ‘know-how’ in delivering his understanding/awareness to the client. Suggesting that without the skill of delivery, the counsellor’s accepting and regardful understanding is ‘lost’. “Empathy that remains locked up in the helper contributes little to the helping process” (ibid, p.109). Barrett-Lennard’s (1981; cited by Mearns and Thorne 1999) ‘empathy cycle’ model - describing the interactional nature of empathy - similarly appreciates that in so far as the counsellor needs to be able to ‘offer back’ to the client his understanding, empathy is also a communication skill. The empathy cycle also hi-lights the interconnectedness of the core conditions.13 Truax and Carkuff’s (1967, ibid), also define empathy as a communication skill that can be learned. And in their empathy scale illustrate variety and accuracy in empathic responses. Alternatively, Prouty (1994, cited by Schmid, 2001) - uncomfortable with a ‘reductionistic interpretation’ of empathy as a listening skill/technique – views empathy as “an art … because it really does involve the whole person. It is like playing a harp” (p.12). Consistent with Rogerian philosophy, is Gendlin’s (1981, 86; cited by McLeod, 2003)‘focusing’ skills programs. Gendlin’s model of experiential focusing aims to empower the individual and promote greater experiential awareness and empathy of self by attending to one’s ‘felt sense’/ ‘inner referent.’

Finding appropriate ways to communicate empathy is as Rogers reminds “a very demanding task” (1985, p.1). In the process of fully integrating empathy as a ‘way of being’, I – as a beginner – have found examining such ‘skills’ a helpful place to start.

“With a professional humility and willingness to learn from the client”(Rogers, 1946),14 the counsellor – as a sensitive companion and equal 15- trusts the client’s self-initiated experiential learning. And views the client as the ‘expert’ on himself and as the initiator throughout the process. The locus of responsibility and control lie with the client in terms of content, pace, outcome. The counsellor, respecting the client’s internal frame of reference and locus of evaluation, facilitates - not leads, and remains in the responsive mode.15 This accepting and non-directive stance empower the client to gradually rely more upon his ‘internal locus of evaluation’ (not the counsellor as an ‘external locus of evaluation’), respond according to the needs of his real/organismic self and trust and act upon his ‘organismic valuing system.’ Absorbing the counsellors’ attitudes, the client experiences sufficient interest in himself and acceptance (enhanced self-worth) as a person, which allow for a deeper exploration, and (more spontaneous) expression of feelings and attitudes (hidden/denied/unaccepted) than ordinarily allowed.

“ … to be fully met and understood by a therapist allows for a shift in feelings and perception by the client. Empathic listening also encourages peeling the layers of self denial and defence” (N.Rogers see Merry, 1997, p.265)

The counsellor’s presence, well described by Rogers (1946) permit a more differentiated and realistic view of self. This realism and consequent ‘reorganization of behavior’ make for a self-acceptance and an “inner peace which constitutes adjustment … congruence” (p.13) – in essence, the aim/goal of empathy and indeed therapy.

Working in a rehab1 and homeless shelter, I learned the value of empathy, both for myself, in a helping capacity, and for the residents. In my experience, empathy afforded me an opportunity to achieve, at least partially, the others’ internal frame of reference. And provided a learning experience I would have struggled to match through academic study alone.

As a volunteer, I noticed that individuals perceiving empathy, (acceptance and - to the extent I was able – congruence), began to share deeply their often moving and painful experiences. While privileged to be privy to, and humbled by such personal ‘stories’, my own vulnerability, lack of experience, (and possibly supervision) innate ‘rescuing tendency’ and inclination to become emotionally over involved, resulted in my inability to maintain boundaries. While keen to enter the others perceptual world, I was at times uncomfortable and overwhelmed with what I found there. In retrospect, while accepting the individual as a person, I did not accept the places his particular, recovery/growth process or precarious journey took/might take him – literally and metaphorically. Unable to let individuals ‘be’ – in their pain, even brink of relapse, etc, I attempted my own ‘rescue mission’ (having little faith that their actualizing tendency would do the job … or even if it existed); by tentatively offering encouragement, affirmations, humble words of wisdom 2 … even occasionally, exchanging numbers, helping with lifts to (12 step) meetings, etc.

With its seductive, contact-building quality, empathic listening responded to the residents’ need to be understood, accepted/valued and gently invited them to engage in self-exploration, honest disclosure; resulting in awareness and ultimately for many – not all – the release of inner strengths (AT), that neither the resident or myself had anticipated. Empathy also responded to my own need to understand and learn, to be considered a valued listener/person, helpful, etc. Initially, surprised and indeed flattered by residents’ openness, I acknowledged the ego-enhancing dimension of being the helper with whom residents felt sufficiently ‘safe’, accepted, etc, to be able to share their ‘stuff’; And whom (by their admission) were encouraged and helped by talking to. Thus, satisfying various personal needs, my endeavor to experience and communicate empathy3, acceptance, etc, was not purely altruistic.

The goal of empathy and the other conditions is to free and foster the process of self-actualisation in the client. However, while ‘necessary’ - within a therapeutic relationship, I’m not convinced that their presence always - in every individual, case/situation – dapper achieves this. (i.e. results in concomitant changes in perception and behavior). Often empathy, etc, is not ‘sufficient’4 to bring about the kind of behavioral changes, perhaps desired by the individual, by his friends/family, the organizations, society, etc, in which he finds himself. While their effectiveness can undoubtedly result in major behavioral changes over a wide range of client conditions and problems, such changes are often partial, gradual, (transient – typical of addiction; and indeed, human nature). And thus, not easily quantified/measured – at least by external observation or assessment.

My empathizing with the other (albeit far from a purely ‘person-centered’ perspective) tremendously enhanced my understanding about the other, myself, relationships and fundamentally, people. As a powerful experience and learning tool, however, it requires respect/humility and temperance with personal introspection and development,

disciplined boundaries and realism.

External factors unrelated to therapy or a particular helping relationship, may bring about altered perception and behavior, i.e., psychological processes, alterations in family relationship, support network, community, etc. that are involved in the generation and maintenance of the difficulties residents came to rehab. Influences then outside therapy, the client and counsellor’s control may interrupt, hinder or strengthen any derived or potential therapeutic benefits.

Fundamentally, individuals are unique; the way one feels, progresses and changes (and blocks impeding such) are immensely variable and dependant on many factors, both within and beyond the client-counselor experience.

2 Lack of personal development, competence, emotional over-involvement, vulnerability, etc, may also be seen as (potential) ‘blocks’ to empathy.

3 Illustrated in BACP’s code of Ethics and Practice (2002).

4 Similarly described as ‘blocks’ to empathy by Mearns and Thorne (1999)

5 Rogers (1957), also postulated the need for two persons to be in ‘psychological contact’ as a necessary condition. Barrett-Lennard (1993), notes that ‘highly defended’ – relatively ‘fully functioning’ persons wouldn’t “in theoretical expectation find person-centered therapy a means to basic self-change” (p.5). Alternatively, for those whom basic contact with another is problematic, i.e., cognitively impaired, seriously anxious, schizophrenic (as in the Wisconsin project), etc, may benefit from Prouty’s pre-therapy (cited by Barrett-Lennard, 1993); or require different forms of interaction (Brodley, 1986)

6 Resourcefulness as a helper can include utilizing techniques from other therapies, e.g., focusing, gestalt, relaxation, meditation, etc (Brodley, 1986)

7 While not limited, EURP is mostly used and effective with clients who choose and are able to engage in self-exploration.

8 I.e., faith in the actualizing tendency and core conditions.

10 Termed ‘depth reflection’- level 3 of Truax and Carkcuff’s empathy scale; cited by McLeod, (2003).

12 Part of the social influence process (Egan, 1994).

13 That the 3 basic interpersonal dimensions are intrinsically related is generally accepted.

14 Adopting what Schmid (2001) calls a ‘sophisticated naivety’.

15 Committed to sharing (not the pursuit of) control. An expert only in maintaining the relational attitudinal conditions.

16 Even in person-centered career counseling; C.H.Patterson, see Freeman (1990)

1 Walsingham House, Rehab for drug /alcohol addiction.

2 Adopting a quasi-psychodynamic counselling role, I’d occasionally offer ‘helpful’ insights.

3 Empathy becomes integrated with the other ‘conditions’ and is difficult/impossible to separate. Besides, while a vital mechanism for change, empathy by itself is not enough.

4 I.e., effective/successful in terms of producing immediate or prompt results.