After defining empathy, discussing its measurement, and offering an example of empathy in practice, we present the results of an updated meta-analysis of the relation between empathy and psychotherapy outcome. Results indicated that empathy is a moderately strong predictor of therapy outcome: mean weighted r = .31 (95% confidence interval: .28 -.34), for 59 independent samples and 3599 clients. Although the empathy-outcome relation held equally for different theoretical orientations, there was considerable nonrandom variability. Client and observer perceptions of therapist empathy predicted outcomes better than therapist perceptions of empathic accuracy measures, and the relation was strongest for less experienced therapists. We conclude with practice recommendations, including endorsing the different forms that empathy may take in therapy.
The paradox of distress expression is that expression of negative feelings is both a sign of distress and a possible means of coping with that distress. This article describes research illustrating the paradox of distress expression. It reviews evidence concerning 3 possible mechanisms by which expression might alleviate distress, focusing on the role of expression in (a) reducing distress about distress, (b) facilitating insight, and (c) affecting interpersonal relationships in a desired way. The authors conclude by highlighting the circumstances under which expression is most likely to be adaptive. Overall, the authors argue that expression of negative feelings is adaptive to the extent that it leads to some kind of resolution involving the source or significance of distress.
Put simply, empathy refers to understanding what another person is experiencing or trying to express. Therapist empathy has a long history as a hypothesized key change process in psychotherapy. We begin by discussing definitional issues and presenting an integrative definition. We then review measures of therapist empathy, including the conceptual problem of separating empathy from other relationship variables. We follow this with clinical examples illustrating different forms of therapist empathy and empathic response modes. The core of our review is a meta-analysis of research on the relation between therapist empathy and client outcome. Results indicated that empathy is a moderately strong predictor of therapy outcome: mean weighted r = .28 (p < .001; 95% confidence interval: .23-.33; equivalent of d = .58) for 82 independent samples and 6,138 clients. In general, the empathy-outcome relation held for different theoretical orientations and client presenting problems; however, there was considerable heterogeneity in the effects. Client, observer, and therapist perception measures predicted client outcome better than empathic accuracy measures. We then consider the limitations of the current data. We conclude with diversity considerations and practice recommendations, including endorsing the different forms that empathy may take in therapy. Clinical Impact Statement Question: Does therapist empathy predict success in psychotherapy? Findings: In general, clients have moderately better outcomes in psychotherapy when clients, therapists and observers perceive therapists as understanding them. Meaning: Empathy is an important element of any therapeutic relationship, and worth the investment of time and effort required to do it well and consistently. Next Steps: Careful research using diverse methods is needed to firmly establish and explain the causal role of therapist empathy in bringing about client outcome; clinicians can contribute by identifying situations in which empathy may be particularly valuable or conversely contraindicated.
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