“…One of the major threats to the therapeutic alliance is a failure in empathy (Chadwick, Birchwood, & Trower, 1996) and low empathy has been associated with higher burnout rates among workers (Astroem, Nilsson, Norberg, Sandman, & Winblad, 1991), higher hos-tility and anxiety in patients (La Monica, Wolf, Madea, & Oberst, 1987), less involvement and increased belittling comments, and an increased sense of isolation and loneliness felt by the patient (Fox, 2000). However, the development of empathy may be difficult when clinicians are faced with symptoms that are outside the scope of our own experiences (Chadwick et al, 1996;Fowler, Garety, & Kuipers, 1995).…”