Therapist empathy and client outcome: An updated meta-analysis.

Abstract

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.

Participant experiences of a low-energy total diet replacement programme: A descriptive qualitative study

“…The participants felt the counsellors had knowledge and deep understanding of their experience which contributed to the empathy they displayed. A meta-analysis of studies exploring the effect of psychotherapy therapist empathy on client outcomes, reported that the level of empathy displayed by a therapist is a moderately strong predictor of therapy outcome [28], and future studies could explore in more depth the importance of empathy and embodiment in participant/counsellor relationships.…”

Personal therapy and the personal therapist

“…Several meta-analyses and reviews have stressed the importance of empathy (Elliott et al, 2018) and related qualities, including positive regard (Farber et al, 2018), interpersonal skills (Wampold, 2017), genuineness (Kolden et al, 2018), and feedback (Norcross, 2002;Lambert et al, 2018). The meta-analyses (Elliott et al, 2018;Kolden et al, 2018;Farber et al, 2018;Tryon et al, 2018) discussed below consist mainly of cross-sectional studies. This is an important shortcoming, since psychotherapy is an ongoing process that requires repeated measures.…”

“…Recent meta-analyses have related empathy (Elliott et al, 2018), congruence/genuineness (Kolden et al, 2018), positive regard (Farber et al, 2018), and goal consensus and collaboration (Tryon et al, 2018) to treatment outcome. Other therapist characteristics that may influence treatment outcomes were self-disclosure and immediacy (Hill et al, 2018), countertransference management (Hayes et al, 2018), and therapist and client emotional expression (Peluso & Freund, 2018).…”

Does it make a difference to be more “on the same page”? Investigating the role of alliance convergence for outcomes in two different samples

“…Having established that psychotherapy works well for most common mental health problems (Norcross & Lambert, 2018), and better than many other evidence-based medical practices (Wampold & Imel, 2015), we are also getting closer to understanding why psychotherapy works across different approaches. Some of the (pan-theoretical) process factors with the most promising evidence thus far are; a sound alliance between therapist and client (Flückiger et al, 2018); collecting and giving feedback on client progress using routine outcome monitoring (Lambert et al, 2018); therapist empathy (Elliott et al, 2018), facilitative interpersonal skills (Anderson et al, 2009) and cultivating client positive expectations (Constantino et al, 2018).…”