Therapist empathy,homework compliance,and outcome in cognitive behavioral therapy for generalized anxiety disorder: partitioning within- and between-therapist effects

Although client-perceived therapist empathy relates to positive therapy outcomes, including in cognitive behavioral therapy (CBT), little is known about how empathy exerts its ameliorative effect. One possible way is by promoting clients’ subsequent homework compliance, a variable that also predicts positive outcomes in CBT. The present study sought to investigate simultaneously, in the context of 43 therapist–client dyads receiving 15 sessions of CBT for generalized anxiety disorder, (1) the association of early client-perceived therapist empathy (averaged over sessions 1, 3, 5) with mid-treatment client homework compliance (averaged over sessions 6, 8, 10); (2) the association of mid-treatment homework compliance on client posttreatment worry severity; and (3) the indirect effect of early perceived therapist empathy on posttreatment worry through mid-treatment homework compliance. Given that clients were nested within therapists, we examined both within- and between-therapist differences in clients’ ratings of therapist empathy and homework compliance, and tested both of these indices as predictors of the relevant dependent variables in a multilevel model. At the within-therapist level (i.e., differences between clients within a given therapist’s caseload), greater early empathy was associated with greater mid-treatment homework compliance. At the between-therapist level (i.e., differences between therapists across all of their cases), greater between-therapist homework compliance was related to lower posttreatment worry. Finally, homework compliance was not found to mediate the relationship between empathy and posttreatment outcome. The results underscore the importance of parsing client and therapist effects, and are discussed with regard to their training and research implications.     

Transcendental empathy in the therapeutic encounter

Abstract

The experience of many therapists suggest that most contemporary conceptions of empathy underestimate empathic potential. This paper describes deep or transcendental empathy as a more direct knowing of the client's world. The author examines the epistemic process or the activity of knowing of transcendental empathy by considering two broad forms: transcendental countertransference and psychological resonance. Difficulties and distortions are explored as well as characteristics of an individual that correspond with deep empathy.     

A narrative social constructionist approach to therapeutic empathy

The concept of empathy has been a centrol conceptual element in approaches to counselling and psychotherapy that emphasise exploration of meaning in the context of a facilitative relationship. However, the existing literature on therapeutic empathy lacks theoretical coherence. a narrative social constructionist perspective represents a theoretical approach that enables the integration of diverse strands of clinical observation and research into the creation of empathic understanding in counselling. From a social constructionist position, therapeutic empathy can be understood as a relational process, a step-by-step co-construction by counsellor and client of the life-narrative of the client. In this paper, the Barrett-Lennard (1981) cyclical model of empathy is used as a fremework for examining the counsellor and client actions, strategies and tasks that constitute empathic engagement around the task of emploring and re-authoring life-narratives. Constructionist analysis of the cultural origins of the concept of empathy suggest some limitations of this way of conceptualising what happens in therapy. The implications of these ideas for theory, training and research are discussed.     

Therapist specific communication styles and patient resistance: An analogue study

Two contrasting pairs of verbal therapist communication styles were covaried with three areas of communication loci and were studied in relation to subjects' choices of resistant or resonant ‘patient responses’. Thirty medical students, serving as vicarious patients, observed a videotape of a simulated psychotherapy session and made response choices in relation to 12 therapists' well-specified communications. Contrary to expectations, subjects chose fewer resistant responses following engaged styles of communication than with disengaged styles. Collaborative style of communication, as hypothesized, was followed by less resistant responses than was unidirectional style. Communications that were cast in terms of transferential relationships were generally followed by significantly lower resistant choices than were those relating to past and current relationship loci. No gender differences were observed. Rationale, findings and possible inferences were in relation to dyadic interpersonal influences. Experimental manipulation of variables within psychotherapy sessions is encouraged.     

Therapist orientation,supervisor match,and therapeutic interventions: Implications for session quality in a psychotherapy training PRN

Background: Theoretical orientation is a multifaceted construct that is integral to the process of psychotherapy and psychotherapy training. While some research has been conducted on personal identification with particular schools of psychotherapy, techniques used in psychotherapy sessions, and match between trainees and supervisors in training, there is insufficient information regarding how these may interact with one another. Aim: This study, conducted in a practice research network of trainee therapists, was designed to test whether these variables may be related to one another in predicting session quality. Method: The sample comprised 328 sessions from 26 clients and 11 therapists, with the clients completing session quality measures and therapists completing measures of technique immediately post‐session. Results: Using multilevel linear modelling, the data showed varied results. For behavioural therapy and person‐centred therapy, techniques and orientation were unrelated to session quality in the sample. However, process‐experiential, psychodynamic, and cognitive therapy techniques were all involved in interactions with therapist and/or supervisor orientations. Conclusions: These results suggest that the impact of specific psychotherapy techniques sometimes depends on the orientation of the therapist and/or supervisor. For instance, sessions high in cognitive therapy techniques were only associated with positive outcome when both the therapist and supervisor were highly cognitively oriented. Though preliminary, these results suggest that orientation may be an important variable to consider in training and supervision, especially in the context of other variables.     

Simulation, projection and empathy

Simulationists have recently started to employ the term “empathy” when characterizing our most basic understanding of other minds. I agree that empathy is crucial, but I think it is being misconstrued by the simulationists. Using some ideas to be found in Scheler’s classical discussion of empathy, I will argue for a different understanding of the notion. More specifically, I will argue that there are basic levels of interpersonal understanding—in particular the understanding of emotional expressions—that are not explicable in terms of simulation-plus-projection routines.     

Self-compassion,empathy, and helping intentions

The trait of self-compassion has three components: (1) kindness toward oneself when facing pain or failure; (2) perceiving one’s experiences as part of a larger human experience rather than feeling isolated; and (3) holding painful thoughts and feelings in balanced awareness. The present research explores if self-compassion predicts willingness to help others and empathy for others in need of help. Study 1 found that self-compassion predicted greater willingness to help a hypothetical person while simultaneously reducing empathy for that person. Study 2 used a more nuanced measure of empathy and found that self-compassion was only related to feeling less personal distress in response to someone else’s emergency. In addition, in Study 2, self-compassion only predicted greater helping intentions when the target was at fault for the emergency. Lastly, both self-compassion and empathy were uniquely related to participants’ willingness to help an individual in need.     

Imaging,empathy, and causal attribution

Three studies were conducted to test whether imagery accounts for the effects of empathy on attributions, that is, whether attributers construct and scan a mental image of social scenarios the same way that actual participants scan a real environment. According to this interpretation, attributers “see” the world as the participant does and make vicarious attributions. An alternative interpretation holds that subjects base vicarious attributions on recreating the motivations and affect of the actor, so that imaging is irrelevant to empathy and attributions. In the first study, subjects who imagined a story from the perspective of a particular character later showed differential recall of story details as a function of role, but not differential attributions. In Experiment 2, role-taking subjects showed clear effects of imaged perspective on recall for story details, but no effects on attributions of causality for an accident. Further, recall and attribution were uncorrelated. In the last study, empathy and imagery role-taking instructions produced independent effects: imagers showed pronounced perspective-relevant recall and empathizers did not. Neither showed unambiguous vicarious attributions. Recall and attribution were again uncorrelated. These studies suggest that the imagery explanation of empathy effects is untenable, and imply that the recall of perspective-relevant details is unlikely to mediate attributions of causality in imaginary scenarios.     

Introversion,neuroticism, empathy and embarrassibility

Previous research suggests that actors particularly susceptible to embarrassment are likely to be sensitive to others (especially to others' views), inhibited and overconcerned with their public image. That is, they are likely to be empathic, but neurotic introverts. This experiment was designed to investigate this possibility. The EPQ, Hogan Empathy Scale (HES) and Embarrassibility Scale (ES) were administered to over 100 Ss. The factor structures obtained in the present study for the latter two scales were compared with those obtained in previous studies and revealed a close correspondence. There was a predicted significant negative correlation between E and embarrassibility and a significant positive correlation between N and embarrassibility. Contrary to expectation, empathy was significantly negatively correlated with embarrassibility, although this was largely accounted for by the Social Self-confidence and Nonconformity subscales of the HES. Three aspects of the results are discussed: the multidimensionality of the HES; whether the ES is uni- or multidimensional and implications of the results for our understanding of embarrassibility.     

Therapist competence, therapy quality, and therapist training

Large numbers of therapists worldwide wish to receive training in how to deliver psychological treatments. Current methods of training are poorly suited to this task as they are costly and require scarce expertise. New forms of training therefore need to be developed that are more cost-effective and scalable. Internet-based methods might fulfil these requirements whilst having the added advantage of being able to provide trainees with extensive exposure to the treatment as practised. New strategies and procedures for evaluating training outcome are also required. These need to be capable of assessing the therapist's knowledge of the treatment and its use, as well as the therapist's ability to apply this knowledge in clinical practice. Standardised role play-based techniques might be of value in this regard.     

Therapist responses to requests for disclosure of therapeutic records: An introductory study

This paper describes a questionnaire survey of therapists in the UK who have been subject to requests for disclosure of client records as part of a legal process. Therapist responses are outlined in terms of the perceived effect of such disclosure on the client, therapist and the therapeutic relationship. Negative effects included the experience of exposure of sensitive client material in an adversarial legal system, of powerful emotional responses by therapists, and a sense of feeling professionally de‐skilled in an unfamiliar and often challenging legal environment. Positive effects for the client included the achievement of valued outcomes such as compensation, and, for the therapist, the facilitation of support for the client in this process. These findings are discussed in terms of a contrast between therapist perceptions of consensual and contested disclosure. In the former, therapist and client are in agreement about the restorative value and outcome of disclosure. In contested disclosure, the process is experienced as disrupting therapeutic privacy, undermining professional self‐confidence and introducing an unwelcome element of critical re‐evaluation of client motives for undertaking therapy.